"Grab Bag"

Case #1

A child with a headache and more frequent seizures.  She has a history of hydrocephalus and has had multiple ventricular shunts placed and revised.  Plain x-rays in this setting (i.e. shunt series) are often ordered as a "reflex" but are rarely helpful.  In this case a picture makes the diagnosis . . .  view the x-ray first then proceed to the answer.

And, the reason for her increased headache and seizures is . . .  

Case #2

A child with abdominal pain, one episode of emesis, no fever or diarrhea, eating little.  Again, view the x-rays then make your diagnosis.

Case #3

A 20 year old man had a mild cold yesterday and today a high fever, headache, rash and stiff neck.

Case #4

This patient lost control of her vehicle on "black ice" while driving to work.  She was traveling at highway speed.  Med Flight was called to the scene.  Extraction time was prolonged.  Fortunately the patient was wearing a seatbelt and her car was equipped with an air bag.  She survived and eventually made a "full recovery."  At the accident her primary complaint was difficulty taking a deep breath due to pain in her right chest and shoulder.

• take some time with the CXR and try to list at least four findings

• what would you expect her physical exam to be (chest inspection, palpation, auscultation)?

So . . .  are you wearing your seatbelt home tonight . . . and every night?

Case #5

This patient was also in a severe motor vehicle collision.  Name at least three findings on the chest x-ray . . . .

Case #6

This patient was at work cleaning an industrial "power grinder" in a sheet metal factory.   He noticed that something was caught between two of the grinding wheels.  The wheels are designed to have sheets of metal "fed" between them and pulled into and through the mechanism which "grinds" both surfaces of the sheet.  The patient attempted to kick free the material caught between the grinding wheels and had his foot pulled into the wheels and feeding mechanism.  He was wearing steel toed boots with heavy soles and thus the sole of his foot and toes were spared injury.  The top of the boot (around the laces) was stripped away and his foot was crushed and caught in the grinder from above.

His dorsalis pedis artery has been destroyed -- however -- he does have normal capillary refill in the toes and is able to flex them but cannot extend them.   Can you explain this based on your knowledge of foot anatomy?

Is this injury repairable -- i.e. is the foot salvageable or will it have to be amputated?

These cases were written & posted by Mark Bogner, M.D.
All material is from the U.W. ER & Med Flight
Note additional "credits" at the end of each case when material was submitted by others

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