⭕ common finding in clinical exam
Medicine 3rd batch 🩺
@medicine_3b
قناة كورس الباطنة
اللجنة العلمية للدفعة الثالثة
كلية الطب البشري
جامعة 21 سبتمبر للعلوم الطبية والتطبيقية ..
لاستقبال طلباتكم يمكنكم مراسلتنا عبر البوت :
@Medicine3_bot
Medicine 3rd batch 🩺 (Arabic)
تعتبر قناة كورس الباطنة (@medicine_3b) واحدة من أهم القنوات التي تقدم محتوى طبي متخصص للدفعة الثالثة في كلية الطب البشري بجامعة 21 سبتمبر للعلوم الطبية والتطبيقية. تهدف هذه القناة إلى توفير موارد تعليمية عالية الجودة ومحتوى متخصص في مجال الباطنة للطلاب والمهتمين بالطب البشري. يمكنكم التواصل مع القناة وطلب المعلومات عبر البوت الخاص بالقناة: @Medicine3_bot. انضموا إلينا اليوم للاستفادة من المحتوى القيم والفرص التعليمية الرائعة التي تقدمها هذه القناة الطبية المتميزة!
Medicine 3rd batch 🩺
24 Jan, 08:36
لماذا نصلي على النبي ؟؟؟
أولاً / لأننا مأمورون بذلك ، قال الله تعالى : ( يا أيها الذين ءامنوا صلوا عليه وسلموا تسليما)
ثانياً / فضل الصلاة على النبي عائدٌ علينا نحن ... فقد قال الرسول صلى الله عليه وسلم: ( مَنْ صلَّى عليَّ صلاَةً، صلَّى اللَّه علَيّهِ بِهَا عشْرًا)
وقال : (أَوْلى النَّاسِ بِي يوْمَ الْقِيامةِ أَكْثَرُهُم عَليَّ صَلاَةً)
وحديث.... قال: يا رسول الله! فأجعل صلاتي كلها لك؟ قال: « إذًا تكفى همك، ويغفر ذنبك»
ثالثاً / رد الجميل لسيدنا محمد فقد بلغ الرسالة وتحمل في سبيل ذلك الكثير، وبها نعبر عن محبتنا واحترامنا له، وأيضاً الصلاة على النبي تعني الدعاء بأن يرفع الله درجته ويذكره ويثني عليه في الملأ الأعلى.
جمعة مباركة ، أكثروا فيها من الصلاة على النبي
لعل الله يرفع عنا ما حل بنا من كربة
أولاً / لأننا مأمورون بذلك ، قال الله تعالى : ( يا أيها الذين ءامنوا صلوا عليه وسلموا تسليما)
ثانياً / فضل الصلاة على النبي عائدٌ علينا نحن ... فقد قال الرسول صلى الله عليه وسلم: ( مَنْ صلَّى عليَّ صلاَةً، صلَّى اللَّه علَيّهِ بِهَا عشْرًا)
وقال : (أَوْلى النَّاسِ بِي يوْمَ الْقِيامةِ أَكْثَرُهُم عَليَّ صَلاَةً)
وحديث.... قال: يا رسول الله! فأجعل صلاتي كلها لك؟ قال: « إذًا تكفى همك، ويغفر ذنبك»
ثالثاً / رد الجميل لسيدنا محمد فقد بلغ الرسالة وتحمل في سبيل ذلك الكثير، وبها نعبر عن محبتنا واحترامنا له، وأيضاً الصلاة على النبي تعني الدعاء بأن يرفع الله درجته ويذكره ويثني عليه في الملأ الأعلى.
جمعة مباركة ، أكثروا فيها من الصلاة على النبي
لعل الله يرفع عنا ما حل بنا من كربة
Medicine 3rd batch 🩺
11 Jan, 13:08
internal medicine 99% done ✅
باقي بس بكرة موفقين ان شاء الله 😅
Next ---> Surgery15 days ⏳️
><><><><><><><><
📍نظري 👇
https://t.me/Surgery_3B/3887
📍عملي 👇
https://t.me/Surgery_3B/3887
📍OSCE
><><><><><><><><
باقي بس بكرة موفقين ان شاء الله 😅
Next ---> Surgery
><><><><><><><><
📍نظري 👇
https://t.me/Surgery_3B/3887
📍عملي 👇
https://t.me/Surgery_3B/3887
📍OSCE
><><><><><><><><
Medicine 3rd batch 🩺
11 Jan, 13:02
🛑 insulin in DM type 2
✅The initial dose for any basal insulin is 0.2 units per kg daily (minimum 10 units, up to 15 to 20 units).
✅If fasting glucose levels are very elevated (>250 mg/dL [13.9 mmol/L]), A1C is >8 percent, or insulin resistance is severe, initial doses of basal insulin in type 2 diabetes can be higher (eg, 0.3 units per kg or up to 25 to 30 units daily).
#Uptodate2024
✅The initial dose for any basal insulin is 0.2 units per kg daily (minimum 10 units, up to 15 to 20 units).
✅If fasting glucose levels are very elevated (>250 mg/dL [13.9 mmol/L]), A1C is >8 percent, or insulin resistance is severe, initial doses of basal insulin in type 2 diabetes can be higher (eg, 0.3 units per kg or up to 25 to 30 units daily).
#Uptodate2024
Medicine 3rd batch 🩺
11 Jan, 11:51
Choice of the antihypertensive drugs
👇
S.creatinine more than 3....تغير CCB
👇
S.creatinine more than 3....تغير CCB
Medicine 3rd batch 🩺
11 Jan, 11:35
🟢Terms used in uncontrolled diabetes :-
- Ketonuria
- Ketosis
- Diabetes ketoacidosis
- Hyperosmolar hyperglycemic stat
- Lactic acidosis
- Ketonuria
- Ketosis
- Diabetes ketoacidosis
- Hyperosmolar hyperglycemic stat
- Lactic acidosis
Medicine 3rd batch 🩺
11 Jan, 11:34
📍خلال الفحص السريري حطيت ايدك ع Pulse ولقيت :
Pulse = Irregular Irregular
تفكيرك راح يروح فقط لل Atrial Fibrillation
✅ لكن من ضمن أسبابه :
✅ 1.Atrial fibrillation.
✅ 2.Multiple ectopics.
✅ 3.Atrial flutter with variable block. .
✅ 4.Paroxysmal atrial tachycardia with variable block.
Pulse = Irregular Irregular
تفكيرك راح يروح فقط لل Atrial Fibrillation
✅ لكن من ضمن أسبابه :
✅ 1.Atrial fibrillation.
✅ 2.Multiple ectopics.
✅ 3.Atrial flutter with variable block. .
✅ 4.Paroxysmal atrial tachycardia with variable block.
Medicine 3rd batch 🩺
11 Jan, 08:46
Treatment of H.pylori
👍 فيه معنا علاج ثلاثي وهو الاساسي
ويستخدم للبكتيريا الذي هي moderate or weak
وفيه رباعي او خماسي ينضاف للأدوية الثلاثي في حاله strong H.pylori
اولا الثلاثي
1.Takepron 30mg ...حبه قبل الصبوح
( lanzoprazol)
2.claricide 500mg (clarithromycin)
حبه بعد الصبوح والعشاء لمدة أسبوعين
3.Moxalin 1000mg (amoxicillin)
حبه بعد الصبوح والعشاء لمده اسبوعين
+
1..Tavacin 500mg (levofloxacin)
حبه بعد الغداء لمدة اسبوعين
2.bizmopen262 (bizmut subsalisilat)
حبه بعد الصبوح والعشاء لمدة شهر
Or gastrobiotic 200mg (Rifaxamin)
يوميا لمده شهر
اذا كانت resistance
👍 فيه معنا علاج ثلاثي وهو الاساسي
ويستخدم للبكتيريا الذي هي moderate or weak
وفيه رباعي او خماسي ينضاف للأدوية الثلاثي في حاله strong H.pylori
اولا الثلاثي
1.Takepron 30mg ...حبه قبل الصبوح
( lanzoprazol)
2.claricide 500mg (clarithromycin)
حبه بعد الصبوح والعشاء لمدة أسبوعين
3.Moxalin 1000mg (amoxicillin)
حبه بعد الصبوح والعشاء لمده اسبوعين
+
1..Tavacin 500mg (levofloxacin)
حبه بعد الغداء لمدة اسبوعين
2.bizmopen262 (bizmut subsalisilat)
حبه بعد الصبوح والعشاء لمدة شهر
Or gastrobiotic 200mg (Rifaxamin)
يوميا لمده شهر
اذا كانت resistance
Medicine 3rd batch 🩺
11 Jan, 08:23
DDX of elevated PLT
2ry thrombocytosis
💠IDA
💠Infection
💠Inflammation
💠Ischemia
💠Tissue injury
💠Trauma
💠post- splenectomy
1ry thrombocytosis
💠 essential thrompocythemia(ET)
it's diagnosis of exclusion or by genetic study
2ry thrombocytosis
💠IDA
💠Infection
💠Inflammation
💠Ischemia
💠Tissue injury
💠Trauma
💠post- splenectomy
1ry thrombocytosis
💠 essential thrompocythemia(ET)
it's diagnosis of exclusion or by genetic study
Medicine 3rd batch 🩺
11 Jan, 00:20
When to give a 100% O2 even when the patient not hypoxic(normal SPO2)
💠stroke
💠SCD crisis
💠co poising
💠pneumothorax
💠cluster headache
Do not forget it
💠stroke
💠SCD crisis
💠co poising
💠pneumothorax
💠cluster headache
Do not forget it
Medicine 3rd batch 🩺
11 Jan, 00:12
❇️Causes of Localized Oedema:
👉🏼Acute inflammatory oedema
👉🏼Hypersensitivity oedema
👉🏼Oedema due to venous obstruction
👉🏼Oedema due to Lymphatic obstruction (e.g. Filariasis)
👉🏼Pulmonary oedema, Peritoneal effusion etc
👉🏼Cyclical or periodic oedema
❇️Causes of Generalized Oedema:
👉🏿Cardiac oedema (e.g. CCF)
👉🏿Renal oedema (e.g. Nephrotic syndrome)
👉🏿Nutritinal oedema→ Famine oedema, Protein losing gastro-enteropathy
👉🏿Hepatic oedema (e.g. HCC, Liver cirrhosis)
👉🏿Oedema due to Adrenal hormones
👉🏿Anaphylaxis
👉🏿Cyclical or periodic oedema
Rapid Revise
(FCPS, MD, Diploma)
👉🏼Acute inflammatory oedema
👉🏼Hypersensitivity oedema
👉🏼Oedema due to venous obstruction
👉🏼Oedema due to Lymphatic obstruction (e.g. Filariasis)
👉🏼Pulmonary oedema, Peritoneal effusion etc
👉🏼Cyclical or periodic oedema
❇️Causes of Generalized Oedema:
👉🏿Cardiac oedema (e.g. CCF)
👉🏿Renal oedema (e.g. Nephrotic syndrome)
👉🏿Nutritinal oedema→ Famine oedema, Protein losing gastro-enteropathy
👉🏿Hepatic oedema (e.g. HCC, Liver cirrhosis)
👉🏿Oedema due to Adrenal hormones
👉🏿Anaphylaxis
👉🏿Cyclical or periodic oedema
Rapid Revise
(FCPS, MD, Diploma)
Medicine 3rd batch 🩺
10 Jan, 14:38
Pathology of chronic bronchitis:
يمر بثلاث مراحل مثلاً
Smoking lead to reversible chronic irritation of bronchi with excessive mucus secretion ( this ➡ Simple chronic bronchitis) this stimulation of Smoking cough ..
بعدها يحدث Stasis لهذا mucus
هذا يكون وسط جيد ال
Recurrent infection of bronchi ( this Mucu-purulent chronic bronchitis )
بعد ما حدث ال infection هذا يؤدي إلى
Submucosa inflammatory cells infiltration, submucosal thinking and muscular hypertrophy lead to irreversible narrowing of bronchi ( this is Obstructive chronic bronchitis)
بعدها يحدث ⬇
Obstructive hypoventilation
وهذه تعني أنه يقل الأكسجين الذي يدخل وكمان يقل خروج ثاني أكسيد الكربون. يحصل معنا حاجتين ⬇
1- hypoxia
2- hypercapnia
ال hypoxia تعمل لنا ثلاث حاجات
1- Central cyanosis
2- Vasodilation of all blood vessels except pulmonary blood vessels vasoconstriction later on lead to pulmonary hypertension and cor-pulmonale ( RVF) .
ونتيجة Vasodilation وال
permeability
تحدث edema .... 📚
3- hypoxia lead stimulation of respiratory centre But Hypercapnia decrease sensitivity of respiratory centre ⬇
نتيجة تكون no response
لانه hypoxia تحفز وبنفس الوقت
Hypercapnia
تعمل على تقليل تحفير ال مراكز تنفس تكون نتيجه صفر يعني مافيش استجابه ولهذا يحدث ..
⬇⬇
Hypoventilation = No Dyspnia
تجميعة الكل ما يحدث في حالة ال
Chronic Obstructive bronchitis:
🔹Hypoxia + hypercapnia = type 2 respiratory failure
🔹 Obstructive hypoventilation
🔹No Dyspnia
🔹 Type B of COPD or Bronchitic Type
🔹Blue Bloater ⬇
هذا يكون شكل المريض و يحدث نتيجة ال
Central cyanosis = blue 🔵
Edema = Bloater
ملاحظة هامة:
⭕Mild and moderate hypercapnia lead to stimulation of respiratory centre
⭕ severe hypercapnia lead to decrease sensitivity of respiratory centre
يمر بثلاث مراحل مثلاً
Smoking lead to reversible chronic irritation of bronchi with excessive mucus secretion ( this ➡ Simple chronic bronchitis) this stimulation of Smoking cough ..
بعدها يحدث Stasis لهذا mucus
هذا يكون وسط جيد ال
Recurrent infection of bronchi ( this Mucu-purulent chronic bronchitis )
بعد ما حدث ال infection هذا يؤدي إلى
Submucosa inflammatory cells infiltration, submucosal thinking and muscular hypertrophy lead to irreversible narrowing of bronchi ( this is Obstructive chronic bronchitis)
بعدها يحدث ⬇
Obstructive hypoventilation
وهذه تعني أنه يقل الأكسجين الذي يدخل وكمان يقل خروج ثاني أكسيد الكربون. يحصل معنا حاجتين ⬇
1- hypoxia
2- hypercapnia
ال hypoxia تعمل لنا ثلاث حاجات
1- Central cyanosis
2- Vasodilation of all blood vessels except pulmonary blood vessels vasoconstriction later on lead to pulmonary hypertension and cor-pulmonale ( RVF) .
ونتيجة Vasodilation وال
permeability
تحدث edema .... 📚
3- hypoxia lead stimulation of respiratory centre But Hypercapnia decrease sensitivity of respiratory centre ⬇
نتيجة تكون no response
لانه hypoxia تحفز وبنفس الوقت
Hypercapnia
تعمل على تقليل تحفير ال مراكز تنفس تكون نتيجه صفر يعني مافيش استجابه ولهذا يحدث ..
⬇⬇
Hypoventilation = No Dyspnia
تجميعة الكل ما يحدث في حالة ال
Chronic Obstructive bronchitis:
🔹Hypoxia + hypercapnia = type 2 respiratory failure
🔹 Obstructive hypoventilation
🔹No Dyspnia
🔹 Type B of COPD or Bronchitic Type
🔹Blue Bloater ⬇
هذا يكون شكل المريض و يحدث نتيجة ال
Central cyanosis = blue 🔵
Edema = Bloater
ملاحظة هامة:
⭕Mild and moderate hypercapnia lead to stimulation of respiratory centre
⭕ severe hypercapnia lead to decrease sensitivity of respiratory centre
Medicine 3rd batch 🩺
10 Jan, 12:15
موقع يجيب كل الجايدلاينات وبشكل حديث وملخص له
https://www.guidelinecentral.com/guidelines/
https://www.guidelinecentral.com/guidelines/
Medicine 3rd batch 🩺
05 Jan, 16:03
طلاب الشرطة الذي امتحنوا اليوم فضلاً ترسلوا التجارب لزملائنا
عشان يستفيدوا
رسلوهن للقروب تبع التجارب
اتمنى الكل يتفاعل ومايدعمم
عشان زملائنا
عشان يستفيدوا
رسلوهن للقروب تبع التجارب
اتمنى الكل يتفاعل ومايدعمم
عشان زملائنا
Medicine 3rd batch 🩺
05 Jan, 14:49
فيروس الميتانيومو البشري (HMPV) ليس فيروسًا جديدًا، بل هو أحد الفيروسات التنفسية المعروفة منذ عقود. تم اكتشافه لأول مرة في عام 2001 في هولندا، ويُعتبر هذا الفيروس من الفيروسات الشائعة خلال فصل الشتاء، حيث يسبب التهابات في الجهاز التنفسي العلوي والسفلي، ويؤثر بشكل رئيسي على الأطفال دون سن الخامسة، وكبار السن فوق 65 عامًا، والأشخاص الذين يعانون من ضعف في جهاز المناعة. في الولايات المتحدة، يمثل HMPV حوالي 4% من حالات الالتهابات الرئوية، وتظهر أعراضه بشكل مشابه لنزلات البرد أو الأنفلونزا، مثل السعال، الحمى، احتقان الأنف، وأحيانًا صعوبة التنفس أو الصفير. يتم تشخيص الإصابة بالفيروس من خلال تحليل PCR للمسحة الأنفية، أما العلاج فهو عرضي ويعتمد على الراحة، تناول السوائل، واستخدام خافضات الحرارة عند الحاجة
Medicine 3rd batch 🩺
04 Jan, 17:36
❇️ Nail Changes
🛑Koilonychia
▪︎Spoon-shaped depression of nail plate
▪︎Iron deiciency anaemia
▪︎lichen planus
▪︎repeated exposure to detergents
🛑Splinter haemorrhages
▪︎Small red streaks lie longitudinally in the nail plate
▪︎Trauma
▪︎infective endocarditis
🛑Leukonychia (white nails)
▪︎hypoalbuminaemia
▪︎protein calorie malnutrition (kwashiorkor)
▪︎malabsorption due to protein-losing enteropathy, e.g. coeliac disease
▪︎heavy and prolonged proteinuria (nephrotic syndrome)
🛑Koilonychia
▪︎Spoon-shaped depression of nail plate
▪︎Iron deiciency anaemia
▪︎lichen planus
▪︎repeated exposure to detergents
🛑Splinter haemorrhages
▪︎Small red streaks lie longitudinally in the nail plate
▪︎Trauma
▪︎infective endocarditis
🛑Leukonychia (white nails)
▪︎hypoalbuminaemia
▪︎protein calorie malnutrition (kwashiorkor)
▪︎malabsorption due to protein-losing enteropathy, e.g. coeliac disease
▪︎heavy and prolonged proteinuria (nephrotic syndrome)
Medicine 3rd batch 🩺
04 Jan, 17:31
💢Tremor
❇️ Flapping Tremor (Asterixis/Coarse/Liver Flap)
▪︎Asterixis is a disorder in which a person loses motor control of some parts of the body Specially the Hands
▪︎Patient will experiences irregular jerking movements in the hands
▪︎It can be elicited on physical exam by having the patient extend their arms and bend their hands back. With a metabolic encephalopathy, the patient is unable to hold their hands back resulting in a “flapping” motion
🔹Most Important Causes
▪︎Liver Failure (Causing Hepatic Encephalopathy)
▪︎Kidney failure (High Levels of Urea & Creatinine)
▪︎Respiratory Failure (Co2 Retention/Hypercapnia)
❇️ Fine tremor
▪︎It's a Mild Shaking in the outstretched hands (Hard to Notice)
▪︎Put a Piece of paper over the Overstretched Patients hand and Notice any shaking in the paper
🔹Most Important Causes
▪︎high-dose beta-agonist bronchodilators in Respiratory Patients (salbutamol)
▪︎Thyrotoxicosis
▪︎Anxiety (Stress)
▪︎High Caffeine
▪︎Lack of sleep
▪︎Alcohol Withdrawal
▪︎Hypoglycemia
▪︎Pheochromocytoma
▪︎Essential Tremor
▪︎Parkinson's Disease
▪︎Multiple Sclerosis (MS)
▪︎Vitamin B12 Deficiency
❇️ Flapping Tremor (Asterixis/Coarse/Liver Flap)
▪︎Asterixis is a disorder in which a person loses motor control of some parts of the body Specially the Hands
▪︎Patient will experiences irregular jerking movements in the hands
▪︎It can be elicited on physical exam by having the patient extend their arms and bend their hands back. With a metabolic encephalopathy, the patient is unable to hold their hands back resulting in a “flapping” motion
🔹Most Important Causes
▪︎Liver Failure (Causing Hepatic Encephalopathy)
▪︎Kidney failure (High Levels of Urea & Creatinine)
▪︎Respiratory Failure (Co2 Retention/Hypercapnia)
❇️ Fine tremor
▪︎It's a Mild Shaking in the outstretched hands (Hard to Notice)
▪︎Put a Piece of paper over the Overstretched Patients hand and Notice any shaking in the paper
🔹Most Important Causes
▪︎high-dose beta-agonist bronchodilators in Respiratory Patients (salbutamol)
▪︎Thyrotoxicosis
▪︎Anxiety (Stress)
▪︎High Caffeine
▪︎Lack of sleep
▪︎Alcohol Withdrawal
▪︎Hypoglycemia
▪︎Pheochromocytoma
▪︎Essential Tremor
▪︎Parkinson's Disease
▪︎Multiple Sclerosis (MS)
▪︎Vitamin B12 Deficiency
Medicine 3rd batch 🩺
04 Jan, 17:19
❇️Abnormal Pulse Characters
🔹collapsing pulse is when the peak of the pulse wave arrives early and is followed by a rapid descent. This is exaggerated by raising the patient’s arm above the level of the heart
It occurs in severe aortic regurgitation
🔹A slow-rising pulse has a gradual upstroke with a reduced peak occurring late in systole, and is a feature of severe aortic stenosis.
🔹Pulsus bisferiens is an increased pulse with a double systolic peak separated by a distinct mid-systolic dip. Causes include aortic regurgitation & stenosis
🔹Pulsus alternans is a beat-to-beat variation in pulse volume with a normal rhythm. It is rare and occurs in advanced heart failure.
🔹Pulsus paradoxus is an exaggeration of the normal variability of pulse volume with breathing.This occurs in cardiac tamponade
🔹regularly irregular pusle: due to an ectopic beat occurring at a regular interval or to second-degree atrioventricular block
🔹irregularly irregular pulse: mostly due to Atrial fibrillation
🔹The most common cause of a large pulse pressure is arteriosclerosis, hypertension and advanced age.
🔹A low pulse volume may be due to reduced stroke volume and occurs in left ventricular failure, hypovolaemia or peripheral arterial disease.
🔹Radio-radial delay Due to:
▪︎Subclavian artery stenosis
▪︎Aortic dissection
▪︎Aortic coarctation
🔹Radio-Femoral delay Due to:
▪︎Aortic coarctation
🔹collapsing pulse is when the peak of the pulse wave arrives early and is followed by a rapid descent. This is exaggerated by raising the patient’s arm above the level of the heart
It occurs in severe aortic regurgitation
🔹A slow-rising pulse has a gradual upstroke with a reduced peak occurring late in systole, and is a feature of severe aortic stenosis.
🔹Pulsus bisferiens is an increased pulse with a double systolic peak separated by a distinct mid-systolic dip. Causes include aortic regurgitation & stenosis
🔹Pulsus alternans is a beat-to-beat variation in pulse volume with a normal rhythm. It is rare and occurs in advanced heart failure.
🔹Pulsus paradoxus is an exaggeration of the normal variability of pulse volume with breathing.This occurs in cardiac tamponade
🔹regularly irregular pusle: due to an ectopic beat occurring at a regular interval or to second-degree atrioventricular block
🔹irregularly irregular pulse: mostly due to Atrial fibrillation
🔹The most common cause of a large pulse pressure is arteriosclerosis, hypertension and advanced age.
🔹A low pulse volume may be due to reduced stroke volume and occurs in left ventricular failure, hypovolaemia or peripheral arterial disease.
🔹Radio-radial delay Due to:
▪︎Subclavian artery stenosis
▪︎Aortic dissection
▪︎Aortic coarctation
🔹Radio-Femoral delay Due to:
▪︎Aortic coarctation
Medicine 3rd batch 🩺
04 Jan, 11:37
📌📌📌📌
لوسمحتم الزملاء الي اختبروا يرسلوا التجارب والأسئلة باقرب وقت علشان يستفيدوا الي بعدهم بارك الله فيكم
لوسمحتم الزملاء الي اختبروا يرسلوا التجارب والأسئلة باقرب وقت علشان يستفيدوا الي بعدهم بارك الله فيكم
Medicine 3rd batch 🩺
04 Jan, 11:04
💢 Medicine_Fast_Recall ( 2ed edition )📘
📍 _ الأصدار الثاني مع الحل 🤩🤩
💢 #Group_F_B
<< #قسم_الباطنة >>
💢#اللجنة_العلمية_الدفعة_الثانية 💢
💢#اللجنة_العملية_الدفعة_الثالثة 💢
____
☞ #medicine_Exam
☞ #medicine_mcq
☞ #medicine_summary
https://t.me/MEDICINE2ndbatch
📍 _ الأصدار الثاني مع الحل 🤩🤩
💢 #Group_F_B
<< #قسم_الباطنة >>
💢#اللجنة_العلمية_الدفعة_الثانية 💢
💢#اللجنة_العملية_الدفعة_الثالثة 💢
____
☞ #medicine_Exam
☞ #medicine_mcq
☞ #medicine_summary
https://t.me/MEDICINE2ndbatch
Medicine 3rd batch 🩺
04 Jan, 10:51
الذي امتحنوا اليوم في الشرطة
ممكن ترسلوا لنا ايش كانت الحالات الموجودة
@LAST_memory_bot
ممكن ترسلوا لنا ايش كانت الحالات الموجودة
@LAST_memory_bot
Medicine 3rd batch 🩺
04 Jan, 10:40
🔴Gross appearance of ascitic fluid: can help determine the underlying cause or complications
✒Transparent to yellow: uncomplicated ascites
✒Cloudy: infection or malignancy
✒Bloody: trauma or malignancy
✒Milky: chylous ascites
✒Dark brown: suggests a biliary leak (e.g., gallbladder perforation)
🔴Cell count and differential: A neutrophil count ≥ 250 cells/mm3 indicates spontaneous bacterial peritonitis.
✒Transparent to yellow: uncomplicated ascites
✒Cloudy: infection or malignancy
✒Bloody: trauma or malignancy
✒Milky: chylous ascites
✒Dark brown: suggests a biliary leak (e.g., gallbladder perforation)
🔴Cell count and differential: A neutrophil count ≥ 250 cells/mm3 indicates spontaneous bacterial peritonitis.
Medicine 3rd batch 🩺
04 Jan, 00:29
❇️ Causes of a raised JVP
▪︎A raised JVP indicates the presence of venous hypertension/hypervolaemia.
🔹Cardiac & Pulmonary Causes:
▪︎Right-sided heart failure
▪︎Pulmonary hypertension
▪︎Tricuspid regurgitation
▪︎Constrictive pericarditis
▪︎tension pneumothorax
▪︎large pulmonary embolism
▪︎superior vena cava obstruction
▪︎A raised JVP indicates the presence of venous hypertension/hypervolaemia.
🔹Cardiac & Pulmonary Causes:
▪︎Right-sided heart failure
▪︎Pulmonary hypertension
▪︎Tricuspid regurgitation
▪︎Constrictive pericarditis
▪︎tension pneumothorax
▪︎large pulmonary embolism
▪︎superior vena cava obstruction
Medicine 3rd batch 🩺
04 Jan, 00:27
❇️Assessment of the JVP
1. Position the patient in a semi-recumbent position (at 45°).
2. Ask the patient to turn their head slightly to the left.
3. Inspect for evidence of the IJV, running between the medial end of the clavicle and the ear lobe, under the medial aspect of the sternocleidomastoid (it may be visible just above the clavicle between the sternal and clavicular heads of the sternocleidomastoid).
4. Measure the JVP by assessing the vertical distance between the sternal angle and the top of the pulsation point of the JVP (in healthy individuals, this should be no greater than 3cm) ➡️ Measured Number + 5 = JVP
❇️The hepatojugular reflux
▪︎is a test involves the application of pressure to the liver whilst observing for a sustained rise in JVP.
▪︎This test can be used to further assess the JVP, particularly if you are unsure if the vessel you are observing is the internal jugular vein.
1. Position the patient in a semi-recumbent position (at 45°).
2. Ask the patient to turn their head slightly to the left.
3. Inspect for evidence of the IJV, running between the medial end of the clavicle and the ear lobe, under the medial aspect of the sternocleidomastoid (it may be visible just above the clavicle between the sternal and clavicular heads of the sternocleidomastoid).
4. Measure the JVP by assessing the vertical distance between the sternal angle and the top of the pulsation point of the JVP (in healthy individuals, this should be no greater than 3cm) ➡️ Measured Number + 5 = JVP
❇️The hepatojugular reflux
▪︎is a test involves the application of pressure to the liver whilst observing for a sustained rise in JVP.
▪︎This test can be used to further assess the JVP, particularly if you are unsure if the vessel you are observing is the internal jugular vein.
Medicine 3rd batch 🩺
04 Jan, 00:26
❇️Jugular Venous pressure (JVP)
▪︎Is indirect measurement of the pressure inside the venous system (Right Side of the Heart) By Measuring the Pressure inside the internal jugular vein, in the Absence of Invasive Direct Methods
▪︎Assessment of the JVP can provide insight into the patient’s fluid status and central venous pressure.
▪︎If a patient is hypervolaemic the JVP will appear raised due to increased venous pressure within the right atrium
▪︎The normal jugular venous pressure Measurement is 6 to 8 cm H2O (Or 3-4 cm Above Sternal Angle)
▪︎Is indirect measurement of the pressure inside the venous system (Right Side of the Heart) By Measuring the Pressure inside the internal jugular vein, in the Absence of Invasive Direct Methods
▪︎Assessment of the JVP can provide insight into the patient’s fluid status and central venous pressure.
▪︎If a patient is hypervolaemic the JVP will appear raised due to increased venous pressure within the right atrium
▪︎The normal jugular venous pressure Measurement is 6 to 8 cm H2O (Or 3-4 cm Above Sternal Angle)
Medicine 3rd batch 🩺
03 Jan, 20:54
💢Cardiac Case Senario 2
❇️Aortic regurgitation
▪︎Normal s1 normal s2
▪︎No added Herat sounds (NO S3/S4)
▪︎There is Early diastolic murmur beast heard At the tricuspid area
▪︎whistling in character
▪︎No radiation
▪︎Grade 3
🔹DDX:
•AR ➡️ increases with leaning forward & Hold Expiration
•PR ➡️ doesn’t increase with leaning forward
•TS ➡️ increases with inspiration
•MS ➡️ increases when turning the patient to the left lateral position
▪︎Maneuver: ask the patient to lean forward & Hold Expiration
❇️Mitral stenosis
▪︎Normal s1 normal s2
▪︎No added Herat sounds (NO S3/S4)
▪︎There is Mid diastolic murmur best heard at the mitral area
▪︎Rumbling in character
▪︎No radiation
▪︎Grade 3
🔹DDX:
•MS ➡️ Increase with left lateral position
•TS ➡️ Not increase when Turning the patient to the left lateral position
▪︎Maneuver: turn the patient to the left lateral position and listen with the bell (Sound will increase in caes of MS)
❇️Aortic regurgitation
▪︎Normal s1 normal s2
▪︎No added Herat sounds (NO S3/S4)
▪︎There is Early diastolic murmur beast heard At the tricuspid area
▪︎whistling in character
▪︎No radiation
▪︎Grade 3
🔹DDX:
•AR ➡️ increases with leaning forward & Hold Expiration
•PR ➡️ doesn’t increase with leaning forward
•TS ➡️ increases with inspiration
•MS ➡️ increases when turning the patient to the left lateral position
▪︎Maneuver: ask the patient to lean forward & Hold Expiration
❇️Mitral stenosis
▪︎Normal s1 normal s2
▪︎No added Herat sounds (NO S3/S4)
▪︎There is Mid diastolic murmur best heard at the mitral area
▪︎Rumbling in character
▪︎No radiation
▪︎Grade 3
🔹DDX:
•MS ➡️ Increase with left lateral position
•TS ➡️ Not increase when Turning the patient to the left lateral position
▪︎Maneuver: turn the patient to the left lateral position and listen with the bell (Sound will increase in caes of MS)
Medicine 3rd batch 🩺
29 Dec, 11:15
- MS ➡️ mid diastolic murmur
- TS ➡️ mid diastolic murmur
- MR ➡️ pan systolic murmur
- TR ➡️ pan systolic murmur
- AS ➡️ ejection systolic murmur
- PS ➡️ ejection systolic murmur
- AR ➡️ early diastolic murmur
- PR ➡️ early diastolic murmur
- المرمر اللي بالصمامات اليمين يزيد مع ال inspiration أما اللي بالصمامات اليسار يزيد مع ال expiration
🛑 ال Apex beat تكون forceful and sustained في ال hypertrophy زي ال AS
🛑 ال Apex beat تكون forceful and non sustained في ال dilatation زي ال MR and AR
🛑 في ال ECG حتى ال dilatation يقول عليه hypertrophy
- TS ➡️ mid diastolic murmur
- MR ➡️ pan systolic murmur
- TR ➡️ pan systolic murmur
- AS ➡️ ejection systolic murmur
- PS ➡️ ejection systolic murmur
- AR ➡️ early diastolic murmur
- PR ➡️ early diastolic murmur
- المرمر اللي بالصمامات اليمين يزيد مع ال inspiration أما اللي بالصمامات اليسار يزيد مع ال expiration
🛑 ال Apex beat تكون forceful and sustained في ال hypertrophy زي ال AS
🛑 ال Apex beat تكون forceful and non sustained في ال dilatation زي ال MR and AR
🛑 في ال ECG حتى ال dilatation يقول عليه hypertrophy
Medicine 3rd batch 🩺
28 Dec, 23:04
قناة الدكتور حسام الصيادي على اليوتيوب
https://www.youtube.com/@HussamAlsayydi
https://www.youtube.com/@HussamAlsayydi
Medicine 3rd batch 🩺
28 Dec, 21:59
#اخر_تذكير_خلاص 🙂💔
2 days left ⏳💔🚶♂️
6 7 8 9 10 11 12 13 14 15 16 17 18
19 20 21 22 23 24 25 26 27 28 29 30
#الوقت_ينفذ
#הזמן_אוזל
#Time_Is_Running_Out...
#الالتزام_الالتزام
#مابش_وقت_تضيعه
2 days left ⏳💔🚶♂️
#الوقت_ينفذ
#הזמן_אוזל
#Time_Is_Running_Out...
#الالتزام_الالتزام
#مابش_وقت_تضيعه
Medicine 3rd batch 🩺
28 Dec, 16:39
Oral Antibiotics doses for Cholera (UpToDate 2024)🗣️🗣️
💊 Azithromycin:
• Adult dose: 1 g (جرعة واحدة)
• Pediatric dose: 20 mg/kg (جرعة واحدة)
👌 بالنسبه للاطفال هتكون الجرعه نص وزن الطفل مره واحده يوميا من تركيز azithromycin 200
بشرط ان لا يزيد اجمالي الجرعه للطفل عن جرعه ال adult
📚 مثال طفل وزنه 20 كيلو ياخد جرعه واحده ١٠ مل بالسرنجه من تركيز azithromycin تركيز 200 مثل xithrone 200 mg susp
مره واحده لا تكرر
OR
💊 Doxycycline:
• Adult dose: 300 mg (جرعة واحدة)
• Pediatric dose: 4-6 mg/kg (جرعة واحدة)
OR
💊 Ciprofloxacin:
• Adult dose: 500 mg مرتين يوميًا لمدة 3 أيام
• Pediatric dose: 15 mg/kg لكل جرعة، مرتين يوميًا لمدة 3 أيام
🗣️ ملاحظات من UpToDate 2024:
🩺 •طبقا للأكاديمية الأمريكية لطب الأطفال
جرعة واحدة من دوكسيسيكلين مش بتسبب تصبغ للأسنان أو مشاكل اخري للأطفال، وبتعتبر آمنة للاستخدام قصير المدى لكل الأعمار
👍 منظمة CDC ومنظمة مكافحة الكوليرا (GTFCC) تري إن الجرعة الواحدة مناسبة للأطفال والسيدات الحوامل لو مفيش resistance.
‼️ بالنسبة لعلاج ال Cholera:
منظمة CDC ومنظمة مكافحة الكوليرا (GTFCC) بيعتبروا السيبروفلوكساسين مناسب للأطفال والحوامل لو مفيش resistance.
💊 Azithromycin:
• Adult dose: 1 g (جرعة واحدة)
• Pediatric dose: 20 mg/kg (جرعة واحدة)
👌 بالنسبه للاطفال هتكون الجرعه نص وزن الطفل مره واحده يوميا من تركيز azithromycin 200
بشرط ان لا يزيد اجمالي الجرعه للطفل عن جرعه ال adult
📚 مثال طفل وزنه 20 كيلو ياخد جرعه واحده ١٠ مل بالسرنجه من تركيز azithromycin تركيز 200 مثل xithrone 200 mg susp
مره واحده لا تكرر
OR
💊 Doxycycline:
• Adult dose: 300 mg (جرعة واحدة)
• Pediatric dose: 4-6 mg/kg (جرعة واحدة)
OR
💊 Ciprofloxacin:
• Adult dose: 500 mg مرتين يوميًا لمدة 3 أيام
• Pediatric dose: 15 mg/kg لكل جرعة، مرتين يوميًا لمدة 3 أيام
🗣️ ملاحظات من UpToDate 2024:
🩺 •طبقا للأكاديمية الأمريكية لطب الأطفال
جرعة واحدة من دوكسيسيكلين مش بتسبب تصبغ للأسنان أو مشاكل اخري للأطفال، وبتعتبر آمنة للاستخدام قصير المدى لكل الأعمار
👍 منظمة CDC ومنظمة مكافحة الكوليرا (GTFCC) تري إن الجرعة الواحدة مناسبة للأطفال والسيدات الحوامل لو مفيش resistance.
‼️ بالنسبة لعلاج ال Cholera:
منظمة CDC ومنظمة مكافحة الكوليرا (GTFCC) بيعتبروا السيبروفلوكساسين مناسب للأطفال والحوامل لو مفيش resistance.
Medicine 3rd batch 🩺
28 Dec, 16:31
🟢SIGNS:
1. PTB – low grade afternoon fever
2. PNEUMONIA – rusty sputum.
3. ASTHMA – wheezing on expiration.
4. EMPHYSEMA– barrel chest.
5. KAWASAKI SYNDROME – strawberry tongue
6. PERNICIOUS ANEMIA – red beefy tongue
7. DOWN SYNDROME – protruding tongue
8. CHOLERA – rice watery stool.
9. MALARIA – step ladder like fever with chills.
10. TYPHOID – rose spots in abdomen.
11. DIPTHERIA – pseudo membrane.
12. MEASLES – koplick’s spots
13. SLE – butterfly rashes.
14. LIVER CIRRHOSIS – spider like varices
15. LEPROSY – lioning face
16. BOLIMIA – chipmunk face.
17. APPENDICITIS – rebound tenderness
18. DENGUE – petichae or positive herman’s sign.
19. MENINGITIS – kernig’s sign (leg pain), brudzinski sign (neck pain).
20. TETANY – hypocalcemia (+) trousseu’s sign or carpopedal spasm/ (+) chvostek sign
21. TETANUS – risus sardonicus
22. PANCREATITIS – cullen’s sign (echymosis of umbilicus) / (+) grey turners spots.
23. PYLORIC STENOSIS –olive like mass.
24. PDA – machine like murmur
25. ADDISON’S DISEASE – bronze like skin pigmentation.
26. CUSHING’S SYNDROME – moon face appearance and buffalo hump.
27. HYPERTHYROIDSM/GRAVES DISEASE – exopthalmus.
1. PTB – low grade afternoon fever
2. PNEUMONIA – rusty sputum.
3. ASTHMA – wheezing on expiration.
4. EMPHYSEMA– barrel chest.
5. KAWASAKI SYNDROME – strawberry tongue
6. PERNICIOUS ANEMIA – red beefy tongue
7. DOWN SYNDROME – protruding tongue
8. CHOLERA – rice watery stool.
9. MALARIA – step ladder like fever with chills.
10. TYPHOID – rose spots in abdomen.
11. DIPTHERIA – pseudo membrane.
12. MEASLES – koplick’s spots
13. SLE – butterfly rashes.
14. LIVER CIRRHOSIS – spider like varices
15. LEPROSY – lioning face
16. BOLIMIA – chipmunk face.
17. APPENDICITIS – rebound tenderness
18. DENGUE – petichae or positive herman’s sign.
19. MENINGITIS – kernig’s sign (leg pain), brudzinski sign (neck pain).
20. TETANY – hypocalcemia (+) trousseu’s sign or carpopedal spasm/ (+) chvostek sign
21. TETANUS – risus sardonicus
22. PANCREATITIS – cullen’s sign (echymosis of umbilicus) / (+) grey turners spots.
23. PYLORIC STENOSIS –olive like mass.
24. PDA – machine like murmur
25. ADDISON’S DISEASE – bronze like skin pigmentation.
26. CUSHING’S SYNDROME – moon face appearance and buffalo hump.
27. HYPERTHYROIDSM/GRAVES DISEASE – exopthalmus.
Medicine 3rd batch 🩺
28 Dec, 16:27
🔴Emergent Hyperkalemia Treatment
✅ECG changes, weakness, K+ >6.5 Or renal insufficiency with K >5.5 with cellular breakdown (ongoing rhabo, crush injury, etc)
✅ECG changes? (peaked T waves, prolonged PR, wide QRS, bradycardia, AV blocks)
✅Membrane Stabilization
- Calcium gluconate or chloride
-> Calcium - Stabilizes cardiac membrane
✅ Redistribution- Shift K+ into cells
- Insulin
- Albuterol
- Sodium bicarbonate
-Combo of insulin + beta-agonist = greatest reduction
• Insulin
Onset <15 minutes, lasts -2 hours
Dose: 5 units regular insulin
Side effect: hypoglycemia in up to 20% of patients, monitor glucose x 3 hrs
Give 25 g dextrose if glucose 100-200 mg/dL or 50 g if glucose <100
• Beta-agonist
Onset 20-30 minutes, lasts ~2 hours
Dose: 10-20 mg nebulized
• Sodium Bicarbonate
Limited utility, not to be used as a standalone treatment
✅Remove potassium
• Furosemide
• Hemodialysis
• Time and removal of offending agent (ACE-I. dehydration. obstruction. etc)
• Exchange resins - Sodium polystrene sulfonate (kayexelate) and others lower K+ in hours to days (not quickly)
#طوارئ
✅ECG changes, weakness, K+ >6.5 Or renal insufficiency with K >5.5 with cellular breakdown (ongoing rhabo, crush injury, etc)
✅ECG changes? (peaked T waves, prolonged PR, wide QRS, bradycardia, AV blocks)
✅Membrane Stabilization
- Calcium gluconate or chloride
-> Calcium - Stabilizes cardiac membrane
✅ Redistribution- Shift K+ into cells
- Insulin
- Albuterol
- Sodium bicarbonate
-Combo of insulin + beta-agonist = greatest reduction
• Insulin
Onset <15 minutes, lasts -2 hours
Dose: 5 units regular insulin
Side effect: hypoglycemia in up to 20% of patients, monitor glucose x 3 hrs
Give 25 g dextrose if glucose 100-200 mg/dL or 50 g if glucose <100
• Beta-agonist
Onset 20-30 minutes, lasts ~2 hours
Dose: 10-20 mg nebulized
• Sodium Bicarbonate
Limited utility, not to be used as a standalone treatment
✅Remove potassium
• Furosemide
• Hemodialysis
• Time and removal of offending agent (ACE-I. dehydration. obstruction. etc)
• Exchange resins - Sodium polystrene sulfonate (kayexelate) and others lower K+ in hours to days (not quickly)
#طوارئ
Medicine 3rd batch 🩺
28 Dec, 14:57
سلمت أناملك ..
كتبتي فأنصفتي
"وماتوفيقي إلا بالله" ...
الله يوفقنا جميعاً ويسهل لنا..
كتبتي فأنصفتي
"وماتوفيقي إلا بالله" ...
الله يوفقنا جميعاً ويسهل لنا..
Medicine 3rd batch 🩺
28 Dec, 09:46
quick review in AKI :
define : situation where there is a sudden and often reversible loss of renal function, which develops over days or weeks and is often accompanied by a reduction in urine volume.
➡️ Pre-renal :
💎 causes ; ( Hypovolemia - many causes - Hypotension , Decreased circulating volume , Renal artery stenosis , Drugs - nsaid and ACE-Is )
🤩 LAB :
- BUN:creatinine ratio = >20:1
- FENa = <1%
- FEUrea = <35%
- Urine sodium concentration = <20mEq/l
- Urine osmolality = >500mOsm/kg
👍🏻 Correct adverse hemodynamic factors and replace the depleted volume as needed.
➡️ Intrinsic acute kidney injury :
💎 causes :
- Acute tubular necrosis - gentamycin
- Acute interstitial nephritis - PPIs
- Vascular diseases
- Glomerulonephritis
🤩 LAB :
- BUN:creatinine ratio = <15:1
- FENa = >2%
- FEUrea = >50%
- Urine sodium concentration = >40mEq/l
- Urine osmolality = <350mOsm/kg
- muddy brown, RBC casts , WBC casts
👍🏻 Consider a trial of IV fluids; identify and treat underlying causes that require specific interventions.
➡️ Postrenal acute kidney injury :
💎 Causes :
- Acquired obstructions ( bilateral stones , Benign prostatic hyperplasia )
- Neurogenic bladder
👍🏻 Relieve the urinary tract obstruction.
define : situation where there is a sudden and often reversible loss of renal function, which develops over days or weeks and is often accompanied by a reduction in urine volume.
➡️ Pre-renal :
💎 causes ; ( Hypovolemia - many causes - Hypotension , Decreased circulating volume , Renal artery stenosis , Drugs - nsaid and ACE-Is )
🤩 LAB :
- BUN:creatinine ratio = >20:1
- FENa = <1%
- FEUrea = <35%
- Urine sodium concentration = <20mEq/l
- Urine osmolality = >500mOsm/kg
👍🏻 Correct adverse hemodynamic factors and replace the depleted volume as needed.
➡️ Intrinsic acute kidney injury :
💎 causes :
- Acute tubular necrosis - gentamycin
- Acute interstitial nephritis - PPIs
- Vascular diseases
- Glomerulonephritis
🤩 LAB :
- BUN:creatinine ratio = <15:1
- FENa = >2%
- FEUrea = >50%
- Urine sodium concentration = >40mEq/l
- Urine osmolality = <350mOsm/kg
- muddy brown, RBC casts , WBC casts
👍🏻 Consider a trial of IV fluids; identify and treat underlying causes that require specific interventions.
➡️ Postrenal acute kidney injury :
💎 Causes :
- Acquired obstructions ( bilateral stones , Benign prostatic hyperplasia )
- Neurogenic bladder
👍🏻 Relieve the urinary tract obstruction.
Medicine 3rd batch 🩺
28 Dec, 09:38
clue to answer mcq of lung cancer :
💎 woman , not smoker , had clubbing and mass in periphral lung
adenocarcinoma
🤦🏻♂️ man , smoker , hemoptysis , had hypercalcemia ( or its signs ) and mass in central lung ( or its signs like cough and SOB )
squamous cell carcinoma
🤨 man , smoker , hemoptysis , other endocrine diorders ( paraneoplastic syndromes ) and mass in central lung ( or its signs like cough and SOB )
Small cell lung cancer
change in the character of a smoker’s cough, particularly if associated with other new symptoms, should always raise suspicion of lung cancer
haemoptysis in a smoker should always be investigated to exclude a lung cancer. ( especially with central bronchial tumours )
monophonic , unilateral wheeze that fails to clear with coughing suggests carcinoma
Recurrent respiratory infections (e.g., pneumonia) in the same pulmonary region in patients ≥ 40 years old should always raise suspicion for lung cancer.
weight loss
💎 woman , not smoker , had clubbing and mass in periphral lung
adenocarcinoma
🤦🏻♂️ man , smoker , hemoptysis , had hypercalcemia ( or its signs ) and mass in central lung ( or its signs like cough and SOB )
squamous cell carcinoma
🤨 man , smoker , hemoptysis , other endocrine diorders ( paraneoplastic syndromes ) and mass in central lung ( or its signs like cough and SOB )
Small cell lung cancer
change in the character of a smoker’s cough, particularly if associated with other new symptoms, should always raise suspicion of lung cancer
haemoptysis in a smoker should always be investigated to exclude a lung cancer. ( especially with central bronchial tumours )
monophonic , unilateral wheeze that fails to clear with coughing suggests carcinoma
Recurrent respiratory infections (e.g., pneumonia) in the same pulmonary region in patients ≥ 40 years old should always raise suspicion for lung cancer.
weight loss
Medicine 3rd batch 🩺
26 Oct, 17:31
🛑 SLE Treatment
♦️ Goals :educate the patient , to control symptoms , prevent organ damage & avoid sun and UV light exposure
♦️ Treatment can be devided into :
▪️Mild to severe disease:
- Limited to skin & joints
▫️ Analgesics, NSIAD and HCQ
▫️ GC are also necessary ( Prednisolone 5-20 mg/day)+ IS (MTX, AZA or MMF)
▪️Severe to life-threatening:
- affecting multiple organs[cardiac, renal and CNS]
▫️High dose GC and IS [Pulsed methylprednisolon (10mg/kg IV + Cyclophosphomide (15mg/kg IV)]
▫️MMF + high dose GC has been used successfully with renal involvment
▫️Belimumab (monoclonal AB drug)+ standard therapy can also decreas SLE dis. activity
▪️Maintenance:
- Following control of acute dis.
▫️ Oral prednisolone (40-60 mg/d gradully reduced to 10-15 mg/d or less by 3 months) + AZA , MTX OR MMF
♦️pt. with SLE and aniphospholipid syndrome have risk of thrombosis(&PE) --> Life long Warfarin
♦️ Goals :educate the patient , to control symptoms , prevent organ damage & avoid sun and UV light exposure
♦️ Treatment can be devided into :
▪️Mild to severe disease:
- Limited to skin & joints
▫️ Analgesics, NSIAD and HCQ
▫️ GC are also necessary ( Prednisolone 5-20 mg/day)+ IS (MTX, AZA or MMF)
▪️Severe to life-threatening:
- affecting multiple organs[cardiac, renal and CNS]
▫️High dose GC and IS [Pulsed methylprednisolon (10mg/kg IV + Cyclophosphomide (15mg/kg IV)]
▫️MMF + high dose GC has been used successfully with renal involvment
▫️Belimumab (monoclonal AB drug)+ standard therapy can also decreas SLE dis. activity
▪️Maintenance:
- Following control of acute dis.
▫️ Oral prednisolone (40-60 mg/d gradully reduced to 10-15 mg/d or less by 3 months) + AZA , MTX OR MMF
♦️pt. with SLE and aniphospholipid syndrome have risk of thrombosis(&PE) --> Life long Warfarin
Medicine 3rd batch 🩺
26 Oct, 17:31
🔴 Rhuematoid Arthritis
Pharmacological therapy
■ we start in prednisolone 30mg daily then reduced 5mg/2week & stopped
■ at the same time methotrexate is given 15mg weekly(up to 25mg) + folic acid 5mg
- We do that becuase methotrexate takes time until it's action start to have an effect so we give with it prednisolone to manage symptoms
▪️🥇Gold standard Tx is : methotrexate + folic acid
Pharmacological therapy
■ we start in prednisolone 30mg daily then reduced 5mg/2week & stopped
■ at the same time methotrexate is given 15mg weekly(up to 25mg) + folic acid 5mg
- We do that becuase methotrexate takes time until it's action start to have an effect so we give with it prednisolone to manage symptoms
▪️🥇Gold standard Tx is : methotrexate + folic acid
Medicine 3rd batch 🩺
26 Oct, 17:31
🔴Systemic Sclerosis [Scleroderma
▪️Clinical Features :
▫️ Raynauds phenomenon in almost all cases
▫️ Hands showing tight ,shiny skin ,sclerodactyly & flexion flexion contractures of the fingers
▫️ Face in limited type may show telagiectesia (small, widened blood vessels on the skin)
▫️ GIT involvment specially w/limted type
• Esophageal atrophy & fibrosis -->dysphagia & GERD
• Intestinal involvment -->malabsorbtion
▫️ Pulomonary involvment
• Pulomonary HTN specially w/limited type
• ILD common w/diffuse type
▫️Renal involvment -->Hypertensive renal crisis specially w/Diffuse type
▪️Investigations :
▫️ Routin assessment [CBC, LFT, RFT, BFT, LFT, CXR & urinanalysis]
▫️ ANA (anti-nuclear ab) +ve ,
Diffuse have topoisomerase 1 antibodies
▫️Limited have anticentromere antibodies
▫️ Barium swallow to assess Esophageal involvment
▫️ Hydrogen breath test indicate small intestine becterial overgrowth
▪️Management :
Goal is to reduce or control symptoms, there is no spicific treatment [e.g. Tx of git complications --> PPI & anti- reflux drugs ,Tx of joint involvment--> NSIADS ... ect]
▪️Clinical Features :
▫️ Raynauds phenomenon in almost all cases
▫️ Hands showing tight ,shiny skin ,sclerodactyly & flexion flexion contractures of the fingers
▫️ Face in limited type may show telagiectesia (small, widened blood vessels on the skin)
▫️ GIT involvment specially w/limted type
• Esophageal atrophy & fibrosis -->dysphagia & GERD
• Intestinal involvment -->malabsorbtion
▫️ Pulomonary involvment
• Pulomonary HTN specially w/limited type
• ILD common w/diffuse type
▫️Renal involvment -->Hypertensive renal crisis specially w/Diffuse type
▪️Investigations :
▫️ Routin assessment [CBC, LFT, RFT, BFT, LFT, CXR & urinanalysis]
▫️ ANA (anti-nuclear ab) +ve ,
Diffuse have topoisomerase 1 antibodies
▫️Limited have anticentromere antibodies
▫️ Barium swallow to assess Esophageal involvment
▫️ Hydrogen breath test indicate small intestine becterial overgrowth
▪️Management :
Goal is to reduce or control symptoms, there is no spicific treatment [e.g. Tx of git complications --> PPI & anti- reflux drugs ,Tx of joint involvment--> NSIADS ... ect]
Medicine 3rd batch 🩺
26 Oct, 17:31
🔴 Primary sjögren's syndrom
▪️Pathophysiology: Lymphocytic inflitration of salivary & lacrimal glands
▪️ PRESENTAION :
40-50 Yrs old Female ♀️ with Triad of :
▫️ Dry eye(keratoconjuctivitis sicca)
▫️Dry mouth (Xerosomia)
▫️inflammatory Arthritis
♦️Investigations:
▪︎ Schimer tear test: put paper in lower eyelid and see if it gets wet
▪️Salivary glands biopsy(🥇Gold standard)
▪︎ Anti-Ro & Anti-La antibodies
♦️Management:
▪️ no specific Tx ,only Management of symptoms
▪︎ we can give lacrimal substitutes,artificial saliva and chewing gum for oral dryness,oral hygien is essential
▪︎for vaginal dryness ->lubricants
▪︎can give pilocarpine(muscarinic agonist) or HCQ which may help with skin and msk problems
▪️Pathophysiology: Lymphocytic inflitration of salivary & lacrimal glands
▪️ PRESENTAION :
40-50 Yrs old Female ♀️ with Triad of :
▫️ Dry eye(keratoconjuctivitis sicca)
▫️Dry mouth (Xerosomia)
▫️inflammatory Arthritis
♦️Investigations:
▪︎ Schimer tear test: put paper in lower eyelid and see if it gets wet
▪️Salivary glands biopsy(🥇Gold standard)
▪︎ Anti-Ro & Anti-La antibodies
♦️Management:
▪️ no specific Tx ,only Management of symptoms
▪︎ we can give lacrimal substitutes,artificial saliva and chewing gum for oral dryness,oral hygien is essential
▪︎for vaginal dryness ->lubricants
▪︎can give pilocarpine(muscarinic agonist) or HCQ which may help with skin and msk problems
Medicine 3rd batch 🩺
26 Oct, 06:02
Patients with acute heart failure and pulmonary odema usually prefer to be upright, while patients with massive pulmonary embolism are often more comfortable lying flat and may faint (Syncope) if made to sit upright.
Medicine 3rd batch 🩺
25 Oct, 20:41
🛑Important Notes
General Examination
Respiratory system : 🫁
Precordium examination :🫀
CNS Examination
General Examination
Respiratory system : 🫁
Precordium examination :🫀
CNS Examination
Medicine 3rd batch 🩺
25 Oct, 13:34
MCP : metacarpophalangeal joint
PIP : proximal interphalangeal joint
DIP : distal interphalangeal joint
حسب ماكلويد
rheumatoid arthritis cause swelling in MCP & PIP
osteoarthritis cause swelling in DIP ( Heberden's node ) and also in PIP ( bouchard's node )
PIP : proximal interphalangeal joint
DIP : distal interphalangeal joint
حسب ماكلويد
rheumatoid arthritis cause swelling in MCP & PIP
osteoarthritis cause swelling in DIP ( Heberden's node ) and also in PIP ( bouchard's node )
Medicine 3rd batch 🩺
25 Oct, 13:32
pulse examination :
when we can measure the pusle ?
radial a. :
dorsalis pedis a.
post. tibial a.
carotid a.
femoral a.
brachial a.
1- rate :
measure it from radial a. for 30s and *2 or 1min
normal heart rate = 60-100 bpm
tachycardia : >100 bpm ( beats per min )
bradycardia : <60 bpm
2- rhythm :
regular : normal
DDx of irregularly irregular rhythms:
1- Atrial fibrillation ( AF )
2- Atrial flutter with variable AV Block
3- Wandering atrial pacemaker ( WAP )
4-Multifocal atrial tachycardia ( MAT ) common cause of it is COPD
DDx of regularly irregular rhythms:
a- PAC : Premature atrial contraction
= Atrial Ectopic Beat
b- PVC : Premature Ventricular contraction
= Ventricular Ectopic Beat
c- 2nd Degree AV Block
3- volume :
4- character :
slow rising : AS
collapsing or water-hammer pulse : AR , PDA , FEVER , thyrotoicosis
pulsus paradoxus : acute sever asthma , temponade , constrictive pericarditis
5- delay
radio-femoral delay occur in :
- coarctation of the aorta
radio-radial delay occur in :
- Subclavian artery stenosis
- Aortic dissection
6- character of blood vessels
abnormal in atherosclerosis
when we can measure the pusle ?
radial a. :
dorsalis pedis a.
post. tibial a.
carotid a.
femoral a.
brachial a.
1- rate :
measure it from radial a. for 30s and *2 or 1min
normal heart rate = 60-100 bpm
tachycardia : >100 bpm ( beats per min )
bradycardia : <60 bpm
2- rhythm :
regular : normal
DDx of irregularly irregular rhythms:
1- Atrial fibrillation ( AF )
2- Atrial flutter with variable AV Block
3- Wandering atrial pacemaker ( WAP )
4-Multifocal atrial tachycardia ( MAT ) common cause of it is COPD
DDx of regularly irregular rhythms:
a- PAC : Premature atrial contraction
= Atrial Ectopic Beat
b- PVC : Premature Ventricular contraction
= Ventricular Ectopic Beat
c- 2nd Degree AV Block
3- volume :
4- character :
slow rising : AS
collapsing or water-hammer pulse : AR , PDA , FEVER , thyrotoicosis
pulsus paradoxus : acute sever asthma , temponade , constrictive pericarditis
5- delay
radio-femoral delay occur in :
- coarctation of the aorta
radio-radial delay occur in :
- Subclavian artery stenosis
- Aortic dissection
6- character of blood vessels
abnormal in atherosclerosis
Medicine 3rd batch 🩺
25 Oct, 05:50
Medicine 3rd batch 🩺
25 Oct, 05:49
* To palpate the right axilla, support the patient’s right arm with your right arm to relax their shoulder muscles and explore the axilla with your left hand ( A )
* Gently place your fingertips into the apex of the axilla and then draw them downwards, feeling the medial, anterior and posterior axillary walls in turn.
** Support the patient’s right wrist with your left hand, hold their partially flexed elbow with your right hand, and use
your thumb to feel for the epitrochlear node. Examine the left epitrochlear node with your left thumb ( B )
* Gently place your fingertips into the apex of the axilla and then draw them downwards, feeling the medial, anterior and posterior axillary walls in turn.
** Support the patient’s right wrist with your left hand, hold their partially flexed elbow with your right hand, and use
your thumb to feel for the epitrochlear node. Examine the left epitrochlear node with your left thumb ( B )
Medicine 3rd batch 🩺
25 Oct, 05:47
* Examine the cervical and axillary nodes with the patient sitting.
* From behind, examine the submental, submandibular, preauricular, tonsillar, supraclavicular and deep cervical nodes in the anterior triangle of the neck ( A )
* Palpate for the scalene nodes by placing your index finger between the sternocleidomastoid muscle and clavicle. Ask the patient to tilt their head to the same side and press firmly down towards the first rib ( B )
* From the front of the patient, palpate the posterior triangles, up the back of the neck and the posterior auricular and occipital nodes ( C )
* From behind, examine the submental, submandibular, preauricular, tonsillar, supraclavicular and deep cervical nodes in the anterior triangle of the neck ( A )
* Palpate for the scalene nodes by placing your index finger between the sternocleidomastoid muscle and clavicle. Ask the patient to tilt their head to the same side and press firmly down towards the first rib ( B )
* From the front of the patient, palpate the posterior triangles, up the back of the neck and the posterior auricular and occipital nodes ( C )
Medicine 3rd batch 🩺
25 Oct, 05:45
examination of lymph nodes :
* normal LN may be palpable in thin people especially ( submandibular , axilla and groin regions )
* normal size 1 cm in axilla and neck and 2 cm in groin regions
* normal size <0.5 cm in adult ( macleod )
* normal nodes feel soft
we have 4 sites to examine LN
1- cervical LN
2- axillary LN
3- inguinal LN
4- epitrochlear LN
Sequence of exam.
- incpection
- palpable with your hand in special maneuvers
- assess ( site , size , consistency , tenderness and mobaility )
abnormal findings :
* Hodgkin's disease : rubbery LN
* T.B : matted LN
* malignancy : hard LN
* Acute viral or bacterial infection, including infectious mononucleosis, dental sepsis and tonsillitis, causes Tender, variably enlarged lymph nodes.
* more than 3 groups of enlarged LN to say it is generalized lymphadenopathy
* normal LN may be palpable in thin people especially ( submandibular , axilla and groin regions )
* normal size 1 cm in axilla and neck and 2 cm in groin regions
* normal size <0.5 cm in adult ( macleod )
* normal nodes feel soft
we have 4 sites to examine LN
1- cervical LN
2- axillary LN
3- inguinal LN
4- epitrochlear LN
Sequence of exam.
- incpection
- palpable with your hand in special maneuvers
- assess ( site , size , consistency , tenderness and mobaility )
abnormal findings :
* Hodgkin's disease : rubbery LN
* T.B : matted LN
* malignancy : hard LN
* Acute viral or bacterial infection, including infectious mononucleosis, dental sepsis and tonsillitis, causes Tender, variably enlarged lymph nodes.
* more than 3 groups of enlarged LN to say it is generalized lymphadenopathy
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