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Emeritus Professor of Medicine, King's College London School of Medicine at Guy's,. King's and St Thomas' Hospitals, London, UK. CASES in Clinical.
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Sold by Bookfalcons. View Offer Add To Cart. Easy Returns Free returns on eligible items so you can shop with ease. Secure Shopping Your data is always protected. Overview Specifications Specifications Author P. Exploring initial medical assessment, Cases in Clinical Medicine presents scenarios commonly seen by medical students and junior doctors in the emergency or outpatient department, on the ward, or in the community setting. Each case begins with a succinct summary of the patient's history, examination, and initial investigation. The text includes photographs where relevant and questions on the diagnosis and management of each case.

The answers provide a detailed discussion on each topic, with further illustration where appropriate. Most of the cases included are common problems but the book also includes more unusual cases to illustrate specific points and to emphasize that rare things do present. The first 20 cases are arranged by systems; the next 80 are in random order because symptoms such as breathlessness and pain may relate to many different clinical problems in various systems.

These true-to-life cases will teach students and junior doctors to recognize important clinical symptoms and signs and to develop the diagnostic and management skills needed for the cases they will encounter on the job. View Full Specifications.

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Power is globally reduced in the left hand, and also slightly reduced in the right hand. Muscle tone is normal. The biceps and triceps jerks are brisk bilaterally.

There is no sensory loss. There is slight dysarthria. This is a degenerative disease of unknown cause that affects the motor neurones of the spinal cord, the cranial nerve nuclei, and the motor cortex. The disease usually presents between the ages of 50 and 70 years. Weakness and wasting of the muscles of one hand or arm is the commonest presentation. Weakness is most marked after exertion.


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Painful cramps of the forearm muscles are com- mon in the early phases of the disease. Patients may present with lower limb weakness or with dyarthria or dysphagia. The characteristic physical sign of this condition is fascicu- lation, which is an irregular rapid contraction of segments of muscle, caused by denerva- tion of the muscle from a lower motor neurone lesion.

Reflexes can be brisk due to loss of cortical motor neurones. In advanced cases diagnosis is easy, but early cases are more problematic. Limb weakness worsening with fatigue may be confused with myasthenia gravis. Dysphagia and dysarthria in the elderly are much more commonly due to the pseudobulbar palsy of cerebrovascular disease.

Cervical myelopathy is another common cause of wasting and fasciculation of the upper limbs without sensory loss. Brachial plexus lesions from trauma or invasion by an apical lung tumour Pancoast tumour may affect one arm.

A predominant motor periph- eral neuropathy causes a symmetrical pattern of weakness and reflexes are reduced. Unfortunately motor neurone disease is a progressive and incurable condition. Patients tend to develop a spastic weakness of the legs. Bulbar palsy causes dysarthria and dys- phasia. Sphincter function is usually not affected.

Intellect is generally not affected. There is no curative treatment for this condition.

100 Cases in Clinical Medicine

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 com- puters.

100 Cases in Clinical Medicine

A feeding gastrostomy may be required to enable adequate calorie intake. Non- invasive ventilation can be used to help respiratory failure, but death usually occurs from bronchopneumonia. She has noticed difficulty holding her head up, again especially in the evenings. She has problems finishing a meal because of difficulty chewing. Her husband and friends have noticed that her voice has become qui- eter.

She has lost about 3 kg in weight in the past 6 months. The woman has had no sig- nificant previous medical illnesses. She lives with her husband and three children. She is a non-smoker and drinks about 15 units of alcohol per week.

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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.