Act as Internalist 👨🏻‍⚕️🫀🩺

🛑postoperative Jaundice

Dysphagia: Differential Diagnoses and Clinical Clues for Diagnosis.

📝CURB 65 score of pneumonia

#Asthma@Clinicalinternalmedicine

🔴 We have finished topics of #CVS now I will start topics of #respiratory system

🔹Mx Of Asthma 🔶A. Acute Attacks (Status Asthmaticus) 📍1. High Flow Oxygen 📍2. SABA + Antimuscarinics (Salbutamol 2.5mg + Ipratropium 0.5mg) Nebulized Every 20Min (3x) 📍3. Systemic Steroids (Continue For 3-7 Days) : ▪︎Oral Prednisolone (1-2mg/Kg) ▪︎IV Methylprednisolone (1mg/Kg) ▪︎IV Hydrocortisone (5-10mg/Kg) 📍4. Adrenaline (0.01mg/Kg SC Or IV) Every 20Min 📍5. Mg Sulphate (IV 25-75mg/Kg Over 30min) 📍6. Aminophyline (IV Loading 5-10mg/Kg Then Maintenance 1mg/Kg/h) 📍7. Mechanical Ventilation If No Response To All Measure 📍8. Antibiotics If Bacterial infection Suspected 🔶B. Long Term Controllers 📍1. Mild Intermittent & Prophylaxis Against Asthma Attacks ➡️ SABA (Salbutamol [Ventolin] Or Terbutaline) *Induce Bronchial Relaxation in 5-10 Min That Last 4-6h 📍2. Mild Persistent (One Drug) ➡️ [Low Dose ICS (Budesonide)] Or [Leukotriene inhibitors (Montelukast)] 📍3. Moderate Persistent (Two Drugs) ➡️ [Low Dose ICS] + [Leukotriene Inhibitors Or LABA (Formoterol) Or Theophyline] ▪︎No Response ➡️ Moderate Dose ICS ▪︎No Response ➡️ [Moderate Dose ICS] + [Leukotriene Inhibitors Or LABA Or Theophylines] 📍4. Severe Persistent ➡️ [High Dose ICS] + [Leukotriene Inhibitors Or LABA Or Theophylines] ▪︎No Response (4 Drugs) ➡️ [High Dose ICS] + [Leukotriene Inhibitors Or LABA Or Theophylines] + [Oral Steroids] + [Omalizmab]

🔴Asthma ▪︎Chronic Obstructive Inflammatory Disorder Of Airways (Airway HyperResponsiveness) ▪︎In Adults More in Females While In Children More in Males 🔹Risk Factors For Asthma 📍1. +Ve Family Hx Of Asthma Or Atopy 📍2. Severe Respiratory Infections During Childhood (Pneumonia/Bronchiolitis) 📍3. Early Breast Milk Weaning 📍4. Male Gender & Low Birth Weight 📍5. Smoking Exposure 📍6. Eosinophilia & Wheezing Episodes 🔹Types Of Asthma 🔸A. Childhood Asthma 📍1. Allergic Asthma (Atopic/Extrinsic) : ▪︎Most Common Type Of Asthma ▪︎Childhood Onset ▪︎IgE Mediated Type I Hypersensitivity ▪︎Personal & Family Hx Of Allergic Diseases (Atopy) ▪︎Good Response To Tx 📍2. Transient NonAtopic Asthma ➡️ Recurrent Episodes Of Wheeze In Children After Viral Infections That Resolved Without Persistent 🔸B. Cough Variant Asthma ➡️ The Only Predominant Symptoms is Dry Cough 🔸C. Aspirin Induced Asthma ▪︎Mostly In A Middle Age Female With Asthma & Rhinosinusitis & Nasal Polyps ▪︎Symptoms Occur After Alcohol Or Foods Or Any Compound Containing Salicylate (Aspirin) 🔸D. Exercise Induced Asthma ➡️ Symptoms Triggered Only By Physical Activity 🔸E. Non Allergic Asthma ▪︎Onset At Adulthood ▪︎Due To Lung SubMucosal Irritation ▪︎Poor Response To Tx 🔹Clinical Features Of Asthmatic Attacks 📍1. Recurrent Episodes Of Diffuse Bilateral Expiratory Wheeze With SOB & Chest Tightness & Cough 📍2. Diurnal Variation in Symptoms (Worst At Early Morning & Night) 📍3. Sleep Disturbances By Symptoms 📍4. Chest Hyperinflation & HyperResonant With Prolonged Expiration 📍5. Hx Of Other Atopy & +Ve Family Hx 📍6. Symptoms Respond To Bronchodilators 🔹Precipitants Of Asthmatic Attacks 📍1. Exercise in Cold Weather 📍2. Airborne Allergens & Pollutants 📍3. Viral URTI 📍4. Drugs (BB/Aspirin/OCP/Prostaglandin/Cholinegric Agents) 📍5. GERD/RhinoSinusitis 🔹Confirm Dx (If Age >5 Years) 🔶A. Spirometer 📍1. FEV1/FVC <0.7 (<70%) ➡️ Obstructive Picture 📍2. FEV1 >12% Increase After Bronchodilators (Good Response To Bronchodilators Specific For Asthma) 📍3. FEV1 >15% Decrease After 6min Of Exercise 🔶B. Diurnal Variation in PEF >20% On More Than 3 days For 2 Weeks 🔶C. Increase IgE & Eosinophills 🔹Classification Of Asthma Severity 📍1. Mild Intermittent : ▪︎Day Symptoms ➡️ ≤2/Week ▪︎Night Symptoms ➡️ ≤2/Month 📍2. Mild Persistent : ▪︎Day Symptoms ➡️ >2/Week ▪︎Night Symptoms ➡️ >2/Month 📍3. Moderate Persistent : ▪︎Day Symptoms ➡️ Every Day (Daily) ▪︎Night Symptoms ➡️ >1/Week 📍4. Severe Persistent : ▪︎Day Symptoms ➡️ Every Day (Daily) ▪︎Night Symptoms ➡️ Frequent (7x)/Week 📍5. Acute Severe Attack : ▪︎PEF 33-50% ▪︎Tachycardia & Tachypnea ▪︎Can't Complete Sentence in One Breath 📍6. Life Threatening Attack : ▪︎PEF <33% ▪︎SPO² <92% (<8KPa) ▪︎Normal Or Increase PaCo² ▪︎Silent Chest ▪︎Cyanosis/Bradycardia/Hypotension/Delirium & Coma 📍7. Near Fatal Attack ➡️ Increase PaCo² That Requiring Mechanical Ventilation

#PDA@Clinicalinternalmedicine

🛑Valves Sounds ▪︎Lab S1 = M & T Close (Systole) ▪︎Dab S2 = P & A Close (Diastole) ▪︎Ba Lab Dab = S4 ▪︎Lab DeBab = S3 ▪︎Mitral/Aortic In left Heart side ▪︎Tricuspid/Pulmonary in right Heart side

🔰Patent Ductus Arteriosus (PDA) ▪︎It's A Communication Between The Pulmonary Artery & The isthmus Part Of The Descending Aorta That Failed To Close After Delivery ▪︎Results in Continues Blood Flow From Aorta To Pulmonary Artery Then Development Of Pulmonary Hypertension (L To R Shunt) 🔷Risk Factors For PDA 1. Mother Infected With Rubella (Congenital Rubella Syndrome) 2. Premature Infants 3. Female Gender 🔷Clinical Features Of PDA 📍1. Small PDA ➡️ Asymptomatic 📍2. Large PDA : ▪︎Continuous Machinery Murmur With Thrill (At Pulmonary Area) ▪︎Pulmonary Hypertension & Risk Of Shunt Reversal (Eisenmenger Syndrome) ▪︎Heart Failure ▪︎Growth Failure ▪︎LV & BiVentricular Hypertrophy ▪︎CardioMegaly & Lung Congestion & Pulmonary Artery Enlargement ▪︎Collapsing & Bounding Pulse & Wide Pulse Pressure 🔷Mx Of PDA 📍1. Small Asymptomatic Shunt ➡️ Closure At Childhood 📍2. Large & Symptomatic Shunt ➡️ Closure At Infancy 📍3. Methods Of Closure : ▪︎Catheter ▪︎Surgery ▪︎NSAIDS (Indomethacin Or Ibuprofen Induce Shunt Closure in Premature Infants)

🔰Aortic Coarctation (Stenosis)

▪︎Localized Narrowing Of The Thoracic Aorta Below The Origin Of SubClavian Artery (After Aortic Isthmus) ▪︎Results in Raised Blood Pressure in The Proximal Body (Head & Neck) & Reduced Blood Pressure in The Distal Body ▪︎More in Males ▪︎Usually Associated With : 📍1. BiCuspid Aortic Valve 📍2. Cerebral Berry Aneurysm 📍3. Turner Syndrome ▪︎Can Be Acquired Due To Trauma Or Takayasu Arteritis Or Atherosclerosis 🔷Clinical Features Of Coarctation 📍1. Heart Failure 📍2. Headache & Hypertension 📍3. BP Difference Between Upper & Lower Limbs (>20mmHg) 📍4. Radio-Femoral Or Radio-Radial Delay Or Absent Femoral Pulse 📍5. Lower Limb Cramps/Weakness/Weak Pulses 📍6. Ejection Click & Systolic Murmur (in Aortic Area Due To BiCuspid Valve) 📍7. Localized Bruits 📍8. LV Hypertrophy 📍9. On Xray : ▪︎Descending Aorta Indentation (3 Sign) ▪︎Under Ribs Notching (Due To Collateral Vessels Called Rosler sign) 🔷Complications Of Coarctation 📍1. Risk Of Aortic Dissection Or Aortic Rupture 📍2. Heart Failure 📍3. Infective Endocarditis 📍4. Intra-Cranial Haemorrhage 📍5. Persistent Hypertension 📍6. Recurrence Of Stenosis After Tx 📍7. Aortic Valve Stenosis Or Regurgitation 🔷Mx Of Coarctation 📍1. Keep Ductus Arteriosus Open Using Prostaglandin E1 📍2. Repair in Early Childhood

🔰Tetralogy Of Fallot (TOF)

▪︎Most Common Cyanotic Congenital Heart Disease Present After Birth (After 1st Year Of Life) ▪︎Consist Of Four Anomalies : 📍1. Pulmonary Artery Stenosis (RV Outflow Obstruction) 📍2. RV Hypertrophy 📍3. Overriding Of The Aorta (Aorta Receive From Both Ventricles) 📍4. Large VSD ▪︎Results in Elevation in RV Pressure & Blood Flow From R To L Ventricles (DeOxygenated Blood Pumped To The Body That Results in Cyanosis) 🔷Clinical Features Of TOF 📍1. Cyanosis After Birth 📍2. Cyanotic Spells (Tet Spells) : ▪︎Recurrent Attacks Of Increased Cyanosis Usually Starts To Develop At 6m-1Year Age ▪︎Usually Occurs After Feeding Or Crying ▪︎Risk Of Apnea & Loss Of Consciousness 📍3. Exertional Dyspnea 📍4. Squatting Position After Exertion (Increase AfterLoad To Left Side Of Heart That Reduce R To L Shunt [Called Fallot Sign]) 📍5. Finger Clubbing 📍6. Polycythaemia (Due To Hypoxia) 📍7. Failure To Thrive 📍8. Ejection Systolic Murmur (At Left Sternal Border) 📍8. On Xray : ▪︎Boot Shape Heart چنة حذاء ▪︎Abnormally Small Pulmonary Artery 📍9. RV Hypertrophy 🔷Complications Of TOF 📍1. Cyanotic Spells 📍2. CVA (Due To Bleeding & Thrombosis) 📍3. Cerebral Abscess 📍4. Infective Endocarditis 🔷Mx Of TOF 📍1. Mx Of Cyanotic Episodes : ▪︎Oxygen ▪︎Morphine ▪︎Knee-Chest Position ▪︎BB/Na Bicarbonate/PhenylPhrine/Ketamine 📍2. Temporary Shunt 📍3. Surgical Correction Of The Anomalies At 1-2 Years

🔰Transposition Of The Great Arteries (TGA)

▪︎It's The Most Common Cyanotic Congenital Heart Disease That Present Immediately At Birth ▪︎The Aorta Arise From RV & Pulmonary Artery Arise From LV That Results in Severe Cyanosis Immediately At Birth ▪︎Usually Results in Death in 1st Year Of Life If Not Corrected Within 1st Weeks ▪︎More in Male Infants & Diabetic Mothers ▪︎Egg Appearance Of Heart On Xray ▪︎Mx By Keep Ductus Arteriosus Open Then Surgical Correction As Soon As Possible

🔰Pulmonary Artery Stenosis (PS)

▪︎Stenosis Usually Occurs At Pulmonary Valve Results in RV Hypertrophy ▪︎Usually Asymptomatic ▪︎Or Results in Exertional Dyspnea & Chest Pain ▪︎Systolic Ejection Click & Murmur & Thrill (At Pulmonary Area) ▪︎Need Only Follow Up Or Correction if Symptomatic ..... Cyanosis After Birth/Cyanotic Spells/Squatting Position/Boot Shape Heart ➡️ TOF Cyanosis Immediately At Birth/Egg Shape Heart ➡️ TGA

Why we examine Apex Beat & Ventricular Heave with Respiratory System ? 👇 🛑Hyperinflation in obstructive lung disease causes the lingula of the left upper lobe to come between the heart and the chest wall ➡️▪︎making the apex beat impalpable and the heart sounds inaudible 🛑In pulmonary hypertension the lower sternum is lifted by the cardiac cycle ➡️▪︎Producing right ventricular heave

🔵 Managing Hypertension in Diabetes: ADA 2025 🔗Full Guidelines ▪️ BP ≥130/80 mmHg: Start treatment; target <130/80 mmHg. ▪️ BP 130/80 to 150/90 mmHg: Begin single-drug therapy; aim <130/80 mmHg. ▪️ BP ≥150/90 mmHg: Use two drugs or a single-pill combo. ▪️ Prioritise ACE inhibitors/ARBs in CAD or albuminuria. ▪️ Avoid ACEi + ARB combinations. ▪️ Regular monitoring of U&Es is essential. #medicalguidelines #guidelines @Updates_in_Medicine

#Congenital_heart_D@Clinicalinternalmedicine VSD&ASD

🔴Congenital Heart Diseases (CHD) ▪︎These Are Defects in The Formation Of Heart Structures Or The Great Vessels During Embryogenesis ▪︎Usually Present in Neonatal Or Childhood Period (But Some Defects Remain Asymptomatic Until Adulthood) 🔷Risk Factors For CHD 📍1. Congenital Syndromes : ▪︎Down Syndrome ▪︎Marfan Syndrome ▪︎DiGeorge Syndrome 📍2. Maternal Factors : ▪︎Maternal Smoking & Alcoholic ▪︎Maternal Diseases (DM/Hypertension/SLE) ▪︎TORCH Infection During Pregnancy ▪︎Maternal Teratogenic Drugs During Pregnancy (Warfarin/ACEI/Lithium/Anti-Convulsions/Radiation Exposure) 📍3. PreTerm Infants 📍4. Family Hx Of CHD

🔰Ventricular Septal Defect (VSD)

▪︎Most Common Congenital Cardiac Abnormality (30%) ▪︎Due To Incomplete Septation Of The Ventricles That Results in Abnormal Communication Between The R & L Ventricles ▪︎Results in Blood Flow From LV (High Pressure) To The RV (Low Pressure) That Increases Load On RV & Pulmonary Circulation Which Eventually Leads To RV Hypertrophy & Pulmonary Hypertension ▪︎Usually Good Prognosis ▪︎But If Eisenmenger Syndrome Develops It'll Be Bad Prognosis (Death in 2nd-3rd Decade Of Life) 🔷Location Of The Defect 📍1. PeriMembranous (Most Common 80%) 📍2. Muscular/Inlet/Outlet (5%) 🔷Clinical Features Of VSD 📍1. Large VSD : ▪︎Results in High Elevation in The Pulmonary Vascular Pressure Then Increase Pulmonary Vascular Resistant Then Development Of Eisenmenger Syndrome (Shunt Reversal Makes The Flow From RV To LV) يعني تدفق الدم يصير بالعكس ▪︎Heart Failure in Infants (in 1st 4-6w Of Life) ▪︎Dyspnea & Poor Feeding ▪︎Recurrent Chest Infections & Failure To Thrive ▪︎BiVentricular Hypertrophy & CardioMegaly ▪︎Pulmonary Hypertension & Pulmonary Congestion (Dilatation Of Pulmonary Blood Vessels) ▪︎ParaSternal Pulsation/Tachypnea/Lower Ribs indrawing On Inspiration ▪︎Smooth Soft Pan-Systolic Murmur (At Lower Left Sternal Border) 📍2. Small VSD : ▪︎Asymptomatic ▪︎Harsh Loud Pan-Systolic Murmur (At Lower Left Sternal Border) ▪︎More Chance Of Spontaneous Closure During 1st 2 Years 🔷Mx Of VSD 📍1. Small Asymptomatic VSD ➡️ No Tx Required (Usually Spontaneous Closure) 📍2. Large VSD : ▪︎Digoxin & Diuretics For HF ▪︎Surgical Closure ➡️ Before Development Of Eisenmenger Syndrome ▪︎Heart-Lung Transplantation ➡️ If Eisenmenger Syndrome Developed (Surgery Contraindicated If Eisenmenger Syndrome Already Present)

🔰Atrial Septal Defect (ASD)

▪︎It's The 2nd Most Common Congenital Heart Disease (10%) ▪︎Due To Patent Foramen Ovale (Failure To Closure) Between The L & R Atrium ▪︎Results In Blood Flow From LA To RA That Increase Load On RA-RV & Pulmonary Circulation Which Eventually Leads To RA-RV Hypertrophy & Pulmonary Hypertension ▪︎More in Females ▪︎Excellent Prognosis 🔷Location Of The Defect 📍1. Secondum (in The Middle Most Common 80%) 📍2. Primum (in Lower Part)/Sinus Venosus (Near Vena Cava)/Coronary Sinus 🔷Clinical Features Of ASD 📍1. Usually Asymptomatic (Detected Incidentally) 📍2. Dyspnea 📍3. Recurrent Chest Infections 📍4. Heart Failure 📍5. Arrhythmia (AF) 📍6. Special Features : ▪︎Soft Ejection Systolic Murmur (in 2nd Left Intercostal Space) ▪︎Wide Fixed Splitting in The 2nd Heart Sound ▪︎RV Hypertrophy & Pulmonary Congestion (RV Heave/RBBB/R Axis Deviation/Peaked P Wave/Rounded Heart Apex/Increase Pulmonary Markings) 🔷Mx Of ASD 📍1. Small Defects ➡️ Waits For Spontaneous Closure 📍2. Large Defects ➡️ Need Closure

Stroke management