Question Easy:
A 28-year-old woman presents with fatigue, pallor, and dizziness. Her blood test reveals a microcytic hypochromic anaemia. Which of the following is the most likely cause of her symptoms?
A) Vitamin B12 deficiency
B) Iron deficiency
C) Folate deficiency
D) Chronic kidney disease
E) Vitamin D deficiency
Explanations & Answers:
Question Easy Answer: B) Iron deficiency
Question Easy Explanation: Microcytic hypochromic anaemia is most commonly associated with iron deficiency, particularly in menstruating females due to menstrual blood loss. NICE guidelines suggest investigating dietary intake and potential sources of bleeding when iron deficiency is identified.
Question Medium:
A 65-year-old man with a history of smoking and hypertension presents with a painful swollen leg. On examination, there is erythema and warmth, and Homan’s sign is positive. Which of the following is the most appropriate initial investigation?
A) CT venography
B) MRI of the leg
C) Doppler ultrasound
D) D-dimer test
E) X-ray of the leg
Question Medium Answer: C) Doppler ultrasound
Question Medium Explanation: The initial investigation of choice for a suspected deep vein thrombosis (DVT) is a Doppler ultrasound. This non-invasive test allows for visualisation of blood flow in the veins and is recommended by NICE guidelines. While a D-dimer test can be used in conjunction with clinical assessment, it is not diagnostic.
Question Hard:
A 55-year-old woman presents with jaundice and scleral icterus. Laboratory studies show elevated total bilirubin and a normal direct bilirubin level. Her peripheral smear reveals spherocytes. Which of the following is the most likely diagnosis?
A) Gilbert’s syndrome
B) Hepatitis C infection
C) Hereditary spherocytosis
D) Autoimmune haemolytic anaemia
E) Primary biliary cholangitis
Question Hard Answer: C) Hereditary spherocytosis
Question Hard Explanation: The presence of spherocytes on a peripheral blood smear along with indirect (unconjugated) hyperbilirubinaemia suggests hereditary spherocytosis. This condition is caused by defects in red blood cell membrane proteins leading to spherical red cells that are prone to haemolysis. According to NICE, hereditary spherocytosis often presents with haemolytic anaemia, jaundice, and splenomegaly.
Medical fact of the day: Did you know that venous thromboembolism (VTE) can be largely prevented during hospital stays by using appropriate prophylaxis, such as graduated compression stockings or low molecular weight heparin? Adherence to NICE guidelines on VTE prophylaxis can significantly reduce the risk of this potentially life-threatening condition.
Quote of the day: “In the art of medicine, empathy for our patients is as essential as the knowledge we carry. 🌟 Keep learning, but never forget to truly care.”