Professional Documents
Culture Documents
12 ..
Bizarre neurological manifestations
Neck stiffness
Torticollis
Abnormal movements
Eye gaze .
3 G.E
.
: convulsions
Drug history
primperan
Extra pyramidal side effects
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
<<<<<<<
35
40
rigor
pain in the rt ypochondrium
tenderness
severe tenderness
rt lower lobe pneumonia
!!!!!!!
tenderness
presence and degree of tenderness
!!
..........
!!!!
.........
......................................................................................
5
3
!!!! antiedematous as maxilase
!!!
refresh
loose skin
...........................................................
oral ulcer !!!
oracure gel
...........................................................
resistance
unictam unictam
epistaxis adrenalin nasal packing nose
200 packing
obstruction
sever asthma
...........................................................
)(
)
distressed
) (
) 45
(
extensive ant mi
............................................................
7
chest pain GE
)
(
6
4
8
...............................................................
40
...............................................................
disc prolapse
lower limb ischemia
pulse
...............................................................
23
abdominal disturbunces on
the form of alternating Diarrhea and constipation & pains he is admitted for
investigations ( endoscopy ) he is suspected to have an IBD
sigmoidoscopy
hip
phsycic 8
dyspnea
wheels of oedema HR 160
adrenaline anapylactic
shock tacycardia
cpr
25
- -
clonic
tonic
- -
...............................................................
3
A
) (
...............................................................
4
...............................................................
supracondylar fracture
0
(
neurogenic shock
...............................................................
) acute follicular tonsillitis
30 40
40
20
first generation cephalosporins
...............................................................
coma
hysterical
2 40
..
................................
2
coma
hypoglycemic coma
...............................................................
medical guide
analgesic
s&s
sub
senior
antipyritic
subsenior
...............................................................
one touch
80 90
100
!!!!!!!!!!
60
...............................................................
analgesic appendecitis signs
analgesics mask tenderness
....
............................
acute
septic peritonitis
acute
pain sign
alarm
...............................................................
40
!!!!!
severe UTI
!!!!!
...............................................................
liability of infection sole
) (
irrigation of
the wound by saline forign bodies
...............................................................
G.P )
( 17 s&s
TLC 6
11
!!!!!!!!!!!!!!!!
MIDCYCLE PAIN
TLC
3
bladder is empty
rectum is empty
)
( full bladder as a landmark for
the uterus
bladder is empty
bladder is full
...............................................................
TLC
regular 3
...............................................................
.
...............................................................
UltrasonographyA healthy appendix usually cannot be
viewed with ultrasonography. When appendicitis
occurs, the ultrasonogram typically demonstrates a
noncompressible tubular structure of 7-9 mm in
diameter
http://emedicine.medscape.com/article/195778diagnosis
...............................................................
3
...............................................................
membranes infection
membranes ) (
) (
aspiration muconium
..
...............................................................
curve
24
...............................................................
6 7
6 7
...............................................................
7
...............................................................
10
multible trauma
______________________________
antiplatelet
_______________________________
atypical pain
cardiac neurosis
MI
extremities
_____________________________
____________________________
24
________________________
TYPICAL PRESENTATION
FALSE NEGATIVE
____________________________
BYPASS
____________________________
mi reccommended
pts
10
) (
multible trauma
_____________________________
antiplatelet
_______________________________
atypical pain
cardiac neurosis
MI
extremities
_____________________________
____________________________
24
________________________
TYPICAL PRESENTATION
FALSE NEGATIVE
____________________________
BYPASS
____________________________
2 14
vomiting , diarrhea , dehydration
....
HIGH
40
!
____________________________
abuse
fully conscious
leucocytosis
% 95
atypical pain
MI
extremities
%95
good negative evidence
____________________________
congestive appendicitis early suppurative
appendicitis
8
.
____________________________
abuse
mi
!!!
!!!!
fully conscious
<<<<<<<<<<<<<
leucocytosis
% 95
atypical pain
MI
extremities
%95
good negative evidence
________________________________________________________
)
(
!!!!
lying down
tenderness rebound
in the mid ureter
) feedback
________________________________________________________
.. ..
.. ..
... ..
very agitated
.. .. ..
.. )+( ..
.. .. ..
.. massive inferior MI .. ..
..
-:
-1 ..
..
-2 .. .. .. ..
-3 ... ..
.. .. ..
.. .. .. ..
..
.................................
.. ..
.. ..
.. .. .. -
Babinski
.
Investigation
Clinically
Full History
Clinical Examination
Study Smart NOT hard CME
________________________________________________________
preeclnpsia
!!!!!!!!
4
________________________________________________________
preeclampsia
protienuria
eclampsia
________________________________________________________
45
lower part of the sternum
mi
risk factor
) ( )
mi (
) mi
(
mi
%95
healthy
severity of the pain
________________________________________________________
atypical heavy
smoker
angina
Non ST Elevation M.I
pain of mi not relieved by analgesic or nitrates
mi
pain of mi not relieved by rest or nitrates
) (
severe
DD
________________________________________________________
pain relieving mi
Nonnarcotic Analgesics
narcotic Analgesics
mi ) silent
( myocardial infarction
silent
myocardial infarction
nerve ending damage mi
________________________________________________________
m.i 12
atypical
extensive M.I regimen chest pain
typical atypical )
( :
stable
angina
ischemic changes
unstable angina
st elevation st-
elevation M.I
Non ST elevation
M.I
stable unstable angina
stable angina
unstable angina
% 99 unstable angina
unstable
angina stress ecg test
Non ST elevation M.I
vesicles of herpes zoster
________________________________________________________
4
8
dinitra 5
________________________________________________________
thyroid swelling
physiological goiter
us on the neck
) (
!!!!!!!!!!!!!
_______________________________________________________
8
) (
pale
posiotional
hemiplegia due to infarction as a result of bleeding
emboli
dic
dvt
<<<<<<<<<<<<<<<<<
) (
...
thyroiditis
iud
_______________________________________________________
iso
tope scanning
thyroiditis
report iso tope scan ) TC99
oral (
scan diagnostic theraputic
gland
thyroid
While the thought of taking something "radioactive" is
3
%100
_____________________________________________________
3
3
% 90 % 10
Ultrasound urate
intravenous urography is mandatory urinary stone
......
)
(
)
(
+
3
urates
intravenous urography
density in X ray
Radio-opaque
Opacity implies the presence of substantial amounts of
calcium within the stone. Calcium phosphate stones are the
most radiodense stones, being almost as dense as bone.
.Calcium oxalate stones are slightly less radiodense
Relatively radiolucent
Cystine stones are relatively radiodense because they
contain sulphur (Fig. 9.1). Magnesium ammonium phosphate
(struvite) stones are less radiodense than calcium
.containing stones
Completely radiolucent
Uric acid, triamterene, xanthine, indinavir
______________________________________________________
16 !
!!!OLD MI
old MI
autoimmune SLE
16 epigastric pain 10
CBC , KFT ,LFT Hb 7
lncrease ln cardiac shadow
Pericardial
!!!!effusion
Pericardiocentesis
3
24
Complication 24
______________________________________________________
respiratory distress
3
)
(
) (
______________________________________________________
total thyroidectomy is better than subtotal
thyroidectomy
subtotal
!!!!!!!!
!!!!!!!!!
) (
sub
______________________________________________________
!!
ASYMPTOMATIC' ABNORMAL LIVER FUNCTION TESTS
Most hepatologists investigate patients with LFTs that are
.greater than twice the normal range
______________________________________________________
acute severe epigastric pain radiating to the back
acute gastritis
gastritis
!!dramatic relief
______________________________________________________
) (Endotracheal tube
.........
) - (-CPR
______________________________________________________
male
)(
)(symptomatic ttt
CLD
wBCS )one of SIRS
(symptoms
Table 165. Common serologic patterns in hepatitis B virus infection and their
.interpretation
HBsAg
AntiHBs
Anti- HBeAg
HBc
AntiHBe
Interpretation
IgM
IgG
Acute hepatitis B
IgG
IgG
or +
or +
IgM
or +
Acute hepatitis B
IgG
or +
(Vaccination (immunity
IgG
non gonoccocal urethritis
R/ceftriaxone 500 mg vial
doxy 100 MR tab
gonococcal urethritis
non gnoccocal urethritis
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
14
10
10
4D u/s
.........................
24y
lactating her baby is about 4months
complaining of unilateral breast pain
on examination whole breast is swllen , firm and tender
normal nipple &areola,normal axillary LN
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
) (
painful gynecomastia
!!!
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
) (Endotracheal tube
.........
) - (-CPR
et
expiration
)
( leakage
<<<<<<<<<<<<<<<<<<<
50 low grad fever - small amount of blood in
stool 6 ...
sigmodoscope cancer colon
12 CT 3
very small mass in liver
triphasic CT
masses in liver are not metastasis and not
related to the previous cancer
they are small Hemangioma
the patient is on follow up only
?<<<<<<<<<<<<<<<<<<
triphasic
% 99
biopsy triphasic
<<<<<<<<<<<<<<<<<<<
3 4
4
............................
<<<<<<<<<<<<<<<
22 3
... ... ... ...
....... ...gastritis
!.... .... ...
...gasritis ...
...
!!!!!!!!!..... .... .... ...
.... ... ... ...
!!....
....... ....
... ........... !....
... .... .... ...
... !!....
.... ... 3 ....
.... ....
....
<<<<<<<<<<<<<<<<<<<<<
et
expiration
)
( leakage
) (cuffed ET tube
- T-tube
T-tube T
.
<<<<<<<<<<<<<<<<<<<<<<
infections
infection
leptospirosis
infection
.........
a patient was 16 years old presented with disturded concious level ,
anuria and jaundice , labs revealed acute renal failure and hepatic
insufficiency , CT brain was normal. dialysis was performed twice on
two successive days and accurate fluid balance was maintained .
till this stage he was not diagnosed yet , it was very depressive
case because the patient had no treatment apart from dialysis only .
so in the staff round one of professors suggested to start penicillin G
i v because it may be icteric leptospirosis. it was a surprise for us
all but we started treatment with this old antibiotic and the patint
started to improve and completely cured within 10 days
serology for leptospirosis
..........................................
tonsiles bed
...................................
T-tube
T-tube ....
.
-
-
ET tube
-T-tube- -
)(T-tube
ET tube -
)(
Resus
.............................................
) (
,
...........................................
rh
72
<<<<<<<<<<<<<<<<
!!!!
cellulitis
<<<<<<<<<<<<<<<<
angioedema
!
<<<<<<<<<<<<<<<<
cellulitis
tenderness
antihistmainic
solu
<<<<<<<<<<<<<<<<<<<<<
<<<<<<<<<<<<<<<
:
22- - 4
2 .
vomiting and abdominal pain
hypoglycaemia
,
.............................
17
OAD
c-peptide
<<<<<<<<<<<<<<<
:
:
: :
: :
: :
,
. : ,
,
:
: .
:
:
--------------------------------------------------------------------------------------------------------------------- :
**** . dka
:
- - .
:
.
......
personally
gastroenteritis caused by rota usually follow this course
vomiting alone then diahrea and vomiting
hyper extended neck
.............
hyper extended neck
extrapyramidal manifestation of primperan
oculo gyric crisis
disturbed level
neither
bulging fontanel
neither
painful cry with flexion of the neck
.............
<<<<<<<<<<<<<<<<<<
diuretics
anti-oedematous diuretics mannitol
brain edema
reparil gel
haemoclar
alphintern ambezeim
<<<<<<<<<<<<<<<<<<<<
systemic anti odematous alpha
chemotrypsin post
operative ENT septo
rhinoplasty
%20
) dehydrating measurments
( osmotic diuresis CI
old age
<<<<<<<<<<<<<<<<<<<
7
croup
inspiratory wheezes
wheezes
croup
<<<<<<<<<<<<<<<<<<<<<<<<
1
1
<<<<<<<<<<<<<<<<<<<<<<<<
im iv
route of administration
IM IV
.............
.............
.......... CI
..........
............
..........
.........
an emergency
.
.........
.......... .......
<<<<<<<<<<<<<<<<<<
cp
graft
..............................................
9
Haematoma
fissure fracture head trauma
.........................................
vital signs
.............................
rrr miosis
asymmetry
+ 24
3 lateralization
fissure
..............................
16
history
.........
....
cpr ....................
16 psychic
acute abdomen
MI
...............................................
..........
..........
..........................
COPD
.........
asthmatic
....
shock asthmatic
vital signs
local examination general
vital signs
....................................
shocked irritability
shock
shock
............................................
sunken eyes,thirsty,lost skin turgor
........ ..
+
+
...........................................
-1
-2
-3
-4
-5
-6
..........................................
2
coma
hypoglycemic coma
........................................
gastritis and commen cold with nasea and vomiting
rantidine and motilim and congestal haematon
nasea
...............................
gastritis
<<<<<<<<<<<<<<
symptoms
fetal heart beat featal
growth
<<<<<<<<<<<<
!!!
!!
Nu Spasm
!!
Adolor +
Viseralgin
250 Adolor + Viseralgin
2.5 Ca Gluconate
10
Uric
Acid
l
**********
Spasmofen Nu Spasm
Adolor + Visceralgin IV
Analgesic
Antispasmodic
Smooth Muscle
Relaxation
.............................
vit B ) ... ... (
....
) + (
) + .. ... .... .... (
) (
..............................
65
nose on right aspect
abscess
dangerous triangle of face
cavernous
sinus thrombosis
1 12 3
<<<<<<<<<<<<<<<<<<<<<<<<<<
8 8
C/P :: Wet Cough - Difficulty in Breathing Specially
During Inspiratory
wheezy
!!
Stridor
2
0.8
10
Flunaze Cap
Prophylactic Antibiotic + Cortisone
<<<<<<<<<<<<<<<<<<
.
.
<<<<<<<<<<<<<<<<<<<<<
hypoglycemia
........................................
!!
..........
!!!!
.........
<<<<<<<<<<<<<<<<<<<<<
.. ..
: Guardsman's fracture of mandible
Bilateral fracture of condylar head and midline fracture of mandible
stitch .. #
Plastic
<<<<<<<<<<<<<<<<<<<<<
pseudo-ephedrine
<<<<<<<<<<<<<<<<<<<<<
45
5
dvt
<<<<<<<<<<<<<<<<<<<<<
9
1200/ dka
15 28
4
<<<<<<<<<<<<<<<<<<<<<
<<<<<<<<<<<<<<<<<<<<<
.. .
: ... ..
Examination ..
Examination distension ..
..
simethicone .
- -
examination
Fast breathing , chest indrawing , VSD
Chest examination
......................................
Rt loin pain
appendesitis Rebound
............ tenderness & Cross tenderness
colitis
.
24
clo
......................................
hypoglycemia
....................................
5
3
!!!! antiedematous as
maxilase
!!!
refresh
loose skin
<<<<<<<<<<<<<<<<<
about me
i remember my 1st abg
i do by my own
the sample was taken without heparin
so in front of the apparatus i found that it was coagulated
the cuz was this syringe i picked it up and used it by my self
in previous cases drs were prepare it for me and i just
withdraw the sample
i was keen on learning how to take the sample instead ,
noticing the full process
what u get from that
abg syringe should be heprinized
<<<<<<<<<<<<<<<<<
:
22- - 4
2 .
vomiting and abdominal pain
hypoglycaemia
,
......
17
OAD
c-peptide
:
:
: :
: :
: :
,
. : ,
,
:
: .
:
:
------------------------------------------------------------------------------------------- :
**** . dka
:
- - .
:
.
<<<<<<<<<<<<<<<
difficult of respiration
no fever
no couph
normal blood pressure
tachycardia
diminished ear intary bilateral
laryngeal oedema
dexamethazone
solucortife
<<<<<<<<<<<<<
: ..
: ..
..
..
:
captopress
capoten + lasix
:
:
: ..
: .. ..
:
.. ..
:
allergy & laryngeal edema
:
<<<<<<<<<<<<<<<<<
..
Dimetrol 9
Dimetrol = metronidazole + diloxanide
45 5
dvt
....................
25
" "
...................
under
... under
)
( 2
) (emergency
)
(
... ......
Young female senior in Operation room , she decided to perform CS to
pregnant mother , before doing any thing she sterilized the mother with
Alcohol , during uterine incision the blood gushed massively and she decided
to use diathermy to stop bleeding , unfortunately with Alcohol it caused burn
from 2sec degree to the patient in her abdomen,pelvis and thigh - The young
,, female senior was a bout to cry
,, Fatal error
Never ever use Alcohol for sterilization " except " Postoperative
<<<<<<<<<<<<<<<<<
(depakine(anti eplieptic drug
!!!
<<<<<<<<<<<<<<<<<<<<
Nasal drops contain decongestants5
Afrin
Balkis
Nasostop
Nasotal
Rhinex
..
4 7
Rebound Congetion
" "
:
Local decongestant
Low bl. supply to nasal epithelium during therapy with local
decongestants
Chemical Rhinitis
Decongestants
..
Oral decongestant
!
<<<<<<<<<<<<<<<<<<<
rapid iv infusion
pulmonary edema
!!3
pritoneal dialysis
pulmonary edema
amblyopia
hypertolerism
epicanthus fold
D:
<<<<<<<<<<<<<<<<
38 " dm hyper tension
normal
pregnancy test
... ....
: .
: .
: .
: .
: .
: .
: .
: . 1:10
: .
: .
: .
: 48 .
: .
: .ub
: .
: .
: . dvt
: .
: .
: .
head trauma
drowzy 220 120
.. ..
....................................
hypo volemia
)(oliguric
over load
diozoxide
<<<<<<<<<<<<<<<<<<<<<
(diazepam(tranqulizier e'anti epileptic action
<<<<<<<<<<<<<<<<<<
2
,,,,,,,,,,,,,,,,,
2
transmitted nasal sound
!
!
<<<<<<<<<<<<<<<<<<<<