● 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

🗨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

🗨 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

🗨 Note :- ( C5 )

Above C5 :
• unilateral = hemiplegia
• Bilateral = quadriplegia

Below C5 :
• unilateral = monoplegia
• bilateral = paraplegia

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

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

■ 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)

■ توضيح الإجابة : ده تفسير دكتور الهواري اللي سمعه هيعرف ده و مكتوبة في كتابه 😉

أنا بنفع استخدم أي واحد فيهم لأنه كل واحد فيهم effective
بس م ينفعش استخدم الاثنين مع بعض في آن واحد
طيب هو مين ttt of choice طبعاً plasma exchange
ليه ؟ لأنه أقل في side effects من أعراض الجانبية بتاعت IVIG

دي أهم حاجة لازم تبص عليها عشان ال mcq
من كتاب دكتور الهواري

■ Notes on IBS :-

♤   Abdominal pain is increased  after meal & stress & decreased by defecation

♤ IBS with constipation is the most common type

♤ the symptoms are more common in women
♤ IBS is a clinical diagnosis by exclusion of oragnic causes

♤ colonscopy is done if older > 50 years to exclude any pathology

♤ Rectal biopsy is done if frequency of defecation is a featute

♤ the 1st step in ttt is Reassurance with lifestyle modification 

■ Notes on Esophageal diseases :-

● Achalasia :
♤ d.t abscent esophageal ganglion cell

♤ it is more common in middle aged female

♤ dyphagia is more for fluid

♤ LES pressure  is high

♤ it appears in barium swallow as bird's beak appearance or rat's tail appearance

♤ its manily treated by surgical ttt as myotomy & POEM

● GORD :-
♤ it is the most common cause of non cardiac chest pain

♤  it is common in pregnant women : 80%
♤ LES pressure is low

♤ Heartburn is the major feature ( 30%)

♤ chest pain is inceased by bending & starining & lying down & releived by antacids & nitates

♤ GORD is essentially a clinical diagnosis

♤ 24 hour PH monitoring is the most important investigation ( Goldstandard)

♤ Normal endoscopy does not exclude reflux disease

♤ it leads to IDA & barrett' esophagus & adenocarcinoma

♤  PPIs is the drug of choice in ttt especially
omeprazole  

■ Notes on PUD :
♤ the most common site is duodenum

♤ Bismuth containing preparation was considered the DOC for ttt PUD

♤ triple therapy ( omeprazole & Clarithromycin & Amoxicillin ) is the most widely used & approved therapy be given for 7-14 days

♤ Levofloxacin is used in resistant cases of PUD

♤ the most common complication is GIT bleeding 

♤ the most common symptom in DU & GU is epigastric pain

♤  Endoscopy : the most sensitive & specific approach for examining the upper GIT 

♤ H.pylori is present in both GUs & DUs

♤ H.pylori infection : distal gastric cancer & PUs & antral gastritis & MALT lymphoma

♤ H Pylori Ag in stool is the most imporatnt investigation & for follow up of ttt
● DUs :
♤ the pain awake the patient from sleep & increased by fasting & decreased by meal & antacids
♤ more common on O blood group

● GUs predispose to malignant change 

♤ NSAIDs inhibit Cox1 in stomach & it leads to GIT bleeding & Perforation 

♤ Nausea & wt loss are more with GU patients
♤ sudden onset of symptoms indicate perforation

■ Notes on GIT internal medicine :-

● IBD :

○ MCQ on IBD :
https://t.me/med_Notes2/353

○ UC :
https://t.me/med_Notes2/348

○ CD :
https://t.me/med_Notes2/351

● PUD :
https://t.me/med_Notes2/335

● Esophageal diseases :
https://t.me/med_Notes2/334

● IBS :
https://t.me/med_Notes2/333