Radiology - SYB II

Brad Moatz MS IV Penn State – Hershey 2-28-08

Case #1

• Ms. D • Cc: R wrist pain • HPI: 28 y.o. s/p fall from roof . RHD . Pt seen in ED in FL was offered surgery but declined . Pt was instructed to seek medical tx within 3 days. Did not receive any tx while in FL.

• PMH: unremarkable • SH: no tobacco, no EtOH • All: NKDA • PSH: ACL surgery (2000)

Case #1

• PE – numbeness and paresthesia in median n. distribution . • Full sensation in radial and ulnar nn.

• Pt unable to flex/extend wrist • Pt able to move fingers but decreased ROM secondary to pain • Marked swelling appreciated • 2+ radial pulse with <2 sec cap refill

Case #2

• Ms. B • Cc: L hip pain • HPI: 89 y.o. female with h/o fall in bathroom.

Presents with L hip pain. No LOC. • PMH: Dementia, angina, HTN, colon polyps removed in 1990 • SH: no EtOH, no cigs • Meds: Paxil, Nemenda • All: NKDA

Case #2

• PE – No overlying ecchymosis, • Prominence over L ant & lat thigh • LLE shortened, ER • SP/DP/S/S/T SILT • EHL/TA/G/S 5/5, limited ROM with HF and ext. as well as knee flexion/ext • 2+ DP/PT pulse

Case #3

• Mr. B • Cc: R foot pain • HPI: 18 y.o. male. Chasing dog around house and kicked couch. C/o R 5 th toe pain • PMH: unremarkable • Meds: None • SH: no cigs, no EtOH • All: NKDA • PSH: None

Case #3

• PE – R 5 th toe markedly swollen • No overlying ecchymosis • Toe is laterally deviated • Pt able to flex toe slightly • S/S/SP/DP/T SILT • DP/PT 2+ pulse

Case #4

• Mr. M • Cc: R arm pain • HPI: 8 y.o. male. Pt was jumping on trampoline and landed on R arm.

No LOC. RHD • PMH: L forearm fx 4 years ago • Meds: None • All: NKDA • PSH: None

Case # 4

• PE – Pt able to move all 5 fingers but decreased ROM secondary to pain • SILT r/u/m distribution • 2+ radial pulse • No overlying ecchymosis • Prominence over R posterior forearm with marked swelling

2 day f/u

Case #5

• Mr. J • Cc: R arm pain • HPI: 56 y.o. male with h/o HCC. Fell while attempting to sit on stool.

Fell onto R arm and L side. No LOC • PMH: HCC, s/p liver transplant 1994 secondary to Hep C , HTN • All: NKDA • SH: no cigs, no EtOH • Meds: Avastin , Zarafinib, Rapirimine, Pepcid, Lyrica, Ursodiol, Lexapro, Lasix, Fosamax, Dexamethasone

Case #5

• PE – No obvious overlying skin changes • Decreased ROM at R shoulder and R elbow secondary to pain • R and L wrist fused previously (MVA) • No sensory deficits, C5 – T1 SILT • 2+ radial pulse, <2 sec cap refill