100 Cases in Clinical Pathology by Eamon Shamil, Praful Ravi, Ashish Chandra

By Eamon Shamil, Praful Ravi, Ashish Chandra

A 27-year-old Ghanaian girl provides within the emergency division with a three-day background of headache, nausea, and imprecise reduce stomach soreness. She has no major previous scientific heritage, yet is eight-weeks pregnant along with her first baby. She lives in London and again from a visit to Ghana two weeks in the past. you've been assigned her preliminary assessment...

100 situations in scientific Pathology provides a hundred medical eventualities regularly visible by means of scientific scholars and junior medical professionals within the emergency division, outpatient hospital, or regularly perform within which an knowing of the underlying medical pathology is primary to arriving on the right prognosis. A succinct precis of the patient's background, exam, and preliminary investigations—histopathology, chemical pathology, haematology, microbiology, and medical immunology as appropriate—is via questions about every one case, with specific emphasis at the interpretation of the consequences and the arriving at a clinicopathologic prognosis. the reply features a unique dialogue on every one subject, offering an important revision reduction in addition to a realistic consultant for college students and junior medical professionals.

Making quickly and acceptable scientific judgements, and selecting the easiest plan of action to take consequently, is among the most vital and tough elements of educating to develop into a physician. those true-to-life situations will train scholars and junior medical professionals to acknowledge very important scientific stipulations, to request the ideal pathological research and properly interpret these effects, and, accordingly, to improve their diagnostic and administration skills.

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Extra resources for 100 Cases in Clinical Pathology

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What investigations are necessary for this patient? 2. What is the mechanism of paracetamol toxicity? 3. How should the patient be treated? Would management be affected if the patient were unable to remember when she last took the tablets? 31 100 Cases in Clinical Pathology ANSWER 10 Paracetamol is the most common drug taken in overdose in the UK, with around 70,000 cases and 100–200 deaths each year. It is one of the leading causes of acute liver failure. The key aspects of dealing with a suspected paracetamol overdose are a thorough history, complete physical examination and prompt investigations.

In cases where the timing of the paracetamol dose(s) are unknown, treatment with acetylcysteine should be started immediately in any patient who is at potential risk. If risk assessment is uncertain, the latest guidelines allow for treatment with acetylcysteine irrespective of the plasma paracetamol level. KEY POINTS • The most common drug taken in overdose in the UK is paracetamol. • The mechanism of paracetamol toxicity is via depletion of glutathione stores, which helps detoxify NAPQI, a metabolite of the drug.

3. Discuss the pathophysiology underlying the likely condition. What is the likely precipitant? 4. What are the principles of managing this patient in the short-term? 47 100 Cases in Clinical Pathology ANSWER 15 The arterial blood gas is consistent with a partly compensated metabolic acidosis. The low pH and the low bicarbonate levels confirm that the cause of the acidosis is metabolic; since pCO2 is slightly low, there is some degree of respiratory compensation in an effort to blow off H+ as CO2.

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