G’day guys, and welcome back to Diagnose This! Has been an absolutely hectic week for both Dan and myself, but of course instead of studying we are doing more important things; like writing articles for you all to enjoy!
Now then, last week we had the case of the yellow man with the pleuritic chest pain. The main diagnosis that should be considered is haemolytic anaemia, as the tests and examination show classic signs of this condition. But, we cannot rule out a cardiac or haematological cause with chest pain, such as an acute MI or PE, so serial ECGs and troponins should be performed and the Well’s Criteria for this patient checked (in the case of this patient, NAD). Now, to confirm the diagnosis, a Direct Coomb’s test should be performed which, in the case of this patient, is positive. Treatment should then be the following:
- 1st line: removal of insult or treatment of underlying condition + supportive care
- plus: corticosteroids
- adjunct: whole-body plasmapheresis
- 2nd line: splenectomy + supportive care
- adjunct: whole-body plasmapheresis (BMJ, 2015)
The cause of this man’s haemolytic anaemia is autoimmune; this is demonstrated by the positive Direct Coomb’s test.
Again guys, if you want any clarification of what is going on, or would like to correct anything that you believe is wrong, please message us and we will help as best as we can!
Now, onto this week’s marvelous medical mindbender!
A 23 year old presents to the ED after a MVA with excruciating pain in his right leg. He is otherwise asymptomatic. The leg itself looks quite bruised and slightly deformed, with swelling around the distal third of the thigh.
The x-ray below is obtained:
( Courtesy of http://emedicine.medscape.com/article/90779-overview)
Whilst the diagnosis is pretty obviously a broken thumb (kidding!), how would you describe this fracture to the consultant Orthopaedic surgeon? What treatment would be considered? Finally, if this injury happened after the patient fell down his driveway, what would we be expecting/hoping to rule out on investigation?
Tune in next week for the answers!
H. Winnett Orr, an orthopaedic surgeon in World War I, has been credited as the father of modern fracture treatment, being the first person to use plaster as treatment for fractures!
Picture credit: http://image2.findagrave.com/photos/2011/288/49347923_131882658841.jpg