• Personal information

          

    Prof. of Hepatology & Gastroenterology, Cairo University.

    Consultant of Hepatology,Gastroenterology and Endoscopy

    Management Positions: •

    Chief of Hepatology unit El Manial University Hospital (1994-1998).

    • Chief of Gastroentero ICU in Cairo university hospital (1997-2000)

    • President of the board of AlfaScope GI Specialized center (2004-2014).

    • Head of Endoscopy Unit in Cairo University Hospitals (2005-2010).       

     

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    استاذ الكبد و الجهاز الهضمى بكلية الطب جامعة القاهرة

    استشارى الكبد و الجهاز الهضمى و المناظير

    دكتوراه امراض الكبد و الجهاز الهضمى من كلية الطب جامعة القاهرة

    الرئيس السابق لقسم الامراض الباطنية بكلية الطب جامعة ٦ اكتوبر

    الرئيس السابق لوحدة مناظير الجهاز الهضمى و مركز الكبد و الرعاية المركزة بقصر العينى

     

    إقرأ المزيد

     

About Me

Monday, Nov 20th

Last update10:09:06 AM

        

Problem solving

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Case 1:

Mr. Magdy Salah, a 32 year-old man, was transferred to the emergency room in severe dyspnea. He gave the history of recurrent attacks of dyspnea for the last 10 years, which used to improve by using inhaler. The patient was given bronchodilators by inhalation in the emergency room, but his condition did not improve. By examination there was diminished mobility and absent air entry over the right side of the chest.

X-ray for Mr. Magdy showed right side hypertranslucency.

 

1. Enumerate the complications of the original disorder.

2. What is the diagnosis of the recent event?

3. Enumerate other causes for this event.

 

Case 2:

A 30 year-old male presents with a rapid rise in temperature. Within few hours chest pain & cough with production of rusty sputum occurs. The patient appears ill with rapid shallow respiration and chest x-ray shows a lobar opacity. With no treatment, the patient continues to run a temperature up to 39.5 for a week, at which time there is a dramatic improvement in the clinical picture.

 

1. What is your diagnosis?

2. What is the most common cause of this condition?

3. What are the signs that could be found during the week of illness?

4. What are the rest of investigations that could be done?

5. Outline treatment of this condition.

6. What are the complications of this condition?

 

Case 3:

A 30 year-old male presents with a history of recurrent pneumonias & a chronic cough productive of foul-smelling purulent sputum, occasionally blood-tinged, which is worse in the morning and on lying down. The patient appeared chronically ill with clubbing of the fingers. Crepetations are heard at the lung bases.

 

1. What is the most probable diagnosis of this case?

2. How to confirm your diagnosis?

3. How to treat this patient?

 


Case 4:

47 years old male, smokes 30 cigarettes per day during the last 30 years, is complaining of cough of 15 years duration with expectoration of sputum which is white grayish most of the time. His BP is 140/60 and he has blue tongue, warm hands & clubbing of the fingers.

1. What is your diagnosis?

2. What chest signs can be found in such a case?

3. Mention the investigations you need to do in this case?

4. What is the role of smoking in the etiology of this case?

5. outline treatmentof this case?

6. Enumerate the possible complications of this disorder.

 

During the last 4 months the patient’s condition deteriorated markedly. He became severely dyspnoeic, sputum became yellow, together with rise of temperature & weight loss. The trachea is shifted to the right and there is right infra-clavicular dullness together with bronchial breathing.

1. What is the most probable diagnosis of this deterioration?

2. What investigations you need to do at this stage?

 

The patient deteriorated markedly, became severely cyanosed, confused, together with flappy tremors and was transferred to the ICU.

 

1. What is the diagnosis now?

2. How to investigate?

3. How to treat?

 

Case 5:

A 45 year- old man had a routine X-ray chest which showed a solitary rounded density about 2 cm in diameter in the center of the right upper lung field. He had been a heavy smoker but had no symptoms.

 

1. How to investigate this case?

2. Mention the causes of a solitary lung nodule.

 

Case 6:

A 15 year-old boy from a low socioeconomic neighborhood presents with a three-month history of weight loss, night sweats, cough and haemoptysis. Physical examination reveals crepetations in the upper 1/3 of the right lung that persist after coughing. His father had similar symptoms two years earlier.

1. What is your provisional diagnosis?

2. How to confirm diagnosis?

3. How to treat the case after confirming diagnosis?

4. What are the adverse effects of the used drugs?

 

Case 7:

A 21-year old woman complaining of chronic cough and expectoration of a large amount of sputum for the last 6 years. Recently she noticed painless, bilateral ankle swelling together with puffiness of the eyelids. Physical examination revealed clubbing of the fingers and urine was found to contain 5 gm proteins/liter.

1.     What are the possibilities of the original condition?

2.     How to investigate the original condition?

3.     What is the diagnosis of the recent development?

4.     How to investigate the recent development?

5.     What are the complications of the recent condition?

6.     How to treat the patient?

 

Case 8:

An active 50 year old man, suffering from COPD, presented to the emergency room with sudden stabbing right sided chest pain following an acute episode of coughing. He was not distressed but anxious.

1.     What is the probable diagnosis?

2.     Mention the expected clinical signs.

3.     Outline investigations and treatment of this case.

4.     Mention two other more serious types of this clinical condition and outline the treatment of one of them.

 

Case 9:

A male patient aged 65 years, complains of hemoptysis. He had productive cough for years and was a heavy smoker. Smoking was stopped one year ago following an episode of severe pneumonia. On examination he looked toxic and rather cachectic. Finger clubbing grade II was detected. His chest was emphysematous, and a localized wheeze was audible at the lower right back of the chest.   

     1. What is the probable diagnosis?

     2. Mention the investigations you would ask for?

     3. Mention 5 extra-pulmonary manifestations for this disease.

     4. Outline the plan of therapy. 

 


Case 10:

A male patient aged 73 years, heavy smoker since 55 years, complaining of cough and expectoration of mucoid, sometimes mucopurulent sputum during the last 35 years. On examination, blood pressure 165/50, pulse 95/m. There is cyanosis & flappy tremors. Chest examination shows hyperinflation.

1. What is you diagnosis?

2. What is the type of cyanosis in this patient?

3. What is the cause of cyanosis in this patient?

4. What are the signs of hyperinflation of the chest?

5. Enumerate causes of flappy tremors.

6. What is the cause of flappy tremors in this patient?

7. Comment on the blood pressure in this patient.

 

During the last 2 months, his condition deteriorated markedly, he became febrile most of the time with expectoration of large amounts of purulent and offensive sputum, increasing in amount on lying on the left side. On examination, temperature was 39 C, clubbing of the fingers, edema of lower limbs, trachea shifted to the right, diminished movement on the right side of the chest, and hollow breathing on the right infra-clavicular region.

8. What is your diagnosis?

9. Explain the reasons for each of clinical findings.

10. Enumerate causes of clubbing.

11. Mention the investigations you need.

12. Outline how would you react to the final diagnosis.

 

Case 11:

A patient complains of cough with expectoration of large amounts of yellow sputum of several months duration.

                                     

A. What are the probable causes?

B. How to investigate the case?

 

Case 12:

60 years old person developed high fever, severe cough and dyspnea one day after attending The Pyramids sound and Light show in December.      

 

A. Give 2 possible causes for his complaint.

B. Outline how to diagnose and treat of one of them.

 


 

Case 13:

A patient presented with dyspnea. Examination revealed dullness together with bulging and diminished air entry over the base of the right lung. Tidal percussion was negative.                                                             

 

A. What is the most probable diagnosis?

B. Enumerate its causes.

 

Case 14:

40 years old female came to the ER with severe dyspnea. She gave the history of attacks of dyspnea and wheezy chest since she was a child.

Examination revealed tachypnea, working accessory respiratory muscles and silent chest.                                                                               

 

A. What is the most probable diagnosis of her present condition?

B. How to manage it?

C. Differentiate between the 2 forms of her original illness.

 

Case 15:

A driver developed rapidly progressive dyspnea after a car accident. Examination revealed hyper-resonance over the right chest together with shift of the trachea to the left side.                                               

 

A. What is your diagnosis?

B. outline the treatment?

 

Case 16:

30years old man, non-smoker, living in Dar El Salam and working in a carpet factory came to the outpatients clinic complaining of progressive loss of weight, loss of appetite and cough for the past 5 months. Examination revealed dullness and crepitations over the apex of the left lung.  

 

A. How to investigate this patient?

B. If your suspicion proved to be true, outline treatment.

 


Case 17:

 A heavy smoker man 74 year old, presented with hemoptysis. On
examination he was cachectic and had 2 hard lymph nodes, 2 cm in
size, in the right supra-clavicular area. There was dullness in the
upper right anterior part of the chest. He had a history of right
upper limb pains and atrophy of the hypothenar muscles was noted.

 

a) What is your diagnosis?
b) Enumerate causes of atrophy of the small muscles of the hand.
c) Enumerate five hazards related to smoking.
d) Outline the treatment.

 

Case 18:

A 50 year old female presented with dyspnea, dry cough and facial congestion with a bluish tinge. On examination she had a fever of 37.8 degree, neck veins were congested and non pulsating. There were two lymph nodes ( 3 cm in size ) felt in the left supra-clavicular area and the upper sternum was dull. Bilateral axillary nodes were detected and a firm spleen was felt.

  

    A) What is the diagnosis of her chest condition ?

    B) Mention the causes for this chest condition.

    C) What are the investigations to diagnose her chest condition?

    D) What are the investigations to reach the full diagnosis ?

 

Case 19:

A 45 year heavy smoker male presented to the outpatient clinic with an acute respiratory infection of few days duration. On examination his chest was over inflated and bilateral basal medium sized consonating crepitations were detected.

    

     A) What is the diagnosis?

     B) What are the investigations you would ask for?

     C) How would you treat him ?

     D) How would you make him stop smoking?

 

Case20:

A 25 year old male presented with repeated attacks of dyspnea with wheeze since early childhood. Examination showed diffuse ronchi over the chest.

          A. What is the most likely cause of these attacks?

          B. How would you treat the patient during one of these attacks?

          C. Enumerate 5 causes of acute dyspnea?

 

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  • عنوان: 98 شارع التحرير , ميدان الدقي, القاهرة , مصر
     
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حقوق الملكية

 المعلومات الواردة في مختلف صفحات موقع د.سامح لبيب على الإنترنت هي معلومات صادرة عنه لأغراض تعليمية-خدميه. وتلك المعلومات محمية بموجب قوانين  حماية المصنفات الأدبية والفنية واتفاقيات دولية أخرى وبمقتضى القوانين الوطنية الخاصة بحقوق التأليف والحقوق المرتبطة بها. ويجوز استعراض أجزاء من المعلومات الواردة في الموقع أو نسخها أو ترجمتها لأغراض البحث أو لإجراء دراسة شخصية ولكن ليس لبيعها أو استخدامها لأغراض تجارية.

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