Archive for the Quiz Category

Locked knee

10 yr old female presented to ED with painful swollen knee after a fall, while playing netball. On examination, unable to flex or extend the knee. What do you think is the cause for her locked knee? What is your management plan?

Missed more often, than it is recognized…

A 50 year old man presents following a fall down some stairs. He landed on his left elbow. He complains of pain in the left shoulder. On examination, he is unable to move his L shoulder. There is swelling and pain in the region of the left shoulder. No open wound noted.

What do these Xrays of his left shoulder show, and how would you treat it?

Answer: [expand title=”Open” swaptitle=”Close”] The AP film demonstrates a classic “light bulb sign” of a posterior glenohumeral dislocation (the humeral head appears atypically rounded compared to usual). The lateral glenoid “Y” view confirms posterior dislocation of the humeral head (the humeral head is posterior to the “Y” formed by the lateral view of the scapula). An axillary view of the shoulder should be used for additional confirmation, but was not done in this case. Because the changes are subtle, posterior shoulder dislocation is often diagnosed late.

Closed reduction is considered appropriate if the dislocation is reasonably acute (within 3-6 weeks) and if any resultant defect in the humeral head is small (less than 25 % of articular surface, best judged on axillary view).

Reduction of a posterior shoulder dislocation is generally considered more difficult than reducing an anterior dislocation. Good procedural sedation will facilitate this. However, sometimes a GA in theatre will be required.

The arm will be adducted and internally rotated. Traction is applied longitudinally with the elbow in 90 degree flexion. The humeral head is disengaged from the posterior glenoid, and then the arm is externally rotated, which should reduce the dislocation, and result in a return of mobility.

The humeral head can be disengaged directly, by getting an assistant to apply pressure to the humeral head; or indirectly, by applying lateral pressure to the medial side of the upper humerus (thereby moving the humeral head laterally and increasing the adducted position of the elbow). Once the humeral head is disengaged, it should be possible to externally rotate the still adducted arm. However, the external rotation needs to be done carefully as the humeral head can fracture if it has not been disengaged from the glenoid.

Successful reduction should be signalled by a clunk and return of mobility.

A triple set of Xrays (AP, lateral and axillary) should be obtained post reduction to avoid missing any persisting dislocation. If in doubt a CT may be required. The arm requires a sling for three weeks. Orthopaedic referral is mandatory.
Natalie Vu

Spot diagnosis 4

What is the diagnosis? What is the name of test a and test b?

(please use the “Leave a reply” section below to post your response)


What is the cause for these changes in teeth?

Light Box #2

32 years old male presented to ED for first episode of witnessed seizure. Hx of constant headache for 3 weeks, unwell feeling. Recently migrated to Australia from Mexico. No hx of seizures before. Nil other medical problems. CT scan preformed showed the following. What is the likely diagnosis?


Blood Gas Trivia #1

[box]28 yrs old man, BIBA for decreased level of consciousness. Given oxygen enroute to hospital by paramedics. Blood gas done on arrival showed,

pH 6.87 ( 7.35-7.45)

PO2 204 (75 – 100)

PCO2 16 ( 35-45)

HCO3 4 ( 22-26)

BE -29

Lactate 3.1

Half an hour later we received the following blood test results,

Na 140, K 4.9, Cl 99, Urea 20.2, Creat 224, LFTs – unremarkable, BSL 75.1, CRP 4, Hb 95, WCC 36.1, Plat 407, Neu 32.1

Can you describe and interpret the results? What is the differential diagnosis?

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This rash on a teenage boy’s palms began on his hands and spread to his torso and upper and lower extremities over several days. He had no pain or pruritus. Two weeks before the lesions appeared, he had experienced fatigue, fever, and myalgia of 1 week’s duration.

The patient denied use of new skin products, detergents, or medications. He had no pets. There was no history of recent travel, and the patient was not aware of any arthropod bites. None of his family members had a similar rash. The patient was sexually active and had had 3 partners in the past 2 years; he said he always used condoms. His history was otherwise unremarkable, as were physical findings.

What is the likely cause? what are the differential diagnosis? (Please use the “Leave a reply” section below to answer the questions)

Light Box

How good is your Xray Vision? Chest Xray and CT Chest of this patient shows an interesting finding. What is the likely diagnosis?

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What is your diagnosis? Use the comment/reply link below to answer.

(correct answer will be published once enough replies are received…)

Xray Quiz

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Quiz 2

Take the quiz

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CT head Quiz

its obvious…

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