Packet 2 Case 1
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Packet 2 Case 2
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Packet 2 Case 3
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Packet 2 Case 4
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Packet 2 Case 5
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Packet 2 Case 6
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LONG CASE PACKET 2 MODEL ANSWERS
Case 1
Observation and Interpretation
CT abdomen and pelvis with contrast: Thickening of the terminal ileum with mucosal enhancement.
Left adrenal nodule
Negatives No small bowel obstruction. No colonic lesions. Solid organs normal. No adenopathy or lung lesions. No destructive bony changes. Normal SI joints.
Interpretation small bowel abnormality
Indeterminate adrenal lesion
Principle Diagnosis
Inflammatory bowel disease
Differential Diagnosis
Neoplasia
Infection
Further Management
Gastro consult and consideration for colonoscopy
Adrenal protocol mri scan for assessment.
Case 2
Observation
MRI Knee: Large bucket handle tear of the medial meniscus with meniscal fragment flipped into the intercondylar notch.
High signal near collateral ligaments suggestive of mild strain.
Negatives Remainder of menisci normal and tendons normal. No bony injury.
Interpretation
Ruptured menisci
Principle Diagnosis
Bucket Handle tear of menisci
Differential Diagnosis
None
Further Management
Emergency orthopaedic Consultation
Case 3
Observation
CT cervical spine:Fracture of the left body of C2
No other bony injury
MRI cervical spine: Fracture of the odontoid PEG within the body.
High signal areas within the visualised cervical and thoracic level cord.
Negatives, no additional bony injury. No additional cord lesions.
Interpretation
Spine fracture with cord lesions.
Principle diagnosis
C2 fracture. Multiple sclerosis in cord.
Differential Diagnosis
C2 fracture. Cord metastasis.
Further Management
Orthoapedic consult
Contrast enhanced scan of whole spine.
Neurology referral
Case 4
Observation
7 X 6 mm mass in the left internal auditory meatus
Negatives Normal 7th and 8th cranial nerves. No intracranial lesions.
Interpretation
lesion in left IAM.
Principle Diagnosis
Acoustic Neuroma
Differential Diagnosis
Epidermoid
Further Management
Contrast enhanced MRI
ENT Consult
Case 5
Observation
X Ray Cervical Spine :Abnormal cortical erosions involving C5 and C7
MRI cervical spine: C5 and C7 bone marrow infiltration
Negatives, no cord lesions.
Interpretation
Neoplastic process involving spine
Principle Diagnosis
Bony metastasis
Differential Diagnosis
Myeloma
Further Management
Work up and assessment for primary
Staging CT chest, abdomen and pelvis
Case 6
Observation
CT abdomen pelvis with contrast: Ileocolic intussusception in the right iliac fossa with thickened and dilated small bowel.
Multiple enhancing large mucosal polyps are seen in the small bowel loops.
Enlarged mesenteric nodes.
Negatives, no free air or fluid.
Interpretation
Small bowel tumours causing obstruction.
Principle Diagnosis
Small bowel cancer with obstruction.
Differential Diagnosis
Small bowel metastasis with obstruction.
Further Management
Emergency surgical consultation
CT chest