A patient had shown rapid onset of hypertension and hyperglycaemia. In addition, they were showing initial signs of hyperpigmentation i.e. abdominal striae and they were also complaining of a persistent cough and difficulty in sleeping. The patient was subsequently referred for dexamethasone suppression tests (DEX). The results of these tests and additional further blood tests are shown below. Variable Urea (mm) Creatinine (mm) Cortisol (nM) (after a low dose DEX) Cortisol (nM) (after a high dose DEX) ACTH (PM) (after a high dose DEX) K+ (mm) Result 6.2 79 750 747 152 2.35 Reference Range 2.5-7.0 60-120 138-690 138 - 690 <26 3.5-5.0 Based on the patient presentation and the test results in the table, state what is the most probable diagnosis, and also the most common specific cause underlying this diagnosis. (20 words)
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- An old patient suffers from difficulty in evacuation process and lose of weights. During the diagnostic procedures, the physician examine his bowel sounds and identify the presence of mild ascites. He also noted the following symptoms and signs: Phlebitis, Aphthous ulcer, episcleritis and spider naevus. His total bilirubin is 1.5 mg/dl , albumin is 4 g/dl and prothrompine time is 3 sec. laboratory measured In addition, skip lesions between healthy areas diagnosed during the study of the inside of view of the entire colon. A) Calculate and explain the scoring for the Child-Pugh Grading with this case and identify his class. B) Identify the specific types of diseases he is suffering from and the physical examination that used in this case.A 25-year-old female presented to her 28 week antenatal appointment with the complaint of lethargy. It was noted the patient appeared pale. A full blood count was taken. Pateints HB,HCT,MCV,MCH was low but RDW was high. expalin why it is microsytic anemia and not macrosytic anemia analyse the blood film provided below. Provide a detailed diffrential diagonises refering back to blood film.A 65-year-old m a n with a 5-year history of alcoholic cirrhosis comes to the physician for a follow-up examination. Physical examination shows palmar erythema, gynecomastia and moderate ascites. Laboratory studies show an increased prothrombin time. Replacement of which of the following coagulation factors is most likely to improve this patient’s prothrombin time ?A) Factor VII (proconvertin)B) Factor VIII (antihemophilic factor)C) Factor IX (plasma thromboplastin component) D) Factor X (Stuart factor)E) Factor XI (plasma thromboplastin antecedent) F) Factor XII (Hageman factor)
- A female who is 36-year-old, experienced a recent weight loss. Her tongue was red and fissured. She also complained of chronic fatigue and shortness of breath upon exertion. Physical examination suggested signs of jaundice and increased numbness and a tingling sensation of fingers and toes. She was hospitalized with the general diagnosis of moderate anemia, jaundice, and neurological symptoms. Her admitting CBC demonstrated the following laboratory results: RBC: 2.5 X 1012/L WBC: 4.5 X 109/L Hb: 10.0 g/dL Hct: 31% MCV: 124.0 fL MCH: 40.5 pg/dL MCHC: 32.7 gm/dL RDW: 21.2 PLT: 155 X109/L WBC Differential Lymphs: % 36.0 Monos: % 3.8 Neutrophils: % 59.4 Eosinophils: % 1.0 Basophils: % 0.0 NRBCs/100WBCs: 5 The blood film shows anisocytosis and Poikilocytosis in which moderate hyper-segmented neutrophils and abnormal erythrocyte morphology was reported: Macrocytes, Ovalocytes with presence of basophilic stippling and occasional Howell-Jolly bodies. Also, 50 pg/mL (Low) Folate 10.3…A 30-year-old woman arrives at the outpatient department complaining of nausea and vomiting. The patient seems to have jaundice as well. Blood and urine tests are ordered in the laboratory. The following are the results collected from the testing: • Complete Blood Count o Hemoglobin:Normal o WBCcount:Normal • Serum Bilirubin o Total:7.0mg/dL o Conjugated:6.0mg/dL • Serum Enzymes o AlanineTransaminase(ALT):330U/L o AlkalinePhosphatase(ALP):195U/L • Urinalysis o Appearance:Darkbrown o Bilirubin:Positive o Urobilinogen:Decreased ANSWER THE FOLLOWING: 1. Interpret and correlate the patient’s laboratory results. 2. Discuss the possible causes of jaundice in this patient. 3. What part of the bilirubin pathway is severely affected? Explain. 4. What other serum enzyme/s can be used to assess the patient’s condition? Explain.A 25-year-old female presented to her 28 week antenatal appointment with the complaint of lethargy. It was noted the patient appeared pale. A full blood count was taken. Pateints HB,HCT,MCV,MCH was low but RDW was high. i know its microsytic anemia. I am finding it hard to analyse the blood film. Provide a detailed diffrential diagonises refering back to blood film
- A 20 year old man presented with jaundice and tiredness. On investigation his AST was 150IU/L, ALT was175IU/L and bilirubin was 4.5 mg/dl.Serum ceruloplasmin level where found to be low. Which mineral is required to treat this condition?A 42 – year old man experiences respiratory difficulty followed by the appearance of blood – streaked sputum. A chest radiograph shows pulmonary infiltration and sputum culture is negative for pathogens. Symptoms of extreme fatigue and red urine is present. Blood test results indicate anemia, increased BUN and creatinine and the presence of anti – glomerular basement membrane antibodies. A. What is the possible condition of the patient? B. Discuss the pathophysiology of the disease/disorder.A 62-year-old man is initially seen in the Emergency Room complaining of difficulty with speech and swallowing due to an enlarged tongue. Physical examination also reveals a large, sublingual hematoma. In addition, multiple ecchymoses of his skin are noted. He has no history of trauma nor has there been any pervious episodes of bleeding. Coagulation studies show: Platelet Count: 180,000/cumm PT: 12 sec APPT: 72 sec TCT or thrombin time: 10 sec Fibrinogen: 225% Additional laboratory studies reveal: (Mixing Studies) Normal plasma: 20% 50% 80% Patient plasma 80% 50% 20% Repeat APPT: 72 sec 70 sec 68 sec Question: What additional Laboratory test to confirm the diagnosis? Give the relevance of the laboratory tests ordered to the case. Why it is necessary?
- A 62-year-old man is initially seen in the Emergency Room complaining of difficulty with speech and swallowing due to an enlarged tongue. Physical examination also reveals a large, sublingual hematoma. In addition, multiple ecchymoses of his skin are noted. He has no history of trauma nor has there been any pervious episodes of bleeding. Coagulation studies show: Platelet Count: 180,000/cumm PT: 12 sec APPT: 72 sec TCT or thrombin time: 10 sec Fibrinogen: 225% Additional laboratory studies reveal: (Mixing Studies) Normal plasma: 20% 50% 80% Patient plasma 80% 50% 20% Repeat APPT: 72 sec 70 sec 68 sec Questions: What additional Laboratory test to confirm the diagnosis? Give the relevance of the laboratory tests ordered to the case. Why it is necessary?A 62-year-old man is initially seen in the Emergency Room complaining of difficulty with speech and swallowing due to an enlarged tongue. Physical examination also reveals a large, sublingual hematoma. In addition, multiple ecchymoses of his skin are noted. He has no history of trauma nor has there been any pervious episodes of bleeding. Coagulation studies show: Platelet Count: 180,000/cumm PT: 12 sec APPT: 72 sec TCT or thrombin time: 10 sec Fibrinogen: 225% Additional laboratory studies reveal: (Mixing Studies) Normal plasma: 20% 50% 80% Patient plasma 80% 50% 20% Repeat APPT: 72 sec 70 sec 68 sec Question: What additional Laboratory test to confirm the diagnosis? Give the relevance of the laboratory tests ordered to the case. Why it is necessary?The additional test is von willebrand test because it's specific for clotting factor 8. Why is it necessary?An 8-month-old infant presents to the emergency department with a 2-day history of diarrhoea and poor fluid intake. On clinical examination, capillary refill time is 3 seconds and you assess the level of dehydration as 10%. Of the following intravenous fluids, the most appropriate for immediate use is:a. 5% dextrose with 0.45% salineb. Normal salinec. Lactated Ringer'sd. 5% dextrose with 0.9% saline