Case of the Month
A 4-Year-Old Child with an Elbow Injury
A 4-year-old child presents refusing to move their right arm after a sudden pull by the mother. The arm is held in slight flexion with pronation and adduction and there is tenderness over the radial head. 1. What is the most likely diagnosis? This child has suffered a...
A Patient with an Insect in Their Ear
A 19-year-old woman presents to the Emergency Department after an insect flew into her ear. She is complaining of significant pain and can hear the insect buzzing. The triage nurse has administered pain relief, and the patient is now comfortable.1. What should be your...
A 30-Year-Old Patient with a Thyroxine Overdose
A 30-year-old female patient with a history of hypothyroidism presents to the Emergency Department having taken 30 of her 200 mcg levothyroxine tablets 3 hours earlier. She tells you that she is ‘fed up with life’ and ‘can’t take it any more’. She is currently...
A 70-Year-Old Woman with Hypotension and Tachycardia
A 70-year-old woman presents with palpitations and breathlessness. Her observations show that she is hypotensive and tachycardiac, and she is complaining of chest pain. She is promptly transferred to resus. After being moved to resus she is administered three...
A 60-year-old Man with Dizziness and Palpitations
A 60-year-old man presents with dizziness and palpitations. Whilst in the Emergency Department the following rhythm strip is recorded: 1. What does the rhythm strip show? The rhythm strip in this case shows torsades de pointes. 2. Which underlying ECG...
A Patient with Syndrome of Inappropriate ADH Secretion
A 74-year-old man, who is a lifelong smoker, is diagnosed with a small cell carcinoma of the lung. Following further investigation, it is discovered that he has developed the syndrome of inappropriate ADH secretion (SIADH) as a consequence of this. 1. What typical...
A 15-Year-Old Boy with a Sore Throat and a Fever
A 15-year-old boy presents with a 7-day history of a sore throat, low-grade fever, and malaise. He states that a week ago he had a fine rash over his body that faded quickly. On examination, you note the presence of mild splenomegaly. He is eating and drinking well,...
A 24-Year-Old Woman with Conjunctivitis
A 24-year-old woman presents with a sudden onset of left-sided acute follicular conjunctivitis. She complains of severe pain in the eye, and she has blurred vision with copious watery discharge evident. On examination, you note the presence of pseudomembrane formation...
A 24-Year-Old Man with Abdominal Pain and Dark Urine
A 24-year-old man presents complaining of recurrent episodes of abdominal pain and passing dark brown urine first thing in the morning. On examination, he has raised, painful, red nodules on the skin covering his entire back. You organise a set of blood tests, which...
A 30-Year-Old Man with Heartburn and Dysphagia
A 30-year-old man presents with symptoms of persistent heartburn, dysphagia and intermittent food bolus obstruction. He was recently prescribed a short course of standard-dose omeprazole by one of your colleagues but has this has not improved his symptoms. An...
