SAQ 1

Question 1

A 38 year old male presents on the ED with reduced consciousness and nausea. The patient has been in the UK 8 days, visiting from India. His examination findings are as follows:
RR- 19
HR-95 
BP-86/50
Temp- 37.3 

On closer examination you notice some bronze hyperpigmentation.

What biochemical abnormalities would you expect with this patient?

Answer 1

Hypoglycaemia, hyperkalaemia and hyponatraemia

Question 2

A 38 year old male presents on the ED with reduced consciousness and nausea. The patient has been in the UK 8 days, visiting from India. His examination findings are as follows:
RR- 19
HR-95 
BP-86/50
Temp- 37.3 

On closer examination you notice some bronze hyperpigmentation.

Name 2 causes of this presentation of this disease?

Answer 2

Infection or steroid withdrawal

Question 3

A 38 year old male presents on the ED with reduced consciousness and nausea. The patient has been in the UK 8 days, visiting from India. His examination findings are as follows:
RR- 19
HR-95 
BP-86/50
Temp- 37.3 

On closer examination you notice some bronze hyperpigmentation.

What is your initial management for this patient?

Answer 3

A-E assessment
IV hydrocortisone 100mg stat and then 100mg every 6 hours
IV fluid resuscitation
Correct hypoglycaemia by adding 5% dextrose to the fluids

Question 4

A 38 year old male presents on the ED with reduced consciousness and nausea. The patient has been in the UK 8 days, visiting from India. His examination findings are as follows:
RR- 19
HR-95 
BP-86/50
Temp- 37.3 

On closer examination you notice some bronze hyperpigmentation.

The patient is now stable, he has been diagnosed as have had an Addisonian Crisis, due to undiagnosed Addison’s disease.

Name one likely cause of this patients Addisons disease?

Answer 4

Any one from
TB
Autoimmune
Pituitary adenoma

Question 5

A 38 year old male presents on the ED with reduced consciousness and nausea. The patient has been in the UK 8 days, visiting from India. His examination findings are as follows:
RR- 19
HR-95 
BP-86/50
Temp- 37.3 

On closer examination you notice some bronze hyperpigmentation.The patient is now stable, he has been diagnosed as have had an Addisonian Crisis, due to undiagnosed Addison’s disease.

The patient is cultured for TB, what would a chest xray in a patient with TB show?

Answer 5

Caseating granuloma, usually in the upper zone

Hilar enlargement

Question 6

A 38 year old male presents on the ED with reduced consciousness and nausea. The patient has been in the UK 8 days, visiting from India. His examination findings are as follows:
RR- 19
HR-95 
BP-86/50
Temp- 37.3 

On closer examination you notice some bronze hyperpigmentation.The patient is now stable, he has been diagnosed as have had an Addisonian Crisis, due to undiagnosed Addison’s disease.

The cultures come back positive for TB, how do you treat this patient for his active TB?

Answer 6

Rifampicin
Isoniazid
Pyrazinamide
Ethanbutol

All for 2 months and then a further 4 months for Rifampicin and Isoniazid