Question Easy: A 67-year-old woman comes to the GP with swelling in her legs. On examination, there is pitting oedema up to the knees. Blood tests show hypoalbuminemia. Which of the following is a likely cause of her symptoms?
A) Liver cirrhosis
B) Hypertension
C) Deep vein thrombosis
D) Pulmonary embolism
E) Myocardial infarction
Question Medium: A 55-year-old man presents with persistent fatigue, night sweats, and unintentional weight loss over the past three months. Blood tests show a white blood cell count of 80 x 10^9/L with an increased number of mature-appearing granulocytes. He has a low level of leukocyte alkaline phosphatase. What is the most likely diagnosis?
A) Chronic myeloid leukaemia (CML)
B) Chronic lymphocytic leukaemia (CLL)
C) Acute myeloid leukaemia (AML)
D) Acute lymphoblastic leukaemia (ALL)
E) Myelofibrosis
Question Hard: A 32-year-old woman with a history of recurrent miscarriages is evaluated for prolonged aPTT. Mixing studies do not correct the aPTT. She has a history of thrombocytopenia but no significant bleeding episodes. Which of the following is the most likely underlying condition?
A) Von Willebrand disease
B) Factor V Leiden mutation
C) Antiphospholipid syndrome
D) Haemophilia A
E) Vitamin K deficiency
Explanations & Answers:
Question Easy Answer: A) Liver cirrhosis
Question Easy Explanation: Pitting oedema and hypoalbuminemia are classic symptoms of liver cirrhosis due to decreased production of albumin, leading to decreased plasma oncotic pressure. According to NICE guidelines, supporting evidence such as liver function tests and imaging would further assist in confirming the diagnosis.
Question Medium Answer: A) Chronic myeloid leukaemia (CML)
Question Medium Explanation: The clinical presentation of fatigue, night sweats, and unintentional weight loss coupled with a high white blood cell count featuring mature granulocytes suggests CML. The low leukocyte alkaline phosphatase is characteristic as per NHS guidelines for differentiating CML from other leukemias.
Question Hard Answer: C) Antiphospholipid syndrome
Question Hard Explanation: Recurrent miscarriages, prolonged aPTT that does not correct with mixing studies, and thrombocytopenia point towards antiphospholipid syndrome, a condition associated with an increased risk of thrombosis despite prolonged clotting tests. This condition aligns with BNF-referenced management strategies focusing on anticoagulation therapy.
Medical fact of the day: The average adult has about 5 litres of blood, and it takes just about one minute for blood to circulate through the entire body. This is crucial for understanding vascular and circulatory system dynamics in medical practice.
Quote of the day: “In the tapestry of care, every thread matters. Keep weaving hope and healing.”