Interpretation of Results

Dr. Esther Tsang

August 2011

Case One

Asymptomatic patient, 34/female Hb 9.1 g/dL, WBC 7.4, platelets 455 MCV 65 fL, MCH 23 pg

What kind of anaemia is this?

Which parameters do you look at?

What are the two main differential diagnoses?

Name 3 main investigations to send.

PBF as follows :

What are the abnormalities seen?

What are the possible causes for this diagnosis?

Case Two

40/male Breathlessness Hb 5.0 g/dL, Plt 125, TWC 3.9 MCV 100fL

Name three differential diagnosis?

How do you confirm your differential diagnoses?

Some other results comes back abnormal

What is your diagnosis now?

Is there another test to support your diagnosis?

What are the other differential diagnosis of macrocytic anemia?

Case Three

Elderly lady with hypertension comes with confusion.

BUSE as follows :

What are the abnormalities?

What are the possible differential diagnosis?

You decide to give him 1 pint NaCl 3% over one hour.

The next day, his Na was 149 mmol/L. However, he is quadriplegic and his GCS was M3V2E2.

What do you think occurred?

What is the indication for fast correction of Na?

What is the safe rate of correction of Na?

Case 4

25/male was admitted for generalized weakness.

BUSE :

What is the abnormality?

You order an ECG : what do you see?

How do you correct the potassium?

Case 5

60 year old lady with DM presented with tachypnoea.

ABG as follows : pH 7.3 PaO2 12kPa PaCO2 3.0kPa HCO3 11.0 mmol/L

How do you interpret the ABG?

Why is she tachypnoeic?

What are the possible causes of metabolic acidosis in this patient?

The renal profile is as follows : Na 134 K 5.7 Urea 23.0 Creat 500

What are the abnormalities on the renal profile?

How would you manage the hyperkalaemia?

What are the possible causes of renal failure in this patient?

How will you investigate this patient?

UFEME shows protein +++ nitrates ++ RBC++ Leu+ Ketone negative

How would you interpret the results?

Case 6

60 year old man with yellow eyes and skin LFT

TP 65 Alb 24 Bilirubin 85 ALT 20 ALP 200

Identify the abnormalities.

How would you further investigate him?

What are the possible causes of his problem?

Case 6

28/male Asymptomatic, health screening showed the

following : TP 60 Alb 40 Bilirubin 5 ALT 120 ALP 40

What is the abnormality?

Name 3 possible causes :

What other investigations would you order?

Case 7

70 year old lady, admitted with fever and bruising.

FBC Hb10, TWC 4.0, Plt 100 Coagulation profile :

PT 32s INR 3.0 APTT 60

Identify the abnormalities.

What is the diagnosis?

What other investigations to support this diagnosis?

What are the causes of this disorder?

Case 8

70/male with acute breathlessness

CXR as shown Identify the

abnormalities

Case 9 70/female with

acute breathlessness

CXR as shown What are the

abnormalities?

Case 10 25/male, acute

breathlessness CXR shown What

abnormalities?

Case 11 30/male Cough for 4

months What

abnormalities?