Diagnosis

Question 1

An elderly gentleman presents with a three day history of bloody diarrhoea and feverishness. He has no significant travel history. His past medical history is listed as hypertension, osteoarthritis and gout. On examination his temperature is 38.0ºC, heart rate 95/min, blood pressure 120/80 mmHg and his abdomen is soft and non-tender. A stool sample has grown Salmonella.

Answer 1

Enteric fever - typhoid/paratyphoid

Treatment is Ciprofloxacin

Question 2

A 68-year-old man with a 7-month history of reduced appetite and weight loss presents with new-onset painless jaundice (AND what tumour marker should you test for?)

Answer 2

Suspected pancreatic cancer
CA 19-9

Question 3

A 51-year-old woman presents with a 3-month history of feeling bloated. She also reports increased urinary urgency and frequency. Abdominal examination is unremarkable. (AND what tumour marker should you test for?)

Answer 3

Ovarian cancer
CA 125

Question 4

A 33-year-old woman presents with weight loss and excessive sweating. her partner reports that she is ‘on edge’ all the time and during the consultation you notice a fine tremor. Her pulse rate is 96/min. A large, non-tender goitre is noted. Examination of her eyes is unremarkable with no evidence of exophthalmos.

Free T4 26 pmol/l
Free T3 12.2 pmol/l (3.0-7.5)
TSH < 0.05 mu/l

Answer 4

Graves disease