Prognosis : Your Diagnosis

Paralazyed | 2013-05-25

A 3 month old boy presents with diminished upper and lower limb movements, absence of defecation, and dribbling micturition for 4 days. His perinatal history is significant for a prolonged labour with vacuum extraction. A caput succedaneum was present at birth, but resolved spontaneously in 3 days. His medical and family histories are unremarkable.

Suspended | 2013-05-17

A 32 year old woman at 42 weeks of gestation of her 2nd pregnancy presents in active labor. The baby is estimated to be 3.9 kg, with no anomalies. Despite regular, strong contractions, progression through the second stage of labor is slow. A ventouse is applied, following which the head of the baby delivers easily, but then immediately retracts, with the baby's chin abutting the perineum. Her 1st pregnancy was uncomplicated, with a 4.0 kg child delivered vaginally.

Stuffy | 2013-05-12

A 40 year old man presents with recurrent sinusitis for 2 years, associated with a bloody nasal discharge, intermittent cough and breathlessness. The response to antihistamines and antibiotics was poor. His medical and surgical histories are unremarkable and he is currently not on any medications. His full blood count shows a Hb level of 10.1 g/dL, and a leukocyte count of 13,500, with 85% neutrophils. His ESR is 110 mm in the first hour.

Tummy Ache | 2013-05-03

A 42 year old man presents with pain in the right upper abdomen for 3 days, associated with a swinging fever, nausea and vomiting. No other symptoms are present. His medical and drug histories are unremarkable. His history is otherwise significant only for multiple visits to India during the last one year. The last visit was around a month ago. His full blood count shows a leukocyte count of 14,500/mm3, with 89% neutrophils.

Burst | 2013-04-26

A 33 year old man presents with continuous pain in the left flank for one day, which progressively worsened over time, and was only minimally responsive to Ibuprofen. There was no history of fever, urinary symptoms or recent or past trauma to the affected area. His medical and surgical histories are unremarkable. He only drinks socially and does not smoke.

Changed | 2013-04-21

A 16 year old girl is brought in by her parents, as she has not attained menarche. There are no other complaints. Her medical, surgical and family histories are unremarkable. She is not on any drugs.

Sporadic | 2013-04-13

A 4 year old girl presents following multiple episodes of vomiting and confusion over a 4 hour period. She suffered from a ‘flu like' illness 5 days ago, for which acetaminophen (paracetamol) was prescribed in an age-appropriate dose. She continues to experience a low grade fever. Her medical history is unremarkable and all immunizations are up to date. A full blood count, serum electrolyte assay, blood gas analysis and CT brain are normal.

Delayed | 2013-04-04

An 85 year old man presents with progressive dyspnea, fatigue and anorexia for three months. He also experienced pain in the lower right side of his chest during this time. He was a shipyard worker for 30 years, retiring at the age of 55. His medical history is unremarkable. There is no family history of lung disease.

Congested | 2013-03-29

A 29 year old man presents with icterus, right upper abdominal pain, and persistent abdominal swelling with intermittent ankle and scrotal swelling for 1 year. There is no history of blood transfusions, intravenous drug abuse or sexual promiscuity. There is no family history of liver disease. He is not on any drugs and was in good health prior to the onset of symptoms. He only drinks socially.

Rapid | 2013-03-24

An 18 year old girl presents with paresthesia of both lower limbs, which progressed into weakness and difficulty in walking over a period of 3 days. There was no bladder or bowel incontinence, or a history of trauma. She experienced an upper respiratory tract infection 3 weeks earlier. Her medical history is unremarkable.

Another Dilemma | 2013-03-09

A 27 year old lady presents with vaginal bleeding and pelvic pain for 2 hours, which was of sudden onset. There was no history of abdominal trauma. She is currently at 22 weeks of amenorrhea of her first pregnancy, which has been uncomplicated so far. Her medical and drug histories are unremarkable.

Thickened | 2013-03-02

A 4 week old male infant presents with 12 episodes of vomiting over 4 days, which progressively worsened over time and became projectile in nature. No bile or blood was present. He is always hungry and often vomits after feeds. He has been exclusively breastfed so far. He was born at term with a birth weight of 3.6kg, which is between the 50th to 75th centiles.

Even more bleeding | 2013-02-27

A 28 year old woman presents with dizziness, lightheadedness, and mild exertional dyspnea for two days. She also experienced an episode of coffee ground vomitus and melena earlier today. She does not smoke or drink, is not on any drugs, and has an unremarkable medical history.

Compromised | 2013-02-18

A 48 year old woman presents with progressive dyspnea for 1 week. There was no cough or chest pain. She was diagnosed with metastatic cancer of the right breast 1 year ago, for which a radical mastectomy was performed. She completed her 6th cycle of chemotherapy three months ago. On admission, her oxygen saturation was 82%, which improved to 99% with high flow oxygen. A full blood count and chest x-ray are normal.

Palpable | 2013-02-10

A 5 year old boy presents with abdominal pain, a rash over his lower limbs, and a painful right ankle for 2 days, preceded by fever for a week. He had a sore throat around 2 weeks back. His medical history is unremarkable. There is no history of recent vaccinations, and no known allergies to foods or drugs.

More Bleeding | 2013-02-02

A 63 year old nulliparous woman from South Asia presents with irregular vaginal bleeding for 4 months. Her menopause occurred 13 years ago. She is not on hormone replacement therapy. A pap smear performed 5 years ago was normal. Her medical history is unremarkable, and she is not on any drugs.

Tall | 2013-01-26

A 19 year old man presents with dyspnea for several hours, which was sudden in onset. There is no history of asthma, cardiac diseases or chest trauma. He was in general good health, and is not on any medications.

Sudden | 2013-01-11

A 33 year old lady presents in active labor, at the 38th week of her third pregnancy. A recent ultrasound scan showed a fundal placenta and a cephalic presentation. Two years ago, she underwent a lower segment cesarean section during her second pregnancy, due to a breech presentation. Suddenly, she begins to complain of severe abdominal pain, which persists between contractions.

More swelling | 2013-01-04

A 65 year old man presents with pain and swelling of his right leg for several hours. There was no history of fever or constitutional symptoms, or injury to the affected limb. He was in general good health, and is not on any medications.

Broken | 2012-12-25

A 65 year old caucasian woman presents with severe chest discomfort and mild dyspnea for 30 minutes, which started soon after she learnt that her husband had died in a car accident. She was in good health previously, with no known medical conditions. Her surgical history is significant only for an appendectomy at age 25.

Pigmented | 2012-12-08

A 48 year old man presents with episodic watery diarrhea for five months, which was predominantly nocturnal. He had also lost 8 kg of weight during the preceding year. His medical history is unremarkable, and he is not on any drugs. There is no significant history of travel. His serum albumin is found to be 2.5 g/dL (normal: 3.5 to 5.5 g/dL).

Yet another limp | 2012-11-24

A 5 year old boy is brought in by his parents, as he has been limping on his left leg for 4 days. Further questioning reveals that he was generally unwell during the preceding 3 weeks. There is no history of trauma and his medical history is unremarkable. X-rays of the left hip joint and knee are obtained, but no abnormalities are apparent.

Halfway | 2012-11-15

A 50 year old postmenopausal woman presents with a lump in her left breast for 2 months. There was no associated pain or recent rapid enlargement. There is no history of previous breast disease, or a family history of breast, bowel or ovarian malignancy. She is nulliparous, while her menarche was at age 12. She was diagnosed with type 1 diabetes at age 20, which is now complicated by diabetic retinopathy, nephropathy and peripheral neuropathy.

More Chronicity | 2012-11-10

A 25 year old lady presents with pelvic pain of 2 years duration, which worsens with menstruation. Her periods became heavier during the last 6 months, while she also experienced marked dyspareunia. Her medical and gynecological histories are otherwise unremarkable. She married 6 months ago, and is currently planning a pregnancy.

Numb : Part 2 | 2012-10-27

A 60 year old man presented with numbness of both feet for 2 months, and was found to have isolated peripheral neuropathy secondary to underlying vitamin B12 deficiency. He was diagnosed with type 2 diabetes mellitus 6 years ago, which is well controlled on Metformin alone. His medical history is otherwise normal. He takes a mixed diet, and is on no other medications. A full blood count, blood film, iron studies, reticulocyte count and folate levels are all normal.

Numb : Part 1 | 2012-10-19

A 60 year old man presents with numbness of both feet for 2 months. He was diagnosed with type 2 diabetes mellitus 6 years ago, which is well controlled on Metformin alone. His medical history is otherwise unremarkable. He consumes a mixed diet and only drinks socially. His HbA1c is 6.0%, while a recent full blood count and serum creatinine were normal.

Confounded | 2012-10-10

A 78 year old man who lives alone is brought in confused and disoriented. He was supposedly normal one week ago, after which he started feeling generally unwell, with a poor appetite. He also experienced several episodes of nausea and vomiting. He is on treatment for stable ischemic heart disease and atrial fibrillation with Telmisartan, Bisoprolol, Rosuvastatin, Digoxin and Warfarin. A full blood count, urinalysis and chest X-ray are normal. His INR is 2.0

Submerged | 2012-10-03

A 50 year old woman presents with recurrent episodes of pain in the left lower abdomen for 1 year. The pain did not worsen over time and was dull and aching in nature. It was worse on standing upright and walking while analgesics provided only poor relief. There was no history of urinary or gastrointestinal symptoms. Her medical and surgical histories are unremarkable.

Up Above | 2012-09-27

A 32 year old man presents with a painless oral ulcer for one week. Further questioning reveals that he had unprotected orogenital sex with two separate partners during the preceding month. He is otherwise well, with an unremarkable medical history.

Underlying | 2012-09-20

A 30 year old woman presents with spontaneous painless vaginal bleeding at 32 weeks of her third pregnancy. She experienced vaginal spotting about a month ago, after she had engaged in sexual intercourse. Her medical history is unremarkable, while her two previous pregnancies were uncomplicated, ending with vaginal deliveries at term.

Another ulcer | 2012-09-09

A 31 year old man presents with a painful ulcer of the penis and a lump in the left groin for 2 weeks. He recalls having unprotected sex with a commercial sex worker around a week before the ulcer appeared. His medical, surgical and family histories are unremarkable.

Jointed | 2012-08-29

A 22 year old man presents with pain and swelling of his right knee for 2 weeks. The pain worsens with weight bearing. There is no history of trauma. He was prescribed ciprofloxacin for an urinary tract infection around 3 weeks ago. His medical history is otherwise unremarkable. He is sexually active,

Up | 2012-08-25

A 21 year old nulliparous woman presents with fever for 3 days and lower abdominal pain for 1 week. She also experienced deep dyspareunia during the preceding several weeks. Her last menstrual period was 2 weeks ago. She has a single regular sexual partner. An intrauterine device was implanted for contraception around 3 months ago. Her medical and surgical histories are unremarkable. A urine pregnancy test is negative.

Discharged | 2012-08-22

A 26 year old man presents with dysuria, frequency and a copious urethral discharge for 3 days. He has a regular sexual partner with whom his last contact was 1 week ago, and also a casual partner whom he was last exposed to around 3 months ago. His medical history is unremarkable.

After birth | 2012-08-18

A 31 year old primipara at full term delivered a healthy baby vaginally, following an uncomplicated labor. The placenta was delivered completely, following which prophylactic oxytocin was administered. An episiotomy was not performed. When reassessed 30 minutes after delivery, she was found to be bleeding heavily. Her pregnancy had been uneventful, and her medical and surgical histories were unremarkable.

Restricted | 2012-08-12

A 27 year old man presents with pain in the right calf for one day, and swelling of the same area since morning. The pain started abruptly while he was playing football last evening. There was no history of trauma. He obtained a medical consultation, at which he was prescribed analgesics and sent home. However, the pain worsened over time, and is now severe and present at rest. His medical history is unremarkable.

Low | 2012-08-04

A 35 year old marathon runner is brought in after falling down and developing a generalised tonic-clonic seizure lasting 3 minutes. He had been running for 5 hours continuously at that time, in a very hot climate. His medical history is unremarkable, and there is no family history of cardiac disease or early deaths. His random plasma glucose is 83.8 mg/dl.

Behind | 2012-07-22

A 7 year old boy presents with fever, dysphagia, odynophagia, and painful neck movements for 1 day. His surgical history is significant for impaction of a fish bone in the throat 3 weeks ago, with removal 4 days later. He appeared to recover completely afterwards. His medical and family histories are unremarkable.

Twisted | 2012-07-15

A 70 year old man presents with worsening pain in the left lower abdomen associated with an absence of bowel movements and passage of flatus for 6 days. He started vomiting just prior to admission. His surgical and medical histories are unremarkable.

Paused | 2012-06-30

A 23 year old nulliparous woman presents with amenorrhea associated with a weight gain of 12 kg, over a period of 6 months. She attained menarche at age 11, and her menstrual cycles have been irregular since then. She is sexually active and uses barrier methods for contraception. Her family history is significant for type 2 diabetes mellitus in both parents. A urine hCG test is found to be negative.

Bighearted | 2012-06-23

A 25 year old woman presents with progressive dyspnea and chest discomfort for 1 day, 2 days following the delivery of her second child. Her pregnancy and labour were uncomplicated. Her medical history is negative for cardiac and respiratory disease, while her first pregnancy was free of complications. Her hemoglobin level is 11.8 g/dl.

Trip | 2012-06-16

A 9 year old boy is brought in after tripping and falling onto the sidewalk. His parents mention that he started walking at the age of 18 months, and that he has always been clumsy when walking and running. He trips and falls over very frequently, and has difficulty getting up from the floor afterwards. His performance in school is above average. His medical and family histories are unremarkable.

Out of place | 2012-06-09

A 29 year old woman presents with severe pain in the lower abdomen and right iliac fossa for 2 days. A week ago she presented with pelvic pain and vaginal bleeding, and was diagnosed with a complete miscarriage as her urine hCG test was positive and the ultrasound abdomen showed an empty uterus. Her last regular menstrual period was 6 weeks ago. A repeat urine hCG test is positive.

Dizzy | 2012-05-31

A 75 year old lady presents with dizziness and vomiting, which commenced when she sat up in bed today. The symptoms subsided completely after a few minutes. She describes the dizziness as "feeling like the room is spinning around her". Her medical history is only significant for well controlled hypertension.

Ominous | 2012-05-24

A 4 year old girl presents with mild abdominal pain and vomiting since last night. There is no history of fever, diarrhea, or urinary symptoms. Her parents mention that she lost some weight during the previous month, despite a good appetite. Her medical, family and birth histories are unremarkable.

Mixed | 2012-05-19

A 70 year old man presents with altered behavior and slurred speech for one day. He was previously well, except for longstanding osteoarthritis, for which he consumed over-the-counter analgesics regularly. A full blood count, random blood glucose, serial ECGs, chest radiograph, urinalysis and liver profile are normal.

Virilized | 2012-05-11

A 33 year old woman presents with progressive hair growth on her face and chest for 6 months, and irregular periods occurring every 2 to 3 months, for 5 months. Prior to this, her menstrual periods occurred at regular 30 day cycles. Her medical history is unremarkable and she is not on any medications.

More Back Pain | 2012-04-26

An 82 year old woman presents with fever, diminished appetite and urinary incontinence for 10 days. She also gives a history of lower back pain and difficulty ambulating after a fall 3 weeks ago. Her co-morbidities are diabetes mellitus and hypertension, of which treatment details are unavailable. She lives alone. Her CBS is 250 mg/dl, while her FBC shows a WBC of 26,000 with 90% Neutrophils. Serum electrolytes are normal.

Ascending | 2012-04-18

A 35 year old, sexually active woman presents with fever and right upper abdominal pain for 3 days, and pelvic pain for a week. She also vomited twice, just prior to admission. The abdominal pain was sharp and exacerbated by inspiration and movement. Her last menstrual period was 2 weeks ago. Her medical history is unremarkable. Her full blood count shows only a leukocytosis of 12,000/mm3, 80% neutrophils.

High | 2012-04-07

A 10 year old girl presents shortly after a tonic-clonic seizure. She had experienced low-grade fever for a week, a severe headache for 2 days and loss of vision since waking up today. Her medical, family and birth histories are unremarkable.

Chronic | 2012-04-01

A 23 year old woman presents with blood and mucus diarrhea, low grade fever, lethargy, and malaise for 1 week. She experienced around 3 to 4 bowel movements daily. She had several such episodes over the last 4 months, which were unsuccessfully treated with multiple courses of antibiotics. She had gone backpacking around South Asia 6 months earlier. An x-ray of her abdomen is found to be normal.

Another sore throat | 2012-03-29

A 46 year old man presents with throat discomfort and pain upon swallowing since last night. These symptoms rapidly worsened over time, such he now feels as if his throat is "closing up". The discomfort is worse on lying down. He also feels weak and ill. His medical history is unremarkable, while he has smoked a total of 20 pack years.

Swollen | 2012-03-24

A 32 year old lady in her first pregnancy presents at 31 weeks of gestation with pain and swelling of her left leg for one day. She also complains of feeling feverish. There is no history of trauma. She was diagnosed with gestational diabetes mellitus at 27 weeks, which is well controlled via dietary measures. Her medical and surgical histories are unremarkable.

Sore throat | 2012-03-20

A 1 year old boy presents with a high fever for 3 days. On the day of admission, he developed noisy breathing, while his eyelids appeared swollen. He has also been feeding poorly. His birth and medical histories are unremarkable. All immunizations (including diphtheria) are up to date. A urinalysis is found to be normal.

Masquerade | 2012-03-17

A 15 year old boy presents with severe vomiting and diarrhea for 1 day and confusion since waking up today. He complained of a fever and sore throat in the 5 days preceding this. His appetite has been poor for the last few months and he has lost some weight. His medical history is unremarkable.

Itchy | 2012-03-10

A 27 year old primiparous lady presents at 29 weeks of gestation with generalized pruritus for one week. The pruritus is most prominent on the palms and soles and is worse at night. Her pregnancy has been otherwise uncomplicated. Her medical history is unremarkable for dermatological diseases and allergic conditions. Her full blood count, renal functions and clotting profile are normal. Her urine tests negative for proteins.

Bleeding | 2012-03-07

An 18 month old boy presents soon after passing a large amount of dark red blood per rectum. During the preceding 2 days, he had passed dark red, jelly like stools several times. No other symptoms were present apart from the fact that he had been lethargic for the past 24 hrs. His birth, medical and family histories are unremarkable.

Fragile | 2012-03-03

A 47 year old lady is brought in after she slipped and fell on the ground. She was unable to get up due to severe pain in both hips. Close questioning reveals the presence of nocturia and constipation for several months. Her medical history is unremarkable and she is not on any drugs.

Covert | 2012-02-24

A 56 year old woman presents with worsening dyspnea and abdominal distention for 8 months. Her medical history is unremarkable, while her menopause took place at 52 years of age. She has had 3 uneventful pregnancies. A full blood count and chest x-ray show a hemoglobin level of 13 g/dl and a right sided pleural effusion respectively. A recent mammogram was normal.

Wasted | 2012-02-18

A one-week old boy presents with six episodes of non-bilious vomiting within the last 2 days and reduced urine output for the last 12 hours. He is also lethargic and is feeding poorly. There is no history of fever or diarrhea. His antenatal history is uncomplicated, with a birth weight of 3.2 kg. His family history is unremarkable. He was breastfed from birth.

More Weakness | 2012-02-16

A 32 year old woman presents with worsening lower back pain, difficulty in walking and weakness of both lower limbs for 6 months. The pain was severe, exacerbated by activity and poorly responsive to analgesics. The lower limb weakness was pronounced when climbing stairs and getting up from chairs. She also complains of a dry mouth, constipation and urinary frequency. Serum electrolyte levels are normal, while her ESR is 10 mm/1h.

Double Trouble | 2012-02-11

A 17 year old girl presents with a rapidly enlarging, painless lump in the right loin for two weeks. She also gives a history of intermittent passage of fresh blood per rectum for a few months. This was attributed to hemorrhoids and was not investigated further. Her medical and family histories are unremarkable. A full blood count, urea and electrolytes and liver profile are found to be normal.

Ulcerated | 2012-02-04

A 24 year old pregnant lady presents with fever, body aches and malaise for 4 days. She also complains of itching and soreness of the vulva, and dysuria. This is her first such episode. This is her first pregnancy and she is at 36 weeks of gestation. Her last sexual exposure was 1 week ago, with her husband. Her medical history is unremarkable and she is not on any medications.

Slow | 2012-01-28

A 3 day old boy presents with jaundice from the 2nd day of life. He was born via cesarian section at 38 weeks of gestation, following an uncomplicated pregnancy. His mother is 24 years old, and is in good health.

Bloated | 2012-01-21

A 71 year old man presents with persistent lower back pain for one and a half months. The pain is dull and aching in nature and does not radiate. There is no history of recent trauma. His co-morbidities are well controlled hypertension for 15 years and ischemic heart disease for which coronary artery bypass grafting was performed 10 years ago. A full blood count and urinalysis are found to be normal.

Unusual | 2012-01-14

A 10-month-old girl presents with high fever for 8 days, which is remittent in nature and associated with irritability. She was treated with antibiotics for the past 4 days, with little or no improvement in symptoms. She was previously well and was breastfed up to 6 months of age.

Dispersed | 2012-01-07

A 40 year old lady presents with intermittent vaginal bleeding and irregular menstruation for two months. She also complains of an intermittent non-productive cough for six months. She has had two previous pregnancies, which were uncomplicated. Her last delivery was approximately a year ago. She is not on any contraceptives.

Pulseless | 2012-01-04

An 18 year old girl from south asia presents with intermittent pain of the right hand for 6 weeks. She was diagnosed with pulmonary tuberculosis 2 years ago, which was treated with a full course of therapy for 6 months. Followup for an year afterwards showed no evidence of recurrence. Her ESR is 120 mm/1h.

Thirsty | 2011-12-23

A 72 year old man presents with fatigue, weakness, thirst and polyuria for 1 month. He appeared to be in good health prior to this. His medical, surgical and family histories are unremarkable and he is not on any drugs. He does not smoke, and drinks only at social events. His ESR is found to be 130 mm/1h.

Yellow | 2011-12-17

A 5 week old girl presents with persistent yellowish discoloration of her skin and sclera for 3 weeks. She is feeding well and has no other symptoms. She is the product of a normal pregnancy and delivery, with a normal birth weight. Her growth and development are age appropriate.

Surprised | 2011-11-28

A 42 year old woman presents with a slowly enlarging lump in her left breast of 2 months duration. There is no associated pain or nipple discharge. She recalls a history of trauma to the affected area several months ago. Her medical history is unremarkable, while there is no family history of malignancy. She is nulliparous, and attained menarche at the age of 12. Her menstrual cycles are regular.

Slip | 2011-11-22

A 32 year old lady in her fourth pregnancy presents at 37 weeks of gestation following spontaneous rupture of membranes. Her pregnancy was uncomplicated. Her only comorbidity is mild intermittent bronchial asthma, with no recent exacerbations.

Dilemma | 2011-11-12

A 28 year old lady who is 26 weeks pregnant presents with severe right sided abdominal pain for 1 day associated with nausea and vomiting. This is her first pregnancy. Her medical and gynecological histories are unremarkable.

Comatose | 2011-11-06

An 80 year old woman is brought in semi-conscious. She had been lethargic for the last several weeks and was unable to get out of bed yesterday. She has no known comorbidities. A full blood count, c-reactive protein, capillary blood sugar, chest x-ray and CT brain are normal. Her ECG shows sinus bradycardia with low voltage complexes, while cardiac troponins are not elevated.

Break | 2011-10-27

A 54 year old man presents with severe central chest pain for 2 hours, which was acute in onset and is associated with nausea, vomiting and sweating. His medical and family histories are unremarkable. He is a social drinker only and does not smoke. A recent check up showed a normal fasting blood glucose, lipid profile, renal and liver functions. Serial ECGs show sinus tachycardia only, while troponin-I levels are within normal limits.

Quandary | 2011-10-14

A 22 year old lady presents with intermittent pain in the right lower abdomen for 2 days, with sudden worsening over the last 4 hours. She also experienced mild fever, nausea and vomiting. Her medical and drug histories are unremarkable. She is nulliparous, with irregular menstrual cycles. Her last period was 7 weeks ago. She has not been sexually active for the last year and has no history of sexually transmitted disease (STDs).

Torrid | 2011-10-09

A 39 year old delivery man is admitted in the afternoon following a generalized tonic-clonic convulsion which lasted for 5 minutes. He had been transporting parcels by bicycle for the whole day. He was completely well earlier, with an unremarkable medical and drug history. An urgent full blood count and non-contrast CT brain are normal, while an ECG shows sinus tachycardia only. His capillary glucose is 125 mg/dl.

Inherited | 2011-09-30

A 4 year old boy presents with worsening unsteadiness while walking and slurring of speech for a few months. His medical history is significant for recurrent respiratory tract infections for several years. His sister died of overwhelming sepsis at 13 years, following a similar illness with recurrent respiratory infections and developmental regression. His parents are apparently normal. His birth history is unremarkable and all immunizations are up to date.

Sinister | 2011-09-24

A 15 year old boy presents with dull, aching pain just above the right knee for 3 months, which is worse at night. The pain commenced after he slipped and fell on the floor. His movements are unaffected. He is otherwise asymptomatic with an unremarkable medical history. A full blood count is found to be normal, while his ESR is 13 mm in the first hour.

More confusion | 2011-09-13

A 53 year old male nurse presents with drowsiness and confusion for several hours. Prior to becoming drowsy, he complained of palpitations and sweating. He was previously well, with an unremarkable medical history. He does not drink or use recreational drugs. His full blood count and electrolytes are normal, but his capillary blood sugar is 40 mg/dl. Following administration of IV dextrose, he recovers completely.

Calculated | 2011-09-04

A 48 year old lady presents with intermittent upper abdominal pain for 6 months. The pain is dull, radiates towards her back and is often precipitated by heavy meals. There is no history of fever or jaundice. Three months prior to the onset of pain, she had begun to experience vague upper abdominal discomfort, intermittent heartburn and indigestion. Her medical history is unremarkable. She does not smoke, only consumes alcohol intermittently, and is nulliparous.

Insidious | 2011-08-28

A 67 year old lady presents with severe, dull epigastric pain for 6 hours, which was almost instantaneous in onset. The pain is exacerbated by movement, does not radiate and is associated with mild nausea. No other symptoms are present. Her medical history is only significant for well controlled hypertension for 10 years. She does not drink or smoke.

More headaches | 2011-08-20

A 26 year old man presents with a persistent, severe, throbbing occipital headache for 3 days and fever for 2 days. He was woken up by the headache. He is otherwise asymptomatic and has never experienced a similar headache before. His medical, family and drug histories are completely unremarkable. A full blood count is found to be normal.

Weak | 2011-08-10

A 62 year old lady is brought in after falling down and finding herself unable to get back up. She had experienced insidious, progressive upper and lower limb weakness for the last month but was otherwise asymptomatic. She was diagnosed with stage 3 vulval cancer 10 years ago, which was treated by a radical vulvectomy with bilateral groin node dissection and chemo-irradiation, with no recurrence since. Her FBC, urinalysis, electrolytes and renal functions are normal.

Hidden | 2011-08-03

A 32 year old primiparous lady with a period of amenorrhea of 34 weeks presents with vaginal bleeding and intermittent abdominal pain for 3 hours. There is no history of abdominal trauma. Her pregnancy was uncomplicated prior to this, while her medical history is unremarkable. Her blood group is AB -ve, while 1500 IU of anti-D immunoglobulin was administered at 28 weeks of amenorrhea.

Black toe | 2011-07-28

A 58 year old man presents with pain and blackish discoloration of his right little toe for 1 week, in a background of exertional dyspnea, fatiguability and intermittent headaches for 4 months. No other symptoms are present. He has no known medical conditions and has never smoked. At a recent checkup, a fasting blood sugar, lipid profile, liver and renal profile, ECG, chest x-ray and echocardiogram were found to be normal.

Can't walk | 2011-07-20

A 10 year old boy presents with a painful right knee for 10 days, fever for 1 day and refusal to bear weight on the affected limb since waking up today. He is otherwise asymptomatic. His parents recall that he slipped and impacted his knee on the floor around a month ago, but was fine afterwards. His medical and birth histories are unremarkable. All immunizations are up to date.

Breathless | 2011-07-16

A 57 year old lady presents with progressively worsening exertional dyspnea for 1 year, associated with a non-productive cough, fatigue and small-joint arthralgia. She is otherwise asymptomatic and her medical, drug and family histories are unremarkable. She has never smoked and has no history of exposure to organic or inorganic dusts or environmental allergens. Her full blood count and CRP are normal, while her ESR is 50 mm/1h.

Under pressure | 2011-07-06

A 30 year old lady in her first pregnancy is referred from the ante-natal clinic when her blood pressure is found to be 150/95 mmHg, although she is asymptomatic. Her period of amenorrhea is 32 weeks. She was normotensive prior to this, with an unremarkable medical history. Her full blood count is normal. A urinary dipstick tests 2+ for proteinuria.

Perplexed | 2011-07-03

A 48 year old man presents with progressively worsening dyspnea for 3 months, which is worse when sitting up. There is no history of fever, cough or chest pain and he is otherwise asymptomatic. He was diagnosed with alcoholic cirrhosis 5 years ago, following which he stopped drinking. An upper GI endoscopy performed 6 months ago showed grade II esophageal varices, which were banded. A chest x-ray and ECG are performed and found to be normal.

Too early | 2011-06-28

A 32 year old pregnant lady presents with vaginal bleeding for 1 day, which was associated with intermittent lower abdominal pain. Her period of amenorrhea is 9 weeks. This is her first pregnancy and her medical history is unremarkable.

Another headache | 2011-06-25

A 49 year old man presents following a generalized tonic-clonic seizure of 2 minutes duration. He also complains of weakness of the left side since waking up today. He had a persistent headache for the last 2 weeks, which was worse upon waking up and coughing. His medical history is otherwise unremarkable.

A real headache | 2011-06-18

A 32 year old man presents with a progressively worsening left sided throbbing headache for 1 week. He did not experience fever, nausea, photophobia, phonophobia or diurnal symptoms. There was no associated limb weakness or sensory symptoms. His medical history is unremarkable, with no history of chronic headaches.

Postponed | 2011-06-11

A 40 year old man presents with progressively worsening exertional dyspnea for 6 months. He is otherwise asymptomatic. He gives a history of blunt abdominal trauma following a motor vehicle accident 4 years ago. An emergency laparotomy was performed, during which a laceration of the liver was detected. His medical history is otherwise unremarkable. He does not smoke and there is no family history of malignancies or cardiac or respiratory diseases.

More limping | 2011-06-08

A 9 year old caucasian girl presents with acute pain in her right hip for 1 day. She gives a history of chronic, progressively worsening pain in the same hip for the last 6 months. There is no history of trauma and she is otherwise asymptomatic. Her medical history is unremarkable and she is not on any medications.

Unexpected | 2011-06-04

A 58 year old man complains of fever for 3 weeks associated with fatigue and lassitude. He is otherwise asymptomatic and has an unremarkable medical history. He has never undergone any surgical or dental procedures and denies recreational drug use. There is no family history of malignancy. A chest x-ray and urinalysis are found to be normal.

Intrinsic | 2011-05-28

A 12 year old boy presents with non projectile bilious vomiting, abdominal distension and colicky epigastric pain for 2 days. There is no history of constipation, fever or jaundice. He gives a longstanding history of similar but much milder episodes after large meals, none of which required hospital admission. He also suffers from intermittent dyspeptic symptoms. His medical history is otherwise unremarkable and his full blood count is normal.

Impediment | 2011-05-21

A 63 year old man presents with worsening jaundice, steatorrhea, dark urine, pruritis and mild anorexia for 5 weeks. There was no malena or fever. He gives a history of recurrent epigastric pain for many years, which was self medicated. His medical history is otherwise unremarkable. He only drinks a beer or two a week. A full blood count was found to be normal.

Conundrum | 2011-05-16

A 45 year old man presents with severe central chest pain for 3 hours associated with sweating and faintishness. He was asymptomatic prior to this. His medical history is significant for well controlled hypertension for 10 years. He does not smoke and denies recreational drug use. An ECG performed at a routine checkup a few months ago was completely normal.

Loose bowels | 2011-05-11

A 3 year old child presents with fever, vomiting and bloody diarrhea for 5 days, and reduced urine output from yesterday. He is otherwise asymptomatic and has no comorbidities. His birth history is unremarkable and all immunizations are up to date.

A bit too much | 2011-05-07

A 44 year old man complains of fever, abdominal distention, anorexia and nausea for 4 days. He consumes half a bottle of whiskey every day, with his last drink being yesterday and demonstrates features of alcohol dependance. There is no history of blood transfusions, recreational drug use or unsafe sexual contact. His medical history is unremarkable. Chest X-Rays and Urinalysis are normal.

Why cry ? | 2011-05-04

A 1 year old boy presents with intermittent crying for 1 day. There is no history of fever, vomiting, diarrhea or urinary frequency. He was previously healthy with normal growth and development. All immunizations are up to date.

Sky high | 2011-04-30

A 23 year old college student who lives alone was found unconscious in his room after missing lectures for 3 days. His urine output was noticed to be reduced following admission. His friends relate that he appeared withdrawn over the last few weeks, but was in good health when last seen. There was no history of medical issues, alcohol abuse or recreational drug use.

Passing Blood | 2011-04-23

A 64 year old lady presents with painless hematuria for 1 week associated with non mechanical lower back pain. There is no history of trauma. She is otherwise asymptomatic and her medical history is only significant for well controlled hypertension for 10 years. There is no family history of malignancy or coagulation disorders. Her full blood count is normal.

Stuck | 2011-04-16

A 42 year old lady presents with non progressive, intermittent dysphagia to both solids and liquids for 20 years. The dysphagia occurs only after 2 to 3 mouthfuls, is mainly noted in the upper chest and is associated with regurgitation. No respiratory symptoms are noted, while her medical history is otherwise unremarkable.

Limp Limp | 2011-04-09

A 32 year old man presents with progressively worsening pain and restricted movements of the right hip for 6 months. He also complains of pain in the right knee, but there is no associated restriction of movements or swelling. No other joint symptoms are present and he is otherwise asymptomatic. There is no history of recent or old trauma and his medical history is insignificant. He consumes 3 to 4 glasses of whiskey daily. His full blood count is normal.

Cough, Cough | 2011-04-01

A 37 year old lady presents with a non-productive, intermittent cough for 2 months associated with mild dyspnea. There was no nocturnal aggravation, orthopnea or paroxysmal nocturnal dyspnea. She denies fever, night sweats, anorexia or loss of weight but feels lethargic. She also noticed a transient, painful erythematous rash over her shins for the last six months. Her medical history is otherwise normal. She does not smoke and has no family history of lung disease.

Out of comfort | 2011-03-25

A 45 year old man presents with progressively worsening dyspnea and chest discomfort for 2 weeks, which became significantly worse over the last 4 days. He also gives a history of feverishness and malaise for the preceding 3 months. He is otherwise asymptomatic and his medical history is unremarkable.

Cold hand | 2011-03-19

A 50 year old lady presents with sudden, severe pain and numbness in her left hand for the last 4 hours, which is rapidly becoming worse. She is otherwise asymptomatic. She gives a history of recurrent palpitations for many years, which has not been investigated. She also has a background of well controlled diabetes and hypertension of 5 years duration.

Totally Confused | 2011-03-14

A 34 year old man is admitted with fever and confusion of 4 days duration. He is otherwise asymptomatic. He was diagnosed with schizophrenia a month ago, for which olanzapine was commenced. His medical history is otherwise unremarkable and there is no history of anesthesia. His full blood count shows a WBC/DC of 12,000/mm3 (N: 65%, L:34%) and is otherwise normal.

Blocked | 2011-03-05

A 64 year old man presents with severe colicky abdominal pain and vomiting for the past 12 hours. He last opened his bowels 6 hours ago. He is otherwise asymptomatic. There is no history of surgery or trauma to the abdomen and his medical history is unremarkable. He only consumes a beer or two several times a week. His full blood count is normal.

Hot Chest | 2011-02-26

A 30 year old lactating lady presents with pain, redness and swelling of her right breast of 2 weeks duration. There was no associated itching or fever and she is otherwise asymptomatic. She was treated with antibiotics for the past week, with no response. There is no history of trauma or allergies and her medical history is unremarkable. There is no family history of cancer. Her first child was born 9 months ago.

Heady | 2011-02-19

A 66 year old man presents with fever of 3 days duration associated with a severe headache, photophobia and vomiting. The headache was abrupt in onset, is severe and unremitting and predominantly frontal. It is worsened by sudden movements but not by coughing or sneezing. There were no associated seizures. He has no comorbidities, was not on any drugs and was completely well prior to this.

Out of mind | 2011-02-12

A 22 year old man is brought in by paramedics after being found unconscious in a park. No history is available. His full blood count, random blood glucose, electrolytes, renal and liver functions are assayed and found to be normal. A CT scan of the brain appears normal, with no evidence of hemorrhages, space occupying lesions, midline shift or edema.

Out of breath | 2011-02-04

A 40 year old lady presents with progressively worsening dyspnea of 5 days duration. There is no associated orthopnea, paroxysmal nocturnal dyspnea, chest pain or cough. No GI or urinary symptoms were noted. She was completely asymptomatic prior to this, has no comorbidities and was not on any drugs. No history of trauma is noted. Her full blood count was normal.

Sudden Weakness | 2011-01-29

A 45 year old unmarried south Asian lady presents with weakness of her right leg and left arm for the past one day. There was no slurred speech, swallowing difficulty or numbness. She had paranoid delusions for the past year and was under treatment. She denied hair loss, rashes, mouth ulcers or joint pains. She was not on OCP, had never been pregnant, did not smoke and had no family history of strokes, heart disease or pro-coagulant disorders. ECGs and random glucose are normal.

A curious groin lump | 2011-01-22

An 80 year old lady presents with a lump in her left groin of 2 days duration, which is associated with local pain and tenderness. There is no associated fever, abdominal pain or vomiting, although she was constipated since yesterday. She is otherwise asymptomatic and cannot recall noticing a lump in the same area prior to this. Her only co-morbidity is mild hypertension which is well controlled.

More tummy pain | 2011-01-14

A 44 year old man presents with acute onset severe lower abdominal pain of 3 hours duration, following a jog. This was associated with nausea and vomiting. He has no urinary or bowel symptoms and has not undergone instrumentation of the urinary tract. He is otherwise asymptomatic. He gives a history of similar but very much milder episodes of pain over many years which resolved spontaneously without treatment. He has no comorbidities and denies sexual promiscuity.

Oh, my tummy ! | 2011-01-07

A 53 year old lady presents with excruciating generalized abdominal pain for 2 hours which is constant in nature. She also feels nauseous but does not suffer from sweating or chest pain. She is otherwise asymptomatic and this is her first such episode. She has a history of diabetes and hypertension of 5 years duration, which are well controlled. Serum lipase levels, a chest X-ray and 2 serial ECGs are performed and found to be normal.

Too much play | 2010-12-31

A 23 year old professional rugby player presents with severe body aches and reduced urine output with dark urine. He had had a febrile illness 3 days ago with myalgia, but had participated in a circuit training session. He was unable to sleep supine and was in excruciating pain. He denied taking any medications. He had previously been well.

In her blood | 2010-12-24

A 64 year old lady was admitted following a generalized tonic-clonic seizure lasting 5 minutes followed by partial recovery and drowsiness. She had been feeling unwell for the past 4 days. There was no fever, rashes, preceding headaches, joint symptoms or chest pain and her urine output was normal. She was a known hypertensive on Amlodipine.

Stormed | 2010-12-18

A 46 year old lady was brought in following a generalized tonic-clonic seizure which lasted 5 minutes and subsided spontaneously. She had diarrhea, sweating, palpitations and difficulty sleeping for the past two days. She also had a cough and a runny nose for the past one week. There was no neck pain. She lost 3 kg in weight and had intermittent palpitations over the past 3 months. She had no other medical history and was not on any drugs.

Confused | 2010-12-11

A 59 year old man is brought in by his family after he starts behaving in a confused manner. His health has steadily deteriorated over the last 4 days and he also suffered from nausea, vomiting and worsening jaundice. He did not have a fever. This is his first such episode and he was in good health previously. He is not on any drugs. He is a manual laborer who is away from home frequently. He only drinks a beer or two daily.

Hot knee | 2010-12-04

A 77 year old man presents with painful swelling of his left knee of 2 days duration. No other joints are affected and this is his first such episode. He is afebrile but feels unwell. There is no history of trauma, knee surgery or a bleeding disorder and he denies respiratory, urinary or GI symptoms. His comorbidities are osteoarthritis of both knees for 12 years and diabetes for 10 years. He is only on Metformin.

Honk Honk | 2010-11-27

A 68 year old lady presented with polyuria and polydipsia for the past three months and fever, vomiting and dysuria for the past two days. There was no diarrhea or cough. She was on olanzapine for the past six months. She had been otherwise well before the onset of this illness and had no past medical history of diabetes, hypertension or dyslipidemia. She lived alone at home and was managing well. Her random plasma glucose is 55.55 mmol/l (1000 mg/dl).

The worst pain ever | 2010-11-20

A 62 year old man is brought in screaming in pain. The pain is sharp in nature and localized to the back of the chest. It started about 15 minutes ago and was sudden in onset and maximal from the beginning. He did not experience nausea, vomiting or sweating. He has never experienced chest pain in the past. He gives a history of poorly controlled hypertension for 10 years and dyslipidemia for 7 years. He is a heavy smoker. No history of ischemic heart disease or valvular heart disease is noted.

And I couldn't smile | 2010-11-15

A 22 year old girl is brought in after she finds herself unable to smile or frown. She has difficulty moving her eyes about and complains of "seeing double". She also feels unsteady when walking. She is not dyspneic and has not had a fever. She did have an episode of diarrhea around 2 weeks ago.

More dyspnea | 2010-11-15

A 53 year old lady is brought in with acute onset severe dyspnea of 2 hours duration with no associated chest or back pain. She does not have a headache, nausea or visual disturbances, is not confused and moves all 4 limbs equally. This is her first such episode. She has had hypertension for nearly 20 years now, with no etiology found. She defaulted on treatment and follow up nearly a decade ago. No other comorbidities are noted and she is not on any drugs.

Painful back | 2010-11-15

An 80 year old lady presents with acute onset upper back pain which is worse when she attempts to stand or walk. There are no associated neurological symptoms. Nor is there a history of trauma. She gives no history of chronic cough, loss of weight or loss of appetite. She is not on any drugs and is otherwise healthy.

Infections can kill | 2010-11-15

A 55 year old man presents with progressively worsening swelling of his left lower limb of 3 days duration. He is running a high fever and appears to be mildly confused. His wife mentions that he has lost his appetite since the onset of symptoms. This is his 5th such episode in the space of 2 years, although none were as severe. His history is remarkable for very poorly controlled diabetes associated with nephropathy.

Corroded | 2010-11-15

A 22 year old woman is brought in after swallowing half a bottle of drain cleaner a short while ago, following an argument. She did not have hematemesis or epigastric pain and is not dyspneic. However, she has severe odynophagia and is unable to eat or drink. Her history is otherwise unremarkable.

Vomiting Blood | 2010-11-15

A 55 year old patient with end stage cirrhosis secondary to alcohol abuse is brought in after vomiting a large amount of fresh blood half an hour ago. He is dizzy and mildly confused and looks ill. This is his first such episode. An endoscopy around an year ago showed large esophageal varices, which were ligated. Oral propanolol was also commenced. He is not on any other drugs. He has continued to consume half a bottle of whiskey daily despite his diagnosis.

Sudden Dyspnea | 2010-11-15

An 66 year old lady who underwent an uncomplicated hemicolectomy for colo-rectal carcinoma last week is brought in complaining of sudden onset dyspnea of 2 hours duration. There is no associated fever, cough, chest pain, nausea, vomiting, faintishness or calf pain. She has no comorbidities and this is her first such episode. She does not smoke and is not on any drugs.

Recurrent Fever | 2010-11-15

A 45 year old man presents with low grade intermittent fever of 4 weeks duration which is associated with night sweats, loss of appetite and weight loss. He also suffers from a mild productive cough, mostly during the daytime. He denies exposure to gases, fumes or toxic chemicals and is not on any drugs. He comes from a low socioeconomic background. He denies unsafe sexual encounters and has no history of blood transfusions.

Blooded | 2010-11-15

A 62 year old lady is admitted after passing a moderate amount of altered blood per rectum. She also complains of mild left sided lower abdominal pain. This is her first such episode. She has no pain on defecation and no constitutional symptoms. She denies vaginal bleeding and is not on any drugs. Her diet mainly consists of refined foods. The remainder of her history is unremarkable.

Shocked | 2010-11-15

A 25 year old semi-conscious man is brought into the emergency department. He developed a very high fever with chills a few days ago associated with severe arthralgia. The fever subsided yesterday. However he complained of feeling very ill in the morning and collapsed suddenly at home. There was a history of recent travel to Sri Lanka on holiday and he had returned just last week.

In agony | 2010-11-15

A 45 year old man presents with acute severe upper abdominal pain radiating towards his back which is associated with nausea and sweating. There is no associated chest pain and this is his first such episode. He consumes a glass of whiskey 2 to 3 times a day but does not smoke. He has no history of chest pain, upper abdominal pain or dyspeptic symptoms. He has no comorbidities and is not on any drugs.

Jaw pain | 2010-11-15

A 63 year old lady presents with acute continuous dull aching jaw pain of 20 minutes duration. She had several such episodes within the last month during exertion only. She denies headache, rhinorrhea, pain on mastication, chest pain or discomfort. She was diagnosed with diabetes and hypertension 7 and 4 years ago respectively, which are well controlled. She does not smoke. An ECG performed a week ago was normal.