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Second
Edition
in
Clinical
Pathology
and
Laboratory
Medicine
Edited
by
Eamon
Shamil
,
Praful
Ravi
and
Ashish
Chandra
CRC
Press
Series
Editor
:
Janice
Rymer
Taylor
&
Francis
Croup
Second Edition
in
Clinical
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
About the Series
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
outpatient and community scenarios, and have been designed specifically to help medical
students and junior doctors to develop their diagnostic and management skills.
100 Cases in Clinical Pathology and Laboratory Medicine, 2E
Eamon Shamil, Praful Ravi, Ashish Chandra
100 Cases in Clinical Medicine, 3E
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
100 Cases in General Practice, 2E
Anne E. Stephenson, Martin Mueller, John Grabinar
100 Cases in Obstetrics and Gynaecology, 2E
Cecilia Bottomley,Janice Rymer
100 Cases in Orthopaedics and Rhematology
Parminder J Singh,Catherine Swales
100 Cases in Paediatrics, 2E
Ronny Cheung,Aubrey Cunnington,Simon Drysdale,Joseph Raine,Joanna Walker
100 Cases in Psychiatry, 2E
Barry Wright,Subodh Dave,Nisha Dogra
100 Cases in Radiology
Robert Thomas,James Connelly,Christopher Burke
100 Cases in Surgery, 2E
James Gossage, Bijan Modarai, Arun Sahai,Richard Worth, Kevin G Burnand
100 Diagnostic Dilemmas in Clinical Medicine
Kerry Layne
For more information about this series please visit: https://www.routledge.com/100-Cases/
book-series/CRCONEHUNCAS
100
CASES
Second Edition
in
Clinical
Pathology and
Laboratory
Medicine
Eamon Shamil MBBS, MRes, DOHNS, FRCS (ORL-HNS)
Post-CCT Fellow in Rhinology, Anterior Skull Base, and
Facial Plastic Surgery
The Royal National ENT Hospital,
University College London Hospitals NHS
Foundation Trust, UK
Praful Ravi MA, MB, BChir, MRCP
Attending Physician in Genitourinary Oncology,
Dana-Farber Cancer Institute; Instructor of Medicine,
Harvard Medical School, Boston, Massachusetts, USA
Ashish Chandra FRCPath, DipRCPath (Cytol)
Lead Consultant for Cytopathology & Urological
Histopathology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK; Chair, British Association of Urological
Pathologists (BAUP); Vice President, International Academy
of Cytology (IAC); Deputy Editor, Cytopathology
100 Cases Series Editor:
Janice Rymer MBBS, FRACP
Professor of Obstetrics & Gynaecology and Dean
of Student Affairs, 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
Second edition published 2023
by CRC Pres s
600 0 Broken Sound Park way NW, Suite 300, Boca R aton, F L 33487–2742
and by CRC Press
4 Park Square, Milton Pa rk, Abi ngdon, O xon, OX14 4RN
CRC Press is an imprint of Taylor & Francis Group, LLC
© 2023 Eamon Shamil, Prafu l Ravi and Ashish Chandra
First edition published by CRC Press 2014
This book contains i nform ation obt ained from authentic and highly regarded sources. W hile all reasonable eort s have been m ade
to publish reliable data and informat ion, neither the aut hor[s] nor the publisher ca n accept any lega l responsibility or l iability for
any errors or omissions t hat may be made. The publishers wi sh to make clear that any views or opinions expressed in t his book by
individua l editor s, authors or contr ibutors are personal to them and do not necessari ly reflect the views/opinions of the publishers.
The informat ion or gu idance contai ned in this book is intended for use by medical, scient ific or health- care professionals a nd is
provided strictly as a supplement to the medical or ot her profes sional’s own judgement, their knowledge of the patient’s medical
history, releva nt manufactu rer’s instruct ions and the appropriate best practice g uidelines. Because of the rapid advances in medical
science, any information or advice on dosages, pro cedures or diagnoses should be independently verified. The reader is st rongly
urged to consult the relevant national d rug for mulary and t he drug companies’ and device or m aterial manufact urers’ printed
instructions, and their websites, before administering or utilizing any of the drugs, devices or mater ials mentioned i n thi s book.
This book does not indicate whether a part icular treatment is appropriate or suitable for a pa rticular individua l. Ult imately it is
the sole responsibility of the medica l professional to make his or her own professional judgements, so as to adv ise and treat patients
appropriately. The authors and publishers have a lso attempted to trace the copy right holders of all material reproduced in th is
publication and apologi ze to copyright holders i f permission to publish in th is form has not been obtai ned. If any copyright material
has not been acknowledged please write and let us know so we may rect ify i n any fut ure reprint.
Except a s permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any
form by any electronic, mechanical, or ot her means, now known or herea fter invented, i ncludi ng photocopying, microfil ming,
and recording, or in any i nformation storage or retrieval system, without written permission from the publisher s.
For permi ssion to photocopy or use mater ial electronically from this work, access ww w.copyr ight.com or contact the Copyright
Clearance Center, Inc. (CCC), 222 Rosewood Dr ive, Danvers, M A 01923, 978–750– 840 0. For works t hat are not available on
CCC please contact mpkbookspermissions@tandf.co.uk
Trademark notice: Product or corporate names may be trademarks or registered trademarks and a re used only for ident ification and
expla nation without i ntent to infri nge.
Library of Con gress Cataloging-in-Publication Data
Names: Shami l, Eamon, editor. | Ravi, Prafu l, editor. | Chandra, Ashish ( Histopathologist) editor. |
Shamil, Ea mon. 100 cases in c linical patholog y.
Title: 100 cases i n clinical pathology and l aboratory medicine / edited by Eamon Sha mil, Praful Ravi, Ashish Chandra.
Other t itles: One hundred cases in clinical pathology and laboratory medicine | 100 cases
Descr iption: Second ed ition. | Boca Raton : CRC Press, 2023. | Series: 100 cases | Preceded by 100 cases in clinical
pathology / Eamon Sham il, P raful Ravi, Ash ish Chandra. c2014. | Includes bibliog raphical references and index. |
Summary: “100 Cases i n Clinica l Pathology and L aboratory Med icine presents 100 clinical scenarios com monly
seen by medical students a nd junior doctors in the emergency depart ment, out patient clinic, operating theatre or in
general practice. A succinct summary of the patient’s hi story, examination a nd initial investigations is fol lowed by
questions on each case, with par ticu lar emphasis on the interpretation of t he results and in which an understanding
of the underlying cli nica l pathology is central to arr ivi ng at the correct diag nosis. The answer includes a deta iled
discussion on each topic, provid ing an essential revision aid as wel l as a practica l guide for students and junior
doctors, especial ly those preparing for u ndergraduate and postgraduate exa minations. Mak ing speedy and
appropriate cl inical decisions, and choosing the best course of action to take as a result, i s one of the most impor tant
and cha lleng ing pa rts of trai ning to become a doctor. Fully revi sed and updated for this second edition, t hese
true-to-life cases will teach student s and jun ior doctors to recognize important clinical conditions, to request the
appropriate pat hological investigation a nd correctly i nterpret those results, and, as a result, to develop their
diag nostic and management skil ls”— Provided by publisher.
Identi fiers: L CCN 2022032063 (print) | LCC N 2022032064 (ebook) | ISBN 9781032151397 (ha rdback) |
ISBN 9781032151373 (paperback) | ISBN 9781003242697 (ebook)
Subjects: MESH: Pathologic Processes | Sign s and Symptoms | Clinical Laborator y Techniques | P roblems and
Exerci ses | Case Reports
Classification: L CC RC69 ( print) | LCC RC69 (ebook) | NL M 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
ISB N: 9781032151397 ( hbk)
ISBN: 9781032151373 (pbk)
ISBN: 9781003242697 (ebk)
DOI: 10.1201/9781003242697
Typeset in Baskervil le
by Apex CoVa ntage, LLC
Access the Support Mater ial: ww w.routledge.com/9781032151373
https://t.me/medicina_free
importance of kindness, compassion and integrity
Eamon Shamil
To my parents and my teachers
Praful Ravi
To my mother, my first teacher
Ashish Chandra
https://t.me/medicina_free
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
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Contents
viii
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
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Contents
ix
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
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PREFACE
We are pleased to present a second edition of this textbook, having received excellent feed-
back on the first edition, which was published in 2014. We have revised the cases and included
new ones to reflect the updated medical student curriculum. We have also updated the name
of the textbook to include Laboratory Medicine, reflecting content that explains how to inter-
pret and manage abnormal blood tests.
Our aim remains the same: to improve the understanding of the underlying pathology of
both common and rare (but important) conditions. We explain how the underlying pathology
is related to symptoms, investigations, and management of patients, giving the reader a useful
overview of the topic, as well as preparing them for undergraduate and postgraduate exams.
An appreciation for “how does this disease process occur” will help students and doctors
provide better care to their patients and drive enthusiasm to improve care.
Eamon Shamil
Praful Ravi
Ashish Chandra
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