Question Easy:
A 58-year-old woman presents with fatigue, paleness, and shortness of breath. Her blood test reveals a low haemoglobin level and a mean corpuscular volume (MCV) of 70 fL (normal range: 80-100 fL). Which of the following is the most likely diagnosis? 😊
A) Vitamin B12 deficiency
B) Iron deficiency anaemia
C) Thalassaemia
D) Sickle cell disease
E) Acute myeloid leukaemia
Explanations & Answers:
Question Easy Answer: B) Iron deficiency anaemia
Question Easy Explanation: A low MCV indicates microcytic anaemia, of which iron deficiency is the most common cause. Vitamin B12 deficiency typically leads to macrocytic anaemia, not microcytic anaemia.
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Question Medium:
A 42-year-old man is brought to A&E with severe swelling and pain in his left calf. On examination, his left leg is hot to touch, swollen, and tender. A Doppler ultrasound confirms the presence of a deep vein thrombosis (DVT). Which anticoagulant is most appropriate for the initial treatment of this condition? 🏃♂️
A) Warfarin
B) Apixaban
C) Aspirin
D) Heparin (low molecular weight)
E) Dabigatran
Explanations & Answers:
Question Medium Answer: D) Heparin (low molecular weight)
Question Medium Explanation: According to NICE guidelines, low molecular weight heparin (LMWH) is recommended for the initial treatment of DVT, followed by a transition to oral anticoagulants like apixaban or warfarin, if long-term therapy is required.
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Question Hard:
A 65-year-old woman with a history of atrial fibrillation is scheduled for elective cataract surgery. She is on warfarin with an INR target of 2.0-3.0 for stroke prevention. How should her anticoagulation be managed in the perioperative period? 🎯
A) Continue warfarin without adjustment
B) Stop warfarin 5 days before surgery and start bridging with LMWH
C) Stop warfarin 5 days before surgery, no bridging required
D) Increase warfarin dose to achieve an INR of 3.0-4.0 before surgery
E) Switch to dabigatran 2 days before surgery
Explanations & Answers:
Question Hard Answer: C) Stop warfarin 5 days before surgery, no bridging required
Question Hard Explanation: For patients undergoing minor surgery like cataract surgery, warfarin is typically stopped 5 days before the procedure without bridging anticoagulation, as the risk of thrombosis versus bleeding must be balanced. Bridging is generally reserved for patients with higher thrombosis risk.
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Medical fact of the day: Did you know that the human body contains more than 60,000 miles of blood vessels? This vast network is essential for delivering oxygen and nutrients to every cell in the body. 🩸
Quote of the day: “Healing is a journey, not a destination. Every doctor and student plays a vital role in guiding patients along their unique path.” 🩺