FCP2-702
A patient develops methemoglobinemia after being prescribed isosorbide mononitrate. Which enzyme is most likely to be deficient?
FCP2 Category: Haematology & Oncology
FCP2-703
A woman is prescribed docetaxel as part of her chemotherapy for breast cancer. What is the mechanism of action of docetaxel?
FCP2-697
A 72-year-old man, following a fall at home, presents to his GP with acute localised chest pain, associated chronic postural lower back pain and chronic fatigue. On examination, he appears mildly anaemic and dehydrated, and has bruises over his arms and legs despite denying previous trauma. Furthermore, he has marked tenderness over his left lower rib cage, compatible with injured ribs, and tenderness over his lower lumbar spine. The rest of his clinical examination is normal.
In order to establish a diagnosis of multiple myeloma, based on the patient’s symptomatology, which of the following combination of criteria is required?
FCP2-698
A 74-year-old man with longstanding Waldenström’s macroglobulinemia presents to the rheumatology clinic with joint pain and generalised weakness.
Which of the following would be most indicative of type I cryoglobulinemia?
FCP2-699
A 76-year-old lady with known carcinoma of the caecum, was admitted to the hospital for right hemicolectomy. She had a history of osteoarthritis for which she was taking nonsteroidal anti-inflammatory agents (NSAIDs), intermittently. Two years ago, she had a fibroma removed from her right breast as well. The patient was a non-smoker and drank approximately 8 units of alcohol per week.
Investigations carried out pre-operatively showed:
Hb: 10.8 g/dL
MCV: 75 fL
WCC: 8.4 x10^9/L
Plts: 402 x10^9/L
The surgery remained uncomplicated, and she was given two units of packed red blood cells postoperatively. Three days later, she has now become jaundiced and complains of fatigue.
Her blood count now shows:
Hb: 7.2 g/dL
MCV: 110 fL
WCC: 9.5 x10^9/L
Plts: 395 x10^9/L
Which of the following is the best investigation to confirm the diagnosis?
FCP2-700
A 77-year-old female who is a known to have COPD and metastatic lung cancer is admitted with increasing shortness of breath. Following discussion with her family, it is decided to withdraw active treatment including fluids and antibiotics as the admission likely represents a terminal event. Two days after admission, she becomes agitated and restless.
What is the most appropriate management for her agitation and confusion?
FCP2-694
A 67-year-old man who has terminal lung cancer and is taking morphine slow release tablet (MST) 60mg bd as an analgesic, is reviewed. Recently, he has been unable to take medications orally and, thus, a decision has been made to set up a syringe driver.
Out of the following, what dose of diamorphine should be prescribed for the syringe driver?
FCP2-695
A 70-year-old male patient presents to the urology clinic with a one-month history of passing frank haematuria. Flexible cystoscopy shows a mass of the bladder wall and biopsy reveals transitional cell carcinoma.
Out of the following, which industry has he most likely worked in?
FCP2-696
A 72-year-old man is referred to the haematology department with raised haemoglobin and platelet levels. A diagnosis of polycythaemia vera is suspected.
Which other abnormality of the blood would be most consistent with this diagnosis?
FCP2-681
A 60-year-old man has been admitted with dehydration following an attack of gastritis. His initial blood results revealed raised calcium and erythrocyte sedimentation rate (ESR). He has a history of hypertension, angina, chronic obstructive pulmonary disease (COPD), and diabetes.
His most recent results have arrived on the ward, showing:
Hb: 13.8 g/dL
WCC: 7.7 x 10^9/L
Plts: 212 x 10^9/L
Na+: 138 mmol/L
K+: 4.7 mmol/L
Ca+2: 2.4 mmol/L
Urea: 7.2 mmol/L
Creatinine: 104 mmol/L
Albumin: 38 g/L
IgG: 24 g/L (6.0-13.0)
IgA: 2.1 g/L (0.8-3.0)
IgM: 1.3 g/L (0.4-2.5)
Trace amounts of Bence Jones protein have also been detected in the urine. CXR shows normal heart and mediastinal contours, clear lungs bilaterally, osteopenia of the bony skeleton with no lytic lesions.
What is the most likely diagnosis?