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“Hepatitis B Serology
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Chrons disease VS Ulcerative colitis ๐Ÿ“
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๐Ÿ“Most common congenital abnormalty of GIT is

โœ…๏ธ Meckele's Diverticulam
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๐Ÿ“Most common complication of ERCP is

โœ…๏ธAcute PANCREATITIS.
โค6๐Ÿ‘1
๐Ÿ“Some GIT clenchers

Malabsorption symptoms + macrocytosis in young patient >>> coeliac disease

Malabsorption symptoms + improve with control of diary intake + negative endomyseal Abs>>> Lactose intolerance .

Malabsorption + joint pain + Bradycardia in middle age>>> Whipple's disease ( positive PAS biopsy).

Malabsorption + macrocytosis + negative endomyseal Abs and normal IgA>>> think in tropical sprue .

Malabsorption + recurrent epigastric pain to back + positive fecal elastase >>> chronic pancreatitis .

Malabsorption + symptoms of bronchiectasis >>> cystic fibrosis

Dr / Doha Ali Rawaq
โค3๐Ÿ‘1
๐Ÿ“Hands in GIT

โœ…๏ธ*1.Clubbing*
(Liver cirrhosis , IBD)

โœ…๏ธ *2.leuconychia*
(whitening of the nails due to hypoalbuminaemia)

โœ…๏ธ*3.koilonychia*
(โ€˜spooningโ€™ of the nails due to iron, B12, or folate deficiency)

โœ…๏ธ*4.Muehrckeโ€™s lines*
(transverse white lines due to hypoalbuminaemia)

โœ…๏ธ*5.blue lunulae*
(bluish discolouration seen in Wilsonโ€™s disease)

โœ…๏ธ *6.Palmar erythema*
(chronic liver disease, pregnancy)

โœ…๏ธ *7.Dupuytrenโ€™s contracture* (thickening and fibrous contraction of palmar fascia ( most likely alcoholic liver disease)

โœ…๏ธ *8.Hepatic flap/asterixis*
(hepatic encephalopathy, uraemia from renal disease)
โค4
โœ…๏ธPseudomembranous colitis ttt
โค3
ุงู„ุณู„ุงู… ุนู„ูŠูƒู… ูˆุฑุญู…ุฉ ุงู„ู„ู‡ ูˆุจุฑูƒุงุชู‡ ๐Ÿค

ุฏูƒุงุชุฑุฉ ุงู„ู„ูŠ ู…ุดุชุฑูƒูŠู† ู…ุนุงูŠ ููŠ ูƒูˆุฑุณ ุงู„ู‡ุณุชูˆุฑูŠ ุญู†ุจุฏูˆุง ุชุฏุฑูŠุจ ุงู„ู‡ุณุชูˆุฑูŠ ู…ู† ูŠูˆู… ุงู„ุฌู…ุนุฉ ุงู„ุฌุงูŠุฉ ุงู† ุดุงุก ุงู„ู„ู‡ ุงู„ู…ูˆุงูู‚ 8_11

ุฃูŠุงู… ุงู„ุชุฏุฑูŠุจ/ ูƒู„ ุฌู…ุนุฉ

ุฃูˆู„ main complaints ุญู†ุงุฎุฏูˆู‡ู…
Dysnea
Chest pain

ููŠ ูƒู„ ู…ุญุงุถุฑุฉ ุญู†ุฎุชุงุฑ 4 ุฏูƒุงุชุฑุฉ ูŠุงุฎุฏูˆุง ุงู„ู‡ุณุชูˆุฑูŠ ูˆ ุงู„ุจู‚ูŠุฉ ุงุณุชู…ุงุน

ุจุญูŠุซ ูƒู„ main complaint ู†ุงุฎุฏูˆุง ุนู„ูŠู‡ ุฒูˆุฒ ุณูŠู†ุงุฑูŠูˆู‡ุงุช ู…ุฎุชู„ูุฉ๐Ÿ“
ูˆ ู†ุฎุชู…ูˆุง ูƒู„ ุณูŠู†ุงุฑูŠูˆ ุจ Disscussion
DD + Investigations
ู†ูุณ ู…ุง ู…ุทุงู„ุจูŠู† ุจูŠู‡ ููŠ ุงู„ุฅู…ุชุญุงู†

ุดูˆููˆุง ููŠุฏูŠูˆุงุช ุงู„ู…ู†ุตุฉ ู„ู„ู…ูˆุถูˆุนูŠู† ุงู„ู„ูŠ ุจู†ุงุฎุฏูˆู‡ู… ูˆ ู…ูˆูู‚ูŠู† ุงู† ุดุงุก ุงู„ู„ู‡ ๐Ÿ™๐Ÿชป

ุฑุฌุงุกุงู‹ ุงู„ู„ูŠ ู…ุณุฌู„ูŠู† ู…ุนุงูŠ ููŠ ุงู„ูƒูˆุฑุณ ูŠุชูˆุงุตู„ูˆุง ู…ุนุงูŠ ุจุงุด ู†ุถูŠููƒู… ู„ู‚ุฑูˆุจ ุงู„ุชุฏุฑูŠุจ ูˆ ุจุงู„ู†ุณุจุฉ ู„ ุชูˆู‚ูŠุช ุงู„ุงูŠู ุญู†ุฒู„ู‡ ู„ุงุญู‚ุงู‹ ููŠ ุงู„ู‚ุฑูˆุจ ุงู„ู…ุฎุตุต ู„ู„ุชุฏุฑูŠุจ.โŒš๏ธโฐ๏ธ
โค10๐Ÿ‘1
ุงู„ุณู„ุงู… ุนู„ูŠูƒู… ูˆุฑุญู…ุฉ ุงู„ู„ู‡ ูˆุจุฑูƒุงุชู‡ ุฏูƒุงุชุฑุฉ๐Ÿฉบ

ู„ูƒู„ ู…ู† ูŠุชูˆุงุตู„ ู…ุนุงูŠ ุจุฎุตูˆุต ูƒูˆุฑุณ ุงู„ Examination ูƒุงู…ู„ (Manouver+ findings) ู„ู„ุฃุณู ู…ูˆู‚ูุฉ ุงู„ุชุณุฌูŠู„ ุญุงู„ูŠุงู‹

ู„ุงู† ุงุฎุฑ ู‚ุฑูˆุจ ู†ูƒู…ู„ู„ู‡ู… ููŠ ู†ุต 12 ูˆ ู„ูˆ ุงู…ุชุญุงู†ูƒู… ููŠ 1 ุฃุนุชู‚ุฏ ู…ุด ุญูŠูƒูˆู† ู…ู†ุงุณุจ ู†ุนุทูŠ ุจุนุฏ ุงู„ู‚ุฑูˆุจ ู‡ุฐุง

ูˆ ุจุงู„ู†ุณุจุฉ ู„ูุชุฑุฉ ุงู„ุฅู…ุชุญุงู† ุจุนูˆู† ุงู„ู„ู‡ ุญู†ุนุทูŠ ูƒูˆุฑุณ findings ุŒ ุญูŠูƒูˆู† ู…ุฏุชู‡ ูŠูˆู…ูŠู† ุฒูŠ ู…ุง ุนุทูŠุช ู„ู„ุฏูุนุงุช ุงู„ู„ูŠ ู‚ุจู„ูƒู… ุŒ ูˆู‚ุชู‡ุง ุญู†ุฒู„ ุฅุนู„ุงู† ุจุงู„ุฎุตูˆุต


ู…ูˆูู‚ูŠู† ู…ุณุฏุฏูŠู† ุจุนูˆู† ุงู„ู„ู‡ ุชุนุงู„ู‰ ๐Ÿคโœจ๏ธ
โค10๐Ÿ‘1
#Respiratory

๐ŸŸจType 1 respiratory failure (T1RF): is characterised by
hypoxaemia (PaO2 < 8 kPa)
normal or low CO2.

๐ŸŸจType 2 respiratory failure (T2RF): is characterised by
hypoxaemia (PaO2 < 8 kPa) hypercapnia (PaCO2 > 6.5 kPa).
โค3
#Respiratory

โœณ๏ธRespiratory Conditions: Choice of investigations๐Ÿ“
__

โœ…Extrinsic upper airway obstruction assessmentโž Flow-volume loop

โœ…Expiratory obstruction (e.g. Asthma, COPD)โž FEV1

โœ…Respiratory muscle strength assessment (e.g. GBS, Myasthenia gravis)โž FVC

โœ…Assessment whether obstructive or restrictive lung diseaseโž FEV1/FVC ratio
โ—พIf ratio <0.7 indicates obstructive
โ—พIf ratio is >0.7 indicates restrictive

โœ…Monitoring of Asthmaโž PEFR
๐Ÿ‘2โค1
#Respiratory

#Signs_of_Acute_severe_asthma๐Ÿ“
Any one of the followings:

*Peak flow 33% to 50% best
*Predicted Respiratory rate โ‰ฅ25 per minute
*Heart rate โ‰ฅ110 beats per minute
*Inability to complete sentences in one breath.๐Ÿฉบ
โค1
#Respiratory

๐ŸŸจThe most common infective causes of COPD exacerbations are:

๐Ÿ“bacteria:
-Haemophilus influenzae (most common cause)
-Streptococcus pneumoniae
Moraxella catarrhalis

๐Ÿ“Respiratory viruses:
-account for around 30% of exacerbations
-human rhinovirus is the most important pathogen๐Ÿฉบ
โค2๐Ÿ‘1
๐ŸŸจSeverity of COPD categorised by using

โžก๏ธFEV 1
๐Ÿ‘2โค1
๐ŸŸจFactors which improve survival in COPD

Smoking cessation
LTOT (Long Term Oxygen Therapy)
Lung volume reduction surgery
โค7๐Ÿ‘1
Forwarded from Internal Medicine By Doha Rawag (Doha Ali Rawaq)
#Bronchiectasis+HRCT Findings๐Ÿ“

โžก๏ธHoneycombing
โžก๏ธsignet ring sign
โžก๏ธTram track sign
โค2๐Ÿ”ฅ2
Forwarded from Internal Medicine By Doha Rawag (Doha Ali Rawaq)
โ‡๏ธThe mainstay of ttt in bronchiectasis is โžก๏ธ

๐Ÿ“Antibiotics + Chest physiotherapy .
๐Ÿ‘2โค1
Forwarded from Internal Medicine By Doha Rawag (Doha Ali Rawaq)
๐ŸŸจfibrosis predominantly effecting the lower zones of lung ๐Ÿซ

๐Ÿ“Asbestosis
๐Ÿ“Idiopathic pulmonary fibrosis
๐Ÿ“Connective tissue diseases (Except Ankylosing spondylitis)
๐Ÿ“Drug induced โžก๏ธ e.g Amiodarone, Nitrofuranton, Bleomycin , Methotrexate

ูˆ ุงูŠ ุญุงุฌุฉ ุชุงู†ูŠุฉ ุบูŠุฑู‡ู… ุจุชุงุชุฑ ุนู„ู‰ ุงู„ upper zones.
โค6
Forwarded from Internal Medicine By Doha Rawag (Doha Ali Rawaq)
โ‡๏ธHypercalcemia and respiratory diseases

Sarcoidosis โžก๏ธpresence of 1ฮฑ-hydroxylase enzyme in macrophages and giant cells that form part of the granuloma.

Squamous cell carcinoma of lung โžก๏ธ
parathyroid hormone-related peptide (PTHrP), a protein that has similar action to parathyroid hormone (PTH) .

ุฑูƒุฒูˆุง ุนู„ูŠู‡ู… ู…ู‡ู…ุงุช ููŠ ุงู„ MCQ๐Ÿ“
โค9