Internal Medicine By Doha Rawag
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MBBCh ,Tripoli University๐Ÿ‘ฉโ€๐ŸŽ“
GP at TUH๐Ÿ‘ฉโ€โš•๏ธ
Studies arab and Libyan board of internal medicine specialists ๐Ÿฉบ
Medical educator at https://t.me/New_Minds_Edu๐Ÿ’ป
ุงู„ู‚ู†ุงุฉ ุฎุงุตุฉ ุจูƒู„ ุดูŠ ูŠุชุนู„ู‚ ุจู…ุงุฏุฉ ุงู„ุจุงุทู†ุฉ .๐Ÿ’Š๐Ÿ’‰
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Fusiform swelling (Spindle shaped fingers ) / Due to synovitis of PIP joints .
#Rhematoid_arthritis
#Rheumatology
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Facial Nerve examination ๐Ÿ˜‚
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#Bedside_Notes
โ—ฝHematoloy (ุฏ. ุนุจุฏ ุงู„ู„ุทูŠู )

Q1_ What is the DD of Angular stomatitis ?
๐Ÿ‘‡
1_ Iron deficiency anemia
2_ Folate, vit B12 deficiency
3_ Viral infection / CMV , Herpes simplex

Q2_What drugs cause retroperitoneal fibrosis??
๐Ÿ‘‡
1_ Bleomycine
2_ Methotrexate
3_ Methysergide
4_ Methyldopa

https://t.me/internal_medicine_Dr_Doha ๐ŸŒน
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#Bedside_Notes
โ—ฝHematoloy ( ุฏ.ู…ู†ุงู„ ุงู„ู‡ุจุงุด)

Q1_ What are the causes of loss of concoious in pt with chronic liver disease ?
๐Ÿ‘‡
1_ Hepatic encephalopathy
2_ Hypoglycemia
3_ Hypercalcemia

Q2_ What is the DD of Hyperviscosty regarding to Hematological diseases ?
๐Ÿ‘‡
1_ Myeloproliferative disorders
2_ Waldenstroms Macroglobinemia

https://t.me/internal_medicine_Dr_Doha ๐ŸŒน
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#Bedside_Notes
โš€Rheumatology
(ุฏ.ุฑุฌุจ ุชุงุฑุณูŠู†)

Q1_ What are the most common causes of iron deficiency anemia in postmenopausal women ?
๐Ÿ‘‡
1_ GIT causes (Peptic ulcer , CA colon)
2_ Telagiectasia

Q2_ What is the best time to measure the body temperature?
๐Ÿ‘‡
4 _ 6 AM

Q3_ What is the simple bedside test to check for proteinuria ?
๐Ÿ‘‡
1_ Urine dipstick test
2_ boiling test (ุงุฎุชุจุงุฑ ู‚ุฏูŠู…)
ุชุงุฎุฏ ุนูŠู†ุฉ ุงู„ urine ููŠ tube ูˆ ุชุณุฎู†ู‡ุง ุŒ ู„ูˆ ุฏุงุฑุช ุชุฑุณุจุงุช ู…ุนู†ุงู‡ุง ููŠู‡ุง ุจุฑูˆุชูŠู†

ู…ู„ุงุญุธุฉ :- benze jones proteins ุชุชุฑุณุจ ููŠ ุฏุฑุฌุงุช ุญุฑุงุฑุฉ ู…ู† 70 ุงู„ูŠ 100 Cยฐ.

https://t.me/internal_medicine_Dr_Doha๐ŸŒน๐ŸŒน
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Hereditary hemorrhagic telangiectasia (HHT), is a rare autosomal dominant genetic disorder that leads to abnormal blood vessel formation in the skin, mucous membranes, and often in organs such as the lungs, liver, and brain.
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#Bedside_Notes
โš€Rheumatology
(ุฏ.ุจุณู…ุฉ ุงู„ู‡ุจุงุด)

Q1_ What are the most common causes of hip pain in pt with RA?
๐Ÿ‘‡
1_ Avascular necrosis due to long term use of steroids
2_ Avascular necrosis due to vaculitis

Q2_ What is the DD of DIP joints involvement?
๐Ÿ‘‡
1_ Psoriatic arthritis
2_ OA

Q3_ What is the DD of Monoarthritis ?
๐Ÿ‘‡
1_ Gouty arthritis
2_ Septic arthritis
3_ Tuberculus arthritis

Q4_ What is the most common Rheumatological disease which leads to Shoulder and hip Stiffness ?
๐Ÿ‘‡
PMR (Polymyalgia Rheumatica )

Q5_ What is the DD of Generalized hyperpigmentation ?
๐Ÿ‘‡
1_ Adisson disease
2_ Systemic seclerosis
3_ Hemochromatosis

https://t.me/internal_medicine_Dr_Doha๐Ÿ’›๐Ÿงก๐Ÿ’š๐Ÿ’œ๐Ÿ’™โค
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ุงู„ุณู„ุงู… ุนู„ูŠูƒู… ูˆุฑุญู…ุฉ ุงู„ู„ู‡ ูˆุจุฑูƒุงุชู‡๐Ÿ’›๐Ÿงก

ู‚ุฑูˆุจ 1 ุŒ 2 ุŒ 3 ุงู† ุดุงุก ุงู„ู„ู‡ ุชูƒูˆู†ูˆุง ุงุณุชูุฏุชูˆุง ู…ู† ูƒูˆุฑุณ ุงู„ูƒู„ูŠู†ูƒ ูˆ ุงู† ุดุงุก ุงู„ู„ู‡ ู…ุง ู†ูƒูˆู†ุด ู‚ุตุฑุช ู…ุนุงูƒู… ูˆ ุฑุจูŠ ูŠูˆูู‚ูƒู… ูˆ ูŠูุฑุญูƒู… ุจู†ุฌุงุญูƒู… ูˆ ุชููˆู‚ูƒู… ๐Ÿคฒ

ุงูŠ ุฏูƒุชูˆุฑ/ุฉ ูุงุชุงุชู‡ ู…ุญุงุถุฑุฉ ูˆ ูŠุจูŠ ูŠุญุถุฑู‡ุง ููŠ ุฑู…ุถุงู† ุŒ ูŠุชูˆุงุตู„ ู…ุนุงูŠ ุจุงุด ู†ุนูˆุถู‡ุงู„ู‡ ๐ŸŒธ

ุงู„ู‚ุฑูˆุจุงุช ุงู„ู„ูŠ ุณุฌู„ูˆุง ู…ุนุงูŠ ุจุนุฏ ุฑู…ุถุงู† ุญู†ุฏูƒุฑูƒู… ุจู…ูˆุนุฏ ุงู„ูƒูˆุฑุณ ุจุนุฏ ุงู„ุนูŠุฏ ุงู† ุดุงุก ุงู„ู„ู‡ .

ูˆ ูƒู„ ุณู†ุฉ ูˆ ุงู†ุชู… ุทูŠุจูŠู† ูŠุงุงุฑุจ. ๐Ÿ’Œ

https://t.me/internal_medicine_Dr_Doha๐Ÿ’ฎ
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ุงู„ุณู„ุงู… ุนู„ูŠูƒู… ูˆุฑุญู…ุฉ ุงู„ู„ู‡ ูˆุจุฑูƒุงุชู‡๐Ÿ’™

ุจู…ุง ุงู†ู‡ ู…ู‚ุจู„ูŠู† ุนู„ู‰ ุดู‡ุฑ ุฑู…ุถุงู† ูˆ ู„ุงู† ุงู„ู‚ุฑุงูŠุฉ ููŠู‡ ุตุนุจุฉ( ู„ูƒู† ู…ุด ู…ุณุชุญูŠู„ุฉ ู„ูˆ ุชุจูˆุง ุชู‚ุฑูˆุง )ุŒ ู ุจู†ุนุทูŠูƒู… ุดูˆูŠุฉ ู†ุตุงุฆุญ ๐Ÿ‘‡

1_ ู…ุง ุชู‚ุฑูˆุด ุดุงุจุชุฑ ุทูˆูŠู„ ุŒ ุญุงูˆู„ูˆุง ุชู‚ุฑูˆุง ุดุจุงุชุฑ ุตุบูŠุฑุฉ ุฒูŠ
Infectious
Psychiatry
Rheumatology
Nephrology
Endocrine
ุญุชูŠ ุฒูˆุฒ ู…ู†ู‡ู… ุจุณ ุฎูŠุฑ ูˆ ุจุฑูƒุฉ ๐Ÿ˜

2_ ู„ูˆ ู…ู‚ุฏุฑุชูˆุด ุชู‚ุฑูˆุง ุŒ ุญู„ูˆุง ุงุณุฆู„ุฉ(ุชุฌู…ุนูŠุฉ1001)ุŒ ู‡ูŠ ู‚ุฑุงูŠุฉ ู„ูƒู† ุจุทุฑูŠู‚ุฉ ุบูŠุฑ ู…ุจุงุดุฑุฉ ุŒ ุชู‚ุฑูˆุง ุงู„ูƒูŠุณ ูˆ ู„ู…ุง ุชู„ู‚ูˆุง ู…ุนู„ูˆู…ุฉ ู†ุงุณูŠู†ู‡ุง ุงูุชุญูˆุง ุงู„ุดูŠุช ุฑุงุฌุนูˆู‡ุง ุŒ ุนุงู„ุงู‚ู„ ุทุฑูŠู‚ุฉ ุงู„ู‚ุฑุงูŠุฉ ุจุงู„ุฃุณุฆู„ุฉ ู…ุด ู…ู…ู„ุฉ ุฒูŠ ุงู„ู‚ุฑุงูŠุฉ ุงู„ุนุงุฏูŠุฉ ๐Ÿ˜†

3_ ุงูˆ ุงู‚ุฑูˆุง ูƒู„ูŠู†ูƒ ูˆ ุงูˆุฑุงู„ ุŒ ู‚ุงุฑูŠุชู‡ู… ุงุฎู ูˆ ุฃุณู‡ู„ ุจู‡ู„ุจุง ู…ู‚ุงุฑู†ุฉ ุจุงู„ู†ุธุฑูŠ .

ุจุงู„ุชูˆููŠู‚๐Ÿซถ

ูˆ ุฑู…ุถุงู† ู…ูุจุงุฑูƒ ุนุงู„ุฌู…ูŠุน ๐ŸŒŸ๐ŸŒ™

https://t.me/internal_medicine_Dr_Doha๐Ÿ’ฎ
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ู…ู„ุงุญุธุฉ :- ุงู„ุจูˆุณุชุงุช ุงู„ุฌุงูŠุฉ ูƒู„ู‡ุง ุญ ุชูƒูˆู† ุนู„ู‰ ุงู„ X ray ุงู† ุดุงุก ุงู„ู„ู‡.
#X_Ray
#Radiology
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๐ŸŸจDescription
โ—ฝ Plain chest x ray
โ—ฝ PA view
โ—ฝ Showing homogenous white opacity occupying the Lt hemithorax with deviation of the Trachea to the opposite side and obliterations of both costophrenic and cardiophrenic angles

๐ŸŸจDD
1_ Massive pleural effusion
2_ Total lung collapse
3_ Pneumectomy

๐ŸŸจMost likely Dx
Lt Massive pleural effusion

๐ŸŸจNext step
CT scan
Thoracocetesis
CBC , CRP , LFT, RFT , Coagulation profile

๐ŸŸจTTT
1_ Treat the underlying cause
2_ Therapeutic aspiration ( < 1.5 L)
3_ Chest tube
4_ Pleurodesis using Talc or Tetracycline (if the cause is malignancy)
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๐ŸŸจDescription
โ—ฝ Plain chest x ray
โ—ฝ PA veiw
โ—ฝ Showing homogenous white opacity occupying the Rt hemithorax with deviation of the Trachea to the same side .

๐ŸŸจDD
1_ Total lung collapse
2_ Pneumectomy
3_ Massive pleural effusion

๐ŸŸจMost_likely_DX ?
Rt Total lung collapse
Rt Pneumectomy

ูƒูŠู ุชูุฑู‚ ุจูŠู†ุงุชู‡ู… ุŸ
ุจุงู„ EXAMINATION
ู„ูˆ ู„ู‚ูŠุช scar ู…ุนู†ุงู‡ุง Pneumectomy
ู„ูˆ ู…ุงููŠุด scar ู…ุนู†ุงู‡ุง Total lung collapse

๐ŸŸจNext Step?
Bronchoscopy
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๐ŸŸจDescription
โ—ฝ Plain chest x ray
โ—ฝ PA view
โ—ฝ Showing homogenous white opacity occupying the upper zone of the Rt lung.

๐ŸŸจDD
1_ lober pneumonia
2_ lobectomy
3_ lobe collapse

๐ŸŸจMost likely DX
Rt Upper Lobar Pneumonia
(B/C the Trachea is centralized)๐Ÿ’ฌ๐Ÿ’ก

ุจุงู„ู†ุณุจุฉ ู„ู„ collapse ูˆ ุงู„ lobecomy ุชู„ู‚ูˆู‡ุง Deviated to the same side ๐Ÿ’ฌ๐Ÿ’ก

๐ŸŸจNext step
CBC
ESR
CRP
Sputum culture
Urine culture
Blood culture
ABG
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๐ŸŸจDescription
โ—ฝPlain chest x ray
โ—ฝ PA view
โ—ฝShowing Segmental (Wedge Shaped) homogenous white opacity occupying the Middle and lower zones of the Rt hemithorax .

๐ŸŸจDD
1_ Pulmonary infarction
2_ Lobar pneumonia
3_ Lobecomy
4_ Mild pleural effusion

๐ŸŸจMost likely Dx
Rt lower lobe Pulmonary infarction
(B/C๐Ÿ‘‰ it's wedged shaped )๐Ÿ’ก๐Ÿ’ฌ

๐ŸŸจNext step
D.Dimer
HRCT ( CT of Pulmonary a with contrast)
V,Q scan
Pulmonary angiography
ECG
ABG
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