Clinical Mysteries
Follow the clues. Question the obvious. Find the diagnosis.
Story-driven clinical reasoning cases created for medical students, residents and doctors.
The Gastritis That Wasn’t
A middle-aged man came with burning upper abdominal discomfort after dinner. Antacids helped briefly—but one detail did not fit.
Open case →Emergency MedicineThe Wheeze That Needed a Different Treatment
An elderly patient was treated repeatedly as an obstructive airway exacerbation. The wheeze was real—but the lungs were telling a cardiac story.
Open case →Respiratory MedicineThe Pneumonia That Would Not Improve
Fever, cough, an infiltrate and antibiotics—everything pointed to pneumonia. Forty-eight hours later, the trajectory forced a rethink.
Open case →CardiologyThe Dizziness That Wasn’t Vertigo
He described “chakkar,” had no focal weakness and looked stable. A simple pulse check revealed the real emergency.
Open case →General MedicineThe Anaemia That Kept Coming Back
Iron tablets improved the haemoglobin twice. Each time, it fell again. The recurring laboratory problem was actually a clue to ongoing disease.
Open case →EndocrinologyThe Recurrent UTI That Was a Metabolic Warning
Three urinary infections in six months seemed like bad luck. A routine bedside test revealed why they kept returning.
Open case →GastroenterologyThe Abdominal Pain That Followed the Clock
Months of “gastritis” treatment failed. The timing of the pain after meals was more informative than the location.
Open case →Emergency MedicineThe Weakness That Looked Like a Stroke
Sudden limb weakness triggered a stroke pathway. The neurological examination was important—but so was the potassium.
Open case →General MedicineThe Fever That Wasn’t an Infection
Antibiotics were changed twice for persistent fever. The medication chart finally provided the missing clue.
Open case →General MedicineThe Swollen Legs That Weren’t Heart Failure
Bilateral edema quickly suggested heart failure. But the heart was not the organ driving the problem.
Open case →CardiologyThe Palpitations That Weren’t Panic
A young adult had repeated episodes of sudden racing heartbeat and was repeatedly told it was anxiety. The timing held the clue.
Open case →ElectrolytesThe Confusion That Wasn’t Dementia
An older woman became forgetful, slow and unsteady over several days. The family feared rapidly progressive dementia.
Open case →EndocrinologyThe Tremor That Wasn’t Anxiety
A woman with tremor, sweating and poor sleep was treated as anxiety. Her resting pulse kept telling a different story.
Open case →GastroenterologyThe Black Stool That Wasn’t Just Iron Tablets
A patient taking iron ignored black stools for days—until dizziness and a falling haemoglobin changed the meaning.
Open case →Clinical PharmacologyThe Cough That Wasn’t an Infection
A persistent dry cough survived two antibiotic courses. The answer was hiding in the prescription list.
Open case →Vascular MedicineThe Leg Swelling That Wasn’t Just Varicose Veins
One calf became more swollen after a long journey. The patient blamed chronic veins—until asymmetry changed the risk.
Open case →Emergency MedicineThe Headache That Wasn’t Just Migraine
A person with a history of headaches assumed the latest attack was the same. The onset was not.
Open case →Metabolic MedicineThe Thirst That Wasn’t Diabetes
Excessive thirst and frequent urination sounded like diabetes, but the glucose result was normal.
Open case →Infectious DiseaseThe Back Pain That Wasn’t Muscular
A woman developed flank discomfort after several days of urinary burning. The pain was treated as a muscle strain.
Open case →Internal MedicineThe Fatigue That Wasn’t Just Overwork
Months of tiredness were blamed on a busy schedule. A careful examination suggested the body was compensating for something else.
Open case →ElectrolytesThe Sodium That Wasn’t Dehydration
An elderly patient with pneumonia became progressively confused while receiving isotonic fluids. Sodium kept falling.
Open case →CardiologyThe Chest Pain With a Normal Troponin
Recurrent crushing chest pain arrived with an initially normal troponin and a nearly reassuring ECG.
Open case →Emergency MedicineThe Asthma That Stopped Wheezing
A severe asthmatic suddenly became quieter. The room felt relieved; the patient was not.
Open case →Infectious DiseaseThe Fever That Rose After Antibiotics
Sepsis treatment seemed appropriate, yet fever returned with rash and eosinophilia after several days.
Open case →Critical CareThe Low BP That Needed No More Fluid
A breathless patient with hypotension received repeated fluid boluses and became more hypoxic.
Open case →NephrologyThe Kidney Injury That Wasn’t Sepsis
Creatinine rose during an infection, but urine output collapsed despite haemodynamic recovery.
Open case →ElectrolytesThe Weakness After Diuresis
After aggressive diuresis, a heart-failure patient developed weakness, cramps and ectopy.
Open case →EndocrinologyThe DKA With “Normal” Sugar
A diabetic patient had vomiting, tachypnoea and high anion-gap acidosis, but glucose was only mildly elevated.
Open case →Respiratory MedicineThe COPD Patient Who Got Sleepier
Oxygen saturation looked excellent after high-flow oxygen, while the patient became increasingly drowsy.
Open case →Metabolic MedicineThe Bradycardia That Wasn’t a Heart Problem
Profound bradycardia and weakness looked like primary conduction disease until the chemistry returned.
Open case →Infectious DiseaseThe Pneumonia With a Surprisingly Slow Pulse
High fever and pneumonia were accompanied by a pulse slower than expected for the temperature.
Open case →NeurologyThe Headache After Delivery
Days after delivery, a woman developed severe headache and a focal seizure.
Open case →HaematologyThe Anaemia With a High Ferritin
Fatigue and low haemoglobin suggested iron deficiency, but ferritin was unexpectedly high.
Open case →EndocrinologyThe Abdominal Pain With a “Clean” Scan
Repeated imaging found no surgical cause for abdominal pain, vomiting and weakness.
Open case →Metabolic MedicineThe Seizure That Wasn’t Epilepsy
A first seizure led to antiepileptic treatment, but bedside glucose had been overlooked.
Open case →General MedicineThe Pleural Effusion That Kept Returning
A unilateral effusion returned after repeated drainage and antibiotics.
Open case →NeurologyThe High BP That Was Compensation
A patient with intracranial haemorrhage had severe hypertension and bradycardia.
Open case →Critical CareThe Lactic Acidosis With Normal Pressure
Blood pressure appeared acceptable, yet lactate climbed and the patient became mottled and oliguric.
Open case →EndocrinologyThe Thyroid Patient With Chest Pain
Palpitations, weight loss and tremor were followed by chest pain and rapid atrial fibrillation.
Open case →Tropical MedicineThe Fever With Falling Platelets
A febrile patient remained haemodynamically stable while platelets fell rapidly; antibiotics changed nothing.
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