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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

chest wheezes inspiratory expiratory mixed


expiratory asthma
inspiratory (croup (stridor upper air way

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

(Alvarado score MANTREIS


M: migratory Rt iliac pain -1
A: anorexia-2
N: nausea &vomiting-3

T: tender Rt iliac fossa -4


R: rebound tenderness-5
.E: elevated temp-6
L: leucocytosis -4
S:shift to left-5

5 6 thin adult
C.T Elderly
inverted appetit atypical

pelvic

) (
...............................................................

3


bladder is empty

rectum is empty


)
( full bladder as a landmark for
the uterus

bladder is empty
bladder is full

...............................................................


TLC
regular 3


...............................................................

.

regular increase in TLC




...............................................................


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 ... ..
.. .. ..
.. .. .. ..
..
.................................
.. ..
.. ..
.. .. .. -

- both ulnar and radial arteris cut ..


.. ..
-:

.. ..
" .. "
.................................
..
.. .. .. 25 ..
.. .. .. - ..
.. .. ..
!!! .. .. !!! .. .. ..
" .. " ..
.. ..
!!! .. .. ..
!!!
..
..
________________________________________________________

male patient 57 year old
No special Habits of mdical important
history of contact with canal
Compliant : Yellowish discoloration of skin
other important Data
previous Radio-Frequency on liver
Segment

Another focal hepatic lesion in segment 6
Radio-Frequency

Platelet & plasma


Air Hunger === Rapid deep Breasthing
..... .... Response

Babinski

Negative on both sides


Both pupils are dilated and Equal i can't say fixed
low grade temp
sweety forehead
Low Bl.Pressure



140



140 15

55
45



.
2 ventilator

6
30 .
45/27 20
48



.



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

stress ecg unstable



________________________________________________________
oral nitrates hyporesponsiveness
hour nitrate free interval 8 stable angina
________________________________________________________



vesicles of herpes zoster
________________________________________________________




4
8
dinitra 5


________________________________________________________

thyroid swelling

physiological goiter



us on the neck


multiple small nodules



________________________________________________________


graves disease


) (
!!!!!!!!!!!!!







_______________________________________________________
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

not very appealing, it is important to remember that


iodine concentrates only in thyroid tissue, making this
.test safe and also quite specific for thyroid disorders
A thyroid scan can provide information on both the
structure as well as the function of the thyroid gland.
This information can help you and your physician
determine if further investigations, procedures, or
medications may be worthwhile
.
______________________________________________________






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
______________________________________________________

acute epigastric pain radiated to back severe


acute pancreatitis



score for acute pancreatitis

September 19, 2009


This study evaluated for bedside index for severity in acute pancreatitis(BISAP) score
.to predict mortality. BISAP score was calculated from data at 24 hours
BISAP score consists of 5 variables( Urea >25 age >60, Glasgow coma scale <15,
SIRS, Pleural effusion). Score of >3 was associated 1ith 18% mortality and <3 was
.associated 1ith 1% mortality
CONCLUSIONS: The BISAP score represents a simple way to identify patients at
risk of increased mortality and the development of intermediate markers of severity
within 24 h of presentation. This risk stratification capability can be utilized to
.improve clinical care and facilitate enrollment in clinical trials
s amylase & lipase
______________________________________________________




) (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

Chronic hepatitis B with active viral


replication

IgG

Chronic hepatitis B with low viral


replication

IgG

or +

or +

Chronic hepatitis B with heterotypic


(anti-HBs (about 10% of cases

IgM

or +

Acute hepatitis B

IgG

or +

(Recovery from hepatitis B (immunity

(Vaccination (immunity

IgG

False-positive; less commonly, infection


in remote past
1

Low levels of IgM anti-HBc may also be detected

my penis discharges milk


i have very very very annoyed dysuria at urination
at rest
at intercourse
his appearance suggests that he has illegal relationships
anywhere
i examine him
and his penis when squeezed discharges milky white
discharge
press below to show similar penis
with milky discharge
:HTML Code




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

SO my diagnosis is breast engorgement


Iasked the patient to calm down,to do hot
fomentation&increase frequency of lactaton from this side
also i gave her paracetamol as analgesic
after 3 days
patient came with fever about 38,5
by examination the same as above(but with localised
)redness, hotness &tenderness at upper lateral quadrant
+tender axillary LN
NB;no breast lump is apparent
i prescriped amoxcillin500 mg t.d.s
and asked her if not relieved to visit a surgeon within 2
days

breast engorg
) breast
(abcess
.......
breast abcess
) breast abcess once dignosed>>>incision &drainage
ABCESS DESSTRUCTION TO WHOLE
(BREAST TISSUE



) (


<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
) (
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
.

don't prescribe a medication to a patient without examination


or even without seeing him















<<<<<<<<<<<<<<<<<<<<<<


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




<<<<<<<<<<<<<<<<<<
.

.

Pules 100/70 sever tender abdmone



.................

<<<<<<<<<<<<<<<<<<<<<



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

Diloxanide better to be avoided before 2 years



<<<<<<<<<<<<<

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

hyper reactive airway


resistanat airway





<<<<<<<<<<<<<<<<<<<<<<




!!!!!!!!!!!!!
severe&resistant to nebulizer
crepitation

wheezes


transmitted nasal sound
!

!
<<<<<<<<<<<<<<<<<<<<

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