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 Best of Five 124

 

   

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BOF: 124

A 30-year-old Chinese patient presents with a history of weakness of both lower and upper limbs. The weakness started overnight in his lower limbs and spread to involve the upper limbs as well.

The patent had been well till then and had not had any diarrhoea or vomiting. He had not lost any weight. There were no significant past illnesses.

On examination he looked well, fully orientated in place, time and person.  No evidence of weight loss, temperature 37°C. Pulse rate 65 beats per minute regular. BP 120/60. No rash, skin warm and dry. No lymphadenopathy.

On neurological examination of his limbs tone was normal there was weakness of all four limbs, reflexes were diminished, plantars downgoing, no sensory loss.

Investigations

FBC normal

ESR not elevated

LFTs normal

Glucose 7.5 mmol/l

Na 140 mmol/l

K 1.6 mmol/l

Chloride 104 mmol/l pH 7.39

In this patient, whilst awaiting the results of his blood tests, what bedside investigation would give you a clue to the cause of the patient’s weakness?

a)      ECG

b)      Tidal volume

c)      Urine for ketone bodies

d)      Urine analysis

e)       Specific gravity of urine

What other investigation would you arrange for this patient to determine the aetiology of his condition?

a)      Thyroid function tests

b)      Overnight dexamethasone suppression test

c)      Aldosterone plasma rennin activity ratio

d)      Chest x-ray

e)      Adrenal CT scan

 

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