Question Easy:
A 32-year-old woman presents with fatigue and pallor. Her blood test results indicate microcytic, hypochromic anemia. What is the most likely diagnosis? 🤔
A) Vitamin B12 deficiency
B) Iron deficiency anemia
C) Folic acid deficiency
D) Hemolytic anemia
E) Aplastic anemia
Question Medium:
A 55-year-old man with a history of deep vein thrombosis (DVT) is currently managed on warfarin. During his follow-up, his INR is found to be 5.2. He is asymptomatic with no signs of bleeding. What is the most appropriate next step in his management? 💊
A) Omit one dose of warfarin and recheck INR in 24 hours
B) Give oral vitamin K and continue with current dose
C) Increase the dose of warfarin
D) Stop warfarin permanently
E) Admit for heparin therapy
Question Hard:
A 70-year-old woman with a background of chronic atrial fibrillation presents with sudden onset chest pain and shortness of breath. A CT pulmonary angiogram confirms a large pulmonary embolism (PE). Her renal function is normal. Which of the following is the most appropriate immediate management? 🚑
A) Thrombolysis with alteplase
B) Low molecular weight heparin (LMWH)
C) Apixaban
D) Warfarin alone
E) Aspirin
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: The patient exhibits classic signs of iron deficiency anemia, including fatigue and pallor, with microcytic, hypochromic anemia on blood tests. This tends to occur due to insufficient iron needed for hemoglobin synthesis, as per NICE guidelines.
Question Medium Answer: A
Question Medium Explanation: For an asymptomatic patient with an INR between 5 and 8, current NICE guidelines recommend omitting the next warfarin dose. Warfarin should be re-evaluated when INR normalizes, as INR values above 5 increase bleeding risk.
Question Hard Answer: A
Question Hard Explanation: Given the acute nature and severity of the pulmonary embolism, with symptoms of hemodynamic instability, thrombolysis with alteplase is indicated as per NICE guidelines. This is particularly appropriate if no contraindications are present.
Medical fact of the day: Did you know? Bloodletting was once a common treatment for various ailments, including vascular disorders, until scientific advancements in the 19th century highlighted its ineffectiveness. Today, phlebotomy is useful primarily for conditions like hemochromatosis.
Quote of the day: “The heartbeat of healthcare is compassion—keeping it steady transforms ordinary moments into extraordinary care.”