100 Cases in Clinical Medicine

This page intentionally left blank ...

CASE 20: FEVERS AND FATIGUE History A 33-year-old woman is admitted to hospital because of general fatigue, fever and weight los ...

Figure 20.1 Chest X-ray. Questions What is the diagnosis? How would you investigate and manage this patient? ...

ANSWER 20 This patient has fever, marked weight loss and a leucoerythroblastic anaemia. The length of the symptoms makes infecti ...

GENERAL SELF-ASSESSMENT CASES Section 2 ...

This page intentionally left blank ...

CASE 21: TIREDNESS History A 55-year-old man presents to his general practitioner (GP), complaining of lack of energy. He has be ...

ANSWER 21 Fatigue is a very common symptom of both physical and mental illness. The differential diag- nosis is extensive and in ...

Treatment is with T 4 at a maintenance dose of 75–200&g/day. Response is measured clin- ically and biochemically by the retu ...

This page intentionally left blank ...

CASE 22: ANKLE SWELLING History A 72-year-old man goes to his general practitioner (GP) complaining of painless swelling of both ...

ANSWER 22 Peripheral oedema may occur due to local obstruction of lymphatic or venous outflow, or because of cardiac, renal, pul ...

The initial treatment of this patient involves fluid and salt restriction, and diuretics to reduce the oedema. He should be anti ...

This page intentionally left blank ...

CASE 23: ACUTE DIARRHOEA History A 65-year-old man goes to his general practitioner (GP) complaining of diarrhoea. This had deve ...

ANSWER 23 This patient has diarrhoea and weight loss due to giardiasis. It is important to take a care- ful history in a patient ...

CASE 24: SHORTNESS OF BREATH ON EXERTION A 23-year-old student presents to her general practitioner (GP) complaining of shortnes ...

ANSWER 24 This patient has viral myocarditis due to Coxsackie B virus. Viruses which can cause myocarditis include Coxsackie B a ...

This page intentionally left blank ...

CASE 25: FEVER AND SHORTNESS OF BREATH History A 62-year-old man presents to the emergency department complaining of shortness o ...