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A 37- yea d femae mpained f easy fatigabiity and pessive diffity in waking, she finay sstaind biatea fates f the fema nek.
He pevi x-ays shwed diffse stepenia, the sem aim was 11mg%, the abmin was 2.5 gm%.


the sgen idn't fee any mps in the nek and was nhappy t peate n the nek befe eqesting a adiistpi san f the nek and a bd test.


(shwn bew the san f the patient)


1- What is the mst pbabe diagnsis?

2- Why is the sem aim nt makedy eevated?

3- What bd test wi the sgen qest?


4- Is it jstifiabe t peate befe eqesting a adiistpi san?


5- whih san did the sgen eqest?


6- What peatin des the sgen have in mind f this ady?




Eay (10 mintes








ate (3.5) hs




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Whe bdy (15 min

من احدى المنتديات الطبيه

بصراحة مو جدا فهمت الase بس كشي اجة ببالي انه انت الربط بين ال san للnek والكلام عن الnek وال sem aim اجة ببالي مثلا hypepaathyidism مااعرف صراحة الحل بس هذا اللي اتجه اله تفكيري ومامتاكدة واحتمال غلط

الاجابه كامله للى عايز يستفيد
ربنا يوفقك هبه
1- What is the mst pbabe diagnsis?


-Hypepaathyidism:

This disease is aed: the disease f bnes, stnes, abdmina gans, psyhi mans, fatige ve tnes.

Expanatin:
Disease f bnes: de t deaifiatin f bnes.

Stnes: de t exetin f a in ine, asing: nephainsis, mtipe eent biatea ena stnes. (the patient is sing his a in ine!!!!!!!!!)

Abdmina gans: de t 3 ases:
1- paneatitis (a mpiatin f hypeaaemia)
2- hypeaaemia stimates the eease f gastin eading t gasti es.
3- nstipatin.

yi mans:
De t depessin.

Fatige ve tnes:
Easy fatigabiity.




2- Why is the sem a is nt makedy eevated:
De t hypabminaemia.



Expanatin:


The sem a is pesent in tw fms:
inized fm (ative) and bnd fm (bnd t Abmin).


In this ase the a shd have been eevated (bth fms: inized and bnd),


bt as the Abmin is we than the nma eves (3.5 -5.5 Gm%), S, the bnd fm wnt be eevated. And s the tta a eve emains nt makedy eevated.


=================================

3- Bd tests the sgen an eqest:


The bd test whih is meant in the qestin is (paathmne eve)
whih was sky high in the ase (what is the nma vae???)


Bt y an mentin the bd tests:
- Inized a.
- Akaine phsphatase.
- ea, eatinine.
(kidney fntin tests t assess kidney affetin t assess pimay kidney pathgy that ed t hypepaathyidism)

NB: etigy f hypepaathyidism:
1y.
2y: e.g t ena faie: de t hypephsphataemia and hypvitaminsis D.
3y: (adenmats, atnms) when the paathyid nde pgess t be atnms in atin and nt nde nt f pititay hmnes.


(NB: mpae this etigy with that f hypethyidism).
========================



4- Is it jstifiabe t peate befe eqesting a adi istpi san?


say nt.


The pbem in paathyid sgey is the identifiatin f the gand.


The gand an be mistaken f ymph ndes, thyid, fat, thyms gand!!!!!



S, it's bette t eqest a adi istpi san t identify site f the gand.



NB: expeiened sgen an identify the gand intapeativey, (It is Man in ) bt then he has t make a age inisin t seah f it.


====================


5- what san did the sgen eqest?


MIBI san thaim T sbtatin san

In MIBI san:
(MIBI) is taken by thyid and paathyid.

* Then afte 4 hs, the thyid wi get id f the istpe bt the paathyid wi be sti athing it.

* S, we an diffeentiate between thyid nde and paathyid gand.
--> If thyid nde: wi se the istpe in 4 hs.
--> If paathyid gand: wi nt.

In thaim T sbtatin:
Idea:
* Thaim is taken by bth thyid and paathyid.
* T is taken by thyid ny.

S, thyid appeas in bth fims, when we sbstat, the thyid is sbstated, and the paathyid emains in the sbtatin fim and appeas bak.


6- The peatin is:
Paathyidetmy.



emaks:



The mst imptant ases f paneatitis ae:


Ah,
ga stnes
(hypeaaemia is a ae ase).
iniay: ate epigasti pain efeed t the bak.

Diffeene between stepenia and stemaaia:
stemaaia: nma nmbe f bne nits bt ess a in eah.
stepenia: ess nmbe f bne nits with nma in eah. (this s in hypepaathyidism).

Typia site f pathgia bne fate in hypepaa. is fema nek (wt beaing).

The tw pais f ht ndes in the ate fim ae saivay gands.

Nma sem a eve: (9-11 mg %)
nma pasma abmin eve: (3.5-5.5 Gm%)

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