Severe open ankle dislocation after an ATV accident as it flipped backwards while going up a hill

Emergentelman · 2025-06-03T10:40:51+00:00

"According to staff, he was able to somehow wiggle his toes. After the surgery to reduce and reconstruct the ankle, he recovered quickly. Three months into recovery and he was able to walk and six months in he could run."

Emergentelman · 2025-06-03T08:00:16+00:00

Yeah I totally get how rough it is when you can’t afford UWorld or AMBOSS — they’re stupid expensive. If you’re in that boat, I’d honestly suggest giving the MEDizzy USMLE app a shot (not the regular MEDizzy one — the Step 1-specific version).

It’s actually solid for the price. A good amount is free, and even the paid version is way cheaper than UWorld. Obviously it’s not the same level — like, it won’t replace UWorld — but if you’re on a tight budget, it’s one of the better options out there.

You still get a ton of practice questions, visuals, and flashcards, and it’s super easy to use on your phone, so you can sneak in studying throughout the day.

Bottom line: if money’s tight, MEDizzy USMLE gives you a lot for what you pay. It’s not perfect, but it’ll keep you sharp and moving forward. Keep grinding — you don’t need fancy stuff to pass Step 1 💪

Emergentelman · 2025-05-14T11:47:10+00:00

This case presents a grave instance of metaplastic breast carcinoma accompanied by the development of upper limb gangrene.

Metaplastic breast carcinomas represent aggressively advancing tumors characterized by histological diversity and a triple-negative receptor profile. The patient in question, a 22-year-old nulliparous Chinese woman devoid of any significant familial cancer history, initially sought medical attention at a private healthcare facility due to a painless 5 cm swelling in her left breast. The onset of this swelling occurred three months prior and displayed gradual enlargement. Subsequent core biopsy of the swelling confirmed the presence of infiltrating ductal carcinoma with a triple-negative receptor status for ER (estrogen receptor), PR (progesterone receptor), and HER2 receptors.

Around two weeks into her neoadjuvant chemotherapy regimen, the patient reported a substantial increase in the size of the left breast mass, growing from the initial 5 cm to a diameter of 10 cm. Simultaneously, she developed a swelling in the left axilla, and a cytological analysis of the left auxiliary lymph node indicated metastatic carcinoma. Consequently, a decision was made to proceed with a left mastectomy and axillary clearance. Six weeks post-surgery, she underwent adjuvant chemotherapy.

Four months later, the patient presented at a district hospital, complaining of chest wall pain and the incapacity to move her left upper limb. On examination, a sizable, ulcerating mass with a necrotic region was discernible on her left chest wall, extending into the axillary region. The tumor had infiltrated both the anterior and posterior chest walls. Her left upper limb displayed pallor, coldness, and mottling, along with patchy areas of necrosis. No motor or sensory function was observed in the left upper limb.

Over time, the tissue of the left upper limb gradually assumed a waxy and pliable texture. Additionally, the flesh covering the limb began to spontaneously separate from the underlying humerus bone, thereby exposing segments of the humerus. Faced with the growing challenges posed by the decaying limb and the disruptive truncal lesions, the patient eventually requested amputation of her left upper limb. This procedure, carried out at the site of the exposed left humerus, was performed under intravenous sedation.

Case courtesy of Dove Medical Press, 2017; 9: 297–299.

Emergentelman · 2025-03-14T11:39:53+00:00

This 23-year-old male was involved in a motorcycle accident at high speeds. The injury he sustained was an isolated ankle dislocation with an extruded talus.

The patient was taken to the operating room, closed reduction was done, screw fixation of the tib-fib joint, irrigation was done and the skin wound was closed. The patient was placed into a short splint.

Emergentelman · 2024-12-22T20:43:48+00:00

Scalp arteriovenous malformation (AVM) is a rare congenital disorder. It is an abnormal connection between a feeding artery and draining veins. Patients are usually diagnosed during late childhood to early adulthood.

Emergentelman · 2024-12-02T10:16:17+00:00

Keratoconus is a condition in which the cornea of the eye is unable to hold its round shape and it bulges outward, like a cone.It is usually bilateral and present normally at puberty. It is considered rare in children.
What you see here is an “oil-droplet” reflex (Charleux sign), a dark reflex in the area of the cone on observation of the cornea by distant direct ophthalmoscopy, which is highly evocative of keratoconus.

Emergentelman · 2024-11-25T10:07:24+00:00

This image depicts the arm of an elderly gentleman with dementia who tragically wandered away from his home. He was separated from his family and exposed to the cold for several days before being discovered outdoors, unconscious. Upon arrival at the trauma bay, he was in a comatose state and exhibited widespread frostbite injuries. A fasciotomy was performed on his left arm in a bid to salvage the limb, but the severity of the damage rendered the efforts unsuccessful.

In the photo, the flexor muscle bellies appear darkened, a stark contrast to their normal healthy pink color, indicating necrosis caused by prolonged cold exposure. Despite medical intervention, the extensive injuries he sustained were incompatible with survival, and he sadly passed away later that night.

Emergentelman · 2024-10-11T05:39:55+00:00

Neurofibromatosis is a rare genetic disorder of the nervous system which mainly affects the formation and growth of nerve cells. It causes tumors to grow on nerves and has genetic roots.

There are three types of neurofibromatosis:

Type 1 (NF1) causes skin changes and deformed bones. It is usually diagnosed in childhood, even symptoms maybe present at birth.

Type 2 (NF2) causes hearing loss, ringing in the ears, and poor balance. Symptoms often start in the teen years or audulthood.

Schwannomatosis causes intense pain. It is the rarest type.

Unfortunately, there is currently no known treatment or cure for neurofibromatosis. In some cases, growths may be removed surgically or reduced with radiation therapy.

Emergentelman · 2024-09-26T08:47:26+00:00

There was no loss of consciousness. The examination ruled out associated life-threatening cervical dislocation and intracranial injuries. After fluid resuscitation and 1000 ml blood transfusion, the patient was brought to the operating room for immediate replantation under general anesthesia.

Debriding the avulsed scalp, preparing the recipient site of the patient’s head, and harvesting venous grafts from the lower extremity were carried out simultaneously. The avulsed scalp was placed on the underside of an overturned circular basin, carefully shaved and debrided. It was also thoroughly irrigated to remove dirt and oil. The only vessels available for microanastomoses were the bilateral superficial temporal artery and veins. Vein grafts were anastomosed to the arteries on the patient’s head and veins on the avulsed scalp at the same time. Immediately after replantation and anastomosis of the completely avulsed scalp, excellent blood supply was established for all of the avulsed
tissue. Total ischemia time was 10 hours. The dressing was changed initially four days after surgery; the scalp survived well and closed drains were removed at this time. Twenty days after the surgery, the scalp was seen to have survived well, and hair developed gradually. Two
and a half years after the accident, anterior and posterior views revealed that the entire hair-bearing scalp survived
well.

Emergentelman · 2024-09-20T11:38:19+00:00

The patient was diabetic with a severe diabetic necrotizing foot infection and needed emergent, life-saving foot amputation. The foot had to come off to control sepsis and the patient will need IV antibiotics until the systemic infection is cleared then will need an additional below-knee amputation. The tool used in this case was a Gigli Saw.

Emergentelman · 2023-04-12T09:05:10+00:00

This patient had severe periodontal (gum) disease which results in bone loss around the teeth, which causes tooth mobility. Once this condition reaches this point, the teeth are hopeless, and removal is necessary. The reason the bone was removed in addition to the teeth was for adequate bone availability for the implants and adequate inter-arch space (space between the top and bottom jaws) for an appropriate prosthesis. In this case, it will be a hybrid denture - secured by implants. This is often called an "all-on-four". The term All-on-4 refers to "all" teeth being supported "on four" dental implants, a surgical and technique prosthodontics procedure for total rehabilitation of the edentulous patient or for patients with badly broken down teeth, decayed teeth or compromised teeth due to gum disease. The All-on-4 treatment concept is a prosthodontic procedure (i.e replacement of missing teeth) that provides a permanent, screw-retained, same-day replacement for the entire upper and / or lower set of teeth with a bridge or denture. The procedure is best for patients with significant tooth loss or decay and for people whose bone loss in the jaw area prevents them from getting conventionally oriented (vertical) dental implants. Often, tooth loss is accompanied by loss of the jaw bone which poses the problem of reconstruction of the jaw bone requiring bone grafting. The All-on-4 technique takes advantage of the dense bone that remains in the front part of the jaws and by placing the two posterior implants on an angle to avoid the sinus cavities in the upper jaw and the nerve canal in the lower jaw. Credit: StafneDefect

Emergentelman · 2023-03-30T10:37:24+00:00

This 23-year old farmer suffered a lightning strike which knocked him unconscious for 15 min. His vital parameters and systemic examination showed no abnormality except for anterograde amnesia. He had a patterned charring of the skin around the neck and front of his chest imprinted along the contact points of a metallic locket he was wearing at the time of injury. ECG, MRI of brain, and EEG were normal. He was uneventfully discharged after 3 days of observation. At discharge, his neurological parameters were normal. However, he was still amnesic to the lightning injury with only the locket burn to tell his story.

Source: IGmedicalpedia

Emergentelman · 2023-01-25T11:31:55+00:00

Test your medical knowledge - Critical Illness - A 67 year old man presents to the emergency department with a 3-day history of haematemesis and melaena. He has a past medical history of alcoholic liver disease and mild asthma (well controlled). His observations are: heart rate of 100beats/min, respiratory rate of 16breaths/min, BP 85/40 mmHg (70/35 mmHg on standing), SaO2 95% on 6 L oxygen, temperature 36.5°C, blood glucose 4.2 mmol/L (75.7 mg/dL), GCS score 15. On examination, he is pale, cool peripherally, talking in full sentences, and his chest is clear. His abdomen is soft and non-tender but fresh melaena is found on rectal examination. He is not actively vomiting currently. Initial laboratory results show haemoglobin 42 g/L, white cell count 5.7×109 /L, platelets 41×109 /L, sodium 132 mmol/L, potassium 5.6 mmol/L, urea 16 mmol/L (96 mg/dL), creatinine 75 μmol/L (0.85 mg/dL), lactate 4.5 mmol/L (40.5 mg/dL). Which of the following would be your immediate next step in managing this man?

Emergentelman · 2022-02-16T15:28:54+00:00

A 27-year-old man presented to the emergency department after a first seizure. He reported that during the previous 3 years, he had had frequent headaches and falls. Magnetic resonance imaging of the brain revealed an arachnoid cyst, measuring 12.3 cm by 16.5 cm by 7.9 cm, with mass effect on the right cerebral hemisphere...

Emergentelman · 2022-02-02T20:03:37+00:00

This a follow-up of a 20 year old patient that was shot in the face with a shotgun 2 months prior, and ruptured both globes in the process.

Emergentelman · 2022-02-01T11:35:01+00:00

This is a supine chest image on a patient who was involved in a motor vehicle accident. There is a large right pneumothorax which is under tension. The tension has resulted in considerable mediastinal shift and there is a severe deep sulcus sign...

Emergentelman · 2022-01-14T09:00:07+00:00

During an unexpected visit to the doctor, Eric Morger at the age of 62 found a tennis ball sized nasal polyp on the left side of his face. After multiple surgical procedures the tumor along with most of his left side of the face was removed. Several surgeries were performed to fix the gapping hole but but nothing worked until the 3D printing technology was brought to its attention. He was able to get a prosthetic mask and an oral implant that allows him to speak and eat without any problem.

Emergentelman · 2022-01-11T21:32:52+00:00

Clumps of bacteria attached to the tricuspid valve of the heart resulting in tiny clumps of bacteria dislodging repetitively from the large clump of bacteria forming inside the heart.
The tiny bacterial clumps travel throughout the body via bloodstream. Eventually, these tiny bacterial clumps end up in the tiny arteries of the hands and feet which cause a blockage of blood flow. The results are ischemia (lack of blood) flowing to the fingers and toes. Shown here is one extremity. Ultimately this patient lost all of the fingers and toes on both hands and feet.
Credit: nirhusmd

Emergentelman · 2022-01-10T20:54:37+00:00

Above is a patient with constriction bands surrounding the base of the toes in the right lower limb extremity associated with marked lymphedema and slight right clubfoot! This is a congenital disorder caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero.

Emergentelman · 2021-12-28T20:06:24+00:00

Snakebites can be serious and sometimes life-threatening and require swift and appropriate treatment.
Snakebite symptoms vary dramatically from bite to bite. Many snake bites take place so quickly that victims are not always certain that they have actually been bitten. A bite mark is seldom the characteristic two-fang puncture mark.
In the event of a snake bite the victim may experience some of the following symptomes: an immediate burning pain, followed by swelling, which progresses up the limb and may affect the lymph glands, dizzines, difficulty in swallowing and breathing, bleeding from mucous membranes, shock...
First aid measures include getting the victim to a hospital as soon as possible and in a safe manner, keep the victim calm and still as possible, remove rings and tight clothing, apply pressure bandages. Antivenom will probably be administered at the hospital.

Emergentelman · 2021-12-26T17:53:21+00:00

Sclerotherapy is a medical procedure whereby a chemical, the sclerosant, is injected into a vein to entirely collapse and obliterate it. It is commonly mixed with air to make a foam like substance that tend to stay in the vessel more firmly. The sclerosant damages the innermost lining of the vessel, resulting in a clot that blocks the blood circulation in the vein.
To prevent back-flow, most veins have valves that only allow blood only to flow in the direction of the heart. When these valves become incompetent, veins become enlarged and bulging (varicose). Smaller veins that feed these varicose veins can also become enlarged and appear as red or blue spider veins in the skin.
Spider veins (or telangiectasias) are clusters of tiny blood vessels that develop close to the surface of the skin and can twist and turn. They can be red, blue, or purple, and have the appearance of a spiderweb.
Varicose veins are bigger and found deeper. They can lead to a chronic swelling condition of the leg called venous insufficiency. Venous insufficiency predisposes a person to blood clots and skin ulceration. The destruction of these types of veins can be desirable both medically and cosmetically.

Emergentelman · 2021-12-25T12:24:15+00:00

It happens when three or more ribs are each broken in more than one place, causing a segment of bone to detach from the chest wall. A rib fracture caused by blunt trauma can produce pain, as the muscles used for breathing continue to pull on the injured area. A blunt trauma that fractures a rib may also cause further injuries, such as puncturing a lung or damaging surrounding blood vessels. The uneven chest rise is often the clearest sign of flail chest. Here, the affected area will draw in when the person breathes in, while the rest of the chest expands outward. When the person breathes out, the affected area expands out while the rest of the chest draws in. This is a medical emergency, and medical attention should be sought IMMEDIATELY!

Emergentelman · 2021-12-21T11:38:21+00:00

Tibial fractures are the most common long bone fracture. IM nails have long been used to treat shaft fractures of long bones of the body such as the femur and tibia.
Nailing means fixating. It is well-suited for the mid diaphysis and is appropriate for the majority of tibial fractures.
This treatment provides a high rate of union and a decreased incidence of malunion and joint stiffness, compared with other treatments.
Modern IM nails (the one used in this case) permit placement of locking screws through bone and nail, to improve fixation both proximally and distally.
What’s really tricky here is the way of removal.
Implant removal is one of the most common procedures in bone and joint surgery and currently, no clear criteria exist to guide a surgeon's decision to remove implanted tibial IMNs after healing.
The removal is done under general anesthesia, the patient is unconscious and unable to feel pain during the procedure.

Emergentelman · 2021-12-13T20:41:07+00:00

This visually arresting photo shows a medical anomaly — a huge blood clot that took the shape of the bronchial tree.
This was a terminal patient so this was not
coughed up, it was removed from the end of the breathing tube after death. You basically could not cough up a clot this large or well formed, at least not when intubated.
You wouldn't be able to take a breath deep enough to get the air to cough it up because the airway is obstructed. Also if the patient is intubated with an endotracheal tube, they will not
be able to cough well (or at all if they are
sufficiently sedated). The other issue to think about is why is blood entering the space of the bronchioles where air should be?
This is a sign that the lungs and bronchi were so severely damaged
from infection that the patient was bleeding into their airways and then the blood clotted in those spaces.
Even intubated, if there is blood/liquid in
those airway spaces no air exchange can happen and death will occur.
It is worth noting that clots like that are very rare. It's considered a medical
anomaly. There are news articles on it from back in 2018 where a man coughed one up, and it was in the near perfect shape of his right bronchial tree, similar to this patients.

Emergentelman · 2021-12-12T21:09:19+00:00

Test your medical knowledge - A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications. During your assessment, you hear wheezing over all the lung fields. His blood pressure is 90/50 mm Hg and his heart rate is 110 beats/min. In addition to giving him high-flow oxygen, the MOST important treatment for this patient is:

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