A 15-year-old girl comes to the Emergency Department complaining of sudden onset pain in the right iliac fossa, along with nausea, vomiting, and fever. She has no significant medical or surgical history. During the examination, you observe rebound tenderness at McBurney’s point, guarding, and a positive Rovsing’s sign. You suspect appendicitis and decide to take her for surgery.
What is the most probable physiological response in this situation?
Sarah, a 25-year-old type 1 diabetic, is interested in joining a local running group. As her physician, it is important to inform her of the potential impact this increase in physical activity may have on her blood sugar levels. What advice do you give her?
These results were obtained on a 30-year-old male who has presented with tiredness:
Free T4 9.3 pmol/L (9.8-23.1)
TSH 49.31 mU/L (0.35-5.50)
What signs might be expected in this case?
A 28-year-old female with a three year history of type 1 diabetes complains of sudden confusion and excessive sweating. Upon examination, her pulse is 105 bpm, respiratory rate is 16/min, and she appears disoriented. What would be the most suitable initial test to perform for this patient?
Sam, a 75-year-old man, presents to the GP with a complaint of breast growth that has developed rapidly over the past 3 months. Sam insists that he has no trouble with sexual function. He has recently been diagnosed with a heart problem and is taking multiple medications for it, although he cannot recall their names. Other than that, he claims to be in good health.
Upon examination, all of Sam’s vital signs are within normal limits. After measuring his height and weight, his body mass index is calculated to be 24 kg/m². Each breast is approximately 10 cm in diameter, with large nipples and tenderness but no pain. Moderate cardiomegaly and a 3rd heart sound are noted during chest assessment. No abnormalities are found during an abdominal examination. Pitting edema is present up to his mid calf.
Based on the history and examination, what is the most probable cause of Sam’s gynaecomastia?
A 20-year-old woman arrives at the emergency department complaining of abdominal pain, nausea, and vomiting. She reports having a cough and fever for the past few days. Upon examination, she has dry mucous membranes and her breath has a fruity odor. Her vital signs are as follows: blood pressure 95/55 mmHg, heart rate 120/min, respiratory rate 29/min, temperature 37.8ºC (100ºF), and oxygen saturation 98% on room air. Laboratory results show:
– Sodium (Na+): 124 mmol/L (135 – 145)
– Potassium (K+): 5.5 mmol/L (3.5 – 5.0)
– Bicarbonate: 13 mmol/L (22 – 29)
– Serum glucose: 30 mmol/L (4 – 7.8)
– pH: 7.15 (7.35 – 7.45)
– Serum ketones: 3.5 mmol/L (0 – 0.6)
What is the most likely cause of the increased ketones in this patient?
A 35-year-old woman is referred to the endocrine clinic due to missed periods and lactation. She has also gained weight and experiences vaginal dryness. The endocrinologist decides to measure her prolactin levels. What hormone is responsible for suppressing the release of prolactin from the pituitary gland?
A patient with a recent diagnosis of schizophrenia at the age of 40 is prescribed risperidone. During their consultation with the doctor, they are informed that some of the potential side effects are caused by elevated levels of prolactin.
What is the mechanism behind this occurrence?
A 47-year-old woman comes in for her yearly diabetic check-up. Despite being on metformin and gliclazide for a year, her HbA1c level remains at 57 mmol/mol. She mentions difficulty losing weight, and her BMI is recorded as 36 kg/m². The doctor decides to prescribe sitagliptin. How does this medication lower blood sugar levels?
A 43-year-old obese man comes to your clinic for a diabetes check-up. Despite being treated with metformin and gliclazide, his HbA1c remains elevated at 55 mmol/mol. He has previously found it difficult to follow dietary advice and lose weight. To enhance his diabetic management, you prescribe sitagliptin, a DPP-4 inhibitor. What is the mode of action of this novel medication?