100 Cases in Clinical Medicine

Questions What is the likely diagnosis? How would you further investigate and manage this patient? Figure 25.1Chest X-ray. ...

ANSWER 25 This man has Legionella pneumophilapneumonia. Community-acquired pneumonia is most commonly caused by Streptococcus pn ...

CASE 26: LOIN PAIN AND HAEMATURIA History A 46-year-old woman presents to the emergency department with a 2-day history of right ...

ANSWER 26 This patient has autosomal dominant polycystic kidney disease(ADPKD). She has macro- scopic haematuria, hypertension a ...

Figure 26.1Renal ultrasound demonstrating multiple cysts. Patients with ADPKD are often asymptomatic. ADPKD patients may presen ...

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CASE 27: JOINT PAINS History A 38-year-old woman presents to her general practitioner (GP) complaining of pains in her joints. S ...

ANSWER 27 This patient has symptoms and signs typical of early rheumatoid arthritis. Rheumatoid arthritis is a chronic, systemic ...

Rheumatoid arthritis tends to spare the distal interphalangeal joints. Systemic symptoms of rheumatoid arthritis may precede th ...

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Question What should be done? CASE 28: CHRONIC CHEST PAIN History A 25-year-old woman is complaining of chest pain. This had b ...

ANSWER 28 The ECG shown is normal. The pain does not have the characteristics of ischaemic heart disease. On the basis of the in ...

CASE 29: OVERDOSE? History A 30-year-old woman is brought up to the emergency department at 2 pm by her hus- band. He is worried ...

ANSWER 29 It is not evident from the history that the patient herself has been asked about any tablets or other agents she has t ...

CASE 30: AMENORRHOEA History A 23-year-old actress presents to her general practitioner (GP) complaining that she has not had a ...

ANSWER 30 This picture of loss of menstruation (secondary amenorrhoea), weight loss (to a body mass index (BMI) of 14.0) and hyp ...

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CASE 31: PAIN IN THE BACK History A 75-year-old woman presents to her general practitioner (GP) complaining of severe back pain. ...

Questions What is the likely diagnosis? How would you manage this patient? Figure 31.1X-ray of the lumbar spine. ...

ANSWER 31 This woman has vertebral collapse due to osteoporosis. The symptoms of osteoporosis are deformity, localized pain and ...