100 Cases in Clinical Medicine

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CASE 57: COUGH AND JOINT PAINS History A 29-year-old man presents with a cough and some mild aches in the hands, wrists and ankl ...

Questions What is the likely diagnosis? How might this be confirmed? Figure 57.1Chest X-ray. ...

ANSWER 57 The likely diagnosis is sarcoidosis. The age is typical and sarcoidosis is more common in those of African-Caribbean o ...

CASE 58: THIRST AND FREQUENCY History A 63-year-old woman is referred to a nephrologist for investigation of polyuria. About 4 w ...

ANSWER 58 This woman has mild hypercalcaemia but this is not high enough to explain her extreme thirst and polyuria. It is more ...

Figure 58.1Magnetic resonance imaging scan through the pituitary. The commonest causes of polyuria are diabetes mellitus and ch ...

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CASE 59: BLOOD IN THE URINE History A 52-year-old businessman is referred to a nephrologist for investigation of microscopic hae ...

ANSWER 59 Microscopic haematuria has many renal and urological causes, e.g. prostatic disease, stones, but the presence of signi ...

CASE 60: WEIGHT LOSS History A 67-year-old man attends his general practitioner’s (GP’s) surgery. He says that he has lost 10 kg ...

ANSWER 60 The clinical picture suggests obstruction to outflow from the stomach. This would be com- patible with vomiting of res ...

CASE 61: LOSS OF CONSCIOUSNESS History A 52-year-old man is brought to the emergency department by ambulance. His wife gives a h ...

ANSWER 61 This man has had an episode characterized by sudden onset loss of consciousness associ- ated with the development of g ...

CASE 62: MEMORY LOSS History A 38-year-old man presents to a neurologist having been referred because of memory loss and difficu ...

ANSWER 62 The mental test score is very low at 4 out of 10, indicating severe impairment of cognitive function. A longer Mini-me ...

CASE 63: DIARRHOEA History A 35-year-old woman has a year-long history of intermittent diarrhoea which has never been bad enough ...

ANSWER 63 Bloody diarrhoea 10 times a day suggests a serious active colitis. In the absence of any recent foreign travel it is m ...

CASE 64: HEADACHES History A 32-year-old woman is admitted to hospital with a 3-day history of failing vision, a reduced urinary ...

ANSWER 64 This woman has accelerated hypertension, defined by the retinal papilloedema (grade IV retinopathy), and renal failure ...