BOF: 124
A 30-year-old Chinese patient presents with a history of
weakness of both lower and upper limbs. The weakness started overnight in his
lower limbs and spread to involve the upper limbs as well.
The patent had been well till then and had not had any
diarrhoea or vomiting. He had not lost any weight. There were no significant
past illnesses.
On examination he looked well, fully orientated in place,
time and person. No evidence of
weight loss, temperature 37°C. Pulse rate 65 beats per minute
regular. BP 120/60. No rash, skin warm and dry. No lymphadenopathy.
On neurological examination of his limbs tone was normal
there was weakness of all four limbs, reflexes were diminished, plantars
downgoing, no sensory loss.
Investigations
FBC normal
ESR not elevated
LFTs normal
Glucose 7.5 mmol/l
Na 140 mmol/l
K 1.6 mmol/l
Chloride 104 mmol/l pH 7.39
In this patient, whilst awaiting the results of his blood
tests, what bedside investigation would give you a clue to the cause of the
patient’s weakness?
a)
ECG
b)
Tidal volume
c)
Urine for ketone bodies
d)
Urine analysis
e)
Specific gravity of urine
What other investigation would you arrange for this
patient to determine the aetiology of his condition?
a)
Thyroid function tests
b)
Overnight dexamethasone suppression test
c)
Aldosterone plasma rennin activity ratio
d)
Chest x-ray
e)
Adrenal CT scan
