Question Easy:
A 65-year-old woman presents with fatigue, pallor, and shortness of breath on exertion. Blood tests reveal a haemoglobin level of 8 g/dL, MCV of 110 fL, and a low reticulocyte count. Which of the following is the most likely cause of her anaemia?
A) Iron deficiency
B) Vitamin B12 deficiency
C) Acute blood loss
D) Chronic kidney disease
E) Haemolytic anaemia
Explanations & Answers:
Question Easy Answer:
B) Vitamin B12 deficiency
Question Easy Explanation:
The combination of macrocytic anaemia (high MCV) and low reticulocyte count is characteristic of vitamin B12 deficiency. This condition is typically associated with fatigue, pallor, and neurological symptoms, and is common in the elderly due to dietary deficiency or malabsorption issues. In line with NICE guidelines, management would involve identifying the cause and providing vitamin B12 supplementation.
Question Medium:
A 45-year-old man presents with a swollen, painful left leg. He has no significant past medical history but has been sitting for prolonged periods due to recent travel. A Doppler ultrasound confirms a DVT. What is the initial anticoagulation treatment recommended?
A) Aspirin
B) Warfarin
C) Low molecular weight heparin
D) Dabigatran
E) Rivaroxaban
Question Medium Answer:
C) Low molecular weight heparin
Question Medium Explanation:
The immediate treatment for deep vein thrombosis (DVT) in line with NICE guidelines is low molecular weight heparin (LMWH). It provides quick anticoagulation without the need for routine monitoring. LMWH is the preferred initial treatment in the UK before transitioning to an oral anticoagulant such as warfarin or a direct oral anticoagulant (DOAC) like rivaroxaban, often depending on specific patient factors.
Question Hard:
A 30-year-old woman presents with recurrent episodes of abdominal pain, photosensitive skin rash, and hypertension. Urinalysis reveals elevated porphobilinogen levels. Which enzyme deficiency is the most likely cause of her condition?
A) Delta-aminolevulinic acid synthase
B) Porphobilinogen deaminase
C) Uroporphyrinogen decarboxylase
D) Ferrochelatase
E) ALA dehydratase
Question Hard Answer:
B) Porphobilinogen deaminase
Question Hard Explanation:
The clinical presentation is indicative of acute intermittent porphyria, characterized by abdominal pain, neurological manifestations, and photosensitivity, along with hypertension. Elevated levels of porphobilinogen in the urine and deficiency of porphobilinogen deaminase are definitive signs. NICE guidelines discuss the importance of prompt diagnosis and avoidance of precipitating factors to manage porphyria effectively.
Medical fact of the day: Did you know that sickle cell disease is one of the most common severe genetic conditions in England and affects approximately 15,000 people? It requires comprehensive multidisciplinary care to manage pain crises and prevent complications.
Quote of the day: “In the heart of every challenge lies the potential for growth. Let your resilience shine brighter than the obstacles you face in healthcare.”