Question Easy:
A 28-year-old woman presents with symptoms of fatigue, pallor, and shortness of breath on exertion. 💨 She has a history of heavy menstrual periods. Recent blood tests reveal a haemoglobin level of 94 g/L, mean corpuscular volume (MCV) of 72 fL, and ferritin level of 8 µg/L. What is the most likely diagnosis?
A) Vitamin B12 deficiency
B) Iron deficiency anaemia
C) Thalassaemia
D) Anaemia of chronic disease
E) Folate deficiency
Question Medium:
A 65-year-old man is brought to the emergency department with sudden onset of chest pain radiating to his back. He is hypertensive and has a history of smoking 🚬 and poorly controlled hyperlipidaemia. On examination, there are unequal pulses in his arms. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Tension pneumothorax
D) Aortic dissection
E) Costochondritis
Question Hard:
A 50-year-old woman presents with spontaneous bruising and a petechial rash. Her complete blood count shows a platelet count of 20 x 10^9/L, haemoglobin of 120 g/L, and white cell count of 7 x 10^9/L. Bone marrow biopsy indicates increased numbers of megakaryocytes. What is the most appropriate initial management of this patient?
A) Splenectomy
B) High-dose intravenous immunoglobulin (IVIG)
C) Oral iron supplements
D) Ruxolitinib
E) Corticosteroids
Explanations & Answers:
Question Easy Answer: B) Iron deficiency anaemia
Question Easy Explanation: The combination of fatigue, pallor, shortness of breath, microcytic hypochromic anaemia (low MCV), and low ferritin level is consistent with iron deficiency anaemia, which is common in women with heavy menstrual bleeding. NICE guidelines recommend checking for and addressing underlying causes of iron deficiency and treating with iron supplements.
Question Medium Answer: D) Aortic dissection
Question Medium Explanation: In this scenario, the sudden onset chest pain radiating to the back, along with unequal pulse pressures, is characteristic of aortic dissection. Aortic dissection is a medical emergency requiring immediate attention and is highly associated with hypertension, smoking, and hyperlipidaemia. According to NHS guidelines, rapid imaging and management of blood pressure are crucial.
Question Hard Answer: E) Corticosteroids
Question Hard Explanation: This patient’s presentation is typical of immune thrombocytopenic purpura (ITP), characterised by isolated thrombocytopenia and increased megakaryocytes in the bone marrow. The first-line treatment, per BNF guidelines, is corticosteroids to help increase the platelet count.
Medical fact of the day: Did you know that the aorta is the largest artery in the human body, and an aortic aneurysm can go unnoticed until it ruptures, posing a serious health risk? Regular screening is key, especially for high-risk groups such as older males with a history of smoking.
Quote of the day: “In the midst of healing others, find moments to heal yourself. Your well-being fuels the world’s care. 🌟”