•Causes of flapping tremor:

1-Hepatic encephalopathy (the commonest cause)
2-Severe cardiac failure
3-Respiratory failure
4-Renal failure
5-Other causes (rare) cerebrovascular accident (CVA), drug toxicity (phenytoin and barbiturate), acute focal parietal or thalamic lesion (vascular) and hypoglycemia.

#Neurology

Mechanism of flapping tremor in CLD:

-It is due to impaired inflow of joint position sense and other afferent informations to the brainstem reticular formation, resulting in rhythmical lapse of postural muscle tone.

#Neurology
#Liver

Causes of Dupuytren’s contracture:

1-Cirrhosis of liver (commonly alcoholic)
2-Alcoholism (itself, not by cirrhosis)
3-Prolonged antiepileptic drug (phenytoin)
4-Manual worker (gardener) and chronic vibration injury
5-Traumatic
6-Familial:
(as autosomal dominant, associated with Garrod’s patch on dorsum of hand)
7-Diabetes mellitus:
(diabetic cheiroarthropathy, confuses with systemic sclerosis)
8-Peyronie’s disease
9-Idiopathic (in many cases).

#General
#Plastic

What are the causes of granuloma in liver?

1-PBC
2-Tuberculosis
3-Sarcoidosis
4-Brucellosis
5-Parasitic (strongyloidiasis)
6-Schistosomiasis
7-Drug (phenylbutazone).

#Liver

•Pickwickian syndrome:

-It's called Obesity hypoventilation syndrome.
-Sleep-related hypoventilation disorder
-BMI of ≥ 30 kg/m2 Obesity
-Daytime sleeping.

#Respiratory

GN's in which the COMPLEMENT is low:

1-Lupus nephritis
2-IE
3-Post-infectious GN
4-Cryoglobulinemia
5-HSP
6-MPGN.

Normal complement:
Anti-GBM
1-Good pasture syndrome
2-Anti-GBM renal disease.

#Renal

•What are the reversible conditions in obesity?

-Hypothyroidism
-Cushing’s syndrome
-Insulinoma
-Hypothalamic disorder.

#Endocrine

•Alström syndrome (AS), also called Alström–Hallgren syndrome

-It is a very rare autosomal recessive genetic disorder characterised by childhood obesity and multiple organ dysfunction.
-Symptoms include early-onset type 2 diabetes, cone-rod dystrophy resulting in blindness, sensorineural hearing loss and dilated cardiomyopathy.
-Hypergonadotrophic hypogonadism and hypothyroidism.
-Acanthosis nigricans resulting from hyperinsulinemia.

#Endocrine

Remember:

-Drugs causing pedal edema: nifedipine, amlodipine.

#Cardiology

Remember:

-Weakness with preserved reflex: Myotonia dystrophica, also myasthenia.

-Weakness with loss of reflex: Neuropathy, also in case of myopathy, lower motor neuron lesion

-Weakness with exaggerated reflex: Upper motor neuron lesion (MND, typically in amyotrophic lateral sclerosis).

#Neurology

Remember:

-Neuropathy is associated with distal muscular weakness, except diabetic amyotrophy (that involves the proximal muscles).

-Myopathy is associated with proximal muscular weakness, except myotonia dystrophica that involves distal muscles.

#Neurology

•Arthritis with deformity (deforming polyarthritis):

-Rheumatoid arthritis
-Seronegative spondyloarthropathy
-Chronic tophaceous gout
-Primary generalized osteoarthritis
-Infection – Lyme disease.

#Rheumatology

Pattern of joint involvement:

-Distal interphalangeal joint (DIP) is involved in OA, psoriatic arthritis and gout.
-Proximal interphalangeal joint (PIP) and metacarpophalangeal joints (MCP) are involved in rheumatoid arthritis.
-First metatarsophalangeal (MTP) is involved in gout.
-Sacroiliac (SI) joint is involved in ankylosing spondylitis.
-Knee joint is involved in OA.
-Bilateral symmetrical joint involvement— RA
-Asymmetrical joint involvement (also usually bigger joints)—seronegative arthritis.
-Pain increased with activity, relieved by rest—mechanical arthritis.
-Pain worse with rest, improved by activity—inflammatory arthritis.
-Morning stiffness for more than 1 hour, relieved by activity indicates RA.
-Fleeting arthritis—Rheumatic fever, gonococcal arthritis, others (SLE, Lyme arthritis, meningococcal arthritis, drug reaction or serum sickness, IBD, Whipple’s disease).


#Rheumatology

Differential diagnoses of Nephrotic Syndrome:

1-Acute glomerulonephritis
2-Congestive cardiac failure
3-Cirrhosis of the liver
4-Hypoproteinemia due to malnutrition or malabsorption.

#Renal

Complications of Nephrotic syndrome:
In addition to doctor's lecture:

-Hyperlipidemia leading to atherosclerosis.
-Oliguric renal failure.
-May cause bilateral pleural effusion, pericardial effusion.
-Loss of thyroxin binding globulin, that causes low FT3 and FT4 which leads to hypothyroidism.
-Loss of transferrin and iron, resulting in iron deficiency anemia.
-Loss of vitamin D binding protein, leading to osteomalacia.

#Renal

•Causes of puffy face:

-Renal cause nephrotic syndrome, acute GN
-Myxedema
-Cushing’s syndrome
-SVC obstruction
-Angioneurotic edema
-Hypoproteinemia
-Congestive cardiac failure in advanced stage
-Alcoholism
-Acromegaly.

#Renal