100 cases in clinical medicine by P John Rees, James Pattison, Visit Amazon's Christopher

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"Preface such a lot medical professionals imagine that the main memorable strategy to examine medication is to work out sufferers. it really is more straightforward to keep in mind details according to a true individual than a web page in a textbook. one other vital aspect within the retention of knowledge is the intensity of studying. studying that seeks to appreciate difficulties is prone to be obtainable later than superficial authentic accumulation. this can be the root of problem-based  Read more...

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He has not travelled abroad in the last 2 years. He is unemployed and lives in a flat with three other people. There is no relevant family history. 6°C and looks unwell. He looks as if he may be a little jaundiced. He is a little tender in the right upper quadrant of the abdomen. There are no abnormalities to find on examination of the joints or in any other system. 0 mmol/L Questions • What is your interpretation of the findings? • What is the likely diagnosis? • What treatment is required? 21 100 Cases in Clinical Medicine ANSWER 8 The diagnosis is likely to be acute viral hepatitis.

7 mmol/L 70–120 μmol/L 35–50 g/L <5 mg/L Urinalysis: ++ protein; +++ blood; ++ nitrites Urine microscopy: >50 red cells; >50 white cells Abdominal X-ray: normal Questions • What is the likely diagnosis? • How would you investigate and manage this patient? 25 100 Cases in Clinical Medicine ANSWER 10 This woman has the symptoms and signs of acute pyelonephritis. Acute pyelonephritis is much more common in women than men and occurs due to ascent of bacteria up the urinary tract. Pregnancy, diabetes mellitus, immunosuppression and structurally abnormal urinary tracts increase the likelihood of ascending infection.

She is a non-smoker and drinks about 15 units of alcohol per week. She is taking no regular medication. Examination She looks well, and examination of the cardiovascular, respiratory and abdominal systems is normal. Power in all muscle groups is grossly normal but seems to decrease after testing a movement repetitively. Tone, coordination, reflexes and sensation are normal. Bilateral ptosis is present and is exacerbated by prolonged upward gaze. Pupillary reflexes, eye movements and fundoscopy are normal.

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