CLINICAL SCENARIO - LOWER LIMB
1) 24 yr old Mr. Ravi presented to orthopedic OPD with C/O Pain and swelling of Right knee and inability to extend knee for past 2 days. On probing patient gave history of being a food ball player went to a tournament and sustained minor injury and blow to the lateral side of knee, during the play followed by which he developed symptoms. On examination, anterior drawer sign and McMurray’s test was positive. X ray knee joint revealed no fractures. What’s your diagnosis?
ANSWER: TERRIBLE TRIAD- INJURY TO ANTERIOR CRUCIATE,TIBIAL COLLATERAL LIGAMENTS AND MEDIAL MENISCUS OF KNEE JOINT.
2) 35 year old, traffic policeman non smoker, non alcoholic presented to surgical OPD with Complaints of bulging of veins of lower limb for past 6 months. Also complained of swelling, pain while standing and redness, itching over the ankle region for past 1 week. He then complained of cramping pain during nights. There is no history of intermittent claudication/rest pain. No history of any chronic medical disease. On examination physician found dilated tortous veins on medial aspect of leg. Perthe’s and Trendelenburg test confirmed perforator incompetence. Justify your Diagnosis…
ANSWER - CHRONIC VENOUS INSUFFICIENCY-VARICOSE VEINS OF LOWER LIMB
3) 40 year old male smoker presented to Surgery OPD with complaints of sudden blackish discolouration of medial 3 toes associated with severe pain during rest. He gives history of intermiddent claudication pain and numbness in the foot. Ultrasound doppler study reveals block in the distal part of anterior tibial artery. What’s your diagnosis?
ANSWER : THROMANGITIS OBLITERANS/TAO/BUERGER’S DISEASE(PERIPHERAL ARTERIAL DISEASE ) - Dorsalis pedis artery is occluded as it is the continuation of Anterior tibial artery and is the chief artery to the Dorsum of foot and digits.
4) 48 year old male smoker presented with a pulsatile midline mass behind the left knee. He gives history of intermiddent claudication pain and numbness in the foot. Physical examination reveals a palpable, non tender pulsatile mass in the popliteal fossa with a weak dorsalis pedis pulse, Ultrasound doppler study reveals aneurysm in this major vessel. What’s your diagnosis?
ANSWER: POPLITEAL ARTERY ANEURYSM
5)A 42yr old woman presented with numbness, burning sensation in her right foot, radiating to sole of foot. She complained of tingling sensation along the medial side of ankle. Her symptoms worsened during night. On examination tinel’s sign positive, Nerve conduction study confirmed the diagnosis…What’s your diagnosis?
ANSWER - TARSAL TUNNEL SYNDROME-Tibial nerve is compressed in tarsal tunnel below flexor retinaculum
6) A 16yr old boy was discharged after he underwent treatment for alleged history of fall from a building and sustained penetrating injury to his left gluteal region. During his follow up he complained of limping while walking and sagging of pelvis to the right side. On examination physician diagnosed him to have Lurching gait. Trendelenburg sign was positive. Give your diagnosis…
ANSWER: GLUTEUS MEDIUS AND MINIMUS PARALYSIS DUE TO SUPERIOR GLUTEAL NERVE INJURY
7) A 68yr old female patient presented with swelling and pain in the left groin region for past 1yr.The swelling increases during standing and coughing. On Examination reducible swelling was palpable in anteromedial aspect of thigh, cough impulse was positive, swelling was reducible. Three finger test was positive. Give your diagnosis..
ANSWER: FEMORAL HERNIA. Should write about femoral triangle, femoral sheath, femoral canal in detail
8) A 23yr old gentleman presented with complaints of foot pain mainly forefoot and fatigue during his physical activities. On examination physician observed decreased arch height and diagnosed as PES PLANUS. What is the Anatomical basis for pain.
ANSWER: PAIN is due to loss of concavity of the sole. (Loss of longitudinal arches of foot) causing compression of Medial and Lateral plantar nerves resulting in Metatarsalgia(Neuralgic pain in forefoot) Should write in detail about Medial and lateral longitudinal arch.
9) A 3month old baby was bought by his mother with foot deformity to orthopedic OPD. On examination orthopedician diagnosed child to have plantar flexed, medially rotated foot and forefoot is adducted relative to hindfoot. Justify your diagnosis and write the anatomical basis for it.
ANSWER: CTEV/CLUB FOOT/CONGENITAL TALIPES EQUINO VARUS. Should write in detail about Medial and lateral longitudinal arches of foot.
10)While bathing the neonate her grandmother noticed limited movements in neonate’s left hip. They bought the child to a orthopedician. On inspection the doctor found shortening of left limb. Physical examination revealed inability to rotate her left thigh externally. X ray pelvis confirmed the diagnosis. Write the Anatomical basis behind it.
ANSWER: CONGENITAL DISLOCATION OF HIP(CDH)