100 Cases in Clinical Medicine

CASE 41: ABDOMINAL PAIN History A 25-year-old woman presents to her general practitioner (GP) complaining of pain in her right l ...

ANSWER 41 This woman has acute appendicitis. Acute appendicitis classically presents with a short his- tory of central abdominal ...

CASE 42: POSTOPERATIVE DETERIORATION History The medical team is asked to review a postoperative surgical patient. A 62-year-old ...

ANSWER 42 This patient has postoperative acute renal failure due to a combination of intra-abdominal sepsis and aminoglycoside n ...

CASE 43: ABDOMINAL DISCOMFORT History A 64-year-old woman is referred to outpatients with a 6-month history of mild abdominal di ...

ANSWER 43 The symptoms she describes raise the possibility of a 5-hydroxytryptamine (5-HT)-secreting carcinoid tumour. The typic ...

CASE 44: UNCONSCIOUS AT HOME History A 28-year-old woman is admitted to the emergency department in a coma. The patient was foun ...

ANSWER 44 This patient has acute renal failure as a result of rhabdomyolysis. Severe muscle damage causes a massively elevated s ...

CASE 45: EXCESS HAIR GROWTH History A 22-year-old woman is referred to a dermatologist complaining of increasing growth of hair ...

ANSWER 45 This patient has hirsutism and secondary amenorrhoea due to polycystic ovaries(Stein– Leventhal syndrome). This is a c ...

Figure 45.1Ovarian ultrasound. True hirsutism is due to excessive androgens, whereas constitutional hirsutism is found in certa ...

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CASE 46: NAUSEA AND VERTIGO History A 17-year-old woman is admitted to the emergency department complaining of severe vertigo. T ...

ANSWER 46 The acute onset of these symptoms and signs with drowsiness in a 17-year-old girl raise the possibility of a drug over ...

CASE 47: CHEST PAIN History A 64-year-old woman has a 10-year history of retrosternal pain. The pain is often present in bed at ...

ANSWER 47 A number of features in the history make oesophageal refluxa likely diagnosis. The char- acter and position of the pai ...

CASE 48: HEADACHES History A 44-year-old woman presents to her general practitioner (GP) complaining of headaches. These headach ...

ANSWER 48 This patient has a chronic tension headache. This is the commonest form of headache. It occurs mainly in patients unde ...

CASE 49: HEADACHE AND CONFUSION History A 55-year-old man is admitted to hospital with headache and confusion. He has a cough an ...

ANSWER 49 The chest X-ray shows extensive changes in the right upper zone which seem as if they are likely to be more extensive ...