9 year old has sudden onset central abdo pain, then localises to RIF. Hasn't eaten all day, has vomited, had diarrhoea and had a temperature.

After being admitted, he becomes pale, very still and is in severe pain. What could have happened?

60 year old man, who had an MI 3yrs ago, has had sudden severe epigastric pain. It's a searing pain, and it radiates to his back. He's had a cough for the last week.

30y/o lady comes to the surgery. She's recently become very stressed at work. She gets crampy abdo pain before defaecation, bloating, and she's had increased diarrhoea for the last few months.

80 y/o lady presents to your surgery with abdo pain and two bowels movements a week of hard stools. She strains a lot and it often hurts.

57y/o man comes to the surgery, with freq heartburn over last few months. Goes through to back, he gets a waterbrash taste in his mouth&he wakes in the night coughing. He has HTN and is a smoker.

24y/o man comes to A&E, having been on a wknd bender. He's had severe epigastric pain, going through to his back. He's thrown up several times& feels better leaning forward. He won't let anyone touch his stomach and he's started to get weird bruises on his sides.

52y/o lady comes to clinic with a burning pain in epigastrium after she eats. It happens at night& when she's hungry, &often feels sick with it. She had H pylori as a child. She's had RA for 10 years.

42y/o lady comes to surgery. She's overweight, &has had recurrent episodes of severe pain in RUQ. She sometimes get pain in her R shoulder too. She occasionally feels sick.

43y/o lady comes A&E with RUQ pain for a few days. She's noticed she was a bit yellow this morning, and has had very bad shivers and a fever.

48y/o lady comes to A&E because she's had RUQ pain, she's become yellow and she feels very hot. She's noticed her urine becoming dark, and she's had very pale stools. She's also been very itchy.

82y/o lady comes to clinic very worried. She's been straining hard to pass stools recently, and has had some blood coating the stools. She's had some spotting on wiping.

25y/o girl comes to clinic very scared. She's a smoker, and has been very stressed recently. She had gastroenteritis on holiday in Asia 6mts ago, and has lost weight since. She's felt a bit run down& has had lots of mouth ulcers. She's had cramping abdo pain, not relieved on defaecation, &has had diarrhoea for months. There has been some blood mixed in with the loose stool.

28y/o lady comes to clinic, nervous. For >6mts has had frequent bloody diarrhoea with mucus mixed in. She gets very hot for no reason and her heart always feels like it's racing. She's also noticed her fingernails have become a bit rounded. She doesn't smoke.

55y/o man comes into clinic. He's been constipated on& off for a few months, &he's had abdo pain &a bit of distention. He doesn't have a very healthy diet, &increased flatulence embarrasses him.

The same man comes into A&E two days later. He has severe pain in his LIF, and he feels very hot.

54 y/o lady brings in her 7mth old granddaughter. She isn't feeding well& isn't gaining any weight. Lady has also been losing weight for months, has been fatigued &has had diarrhoea, bloating& abdo pain. She's also had some odd rashes which hurt.

25y/o African man, recently moved to the UK, comes to A&E. He is an IDU, &has been tired& feverish for a few days. He has had severe epigastric pain& has now gone very yellow.

A 25y/o lady has just returned from holiday in India. She is 15wks pregnant. She has been feverish& tired for a few days, but came to A&E this AM after she had sudden severe epigastric pain& became very yellow.

34y/o man comes to A&E. He's been feverish& tired for a few days &has slowly been getting yellow. He's had epigastric pain for a few days& feels very unwell. He has recently had a tattoo.

The same man comes to A&E 6mts later, after being in Africa for a spell. He occasionally used IVdrugs whilst there. He feels awful, has severe epigastric pain, is very yellow and has a distended stomach.

26y/o woman comes to A&E. She's been feeling fluey since last week. She's got a difficult history, with substance abuse issues and several sexual partners. She now has severe epigastric pain, nausea and has turned a bit yellow.

40y/o man presents to clinic with ascites, weight loss and RUQ pain. He's noticed over the past few months his palms have become quite red, and his nails have become rounded. He is nervous when discussing his alcohol intake.

52y/o woman presents to clinic as she has been fatigued for last few weeks. She's noticed swelling of her stomach, with some epigastric pain. She has DM, HTN and hyperlipidaemia. She has no history of alcohol excess.

45y/o male with hx of HepC presents to clinic with increasing SOB. He's also noticed a bit of swelling in his stomach, and mild epigastric pain.

62y/o man referred from GP due to feeling tired (iron def. anaemia), weight loss& colicky abdo pain over the last few months. He has no history of abdominal disease and is otherwise well.

59y/o man referred from GP under the 2-week rule, but bright red PR bleed for last few days. He's had increased frequency and diarrhoea for the past month, but feels otherwise well.

65y/o woman referred from her GP, due to fresh red PR bleeding. It's happened twice in a week, and coats and is mixed into stool. She's had tenesmus for a few weeks and frequent diarrhoea.

42y/o lady presents to GP after having pain and finding a small hard lump in her left breast. She's had clear discharge from the same breast, and has noticed a scratchy, flaky rash on her left nipple. She started her periods aged 9, and has not yet gone through menopause. She's had no children, and has been on the COCP for 15yrs. Her mother had breast cancer so she's very concerned.

48y/o lady comes to clinic after finding an odd hard lump in her right breast, with some changes to the skin around it.

An 82y/o man comes to clinic, as he's been having urinary incontinence for a few weeks. He hasn't been passing water as often, until he is incontinent. He is known to have a raised serum PSA.

54y/o male presents to clinic with 5wk history of chest pain& shortness of breath. He's coughed up blood twice, and has lost a lot of weight recently. He's been a smoker since the age of 14, and lives on an estate in Manchester.

23y/o woman from Finland comes to clinic. She had an episode of weakness in her left arm a few months ago, in which the strength recovered after a few days. This time, she's had constant tingling in her right leg for a few days. She had optic neuritis once as a teenager.

63y/o man brought to clinic by his wife. She's worried that he's been getting slower recently, his walking's become more shuffling. His writing has become very small, &his left hand shakes when he's not using it. His face has also seemed blank on some occasions.

42y/o lady complains of clumsy, uncontrollable twitchy movements, a bit like dancing. She's been a bit forgetful recently, and has been more angry than usual. Her daughter says she's been very low. Has been getting progressively worse for 3 weeks. She remembers her father having something similar in his 50s.

Daughter brings 68y/o father to A&E, after he was found on the floor 6hrs earlier. He can't move or feel his left arm or leg, and he's having some difficulty speaking. He's previously had an MI, and is a smoker.

75y/o lady comes into A&E. She's lost the vision in her right eye for 2 hours, is feeling dizzy and sick, and can't walk properly. She's noticed her tongue is pulling into the right side. She's on GTN spray.

64y/o man comes to the GP at 8am. The previous day he lost the feeling and ability to move his left arm and leg, but it returned after a few hours. He's a smoker, on GTN, has HTN and DM.

12y/o boy comes to surgery with his mother, complaining of his right foot dropping so that he can't walk properly. He can't feel touch on the same leg. His mother remembers her Uncle suffering from something similar in his 40s.

69y/o lady brought into clinic by son. She's been increasingly forgetful for 7mts, has stopped being able to knit and has difficulty doing her errands, getting lost several times.

73y/o man brought into A&E by his son. He had a TIA 8mts ago, and has since had an episode of forgetting where he was, and has had two episodes of weakness in his left leg. His moods have been very up and down. He's a smoker, has HTN and DM.

82y/o man brought into clinic by his daughter. He's been having visual hallucinations for 9mts, has been acting oddly whilst asleep, and has had episodes of not knowing where he is. He sometimes has a tremor in his left hand when he's not moving it.

Young lady comes to surgery worried about her 46y/o father. He's been acting strangely for 6mts- mixing up words and getting very angry. He's usually a calm man, and it's very uncharacteristic.

78y/o man with Parkinson's comes to clinic. He's had tremor in his left hand and weakness of his left foot for 5years. For the past year he's been getting confused and hasn't been able make decisions by himself.

75y/o lady comes to clinic due to visual problems. She's had a patchy cloudiness in her left eye for a few months which has been getting worse. She's had difficulty looking at streetlights at night time, and feels that the colour has dulled. She's otherwise well.

A thin 60y/o lady from China comes to the GP because she's broken her wrist &her hip in the past few months. She smokes, used to take HRT since her menopause, but hasn't for six months and drinks 30 units a week.

65y/o man comes to surgery as he's had painful hands for 2mts. He can't do up his buttons in the morning as his hands are still for about half an hour after he wakes, and he's started getting a bit of stiffness in his hip. He used to be an athlete,&he remembers his mother having painful joints.

30y/o lady comes to clinic as she's had swollen, painful hands for three weeks. The joints at the end of two of her fingers are red, hot and swollen. They're stiff& don't really get better during the day. She's got some odd bumps on her other fingers. She's been feeling tired for weeks, and found out her mother has similar problems

77y/o man comes into clinic. He's been having episodes of a thumping chest and feeling his hearbeat for two weeks, and he's been very tired. He is otherwise well.

59y/o man comes to GP with a pain in his chest. It's central, crushing and goes through to his back. It's been happening when he walks for about two weeks, but goes away when he stops. The pain sometimes goes up to his neck.

60y/o man comes to A&E with chest pain. He's had angina for 8mts but it's become worse, &won't get better at rest or with GTN. He collapsed an hour ago.

48y/o male presents to A&E, with severe central pain for two hours, which came on when he sat down. He is very sweaty, is short of breath and feels sick. He has HTN, diabetes but is otherwise well. He is a smoker and drinks a few pints a week.

60y/o lady comes to clinic with a red, swollen right leg, with calf tenderness and swollen veins. She's just returned from Australia, and she is undergoing chemo for breast cancer.

A large 60y/o Asian gentleman comes to clinic, due to having blurry vision for the past few months. He smokes 20 a day, has a poor diet& remembers his father having heart trouble.

65y/o man comes A&E after feeling unwell for a week. He's been getting progressively short of breath whilst walking& he's very tired. He's noticed he's got swollen legs and he's had stomach pain. He has RA and COPD, and hasn't smoked for 10 years.

75y/o lady comes to A&E. She has been very breathless for a week& has been waking up at night. She can't walk up stairs any more, has developed a swollen tummy and has puffy legs. She's had HTN for a few years.

The same lady comes into A&E a few months later. Over 2hrs she's become extremely short of breath, even at rest, has a very fast pulse and is sweaty. She's started to go a bit blue around the lips.

23y/o lady goes to the GP. She's been very tired recently, and has had a few dizzy spells. She's noticed she gets a bit more breathless when she walks& she's been having weird pains in her chest when she walks far. She feels her heart beating strongly sometimes.

42y/o lady comes to A&E, worried, as she almost collapsed after bending down in the supermarket. She felt better after a few minutes once she'd stood up. She has no PMH.

42y/o lady comes to A&E. She recently had a stay in hospital due to having her gallbladder out. For 3hrs she's had pleuritic pain, shortness of breath and she's coughed up a bit of blood. She's also been feeling hot and feverish.

52y/o man comes to the GP. He's had a cough for a few months, and has been getting more short of breath. He coughs up a lot of 'clear stuff' and has had three chest infections recently. He's had a bit of a wheeze. He's been smoking 40 a day for 20 years.

A 24y/o girl comes to the GP. She's been getting short of breath in the morning when she wakes& at night. Her chest gets tight& she wheezes, &she gets a bit of a cough. She has eczema &hayfever, but is otherwise well. Her mother and brother have asthma.

The same girl presents to A&E a week later. She can't complete a sentence, and she is very short of breath. It started after she petted her friend's rabbit.

24y/o, tall thin man comes into A&E. He has had sudden SOB and pleuritic pain. He can't catch his breath. He has asthma but is otherwise well.

A 34y/o guy comes in after falling onto his ladder. He's got severe shortness of breath, pleuritic chest pain and very sore ribs. His heart is starting to race and he's feeling very light-headed.

45y/o man comes into clinic. He's recently moved over from Thailand. He coughed up some blood last week, but hasn't had a cold. He's been feeling very feverish& tired for a few months. He's got some hard lumps in his neck, &he's lost a bit of weight.

An 80y/o lady is brought into A&E by her daughter. She's had a bad cough for a few days, and has become very confused. She's fevery and has had rigors.

Mother comes to clinic with her newborn baby. She hasn't been feeding well& hasn't grown properly. She's had a few chest infections, with pale coloured stool which is sticky. She makes funny noises when she breathes sometimes. Her mother remembers a distant relative had the same issue.

A 57y/o man is referred as he's coughed up blood. He's had increasing shortness of breath, &is currently undergoing chemo for his small cell lung cancer.

26y/o lady comes to GP. For a few weeks she's noticed her eyes becoming 'buggy' and a lump in her neck, and she's been feeling her heat beating. She's lost a lot of weight and is hungry all the time, and gets sweaty and more nervous than she ever has. She's noticed some swelling below her knee, and she's lost some muscle strength in her thigh.

80 y/o lady comes to surgery as she's found a hard little lump in her neck that moves when she swallows. She's previously had neck irradiation and has lost some weight in the past few months.

44y/o lady presents to surgery with a lump in her neck. She's been very tired and has lost weight, and has noticed some bumps along the top of her clavicles. She is otherwise well.

72y/o lady presents after a lump in her lower neck becomes bigger. It's been there for a few months and she's been very tired. In the past few weeks she's been having constant severe back pain.

84y/o lady has found a lump in her neck. She's tired but otherwise well, although she has an increased calcitonin level. She remembers her sister having some form of neck cancer 10 years ago.

63y/o lady comes to the surgery complaining of her heart 'fluttering'. It's been happening for about a month and she's also had swollen ankles and legs. She's noticed that she's waking up coughing at night.

45y/o lady presents with some odd lumps in her neck which moves when she swallows. She's been losing weight recently and has been sweaty and anxious. She's been very tired lately.

61y/o lady comes to surgery as she's been gained a lot of weight in past three months. She's noticed a lump in her neck and her voice has been very husky. She's also noticed she's been quite constipated, and she's had some swelling around her eyes. She's also had terrible pain in her wrists. She takes lithium and amiodarone.

30y/o lady comes to surgery having not had a period in 6 months, she isn't pregnant. She has a decreased libido.
17y/o boy presents with big hands and feet, and a jaw that's grown a lot in the last few mts. He sweats a lot and snores when he sleeps, and he gets a lot of pain in his joints.
44y/o lady presents with central wt gain, some excess fat on her shoulders, a lot of bruising for no reason and has had several fractures over the last year.
They have all had headaches, some blinkered vision with diplopia and have been very tired.

28y/o guy who had an RTA a few years ago says he hasn't been able to walk as far as he used to without getting tired for a few months. He's lost weight and become very lean, and has had very up and down moods.

15y/o presents to surgery, 6mts after suffering a concussion in an RTA. He's been very thirsty and has been urinating very frequently for the past week, and has lost weight in the last month.

30y/o lady comes to clinic as she had an odd large lump in her neck that moves when she swallows. It's enlarged down to her second rib and she's having some difficulty swallowing. She's pregnant and her mother had the same problem in her 40s.

57y/o lady presents to surgery as she's been depressed recently, has had a few fractures and has had RUQ pain. She's also been thirsty, going to the toilet a lot, been very tired and feeling sick and hasn't beeen eating.

Following a thyroid biopsy, a 23y/o lady experiences tingling in her fingers and pain in her middle hand and middle feet. She also gets twitching in her hands after having her b/p measured.