By Chris Roseveare
Acute medication is the imperative a part of beginning and professional normal clinical education and is without doubt one of the so much quickly increasing united kingdom medical institution specialties.
Acute medication: medical circumstances Uncovered combines sufferer circumstances and results, drawn from real-life studies, with regards to the curriculum for education typically (Acute) drugs. It presents self-assessment MCQs, EMQs and SAQs to provide clinical scholars, junior medical professionals, nurses and allied healthcare pros the right guidance for all times at the wards.
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Additional resources for Acute Medicine: Clinical Cases Uncovered
E. ‘explosive’) onset; it is important to establish whether this is what the patient means. The following questions can be helpful. g. ’ If any symptom was truly of sudden onset the patient will usually remember precisely what they were doing at the time; if the patient is unsure or vague about this, then it is likely that the symptom built up in a less dramatic fashion. This does not necessarily mean that the problem is any less severe, but it may help to refine your differential diagnosis (see Table 4).
G. ) 2 The hands • Feel the temperature • Examine finger nails for ‘clubbing’ (see Plate 1), splinter haemorrhages, etc. g. g. tricuspid/ pulmonary valves) or expiration (mitral or aortic valve lesions) 50 5 The chest • Percuss anteriorly and posteriorly over the chest wall, checking for areas of dullness • Auscultate both anteriorly and posteriorly, asking the patient to breathe slowly through their mouth • If crackles are heard, ask the patient to cough and then re-auscultate to see whether the crackles are reduced (when caused by secretions within the airways) or unchanged (suggestive of interstitial fibrosis, consolidation or pulmonary oedema) 6 The abdomen • Inspect for scars and obvious abnormalities • Check that the patient has no areas of tenderness (if so approach these with caution, asking the patient to tell you if you inflict significant discomfort) • Palpate gently over all quadrants of the abdomen, then more deeply to feel for masses • Next palpate specifically for the liver, pressing initially in the right lower quadrant and asking the patient to breathe in, while slowly moving the hand towards the chest • The spleen is palpated similarly, moving the hand from the right lower quadrant to the left upper quadrant as the patient breathes 51 • Enlargements of kidneys may be apparent by pressing deeply in the flanks with one hand while using the other hand to press from behind (balloting the kidney) • Percuss in the flanks for evidence of dullness: if present, rotate the patient away from you to see if it ‘shifts’ (ascites) • External genitalia should normally be inspected • Rectal examination should be considered for most patients, although this is not always indicated 7 Neurological system • Check tone, power, coordination and all reflexes • Check sensation in each dermatomal area (usually light touch only, unless symptoms suggest a problem that may need to be assessed in more detail) • Examine cranial nerves (including papillary responses) • Examine fundi using ophthalmoscope 8 Legs, feet and locomotor system • Ensure that the patient’s legs have been uncovered and inspected for evidence of erythema, warmth, tenderness and swelling • Check for asymmetry (measure calf circumference if any doubt) 52 • Check for ulcers or pressure sores • Check for peripheral oedema around ankles and sacral area • Check peripheral pulses (dorsalis pedis and posterior tibial – if not palpable always feel for popliteal and femoral pulses) • Carefully inspect any joints which the patient has described as painful, or which appear swollen or de-formed: look, feel and move, taking care not to cause pain if the joint is inflamed or appears abnormal 9 Remember urinalysis • Bedside analysis of urine should be considered part of any clinical examination Blood tests: which, when and why?
G. car Rest, simple Chest wall bruising accident while wearing analgesia seatbelt)/local pressure over chest wall Before conducting any examination always consider the following. 47 • Always remember to ask the patient’s permission prior to examination and to take a chaperone wherever possible (particularly when conducting intimate examination in members of the opposite sex) • The presence of a family member may be helpful in some cases, but you must confirm that the patient is happy for them to remain present during the examination • Explain clearly what you are going to do, and confirm that an area of the body is not painful or tender before palpation or percussion • Disinfect your hands (and stethoscope) before and after examining any patient • Watches and jewellery should be removed from your wrists, sleeves rolled up, and neck ties firmly secured or removed Unexpected findings should be documented, allowing careful consideration of their relevance to the presenting complaint, or the need for future investigation if incidental.
Acute Medicine: Clinical Cases Uncovered by Chris Roseveare