Question Easy:
A patient presents with fatigue, pallor, and shortness of breath on exertion. Blood tests reveal a microcytic, hypochromic anaemia. What is the most likely diagnosis? 🤔
A) Vitamin B12 deficiency
B) Iron deficiency anaemia
C) Sickle cell anaemia
D) Aplastic anaemia
E) Haemolytic anaemia
Question Medium:
A 62-year-old man with a history of atrial fibrillation is prescribed warfarin. He presents to the GP complaining of excessive bruising and nosebleeds. Which blood test is most appropriate to assess the risk of bleeding? 🩸
A) Full blood count
B) D-dimer test
C) Activated partial thromboplastin time (aPTT)
D) International normalised ratio (INR)
E) Serum electrolytes
Question Hard:
A 58-year-old woman experiences sudden onset of left leg pain and swelling. She has recently undergone knee replacement surgery. The clinical examination is suggestive of a deep vein thrombosis (DVT). What is the initial recommended investigation to confirm this diagnosis? 🔍🦵
A) CT pulmonary angiography
B) Venous Doppler ultrasound
C) D-dimer test
D) MRI of the lower limb
E) X-ray of the lower limb
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: The patient’s microcytic, hypochromic anaemia is indicative of iron deficiency anaemia. This is the most common cause of such symptoms and findings, especially in the UK. Iron deficiency leads to reduced haemoglobin synthesis, resulting in smaller and paler red cells. NICE guidelines recommend investigating for iron deficiency causes like dietary insufficiency or gastrointestinal blood loss.
Question Medium Answer: D
Question Medium Explanation: Warfarin therapy is monitored using the International Normalised Ratio (INR). An elevated INR increases the risk of bleeding, reflecting the anticoagulant effect of warfarin. According to NHS guidelines, maintaining an appropriate INR range is crucial for efficacy and safety in patients with conditions like atrial fibrillation.
Question Hard Answer: B
Question Hard Explanation: A venous Doppler ultrasound is the initial investigation of choice for suspected DVT according to NICE guidelines. It is a non-invasive and highly effective method to visualise the blood flow in the veins and detect any thrombosis. This is particularly relevant in post-operative patients where DVT risk is increased due to immobility and surgical factors.
Medical fact of the day: The UK has one of the highest rates of iron deficiency anaemia among women of reproductive age compared to other European countries. This highlights the importance of dietary education and monitoring in at-risk populations.
Quote of the day: “In every heartbeat, there lies a commitment to life; in every patient, a world of possibility. Keep the pulse of hope strong.”