A 76-year-old man presents with back pain after a fall. He has a history of prostate cancer with metastases to the liver and bones. He takes tamsulosin and bendroflumethiazide daily and paracetamol as needed. Upon admission, his renal function is stable, but his liver function is abnormal with an INR of 2, ALT of 210 U/L, AST of 90 U/L, ALP of 180 U/L, bilirubin of 30 mmol/L, and albumin of 24 g/L. What pain relief medication would you recommend for him?
A 55-year-old male presents at a well man clinic. He has a significant family history of ischaemic heart disease and is a smoker of 10 cigarettes per day. He also consumes approximately 20 units of alcohol per week. On examination, he is found to be obese with a BMI of 32 kg/m2 and has a blood pressure of 152/88 mmHg. His investigations reveal a fasting plasma glucose of 10.5 mmol/L (3.0-6.0), HbA1c of 62 mmol/mol (20-46), and a cholesterol concentration of 5.5 mmol/L (<5.2). Which intervention would be most effective in reducing his cardiovascular risk?
A 28-year-old woman has been living with type 1 diabetes mellitus for 15 years and has been under your care for the past nine years. During this time, her HbA1c levels have fluctuated between 64 mmol/mol and 75 mmol/mol (20-42).
Today, her blood pressure reads 130/84 mmHg. She has also noticed that her blood glucose levels at home have been fluctuating more than usual over the past three months. Additionally, she reports experiencing nausea after eating and requiring less food than usual to feel full.
Upon conducting investigations, the following results were obtained:
– Urea: 8.1 mmol/L (2.5-7.5)
– Creatinine: 112 µmol/L (60-110)
– Sodium: 138 mmol/L (137-144)
– Potassium: 4.2 mmol/L (3.5-4.9)
– Bicarbonate: 24 mmol/L (20-28)
– HbA1c: 42 mmol/mol (20-42)
– Urinalysis: Protein+
What is the most likely cause of her symptoms?
A 36-year-old man visits his doctor’s office accompanied by his wife, who expresses concern that her husband has been acting strangely and not like himself lately. Upon questioning, the patient appears confused and complains of a persistent headache. The doctor conducts an examination but finds no additional signs. To investigate further, the doctor orders a full blood count with electrolytes and renal function, as well as a urinary analysis. The results reveal hyponatremia with reduced plasma osmolality and high urinary osmolality and sodium. Which medication is most commonly associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
A 52-year-old man comes to his General Practice for a routine check-up of his type 2 diabetes. He was diagnosed with diabetes eight months ago and has been taking metformin 1 g twice daily. His BMI is 30 kg/m2. The results of his laboratory tests are as follows:
Investigation Result Normal range
HbA1C 62 mmol/mol < 53 mmol/mol (<7.0%)
Creatinine 80 µmol/l 50–120 µmol/l
Glomerular filtration rate (GFR) 92 ml/min > 90 ml/min
What would be the most appropriate choice for managing this patient’s diabetes?
A 52-year-old male who works as a truck driver and has been diagnosed with type 2 diabetes for the past 8 years is due for his annual check-up. Despite being on maximum oral hypoglycemic therapy, his HbA1c levels are alarmingly high at 91 mmol/mol (20-42). He has not experienced any hypoglycemic episodes or developed retinopathy. You suggest switching to insulin, but he declines as it would result in him losing his HGV license and having to reapply. The DVLA is aware of his diabetes and current treatment. What is the most appropriate course of action in this scenario?
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 previously healthy 70-year-old man presents with his daughter, who reports that her father has been experiencing a poor appetite, weight loss of at least 4.5 kg, and lack of energy for the past three months. The patient denies any cough or fever, but he tires easily.
Upon examination, the patient appears subdued, is afebrile, and has an irregular pulse of 100 beats per minute and a blood pressure of 156/88 mmHg. Fundoscopic examination reveals grade II hypertensive changes, and the JVP is elevated by 8 cm. Crackles are heard at both lung bases, but the abdomen is normal. The patient has general weakness, particularly in the hip flexors, but the neurologic exam is otherwise unremarkable.
Laboratory investigations show a hemoglobin level of 110 g/L (115-165), a white cell count of 7.3 ×109/L (4-11), and a urea level of 8.8 mmol/L (2.5-7.5). What diagnostic test would be most helpful in establishing the diagnosis?
A 26-year-old female medical student experiences severe epigastric pain, following an evening indulging in large amounts of fatty foods. She went to visit her general practitioner (GP) who, upon further investigation, organised an analysis of her lipoprotein profile.
Analysis showed a deficiency of apolipoprotein (apo) C-II; all other lipoproteins were normal.
Which of the following profiles is plasma electrophoresis most likely to show?
A patient with lipoprotein lipase deficiency visits his General Practitioner (GP) for his regular blood test.
Which of the following results would you expect?