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Case Record Chapter (Thimerosal (Ethylmercury) (The mother's vaccine…

- - - - Abdominal Pain
        
        Patients with a perinephric abscess tend to bend toward the side of the lesion
        
        Patients drawn up in the fetal position often have pancreatitis
        
        Patients who are restless in their agony probably have some form of obstruction
        
        patients with peritonitis tend to hold themselves quite still
        
        Position of patient with Psoas Sign
      - Breathing Difficulty
        
        Paroxysmal Nocturnal Dyspnea
        
        To obtain relief from cardiac paroxysmal nocturnal dyspnea, patients may report going to the window for “better air.” In reality, leaning on the window helps to support the fatigued body in an erect position; it is the standing that is important, the rest being cerebral elaboration.
        
        Orthopnea
        
        Pulmonary Orthopnea
        
        Orthopnea can also occur in asthma. In fact, asthmatic patients who are sweating and sitting up have worse pulmonary functions than those who are not
        
        severe obstructive pulmonary disease and Orthopnea
        
        severe bilateral apical disease with relative sparing of the bases of the lungs, mimick the orthopnea of congestive heart failure.
        
        Cardiac Orthopnea
        
        patients with left-sided heart failure experience some relief of their breathlessness when right-sided heart failure supervenes.
        
        Patients with pure right-sided heart failure do not experience orthopnea
        
        Signifies left-sided congestive heart failure more than 95% of the time
        
        Platypnea
        
        sensation of breathlessness when erect, with relief in the recumbent position
        
        usually accompanied by orthodeoxia, which is a decrease in oxygen saturation in the erect posture when compared with the recumbent. In any pulmonary disease that afflicts primarily the basal segments of the lungs, assumption of the erect or sitting position increases the ventilation/perfusion mismatch and causes the arterial oxygen saturation to decrease.
        
        In the presence of cirrhosis (Santiago and Dalton, 1977) in which case the existence of acquired arteriovenous malformations has been inferred. This hepatopulmonary syndrome, even in the absence of other complications or signs of decompensation, may signal that the patient is headed for a liver transplant
        
        Trepopnea
        
        indicates the preference of certain patients for the lateral recumbent position
        
        As a rule, with unilateral lung disease, pulmonary gas exchange is maximized by placing the normal lung in the dependent position
        
        One exception to the “good side down” rule is pleural disease accompanied by pleuritis in which the patient uses the bed as a way of splinting the painful side of the chest.
    - - Symphysis Pubis-to-Floor Measurements
        
        The length from the pubic symphysis to the floor is about the same as from the pubic symphysis to the crown (i.e.,about half the total height)
        
        More precisely, the pubic symphysis-to-crown/pubic
        symphysis-to-floor ratio is normally 0.92 (SD = 0.04) in whites and 0.85 (SD = 0.03) in blacks (McKusick, 1970)
        
        Achondroplastic dwarfs, but not persons who are constitutionally short statured, have a ratio greater than 1.0 (the symphysis pubis-to-floor span is much less than half the total height).
        
        In achondroplastic dwarfs, the humeri and femora are relatively shorter than the forearms and lower legs.
        
        Patients with Marfan syndrome or “marfanoid habitus”(common in normal black persons) have a lower than normal ratio (the symphysis pubis-to-floor measurement is greater than half the height), whereas equally tall acromegalics do not.
        
        In children, the skeletal changes may be the first sign of Marfan syndrome to be expressed. Recognition of these signs permits early treatment to protect the arteries.
      - Weight: Distribution and Changes
        
        Diameter of waist/diameter of hips = 0.7 (in normals)
        A result of less than 0.7 indicates “pear” obesity and one of more than 0.85 indicates “apple” obesity
      - HIV-associated Lipodystrophy
        
        Patients with HIV, especially when treated with highly active antiretroviral therapy, may develop a progressive syndrome characterized by central lipohypertrophy, peripheral lipoatrophy, hyperlipidemia, lipomata, and insulin resistance (Carr et al., 2003).
        
        Patients appear emaciated because of loss of subcutaneous tissue from the cheeks, arms, thighs, and buttocks, with prominent superficial veins
        
        The dorsocervical fat pad enlarges, forming a “buffalo hump”; the neck circumference expands by 5 to 10 cm because of increased chin fat, or “horse collar”; the breasts hypertrophy; and central truncal obesity occurs
        
        Patients have been vulgarly described as “stick men with a protease paunch,” although not all have been treated with protease inhibitors
        
        Probably, 50% of more of HIV patients on antiretroviral therapy are afflicted (Milinkovic and Martinez, 2005).
        
        “Slim disease” or the AIDS wasting syndrome, recognized in Uganda early in the epidemic, primarily involved loss of nonadipose tissue without changes in fat distribution (Fuller, 2008).
      - Is the Patient Dehydrated?
        
        Sunken eyes or fontanelles
        
        Absence of tears
        
        Dry mucous membranes