The Rational Clinical Examination
David L. Simel, Drummond Rennie
Allan S. Detsky, Philip S. Smalley, Jose Chang
"Ten days before being treated, a 65-year-old man experienced
a Wallenberg stroke involving the lateral medulla, which left him
with difficulty swallowing. Since then, he had been treated with intravenous
fluids, as attempts at eating led to mild aspiration with pneumonia.
In that period, he lost 6% of his usual body weight and
was continuing to lose weight. He felt weak and was able to ambulate
only with difficulty because of his stroke-related ataxia and generalized
weakness. On physical examination, there was an obvious squared-off appearance
to his shoulders from subcutaneous tissue and muscle wasting. There
was no edema...."
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