Case Study 1

Question 1

Patient comes in with a fit, what common causes do you need to exclude via bloods?

Answer 1

Hypocalcaemia
Hyponatraemia
Hypoglycaemia
Hypokalaemia

Question 2

What are the normal U & E ranges?

Answer 2

Na+ – 133–146 mmol/ L

K+ – 3.5–5.3 mmol/ L

Ca2+(adjusted) – 2.2-2.6 mmol/L

Urea – 2.5 – 7.8 mmol/L

Creatinine – (♂ 59–104 μmol/ L) // (♀ 45–84 μmol/ L)

Question 3

What is the commonest brain tumour?

Answer 3

A metastases

Question 4

The patient now has bi lateral adrenal enlargement and lesions in the liver- what test is required?

Answer 4

9 AM cortisol
ACTH
SynACTHen

Question 5

Patient has adrenal masses and low 9am cortisol/ high ACTH- what is the most likley diagnosis?

Answer 5

TB induced addisons disease

Question 6

How does TB look histologically?

Answer 6

Well formed confluent epithelioid granulomata with necrosis and multinucleated giant cells

Caseating granulomata

Question 7

What is the treatment for systemic TB?

Answer 7

4 antibiotics for 2 months and then 2 antibiotics
Isoniazid
Rifampacin 
(Pyrazinamide)
(Ethambutol)