ABSTRACT
History An 85-year-old woman is investigated by her general practitioner (GP) for increasing tiredness, which has developed over the past 6 months. She has lost her appetite and feels constantly nauseated. She has lost about 8 kg in weight over the past 6 months. For the last 4 weeks she has also complained of generalized itching and cramps. She has been hypertensive for 20 years and has been on antihypertensive medication for that time. She has had two cerebrovascular accidents, which have left her with some left side weakness and reduced mobility. She is an African Caribbean, having emigrated to the United Kingdom in the 1960s. She lives alone but uses a ‘meals-on-wheels’ service and goes to a day hospital twice a week. She has two daughters.
