Question Easy:
A 22-year-old woman presents with pallor and fatigue. Blood tests show a low haemoglobin level, low mean corpuscular volume, and a high total iron binding capacity. Which of the following is the most likely diagnosis? 🩸
A) Iron deficiency anaemia
B) Thalassemia minor
C) Anaemia of chronic disease
D) Sickle cell anaemia
E) Vitamin B12 deficiency
Question Medium:
A 65-year-old man with a history of hypertension presents with swelling of the right leg. On examination, there is tenderness on calf compression and his right leg is noticeably larger than his left. A D-dimer test is elevated. What is the most appropriate next step in management? 🦵
A) CT pulmonary angiography
B) Doppler ultrasound of the legs
C) Immediate anticoagulation
D) X-ray of the leg
E) Bone scan
Question Hard:
A 70-year-old woman presents with a sudden onset of sharp chest pain and shortness of breath. She has a history of atrial fibrillation but has not been compliant with her anticoagulation therapy. Her vital signs show tachycardia and hypotension. An ECG indicates right heart strain pattern. Which of the following is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pneumothorax
D) Pulmonary embolism
E) Pericarditis
Explanations & Answers:
Question Easy Answer: A) Iron deficiency anaemia
Question Easy Explanation: The combination of low haemoglobin, low mean corpuscular volume, and high total iron binding capacity is characteristic of iron deficiency anaemia. This is the most common cause of microcytic anaemia, especially in young women, often due to menstrual losses.
Question Medium Answer: B) Doppler ultrasound of the legs
Question Medium Explanation: According to NICE guidelines, a Doppler ultrasound of the legs is recommended as the first-line investigation for suspected deep vein thrombosis (DVT), particularly when clinical signs and an elevated D-dimer test are present. Immediate anticoagulation is considered while awaiting imaging.
Question Hard Answer: D) Pulmonary embolism
Question Hard Explanation: The patient’s presentation is consistent with a pulmonary embolism (PE), especially given the risk factor of atrial fibrillation and non-compliance with anticoagulation. The ECG findings of right heart strain further support this diagnosis, indicating a large PE affecting the hemodynamics.
Medical fact of the day: Did you know that the prevalence of deep vein thrombosis significantly increases with age, connoting why a high index of suspicion is essential in the elderly population with unilateral leg swelling and risk factors like immobility or recent surgery?
Quote of the day: “In the heart of every challenge lies the catalyst for change. As healthcare workers, you are the architects of resilience, molding adversity into strength for the benefit of humanity.”