" Clinical Notes "
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" صدقةٌ جاريةٌ عن أرواحِ شهداء غزة ."🇵🇸

ادعوا لهم بالرحمة و المغفرة .
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" Clinical Notes " pinned «تجميعة للكل notes ع أهم الدروس في مديول CNS: ●Hemiplegia : https://t.me/Medcology_CNS/280 https://t.me/Medcology_CNS/282 https://t.me/Medcology_CNS/303 ●MS: https://t.me/Medcology_CNS/378 ●Myopthay: https://t.me/Medcology_CNS/338 ● PN : https://t.me/Medcology_CNS/306…»
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مساء الخير يا شباب
دي أهم الأسئلة على الجراحة ؛-
● C/P & TTT of cervical spondylosis

●  C/P &  TTT of lumbar disc prolapse

● Management of Lumbar canal stenosis

● Enumerate clinical types of tumors of neuroepithelail tissue

● Enumerate lines of ttt of brain
tumors

● C/P & investigation of brain tumors
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■ Diagnosis of schizophrenia :-

● +ve symptoms :-

3D:♡ Delusions , disorganized behaviour , disorganized speech
Hallucinations

● -ve symptoms:
5A : Anhedonia , Avolition , Alogia , Asociality , Affect flattened

● symptoms last at least 6 months

● not cuz by substance use or medical condition

● presence of significant social or occupational dysfunction
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مساء الخير يا شباب :
دي أهم الأسئلة على السايكاتري
● Diagnostic criteria of schizophrenia

● Diagnostic criteria of major depressive episode

● Diagnostic criteria of manic depressive episode

● pharmacotherapy of major depressive episode & schizophrenia
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All the following cause motor neuropathy except ?
Anonymous Quiz
72%
Pellagra
4%
Perotneal muscular atrophy
6%
GBS
5%
Lead neuropathy
12%
DN
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All the following can casue lost of ankle reflex with preserved knee reflex except ?
Anonymous Quiz
4%
Periphreal neuritis
16%
Epiconus
18%
Cauda equina affect S1
62%
Pellagra
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● Note on pellagra :-

♧It causes mainly sensory peripheral neuropathy

♧ it cause lost of ankle reflex with exaggrerated knee reflex d.t affect on periphral nerve & pyramidal tract
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🗨C/P of GBS :-

■febrile stage : influenza like attack with FAHM
■ latent stage : above symptoms disappear , pt is free for 1-4 weeks

■ paralytic stage :

● Motor :
♧Weakness with an ascending march :-
acute severe symmetric  weakness or paralysis starting in LL & ascending to trunk & respiratory ms followed by the UL ms
♧ Weakness proximal > distal
♧ No wasting in spite of the degree of paralysis

● Sensory :
♧ glove & stoke hyposthesia & deep sensory loss
● Autonomic : instability with hypo or hyper tension
● Reflexes : decrease deep reflexes

● Cr.Nr : especially 7& 10

● CSF : cytoalbumin dissociation
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🗨 TTT of GBS  :-

● Should begin as soon as possible within 1st 7-10 days

● General lines :
♧ bed rest : till HR below 100/min
♧ Vitamins : B1 ,B6 ,B12 IM daily
♧ physiotherapy
♧ Antibiotics : aganist 2ry infection

● Specific lines :
♧ IVIG
♧ Plasma excahnge ( the ttt of choice)
♧ Both IVIG & PE are equally effective

● TTT of complications :
♧ Care of the bulbar ms :
•frequent suction from the pharynx + tube feeding in pharyngeal paralysis

♧ care of respiratory ms :
Suction to keep a patent airway + tracheostomy
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🗨 Note :- ( C5 )

Above C5 :
• unilateral = hemiplegia
• Bilateral = quadriplegia

Below C5 :
• unilateral = monoplegia
• bilateral = paraplegia
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مساء الخير يا شباب دي أهم الأسئلة في الباطنة و النيورولوجي :-
● C/P & TTT of MS

● Risk factors of hemiplegia

● Lines of ttt of hemiplegia

● Give a short account on GBS ( C/P+ TTT)

● enumerate causes of PN & its C/P

● Compare b/w ischemic stroke & ICH

● Enumerate causes of epilepsy & investigations
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الأطفال ركزوا ع سؤال Clinical types& TTT & C/P of cerebral palsy
و برضو ركزوا ع سؤال enumerate causes of inability of walk
و برضو سؤال summarize ttt of epilepsy
ركزوا احتياط ع سؤال diagnosis & ttt of febrile convulsions
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■ Notes on peripheral nerve injury : -

C5, 6: Policeman tip position

C567: wrist drop

T1: Horner syndrome

C8T1: Claw hand deformity and horner syndrome.

Radial nerve : wrtist drop

Median nerve at elbow: FDP, pointing infex.

Ape like hand: median nerve at elbow(small muscles of hand).

Ape like hand, wasting of eminence:
1 Abductor
2 Flexor
3 Opponens: no opposition
4 Radial 2 lumbricals.

Median nerve at wrist : paralysis of above muscles
Radial deviation of hand :ulnar paralysis at elbow

Ulnar deviation of the hand: median n at elbow

Cardboard test: ulnar nerve paralysis of intrrossssi (ring, little, Index)

Froment test(adductor pollicis) thumb and index.

Flattening of hypothenar eminence and interossei hollowing : ulnar nerve

Foot drop : sciatic nerve and lateral popliteal n.
Paralytic equinovarus : longstanding lateral popliteal nerve

Lumber sympathectomy= Upper 3 lumber gangila in Burger's disease

Cervical sympathectomy = 2nd & 3rd thoracic ganglia except stellat ( raynaud's & hyperhydrosis)
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