A 38-year-old woman of Afro-Caribbean origin presents to the Oncology Clinic under the 2-week-wait pathway. She has been noticing some lumps on her neck that are classified as painless, nontender, asymmetrical lymphadenopathy. She complains of increasing night sweats and has noticed some pain when drinking alcohol.
Given the likely diagnosis, which one of the following features is associated with a poor prognosis?
A 65-year-old man who works as a pipe lagger is referred to you with a 6-month history of increasing shortness of breath and weight loss. He is a lifelong non-smoker and has always led a fit, healthy life. Clinical examination indicates a left pleural effusion, which is confirmed on the chest radiograph. Which of the following malignant causes is most likely? Select the SINGLE malignant cause from the list below. Select ONE option only.
An 85-year-old man complains of increasing back pain and overall weakness. An X-ray of his back reveals multiple vertebral collapses and lytic lesions.
What is the most probable diagnosis?
A 50-year-old woman, who is currently four weeks into a course of postoperative radiotherapy for locally advanced cervical carcinoma, is admitted with abdominal pain and diarrhoea.
Which of the following is the most likely cause of the clinical picture?
A 68-year-old woman presents to her General Practitioner to discuss some recent blood tests which were taken for tri-monthly monitoring of her methotrexate. She has rheumatoid arthritis (RA) and takes methotrexate, folic acid and co-codamol.
Investigations:
Investigation Result Normal value
Haemoglobin 91 g/l 115–165 g/l
White cell count (WCC) 5.2 × 109/l 4.0–11.0 × 109/l
Platelets 228 × 109/l 150–400 × 109/l
Neutrophils 5.4 × 109/l 2.0–7.5 × 109/l
Mean corpuscular volume (MCV) 96 fl 85–105 fl
Mean corpuscular haemoglobin (MCH) 29 pg 27–32 pg
Sodium 138 mmol/l 135–145 mmol/l
Potassium 4.1 mmol/l 3.5–5.3 mmol/l
Urea 3.2 mmol/l 2.5–7.5 mmol/l
Creatinine 68 µmol/l 53–100 µmol/l
Estimated glomerular filtration rate > 90 ml/min per 1.73m2 > 90 ml/min per 1.73m2
What is the most likely cause of this patient’s anaemia?
A 70-year-old retired car mechanic who is a smoker is diagnosed with lung cancer. Some fifteen years ago he was treated with surgery and adjuvant chemotherapy for bladder cancer. His brother had oesophageal cancer aged 66 and another brother had prostate cancer in his 70s. His 55-year-old daughter was recently diagnosed with breast cancer.
Which of the following is the most likely explanation for the cancers in your patient?
A 25-year-old woman presents to the antenatal clinic for her booking visit. She speaks very little English and is 20 weeks’ pregnant in her first pregnancy. No medical history of note can be obtained.
Investigations:
Investigation Result Normal values
Haemoglobin (Hb) 101 g/l 115–155 g/l
Haematocrit 38% 40–54%
Red blood cell count (RBC) 5.24 × 1012/l 4.0–5.0 × 1012/l
Mean corpuscular volume (MCV) 63 fl 80–100 fl
Mean corpuscular Hb (McHb) 20 pg 27–32 pg
Mean corpuscular Hb concentration 32 g/dl 32–36 g/dl
White cell count (WCC) 6.9 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 241 × 109/l 150–400 × 109/l
Foetal Hb (HbF) 0.6% < 1%
Haemoglobin A2 (HbA2) 4.5% 1.5–3.5%
Which of the following is the most likely cause of her anaemia?
A 32-year-old patient who is a vegan and very active has been experiencing fatigue and difficulty breathing for the past two months. During examination, she appears to be anaemic.
What is the most probable vitamin deficiency causing her anaemia?
A 60-year-old patient presents with jaundice and an enlarged, nodular liver. A CT scan of the abdomen reveals a cirrhotic liver with a large mass, and CT-guided biopsy of the mass confirms a malignant tumour derived from hepatic parenchymal cells. Which virus is most likely directly related to the development of this tumour?
A 72-year-old man presents to the Haematology Clinic with symptoms of bone pain and anaemia. The medical team suspects multiple myeloma (MM) and orders a set of blood tests, including a full blood count, urea, serum creatinine and electrolytes, serum calcium, albumin, serum protein electrophoresis, serum-free light-chain assay, and serum beta-2 microglobulin. The team also plans to perform an imaging investigation to look for osteolytic lesions. What initial scan should be ordered?