Question Easy:
A 25-year-old woman visits her GP with fatigue and pallor. Blood tests reveal a haemoglobin level of 9 g/dL, mean corpuscular volume (MCV) of 72 fL, and ferritin level of 8 ng/mL. What is the most likely diagnosis?
A) Beta thalassemia minor
B) Iron deficiency anaemia
C) Anaemia of chronic disease
D) Sickle cell anaemia
E) Vitamin B12 deficiency
Explanations & Answers:
Question Easy Answer: B) Iron deficiency anaemia
Question Easy Explanation: Iron deficiency anaemia commonly presents with microcytic, hypochromic anaemia (low MCV and low haemoglobin) and low ferritin levels due to decreased iron stores. According to NICE guidelines, the most common cause of this type of anaemia, particularly in young women, is iron deficiency.
Question Medium:
A 55-year-old man is being investigated for recurrent episodes of calf pain while walking, which resolves after a few minutes of rest. Which diagnostic test is most appropriate to confirm peripheral arterial disease (PAD)?
A) Ankle-brachial index (ABI)
B) Doppler ultrasound of the leg
C) Computed tomography angiography (CTA)
D) Magnetic resonance imaging (MRI)
E) Plain X-ray
Explanations & Answers:
Question Medium Answer: A) Ankle-brachial index (ABI)
Question Medium Explanation: The ankle-brachial index (ABI) is a simple, non-invasive test that compares the blood pressure in the ankle with the blood pressure in the arm to assess for peripheral arterial disease. NICE guidelines recommend ABI as the first-line test for diagnosing PAD, as it is quick, cost-effective, and generally accurate.
Question Hard:
A 30-year-old woman presents with recurrent thrombosis despite being on warfarin. Her INR is adequately maintained at 3. Blood tests reveal a normal full blood count, normal renal function, and elevated antiphospholipid antibodies. Which additional treatment should be considered?
A) Aspirin
B) Increase the dose of warfarin
C) Low-dose heparin
D) Rivaroxaban
E) Hydroxychloroquine
Explanations & Answers:
Question Hard Answer: A) Aspirin
Question Hard Explanation: In patients with antiphospholipid syndrome (APS) and recurrent thrombosis despite adequate anticoagulation with warfarin, adding low-dose aspirin to their regimen might be beneficial. According to guidelines, low-dose aspirin in conjunction with warfarin is often used to provide enhanced thromboprophylaxis in such scenarios.
Medical fact of the day: Did you know that the UK was the first country to introduce routine national screening for abdominal aortic aneurysm (AAA) in 2013? This program aims to reduce deaths from AAA by detecting asymptomatic cases in men aged 65 and over using an ultrasound scan.
Quote of the day: “In the heart of uncertainty, the light of resilience illuminates the path forward. Together, we heal and hope.”