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iron deficiency anemia

Practice targeted AMC-style multiple-choice questions on iron deficiency anemia.

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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Order a barium swallow study
B. Initiate high-dose proton pump inhibitor therapy
C. Referral for surgical assessment and repair
D. Perform an urgent upper endoscopy
E. Advise watchful waiting and lifestyle modifications
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old male with a history of mild dysphagia and iron deficiency anemia presents for further evaluation. He denies any recent weight loss or hematemesis. An abdominal CT scan with contrast is performed, the axial view is shown. What is the MOST likely underlying cause of his anemia?

A. Angiodysplasia
B. Cameron lesions
C. Gastric malignancy
D. Duodenal ulcer
E. Esophageal varices
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 72-year-old male presents to his general practitioner with a 3-month history of progressively worsening constipation alternating with episodes of loose stools, associated with occasional bright red blood per rectum and an unintentional weight loss of 4 kilograms over the same period. He denies any significant past medical history or family history of bowel disease. His vital signs are stable, and physical examination, including abdominal palpation and digital rectal examination, is unremarkable. Routine blood investigations reveal a haemoglobin of 105 g/L with a mean corpuscular volume of 78 fL, and normal inflammatory markers. Given the clinical presentation, a colonoscopy is performed. The image provided is a representative view obtained during this procedure. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?

A. Refer for urgent surgical resection without further investigation.
B. Obtain biopsies from the lesion and arrange for CT staging of the chest, abdomen, and pelvis.
C. Initiate a course of broad-spectrum antibiotics for presumed infectious colitis.
D. Schedule a repeat colonoscopy in 6 months to monitor the lesion's progression.
E. Prescribe a high-fibre diet and laxatives to manage the constipation.
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown CC BY-SA 3.0 · Source

A 70-year-old presents with iron deficiency anaemia and intermittent rectal bleeding. Colonoscopy was performed, and a representative image is shown. Biopsies are pending but malignancy is strongly suspected based on the endoscopic appearance. What is the MOST appropriate next investigation to guide definitive management?

A. Referral for palliative care
B. PET scan
C. Repeat colonoscopy in 3 months
D. CT scan of chest, abdomen, and pelvis
E. Endoscopic ultrasound
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Schedule regular clinical follow-up and repeat imaging in 12 months.
B. Arrange for upper gastrointestinal endoscopy with biopsies.
C. Referral for surgical assessment and repair.
D. Initiate high-dose proton pump inhibitor therapy and review in 3 months.
E. Advise dietary modification, elevation of the head of the bed, and weight loss.
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn CC BY 4.0 · Source

A 63-year-old man presents to his GP with a 6-month history of intermittent postprandial fullness and mild dysphagia, particularly with solid foods. He reports occasional regurgitation but denies significant heartburn or chest pain. His vital signs are stable, and physical examination is unremarkable. Recent blood tests show mild iron deficiency anaemia. The provided image is from a CT scan of the chest and upper abdomen performed as part of his investigation. Considering the clinical presentation and the significant anatomical finding demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Urgent upper gastrointestinal endoscopy to assess for malignancy.
B. Initiation of high-dose proton pump inhibitor therapy.
C. Prescription of iron supplements and dietary advice.
D. Barium swallow study to further characterise the anatomy.
E. Referral for surgical assessment and consideration of operative repair.
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