100 Cases in Clinical Medicine

CASE 65: SORE THROAT History A normally healthy man aged 28 years developed an acute sore throat for which he con- sulted his ge ...

ANSWER 65 The diagnosis is acute drug hypersensitivity causing severe erythema multiforme (Stevens–Johnson) syndrome. The pointe ...

CASE 66: URINARY FREQUENCY History A 37-year-old man presents to his general practitioner (GP) with a 5-day story of urinary fre ...

ANSWER 66 The patient has acute gonorrhoea and gonococcal arthritis. The X-ray of the knee is nor- mal. The diagnosis is made by ...

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CASE 67: BACK PAIN History A 48-year-old woman presented to her general practitioner (GP) with 3 months’ history of back pain in ...

Figure 67.1Lateral X-ray of the thoracic spine. Questions What is the abnormality in the X-ray? What are the likeliest causes? ...

ANSWER 67 The X-ray shows collapse of the T6 vertebra. If there is nothing to suggest osteoporosis or trauma then the commonest ...

CASE 68: A LUMP ON THE SKIN History A 66-year-old farmer is referred to a dermatologist for a lesion on his forearm. It is raise ...

ANSWER 68 The description of the lesion has the characteristic features of a carcinoma of the skin. The risk factors are his age ...

CASE 69: ABDOMINAL PAIN History A 58-year-old woman consults her general practitioner (GP) with a 2-month history of intermitten ...

ANSWER 69 The patient has an obstructive jaundiceas indicated by the history of dark urine and pale stools and the liver functio ...

CASE 70: LEG WEAKNESS History A 24-year-old woman is attending her regular Sunday church service. During the singing of a hymn s ...

ANSWER 70 This patient has hysteria, now renamed as dissociative disorder. The clues to this are the cluster of: the bizarre co ...

CASE71:DROWSINESS History A 72-year-old woman develops a chest infection and is treated at home with doxycycline by her general ...

ANSWER 71 The likeliest diagnosis is secondary acute hypoaldosteronismdue to failure of the hypo- thalamic-pituitary-adrenal axi ...

CASE 72: ABDOMINAL PAIN History A 38-year-old woman presents to the emergency department with a 2-h history of severe abdominal ...

ANSWER 72 The pain’s acute onset, colicky nature and radiation are typical of ureteric colic, the like- liest cause of which is ...

CASE73:CHEST PAIN AND SHORTNESS OF BREATH History A 25-year-old female accountant complains of shortness of breath, cough and ch ...

ANSWER 73 The chest X-ray shows a large right pneumothorax. There is a suggestion of a bullous lesion at the apex of the right l ...