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MSRA · Clinical Problem Solving
A 62-year-old man presents with acute crushing chest pain radiating to the left arm. ECG shows ST elevation in leads II, III, and aVF. What is the most appropriate immediate management?
A. Oral aspirin 300mg + sublingual GTN
B. Primary PCI within 120 minutes
C. IV thrombolysis with alteplase
📎 NICE CG185 78% got this right
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Respiratory · Question 214 of 3,500+
A 72-year-old woman with COPD presents with worsening breathlessness and purulent sputum over 3 days. Her oxygen saturation is 88% on room air. ABG shows pH 7.31, pCO₂ 7.8 kPa, pO₂ 6.2 kPa. What is the most appropriate next step?
A High-flow oxygen via non-rebreather mask
B Non-invasive ventilation (NIV/BiPAP)
C IV aminophylline
D Nebulised salbutamol and ipratropium only
E Intubation and mechanical ventilation
MediWord Revision Notes
Type 2 Diabetes - Management

Endocrinology · Updated March 2026 · Based on NICE NG28

First-Line

Offer metformin as initial drug treatment. Start at 500mg once daily and titrate gradually to minimise GI side effects. If standard metformin is not tolerated, consider modified-release metformin.

Second-Line Options

If HbA1c rises above 58 mmol/mol on metformin alone, consider dual therapy. Options include adding a sulfonylurea, pioglitazone, DPP-4 inhibitor, or SGLT2 inhibitor. Choice depends on patient factors including cardiovascular risk, weight, and hypoglycaemia risk.

📎 NICE NG28 — Type 2 Diabetes in Adults →

🎯 High-Yield Exam Points

HbA1c target: 48 mmol/mol for most patients on lifestyle/metformin; 53 mmol/mol if on drugs causing hypoglycaemia.
SGLT2 inhibitors (e.g. empagliflozin) — proven cardiovascular and renal benefit. First-line add-on if established CVD.
GLP-1 receptor agonists — consider if BMI ≥35 and triple therapy fails. Promote weight loss.

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