hi these r some cases

case 1 ( neuro) :
56 years old pateint presented with attacks of numbness of right upper limb & right side of face,each lasting for 15 minutes & recurred 5 times over the last 2 week
1.what is DX
2. mention 5 IX
3. mention RX & which laboratory test is indicated 2 follow up patient??

case 2 (neuro) :
35 years ol clerk presented with attacks of going vague,talk few meaningless words witout falling or loss of consiousness or generalized spasm & each attacks last for 1-2 minutes, then the patient recover gradually & doesn't remember what happened during the attack
1.what is DX?
2. list IX 2 b done
3 .mention 2 drugs indicated

if u know the DX only post the DX here

take care

here another case concerning renal

case 3 :
56 years old man presented to urology clinic complaining of polyurea, he had HX of multiple renal stones operated upon 6 monthes ago,he also complain of epigastric pain which awaken him from night.
O/E: BP 110/80 mm Hg , PR 80/min ,FBS 126mg/dl, B. urea 56 mg/dl
also ther is hypercalcemia & hypophosphatemia
1. what's DX
2. IX
3. RX

if u know the DX post it here

thx

where are you doctors!!!

hi

1st case,

Dx: transient ischemic attack (lasted for a short time, is recurrent and the neurological is the same in each attack, these r the characteristics of TIA)

Ix: carotid doppler ultrasound (duplex), MRA (to check the carotid artery which is usually responsible for TIA and estimate the degree of stenosis)

ECG, echocardiography (to look for a source of emboli)

contrast angiography (this test is only done after duplex and MRA have shown significant stenosis of the carotid artery. so contrast angiography shows the exact site of obstruction for the surgery which is endarterectomy)

CT scan

Rx: aspirin 75-150 mg daily. warferin is used if there's a cadiac source of emboli
and the patient is followed up with clotting profile.

smiles

thnx all..doddi and hammodi

thx alot hammodi

but what about the other 2 cases ??????

Dx : Partial complex epileptic seizures
( Mouthing , altered behavior, duration > 20 seconds, patient recovers without remembering)

Ix : EEG : where we shall see focal abormalities..
CT-Scan and MRI to see focal lesions if any..

Rx: carbamazepine is the drug of choice..
we can also use phenytoin, NA valproate , and the new drugs e.g: lamotrigine..

Not 100% sure.. but if i am in an exam with that one i'll suppose it is hyperparathyrodism ...

Ix: hmmm .. serum calcium and phosphates though they are mentioned in the case.. perhaps urine calcium is to be measured too...

PTH hormones are to be considered too..

radiography..

Rx: wella hem not sure..i remember there are a couple of drugs to be used with indications and contrindications for each.. don't remember them.... ha and of course surgical removal of the gland ..partial of course..


sorry for the lousy answer...


good luck...

thx alot yezen

I suspect the the 2nd case is paartial coplex epileptic seizure

BUT about the 3rd case : I don't know it may b ur answer is true

thx again yezen

Hi Doddi nice to hear from u ...............hope u're studying good

and Hi to Blood stone too


i have nothing to add more than what Yezen and Hammodi said ...

only about the 2nd case:

it's simple partial not complex Bcoz (there is no loss of consionsness)


and thanx to every one


and By the Way TRY THIS CASE OUT :

A 55 year old man (obese ,chronic smoker )...presented with hematuria ,and hemoptysis,and dull loin pain .....

on examination he was slightly Feverish (38.8-39)c , hypertensive,with a loin mass ,and a plethoric face .

by routine chest X-ray they found a Cannon Ball Mass in his lung field ...


Q\-what's the next investiagtion u might do for this patient ???
-give me the diagnosis ???
(Ps:the point is if U figure out this Case you'll never forget this collection of signs and symptoms..)

hi aws

i just studied this today this patient has an adenocarcinoma of the kidney (hypernephroma or grawtz tumor).

Ix: ultrasound, CT, IVP to check the size of the tumor and its extension and the function of both kidnies. plus an isotope bone scan to detect any bone metastasis that's common with this tumor.

as for the neuro case, i think the case is m5arbi6a, coz it typically explains a complext partial seizure but it says there's no loss of consciousness and in a simple seizure, the patient would remember. where did u get this case from, doddi?

smiles

from the questions of final exam of medicine (2004 I think )

hi guys nice cases keep them coming .......

Hammodi nice answer ...but i wanted someone who wasen't currently studying urology ......to find a genius (Ur a genius too Hmmmodi )whom i'd arrange his accidental disappearance to keep me in the lead ......


about the 2nd neuro case i think it's called a dysphasive fit......isn't considered a simple partial seizure????may be i don't know???
about the 3rd case

i have an addition to :

Yezen did answer it but add this :-.......the complete answer would be :the patient has what is called MEN1(multiple endocrine neoplasia type 1) which explains his Hyperparathyroidism leading to his multiple renal stones and Azotemia

+plus :- this patient has a peptic ulcer due to an associated gastrinoma in the pancreas called Zollinger Elisson syndrome ....this explains his epigastric pain.....

really magnificant & genius explanation

thx y very much aws

by the way : how r u aws ??????? I hope u r fine

I'm fine thank u .....hope ur studying good .........

thanx for this wonderfull topic ....can u bring some more challanges??????