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Final clinical long case 7

Created: 7/4/2004

A 52 year old male presents electively for transurethral resection of the prostate. He has a history of non-insulin-dependent diabetes, and 2–3 months ago underwent chemotherapy and radiotherapy for 'a shadow on the lung'. He has been a life-long smoker, and recently had an episode of haemoptysis. He is currently taking glibenclamide 5 mg once daily.

On examination

– He is of average build
– Respiratory signs: respiratory rate: 18/min; trachea is deviated to the right; bronchial breathing can be heard in the right upper zone
– Cardiovascular signs: pulse: 80 bpm; blood pressure: 130/90 mmHg
– Gastrointestinal signs: palpable enlarged bladder


- Haemoglobin 16 g/dl
- White blood cell count: 8 X 106/ml
- Platelets: normal
- Urea 18: mmol/L
- Creatinine 180 µmol/L
- Na+ and K+: normal
- Liver function tests: normal
- Chest X-ray: right upper lobe collapse
- Pulmonary function tests: FEV1 1.9 L; FVC 3.75 L
- FEV/FVC ratio 0.53


1. Present the salient features of this case.
2. Describe the features of prostatic hypertrophy.
3. Describe the features of renal failure.
4. How might carcinoma of the prostate be diagnosed and treated?
5. Why might this patient have right upper lobe collapse?
6. Why might this patient have a raised haemoglobin level and what is the mechanism for this?
7. Describe the relevance of the lung function results.
8. How might this patient's chest condition be optimised prior to surgery?
9. How would you anaesthetise this man?
10. What are the options for controlling a diabetic patient's glucose perioperatively?
11. Describe the types of oral hypoglycaemic agents available.
12. How would you assess a diabetic patient preoperatively?

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