100 Cases in Clinical Pathology and Laboratory Medicine

354 Pages·2023·5.39 MB·English

by  Eamon Shamil, Praful Ravi, Ashish Chandra

Second Edition
Clinical
in
Pathology and
Laboratory
Medicine
100 Cases in Clinical Pathology and Laboratory Medicine  presents 100 clinical
scenarios commonly seen by medical students and junior doctors in the emergency department,
outpatient clinic, operating theatre or in general practice. A succinct summary of the patient’s
history, examination and initial investigations is followed by questions on each case, with
particular emphasis on the interpretation of the results and in which an understanding of
the underlying clinical pathology is central to arriving at the correct diagnosis. The answer
includes a detailed discussion on each topic, providing an essential revision aid, as well as a
practical guide for students and junior doctors, especially those preparing for undergraduate
and postgraduate examinations.
Making speedy and appropriate clinical decisions, and choosing the best course of action to
take as a result, is one of the most important and challenging parts of training to become
a doctor. Fully revised and updated for this second edition, these true-to-life cases will
teach students and junior doctors to recognise important clinical conditions, to request the
appropriate pathological investigations and correctly interpret those results, and, as a result,
to develop their diagnostic and management skills.
100 Cases
Second Edition
About the Series
100 Clinical
in
Making speedy and appropriate clinical decisions, and choosing the best course of action to
take as a result, is one of the most important and challenging parts of training to become a
doctor. The real-life cases presented in the 100 Cases series encompass emergency, ward and Pathology and
outpatient and community scenarios, and have been designed specifically to help medical
students and junior doctors to develop their diagnostic and management skills.
CASES Laboratory
100 Cases in Clinical Pathology and Laboratory Medicine, 2E
Eamon Shamil, Praful Ravi, Ashish Chandra
100 Cases in Clinical Medicine, 3E Medicine
P John Rees, James Pattison, Christopher Kosky
100 Cases in Clinical Pharmacology, Therapeutics and Prescribing
Kerry Layne, Albert Ferro
100 Cases in Dermatology
Rachael Morris-Jones, Ann-Marie Powell, Emma Benton
100 Cases in Emergency Medicine and Critical Care
Eamon Shamil, Praful Ravi, Dipak Mistry P John Rees MD FRCP
Professor of Medical Education,
100 Cases in General Practice, 2E King’s College London School of Medicine at Guy’s,
Anne E. Stephenson, Martin Mueller, John Grabinar King’s and St Thomas’ Hospitals, London, UK
James Pattison DM FRCP
100 Cases in Obstetrics and Gynaecology, 2E Consultant Nephrologist,
Cecilia Bottomley, Janice Rymer Guy’s and St Thomas’ NHS Foundation Trust,
London, UK
100 Cases in Orthopaedics and Rhematology
Christopher Kosky MD FRCP
Parminder J Singh, Catherine Swales
Consultant Physician,
General and Respiratory Medicine & Sleep Disorders,
100 Cases in Paediatrics, 2E
Guy’s and St Thomas’ NHS Foundation Trust;
Ronny Cheung, Aubrey Cunnington, Simon Drysdale, Joseph Raine, Joanna Walker
Honorary Senior Lecturer, King’s College London, UK
100 Cases in Psychiatry, 2E
Barry Wright, Subodh Dave, Nisha Dogra
100 Cases Series Editor:
Janice Rymer MD FRCOG FRANCOG FHEA
100 Cases in Radiology
Dean of Undergraduate Medicine and Professor of
Robert Thomas, James Connelly, Christopher Burke
Gynaecology,
King’s College London School of Medicine, London, UK
100 Cases in Surgery, 2E
James Gossage, Bijan Modarai, Arun Sahai, Richard Worth, Kevin G Burnand
100 Diagnostic Dilemmas in Clinical Medicine
Kerry Layne
Boca Raton London New York
For more information about this series please visit: https://www.routledge.com/100-Cases/
CRC Press is an imprint of the
book-series/CRCONEHUNCAS Taylor & Francis Group, an informa business
Second Edition
100 Clinical
in
Pathology and
CASES Laboratory
Medicine
Eamon Shamil  MBBS, MRes, DOHNS, FRCS (ORL-HNS)
PPo Jsot-hCnC TR Feeellos wM iDn FRRhCinPology, Anterior Skull Base, and
PFarocfeiasls oPlra osft iMc eSudrigcearl yE ducation,
KThineg R’so Cyaoll lNegaeti oLnoanld EoNnT SHcohsopoitla ol,f Medicine at Guy’s,
KUinnigv’esr asitnyd C Sot lTlehogme Laos’n Hdoosnp Hitaoslsp, iLtaonls dNoHnS, UK
JFaoumndeas tPioant Ttrisuostn, U DKM FRCP
CProanfsuullt aRnatv Ni eMpAh,r oMloBg, BisCt,hir, MRCP
GAtutye’ns dainndg PSth Tyhsiocmiaans i’n N GHeS nFiotouunrdinaatrioy nO Tnrucsot,logy,
LDoanndao-nF,a UrbKer Cancer Institute; Instructor of Medicine,
CHahrrviastrod pMheedri cKaol sSkchyo MolD, B FoRsCtoPn, Massachusetts, USA
CAosnhsisuhlta Cnht Pahnydsircaia FnR,CPath, DipRCPath (Cytol)
GLeeande Craol nasnudlta Rnets fpoirr aCtyotroyp Matehdoilcoignye && USrloeleopg iDcaisol rders,
GHiustyo’ps aatnhdo lSotg Tyh,o Gmuay’ss’ aNnHdS SFto Tuhnodmaatsio’ nN HTrSu Fsto;undation
HTrounsto, Lraonryd Soenn, iUoKr ;L Cechatuirr,e Brr, itKisinh gA’ss sCocoilaletgioen Loof nUdroolong, UicKal
Pathologists (BAUP); Vice President, International Academy
of Cytology (IAC); Deputy Editor, Cytopathology
100 Cases Series Editor:
J1a00n Cicaese Rs ySmerieesr EMdDit oFRr:C OG FRANCOG FHEA
DJaeannic oef URnydmeregrr aMdBuBaSt,e F RMAeCdPic ine and Professor of
GPryonfeasescoor olofg Oy,bstetrics & Gynaecology and Dean
Koifn Sgt’usd Ceonltle Agfefa Liros,n Kdiongn ’Ss cChoololel goef MLoenddicoinn eSc, Lhoonodl o n, UK
of Medicine, London, UK
BBooccaa R Raatotonn LLoonnddoonn NNeeww Y Yoorkrk
CCRRCC P Preresss si si sa ann i mimpprirnint to of ft hthee
TTaayylolor r& & F Frarannccisi sG Grorouupp, ,a ann i ninfoformrmaa b buusisnineessss
Second edition published 2023
by CRC Press
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and by CRC Press
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
CRC Press is an imprint of Taylor & Francis Group, LLC
© 2023 Eamon Shamil, Praful Ravi and Ashish Chandra
First edition published by CRC Press 2014
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Library of Congress Cataloging-in-Publication Data
Names: Shamil, Eamon, editor. | Ravi, Praful, editor. | Chandra, Ashish (Histopathologist) editor. |
Shamil, Eamon. 100 cases in clinical pathology.
Title: 100 cases in clinical pathology and laboratory medicine / edited by Eamon Shamil, Praful Ravi, Ashish Chandra.
Other titles: One hundred cases in clinical pathology and laboratory medicine | 100 cases
Description: Second edition. | Boca Raton : CRC Press, 2023. | Series: 100 cases | Preceded by 100 cases in clinical
pathology / Eamon Shamil, Praful Ravi, Ashish Chandra. c2014. | Includes bibliographical references and index. |
Summary: “100 Cases in Clinical Pathology and Laboratory Medicine presents 100 clinical scenarios commonly
seen by medical students and junior doctors in the emergency department, outpatient clinic, operating theatre or in
general practice. A succinct summary of the patient’s history, examination and initial investigations is followed by
questions on each case, with particular emphasis on the interpretation of the results and in which an understanding
of the underlying clinical pathology is central to arriving at the correct diagnosis. The answer includes a detailed
discussion on each topic, providing an essential revision aid as well as a practical guide for students and junior
doctors, especially those preparing for undergraduate and postgraduate examinations. Making speedy and
appropriate clinical decisions, and choosing the best course of action to take as a result, is one of the most important
and challenging parts of training to become a doctor. Fully revised and updated for this second edition, these
true-to-life cases will teach students and junior doctors to recognize important clinical conditions, to request the
appropriate pathological investigation and correctly interpret those results, and, as a result, to develop their
diagnostic and management skills”— Provided by publisher.
Identifiers: LCCN 2022032063 (print) | LCCN 2022032064 (ebook) | ISBN 9781032151397 (hardback) |
ISBN 9781032151373 (paperback) | ISBN 9781003242697 (ebook)
Subjects: MESH: Pathologic Processes | Signs and Symptoms | Clinical Laboratory Techniques | Problems and
Exercises | Case Reports
Classification: LCC RC69 (print) | LCC RC69 (ebook) | NLM QZ 18.2 | DDC 616/.047—dc23/eng/20220914
LC record available at https://lccn.loc.gov/2022032063
LC ebook record available at https://lccn.loc.gov/2022032064
ISBN: 9781032151397 (hbk)
ISBN: 9781032151373 (pbk)
ISBN: 9781003242697 (ebk)
DOI: 10.1201/9781003242697
Typeset in Baskerville
by Apex CoVantage, LLC
Access the Support Material: www.routledge.com/9781032151373
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 xiii

Reference Ranges xv

Section 1: Laboratory Medicine: Chemical Pathology,
Immunology and Genetics
Case 1 Polyuria and Polydipsia 3

Case 2 Traces of Blood Found on 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 17

Case 8 A Young Woman Is Found Unconscious in Bed 19

Case 9 A Middle-aged Woman with Jaundice 23

Case 10 Drug Overdose 27

Case 11 Fatigue, Weakness and Constipation 29

Case 12 Excessive Hair Growth and Infertility 31

Case 13 Fatigue and Irregular Periods 35

Case 14 Stiff and Painful Hands 37

Case 15 Abdominal Pain, Nausea and Vomiting 41

Case 16 Frequent Throat and Chest Infections 47

Case 17 A Routine ‘Health Check’ for a 55-Year-Old Man 49

Case 18 Collapse in a Patient Undergoing Chemotherapy 53

Case 19 A 10-Day-Old Baby with Ambiguous Genitalia 57

Case 20 Fatigue, Weakness and Weight Gain 61

Case 21 Hypertension in a Young Woman 63

Case 22 Nausea, Vomiting, Weakness and Paraesthesia 65

Case 23 Erectile Dysfunction in a Young Man 67

Case 24 A Young Man with ‘High Cholesterol’ 69

Case 25 Rash after a Bone Marrow Transplant 71

Case 26 A Fall on an Outstretched Hand 73

Case 27 A Patient in Follow-up after a Liver Transplant 75

Case 28 A Man with Poorly Controlled Blood Pressure 79

Case 29 Dizziness on Standing Upright 83

vii
viii
Contents
Case 30 Sudden-onset Chest Pain in a Tall Woman 85

Case 31 Concerns about the Risk of Breast Cancer 87

Case 32 Seizure in a Neonate 89

Section 2: Histopathology
Case 33 A Young Woman with Ankle Swelling and Shortness of Breath 93

Case 34 Chest Pain and Sudden Death 95

Case 35 An Elderly Man with Severe Back Pain 97

Case 36 Increased Breathlessness and Sudden Death 99

Case 37 A Worsening Cough and Haemoptysis 101

Case 38 A Young Man with Shortness of Breath and Haemoptysis 105

Case 39 Sudden-onset Weakness and Dysphasia 107

Case 40 Numbness, Weakness and Clumsiness 111

Case 41 Forgetfulness and Disorientation 113

Case 42 Coffee-ground Vomiting 115

Case 43 Episodic Right Upper Quadrant Abdominal Pain 117

Case 44 Chronic Diarrhoea and Flatulence 119

Case 45 A Young Man with Bloody Diarrhoea 121

Case 46 Abdominal Discomfort and Generalised Weakness 125

Case 47 Abdominal Pain in a Publican 127

Case 48 Abdominal Distension, Loss of Appetite and Malaise 129

Case 49 Back Pain and Fever in a Diabetic 131

Case 50 Urinary Problems in an Elderly Man 133

Case 51 A Young Man with a Testicular Lump 135

Case 52 Heavy and Painful Menstrual Bleeding 139

Case 53 Abnormal Vaginal Bleeding 141

Case 54 A Lump in the Breast 143

Case 55 Lymph Node Enlargement in a Young Man 145

Case 56 An Itchy, Bleeding Mole on the Back 149

Case 57 Blood in the Urine of an Elderly Man 151

Case 58 Thyroid Disease in a Young Woman 153

Section 3: Haematology
Case 59 Shortness of Breath and Heartburn 157

Case 60 Raised White Cell Count in an Asymptomatic Individual 161

Case 61 Worsening Fatigue and Bleeding Gums 165

Case 62 Burning Urine and an Abnormal Clotting Screen 169

Case 63 Headaches, Blurred Vision and Itching 171

Case 64 A Painful Arm and a Large Spleen 175
ix
Contents
Case 65 A Rash on the Thighs 179

Case 66 Fatigue and Weight Loss 183

Case 67 Pneumonia with Abnormal Liver Function 187

Case 68 Recurrent Epistaxis 193

Case 69 Bruising after a Pneumonia 197

Case 70 Headache and a Rash 201

Case 71 Shortness of Breath and Weight Loss 205

Case 72 Anaemia Resistant to a Blood Transfusion 207

Case 73 Asymptomatic Anaemia in the Elderly 211

Case 74 Back Pain and Fatigue 217

Case 75 Short of Breath and Underweight 221

Case 76 Deterioration after a Blood Transfusion 225

Case 77 Headache and Blurred Vision 229

Case 78 Lower Back Pain 231

Section 4: Microbiology
Case 79 Flu-like Illness after Foreign Travel 235

Case 80 Leg Pain and Fevers 239

Case 81 Fever and Collapse 243

Case 82 Burning Sensation When Passing Urine 249

Case 83 A Bit Short of Breath 253

Case 84 Unhappy Camper 257

Case 85 Diarrhoea in an Elderly Man 261

Case 86 A Painful Knee 265

Case 87 A Pain in the Ear 269

Case 88 A Red Eye 271

Case 89 Child with a Rash 275

Case 90 Pelvic Pain 281

Case 91 A Painful, Swollen Jaw 285

Case 92 Traveller’s Diarrhoea 291

Case 93 Fever in a Returning Traveller 295

Case 94 A Spot of Confusion 299

Case 95 Congenital Infection 303

Case 96 A Chronic Cough 307

Case 97 A Jaundiced View 311

Case 98 Gram-negative Bacteraemia 315

Case 99 A Groin Swelling 319

Case 100 Urethral Discharge 323

Index 327