As the medical doctor on an acute medical unit, you receive a referral for a 27-year-old adopted female with a history of recurrent kidney stones who has been found to have hypokalaemia (K+ 2.6 mmol/l) by her GP. Despite feeling well and denying any vomiting or diarrhoea, her blood results show the following:
– Na+ 141 mmol/l
– K+ 2.6 mmol/l
– Bicarbonate 18 mmol/l
– Urea 5.0 mmol/l
– Creatinine 67 µmol/l
– Anion gap 13 mEq/L
What is the most likely cause of her presentation?
A 29-year-old man comes to the clinic for a follow-up on his familial hypercholesterolaemia. He is currently taking 80mg of atorvastatin once daily.
Here are his recent blood test results:
Hb: 135 g/l
Platelets: 322 * 109/l
WBC: 10.5 * 109/l
Neuts: 6.2 * 109/l
Total cholesterol: 7.5 mmol/L (normal range < 5)
LDL cholesterol: 5.5 mmol/L (normal range < 3)
Na+: 138 mmol/l
K+: 4.6 mmol/l
Urea: 6.6 mmol/l
Creatinine: 72 µmol/l
What course of treatment would you recommend?
A 67-year-old retired teacher was referred to the endocrine clinic by her primary care physician due to incidentally-detected hypercalcaemia. She had no significant medical history and was not taking any regular medications. Upon physical and systemic examination, no abnormalities were found.
Lab results:
– Urea: 7.5 mg/dl
– Calcium: 2.8 mmol/l
– Phosphate: 0.74mmol/l
– Creatinine: 98µmol/l
– Alkaline phosphatase: 450 IU/l
What investigation would be most helpful in establishing a diagnosis?
A 67-year-old man presents with fever and difficulty urinating, along with burning pain and numbness ascending from his feet. He has a history of poorly controlled diabetes, hypertension, ischaemic heart disease, and hypercholesterolaemia. The patient is currently taking metformin, gliclazide, linagliptin, ramipril, aspirin, and simvastatin. Physical examination reveals mild suprapubic tenderness and decreased sensation in his feet. What is the recommended first-line treatment for his pain?
A 30-year-old woman presents with recent weight gain, particularly on her face and abdomen. She reports irregular periods and was diagnosed with type 2 diabetes mellitus last year. The patient admits to consuming 15 units of alcohol daily. During examination, violaceous striae are observed on her abdomen, and proximal muscle weakness is evident. Blood tests reveal a sodium level of 143 mmol/L (135 – 145) and a potassium level of 2.8 mmol/L (3.5 – 5.0). The medical team suspects that the patient’s alcohol use may be the cause of her symptoms and wants to differentiate it from an endogenous cause. What is the most appropriate investigation?
A 67-year-old man presents with severe abdominal pain. He has a history of depression and type 2 diabetes, and takes levemir, sitagliptin, and gliclazide. He denies smoking, alcohol, or illicit drug use, and claims to have been taking all his diabetic medications. On examination, he is overweight with dry mucous membranes and generalised abdominal pain. His blood pressure is 101/76 mmHg, pulse rate is 113 beats per minute, and temperature is 37.8ºC. Investigations reveal elevated levels of creatinine, urea, alkaline phosphatase, alanine transaminase, gamma-glutamyl transpeptidase, amylase, glucose, and positive results for WCC, RBC, and ketones in his urine. What is the likely underlying diagnosis?
A 57 year-old man with type 2 diabetes mellitus visits his GP for his yearly check-up. He is currently taking metformin 500mg twice daily and gliclazide 40mg once daily for his diabetes. However, he has been experiencing frequent episodes of hypoglycaemia which is affecting his work as a construction worker. His latest HbA1c reading was 66 mmol/mol. Additionally, he has a medical history of stage 2 heart failure, hypertension and mild chronic obstructive pulmonary disease.
What treatment modification would be most appropriate?
A 35-year-old female presents to the clinic with complaints of tiredness and lethargy for the past three months. She was diagnosed with an underactive thyroid two years ago and has been taking 150 µg of thyroxine daily. After giving birth to her last child six months ago, she has been feeling increasingly tired and has gained weight. She is a light smoker and drinks alcohol in moderation. Her mother also has an underactive thyroid and is on thyroxine replacement therapy. On examination, her pulse is 82 beats per minute, blood pressure is 124/74 mmHg, and there is no palpable goitre. Investigations reveal a strongly positive thyroid peroxidase antibody, along with a high TSH level and low free T3 level. What is the most likely cause of her symptoms?
A 67-year-old male is admitted with an intracranial bleed and is under the care of the neurosurgeons. After undergoing magnetic resonance angiography, he undergoes clipping of a cerebral arterial aneurysm and is stable the following morning. The surgical team records the following blood chemistry results on successive postoperative days:
Day 1:
– Plasma Sodium: 130 mmol/L
– Potassium: 3.5 mmol/L
– Urea: 4.2 mmol/L
– Creatinine: 95 µmol/L
Day 2:
– Plasma Sodium: 127 mmol/L
– Potassium: 3.4 mmol/L
– Urea: 4.2 mmol/L
– Creatinine: 90 µmol/L
Day 3:
– Plasma Sodium: 124 mmol/L
– Potassium: 3.4 mmol/L
– Urea: 4.4 mmol/L
– Creatinine: 76 µmol/L
Day 4:
– Plasma Sodium: 120 mmol/L
– Potassium: 3.5 mmol/L
– Urea: 5.0 mmol/L
– Creatinine: 70 µmol/L
Normal Ranges:
– Plasma sodium: 137-144 mmol/L
– Potassium: 3.5-4.9 mmol/L
– Urea: 2.5-7.5 mmol/L
– Creatinine: 60-110 µmol/L
On day four, the patient is put on a fluid restriction of 1 litre per day. Investigations at that time show:
– Plasma osmolality: 262 mOsmol/L (278-305)
– Urine osmolality: 700 mOsmol/L (350-1000)
– Urine sodium: 70 mmol/L –
What is the most likely diagnosis to explain these findings?
A 44-year-old woman presents to the emergency department with right loin to right groin abdominal pain. She has a history of Sjogren’s syndrome and uses lubricating eye drops and mouth spray. She does not smoke or drink alcohol.
What is the probable cause of her symptoms and test results, which include left costovertebral angle tenderness, blood in the urine, and bilateral nephrocalcinosis on CT KUB?