Question Easy:
A 45-year-old woman presents to her GP with fatigue and pallor. Blood tests reveal microcytic, hypochromic anemia. What is the most likely cause of her condition?
A) Vitamin B12 deficiency
B) Iron deficiency
C) Folic acid deficiency
D) Sickle cell anemia
E) Hemolytic anemia
Question Medium:
A 52-year-old man with a history of hypertension is found to have a deep vein thrombosis (DVT) in his left leg. He is started on anticoagulation therapy. Which of the following is the preferred initial anticoagulant for the treatment of DVT as per NICE guidelines?
A) Warfarin
B) Low molecular weight heparin
C) Aspirin
D) Rivaroxaban
E) Clopidogrel
Question Hard:
A 68-year-old woman presents to the emergency department with shortness of breath and pleuritic chest pain. She has a history of atrial fibrillation and is on warfarin. Her INR is 3.5. A CT pulmonary angiogram confirms a pulmonary embolism (PE). What is the next step in management according to NICE guidelines?
A) Increase the dose of warfarin
B) Switch to low molecular weight heparin
C) Administer thrombolysis
D) Start oral rivaroxaban
E) Begin IV unfractionated heparin
Explanations & Answers:
Question Easy Answer: B) Iron deficiency
Question Easy Explanation: The patient’s presentation of fatigue and pallor, along with microcytic, hypochromic anemia, is classic for iron deficiency anemia. This is often due to chronic blood loss, such as from menorrhagia or gastrointestinal bleeding. According to NICE guidelines, iron deficiency anemia should be confirmed with low serum ferritin levels, and treatment includes oral iron supplementation.
Question Medium Answer: D) Rivaroxaban
Question Medium Explanation: According to NICE guidelines, for the initial treatment of DVT in adults, direct-acting oral anticoagulants such as rivaroxaban or apixaban are recommended over warfarin or low molecular weight heparin. These medications do not require monitoring of INR and have a more predictable pharmacological profile.
Question Hard Answer: C) Administer thrombolysis
Question Hard Explanation: Given the patient’s elevated INR, it is clear she is adequately anticoagulated. The presence of a significant pulmonary embolism with pleuritic chest pain suggests a high-risk situation. According to NICE guidelines, systemic thrombolysis is indicated for massive PE with hemodynamic instability.
Medical fact of the day: Did you know that the UK has one of the highest incidences of venous thromboembolism in Europe, estimated at 1 in 1000 of the population per year? This highlights the importance of thromboprophylaxis in at-risk patients.
Quote of the day: “In the tapestry of healthcare, every caring gesture is a thread that strengthens the fabric of society.”