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قناة تفتح ابوابها لجميع طلبة الطب في العالم تحت اشراف الدكتور المحترم الكبير الاستاذ محمد قاسم للتواصل مع صاحب القناة @Alive332002
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Publicaciones del Canal
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🔴Seizures in ER (Status Epilepticus)
🔷Dx Of Status Epilepticus :
📍1. No Spontaneous Resolution Of Seizure Episode After 5Min
المريض بالعادة مشخص بمرض الصرع سابقا وتجي كل فترة نوبة وتروح بسرعة ٫ بس احيانا اجت النوبة وأخذت وقت أكثر من المعتاد
📍2. Recurrent Seizure Episodes With No Conscious Recovery in Between
يعني المريض بدة يعاني من عدة نوبات وحدة ورة الثانية وخلال هذه النوبات فقد الوعي ومدا يستعيد وعيه ٫ وبالعادة هذه النوبات المتتالية تكون قصيرة
📍3. Features Of Real Fit :
لازم نفرق بين النوبة الحقيقة وبين التمثيل
▪︎Abrupt Onset
▪︎Brief Duration
▪︎Change Level Of Conscious
▪︎Involuntary Purposeless Movements Can't Be Stopped By Limb Holding
▪︎Post-ictal State (DLOC)
🔷Mx Of Seizure :
🔺A. IV Lines & Lab Tests :
▪︎Electrolytes
▪︎Glucose Level
▪︎Toxocology & Drugs Abuse
▪︎RFT/LFT
▪︎Pregnancy Test
▪︎CBC
🔺B. Airway Protection With Left Lateral Position & Suction (To Prevent Aspiration)
🔺C. Oxygen If Needed
🔺D. Drugs (Given When Fit Last >5Min Or Recurrent Fit Episodes) :
📍1. Diazepam (Valium) :
▪︎General Dose ➡️ 0.3mg/Kg (Adult & Pediatrics) Given IV Or Rectally Slowly Over 2Min نعطي مباشر بدون تخفيف
▪︎Adult Dose ➡️ 5-20mg Direct IV Slowly (Dose Can Repeated 3x After 10-20Min)
▪︎Pediatric Dose :
•Direct IV ➡️ 0.3mg/Kg (Slowly Over 2Min | Dose Can Repeated After 2-4h | Maximum Dose 5mg in Children <5 Years & 10mg in Children ≥5 Years)
•Rectally (Dose Can Repeated After 4-12h | Maximum Dose 20mg) :
I. 0.5mg/Kg For Age 2-6 Years
II. 0.3mg/Kg For Age 6-12 Years
III. 0.2mg/Kg For Age >12 Years
📍2. Phenytoin Infusion (Given If No Control Of Seizure After 15-30Min) :
▪︎Bolus (Loading) Dose ➡️ 15-20mg/Kg (Given With 100-200cc NS Over 30Min | Dose Can Repeated After 10Min As 5-10mg/Kg | Maximum Dose 50mg/Kg)
نحسب الجرعة ونحط الامبولات بمغذي نورمل سلاين 100 او 200 مل ونعطي خلال 30د
▪︎Mantitance Dose ➡️ 3-6mg/Kg/24h (Given As 100mg IV Every 6-8h in 500cc NS At Drop Rate 21Drop/Min)
نكرر هذا العملية ثلاث مرات حتى نغطي 24 ساعة
▪︎Phenytoin Contraindications ➡ Bradycardia & Heart Block
📍3. Phenobarbital Infusion (Luminal Given If No Control Of Seizure After 15-30Min) ➡️ 10-20mg/Kg (Given in 100-200cc NS Over 30Min At Drop Rate 133Drop/Min | Maximum Dose 1000mg)
📍4. Intubation & Anesthesia ➡️ If No Response After 30Min
📍5. Correction Of The Causes :
▪︎Low Na ➡️ Give Hypertonic Saline (100ml Bolus Over 10Min in Adults/2-5mg/Kg Over 20Min in Children) Bolus Then Slow Correction
▪︎Give B1 & Naloxone ➡️ For Alcoholic Patients
▪︎Give 10% Glucose (IV 5ml/Kg) ➡️ If Hypoglycemia Suspected
▪︎Give 10% Ca Gluconate (IV Slow 2ml/Kg) ➡️ If Hypocalcemia Suspected
▪︎Give 50% Mg Sulphate (IM 0.2 ml/Kg) ➡️ If Hypomagnesemia Suspected
▪︎Give Antibiotics ➡️ If Sepsis Suspected
▪︎Give Acyclovir (IV 10-20mg/Kg) ➡️ If Herpes Encephalitis Suspected
| 2 | Sjögren Syndrome
Definition
A chronic systemic autoimmune disease characterized by lymphocytic destruction of the exocrine glands, primarily the lacrimal and salivary glands, causing dry eyes (xerophthalmia) and dry mouth (xerostomia) (sicca syndrome). It may also involve multiple organs outside the glands.
Classification
Primary Sjögren Syndrome
• Occurs alone. •Idiopathic.
Secondary Sjögren Syndrome
Associated with another autoimmune disease such as:
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Systemic sclerosis
• Polymyositis
• Primary biliary cholangitis
Epidemiology
Predominantly affects middle-aged women.
Female : Male ≈ 9 : 1.
Usually develops between 40–60 years.
Pathophysiology
Autoimmune lymphocytic infiltration causes destruction of:
• Lacrimal glands
• Salivary glands
Leading to:
↓ Tear production
↓ Saliva production
Extraglandular inflammation may involve: ( Joints, Lungs, Kidneys, Liver
, Nervous System, Skin
, Blood vessels)
Clinical Features
Sicca Symptoms (Hallmark)
• Eyes ( Dry eyes، Foreign body sensation، Burning، Redness، Photophobia، Blurred vision)
• Mouth ( Dry mouth, Difficulty swallowing dry food, Difficulty speaking, Dental caries, Oral candidiasis, Recurrent parotid swelling)
Extraglandular Manifestations
• Musculoskeletal (Arthralgia, Non-erosive arthritis, Myalgia)
• Skin ( Dry skin, Purpura, Vasculitis, Raynaud phenomenon)
• Respiratory
Dry cough
Interstitial lung disease
• Renal
Tubulointerstitial nephritis
Distal renal tubular acidosis
• Neurologic
Peripheral neuropathy
Cranial neuropathy
• Gastrointestinal/Hepatic
Dysphagia
Autoimmune liver disease
• Constitutional
Fatigue
Low-grade fever
Diagnosis
• Clinical Suspicion
Persistent:
Dry eyes (>3 months)
Dry mouth (>3 months)
• Laboratory Tests
Autoantibodies:
ANA (+)
Rheumatoid factor (+)
Anti-Ro (SSA) ★ Most important
Anti-La (SSB)
Inflammatory markers:
↑ ESR
Hypergammaglobulinemia
Diagnostic Tests
Eyes
• Schirmer test
• Ocular surface staining
Salivary glands
• Salivary flow measurement
• Salivary gland ultrasonography (selected patients)
• Minor salivary gland (lip) biopsy
Histology
Minor salivary gland biopsy shows:
• Focal lymphocytic sialadenitis
• Dense lymphocytic infiltration
Treatment
Symptomatic
Dry Eyes
• Artificial tears
• Lubricating ointment
• Topical anti-inflammatory therapy if needed
Dry Mouth
• Frequent water intake
• Sugar-free chewing gum
• Saliva substitutes
• Good oral hygiene
Secretagogues
• Pilocarpine
• Cevimeline
Systemic Disease
Depending on organ involvement:
• Hydroxychloroquine
• Corticosteroids
• Immunosuppressive agents
• Biologic therapy in selected severe cases
Complications
• Severe dental caries
• Oral candidiasis
• Corneal ulceration
• Chronic kidney disease
• Interstitial lung disease
• Peripheral neuropathy
• Vasculitis
↑ Risk of B-cell Non-Hodgkin lymphoma (major long-term complication)
Prognosis
• Usually chronic with slow progression.
• Many patients have a normal life expectancy.
• Prognosis depends on systemic organ involvement and lymphoma development. | 116 |
| 3 | 🔴Malabsorption Syndrome
▪︎Decrease in Intestinal Absorption Of Dietary Nutrients Due To Defective Digestion Or Mucosal Absorption
‼️🔰A. Carbs Malabsorption
🔹Causes
▪︎Lactose Malabsorption
▪︎Glucose-Galactose Malabsorption
▪︎Fructose Malabsorption
🔹Ix ➡️ Stool Tests
▪︎+Ve Reducing Substances (2+ Or More In Clinitest Reagent)
▪︎Acidic Ph (<5.6)
▪︎+Ve Breath Hydrogen Test
‼️🔰B. Fat Malabsorption
🔹Causes
▪︎Cystic Fibrosis
▪︎Shwachman-Diamond Syndrome
▪︎Abetalipoproteinemia
🔹Ix
▪︎Microscopic Examination Of Stool For Fat Droplets After Mix With Water Or Sudan Stain ➡️ +Ve If >6-8 Droplets
▪︎72h Quantitative Fecal Fat Test ➡️ +Ve If >7% Excretion Of Total Fat Intake
▪︎Neutropenia ➡️ Shwachman Syndrome
▪︎Acanthocytosis ➡️ Abetalipoproteinemia
‼️🔰C. Proteins Malabsorption (Protein Losing Enteropathy)
🔹Causes
▪︎EnteroKinase Deficiency
▪︎Blue Diaper Syndrome (Tryptophan Malabsorption)
▪︎Hartnup Disease (Neutral Amino Acids Malabsorption)
🔹Ix
▪︎Presence Of Alpha-1 AntiTrypsin in Stool
▪︎Decrease Serum Albumin & Proteins
‼️🔰D. Minerals & Vitamins Malabsorption
🔹Causes
▪︎Congenital Chloride Diarrhea
▪︎Acrodermatitis Enteropathica (Zinc Malabsorption)
▪︎Menke Disease (Copper Malabsorption)
▪︎Vitamin D Dependent Rickets
▪︎Specific Folate Or B12 Malabsorption
▪︎Terminal Ileum Disease (Crohn's) Or Resection
▪︎Sulfasalazine (Decrease Folate Absorption)
▪︎Phenytoin (Decrease Ca Absorption)
🔹Ix
▪︎MicroCytic Anemia & Low Reticulocytes ➡️ Iron
▪︎MacroCytic Anemia ➡️ Folate & B12
‼️🔰D. Generalised Malabsorption
🔹Causes
▪︎Chronic GIT Infection (Giardia/TB Enteritis/Bilharziasis)
▪︎Celiac Disease
▪︎Short Bowel Syndrome
▪︎MicroVillous Inclusion Disease
▪︎IBD (Crohn's/Ulcerative)
🔰Clinical Clues To Cause
1. Watery Stool From Birth ➡️ Congenital Chloride Diarrhea/MicroVillus Inclusion Disease
2. Loose Bulky Stool After Food Introduction With Anorexia & Digital Clubbing ➡️ Celiac (Gluten Sensitivity)
3. Explosive Watery Diarrhea With Abdominal Distension & Pain & PeriAnal Excoriation ➡️ Carbs Malabsorption
4. Pasty Yellowish Offensive Stool With Very Good Appetite & Digital Clubbing ➡️ Cystic Fibrosis (Exocrine Pancreatic Insufficiency)
5. Green-Brown Watery Stool With Undigested Particles (Peas & Carrots) At Age Of 1-3 Years & Good General Condition ➡️ Toddler's Diarrhea (Rapid Intestinal Transit) ➡️ Mx By Decrease Fluid Intake To <90ml/Kg/24h
6. Body Edema ➡️ Protein Losing Enteropathy
7. Circumoral & PeriAnal Rash ➡️ Acrodermatitis Enteropathica (Zinc Malabsorption)
8. Abnormal Coarse Kinky Hair With Failure To Thrive & Mostly Male ➡️ Menkes Disease (Copper Malabsorption)
9. Bone Fractures & Deformity ➡️ Specific Vitamin D Deficiency
10. Coagulopathy ➡️ Vitamin K Deficiency
11. MicroCytic Anemia & Low Reticulocytes ➡️ Iron Deficiency
12. Mucosal Atrophy & Low Vitamin A & E ➡️ Folate Deficiency | 112 |
| 4 | ➥ If gynaecomastia occurs with small testes, aspermia and elevated plasma or urinary oestrogens ➜ Consider an adrenal androgen-producing tumour with peripheral aromatization.
➥ If gynaecomastia occurs with bronchogenic carcinoma ➜ Consider tumour secretion of hCG, stimulating testicular oestrogen production.
➥ If gynaecomastia develops following refeeding after starvation or malnutrition ➜ Consider nutritional recovery-associated gynaecomastia
➥ If gynaecomastia occurs in older age groups ➜ An underlying pathological cause is more likely, although senescent gynaecomastia may occur due to declining testicular function.
➥ If gynaecomastia develops following exposure to oestrogen-containing creams or oestrogen-treated meat and dairy products ➜ Consider exogenous oestrogen exposure, particularly in young boys and men.
➥ If gynaecomastia occurs during spironolactone treatment (150 mg/day) ➜ Consider a drug-related cause
➥ If gynaecomastia is associated with deep brown pigmentation of the nipple and areola ➜ Consider exposure to diethylstilbestrol.
➥ If gynaecomastia occurs with hyperthyroidism ➜ Consider the association with increased oestrogen production and elevated SHBG
Investigations
■ Mammography and breast ultrasound — To investigate breast enlargement and exclude other causes of breast swelling, such as carcinoma, lipoma and neurofibroma.
■ Testicular ultrasound — To detect small or impalpable testicular tumours.
■ Serum hCG — To investigate suspected germ cell tumours, particularly when the testicular tumour is impalpable.
■ Plasma or urinary oestrogen levels — May demonstrate increased oestrogen production in adrenal tumours.
■ Gonadotrophin levels — May demonstrate suppression associated with adrenal tumours.
■ Urinary 17-oxo-steroids — May be increased or normal in adrenal tumours.
■ Testicular biopsy — May demonstrate Leydig cell hypoplasia in adrenal tumour-associated gynaecomastia.
■ Adrenal CT scan — To localize an adrenal tumour.
References :French’s | 121 |
| 5 | Gynaecomastia
Differential Diagnosis
◉ Physiological Causes
Neonatal gynaecomastia.
Pubertal gynaecomastia.
Senescent gynaecomastia (declining testicular function).
◉ Familial Causes
Familial gynaecomastia.
◉ Endocrine Causes
♦• Decreased Testosterone Production
Congenital:
Klinefelter’s syndrome (47,XXY).
Congenital anorchia.
Defects in testosterone synthesis.
Acquired testicular atrophy:
Viral orchitis (mumps and other viral infections).
Testicular trauma.
Castration.
Neurological disorders:
Dystrophia myotonica.
Traumatic paraplegia.
Syringomyelia.
Friedreich’s ataxia.
Granulomatous diseases (e.g. leprosy).
Renal failure.
♦• Resistance to Testosterone Action
Complete androgen resistance (testicular feminization syndrome).
Incomplete androgen resistance (Reifenstein’s syndrome).
Infertile male syndrome.
♦• Increased Oestrogen Production
Testicular tumours:
Leydig cell tumour.
Sertoli cell tumour.
★ Chorionic carcinoma (most common testicular tumour causing gynaecomastia).
Embryonal carcinoma.
Teratoma.
Seminoma.
Adrenal tumours:
Adrenocortical carcinoma.
Adrenocortical adenoma.
Thyroid disorders:
Hyperthyroidism.
Hypothyroidism.
Pituitary tumours:
Somatotroph adenoma (acromegaly).
Prolactinoma.
Gonadotroph adenoma (non-functioning pituitary adenoma).
LH-secreting pituitary tumours.
Other endocrine causes:
Congenital adrenal hyperplasia.
Hypothalamic lesions.
◉ Disorders of Sex Differentiation
Male pseudohermaphroditism.
True hermaphroditism.
◉ Systemic Causes
• Hepatic Disorders
Hepatitis.
Cirrhosis.
Haemochromatosis.
Hepatic carcinoma.
• Respiratory Disorders
Bronchogenic carcinoma.
Chronic suppurative lung disease.
• Renal Disorders
Chronic renal failure.
Maintenance haemodialysis.
Hypernephroma.
• Neurological Disorders
Traumatic paraplegia.
Dystrophia myotonica.
Friedreich’s ataxia.
Syringomyelia.
• Gastrointestinal Disorders
Chronic ulcerative colitis.
Following extensive gut surgery.
• Other Systemic Causes
Polyostotic fibrous dysplasia (McCune–Albright syndrome).
Refeeding following starvation or malnutrition.
◉ Drug-Induced Causes
• Hormones: Oestrogens; Human chorionic gonadotrophin (hCG); Methyltestosterone.
• Androgen Antagonists: Spironolactone; Progestogens; Cyproterone; Flutamide; Bicalutamide; Zanoterone.
• Other Drugs: Cannabis; Cimetidine; Ranitidine; Griseofulvin; Digitalis glycosides (digoxin); Busulfan; Calcium channel-blocking agents; Diazepam; Isoniazid; Methyldopa; Omeprazole; Penicillamine; Tricyclic antidepressants; Antiretroviral therapy (particularly efavirenz).
• Drugs Interfering with Testosterone Synthesis: Ketoconazole; Metronidazole; Etomidate; Alkylating agents.
Clinical Important Warning and Points
➥ True gynaecomastia is distinguished from fat deposition by palpable glandular tissue behind the areola; in fat deposition, no glandular tissue is palpable.
➥ If gynaecomastia occurs in a neonate ➜ It is usually physiological and may be associated with expressed breast fluid (witch’s milk).
➥ If a pubertal boy has a history of neonatal gynaecomastia or familial gynaecomastia ➜ Consider constitutional sensitivity to oestrogen.
➥ If pubertal gynaecomastia is mild and early ➜ It usually regresses, whereas moderate-to-severe degrees tend to persist.
➥ If an elderly man presents with gynaecomastia, reduced libido and occasional hot flushes ➜ Consider senescent gynaecomastia due to declining testicular function.
➥ If an adolescent male presents with gynaecomastia, small atrophic testes and infertility ➜ Suspect Klinefelter’s syndrome (47,XXY).
➥ If gynaecomastia occurs with one apparently normal testis and a small contralateral testis ➜ Consider a tumour in the apparently normal testis, which may suppress pituitary gonadotrophins and impair development of the opposite testis.
➥ If gynaecomastia is associated with a prolactin-secreting pituitary tumour ➜ It may result from secondary hypogonadism and an altered free testosterone-to-free oestradiol ratio, rather than a direct effect of prolactin on breast tissue. | 116 |
| 6 | 🔴Acute Renal Injury (AKI)
▪︎Sudden & Reversible Loss Of Renal Function Develops Rapidly Over Days To Weeks
▪︎More in Elderly
🔹Causes
🔸A. Pre Renal (Most Common) :
▪︎Decrease Perfusion To Kidney Will Decrease GFR Then Results in Acute Tubular Necrosis (ATN)
1. Heart Failure (Decrease Organs Perfusion)
2. Volume Loss & Hypotension (Severe Vomiting & Diarrhoea/Burns/Hemorrhage/Sepsis/Diuretics/Poor Fluid Intake & Dehydration)
4. Renal Artery Stenosis
5. Drugs (ACEI & ARBS/NSAIDS/Iodine/Calcineurin Inhibitors) ➡️ Affect Renal Blood Flow
6. Liver Disease (HepatoRenal Syndrome)
7. Sepsis
🔸B. Renal :
▪︎Due To Primary Injury To The Kidney
1. Acute Tubular Necrosis (Most Common & Usually Occurs Due To Drugs/Toxins/Prolonged Hypoperfusion)
2. Severe Glomerulonephritis
3. Acute Tubulo-Interstitial Nephritis (Allergic Reaction Affect The Interstitial Tissue Around The Tubules)
4. Drugs (Aminoglycosides/Cisplatin/Tenofovir/Methotrexate/Iodine/PPI/NSAIDS/Penicillin)
5. Rhabdomyolysis (Skeletal Muscle BreakDown After Trauma Or Ischaemia & Myoglobin Release into The Kidney)
6. Bilateral Kidney Infection (PyeloNephritis)
7. Vascular Kidney Disease (Small Vessel Vasculitis/Infarction/Thrombosis/Malignant HT)
🔸C. Post Renal :
▪︎Renal Tract Obstruction ➡️ Increase Ureteral Pressure ➡️ Hydronephrosis & Decrease GFR
1. Bilateral Urinary Stones
2. Prostatic Cancer & Enlargement
3. Bladder & Cervical Cancer
4. Neurogenic Bladder
5. Urethral & Meatal Strictures
6. Retroperitoneal Fibrosis
🔹Clinical Features
A. PreRenal ➡️ Hypotension/Tachycardia/Poor Peripheral Perfusion/Dehydration/Oliguria
B. Renal ➡️ Hypertension/Hematuria/Proteinuria/Rash/Fever/Arthritis/Uveitis
C. Post Renal ➡️ Distended Bladder/Pelvic Mass/Hydronephrosis
D. Consequences Of Renal Failure (Complications)
▪︎Nausea & Vomiting/Lethargy/Pruritus/Pale Skin
▪︎Palpitation/Kussmaul Breathing/SOB/Peripheral Edema/Raised JVP
▪︎Confusion/Altered Mental State (Encephalopathy)
▪︎Platelets & WBCS Dysfunction (Bleeding & Infections Tendency)/Muscle Weakness (High K/Low Ca)/HT/Pericarditis
🔹Dx
1. Rapid Raise in Creatinine Levels (>1 mg/Day)
2. Rapid Decline in Urine Output (<400 ml/Day)
3. High K & Phosphate/Low Ca/Dilutional Hyponatremia (Due To Fluid Retention)
4. Metabolic Acidosis
4. Urine Casts
▪︎Brown Granular (Muddy Brown Casts) ➡️ ATN
▪︎Empty Casts (Hyaline) ➡️ Renal Hypoperfusion (Pre-Renal Cause)
▪︎Eosinophilic Casts ➡️ Tubulo-Interstitial Nephritis
▪︎RBCS ➡️ Acute Glomerulonephritis
▪︎Crystals ➡️ Kidney Stones
▪︎Fatty Casts ➡️ Nephrotic Syndrome
▪︎WBCS Casts ➡️ Pyeleonephritis/Acute Interstitial Nephritis
5. Specific To Pre-Renal Causes
▪︎Decrease Urinary Na (<20 mmol/l)
▪︎Decrease Fractional Excretion Of Na (<1%)
▪︎Increase Urine Osmolarity (>500) & Urea:Creatinine Ratio
لمن الفشل الكلوي سببه اشياء قبل الكلية
معناه ان الكلية ما فيها شي والانابيب تشتغل كويس ⬅️ بالتالي تقدر تمتص الماء والصوديوم واليوريا من داخل الانابيب ⬅️ بالتالي نسبة الصوديوم بالادرار راح تقل لان تم امتصاصه وترتفع الاوزمولارتي مال الادرار ونسبة الكرياتنين لانه تم امتصاص الماء من الأنابيب وصار ادرار مركز
6. Specific To Renal Causes
▪︎Increase Urinary Na (>40 mmol/l) & Fractional Excretion Of Na (≥1%)
▪︎Decrease Urine Osmolarity & Urea:Creatinine Ratio
انابيب الكلية عطلانة ⬅️ بالتالي مافيه امتصاص للصوديوم والماء واليوريا ⬅️ فبالتالي الصودويم يكون عالي بالادرار | اما اليوريا والاوزمولارتي تقل لان الادرار صار مخفف بسبب الماء
7. Specific To Post-Renal Causes
▪︎Hydronephrosis (By US)
▪︎Delayed Excretion (By IsoTope Renogram)
🔹Mx Of Acute Renal Failure (According To The Cause)
1. HypoVolaemic Or HypoTensive ➡️ Give IV Fluids & Inotropic Drugs
2. HyperVolaemic ➡️ Give Loop Diuretics (Furosemide) Or Dialysis (If No Response)
3. Hyperkalaemia (K > 6.5 mmol/l) :
▪︎IV Ca Gluconate (10ml 10%)
▪︎Inhaled Beta-2 Agonist
▪︎IV Insulin (5 IU Actrapid)
▪︎IV Glucose (50ml 50%)
4. Metabolic Acidosis (Ph < 7) ➡️ Give Sodium Bicarbonate (100 mmol)
5. Renal Tract Obstruction :
▪︎Urinary Catheter
▪︎Ureteric Stent
▪︎Percutaneous Nephrostomy | 154 |
| 7 |  Q\ What is the name of sign ?
A\ Battel's sign
Q\ Regarding Battle sign give the site of fracture ?
A\ Basilar skull fracture (middle crainal fossa)
Q\ Associated with ?
A\ CSF Leakage (CSF otorrhea)
Q\ What nerves can be damaged ?
A\ Facial nerve and vestibulocochlear
nerve | 172 |
| 8 | 🔴Cystic Fibrosis
▪︎Autosomal Recessive (AR) Chronic Progressive Disorder Caused By Mutation in CFTR Gene On Long Arm Of Chromosome 7 That Affects The Secretary & Absorptive Function Of Epithelial Cells in Multiple Body Organs
▪︎Results in Excessive Secretion Of Na & Cl in Sweat
▪︎Median Age Of Survival 45 Years
🔹Clinical Features
🔶A. Neonatal Symptoms
📍1. Start in Neonatal period As Delayed Passage Of Meconium (Meconium Ileus)
📍2. Neonatal Cholestatic Jaundice
📍3. Failure To Thrive
📍4. Heat Exhaustion (Heavy Sweating/Cold Pale Skin/Rapid Weak Pulse/Muscle Cramps)
📍5. Hypochloremic Metabolic Alkalosis & Hyponatremia
🔶B. Respiratory Symptoms
📍1. Then Start To Develop Chronic Respiratory Infections (Chronic Productive Cough & Wheeze)
📍2. Lung Hyperinflation & Progressive Bronchiectasis
📍3. Lung Atelectasis/Hemoptysis/Pneumothorax
📍4. Finger Clubbing
📍5. Chronic Sinusitis & Nasal Polyposis
📍6. Poorly Controlled Asthma
📍7. Allergic BronochoPulmonary Aspergillosis
📍8. Respiratory Failure & Death
🔶C. GIT & Endocrine Symptoms
📍1. Exocrine Pancreatic Insufficiency Results in Fat & Protein Malabsorption
▪︎Steatorrhea (Large Pasty Yellowish Offensive Stool That Floating)
▪︎Fat Soluble Vitamin Deficiency (ADEK)
▪︎Hypoalbuminaemia & Peripheral Edema
▪︎UnderNutrition
📍2. Relative Insulin Deficiency & Hyperglycemia
📍3. Mucous Inspissation in Pancreatic Ducts (Risk Of Recurrent Pancreatitis)
📍4. Secondary Amenorrhea in Women (But Can Give Birth) & Infertility in Men
📍5. Gallstones & Osteoporosis
📍6. Distal Bowel Obstruction (Thick Insspisated Mucous in Bowel Lumen)
📍7. Liver Cirrhosis & Portal Hypertension
🔹Dx Of Cystic Fibrosis
📍1. +Ve Neonatal Screening
📍2. +Ve Hx Of Cystic Fibrosis in Family (Siblings)
📍3. Clinical Features Present
📍4. Two +Ve Sweat Chloride Tests (≥60 mEq/L) ➡️ Dx Of Choice
📍5. DNA Analysis ➡️ Identify Two Mutations Responsible For Cystic Fibrosis
📍6. Nasal Potential Difference Test ➡️ Identify Abnormal Ion Transport Across Nasal Epithelium
🔹Mx (Symptomatic)
📍1. Antibiotics & Chest Physiotherapy
📍2. Pancreatic Enzymes Replacement
📍3. Laxatives Or Surgery For Meconium Ileus & Bowel Obstruction
📍4. Insulin For Hyperglycemia | 207 |
| 9 | اخر فرصة لاشتراك جات جي بي تي
جات بلص شهر كامل مع ضمان
@Alive332002 | 211 |
| 10 | 🔴Megaloblastic Anemia
▪︎Anemia Due To B12 Or Folate Deficiency That Interfere With Blood Cell's DNA Synthesis
🔹Causes Of B12 & Folate Deficiency
1. Breast Fed Infants Of Vegetarian Mother
2. Infants On Goat's Milk
3. Malabsorption Syndrome
4. Intrinsic Factor Deficiency (Pernicious Anaemia/Gastrectomy)
5. Ileal Diseases (IBD) Or Resection
6. Small Bowel Bacterial Overgrowth
7. Drugs (Methotrexate/Phenytoin/Valproate)
8. Increase Body Demands (Chronic Hemolytic Anemia/Prematurity/Pregnancy/Chemotherapy)
🔹Clinical Features
1. Anemia (Pallor/Anorexia/Fatigue)
2. Mild HepatoSplenoMegaly & Jaundice (Due To Mild Hemolysis)
3. Atrophic Glossitis (Beefy Red Tongue)
4. Atrophic Gastritis (Dyspepsia & Vomiting & Risk Of Cancer)
6. Intestinal Muocal Atrophy ➡️ Results in Chronic Diarrhea & Abdominal Pain
7. Neurological Changes (Only With Severe B12 Deficiency) ➡️ Peripheral Neuropathy/Deep Sensory Loss & Sensory Ataxia/Weakness & Paraplegia/Depression/Dementia/Coma
🔹Dx
📍1. CBC ➡️
▪︎Low HB
▪︎MCV High (>100)
▪︎Decrease Reticulocytes & WBCS & Platelets in Severe Cases
📍2. Blood Picture ➡️
▪︎Oval MacroCytic RBCs
▪︎HyperSegmented Neutrophils (4-5 Lobes)
📍3. BM Examination ➡️ Erythroid Hyperplasia & Megaloblastic Changes
📍4. Low Serum B12 Or Folate
📍5. +Ve Anti-Parietal Cells & Anti-IF AB ➡️ in Cases Of Pernicious Anaemia
🔹Mx
1. B12 Deficiency ➡️ Hydroxocobalamine IM 1000µg (1mg) Over 3w Then Every 3m For Life
2. Folate Deficiency ➡️ Folic Acid 5mg/Day For 4m | 260 |
| 11 | نصيحة لطلاب الطب لاتقرأ الملزمة مثل ماهي لان اغلب الملازم جافة وتمل بسرعة
خلي موضوع بالجات خاص بس للدراسة وخل هو يشرحلك الملازمة بشكل اجزاء هيج ماتنساها ابد حتى من يكمل شرح يدزلك ملخص بشكل صور او مخططات الها
استخدموا التكنلوجيا | 305 |
| 12 | 🔶C. Breast Cysts
▪︎Cysts Filled With Green-Yellow Fluid Present in The Breast During The Involution Phase (35-55 Years)
🔹Causes Of Breast Cysts
1. Regression (Involution) Of The Breast Stroma Results in Narrowing Of The Lobules Then Secretion Accumulation Then Ductules Obstruction
2. HyperEstrogenAemia
3. Hormonal Replacement Therapy (HRT)
🔹Clinical Features & Dx Of Breast Cysts
📍1. Seen More in PeriMenoPausal Period (35-55 Years Last Decade Of Reproductive Life)
📍2. Present As Sudden Breast Lump
▪︎Painless & Smooth (But Could Be Painful)
▪︎Multiple
▪︎Could Be Bilateral
▪︎May Mimic Carcinoma
📍3. US Features
▪︎AnEchoic Well Defined Halo
Oval Or Round Shape Mass
▪︎Thin Wall
▪︎Posterior Acoustic Enhancement
▪︎Horizontal Orientation بالعرض
🔹Mx Of Breast Cysts
📍1. Observation Only ➡️ If Asymptomatic & No Suspicious Features (Bi-Rads 2)
📍2. Aspiration Only ➡️ For Symptomatic Benign Cyst
📍3. Core Biopsy Or Excision ➡️ For Complex Cyst (Solid & Cystic Components) Or Blood Stained Aspiration (Risk Of CystAdenoCarcinoma)
📍4. Antibiotics ➡️ For Complicated Cysts With Infection
🔶D. GalactoCele
▪︎SubAreolar Breast Cysts Filled With Milk Present In Women During Or After Lactation
▪︎Usually Solitary (Single Cyst)
🔹Mx Of GalactoCele
📍1. Mostly Resolve Spontaneously After Stopping Of Breast Feeding
📍2. Aspiration ➡️ If Large & Not Resolved
📍3. If Recurrence ➡️ Do Nylon Strand To Open The Obstruced Duct Or Do ReAspiration
🔹Complications Of GalactoCele
1. No Resolution (Due To Inspissated Material)
2. Calcification
🔶E. Duct Ectasia
▪︎Abnormal Dilatation Of The Major Milk Ducts Results in Chronic Recurrent PeriDuctal Inflammation & Fibrosis
▪︎Due To Breast Tissue Involution (Shrinkage) During Ageing
🔹Clinical Features & Dx Of Duct Ectasia
1. Seen in Old Age Women (70 Years)
2. Present As Cheesy Or ToothPaste Nipple Discharge (Brown-Green-Mud Colour)
3. Slit-Like Nipple Retraction
4. Chronic Recurrent Mastitis ➡️ Results in SubAreolar Mass (Abscess) & Fistula
5. US Features ➡️ >3mm Major Milk Ducts Dilatation
🔹DDX Of Duct Ectasia
1. Breast Cancer
2. Mastitis
🔹Mx Of Duct Ectasia
1. Exclude Malignancy
2. Antibiotics For 2-3W ➡️ Co-Amoxiclav/Flucloxacillin/Ciprofloxacin/Cefixime/Metronidazole/Tinidazole
3. Major Mammary Duct Excision ➡️ For Profuse Nipple Discharge/SubAreolar Abscess | 350 |
| 13 |  Admission Criteria for Kidney Stones
#Emergency | 293 |
| 14 |  Gastrointestinal causes of chest Pain | 288 |
| 15 | السلام عليكم
يلي يريد يشترك بحساب جات بلس شهري خل يراسلني
@Alive332002 | 118 |
| 16 | أنصح الطلاب بالاشتراك بChat gpt اكثر من اي وقت اخر, النسخ الجديده دتسوي شغل حلو امانه.
كلود مفيد كلش كذلك بس بيها مشكله التوكينز ممكن ما تكون كافيه, فجات أصرف و يفي بالغرض | 220 |
| 17 | 🔴Bronchiectasis
▪︎Abnormal Permanent Dilatation Of Respiratory Bronchi As Result Of Chronic inflammatory Process Leading To Chronic Respiratory Infections (Chronic Productive Cough) & Lung Damage
▪︎Risk Of Progression into Respiratory Failure (Bad Prognosis)
🔹Causes Of Bronchiectasis
📍1. Congenital :
▪︎Cystic Fibrosis & Ciliary Dysfunction Syndrome
▪︎Primary Hypogammaglobulinaemia
▪︎Kartagener Syndrome/Young Syndrome/Yellow Nail Syndrome
📍2. Acquired :
▪︎TB Infection (Most Common)
▪︎Severe Infection in Childhood (Whooping Cough/Measles)
▪︎Foreign Body Ingestion
▪︎Suppurativa Pneumonia Infection
▪︎Allergic Aspergillosis
▪︎Bronchial Tumors
🔹Clinical Features Of Bronchiectasis
📍1. Chronic Daily Productive Cough
📍2. Pleuritic Chest Pain
📍3. Haemoptysis
📍4. Halitosis (Bad Mouth Odour)
📍5. Weight Loss & Anorexia
📍6. Exertional Dyspnea
📍7. Finger Clubbing (Not Always)
📍8. Auscultation :
▪︎Coarse Crackles & Wheeze
▪︎Local Diminished Breath Sounds (Lobe Collapse)
🔹Dx Of Bronchiectasis
📍1. Chest Xray (50% Sensitivity To See Signs Indicate Thickened Airways & Dilatation) :
▪︎Ring Shadow Sign
▪︎Tramlines Sign
▪︎Gloved Fingers Sign
▪︎Consolidation
📍2. CT (97% Sensitivity) :
▪︎1cm Airway Dilatation
▪︎Bronchial Wall Thickening
▪︎Airways Larger Than Accompanying Vessels (Signet Ring Sign)
🔹Mx Of Bronchiectasis
📍1. Regular Physiotherapy (To Assist Sputum Drainage)
📍2. Antibiotics :
▪︎Co-Amoxiclav/Macrolides (Clarithromycin)/Tetracyclines (Most Commonly Used)
▪︎Ciprofloxacin/Piperacillin-Tazobactam/Ceftazidime (For Psuedomonas Infection For 14 Days)
📍3. Bronchial Artery Embolization (For Severe Haemoptysis)
📍4. Surgical Excision Of Bronchiectatic Area
📍5. Lung Transplantation | 320 |
| 18 |  Babinski Sign | 319 |
| 19 |  Modified Allen Test | 369 |
| 20 | السلام عليكم
يلي يريد يشترك بحساب جات بلس شهري خل يراسلني
@Alive332002 | 750 |
