The Hyperexcision Podcast

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 42-year-old woman presents to the outpatient clinic with a 6-month history of joint pain and stiffness.The pain initially started in the small joints of her hands and has progressively worsened. She describes morning stiffness lasting more than an hour, which improves as the day progresses. She reports swelling, warmth, and decreased grip strength. She also reports experiencing general fatigue, a low-grade fever, and weight loss over the past few months.Upon examination, both hands exhibit symmetrical swelling and tenderness in the MCP and PIP joints, accompanied by mild ulnar deviation. The wrists are also tender and slightly limited in movement. There are no nodules seen over the extensor surfaces. Cardiovascular, respiratory, and neurological exams are unremarkable.Laboratory results are as follows: haemoglobin is 10.5 — low. WBC is normal. Platelets are elevated at 420. ESR is markedly elevated at 72. CRP is elevated at 25. Rheumatoid factor is positive at 120 IU per millilitre. Anti-CCP antibodies are positive at high titre. ANA is negative. Serum creatinine is normal. Liver function tests are normal.The X-ray of the hand shows generalised osteopaenia, severe erosion and destructive changes in the distal radius and ulna bilaterally as well as the carpal bones. Extensive joint space narrowing is seen at the intercarpal, carpometacarpal, and wrist joints. Erosive changes are seen along the head and base of the proximal phalanges.

A 14-year-old boy presents with a 3-month history of progressive pain and swelling around his left knee. The pain is dull, constant, and often wakes him at night. His parents report that he has developed a limp and is unable to participate in sports. He has also experienced some weight loss and fatigue, though there has been no history of fever or night sweats.On physical examination, there is a firm, tender swelling over the distal femur measuring approximately 6 cm. The swelling is immobile and associated with warmth and restriction of knee movement. The overlying skin appears stretched but intact, with no redness or ulceration. There is no palpable lymphadenopathy, and distal pulses are well felt.Laboratory studies show the following results:On physical examination, there is a firm, tender swelling over the distal femur measuring approximately 6 cm. The swelling is immobile and associated with warmth and restriction of knee movement. The overlying skin appears stretched but intact, with no redness or ulceration. There is no palpable lymphadenopathy, and distal pulses are well felt.Laboratory studies show the following results: Hemoglobin 10.5 g/dL (12–16 g/dL - Mild ⁠anemia⁠) ESR 40 mm/hr (<20 mm/hr - Elevated) CRP Normal (<10 mg/L - Normal) Alkaline Phosphatase (ALP) 700 U/L (<150 U/L- Markedly elevated) Lactate Dehydrogenase (LDH) 550 U/L (<250 U/L - Elevated)A plain X-ray of the distal femur shows a destructive lesion in the metaphyseal region with mixed lytic and sclerotic changes. There is periosteal elevation forming a Codman’s triangle, and a characteristic “sunburst” appearance of periosteal reaction. Cortical breach with extension into adjacent soft tissue is also seen. MRI confirms a large heterogeneous metaphyseal mass extending into surrounding soft tissue, but without encasement of the neurovascular bundle. A staging CT of the chest reveals small pulmonary nodules suggestive of metastases.A core needle biopsy demonstrates malignant spindle-shaped cells producing osteoid, confirming the diagnosis of osteogenic sarcoma (osteosarcoma) of the distal femur with pulmonary metastases

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 2-day-old female infant born at 39 weeks via breech vaginal delivery is undergoing her routine newborn exam on day 2 of life. The baby is feeding well, active and has no apparent distress.On examination, she is a healthy term neonate. There is a positive Barlow test and a positive Ortolani test on the left. There is no leg length discrepancy. No other congenital anomalies are noted.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 12-year-old boy was brought to the clinic with 1 1-month history of left groin pain and a limp.The pain began in his left groin and radiated to the left knee. It has been gradually increasing in intensity. It is worse with walking and relieved by rest. There is no history of trauma. He does not have pain in other joints or extremities. There is no history of recent infection, no history of fever, chills or malaise. He participates in physical education in school but is otherwise not involved in sports. He has no history of travel or camping trips and lives in an urban area. He takes no medication. There is no family history of joint problems.On physical examination, he is afebrile and appears obese. The left lower extremity is externally rotated, abducted and flexed, and he resists internal rotation. There is no leg length discrepancy. Neurologic and vascular examination is normal.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 32-year-old P2+0 G33 at 32 weeks of gestation presents to the antenatal clinic with swelling and pain in her right leg for 3 days. On examination, her right leg is swollen, erythematous and has dilated superficial veins. On palpation, it is warm and tender. There is a 4 cm difference in leg circumference.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 10-year-old male presents with a 2-month history of swelling of the left scrotum. The swelling has been increasing in size, but is not associated with pain, trauma, fever or urinary symptoms. On examination, the left hemiscrotum is enlarged, non-tender, smooth and fluctuant. It reduces in size when the patient lies down. The left testicle was palpated and felt to be normal and separated from the swelling. The swelling transilluminates in torchlight.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 36-year-old woman, Para 0 + 1, presents with a 10-year history of inability to conceive despite regular unprotected coitus and a 2-year history of heavy menstrual bleeding. She reports prolonged periods lasting 8–10 days with passage of clots and associated dysmenorrhea. She denies post-coital bleeding but notes intermenstrual spotting occasionally. There is no history of chronic pelvic pain, weight loss, or systemic symptoms. On abdominal examination, there is a firm, irregular pelvic-abdominal mass corresponding to an 18-week gravid uterus. The mass is non-tender, nodular, and moves with the cervix. No ascites is detected. These are her laboratory results: Haemoglobin 8.9 g/dL, Serum Ferritin /dL, MCV 74 fL, 9 ng/mL, β-hCG Negative, FSH7 IU/L, LH 6 IU/L, TSH 2.1 µIU/L, and Prolactin14 ng/mL.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 32-year-old man is brought to the emergency department after a motorbike accident. He reports severe pain in the left knee and inability to bear weight. On inspection, there is gross swelling and deformity of the knee joint. The leg appears shortened and displaced laterally. He is in severe distress. Distal pulses in the dorsalis pedis and posterior tibial arteries are absent. The foot is pale and cool to the touch. Sensation over the dorsum of the foot is reduced, and he is unable to dorsiflex the ankle.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 46-year-old woman presents to the emergency department with a 1-day history of constant right upper quadrant abdominal pain.The pain began after eating fried pork. She describes the severity of the pain as a 7 out of 10. She reports that the pain also seems to radiate to her back near her right scapula. She feels nauseated and has vomited twice. She has had similar pain about once a month for the past month but of less severity. The pain comes on and worsens after eating food but previously it has resolved within an hour. She also reports of fever.She does not have yellow discolouration of her eyes, has not lost weight, and does not have diarrhea, constipation, bleeding, or dark-colored stools. There is no history of abdominal distension or a mass in her abdomen.She is Para 6 + 0. She has no significant medical or surgical history, is not on any medication, and has no allergies. She does not smoke, nor does she drink alcohol. Her diet is usually high in fat. Her review of symptoms is unremarkable.She appears ill on physical exam. Her temperature is 37.7 C, heart rate is 110 beats per minute, and blood pressure is 120/80 mmHg. Her BMI is 33. There is no jaundice. She has marked tenderness to palpation in the epigastric region and right upper quadrant. When the right upper quadrant is palpated while she is taking a deep breath, she abruptly stops inspiration due to the pain. No masses are palpable. There is no rigidity, rebound tenderness, or guarding. The rest of her physical examination is unremarkable.Her ultrasound shows stones in the gallbladder, gallbladder wall thickness of 6mm, and pericholecystic fluid. The diameter of the Common Bile Duct is 1.8 mm and there are no stones visualized within it. The liver parenchyma appears normal. Sonographic Murphy’s sign is positive. These are the results of her laboratory investigations:WBC count 14 x 10 ^3 u/L (4.1 – 10.9 x 10^3 u/L), Total Bilirubin 1.0 mg/dL (0.1 – 1.2 mg/dL), Alkaline phosphatase 70 units/L (33-131 u/L), Amylase 60 units/L (30 – 100 u/L), Lipase 30 units/L (7 – 60 u/L)

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 23-year-old woman presents to the emergency department with a 12-hour history of right lower quadrant (RLQ) abdominal pain.The pain originated in the umbilical region and radiated diffusely across the lower abdomen and is now localized in the right lower quadrant. It was of sudden onset, sharp, and constant with increasing intensity. Severity was rated 8 out of 10 on a scale of 1-10 with one being no pain and 10 being the most pain possible. She took over-the-counter Ibuprofen 400mg but this did not alleviate the pain. The pain was exacerbated by lifting the right leg.She has vomited twice and reports that she has not eaten for 24 hours due to a lack of appetite. She opened her bowel post-onset of the pain with no change in the consistency of the stool, and no blood or mucus. She does not have abdominal swelling, dysuria, increased frequency of micturition, vaginal bleeding, or purulent vaginal discharge. She is nulliparous and her last menstrual period was 2 weeks ago with no complaints of dysmenorrhoea. She also has no history of unintentional weight loss, episodes of dyspepsia, strenuous physical activity or abdominal trauma.There is no significant past medical and surgical history. Drug history includes the oral contraceptive pill. She has no known drug allergies. There is no relevant family history. She does not smoke nor does she use recreational drugs. She drinks alcohol occasionally.On examination, she has a temperature of 38.5 degrees Celsius, absent bowel sounds, and marked tenderness to palpation at 1/3 the distance from the anterior superior iliac spine to the umbilicus. While palpating the left lower quadrant, she reports pain in the right lower quadrant. Active flexion and internal rotation of her right hip reproduces the pain. The skin on the RLQ is hypersensitive to touch. Gentle percussion over the right lower quadrant elicits rebound tenderness. There are no hernias. No abnormalities were detected on pelvic and digital rectal exam.A complete blood count reveals leukocytosis of 13.5 x 10^3/uL with 15% bands. Urinalysis demonstrates 1+ WBCs without bacteria. The pregnancy test is negative.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 29-year-old man presents with yellow discolouration of the eyes.For the past week, he has felt unwell with decreased oral intake, a low-grade fever, which he recorded at about 37.7 C, fatigue, anorexia, nausea, and occasional vomiting. He noticed that his eyes became yellow about 4 days ago. Since that time, he has had continuous mild pain in his right upper abdomen. His urine has also gotten darker. There is no change in the colour of his stool.He has no significant past medical history. However, he has been unable to donate blood within the past year for reasons he cannot recall. He has not travelled recently. He works as an accountant. His only medication is Ibuprofen.For his social history, he currently uses marijuana and MDMA (Ecstasy) recreationally and has a prior history of Injection Drug Use (IDU) and cocaine. For his sexual history, he has had 5 sexual partners in the past 6 months. He does not consistently use condoms.On physical exam, he appears ill and has obvious jaundice with scleral icterus. Temperature is 38.0 C, Blood Pressure 110/70 mmHg, Heart Rate 105 beats per minute, Respiratory Rate 16 breaths per minute, and Room air SpO2 of 99%. The lung and heart are normal apart from tachycardia.The upper border of the liver is in the 6ICS MCL. Liver span is 15 cm in percussion and palpable 6 cm below the right costal margin. The liver edge is smooth and tender to palpation. The spleen edge is non-enlarged. There are no stigmata of peripheral liver disease and no peripheral oedema.These are his lab results: AST 1234 U/L, ALT 1560 U/L, ALP 394 U/L, Total Bilirubin 13.4 mg/dL, Direct bilirubin 12.2 mg/dL, INR 2.3, aPTT 52 seconds. These are the results of his hepatitis serology: IgM Anti-HAV Negative, IgG Anti-HAV Negative, IgM Anti-HBc Positive, IgG Anti-HBc Hep B Negative, HBsAg Positive, Anti-HBs Negative, HBeAg Positive, Anti-HBe Negative, Anti-HCV Positive.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 45-year-old male motorcyclist is brought to the Emergency Department after hitting the rear-end of a car at highway speeds. He was wearing a helmet but was thrown from his motorcycle. He was found awake in the field by paramedics, but then quickly became unconscious. His airway is patent, but his respiration is shallow and irregular. His blood pressure is 150/90 mmHg, heart rate is 60 beats per minute, and respiratory rate is 20 breaths per minute. In response to the sternal rub, he moans and withdraws his right upper and lower extremities. He does not move his left upper or lower extremity, and he does not open his eyes. His right pupil is 6mm and non-reactive, while his left is 3mm and reactive to light. There is no obvious head injury or laceration. There is no discharge from the nose or the ears. However, there is a right hemotympanum. The oropharynx is clear. The rest of the physical exam is normal.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 17-year-old girl with a history of Type I Diabetes Mellitus is brought to the Emergency Department with nausea, vomiting, lethargy, and dehydration. The mother reports that she stopped taking her insulin a day before the presentation. She is a thin woman in mild respiratory distress. Respiratory rate is 28 breaths per minute, Blood Pressure 80/40mmHg, Heart Rate 112 beats per minute, Temperature 37.2 C. There are normal heart sounds, the lungs are clear, the abdomen is soft, and there is no organomegaly. She is responsive and oriented to time, place, and person, but somnolent and weak. Mucous membranes are dry. These are her lab results: Serum sodium 126 (132 – 146) mEq/L, Potassium 4.3 (3.5 – 5.5) mEq/L, Magnesium 1.2 (1.3 – 2.1 ) mEq/L, BUN 76 (9-23 )mg/dl, Creatinine 2.2 (0.5 – 1.1) mg/dl, Bicarbonate 10 (22 – 25) mmol/L, Chloride 88 (99 – 109 ) mEq/L, Serum glucose 40 mmol/L (< 11 mmol/L)

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 25-year-old man weighing 70 kg is brought to the casualty department one hour after sustaining burn injuries to his face, torso, and upper extremities in a house fire. He is awake but appears confused and disoriented. He also complains of a severe headache. On examination, his temperature is 39.7 C, blood pressure 90/74 mmHg, heart rate 120 beats per minute, respiratory rate 26 breaths per minute, and oxygen saturation 89%. He has blistering, painful burns to the face with singed nasal hairs and carbonaceous sputum. The remainder of his skin that is not burned has a cherry-red appearance. The burns on his chest and back are painless, circumferential, white, dry, and leathery. The bilateral upper extremities are also burned with painful, swollen, mottled areas with blisters that appear to have open, weeping surfaces. He also has sunken eyes, a dry tongue, and a slow capillary refill.

Welcome to the Hyperexcision podcast. This podcast is a time-efficient alternative to the written content on the website. It supplements the exam preparation material available on the hyperexcision.com website for medical students. You can follow along with the written material on the website while listening to this podcast. If you have any comments or suggestions, email [email protected] case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.A 55-year-old post-menopausal woman presents with a new breast mass in her right breast. She states that the mass has been there for about 3 months and has slowly grown in size. She first noticed it when she was taking a shower. The mass is not painful. She reports no nipple discharge, no nipple inversion, and no skin changes. She had her first menstrual period at 11 years of age. Her only pregnancy was at 35 years of age. Her mother and sister both had breast cancer. You proceed to perform a physical examination, starting with an inspection of the breasts. On physical examination, she has a 2cm palpable, hard, ill-defined, immobile, non-tender mass in the upper outer quadrant of her right breast. There is no palpable axillary or supraclavicular lymphadenopathy.