EMQs in Clinical Medicine.pdf - Peshawar Medical College

208 Metabolic and endocrine disturbances
day is a major criterion for the diagnosis of myeloma. Bisphosphonates
may be used to treat hypercalcaemia associated with myeloma.
Radiotherapy can be used to relieve bone pain.
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A 35-year-old man presents with dry cough and shortness of breath.
His chest radiograph shows bilateral hilar lymphadenopathy.
An abnormal incidental chest radiograph finding or respiratory symptoms
are the initial presentations in up to 50 per cent of sarcoid patients.
TB, malignancy, silicosis and extrinsic allergic alveolitis are other causes
of bilateral hilar lymphadenopathy. There is a higher incidence of
sarcoidosis among African–Caribbeans.
A 35-year-old woman with breast cancer complains of pain and
tenderness over the upper lumbar region. Alkaline phosphatase
400 U/l.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are a
particularly good first-line drug for the treatment of bone pain associated
with metastases.
A 55-year-old smoker has recently been diagnosed with squamous
cell lung cancer. The bone scan is unremarkable.
Ectopic parathyroid hormone (PTH)-related protein secretion by
squamous cell carcinoma is a relatively rare cause of hypercalcaemia.
Hypercalcaemia in a 45-year-old man after renal transplantation.
Tertiary hyperparathyroidism involves the development of autonomous
parathyroid hyperplasia that occurs after long-standing secondary hyperparathyroidism.
Both plasma calcium and phosphate are raised.
Secondary hyperparathyroidism is physiological hypertrophy of the
parathyroid glands in response to hypocalcaemia. In this way, plasma
calcium is usually low or normal in secondary hyperparathyroidism.
Vitamin D deficiency and chronic renal failure are well-recognized
causes of secondary hyperparathyroidism.
83 Diabetic complications
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A 50-year-old man with diabetes complains of impotence.
Other signs include postural hypotension and urinary retention. Patients
sometimes complain of diarrhoea that often occurs at night.
A 65-year-old man presents with loss of sensation in a stocking
distribution.
This is the classic description of a peripheral neuropathy that always
starts distally, hence the term ‘glove-and-stocking’ distribution.