Internal medicine hub

🔎 SLE nephritis: - Stage I & II focuses on treatment of extrarenal manifestations (ex; ACEI, statins & HCQ) - Stage III, IV & V MMF or Cyclophosphamide plus steroid - Stage VI dialysis

وصلني اكثر من استفسار عن مصادر او مراجع للباطنه. شخصيا اللي استخدمه: 1- pocket of medicine: هذا الكتاب بتلقاه بجيب اي رزيدانت مدسن من سنه اولى لرابعه، هو المرجع الاول، على كثر ماهو مختصر الا ان فيه تفاصيل جميله جدا. ممكن تتعب بالبدايه بسبب الرموز والاختصارات بس لابد لابد تختمه مع نهايه الR1 2- board basic: هذا ما اصنفه مرجع ولا انصح تقراه كبدايه؛ بس شخصيا اللي سويته بعد ماختمت بوكت، مريت عليه سريعا وقريته قبل اختبار البارت، ينظم افكارك وفيه تبس حلوه وتركات للMCQ، مره ثانيه اذا ماقريت بوكت او مكساب لا تقراه ماراح يضيف لك شي 3- MKSAP: سمعت عنه مدح كثير، فيه تفاصيل اكثر من بوكت، شخصيا مابديت فيه لكن فيه خطه قريبا باذن الله 4- DynaMed تطبيق جميل احب استخدمه بالانكولات يعطيني الزبده ويستخدم American college كقايدلاين اخيرا UpToDate اذا كنت تبي تقرا عن موضوع بالتفصيل ، ولو انه مايعتبر مرجع معتمد عند بعض الاستشاريين 🤐

🚫 MTX contraindications: - Women who are contemplating becoming pregnant or women not using adequate contraception - Women who are pregnant - Patients with liver disease or excessive alcohol intake - Patients with severe kidney function impairment (estimated glomerular filtration rate [eGFR] less than 30 mL/min)

American heart association stage and management of AS

💡 AS tips: - Criteria for severe AS: • Aortic valve area <1 cm • Transaortic velocity >4 m/second • Mean aortic pressure gradient >40 mmHg - indication for valve replacement: 1- Sever high-grade stenosis in symptomatic patient (angina, HF, exertional dyspnea, syncope or pre-syncope) 2- Asymptomatic with EF <50 3- Severe AS in patient undergoing cardiac surgery - Relative/reasonable: 1- Asymptomatic, but symptoms with exercise 2- Very severe <0.8 cm2 3- High BNP 4- Rapid progression - Scenario: • Symptomatic patient who met all criteria for severe AS > AV replacement • Severely Symptomatic patient who did not meet the criteria for severe AS > cath • Symptomatic patient who did not meet the criteria for severe AS, With reduced EF > dobutamin echo stress test • Asymptomatic patient who met all criteria for severe AS > exercise stress test

📊 Test your self: Write 1-2 indications for IV iron 🩸

BiPAP: Indications and contraindications For exam Purpose, Just remember: - in COPD exacerbation: avoid BiPAP if patient has change in mental status, inability to clear secretions, decreasing pH (more acidic) or normal/high PaCO2 (>42) - BiPAP has no role in asthma exacerbation

📊 Test your self: Write one indication and one contraindication for BiPAP 😷💨

DON'T BE TRICKED 🧐 - A normal arterial Pco2, in a patient with severe asthma exacerbation indicates impending respiratory failure. - So if PaCO2 >42 next step is intubation

Assessment of Asthma severity:

NATIONAL MALARIA DRUG POLICY - Saudi guidelines