Spot the diagnosis 153-156

(153) A patient of head injury has come . He vomits time and again . What is his prognosis?
(154) A patient of road  accident was brought to emergency in a unconscious state . There is no witness who can tell how the accident happened . He has pin point and fixed pupil , pyrexia (104°) and paralysis . What is your diagnosis ?
(155) A patient has been operated for cholecystectomy . After three days there was abdominal distension. On  auscultation of the abdomen , abdominal sound was found to be silent and respiratory and cardiac sound were audible . Spot the diagnosis ?
(156) A boy of two years of age has come with a fit of screaming. A saucer shaped mass was found in the line of colon with concavity towards umbilicus  and emptiness in
 R.I.F .
(a)Spot the diagnosis?
(b) What is "Emptiness in R.I.F" is known as in clinical surgery ?


Answers .
(153) Vomiting is often a good sign of recovery from cerebral concussion .
(154) Pontine hemorrhage . (A case of head injury)
(155) He has developed paralytic ileus .
(156b) Intussusception .
(b) The signe de Dance .

Spot the diagnosis 151-152

(151) You are called to see a patient of head injury admitted four days ago in the ward . There is ecchymosis on the mastoid process .
(a) Where is the site of fracture ?
(b) What is this sign known as ?
(152) A patient of head injury is already  admitted in the ward . One half of his body is paralysed.The peculiar sign is that the temperature of  the paralysed side is two degree higher than the normal side.
(a) What is this sign known as ?
(b) What is your diagnosis?

Answers.
(151a) Fracture of the base of skull behind the foramen magnum .
(b) Battle's sign .
(152a) Victor horsley sign .
(b) Intra cranial hemorrhage .

Spot the diagnosis 150

 ( 150) A patient is admitted in the ward and kept on intravenous fluid therapy for long . He developed fever,rigor and sweating for long . Everything including his heart is normal . Spot the diagnosis?

Ans Bacterial acute endocarditis.

Spot the diagnosis 148-149

(148) A patient has come in
M.O.P.D . He stoops forward with expressionless face ,rigid neck and tremors . Spot the diagnosis?
(149) A known case of vulvular heart disease has come for prolonged fever,rigor and profuse perspiration . Spot the diagnosis?

Answers.
(148) Parkinson's disease.
(149) Bacterial subacute endocarditis .

Spot the diagnosis 146-147

(146) A known case of P.U syndrome was seized with severe abdominal pain in the epigastrium . He was tossing in the bed ,all of a sudden he felt quite relief from pain without any drug and manoeuvre . Spot the diagnosis ?
(147) A patient has come for clubbing of nails of all the fingers with clubbing of radius ,ulna ,tibia and fibula of both the sides.
 What is this condition known as? 

Answers
(146) perforation of peptic ulcer .
(147) Chronic hypertrophic. pulmonary osteoarthropathy .

Spot the diagnosis 144-145

(144) A boy of twelve suffered from cervical lymphadenopathy.
The lymph glands are large in size, elastic and rubbery to feel . There is splenohepatomegaly, lymphocytosis and eosinophilia . Spot the diagnosis?
(145) A patient has come in the S.O.P.D for acute pain in the epigastrium . On examination there rigidity at the epigastrium right side on the upper portion of the right rectus . Spot the diagnosis?

Answers
(144) Hodgekin's disease .
(145) Perforation of peptic ulcer.

Spot the diagnosis 139-143

(139) An adult male has come for enlargement of lyjmph nodes which are firm , discrete and shotty . Spot the diagnosis ?
(140) A patient of fifty has come for the enlargement of lymph nodes which are stony hard and fixed to the surrounding muscles. Spot the diagnosis?
 ( 141) A patient has come with an ulcer whose discharge is greenish with typical smell . Spot the diagnosis?
(142) A patient has come with an ulcerating black mass of the big toe. Spot the diagnosis?
(143) A patient has come with an enlarged and hard liver . Whose one eye has been already  enucleated. Spot the diagnosis?
Answers
(139) Syphilitic nodes .
(140) Secondary carcinoma.
(141) Infected with B. pyocyaneus.
(142) Malignant melanoma .
(143) Malignant melanoma.

Spot the diagnosis 135-138

(135) A boy of sixteen has come in S.O.P.D for an ulcer in the axilla . The margin of the ulcer is thin ,undermined and bluish . Spot the diagnosis?
(136) A man of fifty has come in S.O.P.D for an ulcer on the penis. The margin of the ulcer is raised and everted . Spot the diagnosis?
(137) A man of forty has come in the S.O.P.D for an ulcer on the side his nose . The margin of the ulcer is raised and beaded . Spot the diagnosis ?
(138) A man of fifty has come with an ulcer on his tongue . The margin is punched out . Spot the diagnosis ?


Answers
(135) Tubercular ulcer .
(136) Carcinoma of penis .
(137) Rodent ulcer .
(138) Syphilitic ulcer .

Spot the diagnosis 131- 134

(131) A patient has come in the O.P.D for pain in the shoulder . On examination of the joint there is tenderness  just below the acromion . The arm is lying by the side of the chest . Spot the diagnosis?
(132)  A fatty lady of forty five has come for pain in the shoulder and itching of the back at upper side and sometime naucea and vomiting . On examination of her back there is hypersthecia on the back right side from nine to eleven ribs .
(133) A patient has come for pain in the shoulder and upper arm during the mid range of abduction from (45°to160°) and freedom from pain at the extremes of the range .
(a) Spot the diagnosis ?
(b) What are the causes ?
(134) A lady of sixty five has come for stiffness of the shoulder and pain which is worse at night often wakening her after she has fallen asleep . X-ray of her shoulder is normal . Spot the diagnosis ?

Answers
(131) Painful arc syndrome .
(132) Chronic cholecystitis .
(133)
(a) Painful arc syndrome .
(b1) incomplete rupture of the supraspinatus .
(2) supraspinatus tendnitis .
(3) Calcified  deposites supraspinatus tendons .
(4) subacromial bursitis.
(5) Crack fracture of the greater tuberosity .
(134) Frozen shoulder.

Spot the diagnosis 129-130

(129) An adult male of fifty from a well- to -do family has come  . He complains of pain in the front of medial epicondyle . Nothing abnormal was detected  . Spot the diagnosis ?
(130) A lady of forty has come . She feels pain near the tip of radial styloid process near the  anatomical snuff box. On examination there is tenderness and a firm nodule in the size of a orange pip is palpably enlarged . The Finkelstein 's test is positive.
(a) Spot the diagnosis ?
(b)  What is Finkelstein 's test?
(c) What are the tendons involve in it .
(d) What is the nature of the disease ?

Answers
(129) Golfer's elbow
(130)
(a) De Quervain's tenovaginitis .
(b) Passive adduction or ulnar deviation of the wrist and thumb causes the patient to wince with pain .
(c) Abductor pollicis longus and extensor pollics brevis .
(d) Chronic stenosing tenovagitis.

Spot the diagnosis 127-128

(127) A patient came with injury of the elbow joint . The doctor diagnosed it as posterior dislocation of  the elbow joint without x-ray. The doctor reduced the dislocation very easily but it recurred easily  . What was the cause of recurrence in your opinion ?

(128) A surgeon was consulted for pain in the front of lateral epicondyle . The doctor did two tests .
(a) The doctor flexed passively his hand at the full extent .
(b) The patient was told to dorsiflex  his hand and the doctor tried to flex the hand against resistance .
And in both the tests pain was aggravated . What is your diagnosis?

Answers
(127) Fracture of coronoid process .

(128) Tenis elbow .
(a) Mills's manoeuvre .
(b) Cozen's test

Spot the diagnosis 121-126

(121)An old man of seventy walks with his hands crossed on his back still doesn't stand fully straight .
(122) An old man of seventy five has come with enlarged prostate but he says that there is much pain on his back .
(123) One patient of hand injury has come there is swelling on the anatomical snuff box and tenderness on the same place when the hand moves medially .
(124) A patient has come there is tenderness when the tip of the thumb is pressed against the fore finger of the injured side .
(125) A patient of hand injury has come there is a bony protuberance  felt anteriorly behind the flexor retinaculum .
(126) A patient of hand injury has come . There is tenderness over the knuckle of the second metacarpal on percussion .


Answers
(123) Fracture of scaphoid .
(126) Fracture of scaphoid .
(125) Dislocation of lunate .
(121) Senile osteoporosis.
(122)  Carcinoma prostate .
(124) Fracture of scaphoid .

Spot the diagnosis 121

(1) A patient of severe injury has come in the emergency . He is a well-built adult and his thigh assumes the position of flexion ,adduction and internal rotation . Spot the diagnosis ?
Ans Posterior dislocation of the hip .

Spot the diagnosis 120

(1) A school boy has a motor cycle accident . He has injury on the hip joint one side . Now the only trouble lies with him that he can't flex the outstretched thigh that side .
(a)Where is the fracture?
(b) What is this sign known as ?
Ans -(a) Avulsion fracture of the lesser trochanter .
(b) Ludloff's sign .

Spot the diagnosis 119

(1) An adult male has come in O.P.D for multiple swellings with pain . His urine contains Bence Jones proteoses .
Ans Multiple myloma .

Spot the diagnosis 118

(1) A patient of severe motor-cycle accident has come in emergency. His apex beat has shifted towards left side .
Ans Haemothorax .

Spot the diagnosis 117

(1) A patient of fifty consults a doctor for alternate diarrhoea and constipation . The doctor on examination  finds a lump in his abdomen which is firm, irregular and slightly moves with respiration . Spot the diagnosis ?
Ans Carcinoma colon .

Spot the diagnosis 116

(1) On a radiological view a patient has multiple polyposis coli and there is circumoral black pigmentation . Spot the diagnosis?
Ans Peutz - jeger's syndrome .

Spot the diagnosis 115

(1) In a gynocological case the doctor says that she is sitting on the top of a volcano ,but she is not a case of placenta  paevia .
Ans Retained placenta .

Spot the diagnosis 114

(1) A lady of seventy slips in her bathroom and falls down on the ground . Now she  feels herself quite unable to stand up by herself .
Ans Fracture neck of femur .

Spot the diagnosis 113

(1) A lady of fifty five is already sitting on the ground . Now she is trying to stand up by placing the both hands on the ground . Spot the diagnosis ?
Ans Osteoporosis .

Spot the diagnosis 112

(1) On a radiological view a patient has multiple polyposis coli and there is circumoral black pigmentation . Spot the diagnosis?
Ans Peauz zegger syndrome .