MedShr’s Top 10 Medical Cases of 2017

In 2017, thousands of doctors, medical students and healthcare professionals contributed their knowledge and engaged in fascinating case discussions on MedShr. Here is a list of the top 10 case discussions of 2017 – you’ll find a range of trending cases, strange cases and cases of great educational value.

We hope you enjoy reading them, and please do join the discussions taking place!


Radiology-clinical-case-discussion

10: Imaging Review – patient with headache and altered consciousness?

An 88 year old patient presented after experiencing headache and altered consciousness 45 days ago, which partially improved with oral corticosteroids. The patient is currently awake and responding to voice. HIV (-) and no history of immunosuppression.

What are your thoughts on the imaging? (Click the case to see the image)

What would you do next?

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Respiratory-clinical-case-discussion

9: Breathlessness and restlessness misdiagnosed in young boy

A boy was admitted to hospital with complaints of breathlessness and restlessness. His grandmother gives a history of sudden onset of fever which was followed by 2 week of respiratory symptoms, including cough, tears in his eyes and facial redness.

A doctor diagnosed the child with malaria and hepatitis without proper testing and treatment was started. The symptoms continued and now fever is also present. History is incomplete.

What kind of questions would you ask for patient history?

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Obstetrics-and-gynaecologist-clinical-case-discussion

8: Cervix at 5cm dilatation at 21 weeks gestation

A 27 year old primigravida woman presents at 21 weeks. She has amenorrhea and liquid discharge from the vagina. Upon examination, she has a cervix at 5cm dilatation and intact amniotic membrane on ultrasound. The foetus is normally developed. Amniotic fluid is also in normal quantity.

What are your thoughts?

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Anaesthesia-clinical-case-discussion

7: Young child in serious RTA

This is a traumatic case of a 3.5 year old boy who was involved in a road traffic accident that involved a motorcycle and a glass table.

How would you manage this boy?

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Trauma-clinical-case-discussion

6: A 72 year old woman who has been run over

A 72 year old female was run over on the street. She is conscious, but amnesic. Both legs are injured. She has no pulse, pain and no dyskinesia. History: hypertension. 20/min RR 110b/min 140/90Hgmm

How would you manage this patient?

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Dermatology-clinical-case-discussion

5: A wrist swelling

This man presented with a swelling on his wrist, which had slowly been increasing in size over a few weeks. He worked as a builder and occasionally the area felt uncomfortable at work, but he was still able to use it as normal. He recalled having something similar a number of years before and thought that it had simply disappeared one day at work. He was otherwise fit and well and on no regular medication.

Can you identify the cause of this man’s wrist swelling based on the imaging?

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Oncology-clinical-case-discussion

4: A woman with a history of vulvar condylomata acuminata

A 40-year-old woman, gravida 2, para 2 comes to your clinic for a routine exam. She has type 2 diabetes mellitus but controls it well with glyburide. She has a history of vulvar condylomata acuminata that was successfully treated with laser ablation 10 years ago. She does not smoke but drinks a six-pack of beer every night.

She is sexually active but uses a diaphragm with spermicide for contraception. Her mother had breast cancer at the age of 65. The patient is 157cm tall, and weighs 100kg. Her BMI is 40kg/m2. On PE, there were no other abnormalities.

Pelvic examination shows a 2-cm ulcer on the cervix. A biopsy of the cervical lesion shows INVASIVE SQUAMOUS CELL carcinoma.

Which virus is the most significant predisposing factor for this patient’s cervical cancer?

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Cardiology-clinical-case-discussion

3: Wiring difficult diagonal using distal balloon occlusion

Coronary angiography was performed on a patient with stable angina pectoris and severe LAD disease was found at diagonal septal bifurcation. Provisional stenting to LAD with side branch protection was planned but wiring diagonal was impossible with a different shape of guidewires due to a plaque near the diagonal ostium diverting wires away from the ostilum.

Predilatation with a 2×20 mm balloon was done and balloon was advanced just beyond diagonal. Balloon was inflated at 4 atm and diagonal was wired straightforwardly. A 3×26 mm stent was implanted and postdilated with a 3.5×12 mm nc balloon. Diagonal was protected. We should not spend time and radiation for difficult side branch wiring. Predilation of main branch and advancement of undersized balloon just distal to side branch ensures easy side branch cannulation.

What are your thoughts?

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Dentist-clinical-case-discussion

2: Cyst or tumour?

A patient presents with the pictured lesion, which appeared 20 days ago, beginning small then becoming larger. It does not hurt. It’s soft, with a positive ping-pong sign. Teeth 31,41 are shaky.

In terms of past history, this patient had a submandibular gland tumor (3×3 cm) and had an operation to remove tumour and gland.

What are your thoughts on the imaging?

Is this a cyst or a tumour?

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General-practice-clinical-case-discussion

1: Recurrent pneumothorax due to menstruation

A 40 year old woman presented with severe dyspnea since 2 hours before admission. This patient experienced pneumothorax 3 times for the last 2 years. All the events appeared approximately 24 hours before her menstrual cycle.

A month before this pneumothorax, she was diagnosed with uterine leiomyoma and adenomyosis. The thoracic surgery was performed and we found four implantations at the diaphragm and one at the parietal pleura. Excision of endometriosis, repair the diaphragm with mess and pleurodesis was successfully done. No recurrency after six month follow up.

What are your thoughts on this catamenial pneumothorax case?

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