A 43-year-old man has a routine medical for insurance purposes. The following result is obtained:
He is well with no significant past medical history.
What is the most appropriate test to perform next?
Correct Answer A: Hyperuricaemia may be associated with both hyperlipidaemia and hypertension. It may also be seen in conjunction with the metabolic syndrome.
Hyperuricaemia: Increased levels of uric acid may be seen secondary to either increased cell turnover or reduced renal excretion of uric acid. Hyperuricaemia may be found in asymptomatic patients who have not experienced attacks of gout.
Hyperuricaemia may be associated with hyperlipidaemia and hypertension. It may also be seen in conjunction with the metabolic syndrome.
Increased synthesis:
Decreased excretion:
A 27-year-old man is reviewed in a fertility clinic. Semen analysis has revealed azoospermia. On examination at the previous appointment he was noted to be 1.83 metres tall with a body mass index of 25 kg / m2. A degree of gynaecomastia is noted, testicular volume is around 10ml bilaterally and his visual fields were normal.
Which investigation is likely to be diagnostic?
Correct Answer C: Klinefelter's? - do a karyotype.
Klinefelter's syndrome: Klinefelter's syndrome is associated with karyotype 47, XXY
Features:
Diagnosis is by chromosomal analysis
A 65-year-old woman is investigated for a 6 week history of worsening shortness of breath, lethargy and weight loss. Her past medical history includes chronic obstructive pulmonary disease, hypertension and she is an ex-smoker. Clinical examination is unremarkable. Investigation results are as follows:
Chest x-ray:
Blood:
What is the most appropriate management?
Correct Answer C: Despite a normal chest x-ray an ex-smoker with shortness of breath, weight loss and hyponatraemia should be investigated on an urgent basis for lung cancer. This approach is supported by current NICE guidelines. Whilst gastrointestinal cancer is a possibility the normal MCV is not entirely consistent with chronic blood loss.
Lung cancer: referral: The 2005 NICE cancer referral guidelines gave the following advice: Consider immediate referral for patients with:
Refer urgently patients with:
Refer urgently for chest x-ray for patients with any of the following:
Which one of the following molecules acts as the co-receptor for cells expressing antigens combined with HLA class I molecules?
Correct Answer D: Clusters of differentiation: The table below lists the major clusters of differentiation (CD) molecules:
You are asked to review some arterial blood gases (ABGs) done on a patient who has recently been admitted to the Emergency Department. The ABGs shown below were taken on air:
Which one of the following is the most likely cause?
Correct Answer E: The blood gases show a metabolic alkalosis.
Metabolic alkalosis: Metabolic alkalosis may be caused by a loss of hydrogen ions or a gain of bicarbonate. It is due mainly to problems of the kidney or gastrointestinal tract.
Causes:
Mechanism of metabolic alkalosis:
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