100 Cases in Clinical Pathology and Laboratory Medicine, 2e (Feb 9, 2023)_(1032151390)_(CRC Press).pdf 9781032151397, 9781032151373, 9781003242697

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Second Edition

in Clinical

Pathology and Laboratory

Medicine

Edited by

Eamon Shamil, Praful Ravi

and Ashish Chandra CRC Press Taylor & Francis Croup

Series Editor: Janice Rymer

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) PPost-CCT John Rees MD Fellow in FRCP Rhinology, Anterior Skull Base, and Professor of Medical Facial Plastic SurgeryEducation, King’s College London of Medicine at Guy’s, The Royal National ENT School Hospital, King’s andCollege St Thomas’ Hospitals, London, University London Hospitals NHS UK Foundation Trust, UK James Pattison DM FRCP

Consultant Praful RaviNephrologist, MA, MB, BChir, MRCP Guy’s and Physician St Thomas’inNHS FoundationOncology, Trust, Attending Genitourinary London, UK Cancer Institute; Instructor of Medicine, Dana-Farber Harvard Medical School, Christopher Kosky MDBoston, FRCP Massachusetts, USA

Consultant Physician, Ashish Chandra FRCPath, DipRCPath (Cytol) General and Respiratory Medicine & & Urological Sleep Disorders, Lead Consultant for Cytopathology Guy’s and St Thomas’ NHS Foundation Trust; Histopathology, Guy’s and St Thomas’ NHS Foundation Honorary Senior Lecturer, King’s College UK Trust, London, UK; Chair, British Association London, of Urological Pathologists (BAUP); Vice President, International Academy of Cytology (IAC); Deputy Editor, Cytopathology 100 Cases Series Editor: Janice Rymer MD FRCOG FRANCOG FHEA 100 Cases Series Editor: Dean of Undergraduate Medicine and Professor of Janice Rymer MBBS, FRACP Gynaecology, Professor of Obstetrics & Gynaecology and Dean King’s College London of Medicine, London, UK of Student Affairs, King’sSchool College London School of Medicine, London, UK

BocaRaton Raton London London New NewYork York Boca

CRCPress Pressisisan animprint imprintofofthe the CRC Taylor&&Francis FrancisGroup, Group,an aninforma informabusiness business Taylor

Second edition published 2023 by CRC Press 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487–2742 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 This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as 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 other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978–750–8400. For works that are not available on CCC please contact [email protected] Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe. 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 Acknowledgements Contributors Reference Ranges

xi

xiii

xiii

xv

Section 1: Laboratory Medicine: Chemical Pathology, Immunology and Genetics Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Case 8 Case 9 Case 10 Case 11 Case 12 Case 13 Case 14 Case 15 Case 16 Case 17 Case 18 Case 19 Case 20 Case 21 Case 22 Case 23 Case 24 Case 25 Case 26 Case 27 Case 28 Case 29

Polyuria and Polydipsia Traces of Blood Found on Urine Dipstick Confusion, Lethargy and Shortness of Breath A Child with Facial Swelling Joint Pains and Fatigue Anxiety, Irritability and Reduced Menstrual Frequency Screening for Prostate Cancer A Young Woman Is Found Unconscious in Bed A Middle-aged Woman with Jaundice Drug Overdose Fatigue, Weakness and Constipation Excessive Hair Growth and Infertility Fatigue and Irregular Periods Stiff and Painful Hands Abdominal Pain, Nausea and Vomiting Frequent Throat and Chest Infections A Routine ‘Health Check’ for a 55-Year-Old Man Collapse in a Patient Undergoing Chemotherapy A 10-Day-Old Baby with Ambiguous Genitalia Fatigue, Weakness and Weight Gain Hypertension in a Young Woman Nausea, Vomiting, Weakness and Paraesthesia Erectile Dysfunction in a Young Man A Young Man with ‘High Cholesterol’ Rash after a Bone Marrow Transplant A Fall on an Outstretched Hand A Patient in Follow-up after a Liver Transplant A Man with Poorly Controlled Blood Pressure Dizziness on Standing Upright

3

7

9

11

13

15

17

19

23

27

29

31

35

37

41

47

49

53

57

61

63

65

67

69

71

73

75

79

83

vii

viii

Contents

Case 30 Case 31 Case 32

Sudden-onset Chest Pain in a Tall Woman Concerns about the Risk of Breast Cancer Seizure in a Neonate

85

87

89

Section 2: Histopathology Case 33 Case 34 Case 35 Case 36 Case 37 Case 38 Case 39 Case 40 Case 41 Case 42 Case 43 Case 44 Case 45 Case 46 Case 47 Case 48 Case 49 Case 50 Case 51 Case 52 Case 53 Case 54 Case 55 Case 56 Case 57 Case 58

A Young Woman with Ankle Swelling and Shortness of Breath Chest Pain and Sudden Death An Elderly Man with Severe Back Pain Increased Breathlessness and Sudden Death A Worsening Cough and Haemoptysis A Young Man with Shortness of Breath and Haemoptysis Sudden-onset Weakness and Dysphasia Numbness, Weakness and Clumsiness Forgetfulness and Disorientation Coffee-ground Vomiting Episodic Right Upper Quadrant Abdominal Pain Chronic Diarrhoea and Flatulence A Young Man with Bloody Diarrhoea Abdominal Discomfort and Generalised Weakness Abdominal Pain in a Publican Abdominal Distension, Loss of Appetite and Malaise Back Pain and Fever in a Diabetic Urinary Problems in an Elderly Man A Young Man with a Testicular Lump Heavy and Painful Menstrual Bleeding Abnormal Vaginal Bleeding A Lump in the Breast Lymph Node Enlargement in a Young Man An Itchy, Bleeding Mole on the Back Blood in the Urine of an Elderly Man Thyroid Disease in a Young Woman

93

95

97

99

101

105

107

111

113

115

117

119

121

125

127

129

131

133

135

139

141

143

145

149

151

153

Section 3: Haematology Case 59 Case 60 Case 61 Case 62 Case 63 Case 64

Shortness of Breath and Heartburn Raised White Cell Count in an Asymptomatic Individual Worsening Fatigue and Bleeding Gums Burning Urine and an Abnormal Clotting Screen Headaches, Blurred Vision and Itching A Painful Arm and a Large Spleen

157

161

165

169

171

175

ix

Contents

Case 65 Case 66 Case 67 Case 68 Case 69 Case 70 Case 71 Case 72 Case 73 Case 74 Case 75 Case 76 Case 77 Case 78

A Rash on the Thighs Fatigue and Weight Loss Pneumonia with Abnormal Liver Function Recurrent Epistaxis Bruising after a Pneumonia Headache and a Rash Shortness of Breath and Weight Loss Anaemia Resistant to a Blood Transfusion Asymptomatic Anaemia in the Elderly Back Pain and Fatigue Short of Breath and Underweight Deterioration after a Blood Transfusion Headache and Blurred Vision Lower Back Pain

179

183

187

193

197

201

205

207

211

217

221

225

229

231

Section 4: Microbiology Case 79 Case 80 Case 81 Case 82 Case 83 Case 84 Case 85 Case 86 Case 87 Case 88 Case 89 Case 90 Case 91 Case 92 Case 93 Case 94 Case 95 Case 96 Case 97 Case 98 Case 99 Case 100 Index

Flu-like Illness after Foreign Travel Leg Pain and Fevers Fever and Collapse Burning Sensation When Passing Urine A Bit Short of Breath Unhappy Camper Diarrhoea in an Elderly Man A Painful Knee A Pain in the Ear A Red Eye Child with a Rash Pelvic Pain A Painful, Swollen Jaw Traveller’s Diarrhoea Fever in a Returning Traveller A Spot of Confusion Congenital Infection A Chronic Cough A Jaundiced View Gram-negative Bacteraemia A Groin Swelling Urethral Discharge

235

239

243

249

253

257

261

265

269

271

275

281

285

291

295

299

303

307

311

315

319

323

327

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

xi

ACKNOWLEDGEMENTS The specimen images are from the Gordon Museum of Pathology, King’s College London.

CONTRIBUTORS Dr Mark Ong BSc, MBChB, MRCS Consultant Histopathologist Guy’s & St Thomas’ NHS Foundation Trust London, UK Dr Alexander Polson FRCPath Consultant Histopathologist Guy’s & St Thomas’ NHS Foundation Trust London, UK Dr Caryn Rosmarin MBBCh, DTM&H, MSc (Med Micro), FCPath (SA), FRCPath Microbiology/Infection Control Consultant Microbiology Training Programme Director (NE London) Barts Health NHS Trust London, UK Dr Simran Goyal BA, MBBCh Foundation Doctor School of Clinical Medicine University of Cambridge, UK Dr Hassen al-Sader MBBS, MRCP Haematology Consultant West Hertfordshire Teaching Hospitals NHS Trust Honorary Consultant, Lymphoma Team, University College London Hospital, UK Dr Wael Faroug Elamin MBBS, BSc, MSc, MD, FRCPath, FRCP. Medical Director, G42 Healthcare,UAE;

Honorary Senior Lecturer, QMUL;

Consultant Clinical Microbiologist, Elrazi University, Sudan

xiii

REFERENCE RANGES HAEMATOLOGY Haemoglobin (Hb) White cells (WCC) Neutrophils Lymphocytes Eosinophils Platelets (PLT) Reticulocytes Mean cell volume (MCV) Mean cell haemoglobin (MCH) Serum iron Serum ferritin Total iron binding capacity (TIBC) Transferrin saturation

11.4–15.0 g/dL 3.9–10.6 g/dL 2.0–7.5 × 10 9/L 1.3–3.5 × 10 9/L