(Endocrine & metabolism-Nephrology-Genetics-GIT- Hepatology & Pancreas)

(Ethics-Cardiology-Respiratory)

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18) #caes
A 75-year-old man is brought in by his daughter for progressive mainly unilateral tinnitus, hearing loss, and dizziness for the past year. About 3 weeks ago, he began experiencing unsteadiness and sustained a fall while walking up the stairs. ADDITIONAL HISTORYThe patient’s tinnitus is constant and nonpulsatile and has been interfering with enjoyment of his favorite TV shows. It is low- to moderate-pitched, fairly loud, and occurs mostly on his right side. He has not experienced nausea, headaches, focal weakness, seizures, or constitutional symptoms. In the past, he
worked for many years as an airline mechanic. He reports that
his sense of balance is off and that there is a heaviness or “deadness” in his right ear. During the interview, he asks you to repeat your questions, turning his head to the left to hear you better.
The physical examination is essentially normal, including the cardiac examination. There is no nystagmus. Tympanic membrane appears normal, and you cannot hear any additional sounds. Additional audiologic testing showsmoderate bilateral high-frequency sensorineural hearing loss affecting the right ear much more than the left.

Interested case☺️

Explanation







.
CorrectIanswer:IBI
This 75-year-old man has several reasons to have nonpulsa￾tile tinnitus. He was subjected to chronic noise exposure as
an airline mechanic, which typically causes bilateral high￾frequency hearing loss and tinnitus. Otosclerosis causes
bilateral tinnitus and progressive conductive hearing loss.
Cerumen impaction is associated with unilateral hearing
loss and tinnitus but would be obvious on physical exami￾nation (eg, wax obscuring the tympanic membrane). In this
case, alarm features include the presence of tinnitus associ￾ated with progressive unilateral hearing loss. Additionally,
the patient is experiencing disequilibrium and has fallen.
Magnetic resonance imaging of the head revealed an eighth
nerve mass, which on careful resection was a schwannoma,
without invasion. The patient’s hearing improved, and his
tinnitus diminished to tolerable levels.

Case 19


Explanation






. (C) The gold standard is still a fasting plasmaglucose = 7 mmol/L (126 mg/dL) on two separate occasions. GTTs are rarely required. With typical symptoms even an elevated random
sugar is diagnostic.

Oral slide 🍃👇👇👇

Emergency

ECG

X ray

Instrument

Treatment of the common cold involves supportive therapy to
ease the patient’s discomfort, including zinc acetate lozenges
and nasal gel containing zinc gluconate. Large doses of vitamin
C may shorten the duration of the illness and decrease the
severity of symptoms of the common cold. Handwashing and
disinfecting contaminated objects can help to avoid acquiring
the common cold as well as avoiding contact with others during the cold season.

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Case 20 🔥
A 52-year-old gentleman comes to your office with a history of intermittent difficulty swallowing solid food. His symptoms have been present for the past 5 years. He points to his supraclavicular notch when describing where the food feels stuck, although he is able to chew his food and transfer it into his posterior pharynx without difficulty. He does not choke or cough while eating. Drinking water will usually relieve his symptoms, although on several occasions he has self-induced vomiting. His symptoms are slightly worse
now than they were several years ago, which prompted to￾day’s visit.
ADDITIONAL HISTORY
His symptoms typically happen shortly after swallowing solid food, particularly when he is eating fast and takes alarge bite of food such as bread or meat. He does not have difficulty swallowing liquids. The longest he has had food stuck has been 30 minutes, during which time he had severe pain in his chest. He reports rare episodes of heartburn and regurgitation, which have been relieved with antacids. He denies smoking or excessive alcohol use.