76 ---= ~

-- -
.` -
.`~ -- + --= ` =- ~ ' +- -~=-- ~
Female 20 y complaining oI arthropathy , erythema in Iace and was
treated with cortisone
-- ~ ~ = --= ~ - S.L.E
+- -~=-- ' - .`~ ~=
Child 12 y complained oI sore throat Iollowed by oliguria , hematuria
+ ~ + --= ` ' - post streptococcal G N
- '
-+~ =- '~- -= .' - -+~ + - +- -~=--- ~ '
.`~
Old male heavy smoker bronchogenic carcinoma
Old male complaining oI polyache and elevated ESR above 100
multiple myloma
-- -
+ - -= ~ = +- -~=--` ~ common s&s almost
speciIic == - = = . .`~ - ~ =- ~= hematemsis -
- -~ +- ~ ' -== ' ~' +~ - -
~ --~`
~
' - - - common symptoms , ~ -~~-~ --~' - ' -
Frank hemoptysis
-
common symptom
, pulsus paradoxicus
`'
cardiac temponad
acute sever asthma
~ _- - -~ -~` ' - =~~~ - -- -- , :
-~~=~ --~` ~ - _~ -=
.`~ dyspnic -~ chest pain
-- ' -== chest pain ~= _~ - - dyspnea
-- -~ -== -- =-- s&s -`-` -= ~ - _~ =~~~
-`-` ~ ~ ~~

- -`- ~ -- ' -
~- ` =-
.`~ dyspnea and chest pain
~ +- ' --~` -=
' '
1 pulmonary embolism
2 pneumo thorax
myocardial inIarction
.' =~ ' - s&s - +-- ~ -~ ~` ' ~' '~-
+-~ ---- = - ~ ~`
clp
nvestigation
~` =- --
.' ~ -`- -' ` ` -~ -~` - +---
.`~ hematemsis ' -- -
.' s&s , ---- ' -== ~ -`- ``~ --
rupture varises duodenal ulcer gastric ulcer
. ~ -`= - -- = -~ = EC - short
-- ~--- -`= _~ '~- 1
1 young man was admitted to hospital complaining oI collapse aIter
passing black soIt stool his pulse 110 bl.p 600
+ -~ - ~ = -
case oI melena
upper G bleeding
+--~' -' ' - -
1 esophageal varises
2 cancer stomach
gastric ulcer
duodenal ulcer

hat are the important points oI history and investigation
' -~` ` +-~ _ '~- +' -- ' ~` ~ ~ ~ =-
~ - ~- --
.`~
Esophageal varises portal hyper tension
-' ' liver cirrhosis and splenomegaly
-- - ~ = -- varises -
~= ~ -- ` pain
ainless melena rupture varises
ainIul melena peptic ulcer
nvestigation
pper endoscope
reatment
=- ~= - -~ =` -- +- ' ~` ~ ~ =-
=~ collapse
' -
epatic encephalopathy
`' +=`- ` '~-- `
he pt enter in irritability and coma
+~ .~=
Causes of irritable coma
1 hypertensive encephalopathy
2 hypo glycemia and hepatic encephalopathy
subdural hemorrhage
-- -~- ' -
hepatic encephalopathy
+=` -- -~
~
7 old man was enter in shock aIter vomiting large amount oI dark
brown vomits bl. transIusion to him and then he was conIused and
comatosed
- '
- ' -- .~ -= =` ~
Chronic liver disease lead to cirrhosis
- ~- precipitating Iactors
+-=~ hepatic encephalopathy
`` =
17 y old girl has attacks oI Iever , sore throat chloramphinicol was
described by her doctor at her Iirst attack and she repeated it by her selI
in next attack she has Iever and sore throat but not respond to
chloramphinicol this time
' - + -- ~ - - = --- ~ = ~ - =- .
+~~
) recurrent sore throat (
--~' ~~ ' `
Blood diseases as
1 leukemia
2 a plastic anemia
agranulocytosis
B viral inIection
C bacterial inIection
`' - leukemia -~ =- ~ -~
.' ~' a plastic anemia , agranulocytosis +--~ ~ .~
Bone marrow depression
' ~
mphenicol abuse
~ = ' -`- =- - -
1 leukemia
2 agranulocytosis
a plastic anemia
other inIections
.~
hat are signs
.' ~' +~ --~' -- -= cl p
.' =~ - leukemia
' -- - - + -
cute leukemia
' ~-
Liver
Spleen
Lymph node
- ' -`- ` - - ~ = - ~=
Mononucleosis
--- - a plastic anemia
' ~-
nemia
Repeated inIection
Bleeding
~ = - ~= - sore throat - sever = _~
No sever congestion
No Iollicles nor pus
.' ~' agranulocytosis
- ~ = =`'
Minimal signs oI inIlammation
Small amount oI pus
nvestigation
Blood picture
-- =~-- -~-- ~
~
granulocytosis
Leukemia
plastic anemia
-- - inIection
viral `- increased lymphocyte
bacterial `- increased NL
.~
_= .--~` -~ - -
Not right
s it has dangerous side eIIects it is contra indicated except in some
cases oI inIection as typhoid
hat about selI medication
` --- - -
-~ .-
ncorrect

` drug abuse --- -~ bone marrow depression

- =
y old man complain sever headache Ior the previous 12 hours he was
unable to tilt his neck without pain his temp. 7. with high blood
pressure
' + ~ =
Meningeal irritation

1 sub arachnoid hemorrhage

2 meningities
meningism
encephalitis
se one essential investigation
Lumbar puncture
-- `
Sub arachnoid hemorrhage
`- bloody CSF

-- ~' viral or B
`- increased lymphocyte

-- bacterial
`- increased NL
~ = -- - sub arachnoid hemorrhage
.~
-- +` .=--- ~ =
Neuro surgery
~= =
6 y old girl suIIer Irom pain in R shoulder and R knee increased
temperature and ESR above 100
' - =
rheumatology
arthropathy in child
- ~ +~ - =
Rh Iever
-' = -
Cl.p
nvestigation
Comment on prognosis
- ~= +~
Stell,s disease
-- ~ -- -~
Splenomegaly
~ ~~ ' ~ arthropathy -- .-`
Rh Iever
~
y old male in general hospital with acute chest pain Ior minute his
ECG was normal
~ acute chest pain
~ - ~=
~- ' -`-` ' --
Myocardial inIarction
nstable angina
neumothorax
ortic aneurism
ulmonary embolism
- .- -- - =- ~= neumothorax .' -~ -=~ ` xray
. _~ - .` .-` -
Normal ECG
~- - ` ~
. +=- ~- = -`= = -' EC - ~` -- '~--
hat is your advise to the pt
o be admitted under observation
~= =- ~=- `
You must respect chest pain
Especially in old age
hat particular symptoms you look Ior
.' ' clp - ~` --
nvestigations
xray
ECG
Cardiac enzymes
C scan Ior aneurism
- =
12 y old girl come with convulsion with eye puIIiness bl.p was 170100
ast history oI Iever and sore throat treated with penicillin
-- - '
hyper tensive child
-~ +~
acute glomerulonephrities
Diagnosis
ost strepto coccal glomerulonephrities
Clp : hematuria , oliguria .......
Explain the line oI treatment
B Ior inIection
B blocker diuretic Ior controlling the bl.p
=- ~=
-~- --- convulsion ' =~ --
yper tensive encephalopathy
`' +=`- '~- ` -
hat particular complications oI this case
Chronic glomerulonephrities
Rapidly progressive glomerulonephrities
Liable to hyper tensive encephalopathy
yper volemia lead to .F
ulmonary edema
-~` =
days aIter operation Ior Iracture in amale aged 7 years old he
develop Iever and rigors a week later he develop cough with
hemorrhagic sputum and sharp pain at the lower right side oI the chest

' + ~ =
hemoptysis chest pain
-- -' ~= - ' - _~ +--~'
ulmonary inIarction
neumonia
' +- = -
post operative lung maniIestations
ulmonary embolism ~ -~ -= V
+ .- - pneumonia -~ -=
- aspirated pneumonia
-- + ' -= ' ' - aspirated pneumonia
-~~=~ '
hat are points oI clinical exam .
1 pulmonary inIarction
Look Ior .V. symptoms
Look Ior pleurisy
2 aspirated pneumonia
Look Ior s&s oI pneumonia
ow to manage
-= -
diagnosis treatment
`'
iagnosis oI pulmonary embolism
1 Ior .V. duplex scan on lower limb
2 Ior lung lung scan
Blood picture show leukocytosis

iagnosis oI pneumonia chest xray
. = -
reatment
neumonia with anti biotic
p. embolism with heparin
` - adjust the dose oI heparin
-`
Low molecular weight heparin

Special advise to the pt
roper treatment and suction Ior pneumonia
Start walking early aIter operation
rophylactic heparin
' ~ ~ -=
l.m.w heparin 60 0 u 12 h s.c
=
20 0 u 12 hour s.c

~- =
12 y old boy prescribed with Iever . mild jaundice Ior days with sore
throat well general condition temp. , enlarged lymph node oI axilla
-~ - -
Iever sore throat
1 leukemia
2 agranulocytosis
a plastic anemia
viral inIection EBV CMV
bacterial inIection

-= --~ -- -
plastic anemia , agranulocytosis

Lymph node enlargement
-
) fever + jaundice (
+ ' '
1 viral inIection EBV CMV
2 asending cholangities
Iulminate liver Iailure
hemolytic crisis
hat additional signs
' -`- -=
Leukemia
nIection mononucleosis
~' ~-' s&s +---
-~ -= - mononucleosis
1 pin point peteche between soIt and hard palate
2 I the pt take penicillin , maculo papular rash will develop
blood picture show atypical lymphocytosis
ve agglutination test monospot slide test
aul bunnel test
EBV anti bodies gG gM
rognosis
t is selI limited
~- ~ - - - -
urpic cell lymphoma
=-~ -= ~ -' ' inIection
1 typhoid
2 brucella
mononucleosis
-~ =
You were called to see 6 y old hypertensive woman on irregular
hypotensive therapy with inability to elevate her lt upper and lower
limbs her blood pressure 10 100
She stated that she did not take her drug Irom a time the pulse was
irregular irregularity
days later pain in Rt leg and her Ioot was pale and cold days more
she develop diarrhea and soIt dark stool
hat particular nervous and vascular signs
~ stroke
~ - ~ sign oI hemiplegia
.' -- leveling
+~ .~ - - -='
what is the lesion and where
`
~' ~-' sign oI hyper tension on heart
nvestigation
1 ECG
2 Iundus examination
Echo
hat is the explanation oI the case
Recurrent embolisation
reatment
1 hypotensive drug
2 control oI the heart
anti coagulant aIter control oI melena
~ ~= =
y old male smoke 0 cigarette day with smoker cough develop
recurrent acute chest inIection aIter it the cough changed and the sputum
changed and then he develop general weakness numbness and tingling
=~-
case oI bronchogenic carcinoma
~ - ` ' -
ara malignant
.' - ' systems - `--- ' ara malignant
1 endocrine
2 CNS
.' -~ chest ` CO
.' -~- heart ~ cor pulmonale
he most common investigation
xray
C scan
Bronchoscope
-~ +` +=- ~ = -
horacic surgery
~ ` =
y old man diabetic Irom 20 y come with lower limb edema blood
pressure 10100 last month attack oI pain in Rt lion region Iever and
dysuria doctor give him tetracycline , analgesic and V
reatment
, - + -`'- ==-~ ~-~ ~' .'

rd
generation cephalosporin
' -- -~ -= -=- ` V
n addition it is hepatotoxicty and diabetic nephropathy
nvestigations
1 sonar
2 C , MR in suspected case
= -
V showed stones in kidney and urine culture show gram ve bacilli
sensitive to gentamycin
he doctor give him gentamycin 0mlh the case develop acidosis
oliguria very high blood createnin and urea
' '== -~
~ -= ~~=- = -~- -== -= `
+- - - ---~ =~ -- -=-~ -~- -= ~
~- ~~
Gentamycin should adjusted to blood createnin
ow to manage now
ialysis is argent
~
Young girl 6 y old presented with pyrexia rigor , headache , vomiting
and leIt lion pain she has history oI similar attacks

= -=~ ~ -~=' ~ ' ' ~' ' ~-'
rigor Iever lion pain
+~ ~ pyelonephrities
~ ~ = - -~- ~ - - + - ~=
ReIlux or any other anomaly
--~ -- -~-
Recurrent pyelonephrities
hat is the only important investigation
rine analysis
pyouria
BC cast indicate upper urinary aIIection
`- --~ -=- ,~ - ` pus `- --~ BC cast
ve urine culture
with immune Ilourcin organism coated with anti bodies will be seen
~ bl . p .
`- leukocytosis
iagnosis
cute pyelonephrities
hat Iurther investigations to conIirm diagnosis
1 Xray Ior stones
2 bl. Sugar Ior M suspicion
MR
=- -~-~ --=' ` ' -=-- ` -`=
~ - =
Male y old hypotensive with asthenia his dermatologist give him
along run therapy Ior discoloration oI the trunk
' ~
ddison
t is a primary chronic disease oI adrenal gland
etiology
--~' +~'
B
uto immune diseases
hat other symptoms you suspect to Iind in his history
.' -- clp .' -- ddison
s Iatigue , hypotension , hypoglycemia ....
nvestigation
.' --` `' cortisone .' - - - cortisone
~ = - --` ` adrenal gland
By high C with low cortisone
.' ~ ' +~ ddison
Eosinophilia
~ ~= =
y old male present with delirium his wiIe told you that he had
inIluenza and chest inIection days ago
nd at the last months he was irritable with change in behavior on
examination there was tremor and liver was Ielt
iagnosis
Chronic liver disease with cirrhosis in present oI precipitating Iactor
hepatic encephalopathy was developed
hy
rritable coma
hat is the precipitating Iactor
nIection
hich type oI tremor
Flapping tremor
hat type oI tremors you know
Fine , coarse tremors - .~ -
hat essential lines oI treatment
.' ` --- hepatic encephalopathy
Can you give him morphine
No it will lead to deep coma
Give short acting benzodiazepine as diazepam
~ ~~ =
2 y old male suIIer Irom cough , hemoptysis and night Iever xray
show cavity in Rt upper lobe oI the lung
`'
oI cough hemoptysis
Non speciIic chest inIection 1
, - -== -= - - +- ~ ,~ ' -
B
pneumonia
bronchiectesis sica hemorragica
pulmonary inIarction
2 C.V.S causes as pulmonary venous congestion
= cavity in Rt upper lobe
' -- abscess or B
nvestigation
Sputum culture and sensitivity 1
Or ZN stain
2 Bl.p
in pyogenic inIection will show leukocytosis and neutrophilia
in B will show lymphocytosis
consider your diagnosis is correct what is your treatment
pyogenic inIection will be treated with anti biotic 1
B will be treated with anti tuberculosis 2
he pt take proper treatment Ior months and his condition improved
but he stop aIter that , Iew months later he take irregular course 10 years
later he develop puIIiness oI the eye led and ankle edema
' ~ =
- -- amylodosis
,~ ~ B + ' -
nvestigation
rine analysis show 1
roteinuria and excessive hyaline cast
`' ~ hyaline cast -~~~ =~- - -- -= =
2 sonar show enlarged kidney
renal biopsy
rognosis
reatment only to prevent Iurther amyloid deposition
+~ ~ = ' ~
= 17
1 y old girl presented with asthenia , pallor , sore throat , pyrexia on
examination she was pallor with blood spotted arm , throat ulcers and
murmur on heart one week later she was comatosed and sudden Rt
paralysis then died aIter days
` - ~ --- .= ~ - ~-~ +- -~=-- ' - -
_ -`- -' -- + --= - - ~ '
' ' ) fever + sore throat (
1 leukemia
2 agranulocytosis
a plastic anemia
viral inIection
bacterial inIection
- - ~
Hemiplegia in oung person
+~ --~ -
1 eart as a source oI embolism as in mitral diseases or EC
2 vasculities
-' -- ' ---
.` '
~ =
blood disease a plastic anemia
-~ .-` -- = ' ~ -
allor by anemia
nIection by decreased BC
urperic rash by decreased platelet
. - hemiplegia ---
` blood disease - bleeding tendency
-= ~ -- hemorrhage stroke
-- ' - murmur
`- -'
` '
~ = inIective endocarditis - -~
Fever murmur
- -` -- ' .~ Iever cardiac pt
1 Rh activity
2 chest inIection
.E
.' ~- stroke _~ ~~
heart as a source oI emboli
.' ' - urperic eruption
_~ -=- ' E .' ~ vasculities -- -~
-- '
SLE
` _= --- - + ='
nvestigation
Bl.p
n a plastic anemia
nemia
ecreased BC
hrombocytopenia
n E
blood culture and trans esophageal echo
n lupus N and anti N
hat is the most common cause oI hemiplegia
--~ -=' -~ .- =~
plastic anemia
-- - hemorrhage due to bleeding tendency
E
-- -
he heart as a source oI emboli
+ ' SLE
- -- - vasculities and hematological disorders with lupus
= 1
20 y old girl presented with ankle edema , puIIiness oI eye led and joints
pain her temp was 7. urine analysis show roteinuria she has a
history oI erythemic rash on checks
~- -~
Young Iemale roteinuria Gn lupus nephritis
' =~- ` - SLE
hat is your proIessional diagnosis
SLE
-~ - -- `
1 erythemic rash on checks
2 joints pain
roteinuria kidney aIIection
Iemale
nvestigation
N anti smith anti N c,c
activity
igh anti N and low c,c

he pt improved markedly on drug and the dose oI drug was decreased
gradually 2y later the pt develop sever stitching pain on the Rt side oI the
chest with plural rub
Give an explanation
' +- = -
-
.' ~ `' SLE - ` - serositis . -~ ~- ,~' ' - pleurisy
and plural eIIusion
+ - ~ ` pneumonia +` immunosuppresed by cotisol
therapy
nvestigation
Chest xray
6y later the pt admitted in coma , increased Bl.p with acidosis her
relative stated that she developed anorexia , nausea and vomiting
=- ~= M ~-~ -~ Bl.p - - ~ - renal aIIection
.' ~ = lupus
iagnosis
Lupus nephritis lead to renal Iailure
nvestigations
Blood urea , createnin and K
ow to manage
ialysis
=- - _=- +==- -- ~ ` ~- - ~=
- ~ ~- -= ~~= .' ~ ~ exacerbation
= 1
Male pt 22y presented by Lt side hemiplegia with Lt jaksonin Iits with
a history oI MS with F development 2 months later he develop
hematuria

' - ' hemiplegia in young person
+`- .= ~ the heart as a source oI emboli
.~ ' Neuro .~ -=' `
hat is the lesion and where
Vascular + - localization
-- -- -~ cortical ~ =- -- jaksonin Iits
Explain hematuria on bake ground oI hemiplegia
Embolisation repeated
reatment
= -' --~ - anti coagulant
= 20
1 y old pt develop cough , Iever , chest discomIort and sudden sever
dyspnea appear aIter that on examination there was inspiratory Iilling ,
low Bl.p pulse was paradoxically 120 beat minute

+ = pulsus paradoxicus
--~' -' '
pericardial eIIusion with temponad
acute sever asthma
- ' ' ~ - .` .-` - -
-~- ~ Iever , cough , tachycardia -~- pericarditis ~-
. -=-' pericardial eIIusion - temponad
.' - -' =- ~= sign pericarditis - tachycardia
nvestigation
Echo .' ~' ~- eIIusion
ECG
etiology
Viral or B inIection
= 21
12 y old girl come with pyrexia , pallor , mild jaundice and enlarged
tender liver Bl .p show Eosinophilia
- ~ ~ + ~ =
Fashiola
`- ' + - -== ~
ncreased alkaline phosphates and decreased transaminase
reatment
raziquental
= 22
2 y old male has sever chest pain Ior one hour aIter ECG he was
admitted to CC then palpitation developed Iollowed by dyspnea and
cyanosis
~ = -- '
M lead to L side F which end by cardiogenic pulmonary edema
.' ~- --= -~ - - M = palpitation = -
arrhythmia -=~ ' - F
escribe the ECG oI this case
`-- ' - ECG -~- ~ --
M
nvestigations
1 cardiac enzymes as CKMB and troponin
2 total leukocytic count
- -~- `- leukocytosis
Out line schedule oI treatment
-- treatment oI M treatment og pulmonary edema
-= -' -~ dopamine diuretic
= 2
Male pt 6 y with diIIiculty in writing his name no weakness was
present Bl.p 10060 with extra systole
' ~
arkinsonism
.' --- - tone `-- rigidity
Other symptoms and signs you expect to Iind
.' -- Cl.p .' -- parkinsonism
reatment
nti cholinergic and dopamine derivatives ldopa , carbidopa
= 2
y old Iemale with epistaxis managed with blood transIusion .
months later she develop jaundice y later she develop enlarged
abdomen she take thiazide but not respond to it sonar show amass in the
Rt hypochondriam
~ =
cute viral hepatitis then become chronic hepatitis develop cirrhosis
and Iollowed by ascities ended by hepatoma
Give causes oI epistaxis
vasculities
sever hyper tension
blood disease
Give causes Ior non respond to thiazide
low dose
weak thiazide
malignancy
renal impairment
Explain jaundice
cute viral hepatitis
ow can you prove
ncreased enzymes + . hepatitis
Viral marker + .- viral
= 2
60 y old male heavy smoker with chronic cough suddenly he develop
Irank hemoptysis
+~ - CO
- -- bronchogenic carcinoma
nvestigations
Sputum analysis show malignant cell
Biopsy
Chest xray
Ct show nodules
= 26
2 y old Iemale with headache bl.p 100 with bruit on her abdomen
~
Renal artery stenosis
+ Iibro muscular type
` young Iemale
nvestigations
uplex
Renal angiography
reatment
Control Bl pressure better to avoid CE in bilateral artery stenosis
may need surgical revascularization



6 years old male admitted to CC Ior sever chest pain Ior 0 minute
Blp was 10120 with inIrequent ectopic beat
' -
cute chest pain
-= - - ~ - ` - -~ = -~ - - --~'
+~ -=
- ~- -~~`
cute M
nstable angina
issecting aortic aneurysm
-- ~
pulmonary embolism
neumothorax
-- ' - ~ - esophageal spasm
-=- =- ~= _~ nitrate
- ' - related to meal
.' --- - CL. .- +--~ --- + +--- investigation
' + = -' - . dissection
- ' --
unequal puls volume
diagnosed by C
treatment
--~ ~= +-~ +~ -= - -~ +-~ - ` --
issection treated with graIt and controlling blood pressure
0 years old Iemale with artheralgia in small joint Ior 1 years last
month she developed edema and heavy protenuria

- ~ ` ' nephro -
-`- ~ = .-
rheumatoid
S.L.E
NS cause minimal lesion GN
~ - ` + + SLE

-~- - += = 2 ' - - ~' ' . -~ -~ GN
+' . ~ - - - rheumatoid lead to amyldosis
.
-- -~
nvestigations
reatment oI rheumatoid and SLE
reatment
Lupus with cortisone
Rheumatoid with cortisone and methotrexate
.' -~ -=-~ pulse dose - `' systemic disease
Female 20 years old married suddenly develop involuntary movement
oI lt upper limb proximal more than distal her husband reported that
she was irritable and drop things

' ~
Chorea
- ---- neurological exam +- --
- - =- ~= rheumatic chorea
.' - ~' clinical maniIestation =~- --
~' other clinical maniIestation oI Rh Iever
reatment
Long acting penicillin
anti dopamine
rognosis
SelI limiting
--`' ---~ =-~ -- ` _=

years old lady with rapid sense oI Iatigue , intolerance to cold Irom
months her voice become harsh Irom 2 weeks , dry skin , slow
response and her pulse was 60

' -- ~
- myxodema
0 years old unmarried male with knee joint pain and dysurea
examination revealed congested red eye with maculopapular skin rash
and sacro iliac pain

- ~ =- ~= sacro iliac pain --- - -~ ~' =~- +~ ~
'
= dysuria ` ` -~
-+- - -- ~ = - -~ -
-~ -~ dysurea ~-~ _- -
.~
- -~ ~ -
--- -- ' +` chlamedial inIection +~ = --
non gonoccocal urethrities
non speciIic urethrities
+-- ~ -- -= -
-- `- ~ +-~ ~ --=- -
. ~= ~ ulcer on genetalia
20 years old newspaper develop general weakness ,swelling oI lips
with itchy skin rash Ior one day examination revealed rtecaria
,lymphadenopathy and wheezy chest he had a street cut wound Irom 6
days
-- - ' ~=-- ~ = --~ -' ~ _= - - =- ~=
- -~- - 6 + - ~ - ~ ` '
ypersensitivity type serum sickness
+ + - hyper sensitivity type 1
-~'- -~- ~ . -+= ` - -~ ` - -~
+-' ' .~
rtecaria
Lymph adenopathy
rthropathy like rheumatoid
e had the antigen 1 week ago
years old male with diIIiculty oI swallowing Ior years with Iluid
more than solid ,pain behind the lower part oI the sternum and
retrosternal pain
~
Esophageal achalasia
-
Fluid more than solid
Long time
retrosternal pain
-~ `
esophageal spasm

Cancer Esophagus
- ~= ` -- --~ -
nvestigation
Endoscope
xray with barium swallowing
treatment
_~- -
years ld Iemale used to selI administrate oI pain killers Ior joints
pain last 6 months yellow discoloration oI eye last week exam
enlarged liver Iingers below the costal margin no spida nevai , no
edema
~ =- ~= -- - - '
1 autoimmune hepatitis
2 hepatitis B,C
primary billiary cirrhosis
ilson
hemochromatosis
- --~ - -~-- -= - ` -~ = -~ -
- -~ ~
-~- ~ ~~= - +` -~- --~
nvestigation
utoimmune marker
Viral markers
-=` = --~
+ - liver cirrhosis
- -- -

Osteoarthritis ` -~= hepatotoxicty
. - pain killers - - nephrotoxicty
years male M controlled Ior years last weeks he developed
cough, sputum , polyurea and stress
. - - --- - M -~ =-
-`- ~ - =- `
1 ---~ ~
2 +- ,~ respiratory inIection
---- --- ~
K
yperosmolar
Lactic acidosis
ypoglycemia
yper osmolar

-- chest inIectin ' -~ pneumonia or B
=~ -- ~~ ~ ,~ =~- K
~- ` -- . -~ ~
nvestigations
Sputum
Chest xray
ZN stain
Culture sensitivity
reatment
nti B
I pneumonia give antibiotic
' ~ ~ --- --~
2 years old male working abroad Ior 2 years developed regular Iever
Irom 1 month with joint pain and lymphadenopathy
- ' ~` +~' ' lymphadenopathy
Leukemia
Lymphoma
Brucella
Mononucleosis
V
- ~- --- ~ V ~ -~ -~ -- ~ -
== -`-` --~ ~ -
Child with stunted growth 10 years with bouts oI Iever Ior 1 year
examination revealed pallor , hepatosplenomegaly
~-
~ = anemia hepatosplenomegaly
emolytic
Spherocytosis
halasemia
. - --~
G6 , sickle cell anemia
` --~ ` liver nor spleen
nvestigations
CBC LC blood Iilm bone marrow b
electrophoresis
Lady who is smoker and take contraceptive pills she start to Ieel dyspnea
with moderate excertion ,Irequent bronchiectesis in winter CO
sudden marked weakness oI Rt arm ,diIIicult in walking and aphasia
' ~
Stroke
cute hemiplegia vascular
` ' +--~ - risk Iactors
Smoking
Contraceptive pills
hemiplegia -- neuro -= -=- `
hat's the lesion where is the lesion
- +~ =-- +' - -' -
Cortical
Capsular
Brain stem
. -- - aphasia +' --~ -~ cortical
years old male on irregular treatment oI hypertension complications
will be Iound
. - target organs oI hypertension
eart
Brain
Kidney
- ~~= --- .~ -
Complain dyspnea , polyurea during last week his Bl pressure was
210120 , sustained apex ,mild dehydration with pale urine
- ~ =- ~= pale urine -~- - -~ dehydration - -~- ~ -
-~ I , renal Iailure
. - F . -~ diarrhea , polyurea
~
ypertension complicated by renal Iailure
2 years old Iemale with irregular Iever Ior 1 month apian in the Rt side
oI the abdomen her temp was 7.7 enlarged liver and normal spleen
CBC show eosinophilia
~
Faschiola
--- = -~