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Medicine Cases, azmi04771884375@gmail. com, Ad Dimnah (2025)

29/05/2025

DX? TREATMENT?

25/05/2025

Dx%tt

25/05/2025

Dx&ttt

02/11/2024

The Wells score for **pulmonary embolism (PE)** includes the following criteria:

1. **Clinical signs and symptoms of DVT**: Leg swelling, pain with palpation (3 points)
2. **PE is the most likely diagnosis**: Based on clinical judgment (3 points)
3. **Heart rate > 100 beats per minute**: Tachycardia (1.5 points)
4. **Immobilization for at least 3 days or surgery in the previous 4 weeks**: Recent immobilization or surgery (1.5 points)
5. **Previous objectively diagnosed PE or DVT**: History of PE or DVT (1.5 points)
6. **Hemoptysis**: Coughing up blood (1 point)
7. **Malignancy with treatment within the last 6 months or palliative**: Recent cancer treatment (1 point)

The total score helps determine the probability of PE:
- **Low risk**: 0-1 points
- **Moderate risk**: 2-6 points
- **High risk**: 7 points or more
تتضمن درجة ويلز للانسداد الرئوي (PE) المعايير التالية:

1. **العلامات والأعراض السريرية للانسداد الرئوي**: تورم الساق، والألم عند الجس (3 نقاط)
2. **الانسداد الرئوي هو التشخيص الأكثر احتمالاً**: بناءً على الحكم السريري (3 نقاط)
3. **معدل ضربات القلب > 100 نبضة في الدقيقة**: تسرع القلب (1.5 نقطة)
4. **التثبيت لمدة 3 أيام على الأقل أو الجراحة في الأسابيع الأربعة السابقة**: التثبيت أو الجراحة مؤخرًا (1.5 نقطة)
5. **الانسداد الرئوي أو الجلطة الوريدية العميقة التي تم تشخيصها سابقًا بشكل موضوعي**: تاريخ من الانسداد الرئوي أو الجلطة الوريدية العميقة (1.5 نقطة)
6. **نفث الدم**: سعال الدم (نقطة واحدة)
7. **الخباثة مع العلاج خلال الأشهر الستة الماضية أو العلاج التلطيفي**: علاج السرطان الأخير (نقطة واحدة)

تساعد الدرجة الإجمالية في تحديد احتمالية الانسداد الرئوي:
- **خطر منخفض**: 0-1 نقطة
- **مخاطرة معتدلة**: 2-6 نقاط
- **مخاطرة عالية**: 7 نقاط أو أكثر

31/10/2024

Hemorrhoidectomy, the surgical removal of hemorrhoids, is typically indicated in the following situations:

1. **Grade III and IV Hemorrhoids**: When internal hemorrhoids prolapse and cannot be manually reduced, or when they are permanently pr*****ed.
2. **Thrombosed External Hemorrhoids**: When external hemorrhoids become thrombosed (clotted), causing severe pain and not resolving on their own.
3. **Strangulated Hemorrhoids**: When hemorrhoids become incarcerated and strangulated, cutting off blood supply and causing severe pain.
4. **Persistent Symptoms**: When hemorrhoids do not respond to conservative treatments such as dietary changes, medications, or office-based procedures like rubber band ligation.
5. **Large Hemorrhoids**: When hemorrhoids are very large and cause significant discomfort or hygiene issues.
6. **Severe Bleeding**: When hemorrhoids cause significant bleeding leading to anemia or other complications.

Hemorrhoidectomy is considered the gold standard for treating severe or complicated hemorrhoids, but it is usually reserved for cases where other treatments have failed or are not suitable.
استئصال البواسير، الإزالة الجراحية للبواسير، عادة ما يكون ضروريًا في الحالات التالية:

1. **البواسير من الدرجة الثالثة والرابعة**: عندما تتدلى البواسير الداخلية ولا يمكن تقليصها يدويًا، أو عندما تتدلى بشكل دائم.
2. **البواسير الخارجية المتخثرة**: عندما تصبح البواسير الخارجية متخثرة (متجلطة)، مما يسبب ألمًا شديدًا ولا يختفي من تلقاء نفسه.
3. **البواسير المخنوقة**: عندما تصبح البواسير محبوسة ومختنقة، مما يقطع إمداد الدم ويسبب ألمًا شديدًا.
4. **الأعراض المستمرة**: عندما لا تستجيب البواسير للعلاجات المحافظة مثل التغييرات الغذائية أو الأدوية أو الإجراءات المكتبية مثل ربط الشريط المطاطي.
5. **البواسير الكبيرة**: عندما تكون البواسير كبيرة جدًا وتسبب إزعاجًا كبيرًا أو مشاكل في النظافة.
6. **نزيف حاد**: عندما تسبب البواسير نزيفًا شديدًا يؤدي إلى فقر الدم أو مضاعفات أخرى.

تعتبر عملية استئصال البواسير هي المعيار الذهبي لعلاج البواسير الشديدة أو المعقدة، ولكنها عادة م

31/10/2024

A chest tube, also known as a thoracostomy tube, is typically removed when certain criteria are met. Here are the common indications for chest tube removal:

1. **Improved Respiratory Status**: The patient's breathing has improved, and they are able to maintain adequate oxygen levels without assistance.
2. **Symmetrical Chest Movement**: The chest rises and falls symmetrically with each breath, indicating that both lungs are expanding properly.
3. **Bilateral Breath Sounds**: Breath sounds are present on both sides of the chest, confirming that both lungs are functioning well.
4. **Decreased Drainage**: The amount of fluid or air draining from the chest tube has significantly decreased, usually less than 200-300 mL in 24 hours.
5. **No Bubbling in Water-Seal Chamber**: There is no longer any bubbling in the water-seal chamber during expiration, which suggests that there is no ongoing air leak.
6. **Improved Chest X-ray**: A chest X-ray shows that the lung has re-expanded and there is no significant fluid or air remaining in the pleural space.

It's important to follow the healthcare provider's instructions and ensure that the patient is monitored closely during and after the removal process to prevent complications.

31/10/2024

It seems like you might be asking about the indications for placing a nasogastric tube (NGT). Here are some common reasons for using an NGT:

1. **Decompression**: To relieve distention and pressure in the stomach and intestines due to obstruction, ileus, or atony.
2. **Feeding**: To provide nutrition directly to the stomach or small intestine when oral intake is not possible.
3. **Aspiration**: To remove stomach contents, such as in patients who are intubated to prevent aspiration.
4. **Diagnostic**: To obtain a sample of gastric contents for assessing bleeding, volume, or acid content.
5. **Toxin Removal**: In rare cases, to remove ingested toxins.
6. **Medication Delivery**: To administer medications or oral contrast agents directly to the stomach.

31/10/2024

Here are the answers to your questions:

# # # **Indications for Chest Tube Placement**
Chest tubes are typically placed for:
- **Pneumothorax**: To remove air from the pleural space.
- **Pleural Effusion**: To drain fluid from the pleural space.
- **Hemothorax**: To drain blood from the pleural space.
- **Empyema**: To drain pus from the pleural space.
- **Postoperative drainage**: To remove air or fluid after thoracic surgery.

# # # **When to Remove a Chest Tube**
A chest tube is usually removed when:
- **No further air or fluid drainage**: The underlying issue has resolved.
- **Stable chest X-ray**: No pneumothorax or fluid reaccumulation.
- **Normal respiratory function**: The patient is breathing well without the tube.

# # # **Indications for Nasogastric Tube (NGT) Placement**
NGTs are used for:
- **Bowel obstruction**: To decompress the stomach and intestines.
- **Gastrointestinal bleeding**: To monitor and manage bleeding.
- **Enteral feeding**: To provide nutrition when oral intake is not possible.
- **Preoperative preparation**: To empty the stomach before surgery.

# # # **When to Remove an NGT**
An NGT should be removed when:
- **Goals of therapy are met**: The underlying issue has resolved.
- **No further need for decompression or feeding**: The patient can tolerate oral intake without complications.
- **Provider's orders**: Follow the healthcare provider's instructions for removal.

31/10/2024

General surgery involves a wide range of terms and procedures. Here are some common terms you might encounter:

# # # **Common Terms:**
- **Appendectomy**: Surgical removal of the appendix.
- **Cholecystectomy**: Removal of the gallbladder.
- **Hemorrhoidectomy**: Surgical removal of hemorrhoids.
- **Laparoscopy**: A minimally invasive surgical procedure using a laparoscope.
- **Mastectomy**: Surgical removal of breast tissue.
- **Thoracotomy**: Surgical incision into the chest wall.
- **Tracheostomy**: Creation of an opening in the neck to access the trachea.

# # # **Suffixes and Prefixes:**
- **-ectomy**: Surgical removal (e.g., Appendectomy).
- **-otomy**: Incision into (e.g., Thoracotomy).
- **-oscopy**: Viewing with a scope (e.g., Laparoscopy).
- **-ostomy**: Creation of an opening (e.g., Colostomy).
- **-plasty**: Surgical repair (e.g., Rhinoplasty).

# # # **Diagnostic Procedures:**
- **Biopsy**: Removal of a small piece of tissue for examination.
- **CT Scan**: Computed Tomography scan for detailed images.
- **MRI**: Magnetic Resonance Imaging for detailed images.
- **Ultrasound**: Imaging using high-frequency sound waves.

# # # **Medical Abbreviations:**
- **ABG**: Arterial Blood Gas.
- **CRP**: C-reactive protein.
- **DVT**: Deep Vein Thrombosis.
- **FBC**: Full Blood Count.
- **LFTs**: Liver Function Tests.

25/06/2024

تحية خاصة لأحدث المتابعين لي! يسرني انضمامك! Kabir Singh, Hamadi Al Sunani

14/04/2024

Neonate face presentation

05/03/2024

2yo boy fell off his tricycle and hurt his arm. He got up to start crying, but before there was

any sound, he went pale, unconscious and rigid. He recovered after 1-2 mins but remained pale.

After an hour he was back to normal. His mother says she was afraid he was going to die, and

that he had a similar episode 3 months prior after falling down some steps. What single inv is

indicated?

a. CT head

b. EEG

c. CBC

d. None

e. Skeletal survey

Q. 1. What is the key?

Q. 2. What is the diagnosis?

سقط طفل يبلغ من العمر عامين من دراجته ثلاثية العجلات وأصاب ذراعه. نهض ليبدأ في البكاء، ولكن قبل ذلك كان هناك

أي صوت، أصبح شاحبًا، فاقدًا للوعي، ومتصلبًا. تعافى بعد 1-2 دقيقة لكنه ظل شاحبًا.

وبعد ساعة عاد إلى طبيعته. تقول والدته إنها كانت تخشى أن يموت، و

أنه تعرض لنوبة مماثلة قبل 3 أشهر بعد سقوطه على بعض الدرجات. ما هو inv واحد

مبين؟

أ. رأس الأشعة المقطعية

ب. مخطط كهربية الدماغ

ج. سي بي سي

د. لا أحد

ه. مسح الهيكل العظمي

س 1. ما هو المفتاح؟

س2: ما هو التشخيص؟

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