Case of the Month
A Hospital-Acquired Infection
A patient develops signs of sepsis. She has had a central line in situ for the past ten days. There is erythema surrounding the catheter insertion site.1. What is the most likely diagnosis? The most likely diagnosis, in this case, is line sepsis. Central venous...
A 46-Year-Old Woman with Weight Loss and a Neck Lump
A 46-year-old woman presents with weight loss. On examination, you note that she has prominent eyes, ‘lumpy’ swelling over her shins and the neck lump seen in the image above. 1. What is the most likely diagnosis? This patient has a history of weight loss in...
A 17-Year-Old Boy with a Neck Lump
A 17-year-old boy is concerned as he has noticed a lump in the middle of his neck. His mother has hypothyroidism and is concerned that her son may have it too. He has no other symptoms and is otherwise well. On examination, you note a painless swelling in the midline...
A 60-Year-Old Woman with a Neck Lump
A 60-year-old woman presents with a lump in the middle of her neck. She is also troubled by regurgitation of her food. On examination, the midline lump gurgles on palpation. 1. What is the most likely diagnosis? The diagnosis, in this case, is a pharyngeal pouch. A...
A Swimming Instructor with Ear Pain and Discharge
A 30-year-old swimming instructor presents with right ear pain and discharge. You examine his ear and can see erythema in the ear canal with copious pus and debris also present.1. What is the most likely diagnosis? The diagnosis, in this case, is otitis externa...
Stridor in Infancy
A 6-week-old baby girl is brought in to see you because of concerns about her breathing. She is well at rest but, when feeding, makes a high-pitched, crowing noise on inspiration. It also occurs when the child is sleeping on her back. She has no cough, and her cry is...
Fitness to Drive After a Seizure
A 32-year-old man presents to the Emergency Department following a first episode of a generalized tonic-clonic seizure.1. What is the neuroimaging investigation of choice for patients presenting to the Emergency Department with a first fit? Deferred early outpatient...
Can I Fly with Angina Doctor?
You review a 60-year-old man who was diagnosed with stable angina two months ago. His angina is currently well controlled, but he has run out of his GTN spray and is requesting an emergency prescription. His angina has not changed recently and remains stable. He has a...
Patient Confidentiality and the Police
A 56-year-old man is brought in by the police because he has developed chest pain whilst in their custody. He has been arrested on charges of burglary. He admits that he has a history of angina and hypertension. After you have taken your history and performed an...
A 35-Year-Old Woman with Epistaxis
A 35-year-old woman presents with epistaxis. She has a history of menorrhagia and frequent nose bleeds. She is prescribed a medication to help with this but cannot recall its name or why she takes it. She states that her father and brother also suffer with the same...
