Ten-minute consult

1. A 58-year-old man develops crushing central chest pain radiating to the left arm, with sweating, while in the waiting room. He is clammy and nauseated. What is the most appropriate immediate action? The most appropriate action is: Call 999 and give aspirin 300 mg to chew unless contraindicated

2. A 71-year-old woman with type 2 diabetes reports 40 minutes of epigastric discomfort, breathlessness and nausea, without chest pain. She looks pale. Observations: pulse 98/min, BP 148/88 mmHg, SpO2 95% air. What is the most appropriate next step?

3. A 64-year-old man had 25 minutes of central chest tightness after shovelling snow 3 hours ago. He is now pain-free. Practice ECG is normal. He asks to 'have the blood test here and go home'. What is the most appropriate management?

4. A 78-year-old man with a known 5.8 cm infrarenal aortic aneurysm develops sudden severe lumbar pain and light-headedness. BP is 92/54 mmHg. What is the most appropriate action? The most appropriate action is: Book an urgent outpatient ultrasound to check aneurysm size

5. A 66-year-old man attended NHS AAA screening last month (aorta 3.4 cm, surveillance planned). He now has severe abdominal pain and a tender pulsatile mass. What is the most appropriate next step?

6. A 55-year-old man with hypertension describes sudden tearing interscapular pain at rest, maximal at onset. BP is 168/102 mmHg in the right arm and 132/80 mmHg in the left. He is sweaty. What is the most appropriate next step? The most appropriate action is: Arrange a community D-dimer and review if positive

7. A 29-year-old woman has 12 hours of left iliac fossa pain and spotting. Her last period was 6 weeks ago. She is haemodynamically stable. What is the single most important immediate investigation in general practice? Select TWO correct statements.

Select all that apply.

8. A 34-year-old woman with a copper intrauterine device has unilateral pelvic pain and brown spotting. A urine pregnancy test is positive. She is stable. What is the most appropriate next step? The most appropriate action is: Reassure that an IUCD makes ectopic pregnancy impossible

9. A 27-year-old woman collapses in reception with shoulder-tip pain. BP is 78/40 mmHg, pulse 128/min. A urine pregnancy test is positive. What is the most appropriate action? Select TWO correct statements.

Select all that apply.

10. A 19-year-old student is feverish and drowsy with a rapidly spreading non-blanching purpuric rash. What is the most appropriate immediate action?