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MSc Biomedical Science (Clin Biochem) - Completely Clueless…

Hey Guys;

I have my clinical biochemistry exam in two weeks and this question here is completely stumping me… bit of a long shot but can anyone give me a hand here please?

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(edited 2 months ago)
Original post by Scienceisgood
Hey Guys;
I have my clinical biochemistry exam in two weeks and this question here is completely stumping me… bit of a long shot but can anyone give me a hand here please?
8B89DD3D-2806-4D34-A624-B7807DBFECEC.jpg.jpeg


Hi,
Firstly, the history and physical examination and investigations are incomplete - I would like to know
a] whether the patient's appetite is reduced in line with her loss of weight or not; although the anaemia is mild, a history of anorexia would raise the need to exclude neoplasia s-w in a patient of this age [also a paraneoplastic syndrome could explain some of the findings]. In addition, if the loss of weight is associated with polyphagia, I would ask her questions to exclude hyperthyroidism [feeling hot, palpitations due to tachycardia, any diarrhoea, etc.] and to exclude diabetes mellitus [polyuria, weakness, etc], as well as to exclude malabsorption, which could lead to anaemia due to iron or folate deficiency and to weight loss as well as osteoporosis.
b] whether there is any overt exophthalmos or if not, any lid lag to exclude/confirm thyrotoxicosis as in a] above.
c] on examination, is there any oedema, possibly due to hypoalbuminaemia and consequent reduced blood osmolality?
d] the blood test should include Ca++ level [normal range 2.26 - 2.6 mmol/L] [an 85-year-old lady is likely to have moderate if not severe post-menomausal osteoporosis]; Vitamin D level [the basic history should mention the ethnicity of the patient since Asians in particular, as they wear more clothes and have a darker skin, are more prone to deficiency of cholecalciferol due to lack of UV light; serum glucose [normal < 6 mmol/L] to exclude diabetes; TFTs as above [a low level of TSH would suggest hyperthyroidism]; a full blood picture would help in determining any underlying cause of the anaemia [e.g. folate deficiency would be suggested by a high MCV ]macrocytic anaemia]; if the lady is Asian, B12 level would help, too, as some people are vegetarians so intake of B12 is minimal].
e] with a low-ish Hb level and RBC count together with high haematocrit, the burning Q is what is the WBC count [it is probably high or v high in case the patient has chronic lymphocytic or myelocytic leukaemia].

These are just a few things to consider - I hope I have got the ball rolling for you!
M [ex-medic]

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