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Elderly patient, post colectomy, experienced postoperative dehydration, increased skin turgor, and postural hypotension. ABG results: PH 7.8, HCO3 48, PCO2 44. What is your interpretation?
23M who is a known case of UC presented with 7-8 bouts of bloody diarrhea per day. Associated with fever and joint pain. On examination the patient looks ill and in pain, next step in management?
🩸 RBC transfusion:
- 1 unit of pRBC increase Hb by 1
- target Hb is above 7 except in acute MI and peri-cardiac surgery ≥8
patient presents with typical signs and symptoms of SLE, along with low complement levels, high ESR, and positive anticardiolipin antibodies. What is the most appropriate next step?
💊 C. Diff treatment:
- Fidaxomicin for 10 days (first line)
- Oral Vancomycin for 10 days
- IV Metronidazole for 10-14 days (not preferred to use alone for severe infections)
For fulminant disease (toxic megacolon or sign of toxicity): oral Vancomycin plus IV Metronidazole (if ileus consider rectal vancomycin)
For the first recurrence:
- Preferred regiment: Fidaxomicin
- 2nd line Tapered and pulsed vancomycin regimen
For second or subsequent recurrences:
- same above recommendation
- Fecal microbiota transplantation
patient with ulcerative colitis presents with lower abdominal pain, diarrhea, and fever. Stool culture is negative but positive for C. difficile. What is the most appropriate treatment?
CAPS Definition:
A rare, life-threatening form of antiphospholipid syndrome characterized by widespread thrombosis leading to multi-organ failure.
Diagnostic Criteria (Modified Sydney Criteria):
1- Thrombosis in ≥3 organs.
2- Thrombosis develops within 1 week.
3- Histopathology confirms small-vessel occlusion in at least one organ.
4- Positive antiphospholipid antibodies.
- Infections is the most common trigger
- Treatment: Plasma Exchange or IVIG
- Mortality rate: 30–50% (44%)
📊 Test your self:
What is catastrophic anti phospholipids syndrome “CAPS”, def, criteria and mortality.
💊 PEGylated interferon contraindications:
- Decompensated liver disease (jaundice, ascites, hepatic encephalopathy).
- Cirrhosis with portal hypertension.
- Severe cytopenias
- Autoimmune diseases
- Severe psychiatric illness
- Uncontrolled thyroid dysfunction.
- Pregnancy or planning to conceive.
46F kwnon chronic hep B. has jaundice and lower limb edema. labs high AST, ALT and HBV DNA.
Us: liver micro-fibrotic changes. next step?
🩸 Hemophilia classification based on severity (Part Q):
- mild 5–25% normal factor activity
- moderate 1-5% normal factor activity
- severe <1% normal factor activity
Severe type required prophylactic factors replacement (2-3 time per week for hemophilia A and every 10-14 days for hemophilia B)
Target is to Maintain factor levels: ≥1% for reducing spontaneous bleeds.
Higher targets (>3–5%) for physically active patients or those with joint damage.
💮 Coagulation Factors:
Intrinsic Pathway:
- XII, XI, IX, VIII
- affect: aPTT
Extrinsic Pathway:
- VII
- affect: PT/INR
Common Pathway:
- X, V, II “thrombin”, I “fibrin
- affect: aPTT and PT
🦠 Causes of Negative Cultures in Joint Aspiration:
- Prior antibiotic use
- Fastidious organisms (N.gonorrhoeae, M.tuberculosis)
- Inadequate sample handling
- Non-bacterial causes (fungal)
diabetic patient with severe unilateral knee joint pain presents. knee is erythematous, swollen, and warm. He has fever, aspiration shows wbc 55K, culture negative and crystal is pending, diagnosis
🦴 Arthritis Tips:
- DIP joint: Psoriatic arthritis & OA
- PIP joint: RA, OA & SLE
- thumb: OA
patient with DIP, PIP and bilateral wrist pain, morning stiffness less than 30 minutes, and a non-tender nodule on the DIP.
Labs show negative RF and normal WBC.
