A 16-year-old male presents to his family doctor complaining of tingling sensations in his lips and fingers. He has a medical history of mild learning difficulties. During the examination, the doctor notices that the 5th metacarpal bone on both of his hands appears to be shortened. The following blood tests were conducted:
Calcium 1.74 mmol/L (2.20-2.60)
Parathyroid hormone 11.2 pmol/L (1.6-9.3)
Phosphate 2.12 mmol/L (0.85 – 1.85)
What is the probable diagnosis?
A 41-year-old man presents to his primary care physician with complaints of generalized aches and pains. He has a medical history of glaucoma and takes acetazolamide. He denies smoking or drinking alcohol and works as a marketing manager for an international fashion brand.
During the examination, he displays mild proximal myopathy, but no synovitis is observed.
The following blood tests are conducted:
– Hemoglobin: 136 g/L (normal range for males: 135-180; females: 115-160)
– Platelets: 189 * 109/L (normal range: 150-400)
– White blood cells: 8.2 * 109/L (normal range: 4.0-11.0)
– Sodium: 137 mmol/L (normal range: 135-145)
– Potassium: 2.8 mmol/L (normal range: 3.5-5.0)
– Urea: 5.2 mmol/L (normal range: 2.0-7.0)
– Creatinine: 89 µmol/L (normal range: 55-120)
– Bicarbonate: 16 mmol/L (normal range: 22-29)
– C-reactive protein: 4 mg/L (normal range: <5)
– Bilirubin: 14 µmol/L (normal range: 3-17)
– Alkaline phosphatase: 165 u/L (normal range: 30-100)
– Alanine transaminase: 23 u/L (normal range: 3-40)
– Gamma-glutamyl transferase: 44 u/L (normal range: 8-60)
– Albumin: 36 g/L (normal range: 35-50)
– Parathyroid hormone: 7.9 pmol/L (normal range: 1.6-6.9)
– Calcium: 2.08 mmol/L (normal range: 2.20-2.60)
– Vitamin D: 31 nmol/L (normal range: >50)
What is the underlying diagnosis that could explain this patient’s symptoms?
A 32-year-old woman presents to the endocrinology department with neck pain and abnormal thyroid function tests. She has a medical history of bipolar disorder and takes lithium. She smokes five cigarettes daily and is currently unemployed. Six weeks ago, she gave birth to her first child and has recently recovered from a cold. She is not breastfeeding. On examination, there is a tender swelling in her neck, and she is sweaty, mildly tremulous, and tachycardic. Blood tests reveal a low TSH and high free T4, and a radioactive iodine uptake scan shows globally reduced uptake of iodine-131. What is the likely diagnosis?
A 35-year-old woman presents with recurrent headaches and blurred vision. She is fatigued and has recurrent constipation requiring laxatives. There is a past medical history of hypertension and she is on amlodipine, ramipril and bendroflumethiazide.
On examination, her blood pressure is 178/102 mmHg. Upon fluid balance review, she seems hypervolaemic with bilateral peripheral oedema. She is of slim build and her cranial nerves and neurological examination show no abnormalities. Fundoscopy reveals grade IV hypertensive retinopathy with papilloedema seen.
Her electrocardiogram reveals features of left ventricular hypertrophy. Her urine dip is negative for protein and blood. A CT head reveals no acute bleed.
Blood results are as follows:
Na+ 154 mmol/L (135 – 145)
K+ 2.9 mmol/L (3.5 – 5.0)
Bicarbonate 23 mmol/L (22 – 29)
Aldosterone 70 pmol/L (100 – 500)
Renin 2 mU/L (5-50)
What is the most likely diagnosis?
A 32-year-old male with a history of epilepsy, for which he is taking carbamazepine and has not had any seizures for the last two years, presents with irritability and nausea for the last 2 weeks. His wife says that he is often confused and seems to be lost most of the time. He takes alcohol occasionally and smokes ten to twelve cigarettes per day.
On examination, he is irritable but conscious and alert. Clinical examination revealed eczema over the face, shins and extensor surfaces of the forearms and a tattoo on the right shoulder. There was no evidence of any peripheral oedema.
Lab reports were as follows:
Hb 150 g/l
MCV 81 fl
MCH 31 pg
WBC 9 * 109/l
Plt 250 * 109/l
Urea 3.2 mmol/l
Creatinine 75 µmol/l
9:00 am Cortisol 345 nmol/l (170 700 nmol/l)
TSH 2.4 mU/l
Total T4 102 nmol/l (68 174 nmol/l)
Na+ 119 mmol/l
K+ 4.2 mmol/l
What would be the most appropriate initial management option?
A 55-year-old patient with a history of hypertension undergoes neurosurgery for an intracranial haemorrhage. During the next few days, the patient’s serum sodium level gradually decreases and by the third day, it drops to 118 mmol/l despite being restricted to 1 L of fluids per day. The patient’s urine osmolarity is 700 mOsmo/l and urinary sodium is elevated at 80 mmol/l. What is the probable diagnosis?
A 20-year-old nursing student is admitted to the hospital after collapsing at work. She denies any tongue biting or incontinence during the episode and was groggy but alert upon regaining consciousness. According to her mother, the patient has experienced two previous episodes of collapse.
The nursing student’s vital signs include a blood pressure of 127/77 mmHg, a heart rate of 81 bpm, and oxygen saturation of 97%.
What is the initial investigation that should be performed?
A 20-year-old woman comes in for a check-up. She has a medical history of 11-beta-hydroxylase deficiency and hypertension, which is being treated with ramipril and indapamide. The deficiency was discovered at birth due to clitoromegaly.
What is the most significant elevation expected?
An 80-year-old male attends the diabetes clinic with longstanding type 2 diabetes. He has been experiencing recurrent nausea and vomiting, and has been diagnosed with gastroparesis. Despite being on metoclopramide, his symptoms have not improved and he has lost 10% of his weight over the past year. His HbA1c has improved from 7.6% to 6.2% over the past year. He has chronic kidney disease stage 3 and aortic stenosis, and is currently on Humulin M3, metformin, ramipril, bendroflumethiazide, and aspirin. He lives alone and has had 3 falls in the past month, with difficulty getting up in the morning and low mood. His blood sugar readings have been fluctuating, with some readings as low as 3.1 mmol/l and as high as 16.1 mmol/l.
What is the next appropriate step in managing his diabetes?
A 50-year-old woman visits her primary care physician complaining of headaches that have been bothering her for the past six months. She also mentions that her wedding ring no longer fits and that her hands have been swelling. She has no medical history to report.
During the examination, the physician observes that her brow and jaw are protruding, and there is swelling in her hands. Her blood pressure is 165/78 mmHg.
Blood test results show an HbA1c level of 52 mmol/mol (<48). What is the primary investigation that should be conducted considering the probable diagnosis?