Instructions
You are a medical student on placement in general practice. Your next patient is Huong Nguyen, 56, presenting with constant thirst and passing large amounts of urine. Her blood results from last week are printed for you.
Take a focused history
Outline to the examiner:
- Your findings
- Your interpretation of the results
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
- You do not need to examine the patient; the examiner will give you any findings you ask for
- Ask the examiner for any further results you want
- You do not need to write a prescription or a referral letter
Blood tests (taken last week)
| Item | Value | Reference range |
|---|---|---|
| Sodium | 147 mmol/L | 135-145 mmol/L |
| Potassium | 4.6 mmol/L | 3.5-5.2 mmol/L |
| Chloride | 109 mmol/L | 95-110 mmol/L |
| Bicarbonate | 25 mmol/L | 22-32 mmol/L |
| Urea | 6.2 mmol/L | 3.0-8.0 mmol/L |
| Creatinine | 104 umol/L | 45-90 umol/L |
| eGFR | 52 mL/min/1.73m2 | >90 mL/min/1.73m2 |
| Glucose (fasting) | 5.1 mmol/L | 3.0-6.0 mmol/L |
| HbA1c | 5.3% (34 mmol/mol) | 4.0-6.0 % |
| Calcium (corrected) | 2.41 mmol/L | 2.10-2.60 mmol/L |
| Osmolality (serum) | 302 mOsm/kg | 275-295 mOsm/kg |
| TSH | 6.4 mIU/L | 0.5-4.0 mIU/L |