Question Easy:
A 25-year-old woman presents with fatigue, pallor, and difficulty concentrating. Her blood test shows a haemoglobin level of 9 g/dL and a mean corpuscular volume (MCV) of 72 fL. Which of the following is the most likely diagnosis? 🩺
A) Vitamin B12 deficiency
B) Sickle cell anaemia
C) Iron deficiency anaemia
D) Thalassaemia
E) Chronic disease anaemia
Question Medium:
A 58-year-old man with a history of hypertension and type 2 diabetes presents with calf pain when walking, which is relieved by rest. What is the most appropriate initial investigation to confirm the suspected diagnosis? 🚶♂️
A) MRI of the lumbar spine
B) Ankle-brachial pressure index (ABPI) measurement
C) Venous duplex ultrasound
D) CT angiography
E) Doppler ultrasound of the arteries
Question Hard:
A 45-year-old woman with a history of recurrent deep vein thrombosis is found to have a prolonged activated partial thromboplastin time (aPTT) that does not correct with a mixing study. Which of the following is the most likely underlying disorder? 🔬
A) Antithrombin deficiency
B) Protein C deficiency
C) Factor V Leiden
D) Lupus anticoagulant
E) Vitamin K deficiency
Explanations & Answers:
Question Easy Answer: C) Iron deficiency anaemia
Question Easy Explanation: The combination of microcytic anaemia (low MCV) and low haemoglobin is most commonly due to iron deficiency anaemia. This aligns with NICE guidelines which suggest considering iron deficiency in young women presenting with these symptoms.
Question Medium Answer: B) Ankle-brachial pressure index (ABPI) measurement
Question Medium Explanation: Intermittent claudication (calf pain relieved by rest) is suggestive of peripheral arterial disease. An ABPI measurement is a simple, non-invasive test to confirm this, as recommended by NICE.
Question Hard Answer: D) Lupus anticoagulant
Question Hard Explanation: A prolonged aPTT that does not correct with a mixing study indicates the presence of an inhibitor, such as a lupus anticoagulant, associated with antiphospholipid syndrome known for causing thrombosis. NICE provides guidance on testing for antiphospholipid syndrome in patients with unexplained clotting issues.
Medical fact of the day: Did you know that the ankle-brachial pressure index (ABPI) is a simple bedside test used to diagnose peripheral arterial disease, and its values can indicate the severity of the condition? This test is crucial for early diagnosis and proper management, reducing the risk of severe complications in the UK.
Quote of the day: “In the tapestry of healthcare, every thread of compassion weaves a fabric of hope and healing.”