Medical Clinical Notes

الصاحي يدخل والنايم راحت عليه ♥️🔥🏃‍♀ https://whatsapp.com/channel/0029VbAxzkoCBtxJ8vsKhz0Y

الصاحي يدخل والنايم راحت عليه ♥️🔥🏃‍♀ https://whatsapp.com/channel/0029VbAxzkoCBtxJ8vsKhz0Y

Congenital heart disease accounts for only 2% of heart disease in adults.

Do NOT give antibiotics for endocarditis prophylaxis for: • Native mitral valve prolapse/stenosis • Routine GI (endoscopy) or GU (cystoscopy) procedures

• The initial anticoagulant for VTE treatment includes unfractionated heparin (UFH), low molecular weight heparin (LMWH), pentasaccharide (fondaparinux), or a nonwarfarin oral anticoagulant . Longer-term anticoagulation is typically with warfarin or the novel oral anticoagulants (NOACs). • Duration of anticoagulation: For first episode 3–6 months and for recurrent episodes it should be continued at least for 1 year. Duration of treatment depends, whether DVT is provoked or unprovoked, and risk of bleeding following initiation of anticoagulant. ■ Heparins UFH requires serial monitoring of anticoagulation. LMWHs do not need for routine monitoring. LMWHs require dose adjustments in patients with a CrCl of 15–30 mL/min and are contraindicated in patients undergoing dialysis. LMWHs are the preferred agent for VTE treatment during pregnancy and in patients with cancer

During ventricular systole, the coronary vessels supplying the left ventricle are compressed by the surrounding muscle. As a result, the majority of left ventricular blood flow occurs during diastole. The systolic reduction in coronary blood flow is greatest in the subendocardial region, making this portion of the left ventricle most prone to ischemia and infarction.

Radioactive Iodine Uptake Test Abnormal Findings • Diffuse high uptake: Graves disease • Diffuse low uptake: Hashimoto’s thyroiditis • Multiple areas of high uptake: nodular goiter • Single “hot” nodule:adenoma • Single “cold” nodule: Possible cancer Most cancers do not make hormone About 5-10% cold nodules are malignant

Cushing Syndrome Excess Cortisol Effects • Hypertension • Hyperglycemia • Diabetes (insulin resistance) • Osteoporosis • Neuropsychiatric (depression, anxiety) • Immune suppression • Risk of infections, especially opportunistic • Cataracts

1. 2-level PE Wells score > 4 points - immediate CTPA or interim anticoagulation whilst awaiting CTPA 2. 2-level PE Wells score ≤ 4 points - D-dimer with the result within 4 hours or interim anticoagulation whilst awaiting D-dimer 3. 3 'stacked' defibrillation shocks - should be considered for VF/pulseless VT for a witnessed, monitored cardiac arrest in an HDU setting (adult patient) 4. 50-year-old man with chest pain, STEMI changes on ECG, pulse 90/min, BP 140/80mmHg, sats 96% - aspirin, nitrates, morphine, prasugrel, arrange immediate percutaenous coronary intervention 5. 60-year-old man with chest pain, NSTEMI changes on ECG, pulse 66/min, BP 130/82mmHg, sats 98% - aspirin, nitrates, morphine, clopidogrel, calculate GRACE score 6. 70-year-old man with chest pain, STEMI changes on ECG, pulse 102/min, BP 160/90mmHg, sats 93% - aspirin, nitrates, morphine, oxygen, prasugrel, arrange immediate percutaenous coronary intervention 7. A 10-year-old presents with fever. They complain of fleeting large joint pain and 'jerking' movements of the handand face. On examination a murmur is noted and subcutaneous nodules on the wrists - Streptococcus pyogenes 8. A 25-year-old man is investigated for recurrent syncope and dyspnoea. On examination he has an ejection systolic murmur - hypertrophic obstructive cardiomyopathy

leishmania (visceral kala-azar ) cause by L.donovani (intracellular,hyperglubulinemia ) diagnose by Finding amastigotes most specific , Direct agglutination Test, or PCR or limited settings & fine needle aspiration , bone marrow ttt by Miltofisine if Na stabgluconate Not effect ,- signs & symptoms :( patient for chronic time more than month has intermittent fever, splenomegaly, pancytopenia , epistaxis ) ↪️ Treated with Na stabgluconate ( panostam) 10-20mg one for a day for 30 days .