Wednesday, 4 February 2009

exam question



examin the abdomen of this patient.(hint:note the scar)
how would proceed after inspection?

5 comments:

  1. let me try,
    possibilities:

    patient with renal transplant.

    ?mass under the scar.
    ?bilateral palbable masses of polycystic kidney.

    no bilateral masses ,but scar of nephrectomy:
    ?renal tumor
    ?polycystic kidney

    no bilateral masses and no scar of nephrectomy:
    ?DM
    ?high BP

    contimue inspecting for:
    1.B-C fistula
    2.stigmata of cyclosporin/azathioprin/steroids therapy
    3.other scars:PD,subclavian line
    4.dermopathy of DM,BMS site

    any other thoughts?

    ReplyDelete
  2. scar in iliac fossae

    either a transplant or crohn's dis.

    in transplant you're expected to comment on:
    previous modes of replacement Rx
    current drug therapy
    is it functioning?
    original cause of renal failure
    possible complications: neck scar for hyperparathyroidism, viral warts, native kidney removal scar

    so:
    inspect arms, legs, tremor, gegiva, skin, neck scars

    palpate for transplant and native kidney

    inspect the back, insulin pump, finger tips

    even if you feel liver edge or spleen don't comment on that or else you will put yourself in a big big mess!!!

    ReplyDelete
  3. nice work
    i think its also worth looking for ptosis and a surgical scar in the forhead i.e repair of post. comm artey anuerysm.. incase the setting was a PCKD .

    ReplyDelete
  4. why not to coment on spleen and liver,i had a pt with cld and liver transplant both,pt has dupuytrens contracture and gynecomastia with all other signs of renal transplant.

    ReplyDelete
  5. oh thats a hard one , CLD with liver transplant and kidney transplant and signs of ???

    ReplyDelete