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Stable Angina Management — UKMLA MCQ

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MediumCardiologyStable Angina ManagementUKMLAMRCGP AKTPARAMRCP Part 1PSA

A 66-year-old man has taken metformin for 9 years. He reports new bilateral pins and needles, and vitamin-B12 deficiency is suspected despite a normal haemoglobin and mean cell volume. Metformin remains tolerated and is not otherwise contraindicated. Which management sequence most closely follows current MHRA advice?

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Correct answer: C — Test serum vitamin B12 now; if deficiency is confirmed, give corrective treatment in line with current clinical guidance and continue metformin

C is correct. New-onset neuropathic symptoms are an MHRA example of suspected vitamin-B12 deficiency, so serum vitamin B12 should be tested now even when the full blood count is normal. If deficiency is confirmed, corrective treatment should be given in line with current clinical guidance. Metformin should continue for as long as it is tolerated and not contraindicated, including while vitamin-B12 levels are being corrected. A confuses periodic monitoring of an at-risk patient with the diagnostic testing required when deficiency is suspected; normal haematological indices do not cancel the symptom-triggered advice. B reverses the required sequence and unnecessarily stops metformin before testing. D correctly initiates testing but incorrectly makes metformin withdrawal a prerequisite for vitamin-B12 treatment. E omits the advised diagnostic test and invents a temporary metformin dose reduction not specified by the MHRA.

Reference: MHRA Drug Safety Update, “Metformin and reduced vitamin B12 levels: new advice for monitoring patients at risk”, published 20 June 2022: https://www.gov.uk/drug-safety-update/metformin-and-reduced-vitamin-b12-levels-new-advice-for-monitoring-patients-at-risk