Question Easy: A 65-year-old man presents with fatigue and pallor. Blood tests show microcytic, hypochromic anemia. What is the most likely cause? 🤔
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Sickle cell anemia
D) Thalassemia
E) Anemia of chronic disease
Question Medium: A 23-year-old woman presents with a painful swollen leg. A D-dimer test is positive. Which of the following is the most appropriate initial management? 🚶♀️📈
A) MRI of the leg
B) Low-molecular-weight heparin (LMWH)
C) Aspirin
D) Warfarin
E) Venous ultrasound scan
Question Hard: A 50-year-old man was recently diagnosed with polycythemia vera. Which of the following is the most appropriate initial treatment? 🔬💉
A) Erythropoietin
B) Phlebotomy
C) Hydroxyurea
D) Aspirin
E) Chlorambucil
Explanations & Answers:
Question Easy Answer: B) Iron deficiency anemia
Question Easy Explanation: Microcytic, hypochromic anemia is typically due to iron deficiency, especially in older patients. This could be due to chronic blood loss or a dietary deficiency. NICE guidelines recommend confirming with further tests, such as serum ferritin.
Question Medium Answer: E) Venous ultrasound scan
Question Medium Explanation: A positive D-dimer indicates the need for further investigation for a deep vein thrombosis (DVT). According to NICE guidelines, a venous ultrasound is the first-line imaging to confirm DVT before starting anticoagulation therapy such as LMWH.
Question Hard Answer: B) Phlebotomy
Question Hard Explanation: Phlebotomy is the first-line treatment for polycythemia vera, as it helps to reduce blood volume and maintain hematocrit levels below 45%, thereby reducing the risk of thrombotic events. Hydroxyurea may be considered if phlebotomy alone does not control the condition, as per BNF guidelines.
Medical fact of the day: The spleen can sequester up to one-third of the body’s platelets. This is particularly relevant in conditions that cause splenomegaly, like myelofibrosis or cirrhosis.
Quote of the day: “In the tapestry of healthcare, every thread counts. Let your compassion weave the strength of your practice.” 🌟