Medical notes

📝 Quick note Indicattions of blood transfusion in patient with G6PD deficiency: 👉 Hb less than 7g/dl 👉 Hb less than 9g/dl with concurrent hemolysis 👉 Hb less than 9g/dl with persistent hemoglobinuria While In patient with Hb 7-9g/dl without hemolysis or hemoglobinuria, carefully manage fluid and monitor the urine colour for 48hr #hematology

What are the surgical landmarks for the tympanic segment of 7th N? 🎖Cochleariform process, oval window, pyramidal process, semicanal for the tensor tympani, vertical groove on promontory for the tympanic nerve. What are the landmarks of the tympanic segment of VII from the mastoid approach? 🎖Lateral semicircular canal (SCC) and the cog.

Cardiology Note: In *men or women* who are ≥65 years of age who have ever smoked, *or* have first-degree relatives of patients with AAA, ultrasound screening for detection of AAA is recommended/reasonable (Now it inculdes both men and women, ages at least 65, not limited to ages less than 75 years, history of family AAA is inculded) Reference: 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease

MC phobia encountered in clinical practise - Agoraphobia-60% MC psychiatric symptom in clinical practise - Anxiety Prosopagnosia is - Inability to recognise Face Sexual arousal due to exposure of one's genitalia - Exhibitionism Necrophilia - Sexual arousal with corpses Klismaphilia - sexual arousal with Enemas MC OCD is - Washers - Unmarried males MC ECG change seen with Anti psychotic drug - QT Prolongation Inability to experience pressure is known as - Anhedonia Auditory hallucinations are found in - Schizophrenia What is normal MMSE(mini mental state examination)score - >24 Dellusion is a disorder of  - thought Which is the primary symptom of Mania - Over activity Hallucination is a disorder of - Perception

Right suprarenal vein drain into IVC ; and left suprarenal vein drain into left Renal vein Suprarenal gland is supplied by suprarenal, renal, inferior phrenic artery and aorta

β-hCG is a vital sign in women with  acute abdomen. ⊕ β-hCG in the setting of shock is a ruptured ectopic pregnancy until proven otherwise.

Helicobacter pylori Management eradication may be achieved with a 7-day course ofa proton pump inhibitor + amoxicillin +(clarithromycin OR metronidazole) if penicillin-allergic: a proton pump inhibitor + metronidazole + clarithromycin

#CV_manifastations_of_Sjorens_syn *myocarditis *pericarditis, /pericardial effusion *valvular abnormalities *cardiac arrhythmias including prolonged QT interval. *heart failure *pulmonary hypertension/ pulmonary arterial hypertension (Ph and PAH impact both heart and lungs) *Congenital heart block occurs in about 2% of babies born to SSA positive mothers

signs of pulmonary hypertension As follows: • Low volume pulse. • Prominent ‘a’ wave in JVP. • Palpable P2. • Left parasternal heave (indicates RVH). • Epigastric pulsation (indicates RVH). • Loud P2 on auscultation. • EDM (Graham Steell murmur due to pulmonary regurgitation).

#remember patients with low HDL (≤40 mg/dL) and high triglyceride (  ≥200 mg/dL) levels associated  with risk of AF and its complications #EHRA

AHA/ASA Guideline for Spontaneous ICH : • If SBP = 150 - 220 mm Hg and no contraindication to acute BP treatment, acute lowering to SBP 140 mm Hg is safe (Class I ) • If SBP >220 mm Hg, it is reasonable to consider aggressive reduction of BP with continuous IV infusion (Class IIb ) Subarachnoid Hemorrhage : • Treat pain with analgesics • Consider effects of nimodipine • Control BP until aneurysm obliterated • A decrease in SBP to <160 mm Hg is reasonable • Agents: nicardipine, labetalol,esmolol, clevidipine Ischemic Stroke Guideline : • Eligible for reperfusion therapy − Lower BP if >185/110 mm Hg • During and after reperfusion therapy − Maintain BP less than 180/105 mm Hg • Others: lower BP if >220/120 mm Hg or another indication exists; lower by 15% • Suggested agents: Labetalol, nicardipine Antihypertensive in Acute Intracranial Events : • Nicardipine • Labetalol • Esmolol • Caution with nitroprusside and nitroglycerin May increase cerebral blood flow

Felty syndrome ⚪Clinical features Rheumatoid arthritis Severe erosive joint disease & deformity Rheumatoid nodules Vasculitis (mononeuritis multiplex, necrotizing skin lesions) Neutropenia (ANC <2000/µL) Splenomegaly ⚪Diagnosis Anti-CCP & RF are positive in >90% of patients Markedly elevated ESR, often >85 mm/hr Peripheral smear & bone marrow biopsy to rule out other causes of neutropenia ANC = absolute neutrophil count; anti-CCP = anticyclic citrullinated peptide; ESR = erythrocyte sedimentation rate; RF = rheumatoid factor. This patient with swollen, deformed hand joints and an elevated erythrocyte sedimentation rate likely has untreated inflammatory polyarthritis.  The presence of concurrent neutropenia and splenomegaly raise strong suspicion for Felty syndrome, an uncommon but serious complication of long-standing, erosive rheumatoid arthritis (RA). Felty syndrome is marked by the formation of autoantibodies against neutrophil components and granulocyte colony-stimulating factor, leading to neutropenia (ie, absolute neutrophil count <2,000/mm3) and an increased risk of recurrent bacterial infection (particularly of the skin and sinuses).  Neutrophils coated with antibodies are also trapped in the spleen, which usually results in splenomegaly.  Most patients also have extraarticular manifestations of RA such as lymphadenopathy, rheumatoid nodules, and/or necrotizing skin lesions. The diagnosis is made based on clinical features but is supported by the presence of high-titer rheumatoid factor and anticitrullinated peptide antibodies (both of which are usually elevated in RA).  Most patients are also HLA-DR4 positive (indicating a genetic susceptibility).  Other causes of neutropenia should be ruled out with bone marrow biopsy and peripheral smear prior to establishing the diagnosis.  Symptoms generally improve with treatment of the underlying RA.

✔️HbA1c Is Affected By Many Factors: ▪️Elevated HbA1c Can occur in Iron Deficiency, Vitamin B12 Deficiency, Alcohol Dependence, Chronic Renal Failure, Hyperbilirubinaemia, Splenectomy. ▪️Reduced HbA1c Can occur in Chronic Liver Disease, Hypertriglyceridaemia, Some Haemoglobinopathies, Splenomegaly, Rheumatoid Arthritis. 👌

Pregnancy cause moderate thrombocytopenia

The most common cause of unilatral pulm.edema is Prolonged unilatral depandant position

#Pneumonia Rusty-colored sputum: found in streptococcus pneumonia infection Currant jellylike sputum: found in klebsiella pneumonia infection Foul-smelling sputum: found in patients with aspiration pneumonia

Marfan Syndrome "MARFANS" 🔷Mitral Valve Prolapse 🔷Aortic Dissection 🔷Regurgitant Aortic Valve 🔷Fingers Long ( Arachnodactyly ) 🔷Arm Span>Height 🔷Nasal Voice ( High Arched Palate ) 🔷Sternal Excavation #notes

❇️SVT: Management ✅Acute management➝ ◾Vagal manoeuvres: eg. Valsalva manoeuvre, Carotid sinus massage ◾I/V Adenosine: 6mg→12mg→12mg, contraindicated in Asthmatics (Verapamil is a preferable option) ◾Electrical cardioversion ✅Prevention of episodes➝ ◾β-blockers ◾Radio-frequency ablation #med #cardio (FCPS, MRCP)

Classical triad of carotid artery dissection include 1- partial Horner syndrome 2- headache 3- contralateral weakness . Partial Horner syndrome mean miosis and ptosis but without anhidrosis