8 Rheumatology Osteoarthritis (OA) Case history A 75-year-old woman attends the A&E department with pain in the left groin. The pain has been present for several months but she has…

6 Haematology and Oncology Microcytic and macrocytic anaemia Definition of anaemia Anaemia is present when the level of haemoglobin in the blood is below the normal range. The normal range…

15 Neurology Diplopia Diplopia (double vision) occurs when there is an acquired defect of movement of an eye (paralytic squint). It is maximal in the direction of action of the…

14 Endocrinology and Diabetes Diabetes mellitus Diabetes mellitus is a syndrome of chronic hyperglycaemia due to relative insulin deficiency or resistance or both. Case history (1) You are telephoned by…

17 Dermatology A swollen red leg Case history The A&E officer asks you to come and see a 50-year-old man who is unwell and has a red, swollen leg. He…

4 Gastroenterology Vomiting Vomiting centres are located on the lateral reticular formation of the medulla and are stimulated by chemoreceptors trigger zones on the floor of the 4th ventricle and…

7 Care of the Elderly Blackouts This implies either altered consciousness, with or without falling, or sometimes a visual disturbance. Case history An 86-year-old woman is brought into A&E with…

12 ITU Shock Case history (1) A 60-year-old bank manager presents with crushing central chest pain. This started 45 minutes ago and has remained constant ever since. On examination he…

5 Liver and Biliary Tract Disorders Abnormal liver biochemistry ‘Liver function tests’ are routinely requested. Serum bilirubin, aminotransferases, alkaline phosphatase, γ-glutamyl, transpeptidase (γ-GT) and total proteins are measured. These are…

13 Poisoning Self-poisoning This is a common problem, leading to over 100 000 hospital admissions in England and Wales per annum. It is also a problem in developing countries: in cities,…