Question Easy:
A 25-year-old woman presents with fatigue, pallor, and shortness of breath. Blood tests reveal a haemoglobin level of 9 g/dL, mean corpuscular volume (MCV) of 68 fL, and low serum ferritin. What is the most likely diagnosis? 🤔
A) Vitamin B12 deficiency
B) Iron deficiency anaemia
C) Folate deficiency
D) Sickle cell disease
E) Thalassaemia minor
Question Medium:
A 45-year-old man with a history of hypertension and smoking presents with sudden onset of severe abdominal pain that radiates to his back. On examination, he is hypotensive and tachycardic. An abdominal ultrasound shows an abdominal aortic aneurysm. What is the most appropriate immediate management? 🚑
A) Begin intravenous antihypertensives
B) Schedule elective endovascular aneurysm repair
C) Immediate surgical repair
D) Provide oral analgesia and discharge home
E) Intensive monitoring before intervention
Question Hard:
A 65-year-old man on warfarin for atrial fibrillation presents with a headache and confusion. His INR is 4.5. A CT scan reveals a small subdural haematoma. What is the most appropriate initial management? 🧠
A) Increase warfarin dose
B) Administer intravenous vitamin K
C) Observe and recheck INR in 24 hours
D) Perform an emergency craniotomy
E) Use fresh frozen plasma immediately
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: Iron deficiency anaemia is characterized by microcytic (low MCV), hypochromic anaemia with low serum ferritin. This is the most common cause of anaemia worldwide, particularly in young women due to menstrual blood loss and/or dietary insufficiency. NHS guidelines support iron supplementation as the first-line treatment.
Question Medium Answer: C
Question Medium Explanation: The scenario is suggestive of a ruptured abdominal aortic aneurysm, a life-threatening condition. According to NICE and NHS guidelines, immediate surgical repair is crucial to prevent further haemorrhage and potential death.
Question Hard Answer: B
Question Hard Explanation: An elevated INR in a patient on warfarin with a small subdural haematoma requires urgent reversal of anticoagulation. Intravenous vitamin K and prothrombin complex concentrate, if available, are recommended by NICE for rapid reversal. Fresh frozen plasma might be used if prothrombin complex is unavailable but not as the first option.
Medical fact of the day: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality. The UK has implemented guidelines like VTE risk assessment for all admitted patients aged 16 or over to reduce hospital-associated VTE, highlighting the importance of preventative measures in clinical practice.
Quote of the day: “In the heart of care lies the courage to persist with hope, even when the night seems darkest. Your dedication lights the way.” 🌟