#ملاحظة:
الدكتور محمد قاسم بيركز
على الاعراض الجانبية للعلاجات
وغالبا عتحصل المطلوب
اذا اطلعت عليهن من long case
لانه اذا جابهن بيطرح منه .
الدكتور محمد قاسم بيركز
على الاعراض الجانبية للعلاجات
وغالبا عتحصل المطلوب
اذا اطلعت عليهن من long case
لانه اذا جابهن بيطرح منه .
❤2👍1
Forwarded from N S
The European Society of Cardiology (ESC),and National Institute for Health and Care Excellence (NICE) guidelines recommend that if the patient has a CHA2DS2-VASc score of 2 and above, oral anticoagulation therapy (OAC) with a Vitamin K Antagonist (VKA, e.g. warfarin with target INR of 2-3) or one of the non-VKA oral anticoagulant drugs (NOACs, e.g. dabigatran, rivaroxaban, edoxaban, or apixaban) is recommended.
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أهم المواضيع الي ركز عليها الدكتور في Mysthenia gravis
#myasthenic crisis is the exacerbation of symptoms of myasthenia gravis. May be severe and require artificial ventilation in 10% cases. The patient with bulbar and respiratory involvement are prone to respiratory infection. It may occur in patients who are getting no or inadequate treatment, due to low dose or
following development of drug resistance. Precipitating factors are exertion, extremes of temperature, respiratory infection and surgery. The patient should be closely monitored for pulmonary function and should be treated in ICU. Treatment includes:
1-Respiratory assistance and pulmonary physiotherapy
2-Stop all cholinesterase inhibitors
3_Plasmapheresis or IV immunoglobulin
4_Antibiotic, if there is infection
#cholinergic crisis
Overdose of
anticholinesterase drugs may cause cholinergic crisis, which is due to depolarization block of motor end plates. Features of cholinergic crisis are muscle fasciculation, paralysis, pallor, sweating, excessive salivation, lacrimation, bronchial secretion, small pupil (meiosis), abdominal colic, diarrhea, urinary incontinence, etc.
There may be respiratory insufficiency, confusion and collapse. Infection, diarrhea, aminoglycoside,
penicillamine, steroid, etc may precipitate the crisis. Edrophonium should be avoided in these patients.
#differentiate between myasthenic crisis and cholinergic crisis :
A. The clinical features are as above. In both cases, patient complains of weakness.
1-But muscarinic features are present only in cholinergic crisis, but absent in myasthenic crisis.
2-Pupil in constricted or small in cholinergic crisis, but normal in myasthenic crisis.
3-In myasthenic crisis—edrophonium causes quick improvement.
#treat MG :
. As follows:
1. Symptomatic: Anticholinesterase drugs, e.g. pyridostigmine 60 mg tablet (4 to 16 tablets in divided
doses up to five times a day). Duration of action is 3 to 4 hours. It prolongs the action of
acetylcholine by inhibiting the action of acetylcholinesterase (side effects—overdose can cause cholinergic crisis
2. Definitive:
a)Thymectomy—for all patients with thymoma and thymic hyperplasia.
b)Plasmapheresis—given in severe myasthenia or myasthenic crisis or preoperative preparation.
A course of 5 exchanges, each of 3 to 4 liters fluid is given over a period of 2 weeks.
c)I.v immunoglobulin: It is an alternative to plasma exchange in short-term treatment
of severe myasthenia. Usual dose is 0.4 g/kg daily for 5 days. Improvement occurs in 70% cases.
d)Steroid: Initially there may be marked exacerbation of myasthenic symptoms and treatment
should be initiated in hospital. To minimize the side effect, low dose prednisolone initially 5
mg/day, increase 5 mg/week up to 1 mg/kg. Continued for 1 to 3 months, then gradually
modified to an alternate day regimen over the course of additional 1 to 3 months. On remission,
reduce the dose (may take months). About 70% patients improve with steroid. Azathioprine
may be added (2.5 mg/kg daily) or weekly methotrexate may be given. Sometimes, IV
methylprednisolone may be tried.
E)Other immunosuppressive agents, e.g. azathioprine (2.5 mg/kg daily), mycophenolate
#drugs should be avoided in MG :
Aminoglycoside, penicillamine, ciprofloxacin, quinine, antiarrhythmic drug
# drug which can cause myasthenia gravis :
Penicillamine, (IFN-α also).
#Diagnosis
1-Clinical.
2-Pharmcological
3-Srology
4-Radiology
5-Neurophyisology
#myasthenic crisis is the exacerbation of symptoms of myasthenia gravis. May be severe and require artificial ventilation in 10% cases. The patient with bulbar and respiratory involvement are prone to respiratory infection. It may occur in patients who are getting no or inadequate treatment, due to low dose or
following development of drug resistance. Precipitating factors are exertion, extremes of temperature, respiratory infection and surgery. The patient should be closely monitored for pulmonary function and should be treated in ICU. Treatment includes:
1-Respiratory assistance and pulmonary physiotherapy
2-Stop all cholinesterase inhibitors
3_Plasmapheresis or IV immunoglobulin
4_Antibiotic, if there is infection
#cholinergic crisis
Overdose of
anticholinesterase drugs may cause cholinergic crisis, which is due to depolarization block of motor end plates. Features of cholinergic crisis are muscle fasciculation, paralysis, pallor, sweating, excessive salivation, lacrimation, bronchial secretion, small pupil (meiosis), abdominal colic, diarrhea, urinary incontinence, etc.
There may be respiratory insufficiency, confusion and collapse. Infection, diarrhea, aminoglycoside,
penicillamine, steroid, etc may precipitate the crisis. Edrophonium should be avoided in these patients.
#differentiate between myasthenic crisis and cholinergic crisis :
A. The clinical features are as above. In both cases, patient complains of weakness.
1-But muscarinic features are present only in cholinergic crisis, but absent in myasthenic crisis.
2-Pupil in constricted or small in cholinergic crisis, but normal in myasthenic crisis.
3-In myasthenic crisis—edrophonium causes quick improvement.
#treat MG :
. As follows:
1. Symptomatic: Anticholinesterase drugs, e.g. pyridostigmine 60 mg tablet (4 to 16 tablets in divided
doses up to five times a day). Duration of action is 3 to 4 hours. It prolongs the action of
acetylcholine by inhibiting the action of acetylcholinesterase (side effects—overdose can cause cholinergic crisis
2. Definitive:
a)Thymectomy—for all patients with thymoma and thymic hyperplasia.
b)Plasmapheresis—given in severe myasthenia or myasthenic crisis or preoperative preparation.
A course of 5 exchanges, each of 3 to 4 liters fluid is given over a period of 2 weeks.
c)I.v immunoglobulin: It is an alternative to plasma exchange in short-term treatment
of severe myasthenia. Usual dose is 0.4 g/kg daily for 5 days. Improvement occurs in 70% cases.
d)Steroid: Initially there may be marked exacerbation of myasthenic symptoms and treatment
should be initiated in hospital. To minimize the side effect, low dose prednisolone initially 5
mg/day, increase 5 mg/week up to 1 mg/kg. Continued for 1 to 3 months, then gradually
modified to an alternate day regimen over the course of additional 1 to 3 months. On remission,
reduce the dose (may take months). About 70% patients improve with steroid. Azathioprine
may be added (2.5 mg/kg daily) or weekly methotrexate may be given. Sometimes, IV
methylprednisolone may be tried.
E)Other immunosuppressive agents, e.g. azathioprine (2.5 mg/kg daily), mycophenolate
#drugs should be avoided in MG :
Aminoglycoside, penicillamine, ciprofloxacin, quinine, antiarrhythmic drug
# drug which can cause myasthenia gravis :
Penicillamine, (IFN-α also).
#Diagnosis
1-Clinical.
2-Pharmcological
3-Srology
4-Radiology
5-Neurophyisology
antibody in MG
١)Serum acetylcholine receptor antibody (anti-AChR antibody, found in 80 to 90% patients with
generalized myasthenia gravis. In pure ocular MG, this is present in 50%)
2) Serum anti-MuSK antibody (antibody against muscle specific receptor tyrosine kinase, present
with predominantly bulbar, facial and neck muscle involvement). It is positive in anti-AChR antibody negative patient and in pure ocular MG
In phyromicologic test of MG:
1)edrophonium for ocular myasthenia
2)neostigmine for general myasthenia gravis
Radiology :
1) Chest X-ray (to exclude bronchial carcinoma)
2)CXR right lateral view and CT scan of chest (to exclude thymoma
١)Serum acetylcholine receptor antibody (anti-AChR antibody, found in 80 to 90% patients with
generalized myasthenia gravis. In pure ocular MG, this is present in 50%)
2) Serum anti-MuSK antibody (antibody against muscle specific receptor tyrosine kinase, present
with predominantly bulbar, facial and neck muscle involvement). It is positive in anti-AChR antibody negative patient and in pure ocular MG
In phyromicologic test of MG:
1)edrophonium for ocular myasthenia
2)neostigmine for general myasthenia gravis
Radiology :
1) Chest X-ray (to exclude bronchial carcinoma)
2)CXR right lateral view and CT scan of chest (to exclude thymoma
Mohammad Aldailami:
إختبار الباطنة النصفي-الدفعة 20-2022
Choose the best answer for each of the following questions:
1)The most specific antibody in SLE is:
a-AntiRo/La
b-Anti-Smith
c-ANA
d-Anti-DNA.
2)The most common ocular manifestation of Rheumatoid arthritis is:
a-Scleritis
b-Episcleritis
c-Scleromalacia
d-Sjögren’s syndrome.
3)Which of the following organs is mostly involved in systemic sclerosis:
a-Esophagus
b-Stomach
c-Ilium
d-Colon.
4)Commonest cause of death in SLE is:
a-CAD
b-Infections
c-Atherosclerosis
d-Lupus nephritis.
5)Match each of the following ocular manifestations to their rheumatic diseases that cause them:
a-Corneal melt
b-Ischemic optic atrophy
c-Anterior uveitis
d-Vascular retinal disease
1-SLE
2-Ankylosing spondylitis
3-Rheumatoid arthritis
4-Temporal arteritis
6)The most sensitive antibody in SLE is:
a-AntiRo/La
b-Anti-Smith
c-ANA
d-Anti-DNA.
7)All of the following are causes of increased CPK EXCEPT:
a-Myocardial infarction
b-Motor neuron disease
c-Polymyalgia rheumatica
d-Polymyositis
e-Carnitine palmitoyltransferase deficiency.
8)Which is the commonest cause of ocular monoblindness "transient amaurosis fugax" ?:
a-Ipsilateral internal carotid artery atherosclerosis
b-Temporal arteritis
c-Ophthalmic artery spasm
d-Hypotension
9)Which of the following is least associated with PD:
a-Anosmia
b-Rapid eye movement with dream disturbance
c-Oculogyric crisis
d-Depression.
10)Which of the following is least likely to increase the risk for stroke in a patient with atrial fibrillation:
a-Congestive heart failure
b-Hypertension
c-Diabetes
d-Age 60 years
11)The drug that causes Polycystic ovary syndrome and fatal hemorrhagic pancreatitis is:
a-Phenobarbitone
b-Valproic acid
c-Phenytoin
d-Oxcarbazepine.
12)Trihexyphenidyl which is used in PD, what is the mechanism of action of it?
a-Catecholamine-O-methyltransferase inhibitor
b-Monoamine oxidase inhibitor
c-Dopamine agonist
d-Muscarinic receptor antagonist .
13)Which of the following is typically associated with migraine without aura than migraine with aura:
a-Generalized Cortical spread
b-Prominent visual symptoms
c-Associated with menstrual cycle
d-Increased risk of ischemic stroke.
14)Patients with which of the following conditions are most likely to have asymmetric facial weakness?
A. Fascioscapulohumeral dystrophy
B. Myasthenia gravis
C. Myotonic dystrophy
D. Oculopharyngeal dystrophy
15)Most focal seizures in adults arise from which area?
A. Frontal lobe
B. Temporal lobe
C. Parietal lobe
D. Occipital lobe
16)Which of the following is least associated with relapse of MS:
a-Fever
b-Exercise
c-Pregnancy
d-Urinary tract infection.
17)Which of the following drugs is safest during pregnancy in MS:
a-Fingolimod
b-Glatiramer acetate
c-Cladribine
d-Natalizumab.
Best wishes.✨
إختبار الباطنة النصفي-الدفعة 20-2022
Choose the best answer for each of the following questions:
1)The most specific antibody in SLE is:
a-AntiRo/La
b-Anti-Smith
c-ANA
d-Anti-DNA.
2)The most common ocular manifestation of Rheumatoid arthritis is:
a-Scleritis
b-Episcleritis
c-Scleromalacia
d-Sjögren’s syndrome.
3)Which of the following organs is mostly involved in systemic sclerosis:
a-Esophagus
b-Stomach
c-Ilium
d-Colon.
4)Commonest cause of death in SLE is:
a-CAD
b-Infections
c-Atherosclerosis
d-Lupus nephritis.
5)Match each of the following ocular manifestations to their rheumatic diseases that cause them:
a-Corneal melt
b-Ischemic optic atrophy
c-Anterior uveitis
d-Vascular retinal disease
1-SLE
2-Ankylosing spondylitis
3-Rheumatoid arthritis
4-Temporal arteritis
6)The most sensitive antibody in SLE is:
a-AntiRo/La
b-Anti-Smith
c-ANA
d-Anti-DNA.
7)All of the following are causes of increased CPK EXCEPT:
a-Myocardial infarction
b-Motor neuron disease
c-Polymyalgia rheumatica
d-Polymyositis
e-Carnitine palmitoyltransferase deficiency.
8)Which is the commonest cause of ocular monoblindness "transient amaurosis fugax" ?:
a-Ipsilateral internal carotid artery atherosclerosis
b-Temporal arteritis
c-Ophthalmic artery spasm
d-Hypotension
9)Which of the following is least associated with PD:
a-Anosmia
b-Rapid eye movement with dream disturbance
c-Oculogyric crisis
d-Depression.
10)Which of the following is least likely to increase the risk for stroke in a patient with atrial fibrillation:
a-Congestive heart failure
b-Hypertension
c-Diabetes
d-Age 60 years
11)The drug that causes Polycystic ovary syndrome and fatal hemorrhagic pancreatitis is:
a-Phenobarbitone
b-Valproic acid
c-Phenytoin
d-Oxcarbazepine.
12)Trihexyphenidyl which is used in PD, what is the mechanism of action of it?
a-Catecholamine-O-methyltransferase inhibitor
b-Monoamine oxidase inhibitor
c-Dopamine agonist
d-Muscarinic receptor antagonist .
13)Which of the following is typically associated with migraine without aura than migraine with aura:
a-Generalized Cortical spread
b-Prominent visual symptoms
c-Associated with menstrual cycle
d-Increased risk of ischemic stroke.
14)Patients with which of the following conditions are most likely to have asymmetric facial weakness?
A. Fascioscapulohumeral dystrophy
B. Myasthenia gravis
C. Myotonic dystrophy
D. Oculopharyngeal dystrophy
15)Most focal seizures in adults arise from which area?
A. Frontal lobe
B. Temporal lobe
C. Parietal lobe
D. Occipital lobe
16)Which of the following is least associated with relapse of MS:
a-Fever
b-Exercise
c-Pregnancy
d-Urinary tract infection.
17)Which of the following drugs is safest during pregnancy in MS:
a-Fingolimod
b-Glatiramer acetate
c-Cladribine
d-Natalizumab.
Best wishes.✨
❤2👍1🔥1😁1🤔1🤯1
☝️
زملاء راوند الجلدية هذا الكتاب
تمام بشكل عام، بتحصل معلوماتك
مرتبه بعده ، (شرح المواضيع اللي
مش موجودة في الاطلس المقرر..)
مثل
Topical treatment in dermatology &
xeroderma pigmentosa .
#dermatology .
زملاء راوند الجلدية هذا الكتاب
تمام بشكل عام، بتحصل معلوماتك
مرتبه بعده ، (شرح المواضيع اللي
مش موجودة في الاطلس المقرر..)
مثل
Topical treatment in dermatology &
xeroderma pigmentosa .
#dermatology .
👍3❤1
⭕⭕⭕
⭕الدكتور بشار قال بدلوا الجراحة مع الجلدية في الجدول النهائي
⭕ و قال اللي عندة 7 غيابات ما يدخل الاختبار ، و المحرومين 35 من الجراحة النهائي، و بيعلق أسمائهم في الدائرة السريرية ، و بيعلقوا لكل المواد ، و العميدة بتابع الموضوع بنفسها .
⭕اللي هم الان راوند جراحة يتواصلوا مع الدكتور حفظ الله يحضر لهم ، أو بينحرموا من الإمتحان العملي.
⭕الدكتور بشار قال بدلوا الجراحة مع الجلدية في الجدول النهائي
⭕ و قال اللي عندة 7 غيابات ما يدخل الاختبار ، و المحرومين 35 من الجراحة النهائي، و بيعلق أسمائهم في الدائرة السريرية ، و بيعلقوا لكل المواد ، و العميدة بتابع الموضوع بنفسها .
⭕اللي هم الان راوند جراحة يتواصلوا مع الدكتور حفظ الله يحضر لهم ، أو بينحرموا من الإمتحان العملي.
Forwarded from الدفعة الـ20
المحاضرات التي اخذناها في العيون
د.محمد العنسي
anatomy of eye
conjunctiva
cornea
د.فؤاد الخياط
cataract
retina
د نبيل صبر
Optic nerve
Uveal tissue
Orbit & lacimal,Eye lid
strabismus
د.محمد العنسي
anatomy of eye
conjunctiva
cornea
د.فؤاد الخياط
cataract
retina
د نبيل صبر
Optic nerve
Uveal tissue
Orbit & lacimal,Eye lid
strabismus