Most doctors think that the most memorable way to learn medicine is to see patients. It is
easier to recall information based on a real person than a page in a textbook. Another
important element in the retention of information is the depth of learning. Learning that
seeks to understand problems is more likely to be accessible later than superficial factual
accumulation. This is the basis of problem-based learning, where students explore prob-
lems with the help of a facilitator. The cases in this book are designed to provide another
useful approach, parallel to seeing patients and giving an opportunity for self-directed
exploration of clinical problems. They are based on the findings of history taking and
examination, together with the need to evaluate initial investigations such as blood inves-
tigations, X-rays and ECGs.
These cases are no substitute for clinical experience with real patients, but they provide a
safe environment for students to explore clinical problems and their own approach to
diagnosis and management. Most are common problems that might present to a general
practitioner’s surgery, a medical outpatients or a session on call in hospital. There are a
few more unusual cases to illustrate specific points and to emphasize that rare things do
present, even if they are uncommon. The cases are written to try to interest students in
clinical problems and to enthuse them to find out more. They try to explore thinking
about diagnosis and management of real clinical situations.
The first 20 cases are arranged by systems, but the next 80 are in random order since, in
medicine, symptoms such as breathlessness and pain may relate to many different clinical
problems in various systems. We hope you enjoy working through the problems presented
here and can put the lessons you learn into practice in your student and subsequent career.
P John Rees
James Pattison
Gwyn Williams
January 2007