Quick Review of Pathology for clinicians and senior students. Trauma, head injury

1. “Do we not realize that self respect comes with self reliance?” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.

2. Quick Pathology Review Pathology of Trauma, healing, Fractures Connective tissue pathology System : Musculoskeletal Class : Trauma, Healing, Connective tissue. Topic : Pathology of Fractures & healing. Shashidhar Venkatesh Murthy A/Prof.& Head of Pathology School of Medicine & Dentistry James Cook University Australia.

3. CPC 33 - MS – Trauma, Fractures, Major CLI: Trauma: Pathology, common Types, Fractures & healing. Head injury. Minor CLI: Forensic pathology: Types: gunshot, blunt, electric shock, burns, knife injuries. Burns – Pathophysiology. Blunt abdominal injury, spleen injury. Blunt and penetrating Chest injury, surgical emphysema, Crush injury, Fat embolism.

4. A 17 year boy involved in motorcycle crash. Paramedics arrive at the scene within minutes and boy reports severe headache, vomits and while examination develops shakky movement of his body but recovers immediately. Image shows his CT scan report:What is the most likely diagnosis ? Subdural hematolma. Intracerebral hematoma. MCA Infarction. Epidural hematoma. Temporal Hematoma. What other findings are there on the image? Differentiate: Epidural, Subdural & Subarachnoid hematomas. List Clinical features of each type.

5. Head injury, postmortem section of brain specimen. What is the most likely diagnosis ? Epidural hematoma Subdural hematoma Subarachnoid hematoma Intracerebral hematoma Superior Sagittal sinus thrombosis. List common patterns of head injury with brief clinical features? Differences in etiology and pathogenesis of each type. List types and presentation of global ischemic brain damage.

6. A 71 year old man falls off a ladder and strikes the left of his head. He initially loses consciousness for few minutes then recovers with severe headache. After 3 hours, again becomes unconscious. At that time his pulse is 52/min, respiratory rate 9/min, BP 162/110 mm Hg. He develops papilledema on the right and then dies. His brain at autopsy is shown in the image. What is the most likely diagnosis ? Epidural hematoma. Subdural hematoma. Temporal laceration. Subarachnoid hematoma Temporal & parietal infarction. Explain her signs & symptoms? List differential diagnosis? List Laboratory findings expected in her? List three microscopic features shown?

7. A 56 year old woman, found dead in a car crash scene with no apparent fractures or head injury. Her partner reports she was hypertensive and diabetic on treatment. Image shows section of her brain.What is the most likely cause of death? Embolic infarct. Bilateral ACA hemorrhage. Whiplash injury. Ruptured aneurysm (CBA). Gliding contusions. The hemorrhagic white matter lesions are characteristic of gliding contusions, a form of traumatic brain injury caused by excessive movement of the brain inside the skull resulting from blows to the head and other mechanisms.

8. A 52 year old man Diabetic and hypertensive on therapy, had a fall from ladder and strikes his head on the ground. He initially loses consciousness but regains for two hours then he became again unconscious later sliding off to coma & dies. Image shows section of his brain stem. What is the most likely diagnosis ? PICA embolic stroke. Intraventricularhemorrhage (hypertensive). Bleeding AV malformation . Central pontinehemorrhage. Lacunar infarcts. What are the likely steps that lead to his death? List other causes of this condition?

9. A 81 year old man, found dead in a car crash. Image shows slice of his brain with bleeding. What is the most likely etiologic factor? Hypertension. Skull fracture. Berry aneurysm. AV Malformation. Embolism. List 4 major types of CNS bleeds and their etiopathogenesis. List CNS complications of hypertension? List 3 gross & 3 clinical features & 3 complicatons of cerebral edema.?

10. A 74 year old man 8 year history of sinusitis, frontal headache, increasing knee pain and increasing hat size. Develops frequent micro fractures in legs. Labs show high alkaline phosphatase. Serum calcium is normal. Image shows his skull on x-ray. http://www.nejm.org/doi/full/10.1056/NEJMicm0912945 (nejm) Multiple myeloma. Bone metastases. Thalassemia major. Sickle cell disease. Paget’s disease. Explain his signs, symptoms & lab investigations? What is the etiology and pathogenesis of this condtion? List three complications of this disease?

11. A 66 year old woman, chronic corticosteroid therapy for vasculitis. Now presents with limping with severe pain in her hip on walking since a month. Image shows microscopic appearance of her femoral head.What is the most likely diagnosis ? Paget’s disease. Osteoporosis. Osteoarthritis. Osteonecrosis. Metastastatic deposits. Explain her signs & symptoms? List differential diagnosis? List Laboratory findings expected in her? List three microscopic features shown?

12. A 66 year old Diabetic and hypertensive man died in a car crash. He initially loses consciousness for 25 minutes then regains for two hours when again he became unconscious at that time pulse 52, RR 9/min, BP 164/102 mm Hg, He develops papilledema and then dies. Image shows his brain. What is the most likely diagnosis ? Epidural hematoma Middle meningial artery tear. Subdural hematoma. Massive Subarachnoid hemorrhage. Cerebral contusion. What are the likely steps that lead to his death? List other causes of this condition?

13. A 28 year old woman is found dead in her home. There is no evidence of trauma, tests for toxicology is negative for drugs of abuse and ethanol. There is an unvented kerosene heater in her bedroom. Image shows her hand. Most likely diagnosis ? Polycythemiarubravera. Secondary polycythemia (smoking). Septicemic shock. Insect/snake bite. Carbon monoxide poisoning. Cherry red skin discoloration typical of CO poisoning. CO from partially burnt kerosene cigarrette, fossil fuel (vehicle exhaust) binds 200 times more avidly than oxygen . What would be the result on pulse oximetry? What is the cause of her death? – pathogenesis.

14. A 48 year bike rider involved in road crash presents with multiple fractures. On arrival at the emergency becomes drowsy, on examination has bilateral papilledema and dies following cardiac arrest. Image shows his brain section. What is the most likely diagnosis ? Thromboembolic stroke. Diffuse ischemic stroke. Cerebral lacerations. Thrombocytopenic purpura. Fat (marrow) embolism. Widespread bilateral white-matter pinpoint hemorrhagesare characteristic of bone marrow (fat) embolization. Clinically present as generalized cerebral dysfunction with disturbances of higher cortical function and loss consciousness, often without localizing signs. Other causes: Cardiac - MI, MS, AF, Cancers, air etc.

15. “We should not give up and we should not allow the problem to defeat us” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.I am bigger than experience...!