100 Cases in Clinical Pathology 100 Cases in Clinical Pathology Eamon Shamil MBBS MRes Foundation Year 2 Doctor, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK Praful Ravi MA MB BChir Academic Foundation Year 2 Doctor, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK Ashish Chandra MD FRCPath DipRCPath (Cytol) Consultant Histopathologist, Guy’s & St Thomas’ Hospitals, NHS Foundation Trust, London, UK 100 Cases Series Editor: Janice Rymer MBBS FRACP Dean of Undergraduate Medicine and Professor of Gynaecology, King’s College London School of Medicine, London, UK Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business 100 Cases in Clinical Pathology Eamon Shamil MBBS MRes Foundation Year 2 Doctor, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK Praful Ravi MA MB BChir Academic Foundation Year 2 Doctor, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK Ashish Chandra MD FRCPath DipRCPath (Cytol) Consultant Histopathologist, Guy’s & St Thomas’ Hospitals, NHS Foundation Trust, London, UK 100 Cases Series Editor: Janice Rymer MBBS FRACP Dean of Undergraduate Medicine and Professor of Gynaecology, King’s College London School of Medicine, London, UK Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2014 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20140422 International Standard Book Number-13: 978-1-4441-7999-6 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com Dedications To my parents, siblings and mentors, who taught me the importance of kindness, compassion and integrity Eamon Shamil To my parents and my teachers Praful Ravi To my mother, my first teacher Ashish Chandra CONTENTS Preface xi Acknowledgements xiii Contributors xv Section 1: CHEMICAL PATHOLOGY, IMMUNOLOGY AND GENETICS Case 1: Polyuria and polydipsia 3 Case 2: Traces of blood found on a routine urine dipstick 7 Case 3: Confusion, lethargy and shortness of breath 9 Case 4: A child with facial swelling 11 Case 5: Joint pains and fatigue 13 Case 6: Anxiety, irritability and reduced menstrual frequency 15 Case 7: Screening for prostate cancer? 19 Case 8: A young woman found unconscious in bed 23 Case 9: A middle-aged woman with jaundice 27 Case 10: Drug overdose 31 Case 11: Fatigue, weakness and constipation 33 Case 12: Excessive hair growth and infertility 37 Case 13: Fatigue and irregular periods 41 Case 14: Stiff and painful hands 43 Case 15: Abdominal pain, nausea and vomiting 47 Case 16: Frequent throat and chest infections 51 Case 17: Right-sided flank pain moving to the groin 53 Case 18: A routine ‘health check’ for a 55-year-old man 55 Case 19: Collapse in a patient undergoing chemotherapy 59 Case 20: A 10-day-old baby with ambiguous genitalia 63 Case 21: Fatigue, weakness and weight gain 67 Case 22: Hypertension in a young woman 69 Case 23: Nausea, vomiting, weakness and paraesthesia 71 Case 24: Erectile dysfunction in a young man 73 Case 25: A young man with ‘high cholesterol’ 75 Case 26: Rash after a bone marrow transplant 77 Case 27: A fall on an outstretched hand 79 Case 28: A patient in follow-up after a liver transplant 81 vii Contents Case 29: A man with poorly controlled blood pressure 85 Case 30: Dizziness on standing upright 89 Case 31: Sudden-onset chest pain in a tall woman 91 Case 32: Concerns about the risk of breast cancer 93 Case 33: Seizure in a neonate 95 Case 34: Flu-like illness after foreign travel 97 Section 2: HISTOPATHOLOGY Case 35: A young woman with ankle swelling and shortness of breath 103 Case 36: Chest pain and sudden death 105 Case 37: An elderly man with severe back pain 109 Case 38: Increased breathlessness and sudden death 111 Case 39: A worsening cough and haemoptysis 113 Case 40: A young man with shortness of breath and haemoptysis 117 Case 41: Sudden onset weakness and dysphasia 119 Case 42: Numbness, weakness and clumsiness 121 Case 43: Forgetfulness and disorientation 123 Case 44: Coffee-ground vomiting 125 Case 45: Episodic right upper quadrant abdominal pain 129 Case 46: Chronic diarrhoea and flatulence 133 Case 47: A young man with bloody diarrhoea 135 Case 48: Abdominal discomfort and generalized weakness 139 Case 49: Abdominal pain in a publican 143 Case 50: Abdominal distension, loss of appetite and malaise 145 Case 51: Delayed passage of meconium in a newborn 147 Case 52: Back pain and fever in a diabetic 149 Case 53: Urinary problems in an elderly man 153 Case 54: A young man with a testicular lump 155 Case 55: Heavy and painful menstrual bleeding 159 Case 56: Abnormal vaginal bleeding 163 Case 57: A lump in the breast 165 Case 58: Lymph node enlargement in a young man 167 Case 59: An itchy, bleeding mole on the back 171 Section 3: HAEMATOLOGY Case 60: Shortness of breath and heartburn 175 Case 61: Raised white cell count in an asymptomatic individual 179 viii Contents Case 62: Worsening fatigue and bleeding gums 183 Case 63: Burning urine and an abnormal clotting screen 187 Case 64: Headaches, blurred vision and itching 189 Case 65: A painful arm and a large spleen 193 Case 66: A rash on the thighs 197 Case 67: Fatigue and weight loss 201 Case 68: Pneumonia with abnormal liver function 205 Case 69: Recurrent epistaxis 211 Case 70: Bruising after a pneumonia 215 Case 71: Headache and a rash 219 Case 72: Shortness of breath and weight loss 223 Case 73: L ow platelets in pregnancy 227 Case 74: Anaemia resistant to a blood transfusion 231 Case 75: Asymptomatic anaemia in the elderly 235 Case 76: Back pain and fatigue 241 Case 77: Short of breath and underweight 245 Case 78: A large epigastric mass 249 Case 79: Deterioration after a blood transfusion 253 Section 4: MICROBIOLOGY Case 80: Leg pain and fevers 259 Case 81: Fever and collapse 263 Case 82: Burning sensation when passing urine 269 Case 83: A bit short of breath 273 Case 84: Unhappy camper 277 Case 85: Diarrhoea in an elderly man 283 Case 86: A painful knee 287 Case 87: A pain in the ear 291 Case 88: A red eye 293 Case 89: Child with a rash 297 Case 90: Pelvic pain 303 Case 91: A painful swollen jaw 305 Case 92: Traveller’s diarrhoea 311 Case 93: Fever in a returning traveller 315 Case 94: A spot of confusion 319 Case 95: Congenital infection 323 ix Contents Case 96: A chronic cough 327 Case 97: A jaundiced view 331 Case 98: Gram negative bacteraemia 335 Case 99: A groin swelling 339 Case 100: Urethral discharge 343 Reference Ranges 347 Index 349 x