تصفح
دخول
تسجيل
نسيتها؟

حالات سريرية


ما هو التدبير الأفضل لهذه السيدة التي تعاني من صداع؟ |

حالة سريرية

الوصف الكامل Background

أتت سيدة إلى قسم الإسعاف تشكو من صداعٍ شديد بدأ منذ البارحة. بالفحص السريري وجد لديها درجة حرارة بمقدار 103ْF، صلابة نقرة nuchal rigidity، وخوف من الضياء photophobia. أجري لها تصوير طبقي محوري للرأس وكان طبيعياً. وكانت نتيجة البزل القطني WBCs = 1250، RBCs = 50.000.

ما هي الخطوة التالية الأفضل في تدبير هذه المريضة؟

1- تصوير الأوعية angiography.
2- Ceftraiaxone و Vancomycin.
3- Nimodipine.
4- إصمام الأوعية embolization.
5- مشابك جراحية surgical clipping.
6- إعادة إجراء الطبقي المحوري مع الحقن.
7- استشارة جراحية عصبية.

المرجع

Fischer, C. (2011) Master The Boards for USMLE Step2 CK. New York (US): Kaplan Publishing pp. 283


Neonatal Conjunctivitis |

حالة سريرية

الوصف الكامل Background

A 28-year-old woman gave birth to a full-term male infant weighing 4.1 kg. The labor and delivery were unremarkable, and the infant and mother were discharged home 2 days postpartum. At day 4, the mother brings the baby to the pediatrician, complaining that he has red eyes. Physical examination reveals red eyes and bilateral mucopurulent discharge. The mother explains that the discharge seemed to "pour out of his eyes" when she first opened his lids, but now it just seems to be constant. On examination, both of the baby's eyes are moderately injected with a definite purulent discharge. His corneas are clear and his pupils react normally.

كتابة حرة وطرح موضوع النقاش!


What is the most likely cause of neonatal conjunctivitis in this infant?

Chemical (sterile) conjunctivitis
Chlamydia trachomatis
Haemophilus influenzae
Neisseria gonorrhoeae
Staphylococcus aureus
المرجع

Medscape


شابة تشكو من ألم بطني وإقياء مع ترفع حروري |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

اتصل بك جارك أبو سعيد لتعاين حالة ابنته البالغة من العمر 21 عاماً.
حين وصولك أخبرك أنها كانت تشكو من تعب وإعياء في اليومين الماضيين، وأضاف أيضاً (كانت ما لها حيل)، ظن الأهل أن لديها أعراض كريب أو ما شابه.
لكن حالتها ازدادت سوءاً حين بدأت تشكو من ألم بطني ترافق مع إقياء وحرارة .
ثم ترك لك الساحة:
- ما هي الأسئلة التي ترغب بطرحها على المريضة؟
- عن ماذا تريد الاستفسار ريثما تبدأ بالفحص السريري؟

المرجع

لاحقاً


صرع مفاجئ لمدة نصف دقيقة |

حالة سريرية

الوصف الكامل Background

A 40 year old woman presents with new onset of seizures. She reports that she was having dinner with friends and suddenly lost consciousness. Her friends report that she fell to the ground and began moving her limbs in a rhythmic manner, lasting for about 30 seconds. She denies any history of neurologic problems. She is an immigrant from Ecuador and has been living in the US for the past ten years. Physical examination is unremarkable. A head CT is obtained. What is the most likely factor leading to her development of seizures?

A. Consumption of undercooked pork
B. Consumption of undercooked beef
C. Consumption of fecally contaminated food or water
D. Exposure to acid fast bacilli as a child
E. Inheritance of gene encoding for an infective protein


تعرق ليلي ونقص وزن +حرارة وانتفاخ بطن ترافقت ضخامات لمفاوية |

حالة سريرية

الوصف الكامل Background
A 35 year-old male presents with fever and abdominal swelling. He reports weight loss and night sweats over the past month. Physical exam reveals enlarged abdominal lymph nodes; a lymph node biopsy demonstrates a "starry sky" appearance.

Which virus is most likely associated with the condition described above?

A. Epstein Barr Virus
B. Hepatitis B Virus
C. Human Immunodefiency Virus
D. Human Papilloma Virus
E. Human T-cell Lymphoma Virus-1


مريض إيدز ارتفعت حرارته وأصيب بصداع وفوتو فوبيا |

حالة سريرية

الوصف الكامل Background
A 35 year old male with human immunodeficiency virus comes to the ER presenting with one week of fever, malaise, and headache. He also reports having some neck stiffness over the past two days. On physical exam, he has a temperature of 102.4 F with stable blood pressure and heart rate. He has no focal neurological deficits, but is very uncomfortable when a pen light is shined in his eye to examine his pupils. You suspect cryptococcal meningitis and perform a spinal tap to obtain CSF. Which preparation would most likely lead to the correct identification of the organism responsible for this patient’s meningitis?

A. Congo red
B. India ink
C. Periodic acid-Schiff
D. Silver stain
E. Ziehl-Neelsen


حالة صعبة ... مين قدها |

حالة سريرية

الوصف الكامل Background

A 14-year-old, previously healthy, fully immunized girl is presented to the emergency department (ED) with a 2-week history of left ear pain and discharge. She has just completed a 10-day course of antibiotic therapy, prescribed by her primary care provider, for marked left ear pain and swelling with purulent bloody discharge, headache, and left temporal and facial pain. She denies any history of foreign body in the ears, hearing loss, or fever. The review of systems is not contributory. Her past medical history is unremarkable, and the patient has no known history of allergy.

On examination, the patient is a young white girl who is ill-appearing but in no obvious distress. Her vital signs include a temperature of 97.9°F (36.6°C), a regular heart rate of 86 bpm, a respiratory rate of 16 breaths/min, and a blood pressure of 110/80 mm Hg. On examination of the head, swelling and tenderness are noted behind the left ear lobe, with purulent bloody discharge from the left ear. The central nervous system (CNS) examination reveals an alert and well-oriented young girl with a Glasgow Coma Score of 15/15. She is unable to wrinkle the left side of her forehead, she can not close her left eyelid, and the left nasolabial fold is flat and with deviation of the mouth to the right. The cardiovascular, respiratory, and abdominal examinations are all normal.

The initial laboratory analysis, which includes a complete blood cell count (CBC) and basic metabolic panel, are normal. Computed tomography (CT) scanning of the brain confirms a left-sided mastoiditis, but no findings to suggest increased intracranial pressure are noted. An analysis of the cerebrospinal fluid (CSF) shows no significant white or red blood cells or abnormalities in the glucose and protein concentrations. A swab of the purulent discharge from the left ear, blood, and CSF samples are sent for culture. She is admitted for suppurative otitis media, mastoiditis, and seventh nerve palsy. Infectious disease, head and neck surgery, and neurology specialists are consulted. Her initial management includes intravenous fluid, pain medications, tympanostomy for drainage and culture, and intravenous meropenem pending the culture and sensitivity results. On admission day 2, however, the patient develops severe left orbital pain, double vision, and the inability to abduct the left eye. The neurologist clinically confirms a sixth nerve palsy, and a request is made for magnetic resonance imaging (MRI) of the temporal bones, as well as magnetic resonance angiography (MRA) and magnetic resonance venography (MRV) to rule out venous sinus thrombosis.

المرجع

.


حمى ويرقان بعد العودة من السفر ( ملاريا ) |

حالة سريرية

الوصف الكامل Background
A 25-year-old student is experiencing recurrent fevers and jaundice after returning from a trip to Sub-Saharan Africa. A diagnosis of Plasmodium ovale malaria is made. In addition to standard treatment, primaquine is added. Which stage of the infecting organism's life-cycle is targeted by this drug?

A. Gametocyte
B. Hypnozoite
C. Merozoite
D. Sporozoite
E. Trophozoite

المرجع

-


ألم شديد في الفخذ تلاه احمرار وانتفاخ انتشر إلى الأعضاء المجاورة |

حالة سريرية

الوصف الكامل Background


A 66 year-old man presents complaining of fever and thigh pain. 24 hours ago he noted intense pain followed by redness and swelling in a small area of the right lateral thigh. Since then, the affected area has progressively increased to the current state, which on exam includes almost all of the right thigh and buttock, the lateral aspect of the right leg, and extends to the abdomen and right flank, 5 cm above the iliac crest. Crepitus is present on palpation. Leukocyte count is 14,000/mm3. Blood cultures are pending. Which organism is the most common etiologic agent of this clinical scenario?
A. Group A Streptococcus
B. Moraxella catarrhalis
C. Mycoplasma pneumoniae
D. Staphylococcus aureus
E. Staphylococcus epidermidis


عامل طبي عولج بالأيزونيازيد بعد فترة أصيب بإحساس وخز وحرق في أطرافه ماالفيتامين الذي نقص بسبب العلاج وأدى إلى هذه الأعراض |

حالة سريرية

الوصف الكامل Background
A 54 year old health care worker tests 11 mm on his PPD exam that he gets annually. Chest X-ray does not demonstrate upper lobe cavitary lesion. He does not complain of any weight loss, fatigue or night sweats. Physical exam is normal. He receives isoniazid therapy for 9 months but starts to complain of stinging and burning sensations in his legs and arms a few weeks into his treatment. Supplementation with which of the following would resolve his new symptoms?

A. B6
B. Folate
C. B12
D. Vitamin A
E. Vitamin D

المرجع

.


أكل سمك وبعد سنة أصيب بضعف مترقي وتعب |

حالة سريرية

الوصف الكامل Background
A 46-year-old man goes on a camping trip and ingests undercooked pike Fish from a nearby lake. Eleven months later, he complains of progressive weakness and fatigue. His CBC reveals a hemoglobin of 9.6 g/dL. What is the likely cause of his anemia?

A. Folate deficiency
B. Iron deficiency
C. Lead poisoning
D. Pyridoxine deficiency
E. Vitamin B12 deficiency

المرجع

-


سكري أصيب بألم مترقي في الوجه |

حالة سريرية

الوصف الكامل Background
A 61 year-old diabetic male presents with facial pain on the right side, progressively worsening over the past 5 days. The maxillary sinus is biopsied and reveals the image above.
This organism is associated with which of the following?

A. Diabetic ketoacidosis
B. Misuse of common antibiotics
C. HLA B27 haplotype
D. Exposure to bird or bat droppings
E. Live vegetation with budding yeasts


إسهال مدمى + ألم المراق الأيمن |

حالة سريرية

الوصف الكامل Background

A patient presents with severe bloody diarrhea for the last three days and right upper quadrant pain. Stool analysis reveals cysts with 4 nuclei. This patient is most likely infected with which of the following?

A. Acanthoamoeba
B. Cryptosporidium
C. Entamoeba histolytica
D. Giardia lamblia
E. Leishmania donovani


صرع واختلاجات معممة تلاها إسهال مائي فيه مخاط و دم + حرارة |

حالة سريرية

الوصف الكامل Background
An 18-month-old child presents to the emergency center having had a brief, generalized tonic-clonic seizure. He is now postictal and has a temperature of 40°C (104°F). During the lumbar puncture (which ultimately proves to be normal), he has a large, watery stool that has both blood and mucus in it. Which of the following is the most likely diagnosis in this patient?

- Salmonella
- Enterovirus
- Rotavirus
- Campylobacter
- Shigella


حالة سريرية 1 |

حالة سريرية

الوصف الكامل Background
An 18-year-old male college student is seen in the student health clinic for urinary frequency, dysuria, and urethral discharge. Which of the following is likely to explain his condition?
a. Herpes simplex
b. Escherichia coli urinary tract infection
c. Chlamydial urethritis
d. Syphilis
e. HIV infection

طفح جلدي بسبب رعاية الكلاب |

حالة سريرية

الوصف الكامل Background
A teenager who works in a dog kennel after school has had a skin rash, eosinophilia, and an enlarged liver and spleen for 2 years. The most likely cause of this infection is:

a) Isospora
b) Leishmania
c) Trypanosoma Cruzi
d) Toxocara
e) Echinococcus Granulosus

مراهق يعمل برعاية الكلاب بعد الدوام، لديه طفح جلدي وفرط أيوزينات وضخامة في الكبد والطحال منذ سنتين.
السبب الأشيع لهذه العدوى هو:


a) متماثلة الأبواغ.
b) اللشمانيا
c) المثقبيات الأمريكية (الكروزية)
d) السهميات
e) المشوكة الحبيبية


نقاش داء الرشاشيات Aspergillosis |

حالة سريرية

الوصف الكامل Background
A woman undergoing chemotherapy for acute myeloid leukemia alarms her physician when she develops a fever, experiences chest pains and coughs up blood. Chest X-ray shows pulmonary infiltrates, and subsequent biopsy reveals branched hyphae. The physician is quite concerned with the diagnosis and begins treating the patient with antifungals including amphotericin B.

امرأة تخضع لعلاج كيميائي بسبب إصابتها بحالة ابيضاض نقوي حاد. تم إعلام الطبيب المشرف عليها بأن مريضته تعاني مؤخراً من حمى وألم في الصدر ونفث دم. وبالتصوير الشعاعي تبين وجود ارتشاحات رئوية وبأخذ خزعة تبين وجود مشيجة متفرعة. وقد كان الطبيب متأكداً من التشخيص فبدأ بالعلاج فوراً بالمضادات الفطرية وعلى رأسها الأمفوتيرسين ب.


A woman with severe retinitis |

حالة سريرية

الوصف الكامل Background
A 30-year-old female stored her contact lenses in tap water. She noticed deterioration of vision and visited an ophthalmologist who diagnosed her with severe retinitis. Culture of the water as well as vitreous fluid would most likely reveal:

a. Naegleria
b. Pneumocystis
c. Acanthamoeba
d. Babesia
e. Entamoeba coli


ما سبب هذه الآفة ؟ |

حالة سريرية

الوصف الكامل Background

While you are on duty in the
emergency room, a 12-year-old
boy arrives with pain and inflammation
over the ball of his left foot
and red streaks extending up the
inner aspect of his leg. He remembers
removing a wood splinter
from the sole of his foot on the previous
day. The most likely infecting
organism is
a. Clostridium perfingens
b. Clostridium tetani
c. Staphylococcus
d. Escherichia coli
e. Streptococcus

The appropriate antibiotic to
prescribe while awaiting specific
culture verification is
a. Penicillin
b. Erythromycin
c. Tetracycline
d. Azathioprine
e. Cloxacillin


رجل يشتكي من سعال وحمى وألم بالبطن. |

حالة سريرية

الوصف الكامل Background
A man in Louisiana develops coughing, fever, and abdominal pain. His doctor orders a series of X-rays, which show pulmonary infiltrates characteristic of pneumonia as well as intestinal images consistent with obstruction. On CBC, the patient has increased eosinophils. The doctor examines a stool sample from the patient and discovers microscopic oval eggs with rough surface.

رجل من لويسيانا (ولاية في أمريكا) يشتكي من سعال ،حمى ،وألم بالبطن.
طلب طبيبه سلسلة من فحوص الأشعة السينية والتي أظهرت ارتشاح رئوي يتظاهر بذات رئة، كما أظهرت صور الأمعاء انسداد فيها.
في تعداد كريات الدم ظهر هنالك زيادة في الحمضات.
فحص الطبيب البراز فأظهر بيوضاً مجهرية بيضوية الشكل ذو سطح خشن.
ما هو العامل المسبب؟


الملاريا |

حالة سريرية

الوصف الكامل Background

أحد أصدقائك في الـ facebook أرسل إليك دعوة لزيارته في كينيا Kenya ،وقد أرسل لك بطاقة الطائرة وكل مصاريف السفر مما جعلك تقبل الدعوة.
بعد أن وصلت إلى كينيا بيومين أصيب شقيق صديقك ذو الأربع سنوات بقشعريرة مع برودة ثم حمى ومن ثم تعرق تعرقاً غزيراً.
زالت هذه الأعراض لمدة يومين وفي اليوم الثالث عادت إليه النوبة مرة ثانية.
ومن معلوماتك القيمة في السنة الثالثة عرفت فوراً بأنه مصاب بالملاريا.

المرجع

.


مريض مصاب بالملاريا يعاني ألماً في الربلة.. |

حالة سريرية

الوصف الكامل Background

مريض مصاب بالملاريا، يأخذ الدواء ويلازم الفراش منذ 5 أيام، حصل لديه ألم في الربلة يمنعه من الوقوف.
ما هي الأسباب المحتملة برأيكم؟

المرجع

.


rash |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

A 48-year-old man comes to the physician because of a skin rash his girlfriend noticed on his chest and back. He is not sure how long it has been there. He is in good health and routinely takes vitamin supplements. His job is very demanding and he works out in a gym five nights a week to stay fit and alleviate stress. After his girlfriend commented on the rash he did notice that he has lately started feeling slightly itchy after working out, but did not make anything of that. He has no history of allergies to medications and the family history is negative for skin diseases. On physical examination, the patient is a muscular, fit man in no acute distress. On the sides of the neck, anterior chest, shoulders, and upper back, there are many round and oval, discrete and confluent, hypopigmented patches with a barely visible fine scale that is accentuated by rubbing. An image of the lesion is shown. The rest of the physical examination is unremarkable. Which of the following is most likely mechanism of the pigmentary change?

A. Abnormal transfer of melanosomes

B. Autoimmune destruction of melanocytes

C. Competitive inhibition of tyrosinase

D. Lysosomal defect E. Self-inflicted physical trauma

E. Self-inflicted physical trauma


حالة خمجية.. شاب يشكو من ألم في ساقه وقدمه |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 19-year-old male has a history of athlete’s foot but is otherwise healthy when he develops the sudden onset of fever and pain in the right foot and leg. On physical exam, the foot and leg are fiery red with a welldefined indurated margin that appears to be rapidly advancing. There is tender inguinal lymphadenopathy. The most likely organism to cause this infection is:
a. Staphylococcus epidermidis
b. Tinea pedis
c. Streptococcus pyogenes
d. Mixed anaerobic infection

التهاب احليل .. |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
An 18-year-old male has been seen in clinic for urethral discharge. He
is treated with ceftriaxone, but the discharge has not resolved and the culture
has returned as no growth. The most likely etiologic agent to cause this
infection is

a. Ceftriaxone-resistant gonococci
b. Chlamydia psittaci
c. Chlamydia trachomatis
d. Herpes simplex

ذات رئة 2 |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A previously healthy 25-year-old music teacher develops fever and a
rash
over her face and chest. The rash is itchy and on exam involves multiple
papules and vesicles in varying stages of development. One week later
she complains of cough and is found to have an infiltrate on x-ray. [i]The
most likely etiology of the infection is

a. Streptococcus pneumoniae
b. Mycoplasma pneumoniae
c. Pneumocystis carinii
d. Varicella virus

ضعف وجهي ثنائي الجانب بعد رحلة |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 40-year-old male develops bilateral facial weakness after returning from
a camping
trip in Wisconsin that lasted 6 weeks. The patient gives a history
of arthralgias. On exam, he cannot close either eye well or raise either eyebrow.
The first heart sound is diminished. There is no evidence of arthritis.
Hgb: 14 g/dL
WBC: 10,000/μL
VDRL: negative
FTA-Abs: positive
ECG: first-degree AV block
1. Which of the following would be most useful?
a. CT scan of head
b. MRI of head
c. More detailed history
d. Kveim test
2. The likely cause of these symptoms is
a. Intracranial infection
b. Lyme disease
c. Endocarditis
d. Herpes simplex
3-Treatment of choice is
a. Penicillin or ceftriaxone
b. Acyclovir
c. Corticosteroids
d. Aminoglycoside

توصيل خمجية .. |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
Match the clinical description with the most likely organism.
a. Streptococcus pneumoniae
b. Staphylococcus aureus
c. Viridans streptococci
d. Providencia stuartii
e. Actinomyces israelii
f. Haemophilus ducreyi
g. Neisseria meningitidis
h. Listeria monocytogenes

1. A 30-year-old female with mitral valve prolapse and mitral regurgitant
murmur develops fever, weight loss, and anorexia after undergoing a dental
procedure. (CHOOSE 1 ORGANISM)

2. An 80-year-old-male, hospitalized for hip fracture, has a Foley
catheter in place when he develops shaking chills, fever, and hypotension.
(CHOOSE 1 ORGANISM)

3. A young man develops a painless, fluctuant purplish lesion over the
mandible. Cutaneous fistula is noted after several weeks. (CHOOSE 1
ORGANISM)

4. A sickle cell anemia patient presents with high fever, toxicity, signs of
pneumonia, and stiff neck. (CHOOSE 1 ORGANISM)


ضخامة طحال و ضخامة عقد رقبية .. |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 19-year-old male presents with a 1-week history of malaise and anorexia
followed by fever and sore throat. On physical examination, the throat is
inflamed without exudate. There are a few palatal petechiae. Cervical
adenopathy is present. The liver is percussed at 12 cm and the spleen is
palpable.

Throat culture: negative for group A streptococci
Hct: 38%
Hgb: 12 g/dL
Reticulocytes: 4%
WBC: 14,000/μL
Segmented: 30%
Lymphocytes: 60%
Monocytes: 10%
Bilirubin total: 2.0 mg/dL (normal 0.2 to 1.2)
Lactic dehydrogenase (LDH) serum: 260 IU/L (normal 20 to 220)
Aspartate (AST): 40 U/L (normal 8 to 20 U/L)
Alanine (ALT): 35 U/L (normal 8 to 20 U/L)
Alkaline phosphatase: 40 IU/L (normal 35 to 125)
1. The most important initial test is
a. Liver biopsy
b. Strep screen
c. Peripheral blood smear
d. Toxoplasmosis IgG
e. Lymph node biopsy
2. The most important serum test is
a. Heterophile antibody
b. Hepatitis B IgM
c. Cytomegalovirus IgG
d. ASLO titer
e. Hepatitis C antibody
3. Corticosteroids would be indicated if
a. Liver function tests worsen
b. Fatigue lasts more than 1 week
c. Severe hemolytic anemia is demonstrated
d. Hepatitis B is confirmed

طفح |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 25-year-old male student presents with the chief complaint of rash. There
is no headache, fever, or myalgia. A slightly pruritic maculopapular rash is
noted over the abdomen, trunk, palms of the hands, and soles of the feet.
Inguinal, occipital, and cervical lymphadenopathy is also noted. Hypertrophic,
flat, wartlike lesions are noted around the anal area
. Laboratory
studies show the following:
Hct: 40%
Hgb: 14 g/dL
WBC: 13,000/μL
Diff:
Segmented neutrophils: 50%
Lymphocytes: 50%
1. The most useful laboratory test in this patient is
a. Weil-Felix titer
b. Venereal Disease Research Laboratory (VDRL) test
c. Chlamydia titer
d. Blood cultures
2. The treatment of choice for this patient is
a. Penicillin
b. Ceftriaxone
c. Tetracycline
d. Interferon α
e. Erythromycin
ابق على تواصل مع حكيم!
Google+