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    (Original post by GodspeedGehenna)
    http://www.mirror.co.uk/news/top-sto...5875-23425423/



    I hope it wasn't one of my cohort that came out with that cracker.
    Is that in Coventry? If it was: I was in there back in feb!
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    Same! Also thanks so much for your message about my iBSc PS, sadly illness kinda caught up with me and I never actually applied. So I've been flung into clinicals.....
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    (Original post by Phryx)
    Is that in Coventry? If it was: I was in there back in feb!
    Yeah it was.
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    (Original post by Alanine)
    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!
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    First day of this iBSc.

    Too much to read. Way too much to read. :/
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    (Original post by digitalis)
    Write the full history!
    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?
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    (Original post by Becca-Sarah)
    Help... :puppyeyes: 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... :getmecoat:
    I have no idea

    I'm just going to go to the things mentioned in the email I think... :confused:

    No entirely sure about when the Project Supervisors stuff is, but the email I got said to go in on Weds for a tour 12-2.30 G20 Engineering Building, Thurs 10-11 SEMS Seminar Room 3rd Floor Engineering Building and 1-2 Library Group Study Room 1.

    On top of that the safety talk Friday 10-11.

    I didn't go in for anything today since I have not been told to
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    Not a teenager anymore. Scary.
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    (Original post by Helenia)
    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...
    I'm just too post-nights to do more than work up a quiet throbbing rage.

    I'm also tending to be more apathetic towards medical school and medical students in general, although I did meet one at 02:00 wandering around the ED looking for something to clerk.
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    (Original post by Alanine)
    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.
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    Thanks for the correct- it's scary how little I know about medicine. I didn't know DM sometimes wasn't picked up in the urine, nice one.
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    (Original post by Captain Crash)
    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.
    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.
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    (Original post by Alanine)
    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'd guess some kind of haemolysis..? the bilirubin causing darkened urine, and the anaemia causing the fatigue.

    not sure about the increased thirst, though sickle cell anaemia could cause polydipsia and polyuria by way of nephropathy..
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    er would it not be SIADH instead of DI? (DI causes dilute urine)

    The headaches are definitely alluding to a pituitary tumour though
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    two questions,

    abestososis + blood stained pleural effusions = mesothelioma, right?

    when is the common cold contagious? while, before or how long after you are symptomatic?
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    (Original post by edcourageous)
    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.
    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....
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    (Original post by buzzcat)
    er would it not be SIADH instead of DI? (DI causes dilute urine)
    SIADH doesn't cause polydipsia or polyuria though.
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    (Original post by buzzcat)
    two questions,

    abestososis + blood stained pleural effusions = mesothelioma, right?
    It's a possibility, but it could also be due to lung cancer or another cause unrelated to asbestos exposure (PE, pneumonia, trauma). Depends on the clinical scenario.

    (Original post by buzzcat)
    when is the common cold contagious? while, before or how long after you are symptomatic?
    God knows. I imagine before symptoms like most other viruses, but that's a guess.
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    (Original post by Captain Crash)
    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....
    Also, why are people jumping onto the ?DI bandwagon, when a) thats really rare, and b) - we have no examination findings???!

    Now we have some history, if possible, examination findings please. We don't even have a basic set of obs.

    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.
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    (Original post by Captain Crash)
    SIADH doesn't cause polydipsia or polyuria though.
    oh yes of course. damn summer brain melt

    thanks for answering the other questions.

    only other thoughts would be an RCC that has metastasised?? O_O maybe a kidney infection. or the headaches are psychogenic, they've been put on a neuroleptic like chlorpromazine and now have DI

    who knows...maybe it's lupus!
 
 
 
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