Some of the clinical statements below are true, and some are not. Can you distinguish the facts from the fibs on microcytosis, foot drop and gonorrhea?
1. An incidental finding of microcytosis
True / False
a) Most often signifies iron deficiency anemia in an adult.
b) Most often signifies thalassemia syndrome in a child under 18.
c) May also signify lead toxicity, anemia of chronic disease, or sideroblastic anemia.
d) Ferritin is the indicated first investigation in microcytosis, with low ferritin generally indicating iron deficiency anemia.
e) Low total iron-binding capacity also generally points to iron deficiency anemia.
f) Iron deficiency can’t be excluded by high ferritin alone, but is unlikely when ferritin level is > 30 ng per mL (30 ug/L).
g) Restless legs syndrome is a symptom associated with iron deficiency.
h) Low ferritin is diagnostic of iron deficiency if under 12 µg/L in an adult or under 15 µg/L in a child.
i) A trial of iron supplementation is useful in suspected iron deficiency anemia, but thalassemia must be excluded first as hemochromatosis may result.
j) Iron supplementation should not be given when bacterial infection is suspected.
2. Foot drop
True / False
a) May also be referred to as drop foot.
b) Is a painful condition in which dorsiflexion is impaired.
c) Is generally related to muscle injury or wasting in the lower leg.
d) The commonest causes are L5 nerve root and peroneal (also known as common fibular) nerve damage.
e) When L5 root is involved, it’s usually due to spinal disc herniation.
f) Charcot–Marie–Tooth disease is a common hereditary cause.
g) Foot drop is often seen in diabetes and multiple sclerosis.
h) Charcot foot is a form of foot drop.
i) If peripheral nerve injury is implicated, surgery is needed swiftly to prevent the foot drop becoming permanent.
True / False
a) Sore throat is a common symptom.
b) Women are more likely to be asymptomatic, or to have mild or nonspecific symptoms.
c) Symptoms often take longer to appear in women than in men.
d) After decades of decline, gonorrhea rates have been rising sharply in Canada for several years.
e) Health Canada has argued that improvements in AIDS therapy have made young people less scared of the consequences of unprotected sex.
f) Meningitis is a possible complication.
g) Pregnant women can pass gonorrhea to their baby during pregnancy or delivery.
h) Antibiotic resistance is growing fast, and last year, the first strains were identified that were resistant to ceftriaxone.
1. Microcytosis: a) True; b) False, it’s still iron deficiency anemia; c) True; d) True; e) False, high TIBC suggests IDA; f) False, IDA is unlikely when ferritin > 100 µg/L; g) True; h) False, it’s 12 in a child, 15 in an adult; i) True; j) True.
2. Foot drop: a) True; b) False, it’s not usually painful; c) False, muscle damage is a rare cause; d) True; e) True; f) True; g) True; h) False, Charcot foot is due to bone fractures; i) False, it’s normal to allow a year or two for natural recovery and resort to surgery only if there’s no improvement.
3. Gonorrhea: a) True; b) True; c) False, they are more likely to be delayed in men; d) True; e) True; f) True; g) True; h) True.
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