Case of the Month

Chest Pain and Syncope in a 72-Year-Old Man

Chest Pain and Syncope in a 72-Year-Old Man

A 72-year-old man presents with chest pain and intermittent syncope. He tells you that he has been suffering with episodes of dizziness and fatigue over the past few weeks. On review today his heart rate is 37 bpm and his rhythm strip is shown below: 1. What does the...

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A Farm Worker with a Dirty Wound

A Farm Worker with a Dirty Wound

A 24-year-old man from Russia presents with a wound on his left forearm sustained whilst working on a farm the day before yesterday. The wound has been cleaned under a tap but still contains some debris and dirt. You clean the wound carefully and prescribe...

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Severe Chest Pain Following Blunt Thoracic Trauma

Severe Chest Pain Following Blunt Thoracic Trauma

A 37-year-old man is involved in a high-speed motor vehicle collision. He was not wearing a seat belt and struck his chest on the steering wheel. He has presented complaining of severe central chest pain and breathlessness. You are the trauma call team leader. His...

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An Unusually Severe Ear Infection

An Unusually Severe Ear Infection

A 76-year old woman presents has severe otalgia in her left ear that has been gradually worsening over the past few weeks. She describes the pain as being ‘unrelenting’ and she has been unable to sleep for several nights. Her family have noticed that the left side of...

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A Strange Rash After Swimming the English Channel

A Strange Rash After Swimming the English Channel

A 58-year-old woman presents to a walk-in clinic with a severe rash on her arms, legs and torso. The previous day she had swum the English Channel in 12 hours. When you examine her, you can see well-demarcated welts all over the affected areas with surrounding...

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Spontaneous Ankle Pain After a Course of Antibiotics

Spontaneous Ankle Pain After a Course of Antibiotics

A 62-year-old man presents with pain in the back of his right ankle. He was walking to the shops when he suddenly heard a loud ‘snap’. He states it felt like he had been ‘kicked in the back of the ankle’. On examination there is swelling, tenderness and bruising...

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The Man Who Forgot Who He Was

The Man Who Forgot Who He Was

A 24-year-old man is brought into an A&E department by the Police. He has been found wandering the streets locally. He is unable to remember anything from his past and is unsure where he is. He is also unable to answer questions about his own personal identity....

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‘Ripping’ Chest Pain in a 38-Year-Old Man

‘Ripping’ Chest Pain in a 38-Year-Old Man

A 38-year-old man with Marfan syndrome presents with sudden severe chest pain that radiates through to his back. He describes the pain as being sharp and ‘ripping’ in nature. He smokes 25 cigarettes per day. He is sweaty, nauseated and appears pallid. On examination...

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An HIV Positive Patient with Blurred Vision

An HIV Positive Patient with Blurred Vision

A 34-year-old man with a known history of HIV presents with blurring of his vision and ‘floaters’ in his right eye that have gradually worsened over the past 10 days. He is experiencing no eye pain and there is no redness or injection of the eye. He states that he had...

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A 60-Year-Old with Abdominal Pain

A 60-Year-Old with Abdominal Pain

A 60-year-old woman presents with a one-week history of abdominal pain, nausea and reduced frequency of bowel motions. Her observations are as follows: HR 97, BP 113/76, RR 19, SaO2 98% on air. On examination she has right upper quadrant tenderness. Her chest X-ray is...

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