Question Easy:
A 68-year-old man presents with a swollen, tender left leg that has become progressively worse over the past three days. He recently underwent knee replacement surgery. What is the most likely diagnosis?
A) Cellulitis
B) Deep vein thrombosis (DVT)
C) Superficial thrombophlebitis
D) Chronic venous insufficiency
E) Baker’s cyst
Explanations & Answers:
Question Easy Answer: B) Deep vein thrombosis (DVT)
Question Easy Explanation: Given the patient’s recent surgery (a known risk factor), along with the progressive swelling and tenderness, a DVT is the most likely diagnosis. NICE guidelines recommend considering DVT in patients with these signs, especially postoperatively.
Question Medium:
A 35-year-old female presents with fatigue, pallor, and shortness of breath. Blood tests reveal: Hb 90 g/L, MCV 68 fL, ferritin low, serum iron low, and TIBC high. What is the most appropriate initial management?
A) Vitamin B12 supplementation
B) Folate supplementation
C) Prednisolone
D) Iron supplementation
E) Blood transfusion
Explanations & Answers:
Question Medium Answer: D) Iron supplementation
Question Medium Explanation: The blood test results indicate iron deficiency anaemia, characterized by low Hb, low MCV, low serum iron, low ferritin, and high TIBC. According to NICE guidelines, the initial management should focus on correcting the iron deficiency with iron supplementation.
Question Hard:
A 55-year-old female with a history of systemic lupus erythematosus (SLE) presents with sudden onset chest pain, tachypnea, and hemoptysis. Her D-dimer is considerably elevated. What is the most appropriate next step in her management?
A) Start IV fluids
B) Order an echocardiogram
C) Begin low molecular weight heparin (LMWH)
D) Perform serum troponin test
E) Initiate aspirin therapy
Explanations & Answers:
Question Hard Answer: C) Begin low molecular weight heparin (LMWH)
Question Hard Explanation: The presentation of chest pain, tachypnea, hemoptysis, and elevated D-dimer is highly suggestive of a pulmonary embolism (PE). In a patient with SLE (which increases the risk of thromboembolic events), NICE guidelines recommend prompt anticoagulation therapy with LMWH as the initial treatment while awaiting further imaging.
Medical fact of the day:
Did you know that the life expectancy of a single red blood cell in the human body is approximately 120 days? This cycle helps ensure continuous oxygen delivery throughout the body and is particularly relevant in conditions like anaemia and haemolytic disorders.
Quote of the day:
“In the realm of healthcare, every act of kindness and every ounce of effort can change a life. Stay inspired, for in your hands lies the power to heal and to care.”