Case of the Month

A 30-Year-Old Man with Recurrent Migraines

A 30-Year-Old Man with Recurrent Migraines

A 30-year-old accountant presents to your afternoon surgery to discuss the management of his migraines. He has been under quite a lot of stress at work and his migraines are occurring 4-5 times per month. His last attack was quite disabling and lasted 3 days. He...

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A 24-Year-Old Woman with Conjunctivitis

A 24-Year-Old Woman with Conjunctivitis

A 24-year-old woman presents with a sudden onset of left-sided acute follicular conjunctivitis. She complains of severe pain in the eye, and she has blurred vision with copious watery discharge evident. On examination, you note the presence of pseudomembrane formation...

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A 60-Year-Old with Weight Loss and Yellow Skin

A 60-Year-Old with Weight Loss and Yellow Skin

A 60-year-old woman presents with a history of weight loss, poor appetite and intermittent diarrhoea. She also complains of recurrent oral ulcers. Her only past medical history of note is vitiligo, and she takes no regular medications. On examination, you note that...

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A 24-Year-Old Man with Abdominal Pain and Dark Urine

A 24-Year-Old Man with Abdominal Pain and Dark Urine

A 24-year-old man presents complaining of recurrent episodes of abdominal pain and passing dark brown urine first thing in the morning. On examination, he has raised, painful, red nodules on the skin covering his entire back. You organise a set of blood tests, which...

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A 36-Year-Old Man with Loin Pain

A 36-Year-Old Man with Loin Pain

A 36-year-old man presents to his GP with dysuria, fevers, rigors and left-sided loin pain. On examination he is tender over the left renal angle and he has a temperature of 38.6°C. What is the most likely diagnosis? This patient has symptoms and signs consistent with...

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A 30-Year-Old Man with Heartburn and Dysphagia

A 30-Year-Old Man with Heartburn and Dysphagia

A 30-year-old man presents with symptoms of persistent heartburn, dysphagia and intermittent food bolus obstruction. He was recently prescribed a short course of standard-dose omeprazole by one of your colleagues but has this has not improved his symptoms. An...

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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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