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الإشارات الواردة والصادرة
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جذب المشتركين
أكتوبر '26أكتوبر '26
أكتوبر '26
+252
في 3 قنوات
| التاريخ | نمو المشتركين | الإشارات | القنوات | |
| 30 أكتوبر | 0 | |||
| 29 أكتوبر | 0 | |||
| 28 أكتوبر | +1 | |||
| 27 أكتوبر | +3 |
منشورات القناة
| 2 | #HAP@Clinicalinternalmedicine | 21 |
| 3 | #Pneumonia@Clinicalinternalmedicine | 21 |
| 4 | 🔴Interstitial & Occupational Lung Diseases
▪︎Group Of Diseases Share A Similar Presentation & Radiological Features That Causing Interstitial (Parenchymal) Or Alveolar Lumen Damage
🔹Clinical Features & Dx
📍1. Chronic Dry Cough
📍2. Gradual (Insidious) SOB
📍3. Bilateral Basal Fine Inspiratory Crackles
📍4. Finger Clubbing (Mostly in IPF)
📍5. Restrictive Lung Pattern :
▪︎Decrease FVC & Lung Volumes
▪︎impair Gas Transfer
▪︎FEV1:FVC >0.7 (>70%) اكبر من
📍6. Radiological Features :
▪︎Reticulonodular Shadows
▪︎Ground Glass Opacity
▪︎Honeycomb Cysts
▪︎Tractional Bronchiectasis
▪︎Small Lungs
📍7. Central Cyanosis With RHF & Pulmonary HT In Advanced Cases
🔰Idiopathic Pulmonary Fibrosis (IPF)
▪︎Most Common Interstitial Lung Disease
▪︎Causes Progressive Interstitial Lung Fibrosis
▪︎Unknown Cause
▪︎Usually Seen in Older Adults
▪︎Smoking is Strong Risk Factor
🔹Mx Of IPF
📍1. Pirfenidone/Nintedanib (Reduce Decline in Lung Function) ➡️ Useful When Vital Capacity 50-80%
📍2. Stop Smoking
📍3. Control GERD
📍4. Vaccination (Pneumococcal & Influenza)
📍5. Domiciliary Oxygen (Oxygen At Home)
📍6. Lung Transplantation
🔰Non Specific Interstitial Pneumonia
▪︎More in Young Women
▪︎Better Prognosis
🔰Eosinophilic Pneumonia
🔹Clinical Features Of EosinoPhilic Pneumonia
📍1. Acute Presentation :
▪︎Acute Diffuse Alveolar Damage & Pulmonary Infiltration & Hypoxic (Type I) Respiratory Failure (in <5 Days)
▪︎Eosinophils >25%
▪︎Good Response To Steroids
📍2. Chronic Presentation :
▪︎Gradual (Insidious) Onset Of Fever/Dry Cough/SOB/Weight Loss/Malaise
▪︎Present in Middle Age Female
▪︎Increase ESR/IgE/Eosinophils (>10%)
▪︎Good Response To Steroids (Also Need Low Dose Maintenance)
🔰Hypersensitivity Pneumonitis (Extrinsic Allergic Alveolitis)
▪︎Type III & IV Immune Reaction To Organic Antigens Inhalation Causing Diffuse inflammation in Walls Of Bronchioles & Alveoli
▪︎Non Caseating Granulomas Present
🔹Dx Of Hypersensitivity Pneumonitis
📍1. Symptoms Develop Within 4-8h After Exposure To Specific Antigens
📍2. Cough/SOB/Wheeze/Diffuse Inspiratory Crackles/Weight Loss
📍3. +Ve Antibody To That Specific Antigen
📍4. Recurrent Episodes
📍5. Elevated CD8 Lymphocytes
🔰Sarcoidosis
▪︎Multi Systemic Granulomarous Disease Of Unknown Cause
▪︎Mostly In Colder Parts Of Northern Europe
🔹Clinical Features Of Sarcoidosis
📍1. Asymptomatic (Only Xray Changes) :
▪︎Stage1 ➡️ Symmetrical Bilateral Hilar Lympahdenopathy (BHL)
▪︎Stage2 ➡️ BHL + Parenchymal Infiltration
▪︎Stage3 ➡️ Only Parenchymal Infiltration
▪︎Stage4 ➡️ Pulmonary Fibrosis
📍2. Lofgren Syndrome (More in Women) ➡️ Erythema Nodosum/Arthropathy/Uveitis/BHL/Lethargy/Fever
📍3. Cough/Exertional SOB/Lung Fibrosis
🔹Dx Of Sarcoidosis
📍1. LymphoPenia & Increase ACE (Angiotensin Converting Enzyme)
📍2. Abnormal Liver Function Test
📍3. Hypercalcemia & Nephrocalcinosis
📍4. Non Caseating Granuloma
📍5. Erythema Nodosum + BHL (Confirm Dx)
🔹Mx Of Sarcoidosis
📍1. Acute Exacerbations ➡️ NASIDS/Steroids
📍2. Severe Disease ➡️ Methotrexate/Azathioprine/TNF a Inhibitors
📍3. Cutaneous Sarcoid ➡️ Chloroquine & Hydroxychloroquine/Thalidomide
*
Asbestos ➡️ Risk Of Lung Cancer (Mesothelioma) & Pleural Plaques | 21 |
| 5 | 🔰Hospital Acquired Pneumonia (HAP)
▪︎More In Elderly & ICU (Intensive Care Unit) & Mechanically Ventilated Patients
🔹Dx Of HAP
📍1. Symptoms Develop At Least 2 Days After Hospitalization Or Ventilated
📍2. Purulent Sputum
📍3. New Chest Xray Changes
📍4. Increase Oxygen Requirements
📍5. Increase Temperature (>38.3°C)
📍6. Leucocytosis Or Leucopenia
📍7. Culture Required (To Determine Type Of Organism)
🔹DDX Of HAP
1. Pulmonary Embolism (PE)
2. Drug Toxicity
3. ARDS
4. Pulmonary Edema & Pulmonary Hemorrhage
🔹Mx Of HAP
📍1. Early Onset HAP (Within 4-5 Days) :
▪︎Give Co Amoxiclav Or Cefuroxime (If No AB Given Before)
▪︎Give Piperacillin-Tazobactam Or 3rd Cephalosporins (If AB Given Before)
📍2. Late Onset (HAP) :
▪︎Usually Caused By Staph.Aureus Or Anaerobes Or Gram -Ve Organisms (E.coli/Psedomonas/Klebsella/Acinetobacter)
▪︎For Psedomonas ➡️ Give Carbapenem (Meropenem)/Cephalosporin/Piperacillin-Tazobactam
▪︎For Staph.Aureus (MRSA) ➡️ Give
Vancomycin/Linezolid
▪︎For Acinetobacter ➡️ Give Carbapenem (Meropenem)/IV Colistin
🔰Suppurativa Pneumonia
▪︎Pneumonia Associated With Destruction Of Lung Parenchyma That Leads To Abscess Formation & Accumulation
▪︎Mostly Due To Mixture Of Anaerobic & Aerobic Bacteria & Normal Flora Of Mouth & Upper Respiratory Tract
▪︎In Previously Healthy Lung ➡️ Infection Mostly Due To Staph.Aureus/Klebsella
▪︎With Poor Dental Hygiene ➡️ Mostly Due To Actinomyces Israelii
▪︎With Suppurativa Skin Infection ➡️ Mostly Due To Staph.Aureus (CA MRSA)
▪︎Endocarditis With Suppurativa Pneumonia ➡️ Occur in IV Drug Abusers
🔹Risk Factors For Suppurativa Pneumonia
📍1. Inhalation Of Septic Material During Operations (On Nose/Mouth/Throat)
📍2. Inhaled Foreign Body
📍3. Aspiration (Due To Anesthesia Or Coma Or Neurological Dysfunction Or GERD)
📍4. Immunocompromised
🔹Clinical Features Of Supportive Pneumonia
📍1. Cough With Large Amounts Of Sputum That is Fetid (Bad Odour) & Blood Stained
📍2. High Remitting Pyrexia
تبقى فوك الطبيعي طول الوقت
📍3. Finger Clubbing (Within 10-14 Days)
📍4. Marked Weight Loss
📍5. Pleural Pain & Systemic Upset
🔹Dx Of Supportive Pneumonia
📍1. Homogeneous Opacity
📍2. Cavitation
📍3. Air Fluid Level
🔹Mx Of Supportive Pneumonia
📍1. Amoxicillin + Metronidazole ➡️ For Aspiration Pneumonia
📍2. Trimethoprim-Sulfamethoxazole/Clindamycin/Tetracycline/Linezolid ➡️ For Staph.Aureus (CA MRSA)
📍3. 6-12m Tx With Penicillin Or Tetracycline ➡️ For Actinomycosis
🔰Pneumonia in Immunocompromised
▪︎Pneumonia Here is The Most Common Cause Of Death
▪︎Infection By Multiple Organisms
▪︎Pneumocystis Carinii (Jirovecii/PCC) Usually Infect HIV Patients As Opportunistic Infection
▪︎Present With Fever/Cough/SOB
🔹Mx By Broad Spectrum AB ➡️ 3rd Cephalosporins/Quinolone + Anti Staph/Penicillin + Aminoglycosides
*
▪︎Community Pneumonia ➡️ Streptococcus
▪︎Hospital Pneumonia ➡️ Gram -Ve & Staph
▪︎Aspiration Pneumonia ➡️ Anaerobic
▪︎Pediatric Pneumonia ➡️ Mostly Viral (RSV/Parainfluenza/Adenovirus) | 12 |
| 6 | 🔴Pneumonia
▪︎Acute Lower Respiratory Tract Infection Affects Lung Parenchyma & Alveolar Spaces & Bronchioles
▪︎Characterized By Lung Consolidation On Chest xray
🔹Risk Factors For Pneumonia
1. Old Age
2. Smokers & Alcoholic & Steroids
3. Infections (HIV/Influenza/Upper Respiratory Tract Infection)
4. Preexisting Lung Disease
5. Air Pollution
6. Neurological Dysfunction (Difficult Swallowing/Recurrent Aspiration/GERD)
7. Hospitalization
🔹Classification Of Pneumonia
📍1. Lobar ➡️ Homogeneous Consolidation Of One Or More Lung Lobes + Pleural Inflammation
📍2. BronchoPneumonia ➡️ Patchy Consolidation With Bronchial & Bronchiolar Inflammation (Mostly Affects Lower Lobes)
📍3. Interstitial ➡️ Diffuse Reticular Opacity (Mostly Viral Or Mycoplasma)
📍4. Community Acquired ➡️ Pneumonia Develops In Community Settings
📍5. Hospital Acquired (Nosocomial) ➡️ Pneumonia Develops At Least 2days (48h) After Hospital Admission
📍6. Ventilator Associated Pneumonia ➡️ Pneumonia Develops 48-72h After Endo-Trachial Intubation
📍7. Health Care Associated Pneumonia ➡️ Pneumonia Develops In Person That :
▪︎Spent At Least 2days in Hospital (in last 90days)
▪︎Attend Hemodialysis Unit
▪︎Received IV Antibiotics
▪︎Worked in Nursing Home Or Long Term Care Unit
🔰Community Acquired Pneumonia (CAP)
▪︎Mostly Affect Children & Elderly
▪︎Mostly Due To Streptococcus Pneumonia
▪︎Mostly Spread By Droplet Infection
▪︎Viral Infections More in Children
🔹DDX Of CAP
▪︎Pulmonary Infarction
▪︎Pulmonary Edema
▪︎Pulmonary Eosinophilia
▪︎TB Infection
▪︎Malignancy
▪︎CryptoGenic Organising Pneumonia
▪︎Bronchiolitis Obliterans
🔹Clinical Features Of CAP
📍1. Fever :
▪︎High Grade ➡️ Bacterial
▪︎Low Grade ➡️ Viral/Atypical
▪︎No Fever ➡️ Afebrile Pneumonia
📍2. Rigor/Shivering/Delirium/Malaise/Loss Appetite/Headache
📍3. Cough ➡️ Start As Short Painful Dry Then Become With Mucopurulent Sputum
📍4. Haemoptysis
📍5. Pleuritic Chest Pain ➡️ Radiate To Shoulder & Anterior Abdomen
📍6. Upper Abdominal Pain (In Lower Lobe Pneumonia Or Associated Hepatitis)
📍7. Chest Examination :
▪︎Chest Dullness (Consolidation)
▪︎Bronchial Breathing
▪︎+Ve Whispering Pectoriloquy
▪︎Crackles (Fine Then Coarse)
▪︎Increase Vocal Resonant
🔹Dx Of CAP
📍1. Lung Infiltration On Chest Xray :
▪︎One Or More Lobes ➡️ Lobar Bacterial Pneumonia
▪︎Scattered Bilateral Patchy Infiltration ➡️ Bronchopneumonia
▪︎Diffuse Bilateral Interstitial Infiltration With Hyperinflation ➡️ Viral Or Atypical Pneumonia (Mycoplasma/Chlamydia/Legionella)
▪︎Cavity/Air Fluid Level/Effusion/Collapse/Fibrosis/Pneumatocele ➡️ Staph.Aureus Pneumonia
📍2. CBC :
▪︎Lymphocytosis ➡️ Viral
▪︎Neutrophilia & High ESR & CRP ➡️ Bacterial
▪︎Eosinophilia ➡️ Chlamydia Trachomatis (Atypical Pneumonia)
📍3. Blood Culture
🔹Mx Of CAP
📍1. Oxygen (To Maintain Saturation >92%)
📍2. IV Fluids
📍3. Analgesia For Pleural Pain (Paracetamol/Co Codamol/NASIDS/Opioids)
📍4. Antibiotics :
🔻I. Uncomplicated CAP (CURB Score 0-1) :
▪︎Amoxicillin (Oral 500mg 3x Daily For 5 Days)
▪︎If Patient Allergic To Penicillin ➡️ Clarithromycin (500mg 2x Daily Oral) Or Erythromycin (500mg 4x Daily Oral)
🔻II. Moderate CAP (CURB Score 2) ➡️ Amoxicillin + Clarithromycin For 7 Days (Oral Or IV)
🔻III. Severe CAP (CURB Score ≥3) ➡️ Combined 3 IV Drugs :
▪︎[Clarithromycin Or Erythromycin]
▪︎+ [Co Amoxiclav Or Ceftriaxone Or Cefuroxime Or Amoxicillin]
▪︎+ Flucloxacillin
🔹Prognosis Of CAP
1. Fever Persists Days After Tx
2. Radiological Changes Persist
Weeks-Months After Tx
3. If No Response ➡️ Wrong Dx Or Complications Develop
🔹Prevention Of CAP
📍1. Stop Smoking
📍2. Vaccination (Influenza/Pneumococcal/Measles/Pertussis/H.influenza)
🔹Complications Of CAP
1. Pus Accumulation inside The Pleura (Embyema) Or Lung (Lung Abscess)
2. Para-Pneumonic Effusion (Effusion in The Pleural Cavity Adjacent To The Affected Lobe)
3. Lobar Collapse (Due To Sputum Retention)
4. DVT & Pulmonary Embolism
5. ARDS & Organs Failure
6. Arrhythmia
7. Drugs Hypersensitivity & Pyrexia
8. Organs Inflammation
9. Pneumothorax | 17 |
| 7 | +3 هذا ملخص ل ماكلاويد
#عملي | 46 |
| 8 | ملفات حلوة وسهلة جداً جداً للفحص لجميع ال System | 33 |
| 9 | +9 1- General examination.pdf | 32 |
| 10 |  +8🟣ازاى تفحص مريض الصدر باحترافيه 🩺
🟣 Chest Examination Made Easy 🚩 | 24 |
| 11 |  +8#تشوهات_اليد_الخلقية✋
1_الأصابع العنكبوتية Arachnodactyly
2_الإصبع العملاق Macrodactyly
3_انثناء الأصابع Camptodactyly
4_الأصابع القزمة Micodactyly
5_التحام الأصابع Syndactyly
6_الأصابع المرآة Miror Finger
7_بتر الأصابع الولادي Conginital Amputation
8_كثرة الأصابع polydactyly
9_قلة عدد الأصابع(يد لوبستر)
Oligodactyly | 25 |
| 12 |  ❇️Important DDX of Finger Clubbing | 199 |
| 13 |  ❇️Important Facial Features | 24 |
| 14 | ❇️Abdominal Examination
🛑General examination (Specific for GIT)
⭕️Inspection of
⭕️General Appearance
▪︎In pain
▪︎Cachexia
▪︎Obese
▪︎Thin
⭕️Face for
▪︎Pallor
▪︎parotid Swelling
▪︎Yellowish Discoloration of sclera
▪︎pale Conjunctiva
▪︎Xanthelasma in eyelids
⭕️Mouth For
▪︎Angular Stomatitis (Iron Deficiency)
▪︎Atrophic Glossitis
(Beef tongue in folate/B12 Deficiency)
⭕️Neck For
▪︎Lymphadenopahy
⭕️Hands for
▪︎Clubbing
▪︎Koilonychia
▪︎Leukonychia
▪︎Palmar Erythema
⭕️Abdomen For
▪︎Distension
▪︎Scars
▪︎Mass
▪︎Pulsation
▪︎Peristalsis
▪︎Dilated Veins
▪︎Hernia
▪︎Hair Distribution
▪︎Striae
▪︎Scratch Marks
▪︎Umbilical Shape
⭕️Legs for
▪︎Odema
🛑Palpation of Abdomen For
▪︎Mass
▪︎OrganoMegaly
▪︎Tenderness
🛑Percussion For
▪︎Shifting Dullness
▪︎Transmitted Thrills
🛑Asucilataion For
▪︎Bowel Sounds
▪︎Bruits
*تفاصيل كل فحص موجودة بالملف | 21 |
| 15 | ❇️Endocrine | 20 |
| 16 | +4 ❇️Abdominal | 20 |
| 17 | #COPD@Clinicalinternalmedicine | 18 |
| 18 | 🔴 Chronic Obstructive Pulmonary Disease (COPD)
▪︎It's A Preventable & Treatable (Controlled) Group Of Diseases (Chronic Bronchitis & Emphysema) Consist Of AirFlow Limitation & Premature Closure Of Airways That Increasing The Work Of Breathing Due To Chronic Inflammation
▪︎Major Cause Of Death & Disability Worldwide
🔰Types Of COPD
📍1. Chronic Bronchitis (Blue Bloater)
▪︎Bronchial Wall Inflammation & Thickening & Increase Gland Secretions
▪︎Results in Chronic Cough & Sputum For 3m in 2 Years
▪︎Cyanosis & Secondary Polycythemia Due To Hypoxia
▪︎Low Ph (Acidosis)
▪︎More Chest Infection
📍2. Emphysema (Pink Puffer)
▪︎Abnormal Permanent Airspaces (Alveoli) Enlargement & Wall Destruction & Loss Elasticity Causing Air Trapping Inside Alveoli & Hyperinflation
▪︎Severe Dyspnea & Pursed Lips
▪︎Normal Skin Color (Pink)
▪︎Barrel Chest By Hyperinflation
▪︎Near Normal Ph (No Acidosis)
📍3. ExtraPulmonary Features Of COPD :
▪︎Weight Loss
▪︎Skeletal Muscle Dysfunction
▪︎Lung Cancer
▪︎Osteoporosis
▪︎Depression
▪︎Metabolic Syndrome
▪︎Cardiovascular & Cerebrovascular Diseases
🔰Risk Factors For COPD
📍1. Smoking (>10 Pack Years) ➡️ Single Most Important Risk Factor
📍2. Low Birth Weight/Childhood Infections/Maternal Smoking/Cannabis Smoking
📍3. HIV & AdenoVirus Infections/Air Pollution/Low Socioeconomic State
📍4. Genetic Alpha-1 Anti-Trypsin Deficiency ➡️ Emphysema At Young Ages
🔰Dx Of COPD
🔸A. By Spiromerty
📍1. FEV1/FVC <0.7 (<70%)
📍2. Poor Response To Bronchodilators (Confirm Dx)
📍3. Determine Severity By Post Bronchodilators FEV1% :
▪︎Stage 1 (Mild): FEV1 >80%
▪︎Stage 2 (Moderate): FEV1 50–79%
▪︎Stage 3 (Severe): FEV1 30–49%
▪︎Stage 4 (Very severe): FEV1 <30%
🔸B. By Clinical Features
📍1. Chronic Productive Cough & Dyspnea (Smoker Cough 1st Symptoms)
📍2. Onset in Mid Life (40 Years) With Hx Of Smoking
📍3. Persistent (Irreversible) AirFlow Limitation
📍4. Fixed Symptoms (No Symptoms Variation During the Different daytime)
📍5. Fatigue/Anorexia/Weight Loss (In Severe COPD)
📍6. Chest Xray/CT ➡️ To Detect Lung Hyperinflation/Bullae/HF/Lung Cancer
📍7. Peripheral Edema (R HF/Salt & Water Retention)
📍8. Morning Headache (High CO2)
📍9. Quiet Breath Sounds (Hyperinflation) & Crackles (Infection)
🔰Mx Of COPD
📍1. Reduce Exposure To Noxious Particles & Smoking Cessation
📍2. Mild Symptoms ➡️ Short Acting B2 Agonist (SABA)
📍3. Moderate To Severe Symptoms :
▪︎Long Acting B2 Agonist (LABA)
▪︎Inhaled Steroids (ICS) + Long Acting B2 Agonist (LABA)
▪︎Oral Systemic Steroids (Prednisolone)
📍4. Pulmonary Rehabilitation (Exercise)
📍5. Long Term Domicillary Oxygen ➡️ 15h/Day (To Reach 90% Oxygen Saturation)
📍6. Surgical Resection Of Bullae
📍7. Annual Influenza & Pneumococcal Vaccine
🔰Acute Exacerbations Of COPD
▪︎Mostly Due To Infection (Bacterial/Viral) Or Change Air Quality
▪︎Haemophilus influenzae Most Common Infection
▪︎Risk Of Respiratory Failure/Fluid Retention/Death
🔹Mx Of Acute Exacerbations
📍1. Low Concentration Oxygen (24-28%) By Venturi Mask Or Nasal Cannula ➡️ To Reach Oxygen Saturation >90%
📍2. Short Acting B2 Agonist (SABA) + Anticholinergic (Salbutamol + Ipratropium)
📍3. Oral Systemic Steroids (Prednisolone 30mg For 10 Days)
📍4. Antibiotics (Aminopenicillin/Tetracycline/Macrolides)
📍5. Ventilation (Non Invasive Or Mechanical)
📍6. Diuretics For Peripheral Edema
🔰Complications Of COPD
1. Respiratory Failure
2. Recurrent Respiratory Infections
3. Pulmonary Hypertension
4. Pneumothorax
5. Right Side HF
6. Skeletal Muscle Dysfunction
7. Depression & Anxiety | 21 |
| 19 |  📝Work up of pt suspected PE | 20 |
| 20 |  📝Modified Wells Score for PE | 21 |
