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 15-year-old girl presents to the Emergency department with a four day history of nausea and vomiting. She has a 10 year history of insulin-dependent diabetes mellitus and has had multiple admissions for diabetic ketoacidosis due to poor glycaemic control. On examination, she appears alert and oriented with dry mouth but no loss of skin turgor. Laboratory investigations reveal elevated glucose, ketones, and creatinine, as well as low bicarbonate levels. She is treated with intravenous fluids and insulin, which initially improves her symptoms, but nausea and vomiting resume when fluids are discontinued. Seven days later, her blood biochemistry shows abnormal levels of sodium, potassium, urea, and bicarbonate. What single test would be most useful in determining the cause of these biochemical abnormalities?
A 28-year-old woman presents to the Emergency department.
She has been experiencing increasing fatigue for the past few months and is now suffering from persistent vomiting. She has lost 6 kg over three months.
During examination, her blood pressure is 100/60 mmHg, pulse is 70 and regular. She appears tanned and has a BMI of 21.
Investigations reveal the following results:
– Haemoglobin: 122 g/L (115-160)
– White cell count: 8.2 ×109/L (4-11)
– Platelets: 222 ×109/L (150-400)
– Sodium: 130 mmol/L (135-146)
– Potassium: 4.0 mmol/L (3.5-5)
– Creatinine: 132 µmol/L (79-118)
Which of the following treatments is most likely to be effective?
A 64-year-old man presents with cramps and twitching in his legs after undergoing a thyroidectomy for follicular thyroid cancer. He reports that the surgery went well without complications, but his regular medications were held for one day. He has a medical history of hypertension, vitamin D deficiency, depression, and gout and was taking ramipril, cholecalciferol with calcium, and allopurinol. What is the probable cause of his cramps?
A 32-year-old woman is diagnosed with gestational diabetes during her first pregnancy. Her fasting blood glucose level is 5.9mmol/l and her blood glucose level after an oral glucose tolerance test (OGTT) is 8.2mmol/l. She manages her blood glucose levels during pregnancy with diet, exercise, and metformin. At 39 weeks, she gives birth to a healthy baby. On the first day after delivery, her fasting blood glucose level is 5.2mmol/l.
What is the appropriate follow-up monitoring for diabetes in this case?
A 48 year old woman presents with complaints of excessive thirst and frequent urination. She has a medical history of hypertension, hypercholesterolemia, and bipolar disorder, and a strong family history of diabetes, although she is unsure which type.
The following results were obtained:
– Sodium (Na+): 131 mmol/l
– Urine osmolality: 287 mOsmol/kg (normal range: 300 – 900 mOsmol/kg)
– Plasma osmolality: 287 mOsmol/kg (normal range: 285 – 295 mOsmol/kg)
What is the most likely cause of this patient’s symptoms?
A 56-year-old man with a history of type 2 diabetes is recovering on the surgical ward after experiencing an episode of acute pancreatitis about 4 days ago. He is currently taking metformin, dapagliflozin, and liraglutide for glucose control. During examination, his blood pressure is 135/80 mmHg, pulse is regular at 72, and his body mass index is 35 kg/m². His recent HbA1c is 63 mmol/mol, and his renal function is normal. What is the appropriate course of action for his long-term blood glucose lowering medication?
A 65-year-old male presented with a six month history of polyuria, polydipsia and generalised aches and pains.
He is a known hypertensive for fifteen years and is taking bendroflumethiazide 2.5 mg daily. He has been taking calcium and vitamin D supplements for the last three years as he has a strong family history of osteoporosis.
On examination, his pulse rate is 80 beats per minute and his blood pressure is 150/90 mmHg. Cardiovascular, respiratory and abdominal examination were normal.
Investigations reveal:
Serum sodium 130 mmol/L
Serum potassium 3.1 mmol/L
Serum urea 7.7 mmol/L
Serum creatinine 88 mol/L
Serum corrected calcium 2.9 mmol/L
Phosphate 0.8 mmol/L
PTH 4.5 pmol/L (0.9-5.4)
Urinalysis glycosuria ++
What is the most likely cause of this gentleman’s symptoms?