Case of the Month
A Vomiting Medical Student
A 21-year-old medical student presents with severe retrosternal pain, pain on swallowing, and breathlessness. Over the weekend he went on a heavy drinking binge after finishing his exams and spent most of the previous evening vomiting and retching forcefully. You...
An Intravenous Drug User with Back Pain
A known intravenous drug user of no fixed abode presents with very severe back pain, fever, and left leg weakness. He has been woken at night several times because of the pain and is having difficulty walking. On examination he has tenderness over the lower lumbar...
A Homeless Man with a Head Injury
A 61-year-old man of no fixed abode suffers a head injury during a fall. You organise a full set of bloods and a CT scan of the head as part of his work up. The bloods show deranged liver function tests and a macrocytic anemia. The CT scan of the head is reported as...
Sudden Onset Severe Abdominal Pain
A 68-year-old man with a history of rheumatoid arthritis presents with sudden onset severe abdominal pain. On examination his abdomen is rigid, with generalized tenderness, guarding and rebound tenderness. An erect chest X-ray is performed, which is shown below:...
Drug-Induced QT Prolongation
A patient is discovered to have new onset QT prolongation when an ECG is performed as part of a cardiovascular assessment. He tells you that he was recently prescribed a new medication by his GP and wonders if that may be the cause. 1. What is a prolonged QT interval?...
A Student with a Sore Throat
A 19-year-old student presents with a one-week history of a sore throat, low-grade fever, and malaise. She states that a week ago she had a fine rash over her body that faded quickly. On examination you note the presence of mild splenomegaly. 1. What is the most...
A 30-Year-Old Man with a Strange Rash
A 30-year-old man presents with a rash on his hands that has been spreading proximally over the past couple of days and is now involving his trunk. He has recently suffered an infection. The rash is shown below: 1. What is the most likely diagnosis? This gentleman has...
A 32-Year-Old Man with Recurrent Haematuria
A 32-year-old man presents with recurrent episodes of haematuria and flank pain. On examination he has bilateral masses in his flanks and 3+ blood in his urine dipstick. He has a history of recurrent urinary tract infections and difficult to control hypertension. 1....
A 67-Year-Old Woman with Agitation and Confusion
A 67-year-old lady presents to the Emergency Department anxious, confused and agitated. She has also vomited several times. She has recently been started on a course of amoxicillin for a presumed chest infection by her GP. You are unable to take a coherent history...
A 65-Year-Old Woman with Abdominal Pain and Syncope
A 65-year-old woman presents to the Emergency Department acutely unwell with abdominal and lower limb pain. She had a syncopal episode in the department and was moved into the resuscitation area. She had been taking prednisolone for polymalgia rheumatica until...
