Meningococcal purpura

De musset's sign: head nodding.

Corrigan's sign: Suprasternal notch pulsation ( large volume pulse)

*This is a condition of aortic regurgitation

The first sign was noticed in the French poet "Alfred de Musset" by his brother,
He had syphilitic aortitis which is one of the causes of AR.

مرضى الربو الي يستعملون inhaled glucocorticoids يُنصحون انو بعد ال inhaler يمضمضون بمي ويذبوا( rinse and spit ) بهذه الطريقة ينظفون الفم من بقايا ال inhaler لأن استعمال ال steroid فترة طويلة يعرضهم لـ oropharangeal candiasis

This x-ray showing bilateral pulmonary infiltrate
DDX:
cardiac pulmonary oedema
Non cardiac pulmonary oedema ( ARDS)
Acute eosinophilic pneumonia

With clinical contexts and doing Echo for the heart we can exclude the 1st diagnosis in case of normal LV.

By doing Bronchoalveolar lavage (BAL) with bronchoscopy we can exclude the 3rd one in case there’s no raise in eosinophilia above 25%.

With other contexts: like patient is a young with recent sepsis or trauma, aspirated or any other causes of ARDS .. we can confirm the ARDS.

3 lifesaving ARDS tips :
1- apply mechanical ventilation for all your patients.
2- Give steroid:
”dexamethasone 20 mg/day followed by 10 mg/day”
3- Prone positioning.

بإختصار:
Any patient who diagnosed with IE due to streptococcus bovis should be sent for colonoscopy because this bacteria is usually associated with colonic carcinoma.

Raised ALP & GGT indicate obstructive jaundice.
While raised ALT is indicative of hepatocellular damage.

Courvoisier's sign:
A painless palpably enlarged gallbladder accompanied with mild jaundice is unlikely to be caused by gallstones. It's more likely to be caused by a malignancy at the head of the pancreas.

The condition is painless because it's chronic and the gallbladder is distended and obstructed in a gradual manner due to the malignant growth. This is in contrast with the sudden onset of painful gallstones.

+ لازم أتذكر أسولف عن:
SIADH & meningitis
+ Cerebral Salt-Wasting (CSW) syndrome

بس ورة النسائية...

Helpful tips:

🐈‍⬛ AST/ALT > 2 = alcoholic liver

🐈‍⬛ AST/ALT > 5 = rhabdomyolysis or MI

🐈‍⬛ ALP levels are also raised in conditions associated with increased bone turnover or bone loss (e.g.: Paget’s disease, bone metastases)

🐈‍⬛ Low ALP is characteristically observed in Wilson disease

Everyone, say hi to Murtadha 🍻

A 67-year-old man
- history of vague abdominal discomfort on the right side, intermittent diarrhea

- episodes of facial flushing every 2 to 3 days

- no history of ingestion of alcohol or other precipitants of flushing

- recent echocardiogram showed trace tricuspid regurgitation.

Suspected Carcinoid tumor

To confirm the dx: CT abdomen was done and there was a mass in the midgut in addition to liver lesion which guided to a biopsy that revealed a well-differentiated neuroendocrine tumor.