Fever Series (1st Challenge): 'A neck lump, high temp and loose pants' What's the diagnosis?

23 year-old British Caucasian university student felt some gland swelling at her neck. Upon further questioning, she reports on and off fever with overnight sweating, and noticed 7 kg weight loss. She travelled to Malaysia, Thailand and Hong Kong 6 months previously. BCG vaccination has been obtained. On examination, there is palpable rubbery cervical lymphadenopathy. Subsequent chest X ray uncovers increased mediastinal opacity and enlargement.

What is the differential diagnosis and course of action?

Medics Challenge!

61 year-old lady with a history of Alzheimer’s dementia develops shortness of breath and coughing.

Her husband explains that she became rather vague and unusual during the last 4-5 days; her speech is incoherent with some rambling and irrelevant chatting, which come and go. She also has difficulty focusing and has become very lethargic.

The patient developed pneumonia twice over the last 2-3 weeks. Her past medical history is significant for hypertension and depression for which she takes vals

artan and paroxetine, respectively. She smokes cigarettes and drinks no alcohol.

Bloods for haematology and biochemistry are shown.

What's going on?!!

NB. please note normal values for lab parameters:

Hb (11.7-15.7), MCV(80-99), WBC (3.5-11), Platelets (150-440), Na (135-145), K (3.5-5), Urea (2.5-6.7), Creatinine (70-120). Glucose (4-6), Albumin (35-50), plasma osmolality (275-295), urine osmolality (rang

e; 100-1000).

CLINICAL LESSONS;

1/ be able to differentiate confusion from dementia using CAM

2/ Be able to recognize SIADH - it is suggested by dilutional hyponatraemia with

3/ Be able to categorize the causes of hyponatraemia (dilutional or salt-losing causes)