اکنون در دسترس! پژوهش تلگرام ۲۰۲۵ — مهمترین بینشهای سال 
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پستهای کانال
| 2 | H-Pylori Eradication TripleEtherapy
TheEvastEmajorityEofEGUsEandEDUsEareEassociatedE
withEH-pyloriEinfectionEandEeradicationEtherapyEisE
indicatedEifEinfectionEisEpresent.EEmpiricEeradicationE
ofEH.EpyloriEwithoutEtestingEisEnotErecommended
→ Antibiotics
FirstEchoice
o OmeprazoleEtabletEEW0EmgEbidEE(onEemptyEE
stomach),EEOrE:EegE:ERanitidineEEtablet150EmgE
bidEEforEE10-14EdaysE
o +EAmoxicillinE1gEbidEatEtheEendEofEtheEmealE
forE10-14Edays
o +EClarithromycinE500EmgEbidEatEtheEendEofE
theEmealEforE10-14Edays
→ AlternativeE
Omeprazole tabletEEW0EmgEbidEE(onEemptyEE
stomach),EEORE:EegE:ERanitidine Etablet150EmgEbidEE
forEE10-14EdaysEE
+EAmoxicillinE1gEbidEatEtheEendEofEtheEmealEforE
10-14Edays
+ECiprofloxacinE500EmgEbidEatEtheEendEofEtheE
mealEforE7EdaysE
Or
Omeprazole tabletEEW0EmgEbidEE(onEemptyEE
stomach),EEorEEegE:ERanatidine Etablet150EmgEbidEE
forEE10-14Edays
+ETetracyclineE500EmgEqidEand/orEClarithromycin
500mgEbdEEforE10-14Edays
N Metronidazole 500mgEbidEatEtheEendEofEtheE
mealEforE10-14Edays
(bestEregimeEforEpenicillinEintolerantEpatients) | 1 |
| 3 | https://vt.tiktok.com/ZSCuYbRtT/ | 513 |
| 4 | 3. A 31 year-old male presented came to the OPD after he
sustained trauma to his right flank. He fell down from a two
story building .He complains of pain at the site and has gross
hematuria. On examination, He is acutely sick looking in pain
BP=110/70mmhg, PR=96/min. There is a bruise over the right
flank arca that is tender to touch. Which organ is most likely
injured ?
A.kidney B. Liver C.Ureter D. Urinary Bladder
4. A 60 year-old female patient presented with right sided
flank pain and hematuria of one month duration .she also had
significant weight loss night sweats and malaise. One physical
examination, she is chronically sick looking with normal vital
signs, a bimanually palpable mass on the right flank . what is
the most likely diagnosis?
A. Chronic pyelonephritis
B. Neuroblastoma
C. Renal cell cancer
D. wilm,s tumor
5. A 35 year-old male patient presented to the Emergency Room
after sustaining a bullet injury to his left fore arm, intact distal
neurovascular examination. X-ray showed comminuted displased
radioulnar fracture. Which of the following is a temporary means of
immobilization?
A.Apply POP cast
B.External fixation
C.Lateral arm traction
D. plating and screw | 580 |
| 5 |  General Gynecology For Your Exit ExM | 729 |
| 6 |  +5بدون متن... | 1 404 |
| 7 |  +9بدون متن... | 1 265 |
| 8 |  #Updates
Godina Jimmaa
Waamicha qaxarrii Ogeeyyii Fayyaa Marsaa 2ffaa bara 2018. | 1 358 |
| 9 | Hi Guys how about the exam? | 80 |
| 10 | Stevens-Johnson syndrome (SJS) is a rare, severe, and potentially life-threatening disorder affecting the skin and mucous membranes. It is typically a hypersensitivity reaction, most commonly triggered by medications, though it can also be caused by infections.
SJS is considered part of a spectrum of disease that includes toxic epidermal necrolysis (TEN), with the classification based on the percentage of body surface area (BSA) affected by skin detachment:
SJS: Less than 10% of BSA.
SJS/TEN Overlap: 10–30% of BSA.
TEN: More than 30% of BSA.
Key Clinical Features
The condition typically begins with a prodromal phase (1–3 days) of flu-like symptoms, followed by rapid progression:
Early Symptoms: Fever, sore throat, cough, fatigue, and burning eyes.
Skin Manifestations: A painful, red, or purple rash that spreads quickly. It may develop into "atypical target lesions" (dark centers with lighter rings).
**Blistering & Peeling: Blisters form and eventually cause the top layer of skin (epidermis) to die and shed, often in large sheets. A positive Nikolsky sign (where the skin peels off when rubbed gently) is common.
Mucosal Involvement: Nearly all patients experience involvement of two or more mucosal surfaces, including the mouth/lips (making eating/swallowing painful), eyes (conjunctivitis, swelling, potential corneal scarring), and genital/urinary tracts.
Causes
Medications: The most common trigger. High-risk drugs include certain anticonvulsants (e.g., carbamazepine, lamotrigine, phenytoin), sulfonamides (antibiotics), and allopurinol. Symptoms can appear while taking the medication or up to two weeks after discontinuation.
Infections: More common in children; examples include Mycoplasma pneumoniae, HIV, and herpes viruses.
Genetic Factors: Certain HLA (human leukocyte antigen) genetic variations are known to increase susceptibility to specific drug-induced reactions. | 1 586 |
| 11 | Question 4/10
A patient with a communited fracture of the femur is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when:
A) Adequate alignment cannot be obtained by other nonsurgical methods.
B) The patient cannot tolerate the discomfort of a closed reduction.
C) Cast would be too large to provide normal mobility.
D) The patient is able to tolerate long-term immobilization.
Correct
Answer: A) Adequate alignment cannot be obtained by other nonsurgical methods.
Explanation:
ORIF is indicated when nonsurgical methods (like casting or traction) fail to achieve proper bone alignment. Option a correctly states this. Option b refers to pain tolerance, which is not the primary indication. Option c is impractical; cast size is not a deciding factor. Option d is incorrect because ORIF aims to avoid long-term immobilization. | 1 300 |
| 12 | Question 3/10
Patients with eye inflammation or an eye infection should be taught:
A) Those acute conditions commonly lead to chronic problems.
B) That regular, careful hand washing may prevent the infection from spreading.
C) To wear dark glasses to prevent irritation from UV light.
D) To apply a cold washcloth with pressure to the inflamed area frequently.
Answer: B) That regular, careful hand washing may prevent the infection from spreading.
Explanation:
Hand washing (option b) prevents spread of infection. Not all acute conditions become chronic (a). Dark glasses (c) may help but not primary. Cold compress (d) may be used but not with pressure. | 975 |
| 13 | Question 2/10
Mr. Abera is receiving continuous tube feedings through a small-bore nasogastric tube. Which method is the most accurate in verifying correct tube placement?
A) Measurement of the gastric aspirate pH.
B) Auscultatory method.
C) Radiographic examination.
D) Measurement of the amount of residual.
Answer: C) Radiographic examination.
Explanation:
Radiographic examination (option c) is the gold standard for verifying NG tube placement. pH testing (a) is helpful but not definitive. Auscultation (b) is unreliable. Residual measurement (d) assesses tolerance, not placement. | 689 |
| 14 | Question 1/10
A 28-year-old woman who is 6 months pregnant presents to the emergency department with a temperature of 38.2°C (100.8°F) and complains of shaking chills and pain on her right side, which she locates by pointing to the area above her right iliac crest. During the examination she is tender to percussion at the junction of the lower ribs and the thoracic vertebrae. Urinalysis reveals WBC casts. Which of the following is the most likely diagnosis?
A) Pyelonephritis.
B) Localized cystitis.
C) Ectopic pregnancy.
D) Appendicitis.
✅ Correct!
Explanation:
Symptoms suggest pyelonephritis (option a): fever, flank pain, CVA tenderness, WBC casts. Cystitis (b) usually lacks fever and flank pain. Ectopic pregnancy (c) is unlikely at 6 months. Appendicitis (d) pain is typically lower right quadrant. | 623 |
| 15 | ANSWER 2
The most likely diagnosis is laryngotracheobronchitis (croup). Ewa has stridor, which is an
inspiratory sound, secondary to narrowing of the upper airway. In contrast, wheeze is an
expiratory sound caused by narrowing of the lower airways. The effort required to shift air
through the narrowed airway has resulted in tachypnoea and recession.
The upper airway of a child with stridor should not be examined and the child should not be
upset by performing painful procedures such as blood tests as there is a small risk that this
may lead to a deterioration; a partially obstructed airway can progress to complete obstruction and a respiratory arrest.
! Differential diagnosis of acute stridor
• Laryngotracheobronchitis (croup)
• Inhaled foreign body
• Anaphylaxis
• Epiglottitis
• Rarer causes include the following:
– Bacterial tracheitis
– Severe tonsillitis with very large tonsils
– Inhalation of hot gases (e.g. house fire)
– Retropharyngeal abscess
Croup typically occurs in children 6 months to 5 years old. It is characterized by an upper
respiratory tract infection that is followed by a barking-type cough, a hoarse voice, stridor
and a low-grade fever. Croup is most commonly caused by the parainfluenza virus.
When a foreign body is inhaled, there is usually a history of sudden coughing and/or choking
in a child who was previously well. There may be accompanying cyanosis. The foreign body
is usually a food (e.g. peanut), but may be a small toy or other object. On examination, there
may be a unilateral wheeze with decreased air entry on one side.
Ewa’s case is not typical of anaphylaxis. There is no history of the child having contact
with a known allergen (i.e. peanuts) and there is a lack of other features that often accompany anaphylaxis, such as an itchy urticarial rash, facial swelling, vomiting, wheeze or
hypotension.
Epiglottitis would be very unlikely in Ewa as she is fully immunized and would have received
the Haemophilus influenzae type b (Hib) vaccine.
Initial management deals with the ABC. If Ewa’s oxygen saturation was low, high-flow
100 per cent oxygen would be needed to elevate the saturation to >95 per cent.
The first step in the treatment of croup is oral dexamethasone. A less frequently used, and
more expensive, alternative is nebulized budesonide. If 2 to 3 hours later Ewa has improved
significantly and the oxygen saturation remains >95% in air, she could be discharged with
clear safety netting advice and a follow up plan. In some cases a further dose of steroids can
be administered 12 to 24 hours later. If Ewa’s condition deteriorated, then nebulized adrenaline could be administered. If adrenaline is required then senior help and an anaesthetist
should be summoned urgently. If there is a further deterioration (increasing tachypnoea, | 563 |
| 16 | CASE 2: A CHILD WITH NOISY BREATHING
History
Ewa is a 4-year-old child who presents to the emergency department (ED) with a sudden onset
of noisy breathing. She has had a runny nose for 2 days, a cough for 1 day and developed noisy
breathing 3 hours earlier. Her mother feels that she is getting progressively more breathless.
Her father had a cold the previous week. She is otherwise well but has troublesome eczema,
which is treated with emollients and steroid creams. Her mother states that she is allergic to
peanuts, as they lead to a deterioration of the eczema within 1 to 2 hours. She avoids peanuts
and all types of nuts. She is fully immunized. Her 8-year-old sister has asthma.
Examination
Her oxygen saturation is 96 per cent in air and the temperature is 38.0°C. There is loud noisy
breathing, mainly on inspiration. Ewa’s respiratory rate is 52 breaths/min with supracostal
and intercostal recession. On auscultation, there are no crackles or wheezes. There are no
other signs.
Questions
• What is the most likely diagnosis?
• What is the differential diagnosis?
• What is the treatment? | 613 |
| 17 | ANSWER
Stridor is an inspiratory sound due to narrowing of the upper airway. Mohammed is most
likely to have stridor due to laryngomalacia. This means that the laryngeal cartilage is soft
and floppy, with an abnormal epiglottis and/or arytenoid cartilages. The larynx collapses
and narrows during inspiration (when there is a negative intrathoracic pressure), resulting in
inspiratory stridor. It is usually a benign condition with noisy breathing, but no major problems with feeding or significant respiratory distress. Most cases resolve spontaneously within
a year as the larynx grows and the cartilaginous rings stiffen. The reason Mohammed now
has respiratory distress is that he has an intercurrent viral upper respiratory tract infection.
A very important diagnosis to consider in Mohammed is a haemangioma in the upper airway.
The majority of haemangiomas are single cutaneous lesions, but they can also occur at other
sites, and the upper airway is one position where they can enlarge with potentially lifethreatening consequences. The presence of one haemangioma increases the likelihood of a
second one. Mohammed should be referred for assessment by an ENT surgeon.
There are many other possible congenital causes of stridor that affect the structure or function
of the upper airway. Infectious causes of stridor, such as croup and epiglottitis, are very rare
in this age group.
👇👇👇👇
! Differential diagnosis of stridor in an infant
• Laryngomalacia
• Laryngeal cyst, haemangioma or web
• Laryngeal stenosis
• Vocal cord paralysis
• Vascular ring
• Gastro-oesophageal reflux
• Hypocalcaemia (laryngeal tetany)
• Respiratory papillomatosis
• Subglottic stenosis
The diagnosis of laryngomalacia can be confirmed by visualization of the larynx using flexible laryngoscopy. This can be done by an ENT surgeon as an outpatient procedure. This
demonstrates prolapse over the airway of an omega-shaped epiglottis or arytenoid cartilages.
Congenital structural abnormalities may also be seen. Lesions below the vocal cords may
require bronchoscopy, CT or MRI scan for diagnosis.
🔑Key Points
• The commonest cause of congenital stridor is laryngomalacia.
• Laryngomalacia can be exacerbated by intercurrent respiratory infections. | 585 |
| 18 | PEDIATRICS QUESTION
RESPIRATORY
CASE 1: AN INFANT WITH NOISY BREATHING
History
Mohammed is a 3-month-old boy, brought to a paediatric rapid referral clinic because of
persistent noisy breathing. He was born in the United Kingdom at term, after an uneventful
pregnancy, and is the fifth child of non-consanguineous Somalian parents. His birth weight
was 3.7 kg (75th centile). Since he was a few weeks old, he has had noisy breathing, which has
not affected his feeding, and his parents were repeatedly reassured that it would get better. He
has continued to have intermittent noisy breathing, especially when agitated, and sometimes
during sleep. Over the past few days, his breathing has been noisier than usual. Otherwise
he has been well without any fevers. All of his siblings have recently had coughs and colds.
Examination
Mohammed is active and smiles responsively. His oxygen saturations are 95 per cent in air
and his temperature is 36.9°C. He is coryzal and has intermittent stridor. There is a small
‘strawberry’ haemangioma on his forehead. His respiratory rate is 45 breaths/min, and he
has subcostal recession and mild tracheal tug. Air entry is symmetrical in his chest, with
no crackles or wheeze. Cardiovascular examination is unremarkable. His weight is 6.7 kg
(75th centile).
Questions
• What is the most likely cause of his stridor?
• What other important diagnoses need to be considered?
• How can the diagnosis be confirmed? | 480 |
| 19 | ANSWER
The diagnosis is of an endometrial polyp, These can occur in women of any age although they are more common in older
women and may be asymptomatic or cause irregular bleeding or discharge. The aetiology
is uncertain and the vast majority are benign. In this specific case all the differential diagnoses are effectively excluded by the history and examination.
👇👇👇👇
! Differential diagnosis for intermenstrual bleeding
• Cervical malignancy
• Cervical ectropion
• Endocervical polyp
• Atrophic vaginitis
• Pregnancy
• Irregular bleeding related to the contraceptive pill
👇👇👇👇
Management
Any woman should be investigated if bleeding occurs between periods. In women over the
age of 40 years, serious pathology, in particular endometrial carcinoma, should be excluded.
The polyp needs to be removed for two reasons:
1 to eliminate the cause of the bleeding
2 to obtain a histological report to ensure that it is not malignant.
Management involves outpatient or day case hysteroscopy, and resection of the polyp
under direct vision using a diathermy loop or other resection technique This
allows certainty that the polyp had been completely excised and also allows full inspection of the rest of the cavity to check for any other lesions or suspicious areas. In some
settings, where hysteroscopic facilities are not available, a dilatation and curettage may
be carried out with blind avulsion of the polyp with polyp forceps. This was the standard
management in the past but is not the gold standard now, for the reasons explained.
👇👇👇👇.
KEY POINTS
• Any woman over the age of 40 years should be investigated if bleeding occurs between
the periods, to exclude serious pathology, in particular endometrial carcinoma.
• Hysteroscopy and dilatation and curettage is rarely indicated for women under the age
of 40 years. | 486 |
| 20 | CASE 1: INTERMENSTRUAL BLEEDING
👉History
A 48-year-old woman presents with intermenstrual bleeding for 2 months. Episodes of
bleeding occur any time in the cycle. This is usually fresh red blood and much lighter than
a normal period. It can last for 1–6 days. There is no associated pain. She has no hot
flushes or night sweats. She is sexually active and has not noticed vaginal dryness.
She has three children and has used the progesterone only pill for contraception for 5 years.
Her last smear test was 2 years ago and all smears have been normal. She takes no medication and has no other relevant medical history.
Examination
The abdomen is unremarkable. Speculum examination shows a slightly atrophic-looking
vagina and cervix but there are no apparent cervical lesions and there is no current bleeding.
On bimanual examination the uterus is non-tender and of normal size, axial and mobile.
There are no adnexal masses.
INVESTIGATIONS👇
Haemoglobin 12.7 g/dL Range11.7–15.7g/dL
White cell count 4.5 109/L
Range 3.5–11 109/L
Platelets 401 109/L
Range 150–440 109/L
INVESTIGATIONS
Questions
• What is the diagnosis and differential diagnosis?
• How would you further investigate and manage this woman? | 609 |
