100 Cases in Clinical Medicine

CASE 32: ABDOMINAL PAIN History A 31-year-old woman has a 6-year history of abdominal pain and bloating. She has had an irregula ...

ANSWER 32 The pattern of the pain, the absence of physical signs, normal investigations and repro- duction of the pain during si ...

CASE 33: HEADACHES AND CONFUSION History A 28-year-old black South African theatre nurse in London is admitted to the emergency ...

ANSWER 33 This woman has cerebral toxoplasmosissecondary to HIV infection. This condition is caused by the protozoan Toxoplasma ...

CASE 34: SEIZURES History A 23-year-old African-Caribbean woman is admitted to the emergency department hav- ing had two tonic–c ...

ANSWER 34 This patient has a number of important symptoms, particularly the generalized seizures, auditory hallucinations, fever ...

CASE 35: SWELLING IN THE NECK History A 38-year-old man presents to his general practitioner (GP) complaining of a painless lump ...

ANSWER 35 Transient small nodes in the neck or groin are common benign findings. However, a 3%4cm mass of nodes for 2 months is ...

Figure 35.1CT–PET image showing increased activity in enlarged lymph nodes, particularly in the right side of the neck. The cha ...

CASE 36: ABDOMINAL PAIN History A 74-year-old woman has a 10-year history of intermittent lower abdominal pain. The pain has bee ...

Questions What is the likely diagnosis? What should be the initial management? Normal Haemoglobin 11.8 g/dL 11.7–15.7 g/dL Mea ...

ANSWER 36 This woman has diverticulitis. Colonic diverticula are small outpouchings which are most commonly found in the left co ...

CASE 37: HIGH BLOOD PRESSURE History A 36-year-old woman is referred by her general practitioner (GP) to a hypertension clinic. ...

ANSWER 37 This woman has hypertension due to renovascular disease. The vast majority of cases of hypertension are due to essenti ...

CASE 38: SWELLING ON THE LEGS History A 34-year-old woman presents to her general practitioner (GP) complaining of a rash. Over ...

ANSWER 38 This patient has erythema nodosum, in this case secondary to previously undiagnosed Crohn’s disease. Erythema nodosum ...

CASE 39: BLISTERS ON THE SKIN History An 83-year-old man presents to his general practitioner (GP) having developed multiple bli ...

ANSWER 39 This patient has pemphigus vulgaris. This is a blistering disease where the level of the blister is within the epiderm ...

CASE 40: PAIN IN THE CHEST AND SHORTNESS OF BREATH History A 16-year-old African-Caribbean boy presents to the emergency departm ...

ANSWER 40 This boy has sickle cell diseaseand presents with his first serious bony/chest crisis. Sickle cell disease occurs main ...