A man is investigated for anaemia. A blood film is ordered and reported as follows:
Which one of the following is least likely to give this picture?
Correct Answer C: Pyridoxine is actually a treatment for sideroblastic anaemia. Rarely pyridoxine deficiency may be the cause.
Sideroblastic anaemia: Sideroblastic anaemia is a condition where red cells fail to completely form haem, whose biosynthesis takes place partly in the mitochondrion. This leads to deposits of iron in the mitochondria that form a ring around the nucleus called a ring sideroblast. It may be congenital or acquired.
Congenital cause:
Acquired causes:
Investigations:
Management:
A 65-year-old man comes for review. He has a history of small cell lung cancer and ischaemic heart disease. His cancer was diagnosed five months ago and he has recently completed a course of chemotherapy. From a cardiac point of view he had a myocardial infarction two years ago following which he had primary angioplasty with stent placement. He has had no angina since. For the past week he has become increasingly short-of-breath. This is worse at night and is associated with an occasional non-productive cough. He has also noticed that his wedding ring feels tight. Clinical examination is of his chest is unremarkable. He does however have distended neck veins and periorbital oedema.
What is the most likely diagnosis?
Correct Answer D:
Superior vena cava obstruction: Superior vena cava (SVC) obstruction is an oncological emergency caused by compression of the SVC. It is most commonly associated with lung cancer.
Features:
Causes:
A 35-year-old woman presents with menorrhagia and a persistent sore throat. A full blood count shows the following:
Which one of the following medications is most likely to account for this finding?
Correct Answer A: Trimethoprim may cause pantcytopaenia.
Drug-induced pancytopaenia: Drug causes of pancytopaenia:
*Causes both agranulocytosis and pancytopaenia.
A 35-year-old female who is 34 weeks pregnant presents with a swollen, painful right calf. A deep vein thrombosis is confirmed on Doppler scan.
What is the preferred anticoagulant?
Correct Answer E: Although teratogenic effects of warfarin are greater in the first trimester most clinicians would use low molecular weight heparin in this situation. Another factor to consider is the risk of peripartum haemorrhage and potential problems reversing the effects of warfarin if this occurred.
Pregnancy: DVT/PE:
Overview:
Pathophysiology:
Which one of the following features is least recognized in myeloma?
Correct Answer D: Night sweats are a feature of non-Hodgkin's lymphoma.
Myeloma: features: Multiple myeloma is a neoplasm of the bone marrow plasma cells. The peak incidence is patients aged 60-70 years.
Clinical features:
Diagnosis is based on:
Hypercalcaemia in myeloma:
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