Question Easy:
A 24-year-old woman attends the GP surgery complaining of fatigue, pallor, and an unusual craving for ice. Blood tests reveal a low haemoglobin level and microcytic hypochromic red blood cells. What is the most likely cause of her symptoms? ❄️
A) Vitamin B12 deficiency
B) Iron deficiency
C) Folate deficiency
D) Sickle cell disease
E) Thalassemia
Question Medium:
A 65-year-old man presents to A&E with a swollen, painful right leg. He has a history of atrial fibrillation and hypertension. On examination, the leg is warm and erythematous. Doppler ultrasound confirms deep vein thrombosis (DVT). What is the most appropriate initial treatment for this patient? 💉
A) Low molecular weight heparin
B) Oral warfarin
C) Aspirin
D) Direct oral anticoagulants (DOACs)
E) Compression stockings
Question Hard:
A 40-year-old woman is referred to haematology for the investigation of recurrent venous thromboembolism (VTE). She has a history of recurrent miscarriages and her mother suffered from similar episodes. Which of the following is the most likely underlying condition? 🧬
A) Protein C deficiency
B) Factor V Leiden mutation
C) Antiphospholipid syndrome
D) Prothrombin gene mutation
E) Antithrombin deficiency
Explanations & Answers:
Question Easy Answer: B) Iron deficiency
Question Easy Explanation: The combination of fatigue, pallor, and pica (craving for non-nutritive substances like ice) is classic for iron deficiency anaemia. This condition leads to microcytic hypochromic anaemia, commonly seen in menstruating women due to blood loss. According to NICE guidelines, the most common cause is dietary deficiency or bleeding, and should be managed accordingly with iron supplementation.
Question Medium Answer: A) Low molecular weight heparin
Question Medium Explanation: The NICE guidelines recommend initiating anticoagulation with low molecular weight heparin for acute management of DVT, especially in the presence of atrial fibrillation where bridging is required. This provides rapid anticoagulation while planning for long-term management.
Question Hard Answer: C) Antiphospholipid syndrome
Question Hard Explanation: This woman’s history of recurrent VTE and miscarriages, coupled with a family history, strongly suggests antiphospholipid syndrome, an autoimmune disorder where antibodies increase the risk of thrombosis. NICE guidelines suggest screening for antiphospholipid antibodies in cases of unexplained thrombosis or pregnancy morbidity.
Medical fact of the day: Haemophilia, a genetic disorder mostly affecting males, is characterised by the inability to effectively form blood clots due to the deficiency of specific clotting factors (Factor VIII in haemophilia A and Factor IX in haemophilia B). Advanced treatments now include gene therapy, offering potential cures and reflecting rapid advancements in the UK medical landscape.
Quote of the day: “In the world of healing, every effort is a beat that pushes us towards light. Keep pushing.”