Question Easy:
A 70-year-old woman presents with fatigue and pallor. Her haemoglobin level is 7.8 g/dL, her mean corpuscular volume (MCV) is 115 fL, and her peripheral blood smear shows hypersegmented neutrophils. What is the most likely cause of her anaemia?
A) Iron deficiency anaemia
B) Sickle cell disease
C) Thalassemia
D) Vitamin B12 deficiency
E) Anaemia of chronic disease
Explanations & Answers:
Question Easy Answer: D) Vitamin B12 deficiency
Question Easy Explanation: The combination of macrocytic anaemia (increased MCV) and hypersegmented neutrophils is highly suggestive of vitamin B12 deficiency. This can cause megaloblastic anaemia, common in the elderly, and is consistent with NICE guidelines for identifying the cause of such anaemia.
Question Medium:
A 50-year-old man with a history of hypertension and smoking presents with sudden onset of chest pain that radiates to his back. Investigations reveal a widened mediastinum on chest X-ray. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pneumothorax
E) Angina
Question Medium Answer: B) Aortic dissection
Question Medium Explanation: Aortic dissection often presents with sudden severe chest or back pain and a widened mediastinum on X-ray, especially in patients with risk factors like hypertension and smoking. NICE guidelines emphasize the need to promptly identify and manage this life-threatening condition.
Question Hard:
A 30-year-old woman presents with intermittent episodes of pain, swelling, and warmth in her left leg. Doppler ultrasound shows normal venous coordination. A coagulation profile reveals an isolated prolonged APTT that does not correct with mixing studies. What is the most likely diagnosis?
A) Lupus anticoagulant
B) Factor VIII deficiency
C) Hemophilia A
D) von Willebrand disease
E) Antithrombin III deficiency
Question Hard Answer: A) Lupus anticoagulant
Question Hard Explanation: An isolated prolonged activated partial thromboplastin time (APTT) that fails to correct on mixing studies is characteristic of the presence of lupus anticoagulant, a type of antiphospholipid antibody. This condition can cause thrombotic events despite the laboratory findings of a bleeding tendency, following NICE and NHS guidance on diagnosing complex coagulation disorders.
Medical fact of the day: Did you know? The UK has one of the highest rates of venous thromboembolism (VTE) in the Western world, making the timely diagnosis of conditions like DVT and PE crucial in everyday practice.
Quote of the day: “In the face of adversity, let compassion be your compass, guiding you to make a lasting impact on every life you touch.”