A 55-year-old female presents with epigastric pain that radiates to her back. She has no medical history and does not take any regular medications. Her alcohol consumption is limited to 3 glasses of wine per week. Blood tests reveal elevated triglyceride levels and a high CRP level. An abdominal ultrasound shows no gallstones or duct dilation. What measures can be taken to prevent the recurrence of pancreatitis?
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?
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?