**Question Easy:**
A 25-year-old woman presents to the GP with fatigue, pallor, and a craving for ice 🍦. Her blood test reveals microcytic hypochromic anemia. What is the most likely diagnosis?
A) Vitamin B12 deficiency
B) Folate deficiency
C) Iron deficiency anemia
D) Sickle cell anemia
E) Thalassemia minor
Explanations & Answers:
Question Easy Answer: C
Question Easy Explanation: The presence of microcytic hypochromic anemia, along with pica (a craving for non-nutritive substances like ice), is highly suggestive of iron deficiency anemia. According to NICE guidelines, iron deficiency is the most common cause of microcytic anemia and requires further investigation and management with oral iron supplements.
**Question Medium:**
A 50-year-old man with a history of hypertension develops sudden, severe pain in his left leg while exercising. On examination, the leg is pale, cold, and pulseless. Which is the most appropriate next step in management?
A) CT angiography
B) Oral anticoagulation
C) Surgical embolectomy
D) IV thrombolysis
E) Bed rest and elevation
Explanations & Answers:
Question Medium Answer: C
Question Medium Explanation: The clinical presentation suggests acute limb ischemia likely due to an embolic event. According to NHS guidelines, surgical embolectomy is the treatment of choice for removing emboli from occluded arteries to restore blood flow immediately and prevent permanent tissue damage.
**Question Hard:**
A 65-year-old woman is admitted with signs of deep vein thrombosis (DVT) confirmed on duplex ultrasound. She has a history of recurrent venous thromboembolism and is currently on warfarin with an international normalized ratio (INR) of 2.5. Despite therapeutic anticoagulation, she now presents with a new DVT. What is the best course of action?
A) Increase the dose of warfarin
B) Start low molecular weight heparin (LMWH)
C) Add clopidogrel to her regimen
D) Check for antiphospholipid syndrome
E) Consider inferior vena cava (IVC) filter placement
Explanations & Answers:
Question Hard Answer: E
Question Hard Explanation: In cases of recurrent venous thromboembolism despite adequate anticoagulation, an IVC filter can be considered to prevent further embolic events. NICE guidelines recommend consideration of an IVC filter in high-risk patients where anticoagulation is not sufficient or contraindicated.
Medical fact of the day: Did you know that the UK has a comprehensive National Abdominal Aortic Aneurysm Screening Programme? Men over the age of 65 are offered screening because abdominal aortic aneurysms (AAA) can develop without symptoms and can be fatal if they rupture.
Quote of the day: “Medicine is more than a profession; it’s a calling to serve others with empathy and dedication. Each patient is a journey, and every diagnosis a story to unfold.”