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...it took several Xrays and an MRI before this abnormality was acted on. Can you see what injury this elderly lady sustained when she fell? 
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A middle aged lady fell hard, breaking some furniture in the process. She had tenderness all over the wrist (including ASB and ulnar aspect), and these Xrays. What do they show? How do you manage it?
Most of us are familiar with the anterior humeral line, used to spot supra-condylar fractures in kids (if you're not sure, click here and pay particular attention to about 1:30). But what's the other one?
And here's the next. Middle aged patient fell while at work. Reported to have ?clinical scaphoid injury. At review in clinic, all tenderness localised to the proximal pole of the scaphoid on the palmar wrist, with a 10p sized bruise. Reasonable ROM and not too much pain. What injury was missed on the Xray, how do you measure it, and what does it need?   A couple of interesting ones from today's clinic. The first's an easy one for you. Notes document a fall (now 10/7 ago) with tenderness in the ASB, non tender distal radius, and pain on telescoping the thumb and on opposition. In clinic his swelling was localised just proximal to Listers tubercle, and point tender there only. What's the diagnosis?  by Adam HerbstrittA female in her 20s has had recurrent presentations over the years, usually in clusters every 6 months or so.
Her only proven PMH is a previous OGD showing a small healed ulcer. She has been labeled as ‘seeking opiates’ on HAS… HPC: vomiting+++ hourly for days. She was admitted under general surgery with similar symptoms last week but self discharged on symptoms resolution. No clear cause had been identified. She now represents as symptoms returned+++ over 24 hours. Has been making periodic trips to the water fountain in ED, and appears to be inducing emesis back in the cubicle. Vitals all normal, exam unremarkable other than some upper ado tenderness without guarding. Bloods awaited. Thoughts? A middle aged male patient presents to Emergency Department following a brief severe retrosternal pain which has now resolved. He's currently undergoing chemotherapy and radiotherapy for esophageal cancer. When you see him, he's pain free, afebrile and reasonably well appearing with an unremarkable clinical exam
All kinds of scary differentials raise their head: Radiation oesophagitis, mediastinitis, oesophageal rupture, radiation pericarditis , pleural effusion, PE, aortic dissection, ACS, severe reflux / gastritis to name but a few... In the end, his chest Xray is normal, his bloods show (borderline) neutropenia with no evidence of sepsis, and he goes home, advised to keep an eye on his temperatures. A few days later his blood cultures grow Clostridium Ramosum. What is it? Is it a contaminant? Does it matter?  So while evading a piece of runaway machinery, this gent fell over a wall and landed heavily on his left shoulder. Shoulder and scapula views were ordered. What's he done? Just as importantly, when does this need more than than just time in a sling and physio....?
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Created by N Bothma
Last updated July 2020 |