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Recurrent anterior subcoracoid dislocation with Hill-Sachs deformity of the humeral head (arrow).

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Presentation on theme: "Recurrent anterior subcoracoid dislocation with Hill-Sachs deformity of the humeral head (arrow)."— Presentation transcript:

1 Recurrent anterior subcoracoid dislocation with Hill-Sachs deformity of the humeral head (arrow).

2 Image Challenge What is the diagnosis? 1. Dental abscess 2. Neurofibromatosis type 1 3. Cleft jaw 4. Hemiatrophy syndrome 5. Mandibular fracture Q:Q:

3 Answer: Image Challenge What is the diagnosis? Q:Q: 5. Mandibular fracture This patient developed a comminuted fracture of the left and right mandible after being struck on his right lower jaw. The open fracture allowed upward displacement of the left half of the mandible.

4 Image Challenge This patient underwent computed tomography of the pelvis having presented with lower extremity edema. What diagnosis is suggested? 1. Uterine fibroid 2. Ovarian cyst 3. Urinary retention 4. Teratoma 5. Aortic aneurysm Q:Q:

5 Answer: Image Challenge This patient underwent computed tomography of the pelvis having presented with lower extremity edema. What diagnosis is suggested? Q:Q: 3. Urinary retention Bladder outflow obstruction resulted in bladder distension and compression of the iliac veins. Read More: New Engl J Med 354;6:e5

6 Image Challenge What is the most likely diagnosis? 1. Cisplatin overdose 2. Lesch-Nyhan syndrome 3. Rhabdomyolysis 4. Primary hyperparathyroidism 5. Ethylene glycol poisoning Q:Q:

7 Answer: Image Challenge What is the most likely diagnosis? Q:Q: 5. Ethylene glycol poisoning This urine sediment contains calcium oxalate crystals of two types. The crystals shaped like envelopes with diagonally crossing lines are octahedrons of calcium oxalate dihydrate. The needle-shaped crystals are calcium oxalate monohydrate. Calcium oxalate monohydrate crystals are rarely seen in the urinary sediment but are typical of ethylene glycol ingestion, and therefore when seen, they strongly suggest the diagnosis. Read More: New Engl J Med 354;10:1065

8 Image Challenge What diagnosis explains this 15-year-old patient's chest pain? 1. Aortic coarctation 2. Metastatic carcinoma 3. Pneumomediastinum 4. Acute severe asthma 5. Pulmonary hypertension Q:Q:

9 Answer: Image Challenge What diagnosis explains this 15-year-old patient's chest pain? Q:Q: 3. Pneumomediastinum The chest radiograph shows clear lungs, pneumomediastinum and pneumopericardium without evidence of rib fracture or pneumothorax. Read More: New Engl J Med 354;11:1177

10 Image Challenge What is the most likely diagnosis? 1. Paget's disease 2. Meningioma 3. Neurocysticercosis 4. Pneumocephalus 5. Hyperparathyroidism Q:Q:

11 Answer: Image Challenge What is the most likely diagnosis? Q:Q: 4. Pneumocephalus The cranial radiograph shows air in the left temporal region without evidence of fracture. Pneumocephalus can occur after neurosurgical procedures, head and facial trauma, or ear infection and can even occur spontaneously. The finding is not typical of a brown tumor, Paget's disease, neurocysticercosis, or meningioma. Read More: New Engl J Med 358;12:e13

12 Image Challenge What is the diagnosis? 1. Small-bowel obstruction 2. Echinococcosis 3. Mesenteric ischemia 4. Pancreatic pseudocysts 5. Cecal volvulus Q:Q:

13 Answer: Image Challenge What is the diagnosis? Q:Q: 1. Small-bowel obstruction The computed tomogram reveals small-bowel obstruction by a left-sided luminal mass. The mass has a hyperdense periphery and an aerated core. Read More: New Engl J Med 358;13:1381

14 Image Challenge A patient with this tomogram would be most likely to present with which one of the following signs? 1. Uniocular blindness 2. Hemiplegia 3. Alexia without agraphia 4. Hemiballismus 5. Internuclear ophthalmoplegia Q:Q:

15 Answer: Image Challenge A patient with this tomogram would be most likely to present with which one of the following signs? Q:Q: 2. Hemiplegia The tomogram shows a calcified object in the proximal right middle cerebral artery. Occlusion of the middle cerebral artery would be most likely to be associated with contralateral hemiparesis, as in this case. The other listed choices represent stroke syndromes that most typically involve other vascular territories. Read More: New Engl J Med 358;15:e17

16 Image Challenge What is the diagnosis? 1. Central retinal artery occlusion 2. Diabetic papillopathy 3. Ocular toxoplasmosis 4. Optic neuritis 5. Malignant hypertension Q:Q:

17 Answer: Image Challenge What is the diagnosis? Q:Q: 5. Malignant hypertension The fundus photograph shows disk edema, cottonwool spots, a swollen optic nerve, and retinal hemorrhages. Together, these findings suggest a diagnosis of malignant hypertension. Read More: New Engl J Med 358;18:1951

18 Image Challenge What is the most likely cause of the abnormality on the chest radiograph? 1. Aspiration pneumonia 2. Pneumocystis jiroveci pneumonia 3. Acute respiratory distress syndrome 4. Hemothorax 5. Reexapansion pulmonary edema Q:Q:

19 Answer: Image Challenge What is the most likely cause of the abnormality on the chest radiograph? Q:Q: 5. Reexapansion pulmonary edema Unilateral pulmonary edema and the presence of a chest tube in the right thorax suggest reexpansion pulmonary edema as the diagnosis. Read More: New Engl J Med 354;19:2046

20 Image Challenge What term is used to describe this finding? 1. Hyphema 2. Hypopyon 3. Iridocyclitis 4. Iridodonesis 5. Synechia Q:Q:

21 Answer: Image Challenge What term is used to describe this finding? Q:Q: 1. Hyphema Layering of blood in the anterior segment is termed hyphema. Hypopyon refers to pus in the anterior segment. Iridocyclitis refers to inflammation of the iris. Iridodonesis is a quivering of the iris when the patient moves the eye. Synechia is an adhesion between the iris and the lens. Read More: New Engl J Med 358;21:2265

22 Image Challenge What is the diagnosis? 1. Ludwig's angina 2. Glossopharyngeal nerve palsy 3. Pharyngeal gonorrhea 4. Bilateral peritonsillar abscesses 5. Infectious mononucleosis Q:Q:

23 Answer: Image Challenge What is the diagnosis? Q:Q: 4. Bilateral peritonsillar abscesses Bilateral swelling of the soft palate is visible with a midline uvula pushed anteriorly. This is most consistent with a diagnosis of bilateral peritonsillar abscesses. Read More: New Engl J Med 358;23:e27

24 Image Challenge What is the diagnosis? 1. Rheumatoid arthritis 2. Amyloidosis 3. Cirrhosis 4. Psoriasis 5. Endocarditis Q:Q:

25 Answer: Image Challenge What is the diagnosis? Q:Q: 5. Endocarditis Typical subungual ("splinter") hemorrhage and numerous petechiae on the skin of the abdomen are seen in a patient with staphylococcal endocarditis. Read More: New Engl J Med 329;22:1626

26 Image Challenge What is the diagnosis? 1. Left facial palsy 2. Cavernous sinus thrombosis 3. Orbital lymphoma 4. Herpes zoster ophthalmicus 5. Orbtial fracture Q:Q:

27 Answer: Image Challenge What is the diagnosis? Q:Q: 4. Herpes zoster ophthalmicus The image illustrates a left VI nerve palsy from herpes zoster ophthalmicus. Read More: New Engl J Med 353;16:e14

28 Image Challenge What is the diagnosis? 1. Graves' ophthalmopathy 2. Retinal detachment 3. Choroidal melanoma 4. Ocular implant 5. Angle closure glaucoma Q:Q:

29 Answer: Image Challenge What is the diagnosis? Q:Q: 2. Retinal detachment The magnetic resonance imaging shows an unusual appearance of retinal detachment with symmetrical bulging in the right eye. Read More: New Engl J Med 357;17:e18

30 Image Challenge This patient presented with a 10-day history of left foot discoloration that resolved with elevation. What is the most likely diagnosis? 1. Angioneurotic edema 2. Arterial insufficiency 3. Erysipelas 4. Peripheral microembolization 5. Phlegmasia cerulea dolens Q:Q:

31 Answer: Image Challenge This patient presented with a 10-day history of left foot discoloration that resolved with elevation. What is the most likely diagnosis? Q:Q: 2. Arterial insufficiency Buerger's symptom refers to dependent rubor after elevation and is suggestive of arterial insufficiency. The foot is not edematous. Erysipelas and peripheral microembolization would not typically resolve with elevation. Phlegmasia cerulea dolens presents with a bluish discoloration following deep venous thrombosis. Read More: New Engl J Med 357;18:e19

32 Image Challenge Which one of the following drugs of abuse is most typically associated with the illustrated complication? 1. Ketamine 2. Heroin 3. Cocaine 4. Phencyclidine 5. Mescaline Q:Q:

33 Answer: Image Challenge Which one of the following drugs of abuse is most typically associated with the illustrated complication? Q:Q: 3. Cocaine Perforation of the nasal septum and palate are well recognized complications of intranasal cocaine use. Read More: New Engl J Med 357;19:1956

34 Image Challenge This radiograph was taken 12 minutes after infusion of intravenous contrast. What diagnosis is suggested? 1. Left renal artery stenosis 2. Right staghorn calculus 3. Left hypernephroma 4. Bladder carcinoma 5. Right ureterovesical calculus Q:Q:

35 Answer: Image Challenge This radiograph was taken 12 minutes after infusion of intravenous contrast. What diagnosis is suggested? Q:Q: 5. Right ureterovesical calculus The intravenous urogram shows caliectasis and a dilated ureter with columnation (absence of peristalsis), a filling defect around the ureteric meatus, and edema of the distal ureter wall. These findings are most suggestive of a calculus at the right uretero- vesical junction. Read More: New Engl J Med 353;19:2056

36 Image Challenge What is the most likely diagnosis? 1. Renal tubular acidosis 2. Primary hypoparathyroidism 3. Familial hypocalciuric hypercalcemia 4. Salicylate overdose 5. Paget's disease Q:Q:

37 Answer: Image Challenge What is the most likely diagnosis? Q:Q: 1. Renal tubular acidosis The film reveals bilateral symmetric calcification of the renal parenchyma, sparing only the renal pelvis. This patient had been diagnosed with renal tubular acidosis at 9 years of age, but did not undergo medical follow-up for 20 years. The other listed choices are not common causes of nephrocalcinosis. Read More: New Engl J Med 359;1:e1


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