Creative Doctors ๐Ÿ–ค
4.19K subscribers
968 photos
27 videos
358 files
458 links
Med notes ๐ŸŽถ
Download Telegram
ูŠู‚ูˆู„ ุฃุญุฏ ุงู„ุฃุทุจุงุก:
ุงู„ูุณูŠูˆู„ูˆุฌูŠ ุจุนุถ ู…ู† ุชุฎูŠู„ู†ุง ๐Ÿ˜ ุฅู† ู„ู… ู†ุฌุฏู‡ุŒ ู„ุงุฎุชุฑุนู†ุงู‡..!๐Ÿ’›
Creative Doctors ๐Ÿ–ค
#cvs_s6 ู†ูƒู…ู„ ุงู„ุญุงู„ุงุช ุงู„ูŠ ุนุฏู†ุง ๐Ÿ˜๐Ÿ‘‡ ๐Ÿ’ซ (( ุงู„ุญุงู„ุฉ ุงู„ุซุงู†ูŠุฉ )) ๐Ÿ’ซ ๐ŸŒ Consuming a meal at rest ๐ŸŒ ุชุตูŠุฑ ูƒู„ ูŠูˆู… ูˆ ุจูƒู„ ูˆู‚ุช ุŒ ูˆ ุงูƒูˆ ู†ุงุณ ู…ูŠุจุทู„ูˆู† ุฃูƒู„ ุน ๐ŸŒฑ ุทูˆู„ ุงู„ูŠูˆู… ๐Ÿคฃ ูู‡ุงูŠ ุงู„ุญุงู„ุฉ ู…ุณุชู…ุฑุฉ ูˆูŠุงู‡ู… ๐Ÿคฃ ู†ุจุฏูŠ: ๐ŸŒฑ ุงู„ุงูƒู„ ุนู…ูˆุฏ ูŠู†ู‡ุถู… ูˆ ูŠู…ุชุต ูˆ ุชุงู„ูŠ ูŠู†ุชู‚ู„ ุงู„ุงูƒู„ ุงู„ู…ู…ุชุต ูˆ ูŠุฑูˆุญ ุนุจุฑ ู…ุฌุฑู‰โ€ฆ
๐Ÿ›‘ ู…ู„ุงุญุธุฉ ู‡ู†ุง ุฎุทุฃุช ุจูŠู‡ุง ๐Ÿ’”๐Ÿ’”
ุงู„ parasympathetic ู…ูˆ ู‡ูˆ ุงู„ูŠ ูŠูˆุณุน ุงู„ุงูˆุนูŠุฉ ๐Ÿคฆโ€โ™‚ุงู„ุจุงุฑุง ุณุจู…ุซุงูˆูŠ ู…ู† ุงุฏุฒู‡ ูŠุฑูˆุญ ูŠุฎู„ูŠ ุงู„ู…ุนุฏุฉ ุชู†ู‚ุจุถ ูˆ ุชู†ุจุณุท ุญุชู‰ ุชู‡ุถู… ุงู„ุงูƒู„ ...

ูˆ ุงูƒูˆ ู…ูˆุงุฏ ุฑุงุญ ุชุชูƒูˆู† ู‡ูŠ vasodilator metabolites ู‡ูŠ ุงู„ูŠ ุชูˆุณุน ุงู„ุงูˆุนูŠุฉ ๐Ÿ™‚๐Ÿ’”

ูˆ ุชู†ุชู‚ู„ ุนุจุฑ ู…ุฌุฑู‰ ุงู„ุฏู… ูˆ ุชูˆุณุน ุงู„ peripheral vasculture ูˆ ุชู‚ู„ู„ TPR ูˆ ูŠู‡ุจุท ุงู„ุถุบุท ๐Ÿ™‚๐Ÿ‘Ž
ุจุณ ุนุชุจูŠ ุนู„ูŠูƒู… ู…ุญุฏ ู…ู†ุชุจู‡ ๐Ÿ˜‘๐Ÿ˜‘
A nice Note ๐Ÿ’› keep it in your minds

The state of vessel tone (bower of contraction) is determined by the balance between constrictor โ™ก and dilator โ™ก in๏ฌ‚uences.
- Extrinsic in๏ฌ‚uences originate from outside of the tissue
- Intrinsic in๏ฌ‚uences originate from the vessel or surrounding tissue.
As u see in this image ๐Ÿ‘†๐Ÿป
๐ŸŒฟ Notes :

๐Ÿ’› vasoconstrictor mechanisms are important for maintaining systemic vascular resistance [ TPR ] & AP
๐Ÿ’› like in stunding up or lossing blood after trauma .

๐Ÿ’™ whereas vasodilator mechanisms regulate blood ๏ฌ‚ow within organs
๐Ÿ’™ like in exercising muscle or eating food.

ุฎู„ูˆู‡ู† ุจุจุงู„ูƒู… ุญุชู‰ ู„ุง ุชู†ุณูˆู† ุดูˆูƒุช ูŠุตูŠุฑ ูƒูˆู†ุณุชุฑูƒุดู† ูˆ ุดูˆูƒุช ุฏุงูŠู„ูŠุดู† ุจ vessles ๐Ÿ˜ด
#CVS_S6 ๐Ÿ‘†๐Ÿป
Creative Doctors ๐Ÿ–ค
#cvs_s6 ๐Ÿ’ซ (( ุงู„ุญุงู„ุฉ ุงู„ุฑุงุจุนุฉ )) ๐Ÿ’ซ When we raise from lying to standing position (may cause postural or orthostatic hypotension) ู‡ุงูŠ ุงู„ุญุงู„ุฉ ุฏูˆู… ุชุตูŠุฑ ูˆูŠุงู†ุง ู„ู…ู† ู†ูƒูˆู† ู†ุงูŠู…ูŠู† ูˆ ุจุณุน ู†ูˆูƒู ุน ุฑุฌู„ูŠู†ุง ู…ู…ูƒู† ุชุณุจุจ ู‡ุจูˆุท ุงู„ุถุบุท ๐Ÿ˜ ูˆ ู…ู…ูƒู† ู†ุญุณ ุจุฏูˆุฎุฉ ๐Ÿฅด ูˆ ุฑุงุญ ู†ุนุฑู ุณุจุจู‡ุง ุดู†ูˆ ๐Ÿ‘‡๐Ÿปโ€ฆ
๐Ÿ’ข ู†ู‚ุทุฉ ู…ู‡ู…ุฉ ุงุญุจ ุงุถูŠูู‡ุง ู‡ู†ุง ูˆู‡ูŠ:

If AP falls โฌ‡๏ธ by more than 20mmHg
ู‡ู†ุง ูŠู„ุง ูŠุตูŠุฑ
Postural or Orthostatic hypotension โฌ‡๏ธ
ูˆ ูŠุตูŠุฑ ุงู„ faint or loss of consciousness ูŠุฏูˆุฎ ุงู„ุดุฎุต ุงูˆ ูŠุบู…ู‰ ุนู„ูŠู‡๐Ÿฅบ ุฎู„ูˆู‡ุง ุจุจุงู„ูƒู… ุชููŠุฏ ุจุญูŠุงุชูƒู… ุงู„ูŠูˆู…ูŠุฉ .
โ™ฆ๏ธ ุนุฏู„ูˆุง ุงุฎุฑ ุดูŠ ูƒุงุชุจ TPR โฌ†๏ธ ูˆ ูŠู…ู‡ุง vasodilation ุณูˆูˆู‡ุง vasoconstriction ๐Ÿ™‚ ูˆ ุญุชู‰ ุญุงู„ุฉ 5 ู‡ู… ุจูŠู‡ุง ู‡ูŠุฌ ุจุงู„ุงุฎูŠุฑ ุนุฏู„ูˆู‡ ูŠู…ูƒู…๐Ÿ‘
#cvs_s6
ู…ู„ุงุญุถุงุช ุณุฑูŠุนู‡

The inferior part of the glenohumeral joint is the weakest area?๐Ÿค”

Beacuse this part not reinforced by the rotater cuff muscles
ูˆู…ู…ูƒู† ูŠุฌูŠ ุจุบูŠุฑ ุตูŠุบู‡ ู„ูŠุด ุงูƒุซุฑ ุงู„ุฎู„ุน ูŠุตูŠุฑ ุจู‡ุงูŠ ุงู„ู…ู†ุทู‚ู‡ ุงูˆ ู…ู…ูƒู† ูƒุงุงู…ุณูƒูŠูˆ ๐Ÿ™ƒ
______________________
Rotator cuff ๐Ÿ‘‡
Supraspinatous๐Ÿ‘‰suprascapular nerve ๐Ÿ‘‰abduct arm 0-15
Infraspinatous ๐Ÿ‘‰suprascapular nerve๐Ÿ‘‰laterally rotates arm
Supscapularis ๐Ÿ‘‰upper and lower subscapular nerve๐Ÿ‘‰medialy rotates arm
Teres minor๐Ÿ‘‰axillary nerve ๐Ÿ‘‰laterally rotates arm
_______________________
๐ŸŒŸSupraspinatous
Intiation of abduction 0-15

๐ŸŒŸDeltoid
Abduction 15-90

๐ŸŒŸTrapezius and sarratus anterior
above 90
ุงู‡ู†ุง ู…ู…ูƒู† ูŠุฌูŠ ุณุคุงู„ ุงู†ูˆ ู…ุงูŠูƒุฏุฑ ูŠุณูˆูŠ abduction ู…ุซู„ุง ู…ู† 0_15ูุงู†ุชู‡ ุฑุงุญ ุชุนุฑู ุงู„ุนุถู„ู‡ ุงู„ู…ุณุคูˆู„ู‡ ุนู† ู‡ุงูŠ ุงู„ุฏุฑุฌู‡ ู…ุงู„ุช ุงู„abduction ูˆู…ู…ูƒู† ูŠุณุฃู„ูƒ ุนู† ุงู„ู†ูŠุฑู ุงู„ูŠ ูŠุบุฐูŠ ู‡ุงูŠ ุงู„ุนุถู„ู‡ ุงูˆ ุงู…ุณูƒูŠูˆ ๐Ÿ˜Œ๐Ÿค 
___________________
ุงู„ู†ูŠุฑู ุงู„ูŠ ูŠุตูŠุฑ ุจูŠ injury ุงุฐุง ุตุงุฑ ุนู†ุฏูŠ shoulder dislocation ุงูˆ ูƒุณุฑ ุจู‡ุงูŠ ุงู„ู…ู†ุทู‚ู‡ ู‡ูˆ ุงู„axillary injury

Axillary nerve injury is indicated by:โ€“

-Paralysis of the deltoid muscle with loss of abduction ูˆุงูŠุถุง ูŠุตูŠุฑ ุจูŠู‡ุงatrophy

-Loss of sensation in a small area of the skin(regimental badge area)over the central part of the deltoid. ุงู…ุง ุจู„ู†ุณุจู‡ ู„ู„sensory ุจู„upper lateral aspect of the arm
ูˆู‡ุงูŠ ุงู„ู…ู†ุทู‚ู‡ ุงู„ู‡ู‡ ุชุณู…ูŠู‡ ูˆู‡ูŠู‡ regimental badge area ุฑู‚ุนุฉ ุงู„ุนุฑูŠู ๐Ÿ˜Ž๐Ÿ‘จโ€โœˆ๏ธ
regimental badge area
ุงู‡ู†ุง ุจู‡ุงูŠ ุงู„ู…ู†ุทู‚ู‡ ุฑุงุญ ูŠุตูŠุฑ ุนู†ุฏูŠ
loss of sensation
ุงุฐุง ุฌุงู† ุนู†ุฏูŠ injury of axillary nerve
Creative Doctors ๐Ÿ–ค
regimental badge area ุงู‡ู†ุง ุจู‡ุงูŠ ุงู„ู…ู†ุทู‚ู‡ ุฑุงุญ ูŠุตูŠุฑ ุนู†ุฏูŠ loss of sensation ุงุฐุง ุฌุงู† ุนู†ุฏูŠ injury of axillary nerve
๐Ÿ›‘ ุงุชุฎูŠู„ ูˆูŠุงูŠ ุงู„ูƒูŠุณ /
ุงุฌุงูƒ ู…ุฑูŠุถ ู„ู„ุทูˆุงุฑุฆ ุฌุงู† ูˆุงฺฏุน ุน ุงู„ุงุฑุถ ูˆ ูŠุตุฑุฎ ู…ู† ุงู„ู… ุจุงุนู„ู‰ ุงู„ arm ๐Ÿฅบ ูุชุฌูŠ ุงู†ุช ูƒ ุทุจูŠุจ ุชุณูˆูŠู„ู‡ x-ray ูˆ ุชู„ฺฏู‡ ุนู†ุฏู‡ ูƒุณุฑ ุจู…ู†ุทู‚ุฉ surgical neck๐Ÿ˜ฅ (ู‡ุงูŠ ุงู„ู…ู†ุทู‚ุฉ ุงู†ุช ุชุนุฑูู‡ุง ูŠู…ุฑ ุจูŠู‡ุง axillary nerve)

๐Ÿ›‘ูุชุฑูŠุฏ ุชุชุฃูƒุฏ ู‡ู„ ุงู„ุนุตุจ ู†ุฌุฑุญ ุงูˆ ู„ุง ๐Ÿ˜ญ ูˆ ุนู†ุฏูƒ ุฎูŠุงุฑูŠู† :

1โƒฃ ุชูุญุต ุงูƒุดู† ุนุถู„ุฉ ุงู„ Deltoid ุงู„ูŠ ูŠุบุฐูŠู‡ุง Axillary nerveูˆ ุงู„ูŠ ู‡ูˆ
Abduction of shoulder joint 15-90ยฐ
ู‡ุฐุง ุงู‡ู… ุงูƒุดู† ู„ู‡ู„ ุงู„ุนุถู„ุฉ ุญุชู‰ ุงุนุฑู ุงุตุงุจุฉ ุงู„ุงูƒุฒู„ุฑูŠ ู†ูŠุฑู
ู„ุงู† ุจู‚ูŠุฉ ุงู„ุญุฑูƒุงุช ุงู„ูŠ ุชุณูˆูŠู‡ู† ุงู„ุนุถู„ุฉ ู…ู† flexion & extension ุงูƒูˆ ุนุถู„ุงุช ุบูŠุฑู‡ุง ุงู‚ูˆู‰ ู…ู†ู‡ุง ุชุณูˆูŠู‡ู† ูู…ุง ุฑุงุญ ุงุณุชูุงุฏ ู…ู† ู‡ู„ ุงู„ุญุฑูƒุชูŠู† ุจู…ุนุฑูุฉ ุงู† ุงู„ุนุถู„ุฉ ู…ุดู„ูˆู„ุฉ ุงูˆ ู„ุงุŒ ู„ุงู† ู‡ูŠ ุฏูˆุฑู‡ุง ุจูŠู‡ู† ุซุงู†ูˆูŠ ๐Ÿ‘๐Ÿป

ู ุงูƒูˆู„ ู„ู„ู…ุฑูŠุถ ุงูˆูƒู๐Ÿงโ€โ™‚ูˆ ุงุฑูุน ุงูŠุฏูƒ ูˆ ุงู†ุง ุงุณูˆูŠ ุงู„ุญุฑูƒุฉ ูˆ ู‡ูˆ ูŠุณูˆูŠ ู†ูุณูŠ๐Ÿคญ ุงุฐุง ุดูุชู‡ ู…ุง ูƒุฏุฑ ูŠุฑูุน ุงูŠุฏู‡ ููˆู‚ ุงู„ 15 ุฏุฑุฌุฉ ุฑุงุญ ุงุนุฑู ุงู† ุนุถู„ุฉ ุงู„ Deltoid ุงู†ุดู„ุช ูˆ ุงู† ุงู„ุงู„ูƒุฒู„ุฑูŠ ู†ูŠุฑู ู…ุชุถุฑุฑ

โŽ ูˆ ูˆุฑุฉ ู‡ู„ ุงู„ุญุฌูŠ ูƒู„ู‡... ุงุญุจ ุงูƒู„ู„ูƒู… ุงู† ุงุญู†ุง ู…ุฑุงุญ ู†ุณูˆูŠ ู‡ู„ ุงู„ุฎุทูˆุฉ ๐Ÿคฃ ูˆ ู„ุง ุฑุงุญ ู†ูƒูˆู„ ู„ู„ู…ุฑูŠุถ ูŠุฑูุน ุงูŠุฏู‡ ูˆ ู†ูุญุต ุงู„ุงูƒุดู†ุŒ ู„ุงู† ู‡ูˆ ุงุตู„ุง ุนู†ุฏู‡ ูƒุณุฑ ูˆ ุงุฐุง ุฑูุน ุงูŠุฏู‡ ูŠุชูˆุฌุน ูƒูˆู„ู„ุด ๐Ÿฅบ ู ุงู†ุง ู…ุง ุงุฑูŠุฏ ุฃุงุฐูŠ ู…ุฑูŠุถูŠ (ุงุฐุง ุงู†ุฌุฑุญ ุงู„ู†ูŠุฑู ุจุณุจุจ ุบูŠุฑ ุงู„ูƒุณุฑ ูˆ ู…ุง ูƒุงู† ุงูƒูˆ ุงุญุชู…ุงู„ ุงู† ุงุงุฐูŠ ุงู„ู…ุฑูŠุถ ูู…ู…ูƒู† ุงุณูˆูŠ ู‡ู„ ุงู„ุฎุทูˆุฉ)

๐Ÿ›‘ ูุงู†ุชู‚ู„ ู„ู„ุฎุทูˆุฉ ุงู„ุซุงู†ูŠุฉ ูˆ ุงู„ูŠ ุชูƒูˆู† ุงุจุณุท ูˆ ุงุณู‡ู„๐Ÿ‘‡๐Ÿป

2โƒฃ ุงูุญุต ุงู„ loss of sensation ุจุงู„ู…ู†ุทู‚ุฉ ุงู„ู…ุฐูƒูˆุฑุฉ ุจุงู„ุตูˆุฑุฉ ุจุงู„ุงุนู„ู‰๐Ÿ‘†๐Ÿป ุงุฌูŠุจ ู…ุซู„ุง ุฏุจูˆุณ ุงูˆ ุจุฃุจุฑุฉ ูˆ ุงฺ†ูƒ ุงู„ู…ุฑูŠุถ ฺ†ูƒุงุช ุฎููŠูุฉ ุจู‡ู„ ุงู„ู…ู†ุทู‚ุฉ.. ุฑุงุญ ุงุดูˆูู‡ ู…ุง ูŠุญุณ ุจุงู„ู…ุŒ ูˆ ุงู„ู…ู†ุทู‚ุฉ ู…ุชุฎุฏุฑุฉ ุนู†ุฏู‡ ูุงุนุฑู ุงู† ุงู„ุงูƒุฒู„ุฑูŠ ู†ูŠุฑู ู…ุชุถุฑุฑ ู…ู† ุงู„ูƒุณุฑ โœ…
ูƒู„ูŠู†ูŠูƒุงู„ ๐Ÿ˜ƒ๐Ÿ‘†๐Ÿป
#MSK_S3
#MSK_S4

๐Ÿ’ฅThe cubital fossa;The cubital fossa is an area of transition between the anatomical arm and the forearm. It is located as a depression on the anterior surface of the elbow joint.

๐ŸŒŸBorders
The cubital fossa is triangular in shape, and thus has three borders:

Lateral border โ€“ medial border of the brachioradialis muscle.
Medial border โ€“ lateral border of the pronator teres muscle.
Superior border โ€“ hypothetical line between the epicondyles of the humerus.
The floor_ of the cubital fossa is formed proximally by the brachialis, and distally by the supinator muscle.
The roof _consists of skin and fascia, and is reinforced by the bicipital aponeurosis.
The contents of the cubital fossa include vessels, nerves and the biceps tendon (lateral to medial):

_Radial nerve
_Biceps tendon
_Brachial artery
_Median nerve
In full extension the ulna makes an angle of about 170 ยฐ with the long axis of the humerus. This is termed the carrying angle and is more acute in women ( โ™ ๏ธ due to the wider hip bones .
ุนุธู… ุงู„ุญูˆุถ ู„ู„ู†ุณุงุก ุงุนุฑุถ.. ููŠุฒูŠุฏ ู…ู† ุงู„ู…ุณุงูุฉ ุจูŠู† ุงู„ูŠุฏูŠู† ูˆ ุงู„ุฌุณู… ุนู†ุฏ ุงู„ูˆู‚ูˆู ุจูˆุถุนูŠุฉ anatomical position ๐Ÿงโ€โ™€)

ู…ู…ูƒู† ูŠุฌูŠ ุงู…ุณูƒูŠูˆ ๐Ÿค“๐ŸŒš

Cubitus varus: A deformity of the elbow resulting in a decreased carrying angle There is deviation of the forearm toward the midline of the body. ุงู‡ู†ุง ุงู„ุฒุงูˆูŠู‡ ุฑุงุญ ุชู‚ู„ ูˆุชูƒูˆู† ุงูŠุฏู†ุง โœ‹๐Ÿปุงู‚ุฑุจ ุงู„ู‰ ุงู„ุฌุณู…

Cubitus valgus: A deformity of the elbow resulting in an increased carrying angle, the forearm and hand are held at greater than 15 degrees). ุงู‡ู†ุง ุงู„ุฒุงูˆูŠู‡ ุฑุงุญ ุชุฒูŠุฏ ูˆุชูƒูˆู† ุงูŠุฏู†ุงโœ‹๐Ÿป ุงุจุนุฏ ุนู† ุงู„ุฌุณู…
#MSK_S5 ๐Ÿ‘†๐Ÿป
๐Ÿ’ซcell involved in chronic inflammation

โค๏ธ-microphage:--- domint cell

ุงู„ู…ุงูŠูƒุฑูˆููŠุฌ ูŠุฌูŠ ู…ู† monocyte
ุชูˆุฌุฏ macrophage ููŠ ุงู„ุนุฏูŠุฏ ู…ู† organูˆูƒู„ ุงูˆุฑูƒุงู† ุงู„ู‡ุง ุงุณู… ุจูŠู‡ ๐Ÿ‚

๐ŸŒ™spleen+lymph nodโžก๏ธsinus histeocytes

๐ŸŒ™CNSโžก๏ธmicroglial cell

๐ŸŒ™liverโžก๏ธkuffer cell

๐ŸŒ™lungโžก๏ธalveolar macrophage

๐ŸŒ™boneโžก๏ธosteoclast


function of macrophage

๐ŸŒน-phagocytosis

๐ŸŒน-display antigen to T lymphocyte

๐ŸŒน-inities tissue repair

๐ŸŒน-secret inflammator mediator such as cytokines(TNF/IL)

#mod_s3
๐Ÿฃcompostion of granuloma

1-epitheloid cell
2-multinucleat giant cell
3-lymphoid cell
4-nicrosis&fibrosis

๐ŸŒธ๐Ÿ€cause of granuloma

1-unknown etiology
โžก๏ธsarcoidosis
โžก๏ธde nova granuloma

๐ŸŒธ๐Ÿ€2-immune-mediated disease

โžก๏ธchronic disease
โžก๏ธrheumatoid disease
โžก๏ธulcerative colits

๐ŸŒธ๐Ÿ€3-response to foreign body

๐ŸŒธ๐Ÿ€4-persistent T cell response to microbe

#mod_s3
ุชุนุงู„ูˆุง ุดูˆูŠู‡ ูˆูŠุงูŠ ูˆุฑูƒุฒูˆุง ุทุจุนุง ูƒู„ุด ุจุณูŠุท ุชุดุฑูŠุญ ุจุณ ู…ุดูƒู„ู‡ ุงู„ู†ุณูŠุงู† ุนู„ุงุฌู‡ ุงูŠุด ุงู†ูˆ ุชูƒุฑุฑ ูˆุชุฑุณู… ู…ุฎุทุท ุจุณูŠุท ู„ู„ูŠ ุญูุธุชู‡ ูŠู„ุง โค๏ธ๐Ÿ‘Š๐Ÿ‘๐Ÿ‘‡๐Ÿป๐Ÿ‘‡๐Ÿป