A 25-year-old female presents to the acute medical unit with several lumps in her neck and under her arms, weight loss, vomiting, and low mood. She is investigated and is found to have several areas of suspicious lymphadenopathy including in the neck, both axillae, and mediastinum. She also has multiple lesions in her liver which are confirmed to be the manifestations of Hodgkin lymphoma after biopsy.
Which stage of the disease is the patient currently at?
A 25-year-old man having sickle cell anaemia presents with headache, lethargy, and pallor. His blood count shows:
Haemoglobin: 4.6 g/dL
Reticulocytes: 3%
Infection with parvovirus is suspected. Out of the following, what is the most likely diagnosis?
A 25-year-old woman noticed an episode of passing blood instead of urine in the morning. She looks anaemic, but rest of the examination is normal. Her GP has arranged for a urological examination, which has come out to be normal as well.
What is the most likely diagnosis?
A 28-year-old man is investigated for cervical lymphadenopathy. Lymph node biopsy reveals nodular sclerosing Hodgkin lymphoma.
Which one of the following factors is associated with a poor prognosis?
A 28-year-old man is investigated for lethargy. His full blood count (FBC) report shows:
Hb: 8.6 g/dL
Plts: 42 x 10^9/L
WCC: 36.4 x 10^9/L
His blood film report reveals 30% myeloblasts with Auer rods. Given the likely diagnosis, which one of the following is associated with a good prognosis?
A 28-year-old woman presents with easy bruising. She has no history of mucosal bleeding and is generally well apart from occasional diarrhoea. She has previously attended a psychiatric unit for self-harming behaviour and is now brought in by her mother having consumed a number of pills. Her mother has had recurrent venous thromboses, but there is no family history of a bleeding disorder.
Her full blood count (FBC) is normal, but her coagulation profile shows:
Activated partial thromboplastin time (APTT): 60 secs (28-38 secs)
Prothrombin time (PT): no clot after 120 secs (10-14 secs)
Fibrinogen: 3.6 g/L (2-4 g/L)
What is the most likely explanation?
A 28-year-old woman with a history of recurrent pulmonary emboli (PE) has been identified as having factor V Leiden. How does this particular inherited thrombophilia increase her risk of venous thromboembolic events?
A 30-year-old female presents to the A&E department with epistaxis, which has now stopped. According to her boyfriend, she has a recent history of mucosal bleeding and has at times been very disorientated. On examination, she has a low-grade fever and appears confused and jaundiced. There is bruising over her legs and arms. A urine pregnancy test is negative. You receive the following blood results from the laboratory:
Hb: 8.5 g/dL
Plts: 8 x 10^9/L
WCC: 4.5 x 10^9/L
MCV: 92 fL
Na+: 138 mmol/L
K+: 4.9 mmol/L
Urea: 10.2 mmol/L
Creatinine: 182 mmol/L
Her coagulation profile is normal.
Given the likely diagnosis, what is the most appropriate management of this patient?
A 32-year-old female who is 37 weeks pregnant presents with a swollen, painful right calf. A deep vein thrombosis (DVT) is confirmed on Doppler scan.
What should be the preferred anticoagulant?
A young man complains of dyspnoea and tiredness. His blood film shows spherocytes and 6% reticulocytes. What test would you perform next?