How Would You Proceed?
Spotted this patient while doing ward round. What is the clinical sign?
How would you proceed to examine him?
Photo contributed by Wuchereria
Labels: Quiz series
posted by Dr. David Teoh @ 8/09/2007 07:53:00 PM
Thursday, August 09, 2007
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8 Comments:
Ascertain gum hypertrophy/gingivitis... Most likely hypertrophy in exam. Firstly stratify what is most likely- haemato/nephro/neuro/nutritional status ie skin. If any is most likely- proceed with that system. Haemato ie AMML? Proceed to examine haematological system. Nephro as in cyclosporin use in transplant- Hirsutism/tremor/renal transplant scar then abdomen. Check for dysmorphism and gross sign of mental retardation/neurological signs. Also notice for any evidence of malnutrition in particular any perifollicular haemorrhage. Lastly request to ask for drug history ie phenytoin/cyclosporin.
drug-induced gum hypertrophy
Gingival swelling/redness
Causes:
Infection / Gingivitis
Scurvy
Side effect of some drugs
Poor toothbrushing technique
Pregnancy
gingival hypeertrophy.drug induced,,amml,cyclosprin treat ment etc should be ruled out
this pt with purpuric rash and gum hyperplasia most likely case of acute myeloid leukemia , as scurvey do not cause gum hypertrophy , drugs can cause gum hypertrophy but not the purpura
scurvy
gum hypertrophy / sec to drugs like phenytoin or cyclosporine.
we should loo for signs of pheytoin toxicity like ataxia and nystagmes. also look for a-v fistula on upper limb, and renal transplant scar
gumm hypertrophy due to either cyclosporine , phynetoin,
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