Cancer / Infection / Blood

Question 1

DDx for easy bruising and recurrent epistaxis

Answer 1

Possible inherited bleeding disorders
• von Willebrand disease (VWD)
• platelet function defect
• haemophilia

Acquired bleeding disorder:
• disorders secondary to liver or renal disease
• disorders related to over-the-counter medication - NSAID
• acquired haemophilia
• disorders related to bone marrow failure

Question 2

3 main side effects of IV iron infusion

Answer 2

1. Allergy to the product
2. Serum sickness–like illness for 48 hours post-infusion
3. Tattooing of the skin if the cannula tissues

Question 3

Possible causes of thrombocytopenia

Answer 3

1. Pregnancy
2. Medications:
   - heparin, tetracycline, penicillin, trimethoprim
3. Underlying medical condition:
   - chronic liver disease
   - autoimmune disease (SLE)
   - haematological malignancy (lymphoma)

Question 4

Tx of ITP

Answer 4

• Observation, particularly if the patient has a stable count
  of >30 × 109/L
• Corticosteroids, either dexamethasone or prednisolone
• IV Ig, more rapid increase in Plts than corticosteroids

Question 5

Side effects of Multiple Myeloma tx?

Answer 5

1. Infection
   - especially Herpes Zoster + Pneumocystis jiroveci
   - require prophylaxis for both
2. VTE
   - require Aspirin 100mg daily
3. Peripheral neuropathy
   - tx with Amytriptiline, Gabapentin or Pregabalin
4. Proximal myopathy + decreased exercise tolerance
   - can be secondary to prolonged steroid use in tx

Question 6

PSA blood test returns hight, what two investigations are required next

Answer 6

1. Repeat total PSA (within 1-3 months)

2. Free to total PSA

Question 7

Pros and cons for prostate cancer screening

Answer 7

Potential benefits for having PSA testing:

1. Reassurance if the test result is normal or very low
2. Early detection of prostate cancer may mean that early treatment can potentially cure the disease and avoid disability or reduced life expectancy as a result of the cancer.

Potential harms from PSA testing:

1. Risk of false positives leading to further investigations with ultimately no cancer found
2. Further investigation prompted by a raised PSA can cause harm e.g. prostate biopsy carries risk of infection, prostatectomy has risk of impotence/incontinence etc.
3. Risk of false negatives meaning that patient is falsely reassured
4. Risk of over-diagnosis of prostate cancer (i.e. diagnosing a very slowly progressive cancer that would otherwise not have caused health problems, with resultant treatment possibly causing harmful side effects).

Question 8

First line invx for bruising

Answer 8

FBE
APTT
INR / PT
Fibrinogen

Question 9

Specific features you look for on examination of someone with low platelets

Answer 9

• purpura
• hematuria
• bleeding gums
• neuro features: weakness, sensory changes
• CLD signs: spider naevi, gynaecomastia
• malignancy signs: splenomegaly, lymphadenopathy
• fever

Question 10

Ongoing mx for ITP in terms of reducing bleeding risk

Answer 10

1. Restrict activities to minimise head injury: no contact sport
2. Avoid aspirin / NSAIDs / IMI
3. Monitor for significant bleeding and present to ED
4. Monitor for signs of intracranial haemorrhage
5. Reduce EtOH to 2 drinks / day