A 49 year old woman receiving hormone replacement therapy (HRT), was found to have a thyroid nodule with no lymphadenopathy and was clinically euthyroid. A technicium scan identified a 'cold' nodule and ultrasound identified the nodule as cystic. Besides routine biochemistry the [T.sub.4] was [185noml.l.sup.-1] and the TSH was [0.40mU.l.sup.-1.] Why was the [T.sub.4] elevated?
A 59 year old man woke during the night with severe pain in his left toe. He was shivering and feverish. The severity of the pain prevented any weight bearing from the bed-clothes. What would be the main diagnostic biochemical test for this patient?
A 40 year woman, who had been a vegan for many years, presented with a history of lethargy, breathlessness and dizziness. On examination she had brittle hair and finger-nails. In addition she indicated that she had heart palpitations and was not yet post-menopausal, had heavy periods. The blood results returned to the GP were: serum iron [3mmol.l.sup.-1]; transferrin saturation 8% and ferritin <[5mg.l.sup.-1.] What was the diagnosis and what other investigation should the GP have done first?
A male one-year old child presenting with failure to thrive was diagnosed with cystic fibrosis and had three older siblings (two brothers and a sister). How would the one-year old be routinely diagnosed and how should his siblings be tested?
Answers on page: 67
Quick Quiz Answers
HRT stimulates the synthesis of thyroxine binding globulin, therefore to maintain physiologically active [T.sub.4] the total serum [T.sub.4] needs to be increased.
Urate, with joint aspiration to identify urate crystals and culture to exclude septic arthritis.
Iron deficiency anaemia. A blood film would have shown a hypochromic microcytic anaemia.
The child diagnosed with cystic fibrosis would normaly be tested by the sweat test as elevated sweat chloride is diagnostic for cystic fibrosis. As the other siblings did not show any clinical symptoms the only option of testing would be to test for mutations in the CFTR gene. The sweat test is not diagnostic for identifying carriers of cystic fibrosis.
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|Title Annotation:||questions on diagnosing medical conditions|
|Publication:||New Zealand Journal of Medical Laboratory Science|
|Date:||Aug 1, 2017|
|Previous Article:||ASA 2017 Adelaide.|
|Next Article:||NZIMLS: Barrie Edwards & Rod Kennedy Scholarship.|