تسجيلات شرح مادة النسا والتوليد 2012 لدكتور محمد السكري متجدد ان شالله


شارك في اخراج هذا العمل ( علي كمال - هايدي محمد - ريهام الليثي - احمد حسين - اسماء مجدي)

تجميعات و جداول أطفال لبعض مواضيع الأطفال



1- Common BF Problems :

http://www.mediafire.com/?4b7hrfch7dk6cvm



2- Management of Protein Energy Malnutrition :

http://www.mediafire.com/?utx110i82ir3072



3- Renal Rickets :

http://www.mediafire.com/?m2mh9mc8yjs3jac



4- Genetic Disorders : NEW( Down $ , Edward $ , Patu $ , Turner $ , Kleinfilter $ , , Cri du chat , Poly X , Multi Y , Fragile X )

in 2 papers only



http://www.mediafire.com/?qfl2s365amw8x3a

Davidson Extras
by dofa3t 2012

10 Branches



http://www.mediafire.com/?urci1sl8kqog3kr



Except for Neurology & Respiration , waiting for Editing bs , to be completed today ISA :)

FINAL BA6NA MCQS & ANSWERS

Edit doc


http://www.mediafire.com/download.php?zehlskdc0t6atox

thnxxxxxx khoulod

Case 1
1. What features help you to diagnose chronic versus acute liver disease in this patient?
Low serum albumin level (2.5 g/dl)
Liver is firm in consistency and shrunken (span 8 cm)
Presence of ascites
Parotid enlargement
2. Does any particular factor from history help you determine the cause of this man’s liver disease?

The history of blood transfusion 25 years before that might transmitted viral infection such as hepatitis B or hepatits C viruses to the patient.
3. What reversible factors could be contributing to this man’s presumed portosystemic encephalopathy?

The precipating factor for development of encephalopathy in this patien is the administration of the sedative drug diazepam.
4. What is the serum ascites albumin gradient, and what value is it, can you calculate it for this patient?

Serum ascites albumin gradient means the difference(subtraction) between serum albumin level and albumin level in ascitic fluid

If the differenc between serum albumin and ascitic albumin in equal or more the 1.1 this mean that the ascitic fluid is of transudate nature (portal hypertension and liver cell failure) while difference less than 1.1 mean that the ascitic fluid is of exudative nature as in case of spontaneous bacterial peritonitis, tuberculous peritonitis or malignat ascites.

SAAG for this patient= 2.5- 0.5=2 g/dl (more than 1.1 g/dl) this means the ascitic fluid in this patient is of transudative nature and not exudative.
5. Could you start diuretic therapy now? Expalin?

No, diuretic therapy might incduce hypokalemia which aggrevates the encephalopathy state cause hypokalemic alkalosis is supposed to increase ammonia production and to facilitate its passage into the brain tissue.
6. What treatment would you offer this patient now and what is the long term plan?

The immediate treatment for this patient:
Stop diazepam therapy
Protein free diet for only 2 days
Enema or lactilol
Lactulose syrup
Neomycin or metronidazole or rifaximin
Low ornithine, low aspartate formula (hepamerz)
Branched chain amino acid iv infusion
L -Dopa for congnitive impairment.
Bio artifial liver support
Hemoperfusion



The long term plan depends on :
Avoid precipitating factors for hepatic encephalopathy
Low salt diet
Diuretic therapy with either lasix and or spironolactone after recovery from encephalopathy for treatment of ascites
Liver support such sylimarin and vitamin k supplementation
Liver transplantation if possible



Case 2
1. Discuss the diagnosis; list the classic signs and symptoms?

This is a case of hyperosmolar non ketotic condition which affects usually old age type 2 diabetic patient who are neglected or undiagnosed with uncontrolled diet containing sugary fluids, the patient is usually presented by disturbed level of consienceness and marked dehydration, the hyper viscosity state present in this condition commonly results in thrombosis in blood vessels causing cerebrovascular stroke, MI or pulmonary embolism.

The diagnosis of hyperosmolar non ketotic state in this patient depends on:
The patient is old age and has type 2 DM. as hyperosmolar non ketotic condition usually affects old patient with type 2 DM.
Urinary tract infection present in this patient as denoted by the presence of pyuria, plus fever and chest rhonchi due associated chest infection both represent precipitated factors for development of hyperosmolar state.
The patient was presented with left sided hemiparesis (cerebrovascular stroke) a condition which may complicate the hyperosmolar condition due to existence of blood hyperviscosity caused by the high blood sugar plus the sever degree of dehydration.
The serum osmolarity is markedly elevated 340 mOsm/kg.
Prsence of alkalotic ph decreases the posibility of diabetic ketoacidosis, as this ph is caused by the respiratory stimulation due the central lesion.
2. What is the differential diagnosis?

1) Diabetic ketoacidosis:

The findings that goes with this diagnosis:
Presence of risk factors for development of DKA in a diabetic patient are present here in the form of urinary and respiratory tract infection and cerebro vascular stroke
Presence dehydration goes with DKA
Presence of high blood sugar

Against the diagnosis of DKA:
Absence of ketone bodies in the urine test
Alkalotic ph not acidotic.
DKA commonly occur in type 1 DM and not typer 2 DM as in this case.

2) Lactic acidosis

Findings with this diagnosis:
Presence of renal impairment increases the possibility of lactic acidosis in diabetic cases treated orally with metformin however, it is not mentioned here whether the patient is on metformin therapy or not.

Against the diagnosis of lactic acidosis:
The ph is alkalotic not acidotic
No definite history of treatment with metformin

3) Hypoglycemic coma

As the patient is diabetic and on oral hypoglycemic therapy. However, against this diagnosis is the presence of high blood sugar. And presence of sugar in urine.

4) Cerebro vascular stroke

This complication is expected in this patient due presence of many risk factor such as, DM, hypertension, dyslipidemia in addition to her old age. Furthermore, this condition might be complicated by both urinary tract and chest infection. But the presence of hyperosmolarity makes the diagnosis of hyperosmolar state complicated by cerebrovascular stroke more reasonable.
3. Discuss the lab. Value of sodium, glucose, osmolarity and other lab values?
WBC 18,000 /ccm is caused by presence of both urinary tract and chest infection.
Hemoglobin 10.8 gm/dl. The presence of anemia in this patient is due to presence of renal impairment .
Hematocrite value is reasonable as the presence of anaemia is balanced by the co existence of marked dehydration
Glucose level of 780 mg/dl due to presence of low insulin level that is not enough to control blood sugar but enough to suppress ketogenesis as evidenced by the absence of ketone bodies in urine in this patient.
Hemoglobin A1c is high that denotes the presence of high blood sugar at least during the previous 2 months.
Serum creating is high as a result of presence of diabetic nephropathy cause by the long duration of DM
Serum osmolarity is high because of the high blood sugar 780 mg/dl.
Serum Na is high which means presence of sever dehydration
Specific gravity is high due to presence of high urinary glucose
Ph 7.5 means alkalosis which is associated with low CO2 as this alkalotic ph is due to respiratory alkalosis caused by central respiratory stimulation (c.v.s) and as a result of the renal correction by excretion of HCO3 , serum HCO3 is low.
4. What are the potential precipitating factors?
Urinary tract infection
Respiratory tract infection
Cerebrovascular stroke
Possibly neglected treatment

5.Discuss the treatment?

1. intavenous fluid hydration with saline half normal or normal saline.

2. insulin short acting by intravenous infusion, starting with a smaller dose of 3 unit/hour after a shot iv dose of 10 units

3. hourly monitoring of blood sugar with addition of glucose 5% iv on reaching to a level of 250 mg/dl. And prepration for shifting to sc insulin

4. k intravenous infusion with insulin therapy to avoid hypokalemia

5. management of the risk factors as antibiotic therapy for UTI and respiratory tract infection.

6. treatment of the CVS if not present it is advised to give prophylactic dose of heparin

6. list the potential complications of this problem?

1. myocardial infarction

2. pulmonary embolism

3. cerebrovascular stroke.



Case 3
1. What is your diagnosis?

A case of diabetic nephropathy as there is history of DM for 15 years, with development of bilateral lower limb edema and high blood pressure in association with presence of nephrotic range of proteinuria.
2. Enumerate 5 conditions that can lead to proteinuria of the same range as such patient?
Idiopathic OR secondary minimal lesion GN
Idiopathic OR secondary membranous GN
Idiopathic OR secondary Focal and segmental GN
Idiopathic OR secondary membrano proliferative GN
Idiopathic OR secondary mesengial proliferative GN

Also, cases of lupus nephritis, amyloidosis kidney, drugs as ACE I.
3. How can you control his blood pressure?
Low salt diet
Use of ACE inhibitors or ARBs that decrease the intraglomerular pressure as a result of the their vasodilator effect on the efferent arteriolr, to less extent calcium channel blockers can be used
4. What is the most probable explanation of his hyponatremia; enumerate 3 other conditions that can lead to low Na level?

-Hyponatremia might be due to presence of volume oveload in case of nephrotic syndrome or might be due to presence of salt losing nephropathy in diabetic cases due to presence of interstitial nephritis.

- three causes of hyponatremia: SIADH , myxedema, Addison’s disease, chronic pyelonephritis, diuretic therapy,diarrhea, heat exposure, liver cirrhosis.

5. how can you manage his hyperkalemia?

1. low dietary k intake

2. glucose insulin intravenous

3. calcium gluconate intravenous

4. cation exchange resins

5. hemodialysis if the serum k is higher than 7 meq/l.

6. name one diuretic that can be used in such condition and mention 3 of the main adverse reaction to such drug?

Lasix or thiazide diuretic spironolactone therapy is contraindicated

Side effects of lasix or thiazide include, hypovolemia, hyponatremia, hypokalemia, hypomagnesemia, hyperuricemia, hyper lipidemia, hyperglycemia, hyperclacemia with thiazide diuretic only.



Case 4

1. What are the important points to be in the history taking, general and local chest examination to this patient?
History taking: important points include age that raises the possibilty of malignancy in old age. Sex hence malignancy is commoner in males. Occupation as occupation exposture to asbestos carries risk for mesothelioma and bronchogenic carcinoma and special habitis of medical importance is of great value as it carries the risk of development of COPD and recurrent chest infection and pneumonia and also increased risk of bronchogenic carcinoma.

Regarding the history of present illness, stress on cough and hemoptysis, fever and sweating plus loss of body weight that might go with the diagnosis of chest infection as pneumonia or TB.

Past history of diabetes mellitus is of great value in suspecting either lober pneumonia or TB.
General examination must stress on, built which is low in case of TB or malignancy,pulse rate and equality for suspecting pancoast tumor, temp. for infection, presence of cyanosis for evidence of presence or absence of respiratory failure, eye examination for evidence of Horner’s syndrome associated with Pancoast tumor. Examiantion of lymph nodes for scalene lymph node.
Local examination with stress on, respiratory movement , TVF, Palpable rub, presence of dullness by percussion, presence of bronchial breathing, vocal resonance , pleural rub or crepitation on auscultation

2. What is the most likely diagnosis and differential diagnosis?
Right upper lobe pneumonia as the patient is liabel for chest infection being smoker in addition to presence of fever, cough and blood tinged sputum and dyspnea of only few days duration denoting acute condition. X ray showed apical lung lesion that might caused by klebsiella pneumonia specially.
Pulmonary tuberculosis as there is fever and hemoptysis however, the condition is acute in onset rather than chronic. But the presence of apical x ray lesion may suggest pulmonary T.B.
Pancoast tumor which is logical diagnosis in a male patient with history of smoking and causing cough and hemoptysis. This diagnosis also supported by the presence of apical lesion in x ray.
Brochiectasis sicca hemorrhagica which cause cough and hemoptysis and give honey comb appearance in the apex of the lung.

3. What are the importatn investigations required for this patient?
CBC , lecucocytosis with neutrophilia goes with diagnosis of infection as pneumonia.
ESR , which is non specific and is expected to be high in case of pneumonia, TB or bronchogenic carcinoma
Sputum culture and sensitivity for detection of bacteria
Sputum Z.N for TB OR sputum PCR for TB
Sputum cytology for malignancy
Tuberculin skin test for possibility of TB
C T chest
Bronchoscopy with broncho alveolar lavage for evidence of any malignat cells
Biopsy whether through the bronchoscope if a mass is seen or trans thorax under CT guidance.

4. Discuss the progress and sequence of events in this case?
the development of drowziness and confusion might be caused by septicemic complicating lober pneumonia or due to occurrence of respiratory failure as a complication of pneumonia.
Pulmonary TB may dissminate to the C.N.S resuting C.N.S tuberculoma or meningitis that may result in confusion.
Pancoast tumor may result in confusion due to either C.N.S metastases or SIADH causing water intoxication.

5.what is the proper treatment of this patient, both in the emergency room or inside the hospital?

1. in the emergency room, proper history taking, clinical examingtion must be done in addition to simple investigations such as, plain x ray film, arterial blood gases, and CBC if possible plus oxgen supply if needed

2. inside the hospital, antibiotic should be started emprical at first then according to culture and sensitivity

3. O2 Supply

4. antipyretic and plenty of fluids in diet

5. treatment of pancoast tumor if the diagnosis of pancoast tumor is confirmed or treatment of TB if it was the final diagnois

6. what is the management and follow up of this patient after discharge from the hospital?

1. stop smoking

2. clinical follow up on regular basis

3 . follow by x ray for detecting complete healing

Case 5
1. What is the most likely diagnosis and differential diagnosis of chest pain?

The most likely diagnosis is myocardial infarction as the pain is sever retrosternal and persistent for more than 3 hours in case liable for ischemic heart disease as hypercholesterolemia, and smoking in addition presence of S4 denotes myocardial abnormality. Furthermore, the S T segement elevation in ECG goes with the diagnosis of MI.

Dfferential diagnosis includes
Anginal attack however, the pain is prolonged for more than 3 hours in addition to presence of ST elevation that support MI rather than anginal attack.
Pericarditis which is usually associated by elevated S T segment in ECG however, the pain is not stitching in nature and there is no S4 in pericarditis
Dissecting aortic aneurysem with sever retrosternal pain however, there is no evidence of unequal pulse or blood pressure differece between both upper limbs, also there is no history of cerebral ischemic injury
Pneumonia causing pleurisy, however the pain is not stitching, also there no evidence of chest disorder whether clinically or radiologically
Penumothorax however there is no evidences of pulmonary disorders whether clinically or radiologically.
Pulmonary embolism, but there is no risk factor for this condition regardign our case also the ECG finding is not consistent with that diagnosis
Osophageal spasm
Musculoskeletal causes as myalgia or costo chondritis.
2. What are the causes of elevated ST segment?
Recent transmural myocardial infarction
Myocardial aneurysem
Pericarditis
Prinz metal angina during attacks
Sometimes in normal athelets as an early repolarization state.
3. Commont on further investigation?
Cardiac enzyme assay as CK both total and MB fraction in serum
myoglobin in blood
AST level
Cardiac specific troponin I and T
ESR and CRP
Serum lipid profile and blood sugar
PTC if indicated
4. What is the next step in therapy?
Glyceryl trinitrate
O2
Morphine i.v
Thrombolytic therapy as streptokinase or urokinase
Heparin
Asprin
Beta blocker of calcium channel blocker
Control of lipid and blood sugar if high
5. Mention risk factors for ischemic heart disease?
Old age
Male sex
Stressful intellicutal jobs
Smoking
Obesity
Dylipidemia
Hypertension
DM
High blood fibrinogen level
High blood homocystein level
Low intake of fruits and vegetables
6. What are causes and mechanism of jaundice in a cardiac patient?
Intravascular traumatic hemolysis in case of presence of artificial valve
Cardiac cirrhosis due to long standing hepatic congestion as in case of right sided heart failure that result in hepatocye anoxia and death
Associated hepatitis
Pulmonary embolism causing large sized pulmonary infarction with occurrence of local hemolysis in lung



Case 6
1. What is the most likely diagnosis?

A case of acute gout as gout is more common in males specially after age of fourty also might present with monarthritis that develop rapidly and the condition is usually associated with leucocytosis and elevated ESR.
2. What is the differential diagnosis?
Septic arthritis which is usually presented as mono arthritis in association with leucocytosis and high ESR. However, joint aspiration of monosodium urate crystal and not pus comfirms gout rather than septic arthritis
Pseudogout that might be similar to gout with also leucocytosis and elevated ESR. However, joint aspiration give rise to ca pyrophosphate crystals.
Rheumatic arthritis which is usually present as poly arthritis disease rather than monoarthritis
Traumatic arthritis which is usually presented as a mono arthritis condition but history of trauma is usually present and aspirtation shows no crystals
T B arthritis
3. What is your next step?

Assessment of serum uric acid, diagnositic aspiration of joint might be needed for confirmation
4. What is the best initial treatment?
Non steroidal anti infilammatory drugs such as indomethacin, diclofenac or ibuprufen
Colchicine orally to inhibit leucocyte migration
Short course of steroid may be given if there no response for the previous treatment

Allopurinol is not given in the acute state.

5.what are the precipitating factors?

In this patient the precipitating factor for hyper uricemia and gout is the use of thiazide diuretic as a line of therapy for hypertension .

6.what is the complication of the disease?

1. joint destruction

2. renal stones

3. renal nephrocalcinosis

4. chronic interstitial nephritis that may progress to renal failure

5. complication to treatment as allopurinol as GIT upset, renal or hepatic insufficiency

Case 7
1. What is the most likely diagnosis?

A case of vitamin B 12 deficiency anemia (megaloblastic anemia) as there is pancytopenia associated with jaundice due to ineffective erythropoeisis also there is picture of peripheral neuropathy with evidence of posterior column affection (sensory ataxia) plus pyramidal tract lesion evidenced by the presence of positive babinski test.
2. Differential diagnosis of absent ankle and preserved knee reflex?
Megaloblastic anemia
Friedreich’s ataxia
Peroneal muscle atrophy
Pellagra
Conus medullaris lesion
3. What are the further investigations needed to confirm the diagnosis?
Bone marrow aspiration to confirm the presence of megaloblastic changes in bone marrow
Assessment of serum vitamin B12 level
Schilling test form documentation of absence of the intrinsic factor as a cause of megaloblastic anemia in this case
Serum LDH which is expected to be high
Assessment of anti parietal cell antibodies. That is expected to be negative in this case as it is most probably due to intrinsic factor deficiency caused by the previous gastric surgery.

4.what is the treatment of this patient?

1. vitamin B12 intramuscular 1000 ug twice weekly for one week followed by once weekly for 6 weeks then every month for life

2. iron supplement

3. potassium supplement

5.what is the differential diagnosis of pancytopenia?

1. megaloblastic anemia

2. bone marrow aplasia

3.subleukemic leukemia

4. late stages of lymphoma

5. SLE

6. Myelodysplasia

7. hyper splenism

6. what is the treatment of peptic ulcer?

1. soft bland diet (ulcer diet)

2. local ant acid such as Mg trisilicate or aluminium hydroxide

3. H2 receptor blockers as ranitidine or famotidine

4. muscurinic receptor blocker as gastrozepine

5. proton pump inhibitors as omeprazole

6. surgical treatment is indicated in case of failure of medical treatment as billroth one or two opertion of Roux en y surgery.

all what u need in ECG

Edit doc


dr osama shar7 thnx sara and ali

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tasgeelat ECG for dr osama

By إدارة جروب دفعة جديدة · Last edited about a week ago · Edit Doc



ECG 1

http://www.mediafire.com/?342562og157lm97





ECG 2

http://www.mediafire.com/?b4f0d12nvk8hsv2





ECG 3

http://www.mediafire.com/?8barbbkn63orn76





ECG 4

http://www.mediafire.com/?56baqh8fafhthaf





ECG 5

http://www.mediafire.com/?4juynfn6eulni7d





ECG 6

http://www.mediafire.com/?rjfw9t9wpoomsma







data show simply ecg 3la el sare3

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books for practice

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http://www.2shared.com/document/d6nm..._Problems.html



and

http://www.2shared.com/document/iOlY...s_in_ECG_.html

thanks walaa

د نوران الغندور

وران الغندور

General Examination Videos



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Abdomen Examination Videos



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Cardio Examination Videos



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Chest Examination Videos



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د / محمد على



http://www.mediafire.com/?o3jysczfdehe2sc



abdominal ex . 1



http://www.mediafire.com/?yy61v4sx4vj0lem



ex. 2



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chest .



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cardio .

امتحان الحالات القصيرة (short case ) ....اجمع هنا
--------------------
اسلام صلاح
El modo3 elnharda kan baseet ela 7d ma
---cases ( git w chest w rheuma ) shoait as2la fel related nazary w m3 el salama :)
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Semsema Magdy ‎
2na emt7nt f ba6na wa7ed wkan f case cardio, chest & abdomen kol case 3leha dr y2olk e3ml general examination l kza w kol local examination bs elly 8azny en emt7nt f el2a5er wkan dr elly emt7ny chest me4 mrkez 5ales m3aya wla shaf 2na 3mlt eh akol ma a2olo 7aga y2oly ma4y wkrwetny krwta hl b2a dh 7elw wala w7sh
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‎Mostafa Mohamad Abbas
m3lsh ana mktbtsh details msd2t 5last :) l chest kant ascultate w percuss w s2ltny sm3ty a w y3ny a COPD w y3ny a harsh vesicular breathing w emta nsm3o w a fr2 ben asthma w COPD w al tnya kant rhumatolgy kant examine elbow w b3dyn s2ltny 3la a l f aid al pt da w a al fr2 ben swan neck w bot. w a criteria of rh. arthritis w bn3algo b a in details w al a5era examine al abdomen w olyly kol 5twa bt3mlyha leh w de 3aket feha awe :( ?
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أواب على
الامتحان النهارده كان فى وحده با طنه 1 والامتحان كان اول حاله مع د نانيس examine complextion and palpate liver i do the examination with some question first dont say any thing that doctor can use against you the case had pallor isaid mild pllor te doctor asked how to differentae clinically and then cyanosis definition whee we saw it types of it and i forget lookinhg in leg for differential cyanois in the liver the doctor ask span of liver span of left lobe need afull comment on liver i said all i know but she dont look satisfied
الحاله التانيه كانت مع دكتور شريف منير examine lower limb and auscultate the chest in lower limb the doctor need full examintion as check list and asked me the diagnosis i sid diabetes nd he said you dont reach the diagnoais as you dont do neuro examination then h saw muscle atrophy in one limb than other and it was apoliomyeltis
الحاله التالته كانت مع دكتوره مش عارف اسمها examine complextion and auscultate heart كانت سريعه عشان اخر حاله ومتسالتش والدرجات الى الدكتوره كانت بتديها 27 ا
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Aya Adel
ana emt7nt f 5 batna endocrine kan awl case examine neck (thyroid) w eldoctor s2lt investigation w RAIU w eh y3leh w eh la w klmten 3nhm tany case kant examine chest w kano byshofo el examination kolo mn 2wlo g 2khrh w 3rd case kant examine abdomine brdo examination kamel w hnvestigation w complication w traube area b eltwfiq b2zn ellah
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Dr-Hosam Hafez
امتحانى كان فى 12 باطنه ( الروماتولوجى ) واحده شيست COPD
وواحده كارديوMarfan AI and mitral incompetence
وواحدو روماتولوجى :RH
examination
complication
treatment
دكتوره داليا بتركز على التكنيك بطريقه ممله
الحمد لله
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git 2 unit
caerdio pt `case was ms i make all local cardiac ex and neck veins dr asked me why 45degrre??? why internal jugalr v???
investigation in this pt??? ecg finding???compensated or not?? which champer enlargment???

abdomen case ```tense accites how to prove ?? fluid thrill
make palpation on pt ?? make milking of vein ??
complextion ??? oedema??? tremor ?/? only examination

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Eman Ghareeb ‎7alet elchest ms2lnesh chest 2aly 2ol so2al built of patient ???????
s2lt el3ian wzno we 6olo we 2oltlo ne7sb BMI we skin fold (s2lni esm elgehaz ) we kan 3aiz hight we span
وبعد كده قالي عيان ايده قصيره ورجله قصيره ودماغه كبيره والجزء اللي فوق كويس يطلع ايه؟؟؟؟
كان عايز achondroplasia
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Hamdy Elnaggar
الدكتورة في حالة التشيست وقفت معايا و قالتلي اعمل انسبكشن بالباشن و بركشن و اوسكالتيشن للتشيست للعيان ده و اديني الفل كومنت و بعدين سألت عن الكوبليكيشن و بعدين سألتني افحص العيان ده جنرال ازاي عشان اتوقع الكومبليكيشن و بعدين سالتني في البرونكوجنيك كارسينوما نظري دياجنوزيز و انفزستيجيشن و بعدين قالتلي قول العلاج للسي او بي دي اللي هو الحالة بتاعتي و بعدين ايه الاستراتجي للعيان ده مخصوص و بعدين قولي الدوز بتاعة السابيوتامول و البكلوميثازون و بعدين قوليhome taken messages for the patient و بعدين قالتلي ايه بقي الدفرنشيال دياجنوزيز و بعدين قالتلي كفاية كده و ده بعد ساعة الا تلت في اول شورت كي

تاني لجنة كان اسمع الهارت للعيان و بعد الفل اسكلتيشن قالتلي قولي الكومننت و الدياجنوزيز العيان كان ميترال انكومبيتنس و اورتيك انكومبيتنس قالتل انت اصلا ازاي تسمع الاتنين مرمر في نفس الوقت هو ينفع قلتلها اكيد ما علينا قالتلي توقع العيان ده هيشتكي من ايه بالترتيب و ليه و بعدين امتي ادخل العيان العملية يغير الفالف و امتي مدخلوش و ايه البروفيلاكسيس للعيان و ايه البروفيلاكسيس قبل ما يخلع سنانه بالدوزز يا جدعان و بعدين قولي ايه انواع الفالفز الصناعي و البيلوجي و الانواع في كل واحد و ده كان تاني شورت كيس

الشورت كيس التالتة كانت روماتويد ارسرايتس و بعد ما تعمل فل هاند اكزامينيشن روماتولوجيكال و جنرال و تعلق علي البلس و السولينج و الديفورميتيز و الوارت اللي كان في ايدها و الاونيكومايكوزيز اللي في الثامب سألتني عن اسباب الباسيف موفمنت بعد الاكتف وليه بتعمل ماسل باور سالتني نظري روماتولوجي الكريتريا كام واحدة ولازم تقول السبعة و لازم كام كريتاريا للدياجنوزيز و لمده اد ايه و بعدين قول الانفستيجيشنز و التريتمنت واما في التريتمنت عينك ماتشوف الا النور كانت عايزة دوز الاسترويد و السايد ايفكتس كلها و تديله ايه عشان تمنعها و دوز الهيدروكسكلوروكين و السايد ايفكتس و دوز الميثوتريكسيت و السايد ايفكتس و قول مثال علي التي ان اف بلوكر و بيتاخدوا ازاي و شكرا و دي كانت قصتي مع الشورت النهاردة بعد ما امتحنت في النفرو امبارح مع دكتور مجدي الشرقاوي
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Reem Hussein
Emt7nt elnhrda fel endocrine kan chest w endo w cardio el cases el chest wel cardio kan talb examination w endo kan cushing's examine face w skin w vital signs el drs kano tyben bs kan f wa7d msh by3gbo el kalam whatever hwa a :D
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رشا سعد
copd
liver:سال ايه الي يخليني اقول العيان ده عنده هايبر سبلينزم ... وايه المفروض اعمله قبل مااعمل سبلينوكتومي ((العيان كان عامل سبلينوكتومي )..كان مهم جدا بالنسبة ليه الادوات ومظهرك وثقتك كدكتور ...مش فاكرة سال في ايه تاني
cardio :ماطلبش diagnosis لكن قالي وريني بتعملي ازاي بيركشن للهارت ..ونظرا لان كدان في حد خهنا قال قبل كدة انه لما قال للدكتور ده اوبسوليت راح طرده وواحد تاني قال للدكتور حاضر وراح يعمله راح قاله معرفش ايه .فبهعد ما توجهت للعيان روحت قلت للدكتور .في authorsبيقلو اوسوليت وتانين بيقولوا يتعمل عادي فانا اعملايه ؟؟ راح قالي هو اه بس عل الاقل لازم تبقي عارفة البيزك بتاعه .وسالتني عليه كام سؤال كدة .لما تلاقي dull
هنا يبقةى ايه ...وهناك يبقى ايه .سالني ايه اسباب اله؟
hemoptysis in cardiac Pt بس كان طيب
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Sora Silver
case acromegaly we3ml el visual field
case MS+pulm hypertension wekanet 3amala ts2lny fel grades of murmur :S
case m3rfsh tsh5esha l7ad delw2ty l2no kan 7etet copd 3la 7etet bronchaial ashma 3la 7etet fibrosis wemafesh 7aga 3ndo t3raf t7ddha belzbt weldr ma3agabosh el examination we 23d yes2lny nazry bronchial asthma we res failure we a anwa3 elbreathing :S
good luck kolo naseeb ya gama3a we fawdo amrko lrabna wel7dl 3la kol she2 ....

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إيمان عطا باطنة 1
*****
فى حالتين الدكاترة قالوا عليهم

الحالة التالتة كانت ابدومين
palpation
الاسئلة كلها عادية
بس الدكتور طلب الsurface anatomy of the upper border of the liver
2-dont forget to palpate upper border before saying it is normal size as it may be shrunken
3-can pallor occur with cyanosis and the doctor said no
4-bimanual palpation of spleen"لازم تخلى العيان ييجى على جنبه اليمين"
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Samar Smsm اناا اتظبطت بس الحمد لله اولا انا كنت وحده gitالوحده الاولى اول حاجه كده كانت د نانيس فى شرف استقبالى وامتحنت عندها شست وكومبليكسشن وطبعا اسئله الشست كل ماجاوب معاها حاجه تسال تانى لحد مزنقتنى الحمد لله فى السؤال وبصت بصه الانتصار وانها ادت مهمتها الله يسامحها تانى دكتوره كانت تحفه هرتنى اسئله تخص الفحص والنظرى والاسئله كانت بلبات ليفر وكومبليكشن بس كانت تحفه وحستتنى انى الاولى على الدفعه اما الختام بقى فكان الصدمه الكبرى حاله اديسون واكزمن السكن ماكنش فى وقت اتصدم الدكتور كان جمبى بس عسول اوى بس حاول يلخبطنى كتير وانا ثبت على موقفى لانى معرفش حاجه غير اللى جوبته مش شطاره يعنى وسأل كل الاديسون تقريبا وبعدها السؤال التانى اوسكلتيت الهارت كان تمام وخلاص على كده خارجه مزبهله بس الدنيا بتمشى اطمنو يادكاتره وخليكو واثقين فى نفسكو رزقك مكتوب ومهما حاولو ينقصوك ربنا عارف تعبنا قد ايه والنتيجه دى فى ايده مش ايديهم الحمد لله على كل حال
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عبدالله سعودى طيب..انا النهاردة دخلت على حالة سيكيترى...العملى بتاعها يتراجع فى أقل من 5 دقايق لو أنت كانت عندك فكرة عن السيكسترى بس..بس المشكلة أن الدكتور بتسأل فى النظرى...هو أكيد فى حاجات الواحد مبيعرفهاش.لأنها سألت كتيير فيه.بس بصراحة معاملتهم ممتازة...كفاية الابتسامة و راحة الوجه...و متهيألى درجاتهم إن شاء الله مش وحشة
_________
التانية كانت قلب..pulmonary stenosis
أنا أول مرة أسمع مرمر:)بالشكل ده ..
there was enlargement of right ventricle
pulsation &thrill on pulmonarry area
بس بصراحة أنا لما جيت قلت للدكتور على المرمر فى السمع...قلتله أنه شبه ال AS:)
بس قلتله مش ماشى مع الفايندينج
و اللى خدوا مع دكتور خالد هيفهمونى..لما تحط على الأورتك أريا :)
و تسمع مرمر واصل للرقبة و الأبيكس
بس فالدكتور مدقش أوى و اهتم بالوصف
معرفش بقى فى الدرجات
____________
ال3 :كانت ascitis
shifting dullness
spleenomegaly
الدكتور حسسهونى بالdipping:)
و الأسئلة العادية يعنى
_____________
صفاء خيري الحمد لله امتحنت في الهيماتولوجي case abdomen : doctor asked about deep palpation of liver -- percussion of ascitis -- symptoms of LCF & wt is ur diagnosis

2nd case was thyroid simple goitre ; pt was euthyroid but the doctor asked about the ttt & she wanted me to say surgery : thyroidectomy followed by L thyroxine

3rd case : Bronchial asthma ; the doctor asked about findings in inspection palpation percussion auscultation ; boundaries of bare area & traubs area ..... in all cases we took the history
--------------------------------
Rona Mamdouh الحمد لله ,,الحمد لله ,,الحمد لله هو صحيح وحدة الاندوكرين وفضلنا نمتحن من الساعة 8 الى 1 بس الامتحان كان كويس 90% كلينيكال مثل ex.chest ex.cardio كله اعملوا معاها neck veins &per. pulsation والحالة التالتةex neck &eye بس الوقت كبير بيكفى ترتب افكارك وتعمل كل حاجة على العيان و الدكاترة كان معظمهم كويسين
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سعيد العنانى ana etsa2lt fe el scleroderma eh el extr articular manifestation we el ttt we el crises
we el copd we el asthma we 3elag el asthma we el adverse effect bta3 el anti asthmatic drugs
el talta b2a kanet abdomen ascites eh el facies bta3et el liver cell failure we 5ali balko el patient kan 3ando fine tremors we m3ndosh flapping tremors
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Like

عبدالرحمن وجدى باطنه 2
General examination of LCF + local examination of abdomen 3la sareeeeeeeeee3
auscultate chest ( COPD ) + difference between central and peripheral cyanosis + surface anatomy of kronig's isthmus
complexion + midline sternotomy scar + causes of jaundice in a cardiac case
Good luck :P:p:P
-----------------
Mohamed Zidane Immnnology...........
Case 1 : chest : COPD with emphysema ..>>> insp,palp,perc.ausc , traub's area & kronig's ithmus ……..don't forget exam of back >>>>>>> Full comment
Case 2 : thalassemia >>>> palp liver _ most imp invest : Hb eletroph : HbF _ +ve scar of splenectomy _ adilh aih 2bl ma a3ml splenectomy : vaccine of capsulated organisms _ lw lsa 3andh hemolysis b3d splenectomy : yb2a lsa fih splenic spenules !!!!! _ lw 3andh splenomegaly w dullness 3la el sterum tfkr fi aih !!??? leukemia (CML) _ lw 3amltlh X-ray hatla2y aih ?? _ w face exam (Mongolic facies ) w fih hyperpigmentation >>> haemosidrosis

Case 3 : cardio : double mitral + TI + AF + RT vent ++ w mrkb artificial valve ……… Insp , palp , auscult >>>>>> Full comment ezay tfr2 byn MI w TI ?? 2oly ll 3ian ya5d nfs w yktmh hatla2y TI wad7 gdn ….. TI mostly localized but MI radiating to axilla
Rbna ma3aaaaaaana gami3n shdo 7ilkm
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نبع مصرى GIT 1
1st case : examine complexion, inspect abdomen & superficial palpation
I was asked in peripheral and central cyanosis where to be found and how to differentiate
2nd case: measure blood pressure, palpate & auscultate heart
3rd case : complexion, pulse & palpate abdomen
the doctor asked me why to expose from the level of the nipple and not from costal margin!!!!!
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Maram Osama Fndocrine>> no history we paid 30 lel nayeb
1st case was grave's eye n neck examination
D.D of proptosis , name of eye signs , triad of grave's
2nd was cardio double mitral n aortic valve replacement it went smoothly I just said the findings and performed aurcultation
Of apex n that was it

3rd was chest I did the examination and told the findings no questions as
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Like

محمد رضا IMMUNOLOGY
1st case cardiac (double mitral - AF - may be also TR ) msh far2a el 7ala eh 3ala 2d ma fare2 2mt7ntaha m3a meen :)
dr nazmi bys2l kteer w by5wef :) bas daragatoh kwayesa
howa talab menni 27aded el signs of LV++ in the pt w talab 27aded makan el apex bel mazoora.... ah wallahy
grades of MS, causes of LV++ with diffuse apex , how to diagnose MS+MI,
2nd case thalassemia with dr el SHAF3EE .....by2olo 3aleh malignant laken 2s2elto kolaha sahla gdan ......msh 3aref homma zalmeno wala howa malignant f el daragat :P
3rd case GRAVE`S laken el dr talabet examine the wrist & palpate the cervical LNs w ms2aletsh nazary 5ales
DFA3NA BARRA 60 LE W EL PTS MATALABOSH 7AGA GOWWA 3SHAN EL DRS 2A3DEEN GAMBOHOM
----------------------------
GIT 1
abdomen(percussion_blood pressure)
cardio(auscultate the heart_complexion)
chest (examine lower limb_ palpate & auscultate chest)
الدكاتره كانوا حلوين بس الواحد كان بطيخه خالص مش عارف زي مايكون خلاص مش عاوز ارد على اي اسئله مش عارف واريح ددماغي بس الحمد الله الدكاتره كانوا مفكرين نفسهم في سيكشن واعدوا يشرحولي وخصوصا دكتور الكارديو اما بالنسبه للدرجات الله اعلم بس اعتقدنهم طيبين
-------
Christine Raafat el emta7an kan fi ksm el hem. We kan el matlob short history we case cardio (auscultation) MS we Af we kan 3amel MVR . 2nd case simple goiter (examine neck) we mafish ma3aha ay manifestation tany 3rd case chest (examine chest) el as2ela kolha kanet oral mafish ay 7aga et3amalet 2odam el dr.

يا جماعه انا بذاكر من ورق دكتور علاء بس حاسه انه كميه كبيره و كمان مش بفتكر منه فى الامتحان كنت عايزه اجيب ورق دكتور ايمن الم منه فى الاخر بس ناس كتير خوفتنى انه ناقص اوى انتوا ايه رايكم انا محتاره:rockin: ؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟؟

LAST 2 hours Revision by hany ramdan

This File Contains:

-Derma Ppt Revision 18 Slides > Notes & Collections From MCQs

-All Derma in 9 Pages

-Collections & Mind Maps

** Sorry For Delay But u can revise in 2 hours isA


http://www.mediafire.com/download.php?efm83ecvrs981dn

*******************************
NAZARY
=======
By hazem gamaL

دول تمان ورقات من المراجعة بتاعت قسم ال ديرما كنت كتبتهم ايامها ..ممكن نفرهم كــ ...

Introduction لل venereal and STDS

http://www.mediafire.com/?u975wrxamtm2ibn
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***Some previous years round exams and finals


http://www.2shared.com/file/gogEPxb6...ams.htmlanswer d
http://www.mediafire.com/?cj0w5js4wz5b0x6 s by Ahmed Nasr Mohame

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**** Faculty final revision handout by hazem gamal

NB: it s supposed to be important according to elder colleagues

http://www.2shared.com/file/zd5ItGIe...n_handout.html

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**** Tables nazary Bacterial,viral,fungal ,parasitic by Little med

http://www.2shared.com/file/RMwX4m2n/summary.html
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**** Derma Notes Dr gar7y

http://www.2shared.com/file/7OK-oFzZ/derma_notes.html

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derma NB by kareem kamel thnx dr aziz ahmed

http://www.2shared.com/file/7gMvcoFG...eem_kamel.html
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***** collections and DD

http://www.2shared.com/file/ALuZBSMg/__online.html


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***** MCQ the white book and red book

in one link

http://www.2shared.com/file/ZqZt6YEU...Red_books.html
or each in seperate link thnx aya tawfik :)
http://www.mediafire.com/?69k0rn9ghhkohup
and http://www.mediafire.com/?ot2giul0cjx8hld

------------------------

derma MCQ 7elw 2y isa

http://mc.medshams.com/books/5th-Derma.html

------------------------
3AMLY

-=======
****Department CD

http://www.2shared.com/document/pvDE...SUderma09.html
---------------
*****Abu Bakr Family notes

http://www.2shared.com/document/vNO-yH5v/Derma_ABF.html

---------------
Derma atlas

http://www.mediafire.com/?wg1mkmyjnny----------------
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check this site , it is free coloured atlas with images of almost all disease i think it is good to see picture while you study so you can imagine and fix the info into your memory thnx Adel Taha Alloush :)

http://www.dermnet.com/


--------------
Mahmoud El Ghazawy
ya gma3a de kol al 7alat bl swr wl as2la bta3etha fl drma 7aga gmda kda
http://www.2shared.com/file/fFxFzRb2/__90_________.html


dh link f CDs mohma f derma kona wa5dnha mn dr 2yam round zman wnazrn en face me4 by7b 4sharedf 2na 76et 5 mkan 4 f 4shared 3shan link yrda ysht8l f kol wa7ed yrg3 tany yshel 5 wy7o6 4 bs kda



http://www.5shared.com/get/inLgyyB5/..._of_derma.html

wdh nfs link bs 3la mediafire

http://www.mediafire.com/?ota3f16oxu0u245


CD dr Salim:-
http://www.mediafire.com/?cyjqeqtymzt#

THANKS MAHMOUD MAHFOUZ
_________



Clinical Pediatrics

يحتوى على 3 ملفات ب صيغة pdf شرح لعملى الأطفال
http://www.mediafire.com/?7ybuijxg9u1zfrr
_______________________

Pediatrics Slides for undergraduate ( pdf , ppt, photos ) يحتوى على ملفين

1/ pediatric cases
2/ Pediatrics Slides for undergraduate
عملى سلايدز بصيغ مختلفه

http://www.mediafire.com/?c871v35phd8fcwq
________________________

problem solving

تجميعة أسئلة كاسيز من أماكن مختلفة

http://www.mediafire.com/?gjhjjje4bymd025
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revision pediatrics ( dd . inv. drugs )

ملف يحتوى على

DD in pediatrics - investigation in pediatric -Drugs in pediatrics
http://www.mediafire.com/?9yud3wwk7k2ak4w
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أطفال slides يحتوى على صور لحالات كتيره مقسمه حسب كل برانش

http://www.mediafire.com/?ag7t8vzdr1sta9x

_______________________
by Hany Ramadan :D

Ped. Last Minute Revision

http://www.mediafire.com/?7ckz43lxf1bm95k
_________________________
pediatric summary

دكتور أحمد حمدى
http://www.mediafire.com/?o3dp0l5bbm7ldnp
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Pediatrics In Breif ( Images ).rar

http://www.mediafire.com/?uy79wnmiww3d3igLike ·