By John Rees, James Pattison, Gwyn Williams
This article covers middle fabric in scientific medication. overlaying the key structures in 15 sections, each one part contains 8 instances. those instances replicate these which scholars and residence officials will meet in outpatients and common perform. disguise; e-book identify; Contents; Preface; Acknowledgements; Abbreviations; part 1: Systems-related situations; part 2: normal self-assessment situations; Index
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Her pulse rate is 96/min regular, and blood pressure 142/72 mmHg. Examination of her cardiovascular, respiratory and abdominal systems is normal. She has a symmetrical distal weakness affecting her arms and legs. Knee and ankle jerks are absent and she has extensor plantar responses. She has sensory loss in a glove and stocking distribution with a particularly severe loss of joint position sense. 0 mmol/L 3–17 mmol/L 5–35 IU/L 30–300 IU/L Questions • What is the diagnosis? • How would you investigate and manage this patient?
She is married with one daughter aged 11 years. There is no family history of a bleeding disorder. She is a non-smoker and drinks a small amount of alcohol socially. Examination On examination there are multiple areas of purpura on her legs and to a lesser extent on her abdomen and arms. The purpuric lesions vary in colour from black–purple to yellow. There are no signs of anaemia, but there are two bullae in the mouth and there is spontaneous bleeding from the gums. There are no retinal haemorrhages on funduscopy.
His jugular venous pressure (JVP) is not raised and his blood pressure is 146/84 mmHg. The cardiovascular and respiratory systems are normal. The abdomen is distended. He has no palpable masses but there is shifting dullness and a fluid thrill. 45 mmol/L 60–80 g/L 35–50 g/L 3–17 mmol/L 5–35 IU/L 11–51 IU/L 30–300 IU/L Urinalysis: no protein; no blood Questions • What is the diagnosis? • How would you manage this patient? 19 ANSWER 7 This man has abnormal liver function tests which indicate hepatic failure; the hypoproteinaemia has caused the ascites and ankle swelling.