طبيب إمتياز.

كل عام وأنتم بخير ❤ رمضانكم كريم ❤️ جعلنا الله وإياكم فيه من المقبولين الفائزين ❤️

The sound of the crackles heard on chest auscultation in heart failure is described as ‘wet’ and sounding like Velcro. Crackles in heart failure are usually fine and quiet rather than the coarse sounds that are more commonly heard in lung disease. They can be mistaken for the bilateral crackles of lung fibrosis, but patients with fibrotic lungs are more likely to be hypoxic with exertional desaturation. Always check above the level of the patient’s earlobes for a raised jugular venous pressure because this is easily missed. However, a raised jugular venous pressure can be difficult to spot, even for a heart failure specialist.

بإذن الله هينزل كل فترة ريكورد صغير مع كل صورة من دول ... الله المستعان .. 1- Pericarditis ✅ 2- Acute adrenal insufficiency ✅ 3- management of hyperkalemia ✅ 4- Status epilepticus ✅ 5- Acute management in cardiology ✅ 6- Electrolyte abnormalities that refuse to correct ✅ 7- AKI ✅ 8- DKA & HHS ✅ 9- sepsis ✅ 10-

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بإذن الله هينزل كل فترة ريكورد صغير مع كل صورة من دول ... الله المستعان .. 1- Pericarditis ✅ 2- Acute adrenal insufficiency ✅ 3- management of hyperkalemia ✅ 4- Status epilepticus ✅ 5- Acute management in cardiology ✅ 6-

376/ In T3 thyrotoxicosis the free T4 will be normal.

Secondary hypothyroidism:

TSH is low and free T4 is low, replacement steroid therapy is required prior to thyroxin in pan-hypopituitarism.

Sub-clinical hypothyroidism:

TSH is high and normal free T4.

Steroid therapy:

low TSH and normal free T4.

Sub-clinical hyperthyroidism:

low TSH and normal free T4. #Notes

376/ In T3 thyrotoxicosis the free T4 will be normal.

Secondary hypothyroidism:

TSH is low and free T4 is low, replacement steroid therapy is required prior to thyroxin in pan-hypopituitarism.

Sub-clinical hypothyroidism:

TSH is high and normal free T4. Steroid therapy: low TSH and normal free T4.

Sub-clinical hyperthyroidism:

low TSH and normal free T4. #Notes

375/ If hypocapnia occurs with acidaemia, a primary respiratory alkalosis is present, if the degree of hypocapnia is greater than would be expected in response to the coexisting metabolic acidosis. #Notes

374/ That serum HCO₃- rarely decreases below 12 to 14 mmol/L in isolated chronic respiratory alkalosis and values below this suggest an independent component of metabolic acidosis. #Notes

373/ The combination of headache, vomiting, visual disturbance and hormonal dysfunction should lead you to consider a dx of pituitary apoplexy. - MRI pituitary to confirm the dx.

Treatment:

Hydrocortisone IV should be given to prevent Addisonian crisis, and over the long term ➡️ corticosteroids and testosterone and thyroid hormone replacement. #Notes

372/ Normal plasma osmolality= 270-300 mOsm/kg Normal urinary osmolality= 350-1000 mOsm/kg #Notes

371/

DIDMOAD ( Wolfram's syndrome):

- Cranial DI - DM - Optic atrophy - Deafness #Notes

370/

SIADH:

No hypovolemia, hyponatremia, urin Na+ concentrations >20 mEq/L, treated with fliud restriction and Demeclocycline, even hypertonic salin may be used.

Cerebral Salt Wasting (CSW):

Hypovolemic, hyponatremia, urin Na+ concentration >100, polyuria, treated with replacing fluid and sodium loss. #Notes