ABSTRACT
You are reviewing patients in the medical outpatient clinic. Your next patient has been referred by his general practitioner with the following letter. Please read the letter and then review the patient.
Dear Doctor,
Re: Mr Luke Stannage
Age: 67 years
This gentleman has been suffering with progressive shortness of breath for some months. I have tried multiple courses of antibiotics without any benefit. Chest examination yielded basal crepitations. Unfortunately, a course of diuretics failed to improve the situation. At his last visit, our registrar noticed that he has clubbing of the nails. After discussing the case with me today we are concerned therefore that we may be missing serious pathology and would very much value your expert opinion. Thank you.
Yours sincerely
