Download Making Sense of Acute Medicine: A Guide to Diagnosis (Hodder by Paul F. Jenkins, Paula H. Jensen PDF

By Paul F. Jenkins, Paula H. Jensen

Given the wealth of more and more complicated expertise now to be had to medical professionals and the accompanying power hazards to sufferers, reliable reasoning and decision-making talents have arguably by no means been extra very important in scientific drugs; scientific talents, diagnostic abilities, and the power to formulate cogent administration plans are important attributes of the standard surgeon. Making feel of Acute drugs makes a speciality of the scientific decision-making strategy, because it applies to universal shows in acute drugs, with each one bankruptcy reading a special clinical presentation in a scientific manner. This fresh e-book is the best creation to this significant topic region; it really is designed to assist the medical reasoning talents of scientific scholars and citizens as they discover ways to make the transition from clerking sufferers to rationalizing differential analysis. This e-book additionally is helping the reader make judgements approximately soliciting for acceptable and concentrated investigations, and formulate acceptable administration plans.

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Example text

Most cases of pulmonary hypertension (PHT) are secondary to chronic lung disease such as chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis, when it is commonly referred to as cor pulmonale. Less common causes of secondary PHT include: ● severe obstructive sleep apnoea or obesity hypoventilation syndrome ● chronic thromboembolic PHT (CTEPH) ● congenital heart disease with right–left shunt (Eisenmenger’s syndrome) ● severe mitral stenosis ● sarcoidosis – usually only in chronic and severe cases ● HIV infection ● multi-system inflammatory diseases such as systemic lupus erythematosis (SLE) ● chronic ingestion of stimulants such as amphetamines and cocaine.

Parietal pleura, nerves, intercostal muscles or ribs) is required for primary lung cancer to cause pain. 3: Chest pain ● Character of the pain ● ● ● ● The pain of MI or ACS is typically central and ‘heavy’ or ‘crushing’ in nature. Patients often clench their fists over their chests when describing it. Aortic dissection classically causes a ‘tearing’ pain which radiates posteriorly between the scapulae. Gastro-oesophageal reflux disease (GORD) may cause a burning retrosternal pain but can be indistinguishable from cardiac-sounding pain.

Patients often report an episode of pleurisy in their past medical history and the differential diagnosis of this event will be broad, as discussed above. ● History Speed of onset ● ● 34 A rapid onset of pain implies a cause that evolves quickly. Examples include myocardial infarct (MI), acute coronary syndrome (ACS), pulmonary embolism, aortic dissection, pneumothorax and rib fracture. The pleuritic chest pain of pneumonia can also have a surprisingly rapid onset. Always consider spontaneous pneumothorax in tall young men with sudden onset of pleuritic chest pain – although this is not an exclusive group for suffering this condition.

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