What is the possible diagnosis? (2 marks)
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1- A male patient 55year old, presented to the outpatient clinic complaining of sever dysuria and hematuria. He gave a strong positive history of bilharziasis. These symptoms did not respond to urinary antiseptics. U/S showed back pressure of the left kidney and thickened lateral bladder wall. • What is possible diagnosis? (2 mark) • Mention another condition that may give same clinical picture in this patient. How to differentiate between both? (5 mark) • Enumerate the investigations required to confirm your diagnosis? (3mark) Bladder CA until prove otherwise. ct< Cystoscopy and biopsy is mandatory ……………………………………………………………………… ……………………………………………………………………… ………………… A 28 year old male patient, presented with purulent urethral discharge for 1 week duration. He gave history of sexual relation with a prostitute since two weeks. What’s your provisional diagnosis? Write treatment plan. Provisional diagnosis : Gonorrheal infection Treatment plan : 1) Avoid sexual relation during the course of treatment, 2) Give antibiotic : Ceftriaxone or Quinolone..3) if the patient was married,his wife should get antibiotic treatment but Quinolone can't be given if his wife is pregnance.. ……………………………………………………………………… ……………………………………………………………………… ………………… A pregnant lady, 28 year old, presented to emergency department with nausea and vomiting, temp. 39.5°C , rigor, right flank pain, and mild dysuria. What’s your provisional diagnosis? Write in brief broad lines of management? Acute pyelonephritis with pregnancy usually need hospitalization, bed rest,and IVF imperical anti biotic suitable for pregnant until doing culture and sensitivity yas, also should be given parentral and it should be broad spectrum acting mainly on gram negative ……………………………………………………………………… ……………………………………………………………………… ………………… A male patient, 56 year old, complaining of gross hematuria.Cystoscopic examination revealed two bladder masses. Biopsy was taken and Histopathologic examination revealed non-muscle invasive tumor grade 2. Write lines of treatment Transurethral resection of the tumor followed by immediate single post operativeintravesicle instillation of chemotherapy or BCG, with follow up for 5 years to detect recurrence. superficial bladder cancer ……………………………………………………………………… ……………………………………………………………………… ……………….. Hasan is 15 year old, He presented to Emergency Room with acute onset of painful scrotal swelling with nausea and vomiting. Physical examination revealed tender high riding left testis. He gave history of similar previous episodes. What is your provisional diagnosis and Differential diagnosis? provisional diagnosis is testicular torsion Differential diagnosis is1- epididymo-orchitis there is fever,pyuria&leucocytosis. 2- hydrocele which is painless &transillumination. 3- testicular tumor is rarely acute. 4idiopathic scrotal edema there is thickened,inflamed skin and testis is not tender and of normal size and position. 1.Scrotal color doppler sonogram. 2.Testicular nuclear scan to differentiate torsion from acute epididymitis. ……………………………………………………………………… ……………………………………………………………………… …………………. a 75 year old male patient presented to emergency unit with an attack of urine retention. he stated that it is the 3rd attack in this year. on examination there is suprapubic tenderness and dullness. cathetrization failed. what is the most probable cause of retention are parasympathomimetic beneficial how to manage this case? Failed cathtrization means it is difficult to pass up to the bladder mostly due to enlarged prostate or urethral stricture here we need you to mange this acute situation ie to do suprapubiccathetrization to relieve the retention after that complete the investigation and ttt in emergency department just suprapubiccystocath... then prepare the patient as an elective case in operation list for surgical intervention enlarged prostate or urethral stricture Parasympathomimitics has no role in case of organic bladder outlet obstruction as in this case of BPH, we should remove the obstructing cause or overcome it by supra-pubic catheter (if urethral cathetrization failed) here we need you to mange this acute situation ie to do suprapubiccathetrization to relieve the retention after that complete the investigation and ttt in emergency department just suprapubiccystocath... then prepare the patient as an elective case in operation list for surgical intervention ……………………………………………………………………… ……………………………………………………………………… ……………. In a case of BPH with moderate symptoms associated with inguinal hernia and chronic cough..plan your treatment combining mesh hernioplasty and trans uretheral resection of prostate is a better option because of low wound infection and low hernia recurrence rate , combining these two also saves the patient to undergo another hospital admission and cost saving chronic cough should be controlled to prevent recurrence of hernia . The treatment of chronic cough is directed toward the particular by the" cause". However, patients may get symptomatic relief from over-the-counter cough medicines containing guaifenesin and/or dextromethorphan, drinking lots of water, inhaling steam, and using cough lozenges. In severe cases a doctor may prescribe codeine, which is an effective cough suppressant. ……………………………………………………………………… ……………………………………………………………………… …………….. what are DD of a flank mass in a child? 1- lymphoma 2- wilms tumor 3-pyelonephritis 4-angiomyolipoma 5-oncocytoma 6-renal cyst 7-benign renal adenoma 8-metastasis from distant 1ry tumor 9-renal cell carcinoma " more in adult" Thanks Dra ShimaaElkamash plz. in that order:Hydronephrosis Cystic kidneys Neuroblastoma, Nephroblastoma and various rare sarcomas. ……………………………………………………………………… ……………………………………………………………………… ……………….. how can you deferentiateEctopc testis in superficial inguinal pouch from undescended testis in inguinal canal? may be: -During contraction of external oblique muscle: if in the canal....it will be less prominant if in the pouch.... it will be more prominant -By introducing the the tip of the little finger into the superficial inguinal ring through the neck of the scrotum: if in the pouch..... the cord will be felt against the margin of the ring if in the canal.... the ring will be empty or the gabernaculum can be felt if intact ……………………………………………………………………… ……………………………………………………………………… …….. a 42 year old farmer, presented with lt testicular swelling that enlarge progressively over the last 6months but without pain. on examination the lt. testis is larger and heavier than the rt. with loss of testicular sensation. abdominal us revealed enlarged para-aortic LNs. the pregnancy test is positive what is your provisional diagnosis? DD how to manage such case pro .d: lt testicular tumor. DD: torsion - epididymoorchitis -hydrocele hernia - hematocele - $ gumma spermatocele- epidermal cyst management: radical orchiectomy - para aortic L.n dissection then according to whether the tumor is seminoma or not we apply chemotherapy or radiotherapy... ………………. another answer case of testicular tumor most probably seminoma because: age of the patient_loss of testicular sensation_early LN involvement stage2(para-aortic LN involvement) DDx:teratoma - hydrocele - hematocele - spermatoceleepidydimo_ orchitis manaement:CT-CXR-bone scan-.....>for staging initial ttt>>>simple orchiectomy further ttt>>>>according to stage if stage2>>>radiotherapy to para -aortic LN and mediastinum with protection of the other testis and both kidneys if higher stage>>> chemotherapy can be added follow up after surgery by tumor markers ……………………………………………………………………… ……………………………………………………………………… ……………… A 4 year old girl presented by her mother to the physician with abdominal swelling discovered accidentally. On examination, the swelling was firm, felt in the Rt lumber area, and by U/S it is a Rt. renal mass. Reviewing the history, the mother observed that her daughter had anorexia in the last few months and started to lose weight. 1- What is the possible diagnosis? (2 marks) 2- Enumerate (name only) the DD of renal swelling (solid or cystic) in such age. (4 marks) 3- Mention the investigation needed to confirm the diagnosis. (4 marks wilmstumer D.D of flank mass in child : hydronephrosis . intrarenalneuroblastoma .cystic kidneys.mesoblasticnephroma ..sarcoma ..hepatoblastoma .. ………………. another answer case of renal tumor mostly wilm's tumor because: age of the patient-firm renal mass-anorexia-loss of weight DDx:neuroblastoma-hepatoblastoma-cystic kidneyhydronephrosis investigations:U/S +percutanous needle biopsy spiral CT>>>confire and for staging urine analysis>>>microscopic hamaturia IVU (provided that KFTs are normal) >>>may show displaced pelvicalceal system VMA in urine>>>exclude neuroblastoma pre -operative investigations:CBC,KFTs,FBS,ECG,CXR ……………………………………………………………………… ……………………………………………………………………… ……………… a 57 year old male patient with a history of oxalate stone passer. he had an attack of ureteric colic together with significant heamaturia . an IVP revealed an irregular filling defect in the renal pelvis & US revealed enlarged para aortic LNs what is the probable diagnosis how to prove it? long standing stone complicated by malignancy.. by biopsy??!! Flexible Uretroscope can pass up to the renal pelvis and biopsy can be taken filling defect in IVU may be due to tumor ,radiolucent stone(urate) or blood clot( he has significant hematuria) however,LNs enlargement suggests renal pelvic tumor case of renal pelvis tumor mostly SCC on top of leukoplakia complicating along standing stone ……………………………………………………………………… ……………………………………………………………………… ……………… A male patient 25 years old, presented with painful scrotal swelling with discharging sinus posteriorly and beaded vas. PCR indicates TB infection. Write medical treatment? ……………………………………………………………………… ……………………………………………………………………… ……………… ESWL is a new modality in treatment of urolithiasis. Predict possible complications and its contraindications ……………………………………………………………………… ……………………………………………………………………… ……………… Enumerate types of urinary stones. how can u differentiate between chyloria and turbid urine due to phosphaturi write short account on pathogenesis of infection stone write pathogenesis of urteropelvic junction obstruction. where common sites of ectopic testis? (1.Superficial inguinal pouch(the most common site).2.Base of the penis(pubic).3.Perineum.4.Femoral canal. what is the "Filarial dance sign”?? Direct ultrasonographic observation of adult filariae has been reported in lymph vessels ……………………………………………………………………… ……………………………………………………………………… ……………… Choose the correct answer and compete the following 1. Oligospermia means number of sperm less than 20000000 per ml. 2. Stress urinary incontinence means : riiruapo pgassap auoegassupiogunssuupisaanssuupa aaisiaoapposinogipearsssupio grgunssu 3. Drugs used for intracavernosal injection therapy for ED are: Papaverine - prostaglandinE2 - phenoxyenzamine - atropine 4. The average weight of the prostate in an adult male aging 30 years is(18 gram) 5. The most common kind of bladder cancer is: A) Transitional cell carcinoma B) Squamous cell carcinoma C) Adenocarcinoma D) Undifranciated carcinomas.
