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 hello@hyperexcision.com.

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 23-year-old woman presents to the emergency department with a 12-hour history of right lower quadrant (RLQ) abdominal pain.

The pain originated in the umbilical region and radiated diffusely across the lower abdomen and is now localized in the right lower quadrant. It was of sudden onset, sharp, and constant with increasing intensity. Severity was rated 8 out of 10 on a scale of 1-10 with one being no pain and 10 being the most pain possible. She took over-the-counter Ibuprofen 400mg but this did not alleviate the pain. The pain was exacerbated by lifting the right leg.

She has vomited twice and reports that she has not eaten for 24 hours due to a lack of appetite. She opened her bowel post-onset of the pain with no change in the consistency of the stool, and no blood or mucus. She does not have abdominal swelling, dysuria, increased frequency of micturition, vaginal bleeding, or purulent vaginal discharge. She is nulliparous and her last menstrual period was 2 weeks ago with no complaints of dysmenorrhoea. She also has no history of unintentional weight loss, episodes of dyspepsia, strenuous physical activity or abdominal trauma.

There is no significant past medical and surgical history. Drug history includes the oral contraceptive pill. She has no known drug allergies. There is no relevant family history. She does not smoke nor does she use recreational drugs. She drinks alcohol occasionally.

On examination, she has a temperature of 38.5 degrees Celsius, absent bowel sounds, and marked tenderness to palpation at 1/3 the distance from the anterior superior iliac spine to the umbilicus. While palpating the left lower quadrant, she reports pain in the right lower quadrant. Active flexion and internal rotation of her right hip reproduces the pain. The skin on the RLQ is hypersensitive to touch. Gentle percussion over the right lower quadrant elicits rebound tenderness. There are no hernias. No abnormalities were detected on pelvic and digital rectal exam.

A complete blood count reveals leukocytosis of 13.5 x 10^3/uL with 15% bands. Urinalysis demonstrates 1+ WBCs without bacteria. The pregnancy test is negative.

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 hello@hyperexcision.com.

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 29-year-old man presents with yellow discolouration of the eyes.

For the past week, he has felt unwell with decreased oral intake, a low-grade fever, which he recorded at about 37.7 C, fatigue, anorexia, nausea, and occasional vomiting. He noticed that his eyes became yellow about 4 days ago. Since that time, he has had continuous mild pain in his right upper abdomen. His urine has also gotten darker. There is no change in the colour of his stool.

He has no significant past medical history. However, he has been unable to donate blood within the past year for reasons he cannot recall. He has not travelled recently. He works as an accountant. His only medication is Ibuprofen.

For his social history, he currently uses marijuana and MDMA (Ecstasy) recreationally and has a prior history of Injection Drug Use (IDU) and cocaine. For his sexual history, he has had 5 sexual partners in the past 6 months. He does not consistently use condoms.

On physical exam, he appears ill and has obvious jaundice with scleral icterus. Temperature is 38.0 C, Blood Pressure 110/70 mmHg, Heart Rate 105 beats per minute, Respiratory Rate 16 breaths per minute, and Room air SpO2 of 99%. The lung and heart are normal apart from tachycardia.

The upper border of the liver is in the 6ICS MCL. Liver span is 15 cm in percussion and palpable 6 cm below the right costal margin. The liver edge is smooth and tender to palpation. The spleen edge is non-enlarged. There are no stigmata of peripheral liver disease and no peripheral oedema.

These are his lab results: AST 1234 U/L, ALT 1560 U/L, ALP 394 U/L, Total Bilirubin 13.4 mg/dL, Direct bilirubin 12.2 mg/dL, INR 2.3, aPTT 52 seconds.

These are the results of his hepatitis serology: IgM Anti-HAV Negative, IgG Anti-HAV Negative, IgM Anti-HBc Positive, IgG Anti-HBc Hep B Negative, HBsAg Positive, Anti-HBs Negative, HBeAg Positive, Anti-HBe Negative, Anti-HCV Positive.

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 hello@hyperexcision.com.

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 male motorcyclist is brought to the Emergency Department after hitting the rear-end of a car at highway speeds. He was wearing a helmet but was thrown from his motorcycle. He was found awake in the field by paramedics, but then quickly became unconscious. His airway is patent, but his respiration is shallow and irregular. His blood pressure is 150/90 mmHg, heart rate is 60 beats per minute, and respiratory rate is 20 breaths per minute. In response to the sternal rub, he moans and withdraws his right upper and lower extremities. He does not move his left upper or lower extremity, and he does not open his eyes. His right pupil is 6mm and non-reactive, while his left is 3mm and reactive to light. There is no obvious head injury or laceration. There is no discharge from the nose or the ears. However, there is a right hemotympanum. The oropharynx is clear. The rest of the physical exam is normal.