Phase 1 ( Viva )

a 40 year old man, recently diagnosed as unstable angina. He was put on aspirin, isordil, clopidogrel and simvastatin for his unstable angina. He is a frequent defaulter of his medication.

One day he presented to you after develop progressive onset of chest tightness. He claimed the tightness occurred after his visit to cardiology clinic. He claimed took all medications without failed after being adviced by cardiology doctor. He also claimed the shortness of breath occured about 2 hours after ingestion the medications but wasn't sure which one giving him the problem. After 30 min ingestion of medication he developed runny nose, and progress with shortness of breath.

on examination, generalized wheezing and runny nose. Nasal inspection revealed nasal polyps.

ECG normal, Cardiac enzyme normal, cxr normal.


1. What is your diagnosis?
2. What is the pathogenesis of your primary diagnosis?
3. How would you diagnose your primary diagnosis?
4. How would you manage this gentleman?