If you find the material on this website useful, you will find that the two books ACES for PACES and KEYS to SUCCESS in Medicine complement the material on these sites and will enhance your studying and revision

 Best of Five 127

 

   

Home
Preparing for MRCP
Best of Five 1
Best of Five 2
Best of Five 3
Best of Five 4
BOF( Guest )
MRCP Part 2 BOF
MRCP Part 2 Images
PACES
MRCP theory examination topics
Books for MRCP
MRCP Courses
EMQS
OSCEs
Medical Finals & OSCE Courses
Recommended Reading
Forum
Links
ydr search engine
FAQ
Contributions
Authors
Privacy Policy
Contact

 

amazon astore

ACES for PACES

Medical Revision

Clinical Skills Blogspot

 

 

 

Google
Web ydr.org.uk
acesforpaces.com medicalrevision.org

BOF: 127

A 50-year-old male presents with malaise. He finds it difficult to cope with his work, sleeps poorly and has an itch especially at night.  He has difficulty climbing stairs and also finds it difficult to stand up from a seated position.  He had no significant past illnesses but had been told that he had high blood pressure years earlier but had taken no action regarding this.

On examination he underweight and pale. His skin was dry and covered in scratch marks. Blood pressure 190/110. No oedema. Heart sounds were normal, lungs were clear. Fundus showed arteriovenous nipping and thickened arteries.  On neurological examination it was noticed that he had difficulty standing from the seated position.

Investigations:

Hb 8.0

MCV 90 fl

WBC 4.8 x 10 9 /l

Na 138 mmol/l

K 6.1 mmol/l

Chloride 90 mmol/l

Urea 53 mmol/l

Creatinine 1850 micromoles/l

Calcium 1.40 mmol/l

Phosphate 2.31 mmol/l

Albumin 30 g/l

Fasting Blood Glucose 5.2 mmol/l

In this patient:

a)      Excellent control of blood pressure is not a priority as he is not diabetic

b)      Control of blood pressure is essential but care should be taken not to lower the blood pressure to less than 130/80 as this will compromise renal function

c)      ACE inhibitors should be avoided as they will cause further deterioration of renal function

d)      Treatment of hypertension with ACE inhibitors would be of particular value

e)      Low dose diuretics should be used so as to avoid dehydration which will further compromise renal function 

In this patient:

a)      Treatment of hypercalcaemia should aim to keep the PTH level below three times the upper limit of normal

b)      Calcitriol should be given immediately

c)      Dietary restriction of phosphate will control the high phosphate levels

d)      Calcium carbonate will reduce bioavailibilty of dietary phosphate

e)      H2 antagonists should be used to increase the effectiveness of phosphate binders

 

Back
Up
Next

Up ] Answer ]