Act as Internalist 👨🏻‍⚕️🫀🩺

🛑postoperative Jaundice

Dysphagia: Differential Diagnoses and Clinical Clues for Diagnosis.

📝CURB 65 score of pneumonia

#Asthma@Clinicalinternalmedicine

🔴 We have finished topics of #CVS now I will start topics of #respiratory system

🔹Mx Of Asthma 🔶A. Acute Attacks (Status Asthmaticus) 📍1. High Flow Oxygen 📍2. SABA + Antimuscarinics (Salbutamol 2.5mg + Ipratropium 0.5mg) Nebulized Every 20Min (3x) 📍3. Systemic Steroids (Continue For 3-7 Days) : ▪︎Oral Prednisolone (1-2mg/Kg) ▪︎IV Methylprednisolone (1mg/Kg) ▪︎IV Hydrocortisone (5-10mg/Kg) 📍4. Adrenaline (0.01mg/Kg SC Or IV) Every 20Min 📍5. Mg Sulphate (IV 25-75mg/Kg Over 30min) 📍6. Aminophyline (IV Loading 5-10mg/Kg Then Maintenance 1mg/Kg/h) 📍7. Mechanical Ventilation If No Response To All Measure 📍8. Antibiotics If Bacterial infection Suspected 🔶B. Long Term Controllers 📍1. Mild Intermittent & Prophylaxis Against Asthma Attacks ➡️ SABA (Salbutamol [Ventolin] Or Terbutaline) *Induce Bronchial Relaxation in 5-10 Min That Last 4-6h 📍2. Mild Persistent (One Drug) ➡️ [Low Dose ICS (Budesonide)] Or [Leukotriene inhibitors (Montelukast)] 📍3. Moderate Persistent (Two Drugs) ➡️ [Low Dose ICS] + [Leukotriene Inhibitors Or LABA (Formoterol) Or Theophyline] ▪︎No Response ➡️ Moderate Dose ICS ▪︎No Response ➡️ [Moderate Dose ICS] + [Leukotriene Inhibitors Or LABA Or Theophylines] 📍4. Severe Persistent ➡️ [High Dose ICS] + [Leukotriene Inhibitors Or LABA Or Theophylines] ▪︎No Response (4 Drugs) ➡️ [High Dose ICS] + [Leukotriene Inhibitors Or LABA Or Theophylines] + [Oral Steroids] + [Omalizmab]

🔴Asthma ▪︎Chronic Obstructive Inflammatory Disorder Of Airways (Airway HyperResponsiveness) ▪︎In Adults More in Females While In Children More in Males 🔹Risk Factors For Asthma 📍1. +Ve Family Hx Of Asthma Or Atopy 📍2. Severe Respiratory Infections During Childhood (Pneumonia/Bronchiolitis) 📍3. Early Breast Milk Weaning 📍4. Male Gender & Low Birth Weight 📍5. Smoking Exposure 📍6. Eosinophilia & Wheezing Episodes 🔹Types Of Asthma 🔸A. Childhood Asthma 📍1. Allergic Asthma (Atopic/Extrinsic) : ▪︎Most Common Type Of Asthma ▪︎Childhood Onset ▪︎IgE Mediated Type I Hypersensitivity ▪︎Personal & Family Hx Of Allergic Diseases (Atopy) ▪︎Good Response To Tx 📍2. Transient NonAtopic Asthma ➡️ Recurrent Episodes Of Wheeze In Children After Viral Infections That Resolved Without Persistent 🔸B. Cough Variant Asthma ➡️ The Only Predominant Symptoms is Dry Cough 🔸C. Aspirin Induced Asthma ▪︎Mostly In A Middle Age Female With Asthma & Rhinosinusitis & Nasal Polyps ▪︎Symptoms Occur After Alcohol Or Foods Or Any Compound Containing Salicylate (Aspirin) 🔸D. Exercise Induced Asthma ➡️ Symptoms Triggered Only By Physical Activity 🔸E. Non Allergic Asthma ▪︎Onset At Adulthood ▪︎Due To Lung SubMucosal Irritation ▪︎Poor Response To Tx 🔹Clinical Features Of Asthmatic Attacks 📍1. Recurrent Episodes Of Diffuse Bilateral Expiratory Wheeze With SOB & Chest Tightness & Cough 📍2. Diurnal Variation in Symptoms (Worst At Early Morning & Night) 📍3. Sleep Disturbances By Symptoms 📍4. Chest Hyperinflation & HyperResonant With Prolonged Expiration 📍5. Hx Of Other Atopy & +Ve Family Hx 📍6. Symptoms Respond To Bronchodilators 🔹Precipitants Of Asthmatic Attacks 📍1. Exercise in Cold Weather 📍2. Airborne Allergens & Pollutants 📍3. Viral URTI 📍4. Drugs (BB/Aspirin/OCP/Prostaglandin/Cholinegric Agents) 📍5. GERD/RhinoSinusitis 🔹Confirm Dx (If Age >5 Years) 🔶A. Spirometer 📍1. FEV1/FVC <0.7 (<70%) ➡️ Obstructive Picture 📍2. FEV1 >12% Increase After Bronchodilators (Good Response To Bronchodilators Specific For Asthma) 📍3. FEV1 >15% Decrease After 6min Of Exercise 🔶B. Diurnal Variation in PEF >20% On More Than 3 days For 2 Weeks 🔶C. Increase IgE & Eosinophills 🔹Classification Of Asthma Severity 📍1. Mild Intermittent : ▪︎Day Symptoms ➡️ ≤2/Week ▪︎Night Symptoms ➡️ ≤2/Month 📍2. Mild Persistent : ▪︎Day Symptoms ➡️ >2/Week ▪︎Night Symptoms ➡️ >2/Month 📍3. Moderate Persistent : ▪︎Day Symptoms ➡️ Every Day (Daily) ▪︎Night Symptoms ➡️ >1/Week 📍4. Severe Persistent : ▪︎Day Symptoms ➡️ Every Day (Daily) ▪︎Night Symptoms ➡️ Frequent (7x)/Week 📍5. Acute Severe Attack : ▪︎PEF 33-50% ▪︎Tachycardia & Tachypnea ▪︎Can't Complete Sentence in One Breath 📍6. Life Threatening Attack : ▪︎PEF <33% ▪︎SPO² <92% (<8KPa) ▪︎Normal Or Increase PaCo² ▪︎Silent Chest ▪︎Cyanosis/Bradycardia/Hypotension/Delirium & Coma 📍7. Near Fatal Attack ➡️ Increase PaCo² That Requiring Mechanical Ventilation

#PDA@Clinicalinternalmedicine

🛑Valves Sounds ▪︎Lab S1 = M & T Close (Systole) ▪︎Dab S2 = P & A Close (Diastole) ▪︎Ba Lab Dab = S4 ▪︎Lab DeBab = S3 ▪︎Mitral/Aortic In left Heart side ▪︎Tricuspid/Pulmonary in right Heart side