◽لو كانت الفاينديقraised JVP

~بعدها يسألك على ال DD ؟
1_ Pulsatile / Rt side HF
2_ Pulsless / SVC Obstruction ( Bronchogenic carcinoma , Cervical rib syndrome)

~بعدها يسألك على ال investigations ؟
1_ Echo
2_ ECG
3_ CXR .

Raised JVP

#General
**Rheumatology

بما انه Hand examination على طول ال DD بيكون
DD of small joint arthritis 💡

بعد ما تكمل خطوات الاقزامنيشن تسمي ال DD و اللي هما
1_RA
2_SLE
3_Psoriatic arthritis
4_Osteoarthritis
5_ Gouty arthritis

~و يسألك كيف تعرف الحالةactive و لا لا ؟

Hx / joint pain ,morning stifness, joint swelling
Ex/ Tenderness , Hotness ,joint Swelling , Rhematoid nodules
Inx / CBC ,ESR ,CRP

و طبعاً هني على حسب شن شوفت في الاقزامنيشن ، لو فيه تندرنس و هوتنس بتقوله اكتف .

~ و يسألك بعدها عال investigations؟
CBC
ESR
CRP
RF
AntiCCP
ANA ,Antids
Joint aspiration
X,ray

Fusiform swelling (Spindle shaped fingers ) / Due to synovitis of PIP joints .
#Rhematoid_arthritis
#Rheumatology

#General
**Endocrine
الفايندينق حتكون يا اما signs of hypo or hyperthyroidism

~بعدها يسألك على ال Causes ؟

🔸️لو كانت hypo
1_Autoimmune/ Hashimoto,s
2_Post_thyrodectomy or radiotherapy
3_Iodine deficiency
4_Drugs SE / lithium, Amiodarone

🔸️لو كانت hyper
1_ Graves
2_ Multinodular goiter
3_ Single toxic nodule
4_ Thyroiditis

~و بعدها يسألك على investigations ؟

TFT / Free T3 , T4 , TSH
Neck US
Antibodies اللي خاصة بكل واحد منهم
Anti TSH stimulating hormone antibodies
Anti thyroid peroxidase antibodies

🟪Rheumatoid hand examination

Initial approuch to the patient, introduce yourself, explain what are you going to do , take permission , ask about pain , hand hygiene

➡️Inspection
Inspection for joint swelling, deformity, redness, Ms atrophy, palmer erythema, scars , rash , nail changes (pitting nails / splinter hemorrhage/ peranular telagectasia)

➡️Palpation
Palpate all of hand joints for hotness and tenderness
Palpable for rheumatoid nodules
Assess the skin laxity

➡️Movement and Ms resistance
Tumb / flexion , extension, adduction , abduction , apposition
4 fingers /flexion , extension, adduction ,abduction

➡️Special test
Phalen test
Tinel test

Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark

🟪 Thyroid examination

➡️Inspection
Inspent the swelling and comment on (5 S)
Site
Size
Shape
Skin over (scars , redness)

➡️Palpation
Palpable for hotness and tenderness
Palpable the mass and comment on
Site
Size
Shape
Surface
Consistency
Is it attached to skin ,ms and underlying structure
Special test/ ask the patient to swallow again

➡️Percussion
Percuss from the suprasternal notch toward the sternum

➡️Auscultation
Ascultate Rt and Lt lobe for bruit


Describe your findings
Give appropriate DD
Elict investigations which will help you to reach you Dx
Overall approach to task
Total mark