Scenario 3 – Part 3: Part II: three months later The patient continued to have improvement of her fatigue. A significant improvement in her depressive illness was noted using a patient-rated Hamilton Scale for depression (HAM-D). Follow-up lab tests results showed the following: Test Value S. Creatinine 0.7 mg/dL S. Corrected Calcium 8.7 mg/dL S. Phosphorus […]
Scenario 3 – Part 2: The patient had been started on vitamin D3 (6000 IU/d) and was referred for detailed psychiatric assessment. Four weeks later, the patient reported feeling well with better energy. She was instructed to continue on the regimen as previously described. Appraise the above management plan in view of the […]
Scenario 3 – Part 1: A 40-year-old female with a long history of photophobia for several years, presented with muscle aches and fatigue for the last few months. Fatigue has been gradually developing, and the patient became unable to perform her daily activities. The patient has been treated for seizures for several years and […]
Scenario 2 – Part 3: The patient was started Vitamin B6, potassium citrate and lithotriptics. He was advised to have a moderate calcium diet and avoid oxalate, VIT-C and fatty food. Three months later, the patient had gradual improvement with normalization of his laboratory abnormalities. Suggest an approach to metabolic evaluation of uncomplicated calcium stone […]
Scenario 2 – Part 2: The patient had an ultrasonography showing bilateral multiple renal stones. Further laboratory investigations are shown in table 2 Test Value Urine volume 1.8 L 24-hr urinary calcium 390 mg/24hr (100-300 mg/24hr) 24-hr urinary oxalate 97 mg/24hr (<40 mg/24hr) 24-hr urinary uric acid 510 mg/24hr (250-750 mg/24hr) 24-hr urinary citrate 47 […]
Scenario 2 – Part 1: A 39-year-old male with a prior history of recurrent stone formation, presents with right-sided flank pain, burning urination and vomiting. On physical examination, there is tenderness over the right lumbar area. The patient had a history of sudden weakness for which he received several shots of Vit-D injection over the […]
Scenario 1 – Part 3: The patient had been treated with Intravenous fluids, diuretics, and calcitonin. Two weeks later, the patient’s symptoms had gradually improved and had been discharged with normal serum calcium and creatinine. Suggest a long-term management plan for this patient. Appraise the rationale of serum 25(OH)D3& 1,25(OH) D3 assay in assessment of […]
Scenario 1 – Part 2: On laboratory investigation the following results were obtained: 25 (OH) Vit D was 189 ng/mL, ESR 65 mm. Urine analysis did not show any blood or protein. Protein electrophoresis did not reveal any monoclonal bands. Brain, abdominal and chest imaging were all normal. What is the most likely cause of […]
Scenario 1 – Part 1: A 52-year-old male with a past medical history of hypertension and atrial fibrillation, presents with a two-week history of lethargy and polyuria. On examination, Blood pressure was 105/62mm/Hg, heart rate was 110/min. The patient had been maintained on bisoprolol 10 mg, rivaroxaban 2.5 mg BID, Aspirin 75 mg and lisinopril […]
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