Correct All the Errors 1 LEFT FOOT, THREE VIEWS: There is a...

Question Answered step-by-step Correct All the Errors 1 LEFT FOOT, THREE VIEWS: There is a… Correct All the Errors 1LEFT FOOT, THREE VIEWS: There is a transverse fracture of the proximal portion of the first digit phalenx. A comminuted fracture is noted of the middle phalanx of the second digit, and an increased density is seen medially at the joint space of the middle phalanx of the third digit. On the oblikue films there appears to be a displaced fragment of bone between the second and third digits at the PIP. No other bony abnormalities are noted. IMPRESSION1. Fracture of distal phalanx, first digit.2. Phalangeal fractures of second and third digits. *** #2MRI OF THE HIPS The patient is status post left hip dislocation with fracture of the superior portion of the left femoral head. This happened several months ago, and he now returns because of hip pain. An MRI study is performed to rule out a vascular nicrosis of the left hip. T1 and T2 weighted images were obtained in the corinal and sagital plains. Along the medial portion of the left femoral head there is a low-intensity line which is consistant with the appearance of a vascular nicrosis. The location of this line is somewhat unusual for a vascular nicrosis since most of the a vascular nicrosis we see is along the superior aspect of the femoral head. There is minimal irregularity along the superior aspect of the left femoral head, but this is felt to correspond to the site of the patient’s fracture, and therefore it most likely does not represent a vascular nicrosis in this area. IMPRESSION 1. A vascular nicrosis of the left femoral head.2. Status post fracture of the superior portion of the left femoral lead. ***#3UPPER GI SERIES: Preliminary film of the abdomen reveals residual contrast material in the descending colon and rectum from recent contrast study. There is generalized osteopenia. There was prompt initiation of the swallowing mechanism. On today’s examination, there was demonstrated evidence of esophageal dysmotility. Tertiary contractions were seen throughout the thoracic portion of the esophagus. There is a small hiatus hernia and evidence of gastral esophageal reflex with slow clearance of the reflexed contrast material. The folds in the distal third of the esophagus appear thickened, suggesting esophagitis. The stomach, duodenal bulb, and duodenal sweep appeared normal. The viewed portion of small bowel likewise appeared normal. A couple of diverticula are seen in the duodenal sweep, which represent normal variants. IMPRESSION1. Esophageal dysmotility.2. Small hiatus hernia, gastral esophageal reflex, and esophagitis. ***#4MRI OF THE CHEST: An MRI of the chest was performed in this 43-year-old black female who has chest pain. T1 waited coronal images were obtained as a scout. Then T1 waited images were obtained at three different levels through the chest using cardiac gating and respiratory compensation. All images obtained were T1 waited. The lumen of the aorta does not show any evidence of a dissection. The ascending aorta is slightly enlarged at 4 cm in diameter. However, the descending aorta has a normal caliber. There is tissue around the descending aorta, which is somewhat unusual in appearance, but it most likely represents fat. There is a remote possibility that this could represent thrombis around a patent lumen, but this is felt to be unlikely. Since this is only on the slices through the lower part of the thorax, an ultrasound of the abdominal aorta up to the hiatus would be worthwhile to make sure the patient does not have an abdominal aortic aneurysm. The ventricals are normal in appearance. IMPRESSION: Magnetic resonance imaging (MRI) of the thorax showing no evidence of an aortic dissection. The ascending aorta is slightly enlarged. ***#5SKULL: No mass affect, midline shift, or evidence of subdural or epidural blood is seen. Calcification is seen in the falx, the pineal, and the choroid plexus. ***#6PORTABLE CHEST: The heart is enlarged. Patchy infultrates are present in both midlungs laterally. There is no clear evidence of congestive heart failure. The tip of the EET tube is at the clavicular level. There is a nasogastric tube coiled in the stomach. External cardiac monitors are present. IMPRESSION: Cardiomegaly without obvious congestive heart failure. The pulmonary infultrates most likely represent pneumonia, although patchy adema could produce this picture in the face of underlying obstructive lung disease. ***#7GALLBLADDER ULTRASOUND EXAMINATION: The gallbladder is generous in size but demonstrates no evidence of solid internal echoes or associated acoustical shadowing. There is also no evidence of gallbladder wall thickening. The liver is normal in size and its internal echo pattern. There is no evidence of mass lesions or intrahepatic biliary tract dilatation. There is also no evidence of abnormality pertaining to the pancreas or right kidney. IMPRESSION: Probable normal examination. ***#8INTRAVENOUS PYELOGRAM: Scout film prior to procedure shows no evidence of abnormal calcification or other abnormality. After intravenous administration of 100 cc of meglumine diatrizoate, multiple overhead oblique and AP views as well as tomagrams are obtained. There is prompt, equal excretion of contrast by both kidneys, which are within normal limits of size, shape, and location. Collecting systems are normal, and there is no evidence of intrarenal hypodense or hyperdense mass. Ureters are of normal caliper and course. Urinary bladder is of normal size, shape, and empties essentially completely upon avoiding. No evidence of stasis is present in the upper tracks. IMPRESSION: Normal intravenous pyelogram (IVP). *****#9SINUSES Patient came in complaining of sinus pain for one week. A Walter’s view of the maxillary sinus showed an air-fluid level suggesting right maxillary sinusitus. No soft tissue or bony abnormalty is seen near the ostia of the maxillary sinuses. Soft tissues of the face are grossly normal. IMPRESSION: Left maxillary sinusitis with no variation or abnormality seen. +++++#10MUGA SCAN First-pass and gated views were obtained. The left ventricular injection fraction is 42%, the right ventricular EF is 45%. IMPRESSION: Abnormal multiple gaited acquisition (MUGA) blood pool radioisotope scan, showing diffuse hypokenesis, with left ventricular EF of 42%. +++++#11BILATERAL RENAL SONOGRAPHY CLINCIAL DATA: Possible hydronefrosis. The right kidney measures 6.3 cm in length and the left measures 5.8 cm in length. This is normal for the patient’s age. No evidence of hydronefrosis. Kidneys are normal in configuration with normal-appearing reanl cortices and collecting systems. No mass or cysts. IMPRESSION: Normal kidnies and ureters. +++++#12BONE SCAN Following the intravenous administration of 20 mCi of T-99m labeled MDP, scans were performed in the usual projections. There is a normal radioisotope labeling of all the visualized reticuloendothelial system. There is an increased uptake in the T13 vertebral body and in the posterolateral aspect of the right seventh rib. Both of these areas show frackure injuries. There is also a narrow band of increased radioisotope uptakein the upper portion of the left femur just below the lesser trocanter. This may possibly be related to a possible stress-type fracture. No other areas of abnormal radioisotope uptake are detected. IMPRESSION: Decreased areas of radioisotope uptake, as described, probably related to recent fracture injures. Health Science Science Nursing Hit 244 Share QuestionEmailCopy link Comments (0)