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Jamal Washington, hombre de 69 años, presenta dolor torácico central de aparición repentina.
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How can heart failure occur with a normal ejection fraction?
In HFpEF, impaired relaxation and increased ventricular stiffness raise filling pressures. Congestion can occur even when the proportion of blood ejected is preserved.
Ejection fraction describes emptying, not filling. A preserved EF does not exclude heart failure.
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 next step?
- A enfermedad de Graves
- B tiroiditis de Hashimoto
- C Commence amiodarone 200 mg TDS for atrial fibrillation rate control
- D Cáncer de tiroides
- E Síndrome eutiroideo enfermo
Los síntomas son compatibles con la tirotoxicosis, siendo el exoftalmos (y el mixedema pretibial) más específicos de la enfermedad de Graves. Las pruebas de...
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)
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Tasneem
GP, Adelaide, SA
FRACGP, M.D. (Griffith University)
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