100 Cases in Clinical Medicine

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CASE 50: CHEST PAIN AND SHORTNESS OF BREATH History A 29-year-old woman complained of a sudden onset of right-sided chest pain w ...

Figure 50.2Chest X-ray. Questions What is the likely diagnosis? How can it be confirmed? ...

ANSWER 50 This woman has had a sudden onset of pleuritic pain, breathlessness and cough. The phys- ical signs of tachypnoea, tac ...

Immediate management should involve heparin, usually as subcutaneous low-molecular- weight heparin. The anticoagulation can then ...

CASE 51: CHEST PAIN History A 62-year-old man is admitted to hospital with chest pain. The pain is in the centre of the chest an ...

Questions What is the likely diagnosis? How might this be confirmed? Figure 51.2Chest X-ray. ...

ANSWER 51 This 62-year-old man had an anteroseptal myocardial infarctionindicated by Q-waves in V2 and V3 and raised ST segments ...

CASE 52: GENERAL WEAKNESS History An 82-year-old man is sent up to the emergency department by his general practitioner (GP). He ...

ANSWER 52 A dietary history is an essential part of any history and is particularly important here where a number of features po ...

CASE 53: LOSS OF CONSCIOUSNESS History An unkempt man of uncertain age, estimated to be 55–65 years, is brought in to hospital b ...

ANSWER 53 This man has been unconscious in the open air for an unknown period. Little history is available, but the tablets in h ...

The management of hypothermia is gradual passive rewarming with replacement of fluids by warmed colloids as rewarming takes plac ...

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CASE 54: TIREDNESS History A 22-year-old woman complains of tiredness for 6 months. Her only other symptom is a gradual increase ...

ANSWER 54 The most likely diagnosis is malabsorption from coeliac disease.The report of a dimorphic blood film means that there ...

CASE 55: RECURRENT CHEST INFECTIONS History A 45-year-old woman is admitted to hospital with pneumonia. She has had three episod ...

ANSWER 55 The likely diagnosis is achalasia of the cardia, a primary neurological disturbance of the nerve plexuses at the lower ...

CASE 56: GENERALIZED ITCHING History A 63-year-old man presents to his general practitioner (GP) complaining that over the past ...

ANSWER 56 This patient has polycythaemia rubra vera. This is due to abnormal proliferation of red cell precursors derived from a ...