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Jamal Washington, 69-year-old male, presents with sudden-onset central chest pain.
Jamal Washington
History of Presenting Complaint
5- Asks about onset and duration of chest pain (establishes acute onset 45 minutes ago at rest) +1
- Asks about radiation of chest pain to the left arm or jaw +1
- Asks Jamal to rate his pain on a 0–10 scale (he reports 8/10) +1
- Asks about associated symptoms — shortness of breath, nausea, and diaphoresis +1
- Asks whether anything makes the pain better or worse (Jamal reports no relief from rest or position change) +1
Past Medical History and Risk Factors
5- Asks about known cardiovascular conditions — hypertension, diabetes, and hyperlipidaemia +1
- Asks about smoking history, diet, and exercise (Jamal: 20 pack-year history, quit 10 years ago; poor diet; minimal exercise) +1
+ 28 more criteria across 7 domains
Which of the following is the most appropriate initial management?
- A Commence carbimazole 20 mg daily and propranolol 40 mg TDS for rate control
- B Commence propylthiouracil 100 mg TDS as first-line antithyroid therapy
- C Refer for radioactive iodine therapy as definitive treatment
- D Arrange an urgent thyroidectomy given the presence of atrial fibrillation
- E Commence amiodarone 200 mg TDS for atrial fibrillation rate control
Carbimazole 20 mg daily plus propranolol 40 mg TDS is the correct initial management. This patient has newly diagnosed Graves' disease confirmed by primary...
Explain your differential, investigations, and management under examiner prompts.
- Prioritise the dangerous diagnoses. Lead with time-critical conditions before broadening the list.
- Justify investigations. Explain how each result would change your next step.
- Close with management. Show escalation, safety-netting, and patient-centred communication.
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Follow the same case as a structured reasoning walkthrough.
- Characterise the complaint. SOCRATES separates dangerous causes from benign ones.
- Screen red flags and risks. They shift your differential and your urgency.
- Reveal the findings. Check your reasoning against the model answer.
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Adelaide · Sydney | Australia
The team
-
Raymond
GP, Adelaide, SA
FRACGP, M.D. (Griffith University)
-
George
Ophthalmology Registrar, Sydney, NSW
M.D. (University of Melbourne)
-
Marie
ENT Registrar, Adelaide, SA
M.D. (Griffith University)
-
Tasneem
GP, Adelaide, SA
FRACGP, M.D. (Griffith University)
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