A 38-year-old man presents to the infertility clinic with a low sperm count and suspected left varicocele, as noted by his GP. He also has a history of hypertension treated with ramipril and has been experiencing night sweats intermittently over the past few months. His FBC shows anaemia and his ESR is markedly raised. Additionally, haematuria is present on urinalysis. What is the most likely diagnosis for this clinical presentation?
A 45-year-old man presents to his General Practitioner with a past medical history of type 2 diabetes and a newly diagnosed non-alcoholic fatty liver disease. He has significantly changed his diet and has been reading a lot about liver disease. He realises that he is at increased risk of hepatocellular carcinoma (HCC) due to his liver disease and wanted to know what can be done to monitor him for HCC.
How is HCC screened for in high-risk patients?
A 45-year-old woman with a 30-pack-year history of smoking visits her General Practitioner with complaints of dark urine, nausea and overall weakness. She reports experiencing a seizure and was admitted to the hospital where she was diagnosed with a ‘hormone tumor’. What is the most probable diagnosis?
A 47-year-old man is seen by his General Practitioner for his annual hypertension review. He agrees to be referred to the local smoking cessation service, as he is currently experiencing chest pain.
Which of the following medications will need to be monitored closely on cessation of smoking?
A 32-year-old patient presents with a month-long fever and occasional afebrile episodes. Blood cultures and infection screening have yielded negative results. During examination, the patient has a temperature of 38°C and nontender lymph nodes in the neck. What is the most crucial step in reaching a diagnosis?
A 45-year-old woman, who is a non-smoker, presents with back pain. A bone scan shows multiple lesions highly suggestive of metastases. Clinical examination is normal apart from unilateral axillary lymphadenopathy. Excision biopsy of an affected lymph node shows adenocarcinoma.
Which of the following investigations should be prioritised to find the site of the primary?
A 32-year-old woman presents to her General Practitioner with a 1-week history of epistaxis and bleeding gums. She recently recovered from influenza and has a history of hypothyroidism for which she takes levothyroxine. On examination, she has multiple bruises and petechiae over her lower limbs and trunk. Her investigations reveal a low platelet count and normal coagulation parameters. What is the most likely diagnosis?
A 35-year-old woman presents to her General Practitioner complaining of fatigue and lack of energy. She has a 1-year history of heavy menstrual bleeding with excessive blood loss. She is clinically anaemic.
Investigations:
Investigation Result Normal value
Haemoglobin (Hb) 102 g/l 115–155 g/l
Haematocrit 28% 36–47%
Mean corpuscular volume (MCV) 70 fl 80–100 fl
Mean cell haemoglobin (MCH) 25 pg 28–32 pg
Mean corpuscular haemoglobin volume (MCHC) 300 g/l 320–350 g/d
White cell count (WCC) 7.5 × 109/l 4.0–11.0× 109/l
Platelets (PLT) 400× 109/l 150–400× 109/l
What is the most appropriate dietary advice for this patient?
Select the SINGLE advice option from the list below.
A 25-year-old woman comes to the General Practitioner complaining of pallor, fatigue, weakness, palpitations and dyspnoea on exertion. Her symptoms have developed rapidly over the past two weeks. A blood test and bone marrow biopsy reveal a diagnosis of acute myeloid leukaemia (AML).
What is the most appropriate initial treatment for this patient’s condition?
A 30-year-old woman comes to her General Practitioner complaining of fatigue and sudden shortness of breath. An urgent full blood count is performed and the patient is diagnosed with acute lymphoblastic leukemia (ALL).
What is the most probable first-line treatment option for this patient’s leukemia?