Case of the Month
A Case of Difficult to Control Hypertension
A 53-year-old man returns for a review of his antihypertensive medication. He has attended multiple times, and his blood pressure has remained persistently elevated despite optimal therapy. He reports increasing fatigue and wonders if his symptoms are due to his...
A 78-Year-Old Man with Tiredness and Weight Gain
A 78-year-old British gentleman presents with tiredness, poor appetite and weight gain. He has noticed that his voice has become hoarse and deep. His hearing has also worsened over recent months. A photo of the patient is shown below: 1. What is the most likely...
A 38-Year-Old Woman Being Treated for a Paracetamol Overdose
A 38-year-old woman is being treated for a paracetamol overdose with acetylcysteine. Shortly after treatment started, she developed nausea, an urticarial rash and mild wheeziness.1. What has happened? She has developed an anaphylactoid reaction to acetylcysteine....
A 46-Year-Old Woman with Symptoms of Paroxysmal Flushing
A 46-year-old woman presents with symptoms of paroxysmal flushing that is most marked after drinking alcohol and coffee. She is also experiencing intermittent episodes of explosive watery diarrhoea, abdominal pain and wheezing. On examination of her abdomen, you note...
A 4-Year-Old Child With Recurrent Chest Pain
A 4-year-old child is brought to the GP with a history of recurrent chest pain and offensive-smelling stools. On physical examination, finger clubbing is noted. The child’s growth appears slightly below average for age, and the mother mentions that he has frequent...
A 63-Year-Old Woman With Progressive Dysphagia
A 63-year-old woman presents with a history of progressive difficulty swallowing and pain when swallowing. She notes that the symptoms occur with both solids and liquids. The dysphagia has gradually worsened over time. A barium swallow study is performed, which...
A 67-Year-Old Man With Painless Haematuria
A 67-year-old man presents with painless haematuria that has persisted for several weeks. He denies any associated symptoms such as dysuria, fever, or flank pain. He reports a mild increase in urinary frequency but no urgency or nocturia. He has a past medical history...
A 60-Year-Old Woman with a History of Weight Loss
A 60-year-old woman has a history of weight loss, poor appetite and intermittent diarrhoea. What is the most likely diagnosis?
A 42-Year-Old Man With a Longstanding History of Alcohol Abuse
A 42-year-old man with a longstanding history of alcohol abuse presents with tiredness, shortness of breath and marked abdominal distension. A photo of his abdomen is shown below: 1. What is the most likely cause of the abdominal distension in this case? This patient...
A 14-Year-Old Boy with Hip Pain
A 14-year-old boy presents with a 3-day history of pain in his anterior right thigh and anterior pelvic region that is worse on walking. The pain started in a football match. The pain started after a sudden change of direction whilst sprinting for the ball in the...
