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?
An 84-year-old man presents with fatigue and a history of hypertension and type 2 diabetes mellitus. He takes lisinopril and metformin. His blood pressure is 140/80 mmHg and he appears to be clinically hydrated. Routine blood tests show:
Test Result Normal Range
Sodium (Na+) 128 mmol/L 135-145 mmol/L
Potassium (K+) 4.2 mmol/L 3.5-5.0 mmol/L
Urea 6.8 mmol/L 2.5-6.5 mmol/L
Creatinine 90 µmol/L 50-120 µmol/L
Which laboratory test would be most helpful in determining his fluid balance status?
A 28-year-old female patient presents to her GP with complaints of ongoing fatigue and struggles with weight loss. She frequently feels cold and has been experiencing constipation. After discussing her symptoms with her family, she was advised to seek medical attention as her mother had similar symptoms when diagnosed with Hashimoto’s thyroiditis. What autoantibody is most likely to be present in her blood?
A 30-year-old woman presents to the Emergency Department with complaints of increasing fatigue over the past few weeks. She is now unable to leave her house due to exhaustion, has significant nausea, and has not been able to eat for the past 48 hours. The patient has a history of Hashimoto’s thyroiditis and type 1 diabetes, for which she takes thyroxine and insulin. On examination, her blood pressure is 100/70 mmHg, with a postural drop of 20 mmHg on standing, and her pulse is 90 bpm and regular. Laboratory investigations reveal low haemoglobin, low sodium, high potassium, and high creatinine levels. What is the most likely diagnosis?
A 12-year-old boy is presenting with nocturnal enuresis, poor academic performance, and easy fatigue with physical activity. A full examination, including blood pressure, is unremarkable. Laboratory results show elevated WBC count and high bicarbonate levels. The 24-hour urine test reveals high potassium levels and low sodium levels. What is the likely diagnosis?
A 50-year-old man visits the endocrine clinic with difficulty in managing his type 2 diabetes. He has been diagnosed with the condition for five years and is currently taking Metformin 1g BD, Gliclazide 160 mg BD, and Sitagliptin 100 mg OD. As a bus driver, he finds it challenging to control his weight due to his busy shifts, resulting in a BMI of 34 kg/m².
Upon conducting investigations, his serum creatinine levels are at 120 µmol/L (60-110), and his Haemoglobin A1c levels are at 66 mmol/mol (8.2%). What would be the most appropriate next step?
A 36-year-old woman presents to the outpatient department with complaints of pain in her calves when walking 50 meters. She has no significant medical history except for a history of migraines. Her family history includes her mother having diabetes and her father dying of a heart attack at the age of 46. She is a heavy smoker, smoking 35 cigarettes per day, and drinks a glass of wine every evening. She works as a financial advisor.
During the examination, the physician observes tendon xanthomas affecting the extensor tendons of her fingers. Additionally, xanthelasma is noticed around both eyes and corneal arcs.
What is the most likely diagnosis?
A 45-year-old female presented to Endocrinology Clinic with a 4-month history of weight gain, fatigue and headaches. Over the last 4 weeks, she has also experienced galactorrhoea and reduced libido. She was diagnosed with type 2 diabetes and hypertension 2 months ago and is on diet control for both. She is not currently on any regular medications.
During examination, there was evidence of hirsutism and acne, a cervical fat pad, striae on her abdomen and proximal myopathy. Areas of hyperpigmentation were noted on her mucous membrane and palmar creases.
Which of the following investigations will reveal the diagnosis?