BATCH 23 MEDICAL UST #دفعة الدكتور حسن العريفي

〰️〰️〰️〰️〰️〰️〰️〰️〰️ 7. Scrotal swelling 〰️〰️〰️〰️〰️〰️〰️〰️〰️ History: 💠 Great , introduce, Permission 💠 Personal data: 1. Name 2. Age Children ➡️ primary hydrocele ; patent process vaginalis (20-40) ➡️ secondary hydrocele ; trauma , infection , neoplasm ( > 40 ) ➡️ primary, idiopathic 3. Residence 4. Occupation 5. Marital status 💠 C/O + duration: increase size of testis/ swelling in the scrotum 💠HPI : 🔸onset and progression بالليل كيف ، بالصباح كيف ، مع اللعب ، هل بالليل بتختفي 🔸Pain : socrates ▪️Painful : Mild : secondary hydrocele Severe : child - adolescence > torsion Elderly > epididymo- orchitis ▪️Painless: idiopathic hydrocele/ tumor 🔸Micturaion problem ( burning - frequency ; epididymo- orchitis ) 🔸Trauma > hematocele 🔸Loss of weight, appetite + malaise > tumor 🔸Sexual and social problem 💠past medical hx 💠family hx 💠social hx 💠drug hx all as usual

Abdomen Examination 💠 Great, introduce, permission, privacy, wash 💠 Position: supine 💠 Exposure: from nipple to upper thigh 💠general ex ▪️Well flat comfortable ▪️Hand: 1. palmar erythema 2. dupuytene contracture 3. palar 4. clubbing 5. koilonychia 6. leukonychia 7. asterixis 8. pulse 9. bp ▪️Head 1. palar 2. jaundice 3. parotid swelling ▪️Chest 1. spider navii 2. gynecomastia 🟫Inspection Movement Contour Flanks Umbilicus Scar Striae Pulsations Prominent veins Hernial orifice 🟫PALPATION : Ask him about pain 🔸Superficial palpation ▪️mass ▪️tenderness ▪️temperature If you find mass: elevate the leg if it disappear➡️ from visera not disappear➡️subcutaneous 🔸Deep palpation for liver +liver span 🔸Deep palpation for spleen (if palpable mention its charter) 🔸Deep palpation for kidney 🔸Deep palpation para aortic 🔸Sucussion splansh(م. ناصر) 🔸Murphy sign 🟫 PERCUSSION Percussion for ascitis Fluid thrill for massive ascitis 🟫 AUSCULTATION : bowel sounds added sounds Renal bruit Venous hum Splenic and hepatic rub in Hepatosplenomegally 🟫BACK Sacral edema Spider navii 🟫Compelete examination by PR , examine genitalia anf lymph node

〰〰〰〰〰〰〰〰〰〰 6. abdomen 〰〰〰〰〰〰〰〰〰〰 History 🟣1. Cholecystitis 💠great, introduce, permission 💠complain/duration 💠HPI: 🟫 Pain: socrates 1. Site: cholicystitis➡️ rt upper quadrant biliary colic➡️ upper abdomen 2. Onset: sudden 3. Character: ▪️colicky; stone ➡️ ▪️dull burning; cholicystitis ➡️ ▪️throbbing; pyocele? ➡️ ▪️stabting 4. Radiation tip of the rt shoulder 5. Association ▪️nausea ▪️fever/chills ▪️jaundice/itching 6. Timing more than 6 hours➡️cholicystitis less than 6 hours➡️ biliary colic (biliary colic is constant and not true colic) 7. Exacerbating ▪️fatty food ▪️breathing/movement Relieving ▪️biliary colic➡️only strong analgesic 8. Severity ▪️impair activity ▪️or from 10 🟫 GIT Vomiting, Constipation, Diarrhea, Dystension, Dyspepsia, Dysphagia Bloody stool Appetite Weight loss 💠Systemic Review Cardiovascular: chest pain, dysnea, hemoptysis Urinary: color, amount CNS: drowsness, 💠Past Medical History 1. Similar condition 2. admission 3. blood transfusion 4. surgery 5. history of jaundice, recurrent malaria, anemia, IHD, asthma, HTN, DM 💠Family hx Similar condition 💠Social hx smoking alcohol insurance 💠Drug hx current chronic: contraceptive pills allergy

Examination 💠Great, introduce, permission, privacy wash 💠Position: Standing 💠General: well, standing comfortable 🟫Inspection for the veins 👉There is abnormal superficial elongated dialated tortuous vien/s 1⃣Site 🔸anterio-medial thigh and calf➡️ Great saphenous vein 🔸anterio-lateral thigh➡️ accessory saphenous vein 🔸Posterio-lateral of the calf➡️ Small saphenous vein 🔸above the inguinal ligament➡️ superficial circumflux iliac, superficial pudendal, superficial epigastric veins 🔸Other sites ➡️ Stray varicosit 2⃣Extent 3⃣Blow out + Saphena varix (if +ve ask the pt to cough) 4⃣Raise the leg for collapsibility 🔸collapsed: primary 🔸not collapsed: secondary eg: DVT, pelvic tumor, & AV malformation 5⃣while the leg is raised ask the pt to cough➡️ morrissey test 🟫 Inspection for signs of venous hypertension "THe PEAU D'orange" 1. Thicking or atrophic changes 2- Hemorrhage 3- Pigmentation 4- Edema: pitting and start distally 5- Ankle flare: small dilated venules (incompetent perforators) 6- Ulceration: over gater area 7- Dermatitis 8- Deformites: Talipes equinovarus (chronic ulcer▶️contracture) and ankylosis of the unkle 🟫Palpation 1⃣Temperature 2⃣Tenderness 3⃣Thrill ➡️ saphenofemoral junction & behind the knee while coughing 4⃣Lower third of the leg for ▪️thicking➡️ lipodermatosclerosis ▪️edema ▪️tenderness ▪️base of the ulcer if found 5⃣palpate for peripheral pulses 🟫 Percussion (Shwartz's test): if +ve ➡️ incompetent valves 🟫 Auscultation 💠percuss proximally and auscultate distally if +ve ➡️incompetent valve 💠 Bruit: machinary continous (AV malformation) 🟫 Special Tests ◾️Trendelenburg test ◾️Mutlipe trendelenburg test ◾️Perthe's Tests 🟫Complete the examination by: 1. Abdominal Ex: for ▪ dilated collateral, do harvest test ▪ masses 2. Scrotum for varicocele and masses 3. Per-rectal & Per-vaginal Ex for ▪️️masses ▪️coexistnce hemorrhoids (note: read about; Tredelenburg test, Mutlipe trendelenburg test, Perthe's Tests & shwart's test)

〰〰〰〰〰〰〰〰〰〰〰 5. Varicoce 〰〰〰〰〰〰〰〰〰〰〰 History: 💠 Great, introduce, Permission 💠 Personal data 1. Name 2. Age ➡️ All age groups 3. Sex ➡️ 10:1 F:M 4. Occupation ➡️ job involve long standing 5. Residency ➡️ more in Europe and north america 6. Marital status 💠 Complain/Duration: 1. Disfiguring effect of the viens 2. Pain 3. Mild swelling at the end of the day 4. Night crumps and itching 5. Pain ful lumps 💠History of present illness: 1⃣Onset ➡️ gradually 2⃣Progression ➡️ 1. how discovered , 2. disappear? , 3. difference between start and now 3⃣Aggravated by: 4⃣Associted with ▪️Pain: 1. Site : calf or lower leg 2. Onset 3. Character : dull , Night crumps or heaviness 4. Radiation 5. Aggravate: standing 6. Relieve: lying down 7. Association : fever 8. timing: night 9. Severity ▪️Itching ▪️Swelling ▪️Skin changes / ulcer 5⃣Other sites 6⃣Risk factors: 🔸long standing 🔸trauma 🔸DVT 🔸multiple parity 💠Systemic review: Abdomen: pain, distention " asictes, pregnancy " 💠Past medical history: Admission , blood transfusion, surgery , DVT , clotting disorders , pelvic tumors , DM or HTN 💠Family history: similar condition 💠 Social history: Smoking , alcohol, health insurance 💠Drug history: current , chronic, allergy

Examination 💠Great, Introduce, Permission, Privacy, Wash 💠Exposure: both legs 💠General examination: well, flat, comfortable, pale & jaundice 🟫Inspection: 1⃣Site 2⃣Size and depth 3⃣Shape 4⃣Single or multible (look between the toes) ______ 5⃣Floor: 1. discharge 2. granulation (healthy or not) 3. sloughs 4. color 6⃣Margin: regular or not 7⃣Edge 1. flat (sloping) ➡️ shallow, traumatic, healing, venous 2. punched out ➡️ trophic ucler, ischemia, DM, tertiary syphilis, chronic infection 3. Undermined➡️ TB, bed sore 4. Elevated➡️ carcinoma 5. Rolled (raised)➡️ Basal cell carcinoma ______ 8⃣Skin changes: 1. Trophic changes: 🔸loss hair 🔸shiny skin 🔸muscle wasting 🔸nail changes (brittle) 2. Other changes 🔸Dilated viens or venous guttering 🔸Discoloration: Hyperpigmentation (venous) Hypopigmentation (non healing) 🔸Deformity 🔸Bruising 🔸Blisters 🔸Gangrene 🟫Palpation 1⃣Tenderness 2⃣Temperature _____ 3⃣Floor (exposed surface of the ulcer) for consistency 4⃣Base (tissue in which ulcer rest) feel around the margin for consistency if firm (indurated)➡️ inflammation 5⃣Edge 1. Discharge 2. soft: healing 3. firm: non-healing 4. hard: malignant 6⃣Fixity to underlying structure ____ 7⃣Neurological ex 1. proproiception 2. light tough 3. pain (by 10 gram monofilament test) 4. motor 8⃣Peripheral pulses 9⃣LNs 🟫complete by 1. examining the other limp 2. Cardiovascular ex 3. Special tests 🔸if Ischemic ulcer➡️ Burger's test & Ankle brachial index 🔸if Varicose ulcer➡️Tourniquit(Trendlenburg test)

〰〰〰〰〰〰〰〰〰〰〰 4. (Ulcer) 〰〰〰〰〰〰〰〰〰〰〰 History: 💠 Great, Introduce, Permission 💠Personal data 💠 Complain+duration 💠 History of presenting illenss 🟫History of the ulcer ◾️how discovered ◾️progression (eg: change in size) ◾️associated symtoms: pain, fever, discharge (analyse it) ◾️ulcer in other area ◾️action taken ◾️ulcer in the past: analyse it: site, association, continue for how long, what did for it? ◾️The cause: 1. trauma 2. hx of dilated vien (varicose) 3. Heart diseases 4. pain during exercise(claudication) distance? 🔸This distance like the past? 🔸For how long you stop for rest? 🔸Rest pain? 🔸Socrates 5. Diabetes (then jump to the hx of Diabetes below⬇️) 🟫 History of Diabetes ◾️For howe long ◾️Medications/dose ◾️Adherence to medications ◾️Follow up and last blood sugar chack up 🟫 Systemic effects of DM (systemic review) CNS: Loss of sensation, Weakness, numbness, blurred vision Cardiovascular: chest pain, dysnea, cough ️GIT: abdominal pain (after meals!), constipation, diarrhea, jaundice Urinary: urine color, amount, frequency 💠Past medical history: 1. similar condition 2. ️admission 3. ️blood transfusion 4. ️surgery 5. ️amputation 6. ️revascularization 7. ️chronic dx: HTN, Asthma, renal dx, stroke or ischemic heart diseases 💠Family History Family hx of similar condition ️Family hx of DM, HTN, Stroke, IHD, Kidney dx 💠Social Hx ️Smoking ️Alcohol ️Health insurance 💠Drug Hx Current drugs Chronic drugs ️Allergy

🌸 Snake bite 🌸 🔰 Analgesics are contraindicated in snake bite 🔰 No cover it 🔰 No use cautery 🔰 No sucking 🔰 No use tourniquet 🔰 Calm the patient because stress increase toxicity and reached to heart 👌 🔰 Snake bite( dry_ moist) 🔰 may come with hypovolemic shock 🔰 May complicated by compartment syndrome and treated by fasciotomy and use vaccine في العلاج نهتم بالتالي التي نعطيها أو نراقبها 👇 RR, UOP, conscious , vaccine, Antibiotics, fluid كلما كانت العضه قريبه من الرقبه تكون خطيره وقاتله

What is the differential diagnosis of a groin mass? Lymphadenopathy, hematoma, seroma, abscess, hydrocele, femoral artery aneurysm, EIC, undescended testicle, sarcoma, hernias, testicle torsion.

What is the diferential diagnosis of a thyroid nodule? Multinodular goiter Hyperfunctioning adenoma Cyst thyroiditis Carcinoma lymphoma

The boundaries of hesselbach triangle: ✨inferior epigastric aretery ✨inguinal ligament ✨lateral border of rectus sheath الــ floor عبارة عن: ✨fascia transervalis ✨conjoint tendon ✨✨✨✨✨

Difference between radiate and referred pain😉

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