Pathology EMQ template.

Name: Kiran Prabhu

Theme: Sodium handling

                 

OPTION LIST

 

A

39 mmol/l

I

Cushing’s disease

B

211.1 mmol/l

J

6 mmol/kg

C

SIADH

K

Diabetes Insipidus

D

115.2 mmol/l

L

Psychogenic polydipsia

E

13 mmol/kg

M

33 mmol/l

F

208.2 mmol/l

N

Primary hyperthyroidism

G

Pseudohypokalaemia

O

419.8 mmol/l

H

361 mmol/l

P

23 mmol/kg

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 17 year old girl presents to A+E with a 24hr history of polyuria, severe abdominal pain and nausea. Biochemistry on admission reveals; Na+ 138 mmol/l, K+ 4.2 mmol/l, Cl- 102 mmol/l, HCO3- 7.2 mmol/l, Glucose 18.7 mmol/l, Urea 8.3 mmol/l, Creatinine 96 µmol/l. What is the calculated anion gap?

 

2. A 63 year old man, with a fifty pack-year smoking history, complains to his GP of a one month history of worsening shortness of breath and haemoptysis. He seems disorientated and confused. Blood biochemistry reveals; Na+ 119 mmol/l, K+ 4.5 mmol/l, Cl- 84 mmol/l, HCO3- 25 mmol/l, Urea 3.2 mmol/l, Creatinine 97 µmol/l, Plasma osmolality 249 mmol/kg. Urine biochemistry reveals; Na+ 57 mmol/l, K+ 26 mmol/l, Urine osmolality 530 mmol/kg. What is the most likely diagnosis?

 

3. A 57 year old man with known Type 2 Diabetes Mellitus is brought in to A+E by his daughter. The man is confused, with gross sensory and motor impairments. Blood tests show; Na+ 146 mmol/l, K+ 3.9 mmol/l, Cl- 97 mmol/l, HCO3- 23 mmol/l, Glucose 54 mmol/l, Urea 7.2 mmol/l, Creatinine 147 µmol/l. What is the calculated plasma osmolarity?

 

4. The patient in question 3 is found to have a measured plasma osmolality of 367 mmol/kg. What is the osmolar gap?

 

5. A 25 year old medical students trips and hits her head hard on the table. Shortly afterwards she finds that she is very thirsty and drinking several litres of water because she has become more thirsty. She also wakes at night to pass urine, and drinks more water whenever she awakes. Na 130.  K 4.0.  U: 2.2  Cr: 57.

What is the diagnosis?

 

 

ANSWERS

1. M

2. C

3. H

4. J

5. L