CHANCROID

Cause: H.ducreyi
Transmission: sexual
Primary lesion: Chancroid
Tender papule with erythematous halo that evolves to pustule, erosion, and ulcer. Ulcer is usually quite tender or painful .Its borders are sharp, undermined, and not indurated.With surrounding oedema. Base is friable with granulation tissue and covered with gray to yellow exudate.
Painful inguinal lymphadenitis (usually unilateral).
Dx: culture
DOC: Azithromycin.


#Dermatology

Tinea pedis
-Macerated interdigital type:
Local: Aluminum chloride hexahydrate 20%, with T.Antifungal.

Systemic
-Inflammatory or bullous and Moccasin:
Terbinafine
-Tinea manuum,Tinea ungium:
Terbinafine

-Tinea capitis:
Griseofulvin

With severe, painful kerion:
Prednisone

Tinea versicolor:
Ketoconazole shampoo.

#Dermatology

-In basal fractures of the skull, all cranial nerves are liable to be injured EXCEPT the 12th CN.

#Surgery

Nikolsky sign:
-SSSS
-Pemphigus
-TEN
-Von Zumbesch
-Severe EM major


Desqumation:
-SSSS
-Scarlet fever.

#Dermatology

•Intralesional Triamcinolone Uses:
(Dose is usually 3-5 mg /ml)

- Inflammatory Cysts & Nodules of acne.
- Alopecia areata.
- Keloids & Hypertrophic scars.
- Small Thick psoriatic plaques.
- Cutaneous Sarcoidosis.
- Lichen planus.
- Prurigo nodularis.
- Hydradenitis suppurativa.
- Dyshydrotic Eczema.
- Granuloma annulare.
-Lichen simplex chronicus.
-Recurrent localized Bullous pemphigoid
-Scabietic Nodules.

#Dermatology

Telangiectasia can be seen in:

1-Systemic sclerosis "CREST syndrome".
2-SLE.
3-Dermatomyositis.
4-Rosacea.
5-BCC.
6-Habitual corticosteroid use.
7-Alcoholism.
8-Pregnancy.
9-Hereditary.
10-Chronic exposure to the sun or extreme temperatures.

#Dermatology

•Rifaximin:

-It is a broad-spectrum, nonabsorbable oral antibiotic.
-Reduces the number of ammonia-producing intestinal bacteria.
-May be added to lactulose if a second episode occurs to prevent recurrent episodes of hepatic encephalopathy.

زمان كانوا يستخدموا Neomycin.

#Medicine

Antinuclear Antibody +ve:
4 S

-SLE
-Systemic sclerosis
-Sjorgen syndrome
-Sometimes normal

#Medicine

Difficult intubation:

L E M O N

-Look externally
-Evaluate 3-3-2 rule
-Mallampati score
-Obstruction
-Neck Mobility.


#Medicine

Varicose vein : symptoms

AEIOU

-Aching
-Eczema
-Itching
-Oedema
-Ulceration (LDS, hemosiderin, varicosities)

#Medicine

Causes of chronic constipation


🇺🇸👤JOE BIDEN 🏛


🗳Juvenile eating disorder(anorexia nervosa)
🗳Other(pregnancy, systemic sclerosis, myotonic dystrophy)
🗳Environmental and dietary(low fiber diet, immobility,...)

🗳Bowel obstructing lesions
🗳Irritable bowel syndrome, Idiopathic chronic constipation
🗳Drugs(Aluminum,Opiates,
...), Dyssynergic defecation
🗳Endocrine and metabolic (hypothyroidism,hypokalemia,hypercalcemia)
🗳Neurogenic disorders(Multiple sclerosis, Hirschsprung disease,...)


#Medicine

•Carpal tunnel syndrome; causes


🇺🇸DONALD TRUMP🏛

💲Diabetes
💲Overuse injury, Obesity
💲Neoplasm
💲Acromegaly
💲Low thyroid(hypothyroidism)
💲Dialysis-related amyloidosis

💲Trauma(colles fx)
💲Rheumatiod arthritis
💲Use of Aromatase inhibitors
💲Menopause, Myxoedema
💲Pregnancy


#Medicine
#Surgery

Hypercalcemia DDx

🥛HyperCALCEMIAS


💠Hyperparathyroidism
💠Carcinoma
💠Antacids containing Calcium, Acute renal failure
💠Lymphoma, Leukemia, Low phosphate, Lithium
💠Calcium Supplements, Congenital (familial hypocalciuric hypercalcemia)
💠Endocrine: hyperthyroidism, pheochromocytoma
💠Multiple Myeloma, Metistatic Lesions to Bone, Milk-alkali syndrome
💠Immobilization (exacerbates another underlying disorder), Iatrogenic(thiazide, diuretics, vitamin D)
💠Addison's Disease, Acromegaly, A hypervitaminosis
💠Sarcoid and other granulomatous diseases


#Medicine

Thyroid storm
Causes and management

🏷Causes

🌪THIS Powerful storm

🔻Trauma
🔻Hyperthyroidism
🔻Infection/ Illness/ Iodine load
🔻Surgery
🔻Parturition

🏷Management

4🅿’s

🅿redinisone
🅿ropylthiouracil
🅿ropranolol
🅿otassium Iodide


#Thyroid
#Surgery

•What are the causes of anemia in hypothyroidism?

-Causes of anemia:
1)Anemia of chronic disorder
2)Iron deficiency
3)Vitamin B12 deficiency
4)Folate deficiency
5)Other factors responsible menorrhagia in female, anorexia.

#Medicine
#Surgery

•What are the types of anemia in hypothyroidism?

-Anemia may be:
1-Usually normocytic normochromic
2-Iron deficiency, if menorrhagia (in female)
3-May be macrocytic due to associated pernicious anemia (due to deficiency of vitamin B12).

#Thyroid
#Surgery

•Why thyroxine should be started in low dose?

-Because if high dose is given, it may precipitate anginal attack.

#Thyroid

•What is the bedside test in hypothyroidism?

-Ankle jerk, which shows slow relaxation, also called “hung-up reflex” (other jerks may also show slow relaxation).

•How slow relaxation is best elicited in the ankle? Why slow relaxation?

-It is best elicited in kneel down position on a chair or bedside.
-Slow relaxation is due to decreased rate of muscle contraction and relaxation.

#Thyroid

•Cave!!

-If the patient has deficiency of cortisol (as in hypopituitarism or Addison’s disease), corticosteroid should be given first and then thyroxine. Otherwise, if thyroxine is given first without correcting cortisol deficiency, there will be severe Addisonian crisis.

#Thyroid
#Medicine

•What is Hashimoto’s thyroiditis?

-It is an autoimmune thyroiditis characterized by destructive lymphoid infiltration of thyroid leading to atrophic change with regeneration and goiter formation.
-It is more common in middle aged woman.

-The goiter is usually diffuse, moderately enlarged and firm or rubbery. Sometimes, it may be soft to hard.

-Antithyroid antibody (very high, >1000 IU/L)—antimicrosomal (antiperoxidase) in 90% and antithyroglobulin antibodies (no rise of TSH-receptor antibody).

-Initially, the patient may present with features of toxicosis, called Hashi-toxicosis.

-About 25% patients are hypothyroid at presentation. In the remaining patients, serum T4 is normal and TSH is normal or raised.
-There is risk of developing overt hypothyroidism in future.

-Treatment– thyroxine (it reduces the size of goiter also).

#Thyroid
#Medicine
#Surgery

•What is the natural history of Graves’ disease?

-It may be hyperthyroid, euthyroid followed by hypothyroidism.

•What is euthyroid Graves’ disease?

-The patient is clinically and biochemically euthyroid, but there is ophthalmopathy (also there is diffuse goiter, dermopathy).
-Thyroid releasing hormone (TRH) stimulation test show flat response curve.

#Thyroid
#Surgery
#Medicine