Ma legs are wobbly!

 

This SAQ is worth 17 marks

A 30 year old man presents to the emergency department with new onset bilateral lower leg weakness. He denies any past medical history. His venous blood gas is reproduced here.

pH 7.399 (7.320-7.420)
pCO2 32.8 mmHg (41.0-51.0)
pO2 56.0 mmHg (20-40)
HCO3- 19.9 mmol/L (21.0-30.0)
Base Excess -4.1 mmol/L (-3.0-3.0)
Na+ 143 mmol/L (135-145)
K+ 1.5 mmol/L (3.5-5.0)
Cl- 113 mmol/L (95-107)
Glucose 8.3 mmol/L (3.0-10.0)
Lactate 2.3 mmol/L
Creatinine 51 μmol/L (50-120)

Question 1.
List three (3) abnormalities and explain their significance. (6 marks)

   Abnormalities Significance
1    
2    
3    



Question 2.
Calculate two (2) values and state how they contribute to your diagnosis.
(4 marks)


1. ___________________________________________________________________________

2. ___________________________________________________________________________



Question 3.
List four (4) differential diagnoses for this patient’s presentation. (4 marks)

1. ___________________________________________________________________________

2. ___________________________________________________________________________

3. ___________________________________________________________________________

4. ___________________________________________________________________________



Question 4.
List three (3) changes on an ECG that could be expected for this patient based on his blood results.
(3 marks)


1. ___________________________________________________________________________

2. ___________________________________________________________________________

3. ___________________________________________________________________________



 

This SAQ is worth 17 marks

A 30 year old man presents to the emergency department with new onset bilateral lower leg weakness. He denies any past medical history. His venous blood gas is reproduced here.

pH 7.399 (7.320-7.420)
pCO2 32.8 mmHg (41.0-51.0)
pO2 56.0 mmHg (20-40)
HCO3- 19.9 mmol/L (21.0-30.0)
Base Excess -4.1 mmol/L (-3.0-3.0)
Na+ 143 mmol/L (135-145)
K+ 1.5 mmol/L (3.5-5.0)
Cl- 113 mmol/L (95-107)
Glucose 8.3 mmol/L (3.0-10.0)
Lactate 2.3 mmol/L
Creatinine 51 μmol/L (50-120)

Question 1.
List three (3) abnormalities and explain their significance. (6 marks)



Question 2.
Calculate two (2) values and state how they contribute to your diagnosis.
(4 marks)



Question 3.
List four (4) differential diagnoses for this patient’s presentation. (4 marks)

Examiner Comments: Poor candidates were unable to describe the significance of the principal biochemical abnormalities, unable to correctly explain the acid-base disturbance using calculations and unable to provide an adequate DD for NAGMA + hypokalaemia.

Question 4.
List three (3) changes on an ECG that could be expected for this patient based on his blood results.
(3 marks)




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VBG   ABG   gas   hypokalaemia   ACEM_2015.1