A 57-year-old man presented to the emergency department complaining of a worsening cough. The cough had been present for approximately two weeks and was productive of green sputum. The patient had seen his general practitioner one week earlier and taken a course of amoxicillin for a presumed lower respiratory tract infection with no improvement of symptoms. He was febrile, experiencing frequent headaches and a feeling of general malaise, and had been unable to eat solid food for the last 48 hours due to facial pain on chewing. You have been asked to assess him and devise a management plan…
100 Diagnostic Dilemmas in Clinical Medicine presents 100 real-life scenarios seen in the hospital and community setting. A succinct summary of the patient's history, examination and any initial investigations is followed by a detailed consideration of the diagnosis and management of each case, in the short, medium and, where appropriate, long term.
Making speedy and appropriate clinical decisions, and choosing the best course of action to take as a result, is one of the most important and challenging parts of training to become a doctor. These extended true-to-life cases will teach students and junior doctors to recognize important medical conditions and to develop their diagnostic and management skills.
Key features:
- Extended case studies presented in an easy-to-read format, presenting patient history, examination, investigations and differential diagnosis
- Readers are guided through the clinician's sequence of thoughts and actions as they consider how to manage the case appropriately in the short, medium and, if necessary, long term
- Plentiful illustrations supplement the text
- A broad range of conditions is covered, from acquired haemophilia to intestinal tuberculosis
Preface
Acknowledgements
List of Abbreviations
Reference Ranges for Common Investigations
Case 1. Confusion and Persistent Fever
Case 2. Painful Upper Limb Swelling
Case 3. An Unusual Infection
Case 4. A Teenager with Falls
Case 5. A Case of Intrapartum Fever
Case 6. Jaundice and Diarrhoea
Case 7. Erratic Behaviour
Case 8. A Young Woman with Fever and Chest Pain
Case 9. An Enlarged Tongue
Case 10. A Young Man with an Abnormal Chest X-ray
Case 11. Visual Loss and Confusion
Case 12. Left-Eye Pain
Case 13. Spontaneous Bleeding
Case 14. A Young Man with a Rash and Hearing Impairment
Case 15. Recurrent Loss of Consciousness
Case 16. Visual Loss and Anuria
Case 17. Abdominal Pain and Weight Loss
Case 18. Worsening Shortness of Breath and Cough
Case 19. Fatigue and Constipation
Case 20. An Upper Limb Mass
Case 21. A Teenager with a Rash and Fever
Case 22. Hepatitis in a Nightshift Worker
Case 23. Yellow Blood
Case 24. An Unusual Method of Deliberate Self-Harm
Case 25. Coffee Ground Vomiting
Case 26. A Case of Parotitis Followed by Acute Hearing Loss
Case 27. A Purpuric Rash
Case 28. An Elderly Patient Admitted with a Fall
Case 29. A Young Mother with Constipation
Case 30. Hyperpigmented Skin Lesions
Case 31. It’s All in Your Head
Case 32. A Right Upper Quadrant Pain Puzzle
Case 33. Arthritis, Miscarriage and Drowsiness
Case 34. A Confused Traveller
Case 35. A Pleural Effusion on a Background of Knee Pain
Case 36. A Hypertensive Patient with Carpal Spasms
Case 37. A Patient with HIV and Personality Change
Case 38. Unilateral Facial Weakness
Case 39. Chest Pain with a Gynaecological Cause
Case 40. A First Fit
Case 41. Collapse in the Corridor
Case 42. ITP or Not ITP?
Case 43. Recurrent Haemothorax
Case 44. Hepatosplenomegaly
Case 45. Cutaneous Ulceration in a Patient with Rheumatoid Arthritis
Case 46. An Elderly Man with Confusion
Case 47. Severe Sepsis Following Tonsillitis
Case 48. A Farmer with Abdominal Pain
Case 49. Recurrent Episodes of Acute Kidney Injury
Case 50. A Sauna Cleaner with Shortness of Breath
Case 51. A Hypernatraemic Patient
Case 52. Recurrent Abdominal Pain and Diarrhoea
Case 53. A Teenager with a Rash
Case 54. Bilateral Foot Weakness
Case 55. Hepatomegaly in a Patient with Newly Diagnosed Diabetes Mellitus
Case 56. A Teenager with Palpitations
Case 57. A Patient with Sickle Cell Disease and Flu-Like Symptoms
Case 58. Vomiting without Gastrointestinal Pathology
Case 59. Seizures and Hand Lesions
Case 60. New Confusion in a Patient with Bipolar Affective Disorder
Case 61. A Blistering Rash
Case 62. Heart and Lungs
Case 63. Sudden Onset Headache
Case 64. A Febrile Canoeist
Case 65. Chest Pain and an Abnormal Blood Film
Case 66. Numb Fingers and Eosinophilia
Case 67. Fevers and Cough (Part 1)
Case 68. Fever and Cough (Part 2)
Case 69. Fevers, Night Sweats and Lymphadenopathy
Case 70. Unconscious outside a Club
Case 71. A Relentless Rash
Case 72. Bleeding Gums
Case 73. Chest Pain after Bad News
Case 74. HIV and Seizures
Case 75. A Patient with Crohn’s Disease and Worsening Diarrhoea
Case 76. Bilateral Hip Pain
Case 77. A Young Woman with Chest Pain
Case 78. A Heavy Smoker with Proximal Weakness
Case 79. Collapse Following Influenza
Case 80. Diarrhoea and Proximal Weakness
Case 81. Haemoptysis and Renal Failure
Case 82. A Young Patient with a Chronic Cough
Case 83. Abdominal Pain and Bloody Diarrhoea
Case 84. Nocturnal Enuresis and Back Pain
Case 85. Shivering at the Station
Case 86. Loss of Vision and Ophthalmitis
Case 87. A Pregnant Woman with Loss of Vision
Case 88. Rash, Fevers and Headache
Case 89. Haemoptysis and Diplopia
Case 90. Post-Partum Auditory Hallucinations
Case 91. Rapidly Progressive Dementia
Case 92. A Hillwalker with Fever and Chest Pain
Case 93. Fever, Weight Loss and Night Sweats
Case 94. Painless Jaundice
Case 95. A Young Man with Chest Pain
Case 96. An Unusual Cause of Haematemesis
Case 97. TB or Not TB?
Case 98. Headache at the Cattle Farm
Case 99. Recurrent Lower Respiratory Infections Following a Renal Transplant
Case 100. An Unsolved Mystery
Index
Biography
Kerry Layne, Consultant in Acute Medicine Department, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
