Question Easy:
You’re assessing a 68-year-old woman who presents with fatigue, pallor, and spoon-shaped nails. Her blood tests show a low haemoglobin level and low mean corpuscular volume (MCV). What is the most likely diagnosis? 🍏
A) Vitamin B12 deficiency anemia
B) Sickle cell anemia
C) Iron deficiency anemia
D) Beta thalassemia
E) Normocytic anemia
Question Medium:
A 72-year-old man presents with intermittent claudication. He has a 30-year history of smoking and is diagnosed with peripheral artery disease (PAD). What is the first-line pharmacotherapy to improve his symptoms? 🚶♂️💊
A) Clopidogrel
B) Simvastatin
C) Ramipril
D) Atorvastatin
E) Cilostazol
Question Hard:
A 54-year-old woman with a history of deep vein thrombosis (DVT) is started on warfarin. She is stable, but her INR is persistently subtherapeutic. Which of the following could be an explanation for poor INR control? 🔍💉
A) Increased dietary vitamin K intake
B) Co-administration with ibuprofen
C) Low body weight
D) Genetic variation in CYP2C9
E) Poor medication adherence
Explanations & Answers:
Question Easy Answer:
C) Iron deficiency anemia
Question Easy Explanation:
This patient’s symptoms and lab findings are classic for iron deficiency anemia, the most common cause of anemia in the UK. The symptoms such as fatigue, pallor, and koilonychia (spoon-shaped nails) along with low MCV, point towards iron deficiency.
Question Medium Answer:
E) Cilostazol
Question Medium Explanation:
According to NICE guidelines, cilostazol is used in patients with intermittent claudication due to PAD when lifestyle modifications such as exercise and smoking cessation are not adequate. It’s known for improving walking distances in such conditions.
Question Hard Answer:
A) Increased dietary vitamin K intake
Question Hard Explanation:
Warfarin’s anticoagulant effect is influenced by vitamin K. Dietary changes increasing vitamin K intake can lower INR, leading to subtherapeutic levels. Warfarin dosing needs to consider dietary vitamin K, adherence, and genetic factors like CYP2C9, but dietary intake is a simple, key consideration.
Medical fact of the day:
The abdominal aorta is the most common site for aneurysms in the UK. Abdominal aortic aneurysms (AAA) often have no symptoms and are most prevalent in men aged over 65. The NHS offers screening to detect AAAs early and prevent rupture.
Quote of the day:
“In the tapestry of care, every thread of kindness weaves a garment of hope.”