By John Rees, James Pattison, Gwyn Williams
This article covers middle fabric in medical medication. overlaying the main structures in 15 sections, every one part comprises 8 circumstances. those situations reflect these which scholars and condo officials will meet in outpatients and basic perform. conceal; e-book identify; Contents; Preface; Acknowledgements; Abbreviations; part 1: Systems-related instances; part 2: normal self-assessment instances; Index
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Additional info for 100 Cases in Clinical Medicine
She has two daughters. Examination Her conjunctivae are pale. Her pulse is 88/min regular, blood pressure 190/110 mmHg; mild pitting oedema of her ankles is present. Otherwise, examination of her cardiovascular and respiratory systems is normal. Neurological examination shows a left upper motor neurone facial palsy with mild weakness and increased reflexes in the left arm and leg. She is able to walk with a stick. Funduscopy shows arteriovenous nipping and increased tortuosity of the arteries. 45 mmol/L 3–17 mmol/L 5–35 IU/L 30–300 IU/L Urinalysis: ϩ protein; ϩ blood Blood film: normochromic, normocytic anaemia Questions • What is the diagnosis?
The white cell count is usually moderately reduced. There is often a mild rise in serum bilirubin giving the patient a ‘lemon-yellow’ complexion. As in this patient, profound vitamin B12 deficiency also causes a peripheral neuropathy and subacute degeneration of the posterior columns and pyramidal tracts in the spinal cord, causing a sensory loss and increased difficulty walking. The peripheral neuropathy and pyramidal tract involvement produce the combination of absent ankle jerks and upgoing plantars.
There is no curative treatment for this condition. The mean duration of survival from presentation is between 2 and 4 years. The patient and his family will have to be told of the diagnosis and prognosis. Support must be given by a multidisciplinary team. As the disease progresses and speech deteriorates communication may be helped by using computers. A feeding gastrostomy may be required to enable adequate calorie intake. Noninvasive ventilation can be used to help respiratory failure, but death usually occurs from bronchopneumonia.
100 Cases in Clinical Medicine by John Rees, James Pattison, Gwyn Williams