Case of the Month

A Patient with Bleeding Gums and Spontaneous Bruising

A Patient with Bleeding Gums and Spontaneous Bruising

A 27-year-old man presents with bleeding gums and easy bruising. He also states that he has felt very tired lately and has had recurrent chest infections over the past few months. He had glandular fever approximately 6 months ago and feels that his...

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A Patient with von Willebrand Disease

A Patient with von Willebrand Disease

You are working at a local walk in centre on a busy Saturday afternoon. A patient presents with epistaxis. You are having difficulty in controlling the bleeding and consider packing his nose and transferring him to the nearest Emergency Department. The patient tells...

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A 4-Month-Old with Bronchiolitis

A 4-Month-Old with Bronchiolitis

A 4-month-old boy is brought by his parents to see his GP due to a history of fever, cough and breathing difficulties. A diagnosis of acute bronchiolitis is made. What is bronchiolitis? Bronchiolitis is an acute infection of the lower respiratory tract that is most...

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A Subdural Haematoma in a Patient Taking Warfarin

A Subdural Haematoma in a Patient Taking Warfarin

A 73-year-old woman with a history of atrial fibrillation (AF) presents with a head injury and reduced conscious level. She takes warfarin for her AF and her INR was 2.7 a few days ago. A CT scan of her head is performed which demonstrates the presence of a subdural...

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A Crashing Asthmatic

A Crashing Asthmatic

A 24-year-old woman with a history of brittle asthma is brought to the Emergency Department by her boyfriend. She is very short of breath and wheezy and her condition deteriorates rapidly. Following back to back nebs, hydrocortisone and IV magnesium sulphate, she is...

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An Overdose with an Unknown Substance

An Overdose with an Unknown Substance

A 30-year-old woman presents having taken an overdose of an unknown substance. She is drowsy and slurring her speech. Her observations are as follows: HR 116, BP 91/57, SaO2 96% on air. GCS 11/15. The results of her arterial blood gas (ABG) on air are shown below:  ...

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A Vomiting Medical Student

A Vomiting Medical Student

A 21-year-old medical student presents with severe retrosternal pain, pain on swallowing, and breathlessness. Over the weekend he went on a heavy drinking binge after finishing his exams and spent most of the previous evening vomiting and retching forcefully. You...

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An Intravenous Drug User with Back Pain

An Intravenous Drug User with Back Pain

A known intravenous drug user of no fixed abode presents with very severe back pain, fever, and left leg weakness. He has been woken at night several times because of the pain and is having difficulty walking. On examination he has tenderness over the lower lumbar...

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A Homeless Man with a Head Injury

A Homeless Man with a Head Injury

A 61-year-old man of no fixed abode suffers a head injury during a fall. You organise a full set of bloods and a CT scan of the head as part of his work up. The bloods show deranged liver function tests and a macrocytic anemia. The CT scan of the head is reported as...

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Sudden Onset Severe Abdominal Pain

Sudden Onset Severe Abdominal Pain

A 68-year-old man with a history of rheumatoid arthritis presents with sudden onset severe abdominal pain. On examination his abdomen is rigid, with generalized tenderness, guarding and rebound tenderness. An erect chest X-ray is performed, which is shown below:   1....

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