■ Notes on pharynx ( Part 1)  :-

♤ the routine investigation to diagnose adenoids are plain x-ray on nasopharynx

♤ the commonest cause of death in diphtheria is airway obstruction d.t pseudomembrane

♤ pulse in diphethria :not conicides with temperature

♤ the most imporatnt item in ttt post tonsillectomy 2ry Hge is Antibiotics

♤ during tonsillectomy the neck must be extended

♤ the cause of 2ry hge after tonsillectomy is due to infection of tonsillar bed

♤ tonsillectomy is absolutely  CI  in case of hemophilia & purpura & heart & kidney diseases

♤ during adenoidectomy the neck must be flexed to avoid injury of prevertebral ms

♤ in plummer vinson s : dysphagia is more for solids then fluids

♤  quinsy is ch.ch by deviation of uvula to opposite side & trismus & drooling of saliva

♤ trismus in qunisy is due to spasm of medial pterygoid ms

♤ the most dangerous organism causing acute follicular tonsillitis is beta hemolytic streptoccus

♤  Trotter's triad is ch.ch by unilateral ( facial pain , conductive deafness , palatal immobility )

♤ Nasophayngeal carcinoma don't affect on the facial nerve

♤ the most common presentation for nasopharyngeal cancer is neck mass

♤ peritonsillar & parapharyngeal & retropharyngeal & submandibular spaces are the site of abscess formation in the head & neck

■  Notes of Pharynx (Part 2 ) :

♤ Acute retropharyngeal abscess is treated by internal drainage via longitudinal inscision

♤  the swelling in Acute retropharyngeal abscess in one side of the midline of the pharynx

♤ the commonest site of quinsy is superior to tonsils


♤  While chronic retropharyngeal abscess is ttt by External drainage posterior to sternomastoid ms

♤  Frog face appearnce is a clinical manifestation of nasopharyneal fibroma

♤ Ludwig angina is a cellulitis of floor of mouth



♤  Pain in the ear in cases of acute tonsillitis referred via 9th nerve


♤ Vincet's angina is ch.ch by very severe local symptoms & mild systemic symptoms

♤ low grade fever &  feeble  very rapid pulse & bull neck are known to occur in tonsillar diphtheria 

■ Notes on Phaynx :

● Part 1 :

https://t.me/med_Notes2/366

● Part 2 :

https://t.me/med_Notes2/368

■ 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

الجواب ده صح

* Crypts infiltrated by excessive neurtophil
يعني crypts م بيحصلش ليها destruction  ال lumen بتاع ال crypts  infiltrated by
neurtophil
▪︎ خلي بالك ال neutrophil  بتكثر ف حالات bacterial infection & و ف حالات non infective inflammatory disease

مساء الخير
لازم ع الأقل
حاولوا ع قد م تقدروا تحلوه MCQ الجراحة الميد و الفاينال و ال case تعت tbl كلها جت من كتاب MCQ الجراحة رغم أنه في حاجات مش علينا فيه

# إجابات أسئلة الميد الخاصة بالباطنة :-

● the most common extra-intestinal manifestation for UC is PSC

● the manistay drug used in maintenance in mild to moderates UC is: sulfasalasin

● All the following about NSAIDs using in peptic ulcer are true except :
mucosal ulcer due to inhibit COx2

● cobblestone mucosa in case of: CD

● in case of Acute flares up of colitis the drug used is IV Glucocorticosteroid for 3 days

● Combination of drugs used in case of H pylori infection for 14 days

●zolinger ellison syndrome ( Hypersecrteory state )

# إجابات الأطفال :-
● All true is about fluid maintenance therapy in the following except : 30 mL for 11 to 20 kg

●Acute liver cell faliure is defined by the following except : Coagulopathy corrected by vit k

● the components of ORS are true except : Glucose 5 gm

اللهم يا رحيم يا كريم، نسألك أن تفرج كرب أهلنا في رفح، وأن ترحم ضعفهم، وتؤمن خوفهم. اللهم احفظهم بحفظك، واكلأهم برعايتك، وكن لهم معينًا ونصيرًا.

اللهم داوِ جرحاهم، واشفِ مرضاهم، وارحم شهداءهم. اللهم فرج همهم، وارفع عنهم البلاء، وارزقهم الأمن والسلام. اللهم احفظ أطفالهم، وبارك في شبابهم، واغمرهم بواسع رحمتك ومغفرتك.

اللهم كن لهم عونًا ونصيرًا، وأعد إليهم بيوتهم وأمنهم، واجعل لهم من كل ضيق مخرجًا ومن كل هم فرجًا. اللهم ارزقهم الصبر والثبات، واملأ قلوبهم بالأمل والإيمان.

اللهم اجعل لهم نصيبًا من نصرك وعزك، وانصرهم على من ظلمهم، واجعل لهم فرجًا قريبًا. اللهم احفظهم بحفظك، واكلأهم بعنايتك، وكن لهم سندًا وعونًا يا رب العالمين.

آمين يا رب العالمين.

🗯 Notes on IDA :-

● the most common cause of anemia worldwide

● The most common cause for IDA is Increase blood loss of iron

● the 2nd most common casuse for IDA is Malabsorption syndrome

● Iron deficiency in an adult male or postmenapasual means GIT blood loss until proven otherwise

● koilonychia is a characteristic feature for IDA

●Ankylostoma duodenale cause IDA & alternating diarrhea & constipation & Eosinophilia

● Plummer vinson syndrome cause IDA with stomatitis & spooning & splenomegly

● CBC : feature of microcytic hypochromic anemia

● Iron profile :
all decreased except TIBC ( is the amount of iron in the lab needed to be fully saturated the transferrin molecule)
( محتاج حديد زيادة عشان اشبع transferrin )

● occult blood stool :
دكتور الهواري قال لازم عشان تعمله لازم المريض قبل 3 days ميأخذش Fe or NSAIDs or Aspirin or meat or washing the teeth عشان ممكن
يطلع ال test is false positive

● repeated blood donation :
بتعمل IDA يعني م ينفعش حد يتبرع دايما لازم يكون في proper space time من 3 لحد 4 شهور
إلا إذا مع سابق الرصد و الترصد تجيب للعيان مشكلة

🗯 Notes on ttt of IDA :-

● Oral replacement of iron : the ttt of choice in case of ferrous

● Hgb increase About 1gm% weekly until normal level are stored ( 4-8 ) weeks

● once Hgb normalize , oral iron should be continue for 6 months
دكتور الهواري بقول لو أعطيته أكثر من 6 شهور هتعمل overcorrection و هتجيب للعيان مرض بسبب ال iron الزيادة ده ( hemochromatosis )

● Parental iron replacement is given in case of MAS & chronic blood loss
خلي بالك لو اعطيته IV فهو very very irritant و مش اي حد يعطيه لازم دكتور hematologist و لو حصل anaphylaxsis لازم تكون محضر
Adrenaline & steroids

● Packed RBCs are given in case of severe symptoms of anemia , anemic HF , Hgb less than 7 g  / dl

" في هذه الأيام  المباركة وفي يوم عرفة  حيث يتباها الله بعبادة...وخير الأعمال فيه الدعاء... لا تنسوا الدعاء لغزة وفلسطين والمجاهدين  المرابطين في سبيل الله المدافعين عن الأرض والعرض وثالث الحرمين " .

🗯 Notes on megaloblastic anemia :-

● Anemia is due to deficiency Vit B12 & folic acid
●  Neurological manifestations only in Vit B12 deficiency

● there are anemia & pancytopenia

● Vit B12 defieciency affect on 3P
( posterior column & pyramidal tract & PN )

● Pernicious anemia ( PA ) :

♡ Autoimmue disease which lead to decrease IF & Vit B12

♡ serology :  ( Antiparieral cell Ab , Anti IF Ab)

♡affect Male more than female > 50 years

● CBC :
* features of macrocytic  anemia

● leucopenia ; with shift to the right

● Reticulocyte count is increased ( anemia under ttt )
● Serum homocysteine increase with both

●  Schilling test :
* only with vit B 12 deficiency
* before performing the test , KFT should be completely normal

● in folic acid deficiency make sure this is not Vit B 12 deficiency

● Vit B12 deficiency should be excluded before given folic acid since it may aggrevate the neurological manifestations

 

■ Notes on Hematology :-

● IDA :
https://t.me/med_Notes2/377
https://t.me/med_Notes2/380

● megaloblastic anemia :
https://t.me/med_Notes2/383

جدول مهم

🗯 Notes on ACD & sideroblastic anemia :-

■ ACD :

● it is the 2nd most common of anemia

● buz of impaired release of iron

● serum ferritin is high as part of APR

● I repeated
مش كل chronic disease بيعمل anemia of chronic disease دي قاعدة لازم تحطها دايما
الحقيقة  LCF ع الرغم انه chronic disease لكن ميعملش ACD طبعا ليها مواصفات معينة :
chronic inflammation , chronic infection , malignancy

■ sideroblastic anemia :-

● inability to use iron in formation of Hb
● ringed siedroblasts is the hallmark of sideroblastic anemia

● in 10 % tansform to AML

🗯 Aplastic anemia :

●  خلي بالك بتعمل Normocytic normochromic anemia 

● ممكن يحصل mild macrocytosis و دا في حالتين : stress erythropoiesis & elevated fetal hemoglobin

♤ سبب mild macrocytosis ؟

◇   as RBCs مثلاً لما تبدأ  synthesized بتكون big cell و لما تصل لل mature RBCs تصغر حجمها ، عشان كده لو حصل مشكلة ف BM ف كل steps اللي بتخلي pre-erythrocyte تتوقف أنها تتحول ل mature RBCs و عشان كده الخلية preginator cell is big cell , which give u high MCV