A 46-year-old woman is on day 2 after an elective laparoscopic cholecystectomy for symptomatic gallstones. Overnight the subhepatic drain has produced 300 mL of bile-stained fluid. She is comfortable at rest but has mild right upper quadrant pain, a pulse of 96 and a temperature of 37.8 °C.
A 24-year-old man presents with five days of periumbilical pain that has moved to the right iliac fossa, anorexia and vomiting. He is febrile at 38.4 °C with a tender, ill-defined mass in the right iliac fossa. White cell count is 16.8 ×10⁹/L and CRP 180 mg/L.
A 72-year-old man with atrial fibrillation develops sudden severe pain in the left leg. The leg is pale and cold below the mid-thigh, with absent femoral and distal pulses, reduced sensation over the foot but preserved power.
A 54-year-old postmenopausal woman finds a firm, painless lump in the upper outer quadrant of the right breast. It is 2 cm, hard, irregular and tethered to skin. There is one mobile axillary node.
Four hours after a total thyroidectomy for multinodular goitre, a 61-year-old woman becomes agitated with noisy breathing. The wound is tense and swollen and her oxygen saturation is falling.
