Medical notes

danger sign of asthma:: 1..silent chest 2..cyanosis 3..inability to talk or walk 4.. exhaustion 5.. tripod position ☝🏽@clinicalnote

Red Flags in Vertigo : * Age more than 55 years * Vertical Nystagmus * Cerebellar Signs * Abnormal Gait @clinicalnote

Differential diagnosis of acute abdominal pain

Causes of Hypocalcemia  : * Chronic kidney disease * Hypoparathyroidism * Hypomagnesemia * Pancreatitis * Vitamin D deficiency

🔺🔺TRIADS🔻🔻 ✅Wernicke’s encephalopathy: GOA : Global confusion opthalmoplegia Ataxia ✅Beck’s triad : Hypotension + muffled heart sound + distended neck veins ✅ Kartagenar syndrome: Sinusitis Ciliary dyskinesia Situs inversus ✅Miller fisher syndrome : Ataxia Areflexia opthalmoplegia ✅Terrible lethal triad of trauma : Acidosis Coagulopathy Hypothermia

Complications of sickle cell disease requiring  inpatient management •  Pain – uncontrolled by non- opiate analgesia •  Swollen, painful joints •  Acute sickle chest syndrome or pneumonia •  Mesenteric sickling and bowel ischaemia •  Splenic or hepatic sequestration •  Central nervous system deficit •  Cholecystitis (pigment stones) •  Cardiac arrhythmias •  Renal papillary necrosis resulting in colic or severe  haematuria •  Hyphaema and retinal detachment •  Priapism

mnemonic to remember drugs causing QT prolongation.                                         Chloroquine Ondan Loratidine (antihistamine) Levoflox Amiodarone Psychiatric (haloperidol) Sertraline Erythromycin COLLAPSE

The petrous part of the Temporal bone separates middle cranial fossa from the posterior cranial fossa.

#snake bite ✅ The history is straightforward. (80% of the snake bites are non-venomous). ✅  Examine the site of bite to check if the bleeding starts or not and check if there is other site of bleeding (open the mouth, ascultate chest, ask about the abdominal pain, ask about melena) because the bleeding can be either internal or external.                🔻 At the site of bite often there will be pain, swelling, echyomosis and maybe bleeding. ✅ Management:         1️⃣ Reassurance         2️⃣Check vital signs first because there is risk for anaphylactic shock.         3️⃣Two IV line and take blood samples to send for investigations:                  🔻CBC (check for thrombocytopenia could be severe, number of RBC is low due to hemolysis due to MAHA).                  🔻PT, PTT, INR (There will be consumption of platelets and clotting factors ➡️ There will be risk for thrombosis and bleeding, but mostly bleeding).                  🔻RFT, urinalysis (checking for hematuria), if there is bleeding send for blood group.                  🔻If the patient has massive local edema send for creatine kinase and serum potassium and check ECG.      4️⃣ Immobilize the bitten limb: The only first aid you can do it to the patient at the home is immobilisation and treat it like a fractured limb (to decrease the circulation in order to decrease the absorption).               🔻 The tourniquet is prohibited because it will mask the real edema and can obstruct arterial flow and cause ischemia.               🔻 Do not remove tourniquets or constricting bands until anti-venom is available, except where there is clear arterial vascular compromise threatening limb viability. هاي اذا جاك المريض و شادين رجله او ايده لا تشيلها مباشرة      5️⃣ Opoid for the pain (tramal + plasil)      6️⃣ Anti venom is the corner stone. But not all patient are indicated for anti venom, check the table below. If the patient is indicated how to give it:              🔻 send for 5 vial at least.              🔻 Put 5 vials with 100 cc of NS and infuse them over 30 - 60 minutes, first drops given slowly. No need for sensitivity test although there is high risk for anaphylaxis. لذلك لازم انت محضر الادرينالين قبل لا تنطي              🔻 When you give ASV the patient needs serial blood pressure measurement and keep asking him about back pain or abdominal pain.              🔻 The response for ANS is clinical like cessation of bleeding, or no new bleeding —> After completing the infusion of 5 vials now check the patient by pinch him from the sternum to check for bleeding:                           🟢 If there is response and no bleeding: Now give the patient the maintenance dose (2 vial/ 6 hour of ASV) until normalisation of bleeding profile (PT, PTT,..), or three days if the lab test doesn't normalise.                           🟢 If there is no response: repeat the loading dose (the 5 vials).                           🟢 If also doesn't response after the second load dose give FFP.              🔻 There is no window period for but it is preferred within the first 6 hours of bite ASV. شوكت ما يجي المريض انطي          7️⃣ Hydrocortisone + allermine      8️⃣The patient needs serial history taking and examination because he can deteriorated very rapidly.            🔻Outline the advancing border of edema with a pen every 30 minutes.            🔻Repeat laboratory investigations every 4 hours            🔻And if the patient is asymptomatic at least keep him for 6-8 hours in the ED.      9️⃣ Give anti tetanus prophylaxis give it after normalisation of bleeding profile because there is contraindication for IM injections.      🔟 No need for antibiotics prophylaxis. And always check for compartment syndrome

Beta-blockers inhibit the sympathomimetic nervous system and block alpha1-adrenergic vasoconstrictor activity. These agents have moderate afterload reduction properties and cause slight preload reduction. In addition to decreasing mortality rates, beta-blockers also reduce hospitalizations and the risk of sudden death; improve LV function and exercise tolerance; and reduce heart failure functional class. Although other beta-blockers with similar pharmacologic properties might hypothetically be beneficial in heart failure, the target doses have not been identified in clinical trials Medscape

Any pt has heart failure and on Beta blockers and admitted as case of decompensated failure you must keeping or decreasing the dose of beta blockers but don’t don’t increasing the dose or stop them due to increasing the risk of mortality rate

DD of empty scrotum in napkin area examination - retractile testis - undescended testis - ectopic - testicular agensis - orchidectomy @clinicalnote

Alvaradoo score: 1-Symptoms: • Abdominal pain migrating to the right iliac fossa »1  • Anorexia »1  • Nausea or vomiting »1 2-Sings: • Tenderness in the right iliac fossa »2  • Rebound tenderness(Blumberg) »1  • Fever 37 or more »1 3- Laboratory: • Leukocytosis >10000 »2  • Neutrophilia >70% »1 Total 10 • A score 5-6 is compatible with diagnosis. • A score 7-8 indicated probable appendicitis. • A score 9-10indicate very probable acute appendicitis .

Causes of Nonalcoholic fatty liver disease "NFLD"⤵️ : •Overweight or obesity. •Insulin resistance. •High blood sugar . •Medications. •Viral hepatitis. •Autoimmune or inherited liver disease. •Fast weight loss. •Malnutrition.

In HOCM a double apical impulse may be felt as a result of a palpable S4.

♠DVT : is more common on Lt. side because of the anatomical fact that the Rt. common iliac artery crosses over and compresses the Lt. common iliac vein.  ♠ Etiology : Virchow's traid " 3V • velocity • viscosity  • vessel wall " ♠C/P: •Mainly asymptotic . •🔺pain, swelling,  tenderness & Homan sign.  ♠Complication: • General >> PE. • Local >> - phlegmasia alba dolens. - phlegmasia cerulae dolens. - venous gangrene. ♠Investigation : • Dopplex " accurate in 80-85%" • Duplex " accurate in 90-100%" most error are in below knee veins. • Recently >> spiral CT " most accurate " • Venography "it's the gold stander but invasive " . @clinicalnote

#SUR 1. Charcot's cholangitis triad ( Right Upper Quadrant Pain, Fever, Jaundice ) = Ascending cholangitis 2. Charcot's neurologic triad ( scanning speech, intention tremor, nystagmus ) = Multiple sclerosis @clinicalnote

✴Signs and symptoms of acute pancreatitis: •Upper abdominal pain that radiates into the back; it may be aggregate by eating fatty meals . •Swollen and tender abdomen. •Nausea and vomiting. •Feverish,  tachypnoeic,  cyanosis. •Increased heart rate. •Discoloration of the flanks or around umbilicus. •Shift dullness may be detect on percussion due to free fluid in peritoneal cavity. @clinicalnote

#SUR #MED 🔎Most common cause of Peptic ulcer is - H.pylori (it causes 90% of Duodenum ulcer and 70% of Gastric ulcer) 🔎Most common site of Peptic ulcer - Anterion wall of Proximal half of the 1st part of the Duodenum. 🔎Most common site of Gastric ulcer- Lesser curvature. 🔎Most common complication - Bleeding. 🔎Posterior wall Duodenal ulcer have more tendency to bleed. 🔎Source of Bleeding in Duodenal ulcer - Gastroduodenal artery. 🔎Source of Bleeding in Gastric ulcer - left Gastric artery. 🔎Most common life treating complication of Peptic ulcer is - Perforation ; more commonly from anterior wall Duodenal ulcer.

Beta-blockers contraindicated in acute MI if: Systolic BP < 110 Pulmonary edema Bradycardia/Heart block Cocaine use