NBCE Part 3 Vignettes
24 year old female presents with hand pain and shiny skin on her arms and hands.
Provocative cold environment and cryotherapy. X-ray shows erosions of distal tufts and
calcinosis in hands. - ANS-Scleroderma
Scleroderma
• Most likely differential diagnoses: - ANS-1) Acro-Osteolysis
2) Calcinosis Cutis
3) Systemic Sclerosis
Scleroderma
Most likely associated signs: - ANS-1) Raynaud's Phenomenon
2) Skin hardening
3) Increase ANA
Scleroderma
Most likely sequelae to condition: - ANS-1) Dysphagia
2) Gastric problems
3) Pulmonary fibrosis
62 year old male presents with low back pain, difficulty initiating urine stream, and
polyuria in the middle of the night. Kemps produces LBP in every direction. X-ray shows
non-enlarged ivory white vertebra - ANS-Blastic Mets and Prostate Cancer
Blastic Mets and Prostate Cancer
Positive Labs - ANS-1) PSA
2) Acid Phosphatase
3) Alkaline Phosphatase
Blastic Mets and Prostate Cancer
• Most likely differential diagnoses from the film: - ANS-1) Paget's Disease
2) Blastic Mets
3) Hodgkin's Disease
Blastic Mets and Prostate Cancer
• Best follow up actions for condition: - ANS-1) Refer to oncologist
2) CT of spine
, 3) Radionucleotide scan (Radiosyntogrophy, Bone scan)
39 year old female falls on an out stretched hand 8 weeks ago. The pain is getting
worse and radiating to the shoulder. There is inflammation and color changes in the
hand. Brachioradialis DTR could not be performed due to pain. She has a history of
hypothyroid and is taking synthyroid for it. Provocative is emotional stress and an
increase of activity. X-ray shows osteoporosis on hand. - ANS-Reflex Sympathetic
Dystrophy
Reflex Sypathetic Dystrophy
Most likely Diagnosis: - ANS-1) Regional complex pain syndrome
2) Sudek's Atrophy
3) Reflex Sympathetic Dystrophy
Reflex Sympathetic Dystrophy
Best indicated tests: - ANS-1) Sympathetic nerve block
2) Nerve conduction velocity
3) Thermography
Most likely Sequelae: - ANS-1) Hyperhydrosis (sweating from firing sympathetics)
2) Osteoporosis
3) Atrophic skin changes
23 year old football player who was hit from behind and injured his neck and is
experiencing nausea and dizziness when stretching his neck. - ANS-Os-Odontoideum
Differential Diagnosis: - ANS-1) Os-odontoideum
2) Odontoid fracture
3) Whiplash
Other findings most commonly associated: - ANS-1) Congenital block
2) Occipitalization
3) Atlas hyperplasia
Tests that will most likely be performed: - ANS-1) Flexion and Extension x-rays
2) Neurological Evaluation
3) CT Scan (tells you fracture versus non-union)
32 year old female presents with bilateral leg weakness, vertigo, diplopia, and recent
bladder issues. She has been smoking for 10 years. Babinski's is positive, Straight Leg
24 year old female presents with hand pain and shiny skin on her arms and hands.
Provocative cold environment and cryotherapy. X-ray shows erosions of distal tufts and
calcinosis in hands. - ANS-Scleroderma
Scleroderma
• Most likely differential diagnoses: - ANS-1) Acro-Osteolysis
2) Calcinosis Cutis
3) Systemic Sclerosis
Scleroderma
Most likely associated signs: - ANS-1) Raynaud's Phenomenon
2) Skin hardening
3) Increase ANA
Scleroderma
Most likely sequelae to condition: - ANS-1) Dysphagia
2) Gastric problems
3) Pulmonary fibrosis
62 year old male presents with low back pain, difficulty initiating urine stream, and
polyuria in the middle of the night. Kemps produces LBP in every direction. X-ray shows
non-enlarged ivory white vertebra - ANS-Blastic Mets and Prostate Cancer
Blastic Mets and Prostate Cancer
Positive Labs - ANS-1) PSA
2) Acid Phosphatase
3) Alkaline Phosphatase
Blastic Mets and Prostate Cancer
• Most likely differential diagnoses from the film: - ANS-1) Paget's Disease
2) Blastic Mets
3) Hodgkin's Disease
Blastic Mets and Prostate Cancer
• Best follow up actions for condition: - ANS-1) Refer to oncologist
2) CT of spine
, 3) Radionucleotide scan (Radiosyntogrophy, Bone scan)
39 year old female falls on an out stretched hand 8 weeks ago. The pain is getting
worse and radiating to the shoulder. There is inflammation and color changes in the
hand. Brachioradialis DTR could not be performed due to pain. She has a history of
hypothyroid and is taking synthyroid for it. Provocative is emotional stress and an
increase of activity. X-ray shows osteoporosis on hand. - ANS-Reflex Sympathetic
Dystrophy
Reflex Sypathetic Dystrophy
Most likely Diagnosis: - ANS-1) Regional complex pain syndrome
2) Sudek's Atrophy
3) Reflex Sympathetic Dystrophy
Reflex Sympathetic Dystrophy
Best indicated tests: - ANS-1) Sympathetic nerve block
2) Nerve conduction velocity
3) Thermography
Most likely Sequelae: - ANS-1) Hyperhydrosis (sweating from firing sympathetics)
2) Osteoporosis
3) Atrophic skin changes
23 year old football player who was hit from behind and injured his neck and is
experiencing nausea and dizziness when stretching his neck. - ANS-Os-Odontoideum
Differential Diagnosis: - ANS-1) Os-odontoideum
2) Odontoid fracture
3) Whiplash
Other findings most commonly associated: - ANS-1) Congenital block
2) Occipitalization
3) Atlas hyperplasia
Tests that will most likely be performed: - ANS-1) Flexion and Extension x-rays
2) Neurological Evaluation
3) CT Scan (tells you fracture versus non-union)
32 year old female presents with bilateral leg weakness, vertigo, diplopia, and recent
bladder issues. She has been smoking for 10 years. Babinski's is positive, Straight Leg
