Passmed stuff 3 Flashcards
Which two fractures are most likely to result in compartment syndrome?
Supracondylar fractures and tibial fractures
A 55-year-old man presents to his GP with a gradual onset of back pain over the past 8 months. The back pain is worse on activity and walking causes bilateral pain and weakness in his calves. The back pain is relieved by sitting or leaning forward.
On examination, no neurological findings are present. He has no relevant past medical history, smokes socially and drinks a glass of wine with dinner each night. He is currently a builder and is concerned because his back is starting to interfere with his ability to work.
What is the most likely diagnosis?
Diagnosis?
Treatment?
Spinal stenosis
MRI
Lamenactomy
Ryan, a 17-year-old boy, presents to the emergency department following a seizure. On examination, he has a unilateral shoulder deformity and his shoulder is locked in an internally rotated position. A shoulder x-ray has just been ordered.
What would you expect to see on his shoulder x-ray?
Posterior shoulder dislocation
A 75-year-old woman presented to her GP with shoulder pain and discomfort. She had a full shoulder examination performed, during which she was unable to abduct her shoulder when it was flat against her body while standing. She was, however, able to fully abduct the shoulder after the doctor passively abducted it during the first 20 degrees. Which muscle is most likely to have been affected?
Supraspinatus
Anti-mitochondrial antibodies are present in:
Primary biliary cirrhosis
Anti-smooth muscle antibodies are present in:
Autoimmune hepatitis
Colin is a 77-year-old man who attends for a review of his left wrist in fracture clinic 2-weeks after a fall on an outstretched hand. His X-ray at the time of injury was normal but his wrist was immobilised in a Futuro splint as he was tender in the anatomical snuffbox. Follow-up imaging today reveals a fracture of the proximal scaphoid pole.
What is the appropriate definitive management of this?
Should be referred for surgical fixation of his injury as it is a proximal scaphoid pole fracture. These all require surgical fixation due to the risk of avascular necrosis.
Terry is a 45-year-old man who presents to his GP with a burning pain on the outer part of his right knee. The pain is present on movement and he has not noticed any swelling of the knee. There is no history of trauma and no locking of the knee joint. He is an endurance runner and is training for the London marathon. On examination, there is pain on palpation of the lateral aspect of the joint line. He has a good range of movement of his knee joint. However, you do notice a snapping sensation on the lateral aspect of the knee during repeated flexion and extension of his joint .
What is the most likely diagnosis?
Management?
Iliotibial band syndrome
Management:
- activity modification and iliotibial band stretches
- if not improving then physiotherapy referral
A 22-year-old male presents to the emergency room with pain in the left knee following a twisting injury during a rugby match. He states that it has gradually swollen over the past 24 hours, and he is unable to fully extend it. On examination you note tenderness over the medial joint line, a joint effusion, and the joint is held in a flexed position. There is no laxity on valgus stress test.
What is the most likely diagnosis?
Medial meniscal tear
Gradual swelling of the knee is suggestive of effusion which often occurs due to meniscal injury. Tenderness over the medial joint line suggests a medial meniscus tear.
What would anti-centromere antibodies indicate?
Systemic sclerosis
Most common form of prostate cancer?
Adenocarcinoma
Most common type of renal stone?
Calcium oxalate
A 41-year-old man develops itchy, polygonal, violaceous papules on the flexor aspect of his forearms. Some of these papules have coalesced to form plaques. What is the most likely diagnosis?
Lichen planus
A 53-year-old teacher is admitted to the vascular ward for a carotid endarterectomy. You do a preoperative assessment and note that there is a right homonymous hemianopia with macula sparing. There is no other neurology.
What type of stroke?
Posterior cerebral artery infarct
This patient has had a left occipital infarct, as there is only a homonymous hemianopia. If this patient had a temporal or parietal lobe infarct, there would be associated hemiparesis and higher cortical dysfunction. This is important to differentiate, as the carotid endarterectomy is inappropriate in this patient as the lesion is in the posterior cerebral artery.
A 48-year-old type 2 diabetic complains of numbness in his left arm and leg. Otherwise there is no other neurological signs.
Type of stoke?
Lacunar infarct
