Question Easy:
A 25-year-old woman presents with fatigue, pallor, and shortness of breath. Blood tests reveal a haemoglobin level of 9 g/dL, a mean corpuscular volume (MCV) of 70 fL, and serum ferritin of 10 µg/L. What is the most likely diagnosis?
A) Vitamin B12 deficiency
B) Iron deficiency anaemia
C) Aplastic anaemia
D) Thalassaemia
E) Sickle cell anaemia
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: Iron deficiency anaemia is characterised by a low haemoglobin level, microcytic (low MCV), and hypochromic red cells. Low serum ferritin confirms depleted iron stores. This condition is common, particularly among young women due to menstrual blood loss and suboptimal dietary intake (NICE guidelines).
Question Medium:
A 45-year-old man presents with swelling, pain, and redness in his left calf for the past two days. He has recently undergone left knee replacement surgery. On examination, his left calf is tender and there is noticeable pitting oedema. What is the most appropriate initial diagnostic test?
A) D-Dimer test
B) Venous ultrasound
C) MRI of the lower limb
D) CT angiography
E) X-ray of the left leg
Explanations & Answers:
Question Medium Answer: B
Question Medium Explanation: Given the history and clinical presentation suggestive of deep vein thrombosis (DVT), a venous ultrasound is the initial diagnostic test of choice. It is non-invasive and highly sensitive and specific for detecting DVT (NICE guidelines).
Question Hard:
A 68-year-old woman with a history of hypertension, diabetes, and hyperlipidaemia presents with sudden onset chest pain radiating to the back. She is sweaty and appears in distress. BP is 210/120 mmHg. An ECG shows left ventricular hypertrophy. What is the next most appropriate investigation to confirm the diagnosis?
A) Chest X-ray
B) Echocardiogram
C) Troponin levels
D) CT aortogram
E) Coronary angiography
Explanations & Answers:
Question Hard Answer: D
Question Hard Explanation: The clinical presentation is suggestive of an aortic dissection, particularly given the severe hypertension and chest pain radiating to the back. A CT aortogram is the investigation of choice to confirm and assess the extent of the dissection (NHS guidelines).
Medical fact of the day: Did you know that the prevalence of iron deficiency anaemia in the UK is significantly higher in females, especially those of reproductive age? Approximately 23% of women aged 19-64 are thought to be affected by iron deficiency, highlighting the need for regular screening and dietary management (NHS, NICE guidelines).
Quote of the day: “In the quiet moments, remember why you chose to heal. The heart behind the stethoscope is as important as the mind behind the knowledge.”