19/01/2025 – Haem and Vascular

Question Easy: A 25-year-old woman presents to the GP with fatigue and pallor. Her full blood count shows microcytic hypochromic anaemia. What is the most likely underlying cause of her anaemia? 🩸

A) Vitamin B12 deficiency
B) Iron deficiency
C) Folic acid deficiency
D) Sickle cell anaemia
E) Thalassaemia

Question Medium: A 50-year-old man with a 30-pack-year smoking history presents with a bluish discoloration of the hands and feet, particularly when exposed to cold temperatures. He also complains of pain in these areas. What is the most likely diagnosis? 🩺

A) Peripheral neuropathy
B) Raynaud’s phenomenon
C) Deep vein thrombosis
D) Chronic venous insufficiency
E) Berger’s disease

Question Hard: A 65-year-old female with a history of atrial fibrillation presents with sudden-onset left leg pain and paresthesia. On examination, the left leg is pale, cold, and pulseless. What is the most appropriate immediate management step? ⚠️

A) Intravenous antibiotics
B) Oral anticoagulation
C) Urgent fasciotomy
D) Immediate vascular surgical intervention
E) Compression stocking

Explanations & Answers:

Question Easy Answer: B
Question Easy Explanation: The most common cause of microcytic hypochromic anaemia, especially in a young woman, is iron deficiency. This is often due to menstrual blood loss and/or inadequate dietary intake. NICE guidelines recommend checking iron levels and dietary history in such cases before considering other causes like thalassemia.

Question Medium Answer: B
Question Medium Explanation: Raynaud’s phenomenon is characterized by episodic vasospasm causing color changes in the extremities, often triggered by cold or stress. Smoking may exacerbate this condition. NICE guidelines suggest lifestyle modifications as first-line management, including smoking cessation and cold avoidance strategies.

Question Hard Answer: D
Question Hard Explanation: The clinical presentation suggests acute limb ischaemia likely due to an embolus. Immediate vascular surgical intervention is crucial to restore blood flow and salvage the limb. BNF guidelines advocate for urgent revascularization procedures in such cases to prevent ischemic necrosis.

Medical fact of the day: Did you know that sickle cell disease is the most common genetic condition screened for in newborns in the UK? This screening helps identify affected individuals early, which is crucial for the management and prevention of complications.

Quote of the day: “In the quiet moments of compassion, every heartbeat can become a beacon of healing.”