Global medicine

Cases from inpatient and outpatient medicine around the world. Biased towards Malawi, as that’s where the project began.

Cases are listed below.  Via Advanced Search in the right hand menu bar you can narrow the list down by Tags, including Level of Difficulty (You can use the tags to choose by topic and subtopic or difficulty (A=Learner; B=Practioner; C=Expert), e.g. search on Malawi Medicine and Level A or B).

Please send examples you’d like us to consider to renal@ed.ac.uk – you will be credited.  And give us feedback by commenting or email.

Global Medicine cases

  • Jaundice and AKI after return from Papua
    A 36 year old soldier developed a flu-like illness (fever, chills, headache, myalgia) 4 days after returning to Jakarta, Indonesia, from a 1 year posting to Papua New Guinea. He was known to have chronic hepatitis B infection, with chronically mildly abnormal liver function tests, but was not on any treatment for this, and had ...
  • Hypertension in a 6th pregnancy
    A 36 year old seamstress from Port Harcourt, Nigeria, presents at 35 weeks of her 6th pregnancy. 3 pregnancies went to term and she has 2 surviving children. She has had hypertension in previous pregnancies, and preterm labour with Caesarian sections; has had cervical cerclage. In this pregnancy she developed leg and facial swelling in ...
  • A jaundiced 35 year old with late quadriparesis
    MRI T2/FLAIR on day 17 A 36 year old alcoholic man was admitted to hospital with obtunding, jaundice and cachexia. In addition to deranged LFTs, anaemia and thrombocytopenia, all thought to be related to cirrhosis, he had Creat 194 (eGFR 36), Na 138, K 2.6. He was treated for alcohol withdrawal but was difficult to manage; ...
  • A breathless 20 year old with cough and fever
    A 20 year old man complains of 3 weeks of cough and fever, and 4 days of oedema of his feet. On examination he is breathless.  There is marked engorgement of his neck veins, JVP higher than ears, ascites, 2+ oedema of his feet. P130/min irregularly irregular, of waxing and waning volume, apex rate 160. ...
  • A patient with big kidneys
    A 48 year old man is found to have BP 170/95 and a follow-up blood test shows eGFR 55.  The abdomen seems to contain hard masses.  On following this up, this investigation is undertaken: After the quiz, a couple more questions So that’s the diagnosis.  What is the prognosis likely to be?  Is there anything you can ...
  • A girl with facial swelling
    A 14 yearl old schoolgirl is referred from Thyolo District Hospital, Malawi, complaining of facial swelling for 3 weeks, worse in the morning.  3 days later she developed bilateral leg swelling and increasing abdominal distension with some suprapubic colicky pains.  She reported concentrated urine but no haematuria.  There was no significant past ...
  • A swollen leg
    A 39 year old subsistence farmer is referred to the dermatology clinic with massive left leg swelling, present for several years.  His main complaint is of “leaking” and malodour, and he is reluctant to remove the tubifast dressing that he has applied himself. What is the likely diagnosis? What advice and treatment would you give?
  • A call from a concerned GP
    They have been treating an 86yo lady who is resident in a local nursing home.  She has known Stage 3 CKD, hypertension, peripheral vascular disease, eczema, osteoporosis and mild/moderate Alzheimer’s disease (which which she is usually independent in dressing and eating+drinking).  She has suffered from urinary tract infections in the past and these have been ...
  • A call from the bone marrow transplant unit
    They are concerned about the renal function of a 43yo lady who is day 26 post allogenic stem cell transplant for relapsed Acute Myeloid Leukaemia (conditioning with alemtuzumab, melphalan and fludarabine.  Her pre-transplant renal function was normal (creatinine around 60umol/L, eGFR>60ml/min), but has been on a pattern of fluctuating deterioration since around day 5 post ...
  • A call from the hepatology ward
    A call from the Hepatology FY1:  She has been asked to ring due to concerns on the morning ward round about worsening renal function – specifically do we think this is hepato-renal syndrome? 56yo with history of alcohol excess, chronic obstructive airways disease and known cirrhosis with and previous oesophageal varices (in banding program).  Admitted 5 ...