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

🟨First sign in PBF in pt with vit B12 deficiency is

➡️Hypersegmented neutrophils

🟪key points 📝
#Hematology

Symptoms of anemia + neurological symptoms = Vit B 12 deficiency

Symptoms of anemia + neurological symptoms + H/O autoimmune diseases = Pernicious anemia

Pruritus after hot bath = PRV

Lower backpack + symptoms of hypercalcemia + high ESR = Multiple myeloma

Thrombocytopenia + hemolytic anemia + renal dysfunction + neurological symptoms = TTP

باش ما تتخلبطوش بين ال
HMWH and LMWH💡


📝نجوا لل LMWH
لان Low بيكون Fractionated
لان low بيأتر على factor واحد بس اللي هو factor
10
(تفكروا ال 10 بال O متع ال low😂)
و هذا علاش حتى لما بنديره monitoring نقيس مستوى
Factor 10
و لان low يصيرله elimination by kidney فقط


...........
توا نجوا لل HMWH
لان high ف اكيد هو اللي بيكون unfractionated
😏
ولأن high حيأتر على أكثر من factor و اللي هما، 9 ،10 ،11
و هذا علاش يندارله monitoring بال APTT
و لان high ف بيصيرله
Eilemenatin by liver and kidney 😇

ملاحظة:-اسمه un fractionated مش HMWH غير طبعا للتبسيط و تسهيل الحفظ

📝drugs that cause sidroplastic anaemia
( ALI)

A- Alcohol
L- Lead
I- Isoniazide

📝poor prognosis HL
( HALW SAM )

H- HB <10
A- Albumin <40
L- leukopenia
W- WBC >15×10^3
S- Stage 4
A- Age >45
M- Male gender

📝poor prognosis NHL
( BAD LM )

B- ⬆️B2 microglobulin
A- Age >65
D- coexcit Disease
L- ⬆️LDH
M- Metastisis

📝poor prognosis multiple myeloma
( ABCH )

A-albumin<40
B- ⬆️B2microglobulin
C- ⬆️creatinine
H- HB<10

🟨Genetic inheritance in hematological diseases

G6P deficiency + Hemophilia ➡️ X linked recessive

HS + VWD ➡️ AD

Sickle cell anemia and Thalassemia ➡️
AR

#Important_noes 📝

#B12 deficiency anemia

📝Causes
Vegetarian
Pernicious anemia
Ileal disease/ Chrons
Short Bowel syndrome

📝Dx
CBC➡️Macrocytic anemia
Peripheral blood film➡️Hyperpigmented neutrophils (MCQ مهمة هلبا)

#AML (M3)📝

Good prognosis
Characterised by DIC and Gum bleeding
Treated by / ATRA

#Thalassemia and SCA and Hb electrophoresis 📝

🟨Thalassemia➡️Hb F + Hb A2
🟨SCA ➡️ Hb S + Hb F

#Meylofibrosis📝

🩺presentation/ pancytopenia , old age

🩺DX
🟨PBF➡️ tear drop poikilocytes
🟨BM aspiration ➡️Dry tap
🟨BM biopsy ➡️ excessive proliferation of megakaryocytes

🩺Most common causes of pancreatitis in UK are

📝Gallstones
📝Alcohol

❇️CRP is now widely used marker of severity in acute pancreatitis.

مهمة هلبا في ال MCQ📝

ديما ال exception يجيبوا Lipase او Amylase و هما ما ليهم علاقة بالكرايتيريا.

🩺Dx of acute pancreatitis

❇️To confirm the DX
➡️pancreatic enzymes
Lipase more specific than Amylase ركزوووا 💢

❇️To assess the severity
➡️HCT
➡️WBC
➡️BUN
➡️CRP

❇️Imaging
➡️Abd US
📝Initial test ركزووووا💢
تشوفوا بيها edematous pancrease و منه ينشاف بيها لو فيه gallstones او dilatation of biliary tract و هكي نكونوا عرفنا السبب و نزيدوا ناكدوا نطلبوا عالبيشنت MRCP

➡️CT with contrast
Not routinly indicated, only in Dx is in doubt ركزوووا 💢.

💠Barrett’s esophagus.
✅Dx:
1️⃣The appearance of the esophageal lining (salmon pink color compared to normal white color).
2️⃣The salmon-pink area has specialized intestinal metaplasia.
3️⃣The white area is squamous epithelium.