07/07/2024 – Haem and Vascular

Question Easy:
Which of the following is the first-line treatment for a patient presenting with iron-deficiency anaemia according to NICE guidelines?

A) Oral folic acid
B) Intravenous iron
C) Oral ferrous sulfate
D) Blood transfusion
E) Vitamin B12 injections

Explanations & Answers:

Question Easy Answer:
C) Oral ferrous sulfate

Question Easy Explanation: According to NICE guidelines, the first-line treatment for iron-deficiency anaemia is oral ferrous sulfate. It is preferred due to its efficacy in replenishing iron stores and ease of administration. Intravenous iron is generally reserved for cases where oral iron is not tolerated or ineffective.

Question Medium:
A 55-year-old man presents with intermittent claudication impacting his ability to walk. What is the recommended first-line management approach according to NICE guidelines?

A) Angioplasty
B) Supervised exercise program
C) Statins
D) Antiplatelet therapy
E) Smoking cessation

Explanations & Answers:

Question Medium Answer:
B) Supervised exercise program

Question Medium Explanation: NICE guidelines recommend a supervised exercise program as the first-line management for intermittent claudication. This helps improve symptoms and overall vascular health. While smoking cessation, statins, and antiplatelet therapy are also important, the supervised exercise program specifically targets and alleviates the symptoms of claudication.

Question Hard:
A 70-year-old female with atrial fibrillation is on warfarin therapy. She presents to the A&E with a sudden onset of back pain and hypotension. A CT scan reveals a retroperitoneal bleed. What is the most appropriate immediate management according to current guidelines?

A) Administer intravenous vitamin K
B) Transfusion of fresh frozen plasma
C) Start IV heparin
D) Administer prothrombin complex concentrate
E) Observation and supportive care

Explanations & Answers:

Question Hard Answer:
D) Administer prothrombin complex concentrate

Question Hard Explanation: In the case of a life-threatening bleed such as a retroperitoneal hemorrhage in a patient on warfarin, the immediate administration of prothrombin complex concentrate (PCC) is recommended to reverse the anticoagulation rapidly. Vitamin K can also be given, but PCC acts much faster in acute settings.

Medical fact of the day: Venous leg ulcers, a common vascular condition, affect approximately 1% of the adult population in the UK, mainly due to chronic venous insufficiency. Prompt and appropriate management, including compression therapy, is essential to prevent complications and improve outcomes.

Quote of the day: “In healthcare, every small act of kindness can make a big difference. Keep shining, and let your compassion light the way.”