The Hyperexcision Podcast

A 17-year-old with laboratory abnormalities and acute kidney injury following induction of chemotherapy

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 17-year-old male with newly diagnosed Burkitt lymphoma is admitted for induction chemotherapy. Two days after starting treatment, he develops nausea, vomiting, muscle cramps, and confusion. Vitals show tachycardia and mild hypotension. His laboratory results: K⁺ 6.2 mmol/L, phosphate 2.3 mmol/L, uric acid elevated, calcium 1.6 mmol/L, and creatinine elevated.

Ep 18: A 52-year-old woman with stage II breast cancer is scheduled for radiotherapy

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 52-year-old woman presents with a 3-month history of a painless lump in her left breast. Biopsy confirms invasive ductal carcinoma, stage II (T2N1M0). She undergoes breast-conserving therapy (lumpectomy with sentinel lymph node biopsy). Post-operatively, she is referred to the oncology clinic where the multidisciplinary team recommends adjuvant radiotherapy to the left breast and regional lymph nodes. She is scheduled for external beam radiotherapy using modern planning techniques.

Ep 17: A 45-year-old with fever and neutropenia

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 woman with breast cancer on adjuvant chemotherapy presents with a fever of 38.9°C, chills, and malaise. She looks acutely unwell. On physical examination, she has hypotension (BP 90/60 mmHg), tachycardia [https://hyperexcision.com/sinus-tachycardia/], with no localising source of infection. Her laboratory results: WBC 0.3 ×10⁹/L, neutrophils 0.1 ×10⁹/L.

Ep 16: A 42-year-old with joint pain and stiffness

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 42-year-old woman presents to the outpatient clinic with a 6-month history of joint pain [https://hyperexcision.com/approach-to-a-patient-with-joint-pain/] and stiffness. The pain initially started in the small joints of her hands and has progressively worsened. She describes morning stiffness lasting more than an hour, which improves as the day progresses. She reports swelling, warmth, and decreased grip strength. She also reports experiencing general fatigue, a low-grade fever, and weight loss over the past few months. Upon examination, both hands exhibit symmetrical swelling and tenderness in the MCP and PIP joints, accompanied by mild ulnar deviation. The wrists are also tender and slightly limited in movement. There are no nodules [https://hyperexcision.com/basics-of-dermatology/] seen over the extensor surfaces. Cardiovascular, respiratory, and neurological exams are unremarkable. Laboratory results are as follows: haemoglobin is 10.5 — low. WBC is normal. Platelets are elevated at 420. ESR is markedly elevated at 72. CRP is elevated at 25. Rheumatoid factor is positive at 120 IU per millilitre. Anti-CCP antibodies are positive at high titre. ANA is negative. Serum creatinine is normal. Liver function tests are normal. The X-ray of the hand shows generalised osteopaenia, severe erosion and destructive changes in the distal radius and ulna bilaterally as well as the carpal bones. Extensive joint space narrowing is seen at the intercarpal, carpometacarpal, and wrist joints. Erosive changes are seen along the head and base of the proximal phalanges.

Ep 15: A 14-year-old with progressive pain and swelling over the left knee

A 14-year-old boy presents with a 3-month history of progressive pain and swelling around his left knee. The pain is dull, constant, and often wakes him at night. His parents report that he has developed a limp and is unable to participate in sports. He has also experienced some weight loss and fatigue, though there has been no history of fever or night sweats. On physical examination, there is a firm, tender swelling over the distal femur measuring approximately 6 cm. The swelling is immobile and associated with warmth and restriction of knee movement. The overlying skin appears stretched but intact, with no redness or ulceration. There is no palpable lymphadenopathy, and distal pulses are well felt. Laboratory studies show the following results: On physical examination, there is a firm, tender swelling over the distal femur measuring approximately 6 cm. The swelling is immobile and associated with warmth and restriction of knee movement. The overlying skin appears stretched but intact, with no redness or ulceration. There is no palpable lymphadenopathy, and distal pulses are well felt. Laboratory studies show the following results: Hemoglobin 10.5 g/dL (12–16 g/dL - Mild ⁠anemia⁠ [https://hyperexcision.com/anaemia/]) ESR 40 mm/hr (<20 mm/hr - Elevated) CRP Normal (<10 mg/L - Normal) Alkaline Phosphatase (ALP) 700 U/L (<150 U/L- Markedly elevated) Lactate Dehydrogenase (LDH) 550 U/L (<250 U/L - Elevated) A plain X-ray of the distal femur shows a destructive lesion [https://hyperexcision.com/basics-of-dermatology/] in the metaphyseal region with mixed lytic and sclerotic changes. There is periosteal elevation forming a Codman’s triangle, and a characteristic “sunburst” appearance of periosteal reaction. Cortical breach with extension into adjacent soft tissue is also seen. MRI confirms a large heterogeneous metaphyseal mass extending into surrounding soft tissue, but without encasement of the neurovascular bundle. A staging CT of the chest reveals small pulmonary nodules [https://hyperexcision.com/basics-of-dermatology/] suggestive of metastases. A core needle biopsy demonstrates malignant spindle-shaped cells producing osteoid, confirming the diagnosis of osteogenic sarcoma (osteosarcoma) of the distal femur with pulmonary metastases