A middle-aged man in his late 50’s presented with fever for 3 days associated with poor appetite and epigastric discomfort. He had been prescribed augmentin by his general practitioner 2 days ago without relief of symptoms. His only premorbid conditions were hypertension and hyperlipidemia, and there was no travel or contact history of significance. Physical […]
A middle-aged housewife with a history of chronic eczema and penicillin allergy (“rash and eye swelling”) presented with 2 days of fever, chills and lethargy. The initial clinical examination was unremarkable except for ongoing eczema and fever. The initial laboratory tests were remarkable only for mild thrombocytopaenia (114) and neutrophilia. However, she had chest pain […]
A middle-aged woman underwent chemotherapy after being diagnosed with acute lymphoblastic leukaemia (ALL). She was re-admitted 4 days post-completion of #1A and #1B hyperCVAD with septic shock requiring dopamine support. Her absolute neutrophil count (ANC) was 0.02 and her initial chest X-ray was normal. She was treated with intravenous (IV) imipenem as per protocol, and blood cultures grew Pseudomonas […]
An elderly man was knocked down by a taxi while riding on his bicycle. He developed a right subarachnoid hemorrhage and became progressively drowsy, requiring emergent evacuation of the clot and insertion of an external ventricular drain (EVD). He got progressively better in the hospital, and the EVD was removed 12 days later. At that time, […]
A middle-aged man with Type 2 diabetes mellitus and hypertension developed extensive subarachnoid haemorrhage acutely, and underwent a 4-vessel cerebral angiogram during which an anterior communicating artery aneurysm was found and coiled. He recovered gradually with inpatient rehabilitation, and was sent home after 2 weeks of hospitalisation. However, he had developed a cough with mild […]
A middle-aged man presented with fever and dysuria for 5 days. He worked as a gardener at a large private housing estate, and suffered from both hypertension and type 2 diabetes mellitus. A CT pelvis was performed, with a representative image shown below. Question: What is the diagnosis and what is the bacterial aetiology? The CT […]
This elderly gentleman had pulmonary tuberculosis 40 years ago. He was also a chronic smoker of 60-odd years, smoking at least 10 cigarettes a day. He presented with paroxysmal coughing for 2 days (more than his usual “smoker’s cough”), accompanied initially by rusty, blood-streaked sputum, but developed frank hemoptysis (coughing out bright red blood) in the […]
The ECG from Clinical Vignette 17 was actually obtained from the patient described below: This middle-aged man, a sailor, was transferred to the hospital directly after his ship sailed into port. He had been ill for 2 months, with low-grade fever, weight loss of almost 8 kg, and shortness of breath upon exertion. His chest […]
Rather than a case description, it’s just an ECG this time, obtained from a middle-aged man almost two decades ago. Question: What is the ECG diagnosis? [Updated 24th January 2015] The ECG shows short voltages on all leads, and electrical alternans (i.e. alternating taller and shorter voltages) on the long lead 2 at the bottom. These […]
MIPHIDIC 