The fever, headache, vomiting and drowsiness are nonspecific but given there is absent history of symptoms of a urinary tract infection or respiratory infection, we should consider CNS involvement. The key phrase here is also photophobia which makes meningitis the …
There is suspicion of Paget’s disease of the breast/nipple here. These are usually diagnosed by having a simple skin punch biopsy. PAGET DISEASE OF THE BREAST/NIPPLE This is an uncommon breast malignancy with a generally better prognosis thaninfiltrating ductal carcinoma. …
Perioperative management of diabetes is often quite confusing. Below are guIdelines that give you an idea of which medications need to be stopped and when they can be restarted. It is not an exhaustive list and different hospitals have different …
The first hint here is his sex (male) and his occupation (manual worker). In adults, malesex and heavy lifting are risk factors for inguinal hernias Traditionally it is taught that an inguinal hernia will lie above and medially to the …
Anal fissures are caused by constipation and straining. Patients often remember the episode of pain when the tear occurred. The pain is so severe tht they would refuse rectal examinations. The distractor here is anal abscesses and haemorrhoids. Anal abscesses …
Low or simple fistulae like in this stem are usually “laid open” by cutting a small amount of anal skin and muscle to open the tract. Chronic granulation tissue is removed and the tract is left open to allow it …
Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring, lateral to the inferior epigastric vessels; this may be caused by failure of embryonic closure of the processus vaginalis. An indirect inguinal hernia like other inguinal hernias …
In acute mesenteric ischaemia, VBG typically show a high lactate. If an ABG would have been performed, it would reveal severe metabolic acidosis with a high lactate. Atrial fibrillation is the likely cause of the embolism that has caused the …
Carcinoembryonic antigen (CEA) is especially important to monitor response totreatment and identify relapse in tumours showing raised CEA at diagnosis (e.g.colorectal cancers) The history of the right upper quadrant discomfort and the examinations of a palpableliver are descriptions of tumour …
The diagnosis here is primary biliary cirrhosis The classic presentation is itching in a middle-aged woman as we see here. Often asymptomatic and diagnosed after finding alkaline phosphatase on routine LFT.Lethargy, sleepiness, and pruritus may precede jaundice. There is an …