AAS Medical Notes

Effect of pregnancy on RA, MS & SLE: 📑 RA 👉 50% of pregnant women with rheumatoid arthritis have low disease activity, & 20% - 40% achieve remission by the third trimester. 📑 MS 👉 Decreased relapse rate of MS during pregnancy or does not appear to speed up the course or worsen the effects of MS 📑 SLE 👉 It make SLE worse and increase the risk of miscarriage and other complications ——————————— #SpongeBob #Uptodate

Definition of MIs according to ECG : 1. STEMI : includes -- ST- segment elevation -- new-onset LBBB, look to sgarbossa criteria -- posterior MI : ST depression in V1-V3 with tall R wave and upright T wave. Confirmed by posterior ECG 2. NSTEMI : -- No ST-segment elevation, or just Transient elevation. -- ST depression -- T wave inversion -- non-specific changes -- or even normal. #ECG

High troponin : 1. consistently elevated troponin >>> renal failure. 2. Acute elevation of troponin : A. Cardiac cause : MI, myocarditis, pericarditis. B. Extr cardiac : Burn, sepsis, stroke, and pulmonary embolism #emergency #cardio

Alteplase regimen in ST elevation MI #emergency #cardio

45 yo M with fatigue , tachycardia , general weakness & his eyes are yellowish PMHx: No DM & No HTN investigation: ECG is normal except sinus tachycardia Routine CBC What is the next step in the investigation ? 👇 @AASmedicalbot #hematology #oncology

طفل عمره 5 سنوات جاي يراجع ع اللقاح ولاحظنا عنده numerous brown macules on his face, arms & freckling is seen under his arms.. و امه عندها نفس الحالة باديها من يكبر مستقبلا شتتوقع يصير بعيونه ؟ ——————————————— axillary freckling + multiple café au lait + family hx ⏩ indicative of neurofibromatosis 1 Most Likely To Develop👇👇 👉👉 Lisch nodules are raised, tan-colored hamartomas of the iris and represent a specific finding for NF1 & not affect vision. Typically found in adults. Less Likely To Develop👇👇 👉👉 15% of children with this disorder develop optic pathway gliomas. If eye examination is abnormal 👉 MRI #neurology

Cigarettes and coffee with a rough stupid person with a butterfly on his nose while he is dancing when hit by stone 🔽 - Cigarettes: 👉 (ash leaf) - Coffee: 👉 (café-au-lait) - Stupid: 👉 (intellectual and developmental) 👉 (Shagreen patches & Subungual fibromata) - Butterfly: 👉 (Adenoma sebaceum) - Dancing: 👉 (epilepsy) - Stone: 👉 (renal: angiomyolipoma) 👉 (brain: subependymal calcified lesions) ———————- That's Tuberous sclerosis #neurology

NOTE: 👉 Iron and folate malabsorption are common in untreated celiac disease as the proximal small intestine is predominantly affected. 👉 Vitamin B12 deficiency is thought to be uncommon, as the terminal ileum is relatively spared in celiac disease celiac disease #GIT

📌 Malabsorption: 📑 Malabsorption symptoms + macrocytosis or IDA in young pt 👉 celiac disease 📑 Malabsorption symptoms + improve with control of diary intake + negative endomyseal Abs 👉 Lactose intolerance 📑 Malabsorption + joint pain + Bradycardia in middle age 👉 Whipple's disease ( positive PAS biopsy) 📑 Malabsorption + macrocytosis + negative endomyseal Abs and normal IgA 👉 think in tropical sprue 📑 Malabsorption + recurrent epigastric pain to back + positive fecal elastase 👉 chronic pancreatitis 📑 Malabsorption + symptoms of bronchiectasis 👉 cystic fibrosis #GIT

#neurology

Bilateral ptosis keeps a narrow differential. 1-Myasthenia gravis: ممكن تجي ptosis = bilateral or unilateral وتعتبر most common initial symptom وننتبه ع muscle fatigability hx وتجي ويه dysphagia = worse with liquid than solid واللي تكون معاكس لل achalasia 2- Chronic progressive external ophthalmoplegia: bilateral ptosis + fatigue + mitochondrial disease 3- Miller Fisher syndrome: ataxia + ophthalmoplegia+ areflexia ويكون descending paralysis عكس لل GBS 4- Bickerstaff brainstem encephalitis 5- Lambert eaton syndrome هنا ptosis تكون اقل من MG 6- Neurosyphilis 7- Brainstem CVA #neurology

📌 Thrombocytopenia in pregnancy: 📑 Gestational- 3rd trimester + mild + no Rx 📑 ITP- 1st tri + mild-no Rx ; if severe/IVIg or steroid 📑 Pre-eclampsia- 3rd tri + HTN 📑 HELLP- 3rd tri + transaminitis 📑 TTP/HUS- 3rd tri + Hemolytic 📑 AFLP- 3rd tri + Upper abdominal pain + Coagulopathy

35 yo F with dysphagia for liquid more than solid & inability to open her eyes since 3 days.. O/E: conscious, alert but not responding , Vital signs are normal Neurological exams shows: nasal speech with bilateral ptosis & total ophthalmoplegia impaired gag reflexe with bulbar palsy global hyporeflexia planter reflexes are down going with intact sensation What is Ddx? 👇 @AASmedicalbot #neurology

وحسب tintinalli "Steroids are often used to decrease mucosal edema of the epiglottis" (dexamethasone = 0.15–0.6 mg/kg) - IV access, hydration as indicated ونبلغ ابو ENT اذا ما استجاب intubation or tracheotomy واذا قفل كلش بعد يتحول ع جراحه emergent surgical airway

هلو Dx: Epiglottitis طبعا الكيس من برزنتيشن واضح لهذا سوينه lateral neck x-ray fever+SOB+dysphagia & drooling + radiology finding واضافة لاعراض اخرى ممكن تجي muffled voice, voice change(hot potato voice) والاسباب معروفه قد تكون - Infectious (hemophilus influenzae B..etc..) is common - Chemical and thermal burns or truma بس بهل العمر مو كموون تجي واحتمال: immuncompromise or unimmunized pt نجي لل x-ray - swollen epiglottis 👉 Thumbprint sign (لون الازرق) اما باللون الاحمر normal air space b/w tongue base and epiglottis تقريبا تشبه حرف V ونوبات يصير بيها obliterated نتيجة swollen epiglottis - loss of vallecular air space 👉 Vallecula sign اما Mx: - ABC - upright in a position (prefer) - humidified O2 - empiric IV antibiotics Cefotaxime: 2 g IV كل 8 ساعات or Ceftriaxone: 2 g IV كل 24 ساعه - nebulized l-epinephrine to decrease airway edema(0.5 mL/kg nebulized) - corticosteroids are controversial اكو مصادر تكول نطيه واكو لا

Delay relaxation of ankle jerk in hypothyroid pt

شاب بعمر 35 سنه اجه للطوارئ عنده خنكه وصخونه و 2 day of dysphagia & drooling O/E : conscious, oriented & anxious Spo2 98, BP 110/60, PR 110 سوينه اشعه وطلعت هيج What’s Dx? Mx ? 👇 @AASmedicalbot

دام ما عندي شي خل اشرح هذا ال ecg 😑😑 #ECG