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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๐ŸŸฅ TTT of moderate to sever thyroid eye disease ๐Ÿ‘

(Sight threateningโžก๏ธ malignant exophthalmous, diplopia , loss of color vision)

๐ŸฉบIV glucocorticoids
๐Ÿฉบ Surgical orbital decompression
โค6
โ‡๏ธMost common cause of hypercalcemia is

๐Ÿ“primary hyperparathyroidism

โ‡๏ธMost common cause of primary hyperparathyroidisim is

๐Ÿ“ solitary adenoma.
โค10๐Ÿ”ฅ1
๐ŸŸชMost common cause of primary hyperaldesteronism is

๐Ÿ“Bilateral adrenal hyperplasia
โค9
๐ŸŸจrule of 10 pheochromocytoma๐Ÿฉบ
โค7๐Ÿ”ฅ4
๐ŸŸฉPheochromocytoma chould be part of

๐ŸฉบMEN 2A
๐ŸฉบMEN 2B
๐ŸฉบNF1
๐ŸฉบVHL
๐Ÿ”ฅ7๐Ÿ‘1
๐ŸŸงDX of pheochromocytoma

๐Ÿ“Initial test โžก๏ธ Plasma free metanephrines test
๐Ÿ“Definitive testโžก๏ธ CT or MRI abdomen.
โค8๐Ÿ‘3๐Ÿ”ฅ1
โฌœ๏ธMost common cause of adrenal insufficiency is

๐ŸฉบAutoimmune โžก๏ธDeveloped countries
๐ŸฉบTB โžก๏ธ Developing countries
โค7๐Ÿ”ฅ1
โฌ›๏ธDX of adrenal insufficiency

๐Ÿ“Initial test โžก๏ธ Morning cortisol level
๐Ÿ“Gold standard testโžก๏ธ Short synacthen test

ู…ู‡ู… ู‡ู„ุจุง ููŠ ุงู„ MCQ. ๐Ÿ’ข
โค6๐Ÿ‘3๐Ÿ”ฅ1
๐ŸŸกMost common cause of crushing is

๐Ÿ“Exogenous crushing syndrome (prolonged steroids ttt)
โค9
๐ŸŸจDX of Cushing

ู…ุง ุชู†ุณูˆูˆูˆูˆุด
๐ŸฉบInitial test to confirm the DX
๐Ÿ“Low dexamethasone suppression test
ู‡ุงุฏูŠ ููŠ ุงู„ guidelines ุงู„ุฌุฏูŠุฏุฉ
๐Ÿ“ 24 hrs urinary free cortisol
ู…ู…ูƒู† ุชู†ุฏุงุฑ ู‚ุจู„ู‡


๐ŸฉบFirst Test to localise the lesion
๐Ÿ“ACTH level
ูˆ ุนู„ูŠ ุฃุณุงุณู‡ ู†ู‚ุฑุฑ ุงู„ next step .
โค8๐Ÿ”ฅ3
๐ŸŸฅMetformin hydrochloride๐Ÿ’Š
ContraindicationsโŽ๏ธ

1- Acute or chronic metabolic acidosis including diabetic ketoacidosis with or without coma
2- Hypersensitivity to metformin
3- Severe renal impairment (eGFR below 30 mL/min)
โค9๐Ÿ‘1
๐ŸŸฉMost common precipitating factor for DKA is
๐Ÿ“Infection 40%

๐ŸŸฉ2 nd most common causes is
๐Ÿ“Missed dose 25%
โค10๐Ÿ‘1๐Ÿ”ฅ1
๐ŸŸจInitial management of DKA is

๐ŸฉบFluid replacement
โค7๐Ÿ”ฅ3
๐ŸŸชDx of insulinoma

+
CT abdomen with contrast
โค7
๐ŸŸฅMEN
ุงุบู„ุจู†ุง ู…ุง ู†ุญุจูˆุด ู†ู‚ุฑูˆู‡ู…๐Ÿ˜‚


ุงุญูุธูˆู‡ู… ู…ู† ุงู„ุฑุณู…ุฉ ู‡ุงุฏูŠ ู…ุณู‡ู„ุชู‡ู… ู‡ู„ุจุง

ู…ุฑุงุช ููŠ ุงู„ุฃุณุฆู„ุฉ ุงูˆ ุงู„ูƒูŠุณุงุช ูŠูƒุชุจูˆู„ูƒู… Zollinger-Ellison syndrome (Gastrinoma) ุทุจุนุง ู‡ุงุฏูŠ ุชุนุชุจุฑ ูˆุญุฏุฉ ู…ู† ุงู„ pancreatic tumors ู ุชูƒูˆู† ุงู„ุฅุฌุงุจุฉ MEN1๐Ÿ“
โค11๐Ÿ”ฅ4๐Ÿ‘1
ุงู„ุฌุฏูˆู„ ุงู„ุจุงุฑุฏ ู…ุชุน HIV๐Ÿ˜ฌ

ุงู‡ูŠ ุทุฑูŠู‚ุฉ ู…ุฑุชุจุฉ ุงุญูุธูˆู‡ ุจูŠู‡ุง๐Ÿ‘‡

๐Ÿ“CD4<500
Kaposi
+
Chest/ TB

๐Ÿ“CD4<200
Chest /psj
CNS / progressive multifocal encephalopathy
ุงู‚ู„ ู…ู† 200 ู†ู‡ุงูŠุชู‡ู… ii๐Ÿคฃ
ุงู†ูƒูŠูุงู„ูˆุจุงุชูŠ
ุฌูˆููŠู†ูŠุณูƒูŠ

๐Ÿ“CD4<100
CNS / toxoplasmosis, lymphoma, meningitis
ุงู„ู„ูŠ ู‡ู…ุง DD ู„ ุจุนุถ
GIT / esophageal candidates, herpes esophagitis

๐Ÿ“CD4<50
CMV
MAC.
๐Ÿ”ฅ8
๐ŸŸฉAnti TB S/E

๐Ÿ’ขRiphampicin
๐Ÿ“Orange secretions (Orange or red urine)
๐Ÿ“Hepatitis

๐Ÿ’ขIsoniazide
๐Ÿ“Peripheral neuropathy
๐Ÿ“Hepatotoxicity

๐Ÿ’ขPyrazinamide
๐Ÿ“Hyperuracemia (Gout)
๐Ÿ“Hepatotoxicity

๐Ÿ’ขEthambutol
๐Ÿ“Optic neuritis

๐Ÿ’ขStreptomycin
๐Ÿ“Nephrotoxicity
โค7๐Ÿ‘1๐Ÿ”ฅ1
ุงู„ุณู„ุงู… ุนู„ูŠูƒู…  ุฏูƒุงุชุฑุฉโœจ๏ธ

ุฑุจูŠ ูŠูˆูู‚ูƒู… ูˆ ูŠูุชุญ ุนู„ูŠูƒู… ุบุฏูˆุง ูˆ ูŠูˆู… ุงู„ุงุซู†ูŠู† ูˆ ุชุทู„ุนูˆุง ู…ู† ุงู„ุฅู…ุชุญุงู† ูˆ ุงู†ุชูˆ ู…ุฌุงูˆุจูŠู† ูƒูˆูŠุณ  ูŠุงุงุฑุจ ๐Ÿคฒ

ุงู„ุชูˆุชุฑ ูˆ ุงู„ุฎูˆู ู‚ุจู„ ุงู„ุฅู…ุชุญุงู† ูˆ ุดุนูˆุฑ ุงู†ูƒู… ู†ุงุณูŠู† ู‡ู„ุจุง ู…ุนู„ูˆู…ุงุช ูƒู„ู†ุง ู…ุฑูŠู†ุง ุจูŠู‡๐Ÿ˜ฅ ูˆ ุฑุงู‡ูˆ ุฃู…ุฑ ุทุจูŠุนูŠ ู‡ุฐุง ู…ุน ุถุฎุงู…ุฉ ูˆ ุทูˆู„ ู…ู†ู‡ุฌ ุงู„ุจุงุทู†ุฉ ูˆ ุจุงู„ุนูƒุณ ู‡ุฐุง ุฏู„ูŠู„ ุนู„ู‰ ุงู†ูƒู… ู‚ุฑูŠุชูˆุง ูˆ ุจุฏู„ุชูˆุง ุฌู‡ุฏูƒู….

ู†ุตูŠุญุฉ ู„ูŠูƒู… ุนุดูŠุฉ ุงู„ูŠูˆู… ุงุฑุชุงุญูˆุง ุŒ ุงุนุทูˆุง ุฑุงุญุฉ ู„ู„ brain ุจุงุด ูŠุฑุชุงุญ ูˆ ูŠุชุฑุชุจ ูƒุฏุณ ุงู„ู…ุนู„ูˆู…ุงุช ู„ู„ูŠ ููŠู‡๐Ÿ“

ุชููƒุฑูˆุง ุงู† ู…ุด ู…ุทู„ูˆุจ ู…ู†ูƒู… ุงู„ู†ุฌุงุญ ู…ุทู„ูˆุจ ู…ู†ูƒู… ุงู„ุณุนูŠ ูู‚ุท ุŒ ูˆ ู…ุง ุชู…ุฑุฉ ุงู„ุณุนู‰ ุงู„ุง ุงู„ู†ุฌุงุญ ุจุฅุฐู† ุงู„ู„ู‡๐Ÿค

ุชูˆูƒู„ูˆุง ุนู„ู‰ ุฑุจูŠ ูˆ ุงู† ุดุงุก ุงู„ู„ู‡ ุฎุชุงู…ู‡ุง ู…ุณูƒ ูˆ ุฑุจูŠ ูŠุฌุงุฒูŠูƒู… ูƒู„ ุฎูŠุฑ ุนู„ู‰ ู‚ุฏ ุงู„ุตุจุฑ ุงู„ู„ูŠ ุตุจุฑุชูˆู‡๐Ÿค

ุงู„ู„ู‡ู… ุฅู† ู…ู† ุชูˆูƒู„ ุนู„ูŠูƒ ูู„ู† ูŠุฎูŠุจ ุŒ ูˆู…ู† ุฌุนู„ูƒ ู…ู„ุงุฐู‡ ูู„ู† ูŠุถูŠุนโœจ๏ธ
โค53๐Ÿฅฐ4
ุงู„ู„ู‡ู… ุฅู†ุง ู†ุณุฃู„ูƒ ุงู„ู†ุฌุงุญ ูˆ ุงู„ูู„ุงุญ ูˆ ุงู„ุชูˆููŠู‚ ูˆ ุงู„ุณุฏุงุฏ ููŠ ูƒู„ ุฃู…ูˆุฑู†ุง
ุงู„ู„ู‡ู… ุนุฒู…ุงู‹ ู„ุง ูŠุซู†ู‰ ูˆ ุตุจุฑุงู‹ ู„ุง ูŠู†ูุฐ ูˆ ู‚ู„ุจุงู‹ ู„ุง ูŠุนุฑู ู„ู„ูŠุฃุณ ุณุจูŠู„
ุงู„ู„ู‡ู… ุงุฑุถู†ุง ูˆ ุงุฑุถู‰ ุนู†ุง

ุตุจุงุญ ุงู„ุชูˆููŠู‚ ูˆ ุงู„ู†ุฌุงุญ ู„ูƒู„ ู…ู† ุชู…ู†ุงู‡๐Ÿค

Good luck ๐Ÿค๐Ÿ’ช
โค27
ุดู† ุตุงุฑ ู…ุนุงูƒู… ุทู…ู†ูˆู†ูŠ

ููŠู‡ ู…ู† ุทู„ุน ู…ู† ุงู„ุฅู…ุชุญุงู†ุŸ
๐Ÿ‘3๐Ÿ’”2โค1
ุฏูƒุงุชุฑุฉ ุจูŠุจุฑ ูˆู† ุงุตุญุจุช ู…ู† ุงู„ู…ุงุถูŠ ุฎู„ุงุต ู…ุนุงุด ุชููƒุฑูˆุง ููŠู‡ุง๐Ÿ™…โ€โ™€๏ธ ูˆ ุจุฅุฐู† ุงู„ู„ู‡ ุชูƒูˆู†ูˆุง ุฌุงูˆุจุชูˆุง ููŠู‡ุง ูƒูˆูŠุณ


ุชูˆุง ูƒูŠู ุชุฑุงุฌุนูˆุง ู„ ุจูŠุจุฑ ุชูˆ ุŸ๐Ÿค”

โฌ…๏ธุจุงู„ุฃุณุฆู„ุฉ ูˆ ุฑูƒุฒูˆุง ุนุงู„ุดุจุงุชุฑ ุงู„ุตุบูŠุฑุฉ ูˆ ุงู„ู…ุชูˆุณุทุฉ ุŒ ู„ุฃู†ู‡ุง ุชู†ุชุณู‰ ู…ุด ุฒูŠ ุงู„ุดุงุจุชุฑ ุงู„ูƒุจูŠุฑุฉ ุฏูŠู…ุง ู†ุจุฏูˆุง ู‚ุงุฑูŠู†ู‡ู… ูˆ ู…ุชุจุชูŠู†ู‡ู… ูƒูˆูŠุณ

Nephrology
Rheumatology
Endocrinology
Hematology
Infections
Dermatology
Psychiatry

ุงู„ู„ูŠ ุชู„ุญู‚ูˆุง ุนู„ูŠู‡ ุฎูŠุฑ ูˆ ุจุฑูƒุฉ ุŒ ุญุชู‰ ุฒูˆุฒ ุชู„ุงุชุฉ


ุจุงู„ุชูˆููŠู‚ ูˆ ุงู„ู†ุฌุงุญ ุงู† ุดุงุก ุงู„ู„ู‡.๐Ÿค
โค23๐Ÿ”ฅ1