Osce dr shawgi adugory
Transcript of Osce dr shawgi adugory
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By dr\Shawgi
Adugory
طالب الي إهداء
الفاشرجامعة الطب كلية
5/1/2011 1dr\Shawgi Adugory
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I hope that you gain the
acceptance and
illuminates the doctor will
have a significant
effect tomorrow5/1/2011 2dr\Shawgi Adugory
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Angioedema
5/1/2011 3dr\Shawgi Adugory
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In the second image, the lesions of the patient's palm were painless (Janeway lesions). A way to differentiate Osler's node from Janeway lesions is that Osler's node is pain, Janeway lesion is painless
5/1/2011 4dr\Shawgi Adugory
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Select one of the following answers:
DiphenhydramineAdrenaline
HydrocortisoneOxygen
Adrenaline
5/1/2011 5dr\Shawgi Adugory
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5/1/2011 dr\Shawgi Adugory 6
Charcot joint----------
1-leprosy2-syringomyelia3-tabes dorsalis
4-Repeated intra-articular steroid
injection
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Select one of the following answers: Heamaturia Elephentiasis Hemoptysis Heamatemesis Hematuria
5/1/2011 7dr\Shawgi Adugory
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Miliary T B______
Sputum for AAFB______CAT 1
5/1/2011 8dr\Shawgi Adugory
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5/1/2011 dr\Shawgi Adugory 9
Howell-jolly
bodies---
HYPOSPLENISM
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Mariam is 68 year old . She presents with pains in her 'hand joints which tend to get worse as the day progresses. Her hands do get stiff particularly after use. She has never noticed her hands to be swollen but has noticed little 'swellings on the ends of her fingers'. What is the likely diagnosis?
Select one of the following answers: 1-Rheumatoid arthritis2-Osteoarthritis3-Psoariatic arthritis4-Gouty arthritis
>>>>>>>no 4
5/1/2011 10dr\Shawgi Adugory
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defibrillator5/1/2011 11dr\Shawgi Adugory
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Acromegaly____________
Large spade like hand
Spacing apart of teeth
Tongue enlargeMyopathy
Cardiomegaly___________
HTNCarpal tunnel
syndromeVisual field defect
5/1/2011 12dr\Shawgi Adugory
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Select one of the following answers:
1-Epidural haematoma2-Subarachnoid haemorrhage3-Subdural haematoma4-Intracerebral haemorrhage
>>no 1
5/1/2011 13dr\Shawgi Adugory
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5/1/2011 dr\Shawgi Adugory 14
arachnodactyly
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Sarcodosis because .. wide mediastinum
5/1/2011 15dr\Shawgi Adugory
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Diabetic Retinopathy
Hypertensive Retinopathy
Glaucoma5/1/2011 16dr\Shawgi Adugory
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erythema nodosum
5/1/2011 17dr\Shawgi Adugory
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Ring stage plasmodio
m falciprum
5/1/2011 18dr\Shawgi Adugory
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HERPES SIMPLEX LABIALIS
5/1/2011 19dr\Shawgi Adugory
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Select one of the following answers: 1-Depression2-Type 2 diabetes3-Cushing's disease4-Hypothyroidism
This is a 76-year-old woman, who is complaining of fatigue and a 30-pound
weight gain occurring over several months. She is hypertensive and controlled on
hydrochlorothiazide. Her blood pressure today is 130/85 mmHg, and her heart rate is regular at 52 beats per minute. What is the
most likely diagnosis?
>>>no 4
5/1/2011 20dr\Shawgi Adugory
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Ophthalmic shingle(H sozter in
the eye)________
Acyclver tabs & ointment
___________-post herpetic
neuralgia
5/1/2011 21dr\Shawgi Adugory
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Myathenc snarl
5/1/2011 22dr\Shawgi Adugory
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Pectus
exacavatum
5/1/2011 23dr\Shawgi Adugory
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Cushing’s syndrome
1-24-hour urinary free cortisol level.2-Midnight plasma cortisol and late-
night salivary 3-cortisol
measurements Low-dose
dexamethasone suppression test
(LDDST).4-Dexamethasone-
corticotropin-releasing hormone
(CRH) test.
5/1/2011 24dr\Shawgi Adugory
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Kalazar_____________
Rx----admission
-pantostame 20mg\kg-iv_30
days_____________
Liver cirrhosiscancrum oris
Spleen ruptureAnemia
Skin pigmentationArrhythmia
(drug complication)
5/1/2011 25dr\Shawgi Adugory
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Anti Retroviral Drug
Nucleoside Reverse
Transcriptase Inhibitors(NRTI)
group
Use in the treatment of HIV pt
s\e– nausea-headache- insomnia –
damage the blood tiusse in BM
5/1/2011 26dr\Shawgi Adugory
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Trachoma-__________
Tetracycline eye ointment ( 2\d—6 wks)
Azithromycin caps 500mg \d-3 days
If not respond surgical removal
5/1/2011 27dr\Shawgi Adugory
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Stomach ulcer
____________
Eradication therapy
;-PPI(omeprazole)
+flagyl tabs
5/1/2011 28dr\Shawgi Adugory
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Necrobiosis lipoidica diabeticorum
5/1/2011 29dr\Shawgi Adugory
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Peroneal muscle atrophyPeripheral neuropathy
champagne bottle appearance
5/1/2011 30dr\Shawgi Adugory
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Lymphnode test to asses the group of
posterior triangle of the neck
5/1/2011 31dr\Shawgi Adugory
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bancroftia
n filariasis
5/1/2011 32dr\Shawgi Adugory
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1. Cytomegalovirus retinitis2. Roth spots3. Central retinal vein occlusion4. Hypertensive retinopathy5. Papilledema
5. Papilledema
Normal-disc_
5/1/2011 33dr\Shawgi Adugory
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--microfilariae__________
Onchocerca volvulus
5/1/2011 34dr\Shawgi Adugory
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Palmar erythemaascitesclubbing
dupuytren’s contracture jaundice gynaecomas
tia
Liver cirrhosis
5/1/2011 35dr\Shawgi Adugory
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Pneumothorax-percutaneous aspiration & chest
tube drainageHemothorax_chest tube
drainge5/1/2011 36dr\Shawgi Adugory
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Rt. Hypoglossal palsy
5/1/2011 37dr\Shawgi Adugory
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Peutz jegher syndrome5/1/2011 38dr\Shawgi Adugory
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Sixth Left Cranial Nerve Palsy horner's
syndromes5/1/2011 39dr\Shawgi Adugory
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HERPES ZOSTER (produced by reactivation of latent Varicella zoster virus VZV from the dorsal root ganglion of sensory nerves)Complication-- post-herpetic neuralgia: persistence of pain for 1-6 months or more following healing of the rash----Drug aciclovir 800 mg 5 times daily or valaciclovir 1 g 8-hourly
5/1/2011 40dr\Shawgi Adugory
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Foot with verrucous
skin change
5/1/2011 41dr\Shawgi Adugory
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Figure 13.15 Typical
Stevens-Johnson syndrome (SJS)
Causes Drugs(Anti-gout medications, NSAIDs,Sulfonamides &penicillins,Anticonvulsants)Infectious causes(herpes zoster,Influenza,HIV,Diphtheria,Typhoid,Hepatitis)&others (radiation therapy or
ultraviolet light).Complications:-
Secondary skin infection (cellulitis)Sepsis.Eye problems.
Damage to internal organs)- Permanent skin damage. Stopping
medication causesSupportive care (-Fluid replacement;Skin nursing _remove any dead skin.Medications Painkellar ,Antihistamines,Antibiotics,Topical steroids
5/1/2011 42dr\Shawgi Adugory
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Dx: air under
diaphragm(pneumope
ritoniu-perforating peptic (duednal ulcer)
5/1/2011 43dr\Shawgi Adugory
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Lipodystrophy1-infections
2-nephropathy3-neuropathy
4-D-foot5/1/2011 44dr\Shawgi Adugory
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5/1/2011 dr\Shawgi Adugory 45
psoriasis
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Sjogren's syndrome__Dryness of mause & eye ass-paroted gland enlargement5/1/2011 46dr\Shawgi Adugory
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5/1/2011 dr\Shawgi Adugory 47
claw hand
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Flattened “T”wave ,prominent “U”wave
hypokalemia
Tall tented “T”wave wide QRS
complex (sine wave)
hyperkalemia
Long “G-T”interval(eg –tetany)
hypocalcemia5/1/2011 48dr\Shawgi Adugory
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ST-depression
myocardial ischemia
ST-elevation
acute myocardial infarction
saddle shaped ST-elevation
acute constrictive pericarditis
5/1/2011 49dr\Shawgi Adugory
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atrial fibrillationAbsent “P”wave
Sow-tooth patter with normal complexes—
Atrial flutter
5/1/2011 50dr\Shawgi Adugory
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Peaked “P”waveright atrial hypertrophy
eg(pulmonary HTN & tricuspid stenosis).
A biphasic P wave
left atrial enlargement
eg(mitral stenosis)5/1/2011 51dr\Shawgi Adugory
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Hypertensive with angina &
Hyperthyroidism-pt bellow 35
yrs old &DM.
Fatigue & impotence
5/1/2011 52dr\Shawgi Adugory
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Give the names of these Different liver pathology---?
SecondariesCirrhosis fatty liver5/1/2011 53dr\Shawgi Adugory
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Simple partial motor epilepsy
Complex partial motor epilepsy
Grandmal epilepsy____________
Gum hypertrophy Acine like
Increase vit D consumption
5/1/2011 54dr\Shawgi Adugory
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Visual acuityExamination of 2nd
CN For far vision with the snellen chart
5/1/2011 55dr\Shawgi Adugory
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5/1/2011 dr\Shawgi Adugory 56
burr cells---
uraemia
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Rt side nasal hemianopia,
damage to the right optic chiasma ...
5/1/2011 57dr\Shawgi Adugory
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Extra-dural haematomaBiconvex (lenses)
5/1/2011 58dr\Shawgi Adugory
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-
Xanthelasma
Sign of hyper-lipideamia
-serum cholesterol
5/1/2011 59dr\Shawgi Adugory
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Spindling shape
--z-deformity
rheumatoid_nodules
Baker Cysts
Heberden’s nod’s—(SWELLING OF THE distal
interphalangelJoint)--- Osteoarthritis5/1/2011 60dr\Shawgi Adugory
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caput medusaedInferior vena cava
obstructionPortal
hypertensioncirrhosis of the
liver.
5/1/2011 61dr\Shawgi Adugory
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Acanthosis_nigricans-causes:- hypothyroidism or
hyperthyroidism, acromegaly, polycystic ovary disease,& insulin-
resistant diabetes.
5/1/2011 62dr\Shawgi Adugory
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Cholera-- Vibrio cholerae
-call the emergency room in the menstery
of health
Stool sample5/1/2011 63dr\Shawgi Adugory
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5/1/2011 dr\Shawgi Adugory 64
target cell -- liver disease
& iron deficiency anaemia
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Butter fly_rashSystemic Lupus Erythematosus
(SLE)—Steroid Creams
malar flush occur with severe mitral
stenosis
5/1/2011 65dr\Shawgi Adugory
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Superior vena caval obstructio
n
5/1/2011 66dr\Shawgi Adugory
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5/1/2011 dr\Shawgi Adugory 67
Hirsutism-------
increased level of
androgens------
Spironolactone
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What this sign call? if this pt with weakness of quadriceps (difficulty in walking) & fasciculation
also with hyperrflexia but no involvement of sensory system;
bladder or ocular muscles? Yr spot diagnosis? & one drug in this case?+ve planter
reflex__________
Amyotrophic lateral sclerosis
___________
Riluzole
5/1/2011 68dr\Shawgi Adugory
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Indication of this i-v fluide in pt admission with DKA ?
1-when the blood glucose level rech 250 mg
5/1/2011 69dr\Shawgi Adugory
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1-Lt facial and Lt occulomotor nerve palsy2-Lt facial nerve palsy3-Both Rt facial and Lt occulomotor nerve
palsy4-Rt facial nerve palsyLt facial nerve
palsy5/1/2011 70dr\Shawgi Adugory
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1-Uremic Pericarditis or pleuritis - (urgent indication)-2-Progressive uremic encephalopathy or neuropathy, (with confusion, asterixis, myoclonus, 0r seizures (urgent indication)-A clinically significant bleeding diathesis attributable to uremia (urgent indication)-Fluid overload refractory to diuretics-Hypertension poorly responsive to antihypertensive medications-Persistent metabolic disturbances that are refractory to medical therapy; these include hyperkalemia, metabolic acidosis, hypercalcemia, hypocalcemia, and hyperphosphatemia-Persistent nausea and vomiting-Evidence of malnutrition
5/1/2011 71dr\Shawgi Adugory
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Select one of the following answers: 1-Slow relaxation phase of ankle jerk2-Collapsing pulse3-Pretibial myxoedema4-Lid lag
>>>No 1
5/1/2011 72dr\Shawgi Adugory
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Lid lag for case of hyper
Thyrodism (graves disease)
___________
-neumercazol______________
-heart failure5/1/2011 73dr\Shawgi Adugory
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Investagation - x ray ,ECG&echo.
Treatment -bedrest in cardiac bed
-O2--lasix 40 mg iv
-digitalis-captrapil or atenalol
& follow up
5/1/2011 74dr\Shawgi Adugory
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Atrial Flutter5/1/2011 75dr\Shawgi Adugory
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-dx Plain PA chest X-ray of a patient with mixed mitral valve disease.The left atrium is markedly enlarged Note the large bulge on the left heart border (left atrium)The ‘double shadow’ (border of the right and left atria) on the right side of the heart. There is cardiac (left ventricular) enlargement due to mitral regurgitation.
5/1/2011 76dr\Shawgi Adugory
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Kerning’s sign
-L P (CSF analysis)
-1-admission2-I v floud
3-analgesia (votrex inj &
tabs)4-benzyl
penicillin (iv 24 million U\24
hrs)& chloroamphencol
1 g\day- or samixon 2 g\day5/1/2011 77dr\Shawgi Adugory
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Biomphalaria (water suitable intermediate for
schistosoma mansoni….)
Acute or chronic intestinal diseaseLiver involvement(
portal HTN & organomegaly)
AnaemiaPrazaquantel (single dose
40mg\kg)
5/1/2011 78dr\Shawgi Adugory
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Oral candidiasis
Seborrheic 0dermatitis0in
leukoplakia
Kaposi sarcoma Kaposi sarcoma of palate
aphthous ulcer
5/1/2011 79dr\Shawgi Adugory
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Hypocalcaemia5/1/2011 80dr\Shawgi Adugory
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bilateral nodular
consolidation
5/1/2011 81dr\Shawgi Adugory
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Dx Left ventricular aneurysmon the left lateral border. This bulge is due toAneurysm formation of many years following a myocardial infarction. A thin line of calcification can be seen along the edge of this bulge.
5/1/2011 82dr\Shawgi Adugory
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Select one of the following answers: Lobar pneumonia Bronchopneumonia Lung cancer Pulmonary tuberculosis
Pulmonary
tuberculosis5/1/2011 83dr\Shawgi Adugory
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Select one of the following answers:
Status epilepticus Tetany Acute severe asthma Depression
Status epilepticus
5/1/2011 84dr\Shawgi Adugory
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Pleural effusion
5/1/2011 85dr\Shawgi Adugory
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SUBDURAL HAEMATOM
A
5/1/2011 86dr\Shawgi Adugory
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Left-sided Horner's syndrome-
5/1/2011 87dr\Shawgi Adugory
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Right side facial nerve palsy--
5/1/2011 88dr\Shawgi Adugory
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Buruli ulcercaused by-----
Mycobacterium ulceransTreatment is by
surgical excision (removal) of the lesion,
5/1/2011 89dr\Shawgi Adugory
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Lower motor neuron Lt. hypoglossal nerve palsy5/1/2011 90dr\Shawgi Adugory
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Estimation of arterial O2 saturation5/1/2011 91dr\Shawgi Adugory
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pneumoniaasthma_ hyperinflation5/1/2011 92dr\Shawgi Adugory
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7 differential diagnoses?
1-chronic liver disease
2-disseminated TB3-brucellosis
4- chronic anemia(megaloblas
tic;hemolytic)5-amyloidosis
6-CCF7-Gaucher’s syndrome.
5/1/2011 93dr\Shawgi Adugory
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rheumatoid nodules
5/1/2011 94dr\Shawgi Adugory
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evaluate the visual
fields via confrontati
on. For examin the optic nerve
(field of vision)
5/1/2011 95dr\Shawgi Adugory
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27 yrs old female from Almanagel area c\f---- fever headache\ 5days constipation \3days.. O\E ---- small spleen which is soft &
tender?Give 2 diff Dx? &Explain pathophysiology of this picture show ?
1-Malaria2-Entrica
________
Due to effection of the RBCs ---
thrombocytopenia---decrease platelate---
epistaxis
5/1/2011 96dr\Shawgi Adugory
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epidural heamatomaSubdural hematoma[5/1/2011 97dr\Shawgi Adugory
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Biconvex epidural hematoma
subarachnoid hemorrhage 5/1/2011 98dr\Shawgi Adugory
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SENEMET___ contains 250mg L-dopa
+ 25mg carbi-dopa .
Rx of parkinsonism
S\E incloude:- Confusion; drowsiness; dry mouth;
headache; increased sweating; loss of appetite;;
trouble sleeping; upset abd-; urinary tract infection; nausea&
vomiting.5/1/2011 99dr\Shawgi Adugory
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DVTCelloliti
s
5/1/2011 100dr\Shawgi Adugory
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Abd- thrill
5/1/2011 101dr\Shawgi Adugory
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Vitiligo.
5/1/2011 102dr\Shawgi Adugory
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Lumbar Puncture
__________
Post puncture headache
herniation, Infections
Traumatic lumbar puncture
5/1/2011 103dr\Shawgi Adugory
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Left eye cataract
.IOL-
Intraocular lens
implantation
5/1/2011 104dr\Shawgi Adugory
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Hypo & hyper thyroidism
_____
TFT_________
Thyroxine tabs or
Neo mercazole tabs
5/1/2011 105dr\Shawgi Adugory
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non-pulsatile vesselsthe vessels do not collapse with inspiration direction of flow in the vessels is downwards positive hepatojugular rflux
positive hepatojugul
ar rflux
5/1/2011 106dr\Shawgi Adugory
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Abd- paracentesis
-Therapeutic &diagnostic
studies( color; cell count ; SAAG & culture & gram
stain)-abd- ultrasound
Causes 1-portal HTN
2-Nephrotic syndrome3-Abd- TB
4-CCF5/1/2011 107dr\Shawgi Adugory
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Finger nose test
For test sensory ataxia
5/1/2011 108dr\Shawgi Adugory
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1-Renal cysts2-Renal stones
3-Intersitial nephritis
4-Renal tumur
5/1/2011 109dr\Shawgi Adugory
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Severe malaria
_____________
Hypoglycemia
5/1/2011 110dr\Shawgi Adugory
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لعلني عبرت بعد جهد جهيد لعلني عبرت بعد جهد جهيد فأنا حيث أنتم قضيت شهد فأنا حيث أنتم قضيت شهد qسنين عمري بكيت كثيرا qسنين عمري بكيت كثيراوفرحت مرات أخري نمت وفرحت مرات أخري نمت
qوسهرت تألمت وسعدت وأخيرا qوسهرت تألمت وسعدت وأخيرا اغادر كلية الطب معقل اغادر كلية الطب معقل
اإلكتاب الي حيث ال أشتكي اال اإلكتاب الي حيث ال أشتكي اال من جهد العمل~ كخريج أحمل من جهد العمل~ كخريج أحمل راية كلية الطب جامعة الفاشر راية كلية الطب جامعة الفاشر
في سويدا قلبي وخارجه في سويدا قلبي وخارجه ولسوف اكن مدين لكم ولسوف اكن مدين لكم
وبصفة خاصة الي سنايري (وبرالمتي-- والي الذين
qعرفتهم ثم أثروا الذهاب بعيداعني
-- ) فرداq فرد --12الي الدفعة وسوف اكن مدين لكم بالكثير .....وفقكم الله وسدد خطاكم
[email protected] د\ شوقي الدقوري
5/1/2011111
dr\Shawgi Adugory
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يارب نستودعك ما
.....ودائعكتضيع علمتنا فإنه ال
سبحانك ال علم )
لنا اال ما علمتنا
انك انت العليم (الحكيم
5/1/2011 112dr\Shawgi Adugory