Question Easy:
A 45-year-old female presents with easy bruising and prolonged bleeding after minor cuts. Blood tests reveal an isolated prolonged activated partial thromboplastin time (aPTT), while prothrombin time (PT) and platelet count are normal. Which factor deficiency is most likely responsible for these findings?
A) Factor II
B) Factor V
C) Factor VIII
D) Factor IX
E) Factor X
Question Medium:
A 60-year-old male presents with leg swelling, pain, and tenderness over the left calf. He has recently had abdominal surgery a week ago. A Doppler ultrasound confirms a deep vein thrombosis (DVT). What is the most appropriate initial management?
A) Aspirin
B) Warfarin
C) Direct oral anticoagulant (DOAC)
D) Low molecular weight heparin (LMWH)
E) Compression stockings
Question Hard:
A 32-year-old woman presents with fatigue, palpitations, and shortness of breath on exertion. Her blood tests show the following:
– Hemoglobin: 8.2 g/dL
– Mean corpuscular volume (MCV): 72 fL
– Ferritin: 10 µg/L
– Total iron binding capacity (TIBC): Increased
What is the most likely underlying cause of her anemia?
A) Chronic kidney disease
B) Iron deficiency due to menorrhagia
C) Thalassemia trait
D) Vitamin B12 deficiency
E) Anemia of chronic disease
Explanations & Answers:
Question Easy Answer: C) Factor VIII
Question Easy Explanation: The isolated prolongation of aPTT with normal PT suggests an intrinsic pathway deficiency. Hemophilia A, caused by Factor VIII deficiency, typically presents with these findings. 🤓 According to NHS guidelines, Factor VIII deficiency is the most common cause of such a presentation.
Question Medium Answer: D) Low molecular weight heparin (LMWH)
Question Medium Explanation: As per NICE guidelines, the initial treatment for DVT in the context of recent surgery should start with LMWH due to its rapid onset of action and ease of dose adjustment. Warfarin or DOACs might follow, but LMWH is preferred initially, especially in cases needing rapid anticoagulation post-surgery. 🏃♀️
Question Hard Answer: B) Iron deficiency due to menorrhagia
Question Hard Explanation: The lab results indicate microcytic anemia (low MCV) with low ferritin and high TIBC, consistent with iron deficiency anemia. Given the patient’s age and gender, menorrhagia is a common cause of iron deficiency in pre-menopausal women. NICE guidelines emphasize treating underlying causes such as heavy menstrual bleeding in these cases. 🚺
Medical fact of the day: One interesting fact about haemoglobin is that in the UK, one of the most prevalent genetic disorders is thalassemia. It’s screened for in high-risk populations as part of prenatal care, highlighting the importance of early diagnosis and management.
Quote of the day: “In the labyrinth of healing, every patient’s story is a chapter; our compassion is the guiding light through which they find hope.”