case 12

what could it be

i couldnot get the clinical case but what is your opinion about this x_ray

case 11 from Tanta tropical centre

general aspect: 24 years old female is noticed to have rapidly developing diffuse abdominal distention within 20 days.on examination no jaundice ,no ll edema, no organomegally,just pallor and dullness allover the abdomen.

by investigations :

HB:10.2

prothrombin activity:92%

liver functions:billirubin D:0.2

IND:0.8

SGPT :22

SGOT :26

albumin:3.6gm

ascitic fluid :total protein 5 (normally no ascitic fluid or protein)and no RBCS, cells:50

U.S:hepatosplenomegally ,cirrhotic liver,patent portal vein

E.S.R:32,68

WHAT IS YOUR DIAGNOSIS

case 10

general aspect:49 years old male with periumbilical abdominal pain ,fever and diarhoea for 5 days

no rash no ronchi no splenomegaly yet

leuckocytic count is 12600

CRP is 96 mg/L

against widal in this case is :choose

leuckocytosis

duration of symptoms

diarhoea

all of the above

after 1 weaks he developed severe epigastric tenderness and mild generalized abdominal

distention

U.S showed thrombosis of the left branch of portal vein

how to manage this case.......

case 9

thanks Dr semsema for your useful participation

] semsema يقول...
أول مشاركة لي في المدونة ويارب تفيدكم

male patient aged 45 ,came to hospital complaining of feeling drowsy during doing exercise in the morning and some dysnea last night,nausea and mild chest pain which releaved spontaneously he had D.M 5 years ago and it is controlled by treatment

how to deal with this case??

case 8

thanks dr_roda for your successful participation

dr_roda يقول...
male patient aged50 years old came to emergency room with his family he was conscious and can wake but he was very annoying as he suffers from severe epigastric pain refered to his left shoulder from two hours and it is the first time.his history revealed only that he is smoker from 30 years ago and he never complained before.his blood pleasure was120/80and his pulse rate was 72b/min.by examination of abdomen nothing except epigastric tendernes. by heart examintion heart sounds just audible but no murmurs.what is your dignosis and how to manage??دى حاله جيت الطوارىء انا كشفت عليه وبعدين طلبت مساعده دكتور امتياز لانى شكيت فى حاجه وبعدين هو فحصها وتناقشنا وعايزه اشوف رايكم وان شاء الله هعرفكم طلعت ايه

اقتراحات

هذه الرساله لتلقى اقتراحات الزملاء واى طلبات لتطوير المدونه وعرض الحالات .وشكرا لجميع الزملاء

case 7

male patient 56years old is noticed to have pallor , jaundice, splenomegally and orthopnea
he is known to be hepatic and received blood at different times


his lower right chest was dull in percussion. his Hb was as follows

his x_ ray as follows showing obliteration of the angle




questions
CBC will show : choose
hypochromic anemia
leukocytosis
reticulocytosis
abnormal cells

for management : choose
surgical splenectomy
radio splenectomy
continuous blood transfusion
iron supplementaion

case 6

.a10 years girl presented with dehydration ,vomitting and abdominal pain for 10 days

her x_ray showed suspicious of intestinal obstruction as fluid levels but it were ordinary gases

fortunately, anurse noticed actone odour from her breath.

.she was managed butwhile therapy she arrested twice and now she is under ventilation in ICU.

questions

diagnosis?

if brain edema ocurred while therapy mannitol is contraindicated(t/f).choose

normal potassium levels monitored by ECG before therapy indicates potassium supplementation.(t/f) choose

to confirm your diagnosis and exclude intestinal obstruction :choose

serum amylase

urine analysis

ECG

serum electrolytes

case 5

انظر التعليقات للاجابه

ECG shows ischemic heart disease(depressed ST) 11

general aspect: 62 years old female complained abdominal pain in the flanks,vomitting ,hiccough and frequent dyspnea

she mentioned chest pain of breath compression (as i thought) .her ECG shows depressed ST segment

the case didnot have any renal function tests available

the case is on dialysis
questions

mention the cause of chest pain
arrythmias may be present in this case due to except: choose

hyperkalemia

hypercalcemia

ischemic heart disease

metabolic acidosis

investigations needed for dialysis

ttt used for this case include except :1

isosorbid di nitrate

ph lowering drug

iron supplementation

frusemide

case 4

general aspect:49 years old male complains fever of unknown origin since 19Ramadan

the patiemt is hepatic, with no other remarkable history

he was investigated by widal test and the titre was 1/80

afterthat he did CBC as shown

ESR is as shown

the patient is pale ,tinge of jaundice and no lymph node enlargment

questions:

1polymorphnuclear leukocytosis to lymphocytes in this case supports: choose

leukemia or malignancy

hidden abscess

collagen disease

2type one necessary investigation

3presence of myelocytes diagnoses leukemia (T/F)c

4if there is normal leukocyte exclude leukemia (T/F)c

CASE 3

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general aspect :9 months old boy with tachypnea ,chest wheezes and splenomegaly

he has ahistory of congenital heart disease:acontinuous murmur is heard below left clavicle and
interscapular area
bilateral coarse bubbling crepitations also present

questions
the first step in management is :choose
blood culture
penicillin
echo

the best of ttt of chest wheezes include :choose
antibiotics
digitalis
steroids

case 2

انظر التعليقات للاجابه



أعتذر بشده لصعوبة الحصول على التحاليل والاشاعات الخاصة بهذه الحاله فيها بعض التدخل.

هذه الصور لا تخص الحاله المذكورة انما لحديث ولاده

with respiratory distress

ولكن فيها نفس السبب

general aspect

seven years old boy presented with pallor and headache

the child experienced along history of pallor since about two years with frequent blood transfusion ,improvment and relapse again

he was admitted to hospital before with no obvious answer for his case

investigated by

heamoglobin 7gm/dl

serum ferritin 35ng/ml

CRP 9mg/L

plain x_ray show shadow of diaphragmatic hernia

questions

comment on diagnosis

confirmatory investigation

in x_ray how to differentiate diaphragmatic hernia from pneumothorax

in this case the most single diagnostic lab. invest.is:choose

serum ferritin

TIBC

CRP

CBC

case 1

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general aspect

female child aged 13 years old suffering from

headache , intermittent bloody stools, abdominal pain, lower leg rash, red urine and joint pain

the patient experience ahistory of URI 3weeks ago

she was investigated by urine analysis with the finding of macroscopic hematuria ,protienuria of nephrotic range.

antistreptolysin o titre elevated

CBC :bandemia

elevated ESR, C reactive protein ,normal coagulation and bleeding profile

:study questions
what is your diagnosis ?

conclusive investigation for diagnosis?

renal biopsy indication?

cause of bandemia ,elevated anti streptolysin o titre ,causes of bloody stool in this case

follow up your patient

comment on the treatment used

any other comments

learn&refresh

بسم الله الرحمن الرحيم

فى هذا المشروع ان شاء الله سنعرض فى كل اسبوع تقريبا حاله اكلينيكيه من واقع دراستنا ومن واقع مستشفانا على غرار المواقع العالمية الكبرى الا اننا سنركز على ان تكون هذه الحالات من مستوانا نحن وفى مجال دراستنا فقط .نذكر أن هذه الحالات من مستشفانا مستشفى جامعة طنطا واقعيه بالكامل وكل ما هو مدرج معها . أعتذر فى حالة وجود بعض التدخل حتى تكتمل الحاله.
سيكتب التعليق النهائى ان شاء الله بعد انتهاء الزملاء من التعليقات
نشكر فى ذلك أساتذتنا الذين أمدونا بما احتجناه وطلبناه.

نذكر أن هذا المشروع خاص بالفرقة الخامسة وما قبلها سأحاول ألا أتطرق الى الجراحة أو النساء والتوليد الا بعد الدراسة اللازمة منى ومن زملائى فى الدفعة ................والله الموفق