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Oxford Challenging Concepts in Oncology Cases with Expert Commentary: Part 2

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(BQ) Continued part 1, part 2 of the document Artificial ventilation and respiratory mechanics basic has contents: Alveolar micromechanics, how the diaphragm works in normal subjects, altered elastic properties of the respiratory system, closed ioop control mechanical ventilation, and other contents. Invite you to refer. | Oxford Challenging Concepts in Oncology Cases with Expert Commentary Part 2 CA SE Metastatic renal cell cancer 13 and hypercalcaemia Meenali Chitnis Expert commentary Matthew Wheater Case history A 63-year-old man presented to his GP with a 2-week history of new-onset lower back pain and lethargy. The pain was present at all times including at rest and was inadequately controlled by simple analgesia. In the week prior to presentation the patient s wife had noticed him to be intermittently confused. On further question- ing the patient had urinary frequency and nocturia which was new. He had not opened his bowels for 2 days. His appetite was good but he had lost 1 kg in weight over the last 2 months and had experienced mild nausea. He had a history of hypertension diagnosed at the age of 54 and controlled on amlodipine 5 mg daily. He was a retired maths teacher and had continued to keep active with hobbies including cycling reading and fishing but had been struggling with these over the preceding 2 3 weeks. On examination he was apyrexial and his BP was 150 85. Routine examination of the cardiovascular respiratory and abdominal systems was normal. There was no neurological deficit but the patient did have percussion tenderness over the area corresponding to T12 L1. The GP arranged for the patient to be reviewed by the on- call medical team at the local hospital. He underwent routine blood tests and had plain X-ray films of the thoracic and lum- bar spine. Biochemistry Table 13.1 showed the patient to have renal impairment and hypercalcaemia. A plain X-ray of the thoracolumbar spine revealed a compression frac- ture of the T12 vertebral body. The patient was admitted to the medical ward for treat- ment of his hypercalcaemia analgesia for his back pain and for further investigations. He received 3 L of fluid over the course of the evening and overnight. Blood results the following day revealed a minor improvement in hypercalcaemia with the corrected calcium now .