Spotthe diagnosis 277-281

(277) A case of acute intestinal obstruction has been admitted . There is rebound tenderness . What does it indicate ?

(278) A patient of acute intestinal obstruction has come . There is early appearance of abdominal rigidity . What does it indicate ?

(279) An already diagnosed case of peptic ulcer was admitted, he has rigidity on the upper part of right rectus muscle and pain has disappeared .

(280) A patient has come who has persistent vomiting with gradually increasing abdominal distension . The urine report came which shows albumin ,cast and low specific gravity .

(281) A robust fat man of forty has come for acute severe pain abdomen and fullness in the epigastrium . Pain penetrates back . Spot the diagnosis ?

Answers.
(277) It indicates strangulation of gut.
(278) There is strangulation of gut.
(279) Perforation of peptic ulcer.
(280) Uraemia .
(281) Acute pancreatitis .

Spot the diagnosis 272-276

(272) A patient of bus-accident has been admitted . He is getting pallor ,restless and  has running pulse. Right hypochondrium is tender ,increased areas of liver dullness and there is sifting dullness . Spot the diagnosis?

(273) A serious case of pain abdomen has been referred to sadar hospital . He has ecchymosis in the loin and bluish hue near the umbilicus .
(a)What are these signs?
 (b)Spot the diagnosis?

(274) A patient has come. He has hypersthecia in sherren's triangle .
(a) What is sherren's triangle ?
(b) In which disease there is hypersthecia in that triangle?

(275) A patient of acute appendicitis has been admitted ,later on the pain has sifted from R.I.F to the L.I.F . What does it indicate?

(276) A patient has come with hypersthecia in sherren's triangle. Later on it disappeared . What does it indicate?

Answers.
(272) Rupture of liver .
(273a) Grey turner sign(Ecchymosis in the loin )
(b) Cullen sign (Bluish hue around the umbilicus) They are present in late cases of acute pancreatitis and ruptured ectopic gestation .
(274) Sherren's triangle is formed by three lines .
(a) A line which joins umbilicus to right anterior superior iliac spine .
(b) The line which joins the umbilicus to right pubic tubercle.
(c) Third line joins right anterior superior iliac spine to right pubic tubercle .
(b)Acute appendicitis .
(275) It indicates that peritonitis has set in and demands immediate operation.
(276) It indicates that gangrenous appendix has ruptured .

Spot the diagnosis 267- 271

(267) A patient has come with 3P's paroxymal,profuse and painless haematuria . Spot the diagnosis?
(268) A patient of pyrexia of unknown origin has come. He has fullness ,rigidity and tenderness at the renal angle with scoliosis . Spot the diagnosis?
(269)  A patient complains of pain and strangury ,frequent painful discharge of urine,and pain is reffered to the tip of penis.
(270) A pregnant lady of three months pregnancy complains of passing grapes like structure in her urine .
(271) A patient of abdominal injury has come. On examination,pressure by finger- tip on the left clavicle between sternomastoid and sclenius medius causes violent pain . (a)Spot the diagnosis?
(b) What is the name of this point?

Answers
(267) Papilloma arising from renal pelvis .
(268) Perinephric abscess.
(269) Stone in the ureter .
(270) Molar pregnancy .
(271) Saegesser's splenic point.

Spot the diagnosis 262-266

(262) A patient has developed pitting oedema on the scalp . (a)Spot the diagnosis?
(b) What does it indicate?
(263) A patient has come with 3P's ,pyrexia ,proptosis and paralysis of occular muscles specially of the sixth nerve ,third and fourth escaping .
(264) A boy of seventeen has come with superficial ulcer of the face which tends to heal at the centre and active at the periphery . Spot the diagnosis?
(265) A patient of thirty five has come with inguinal lymphadenitis with suppuration ,ulceration and sinus formation. Spot the diagnosis?
(266) A lady patient of forty has come with enlarged ,hard ,irregular and fixed lymph gland to the surrounding structure in the axilla . Spot the diagnosis?

Answers .
(262a) Pott's puffy tumour .
(b) It indicates osteomylitis of skull bone and extradural abscess .
(263) cavernous sinus thrombosis.
(264) Lupus vulgaris .
(265) Lymphogranuloma inguinale.
(266) Secondary carcinoma.

Spot the diagnosis 257-261

(257) A run-down patient of seventy has come for chronic pain abdomen ,anorexia and tachycardia . His abdomen feels doughy . Spot the diagnosis?
(258) A patient of jaundice has come . He has moderate enlargement of spleen and his urine does not contain bile but his stool contains bile . Spot the diagnosis?
(259) A lady of fifty has come with severe cutaneous haemorrhage with splenic enlargement. Her platelet count is low . Spot the diagnosis?
(260) A patient has come with huge enlargement of spleen with sternal tenderness . Spot the diagnosis?
(261) A patient has come with hard ,irregular ,nodular and umbilicated liver but spleen is not palpable . Spot the diagnosis?

Answers.
(257) Koch's abdomen .
(258) Acholuric jaundice or hemolytic jaundice .
(259) Essential thrombocytic purpura haemorrhagica .
(260) Chronic myeloid leukaemia.
(261) Secondary carcinoma of liver.

Spot the diagnosis 252-256

(252) A patient was operated for appendicectomy and was released from the hospital after some days . After a month he came again with a hard lump in right iliac fossa with multiple discharging sinuses .
(253) A lady of thirty has come with severe lower pain abdomen with tachycardia and shock . She gives the history of two missed periods . She was also operated for  tubectomy two years back . Spot the diagnosis?
(254) A lady of forty has come with globular swelling in the midline of lower abdomen just at the suprapubic region . It is tender and dull at percussion . Pressure induces a desire to micturate .
(255) A patient has fever ,rigor tachycardia and pain lower abdomen . On per rectum examination there is bulging on the anterior rectal wall .
Spot the diagnosis?
(256) A patient of sixty has multiple swellings in the abdomen . He was admitted twice for chronic bronchitis in the TATA main hospital . He has a family history of tuberculosis .

Answers.
(252) Actinomycosis.
(253) Ruptured tubal pregnancy .
(254) Distended urinary bladder .
(255) Pelvic abscess.
(256) Retroperitoneal tuberculous lymphadenitis .

Spot the diagnosis 247-251

(247) A young patient of sixteen has come with a lump in right iliac fossa, in his Ba-meal x-ray  there is filling defect and terminal part of the ileum is elevated . Spot the diagnosis?
(248) A patient of fifty five has come with a lump in right iliac fossa with a history of alternate diarrhoea and vomiting there is occult blood in stool .
(249) A lady of thirty was operated for a firm and rounded swelling arising from the rectus abdominis . The swelling recurred again . Spot the diagnosis?
(250) A patient of thirty has come with oedema of both the lower extremities and a abdominal lump which is huge, firm ,nodular and fixed to the posterior abdominal wall . Spot the diagnosis?
(251) A child of ten has come with bloody diarrhoea. His R.I.F is empty . Spot the diagnosis?


Answers.
(247) Hyperplastic ileocaecal tuberculosis.
(248) Carcinoma caecum.
(249) Desmoid tumor .
(250) Retro peritoneal sarcoma.
(251) Intussusception.

Spot the diagnosis 242-246

(242) A patient has come who has swelling and tenderness in his anatomical snuff box and you suspect fracture of scaphoid which view of x-ray would you like to have .
(243) You have been shown an x-ray plate of a boy of ten . There is haziness in the Babescock's triangle. Spot the diagnosis?
(244) A patient of sixty has come he has a chronic ulcer that bleeds on touch . Spot the diagnosis?
(245) A patient of thirty five has come with pain ,swelling and sluggish movement of his right knee joint . On x-ray there is soft tissue shadow with flecks of calcification in the joint . Spot the diagnosis?
(246) A patient has redness on both the maxillary prominence and gives the history of epistaxis. Spot the diagnosis?

Answers.
(242) Oblique view .
(243) Tuberculosis of the hip joint .
(244) Malignant ulcer .
(245) Malignant synovioma.
(246) Mitral stenosis.

Spot the diagnosis 226-234

 ( 226)A patient has come who has a cystic swelling near the outer canthus of his right eye .
spot the diagnosis?
 (227)A patient has come ho has a cystic swelling behind the right ear. spot the diagnosis?
(228) A patient has come whose colour of the face is earthy hue. spot the diagnosis
(229)A patient has come with a cyst on the dorsum of middle finger .He gives the history of pin-prick there.
 Spot the diagnosis
(230) A patient has an ulcer on the maxillary prominence. The margin of the ulcer is raised and beaded. Spot the diagnosis
 ( 231) A patient had three sebaceous cyst on his scalp. The upper one is ulcerated, fungated and gives profuse and offensive discharge. That virtually looks like carcinoma. Spot the diagnosis
(232) A lady of thirty has come with coils of soft tissue hanging around the neck .
(233)A patient of neurofibromatosis has come .He has fibromyxomatous masses which has arisen from the opthalmic branch of trigeminal nerve.
(234) A patient of thirty has come with multiple and painful lipomas all over his body
A)Spot the diagnosis
B)Which diseases is associated with it

Answer
(226)External angular dermoid cyst
(227)Posterior auricular dermoid cyst
(228)Chronic amoebic colitis
(229)Implantation dermoid
 (230)Rodent ulcer
(231)Cock"s peculiar tumour
(232)Pachydermatocele
 ( 233)Plexiform neurofibromatosis
 (234)A)Neurolipomatosis
B)Dercum" s disease.

Spot the diagnosis - 235- 241

(235) A lady of fifty has come with a lump in the breast which is firm . She has also multiple nodules all over the body in the size of a pea to cricket ball . (a)What is this tumor in the breast ?
(b) What is this condition known as?
(236) A patient of sixty has developed a horn like structure on his scalp .
(a) spot the diagnosis?
(b) How has this developed?
(237) A lady patient of thirty has come with occasional headache ,vertigo and convulsions . There is a pot wine stain on her right cheek . Spot the diagnosis?
(238) A baby was born . She has a nevus in the midline over the small of the back . Spot the diagnosis?
(239) A baby has a mass attached to the sacro-coxygeal region . There is a hand like projection protruding out from the mass . Spot the diagnosis?
(240) An already  diagnosed case of carcinoma ,now complains of pain . What does it indicate .
(241) A patient has come he has six cafe au lait pigmentation on the trunk and extrimites . Spot the diagnosis?

Answers.
(235a) Neurofibroma of the breast .
(b) Neurofibromatosis.
(236a) This horn is known to be sebaceous horn .
(b) It is caused by deposition of inspissitated sebaceous material.
(237) Sturge-weber disease .
(238) Spina- bifida -occulta.(239) Sacrocoxigeal teratoma.
(240) It indicates complications such as ulcerations deep infiltration and involvement of nerves and it also indicates inoperability .
(241) Neurofibromatosis ( Von-Reclighausen disease)

Spot the diagnosis 217- 225

(218) A patient with anasarca has come . He has raised blood pressure and there is microscopic haematuria . Spot the diagnosis?
(219) A patient is admitted in the ward for persistent fever, cardiac murmurs and palpable spleen. Spot the diagnosis?
(220) A patient of urticaria and eosinophilia has come with enlarged and soft liver with spherical and smooth surface . Spot the diagnosis?
(221) A lady of forty five who had a nodular goitre for years ,now she complains of palpitation ,precordial pain and exhaustion on strain . Spot the diagnosis?
(222) A deaf and dump has come with fever . His spleen is enlarged and his total W.B.C count is only 2000 . Spot the diagnosis?
(223) If you have to choose one thing for yourself between the two (a) Painful and intermittent jaundice .
(b) Painless and progressive jaundice . What will you choose and why ?
(224) A patient of severe abdominal pain has come . He is changing his posture every minute to get a relief but still there is no relief . He does not allow the doctor to examine out of restlessness . Spot the diagnosis?
(225) You are sent for to see a patient who was tossing in the bed for abdominal pain . You have prescribed heavily but still then there is no relief even after one hour of the injections . Spot the diagnosis ?
Answers.
(218) Subacute glomerulonephritis .
(219) Subacute bacterial endocarditis .
(220) Hydatid cyst .
(221) Secondary thyrotoxicosis .
(222) Kalazar.
(223a)Painful and intermittent jaundice is due to calculus in the common bile duct which is curable after surgery.
 (b) It is due to carcinoma head of pancreas which is fatal to life.
(224) Renal stone .
(225) Renal stone.

Spot the diagnosis 213- 217

(213) A patient has come with rounded fullness of soldier joint . The orthopaedic surgeon examines and says it not effusion in the joint. Spot the diagnosis?
(214) A run- down boy of ten has come with flattening of the shoulder joint with wasting of the deltoid muscles . Spot the diagnosis?
(215) A lady patient of child- bearing age has come . She complains of haematuria during every menstruation . Spot the diagnosis?
(216) A lady of child -bearing age complains of bleeding from umbilicus during every menstruation . Spot the diagnosis?
(217) A patient has enlarged lymph glands of both the axilla and the groin . The lymph glands are hard ,irregular and fixed . Spot the diagnosis?
Answers.
(213) Subdeltoid bursitis.
(214) Tuberculous arthritis .
(215) Endometriosis of urinary tract provided the contamination from vagina has been excluded .
(216) Endometrioma. It is associated with similar growth of uterus and ovary.
(217) Carcinoma umbilicus .

Spot the diagnosis 208- 212

(208) A patient has come with gangrene of finger of his right hand . On auscultation of his heart it is all okay . Spot the diagnosis?
(209) One patient has come with an x-ray plate of his cervical spine and upper chest . He has gangrene of fingers but his x-ray for cervical rib is okay there is no cervical rib.
(210) A young female has come with bilateral superficial gangrene of his fingers tip (thumbs escaping) her pulse is normal . Spot the diagnosis?
(211) A chain smoker of forty has come with dry gangrene of his right big toe . Spot the diagnosis?
(212) A man of sixty five has come with dry gangrene of big toe . He had a history of trauma of the toe . Spot the diagnosis?
Answers.
(208) Cervical rib .
(209) Embolic gangrene.
(210) Raynaud's  disease.
(211) Buerger's disease.(thromboangitis oblitrans).
(212) Senile gangrene due to atherosclerosis.

Spot the diagnosis 203 -207

(203) A run-down boy was come with pain in his hip joint .
(204) A blue sclerotic infant from a blue sclerotic mother has come with multiple fractures.
(205) A patient has come with a fracture of humerus but the colour of the skin a khaki colour .
(206) A patient has come with arthritics of knee joint . There is abnormal knee movement; towards abduction of the knee joint .
(207) A child has come with arthritics . His nasal breeze is depressed and moon shaped teeth .
Answers.
(203) Tubercular arthritics .
(204) Osteogenesis imperfecta .
(205) Gas gangrene .
(206) Charcot's joint.
(207) Clutton's joint .

Spot the diagnosis 197 - 202

(197) A female of fifty has come with a goitre with well defined margin and India rubber consistency. Her liver and spleen is enlarged . Spot the diagnosis?

(198) A lady of sixty has come with a hard ,irregular and fixed thyroid gland with fracture of neck of femur . Spot the diagnosis?

(199) A lady has come with long standing goitre and has no other complain or finding. Spot the diagnosis?

(200) An old man of seventy has come for a swelling on the femur. On  blood examination his acid phosphatase was found to be raised . Spot the diagnosis?

(201) A patient has come with foot drop . On examination there is tumor of the head of fibula . Spot the diagnosis?

(202) A patient has come with the following features
(a)Pseudoptosis.
(b) Enophthalmous .
(c) Myosis.
(d) Anhydrosis of the affected side of the face .
(a) What is this syndrome known as?
(b) What  is the reason ?

Answers.
(197) Hashimoto's disease.
(198) Carcinoma thyroid.
(199)Secondary toxic goitre.
(200) Prostatic metastasis in bone .
(201) Foot drop is due to involvement of external popliteal nerve by the tumor .
(202a) Horner's syndrome.
(b) Due to involvement of sympathetic trunk .

Spot the diagnosis 191-196

(191) A lady patient who was having a painless goitre has come for severe and sudden pain and swelling in the size of goitre.
(192) A lady patient have an abscess in the mid line of her neck . The abscess was incised by a surgeon about nine months back but there is still a fistuala has been formed .
(193) A lady of fifty has come with a stare and fullness of the neck .
(194) A lady patient of fifty five has come with a swelling on the lateral side of her goitre . Spot the diagnosis?
(195) A boy has come with a small swelling near the hyoid bone exactly on the midline . Spot the diagnosis ?
(196) A patient having a goitre for a long time in which pulsation of the carotid artery is not felt . Spot the diagnosis?


Answers.
(191) Haemorrhage in the goitre .
(192) Thyroglossal fistula.
(193) Exopthalmic goitre.
(194) Metastatic lymph node from a hidden carcinoma in the goitre.
(195) Thyroglossal cyst.
(196) Carcinoma thyroid.

Spot the diagnosis 180 -190

(180) You are told to say about the prognosis of a patient of head injury who has lost his sphincteric control .
(181) A child has come . He complains of headache and vomiting before breakfast . Spot the diagnosis?
(182) In which tumor of the brain there is bitemporal headache ?
I(183) A patient has come with early dimness of vision and pain in the occipital region radiation towards neck .
(184) A patient has come with painless whitlow . Spot the diagnosis?
(185) A patient has come with three cardinal features .
(a) Muscular atrophy causing claw hands ,
(b) Scoliosis and
(c) Unequal pupil .Spot the diagnosis?
(186) A patient has come with a perforating ulcer of the foot with gangrene starting around it . Spot the diagnosis?
(187) What are the conditions in which there are bedsores or gangrene due to trophic change occurs .
(188) A patient previously operated for cholecystectomy has come with hectic rise of temperature, rigor,sweating and pain in the shoulder . Percussion on the midaxilliary line there are alternate areas of resonance and dullness . On x-ray there is gas under the diaphragm which is raised and fixed . Spot the diagnosis?
(189) A lady of twenty eight has come with a firm and rounded swelling of the rectus sheath . The patient was operated for this but the swelling reccured after some months .
(a)What is the name of this swelling ?
(b) What is the nature of the swelling which recurred after operation .
(190) A patient feels  sudden and severe pain in the mouth specially on the cheek whenever he thinks ,sees ,smells and chews spicy or sour food . Spot the diagnosis?

Answers
(180) His prognosis is grave .
(181) Medulloblastoma of cerebellum .
(182) Pituitary tumor .
(183) Subtentorial growth .
(184) Morvan's disease.
(185) Syringomyelia .
(186) He is a tabetic patient .
(187) In disorder of the .
(a) Central nervous system.
(b) Pott's disease.
(c) Fracture - dislocation of the spine .
(188) Subphrenic abscess.
(189a) Desmoid tumor .
(b) In malignancy recurrence is the rule.
(190) Meal time syndrome (Due to calculus in the Wharton's duct) .

Spot the diagnosis177- 179

(177) An adult male of forty complains of alternate dirrohea and constipation having an irregular and firm lump in right iliac fossa which moves slightly with respiration there is occult blood in the stool . Spot the diagnosis ?
(178) A patient of head injury has come with a boggy swelling under the temporal muscles and fascia in the temporal region of scalp .
(179) In a motorcycle accident a patient has developed squint .
Which cranial nerves are affected?
Answers.
(177) Carcinoma colon .
(178) Middle meningeal haemorrhage.
(179) It is usually due to third, fourth and sixth cranial nerves.

Spot the diagnosis 166-176

(166) A female of forty five has a stony hard and a fixed thyroid gland . The thyroid gland has engulfed the carotid sheath but in biopsy there is no carcinoma . Spot the diagnosis?
(167) A girl of fifteen has a fistula near the midline a little below the hyoid bone . The opening of the fistula is indrawn and overlaid by a crecentric fold of skin . Spot the diagnosis?
(168) A female patient of fifty five having a goitre of long duration has now developed hoarseness of voice for some months . Spot the diagnosis?
(169) A patient of head injury has come with rigidity of neck, fever and no other complain or finding.
(170) A patient of head injury has come only with rigidity of neck but no fever .
(171) A child has come with rigidity of neck , vomiting and high fever but there is no history of injury .
(172) In an injured patient the heart sound is absent but patient is alive .
(173) A lady patient complains of pain in the right hypochondrium which is referred to inferior angle of right scapula .
(174) A patient of peptic ulcer now complains of pain at the left side of umbilicus which is referred to left iliac fossa .
(175) A patient of irregular bowel habits complains of pain on the left iliac fossa on pressure .
(176) A patient of chronic duodenal  ulcer now complains of  pain in the epigastrium which is penetrating to the back . Spot the diagnosis?
Answers.
(166) Riedel thyroditis .
(167) Thyroglossal fistula .
(168) Carcinoma of thyroid .
(169) Subarachnoid hemorrhage.
(170) Fracture dislocation of cervical spine .
(171) Meningitis .
(172) Haemopericardium .
(173) Gallbladder disease.
(174) Gastrojujenal ulcer .
(175) Chronic amoebic colitis .
(176) Ulcer penetrating to the pancreas.

Spot the diagnosis161-165

(161) An emaciated patient of twenty comes with a depressed scar in the neck . Spot the diagnosis?
(162) A kashmiri patient of sixty comes with a chronic ulcer all around the umbilicus .
(163) A boy of fifteen has come with a swelling in the metaphysis of tibia with  variable consistency . Spot the diagnosis?
(164) A patient has come with the swelling in the metaphysis of tibia . His x-ray shows a cavity in the bone and the cavity is surrounded by a thick , sclerosed bone . There is one sequestrum inside the cavity . Spot the diagnosis?
(165) A patient consulted a surgeon for a swelling in the diphysis of tibia . The doctor says that his x-ray picture is most diagnostic and the tumor is highly radio-sensitive . This tumor melts like snow  in sunshine . Spot the diagnosis?
Answers.
(161) Tuberculosis .
(162) Carcinoma skin (khangri cancer) .
(163) Osteogenic sarcoma .
(164) Brodies abscess .
(165) Ewing's tumor.

Spot the diagnosis 157- 160

(157)A patient who has fallen from a tree has been brought in the emergency ward. He can't raise one leg but can move his injured foot . Spot the diagnosis? (158) A patient has come . He has fallen from the roof of his house . He can't raise both his legs. Spot the diagnosis?

(159) A patient has come . He gives the history of 
(a) Intermitted abdominal colic .
(b) Intermitted jaundice following each attack of colic
(c) Intermitted fever .
(1) Spot the diagnosis ?
(2) What is this triad known as? 

(160) A jaundiced patient has come . On examination of his abdomen his gallbladder is palpably enlarged .
(a) What is your diagnosis?
(b) What is Corvoisier's law ?
(c) What are the main exception of this law ?

Answers

(157) Fracture neck of femur .
(158) Paraplegia due to involvement of his cord .
(159) (1 ) Stone in the common bile duct .
    (2) Charcot's triad .
(160a) Carcinoma head of pancreas
  (b) Corvoisier's law states that in a jaundiced patient if the gallbladder is palpably enlarged it is a case of carcinoma head of pancreas .
 (c) Two man exceptions are
 (a) Double impaction , one in the cystic duct and another in the common bile duct .
 (b) Pancreatic calculi .