Transcript EXAMPLES FOR DISCUSSION

EXAMPLES FOR
DISCUSSION
CLINICAL CHEMISTRY COURSE
VIETNAM, 2010
SODIUM - 1
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Na1. A previously healthy man aged 18 falls from his moped and hits his
head on the road, with loss of consciousness. After admission to hospital
he is noted to pass 300 ml urine per hour while on iv normal saline support.
Na 154, K 4.1, Cl 117, Bic 26, urea 1.9, crea 85.
What is the likely cause of the polyuria?
What would you expect the urine electrolytes and osmotic pressure to
show?
Na2. A man aged 37 has suffered from manic-depressive episodes since
age 18, and has been on lithium carbonate treatment for several years with
reasonable control of his psychotic symptoms. He is admitted to hospital for
some minor surgery under general anaesthesia, and so has nil by mouth
from the previous evening. His overnight urine output is 1.6 L and he is
confused on waking from the anaesthetic.
At that time Na 156, K 4.0, Cl 115, Bic 28, urea 6.1, crea 100, albumin 49.
He is still passing 180 ml urine per hour and his blood pressure is 100/70,
pulse 100.
What is his problem? How could you confirm this? What would the urine
osmotic pressure and electrolytes show?
SODIUM - 2
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Na3. A woman aged 27 reports that she drinks 5 L water every day and that
she feels “terrible” if she is restricted.
Na 141, K 4.3, Cl 107, Bic 27, urea 2.9, crea 70.
Spot urine shows Na 26, K 20, osmotic pressure 157.
What could be the problem? How could you distinguish among the
possibilities?
Na4. A man aged 64 with type 2 diabetes moderately well controlled on oral
hypoglycaemic treatment is given 25 mg prednisone daily for arthritis of the
wrist. A week later he complains of polyuria and thirst and his glucose is 64,
Na 120. Why has the glucose increased?
Why is the sodium low?
Na5. A woman aged 76 has a 2-day history of vomiting and diarrhoea after
a meal of contaminated fish. She has “not been able to retain any food or
drink” for 36 hours.
Na 157, K 3.6, Cl 120, Bic 12, urea 21.2, crea 167, blood pressure 85/55,
pulse 104, Temp 36.5.
Explain the results and suggest the appropriate management.
SODIUM - 3
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Na6. A woman aged 65 has height 155 cm and weight 43 Kg. Her blood
pressure was 180/120, reduced to 140/100 with 2-drug treatment. She has
recently developed some congestive cardiac failure with oedema and has
recently had the addition of 50 mg hydrochlorothiazide to her daily pills.
She has had 3 falls in the last week.
Na 119, K 2.8, Cl 82, Bic 32, albumin 32, urea 9.8, crea 130.
Explain the results and give a basis for management.
What would you expect the arterial blood gas results to show?
Na7. A man aged 71 has had hypertension for 25 years, and he developed
dyspnoea on exertion with mild angina 4 years ago. These symptoms have
gradually increased, with orthopnoea and peripheral oedema over the last
12 months. He has had increasingly vigorous treatment with diuretics
(frusemide and recently added spironolactone) and antihypertensives (βblockers and ACE inhibitors). He can now walk only a few metres at home.
His blood pressure is 140/100, pulse 64, temp 36.6, oedema to knee and
over sacrum. Some creps at lung bases; oximetry shows 94% saturation on
room air.
Na 112, K 5.7, Cl 82, Bic 24, urea 11.4, crea 200.
Explain the abnormal results. What is a plan of management and what are
the risks?
SODIUM - 4
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Na8. A woman aged 81 has a fall and fractures the neck of left femur. This
is pinned at operation so that she can walk, but she is slow to mobilise
because of co-existing age related problems and needs much
encouragement. 2 weeks after the operation she is seen to have an
epileptic fit with post-ictal confusion.
Na 106, K 3.4, Cl 70, Bic 27, urea 2.9, crea 130.
Explain the abnormalities and suggest how this problem may have been
avoided.
Na9. A woman aged 49 has smoked since age 14. She now presents with
cough of 2 months duration, a little sputum which had blood staining
yesterday, a loss of 5 Kg in the last month and general weakness and
lassitude. On examination there is poor air entry at the left base.
Na 112, K 3.4, Cl 80, Bic 27, alb 21, GGT 324, ALP 249, ALT 41, AST 38,
bili 9.
Explain the electrolyte abnormalities, and how could you confirm your
diagnosis? What do the LFT indicate?
Suppose that the K had been 5.7. What extra suggestion(s) would you have
made?
SODIUM - 5
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Na10. A woman aged 64 is found to have Na 120. The intern says “SIADH”.
What are the necessary steps needed to confirm/refute this statement?
Na11. A man aged 47 was found in the sea after his small boat sank. The
following results were obtained on blood from his heart. Did he die from a
myocardial infarct or did he drown?
a) Na 131, K 12.2, Cl 100, Bic 3, Ca 2.37, Mg 1.39, phosphate 4.6.
b) Na 183, K 12.2, Cl 156, Bic 3, Ca 2.37, Mg 2.27, Phosphate 4.6.
Interpret each set of possible results in the light of the history and explain all
the abnormalities.
Na12. A child aged 9 presents with generalised oedema and oliguria
following a febrile illness. Urine dipstick shows albumin ++++. Plasma
shows Na 134, K 4.1, Cl 109, Bic 24, urea 3.1, crea 42, albumin 18,
globulin 48.
Interpret the findings and explain the oedema formation. What would you
expect the serum EPG to show?
POTASSIUM 1
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K1. A female patient aged 37 has end stage renal failure as a result of
glomerulonephritis, and she has been on 3 times weekly haemodialysis for
2 years. Usually her K predialysis is 6.0-6.5 and postdialysis 2.5-3.0. One
day she shows a slow pulse, high peaked T waves and a K of 8.4.
What may have occurred to cause this marked change from her usual
results?
K2. A male patient aged 45 with cirrhosis of the liver has been well
controlled on frusemide and ACE inhibitor, but he becomes progressively
more resistant to these drugs and his ascites and leg oedema gradually
become worse. Spironolactone is added to his therapy and after 2 months
his K is noted to be 6.7. Explain.
K3. A general practice which is 40 Km from the laboratory finds that about
40% of its blood samples show a K > 5.2. What questions would you ask in
trying to establish the cause of such results?
POTASSIUM - 2
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K4. A female patient ages 62 who is known to suffer from chronic
lymphocytic leukaemia shows a plasma K of 5.9. Her blood count shows
Hb 94, white cells 100, 45% lymphocytes, 50% “smear cells”, platelets 198.
What may be the cause of the high K?
K5. A female aged 19 reads on the Internet that “potassium is dangerous”
and she commences a diet that is essentially free from K. After a month she
is quite weak and is found to have K 2.1, Bic 39. Explain why this has
happened.
K6. A woman aged 28 eats contaminated food and vomits several times
over 24 hours, and then recovers. At the end of the vomiting period she
shows:
Na 147, K 2.7, Bic 35. Explain the abnormal results.
K7. Her daughter aged 6 has several vomits and also considerable
diarrhoea over 36 hours. At the end of this period she recovers, and shows:
Na 152, K 1.7, Cl 110, Bic 22, urea 6, crea 75. Explain the abnormal
results.
K8. Her younger brother, aged 18 months, has severe diarrhoea and some
vomiting, and is brought to the emergency with collapse. His pulse is 140
and weak, blood pressure 70/40 (normal 90/55). His results are:
Na 144, K 2.0, Cl 106, Bic 10, urea 5.1, crea 70. Explain the abnormal
results.
POTASSIUM - 3
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K9. A very thin woman aged 21 is found to have K 2.7, Bic 32, urea 2.0,
crea 50, pulse 70, BP 105/70. She denies taking any medications. What
may be the cause of her abnormal biochemistry? How may you obtain
confirmation of your suspicions? What are the long term risks?
K10. A male patient aged 37 has blood pressure 190/115, resistant to the
normal drug regimens. He is found to have K 2.7, Bic 33. What do you
suspect and how would you investigate?
K11. A man aged 65 who has untreated hypertension of 185/105 goes into
atrial fibrillation and develops signs of left ventricular failure with moist
crackles to mid zone bilaterally. He is prescribed digoxin (0.5 mg followed
by 0.25 mg daily) and a thiazide diuretic to reduce blood pressure and fluid
overload. His initial results are:
Na 139, K 4.1, Cl 104, Bic 25, urea 5.8, crea 190.
A week later he shows Na 136, K 2.7, Cl 96, Bic 32, urea 6.9, crea 200,
digoxin 3.4 (1.0-2.5). His pulse is 60, still in atrial fibrillation. Explain the
abnormalities that have developed and identify any risks to the patient. Is it
urgent to notify the doctor?
POTASSIUM - 4
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K12. A woman aged 43 has suffered from duodenal ulcer for years and
develops pyloric stenosis which requires a gastroenterostomy. Post
operation she is slow to recover normal bowel function and even on day 4
she has few bowel sounds and still requires gastric suction to control
nausea and vomiting. She has received approximately 2 L normal saline
and 1 L 5% glucose daily intravenously.
Na 132, K 2.3, Cl 94, Bic 33, urea 2.1, crea 110, albumin 32.
What factors have contributed to the low K? What effects may it have?
K13. A man aged 75 has a prostatectomy following an episode of urinary
retention. A week later he is found to have Na 140, K 2.6, Cl 115, Bic 14,
albumin 39, and his crea has returned to 140. What is the probable cause
of the abnormal results?
ACID BASE - 1
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AB1. A male patient aged 57 with known chronic renal failure has these
results:
Na 140, K 4.9, Cl 107, Bic 16, urea 24.3, crea 457. Explain the Bic.
What would you expect the blood gases to show?
AB2. Another male patient aged 52 from the same renal clinic has the
following results:
Na 140, K 4.9, Cl 114, Bic 10, urea 17.2, crea 317. What is the likely
problem(s) in this patient? How may the blood gas result differ from case
1?
AB3. Reconsider problems K 6, 7 and 8. Explain why the Bic results are so
different in the three patients.
AB4. A child aged 7 has a short stature and has suffered several bone
fractures with some residual deformity. His plasma shows:
Na 140, K 3.0, Cl 117, Bic 14, urea 3.2, crea 65, albumin 39, Ca 2.20, P04
0.63. Venous blood gas: pH 7.33, PCO2 22, PO2 25, Bic 13, Base excess
– 12.
How can you explain these results?
ACID BASE - 2
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AB5. What would you expect the arterial blood gas to be in patient K12?
AB6. A man aged 18 has a grand mal epileptic fit. Plasma results 10
minutes later are:
Na 138, K 5.8, Cl 104, Bic 4. Explain these results; what would you expect
results 3 hours later to show?
AB7. A man aged 67 comes to emergency complaining of crushing chest
pain and the ECG shows a STEMI with leads V2-V6 all affected. While
thrombolytic therapy is being instituted he suffers a VF arrest and needs 3
shocks to restore sinus rhythm. Plasma results at that time are: Na 140, K
5.9, Cl 104, Bic 6, urea 7, crea 120, bilirubin 3, GGT 32, ALP 95, ALT 42,
AST 36, Troponin I 0.12.
Next day: Na 138, K 4.6, Cl 103, Bic 9, urea 10, crea 210, bilirubin 32, GGT
40, ALP 97, ALT 7950, AST 8520, Troponin I 78.6.
Explain the findings, and suggest what may be the results on Day 4 if the
man is to make a recovery.
ACID BASE - 3
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AB8. A man aged 54 with a 45 pack year smoking history and a chronic
cough is normally slightly cyanosed and his exercise tolerance is limited to
slow walking on level ground for no more than 300 metres. Arterial blood
gas on room air shows:
pH 7.38, PCO2 42, PO2 60, Bic 24, Base excess -1. Explain these results.
He is admitted to hospital with worse cough and more marked cyanosis,
temperature 37.5 and severe dyspnoea. Arterial blood gas on room air
shows pH 7.32, PCO2 55, PO2 40, Bic 27, base excess -3. What has
happened?
After 3 days he is not much better but on 3 L oxygen by nasal prongs his
cyanosis has gone. pH 7.32, PCO2 58, PO2 72, Bic 34, Base excess + 4.
Explain the changes.
He recovers slowly from the infection and is sent home. 6 months later he
is confined to his room and has trouble walking to the toilet on account of
severe dyspnoea.
pH 7.35, PCO2 55, PO2 45, Bic 34, Base excess + 6. Explain the new
results. What would happen now with a respiratory tract infection? Would
access to oxygen therapy at home help?
ACID BASE - 4
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AB9. A woman aged 41 has had cystic fibrosis all her life and her lung
function has become worse over the last 10 years in spite of optimal
management. She is now considered to be terminally ill with severe
dyspnoea on the slightest exertion, and also chronic malabsorption. Her
plasma results are:
Na 134, K 2.1, Cl 76, Bic 52, urea 3.4, crea 35, albumin 16.
Arterial blood gas shows: pH 7.54, PCO2 57, PO2 (on 50% oxygen) 60, Bic
51, Base excess + 27, glucose 18. Explain the abnormal findings.
AB10. A woman ages 22 has a narrow escape from injury in a motor cycle
accident, and is very distressed afterwards. Arterial blood gas on room air
shows:
pH 7.59, PCO2 19, PO2 113, Bic 20, Base excess – 1. Explain.
4 days later she is still upset and afraid to go to work on a motor cycle.
Blood gas now shows pH 7.53, PCO2 20, PO2 112, Bic 16, Base excess
– 5. Explain the changes.
ACID BASE - 5
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AB11. A woman aged 78 has had Type 2 diabetes for 8 years and is
managed with oral hypoglycaemics and has a HbA1c of 7.1%. She
develops a urinary tact infection with temperatures to 38.5, anorexia and
confusion. Arterial blood gas shows:
pH 6.95, PCO2 22, PO2 81, Bic 4.5, Base excess - 23. Her plasma
biochemistry shows:
Na 140, K 5.2, Cl 104, Bic 4, urea 16, crea 320 (previously stable at 160).
What do you suspect has happened, what investigations would help to
confirm this?
AB12. A child aged 5 is found with a reduced state of consciousness and is
noticed to be breathing deeply. He had been noted to be less and less
active over the last 2-3 weeks.
Arterial blood gas on room air shows: pH 7.05, PCO2 10, PO2 115, Bic 3,
Base excess – 24. What may be the problem and what tests would you do
to confirm this? What history could help?
If this child had been perfectly normal until the day before, what further
causes would you consider? And how would you check on these?
ACID BASE - 6
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AB13. A woman aged 60 is making a good recovery in the intensive care
ward from sepsis for which she received flucloxacillin, vancomycin, nasal
oxygen and also paracetamol for chronic back pain. Arterial blood gas
shows: pH 7.14, PCO2 17, PO2 70, Bic 5, Base excess -16. What may be
the cause of her acidosis and what further tests could you do?
AB14. A man aged 74 is admitted with pneumonia. His systolic blood
pressure is 80 mm, his pulse rate 125 and temperature 34.6. Arterial blood
gases show pH 7.04, PCO2 30, PO2 54, Bic 8, Base excess – 14.
Plasma Na 134, K 5.1, Cl 103, Bic 7, albumin 23.
What may be happening? What other tests could you do to confirm your
suggestion?
ACID BASE - 7
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pH
pCO2
pO2
Sodium
Potassium
Chloride
Ion. Ca
Glucose
Hb
Bicarbonate
Lactate
7.37
31
106
141
3.0
104
1.19
12.6
130
18
6.3
Anion Gap 17
Base Excess -6.2
LIVER FUNCTION - 1
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LF1. Explain the liver function results in problems Na 9 and blood gas 7.
LF2. A woman aged 23 has not had any special vaccinations before a visit
to Vietnam. She goes walking with a party of friends. She is thirsty and
drinks water from a stream without any purification. On return to her home
country she has anorexia, nausea and general illness and then some
jaundice.
Total protein 80, albumin 38, bilirubin 220, GGT 50, ALP 95, ALT 4750, AST
3210, LD 1000. Interpret these findings.
A week later she shows: albumin 33, bilirubin 40, GGT 60, ALP 110, ALT
420, AST 70, LD 240. Explain the changes.
Some weeks later she feels almost normal but her LFT show:
Albumin 38, GGT 150, ALP 200, ALT 35, AST 30, LD 220. What may be the
cause of these residual changes?
LF3. A girl aged 16 comes to emergency looking anxious and complains of
nausea and anorexia. She has not been away from her home suburb for the
last weeks and has been attending school as usual.
Total protein 76, albumin 37, bilirubin 74, GGT 35, ALP 120, ALT 3400, AST
4020.
What may be the cause of this picture? What would you seek in the history
and what test(s) could you add to help?
LIVER FUNCTION - 2
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LF4. A healthy man aged 27 consults his doctor because he “has jaundice
again”. He has just had a mild upper respiratory tract infection but is nearly
recovered.
Total protein 80, albumin 42, bilirubin 65, GGT 27, ALP 90, ALT 25, AST 24,
LD 190, Hb 154, MCV 86, White cells 6.8, Neutrophils 4.9.
What is the likeliest cause of the jaundice? What test(s) could you do to
confirm?
LF5. A man aged 17 has suffered from idiopathic epilepsy since age 7 and
has responded well to drug treatment, currently phenytoin and valproate.
Findings are:
Total protein 75, albumin 41, bilirubin 8, GGT 230, ALP 250, ALT 30, AST 25
, LD 200, Hb 140, MCV 87, phenytoin 48, valproate 590.
Explain the LFT. What interaction is important between the antiepileptic
drugs? How may other factors influence these drugs?
LIVER FUNCTION - 3
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LF6. An American tourist aged 42 who has visited Bangkok and Ho Chi
Minh City asks for a check up a month after return home as he has indulged
in some sexual encounters while on holiday. He was vaccinated against
Hep A and B, and his Hep C and HIV tests are negative. Liver function tests
show:
Total protein 76, albumin 40, bilirubin 9, GGT 85, ALP 125, ALT 65, AST 50,
LD 225, Hb 150, MCV 87, WBC 7 Neut 5.
What is the likeliest cause of these results? What further biochemical tests
could help confirm this and what history would you ask for?
LF7. A man aged 67 who was previously well has lost 4 Kg in the last 3
months and has recently noticed some blood in his faeces. His tests show:
Total protein 64, albumin 26, bilirubin 4, GGT 210, ALP 190, ALT 25, AST
30, LD 400, Hb 122, MCV 76. What could explain all these findings? What
confirmatory biochemical test(s) could you perform?
LIVER FUNCTION - 4
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LF8. A man aged 27 has been a heavy drinker of various alcoholic drinks for years;
most days he would have at least 4-6 units (1 unit = 10 g alcohol) and on weekends
usually > 10 units each day. He recently lost his job because he arrived in the
morning with a blood ethanol of 2.3 g/L (50 mmol/L). He says he would like to reform;
his LFT show:
Total protein 76, albumin 36, bilirubin 7, GGT 136, ALP 90, ALT 74, AST 110, LD 230,
HB 146, MCV 104. Interpret these figures. What prognosis would you give for
normal liver function to be restored if he does indeed stop drinking? What other
biochemical tests could be relevant at this time?
LF9. The patient in LF8 sees his doctor 10 years later complaining of moderate to
severe epigastric pain that he has experienced for a couple of years, but this is the
worst attack. He admits that he has not managed to stop drinking but says he now
has “much less”. His sclerae show a trace of jaundice and he has 11 spider naevi.
Total protein 76, albumin 27, bilirubin 55, GGT 1290, ALP 125, ALT 69, AST 100, LD
230, Lipase 1270, Hb 136, MCV 102, prothrombin time 16 sec (INR 1.6), Fe 8, TIBC
65, sat 12%, ferritin 36. Do you believe his story? Interpret the test results and
outline the likely findings if a liver biopsy is performed.
LF10. 2 years later the patient in LF9 reappears with severe jaundice.
Total protein 67, albumin 16, bilirubin 390, GGT 120, ALP 100, ALT 35, AST 40, Hb
110, MCV 106, INR 2.1. Explain the results. What is the prognosis now?
ENDOCRINE - 1
E1. Analyse these sets of thyroid tests from patients A – L.
NUMBER
TSH
FT4
FT3
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0.90
15.6
5.7
B
2.37
14.7
5.3
C
4.90
12.3
4.9
D
1.56
7.30
3.9
E
27.5
11.3
4.1
F
27.5
4.2
3.9
G
0.12
19.7
5.9
H
0.09
21.4
6.7
J
0.08
9.72
4.1
K
<0.03
43.2
11.5
L
<0.03
19.6
7.6
ENDOCRINE - 2
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E2. A patient has been diagnosed as thyrotoxic and therapy commenced
with carbimazole. Pre-treatment TFT were:
TSH <0.03, FT4 47.3, FT3 12.4.
After 3 weeks therapy the TSH was still <0.03. Is she still toxic?
The FT4 was then assayed on this sample and found to be 19.7. Is she
euthyroid?
The FT3 was then assayed and found to be 8.7.
Explain these results.
2 months later TFT showed: TSH <0.03, FT4 6.3, FT3 3.9. Explain.
E3. A woman aged 45 has a TSH of 4.9. Follow-up FT4 is 14.9. All
antibodies are reported to be negative. Should she be given thyroxine?
6 years later she returns and TSH is now 31.5, FT4 is 9.7. Should she be
given thyroxine?
She is commenced on thyroxine 100µg per day and her TSH a month later
is 1.5, FT4 20.4. Three months later the results are essentially the same.
2 years later she returns and TSH is 102, FT4 3.5. What is the likely
reason? What other possibilities are there for this change?
ENDOCRINE - 3
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E4. A man aged 27 is found to have a TSH of 20.7, and his FT4 is 19.3, FT3
6.0.
What is the most likely reason for these discordant results? How could you
confirm your hypothesis?
E5. A hypothyroid child aged 2 finds the bottle of thyroxine tablets and eats
many. He is very thyrotoxic but is back to normal in 2 weeks. A woman with
acute onset Graves disease responds to carbimazole treatment and has
normal FT4 FT3 within a month. An old man with multinodular goitre who
becomes thyrotoxic following a CT scan with iodinated contrast medium
remains significantly thyrotoxic after 2 months of carbimazole treatment.
Explain.
E6. A child aged 11 complains of headaches and on examination is found to
have limitation of lateral vision in both eyes and skull X-ray shows an
expanded sella turcica. His height is at the 10th centile although at 2 years it
was at the 60th centile, and his weight is at the 5th centile. His endocrine
findings are:
TSH 0.7, FT4 5.3, morning CORT 150, prolactin 75, FSH and LH
undetectable, growth hormone undetectable after insulin induced
hypoglycaemia to1.9 mmol/L.
Analyse these results. Comment on the precautions needed with the insulin
test. Why does he not have polyuria?
ENDOCRINE - 4
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E7. A woman aged 28 has persistent lactation for 3 years following the
weaning of her second child and she has not conceived again since then.
Her vision is normal as are the visual fields. Results show:
TSH 1.3, FT4 15.4, FT3 5.2, morning CORT 515, FSH 1.5, LH 1.7, prolactin
915.
Explain the results. What would imaging of her pituitary show? Following
treatment with cabergoline her lactation ceases and she becomes pregnant.
Explain.
E8. A man aged 42 complains of impotence and lack of libido along with
feeling generally lazy. Physical examination shows no abnormalities except
that his skin appears soft and more delicate than usual in men. His results
show:
TSH 1.3, FT4 9.5, morning CORT 240, FSH 1.0, LH 1.5, testosterone 4.7,
prolactin 100. The endocrinologist requests a re-assay of the sample for
prolactin after dilution, and after a 1:20 dilution the prolactin result is 12500.
Explain the results and the prolactin problem. What would you expect his
imaging to show?
ENDOCRINE - 5
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E9. A newborn child becomes hypotensive and loses weight rather rapidly.
Results:
Na 118, K 5.7, Bic 16, glucose 1.5. He is resuscitated with normal saline
and glucose and given hydrocortisone, while awaiting urine analysis (taken
before hydrocortisone!!!), which shows 17-hydroxyprogesterone 230. He is
placed on a maintenance dose of (audience to supply suggestions) and
remains normal unless he is not given his pills. Explain his lesion.
E10. A healthy quite normal appearing woman aged 22 with a 28/5 regular
cycle has the following results:
TSH 1.2, FT4 16.9, morning CORT 490, FSH 0.9, LH 1.2, oestradiol <100,
progesterone 0.9. What is the explanation?
E11. A girl aged 10 has breast development stage 3 and some pubic hair for
6 months. Her oestradiol is noted to be 2700 and progesterone 104. Two
weeks later these have increased to 3600 and 130. What other tests
could/should have been done? What explanation can you give?
ENDOCRINE - 6
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E12. A woman aged 25 has a BMI of 31, some obvious hair on her upper lip
and a little residual acne. Her periods are irregular, and after 2 years
marriage she has not conceived. Her results 3 weeks after the start of her
last period are:
FSH 4.7, LH 8.9, SHBG 42, testosterone 3.9, FAI 9.1, androstenedione 14,
fasting glucose 6.3. What is the problem?
E13. A woman aged 37 develops irregular periods and wonders whether
she is becoming menopausal. At the end of her last period her FSH is 17,
LH 15, oestradiol 150. Is she correct?
E14. A patient with persistent hypertension of 190/120 is resistant to
therapy. Even with 3 antihypertensive drugs he is still at 165/105. His results
are:
Na 145, K 2.1, Bic 35. His aldosterone is 740 and his plasma renin activity
0.2 (aldosterone/renin ratio 130) when all his drugs have been stopped.
Analyse these results and suggest what the problem may be and how to
make a firm diagnosis.
Enzymes - 7
E15. Analyse the following sets of results in patients A - J
NUMBER
CORT am
CORT post
SYNAC
CORT post
DEX
ACTH
ACTH post
DEX
A
510
905
B
100
505
C
100
175
D
610
40
6
0
E
620
205
0
F
1200
1100
0
G
1200
1100
17.5
5
H
1200
1200
175
175
J
<30
370
5
<30
ENZYMES - 8
E16. Analyse the following sets of results and explain the findings
NUMBER
Ca total
PO4
ALBUMIN
Ca++
PTH
Vit D
A
2.37
1.15
40
1.16
47
74
B
2.27
0.82
39
1.12
123
39
C
1.58
0.64
36
0.91
403
15
D
2.87
0.81
39
1.30
70
70
E
3.94
1.57
28
2.15
3
59
F
3.72
1.62
37
1.99
5
450
G
1.25
0.50
19
0.64
30
20
H
1.30
1.97
38
0.62
4
57
I
2.08
3.52
30
0.99
642
53
J
1.92
4.03
28
0.87
2046
40