Batch ’64 Medical Quiz – Seelan

 

 

 

 

 

 

 

Dear Batch Mates ,

The controversy surrounding the age old question whether Praxy’s answer to the first year anatomy sig question was accurate or not has led to inaugural  Batch’64 Clinical Corner. Seelan has kindly come up with the related  radiology quiz,  below. Your participation is greatly appreciated. Sam

 

 

 

 

History: This patient arrived at the A&E with severe pain after a heavy night (Seelan’s words) Resident decided to order an Xray. 

Q: What is your diagnosis & how will you treat this patient aiming at speedy recovery?

(Webmaster’s note: Many thanks to Ariya for constantly coming up with new ideas to make this blog interesting and informative!)

 

 

 

28 thoughts on “Batch ’64 Medical Quiz – Seelan

  1. You guys are just crazy !!
    I am a good Holy, Holy convent educated girl- just like Praxy- so , I had to defend ‘ my kind ‘ !

    I still dont know the answer- even after all these years- so I will wait for the All Boys School Educated Boys to give me the right answer !

    deepthie

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  2. The Penis bone also called the Baculum is not present in humans , marsupials, Rhinos to name a few. The Baculum is present in other primates, rodents, Walruses etc. etc. The bone is kept in the abdominal cavity and when the need arises for the animal to copulate ,certain muscles come into play and it is pushed into the penis.

    The X- ray that Seelan put up may be from an animal that is No 1.
    No 2.
    If indeed if it is a human penis I think I can picture the situation. Perhaps the individual got a hold of an animal Baculum and introduced it through the urethra. ( Baculums are available for sale and some cultures wear them for good luck as ornaments in the form of a necklace. Eskimos for example ) . Our patient here wanted to make it very stiff, boney hard and after the “Heavy night ” fractured the baculum he inserted into his urethra and had to come to the Emergency Department. The sharp fractured edges would caused tremendous amount of pain impinging on the urethra.

    Nisantha Banda

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  3. Sorry forgot to mention about the treatment. Under anesthesia prep for cystoscopy. Use a lot of lubricant to gently extract the fractured baculum through the urethra. The first piece would come out easily. The second piece may have to be taken out after urethral dilatation and very careful extraction so as to not tear the urethra further.

    Nisantha

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    • I wish we can keep this bone in our abdomen. Even better in our pockets – then we can carry a spare one. I envy those rodents & walruses . The bone is up to 2 ft.long.!

      Nisantha’s No.1 answer is wrong. I don’t know any animal with such a beautiful Glans penis.
      No.2 is heading towards the wright path, still not there. This can be one of the DD. Why would anyone insert the wider side of the Baculum 1st? Oochh…

      The treatment you suggested is also possible but the 2nd fragment with rugged end will surely cause laceration of the urethra, even if your are careful – & eventual strictures.
      What do we do now?

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    • Dear Simone, it is very clever of you to recommend ‘Rasetsu’
      Treatmenr for a person with fractured ‘Bacculum’ as a teaser
      Concern is about nature and possible horrendous behaviour
      Of a resulting offspring of union of one with another monster
      Ariya

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  4. Thank you Seelan for the evidence beyond any doubts
    Now I am convinced of the clinical diagnosis ‘Os Penis’
    Nisantha’s explanation is credible with knowledge incredible
    Thanks Seelan and ‘web master’, enjoyment is incomparable

    Hope “the clinical corner” too will thrive, expanding our knowledge
    There must be many more gems to publish among our batch mates
    Radiology corner was always very popular during our student days
    It is wonderful setting up of a portal of learning for septuagenarians

    Ariya

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  5. Dear All,
    Yes as Deepthie mentioned we were educated in a very Holy Holy Family Convent. I never thought that my anatomy error will lead to all these discussions fifty three years later. Anyway I am absorbing all the information given by all my highly qualified batch mates. It is very interesting to see the interaction between batch mates and I am happy that these discussions are leading to communication between all of us. Keep the discussions going. Praxy

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    • Hi Praxy,
      Please don’t get upset. After all we are all medicos. All started with Narme’s comment. He didn’t mean to insult – just meant to be a joke. Ariya took this opportunity & came out with the idea of Medical Quiz. I just responded. I thought that the 1st few could be jovial to make the quiz interesting. After that I will contribute something more educational – reasonably.

      Sam, may be I will wait for another day & give the final conclusion

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  6. Dear Praxy and Deepthie,
    Innocence of associates and upbringing are praiseworthy and noble
    Alas! Some of us learnt what should not be known much early in lives
    There were of course brighter aspects for rugged childhoods carefree
    Our life histories are very different, believe me, plentiful were privileges
    Ariya

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  7. Just loved the ‘flow of discussions ‘ on the Bone Joke !

    Praxy-
    imagine this after 53 yrs !!

    Narme-
    thank you Narme ! your joke was a GOOD Bony Joke — see all the fun we are having ? !! ha !- ha!- ha!!!
    I sure did learn something today- after my brain woke up with the First Coffee and was receptive to new ideas from the Class of 64.
    Great Wake Up Call !!

    Ariya-

    Praxy and I – we still remain ” Holy Holy Family Convent Girls ‘ though it was a bit tough on us when we were in the Block- having to see ‘things ” for the first time !
    But, all of you guys made it easy ( and fun !!!! ) for – for me at least – to learn these new ‘things ‘ like ” how are babies born ‘ ( Another good one at an Anatomy Sig with Joe Olivelle !) .
    Ref- Souvernier- Class of 64, page 103: para 1.

    Rajes- she says she really enjoys reading our ‘page’ even though she do does not write a comment

    Ob/ Gyn and GU folks- for better or worse , see the end results of Bony Jokes .

    Anesth- watch it from the head end – a new kind of ‘back seat drivers ‘.

    Nisantha- that was a great chapter you put out on the subject- though I am not sure of the Eskimo statement (this word ‘Eskimo” is NOT used anymore- it is like the n word- the correct word is Inuit ).

    Hey all you Septugenerian guys – start wearing this ” thing ” around your neck- Never too late for a Second Start at an Old Game !!!!

    eaglemd

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  8. Oh By the Way- A Very Special Honourable Mention to that The Great Down Under Radiologist who started the Ball Rolling-
    Many thanks for the Fun and Games pouring out of the Four Corners of the World in response to the Medical quiz!
    Keep it coming – this Holy Holy Girl- is learning new tricks about ” things ” in her old age .
    Who ever said ‘ cant teach old dog new tricks ‘ got it all wrong and read the page upside down and backwards !!
    eaglemd.

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    • By the way just for the record, I do not have any recollection of this sig answer from Praxy I should know because I was in her sig group. Could this be Narme’s imagination! Hope Praxy would clarify the facts.

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  9. Seelan will give us the answer soon enough. Well here is my two cents,
    Fractured Penile Prosthesis inserted for erectile dysfunction. It must have been a cheap Chinese import that didn’t hold up to the excessive mechanical stress!
    Treatment would involve removal/revision under anesthesia.

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  10. Thanks Deepthi for correcting me. No more “N” words . Inuit it is.

    Now that Rani and Sam have mentioned Penile prosthesis I looked at the X-Ray again. I see a small tube from the scrotal area circling towards the base of the device. It could be an inflatable penile prosthesis ? If it is an inflatable device it cannot easily fracture. Therefore it may be a rigid penile prosthesis , that fractured.

    Having anesthetized many patients for Urologists for insertion of penile prosthesis , I have seen my share of these devises.

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  11. gee- I forgot that Anesthetists are curious bunch- after the patient goes to sleep, the anesthetist remains very vigilant on the ‘goings on ‘ in the OR !
    As for my self- the Good Holy Holy girl that I am, this whole things is like Greek and Double Dutch combined .
    As for the ‘original bone joke’– I do have a very vague recollection about it and laughing over it .
    But then, it was 53 yrs ago- and some of those old neurons have atrophied due to disuse ( use it or lose it ! )
    How ever- it is good to await the much anticipated answer from my dear good friend and companion from that Holy Holy Convent !

    Like

  12. Hi All,
    I am a God Fearing man who never talk bad about any religion or belief , but I am unable to resist telling you a storey told by someone else (Disclaimer)

    This Nun from the convent went to the Mother Superior & complained about her room mate.:-
    “Mother, everyday a bird comes & sits on our window sill and defecates. My room mate gets angry shouts – using the 4 letter word & chase the bird away. I cant tolerate listening to this- F- word again.
    So, the Mother Superior called the other Nun & told her in her kind voice ;- Child, next time when the bird do this, you say – Chooo… Chooo.. Chooo…and the bird will Fuck off.

    I don’t know whether the storey is true or not. Being educated in a Methodist school, we learned about reproduction in our biology class in S.S.C & H.S.C. Until then I was under the impression that Women produce baby Girls & Men produce baby Boys from our back side !!!! Such an innocent boy I was. Therefore I can understand the girls from the Holy Family Convents being innocent as well.

    At least, after medical education, we all know about ” IT.”

    I apologise if I have offended any one

    Its 12.30 AM in Sydney. I will send the answer to the quiz tomorrow as suggested by Sam.

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  13. It is 8.45 pm- in Ontario .– it will be dream time for this old gal now !

    It is good that the Two Innocent Hearts ( remember that old song ? Cliff Richards was it ? ) from Holy Family Convent have company from an Innocent Heart Boy from from a Methodist School !

    Thanks a lot my dear Innocent Boy from the Methodist School- for that wonderful clinical presentation of a mysterious fracture .
    By the way- how does one apply a POP cast to fix this broken bone ?
    I am just curious .
    perhaps – it will come to me at Dream Time !
    good night- see you in the morning !
    eaglemd.

    Like

    • Applying POP in this case is very easy.
      You ask a young female nurse to hold the penis. The penis will stand straight & the fracture will reduce by itself – then you just apply the POP
      Good luck
      Seelan

      Like

  14. Hi Batch mates,
    Simone Rani thinks its Humerus. If Olivelle finds out, he will commit suicide. Being a Down Under girl, I am sure you are Joking & impatient to find out the answer. Here are my comments :-

    What we see is a fracture of the “penile bone” If it is true, the best treatment is internal fixation with appropriate plate & screws (instead of POP) so that union is fast with less callus which results in good remodeling & less deformity. I had the post op x ray with plate & screws, but unfortunately lost it by lending to a Policeman who wanted to show them in the Police Academy. You have to just imagine the image.

    Unfortunately the general consensus is that this is a fracture of a prosthesis. Nisantha has correctly said that there is no penile bone in human ! Now that I am caught out – have to tell the truth. Lucky, I am Down Under other vice you guys will kill me.

    The x ray is real but the image is fabricated. The bone is Chicken tibia without flesh ( eg from soup) and penis is carefully made out of Play Doh ! X ray image is magnified by increasing object film distance. The scrotum has 2 small “nuts” to represent atrophied testes of an old man needing some reinforcement ( unfortunately they are superimposed & Nisantha confused it for a coiled tube )
    Treatment:-
    I treat this x ray as a party joke. (The post op model I made was with P.O.P)

    I am sorry for confusing all of you & embarrassing some – especially the girls from Holy Family.
    Part of the blame should go to Narme . He was the instigator. Praxy was the subject ,Ariya suggested Medical quiz. & Poor Sam has to put up with all this.

    I promise, hereafter, I will show only genuine X Rays & no fabrications – ie: if you are not fed up of me.

    By the way Fracture of Penis is not uncommon. I see this occasionally as the urology center is 2 door from my Imaging center.

    It is rupture of Tunica albuginea , Corpus cavernosum & even urethra – usually caused by blunt trauma to an engorged erect penis during intercourse or violent masturbation (girls, don’t ask me to explain).
    Investigation & treatment :- depends on the degree of damage but it is a “urological emergency” to avoid complications such as fibrosis, Peyronie’s disease, deformity, erectile dysfunction, pain, urethral stricture etc
    Investigation:- Usually, Corpora caverno-sonography ( sometimes we inject contrast into C Cavernosum – Cavernosogram) & retrograde urethrography
    Treatment: Evacuate hematoma, repair urethra, ligate torn vessels, repair corpus cavernosa & tunica albuginea

    I can see someone dozing off. Bit too much to read !!

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    • This is typical of Seelan the master Humerus! Sorry I saw the quiz late. I would have answered that it was Seelan’s hand at work superimposing the original!
      Narme

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  15. Thanks a lot Seelan
    In this visually focused Medical Quiz,it is interesting to realise that by ,varying the level of your words ,and language ,you were able to build up an effective humour to this case.
    As you know Seelan I think humour is not inherently funny or make some one laugh by default. Humour comes from the excellent way you have presented it . You can make any thing funny.

    Congratulations. Keep theDown Under Flag flying high

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  16. After a a good night of good dreamless sleep, morning coffee, I am awake alert and oriented in all three spheres !
    Thank you to those sharp minded folks Down Under- yes- Keep that flag flying HIGH !!

    What would we do without that Down Under Special Brand of Humour by the Distinguished Radiologist, assisted by the the Class of 64 Encyclopedia- aka SDR Kuveni !!

    The Radiology Reporting was excellent , and accurate- no mistakes here !
    Might even make it to some renowned Radiology Journal somewhere .

    Special Mention of THANKS to that unfortunate Spider Web Master way south in the North Western Hemisphere , who has to put up with all this .

    Of course- how can we forget that good innocent boy from St T College in the Eastern Hemisphere , who started it all !!

    To my good friend with the Innocent Heart from Holy Holy School– see what a fun filled Birthday Salutation you got , after that suggestion by the OBE guy out there !

    eaglemd .–from Up Above !!!

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  17. Thank you Seelan for that brilliant and “creative” medical quiz. I am sure Praxy must be breathing a sigh of relief that it’s over. You got 366 views (7 countries) and 25 responses.
    On serious note Seelan has forwarded two more “conventional” medical puzzles for publication
    Sam

    Like

  18. Seelan thanks for the quiz. We need more of these bizarre unimaginable never seen quizzes. At our age we need to recruit more neurons on a daily basis to stay alert. The discussions were fascinating to read. Some of our colleagues now know about the Baculum ( Penis bone) . As you mentioned the Walrus baculum can be a foot long.

    Nisantha

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  19. Dear friends,

    It is fantastic how to the first ‘ Clinical quiz’ mates have responded
    Over three hundred clicks and mates in seven counties woken up
    Says a lot of Seelan’s story telling skills & efficiency of Sam to publish
    Further more enthusiasm, and creative proficiency of mates in our batch

    There must be plenty of ‘hidden gems’ gathered over half a century among our mates
    Let us put one by one under the banner of ‘clinical corner’ in ’64 batch web, prestigious
    Who knows the material would come out, will be such readworthy, if made into a book
    Would be a best seller, we may have miraculously planted seeds of something astonish

    Ariya

    Like

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