•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

Important for MCQ, Clinical and discussion.

In PUD:

-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

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

-Anti CCP antibodies are the most specific blood test for rheumatoid arthritis.
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

-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

Remember:

-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

•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

Remember:

-Appendicectomy is protective of ulcerative colitis, but may increase the risk of Crohn’s disease or may result in more aggressive disease.

#GIT

What are the complications of Crohn’s disease?

1-Intestinal obstruction
2-Enteric fistula to bladder or vagina
3-Abscess formation
4-Perianal disease (fissure, skin tag, fistula, perianal abscess, hemorrhoid)
5-Carcinoma (rare, may occur if Crohn’s disease involves the colon)
6-Toxic dilatation of the colon (more common in ulcerative colitis) 7-Malabsorption syndrome.

#GIT

•How to assess the activity of Crohn’s disease?

Signs of activity are:
1. Clinical:
•Eye signs—episcleritis, conjunctivitis and iritis
•Mouth—aphthous ulcer
•Skin—erythema nodosum and pyoderma gangrenosum
•Arthralgia of large joints
•Fatty liver or liver abscess or portal pyemia
•Mesenteric or portal vein thrombosis
•Venous thrombosis (in other veins).

2. Morphology—by radiological or endoscopy

3. Laboratory:
•Low albumin (due to protein losing enteropathy)
•High ESR
•High C-reactive protein (CRP).

4. Scanning with white cell labelled with 111Indium or 99mTc to locate active site.

#GIT

•What are the extra-intestinal manifestations of Crohn’s disease?

•Eyes—conjunctivitis, episcleritis, uveitis or iritis.
•Mouth—aphthous ulcer and thickened lip.
•Skin—erythema nodosum, pyoderma gangrenosum or fistula in abdominal wall.
•Bones and joints—acute peripheral arthritis (occurs in 15 to 20%, related to active disease, treatment of Crohn’s disease improves the condition. In severe case, even colectomy improves arthritis). Sometimes, ankylosing spondylitis or sacroiliitis and clubbing may also occur.
•Perianal region—perianal fistula, skin tag and abscess.
•Liver or hepatobiliary—fatty liver, pericholangitis, sclerosing cholangitis (common in ulcerative colitis), autoimmune hepatitis, cirrhosis of liver, granuloma, liver abscess or portal pyemia, gall stone and cholangiocarcinoma.

#GIT

In new Update:

-The most common cause of death in GBS is cardiac arrhythmias.

#Neurology

Remember

-Morphine is avoided in acute abdominal pain in Addison’s disease, as the patient is more sensitive to this drug.

#Endocrine