By Andrew T. Raftery, Eric K. S. Lim, Andrew J. K. Ostor
Having the ability to make an accurate analysis is without doubt one of the key features of each clinical student's and junior doctor's medical education. Problem-based studying is more and more getting used to target the explanations in the back of the presentation of a medical characteristic. The 3rd version of this best-selling ebook is packed choked with info to aid the reader circulate from a offering challenge to a correct prognosis.
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Extra resources for Churchill’s Pocketbook of Differential Diagnosis
EXAMINATION Classical findings are shifting dullness and a fluid thrill. As liver disease and carcinomatosis account for 90% of the cases presenting with ascites, a detailed examination of all systems is required. The next commonest causes are cardiac failure and nephrotic syndrome. Inspection Evidence of liver disease would be suggested by the presence of jaundice, spider naevi, loss of body hair, gynaecomastia, palmar erythema and caput medusae. The jugular venous pressure (JVP) is elevated in the presence of cardiac failure, and a prominent n wave is seen with tricuspid regurgitation.
They may slip in and out between the pectoral muscles. They may be firmer and not have the lobulated feel of a more superficial lipoma. Axillary artery aneurysm A pulsatile mass will be palpable within the axilla. Check the distal circulation. If an axillary artery aneurysm is large, when the patient stands with the arms by the sides, the arm moves away from the side of the body as the lump pulsates. Breast lumps A lump on the medial wall of the axilla may be a lump in the axillary tail of the breast.
A past history of prolapsing piles, with failure to reduce them, associated with pain and tenderness suggests thrombosed haemorrhoids. Gradual onset of pain and tenderness with swelling is suggestive of abscess formation. A careful history must be taken of trauma. A history of anal sexual exposure will suggest gonorrhoea or herpes. With gonorrhoea there may be irritation, itching, discharge and pain. With herpes there will be pain and irritation. Proctalgia fugax is diagnosed on the history of perineal pain, which is spasmodic, the spasms lasting up to 30 min.