W5

PBL 1

100

What are some other aspects of care that should be considered for George?

- Mental and Psychological support: ongoing counselling, refer to support group e.g., Myeloma Australia) 

- Consider to caregiver (Ellen, his wife) - may also need emotional and mental support

- Financial struggle due to work limitations 

- MM is incurable, therefore it is important to discuss advanced care planning, including palliative care and advanced directives if needed.  

200

List >5 possible causes of hypercalcemia 

• C - Calcium supplementation/excess: 
• H - Hyperparathyroidism: 
• I - Iatrogenic/Immobilization: 
• M - Multiple myeloma
• P - Parathyroid hyperplasia or adenoma: Enlargement or tumors of the parathyroid glands can cause excessive PTH production. 
• A - Alcohol: Excessive alcohol consumption can sometimes contribute to hypercalcemia.
• N - Neoplasm (e.g., breast cancer, lung cancer): Certain cancers, especially those that metastasize to bone, can cause hypercalcemia.
• Z - Zollinger-Ellison syndrome: This rare condition involving acid-producing tumors can be associated with hypercalcemia. 
• E - Excessive vitamin D
• E - Excessive vitamin A
• S - Sarcoidosis: This inflammatory condition can lead to increased vitamin D production, resulting in hypercalcemia

300

Distinguish Lymphoma, Leukemia, and Multiple Myeloma

Multiple Myeloma:

• Origin: Plasma cells.
• Effect on the Body: Causes bone destruction, typically presenting with bone pain, fractures, hypercalcemia and/or renal dysfunction. 
• Key Characteristic: Abnormal plasma cells in the bone marrow, leading to production of monoclonal antibodies.

Leukemia:

• Origin: Abnormal WBCs in the bone marrow and blood.
• Effect on the Body: Characterized by elevated WBC, often leading to bone marrow dysfunction and systemic symptoms like fatigue and bleeding.
• Key Characteristic: Abnormal proliferation of white blood cells, which can be myeloid or lymphoid in origin.

Lymphoma:

• Origin: Lymphatic system, specifically the lymph nodes or other lymphoid tissues.
• Effect on the Body: Typically presents as painless lymph node enlargement, with potential systemic symptoms (e.g., fever, weight loss).
• Key Characteristic: Can be Hodgkin or non-Hodgkin lymphoma, with malignancy arising from B-cells or T-cells.

PBL 2

100

What is the acronym for breaking bad news? What does it stand for? 

• S: Set up the interview
• P: Assess the patient's perception
• I: Obtain the patient's invitation
• K: Give knowledge and information to the patient
• E: Address the patient's emotions with empathic responses
• S: Strategy or summarize

200

A patient with hypercalcemia may present with...

Bones: Refers to bone pain, which can be a result of abnormal bone remodeling and bone-related complications like osteoporosis.
Stones: Indicates kidney stones (nephrocalcinosis) and other calcium-related kidney problems.
Abdominal Groans: Represents gastrointestinal symptoms like constipation, indigestion, nausea, and vomiting.
Psychic Moans: Highlights neuropsychiatric symptoms such as lethargy, fatigue, depression, and confusion

300

Outline how hyperparathyroidism can lead to hypercalcemia

Overactive parathyroid glands secrete excess parathyroid hormone which upregulates RANKL activity on osteoblasts to indirectly activate osteoclastic bone resorption (upon binding to RANK). PTH also stimulates calcitriol conversion in the kidneys to increase calcium absorption in the gut, and increase renal reabsorption in the kidneys.