Case of the Month
Unexplained Debilitating Nausea and Vomiting
A 30-year-old woman presents with debilitating nausea and vomiting. The vomiting occurs in a cyclical pattern, with the patient experiencing episodes every few months. She is also complaining of colicky abdominal pain but her bowel movements are normal. She states...
Managing Paracetamol Overdose
A 25-year-old woman with a long history of depression has taken an overdose of paracetamol. She took the overdose 10 hours ago and cannot recall how many tablets she has taken. She is complaining of abdominal pain and nausea. 1. What is the mechanism of liver damage...
A 2-Year-Old Child with Breathing Difficulties
A 2-year-old boy is brought in to the Emergency Department with stridor and a barking cough. His mum states that he has had a mild cold for a few days and his voice had been hoarse. His observations are as follows: Temperature 38.1°C, HR 135, RR 30, SaO2 97% on air....
Chest Pain and Syncope in a 72-Year-Old Man
A 72-year-old man presents with chest pain and intermittent syncope. He tells you that he has been suffering with episodes of dizziness and fatigue over the past few weeks. On review today his heart rate is 37 bpm and his rhythm strip is shown below: 1. What does the...
A Farm Worker with a Dirty Wound
A 24-year-old man from Russia presents with a wound on his left forearm sustained whilst working on a farm the day before yesterday. The wound has been cleaned under a tap but still contains some debris and dirt. You clean the wound carefully and prescribe...
Severe Chest Pain Following Blunt Thoracic Trauma
A 37-year-old man is involved in a high-speed motor vehicle collision. He was not wearing a seat belt and struck his chest on the steering wheel. He has presented complaining of severe central chest pain and breathlessness. You are the trauma call team leader. His...
An Unusually Severe Ear Infection
A 76-year old woman presents has severe otalgia in her left ear that has been gradually worsening over the past few weeks. She describes the pain as being ‘unrelenting’ and she has been unable to sleep for several nights. Her family have noticed that the left side of...
A Strange Rash After Swimming the English Channel
A 58-year-old woman presents to a walk-in clinic with a severe rash on her arms, legs and torso. The previous day she had swum the English Channel in 12 hours. When you examine her, you can see well-demarcated welts all over the affected areas with surrounding...
Spontaneous Ankle Pain After a Course of Antibiotics
A 62-year-old man presents with pain in the back of his right ankle. He was walking to the shops when he suddenly heard a loud ‘snap’. He states it felt like he had been ‘kicked in the back of the ankle’. On examination there is swelling, tenderness and bruising...
The Man Who Forgot Who He Was
A 24-year-old man is brought into an A&E department by the Police. He has been found wandering the streets locally. He is unable to remember anything from his past and is unsure where he is. He is also unable to answer questions about his own personal identity....
