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حالات سريرية


سيدة تعاني من نوبات ألم وجهية قاتلة |

حالة سريرية

الوصف الكامل Background

أتت السيدة كاتيا عمرها 55 سنة عانت من نوبات متقطعة من ألم صاعق تشنجي لعدة ثواني ثم ينقطع على الجهة اليسرى من الوجه بين الشفة العليا و الجفن السفلي تكررت الحالة عدة مرات في الشهرين الأخيرين .
اشتدت حالة الألم مرة إلى درجة فقدان الوعي .

القصة المرضية HPI

المرة الأولى التي واجهت بها هذه الحالة منذ شهرين بينما كانت تمضغ عِلْكَة
والمرة الثانية كانت أثناء وضعها لمساحيق التجميل (Make up) على وجهها
ثم تتالت الحالات مرات أخرى

السوابق المرضية الشخصية PMH

تم تشخيص التصلب العديد Multiple sclerosis منذ سنتين من الآن

الفحص السريري Clinical Exam

الرأس , العينين , الأذنين , الأنف والحنجرة (HEENT):طبيعي
لا وجود لتضخم العقد اللمفاوية
لا وجود لخدر في مناطق محددة من الجسم

الاستقصاءات Investigations

صورة الرنين المغناطيسي MRI أظهرت ثخانة في أحد الأعصاب القحفية

المرجع

Later


حالة سريرية عصبية |

حالة سريرية

الشكوى الرئيسية CC

تراجع الوظائف العصبية للمريضة

القصة المرضية HPI

السيدة ج 35 عاما بيضاء. اتت للعيادة العصبية...لتقييم شكواها العصبية التي تعاني منها منذ فترة طويلة.لاحظت المريضة منذ عدة سنوات تغيرات في وظائفها العصبية.
خاصة بالنسبة لتحمل الحرارة والمشية المتعثرة والميل للسقوط اثناء المشي.قالت المريضة كذلك ان حدة بصرها بدات تتاثر منذ عدة سنوات.
منذ شهرين كانت المريضة تعمل بجهد كبير،وكانت تعاني الكثير من الضغط بالاضافة للاصابة بالانفلونزا.نتيجة لذلك ساءت حالتها العصبية واصبحت تعاني من رجفان شديد في يديها لدرجة انها لم تعد تستطيع امساك الاشياء.كذلك عانت المريضة من الام مفصلية..بعد ذلك طورت المريضة اصابة حسية في الجانب الايمن من جسدها بعد ايام من العمل.
تم عمل MRI للمريضة ليكشف عن عدة افات للمادة البيضاء في الدماغ...واشارة T2زائدة في كلا الكرتين المخيتين.فحص السائل الدماغي االشوكي اثبت وجود عصابات وحيدة النسيلة فيه.واجري كذللك للمريضة اختبار الكمون المثار بصريا ليدل على وجود تباطأ في النقل في الاعصاب البصرية
.

السوابق المرضية الشخصية PMH

عانت المريضة في طفولتها من الحصبة والنكاف.وبعد ذلك عانت من فقر الدم.نذ فترة قصيرة اجرت المريضة عملية ربط للبوقين

السوابق المرضية العائلية FMH

ارتفاع في ضغط الدم..وأمراض قلبية

كتابة حرة وطرح موضوع النقاش!

اسئلتنا لهذه الحالة سأسوقها تباعا...نبدأ بالمجموعة الاولى للأسئلة:

1-اذكر جميع الأعراض في القصة المرضية لهذه المريضة التي تجعلك تشك بتشخيص التصلب المتعدد.اذكرها وفقا لاهميتها

2-ما الحالات الأخرى التي يمكن ان تسبب افات معممة في المادة البيضاء على الMRI؟

3-ماذا يعني وجود عصابات وحيدة النسيلة في السائل الدماغي الشوكي وما هي الامراض التي قد نجد فيها ذلك؟

المرجع

ثالثة: شابة تعاني من صداع |

حالة سريرية

الشكوى الرئيسية CC

أتت شابة في العشرين من عمرها إلى العيادة، تشكو من نوبات صداع نابض متقطعة

كتابة حرة وطرح موضوع النقاش!

ما هي الأسئلة التي تريدون طرحها على المريضة؟

المرجع

later!


Young Girl With Clumsiness, Dystonia, and Speech Difficulty |

حالة سريرية

الشكوى الرئيسية CC
A 17-year-old girl has developed slowly progressive clumsiness over the past 6 months. She now displays dystonic movement of all of her limbs, as well as impaired speech.
She presented to your clinic with this CC, what do you want to know?
المرجع

eMedicine CME Case Study


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


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


فرط منعكسات ، رنح ، ضعف في حس الاهتزاز والوضعة |

حالة سريرية

الوصف الكامل Background
A 41-year-old woman with no significant medical history presents complaining of fatigue and lightheadedness. Physical exam is notable for conjunctival pallor, bilateral brisk patellar reflexes, slightly ataxic gait, and impaired position and vibration sense in the feet bilaterally. Her hematocrit is 23%. Serologic studies are positive for anti-parietal cell antibodies. What would you expect to see on peripheral blood smear?

A. Burr cells
B. Hypersegmented neutrophils
C. Howell-Jolly bodies
D. Schistocytes
E. Spur cells

المرجع

.


صداع .. |

حالة سريرية

الوصف الكامل Background
Mr. T. is complaining of a headache. He has just awakened from a nap and states that the
headache always begins behind one eye, “feels like an icepick,” and is accompanied by tearing
and a runny nose. You suspect Mr. T has:
(A) Migraine headache
(B) Tension headache
(C) Cluster headache
(D) A stroke

شلل عصب وجهي .. |

حالة سريرية

الوصف الكامل Background

بعد 3 أيام من تعرض سيدة 25 عاما لحادث سير عانت خلاله من كسر في الفكين العلوي والسفلي , شوهد لديها شلل عصب وجهي مع اضطراب وظيفة الكلام , كيف ندبر مشكلة العصب الوجهي :
1- تطعيم العصب الوجهي
2- خياطة العصب الوجهي
3- المعالجة الغير جراحية
4- نقل جزء من العضلة الماضغة للملتقى الفموي

المرجع

.


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


Neurology 3 |

حالة سريرية

الوصف الكامل Background
A 64-year-old woman is evaluated in the emergency department for a 4-day history of progressive leg weakness and numbness and a 1-day history of urinary incontinence. She has also had increasingly severe midback pain for the past 2 months. She has a history of breast cancer diagnosed 2 years ago, treated with surgery and local radiation therapy. Her only current medication is tamoxifen.

Physical examination shows normal mental status and cranial nerves. Strength in the arms is normal. Legs are diffusely weak, 3/5 proximally and 4/5 distally. Sensory examination shows diminished pin sensation from the nipples downward; vibratory sense is severely diminished in the feet. Reflexes are 2+ in the biceps and triceps and 3+ in the knees and ankles. An extensor plantar response is present bilaterally. Anal sphincter tone is diminished.

Which of the following is the most appropriate diagnostic study at this time?

A. CT of the lumbar spine
B. Electromyography and nerve conduction studies
C. MRI of the brain
D. MRI of the entire spine
E. Plain radiographs of the entire spine


دوار شديد متكرر |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

امرأ 35 سنة اتت بسبب دوار شديد مفاجئ يسبب لها شعور بالغثيان
بالاضافة لطنين وسماع اصوا بالاذن
بعد عدة ساعات ذهبت الهجمة المرضية , حدث لديها عدة حالات مشابهة بالسابق بدأت بعمر ال26 سنة ولا تحدث الحالات بالحركة او حركات الجسد أو الرأس , لم يوجد بالسابق امراض فيروسية ونفت أي أعراض عصبية .
ما التشخيص الأكثر احتمالا ؟
1- ورم بالزاوية الجسرية المخيخية
2- دوار الوضعة السليم
3- التهاب تيه حاد
4- داء مينيير
5- احتشاء مخيخ

المرجع

.


ما سبب الصداع الحاد ؟ |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

A 29-year-old man is brought to the emergency department in a comatose state a few hours
after complaining of sudden onset of excruciating headache. His friend does not know if the
patient has any underlying medical conditions. Neurologic examination reveals dilated pupils
poorly responsive to light. A CT scan of the head without contrast demonstrates hyperdensity
within the suprasellar cistern, while MRI is unremarkable. Lumbar puncture shows
hemorrhagic cerebrospinal fluid. Which of the following is the most likely diagnosis?
A. Amyloid angiopathy-related hemorrhage
B. Cavernous sinus thrombosis
C. Hemorrhagic infarction
D. Pituitary apoplexy
E. Ruptured berry aneurysm


ما الورم الدماغي ؟ |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

A 10-year-old boy is brought to the emergency department because of headache, nausea, and
vomiting for the past 3 days. Neurologic examination reveals nuchal rigidity and papilledema. A
CT scan reveals an infiltrating cerebellar tumor, which is located in the midline (vermis), with
plaque-like extensions onto the cerebellar surface. There is no cystic component. The fourth
ventricle is compressed, and the third and lateral ventricles are dilated. His 3 siblings are all
healthy. Which of the following is the most likely diagnosis?
A. Ependymoma
B. Hemangioblastoma
C. Medulloblastoma
D. Meningioma
E. Oligodendroglioma
F. Pilocytic astrocytoma


مشية غير ثابتة مع تبدلات بالمرنان وبال IGg ? |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

A previously healthy, 35-year-old woman comes to medical attention because of an unsteady
gait. Her temperature is 37 C (98.6 F), blood pressure is 130/70 Hg, pulse is 80/min, and
respirations are 20/min. Neurologic examination reveals spasticity and decreased vibratory
sensation in her right lower extremity, and decreased strength in her left arm. MRI studies
show well-demarcated periventricular areas of T2 hyperintensity. A lumbar puncture shows
mildly increased protein concentration with oligoclonal IgG bands. Which of the following is the
most likely diagnosis?
A. Cytomegalovirus encephalitis
B. Multiple sclerosis
C. Oligodendroglioma
D. Progressive multifocal leukoencephalopathy
E. Lymphoma


ما الأعصاب القحفية المصابة ؟ |

حالة سريرية

الوصف الكامل Background
A 16-year-old girl with Sjögren syndrome complains of decreased ability to sense taste in many of the foods she eats. The symptoms became noticeable 2 weeks ago, after a flare-up of her Sjögren syndrome. Before this, she has had no problems with gustatory sense. Which of the following cranial nerves are most likely affected?
A. I and VII
B. V and VII
C. VI and VII
D. VII, IX, and X
E. IX and XI
المرجع

.


ما الاختبار الذي يجب اجرائه بشكل دوري ؟ |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 48-year-old man, recently diagnosed with type 2 diabetes mellitus, comes to his primary
care physician's office for follow-up. He is advised on a regimen of diet and exercise with
frequent monitoring of his fasting and 2-hour postprandial blood sugars. His blood pressure is
checked on several separate occasions, and he is started on an ACE inhibitor that affords
good blood pressure control. A physical examination at this visit is within normal limits. A
fasting lipid profile, 12-lead electrocardiogram (ECG), blood urea, and creatinine are all within
normal limits. Urinalysis including microalbumin is also within normal limits. Which of the
following screening tests should be recommended in this patient, given the recent diagnosis of
diabetes?

A. 2D echocardiogram
B. Colonoscopy
C. Eye examination yearly
D. PSA yearly
E. Upper gastrointestinal endoscopy

شلل عصب وجهي |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 56-year-old man develops slow, progressive paralysis of the facial nerve on one side. It took
several weeks for the full-blown paralysis to become obvious, and it has been present now for
3 months. It affects both the forehead and the lower face. He has no pain anywhere, and no
palpable masses by physical examination. Which of the following is the most likely diagnosis?A. Bell's palsy
B. Facial nerve tumor
C. Hemorrhagic stroke
D. Parotid gland cancer
E. Pleomorphic adenoma of the parotid gland
المرجع

.


شفع |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A previously healthy 50-year-old woman comes to the physician because of double vision for
three days. Her temperature is 37 C (98.6 F). The patient denies nausea or vomiting.
Examination reveals drooping of the right eyelid and slight divergence of the right eye.
Extraocular movements are limited in all directions, except laterally. The right pupil is larger
than the left and poorly reactive to light. Examination of the fundus fails to reveal papilledema.
Which of the following is the most likely underlying condition?
A. Aneurysm of the posterior communicating artery
B. Carcinoma of the right pulmonary apex
C. Diabetes mellitus
D. Giant cell arteritis
E. Syphilis
F. Systemic hypertension

تغيرات عقلية بعد أسبوع من سقوط |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 77-year-old man becomes "senile" over a period of 3 or 4 weeks. He used to be active and
managed all of his financial affairs. His daily routine typically included horseback riding, a long
walk with the dog, and household chores. Now, he stares at the wall, barely talks, and sleeps
most of the day. His daughter recalls that he fell from a horse about a week before the mental
changes began. Which of the following would a CT scan of his head most likely show?
A. Chronic epidural hematoma
B. Chronic subdural hematoma
C. Diffuse intracerebral bleeding
D. Frontal lobe infarction
E. Generalized, severe brain atrophy

صرع |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 12-year-old boy is brought to the clinic because of a several-month history of strange
behavior
. According to his parents, the boy occasionally will start staring and not respond. He
will also have tears in his eyes. These episodes last several seconds and he then returns to
his baseline
. He has not sustained any head trauma and is on no medications. Which of the
following drugs is the most appropriate treatment
?
A. Diazepam
B. Diphenhydramine
C. Ethosuximide
D. Phenobarbital
E. Phenytoin

صداع حاد ؟ |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 33-year-old woman without any medical history comes to the emergency department
complaining of the worst headache of her life. The headache occurred suddenly and awoke
her from sleep approximately 32 hours before presentation. She delayed coming to the
hospital and was trying to manage the pain at home with ibuprofen and acetaminophen.
Further history reveals that her mother, grandfather, and three sisters all have kidney disease,
and her mother and one sister are currently on hemodialysis
. Her aunt died from a bleed in her
head when she was 40 years of age and had kidney problems also. Which of the following
studies is the most sensitive test to diagnosis this patient's acute problem
?
A. Bleeding scan
B. CT scan of the head
C. Genetic testing
D. Lumbar puncture
E. MRI of the head

ضعف عضلي مع فقد حس |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
An 80-year-old woman experiences the sudden onset of lower extremity weakness and
collapse on getting out of bed. She has been previously healthy and has not taken any
medications. She has no history of back pain. On examination, she is alert and oriented to
time, place and date. Her upper extremity sensation and strength are intact. Her legs are weak
bilaterally, with loss of pain and temperature sensation and areflexia. Her bladder is distended.
Which of the following is the most likely diagnosis?
A. Anterior cerebral artery occlusion
B. Anterior spinal artery occlusion
C. Cauda equina syndrome
D. Guillain-Barré syndrome
E. Thoracic spinal cord compression

حالة عصبية سهلة - ما التشخيص الأكثر احتمالا ؟ |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 70-year-old woman with long history of diabetes mellitus is brought to the emergency
department with sudden onset of weakness in the right arm.
Physical examination confirms
loss of strength in the right upper extremity and further demonstrates subtle bilateral
neurologic deficits, both sensory and motor. A CT scan of the head shows small punched-out
hypodense areas in the basal ganglia and anterior limb of the left internal capsule.
Which of the following is the most likely diagnosis?
A. Berry aneurysms
B. Cerebral hemorrhage
C. Embolic infarcts
D. Lacunar infarcts
E. Metastatic lesions

Neurology 2 |

حالة سريرية

الوصف الكامل Background
A 36-year-old-woman with longstanding epilepsy is evaluated for episodes of crying and feelings of helplessness; she is not suicidal. Her epilepsy was diagnosed 14 years ago. Although her seizures have been well controlled, she has been treated with various antiepileptic drugs, including valproate, phenobarbital, and carbamazepine; the first two drugs were stopped because of side effects. She recently had a generalized tonic–clonic seizure and lost her driver's license.

Which of the following is the next best step in this patient's management?

A. Refer for psychotherapy
B. Start a selective serotonin reuptake inhibitor
C. Discontinue antiepileptic drug therapy
D. Switch to another antiepileptic drug


Neurology 1 |

حالة سريرية

الوصف الكامل Background
A 71-year-old man presents to the emergency department at the instruction of his primary care physician. The patient felt well when he went to bed at midnight but awoke at 8:00 a.m. with left upper-extremity weakness and numbness. He called his physician who told him to go to the emergency department. He arrives at the emergency department at 9:00 a.m.

The patient's medical history includes hypertension and hyperlipidemia for which he takes a thiazide diuretic and a statin. His blood pressure is 178/92 mm Hg; physical examination reveals mild left-sided neglect, a mild left central facial palsy, mild left upper- and lower-extremity weakness, and a mild left hemisensory deficit. Complete blood count and serum electrolytes and glucose are normal. CT scan of the brain is normal.

Which of the following is the most appropriate next step in this patient's management?

A. Start aspirin
B. Start intravenous heparin
C. Start clopidogrel
D. Start intravenous tissue plasminogen activator
E. Lower blood pressure to 140/90 mm Hg


ما مشكله هذا المريض ؟ |

حالة سريرية

الوصف الكامل Background

A 24-year-old male is brought to the ER by his friend, who says
that the patient had a spell about 1 hour ago. The patient explains
that he started a new job today, and upon receiving this
information, he suddenly felt muscle weakness, fell onto the floor,
and was unable to move. The episode lasted for several minutes,
and then he regained his muscular strength. His past medical
history is insignificant. He admits that recently he frequently feels
sleepy during the day. He also remembers two episodes during
the last month of vivid dreaming before falling asleep. He does not
smoke or consume alcohol. His vital signs are: BP 130/80 mm Hg
while supine and 128/70 mm Hg while standing, and PR 70/min.
Which of the following is the most probable pathophysiologic
mechanism of the episode experienced by this patient?

A.Transient ischemic attack (TIA)
B.Arrhythmia
C.Rapid eye movement (REM) sleep-related phenomenon
D.Hypoglycemia
E.Seizure


tremor |

حالة سريرية

الوصف الكامل Background

A 54-year-old presents to you with a history of tremor in his hands.
He says the tremor has been on going for several months and has
not been responding to over the counter medications. He denies
trauma, fever, loss of muscle function or any prior stroke. In his
past history he has had vague abdominal pains, the cause of
which was never found. He says that the tremor always get worse
when he is in public. At times the hand tremor is so bad that he is
unable to grasp. You decide to treat him with a medication. A
month later the patient comes back with the tremor gone but now
he has complains of colicky abdominal pain, confusion,
headaches, hallucinations and dizziness. The drug you gave him
was?

A.Alcohol
B.Propranolol
C.Primidone
D.Diazepam
E.Lithium


ما سبب النزف الدماغي ؟ |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 75-year-old man with a history of recent memory impairment is
admitted with headache, confusion, and a left homonymous hemianopsia.
He has recently had two episodes of brief unresponsiveness. There is no history
of hypertension. Computed tomography (CT) scan shows a right occipital
lobe hemorrhage with some subarachnoid extension of the blood. An
MRI scan with gradient echo sequences reveals foci of hemosiderin in the
right temporal and left frontal cortex. The likely cause of this patient’s symptoms
and signs is

a. Gliomatosis cerebri
b. Multi-infarct dementia
c. Mycotic aneurysm
d. Amyloid angiopathy
e. Undiagnosed hypertension

نشبة دماغية 2 |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!
A 61-year-old man with a history of hypertension has been in excellent
health until he presents with vertigo and unsteadiness lasting for 2 days. He
then develops nausea, vomiting, dysphagia, hoarseness, ataxia, left facial
pain, and right-sided sensory loss. There is no weakness. On examination, he
is alert, with a normal mental status. He vomits with head movement. There
is skew deviation of the eyes, left ptosis, clumsiness of the left arm, and titubation.
He has loss of pin and temperature sensation on the right arm and leg
and decreased joint position sensation in the left foot. He is unable to walk.
1. Magnetic resonance imaging (MRI) in this patient might be expected
to show which of the following?

a. Basilar artery tip aneurysm
b. Right lateral medullary infarction
c. Left lateral medullary infarction
d. Left medial medullary infarction
e. Right medial medullary infarction
2. The dysphagia in this case is secondary to involvement of which of the
following structures?

a. Nucleus solitarius
b. Nucleus and descending tract of CN V5
c. Nucleus ambiguus
d. Lateral spinothalamic tract
e. Inferior cerebellar peduncle

3. Occlusion of which of the following arteries typically produces this
syndrome?

a. Basilar artery
b. Vertebral artery
c. Superior cerebellar artery
d. Anterior inferior cerebellar artery (AICA)
e. Anterior spinal artery

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