Question Easy:
A 25-year-old woman presents with fatigue and dyspnoea on exertion. Blood tests reveal a haemoglobin level of 9 g/dL, a mean corpuscular volume (MCV) of 68 fL, and a serum ferritin level of 8 ng/mL. What is the most likely diagnosis?
A) Vitamin B12 deficiency
B) Iron deficiency anaemia
C) Thalassemia
D) Chronic kidney disease
E) Aplastic anaemia
Explanations & Answers:
Question Easy Answer:
B
Question Easy Explanation:
This patient’s microcytic anaemia (low MCV) combined with low serum ferritin suggests iron deficiency anaemia. NICE guidelines recommend checking ferritin levels as ferritin <30 ng/mL usually confirms iron deficiency anaemia.
Question Medium:
A 57-year-old man with a history of hypertension and diabetes presents with pain in his left calf that’s worse with walking and relieved by rest. What is the most appropriate initial diagnostic test?
A) Ankle-brachial pressure index (ABPI)
B) Doppler ultrasound
C) MRI angiography
D) CT angiography
E) Plain X-ray
Question Medium Answer:
A
Question Medium Explanation:
Ankle-brachial pressure index (ABPI) is the most appropriate initial diagnostic test for peripheral arterial disease (PAD). According to NICE guidelines, ABPI is recommended to confirm the presence of PAD and assess its severity.
Question Hard:
A 35-year-old man presents with spontaneous bruising and gingival bleeding. His platelet count is 20 x 10^9/L, and bone marrow examination shows increased megakaryocytes. Which of the following is the most likely diagnosis?
A) Immune thrombocytopenic purpura (ITP)
B) Acute myeloid leukaemia
C) Thrombotic thrombocytopenic purpura (TTP)
D) Aplastic anaemia
E) Disseminated intravascular coagulation (DIC)
Question Hard Answer:
A
Question Hard Explanation:
Immune thrombocytopenic purpura (ITP) is characterized by low platelet counts due to autoantibody-mediated destruction, with a typically normal bone marrow showing increased megakaryocytes. NICE guidelines support that ITP often presents with mucocutaneous bleeding in the context of thrombocytopenia.
Medical fact of the day: Did you know that the giant cell arteritis typically diagnosed in the UK needs prompt treatment with high-dose steroids to prevent serious complications like blindness and stroke? Early diagnosis and intervention are crucial.
Quote of the day: “In the face of adversity, always remember that your hands hold the power to heal. Every small act of care can lead to a ripple of hope.”