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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๐ŸŸจDescription
โ—ฝPlain chest x ray
โ—ฝPA view
โ—ฝShowing single cavitary mass occupying the lower zone of the Rt hemithorax with water lilly appearance (camalote sign)

๐ŸŸจDD
1_ Infection ๐Ÿ‘‰Hydatid cyst , TB , Fungal infection
2_ Cancer

๐ŸŸจMost likely DX
Hydatid cyst
(B/C of ๐Ÿ‘‰ Water lilly appearance )

๐ŸŸจNext step
Chest CT scan
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๐ŸŸจDescription
โ—ฝPlain chest x ray
โ—ฝPA view
โ—ฝShowing single liquifactive cavitary mass with air fluid level occupying the upper zone of the Rt hemithorax

๐ŸŸจDD
1_ Infection ๐Ÿ‘‰ Abscess, TB , Hydatid cyst,
Fungal infection
2_ Cancer

๐ŸŸจMost likely DX
Abscess
(B/C of ๐Ÿ‘‰ Air fluid level )๐Ÿ’ก๐Ÿ’ฌ

๐ŸŸจNext step
Chest CT scan
Sputum C/S

ู…ุฑุงุช ูŠุณุฃู„ูƒ ุณูˆุงู„ ุชุงู†ูŠ ุŒ ุจุงู„ Examination ุดู† ู…ู…ูƒู† ุชู„ู‚ู‰ ุนู†ุฏู‡ ุŸ
1_ Finger clubbing
2_ Halitosis
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The water-lily sign, also known as the camalote sign, is seen in hydatid infections when there is detachment of the endocyst membrane which results in floating membranes within the pericyst .

ูˆ ุชุดูˆููˆู‡ุง ุญุชู‰ ุจุงู„ abd US ุŒ Chest
CT ุŒ MRI
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๐ŸŸจDescription
โ—ฝPlain chest x ray
โ—ฝPA view
โ—ฝShowing multiple white homogenous lesions (Giving Cannon ball appearance) occupying both Rt and lt hemithorax

๐ŸŸจDD
1_ Cancer / lung Metastasis
2_ Inflammation/ Wegner granulomatosis, RA nodules

๐ŸŸจMost likely DX
Lung Metastasis

๐ŸŸจNext step
Brochoscopy and lung biopsy
Chest CT scan
CT abdomen and pelvis with contrast
Dexa scan
CBC
ESR
CRP
LFT
RFT
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๐ŸŸจDescription
โ—ฝPlain chest x ray
โ—ฝPA view
โ—ฝShowing oval shaped white opacity at the hilum of both Rt and lt hemithorax.

๐ŸŸจDD
1_Sarcidosis
2_Fungal infection
3_Viral infection
4_Bacterial infection / Mycoplasma

๐ŸŸจMost likely DX
Sarcidosis

๐ŸŸจNext step
PFT
ABG
CBC
HRCT
BAL
Lung biopsy
โค3๐Ÿ‘2
๐ŸŸจDescription
โ—ฝPlain chest x ray
โ—ฝPA view
โ—ฝShowing air under diaphragm

๐ŸŸจDD
1_ Perforated viscus
2_ Post_surgery
3_ Post_Truma (Stab wound)

๐ŸŸจMost likely DX
Perforated viscus

๐ŸŸจNext step
โžก๏ธStabilize the pt ๐Ÿ‘‰ ABC / IV fluids , Antibiotics
โžก๏ธSend investigations
CBC
ESR
CRP
RFT
Blood group, Cross match
โžก๏ธImaging
Abdominal CT scan with contrast
๐Ÿฅฐ4๐Ÿ‘1
Air under diaphragm
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๐ŸŸจDescription
โ—ฝErect abdominal x ray
โ—ฝAP view
โ—ฝShowing multiple air fluid level

๐ŸŸจMost likely DX
IO (Intestinal obstruction )

๐ŸŸจNext step
โžก๏ธMedical TTT
NPO
IV fluids
Analgesics
Antibiotics

โžก๏ธSurgical TTT
Resection and Anastomosis
๐Ÿฅฐ3๐Ÿ‘1
ูˆ ู‡ุงุฏูŠ ุงุบู„ุจ ูˆ ุงู‡ู… ู…ูˆุงุถูŠุน ุงู„ X ray ุงู„ู„ูŠ ู…ุทุงู„ุจูŠู† ุจูŠู‡ู…

ุงู† ุดุงุก ุงู„ู„ู‡ ุจุงู„ุชูˆููŠู‚. ๐ŸŒธ๐ŸŒธ๐ŸŒธ๐ŸŒธ
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ุงู„ุณู„ุงู… ุนู„ูŠูƒู… ุฏูƒุงุชุฑุฉ ๐ŸŒธ๐ŸŒธ

ุดู† ุชุจูˆุง ู†ุนุทูŠูƒู… ุจุนุฏ ุงู„ xray
Anonymous Poll
60%
ECG
19%
Emergency
11%
Instrument
10%
ู†ุญู„ูˆุง ุฃุณุฆู„ุฉ
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ุทุจุนุงู‹ ุงู„ Most common cause of 2ry causes is Metabolic ๐Ÿ’ก

ู„ุฐู„ูƒ ุงูŠ pt admitted as a case with convlusion ู„ุงุฒู… ู†ุจุนุชู‡๐Ÿ‘‡
Ca
Phosphorus
Mg
Na
K
RBS
โค4๐Ÿ”ฅ2๐Ÿ‘1
๐Ÿ‘3โค1๐Ÿ‘1
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