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الموضوع على ثلاث اجزاء ارجو ان ينال اعجابكم

الجزء الاول
BACKGROUND
A 52-year-old man presents with a 6-month history of right upper quadrant discomfort, which is occasionally associated with vomiting. He says that the pain is unrelated to eating, his diet, physical exertion, or any specific posture. His appetite has been good, and he denies any weight loss. Remaining findings on the review of systems are unremarkable. He does not have any chronic medical conditions and is currently only taking a multivitamin once a day.

On physical examination, the patient’s vital signs are within normal range and stable. The patient appears to be a well-nourished, middle-aged man who is alert and oriented. His lungs are clear to auscultation. Cardiovascular examination reveals a regular heart rate and rhythm. Abdominal examination reveals a positive Murphy sign, with minimal tenderness in the right upper quadrant and no fluid wave or masses to palpation. The abdomen is soft and nondistended and has normal bowel sounds. A complete blood count reveals leukocytosis but is otherwise unremarkable, as are the results of other routine laboratory investigations including liver function tests and a lipase determination.

Abdominal ultrasonography (US) was performed, and the findings prompted CT scanning. What is the diagnosis?
Hint
Consider a condition that mimics gallbladder ca

new case2 from e_medicine

الجزء الثاني
BACKGROUND
Paramedics bring a 55-year-old woman to the emergency department after she was shot above the right eye with a BB gun. The patient is alert and awake, but she is irritated and complains of pain with decreased vision in her right eye. She has no other associated injuries.

On physical examination, her right upper eyelid is mildly edematous with a noticeable puncture wound at the BB entrance site marked by a drop of blood. The right eye is visibly proptotic, and the sclera is injected with chemosis. The patient has restricted movement of the affected eye. The pupil is round, 2 mm in diameter, and minimally reactive to light. She has no light perception in that eye. The pupil of the unaffected eye is 4 mm and briskly constricts to 2 mm with light. Repeated bedside testing with a Tonopen shows intraocular pressures (IOPs) of 75-80 mm Hg in the right eye with a normal IOP of 10 mm Hg in the unaffected, left eye. Instillation of fluorescein reveals no corneal damage. Her vital signs are remarkable for an increased heart rate of 102 bpm and a blood pressure of 163/84 mm Hg. The remaining physical examination findings are unremarkable.

What emergency condition do the increased IOP and proptosis indicate (see Image)?
Hint
An emergency procedure may be required to help restore the patient’s vision.

new case 3 from e medicine
الجزء الثالث
BACKGROUND
A 68-year-old Filipino man presents to the emergency department with swelling and redness of his right eye for 4 days. He denies any pain, visual blurring, or double vision in the affected eye. Both the swelling and the redness have progressively worsened since he first noticed them. He has no history of trauma or weakness and no strange sensation on his face or in his extremities. He has not had vertigo, headache, or difficulty walking.

On physical examination, the patient has normal and stable vital signs, though headache may be present. Chemosis of his right eye with proptosis is observed. Visual acuity is 20/60 in the affected eye and 20/20 in the unaffected eye. No evidence of corneal abrasion or ulceration is noted, and the patient does not have any visual field deficits. The fundus appears congested with no signs of pallor. His extraocular movements are intact with no pain on movement. Gross findings on neurologic examination are within normal limits, with a specific note of intact cranial-nerve function. No bruit is noted around the affected eye.

Looking at the photo of the patient’s eye (see Image), what is your diagnosis?
Hint
The patient has a history of diabetes mellitus and hypertension

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