100 Cases in Clinical Medicine

CASE 83: WEAKNESS History A 76-year-old woman presents to the emergency department complaining of an episode of weakness in her ...

ANSWER 83 This woman gives a history of transient neurological symptoms with no residual signs. She is at increased risk of cere ...

CASE84:VOMITING History A 32-year-old man presents to the emergency department at 2 am rather inebriated. He had been to an end ...

ANSWER 84 The most likely diagnosis is a tear of the mucosa in the lower oesophagus or upper stom- ach causing haematemesis (a M ...

CASE 85: TIREDNESS AND IRRITABILITY History A 33-year-old housewife has noticed that she is becoming tired and having difficulty ...

ANSWER 85 Although anxiety might produce some of these symptoms and signs, they fit much better with a diagnosis of hyperthyroid ...

CASE 86: WEAKNESS OF THE LEGS History A 48-year-old man presents to the emergency department with weakness of his legs. Four wee ...

ANSWER 86 The most marked feature is the loss of power. The reduced tone and absent reflexes indi- cate that this is a lower mot ...

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CASE 87: RECURRENT FALLS History An 85-year-old man is admitted to hospital because of a fall in which he has sustained a mild f ...

I aVR aVL aVF V1 V2 V3 V4 V5 V6 II III II Figure 87.1Electrocardiogram. Question What are the most likely diagnoses? ...

ANSWER 87 There are a number of possibilities to explain falls in the elderly. Some more information in the history about the ci ...

CASE 88: FATIGUE History A 63-year-old woman is brought in to the surgery by her neighbour who has been wor- ried that she looks ...

ANSWER 88 The liver function tests show a predominantly obstructive picture with raised alkaline phosphatase and gamma-glutamyl ...

CASE 89: LOSS OF CONSCIOUSNESS History A 40-year-old man is admitted to the emergency department having been found uncon- scious ...

ANSWER 89 This man has signs of dehydration and the high urea with a normal creatinine is consistent with this. He is acidotic. ...

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CASE 90: COUGH AND BREATHLESSNESS History A 69-year-old widower smoked 20 cigarettes a day for over 40 years but then gave up 9 ...

Figure 90.1Chest X-ray. Questions What is the likely diagnosis? What management is appropriate? ...

ANSWER 90 The most likely diagnosis is chronic obstructive pulmonary disease(COPD). The physical signs and chest X-ray indicate ...