100 Cases in Clinical Medicine

CASE 74: CONFUSION History An 86-year-old man has been in a residential home for 3 years since his wife died. He was unable to l ...

ANSWER 74 This is not the picture of dementia. The acute onset with clouding of consciousness, hal- lucinations, delusions, rest ...

CASE 75: UNCONSCIOUS AT HOME History A 21-year-old man is brought in to hospital at 5 pm. He was found unconscious in his flat b ...

ANSWER 75 This young man has been brought in unconscious having been well less than 24 h previ- ously. The most likely diagnoses ...

CASE 76: HEADACHE History A 24-year-old man presents to an emergency department complaining of a severe headache. The headache s ...

ANSWER 76 This patient has bacterial meningitis. He has presented with sudden onset of severe headache, vomiting, confusion, pho ...

CASE 77: ABDOMINAL PAIN History A 70-year-old woman has been complaining of upper abdominal pain which has increased over the la ...

ANSWER 77 This woman has a 5-year history of intermittent upper abdominal pain. Her current pain has lasted longer than previous ...

CASE 78: FEVER History A 36-year-old man presents to his general practitioner (GP) complaining of a fever and generalized aching ...

ANSWER 78 This seems likely to be an infective problem which has gone on for over a week. The length of the history makes influe ...

CASE 79: CONFUSION History A 79-year-old woman is brought to hospital by her daughter because of increasing con- fusion. This ha ...

ANSWER 79 This woman’s confusion is due to hyponatraemia. There are many causes of confusion in the elderly but the very low sod ...

CASE 80: PAIN IN THE LEG History A 38-year-old woman presents to the emergency department with a painful left calf. She had woke ...

ANSWER 80 The most likely clinical diagnosis in this patient is a left deep vein thrombosis(DVT). The main differential diagnose ...

finding, primary antiphospholipid antibody syndrome. Although the antibodies prolong the activated partial thromboplastin time ( ...

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CASE 81: ABDOMINAL PAIN History A 38-year-old man has a 2-month history of abdominal pain. The pain is epigastric or cen- tral a ...

ANSWER 81 The blood count shows anaemia with a low MCV indicating a microcytic anaemia. The high red cell count with low haemogl ...

CASE 82: ACHES AND PAINS History A 76-year-old woman has felt non-specifically unwell for about 10 weeks. She feels stiff especi ...

ANSWER 82 This woman has the typical clinical symptoms of polymyalgia rheumatica/giant cell arteritis. Most patients are over 65 ...