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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๐ŸŸชKey points ๐Ÿ“
#Gastroenterology

Jundice + newly diagnosed DM = Hemochromatosis

Jundice + abnormal movement = Wilsone disease

Jundice + itching = PBC

Jundice + H/O UC = PSC

Jundice + fever + RUQ pain = Ascending cholngitis

H/O DM + HTN + smoking + H/O post prandial abdominal pain = Mesenteric ischemia

Multiple ulcers + diarrhea = Zolinger syndrome
๐Ÿ”ฅ16๐Ÿ‘2โค1
๐ŸŸจDyphagia๐Ÿ“

Dysphagia to both fluids and solids = Achalasia
Dysphagia to solids only = Malignancy
โค12๐Ÿ‘1๐Ÿฅฐ1
๐ŸŸจAlcoholic hepatitis
โฌ†๏ธAST > ALT 2:1

๐ŸŸจNon Alcoholic fatty liver
โฌ†๏ธALT > AST

ุนูƒุณ ุจุนุถ ุฑูƒุฒูˆุง ุนู„ูŠู‡ู…๐Ÿ“
๐Ÿ”ฅ11๐Ÿ‘1
๐ŸŸจPBC and ( role of M)๐Ÿ“

Ig M
Anti Mitochondrial Abs
M2 subtype
Middle aged female
โค10๐Ÿ”ฅ1
๐ŸŸจMost common site of Carcinoid syndrome is

๐Ÿ“Ileum.
โค12
โœณ๏ธSpontaneous bacterial peritonitis
SBP

๐Ÿ“Cause โžก๏ธE.coli
๐Ÿ“Dxโžก๏ธParacentesisโžก๏ธNeutrophils > 250 cells/ul
๐Ÿ“TTTโžก๏ธIV cefotaxime
โค10
โœณ๏ธCharcot's triad of Ascending cholangitis

1-RUQ pain
2-Fever
3-Jundice

โœณ๏ธReynoid's pentad
ู†ูุณู‡ู… +
๐Ÿ“Confusion
๐Ÿ“Hypotension
โค8๐Ÿ”ฅ4
ุงู„ุณู„ุงู… ุนู„ูŠูƒู… ูˆุฑุญู…ุฉ ุงู„ู„ู‡๐Ÿค

ุฏูƒุงุชุฑุฉ ูˆ ุฏูƒุชูˆุฑุงุช ู…ูˆูู‚ูŠู† ููŠ ุงู„ู†ุธุฑูŠ ุงู„ุงุณุจูˆุน ุงู„ุฌุงูŠุŒ ุฑุจูŠ ูŠูุชุญ ุนู„ูŠูƒู… ูˆ ูŠุณู‡ู„ู‡ุง ู‚ุฏุงู…ูƒู…๐Ÿ™

ู„ูƒุซุฑุฉ ุงู„ุงุณุชูุณุงุฑุงุช ุจุฎุตูˆุต ูƒูˆุฑุณ ุงู„ Findings ูˆ ุจู…ุง ุงู† ุงู„ูƒู„ูŠู†ูƒ ุชุฃุฌู„ ูˆ ุงู„ุญู…ุฏ ู„ู„ู‡ ุฌุชูƒู… ูุฑุตุฉ ูƒูˆูŠุณุฉ ุชู‚ุฑูˆุง ูˆ ุชุฌู‡ุฒูˆุง ููŠู‡ุง ู„ู„ูƒู„ูŠู†ูƒ ุงู„ู„ูŠ ูŠุดูƒู„ 60% ู…ู† ุงู„ู…ุนุฏู„ ุงู„ุนุงู… ู„ู…ุงุฏุฉ ุงู„ุจุงุทู†ุฉ
ู ุจุนูˆู† ุงู„ู„ู‡ ุญู†ูุชุญ ูƒูˆุฑุณ findings ุจุนุฏ ุฅู…ุชุญุงู† ุงู„ุจูŠุจุฑ ุนู„ู‰ ุทูˆู„๐Ÿ“

ุทุจุนุงู‹ ููƒุฑุฉ ุงู„ูƒูˆุฑุณ ู…ุฎุชู„ูุฉ ุนู„ู‰ ูƒูˆุฑุณ ุงู„ุงู‚ุฒุงู…ู†ูŠุดู† ุงู„ุนุงุฏูŠ ุŒ ุงู„ุชุฑูƒูŠุฒ ุญูŠูƒูˆู† ุนุงู„ findings ุงูƒุซุฑ ู…ู† ุงู„ุชุทุจูŠู‚ ุŒ ุจุญูŠุซ ู†ู„ููˆุง ุนู„ู‰ ูƒู„ ุงู„ุฃู‚ุณุงู… ูˆ ู†ุดูˆููˆุง ู…ุน ุจุนุถ ุงุบู„ุจ ุงู„ุญุงู„ุงุช ุงู„ู„ูŠ ุชุฌูŠ ููŠ ุฅู…ุชุญุงู† ุงู„ูƒู„ูŠู†ูƒ ู…ุน discussion ุนุงู„ุญุงู„ุฉ DD ูˆ Inv ุฒูŠ ู†ุธุงู… ุงู„ุฅู…ุชุญุงู† ๐Ÿ“


ู…ุฏุฉ ุงู„ูƒูˆุฑุณ / ุญุชูƒูˆู† ูŠูˆู…ูŠู†

ุชูˆู‚ูŠุช ุงู„ูƒูˆุฑุณ / ู…ู† ุงู„ุณุงุนุฉ 12 ุงู„ูŠ ุงู„ุณุงุนุฉ 5 ู…ุณุงุกุงู‹ โฐ๏ธ

ู…ูƒุงู† ุงู„ูƒูˆุฑุณ / ุงู„ู…ุณุชุดูู‰ ุงู„ุฌุงู…ุนูŠ ุทุฑุงุจู„ุณ (ุงู„ุทุจูŠ)๐Ÿจ

ุณุนุฑ ุงู„ูƒูˆุฑุณ / 80 ุฏ


ุงู„ุนุฏุฏ ุญูŠูƒูˆู† ู…ุญุฏูˆุฏ ุนู„ู‰ ุญุณุจ ุงู„ูˆู‚ุช ุงู„ู„ูŠ ุจู†ุญุตู„ูˆู‡ ุจุนุฏ ุงู„ุจูŠุจุฑ ุŒ ูุงู„ู„ูŠ ูŠุฑุบุจ ุจุงู„ุชุณุฌูŠู„ ูŠู†ุถู… ู„ู„ู‚ุฑูˆุจ ู‡ุฐุง๐Ÿ‘‡
https://t.me/+5WrFSC09o005MDM8

ูˆ ู„ุงุญู‚ุงู‹ ุญู†ู‚ุณู…ูƒู… ู…ุฌู…ูˆุนุงุช ุงู† ุดุงุก ุงู„ู„ู‡.
๐Ÿ‘4๐Ÿ”ฅ4โค2๐Ÿ˜1๐Ÿ†1๐Ÿ˜‡1
โœด๏ธIn patient with hypopituitrism the first hormone to be fall is๐Ÿ“

โžก๏ธGrowth hormone .
โค12๐Ÿฅฐ1
โœด๏ธMost common cause of panhypopituitrism is

โžก๏ธNon secretary pituitary macroadenoma.
โค11๐Ÿฅฐ1
โ‡๏ธGold stander Diagnostic test for Panhypopituitrism is

โžก๏ธInsulin stress test.
โค12โคโ€๐Ÿ”ฅ2๐Ÿ‘1
โ‡๏ธC/I of Insulin stress test

๐Ÿ“Epilepsy
๐Ÿ“IHD
๐Ÿ“Adrenal insufficiency
โค7๐Ÿ”ฅ1
โบ๏ธImportant note

Patients with TSH deficiency should not treated with levothyroxine until ACTH deficiency has been ruled out
Because levothyroxine increase the clearnse of cortisone and may precipitate adrenal cirsis๐Ÿ“
โค7๐Ÿฅฐ2
โ‡๏ธDX of Acromegaly

๐Ÿ“IGF 1 โžก๏ธ Initial test + screening test
๐Ÿ“OGTTโžก๏ธ definitive test
โค6๐Ÿ”ฅ2
โบ๏ธ Important note

๐Ÿ“Acromegaly โฌ†๏ธ the risk for colon cancer so regular Colonoscopy screening should be started at age of 40 yrs.
โค7๐Ÿ”ฅ2
โœด๏ธLevels of prolactin

<1000 โžก๏ธDrug induced prolactinaemia
1000-3000โžก๏ธMicroprolactinoma
>3000โžก๏ธMacroprolactinoma
๐Ÿ”ฅ9
โ‡๏ธ Most common cause of hypothyroidism is

๐Ÿ“Hashimoto thyroiditis.
๐Ÿ”ฅ5โค3
โ‡๏ธ Indication for treatment in patient with subclinical hypothyroidism

๐Ÿ“TSH> 10
๐Ÿ“Symptomatic
๐Ÿ“pregnancy
๐Ÿ‘3๐Ÿฅฐ2๐Ÿ”ฅ1
โ‡๏ธMost common cause of hyperthyroidism is

๐Ÿ“Graves disease.
โค8
โ‡๏ธindication of treatment for patients with subclinical hyperthyroidism

๐Ÿ“TSH<0.1
๐Ÿ“Symptomatic
๐Ÿ“older than 65
๐Ÿ“Risk of osteoporosis or heart disease
โค4๐Ÿ”ฅ2
๐ŸŸฆMx of thyrotoxicosis in pregnancy

๐Ÿ“1 St trimester โžก๏ธ Propylothiouracil
๐Ÿ“2nd + 3rd trimester โžก๏ธ Carbimazol
โค9๐Ÿ”ฅ1