A 32-year-old woman visits her General Practitioner with complaints of muscle weakness and twitching throughout her body. During the consultation, she also mentions experiencing occasional palpitations, which she had attributed to anxiety and a lack of appetite. The patient has a medical history of Crohn’s disease and chronic diarrhea. What is the most probable abnormality that will be detected in her blood test results?
A 70-year-old man has been experiencing increasing pain in his left hip for the past six months, resulting in severe limitations in movement. Upon examination, there is significant restriction in flexion and external rotation of the left hip. An X-ray of the hip reveals significant joint deformity with loss of joint space and extensive new bone growth. The possibility of Paget’s disease is being considered. What is the most likely elevated factor in this case?
An 87-year-old man is admitted with fever, nausea and diarrhoea for four days. Stool culture grows Escherichia coli. His laboratory results are as follows:
Investigation Result Normal value
Sodium (Na+) 136 mmol/l 135–145 mmol/l
Potassium (K+) 3.0 mmol/l 3.5–5.0 mmol/
Magnesium 0.2 mmol/l 0.75 –1.00 mmol/l
Urea 11 mmol/l 2.5–6.5 mmol/l
Creatinine 78 μmol/l 50–120 μmol/l
Which of the following should be used to manage his hypomagnesaemia?
A 35-year-old man is brought to your Emergency Department after falling off a ladder while working on his roof. He has been evaluated at the scene and transported for further evaluation and treatment of a severe head injury.
Upon arrival, an arterial blood gas is obtained: pH 7.2, PaCO2 8.0 kPa, PaO2 8.0 kPa, HCO3− 24 mmol/l, base excess −0.5 mmol/l.
What is the abnormality indicated by this blood gas?
An 82-year-old woman visits her GP complaining of increasing weakness all over her body. She had recently been hospitalized for a severe chest infection and heart failure. The GP notes that she is taking bendroflumethiazide, furosemide, aspirin, and atorvastatin. The GP conducts a physical examination, which reveals nothing significant, but orders some routine blood tests. The results show a hemoglobin level of 93 g/l, MCV of 84 fl, WCC of 5.9 × 109/l, and platelets of 108 × 109/l. Her U&Es show a sodium level of 129 mmol/l, potassium level of 2.1 mmol/l, urea level of 12.2 mmol/l, and creatinine level of 146 μmol/l. Her blood glucose level is 9.6 mmol/l, and her CK level is 112 iu/l. Which of these blood results is likely causing her weakness?
A 67-year-old woman comes to the General Practice complaining of lethargy and fatigue. She had undergone abdominal surgery for ulcerative colitis and was discharged from the hospital recently. She is waiting for the reversal of a stoma and has been experiencing profuse diarrhoea and high output from the stoma. Her routine blood tests are normal, except for a significantly low magnesium level. What is the best course of action to correct her magnesium levels?
A 70-year-old man with a history of chronic obstructive pulmonary disease (COPD) is admitted with a one-day history of symptoms suggestive of severe pneumonia. Before admission, he had become increasingly confused. On examination, he is drowsy; his oxygen saturations were 90% on room air, blood pressure 142/75 mmHg and pulse 98 bpm, with coarse crackles in the right lung on auscultation. He is clinically euvolaemic. A chest X-ray reveals dense right lung consolidation. Computed tomography (CT) of the brain is normal. While in the Emergency Department, he has a tonic–clonic seizure.
Investigation Result Normal value
Sodium (Na+) 112 mmol/l 135–145 mmol/l
Potassium (K+) 3.9 mmol/l 3.5–5.0 mmol/l
Glucose 5.2 mmol/l 3.5–5.5 mmol/l
Urea 2.4 mmol/l 2.5–6.5 mmol/l
Creatinine 64 μmol/l 50–120 μmol/l
Plasma osmolarity 261 mOsmol/kg 280–295 mOsmol/kg
Thyroid-stimulating hormone (TSH) 3 µU/l 0.17–3.2 µU/l
Random cortisol 450 nmol/l
9 am: 140–500 nmol/l
Midnight: 50–300 nmol/l
Urine osmolarity 560 mOsmol/kg 300–900 mOsmol/kg
Urine sodium 55 mmol/l
What is the most appropriate management of this patient’s hyponatraemia?
A 45-year-old man visits his General Practitioner (GP) complaining of generalised aches, especially in his knees when he walks. He also feels like his muscles are weaker now despite maintaining the same exercise routine as always. The GP notices that the patient is wearing long sleeves and trousers despite the warm weather, and the patient admits to disliking the sun. Upon conducting a blood test, the GP discovers low levels of calcium and phosphate. What is the most probable diagnosis for this metabolic bone condition?
An 80-year-old woman, who has been homebound for several years due to difficulty with mobility, presents with worsening bone pain. She appears unsteady on her feet but has no other specific complaints. Laboratory tests are conducted.
Investigation Result Normal value
Haemoglobin 118 g/dl 115–155 g/l
White cell count (WCC) 5.8 × 109/l 4–11 × 109/l
Platelets 240 × 109/l 150–400 × 109/l
Calcium 2.01 mmol/l 2.20–2.60 mmol/l
Phosphate 9.8 mmol/l 15–50 mmol/l
Alkaline phosphatase 450 IU/l 30–130 IU/l
What is the most probable diagnosis?
A 56-year-old man is suspected of having bone disease.
The following results are obtained:
Plasma
Investigation Result Normal range
Corrected Ca2+ 1.85 mmol/l 2.20–2.60 mmol/l
Albumin 42 g/l 35–55 g/l
PO43− 0.7 mmol/l 0.70–1.40 mmol/l
Alkaline phosphatase 180 IU/l 30–130 IU/l
Which of the following diagnoses is consistent with these results?