A.) Adrenal crisis
B.) Myxoedema coma
C.) Primary adrenal insufficiency
D.) Primary hyperthyroidism
E.) Primary hypothyroidism
F.) Secondary adrenal insufficiency
G.) Secondary hyperthyroidism
H.) Secondary hypothyroidism
I.) Thyroid storm
For each presentation choose the most appropriate diagnosis.
- A 43 year old woman presents with a 3 month history of weight loss, lethargy, weakness, decreased appetite, diarrhoea and nausea. Her vitals are Hr 76 bpm, BP 127/87 mmHg, RR 12 bpm, O2 sats 96% RA, temp 36.2°C, GCS 15. On exam her skin is hyperpigmented with striae over her abdomen and legs. Her initial VBG shows a K of 6.2 mmol/l, Na of 121 mmol/l and BSL of 3.5 mmol/L.
- A 43 year old woman presents with a 3 month history of weakness, lethargy, weight gain and hoarse voice. In the last few days she has had shortness of breath and decreased exercise tolerance. Her vitals are HR 54 bpm, BP 89/58 mmHg, O2 sats 99& on 15 L, RR 10 bpm, temp 35.2°C and GCS if 12 (E3, M5, V4). On exam she is periorbital puffiness, cool dry skin, non-pitting pre-tibial oedema and decreased air entry in the right base. Her initial VBG shows a K of 3.8 mmol/L, Na 141 mmol/L and BSL of 4.7 mmol/L.
- A 43 year old woman presents with a 3 month history of lethargy, weakness, diarrhoea and visual changes. In the last few days she has had palpitations and shortness of breath. Her vitals are HR 136 bpm, BP 154/68 mm Hg, RR 22 bpm, O2 sats 99% on 15 L, temp 38.2°C, GCS 14 (E4, M6, V4) and agitated. On exam she has warm moist skin, well perfused, sweaty and tremulous. Her initial VBG shows a K of 3.7 mmol/L, Na 138 mmol/L and BSL of 6.2 mmol/L.
- A 43 year old woman presents with a 3 month history of lethargy, weakness, diarrhoea and intermittent abdominal pain. In the last 2 days she has been vomiting. Her vitals are HR 127 bpm, BP 86/54 mmHg, RR 22 bpm, O2 sats 99% on 6L, temp 36.5°C, GCS of 13 (E4, M5, V4). On exam she is markedly dehydrated, has a large abdomen, thin limbs and purple marks on her abdomen and limbs. Her initial VBG shows a K of 2.9 mmol/L, Na 142 mmol/L and BSL of 5.6 mmol/L.
Author: J Haire
Ref: Tintinalli p.1444-56
A.) Acute glomerulonephritis
B.) Acute renal artery occlusion leading to intrinsic renal failure
C.) Aortic dissection leading to pre-renal failure
D.) Bilateral pyelonephritis leading to intrinsic renal failure
E.) Benign prostatic hypertrophy leading to postobstructive renal failure
F.) Goodpastures syndrome leading to intrinsic renal failure
G.) Haemorrhagic shock leading to pre-renal failure
H.) High-output cardiac failure leading to pre-renal failure
I.) Hypovolaemic pre-renal failure
J.) Ischaemic acute kidney injury causing intrinsic renal failure
K.) Lymphoma infiltration leading to intrinsic renal failure
L.) Microvascular thrombosis leading to pre-renal failure
M.) neurogenic bladder leading to postobstructive renal failure
N.) Urethral stricture leading to postobstructive renal failure
For each of these patients with acute renal failure select the most likely process.
- A 67 year old man who presents with 3 days of diarrhoea and vomiting on a background of poorly treated chronic hypertension. His medications include Lisinopril, Metformin and Ibuprofen.
- A 34 year old woman who is 31 weeks pregnant and presents with headache and visual disturbances.
- A 54 year old woman who presents with a 2 month history of weight loss, palpitations and anxiety who has warm sweaty skin, is hypotensive and tachycardic.
- A 76 year old man post-cardiac arrest.
- A 27 year old woman who had an upper respiratory tract infection 2 weeks ago presents with lethargy, darkening urine and pre-tibial pitting oedema.
- A 28 year old woman who presents with increasing lethargy, shortness of breath, cough and haemoptysis.
- 37 year old woman with multiple sclerosis presents with alternating oliguria and polyuria
Author: J Haire
Ref: Tintinalli p615-18