EMQs in Clinical Medicine.pdf - Peshawar Medical College

Cancer care – answers 65
In Ham’s test, the cells from a PNH patient will lyse more readily in acidified
serum than normal red blood cells. Serum heated to around 56°C
will inactivate complement and thus haemolysis will not occur.
As a result of the high risk of venous thrombosis, long-term coagulation
may be necessary. Deficient haematopoeisis may also occur and PNH
may progress to aplastic anaemia in around 10–20 per cent individuals.
C
A 60-year-old man presents with headaches, blurred vision and itching
over the whole body (the last after a hot bath). Positive findings
on examination include plethoric facies and moderate splenomegaly.
Haematocrit: 65 per cent.
Polycythaemia rubra vera (PRV) is a primary polycythaemia where there
is excessive proliferation of red blood cells caused by a clonal disorder of
pluripotent stem cells. The condition usually presents in late middle age –
elderly patients with signs of hyperviscosity, e.g. blurry vision (retinal
haemorrhages), headaches, bleeding, etc. Severe pruritus after a hot bath
is a commonly reported finding. The patient typically has plethoric facies
and may be cyanotic as a result of stagnation and deoxygenation of the
blood in peripheral vessels. Splenomegaly is very common in PRV, unlike
secondary polycythaemia. Blood tests show an elevated packed cell
volume. The white cell count is usually raised. A raised red cell mass can
be shown with 51 Cr studies.
The aim of treatment is to normalize the full blood count and prevent the
complications of thrombosis and haemorrhage. Venesection is the treatment
of choice. Hydroxyurea chemotherapy can also be used to control
thrombocytosis.
24 Cancer care
Answers: F I J D E
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A 65-year-old lung cancer patient with brain metastases is suffering
from severe headache. He has papilloedema in both eyes.
Dexamethasone is used in the short term to reduce the raised intracranial
pressure caused by cerebral oedema around metastases.
A 60-year-old man with metastatic colorectal carcinoma is suffering
from severe pain.
Severe pain from terminal malignancy often requires the use of strong
opioids. The most common adverse effect is constipation. If morphine is
being used regularly (e.g. in terminal care), a laxative should also be
prescribed to limit constipation.
A 50-year-old man requires first-line pain relief for bony metastases.
NSAIDs are a very effective first-line analgesic for bony metastases.