Clinical ed cases (8 2-12)

Dr Bish – Miscellaneous ED case presentations

Clinical CasesMiscellaneous ED presentationsPort Hedland – Rural Clinical School tutorial (8/2/12)

Dr Bishan Rajapakse


Renal failure and back pain49 yo man end stage renal failureOn dialysis times a weekFall 4 weeks ago – back pain and

lower leg pain since – walking with limp, uses a stick

OE// Tender in L upper thigh, lower lumbar spine





Describe what is seen on the Xray?

What is your differential diagnosis?

What further investigations do you want?


CT scan of the abdomen showed changes consistent with renal osteodystrophy

ESR was not raised


Red eyes and abnormal Cornea11 yo boy with 3 day history of

bilateral red eyes (worse on L)Treated for viral conjunctivitis

with Chloracetmycin drops but not improving

Visual acuity in L eye 6/18 R eye 6/6

Diffuse Fluoroscein uptake



Nb vertical line is light reflexDescribe what you see?


What can be the cause of this appearance?

What is your plan?


Ophthalmology consulted◦Likely to be viral conjunctivitis◦Chloramphenicol drops further irritant

to cornea resulting in oedma and swelling

◦Treat viral conjunctivitis stop antibiotic drops and continue with sterile lubricant Review in 24 hours Urgent referral if no improvement


Nb Visual acuity was 6/6 at follow up, patient improved


Ankle pain without trauma38 yo with painful swollen Ankle2 day history, no trauma

reportedProgressively worse yesterdayToday unable to walk without

limp




What is your differential diagnosis

Describe the ankle x-rays◦Is there anything to see?


Painful red eye…32 year old male with one day

history of painful red eye



Describe what you see?What is the likely diagnosis?


Chest abnormalities78 yo man presents with SOB to

provincial hospital ED




Describe what you see?What is your differential

diagnosis?What is your plan?



What was done?Describe what you seeWhat is the diagnosis now?What else will need to be done?


Hand is hurting!


What is the diagnosis?


He was treated in a volar resting splintComment on this treatment


Acute Breathlessness 62 yo male truck driver acutely SOB –

BIBA as a category one to resus bay◦Transfer from airport after one hour flight

Lips blue, RR 50, O2 sats 88% on RAGiven oxygenSpeaking in short sentences, some

chest tightness, no painDoesn’t admit to previous lung

pathology



What is the differential diagnosis?

What other history will you ask for?

What other investigations will you order?







Presumed malignancy with initial differential as

History of wt loss and haemoptysis

This was first medical presentation

Lung Ca confirmed on bronchial washings – referred from respiratory to oncology team


Abnormal CXR

64 year old presents non-distressed with epigastric discomfort





What does this CT scan show?


The patient has a ruptured diaphragm with bowel herniation seen on CT


Child with distension?8 y.o. boy with history of

development delay Abdominal distension ++Pain requiring morphineLimited history from mother

◦Suddenly became unwell in the last 2 hours



Describe what you see?What is the treatment?Do you know the diagnosis?



He has a history of ingesting objects on further questioning of mother◦Battery ingested

Management◦Resuscitation and supportive cares◦Nasogastric to decompress the

stomach, referred urgently to paed surg


5 hours later after conservative Rx


Acute dysponea32 year old female presents with

acute dyspnoea 12 hours after a long haul flight from Europe to Australia

Saturations are 88% on RA, improve with oxygen


Describe what you see?



Multiple filling defects on CTPA consistent with PE

Date post:	03-Nov-2014
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Clinical ed cases (8 2-12)

Education