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?
A 27-year-old man was referred to clinic by his general practitioner due to increasing exertional dyspnoea over the past two months. He used to be physically active and jogged regularly, but now he gets breathless climbing just one flight of stairs. He has a past history of asthma and underwent an orchidopexy as a child for an undescended right testis. On examination, gynaecomastia was noted and a firm mass of 1 cm × 1 cm was found in his right testis.
The following investigations were conducted and showed abnormal results:
– Serum alpha-fetoprotein 90 kU/L (<10)
– Serum beta-human chorionic gonadotrophin 1250 U/L (<5)
What is the most likely diagnosis?
A 60-year-old woman has been admitted to the hospital due to abdominal swelling and constipation that has been progressively worsening for the past three weeks. She was referred from the gynaecology ward for further evaluation. An ultrasound of her abdomen was ordered by the gynaecological team, which revealed a large pelvic mass and gross ascites. The ascites has been drained, and the cytology report shows adenocarcinoma cells with occasional psammoma bodies. What genetic syndrome could be responsible for this patient’s condition?
A 70-year-old male presents with a two day history of pain in the lower thoracic region and he has not passed urine for 12 hours. He has a three year history of prostate carcinoma for which he has been receiving LHRH analogue therapy.
On examination, he is obviously in discomfort, appears dehydrated, has a pulse of 102 beats per minute (irregular) and a blood pressure of 108/72 mmHg. Cardiovascular and respiratory examinations are normal.
On abdominal examination he has a palpable bladder. Examination of his legs reveals bilateral weakness of ankle plantar flexion with loss of tendon reflexes.
What would be the most appropriate investigation for this man?
A 56-year-old male has a medical history of metastatic colon cancer and is currently undergoing active adjuvant chemotherapy. During his hospital admission for shortness of breath, he was diagnosed with a pulmonary embolism (PE). Despite recovering from a colectomy, the patient has not experienced any immobility or long-distance travel in the past.
What is the most appropriate treatment for this patient? It should be noted that while some centers use LMWH or DOACs, most opt for a 6-month anticoagulation treatment for DVT.
A 55-year-old man with a 35 pack year smoking history arrives at the medical admission unit after experiencing a fall at home. According to the FY1 doctor who assessed him, the patient has been noticing a gradual decline in his arm and leg strength over the past few months, along with changes in his speech and difficulty swallowing.
During the examination, the patient exhibits bilateral leg weakness that is graded 3/5, but interestingly, it seems to improve with repeated movements. Additionally, his speech is slurred, and he fails the bedside swallow assessment. A chest x-ray reveals a small area of soft tissue density in the right middle lobe.
What type of cancer is most likely causing these symptoms?
A 58-year-old man with a 35 year smoking history arrives at the medical admission unit after experiencing a fall at home. The patient has reported a gradual decline in arm and leg strength over the past few months, along with changes in speech and difficulty swallowing. Upon examination, the patient displays bilateral leg weakness graded at 3/5, which paradoxically improves with repeated movements. The patient’s speech is slurred and they fail their bedside swallow assessment. A chest x-ray reveals a small area of soft tissue density in the right middle lobe. What is the probable diagnosis?
A 55-year-old man with a history of smoking presents with haemoptysis and weight loss. Upon examination, he is found to have clubbing and clinical evidence of right pleural effusion. His serum calcium levels are elevated at 3.2 mM (2.2-2.6 mmol/L), and a bone scan shows no abnormalities. Based on these findings, what is the most likely histological type of lung cancer he is suffering from?
A 49-year-old woman is currently receiving multiple rounds of chemotherapy for breast cancer. She seeks advice from the oncology team as she experiences severe nausea and vomiting that lasts for several days, 2-3 days after chemotherapy, despite taking antiemetics during and after the treatment. What is the most suitable medication to prevent this delayed reaction?
A 67-year-old man with a history of metastatic prostate cancer to the spine and right hip presents with right jaw pain that has been ongoing for four weeks. He recently had a right lower molar dental extraction six weeks ago. The patient is currently taking Oxycontin for pain and receives monthly IV zoledronic acid. A bone scan performed one month ago showed no changes over the past six months. He is also on leuprolide for prostate cancer. On physical examination, he has a temperature of 38.0°C (100.4°F), blood pressure of 116/70 mm Hg, pulse rate of 72/min, and respiration rate of 14/min. There is swelling over his right mandible with tenderness and limited mouth opening. His recent prostate specific antigen (PSA) is undetectable. What is the most likely diagnosis?