EMQs in Clinical Medicine.pdf - Peshawar Medical College

66 Haematology and oncology
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A 55-year-old patient with metastatic cancer from an unknown primary
requires medication to treat convulsions, vomiting and terminal
restlessness.
Midazolam is used to treat both convulsions and terminal restlessness.
A 30-year-old man undergoing chemotherapy for teratoma is
suffering from severe vomiting shortly after receiving the drug.
Vomiting during cancer chemotherapy is common and can be classified as
anticipatory, immediate or delayed. Anticipatory symptoms can be controlled
with a benzodiazepine, e.g. diazepam. Corticosteroids, e.g. dexamethasone,
can be used to treat delayed vomiting. Ondansetron is a
serotonin 5HT 3 antagonist that is used for immediate severe vomiting, particularly
in those individuals receiving highly emetogenic chemotherapy.
25 Tumour markers
Answers: A E L G D
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A 60-year-old man presents with poor stream, weight loss and back
pain. Digital rectal examination reveals a hard irregular prostate gland.
This is a presentation of carcinoma of the prostate. The benefit of screening
asymptomatic men with respect to increased later survival is unclear.
PSA may also be raised in benign prostatic hypertrophy. It is always
important to remember that a patient with carcinoma of the prostate may
have a normal PSA. PSA levels increase with age and therefore the
reference range for ‘normal values’ also changes.
A 65-year-old woman with weight loss and painless jaundice. There is
evidence of thrombophlebitis migrans and computed tomography (CT)
shows a mass in the pancreatic head.
CA 19-9 is usually raised in patients with pancreatic carcinoma (around
80 per cent). CEA can also be raised in pancreatic carcinoma but this is
less common (around 40–50 per cent). The use of CA 19-9 is very limited
diagnostically because it can be raised in other malignancies and benign
processes, e.g. cirrhosis, cholangitis.
A 70-year-old man presenting with a suspected recurrence of
colorectal carcinoma.
CEA can be used clinically to monitor response to treatment. As with
most tumour markers, it is not specific enough to be of diagnostic value.
A 68-year-old person with chronic alcohol problems and hepatocellular
carcinoma.
Hepatocellular carcinoma is associated with a raised AFP level. It is also
raised in germ-cell tumours, hepatitis and pregnancy.