Remember:

-Dyskariosis refers to abnormality from a smear.
-Dysplasia or cervical intraepithelial neoplasia are histological terms from a biopsy sample.
-CIN should be treated to prevent long-term progression to cervical carcinoma.
-LLETZ is the usual treatment for CIN, with yearly follow-up for 10 years.

-USMEL
#Obs_Gyne

Remember:

-Most prolactinomas respond to medical treatment with bromocriptine or cabergoline.
-Surgery is only indicated rarely.

#Obs_Gyne

Remember:

The earliest symptom of digoxin toxicity is appetite loss, followed by nausea and vomiting.

-MRCP
#Medicine

What are the indications for steroids in chronic asthma?

-Sleep is disturbed by wheeze
-Morning tightness persists until midday
-Symptoms and peak expiratory flows progressively deteriorate each day
-Maximum treatment with bronchodilators not controlling symptoms
-Emergency nebulizers are needed.

-MRCP
#Medicine

•Main causes of esophageal varices:

1-Severe liver cirrhosis as aresult of:
a-Chronic hepatitis
b-Alcoholic liver disease
c-Fatty liver disease
2-Primary biliary cirrhosis
3-Thrombosis of portal/splenic vein
4-Parasitic infection as schistosomiasis
5-Budd-chiary syndrome

•RISK_FACTORS:
1-High portal pressure
2-Increase size (large)varices
3-Red streaks on the varices ..when seen by endoscope
4-Continous use of alcohol
5-Sever liver cirrhosis or liver failure.

#Medicine

Remember:

-Ticagrelor antiplatlet agent demonestrates bactericidal activity against MRSA & may be active against multidrug resistant staphylococcus,or enterococci.

-Medscape

#Medicine

Remember:

Low TSH + normal FT4+normal T3:

-subclinical hyperthyroidisim
-sick euothyroid syndrome
-drug effect.

-MRCP
#Medicine

Remember:

-Plasmapheresis & IV immunoglobulins are the main stay of treatment of mysthenia crisis.


-MRCP
#Medicine

Remember:

-Fresh frozen plasma is helpfull in stopping bleeding in patients of DIC with raised PT & APTT.

-MRCP
#Medicine

Nifedipine Indications.

-Hypertension

-Angina

-High-altitude pulmonary edema (HAPE)

-Reynaud's phenomenon

-Premature labor


-MRCP
#Medicine

Remember:

No role for NOACs in the following patients with venous thromboemoblism (VTE)

1-Antiphospholipid syndrome

2-Pregnancy and lactation

3-CKD(GFR below 30 for dabigatran, GFR below 15 for Rivaroxaban )

4- Chronic thromboembolic pulmonary hypertension(CTEPH).

#Medicine

Hemochratosis classic triad:

Cirrhosis
DM
Skin pigmemtation.

#Medicine

Remember:

Budd-Chiari syndrome =
Hepatomegaly+
Ascites+
Abdominal pain.

#Medicine

Asbestosis:

-Chest xray PA veiw showes Holly leaf appearance of pleural plaques oftenly due to asbestosis.

#Medicine

Remember:

Angiography is the standard imaging approach for detecting fibromuscular dysplasia/arterial stenoses and aneurysms.

-MRCP
#Medicine

 “Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from the words heard in the lecture room or read from the book. See and then reason and compare and control. But see first.” 

-Sir William Osler

Treatment of pulmonary embolism:

•ABCD,
•Establish IV access

General management:

1-Give oxygen if the patient is hypoxic, Spo2 <90%.
-Start with 2L/min by nasal canula "1-6L/min".
سوي assessment بعد ربع إلى نصف ساعة، إذا استمر الإنخفاض نرفع 3 لتر بالدقيقة.
لو زال منخفض:
-Simple face mask" 6-10L/m"
It's used when the patient doesn't improve with nasal canula.


وبعدها نشوف المريض إذا كان stable or unstable!
كيف؟!
-Patient is considered unstable in PE if there is hypotension, SBP <90 mmHg in previously normotensive patients, but if the patient is previously hypertensive, we should consider him hypotensive when there is 40mmHg decease in SBP, Ex, patient SBP is 170mmHg, it's hypotension when it drops to 130mmHg, so it's considered Unstable.

Treatment of haemodynamically unstable PE patient:

-Give the patient fluid ( NS 500ml over 15-30 minutes).
-إذا تحسن الضغط بعد ما جبنا له الـ fluid كان بها، إذا ما في improvement هنا يكون indication للـ Thrombolysis.
نشوف أول شيء مافي Contraindication للـ Thrombolysis.

-حتى يتم إعطاء الـ Thrombolysis، ممكن ندي للمريض vasopressors:
-Give noradrinaline (4mg /2ml ampoule)
Dose: 0.2- mcg / kg /min
يعني نحل الجرعة المطلوبة في 100ml محلول NS or Dexterose.
-Dobutamine 2.5-10 mcg/kg /min.
يعني ندي له 5mcg
Aiming for systolic BP >90mmHg

-بعدها نعطي الـ Thrombolysis واللي هو:
-Alteplase:100mg

تجي على شكل vial فيها 50mg ومعها حقها اللي نحله فيها 50ml.
نحضره يصير عندنا 50mg in 50ml .
Dose:
-Alteplase10 mg intravenous bolus over 1-2 minutes, followed by 90 mg intravenous infusion over 2 hours (maximum 1.5 mg/kg in patients <65 kg body weight).

Or

-Streptokinase1,500,000 units by intravenous infusion over 1-2 hours.

نحلها في 100ml NS.
هذا اللي موجود عندنا في ذمار، بس الـ alteplase متوفر في صنعاء لكنه غالي.
طبعاً إذا مافي Contraindications للـ Thrombolysis.

بس ضروري نسوي موافقة ضروري، شارسل الصيغة اللي سويتها قبل فترة لـ relatives لمريض كان معه STEMI.