A 35-year-old female, who was diagnosed three months earlier with Graves disease and was started on carbimazole 40 mg per day, presents with a complaint of sore throat.
Based on the investigations, which show a haemoglobin level of 11.5 g/dl, MCV of 80 fl, white cell count of 4.2 x 109/l, neutrophils of 2.0 x 109/l, lymphocytes of 2.3 x 109/l, basophils of 0.08 x 109/l, eosinophils of 0.1 x 109/l, and platelets of 170 x 109/l, what is the most appropriate treatment for this patient?
A 39-year-old man presents with a six-month history of diarrhea, dyspnea, and weight loss. He used to be quite active and fit before these symptoms started. He reports having up to 10 episodes of diarrhea daily and experiencing wheezing and breathlessness during flushes that occur at any time of the day. His face turns red during these episodes. On examination, his pulse is regular at 90 beats per minute, blood pressure is 122/76 mmHg, and saturations are 98% on air. He has an elevated jugular venous pressure and a soft pan-systolic murmur at the left sternal edge. Abdominal examination reveals hepatomegaly of 8 cm. Investigations show elevated levels of ALP and 24hr Urine HIAA. Echocardiography reveals marked tricuspid regurgitation and mild pulmonary stenosis. What is the most appropriate initial treatment for this patient?
A 54-year-old female presents with a six month history of weight loss and frequent watery diarrhoea. She has lost approximately 10 kg in weight and experiences diarrhoea three to four times daily. She also reports experiencing more frequent flushes since menopause at the age of 50. She has no significant medical history, takes no medication, is a non-smoker, and drinks approximately 12 units of alcohol weekly. On examination, she has a reddish complexion, a BMI of 24 kg/m2, a regular pulse of 88 beats per minute, and a blood pressure of 122/88 mmHg. Abdominal examination reveals hepatomegaly. Investigations show numerous echo-dense deposits within the liver and elevated levels of 5-Hydroxyindoleacetic acid (5-HIAA) in her urine. What is the most appropriate treatment for this patient’s diarrhoea?
A 49-year-old man presents to the clinic with complaints of fatigue and weakness. He has a history of alcoholism and currently consumes 90 units of beer per week. He is taking regular thiamine and appears to be euvolaemic on examination.
The following are his blood test results:
– Hemoglobin (Hb): 122 g/l
– Platelets: 385 * 109/l
– White blood cells (WBC): 8.5 * 109/l
– Neutrophils (Neuts): 4.6 * 109/l
– Lymphocytes (Lymphs): 2.2 * 109/l
– C-reactive protein (CRP): 8 mg/l
– Sodium (Na+): 128 mmol/l
– Potassium (K+): 3.6 mmol/l
– Urea: 3.2 mmol/l
– Creatinine: 38 µmol/l
A paired serum and urine test shows:
– Serum osmolarity: 271 mOsm/kg (normal range 285-295)
– Urine osmolarity: 50 mOsm/kg (low)
– Urinary sodium: 8 mmol/l (low)
What is the most likely diagnosis?
A 49-year-old female presents with recurrent palpitations, sweating, blurring of vision, and generalized weakness. She denies any chest pain, shortness of breath, or loss of consciousness. She has had several similar episodes over the past few months, usually occurring in the morning or just before a meal. Her symptoms improve after eating something. She has gained about 9 kg of weight over the last few months. She has a past history of an anxiety disorder but is not currently taking any regular medications. She does not smoke and only occasionally drinks alcohol. Her blood glucose at present is 4.9 mmol. Based on the history, what is the next step in evaluating this patient for insulinoma?
A 56-year-old man comes to the clinic complaining of increased thirst and urinary frequency. He has a history of stable angina and is currently taking aspirin, atenolol, and atorvastatin.
Upon examination, no abnormalities are found.
Blood tests reveal an Hba1c level of 54 mmol/mol (<48). The patient is prescribed metformin 500mg twice daily. What is the next step in the pharmacological treatment of this patient given his current presentation?
A 35-year-old man is admitted after being found at home covered in his vomit and excrement. He is a known alcoholic and has not been seen for three weeks.
On examination, he is drowsy and complaining of generalised aches and pains.
An ECG shows prolonged PR interval and prolonged QTc of 620ms.
On examination JVP is not visible, his mucous membranes are dry, and his eyes are sunken. His chest is clear, his heart sounds normal, and his abdomen soft and non-tender. There is moisture damage to his buttocks.
CT head is unremarkable.
Blood tests are completed and results are detailed below:
Hb 114 g/L Male: (135-180)
Female: (115 – 160)
Platelets 98 * 109/L (150 – 400)
WBC 10 * 109/L (4.0 – 11.0)
Na+ 131 mmol/L (135 – 145)
K+ 2.2 mmol/L (3.5 – 5.0)
Urea 14.2 mmol/L (2.0 – 7.0)
Creatinine 190 µmol/L (55 – 120)
Calcium 1.9 mmol/L (2.1-2.6)
Phosphate 0.6 mmol/L (0.8-1.4)
Magnesium 0.4 mmol/L (0.7-1.0)
What is the top priority in managing the electrolyte imbalances of this patient?
A 67-year-old man with a history of diabetic nephropathy is referred to the rheumatology clinic after suffering a right Colles’ fracture. He is currently taking linagliptin for diabetes, as well as Ramipril and atorvastatin for hypertension and primary cardiovascular prevention.
During examination, his blood pressure is 140/80, pulse is 72 and regular, and BMI is 28. The cast has been removed from his wrist and there is minimal residual deformity. The doctor is considering starting him on bisphosphonate therapy. Routine blood tests show normal levels of calcium and phosphate, and an HbA1c of 56 mmol/mol (<53). What GFR level would be a contraindication for bisphosphonate therapy?
A 65-year-old man with a history of ischaemic heart disease and type 2 diabetes mellitus presents for his annual review and is found to have non-visible haematuria. He reports feeling well and is not experiencing any symptoms. Upon urine dipstick testing, blood ++ is detected, with no presence of protein or leucocytes. The test is repeated one week later.
The patient is currently taking aspirin, bisoprolol, atorvastatin, ramipril, metformin, and pioglitazone. Which medication should be discontinued while awaiting further investigations?
A 67-year-old man is referred to the urology clinic due to experiencing macroscopic haematuria for three weeks. He has a medical history of type 2 diabetes and recently received treatment for a threadworm infection. His current medications include linagliptin, metformin, and pioglitazone. The patient does not smoke or drink alcohol and works as a dairy farmer. He originally comes from Jamaica. During a cystoscopy, an exophytic lesion is discovered in his bladder. What is the most significant risk factor for the development of this condition in this patient?