JAWAL-3LMNY

CASE SCENARIO ,,, A 65 year old white woman is brought to the emergency room by her family for increasing confusion and lethargy over the past week. She was recently diagnosed with small cell cancer of the lung. She has not been febrile or had any other recent illnesses. She is not taking any medications. Her blood pressure is 136/86 mmHg, heart rate 84 bpm, and respiratory rate 14 breaths per minute and unlabored. She is afebrile. On examination she is an elderly appearing woman who is difficult to arouse and reacts only to painful stimuli. She is able to move her extremities without apparent motor deficits, and her deep tendon reflexes are decreased symmetrically. The remainder of her examination is normal, with a normal JVP and no extremity edema. You order some laboratory tests, which reveal the serum sodium level is 108 mmol/L, potassium 3.8 mmol/L, bicarbonate 24 mEq/L, blood urea nitrogen 5 mg/dL, and creatinine 0.5 mg/dL. Serum osmolality is 220 mOsm/kg, and urine osmolality is 400 mOsm/Kg. A CT scan of the brain shows no masses or hydrocephalus.

• What is the most likely diagnosis?
• What is your next step in therapy?
• What are the complications of therapy?

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CASE SCENARIO ,,,  A 28 year old female teacher complaining of increased irritability and anxiety. Her changes in personality has been noticed by her husband and colleagues at work. She feels constantly restless and has difficulty concentrating on a subject for more than a few moments. Her increased anxiety has developed over the past three months. She  has lost 6 kg in weight despite a healthy appetite. She has also noticed an increased frequency of bowel movement. Her periods have become lighter and shorter. She feels extremely tired, sweats profusely and cannot tolerate hot weather. She has no significant illnesses previously. She is married with no children. She is a non-smoker and drinks 10 units of alcohol per week.

On examination she appears agitated and her hands are sweaty and tremulous. Her eyes appear prominent with lid retraction. Her pulse is 104, regular and blood pressure 130/70. Examination is otherwise normal. CBC with only bicarbonate of 22 mmol/l, rest in normal.

What is the most likely diagnosis? And how would you manage this patient?

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CASE SCENARIO ,,, A 56 year female complaining of increasing tiredness over the past few months. She feels depressed and her husband has noticed her altered mood. She is sleeping poorly and tends to wake up early but denies any suicidal ideas. She also complains of mild nausea and constipation and noticed that she has been more thirsty and passing urine more often. Her legs also ache. She had two episodes of renal colic in the past three years. She has no significant past medical history. She is married and has three grown up children. She is a non-smoker and is on no medications.

On examination, the patient appears to have a rather flat emotional appearance with a poverty of facial expression. Her pulse is 76/min, blood pressure 168/94, JVP not raised, heart sounds normal with no peripheral edema. Examination of her respiratory, abdominal and neurological system is normal.

Investigations: Calcium 3.25 mmol/l, Phosphate 0.8 mmol/l alkaline phosphatase 323 IU/L

What is the likely explanation for this presentation?

How would you investigate and manage this patient? (أكمل قراءة بقية الموضوع ….)

T & F

Graves’ Disease:

1. Is the most common cause of hypothyroidism
2. Is the result of an autoimmune process
3. Is associated with TSH receptor antibodies
4. Has a natural history of remissions and relapses
5. Patients may eventually may be hypothyroid

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T & F

Causes of goitre include:

1.Lymphomas
2.Hashimotos Disease
3.Iodine Deficiency
4.Sulphonylureas
5.Sarcoidosis

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T & F

The following may be features of thyrotoxicosis of any aetiology:

A. Artial fibrillation

B. Pre-tibial myxoedema

C. Lid retraction

D. Menorrhagia

E. Proptosis

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Vit. D effect on bone depends on plasma level of Ca
Low plasma Ca –> Vit. D will increase bone resorption –> increase plasam Ca
Normal plasma Ca –> Vit. D will increase bone mineralization –> decrease plasma Ca

This info is from Bedro.

Thanx Bedro

T & F

Typical biochemical findings in primary hyperparathyroidism include:

A. Increased serum calcium and phosphate concentrations

B. Decreased serum 1,25-dihydroxy-cholecalciferol concentration

C. Hypercalciuria and hyperphosphaturia

D. Increased serum alkaline phosphatase with bony involvement

E. Increased serum calcium and PTH concentrations

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