•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
(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
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
-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
Difficult intubation:
L E M O N
-Look externally
-Evaluate 3-3-2 rule
-Mallampati score
-Obstruction
-Neck Mobility.
#Medicine
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
AEIOU
-Aching
-Eczema
-Itching
-Oedema
-Ulceration (LDS, hemosiderin, varicosities)
#Medicine
C
🇺🇸👤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
auses 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
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
🥛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
•Why thyroxine should be started in low dose?
-Because if high dose is given, it may precipitate anginal attack.
#Thyroid
-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
-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
•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
-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
-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
•What is thyrotoxic crisis?
-Thyrotoxic crisis is a medical emergency that's characterized by life threatening increase of signs and symptoms of thyrotoxicosis (also called thyroid storm).
•What are the Precipitating factors for thyroid crisis?
1-Infection
2-Stress
3-Surgery in unprepared patient
4-Following radioiodine therapy (due to radiation thyroiditis).
#Thyroid
#Medicine
-Thyrotoxic crisis is a medical emergency that's characterized by life threatening increase of signs and symptoms of thyrotoxicosis (also called thyroid storm).
•What are the Precipitating factors for thyroid crisis?
1-Infection
2-Stress
3-Surgery in unprepared patient
4-Following radioiodine therapy (due to radiation thyroiditis).
#Thyroid
#Medicine
•What are the Features of thyrotoxic crisis?
-High fever
-Restlessness,agitation and irritability
-Nausea, vomiting, diarrhea and abdominal pain
-Tachycardia, AF and in elderly, cardiac failure
-Confusion, delirium and coma.
•Diagnosis:
-Mostly clinical and high degree of suspicion is vital.
-FT3, FT4 and TSH should be done immediately.
#Thyroid
#Medicine
-High fever
-Restlessness,agitation and irritability
-Nausea, vomiting, diarrhea and abdominal pain
-Tachycardia, AF and in elderly, cardiac failure
-Confusion, delirium and coma.
•Diagnosis:
-Mostly clinical and high degree of suspicion is vital.
-FT3, FT4 and TSH should be done immediately.
#Thyroid
#Medicine
•Treatment of Thyrotoxic crisis
(Blood sample is taken for T3, T4 and TSH).
1-The patient should be treated in intensive care unit (ICU).
2-Propranolol 80 mg 6 hourly (or 1 to 5 mg IV 6 hourly).
2-IV fluid (normal saline and glucose).
3-Carbimazole 40 to 60 mg daily. Or propylthiouracil 150 mg 6 hourly (if needed, through Ryle’s tube). Carbimazole can be given per rectally also.
•Other therapy:
-Sodium ipodate, a radiographical contrast media, 500 mg daily is rapidly effective. Or potassium iodide or Lugol’s iodine may be given.
-Dexamethasone 2 mg 6 hourly and amiodarone are also effective.
-Broad spectrum antibiotic.
•General measures:
-Control of temperature and O2 therapy.
-After 10 to 14 days, the patient can usually be maintained on carbimazole alone.
Mortality rate in thyrotoxic crisis is 10%.
#Thyroid
#Medicine
(Blood sample is taken for T3, T4 and TSH).
1-The patient should be treated in intensive care unit (ICU).
2-Propranolol 80 mg 6 hourly (or 1 to 5 mg IV 6 hourly).
2-IV fluid (normal saline and glucose).
3-Carbimazole 40 to 60 mg daily. Or propylthiouracil 150 mg 6 hourly (if needed, through Ryle’s tube). Carbimazole can be given per rectally also.
•Other therapy:
-Sodium ipodate, a radiographical contrast media, 500 mg daily is rapidly effective. Or potassium iodide or Lugol’s iodine may be given.
-Dexamethasone 2 mg 6 hourly and amiodarone are also effective.
-Broad spectrum antibiotic.
•General measures:
-Control of temperature and O2 therapy.
-After 10 to 14 days, the patient can usually be maintained on carbimazole alone.
Mortality rate in thyrotoxic crisis is 10%.
#Thyroid
#Medicine