طبعًا السالفة بيها تفاصيل أكثر؛ أكو تقريبًا 57 إنزيم ضمن الـ cytochrome system بس عدنا منهن 6 كلش مهمات، لأنهن مسؤولات عن أيض العديد من الأدوية، وكل إنزيم من ذني الـ 6 يتأثر بعدة أدوية ومواد كيميائية، قسم منها يحفزنّه inducers، قسم يثبطنّه inhibitors، وقسم هنّ ركائز substrates يشتغل عليهن الإنزيم.

The 6 most essential CYP450 enzymes with their inducers, inhibitors, and substrates.

The coagulation cascade is intricate and cross-linked that it's better to call it the coagulation network, since it doesn't proceed like a cascade from point A to point B, rather, point A affects both points B and C which subsequently affect point A,... etc.

Cell formation in the bone marrow

This book is elegantly simplistic and integrative

When examining the patient with Broca’s aphasia, the patient often feels frustrated, while when examining the patient with Wernicke’s aphasia, the examiner may feel frustrated.

Other names are sometimes used to refer to Broca’s aphasia and Wernicke’s aphasia, respectively, including expressive and receptive aphasias, motor and sensory aphasias, anterior and posterior aphasias, and nonfluent and fluent aphasias. However, these terms each have drawbacks. For example, Broca’s aphasia is not simply an expressive deficit, since comprehension of syntactically dependent structures is impaired. Conversely, Wernicke’s aphasia is not simply a receptive deficit, since speech expression is highly paraphasic and largely uninterpretable. Similarly, although Broca’s and Wernicke’s aphasias are usually caused by anterior and posterior lesions, respectively, this is not always the case. The simple syndromic names Broca’s aphasia and Wernicke’s aphasia are preferable.

When examining patients with aphasia, recall that neurologic deficits are not all-or-none phenomena. In addition to deciding on the absence or presence of a deficit such as decreased fluency or impaired comprehension, it is important to assess the deficit’s severity. This assessment can help both to clarify the diagnosis and to track the clinical progression of the disorder. For example, consider a patient with normal fluency who can comprehend and repeat simple phrases but who has difficulty comprehending and repeating more complex phrases and has occasional paraphasic errors. Despite the fact that some comprehension is present, this patient would be considered to have Wernicke’s aphasia, but in a relatively mild form.

Approach to Jaundice Investigations

The initial step in investigating jaundice is determining which type of bilirubin is elevated: indirect (unconjugated), direct (conjugated), or sometimes both. This guides you toward identifying the underlying cause.

1. Indirect Bilirubin Elevation
• Prehepatic Causes:
Focus on hemolysis or other hematological disorders. Look for signs and symptoms of hemolytic anemia (e.g., pallor, fatigue, splenomegaly, or increased reticulocyte count).
• Intrahepatic Causes:
Consider Gilbert syndrome or other metabolic defects affecting bilirubin conjugation. These often present with mild, intermittent jaundice triggered by stress, fasting, or illness.

2. Direct Bilirubin Elevation
• Bile Duct Obstruction:
• Determine if the obstruction is intrahepatic or extrahepatic.
• Elevated ALP and GGT typically suggest a biliary cause. Imaging (e.g., ultrasound, MRCP) can help confirm obstruction and locate its origin (e.g., stones, strictures, or tumors).
• Hepatocellular Causes:
• Conditions like hepatitis, cirrhosis, or toxic liver injury damage hepatocytes and impair bile excretion.
• Elevated AST and ALT levels are more indicative of hepatocyte injury.
• All LFTs Normal:
If liver function tests are normal, consider rare metabolic conditions like Dubin-Johnson syndrome or Rotor syndrome that cause conjugated hyperbilirubinemia without significant liver damage.

من الملاحظات المهمة الي لازم تخليها على بالك، و ممكن تنساها بظل لوود الطوارىء التعيس للأسف.

old age male, with hx of COPD, presented with severe SOB for the last 2 days.

O/E:
diminshed air entry all over the chest, absent bi-basally, and expiratory wheeze.

دزينه CXR، و مثل متشوفون:
microcardia
bilatered oblitered costophrenic angle with wavy like borders
bilateral (mainly on the right) basal loss of bronchovascular marking

ممكن اول شي يجي ع بالك pneumothorax، تفكير صحيح، بس ميمشي وي الكيس هذا:
1. pneumo usually sited superiorly not basally.
2. pneumo always has homogenous translucency
و لو تلاحظون بال right side اكو اختلاف بال density.
3. pneumo usually has white line sign

فهذا الكيس
multiple giant bullae

ما احجيلك اذا تورطت و استعجلت و خليت chest tube شنو ممكن راح يصير
الي راح يصير
pleuro-pulmonary fistula
ما راح تطلع منها الا بـ
partial pneumonectomy

اتمنى متنسون هالكيس.

Important notes to be remembered and applied in real practical life.

AOM

Acute mastoiditis