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“Sleroderma features (Another findings in General examination stations)

ุชุนู‚ู„ูˆุง ุนุงู„ููŠุณ ุฒูŠ ู…ุง ู…ูƒุชูˆุจ ููŠ ุงู„ุตูˆุฑุฉ ููˆู‚ ูˆ ุจุงู„ู†ุณุจุฉ ู„ู„ hands ุชุนู„ู‚ูˆุง ุนู„ู‰
Flexed deformity
Hyperpigmentation + hypopigmented patches
ุฏูŠู…ุง ุฑูƒุฒูˆุง ุนู„ู‰ salt on paper appearance ุงุบู„ุจ ุงู„ุญุงู„ุงุช ุนู†ุฏู‡ู…
Sclerodactaly

ู…ุฑุงุช ุชู„ู‚ูˆุง ุญุชู‰ ulcer ูˆ gangrene
ุจุณุจุจ ุฑูŠู†ูˆุฏ ุนู„ู‚ูˆุง ุนู„ูŠู‡ุง

๐Ÿ“DD
Scleroderma
Chronic Graft versus host diseses

๐Ÿ“Investigations
CBC , ESR , CRP, UEC, LFT ,ANA , Anti centromere antibodies, HRCT , CXR , ECG , Echo, Urine for Routine examination

๐Ÿ“Most common cause of death
Pulmonary hypertension
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โ—ผ๏ธููŠ ุจุนุถ ุงู„ุณู†ูˆุงุช ู„ู…ุง ุชูƒูˆู† ุงู„ findings ููŠ ู„ุฌู†ุฉ ุงู„ู†ูŠูˆุฑูˆ LMNL ) facial palsy) ุณุฃู„ูˆุง ุญุชู‰ ุนุงู„ treatment ุจุงู„ุฅุถุงูุฉ ุงู„ู„ูŠ DD ูˆ ุงู„ Investigations

๐Ÿ“Bellโ€™s Palsy โ€“ Treatment

Prednisone 50โ€“60 mg daily ร— 5 days โ†’ then taper over 5 days (should be started within 72 hrs).

ยฑ Antiviral (Acyclovir / Valacyclovir) if severe or Ramsay Hunt suspected.

Eye protection: artificial tears (day), ointment + eye patch (night).

Analgesics (paracetamol/NSAIDs) for pain.

Physiotherapy / facial exercises if prolonged weakness.


๐Ÿ‘‰ Most recover fully in 3โ€“6 months.
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๐Ÿ“ู‚ุงุนุฏุฉ ุงูŠ Nerve palsy ุงุญูุธูˆุง ุฃุณุจุงุจู‡ ุจุงู„ุงุฎุชุตุงุฑ ู‡ุฐุง

1-Vascular/ Stroke , Vasculitis, aneurysm , Cavernous Sinus Thrombosis
2-Infection/ meningitis, encephalitis, brain Abscess
3-Inflammation/ MS
4-Trauma
5-Tumeur / space occupying lesion (โฌ†๏ธ ICP)
6-Systemic diseases/ DM , sarcoidosis
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๐Ÿ“Knee joint examination steps

1. Inspection โ€“ posture, deformity, swelling, scars, muscle wasting

2. Palpation โ€“ warmth, tenderness, effusion (bulge sign, patellar tap), crepitus, quadriceps wasting.

3. Movement โ€“ flexion/extension

4. Special tests ู‡ุงุฏูˆ ู…ุด ู„ูŠูƒู… ุชุจุน ุงู„ุฌุฑุงุญุฉ

5.assess the gait
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๐Ÿ“DD of Monoarthritis of the Knee joint


๐Ÿ”ธ๏ธInfectious: Septic arthritis, TB, viral, fungal

๐Ÿ”ธ๏ธCrystal-induced: Gout, pseudogout (CPPD)

๐Ÿ”ธ๏ธTraumatic/mechanical: Hemarthrosis, meniscal tear, loose body

๐Ÿ”ธ๏ธInflammatory/autoimmune: Early RA, SLE, spondyloarthropathies (reactive, psoriatic, enteropathic)

๐Ÿ”ธ๏ธDegenerative: Osteoarthritis with effusion

๐Ÿ”ธ๏ธNeoplastic/infiltrative: PVNS, synovial chondromatosis, metastasis

๐Ÿ”ธ๏ธOthers: Hemophilia, sickle cell, sarcoidosis, amyloidosis
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๐Ÿ“What investigations would you like to Elict?

๐ŸŸจ Arthrocentesis (joint aspiration)
โžก๏ธGross appearance: purulent, bloody, clear, cloudy
โžก๏ธSynovial fluid analysis

๐ŸŸจ Blood investigations
โ—พ๏ธCBC, ESR, CRP โ†’ inflammation / infection markers
โ—พ๏ธBlood cultures
if septic arthritis suspected
โ—พ๏ธUric acid level
(may support gout but not diagnostic)
โ—พ๏ธAutoimmune markers
(if chronic/atypical):
Rheumatoid factor (RF), anti-CCP
ANA, HLA-B27 (if spondyloarthropathy suspected)

๐ŸŸจ Imaging
โ—พ๏ธPlain X-ray (knee)


๐ŸŸจUltrasound
Detect effusion, guide aspiration

๐ŸŸจMRI
If internal derangement (meniscal tear, ligament injury) or neoplastic/synovial pathology suspected


๐ŸŸจSpecial tests (when indicated)
โ—พ๏ธSynovial biopsy โ†’ TB arthritis, PVNS, tumors
โ—พ๏ธPCR (TB, gonococcal, viral causes) if culture negative but suspicion high
โ—พ๏ธCoagulation profile if hemarthrosis suspected
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Internal Medicine By Doha Rawag
Most common findings in clinical exam By Dr Doha Ali Rawag.pdf
ุจุงู‚ูŠ ุงุณุฆู„ุฉ ุงู„ Disscussion ุงู‚ุฑูˆู‡ุง ู…ู† ุดูŠุชูŠ most common findings in clinical exam

ุจุงู„ุชูˆููŠู‚ ูˆ ุงู„ุณุฏุงุฏ ู„ู„ุฌู…ูŠุน ๐Ÿคฒ๐Ÿค
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ุงู„ุดูŠุชุงุช ู…ุชูˆูุฑุงุช ููŠ ู…ุตูˆุฑ ุงู„ูˆุงุถุญโœจ๏ธ
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ุงู„ุณู„ุงู… ุนู„ูŠูƒู… ูˆุฑุญู…ุฉ ุงู„ู„ู‡ ูˆุจุฑูƒุงุชู‡ ๐Ÿค

ู…ุชูˆูุฑ ุงู„ุดูŠุชุงุช ุงู„ุฌุฏุฏ ู„ู€ ุฏ. ุถุญู‰

‏Clinical Medicine
‏The Most Common Findings in Clinical ExamุŒ

ุงู„ู„ูŠ ุงุณุชูุงุฏูˆุง ู…ู†ู‡ ุจูุถู„ ุงู„ู„ู‡ ุฏูุนุงุช ุณุงุจู‚ุฉ ูˆุณู‡ู‘ู„ ุนู„ูŠู‡ู… ุงู…ุชุญุงู† ุงู„ูƒู„ูŠู†ูƒ. ๐Ÿฉบ

ุงู„ุดูŠุช ู…ุฑุชุจ ุจุทุฑูŠู‚ุฉ ู…ุจุณุทุฉุŒ ุดุงู…ู„ ุฃู‡ู… ุงู„ู€findings ุงู„ู…ุทู„ูˆุจุฉ ู„ุทู„ุงุจ ุงู„ุณู†ุฉ ุงู„ุฎุงู…ุณุฉุŒ ู…ุน DD ูˆInvestigations ุงู„ู…ุฑุชุจุทุฉ ุจู‡ุง. ๐Ÿ“

ู…ูˆูู‚ูŠู† ุฌู…ูŠุนุงู‹ุŒ ูˆู„ุง ุชู†ุณูˆู‡ุง ู…ู† ุฏุนูˆุงุชูƒู…. ๐Ÿค

https://t.me/IntMedByDoha
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ุงู„ุณู„ุงู… ุนู„ูŠูƒู… ุฏูƒุงุชุฑุฉ โœจ๏ธ

ุงู„ู„ูŠ ูŠุจูŠ ูŠู…ุดูŠ ูŠุฑุงุฌุน ููŠ ุงู„ุทุจูŠ ุŒ ูŠูƒู„ู…ู†ูŠ ุนุงู„ุฎุงุต ู†ู‚ูˆู„ู‡ ุนู„ู‰ ุงู„ุญุงู„ุงุช ุงู„ู„ูŠ ุนู†ุฏู‡ู… findings

ุฑุจูŠ ูŠูุชุญ ุนู„ูŠูƒู… ูˆ ูŠูˆูู‚ูƒู… .๐Ÿคฒ๐ŸŒธ
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‏๏ดฟุจููŠูŽุฏููƒูŽ ุงู„ุฎูŽูŠุฑู ุฅูู†ูŽู‘ูƒูŽ ุนูŽู„ู‰ ูƒูู„ูู‘ ุดูŽูŠุกู ู‚ูŽุฏูŠุฑูŒ๏ดพ.


‏ููˆูู‘ุถ ุฃู…ุฑูƒ ู„ู„ู‡, ูˆุฃู†ุช ู…ูุทู…ุฆู† ูˆุชูˆูƒูŽู‘ู„ ุนู„ูŠู‡ ูˆู…ู† ุชูˆูƒูŽู‘ู„ ุนู„ู‰ ุงู„ู„ู‡, ู„ุง ูŠูุบู„ุจ ูˆู…ู† ุงุนุชุตู… ุจุงู„ู„ู‡ ู„ุงูŠูู‡ุฒู… ูˆุชุฐูƒูŽู‘ุฑ ุฃู†ูŽู‘ ุนุทุงุก ุงู„ู„ู‡ ู„ุง ุญุฏูŽู‘ ู„ู‡ ูˆู„ุง ู…ู†ุชู‡ู‰.๐Ÿค

ูƒู„ ุงู„ุชูˆููŠู‚ ู„ู‚ุฑูˆุจ ุงู„ูŠูˆู…๐Ÿฉบโœจ๏ธ
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‏ุงู„ู„ู‡ูู…ูŽู‘ ุฅู†ู‘ุง ู†ุณุฃู„ูƒ ุตุจุงุญู‹ุง ูŠุชุฌู„ู‘ู‰ ููŠู‡ ู„ุทููƒุŒ ูˆูŠุชุณุน ููŠู‡ ุฑุฒู‚ูƒุŒ ูˆุชู…ุชุฏ ููŠู‡ ุนุงููŠุชูƒุŒ ูˆู†ุณุชูุชุญ ููŠู‡ ุจุฑุญู…ุชูƒุŒ ูˆูŠูุญูŠุทู†ุง ููŠู‡ ุญูุธูƒ.๐Ÿฉต๐Ÿค

ุจุงู„ุชูˆููŠู‚ ู‚ุฑูˆุจ ุงู„ูŠูˆู…๐Ÿ™๐Ÿฉบ
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ุงู„ุญู…ุฏ ู„ู„ู‡ ูˆ ุนู‚ุจุงู„ ู‚ุฑูˆุจ ุบุฏูˆุง ุŒ ุชูˆูƒู„ูˆุง ุนู„ู‰ ุฑุจูŠ ูˆ ุชูุฃู„ูˆุง ูˆ ุดุฏูˆุง ุงู„ู‡ู…ุฉ๐Ÿ’•๐Ÿ’ช
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