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Pale or bluish nasal mucosa is associated with allergic rhinitis Erythematous nasal mucosa is associated with nonallergic rhinitis #ENT

Appearance of the face in allergic rhinitis. - 'Allergic shiners' are dark circles around the eyes and are related to vasodilation or nasal congestion. - 'Nasal crease' (AKA allergic salute) is a horizontal crease across the lower half of the bridge of the nose that is caused by repeated upward rubbing af the tip of the nose. Other physical exam findings include: high-arched palate, pale blusih turbinates, and phayrngeal cobblestoning. #ENT

The CRH stimulation can also be used to differentiate secondary from tertiary adrenal insufficiency. No cortisol rise on CRH stimulation test indicates secondary adrenal insufficiency Cortisol rise indicates tertiary adrenal insufficiency Note: both (2ry and 3ry) are central adrenal insufficiencies. Hypothalamus not working → tertiary adrenal insufficiency Pituitary not working → secondary adrenal insufficiency Adrenals not working → primary adrenal insufficiency #Endocrinology

Another way to differentiate Cushing disease from ectopic ACTH-production is the CRH stimulation A CRH stimulation test in the setting of a pituitary adenoma will cause an increase on ACTH and cortisol levels A CRH stimulation test in the setting of a ectopic ACTH production will causes a no effect on ACTH and cortisol levels #Endocrinology

كرهت كل لحظة من التدريب و لكني كنت اقول : لا تستسلم ، اتعب الان ثم عش بطلا بقية حياتـك . –محمد علي كلاي 💪🏻

The low-dose dexamethasone suppression test is used to diagnose hypercortisolism. (Cortisol should normally be lower the next morning) The high-dose dexamethasone suppression test is used to determine where the ACTH is coming from (pituitary or ectopic production) In pituitary production (Cushing disease), cortisol production will be suppressed after the test. #Endocrinology

The difference between racoon eyes and a black eye - Racoon eyes tend to occur bilaterally as a result of basilar skull fracture. - Racoon eyes develop over a few days wheres black eyes occur within hours. - ‘tarsal plate sparing’ tends to occur in raccoon eyes which is an area of the upper eyelid without bruising as the fibrous tarsal plate impedes the spread of bruising. - Raccoon eyes bruising tends to be confined to the orbit, whereas a black eye may spread outside this area. #Trauma #Surgery

Signs of fracture in the base of the skull: - Battle sign (retroauricular bruising) - Racoon eyes - Otorrhea, rhinorrhea - Hemotympanum #Surgery #Trauma

Amiodarone induced thyroiditis has two types. - Type I occurs in patients with pre-existing thyroid disease such as Grave's disease or toxic adenomas. - Type II involves destructive thyroiditis in patients with normal thyroid. ~ Management: 1. Stop the drug 2. Perform a Radioiodine uptake test. If uptake is high → type 1 so give anti-thyroid drugs (beta-blockers, thionamides) If uptake is low → type 2 so give glucocorticoids. Remember to check thyroid hormone levels before administering amiodarone to establish the baseline. #Endocrinology #IM

The diagnosis of bacterial pharyngitis in children should be confirmed prior to treatment to avoid unnecessary antibiotic prescription for viral pharyngitis. Confirm with a Rapid Strep Antigen test (RSAT) or a throat culture. A positive RSAT in children → Treat with antibiotics A negative RSAT in children → Do a throat culture RSAT has low sensitivity. #ENT

Who gets a Rapid Strep test? - All symptomatic children ≥ 3 years of age and adults (unless symptoms are suggestive of acute viral tonsillopharyngitis) - Consider in symptomatic children < 3 years of age if there is a household or other close contact with proven GAS infection.  - Modified Centor score ≥ 2 (if scoring has been used) #ENT

The Centor Criteria is a scoring system used to assist with risk stratification for GAS pharyngitis. It is not reliable for preadolescents! Clinical features, including prediction rules and scoring systems, do not reliably distinguish bacterial from viral pharyngitis in children except when obvious viral manifestations (eg, conjunctivitis, rhinorrhea, cough, exanthem, oral ulcers) are present. #ENT

Diagnosing acute tonsillopharyngitis #ENT

Necrotizing soft tissue infection (NSTI) due to C. perfringens should be treated with broad spectrum antibiotics + Clindamycin because it decreases alpha toxin production. #Surgery #Skin

#Orthopedics #Neurology

Nerve injuries associated with #Orthopedics injuries

Dermatomyositis is a inflammatory myopathy that causes myalgias and symmetric proximal muscle weakness along with skin findings, such as Gottron papules and a heliotrope rash which are pathognomonic for the condition. Other skin findings includes: ~ Malar rash ~ Shawl and V sign: red-brown discoloration in sun-exposed areas like the neck and upper back. ~ Mechanic's hands: cracks/fissures on palms with increased pigmentation #Rheumatology

A patient comes to you complaining of symmetric proximal muscle weakness and the following skin findings, what is the diagnosis?

Stages of Trachoma: Trachomatous Folliculitis (TF) The presence of 5 or more follicles (>0.5 mm) in the upper tarsal conjunctiva Trachomatous Inflammation (TI) Inflammatory thickening of the tarsal conjunctiva that obscures more than 50% of the deep normal vessels Trachomatous Scarring (TS) The presence of scarring in the tarsal conjunctiva Trachomatous Trichiasis (TT) At least one lash rubs on the eyeball Corneal Opacity Easily visible corneal opacity over the pupil #Ophthalmology