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كاتب الموضوع | رسالة |
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: حالات انف واذن 14/03/10, 06:06 pm | |
| NAME
Islam
RESIDENCE
Cairo
AGE
21
COMPLAINT
1- Pain in the rt ear 9 months ago 2- Pain in the rt side of the neck 8 months ago 3- Diminution of hearing ability 4- Rt nasal bleeding 5- Slight dysphagia 6- Frontal headache
the patient has normal breathing through the nose he has no history of any other health problems nor surgical interventions nor medications, except for analgesics to relief his previous complaint
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Full report isA about the case is gonna be here after discussing the case with dr mahmoud fawzy next wednesday isA
don't miss it |
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: رد: حالات انف واذن 14/03/10, 06:08 pm | |
| WELCOME BACK
THE HISTORY ONCE AGAIN
NAME
ISLAM ZACKARIYYA
AGE
21
RESIDENCE
CAIRO
COMPLAINT
1-RT EAR PAIN AND PUS 9 MONTHS AGO 2-RT NECK MASS "AND PAIN" 8 MONTHS AGO 3-SLIGHT HEARING LOSS 4-RT NASAL BLEEDING 5-SLIGHT DYSPHAGIA 6-FRONTAL HEADACHE
NO SURGICAL HISTORY NO HISTORY OF MEDICATIONS EXCEPT FOR ANALGESICS NO HISTORY OF ANY OTHER HEALTH PROBLEMS
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: رد: حالات انف واذن 14/03/10, 06:09 pm | |
| WE R GONNA DESCRIBE THE NECK MASS 2 U NOW
THE PROBLEM OF THE MASS DESCRIPTION WAS THAT ???????????
HOW 2 DESCRIBE THE MASS??????????
MMMMM......
SHAPE OVOID SIZE LARGE SITE خليها شوية دي CONSISTENCY FIRM TENDERNESS ???????? PAIN ??????? خليهم شوية برده
COLOR COVERED BY SKIN OF A NORMAL COLOR MOBILITY MOBILE NUMBER SINGLE |
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: رد: حالات انف واذن 14/03/10, 06:10 pm | |
| ABOUT THE PAIN AND THE TENDERNESS
REMEMBER THAT THE PATIENT HAS TOLD US THAT THE MASS IS PAINFUL
ON EXAMINATION THE MASS WAS NEVER TENDER
AND AFTER U REACH THE DIAGNOSIS WITH US U WILL FIND OUT THAT THE MASS CAN NEVER BE PAINFUL
THUS NEVER TRUST THE PATIENT ON HIS HISTORY
TRY 2 THINK WELL
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THERE IS ANOTHER LESSON 2 LEARN IN HISTORY TAKING WHICH IS A TYPE KNOWN AS HISTORY TAKING USING LEADING QUESTIONS
NEVER DO THAT
THIS MEANS THAT U R LEADING THE PATIENT 2 THE ANSWERS
4 INSTANCE
A PATIENT IN THE OUTPATIENT CLINIC COMPLAINS FROM SUSTAINED HEADACHE U, AS AN OTORHINOLARYNGOLOGIST, KNOW THAT THE COMMONEST CAUSE FOR THE HA=EADACHE IN THE CLINIC IS CHRONIC SINUSITIS
THUS, U START 2 LEAD HIM 2 ANSWER U SO THAT U GET CONVINCED THAT HE IS REALLY SUFFERING FROM SINUSITIS
-IS THE HEADACHE FRONTAL? -YES
-IS IT RELATED 2 THE POSITION OF UR HEAD? -YES
DOES IT SHOW DIURNAL VARIATIONS? -YES
U R GUIDING THE PATIENT TO ANSWER WITH YES OR NO, THIS IS THE MEANING OF THE LEADING QUESTION
THE PATIENT IS IN PANIC AND IN PAIN, SO HE ALWAYS GIVES THE MISLEADING ANSWER AND IMAGINES THAT HE REALLY HAS THE SYMPTOMS U ASKED HIM ABOUT
WHAT WE HAVE 2 DO IS NOT TO USE A YES/NO QUESTION
MAKE THE PATIENT ANSWER
LET'S REPEAT THE PREVIOUS DIALOGUE
-WHERE DO U FEEL THE PAIN MOSTLY? -MMMMM......SOMETIMES IN THE FRONT, SOMETIMES AT THE SIDES......
-NO, PLEASE TELL ME EXACTLY WHERE U FEEL THE HEADACHE -FRONTAL, DOCTOR
-AT WHAT TIME? -WHEN I'M IN STRESS, SOMETIMES DURING MY WORK HOURS........
-SURE? NOT AT NIGHT? -MMM,, NO NO, NOT AT NIGHT
-WHAT POSITION CAUSES UR HEADACHE MOST? -WHEN I AM STANDING AND WHEN I ...............................BLA BLA BLA
-NO, SIR, IF THE SEVERITY OF THE HEADACHE INCREASES AT A CERTAIN POSITION, PLEASE TELL ME. IF NOT, ITS OK -YES, DOCTOR, IT GETS SEVERE WHEN I KNEEL DOWN
-THANX
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SO THE THREE LESSONS WE HAVE LEARNT TILL NOW FROM OUR CASES ABOUT HISTORY TAKING ARE
1- CONSIDER FALSE MISLEADING INFORMATION 2- AVOID LEADING QUESTIONS 3- TAKE CARE OF THE DENIAL DEFENCES "AS IN THE CASE OF AHMAD ABDUL FATTAH"
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WE'LL BE BACK SOON ISA |
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: رد: حالات انف واذن 14/03/10, 06:11 pm | |
| كنا وقفنا لحد وصف ال MASS
و أجلنا ال SITE شوية
و ده وقتها
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HOW 2 DESCRIBE THE SITE OF A MASS IN THE NECK?????
THERE ARE 2 METHODS
1- ANATOMICAL REGIONS
DO U REMEMBER THOSE TRIANGLES????
Determining the triangle in which the mass is located is a good method of description
However, there can be another more advanced method
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: رد: حالات انف واذن 14/03/10, 06:11 pm | |
| If our mass is an enlarged lymph node, its location can be described in terms of its position among the lymph nodes groups in the head and neck
so, the question is
WHAT ARE THE LYMPH NODES IN THE HEAD AND NECK???????????
There exist a superficial group, which does not concern us so much, and a deep group, with which we are so far concerned.
To get out of the trap of the variations in the anatomical nomenclature in such serious problems, the AJCC (American Joint Commitee on Cancer) has settled a system of numeral nomenclature to the lymph nodes in the head and neck using roman numerals as follows
such that
Lymph nodes in the neck have been divided into 7 levels, generally for the purpose of squamous cell carcinoma staging. This is however not all inclusive as the parotid nodes and retropharyngeal space nodes are not included in this system.
- Level I: below myohyoid to hyoid
bone anteriorly
- Level Ia: submental
- Level Ib: submandibular
Level II: jugulodigastric (base of skull to hyoid) Level III: deep cervical (hyoid to cricoid) Level IV: Virchow (cricoid to clavicle) Level Va: accessory spinal (posterior triangle)- superior half Level Vb: accessory spinal (posterior triangle)- inferior half Level VI: prelaryngeal / pretracheal / Delphian node Level VII: superior mediastinal (between CCAs, below top of manubrium)
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: رد: حالات انف واذن 14/03/10, 06:12 pm | |
| Back again to Islam Zackariyya
Islam has a very large mass in the posterior triangle
if a lymph node is suspected, it might be from group V
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let's proceed to the next step as usual
THINK THOROUGHLY
WHAT MIGHT HAVE CAUSED THE LESION |
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: رد: حالات انف واذن 14/03/10, 06:13 pm | |
| IS THE LESION
CONGENITAL: MAYBE TRAUMATIC: NO INFLAMMATORY: ACUTE: NO CHRONIC: MAYBE NEOPLASTIC BENIGN: NO MALIGNANT: MAYBE OTHERS: NO
A congenital disease might be a branchial cyst
but this is excluded because the branchial cyst has a cystic consistency, unlike our mass, which is firm
A chronic inflammation may be a tuberculous lymphadenopathy
but this can also be excluded because of the absence of any past or present history of TB in addition to the firm consistency, which cannot go with the granular matted consistency of the tuberculous LNs
A malignant tumor might be a lymphoma or a squamous cell carcinoma
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what is the next step |
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بيانات العضو | مسلمة | عضو ذهبى |
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معلومات العضو | الجنس : عدد المساهمات : 931 عدد النقاط : 28255
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| موضوع: رد: حالات انف واذن 14/03/10, 06:13 pm | |
| Examination
NOSE : FREE OF SYMPTOMS
EAR: CENTRAL PERFORATION
FLEXIBLE ENDOSCOPY SHOWED A MASS IN THE NASOPHARYNX |
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