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Koilonychia — SCE Dermatology MCQ

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HardNail DisordersKoilonychiaSCE Dermatology

A 64-year-old man with new koilonychia has haemoglobin 92 g/L, MCV 69 fL and ferritin 5 micrograms/L. He reports no visible bleeding and has no gastrointestinal symptoms. What should accompany iron replacement?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Investigate the cause, including coeliac screening and upper and lower gastrointestinal evaluation

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

B is correct. This man has unequivocal iron-deficiency anaemia. In adult men, occult gastrointestinal blood loss, malabsorption and malignancy must be considered even without symptoms or visible bleeding. BSG guidance supports coeliac screening and, in an appropriate newly diagnosed man, bidirectional gastrointestinal investigation while iron is replaced unless there is a compelling alternative explanation or investigation is unsuitable. Age alone is not a diagnosis, thyroid testing does not address the biochemical deficiency, and waiting for pain or frank bleeding may delay detection of important pathology. Response to iron supports correction of deficiency but does not substitute for finding its cause.

Reference: British Society of Gastroenterology iron-deficiency anaemia guideline: https://gut.bmj.com/content/70/11/2030