100 Cases in Clinical Medicine

CASE 91: PAIN IN THE FOOT History A 65-year-old man presents with an ulcer on the dorsum of his right foot. He noticed a sore ar ...

ANSWER 91 The presence of varicose veins raises the possibility of a venous ulcer related to poor venous return. However, venous ...

CASE 92: A HEALTHY MAN? History A 50-year-old man has a health screen as part of an application for life insurance. He has no sy ...

ANSWER 92 The ECG shows left ventricular hypertrophy (R-wave in V5 and S-wave in V1 #35 mm). Although only a single reading is g ...

This page intentionally left blank ...

CASE 93: TIREDNESS History A 79-year-old man is brought to his general practitioner by his daughter who says that he is getting ...

I aVR V 1 V 4 V 5 III aVF V 3 V 6 II II aVL V 2 Figure 93.1Electrocardiogram. Questions What is the most likely diagnosis? What ...

ANSWER 93 This 79-year-old man has the clinical features of aortic stenosis and regurgitation. The murmurs are of mixed aortic v ...

CASE 94: ABDOMINAL PAIN History A 70-year-old woman is admitted to hospital with acute onset of abdominal pain. The abdominal pa ...

ANSWER 94 One diagnosis of the abdominal pain which would explain her condition and fit with her predisposing situation is ischa ...

CASE 95: CLUMSINESS History A 66-year-old woman notices that she is having trouble performing some everyday tasks such as doing ...

ANSWER 95 There is evidence in the history and examination of tremor, rigidity and bradykinesia. Her writing shows micrographia ...

This page intentionally left blank ...

CASE 96: SHORTNESS OF BREATH History A 35-year-old woman presents with a 6-month history of increasing shortness of breath. This ...

Figure 96.1Chest X-ray. Figure 96.2High-resolution computed tomography scan. Questions What is the likely diagnosis? What furth ...

ANSWER 96 The history shows a progressive condition over at least 6 months. It is often difficult to be sure of the exact length ...

CASE 97: ROUTINE FOLLOW-UP History Four months ago a 47-year-old publican was admitted to hospital with acute chest pain. A sube ...

ANSWER 97 The obvious abnormal investigation is a very high serum cholesterol with high LDL and low HDL levels. He has many clin ...

CASE 98: CHANGE IN CHARACTER History A 66-year-old man has been persuaded by his wife to go to his general practitioner (GP). Sh ...

ANSWER 98 The blood results show hyponatraemia and the chest X-ray shows a mass overlying the right hilum. This degree of hypona ...