100 Cases in Clinical Medicine

Figure 11.1Magnetic resonance imaging scan through the pituitary. Patients with rapid-onset obesity should have endocrine cause ...

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CASE 12: PERSONALITY CHANGE History A 64-year-old investments manager is causing increasing concern to his wife owing to increas ...

ANSWER 12 The acute abdominal pain and the haematuria indicate ureteric colic due to a renal stone. The polyuria and polydipsia ...

Neurology CASE 13: A WEAK HAND History A 67-year-old man is referred to a neurologist by his general practitioner (GP). His symp ...

ANSWER 13 This man has motor neurone disease. This is a degenerative disease of unknown cause that affects the motor neurones of ...

CASE 14: DOUBLE VISION History A 43-year-old woman presents to her general practitioner (GP) complaining of diplopia, more marke ...

ANSWER 14 This woman’s generalized weakness is due to myasthenia gravis. Myasthenia gravis is due to the presence of acetylcholi ...

Rheumatology CASE 15: PAINFUL KNEE History A 35-year-old man is seen in the emergency department because he has developed a pain ...

ANSWER 15 This patient has a monoarthropathy, a rash and red eyes. Investigations show a raised white cell count and ESR. The di ...

drugs (NSAIDs) for the pain and he may require bed rest. If his disease relapses he should be referred to a rheumatologist. He a ...

CASE 16: PAIN IN THE KNEE History An 80-year-old woman presents to her general practitioner (GP) with pain and swelling in her l ...

Questions What is the likely diagnosis? What is the appropriate management? Figure 16.1X-ray of both knees. ...

ANSWER 16 The clinical picture is one of acute monoarthritis. The patient has a history of some hip pains but this and the Heber ...

Haematology CASE 17: EASY BRUISING History A 36-year-old woman presents to her general practitioner (GP) complaining of spont- a ...

ANSWER 17 This woman has spontaneous bruising due to idiopathic thrombocytopenic purpura (ITP). She has profound thrombocytopeni ...

CASE 18: TIREDNESS,BREATHLESSNESS AND HEADACHES History A 63-year-old woman goes to her general practitioner (GP) complaining of ...

ANSWER 18 This patient has a severe macrocytic anaemia and neurological signs due to vitamin B 12 defi- ciency. There is a famil ...

Infection CASE 19: THREE DAYS OF FEVER History A 24-year-old man presents to his general practitioner (GP) with a fever. This ha ...

ANSWER 19 There is a raised bilirubin with normal liver enzymes, a mild anaemia with a high normal mean corpuscular volume and a ...