A 49-year-old woman with no known medical conditions is diagnosed with thyroid cancer and undergoes a three-hour thyroidectomy. The day after the surgery, she reports experiencing tingling sensations in her hands and mouth, followed by a seizure that resolves on its own. Her ECG reveals a sinus rhythm with a QTc interval of 510 ms. Which abnormal test result is most likely responsible for her symptoms?
A 40-year-old man has been admitted to the high dependency unit after undergoing surgery to remove a pituitary tumour. He is experiencing polyuria and dehydration 20 hours after the procedure. The following biochemistry results have been obtained:
– Urinary specific gravity: 1.004
– Urinary sodium: 40 mmol/L
– Urinary osmolality: 185 mOsm/kg
– Plasma sodium: 153 mmol/L
– Plasma osmolality: 309 mOsmol/kg
Based on these findings, what is the most likely diagnosis?
A 30-year-old woman presents to the Emergency department with a severe viral upper respiratory tract infection. She has a history of type 1 diabetes for which she takes a basal bolus insulin regimen and a recent HbA1c was elevated at 66 mmol/mol.
On examination, her BP is 100/65 mmHg, pulse is 95 and regular, and she has a respiratory rate of 28. Her BMI is 21.
Investigations show:
Hb 124 g/L (115-160)
WCC 9.1 ×109/L (4-11)
PLT 189 ×109/L (150-400)
Na 137 mmol/L (135-146)
K 3.4 mmol/L (3.5-5.0)
Cr 129 µmol/L (79-118)
Bicarb 14 mmol/L (22-30)
pH 7.12 (7.35-7.45)
She is started on an insulin infusion and is rehydrated aggressively. Bloods are repeated two hours later.
Repeat investigations show:
Na 138 mmol/L (135-146)
K 4.0 mmol/L (3.5-5.0)
Cr 121 µmol/L (79-118)
Bicarbonate 19 mmol/L (22-30)
pH 7.25 (7.35-7.45)
The nursing staff have become very worried as she has become unconscious.
What is the most likely cause of her unconsciousness?
A 42-year-old man visits the Diabetes Clinic. He was diagnosed with type II diabetes 2 years ago and has been taking metformin modified release 1 g twice a day, pioglitazone 30 mg once a day and gliclazide 80 mg once a day.
During examination, his HbA1c level is 80 mmol/mol (9.5%), and blood pressure (BP) is 140/80 mmHg. He has no microalbuminuria. Despite dietary advice and modification, he remains overweight, with a body mass index (BMI) of 32 kg/m2.
What is the most appropriate course of action for weight and glucose control?
A 70-year-old male diabetic presents with weakness and lethargy. He has been diagnosed with type 2 diabetes mellitus for 10 years and is currently taking gliclazide, metformin, and atenolol for hypertension. On examination, there are no significant findings except for the following results: blood pressure of 160/90 mmHg while lying and standing, serum sodium of 135 mmol/L (137-144), non-haemolysed serum potassium of 5.7 mmol/L (3.5-5.5), urea of 8.3 mmol/L (2.5-7.5), serum creatinine of 141 µmol/L (60-110), plasma glucose of 10.1 mmol/L (3.0-6.0), and HbA1c of 62 mmol/mol (20-42) or 7.8% (3.8-6.4). He also has loss of pin prick and vibration sensation to the ankle in both legs and a background diabetic retinopathy. What could be the possible cause of these electrolyte abnormalities?
A 35-year-old woman presents to her GP with a four-month history of weight loss and agitation. On examination, she has a fine tremor, a resting tachycardia, and a smooth goitre. Her lab results show elevated Free T4 and Free T3 levels and a suppressed TSH level. She is started on carbimazole and propranolol and returns a month later feeling better but with a three-day history of a sore throat. Her blood work shows a low hemoglobin level, low neutrophil count, and elevated lymphocyte count. What is the most appropriate management for this patient?
A 49-year-old man with type 2 diabetes is on a twice daily pre-mixed insulin (NovoMix 30). He has come for a diabetic review at the clinic and has brought his recent blood sugar readings. He checks his blood sugar levels four times a day: before breakfast, before lunch, before dinner, and before bed. His pre-breakfast glucose readings range from 5.0 to 6.0 mmol/L, pre-lunch readings range from 8 to 11 mmol/L, pre-dinner readings range from 8 to 10 mmol/L, and pre-bed readings range from 6.0 to 8.0 mmol/L.
Which of the following statements is true in this case?
A 36-year-old woman has a family history of multiple endocrine neoplasia type 2a and has tested positive for the RET oncogene. She is worried about developing thyroid cancer like her mother but is hesitant to undergo a prophylactic thyroidectomy. What other management options are available for her?
A 49-year-old woman presents to clinic for follow-up after undergoing surgery to remove a medullary thyroid cancer. She had presented with a neck lump and diarrhea, and genetic testing revealed a RET oncogene mutation. The patient reports feeling well and there are no signs of local recurrence on examination.
What is the recommended test for monitoring potential recurrence?
A 67-year-old man presents with a hot swollen right toe. Upon examination, there is swelling over the MTP joint of the right toe, reduced range of movement, and it is hot, swollen, and painful to touch. The patient has a history of alcohol excess and is not taking any regular medications. An aspirate of the joint fluid reveals negatively birefringent crystals that are needle-shaped. Due to the patient’s intolerance to NSAIDs and colchicine, a trial of prednisolone is initiated, but unfortunately, the patient develops steroid-induced psychosis. What alternative medication will be considered for this patient?