A 71-year old retired missionary presented with a 2- week history of increasing dyspnoea, orthopnoea, and peripheral oedema. The patient had no previous significant past medical history. On clinical examination, his heart sounds were dual and his jugular venous pressure was elevated to 7cm. On chest auscultation there were bilateral crepitations at his lung bases.
An unusual suspect for heart failure Read More
An 82-year-old lady was found on the floor of her home, confused and surrounded by vomitus. She had a past medical history of type II diabetes, hypothyroidism, previous left total hip replacement, and previous hip fracture treated with right dynamic screw fixation. Prior to the current presentation she had been living alone, mobilizing independently with a walking stick and self-caring for her activities of daily living. She was last seen by her daughter on the previous day, and reported no concerning symptoms.
MR-Brain Causing Confusion Read More
A 91-year old female presented to Acute Medical Unit with a 2 week history of shortness of breath and haemoptysis. Her past medical history included osteoporosis, depression, irritable bowel syndrome, asthma, cataracts, and a colonic polypectomy. Her medications: Citalopram 10 mg, Co-codamol, Beclomethasone 200 mcg inhaler, Salbutamol MDI inhaler, Omeprazole 20 mg and Alendronic acid. She was an ex-smoker with a 20-pack year history who had stopped smoking 40-years ago. She did not drink alcohol and lived alone independently.
A Chest X-Ray causing confusion Read More
58-year-old lady presented to the Emergency Department with a two-day history of shortness of breath and confusion, on a background of one week’s history of general malaise, vomiting, fevers and chills. Her past medical history was unremarkable except for a large, benign goitre. Systemic enquiry revealed no symptoms to suggest a focus of infection.
The Source of the Problem Read More
A 64-year-old male presents to the emergency department in acute respiratory distress. He gives a limited history of progressive shortness of breath of one week’s duration and several episodes of sudden unexplained syncope. There was no history of chest pain, palpitations or localising symptoms of infection. He takes no regular medications.
Abnormal cardiac conduction in a septic patient: incidental finding or cause for concern? Read More
A 34-year-old gentleman, with a background of osteoarthritis, presented to the Acute Medical Unit with a short history of breathlessness. He had returned from holiday to the United States five days previously. Since return, he had complained of myalgia, sore throat, a non-productive cough, mild anorexia and fevers at home. More acutely, prompting his presentation to hospital, was acute dyspnoea, which was sudden onset, with some central anterior chest discomfort and worse lying flat.
A young breathless patient Read More
A previously fit and healthy 57 year old gentleman presented to hospital 2 weeks after a previous admission with acute severe headache. At the time of his previous admission the patient had reported that the headache was preceded by an unprovoked sharp pain in his back which had quickly resolved. The headache developed a few hours later and was noted to be markedly worsened by any attempt to sit upright, accompanied by intense nausea, and relieved by lying flat.
An Acute Severe Headache Read More
The case:
A 58 year old man was brought to the emergency department with acute confusion after being found unconscious on his floor at home. He had a background of alcohol misuse with alcoholic liver disease. He was not taking any regular medications. On examination he smelt of alcohol and was tachycardic at 96 bpm with BP 110/70. The patient’s Glasgow Coma Score was 14, being drowsy but responsive with bilateral lower zone crepitations on auscultation of the chest. Neurological examination revealed generalized reduced muscle bulk but no focal deficits.
Persistent dysphagia and drowisness following collapse in an alcohol-dependent patient Read More
This T2 weighted MRI scan demonstrates a hyperintense trident shaped lesion extending from the pontomedullary junction to the midbrain with peripheral sparing (figure 2 – abnormality indicated by white arrows).
A 57-year-old man was admitted to the Acute Medical Unit with an episode of collapse following chest pain and shortness of breath. On examination he was tachycardic, and tachypnoeic with a heart rate of 120 beats per minute and a respiratory rate of 30.
A patient presenting with collapse and breathlessness Read More