Each case is presented in the form of 'salient' feautures in the history, and the examination findings, followed by a question and answer discussion around the topic. The salient history is useful because it is often skipped by most of these case-based books like Ryder. The examination is presented in a kind of instructive way and not as a case record like with Ryder. The discussion questions are split into standard and advanced level questions. Many of the answers are extremely detailed and at quite a high level. They also include references to important literature. This is essential reading for MRCP candidates, and complements a standard medical text very nicely. But it won't specifically tell you what to say like Ryder does. It will however give you a more comprehensive review of each case compared to Ryder. The danger for undergraduate students is that they might become bogged down in the detail of this book and I would certianly recommend getting used to 'Medical Finals - Passing the clinical' as this is a highly useful and efficient means of revising for medical finals.
For the most part the book does lack pictures but uses them to good effect for the ophthalmology and dermatology sections. The pictures are fairly small but of a high print quality.