Spot the diagnosis 401-405

(401) A patient has come with a cystic swelling near the knee joint in between the medial collateral ligament and tendons of sartorius ,gracilis and semitendinosus superficially . Spot the diagnosis?

(402) A patient has come with a big cystic swelling which lie posteromedially in the popliteal fossa . Spot the diagnosis?

(403) A robust patient of sixty has come with a cystic swelling which lies centrally in the popliteal fossa of both the knee joints . Spit the diagnosis?

(404) A patient has come with a depressed scar . What does it indicate?

(405) An adult male has come with enlargement of epitrochlear lymph -node and lymph -node in the occipital triangle . The lymph- node is firm and shorty . Spot the diagnosis?
Answers.
(401) Bursa anserina.
(402) Semimembronosus bursitis.
(403) Morrant baker cyst.
(404) Depressed scar indicates fibrosis due to previous suppuration.
(405) Syphilitic gland.

Spot the diagnosis 398-400

(398) A female patient of fifty has come with fracture neck of femur . The fracture occurred in her bathroom . On examination there was a stony hard swelling in her neck arising from thyroid ,irregular in feel and fixicity to the surrounding structures. Spot the diagnosis?

(399) You have been given an
 x-ray plate of pelvis to comment on  . The Shenton's line on the left side is normal and on the right side distorted . Spot the diagnosis?

(400) An adult male has come with bilateral renal swelling and occasional haematuria . Spot the diagnosis?

Answers.
(398) Pathological fracture of neck of femur . The primary carcinoma lies in the thyroid .
(399) Perthe's disease. Distortion of shenton's line in the right side is due to upper displacement of femur due to flattening of head.
(400) Polycystic kidney.

Spot the diagnosis 391-397

(391) A robust manual worker of more than fifty has come with arthritis of his knee joint . Spot the diagnosis?


(392) A boy of twenty has come with an excessive broadening of his ankle joint . He had a motorcycle accident . Spot the diagnosis?

(393) A robust adult gentleman got a severe motorcycle accident. There is tenderness and swelling over the greater trochanter . Spot the diagnosis?

(394) A child had been brought to you . He has flattening of his buttucks and loss of gluteal folds. Spot the diagnosis?

(395) A patient has come with effusion in both the knee joints but does not move in all directions . Spot the diagnosis?

(396) A patient has come with a swelling in the popliteal fossa . When pressed the pain shoots down to the foot .

(397) A boy of ten has been brought . He has bony thickening with sinuses attached to the bone . Spot the diagnosis?

Answers.
(391) Osteo-arthrosis of knee joint.
(392) Dupuytren's Fracture- dislocation in which inferior tibio -fubular ligament is torn.
(393) Trochanteric fracture.
(394) Tubercular arthritis of hip- joint .
(395) Haemophilia.
(396) Neuromyofibroma of the common peroneal or lateral popliteal nerve .
(397) Osteomylitis of the bone.

Spot the Diagnosis - 388 -390

(388) An x-ray plate of knee joint was shown to you . There is triple displacement that is flexion, posterior displacement and lateral deviation of tibia . Spot the diagnosis?

(389) A patient has come with a pulsating swelling in the popliteal fossa . Spot the diagnosis?

(390) A patient's knee joint can be moved in any direction and there is effusion in both the joints . Spot the diagnosis?

Answers.
(388) Tuberculosis of knee joint.
(389) Aneurysm of popliteal artery .
(390) Charcot's joint.

Spot the Diagnosis 385-387

(385) A patient of ten years of age has been brought to you . He has polyarticular arthritis  with spleenomegaly and lymphadenopathy. Spot t joint he diagnosis?

(386) An x-ray plate of knee joint is shown to you . The x-ray plate of knee joint shows generalised decalcification,diminution and obliteration of joint space with erosion of articular ends . Spot the diagnosis?

(387) A patient has come with the complaint of boring pain in the tibia when the part is warm and there is an ulcer with  punched out margins . Spot the diagnosis?

Answers.
(385) Still's disease.
(386) Tuberculous arthritics .
(387) Syphilis of tibia .

Spot the Diagnosis 381-384

(381) A patient has come with an ulcer . The discharge is greenish with a peculiar smell . Spot the diagnosis?

(382) A patient has come with multiple sinuses with yellowish discharge . Spot the diagnosis?

(383) A diabetic patient of fifty has developed a big swelling on the nape of his neck . The central part of the swelling has softened and there is purulent discharge through the multiple openings .

(384) A patient has come. He has pain in the knee joint . In radiological picture he has no evidence of disease . The joint is perfectly normal but he has pain. Spot the diagnosis?

Answers.
(381) Infection by E. pyocyneous 
(382) Actinomycosis .

(383) Carbuncle.

(384) Pain is referred from hip joint .

The epidemic of Dengue in Delhi

It is iatrogenic and is due to misuse of analgesic . This dengue is not due to mosquito-bite but it is due to drug -bite. 

  
It was in the hottest summer in Delhi when there was virtually a flu-like-situation . This situation was due to large numbers of air-conditioned offices ,cinema- halls ,cars and trains etc but when they were exposed to outside temperature  which was very hot and caused a flu like situation . In long years back at about 1941s in Britain there was an epidemic of flu. The doctors combated this by salicylates, paracetamol and other analgesic. The patient started taking drugs . As analgesics are also euphoric . The patient felt a sense of well-being and hence many of them continued taking analgesic regularly . After a few months or so there was another epidemic of kidney failure. When some of experienced doctors searched for the cause of the disease they could find regular use of analgesic in the root of the epidemic . Then the government banned the use of drugs without the prescription of registered doctor      

                  Like largectil (chlorpromazine )salicylates have also large number of actions
(a) Analgesic
(b)Antipyrectic
(c) Anti-inflamatory
(d) Respiratory stimulation
(e) Insulin like effect
(f) Uricosuric agent
(g) Hypoprothrobonaemic effect  and many blood disorders
(h) Gastric irritation
(I) Ulceration,
(j) and perforation and some persons are highly allergic to it. The great Bruce Lee, the steel- man of Hong Kong died due to taking single tablet of analgesic. This is only salicylates but the other analgesic have also another side effect . In India what to talk of educated people even the laymen have made it a fashion of self -medication. In any big hospitals more than 30% cases are admitted due to toxicity of drugs 

                      In long years ago a lady of fifty came to me for treatment . She was a case of migraine for long years she was taking saridon (analgesic) for long years. I told her to avoid this drug she said ,“ I can't sleep when sarodon in not at hand or at home . This is the  drug dependence . Many people depend on drug.
 one day I happened to go to my native village .A few people on considerable repute came to meet me in the night but they were told to come early next morning as I had gone into deep sleep . Very early in the morning they reported with a young man who was working in Delhi and was diagnosed as a case of dengue and was referred to a nursing home in Delhi for hospitalization. He was asked for rupees 50000 extra as there was no vacant seats . As he had no money to pay the extra he left for his native village . I examined the patient and found him clinically fit. I prescribed him only some tonic as a placebo and told him to meet me if he is not cured. The chap never reported and was completely well off.

                 A good doctor should be a good psychologist.  when I was posted in a block in Santhal Pargana I had a call from affluent Bengali family.  A lady was suffering from migraine and was under the treatment of very renowned physician of Kolkata she was taking stemetil with other drugs for many years. I diagnosed her to be a case of agranulocytosis because she was very-very anaemic and was taking stemetil for long years I stopped the drug and told her to immediately report to the physician in Kolkata.When consulted in Kolkata the doctor felt guilty and started rebuking his compounders for prolonged use of stemetil .

                For every epidemic we blame the bacteria,virus and mosquito etc but never look towards drugs used previously . It is but quite natural to blame others for our own fault.

           Any drug in an unskilled hand should be taken as poison.

Spot the diagnosis 378-380

(378) An x-ray plate of lower end of tibia was shown to you in which there is cyst like appearance in which there is piece of sequestrum and margin of the cyst is sclerosed all around. Spot the diagnosis?

(379) A patient of thirty has been referred to Delhi for oedema of the both lower extremities and a huge, firm and nodular lump in the umbilical area of abdomen which does not move with respiration. Spot the diagnosis?

(380) A patient has come with recurrent urticaria and eosinophilia . On examination of abdomen the liver is enlarged . There is spheroidal and smooth cyst in the lower part of the liver . The cystic swelling has a fluctuation. Spot the diagnosis?

Answers.
(378) Brodies abscess .
(379) Retroperitoneal sarcoma. Oedema of legs is due to pressure over inferior vena cava.
(380) Hydatid cyst.

Spot the Diagnosis 375-377

(375) A cynosed baby was born in a labour-room .When it cries the cynosis deepens .
spot the diagnosis ?
(376) In an X-ray plate the lower end of ulna is expanded transversely.
spot the diagnosis?
(377) In an X-ray plate of upper end of humerus was shown to you there is a cyst whose margin is not sclerosed.
spot the diagnosis?

 Answer
(375) Fallots  of tetralogy
(376) Osteoclastoma
(377) Bone cyst

Spot the Diagnosis 371-374

(371) A baby was born in a labour room . There pours a continuous frothy saliva from the mouth and  the nose of the neonate . Spot the diagnosis?

(372) An x-ray plate was shown to you there are  Sunrays appearances and codman's triangle . Spot the diagnosis?

(373) Another x-ray plate of tibia was shown to you . There is onion effect -calcifications layer after layer . Spot the diagnosis?

(374) A patient was shown to an orthopaedic surgeon . After full radiological investigation the surgeon said, “ The patient is suffering from the tumour of bone ,no doubt, but this tumour will melt like snow in sunshine after radiotherapy ". Spot the diagnosis?

Answers.
(371) Congenital atresia of oesophagus .
(372)  Osteogenic sarcoma.
(373) Ewing's tumour .
(374)Ewing's tumour .