A 68-year-old man with lung cancer is admitted to the hospital by his spouse due to experiencing peculiar symptoms. He has begun to make odd facial expressions, protrude his tongue, and struggle with speaking. Despite this, his vital signs are stable, and he appears to be cognizant of his surroundings. His wife is curious if a medication he began taking three days ago could be responsible for his condition. Which of the listed medications is the probable culprit for his symptoms?
You are requested to assess a 93-year-old man on the Geriatric Ward who has been admitted for end-of-life care after a massive intracerebral haemorrhage. He has not required any pain relief or sedation until now, but the nursing staff urgently asks you to see him as he has experienced a generalised tonic-clonic seizure with residual right-sided twitching.
Upon examination, you observe that his blood pressure is 190/98 mmHg. He is unconscious, but you notice intermittent, right-sided clonic jerks of the face and arm. His pupils are dilated bilaterally and unresponsive. Every few minutes, this seems to progress into generalised seizure activity for a brief period.
What is the most appropriate course of action?
A 54-year-old man with non-small cell lung cancer and liver metastases, as well as widespread mediastinal lymph nodes, is experiencing deep aching pain in his right thigh. He has been taking regular doses of paracetamol 1 g four times a day and MST 60 mg twice a day. Upon review of previous investigations, a large lytic lesion was found in his right femoral shaft with a corresponding area of increased uptake on isotope bone scan. Which of the following treatment options would be inappropriate for palliative care in this case?
A 65-year-old man is admitted to hospice with metastatic bowel cancer and a prognosis of days to short weeks. What factors would prompt a palliative care physician to consider offering him a blood transfusion?
A 78-year-old patient has been diagnosed with metastatic lung cancer. They are currently taking 30 mg of oral morphine sustained release twice a day and have taken 60 mg of PRN breakthrough Oramorph on each of the last three days. However, during the ward round, they complain of vomiting and difficulty keeping their medication down. The medical team decides to switch their analgesia to a diamorphine subcutaneous infusion pump. What is the appropriate dose of diamorphine to be placed in the infusion pump over 24 hours?
A 28-year-old male patient visits his family doctor after discovering a lump in his left testicle. The lump is painless and the patient is unsure how long it has been there. He has no significant medical history, except for a case of chickenpox at the age of 10. He is a moderate smoker, consuming 5 cigarettes per day.
During the examination, the doctor detects a firm, well-defined non-translucent lump (approximately 1.5 cm) attached to the left testis. After conducting laboratory tests, scrotal ultrasound is performed, revealing the presence of a homogeneous hypoechoic testicular mass. CT scanning of the abdomen and pelvis with IV and oral contrast fails to identify any metastatic disease. The patient undergoes a radical inguinal orchidectomy, and the histology report confirms a pure seminoma that was confined to the testis.
Which of the following serum tumor markers is the most specific for this diagnosis?
A 62-year-old woman complains of epigastric discomfort that radiates to her back. She is diagnosed with pancreatic cancer and undergoes an intensive course of chemotherapy. What serial measurements may suggest a recurrence or advancement of the disease?
A 20-year-old man presents to his primary care physician (PCP) with complaints of persistent lower right-sided back pain for the past few weeks. He reports that the pain has been gradually increasing in intensity. Upon further questioning, he reveals that he has lost approximately 5 kg in weight over the last month. He denies any recent travel history.
During the physical examination, a tender and palpable mass is detected over his right iliac crest. The PCP orders an urgent MRI scan and routine blood tests. The blood results show mild anemia but no leukocytosis, and C-reactive protein levels are normal. The MRI findings are consistent with a diagnosis of Ewing’s sarcoma.
Which of the following factors is most strongly associated with a poor prognosis in this patient?
As the medical doctor in charge of an acute admission unit, you receive a patient who is an elderly male with recently diagnosed ovarian cancer. He is currently on day 8 of cisplatin chemotherapy and presents with a temperature of 39°C, tachycardia at 130 bpm, blood pressure 128/68 mmHg, respiratory rate 14/min, and sats 98% on room air. The patient is complaining of abdominal pain and has been vomiting today. Bloods and blood culture have been sent and you are awaiting the results. The chest x-ray was normal and urine dipstick clear. What is the most appropriate antibiotic therapy to initiate for this patient?
A 68-year-old man came for his routine follow-up in the oncology clinic. He has metastatic poorly differentiated adenocarcinoma of unknown primary and started palliative chemotherapy with oxaliplatin and fluorouracil two months ago. His recent CT scan showed stable disease.
He was admitted to the local emergency department ten days ago with a fever and diagnosed with neutropenic sepsis, but the cause was unclear. He received IV Tazocin for five days and was discharged with co-amoxiclav and filgrastim (G-CSF). Currently, he feels well, and there are no abnormalities on examination.
His observations are as follows: saturations 95%, respiratory rate 14/min, blood pressure 152/83 mmHg, heart rate 69/min, and temperature 37.3°C. His blood tests from 14 days ago showed Hb 135g/l, platelets 322* 109/l, and WBC 0.2* 109/l. Today, his blood tests showed Hb 124g/l, platelets 285* 109/l, and WBC 23.6* 109/l.
What is the most appropriate course of action?