By Eamon Shamil, Praful Ravi, Ashish Chandra
A 27-year-old Ghanaian girl offers within the emergency division with a three-day background of headache, nausea, and imprecise reduce belly ache. She has no major earlier scientific background, yet is eight-weeks pregnant along with her first baby. She lives in London and back from a visit to Ghana two weeks in the past. you've been assigned her preliminary assessment...
100 situations in medical Pathology provides a hundred scientific eventualities typically noticeable through clinical scholars and junior medical professionals within the emergency division, outpatient sanatorium, or typically perform within which an figuring out of the underlying medical pathology is vital to arriving on the right analysis. A succinct precis of the patient's historical past, exam, and preliminary investigations—histopathology, chemical pathology, haematology, microbiology, and medical immunology as appropriate—is by way of questions about each one case, with specific emphasis at the interpretation of the consequences and the coming at a clinicopathologic prognosis. the reply incorporates a certain dialogue on each one subject, offering a vital revision relief in addition to a pragmatic advisor for college students and junior medical professionals.
Making quickly and acceptable medical judgements, and selecting the simplest plan of action to take for this reason, is likely one of the most crucial and tough components of teaching to turn into a physician. those true-to-life circumstances will train scholars and junior medical professionals to acknowledge vital scientific stipulations, to request the precise pathological research and properly interpret these effects, and, consequently, to advance their diagnostic and administration skills.
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Further investigations that may be performed to look for other causes include: • Thyroid function (hypothyroidism) • Serum prolactin (hyperprolactinaemia) • 24-hr urinary cortisol (Cushing’s syndrome) • Morning 17-hydroxyprogesterone levels (elevated in nonclassic congenital adrenal hyperplasia) • Oral glucose tolerance test and growth hormone suppression (acromegaly) • Follicle-stimulating hormone (FSH) and oestradiol (high and low/normal, respectively, in premature ovarian failure) Biochemical investigations may show increased testosterone levels, reduced SHBG, increased LH and a high LH:FSH ratio.
Normally, the drug is metabolized by cytochrome P4502E1 to form a reactive metabolite, N-acetyl-p-benzoquinoneimine (NAPQI), which can be hepatotoxic. However, NAPQI is detoxified by glutathione and hence, when there are sufficient amounts of the latter, the liver is not damaged. Overdoses of the drug deplete glutathione stores, and hepatic damage results. Glutathione stores also depend on nutritional status, which is why it is important to assess for background risk of liver damage. The key investigation for paracetamol overdose is measurement of paracetamol concentration in the blood 4–16 hours post-dose.
Discuss the pathophysiology of the likely diagnosis and suggest further investigations that may be useful. 3. What is the explanation for the visual signs and symptoms? 4. Suggest a preliminary management plan for this patient. 15 100 Cases in Clinical Pathology ANSWER 6 The cardiovascular, neurologic, reproductive and metabolic findings are classic symptoms of a thyrotoxic state. Hyperthyroidism specifically refers to the increased production of thyroid hormone by the thyroid gland, and the suppressed thyroid stimulating hormone (TSH) level and high levels of T4 and T3 confirm that it is the cause of thyrotoxicosis here.
100 Cases in Clinical Pathology by Eamon Shamil, Praful Ravi, Ashish Chandra