Notes
Time Created Summary
2 days ago 21:33
Original saved

Refined clerking

Brandon Brooks is a young adult man with rhinovirus infection presenting with back pain, fever, headache, photophobia and transient oxygen requirement. He has known Ebstein’s anomaly and was felt to have a viral illness with mild transaminitis; meningitis was considered but is unlikely.
2 days ago 21:08
Original saved

Refined clerking

Patient with Turner syndrome and hypothyroidism presented with left lower abdominal pain following a recent self-limiting febrile vomiting illness. Bloods showed mildly abnormal liver tests and alkaline phosphatase, with differential including post-viral change versus biliary pathology.
2 days ago 21:07
Original saved

Refined clerking

Turner syndrome, hypothyroidism and prior hysterectomy, presenting with left lower abdominal pain and breathlessness following a recent viral illness. Bloods showed mild liver function derangement with raised alkaline phosphatase, with differential of transient viral hepatitis versus biliary pathology.
2 days ago 21:02
Original saved

Refined clerking

Adult female with Turner syndrome and hypothyroidism presented with left lower abdominal pain after a recent viral illness, with mildly abnormal liver function tests. Clinical picture was felt most likely to represent a post-viral hepatobiliary process, with gallstones/choledocholithiasis and viral hepatitis as differentials.
2 days ago 20:55
Original saved

Refined clerking

43-year-old woman with recent viral prodrome, left lower abdominal pain and breathlessness, found to have mildly abnormal liver function tests with raised ALP. Differential includes transient viral hepatitis versus biliary pathology, and she was planned for repeat bloods, viral serology and abdominal ultrasound.
2 days ago 20:49
Original saved

Refined clerking

Turner syndrome patient with hypothyroidism and recent viral gastroenteritis, now presenting with left-sided abdominal pain, breathlessness and mildly abnormal liver function tests. Impression is post-viral transaminitis versus biliary pathology, with plan for repeat LFTs, viral screen and ultrasound.
2 days ago 20:48
Original saved

Refined clerking

Adult female with Turner syndrome and hypothyroidism presented with left-sided abdominal pain following a recent viral-type illness, with mild breathlessness and transient dizziness. Blood tests showed mild cholestatic liver derangement, with differential including reactive viral hepatitis versus biliary pathology.
2 days ago 20:47
Original saved

Refined clerking

26-year-old man with Ebstein's anomaly presented with headache, photophobia, dizziness and back pain following a recent coryzal illness. He was found to have rhinovirus infection with mild transaminitis and an oxygen requirement; meningitis was felt unlikely clinically.
2 days ago 20:46
Original saved

Refined clerking

26-year-old man with rhinovirus infection presenting with headache, photophobia, myalgia and transient oxygen requirement. Clinical picture is most consistent with viral illness on a background of Ebstein's anomaly/cyanotic congenital heart disease, with mild transaminitis and meningitis felt unlikely.
2 days ago 16:10
Original saved

Notes

Brendan is a 26-year-old man reviewed for acute headache, photophobia, rigors, back pain, and transient oxygen requirement following a viral prodrome. He was found to have rhinovirus infection with mild transaminitis and cardiomegaly on CXR, with meningitis felt unlikely and known Ebstein's anomaly contributing to the cardiac findings.
2 days ago 16:07
Original saved

Notes

Brandon Brooks is a 26-year-old man presenting with severe headache, myalgia, dizziness, photophobia and low-grade fever following a recent viral illness, with rhinovirus detected and mild hypoxia. Examination and investigations suggest viral infection with mild transaminitis and cardiomegaly in the context of known Ebstein's anomaly; meningitis was considered unlikely.
4 days ago 17:33
Original saved

Refined clerking

Male patient with COPD presented with 5 weeks of nasal catarrh, 3 weeks of productive cough and worsening breathlessness, consistent with an infective COPD exacerbation. He also had a chest rash likely related to heat pad use and constipation with dark stools, which was not felt to represent melaena.
4 days ago 14:45
Original saved

Refined clerking

36-year-old man with ulcerative colitis and a defunctioned pouch/loop ileostomy presented with 2 to 3 days of high stoma output, crampy abdominal pain, vomiting and marked dehydration with AKI. Working diagnosis is high-output ileostomy due to gastroenteritis versus inflammatory activity/pouchitis.
4 days ago 13:04
Original saved

Refined clerking

26-year-old man with Ebstein's anomaly presented with 2 days of back pain, headache, photophobia, rigours and an oxygen requirement following a recent viral upper respiratory tract illness. Investigations showed rhinovirus positivity, cardiomegaly and mild transaminitis consistent with viral illness; meningitis was felt unlikely.
5 days ago 19:16
Original saved

Refined clerking

30-year-old man with migraine and depression presented with fluctuating left-sided facial and arm weakness/tingling and transient facial droop. Assessment was most consistent with migraine with aura, with stroke felt less likely, and urgent CT head was arranged to exclude acute pathology.
5 days ago 17:54
Original saved

Refined clerking

86-year-old lady with COPD and bronchiectasis presenting with a persistent infective exacerbation despite two courses of antibiotics and steroids, with cough, dyspnoea, green sputum and pleuritic chest pain. Impression is infective exacerbation of COPD, with plan for cotrimoxazole, a further steroid course, chest x-ray and repeat blood tests.
5 days ago 14:16
Original saved

Refined clerking

Mr John Neal presents with acute dysphagia and inability to tolerate oral intake due to likely oesophageal food bolus obstruction. He has a background of recurrent food bolus obstruction and a pelvic stricture, with plans for urgent OGD today.
5 days ago 10:05
Original saved

Refined clerking

69-year-old man with a previous lacunar basal ganglia stroke in August 2025 presented with overnight worsening bilateral weakness and gait difficulty on a background of coryzal symptoms, urinary frequency, and hyperglycaemia. Presentation was felt most consistent with recrudescence of old stroke symptoms triggered by intercurrent infection and raised blood glucose, rather than a new stroke.
8 days ago 16:09
Original saved

Refined clerking

82-year-old lady from a nursing home presenting with vomiting and shortness of breath, with fever, hypoxia, right leg cellulitis, constipation and AKI on CKD. Working diagnosis is hospital-acquired pneumonia versus viral infection, with cellulitis and dehydration contributing to her presentation.
8 days ago 11:44
Original saved

Refined clerking

83-year-old man presented with reduced consciousness and intermittent apnoea after being found unresponsive in bed. Imaging and examination suggest pulmonary oedema/possible cardiac failure, with incidental old left occipitoparietal infarct and first-degree heart block with bradycardia.
9 days ago 16:39
Original saved

Refined clerking

45-year-old man with advanced metastatic colorectal cancer and malignant bowel obstruction, admitted with left lower leg erythema, warmth and swelling consistent with cellulitis, with DVT also considered. He is receiving home TPN via PICC line and palliative care support, with prognosis felt to be measured in weeks.
9 days ago 14:01
Original saved

Refined clerking

78-year-old lady presented with sudden onset dyspnoea on a background of cardiomyopathy and left bundle branch block. Findings are most consistent with acute pulmonary oedema due to decompensated heart failure, with myocardial infarction felt less likely given recent normal CT coronary angiography.
9 days ago 12:02
Original saved

Refined clerking

62-year-old woman with type 2 diabetes, hypertension, previous breast cancer and osteoporosis presenting with constant epigastric pain since January, worse since yesterday. Mild jaundice and isolated bilirubin rise were noted, with normal liver enzymes and amylase; differentials include Mounjaro-related upper GI symptoms and biliary pathology.
9 days ago 09:35
Original saved

Refined clerking

85-year-old lady with COPD, HFrEF and significant frailty admitted with shortness of breath following a recent chest infection, with possible fluid overload and resolving respiratory infection. Plan was to treat with increased diuretics, antibiotics and support discharge home with an enhanced package of care.
10 days ago 18:43
Original saved

Refined clerking

20-year-old woman with type 1 diabetes mellitus admitted with DKA following interruption of her insulin pump after recent delivery, with associated poor oral intake and a draining left arm pump site infection. Ketones and pH are improving on DKA protocol; plan is to treat infection, bridge with long-acting insulin, then restart the pump once resolved.
10 days ago 16:10
Original saved

Refined clerking

31-year-old man with Brugada syndrome and recurrent atrial fibrillation presented with palpitations from 07:00. ECG showed AF with Brugada pattern changes in V2; symptoms were not improved with IV metoprolol or bisoprolol.
10 days ago 11:46
Original saved

Refined clerking

Lisa presents with recent pruritus and transient bilateral arm swelling after starting flucloxacillin, concerning for drug-induced liver injury. Biliary obstruction is also being excluded with blood tests and abdominal imaging.
19 days ago 20:00
Original saved

Refined clerking

21-year-old woman with acute severe ulcerative colitis and extraintestinal manifestations, including inflammatory arthritis, erythema nodosum and hidradenitis suppurativa. She has systemic inflammation with anaemia, hypoalbuminaemia and stage 1 AKI, and is being prepared for infliximab therapy.
19 days ago 19:55
Original saved

Refined clerking

21-year-old lady with ulcerative colitis diagnosed April 2025 presenting with an acute severe flare characterised by increased diarrhoea with intermittent rectal bleeding, abdominal pain, night sweats, significant weight loss, and extraintestinal features. She has systemic involvement with microcytic anaemia, thrombocytosis, hypoalbuminaemia, raised CRP, and AKI stage 1, with plans to start infliximab after repeat safety imaging and blood tests.
19 days ago 19:54
Original saved

Refined clerking

21-year-old woman with acute severe ulcerative colitis flare, systemic inflammation, microcytic anaemia, thrombocytosis, hypoalbuminaemia and stage 1 AKI. She also has IBD-related arthritis with erythema nodosum and hidradenitis suppurativa, with plans for infliximab-based biologic therapy.
20 days ago 14:45
Original saved

Refined clerking

Bethany Knutton is a 21-year-old lady with known ulcerative colitis presenting with an acute severe flare complicated by AKI stage 1, microcytic anaemia (Hb 84), hypoalbuminaemia (albumin 28), raised CRP (68), IBD-related arthritis flare, erythema nodosum, and hidradenitis suppurativa, requiring urgent transfer to Allerton Ward for initiation of infliximab and azathioprine.
20 days ago 13:02
Original saved

Refined clerking

Leslie Broad is a 59-year-old woman presenting with colicky abdominal pain radiating to the back, chronic diarrhoea, vomiting, and significant functional decline. Clinical impression is overflow constipation in the context of poor mobility, with secondary concerns including left-sided colonic wall thickening on X-ray, postural hypotension, and expressed suicidal ideation.
20 days ago 12:53
Original saved

Refined clerking

A 64-year-old lady with known paroxysmal AF presented with fast AF (HR up to 200 bpm) associated with vomiting, ischaemic ECG changes, and early cardiac failure, unresponsive to bisoprolol; she subsequently spontaneously cardioverted to sinus rhythm following administration of treatment-dose LMWH.
3 weeks ago 18:12
Original saved

Refined clerking

Mr Peter Wellum, a fit and active male of approximately 12 stone, presented with a significant episode of haematemesis at home with a brief loss of consciousness. The likely diagnosis is an upper GI bleed, most probably from an oesophageal source in the context of possible silent reflux or recent NSAID use, and he is being admitted for IV PPI therapy and OGD the following day.
3 weeks ago 17:34
Original saved

Refined clerking

Rosa Sloan is an 89-year-old lady presenting following a mechanical fall down 7 steps with a resultant acute subdural haematoma on the falx cerebri and large left subgaleal haematoma, in the context of anticoagulation with rivaroxaban for AF. She has been admitted for neurosurgical observation, DOAC reversal with PCC has been performed, and rivaroxaban has been stopped.
3 weeks ago 15:43
Original saved

Refined clerking

Peter Francis is a 76-year-old gentleman with known T4N2M1 metastatic rectal adenocarcinoma who presented with progressive left-sided hemiparesis, back pain following a fall, and reduced stoma output; CT head today demonstrated bilateral cerebral lesions most consistent with intracranial metastatic disease with peritumoral oedema, and there is additional concern regarding spinal metastases given significant bony tenderness on examination.
3 weeks ago 14:29
Original saved

Refined clerking

Philip Birkinshaw is a 74-year-old man presenting with a flare of known post-stroke absence seizures whilst on holiday in Torbay, away from his usual neurology team in Hull/Lincolnshire. He has a background of left TACI (2015), type 2 diabetes, and hypertension, and is currently managed on carbamazepine. Investigations have not identified an acute metabolic or structural cause; he is being loaded with levetiracetam and admitted to the Acute Medical Unit for observation.
3 weeks ago 13:28
Original saved

Refined clerking

Ruth Parkhouse is a 77-year-old lady admitted with worsening confusion and fever, found to have an acute haemorrhagic stroke in the right anterior parietal lobe at the site of a previous haemorrhagic stroke, with likely concomitant urinary tract infection as a precipitant of delirium, on a background of Alzheimer's dementia.
25 days ago 21:05
Original saved

Refined clerking

John Woodward is an adult man with decompensated alcohol-related cirrhosis who presented with haematemesis and dizziness. Impression is probable variceal upper GI bleed with associated AKI and ascites, without current overt hepatic encephalopathy.
25 days ago 21:00
Original saved

Refined clerking

Adult patient with decompensated alcohol-related liver disease presenting with hematemesis and suspected variceal bleed. Plan includes terlipressin, IV fluids, antibiotics, and urgent upper GI endoscopy with potential tamponade or stenting; ongoing monitoring and multidisciplinary escalation as needed.
25 days ago 20:55
Original saved

Refined clerking

Patient with alcohol-related cirrhosis presented with haematemesis and presyncope; impression is variceal bleed secondary to decompensated liver disease with associated AKI. Management includes terlipressin, IV fluids and albumin, broad-spectrum antibiotics, urgent discussion with on-call endoscopist for possible endoscopic therapy, and close monitoring of Hb, INR and lactate.
25 days ago 20:45
Original saved

Refined clerking

59-year-old man with previous fibrillary astrocytoma resection and epilepsy presented as a stroke call with fluctuating predominantly left-sided weakness, nausea, vomiting and diarrhoea. Assessment was most consistent with infectious gastroenteritis causing dehydration and pre-AKI, leading to a stroke mimic on a background of chronic neurological deficit.
25 days ago 20:43
Original saved

Refined clerking

59-year-old man with 3 days of vomiting, diarrhoea and fever who developed acute fluctuating left-sided weakness; CT head shows stable post-surgical/radiation changes and no acute mass lesion. Impression: dehydration from infectious gastroenteritis causing a low-flow state and stroke mimic.
25 days ago 20:30
Original saved

Refined clerking

59-year-old man presenting with stroke mimic symptoms after a few days of gastroenteritis. Diagnosed with dehydration related to illness without acute intracranial pathology.
25 days ago 20:28
No original

Refined clerking
25 days ago 18:48
No original

Refined clerking
38 days ago 01:41
Original saved

Refined clerking

Mr Luke Temblett presented to A&E with a 1-2 week history of right-sided headache and right-sided facial droop with incomplete eye closure, in the context of a recent right-sided ear infection with brown exudate. Clinical examination is consistent with a right-sided lower motor neurone facial nerve palsy (Bell's palsy); stroke has been excluded clinically.
38 days ago 01:27
Original saved

Refined clerking

Monique Jones is a 54-year-old radiographer presenting following a collapse stepping off a bus, with associated left-sided weakness, numbness, diplopia, and word-finding difficulties, in the context of a background of chronic hemiplegic migraine and FND. The treating clinician and stroke nurse assessed the presentation as most consistent with a severe hemiplegic migraine episode rather than acute stroke, and treatment with aspirin, sumatriptan, and metoclopramide has been initiated.
38 days ago 00:19
Original saved

Refined clerking

Lee Roberts is a 59-year-old male presenting with a three-day history of nausea, vomiting, diarrhoea and fever, brought to the Emergency Department as a stroke pre-alert due to predominantly left-sided weakness in the context of previous fibrillary astrocytoma resection. The most likely diagnosis is a stroke mimic secondary to infective gastroenteritis and dehydration in a patient with pre-existing neurological deficit, with CT head showing no new acute intracranial pathology and stable appearances compared to prior imaging.
38 days ago 00:18
Original saved

Refined clerking

Lee Roberts is a 59-year-old male with a background of fibrillary astrocytoma (excised 2014) who presented with a three-day history of nausea, vomiting, diarrhoea, and fluctuating predominantly left-sided weakness. The impression is a stroke mimic secondary to infective gastroenteritis causing dehydration and a low-flow state in the context of prior neurosurgery, with CT head showing no new intracranial pathology and stable appearances compared to previous imaging.
39 days ago 15:11
Original saved

Refined clerking

Pamela Biffle, an 83-year-old lady with known heart failure with moderately reduced ejection fraction (EF 35–40%), permanent pacemaker, and type 2 diabetes mellitus, presenting with a 3–4 day history of worsening breathlessness, found to have decompensated congestive cardiac failure with type 2 respiratory failure requiring BiPAP, with improving ABGs on ventilatory support and planned transfer to CCU.
39 days ago 13:05
Original saved

Refined clerking

Lewis Waller is an 89-year-old gentleman presenting to the Emergency Department with hyperkalaemia and acute kidney injury, likely secondary to obstructive uropathy in the context of known advanced prostate cancer. He reports a 3–4 month history of lethargy, reduced urinary output, and chronic lower urinary tract symptoms consistent with prostatic obstruction.
40 days ago 19:05
Original saved

Refined clerking

Colin Penn is an 88-year-old male who presented to Torbay Hospital ED with acute breathlessness, found to have acute decompensated heart failure with pulmonary oedema, likely secondary to a missed myocardial infarction approximately 10 days prior, complicated by significant background cardiorespiratory comorbidities including atrial fibrillation, asbestos-related pulmonary fibrosis, and CKD stage 3.
40 days ago 19:02
Original saved

Refined clerking

Colin Penn is an 88-year-old gentleman presenting with acute hypoxic respiratory failure in the context of a 10-day history of general deterioration, with clinical, biochemical and ECG findings consistent with acute decompensated heart failure likely secondary to a missed myocardial infarction. He has significant background comorbidities including atrial fibrillation, CKD stage 3, asbestos-induced pleural disease, and pulmonary fibrosis.
40 days ago 11:22
Original saved

Refined clerking

93-year-old gentleman presenting with acute onset breathlessness from 03:30 this morning, with a background of several days of reduced exercise tolerance and nocturnal cough. Findings consistent with community-acquired pneumonia with parapneumonic effusion and congestive cardiac failure, likely infective in aetiology, compounded by paroxysmal atrial fibrillation, mixed aortic valve disease, and chronic anaemia.
41 days ago 10:06
Original saved

Refined clerking

Lisa Rogers is a 58-year-old lady presenting with her first episode of significant haematemesis (approximately two litres of bright red blood) in the early hours of 26/02/2024, with biochemical coagulopathy, a falling haemoglobin, and clinical signs of portal hypertension (spider naevi, palmar erythema, tremulousness), consistent with a first presentation of decompensated alcohol-related liver disease with likely oesophageal variceal haemorrhage.
43 days ago 21:58
Original saved

Refined clerking

77-year-old gentleman (MRN 320761) presenting with acute left visual disturbance and transient right-sided weakness (NIHSS 6→0) on a background of mechanical aortic valve, previous aortic root infection, right eye blindness from previous CRAO, and ongoing inconclusive investigations for giant cell arteritis; plan for IV methylprednisolone and rheumatology review.
43 days ago 20:02
Original saved

Refined clerking

Lisa Rogers, a 58-year-old lady (MRN 414396), presented on 22/02/2026 with a first episode of significant haematemesis (approximately two litres of bright red blood) in the context of a longstanding history of heavy alcohol use. Clinical and biochemical findings are consistent with a first presentation of decompensated alcohol-related liver disease with portal hypertension and likely oesophageal variceal bleeding, complicated by coagulopathy and acute anaemia.
43 days ago 13:32
Original saved

Refined clerking

77-year-old gentleman with acute onset left visual blurring and transient right-sided weakness. History under investigation for giant cell arteritis. Rapid improvement post-admission (NIHSS 6 to 0). Plan for IV methylprednisolone and rheumatology review.
43 days ago 13:26
No original

Refined clerking

{ "mrn": "320761", "patient_name": "Anthony Domaine", "content": "Medical ST5 Miller Clerking\n\nPresenting Complaint:\nVisual disturbance\n\nHistory of Presenting Complaint:\nAt 09:00 this morning, whilst eating breakfast, patient developed sudden onset blurriness and haziness in his left eye with inability to see objects at distance. He describes this as if his eyes are not opening properly to see. Vision has partially improved since onset but remains significantly impaired compared to baseline. His right eye has had no perception of light since 2023 following right central retinal artery occlusion, making preservation of left eye vision critical.\n\nAssociated with the visual changes, he experienced sweating, nausea with several episodes of vomiting, and a sensation of feeling faint. He was unable to stand from his chair at home. He measured his blood pressure which was 150 mmHg systolic (normally 120 mmHg). He developed dull aching pain in the right elbow crease and right shoulder, with associated weakness and heaviness in the right arm which prevented him from lifting it. The weakness has improved over 2-3 hours. He also experienced difficulty remembering how to perform familiar tasks at home and gave incorrect answers to some questions initially.\n\nHe reports ongoing intermittent frontal and periorbital headaches described as pulsating, occurring every few hours, which he has had since investigations began. He also describes occasional lightheadedness when looking up and down, particularly when bending to the fridge, which has been present since his cardiac surgery but has reduced in frequency recently. He denies any classic symptoms of polymyalgia rheumatica such as bilateral shoulder or hip girdle stiffness, though does have chronic shoulder discomfort.\n\nPatient has been under investigation for possible giant cell arteritis following presentation to TIA clinic on 08/01/2026 with two episodes of blurred vision and flashing lights in the left eye. Multiple investigations have been performed but remain inconclusive. Rheumatology recommended initiation of steroids if he presented with further visual disturbances.\n\nPrevious history includes right central retinal artery occlusion in 2023 with complete vision loss in right eye and right afferent pupillary defect. This was felt to represent previous embolic disease.\n\nPast Medical History:\n• Aortic root replacement (January 2022) - for infected aortic root abscess, complicated by post-operative haemorrhage requiring reoperation\n• Previous aortic valve replacement (2017) - mechanical valve\n• Endocarditis (2022) - treated with Meropenem and Teicoplanin\n• Right central retinal artery occlusion (2023) - resulting in no perception of light in right eye, 6/9 vision in left eye\n• TIA (16/12/2025)\n• Previous diagnosis considered: non-diabetic hypoglycaemia\n• Inguinal hernia repair with hydrocele - complicated by nerve damage to right leg\n• Hypothyroidism\n• Benign prostatic hyperplasia\n• Glaucoma - left eye, on regular drops, 6-monthly ophthalmology follow-up\n• Cataract - left eye (small)\n\nDrug History:\n• Warfarin dose adjusted to INR (10mg 5 times weekly, 9mg 2 times weekly)\n• Atorvastatin 40mg PO OD\n• Bisoprolol 2.5mg PO OD\n• Aspirin 75mg PO OD\n• Lansoprazole 30mg PO OD\n• Levothyroxine 125mcg PO OD\n• Pregabalin 50mg PO BD\n• Finasteride 5mg PO OD\n• Frusemide 20mg PO OM\n• Latanoprost eye drops\n\nAllergy History:\nNo known drug allergies\n\nSocial History:\nLives with wife. Independent in activities of daily living. Enjoys gardening. Previously never attended doctor or hospital until recent cardiac issues. Has required multiple hospital appointments and admissions over past month. Non-smoker. Alcohol consumption not documented.\n\nOn Examination:\nAlert, oriented. NIHSS on admission: 6. NIHSS 45 minutes post-admission: 0.\n\nNeurological examination:\n• Cranial nerves: Left homonymous superior quadrantanopia on formal visual field testing (improved from initial examination). Cannot see examiner's finger in superior temporal field on left. Finger counting preserved peripherally on left. Right eye: no perception of light. Right afferent pupillary defect present. Facial movements symmetrical, no facial droop. Voice character altered - slightly husky/croaky quality (noted by wife). No dysarthria or word-finding difficulty on formal testing. Successfully named objects and read text.\n• Motor: Minimal right arm drift initially (resolved on repeat testing). Right arm weakness on admission with difficulty lifting arm (improved significantly over 2-3 hours). Normal tone. Power now 5/5 all limbs on formal testing. Right leg has chronic weakness from previous nerve damage (longstanding, unchanged).\n• Sensory: Reduced sensation right leg compared to left (chronic from previous nerve damage). Facial sensation intact and symmetrical. Upper limbs symmetrical.\n• Coordination: Finger-nose testing accurate bilaterally (patient notes depth perception difficult with monocular vision but no true past-pointing). Clapping and hand movements performed well.\n• Gait: Not formally assessed due to initial inability to mobilise (now resolved).\n\nCardiovascular:\nMetallic aortic valve heard with soft systolic murmur loudest in aortic area on expiration. No peripheral oedema. Single right thumb splinter haemorrhage noted. No other stigmata of endocarditis.\n\nRespiratory:\nChest clear to auscultation bilaterally.\n\nAbdomen:\nSoft, non-tender. No organomegaly.\n\nInvestigations:\n• Venous blood gas: pH 7.48, Sodium 129, Lactate 2.1\n• Temporal artery ultrasound Doppler: Right temporal artery tortuous with mild intimal thickening 1.5mm, patent frontal vessel compressible with mild intimal thickening 0.4mm, normal waveform velocities, no halo or stenosis. Left mild intimal thickening 0.7mm parietal and 0.4mm frontal, normal waveform and velocities.\n• Right temporal artery biopsy: Marked internal thickening, fragmentation of elastic fibres, few lymphocytes present in adventitia, numerous calcifications. Aspects may suggest temporal arteritis but inconclusive.\n• Whole body PET-FDG scan (02/20/2026, reported 02/22/2026): Moderate increased uptake in root of ascending aorta in region of aortic root collection, could be related to ongoing low-grade inflammation. Moderate increased uptake in wall of root of ascending aorta similar to background liver (intermediate grade 2). Low-grade asymmetrical increased uptake in region of fossa of Rosenmüller. Uptake within wall of thoracic and abdominal aorta is low grade.\n• Blood tests (18/02/2026): CRP 2, normal LFTs and FBC\n• Carotid duplex scan (TIA clinic): No evidence of significant stenosis in left internal carotid artery\n• CT head with contrast today: No large vessel occlusion in brain (full report pending)\n• ECG: Pending\n• INR: Pending\n\nImpression:\nRecurrent visual disturbance in only functioning eye in 77-year-old gentleman with multiple investigations for suspected giant cell arteritis (all inconclusive to date).\n\nDifferential Diagnoses:\n1. Giant cell arteritis with evolving left eye involvement - most concerning given history, typical headache pattern, and visual symptoms, despite inconclusive investigations\n2. Thromboembolic event affecting retinal/ophthalmic circulation - given history of right central retinal artery occlusion, mechanical valve, and infected aortic root\n3. Aortic root infection recurrence with embolic phenomena - given PET scan showing uptake in aortic root region\n4. Transient ischaemic attack affecting visual cortex - though rapid improvement atypical\n5. Stroke affecting visual pathways - though NIHSS improvement to 0 makes this less likely\n\nManagement Plan:\n1. Admit to Acute Medical Unit (not stroke ward) for monitoring and treatment\n2. Check INR urgently - if therapeutic (target range for mechanical valve 2.5-3.5), proceed with steroid therapy. If subtherapeutic, consider thromboembolic aetiology and load with aspirin, discuss with ophthalmology\n3. 12-lead ECG\n4. Blood tests including full inflammatory markers panel\n5. Initiate methylprednisolone IV (check local guidelines for dosing in suspected GCA with visual symptoms) given rheumatology recommendation to treat with steroids if further visual symptoms develop\n6. Urgent rheumatology review tomorrow morning for assessment and management plan regarding possible giant cell arteritis\n7. Ophthalmology review for formal assessment of visual fields and fundoscopy\n8. Monitor visual symptoms closely - any deterioration requires immediate senior review\n9. Consider imaging of aortic root if not adequately visualised on CT head (imaging extended to approximately thoracic inlet level but aortic root not fully captured)\n10. Full escalation plan - patient appropriate for CPR, ITU and NIV if required\n11. Ensure warfarin dosing continues as per usual regimen\n12. Patient and wife educated regarding red flag symptoms requiring immediate review: sudden vision loss, severe headache, jaw claudication", "summary": "77-year-old gentleman with sudden onset left visual disturbance, right arm weakness (now resolved), and previous right eye blindness, under investigation for possible giant cell arteritis with inconclusive tests. NIHSS improved from 6 to 0 within 45 minutes.", "investigations": "Venous blood gas: pH 7.48, Sodium 129, Lactate 2.1. Temporal artery ultrasound Doppler: Bilateral mild intimal thickening, no halo or stenosis. Right temporal artery biopsy: Marked internal thickening, inconclusive for temporal arteritis. PET-FDG scan 20/02/2026: Moderate increased uptake in aortic root region. Blood tests 18/02/2026: CRP 2, normal LFTs and FBC. Carotid duplex: No significant left internal carotid stenosis. CT head with contrast 22/02/2026: No large vessel occlusion.", "tasks": [ { "item": "Check INR result urgently", "time_frame": "2026-02-22T14:00:00Z", "request": "Urgent INR result required for patient Anthony Domaine (MRN 320761) admitted with visual disturbance. Patient on warfarin for mechanical aortic valve. INR result needed to guide management decision between steroid therapy (if therapeutic) versus thromboembolic treatment (if subtherapeutic). Please prioritise - patient has only one functioning eye." }, { "item": "Request urgent rheumatology review", "time_frame": "2026-02-23T09:00:00Z", "request": "Urgent inpatient rheumatology review requested for Anthony Domaine (MRN 320761), 77-year-old male on AMU.\n\nPresenting complaint: Recurrent visual disturbance in only functioning eye (right eye blind from previous CRAO 2023).\n\nHistory: Under investigation for suspected GCA. Multiple inconclusive tests including temporal artery biopsy (showed intimal thickening, fragmentation of elastic fibres, few lymphocytes - inconclusive), temporal artery USS (mild intimal thickening, no halo), PET-CT (moderate uptake in aortic root region). Previous rheumatology letter recommended initiating steroids if further visual symptoms.\n\nToday: Sudden onset left visual blurriness at 09:00, associated with right arm weakness (now resolved), nausea, vomiting. Initial NIHSS 6, improved to 0 within 45 minutes. Persistent left superior quadrantanopia on examination. Patient reports ongoing intermittent frontal/periorbital pulsating headaches.\n\nBackground: Infected aortic root with replacement 2022, mechanical aortic valve 2017, on warfarin.\n\nRequest: Urgent review for assessment and management plan regarding possible GCA. Patient commenced on IV methylprednisolone pending review. Requires definitive diagnosis and long-term management strategy given risk to remaining eye." }, { "item": "Request urgent ophthalmology review", "time_frame": "2026-02-23T09:00:00Z", "request": "Urgent inpatient ophthalmology review requested for Anthony Domaine (MRN 320761), 77-year-old male on AMU.\n\nPresenting complaint: Acute visual disturbance in only functioning eye.\n\nHistory: Right eye - no perception of light since right central retinal artery occlusion 2023, right afferent pupillary defect. Left eye - baseline vision 6/9, known small cataract, on latanoprost for glaucoma, regular 6-monthly ophthalmology follow-up.\n\nToday: Sudden onset left visual blurriness and haziness at 09:00. Describes vision as not clear, difficulty seeing objects at distance. Examination findings: left homonymous superior quadrantanopia on formal visual field testing, finger counting preserved peripherally.\n\nContext: Under investigation for suspected giant cell arteritis (multiple tests inconclusive). CT head today showed no large vessel occlusion. Patient commenced on IV methylprednisolone for presumed GCA given visual symptoms.\n\nRequest: Formal visual field assessment, fundoscopy, and clinical opinion on aetiology of visual disturbance. Is this consistent with GCA-related visual loss, thromboembolic event, or alternative pathology? Patient has only one functioning eye - urgent assessment required." }, { "item": "Request 12-lead ECG", "time_frame": "2026-02-22T14:00:00Z", "request": "12-lead ECG requested for Anthony Domaine (MRN 320761) on AMU. Patient with mechanical aortic valve, history of endocarditis, presenting with visual disturbance and transient neurological symptoms. ECG required as part of baseline workup to assess for arrhythmia (particularly atrial fibrillation) which could contribute to thromboembolic risk. Patient on warfarin but INR pending." }, { "item": "Prescribe methylprednisolone IV", "time_frame": "2026-02-22T14:30:00Z", "request": "Prescribe IV methylprednisolone for Anthony Domaine (MRN 320761) on AMU. Patient with suspected giant cell arteritis presenting with acute visual symptoms in only functioning eye. Rheumatology previously recommended steroid initiation if further visual symptoms develop. Please check local guidelines for appropriate high-dose steroid regimen for GCA with visual involvement (typically methylprednisolone 500mg-1g IV OD for 3 days). Ensure INR is therapeutic before administration (mechanical aortic valve on warfarin). Patient requires urgent treatment to prevent irreversible vision loss." }, { "item": "Consider imaging of aortic root", "time_frame": "2026-02-23T10:00:00Z", "request": "Consider dedicated imaging of aortic root for Anthony Domaine (MRN 320761). Patient has history of infected aortic root with replacement 2022, mechanical aortic valve, previous endocarditis. Recent PET-CT showed moderate increased uptake in aortic root region suggesting possible ongoing low-grade inflammation. CT head performed today extended to approximately thoracic inlet but did not fully capture aortic root. Given current presentation with possible embolic phenomena (visual disturbance, transient right arm weakness), recommend dedicated cardiac imaging (? CT aorta, ? TOE) to assess aortic root for possible infection recurrence or source of embolism. Please discuss with cardiology." }, { "item": "Monitor visual symptoms", "time_frame": "2026-02-22T17:00:00Z", "request": "4-hourly visual symptom monitoring for Anthony Domaine (MRN 320761) on AMU. Patient has only one functioning eye (left) following previous right CRAO. Currently being treated for suspected GCA with visual involvement. Please document: any change in visual acuity, new visual field
44 days ago 19:13
Original saved

Refined clerking

25 year old electrician with persistent dizziness since October 2025 described as off-balance sensation with difficulty concentrating. Abnormal head impulse test suggests central cause. CT head normal. Plan for urgent MRI head to exclude posterior circulation pathology.
44 days ago 19:13
No original

Refined clerking

Adult male with decompensated alcohol-related liver cirrhosis presenting with fresh haematemesis secondary to variceal bleeding, now haemodynamically stable on terlipressin with plan for endoscopy if further bleeding or electively tomorrow.
44 days ago 17:55
Original saved

Refined clerking

Patient with known decompensated alcohol-related liver cirrhosis and oesophageal varices presenting with acute variceal haematemesis, tachycardia, hypotension, acute kidney injury and elevated lactate requiring urgent resuscitation and potential emergency endoscopy.
44 days ago 16:28
Original saved

Sdec

71-year-old man with depression and recent bereavement presented with feeling unwell, hypotension and bradycardia secondary to reduced oral intake. Investigations normal, discharged home.
44 days ago 09:55
Original saved

Sdec

21-year-old lady with 4-month history of bilateral foot rash consistent with allergic contact dermatitis, now with secondary staphylococcal infection and new papular rash on forearms.
45 days ago 19:54
Original saved

Refined clerking

82-year-old man with recurrent migraine with aura presenting with typical episode of severe headache, transient dysphasia and limb weakness, fully resolved at assessment. Diagnosed as migraine with aura, discharged with Sumatriptan.
45 days ago 15:06
Original saved

Refined clerking

58-year-old lady with alcohol dependency presenting with 2-day history of melaena, probable upper GI bleed with chest infection and ongoing self-neglect.
45 days ago 14:03
Original saved

Refined clerking

58-year-old lady presenting with 2-week history of melaena and progressive weakness, found to be severely anaemic (Hb 61) on background of recent vascular bypass surgery and dual antiplatelet/anticoagulant therapy.
45 days ago 12:58
Original saved

Refined clerking

93 year old gentleman with ischaemic heart disease presenting with recurrent chest pain and paroxysmal atrial fibrillation causing transient visual loss. Diagnosis: NSTEMI with paroxysmal AF.
45 days ago 11:44
No original

Refined clerking

{ "mrn": "548198", "patient_name": "Jeffrey Tompkins", "content": "Medical ST5 Miller Clerking\n\nPresenting Complaint:\nChest pain / palpitations\n\nHistory of Presenting Complaint:\nJeffrey Tompkins is a 93-year-old gentleman with a significant cardiac history who presented to the Emergency Department in the early hours of the morning with recurrent chest pain and palpitations.\n\nHe has a background of exertional chest discomfort for approximately one year, which he reports is consistent with his known ischaemic heart disease. He describes becoming breathless and experiencing chest discomfort after walking only 10–20 yards, which limits his daily activities considerably.\n\nYesterday morning (25/02/26), he woke between 08:30 and 09:30 and developed central chest pain with a squeezing character, radiating to the back, associated with sweating and clamminess. This episode lasted approximately one hour before subsiding spontaneously. He was pain-free for the remainder of the morning. Later that afternoon, at approximately 18:30, he went out for coffee and developed a further episode of chest pain lasting several hours. On returning home, he was unable to lie flat due to cough. At approximately 01:00 this morning, his chest pain returned and, at his wife's persuasion, he called for help and attended hospital.\n\nHe also reports a one-to-two-day history of episodic visual disturbance, occurring three times during this admission. He describes a sudden onset, with a sensation of something in his vision accompanied by a loud noise, with complete resolution shortly afterwards. These episodes are temporally associated with his heart going into a fast rhythm, suggesting haemodynamic compromise during episodes of supraventricular tachycardia (SVT). This symptom had not been present prior to this presentation.\n\nSeparately, he reports a two-to-three-month history of left-sided neck and shoulder pain radiating up the back following a fall at home, in which he was struck by a door and knocked off his feet. He did not seek medical attention at the time. This pain has persisted since.\n\nHe was reviewed by the ACS nurse in the Emergency Department. He is well known to cardiology.\n\nRegarding medications: isosorbide mononitrate had previously been stopped but was restarted by his GP one to two weeks prior to this presentation. He has been taking aspirin daily as prescribed.\n\nPast Medical History:\n• Ischaemic heart disease — primary percutaneous coronary intervention (PCI) to OM1 with two stents, July 2020; previous elective PCI to the right coronary artery (RCA) and distal/mid LAD with two stents for CCS Class 3 angina, June 2020; bystander distal LAD and distal circumflex disease managed medically\n• Cholecystectomy — 1990\n• Fractured neck of femur — 2019, managed with dynamic hip screw (DHS); walks slowly with aid of a stick\n• Small bowel obstruction — 2021\n• Benign paroxysmal positional vertigo (BPPV)\n• Hypertension\n• Chronic kidney disease — Stage 3\n• Colonic diverticulosis\n• Primary open-angle glaucoma\n• Bilateral hip replacements\n• Background pulmonary fibrosis (noted on CT July 2023, progressed compared with CT 2019)\n\nDrug History:\n• Alendronic acid 70mg PO once weekly\n• Calcichew D3 1 tablet PO OD\n• Furosemide 20mg PO OD\n• Atorvastatin 40mg PO OD\n• Aspirin 75mg PO OD\n• Omeprazole 20mg PO OD\n• Latanoprost 50mcg/ml eye drops — both eyes OD\n• Lisinopril 10mg PO OD\n• Isosorbide mononitrate — recently restarted by GP (see below)\n\nRecently Stopped Medications:\n• Isosorbide mononitrate — stopped several weeks ago, restarted by GP approximately one to two weeks prior to this admission\n\nAllergy History:\n• NKDA\n\nSocial History:\nLiving situation: Lives with his wife in a bungalow.\nMobility: Walks with a stick, though able to manage short distances without it. Functional range limited to approximately 10–20 yards before becoming breathless.\nOccupation: Retired chauffeur, ceased working in 2019. The family business was established by his father in 1924.\nSmoking: Ex-smoker — smoked approximately 20 cigarettes per day during his twenties; ceased following a chest problem. Estimated light pack-year history.\nAlcohol: Previous heavy whisky drinker; currently does not drink.\nFunctional Status: Manages at home with his wife. Active in the garden. Wears glasses for visual impairment secondary to glaucoma.\n\nOn Examination:\nGeneral Appearance: Alert and conversant. Cooperative with examination.\nObservations: HR fluctuating between 94–95 bpm in sinus rhythm and episodes of SVT at approximately 160 bpm. BP 102/77 mmHg. RR 23. O2 saturations 97% on air.\n\n• Cardiovascular: JVP not raised. Heart sounds noted; palpitations confirmed on examination. During the consultation, the patient experienced further episodes of visual disturbance correlating with SVT on monitoring.\n• Respiratory: Lungs auscultated — stiff lung fields consistent with age and background fibrosis. No acute findings to suggest pulmonary oedema on examination, though left basal haziness noted on imaging (see below).\n• Abdomen: Examined — no specific findings documented.\n• Other: Bilateral hip replacements noted. Left neck and shoulder tenderness consistent with history of fall two to three months ago.\n\nInvestigations:\n• Haemoglobin: 113 (previously 115 and 109 in June and February respectively)\n• Troponin T: 397 at 06:23 and 207 at 02:48\n• Venous blood gas: Normal\n• Full blood count: Normal\n• Urea: 16.6\n• Creatinine: 156 (previously 128 in November 2025) — consistent with AKI Stage 1\n• ALT: 50 (previously 9 in June 2025)\n• AST: 53\n• CRP: <1\n• Liver function tests: Otherwise normal\n• CRP (repeat): Awaited\n• Coagulation screen: Awaited\n• Chest X-ray (26/02/26): Clear lung fields with mild left basal haziness at the costophrenic angle; increased bronchovascular markings bilaterally compared with previous X-ray from 2023, which showed left lower zone atelectasis — overall stable appearances\n• CT Thorax, Abdomen and Pelvis (July 2023, indication: trauma): Background pulmonary fibrosis progressed compared with CT 2019; post-cholecystectomy changes; liver cyst; heavy aortic calcification; atrophic right kidney; faecal loading in rectum; uncomplicated colonic diverticulosis; bilateral hip replacements; osteopenia; degenerative spinal changes; no rib fractures\n\nImpression:\nNSTEMI — in the context of rising troponin (peak 397), exertional chest pain, and diaphoresis, on a background of significant ischaemic heart disease with prior PCI.\nSVT — with episodes of visual disturbance likely secondary to haemodynamic compromise during tachycardic episodes.\nAKI Stage 1 — creatinine 156, up from baseline of 128 in November 2025.\nMild transaminitis — ALT 50 (previously 9 in June 2025), aetiology to be determined.\n\nDifferential Diagnoses: Atrial fibrillation (to be confirmed on ECG review); demand ischaemia secondary to tachyarrhythmia.\n\nManagement Plan:\n1. Monitoring: CCU bed with continuous cardiac monitoring. Long line to be inserted for amiodarone infusion.\n2. Medications:\n a. Amiodarone infusion — commenced for rhythm control\n b. Fondaparinux 2.5mg SC OD — for NSTEMI management and VTE prophylaxis\n c. Apixaban 2.5mg PO BD — as recommended by cardiology (Dr Hayder) for dual indication: anticoagulation for atrial fibrillation and NSTEMI medical management\n d. Clopidogrel 300mg PO loading dose, then 75mg PO OD — as per cardiology recommendation\n e. Aspirin 75mg PO OD — to be ceased in favour of clopidogrel as per cardiology guidance\n f. Isosorbide mononitrate — restarted; to continue to ensure the patient remains pain-free\n3. Investigations: Repeat coagulation screen and CRP when available. Ongoing monitoring of renal function and troponin trend. Review ECG for atrial fibrillation.\n4. Referral: Cardiology review — discussion regarding suitability for repeat coronary angiography given NSTEMI in context of prior stenting.\n5. Escalation plan: Discussion held with the patient regarding resuscitation. He is for CPR and attempted cardioversion in the context of a clearly reversible arrhythmic cause. If prolonged resuscitation without an identified reversible cause, prompt cessation is appropriate given his advanced age (93 years). He has capacity and expressed agreement with this approach. DNACPR form to be completed and filed. His quality of life was noted to be reasonable — he remains active at home, particularly in the garden.\n6. Ward: Cardiology CCU bed.", "summary": "Jeffrey Tompkins is a 93-year-old gentleman with significant ischaemic heart disease (prior PCI with stenting) presenting with recurrent central chest pain, diaphoresis, and palpitations with associated transient visual disturbance. Elevated troponin T (peak 397) and clinical picture are consistent with a diagnosis of NSTEMI with concurrent SVT/possible atrial fibrillation.", "investigations": "Haemoglobin 26/02/26: 113 (previously 115 and 109 in June and February respectively)\nTroponin T 26/02/26 02:48: 207\nTroponin T 26/02/26 06:23: 397\nVenous blood gas 26/02/26: Normal\nFull blood count 26/02/26: Normal\nUrea 26/02/26: 16.6\nCreatinine 26/02/26: 156 (previously 128, November 2025) — AKI Stage 1\nALT 26/02/26: 50 (previously 9, June 2025)\nAST 26/02/26: 53\nCRP 26/02/26: <1\nCoagulation screen: Awaited\nCRP repeat: Awaited\nChest X-ray 26/02/26: Mild left basal haziness at costophrenic angle; increased bronchovascular markings bilaterally; stable compared with 2023 (which showed left lower zone atelectasis)\nCT Thorax Abdomen and Pelvis July 2023: Background pulmonary fibrosis (progressed vs 2019); post-cholecystectomy; liver cyst; heavy aortic calcification; atrophic right kidney; faecal loading in rectum; uncomplicated colonic diverticulosis; bilateral hip replacements; osteopenia; degenerative spinal changes; no rib fractures", "tasks": [ { "item": "Arrange CCU bed with continuous cardiac monitoring", "time_frame": "2026-02-20T12:00:00", "request": "Please arrange a CCU bed with continuous cardiac monitoring for Jeffrey Tompkins (MRN: 548198), a 93-year-old gentleman admitted with NSTEMI (peak troponin T 397) and SVT (HR up to 160 bpm). He is currently on an amiodarone infusion and requires a long line for administration. Ongoing monitoring of heart rhythm, blood pressure, and oxygen saturations is essential." }, { "item": "Insert long line for amiodarone infusion", "time_frame": "2026-02-20T12:00:00", "request": "Please insert a long line (PICC or central venous access) for Jeffrey Tompkins (MRN: 548198) to facilitate administration of amiodarone infusion. Peripheral administration is not appropriate for prolonged amiodarone infusion due to phlebitis risk. Patient is a 93-year-old on CCU with NSTEMI and SVT requiring rhythm control." }, { "item": "Prescribe amiodarone infusion", "time_frame": "2026-02-20T12:00:00", "request": "Please prescribe amiodarone infusion for Jeffrey Tompkins (MRN: 548198), a 93-year-old with confirmed SVT and NSTEMI. Standard loading and maintenance infusion protocol to run for approximately 12 hours as per NSTEMI and arrhythmia management. Long line to be arranged prior to commencement." }, { "item": "Prescribe fondaparinux 2.5mg SC OD", "time_frame": "2026-02-20T12:00:00", "request": "Please prescribe fondaparinux 2.5mg SC OD for Jeffrey Tompkins (MRN: 548198) for NSTEMI management and VTE prophylaxis. Note CKD Stage 3 (creatinine 156, AKI Stage 1 on background of 128). Renal function monitoring required." }, { "item": "Prescribe apixaban 2.5mg PO BD", "time_frame": "2026-02-20T12:00:00", "request": "Please prescribe apixaban 2.5mg PO BD for Jeffrey Tompkins (MRN: 548198) as recommended by cardiology (Dr Hayder) for dual indication: anticoagulation for possible atrial fibrillation and NSTEMI medical management. Note: aspirin to be ceased; clopidogrel 300mg loading dose then 75mg OD to be commenced concurrently." }, { "item": "Prescribe clopidogrel 300mg loading then 75mg OD — cease aspirin", "time_frame": "2026-02-20T12:00:00", "request": "Please prescribe clopidogrel 300mg PO loading dose followed by 75mg PO OD for Jeffrey Tompkins (MRN: 548198) as per cardiology recommendation (Dr Hayder). Aspirin 75mg OD should be ceased concurrently. Indication: NSTEMI management in the context of prior coronary stenting." }, { "item": "Cardiology referral — review and consideration of repeat coronary angiography", "time_frame": "2026-02-20T13:00:00", "request": "Urgent cardiology review requested for Jeffrey Tompkins (MRN: 548198), a 93-year-old gentleman admitted with NSTEMI (peak troponin T 397) and SVT on a background of ischaemic heart disease with prior PCI (OM1, RCA, LAD stenting June/July 2020). He has been commenced on amiodarone infusion, fondaparinux, apixaban 2.5mg BD, and clopidogrel 300mg load per Dr Hayder's advice. Please review and advise on suitability for repeat coronary angiography. Currently awaiting CCU bed." }, { "item": "Request 12-lead ECG and review for atrial fibrillation", "time_frame": "2026-02-20T12:00:00", "request": "Please perform and review a 12-lead ECG for Jeffrey Tompkins (MRN: 548198). Clinical concern for atrial fibrillation underlying his episodes of SVT (HR up to 160 bpm). ECG review will guide anticoagulation decision-making (apixaban already commenced per cardiology advice). Please document rhythm and
45 days ago 11:23
No original

Refined clerking

{ "mrn": "548198", "patient_name": "Jeffrey Tompkins", "content": "Medical ST5 Miller Clerking\n\nPresenting Complaint:\nChest pain / palpitations\n\nHistory of Presenting Complaint:\nJeffrey Tompkins is a 93-year-old gentleman with a significant cardiac background who presented to the emergency department in the early hours of the morning with recurrent chest pain and palpitations.\n\nHe gives a background history of exertional chest discomfort over the past year, consistent with his known ischaemic heart disease. This manifests as exertional dyspnoea and chest discomfort, limiting his walking to approximately 10–20 yards before he must stop. He had previously been on isosorbide mononitrate, which was stopped some weeks prior to this presentation; his GP had re-prescribed this approximately one to two weeks ago, though he had not yet taken the medication.\n\nThe acute presentation began yesterday morning. He awoke between 08:30 and 09:30 and developed central chest pain, which he described as a squeezing sensation radiating into the back, associated with diaphoresis. This episode lasted approximately one hour before subsiding spontaneously. He was pain-free throughout the remainder of the morning and went out for coffee. At approximately 18:30, a further episode of chest pain occurred lasting several hours. He then went to bed but felt unable to lie flat due to coughing. At approximately 01:00, chest pain returned and his wife persuaded him to attend hospital.\n\nOn arrival, he was noted by the radiographer to have a heart rate fluctuating up to 160 bpm consistent with a supraventricular tachycardia (SVT), reverting to sinus rhythm at 94–95 bpm at times. He reported palpitations occurring approximately every 90 seconds.\n\nIn addition to the cardiac symptoms, he reported two further issues of note. Firstly, he described recurrent brief episodes of complete visual loss in both eyes over the preceding two days, occurring up to three times during this admission, associated with an auditory phenomenon described as a loud bang, with full recovery of vision thereafter. These episodes appeared to correlate temporally with episodes of tachycardia, suggesting haemodynamically mediated cerebral hypoperfusion. Secondly, he reported left-sided neck and shoulder pain radiating up into the shoulder and neck, developing after an unwitnessed fall approximately two to three months ago in which he struck his head, was knocked off his feet and sustained a shoulder injury. He did not attend hospital at the time. This pain has been persistent since the fall.\n\nHe denied any calf pain or symptoms suggestive of peripheral vascular disease. He reported no claudication symptoms, attributing his limited mobility primarily to cardiac symptoms and his known hip replacements.\n\nHe is well known to cardiology with a history of previous percutaneous coronary intervention.\n\nPast Medical History:\n• Ischaemic heart disease — primary PCI to OM1 (×2 stents) July 2020; elective PCI to distal/mid LAD (×2 stents) June 2020 for CCS Class III angina; bystander distal LAD and distal circumflex disease managed medically\n• Fractured neck of femur 2019 — dynamic hip screw; bilateral hip replacements\n• Small bowel obstruction 2021\n• Cholecystectomy 1990\n• Colonic diverticulosis\n• Hypertension\n• Chronic kidney disease stage 3 (baseline creatinine ~128 µmol/L, November 2025)\n• Benign paroxysmal positional vertigo (BPPV)\n• Primary open-angle glaucoma\n• Background pulmonary fibrosis (noted on CT July 2023, progressed from 2019)\n\nDrug History:\n• Alendronic acid 70mg PO once weekly\n• Calcichew D3 1 tablet PO OD\n• Furosemide 20mg PO OD\n• Atorvastatin 40mg PO OD\n• Aspirin 75mg PO OD\n• Omeprazole 20mg PO OD\n• Latanoprost 50 micrograms/mL eye drops — 1 drop in both eyes OD\n• Lisinopril 10mg PO OD\n\nRecently Stopped Medications:\n• Isosorbide mononitrate — stopped several weeks ago; re-prescribed by GP approximately one to two weeks prior to this admission; patient had not yet recommenced\n\nAllergy History:\n• NKDA\n\nSocial History:\nLiving situation: Lives with his wife in a bungalow in the Birmingham area.\nMobility: Mobilises with a stick on occasion, though can walk short distances unaided. Limited to approximately 10–20 yards before stopping due to exertional dyspnoea. Managed stairs prior to admission.\nCarers: Wife present; family involved (son contactable by phone).\nOccupation: Retired. Previously worked as a chauffeur, a family business established by his father.\nSmoking: Ex-smoker. Smoked approximately 20 cigarettes per day during his twenties; stopped due to chest problems. Estimated pack years: approximately 5–10.\nAlcohol: Previous drinker (whisky); no longer drinks.\nFunctional Status: Independently mobile at baseline with moderate functional limitation due to cardiac symptoms. Able to manage activities of daily living and tends to the garden.\n\nOn Examination:\nGeneral Appearance: Alert and orientated. Cooperative and conversational throughout.\nObservations: HR fluctuating 94–160 bpm (SVT noted on monitoring), BP 102/77 mmHg, RR 23 breaths/min, O2 saturations 97% on air.\n\n• Cardiovascular: Heart rate irregular during examination with episodes of tachycardia correlating with reported visual symptoms. JVP not raised. Episodes of visual disturbance observed to correlate with tachycardic episodes during assessment.\n• Respiratory: Lungs auscultated — age-related stiffness noted. No acute concern identified clinically.\n• Abdomen: Abdomen examined — no significant findings documented.\n• Other: Bilateral hip replacements noted. Walks with a stick.\n\nInvestigations:\n• Haemoglobin (today): 113 g/L (previously 115 g/L June 2025, 109 g/L February 2025)\n• Troponin T (02:48): 207 ng/L\n• Troponin T (06:23): 397 ng/L (rising trend — consistent with myocardial injury)\n• Creatinine (today): 156 µmol/L (previously 128 µmol/L November 2025) — AKI Stage 1\n• Urea (today): 16.6 mmol/L\n• ALT (today): 50 U/L (previously 9 U/L June 2025)\n• AST (today): 53 U/L\n• CRP: <1 mg/L\n• Liver function tests: Otherwise normal\n• Full blood count: Otherwise normal\n• Venous blood gas: Normal\n• CRP (repeat): Awaited\n• Coagulation screen: Awaited\n• Chest X-ray (today): Clear lung fields; mild left basal haziness at the costophrenic angle; increased bronchovascular markings bilaterally compared with 2023. Previously noted left lower zone atelectasis — stable appearances overall.\n• CT Thorax/Abdomen/Pelvis (July 2023, indication: trauma): Background pulmonary fibrosis progressed from 2019; cholecystectomy noted; liver cyst; heavy aortic calcification; atrophic right kidney; faecal loading in rectum; uncomplicated colonic diverticulosis; bilateral hip replacements; osteopenia; degenerative spinal changes; no rib fractures.\n\nImpression:\nNSTEMI (rising troponin T with chest pain and known ischaemic heart disease) — likely precipitant for new-onset atrial fibrillation / SVT.\nAtrial fibrillation / SVT — haemodynamically significant, with episodes of visual loss likely representing haemodynamically mediated transient cerebral hypoperfusion during tachycardic episodes.\nAKI Stage 1 — on background CKD Stage 3, likely in context of reduced cardiac output.\nDifferential for visual episodes: haemodynamic compromise secondary to arrhythmia (most likely); vertebrobasilar insufficiency; occipital TIA — to be considered.\nLeft neck and shoulder pain following fall 2–3 months ago — requires assessment; cervical or shoulder pathology possible.\n\nManagement Plan:\n1. Continuous cardiac monitoring on CCU with close haemodynamic observation.\n2. Amiodarone infusion — commence for rate/rhythm control; long line to be arranged for administration.\n3. Anticoagulation and antiplatelet therapy as per cardiology advice (Dr Hayder):\n - Apixaban 2.5mg PO BD — to provide anticoagulation for atrial fibrillation and NSTEMI cover.\n - Clopidogrel 300mg PO OD loading dose.\n - Aspirin 75mg PO OD — to be discontinued (ceased on commencement of above regimen).\n4. Commence nitrate therapy to ensure ongoing pain relief.\n5. Fondaparinux — continue for VTE and NSTEMI prophylaxis.\n6. Cardiology review — discuss suitability for further coronary angiography +/- repeat PCI in context of rising troponins and known coronary disease.\n7. Consider CT head if episodes of visual loss continue or cannot be fully explained by haemodynamic compromise alone, to exclude intracranial pathology.\n8. Monitor renal function closely given AKI Stage 1 on background CKD — review nephrotoxic medications as appropriate.\n9. Cardiology bed (CCU preferred given ongoing amiodarone infusion requirement and need for continuous monitoring).\n10. Escalation plan: For attempted resuscitation including CPR if there is a clearly reversible cause of cardiac arrest (e.g., arrhythmia). Patient and clinician agree that in the context of a reversible precipitant, active treatment is appropriate. However, in the event of prolonged resuscitation without identifiable reversible cause, prompt cessation of resuscitation agreed given advanced age. Patient engaged with and understood this discussion. Patient is NOT currently for ITU-level escalation — this was not explicitly discussed but would require senior review. DNACPR form to be completed formally.\n11. Involve family (wife and son) in ongoing communications regarding clinical progress and future planning.", "summary": "Jeffrey Tompkins is a 93-year-old gentleman with extensive ischaemic heart disease and previous PCI who presented with recurrent central chest pain and haemodynamically significant SVT/atrial fibrillation, with rising troponins consistent with NSTEMI. He is being admitted to CCU for amiodarone infusion, anticoagulation, antiplatelet therapy, and cardiology review regarding further coronary angiography.", "investigations": "Troponin T 02:48 on 26/02/2026: 207 ng/L\nTroponin T 06:23 on 26/02/2026: 397 ng/L (rising)\nHaemoglobin 26/02/2026: 113 g/L (previously 115 g/L June 2025; 109 g/L February 2025)\nCreatinine 26/02/2026: 156 µmol/L (previously 128 µmol/L November 2025) — AKI Stage 1\nUrea 26/02/2026: 16.6 mmol/L\nALT 26/02/2026: 50 U/L (previously 9 U/L June 2025)\nAST 26/02/2026: 53 U/L\nCRP 26/02/2026: <1 mg/L\nVenous blood gas 26/02/2026: Normal\nFull blood count 26/02/2026: Otherwise normal\nLiver function tests 26/02/2026: Otherwise normal (apart from elevated ALT/AST above)\nCoagulation screen: Awaited\nCRP repeat: Awaited\nChest X-ray 26/02/2026: Mild left basal haziness at costophrenic angle; increased bronchovascular markings bilaterally; stable compared with 2023 (previously left lower zone atelectasis).\nCT Thorax/Abdomen/Pelvis July 2023: Background pulmonary fibrosis (progressed from 2019); liver cyst; heavy aortic calcification; atrophic right kidney; faecal loading in rectum; uncomplicated colonic diverticulosis; bilateral hip replacements; osteopenia; degenerative spinal changes; no rib fractures.", "tasks": [ { "item": "Arrange long line insertion for amiodarone infusion", "time_frame": "2026-02-20T13:00:00", "request": "Please arrange long line insertion for Mr Jeffrey Tompkins (MRN: 548198), a 93-year-old gentleman admitted to CCU with NSTEMI and SVT/atrial fibrillation. He requires a long line for administration of amiodarone infusion as per CCU nurse-in-charge recommendation. Peripheral access is not suitable for amiodarone due to risk of phlebitis. Please prioritise as infusion needs to commence urgently." }, { "item": "Commence amiodarone infusion", "time_frame": "2026-02-20T13:00:00", "request": "Please prescribe and commence amiodarone infusion for Mr Jeffrey Tompkins (MRN: 548198), 93-year-old male admitted with NSTEMI and haemodynamically significant SVT/atrial fibrillation. HR noted up to 160 bpm on monitoring. To be administered via long line. Duration approximately 12 hours as per plan. Please refer to local amiodarone infusion protocol." }, { "item": "Prescribe Apixaban 2.5mg PO BD", "time_frame": "2026-02-20T13:00:00", "request": "Please prescribe Apixaban 2.5mg PO BD for Mr Jeffrey Tompkins (MRN: 548198), 93-year-old male with new atrial fibrillation in the context of NSTEMI. Dose of 2.5mg BD recommended by cardiology (Dr Hayder) to provide dual coverage for AF anticoagulation and NSTEMI medical management. Note: Aspirin 75mg OD to be ceased concurrently." }, { "item": "Prescribe Clopidogrel 300mg PO loading dose", "time_frame": "2026-02-20T13:00:00", "request": "Please prescribe Clopidogrel 300mg PO as a loading dose for Mr Jeffrey Tompkins (MRN: 548198), 93-year-old male with NSTEMI. Recommended by cardiology (Dr Hayder) as part of dual antiplatelet/anticoagulation strategy. Aspirin to be ceased on commencement. Ongoing dose to be determined following cardiology review." }, { "item": "Discontinue Aspirin 75mg", "time_frame": "2026-02-20T13:00:00", "request": "Please discontinue Aspirin 75mg PO OD for Mr Jeffrey Tompkins (MRN: 548198) with immediate effect. Aspirin is to be ceased as per cardiology advice (Dr Hayder) on commencement of Apixaban and Clopidogrel loading for NSTEMI and atrial fibrillation management." }, { "item": "Commence nitrate therapy for ongoing chest pain relief", "time_frame": "2026-02-20T13:00:00", "request": "Please prescribe isosorbide mononitrate (or equivalent nitrate as per cardiology/local protocol) for Mr Jeffrey Tompkins (MRN: 548198), 93-year-old male with NSTEMI and exertional chest pain. Previously prescribed isosorbide mononitrate by GP but not yet recommenced. Nitrates indicated to ensure ongoing pain relief during admission. Please liaise with cardiology regarding preferred agent and dose." }, { "item":
45 days ago 10:59
No original

Refined clerking

93-year-old man with recurrent chest pain over 48 hours and paroxysmal SVT causing pre-syncope. NSTEMI with dynamic troponin rise requiring cardiology assessment for possible further PCI.
55 days ago 17:42
Original saved

Refined clerking

79-year-old lady who fell onto right knee causing comminuted patella fracture, with single episode of syncope in ED likely multifactorial (pain, dehydration, no oral intake). Observed 20 hours with no recurrence, cardiac causes excluded.
55 days ago 17:22
No original

Refined clerking

79-year-old lady presenting with comminuted patellar fracture following mechanical fall and subsequent vasovagal syncope. Cardiac monitoring reassuring. Awaiting orthopaedic definitive management plan.
55 days ago 16:25
No original

Refined clerking

72 year old man with Type 1 diabetes mellitus presenting with syncope secondary to complete heart block (HR 33), now with acute heart failure requiring isoprenaline infusion and pacemaker consideration.
55 days ago 13:46
No original

Sdec

32-year-old pregnant woman with right-sided pyelonephritis, intolerant of co-amoxiclav, treated with cephalexin and discharged with outpatient ultrasound scan arranged.
55 days ago 11:29
No original

Refined clerking

49-year-old man presenting with acute shortness of breath and severe hyperglycaemia (41.2 mmol/L) secondary to intentional insulin non-compliance in context of active suicidal ideation. Diagnosis: left basal pneumonia with infective exacerbation of COPD causing decompensation and hyperosmolar state.
55 days ago 10:22
No original

Refined clerking

72-year-old lady with COPD presenting with sudden onset shortness of breath 24 hours post-discharge following recent exacerbation. Acute exacerbation of COPD likely precipitated by too rapid steroid wean, now requiring oxygen therapy.
55 days ago 09:25
No original

Refined ultra rapid review

Elderly widow living alone, presented following fall, found to have hypotension (86/51), raised inflammatory markers (CRP 111), right-sided pleural effusion with consolidation, and AKI. Diagnosis: Hospital-acquired pneumonia with sepsis.
8 weeks ago 23:20
No original Cannot regen (missing thread/transcript)

No thread
8 weeks ago 19:09
No original

Refined clerking

75-year-old gentleman with heart failure and atrial fibrillation presenting with collapse, head injury, and subsequent palpitations requiring urgent investigation for intracranial bleeding and cardiac arrhythmias.
8 weeks ago 18:49
No original

Refined clerking

26-year-old man with progressive neurological symptoms including left-sided weakness, falls, and incontinence. Complex background of chronic ptosis, PTSD, and memory problems under neurology investigation.
8 weeks ago 15:14
No original

Refined clerking

87-year-old lady presenting with left sided weakness, differential diagnosis includes infection versus acute ischaemic stroke.
8 weeks ago 14:05
No original

Refined clerking

29-year-old female with background HNPP presenting with acute right facial nerve palsy consistent with Bell's palsy.
8 weeks ago 11:46
No original

Refined clerking

Ashley Hamilton, type 2 diabetic with alcohol dependence, presenting with pre-diabetic ketoacidosis and possible acute pancreatitis following alcohol binge and withdrawal.
8 weeks ago 10:35
No original

Refined ultra rapid review

Karen, adult female, admitted following falls and confirmed seizure, requesting discharge against medical advice despite understanding stroke risk.
8 weeks ago 10:32
No original

Refined ultra rapid review

Patient with infectious exacerbation of COPD presenting after feeling unwell at home, managed with antibiotics and steroids for discharge.
64 days ago 23:23
No original

Refined ultra rapid review

Adult patient re-presented with hypotension and diagnostic uncertainty following abdominal pain, likely biliary infection or cholangitis with pancreatic inflammation.
64 days ago 19:56
No original

Refined clerking

77-year-old gentleman with recurrent chest pain, confusion, and sepsis with AKI, requiring IV antibiotics and investigation for source of infection.
64 days ago 17:11
No original

Refined ultra rapid review

83-year-old lady with upper GI bleed and haematemesis, likely secondary to 6 weeks of naproxen use, requiring urgent endoscopy and blood transfusion.
64 days ago 16:13
No original

Met call

90-year-old lady Audrey Trenary with symptomatic anaemia (Hb 61) thought secondary to DOAC, stable following emergency call.
64 days ago 15:33
No original

Met call

71-year-old gentleman with fast atrial fibrillation (160-180 bpm) in context of UTI and possible prosthetic knee infection, with complex background including Parkinson's disease and renal transplant.
65 days ago 20:22
No original

Refined ultra rapid review

51-year-old lady with multiorgan dysfunction following surfing incident, likely hypothermia-related but requiring extensive investigation to exclude multisystem disease.
66 days ago 23:13
No original

Refined clerking

78-year-old man with mild cognitive impairment and diabetes medication non-compliance, investigations normal except mildly elevated CRP, suitable for discharge with memory clinic follow-up.
66 days ago 20:50
No original

Custom

34-year-old diabetic male with infected leg ulcer and MSSA, multiple drug allergies, commenced on ceftriaxone 3g IV OD following microbiologist advice.
66 days ago 20:44
No original

Refined clerking

34-year-old man with Type 1 diabetes presenting with right leg cellulitis secondary to infected diabetic foot ulcer, complicated by stage 2 AKI.
66 days ago 19:40
No original

Clerking

63-year-old man with perioperative hypertension during planned shoulder surgery, likely due to missed medications or perioperative stress.
81 days ago 12:11
No original

Refined clinic letter

36-year-old veterinary surgeon with left-sided ulcerative colitis experiencing intermittent flaring, now responding to double-dose Mesavant. Also has 8-month history of neurological symptoms with neurology review pending.
12 weeks ago 09:51
No original

Endoscopy report

Evelyn, long-standing acid reflux (7-8 years) with regurgitation and nocturnal symptoms, scheduled for upper GI endoscopy.
87 days ago 06:15
No original

Refined clerking

81-year-old lady with antibiotic-associated diarrhoea following nitrofurantoin, now constipated for 4 days with significant weight loss and dehydration.
87 days ago 06:15
No original

Refined clerking

81-year-old lady presenting with one-week history of bloody diarrhoea following antibiotics, now constipated for 4 days with significant weight loss. CT shows slow transit constipation. Likely overflow diarrhoea.
87 days ago 06:11
No original

Refined clerking

81-year-old lady presenting with one week history of severe diarrhoea, vomiting and significant weight loss, likely representing overflow diarrhoea secondary to faecal impaction.
87 days ago 06:08
No original

Refined clerking

81-year-old lady with severe diarrhoea and weight loss following antibiotic courses, likely antibiotic-associated diarrhoea with possible overflow component.
87 days ago 04:52
No original

Refined clerking

Elderly gentleman presenting after fall with 2-3 week history of right-sided chest pain. CT shows possible haemothorax requiring urgent surgical assessment.
87 days ago 04:29
No original

Refined clerking

59-year-old lady with locally advanced pancreatic cancer presenting with increasing abdominal pain post-ERCP, likely cholangitis.
87 days ago 01:58
No original

Refined clerking

68-year-old man with mitochondrial cytopathy presented with diabetic ketoacidosis following prolonged collapse, complicated by bilateral chest infections and AKI, with background enlarging cavitating lung lesion requiring urgent investigation.
88 days ago 22:56
No original

Refined clerking

45-year-old gentleman with alcohol-related hepatitis and ascites, recently stopped drinking after years of heavy consumption.
88 days ago 19:32
No original

Met call

Staff member Tina Hayes experienced anxiety attack exacerbated by salbutamol inhaler use, presenting with palpitations, tremor and collapse requiring peri-arrest call.
88 days ago 09:00
No original

Email

Correspondence regarding a patient with Parkinsonian crisis who deteriorated despite treatment and was transitioned to palliative care following family discussion.
88 days ago 05:28
No original

Refined clerking

62-year-old man with fall and months of feeling unwell, found to have decompensated alcohol-related liver disease with AKI and metabolic derangement.
88 days ago 02:52
No original

Rapidreview

Paul Veal (age unknown) with 14cm upper quadrant mass (likely lymphoma) presented with acute deterioration secondary to aspiration pneumonia during Parkinsonian crisis, now requiring respiratory support and palliation following ITU review.
88 days ago 02:51
No original

Refined ultra rapid review

Paul Veal with newly diagnosed 14cm abdominal lymphoma presenting with acute deterioration, aspiration and respiratory failure secondary to Parkinsonian crisis.
88 days ago 02:50
No original

Refined clerking

Paul Veal, inpatient with newly diagnosed 14cm upper abdominal lymphoma presenting with acute respiratory failure secondary to aspiration pneumonia and Parkinsonian crisis.
88 days ago 00:18
No original

Refined clerking

86-year-old nursing home resident with vascular dementia presenting with acute anterolateral STEMI complicated by heart failure and pulmonary oedema, poor prognosis.
89 days ago 21:50
No original

Refined clerking

54-year-old gentleman with Type 2 diabetes presenting with euglycaemic diabetic ketoacidosis, likely dapagliflozin-induced, requiring intensive insulin therapy and diabetes type reassessment.
89 days ago 08:28
No original

Refined clerking

80-year-old lady with atrial fibrillation presenting with fast ventricular response (120-125 bpm) and problems with bisoprolol therapy causing bradycardia, considering switch to digoxin.
89 days ago 08:25
No original

Refined clerking

Patient with acute right-sided intracerebral haemorrhage causing left-sided weakness, requiring anticoagulation reversal and neurosurgical assessment.
89 days ago 07:58
No original

Refined clerking

Sarah presented with acute right-sided intracerebral haemorrhage causing left-sided neurological symptoms, requiring anticoagulation reversal and neurosurgical assessment.
89 days ago 04:11
No original

Refined clerking

73-year-old gentleman with recurrent sepsis secondary to transphincteric fistula and pelvic abscess, requiring IV antibiotics and surgical management.
89 days ago 03:30
No original

Refined rapid review

GP with new-onset neuropsychiatric symptoms including rigidity, tremor, incontinence and mobility issues following medication switch from sertraline to mirtazapine, requiring neurology and psychiatry review for possible parkinsonism vs medication-induced symptoms.
89 days ago 03:27
No original

Refined ultra rapid review

Patient with neuropsychiatric presentation including mobility issues, incontinence, and parkinsonian features following recent medication changes, requiring neurology and psychiatry review.
89 days ago 03:17
No original

Rapidreview

Elderly patient presenting with new-onset neurological symptoms including parkinsonian features, mobility issues, and incontinence following recent medication changes from sertraline to mirtazapine.
89 days ago 00:59
No original

Refined clerking

80-year-old gentleman with metastatic oesophageal adenocarcinoma presenting with worsening dysphagia and dehydration, found to have oropharyngeal candidiasis requiring antifungal treatment and IV rehydration.
89 days ago 00:05
No original

Rapidreview

Patient Sharon with fever documented in emergency department, plan includes repeat cultures and orthopaedic consultation.
90 days ago 23:06
No original

Refined clerking

Sharon Patient, post right total knee replacement, presenting with severe epigastric pain likely secondary to hiatus hernia/oesophagitis and ongoing right leg pain with recent DVT diagnosis.
90 days ago 09:49
No original

Rapidreview

Christine Rhodes with large vessel occlusion stroke, assessed overnight for thrombectomy but deemed unsuitable due to large core infarct on CT perfusion and baseline disability.
90 days ago 07:33
No original

Refined clerking

82-year-old lady with severe bilateral leg oedema and ulceration following hip surgery, likely multifactorial cause including cardiac failure and peripheral arterial disease.
90 days ago 05:23
No original

Refined clerking

78-year-old man with Alzheimer's disease presenting with melaena and syncope secondary to NSAID-induced peptic ulcer bleeding.
13 weeks ago 22:04
No original

Refined clerking

28-year-old woman with 3-week history of severe intermittent headaches and visual disturbance following flu-like illness, requiring CT venogram to exclude cerebral venous sinus thrombosis.
94 days ago 12:43
No original

Refined clinic letter

67-year-old lady with severe iron deficiency anaemia (Hb 30g/L) requiring blood transfusion and iron infusion, scheduled for bidirectional endoscopy to investigate source of blood loss.
94 days ago 12:34
No original

Refined clinic letter

67-year-old lady with severe iron deficiency anaemia (Hb 30 g/L) requiring 12 blood transfusions and iron infusion, scheduled for bidirectional endoscopy to investigate potential GI blood loss.
94 days ago 11:57
No original

Refined clinic letter

51-year-old lady with iron deficiency anaemia developing over several years, recently diagnosed following December 2025 STEMI admission. Plan for CT colonoscopy given recent cardiac stenting and dual antiplatelet therapy.
94 days ago 11:25
No original

Refined clinic letter

77-year-old man with new iron deficiency anaemia and positive qFIT, presenting with fatigue and previous melaena episode, requiring bidirectional endoscopy to exclude GI malignancy.
94 days ago 11:05
No original

Refined clinic letter

75-year-old lady with iron deficiency anaemia and positive qFIT test requiring bidirectional endoscopy to exclude gastrointestinal malignancy.
94 days ago 10:33
No original

Refined clinic letter

50-year-old lady with recurrent GI bleeding and positive H pylori following previous peptic ulcer disease, now requiring urgent endoscopy.
94 days ago 10:32
No original

Refined clinic letter

78-year-old lady with long-standing iron deficiency anaemia since 2024, metabolic syndrome, and recent ultrasound findings suggestive of liver cirrhosis requiring investigation to exclude malignancy.
94 days ago 10:31
No original

Refined clinic letter

84-year-old lady with coeliac disease and multiple food intolerances presenting with iron deficiency anaemia, likely dietary in origin, commenced on ferric maltol.
94 days ago 10:28
No original

Refined clinic letter

84-year-old lady with coeliac disease and iron deficiency anaemia, presenting with severely restricted diet due to multiple food intolerances, started on ferric maltol trial.
94 days ago 10:01
No original

Refined clinic letter

50-year-old lady with recurrent GI bleeding likely secondary to peptic ulceration with positive H. pylori, now requiring urgent upper GI endoscopy.
96 days ago 15:38
No original

Referral

60-year-old man with ATP1A3 gene mutation presenting with progressive dysphagia, 2 stone weight loss, and CT findings of likely advanced oesophageal carcinoma with metastases.
104 days ago 15:29
No original

Clinic letter

Patient with iron deficiency and rectal bleeding, background of spinal stenosis, underwent upper GI endoscopy and planned for CT colonography to exclude colorectal malignancy.
104 days ago 11:37
No original

Issues review

59-year-old man with decompensated alcohol-related liver disease presenting with CT evidence of partial small bowel obstruction and worsening ascites requiring drainage.
104 days ago 09:27
No original

Refined clinic supervision

91-year-old lady with 18-month history of dysphagia, weight loss, and volume reflux, suspected oesophageal dysmotility requiring urgent upper GI endoscopy.
104 days ago 09:27
No original

Refined clinic supervision

83-year-old fit and active man with new onset microcytic anaemia, low ferritin, positive FIT and change in bowel habits requiring upper and lower GI endoscopy.
104 days ago 09:10
No original

Clinic letter

71-year-old lady with severe COPD and alpha-1 antitrypsin deficiency presenting with cor pulmonale and poor prognosis (estimated 3 months).
104 days ago 06:38
No original

Refined clinic supervision

74-year-old lady with giant cell arteritis on steroids presenting with persistent iron deficiency and recent microcytosis, Hb 120 g/L, challenging to differentiate from anaemia of chronic disease.
104 days ago 06:30
No original

Refined clinic supervision

New referral for progressive microcytosis in patient with long-standing anaemia, breathlessness, and elevated FIT test requiring upper GI endoscopy and CT imaging.
104 days ago 06:28
No original

Refined clinic supervision

69-year-old lady with new iron deficiency anaemia, positive FIT, and recent rectal bleeding requiring CT imaging if iron responsive.
104 days ago 06:27
No original

Refined clinic supervision

88-year-old independent lady with long-standing anaemia, recent microcytosis and iron deficiency (ferritin 13) with folate deficiency, declining further investigations.
104 days ago 06:07
No original

Refined clinic supervision

Wayne Monday with learning disabilities presenting with iron deficiency anaemia and unprovoked DVT, requiring investigation with colonoscopy if iron deficiency persists after stopping supplementation.
15 weeks ago 17:45
No original

Refined clinic supervision

71-year-old lady with end-stage COPD, cor pulmonale, and incidental pancreatic cystic mass requiring gastroenterology assessment.
15 weeks ago 17:35
No original

Referral

71-year-old lady with end-stage COPD and alpha-1 antitrypsin deficiency, presenting with cor pulmonale and respiratory failure, with poor prognosis of approximately 3 months.
15 weeks ago 16:05
No original

Refined clinic supervision

76-year-old female with incidental finding of anaemia likely secondary to chronic disease rather than iron deficiency, related to recent pelvic fracture.
15 weeks ago 15:54
No original

Refined clinic supervision

87-year-old man with persistent anaemia despite iron supplementation, heart failure, and metallic aortic valve, requiring investigation for possible upper GI bleeding.
15 weeks ago 15:33
No original

Refined clinic supervision

96-year-old gentleman Frederick Young presenting with melena and falling haemoglobin (97→89), currently stable on PPI therapy with conservative management planned pending consultant review.
15 weeks ago 15:24
No original

Refined clinic supervision

Andrew McLoughlin presents with decompensated cirrhosis and alcohol-related hepatitis, bilirubin risen from 23 to 125, following pattern of alcohol cessation then resumption.
15 weeks ago 15:14
No original

Refined clinic supervision

77-year-old lady with AKI stage 3, developing anaemia with melaena and deranged liver function tests requiring endoscopy and CT imaging.
15 weeks ago 14:59
No original

Refined clinic supervision

16-year-old girl with 6-month history of diarrhoea and recent rectal bleeding, with iron deficiency anaemia requiring urgent gastroenterology assessment.
15 weeks ago 14:59
No original

Refined clinic supervision

91-year-old lady with dysphagia, 1.5 stone weight loss over 1.5 years, and significant reflux symptoms, suspected oesophageal dysmotility possibly achalasia.
15 weeks ago 14:58
No original

Refined clinic supervision

83-year-old fit gentleman with developing microcytic anaemia, low ferritin, elevated FIT (53 micrograms/gram) and change in bowel habits requiring investigation for possible GI malignancy.
15 weeks ago 14:57
No original

Refined clinic supervision

74-year-old lady with giant cell arteritis on steroids, presenting with persistent iron deficiency and recent microcytosis, Hb 120, requiring assessment for iron deficiency anaemia versus anaemia of chronic disease.
15 weeks ago 14:56
No original

Refined clinic supervision

68-year-old frail lady with PR bleeding, weight loss, and new microcytic anaemia. Plan for CT imaging rather than invasive investigations given poor functional status.
15 weeks ago 14:56
No original

Refined clinic supervision

69-year-old lady with new iron deficiency anaemia and positive FIT test, presenting with fatigue and recent episodes of rectal bleeding.
15 weeks ago 14:32
No original

Refined clinic supervision

88-year-old independent lady with iron deficiency anaemia (ferritin 13) and folate deficiency, declining invasive investigations - plan for blood tests and iron supplementation.
15 weeks ago 14:30
No original

Refined clinic supervision

Wayne Monday with learning disabilities and autism presenting with iron deficiency anaemia following unprovoked DVT, requiring investigation with potential colonoscopy under GA if iron deficiency persists.
111 days ago 16:57
No original

Endoscopy report

John Matthew (MRN: 1036832) presented with epigastric pain and early satiety, underwent upper GI endoscopy for diagnostic evaluation.
111 days ago 16:19
No original

Endoscopy report

60-year-old male with 6-month history of dysphagia and recent choking episode on water, undergoing upper GI endoscopy.
111 days ago 14:48
No original

Letter

71-year-old male with resolved upper GI symptoms and current chronic urinary retention causing abdominal bloating and flatulence, declining endoscopy.
111 days ago 14:46
No original

Endoscopy report

Victor Morgan (age not specified) with chronic urinary retention and associated abdominal discomfort/flatulence, likely urological rather than gastroenterological cause. Upper GI endoscopy declined.
115 days ago 16:20
No original

Meeting

Multiple gastroenterology follow-up consultations covering iron deficiency investigations, IBD management, and complex diagnostic cases requiring endoscopic and imaging follow-up.
118 days ago 19:45
No original

Refined clerking

54-year-old gentleman with known COPD presenting with 5-day history of progressive shortness of breath and chest pain, differentiating between COPD exacerbation and possible pulmonary embolism.
127 days ago 19:30
No original

Refined clerking

72-year-old man with rectal cancer on XELOX chemotherapy presenting with chemotherapy-induced diarrhoea and dehydration.
127 days ago 14:29
No original

Refined clerking

91-year-old gentleman with post-oesophageal stent pain, nausea and dehydration 3 days following stent insertion for T3N2M0 oesophageal adenocarcinoma.
128 days ago 20:59
No original

Refined clerking

53-year-old nurse lecturer presenting with right upper quadrant pain similar to previous gallstones, with raised liver enzymes suggesting possible retained stone post-cholecystectomy.
129 days ago 22:53
No original

Refined clerking

89-year-old man with falls and weakness, likely viral illness, CT head normal, mildly raised inflammatory markers.
129 days ago 19:06
No original

Refined clerking

89-year-old gentleman presenting with acute onset worst-ever headache, collapse, confusion, and tendency to lean right - requiring urgent neurological assessment.
129 days ago 14:26
No original

Endoscopy report

Mrs Harry presenting with dysphagia requiring positional changes to swallow, associated weight loss and anxiety, undergoing upper GI endoscopy to investigate swallowing difficulties and exclude coeliac disease.
130 days ago 20:01
No original

Issues review

Gentleman with Type 3 diabetes presenting with DKA following insulin supply interruption, also requiring diabetic foot team assessment for right big toe ulcer.
130 days ago 19:54
No original

Issues review

66-year-old gentleman Andrew Mathias with abnormal liver function tests showing cholestatic pattern (elevated ALP 185, bilirubin 64) requiring investigation and monitoring.
130 days ago 19:52
No original

Rapidreview

35-year-old lady at 35+4 weeks gestation presented with tachycardia and shortness of breath. Tachycardia resolved, ECG normal, very unlikely pulmonary embolism. Discharged with safety netting.
130 days ago 19:50
No original

Rapidreview

35-year-old lady at 35+4 weeks gestation with resolved tachycardia and positional shortness of breath, very unlikely pulmonary embolism.
130 days ago 19:45
No original

Rapidreview

35-year-old woman at 35+4 weeks gestation presented with tachycardia and positional shortness of breath, now resolved. Very unlikely pulmonary embolism with normal ECG and no concerning clinical features.
130 days ago 19:40
No original

Clerking

35-year-old lady at 35+4 weeks gestation presenting with resolved tachycardia and positional shortness of breath, very unlikely pulmonary embolism.
19 weeks ago 09:26
No original

Endoscopy report

Adult patient presenting with severe abdominal pain, food impaction symptoms, vomiting after meals, and 11kg weight loss over 4 months, undergoing upper GI endoscopy for investigation.
19 weeks ago 09:11
No original

Endoscopy report

Patient Benjamin with >10 years abdominal pain underwent repeat upper GI endoscopy with biopsies taken for coeliac disease and H. pylori testing.
134 days ago 21:49
No original

Rapidreview

Brooke Osborne with left lower zone community acquired pneumonia, increasing oxygen requirement despite early antibiotic treatment with IV co-trimoxazole and oral clarithromycin.
137 days ago 22:50
No original

Refined clerking

Young patient with newly diagnosed aggressive ulcerative colitis presenting with disease flare following infliximab discontinuation due to severe allergic reaction, requiring IV steroid therapy.
137 days ago 20:17
No original

Refined clerking

56-year-old man with extensive cardiac history presenting with refractory angina exacerbation requiring hospital admission for pain control and cardiology review.
138 days ago 21:03
No original

Sdec

35-year-old lady at 35+4 weeks pregnancy presenting with tachycardia and shortness of breath. Very unlikely pulmonary embolism, symptoms likely pregnancy-related.
150 days ago 16:27
No original

Rapidreview

80-year-old man with multiple comorbidities including heart failure and previous CABG, presenting with several months of intermittent melaena, planned for IV PPI therapy and endoscopy once stable.
150 days ago 16:23
No original

Rapidreview

79-year-old lady with Crohn's disease presenting with diarrhoea following medication change, requiring colesevelam restart and possible endoscopic investigation for CT-detected colonic inflammation.
151 days ago 21:40
No original

Refined clerking

66-year-old lady with recurrent dark vomiting secondary to gastric outlet obstruction from duodenal stricturing, second presentation within 2 weeks with nutritional anaemia.
151 days ago 21:23
No original

Rapidreview

George Clay requiring 15L oxygen with bilateral pneumonia, pulmonary oedema and AKI. DNAR in place but agreeable to ITU assessment for single organ support.
151 days ago 17:24
No original

Refined clerking

80-year-old gentleman presenting with haemoptysis and bilateral pneumonia requiring 7L oxygen, with background of diabetes, AF, and previous cardiac surgery.
151 days ago 15:45
No original

Refined clerking

42-year-old man with acute right-sided facial droop consistent with partial Bell's palsy, significant hypertension requiring investigation for secondary causes.
151 days ago 15:26
No original

Refined clerking

69-year-old gentleman with mechanical fall secondary to generalised weakness, now presenting with hypotension and community-acquired pneumonia requiring oxygen therapy and IV antibiotics.
151 days ago 10:54
No original

Refined clerking

Gareth Williams, 724400, presented with chest infection complicated by bradycardia in atrial fibrillation requiring atropine, with background of COPD and peripheral vascular disease.
152 days ago 19:45
No original

Refined clerking

Charlene Flynn with recurrent biliary colic post-cholecystectomy due to retained 8mm common bile duct stone requiring urgent ERCP.
152 days ago 18:47
No original

Refined clerking

61-year-old man with Type 3c diabetes presenting with DKA secondary to missed long-acting insulin doses over weekend, complicated by AKI and diabetic foot ulcer.
152 days ago 16:15
No original

Refined clerking

Jane Johnson presenting with psychiatric crisis diagnosed as bipolar manic episode with paranoid ideation, requiring admission while awaiting psychiatric placement.
152 days ago 14:15
No original

Refined clerking

84-year-old man with vascular dementia presenting with acute on chronic subdural hemorrhage, possibly following unwitnessed fall in care home.
152 days ago 11:46
No original

Refined clerking

84-year-old lady with dementia presenting with urinary retention and delirium, sustained subdural haemorrhage following fall in ED.
167 days ago 18:08
No original

Refined clerking

75-year-old lady with decompensated cardiac failure presenting with worsening shortness of breath over one week, with pulmonary oedema on chest X-ray.
167 days ago 17:34
No original

Rapidreview

Brooke Osborne with left lower zone community acquired pneumonia, CRP 266, requiring escalating oxygen therapy from nasal specs to Hudson mask.
167 days ago 15:28
No original

Refined clerking

Sharon McGrath with alcohol withdrawal syndrome, experiencing intermittent chest pains and increased tremor, managed with benzodiazepines and referred to Alcohol Care Team.
167 days ago 11:57
No original

Refined clerking

Right leg cellulitis and breathlessness. Has significant history of necrotising fasciitis (2010) and multiple comorbidities including heart failure and atrial fibrillation.
167 days ago 11:25
No original

Refined clerking

18-year-old man with staggered paracetamol overdose and self harm in context of known mental health conditions including autism, ADHD and depression.
167 days ago 09:21
No original

Refined clerking

80-year-old male with paroxysmal atrial fibrillation presenting with rapid ventricular response and runs of VT (rate 151 bpm), now improved to 100 bpm with bisoprolol.
167 days ago 08:34
No original

Refined clerking

Richard Pastewski, elderly gentleman with previous stroke, presented with severe headache and shortness of breath. Investigations show ACS with pulmonary oedema, though venous sinus thrombosis requires exclusion.
24 weeks ago 17:37
No original

Rapidreview

28-year-old male with emotionally unstable personality disorder following intentional venlafaxine overdose, expressing ongoing suicidal ideation and plan to take further overdose if discharged home.
24 weeks ago 17:15
No original

Rapidreview

77-year-old Mrs Mona Gee presenting with relapse of bipolar illness, currently very unwell and requiring inpatient psychiatric care with concurrent mild AKI.
24 weeks ago 16:52
No original

Refined clerking

82-year-old man with myelofibrosis and recent nephrostomy for obstructing ureteric calculus presenting with severe hyperkalemia (8.1) and ECG changes following recent fall.
24 weeks ago 16:50
No original

Refined clerking

82-year-old male with myelofibrosis and recent nephrostomy for obstructed left ureteral calculus, presenting with dangerous hyperkalaemia (K+ 8.1) following fall, now improving with shifting therapy.
24 weeks ago 15:05
No original

Refined clerking

Marjorie Rawlins, post-TAVI patient with COVID-19 pneumonitis and bilateral leg oedema following long-haul flight, requiring oxygen therapy and steroid treatment.
25 weeks ago 16:12
No original

Clinic letter

Retired gentleman presenting with 3-4cm pancreatic head mass consistent with adenocarcinoma, causing bile duct obstruction and significant weight loss.
25 weeks ago 14:21
No original

Custom

Leslie Johnson presented with vomiting and haematemesis, diagnosed with likely gastritis, responding well to PPI therapy and suitable for discharge with planned endoscopy.
25 weeks ago 13:30
No original

Referral

Leslie Johnson, age unknown, presented with vomiting and single episode of haematemesis, diagnosed with gastritis in context of alcohol-related liver disease.
179 days ago 17:53
No original

Email

44-year-old man Ian Beattie with metastatic melanoma on pembrolizumab presenting with change in bowel pattern from diarrhoea to complete bowel obstruction, concerning for ileus or complication of immunotherapy colitis.
179 days ago 17:51
No original

Email

44-year-old Mr BT with metastatic melanoma on pembrolizumab presenting with change in bowel pattern from diarrhoea to complete constipation, concerning for ileus or complications in setting of immunotherapy-related colitis.
26 weeks ago 08:47
No original

Clinic letter

Ms Natalie Pittman with Primary Sclerosing Cholangitis, clinically stable with successful weight loss, requiring restaging investigations including MRCP and MRI small bowel.
27 weeks ago 04:50
No original

Refined clerking

88-year-old man with empyema presenting with melaena in stoma bag and worsening sepsis with rising lactate, requiring antibiotic escalation and urgent OGD.
27 weeks ago 00:19
No original

Refined clerking

79-year-old lady with complete heart block secondary to digoxin toxicity, requiring isoprenaline infusion and CCU monitoring.
190 days ago 06:34
No original

Refined clerking

76-year-old lady with severe hyponatraemia (114 mmol/L) secondary to indapamide, presenting with anxiety, confusion, and cognitive impairment.
190 days ago 05:17
No original

Refined clerking

68-year-old gentleman with metastatic breast cancer and recent multiple fractures presenting with acute pulmonary oedema, responding well to diuretic treatment.
190 days ago 03:54
No original

Refined clerking

88-year-old lady with advanced Alzheimer's dementia presenting with convulsive status epilepticus, now in prolonged postictal phase with aspiration pneumonia and new atrial fibrillation.
190 days ago 01:04
No original

Refined clerking

75-year-old lady with metastatic small cell lung carcinoma presenting with 2-day deterioration and left lower lobe pneumonia, now requiring terminal palliative care.
191 days ago 21:52
No original

Refined clerking

75-year-old lady with metastatic small cell lung carcinoma presenting with terminal deterioration, left lower lobe pneumonia, and profound electrolyte abnormalities.
191 days ago 21:40
No original

Issues review

Patient with worsening thrombocytopenia (platelets 21) and active epistaxis, deteriorating AKI, and raised inflammatory markers (CRP 400) with unknown source of infection.
191 days ago 21:16
No original

Refined clerking

94-year-old lady with atrial fibrillation presenting with fast ventricular response following recent hospitalisation for tibial plateau fracture, requiring IV digoxin for rate control.
191 days ago 20:24
No original

Issues review

Recurrent functional dyspepsia and GORD presenting with regurgitation symptoms, currently under active gastroenterology follow-up.
191 days ago 06:27
No original

Refined clerking

72-year-old female with previous cerebral abscess presenting with hypotension secondary to atrial fibrillation, dehydration, and possible UTI.
191 days ago 04:20
No original

Refined clerking

88-year-old gentleman with dementia presenting with UTI/sepsis, developed flash pulmonary oedema post-fluid resuscitation, now stable on NIV with ceiling of care agreed.
191 days ago 00:46
No original

Refined clerking

69-year-old lady with alcoholic cirrhosis presenting with drowsiness and decompensation secondary to enlarging pelvic sidewall collection with possible bowel ischaemia and encephalopathy.
28 weeks ago 06:19
No original

Refined clerking

Leon Gardiner, 20 year-old man with Duchenne muscular dystrophy presenting generally unwell. UTI with possible infected obstructed kidney requiring IV antibiotics and multidisciplinary input.
28 weeks ago 06:17
No original

Refined clerking

Leon Gardiner presents with general unwellness and weakness secondary to UTI with E. coli in the context of advanced Duchenne muscular dystrophy, complicated by possible obstructed kidney and poor nutritional status.
28 weeks ago 04:59
No original

Refined clerking

75-year-old male with hospital-acquired pneumonia following recent pleural effusion drainage, presenting with productive cough and clinical deterioration.
28 weeks ago 00:41
No original

Refined clerking

Elderly male patient with mixed dementia presenting with confusion and dark urine, suspected urinary tract infection.
28 weeks ago 00:18
No original

Refined clerking

100-year-old female from residential care with 3 days of severe headache and transient neurological symptoms, possible small lacunar infarct or TIA.
197 days ago 23:59
No original

Refined clerking

100-year-old nursing home resident with headache and possible atypical stroke presentation, multiple comorbidities including AF not anticoagulated.
197 days ago 21:55
No original

Refined clerking

Retired gentleman with metastatic prostate cancer presenting with second episode of upper GI bleeding (melaena) and raised inflammatory markers requiring urgent endoscopy and septic screen.
197 days ago 06:22
No original

Refined clerking

59-year-old female presented with witnessed collapse and 15-20 minute loss of consciousness requiring CPR, now complaining of severe headache. Investigations pending to exclude cardiac and neurological causes.
197 days ago 04:48
No original

Refined clerking

Marie Brown attended for routine medication review with complex polypharmacy including treatment for COPD, atrial fibrillation, and epilepsy.
197 days ago 01:18
No original

Refined clerking

Roger Harvey with end stage renal disease presenting with ongoing fresh red PR bleeding causing hypotension, likely secondary to CKD-related vasculopathy.
197 days ago 01:09
No original

Rapidreview

Roger Harvey (758387) presenting with fresh red PR bleeding on background of end-stage renal disease and multiple cardiac comorbidities, likely secondary to vasculopathy from CKD.
198 days ago 22:17
No original

Refined clerking

73-year-old lady with pancreatic head mass causing biliary obstruction, likely pancreatic adenocarcinoma requiring urgent ERCP and surgical evaluation.
198 days ago 22:03
No original

Refined clinic letter

73-year-old lady presenting with obstructive jaundice secondary to 24mm pancreatic head mass, likely adenocarcinoma requiring urgent ERCP and staging investigations.
198 days ago 20:55
No original

Refined clerking

68-year-old lady with recent paroxysmal atrial fibrillation presenting with exertional chest pain concerning for stable angina, GRACE score 95.
198 days ago 07:23
No original

Refined clerking

81-year-old gentleman with fall and shortness of breath secondary to infective exacerbation of bronchiectasis with background of recurrent falls and suspected heart failure.
199 days ago 06:22
No original

Refined clerking

Deborah Daymond, patient on chemotherapy for breast cancer, presenting with left-sided community acquired pneumonia and neutropenia.
199 days ago 03:39
No original

Refined clerking

Derek Davies, elderly gentleman with history of prostate cancer, presented with transient speech disturbance and generalised weakness lasting several hours, consistent with TIA, now resolved.
200 days ago 22:06
No original

Refined clerking

86-year-old man with bronchiectasis presenting with 3-day history of worsening breathlessness, found to have symptomatic Mobitz type 2 heart block with bradycardia of 36 bpm.
208 days ago 11:33
No original

Referral

Patient with severe gastroenteritis presenting with profuse watery diarrhoea and abdominal pain, currently taking Mounjaro, with reactive lymphadenopathy on imaging but no acute surgical pathology identified.
214 days ago 11:24
No original

Refined clinic letter

Mark Barratt presents with early portal hypertension and portal gastropathy following investigation for melaena, with underlying severe hepatic steatosis.
214 days ago 11:22
No original

Refined clinic letter

49-year-old male with chronic Hepatitis B on Entecavir therapy, viral load undetectable, attending for routine monitoring and assessment of mild fatigue.
214 days ago 11:21
No original

Refined clinic letter

Mrs Julia Stone, presenting with functional dyspepsia and suspected GORD following weight loss episode earlier this year, now stabilised on Gaviscon therapy.
214 days ago 11:20
No original

Refined clinic letter

Ms Allison Dayman with chronic liver disease under transplant assessment, recently had spironolactone discontinued due to resolved ascites, requires HCC surveillance and coordination between multiple liver teams.
214 days ago 10:12
No original

Refined clinic letter

86-year-old gentleman with resolved cholestatic liver function tests, likely due to passed stone or drug reaction, with spinal stenosis as primary concern requiring pain management.
214 days ago 09:05
No original

Refined clinic letter

Mrs Pamela Reddy, 66 years old, with well-controlled autoimmune hepatitis on azathioprine presenting with fatigue and new lipomas.
221 days ago 09:46
No original

Refined clerking

48-year-old lady with ulcerative colitis presenting with severe flare (8-9 watery stools daily) and possible mercaptopurine-induced pancreatitis, requiring IV steroids and admission.
34 weeks ago 03:25
No original

Refined clerking

79-year-old gentleman with acute deterioration, fever and weakness, diagnosed with community acquired pneumonia on background of asbestos-related lung disease.
239 days ago 22:27
No original

Refined clerking

41-year-old man with autoimmune hepatitis and cirrhosis presenting with acute cholangitis secondary to choledocholithiasis, complicated by accidental paracetamol overdose.
239 days ago 07:23
No original

Refined clerking

91-year-old male presenting with fall and acute delirium, likely secondary to underlying infection, requiring admission for investigation and treatment.
239 days ago 07:21
No original

Refined clerking

91-year-old man presenting with fall and acute delirium on background of increasing confusion over past 3 weeks, with slightly raised infection markers suggesting possible UTI or chest infection as trigger.
239 days ago 03:34
No original

Refined clerking

89-year-old gentleman with known coronary artery disease presenting with 12-month history of worsening chest pain and dyspnoea, likely unstable angina requiring cardiac assessment.
239 days ago 00:58
No original

Refined clerking

98-year-old lady presenting with 2-3 days of new cough, white sputum production and left-sided chest pain consistent with community-acquired pneumonia.
240 days ago 23:22
No original

Refined clerking

Elderly lady with COPD presenting with worsening wheeze and productive cough, diagnosed with infective COPD exacerbation versus decompensated CCF.
241 days ago 15:51
No original Cannot regen (missing thread/transcript)

No thread
241 days ago 15:50
No original Cannot regen (missing thread/transcript)

No thread
241 days ago 15:42
No original Cannot regen (missing thread/transcript)

No thread
243 days ago 02:54
No original

Refined clerking

Elderly gentleman with lung adenocarcinoma on maintenance chemotherapy, presenting with acute shortness of breath and community acquired pneumonia.
243 days ago 01:06
No original

Refined clerking

70-year-old female with known glioblastoma post-craniotomy presenting with fall and imaging showing GBM progression with cerebral oedema and herniation.
244 days ago 22:01
No original

Letter

80-year-old frail nursing home resident Linda Mays with infectious gastroenteritis developed severe hypokalaemia (K+ 2.3) and AKI 1. Family opted for nursing home treatment rather than hospital admission.
35 weeks ago 06:03
No original

Refined clerking

86-year-old lady with accelerated hypertension secondary to fluid overload and heart failure with preserved ejection fraction, treated with furosemide and planned for same-day discharge.
35 weeks ago 05:24
No original

Refined clerking

34-year-old lady with new onset recurrent severe vomiting episodes throughout 2025, ?cyclical vomiting syndrome.
35 weeks ago 04:35
No original

Refined clerking

85-year-old lady with chest pain and shortness of breath, diagnosed with NSTEMI and community acquired pneumonia.
247 days ago 06:28
No original

Refined clerking

86-year-old man with myelodysplastic syndrome presenting with shortness of breath secondary to hospital-acquired pneumonia with significant neutropenia and immunocompromise.
247 days ago 02:45
No original

Refined clerking

67-year-old man with alcohol misuse disorder presenting after 9-day binge following 100 days sobriety, with alcohol-related gastritis and lactic acidosis.
247 days ago 00:31
No original

Refined clerking

89-year-old man with fall through glass door causing head lacerations, admitted for observation following presyncope episode. Background of frailty, peripheral oedema and CKD stage 3.
248 days ago 23:00
No original

Clerking

59-year-old female with hypertensive crisis (BP 230/80) during elective gynaecological surgery, likely due to inadequate BP control and recent stress. Surgery postponed pending optimisation.
256 days ago 18:00
No original

Sdec

Middle-aged gentleman with type 2 diabetes and previous coronary stents presenting with 4-day history of left shoulder and chest wall pain, likely musculoskeletal in origin.
256 days ago 12:29
No original

Sdec

77-year-old man with small peripheral pulmonary emboli requiring anticoagulation, complicated by iron deficiency anaemia of uncertain cause.
256 days ago 11:15
No original

Sdec

49-year-old lady with recent myocarditis and pulmonary embolism presenting with chest pain and severe anxiety, likely related to viral myocarditis and significant psychosocial stressors.
256 days ago 09:20
No original

Refined clerking

Mr Kevin Ridge, retired RAF serviceman with complex medical history including previous sepsis and permanent pacemaker, presenting with 3-week history of progressive breathlessness due to atrial fibrillation with fast ventricular response and acute heart failure.
257 days ago 12:21
No original

Sdec

74-year-old lady presenting with 6-month history of lethargy and recent deterioration, found to have significantly deranged liver function tests with cholestatic picture, awaiting CTTAP..
257 days ago 12:10
No original

Sdec

Mrs Armstrong, a hypertensive patient, presented with atypical chest pain. Diagnosis: atypical chest pain with uncontrolled hypertension requiring further cardiac assessment.
257 days ago 11:22
No original

Sdec

Young man presenting with infectious mononucleosis causing jaundice, abdominal pain, and constitutional symptoms with elevated bilirubin.
257 days ago 10:23
No original

Sdec

81-year-old lady with resolving COPD exacerbation and abdominal pain, likely secondary to drug-induced liver injury from levofloxacin, with incidental finding of gallbladder adenomyomatosis.
258 days ago 17:03
No original

Sdec

Anthony presented with collapse in bank this morning. Previous similar episode 2 years ago. Plan for Holter monitor, CT head and postural BP measurements.
258 days ago 09:48
No original

Sdec

67kg marine engineer with 4-week upper abdominal discomfort and recent melaena episode, likely oesophagitis/gastritis secondary to GORD rather than significant GI bleeding.
37 weeks ago 16:16
No original

Sdec

Patient with lower gastrointestinal bleeding presenting with 3-4 day history of dark stools with blood and significant haemoglobin drop from 94 to 79 g/L, likely secondary to colonic angiodysplasia.
37 weeks ago 16:00
No original

Sdec

Patient presenting with 3-4 day history of mixed rectal bleeding and morning malaise, requiring urgent investigation for lower GI bleeding.
37 weeks ago 14:12
No original

Sdec

Mark Berbery presented with right popliteal vein DVT, commenced on Rivaroxaban with plan for 6-month anticoagulation course.
37 weeks ago 12:49
No original

Sdec

Lauren Goodinson Powell presented with post-traumatic numbness and tingling in her hand following recent trauma, with possible radial nerve neuropraxia and improving liver markers.
37 weeks ago 12:47
No original

Sdec

Lauren Goodinson Powell presented with post-traumatic numbness in her hand following extensive trauma, with preserved motor function but altered sensation requiring neurology review.
37 weeks ago 08:54
No original

Sdec

Sarah Pike (MRN 764467) presented with acute chest pain and ongoing abdominal pain. Past history of PE and Factor V Leiden deficiency. Query PE versus musculoskeletal pain.
272 days ago 14:56
No original

Refined clinic letter

Miss Pickering with 6 months of GORD symptoms, significant weight loss (15 to 11 stone), and altered bowel habit requiring colonoscopy investigation.
272 days ago 11:59
No original

Refined clinic letter

Patient with long-standing change in bowel habit and weight loss of uncertain cause, with episodic loose stools every 3 weeks lasting 12-24 hours with associated vomiting. Recent investigations rule out coeliac disease despite positive HLA DQ2.
272 days ago 11:34
No original

Refined clinic letter

Mrs Ugaldi with functional dyspepsia, IBS-C and GORD, started on Senna 15mg nocte with patient-initiated follow-up arranged.
272 days ago 10:01
No original

Refined clinic letter

49-year-old lady with newly diagnosed eosinophilic oesophagitis presenting with dysphagia and throat swelling, commenced on budesonide orodispersible therapy.
272 days ago 09:25
No original

Refined clinic letter

Mr Colin Wilkinson with probable naproxen-related enteropathy who has made full recovery since stopping anti-inflammatory medications and is being discharged from gastroenterology clinic.
272 days ago 09:10
No original

Refined clinic letter

Ms Conway, patient with pancreatic exocrine insufficiency, presented with sharp upper abdominal pain and loose stools after stopping Creon 4 weeks ago, with erratic blood sugars noted on Libre monitoring.
272 days ago 08:41
No original

Refined clinic letter

41-year-old lady with suspected Crohn's disease presenting with chronic diarrhoea, abdominal pain, joint symptoms, and raised faecal calprotectin requiring urgent colonoscopy and MRI small bowel.
281 days ago 16:03
No original

Clerking

56 year-old lady on haemodialysis presenting with 2-day history of haemoptysis and dyspnoea with suspected pulmonary embolism.
281 days ago 15:53
No original

Sdec

Sylvia Lingu, haemodialysis patient presenting with 2-day history of haemoptysis and dyspnoea, suspected pulmonary embolism with elevated D-dimer.
281 days ago 14:20
No original

Sdec

Mr Richard Greenwood presented with 2-day history of right calf pain and swelling, suspected deep vein thrombosis with raised D-dimer.
281 days ago 13:13
No original

Refined results letter

liver ultrasound surveillance results showing stable appearances with no evidence of hepatocellular carcinoma in patient with metabolic liver disease.
281 days ago 11:31
No original

Refined clerking

37-year-old military serviceman with 8-month history of severe upper abdominal pain and vomiting (30+ episodes daily), 10kg weight loss, and functional impairment, most likely functional dyspepsia with IBS.
281 days ago 11:15
No original

Refined clerking

37-year-old military personnel with 8-month history of severe upper abdominal pain and progressive vomiting (up to 30 times daily), diagnosed with functional dyspepsia and severe constipation.
281 days ago 09:19
No original

Sdec

61-year-old man with chest pain, normal cardiac investigations, incidental finding of low platelets and haemoglobin - possibly related to Lithium use.
282 days ago 14:07
No original

Sdec

Ms Drayton reviewed in SDEC for bilateral lower limb cellulitis with antibiotic escalation to flucloxacillin and warfarin dose adjustment.
282 days ago 09:58
No original

Sdec

Young computing student presenting with 2-month history of abdominal pain, headaches, and recent melaena, suspected peptic ulcer disease secondary to high-dose NSAID therapy.
282 days ago 09:35
No original

Sdec

65-year-old female with several months history of paroxysmal tachycardia and exercise intolerance. Raised D-dimer warrants exclusion of chronic pulmonary embolism.
282 days ago 09:26
No original

Sdec

Carolyn Thomas presents with exertional tachycardia reaching 150-160 bpm with minimal exercise and previous episodes of unexplained resting tachycardia in 2021.
283 days ago 16:26
No original

Sdec

80-year-old man presenting with 24-hour history of left leg swelling and pain below the knee, suspected Baker's cyst rupture.
283 days ago 16:17
No original

Sdec

80-year-old man presenting with acute left leg swelling and pain, suspected ruptured Baker's cyst or Achilles tendon injury, referred for orthopaedic assessment.
283 days ago 14:50
No original

Custom

Patient with atrial flutter causing heart failure symptoms, currently on bisoprolol with good symptom control but medication side effects, planned for hospital admission for cardioversion and electrophysiology assessment.
283 days ago 14:21
No original

Clerking

Scott Powell, young male with atrial flutter since May 2025, presenting with inadequate rate control despite optimal beta-blockade, requiring admission for rate control and cardiology review.
283 days ago 14:17
No original

Meeting

Scott Powell requiring cardiology admission for rate control with stepped approach using bisoprolol then digoxin if needed.
283 days ago 14:03
No original

Sdec

35-year-old male with atrial flutter since May 2025, persistent tachycardia (146 bpm) despite Bisoprolol 5mg OD, now with hypotension and ankle oedema.
283 days ago 13:12
No original

Sdec

33-year-old lady with fever, haemoptysis and back pain. Normal inflammatory markers suggest viral URTI rather than bacterial pneumonia.
283 days ago 12:44
No original

Email

Patient initially well for discharge but developed cholangitis requiring inpatient antibiotics and urgent ERCP consideration.
283 days ago 12:43
No original

Email

Patient initially planned for discharge has developed cholangitis requiring inpatient antibiotics and urgent ERCP consideration.
283 days ago 12:29
No original

Email

This appears to be a correspondence regarding training day organisation rather than a patient consultation.
283 days ago 12:25
No original

Notes

Jacqueline Venn requires follow-up communication with Dr Vine regarding OGD results for potential ERCP consideration.
283 days ago 11:52
No original

Sdec

33-year-old lady with ADHD and asthma presenting with 3-day history of fever, haemoptysis, and acute asthma exacerbation, diagnosed with lower respiratory tract infection.
283 days ago 11:20
No original

Sdec

Mr Trevathan presented with concerns of right leg DVT which was excluded on ultrasound. Bilateral lower limb oedema secondary to congestive cardiac failure, switching diuretic therapy.
283 days ago 08:51
No original

Sdec

36-year-old lady at 25 weeks gestation presenting with 3-week history of pleuritic chest pain and dyspnoea, being investigated for possible pulmonary embolism with VQ scan.
283 days ago 07:55
No original

Refined results letter

Barry Jones (MRN: 800278) - colonoscopy results showing scattered small bowel ulcers with mild inflammation but no evidence of IBD.
283 days ago 07:45
No original

Refined results letter

Results letter for Dennis Dodds regarding blood test monitoring while on Colazide - kidney and liver function normal with borderline low potassium.
283 days ago 07:35
No original

Refined results letter

Results letter for Angela Palford regarding blood tests showing low vitamin D (58 nmol/L) with normal thyroid function and other parameters.
285 days ago 16:40
No original

Notes

Jacqueline Venn - update required for Dr Vine regarding patient status.
286 days ago 08:09
No original

Refined results letter

Results letter for Linda Pierce following normal colonoscopy with reassuring histology showing no inflammation or pathological abnormality.
286 days ago 08:03
No original

Refined results letter

Diane Freud with flexible sigmoidoscopy showing active ulcerative colitis flare, biopsies confirming inflammation with no sinister changes.
290 days ago 10:40
No original

Refined clinic letter

Mrs Herriman with stable Crohn's disease and end ileostomy, concerned about bone health following previous osteopenia diagnosis 5 years ago.
290 days ago 10:17
No original

Refined clinic letter

28-year-old gentleman with 6-month history of loose stools, weight loss and fatigue with elevated inflammatory markers, investigating for suspected inflammatory bowel disease.
290 days ago 09:52
No original

Refined clinic letter

Mr Matthew Parnell with ulcerative colitis (2008) and PSC, currently well controlled on Pentasa with recent normal colonoscopy showing two benign polyps removed.
290 days ago 09:33
No original

Refined clinic letter

Mr Martin Warnecki with distal ulcerative colitis diagnosed March 2023, DNA
290 days ago 09:24
No original

Refined clinic letter

58-year-old man with Crohn's disease (diagnosed 1988) presenting with occasional tenesmus and colicky abdominal pain episodes, requiring surveillance colonoscopy.
290 days ago 08:56
No original

Refined clinic letter

45-year-old gentleman with extensive colitis (IBD-U) diagnosed 2005, currently in remission with last flare in 2017. Restarted on Salofalk for cancer risk reduction and planned for surveillance colonoscopy.
290 days ago 08:35
No original

Refined clinic letter

82-year-old lady with ulcerative colitis (total colectomy 2004) presenting with reflux symptoms secondary to hiatus hernia, managed conservatively with lifestyle measures and acid suppression.
292 days ago 11:53
No original

Endoscopy report

Ross Eldaran presented with melaena and dark vomitus. Upper GI endoscopy revealed hemorrhagic and erosive gastritis with duodenitis but no active bleeding source. Incidental rectal mass found on examination.
292 days ago 11:31
No original

Rapidreview

Trevor Hookway developed symptomatic hypertension (BP 234/105) with vomiting and ECG changes following upper GI endoscopy, attributed to missed morning Lisinopril dose.
293 days ago 20:00
No original

Rapidreview

Elderly male patient with deranged liver function tests and clinical jaundice, suspected choledocholithiasis on biochemistry but ultrasound non-diagnostic due to hepatic steatosis.
293 days ago 18:03
No original

Issues review

John Botterall presenting with acute obstructive jaundice (likely choledocholithiasis) requiring urgent lower limb bypass surgery for chronic limb ischaemia.
293 days ago 17:37
No original

Custom

89-year-old lady with decompensated heart failure, community acquired pneumonia, and possible UTI with urinary retention leading to fluid overload and respiratory compromise.
293 days ago 16:58
No original

Met call

Patient collapsed following mobilisation with postural hypotension, likely secondary to dehydration and antihypertensive medication effect.
293 days ago 14:41
No original

Referral

Gentleman with 60-year smoking history presenting with progressive exertional dyspnoea since October and productive cough, with bronchiectasis found on CT scan and concerning right leg swelling.
42 weeks ago 18:39
No original

Clerking

Mr Paul Smith (age not specified) presents with 6-month history of recurrent infective exacerbations of bronchiectasis with progressive breathlessness, bilateral leg swelling, and low oxygen saturations requiring admission for investigation of possible PE, CCF or malignancy.
42 weeks ago 18:29
No original

Clerking

Retired primary school teacher with 6-month history of recurrent chest infections and progressive breathlessness, likely bronchiectasis with possible PE or cardiac failure.
42 weeks ago 17:56
No original

Rapidreview

Aiden Breuford presented with sensation of food going down the wrong way whilst eating, causing pharyngeal pain and globus sensation - suspected food debris in larynx causing airway irritation.
42 weeks ago 13:23
No original

Results letter

Results letter for Gareth Tookey regarding liver surveillance ultrasound showing no evidence of hepatocellular carcinoma with mild hepatomegaly.
298 days ago 20:59
No original

Notes

Patient with jaundice and significantly elevated ALT 1584 requiring urgent contact and assessment.
298 days ago 19:45
No original Cannot regen (missing thread/transcript)

No thread
298 days ago 19:02
No original

Refined clerking

70-year-old lady with alcohol use disorder presenting with haematemesis and lactic acidosis, requiring admission for alcohol withdrawal management and monitoring.
298 days ago 18:20
No original

Rapidreview

Mrs Brenda Ganter with multifactorial seizures secondary to old stroke, severe hyponatraemia (Na+ 113), and infection requiring Level 1 care.
298 days ago 18:19
No original

Rapidreview

Mark Yeo with repeat blood gas showing improved pH 7.364 and PCO2 8.2 kPa following optimal medical management, with oncology review planned.
298 days ago 16:15
Original saved

Refined clerking

52-year-old gentleman with COPD and kyphoscoliosis presenting with type 2 respiratory failure secondary to acute exacerbation and chest wall deformity.
298 days ago 14:25
No original

Refined clerking

78-year-old lady with long-standing Type 1 diabetes presenting with hypoglycaemia followed by diabetic ketoacidosis after omitting insulin doses.
298 days ago 13:25
No original

Refined clerking

82-year-old gentleman with COPD exacerbation and Addisonian crisis secondary to underlying panhypopituitarism, showing improvement with steroid treatment.
298 days ago 10:39
No original

Refined clerking

84-year-old man with multiple comorbidities presented with witnessed 15-minute unresponsive episode at home, found to have symptomatic bradycardia due to slow AF causing type 2 MI, also has fluid overload and severe iron deficiency anaemia.
298 days ago 10:16
No original

Refined clerking

84-year-old man with syncopal episode secondary to fast AF, presenting with iron deficiency anaemia, AKI on CKD, and fluid overload with pleural effusion requiring oxygen therapy.
298 days ago 08:14
No original

Handover

Informal staff discussion regarding an unidentified patient with Lennox-Gastaut syndrome on multiple anti-epileptic medications who experienced multiple seizures.
299 days ago 19:06
No original

Handover

Blood test results review for 4 patients with various renal function abnormalities requiring follow-up calls and documentation.
299 days ago 18:54
No original

Referral

75-year-old patient Marilyn Optin referred for in-person clinical review.
299 days ago 18:24
No original

Referral

Post-operative patient with hospital-acquired pneumonia and severe constipation causing respiratory compromise.
299 days ago 17:24
No original

Rapidreview

Post-operative spinal surgery patient with sepsis of unknown origin (presumed pneumonia) and significant constipation secondary to opiate analgesia.
299 days ago 17:16
No original

Handover

54-year-old Mr Gibbons with decompensated cirrhosis and multiple myeloma, post-TIPS procedure complicated by portal vein thrombosis and active bleeding into gallbladder secondary to bile duct injury.
299 days ago 17:14
No original

Met call

Patient experienced transient loss of consciousness and hypotension during dialysis, resolved with cessation of treatment after 2.5 hours of planned 3-hour session.
299 days ago 17:07
No original

Met call

Patient with long bone fracture 5 days ago presenting with deteriorating respiratory function, requiring 80% oxygen with type 2 respiratory failure, likely secondary to pulmonary contusion with differentials including PE and fat embolism.
299 days ago 15:15
No original

Met call

Emergency assessment of patient Liam with altered consciousness, found to have voluntary neurological movements rather than seizure activity, requiring ongoing monitoring and investigation.
299 days ago 14:47
No original

Met call

Patient with recent seizure and past history of gastric cancer requiring urgent head CT to exclude cerebral metastases.
299 days ago 13:28
No original

Met call

Patient with 3-week history of worsening dyspnoea, pericardial effusion drained (400ml+) but persistent hypotension requiring urgent cardiac imaging and cardiology input.
299 days ago 13:20
No original

Met call

Admitted 7th June with bilateral pneumonia, showing severe respiratory deterioration requiring high-flow oxygen with decision made to transition to palliative care following family discussion.
299 days ago 12:31
No original

Refined results letter

Results letter for Linda Pearce following normal colonoscopy with biopsies taken to investigate microscopic colitis, awaiting histology results.
299 days ago 12:18
No original

Refined results letter

Results letter for Patricia Nettleship following colonoscopy showing mild sigmoid diverticular disease with no polyp regrowth, discharged from gastroenterology care.
299 days ago 12:05
No original

Met call

Post-operative patient with necrotising pancreatitis and pancreatic-colonic fistula, now day 5 post defunctioning ileostomy, presenting with septic shock and new retroperitoneal collection.
299 days ago 10:18
No original

Met call

72-year-old male presented with acute deterioration due to cardiac tamponade from large pericardial effusion, requiring urgent pericardiocentesis.
299 days ago 08:57
No original

Met call

Post-ictal patient with known epilepsy who had generalised tonic-clonic seizure on surgical ward. History of small bowel obstruction and previous hyponatraemia.
311 days ago 17:03
No original

Meeting

33-year-old male with persistent vomiting and food intolerance since laparoscopic cholecystectomy, currently tolerating liquids only. Imaging to date unremarkable. Plan for patency capsule study to investigate possible distal small bowel obstruction.
311 days ago 15:15
No original

Referral

Gentleman with progressive vomiting and inability to tolerate solids 10 months post-cholecystectomy, with imaging suggesting possible partial small bowel obstruction.
311 days ago 11:45
No original

Clinic letter

Diane Froude is a patient with left-sided ulcerative colitis diagnosed in 2022, currently experiencing a moderate flare with bloody diarrhoea 6 times daily, requiring steroids and 5-ASA suppositories whilst awaiting urgent flexible sigmoidoscopy to guide further management.
311 days ago 11:14
No original

Clinic letter

41-year-old man with ulcerative proctitis diagnosed in 2012, experiencing 1-2 stress-related flares per year with PR bleeding and left iliac fossa pain, well controlled with Pentasa suppositories.
311 days ago 10:53
No original

Clinic letter

Patient with ileal Crohn's disease post ileocaecal resection 1997, now with neoterminal ileal stricture and bile acid malabsorption, presenting with 10x daily loose stools and right-sided abdominal pain.
311 days ago 10:25
No original

Clinic letter

Mr Randall has extensive ulcerative colitis diagnosed in 2017, currently well controlled on Octasa 1.6g daily with quiescent disease on last colonoscopy in 2018, now due surveillance colonoscopy.
311 days ago 09:59
No original

Clinic letter

Mr Dodds is a gentleman with ulcerative colitis diagnosed in 1977, recently returned to Plymouth, experiencing mild flare symptoms managed by increasing Balsalazide dose, requiring routine colonoscopy surveillance and annual follow-up.
311 days ago 09:27
No original

Clinic letter

Mrs Harvey, a lady with terminal ileal Crohn's disease since the 1990s, most recently had ileocaecal resection in January 2024 but continues to have significant diarrhoea with urgency (10-15 times daily) and recent colonoscopy shows active disease at the anastomosis.
311 days ago 08:38
No original

Clinic letter

Mr Jones, a bus driver with previous ileocaecal resection, has bile acid malabsorption causing loose stools 2-3 times daily, well controlled with colesevelam which can be increased to effect.
311 days ago 06:21
No original

Results letter

Patient with liver cirrhosis showing improvement on surveillance ultrasound with reduction in splenomegaly from 17.7cm to 15.4cm, suggesting decreased portal hypertension.
311 days ago 06:20
No original

Results letter

Patient with known metabolic liver disease showing fatty infiltration on ultrasound scan, requiring ongoing 6-monthly surveillance with no evidence of complications.
312 days ago 18:57
No original

Results letter

Patient with endoscopic evidence of stomach inflammation, H. pylori stool antigen test negative, currently on doubled dose of antacid therapy.
312 days ago 12:47
No original

Notes

Patient with likely Crohn's disease currently on intensive care with significant electrolyte abnormalities, also has child in neonatal intensive care.
312 days ago 11:14
No original

Referral

Ms Clements with complex Crohn's colitis and defunctioned ileoanal pouch presenting with 7-day history of abdominal pain, ongoing enteritis on CT unchanged from February, possible adalimumab failure requiring therapeutic drug monitoring and consideration of MRI small bowel.
312 days ago 10:41
No original

Referral

Complex Crohn's patient with defunctioned ileoanal pouch presenting with abdominal pain, CT showing unchanged enteritis and known stricture, planning therapeutic drug monitoring and infectious workup.
312 days ago 10:07
No original

Referral

85-year-old gentleman with radiation proctopathy following prostate cancer treatment, presenting with collapse secondary to anaemia from PR bleeding and type 2 MI.
312 days ago 10:05
Original saved

Referral

Patient with coffee ground vomiting, Glasgow-Blatchford score 0, unlikely GI bleeding - advised to investigate for gastric outlet obstruction or other causes of stagnant vomiting.
314 days ago 15:01
Original saved

Email

Administrative email regarding annual leave cancellation and new leave requests.
316 days ago 01:36
Original saved

Clerking

31-year-old male with type 1 diabetes presenting with diabetic ketoacidosis following garage explosion causing flash burns, on background of alcohol excess and self-neglect.
316 days ago 01:06
Original saved

Clerking

```json { "mrn": "F882284", "content": "Medical ST4 Miller Clerking\n\nPresenting Complaint:\nDecreased responsiveness, noisy breathing\n\nHistory of Presenting Complaint:\nFound unwell by care staff this morning. Less responsive with noisy breathing. Known aspiration risk. Only responsive to pain with ambulance crew, hypoxic, tachypnoeic. Evidence of vomit on clothing. No history from patient as unresponsive.\n\nPast Medical History:\n• Multiple lacunar infarcts (June 2024)\n• Post-stroke seizures (October 2024, April 2025, January 2025)\n• Left-sided weakness post-stroke\n• Aspiration pneumonia (June 2024)\n• Alcohol dependence\n• Not seen GP in 40 years prior to June 2024 presentation\n\nMedication History:\n• Atorvastatin 80mg PO mane\n• Baclofen 10mg PO BD\n• Clopidogrel 75mg PO mane\n• Docusate 100mg PO BD\n• Lansoprazole 15mg PO mane\n• Levetiracetam 1g PO BD\n• Thiamine 100mg PO BD\n• Oilatum 11% cream apply to skin PRN\n\nAllergic History:\nNot mentioned\n\nSocial History:\nLives in a care home\n\nOn Examination:\nGCS 11 (E3 V3 M5). No response to verbal stimulus. Warm to touch. Regular pulses. Soft systolic murmur, non-radiating. No peripheral stigmata of infective endocarditis in hands or toes. Left-sided weakness post-stroke. Abdomen soft and non-tender. Decreased breath sounds left base. Bilateral peripheral oedema to knees. Productive cough.\n\nInvestigations:\nBloods: Creatinine 97 (baseline), electrolytes normal, CRP 3, neutrophils 13.8, WCC 15.2, Hb 132, iron 1.9, LFTs normal, ABG normal\nChest X-ray: Poor quality film, slumped to left, no clear focal consolidation\nECG: Sinus rhythm, first degree AV block, rate 97\nEEG (January 2025): Sharp waves right frontotemporal region, excess irregular slow activity in similar distribution\nObservations: HR 100, SpO2 100%, RR 21, BP 145/71\n\nImpression:\nAspiration pneumonia\n\nPlan:\n1. Blood cultures if spikes fever [_]\n2. IV antibiotics [_]\n3. IV fluids [_]\n4. Paracetamol for temperature [_]\n5. Sputum culture [_]\n6. Catheter specimen of urine for culture [_]\n7. Saline nebuliser to aid expectoration [_]\n\n----- \nSummary:\n80-year-old man with post-stroke seizures and left-sided weakness, lives in care home, presents with decreased responsiveness and noisy breathing, likely aspiration pneumonia.\n\nAI Diagnosis:\nAspiration pneumonia in the context of known aspiration risk, post-stroke dysphagia and evidence of vomiting. Differential includes hospital-acquired pneumonia given recent admissions.\n\nAI Plan:\n1. Empirical broad-spectrum antibiotics (e.g., co-amoxiclav) to cover aspiration pathogens\n2. Oxygen therapy if required to maintain saturations\n3. IV fluid resuscitation\n4. Blood cultures before antibiotics\n5. Sputum culture and sensitivity\n6. Urine culture to exclude concurrent UTI\n7. Speech and language therapy assessment when stable\n8. Consider nasogastric feeding if unsafe swallow\n9. Regular chest physiotherapy\n10. Monitor for seizure activity given history", "summary": "80-year-old man with post-stroke seizures and left-sided weakness, lives in care home, presents with decreased responsiveness and noisy breathing, likely aspiration pneumonia.", "investigations": "Creatinine 97 (baseline), electrolytes normal, CRP 3, neutrophils 13.8, WCC 15.2, Hb 132, iron 1.9, LFTs normal, ABG normal. Chest X-ray: Poor quality film, slumped to left, no clear focal consolidation. ECG: Sinus rhythm, first degree AV block, rate 97. EEG January 2025: Sharp waves right frontotemporal region, excess irregular slow activity in similar distribution.", "tasks": [ { "item": "Request blood cultures", "time_frame": "2025-05-25T14:06:00Z", "request": "Please take blood cultures if patient spikes fever. 80-year-old man with post-stroke seizures, found unresponsive with noisy breathing, suspected aspiration pneumonia. Currently on antibiotics." }, { "item": "Request sputum culture", "time_frame": "2025-05-25T14:06:00Z", "request": "Please send sputum sample for culture and sensitivity. 80-year-old man with productive cough, decreased breath sounds left base, suspected aspiration pneumonia. Known aspiration risk post-stroke." }, { "item": "Request urine culture", "time_frame": "2025-05-25T14:06:00Z", "request": "Please send catheter specimen of urine for culture. 80-year-old man with indwelling catheter, presenting with decreased responsiveness, to exclude concurrent UTI as source of infection." }, { "item": "Follow up culture results", "time_frame": "2025-05-27T02:06:00Z", "request": "Review blood, sputum and urine culture results. Adjust antibiotic therapy according to sensitivities if required." } ], "feedback": "- Missed opportunity to document full neurological examination given history of stroke and seizures\n- No mention of seizure prophylaxis review despite recent seizures and current admission\n- Failed to ask about or document recent oral intake/feeding history given aspiration risk\n- No safety-netting advice documented for care home staff regarding seizure monitoring\n- Missed opportunity to clarify antibiotic choice - 'IV antibiotics' is too vague\n- No mention of DVT prophylaxis assessment despite reduced mobility\n- Failed to document capacity assessment or best interests discussion despite patient being unresponsive\n- No clear escalation plan or ceiling of care discussion documented" } ```
319 days ago 05:24
Original saved

Clerking

Elderly woman with longstanding asthma and previous severe COVID-19 infection presenting with worsening breathlessness and cough, likely an asthma exacerbation; cardiac aetiology for leg swelling is being excluded.