A 32-year-old woman presents with dyspnoea and pleuritic chest pain. An elevated D-dimer and subsequent CTPA reveal a pulmonary embolism. She has a history of giving birth to her daughter 18 months ago (full term, vaginal delivery) and anxiety. Her 52-year-old mother has had two deep vein thromboses in the past 10 years. What is the most probable underlying cause?
A 32-year-old woman of Greek ethnic origin presents to her GP for investigation of anaemia. She has been feeling tired and weak for the past few weeks. Upon examination, there are no significant findings.
The following investigations were conducted:
Haemoglobin (Hb) 105 g/l 120–160 g/l
White cell count (WCC) 7.2 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 280 × 109/l 150–400 × 109/l
Mean corpuscular volume (MCV) 72 fl 76–98 fl
Haemoglobin electrophoresis reveals the following:
s
HbA 60.0% 95–98%
HbS 35.0% 0%
HbF 5.0% 1.0–2.0%
Other protein bands None seen
What is the most likely diagnosis?
A 15-year-old male was admitted with sudden onset facial swelling. The swelling started 30 minutes ago and initially involved his lips. He complained of feeling like he was choking and had difficulty speaking with hoarseness of his voice. He had a history of recurrent abdominal pain but was otherwise healthy and not taking any medication.
Upon admission, he was given prednisolone 40 mg PO and chlorpheniramine 10mg PO and was observed. However, his swelling worsened and involved his entire face. He developed severe biphasic stridor and was in respiratory distress with a respiratory rate of 34/min and an oxygen saturation of 87% on air. Auscultation of his chest revealed a widespread polyphonic wheeze. His cardiovascular system showed flushed peripheries with a bounding peripheral pulse, a pulse rate of 100 bpm, and a blood pressure of 90/70 mmHg. His GCS was 15, and neurological and abdominal examinations were unremarkable. He was immediately given intravenous colloid solution and adrenaline 0.5mg IM on three separate occasions within 10 minutes, but there was no improvement.
What is the most appropriate immediate management step while awaiting definitive airway management?
A 25-year-old female presents with complaints of fatigue. She has no significant medical history and is not on any medications. Upon conducting blood tests, the following results were obtained:
– Hemoglobin (Hb): 84g/L
– Mean Corpuscular Volume (MCV): 70fL
– White Blood Cells (WBC): 8×10^9/L
– Platelets: 460×10^9/L
Further analysis of the blood film reveals hypochromic anemia with pencil cells, target cells, acanthocytes, and Howell Jolly bodies. What is the most probable diagnosis?
A 25-year-old male who received a bone marrow transplant from his sister for acute myeloid leukaemia presents with a rash, general malaise, lethargy, and poor appetite. He reports having green-coloured diarrhoea for several weeks. His medications include cyclosporin, penicillin V, co-trimoxazole, and aciclovir. On examination, a diffuse macular rash is visible, mainly affecting the palms of the hands and soles of the feet. His pulse is 110 beats per minute and regular. Blood pressure is 105/60 mmHg. Investigations reveal abnormal blood counts and liver function tests. What is the diagnosis?
Haemoglobin: 129 g/L (130-180)
MCV: 94 fL (80-96)
White cell count: 3.65 ×109/L (4-11)
Neutrophils: 1.7 ×109/L (1.5-7)
Lymphocytes: 1.0 ×109/L (1.5-4)
Monocytes: 0.8 ×109/L (0-0.8)
Eosinophils: 0.05 ×109/L (0.04-0.4)
Basophils: 0.1 ×109/L (0-0.1)
Platelets: 147 ×109/L (150-400)
Serum albumin: 35 g/L (37-49)
Serum total bilirubin: 50 µmol/L (1-22)
Serum alanine transferase: 35 U/L (5-35)
Serum alkaline phosphatase: 120 U/L (45-105)
Serum gamma glutamyl transferase: 35 U/L (4-35)
A 35-year-old female patient presents with acute cholecystitis and imaging reveals the presence of gallstones. Her full blood count shows a hemoglobin level of 104 g/L, reticulocytosis, and a blood film displaying numerous spherocytes. The direct Coombs’ (DAT) test is negative. Upon further questioning, the patient reveals that her mother had a splenectomy due to anemia. What is the probable diagnosis?
A previously healthy 67-year-old male patient is referred to the general medical clinic by his GP. He is experiencing pain in multiple areas, including his upper arm, neck, and legs, which has worsened over several months despite taking various analgesics such as paracetamol, codeine phosphate, and ibuprofen. Additionally, he has become increasingly short of breath.
After conducting a full workup, the following results were obtained:
– Hb: 9.4 g/dl
– Platelets: 174 * 109/l
– WBC: 8.4 * 109/l
– Na+: 136 mmol/l
– K+: 4.7 mmol/l
– Urea: 8.4 mmol/l
– Creatinine: 125 µmol/l
– Corrected calcium: 2.9mmol/l
– Albumin: 34g/L
– Kappa light chains detected
– Lambda light chains absent
– IgG elevated
– IgA normal
– IgM normal
– Urine Bence Jones proteins detected
– Skeletal survey revealed multiple osteolytic lesions throughout the axial skeleton, including on the right humerus, thoracic spine, and both femurs.
What tests are most relevant for staging the presumed diagnosis?
A 29-year-old woman presents to the emergency department with abdominal pain, fatigue, and lethargy. She is currently 36 weeks pregnant.
Her blood results show:
– Hb 60 g/L (Female: 115-160 g/L)
– Platelets 190 * 10^9/L (150-400 * 10^9/L)
– WBC 9.2 * 10^9/L (4.0-11.0 * 10^9/L)
The obstetrics registrar advises you to arrange a blood transfusion. What specific red cell requirements should be considered for this patient?
A 19-year-old female presents to the emergency department with a two-week history of right upper quadrant pain and longstanding pain in her right femur. She recently returned from a trip to Tanzania. On examination, she has mild tenderness in the right upper quadrant, hepatomegaly, splenomegaly, and conjunctival pallor. Her blood work shows anemia, thrombocytopenia, and elevated LDH. An ultrasound reveals massive splenomegaly and hepatomegaly, while an x-ray of the right femur shows an Erlenmeyer flask deformity. What is the most likely diagnosis?
A 50-year-old man is referred by his GP to the haematology clinic with a four-week history of night sweats and early satiety. He reports feeling unwell for some time, but had attributed it to the added stress of his recent promotion as a managing director. On examination, there is a fullness in the left upper quadrant and widespread small volume lymphadenopathy. Blood tests reveal lymphocytosis with smudge cells and a bone marrow biopsy confirms diffuse growth pattern lymphocytosis. Chromosomal analysis is performed to guide further management. Which of the following findings on the analysis would suggest a poor prognosis?