Internal medicine hub

🦠 General rules in treating malaria: - Assume all areas around the world are Chloroquine resistant except for Panama, Dominican republic & Haiti - The preferred regimens for drug resistant Malaria is an Artemisinin combination therapy (ACT), Artemether-Lumefantrine is the most used combination - IV Artesunate based regimens are preferred in cases of Severe Malaria (Seizures: More than 2 within 24 hours, Hypoglycemia <40, Anemia <7 g/dL, AKI >256 mmol/L, pulmonary edema,, acidosis Hco3 <15, Jaundice “T bili > 50 mcmol/L” and Uncontrolled continuous bleeding) - Plasmodium vivax/ovale can relapse due to dormant liver hypnozoites. Primaquine is required to eradicate hypnozoites and prevent future relapses (radical cure).

🔜 Part I

🔬 indication of EGD in patient presented with GERD symptoms: - no response to PPI after 4-8 weeks - alarm features: dysphagia, vomiting, weight loss, anemia, age >60 - chest pain "if cardiac diease exluded" if EGD normal → 24-h pH monitoring to confirm diagnosis

🎯 Asthma plus syndromes: 1- Atopy: asthma, allergic rhinitis and atopic dermatitis 2- Samter's syndrome: asthma, ASA sensitivity and nasal polyps 3- ABPA: asthma, pulmonary infiltrates and hypersensitivity to Aspergillus 4- Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): asthma, eosinophilia and granulomatous vasculitis

A 40-year-old female patient with a known case of bronchial asthma and allergic rhinitis presents with poor control despite using inhaled steroids and oral steroids. She also takes aspirin and ibuprofen for joint pain. Examination reveals nasal polyps and chest wheezing.

Screening for Type 2 Diabetes - Screen using the following tests: FPG, OGTT or Hba1c. - If two separate tests are done simultaneously and both are abnormal “diabetic range”, diagnose diabetes. - If only one of the two tests is abnormal, repeat the abnormal test. - random plasma glucose level ≥200 mg/dL with hyperglycemic symptoms is diagnostic of diabetes. - If two separate tests are done simultaneously and both are pre-diabetic, Monitor for type 2 diabetes at least annually

Evaluation of Chronic Cough X: @ManualOMedicine

💉 Response to oral iron therapy: - Reticulocyte count increases within days - Hemoglobin increases by 1-2 g/dL within 2 weeks - Normal hemoglobin level usually achieved in about 2 months. - Serum ferritin may take 6 months to return to normal. If there is an unsatisfactory response after >3 weeks of iron therapy, consider assessing for: - noncompliance - ongoing blood loss - malabsorption of iron - an incorrect diagnosis

💡 Thalassemia hints: - Microcytic hypochromic anemia not responsive to supplemental iron. - Microcytic anemia with a disproportionately high RBC count (MCV/RBC ratio <13) - Normal RDW - Coombs test negative (distinguish from AIHA)

Diagnostic criteria for anaphylaxis

💡 Remember: - Pleural effusion is classified as exudative if any one of the criteria is met - While pleural effusion is classified as transudative if all three of the criteria are met

Light criteria for pleural effusion