HiMed NUCOM 32

Constructional apraxia in patient with hepatic encephalopathy #medicine Thanks to @Taqwa307 for sharing this photo

Viral hepatitis scenarios: 1-Viral hepatitis then present as sore throat petechial spots and easy fatigability= aplastic anemia(AA) as HB<10, platelets <100 and neutrophils<1500 2- 40 yrs old male diagnosed case of hepatitis B presented with fever night sweats weight loss, bilateral knee pain and swelling,palpable purpura and red color urine= polyarteritis nodosa causing systems symptoms, vasculitic rash and glomerulonephritis 3- patient has long standing hepatitis C recently started developing night sweats and palpable purpura on his legs with bilateral knee swelling and pain= Essential cryoglubulinemia Note: PAN=MAN always in men in association with hepatitis B 4- patient has chronic hepatitis then started to develop petechial rash, episodes of epitaxis and prolonged bleeding from any simple scratch= secondary immune thrombocytopenic purpura (ITP) 5- patient with long standing hepatitis C started to notice multiple lumps in his neck and axilla= lymphoma secondary to hepatitis C #medicine

🔸Causes of diarrhea in diabetes mellitus. ABCD Autonomic neuropathy. Bacterial overgrowth. Celiac disease (autoimmune). Drugs : e.g. metformin induced diarrhea. #medicine

🔸Liver disease with pleural effusion: Amoebic liver ebscess ➡️right sided pleural effusion (exudate). Liver cirrhosis + Ascites ➡️right sided pleural effusion (transudate). Liver cirrhosis + Ascites with left sided pleural effusion, ➡️suspect lung diseas.e e.g.putmonery T.B. (exudete) Liver cirrhosis ➡️bilateral pleural effusion due to hypoproteinemia (transudate). #medicine

🔸Jaundice + leucocytosis : Amoebic liver abscess. Leptospirosis. Ascending cholangitis. Fulminant liver failure. #medicine

*Refractory ascites in cirrhotic patients: ascites not responding to max dose of diuretics (Spironolactone 400 mg and furosemide 160 mg) Or development of azotemia despite submaximal dose of diuretics Causes of refractory ascites: spontaneous bacterial peritonitis, portal vein thrombosis, hepatocellular carcinoma Mx: paracentesis or doing TIPS procedure (transjugular intrahepatic portosystemic shunt) Caution: TIPS is one of precipitating factors of hepatic encephalopathy #medicine

Causes of renal impairment in Multiple Myeloma(MM): Hypercalcemia Hyperuricemia Cast nephropathy Nephrotoxic drugs Amyloidosis Pyelonephritis #Medicine

Obese+ headache =OSA, pseudotumor cerebri, htn Obese+ polyuria= DM2 Obese+ abdominal pain=cholecystitis, pancreatitis, Obese+ jaundice=Non alcoholic cirrhosis Obese+ joint pain= OA, gout Obese+ proteinuria=FSGS, DM nephropathy Obese+ irregular mense, hirsutism and acne = PCOS Obese+ chest pain=IHD, GERD Obese+ cough= obesity-related asthma, GERD Obese+ dermatological manifestations= acanthosis nigricans, skin tags(acrochordon), striae, calluses and corns Obese+ malignancy association = colon, renal, breast, endometrial, prostate Cancers #medicine

1-This rash is scattered all over the body of the child, which is transient raised erythematous swelling of the dermis which is urticaria (hives) Viral exanthem and scarlet fever are potential DDX as Mustafa and Ali said but they usually have maculopapular appearance and scarlet fever has characteristic goose-pimple appearance Actually one of the viral exanthem causes to be considered is roseola infantum especially if there was hx of preceding high grade fever 2- In history you should ask about triggers of this condition like: Any recent infection? Hx of new food added to the diet? Hx of drug ingestion especially aspirin and NSAID Hx of bee or insect bite? Does this rash appear by physical stimuli (heat, cold ,pressure) Is this rash itchy?(usually wheals are very itchy) How long does each wheal last ?(usually each wheal in skin lasts max 24 hrs then dissappear and start to reappear in other skin areas)

This child presented with this rash. 1-Describe the rash with the Dx 2-Important points in history to be asked #spot_diagnosis #pediatrics

Anti hypertensive drugs that cause gingival hypertrophy : Nifedipine Felodipine Amlodipine, Verapamil, Diltiazem #Medicine

Causes Of Eosinophilia : Asthma Worm infestation Sarcoidosis Ulcerative colitis Crohn's disease Churg-strauss syndrome Psoriasis Polyarteritis nodosa Pulmonary esinophilia Hodgkin disease Sulfonamides , quinine #Medicine

Uses of Mg in medicine : Torsades de pointes Last medical therapy in asthma Eclampsia Refractory hypokalemia Refractory hypocalcemia hypomagnesemia Antacids Constipation as its side effect is diarrhoea #medicine

(حَتَّىٰٓ إِذَا ٱسْتَيْـَٔسَ ٱلرُّسُلُ وَظَنُّوٓاْ أَنَّهُمْ قَدْ كُذِبُواْ جَآءَهُمْ نَصْرُنَا فَنُجِّىَ مَن نَّشَآءُ ۖ وَلَا يُرَدُّ بَأْسُنَا عَنِ ٱلْقَوْمِ ٱلْمُجْرِمِينَ)) جرت مشيئة الله في خلقه منذ بدأ الخليقة والى يومنا هذا بنصر المؤمنين بعد ان تضيق عليهم الأرض وبعد أن يمتحنوا في إيمانهم مشيئة لم يستني الله منها أحب خلقه اليه من الأنبياء والاوصياء والصالحين فمنهم من قطع بالمناشير ومنهم من عذب ومنهم ذبح هو وأهله وسبية عائلته فلم يزدهم ذالك الا إيمانا فوق إيمانهم فلم يدخلهم الشك في الله ولسنا أعز على الله من صفوة خلقه رغم الفواجع والمصائب التي تحل بأهلنا في غزة لا تجعلو حبائل الشيطان تلتف عليكم وتجعلكم توسيؤون ظنكم بالله وتستعجلونه وتشككون في قدرته هو إمتحان وإبتلاء لكم كما هو الحال بالنسبة لهم وليكن جل همكم التسليم لله ولقضاءه وإجعلوا الإمام الحسين مثالًا لكم في مذبحة كربلاء حين قال (رب إن كان هذا يرضيك فخذ حتى ترضى) لا إعترض على حكم الله وفوضوا أمركم لله فهو خير حافظا وهو أرحم الراحمين وما هذه الدنيا الا صبر ساعة وما عند الله خير وابقى وإنا لله وانا اليه واجعون

Proximal muscle weakness +normal reflexes? =MG, Inflammatory myopathy, Osteomalacia, Endocrinal myopathy Proximal muscle weakness +hyperreflexia? = Thyrotoxicosis Proximal muscle weakness +absent or hyporeflexia? = GBS, Lambert-Eaton, Botulism, Hypokalemia #Medicine

Excellent mohamed Sadeq This infant has large eye (buphthalmos) and corneal oedema consistent with congenital glaucoma

#spot_diagnosis #pediatrics This infant has?

1- cardiomyopathy 2- cerebellar degeneration =ataxia 3- gout 4- peptic ulcer disease, variceal bleeding, Mallory-Weiss tears, alcoholic erosive gastritis 5- peptic ulcer , gastritis, pancreatitis 6- pneumonia (aspiration or klebsiella pneumonia) 7- hypoglycaemia, Wernicke's encephalopathy, SDH 8- peripheral neuropathy 9- macrocystosis 10- cluster headache 11- alcoholic-myopathy

1-Alcoholic and HF? 2-Alcoholic and unsteadiness? 3-Alcoholic and painful toe? 4-Alcoholic and maelena ,hematemesis? 5-Alcoholic and abdominal pain? 6-Alcoholic and SOB+fever? 7-Alcoholic and DLOC? 8-Alcoholic and numbness? 9-Alcoholic and CBC finding 10-Alcoholic and headache? 11-Alcoholic and inability to sit up from chair? #medicine