Port Said University 20-9-2023 SO ee Internal Medicine I EBE- Paper 2 Ma"ks:?? A 67-year-old hypertensive heavy smoker gentleman comes to the ER with sudden onset of complete paralysis of the right side of the body. His last time to be seen normal was just two hours ago. On neurological evaluation; both right arm and right leg were affected to nearly the same degree. His right nasolabial fold is markedly obliterated and his speech is slurred. Despite this, he is completely aware of his surroundings and has normal memory and affect. His sensory examination is normal, No visual field affection is detected. On eliciting superficial planter reflex, his right toe is upgoing. Concerning the previous case scenario, answer all of the following questions I- Name the most possible diagnosis of this acute problem (specify). 2+ Mention the risk factors in this neurologic disorder (in general) 3- Determine the site of the lesion in the nervous system. 4- Mention the significance of the underlined sentence. 5- Name the most urgent investigation you may order. A 49 years old woman presents with diarrhea for 1 month of diarrhea deseribedas 2 to 5 semi-formed stools per day that are non-blody, greasy and foul smelling. She is constantly “gassy” and bloated. She notes a decreased appetite, mild fatigue and a 4 kgs weight loss over the past 2 months. She lives with her husband in Cairo and returned from a vacation in Thailand 6 weeks ago. 1- Explain your approach for a case with such complaint An active 52 years old man .suffering from COPD. Presented to ER_ with Sudden right side sharp chest pain following A cute episode of coughing. On examination: He was distressed anxious, B.P : 125/80 mmHg , a sinus tachycardia of 110 beats/min., Afebrile, R.R: 30 breaths/min with no cyanosis. On respiratory examination, the breath sounds on the left side were harsh vesicular in nature with expiratory wheeze but the Right side was hyper resonant on percussion and on auscultation breath sounds of reduced intensity. Investigations: CBC: platelet count of 487 109/1., Renal and liver function tests were normal. 1: Name the provisional diagnosis of this ca 2: Mention the needed investigation to confirm your provisional diagnosis. 3: Describe the plan of treatment of this case Page 1 of 24; Enumerate dcauses of acute dyspnec. 5: Mention 5 complications of pneumonia A 73 years old man with a history of hyperlipidemia an hypertension evaluated in the emergency room after a syncopal event. He was doing some exercise , became “winded,” and suddenly “blacked out.” He remarks that he has has two other episodes of syncope over the past 3 months, an has developed cccasional exertional chest discomfort over the past year. His medications included lisizopril (ACEI) an simvastatin (statin). On assessment, vitals are BP 146/ 87 mmHg , HR 102 bpm an irregular, with normal respirations at 14 breaths/ min. Examination is notable for a I1I/ VI late- peaking systolic murmur most audible at the right upper sternal border, which obliterates the second heart sound and radiates to the carotid arteries. His carotid pulse is blunted , an the upstroke is delayed compare to his heart sounds on auscultation. Name the provisional diagnosis 2. Mention possible differential diagnosis for this condition 3. Determine the needed investigations in this case 4. Discuss the plan of management 5. “Mention the possii eee 55 years old female patient in the endocrive clinic referred by primary care physician for evaluation .she reported lethargy ,fatigue ,recurrent loin pain and constipation. Serum caleium 12mg {dl and abdominal ultrasound showed bilateral backpressure and hydronephrosis (renal stones ). 1. List the most common causes of this condition. 2. Mention the other possible investigations helpful in diagnosis End of Questions Page 2 of 2