6 Scenarios contain the text: 'hypercalcaemia' |
| Title | Description |
|---|---|
| Hypercalcaemia and back pain | A 62 year old woman sees her GP because of worsening lower back pain for the last 2 months. She has tried paracetamol and codeine, with no improvement in pain control. She has lost weight, lost her appetite and has been constipated for the last 3 weeks. Past medical history includes breast cancer treated with mastectomy 2 years ago. She is an ex-smoker with a 40 pack-year history of smoking. A blood test shows an elevated creatinine of 168 µmol/L (normal at 62 µmol/L 6 months ago), elevated adjusted calcium of 2.9 mmol/L and a normal full blood count. The serum IgG is elevated at 31 g/L. D/O: Clinical Biochemistry (•••), Haematology (•••), Palliative Medicine (•••), Oncology (••), Musculoskeletal System (•) PTT: Blood and lymph, Homeostasis |
| Chronic kidney disease / asymptomatic worsening renal function | A 45 year old Māori man is referred to you from by his GP. He was diagnosed with diabetes 15 years ago and routine monitoring of his renal function demonstrates a steadily increasing serum creatinine level. Renal ultrasound reveals small echogenic kidneys. His blood pressure is 150/92 mmHg. D/O: Genitourinary System (•••), Renal Medicine (•••), Ethics (••) PTT: Renal |
| Agitated and combative patient | A 68 year old NZ European man, with no fixed abode, presents under police escort to the Emergency Department agitated and aggressive. He has presented on previous occasions as intoxicated on alcohol, sedated and non-confrontational. He has also sometimes presented with physical symptoms that can’t be medically explained with the hope of acquiring an overnight stay in hospital. However, on this presentation he has threatened to punch you and the nursing staff when you discussed the need for him to stay in the Emergency Department for further investigations. D/O: Clinical Biochemistry (•••), Emergency Medicine (•••), Psychiatry/Health Psychology (••) PTT: Homeostasis |
| Alcohol and drug dependence disorders | A 54 year old NZ European male, recently separated from his wife, is a general surgeon working at a large metropolitan hospital. He also has a part-time private practice. He is seen in the Emergency Department with a history of having arrived at a work-related social event earlier in the evening in a 'slightly intoxicated' state, and then being found collapsed and comatose in the male toilets two hours later. A colleague called an ambulance. On examination, he has an impaired Glasgow Coma Score of 12 while no neurological localising signs are detected. His breath smells of alcohol and alcohol blood levels are twice the driving limit (160 mg/dL). His blood glucose is normal. There is no paracetamol in his blood and urine toxicology results for other drug metabolites are negative. His estranged wife, who is the next of kin identified on his medical records, confirms that he drinks heavily. She reports that, as of late, he has started his first glass of wine in the morning, 'to steady his nerves'. On average, he drinks about two bottles of white or red wine per night. His drinking increases on weekends, and at these times he often becomes inebriated. His busy work schedule and heavy drinking patterns resulted in their recent separation. They remain amicable however, and his wife has encouraged him to seek help for his drinking. You go to see him after he regains consciousness and start to discuss his drinking habits. D/O: Psychiatry/Health Psychology (•••), Emergency Medicine (••), Digestive System (•), Gastroenterology & Hepatology (•), Neurology (•) PTT: Mental health |
| Anxiety disorder | You are attached to a psychiatry outpatient clinic where a 50 year old South African married businessman sees the Consultant Psychiatrist you are shadowing complaining of feeling uptight, tense and questions whether he is heading for a 'nervous breakdown'. On three occasions in the past month, he thought that he was having a heart attack because of sharp chest pains and shortness of breath. Twice he went to the Emergency Department (ED) for treatment. Blood investigations and an ECG were normal and he was sent home both times with reassurance. On the last occasion the ED doctor thought that he was having a panic attack and suggested that he visit your outpatient clinic. He is fearful of having another similar episode. His mother gave him a tranquilizer (he has the name 'Ativan' written on a piece of paper which he shows you) and says that it made him calm and relaxed; he wants your Consultant to prescribe these for him. He also adds that he sleeps poorly. His GP diagnosed essential hypertension three years ago and he has been stabilised on a beta-blocker. D/O: Psychiatry/Health Psychology (•••), General Practice (••) PTT: Mental health |
| Neuromuscular disease / generalised muscle weakness | A 36 year old NZ European woman presents to her GP with generalised fatigue, weakness and dysarthria. She has no significant past medical history. D/O: Nervous System (•••), Neurology (•••), Palliative Medicine (•) PTT: Neurological |
| Title | Description |
