Lauren Bick is a 13-year-old girl who presents to her family physician's office with a 6-month history of weight loss. Her mother is concerned because she has noticed that Lauren has lost at least 10 pounds since her last doctor's visit which she had just before she started at her new school. Although Lauren has always been a "petite" girl, she is now the shortest in her class. The doctor asks Lauren's mom to give her a few minutes alone with Lauren. Once Lauren's mom has left the room, the doctor reviews the limits of confidentiality with Lauren and asks her about her weight loss. Lauren explains that she has met a new group of friends who do not believe that it is healthy to eat animals so she has joined them in following a vegan diet. She also reports that she's recently joined the long distance running club at her school. Lauren indicates that despite her mother's wishes, Lauren's goal is to get her weight down to 25 kg in the next few months. Lauren requests that you don't tell her mother this as it will likely cause them to argue. Lauren's menarche was at age 11 and she had been having regular menstrual periods but in the last 4 months, she has not had a period. Lauren indicates that she has not been sexually active. On questioning, she reports some constipation and says that she often feels cold.

Mr. Dupois is a 35-year-old French-Canadian man born in rural Quebec who moved to Hamilton with his wife a few years ago. His family physician noted a persistent rash around his eyes that he identified as xanthelasma. This prompted some blood tests and a referral to the Lipid Clinic. He is rather reluctant to see you at the Lipid Clinic because he is completely asymptomatic. He denies any significant medical history and is taking no medications. He is a lifelong non-smoker who faithfully walks to work for 1 km with no problems. A family history indicates that Mr. Dupois’ father died suddenly at the age of 46 with no clear explanation. He has multiple family members on his father’s side had a history of heart attacks, some at an unusually young age. His mother is healthy. On physical exam he has soft, velvety, yellowish, non-tender plaques in the palpebral area. Thickening of the Achilles tendons bilaterally were also noted. His blood pressure was 145/90 and waist circumference 98 cm.

Stephen Golding, a 22 year old man presents to the emergency department with nausea, vomiting, abdominal pain and a 3-day history of polyuria, polydipsia, and weight loss. He states that he has "junvenille insulin-dependent" diabetes but stopped taking his insulin 5-days ago.

Susanna Green is a 59-year-old member of the Six Nations of the Grand River. She has a strong family history of type 2 diabetes mellitus. Until two years ago, Susanna had been closely followed since she was diagnosed with diabetes mellitus 28 years ago. Unfortunately, Susanna has not been seen for two years while she was living in the United States. She has self-reported "good" control of her sugars, though she admits that she uses her glucometer only infrequently. Several years ago, she had laser therapy for diabetic retinopathy, but her vision is now stable. She has mild orthostatic hypotension and numbness of her toes. She also has a history of coronary artery bypass grafting following a myocardial infarction six years ago. She has no symptoms to suggest cardiac ischemia, and her exercise tolerance is not restricted. Her medications include metformin, sitagliptin and gliclazide for blood sugar control. Her hypertension, diagnosed about 5 years ago, is currently treated with amlodipine and ramipril. She is taking rosuvastatin to control her cholesterol. Examination reveals a well-looking woman with blood pressure of 155/93 mmHg, BMI of 32.5, increased waist to hip circumference ratio, normal chest and cardiac examination, trace edema to her ankles, normal cardiorespiratory examination. No acute changes are present on fundoscopy, though there the telltale findings of a history of laser photocoagulation are present.

Stephen Golding, a 22 year old man presents to the emergency department with nausea, vomiting, abdominal pain and a 3-day history of polyuria, polydipsia, and weight loss. He states that he has "junvenille insulin-dependent" diabetes but stopped taking his insulin 5-days ago.

Stephen Golding, a 22 year old man presents to the emergency department with nausea, vomiting, abdominal pain and a 3-day history of polyuria, polydipsia, and weight loss. He states that he has "junvenille insulin-dependent" diabetes but stopped taking his insulin 5-days ago.

Susanna Green is a 59-year-old member of the Six Nations of the Grand River. She has a strong family history of type 2 diabetes mellitus. Until two years ago, Susanna had been closely followed since she was diagnosed with diabetes mellitus 28 years ago. Unfortunately, Susanna has not been seen for two years while she was living in the United States. She has self-reported "good" control of her sugars, though she admits that she uses her glucometer only infrequently. Several years ago, she had laser therapy for diabetic retinopathy, but her vision is now stable. She has mild orthostatic hypotension and numbness of her toes. She also has a history of coronary artery bypass grafting following a myocardial infarction six years ago. She has no symptoms to suggest cardiac ischemia, and her exercise tolerance is not restricted. Her medications include metformin, sitagliptin and gliclazide for blood sugar control. Her hypertension, diagnosed about 5 years ago, is currently treated with amlodipine and ramipril. She is taking rosuvastatin to control her cholesterol. Examination reveals a well-looking woman with blood pressure of 155/93 mmHg, BMI of 32.5, increased waist to hip circumference ratio, normal chest and cardiac examination, trace edema to her ankles, normal cardiorespiratory examination. No acute changes are present on fundoscopy, though there the telltale findings of a history of laser photocoagulation are present.

Stephen Golding, a 22 year old man presents to the emergency department with nausea, vomiting, abdominal pain and a 3-day history of polyuria, polydipsia, and weight loss. He states that he has "junvenille insulin-dependent" diabetes but stopped taking his insulin 5-days ago.

Susanna Green is a 59-year-old member of the Six Nations of the Grand River. She has a strong family history of type 2 diabetes mellitus. Until two years ago, Susanna had been closely followed since she was diagnosed with diabetes mellitus 28 years ago. Unfortunately, Susanna has not been seen for two years while she was living in the United States. She has self-reported "good" control of her sugars, though she admits that she uses her glucometer only infrequently. Several years ago, she had laser therapy for diabetic retinopathy, but her vision is now stable. She has mild orthostatic hypotension and numbness of her toes. She also has a history of coronary artery bypass grafting following a myocardial infarction six years ago. She has no symptoms to suggest cardiac ischemia, and her exercise tolerance is not restricted. Her medications include metformin, sitagliptin and gliclazide for blood sugar control. Her hypertension, diagnosed about 5 years ago, is currently treated with amlodipine and ramipril. She is taking rosuvastatin to control her cholesterol. Examination reveals a well-looking woman with blood pressure of 155/93 mmHg, BMI of 32.5, increased waist to hip circumference ratio, normal chest and cardiac examination, trace edema to her ankles, normal cardiorespiratory examination. No acute changes are present on fundoscopy, though there the telltale findings of a history of laser photocoagulation are present.

Stephen Golding, a 22 year old man presents to the emergency department with nausea, vomiting, abdominal pain and a 3-day history of polyuria, polydipsia, and weight loss. He states that he has "junvenille insulin-dependent" diabetes but stopped taking his insulin 5-days ago.

Susanna Green is a 59-year-old member of the Six Nations of the Grand River. She has a strong family history of type 2 diabetes mellitus. Until two years ago, Susanna had been closely followed since she was diagnosed with diabetes mellitus 28 years ago. Unfortunately, Susanna has not been seen for two years while she was living in the United States. She has self-reported "good" control of her sugars, though she admits that she uses her glucometer only infrequently. Several years ago, she had laser therapy for diabetic retinopathy, but her vision is now stable. She has mild orthostatic hypotension and numbness of her toes. She also has a history of coronary artery bypass grafting following a myocardial infarction six years ago. She has no symptoms to suggest cardiac ischemia, and her exercise tolerance is not restricted. Her medications include metformin, sitagliptin and gliclazide for blood sugar control. Her hypertension, diagnosed about 5 years ago, is currently treated with amlodipine and ramipril. She is taking rosuvastatin to control her cholesterol. Examination reveals a well-looking woman with blood pressure of 155/93 mmHg, BMI of 32.5, increased waist to hip circumference ratio, normal chest and cardiac examination, trace edema to her ankles, normal cardiorespiratory examination. No acute changes are present on fundoscopy, though there the telltale findings of a history of laser photocoagulation are present.

Stephen Golding, a 22 year old man presents to the emergency department with nausea, vomiting, abdominal pain and a 3-day history of polyuria, polydipsia, and weight loss. He states that he has "junvenille insulin-dependent" diabetes but stopped taking his insulin 5-days ago.

Susanna Green is a 59-year-old member of the Six Nations of the Grand River. She has a strong family history of type 2 diabetes mellitus. Until two years ago, Susanna had been closely followed since she was diagnosed with diabetes mellitus 28 years ago. Unfortunately, Susanna has not been seen for two years while she was living in the United States. She has self-reported "good" control of her sugars, though she admits that she uses her glucometer only infrequently. Several years ago, she had laser therapy for diabetic retinopathy, but her vision is now stable. She has mild orthostatic hypotension and numbness of her toes. She also has a history of coronary artery bypass grafting following a myocardial infarction six years ago. She has no symptoms to suggest cardiac ischemia, and her exercise tolerance is not restricted. Her medications include metformin, sitagliptin and gliclazide for blood sugar control. Her hypertension, diagnosed about 5 years ago, is currently treated with amlodipine and ramipril. She is taking rosuvastatin to control her cholesterol. Examination reveals a well-looking woman with blood pressure of 155/93 mmHg, BMI of 32.5, increased waist to hip circumference ratio, normal chest and cardiac examination, trace edema to her ankles, normal cardiorespiratory examination. No acute changes are present on fundoscopy, though there the telltale findings of a history of laser photocoagulation are present.

A 40-year old man, Adam Pajek, was seen in a walk-in clinic complaining of palpitations, heat intolerance (felt hot when others were comfortable or cold), sweating, anxiety, weight loss, fatigue, and sleeplessness for two months. He reports that his sister has a hypothyroid problem for which she takes Eltroxin pills.

Dr. Jones has been following Calvin Shin for several years for obstructive sleep apnea. He had been doing well with reduced symptoms of daytime sleepiness since he had been using his CPAP machine. Dr. Jones was reviewing John's chart in his clinic. He missed his appointment several months ago but booked an urgent appointment through his family doctor. Calvin explains that he thinks his tongue, nose and lips have been getting thicker. He also states that he seems to be sweating and his skin feels thicker and oilier than it used to.

You are on a horizontal elective with a pediatric endocrinologist at MUMC when you and your preceptor see your first patient of the day, Chantal. Chantal is a 5-year-2-month-old child presenting with advanced breast development over the past seven months and scant pubic hair growth. This has been associated with rapid growth and intermittent "spotting" over the last two days. Aside from occasional emotional outbursts (crying, arguments with her 9-year-old sister and her mother), there are no other reported concerns. Chantal's mother, a 36-year-old schoolteacher, has a height at the 50th percentile and experienced menarche at age 13. Chantal’s father, a 44-year-old lawyer, also has a height at the 50th percentile and began shaving around age 15 or 16. He has mild hypertension. The family history is negative for early puberty. The parents are not consanguineous. On examination, Chantal's height and weight are both above the 97th percentile. She has grown 9.6 cm in the past year. Physical findings are depicted in the associated media. A bone age radiograph shows a skeletal maturity equivalent to that of a 9-year-old girl. Keanu is a 14-year-old youth who was referred two months ago after repeated attempts to access medical gender-affirming care. Keanu identifies as gender diverse and transfeminine, preferring she/her or they/them pronouns. At Keanu’s last visit, the use of GnRH agonists and gender-affirming hormone therapy (GAHT) was discussed with Keanu and their parents. During today’s appointment, they wish to understand whether the effects of puberty blockers are permanent and to learn about potential health outcomes related to their use.

A 55 year old female, Emily Bradstone, is seen by a hematologist for easy bruising. No hematological problem was found. An internist also saw the patient. There has been a one-year history of easy bruising, weight gain, worsening of diabetes, difficulty climbing stairs and edema of the ankles

A 32-year-old female was seen in emergency department for abdominal pain, nausea and diarrhea. Her serum calcium was found to be elevated at 2.94 mmol/L (normal 2.15-2.55 mmol/L). She was treated with intravenous fluids. Her calcium improved to 2.65 mmol/L and she was discharged home to care for her 6-year-old son. She was referred urgently to an outpatient clinic to investigate her elevated calcium. She was also prescribed pantoprazole for worsening heartburn. In the clinic, Ms. Parapan reported a 2-year history of abdominal pain that was getting worse over time. The pantoprazole she was prescribed was modestly helpful in easing her heartburn and abdominal pain. She denied symptoms of polyuria, polydipsia, confusion or mood changes. There is no history of kidney stones. She had a fracture of her humerus at age 15 due to a ski accident. She was taking pantoprazole and a multivitamin daily. Ms. Parapan’s family history is significant for a father who had a pancreatic tumour, though she does not know any more details about his condition. Both her sister and her paternal aunt had a parathyroidectomy. The same aunt had a pituitary tumour requiring surgery.

A 55 year old female, Emily Bradstone, is seen by a hematologist for easy bruising. No hematological problem was found. An internist also saw the patient. There has been a one-year history of easy bruising, weight gain, worsening of diabetes, difficulty climbing stairs and edema of the ankles

Dr. Jones has been following Calvin Shin for several years for obstructive sleep apnea. He had been doing well with reduced symptoms of daytime sleepiness since he had been using his CPAP machine. Dr. Jones was reviewing John's chart in his clinic. He missed his appointment several months ago but booked an urgent appointment through his family doctor. Calvin explains that he thinks his tongue, nose and lips have been getting thicker. He also states that he seems to be sweating and his skin feels thicker and oilier than it used to.

Dr. Jones has been following Calvin Shin for several years for obstructive sleep apnea. He had been doing well with reduced symptoms of daytime sleepiness since he had been using his CPAP machine. Dr. Jones was reviewing John's chart in his clinic. He missed his appointment several months ago but booked an urgent appointment through his family doctor. Calvin explains that he thinks his tongue, nose and lips have been getting thicker. He also states that he seems to be sweating and his skin feels thicker and oilier than it used to.

A 32-year-old female was seen in emergency department for abdominal pain, nausea and diarrhea. Her serum calcium was found to be elevated at 2.94 mmol/L (normal 2.15-2.55 mmol/L). She was treated with intravenous fluids. Her calcium improved to 2.65 mmol/L and she was discharged home to care for her 6-year-old son. She was referred urgently to an outpatient clinic to investigate her elevated calcium. She was also prescribed pantoprazole for worsening heartburn. In the clinic, Ms. Parapan reported a 2-year history of abdominal pain that was getting worse over time. The pantoprazole she was prescribed was modestly helpful in easing her heartburn and abdominal pain. She denied symptoms of polyuria, polydipsia, confusion or mood changes. There is no history of kidney stones. She had a fracture of her humerus at age 15 due to a ski accident. She was taking pantoprazole and a multivitamin daily. Ms. Parapan’s family history is significant for a father who had a pancreatic tumour, though she does not know any more details about his condition. Both her sister and her paternal aunt had a parathyroidectomy. The same aunt had a pituitary tumour requiring surgery.

Endocrine system anatomy

A 40-year old man, Adam Pajek, was seen in a walk-in clinic complaining of palpitations, heat intolerance (felt hot when others were comfortable or cold), sweating, anxiety, weight loss, fatigue, and sleeplessness for two months. He reports that his sister has a hypothyroid problem for which she takes Eltroxin pills.

A 40-year old man, Adam Pajek, was seen in a walk-in clinic complaining of palpitations, heat intolerance (felt hot when others were comfortable or cold), sweating, anxiety, weight loss, fatigue, and sleeplessness for two months. He reports that his sister has a hypothyroid problem for which she takes Eltroxin pills.

A 40-year old man, Adam Pajek, was seen in a walk-in clinic complaining of palpitations, heat intolerance (felt hot when others were comfortable or cold), sweating, anxiety, weight loss, fatigue, and sleeplessness for two months. He reports that his sister has a hypothyroid problem for which she takes Eltroxin pills.

A 40-year old man, Adam Pajek, was seen in a walk-in clinic complaining of palpitations, heat intolerance (felt hot when others were comfortable or cold), sweating, anxiety, weight loss, fatigue, and sleeplessness for two months. He reports that his sister has a hypothyroid problem for which she takes Eltroxin pills.

Endocrine system anatomy

A 55 year old female, Emily Bradstone, is seen by a hematologist for easy bruising. No hematological problem was found. An internist also saw the patient. There has been a one-year history of easy bruising, weight gain, worsening of diabetes, difficulty climbing stairs and edema of the ankles

Pia Meta is a 21-year-old female university student with paroxysmal attacks of palpitations, dizziness, blurring of vision and headache over the past 6 months. Each attack persists for a few minutes to half an hour. They occur irregularly with essentially no warning. She reports that during one of her attacks, she went to the emergency department and was found to have a blood pressure of 210/140 mmHg. She was told that she was having a panic attack. She was previously well and has no significant family history. Pia occasionally consumes alcohol on weekends only. She denies the use of any medications or recreational drugs, particularly methamphetamines or other sympathomimetics. She has one cup of coffee per day unless she is studying for exams, in which case she drinks 2-3 cups per day at most. She lives with roommates with whom she attends McMaster University. She has been performing well at school and has an active social life. On examination in the clinic, she has no abnormal physical findings.

A 55 year old female, Emily Bradstone, is seen by a hematologist for easy bruising. No hematological problem was found. An internist also saw the patient. There has been a one-year history of easy bruising, weight gain, worsening of diabetes, difficulty climbing stairs and edema of the ankles

Pia Meta is a 21-year-old female university student with paroxysmal attacks of palpitations, dizziness, blurring of vision and headache over the past 6 months. Each attack persists for a few minutes to half an hour. They occur irregularly with essentially no warning. She reports that during one of her attacks, she went to the emergency department and was found to have a blood pressure of 210/140 mmHg. She was told that she was having a panic attack. She was previously well and has no significant family history. Pia occasionally consumes alcohol on weekends only. She denies the use of any medications or recreational drugs, particularly methamphetamines or other sympathomimetics. She has one cup of coffee per day unless she is studying for exams, in which case she drinks 2-3 cups per day at most. She lives with roommates with whom she attends McMaster University. She has been performing well at school and has an active social life. On examination in the clinic, she has no abnormal physical findings.

A 55 year old female, Emily Bradstone, is seen by a hematologist for easy bruising. No hematological problem was found. An internist also saw the patient. There has been a one-year history of easy bruising, weight gain, worsening of diabetes, difficulty climbing stairs and edema of the ankles

Pia Meta is a 21-year-old female university student with paroxysmal attacks of palpitations, dizziness, blurring of vision and headache over the past 6 months. Each attack persists for a few minutes to half an hour. They occur irregularly with essentially no warning. She reports that during one of her attacks, she went to the emergency department and was found to have a blood pressure of 210/140 mmHg. She was told that she was having a panic attack. She was previously well and has no significant family history. Pia occasionally consumes alcohol on weekends only. She denies the use of any medications or recreational drugs, particularly methamphetamines or other sympathomimetics. She has one cup of coffee per day unless she is studying for exams, in which case she drinks 2-3 cups per day at most. She lives with roommates with whom she attends McMaster University. She has been performing well at school and has an active social life. On examination in the clinic, she has no abnormal physical findings.

A 55 year old female, Emily Bradstone, is seen by a hematologist for easy bruising. No hematological problem was found. An internist also saw the patient. There has been a one-year history of easy bruising, weight gain, worsening of diabetes, difficulty climbing stairs and edema of the ankles

Awat Khali, a 3.2 kg female infant, is born to a 28 year old mother at 41 weeks gestation. The family is Muslim and has recently immigrated from the Kurdish region of Turkey. Her parents are first cousins. Each parent has numerous brothers and sisters and most have already had children. Everybody is reported as healthy and well. At delivery the child is noted to have atypical genital development. The clitoris is prominent, length being approximately 1.5 cm. There is posterior fusion of the labia.

A healthy 3.6-kg baby boy, Riley, is born to a 25-year-old nulliparous mother in a community hospital. The family doctor notes that the boy's genital development is somewhat atypical. Her examination reveals that the infant has hypospadias, chordee and undescended testes. A plan is put in place for the infant to be seen by a pediatric urologist in 6 weeks with a view to eventual surgical correction. At one week of age, the infant is brought to the family physician's office for routine follow up. Riley's mother comments that he seems to be breastfeeding poorly. She describes him as increasingly uninterested in feeding and is concerned that he seems to be "spitting up" a lot. The infant now weighs 3.1 kg. A recommendation is made to begin some formula supplementation to help support weight gain. At 10 days of age, Riley's mother finds him in his crib, non-rousable, cool, mottled and covered in vomit. Riley is rushed to the emergency department via ambulance. In the emergency room, resuscitative measures are initiated. The airway is suctioned. He is intubated and hand-bagged to achieve ventilation. A 20 mL/kg bolus of normal saline is administered.

A healthy 3.6-kg baby boy, Riley, is born to a 25-year-old nulliparous mother in a community hospital. The family doctor notes that the boy's genital development is somewhat atypical. Her examination reveals that the infant has hypospadias, chordee and undescended testes. A plan is put in place for the infant to be seen by a pediatric urologist in 6 weeks with a view to eventual surgical correction. At one week of age, the infant is brought to the family physician's office for routine follow up. Riley's mother comments that he seems to be breastfeeding poorly. She describes him as increasingly uninterested in feeding and is concerned that he seems to be "spitting up" a lot. The infant now weighs 3.1 kg. A recommendation is made to begin some formula supplementation to help support weight gain. At 10 days of age, Riley's mother finds him in his crib, non-rousable, cool, mottled and covered in vomit. Riley is rushed to the emergency department via ambulance. In the emergency room, resuscitative measures are initiated. The airway is suctioned. He is intubated and hand-bagged to achieve ventilation. A 20 mL/kg bolus of normal saline is administered.

Awat Khali, a 3.2 kg female infant, is born to a 28 year old mother at 41 weeks gestation. The family is Muslim and has recently immigrated from the Kurdish region of Turkey. Her parents are first cousins. Each parent has numerous brothers and sisters and most have already had children. Everybody is reported as healthy and well. At delivery the child is noted to have atypical genital development. The clitoris is prominent, length being approximately 1.5 cm. There is posterior fusion of the labia.

Mr. Knight is a 65-year-old obese male of African descent who works as a miner in Yellowknife, NWT. He smokes one pack of cigarettes per day. Outside of work he is generally sedentary and tends not to leave his home unless it is really necessary. He has a past medical history of type 2 diabetes mellitus, chronic kidney disease and COPD. His medications include metformin, sitagliptin and the inhalers ipratropium and fluticasone. He recently completed a course of prednisone for a COPD exacerbation, which he has a few times per year. He presented to the local Emergency Department after a fall at work. He tripped over a drill bit and fell on his outstretched hand. He felt a snap, followed by severe pain in the left wrist with noticeable swelling and bruising.

A 32-year-old female was seen in emergency department for abdominal pain, nausea and diarrhea. Her serum calcium was found to be elevated at 2.94 mmol/L (normal 2.15-2.55 mmol/L). She was treated with intravenous fluids. Her calcium improved to 2.65 mmol/L and she was discharged home to care for her 6-year-old son. She was referred urgently to an outpatient clinic to investigate her elevated calcium. She was also prescribed pantoprazole for worsening heartburn. In the clinic, Ms. Parapan reported a 2-year history of abdominal pain that was getting worse over time. The pantoprazole she was prescribed was modestly helpful in easing her heartburn and abdominal pain. She denied symptoms of polyuria, polydipsia, confusion or mood changes. There is no history of kidney stones. She had a fracture of her humerus at age 15 due to a ski accident. She was taking pantoprazole and a multivitamin daily. Ms. Parapan’s family history is significant for a father who had a pancreatic tumour, though she does not know any more details about his condition. Both her sister and her paternal aunt had a parathyroidectomy. The same aunt had a pituitary tumour requiring surgery.

Mr. Knight is a 65-year-old obese male of African descent who works as a miner in Yellowknife, NWT. He smokes one pack of cigarettes per day. Outside of work he is generally sedentary and tends not to leave his home unless it is really necessary. He has a past medical history of type 2 diabetes mellitus, chronic kidney disease and COPD. His medications include metformin, sitagliptin and the inhalers ipratropium and fluticasone. He recently completed a course of prednisone for a COPD exacerbation, which he has a few times per year. He presented to the local Emergency Department after a fall at work. He tripped over a drill bit and fell on his outstretched hand. He felt a snap, followed by severe pain in the left wrist with noticeable swelling and bruising.

Mr. Knight is a 65-year-old obese male of African descent who works as a miner in Yellowknife, NWT. He smokes one pack of cigarettes per day. Outside of work he is generally sedentary and tends not to leave his home unless it is really necessary. He has a past medical history of type 2 diabetes mellitus, chronic kidney disease and COPD. His medications include metformin, sitagliptin and the inhalers ipratropium and fluticasone. He recently completed a course of prednisone for a COPD exacerbation, which he has a few times per year. He presented to the local Emergency Department after a fall at work. He tripped over a drill bit and fell on his outstretched hand. He felt a snap, followed by severe pain in the left wrist with noticeable swelling and bruising.

Mr. Knight is a 65-year-old obese male of African descent who works as a miner in Yellowknife, NWT. He smokes one pack of cigarettes per day. Outside of work he is generally sedentary and tends not to leave his home unless it is really necessary. He has a past medical history of type 2 diabetes mellitus, chronic kidney disease and COPD. His medications include metformin, sitagliptin and the inhalers ipratropium and fluticasone. He recently completed a course of prednisone for a COPD exacerbation, which he has a few times per year. He presented to the local Emergency Department after a fall at work. He tripped over a drill bit and fell on his outstretched hand. He felt a snap, followed by severe pain in the left wrist with noticeable swelling and bruising.

Mr. Knight is a 65-year-old obese male of African descent who works as a miner in Yellowknife, NWT. He smokes one pack of cigarettes per day. Outside of work he is generally sedentary and tends not to leave his home unless it is really necessary. He has a past medical history of type 2 diabetes mellitus, chronic kidney disease and COPD. His medications include metformin, sitagliptin and the inhalers ipratropium and fluticasone. He recently completed a course of prednisone for a COPD exacerbation, which he has a few times per year. He presented to the local Emergency Department after a fall at work. He tripped over a drill bit and fell on his outstretched hand. He felt a snap, followed by severe pain in the left wrist with noticeable swelling and bruising.

Endocrine system anatomy

Endocrine system anatomy

Endocrine system anatomy

Endocrine system anatomy