Table Of Content

100 CASES in Acute Medicine 100 Cases in Acute Medicine presents 100 acute conditions commonly seen by medical students and junior doctors in the emergency department or on the ward or in the community setting. A succinct summary of the patient’s history, examination and initial investigations, including photographs where relevant, is followed by questions on the diagnosis and management of each case. The answer includes a detailed discussion on each topic, with further illustration where appropriate, providing an essential revision aid, as well as a practical guide for students and junior doctors. Making clinical decisions and choosing the best course of action is one of the most challenging and dif cult parts of training to become a doctor. Fully revised and updated for this second edition, these cases will teach students and junior doctors to recognise important clinical symptoms and signs and to develop their diagnostic and management skills. About the Series Making speedy and appropriate clinical decisions, and choosing the best course of action to take as a result, is one of the most important and challenging parts of training to become a doctor. The real-life cases presented in the 100 Cases series encompass emergency, ward, and outpatient and community scenarios, and have been designed specifi cally to help medical students and junior doctors to develop their diagnostic and management skills. 100 Diagnostic Dilemmas in Clinical Medicine Kerry Layne 100 Cases in General Practice, 2E Anne E. Stephenson, Martin Mueller, John Grabinar 1 00 Cases in Clinical Pharmacology, Therapeutics and Prescribing Kerry Layne, Albert Ferro 100 Cases in Acute Medicine Kerry Layne, Henry Fok and Adam Nabeebaccus For more information about this series please visit: www.routledge.com/100-Cases/ book-series/CRCONEHUNCAS 100 CASES in Acute Medicine Second Edition Henry Fok Honorary Consultant Physician, St George’s University Hospitals NHS Foundation Trust, London, UK Kerry Layne Consultant in Acute Medicine, Guy’s & St Thomas’ NHS Foundation Trust, London, UK Adam Nabeebaccus Honorary Consultant in Cardiology, King’s College Hospital NHS Foundation Trust, London, UK 100 Cases Series Editor: Janice Rymer MBBS, FRACP Professor of Obstetrics & Gynaecology and Dean of Student Affairs, King’s College London School of Medicine, London, UK Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business Second edition published 2023 by CRC Press 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487–2742 and by CRC Press 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN CRC Press is an imprint of Taylor & Francis Group , LLC © 2023 Henry Fok, Kerry Layne and Adam Nabeebaccus First edition published by CRC Press 2012 This book contains information obtained from authentic and highly regarded sources. While all reasonable ef orts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily refl ect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientifi c or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verifi ed. 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L ibrary of Congress Cataloging-in-Publication Data [ Insert LoC Data here when available] I SBN: 978-1-032-14803-8 (hbk) I SBN: 978-1-032-14801-4 (pbk) I SBN: 978-1-003-24117-1 (ebk) DOI: 10.1201/9781003241171 T ypeset in Baskerville b y Apex CoVantage, LLC CONTENTS Abbreviations ix Case 1: Acute Confusion 1 Case 2: Apparent Adverse Drug Reaction 5 C ase 3: Shortness of Breath and a Cough 9 C ase 4: Collapse and Confusion in a Young Woman 13 C ase 5: Drowsy After a Fall 16 C ase 6: Constipation with Confusion 20 C ase 7: Diarrhoea Following Antibiotics 25 C ase 8: Worsening Delirium 29 C ase 9: Swollen Glands and Hearing Impairment 31 C ase 10: Nose Bleed (Epistaxis) Following an Operation 33 C ase 11: Deliberate Self-Harm with Antifreeze 35 C ase 12: Right-Sided Chest Pain 37 C ase 13: A Case of Deliberate Self-Harm 41 C ase 14: Lymphadenopathy and Malaise 45 C ase 15: Loss of Consciousness in Diabetes 49 C ase 16: Fevers, Weight Loss, and Night Sweats 52 C ase 17: The Ill Returning Traveller 55 C ase 18: An Atypical Seizure 57 C ase 19: Delirium and Urinary Symptoms 59 C ase 20: Headache in Pregnancy 61 C ase 21: Epigastric Pain and Vomiting 63 C ase 22: Fever in a Returning Traveller 65 C ase 23: Shortness of Breath during a Sickle Cell Crisis 69 C ase 24: Chest Pain Radiating to the Back 71 C ase 25: Shortness of Breath 73 C ase 26: Recurrent Abdominal Pain 75 C ase 27: A Persistent Cough 78 C ase 28: Bloody Diarrhoea 81 C ase 29: Progressive Dysphagia in a Patient with Known Malignancy 83 C ase 30: Progressive Lower Limb Weakness 85 C ase 31: Seizure and Agitation 87 C ase 32: Substance Misuse 91 C ase 33: Unilateral Leg Swelling 93 C ase 34: Vomiting Caused by Norovirus 95 C ase 35: Fever and Sore Throat 99 v vi Contents C ase 36: A Couple with Headaches and Vomiting 101 C ase 37: Recurring Dizziness with Exercise 103 C ase 38: Palpitations and Collapse 107 C ase 39: Shortness of Breath in a Young Non-Smoker 110 C ase 40: ‘Indigestion’ with Radiating Pain 114 C ase 41: Memory Loss and Unsteadiness 119 C ase 42: Ecchymosis 123 C ase 43: Petechiae and Limb Weakness 125 C ase 44: Acute Breathlessness 127 C ase 45: Dysphagia and Shallow Breathing 129 C ase 46: Painful Ankles and Rash 131 C ase 47: Collapse Associated with a Headache 133 C ase 48: Blisters and Itchy Skin 137 C ase 49: Postoperative Hypotension 139 C ase 50: Drowsiness Bordering on Coma 143 C ase 51: Anxiety with Graves’ Disease 147 C ase 52: Episodic Anxiety and Headache 151 C ase 53: Cough, Fever, and Shortness of Breath 154 C ase 54: Shortness of Breath Following a Fall 157 C ase 55: A Lady with Fatigue 159 C ase 56: Haematuria and Flank Pain 161 C ase 57: Bradycardia and Malaise 164 C ase 58: Swelling of Lower Limbs 169 C ase 59: Haemoptysis and Shortness of Breath 173 C ase 60: Headache and Eyelid Drooping 175 C ase 61: Knee Swelling and Pain 177 C ase 62: Lower Abdominal Pain 181 C ase 63: Abdominal Pain, Bruising, and Confusion 183 C ase 64: Jaundice and Pruritis 187 C ase 65: Bleeding Gums and Nose 191 C ase 66: Palpitations and Shortness of Breath 194 C ase 67: Shortness of Breath and Pedal Oedema 199 C ase 68: Sharp Central Chest Pain 201 C ase 69: Chest Pain with Fever, Malaise, and Myalgia 203 C ase 70: Deteriorating Renal Function 207 C ase 71: Petechial Rash and Loss of Consciousness 211 C ase 72: Wheeze and Productive Cough 213 C ase 73: Flu-Like Illness and Generalised Weakness 217 C ase 74: Fever and a Murmur 219 C ase 75: Wheeze and Shortness of Breath 223 Contents vii Case 76: Red Eyes and Sight Impairment 227 Case 77: Severe Abdominal Pain and Fever 229 Case 78: Rash and Flu-Like Symptoms 231 Case 79: Substance Abuse and Agitation 233 Case 80: Generalised Rash and Malaise 237 Case 81: Coffee-Ground Vomiting 239 Case 82: Blurred Vision with Headache 243 Case 83: Pruritic Rash and Alopecia 247 C ase 84: Abdominal Pain, Diarrhoea, and Fever 250 C ase 85: Progressive Dysphagia and Muscle Stiffness 253 C ase 86: Headache and Double Vision 257 C ase 87: Defective Vision and Eye Pain 259 C ase 88: Back Pain and Weight Loss 262 C ase 89: Abdominal Pain Following Alcohol Binge 265 C ase 90: Abdominal Pain, Malaise, and Fever 267 C ase 91: Respiratory Distress and Oedema 270 C ase 92: Night Sweats, Polyuria, and Polydipsia 274 C ase 93: Painful Shoulder and Malaise 277 C ase 94: Facial Rash 279 C ase 95: Self-Limiting Generalised Seizures 281 C ase 96: Target-Like Rash and Fever 285 C ase 97: Seizure 287 C ase 98: Loss of Pain Sensation 291 C ase 99: Shortness of Breath in a Returning Traveller 296 C ase 100: A Woman “Off Her Legs” 301 I ndex 305 ABBREVIATIONS ABG arterial blood gas ALP alkaline phosphatase ALT alanine aminotransferase BE Base excess Bili bilirubin BP blood pressure BD twice daily Creat creatinine CRP C-reactive protein CT computed tomography D KA diabetic ketoacidosis E CG electrocardiogram E EG electroencephalogram G TN glyceryl trinitrate H b haemoglobin H bA1c glycated haemoglobin H IV human immunodef ciency virus H R heart rate J VP jugular venous pressure K potassium L MWH low molecular weight heparin M RI magnetic resonance imaging N a sodium N IV non-invasive ventilation O D once daily P lt platelet count Q DS four times daily RNA ribonucleic acid R R respiratory rate S BP systolic blood pressure S pO2 peripheral capillary oxygen saturations T DS three times daily V BG venous blood gas W CC white cell count ix