SLE MARCH 2008

,-* +# )('& $% "!# 2008 . . = ",8< + :6- hepatocellulat hepatoma metastesis : : ;789 16 5 4 3 12 /0 . 78>( how to inform the patient 3 CD4 B3 12 A(+ @ 1 ?you ha e to fin! out how must "now :";4 K;M% @? " K5 KL @ $5 J* ($% GI>( E?% paralysis : G,H E F 3 12 2 F 4' @ O(" neuro D A,N K;M% con ersion !isor!er V (>U K*6M R) G,N @ 0')" T9 B+ G;M% GD i#s 0')" @ S6) P /) R , )% E QP \\ S [Z X-Y W< ((;+ $astroenterolo$y W< (;+ ,5Y K *! _'G ")' ^..F.Z U 0'"6 " S ?[.0F00 1 " K;MI K *! "'E Q] `` complicate! patient 60 X ?[A," ?@ $8 64?@ - K) S8 \\ W< (;+ Ib GM a C% X')" '6 G _a4 $3,* _ 6* H 0'* U ":, :5 'QZ ``hematoma 1 B >4 c' *6 All features of tonsillar a#scess e%cept & deviation of uvula to affected side: central artery em#olism all true e%cept & causes painful visin loss first EC' si$n of acute pericar!itis & ST elevation q waves porlonged PR interval (n initial e aluation couples for infertility& temperature chart semen analysis refer to reproductive clinic...? Erethema no!osum & painful red nodules initial (n% in small #owel o#struction & Erect & supine a dominal !" ray chil! with ec)ema flare up he is on steroi! an! ha in$ itchin$ !istur# his sleepin$ my answer to $i e antihistamine**

%" !#$ ! 'ol! stan!ar! ima$in$ in acute panceriatitis & &#T scan pre$nant la!y 28 w"s with chlamy!a infection & a$ithromycin erythromycin do%cyline common cause of male infertility& primary hypogonadism secondary hypogonadism e&aculation o struction ... )( %' +8years ol! #oy with #ac" pain in esti$ation to !o e%cept & #'# ? ESR ! "ray one scan iron !eficiency aneamia & serum iron ferritin T('# Hypothyroi!isim & free T) TS* T) in which $roup you will !o lower en!oscopy for patients with iron !eficiency aneamia in with no #eni$n cause& male all age group children permanupausal women women + ,#P (-. ,* + chil! with piece of $lass !eep in ear canal what to !o& si!e effects of Le o!opa & dys-inesia speech fatal hepatic to%icity..? +, patient while he playin$ foot #all there is one come - pop his "nee from the lateral si!e .come to the hospital . /hat is the most pro#a#ly cut in0ury occur* "medial meniscus 2, 1or this case the treatment is& ." Surgery

2, 30 or 33 4.5 patient present with unilateral shoul!er. upper - lower limp pain with mornin$ stiffness of more intensity after wa"e up .there is mil! fe er - the patient is !epresse! & 6ia$nosis& ."R.. '" Polymyalgia rheumatica. 7, Male patient "nown case of 6M (( come with H# A+C & 88 .he is ta"in$ metformin - $li#enclami!. to re$ulate the #loo! su$ar nee! & ." ............insulin '"............insulin #" metformin & acar ose . 3, case scenario patient present with constipation ......6% & hypothyroi!ism 9o confirm that the patient has hypothyroi!ism& ."T) '"TS* #"free T) :, Case scenario ;patient present with symptoms of hyperthyroi!ism. ten!er nec" swellin$ & 6ia$nosis& su acute thyroiditis <, mother #rin$ her #a#y to you when she complain of !iaper rash . she went to !ifferent !ru$ #efore she come to you . she use! 2 !ifferent corticosteroi! !ru$ prescri#e! #y !ifferent physician. .......... the rash is well !emarcate! - scaly & 6ia$nosis& ."se orrheic dermatitis '"contact dermatitis #"? <, 9he treatment& ** 8, female patient man$er since short time . #ecome !epresse! . she sai! she can=t mana$e the conflicts that happen in the wor" #etween the employees. 6ia$nosis& ."/epression. '"0enerali$ed an%iety disorder. #".d&ustment /isorders >, Case scenario ;female patient present with e%cessi e fear in her chil!ren ....... ...? my opinion it is a case $enerali)e! an%iety !isor!er. 9reatment& * +0, @atient #efore menstruation #y 2,2 !ays present with !epresse! moo! that !isappear #y 2,2 !ay after the #e$innin$ of menstruation... 6ia$nosis& ."Premenstrual dysphoric disorder 1or premenstrual syndrome ?2. ++, 1emale patient #reast fee!in$ present with mastitis in upper outer Aua!rant& 9reatment&

."stope reast feeding & evacuate the mil- y the reast pump. '" 0ive.....anti iotic to the mother & anti iotic to the a y. +2, case scenario . #a#y present with unilateral !eformity in the foot appear when it is #ecome the wei$ht #earin$ is in the other foot #ut when it is the wei$ht #earin$ the !eformity !isappear .the patient has !efect in !orsifle%ion of that foot .......( thin" they are ta"in$ a#out ; clu# foot ? treatment & ."orthopedic correction ...? '"shoe.... #"surgery .... +2, case scenario ; ....patient present planter fascitis? 9reatment& ."#orticosteroid in&ection. '"silicon... +7, @atient present with retinal artery occlusion. which is wron$& ." Painful loss of vision. '"" Painless loss of vision. +3, @atient present with corneal a#rasion& 9reatment& ."#over the eye with a dressing. '".nti iotic ointment put it in the home without covering the eye? +:, @atient present with epista%is& 9he #est mana$ement& " the patient leaning forward 3ma-e pressure in the lower side of the nose . +<, @atient present with unilateral nasal !ischar$e . foul smellin$ in the nose . Most pro#a#ly !ia$nosis& " .denoid " 4oreign ody , .8 3 #a#y present that he only sayin$ mama #a#a which is a#normal for his a$e . no other symptoms or si$n a#normal . first thin$ to #e asses & " "hearing assessment . " "developmental assessment . +>, Case scenario .chil! present with rhinorrhea - sore throat for 3 !ays present with mi!!le ear perfusion. e%amination of the ear & no re!ness in the ear the cause of perfusion & " otitis media . " 5pper respiratory infection. 20 Case scenario ;patient "nown case of coronary artery !isease. present with a symptoms of it. to !ia$nose that patient has M( or not. #y ." E%ercise stress test. '" #oronary angiography #" E%ercise.... 2+, @atient present with acute precar!itis . (n EC' we see & , S,9 se$ment ele ation. "q waves "prolonged PR interval

22,case scenario ;patient present with caroti! artery o#struction #y 808. treatment #y " carotid endarterectomy. " ........surgical ypass 22, @atient present with $enerali)e! sei)ures not "nown case #efore of any siu)er . no per ious history li"e that & 9he most important thin$ to !o now is& " EE0. " 6a oratory test . 27, Case scenario patient present with carpal tunnel syn!rome. 9reatment& "corticosteroid in&ection B.C they !i!n=t mention a sur$ery in the MCD 23,case scenario ;..... patient present with SLE? 9he least !ru$ has si!e effect& " methotre%ate " name of other chemotherapy 2:, case scenario ; ....patient present with prostatitis . #y culture $ram ne$ati e ro!e ? treatment & " Trimethoprim and Sulfametho%a$ole " ampicillin " gentamicin 2<, case scenario ; patient present with ER9(. after + wee" the patient present to ha e hematuria .e!ema .... most pro#a#ly !ia$nosis& " (g. nephropathy " post streptococcus 07 28, the most important !ia$nostic test for that is & , 8icroscopic R'# "8acroscopic R'#. " R'# cast. 2>, case scenario patient "nown case of hypercholesteremia .CM( &2+ @resent with in esti$ation. showin$ ; num#ers ? &hi$h total cholesterol .hi$h L6L - hi$h 9'...... 5f these in esti$ation what is the !an$er one for !e elopin$ coronary artery !iseas & "6/6 20, Case scenario patient present with acute pancreatitis .#est !ia$nosis #y & " 8R( " #ontrast computed tomography " !"ray 2+, Case scenario patient present with 2 !ays history of #lee!in$ per rectum . present of pain after !efecation . #y e%amination ; mass at 2 o=cloc" ? & 9reatment& ."Put a sit$ ath 9 time a day .

'" 7S.(/ ointment locally . #" ligate the mass then remove it . 22, case scenario ; female patient present with Erticaria. there is a history of swellin$ in the lip some times. !ia$nosis & 6ia$nosis& " angioedema 22, D a#out peptic ulcer .how to "now if it is !ue H.pylori or not . 27, 3 patient .your !ia$nosis for hem is cancer .how to #rea" that #a! new for hem & " see the patient how many -now a out the disease. , 23, 33 4.5 male patient present for chec" up .physical e%amination is normal .la# in esti$ation microcytic hypochromic anemia . H# &> the most li"ely cause to e%clu!e is " lymphoma. " gastroenterology malignancy. , 2:,patient who is smo"er the least !isease to occur in him is & "5rinary cancer. " #olon cancer. 2<, case scenario patient present with acute symptoms of #loo!y !iarrhea ...... 6ia$nosis .acute ulcerati e colitis & the initial treatment for this patient & "corticosteroid therapy . " methotre%ate. " 9".minosalicylic acid 28, @re$nant women present with a mass in her mouth #lee!in$ when #rush her teeth #y e%amination mass 2%2 cm. !ia$nosis & " aphthous ulcer. " .....cancer " .....granuloma 2>, case scenario .patient present with intestinal o#struction & (n esti$ation to #e !one& " !"ray supine & erect position. " c"scan 70, Beonate #a#y present with rash o er the face - trun"- #luster formation . 6ia$nosis& " Erythema to%icum , 7+, 1emale patient present with itchin$ in the a$ina associate! with the a$inal !ischar$e . @H & 3 . no 9richomonas infection . pseu!ohyphae #y culture !ia$nosis & " physiological discharge . " #andida infection . 72, female patient present with thic" a$inal !ischar$e color..... . no itchin$ . a$inal e%amination #y speculum normal .@H & 7 6ia$nosis&

"physiological discharge 72, case scenario ; patient who is "nown case of hepatitis C .(n esti$ation shows& hi$h al"aline phosphates - aminotransferase HCs A$ & F e HCs a# & , e 6ia$nosis& "o struction of iliary tract ?? 77,epi!emiolo$ical stu!y for smo"er sai! there is +0.ooo smo"er in the area . at start of the stu!y there is 2000 . at the en! of the stu!y there is +000 . the inci!ence of this stu!y is & ." :;< '" =;< 73, epi!emiolo$ical stu!y want to see the affect of smo"in$ in the #roncho$enic carcinoma . they saw that is >08 of smo"er has #roncho$enic carcinoma . 208 of non smo"er has the !isease . the specificity of the !isease as a ris" factor is & ">;< "?;< 7:, female patient complainin$ of thirsty - !rin" a lot of water - freAuent urination . she has a history of !ia$nose! as #ipolar since ; 2 wee" ? .start with a me!ication of lithium. " psychogenic polydipsia. " central dia etes insipidus. nephrogenic dia etes insipidus . 7<, case scenario female patient present with lower a#!ominal pain ; or #ac" pain? 2,2 !ay #efore menstruation. then 2,2 !ay after #e$innin$ of it & 6ia$nosis& "primary dysmenorrhea. " secondary dysmenorrhea . 78,el!rly women present with !iarrhea. hi$h fe er - chills. other physical e%amination is normal inclu!in$ #ac" pain is normal . 6ia$nosis& ." Pyelonephritis. '" 'acterial gastroenteritis. #" @iral gastroenteritis. 7>, @atient ta"in$ anti!epressant !ru$. ;names of a !ru$ ( cant remem#er it #ut what ( remem#er it a !ru$ of hypertension -.....? the anti!epressant !ru$ ma"e !ru$ !ru$ interaction with one of the followin$ !ru$ & " 7on of the a ove. 30, @atient present with se er #ronchial asthma which of the followin$ !ru$ . not recommen!e! to $i e it & ." Sodium gluconate . '" #orticosteroid 1in&ection or orally? 2 #" #orticosteroid ne uli$er. 3+, #a#y present with pain in the ear .#y e%amination there is piece of a $lass !eep in his ear canal . the mother mention a history of a #ro"en $lass in the "itchen #ut she clean that completely .... /e treat that #y&

." 'y applying a stream of solution to syringing the ear. '" Remove it y forceps. 32, Case scenario.... #a#y ;G2 years a$e ? present with a history of ER9( .... nasal !ischar$e after that complicate! to whee)in$ . - there is rales in the en! inspiratory - early e%piratory phase .prolon$e! e%piratory phase . se er respiratory !istress .usin$ the accessory muscle in respiration. 6ia$nosis& ."@iral pneumonia. '"'ronchilitis. #"'acterial pneumonia. 32, Mother #rin$ her #a#y to you when he present with hematoma in his nail. How to mana$e this patient& ."7o need things & as- him to go to the home. '" ring a sharp metal 1 / 2 & press in the middle to evacuate the *ematoma. #"remove the nail. 37, in the initial e aluation for infertility& ." Temperature chart. '" Semen analysis. #" Refer to reproductive clinic. /" 5rine analysis to detect the ovulation . 33,si!e effect of le o!opa & " fatal hepatic to%icity . " fatal renal to%icity. "dys-inesia "speech 3:, patient present to you . when you see his case . you !isco er that patient has terminal sta$e of chronic illness . how to mana$e this patient & " ma-e him go to the home. 3<, All features of tonsillar a#scess e%cept & deviation of uvula to affected side: 38,Erethema no!osum & painful red nodules 3> chil! with ec)ema flare up he is on steroi! an! ha in$ itchin$ !istur# his sleepin$& mana$ement & " ointment " antihistamine?? , :0,pre$nant la!y 28 w"s with Chlamy!ia infection & "a$ithromycin 1 single dose 2 "erythromycin 1 this point 3what ( remem er was not present 2 " /o%ycycline " A points of A drug of oinolon group , :+, common cause of male infertility& "primary hypogonadisim "secondary hypogonadisim "e&aculation o struction

:2,+8years ol! #oy with #ac" pain in esti$ation to !o e%cept & CCC * ESR ! "ray one scan :2, iron !eficiency anemia & "serum iron "ferritin "T('# :7 ,(n which $roup you will !o lower en!oscopy for patients with iron !eficiency anemia in with no #eni$n cause& "male all age group "children "permanupausal women "women + ,#P :3, female patient "nown to you since 2 years a$o has (CS . she !i!nHt a$ree with you a#out that .you !o all the in esti$ation nothin$ su$$esti e other than that . she want you to refer her . at this case .what you will !o " ..............you will response to her & refer her to the doctor that he is want . " ...........you will response to her & refer her to the doctor that you are want . ::, one of your female patient has complicate! case .come to you - $i e him other appointment for 1IE . when he came her appointment was at +0&00 - !i!nHt inter to you e%cept at ++&+3 . she was an$ry #ecause of that . what you will !o now & " Empathy with the patient &........ "empathy with the patient &........ ".................... told to the patient you have other complicated case must inter efore you . :<, 3 female patient present to you complainin$ of su!!en paralysis. she has a history that hus#an! anointe! her ;or happen that in the clinic *? @hysical e%amination inclu!in$ neurolo$ical e%amination is normal 6ia$nosis& "#onversion disorder 9HERE (S D. AC5E9 ER9( CAESE66 C4 RSJ H5/ 95 9REA9 9HE KBEE (BLER4 ( 9H(BK C4 KBEE CRACE B59 (BLEC9(5B 51 S9ER5(6 '(RL /(9H +R4 64SMEB5RRHEA AB6 E /(LL '(JE BSA(6S in Auestion < i thin" it was mension that there was stellate lesion ** patient came with scrotal swellin$ what in est$ation to !o& 5BS there was a Auestion a#out #a#y with melanoma& wide e%ision and follow up

refer to dermatology ..... youn$ la!y with pel ic pain an! menorrh$ia e%. shwe! uterine mass* !%. uterine fi roid adenomyosis endometriosis #est in%& 5BS laproscopy tennis el#ow treatment& 7S.( 7S.( + restrict activity @@H mana$ement & o%itocin infusion mesoprosto mana$ement of o#esity in * +0 years #oy& multifactorial youn$ man with plurisy #est mana$ement& 7S.( acetaminophen cortisone there D a#out patient with !ia#etes an! hyper tension... which one of anti hypertensi e ma!ication you wanna a!! first :..#E A. " loc-er =.ca"channel loc-er ).alpha" lo-er then if patient stil hypertensi e what the ne%t choice.........* :. " lo-er A.thia$ide =..R' ).ca"channel loc-er reccurent a#ortion at +> wee" . normal fetus ;without any con$enetal anomalieis "cervical incompetence a$inal itchin$ . white !ischar$ not offensi e candida a$inal itchin$ . white !ischar$ M#N offensi eMIC acteial vaginosis

CCC.8E/(#.6.#./E8D.7ET