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Student Discussions:


Semester 10: February to July 2017
1. A patient has diabetes, hypertension and chronic kidney disease. His serum alanine transaminase is noted to be persistently high at 127U/L (about three times the upper limit of normal) for over 3 months. The other parameters of his liver function test are normal. He is negative for Hep B surface antigen and antibodies to Hep C. His total cholesterol and LDL cholesterol are both high at 8mmol/L and 5mmol/L respectively. His triglyceride level is also high at 2.6mmol/L. With this information, suggest a likely cause for his abnormal ALT value.

2. A woman is being treated for hypothyroidism with Tab Thyroxine 75 ug OD. Her serum T4 is 13.73pmol/L (normal) and her serum TSH is 11.22mIU/L (high). She is clinically euthyroid. Is any dose adjustment of Thyroxine necessary?

3. A patient with DM, HPT and CKD has a hemoglobin of 9.9gm%. Her serum creatinine is 188umol/L and her serum K is 5.5mmol/L. She takes insulin, atorvastatin, aspirin, perindopril and felodipine. How will you decide whether the elevated serum K is significant enough for her to be admitted in the hospital? What changes in her current treatment will you make?

4. A 49 year old man has been on antithyroid drugs for past 10 years for toxic nodular goitre. Currently he is on Tab Carbimazole and his serum T4 and TSH are both normal. He is reluctant to stop Carbimazole because of recurrence of hyperthyoidism on every occasion when he stopped it in the past. What is the appropriate advice for him regarding his thyroid disease?

5. A 69 year old man has breathlessness on exertion. There are fine crepitations heard in both lungs on auscultation of the back of the chest. He does not have cardiac failure. His spirometry shows reduced FEV1 and reduced FVC but normal FEV1/FVC ratio. What type of disease can explain his breathlessness?

6. A 62 year old woman was diagnosed as bronchial asthma with atrial fibrillation two years ago because of breathlessness. Now, her ECHO shows mitral stenosis, mitral regurgitation. Explain what you think about the diagnosis offered to her two years ago and what may have been the cause of breathlessness at that time.

7. A 60 year old woman with IHD and HPT is on these medicines: Perindopril, Amlodipine, Simvastatin, and Aspirin. She developed bilateral pedal edema recently but denies any shortness of breath on exertion or orthopnoea. Clinical examination shows that she is not in heart failure. Suggest a reason for her pedal edema. What medication do you think she may need apart from those that she is currently taking?

8. A pregnant woman has a fasting plasma glucose of 4.9mmol/L. Following oral intake of 75-gram glucose, her one-hour postprandial plasma glucose is 10.1mmol/L and and two-hour postprandial glucose is 8.7mmol/L. Is she diabetic?

9. A 63 year old man with CAD, COPD, atrial fibrillation, mitral regurgitation and chronic kidney disease is prescribed Verapamil. What do you think is the indication for Verapamil?

10. A 52 year old man with DM and HPT and an old R hemiplegia is on treatment with Inj Mixtard insulin 18units sc BD. His current glycosylated hemoglobin is 9%. What is your advice regarding his diabetes?

Dr Velayudhan Menon, MD
Clinical Associate Professor of Medicine
International Medical University, Malaysia

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