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حالات سريرية


MICROBIOLOGY-7 |

حالة سريرية

الوصف الكامل Background
A man 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 surfaces..
What’s the Diagnosis Idea What is the Treatment Question

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رجل يعاني من سعال و حمى وآلام بطنية ..
ذهب إلى طبيبه فطلب عدة صور شعاعية X-Ray والتي أظهرت ارتشاحات مميزة لالتهاب الرئة و صورا تظهر انسدادا معويا ..
وبــتعداد عناصر الدم CBC لدى المريض تبين وجود ارتفاع في الحمضات ..
وبفحص عينة برازية تبين وجود بيوض بيضوية الشكل وذات سطح خشن ..
ما هو التشخيص Question وما هو العلاج Question


36-h history of acute malaise |

حالة سريرية

الوصف الكامل Background

A 5-year-old boy presented to his general practitioner with a 36-h history of acute malaise, shivering and vague pains in his legs. For 12h he had complained of a dry, sore throat and had vomited twice. He was febrile (temperature 40.2°C) with a tachycardia of 140/min and tender, bilateral, cervical lymphadenopathy. His pharynx, tonsils and buccal mucosa were red and inflamed and his tonsils were studded with white areas of exudate

كتابة حرة وطرح موضوع النقاش!
what is the diagnosis?
Treatment?

Microbiology-6 |

حالة سريرية

الوصف الكامل Background
A student cuts short an extended backpacking trip after developing diarrhea.
He explains to his doctor the diarrhea is non-bloody but smells very bad.
On further questioning, the student tells his doctor that he has been drinking water from a fresh water spring.
The patient appears malnourished on physical exam.
A diarrhea sample reveals 2-nuclei motile ameba with a tear-drop shape and 4 pairs of flagella.
What is the diagnosis ? and what is the treatment ?

قطع طالب رحلته للتخييم مبكراً بسبب تعرضه للإسهال.
وقد ذكر لطبيبه أن الإسهال غير مدمى ولكن ذو رائحة بشعة جداً.
وفي الاستجواب ذكر الطالب أنه كان يشرب الماء من ينبوع للمياه العذبة.
وبالفحص السريري تبين أن المريض يعاني من سوء تغذية.
عينة من الاسهال أظهرت أميبا متحرك ذو نواتين على شكل دمعة وله 4 أزواج من السياط.
ما هو التشخيص ؟ وما هو العلاج؟


Microbiology-5 |

حالة سريرية

الوصف الكامل Background
After a camping trip, a patient visits her doctor complaining of loose stools and abdominal cramps.
The patient describes the stools as having flecks of blood and lots of mucus.
The doctor orders a stool specimen in which she finds motile ameba with ingested RBCs.
She starts the patient on the treatment and considers a CT scan to detect any liver abcesses.
What is the diagnosis ? What is the treatment ?

بعد رحلة تخييم جاءت مريضة إلى طبيبتها تشتكي من براز رخو (loose) و مغص بطني.
وصفت المريضة البراز بأنه يحوي بقع من الدم والكثير من المخاط.
طلبت الطبيبة فحص عينة براز لتجد فيها أميبا متحركة تحوي كريات دموية حمراء.
بدأت مع المريضة بالعلاج وطلبت CT Scan لتحري أي خراج في الكبد.
ما هو العلاج ؟ وماهو التشخيص ؟


Microbiology-4 |

حالة سريرية

الوصف الكامل Background
An East African man is asked to leave his job after repeatedly falling asleep.
He visits the doctor hoping to cure his somnolence as well as accompanying headache and dizziness.
During the interview, the patient explained that he had suffered recurring bouts of fever and enlarged lymph nodes before the sleepiness started.
The doctor decides to perform a lumbar puncture and finds a flagellated protzoan in the CSF.
What is the diagnosis? What is the treatment?

رجل من شرق أفريقيا طرد من طُلِبَ منه ترك عمله بعد نومه المتكرر في العمل.
ذهب إلى الطبيب آملا أن يعالج نعاسه وما يرافقه من صداع ودوخة.
أثناء المقابلة ذكر المريض أنه عانى من نوبات متكررة من الحمى وتضخم في عقده اللمفاوية قبل ظهور حالة النعاس هذه.
قرر الطبيب أن يقوم ببزل قطني ووجد أوالي مسوطة في السائل الدماغي الشوكي.
ما هو التشخيص ؟؟ وما هو العلاج ؟؟


Microbiology-3 |

حالة سريرية

الوصف الكامل Background
An AIDS patient is brought to the emergency ward after suffering a grand mal seizure.
The man informs the emergency ward physician that he has suffered a persistent headache in the past few weeks, but denies any sensory problems or weakness.
Fearing a brain tumor, the emergency ward physician orders a CT scan of the patient.
However, the scan instead reveals several ring-enhancing masses in the patient's brain.
The physician confirms his suspicions when he learns the patient has many cats at home.
He expects that a brain biopsy whould show crescent-shaped trophozoites.
What is the diagnosis?? and what is the treatment??

مريض AIDS أحضر إلى جناح الطوارئ بعد أن تعرض لنوبة صرع كبير.
ذكر المريض للطبيب أنه عانى من صداع مستديم في الأسابيع السابقة ولكنه لم يتعرض لأي مشاكل حسية أو ضعف.
خوفا من ورم دماغي طلب الطبيب CT Scan.
أظهر التصوير عدة كتل ذات تعزيز محيطي في دماغ المريض.
أكد الطبيب ظنونه عندما علم أن المريض لديه عدة قطط في المنزل.
وتوقع أن خزعة الدماغ ستظهر أتروفات هلالية الشكل.
ما هو التشخيص؟؟ وما هو العلاج؟؟

الاستقصاءات Investigations
MRI:

CT:


MICROBIOLOGY-2 |

حالة سريرية

الوصف الكامل Background
An amateur bird-keeper presents with headache and stiff neck.
Fearing some form of meningitis, the physician orders a CT scan
The image reveals well-circumscribed ring-like lesions in the brain.
Subsequent CSF analysis, from a lumbar puncture shows high CSF pressure, high protein, low glucose and encapsulated budding yeast with India ink stain.
what is the diagnosis?? and what is the treatment??

كشاش حمام (بس مو محترف) يعاني من صداع و تصلب رقبة.
خوفا من أن يكون نوعا من أنواع التهاب السحايا طلب الطبيب CT scan.
لأظهرت الصورة آفات خاتمية متحددة جيدا في الدماغ.
فحص السائل الدماغي الشوكي عن طريق البزل القطني أظهر ارتفاع في الضغط و ارتفاع البروتين و انخفاض الغلوكوز وفطور متبرعمة ذات محفظة عند التلوين بالحبر الصيني (الهندي) .
ما هو التشخيص ؟؟ وما هو العلاج المناسب ؟؟


MICROBIOLOGY-1 |

حالة سريرية

الوصف الكامل Background
A 10 years old kid presents with severe headaches and seizures.
A physical exam reveals several nodules across his body.
Concerned about a neurological disease, the doctor first orders a head CT scan that shows 5 calcified cysts.
This observation, along with high eosinophils on a CBC, prompts the doctor to perform a biopsy of a nodule.
Th doctor finds cysts in the nodule.
What is the diagnosis?? and what is the right treatment??

طفل بعمر 10 سنوات يعاني من صداع شديد و نوبات صرعية .
بالفحص السريري تبين وجود عدة عقيدات في جسمه .
طلب الطبيب CT scan للرأس (لمعرفة وجود مرض عصبي أم لا) وتبين فيه وجود 5 أكياس متكلسة.
وجود هذه الأكياس المتكلسة بالإضافة لارتفاع الحمضات عند تعداد الكريات جعل الطبيب يأخذ خزعة من عقدة من العقد.
بفحص العقدة تبين وجود أكياس أيضا.
ما هو التشخيص؟ وما هو العلاج المناسب؟


Over the past week noted increasing fatigue |

حالة سريرية

الوصف الكامل Background
23 year old male.

Over the past week noted increasing fatigue, sore throat, earaches, headaches, and episodic fever and chills. Unable to run his customary 25 miles per week.

الفحص السريري Clinical Exam
Erythematous throat and tonsils.
Swollen cervical lymph nodes.
No other organomegaly.
الاستقصاءات Investigations
كتابة حرة وطرح موضوع النقاش!


Question 1
What morphologic alterations are seen in this blood smear field?

Question 2
What further laboratory studies, if any, are indicated?

Question 3
What is the most likely diagnosis?

المرجع

.


scaly alopecia |

حالة سريرية

الوصف الكامل Background
A 10-year-old HIV-infected boy presents with scaly alopecia.

What is your diagnosis?
what is the treatment ?


CAN YOU IDENTIFY THIS CONDITION? |

حالة سريرية

الوصف الكامل Background
A 25-year-old woman had had annular migratory patches on her tongue for 3 years. She complained of a burning sensation when she ate acidic or spicy foods.

The most likely diagnosis is:

1. Geographic tongue
2. Herpes gingivostomatitis
3. Oral candidiasis
4. Aphthous stomatitis


short case |

حالة سريرية

الوصف الكامل Background

Joey is a 7 year-old boy with HIV infection who comes to the clinic with a painful, vesicular, crusting rash across the left side of his face, neck and upper chest. The rash does not extend across the midline of his body. Prior to the appearance of the rash he experienced burning pain and itching in the area where the rash subsequently appeared.

كتابة حرة وطرح موضوع النقاش!

What is your diagnosis?


ten-day history of frontal headache |

حالة سريرية

الوصف الكامل Background

A previously healthy 12-year-old girl presented with a ten-day history of frontal headache, intermittent fever, and emesis. Double vision developed immediately prior to hospital admission.

السوابق المرضية الشخصية PMH
Her past medical history was unremarkable, and her family reported that she had never missed a day of school due to illness.
الفحص السريري Clinical Exam
Physical examination revealed bilateral sixth nerve palsy.
الاستقصاءات Investigations
Work-up included head CT scan.
كتابة حرة وطرح موضوع النقاش!
What is your diagnosis?

Amelie and her HIV Infection |

حالة سريرية

الوصف الكامل Background
Amelie is a 12 year-old girl vertically infected with HIV.
She is currently being treated with Combivir (lamivudine/zidovudine) and Kaletra (lopenivir/ritonavir).
الشكوى الرئيسية CC
She presents in clinic today with vomiting, loss of appetite and fever.
الفحص السريري Clinical Exam
On physical examination you note some peri-umbilical pain but no guarding or rebound. She also complains of right shoulder pain. Bowel sounds are normal
الاستقصاءات Investigations
Laboratory studies reveal the following:

Electrolytes, creatinine, and blood urea nitrogen are all normal; liver enzymes, bilirubin, triglycerides and cholesterol are mildly elevated; amylase 163 U/L (normal 5-15 U/L), lipase 4067 U/L (normal 15-110 U/L); urine chemistry and microscopy are normal

An abdominal ultrasound shows a mildly enlarged pancreas with decrease echogenicity.

كتابة حرة وطرح موضوع النقاش!
What is your diagnosis?
المرجع

.


حالة سريرية هضمية. وبنفس الوقت قصة مشوقة |

حالة سريرية

الشكوى الرئيسية CC
The patient was a prominent 52-year-old male entertainer who developed abdominal pain and fever after a blow to the abdominal wall.
القصة المرضية HPI
The patient's illness began during a performance in Montreal, Canada. While in his dressing room, preparing to go on stage, he talked with a student who asked whether or not it was true that the entertainer's abdominal musculature was so well developed that he could withstand strong abdominal punches. The entertainer invited him to try, and the student immediately landed several blows to his abdomen.

During his Montreal performance, the entertainer appeared to be in pain not only from his abdomen, but also from a recent ankle injury. He finished the performance, and then boarded a train for Detroit, where a sold-out audience awaited his next performance. Because the pain became much more severe, the patient wired ahead, asking for a physician to meet him on his arrival in Detroit.

About 48 hours later he arrived, feeling much worse. He was quoted as saying: "I'll do this show even if it's my last." Rather than disappoint the large audience gathered to witness his performance in Detroit, the performer, although acutely ill, immediately went on stage.

After performing, the patient returned to his dressing room where he complained of abdominal pain, which gradually increased and was accompanied by weakness. After struggling through his performance, he was examined by a physician.

الأجهزة الأخرى ROS
Other than the abdominal findings, the remainder of the physical examination was within normal limits. Initially his temperature was 102° F, but it soon rose to 104.
السوابق المرضية الشخصية PMH
The patent was a nonsmoker and nondrinker, but during his professional career he sustained many bruises and fractures. His most significant illness was a prolonged bout of hematuria from a suspected ruptured renal blood vessel.
السوابق المرضية العائلية FMH
The patient's father died at age 63 of cancer of the tongue. His mother died in her 70s from a stroke. He had five brothers and sisters, one of whom died from tuberculosis.
الفحص السريري Clinical Exam
A muscular male below average in height, the patient appeared to be acutely ill, complaining of abdominal pain and tenderness, especially in the right lower quadrant.
الاستقصاءات Investigations
After the physician performed the initial examination, the patient was then examined by a surgeon, who recommended surgery. The patient underwent an emergency laparotomy approximately 72 hours after the initial onset of his illness.

Postoperatively he continued to be febrile, with a temperature of 101° F and rapid pulse, but was alert and responsive. Because of persistent postoperative ileus, he was reoperated approximately 4 days after the initial laparotomy. He failed to recover and died 10 days after the initial onset of symptoms.

كتابة حرة وطرح موضوع النقاش!

1. What is your diagnosis?

A) Perforated peptic ulcer

B) Splenic rupture

C) Appendicitis

D) Acute pancreatitis

2. Who was our mystery patient?

A) Rudolf Valentino

B) Charlie Chaplin

C) Ehrich Weiss

D) Jerry Garcia


HIV / Oral Manifestations / Case 1: Oral Hairy Leukoplakia |

حالة سريرية

الوصف الكامل Background
A 35-year-old HIV-infected man with a CD4 count of 100 cells/mm3 visits the clinic for a routine appointment. On examination, white papular lesions are observed bilaterally on the lateral aspect of his tongue (Figure 1 and Figure 2). These white lesions are presumptively diagnosed as oral hairy leukoplakia.
كتابة حرة وطرح موضوع النقاش!
FIG.1

FIG.2
Which of the following statements is TRUE regarding oral hairy leukoplakia?

A: It occurs in approximately 5% of persons infected with hepatitis C virus (who are not co-infected with HIV).
B : It is caused by infection with human herpes virus type 8 (HHV- 8 ).
C: It is caused by infection with Epstein-Barr virus.
D: Approximately 15% of lesions develop into premalignant lesions that require surgical removal.


woman developed herpes zoster and lobar pneumonia |

حالة سريرية

الوصف الكامل Background
A 29-year-old woman developed herpes zoster and lobar pneumonia.
القصة المرضية HPI
Over the next 5 years, she was admitted to hospital with pneumonia on four occasions and yet there had been no history of recurrent chest infections during childhood. .
السوابق المرضية الشخصية PMH
At the age of 33, she developed a non-erosive seronegative arthritis. On direct questioning, she gave a history of intermittent diarrhoea since her late teens. Her bowel upsets lasted from 2 days to 2 weeks and during this time she passed five to six partly formed stools a day.
السوابق المرضية العائلية FMH
There was no family history of recurrent infections:
الوضع الصحي والاجتماعي SH
she had two sons, aged 10 and 7, both of whom were well.
الفحص السريري Clinical Exam
Physical examination was normal though she was thin
الاستقصاءات Investigations
Investigations showed a haemoglobin of 115g/l with a normal white-cell count and differential. Immunological studies (Table C3.2) showed marked hypogammaglobulinaemia and no specific antibodies, despite a tetanus toxoid boost 1 year earlier. She had normal numbers of T and B lymphocytes. Antinuclear antibodies and rheumatoid factor were not detected. Investigations into the cause of her recurrent diarrhoea revealed Giardia lamblia in the jejunal aspirate.
كتابة حرة وطرح موضوع النقاش!
question 1:
what is the diagnose?
question 2:
what is the Treatment in this case?

Acquired immune deficiency syndrome: persistent generalized lymphadenopathy |

حالة سريرية

الوصف الكامل Background
[eng]A 29-year-old man had a history of fatigue, night sweats and axillary lymphadenopathy for 6 months. Fine-needle lymph-node biopsy suggested a reactive cause rather than malignancy. At a follow-up visit 2 months later he was found to have palpable, non-tender cervical and inguinal nodes and considerable weight loss (8.5kg).

[/eng]

الفحص السريري Clinical Exam
الاستقصاءات Investigations
Further investigations were done to exclude a lymphoma. Computed tomography scan of his chest and abdomen showed no lymph-node enlargement and no organomegaly.
Immunological investigations are shown in Table C3.8. Full blood counts were normal as was the C-reactive protein level. In view of these findings, he was asked about previous blood transfusions (none) and high-risk activity for HIV infection (three heterosexual partners), counselled and tested for HIV antibody. He was HIV-1-antibody positive. A diagnosis of AIDS was made on the basis of a positive HIV antibody test and weight loss of more than 10% in 12 months.

كتابة حرة وطرح موضوع النقاش!
Viral load measurement showed 46 x 103 copies of HIV-RNA per millilitre and he was positive for cytomegalovirus infection by PCR. In view of the low CD4 count he was started on prophylactic co-trimoxozole and triple antiviral therapy, namely zidovudine, didanosine and ritonavir. He is being reviewed at 2-4-weekly intervals and monitored with viral load measurements.this case emphasizes several important points:

Not all patients with HIV present with recognizably HIV-related symptoms or signs. 1
A careful 'high-risk' history is important but not always helpful. 2
If there is a possibility of HIV infection, an HIV antibody test should always be done after appropriate counselling. 3


skin 'rash' of 2 months duration |

حالة سريرية

الوصف الكامل Background
A 35-year-old man presented with a skin 'rash' of 2 months duration. This had started as a single, small spot on his trunk, followed later by crops of similar lesions, all over; they were painless and did not itch.
القصة المرضية HPI
He had no other symptoms; in particular, no cough, chest symptoms, fever, weight loss or lymphadenopathy. He was apyrexial, with bilateral axillary and inguinal lymphadenopathy. About 20 purplish-red nodules were present on his trunk, face and palate as well as at the anal margin. His nose showed similar discoloration and swelling. White, wart-like projections of 'oral hairy leucoplakia' were present on the sides of his tongue.
الوضع الصحي والاجتماعي SH
He was homosexual, with one regular sexual partner over the preceding 2 years. He also participated in casual, unprotected sexual intercourse whilst on holiday. He had never used intravenous drugs.
الاستقصاءات Investigations
Investigations showed a normal haemoglobin, a normal white-cell count (4.9 x 109/l) and normal absolute lymphocyte count (1.8 x 109/l). After counselling, blood was sent for an HIV antibody test which was positive by enzyme-linked immunosorbent assay (ELISA) and confirmed by Western blotting . A second test was also positive. Immunological studies (Table C3.7) showed a raised serum IgA and analysis of lymphocyte subpopulations showed absolute depletion of CD4+ cells.
كتابة حرة وطرح موضوع النقاش!
what is the right diagnose?
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