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46M presented with SOB for 2m. He has a known Tab. On examination, his blood pressure is 112/77 mmHg. He has a distended JVP that increases with inspiration.
Without murmurs. most likely diagnosis is?
indications for long-term oxygen therapy in COPD patients:- PaO2 ≤ 55 mmHg (7.3 kPa) or SpO2 ≤ 88% on room air. - PaO2 56–59 mmHg (7.4–8.0 kPa) or SpO2 ≤ 89% if there is evidence of: Pulmonary hypertension or Secondary polycythemia - Nocturnal hypoxemia with PaO2 ≤ 55 mmHg during sleep.
LTOT is not recommended in patients:- who continue to smoke (due to fire safety concerns, including facial burns and house fires) - who continue to be noncompliant after education - with COPD who have moderate chronic resting hypoxemia (SpO2 = 89%-93%) - unable to properly handle oxygen supply systems - with severe cardiopulmonary disease with primary complaint of dyspnea, but arterial oxygen partial pressure PaO2 > 60 mm Hg and no secondary evidence of chronic hypoxia - who have not received adequate therapy for underlying medical conditions causing hypoxemia
female patient had COPD and is currently on medication. Her ABG showed p02= 8kPa. Which of the following will improve survival?
Male presents with slurred speech and weakness of his right upper limb. The following day, all his neurological signs resolve. there is no carotid bruit. carotid Doppler: 80% stenosis. Next?
34-year-old female diagnosed with hyperprolactinemia for one year is on cabergoline. Which of the following is an indication for brain MRI in this patient?
39F C/O heartburn for 6m, occasionally chest pain, not associated with weight loss. eats dinner 2 hours before going to bed. She's taking omeprazole 20 mg. EGD showed distal esophagitis. BMI 28. Next?
25-year-old male presents with rectal bleeding and abdominal pain. Both his sibling and mother have the same condition. The guaiac stool test is positive. What is the most likely diagnosis?
Electrolytes imbalance precipitants in hepatic encephalopathy- Hyponatremia - hypokalemia - hypo or hyper calcemia
hepatic encephalopathy treatment:- Identify and correct precipitating factors: (infection, GI bleeding, RF, electrolyte disturbances) - Maintain nutrition with protein intake of 1.2-1.5 g/kg/day and daily energy intake of 35-40 kcal/kg - Lactulose (treatment & prevention after 1st attack) maintain 2-3 bowel motions per day - Rifaximin: after a second episode of hepatic encephalopathy - add on: PEG, Oral branched-chain amino acids or IV L-ornithine L-aspartate - Flumazenil: symptomatic improvement - TIPS: Recurrent bouts of overt hepatic encephalopathy in patients with preserved liver function - liver transplant. (Indicated in recurrent intractable overt hepatic encephalopathy plus liver failure)
patient with liver cirrhosis due to hepatitis C has esophageal varices and altered cognitive function. The patient is inquiring about which nutrient should be restricted?
🧮 Uses of fecal calprotectin:
- Diagnostic utility in IBD (sensitive is 80-90)
- Monitoring disease activity and treatment response
- Distinguishing IBD from non-inflammatory conditions (ex IBS)
Limitations:
- Non-specificity in certain conditions: can also be elevated in non-IBD conditions (infection or colorectal cancer)
- Influence by medications, like NSAIDs
38F with 7-weeks of frequent, loose and bloody bowel movements that associated with campy abdominal and rectal pain. She has a family history of Crohn's disease. Hb 11, CRP 22 , next step is?
🚩 dysphagia, Red flags:
- more than 50 years at onset
- B symptoms (weight loss, fever & nights sweating)
- Symptom progress over a short period of time
- GI bleeding
- Recurrent vomiting
- History of malignancy
40F with worsening dysphagia for 9m to both liquid & solids she has ill-defined central chest pain and nocturnal cough no other past history. examination was unremarkable, ESR 13. Likely diagnosis is?
📖 Definitions
Significant weight loss is generally defined as losing 5% or more of one's total body weight within a period of 6 to 12 months, without intentional efforts.
Sarcopenia is the gradual loss of muscle mass and strength that occurs as part of the normal aging process.
Cachexia is a severe form of muscle wasting associated with chronic illnesses, Unlike sarcopenia, cachexia involves not only muscle loss but also fat depletion, fatigue and significant weight loss.
صباح الخير من الED مره ثانيه 👋🏻
حاله اليوم:
22 year old male, with history of treated pre-B cell lymphoblastic leukemia (post-Stem cell transplant 2017). Presented with productive cough associated with subjective fever and weight loss
As per the patient he lost 4 kg (from 39 to 35) within 1 month
Q: Can this be classified as significant weight loss 🌚?
SCA presents with right side chest pain and SOB associated with pain in both legs and back. fine crackles on chest exam. Temp: 37.9°. O2 saturation 91% on RA, what is most likely diagnosis?
