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حالات سريرية


خفقان غير منتظم في القلب |

حالة سريرية

المرجع

لايوجد


end-stage renal disease, painful skin lesions, diffuse pulmonary infiltrates, and respiratory failure |

حالة سريرية

الوصف الكامل Background

HISTORY — A 20-year-old man with end-stage renal disease and a painful, violaceous, plaque-like skin eruption over the lower extremities was admitted to the hospital. His past medical history was remarkable for a rapidly progressive glomerulonephritis, an unsuccessful cadaveric renal transplant, and poorly controlled hypertension. Shortly after admission, he developed respiratory distress requiring mechanical ventilation. Over the next few weeks, his skin lesions spread to the abdomen and back and became ulcerative and necrotic, forming eschars. The patient eventually required tracheotomy for chronic ventilator support.

HOSPITAL COURSE — Later in the hospitalization, the serum calcium increased to 14 mg/dL, and a serum mid-chain parathyroid hormone level was increased at 246 pg/mL. A skin biopsy revealed diffuse subcutaneous and vascular calcification with in situ thrombosis. A bone scan is shown

الفحص السريري Clinical Exam

PHYSICAL EXAMINATION — Afebrile; respirations 24 on the ventilator; blood pressure 100/90. General: chronically ill appearing. Chest: scattered rhonchi. Cardiac examination: II/VI systolic ejection murmur at the left sternal border. Skin: multiple plaque-like lesions with areas of necrosis, ulceration, and eschars.

التشخيص التفريقي DD

???

الاستقصاءات Investigations

LABORATORY FINDINGS — Hct 19.7 percent; WBC 14,500/mm3. Na+ 125 mEq/L; K+ 3.6 mEq/L; Cl - 89 mEq/L; HCO3 -16 mEq/L; BUN 95 mg/dL; creatinine 10.3 mg/dL; phosphate 6.5 mg/dL; calcium 7.2 mg/dL. Chest radiograph : diffuse infiltrates. Right heart catheterization: PAOP 12 mmHg; CI 3.7 L/min/m2; SVR 1170 dyne sec cm -5.

التدبير Managment

???

كتابة حرة وطرح موضوع النقاش!

QUESTION — What is the cause of the patient's respiratory failure?


ورم لدى طفل ؟ |

حالة سريرية

الوصف الكامل Background
A 15-year-old with tibial pain (which is worse at night and relieved by aspirin) has a small hypodense area surrounded by reactive bone formation on x-ray. What is the likely diagnosis?

ابتلاع شكالة ؟ |

حالة سريرية

الوصف الكامل Background

راجع شاب 28 سنة قسم الاسعاف بعد ابتلاع شكالتين معدنيتين منذ 6 ساعات . أظهرت الصورة الشعاعية أن الشكالتين متوضعتين بالأمعاء الدقيقة , ما التدبير الأمثل للمريض ؟
1- اعطاء صادات وريدية
2- اعطاء 250 ملغ سيترات مغنزيوم لتحريض الاسهال
3- المتابعة بالصور الشعاعية و فحص البطن
4- تداخل جراحي فورا


كتلة بعد استئصال كولون تام ؟ |

حالة سريرية

الوصف الكامل Background

فتاة 18 سنة خضعت لاستئصال كولون تام بسبب داء البوليبات الغدية الكولونية العائلية . بعد سنتين من الجراحة شوهدت كتلة لا عرضية 4 سم بجدار البطن مكان الشق الجراحي , ما التدبير الملائم؟
1- شوط من الستيروئدات ومثبطات المناعة
2- شوط من مثبطات المناعة
3- تطبيق علاج شعاعي
4- الاستئصال الواسع للكتلة
5- لا علاج .


حادث مروري + نزف شديد = رغم ذلك كان الضغط طبيعياً |

حالة سريرية

الوصف الكامل Background
A 27-year-old man is involved in a motor vehicle accident and sustains massive blood loss. Paramedics report an initial blood pressure of 110/65 mmHg.

What anatomical structures are involved in the afferent pathway of the physiologic response to maintain this patient's blood pressure?

A. Aortic arch transmits via vagus nerve to medulla
B. Aortic body transmits via vagus nerve to medulla
C. Carotid body transmits via glossopharyngeal nerve to medulla
D. Carotid sinus transmits via glossopharyngeal nerve to medulla
E. Carotid sinus transmits via vagus nerve to medulla


رجل تعرض لحادث مروري ،،، ماذا تفعل؟ |

حالة سريرية

الوصف الكامل Background
A 33-year-old man has suffered severe head trauma in a motor vehicle accident. Which of the following precautionary treatments would be most appropriate?

A. Hyperventilation
B. Hypoventilation
C. Intravenous hypotonic saline
D. Intravenous thiamine
E. Lumbar puncture

قرحة ضغط .. |

حالة سريرية

الوصف الكامل Background
You are on rounds at the nursing home when you are asked to see an 83-year-old retired
farmer who is bed-ridden. The aide is concerned because she has noticed an area on his coccyx
that is broken down. You examine the skin and determine that there is a partial thickness skin
loss, which involves the epidermis. What stage is this pressure ulcer?
(A) Stage I
(B) Stage II
(C) Stage III
(D) Stage IV

حالة سبات |

حالة سريرية

الوصف الكامل Background

أتت السيدة (م.س) البالغة من العمر 60 عاما بحالة بسبات مع فرط تهوية دون تعرضها لقصة رض ولدى سؤال مرافقيها تبين أنها مصابة بالقصور الكلوي المزمن والداء السكري منذ عدة سنوات وكذلك تبين أنها استأصلت كتلة (ميلانوما) خلف الاذن مع انتقالات ورمية للدماغ.....

ولقد تم إجراء العديد من الفحوصات السريرية والكيميائية ولكنني لم ادرجها الآن منتظرا منكم أن تتطلبوها لأجيبكم بالفحص وبنتيجته

من الواضح في قصة السريرية أن المريضة مؤهبة لحدوث السبات لعدة اسباب........

بانتظار مشاركتكم


Eldery with pallor |

حالة سريرية

الوصف الكامل Background
An 80-year-old female is brought to your office, by her son, because of severe fatigue. She lives alone and is suffering from severe degenerative joint disease, which puts her in a house arrest-type state. Her son usually helps with getting grocery. Her only other medical problem is hypertension. She takes hydrochlorothiazide and acetaminophen. Her vitals are stable. On examination, she has pallor, and evidence of severe degenerative joint disease. Which of the following is the most likely cause of pallor in this patient?

A. Vitamin D deficiency
B. Vitamin C deficiency
C. Iron deficiency
D. Folate deficiency
E. Chronic hemolysis
F. Anemia of chronic disease
G. Vitamin B12 deficiency
H. Copper deficiency


What to say |

حالة سريرية

الوصف الكامل Background
Mr. Mathews is a 44-year-old man who came to you with several episodes of hemoptysis 2 months ago. He has been smoking 2-3 packs for the last 24 years. After complete examination and chest X-ray you suspected a lung malignancy. You ordered CT chest and bronchoscopy with biopsy. The patient went on a vacation to Aruba. In the mean time you get back the results, which shows that tumor, has spread to hilar and mediastinal lymph nodes with bony extension. He has an appointment with you to discuss the results of the findings. What is the most appropriate statement to start the discussion?

A. Mr. Mathews, How much would you like to know about your condition?
B. Mr. Mathews, I am sorry to tell you that you have lung cancer and it is fairly advanced.
C. Mr. Mathews, What do you think about your symptoms?
D. Mr. Mathews, Unfortunately, the situation is more serious than what I earlier thought.
E. Mr. Mathews, Would you like to have some one else with you as I don't have good news for you?


بعد كسر بالعضد |

حالة سريرية

الوصف الكامل Background

A 34-year-old Hispanic male comes in after being involved in a
street fight. He complains of painful and swollen left arm. X ray
shows fracture of midshaft of humerus. The neurovascular
examination is normal in left arm. Closed reduction of facture is
done and arm is kept in hanging cast. One hour later the patient
complains of numbness in the left wrist with marked limitation of
extension at wrist. Which of the following is the most likely
diagnosis at this time?
A.Radial nerve injury.
B.Brachial artery injury.
C.Compartment syndrome.
D.Ulnar nerve injury.
E.Median nerve injury


ما سبب الألم البطني ؟ |

حالة سريرية

الوصف الكامل Background

A 32-year-old man has had increasing lower abdominal pain, mild
diarrhea and rectal pain on defecation, since 3 days. 10 days ago
he had right lower quadrant (RLQ) pain, for about 24 hours that
resolved spontaneously. Since then, he has had malaise and low-
grade fever. His vital signs are, PR: 110/min; BP: 150/90mm of
HG; RR: 15/min; Temperature: 38.7C(101.6F). He has low
abdominal tenderness, without rebound. No masses are palpable.
Bowel sounds are present. Rectum is very tender and boggy and a
fluctuant bulging is palpated with the tip of the finger anteriorly.

Laboratory results are:
Hb
13.5
WBC
16,700cmm
ESR
38
Most probably this is a complication of:

A.Anorectal abscess

B.Invasive diarrhea
C.Acute appendicitis

D.Diverticulitis

E.Colon cancer


بعد الجراحة2 |

حالة سريرية

الوصف الكامل Background

A 45-year-old woman underwent elective surgery for an inguinal
hernia. In the postoperative recovery room, she developed
nausea, vomiting, and acute abdominal pain. Her other medical
problems include systemic lupus erythematosus, pernicious
anemia, type-1 diabetes, chronic low back pain, and uterine
fibroids. Her preoperative medications include monthly vitamin B-
12 injections, insulin, prednisone, hydroxychloroquine, and
acetaminophen. Her blood pressure is 70/40 mmHg and heart rate
is 110/min. Initial labs showed blood glucose of 50 mg/dL. What is
the most probable cause of this patient’s condition?

A.Postoperative bleeding

B.Diabetic ketoacidosis

C.Intra-abdominal abscess

D.Intestinal obstruction
E.Adrenal insufficiency

F.Allergic reaction

G.Insulin-induced hypoglycemia

H.Atelectasis

I. Bleeding into uterine fibroid


بعد الجراحة |

حالة سريرية

الوصف الكامل Background

A 35-year-old Mexican male undergoes an exploratory laparotomy,
for intractable abdominal bleeding. A ruptured spleen is found and
a splenectomy is performed. During anesthesia he is administered
oxygen, nitrous oxide, muscle relaxant and narcotics. Surgery is
uneventful and no blood products are administered. His vitals
immediately after extubation are, RR: 9/min; BP: 160/90mm Hg;
PR: 130/min. His neurological examination is normal. However, his
vitals after 1 hour are RR: 7/min; BP: 110/60mm Hg; PR: 70/min.
His arterial blood gases show pH: 7.30; pCO2: 50 mmHg and pO2:
70 mmHg. What is the most likely cause of these findings?

A.Postoperative hypotension due to bleeding.

B.Cardiogenic shock.
C.Delayed emergence from anesthesia.

D.Another source of bleeding, which was overlooked.
E.Acute respiratory distress syndrome


اطلاع المريض على سجله الطبي |

حالة سريرية

الوصف الكامل Background
A 27-year-old office manager with a history of generalized anxiety has had multiple recent visits to the physician for a several month history of fatigue. Evaluation thus far has revealed a normal physical examination as well as screening laboratories that are within normal limits. The serum thyroid- stimulating hormone level is 2.3 µU/mL. Inquiring about specific symptoms of depression on the last visit yielded the diagnosis of depression, and treatment options were discussed with her. On this visit she expresses frustration that a medical etiology of her fatigue has not been identified and she demands to see the clinic notes from her last several visits. Which of the following would be the most appropriate response the physician could make?

A.Agree to show her the records only after she undergoes treatment for her depression
B.Attempt to arrange to review her clinic records with her as soon as possible
C.Discuss her case with a lawyer prior to showing her the records
D.Explain to her that physician-patient confidentiality prohibits her from seeing her medical record
E.Immediately make copies of her medical record for her to review at her convenience


اختلاط لتركيب شنط دماغي |

حالة سريرية

كتابة حرة وطرح موضوع النقاش!

A 2-year-old boy was diagnosed with hydrocephalus shortly after birth. At age 3 months he
had a ventriculoperitoneal shunt placed. The family has been instructed to manually pump the
shunt at regular intervals, and they know where the pump is located over the rib cage. In the
last 3 days the child has become irritable, complains of headache, and has developed nausea
and vomiting. This morning the family noted impairment of upward gaze. These symptoms
suggest which of the following situations?
A. Intracranial bleeding
B. Obstruction of the shunt
C. Shunt infection
D. The child has outgrown the shunt
E. The child no longer needs the shunt


what are the DDs-case1 from step2 cs |

حالة سريرية

الوصف الكامل Background
HPI: The patient is a 51 yo construction worker complaining of lower back pain that started after lifting heavy
boxes 1 week ago. The pain is 8/10, is sharp, and radiates to the left thigh and sometimes to the left foot. Pain
worsens with movement, cough, and sitting for a long time. Pain is relieved by lying still and partially by
ibuprofen. He denies urinary or stool incontinence or weakness or loss of sensation in the lower extremities. No
fever, night sweats, or weight loss. He does report difficulty urinating and incomplete emptying of the bladder
for 6 months as well as a 1-year history of intermittent lower back pain and leg pain with ambulation that resolves
with sitting.
ROS: Negative except as above.
Allergies: Penicillin (causes rash).
PMH: None.
PSH: None.
SH: One PPD for 18 years, drinks a couple of beers on weekends, CAGE 0/4.
FH: Noncontributory.
Physical Examination
Patient is in mild distress due to back pain.
Back: Mild paraspinal muscle tenderness bilaterally, normal range of motion. No warmth or erythema.
Extremities: 2popliteal, dorsalis pedis, and posterior tibial pulses bilaterally. Hips normal, nontender range of
motion bilaterally.
Neuro: Motor: Strength 5/5 throughout, including left great toe dorsiflexion. DTRs: 2symmetric, _Babinski
bilaterally. Gait: Normal (including toe and heel walking), although walks with back slightly bent forward.
Straight leg raising negative bilaterally. Sensation: Intact
What are your DD? What are your diagnostic work up?

قصة المرض الحالية : مريض 51 سنة , عامل بناء , يشكو من الم اسفل الظهر بدأ بعد حمله لصندوق ثقيل من اسبوع مضى , المه حاد وينتشر للفخذ الايسر وبعض الاحيان للقدم اليسرى وحدد المريض درجة المه –على مقياس من عشرة بحيث 1 هو الاخف و10 الاشد – ب 8 من 10 .
يسوء الالم بالحركة والسعال والجلوس لفترات طويلة , ولكنه يتحسن بالاستلقاء وجزئيا ب الايبوبروفين (مضاد التهاب غير ستيروئيدي) .
ينكر المريض عدم استمساك غائطي او بولي او ضعف او فقد حس بالطرف السفلي , لا حرارة او تعرق ليلي او نقص وزن . لا يشكو من صعوبة تبول او افراغ غير كامل للمثانة
لمدة ستة اشهر, ولديه الم اسفل ظهر و الم قدم متقطع من سنة .
فصح باقي الاجهزة : سلبي ما عدا ما ذكر فوق
تحسس : البنسلين ويسبب طفح
سوابق مرضية : لا يوجد
سوابق جراحية : لا يوجد
قصة اجتماعية : مدخن باكيت يوميا لمدة 18 سنة ,يشرب كأسي بير باعطل نهاية الاسبوع
سوابق عائلية : لا يعلم
الفحص السريري : المريض متضايق قليلا بسبب الالم الظهري
الظهر : مضض بالعضلات جانب الظهرية بالجانبين , مجال حركة طبيعي , لا حرارة او احمرار
الاطراف :2+ المأبضي ظهر القدم و الظنبوبي الخلفي مجسوسة بالطرفين , الورك طبيعي لاتحدد بالحركة بالجانبين .
عصبيا : حركيا : القوة 5 من 5 بكل الاطراف
المنعكسات : متناظرة ++
لا يوجد بابنسكي
المشية : طبيعية ( متضمنة المشي على الكعب و لاصابع ) ,لازك سلبية .
الحس : سليم


Good ethics Q |

حالة سريرية

الوصف الكامل Background
You are called to see a 75-year-old man who has metastatic lung cancer because of hypoxia, hypotension, and mental status changes. He has been your patient for many years and he has told you multiple times that he does not want to be placed on a respirator for any reason. On multiple occasions after his wife died, he has explained to you that if he was ever in a situation where mechanical respiration or any heroic measures should become necessary, that he would prefer to simply be made comfortable and be "allowed to go." He has a living will, which states that if he was in a terminal condition he does not want any life sustaining treatments including hemodialysis, intubation, and cardiac resuscitation. Rather, he wants comfort care only. His two daughters and three sons are all present in the room with you. They explain to you that they are very upset by their father's condition and that they want to place him on a ventilator to help him get through this episode. You explain that their father did not want aggressive medical care at the end of life, but the family insists on intervention. They threaten to sue you for malpractice if he dies. His temperature is 37.0 C (98.6 F), blood pressure is 75/40 mm Hg, pulse is 130/min, and respirations are 29/min. Physical examination shows a cachetic man in moderate respiratory distress. He is extremely disoriented and agitated and appears to be in pain. The most appropriate course of action at this time is to
A. ask the family to leave and inject a lethal dose of morphine in accordance with the patients wishes

B. do not intubate patient but administer morphine and dopamine together to alleviate his suffering while maintaining his blood pressure

C. do not intubate the patient but administer morphine for comfort even though this might lower his blood pressure and respiratory rate and hasten the patient's demise

D. contact the hospital ethics committee to decide on the proper course of action

E. intubate the patient for now; when the situation is more stable discuss the patient's end of life wishes with the family


Ethics case |

حالة سريرية

الوصف الكامل Background

An HIV-positive 37-year-old homeless man with schizophrenia, paranoid type, is admitted to the hospital because of a dry cough, hemoptysis, weakness, fever, sweating, and weight loss. He came voluntarily, wanting to get "something for the cough" but after the necessary tests were performed he was admitted because of the possibility of active tuberculosis. On the unit he is started on anti-tuberculosis medication and antipsychotics. Initially he is cooperative with therapy. After two days in the hospital, however, he begins yelling at the nurses and demands to be discharged. He is determined to get out of the hospital and any conversation to persuade him that he needs treatment is futile. He threatens to sign himself out of the hospital against medical advice. Which of the following facts should lead the physician in charge of his care to justify involuntary commitment?

A.
The patient has schizophrenia

B.
The patient has tuberculosis

C.
The patient is agitated

D.
The patient is HIV positive

E.
The patient is homeless and unable to keep follow-up appointments


Challenging case |

حالة سريرية

الوصف الكامل Background

A 68-year-old woman comes to the physician's office because of recent depression. She feels tired, lazy, has no energy, and describes herself as being in "slow motion." She has difficulty concentrating and is very forgetful. She feels down and describes herself as apathetic. She sleeps and eats more than usual and has gained some weight. She has no prior history of mental illness and her family history is negative. She denies any recent stressors and so does her family. The treating physician remembers that a first episode of depression in later life is not uncommon. In diagnosing and treating major depressive disorder in a patient with no prior psychiatric history, however, one should always rule out organic etiologies of depression. Which of the following disorders presents with a clinical picture of retarded depression?

A.
Hyperthyroidism

B.
Islet cell tumors

C.
Multiple myeloma

D.
Pheochromocytoma

E.
Vitamin D deficiency


الزلة التنفسية 3 |

حالة سريرية

الوصف الكامل Background

مريض سكري من النمط الأول عمره 49 سنة جاء بقصة زلة جهدية منذ شهرين . تسوء الز لة بعد مسير 2-3 blocks.نفى المرض وجود ألم صدري أو في الفك أو الحلق أو اليد عند الجهد أو الراحة.
يتناول المريض إضافة للأسولين الأسبرين وAtorvaststin (خافض لشحوم الدم ) .
بالفحص السريري كان الضغط 160/90 بينما كانت بقية الفحوص وإيكو القلب ضمن الحدود الطبيعية .
ما هو التشخيص الأكثر احتمالاً :
A -آفة رئوية سادة مزمنة
B - اعتلال قلب توسعي
C- آفة في الأوعية الإكيلية
D - ضيق أبهري
E - تليف رئوي

: الجواب هو رقم C
الهدف من هذه الحالة : دراسة ما يسمى ( Anginal equivalent ) أو مشابهات الخناق عند مريض سكري
يجب الاشتباه بوجود مشابهات الخناق عند هذا المريض السكري ( Anginal equivalent ) حيث أن المرضى السكريين قد لا يشعرون بالألم الخناقي ( الألم الصامت ) لذا يجب هنا إجرء اختبار الجهد للتأكد .
بما أن الفحوص الأخرى الرئة والقلب طبيعية فهذا يبعدنا عن التفكير بالآفات الرئوية السادة المزمنة والتليف الرئوي وتضيق الأبهر . أما اعتلال القلب التوسعي فهو ممكن ولكنه اقل احتمالاً من آفات الأوعية الاكليلية وإمكانية علاجه أقل .
تعد المعالجة بالنترات والنتروغليسرين أمراً ضرورياً عند هذا المريض .وهنا نشير إلى أنه عندما تكون عند مريض قصة سكري وارتفاع بالتوتر الشرياني يجب إعطاؤه مثبطات خميرة تحول الأنجيوتنسين للسيطرة على ارتفاع الضغط وللوقاية من حدوث آفة متقدمة في الأوعية الاكليلية . وحتى عند المرضى الذين ليس لديهم ارتفاع في التوتر الشرياني فإن إعطاء كميات منخفضة من مثبطات خميرة الأنجيوتنسين يساهم في خفض نسبة الوفيات وخفض نسب حدوث الاحتشاء وقصور القلب عند المرضى المؤهبين لذلك كما آن نسب الاختلاطات العينية والكلوية بسبب السكري تنقص أيضاً عند تناول هذا الدواء .


female with lower GI bleeding |

حالة سريرية

الوصف الكامل Background

45 years old married lady came to ER complaining of abdominal pain for the last 3 days and today she noticed blood in her stools, no diarrhea, no constipation, no previous history of hemorrhoids or anal pain.

the patiant is hyperlipidemic and suffers multi-arthralgias and she is using the following perscribed medications:

tramadol
diclofenac sodium
pravastatin
orlistat
calcium carbonate + vit d3
adavit
lansoprazole

كتابة حرة وطرح موضوع النقاش!

what do you think is happening with the patiant?

what is your next step?


Ethics case |

حالة سريرية

الوصف الكامل Background
A 70YO patient and long-time friend of yours comes to the office for routine check-up . Near the end of the visit , she asks you to write a medical condition letter so she can get a refund on the airline ticket she purchased several months ago . She discloses that they recently lowered their fares for her flight next week , and she would like to get her money back and buy a new ticket at the lower peice

You decide to

A/ Not write the letter and tell her why you cannot
B/ Write a letter to the airline asking them to change their refund policy
C/ Write the letter she asks , but only this once
D/ Not write the letter and report her to the airline for attempted fraud
E/ Tell her to write the letter and use your name


weight gain |

حالة سريرية

الوصف الكامل Background

44yo f presetns with a weight gain of >11 kg
over the past 2 months.
she quit smoking 3 months ago and is on amitriptyline for deppression
she also reports cold intorelance and constipation
what are the differential diagnosis?I need 5
and what is the workup"tests"

الشكوى الرئيسية CC

weight gain


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


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?

A neuropthalmological case |

حالة سريرية

الوصف الكامل Background
A case presentation to Final Year medical student .
كتابة حرة وطرح موضوع النقاش!
Question 1
What is the clinical sign?
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