A 42 years old female patient presented with attacks of severe throbbing headache with palpitation, & tightness in the chest. Her blood pressure during the attacks was 240/140 mmHg, & dropped to normal between the attacks. Discuss the Dx & medical Mx of this patient ??

Tough one, right ?
Waiting for your replies ...


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Ahmed A. Al-Jubouri

hi


i think its a typical case of pheochromocytoma

its arare tumor of chromaffin tissue which secrets catecholamine
dx by measuring the vma in urine
and the hormons ( adrenaline ,nor ...,and dopamine )in the plasma

also we should localise the tumor by abdominal ct scan

management
medical therapy is required for at least 6 weeks to prepare the p for surgery
the most ueful drug is alph bloker phenoxybenzamine(10_20mg oraly 6-8 houres)
if itproduses a marked tachcardia then betabloker (propanolol)
and then surgery but you should use sodium nitropossied and phentolamine to control hypertensive episode



i hope i am not wrong

i want to thankyou and god bless you

typical spells of pheochromcytoma

i would start by
1. ultrasound or CT for the adrenal glands looking for malignancy.
2.urine metnephrines level and VMA (vanillymandilec acid).

treatment surgical adrenalectomy



waiting for the feedback
Farah Baha

Both of U ( Dr. Fara7 & Dr. Mobic ) post the correct & accurate answer ..

هذولــــه أهـــل طــب بغــــداد

I think there is nothing more to add


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Ahmed A. Al-Jubouri

Hi All ....

I couldnt diagnose the case ((cause halsana nija7it lil rabi3))...
But i could undestand the discussion and explanation of the case that has been said by both hour glass and mobic ..

Thank U Ahmed for this topic and the two previous ones ..... i really get
benifit from them ... KEEP ON ((DIAGNOSIS)) TOPICS MY FRIEND ...

Thanx Again...

An 18 years old man presented with shortness of breath of few hours duration, he gave a history of dark color urin, oliguria, nausia & vomitting for the preceding 2 days, he also gave a history of sore throat treated by antibiotics 2 weeks ago. O/E he had puffiness of the face & bilateral chest criptations up to the mid-zone on chest auscultation .. What is the most likely Dx ??



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Ahmed A. Al-Jubouri

Wella great job u r doing here Ahmed ...really great ..keep it up please..and guys let's help him and put cases and questions too ..I promise i will spare time specially for that ..

Concerning this one ...hmmm...It is a post streptococcus glomerulonephritis complicating an acute renal failure which causes a pulmonary oedema ..i think we had a similar one last year final exam..

The symptoms are due to the uraemia and the fluid overload..

salam ..

U R certainly right Dr. Yezen
But I didn't that they bring it last year ..

I'm happy that U like these subjects that I've put it in our forum, & I wish we all concentrate on the Medical side coz we are the doctors of the future ..

& I hope our STAGERS participate in solving these cases ..


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Ahmed A. Al-Jubouri

A 25 years old man sustained a bullet injury to the left leg causing a comminuted fracture of the Tibia; P.O.P. was applied as a treatment. 8 days later he presented with fever, cough, & haemoptysis with extreme SOB, O/E : temp. 38.5, P.R. 135/min, respiratory rate 39/min, centrally cyanosed, chest examination reveals some crepitation & ronchi with pleural rub over the right lower zone posteriorly.
What is the most probable diagnosis ?


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Ahmed A. Al-Jubouri

hi


its a case of acute small\medium pulmonarythromboembolism


take care

This guy has almost typical presentation of Pulmonary Embolism

I agree with both Dr. Mobic & Dr. Navigator

so the committee agreed so do i

45 female ...had past history of thrombosis..and she continue recieving warfarin till now ..

before 2 days she develope amigrating pain from both flanks 2 umblicus.. (features of acute abdomen)

what is ur Dx?

this case i saw it in the hospital .. enjoy thinking !!!!