اکنون در دسترس! پژوهش تلگرام ۲۰۲۵ — مهمترین بینشهای سال 
Internal medicine hub
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🦠 Post-streptococcus complications:
- Otitis media
- Peritonsillar abscess
- Retropharyngeal abscess
- Lemierre syndrome (necrobacillosis)
- Acute rheumatic fever: only after pharyngitis, not streptococcal skin infections
- Poststreptococcal glomerulonephritis: after throat or skin infections
- Streptococcal toxic shock syndrome
- Poststreptococcal reactive arthritis: overlap with ARF
22-year-old man presents with fever and acute right knee swelling one week after a sore throat. The knee is warm, erythematous, and tender. What is the next best step?
💧 Strategies for managing common adverse effects during diuresis include:
- For symptomatic hypotension, consider decreasing the diuretic dose
- For hypokalemia and hypomagnesemia, consider adding a MRA, potassium and magnesium supplement.
- For hyperkalemia due to MRAs, consider decreasing the dose of MRA or discontinuing therapy (based on the potassium level).
- For worsening kidney function consider discontinuing use of thiazide diuretics for patients receiving a combination of a loop and thiazide diuretics.
- For metabolic alkalosis, Consider acetazolamide if the serum creatinine is < 4 mg/dL and the patient is not volume contracted or hypokalemic.
heart failure patient on IV furosemide (–1.5 L net) remains oxygen-dependent. VBG shows metabolic alkalosis (pH 7.53, high HCO₃⁻). What is the next step?
💡 Remember:
Avoid clarithromycin and levofloxacin based regimens in the absence of demonstrated antibiotic susceptibility.
First-line eradication regimens H. pylori infection is optimized bismuth quadruple therapy for 14 days (PPI, bismuth subcitrate, tetracycline and metronidazole)
**Previous question from old Q-bank 😁
patient with a positive urea breath test, what is your next step?
45 woman presents with weight gain, facial rounding and proximal muscle weakness. What is the most appropriate initial investigation to evaluate her condition?
patient diagnosed with cough variant asthma on albuterol
Initially symptoms improved, but they still complain of cough, need to clear the throat, especially at night & when lying down. Next step?
When should an adult with FSGS be considered glucocorticoid-resistant?
🫁 Pulmonary manifestations in patients with RA may include:
- Interstitial lung disease
- Pleura inflammation (thickening & effusions)
- Pulmonary hypertension
- Caplan syndrome
30F with RA presents with SOB and dry cough for 3 months
denies fever or weight loss examination: cyanosis, digital clubbing, and bibasilar end-inspiratory crackles (velcro crackle). Likely diagnosis?
43-year-old male presented to the ER with syncope and hypotension. ECG showed supraventricular tachycardia (SVT). What is the best next step?
🚫 Don’t be tricked:
- in aortic dissection: give BB first then vasodilation (nitroprusside)
- in Pheochromocytoma: give Alpha-blocker then BB
- in Myxedema Coma: give hydrocortisone first then levothyroxine
patient presents with sudden severe chest pain, shortness of breath, a systolic ejection murmur BP 220/100. What is the most appropriate immediate
management?
47-year-old alcoholic patient presents with a 6-week history of weight loss, fever, and right hypochondrium pain. Lab results and imaging findings include: Alpha fetoprotein: 120 ng/mL (normal: 0-40 ng/mL)
Abdominal ultrasound: Ascites and a focal liver lesion in a cirrhotic liver.
