A 49-year-old female is admitted to the hospital with shortness of breath and pleuritic chest pain. She also complains of loss of appetite for the past four months. Her admission CXR shows right-sided pleural effusion. An underlying malignancy is suspected and a series of tumour markers are requested, the results of which are:
CA 19-9: 36 IU/mL (<40)
CA 125: 654 IU/ml (<30)
CA 15-3: 9 IU/ml (<40)
What is the most likely underlying diagnosis?
A 50-year-old female patient is started on cyclophosphamide for vasculitis associated with Wegener’s granulomatosis. Which of the following adverse effects is most characteristically associated with cyclophosphamide use?
A 50-year-old woman is investigated for weight loss and anaemia. Clinical examination reveals splenomegaly associated with pale conjunctivae.
Her full blood count (FBC) report shows:
Hb: 10.9 g/dL
Plts: 702 x 10^9/L
WCC: 56.6 x 10^9/L
Moreover, all stages of granulocyte maturation are seen on her blood film.
Given the likely diagnosis, what should be the most appropriate treatment?
A 50-year-old woman with lung cancer develops deep vein thrombosis (DVT). She is reviewed in the hospital clinic and started on low-molecular-weight heparin (LMWH).
Which of the following should be the most appropriate treatment plan?
A 51-year-old man was admitted with right-sided hemiparesis and right upper motor neuron facial nerve palsy. He was known to be on warfarin for a mitral valve replacement and had been adequately anticoagulated. He was also taking furosemide and had recently been started on St John’s wort for low mood.
On examination, his pulse was 90 bpm and regular, and his blood pressure was 150/80 mmHg. Cardiac examination demonstrated normal prosthetic valve sounds with an ejection systolic murmur at the left sternal edge. CT scan showed evidence of a left middle cerebral artery infarction.
What is the possible explanation for the presentation?
A 52-year-old man is referred to the oncology clinic by his GP. He recently suffered a fracture of his right humerus with minimal trauma.
The results of the blood tests, taken on his arrival, prompted the referral:
Hb: 8.9 g/dL
WCC: 9.5 x 10^9/L
Plts: 140 x 10^9/L
MCV: 86 fL
ESR: 60mm/1st hour
Na+: 149 mmol/L
K+: 3.6 mmol/L
Urea: 15 mmol/L
Creatinine: 160 mmol/L
Calcium (corrected): 2.89 mmol/l
Albumin: 28g/L
Total protein: 89 g/L
X-ray of right humerus reported a possible pathological fracture. Which of the following investigations would help best in confirming the most likely diagnosis?
A 52-year-old woman is being reviewed in the oncology clinic following debulking surgery one month ago. She is a known case of primary peritoneal cancer with two liver metastases and has now come in for review prior to adjuvant chemotherapy.
During her chemotherapy, which of the following tumour markers would be the most appropriate to monitor her disease progression?
A 52-year-old woman is diagnosed as having acute myeloid leukaemia. What is the single most important test in determining her prognosis?
A 42-year-old man is a known case of Waldenström’s macroglobulinemia and is admitted to the hospital with headache, visual disturbances, pale conjunctivae, and breathlessness. While in the assessment unit, he has had an episode of nosebleed that has been difficult to control. On examination, his heart rate is 120 bpm, blood pressure is 115/65 mmHg, and he is febrile with a temperature of 37°C. Fundoscopy shows dilated retinal veins with a retinal haemorrhage in the right eye.
What is the most appropriate next step of management?
A 43-year-old man is about to be started on chemotherapy for a high-grade lymphoma. He is given intravenous rasburicase to help lower the risk of tumour lysis syndrome (TLS).
What is the mechanism of action of this drug?