Bone Calcium Calculation LastPage Summary Page MainBackground Medi-CAL nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnng Unit University of Aberdeenberdeen University of Aberdeenn Hypercalcaemia Ieeee txclassname 3DFrame Recessed explain ButtonDown "Browse Forwards." "explain" ButtonDown buttonUp ButtonDown Browse Forwards. explain buttonUp explain z txClassName button defStroke 0,0,0 Previous ButtonDown "Browse Backwards." "explain" ButtonDown buttonUp ButtonDown Browse Backwards. explain buttonUp explain txClassName button defStroke 0,0,0 ButtonDown "Return CAL Menu." "explain" X"user" bringWindowToTop( toolbook M"casemenu.tbk" bringwindowtotop( b doesn't even un-iconize 47,119" default ButtonDown buttonUp ButtonDown Return to this CAL Menu. explain buttonUp explain bringWindowToTop sysWindowHandle casemenu.tbk bringwindowtotop set position of mainWindow to 47,119 casemenu.tbk casemenu.tbk default toolbook txClassName button defStroke 0,0,0 Previous ButtonDown "Exit the "explain" "Quit Case Study One ?"\ f"Yes" SysSuspendMessages ButtonDown buttonUp ButtonDown Exit the application. explain buttonUp Quit Case Study One ? explain defStroke 0,0,0 txClassName button ButtonDown "explain" ButtonDown buttonUp ButtonDown Go to the first page. explain buttonUp explain defStroke 0,0,0 txClassName button ButtonDown "History." "explain" ButtonDown buttonUp ButtonDown History. explain buttonUp Yhistory explain txClassName button defStroke 0,0,0 "Look up the Help Contents." "explain" contents buttonDown buttonUp buttonDown Look up the Help Contents. explain buttonUp ycontents explain ButtonDown Jvisited "explain" ButtonDown buttonUp ButtonDown Go to last visited page. explain buttonUp explain defStroke 0,0,0 txClassName button txclassname 3DFrame MainPoints Main Points Mechanism of Hypercalcaemia Worth Treating Patient ? After Patient is Discharged -- Case Study Series HNeil M Hamilton $One V2.0 -- Copyright University Aberdeen -- 07/06/93 -- Please complete the registration form notify us bugs innacuracies. Mfeel free e, revise reuse ]scripts -- You may x, however, entire a substantial -- part redistribution %your own product. -- Portions are copyright Asymetrix Corporation- EnterBook --general initialization Reader --Preparing c"Edit" c"Text" c"File" c"Help" "SelectPage" c"Admission Notes" c"Tools" notes" e"Calculator" e"Notepad" e"Contents" e"Windows Tutorial" e"About" --Declaring a widgets font ("dva-4000.tbk") ("tbkmm.sbk") --Removing re-sizing boxes linkDLL "user.exe" INT ShowWindow(WORD, FindWindow(STRING, PostMessage( 8LONG) SendMessage( SetFocus( DWORD GetWindowLong( SetWindowLong( 6 GetMenu( H GetSubMenu( ` GetMenuITemID( DeleteMenu( DrawMenuBar( POPUPNUM 2147483648 MINIMIZEBOXNUM 131072 MAXIMIZEBOXNUM 65536 SYSMENUNUM 524288 CAPTIONNUM 12582912 THICKFRAMENUM 262144 2147483648 ,-16) ,-16, --Customised Handlers calculator bringWindowToTop( toolbook M"casecalc. bringwindowtotop( a doesn't even un-iconize 47,119" default notepad INT hWnd - (Untitled)") "c:\windows\ P, 1) contents 0,"Medical Faculty CAL "aberdeen.hlp" WindowsTutorial 0,"Microsoft "wintutor. about One. Developed Unit, HStuart Ralston, MD, FRCP. Design V , BSc, PhD." ReadTheNotes "A fifty year old man admitted Ward 47"&&\ fconfusion, severe constipation, nausea vomiting."&&\ "He a smoker shows signs weight loss." --Cursor Control --Alphabetic Input data accept buttons alphacheck "answer1" "Type kbox. Do numbers, "&&\ "hyphens tabs." ) >= 65 ) <= 90 ) >= 97 ) <= 122 --test alphabetic --The LeaveBook handler lculator WindowsTutorial about EnterBook ReadTheNotes notepad enterPage leavePage contents alphacheck calculator LeaveBook EnterBook sizetopage SelectPage Admission Notes Tools Read the notes Admission Notes Calculator Tools Notepad Tools Contents Windows Tutorial About tbkmm.sbk user.exe ShowWindow FindWindow PostMessage SendMessage SetFocus GetWindowLong SetWindowLong GetMenu GetSubMenu GetMenuITemID DeleteMenu DrawMenuBar GetWindowLong SetWindowLong SYSMENUNUM MAXIMIZEBOXNUM MINIMIZEBOXNUM POPUPNUM calculator bringWindowToTop sysWindowHandle casecalc.tbk bringwindowtotop set position of mainWindow to 47,119 casecalc.tbk casecalc.tbk default toolbook notepad FindWindow ShowWindow Notepad - (Untitled) FindWindow c:\windows\notepad.exe ShowWindow default contents FindWindow ShowWindow Medical Faculty CAL Help FindWindow aberdeen.hlp ShowWindow default WindowsTutorial FindWindow ShowWindow Microsoft Tutorial FindWindow wintutor.exe ShowWindow default about Case Study One. Developed by the Medical Faculty CAL Unit, University of Aberdeen. Medical Content by Stuart Ralston, MD, FRCP. Design by Neil M Hamilton, BSc, PhD. ReadTheNotes A fifty year old man is admitted to Ward 47 with confusion, severe constipation, nausea and vomiting. He is a smoker and shows signs of weight loss. enterPage default leavePage alphacheck answer1 Type your answer in the yellow box. Do not use numbers, hyphens or tabs. answer1 Type your answer in the yellow box. Do not use numbers, hyphens or tabs. answer1 LeaveBook :PHYSSIZE explain ButtonDown "Return CAL Menu." "explain" X"user" bringWindowToTop( toolbook M"casemenu.tbk" bringwindowtotop( b doesn't even un-iconize 47,119" default ButtonDown buttonUp ButtonDown Return to this CAL Menu. explain buttonUp explain bringWindowToTop sysWindowHandle casemenu.tbk bringwindowtotop set position of mainWindow to 47,119 casemenu.tbk casemenu.tbk default toolbook txClassName button defStroke 0,0,0 Previous ButtonDown "Exit the "explain" "Quit Case Study One ?"\ f"Yes" SysSuspendMessages ButtonDown buttonUp ButtonDown Exit the application. explain buttonUp Quit Case Study One ? explain defStroke 0,0,0 txClassName button ButtonDown "explain" ButtonDown buttonUp ButtonDown Go to the first page. explain buttonUp explain defStroke 0,0,0 txClassName button ButtonDown "History." "explain" ButtonDown buttonUp ButtonDown History. explain buttonUp Yhistory explain txClassName button defStroke 0,0,0 "Look up the Help Contents." "explain" contents buttonDown buttonUp buttonDown Look up the Help Contents. explain buttonUp ycontents explain ButtonDown Jvisited "explain" ButtonDown buttonUp ButtonDown Go to last visited page. explain buttonUp explain defStroke 0,0,0 txClassName button ButtonDown "History." "explain" ButtonDown buttonUp ButtonDown History. explain buttonUp Yhistory explain txClassName button defStroke 0,0,0 Medi-CAL nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnng Unit University of Aberdeenberdeen University of Aberdeenn Hypercalcaemia Ieeee txclassname 3DFrame Recessed explain Previous ButtonDown "Browse Backwards." "explain" ButtonDown buttonUp ButtonDown Browse Backwards. explain buttonUp explain ~ txClassName button defStroke 0,0,0 ButtonDown "Return CAL Menu." "explain" X"user" bringWindowToTop( toolbook M"casemenu.tbk" bringwindowtotop( b doesn't even un-iconize 47,119" default ButtonDown buttonUp ButtonDown Return to this CAL Menu. explain buttonUp explain bringWindowToTop sysWindowHandle casemenu.tbk bringwindowtotop set position of mainWindow to 47,119 casemenu.tbk casemenu.tbk default toolbook txClassName button defStroke 0,0,0 Previous ButtonDown "Exit the "explain" "Quit Case Study One ?"\ f"Yes" SysSuspendMessages ButtonDown buttonUp ButtonDown Exit the application. explain buttonUp Quit Case Study One ? explain defStroke 0,0,0 txClassName button ButtonDown "explain" ButtonDown buttonUp ButtonDown Go to the first page. explain buttonUp explain defStroke 0,0,0 txClassName button ButtonDown "History." "explain" ButtonDown buttonUp ButtonDown History. explain buttonUp Yhistory explain txClassName button defStroke 0,0,0 "Look up the Help Contents." "explain" contents buttonDown buttonUp buttonDown Look up the Help Contents. explain buttonUp ycontents explain ButtonDown Jvisited "explain" ButtonDown buttonUp ButtonDown Go to last visited page. explain buttonUp explain defStroke 0,0,0 txClassName button Bone Calcium Calculation EnterPage default "answerbox" LeavePage toolbook M"casecalc.tbk" EnterPage LeavePage EnterPage answerbox default LeavePage answerbox sysWindowHandle casecalc.tbk send exit casecalc.tbk toolbook Browse Forwards.[ answerbox answerbox Correct Answer: Observed Calcium + [[40 - Observed Albumin] x 0.02] 2.7 + ((40 - 20) x 0.02) = 2.7 + (20 x 0.02) = 2.7 + 0.4 = 3.1 mmol/lll3.1 mmol/l "answerbox" buttonUp buttonUp answerbox From the bone calcium test you found out that the calcium value was high. Calculate the Albumin corrected calcium. Use the calculator if you wish.X ON THE RIGHT). txclassname 3DFrame Recessed HINT FOR CALCULATION The bone Ca value was 2.70 mmol/l The albumin value was 20 g/l Show the correct answer and calculationnnnnnnn "answerbox" default buttonUp buttonUp answerbox default X"user" bringWindowToTop( toolbook M"casecalc.tbk" bringwindowtotop( c doesn't even un-iconize 45,150" default ButtonUp buttonUp buttonUp bringWindowToTop sysWindowHandle casecalc.tbk bringwindowtotop set position of mainWindow to 45,150 casecalc.tbk casecalc.tbk default toolbook Browse Forwards. "No. This Sclavicle." buttonup buttonup No. This is the left clavicle. "No. This the mediastinum." buttonup buttonup No. This is the mediastinum. "No. This the heart mass mediastinum." buttonup buttonup No. This is the heart mass of the mediastinum. "explain" default enterPage enterPage explain default Exit the application. After Patient is Discharged EnterPage "MonitorCalcium" "GiveProphylaxis" "Nothing" default LeavePage EnterPage LeavePage EnterPage MonitorCalcium GiveProphylaxis Nothing default LeavePage MonitorCalcium GiveProphylaxis Nothing Browse Forwards. Nothing No - some sort of follow up would be indicated. MonitorCalcium Yes - check weekly. Also, think about giving prophylaxis. GiveProphylaxis A good suggestion, although life expectancy of these patients is short and not all will need prophylaxis. Monitoring calcium is also recommended. You treat the patient with 0.9% saline 3 l/day for 2 days and give him 60mg i.v. pamidronate over 4h on day 1. The hypercalcaemia improves over the next few days and is normal after 5 days. He is well enough to discharge after 1 week. What do you do now ??? (you may choose to do more than just one thing). Give prophylaxis Monitor calcium Nothing txclassname 3DFrame Recessed answerbox1 txclassname 3DFrame HelpButton "MonitorCalcium" "GiveProphylaxis" "Nothing" buttonUp buttonUp MonitorCalcium GiveProphylaxis Nothing GotoPageTwo "MonitorCalcium" "GiveProphylaxis" "Nothing" buttonUp buttonUp MonitorCalcium GiveProphylaxis Nothing "MonitorCalcium" "GiveProphylaxis" "Nothing" buttonUp buttonUp MonitorCalcium GiveProphylaxis Nothing Browse Forwards. Admission Details txclassname 3DFrame Recessed Mission Your aim is to identify the correct treatment. correct treatment. (Use the mouse to click on the grey button of your choice)t, incorrect diagnosis or innefective treatment will reduce your credit points ! A fifty year old man is admitted to Ward 47 with confusion, severe constipation, nausea and vomiting. He is a smoker and shows signs of weight loss. phadenopathy. aclavicular lymphadenopathy. signs of collapse of the L lung. Browse Forwards. EnterPage "explain" default LeavePage EnterPage LeavePage EnterPage explain default LeavePage buttonup buttonup Frusemide Fluids Mithramycin Calcitonin Bisphosphonate Treatment alphacheck "answer1" c"PTHrP" "Parathyroid Hormone Releasing Peptide, ( correct. This a hormone which"&&\ "mimics yeffects o on bone kidney commonest"&&\ "reason hypercalcaemia malignancy." B"accept" "help" B"helpme" B"BoneMetastases" B"EctopicPTH" "related"\ "peptide" "releasing"\ PTH on response1 "Wrong. You answered" && buttonUp buttonUp alphacheck answer1 PTHrP Parathyroid Hormone Releasing Peptide, (PTHrP), is correct. This is a hormone which mimics the effects of PTH on bone and kidney and is the commonest reason for hypercalcaemia in malignancy. answer1 answer1 accept helpme BoneMetastases EctopicPTH answer1 Parathyroid answer1 Hormone answer1 related answer1 peptide Parathyroid Hormone Releasing Peptide, (PTHrP), is correct. This is a hormone which mimics the effects of PTH on bone and kidney and is the commonest reason for hypercalcaemia in malignancy. answer1 answer1 accept helpme BoneMetastases EctopicPTH answer1 Parathyroid answer1 Hormone answer1 releasing answer1 peptide Parathyroid Hormone Releasing Peptide, (PTHrP), is correct. This is a hormone which mimics the effects of PTH on bone and kidney and is the commonest reason for hypercalcaemia in malignancy. answer1 answer1 accept helpme BoneMetastases EctopicPTH answer1 Wrong. You answered . Parathyroid Hormone Releasing Peptide, (PTHrP), is correct. This is a hormone which mimics the effects of PTH on bone and kidney and is the commonest reason for hypercalcaemia in malignancy. answer1 accept helpme BoneMetastases EctopicPTH response1 Bone Calcium Calculation EnterPage default "answerbox" LeavePage toolbook M"casecalc.tbk" EnterPage LeavePage EnterPage answerbox default LeavePage answerbox sysWindowHandle casecalc.tbk send exit casecalc.tbk toolbook Browse Forwards.[ answerbox answerbox Correct Answer: Observed Calcium + [[40 - Observed Albumin] x 0.02] 2.7 + ((40 - 20) x 0.02) = 2.7 + (20 x 0.02) = 2.7 + 0.4 = 3.1 mmol/lll3.1 mmol/l "answerbox" buttonUp buttonUp answerbox From the bone calcium test you found out that the calcium value was high. Calculate the Albumin corrected calcium. Use the calculator if you wish.X ON THE RIGHT). txclassname 3DFrame Recessed HINT FOR CALCULATION The bone Ca value was 2.70 mmol/l The albumin value was 20 g/l Show the correct answer and calculationnnnnnnn "answerbox" default buttonUp buttonUp answerbox default X"user" bringWindowToTop( toolbook M"casecalc.tbk" bringwindowtotop( c doesn't even un-iconize 45,150" default ButtonUp buttonUp buttonUp bringWindowToTop sysWindowHandle casecalc.tbk bringwindowtotop set position of mainWindow to 45,150 casecalc.tbk casecalc.tbk default toolbook Browse Forwards. !H 6 6 % Worth Treating Patient ? EnterPage default LeavePage EnterPage LeavePage EnterPage false 0,100,0 false 0,100,0 default LeavePage false 0,100,0 false 0,100,0 8 8 8 8 8 Browse Forwards.= "Yes. It important" &&\ treat his symptoms even though he has advanced cancer." buttonup buttonup 120,50,100 Yes. It is important to treat his symptoms even though he has advanced cancer. False "Remind me avoid your receiving days!"&&\ important" &&\ treat his symptoms even though he has advanced cancer." buttonup buttonup 0,50,100 Remind me to avoid your receiving days! It is important to treat his symptoms even though he has advanced cancer. Do you think that it is worth treating the patient ? txclassname 3DFrame Recessed answerbox1 txclassname 3DFrame Browse Forwards. Admission Details txclassname 3DFrame Recessed Mission Your aim is to identify the correct treatment. correct treatment. (Use the mouse to click on the grey button of your choice)t, incorrect diagnosis or innefective treatment will reduce your credit points ! A fifty year old man is admitted to Ward 47 with confusion, severe constipation, nausea and vomiting. He is a smoker and shows signs of weight loss. phadenopathy. aclavicular lymphadenopathy. signs of collapse of the L lung. Browse Forwards. txclassname 3DFrame Sor&t Cause of Hypercalcaemia Xray1 Admission Details results Mechanism of Hypercalcaemia EnterPage "answer1" B"accept" "help" B"helpme" B"BoneMetastases" B"EctopicPTH" B"OtherFactor" default LeavePage EnterPage LeavePage EnterPage answer1 accept helpme BoneMetastases EctopicPTH OtherFactor BoneMetastases 0,100,0 EctopicPTH 0,100,0 OtherFactor 0,100,0 default LeavePage BoneMetastases EctopicPTH OtherFactor BoneMetastases 0,100,0 EctopicPTH 0,100,0 OtherFactor 0,100,0 answer1 accept helpme answer1 answer1 ProbableCauseText What is the probable mechanism of the hypercalcaemia ?? EctopicPTH "No, ectopic PTH rarely a cause cancer-associated hypercalcaemia."\ f"Try "Reference" "Hypercalcaemia ': Lancet 1987; ii; 1443-1445" buttonup buttonup 0,50,100 No, ectopic PTH is rarely a cause of cancer-associated hypercalcaemia. Try again Reference Reference Hypercalcaemia Reference: Lancet 1987; ii; 1443-1445 Ectopic PTH produced by the tumour OtherFactor "Yes. What factor zyou think being produced Hthe tumour ? Click OK Ftype your answer 1box which appears." B"accept" "answer1" B"helpme" buttonup buttonup 120,50,100 Yes. What factor do you think is being produced by the tumour ? Click OK and then type your answer in the box which appears. accept answer1 helpme answer1 Some other tumour produced factor BoneMetastases "Unlikely: massive amounts bone mets are necessary cause hypercalcaemia patients wrenal function, since the kidney can excrete extra calcium."\ buttonup buttonup 0,50,100 Unlikely: massive amounts of bone mets are necessary to cause hypercalcaemia in patients with normal renal function, since the kidney can excrete the extra calcium. Bone Metastases helpme "help" buttonUp buttonUp pthrptext How to type in your answer Type the name of the other factor (you can use an abbreviation if you want) in the yellow box. If you make a mistake you can type over or delete the word. When you are satisfied with your answer click on the 'Accept' button. tton. r' button. ick on the 'Accept Answer' button. on. "help" "answer1" buttonUp buttonUp answer1 Accept Accept txclassname 3DFrame Recessed answerbox1 txclassname 3DFrame Browse Forwards. Introduction ty CAL Menu Page 1 Go to last visited page. rPage default EnterPage EnterPage default History. Browse Forwards. University of Aberdeen, 1993 Portions of this application are the copyright of Asymetrix Corporationnn"""" Click the browse button marked & to starttrt txclassname 3DFrame Recessed txclassname 3DFrame Recessed Click the Help button marked ? or choose Help from the menubar at the top of the page if you are stuck. Glossary of Complications. EnterPage "explain" default LeavePage EnterPage LeavePage EnterPage explain default LeavePage Browse Forwards. Browse Forwards. University of Aberdeen, 1993 Portions of this application are the copyright of Asymetrix Corporationnn"""" Click the browse button marked & to starttrt txclassname 3DFrame Recessed txclassname 3DFrame Recessed Click the Help button marked ? or choose Help from the menubar at the top of the page if you are stuck. Glossary of Complications. Browse Forwards. Medi-CAL nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnng Unit University of Aberdeenberdeen University of Aberdeenn Hypercalcaemia Ieeee txclassname 3DFrame Recessed explain evious ButtonDown "Browse Backwards." "explain" ButtonDown buttonUp ButtonDown Browse Backwards. explain buttonUp explain ~ txClassName f button defStroke 0,0,0 ButtonDown "Return CAL Menu." "explain" X"user" bringWindowToTop( toolbook M"casemenu.tbk" bringwindowtotop( b doesn't even un-iconize 47,119" default ButtonDown buttonUp ButtonDown Return to this CAL Menu. explain buttonUp explain bringWindowToTop sysWindowHandle casemenu.tbk bringwindowtotop set position of mainWindow to 47,119 casemenu.tbk casemenu.tbk default toolbook txClassName button defStroke 0,0,0 Previous ButtonDown "Exit the "explain" "Quit Case Study One ?"\ f"Yes" SysSuspendMessages ButtonDown buttonUp ButtonDown Exit the application. explain buttonUp Quit Case Study One ? explain defStroke 0,0,0 txClassName button ButtonDown "explain" ButtonDown buttonUp ButtonDown Go to the first page. explain buttonUp explain defStroke 0,0,0 txClassName button ButtonDown "History." "explain" ButtonDown buttonUp ButtonDown History. explain buttonUp Yhistory explain txClassName button defStroke 0,0,0 "Look up the Help Contents." "explain" contents buttonDown buttonUp buttonDown Look up the Help Contents. explain buttonUp ycontents explain ButtonDown Jvisited "explain" ButtonDown buttonUp ButtonDown Go to last visited page. explain buttonUp explain defStroke 0,0,0 txClassName button !P P P & Worth Treating Patient ? EnterPage default LeavePage EnterPage LeavePage EnterPage false 0,100,0 false 0,100,0 default LeavePage false 0,100,0 false 0,100,0 8 8 8 8 8 Browse Forwards.= "Yes. It important" &&\ treat his symptoms even though he has advanced cancer." buttonup buttonup 120,50,100 Yes. It is important to treat his symptoms even though he has advanced cancer. False "Remind me avoid your receiving days!"&&\ important" &&\ treat his symptoms even though he has advanced cancer." buttonup buttonup 0,50,100 Remind me to avoid your receiving days! It is important to treat his symptoms even though he has advanced cancer. Do you think that it is worth treating the patient ? txclassname 3DFrame Recessed answerbox1 txclassname 3DFrame Browse Forwards. System MS Sans Serif MS Sans Serif Case Study One MS Sans Serif System MS Sans Serif Courier New MS Sans Serif MS Sans Serif Arial Me" Main Menu" 2 Me" HelpMainMenu X"user" --bringWindowToTop a Windows function that puts the + whose passed front %other windows. toolbook MfAppName bringwindowtotop( doesn't even un-iconize SizeToPage" app isn't running, so we'll "casehelp.tbk" LeaveBook terBook HelpMainMenu EnterBook LeaveBook EnterBook sizeToPage Help Me Help Main Menu Help Me HelpMainMenu bringWindowToTop sysWindowHandle bringwindowtotop send SizeToPage casehelp.tbk fAppName toolbook LeaveBook System all Fonts Small Fonts c"File" c"Help" Me" Main Menu" 2 Me" HelpMainMenu X"user" --bringWindowToTop a Windows function that puts the + whose passed front %other windows. toolbook MfAppName bringwindowtotop( doesn't even un-iconize SizeToPage" app isn't running, so we'll "casehelp.tbk" LeaveBook terBook HelpMainMenu EnterBook LeaveBook EnterBook sizetopage Help Me Help Main Menu Help Me HelpMainMenu bringWindowToTop sysWindowHandle bringwindowtotop send SizeToPage casehelp.tbk fAppName toolbook LeaveBook TBKWidgets MS Sans Serif TBKWidgets gD|D|} KWidgets \D|D| KWidgets Sans Serif KWidgets KWidgets KWidgets \D|D| TBKWidgets MS Sans Serif MS Sans Serif sizetopage Help Me Help Main Menu Help Me HelpMainMenu bringWindowToTop sysWindowHandle bringwindowtotop send SizeToPage casehelp.tbk fAppName toolbook LeaveBook alphacheck "answer1" c"PTH" "Yes. Parathyroid Hormone, ( correct. The 5 would be raised." B"accept" "help" B"helpme" B"Hyperparathyroidism" B"Theconfusion" B"Theanaemia" PTH), response1 "Sorry. You answered" && ". buttonUp buttonUp alphacheck answer1 Yes. Parathyroid Hormone, (PTH), is correct. The PTH would be raised. answer1 answer1 accept helpme Hyperparathyroidism Theconfusion Theanaemia answer1 Parathyroid Hormone Yes. Parathyroid Hormone, (PTH), is correct. The PTH would be raised. answer1 answer1 accept helpme Hyperparathyroidism Theconfusion Theanaemia answer1 Sorry. You answered . Parathyroid Hormone, (PTH), is correct. The PTH would be raised. answer1 accept helpme Hyperparathyroidism Theconfusion Theanaemia response1 Medi-CAL nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnng Unit University of Aberdeenberdeen University of Aberdeen Hypercalcaemia Ieeee txclassname 3DFrame Recessed explain ButtonDown "Browse Forwards." "explain" ButtonDown buttonUp ButtonDown Browse Forwards. explain buttonUp explain defStroke 0,0,0 txClassName button Previous ButtonDown "Browse Backwards." "explain" ButtonDown buttonUp ButtonDown Browse Backwards. explain buttonUp explain defStroke 0,0,0 txClassName button ButtonDown "Return CAL Menu." "explain" X"user" bringWindowToTop( toolbook M"casemenu.tbk" bringwindowtotop( b doesn't even un-iconize 47,119" default ButtonDown buttonUp ButtonDown Return to this CAL Menu. explain buttonUp explain bringWindowToTop sysWindowHandle casemenu.tbk bringwindowtotop set position of mainWindow to 47,119 casemenu.tbk casemenu.tbk default toolbook defStroke 0,0,0 txClassName button Previous ButtonDown "Exit the "explain" "Quit Case Study One ?"\ f"Yes" SysSuspendMessages ButtonDown buttonUp ButtonDown Exit the application. explain buttonUp Quit Case Study One ? explain txClassName button defStroke 0,0,0 ButtonDown "explain" ButtonDown buttonUp ButtonDown Go to the first page. explain buttonUp explain txClassName button defStroke 0,0,0 ButtonDown "History." "explain" ButtonDown buttonUp ButtonDown History. explain buttonUp Yhistory explain defStroke 0,0,0 txClassName button "Look up the Help Contents." "explain" contents buttonDown buttonUp buttonDown Look up the Help Contents. explain buttonUp ycontents explain ButtonDown Jvisited "explain" ButtonDown buttonUp ButtonDown Go to last visited page. explain buttonUp explain txClassName button defStroke 0,0,0 Results EnterPage B"false1" B"false2" B"false3" B"true1" B"true2" B"true3" default LeavePage EnterPage LeavePage EnterPage false1 0,100,0 false2 0,100,0 false3 0,100,0 true1 0,100,0 true2 0,100,0 true3 0,100,0 default LeavePage false1 false2 false3 true1 true2 true3 false1 0,100,0 false2 0,100,0 false3 0,100,0 true1 0,100,0 true2 0,100,0 true3 0,100,0 Browse Forwards./ LFT Results: AAT 45 u/l GGT 100 u/l Bil 10 mol/l AlkP 190u/l Alb 20 g/l Glob 30 g/l Bone Calcium Result: Ca 2.70 mmol/l Plat 350 x 10 /ml Alb 20 g/l Glob 30 g/l Haematology: FBC: Hb 100g/l WCC 15.0 x 10 /ml Plat 350 x 10 /ml lb 20 g/l Glob 30 g/l U+E Results: Na 135 mmol/l K 3.2 mol/l Urea 4.8 mmol/l Creat 110 mol/l CO2 31O2 311 CT Scan, head: Normal CXR: L Lung Mass CXR: L Lung Mass L collapse True3 "Yes. The calcium high the likely"&&\ "cause his symptoms - %hypercalcaemia worse"&&\ "than you might think !" buttonup buttonup 120,50,100 Yes. The calcium is high and the likely cause of his symptoms - and the hypercalcaemia is worse than you might think ! False3 "Wrong. The calcium high the likely"&&\ "cause his symptoms - %hypercalcaemia "worse than you might think !" buttonup buttonup 0,50,100 Wrong. The calcium is high and the likely cause of his symptoms - and the hypercalcaemia is worse than you might think ! True1 "Yes. The LFT abnormal. Is the likely cause his symptoms ?"\ x- although these results might indicate liver deposits." "Correct. It buttonup buttonup 120,50,100 Yes. The LFT is abnormal. Is this the likely cause of his symptoms ? No it is not - although these results might indicate liver deposits. Correct. It is not the likely cause of his symptoms. - although these results might indicate liver deposits. False1 "No. The LFT abnormal. Is the likely cause his symptoms ?"\ f"Yes" x- although these results might indicate liver deposits." "Correct. It buttonup buttonup 0,50,100 No. The LFT is abnormal. Is this the likely cause of his symptoms ? No it is not - although these results might indicate liver deposits. Correct. It is not the likely cause of his symptoms. - although these results might indicate liver deposits. True2 "Yes. There evidence anaemia. Is the likely cause his symptoms ?"\ "Wrong. It "Correct. It buttonup buttonup 120,50,100 Yes. There is evidence of anaemia. Is this the likely cause of his symptoms ? Wrong. It is not the likely cause of his symptoms. Correct. It is not the likely cause of his symptoms. False2 "Wrong. There evidence anaemia. Is the likely cause his symptoms ?"\ f"Yes" "Correct. It buttonup buttonup 0,50,100 Wrong. There is evidence of anaemia. Is this the likely cause of his symptoms ? Wrong. It is not the likely cause of his symptoms. Correct. It is not the likely cause of his symptoms. Is the calcium value high ? Are the LFT values abnormal ? e of anaemia ? the calcium value high ? ne: Ca 2.70 mmol/l Is the calcium value high ? Bone: Ca 2.70 mmol/l10 /ml ; Plat 350 x 10 /ml Is the calcium value high ? Bone: Ca 2.70 mmol/lium value high ? Bone: Ca 2.70 Is there evidence of anaemia ? txclassname 3DFrame Recessed The rest of the results have arrived. answerbox1 txclassname 3DFrame Browse Forwards. when you have selected the appropriate tests.e next page will reitterate these results so don't worry about copying them down... "Certain types monitor may xdisplay"&&\ "the CXR properly." "explain" "Xray" buttonUp buttonUp Certain types of monitor may not display the CXR properly. explain cxrbutton Look at CXR MainBackground Summary Page LeavePage "summarytable" LeavePage LeavePage summarytable Confusion Constipation Nausea Vomiting Tumour Hypercalcaemia Constipation stipation Nausea Vomiting Nausea stipation Nausea Vomiting Vomiting stipation Nausea Vomiting The patient has a L lung tumour. The tumour is responsible for the hypercalcaemia. Hypercalcaemia can cause several symptoms and signs. In this case it is causing confusion, severe constipation, nausea and vomiting. e next page to make your next descision. escision................descision. txclassname 3DFrame Recessed "summarytable" default buttonUp buttonUp summarytable default Summary Table summarytable Kidney Gut CNS CVS Otherrrrrrrrrrrrrrrrr polyuria anorexia confusion hypertension conjunctivitis thirst vomiting coma arrythmias lowered pain renal stones nausea fits threshold ? constipation various- malaise neurologial signs Symptoms and Signs of Hypercalcaemia answerbox1 txclassname 3DFrame "summarytable" default buttonUp buttonUp summarytable default Dismiss the table Browse Forwards. Introduction ty CAL Menu Page 1 EnterPage default EnterPage EnterPage default Browse Forwards. University of Aberdeen, 1993 Portions of this application are the copyright of Asymetrix Corporationnn"""" answerbox1 txclassname 3DFrame Initial Tests LastPage Browse Backwards. You start the patient on oral clodronate and discharge him home. The GP checks his calcium weekly and it remains normal. He gradually deteriorates and dies of progressive carcinomatosis at home, 4 weeks after his admission. Was the treatment worthwhile ? Discuss with your colleagues University of Aberdeen, 1993 Portions of this application are the copyright of Asymetrix Corporationnn"""" txclassname 3DFrame Recessed answerbox1 txclassname 3DFrame MainPoints "Main Points" buttonUp buttonUp Main Points EnterPage "explain" default LeavePage EnterPage LeavePage EnterPage explain default LeavePage t factor do you think is being produced by the tumour ? Click OK and then type your answer in the box which appears. accept answer1 helpme answer1 Some other tumour produced factor BoneMetastases "Unlikely: massive amounts bone mets are necessary cause hypercalcaemia patients wrenal function, since the kidney can excrete extra calcium."\ buttonup buttonup 0,50,100 Unlikely: massive amounts of bone mets are necessary to cause hypercalcaemia in patients with normal renal function, since the kidney can excrete the extra calcium. Bone Metastases helpme "help" buttonUp buttonUp pthrptext How to type in your answer Type the name of the other factor (you can use an abbreviation if you want) in the yellow box. If you make a mistake you can type over or delete the word. When you are satisfied with your answer click on the 'Accept' button. tton. r' button. ick on the 'Accept Answer' button. on. "help" "answer1" buttonUp buttonUp answer1 Accept Accept txclassname 3DFrame Recessed answerbox1 txclassname 3DFrame Browse Forwards. txclassname 3DFrame Introduction Hypercalcaemia Responsibility LastPage Browse Backwards. You start the patient on oral clodronate and discharge him home. The GP checks his calcium weekly and it remains normal. He gradually deteriorates and dies of progressive carcinomatosis at home, 4 weeks after his admission. Was the treatment worthwhile ? Discuss with your colleagues University of Aberdeen, 1993 Portions of this application are the copyright of Asymetrix Corporationnn"""" txclassname 3DFrame Recessed answerbox1 txclassname 3DFrame MainPoints "Main Points" buttonUp buttonUp Main Points Browse Backwards. Go to last visited page. Click on the unusual feature which you can see in the patient's X-ray.. ButtonUp "Yes, the patient has some mass SLung."&&\ "Further investigation shows that Ta L 0 tumour." ButtonUp ButtonUp Yes, the patient has some sort of mass in the left Lung. Further investigation shows that the patient has a L Lung tumour. "No. This clavicle." buttonup buttonup No. This is the right clavicle. "No. This Sclavicle." buttonup buttonup No. This is the left clavicle. "No. This the mediastinum." buttonup buttonup No. This is the mediastinum. "No. This the heart mass mediastinum." buttonup buttonup No. This is the heart mass of the mediastinum. "explain" default enterPage enterPage explain default Click the % button to return. the tutorial txclassname 3DFrame Recessed buttonUp MonitorCalcium GiveProphylaxis Nothing "MonitorCalcium" "GiveProphylaxis" "Nothing" buttonUp buttonUp MonitorCalcium GiveProphylaxis Nothing }g6-- }g6-- nB66- !6Qnohho !6Qnohho u<6.&! 6))&& 6))&& D]ndnnwuu} n66)) D]ndnnwuu} n66)) g4661!! g4661!! !4G]nn h6.)-! ![8;P J`ANw9 ]]|_1 _Qwjr rsa8iD t5WR( xhI/{e o?hL#H XQa@Lq >?{jrV 0B@C" }&tDA yyTw^p `<)`B xb3|: H8NNl }t>d,8 |7qR"t KXWvB -JVI@ #y0B$