Chief complaint: Jaundice for 2 weeks, abdominal pain.
History of presenting illnesses:
Fifty six YO male with NHL referred from hematology clinic for jaundice that was noticed first by the wife for 2 weeks. Jaundice seems to be progressive with darkening of urine but no change in stool color. There is no history of previous such episode of jaundice, history of liver diseases, abdominal swelling, confusion or sleep disturbances. There is moderate diffuse abdominal pain aggravated with food, relieved with fasting for 24 hours felt mostly in peri-umbilical and sub-costal area. Patient complains of recent constipation relieved by laxatives. Bowel movement frequency and consistency are normal. No overt GI bleeding.
Patient reports loss of appetite and loss of weight of least 5 KGs noticed by the wife. NO other gastrointestinal symptoms. He also complains of general fatigue, easy fatigability, vertigo for more than a year that gets better by laying back.
Other review of systems (ROS) reveals chronic dry spontaneous cough relieved by "toplixil without prescription". No wheezing, hemoptysis, dyspnea, fever, or other respiratory symptoms.
Past medical history:
the patient was diagnosed 2 years ago to have NHL affecting the majority of his lymphoid tissues below and above the diaphragm ( i.e. stage IV). he is being treated with the CHOP protocol. The patient was hospitalized 4 times in the past 2 years for sever chemotherapy reaction and 2 times for sever GI compilcations.
Past Surgical History: NONE
Current Medications "Arabic medicine" composed of:
Gazelle's horn mixed with boiling milk!! "one food spoon 3 times a day".
Donkeys seeds juice eye drops "3 times a day" !!.

Family history:
father was diabetic, hypertensive died at age 60 because of MI. mother was diabetic, died at age 55 because of MI too.
Social history:
56 y/o, houses and offices painter, married with 9 children, Smoker 1 pack/39 years. Not alcoholic.
O/E
General inspection: alert, responding, oriented to T P P, looks tired.
Vital signs:
Blood pressure: 135/75
Heart beat: 62 per minute
Breathe rate: 16 per minute
Heat: 36.9ْ C
HEENT : icterus, The rest was clear.
Lungs: lung sounds clear NO crackles NO rubs , 3-4 cm chest limitation.
CVS: heart sounds clear to auscultation.
Abdomen: no tenderness, no guarding, no organomegaly.
CNS: vision clear, apparent hearing loss, normal cranial and spinal refluxes.
Musculoskeletal system was clear to physical examination, normal movement, no limitation, no arthralgia, no joint swelling.
Skin: Jaundice color all over the skin.
Lymphoid system:
2 small tough lymph nodes behind left ear both 0.5 cm. adherent in deep, movable to skin.
2 attached sub-mandibuler lymph nodes 2-3 cm, tough, adherent in deep, movable to skin.
1 node behind left stern-mastoid muscle 4 cm, tough, adherent in deep, movable to skin.
5-7 lymph nodes in both the left and the right axial region.
1 lymph node 1.5 cm in the left groin adherent in deep, movable to skin.

Make a problem list and a differntial diagnosis.

شكرا يازميل تبان علحالة السريرية ...
بس ياريت كاتبها بالعربي .. لأنو الموقع باللغة العربية ... وماكلياتنا لغتهنا الانكليزية جيدة

i didn't use a though medical language, try to read it carefully, it's an intresting case.