•Peptic ulcer is more frequent in patients with liver cirrhosis, Why ?

-The liver is responsible for the metabolism and degradation of the Gastrin hormone

-In case of liver cirrhosis, the gastrin is not degradated in the liver 👉🏼increase the level of Gastrin hormone 👉🏼 increase secretion of the pepsinogen and HCl from the stomach 👉🏼 Ulceration.

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•Respiratory causes of haemoptysis:

1- Infective : bronchitis - TB - pneumonia - COPD others fungal & viral infections of the lung
2- Neoplastic : either primary or secondary
3- Vascular : lung infarction - vasculitis ( ANCA-associated, SLE, Rheumatoid arthritis )
4- Parenchymal : Diffuse Interstitial fibrosis, sarcoidosis, haemosiderosis, cystic fibrosis
5- Pulmonary Hypertension
6- Trauma or foreign body in the airway.


Massive haemoptysis causes:

1-TB
2-Bronchiectasis
3-Bronchogenic carcinoma
4-Trauma in the Airway

-Because the lesion is supplied by bronchial artery ( high pressure ).

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•Ortner's syndrome:

Mitral stenosis 👉🏼dilatetion of the left arium leading to :

1-Compression of Left laryngeal nerve👉🏼Hoarseness of voice.
2-Compression of the esophagus 👉🏼dysphagia.
3-Compression of the trachea 👉🏼shortness of breath, risk of aspiration, cough and hemoptysis.

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•Hemoptysis associated with Hematuria:

-We must consider Goodpasture syndrome as possible cause.

Goodpasture syndrome most often manifests as diffuse alveolar hemorrhage and glomerulonephritis together.

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-Hemoptysis only during menstruation in female patients?

Catamenial Hemoptysis intrabronchial or parenchymal endometrial tissue deposits, and is considered a subset of extrapelvic endometriosis.

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-Common migrine which is bilateral without aura is more common than classical migrine which is unilateral with aura.

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•Causes of bradycardia in ER:

5H

Hypothermia
Hyperkalemia
H+ increase ( acidosis)
Hypoxia
Hypovolumia


5T

Tension pneumothorax
Tamponade ( cardiac)
Thrombosis pulmonary PE
Trombosis cardiac MI
Toxins.

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-Infection above diaphragm is usually of Gram positive bacteria while infection below diaphram is usually of gram negative .

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-In correction of hyperkalemia the first thing we give the patient is membrane stabilizers ( Ca gluconate to prevent caradic arrest ) which will not restore the potassium level but more importantly will counter the action of K on cardiac muscle cell membrane.

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-Severe thrombocytopenia (< 10 × 109/L) may result in retinal haemorrhage and potentially fatal intracranial bleeding, but this is rare.

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-In case of thrombocytopenia, Spontaneous bleeding does not usually occur until the platelet count falls below 20 × 109/L, unless their function is also compromised.

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-Apparent erythrocytosis with a raised Hct, normal red cell mass (RCM) and reduced plasma volume may be associated with hypertension, smoking, alcohol and diuretic use (Gaisböck’s syndrome).

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(Gaisböck’s syndrome):

-The presence of hypertension, smoking, excess alcohol consumption and/or diuretic use is consistent with low-volume polycythaemia.

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-In polycythaemia rubra vera (PRV), a mutation in a kinase, JAK-2 V617F, is found in over 90% of cases.

-Patients with PRV have an increased risk of arterial thromboses, particularly stroke, and venous thromboembolism.

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Symptoms/signs of possible acute transfusion reaction:

-Fever, chills, tachycardia, hyper- or hypotension, collapse, rigors, flushing, urticaria, bone, muscle, chest and/or abdominal pain, shortness of breath, nausea, generally feeling unwell, respiratory distress.


د. محمد قاسم في الراوند قال:
"Back pain is the first! ".

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-The most common reason for a raised platelet count is that it is reactive to another process, such as infection, inflammation, connective tissue disease, malignancy, iron deficiency, acute haemolysis or gastrointestinal bleeding.

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-Antiplatelet medications are of greater efficacy in the prevention of arterial thrombosis and of less value in the prevention of venous thromboembolism.

-Thus, antiplatelet agents, such as aspirin, clopidogrel and, increasingly, ticagrelor, are the drugs of choice in acute coronary events and in ischaemic cerebrovascular disease.


-While Warfarin and other anticoagulants are favoured in VTE " venous " and management of atrial fibrillation.

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-ESR: blood cells sediment in a period of one hour, Normally more in adult female.
-Increase in: - all collagen diseases (autoimmune), infection, malignancy.
-Decrease in: - polycythemia, congestive heart failure, sickle cell anemia, hereditary spherocytosis , Hyper viscosity.

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Anemia according to WHO:

• Hb <13 g/dL in adult male.
• Hb <12 g/dL in adult females.
• Hb <11 g/dl in pregnancy.

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-Iron is absorbed from the duodenum & upper jejunum.

-Serum ferritin is the best single test to confirm iron deficiency.

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