Question Easy:
A 56-year-old woman presents with tiredness, palpitations, and pallor. Her blood tests reveal hemoglobin of 9 g/dL, MCV of 110 fL, and elevated serum homocysteine. Which vitamin deficiency is most likely responsible for her symptoms? 🍊
A) Vitamin A
B) Vitamin B6
C) Vitamin B12
D) Vitamin C
E) Vitamin D
Question Medium:
A 72-year-old man comes to the clinic with intermittent claudication. He smokes 20 cigarettes a day and has a history of hypertension. Which of the following is the first-line management for his symptoms in addition to lifestyle modifications? 🚶♂️
A) Clopidogrel
B) Atorvastatin
C) Percutaneous transluminal angioplasty
D) Supervised exercise programme
E) Heparin
Question Hard:
A 65-year-old woman is diagnosed with antiphospholipid syndrome. She has a history of recurrent miscarriages and a prior deep vein thrombosis (DVT). She is currently on warfarin. What is the most appropriate target INR range for this patient to prevent further thromboembolic events? 🧪
A) 1.5-2.0
B) 2.0-2.5
C) 2.5-3.0
D) 3.0-3.5
E) 3.5-4.0
Explanations & Answers:
Question Easy Answer: C) Vitamin B12
Question Easy Explanation: The symptoms and the macrocytic anemia (high MCV) point towards a vitamin B12 deficiency. This can lead to elevated homocysteine levels and is often associated with neurological symptoms. Vitamin B12 plays a vital role in red blood cell formation and neurological function.
Question Medium Answer: D) Supervised exercise programme
Question Medium Explanation: NICE guidelines recommend a supervised exercise programme as the first-line treatment for intermittent claudication in addition to lifestyle changes, such as smoking cessation. Exercise helps improve muscle metabolism and enhances the development of collateral circulation.
Question Hard Answer: C) 2.5-3.0
Question Hard Explanation: For patients with antiphospholipid syndrome with a history of thromboembolic events, including DVT, the target INR range is generally 2.5-3.0 as per BNF guidance. This range helps to effectively prevent further clotting incidents without increasing the risk of bleeding excessively.
Medical fact of the day: Did you know that the UK has one of the highest rates of deep vein thrombosis and pulmonary embolism in Europe, leading to significant morbidity and mortality? Early diagnosis and effective anticoagulation can prevent these complications. 🇬🇧
Quote of the day: “In the heart of service, you find the courage to heal, the strength to care, and the power to make a difference, one patient at a time.” 🌟