HiMed NUCOM 32

1-Alcoholic and HF? 2-Alcoholic and unsteadiness? 3-Alcoholic and painful toe? 4-Alcoholic and maelena ,hematemesis? 5-Alcoholic and abdominal pain? 6-Alcoholic and SOB+fever? 7-Alcoholic and DLOC? 8-Alcoholic and numbness? 9-Alcoholic and CBC finding 10-Alcoholic and headache? 11-Alcoholic and inability to sit up from chair? #medicine

لا عجبَ أن نرى هذه الجرائم ممن وصفهم الله في كتابه فقال ثُمَّ قَسَتْ قُلُوبُكُمْ مِنْ بَعْدِ ذلِكَ فَهِيَ كَالْحِجارَةِ أَوْ أَشَدُّ قَسْوَةً قلوبنا مع أخواننا في فلسطين. ولا حول ولا قوة إلا بالله العلي العظيم #طوفان_الأقصى *الصورة لأربعة أطفال استشهدوا في القصف الصهيوني

Correct answers This px has lung ca 1-low Na levels is due to paraneoplastic secretion of SIADH 2- these complaints are paraneoplatic Lambert-Eaton syndrome characterised by triad of weakness, autonomic dysfunction(dry mouth, postural hypotension) and hyporeflexia

Mr. Sajid , a 63-year-old male, presented to his primary care physician with complaints of persistent cough, chest pain, and unintentional weight loss over the past few months. He had a 40-pack-year history of smoking. Upon further evaluation, his physician ordered a chest X-ray, which revealed a suspicious mass in the left lung . Electrolyte panel shows : Na 126 meq/l 1-What do you think the possible cause of his sodium level ? 2- if this px developed lower limb weakness associated with dry mouth and postural hypotension What do you think the possible cause? #medicine

Good thinking Ali and Mustafa The possible causes: MI Congestive gastropathy Mesenteric ischaemia ACEI side effect (angio-oedema of the bowel wall)

Patient with heart failure developed abdominal pain What are the possible causes? #medicine

Excellent bodoor 1-this child has abdominal distention and periorbital puffiness 2-you should examine any dependent area that can accumulate fluid (Leg oedema, scrotal oedema, sacral oedema, ascites, pleural effusion, lung bases) 3-this child has nephrotic syndrome 4- you should send for 24 urine collection for protein in urine >3.5g/day , also send for lipid profile s.albumin , RFT and BP and GUE to exclude nephritic syndrome 5- most important cause is chest infection because these patients are immunocompromised , Other causes : severe ascites, p.effusion, pulmonary embolism 6- pneumonia and UTI 7-prednisolone is drug of choice given over 6 wks then tapering over 4wks

1-what do you notice when inspecting this 4 yrs old child 2-what will you examine in this patient ? 3- what do you think the diagnosis ? 4-what are the investigations required? 5- if this patient developed SOB What do you think the possible causes? 6-what is the most common infections this child is liable to get? 7-what is the management? #clinical_findings #pediatrics

Nice thinking Bodoor and Ahmed, it could be side effect of one of the drugs But in this case specifically 1-the patient has lupus-like reaction due to INH tx 2-send the patient for anti histone ab 3-stop the offending drug and change the regimen

26 yrs old prisoner diagnosed with TB and started on anti TB coarse recently.1wk after, he started to develop rash in the face, fever and arthralgia 1-What do you think his condition and the cause ? 2-What will you send the patient to confirm your suspicion? 3-What is the management? #clinical_findings #medicine

Perfect answers by Ali, Bedoor and Mustafa Khedher is 19 yrs old who is asthmatic and presented with recurrent chest infection and copious amount of sputum in the early morning. He has coarse crepitation on auscultation and also has nasal polyposis 1-this px having marfanoid body habitus (high arched palate , thumb sign, arachynodactyly) 2-other possible diagnoses are Ehler-Danlos syndrome which is another form of connective tissue disorder And Homocysteinuria which also could have marfanoid features but the usual presentation is thrombosis because Homocysteinuria is toxic to the vessels and exaggerate the atherosclerosis process 3-examine the heart for MVP and send for echo for possible aortic root dilatation and aneurysm formation and examine the lens by slit-lamp for possible ectopia lentis Finally I have question for you If patient has asthma, nasal polyps Do you want to ask about something in the history to confirm a triad? And what is this triad called ? Hopefully you get benefit from this case

1-what do you think this px has? 2-what is the other diagnosis ? 3- what other parts you want to examine? #clinical_findings #medicine

Excellent answers Ahmed 1- on inspection we notice large head, Dilated veins, sun-set eyes and 6th CN palsy 2- Dx is hydrocephalus 3- there are many congenital causes of hydrocephalus including Cerebral aqueductal stenosis Dandy-Walker malformation Arnold-Chiari malformation 4- CT shows obvious ventriculomegaly 5- other parts to be examined are fontanelles, back (you should always look for the back for myelomeningocele) and motor exam of lower limb By the way Fatima is diagnosed as aqueductal stenosis We pray for her to get better 🙏

This neonate is named Fatima presented with large head and lethargy since birth 1-what do you see when you start inspection 2-what is the diagnosis 3- give at least 3 causes for her diagnosis 4-what does CT show ? 5-what other part of the body you should exam and why? #clinical_findings #pediatrics

Nice answers all 1-this radiograph shows distended and thickened bowel wall along with intramural gas (pneumatosis coli) 2-Necrotizing enterocolitis 3-stop the oral feeding , NG tube for decompression, use TPN for feeding through central venous line , antibiotics coverage and monitoring for signs of perforation which necessitate surgical correction

Premature neonate presented with abdominal distension and vomiting after over-feeding 1-what does abdominal radiograph show ? 2-what is the diagnosis ? 3- what is the management #clinical_findings #pediatrics

Nice answers Ali and Asia This patient ECG shows: Tachycardia, regular rhythm, absent p wave and narrow QRS These findings are consistent with SVT The management is by starting with vagal maneuvers and giving adenosine rapid IV push. You can start by washing the face with cold water as cold water is considered strong vagal stimulator.