[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient feels itchy, please examine their hands and then proceed from there, then present your findings to the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191650″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10 ” counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]

  1. How would you like to begin investigating this patient?
  2. What is the most likely cause for this patient’s disease?
  3. If this patient’s illness was attributable to alcohol abuse, what other complications would you like to look for?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has numerous stigmata of chronic liver disease, including:

  • Leukonychia;
  • A Dupuytren’s contracture;
  • Jaundice;
  • Excoriations in the antecubital fossa due to pruritis;
  • Spider naevi.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Clinical features:

Jaundice is not a disease, but a clinical manifestation of an underlying pathology. It presents with yellow discoloration of the skin, the sclera of the eye and the mucous membranes. A patient with jaundice may also experiences pruritis, all over his/ her body or on a particular area. Light colored stools and dark colored urine are two classic clinical features of jaundice. Apart from these major symptoms, patient might also complain of nausea, vomiting, loss of appetite, fever, confusion, fatigue or edema of legs or abdomen.

Initial investigations:

To rule out the cause of jaundice, emphasis is laid on the history from the patient and a proper examination. However, some additional relevant tests are also required to confirm the diagnosis. These include a full blood count, liver function tests, amylase and lipase levels to rule out the possibility of pancreatitis, serum electrolytes, and a urine analysis. After these initial tests, further tests for example, ultrasound abdomen can be done as per need.

Underlying pathology:

Jaundice occurs due to increased level of serum bilirubin which may either be because of increased production or decreased excretion. These can be divided into prehepatic, intra hepatic and post hepatic causes.

Prehepatic causes include:

  • Thalassemia
  • Malaria
  • Glucose 6 phosphate dehydrogenase deficiency
  • Spherocytosis
  • Sickle cell disease

Intra hepatic causes include:

  • Hepatitis
  • Cirrhosis
  • Criggler Najjar syndrome
  • Gilbert’s syndrome
  • Drug induced
  • Cancer

Post hepatic causes include:

  • Pancreatitis
  • Gall stones
  • Bile ducts blockage or strictures
  • Cancer
  • Newborn jaundice
  • Cholangitis

Common treatments:

Treatment is always determined by the underlying cause.  Alcohol abstinence is essential.  General treatment steps that are taken to treat jaundice include intake of fluids, relevant medications, and antibiotics.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has clinical evidence of chronic liver disease including leukonychia, a Dupuytren’s contracture, excoriations in the antecubital fossa, spider naevi and jaundice.  In light of the Dupuytren’s contracture I would like to take a thorough alcohol history.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]