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].

Every 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 52-year-old woman presents with a 3-month history of a painless lump in her left breast. Biopsy confirms invasive ductal carcinoma, stage II (T2N1M0). She undergoes breast-conserving therapy (lumpectomy with sentinel lymph node biopsy). Post-operatively, she is referred to the oncology clinic where the multidisciplinary team recommends adjuvant radiotherapy to the left breast and regional lymph nodes. She is scheduled for external beam radiotherapy using modern planning techniques.

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].

Every 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 woman with breast cancer on adjuvant chemotherapy presents with a fever of 38.9°C, chills, and malaise. She looks acutely unwell. On physical examination, she has hypotension (BP 90/60 mmHg), tachycardia, with no localising source of infection.

Her laboratory results: WBC 0.3 ×10⁹/L, neutrophils 0.1 ×10⁹/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].

Every 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].

Every 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].

Every 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].

Every 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].

Every 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].

Every 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].

Every 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.