A 75-year-old male with type 2 diabetes needs better control of his blood sugar levels. He also has heart failure that is managed with furosemide, ramipril, and bisoprolol.
Which of the following hypoglycemic medications should be avoided in this patient?
What is a metabolic effect of exenatide?
A 35-year-old male with type 2 diabetes presents with a blood pressure reading of 140/85 mmHg and persistent traces of albuminuria in his urine examination. What is the most suitable course of treatment for this individual?
A 28-year-old woman visited her GP complaining of low mood, weight gain, and irregular menstrual cycles. The GP conducted some tests and referred her to the hospital. The results of the investigations were as follows:
– Sodium: 150 mmol/l (135–145 mmol/l)
– Potassium: 2.5 mmol/l (3.5–5 mmol/l)
– Fasting blood glucose: 7.7 mmol/l (5–7.2 mmol/l)
– 24-hour urinary cortisol excretion: 840 nmol/24 hours (<300 nmol/24 hours)
– Plasma adrenocorticotropic hormone (ACTH): undetectable
– Dexamethasone suppression test:
– 0800 h serum cortisol after dexamethasone 0.5 mg/6 hours orally (po) for 2 days: 880 nmol/l (<50 nmol/l)
– 0800 h serum cortisol after dexamethasone 2 mg/6 hours po for 2 days: 875 nmol/l (<50 nmol/l)
What is the most probable clinical diagnosis?
A 67-year-old man with a 20-year history of insulin dependent diabetes mellitus presents with a haemoglobin A1C of 10.3% (89 mmol/mol). He reports experiencing abdominal pain after meals for the past year, which has been gradually worsening. Upon physical examination, his abdomen appears normal. What is the most probable pathological finding in this patient?
A 56-year-old man is brought into the Emergency Department following a fall in the local supermarket. He is in an acute confusional state and unaccompanied, so a history is not available. Upon examination, the doctor noted digital clubbing and signs of a right-sided pleural effusion. The patient was euvolaemic.
Investigations:
Serum:
Na+ 114 mmol/l (135–145 mmol/l)
K+ 3.6 mmol/l (3.5–5 mmol/l)
Urea 2.35 mmol/l (2.5–6.7 mmol/l)
Osmolality 255 mOsmol/kg (282–295 mOsm/kg)
Urine:
Osmolality 510 mOsmol/kg (raised)
Na+ 50 mmol/l (25–250 mmol/l, depending on hydration state)
Which of the following could be the diagnosis?
A 50-year-old woman is brought to the Emergency Department after being found near-unconscious by her husband. He claims she has been increasingly depressed and tired over the last few weeks. Past medical history includes coeliac disease, for which she follows a strict gluten-free diet, and vitiligo. She is on no medical treatment. On examination, she is responsive to pain. Her pulse is 130 bpm and blood pressure is 90/60 mmHg. She is afebrile. Pigmented palmar creases are also noted. Basic blood investigations reveal:
Investigation Result Normal value
Haemoglobin 121 g/l 115–155 g/l
White cell count (WCC) 6.1 × 109/l 4–11 × 109/l
Platelets 233 × 109/l 150–400 × 109/l
Sodium (Na+) 129 mmol/l 135–145 mmol/l
Potassium (K+) 6.0 mmol/l 3.5–5.0 mmol/l
Creatinine 93 μmol/l 50–120 µmol/l
Glucose 2.7 mmol/l 3.5–5.5 mmol/l
What is the most likely diagnosis?
A 47-year-old female collapses at home and is referred to the medical team. She has had two episodes of haematemesis in the emergency department, but no melaena. Her family denies any history of alcohol excess, and she has been otherwise healthy.
Upon examination, the patient appears pale and sweaty with a pulse of 110 bpm. Her lying blood pressure is 95/60 mmHg, which drops by 30 mmHg systolic upon standing. Palmar erythema, purpura, and spider naevi are noted. There is no hepatomegaly, but a fullness is present in the left hypochondrium.
What is the appropriate course of action for this patient?
A 33-year-old male presents to the Emergency department with complaints of severe chest pain that has been ongoing for an hour. Upon examination, he is tall and slim with a blood pressure reading of 135/80 mmHg and an early diastolic murmur. The electrocardiogram reveals 1 mm ST elevation in II, III, and aVF. What is the best course of action in this situation?
A nervous 23-year-old man with a rapid breathing rate presents with the following arterial blood gas findings:
pH 7.27 (7.36-7.44)
PCO2 2.6 KPa (4.7-6.0)
Base excess −12 mmol/L
What is his acid-base status?