Case of the Month

A Patient with Suspected Irritable Bowel Syndrome

A Patient with Suspected Irritable Bowel Syndrome

A 26-year-old woman presents with symptoms of intermittent abdominal pain, bloating and looser stools for the past few months. You consider a diagnosis of irritable bowel syndrome (IBS), but plan to organise some investigations first to exclude more serious pathology....

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A 45-Year-Old Woman with Palpitations

A 45-Year-Old Woman with Palpitations

A 45-year-old woman presents to her GP surgery with palpitations. On examination, her heart rate is 156 bpm with an irregularly irregular rhythm. She denies chest pain or dizziness and her BP is 110/75 mmHg. She is otherwise well and has no past medical history of...

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A Patient with Troublesome Acne

A Patient with Troublesome Acne

You review a patient with moderately severe acne that has been treated with a variety of topical agents over the past 6 months. There has been a poor response treatment and you consider switching to an oral antibiotic. You are aware that there is an increasing issue...

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A 57-Year-Old Man with Difficult to Control Diabetes

A 57-Year-Old Man with Difficult to Control Diabetes

You review a 57-year-old man that is currently taking a combination of standard-release metformin, gliclazide and pioglitazone for the management of his type 2 diabetes. His most recent HbA1c was 65 mmol/mol. He is tolerating the drugs well.  He frequently has...

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A 67-Year-Old Woman with Anxiety and Confusion

A 67-Year-Old Woman with Anxiety and Confusion

A 67-year-old lady presents anxious, confused and agitated. She has also vomited several times. She has recently been started on a course of amoxicillin for a presumed chest infection by one of your colleagues. You are unable to take a coherent history from her but...

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A 66-Year-Old Man with a Pigmented Skin Lesion

A 66-Year-Old Man with a Pigmented Skin Lesion

A 66-year-old Australian man presents with a pigmented lesion on his upper back that has recently increased in size. The lesion has a symmetrical circular shape and the colour of the lesion is uniform. The largest diameter of the lesion is 8 mm. There is no...

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A 60-Year-Old Man with Diverticular Disease

A 60-Year-Old Man with Diverticular Disease

A 60-year-old man presents with left-sided lower abdominal pain and minor rectal bleeding. He has a known past history of diverticular disease and following a full clinical assessment you make a diagnosis of acute diverticulitis. He is clinically quite well and has no...

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A 25-Year-Old Woman with a Neck Injury

A 25-Year-Old Woman with a Neck Injury

A 25-year-old female patient is being assessed for a possible cervical spine injury following blunt trauma. Her C-spine X-ray series is inadequate and a decision is made to organise a CT scan of her cervical spine. Under what circumstances should CT scanning be used...

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A 50-Year-Old Woman with Forearm and Hand Pain

A 50-Year-Old Woman with Forearm and Hand Pain

A 50-year-old woman develops pain and parasthesia on the ulnar border of her left forearm and hand. On examination, her radial pulse is weaker on the left-hand side and her arm appears pale when elevated above her head. What is the most likely diagnosis? This patient...

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A 23-Year-Old Woman with Lower Abdominal Pain

A 23-Year-Old Woman with Lower Abdominal Pain

A 23-year-old woman presents with lower abdominal pain, dysuria, dyspareunia, and purulent vaginal discharge. A pregnancy test performed today is negative. She is afebrile and her observations are normal. On examination, her abdomen is soft but she cervical motion...

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