Case of the Month
An 8-Week-Old Baby with a Crusty Scalp Rash
An 8-week-old baby girl is brought in to see her GP because her parents are concerned about the appearance of her scalp. She has a thick crusty rash evident, which is shown above. 1. What is the most likely diagnosis? This baby has seborrhoeic dermatitis, which is...
An 11-Year-Old Boy With a Painful Red Eye
An 11-year-old boy presents with a painful, red, swollen left eye. He has had a recent sinus infection but has no other medical history of note. His temperature is 38.2°C. His eye movements are painful, and he is complaining of double vision. 1. What is the most...
A 24-Year-Old Man with Blurred Vision
A 24-year-old man presents with blurring of his vision and worsening eyesight that is more noticeable at night. He states that his father is registered blind and lost his vision in his late 30s. You examine his fundi and see bony spicule-shaped pigment deposits in the...
Intense Itching in Pregnancy
A 30-year-old woman presents at 27 weeks gestation with intense itching on her abdomen, hands and feet. The itching is localised to the palms and soles, and you can see no associated rash. On examination, you note scleral icterus but no other abnormalities. Her...
Chickenpox Exposure in Pregnancy
You review a 31-year-old patient who is 14 weeks pregnant. She is worried as she was exposed to chickenpox two days ago. She cannot remember whether she had chickenpox as a child.1. How should this patient be managed? Any pregnant woman who has not had chickenpox or...
A 78-Year-Old Woman with Worsening Shortness of Breath
A 78-year-old woman presents with worsening shortness of breath. She has been a heavy smoker for most of her life and has had a couple of episodes of haemoptysis over the last week. On examination, you note that her face appears oedematous and that she has dilated...
A 37-Year-Old Man with Chronic Diarrhoea
A 37-year-old man presents with a 6-month history of general malaise and intermittent diarrhoea. His stools have varied between watery and occasionally more solid but foul-smelling and difficult to flush. He also frequently experiences abdominal distension and pain....
A Hospital-Acquired Infection
A patient develops signs of sepsis. She has had a central line in situ for the past ten days. There is erythema surrounding the catheter insertion site.1. What is the most likely diagnosis? The most likely diagnosis, in this case, is line sepsis. Central venous...
A 46-Year-Old Woman with Weight Loss and a Neck Lump
A 46-year-old woman presents with weight loss. On examination, you note that she has prominent eyes, ‘lumpy’ swelling over her shins and the neck lump seen in the image above. 1. What is the most likely diagnosis? This patient has a history of weight loss in...
A 17-Year-Old Boy with a Neck Lump
A 17-year-old boy is concerned as he has noticed a lump in the middle of his neck. His mother has hypothyroidism and is concerned that her son may have it too. He has no other symptoms and is otherwise well. On examination, you note a painless swelling in the midline...
