Remember:

Campylobacter jejuni: campylobacter enteritis is the most common disease associated with GBS.

Cytomegalovirus: most common virus associated with GBS.

#Neurology

In GBS

-Albuminocytologic dissociation, characterized by elevated protein levels and normal cell counts in cerebrospinal fluid (CSF), is a hallmark finding of GBS.

#Neurology

Remember:

It's simple, just believe in your abilities.

Quick Summary in Pediatric History Taking

▪️Personal History:
1-Name, age and gender.
2-Residence, e.g. from Dhamar and lives there.
3-Number or order among his siblings.
4-Date of admission and through what.
-May be as OPC or ED or as a referable case from a private clinic or hospital.
5-Source of the information or the informant.

💬Example, Comment:
-A 6 month old male infant, Ali Saleh Ahmad, from Jahran and lives in Maaber city. He is the 3rd kid in his siblings.
-DOA: The patient was admitted to hospital on Wednesday in the 1st of December, 2022 through ED at 7:00 a.m. Or say: the patient was admitted one day ago..etc
-The informant is the infant's mother.
-The date of history taking is in 2-12-2022 on Thursday.


▪️Chief complaint:
-As usual with duration, can be three.

💬Example:
-The patient was suffering from Cough and Fever 2 days prior to admission and difficulty of breathing 1 day before admission.
Or " better"
-Fever,Cough 2 days
-Difficulty of breathing 1 day.

▪️History of present illness:
1-Last time when the patient was healthy.
-If the patient is less than 3 year-old you say the patient started suffering ,but if more you can say started complaining.
2-The first symptom that appeared .
3-Analysis of the each complaint.
4-Associated symptoms with analysis.
5-Significant review of other symptoms to support your Dx & narrow your differential diagnosis or to look up for complications.

💬Example:
-The patient was quite well till 2 days back when he started suffering from fever which was gradual in onset, low grade, intermittent in course, 3- 4 times /day each one remains 1-2 h, relieving by medication and cold fomentations or pads. No aggravating factors, interfering with patient's sleep. Not documented "يعني ما قاستها الأم"
-Associated with Cough which was gradual, with progressive course 2 days duration, aggravated in cold weather, no relieving factors, not productive interfering with infant's sleep. Not related to position. Yesterday the fever became high grade or increased in severity according to mother saying, continous, not relieved by medication and cold fomentations. The cough became productive with small amount sputum white color, no blood. Also the patient suffered from difficulty of breathing, gradual in onset, 1 day duration, progressive in course, no relieving or aggravating factors and it's interfering with sleep.
-There's no history of noisy respiration, no cyanosis, no sweating, .. etc
-Systemic review:
Including general and systemic:
Should write them especially the important symptoms related to the case in each system even when negative.
Note:
-You should ask and comment on hospital stay, like investigations done, procedures performed, treatment given and if new symptoms developed, and the current condition of the patient.

-Note:
بعض الدكاترة مثل الشهاري مايعجبه تقول: The baby was well،تكتب رأساً :
The condition started as...etc
▪️Past History:
-Like any history, including drug and trauma hx.

▪️Perinatal History:
-هذا تذكره لوكان أقل من سنتين،و كذلك لو كانت الحالة Neurological مثل CP أو Endocrine في أي عمر.
▫️Prenatal or Antenatal hx:
- Mother age at pregnancy.
-Antenatal Care : antenatal Visits , Folic acid supplementation.
-History of fever and rash and if present ask about the trimester.
-يهمنا لوفي TORCH infections خصوصاً في الشهور الأولى تسوي congenital diseases.
-History of maternal diseases during pregnancy such DM, PIH..etc
وكذلك لو معهDM؛ لأنه قد يسوي CHD.
-History of drug intake and ask if she knows the name, it may be teratogenic.
-History of maternal exposure to radiation, teratogenic.
-History of tetanus vaccination "important to know the doses".

💬Example:
-The mother is Para 3 plus 0 and her age at pregnancy was 26 year-old.
-Regular antenatal care, a visit per month, had folic acid and iron supplementation.
-No history of fever and rash, no history of maternal diseases during pregnancy like DM or HTN, no history of drug intake apart from some vitamins and the above mentioned supplements. No hx of exposure to radiation. No history of tetanus vaccination.

This is a brief explanation of history with comments.

Do not forget etiological history, for example in case of seizures, you should exclude febrile seizures, meningitis, metabolic disturbances such as tetany ask about Rickets, also hypoglycemia ask about a history of DM, and so on in each case to make a typical brilliant history.

Remember:

-Malabsorption symptoms + macrocytosis in young patient👉🏼 coeliac disease.

-Malabsorption symptoms + improve with control of diary intake + negative endomyseal Abs👉🏼Lactose intolerance .

-Malabsorption + joint pain + Bradycardia in middle age👉🏼 Whipple's disease ( positive PAS biopsy).

-Malabsorption + macrocytosis + negative endomyseal Abs and normal IgA👉🏼 think in tropical sprue .

-Malabsorption + recurrent epigastric pain to back + positive fecal elastase 👉🏼 chronic pancreatitis .

-Malabsorption + symptoms of bronchiectasis 👉🏼 cystic fibrosis.

-MRCP
#GIT

•Factors suggesting a malignant diagnosis of a thyroid nodule:

-Age younger than 20 years or older than 70 years
-Male sex
-Associated symptoms of dysphagia or dysphonia
-History of neck irradiation
-Prior history of thyroid carcinoma
-Firm, hard, or immobile nodule, cervical lymphadenopathy.

#Surgery

•Causes of hypertension with hypokalaemia:

-Conn's syndrome
-Liddles syndrome
-Cushing syndrome
-Renal artery stenosis
-11 beta hydroxylaze defeciency
-Over diuretics in hypertensive patient
-Excessive liqour intake by hypertensive patient.

-MRCP
#Medicine

Remember:

-There may be asymmetrical enlargement of the uterus if there is lateral implantation.
-This is called Piskacek’s sign where one half is more firm than the other half.

#Obs_Gyne

Remember:

Goodell’s sign:
-Cervix becomes soft as early as 6th week of pregnancy, a little earlier in multiparae.

#Obs_Gyne

Remember:

Osiander’s sign:
-There is increased pulsation, felt through the lateral fornices at 8th week of pregnancy.

#Obs_Gyne

Remember:

Jacquemier’s or Chadwick’s sign:
-It is the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy.
-The discoloration is due to local vascular congestion.

Remember:

-Fetal heart sound (FHS) is the most conclusive clinical sign of pregnancy.

-With an ordinary stethoscope, it can be detected between 18–20 weeks.

-The sounds resemble the tick of a watch under a pillow.

-Its location varies with the position of the fetus.

-The rate varies from 110–160 beats per minute.

#Obs_Gyne

Remember:

-Active fetal movements can be felt at intervals by placing the hand over the uterus as early as 20th week.

#Obs_Gyne

Palpation of fetal parts can be felt distinctly by 20th week.

-The findings are of value not only to diagnose pregnancy but also to identify the presentation and position of the fetus in later weeks.

#Obs_Gyne

Remember:

-FHS may not be audible in cases of maternal obesity, polyhydramnios, occipitoposterior position and certainly IUD.

#Obs_Gyne

Antenatal care visits:

-Generally check up is done:
•at interval of 4 weeks up to 28 weeks;
•at interval of 2 weeks up to 36 weeks
•and thereafter weekly till delivery.

- Ideally this should be more flexible depending on the need and the convenience of patient.

-In the developing countries, as per WHO recommendation, the visit may be curtailed to at least 4; first in second trimester around 16 weeks, second between 24–28 weeks, the third visit at 32 weeks and the fourth visit at 36 weeks.

-WHO recommends a minimum of eight antenatal care visits for a healthy pregnancy.

#Obs_Gyne