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”ด#Bedside_Notes
#Cardiovascular / ุฏ.ุฃุณุงู…ุฉ ุงู„ุจู‡ูŠู„ูŠู„

Q1_ What is the mechanism of PND and why it occurs at night ?
๐Ÿ‘‡
1_ โฌ†๏ธ venous return / Flat position
2_ โฌ‡๏ธ sympathetic/ Broncho-construction + โฌ‡๏ธ contractility of heart

Q2_ What are the uses of Slidinifine (Vigra)?
๐Ÿ‘‡
1_ Pulmonary HTN
2_ Erectile dysfunction

Q3_ What is the mechanism of action of Slidenifine ?
๐Ÿ‘‡
1_ Vasodilatation
2_ โฌ†๏ธ NO (Nitrous Oxide)

Q4_ What are the causes of Pulmonary HTN ?
๐Ÿ‘‡
1_ Lt side HG
2_ Chronic lung disease (Hypoxia)
3_ CTD / SLE
4_ Portal HTN ( porto_pulmonary HTN which occurs in sever advanced liver cirrhosis )
5_ Idiopathic
6_ Congenital

Q5_ What is the age of sudden death ?
๐Ÿ‘‡
Male / 45
Female / 50

Q6_What are the cardiopulmonary diseases which are absolutely C/I for pregnancy?
๐Ÿ‘‡
1_ Sever AS
2_ HOCM
3_ Pulmonary HTN

Q7_ ุนู„ุงุด ู†ุดูˆููˆุง ููŠ ุงู„
central cyanosis
ููŠ ุงู„ Tongue ุŸ
๐Ÿ‘‡
1_ High and rich in vasculature
2_ No sympathetic nerve supply
3_ internal organ / ู…ุง ูŠุชุนุฑุถุด ู„ู„ุตู‚ุน ุฒูŠ ุงู„ุตุจุน
โค1
๐Ÿ”ด#Bedside_Notes
#Cardiovascular/ ุฏ.ุฑุถุง ุจู† ูุถู„

Q1_ What is the DD of visible pulsation at suprasternal notch ?
๐Ÿ‘‡
1_ Thoracic aortic aneurysm
2_ Hyperdynamic circulation
3_ Normal ( Thin person )

Q2_ What is the DD of visible pulsation at Epigastric area ?
๐Ÿ‘‡
1_ Abnormal aortic aneurysm
2_ Rt ventricular dilatation
3_ Pulsatile liver ( Due to TR )
4_ Normal (Thin person )

Q3_ What are the causes of displaced apex in pt with MS ?
๐Ÿ‘‡
ุทุจุนุงู‹ ููŠ ุงู„ุญุงู„ุฉ ู‡ุงุฏูŠ ู…ูุฑูˆุถ lt ventricule ูŠูƒูˆู† normal size
ูุงู„ุงุณุจุงุจ ุญุชูƒูˆู† ูŠุง ุงู…ุง
1_ Rt ventricular dilatation
ูˆ ู‡ุงุฏูŠ ุชุตูŠุฑ late ุจุณุจุจ ุงู„ Backwards symptoms on the lung then on the Rt side of the heart
2_ Presence of other pathology / Congenital heart disease

Q4_ What are the causes of Acute MR ?
๐Ÿ‘‡
1_ Acute MI
2_ Endocarditis
3_ Sever chest truma

Q5_ What are the DD of Kussmal sign ?
๐Ÿ‘‡
1_ Constictive pericardaitis
2_ Cardiac temponade
3_ Restrictive cardiomyopathy
โค4
#Cardiology_Notes๐Ÿ’ญ

Q1_What is the DD of ejection systolic murmer at 1st aortic area ?
๐Ÿ‘‡
1_AS
2_Aortic sclerosis
3_Hyperdynamic circulation

ูƒูŠู ุชูุฑู‚ูˆุง ุจูŠู†ู‡ู… ุŸ
โžก๏ธMurmur of AS radiates to the root of neck + associated with slow volume pulse

โžก๏ธMurmur of Aortic sclerosis has no radiation + associated with normal pulse

โžก๏ธMurmur of hyperdynamic circulation has no radiation + associated with large volume pulse and +ve collapsing pulse
#Cardiology_Notes๐Ÿ’ญ

ุงู„ murmer ุงู„ู„ูŠ ุชุญุณูˆุง ู…ุนุงู‡ trill ู‡ูˆ ูู‚ุท ุงู„ Systolic murmer .
๐Ÿ”ฅ2
#Cardiology_Notes ๐Ÿ’ญ

โš€Drugs which doesn't improve the prognosis in pt with HF (Doesn't โฌ‡๏ธ Mortality and Morbidity)

ุงุญูุธูˆู‡ู… ุจุฅุฎุชุตุงุฑ DD ๐Ÿ“๐Ÿ’ก๐Ÿ’ฌ

Diuretics (Except Spironolactone)
Digitalis

ู…ู‡ู…ุงุช ุฌุฏุงู‹ ูˆ ู„ุงุฒู… ูŠุฌูŠ ู…ู†ู‡ู… ุณุคุงู„ ููŠ ุงู„ุจูŠุจุฑ.
โค1
#Cardiology_Notes ๐Ÿ’ญ

โš€Drugs which doesn't improve the prognosis in pt with MI (Doesn't โฌ‡๏ธ Mortality and Morbidity)

ุงุญูุธูˆู‡ู… ุจุฅุฎุชุตุงุฑ CMN ๐Ÿ“๐Ÿ’ก๐Ÿ’ฌ

CCB
Morphine
Nitrates

ุญุชู‰ ู‡ู…ุง ู…ู‡ู…ุงุช ู‡ู„ุจุง ูˆ ูŠุชูƒุฑุฑูˆุง ููŠ ุงุณุฆู„ุฉ ุงู„ุจูŠุจุฑ.
โค1
#Cardiology_Notes ๐Ÿ’ญ

โ—ฝSplitting of S2

ุงู„ุทุจูŠุนูŠ ู„ู…ุง ุชุณู…ุน S2 ูŠูƒูˆู† ููŠู‡ Normal Splitting ูˆ ุงู„ู„ูŠ ู‡ูˆ ุงู†ูƒ ุชุณู…ุน ุงู„ A closure ู‚ุจู„ ุงู„ P closure

ุนู„ุงุด ุŸุŸ

ู„ุงู† lt ventricle more thicker than Rt venticule ู ุญ ูŠู†ู‚ุจุถ ุฃุณุฑุน ูˆ ูŠุชุณูƒุฑ ุงู„ A valve ู‚ุจู„ ุงู„ P valve

ูˆ ููŠู‡ ู…ุฌู…ูˆุนุฉ abnormality ูŠุตูŠุฑูˆุง ู„ู„ Splitting ู…ู†ู‡ุง ๐Ÿ‘‡

โš€Prolonged (Wide) Splitting

ูˆ ู‡ุงุฏูŠ ุชุตูŠุฑ ู„ู…ุง ุชุจุฏุง ููŠู‡ ู…ุดูƒู„ุฉ ููŠ ุงู„ Rt side of the heart
ูŠุนู†ูŠ ู‡ูˆ ู…ู† ุงู„ุฃุณุงุณ ูŠู†ู‚ุจุถ ุจุนุฏ ุงู„ lt
ูˆ ูŠุฏูŠุฑ splitting ู„ุง ุจุงู„ ุตุงูŠุฑ ููŠู‡ ู…ุดูƒู„ุฉ ู ุญูŠุฒูŠุฏ ูŠุชุฃุฎุฑ ูˆ ุชุทูˆู„ ู…ุฑุญู„ุฉ ุงู„ Splitting.
E.g
๐Ÿ‘‡
1_pulmonic stenosis
2_ right bundle branch block


โš€Revese splitting

ู…ู† ุงุณู…ู‡ุง ูŠุนู†ูŠ ุตุงูŠุฑ ุงู„ุนูƒุณุŒ ุจู…ุนู†ูŠ ุชุงู†ูŠ ุงู„ P valve ู‡ูˆ ุงู„ู„ูŠ ูŠุชุณูƒุฑ ู‚ุจู„ ุงู„ A valve ูˆ ู‡ุงุฏูŠ ุชุตูŠุฑ ู„ู…ุง ููŠู‡ ู…ุดูƒู„ุฉ ููŠ ุงู„ Lt side of the heart

E.g
๐Ÿ‘‡
1_Aortic stenosis
2_left bundle branch block (LBBB)


ู…ู„ุงุญุธุฉ:- M , T valve lesions ู…ุง ูŠู‡ู…ูˆูƒู…ุด ุŒ ู„ุงู†ู‡ู… ู…ุณุคูˆู„ูŠู† ุนู„ู‰ S1.
โค1
#Cardiology_Notes๐Ÿ’ญ

โš€DD of persistent ST segment elevations๐Ÿ“
๐Ÿ‘‡
1_Lt ventricular aneurysm
2_LBBB
3_Post MI Pericarditis

ู†ุณุฃู„ุช ุงู„ุณุคุงู„ ู‡ุฐุง ููŠ ุฅู…ุชุญุงู† ุงู„ุงูˆุฑุงู„ ูˆ ู‚ุนุฏ ุงู„ุฏูƒุชูˆุฑ ูŠู‚ูˆู„ูŠ what else ุŸ๐Ÿค”

ูƒุงู† ูŠุจูŠ ู…ุนุงู‡ู…
Failed thromolysis
Subarachnoid haemorrhage as a complication of thrombolytic use .
โค1
#Cardiology_Notes ๐Ÿ’ญ

๐Ÿ”ดPoor prognostic criteria of heart failure ๐Ÿ“๐Ÿ’ญ

โ—ฝ4 ู…ู† ุงู„ู‡ุณุชูˆุฑูŠ ๐Ÿ‘‡
1_Old age
2_Male
3_Sever symptoms
4_PMH of IHDs

โ—ฝ4 ู…ู† ุงู„ุงู‚ุฒุงู…ู†ูŠุดู†๐Ÿ‘‡
1_Gallop rythym
2_Raised JVP
3_ Bilateral basal lung fine crepitations
4_Unstable Vital signs/ Hypotension, Bradycardia or pulses alternals , Cheyen stock breathing

โ—ฝ4 ู…ู† ุงู„ investigation ๐Ÿ‘‡
1_ Electrolyte / hyponatremia , hypokalemia
2_ RFT / โฌ†๏ธ bun
3_โฌ†๏ธ BNP
4_Echo / โฌ‡๏ธEF , lt ventricular hypertrophy .
โค2