•What is erythema nodosum?
-It is an inflammatory disorder characterized by non-suppurative, painful, palpable, tender, erythematous nodular lesion in the skin, common in shin below the knee.
#Infections
-It is an inflammatory disorder characterized by non-suppurative, painful, palpable, tender, erythematous nodular lesion in the skin, common in shin below the knee.
#Infections
•Causes of Erythema nodosum:
-Acute sarcoidosis
-S.β-hemolyticus (in throat)
-Primary pulmonary T.B.
-Drugs (sulfonamide, penicillin, estrogen-containing OCP, salicylates, barbiturates, sulfonylureas, bromides and iodides)
-IBD (Crohn’s disease, UC)
-Fungal infections (histoplasmosis, coccidioidomycosis and blastomycosis)
-Protozoal (toxoplasmosis)
-Leprosy (erythema nodosum leprosum (ENL)
-Idiopathic (up to 50% cases)
-Physiological: Pregnancy (often unilateral).
-Others: Salmonella, Shigella, Yersinia, brucellosis, Chlamydia, rickettsial and mycoplasma infection, viral infection, lymphoma, cat-scratch disease, Behçet’s syndrome and SLE.
#Infections
-Acute sarcoidosis
-S.β-hemolyticus (in throat)
-Primary pulmonary T.B.
-Drugs (sulfonamide, penicillin, estrogen-containing OCP, salicylates, barbiturates, sulfonylureas, bromides and iodides)
-IBD (Crohn’s disease, UC)
-Fungal infections (histoplasmosis, coccidioidomycosis and blastomycosis)
-Protozoal (toxoplasmosis)
-Leprosy (erythema nodosum leprosum (ENL)
-Idiopathic (up to 50% cases)
-Physiological: Pregnancy (often unilateral).
-Others: Salmonella, Shigella, Yersinia, brucellosis, Chlamydia, rickettsial and mycoplasma infection, viral infection, lymphoma, cat-scratch disease, Behçet’s syndrome and SLE.
#Infections
Causes of postural hypotension:
-Drop of systolic blood pressure 20 mmHg &drop of diastolic blood pressure 10 mmHg on standing.
1. Hypovolemia-dehydration, bleeding, hypopituitarism
2. Addisons
3. Neuropathy-autonomic as in DM, Amyloidosis, Shy-drager syndrome
4. Drugs-nitrates, antihypertensive, TCA, antipsychotic, diuretics
5. Idiopathic orthostatic hypotension-progressive degeneration of the autonomic nervous system usually in elderly.
#Cardiology
-Drop of systolic blood pressure 20 mmHg &drop of diastolic blood pressure 10 mmHg on standing.
1. Hypovolemia-dehydration, bleeding, hypopituitarism
2. Addisons
3. Neuropathy-autonomic as in DM, Amyloidosis, Shy-drager syndrome
4. Drugs-nitrates, antihypertensive, TCA, antipsychotic, diuretics
5. Idiopathic orthostatic hypotension-progressive degeneration of the autonomic nervous system usually in elderly.
#Cardiology
Liver cirrhosis
-In the micronodular form, the nodules are less than 3 mm across with uniform liver involvement - seen in alcohol or biliary disease.
-In the macronodular form there are larger nodules, classically seen in chronic viral hepatitis.
#Liver
-In the micronodular form, the nodules are less than 3 mm across with uniform liver involvement - seen in alcohol or biliary disease.
-In the macronodular form there are larger nodules, classically seen in chronic viral hepatitis.
#Liver
How is the appetite in Kala-azar?
-Usually good.
Remember:
-Usually no anorexia, no malaise, no coated tongue.
#Infections
-Usually good.
Remember:
-Usually no anorexia, no malaise, no coated tongue.
#Infections
•Leishmania has two forms:
amastigote and promastigote.
-Amastigote form "oval" is found in human, LD body is found in monocyte macrophage system. It's the diagnostic stage.
-Promastigote form (flagellate) is found in sandfly, and in culture media.It's the infective stage.
#Infections
amastigote and promastigote.
-Amastigote form "oval" is found in human, LD body is found in monocyte macrophage system. It's the diagnostic stage.
-Promastigote form (flagellate) is found in sandfly, and in culture media.It's the infective stage.
#Infections
In Kala-azar:
•Detection of antigen—done by latex agglutination test (Katex) for detecting leishmanial antigen in urine.
-This test is very simple ,more specific than antibody-based test, highly sensitive (96%) and also specific(100%)
-This test indicates active disease.
-The antigen is detected in urine within a week, disappears from urine within 3 weeks following successful treatment.
-Hence, this test is helpful for early diagnosis and also to see the response to therapy.
#Infections
•Detection of antigen—done by latex agglutination test (Katex) for detecting leishmanial antigen in urine.
-This test is very simple ,more specific than antibody-based test, highly sensitive (96%) and also specific(100%)
-This test indicates active disease.
-The antigen is detected in urine within a week, disappears from urine within 3 weeks following successful treatment.
-Hence, this test is helpful for early diagnosis and also to see the response to therapy.
#Infections
•What are the complications of kala-azar?
1-Secondary infection (pneumonia, tuberculosis)
2-Anemia
3-Bleeding
4-Gastroenteritis, bacillary dysentery
5-Liver disease (cirrhosis of liver)
6-PKDL
7-Rarely, cancrum oris.
#Infections
1-Secondary infection (pneumonia, tuberculosis)
2-Anemia
3-Bleeding
4-Gastroenteritis, bacillary dysentery
5-Liver disease (cirrhosis of liver)
6-PKDL
7-Rarely, cancrum oris.
#Infections
-Painless terminal haematuria is usually the first and most common symptom in chronic S. haematobium infection.
-There is association of S. haematobium infection with squamous cell carcinoma of the bladder.
-Both S.haematobium and S.mansoni cause Pulmonary HTN, but only S.mansoni causes Portal HTN.
#Infections
-There is association of S. haematobium infection with squamous cell carcinoma of the bladder.
-Both S.haematobium and S.mansoni cause Pulmonary HTN, but only S.mansoni causes Portal HTN.
#Infections
In PUD:
-Breath tests or faecal antigen tests are best because of accuracy, simplicity and non-invasiveness.
#Stomach
-Breath tests or faecal antigen tests are best because of accuracy, simplicity and non-invasiveness.
#Stomach
•Sepsis:
-It is a severe, life-threatening condition that results from a dysregulation of the patient's response to an infection, causing tissue and organ damage and subsequent organ dysfunction.
•Septic shock:
-It is a sepsis syndrome accompanied by circulatory and metabolic abnormalities that can significantly increase mortality .
Diagnostic criteria:
-Persistent hypotension: Vasopressors are required to maintain mean arterial pressure(MAP) ≥ 65 mm Hg.
-Persistent lactic acidosis: lactate > 2 mmol/L(18 mg/dL) despite adequate fluid resuscitation.
#Surgery
#Medicine
-It is a severe, life-threatening condition that results from a dysregulation of the patient's response to an infection, causing tissue and organ damage and subsequent organ dysfunction.
•Septic shock:
-It is a sepsis syndrome accompanied by circulatory and metabolic abnormalities that can significantly increase mortality .
Diagnostic criteria:
-Persistent hypotension: Vasopressors are required to maintain mean arterial pressure(MAP) ≥ 65 mm Hg.
-Persistent lactic acidosis: lactate > 2 mmol/L(18 mg/dL) despite adequate fluid resuscitation.
#Surgery
#Medicine
Systemic inflammatory response syndrome (SIRS) :
-a group of physiological and immune-mediated reactions that are triggered in response to an infectious or noninfectious insult (e.g., an acute inflammatory process or trauma) .
•SIRS is diagnosed if ≥ 2 of the following 4 criteriaare fulfilled:
-Temperature: > 38°C or < 36°C
-Heart rate: > 90/min
-Respiratory rate: > 20/min or PaCO2 < 32 mm Hg
-White blood cell count: > 12,000 mm3, < 4000/mm3, and/or > 10% band cells.
#Infections
-a group of physiological and immune-mediated reactions that are triggered in response to an infectious or noninfectious insult (e.g., an acute inflammatory process or trauma) .
•SIRS is diagnosed if ≥ 2 of the following 4 criteriaare fulfilled:
-Temperature: > 38°C or < 36°C
-Heart rate: > 90/min
-Respiratory rate: > 20/min or PaCO2 < 32 mm Hg
-White blood cell count: > 12,000 mm3, < 4000/mm3, and/or > 10% band cells.
#Infections
Antiplatelet Drug Mechanisms:
Aspirin = Inhibit COX-1/2 (↓thromboxane A2)
Dipyridamole/Cilostazole/Pentoxyphylline =
Inhibit PDE->↑cAMP
Clopidogrel/ticlopidine/Prasugrel/Ticagrelor/Cangrelor= Inhibit ADP receptor P2Y12
Abciximab/Eptifibatide/Tirofiban = Inhibit GPIIb/IIIa.
#Cardiology
Aspirin = Inhibit COX-1/2 (↓thromboxane A2)
Dipyridamole/Cilostazole/Pentoxyphylline =
Inhibit PDE->↑cAMP
Clopidogrel/ticlopidine/Prasugrel/Ticagrelor/Cangrelor= Inhibit ADP receptor P2Y12
Abciximab/Eptifibatide/Tirofiban = Inhibit GPIIb/IIIa.
#Cardiology
-Anti CCP antibodies are the most specific blood test for rheumatoid arthritis.
It correlate with disease activity but RF dosen't
#Rheumatology
It correlate with disease activity but RF dosen't
#Rheumatology
-Gold standard test for early Diabetic retinopathy is Fluorescein Angiography.
-Microaneurysm in Fluorescein Angiography is the earliest sign of Diabetic retinopathy.
-MRCP
#Endocrine
-Microaneurysm in Fluorescein Angiography is the earliest sign of Diabetic retinopathy.
-MRCP
#Endocrine
-Hyperthyroidism during pregnancy can present as hyperemesis gravidarum or as thyroid storm.
-Always check the TFTs.
-These women usually need urgent admission to hospital.
#Thyroid
-Always check the TFTs.
-These women usually need urgent admission to hospital.
#Thyroid
Remember:
-Any assymetrical neurological deficit , occuring at different time, zones , think of Multiple sclerosis.
#Neurology
-Any assymetrical neurological deficit , occuring at different time, zones , think of Multiple sclerosis.
#Neurology
SARS-CoV-2 variants:
Alpha (B1.1.7)
Beta (B1.351)
Gama (P. 1)
Delta (B.1.617.2)
Omicron (B.1.1.529)
#Infections
Alpha (B1.1.7)
Beta (B1.351)
Gama (P. 1)
Delta (B.1.617.2)
Omicron (B.1.1.529)
#Infections
•NAAT (RT-PCR) is the gold standard for detecting active SARS-CoV-2 infection.
•Delta or Omicron variants of COVID-19 often manifest with milder symptoms (e.g., headache,rhinitis, fever, and sore throat) compared to prior strains.
#Infections
•Delta or Omicron variants of COVID-19 often manifest with milder symptoms (e.g., headache,rhinitis, fever, and sore throat) compared to prior strains.
#Infections
Remember:
-Appendicectomy is protective of ulcerative colitis, but may increase the risk of Crohn’s disease or may result in more aggressive disease.
#GIT
-Appendicectomy is protective of ulcerative colitis, but may increase the risk of Crohn’s disease or may result in more aggressive disease.
#GIT