Question Easy:
A 68-year-old man with a history of hypertension presents with sudden onset of severe chest pain radiating to the back. His blood pressure is 180/100 mmHg, and there’s a significant difference between the readings in his right and left arm. Which is the most likely diagnosis?
A) Acute Myocardial Infarction
B) Aortic Dissection
C) Pulmonary Embolism
D) Pneumothorax
E) Acute Pericarditis
Explanations & Answers:
Question Easy Answer: B) Aortic Dissection
Question Easy Explanation: Aortic dissection often presents with sudden onset of severe chest pain radiating to the back, and a significant difference in blood pressure between arms. Immediate diagnosis and intervention are critical. According to NICE guidelines, urgent imaging (CT angiography) should be performed. 🚨
Question Medium:
A 35-year-old woman presents with fatigue, pallor, and a tingling sensation in her hands and feet. Blood tests reveal a haemoglobin level of 8 g/dL, a mean corpuscular volume (MCV) of 110 fL, and a low serum B12 level. Which of the following conditions is most likely?
A) Iron Deficiency Anaemia
B) Thalassemia
C) Sickle Cell Anaemia
D) Vitamin B12 Deficiency
E) Folate Deficiency
Explanations & Answers:
Question Medium Answer: D) Vitamin B12 Deficiency
Question Medium Explanation: This patient presents with macrocytic anaemia (high MCV) and neurological symptoms, which are characteristic of Vitamin B12 deficiency. NICE guidelines recommend checking serum B12 levels in patients with macrocytic anaemia, and treatment involves Vitamin B12 supplementation. 💉
Question Hard:
A 55-year-old patient with a history of deep vein thrombosis (DVT) is on warfarin therapy. He presents with a nosebleed that has been ongoing for over an hour. His INR is found to be 8.5. What is the most appropriate immediate management?
A) Continue warfarin at the same dose
B) Reduce the dose of warfarin
C) Stop warfarin and give Vitamin K
D) Stop warfarin and give fresh frozen plasma
E) Stop warfarin and give prothrombin complex concentrate
Explanations & Answers:
Question Hard Answer: E) Stop warfarin and give prothrombin complex concentrate
Question Hard Explanation: The patient has a critically high INR and active bleeding. According to the BNF and NICE guidelines, immediate INR reversal with prothrombin complex concentrate is recommended, along with stopping warfarin. Vitamin K should also be administered but acts more slowly. 🩸
Medical fact of the day: Did you know that Peripheral Arterial Disease (PAD) affects approximately 20% of people over the age of 60 in the UK? Early recognition and management are crucial to prevent serious complications like limb ischemia and amputation.
Quote of the day: “In the quest to heal others, remember to heal yourself. Your well-being is the cornerstone of compassionate care.” 🌟