AAS Medical Notes

📑 Hyper-segmented neutrophil It is defined as the presence of neutrophils with 6 or more lobes or the presence of more than 3% of neutrophils with at least 5 lobes. 🎗 It is seen in 👉 Megaloblastic anemia (deficiency of folate or vit.B12) 🎗 It is Not seen 👉 Macrocytic non megaloblastic anemia (alcohol, liver disease, phenytoin therapy, hypothyroidism) 🔖 So Clinicians may send requests to search a hyper-segmented neutrophils to differentiate between megaloblastic vs non megaloblastic macrocytic anemia. 🔖 But hyper-segmented neutrophils are not pathognomic of megaloblastic anemia as they are also seen in: 👉Uremia 👉Patients on methotrexate or other chemotherapeutic agents 👉Severe Iron deficiency anemia 👉Myelodyplastic syndrome #hematology

Very Nice case to see This 39 yo medically free female presented with central chest pain which was sudden in onset. المفروض هجي كيس نبدي ب ECG المهم، الي كان موجود دزاها Chest X ray، و الي من الوهلة الأولى تبدي نورمل In this CXR : there are 2 important and highly specific signs : Fleischner sign on the right and Westermark's sign on the left. تگدر تبدي بال anti coagulants و تعامل هذا الكيس ع انه pulmonary embolism فقط بناءاً ع هاي ال chest X ray. Later on : CTPA was done which confirm bilateral PE. #emergency #respiratory #radiology

📑 Iron deficiency anemia (IDA) 📝 IDA + dysphagia + esophageal webs 👉 Plummer Vinson 📝 IDA + angiodysplasia + aortic stenosis 👉 Heyde syndrome 📝 IDA + nocturnal leg discomfort 👉 Restless leg syndrome 📝 IDA + Gluten intolerance 👉 Celiac 📝 IDA + urine loss of iron + intravascular hemolysis 👉 Paroxysmal nocturnal hemoglobinuria 📝 IDA + Haemolytic Anaemia + Eosinophilia 👉 Infection cause (Ankylostoma) 📝 IDA + Middle age or post menopausal + Hx of melena or rectal blood loss 👉 Colon cancer #hematology

Pulmonary embolism #respiratory #emergency

اي تطبيق زين يدمج صور بحيث يحافظ ع الحجم للصوره وما ياثر بدقتها خل يرسله لل د احمد 😂 @AASmedicalbot

Acute Coronary Syndrome ACS Vs pulmonary embolism PE in ECG أثنينهم يصير عدهم Chest pain, positive troponin, ST-T changes, and high D-dimer ف اشلون أگدر افرقهم عن بعض ب استخدام ال ECG 🙄🙄 Look to the T wave in V1-V4 and inferior leads : ١. إذا لكيت Inverted T in V1 and in Lead III، فهذا تعامله معاملة ال PE ٢. إذا لگيت discordant T waves، يعني وحدة عكس الثانيه in V1 and lead III، ف تعامله معاملة ال ACS. ٣. إذا لگيت Inverted T in V3-V4 أكثر من V1-V2، ف تعاملها معاملة ال ACS. أهم نقطة و الي لازم الكل يعرفها هي النقطة الأولى. الباقي زيادة خير This pt presented with chest pain and positive troponin طبعا اكو هواي signs بهذا ال ecg بس حبيت اشرح هاي الساين لأن هي ال most specific و الي دائما تُنسى. S1Q3T3 pattern neither sensitive nor specific 😒😒 By #Ahmed_Abdsam #ECG

📔 PPI 📄 Best time to take PPI 👉 30 min before breakfast.Why? 👉To ensure maximum plasma concentration of PPI in plasma before activation of proton pump. 📄 Omeprazole & esomeprazole is described as inhibiting CYP2C19 👉 decreasing clearance of diazepam, phenytoin & warfarin. 📄 Lansoprazole 👉 increases metabolism of theophylline by inducing CYP1A. 📄 Long-term PPI in older pt on high dosages 👉 increased risk of hip fractures by inhibition of calcium absorption by PPI-induced hypochlorhydia. 📄 PPIs 👉 increased risk of infections (e.g,pneumonias, enteric infections) 👉 less acidic environment #pharma

هلووو ردت اشوفكم هاي ال sign اسمها Strawberry tongue لسان الفراوله 😭😭😭 Causes : Kawasaki disease Scarlet fever Allergy B12 deficiency #pediatric

📑 Sharp stabbing chest pain ✓ Sharp stabbing chest pain, fever and cough 👉 suggests pneumonia ✓ Sudden sharp stabbing chest pain, dyspnea without fever 👉 suggests pulmonary embolism ✓ Sharp stabbing chest pain improves on leaning forward 👉suggests pericarditis

Cullen's sign and Grey Turner's sign in necro-haemorrhagic acute pancreatitis By #Ahmed_AbdSam

Cullen's sign and Grey Turner's sign in necro-haemorrhagic acute pancreatiti

23 yo M marfanoid-looking with Arachnodactyly (spider fingers) 👉 fingers are long, slender, and curved. Note: 📑ALL pt with Marfan's syndrome should be on BB"Beta-blocker" 👉BB significantly reduce the risk of Aortic Dissection "the most serious complication of Marfan"

صار لازم نشرح ال hypo Calcaemia و بالتفصيل الممل يعني من تسمع الفويس الي راح ينزل، اخليك اول مرة تحس بنفسك تعرف الكالسيوم 😂😂😂 لا لا أتشاقه Remember : The devil in the details 😎😎😎😎

24 yo M has facial muscle wasting and weakness, wasting of scapular muscles with winging of scapula, He also have deltiod muscle atrophy with whistling difficulty. 👇 Diagnosed as case of Facio-scapulo-humeral muscular dystrophy clinically.

📑 Edema: ✒️ Initially leg edema then facial edema & ascites 👉 suggests cardiac cause (congestive heart failure) ---------- ✒️ Initially facial edema followed by leg edema 👉 suggests renal cause of edema (CKD, GN/Nephrotic syndrome) ---------- ✒️ Initially ascites followed by leg or facial swelling 👉 suggests liver cause (decompensated liver cirrhosis ) ---------- ✒️ Sudden onset perioral or periorbital swelling associated with shortness of breath or abdominal pain 👉 suggests angioedema

Dental cleaning 👇 Fevers 👇 Pulsatile mass 👇 Ulnar artery mycotic aneurysm 👉 Infective Endocarditis #nejm