A 28-year-old woman presents to her general practitioner after suffering from several miscarriages and is afraid her husband will leave her. The patient gave the history of bruising even with minor injuries and several spontaneous miscarriages. On examination, the patient is noted to have a rash in a butterfly distribution on the nose and cheeks. Tests reveal 1+ proteinuria only.
What is the most likely cause of her main concern?
In a 71-year-old man who is asymptomatic and attending clinic for an annual review, a full blood count result shows a mild lymphocytosis of 15 × 109/l with a few smear cells. What is the most crucial investigation to determine a diagnosis of chronic lymphocytic leukaemia (CLL)?
Which autoantibody is correctly matched with its associated disease in the following list?
A 15-year-old girl presents to the clinic with her mother, reporting an increase in abdominal size and no menstrual periods for the past three months. Despite denying any sexual activity, you suspect she may be pregnant. What is the specific measurement of a urinary pregnancy test?
A patient who is seen in the Renal Outpatient Department for glomerulonephritis presents to the Emergency Department with a swollen, erythematosus right leg with a 4-cm difference in circumference between the right and left leg. Routine blood tests show:
Investigation Result Normal value
Sodium (Na+) 143 mmol 135–145 mmol/l
Potassium (K+) 4.2 mmol 3.5–5.0 mmol/l
Urea 10.1 mmol 2.5–6.5 mmol/l
Creatinine 120 μmol 50–120 µmol/l
eGFR 60ml/min/1.73m2
Corrected calcium (Ca2+) 2.25 mmol 2.20–2.60 mmol/l
Bilirubin 7 μmol 2–17 µmol/l
Albumin 32 g/l 35–55 g/l
Alkaline phosphatase 32 IU/l 30–130 IU/l
Aspartate transaminase (AST) 15 IU/l 10–40 IU/l
Gamma-Glutamyl transferase (γGT) 32 IU/l 5–30 IU/l
C-reactive protein (CRP) 15 mg/l 0–10 mg/l
Haemoglobin 78 g/l
Males: 135–175 g/l
Females: 115–155 g/l
Mean corpuscular volume (MCV) 92 fl 76–98 fl
Platelets 302 x 109/l 150–400 × 109/l
White cell count (WCC) 8.5 x 109/l 4–11 × 109/l
Which of the following should be commenced after confirmation of the diagnosis?
Which structure, containing both white and red pulp, is responsible for trapping foreign substances present in the blood?
A 67-year-old man presented with fever and body ache for 6 months. His blood tests revealed a haemoglobin level of 110 g/l and erythrocyte sedimentation rate (ESR) of 121 mm in the first hour. Serum protein electrophoresis revealed an M band in the gamma globulin region with a total IgG level of 70 g/l. Bone marrow biopsy shows plasma cells in the marrow of 11%. A skeletal survey reveals no abnormalities. Other blood tests revealed:
Test Parameter Normal range
Calcium 2.60 mmol/l 2.20–2.60 mmol/l
Creatinine 119 μmol/l 50–120 μmol/l
Phosphate 1.30 mmol/l 0.70–1.40 mmol/l
Potassium (K+) 4.6 mmol/l 3.5–5.0 mmol/l
Lactate dehydrogenase 399 IU/l 100–190 IU/l
His body weight was 80 kg.
What is his condition better known as?
A 65-year-old African-American has marked left-sided weakness and an expressive aphasia. He is diagnosed with a stroke. Blood results show the following:
Investigation Result Normal value
Haemoglobin (Hb) 90 g/l 135–175 g/l
Platelets 80 × 109/l 150–400 × 109/l
calcium 3.80 mmol/l 2.20–2.60 mmol/l
creatinine 128 µmol/l 50–120 µmol/l
Which investigation is likely to reveal the cause of this man’s stroke?
A 67-year-old man was admitted with pain in the left groin. He had fallen from his chair, after which the pain started. He was unable to walk and his left leg was externally rotated. X-rays revealed a neck of femur fracture. He lives alone in a flat and is a vegetarian. His past medical history includes shortness of breath, body itching and occasional swelling of legs. His blood tests revealed:
Investigation Result Normal range
Haemoglobin 120 g/l 135–175 g/l
Calcium 3.5 mmol/l 2.20–2.60 mmol/l
Phosphate 1.52 mmol/l 0.70–1.40 mmol/l
Erythrocyte sedimentation rate (ESR) 184 mm/h 0–15 mm/h
What is the most likely diagnosis?
A 70-year-old man presents with increasing shortness of breath on exertion. He also notes he has been bruising more easily of late. He is noted to be in sinus tachycardia but otherwise is haemodynamically stable. Examination reveals conjunctival pallor and hepatosplenomegaly. No definite lymphadenopathy is palpable. A full blood count is performed:
Investigation Result Normal value
Haemoglobin 69 g/l 135–175 g/l
White cell count (WCC) 0.7 × 109/l 4.0–11.0 × 109/l
Platelets 14 × 109/l 150–400 × 109/l
Blood film is reported as a leukoerythroblastic picture with teardrop-shaped erythrocytes. A bone marrow aspirate is attempted, but this is unsuccessful.
What is the likely diagnosis?