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Pregnant Woman with Vaginal Bleeding

Tuesday, March 30, 2010

 41 years Old  Pregnant Woman who married for 10 years, admitted to the ward complaining of vaginal bleeding and severe nausea and vomiting for 3 days duration.
Parity  - 00 Gravida - 01
Her Last Menstrual Period - 3 1/2 months prior to the onset of vaginal bleeding.
Menarche - 14 years
She had regular periods of 32 days Cycle with normal Bleeding for 3-5 days.No Hx of Intermenstrual Bleeding or Dysmenorrhagia.
No significant past medical,surgical or contraceptive history.

On examination 
Not pale, Not ill- looking or Not in pain
Regular pulse of 76bpm
BP - 130/80 mmHg
Abdominal Examination
  • No Striae Gravidarum
  • Symphisio Fundal Height is greater than the Gestational Age

 hCG  level was Markedly increased

What is the Diagnosis?

4 year Old Boy Stares Vacantly

Saturday, March 27, 2010

Here shows an abnormal behavior of a  4 year old boy  who was having a positive family history epilepsy.
This Child was brought to the pediatric ward by mother as she was told that this child was staring vacantly in the nursery.This has been happened several times a day and short lasting.Immediately after the event, the child will usually resume whatever he  was doing prior to its onset.No history of falls during that Event.

His EEG(Electroencephalography) is given below

What is the Diagnosis?
What are the EEG changes?

8-year old male,has a long history of progressive weakening of his muscles.In the first year of his life, He reached many gross motor skill milestones, such as holding his head up, rolling over, sitting, and standing, at normal times. But he did not walk until age 16 months.During last 5 years he suffered progressive muscle weakness and Frequent falls when trying to walk, most notably in the proximal musculature of the arms and legs.He has has a younger sister in good health.

What is your diagnosis?
What are the important physial signs that you would expect in this Child?
How would you confirm the Diagnosis?

Man with Abdominal Pain and Jaundice

Tuesday, March 16, 2010

32 Years old man was admitted to the medicine ward complaining of feeling tired for last 3weeks associated with yellowish discoloration of eyes.And he also complained that he had on and off abdominal pain for about 1week duration.There  is no history of fever,nausea,vomiting,loss of weight or loss of appetite.He has undergone appendectomy when he was 5 years.There was no significant past medical history or drug history.

On General Examination he looked well but mildly icteric.
Abdominal Examination - Mild tenderness in the upper quadrant of the Abdomen and there was a palpable mass in the upper left quadrant felt 3cm below the costal margin. 

  • What  are the differential diagnosis???

FBC,Blood Picture,Biochemical tests  were done

Full blood Count
  • HB        11.8g/dl
  • MCV     103fl
  • MCH     30pg/cell
  • MCHC   36g/dl
  • RBC      6x1012/l
  • WBC     10.5x109/l
  • Reticulocyte count  130x109 /l

Biochemical Tests
  • Bilirubin 25umol/L (0-17umol/L)
  • LDH 680IU/L(220 - 450 IU/L)
  • Coombs' test was negative 

Blood Picture

  •  What are the abnormalities in this blood picture??
  •  What further tests that you would need to do for a defenitive diagnosis??
  •  What is your diagnosis??

32 year Pregnant Mother Came to the ENT Clinic Complaining of right sided hearing loss especially for low freaquency sounds and hearning of ringing, roaring and  buzzing like sounds.Examination of her Tympanic membranes are normal on both sites.
Interpret this Audiogram???

ECG Abmormalities_Part04

Sunday, March 7, 2010

A 58 year old male with a history of hypertension, dyslipidemia, and diabetes mellitus presents to the emergency department with substernal chest pain radiating to his left arm and shortness of breath. He has vomited twice and now is intermittently feeling lightheaded.

His temperature is 37.4, heart rate 70, blood pressure 110/70, and respiratory rate 24.  His heart sounds are regularly irregular, and an S4 heart sound is present.

What are the ECG abnormalities you can see?
How would you expalin these ECG changes with the clinical presentation ofthe patient?

4 1/2 years old child presented with marked abominal distension which was more prominent on the left side of the abdomen which was associated with abdominal pain and haematuria.There  was no family history of any significant diseases or any malignancy. On examination of  this child it was found that he was pale and abdomen was tender.

His CT Scan was given below.

What is the Diagnosis?
What are the biochemical tests that you would do to conform the  Dx?
What arethe Management options available and How is the Prognosis of this Disease?

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