TSR Med Students' Society Part III

Is that in Coventry? If it was: I was in there back in feb!

Hi, could I have some help with these 2 patient scenarios? One of my tutors has taken to giving us long lists to do 'in our spare time.' There is NO SPARE TIME!!

They're all really long so to summarise:

1. 5 year old male with intermittent severe stomach cramps & anorexia that often mean he is not able to go to school. No infection or funny blood results, otherwise in good health. Mother convinced this is more than just school anxiety.

2. 23 year old female with polydipsia (4-5L) and polyurea BUT urine is not clear/unusually light. Urine dipstick normal. Patient complains of fatigue and headaches.

1. Abdominal migraine?
2. Potentially just drinking too much water.......the lazy answer
or can anyone think of some kind of syndrome/disease? I don't know if I'm just being really stupid, but I can't think of any other conditions that make you thirsty apart from diabetes M & I, and obv they're both ruled out...

Thanks

Write the full history!

Help... I was fairly sure I knew what we were doing this week, until I got todays email. Now I'm just confused. Do we have stuff today?! I just want to go back to bed...

This may or may not have been spotted several days ago by some mods, and the reaction of certain older BL medics may or may not have been anticipated with interest...

Ok good sir!
The first one I'll leave seeing as I'm pretty sure I've got it (mainly because it seems to be based on my little bro)

You are working as a GP. Your next patient is a 23 yo female student. Her chief complaint is of fatigue and headaches which have developed over the last couple of months. The headaches are 'not that bad' but very persistent, occurring most days. She finds some relief with over the counter painkillers, although she is relunctant to take them frequently. She reports polydipsia and polyurea, and states she has been drinking between 4-5l water a day, and finds it strange her urine is not 'lighter' while drinking this amount. She reports no other symptoms and has no history of anxiety or depression. She is otherwise fit and healthy, with no notable medical history. She does not smoke, and consumes 4-7 units of alcohol per week.
A urine dipstick test is normal, but you agree the colour is potentially darker than what you'd expect in a patient that hydrated. What do you think is causing your patients symptoms? What tests would you order to confirm this or gain further information?

I presume you mean polyuria rather than polyurea?

It's not a straightforward one. The headache could be indicative of a ADH tumour and therefore diabetes insipidus, but as you said the urine should be more dilute.

It could also be diabetes mellitus - it would give a 'normal' looking urine due to osmotic diuresis and glucose isn't always picked up on the urine dip. It would also account for the fatigue.

Ok good sir!
The first one I'll leave seeing as I'm pretty sure I've got it (mainly because it seems to be based on my little bro)

You are working as a GP. Your next patient is a 23 yo female student. Her chief complaint is of fatigue and headaches which have developed over the last couple of months. The headaches are 'not that bad' but very persistent, occurring most days. She finds some relief with over the counter painkillers, although she is relunctant to take them frequently. She reports polydipsia and polyurea, and states she has been drinking between 4-5l water a day, and finds it strange her urine is not 'lighter' while drinking this amount. She reports no other symptoms and has no history of anxiety or depression. She is otherwise fit and healthy, with no notable medical history. She does not smoke, and consumes 4-7 units of alcohol per week.
A urine dipstick test is normal, but you agree the colour is potentially darker than what you'd expect in a patient that hydrated. What do you think is causing your patients symptoms? What tests would you order to confirm this or gain further information?

My first thought would have been DI too.

23 seems a bit old for T1DM though, and too young for T2DM (especially in the absence of any noted risk factors); it also doesn't explain the headaches - although I guess they could be unrelated.]

EDIT: Perhaps Cushing's? Can cause diabetes-like symptoms without abnormal BM; and gives chronic headaches. Also more common in females.

er would it not be SIADH instead of DI? (DI causes dilute urine)

two questions,

abestososis + blood stained pleural effusions = mesothelioma, right?

when is the common cold contagious? while, before or how long after you are symptomatic?

I'm tempted to ignore the headaches - they're occuring every day, which would make raised ICP less likely. It's also relieved by painkillers and 'not that bad' which again counts against raised ICP.


T1DM in slightly older populations isn't that uncommon.

Of course, it could be gestational diabetes....

SIADH doesn't cause polydipsia or polyuria though.

x

No BHCG. I would be tempted by ?hypercalcaemia which could explain the polyuria, the polydipsia compensates, and of course, malignancy is a leading cause which would explain the tiredness, could also account for headaches, or they could just be part of the constitutional picture.

Plan, repeat urine dip + miscoscopy
CXR
FBC, U+E, LFT.
D/W senior, hold off any action on ?DI pending examinations, especially ?Fluid status. If in hospital, start fluid chart, free fluids for now, send MSU.