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Case Studies

Incidental Pancreatic Cysts: Key Steps

May 18, 2016

Jack was 72 years old and had complained of upper abdominal pain. He was investigated initially by ultrasound and this suggested a 1.3cm by 1.5 cm cyst in the tail of the pancreas. A multi-detector CT scan confirmed that this cyst appeared isolated and uncomplicated and there were no other …

Male Breast Cancer

May 11, 2016

Joe, aged 63 years, had noticed a dragging sensation in his left breast for some months. When he brought his unwell wife to the doctor, she mentioned this to the GP. Joe had no pain but had noted his left nipple had retracted inwards in recent weeks. There was no …

Gout Treatments: Colchicine and Allopurinol

May 04, 2016

Ron was a builder by trade and was fifty-nine years old. He now had had three episodes of gout in two years. He presented to his GP after putting up for over two weeks with the third attack that now affected his left, first metatarsophalangeal joint. He had ceased his …

An Addictive Personality

April 27, 2016

James smoked 25 cigarettes daily, used to drink a couple of beers most days and six to ten on Saturday and Sunday. He loved food and it showed; he would joke about being addicted to his wife’s cooking. Then James developed diabetes, was diagnosed with steatohepatitis and was advised to …

Vaccinating the Immunosuppressed

April 14, 2016

Joanne is a fifty-eight year old woman who has had an autologous stem cell transplant for aggressive multiple myeloma eight months ago. After a stormy course, she has finally got some strength back and appears to be in remission. She has been told by her oncologist that she requires vaccination …

Bipolar Disorder Presenting as an Agitated Depression

March 22, 2016

Janice was fifty-five years old, unemployed, and as her regular GP was retiring, she needed to find a new doctor. She presented as well-presented and colourfully dressed, agitated but cheerful. Janice said she had always suffered from anxiety and had tried numerous antidepressants over the years. She found none had …

Misophonia

Cindy is a twelve-year-old girl whose parents have always described as ‘sensitive’, having an anxious personality, and in more recent years, perfectionistic. They bring her to see the GP as over the last few months, Cindy has been complaining about feeling stressed by certain noises, especially people eating, laughing, coughing …

Lobular Carcinoma of the Breast

 

Francesca has had regular mammograms every two years since turning fifty. She is now fifty-five and presents to her GP with a lump in the breast. Her last mammogram was normal just under a year ago and she does not normally do breast self-examination, and so is unaware how long …

Pyllodes Tumour of the Breast

March 01, 2016

 

Fiona was twenty-nine-years old when she presented to the GP with a lump in the breast. She did not normally examine her breasts but had noticed it whilst showering the week before.  She was on the oral contraceptive for acne management, but otherwise had no medication and was healthy. Examination …

Acute, Severe Hypertension in a Middle-Aged Man

February 16, 2016

 

Frank, aged 58 years, was in excellent health (as he had not seen a doctor for years!). One day, he was sent to hospital by ambulance with a blood pressure of 190/124mmg/Hg. He was asymptomatic. This diagnosis was courtesy of Frank’s first work medical. He had been doing field work …

Why Medication Isn’t Enough for Reflux Oesophagitis

February 04, 2016

Johan had been suffering from gastro-oesophageal reflux for some time, but now it was not responding esomeprazole (40mg nocte). Johan had no weight loss, no dysphagia or hoarseness and was otherwise well. He was finding the Christmas season especially difficult regarding his symptoms and a GP colleague had referred him …

An Unusual Complication from a Tick Bite

Jack saw his GP urgently one morning because he had significant genital swelling which had worsened overnight. The evening before Jack had removed a tick from his groin and, despite the gymnastic challenge of this act, believed the creature had been removed in its entirety. He had not killed the …

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