By Steve Bain, Jeffrey W. Stephens
The problem-solving method of center scientific circumstances courses you to consider the sufferer as an entire, instead of as a series of unconnected signs. With its emphasis on daily perform strongly associated with underlying thought, the sequence integrates your wisdom with the realities of coping with scientific difficulties, and gives a foundation for constructing sound analytical and assured decision-making skills.
The center components of undergraduate research are lined in a logical series of studying actions; a similar questions are requested of every medical case, by means of distinct explanatory solutions. OSCE counselling instances, with similar questions and solutions, additionally characteristic in each one section.
Key suggestions and demanding info are highlighted, and the reader-friendly structure displays precisely the form of query you are going to come upon, making those volumes the proper revision relief for every type of case-based examination.
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Extra info for Core Clinical Cases in Medicine and Medical Specialties (2nd Edition)
Abdominal pain, masquerading as an acute abdomen, is frequently present. In HONK, patients are severely dehydrated and glucose levels are always very high. The prognosis in HONK is poor as a result of the concomitant illnesses (coronary heart disease, renal disease, cardiovascular disease) seen in this usually elderly cohort. 13 – A 77-year-old man who is drowsy and dehydrated with a plasma glucose of 84 mmol/L. A1: What is the likely diagnosis? The likely diagnosis is hyperosmolar non-ketotic coma, which usually affects older people with type 2 diabetes and can be the presenting feature (as in this case).
Insulin thus becomes a leading option, especially given the patient’s young age and the development of diabetic retinopathy. Clearly the patient is not keen to go on insulin and the reasons for this need to be explored, because many patients are pleasantly surprised at how painless insulin injections are (compared with HBGM) and feel much better when their glycaemic control improves. A dietary assessment is reasonable because weight gain is highly likely with insulin; for this reason, metformin should be continued (while the sulphonylurea may be withheld).
The outcome of a large trial (called ASCEND) assessing the use of aspirin in ‘low-risk’ type 2 diabetes is awaited. ’ Hypertension is commonly associated with type 2 diabetes but is difficult to treat to target. This difficulty is made worse by the lowering of target levels, based on results of large clinical trials. In the UKPDS, blood pressure targets were less stringent than those that are now advocated for routine primary care (140/80 mmHg in type 2 diabetes); nevertheless, more than one-third of patients required three or more antihypertensive drugs.