If a patient with lupus Is admitted for fever, it is essential to rule out infection prior to attributing the fevers to lupus, especially if they are already on immunosuppres-
slve medications.
slve medications.
Internal Medicine Insights ๐ง
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Internal Medicine Insights ๐ง (English)
Welcome to Internal Medicine Insights ๐ฉบ, the channel for medical students and healthcare providers who love internal medicine. Our channel is dedicated to providing valuable information and insights into the field of internal medicine. Whether you're a medical student looking to expand your knowledge or a healthcare provider seeking updates on the latest trends and research in the field, this channel is for you. We cover a wide range of topics related to internal medicine, including disease management, treatment options, and new developments in the field. Our goal is to create a community where like-minded individuals can come together to learn, share, and grow in their understanding of internal medicine. Join us today and take your knowledge of internal medicine to the next level with Internal Medicine Insights ๐ฉบ!
Internal Medicine Insights ๐ง
24 Dec, 12:27
Renal biopsies are crucial in any
lupus patient presenting with
renal insufficiency orproteinuria and typlcally show a prollferatlve glomeruloneptuitis. lmmuno- fluorescence shows โขtun house" staining (e.g., positive for lgG, lgA, lgM, C3, and Cl q).
lupus patient presenting with
renal insufficiency orproteinuria and typlcally show a prollferatlve glomeruloneptuitis. lmmuno- fluorescence shows โขtun house" staining (e.g., positive for lgG, lgA, lgM, C3, and Cl q).
Internal Medicine Insights ๐ง
22 Dec, 14:46
There Is often an ESR/CRP discrepancy in active lupus, witli a very high ESR and only mildly elevated CRP. If a patient with lupus lias a very high CRP, infection must be ruled out.
Internal Medicine Insights ๐ง
20 Dec, 17:28
Always look at a patient's albumin prior to calculating anion gap and correct a normal anion gap for the patient's serum albumin. For example, if the albumin is 2 g/L (normal is 3.5 to 5.0), the patient's normal anion gap is 5. If the albumin is normal, assume the anion gap is near 10.
Internal Medicine Insights ๐ง
19 Dec, 06:31
As CKD progresses, reductions in GFR dramatically impair clearance of insulin by the kidney. This may manifest as improved glycemic control.
Internal Medicine Insights ๐ง
18 Dec, 10:08
Anemia in patients with CKD is primarily due to erythropoietin deficiency and is treated to a target hemoglobin of 9 to 11 g/ dL with erythropoiesis-stimulating agents (ESAs). Blood transfusions should be avoided in potential kidney transplant recipients to prevent antibody formation.
Internal Medicine Insights ๐ง
17 Dec, 10:16
High urine output after obstruction relief is described as postobstructive diuresis. Urine output should be replaced with hypotonic fluid to prevent volume depletion. Electrolytes should be monitored and replaced often
Internal Medicine Insights ๐ง
12 Dec, 16:42
Not all black stool is GI bleeding!
Iron or bismuth consumption can turn stool black.
Epistaxis or gum bleeding can lead to melena.
Iron or bismuth consumption can turn stool black.
Epistaxis or gum bleeding can lead to melena.
Internal Medicine Insights ๐ง
11 Dec, 19:09
Patients with cirrhosis can take
acetaminophen, just make sure it's less than 2000 mg/day
acetaminophen, just make sure it's less than 2000 mg/day
Internal Medicine Insights ๐ง
10 Dec, 13:52
It is not necessarily abnormal to be able to palpate the liver below the costal margin, though in adults it is generally abnormal to have a palpable spleen.
Internal Medicine Insights ๐ง
09 Dec, 07:50
(COPD)๐ซ
clubbing is generally absent, even in the presence of hypoxia. The occurrence of clubbing should prompt consideration of alternative diagnoses such as idiopathic pulmonary fibrosis (IPF) or lung cancer, as these conditions are more commonly associated with digital clubbing.
clubbing is generally absent, even in the presence of hypoxia. The occurrence of clubbing should prompt consideration of alternative diagnoses such as idiopathic pulmonary fibrosis (IPF) or lung cancer, as these conditions are more commonly associated with digital clubbing.
Internal Medicine Insights ๐ง
22 Nov, 05:46
Patients with systemic lupus erythematosus (SLE) should practice sun avoidance and protection, as ultraviolet (UV) light can trigger not only cutaneous lupus but also systemic manifestations of the disease.
Internal Medicine Insights ๐ง
21 Nov, 19:40
* Topiramate-induced renal tubular acidosis (RTA) is a mixed form, not fitting neatly into traditional classifications.
* It inhibits carbonic anhydrase, leading to:
* Reduced bicarbonate reabsorption in the proximal tubules (similar to type 2 RTA).
* Impaired hydrogen ion excretion in the distal tubules (resembling type 1 RTA).
* This results in metabolic acidosis with an inappropriately high urine pH.
* Unlike classical RTA, it's usually associated with normal or mild hypokalemia.
* Clinical effects like nephrolithiasis or bone disorders can often be managed with potassium citrate.
* It inhibits carbonic anhydrase, leading to:
* Reduced bicarbonate reabsorption in the proximal tubules (similar to type 2 RTA).
* Impaired hydrogen ion excretion in the distal tubules (resembling type 1 RTA).
* This results in metabolic acidosis with an inappropriately high urine pH.
* Unlike classical RTA, it's usually associated with normal or mild hypokalemia.
* Clinical effects like nephrolithiasis or bone disorders can often be managed with potassium citrate.
Internal Medicine Insights ๐ง
21 Nov, 10:49
๏ปฟFebuxostat (black box warning regarding CV disease)
๏ปฟProbenecid: not effective in renal failure
๏ปฟProbenecid: not effective in renal failure
Internal Medicine Insights ๐ง
20 Nov, 12:02
For symptomatic treatment of acute gout in
CKD, low-dose colchicine or intra-articular/ oral glucocorticoids are preferable to nonsteroidal anti-inflammatory drugs (NSAIDs).
CKD, low-dose colchicine or intra-articular/ oral glucocorticoids are preferable to nonsteroidal anti-inflammatory drugs (NSAIDs).
Internal Medicine Insights ๐ง
18 Nov, 07:19
Pickwickian syndrome
is the combination of severe obesity, a plethoric face and obstructive sleep apnoea causing hypoxia and hypercapnia, resulting in marked daytime somnolence. It is named after the โfat and red-faced boy in a state of somnolencyโ as described in the novel The Pickwick Papers by Charles Dickens.
is the combination of severe obesity, a plethoric face and obstructive sleep apnoea causing hypoxia and hypercapnia, resulting in marked daytime somnolence. It is named after the โfat and red-faced boy in a state of somnolencyโ as described in the novel The Pickwick Papers by Charles Dickens.
Internal Medicine Insights ๐ง
17 Nov, 06:03
Common clinical characteristics of sarcoidosis include:
โข Skin:
Erythema nodosum โ caution, not always on the shins
Lupus pernio โ red crusty lesions, often around the nose
Annular lesions
โข Polyuria:
Secondary to hypercalciuria/hypercalcaemia (can also cause renal calculi and nephrocalcinosis)
Secondary to central diabetes insipidus
โข Cardiac:
Ventricular arrhythmias
Conduction defects
Cardiomyopathy
Congestive cardiac failure
โข Neurological:
Involvement of CNS occurs in 2%
Cranial diabetes insipidus
โข Ocular:
Anterior uveitis
Conjunctivitis
Retinal lesions
Keratoconjunctivitis sicca and lacrimal gland enlargement
Optic neuritis
โข Metabolic:
Hypercalcaemia and hypercalciuria
โข Bone and joints:
Arthralgia
Bone cysts
โข Others:
Hepatosplenomegaly
Lรถfgren syndrome (acute sarcodosis) โ triad of bihilar lymphadenopathy, arthritis and erythema nodosum.
โข Skin:
Erythema nodosum โ caution, not always on the shins
Lupus pernio โ red crusty lesions, often around the nose
Annular lesions
โข Polyuria:
Secondary to hypercalciuria/hypercalcaemia (can also cause renal calculi and nephrocalcinosis)
Secondary to central diabetes insipidus
โข Cardiac:
Ventricular arrhythmias
Conduction defects
Cardiomyopathy
Congestive cardiac failure
โข Neurological:
Involvement of CNS occurs in 2%
Cranial diabetes insipidus
โข Ocular:
Anterior uveitis
Conjunctivitis
Retinal lesions
Keratoconjunctivitis sicca and lacrimal gland enlargement
Optic neuritis
โข Metabolic:
Hypercalcaemia and hypercalciuria
โข Bone and joints:
Arthralgia
Bone cysts
โข Others:
Hepatosplenomegaly
Lรถfgren syndrome (acute sarcodosis) โ triad of bihilar lymphadenopathy, arthritis and erythema nodosum.
Internal Medicine Insights ๐ง
17 Nov, 05:37
โข BTS Recommendation on Repeat X-ray: Not recommended routinely for all patients with pneumonia before discharge or at six weeks.
โข BTS Recommendation on Chest X-ray After Six Weeks: Recommended for patients with persistent symptoms, physical signs, or higher risk of malignancy.
โข Patients at Higher Risk of Malignancy: Smokers and those aged over 50 years. โข BTS Recommendation on Repeat X-ray: Not recommended routinely for all patients with pneumonia before discharge or at six weeks.
โข BTS Recommendation on Chest X-ray After Six Weeks: Recommended for patients with persistent symptoms, physical signs, or higher risk of malignancy.
โข Patients at Higher Risk of Malignancy: Smokers and those aged over 50 years.
โข BTS Recommendation on Chest X-ray After Six Weeks: Recommended for patients with persistent symptoms, physical signs, or higher risk of malignancy.
โข Patients at Higher Risk of Malignancy: Smokers and those aged over 50 years. โข BTS Recommendation on Repeat X-ray: Not recommended routinely for all patients with pneumonia before discharge or at six weeks.
โข BTS Recommendation on Chest X-ray After Six Weeks: Recommended for patients with persistent symptoms, physical signs, or higher risk of malignancy.
โข Patients at Higher Risk of Malignancy: Smokers and those aged over 50 years.
Internal Medicine Insights ๐ง
16 Nov, 16:45
Lateral medullary syndrome, also known as Wallenberg syndrome
occurs when the lateral medulla and the inferior surface of the cerebellum are affected by an infarction. This condition results in deficits that involve specific areas of the brain, including the nucleus ambiguous, trigeminal nucleus, vestibular nuclei, cerebellar peduncle, spinothalamic tract, and autonomic fibers.
โข Nystagmus
โข Ipsilateral involvement of the V and VIII cranial nerves
โข Ipsilateral Horner syndrome
โข Ipsilateral ataxia
โข Crossed pattern of sensory loss
โข Pain and temperature sensation are lost on the ipsilateral face and contralateral trunk and limbs.
The syndrome can be caused by an occlusion of any of the five following arteries: the posterior inferior cerebellar artery, vertebral artery, superior lateral medullary artery, middle lateral medullary artery, or inferior lateral medullary artery.
occurs when the lateral medulla and the inferior surface of the cerebellum are affected by an infarction. This condition results in deficits that involve specific areas of the brain, including the nucleus ambiguous, trigeminal nucleus, vestibular nuclei, cerebellar peduncle, spinothalamic tract, and autonomic fibers.
โข Nystagmus
โข Ipsilateral involvement of the V and VIII cranial nerves
โข Ipsilateral Horner syndrome
โข Ipsilateral ataxia
โข Crossed pattern of sensory loss
โข Pain and temperature sensation are lost on the ipsilateral face and contralateral trunk and limbs.
The syndrome can be caused by an occlusion of any of the five following arteries: the posterior inferior cerebellar artery, vertebral artery, superior lateral medullary artery, middle lateral medullary artery, or inferior lateral medullary artery.
Internal Medicine Insights ๐ง
16 Nov, 15:39
Occlusion of the inferior division of the MCA is nearly always embolic.
โข This is typically seen following heart surgery.
โข The non-dominant hemisphere involvement leads to anosognosia, unilateral neglect, dressing apraxia, and constructional apraxia.
โข These findings reflect the non-dominant parietal lobe involvement.
โข A superior quadrantanopia is due to involvement of the optic radiations deep to the second temporal convolution.
โข This is typically seen following heart surgery.
โข The non-dominant hemisphere involvement leads to anosognosia, unilateral neglect, dressing apraxia, and constructional apraxia.
โข These findings reflect the non-dominant parietal lobe involvement.
โข A superior quadrantanopia is due to involvement of the optic radiations deep to the second temporal convolution.
Internal Medicine Insights ๐ง
16 Nov, 06:28
Frontotemporal dementia is an insidious condition which manifests in one of three patterns:
โข behavioural variant (including rituals, loss of inhibition and change in motivation without depression, all manifesting in this stem)
โข semantic dementia (loss of vocabulary)
โข progressive non-fluent aphasia (grammatical errors and changes in comprehension).
โข behavioural variant (including rituals, loss of inhibition and change in motivation without depression, all manifesting in this stem)
โข semantic dementia (loss of vocabulary)
โข progressive non-fluent aphasia (grammatical errors and changes in comprehension).
Internal Medicine Insights ๐ง
16 Nov, 06:25
The Tensilon test can be positive in other neuromuscular conditions and is not specific to MG.
Internal Medicine Insights ๐ง
16 Nov, 05:59
The 6th-nerve nucleus is encircled by seventh-nerve fibres in the pons, so pontine lesions of the seventh cranial nerve are often associated with a convergent squint (due to lateral rectus palsy). Causes include pontine tumours (such as a glioma), demyelination due to multiple sclerosis and vascular lesions.
Internal Medicine Insights ๐ง
14 Nov, 15:35
In this patient with acute pyelonephritis due to obstructive uropathy, emergency surgical intervention should be made to decompress the urinary tract. Indications for emergency surgery are:
โข confirmed complicated urinary tract infection due to obstructing stones
โข bilateral obstruction and acute kidney injury (AKI)
โข unilateral obstruction with AKI in a solitary functioning kidney.
โข confirmed complicated urinary tract infection due to obstructing stones
โข bilateral obstruction and acute kidney injury (AKI)
โข unilateral obstruction with AKI in a solitary functioning kidney.
Internal Medicine Insights ๐ง
14 Nov, 12:11
The Kidney Disease: Improving Global Outcomes (KDIGO) organisation does not recommend routine screening of autosomal dominant polycystic kidney disease (ADPKD) patients, except in the following situations:
โข Family history of intracerebral aneurysm (ICA) or subarachnoid haemorrhage.
โข Personal history of previous ICA rupture.
โข Patients with a high-risk profession (e.g., aeroplane pilot).
โข Patient anxiety despite being given adequate information regarding risk.
โข Family history of intracerebral aneurysm (ICA) or subarachnoid haemorrhage.
โข Personal history of previous ICA rupture.
โข Patients with a high-risk profession (e.g., aeroplane pilot).
โข Patient anxiety despite being given adequate information regarding risk.
Internal Medicine Insights ๐ง
14 Nov, 07:44
Nephrogenic systemic fibrosis (NSF) is a super rare condition that happens to people with kidney disease after theyโve had an MRI with gadolinium-based contrast agents. Itโs more common with older MRI gadolinium agents, so itโs still happening, but itโs pretty rare now. Nephrologists are still debating it. It looks like systemic sclerosis, but it doesnโt have autoimmune antibodies. And guess what? Post-MRI dialysis doesnโt seem to make it any less likely.
Internal Medicine Insights ๐ง
13 Nov, 13:22
A JarischโHerxheimer reaction is a bodyโs response to endotoxin-like substances released when bacteria are killed during antibiotic treatment. Itโs been linked to syphilis, Lyme disease, leptospirosis, and relapsing fever. It usually happens 1 to 12 hours after the first antibiotic dose and doesnโt happen again with subsequent treatments. Symptoms include feeling tired, fever, redness, and a fast heartbeat. This can sometimes lead to low blood pressure because the blood vessels in the extremities dilate.
Internal Medicine Insights ๐ง
13 Nov, 13:21
Procaine penicillin can cause a serious reaction if accidentally given IV instead of IM. Itโs like a sudden rush of fear, with delusions and hallucinations. Patients might need help restraining themselves. The reaction usually goes away within 20 minutes. Sometimes, patients might have a seizure, which should be stopped with IV or PR diazepam.
Internal Medicine Insights ๐ง
12 Nov, 15:38
โข Purpuric rash
โข Raynaudโs
โข Polyarthralgia
โข Positive rheumatoid factor (RF)
โข Low C4
โข Suggestive ofcyroglobulinaemia
Internal Medicine Insights ๐ง
12 Nov, 07:16
The 2019 revised International Prognostic Scoring System for Waldenstrรถmโs Macroglobuinaemia (IPSSWM) allows risk stratification of patients with WM
according to the following factors:
โข age < 65 years (0 point)
โข age 66โ75 years (1 point)
โข age > 75 years (2 points)
โข beta-2 microglobulin > 4 mg/l (1 point)
โข lactate dehydrogenase (LDH) level > 250 IU/l (1 point)
โข serum albumin < 35 g/l (< 3.5 g/dl) (1 point).
Risk groups are defined as (with points needed and 5-year survival rate in brackets): very low risk (0 points; 95%); low risk (1 point; 86%); intermediate risk (2 points; 78%); high risk (3 points; 47%); and very high risk (4โ5 points; 36%). This patient can be stratified as being intermediate risk due to beta-2 microglobulin and LDH levels.
according to the following factors:
โข age < 65 years (0 point)
โข age 66โ75 years (1 point)
โข age > 75 years (2 points)
โข beta-2 microglobulin > 4 mg/l (1 point)
โข lactate dehydrogenase (LDH) level > 250 IU/l (1 point)
โข serum albumin < 35 g/l (< 3.5 g/dl) (1 point).
Risk groups are defined as (with points needed and 5-year survival rate in brackets): very low risk (0 points; 95%); low risk (1 point; 86%); intermediate risk (2 points; 78%); high risk (3 points; 47%); and very high risk (4โ5 points; 36%). This patient can be stratified as being intermediate risk due to beta-2 microglobulin and LDH levels.
Internal Medicine Insights ๐ง
12 Nov, 07:08
Mucosa-associated lymphoid tissue lymphoma (MALToma), also known as marginal zone lymphomas, are low-grade lymphomas that predominantly affect the stomach. They exhibit a unique association with chronic inflammation of one of the following types:
- Stomach: Chronic H. pylori gastritis
- Eyes: Sjรถgren syndrome
- Thyroid: Hashimotoโs thyroiditis
- Intestine: Crohnโs disease or coeliac disease
Treatment against H. pylori is effective and leads to regression in 90% of low-grade gastric MALTomas. Given the significance of establishing H. pylori diagnosis, if the tumor biopsy is negative for H. pylori, non-invasive testing such as stool antigen testing or urea breath test for H. pylori should be performed. In the event of a positive non-invasive test result, the patient should be initially managed with triple therapy.
- Stomach: Chronic H. pylori gastritis
- Eyes: Sjรถgren syndrome
- Thyroid: Hashimotoโs thyroiditis
- Intestine: Crohnโs disease or coeliac disease
Treatment against H. pylori is effective and leads to regression in 90% of low-grade gastric MALTomas. Given the significance of establishing H. pylori diagnosis, if the tumor biopsy is negative for H. pylori, non-invasive testing such as stool antigen testing or urea breath test for H. pylori should be performed. In the event of a positive non-invasive test result, the patient should be initially managed with triple therapy.
Internal Medicine Insights ๐ง
11 Nov, 17:33
Teduglutide
is a special medicine that helps the small intestine grow. Itโs especially helpful for people with short bowel syndrome caused by many surgeries for Crohnโs disease. After six months of taking Teduglutide, people with short bowel syndrome who needed extra nutrition through a tube (TPN) saw a big drop in how much TPN they needed. Some people needed 20% less, while others needed 100% less!
is a special medicine that helps the small intestine grow. Itโs especially helpful for people with short bowel syndrome caused by many surgeries for Crohnโs disease. After six months of taking Teduglutide, people with short bowel syndrome who needed extra nutrition through a tube (TPN) saw a big drop in how much TPN they needed. Some people needed 20% less, while others needed 100% less!
Internal Medicine Insights ๐ง
10 Nov, 14:42
insulin-related worsening of heart failure and fluid overload
which occurs because insulin itself promotes salt and water retention.
which occurs because insulin itself promotes salt and water retention.
Internal Medicine Insights ๐ง
09 Nov, 13:51
The Scandinavian Simvastatin Survival Study (4S) was a randomised trial of cholesterol lowering in 4444 patients with coronary artery disease.
Internal Medicine Insights ๐ง
09 Nov, 13:50
The CAPRIE trial was a randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events; it demonstrated an 8.7% relative risk reduction with respect to ischaemic events versus aspirin.
Internal Medicine Insights ๐ง
09 Nov, 13:50
The First International Study of Infarct Survival (ISIS-1) revealed an improved survival in a randomised trial of intravenous atenolol among 16,027 cases of suspected acute myocardial infarction.
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