Okay, so here is a game:
Based on these ordered tests and referrals, guess that the presenting complaints and the disease:
24 hour heavy metals urine collection
TSH (Thyroid Stimulating Hormone)
Hep C Antibody Test
Magnesium Level
Vit B1 (Thiamine Level)
Vitamin E Level
Vitamin B12 Level
Folate Level
Fasting Blood Glucose
2 Hour Glucose Tolerance Test
RPR (Syphilis Test)
ANA (Antinuclear Antibody Test)
CRP (C-Reactive Protein)
ds DNA (Double Stranded DNA Antibody IgG)
ESR (Erythrocyte Sedimentation Rate)
RF (Rheumatoid Factor)
SPEP (Serum Protein Electrophoresis)
Lactate
Aldolase
CPK Total (Creatine Phosphokinase)
CBC (Complete Blood Count)
CMP (Comprehensive Metabolic Panel)
MMA (Methylmalonic Acid)
Homocysteine Level
MRI Brain without Gadolinium
MRI Brain with Gadolinium
MRI C-Spine
Referral Hematology
Referral Neurology
Referral Gastroenterology
Referral Rheumatology
Based on these ordered tests and referrals, guess that the presenting complaints and the disease:
24 hour heavy metals urine collection
TSH (Thyroid Stimulating Hormone)
Hep C Antibody Test
Magnesium Level
Vit B1 (Thiamine Level)
Vitamin E Level
Vitamin B12 Level
Folate Level
Fasting Blood Glucose
2 Hour Glucose Tolerance Test
RPR (Syphilis Test)
ANA (Antinuclear Antibody Test)
CRP (C-Reactive Protein)
ds DNA (Double Stranded DNA Antibody IgG)
ESR (Erythrocyte Sedimentation Rate)
RF (Rheumatoid Factor)
SPEP (Serum Protein Electrophoresis)
Lactate
Aldolase
CPK Total (Creatine Phosphokinase)
CBC (Complete Blood Count)
CMP (Comprehensive Metabolic Panel)
MMA (Methylmalonic Acid)
Homocysteine Level
MRI Brain without Gadolinium
MRI Brain with Gadolinium
MRI C-Spine
Referral Hematology
Referral Neurology
Referral Gastroenterology
Referral Rheumatology
10 comments:
Fibermyalgia?
Mercury poisoning?
Or fibromyalgia.
definitely fibromyalgia!
Last time i saw tests like this, it was for a man with a loooooooong history of ETOH. He was bright yellow. I diagnosed liver failure and DTs just by looking at him.
But...the million dollar work-up followed. Just in case the liver failure and sudden onset confusion (started following admission) was caused by something else.
Sean
http://nursesean.com
I'm with Sean---EtOHer with encephalopathy and anemia.
Oh, the presenting complaint is "fall" or "seizure".
It's true the MRI c-spine definitely suggests a fall. loss of consciousness/seizure preceded it.
oooooh....this is fun! :)
OK, I'm being a comment hog
Putting my last two guesses together: A very drunk old man passed out and fell off a bar stool.
OK...I'll stop now!
Random comments:
TSH doesn't help without a full panel.
Vit D can be an indicator.
How was your ESR?
If you are going to piss in a bottle for 24 hours, you may as well add protein & cortisol.
8am cortisol and fasting insulin also good to know.
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