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Professional Medical EnglishAnswers to the Case Study in Issue 2Welcome to the MedicalEnglish pages for boththe general public andhealth professionalsalike. Health questions,case studies, interviewsand health promotionto educate, challengeand inform.1. List the other clinical signs that maybe picked up during the preliminaryexamination that indicate the need fora more thorough examination of therespiratory system?- Nicotine staining (malignancy, chronic- obstructive pulmonary disease - COPD)- Unilateral wasting of small muscles ofhands (apical lung cancer)- Asterixis (hypercapnoea)-Pyrexia (infection, endocarditis)- Tachycardia (infection)-Dry, inflamed eyes (may be a sign ofautoimmune disease affecting the lungs)- Central cyanosis (hypoxia)- Lymphadenopathy (infection, malignancy)2. Why would it also be important toexamine the cardiovascular system?It is not possible to tell from the historywhether the increasing symptoms aredue to respiratory or cardiac or both. Alsoconsider mental health examination in viewof possible depression due to his increasingsymptoms and the recent death of his wife3. Why is the slow pulse rate ofsignificance here?Patient is taking Atenolol. It does not appearto be achieving the appropriate reductionin blood pressure and may be causingthe slow pulse rate, resulting in reducedcardiac output and fatigue. It may also beexacerbating COPD4. Assuming the examination ofspecific systems is unremarkable, whatare your differential diagnoses at thisstage?May be one or several co-existingpathologies:- Chronic uncontrolled hypertension causingonset of heart failure- Worsening COPD with heart failure- Ischaemic heart disease- Malignancy