Topic: Neurologic pain
Subject: Medicine
A 21-year-old man presented to the emergency hospital with severe abdominal pain. The pain started four hour ago. His medical history reveals Acute Intermittent Porphyria (AIP) and he used to have frequent attacks of abdominal pain and believes that this attack is no different. On examination, the patient is in acute pain and slightly feverish but not pale, jaundiced or cyanosed. However, his blood pressure is found to be high and he has tachycardia.
You should consider a diagnosis other than an AIP attack if the pain is associated with:
Constipation
Tenderness
Abdominal distension
Decreased bowel sounds
Correct Answer :
B. Tenderness
The pain caused by acute intermittent porphyria is neurologic rather than inflammatory, and therefore, tenderness does not accompany the pain. Palpation might seem to reduce the pain rather than aggravating it. Thus if tenderness is elicited in this patient, an inflammatory pain like appendicitis must be considered. The fact that the patient is febrile also prompts one to consider inflammatory pain. Constipation, abdominal distension, decrease in bowel sounds, and nausea and vomiting all accompany the neurologic pain of acute intermittent porphyria. Physical examination may give more clues to understanding the cause of pain.
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A woman presents with chief complaint of tightening, band-like headaches that usually occur upon rising in the morning. What is the most likely diagnosis?
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Topic: Dementia
Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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Subject: Medicine
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