Case Presentations Flashcards
Middle-aged woman presented with problems swallowing both liquids and solids.
Heartburn and regurgitation of foods.
Achalasia
Known alcoholic presents to A&E.
pH 7.2 PaO2 12.3 (10.6-13.4) PaCO2 4.5 (4.0-6.0) Bicarb 15 (22-26) Anion gap 22 (10 -18) Ketones 5 (< 0.6) BM 6.5 (< 7.8)
Alcoholic ketoacidosis
Patients presents to A&E with 24 hr history of vague abdominal pain. Worse when he coughs. He feels hungry.
Vomited once.
Temp 37.7
Hb NAD Eosinophils NAD Basophils NAD Lymphocytes slightly raised Neutrophils raised Platelets NAD
Appendicitis
A 57 yr old female presents with long standing mild SOB, lethargy and poor concentration. She has a slight yellow tinge to her skin. She also reports having a sore tongue.
On examination, she has impaired vibration in her distal legs and feet.
PMH: Rheumatoid arthritis
Pernicious anaemia
Female, vegetarian, presenting with fatigue and SOB. Heavy periods. Also has koilonychia and hair loss.
FBC show hypochromic microcytic anaemia.
High TIBC and high transferrin.
Iron-deficiency anaemia
A middle-aged woman presents to the GP with intermittent diarrhoea and abdominal cramping over a long period of time. She has presented today worried about worsening symptoms along with sudden weight loss. She has some ulcers around her mouth.
PMH: Autoimmune thyroid disease
An intestinal biopsy shows villous atrophy and crypt hyperplasia.
Coeliac disease
A female with coeliac disease presents with an itchy vesicular rash with a red base
Dermatitis herpetiformis
20-40 year old black woman presenting with a dry cough, shortness of breath and nodules on shins
Sarcoidosis
84 yr old man presents with diarrhoea. He is hypotensive and WCC is 22.
He recently finished a course of Clindamycin.
Life-threatening C. Diff
A 43 year old woman attends A&E with RUQ pain and a fever. She also looks mildly jaundiced.
BMI 32
Bilirubin raised
CRP 75
WCC 23 x 10^9
Acute cholangitis
A middle-aged woman presents with fatigue and pruritus. She also has some small yellow deposits around her eyes.
PMH: Coeliac’s disease
CRP 7 WCC 13x10^9 Bilirubin NAD ALP Raised anti-AMA present
PBC
A 36 yr old man presents with jaundice and RUQ pain.
PMH: UC, diabetes, HTN
CRP 6 WCC 12x10^9 Bilirubin NAD ALP Raised p-ANCA present
PSC
An alcoholic attends A&E with severe epigastric pain radiating to his back. He has vomited twice.
O2 97% BP 123/85 HR 112 RR 14 Temp 37.6
Acute pancreatitis
65 yr old man presents to the GP. He has been experiencing weakness of his bicep muscles over the past few weeks. He has also noticed a bit of ptosis, erectile dysfunction and a mild but persistent cough.
He has a smoking history of 30 pack years. He is a current smoker.
Lambert-Eaton Myasthenic Syndrome from SCLC
A young male presents to A&E with glomerulonephritis. He has experienced a few nosebleeds recently too.
Serology reveals the presence of pANCA
Granulomatosis with polyangiitis (Wegeners)
A young male presents to A&E with an AKI and haemoptysis.
Serology reveals the presence of anti-GBM.
Goodpasture’s (Anti-glomerular basement membrane (GBM) disease)
20-40 year old black woman presents to GP with a dry cough and shortness of breath. They may have pretibial erythematous nodules.
Sarcoidosis
Bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia
Lofgren’s syndrome of sarcoidosis
A 50-year-old man attends A&E with a low-grade fever and pleuritic chest pain.
On auscultation, you hear pericardial rub.
ECG shows global ST elevation.
PMH: HTN, DM, MI 2 weeks ago
Dressler’s Syndrome
A 60 yr old man with a background of hypertension, presents to A&E with a sudden onset tearing chest pain.
What are some RFs for this condition?
Aortic dissection
- Hypertension - heavy lifting/cocaine cause sudden increase in BP
- Male
- Older age
- Smoking
- Poor diet
- Reduced physical activity
- Raised cholesterol
- Aortic conditions:
- Bicuspid aortic valve
- Coarctation of the aorta
- Aortic valve replacement
- CABG
- Connective tissue disorders:
- Marfan’s Syndrome
- Ehlers-Danlos Syndrome
38 yr old woman presents to A&E with a swollen left lower limb that is incredibly painful on palpation of the calf.
PMH: x2 prev PEs, x1 prev DVT, recurrent miscarriages
Antiphospholipid Syndrome
A 36-year-old woman of African descent presents to A&E with jaundice.
Hb 90
She reports having eaten broad beans as part of her dinner.
What is the diagnosis?
What else could trigger this?
G6PD deficiency
- Infection
- Recent course one of the following drugs:
- Anti-malarials - primaquine
- Ciprofloxacin
- Sulph-group drugs: sulphonamides, suphasalazine, sulphonylureas
A 26 yr old female who has chronic anaemia suffers from an acute episode of worsened anaemia along with jaundice.
On examination, she has splenomegaly.
PMH: Recurrent gallstones, viral infection 2 weeks ago
Diagnosis? Cause?
Hereditary spherocytosis
Aplastic crisis caused by parvovirus
Patient attends GP with fatigue, weight loss and lymphadenopathy.
When asked about any fevers, they claim they had one 2 weeks ago, were fine last week, but now have another fever.
Hodgkins Lymphoma
= Pel-Ebstein fever
A high-grade fever that keeps rising and falling every 7-10 days or so
Patient currently on chemo for breast cancer attends A&E with a fever and vomiting.
Last chemo cycle: 13 days ago
Neutropenic sepsis
Woman complains of smelling roses suddenly at work, but there are no roses around. She remains conscious.
Focal aware seizure
Man at work suddenly becomes unresponsive, smacks his lips and looks like he is chewing. Lasts for around 1 minute.
Focal impaired awareness seizure
54 yr old woman struggling to use mobile phone and reduced dexterity bilaterally. Pain in neck.
Degenerative cervical myelopathy
Sudden deterioration following ventilation
Tension pneumothorax
