What is the mechanism of action of cisplatin?
Correct Answer B:
Cytotoxic agents:
The table below summarises the mechanism of action and major adverse effects of commonly used cytotoxic agents.
A 72-year-old man is admitted with a deep vein thrombosis. He is normally fit and well but has recently lost weight. Blood tests reveal the following:
What is the most likely diagnosis?
Correct Answer C: IgM paraproteinaemia - ?Waldenstrom's macroglobulinaemia.
Waldenstrom's macroglobulinaemia is more likely than monoclonal gammopathy of undetermined significance given the weight loss and deep vein thrombosis (evidence of hyperviscosity). IgG and IgA and the most common type of immunoglobulins produced in myeloma.
Waldenstrom's macroglobulinaemia:
Waldenstrom's macroglobulinaemia is an uncommon condition seen in older men. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein.
Features:
Which of the following is most associated with thymomas?
Correct Answer E: Thymomas are the most common tumour of the anterior mediastinum.
Associated with:
Causes of death:
Which of the following is a cause of extravascular haemolysis?
Correct Answer A:
Haemolytic anaemias: by site:
In intravascular haemolysis free haemoglobin is released which binds to haptoglobin. As haptoglobin becomes saturated haemoglobin binds to albumin forming methaemalbumin (detected by Schumm's test). Free haemoglobin is excreted in the urine as haemoglobinuria, haemosiderinuria.
1- Intravascular haemolysis: causes:
2- Extravascular haemolysis: causes:
*Strictly speaking there is an element of extravascular haemolysis in G6PD as well, although it is usually classified as a intravascular cause.
A 65-year-old woman is reviewed. She is on the waiting list for a varicose vein operation but during the preoperative assessment was noted to have a raised lymphocyte count. She reports feeling well currently and clinical examination is normal. Her bloods were as follows:
There are no previous bloods to compare these results with. Following referral to haematology a diagnosis of chronic lymphocytic leukaemia was made.
What is the most appropriate management?
Correct Answer B: There is no indication for treating this patient at the current time or not going ahead with surgery.
Chronic lymphocytic leukaemia: management: Indications for treatment:
Management:
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