A 25-year-old male confesses to abusing codeine and diclofenac, consuming up to 30 tablets daily. He presents to the emergency department seeking assistance with his addiction. Upon examination, his baseline bloods reveal:
pH 7.28
PCO2 2.9 kPa
PO2 8.5 kPa
HCO3- 16 mmol/l
Na+ 130 mmol/l
K+ 6 mmol/l
Cl- 110 mmol/l
HCO3- 16 mmol/l
What is the probable diagnosis?
A 42-year-old woman comes to the clinic for evaluation. She recently discovered a hard nodule on the left side of her neck while putting on a necklace. She has no significant medical history. During the examination, you notice a hard nodular area over the left thyroid, and you suspect it may be an underlying carcinoma.
Her vital signs are stable, with a blood pressure of 112/72 mmHg and a regular pulse of 65. The following investigations were conducted:
– Haemoglobin: 127 g/L (115 – 160)
– White cell count: 6.0 ×109/L (4 – 11)
– Platelets: 200 ×109/L (150 – 400)
– Sodium: 138 mmol/L (135 – 146)
– Potassium: 3.9 mmol/L (3.5 – 5)
– Creatinine: 110 µmol/L (79 – 118)
– TSH: 0.8 IU (0.5 – 5)
A fine needle aspiration biopsy was also performed, which revealed large thyrocytes, abnormal nuclei and cytoplasm with several mitoses, and psammoma bodies identified.
What is the most likely diagnosis?
An 80-year-old woman visits her GP complaining of weight gain and increased fatigue. She has a medical history of hypertension and hypothyroidism, for which she takes amlodipine and levothyroxine. The patient was prescribed ferrous sulphate for mild anaemia during her last visit to the GP two weeks ago. What could be the probable reason for her symptoms?
You review a 28-year-old woman with a history of type 1 diabetes who is experiencing fatigue, lack of energy, and weight loss. She reports fainting three times in the past two months and admits to feeling nauseous and vomiting. She has been living in France for several months.
During examination, you notice that she is very thin and has a tan. Her blood pressure is 100/70 mmHg, with a postural drop of 10 mmHg upon standing.
The following investigations were conducted:
s
Thyroxine (T4) 6.0 pmol/l (10-22) 10 – 22 pmol/l
Sodium (Na+) 133 mmol/l 135 – 145 mmol/l
Potassium (K+) 5.1 mmol/l 3.5 – 5.0 mmol/l
Glucose 6.0 mmol/l 3.9 – 7.1 mmol/l
Urea 8.9 mmol/l 2.5 – 6.5 mmol/l
She also has a normochromic, normocytic anaemia.
What is the best way to diagnose the cause of her symptoms?
A 28-year-old pregnant woman (26 weeks) visits her GP complaining of increasing fatigue. She has no significant medical history and had an uneventful previous pregnancy. Her fasting blood glucose level is 5.4 mmol/L, urine dip is negative, and blood pressure is 134/78 mmHg. Abdominal examination is normal. The following are her blood test results:
– Hb: 116 g/L (normal range for females: 115-160 g/L)
– Platelets: 270 * 109/L (normal range: 150-400 * 109/L)
– WBC: 7.3 * 109/L (normal range: 4.0-11.0 * 109/L)
– Na+: 136 mmol/L (normal range: 135-145 mmol/L)
– K+: 3.9 mmol/L (normal range: 3.5-5.0 mmol/L)
– Bicarbonate: 25 mmol/L (normal range: 22-29 mmol/L)
– Urea: 6.5 mmol/L (normal range: 2.0-7.0 mmol/L)
– Creatinine: 89 µmol/L (normal range: 55-120 µmol/L)
– Bilirubin: 4 µmol/L (normal range: 3-17 µmol/L)
– ALP: 170 u/L (normal range: 30-100 u/L)
– ALT: 20 u/L (normal range: 3-40 u/L)
– γGT: 55 u/L (normal range: 8-60 u/L)
– Albumin: 37 g/L (normal range: 35-50 g/L)
What is the most likely diagnosis?
A 25-year-old woman presents to the Endocrine Clinic with concerns about her fertility. She is concerned because although she feels she has developed normally as a woman and has a normal sex drive, she has never had a menstrual period. There is no past medical history of note.
On examination, her BP is 118/76 mmHg and pulse is 80/min and regular. She is 1.75 m tall and has a BMI of 25. Breast development is normal although pubic and axillary hair appears absent, vulval development also appears to be normal.
Investigations reveal the following:
s
Haemoglobin (Hb) 142 g/l 130–170 g/l
White cell count (WCC) 6.8 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 195 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 75 µmol/l 60–110 µmol/l
Glucose 4.8 mmol/l 3.9–7.1 mmol/l
Testosterone 2.1 nmol/l 8.6–29.0 nmol/l
Karyotyping 46 XY
What is the most likely diagnosis for this patient?
A 67-year-old lifelong smoker presents with a 3-week history of gradually worsening confusion, abdominal discomfort and constipation. He admits to a chronic cough which has worsened over the past nine to twelve months, and that he has lost 7 kg in weight.
On examination, his blood pressure (BP) is 148/80, with pulse 76 and regular. There is bilateral wheeze on auscultation of the chest consistent with COPD. He looks thin, with a BMI of 20.
Investigations:
s
Sodium (Na+) 137 mmol/l 135 – 145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5 – 5.0 mmol/l
Creatinine (Cr) 110 µmol/l 50 – 120 µmol/l
Urea 7.5 mmol/l 2.5 – 6.5 mmol/l
Corrected calcium (Ca2+) 3.02 mmol/l 2.2 – 2.7 mmol/l
Albumin 30 g/l 35 – 55 g/l
Alkaline phosphatase (ALP) 155 u/l 30 – 150 u/l
Parathyroid hormone (PTH) 0.7 pmol/l 0.9 – 5.4 pmol/l
What is the most likely cause of his hypercalcaemia?
A frail 83-year-old gentleman was brought in by his son, who found him on the floor in his apartment. He had tripped in a mechanical and had been unable to get back up, lying on the floor for the past 3 days. On examination, he appears extremely dehydrated but has no specific focal weakness, systemic examination is unremarkable. He has sustained no musculoskeletal injuries. His blood tests are as follows:
Na+ 168 mmol/l
K+ 6.0 mmol/l
Urea 24 mmol/l
Creatinine 260 µmol/l (baseline 107 three months ago)
Creatinine kinase 11,000 mmol/l
ECG shows normal sinus rhythm at 99/ minute.
You diagnose him with rhabdomyolysis and an acute kidney injury, likely of a pre-renal cause. Intravenous fluid rehydration is initiated with intravenous 5% dextrose. You ask your colleague to check the patient’s blood tests in 12 hours.
What is the reason for correcting the patient’s hypernatraemia?
A 35-year-old construction worker presents for review. He is 6 feet 2 inches tall and has signs of delayed puberty and infertility on examination, notably small testes with scanty pubic hair.
Investigations:
s
Follicle-stimulating hormone (FSH) 40 u/l 1 – 7 u/l
Testosterone 6 nmol/l 9 – 25 nmol/l
What is the most likely diagnosis based on this clinical presentation and laboratory results?
A 38-year-old woman presents to the emergency department with a suspected drug overdose and reduced GCS. She has a history of type 2 diabetes and takes gliclazide. Upon examination, she appears pale and sweaty. During her initial assessment, the following result is obtained:
Blood glucose 2.0 mmol/L (>3.9 mmol/L)
After receiving an infusion of 50% dextrose, her glucose level is rechecked:
Blood glucose 2.5 mmol/L (>3.9 mmol/L)
What other treatment options should be considered to stop the underlying process?