D********3
发帖数: 786 | 1 未解之谜1： What is the Dx? What does the patient like to have in physical
exam? What other imaging study do you recommend and why?
我们不知道哪儿有fracture.. |
D********3
发帖数: 786 | 2 未解之迷2：
Surgery
1. A 54 year old male was found to have a 4cm x 3cm mass during a routine
colonoscopy. Biopsy showed moderately differentiated adenocarcinoma. He
occasionally has small amount of bright red blood in stool but denies other
symptoms. He has no past medical or surgical history. He does not smoke or
drink alcohol. CT scan showed two masses, 2cm x 2cm and 1cm x1cm, on his
right lung. No mass lesions were found in his liver, brain, or bones.
Where in the GI tract is the most likely location of his cancer?
Answer: Lower 1/3 of rectal.
why lower 1/3 of rectal? |
J*********4
发帖数: 1274 | 3
other
=====
Because the venous return of the lower 1/3 of rectal goes to Inferior vena
cava, whereas anything above will go to portal system, thus lower 1/3
metastasis to lung and the rest goes to liver.
My 2 cents
【在 D********3 的大作中提到】
: 未解之迷2：
: Surgery
: 1. A 54 year old male was found to have a 4cm x 3cm mass during a routine
: colonoscopy. Biopsy showed moderately differentiated adenocarcinoma. He
: occasionally has small amount of bright red blood in stool but denies other
: symptoms. He has no past medical or surgical history. He does not smoke or
: drink alcohol. CT scan showed two masses, 2cm x 2cm and 1cm x1cm, on his
: right lung. No mass lesions were found in his liver, brain, or bones.
: Where in the GI tract is the most likely location of his cancer?
: Answer: Lower 1/3 of rectal.
|
M****a
发帖数: 577 | 4 Correct. Thanks for the clarification. The lower 1/3 of rectum is drained by
the inferior rectal vein, which further drains into the internal iliac vein
then IVC.
If you still recall from Step I FA, in patients with portal hypertension,
one of the four portal-systemic anastomoses is between the superior rectal
vein (middle rectal vein should also be included, FYI) and the inferior
rectal vein. This anastomsis can cause hemorrhoid and subsequent bleeding.
【在 J*********4 的大作中提到】
:
: other
: =====
: Because the venous return of the lower 1/3 of rectal goes to Inferior vena
: cava, whereas anything above will go to portal system, thus lower 1/3
: metastasis to lung and the rest goes to liver.
: My 2 cents
|
D********3
发帖数: 786 | 5
by
vein
多谢Micasa前辈又出题又讲解！
【在 M****a 的大作中提到】
: Correct. Thanks for the clarification. The lower 1/3 of rectum is drained by
: the inferior rectal vein, which further drains into the internal iliac vein
: then IVC.
: If you still recall from Step I FA, in patients with portal hypertension,
: one of the four portal-systemic anastomoses is between the superior rectal
: vein (middle rectal vein should also be included, FYI) and the inferior
: rectal vein. This anastomsis can cause hemorrhoid and subsequent bleeding.
|
D********3
发帖数: 786 | 6
高，实在是高！说你姓高呢。。嘿嘿
【在 J*********4 的大作中提到】
:
: other
: =====
: Because the venous return of the lower 1/3 of rectal goes to Inferior vena
: cava, whereas anything above will go to portal system, thus lower 1/3
: metastasis to lung and the rest goes to liver.
: My 2 cents
|
M********3
发帖数: 269 | 7 just my two cents:
What is the Dx?
from the AP x-ray:
1. nonarticular proximal tibia fracture
2. LCL tear ?
What does the patient like to have in physical exam?
1. local tenderness and swelling
2. pain on weight bearing
3. limited ROM
4. knee unstable
5. foot cool and pale, no pulse of the dorsalis pedis artery --> blood
supply impairment, e.g. popliteal artery injury --> can cause thrombus
6. numbness of the foot --> nerve injury
7. 5 and 6 --> compartment syndrome ? --> if yes --> emergency OR
What other imaging study do you recommend and why?
1. lateral knee x-ray --> help to find fracture
2. x-ray include the knee and ankle joints ( whole tibia and fibula) -->
help to find any combined fracture/injury
3. CT if necessary
4. MRI
【在 D********3 的大作中提到】
: 未解之谜1： What is the Dx? What does the patient like to have in physical
: exam? What other imaging study do you recommend and why?
: 我们不知道哪儿有fracture..
|
D********3
发帖数: 786 | 8
Thanks a lot!
【在 M********3 的大作中提到】
: just my two cents:
: What is the Dx?
: from the AP x-ray:
: 1. nonarticular proximal tibia fracture
: 2. LCL tear ?
: What does the patient like to have in physical exam?
: 1. local tenderness and swelling
: 2. pain on weight bearing
: 3. limited ROM
: 4. knee unstable
|
R*******t
发帖数: 367 | 9 这是segond fracture， highly associated with ACL tear (75-100%). Recommend
MRI. On physical exam, positive Lachman test.
【在 D********3 的大作中提到】
: 未解之谜1： What is the Dx? What does the patient like to have in physical
: exam? What other imaging study do you recommend and why?
: 我们不知道哪儿有fracture..
|
J*********4
发帖数: 1274 | 10 Thanks a lot, Dr. Rubyheart. Really appreciate these great Qs and teaching
us. Is the arrow here pointing toward the fractured site?
Many many thanks! |
R*******t
发帖数: 367 | 11 You are very welcome Jenny. And yes, you are right, the arrow is pointing to
the fracture.
【在 J*********4 的大作中提到】
: Thanks a lot, Dr. Rubyheart. Really appreciate these great Qs and teaching
: us. Is the arrow here pointing toward the fractured site?
: Many many thanks!
|
J*********4
发帖数: 1274 | 12 We have so much fun while learning real stuff. Thanks a lot! You are such
a kind and approachable mentor!
Regards,
Jenny
to
【在 R*******t 的大作中提到】
: You are very welcome Jenny. And yes, you are right, the arrow is pointing to
: the fracture.
|
A*******s
发帖数: 9638 | 13 Ruby is a talented teacher, isn't she?
such
【在 J*********4 的大作中提到】
: We have so much fun while learning real stuff. Thanks a lot! You are such
: a kind and approachable mentor!
: Regards,
: Jenny
:
: to
|
J*********4
发帖数: 1274 | 14 Absolutely. Great news is, we are going to hear some of those mentors
teaching us in the near future!!!
You know, 我幸福的象花儿一样！
多谢，鞠躬！
【在 A*******s 的大作中提到】
: Ruby is a talented teacher, isn't she?
:
: such
|
