Words of wisdom .

It is true that

true-love

and

days-gone-by

are never repeated in life .

Words of wisdom

A delay even for a fraction of a second spoils the whole game not only in football but in each and every game and every walk of life .

Spot the diagnosis 424-426

(424) A patient has come in the S.O.P.D for haematoma of the thenar eminence . He cannot approximate the tip of the thumb with the tip of the ring finger. Spot the diagnosis?

(425) A patient has come with exquisitely tender,red- coloured small localised area beneath the nail. Spot the diagnosis?

(426) A patient has come in the S.O.P.D . He has a painless ,soft cyst under the skin of the pulp of the thumb . The cyst is neither attached to the deeper tissue nor the skin . He has a history of pin-prick .Spot the diagnosis?

Answers.
(424) Benette's fracture.
(425) Glomus tumour .
(426) Implantation dermoid cyst.

Spot the diagnosis 421-423

(421) A patient has come with huge enlargement of spleen which is firm in consistency with sternal tenderness. Spot the diagnosis?

(422) A cachetic old man of seventy five was suffering from chronic bronchitis has come.  He complains of evening rise of temperature for several weeks and severe anorexia . Spot the diagnosis?

(423) A patient of hand injury has come in O.P.D . He has swelling and tenderness in the anatomical snuff-box of his right hand .

Answers.
(421) Myeloid leukaemia .
(422) Pulmonary tuberculosis.
(423) Fracture of scaphoid bone.

Spot the Diagnosis 418-420

(418) A patient of rheumatoid arthritis has come for spleenomegaly with extreme leucopaenia . Spot the diagnosis?

(419) A patient has come for spleenomegaly and enlarged lymph nodes . Spot the diagnosis?

(420) A patient of hand injury has come. He can neither flex nor extend his wrist . Spot the diagnosis?

Answers.
(418) Felty's syndrome.
(419) Lymphatic leukaemia .
(420) Fracture of lunate bone.

Spot the diagnosis 414-417

(414) In a patient who has come in O. P .D for enlargement of both the epididymis and the testes simultaneously . Spot the diagnosis?

(415) A patient has come . His epididymis is enlarged,nodular and hard . Spot the diagnosis?

(416) A patient has come whose Epididymis is enlarged and firm . Spot the diagnosis?

(417) A patient has come in
 O.P.D for enlarged and firm epididymis but there is softening at one place . Spot the diagnosis?

Answers.
(414) Fileriasis.
(415) Tuberculous epididymitis .
(416) Fileriasis.
(417) Tuberculous epididmitis.

Spot the diagnosis 411-413

(411) An adult male was admitted for a tumour of the rib . On biopsy the rumour contains cartilage . The surgeon says that excision is the only way as the tumour is malignant and radioresistant . Spot the diagnosis?

(412) An adult male has come for a lump in the upper abdomen. On clinical examinations there is enlarged lymph node in the left supraclavicular region  .
(a) Spot the diagnosis?
(b) What is the name of this gland?
(c) What is the name of this sign?
(413) In a patient whose one testes has already been removed has come with a lump in the upper abdomen and enlarged Virchow gland. Spot the diagnosis?
Answers.
(411) Chondrosarcoma.
(412a) Carcinoma stomach.
(b) Virchow gland.
(c) Troisier sign.
(413) Carcinoma testes secondary in the upper abdomen and Virchow gland.

Spot the Diagnosis 409- 410

(409) You have been shown an x-ray plate of the chest of an adult of fifty five. There is cannon ball appearance in the chest x-ray . Spot the diagnosis?

(410) You have been shown an x-ray of gall-stone . There is dark shadow of gas in trilucent manner in the stone . What is this sign known as?

Answers.
(409) Hypernephroma .
(410) Mercedes Benz sign or seagull sign.

Spot the Diagnosis 406-408

(406) You have been given an x-ray plate of chest in which there is erosion of upper ribs with 25 paise coin like opacity in the upper portion of the chest . Spot the diagnosis?

(407) You have been given an x-ray plate of hip-joint in which there is rarification in the Babeskoch's triangle of the femoral head . Spot the diagnosis?

(408) You have been given an x-ray plate of vertebral column in which there is bony ankylosis . Spot the diagnosis?

(406) Bronchogenic carcinoma.
(407) Tuberculosis of hip joint.
(408) Pott's disease.
Fibrous ankylosis is the rule in tuberculosis except pott's disease.

Words of wisdom

A pure democratic government should abolish either of the two systems to avoid monopoly and corruption .

(1a) Government schools
 or
 (b) Private schools .

(2a) Government hospitals
or
(b) Private hospitals or nursing homes .

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 .

Spot the diagnosis 369-370

(369) A male patient of forty has come with tenderness over the medial side of knee joint . There is bony thickening and irregularity of medial condyle of femur . He has a history of a fall from a tree in the recent past . Full extension of his knee is painful. Spot the diagnosis?

(370) A known patient of P.U syndrome has come . He can move about freely . There is no vomiting. The patient is afebrile and his pulse rate is about 100 . There is rigidity over the right hypochondrium . Spot the diagnosis?

Answers.
(369) Pellegrini-stieda's disease.
(370) Sealed duodenal perforation.

Spot the diagnosis 367-368

(367) A patient of forty has come with ulceration,sinus formation and extensive scarring in the inguinal area . Spot the diagnosis?

(368) A lady patient of fifty has come for bleeding ulcer from the right big toe . The inguinal lymph node has grown very rapidly . When the gland was divided in to two after operation ,the inner portion of the gland looked pigmented . Spot the diagnosis?

Answers.
(367) Lymphogranuloma inguinale .
(368) Malignant melanoma

Spot the Diagnosis 365- 366

(365) A patient of acute mastoiditis has come with deep seated retrobulbar pain and sixth cranial nerve palsy  . Spot the diagnosis?

(366) A patient has come with vomiting,excruciating pain at the lower thorax and emphysema in the neck. Spot the diagnosis?

Answers.
(365) Gradenigo's syndrome is caused by thrombophlebitis of inferior petrosal sinus.
(366) Rupture of oesophagus

Spot the diagnosis 361- 364

(361) A patient of twenty has come with dyspnoea . He has a spleenohepatomagly with generalised lymph-adenopathy .

(362) A patient of forty five has come . His left supraclavicular (virchow's) lymph node is enlarged which is hard and irregular . On examination nothing abnormal was detected except one testes was found to be enlarged and hard.

(363) A patient of eighteen has reported in the emergency for dysphagia . On examination there is spleenohepatomagly and generalised lymphadenopathy . Spot the diagnosis?

(364) A patient of twenty with a big and firm mass fixed to the deeper structure . The skin over the lump is tensed ,glossy and dilated veins under the skin . Spot the diagnosis?

Answers
(361) Hodgekin's disease . The dyspnoea is due to pressure over the bronchus by the enlarged lymph nodes.
(362) Carcinoma testes .
(363) Hodgekin's disease dysphagia is due pressure over the oesophagus by the enlarged lymph node.
(364) Lymphosarcoma .

Spot the Diagnosis 357-360

(357) A patient previously diagnosed as cirrhosis liver has come with neuropyschiatric symptoms . On examination of the eyes there is Keyser fleischure brown ring in the periphery of cornea . Spot the diagnosis?

(358) A patient of forty has come. He has bilateral epiprochlear lymph -gland enlargement and an enlargement of the lymph- gland in the occipital triangle.

(359) A patient of forty has come with a lymph node enlargement . The gland is tensed ,glossy and there is dilated veins over the gland .  Spot the diagnosis?
(360) A patient has come with a hard ,irregular and fixed lymph node in the neck when he is told to protude tongue ,the tip of the tongue points toward the affected side .

Answers.
(357) Wilson's disease (heptolenticular degeneration )
(358) Syphilitic glands .
(359) Lymphosarcoma.
(360)Carcinoma nasopharynx .

Spot the diagnosis 353 - 356

(353) A patient has come with a pinhead bluish spot beneath the nail of the right big toe . It is very painful and local pressure gives excruciating pain . Spot the diagnosis?

(354)  A male patient has come with a cystic swelling of the right breast which is brilliantly translucent . Spot the diagnosis?

(355) A man of thirty has come with a deep ulcer which has eroded all the tissue even the bones . He gives the history of a brown and firm  nodule previously near the outer canthus of the  left eye. Then the ulcer began . Spot the diagnosis?

(356) An alcoholic patient has come  with spider naevi on the chest and abdomen and his spleen is palpable . Spot the diagnosis?

Answers.
(353) Glomus tumour . It consists of thickened arterio -venous communication associated with large epitheloid cells known as glomus cell.
(354) Hydrocoele of the breast.
(355) Rodent ulcer.
(356) Cirrhosis of liver.

Spot the Diagnosis 349- 352

(349) A patient of rheumatoid arthritis has come . He has leucopaenia ,palpable spleen and ulcer of the leg . Spot the diagnosis?

(350) A cynosed infant was born. When he cries the cynosis deepens .

(351) An infant of seven years squats on heels  ,there is clubbing of fingers and toes and there is breathlessness on exertion has come . Spot the diagnosis?

(352) A neomate has been born . There is constant frothy saliva coming out of his nose and mouth. Spot the diagnosis?

Answers.
O(349) Felty's syndrome.
(350) Fallot's tetralogy .
(351) Fallot's tetralogy .
(352) Congenital atresia of oesophagus .

Spot the Diagnosis 345- 348

(345) A patient has come with a non-pulsating cyst in the burn space of neck . Spot the diagnosis?

(346) A baby was brought with a swelling in the neck with a faint bluish hue . The cyst is not translucent and there is a sign of emptying . Spot the diagnosis?

(347) A boy of six has been brought by his parents . The boy has a unilateral purulent discharge . Spot the diagnosis?
(348) A man of sixty has come . He has thickening and irregularity of nasal skin of about two third of nasal skin.

Answers.
(345) Dermoid cyst .
(346) Cavernous haemangioma of the neck.
(347) Foreign body in the nasal discharge.
(348) Rhinophyma .

Spot the Diagnosis 341- 344

(341) A patient of pale and puffy face has come . He has worn woolen clothes in the month of summer and his voice is hoarse . Spot the diagnosis?

(342) A lady has come to a gynaecologist with a cystic swelling on the right lower portion of vagina . The gynaecologist operated on the patient taking to be a case of bartholin cyst . The cyst contains pultaceous  cheesy material. Spot the diagnosis?

(343) A patient of anasarca has come. He has raised blood pressure and microscopic haematuria  . Spot the diagnosis?

(344) A patient has come with splenic enlargement to the umbilicus and hard to feel . There is sternal tenderness . Spot the diagnosis?

Answers.
(341) Myxoedema .
(342) Sebaceous cyst.
(343) Subacute glomerulo-nephritis.
(344) Chronic myeloid leukaemia .

Spot the Diagnosis 337 -340

(337) A patient has come with exuberant granulation tissue (proud flesh) around a sinus near the lower end of tibia . Spot the diagnosis?

(338) A patient of sixty has come. He has bagginess under the eyes and complains of frequency of urine and dysuria .

(339) A lady of fifty has come with bagginess under the eyes,dryness of skin and hoarseness of voice . Spot the diagnosis?

(340) A patient has come . He has plumb - colour skin and same coloration of tongue and mucus membrane of mouth .

Answers.
(337) Osteomylitis of tibia or foreign body inside.
(338) Nephritis .
(339) Myxoedema.
(340) Polycythemia rubra vera .

Spot the Diagnosis 334-336

(334)  One lady patient of thirty five has come . She has Jacksonians type of fits in her right upper extremity only . Spot the diagnosis?

(335) A patient came he had Jacksonians types of fits. The fits were bilateral . Spot the diagnosis?

(336) A patient of fifty was admitted in the ward with very severe pain in the epigastrium with shock and cynosis morphine was given but no relief. Spot the diagnosis?

Answers
(334) Middle meningeal haemorrhage .
(335) Haemorrhage in superior longitudinal sinus  .
(336) Acute pancreatitis.

Spot the Diagnosis 330- 333

(330) A lady of fair skin ,warm and moist hand has come . She complains of loss of weight and lassitude . On examination of her pulse,the pulse rate is found to be high . Spot the diagnosis?

(331) A patient if prolonged fever has come . He has spleenomegaly and valvular heart disease . Spot the diagnosis?

(332) An unconscious patient of .accident was seen . There  was pyrexia ,neck rigidity and rapid pulse . Spot the diagnosis?

(333) A patient of accident was seen . He has rigidity of neck and fast pulse but no pyrexia . Spot the diagnosis?

Answers.
(330) Hyperthyroidism .
(331) Subacute bacterial endocarditis .
(332) Sub arachnoid hemorrhage.
(333) Fracture dislocation of cervical vertebra .

Spot the Diagnosis 326-329

(326) A patient of sixty has come. He has a big, hard swelling of the right palate and  right side nasal block . Spot the diagnosis?

(327) A lady patient of thirty five has come with a cystic swelling in the upper neck between the upper third of sternomastoid muscle and ramus of mandible . Spot the diagnosis?

(328) A patient of fifty has come. He has a hard lump in the neck and a cotton pad in the ear . Spot the diagnosis?

(329) A patient of sixty five has come with hard and irregular lymph node in the neck with the involvement of third,fourth,ophthalmic division of fifth and sixth cranial nerves . Spot the diagnosis?

Answers.
(326) Carcinoma arising from the right maxillary antrum which is lined by epithelial cells .
(327) Branchial cyst .
(328) Carcinoma of the deep pharynx .
(329) Advance carcinoma of the nasopharynx .

Spot the Diagnosis 322-325

(322) A patient complains of pain , profuse perspiration and hypersthesia in one side of face , When he eats lemon, spicy curry even chocolates . Spot the diagnosis?

(323) A boy has come in S.O.P.D with a big cystic swelling in the neck . On examination it is brilliantly translucent . Spot the diagnosis?

(324) A child has been brought ,he has cellular cellulitis . There is no abraison in the vicinity ,there is no edge , no fluctuation and no puss . Spot the diagnosis?

(325) A patient has come with cellulitis over the bursa of the hallux vulgus . There is small ulcer in the middle of the inflamed  skin.

Answers.
(322) Frey's syndrome (auricular temporal syndrome).
(323) Cystic hygroma.
(324) Osteomylitics .
(325) Bunion .

Spot the Diagnosis 318-321

(318) A patient has a cyst in the floor of mouth which is opaque in nature. Spot the diagnosis?

(319) Which dermoid cyst in the body contains no hair . Spot the diagnosis?

(320) Which cystic swelling in the mid-line of the floor of mouth is brilliantly translucent .

(321) A lady patient has come with a discharging sinus exactly on the mid-line  of the mandible . Spot the diagnosis?

Answers.
(318) Dermoid cyst.
(319) Sublingual dermoid cyst.
(320) Ranula .
(321) Medial mental sinus due to periodontal abscess ,wrongly diagnosed as a infected sebaceous cyst.

spot the diagnosis 314-317

(314) A patient has come with swelling and tenderness in the anatomical snuff - box . You want to prescribe an x-ray to see the fracture of scaphoid bone ,which view of x-ray you think to visualise  the fracture of scaphoid .

(315) A patient has come with wadling gait . Spot the diagnosis?

(316) A patient has come with fullness in the hallow of the palm extending to the forearm . On examination there is cross fluctuation . Spot the diagnosis?

(317) An adult male has come in the S.O.P.D for the gangrene of his little toe of one feet . The patient gives the history that it started as linear groove in the skin at the root of the little toe . Spot the diagnosis?

Answers.
(314) Oblique view .
(315) Bilateral congenital dislocation and bilateral coxa vara.
(316) Compound palmer ganglion. It is tuberculous in nature  . It contains glairy fluid in which melon seed bodies are found .
(317)Ainhum .

Spot the diagnosis 310-313

(310) A patient of forty has come with left supraclavicular enlarged and firm lymph node. Spot the diagnosis?

(311) An adult male has a chronic ulcer on the old burn scar . The margin of the ulcer is raised and everted .

(312) A patient of compound fracture has come with x-ray plate (negative film). There are dark round spots in the x-ray . Spot the diagnosis?

(313) A patient of suspected fracture of os calcis has come. Which x-ray view is essential to detect the line of fracture .

Answers.
(310) Carcinoma stomach. The gland is known as virchow's gland .
(311) Marjolin ulcer .(it is just like epithelioma only the spread or metastasis is very late due to fibrosis all around )
(312) Gas gangrene .
(313) Special axial radiograph.

Spot the Diagnosis 306-309

(306) A patient of fifty has come with stony hard and nodular liver. Spot the diagnosis?

(307) A lady patient of thirty has come with a lump on the epigastrium . The lump is less mobile and more tender . spot the diagnosis?

(308) An adult male has come with a lump in the epigastrium. The lump is firm ,irregular and tender . Spot the diagnosis?

(309) A patient of forty five has come with lightning pain in the limbs . On examination there is loss of ankle jerk and sluggish pupillary reaction to light . Spot the diagnosis?

Answers.
(306) Secondary carcinoma liver.
(307) Leaking peptic ulcer.
(308) Carcinoma stomach.
(309) Tabes dorsalis .

Spot the diagnosis 302- 305

(302) A boy of three years has been brought with bloody diarrhoea with acute abdomen and distension. On examination of his abdomen there is a saugage shaped lump in the line of colon convexity towards the umbilicus.

(303) A female patient of fifty has come with the features of intestinal obstruction . She gives the history of cholelithiasis for long .

(304)  A patient of recurrent renal calculi has come . His urine contains large amount of calcium. Spot the diagnosis?

(305) A patient of forty has come with hard subcutaneous nodules near the umbilicus . Spot the diagnosis?

Answers.
(302) Acute Intussusception .
(303) Gall stone illeus .
(304) Hyperparathyroidism .
(305) It is most likely a case of intra-abdominal carcinoma , Most likely carcinoma stomach.

Spot the diagnosis 298-301

(298) A patient has come with frequency of urine . He gives the history of a fall from the roof of his house . On examination nothing abnormal was found . Spot the diagnosis?

(299) A patient of severe motorcycle accident has been brought  .He has
(a) Blood per urethrum .
(b) Perineal haematoma.and
(c) Distended bladder. Spot the diagnosis?

(300) A patient of severe accident has been brought . He has severe tenderness and a tumour like mass in the suprapubic region with strangury. Spot the diagnosis?

(301) A patient has come with distended,tender and rigid abdomen with vomiting and malaema . On examination of her heart there is valvular disease . Spot the diagnosis?

Answers.
(298) Spinal injury.
(299) Urethral damage .
(300) Injury to the urinary bladder.
(301) Masentric thrombosis.

Spot the diagnosis 293-297

(293) A patient of sixty has come with chronic retention of urine . Spot the diagnosis?

(294) A patient of seventy has come with chronic retention of urine and pain on the back in lumbosacral area . Spot the diagnosis?

(295) A patient of fifty says that straining at micturation hinders the flow . Spot the diagnosis?

(296) A patient of forty says that straining at micturation enhances the flow . Spot the diagnosis?

(297) A patient of twenty one has come with frequency of urine . His urine is sterile on ordinary culture,contains pus cells and acidic in nature. Spot the diagnosis?

Answers.
(293) Benign hypertrophy of prostate .
(294) Carcinoma prostate .
(295) Senile hypertrophy of prostate .
(296) Stricture of urethra .
(297) Renal tuberculosis.

Spot the diagnosis 287-292

(287) A boy of four has been brought with a huge enlargement of one kidney without haematuria . Spot the diagnosis?

(288) A patient of forty has come with a lump in renal area which has grown painlessly . Spot the diagnosis?

(289) A patient of fifty has come with bilateral renal swelling. Spot the diagnosis?

(290) A recurrent case of urinary calculi has come. Which organ should he examined?

(291) A patient of thirty has come with acute retention of urine. Spot the diagnosis?

(292) A patient of seventy five who is a hemiplegic has come with  tenderness of knee joint. He has a history of minor trauma . On x-ray exam there is fracture which is semilunar in shape at the lateral aspect of medial condyle . Spot the diagnosis?
Answers.
(287) Wilms tumour.
(288) Hypernephroma.
(289) Polycystic kidney.
(290) Neck should he examined for parathyroid tumour.
(291) Stricture of urethra.
(292) Osteochondritis dissecans (Paget's quiet necrosis)

spot the diagnosis 282-286

(282) A female patient of thirty five has come . She has pyrexia ,bilateral lower abdominal pain and tenderness. Scalding pain during micturation and vaginal discharge . The urine contains gonococi . Spot the diagnosis?

(283) A male of fifty has come . His nail of big toe is like a  twisted  horn . Spot the diagnosis?

(284) A lady of thirty five has  come with diminished size of areola of her breast with retracted nipple . Spot the diagnosis?

(285) A patient of fifty five has come with pyrexia
 (hyperpyrexia),pin -point- pupil and palsy . The diagnosis also starts with the letter "P" . Spot the diagnosis?

(286) A lady patient of twenty five has come with red ,destroyed and weeping areola and  of her one breast . Spot the diagnosis?
Answers.
(282) Acute salpingitis .
(283) Onichographosis.
(284) Carcinoma breast.
(285) Pontine haemorrhage .
(286) Paget's disease of breast.

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 .

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 .

Spot the diagnosis -111

1.       A chain smoker of 55 complains of dull pain in his left ear. He consulted an E N T specialist but nothing abnormal was detected in his nose throat & ear. Spot the diagnosis.

Ans : Ischaemic Heart disease.

2.       A heavy drunkard has acute pain with profound sweating & shock. A surgeon was consulted

& he thought it to be a perforation & operated the case immediately for gastric perforation but nothing abnormal was detected in his whole abdomen. Can you diagnose the case?

Ans:  Acute Myocardial Infarction

3.       A hefty patient of 59 came with toothache in the left side of his mouth. He consulted a dentist but nothing abnormal was detected in his mouth & teeth. Can you diagnose his case? 

Ans:  Ischaemic  heart disease

4.       A Janitor says that her husband is a heavy drunkard. He drinks the whole amount whatever she earns daily. He consulted a physician in Sadar Hospital saharsa for swelling abdomen and everted umbilicus. The physician referred the case to PMCH for needful. Can you spot the diagnosis?

Ans : Cirrhosis of Liver

5.       A very beautifull lady came to a gynaecologist for habitual abortion. The gynaecologist after examination called for blood test. One test was abnormal. Which test was it??  

Ans : WR

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