السلام عليكم ورحمة الله وبركاته💙

بما انه مقبلين على شهر رمضان و لان القراية فيه صعبة( لكن مش مستحيلة لو تبوا تقروا )، ف بنعطيكم شوية نصائح 👇

1_ ما تقروش شابتر طويل ، حاولوا تقروا شباتر صغيرة زي
Infectious
Psychiatry
Rheumatology
Nephrology
Endocrine
حتي زوز منهم بس خير و بركة 😁

2_ لو مقدرتوش تقروا ، حلوا اسئلة(تجمعية1001)، هي قراية لكن بطريقة غير مباشرة ، تقروا الكيس و لما تلقوا معلومة ناسينها افتحوا الشيت راجعوها ، عالاقل طريقة القراية بالأسئلة مش مملة زي القراية العادية 😆

3_ او اقروا كلينك و اورال ، قاريتهم اخف و أسهل بهلبا مقارنة بالنظري .

بالتوفيق🫶

و رمضان مُبارك عالجميع 🌟🌙

https://t.me/internal_medicine_Dr_Doha💮

ملاحظة :- البوستات الجاية كلها ح تكون على ال X ray ان شاء الله.
#X_Ray
#Radiology

🟨Description
◽ Plain chest x ray
◽ PA view
◽ 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

🟨DD
1_ Massive pleural effusion
2_ Total lung collapse
3_ Pneumectomy

🟨Most likely Dx
Lt Massive pleural effusion

🟨Next step
CT scan
Thoracocetesis
CBC , CRP , LFT, RFT , Coagulation profile

🟨TTT
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)

🟨Description
◽ Plain chest x ray
◽ PA veiw
◽ Showing homogenous white opacity occupying the Rt hemithorax with deviation of the Trachea to the same side .

🟨DD
1_ Total lung collapse
2_ Pneumectomy
3_ Massive pleural effusion

🟨Most_likely_DX ?
Rt Total lung collapse
Rt Pneumectomy

كيف تفرق بيناتهم ؟
بال EXAMINATION
لو لقيت scar معناها Pneumectomy
لو مافيش scar معناها Total lung collapse

🟨Next Step?
Bronchoscopy

🟨Description
◽ Plain chest x ray
◽ PA view
◽ Showing homogenous white opacity occupying the upper zone of the Rt lung.

🟨DD
1_ lober pneumonia
2_ lobectomy
3_ lobe collapse

🟨Most likely DX
Rt Upper Lobar Pneumonia
(B/C the Trachea is centralized)💬💡

بالنسبة لل collapse و ال lobecomy تلقوها Deviated to the same side 💬💡

🟨Next step
CBC
ESR
CRP
Sputum culture
Urine culture
Blood culture
ABG

🟨Description
◽Plain chest x ray
◽ PA view
◽Showing Segmental (Wedge Shaped) homogenous white opacity occupying the Middle and lower zones of the Rt hemithorax .

🟨DD
1_ Pulmonary infarction
2_ Lobar pneumonia
3_ Lobecomy
4_ Mild pleural effusion

🟨Most likely Dx
Rt lower lobe Pulmonary infarction
(B/C👉 it's wedged shaped )💡💬

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

🟨Description
◽ Plain chest x ray
◽ PA view
◽ Showing homogenous white opacity occupying the upper zone of the lt hemithorax with deviations of Thracea to the same side.

🟨DD
1_ Lobe collapse
2_ Lobecomy
3_ Lobar pneumonia

🟨Most likely DD
Lobe collapse
Lobectomy
(B/C the Trachea is deviated to the same side )💬💡
كيف تفرقوا بينهم ؟
👇
1_ ركزوا على ال lung lower borders في حالة ال Lobecomy حتلقوا فيه اختلاف كبير في ال level بين الجهة اليمين و اليسار.

🟨Most likely DX
Lt upper lobe collapse

🟨Next step
Bronchoscopy

هادي lt upper lobecomy

تشبه هلبا ال lt upper lobe collapse

كيف تفرقوا بينهم ؟

ركزوا في lt lung lower border و شوفوا كيف في ركبة فوق ف هادي lt upper lobecomy 💭💡

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous white opacity occupying the middle and lower zones of the Lt hemithorax.

🟨DD
1_ Lobar pneumonia
2_ Lobe collapse
3_ lobecomy

كيف تفرق بيناتهم ؟

عينك على ال apex of the heart
لو كانت واضحة / حتكون lobe collapse
او lobecomy 💡💬

لو كانت مش واضحة (ما تبانش كويس) / معناها lobar pneumonia 💡💬

🟨Most likely DX
Lt Lower Lobar pneumonia
( B/C of👉 affecement of Rt heart border shadow➡️Silhouette sign )💡💬


🟨Next step
CBC
ESR
CRP
Sputum culture
Blood culture
Urine culture

LFT , RFT 👉(هادو as routine investigations لانه حينحط على antibiotics )

🟨Description
◽Plain chest x ray
◽AP view
◽Showing homogenous white opacity occupying the lower zone of the Lt hemithorax

🟨DD
1_ Lobe collapse
2_ lobecomy
3_ Lobar pneumonia

كيف تفرق بيناتهم ؟
عينك على ال apex of the heart
لو كانت واضحة / حتكون lobe collapse او lobecomy 💡💬
لو كانت مش واضحة (ما تبانش كويس) / معناها lobar pneumonia 💡💬

🟨DD توا ال
Lobe collapse
Lobecomy

كيف تفرق بيناتهم؟
1_نشوف ال lower border of both lungs لو فيه اختلاف كبير في ال level معناها lobecomy و لو مافيش معناها lung collapse.

2_بال Examination
لو لقيت Scar معناها lobecomy
لو مافيش Scar معناها lobe collapse.

🟨Most likely DX
Lt Lower Lobe collapse

🟨Next step
Bronchoscopy

Lt lower lobecomy.

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous white opacity occupying the lower and middle zones of the Rt hemithorax + Meniscus sign + Obliteration of both Rt costophrenic and cardiophrenic angles.

🟨DD
1_ Mild pleural effusion
2_ hydropneumothorax
3_ Lobar pneumonia
4_ Lobe collapse
5_ Lobecomy

🟨Most likely DX
Rt Mild pleural effusion
(B/C of 👉 Meniscus sign + Obliteration of both lt costophrenic and cardiophrenic angles ).💡💬

🟨Next step
Chest CT scan
Thoracocetesis

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous white opacity occupying the lower zone of the Rt hemithorax with air fluid level

🟨DD
1_ Hydro_pneumothorax
2_ Hemo_pneumothorax
3_ Mild pleural effusion

🟨Most likely DX
Rt Hydro_pneumothorax OR Rt Hemo_pneumothorax
(B/C of👉 Air fluid level )💡💭

🟨Next step
Chest CT scan
Thoracocetesis

🟨TTT
Chest tube under water seal.

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous black opacity occupying both lungs + Flat diaphragm + tubular heart + widening of all intercostal spaces.

🟨DD
1_ Hyperinflated chest 👉 Emphysema, Br.asthma
2_ Pneumothorax

🟨Most likely DX
Hyperinflated chest
(B/C of 👉 flat diaphragm + tubular heart + widening of all intercostal spaces)💬💡💭

🟨Next step
PFT
Reversibility test
ABG

🟨Description
◽Plain chest x ray
◽PA view
◽Showing homogenous black opacity occupying the Rt hemithorax with deviation of Thracea to the opposite side.

🟨DD
1_ Rt Tension Pneumothorax
2_ Hyperinflated chest 👉 Emphysema, Br.asthma


🟨Most likely DX
Rt tension Pneumothorax
(B/C of 👉 Deviation of Trachea to the opposite side)💡💬

🟨Next step
1_ Start O2
2_ Insert canula in 2nd ICS midclvicular line
3_ Insert chest tube under water seal

🟨Description
◽Plain chest x ray
◽PA view
◽Showing heterogenous white opacity occupying Rt and lt hemithorax

🟨DD
1_ Bronchpneumonia
2_ ILD
3_ Pulmonary edema
4_ Miliary TB

🟨Most likely DX
Bronchpneumonia

🟨Next step
CBS
ESR
CRP
Sputum culture
Blood culture
Urine culture
ABG

LFT , RFT (لانهم بينحطوا على Antibiotics 💬💡)

🟨Description
◽Plain chest x ray
◽PA view
◽Showing heterogenous white opacity occupying Rt and lt hemithorax (reticulonodular appearance ) + Both costophrenic angles are not clear

🟨DD
1_ILD
2_Pulmonary edema
3_ Bronchpneumonia
4_ Miliary TB

🟨Most likely DX
ILD
علاش ؟؟
لان البياض متعه يتميز بانه يبدا من تحت باتجاه ال hilum و ال costophrenic angles تكون مش واضحة (مدخدشة / ما تبانش كويس)💬💡

🟨Next step
PFT
ABG
HRCT
BAL
Lung biopsy

🟨Description
◽Plain chest x ray
◽PA view
◽Showing heterogenous white opacity occupying Rt and lt hemithorax (Glass ground appearance ) + Both costophrenic angles are clear

🟨DD
1_ Pulmonary edema
2_ ILD
3_ Bronchpneumonia
4_ Miliary TB

🟨Most likely DX
Pulmonary edema
علاش ؟؟
لان البياض متعه يتميز بانه يبدا من فوق من ال hilum و ينزل تحت ، و ال costophrenic angles تكون واضحة (تبان كويس)💬💡
🟨Next step
ABG
Measure pulmonary artery pressure
➡️if > 25 mm hg 👉 indicates Cardiogenic
ف تطلب على طول
ECG
Echo

➡️if < 18 mm hg 👉 indicates Non cardiogenic
(Sepsis, Truma , Burns , Pneumonia, Pancreatitis )
ف تطلب
CBC
ESR
CRP
Blood culture
Sputum culture
Urine culture
RFT
LFT

🟨Description
◽Plain chest x ray
◽PA view
◽Showing single homogenous white mass occupying the upper zone of the Rt hemithorax

🟨DD
1_Cancer 👉 Bronchogenic ca , lymphoma
2_ Infection 👉 Hydatid cyst , Aspergilloma
3_ Inflammation 👉 Wegner granulomatosis , Polyartritis nodosa

🟨Most likely Dx
Pancots tumer (Bronchogenic ca)

🟨Next step
Bronchoscopy and biopsy
CT scan (Chest + abdomen ) with contrast
Dexa scan
CBC
ESR
CRP
LFT
RFT