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Harrison series   اليكم قائمة بأسماء الكتب واغلبها 2017 Harrison’s Nephrology and Acid-Base Disorders, 2nd Edition Harrison’s Neurology in Clinical Medicine 3rd Harrison’s Rheumatology 3rd Edition Harrisons Cardiovascular Medicine 2nd Edition_2 Harrison's Cardiovascular Medicine 3rd Edition (2017) Harrison's Endocrinology 4th Edition (2017) Harrison's Endocrinology, 3E Harrisons Gastroenterology and Hepatology 2nd Edition Harrison's Hematology and Oncology, 2e Harrison's Hematology and Oncology, 3rd Edition (2017) Harrison's Infectious disease 3rd Edition (2017) Harrisons Infectious Diseases   Harrisons Manual of Medicine, 18th Edition Harrisons Manual of Oncology Harrison's Neurology in Clinical Medicine 4th Edition (2017) Harrisons Neurology in Clinical Medicine, 3E Harrisons Principles of Internal Medicine 18th Edition Harrison's Principles of Internal Medicine 19th Edition (2015)

AN OVERWEIGHT TEENAGER WITH THICKENED SKIN AROUND HER NECK History A 13-year-old girl attends your clinic with her mother. She is complaining of skin changes affecting her neck , which have been progressively worsening over the past 18 months . In particular the changes are leading to name-calling at school with her peers saying her neck is ‘ dirty ’. Her school attendance for the last term was only 87 per cent. She is a very quiet girl and there is little eye contact through the consultation. Both she and her mother acknowledge that she is overweight . Her menarche was at the age of 11 years and 3 months , her menses are irregular . She is not on medication . She is an only child. Her mother has type 2 diabetes , hypertension and is also overweight , her father suffers from asthma . Examination Her height is 163 cm and weight 97.5 kg – a body mass index ( BMI ) of 37 – and blood pressure 140/85 mmHg. She has symmetrical hyperp

This is   due to   myocardial ischaemia   and presents as a   central chest tightness   or   heaviness , which is   brought on   by   exertion   and   relieved by rest . It may   radiate to   one   or   both arms ,   the neck ,   jaw   or   teeth . Other precipitants : Emotion ,  cold weather , and  heavy meals . Associated symptoms : Dyspnoea ,   nausea ,   sweatiness ,   faintness Causes Mostly   atheroma . Rarely :   anaemia ,  AS ;   tachyarrhythmias ;   HCM ;  arteritis / small vessel disease  ( microvascular angina/cardiac syndrome X ). Types of angina v _Stable angina: induced by effort,   relieved by rest . v _Unstable (crescendo) angina: Angina of increasing   frequency   or   severity;   occurs on   minimal exertion   or   at rest;   associated with   ↑↑ risk of mi. v _Decubitus angina: precipitated by   lying flat. v _Variant (Prinzmetal's) angina: caused by   coronary artery spasm ( rare ;   may   co-e