• 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).       


     .Read more


    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

Wednesday, Jun 19th

Last update01:52:33 AM


Problem solving

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Problem solving

Case 1: A 38 year-old housewife noticed severe dyspnea on climbing one flight of stairs. Recently she had a chronic cough and was unable to sleep flat in bed. One week ago she suddenly developed psychic changes & muscle weakness in the right arm. There was a diastolic rumbling murmur over the cardiac apex.

1. What is the diagnosis of the original condition?

2. What is the cause of psychic changes & muscle weakness?

3. Outline treatment of this patient?


Case 2: A 25 year old male was seen because of a history of frequent head-aches. The blood pressure in both upper limbs was 180/100 mmHg. In the lower limbs the blood pressure was 120/70 mmHg. There was a systolic bruit heard in the left inter-scapular area.

1. What is the diagnostic x-ray finding in this case?

2. Mention 5 causes & 5 complications of hypertension.

3. Outline treatment of hypertension in general.


Case 3: A 42 year-old woman is admitted to the hospital complaining of weakness and fever of 2 weeks duration. Her temperature is 39° C. She is pale and has several petechiae in the conjunctiva. Her spleen is palpable 4 cm below the left costal margin. Examination of the heart reveals a harsh mid-systolic ejection murmur radiating to both carotids.

1. What is the most probable diagnosis?

2. What investigations are needed for this patient?

3. Outline treatment of this patient.


Case 4: A 50 year-old man complained of severe anterior chest pain on the left side, which awoke him from sleep. The pain was crushing in nature and radiated to the left arm. The patient took nitroglycerine tablets at intervals of every 5 minutes with little relief even after taking 10 tablets. The patient’s skin was cold and sweaty. BP 100/80 mm Hg, pulse 100/min and regular. The lungs revealed rales at both bases. The heart sounds were weak, no murmurs or gallops were audible. All peripheral pulses were present.

1. What is the most probable diagnosis?

2. Mention 5 risk factors for this case?

3. Outline management of this patient?


Case 5: A 54 year-old male complained of sudden onset of severe left anterior chest pain radiating to the left arm. The pain was not relieved by nitroglycerine tablets. The patient was markedly short of breath and expectorating blood-tinged frothy sputum. The skin was cold, cyanotic and sweaty, BP was 80/60 mm Hg & heart rate was 120/min and regular. He was oliguric, Examination of the lungs revealed diffuse bilateral rales. The heart sounds were diminished and no murmurs were heard. A third heart sound was heard at the apex.

1. What is your diagnosis?

2. Mention 5 other causes for acute chest pain.

3. Mention 5 complications that may occur to this patient.


Case 6: A 35 year-old female suddenly complained of left lateral chest

Pain aggravated by cough and deep inspiration. She also coughed some blood-tinged sputum. Examination of this afebrile female revealed diminished movement of the left side of the chest and a tachycardia of 110/min. There was acute tenderness, swelling and redness of the left calf. X-ray of the chest taken 3 days after the initial examination revealed a small left pleural effusion.

1. What is the most probable diagnosis?

2. Mention 5 investigations to be done for this patient & why?

3. Outline treatment of this patient?


Case 7: A 28 year-old female complained of sudden severe pain in the left side of the chest, followed by shortness of breath. Few days later she started to cough and expectorate a blood tinged sputum. The temperature was 37.5º C, pulse 100 and BP 110/80. There was slight edema of the left ankle and left calf.

1. Mention 5 predisposing factors for this condition.

2. Enumerate 5 causes for hemoptysis.

3. Enumerate 5 x-ray findings that may be present.


Case 8:40years old male was admitted to ICU because of loss of consciousness which was preceded by severe occipital headache & blurred vision. On examination the blood pressure was 220/150, the optic disc had a blurred edge & no signs of lateralization or meningeal irritation were found.

1. What is the most likely diagnosis?

2. Outline treatment of this patient.

3. Mention 5 lateralizing signs.


Case 9: A 40 year-old man complained of, severe pain in the precordium

following an emotional upset. The pain radiated to the left

mandible. The patient was given some pills to take sublingually

and the pain disappeared in about three minutes. A physical

examination and ECG taken after the attack of pain were normal.


1. What is the most probable diagnosis?

2. Mention 5 investigations to be done for this patient?

3. Outline treatment of this patient.


Case 10: 30 years old female came to the hospital with severe dyspnea & cough with excessive frothy sputum. There were coarse rales all over the chest, edema of lower limbs & congested pulsating neck veins. There were features of biventricular enlargement . No murmurs were heard, the BP was 100/70 and the pulse was 110/minute and regular.

1. What is the diagnosis of this patient?

2. mention 5 precipitating factors for this condition?

3. Outline treatment of the patient.


Case 11: A male patient, 18 years old, living in Embaba, came to the hospital complaining of sore throat and fever, Two weeks later, he came back with pain and swelling in his left knee. His temperature was 38 and he has tender, swollen left knee.

After few days he became dyspneic with lower limb edema.

Examination revealed:

- Pulse: 140 beats/minute, of small volume.

- BP: 95/70.                   - Temperature: 37.5

- Marked pallor.

- Congested pulsating neck veins.

- Epigastric tenderness.

- Lower limb edema.

- The apex: in the 5th space in MCL.

- Muffled S1.        - Soft systolic murmur.  - Gallop rhythm.


1. What is your diagnosis?

2. Mention 5 investigations to be done for this patient and why?

3. Outline treatment of this patient.


Case 12: A 45 year old diabetic, heavy smoker, presents with recurrent precordial pain, often radiating to the chin and left shoulder. The pain is precipitated by moderate physical exertion or emotional stress, and is relieved by rest and sublingual nitroglycerine.


1. What is your diagnosis?

2. Mention 5 investigations to be done and their expected results.

3. Outline the treatment of this patient.


Two years later, he was brought to the emergency department in severe and persistent acute chest pain, with the same distribution as before, yet without relief by rest, sedatives or nitrates. ECG showed depressed ST segment and inverted T wave in leads I, II, aVL and v4-6. CK MB was normal.


4. What is your diagnosis?


Three years later, the patient was brought again in shock, with  BP of 80/30 mm Hg, a regular pulse with a rate of 40/minute, venous pulsations in the neck at a rate of 100/minute, with occasional cannon waves. The patient denies having had significant chest pain at the onset or before this episode. ECG shows deep, wide Q, raised convex ST and inverted T in leads II, III and aVF together with P-QRS dissociation in all the leads.


5. What is the probable diagnosis?

6. Outline treatment of the patient.


Case 13: A male 50 year old presented to the outpatient clinic with a BP of 160/108. On examination he was slightly obese and there was LV hypertrophy. Investigations revealed a random blood sugar of 266 mg %, serum creatinine 0.9 mg % and urine was normal.

1. Mention other investigations you would like to do and why?

2. What are the life style modifications you would ask him to do?

3. Mention the proper antihypertensive drugs you are going to prescribe and the reasons for each of your choice.


Case 14: A 50 year old man, heavy smoker, presented to the emergency room with severe retro-sternal chest pain of one hour duration. On examination he was sweaty, his pulse was 94/m, his BP was 100/70. A third sound was heard over the apex. Troponin levels were high.

1. What is the most probable diagnosis?

2. Outline management of this case.


Six hours later runs of ventricular tachycardia started to show on the monitor.

3. What are you going to do?


In the next few hours he was stable and was discharged from the hospital.


4. Mention the medications he should receive and why.


Case 15: A female patient 70 years old presented to the outpatient clinic with hypersomnia. She complained of dyspnea and orthopnea few days ago. On examination she was puffy, her skin was dry, her pulse was 54/m, congested neck veins were noticed. The apex could not be seen.

1. What is your diagnosis?

2. Mention the investigations you would like to do.

3. Outline treatment of the case.


Case 16: 48 year old woman is brought to the emergency room complaining of a sudden onset of dyspnea. She reports she was standing in the kitchen making dinner when she suddenly felt as if she could not get enough air, associated with palpitations. She denied chest pain or cough. Her past medical history is only significant for gall stones, for which she underwent a cholecystectomy 2 weeks previously, which was complicated by a wound infection, requiring her to sty in the hospital for 8 days.

On examination, she is tachypnic with a respiratory rate of 28/m, blood gases revealed hypoxia, and her heart rate is 124/m, with a blood pressure of 120/90. She appears uncomfortable and sweaty. Her oral mucosa is slightly cyanotic, her neck veins are congested, and her chest is clear to auscultation. Her heart is tachycardic but regular with a loud second sound in the pulmonary area, but no gallop or murmur. Her abdominal examination is normal, with a clean incision site without signs of infection. Her right leg is moderately swollen from mid thigh to her feet, and her thigh and calf are mildly tender to palpation. Laboratory studies including cardiac enzymes are normal, her ECG reveals only sinus tachycardia, and her chest x-ray is interpreted as normal.

1.     What is the most likely diagnosis?

2.     What is the predisposing factor for her illness?

3.     How to investigate to confirm your diagnosis?

4.     Outline treatment?


Case 17: Heavy smoker middle aged man presented to the outpatient clinic
with a history of chest pain on exertion. His Bp was 178/112 and was
obese. His blood sugar was 266 mg% and his creatinine was normal.
He was emphysematous and no edema of the lower limbs.


a) Mention the grades of hypertension.

b) Enumerate the classes of anti-hypertensive agents.
c) What further investigations you would like to do& why?

Case 18: A 55 years old male came to the emergency department presenting with severe retrosternal chest pain. He was a heavy smoker and was on irregular treatment for hypertension. His BP on admission was 110/70 and his pulse rate was 90/mn with 4 extra-systoles per minute. ECG revealed a raised S-T segment in V1-5.


A)  What is your diagnosis?

B)   Mention the investigations you would order.

C)   Outline treatment at this phase.


Few hours later his BP was 80/50, his pulse was 120 beats/mn and despite all measures he died after few minutes.


     E) Enumerate 2 causes for his death.


Case 19:

A 75 year old male presented to the outpatient clinic with dyspnea on mild exertion. On examination he had a BP of 95/70, his pulse was 100/mn, regular and of low volume. Cardiothoracic examination revealed cardiomegaly and bilateral basal fine crepitations. An audible S3 was heard over the apex. Neck veins were congested and mild pitting edema was detected.


1. What is the diagnosis?

2. Mention the investigations you would like to do at this phase?

His random blood sugar was 230mg/dl & his cholesterol was 275mg/dl.


4. What further investigations would you like to order?

5. Outline the treatment.


Case 20:

A 56 year old man presented with attacks of palpitations and shortness of breath of 6 months duration. He used to smoke 25 cigarettes per day and was told one year ago to have “Pre-diabetes” and was advised to re-check his laboratory abnormality every 3 months with some life style modifications, but he did not follow up. Examination showed an irregular pulse at a rate of 135/minute, blood pressure was 135/82 mm Hg, his body mass index was 31. Chest, abdominal and neurological examinations were free. Cardiac examination showed irregular heart sounds, but no clinical evidence of chamber enlargement or murmurs were found. EKG showed irregular QRS complexes and absent P waves.


1. Mention other investigations you would suggest.

2. What is the arrhythmia that this patient is having?

3. Enumerate 5 of its causes.

4. Outline the treatment of this arrhythmia in this patient.


Case 21:

A 45 year-old male came complaining of chest pain with exertion and several weeks of worsening exertional dyspnea. He has orthopnea with occasional paroxysmal nocturnal dyspnea. No significant medical history. No history of medications. He smoke 2packs/day. He has family history of diabetes and his father died of sudden cardiac attack. On examination, temperature 37ºC, with a heart rate of 104/min blood pressure 115/90 mm Hg, and respiratory rate 16 breaths per minute. Chest examination show bilateral basal inspiratory crackles. Cardiac examination is normal. His serum cholesterol was 220mg%.


A.   What is the most likely diagnosis?              3 marks

B.   What are the predisposing factors for this condition present in this patient?                                 3 marks

C.   What is the most appropriate investigations you would order and explain why.?                                3  marks

D.   How would you manage such a patient?     6 marks


Case 22:

A 55 year old male  patient known hypertensive and diabetic  presented at the emergency department with severe retrosternal chest pain since one hour. The pain occurred at rest, radiate to the left arm, is not relieved by sublingual nitroglycerin. Physical examination: vital signs: pulse 90/min. ; blood pressure 200/110. Cardiac: regular rhythm; no murmur or extra sounds. The rest of the examination was not remarkable.


A-     List the medical Problems in this patient ?                       (3 marks)


B-     Mention 5 investigations you would like to order in the ER (5 marks)                                     


C-     What is the urgent  treatment you would recommend?     (2 marks)                                                                  


D-     What is the long term treatment you will suggest to the patient?(5 m)                                 

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كيف تصل الينا

  • 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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