Digested MP3 Series

Cases

Dr Osama Mahmoud Revision

Year 2009
Written by : Ahmed L. Nour
Formatted by : Yahya O. Emara
Al Azhar Medical School
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‫ﻃﺐ اﻷزﻫﺮ‬ ‫‪Cases‬‬ ‫‪Digested MP3s‬‬

‫ﻃﺮﻳﻘﺔ ﺣﻞ ﺍﻟﻤﺴﺎﺋﻞ‬
‫ﻋﺎﻳﺰﻳﻦ ﻧﻌﺮﻑ ﻃﺮﻕ ﺣﻞ ﺍﻭ ﺍﻧﻮﺍﻉ ﺍﻟﻤﺴﺎﺋﻞ ﻓﻴﻪ ﺣﻮﺍﻟﻲ ‪ 76‬ﻧﻮﻉ ﻣﻦ ﺍﻟﻤﺴﺎﺋﻞ ﻭﻧﺨﺘﺼﺮﻫﻢ ﺍﻟﻰ ﺍﺭﺑﻌﺔ‬
‫ﺍﻧﻮﺍﻉ ﺑﺎﻟﻜﺘﻴﺮ‬

‫النوع األول‬
‫ﻣﺴﺎﻟﺔ ﺗﺘﺤﺪﺙ ﻋﻦ ﻧﻔﺴﻬﺎ ﻭﺃﻱ ﻣﺴﺎﻟﺔ ﻭﺍﺿﺤﺔ ﻻ ﻳﺨﺘﻠﻒ ﻋﻠﻴﻬﺎ ﺍﺗﻨﻴﻦ‬
‫ﻣﺜﺎﻝ‬
‫‪Female 20 y complaining of arthropathy , erythema in face and was treated with‬‬
‫‪cortisone‬‬
‫ﻫﻞ ﻣﻤﻜﻦ ﻧﺨﺘﻠﻒ ﻋﻠﻰ ﺍﻥ ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﺍﻛﻴﺪ ﻫﺘﻜﻮﻥ‪S.L.E‬‬

‫ﻧﺎﺧﺪ ﻣﺜﺎﻝ ﺗﺎﻧﻲ ﻟﻤﺴﺄﻟﻪ ﺗﺘﺤﺪﺙ ﻋﻦ ﻧﻔﺴﻬﺎ‬

‫‪Child 12 y complained of sore throat followed by oliguria , hematuria‬‬
‫ﻃﺒﻌﺎ ﺍﻟﻤﺴﺄﻟﻪ ﻻ ﻳﺨﺘﻠﻒ ﻋﻠﻴﻬﺎ ﺍﺣﺪ ﺍﻧﻬﺎ‪post streptococcal gn‬‬

‫المسأله التانيه‬
‫ﺍﻟﻤﺴﺄﻟﻪ ﻣﺶ ﺑﺘﺘﺤﺪﺙ ﻋﻦ ﻧﻔﺴﻬﺎ ﺑﺲ ﻟﻴﻬﺎ ﻃﺎﻟﻌﻪ ﺷﻬﻴﺮﻩ ﻳﻌﻨﻲ ﺃﻭﻝ ﺍﻧﻄﺒﺎﻉ ﻳﺒﺪﺃ ﺑﺠﻤﻠﻪ ﺷﻬﻴﺮﻩ‬
‫ﻣﺜﺎﻝ‬
‫‪Old male heavy smoker _______ bronchogenic carcinoma‬‬
‫______________ ‪Old male complaining of polyache and elevated ESR above 100‬‬
‫‪multiple myloma‬‬

‫النوع التالت‬
‫ﻣﺴﺎﻟﺔ ﻻﺗﺘﺤﺪﺙ ﻋﻦ ﻧﻔﺴﻬﺎ ﻭﺧﺎﻟﻴﻪ ﻣﻦ ﺍﻟﻄﻠﻌﺎﺕ ﺑﺲ ﻓﻴﻬﺎ ‪ common s&s‬ﻭﻛﻤﺎﻥ ‪almost‬‬
‫‪specific‬ﺧﺪ ﺑﺎﻟﻚ ﻣﻦ ﺍﻟﻤﻌﻨﻰ ﻣﺜﺎﻝ ﻋﻤﺎﻝ ﻳﺤﻜﻲ ﻭﻳﺤﻜﻲ ﻭﻓﻲ ﺍﻟﻨﺺ ﺟﺎﻳﻠﻚ ‪ hematemsis‬ﻳﺒﻘﻰ‬
‫ﻫﻲ ﺍﻟﻤﻮﺿﻮﻉ ﺍﻣﺴﻜﻬﺎ ﻭﺃﺷﻮﻑ ﺇﻳﻪ ﺍﻟﺤﺎﺟﺎﺕ ﺇﻟﻲ ﻣﻤﻜﻦ ﺗﻌﻤﻠﻬﺎ ﻭﺍﺷﺘﻐﻞ ﺍﻟﻤﻮﺿﻮﻉ ﻛﻠﻪ ﻋﻠﻰ‬
‫ﺍﻷﺳﺒﺎﺏ ﺩﻱ‬
‫ﻭﻧﺸﻮﻑ‬
‫ﻃﺐ ﻫﻮ ﻳﻌﻨﻲ ﺇﻳﻪ ‪common symptoms‬ﻳﻌﻨﻲ ﺇﻳﻪ ﻳﻌﻨﻲ ﻟﻴﻪ ﺃﺳﺒﺎﺏ ﻣﺘﻌﺪﺩﺓ ﻭﻣﻌﺮﻭﻓﻪ ﺯﻯ‬
‫‪Frank hemoptysis‬‬
‫ﻃﻴﺐ‬
‫ﺃﻻﻗﻴﻪ ﻓﻴﻦ ‪pulsus paradoxicus‬‬
‫‪• cardiac temponad‬‬
‫‪• acute severe asthma‬‬

‫النوع الرابع من المسائل‬

‫ﺯﻯ ﺍﻟﻔﻜﺮﺓ ﺍﻟﺘﺎﻟﺘﻪ ﺑﺲ ﻣﺪﻣﺠﻪ ﻳﻌﻨﻲ ﺃﻋﺮﺍﺽ ﻭﻋﻼﻣﺎﺕ ﻣﻌﻴﻨﻪ ﻟﻤﺎ ﻳﺠﺘﻤﻌﻮﺍ ﻣﻊ ﺑﻌﺾ ﻳﺸﻴﺮﻭﺍ‬
‫ﻷﺳﺒﺎﺏ ﻣﺤﺪﺩﻩ‬

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

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‫ﻃﺐ اﻷزﻫﺮ‬ ‫‪Cases‬‬ ‫‪Digested MP3s‬‬

‫ﻣﺜﺎﻝ‬
‫ﻟﻮ ﺍﻟﻤﺮﻳﺾ ‪ dyspnic‬ﻭﻣﻌﺎﻩ ‪chest pain‬‬
‫ﺍﻟﺤﺎﺟﺎﺕ ﺇﻟﻲ ﺑﺘﻌﻤﻞ ‪ chest pain‬ﻛﺘﻴﺮ ﺑﺲ ﻣﻊ ﻭﺟﻮﺩ‪dyspnea‬‬
‫ﺑﻴﺘﻮﺟﻪ ﺗﻔﻜﻴﺮﻧﺎ ﻟﺤﺎﺟﺎﺕ ﻣﻌﻴﻨﻪ ﺑﻤﻌﻨﻰ ﺍﻥ‪ s&s‬ﻣﺪﻣﺠﻴﻦ ﻣﻊ ﺑﻌﺾ ﻳﺸﻴﺮﻭﺍ ﻭﻳﺤﺼﺮﻭﺍ ﺍﻻﺣﺘﻤﺎﻻﺕ ﻓﻲ‬
‫ﻋﺪﺩ ﻣﻌﻴﻦ ﻣﻦ ﺍﻻﺣﺘﻤﺎﻻﺕ‬

‫ﻃﻴﺐ ﺇﻳﻪ ﺍﻟﻔﻜﺮﺓ ﻣﻦ ﺍﻟﻤﺴﺎﻟﺔ ﺗﻼﺗﻪ ﻭﺍﺭﺑﻌﻪ‬

‫ﺍﻧﺎ ﻫﻤﺴﻚ ﺍﻷﻋﺮﺍﺽ ﺍﻟﻠﻲ ﻋﻨﺪﻱ‬
‫ﻣﺜﺎﻝ‬
‫‪dyspnea and chest pain‬‬
‫ﺍﺟﻴﺐ ﺍﻷﺳﺒﺎﺏ ﺇﻟﻲ ﺗﻌﻤﻠﻬﻢ ﻣﻌﺎ‬
‫ﺃﻓﻜﺮ ﻓﻲ ﺇﻳﻪ‬
‫‪1 – pulmonary embolism‬‬
‫‪2 – pneumo thorax‬‬
‫‪3 – myocardial infarction‬‬
‫ﻳﺒﻘﻰ ﺍﻧﺎ ﻛﻞ ﺇﻟﻲ ﻋﻠﻴﺎ ﺍﻣﺴﻚ ﺇﻝ ‪ s&s‬ﻭﺍﺑﺪﺃ ﺃﺷﻮﻑ ﺇﻳﻪ ﺍﻷﻣﺮﺍﺽ ﺍﻟﻤﺸﺘﺮﻛﺔ ﻣﺎ ﺑﻴﻨﻬﻢ ﻭﻫﻴﻜﻮﻥ‬
‫ﺍﻷﻣﺮﺍﺽ ﺩﻱ ﻫﻲ ﺣﻞ ﺍﻟﺤﺎﻟﺔ ﻭﻫﺴﺘﻨﺒﻂ ﻣﻨﻬﻢ‬
‫‪ cl\p‬ﻭﺍﻟـ ‪ Investigation‬ﺑﺘﺎﻋﺔ ﺗﻠﻚ ﺍﻷﻣﺮﺍﺽ‬
‫ﻳﺒﻘﻰ ﻟﻮ ﻓﻴﻪ ﺍﻋﺮﺍﺽ ﻭﻋﻼﻣﺎﺕ ﻣﻌﻴﻨﻪ ﻻﺯﻡ ﻋﻠﻰ ﺍﻷﻗﻞ ﺃﺗﻜﻠﻢ ﻋﻦ ﺗﻼﺗﻪ ﻣﻦ ﺇﻝ ‪ DD‬ﺑﺘﺎﻋﺘﻬﻢ‬

‫ﻣﺜﺎﻝ‬
‫‪hematemsis‬‬
‫ﻳﺒﻘﻰ ﻋﺎﻳﺰﻙ ﺗﺘﻜﻠﻢ ﻋﻦ ﺇﻳﻪ‬
‫ﻋﻦ ﺇﻝ ‪ s&s‬ﺑﺘﺎﻋﺔ ﻣﺜﻼ ﺗﻼﺗﻪ ﻣﻦ ﺍﻟﺤﺎﺟﺎﺕ ﺇﻟﻲ ﺑﺘﺴﺒﺒﻪ ﺯﻯ‬
‫) ‪( rupture varises – duodenal ulcer – gastric ulcer‬‬
‫ﻭﺍﻟﺠﻤﻴﻞ ﻓﻲ ﻛﺪﻩ ﺍﻧﻚ ﻫﺘﻜﻮﻥ ﺣﻮﻟﺖ ﺍﻟﺤﺎﻻﺕ ﻣﻦ ﺣﺎﻟﻪ ﻝ ‪ essay‬ﺑﺲ ‪short‬‬

‫نبدأ مع الحاالت وھنبدا بسنة ‪81‬‬

‫‪1- YOUNG MAN WAS ADMITTED TO HOSPITAL COMPLAINING OF COLLAPSE AFTER‬‬

‫‪PASSING BLACK SOFT STOOL HIS PULSE 110 BL.P 60/90‬‬

‫ﻳﺒﻘﻰ ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﻗﺒﻞ ﻣﺎﺍﺑﺺ ﻋﻠﻴﻬﺎ‬

‫‪A case of melena‬‬
‫) ‪( upper GIT bleeding‬‬
‫ﻃﻴﺐ ﻧﻔﻜﺮ ﺇﻳﻪ ﺃﻫﻢ ﺃﺳﺒﺎﺑﻬﺎ‬
‫‪1 – esophageal varises‬‬
‫‪2 – cancer stomach‬‬
‫‪3 – gastric ulcer‬‬
‫‪4 – duodenal ulcer‬‬

‫? ‪What are the important points of history and investigation‬‬

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

‫‪2‬‬
‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

‫ﻫﻤﺴﻚ ﻭﺍﺣﺪ ﻭﺍﺣﺪ ﻣﻦ ﺍﻷﻣﺮﺍﺽ ﺇﻟﻲ ﺍﻧﺎ ﺗﻮﺻﻠﺖ ﺇﻟﻴﻬﺎ ﻭﺍﺑﺪﺃ ﺍﻃﻠﻊ ﻣﻨﻬﺎ ﺍﻷﻋﺮﺍﺽ ﻭﺍﻟﻌﻼﻣﺎﺕ ﺇﻟﻲ‬
‫ﻫﺘﻜﻮﻥ ﻋﻨﺪ ﺍﻟﻤﺮﻳﺾ ﻗﺒﻞ ﺍﻟﻤﺮﺣﻠﺔ ﺩﻱ‬
‫ﻣﺜﺎﻝ‬
Esophageal varises __________ portal hyper tension
liver cirrhosis and splenomegaly‫ﺇﻳﻪ ﺃﻋﺮﺍﺿﻪ‬
‫ ﻃﺐ ﻟﻴﻪ ؟؟؟؟‬varises ‫ﻭﻫﻨﺎ ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﻏﺎﻟﺒﺎ ﻫﺘﻜﻮﻥ‬
pain‫ﻷﻧﻪ ﻫﻨﺎ ﻣﺬﻛﺮﺵ ﻭﺟﻮﺩ‬
Painless melena = rupture varises
Painful melena = peptic ulcer

Investigation ??
Upper endoscope

Treatment ???
‫ﻫﻤﺴﻚ ﻛﻞ ﻣﺮﺽ ﻣﻦ ﺍﻷﻣﺮﺍﺽ ﺇﻟﻲ ﺫﻛﺮﺗﻬﻢ ﻭﺍﻛﺘﺐ ﻋﻼﺟﻪ ﻛﻞ ﻋﻠﻰ ﺣﺪﻩ ﺑﺲ ﺧﺪ ﺑﺎﻟﻚ‬
collapse‫ﺍﻟﻤﺮﻳﺾ ﺩﺍﺧﻞ ﻓﻲ‬
‫ﻳﻌﻨﻲ ﺇﻳﻪ ؟؟؟‬
Hepatic encephalopathy
‫ﻓﻼﺯﻡ ﺗﺒﺪﺃ ﺍﻟﻌﻼﺝ ﺑﻌﻼﺟﻬﺎ ﺃﻭﻻ‬

The pt enter in irritability and coma ???

‫ﻓﻴﻪ ﺟﺪﻭﻝ ﻣﻬﻢ‬

Causes of irritable coma
1 – hypertensive encephalopathy
2- hypo glycemia and hepatic encephalopathy
3 – subdural hemorrhage
‫ﻃﻴﺐ ﺇﻳﻪ ﺍﻟﻠﻲ ﻳﻘﺼﺪﻩ ﻫﻨﺎ‬
hepatic encephalopathy
‫ﻭﻣﻨﺴﺎﺵ ﺍﻛﺘﺐ ﻋﻼﺟﻬﺎ‬

84 ‫مايو‬

57 OLD MAN WAS ENTER IN SHOCK AFTER VOMIT ING LARGE AMOUNT OF DARK
BROWN VOMITS BL. TRANSFUSION TO H IM AND THEN HE WAS CONFUSED AND
COMATOSED

‫ﺍﻧﻈﺮ ﺍﻟﻤﺴﺄﻟﻪ ﺍﻟﺴﺎﺑﻘﺔ‬

‫ﻭﻣﻦ ﺍﻻﺧﺮ ﺍﻟﺤﺎﻟﺘﻴﻦ ﺩﻭﻝ ﻋﺒﺎﺭﺓ ﻋﻦ ﺇﻳﻪ ﻏﺎﻟﺒﺎ‬
Chronic liver disease lead to cirrhosis
precipitating factors‫ﻭﺑﻌﺪﻳﻦ ﺣﺼﻞ‬
hepatic encephalopathy‫ﺩﺧﻠﺘﻬﻢ ﻓﻲ‬

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

3
‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

‫الحالة الثالثة‬

17 Y OLD GIRL HAS 3 ATTACKS OF FEVER , S O RE THROAT CHLORAMPHINICOL WAS

DESCRIBED BY HER DOCTOR AT HER FIRST ATTACK AND SHE REPEATED IT BY HER
SELF IN NEXT ATTACK SHE HAS FEVER AND SO RE THROAT BUT NOT RE SPOND TO
CHLORAMPHINICOL THIS TIME

‫ﺣﺎﻭﻝ ﺗﺤﻂ ﻋﻨﻮﺍﻥ ﻣﻌﺎﻳﺎ ﻟﻠﺤﺎﻟﺔ ﺩﻱ ﺍﻋﺘﺒﺮﻫﺎ ﻓﻴﻠﻢ ﻭﺣﻄﻠﻪ ﻋﻨﻮﺍﻥ ﺑﺲ ﺍﻗﺪﺭ ﺍﻛﺘﺐ ﻋﻠﻴﻬﺎ ﻋﻨﻮﺍﻥ ﺇﻳﻪ‬
‫ﻣﺸﻬﻮﺭ‬

( RECURRENT SORE THROA T )

‫ﻻﺯﻡ ﺃﺣﻂ ﻓﻲ ﺩﻣﺎﻏﻲ ﺃﺳﺒﺎﺑﻪ‬

A - Blood diseases as
1- leukemia
2 – a plastic anemia
3 – agranulocytosis
B – viral infection
C – bacterial infection
‫ ﺩﻩ ﻣﺮﺽ ﺑﻴﺠﻲ ﻟﻮﺣﺪﻩ‬leukemia ‫ﻃﻴﺐ ﺃﻭﻻ‬
‫ ﻓﺪﻭﻝ ﻣﻤﻜﻦ ﻳﻜﻮﻥ ﺳﺒﺒﻬﻢ‬aplastic anemia , agranulocytosis ‫ﺃﻣﺎ ﺇﻝ‬
Bone marrow depression
‫ﻣﻦ ﺇﻳﻪ ؟؟‬
Amphenicol abuse
‫ﻃﻴﺐ ﻳﺒﻘﻰ ﺍﻧﺎ ﻫﺤﻂ ﺍﺣﺘﻤﺎﻻﺕ ﺇﻳﻪ ﻟﻠﺤﺎﻟﺔ ﺩﻱ‬
1- leukemia
2 - agranulocytosis
3 – a plastic anemia
4 – other infections

‫ﺳﺆﺍﻝ‬
What are signs ?
cl / p‫ﺍﻧﺎ ﺣﻄﻴﺖ ﺗﻠﺖ ﺃﺳﺒﺎﺏ ﺍﻣﺴﻜﻬﻢ ﻭﺃﺷﻮﻑ ﺇﻝ‬
leukemia‫ﻃﻴﺐ ﺍﻣﺴﻚ ﺇﻝ‬
‫ﺑﻤﺎ ﺍﻧﻬﺎ ﻓﻲ ﻃﻔﻠﻪ ﻓﻐﺎﻟﺒﺎ ﻫﺘﻜﻮﻥ ﺇﻳﻪ ؟‬
Acute leukemia
‫ﻫﺪﻭﺭ ﻋﻠﻰ ﺇﻳﻪ‬
Liver •
Spleen •
Lymph node •
‫ﻭﺍﺧﺪ ﺑﺎﻟﻲ ﺍﻥ ﻓﻴﻪ ﺣﺎﺟﻪ ﻣﻤﻜﻦ ﺗﻌﻤﻞ ﻧﻔﺲ ﺍﻷﻋﺮﺍﺽ ﻓﻲ ﺍﻟﺘﻼﺗﻪ ﺇﻳﻪ ﻫﻲ ؟؟‬
Mononucleosis

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

4
‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

a plastic anemia‫ﻃﻴﺐ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻞ‬

‫ﻫﺪﻭﺭ ﻋﻠﻰ ﺇﻳﻪ‬

Anemia •
Repeated infection •
Bleeding •
‫ ﻭﻣﻊ ﺫﻟﻚ‬sever ‫ ﻫﻴﻜﻮﻥ‬sore throat ‫ﻃﻴﺐ ﺍﺧﺪ ﺑﺎﻟﻲ ﺍﻥ ﻓﻲ ﺍﻟﺤﺎﻟﺔ ﺩﻱ‬
No sever congestion •
No follicles nor pus •

agranulocytosis‫ﺃﻣﺎ ﻓﻲ ﺣﺎﻟﺔ ﺇﻝ‬

‫ﺃﻻﺣﻆ ﺍﻥ ﻓﻲ ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﻫﻴﻜﻮﻥ‬
Minimal signs of inflammation •
Small amount of pus •

Investigation ?
Blood picture
‫ﻭﺩﻱ ﻫﺘﻜﺸﻒ ﻭﻫﺘﺸﺨﺺ ﻟﻮ ﺍﻟﺴﺒﺐ‬
‫ﻣﻦ‬
Agranulocytosis •
Leukemia •
A plastic anemia •

infection‫ﻃﻴﺐ ﻟﻮ ﻛﺎﻥ ﺍﻟﺴﺒﺐ‬

increased lymphocyte‫ ﻫﻼﻗﻲ‬viral ‫ﻟﻮ‬
increased PNL‫ ﻫﻼﻗﻲ‬bacterial ‫ﻟﻮ‬
‫ﺳﺆﺍﻝ‬
‫ﻫﻞ ﻭﺻﻒ ﺍﻟﺪﻛﺘﻮﺭ ﻟﻼﻣﻔﻨﻴﻜﻮﻝ ﺻﺤﻴﺢ ؟‬
Not right
As it has dangerous side effects it is contra indicated except in some cases of
infection as typhoid

What about self medication ??

‫ﻳﻌﻨﻲ ﺗﻜﺮﺍﺭ ﺍﻟﺒﻨﺖ ﻟﻠﻌﻼﺝ‬
‫ﻋﺎﻳﺰﻙ ﺗﻘﻮﻝ ﺍﻥ ﺩﻩ‬
Incorrect
‫ﻟﻴﻪ ؟‬
bone marrow depression‫ ﻭﺩﻩ ﺍﺗﺴﺒﺐ ﻓﻲ‬drug abuse ‫ﻷﻧﻪ ﻋﻤﻞ‬

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

5
‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

‫الحالة الرابعة‬

33 Y OLD MAN COMPLAI N SEVER HEADACHE FOR THE PREVIOUS 12 HOUR S HE WAS
UNABLE TO TILT HIS N ECK WITHOUT PAIN HIS TEMP. 37.4 WITH HIGH BLOOD
PRESSURE

‫ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﻓﻴﻬﺎ ﺇﻳﻪ‬

Meningeal irritation
DD
1 – sub arachnoid hemorrhage
2 – meningities
3 – meningism
4 – encephalitis

Use one essential investigation ?

Lumbar puncture
‫ﻟﻴﻪ ﻻﻥ ﻟﻮ ﻛﺎﻥ ﺍﻟﺴﺒﺐ‬
Sub arachnoid hemorrhage .1
bloody CSF‫ﻫﻼﻗﻲ‬

viral or TB‫ ﺃﻣﺎ ﻟﻮ ﻛﺎﻥ ﺍﻟﺴﺒﺐ‬.2

increased lymphocyte‫ﻫﻼﻗﻲ‬

bacterial‫ ﻭﻟﻮ ﻛﺎﻥ ﺍﻟﺴﺒﺐ‬.3

increased PNL‫ﻫﻼﻗﻲ‬
sub arachnoid hemorrhage‫ﻏﺎﻟﺒﺎ ﻫﺘﻜﻮﻥ ﻓﻲ ﺍﻟﺤﺎﻟﺔ ﺩﻱ‬

‫الحالة الخامسة‬

6 Y OLD GIRL SUFFER FROM PAIN IN RT SHOU LDER AND RT KNEE INCREASE D
TEMPERATURE AND ESR ABOVE 100

‫ﻋﺎﻳﺰﻳﻦ ﻧﺤﻂ ﻋﻨﻮﺍﻥ ﻟﻠﻤﺴﺄﻟﺔ‬

( rheumatology )
( arthropathy in child )
‫ﺍﻟﺤﺎﻟﺔ ﻃﺒﻌﺎ ﻣﻠﻬﺎﺵ ﻏﻴﺮ ﺣﻞ ﻭﺍﺣﺪ ﻭﻫﻮ‬
Rh fever

‫ﻫﻜﻤﻞ ﺍﻟﺤﺎﻟﺔ ﻭﺃﺗﻜﻠﻢ ﻋﻦ‬

Cl.p •
Investigation •
Comment on prognosis •

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

6
‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

‫ ﻣﻬﻢ ﺟﺪﺍ‬DD ‫ﺑﺲ ﻓﻴﻪ‬

Stell’s disease
‫ﻭﺩﻩ ﻫﻴﺒﻘﻰ ﻣﻤﻴﺰ ﺍﻥ ﺑﻴﺒﻘﻰ ﻓﻴﻪ‬
Splenomegaly
‫ ﻓﻲ ﺍﻷﻃﻔﺎﻝ ﺗﺒﻘﻰ‬arthropathy ‫ﻋﻠﺸﺎﻥ ﺃﺣﻂ ﻓﻲ ﺩﻣﺎﻏﻲ ﺍﻥ ﻣﺶ ﻛﻞ‬
Rh fever

85 ‫مايو‬

54 Y OLD MALE IN GEN ERAL HOSPITAL WITH A CUTE CHEST PAIN FOR 45 MINUTE
HIS ECG WAS NORMAL

acute chest pain‫ﺩﻱ ﺣﺎﻟﺔ‬

‫ﻭﺍﺧﺪ ﺑﺎﻟﻲ ﻣﻦ ﺍﻟﺴﻦ‬
‫ﺗﺒﻘﻰ ﺇﻳﻪ ﺍﻻﺣﺘﻤﺎﻻﺕ ﺇﻟﻲ ﻋﻨﺪﻱ‬
Myocardial infarction .1
Unstable angina .2
Pneumothorax .3
Aortic aneurism .4
Pulmonary embolism .5
x-ray‫ ﻷﻧﻪ ﻣﺠﺒﺶ ﺳﻴﺮﺓ ﺇﻝ‬Pneumothorax ‫ﺧﺪ ﺑﺎﻟﻚ ﺍﻧﺎ ﻗﻠﺖ ﻫﻨﺎ ﺍﺣﺘﻤﺎﻝ ﺗﻜﻮﻥ‬
‫ﻭﻗﻠﺖ ﺍﻻﺣﺘﻤﺎﻝ ﺍﻷﻭﻝ ﻭﺍﻟﺘﺎﻧﻲ ﻣﻊ ﺍﻧﻪ ﻗﺎﻝ ﺍﻥ‬
Normal ECG
‫ ﺩﻗﻴﻘﻪ‬45 ‫ﻷﻧﻪ ﺍﺗﻌﻤﻞ ﺑﻌﺪ‬

)‫ ﻭﺗﺒﺪﺃ ﺗﺘﻜﻠﻢ ﻋﻦ ﺍﻷﻣﺮﺍﺽ ﺍﻟﻤﻘﺘﺮﺣﺔ‬essay ‫(ﺃﻫﻢ ﺣﺎﺟﻪ ﻓﻲ ﺍﻟﺤﺎﻻﺕ ﺍﻧﻚ ﺗﻘﺪﺭ ﺗﺤﻮﻟﻬﺎ ﻝ‬

What is your advise to the pt ?

To be admitted ( under observation )
‫ﻻﺯﻡ ﺗﺎﺧﺪ ﺑﺎﻟﻚ ﻛﻮﻳﺲ ﺟﺪﺍ‬
You must respect chest pain
Especially in old age

What particular symptoms you look for ?

‫ ﺑﺘﺎﻋﺔ ﺍﻷﻣﺮﺍﺽ ﺍﻟﻤﺬﻛﻮﺭﺓ‬cl/p ‫ﺃﺣﻂ ﺇﻝ‬

Investigations ??
x-ray
ECG
Cardiac enzymes
CT scan for aneurism

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

7
‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

‫الحالة السابعة‬

12 Y OLD GIRL COME WITH CONVULSION WITH EYE PUFFINESS B L.P WAS 170/100
PAST HISTORY OF FEVE R AND SORE THROAT TR EATED WITH PENICILLI N

‫ﺇﻳﻪ ﺍﻟﻌﻨﻮﺍﻥ ﻫﻨﺎ‬

( hyper tensive child )
‫ﻣﻠﻬﺎﺵ ﻏﻴﺮ ﻛﻠﻤﻪ ﻭﺍﺣﺪﻩ‬
( acute glomerulonephrities )

Diagnosis
Post strepto coccal glomerulonephrities

Cl/p : hematuria , oliguria ……………..

Explain the line of treatment?

AB for infection
B – blocker + diuretic for controlling the bl.p
‫ﺧﺪ ﺑﺎﻟﻚ‬
‫ ﺗﺒﻘﻰ ﺩﺍﺧﻠﻪ ﻋﻠﻰ ﺇﻳﻪ‬convulsion ‫ﺍﻟﺒﻨﺖ ﻋﻨﺪﻫﺎ‬
Hyper tensive encephalopathy
‫ﻳﺒﻘﻰ ﻻﺯﻡ ﺍﺑﺪﺃ ﺑﻌﻼﺟﻬﺎ ﺃﻭﻻ‬

What particular complications of this case ?

Chronic glomerulonephrities •
Rapidly progressive glomerulonephrities •
Liable to hyper tensive encephalopathy •
Hyper volemia lead to H.F •
Pulmonary edema •

‫الحالة الثامنة‬

5 DAYS AFTER OPERATI ON FOR FRACTURE IN A MALE AGED 73 YEARS O LD HE

DEVELOP FEVER AND RIGORS A WEEK LATER HE DEVE LOP COUGH WITH
HEMORRHAGIC SPUTUM AND SHARP PAIN AT THE LOWER RIGHT S IDE OF THE
CHEST

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

8
‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

‫ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﻓﻴﻬﺎ ﺇﻳﻪ ؟‬

( hemoptysis + chest pain )

‫ﺣﻂ ﺃﺳﺒﺎﺑﻬﻢ ﻣﻊ ﺑﻌﺾ ﺇﻟﻲ ﻫﻤﺎ ﻧﺎﺧﺪ ﺃﻫﻢ ﺍﺗﻨﻴﻦ‬

Pulmonary infarction •
Pneumonia •

‫ﻃﻴﺐ ﺍﻟﺤﺎﻟﺔ ﻋﻨﻮﺍﻧﻬﺎ ﺇﻳﻪ‬

( post operative lung manifestations )

DVT‫ﺟﺖ ﻣﻨﻴﻦ ﻣﻦ‬ Pulmonary embolism ‫ﻟﻮ‬

‫ ﺟﺖ ﻣﻨﻴﻦ‬pneumonia ‫ﻃﻴﺐ ﻋﻠﻰ ﺍﺣﺘﻤﺎﻝ ﺍﻧﻬﺎ‬
aspiration pneumonia‫ﻳﺒﻘﻰ‬
aspirated pneumonia‫ﻃﻴﺐ ﺇﻳﻪ ﺇﻟﻲ ﻳﺨﻠﻴﻨﻲ ﺃﻓﻜﺮ ﺍﻧﻬﺎ ﻫﺘﻜﻮﻥ‬
‫ﺍﻟﻤﻜﺎﻥ ﺇﻟﻲ ﻣﺤﺪﺩﻩ‬

What are points of clinical exam. ?

1 – pulmonary infarction
Look for D.V.T symptoms
Look for pleurisy
2 – aspirated pneumonia
Look for s&s of pneumonia

How to manage ??
‫ﻳﺒﻘﻰ ﻋﺎﻳﺰ ﺣﺎﺟﺘﻴﻦ‬
( diagnosis + treatment )
‫ﺃﻭﻻ‬
Diagnosis of pulmonary embolism
1- for D.V.T duplex scan on lower limb
2 – for lung lung scan
Blood picture show leukocytosis •

Diagnosis of pneumonia chest x-ray •

‫ﺗﺎﻧﻲ ﺟﺰﺋﻴﻪ ﻓﻲ ﺍﻟﺴﺆﺍﻝ‬

Treatment
Pneumonia with anti biotic •
p. embolism with heparin •
adjust the dose of heparin‫ﺑﺲ ﻻﺯﻡ‬
‫ﻭﺍﻷﻓﻀﻞ ﺍﻧﻪ ﻳﻜﻮﻥ‬
Low molecular weight heparin

Special advise to the pt ?

Proper treatment and suction for pneumonia

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

9
‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

Start walking early after operation

Prophylactic heparin
‫ﺟﺮﻋﺘﻪ ﺍﻟﺪﻭﺍﺋﻴﺔ ﻗﺪ ﺇﻳﻪ‬
l.m.w heparin 60 – 80 u / 12 h s.c
‫ﺍﻟﺠﺮﻋﺔ ﺍﻟﻮﻗﺎﺋﻴﺔ ؟‬
20 – 40 u / 12 hour s.c

‫الحالة التاسعة‬

12 Y OLD BOY PRESCRIBED WITH FEVE R . MILD JAUNDICE FOR 5 DAYS WITH SORE
THROAT WELL GENERAL CONDITI ON TEMP. 38 , ENLARG ED LYMPH NODE OF AXI LLA

‫ﻗﻠﻨﺎ ﻗﺒﻞ ﻛﺪﻩ‬

( fever + sore throat )
1- leukemia
2 - agranulocytosis
3 – a plastic anemia
4 – viral infection ( EBV – CMV)
5 – bacterial infection

‫ﺑﺲ ﻫﻨﺎ ﻣﻴﻨﻔﻌﺶ ﺣﺎﺟﺘﻴﻦ‬

A plastic anemia , agranulocytosis

‫ﻟﻴﻪ ؟؟‬
Lymph node enlargement
‫ﻃﻴﺐ‬
( fever + jaundice)
‫ﺇﻳﻪ ﺇﻟﻲ ﻳﻌﻤﻠﻬﻢ‬
1 – viral infection ( EBV – CMV )
2 – asending cholangities
3 – fulminate liver failure
4 – hemolytic crisis

What additional signs ?

‫ﺍﻧﺎ ﺣﻄﻴﺖ ﺍﺣﺘﻤﺎﻻﺕ ﺇﻳﻪ‬
Leukemia •
Infection ( mononucleosis ) •
‫ ﺑﺘﺎﻋﺘﻬﻢ‬s&s ‫ﺃﺑﺪﺍ ﺃﺩﻭﺭ ﻋﻠﻰ‬
mononucleosis‫ﻃﻴﺐ ﻓﻴﻪ ﺣﺎﺟﺎﺕ ﻣﻤﻴﺰﺓ ﻟﻞ‬
1 – pin point peteche between soft and hard palate
2 – If the pt take penicillin , maculo papular rash will develop
3 – blood picture show atypical lymphocytosis
4 - + ve agglutination test - monospot slide test Paul bunnel test
5 – EBV anti bodies IgG IgM

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

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‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

Prognosis ?
It is self limited
‫ﺑﺲ ﻋﻠﻰ ﻓﻜﺮﺓ ﻫﻮ ﻋﺮﺽ ﻟﻨﻮﻉ ﻣﻦ ﺍﻧﻮﺍﻉ ﺍﻟﻠﻴﻤﻔﻮﻣﺎ‬
Purpic cell lymphoma

infection‫ﺇﻳﻪ ﺃﻫﻢ ﺍﻟﺪﺭﻭﺱ ﺍﻟﻤﻄﻠﻮﺑﺔ ﻣﻨﻚ ﻓﻲ‬

1 – typhoid
2 – brucella
3 – mononucleosis

‫الحالة العاشرة‬

YOU WERE CALLED TO S EE 36 Y OLD HYPERTEN SIVE WOM AN ON IRREGULAR

HYPOTENSIVE THERAPY WITH INABILITY TO EL EVATE HER LT UPPER AND LOWER
LIMBS HER BLOOD PRESSURE 1 80 / 100

SHE STATED THAT SHE DID NOT TAKE HER DRU G FROM A TIME THE PU LSE WAS
IRREGULAR IRREGULARI TY

5 DAYS LATER PAIN IN RT LEG AND HER FOOT WAS PALE AND COLD 5 DAYS MORE
SHE DEVELOP DIARRHEA AND SOFT DARK STOOL

What particular nervous and vascular signs ?

stroke‫ﺩﻱ ﺣﺎﻟﺔ‬
sign of hemiplegia‫ﺩﻭﺭ ﻋﻠﻰ ﺍﻟﻘﻠﺐ ﻭﺩﻭﺭ ﻋﻠﻰ‬
leveling‫ﻭﺑﺎﻟﻤﺮﺓ ﺃﺣﺎﻭﻝ ﺍﻋﻤﻞ‬
‫ﺃﺟﺎﻭﺏ ﻋﻠﻰ ﺍﻟﻤﺴﺎﻟﺔ ﻓﻲ ﺣﻨﺔ ﺍﻟﻨﻴﻮﺭﻭ ﻋﻠﻰ ﺳﺆﺍﻝ ﻣﻬﻢ‬
what is the lesion and where ?
‫ﺛﺎﻧﻴﺎ‬
sign of hyper tension on heart‫ﺃﺑﺪﺍ ﺃﺩﻭﺭ ﻋﻠﻰ‬

Investigation ?
1 – ECG
2 – fundus examination
3 – Echo

What is the explanation of the case ?

Recurrent embolisation

Treatment ?
1 – hypotensive drug
2 – control of the heart
3 – anti coagulant after control of melena

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

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‫ﻃﺐ اﻷزﻫﺮ‬ Cases Digested MP3s

‫الحالة الحادية عشر‬

55 Y OLD MALE SMOKE 30 CIGARETTE / DAY W ITH SMOKER COUGH DEV ELOP
RECURRENT ACUTE CHES T INFECTION AFTER IT THE COUGH CHANGED AN D THE
SPUTUM CHANGED AND T HEN HE DEVELOP GENER A L WEAKNESS NUMBNESS AND
TINGLING

‫ﺍﻟﺘﺸﺨﻴﺺ‬
A case of bronchogenic carcinoma
‫ﻃﻴﺐ ﻭﺇﻳﻪ ﺍﻷﻋﺮﺍﺽ ﺍﻟﺘﺎﻧﻴﻪ ﺩﻱ ؟‬
Para malignant
Para malignant‫ ﺇﻟﻲ ﺑﺘﺘﺎﺛﺮ ﺏ‬systems ‫ﺇﻳﻪ ﺍﻛﺘﺮ ﺇﻝ‬
1 – endocrine
2 – CNS
COPD‫ ﻻﻥ ﻓﻴﻪ‬chest ‫ﻭﻣﻨﺴﺎﺵ ﺇﻝ‬
cor pulmonale‫ ﻣﻤﻜﻦ ﻳﻜﻮﻥ ﻓﻴﻪ‬heart ‫ﻭﺑﺮﺩﻩ ﺇﻝ‬

The most common investigation ?

x-ray
CT scan
Bronchoscope
‫ﻃﺐ ﺍﻟﺤﺎﻟﺔ ﺩﻱ ﻫﺤﻮﻟﻬﺎ ﻷﻧﻬﻲ ﺩﻛﺘﻮﺭ‬
Thoracic surgery

‫الحالة الثانية عشر‬

55 Y OLD MAN DIABETIC FROM 20 Y COME WITH LOWER LIMB EDEMA BLOOD
PRESSURE 180/100 LAS T MONTH ATT ACK OF PAIN IN RT LI ON REGION FEVER AND
DYSURIA DOCTOR GIVE HIM TETRACYCLINE , A NALGESIC AND IVP

Treatment ?
‫ﺃﺣﺎﻭﻝ ﺃﺩﻱ ﻣﻀﺎﺩ ﺣﻴﻮﻱ ﻣﺒﻴﺨﺮﺟﺶ ﻋﻦ ﻃﺮﻳﻖ ﺍﻟﻜﻠﻰ ﺍﻭ ﺗﺄﺛﻴﺮﻩ ﻋﻠﻴﻬﺎ ﺑﺴﻴﻂ ﺯﻯ‬
3rd generation cephalosporin
IVP ‫ﺛﺎﻧﻴﺎ ﺍﻟﻤﻐﺺ ﺍﻟﻜﻠﻮﻱ ﻳﻌﻤﻞ ﺍﺿﻄﺮﺍﺏ ﻓﻲ ﻭﻇﺎﺋﻒ ﺍﻟﻜﻠﻰ ﻭﺩﻩ ﻛﺎﻥ ﻳﻤﻨﻌﻨﻲ ﺇﻧﻲ ﺍﻋﻤﻞ‬
In addition it is hepatotoxicty and diabetic nephropathy
Investigations
1- sonar
2 – CT , MRI in suspected case
‫ﺗﻜﻤﻠﺔ ﺍﻟﺤﺎﻟﺔ‬
IVP showed stones in kidney and urine culture show gram –ve bacilli sensitive to
gentamycin

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

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‫ﻃﺐ اﻷزﻫﺮ‬ ‫‪Cases‬‬ ‫‪Digested MP3s‬‬

‫‪The doctor give him gentamycin 80ml/8h the case develop acidosis oliguria very‬‬
‫‪high blood createnin and urea‬‬
‫ﺍﻟﺪﻛﺘﻮﺭ ﺍﺧﻄﺄ ﻓﻲ ﺇﻳﻪ‬
‫ﻟﻢ ﻳﺮﺍﻋﻲ ﺍﻷﻋﺮﺍﺽ ﺍﻟﺠﺎﻧﺒﻴﺔ ﺍﻟﺨﻄﻴﺮﺓ ﻟﻠﻤﻀﺎﺩﺍﺕ ﺍﻟﺤﻴﻮﻳﺔ ﺍﻟﻤﺴﺘﺨﺪﻣﺔ ﻭﺧﺼﻮﺻﺎ ﺍﻧﻪ ﻣﺮﻳﺾ ﺳﻜﺮ‬
‫ﻭﻭﻇﺎﺋﻒ ﺍﻟﻜﻠﻰ ﻋﻨﺪﻩ ﻣﻀﻄﺮﺑﺔ ﻭﺑﺎﻟﺘﺎﻟﻲ ﺩﺧﻞ ﺍﻟﻤﺮﻳﺾ ﻓﻲ ﻣﻀﺎﻋﻔﺎﺕ ﻫﻮ ﻓﻲ ﻏﻨﻰ ﻋﻨﻬﺎ‬

‫ﻣﻌﻠﻮﻣﺔ ﻫﺎﻣﻪ‬
‫‪Gentamycin should adjusted to blood createnin‬‬

‫‪How to manage now‬‬

‫‪Dialysis is errgent‬‬

‫ﺳﺒﺤﺎن ﷲ وﺑﺤﻤﺪه ﺳﺒﺤﺎن ﷲ اﻟﻌﻈﻴﻢ‬

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