A 65-year-old patient presents to their GP with a general feeling of unwellness. The following blood results are obtained:
– Adjusted calcium 2.1 mmol/L (2.2-2.4)
– Phosphate 0.7 mmol/L (0.7-1.0)
– PTH 15.21 pmol/L (1.05-6.83)
– Urea 4.6 mmol/L (2.5-7.8)
– Creatinine 81 µmol/L (60-120)
– 25 OH Vit D 12 nmol/L (optimal >75)
What is the most likely diagnosis?
A 60-year-old patient presents to their GP with a general feeling of unwellness. The following blood test results are obtained:
– Adjusted calcium: 2.5 mmol/L (normal range: 2.2-2.4)
– Phosphate: 1.6 mmol/L (normal range: 0.7-1.0)
– PTH: 2.05 pmol/L (normal range: 1.05-6.83)
– Urea: 32.8 mmol/L (normal range: 2.5-7.8)
– Creatinine: 160 µmol/L (normal range: 60-120)
– 25 OH Vit D: 56 nmol/L (optimal level >75)
What is the most likely diagnosis?
An 80-year-old man arrives at the Emergency department feeling generally ill. The laboratory contacts you to report dangerously low serum sodium levels before you can see him. After diagnosis, it is discovered that he has a hormone excess. Which hormone could be the cause?
A 65-year-old man undergoing haemodialysis experiences leg cramps towards the end of his three-hour session. These cramps persist throughout the evening after dialysis and gradually subside. What substance are we removing excessively that could be causing these cramps?
An older woman is brought to the Emergency department with sudden chest pain and coughing up blood. She has been experiencing fatigue, weakness, and weight loss for the past six weeks. Prior to this, she had occasional nosebleeds and hearing loss. Upon admission, she is confused and has a fever of 37.7°C, high blood pressure of 165/102 mmHg, and acute kidney injury with elevated potassium, urea, and creatinine levels. Her albumin is low, CRP is high, and she is anemic with an elevated ESR. A urine dipstick test shows blood and protein, and an ultrasound reveals normal-sized kidneys without obstruction or hydronephrosis. A chest X-ray shows widespread rounded opacities. What is the most likely diagnosis?
A patient is admitted from clinic eight weeks following a renal transplant. Despite feeling well, his creatinine has increased from a baseline of 120 umol/l to 170 umol/l in just one week. After a normal ultrasound scan, he undergoes a transplant biopsy which reveals linear C4d staining along the peritubular capillaries and widespread glomerulitis with neutrophil and macrophage infiltration. What is the probable diagnosis?
A 45-year-old man underwent a renal transplant four weeks ago. The transplant was complicated by delayed graft function, which required haemodialysis on days one and three post-surgery due to hyperkalaemia. By day six, the transplant began to function, and he was discharged on day 10 with decreasing creatinine levels. He is currently taking immunosuppressants (tacrolimus, azathioprine, prednisolone), prophylaxis against opportunistic infections (co-trimoxazole, valganciclovir), aspirin, and amlodipine. Despite regular clinic visits, his potassium levels remain persistently high at 6.5 mmol/l. Which medication is likely causing this issue?
A 67-year-old man presents to the hospital with acute chest pain. He reports experiencing increasing shortness of breath on exertion, a widespread itchy rash, palpitations over the past few days, and ankle swelling. He has not seen his GP in many years due to a lack of trust in doctors. Upon examination, he has a pericardial rub and crackles at both lung bases. Blood tests reveal abnormalities in haemoglobin, white cell count, potassium, urea, creatinine, and CRP levels, as well as baseline troponin. A chest radiograph shows blunting of both costophrenic angles, and an ECG shows widespread ST elevation. What is the most likely cause of his chest pain?
A 30-year-old woman underwent a renal transplant two years ago due to end stage renal failure caused by haemolytic uraemic syndrome. She has been in good health since the transplant, without instances of rejection, and has been stable on antirejection therapy consisting of tacrolimus, prednisolone, and azathioprine. As both she and her donor were CMV seropositive, she is on valganciclovir prophylaxis. Additionally, she takes aspirin, bisoprolol, and paracetamol. She and her partner are contemplating trying to conceive. Which of her medications should she discontinue before attempting to conceive?
A 49-year-old man visits his GP complaining of a weak and painful right leg that has been bothering him for a week. Upon examination, the GP observes a foot drop on the right side with 3/5 power for dorsiflexion, as well as a bilateral sensory peripheral neuropathy that is worse on the right side. The GP also notices weakness of wrist extension on the left, which the patient had not previously mentioned. The patient’s chest, heart, and abdomen appear normal, and his urine dipstick is clear. His medical history is significant only for asthma, which was diagnosed four years ago.
The patient’s FBC reveals a white cell count of 6.7 x109/l (normal range: 4 – 11), with neutrophils at 4.2 x109/l (normal range: 1.5 – 7), lymphocytes at 2.3 x109/l (normal range: 1.5 – 4), and eosinophils at 2.2 x109/l (normal range: 0.04 – 0.4). His ESR is 68mm/hr (normal range: 0 – 15), and his biochemistry is normal except for a raised CRP at 52 mg/l. Nerve conduction studies show reduced amplitude sensory signals bilaterally and patchy axonal degeneration on the right side with reduced motor amplitude.
What is the most likely diagnosis?