03/11/2024 – Haem and Vascular

Question Easy:
A 65-year-old man presents to his GP with leg pain that occurs when walking and is relieved by rest. He has a history of smoking and hypertension. What is the most likely diagnosis? 🚶‍♂️
A) Deep vein thrombosis
B) Peripheral arterial disease
C) Varicose veins
D) Cellulitis
E) Baker’s cyst

Question Medium:
A 40-year-old woman is admitted with spontaneous bruising and nosebleeds. Her platelet count is 20 x 10^9/L, and a blood film shows large platelets. She has no known drug allergies. What is the most appropriate initial management? 🤔
A) Oral prednisolone
B) Intravenous immunoglobulin
C) Platelet transfusion
D) Splenectomy
E) Observation

Question Hard:
A 30-year-old woman presents with a history of recurrent miscarriages, a livedo reticularis rash, and a positive test for lupus anticoagulant. She is currently not pregnant. Which of the following is the best long-term management strategy to reduce her risk of thrombosis? 🔍
A) Aspirin
B) Warfarin
C) Low molecular weight heparin
D) Hydroxychloroquine
E) No treatment necessary

Explanations & Answers:

Question Easy Answer:
B) Peripheral arterial disease

Question Easy Explanation:
This patient exhibits classic symptoms of intermittent claudication, a hallmark of peripheral arterial disease (PAD). PAD is caused by atherosclerosis leading to reduced blood flow to the limbs, and risk factors include smoking and hypertension in alignment with NICE guidelines. 🚴‍♂️

Question Medium Answer:
A) Oral prednisolone

Question Medium Explanation:
This case describes immune thrombocytopenic purpura (ITP). According to NHS guidelines, first-line treatment for ITP typically involves corticosteroids such as prednisolone. Other treatments, like intravenous immunoglobulin, are reserved for particular contexts. 💊

Question Hard Answer:
B) Warfarin

Question Hard Explanation:
The patient likely has antiphospholipid syndrome, and warfarin is recommended for long-term anticoagulation to prevent thrombosis as per current guidelines. Though aspirin is also an anticoagulant, warfarin is preferred in patients with a history of recurrent thrombosis or miscarriages due to its efficacy in reducing thrombotic risks. 📜

Medical fact of the day:
Did you know that the first successful blood transfusion from human to human was performed by British obstetrician James Blundell in 1818? It was done to treat postpartum hemorrhage, marking a pivotal moment in the history of haematology and transfusion medicine.

Quote of the day:
“In the tapestry of healthcare, every act of compassion is a stitch in the fabric that holds humanity together. Stay mindful, stay kind.” 🌟