Case Histories for the MRCP (Hodder Arnold Publication) by Paul Goldsmith, Robert Semple

By Paul Goldsmith, Robert Semple

A overview booklet in query solution layout excellent for examination coaching for college students taking step 1 and step 2 of the forums. All questions are offered within the type of "best of five", "pick-n-from many", advert a number of matching.Features contain in-depth motives to answers,and complete colour phtographs improve illustrative case histories.

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On examination there was no fatiguability. Adrenaline 1 : 1000 had no effect on pupil size. 1% pilocarpine administration: (a) (b) Exam 6 43 1. What is the cause of the anisocoria? 2 A 32-year-old Brazilian plumber on holiday in the UK for two weeks had been on a five-day alcohol binge at a meeting near Stonehenge. He then travelled up to Scotland, where he suffered a generalized tonic–clonic seizure. He had recovered enough on arrival in hospital to inform the staff of his previous good medical health.

He had been otherwise well. 5 ϫ 109/l (80% neutrophils), urea 43 mmol/l, creatinine 78 ␮mol/l, CK 130 mmol/l. CXR: enlarged heart, clear lung fields. The chest radiograph and part of the ECG rhythm strip are shown in the following figures. 48 Questions 1. 7 A 54-year-old man presented with a six-month history of progressive clumsiness and difficulty in performing fine tasks with his right hand. He had no pain. Apart from a chronic cough he was well. Past medical history was unremarkable. He was adopted and did not know his family history.

His JVP was not seen and his heart sounds were normal. There was no peripheral oedema, rash or arthropathy. His respiratory rate was 30/min, with a saturation of 84% on a rebreathing mask. Crepitations were audible throughout both lung fields. CXR showed bilateral alveolar shadowing. Heart size normal. ECG normal. After admission to ICU, intubation and catheter placement, an adult respiratory distress syndrome (ARDS)-like picture was confirmed. Microscopy and immunofluorescence of lavaged material revealed no signs of infection, including specifically Coxiella burnetti, influenza, parainfluenza, Chlamydia psittaci, Mycoplasma pneumoniae, Pneumocystis and Histoplasma.

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