Medicine كلام السناير

🔴Erythema nodosum -group A streptococcus 🔴Erythema marginatum - acute rheumatic fever. 🔴Erythema migrans (bull eye) - lyme disease 🔴Erythema toxicum - newborn pustules. 🔴Erythema multiforme -viral infections & drugs.. 🔴Erythema infectiosum - fifth disease 🔴Erythema ab igne - long term exposure to heat 🔴Erythema induratum -cutaneous tuberculosis

#Atrial_fibrillation:- Irregular Irregular R to R wave Narrow QRS Absent P wave. #Atrial_flutter:- Irregular Irregular R to R wave Narrow QRS Multiple normal shape P wave. #multifocal_atrial_tachycardia:- Irregular Irregular R to R wave Narrow QRS Morphologically distinctive P wave.

♥️Dominant R wave in V1 is seen in: • Wolff-Parkinson-White syndrome Type A (posterior or lateral wall pre-excitation) • Hypertrophic cardiomyopathy • Posterior Myocardial infarction • Duchenne Muscular dystrophy • Right bundle branch block • Myotonic dystrophy • Right ventricular hypertrophy.

Treatment of anal fissure Diltiazem 2% rectal cream BID for 2 months Or GTN 0.2% rectal cream BID for 2 months ( rectogesic)

🔴There are 4 types of distributive shock: Neurogenic shock: Decreased sympathetic stimulation leading to decreased vasal tone. Anaphylactic shock Septic shock Shock due to adrenal crisis

*_Infections in patients with HIV:_* 1. *if CD4 less than 300* : 🔴Eosinophilic folliculitis 2. *if CD4 more than 200* : 🔴Kaposi Sarcoma 🔴Cryptococcus Meningitis 🔴Mycobacterium Tuberculosis 🔴Herpes Zoster 2. *if CD4 less than 200*: 🔴Pneumocystis jiroveci 3. *if CD4 less than 100*: 🔴Cytomegalovirus (encephalitis, retinitis,adrenalitis, eosophagitis, colitis) 🔴Toxoplasmosis: multiple ring enhancing lesions on brain MRI 4. *if CD4 is less than 50*: 🔴Mycobacterium avium intracellulare (diarrhea + pancytopenia) 🔴Cryptosporidiosis (diarrhea) *♥️EBV* : causes primary CNS lymphoma (single homogenous lesion on brain MRI)

#Just_Remember #Permessive_hypertension *Is an approach of treating hypertension in acute ischemic stroke , in which antihypertensive treatment is warranted in patients with systolic blood pressure greater than 220 mm Hg,or diastolic blood presure greater than 120mmhg in the pts receiving thrombolytic therapy, or with concomitant medical issues The goal would be to lower blood pressure by 15% during the first 24 hours after onset of stroke ,* it is recommended that the blood pressure be reduced and maintained below 185 mm Hg systolic for the first 24 hours. The first-line drugs for lowering of blood pressure remain labetalol, nicardipine, and sodium nitroprusside.

Sudanese protocol of managment

*Home Management Protocol for Positive Covid-19 Adult Patients* : *( A) Asymptomatic Positive Covid Patients* :- • Complete isolation. • Complete rest. • Good nutrition. • Good oral hydration. • *Novaldol* 1gm PRN or up to every 6hrs • Vitamin C 2gm per day. • Zinc 200mg per day ( *Octozinc* 110mg cap 2*1 for 5-7 days • vitamin D ( *Devarol* 200,000IU IM once/week or equivalent oral dose ) • Strict control and follow up of any Co-morbid conditions. *( B) Symptomatic Non Pneumonic Covid Patients*:- • Same as (A) + • *Zithromax* 500mg 2*1*5 • Third generation *Cephalosporins* for 5-7 days either Oral/IM/IV according to severity of symptoms and degree of rise of inflammatory markers or according to the availability of home nursing. • Cough syrp according to type of couph. • Proton pump inhibitors or any gastroprotectives. • If DDimer high start therapeutic anticoagulation (*Clexan* 1mg/kg/12hr or *Rivarospire* 20mg tab 1*1 for 5-7 days). • Steroids could be used if there is significant extra-pulmonary manifestations such as :- - Symptoms of viral neuritis ( loss of smell and taste). - Excessive fatigue. - Significant diarrhea. (Solupred 1 mg /Kg/ day max 60mg per day for 5-7 days) • Tight monitoring of oxygen saturation ( if available ). • Follow up Labs:- ( CBC,CRP, s.Ferritin, Ddimer and labs of associated comorbidities ) every 48 hours. • Follow up CXR every 72 hours. *( C) Pneumonic Covid Patients [ Better to be hospitalized if available]* :- • Same as ( B) + *Hydroxy Chloroquine* —> (Loading 6.5-10 mg/kg/12 hr 1st day max : 400mg/dose then 3.25-5 mg/kg/12hr max: 200mg / dose for 5 to 7 days. • Therapeutic anticoagulation regardless DDimer result. • Systemic steroids if no improvement in inflammatory markers or progression of lung infiltrates . (*Solupred* 1 mg /Kg/ day max 60mg per day for 5-7 days) *Hospital Admission Criteria* :- - If no symptomatic and/or Lab improvement despite 72 hours of regular management. - Any degree of Dyspnea or oxygen Desaturation < 90 % on room air at any time or any deterioration of comorbid diseases control . - Patients in Groups (B) and (C) if were at the high risk group ( Children , Old age , Co morbid diseases or Pregnant) Better to be admitted from the start.

‏صورة من مروة عبدالحميد

السلام عليكم اليوم حبيت أنطيكم طريقة مبسطة ل interpretation of ABG (Arterial Blood Gases) للي عنده صعوبة بتحليلها ان شاءالله يفيده هالبوست 🙏 عدنا 3 عوامل رح نعتمد عليها (PH, PCO2, & HCO3) لازم تعرفون النورمال رينج لكل واحد بيهم وعلى شنو يدل: ●normal blood PH (7.35-7.45) يعني اذا قل PH عن lower limit فهذا يعني acidosis , واذا زاد فهو alkalosis باختصار 🙂 وعدنا أيضا: ●normal PaCO2 (35-45 )mmHg هو المسؤول عن acidosis , ويدل على respiratory ●Normal HCO3 (22-29)meq/L or mmol/L هو المسؤول عن alkalosis ويدل على metabolic بعدها نبدأ بالخطوات التالية: 1] اول شي نشوف PH هل هي acidosis or alkalosis 2] بعدها نشوف منو يتناسب ويه التغيير الحاصل ب PH 🤔 مثلا اذا acidosis حيتناسب وياها اما زيادة ب PCO2 او نقصان ب HCO3 و اذا alkalosis حيتناسب وياه العكس اما نقصان PCO2 او زيادة HCO3 اذا شفنا التغيير صار ب PCO2 فهذا معناه respiratory, واذا HCO3 معناه metabolic مثل ماذكرنا سابقا 3] النقطة الثالثة اذا احنه حنكول respiratory or metabolic acidosis or alkalosis هذا اذا صار تغيير ب PH مع واحد بس من الاثنين PCO2 او HCO3 والثاني يكون بالنورمال رينج 💁 اما شوكت حنكول compensated resp./metabolic acidosis/alkalosis اذا كان PH within normal but near to upper or lower limit اضافة الى انه PCO2 & HCO3 ثنينتهم high او low مع بعض 🙌, حنتعامل ويه PH اللي قريب من lower limit على انه acidosis , واللي قريب من upper limit على انه alkalosis ونشوف منو يتناسب وياه من PCO2 او HCO3 مثل ماشرحنا سابقا بس حنضيف قبله كلمة compensated , لان الجسم بهالحالة ديحاول يصلح الامور ويوازنها ويرجعها للمستوى الطبيعي أتمنى تكون وصلت المعلومة واستفدتوا🤗 وعذرا على الإطالة وجمعتلكم هالشرح كله بهذا الجدول للاختصار و تسهيل الفهم 😊 طبعا اذا جينا على التفاصيل بهالموضوع فهي كثييرة وبيها معادلات وكومة شغلات بس اني حاولت انطيكم المعلومات بشكل مبسط وسهل , اما بالنسبة للأرقام هذه بالنسبة لل adults, و من مدسكيب , المراجع تختلف , والpediatric age group , and sex يختلف شي بسيط حتشوفوها بمدسكيب .... بالتوفيق ,,,, #Cpd

تجربة شخصية مع لوكال المدسن و mrcp1 لممتحني شهر ١٢ المقبل بالضبط هي كانت شهرين فقط والحمد لله خلصت بالنجاح : فهم عام المواد المعروفة Note and note or Step up or Only note or Oxford And :بنوك الأسئلة وهي pass test Pass medicine On exam الكتب التلاتة الأولى كلها بتجمع كمية إجابات للأسئلة من بنوك الأسئلة المعروفة مع بعض الإضافة يعني معلومات دسمة جدا كلها مهمة مع ملاحظة الحشو الكثير في Step up and note and note فافضل حاجة للشهرين only note مادة بسيطة مركزة طيب علي حسب تجربتي وتحليلي مصدر الرئيسي لل cases والمعلومات هو دافدسون و أوكسفورد -بمعنى انو صياغة الأسئلة من المصادر دي - يلا بتجي تلقى انو بنوك الأسئلة كالاتي Pass test يحتوي علي typical cases يعني بتكون الحالة واضحة بديك كل المعطيات اما Onexam ودا أصعب واحد ودا يحتوي علي atypical cases or unusual questions يعني بتلقى سيناريو للحالة بمعطيات بسيطة وشحيحة ومرات بتلقى أسئلة صعبة جدا اما Pass medicine بجيب الحالات عشان يناقش ال guidelines يعني لو عايز تعرف القايدلاين شوف باس مدسن الخلاصة Davidson or / and Oxford main sources of information Pass test typical cases /questions Onexam atypical cases /questions Pass medicine guidelines

Artsunate injection for sever malaria : حسب الوزن : لو اقل من 20 كيلو : الوزن *3 لو اكتر من 20 كيلو : الوزن* 2.4 الناتج البجيك ده بالملغم، تقسم على 10 عشان تجيك بالسي سي مثلا جاتك 60 ملغم يعني 6 سي سي بتتلقي ف المستشفيات الحكومية و الخاصه،، م الأمين حامد للاطفال امدرمان، مستشفي قطر الندي امبده، مستشفيات شارع الحوادث الخرطوم اول شي تحل البودرة بالبايكاربونيت كويس لحدي ما الخليط يبقي clear بعديها تحل المويه المعاه... و تديها بالوريد ببط خلال دقيقتين ل 5 دقايق الجرعة كالاتي الان ثم بعد 12 ساعة ثم بعد 12 ساعة بعداك حسب الإستجابة، لو العيان بقي احسن و بقدر يبلع ياخد كوراتم حبوب حسب وزنو و أذا ما قدر ح يستمر في الارتسيونيت بمعدل حقنه مره في اليوم لحدي ما يبقي كويس بس الحد الأقصي 7 جرعات

💢 دا #Protocol علاج #كرونا 👆👆👆

reached the threshold of 58 mmol/mol (7.5%) a type 2 diabetic is found to have a HbA1c of 62 mmol/mol (7.8%) at annual review. They are currently on maximum dose metformin. You elect to add a sulfonylurea Cannot tolerate metformin or contraindicated if the HbA1c rises to 48 mmol/mol (6.5%)* on lifestyle interventions, consider one of the following: ? sulfonylurea ? gliptin ? pioglitazone if the HbA1c has risen to 58 mmol/mol (7.5%) then a one of the following combinations should be used: ? gliptin + pioglitazone ? gliptin + sulfonylurea ? pioglitazone + sulfonylurea if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%) then consider insulin therapy Starting insulin metformin should be continued. In terms of other drugs NICE advice: 'Review the continued need for other blood glucose lowering therapies' NICE recommend starting with human NPH insulin (isophane, intermediate acting) taken at bed-time or twice daily according to need Risk factor modification Blood pressure target is < 140/80 mmHg (or < 130/80 mmHg if end-organ damage is present) ACE inhibitors are first-line Antiplatelets should not be offered unless a patient has existing cardiovascular disease.

#Management_of_type2_Diabetes_mellitus: NICE updated its guidance on the management of type 2 diabetes mellitus (T2DM) in 2015. Key points are listed below: HbA1c targets have changed. They are now dependent on what antidiabetic drugs a patient is receiving and other factors such as frailty there is more flexibility in the second stage of treating patients (i.e. after metformin has been started) - you now have a choice of 4 oral antidiabetic agents It's worthwhile thinking of the average patient who is taking metformin for T2DM, you can titrate up metformin and encourage lifestyle changes to aim for a HbA1c of 48 mmol/mol (6.5%), but should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%) Dietary advice encourage high fibre, low glycaemic index sources of carbohydrates include low-fat dairy products and oily fish control the intake of foods containing saturated fats and trans fatty acids limited substitution of sucrose-containing foods for other carbohydrates is allowable, but care should be taken to avoid excess energy intake discourage use of foods marketed specifically at people with diabetes initial target weight loss in an overweight person is 5-10% HbA1c targets This is area which has changed in 2015 individual targets should be agreed with patients to encourage motivation HbA1c should be checked every 3-6 months until stable, then 6 monthly NICE encourage us to consider relaxing targets on 'a case-by-case basis, with particular consideration for people who are older or frail, for adults with type 2 diabetes' in 2015 the guidelines changed so HbA1c targets are now dependent on treatment: Lifestyle or single drug treatment Management of T2DM HbA1c target Lifestyle 48 mmol/mol (6.5%) Lifestyle + metformin 48 mmol/mol (6.5%) Includes any drug which may cause hypoglycaemia (e.g. lifestyle + sulfonylurea) 53 mmol/mol (7.0%) Practical examples a patient is newly diagnosed with HbA1c and wants to try lifestyle treatment first. You agree a target of 48 mmol/mol (6.5%) you review a patient 6 months after starting metformin. His HbA1c is 51 mmol/mol (6.8%). You increase his metformin from 500mg bd to 500mg tds and reinforce lifestyle factors Patient already on treatment Management of T2DM HbA1c target Already on one drug, but HbA1c has risen to 58 mmol/mol (7.5%) 53 mmol/mol (7.0%) Drug treatment The 2015 NICE guidelines introduced some changes into the management of type 2 diabetes. There are essentially two pathways, one for patients who can tolerate metformin, and one for those who can't Tolerates metformin: metformin is still first-line and should be offered if the HbA1c rises to 48 mmol/mol (6.5%)* on lifestyle interventions if the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should be added from the following list: ? sulfonylurea ? gliptin ? pioglitazone ? SGLT-2 inhibitor if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%) then triple therapy with one of the following combinations should be offered: ? metformin + gliptin + sulfonylurea ? metformin + pioglitazone + sulfonylurea ? metformin + sulfonylurea + SGLT-2 inhibitor ? metformin + pioglitazone + SGLT-2 inhibitor ? OR insulin therapy should be considered Criteria for glucagon-like peptide1 (GLP1) mimetic (e.g. exenatide) if triple therapy is not effective, not tolerated or contraindicated then NICE advise that we consider combination therapy with metformin, a sulfonylurea and a glucagonlike peptide1 (GLP1) mimetic if: ? BMI >= 35 kg/m² and specific psychological or other medical problems associated with obesity or ? BMI < 35 kg/m² and for whom insulin therapy would have significant occupational implications or weight loss would benefit other significant obesityrelated comorbidities only continue if there is a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months Practical examples you review an established type 2 diabetic on maximum dose metformin. Her HbA1c is 55 mmol/mol (7.2%). You do not add another drug as she has not

#primary_hyperparathyroidism: high ca + high or normal PTH causes: parathyroid adenoma #secondary_hyperparathyroidism: low ca + high PTH causes :low intake of vit D and CKD #tertiary_hyperparathyoidism: high ca + very high PTH causes : occur after prologed secondary hyperparathyroidism(CKD) #malignant_hyperparathyroidim: high ca + low PTH causes: PTHrp produced from SCC, CA breast, RCC.