“ملخص لمحاضرات الدكتورة أمة الرحيم القهالي لمقرر CVS

ملاحظات👇

1⃣ يحتوي هذا الملخص على ماتم شرحه من قبل د. أمة الرحيم القهالي مع إضافه بعض المعلومات من مصادر أخرى في بعض المواضيع..

2⃣ هذا الملخص لا يغنيك عن الإطلاع على مصدرك المفضل أو أي مصادر تحب القراءة منها
وكذلك الاطلاع على محاضرات الدكتورة‼️

3⃣ نعتذر عن وجود أي أخطاء ونتمنى منكم إبلاغنا ليتم تعديله.

4⃣ فيما يتعلق بملخص Renal سيتم إنزاله قريباً💯


#اللجنة_العلمية_للدفعة_الخامسة_طب_بشري
#نرسم_لك_الطريق👨‍🦯

تفريغ محاضرة HTN🔥

Cardiology

Kidney

تفريغ محاضرة
Abnormal ECG & Arrhythmia
للدكتورة أمة الرحيم

ملف دورة ECG بصورة واضحة ل الذي لم يتضح له في الملخص

تفريغ لكلام الدكتوره بس ما ادري ان كان كافي او لا 🤷🤷

تفريغ محاضرة الدكتورة أمه الرحيم القهالي

nephritic syndrome.doc'

mechanical valves VS  bioprosthetic valves

محاضرة الدكتورة امة الرحيم congenital heart disease👆👆

من قناة الدفعه 2 البكالوريوس

كل الشكر للزميل عادل القيسي

الملف الذي كتب الدكتور نشوان الحالات منه في الاختبارات السابقة 👆

_____بوست 3️⃣____
Unusual features in SLE & Associated conditions
-----------------------------------------------------------------------------

دليلك الكامل لكل ما هو صعب وغير نمطى فى مريض
الذئبه

#Nonspecific cutaneous SLE
~~||~|~~~

✅Nonspecific cutaneous SLE refers to features relating to underlying illness rather than an autoimmune attack.

🌀These features may occur in other connective tissue and autoimmune diseases.

1) Nail fold capillary telangiectasia

2) Raynaud phenomenon (white fingers and toes on exposure to the cold)

3) Vasculopathy of tips of digits (occlusion of small blood vessels by thrombus)

4- Diffuse hair thinning without brittle hair

5- Urticaria, which may be neutrophilic on biopsy
Angioedema also can occur

6- Cutaneous vasculitis: palpable purpura or
urticarial vasculitis

7- Livedo reticularis (a network pattern of blood vessels) in 20–30% patients with SLE

N.B : patient with SLE can present by Angioedema

🔷Uncommon GIT symptoms
•••••••••••••••••••••••••••••••••••••••

✏️Anorexia , nausea and vomting

✏️Abdominal pain due to peritoneal inflammation ( peritonitis as one of polyserositis)

✏️mesentric vasculitis , bowel infarction , perforation & peritonitis

✏️Liver affection
Associated elevated liver enzymes

✏️SLE can be associated with Autoimmune hepatitis at the same time

🔷Uncommon chest Features
••••••••••••••••••••••••••••••••••••••

✏️Acute pneumonitis :
Presents é fever , cough , dyspnea and pleurisy along with late inspiratory crackles on the chest
🫁CT chest : ground glass apperance

✏️Alveolar hemorrhage ; acute onset of dyspnea , fever , hemoptysis + low O2 saturation
🫁CT chest : bilateral alveolar shadows with airbronchograms

✏️interstitial lung fibrosis related to SLE as any connective tissue disease ( gradual dyspnea , dry cough along with inspiratory crackles on the chest

✏️Pulmonary Hypertension ( high JVP, pitting LL edema , accentuated P2 ± left parasternal pulsations/heave

✏️Shrinking Lung Syndrome
It is a a rare complication characterized by dyspnea , episodic pleuritic chest pain , and progressive reduction in lung volume in abscence of interstitial fibrosis
🫁CT chest : unexplained lobar collapses


✏️Pulomnary embolism can occur due to Anti-phospholipid syndrome secondary to SLE مهمه جداااا

Unusual Cardiac manifestations of SLE
=================================

✏️Valvular lesions called Libman-Sacks endocarditis that develop in 6 - 10 % of all SLE patients
#there are non-bacterial verrucous lesions near the edge of mitral , aortic and tricuspid valves { mostly affecting the mitral valve leading to Mitral Regurge

Some of cases are Asymptomatic while
the others are Symptomatic ,
Some cases lead to systemic emboli
Also Non-bacterial endicarditis may occur

N.B : Mitral Valve proplapse is frequently seen in SLE patients

✏️Myocarditis : is an uncommon comolication of SLE

C/P
resting tachycardia out of proportion to temperature with non specific ECG changes + Cardiomegaly
-> Global hypokinesia is seen on ECHO

✏️Coronary heart disease can occur because of autoimmune coronary vasculitis + accelerated atherosclerosis

✏️Associated Anti-phospholipid Syndrome may lead to Myocardial infarction

✏️Pediatric complications
In mothers of SLE with positive Anti-Ro and/or Anti-La , there is 3% risk of developing NEONATAL LUPUS with Congenital Heart Block

Unusual neuropsychiatric features in SLE
••••••••••••••••••••••••••••••••••••••••••••••••••••••

Rule 1 : the range of neuropsychiatric symptoms of SLE is broad , it ranges from mild symptoms such as poor concentration and emotional disturbances to SEVERE SYMPTOMS such as Seizures, stroke and psychosis



Rule 2 :
التصنيف من الاكثر حدوثا فالاقل و هكذا

From the most to the least common, symptoms range from DEPRESSION, COGNITIVE DISTURBANCES , HEADACHE , MOOD DISORDERS , STROKE/TIA, SEIZURES , POLYNEUROPATHY , ANXIETY and PSYCHOSIS

Rule 3 : any neuro-psychiatric features should be assessed carefully ( there are many causes of each symptoms
لابد من استبعاد اى سبب اخر لاى عرض عصبى او نفسى ،، وفى حالة استبعاد الاسباب الاخرى تصنف الاعراض العصبيه او النفسيه بانها عرض للذئبه الحمراء

الكليه الامريكيه للروماتيزم صنفت كل الاعراض العصبيه
⤵️ للذئبه الحمراء كالاتى

Central ( brain & Spinal cord affection )

- Psychosis
- Mood disorder نفسى
- Cognitive dysfunction
مشاكل فى الذاكره والتركيز
- Anxiety disorder
اضطراب القلق
- Acute Confusional state
خلل حاد فى مستوى الوعى مع اضطراب الكلام والتصرفات

- Seizure تشنجات
- Stroke جلطة بالمخ
- Headache الصداع النصفى والعصبى
- Myelopathy
التهاب حاد فى الحبل الشوكى وغالبا ما يسبب شلل الاطراف وفقدان الاحساس تحت مستوى ال lesion مع عدم التحكم فى البول

- Movement disorders {Chorea & Ataxia}

- Demyelinating diseases

- Aseptic meningitis

Peripheral
••••••••••••••
- Guillain Barré Syndrome ( Association )
- Autonomic Neuropathy
- Mononeuropathy
- Polyneuropathy
- Plexopathy
- Cranial Neuropathy
- Myasthenia Gravis ( Association)

Uncommon manifestations include ⤵️

🚩Tranverse Myelitis
Triad ( Paraplegia + sensory level + Sphincteric features )
ودى حاله طارئه

🚩 CNS vasculitis
Rare manifestion in SLE ( fever, severe headache , confusion , progressing rapidly to seizures , psychosis then coma

🚩Reversible posterior leucoencephalopathy syndrome ( clinically , Seizure , disturbed conscious level , visual changes , and headache
MRI brain in PRES 🧠 --> vasogenic cerebral edema in posterior cerebral hemispheres

🚩Movement disorders ( chorea & Ataxia )

🚩Cranial neuropathies ( 5th, 7th and bulbar )

🚩Aseptic Meningitis

Unusual hematological features of SLE
===================================

#Evans Syndrome

Prescence of Autoimmune hemolytic anemia ( Coomb's positive ) + Thrombocytopenia concurrently at the same time

#TTP ( Thrombotic Thrombocytopenic Purpura )

Hemolytic anemia + thrombocytopenia

بس بشروط وهى ⤵️⤵️⤵️⤵️

1) evidence of intravascular hemolysis ( high retics , high LDH , low haptoglobin , positive hemosiderin ± hemoglobin in urine

2) Coomb's test must be negative to exclude autoimmune type of hemolytic anemia

3) blood film must have evidence of Fragmented RBC's ( Schistocytes)

4) associated Renal impairement
ممكن اه وممكن لا

5) Neurological features at the same time of this hemotological problem
فى صورة خلل فى الوعى او ضعف مؤقت فى جزء من الجسم وليس جلطه مكتمله بالمخ وده بردو ممكن اه او لا

6)associated fever at the same time of hematological problem

والنوع ده من ال ----------⤵️⤵️⤵️
TTP is secondary to SLE

#Pancytopenia

#Macrophage Activating Syndrome ( MAS)
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••

It is a rare condition that occurs secondary to SLE

It is a form of HLH ( hemophagocytic lymphohisteocytosis or hemophagocytic syndrome )

ودى اعراضها كالاتى ⤵️

- Bi or pancytopenia
- high PT , PTT
- marked elevated FERRITIN بالالاف
- high Triglycerides

Cause : low or abscent Natural killer cell activity --> ↑ soluble CD25 ( IL2 receptors)

Clinical features
••••••••••••••••••••••

Fever , weight loss , arthritis and rash

فى مثل هذه الحالات لابد ايضا من عمل بذل نخاع لاثبات التشخيص
BM examination will reveal hemophagocytosis ( infiltration of the BM by phagoctyes or histeocytes )

This condition responds well to
immunosuppression

🪩 Eyes Signs & symptoms in SLE
````````````````````````````````````````````````

المفروض مريضة الذئبه مش بتشتكى من عنيها ،، طب لو اشتكت ايه الاحتمالات الممكنه اللى ممكن تصيب العين ؟

1) Keratoconjunctivitis sicca

ودى هتخلى المريضه تشتكى من جفاف بالعين محتاج قطره واحمرار متكرر واحساس بوجود جسم غريب بالعين يسبب الحكه gritty sensation

Keratoconjunctivitis Sicca ? Why ??
⤵️
Associated Sjogren's syndrome

ملحوظه :
Sjogren's syndrome might come as a primary condition ,or secondary to other collagen diseases like SLE and Rheumatoid Arthritis
RA > SLE

2) Anterior Uveitis , keratitis and episcleritis
ودول بيحمروا العين ودكتور الرمد بيميزهم