امبارح كان آخر نوتس ، آخر MCQ ، آخر تجميعات ، و النهارده آخر امتحان نظري في كلية الطب ، الحقيقة أني سعيد جداً أني واحد من الدفعة أني أكون سبت ذكرى و أتمنى أكون أني قدرت اساعدكم و أني تركت أثر كويس جوا أي حد ، اتمنى أني قدرت أساعدكم وقت ما كنتم تحتاجوني و متأخرش عليكم . 😊🥰 .
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لو حد حابب يكتب أي ذكرى أو موقف أو سؤال أو أي كلمات لطيفة 🥰❤.

🗯🗯 keywords for cases ( part 1):

■ ( Angina pectoris ):
♤old age , smoker é hyperlipidemia , retro-sternal chest pain ⬆️ é exercise & ⬇️ by nitrates & rest < 30 min
♤ ECG : ⬇️ ST segment  , inverted T wave
♤ -ve cardiac enzymes

■( AMI ) : STEMI
♤ old age somker  ، severe chest pain at rest & radiated to lt shoulder > 30 min
♤ ECG : ⬆️ ST segment

■ NSTEMI :
♤ old age smoker , severe retrosternal pain , ♤ elevated cardiac enzymes
♤ ECG : depressed ST segment

■ Aortic dissection :
♤ old male uncontrolled HTN + unequal pulse volume on both sides

♤ sudden severe chest pain radiating to the back + dyspnea + murmur

♤ CXR = wide mediastinum


■ Acute pericarditis :
♤ flu like symptoms ( FAHM )
♤  Acute localized chest pain + pericardial rub
♤ pain ⬆️ é inspiration & swalowing & ⬇️ é leaning forwad
♤ ECG : ST elevation in all leads  with upward concavity

■ Acute pleurisy :
♤ localized sharp chest pain + dry cough + pleural rub
♤ pain ⬆️ é inspiration , ⬇️ holding breathing & lying on affected side

🗯 part 2 :-

■ Massive pulmonary embolsim :
♤ hx of DVT
♤ Acute shock +  central cyanosis + dyspnea + low COP symptoms + sudden severe retrosternal chest pain
♤ ECG = S1Q3T3 & sinus tachycardia

■  Acute lobar pneumonia :

♤ FAHM , dyspnea , chest pain , cough , expectoration of MP & rusty blood stained sputum
♤ CXR = homogeneous opacity in one lobe
♤ Ausculation = bronchial breathing
ABG = Resp failure type 1

■ Acute exacerbation of COPD :

♤ hx of previous episode & hx of infection
♤  ⬆️cough ,  , cyanosis ,heavy smoker , expiratory wheezes , hyper-resonance of the lung  & worsening of dyspnea
♤  CXR = emphysema
♤ ABG = respiratory faliure type 2

■ Acute severe asthma :

♤ hx of asthma , hx of frequent hospitalization , prolonged attack 

♤ dyspnea , cough , cyanosis , unable to speak > than 1_2 words

♤ examination = silent chest
♤  investigation : CXR = hyperinflation only & ABG = resp.faliure type 2
♤ PEFR < than 30-50 % predicted

■ صباح الخير يا شباب بإذن الله هبدأ انزل أسئلة على أغلب العملي اللي معنا ، غالبا cases ال dyspnea هتكون فيها أشعة و cases ال chest pain هيكون فيها ECG في الامتحان بكرا فاعرف بقى تركز ع ايه و انتا بتقرأ و بتدرس.

A 32 year old female smoker has a history of wheeze, shortness of breath
and fever. Her past medical history includes eczema. FEV1/forced vital
capacity (FVC) was measured and was found to be low. This was improved
after taking bronchodilators. What is the SINGLE most likely diagnosis?

A 27 year old man presents with chest pain and respiratory distress
following a road traffic accident. On examination, his neck veins are noted
to be distended and trachea is deviated to right. Breath sounds are absent
on the left and diminished on the right lung field. He has a blood pressure
of 80/40 mmHg and a heart rate of 120 beats/minute.

A 50 year old chronic smoker attended the outpatient department with
complaints of chronic productive cough, dyspnoea and wheeze. A chest X-
ray was ordered and reported as hyperinflated lung with flattened
hemidiaphragm and a small cardiac silhouette. Full blood count shows an
increase in haematocrit.

A 29 year old woman has been short of breath for the last 15 hours and is
feeling unwell. An arterial blood gas is taken:PaO2 8.8 kPa
PaCO2 3.2 kPa
pH 7.50
Bicarbonate (HCO3-) 20 mmol/L
Normal Values:
PaO2 > 10 kPa
PaCO2 4.7-6 kPa
pH 7.35 – 7.45
Bicarbonate (HCO3-) 22-26 mmol/L

A 21 year old lady who smokes has a history of wheezing, chest tightness
and coughing at night. She also notices these symptomsoccur when she
goes out in the cold and breathes cold air.

A 45 year old man has been having a productive cough for the past 3
weeks. He has been having a fever since then. He has not gone to work for
the past 2 weeks as he feels too unwell. He presents to the hospital with
chest pain and shortness of breath. On auscultation, there is decreased
breath sounds on the right upper lobe with crackles. Percussion is dull in
the same area. He has a temperature of 39 C, a respiratory rate of 28
breaths/minute and a pulse rate of 110 beats/minute. His blood results are
as follows:
Haemoglobin 129 g/L
White cell count 15 x 109
/L
Platelets 450 x 109
/L
CRP 110 mg/L

A 24 year old male is admitted with acute exacerbation of asthma. He is
treated intiated with 100% oxygen. He continues to deteriorate. What is
the SINGLE most appropriate next step in management?