Medical notes

𝐀𝐩𝐩𝐫𝐨𝐚𝐜𝐡 𝐭𝐨 𝐋𝐨𝐰 𝐒𝐀𝐀𝐆 𝐀𝐬𝐜𝐢𝐭𝐞𝐬 Ascites with low serum-ascites albumin gradient (SAAG <1.1 g/dL) usually indicates non-portal hypertension causes, often due to peritoneal disease or hypoalbuminemia. 𝐒𝐭𝐞𝐩𝐰𝐢𝐬𝐞 𝐀𝐩𝐩𝐫𝐨𝐚𝐜𝐡: 𝟏. 𝐂𝐨𝐧𝐟𝐢𝐫𝐦 𝐋𝐨𝐰 𝐒𝐀𝐀𝐆: • SAAG = Serum albumin – Ascitic fluid albumin • Low: <1.1 g/dL → non-portal hypertension cause 𝟐. 𝐂𝐡𝐞𝐜𝐤 𝐀𝐬𝐜𝐢𝐭𝐢𝐜 𝐅𝐥𝐮𝐢𝐝 𝐀𝐧𝐚𝐥𝐲𝐬𝐢𝐬: • 𝐂𝐞𝐥𝐥 𝐜𝐨𝐮𝐧𝐭 & 𝐝𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐭𝐢𝐚𝐥: look for infection or malignancy • 𝐏𝐫𝐨𝐭𝐞𝐢𝐧 𝐥𝐞𝐯𝐞𝐥: >𝟐.𝟓 𝐠/𝐝𝐋 → exudative (infection, malignancy) • 𝐏𝐫𝐨𝐭𝐞𝐢𝐧 𝐥𝐞𝐯𝐞𝐥: <𝟐.𝟓 𝐠/𝐝𝐋 → transudative causes • Cytology: rule out malignancy • ADA (adenosine deaminase): consider TB • Gram stain / culture: for bacterial or TB peritonitis 𝐀𝐝𝐝𝐢𝐭𝐢𝐨𝐧𝐚𝐥 𝐓𝐞𝐬𝐭𝐬 𝐁𝐚𝐬𝐞𝐝 𝐨𝐧 𝐒𝐮𝐬𝐩𝐢𝐜𝐢𝐨𝐧: • Imaging: CT abdomen/pelvis → masses, lymphadenopathy, TB features • Biopsy: Peritoneal biopsy if TB or malignancy suspected • Urinalysis / kidney function: If nephrotic syndrome suspected • Pancreatic enzymes: If pancreatic ascites suspected

Drugs that increase the effect of warfarin (increase INR): DEVICOS: Disulfuram Erythromycin, Ethanol toxicity (binge drinking) Valproate Isoniazid Ciprofloxacin, Cimetidine Omeprazole Sulphonamides Drugs that decrease the effect of warfarin (decrease INR): CARSBP: Carbamazepine Alcohol abuse (chronic use) Rifampicin Sulphonylureas Barbiturates Phenytoin

🩺 Splenomegaly – “CHILD with a big spleen” • C – Congestive (portal HTN, CHF) • H – Hematological (hemolytic anemia, leukemia) • I – Infections (malaria, kala-azar, EBV) • L – Liver disease (cirrhosis, hepatitis) • D – Disorders of storage (Gaucher’s, Niemann-Pick)

السلام عليكم ورحمة الله وبركاته ✍️ "منقول للفائدة" ✨ Very Important Changes in Epilepsy Guidelines -2025- 28 ✨ Updated and highly relevant, these are the kind of changes you don’t want to miss! 🚨 Differences Between Old and New Epilepsy Guidelines 1. Generalised tonic–clonic seizures Old guideline: 22-24 Carbamazepine, Lamotrigine, Oxcarbazepine, Sodium valproate (first-line). New guideline: 25-28 Only Lamotrigine and Levetiracetam remain as first-line. ➝ Valproate and Carbamazepine removed due to safety concerns, especially in women/girls. 2 Tonic or atonic seizures Old guideline: Sodium valproate (first-line). New guideline: Lamotrigine only. 3. Absence seizures • Old guideline: Ethosuximide, Lamotrigine, Sodium valproate (options). •New guideline: Only Ethosuximide and Lamotrigine listed. ➝ Valproate removed. 4. Myoclonic seizures • Old guideline: Sodium valproate, Topiramate (first-line). • New guideline: Levetiracetam only. ➝ Valproate no longer first-line. 5. Focal seizures Old guideline: Carbamazepine, Lamotrigine, Levetiracetam, Oxcarbazepine, Sodium valproate. •New guideline: Only Lamotrigine and Levetiracetam remain. ➝ Carbamazepine, Oxcarbazepine, and Valproate removed. *Summary in One Line* The new guideline has streamlined first-line treatment, limiting choices mainly to Lamotrigine, Levetiracetam, and Ethosuximide, and has removed Sodium Valproate, Carbamazepine, Oxcarbazepine, and Topiramate as routine first-line due to safety and teratogenicity concerns. @clinicalnote

Medical Pearls : #Hematuria + proteinuria + hypertension+ periorbital edema= GN #Hematuria+ hemoptysis+ crescent formation in kidney+ rapid deterioration of renal function= Goodpasture. #Hematuria + cramping abdominal pain + P/R bleeding + painful palpable purpura+ arthralgia= Henoch Schonlein purpura #Hematuria + epistaxis+ nasal crust+ saddle nose+ recurrent sinusitis= Wagner's granulomatosis(GPA) #Hematuria+ resistant asthma+ eosinophilia(>1,000)+neuropathy=Churg Strauss (EGPA)

Pyloric stenosis is a condition in infants where the pylorus (the muscle between the stomach and small intestine) becomes abnormally thickened, blocking food from moving into the intestines. 🔍 Key Facts: • Age of Onset: Typically seen in babies 2–8 weeks old • More common in: Males, firstborns, and formula-fed infants ⸻ 🚨 Signs & Symptoms (Classic Triad): 1. Projectile vomiting – forceful, non-bilious vomiting after feeding 2. Olive-shaped mass – felt in the right upper abdomen (hypertrophied pylorus) 3. Visible peristalsis – waves moving across the baby’s belly before vomiting ⸻ 🧪 Diagnosis: • Ultrasound – gold standard; shows thickened pyloric muscle • Lab findings: • Hypochloremic, hypokalemic metabolic alkalosis due to vomiting ⸻ 💉 Treatment: • IV fluids and electrolyte correction first • Surgical repair: Pyloromyotomy – cutting the muscle to relieve obstruction @clinicalnotes

كيف تشخص مرضك من رائحة فمك ♦️Clinical Conditions : 🔶️Fruity / sweet (acetone) seen in Diabetic Ketoacidosis (DKA) 🔶️Fishy odor – Trimethylaminuria (“Fish Odor Syndrome”) 🔶️Alcohol-like smell – Alcohol intoxication or ketoacidosis 🔶️Ammonia / urine-like odor – suggests Uremia (kidney failure) 🔶️Musty or mousy smell – classic for Phenylketonuria (PKU) 🔶️Stale beer or bread odor – seen in Typhoid fever 🔶️Foul or putrid breath – points to Anaerobic infections (e.g., lung abscess, poor oral hygiene) 🔶️Rancid butter / foul smell – may occur in C. difficile colitis 🔶️Corn chip or grape-like smell – associated with Pseudomonas infections (especially in burn patients) 🔶️Garlic odor – may indicate Arsenic or Organophosphate poisoning 🔶️Maple syrup smell – seen in Maple Syrup Urine Disease (MSUD) 🔶️Hay or barnyard smell – associated with Brucellosis 🔶️Sweaty feet or goat-like odor – seen in Isovaleric acidemia 🔶️Sweet, musty breath (fetor hepaticus) – seen in Liver failure ♦️الحالات السريرية: 🔶️رائحة فاكهية/حلوة (أسيتون) - تُلاحظ في الحماض الكيتوني السكري (DKA) 🔶️رائحة سمكية - متلازمة تريميثيل أمين البول (متلازمة رائحة السمك) 🔶️رائحة تشبه الكحول - تسمم كحولي أو حُماض كيتوني 🔶️رائحة الأمونيا/البول - تُشير إلى فشل كلوي (يوريميا) 🔶️رائحة عفن أو فطرية - تُلاحظ عادةً في بيلة الفينيل كيتون (PKU) 🔶️رائحة بيرة أو خبز فاسد - تُلاحظ في حمى التيفوئيد 🔶️رائحة فم كريهة أو كريهة - تُشير إلى عدوى لاهوائية (مثل خراج الرئة، سوء نظافة الفم) 🔶️رائحة زبدة زنخة/رائحة كريهة - قد تحدث في بكتيريا المطثية العسيرة التهاب القولون 🔶️رائحة تشبه رقائق الذرة أو العنب - مرتبطة بعدوى الزائفة الزنجارية (خاصةً لدى مرضى الحروق) 🔶️رائحة الثوم - قد تشير إلى التسمم بالزرنيخ أو الفوسفات العضوي 🔶️رائحة شراب القيقب - تُلاحظ في داء بول شراب القيقب (MSUD) 🔶️رائحة القش أو الحظيرة - مرتبطة بداء البروسيلات 🔶️رائحة عرق القدمين أو رائحة تشبه رائحة الماعز - تُلاحظ في حالة فرط حمض الدم الإيزوفاليريك 🔶️رائحة الفم الكريهة والعفنة (fetor hepaticus) - تُلاحظ في حالة فشل الكبد

Diagnostic Cheat sheet for fever with rash 1.itchy, trunk + face=Chicken pox 2.Non itchy,palm+sole+oral= Hand foot mouth disease 3.Face+trunk,koplik spot=measles 4.Slapped cheek appearance .=Parvo virus B19 5.Fever subside,rashes on face+trunk=HHV6/7 Human herpiviruses 6.Face+trunk,forchheimer spot=Rubella

😁CLINICAL FEATURES OF TYPICAL KAWASAKI DISEASE 😳 👍Diagnostic criteria of Kawasaki disease : fever for ≥ 5 days with ≥ 4 out of 5 of the following features : 1_ conjunctivitis ( bilateral bulbar not purulent) 2_ Rash any rash except vesicular 3_ Extremities *Acute: palmar/plantar erythema and/or edema *Subacute: periungual desquamation 4_ Adenopathy (cervical,≥ 1.5 cm, unilateral) 5_Mucosal changes (strawberry tongue, cracked and erythematous lips, etc.) 😍😍 Incomplete (atypical) Kawasaki disease: 👌 fever for ≥ 5 days with ≥ 2 of the above criteria. 🩺 🔬Assess for supplemental laboratory criteria. 🔬LAB FINDINGS *Anemia Normocytic anemia * ↑ platelets at 1st week normal but 2_3rd weeks increase * ↑ WBC mainly neutrophils * Hyponatremia * ↑ CRP *↑ ESR * ↑ liver enzymes * ↓ albumin * Sterile pyuria  All patient diagnosed with Kawasaki must do an Echo for aneurysm because serous complications * Coronary artery aneurysms Untreated KD : 20-25% *Treated KD: 1-3 % @clinicalnote

😁CLINICAL FEATURES OF TYPICAL KAWASAKI DISEASE 😳 👍Diagnostic criteria of Kawasaki disease : fever for ≥ 5 days with ≥ 4 out of 5 of the following features : 1_ conjunctivitis ( bilateral bulbar not purulent) 2_ Rash any rash except vesicular 3_ Extremities *Acute: palmar/plantar erythema and/or edema *Subacute: periungual desquamation 4_ Adenopathy (cervical,≥ 1.5 cm, unilateral) 5_Mucosal changes (strawberry tongue, cracked and erythematous lips, etc.) 😍😍 Incomplete (atypical) Kawasaki disease: 👌 fever for ≥ 5 days with ≥ 2 of the above criteria. 🩺 🔬Assess for supplemental laboratory criteria. 🔬LAB FINDINGS *Anemia Normocytic anemia * ↑ platelets at 1st week normal but 2_3rd weeks increase * ↑ WBC mainly neutrophils * Hyponatremia * ↑ CRP *↑ ESR * ↑ liver enzymes * ↓ albumin * Sterile pyuria  All patient diagnosed with Kawasaki must do an Echo for aneurysm because serous complications * Coronary artery aneurysms Untreated KD : 20-25% *Treated KD: 1-3 % @clinicalnote

CHILD-PROOFING YOUR HOME : 1_Lock away medications and cleaning products. 2_ Remove small objects or broken parts that could be choking hazards. 3_Use stair gates and window guards. 4_Baby walkers on wheels should never be used. 5_Cover electrical outlets; tuck away cords. Secure furniture to walls. 6_Keep infant away from hot surfaces and be careful when handling hot liquids.

CHILD-PROOFING YOUR HOME : 1_Lock away medications and cleaning products. 2_ Remove small objects or broken parts that could be choking hazards. 3_Use stair gates and window guards. 4_Baby walkers on wheels should never be used. 5_Cover electrical outlets; tuck away cords. Secure furniture to walls. 6_Keep infant away from hot surfaces and be careful when handling hot liquids.

😊Safe sleep 10 strategies to reduced SIDS (sudden infante death syndrome) 👀👌 1_ sleep position ( always place the baby on the thire back to sleep) * The most effective way to reduce SIDS 2_ sleep on the firm and flat surface Avoid soft surfaces like couches, pillows, quilts, or adult beds 3_ avoid smoking during pregnancy and after birth (Smoking increases the risk of SIDS 3–5 times ) 4_ continue breastfeeding significant way to reduce risk for SIDS 4_ sleep in the same room of his parents but not in the same bed ( Ideally for the first 6 months, and preferably up to 1 year ) 5_ Keep the baby's head and face uncovered during sleep and avoid the swaddling. 6_ Use of Pacifier : Offer a pacifier at nap and bedtime (after breastfeeding is well established). Don’t force the baby to take it. If the pacifier falls out during sleep, it’s okay to leave it out. 8_ Avoid Commercial Sleep Positioners or Devices No evidence supports the safety of wedges, positioners, or special mattresses. Devices claiming to reduce SIDS risk are not recommended. 9. Immunizations and Regular Checkups Keep up with the immunization schedule; some studies show it lowers SIDS risk. 10. Tummy Time While Awake Give the baby supervised tummy time daily to promote development and prevent positional plagiocephaly. @clinicalnote

😊Safe sleep 10 strategies to reduced SIDS (sudden infante death syndrome) 👀👌 1_ sleep position ( always place the baby on the thire back to sleep) * The most effective way to reduce SIDS 2_ sleep on the firm and flat surface Avoid soft surfaces like couches, pillows, quilts, or adult beds 3_ avoid smoking during pregnancy and after birth (Smoking increases the risk of SIDS 3–5 times ) 4_ continue breastfeeding significant way to reduce risk for SIDS 4_ sleep in the same room of his parents but not in the same bed ( Ideally for the first 6 months, and preferably up to 1 year ) 5_ Keep the baby's head and face uncovered during sleep and avoid the swaddling. 6_ Use of Pacifier : Offer a pacifier at nap and bedtime (after breastfeeding is well established). Don’t force the baby to take it. If the pacifier falls out during sleep, it’s okay to leave it out. 8_ Avoid Commercial Sleep Positioners or Devices No evidence supports the safety of wedges, positioners, or special mattresses. Devices claiming to reduce SIDS risk are not recommended. 9. Immunizations and Regular Checkups Keep up with the immunization schedule; some studies show it lowers SIDS risk. 10. Tummy Time While Awake Give the baby supervised tummy time daily to promote development and prevent positional plagiocephaly. @clinicalnote

#Complications of Kawasaki Disease Coronary artery thrombosis Peripheral artery aneurysm Coronary artery aneurysms Myocardial infarction Myopericarditis Heart failure Kawasaki shock syndrome Hydrops of gallbladder Aseptic meningitis Irritability Arthritis Sterile pyuria (urethritis) Pancreatitis @clinicalnote

#Complications of Kawasaki Disease Coronary artery thrombosis Peripheral artery aneurysm Coronary artery aneurysms Myocardial infarction Myopericarditis Heart failure Kawasaki shock syndrome Hydrops of gallbladder Aseptic meningitis Irritability Arthritis Sterile pyuria (urethritis) Pancreatitis @clinicalnote

#Criteria for Diagnosis of #Kawasaki Disease ***#fever of >5-day duration associated with at least four* of the following five changes: #Bilateral nonsuppurative conjunctivitis #One or more changes of the mucous membranes of the upper respiratory tract, including pharyngeal injection, dry fissured lips, injected lips, and “strawberry” tongue #One or more changes of the extremities, including peripheral erythema, peripheral edema, periungual desquamation, and generalized desquamation #Polymorphous rash, primarily truncal #Posterior cervical lymphadenopathy >1.5 cm in diameter #Disease cannot be explained by some other known disease process ...

#Criteria for Diagnosis of #Kawasaki Disease ***#fever of >5-day duration associated with at least four* of the following five changes: #Bilateral nonsuppurative conjunctivitis #One or more changes of the mucous membranes of the upper respiratory tract, including pharyngeal injection, dry fissured lips, injected lips, and “strawberry” tongue #One or more changes of the extremities, including peripheral erythema, peripheral edema, periungual desquamation, and generalized desquamation #Polymorphous rash, primarily truncal #Posterior cervical lymphadenopathy >1.5 cm in diameter #Disease cannot be explained by some other known disease process ...

🦠 Poststreptococcal GN may occur 1-6 weeks after resolution of infection: • 1-2 weeks after pharyngitis • 4-6 weeks after impetigo • 3-6 weeks after a pyoderma

#Diagnostic_Cheat_Sheet_for_Diarrhea 1. Acute + watery + travel history = Traveler's Diarrhea (ETEC). 2. Bloody diarrhea + tenesmus + fever = Shigella / EHEC / Inflammatory diarrhea. 3. Chronic + foul smelling + weight loss = Malabsorption (e.g., Celiac, Giardia) 4. Recurrent + post-antibiotics + hospital stay = C. difficile infection 5. Chronic + relieved by defecation + alternating pattern = IBS 6. Chronic + nocturnal + weight loss + blood = IBD