Question Easy:
A 25-year-old man presents with fatigue and paleness. Blood tests reveal a haemoglobin level of 9 g/dL and a mean corpuscular volume (MCV) of 70 fL. Which of the following is the most likely cause of his anaemia?
A) Vitamin B12 deficiency
B) Iron deficiency
C) Folate deficiency
D) Sickle cell anaemia
E) Thalassaemia
Explanations & Answers:
Question Easy Answer: B) Iron deficiency
Question Easy Explanation: This patient presents with microcytic anaemia, indicated by a low MCV. The most common cause of microcytic anaemia in young adults is iron deficiency, often due to dietary issues or chronic blood loss, such as undiagnosed gastrointestinal bleeding.
Question Medium:
A 65-year-old woman arrives at the clinic with complaints of leg pain while walking, which is relieved by rest. She has a history of smoking and hypertension. What is the most appropriate initial investigation to confirm a diagnosis of peripheral arterial disease (PAD) in this patient?
A) Venous Doppler ultrasound
B) MRI of the legs
C) Ankle-brachial pressure index (ABPI)
D) CT angiography
E) Serum D-dimer
Question Medium Answer: C) Ankle-brachial pressure index (ABPI)
Question Medium Explanation: The ankle-brachial pressure index (ABPI) is the most appropriate initial diagnostic tool for confirming peripheral arterial disease. A simple, cost-effective test, the ABPI compares blood pressure measurements in the ankle and the arm, indicating blocked or narrowed arteries. It is aligned with NICE guidelines for non-invasive testing of PAD.
Question Hard:
A 52-year-old man with a history of atrial fibrillation is on warfarin therapy. He presents with sudden onset of right sided weakness and aphasia. His INR is critically elevated at 5.8. What is the most appropriate immediate management for this patient?
A) Vitamin K IV
B) Fresh frozen plasma (FFP)
C) Prothrombin complex concentrate (PCC)
D) Aspirin
E) Heparin infusion
Question Hard Answer: C) Prothrombin complex concentrate (PCC)
Question Hard Explanation: In cases of life-threatening bleeding or INR elevation, Prothrombin complex concentrate (PCC) is recommended over fresh frozen plasma (FFP) due to its rapid action and concentrated factors II, VII, IX, and X, effectively reversing warfarin anticoagulation. NICE guidelines prioritize PCC for critical INR corrections over Vitamin K, which acts slower, and FFP.
Medical fact of the day: Did you know? In the UK, iron deficiency anaemia is the most common nutritional disorder, affecting about 1 in 5 women aged 16 to 64, highlighting the importance of routine screening and healthy dietary intake. 🍏🥦
Quote of the day: “In medicine, as in life, the small acts of kindness often leave the greatest impact.” 🌟