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70 year old female presented to the ER with

severe epigastric pain, she is diabetic and is


on anti-ischemic medications and ranitidine
for gastritis. The doctor discharged her on a
proton pump inhibitor. The second day she
returned with persistent epigastric pain.

DD

History
Important Qs

History
Character of pain, referral, ppt factor

Examination
Epigastric tenderness

Investigations

Investigations
ECG, cardiac enzymes, CBC

A 70 year old male presented to the clinic with


left shoulder pain. He is an ex-smoker,
hypertensive diabetic, CLD, ischemic heart
disease, knee osteoarthritis

DD

History
Important Qs

History
Hypertensive for 30 years on ACEi with regular Fup and
controlled
Diabetic for 30 years on oral antidiabetic with regular
Fup and controlled
ISHD with previous catheter after MI 9stopped heavy
smoking) on aspocid 75mg, anti-ischemic medication
CLD, Hep C +, compensated
Left shoulder pain in left side of the neck and
shoulder , vague character, not referred, precipitated
by carrying his grocery bags, cant associate a
relieving factor.

Examination
Important signs?

Examination
Shoulder examination: free
Neurological examination: hyperthesia left arm
with dermatomal distribution, glove and stock
hypothesia.

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