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Clinical Medicine: Journal of the Royal College of Physicians of London

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https://www.readbyqxmd.com/read/30287452/should-point-of-care-ultrasound-be-in-the-new-internal-medicine-curriculum
#1
LETTER
Gethin Hosford
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287451/gardening-injuries
#2
LETTER
Tony Hall
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287450/response
#3
LETTER
James B Maurice, Pinelopi Manousou
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287449/vitamin-e-a-cause-for-concern
#4
LETTER
Peter E Donnelly
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287448/vitamin-d-testing-the-british-society-for-rheumatology-s-choosing-wisely-recommendations
#5
LETTER
Charlotte A Sharp, Elizabeth Macphie
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287447/bawa-garba-case-an-objective-view-on-diagnosing-group-a-streptococcal-sepsis
#6
LETTER
Ashwin Delmonte Sen, Anna Goodman
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287446/patient-power-kidd-gloves
#7
LETTER
Anneka Burge, Malcolm Green, David Russell-Jones
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287445/image-of-the-month-brachiocephalic-arterial-occlusive-limb-shaking-transient-ischaemic-attacks
#8
Ahmed Abbas, Kurdow Nader, Alok Tiwari, Arunagiri Viruthagiri, Edward Littleton
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287444/lesson-of-the-month-2-an-unusual-cause-of-depression-in-an-older-man-cushing-s-syndrome-resulting-from-metastatic-small-cell-cancer-of-the-prostate
#9
Paul Kleinig, Patrick Russell
This article describes the case of an older patient whose main presenting problem was depression. A constellation of clinical and biochemical features led to a search for medical causes of his low mood, which uncovered ectopic adrenocorticotropic hormone (ACTH) secretion. Post-mortem examination showed that the source of ACTH was small cell neuroendocrine carcinoma of the prostate, and that the patient had died from the sequelae of profound immune suppression.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287443/lesson-of-the-month-1-sodium-valproate-induced-encephalopathy
#10
Lara Camilleri
A 69-year-old man developed reduced consciousness of sudden onset. Examination and parameters were normal, except for a Glasgow Coma Scale (GCS) score of six. Brain imaging and blood tests were also normal, except for high plasma ammonia. His past medical history included epilepsy, hypertension and colitis. He was taking multiple antiepileptic medications, including sodium valproate, with no recent dose alterations. Medical intervention led to the sodium valproate being stopped and naloxone being administered...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287442/cme-neurology-120487-self-assessment-questionnaire
#11
REVIEW
Edwards Cock Mark, Tahseen A Chowdhury
No abstract text is available yet for this article.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287441/assessment-of-acute-headache-in-adults-what-the-general-physician-needs-to-know
#12
Krishna Chinthapalli, Anne-Marie Logan, Rohit Raj, Niranjanan Nirmalananthan
Headache is common. Up to 5% of attendances to emergency departments and acute medical units are due to headache. Headache is classified as either primary (eg migraine, cluster headache) or secondary to another cause (eg meningitis, subarachnoid haemorrhage). Even in the acute setting the majority of cases are due to primary causes. The role of the attending physician is to take a comprehensive history to diagnose and treat benign headache syndromes while ruling out sinister aetiologies. This brief article summarises the approach to assessment of headache presenting in acute and emergency care...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287440/acute-neurology-a-suggested-approach
#13
Kuven K Moodley, Arani Nitkunan, Anthony C Pereira
Acute neurological problems are common, accounting for 10-20% of medical admissions. In the coming years, there will be increased neurology involvement in the acute care of these patients complementing traditional outpatient-based services. Models of acute neurology are reliant on close collaboration between the emergency department, acute medicine and neurology and should integrate with existing hyperacute stroke pathways. In this article the authors briefly describe the two models of acute neurology set up recently in our neuroscience group and suggest a clinical approach that may help non-neurologists involved in acute care settings ...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287439/functional-neurological-disorders-acute-presentations-and-management
#14
Hannah R Cock, Mark J Edwards
Functional neurological disorders (FND) are common and associated with significant morbidity and healthcare costs. Patients with FND often present acutely, particularly with dissociative seizures (resembling epilepsy) or persistent weakness resembling a stroke. History and careful observation and examination are critical to diagnosis, as investigations will often be normal or non-contributory. The nature of convulsive movements in dissociative seizures often differs from that in epilepsy, and long duration of individual events, waxing and waning, closed eyes and high reported frequency in an apparently well individual are all suggestive...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287438/seizures-and-epilepsy-in-the-acute-medical-setting-presentation-and-management
#15
Elizabeth Caruana Galizia, Howard John Faulkner
Epileptic seizures are a common cause for presentation to acute medical services. Whether presenting with an isolated, unprovoked seizure or with status epilepticus, a good understanding of seizures and their mimics ensures appropriate investigation and treatment. This article describes the practical aspects of the management of patients presenting with seizures to the emergency department or the acute medical unit.
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287437/spontaneous-splenic-rupture-secondary-to-dabigatran-the-last-in-a-series-of-unfortunate-events
#16
Rachel Carey, Varun Nelatur
We present the case of a 77-year-old woman who had an accidental fall in her garden, resulting in a fracture of her left ankle. After manipulation of the fracture, she developed sudden onset shortness of breath. An echo led to the diagnosis of Takotsubo cardiomyopathy. Shortly after this she developed sudden onset receptive and expressive dysphasia. Magnetic resonance imaging (MRI) of the head confirmed a left parietal infarct thought to be secondary to left ventricular thrombus formation. She was started on dabigatran...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287436/pneumomediastinum-complicating-adult-onset-measles
#17
Azara Janmohamed, Aula Abbara, Rohma Ghani, Anne Kinderlerer, Thava Sritharan, James Hatcher
Adult-onset measles is rare in the UK, particularly in patients with a complete vaccination history.We present a case of a UK-born patient who received all childhood vaccinations, had no history of recent travel or unwell contacts who was diagnosed with measles complicated by pneumomediastinum. This case highlights the need to consider measles in any patient presenting with a constellation of a macular rash, fever and conjunctivitis, regardless of vaccination status. The nature of the rash can provide an important clue to the diagnosis...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287435/an-old-disease-re-emerging-acute-rheumatic-fever
#18
Asim Khan, Nurhan Sutcliffe, Ali Sm Jawad
We present the case of a 41-year-old Australian woman with a 3-day history of fevers and migratory polyarthritis. Three weeks prior she had been treated by her GP with phenoxymethylpenicillin for acute tonsillitis. Examination confirmed synovitis. Systemic assessment including cardiovascular, neurological and skin examination was unremarkable. Abnormal investigations included a leucocytosis with neutrophilia, C-reactive peptide of 116 mg/L, erythrocyte sedimentation rate of 103 mm/hour and acute transaminitis...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287434/later-careers-regenerating-the-medical-workforce
#19
REVIEW
Harriet Gordon
We have a medical workforce crisis where we have insufficient trainees, demonstrated by rota gaps, and in turn nearly half of advertised consultant physician posts cannot be appointed to. Most physicians retire around age 62, and already 5% of the total consultant workforce is those who have retired and returned. If those reaching retirement age chose not to retire but continue working less than full time this would, at least in part, benefit the workforce and utilise valuable skills and experience to the benefit of the individual, the wider medical community and therefore our patients...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/30287433/what-is-the-significance-of-monoclonal-gammopathy-of-undetermined-significance
#20
REVIEW
Catherine Atkin, Alex Richter, Elizabeth Sapey
Monoclonal gammopathy of undetermined significance (MGUS) is characterised by the presence of a monoclonal paraprotein in the blood, without the characteristic end organ damage seen in multiple myeloma. MGUS is more common in older age groups and has a risk of progression to myeloma of 1% per year. Population screening is not currently recommended, but retrospective studies have suggested improvements in myeloma outcomes in those under MGUS follow-up; in addition, MGUS has associated complications, including fracture, osteoporosis, renal disease and infection, which can be treated...
October 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
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