04/08/2024 – Haem and Vascular

Question Easy:
A 27-year-old woman presents with fatigue, shortness of breath, and palpitations 🫀. Blood tests reveal a low hemoglobin level. Which of the following is the most likely cause of her symptoms given her age and common occurrences in the UK population?
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Sickle cell disease
D) Thalassemia major
E) Aplastic anemia

Explanations & Answers:

Question Easy Answer:
B

Question Easy Explanation:
Iron deficiency anemia is the most common cause of anemia in young women in the UK, largely due to menstrual blood loss and inadequate dietary intake.

Question Medium:
A 55-year-old man with a history of hypertension presents with acute onset chest pain radiating to the back along with breathlessness and a feeling of impending doom 😰. Examination reveals a blood pressure of 180/110 mmHg and a murmur of aortic regurgitation. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pneumothorax
E) Pericarditis

Question Medium Answer:
C

Question Medium Explanation:
Aortic dissection can present with severe chest pain radiating to the back, a new murmur of aortic regurgitation, and hypertension. This is a medical emergency and requires immediate intervention as stipulated by NICE guidelines.

Question Hard:
A 45-year-old woman with a history of systemic lupus erythematosus presents with increasing swelling in her legs 🦵 and proteinuria. Blood tests show hypoalbuminemia and hyperlipidemia. What is the most likely underlying pathology?
A) Acute nephritic syndrome
B) Nephrotic syndrome
C) Hepatorenal syndrome
D) Post-infectious glomerulonephritis
E) Minimal change disease

Question Hard Answer:
B

Question Hard Explanation:
Nephrotic syndrome, which can be secondary to systemic lupus erythematosus, typically presents with proteinuria, hypoalbuminemia, and hyperlipidemia, leading to oedema. Management should be in line with BNF and NHS guidelines, which include controlling proteinuria and the underlying condition.

Medical fact of the day:
Did you know? The spleen is the largest lymphatic organ, and its removal (splenectomy) increases the risk of infections, particularly with encapsulated organisms like Streptococcus pneumoniae. Hence, vaccinations are crucial pre- and post-operatively.

Quote of the day:
“Every patient encounter is an opportunity to demonstrate compassion, because healing the body is intertwined with comforting the soul.”