med5x5

case 15

2009-04-27T12:07:00.000-07:00

الصوره منقوله

general aspect: 28 years old patient with primary infertility since 4 years.she is not obese ,no abnormal hair distribution and no galactorhea. she complains uterine bleeding since 11 days.she had apast history of mastectomy secondary to breast cancer 1 year ago ,taking chemotherapy uptil now which affected her liver functions as she said .she mentioned extreme oligomenorrhea and cycle irrigularities.her u/s showed ovarian enlargment and multiple follicles(12)all of small size

questions

to identify the cause of bleeding in this case all except

D&C biopsy

prothrombin time & activity

cervical smear

prolactin level

hormonal profile in PCOS may include all except

elevated serum FSH

elevated LH

elevated prolactin

elevated androstendione

elevated estrogen

to treat acase of PCOS all except

metformine

clomephine citrate

spironolactone

aromatase inhibitors

parlodel
progestagen

case 14

2009-03-25T03:32:00.000-07:00

general aspect : 27 years old primigravida in her 34 week of gestation complains watery vaginal discharge which is milky white ,spontaneous and increases with movement since 5 days .u/s was done and proved to be acase of preterm premature rupture of membranes

questions

amniotic fluid index will be in case of oligohydraminos: choose

less than 5

between 5-10

between 10-15

more than 20

if this case was complicated by infection ,leukocytes number over 11,000 will be

suggestive .t/f

for management of this case GA 34 wks while tocolytic score is <4:choose>

except

tocolytics

antibiotics

excessive hydration

betamethazone L/S is 2:1

after delivery immediate cord clamping is indicated t/f

case 13

2009-03-11T12:53:00.000-07:00

Male patient presented with fracture shaft of both tibia and fibula .reduction & fixation was done by pop cast .later on the next mornoing he experienced severe pain and tingling in his foot and tightness in his leg after initial improvement.the cast was removed and his leg was covered by haemorrhagic bullae as in the photo.the preripheral pulse is palpable but pale extremeties with painful foot movement

the diagnosis may be choose

acute osteomyelitis

compartment syndrome

crush syndrome

fat embolism

to confirm the previous diagnosis choose

1retrograde after fasciotomy

2muscle enzymes
3measuring intracompartmental pressure

4abscent peripheral pulsation

5non of the above

as amanagement of fracture tibia and fibula all except choose

external fixation

skin graft

intramedullary nail

plate and screws for the fibula

case 12

2008-12-14T09:38:00.001-08:00

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

2008-11-30T11:05:00.000-08:00

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

2008-11-28T05:55:00.000-08:00

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

2008-11-13T14:08:00.000-08:00

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

2008-11-07T13:49:00.000-08:00

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

2008-10-29T03:36:00.000-07:00

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

case 7

2008-10-28T14:18:00.000-07:00

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

2008-10-28T13:41:00.000-07:00

.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

2008-10-19T10:12:00.000-07:00

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

2008-10-19T07:23:00.000-07:00

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

2008-10-15T01:34:00.000-07:00

انظر التعليقات للاجابه
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

2008-10-14T17:23:00.000-07:00

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

2008-10-14T16:05:00.000-07:00

انظر التعليقات للاجابه

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

2008-10-14T04:20:00.000-07:00

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