Short Cases in Clinical Medicine

636 Pages·2013·120.09 MB·English

by  A. B. M. Abdullah

FLSEVIER

Short Cases in

ABM Abdullah

Foreword by
Prof. Ramesh C. Deka
Short Cases
in
Clinical Medicine

Pifih Edition

ABM Abdullah MRCP (UK), FRCP (Edin)
Dean, Facaly 9 sexticine
Trotessor of Mericine
pt shh ule Une
Banglades

\teome
Pan
a
Contents

Foreword ’
Preface the Fifth ation we
fice to he Fis Eon =

Short Cases 1
Chapter 1 General Examination 3

Chapter 2

Chapter 3

ntroduction—3 | Genezal Exzmination~3 | Clubbing | Kollonychia— 1 [Nail Changesin
Dilferent Diseases 12 | Cervical ymphcdenopaths—16] Generalised Lyrmphelenopatiy—18
| Pigmertation—20] Eeylema Ab lgte -? | Gynaecomasiia—23 | Eaytherna Nedosumn —26]
Leprosy-—28 | Superior Vena Caval Cbstrucion—30 | Hirsutism —42 | Leg Uleer—35 |
Pyoderma ‘iangrerosum—37 | Diabetic Foot —39 | Diabetic Amyowaphs—41 | Lipedystophy
fof Thigh—42 | Necrobiesis ipoidica Diaheticorum—13 | Unilateral or Bilateral. Leg
Swell1ng—43]| Deep Venous thrombosis (DVT)—46 | Cellub tis and Ervsipelas—49 [ Periph
ral Vascular Disease—50 | Lautence-Moon-Bardet-Biedl Syndrame—32 | Cenevalizxl
‘Oedema—53 | Tongve—54 | Hairy Leukuplakia—38 | Dupuy-ren Contracture—59 | Paget
Diease—60 | Examination of Hands) [Tupus Persia 68

Cardiovascular Sysem — 68

ngroduction 68 Fsamination Routine 68] Important Discussions ir Relation to CVS—70
| Mita! Stenosis—75 | Micra: Regurgitation 79 | Mieral Valve Prolapse [Brlowe Syncron
fr Floppy Mitral Valve)-80 | Mitral Stenosis ssith Mittal Regugiaton (Med tial Valve
Disease}—st | Annie Stonos's—02 | Aortic Regurptation—34 | Aovtic Stenosis wits Aonic
Reguugiation (Mie Auite Malee Diseese]—S7 [Tricuspid fegagitation (TR)—88 | Pulmo=
nary Stenosis (PS) #9 Prsshesie Hat Valves—90] Congenital ean Distast-—92 [Tetslogy
of Fallot (TOF}—92 | Venticular Sepral Detect {VSD)95 | Aulal Septal Defect (ASD)—28 |
Patent Dutus Artenesus (PTA) | Examination of Pulse—101 | Aerial Fibriltion—102 |
Blew Pulse Rate [Complete Heart Block (CH)]—103} laksyasu Disease —105 | Coarctavion of
Aotts—106| Mattan Syadzotve- 108| Derocardia—1 | Pericardial Efasion —112 [Chromic
‘Consrictive Pericarditie—113 | Acute Peticatdiis—113 | Rhewnatic feves—115 | Hyperapaic
Cardiomyopathy—119

Respiratory System ———___—__ 122

Tnuoduetion— 1221 Exasiination Reutire—122] Fsamination ofthe Chest— 123] Discussions
sim Rontine Fxamination—124 | Crepitation or Pleural Rub—130 | Pleural bffusion—130 |
Prsumetharas—1$6| Rlonehievtatis-- 40] Branchiectasis sth Cystic iheosis— 143 | DPLD
(Previously Called braving lveoits or! »)—145| Conseli¢ation—147| sing Abscoss—15%
[ Collapse of Lang155 | Tibresis of Lang. 156 | Chionie Obstructive Pulmonary Disease
(COPD) 157 | Chronic Broachitis—161 | Lmphysema—163 | trief Discussion About Leow
Function Tee (Spirometty] 165 | Mase esica Tang (Bronchial Carcinoma) 166
UNE contents

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Abdomen — ——— 72

Ingoduction—172 | Examination Routine (Abdomen}—172 | Sore Important Finiegs
fon Taspecton—175 | Llepataspleno nega y-179 | Llepatosplsmomegaly (Malaria)—179 |
epatosplenornegaly {Kala-Azar}—182 | PostKila-izay Deisual Leishnnaiasis (PRDL) 185
| Splenemegaly (Not Hepatumcyaly} 187 "| Splenouegay ropicalSplenomegaly
Syutdrome]—189_ | Hepatomegaly—190 | Hepatomegaly (Hepatoma)—1512 | ascles
‘wits splenomegaly (Luberculous Perlwonits)—19¢ | Ilepatomegaly (Tender Live, Veal
epattis)—119 Brie» cussion on Weil Disease (Leptosp tosis) 147 [Hepatamepaly (Liver
Abscess) —198 | epatomeyaly (LIydaud Cyst}—200 | Chromic Liver Disease or Cethosis ot
Tiver 202 | Poriosistemic Encephalopathy (PSE ot Hepatic Precoma}—204 | llepatomegaly
(Pianary Bliary Cierhosis)—211 | Hepatomegaly (Haesiochramatosis} 213 | Asites—215 |
‘Abdominal Mass--215 | Causes of Mass in Dilferent Sites af Abdomen —218 | Carcivorsa of
Stomach—222 | Carcinome o° Leal of Parcreas (Mass in the Fpigastium)--224 [Pancreatic
Pseudocsst—-226 | Messin che Epipastium (Aneurysm of Aosts)—227 [ Mass is Right lac
Fossa (Mleacaeral Tuberculosis) —228 | Crohn Disease 225 | Carcinoma of Colon 252

Haematology 234

Cenerlized Lemphadenopathy (Hodgkin Lymphoma) ~2%4| Generis Tynpisadenopathy
(Nonaovigkin lymphama)—237 | Genera ied Lytmahadenopathy (Chronic. lymphatic
Teukaemia! 299 | Fursura 241 | Idiopathic Theomborytopaenic Purpura. 20% | Hes
ech-Schinisin Perpuri—245 | splenomegaly (Hereditary Haemolytc Anacaia)—247 |
Splenomegsly (Ch-onic Selo Leckennt]--249 [ Splenomegaly {Myelotibress) 251
om-deficiney Anacmis252

Priloctinology = 257

lnttodaction—257 | tamination of Fayroid Cland—257 | Face in Thyroid Disense (by
Looking at the Face)—259 | Thyrotexicasis—260] Graves Dsease—261 | Simple Atutinodular
Goltte 267 | Taxis Nodular or Valtinodolar Goitre—268 | Simple Bithise Goitwe—269 |
Solty Nodule or Sirp ¢ Nodular Goitze—270 | Hypotytoidism—273 | acromegaly—279 |
Cushing Syndrome284 | Acdisen Disease —288 | Tall Slatwre—292 | lineeler
Syindeorte—293 | Short Stasune—205 | Diabetes Mellnus—296

Nephrology 302

Mass in Plank (Renal}-302 | Bilateral Renal Mass (Polyrystic Kidney Disease)—30% |
UUnilaeral Mass (Renal Call Carcinema)-—304 | Mas it Left or Right Hae Fossa [Transplanted
Kidney) 306 Seplrotie Syndrome 308.

Neurology 33

Inetoducion—3:3 | Neartogial Feamination of Lower Lumb—313 | spastic Pataplegha
Ghinal Cord Conpresion}—316 | Monoplgia [rown-Séquard Spreme) 3A |
Monaplegia—s21 | Muluple Selevoss (Mesenung as Spastic Paraplegis)—322 | Flack
Varaplaga (Clis}—325 | Polyneuropathy—328 | Polmeuropathy. [Subacite Cosnbined
Degeneiation —(SCD)|-—350] Motor Neuron Diseese (MND}—332 | tiered Maxis 336]
CCembsllar lesion —325 | Pokimionism-—34D | Chored~343 | Tremor 348 | Speech 34 |
Dysphasia—330 | Dysantia—352 | Fuamination of Hanals(Wasting of Small Muscles of
Hands)383 | Seringomgelia~384 | Myotonie Dystophy—336 | Mvopalby (Musculae
Dysttphy)—358 | Carpal Tunnel Syaiome—26C [nat New Paky362 | Raat Nene
asy-363 [Cranial Neres363 | Facial (Vd) Nerve Palby—306 [Vth Nerwe Pasy—369 |
nliple Cranial Nene Paey—370 | (V9 with Hlemiplegin 472 | Gait Abnoemalty 37S |
Oofadal Dyskinesia 377 [Too Drop~377 Chascal-Matie-Taoth Dseast—278
conTenTs ETI

Chapter9 Rkeumatvlog, 38

Introduction 381 | Systemic Sclerosis 382 | Raynaud Phenomenon or Disease—396 |
RRhewmatoid Hond—388 | Knee Joint Arthritis (Examination of Knee fing} —396 | henile
Idiopathie.Anitis (FCA) —299 | Septic Arhetis—a02 | ermophilic Atnis—403 | Reiter
Syndrome 40¢| Psoriatic Antropathy-~498] Anlelesing Spondy! tis—a | Dexmatonyoritis
5 Polymyasits—a15] Proximal Syopathy—120 | Cami422 | Systemic Lupus Eryheracowus
(SLE}—425 | Vasculitis 453 | Ostevurluosis—434 | Chareot foine—235

Chapter 10 Examination of the Eye 437

tnuodudion 437 | Optic Attoafy 458 ) Papllcedemua ‘Pure)—440 | Central Retinal Vein
Occhision (CRVO)—t42 | Hypentensive Reinapathy=-t13 | Retinal Haemorrhage 444 |
Diabetic Retinopauhy—<4 | Betis Pigmentosa=#39[Ptos—439 |HomerSyndrome—152
| Argyll Robern Pupil (AR Pupil) —i59 | Different Types of Tupil—s54 | TeluesAdie
Pupil—A55 | Txophaleos—155 | Nystgnuse—s57 | subkyaloid Haemonhaze 59
| Chovcidoveisits-480 | Reinal Decchment 461 | Bilepotal Hemianasie—t6l |
Missense 462

Chapter

Dermarology 460
lnwodction—a65. | Psoriasis—a66 | Feythema Multforme and Stevens—Johnson
Syacrorae 470| Dermatitis Hespetiformie 4172 | Herpes Zoster (Shingles) 424] Acanheais
Nigrcans—476 | Ickchyosis—477 | Pemphigus Vulgaris -479 | Bullous Remphigoid—51 |

casis (Chronic Aisenie Taxicey)—483 | Seabies—485 | Lupus Vilgais a8? | Lieber
Planes —488 | Exfoliauve Dermatiis 431 | Alopecia—493 | Vitligo—195 | Newt
Uncnnt 96 | hytusis Fungoides 095 | Tasers Sclerosis $39 | Kapusi Sa conma—30 |
PiyrisisVersieolor—se

Chapter 12 Miscellany 02

ice in Different Diseases —3C2 | Butteilly Rask—503 | Yumer Symdroms—5n5 | Dozen

50? | Biltea, Parotid Enlargement 508 | Xanthelasma—309 | Sturge-Weber
"51 | Heradicary Haemnoctayic Lelangietas 2—512 | Yellow Nal Syndrorse—513
| Nounal Case—314

Common Interpretations in Medicine sis

Chapter 13 Data Interpretation —

Heepatology—51? Nephrology 519] Neurology-521| Haematology.
| Endocrine—529)

Chapter 14 X-Ray, CTand MRT

Pleural bffusion—536 | Mass Lesion—537 | Solitary Polmonary Nodule—538 | Miitiple
Sevondaries in Lung 538 | Consolidation-539 | Lung. Abseass—340' | Pulmona

Thbereolosis—340 | Mil ary Wuberculosis—341 | Caleification ofthe Tung Parenehsrma—322 |
Emphysema—542 Ballae—s2|Snegical Fmphysema—5a' | Prenmothorsx—s43 [| Idea
neurotrorm S45 | Collasse of Lung—S45 | fib Resection546 | Bilateral Hilsr
Lymphadenopathy—549 | Sercoidosis—547 | Azygos Lolwe—547 | Cavity Superimposed on
Eardiae Shadow 548 | Bronchiecasie528 | Homogeneous Opacity of One Hemitho
rax—549 hodiaatinal Widening —549] Ces Under he Diaphragm—530 [Situs inversus—550
[ Destrocardia 351 | oisal Seenosis—251 | Ventiewlar Aneurysn—552 | Awial Septal
DDefece—952 | Tetralogy of Lallot £33 | Cavdemegaly 553 | Verkandial fusion 534 |

336
SENET conrents

Chapter 15

Chapter 16

Chapter 17

bigeye

Pesicardial Calcification —554 | Pulmonery Cedema—S35 | Pacemaker—556 | Metallic
Prosthetic Vale—536 | Ankylosing Spondylitis—337 | Pow Disease—358 | Mu ciple
‘yeloma538 | Fereditary Haemoltic Angemia—589 | Awamegaly—560 | Tophi—360 |
Rheumatoid Hand—56l | Resoxption of Terminal Phalanges 6 [Rickets 362 [Scurry 363,
| vascular Nectosis 0: Femoral Head —562 | Endoscopic Reuograde Cholangioparcreatogra-
phy CRCP)—564 | Achalasia Cardia—564 | Carcinema of Oesophag.s 589 | Carcicoraa
Stomtech—565 | Gasuic Dutlet Obsuuction—66 | Pancreatic Calcification —566 | Polveystic
Kidiney Disease—587 | CPSCAN 567] Wil SCAN 568 [Tey Cormon CT Scans—$68

Bee

basic Concapt of ECC—572 | Intrpretstion of ECG—375 | Normal ECC—574 | Details of
Wines and eters 974 [yin of Hear 578] Caloltion of Hear Rate 378 Conia
Joie 379 [ECG OL Atal Hbellation 575 | ECA 02: ial Flutte—S80] EC: 02. Vesercular
Tachyeardie380 | LUG 8 Aawe Nyocaical Infarction 581 [LCG 03: Old Myocardl
Tnfaceion—582 | HOG 6: FrseDegee AV Block—583 | ECT 17. Seong ce A lock
{(Mobite Type 1)—383 | LOG 98 Sevon-Deyee AV Blak (Sdobiee Type li) 584 | LOG 09
Complete Heat lack—584 JECG 10 Tet Bune Branch Block--583 CG 1 Right mle
‘ranch Blosk~585 | BCG 12: Let Vensieulae Hypetuoply—965 | ECG 13: Right Yecticular
Hypenepry—s/ | FUG. 14 Pile s88 [CU I>" Puimonale-989 | FOG 16. Pas
Bigeminy—369 [LCG 17 ewe Percardiis—390 | LC 18: Pacemaler—39 | EUG 1 Ss
Tachyeardie 591 | ECG 20; Sinus Bradjeardia--592 | ECG 21; Supravenueulat Tachyear

ig—592 | ECE. 22: Ventricular Prematuse Beat—355 | ECC. 24: VenariculaeHbilat'on—594 |
ECG 24: Hspertalaesnia—59¢
Pictures —____ _ 596

Picwee OL: Infected Scabies—396 | Picwre 02: Puspuia—397 | Plewee 03: Rheumatoid
antis—597 | Picture Ot: Arhets Mutiians—398] Picrare 05: Graves Disease —55R | Pitare
(6 Psorias «599 | Pisce OF Systemnie Lupus Frstbeeatasts—G00 | Plture 08: Enthersa
‘ulforne-609 | Piesare 09: Leprosy—-601 | Picture It: Stevens.;ohnsan Syndrome—60! |
Pture 1: Ring Wore —602 | Peto 12: Subconjuctival Hacmomhage—602 | Pctare 13: Hell
Paley 603]Picture 14: Ramsay HuntSyndrome 603) iewure 15:Coinass Wyxoedema 64
[Picture 16: Gonomces— 60 | iture 17: Hiesutsm 605 | Pieure 18: Oxtsoarbrosie—605
[Pict 19: Peripheral Vascular Disease—606| Petare 20: Hypopituiterisin—GU6l Pitre 31
espes Zoster—607 |Pieware 22: Obstructive [aundice—c07 | Fienre 23. Wegenes Granulor:a
tusis608 | cure 24° Xanthelasmna608 | Pune 25: Bale. Cyst 609 | Piuwie 26: Peas
Garinatum—60 | Pictare 27: Corneal Arcas—609 | Picture 28: Scomegaly—s10|Pienite 29;
Primary Opule Awaphy—610 Pleure 30: Paplloedema 8:1 | Piciute 3t- Cental Retinal Vein
cchision— st

Instruments 62

Invcument O:: Sone Martow Aspiration Newdle—612 | Insemament 02: Lumbar Puncture
Sevdle—613 | Insicument 03: “iver Biopsy Needle—6l5 | Instrument (A: Plewal biopsy
Needle—616 | Instrument 05: Aspiration Need with Rubber Tube 617 | Instrument 16
Inuayenous Cannula—018 | Lnstrunent 07: Foley Catheter—€18| Inseument 8: Nasgastic
“Tbe (Ryle Tubel 619 [Instrument 09: ir Way Thbe ~619 [ Intrucnent 1G: ESR Tube —620]
Insrument 11 Metered-Dese Inhalet—620 Instrument 12: Arcubaler—621 | Instrament 13:
Ferhslee—s9" [Tagtroment la: Peak Flow Meter—629 | Inerament 15° ANI Bag—S2? |
Instrument 16: Tongus Depressor—62? | Oral Rebydation Salt—623

625
627
=i
Short Cases
GENERAL EXAMINATION

deus sat Begs eerste dct

= Autor Views

During esaninaion of short ease, examines unvally
asks 1a examine a parieular par ofthe bod, or sorme-
Tunes the whole syste. oF whole ody. Candies
shoud prepave themselves examine acondingy, but
‘systematically, Commor instmetions by che examiner
forshom cues in any examinations te

1, General examina
nation ofthis patent

Pato the general exami-

1m catdiovasealar system (CVS):
+ Examine the precondium,

+ Palpate and auscaltats he precordiam
+ Fxamine the rise,

amine the CVS.

2. In respiratony spe
+ Tsamine the ees front ox bak or bot)

+ auscuiae for resplatorysysten,
eres dae back and ausculate
4, Abdomen:
+ Examine the abdomen
+ Patpate the abdomces and rele
amine the gastromustnal ste
5, Serology:
+ eeamime the lower rb or upp lit
‘Foaming the cranial nerves, of a pariclar
tranial nerve (eg, fvial nerve),
+ Show me the cerebellar so
+ taoleat hepa afte patent
5. Endocrinology:
+ Gaamine the nec’ (mestty hyo).
* amine the dyed gland and
(Choid disorder and eases of hyper 0:
hypothyroid

* Look 9¢ the face (Chyrotene, mpseederatins
‘or Cush)

+ Perform Lie general examination fobesty
Feauwes cf mexoedema, pigmentation in
‘Addison disease

Rheumatology

‘+ xamine die nands (mostly eheumatou bau,
systemic seo).

+ Beamine the kee joints (or any pariclar
joint monoartsits, or polaris, eusion
inkae it)

Taomine the fice and releran: [feues off

spstemicsceronis steichapas erythematosus
(GSU), der auonnysis
ois ache skin (denratomyesits,

Dermatology

= erarm the gene-al examination (psoriasis,
enfoliavesermais.

+ Look at the skin of this par. What are the
ossibilices (akin rash, erythema mul:
orme, purpura, Stevens-Johason syndrome,
blisters)?

Byes:

Examine the eves piss, saint pigment
tation of sclera. Kayser-Heiseer (KF) sing
comma aes, bernjnetval arr
‘sophehalmer]

+ Pefium fundowapy foplic sooty, retin
‘pathy,

Miscellenen
+ Depends ot paticule ype of ease, eg Tamer
sgidione, Bow syndvae, waelasms, ee.
BEBE) ot cases ns

General Examination

HICAL MEDICINE

Lok at che tongue. what is the diagnose
‘What ate the egeases that canbe diagnosed by
Tooking atthe ongue?

Loe at the fas, Name some dseases chat ean
be diagnosed by looking athe fae

General Examinat

‘Examine the hands, What ae te diseases that
‘an be ciagnased by examining the hands?

+ What diseases are diageosed by looldug at
Ge nalle

Be sure that your ae ot Ie ight sie of he patient
Intidlace yourself as for permission, and he 26m"
tde and polite, A friendly haaushske may ater
patent's reassurance and cooperation, also may
help 10 get informations suck as ware and sweaty
hards (thyrotoxicosis), cold and swea:y Irs
{ansiets}. dey and coarse ands (hypothyroid)
Aoughy teelirg (acromegaly) and sow relaxation.
ot grip (tayotenta)

Tefere starting i exanination take fee moments
to look qqicdy Fors head we foot by keesieg
‘pen your wide-angle ens), which may ie a clue
reading tke Uaghasls. Many cases cam be diag
snowed by just lckeng a 2 glance (sich 4s emaciation
for cachexis, obesity, acromegaly, myanedema and
Gushing syndrome).

Tacial expression will sive a guod cle for the diag
ass see page 502), for eample:

+ vawery in express on oF masktie face (it
Parkinsons)

‘git otto face {in thyrocoicoss

+ Peophshalis (in Gres disease)

Pui fce (in ayxoedema or nephosiessnerome)

+ Apathy (in depression),

Look atthe height:

Tall samure (gieantim, Sarde
inefeter syndrome)

Stow sure (Conscrional, genes o> familil,
achondioplasa, cetinsm cr nemle hypachy.
roids hypopituitarism).

syndiome.

Besides soutine gonsral examination, esis ext Find
ings in invioa, cases shold be seen. For expe

tn Cushing syndrome. some exara_fadings
ae very esendia, eg striae, mocn face and
bullae bump.

‘It butesshy rash is sen or the fee, eee fr sash
in other paris ofthe bods, Also, heliotpe rake
and alopecia

Main Points in General Examination

+ Appearance [illlooking, deessed, anxious

Cussingoid or expressionless face)

Built (obese, emaciated or cachexi, al, shes
ernarnal)

+ Nutuivon (wel nousshed, paor or narmal)

+ Decubitus fan choice, plopped up of Motam-
redar prayer postion)

Anaemia (palpelaal putt of conjunctiva, wongue,
tala, nall and whole body).

+ Jaundice (sler, uncetsrface oF tongue, palm
rhe bods

+ Gyanosis (ip of nose ips, ea lobule, tongue, ip
cf fingers and wes)

Talltoture Maran syndrome)
al Geuconychia)

Clubbing (see Moesation of mall base. angle

becrcen the mall and its bow, cuvatute of nal,

lbw bypsnropiiortesathropathy hy pressing

the lower end of tibia-Rbu'a wr riay-ubs. 36

‘ser of liferentialcusbing it means cing

in fee at notin fingers)

* Kollonychia (deyness, brides
thianing and sponn ng of nals)

+ Leaconychia (hte spas orwhice nl

# Oedema (ie lex alr medi! malleal sacrum if
the patent i econ!)

+ Dekydration (kin wrgor or dey wongue)

+ Pigmentation fexresed port, fee, ney palisar
useac lec, nner ide of moa recente)

+ Lymph modes examine ssa in difeent
ses)

+ Thyroid gland ( entrge, xan in detail and

the featutes tenia or hypothyriisn)
+ Breasts
+ Body hair disebution including head ww see

alopecia)
+ bake.

Blood presse (BE),
+ Tempera
1+ Respiratory rate.

‘auening

Relevant findings shoul be examined carding 10

indi-dual cass, fr cape

1. athe face: [fxanhelasms ie present, see ceaneal
ss suthaovatous eles others pts (lho,
‘ua entero sufies, Achilles tendon ad pslnae
reas)

2. Inthe hands:
+ Dapustren contracare,
+ Palmer enthem

1+ GENERAL EXAM NATION ET

4+ Osler node and sinter haemorthage fin
subacute bacteria enlocarcitis (SUE
+ Heberden node
+ ouhand node
+ Gangrene or nal fold infer nai fold
selangiecasia,
+ Meee,
+ Wasting.
‘+ Skin 18k or Gotuon patch (dermatomyositis).
3. Other findings
Spider angina
4+ Parotid plandenlangemen (unter cr bila,

Skin as,
Sti

* Gamphel de Bergan ns,
* Po
+ vitligo
+ Dervamiy (kyphosis, sea'iosis and lordosis)

hese Sigs ae present you must mention them

Si, Meson, i de patent has any cannula, catheter,
nasogastric (NG) tbe, entra wensne (CV) Hine,
arteriovenous (9) ius, ste

Never forget t9 examine exe lower lis {thone may
be ural leg svclling, sep ws thrombosis [DV].
sliferemial cyarosis, diferent clubbing, uuphit
hiker gingfene ar inietion ae Hp af 08)

Tinaly presentthecxsesystemarcaliy. Remember, ou
rns fallow be esaminesinsiicions, Fer example
‘ecaniner may asl

1 ea ne yo Rings? (Vo sou mention the
positive and impaetant negative ndings)

‘+ Have you ansbd your eannauon® Now cll
sboutyourfindings.(Youshould tll yseratcaly
the postive ard important negative isis}

Examples of Presentation of a Case

Case No. 1

‘The pasenc is illooking, emaciated or cachesic
‘with pao nitro.

+ Mildlyanemic, roniteric and nemcyanosta

#Thete is clubbing involving ll the Angers an
toes, no luconyzhia ard no oedema,

+ Thyroid land ie novmally palpable cnd there is |
ro Ijenphaden pay.

Hes nontlly pignente

Pulse: ymin, BP: 120/8 mmHg, respiration:

1 anal vemperate: nossa

‘|
e
3
5B