Question Easy:
A 25-year-old woman presents with fatigue, pallor, and a history of heavy menstrual bleeding. Blood tests reveal a haemoglobin level of 8 g/dL and a mean corpuscular volume of 70 fL. What is the most likely diagnosis? 😊
A) Vitamin B12 deficiency
B) Iron deficiency anaemia
C) Sickle cell anaemia
D) Aplastic anaemia
E) Thalassaemia
Question Medium:
A 68-year-old man with a history of hypertension and smoking presents to the emergency department with a sudden onset of severe abdominal and back pain. On examination, he is hypotensive and tachycardic. What is the most likely diagnosis? 🚑
A) Pancreatitis
B) Appendicitis
C) Ruptured abdominal aortic aneurysm
D) Gallstones
E) Myocardial infarction
Question Hard:
A 55-year-old woman presents with recurrent deep vein thrombosis despite being on therapeutic warfarin. On further testing, she has a low protein C level. Which of the following is the most appropriate management step? 🔍
A) Increase the warfarin dose
B) Switch to low-molecular-weight heparin
C) Add aspirin
D) Consider long-term anticoagulation with direct oral anticoagulants (DOACs)
E) Add clopidogrel
Explanations & Answers:
Question Easy Answer: B) Iron deficiency anaemia
Question Easy Explanation: The combination of fatigue, pallor, heavy menstrual bleeding, a low haemoglobin level, and microcytic anaemia (MCV of 70 fL) is classic for iron deficiency anaemia. NICE guidelines support the interpretation of these findings.
Question Medium Answer: C) Ruptured abdominal aortic aneurysm
Question Medium Explanation: The patient’s presentation of sudden severe abdominal and back pain, along with hypotension and a history of risk factors like smoking and hypertension, suggests a ruptured abdominal aortic aneurysm. According to NHS guidelines, this is a critical surgical emergency.
Question Hard Answer: D) Consider long-term anticoagulation with direct oral anticoagulants (DOACs)
Question Hard Explanation: Recurrent thrombotic events in the setting of low protein C levels may require management strategies beyond warfarin. DOACs can be considered for long-term anticoagulation in certain scenarios according to BNF and NICE guidelines, especially when warfarin is inadequate.
Medical fact of the day: Did you know that the prevalence of abdominal aortic aneurysms in the UK is approximately 1 in 100 men over the age of 65? This is why the NHS offers a routine screening programme for AAA in this population to prevent life-threatening ruptures.
Quote of the day: “In the world of medicine, a kind heart and a listening ear can be as powerful as any drug in our arsenal.”