A 49-year-old man presents to the Acute Medical Unit with lower back pain and bilateral lower limb weakness. He has a history of smoking, alcohol and recreational drug use. An urgent MRI spine is awaited. Based on his blood results, what is the most likely underlying diagnosis?
A 35-year-old woman presents with a neck mass that has been progressively worsening over the past few months. She also reports experiencing intermittent sweating and diarrhea. Her mother passed away suddenly at the age of 32 from a hypertensive cerebral hemorrhage.
During the physical examination, her blood pressure is found to be 190/96 mm Hg, and her pulse rate is 110/min. A dominant 4 cm nodule is noted on the right side of her prominent nodular thyroid.
Upon further examination, her cardiopulmonary system appears normal with a regular tachycardia and clear lungs. Her abdominal examination is also normal.
A fine-needle aspiration biopsy of the nodule reveals medullary thyroid carcinoma. What is the most appropriate next step in management?
A 55-year-old Caucasian man presents to the Oncology Clinic with a PSA value of 15 ng/ml. He has no symptoms and no significant medical history, but requested the PSA test after hearing about the Prostate Cancer Risk Management Programme (PCRMP) from a friend. A digital rectal examination (DRE) was performed by his General Practitioner (GP) and revealed a normal-sized prostate with preserved midline sulcus and no palpable nodules. What is the best course of action for management?
A 65-year-old woman presented to the emergency department with recurrent episodes of severe headache and vomiting over the past 5-6 days. She had a history of metastatic breast cancer and was receiving palliative chemotherapy. Additionally, she had type 2 diabetes mellitus and osteoarthritis of bilateral knee joints.
During examination, her pulse rate was 100/min, respiratory rate was 18/min, and blood pressure was 130/90 mmHg. Fundoscopy revealed early papilloedema.
A contrast-enhanced CT brain scan was performed, which revealed a solitary mass of 3.5 cm in the left cerebral hemisphere.
What would be the most appropriate course of action now?
A 74-year-old man with ischaemic heart disease and chronic obstructive pulmonary disease has been diagnosed with a well-differentiated small bowel neuroendocrine tumour with liver metastases. He presented with a 6-month history of diarrhoea, abdominal cramps and flushing. His observations are within normal limits, but his blood results show low haemoglobin, high ALT and ALP, and elevated levels of serum 5-hydroxyindoleacetic acid and serum chromogranin A. What is the most appropriate treatment option to improve the patient’s symptoms at this stage?
A 48-year-old woman presents to the emergency department with sudden onset of shortness of breath and pleuritic chest pain. Observations demonstrate marked hypoxia and she is given oxygen and analgesia and undergoes a chest X-ray followed by a CT pulmonary angiogram which shows a pulmonary embolism. There is also an incidental finding of a nodule suspicious of metastatic disease.
She is started on a treatment dose of low molecular weight heparin and admitted under the medical team for further assessment. During a more detailed history, she explains that she has lost one stone in weight over two months and been feeling progressively more tired as well. She denies any other symptoms. She has a past medical history of asthma and also underwent a caesarean section three years ago. She has two children, of which she breastfed both, and has a long history of use of oral contraceptive use. She is an ex-smoker of 5 pack-years and has minimal alcohol intake. Her grandfather died of prostate cancer, and her sister developed breast cancer at the age of 52.
A complete further examination was completed and no abnormalities were found. Routine blood tests are currently pending, and a flexible bronchoscopy for biopsy of the lung nodule has been arranged. How should this patient be further investigated?
A 53-year-old male presents to the emergency department with sudden onset palpitations and shortness of breath which began whilst he was watching television a few hours previously. He describes an odd fluttering sensation in his chest with mild dyspnoea but no chest pain. He denies having experienced this before. On systems review, he also complains of severe muscle cramps and a slight tremor in his hands over the last few days.
His past medical history includes hypertension and gout for which he takes amlodipine and allopurinol. He denies any history of exertional dyspnoea but does occasionally get central chest pain on exertion for which he has not sought help. He has recently been diagnosed with small cell lung cancer and underwent his first round of chemotherapy last week; although he is unsure which drugs are being used. He used to smoke a pipe until his recent diagnosis of cancer and drinks a few measures of whisky most evenings.
On examination, his respiratory rate is 22 breaths/min and his oxygen saturations are 96% breathing two litres of oxygen. His heart rate is irregularly irregular and approximately 130 beats/min, his blood pressure is 152/78 mmHg. An ECG shows atrial fibrillation with no ischaemic changes.
What is the most likely cause for his new atrial fibrillation?
A 42-year-old patient undergoing treatment for breast cancer arrives at the Day Unit with a swollen left leg. She had a right mastectomy and axillary clearance 4 months ago and is currently on her third cycle of FEC (epirubicin, cyclophosphamide and fluorouracil) chemotherapy. An ultrasound doppler reveals a deep vein thrombosis in the left popliteal vein. The patient’s renal function is within normal limits.
What is the recommended course of treatment for this patient?
A 68-year-old man comes to MAU complaining of a gradual decline in his mobility over the past five days. He has noticed a gradual reduction in his ability to walk and has experienced a few falls in the preceding weeks. He has a smoking history of 40 pack years.
During the examination, he exhibits bilateral leg weakness with power graded 3/5 and increased leg reflexes. Palpation of the spine reveals tenderness in the lower thoracic region. Abdominal examination reveals a palpable bladder up to the umbilicus, and PR examination shows reduced anal tone with a large, irregular prostate.
What is the best initial treatment?
A 50-year-old woman with a family history of breast cancer is hesitant to start taking tamoxifen as a preventative measure. However, she has recently been diagnosed with early-stage breast cancer and is now considering tamoxifen as part of her treatment plan. During her follow-up appointment, she expresses concerns about the long-term effects of tamoxifen. What advice can you offer her?