Check Study Program

Roger, aged 33 years, presents with a 12-month history of intermittent, right-sided testicular discomfort and a recently self-detected lump. He is generally fit and well, takes no regular medicines and has no medical history of note. Roger migrated to Australia five years ago and works for a pharmaceutical company. He and his partner, aged 38 years, are trying to conceive. He is a non-smoker and drinks less than 20 g of alcohol per day. 1.What are some of the possible differential diagnoses for testicular pain and/or testicular lumps? 2.What would you ask Roger to help you to make a diagnosis? 3.On the basis of this additional information, what diagnoses would you consider? 4.What investigations are required to confirm the diagnosis? 5.What is your diagnosis based on this information? 6.What are the risk factors for testicular cancer? 7.What next steps should be undertaken at this stage? 8.What is the prognosis for Roger? 9.What would Roger’s follow-up care involve? #week18_Case2

Kaguya, aged 61 years, presents with a four-week history of constant epigastric pain that radiates to her back. She has lost 15 kg over the past three months after initially trying to lose weight subsequent to being told she was ‘borderline diabetic’ at a previous clinic visit. In the past week her urine has become darker, while her stools have become looser over the past two weeks. She has a history of hypertension and asthma and is a current smoker. Her mother died of pancreatic cancer when aged in her 70s. On examination, Kaguya is mildly jaundiced and has epigastric tenderness without any other remarkable findings. 1.What are your differential diagnoses? 2.What investigations would you request for Kaguya? 3.Which patients are at sufficient risk of pancreatic cancer to recommend screening or surveillance for pancreatic cancer? 4.How does pancreatic cancer commonly present? 5.What features are used to determine whether pancreatic cancer is resectable? 6.What could be contributing to these symptoms? 7.What advice would you give? #Week18_Case1

#Achilles_Tendon_Surgery_DVT

#Achilles_Tendinopathy_Insertional

#Anticoagulants_Duration

#Haglund_Deformity

June, aged 56 years, is an active woman with a long history of bumps on both heels. In the past six months, she has noticed her right heel has become increasingly painful, and she thinks it has enlarged in size. She is now getting a blister over the bump and has had to change her footwear several times. June’s medical history includes type 2 diabetes, which she controls with diet and exercise, but she is otherwise well. She has had plantar fasciitis of both feet in the past. June does not smoke and consumes 1–2 standard alcoholic beverages per week. She works part time as a sales assistant in a clothes store. 1.What are the possible causes of a painful bump on the heel? 2.What further information would you like to obtain from June in relation to her symptoms? 3.What features would you look for on examination? 4.What is the most likely diagnosis? 5.What tests would you order to confirm your diagnosis? 6.What is a Haglund’s deformity and how is it associated with Achilles tendon pathology? 7.How would you manage June’s heel pain? 8.Where would you refer June now? 9.How do you manage June now? 10.What do you do now? #Week17_Case3

#Osgood_Schlatter

Togashi, aged 15 years, is brought to see you by his father for right knee pain. Togashi reports dull pain at the front of the right knee on the lower side, which increases when he plays sports. The pain has been present for more than six months. There has been no known trauma to the knee. Togashi is an aspiring athlete who wishes to compete professionally in sports. Togashi has sports training for football or basketball on most days of the week. 1.What further history would you take? 2.What are the important points to consider in physical examination of the knee in an adolescent? 3.What relevant conditions would you include in the differential diagnosis? 4.What is your likely diagnosis, its aetiology and further investigation of this condition? 5.How will you respond? 6.What are main features of this condition? #Week17_Case2