A 45-year-old male patient who was initially investigated for having an abdominal mass is diagnosed as having Burkitt lymphoma. He is due to start chemotherapy today.
Which one of the following should be given prior to his chemotherapy in order to reduce the risk of tumour lysis syndrome?
A 45-year-old woman who is being treated for Hodgkin’s lymphoma with ABVD chemotherapy is reviewed on the haematology ward.
Six days ago, she was admitted with a fever of 38.9°C and was immediately started on piperacillin + tazobactam (Tazocin). Her blood picture on arrival was as follows:
Haemoglobin: 10.1 g/dL
Platelets: 311 x 10^9/L
White cell count: 0.8 x 10^9/L
Neutrophils: 0.35 x 10^9/L
Lymphocytes: 0.35 x 10^9/L
After 48 hours, she remained febrile and tachycardic. Tazocin was stopped and meropenem in combination with vancomycin was prescribed.
She still remains unwell today with a temperature of 38.4°C, heart rate of 96 bpm, and blood pressure of 102/66 mmHg. Respiratory examination is consistently unremarkable and blood and urine cultures have failed to show any cause for the fever.
Which of the following is the most appropriate next step of management?
A 46-year-old man presents with a swollen, red, and painful left calf. He does not have a history of any recent surgery or a long-haul flight. He is generally fit and well and takes no regular medication other than propranolol for migraine prophylaxis. There is also no history of venous thromboembolism (VTE) in his family.
The patient is referred to the deep vein thrombosis (DVT) clinic where he is diagnosed with a proximal DVT in his left calf. Following the diagnosis, he is started on low-molecular-weight heparin (LMWH) whilst awaiting review by the warfarin clinic.
Other than commencing warfarin, what further action, if any, is required?
A 34-year-old man who is HIV positive has started treatment for Burkitt lymphoma. His chemotherapy regime includes cyclophosphamide, vincristine, methotrexate, and prednisolone. After one day of starting chemotherapy, he becomes confused and complains of muscle cramps in his legs.
Which one of the following is most likely to have occurred?
A 34-year-old Nigerian woman who is a known case of sickle cell anaemia presents with fever and worsening of recurrent back pain. There is no history of weight loss or night sweats.
The investigations done on her arrival show:
Hb: 7.8 g/dL
WCC: 10.1 x10^9/L
Plts: 475 x10^9/L
Reticulocytes: 12%
Serum total bilirubin: 88 μmol/L
What is the most likely diagnosis?
A 34-year-old woman is admitted to the hospital with a one-week history of dark urine and fatigue. One day before admission, she developed severe abdominal pain and abdominal distension.
On examination, she has pallor, jaundice, an enlarged tender liver, and ascites. Her investigations show:
Hb: 7.9 g/dL
WCC: 3.2 x 10^9/L
Plts: 89 x 10^9/L
MCV: 101 fL
Peripheral smear: Mild polychromasia
AST: 144 U/L
ALT: 130 U/L
Bilirubin: 54 μmol/L
Urine hemosiderin: ++
Urine urobilinogen +
Abdominal ultrasound reveals an enlarged liver, ascites, and absent flow in the hepatic veins.
Which single test would you request to confirm the underlying diagnosis?
A 35-year-old female has a strong family history of cancer. Out of the following, which cancer is least likely to be inherited?
A 35-year-old man who has haemophilia B with associated arthropathy presents with a large swollen right knee, after playing football with his son. He is unable to bear weight on the affected knee joint.
What should be the most appropriate first step of treatment?
A 35-year-old woman is referred to the oncology clinic by a general surgeon. She has undergone mastectomy for carcinoma of the right breast.
Out of the following, which factor is associated with a poor prognosis in patients with breast cancer?
A 4-year-old boy is admitted to the hospital after developing hemarthrosis in his right knee whilst playing in the garden.
Following blood results are obtained:
Plts: 220 x 10^9/L
PT: 11 secs
APTT: 76 secs
Factor VIIIc activity: Normal
What is the most likely diagnosis?