ABSTRACT
You are reviewing patients in the medical outpatient clinic. Your next patient has been referred by his general practitioner with the following letter. Please read the letter and then review the patient.
Dear Doctor,
Re: Mr Arnold White
Age: 58 years
Please advise on the management of this chap who has been worrying me of late. He has been complaining of a non-specific illness for a few weeks with generalised aches and pains, particularly affecting his legs. Of concern is 5 kg weight loss for no apparent reason, over the same period of time. Also, over the past week he describes numbness in his toes and clinical examination confirmed a sensory neuropathy. Other abnormalities noted on clinical examination was a blood pressure of 175/99 and an odd rash on the lower limbs resembling erythema ab igne (which has only appeared in the last few weeks). Blood tests carried out recently show an ESR of 77 and urea 17.6 with a serum creatinine of 182. There is no past medical history of hypertension or renal impairment. I’m not sure how to proceed and hence value your advice.
Yours sincerely
