By Your Sis: Ghada Odeh :)

Hx: Chest pain ACS.

Hx.: Cough Bronchiectasis.
Hx: Epigastric pain Peptic ulcer disease.
Hx: Joints Pain SLE.
Hx: Hematurea post-strep Glomerulonephritis.
Hx: Jaundice Chronic hepatitis B (liver cirrhosis).
Hx: 21 YO female came to ER complaining of
jaundice for 4 days duration (& give your DDx.)
Hepatitis A.
Hx: Dark urine & Oliguria post-streptococcal GN.
Hx: SOB (6 mon.) Cystic fibrosis + pneumonia.
23 YO female pt, productive cough, fever 39,
married for 4 yrs but cant get pregnant, has
chronic diarrhea, has a brother & sister with
the same complain.
Hx: 27 years old male complain from joint pain &
chest pain RA.
Hx: 60 years old female complain from fatigue
(her HB=8).
Hx: 24 YO female with Hx of bloating for 6 years,
Her Hb 7.4, MCV 65 CELIAC disease.
Hx: Abdominal distention (1 month)
30 YO male, all GI symptoms are -ve except for
heartburn.
>> Ask about 4 Fs ( fluid , fat , feces , flatus ), it turns to be
fluid because he has lower limb edema.
>> Ask about causes for fluid over load (malnutrition,
Malabsorption, heart, liver or kidney failure), everything
is ve, but the pt has family history for liver disease (his
mother has chronic hepatitis).

Whats your diagnosis?

ascites due to decompensated liver failure (viral hepatitis).
Whats the treatment?
Antiviral (interferon , ribavirin ).
Hx: 30 YO male with back pain for 1 month, Give
2 DDx: a- ankylosing spondilitis. b- reactive
arthritis.
Hx: 20 YO female with HB=6 hemolytic anemia.
Hx: 20 YO male presented with chest pain of 2
days duration.
1) What's your Dx? Acute pericarditis.
2) Mention 2 investigations you would like to
do. ECG & ECHO.
Hx: 27 YO female Pt has decrease in Weight in
last 18 days Hyperthyroidism.
Hx: 33 YO male Pt has decrease in Weight in last
3 months Diabetes mellitus.
Hx: 17 YO female pt with dizziness & SOB. Her
Hb. was 6. Iron Deficiency anemia due to
massive menorrhea.
Hx: pt presented with SOB & had an ejection
fraction less than 30% Idiopathic
cardiomyopathy.
Hx: 34 YO female came to ER complaining of
epigastric pain for 2 weeks (& give your DDx.)
Drug induced peptic ulcer voltarin for back pain
for 4 weeks.

Hx. 53 YO male pt came to ER complaining of cough

for 1 week (& give your DDx.) Pneumonia.
Hx: 21 YO male came to ER complaining of cough for
2 yrs duration (& give your DDx.) Asthma.

Hx: A 33 YO male pt with lower limb edema (+ve :

Bilateral, progression with daily activity, facial
Bluffness, urinary symptoms; polyurea, proteinure
, DM (15 years duration, on insulin) HTN).
Hx: 57 YO male pt presented with palpitation (pt
has rheumatic fever Hx)Atrial fibrillation.
Hx: 49 YO female pt, known case of DM, came to
follow up for her diabetes. Evaluate her
condition.
Hx: Diarrhea & abdominal pain 7 months duration
DDx: IBD, diverticulitis, infectious diarrhea.
Hx: Abdominal pain (epigastric region) PUD.
Hx: 67 YO female with SOB for the last 2 wks, She
had orthopnea & PND, she also was a smoker
RHF.
Hx: 67 YO male presented with Hemoptysis for 2
weeks.
Bronchogenic Carcinoma.
Tests: CXR , CT-scan , Bronchoscopy.

Hx: 31 YO female pt presented with fatigue for 6

months & her Hb=6.
Iron deficiency Anemia due to increase demand
(she delivered 8 children).
Tests: CBC , Ferritin , Iron , TIBC , Blood film.
Hx: 21 YO male medical student presented with cough for 1
year.
Exacerbation of bronchial asthma.
Investigation: Stress test (Air hyper-responsiveness).
Results do you suspect? FEV1/FVC <80%, when stress is
encountered it declines further, & when given beta-2
agonist (salbutamol) it has to rise by (12-15%).

Hx: Painless neck mass, it was asymptomatic diffuse goiter.

Hx: 24 YO female pt presented with neck swelling for 3
months.
DDx? Lymphoma, Bronchogenic carcinoma, TB [B
symptoms "or constitutional" symptoms were positive].
Name one only test to diagnose your pt definitely >>
Excisional lymph node biopsy (total removal of the LN).
Hx: A 65 YO male, hypertensive, well controlled on
ACE inhibitors, complains from red urine for 3
days duration.
- Q1: What's the best initial test to be done?
>> Urine analysis.
- Q2: if his Urine analysis was Positive (dipstick) for
blood but it wasn't RBC's, what would it be? (give
two differentials):
>> Myoglobin or Hemoglobin.

Hx: Pt presented with Hb=8 in the last CBC

thalassemia, others had hereditary spherocytosis.
Hx: a 24-year old male presented with jaundice
started 5 days ago. (Acute Hep. A)
Hx: young male presented with red urine. (Post-
infectious glomerulonephritis)
Hx: Lower limb swelling (Lower limb DVT).
Hx: Abdominal pain (PUD).
Hx: Joint pain with chest pain (SLE).
Hx: Chest pain (MI).
Hx: Hemoptysis (Lung CA).

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P/E: Abdominal exam (from A to Z!) Pt was normal.
P/E : abdominal Hepatosplenomegaly.
P/E: abdominal Cushings due to steroids therapy after
kidney transplant.
P/E: Abdominal Hepatomegaly.
P/E: Inspect & palpate the abdomen.
- The pt had polycystic kidney disease (a mass in each
flank).
-----------------------------------
P/E: Precordial exam. (Midline scar: Suggesting valve
replacement or CABG / aortic click may be due a prosthetic
valve).
P/E: Pericardium mitral regurgitation.
P/E: Anterior or Posterior Chest mostly; findings will be
wheeze & basal crepitations (bilateral lung crepitations
in pulmonary edema & lung fibrosis).

Other students were to examine hand & face,

Scleroderma ,rheumatoid arthritis, Acromegaly.
P/E: a pt with clubbing, central cyanosis, conjuctival
congestion; what's the likely Dx? Congenital cyanotic
heart disease with 2o polycythemia.

Examination (one of the following):

Precordium.
Abdomen.
Posterior chest.
Good Luck :)