Cases for JUS

1. Cases for JUS Sameer Smadi

2. 70 years old male presented with jaundice. Please take focused medical history trying to vertify the cause of his jaundice ?

3. 1-Duration: the time when the jaundice started 2-Coarse: intermittent, progressive or static 3- painless or associated with pain and itching 4- tea colored urine and clay colored stool 5- weight loss 6- association with signs of cholangitis 7- history of same condition 8- history of blood transfusion 9- any member of the family has same complaint 10- history and family history of blood diseases 11- any previous intervention or surgery related to biliary system

4. 22 years old male presented with epigastric pain shifted to right iliac fossa of one day duration ? Perform focused abdominal examination related to his condition?

5. Appendicitis 1- Inspection of abdomen movement with respiration 2- cough impulse +ve ( means increasing the pain) 3- Mcburny sign 4- abdomen guard tense at Rt iliac fossa 5- Rebound +ve 6- Rovsing sign +ve 7- Obturator sign 8-Psoas sign 9- PR examination 10- Pulse

6. 40 years old female presented with goiter Take history to define the cause of goiter

7. 1- main complaint 2- symptoms of thyrotoxicosis 3 - Excessive eating, 4-weight loss, 5- amenorrhea, oligmennorea 6-nerveousness, 7 -hot intolerance, 8 -sweat 9- pressure symptoms ( swallowing) 10- Retrosternal extention ( shortness of breath on sleeping) 11- change in voice (hoarseness, stridor) 12- history of radiation 13- history of autoimmune disease( liver)

8. 60 years old male presented with goiter Focused examination of the neck

9. 1- inspection unilateral , multinodular 2- any skin changes signs of inflammation 3- moves with swallowing, tongue protrusion 4- raising the arms over the head to check for retrosternal extention 5-checking trachea centrally 6- palpate the goiter from the front for tenderness 7- palpate from behind for mass characters ( SIZE, MULTINODULARITY, SURFACE ….) 8- check for lymph nodes 9- berry sign 10- percussion for retrosternal extention 10 auscultation for bruit

10. 65 years old male diabetic presented with infected ulcer in the foot • Examine lower limbs to define the cause ?

11. 1- inspection of the characters of ulcer: -site, shape ,size, edge, base, discharge, floor, surrounding tissue, 2- signs of chronic vascular insuffeicency Arterial (shining and thin skin, loss of hair, presence of brittle nail, fungal infection between toes, small ulcers, necrobiosis diabeticorum, 3- capillary refill 4- pulses 5- Burgers test and Burgers angle 6- ankle/ brachial index 7- compare both lower limbs

12. 45 years old female presented with breast mass • Examine breast to vertify the cause

13. 1- put the patient in 45 0 expose both breasts 2- inspect the normal breast first lt breast hanging more than Rt 3-inspect the axilla 4- examine inferior mammary fold 5- Describe the mass 6-Site , shape, size, 7- skin changes peudorange, skin tethering, puckering 8- Nipple changes : retraction, destruction , discharge 9-areola primary, secondary, presence of mass, discoloration( pagets disease) 10- Examine normal breast 11- examine the mass and describe character 12- examine the rest of the breast quadrant by quadrant 13 examine axilla and neck for lymph nodes

14. 40 years old male presented with Rt inguinoscrotal mass • Examine the inguino scrotal area

15. 1-Ask the patient if it is reducable and can he reduce it 2- ask the patient to stand up 3- inspect from the front for mass ( site, size, skin changes….) 4- Ask the patient to cough 5- Can you get above it? 6-Signs of strangulation 7-Reducibility test 8-Invagination test 9-Three finger test Zieman’s technique 10-Ring occlusion test 11-Examine the abdomen; Causes Of raised intraabd. pressure; • Enlarged bladder (BPH) • Ascites