Important knowledge

Causes of low c3 in GN CHAMPS Cryoglobulin induced GN Heavy chain induced GN Atherembolic disease (endocarditis) MPGN Post infection GN SLE nephritis

Levels of conscious مختلف بيها جدا

⚡️Ddx of Upper GIT bleeding + normal endoscopy (د محمد عبدالله ) ▪︎epistaxis ▪︎Dieulafoy`s disease ▪︎mallory wiess tears ( ال tear تكون hidden بال mucosa متبين بالناظور ) ▪︎biliary bleeding ▪︎Hemosuccus pancreaticus ( نزف من البنكرياس عن طريق ال ampulla of Vater )

⚡️Bleeding per rectum + shock = upper GIT bleeding ( do OGD)

⚡️اي مريض جا ينزف وشاكين بي shock وقسنه ضغطة لكيناه normal نوكفه ونقيسله الضغط لانو اول تغير بالضغط بال shock هو postural hypotension

⚡️Necrobiosis lipoidica diabeticorum ▪︎reddened plaques, with a yellowish central ▪︎atrophic skin ▪︎ telangiectasia ----- Skin manifestation of DM pt. (Mainly women with type 1 DM ) [يحبها د. محمد عبدالله]

محمد عبد الله Gold standard Ix for GERD > 24h PH monitoring ( Davidson = endoscopy!!) For Barrett esophagus > endoscopy يرجى التاكد

⚡️Endoscopy is the investigation of choice for GERD (not 24 h ph monitoring) لانو بعض ال pt. ال reflux مالتهم يكون alkaline او weak Acidic وليس Acidic فمراح يفيدنا بالتشخيص فنعتمد على الناظور

⚡️RV infarction -------------------------- ▪︎dyspnia with clear chest + hypotension + raised JVP ▪︎ST elevation in V1 more than in V2 ( in anterior MI more in V2>V1 ) ▪︎persistent hypotension after giving GTN or B blocker وبعد ميصعد ▪︎+- nausea , vomiting , hiccups

⚡️posterior MI can presented with large R wave in V1 V2 leads (anterior leads) الي بالعادة ماعدنا R wave بال V1 V2 او تكون كلش صغيرة As R wave in anterior leads is mirror of Q wave in posterior leads ( الي احنة اصلا ماعدنا post. Lead لازم نخلي leads اضافية V7 V8 V9 حتى نشوف ال post. MI )

Signs of Co2 retention اذا لكيتهن بمريض مختنك فهذا ممكن يكون COPD فممنوع تنطيه اوكسجين عالي لان ممكن تقتله

⚡️ The most common cause of hand deformity is Trauma

⚡️ ⬆️ troponin in situations other than MI ▪︎pulmonary embolus ▪︎ septic shock ▪︎ pulmonary oedema.

⚡️persistent ST elevation on the ECG after MI is due to Ventricular aneurysm

⚡️Budesonide is the only approved nabulized steriod (given in nebulizer )

⚡️Reversability test is contra-indicated in acute state (asthma or COPD) and also done 2w after resolution

⚡️Asthma-COPD overlap syndrome (ACOS) is characterized by persistent airflow limitation with several features usually associated with asthma and several features usually associated with COPD.

Ddx of sputum according to color (د.مروان) + thick yellow sputum ▪︎asthma ▪︎allergic bronchopulmonary aspirgelosis

⚡️anginal equivalent Elderly pt. have neuropathy not feel the of pain & presented with other symptoms as S.O.B

⚡️Before giving steriod (especially large dose steriod) in elderly pt. we should send for HbA1c ( because it is diabetogenic hormone)