A 67-year-old woman is reviewed 6 months after she had a mastectomy following a diagnosis of breast cancer.
Which one of the following tumour markers is most useful in monitoring her disease?
Correct Answer C: Breast Cancer = raised tumour marker CA 15-3.
Tumour markers:
Tumour markers may be divided into:
It should be noted that tumour markers usually have a low specificity.
Monoclonal antibodies:
Tumour antigens:
A 49-year-old woman is referred to the haematology clinic with easy bruising and recurrent epistaxis. She is otherwise well. Blood tests reveal the following:
The patient refuses consent for a bone marrow examination.
What is the most appropriate initial management?
Correct Answer B: Idiopathic Thrombocytopenic Purpura (ITP) - give oral prednisolone.
The likely diagnosis in this patient is idiopathic thrombocytopenic purpura. The first line treatment in such patients is high-dose prednisolone. Bone marrow examination would demonstrate increased megakaryocytes.
ITP: investigation and management: Idiopathic thrombocytopenic purpura (ITP) is an immune mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb-IIIa or Ib complex.
Investigations:
Management:
A 71-year-old woman who is known to have multiple myeloma is admitted with confusion. Blood tests show the following:
Which one of the following is the most significant cause of the raised calcium level?
Correct Answer B: 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 Multiple Myeloma:
What is the mechanism of action of Desmopressin (DDAVP) in von Willebrand's disease?
Correct Answer C: DDAVP induces release of von Willebrand's factor from endothelial cells.
Von Willebrand's disease is the most common inherited bleeding disorder. The majority of cases are inherited in an autosomal dominant fashion* and characteristically behaves like a platelet disorder i.e. epistaxis and menorrhagia are common whilst haemoarthroses and muscle haematomas are rare.
Role of von Willebrand factor:
Types:
Investigation:
Type 3 von Willebrand's disease (most severe form) is inherited as an autosomal recessive trait.
Around 80% of patients have type 1 disease.
Which one of the following statements regarding the aetiology of venous thromboembolism (VTE) is correct?
Correct Answer E:
Venous thromboembolism: risk factors:
Common predisposing factors include malignancy, pregnancy and the period following an operation. The comprehensive list below is partly based on the 2010 SIGN venous thromboembolism (VTE) guidelines:
1- General:
2- Underlying conditions:
3- Medication:
4- SIGN also state that the following are risk factors for recurrent VTE:
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