Question Easy:
A 35-year-old woman presents with easy bruising and frequent nosebleeds. Blood tests reveal a prolonged bleeding time but normal prothrombin time and activated partial thromboplastin time. Which of the following is the most likely diagnosis?
A) von Willebrand disease
B) Haemophilia A
C) Immune thrombocytopenic purpura
D) Disseminated intravascular coagulation
E) Vitamin K deficiency
Question Medium:
A 70-year-old man with a history of peripheral artery disease presents with worsening pain in his left lower leg, especially when walking. An ankle-brachial index test shows a severe decrease. What is the most appropriate initial management to improve his symptoms?
A) Start high-dose aspirin
B) Recommend supervised exercise therapy
C) Perform a femoral-popliteal bypass
D) Prescribe a statin
E) Initiate thrombolytic therapy
Question Hard:
A 45-year-old man with a history of recurrent DVTs is found to have inherited thrombophilia. Genetic testing confirms a factor V Leiden mutation. Which of the following is the most likely mechanism by which this mutation increases thrombotic risk?
A) Decreased activity of antithrombin III
B) Resistance to activated protein C
C) Increased levels of prothrombin
D) Deficiency of protein C
E) Increased fibrinogen levels
Explanations & Answers:
Question Easy Answer: A) von Willebrand disease
Question Easy Explanation: von Willebrand disease is characterized by a defect in von Willebrand factor, leading to prolonged bleeding time with normal PT and APTT. The presence of easy bruising and frequent nosebleeds is suggestive of this disorder. According to NICE guidelines, diagnosis can be confirmed with specific factor assays and bleeding history.
Question Medium Answer: B) Recommend supervised exercise therapy
Question Medium Explanation: For intermittent claudication due to peripheral artery disease, supervised exercise therapy is the most effective initial management as per NICE guidelines. It helps improve walking distance and exercise tolerance. The use of exercise therapy is supported over immediate invasive procedures when there is no critical limb ischemia.
Question Hard Answer: B) Resistance to activated protein C
Question Hard Explanation: Factor V Leiden mutation leads to resistance to inactivation by activated protein C, increasing thrombotic risk. This mutation is a common hereditary cause of increased risk for venous thromboembolism as noted in BNF guidelines, characterized by impaired anticoagulant pathway.
Medical fact of the day: Did you know that more than 70% of venous thromboembolism cases associated with factor V Leiden mutation are triggered by risk factors such as surgery, pregnancy, or being on hormonal therapy?
Quote of the day: “The smallest act of kindness and care towards your patients can light up the world around you.”