AAS Medical Notes

Guttate psoriasis

Note : In chronic liver disease and if the patient develop anaemia that did not respond to blood transfusions, think about spur cell anaemia SCA . SCA occur due to change of RBCs membrane by cholesterol, making these RBCs ready for destruction, so even if you transfuse the patient, the new cells will become spur and destructed . The only treatment for this anaemia is liver transplantation.

Good morning . 9 yo boy presented with these skin lesions since 2 months ago, mild itchy , no other abnormal findings apart from this . What is your ddx?? @AhmedAbdSambot

نجي نجاوب الكيس

For more than 6 months . Spot dx . @AhmedAbdSambot

نجاوب هالكيس

Firstly, begin in the chin then spread gradually to involve the entire face . What is your dx and how will you manage her ??? @AhmedAbdSambot

نجي نحل هذا الكيس بفويسات مبسطة إن شاء الله. اغلب الإجابات صحيحه و هي myasthenia gravis

Normal bilirubin concentration is 1-1.5mg/dl in adults and this is principally unconjugate bilirubin UB with trace conjugate bilirubin CB . اكو مادة اسمها diazo reagent, يضيفوها ع ال serum, ف اذا تفاعل البليروبين مباشرة (يعني بسرعة) فسموا هذا البليروبين direct bilirubin, و اذا تفاعل ببطىء فسموه indirect bilirubin . و لأن ال Un conjugated bilirubin يحتوي على hydrogen bond الي تعرقل تفاعله مع ال diazo reagent, فكالوا ال UB=IB .و العكس بالنسبة لل CB يعني CB = DB . و بالحالة الطبيعية فقط 10-15% من البليروبين will react directly (DB) . اريدك تنتبه وياي اشوية، شغلة ان ال DB = CB و ال IB=UB, هذا صحيح بس مو 100% و ممكن يخربط التشخيص !!! 15% of direct reacting bilirubin is due to unconjugated bilirubin !!!! يعني لو اجاك التحليل و كايلك 90% هو اندايركت و 10% هو دايركت بليروبين ، و ال total bilirubin =5mg/dl ، فهسه اشكد ال CB and UB؟ هذا كله معناها unconjugated bilirubin UB ، ليش ؟ لان ال indirect reacting bilirubin هو 10% (يعني اقل من 15%)، يعني ايضا كان سببها ال UB . لو گايل ال indirect bilirubin =80% while DB is 20%, فهنا راح يكون ٩٥٪؜ هو UB و ٥٪؜ هو CB . تريد تتأكد من كلامك، دز البيشنت على GUE، اذا لكيت bilirubinuria, معناها هذا البيشنت عنده conjugated hyperbilirubinaemia . ضروري تفهم هذا الكلام.

A 35-year-old woman comes to the clinic complaining of double vision that seems to worsen near the end of the day. She also complains of difficulty chewing meat and other hard foods. She notices that her symptoms improve following a good night’s sleep. On neurologic examination, you note a snarling appearance when the patient is asked to smile, and a nasal tone is heard in her voice. You also note a weakness in the upper extremities when the patient is asked to clench her fist around your finger repeatedly. @AhmedAbdSambot

She had covid 2 weeks ago. PCR is negative now, but she developed this rash on her neck and chest. It's not itchy. Some fluid is coming out of the pustules. Fir discussion, @AhmedAbdSambot

Jaundiced patient presented to you with behavioral changes 👉🏽👉🏽 you must think about these ddx : 1) hepatic encephalopathy: there is astrexisis (flapping tremer), very characteristic. 2) Wernke-Korsakoff syndrome : occur in alcoholic persons due to thiamine deficiency . Any alcoholic person presented to you with neuronal abnormality👉🏽👉🏽 give Thiamine. DO NOT GIVE GLUCOSE BEFORE THIAMINE . 3) Wilson disease : there is KF ring (may be non-observable clinically and need slit lamp) . 4) subdural haemorrhage SDH : sudden in onset if it was acute SDH and there is headache . هاي اهم اربع نقاط لازم تخليهن ع بالك ، و كلهن موجودات بالكتاب الي راح انزله الكم من اكمل من عنده ان شاء الله .

For intractable cases of seizures, give the patient trial of B6 injections before intubation and GA . NELSON

Kidney function test in context of liver failure : ١- اكيد تعرفون ان اليوريا تتصنع بالكبد، فلو واحد عند liver failure و نريد نقيس ال kidney function , ف urea level ما راح يعكس ال kidney function لان اصلا ناكو تصنيع لليوريا ٢- الكرياتينين، بعض الكرياتيتين يتصنع بالكبد و بعض منه بال muscles ، و جماعة ال liver failure عدهم muscle wasting , ف بالتالي creatinine production راح يكون قليل، فبالتالي ما يعكس ال kidney function . اتمنى هالنقطتين صارن واضحات عدكم الي بعده ما فاهمهن، يراسل ع البوت اعلاه .