Question Easy:
A 25-year-old man presents with fatigue, shortness of breath on exertion, and pallor. Blood tests reveal a haemoglobin level of 9 g/dL and mean corpuscular volume (MCV) of 70 fL. What is the most likely diagnosis? 🚑
A) Vitamin B12 deficiency
B) Iron deficiency anaemia
C) Sickle cell disease
D) Thalassaemia
E) Aplastic anaemia
Question Medium:
A 65-year-old woman with a history of hypertension presents with sudden onset of pain, coldness, and a pale right leg 🦵. She has absent pulses in the right lower limb and a diminished sensation. Which is the most likely diagnosis?
A) Deep vein thrombosis
B) Chronic venous insufficiency
C) Acute limb ischaemia
D) Peripheral neuropathy
E) Compartment syndrome
Question Hard:
A 50-year-old man with a history of atrial fibrillation is on warfarin. He presents to the ED with spontaneous gum bleeding and a high INR of 8.5. 🎯 What is the most appropriate immediate management of his condition?
A) Intravenous vitamin K
B) Fresh frozen plasma
C) Prothrombin complex concentrate
D) Tranexamic acid
E) Rivaroxaban
Explanations & Answers:
Question Easy Answer:
B) Iron deficiency anaemia
Question Easy Explanation:
The patient presents with microcytic anaemia (MCV of 70 fL). The most common cause of microcytic anaemia, particularly in young adults, is iron deficiency. Signs like fatigue, shortness of breath, and pallor align with this diagnosis according to NICE guidelines.
Question Medium Answer:
C) Acute limb ischaemia
Question Medium Explanation:
Acute limb ischaemia is characterised by the “6 Ps”: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, and “Perishing cold”. The sudden onset and progression of symptoms are consistent with an embolic event causing acute ischaemia, a vascular emergency.
Question Hard Answer:
C) Prothrombin complex concentrate
Question Hard Explanation:
In the case of warfarin-associated bleeding with a high INR, the immediate management is to reverse anticoagulation. Prothrombin complex concentrate is recommended by the BNF and NHS guidelines for rapid reversal of warfarin in life-threatening bleeding as it acts faster than vitamin K.
Medical fact of the day:
Did you know that aspirin, at low doses, is an antiplatelet agent and is used in the UK not only for pain and fever but also for the prevention of cardiovascular events due to its effect on inhibiting platelet aggregation?
Quote of the day:
“To heal a patient is a true privilege; to touch their lives is an honour. Keep learning, keep growing.” 🌟