Trepanation

25 yr old male pt, xray shoulder, h/o injury 1month before

A patient complain of pain in foot on walking after bike accident.. On X-ray it reveals fracture of phalanges.. Give proper treatment and management..

42 yr ,M, slipped in the ground and about to fall but managed with out fall. The next day developed severe pain in the lower back with pain radiating to both legs. *Chief Complaints* Five days ago while walking he slipped and about to fall but managed with out fall. The next day whike getting up noted mild pain in the back. An hr later while getting up from toilet,he developed severe catching pain in both lower lombs and he was unable to walk straight.Evaluated at local hospital received inj analgesic and oral diclofenac. Pain persisted and he attended the OPD on 27th March.Denied having any motor weakness or bowel or bladder symptoms. *History* No significant past medical illness. Occ smoker *Vitals* Vitals stable. Afebrile Bo130/ 70 mmhg. Hr76/ mt. *Physical Examination* Walking with mild stopping forward posture and patient is afraid of pain,and to avoid pain he is not walking straight. Lower limb power gr5/5 .EDH normal power. Knee jerk and ankle jerks normally elicitable. Dulling of sensation L5 S1 bilaterally. *Investigations* Routein blood up including uric acid - normal. MRI L S spine done ( report for discussion). *Diagnosis* Acute Lumbago with radicular pain *Management* Patient insisted for admission. Started Pregabalin 75 mg 0-0-1 with Chymoral forte. TODAY 50% BETTER.Wrote consultation to spinal surgeon also.

Patient of 29 yrs H/o fall , having pain over left chest region while breathing , is there any abnormality...?

Spotters , 19/m, deformity, abnormal mobility of forearm since 2003. But no pain, has multiple subcutaneous nodules on Palpatine and hyper pigmented patches over back and thigh. Diagnosis and management