Spot the Diagnosis - 60

(1) A run down patient has come with swelling of bone with pain . The soft tissue over the swelling  is pale and white .
Ans Tuberculosis of bone .

(2) An emaciated patient with chronic cough has come with a sinus .
Ans Tuberculous sinus .

(3) A boy has come with an x- ray of humerus . There is a cyst whose margin is not sclerosed and expansion is the long axis of the bone .
Ans Bone cyst .

(4) A patient had come with a cyst in the tibia . In x-ray picture there is a cyst . The walls of cyst is sclerosed and there is a piece of sequestium in side .
Ans Brodie's abscess .

(5) A patient of forty has come with swelling of the lower end of ulna . On x-ray the enlargement of the cyst is in transverse direction  .
Ans Ans Osteoclastoma .

(6) A patient has come with multiple extostosis around knee joint .
Ans Diphyseal aclasia .

(7) An x-ray shows sun ray's appearance and codman's triangle.
Ans Osteogenic sarcoma .

(8) A radiograph was shown to you in which the bone ends has converted into a cavity lined by a thin cell of bone and traversed by bony traveculae giving mosaic or soap bubble like appearance.
Ans :-Osteoclastoma.

(9) A patient of forty has deep boring pain in tibia specially when the part is warm.on examination the bone is warm.
Ans :- Syphilis of bone.

(10) A patient has come with a swelling by the side of sternum which is hard,lobulated and yelding mass fixed to the bone.
Ans :-Chondroma.

Spot the Diagnosis -59

(1) A patient has come with a fracture of tibia .The fracture is
transverse and the bone looks thickened.
Ans.Paget's disease.

(2) A radiograph of a patient of gall bladder stone was shown to you .there is a trilucent  gas in
the center of the stone.
Ans.Mercedes Benz or seagulls sign.

3) A patient has come with a plain radiograph. The gall bladder is rather radio opaque.
Ans:- The opacity is due to filling of the gall bladder with the mixture of calcium carbonate or calcium phosphate.This occurs when gradual obstruction of cystic duct and common bile duct and called limey bile.This occurs in case of chronic pancreatitis and carcinoma of head of pancreas.

4)A patient of thirty has come with a bony swelling.On pressure on the swelling there is an egg cell crackling.
Ans:- osteoclastoma.

5) A boy of twelve has come with a swelling of bone.the swelling is of variables in consistency.
Ans:- osteogenic sarcoma.

(6) A patient has come. With a swelling which pits on pressure and there is fluctuation.
Ans.Deep seated abscess.

(7) A patient has come with a fracture which is thought to be a
pathological fracture as the injury is very trivial .Now tell me, what are the diseases  you will look for
in that patient to confirm that the  fracture is pathological?
 Ans.Cyst,sarcoma and secondary carcinoma.

 ( 8) A patient of bony swelling has come with a skiagram showing soft. tissue. Shadows .
Ans.Soft tissue shadow in. the skiagram. is the definite sign of bone sarcoma.

Spot the Diagnosis -58

(1) Which cyst is classed pathologically as epidermoid cyst?
Ans Sebaceous cyst .

(2) A man has many sebaceous cyst on head one of  which has become ulcerated which resembles epithelioma .
Ans Cock's peculiar  tumour .

(3) A patient has been suffering for a prolonged period from Bronchiectasis . Now he has developed spleeno hepatomegaly .
Ans Amyloid disease .

(4) A patient has come with acute  localised headache , tenderness and localised pitting oedema of the scalp .
Ans Pott's puffy tumour .

(5) A patient of swelling of bone has come . When a hand was placed on the swelling for a while , the swelling feels to be pulsatile .
Ans Telengiectatic osteogenic sarcoma.

(6) A patient with a fracture. Of radius two inches above the wrist joint.
Ans.Chauffeur's fracture.

(7) A patient has come with a scar which is depressed.
Ans.A depressed scar indicates previous suppuration.

(8) A patient has come with a sinus with sprouting granulation tissue (proud flesh).
Ans.Presence of sequestrum(dead bone) or foreign body inside.

(9) A boy has come with swelling and pitting oedema of the dorsum of his hand.
Ans. palmar infection.

(10)  An oldman complains of thickening of his nose.The sebaceous follicles are easily seen.The capillaries around are dilated over it assuming bluish red colour.
Ans. Rhinophyma.

Spot the Diagnosis- 57

(1) An x-ray shows an oblique fracture of the first metacarpal bone involving the articular surfaces . What is this fracture known as ?
Ans Benett's fracture .

(2) A boy has come with epistaxis. He has mid  diastolic murmur .
Ans Mitral stenosis .

(3) A boy has come with haemoptysis, he has evening rise of temperature .
Ans Pulmonary tuberclosis .

(4) A case of chronic bronchitis has come with an x-ray plate of his chest . There is a twenty five paise  coin like opacity in the left apex .
Ans Bronchial carcinoma .

(5) A case of chronic bronchitis has come with an x-ray plate , there are some calcified spots in the lung field .
Ans Previous tuberculosis of the lungs .

(6) A patient was treated in Bombay and diagnosed as chronic bronchitis. He has a strong family history of tuberculosis . In his chest x-ray there are light opacities at many places .
Ans  He might have suffered from pulmonary tuberculosis .

(7) A very old and run down patient of chronic bronchitis complains of heavy expectoration in the morning .
Ans Bronchiectasis.

(8) A patient who can't sleep window and door closed . There are fine basal crepts at the base of his lungs .
Ans Acute left ventricular failure .

(9) A patient feels breathlessness only on exertion .
Ans Mitral stenosis .

(10) Name the places where sebaceous cyst does not occur .
Ans Palms and soles .

Spot the Diagnosis - 56

(1) A female of fifty has come with a fracture of femoral neck, she is hypertensive and having raised blood sugar . Her limbs are thin but face looks like a full moon.
Ans Cushing syndrome .
(2) A young lady has come with amenorrhoea and development of hair on face .
Ans Adrenogenital syndrome .
(3) An emaciated and run down patient of thirty five has come with multiple sinuses on the breast and the bluish coloration of skin around the sinuses . On the examination of discharge there is no sulphur granules .
Ans Tuberculosis of the breast .
(4) A patient was under treatment of carcinoma prostate . He developed gynocomazia . What was the reason .
Ans He was taking stilboestrol .
(5)  What are the other drugs besides stilboestrol that can produce gynaecomazia .
Ans Digitalis, spironolactone , cimetidine and isoniazid .
(6) A lady doctor has come with an x-ray of her forearm . In the x-ray there is  a fracture   of ulna in the lower third and a dislocation of the superior radio -ulnar joint . What is the name of this fracture-dislocation?  
Ans Monteggia fracture dislocation .
(7) You have applied a plaster slab to a patient of Colles's  fracture. What should be the correct posture of his hand ?
Ans Pronation, ulnar deviation and Palmer flexion .
(8) A patient has come with a fracture of radius and dislocation of the inferior radio- ulnar joint what is the name of this fracture dislocation ?
Ans Galeazzi fracture dislocation .
(9) In tuberculosis of hip joint which feature is early and constant ?
Ans Wasting of muscles .
(10) What movement is restricted earliest in  tuberculosis of hip ?
Ans Extension of the hip .

Spot the Diagnosis- 55

(1) A lady who cleans the house in a kneeling  posture comes with a subcutaneous swelling and covers the lower half of the patella and upper half of ligamentum patelle .
Ans Prepatellar bursitis
(House maid knee )
(2) A patient has come with a cyst knee joint . The bulging around of the cyst is lateral side of ligamentum patella .
Ans Infrapetellar bursitis.
(3) A patient has come with a cyst which lies centrally in the poplitial fossa .
Ans Morrant baker cyst .
(4) A patient has come with a postromedial cyst in the popliteal fossa .
Ans semimembronosis bursitis .
(5) A patient has come with a cyst in the lateral side of knee joint .
Ans Cyst of lateral semilunar cartilage .
(6) A patient has come with a cyst of medial aspect of knee joint .
Ans cyst of medial semilunar cartilage .
(7) A patient has come with a pulsatile cyst in the popliteal fossa.
Ans Aneurysm of popliteal artery .
(8) A patient has come with a swelling over the olecranon.
Ans Student's elbow.
(9) A fisherman has come with big swelling over the both shoulders .
Ans Bilinzgate Bursitis .
(10) A patient has come with hard , nodular , irregular and tender epididymis .
Ans Tubercular epididymitis .

Spot the Diagnosis - 54

(1) A patient. of run-over -accident has come .He has pelvic injury and there are three things obvious (1) blood per urethrum (2) perineal hematoma(3) distended bladder.
Ans.Urethral damage.
The above patient was tried with a plain rubber Cather and the catheter
was introduced.
Ans.(3) In another case of pelvic injury ,there is a tumour like mass in the suprapubic area associated with strangury and the catheter goes in
easily and withdraws blood stained urine.
Ans.Injury to the bladder.
(4) An adult came whose clavicle is absent and cranial bones are not
united .He can touch his right shoulder by his left shoulder..
Ans.Cleido-cranial dysostosis(anosteoplasia).
(5) A patient has a cystic swelling on the midline of forehead
Ans.Dermoid cyst.
(6) A patient has multiple white cysts on his scrotum.
Ans.Sebaceous cysts.
(7) A patient has come and looks
Like a dwarf with a typical appearance .His trunk is less shortened than his  limbs.
Ans.Achondroplasia.
(8) A boy of fifteen got an injury but he didn't mind it too much . He applied iodex and ignored it . After a few days oedema , blebs and bullae appeared . What do you think about the injury .
Ans Fracture .
(9) A patient has come with injury and his shoulder is full and swollen . Can you make spot diagnosis?
Ans Fracture of the neck of humerus .
(10) In a patient there is  cystic swelling superior to patella and communication with the joint and becomes distended in any effusion of the joint knee joint .
Ans Suprapettelor effusion .

Spot the Diagnosis -53

(1) In an already diagnosed case of carcinoma has developed pain . What does it indicates ?
Ans It signifies complications such as deep interaction ulceration and involvement of nerve . It indicates that carcinoma has become inoperable  .
(2) A patient has come with injury of the ankle joint with excessive broadening of the ankle .
Ans The inferior tibiofibular ligament is torn or avulsion of tibia to which the ligament is attached .
(3) A patient has a loose body in his joint , after x-ray a seasmoid bone in the lateral head of the gastrocnemius is found .
Ans Febella .
(4) Another patient of loose body in his joint has come . On x- ray examination there is  calcification in the tibial collateral ligament after partial avulsion of the ligament from the medial capsule of the femur .
Ans Pallegrini - stieda's disease.h
(5) A patient was admitted in the ward with a very serious and agonising pain . He has bruising in the loin (Great turner sign) and Cullen sign around umbilicus .
Ans Acute pancreatitis .
(6) An x-ray was shown in which there was sun rays appearance and formation of codman's triangle .
Ans Osteogenic sarcoma .
(7)  A kashmiri patient has come with a chronic ulcer on the umbilicus and lower abdomen .
Ans Khangri cancer .
(8) A patient has an ulcer with raised  and everted margin on the scar of burns for many months .
Ans Marjolin's ulcer .
(9) A patient had an ulcer on his penis with involvement of inguinal nodes . After some months the patient died of fatal hemorrhage due to involvement of  femoral artery .
Ans Carcinoma penis .
(10) A patient of serious accident has come in the emergency . There is no fracture in the lower limbs but still he y unable to raise  both the lower limbs .
Ans Involvement of the cord .

Spot the Diagnosis -52

(1) A child patient has come with bony thickening of tibia with a sinus adherent to the bone .
Ans Osteomylitis .
(2) A patient of twelve has come with bony swelling in the diaphysis.
Ans Ewing tumour .
(3) A febrile patient keep his thigh always flexed  .
Ans Ilio-psoas abscess or appendicular  abscess .
(4) A patient of chronic dysentry and often  constipation he has intercostal tenderness .
Ans Amoebic liver abscess .
(5) A patient was admitted in the ward with a huge cyst in the abdomen . He has history of  abdominal trauma .
Ans Pseudopancreatic cyst .
(6) A fatty lady of forty has been admitted with a cholic . She had many attack but this attack is not like others soon after the attack a round swelling appeared in the position of gallbladder .
Ans Hydrops of the gall bladder
(7) A patient with a sinus over the ramus of the mandible and he gives the history of watery discharge at the time of meals .
Ans Parotid  fistula .
(8) A child has come with a big swelling with a rudimentary hand with fingers on the sacrococcygeal area .
Ans Sacrococcygeal teratoma .
(9) A patient has a tumour and there is much wasting of his body since the appearance of the growth . Can you speak of the nature of the tumour .
Ans Malignant growth .
(10) A patient has come with a swelling . He says that at first pain appeared then swelling . Can you spot the diagnosis about the nature of the swelling ?
Ans Inflammatory swelling .
(11) A patient has come with a long static growth . He complains that pain has appeared on the growth .
Ans Malignant transformation .

Spot the Diagnosis -51

(1) A patient of injury has come after fifth week of the injury . He has wasting of supraspinatus,   infraspinatus muscles .
Ans In ruptured of the torn rotator cuff .

(2) What are the muscles which comprise of the rotator cuff of the shoulder .
Ans Supraspinatus Infraspinatus and teres minor. These muscles fuse the joint capsule .

(3) An infant patient complains of attack of painful swelling of the parotid gland often accompanied by fever .
Ans Congenital sialectasis .

(4) A young lady has come with brawny induration over protid with all signs of inflammation .
Ans Acute suppurative parotitis .

(5) A patient has umbilical fistula which discharges faecal  matter .
Ans Patent vitello intestinal duct.

(6) A patient has umbilical fistula from which urine comes out .
Ans Due to patent urachus .

(7) A patient complains of pustular discharge from umbilicus .
Ans Septic , due to infection , abscess formation and any intra abdominal abscess .

(8) A patient has come with red , raspberry like tumour  in the umbilicus which has tendency to bleed.
Ans ( Umbilical adenoma , raspberry tumour ) interoteratoma.

(9) An old lady has come with a chronic ulcer on the umbilicus . She has enlargement of nodes of both axilla and both groin .
Ans Primary carcinoma .

(10) A lady has come who already in a diagnosed case of carcinoma breast . Now she complains of ulceration in the umbilicus .
Ans Secondary carcinoma from breast .

words of wisdom pt-5

(1)A fool earns more than thrice
A Wise befools him in a trice.

(2) A hungry man knows the
real taste of a piece of bread

(3) The hunger is the most
effective appetiser.

(4) The hungry are real and
true hangers-on.

Spot the Diagnosis -50

(1) A patient had an injury a few days ago . Now he has developed ecchymosis on the part .
Ans A fracture or dislocation is suspected .
(2) A lady of thirty five has come with acute intestinal obstruction . She is having also mid diastolic murmur in her heart .
Ans Mesentric vascular thrombosis .
(3) A lady patient of stone in the  gallbladder was operated at Patna under spinal anaesthesia . After some days she developed headache , vomiting , chill and hectic rise of temperature and became unconscious .
Ans Brain abscess .
(4) A patient of very high blood pressure complains of severe headache , vomiting and convulsion .
Ans Hypertensive encephalopathy.
(5) A patient of forty five is suddenly attacked with chill , fever and pain in the right hypochondrium and also felt at the tip of right shoulder .
Ans Cholecystitis .
(6) A patient of eight has come like acute intestinal obstruction with colicky pain vomiting and fever . The surgeon visited and said " Operation is urgent otherwise it will be fatal ."
Ans Appendicular colic in a child .
(7) A robust man of forty five had come with acute agonising pain in  the epigastrium piercing deep into the back .vomiting is profuse , collapse and cynosis are marked feature .
Ans Acute pancreatitis .
(8) A fatty  Lady patient of forty has come with shoulder pain .
Ans cholecystitis .

Words of Wisdom Pt -4

(1)Your thinking is your real god .
He Will make you
as you think to be .
As he is  dry honest
He can't do more or less .
Always think your best
And do your best .

(2) Young children are mirrors
  Of their parents,
Married people are mirrors
Of their wives
 And rest are mirrors
 of their closed companions.

Spot the Diagnosis -49

(1) A child of two years has come with a fit of screaming , with a history of diarrhoea and passes of blood and muses per rectum . On examination there is a sausage shaped lump in the line of the colon with its concavity directed towards umbilicus .
Ans Intussusception .

(2) An adult male comes with large gut obstruction. On examination his abdomen feels like a pneumatic tyre .
Ans Volvulus of pelvic colon .

(3) A patient of volvulus  pelvic colon has come with rigidity of abdominal wall . What does the rigidity indicates ?
Ans  Strangulation .

(4) In a patient on P/R examination the anterior wall is bulging with tenderness .
Ans Pelvic abscess .

(5) A child has come with pain , vomiting and fever . On P/R examination the right wall of his rectum is extremely tender .
Ans Appendicitis of the pelvic type.

(6) A patient has come with acute abdomen with vomiting . On p/R examination there is ballooning of his rectum .
Ans Acute intestinal obstruction .

(7) A child of three years has come in the emergency ward with acute abdomen and vomiting . On P/R examination the finger - stall is smeared with blood and mucus . There is no faecal odour .
Ans Intussusception .

(8)  A run down adult came with pain abdomen . An ultrasound was done but no positive finding was found . There was gibbus on the patient's spine on the back .
Ans Pott's disease .

(9) A patient of forty with marked wasting of his body and alternate diarrhoea and constipation has come .
Ans Carcinoma of the colon .

(10) A patient came with the history of copious vomiting and containing food particle eaten two or three days earlier .
Ans Pyloric obstruction .

(11) A patient has history of whitish or clay coloured stool with marked wasting of his body .
Ans Biliary tract obstruction .

(12) A child has come with marked wasting of his body with large , fatty and offensive - smelling  stool .
Ans Chronic pancreatitis .

Spot the diagnosis -48

(1) A child has come with bony thickening with a sinus adherent to the bone .
Ans Osteomyelitis .

(2) An adult male has come with thickening of tibia . The patient gets deep boring pain when the part is warm .
Ans Syphilis of bone .

(3) A patient has come with   already diagnosed case of osteoclastoma , now he complains the tumour is growing  rapidly and pain has developed on the painless tumour .
Ans There has been malignant transformation .

(4) An old lady of sixty five slipped in the bathroom with lower limb is externally rotated as if paralysed . Spot the diagnosis .
Ans Fracture of the femoral neck .

(5) In a robust adult due to severe violence the lower limb assumes a posture of flexion , adduction and internal rotation . Spot the diagnosis.
Ans Posterior dislocation of hip .

(6) A patient after an injury assumes the posture of flexion , abduction and external rotation of lower limb .
Ans Anterior dislocation of hip.

(7) A patient comes with fracture of femur and her lateral border of foot touches the ground due to external rotation . Can you spot the diagnosis where is the site fracture .
Ans Extracapsular fracture of femoral neck .

(8) A patient of fracture neck of femur has come , her leg is rotated, no doubt but lateral margin of her foot does not touches the ground . Spot the site of fracture .
Ans Intracapsular fracture of femoral neck .

(9) Two patients have come with sublingual cyst one cyst is brilliantly translucent other is opaque .
Ans Brilliantly translucent in ranula and the opaque is dermoid cyst .

(10) From a patient two dermoid cyst have been operated from two different sites and one operated specimen contains hair other does not . Can you say from which place the dermoid without hair has been removed .
Ans Sublingual dermoid cyst.

Spot the Diagnosis- 47

(1) A patient who is alcoholic for long years has come with the history of maelena off and on .
Ans. Cirrhosis of the liver.
 

(2) A patient has come. With circum oral black pigmentation and multiple polyposis coil.
Ans.Peutz zigger syndrome.
 

(3) A patient has come with an x-ray of his chest which shows multiple  canon ball appearances .
Ans Hypernephroma .
 

(4) A patient has been admitted in the paediatric ward with steotorrea, wasting in spite of voracious appetite and chronic cough .
Ans Fibrocystic disease of pancreas .
 

(5) A patient of forty five has come with pigmentation of mucus surface of the mouth . He has muscular weakness and low blood pressure .
Ans Addition's disease .
 

(6) A patient of pleural effusion has now come with hectic rise of temperature , chill and severe chest pain .
Ans Empyema of lung .
 

(7) An old and emaciated patient had come with the complaint of heavy expectoration of sputum in the morning with clubbing of fingers .
Ans Bronchiectasis of lung .
 

(8) An old patient has come with cough haemoptysis and wheezing . His x- ray chest was done . There is typical coin lesion on the left side of his lung .
Ans Bronchogenic carcinoma .
 

(9) A male patient of forty complains of failure to achieve erection of penis . He has a history of a motorcycle accident and he has occulusion in the region of the bifurcation of the aorta and internal iliac artery .
Ans Leriche syndrome .
 

(10) An emaciated Lady of fifty had pain in the right iliac fossa with vomiting . The surgeon made an incision on the Macburney's point and opened the abdomen when he put the finger in the abdomen , he found that the gallbladder full of stones was hanging in the right iliac fossa.
Ans Visceroptosis ( glenard's disease ) .

Spot the Diagnosis- 46

(1) A child has come with bony thickening with a sinus adherent to the bone .
Ans Osteomyelitis .
(2) An adult male has come with thickening of tibia . The patient gets deep boring pain when the part is warm .
Ans Syphilis of bone .
(3) A patient has come with   already diagnosed case of osteoclastoma , now he complains the tumour is growing  rapidly and pain has developed on the painless tumour .
Ans There has been malignant transformation .
(4) An old lady of sixty five slipped in the bathroom with lower limb is externally rotated as if paralysed . Spot the diagnosis .
Ans Fracture of the femoral neck .
(5) In a robust adult due to severe violence the lower limb assumes a posture of flexion , adduction and internal rotation . Spot the diagnosis.
Ans Posterior dislocation of hip .
(6) A patient after an injury assumes the posture of flexion , abduction and external rotation of lower limb .
Ans Anterior dislocation of hip.
(7) A patient comes with fracture of femur and her lateral border of foot touches the ground due to external rotation . Can you spot the diagnosis where is the site fracture .
Ans Extracapsular fracture of femoral neck .
(8) A patient of fracture neck of femur has come , her leg is rotated, no doubt but lateral margin of her foot does not touches the ground . Spot the site of fracture .
Ans Intracapsular fracture of femoral neck .
(9) Two patients have come with sublingual cyst one cyst is brilliantly translucent other is opaque .
Ans Brilliantly translucent in ranula and the opaque is dermoid cyst .
(10) From a patient two dermoid cyst have been operated from two different sites and one operated specimen contains hair other does not . Can you say from which place the dermoid without hair has been removed .
Ans Sublingual dermoid cyst.
 (11) in a case of intestinal obstruction only the cardiac sound is heard .
Ans Paralytic ilelus .

Spot the Diagnosis -45

(1) An adult male of forty five has come with chronic abdominal pain. He has loss of ankle jerks, sluggish pupillary reaction to light and lightening pain in the  legs .
Ans Tabes dorsalis .
(2) A man of thirty has come with a pulsatile swelling in epigastrium . What are the diseases in which this pulsation   is found ?
Ans Tricuspid regurgitation and aneurysm of abdominal aorta .
(3) A patient has come with  palpable and tender liver with tenderness in the left iliac fossa at the manson 's Bar amoebic point .
Ans Amoebic colitis and hepatitis.
(4)  A young patient with generalised wasting has come with arthritis of left ankle joint .
Ans tubercular arthritis .
(5) A patient has come with arthritis of knee joint with hectic rise of fever , chill and tachycardia.
Ans suppurative arthritis .
(6) In a patient there is a firm swelling near the head of fibula . When compressed pain shoots down to the foot ?
Ans Neuromyxofibroma of lateral popliteal nerve .
(7) In a patient there is a cystic swelling in the popliteal fossa of the knee . The cyst does not pulsate.
Ans Semimembrosus bursitis .
(8) A patient has come with a cystic swelling between the tendons of the tibial collateral ligament and the tendons of sartorius , gracialis and semitendinosus superficially .
Ans Bursa anserina .
(9) A patient has come with swelling in the knee joint with muscular atrophy and looks white and puffy .
Ans Tuberculosis of the knee joint. (10) A patient has come with pain in  the knee . His knee was x-rayed but nothing positive was found .
Ans pain was referred from his hip joint which should be examined and x-rayed also .

Spot the Diagnosis -44

(1)A patient has come with chronic empyema who was drained earlier.What are the causes of chronicempyema?
Ans. (a) The drainage was unduly delayed.
(b)the needle was not Placed on dependant part
(c)The drainage tube was removed
too early.
(d) other causes include tuberculosis ,actinomycosis,bronchiectasis,lung abscess ,bronchopleural  fistula, foreign body and rib seqestrum.

(2) A gentleman of fifty who was a heavy smoker has come with the complaints of ptosis ,myosis and enopthalmos on x-ray there is erosion of upper rib and dense apical shadow .
Ans Carcinoma of lung .

(3) A patient has come with pain in the spine and  a lump in the breast . On x-ray of the spine there is osteolytic shadows .
Ans Carcinoma of breast and secondaries in spine.

(4) A lady patient of fifty has come with the size of the areola diminishing around a retracted nipple.
Ans.Carcinoma of breast.

(5) A.  lady of twenty has come with    a  lump in the breast which becomes painful during every
Menstruation.
Ans.Fibroadenosis of breast.

(6) If sister Joseph's nodule I,e. hard subcutaneous nodules are present near umbilicus.
Ans.Carcinoma of stomach.

(7) A patient has come with a enlarged left suprsclavicular  gland .Ans.Gastric carcinoma.A lady of forty has come with nausea and vomiting with tender right eighth costal cartilage.
Ans.cholecystitis.

(8) A patient of peptic ulcer has developed a big lump in the epigastrium which is less mobile
but more tender.
Ans. Sub acute perforation.

(9) A patient of fifty has come with a lump in the epigastrium which is hard ,irregular,mobile
and tender.
Ans.Gastric carcinoma.

(10)A patient of chronic pain abdomen has come.On examination everything seems
to be normal except a gibbus On the spine.
And.Pott's disease.

Words of Wisdom- Pt 3

(1)  Everybody on earth wants
to be appreciated but there are
Very few persons who can tolerate,
appreciate and rejoice others 
appreciation.

(2)Lies spoken by great men are
taken to be something more than
the truth and need not  be investigated.

(3)Most of us are born only
to earn money even by
wrong means and wrong deeds.

(4)The epidemics of Ebola virus
and Encephalitis are never more fatal
and more dangerous than the
epidemic of corruption, only
because it break the back bone
of a nation.

Spot the Diagnosis- pt 43

(1) Why sometimes a cystic swelling feels to be hard.
Ans  When fluid in the cyst is under great tension .
(2) Why sometimes a solid swelling feels to be cystic .
Ans When a cellular swelling having no tension feels to be soft .
(3) In which conditions the swelling is hard , irregular and fixed .
Ans Malignancy and chronic inflammation .
(4) When a patient of chest injury comes with chest pain and surgical emphysema ?
Ans Fracture of ribs .
(5) A patient of road accident  has come in the emergency . His apex beat is found on the other side .
Ans Haemothorax .
(6) A patient of injury has come with silent heart .
Ans Haemopericardium .
(7) A patient of chest injury was x-rayed in the emergency which shows the horizontal level , the hemorrhage is in right plural cavity.
Ans Haemopneumothorax.
(8) A patient of chest injury has come in the emergency . He has displacement of the heart , dullness at the base and weak breath sound .
Ans Haemothorax .
(9) A patient of severe motorcycle  accident has come with silent heart , increased area of cardiac dullness and fall in arterial  blood pressure .
Ans Haemopericardium .
(10) A patient of road traffic accident has come in the emergency . On radiological examination with barium meal revealed the coil of intestine in the thoracic cavity .
Ans Injury to the diaphragm and diaphragmatic hernia.

Words of Wisdom -2

(1) Sincerity without honesty is just like a beautiful lady without virginity .

(2) The government should eradicate quackery and have a very stern and strict drug control policy in stead of wasting time , money and labour over eradicating over encephalitis .

Spot the Diagnosis -XLII

(1) A patient has come with deficient or immobility of chest .
Ans Plural effucion and consolidation .
(2) When heart beat is pushed to the other side .
Ans Collection of blood , serum , pus or air in the pleural cavity .
(3) Apex beat is drawn on the same side .
Ans Massive collapse and fibrosis of the lung .
(4) A patient has come with abdominal board like rigidity and absence of liver dullness .
Ans Perforation of peptic ulcer .
(5) A child patient had Murphy's syndrome i, e pain vomiting and fever . Now the pain has subsided but abdominal rigidity has developed .
Ans Perforation of appendix .
(6) A patient of appendicitis has been admitted in the ward . The patient says his pain had shifted from right to left iliac fossa .
Ans Peritonitis has developed .
(7) A patient has come with rounded and fullness of his shoulder .
Ans Effusion of the shoulder joint or subdeltoid bursitis .
(8) A patient has come with a cystic swelling beneath the acromion process .
Ans Subdeltoid bursitis.
(9) In which disease the rigidity of spine is a constant sign .
Ans Pott's disease  .
(10) A diagnosed case of plural effusion has developed hectic fever .
Ans He has developed acute empyema .

Words of Wisdom

(1) Only the man can do miracles
Who has lost all hopes from all
sides except his determination
to do and die.

(2) A real great man is seldom
aware of his real height..

(3) The most auspicious moment
to start any work is right now .
Start then and there without
much thinking and consultation as the next moment
is as uncertain as life itself.


(4) Knowledge of everything is bottomless . Keep on looking for and plunging into it . The deeper you go the farther you are away
from the bottom . The moment you feel   that you have touched  the bottom , that very moment you must feel and understand in
yourself that now you have ceased learning .

(5) The teacher is yet to be found greater than your keen interest,  keen observation,  prolonged endeavour and constant thinking over it .

                                                               

Spot the diagnosis - XLI

(1) A young lady of twenty five has come with pain, swelling and ulnar deviation of fingers. On X-ray decalcification and diminution of joint spaces are found.
Ans: Rheumatoid arthritis.
(2) A patient of fifty has come with morning stiffness of hip joint which passes of on continued use of limbs.On examination limitation of movement and grating sound is found.
Ans: osteoarthritis of hip joint.
(3) which is more painful fracture or sprain?
Ans: sprain is more painful.
(4) In an X-ray of a patient of compound fracture there is dark round spots are seen in negative films.
Ans: Gas gangrene.
(5) An old man  of seventy five got fracture of the neck of the femur.on radiological examination the fracture is due to secondary deposits in bone. The secondaries are osteosclerotic.
Ans: carcinoma of prostate.
(6) A good surgeon has operated upon a patient for removal of dermoid cyst. The dermoid cyst contains no hair.
Ans: sublingual dermoid.
(7) which swelling of the neck moves upward when the patient is asked to swallow.
Ans: Nodular goitre.
(8) which cystic swelling moves upward when the patient is asked to protude  his tongue?
Ans: Thyroglossal cyst.
(9) Besides nodular goitre what are other swelling which move with swallowing.
Ans: subhyoid bursitis, prelaryngeal and pretracheal lymph node.
(10) which fistula is present near the midline, a little below the hyoid bone and the opening of the fistula is indrawn and often overlaid by a crescentric fold of skin.
Ans: Thyroglossal fistula.

Spot the Diagnosis- XL

(1) In a patient who had supracondylar fracture previously has come with the complaints of inability to oppose the thumb and inability to bend the terminal phalaux of thumb,index and middle fingers.
Ans:Median nerve palsy.
(2) An old lady of sixty five has developed pain in upper part of femoral triangle below inguinal ligament
Ans:she is likely to get fracture of the neck of femur.
(3) A  man walks with a high stepping gait and his foot takes up the position of talepescalcaneovarus. Spot the diagnosis.
Ans: palsy of lateral popletial nerve.
(4) which fracture is thought to be the worst fracture of the body.
Ans:Fracture of the tibia at the junction of lower one third and upper two third.
(5) A nurse of forty five with diabetes mellitus got fracture of femoral neck on a very trivial injury. What is your spot diagnosis.
Ans: Tuberculosis of the hip joint.
(6) A man of sixty five got retention of urine and sciatica after some days he got the fracture of femoral neck.what is your spot diagnosis.
Ans:A case of carcinoma prostate, secondary in bones.
(7) An emaciated and ill looking boy of fifteen has come with a gibbus on his vertebral column. What is your spot diagnosis.
Ans:Pott's disease.
(8) A lady of fifty five has come with fracture of humerus bone.she has goitre for long years. The goitre, on examination is hard nodular and irregular in feel.what is your spot diagnosis.
Ans :carcinoma thyroid with secondary in bones.
(9) A boy of twenty has come with a fracture of humerus. On X-ray there is cyst like appearance. The wall of the cyst is not sclerosed.
Ans :Fracture is due to solitary bone cyst.
(10) A child of twelve has come with bilateral painless hydrops of the knee.
Ans: cluttons joints.

Spot the diagnosis- XXXIX

(1) A patient has come with a cold and numbness of his  right forearm. His superficial  vein are full.
Ans :Venous thrombosis.
(2) A patient of chronic coronary thrombosis is under treatment of a good. Clinician. Now he has developed a bluish, circumscribe lesion on his penis. What is your spot diagnosis.
Ans: Fixed drug erruption.
(3) A patient of forty has an ulcer on his penis. His inguinal lymph nodes are enlarged,firm,discrete and shotty.
Ans: Syphilitic ulcer.
(4) A patient of fiftyfive  has an ulcer on his penis. The margin of the ulcer is thick,raised and everted.
Ans: carcinoma of penis.
(5) An emaciated patient has developed an ulcer on penis. It's margin is thin,undermined and looks bluish.
Ans: Tuberculous ulcer.
(6) You have been told that a young lady of thirty five has developed ulcer on her upper lip which is punched out.
Ans:Syphilitic ulcer.
(7) You have been told that a patient of sixty has developed an ulcer on the lower lip and does not heel on ordinary treatment.
Ans: carcinoma lip.
(8) A young lady of thirty has been brought in the emergency with agonising  pain,shock,severe anemia and pain in lower abdomen.
She gives the history of missed  period.
Ans:Ruptured ectopic gestation.
(9) A patient has come with wasting of hypothenar eminence and hollows in the intermetacarpal spaces.
Ans: ulner nerve palsy.
(10)  A patient has come who is unable to extend the wrist, thumb and metacarpophalgeal joints of the fingers. He has history of abdominal operation under general anesthesia.
Ans:Radial nerve palsy due to hanging of his hand by the side of the table during operation.

Spot the diagnosis -XXXVIII

(1) A patient of sixty has come uwith the complains of sciatica and retention of urine.
Ans: carcinoma of prostate.
(2) A patient has come with throbbing pain in the perineum with fever and rigor.
Ans: prostatic abscess.
(3) A patient has come with huge amount of expectoration in the morning with clubbing of fingers.
Ans: Bronchiectasis.
(4)  A patient has reported for prolonged fever, cardiac murmurs, splinic enlargement and clubbing of fingers.
Ans: sub acute bacterial endocarditis.
(5) A patient has come with fever,rigor and throbbing pain in right side of lower portion of chest.His liver dullness is enlarged and there is clubbing of fingers.
Ans: sub phrenic abscess.
(6) A run down patient has reported for evening rise of temperature, night sweats with clubbing of fingers.
Ans: pulmonary tuberculosis.
(7) A patient has pain in the front of his lateral side of epicondyle of humerus.
Ans: Tenis elbow.
(8) A patient has pain on the front of medial epicondyl of humerus.
Ans: Golfers elbow.
(9) A man of forty has come with gangrene of foot which is extensive and dry. His W.R is positive.
Ans: Syphilitic gangrene.
(10) A patient has come with sudden agonising pain in right upper limb in the course of brachial artery and his arm distal to blockage is cold and blue.
Ans : Embolic  gangrene.

Spot the Diagnosis- XXXVII

(1) Supraclavicular hard and fixed gland on the right side .
Ans. Carcinoma breast or lung.
(2) A patient of sixty has come with deep cervical lymphadenopathy with swelling and hardness.He has developed paralysis of hypoglossal nerve.
Ans: carcinoma deep cervical lymph node.
(3) A patient of sixtey has come lwith submandibular lymph node lenlargement and bulging of the hard palate in the mouth.
Ans:carcinoma arising from the columnar epithelial of the floor of the maxillary antrum.
(4) A patient of fifty has come with proptosis and diplopia with the swelling of maxillary area and submandibular lymph node enlargement.
Ans: carcinoma arising from the columnar epithelial from the roof of the maxillary antrum.
(5) A patient of sixty five has come with a swelling of maxillary area of the face with the enlargement of submandibular lymph node which is hard irregular and fixed.
Ans: carcinoma arising from columnar epithelium on the antrolateral area of maxillary antrum.
(6) A patient of fifty has come with nasal obstruction,epistaxis and epiphora with the swelling of the maxilla and submandibular enlargement of lymph node.
Ans: carcinoma arising from the columnar epithelium from the medial side of maxillary antrum.
(7) A young lady wife of a rikshaw pullar has come with skin rashes over her body.Her supratrochlear lymph node and lymph node in the occipital triangle is painless,enlarged, firm and shotty.
Ans: secondary syphillis.
(8) A man of fifty five has come with a static swelling which was present for more than two years.
Now he has developed pain, local rise of temperature over the swelling. There is no scratch,boil or ulcer.
Ans: Malignant transformation.
(9) A patient has come with a history of extrusion of bone chips.
Ans : osteomyelitis of bone.
(10) A patient of sixty five has come with pain in the sacral area.His prostate is hard and irregular.
Ans: carcinoma of prostate.

Spot the Diagnosis- XXXVI

(1)An old lady who as a result of a very trivial injury falls to the ground. Usually  cannot get up.She lies with the injured limb helplessly rolled out as if paralysed.
Ans:Fractureof the neck of femur.
(2) A rubust patient had a severe violence .There is a swelling and tenderness more marked over the greater trochanter .
Ans Trochanteric fracture .
(3)A boy of school going age has come with strong violence . He has inability to flex the stretched thigh while the patient is seated .
Ans Avulsion fracture of the lesser trochanter and the sign is known as ludloff sign .
(4) A lady has come with a hard , lobulated and painless swelling over the parotid region being present for many years . It is neither adherent to the skin nor to the masseter muscle . The facial nerve is free ..
Ans Mixed parotid tumour .
(5) A lady has come with a huge and static parotid tumour for the last few years . Now it is growing rapidly .
Ans Malignant transformation .
(6)Another patient of mixed parotid tumour has come now he has developed pain on the painless swelling .
Ans Malignant transformation .
(7)A patient of mixed parotid tumour has come . His tumour has become hard and fixed to the surrounding structures .
Ans Malignant transformation .
(8) An old man with old mixed parotid tumour . Now his movement of jaw has become restricted .
Ans malignant transformation .
(9) An old lady has come with mix parotid tumour . Her lymph nodes in the neck has become enlarged, hard and fixed to the skin .
Ans malignant transformation .
(10)A Lady of fifty has come with mixed parotid tumour for years .  There is involvement of facial nerve on that side of the face .
Ans Malignant transformation .

Spot the Diagnosis - XXXV

(1)A child has been brought   with the complaints of sudden screaming and pulling at the prepnce during micturation .
Ans Presence of stone in urinary bladder .
(2) A patient of ten years has pain in the hypogastrium .Pain is referred to the tip of penis with haematuria.
Ans urnary bladder stone .
(3) A patient has come with pain and haematuria the pain is fixed in renal angle and is dull ache made worse by exercise and better with  rest .
Ans Renal calculus .
(5) An adult man has come with painless haematuria . In plain x ray of his chest there is canon - ball appearance .
Ans Hypernephroma.
(6) A patient has come with profuse painless and paroxysmal haematuria on radiological plate there is a filling defect in his renal pelvis .
Ans Papilloma of renal pelvis .
(7) A huge enlargement and hard liver without palpable spleen. In which condition ?
Ans Secondary carcinoma of liver .
(8) A huge and soft enlargement of liver with intercostal tenderness without palpable spleen .
Ans Amoebic liver abscess .
(9) A febrile patient has fullness , rigidity and tenderness on the renal angle .
Ans Perinephric abscess .
(10) A patient of sixty five has come with retention of urine .His prostate feels stony hard , obliteration of median and lateral grooves and the rectal mucosa is adherent to it .
Ans Carcinoma of the prostate .

Spot the Diagnosis - XXXIV

(1) A patient of head injury is admitted with a boggy swelling in the temporal region of scalp under temporalis muscle of scalp.
Ans: Middle meningeal hemorrhage.
(2) What do you think of the prognosis of a head injury whose sphinter- control has gone.
Ans: prognosis seems to be grave.
(3) A patient of head injury has been admitted in the ward,his breathing is stertuous .His lips and cheeks blow ins and out with snoring sound.Where is the compression and what is his prognosis.
Ans: It indicates bulbar compression and his prognosis is grave.
(4) A patient of head injury come with pin point fixed pupil,pyrexia and paralysis.Pin point the site of hemorrhage.
Ans: pontine hemorrhage.
(5)A patient has come with a cystic swelling in the popliteal fossa,the swelling is translucent and becomes more  prominent on extension of the knee joint and disappear on flexion.
Ans: semimembranosus bursitis.
(6) A child gets limping and night cries.
Ans: tuberculosis of hip joint.
(7) An x-ray of hip joint of a child has been shown to you in which there is hazziness in the babcock's triangle.
Ans: Tuberculosis of hip joint.
(8) A lady has come with nodular goitre and precordial pain. The only finding is her pulse rate which is irregular in rate and rythum.
Ans: secondary toxic goitre.
(9) A patient of four has come with painless enlargement of kidney without hemeturia .
Ans: wilm's tumor.
(10)A patient of forty five has come with bilateral renal swelling .
Ans: polycystic kidney.

Spot the Diagnosis - XXXIII

(1) A patient looks pale and puffy feels more cold even in the month of summer.
Ans Myxoedema .
(2) Tumour of which part of the brain is characterised by temporal headache .
Ans pituitary tumour .
(3) Tumour of which part of brain is characterised by epileptic fits .
Ans Cerebral lobe tumour .
(4) After three days of head injury , There is ecchymosis over the tip of mastoid process .
Ans This sign is known as Battle' s sign and is found in the fracture of posterior cranial fossa .
(5) A patient of head injury who is deeply unconscious heralds impending death .What is that thing by which you can say like this .
Ans Rapid pulse rate .
(6) In case of head injury with bleeding from nose , what it indicates ?
Ans Fracture of the anterior cranial fossa .
(7) What does it indicate when bleeding from the ear or mouth happens in the case of head injury.
Ans fracture of middle carnial fossa.
(8) Rigidity of neck ,fever and vomiting is found in meningitis .
(9) In case of a head injury there is neck rigidity with fever .
Ans sub arachnoid hemorrhage .
(10) In which fracture - dislocation there is rigidity of neck but no fever .
Ans Fracture dislocation of cervical spine .

Spot the Diagnosis- XXXII

(1) What are the conditions in which there are pulsatations found in the epigastrium .
Ans-(a) The distensile pulsatation of the liver is found only in gross heart failure associated with tricuspid incompetence .
(b) Displacement of apex beat by left sided pneumothorax.
(c) Aneurysm of abdominal aorta .
(d) Scoliosis.
(e)Any tumour in front of abdominal aorta such as pyloric cancer .
(2) What is your diagnosis when an old patient of chronic bronchitis expectorates large volume of sputum in the morning .He has also developed clubbing of fingers.
Ans Bronchiectasis .
(3) A case of prolonged fever has developed clubbing of fingers , has  cardiac murmur and splenic enlargement.
Ans sub acute bacterial endocarditis .
(4) A patient of sixty had reported for cynosis and oedema of face and neck .His neck veins are all engorged and full .
Ans Retrosternal goitre or neoplasm of the mediastinum.
(5) A child patient has come with clubbing of fingers with heart murmur .
Ans congenital heart disease .
(6) A patient has come with pigmentation of lips and buccal mucosa .
Ans Addition disease .
(7) A patient has puffy and oedematus lower eye lids specially in the morning .
Ans Nephritis.
(8) A child patient has paroxysm of cough for long and having the puffy and oedematous lower eye lid and what disease he is suffering from.?
Ans whooping cough .
(9) A patient is having herpes labials.Which disease should be searched for.?
Ans Preumonia .
(10) Which disease you think of
When emaciation is accompanied with polyurea .
Ans Diabetes mellitus .
(11) Emaciation with exopthalmos.
 Ans Thyrotoxicosis .
(12) Emaciation with hard irregular and fixed  swelling .
Ans malignant growth .
(13) Emaciation with evening rise of temperature .
Ans Tuberculosis .
(14) When there are three things given to you
(a)proteinurea .
(b) haematuria and
(c) hypertension.
Ans subacute glomerulonephritis.
(15) When there is oedema of only one leg with history of rigor and fever at times .
Ans fileriasis .
(16) When oedema of one arm is found .
Ans vascular or lymphatic obstruction .
(17) In a patient the oedema is generalised but specially evident in eye and face specially in the morning .
Ans Anaemia and hypoproteinemia .
(18) Oedema more pronounced in both the legs and accentuated in the evening .
Ans heart failure .
(19) What are the diseases in which orthopnea is absent and patient prefers recumbent posture.
 Ans Tricuspid incompetence and constrictive pericarditis .
(20)A patient with non pitting oedema of legs.
And  myxoedema  .

Spot the Diagnosis - XXXI

(1) A patients has venules over the costal margin.
Ans: Carries no clinical significance.
(2) A patient has come with unilateral enlargement of external jugular vein.
Ans: Vein is partially occluded in supra clavicular fossa by enlarged lymph node,neoplasm or aneurysm.
(3) A patient has come with growing nail of his big toe that looks like ram's horn .
Ans: Onychographosis.
(4) A patient has come with acute pain and shock with the history of missed periods.There is a bluish tinge around her umbilicus.
Ans: Ruptured ectopic gestation.
(5) A women has come with acute pain with restlessness and shock.There is a yellow hue around her umbilicus.
Ans: Acute pancreatitis.
(6) A patient has come with huge enlargement of liver, urticaria and dirty greenish stain around his umbilicus.
Ans: Ruptured hydatid cyst.
(7) A patient has come with ulceration of umbilicus, his lymph nodes in the both groin and axilla are enlarged, hard and fixed.
Ans: Carcinoma of umbilicus.
(8) A patient has pedunculated, ruspberry colour growth from umbilicus.
Ans: Ruspberry tumor.
(9) What are the conditions when there is pulsatation in the neck outside the sternomastoid  muscles .
Ans Exothalmic goitre , aortic incompetence , hypertension and aneurysm of the common carotid artery , on exertion and mental excitement .
(10) In patient there jugular venous pulsation .
Ans It may be due to tricuspid regurgitation or enlargement of right auricle .

Spot the Diagnosis- XXX

(1) A patient complains of pain on the lateral epicondyle of humerus bone.
Ans:Tennis elbow.
(2) A patient complains of pain on the medial epicondyle of humerus bone.
Ans:Golfers elbow.
(3) A patient has come with cystic swelling on the external angle of his eye.There is a bony deficiency.
Ans:External angular dermoid cyst.
(4) There is a swelling which is cystic has no punctum at the base of nose.
Ans: Internal angular dermoid cyst.
(5) There is a cystic swelling behind the ear.
Ans: Posterior auricular dermoid cyst.
(6) Which are the diseases where liberal salting of food is advised for the patients.
Ans: Fibrocystic disease of pancreas and Addison's' disease.
(7) What is the most diagnostic clinical finding of acute left ventricular failure.
Ans: Basal crepts.
(8) A patient on prolonged fluid transfusion has full external jugular vein.
Ans: Over hydration.
(9) A patient has superficial communication between veins of axilla and those of femoral triangle On both the sides.
Ans: Obstruction of inferior vena cava.
(10) A patient has superficial communication between axillary veins and those of veins of femoral triangle of only one side.
Ans: Pressure over the common or external illiac vein of that side.