Thursday, January 24, 2013

Female With Acutely Painful Goiter

1:27 PM | Posted by Unknown | Edit Post

Clinical Vignette: A 40-year-old female with no prior history of thyroid disease, presents with a 5 day history of an acutely painful, left-sided goitre. Clinically she appeared euthyroid, and was apyrexial.
Investigations revealed the following:

  • Haemoglobin 13.0 g/dL
  • White cell count 7.0 x 109/l
  • Platelets count 200,000/mm3
What is the most likely diagnosis?
  1. De Quervain's thyroiditis
  2. Haemorrhage into a cyst
  3. Hashimoto's thyroiditis
  4. Staphylococcal abscess
  5. Thyroid carcinoma
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Saturday, December 25, 2010

Clinical Vignette: Young Married Woman With Amenorrhea and Jaundice

10:48 PM | Posted by Unknown | Edit Post
Clinical Vignette: A 27-year-old married woman with amenorrhoea of 7 months duration is found to have mild jaundice, hepatosplenomegaly, lymphadenopathy and palmar erythema.
Investigations show:
  •     Hb 10.4 g/dL
  •     WBC 2.8 × 109/L
  •     Platelets 72 × 109/L
  •     ESR 29 mm in first hour
  •     Plasma bilirubin 58 μmol/L
  •     Plasma AST 190 IU/L (normal range 5–35)
  •     Plasma ALT 105 IU/L (normal range 2–17)
  •     Plasma alkaline phosphatase 65 IU/L (normal range 30–100)
  •     Serum albumin 35 g/L
  •     Serum globulin 68 g/L
  •     Hepatitis B surface antigen negative
  •     Antinuclear factor positive at titre of 1/512
  •     Anti-smooth muscle antibodies positive
  •     Anti-mitochondrial antibodies positive at titre of 1/64
1 What is the diagnosis?
    (a) Primary biliary cirrhosis
    (b) Chronic active hepatitis
    (c) Wilson’s disease
    (d) Hepatitis C infection
    (e) Drug toxicity
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Thursday, December 23, 2010

Clinical Case: Newborn With Severe Acidosis, Vomiting, Hypotonia, and Neurologic Deficits

10:34 PM | Posted by Unknown | Edit Post
Clinical Vignette: A newborn presents with severe acidosis, vomiting, hypotonia, and neurologic deficits. Serum analysis reveals elevated levels of lactate and alanine. These observations suggest a deficiency in which of the following enzymes? 

            A. Alanine aminotransferase  
            B. Glutamate dehydrogenase 
            C. Lactate dehydrogenase 
            D. Pyruvate carboxylase  
            E. Pyruvate dehydrogenase 

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