EMQs in Clinical Medicine.pdf - Peshawar Medical College

70 Haematology and oncology
continued
Normocytic anaemia:
Look out for anaemia of chronic disease (AOCD), e.g. malignancy, rheumatoid
arthritis
Anaemia is mild, if Hb 8 g/dl it cannot be called AOCD
Endocrine dysfunction can give a normocytic anaemia
Haematological diseases:
Young black patient presenting with anaemia, jaundice:
Hand and foot syndrome (painful infarcts)
‘Sickle chest’ (fever, pain, mimics pneumonia) Sickle-cell anaemia [21]
Priapism leading to impotence
Hepatosplenomegaly (sequestration crisis)
• Patient of Mediterranean origin:
Glucose-6-phosphate
dehydrogenase deficiency [20]
• Rapid anaemia, jaundice and Heinz bodies
Precipitated by fava beans, sulphonamides
• Skull bossing, maxillary hypertrophy, -Thalassaemia [22]
↑ HbF
• Bleeds excessively (e.g. into joints and Haemophilia A
muscle) ↓↓ factor VIII assay
• Dark urine in the morning
Paroxysmal nocturnal
Positive Ham’s test haemoglobinuria [23]
A presentation of malignancy is a common scenario in an EMQ and you should
be able to recognize various classic presentations of malignancy and look for
them immediately in the options given to you (Box 3).
Box 3 Presentation of malignancy
Presentation
EMQ usually includes weight loss plus:
• Anaemia, dysphagia
• Painless obstructive jaundice
• Painless total haematuria
• Haemoptysis, smoking history
• Change in bowel habit, per bleeding
• Flushing, abdominal pain, diarrhoea,
heart failure
• Bladder outflow obstruction, bone pain
(metastatic)
Type of cancer
Oesophageal carcinoma
Carcinoma head of pancreas
Bladder carcinoma
Bronchial carcinoma
Colorectal carcinoma
Carcinoid syndrome
Carcinoma of the prostate