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Publicaciones del Canal
| 2 | আপনি icu ,hdu doctor হিসাবে আছেন!!
একজন রোগী অনেক violent behaviour করছেন।
according to davidson তাকে আপনি
first line :Haloperidol 0.5mg দিতে পারবেন।
second line:benzodiazepnine group এর ড্রাগ আমরা দেই।
(diazepam or lorazepam)
davidson এ উল্লেখ না থাকলে কমন একটা প্রাকটিস হচ্ছে :midazolam দেয়া।এটাও কাজ করে খুব।
আপনি কিভাবে আগাবেন:
১.ধরুন পেশেন্ট old age..Oxygen saturation বাড়ে কমে।সাথে খুবই violent...সারারাত ঘুমাচ্ছেন না।
copd আছে কিংবা emphysema..or RTI...
তখন আপনি Haloperidol choose করবেন।
কারণ respiratory issue আছে এরকম পেশেন্টকে benzodiazepines দেয়া রিস্কি।respiratory depression করে। স্পেশালি midazolam -severe respiratory depression করে।
তবে ,haloperidol এর সিরিয়াস সাইড ইফেক্ট হচ্ছে dystonia করে।।
এজন্য আমরা সাথে আমাদের বহুল পরিচিত perkinil drug টা দেই।এটার জেনেরিক নাম : procyclidine... এটা extrapyramidal effect থেকে বাচিয়ে রাখে।
halop perkinil combo এজন্যই চ্যুজ করা হয়।
আবার যাদের MI,previous arrhythmia history..SVT এগুলে আছে তাদেরও Haloperidol না দিয়ে benzodiazepines দেয়ার চেষ্টা করবেন,কারণ Haloperidol arrhythmia করে।
দিনশেষে যতই পুথিগত বিদ্যা পড়া থাকুক,experience does matter..attending physician experienced হলে নিজেই অনেক কিছু ম্যানেজ করে ফেলতে পারেন।তবে অবশ্যই what mind doesn’t know..eyes cant see...!!
Dr Adnan Tamim | 520 |
| 3 | Histological findings associated with diabetic nephropathy include Kimmelstiel-Wilson lesions and nodular glomerulosclerosis. | 243 |
| 4 | 🧨Narcolepsy is associated with low orexin (hypocretn) levels | 249 |
| 5 | Always replace vitamin B12 before folate - giving folate to a patient defcient in B12 can
precipitate subacute combined degeneraton of the cord | 257 |
| 6 |  Sin texto... | 340 |
| 7 |  Atypical info of Cardiology series 1 | 929 |
| 8 | obesity can cause decreased BNP level
leading to a false negative for heart failure screening..
🫵আবার কারো eGFR <60 হলেও serum natriuretic peptide বাড়তে পারে। | 377 |
| 9 | Ecg changes of ACUTE PERICARDITIS? | 395 |
| 10 | epsilon wave found in? | 393 |
| 11 | A 42-year-old man develops renal infarction, pulmonary embolism and cerebral ischemia over several days. He has known APS and rapidly develops multiorgan failure. What is the most likely diagnosis?
A. TTP
B. HUS
C. Catastrophic APS
D. DIC
E. HIT | 407 |
| 12 | Atrial Fibrillation এ Rhythm control এর ক্ষেত্রে :
🫵Davidsons principles and practice of medicine 25th edition : পেশেন্ট ২৪ ঘন্টার মধ্যে আসলে rhythm control করতে বলেছে।
যদি ২৪ ঘন্টার পর আসে কিংবা duration uncertain হয়,তাহলে ৩ সপ্তাহ anticoagulant নিবে,তারপর cardioversion করা হবে।
cardioversion করার পর মিনিমাম ৪ সপ্তাহ পর্যন্ত anticoagulant maintain করবে।
তাহলে,AF >24 h → delay cardioversion → ≥3 weeks OAC OR imaging-guided cardioversion → cardioversion → ≥4 weeks OAC → thereafter according to stroke risk.
(24th edition থেকে এই চেন্জটা অনেক আপডেট হয়েছে।) | 525 |
| 13 |  Sin texto... | 617 |
| 14 | ⭕ Current Treatment of choice for primary prevention for variceal bleeding: Carvedilol (Davidson 25th) | 595 |
| 15 | * DIP + psoriasis → Psoriatic arthritis
* 1st MTP + needle/negative → Gout
* Knee + rhomboid/positive → CPPD
* Back pain + sacroiliitis → AS
* Dry eyes + dry mouth → Sjögren
* Malar + kidney → SLE
* CREST → limited scleroderma
* Renal crisis → diffuse scleroderma
* Gottron + heliotrope → Dermatomyositis
* Asthma + eosinophilia → EGPA
* Sinus + lung + kidney → GPA
* Pulseless young woman → Takayasu
* Old + headache + jaw claudication → GCA
* Shoulder/hip stiffness >50 → PMR
* Microaneurysms + HBV → PAN
* Purpura + abdominal pain + hematuria → IgA vasculitis
* Oral + genital ulcers + uveitis → Behçet
dr ali | 801 |
| 16 | Rheumatology: Buzzword Questions 🔥
1. Young woman with malar rash, photosensitivity, painless oral ulcers, and proteinuria. Anti-dsDNA is positive.
→ SLE
2. Woman with symmetric MCP/PIP pain and morning stiffness lasting >1 hour. Anti-CCP is positive.
→ Rheumatoid arthritis
3. Older woman with Heberden nodes and knee pain that worsens with activity; morning stiffness lasts 10 minutes.
→ Osteoarthritis
4. Young man with chronic low back pain that improves with exercise and bilateral sacroiliitis.
→ Ankylosing spondylitis
5. Patient with psoriasis develops DIP arthritis, nail pitting, and sausage-like fingers.
→ Psoriatic arthritis
6. Man develops acute, exquisitely painful first MTP swelling. Synovial fluid shows needle-shaped, negatively birefringent crystals.
→ Gout
7. Elderly patient with acute knee arthritis. Synovial fluid shows rhomboid-shaped, weakly positively birefringent crystals.
→ CPPD/pseudogout
8. Woman with dry eyes, dry mouth, dental caries, and bilateral parotid enlargement. Anti-Ro is positive.
→ Sjögren syndrome
9. Woman has Raynaud phenomenon, sclerodactyly, telangiectasias, esophageal dysmotility, and calcinosis.
→ Limited systemic sclerosis (CREST)
10. Patient with diffuse skin thickening develops
sudden severe hypertension and acute kidney injury.
→ Scleroderma renal crisis
11. Young woman with proximal muscle weakness, heliotrope rash, and Gottron papules. CK is elevated.
→ Dermatomyositis
12. Patient has proximal muscle weakness and elevated CK but no characteristic skin findings. Muscle biopsy shows endomysial inflammation.
→ Polymyositis
13. Patient with asthma, eosinophilia, sinusitis, pulmonary infiltrates, and peripheral neuropathy develops vasculitis.
→ EGPA
14. Patient has chronic sinusitis, hemoptysis, cavitary lung lesions, and rapidly progressive glomerulonephritis. c-ANCA is positive.
→ GPA
15. Patient has pulmonary hemorrhage and rapidly progressive glomerulonephritis. p-ANCA/MPO is positive, without granulomas.
→ Microscopic polyangiitis
16. Young woman has arm claudication, absent radial pulses, carotid bruits, and unequal blood pressures between arms.
→ Takayasu arteritis
17. 70-year-old woman develops new temporal headache, jaw claudication, elevated ESR, and transient visual loss.
→ Giant cell arteritis
18. 70-year-old patient has bilateral shoulder and hip stiffness with markedly elevated ESR and normal CK.
→ Polymyalgia rheumatica
19. Patient has abdominal pain, mononeuritis multiplex, hypertension, and renal ischemia. Angiography shows microaneurysms.
→ Polyarteritis nodosa
20. Child develops palpable purpura on the legs, abdominal pain, arthralgia, and hematuria after an upper respiratory infection.
→ IgA vasculitis
21. Young adult has recurrent oral and genital ulcers with uveitis and a positive pathergy test.
→ Behçet disease
22. Patient develops arthritis, conjunctivitis, and urethritis several weeks after a genitourinary infection.
→ Reactive arthritis
23. Young woman has recurrent miscarriages and DVTs. PTT is prolonged despite a hypercoagulable state.
→ Antiphospholipid syndrome
24. Woman with SLE has recurrent fetal loss and positive anticardiolipin antibodies.
→ Antiphospholipid syndrome
25. Patient has bilateral hilar lymphadenopathy, erythema nodosum, uveitis, and noncaseating granulomas.
→ Sarcoidosis
26. Patient has chronic widespread pain, fatigue, and poor sleep but normal ESR, CK, and physical examination.
→ Fibromyalgia
27. Patient develops migratory polyarthritis and carditis several weeks after untreated pharyngitis.
→ Acute rheumatic fever
28. Young patient has urethritis followed by asymmetric oligoarthritis and heel pain.
→ Reactive arthritis
29. RA patient develops splenomegaly and neutropenia.
→ Felty syndrome
30. RA patient who works in coal mining develops pulmonary nodules.
→ Caplan syndrome
The shortest possible recognition rules
* MCP/PIP + prolonged morning stiffness → RA | 701 |
| 17 | A 66-year-old woman came with a history of bilateral wrist and hand pain, which is worse in the mornings. You make a diagnosis of rheumatoid arthritis. Following unsuccessful treatment with a number of different medications, she is commenced on a trial of anakinra.
Which cell type is the main source of the cytokine that this drug blocks?
Options:
A. B cells
B. Macrophages
C. Natural killer cells
D. T helper cells
E. T killer cells | 551 |
| 18 |  all hypersensitivity reaction | 750 |
| 19 | ITP = Isolated ↓ platelets
HSP = Normal platelets + palpable purpura + PAIN
TTP = MAHA + ↓platelets + NEURO
HUS = MAHA + ↓platelets + KIDNEY + bloody diarrhea
DIC = MAHA + ↓platelets + PT/aPTT BOTH ↑ | 993 |
| 20 | * TNF-α → granuloma maintenance
High-Yield Healing
* Healing by first intention → clean surgical wound
* Healing by second intention → large wound/tissue loss
* Granulation tissue → new vessels + fibroblasts
* Granulation tissue ≠ granuloma
* VEGF → Angiogenesis
* FGF → fibroblast proliferation
* TGF-β → collagen synthesis + fibrosis
* Type III collagen → early wound
* Type I collagen → mature scar
* Vitamin C deficiency → impaired collagen hydroxylation
* Zinc deficiency → impaired wound healing
* Keloid → scar extends beyond original wound
* Hypertrophic scar → remains within original wound boundaries
© | 1 021 |
