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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๐Ÿ“drugs that cause sidroplastic anaemia
( ALI)

A- Alcohol
L- Lead
I- Isoniazide
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๐Ÿ“poor prognosis HL
( HALW SAM )

H- HB <10
A- Albumin <40
L- leukopenia
W- WBC >15ร—10^3
S- Stage 4
A- Age >45
M- Male gender
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๐Ÿ“poor prognosis NHL
( BAD LM )

B- โฌ†๏ธB2 microglobulin
A- Age >65
D- coexcit Disease
L- โฌ†๏ธLDH
M- Metastisis
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๐Ÿ“poor prognosis multiple myeloma
( ABCH )

A-albumin<40
B- โฌ†๏ธB2microglobulin
C- โฌ†๏ธcreatinine
H- HB<10
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๐ŸŸจGenetic inheritance in hematological diseases

G6P deficiency + Hemophilia โžก๏ธ X linked recessive

HS + VWD โžก๏ธ AD

Sickle cell anemia and Thalassemia โžก๏ธ
AR

#Important_noes ๐Ÿ“
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#B12 deficiency anemia

๐Ÿ“Causes
Vegetarian
Pernicious anemia
Ileal disease/ Chrons
Short Bowel syndrome

๐Ÿ“Dx
CBCโžก๏ธMacrocytic anemia
Peripheral blood filmโžก๏ธHyperpigmented neutrophils (MCQ ู…ู‡ู…ุฉ ู‡ู„ุจุง)
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#AML (M3)๐Ÿ“

Good prognosis
Characterised by DIC and Gum bleeding
Treated by / ATRA
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#Thalassemia and SCA and Hb electrophoresis ๐Ÿ“

๐ŸŸจThalassemiaโžก๏ธHb F + Hb A2
๐ŸŸจSCA โžก๏ธ Hb S + Hb F
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#Meylofibrosis๐Ÿ“

๐Ÿฉบpresentation/ pancytopenia , old age

๐ŸฉบDX
๐ŸŸจPBFโžก๏ธ tear drop poikilocytes
๐ŸŸจBM aspiration โžก๏ธDry tap
๐ŸŸจBM biopsy โžก๏ธ excessive proliferation of megakaryocytes
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๐ŸฉบMost common causes of pancreatitis in UK are

๐Ÿ“Gallstones
๐Ÿ“Alcohol
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โ‡๏ธCRP is now widely used marker of severity in acute pancreatitis.
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ู…ู‡ู…ุฉ ู‡ู„ุจุง ููŠ ุงู„ MCQ๐Ÿ“

ุฏูŠู…ุง ุงู„ exception ูŠุฌูŠุจูˆุง Lipase ุงูˆ Amylase ูˆ ู‡ู…ุง ู…ุง ู„ูŠู‡ู… ุนู„ุงู‚ุฉ ุจุงู„ูƒุฑุงูŠุชูŠุฑูŠุง.
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๐ŸฉบDx of acute pancreatitis

โ‡๏ธTo confirm the DX
โžก๏ธpancreatic enzymes
Lipase more specific than Amylase ุฑูƒุฒูˆูˆูˆุง ๐Ÿ’ข

โ‡๏ธTo assess the severity
โžก๏ธHCT
โžก๏ธWBC
โžก๏ธBUN
โžก๏ธCRP

โ‡๏ธImaging
โžก๏ธAbd US
๐Ÿ“Initial test ุฑูƒุฒูˆูˆูˆูˆุง๐Ÿ’ข
ุชุดูˆููˆุง ุจูŠู‡ุง edematous pancrease ูˆ ู…ู†ู‡ ูŠู†ุดุงู ุจูŠู‡ุง ู„ูˆ ููŠู‡ gallstones ุงูˆ dilatation of biliary tract ูˆ ู‡ูƒูŠ ู†ูƒูˆู†ูˆุง ุนุฑูู†ุง ุงู„ุณุจุจ ูˆ ู†ุฒูŠุฏูˆุง ู†ุงูƒุฏูˆุง ู†ุทู„ุจูˆุง ุนุงู„ุจูŠุดู†ุช MRCP

โžก๏ธCT with contrast
Not routinly indicated, only in Dx is in doubt ุฑูƒุฒูˆูˆูˆุง ๐Ÿ’ข.
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๐Ÿ’ Barrettโ€™s esophagus.
โœ…Dx:
1๏ธโƒฃThe appearance of the esophageal lining (salmon pink color compared to normal white color).
2๏ธโƒฃThe salmon-pink area has specialized intestinal metaplasia.
3๏ธโƒฃThe white area is squamous epithelium.
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Barium swallow showed corkscrew appearance of the distal esophagus denoting #sever_esophagal_spasm๐Ÿ“
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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
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๐ŸŸจDyphagia๐Ÿ“

Dysphagia to both fluids and solids = Achalasia
Dysphagia to solids only = Malignancy
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๐ŸŸจAlcoholic hepatitis
โฌ†๏ธAST > ALT 2:1

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

ุนูƒุณ ุจุนุถ ุฑูƒุฒูˆุง ุนู„ูŠู‡ู…๐Ÿ“
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๐ŸŸจPBC and ( role of M)๐Ÿ“

Ig M
Anti Mitochondrial Abs
M2 subtype
Middle aged female
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๐ŸŸจMost common site of Carcinoid syndrome is

๐Ÿ“Ileum.
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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
๐Ÿ‘3๐Ÿ‘1