■ 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

■ Notes on IBD :-
● UC :
♤ the disease starts distally in Rectum then spreads proximally

♤ Bleeding per rectum is the most important feature

♤ perforation is the most dangerous of the local complications

♤ Increase risk of cancer colon more than CD

♤ somking is a protective for UC

♤  decrease of Albumin is due to poor nutrition & PLE & -ve ARP

♤ fecal lactoferrin is a highly sensitive & specific marker for detecting intestinal inflammation

♤ colonoscopy is the most important investigation is used to assess disease extent & activity

♤ barium enema :
lead pipe appearance ( loss of haustration + narrowing the lumen)
PseudoPolyp

♤ 5-ASA Agents is the mainstay of ttt in mild to moderate UC

♤GCs is used in acute flares only not in remission manitenance ( moderate to severe UC)

♤ metronidazole & ciprofloxacin is the most commonly used

مقارنة بين UC & CD مهمة

■ Notes on CD :-

♤ terminal ileum & right colon ( ileocolonic) are most commonly involved

♤ cobblestone appearance is the characteristic of CD

♤ pain  & tenderness in right iliac fosaa = acute appendicitis is relieved by defecation

♤ Malabsorption syndrome is more common with CD ( decrease in Na & mg & ca & albumin& fat soluble vitamins )

♤ it lead to intestinal obsdruction & fisula formation

♤ Colonoscopy is the most important investigation

♤ barium enema : severe narrowing of the lumen ( string sign )

♤ AZA as maintenace therapy in UC & CD & treating active perineal disease & fistula in CD

♤ Ciprofloxacin & metronidazole are effective in peri anal CD

♤ Avoid antidiarrheal durgs in toxic megacolon lead to precipitate toxic megacolon with colonic inflammation