**Question Easy:**
A 25-year-old woman presents with bruising and small purple spots on her skin. She reports easy bruising without any significant trauma. She mentions having frequent nosebleeds. Which of the following is the most likely diagnosis?
A) Iron deficiency anemia
B) Haemophilia
C) Von Willebrand disease
D) Vitamin K deficiency
E) Scurvy
**Question Medium:**
A 55-year-old man with a history of smoking presents with calf pain when walking that is relieved by rest. He reports the pain is becoming more frequent. What is the next best step in the management of his condition, according to NICE guidelines?
A) Statin therapy
B) Angioplasty
C) Prescribe a phosphodiesterase inhibitor
D) Smoking cessation advice
E) Surgical bypass
**Question Hard:**
A 68-year-old woman with atrial fibrillation is on warfarin for anticoagulation. She is scheduled for elective knee replacement surgery. What is the most appropriate strategy regarding her anticoagulation management prior to surgery?
A) Continue warfarin as usual
B) Stop warfarin 1 day before surgery
C) Stop warfarin 5 days before surgery and start enoxaparin
D) Stop warfarin 2 days before surgery and monitor INR
E) Bridging with heparin is not necessary
**Explanations & Answers:**
**Question Easy Answer:**
C) Von Willebrand disease
**Question Easy Explanation:**
Von Willebrand disease is the most common hereditary bleeding disorder, resulting in easy bruising, mucous membrane bleeding (such as nosebleeds), and sometimes menorrhagia in women. It is due to a deficiency or dysfunction of von Willebrand factor, which is crucial for platelet adhesion.
**Question Medium Answer:**
D) Smoking cessation advice
**Question Medium Explanation:**
According to NICE guidelines, smoking cessation is a critical part of managing peripheral artery disease (PAD), which is likely the cause of the patient’s intermittent claudication symptoms. While statin therapy and exercise programs are also essential, addressing smoking can significantly impact disease progression and symptom relief.
**Question Hard Answer:**
C) Stop warfarin 5 days before surgery and start enoxaparin
**Question Hard Explanation:**
For patients on warfarin undergoing elective surgery with a moderate to high risk of thrombosis, it is recommended to stop warfarin about 5 days before surgery and start bridging therapy with low molecular weight heparin, like enoxaparin. The bridging helps prevent thromboembolic events during the period when INR is subtherapeutic.
**Medical fact of the day:**
Did you know the prevalence of varicose veins in the UK is higher than 30% in the adult population? They are more common in women and can often lead to complications like venous ulcers if untreated.
**Quote of the day:**
“Healing the body often starts with listening to the heart. Remember, as a healthcare worker, every touch, every word, heals more than just the ailment.” 🌟