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

ادعوا لهم بالرحمة و المغفرة .
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A patient presents with sudden onest of 7th nerve palsy affecting all 3 facial muscles , the 1st line of TTT is
Anonymous Quiz
44%
Continous ocular lubricating
39%
Immediate lateral tarsorrahphy
8%
Immediate resection done of levator ms
10%
Corticosteriods use
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Which of the following should be treated early as possible as ?
Anonymous Quiz
6%
Myasthenic ptosis
4%
Aquired ptosis
0%
Hysterical ptosis
89%
Severe unilateral congenital ptosis
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A pateint come to ophthalomologist clinic complaing of defective division with sleep appearance , the DR do MRD = 2mm with good levator function which is the following operation done for patient ?
Anonymous Quiz
1%
Leavotor tucking
54%
Levator resection
12%
Sling operation
34%
Fasenella servant operation
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" Clinical Notes " pinned «صباح الخير تنسوش ال notes و ال mcq على TBL ■ Eye lid diseases :- https://t.me/med_Notes2/28 https://t.me/med_Notes2/34 ■ MCQ on TBL :- https://t.me/med_Notes2/36 ■ Note on MRD :- https://t.me/Medcology_Special_Sense/654»
بالنسبة للسؤال بتاع ptosis ك misdiagnosed as
طبعا الجواب الصح ipsilateral hypotropia لأنها من ضمن أسباب pseudoptosis
● Ipsilateral hypotropia, a form of strabismus, may give rise to a pseudoptosis because the upper lid follows the globe inferiorly.
و دي أسباب pseudoptosis ؟
︎ ipslateral hypotropia
︎ ipsilateral brow ptosis
︎ ipsilateral lack of support of upper lid
︎ ipsilateral dermatochalasis
︎ contralateral lid retraction
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كدا مفيش كلام بعد كده بعد الشرح و المصدر اللي بجيب منه
عشان كده المصدر و الأسئلة الللي بجيب منه بكون متاكد قبل ما أنزله و بنزل الأسئلة على حسب الكتاب اللي معنا مش من منهج قديم
و د.أحمد كمال أكد الكلام و الجواب زي ما هو محلول ipsilateral hypotropia
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■Notes on Cornea :- ( part 1)
● the commonest cause of interstitial keratitis is HSV & HSV
●Keratoconus :-
♧ It is a progressive conical protrusion of the cornea & it is more common in female
♧ the cause is unknown may be associated with down & Marfan syndrome  
♧ it comes in Ealry adluthood with gradual
painless diminution of vision & sudden painful dimiution of vision d.t Acute hyprops
♧ Corneal totpgraphy is used before LASIK to evaulate corneal ( thickness , curvature , power)
■ Keratoplasty :
♧ the donor cornea must be free from HIV & hepatitis
♧ it dones with circular incision around diseased cornea & removed or by femto laser
♧ corneal graft is sutured
■ Arcus senilis :-
♧ it is common in old age & it is a bilateral & may be unilatreal in case of unilateral carotid stenosis
♧ May affect young d.t DM or hyperlipidemia
■ Notes on cornea :- ( part 2 )

● the diameter of cornea measured by caliber or pentacam topography
● the thickness of cornea measured by pachymetry
● The bowman layer can't regenerate while descement membrane can regenerate
● Endothelium of cornea decrease in no.  with age & examined by specular M.C
● Pneumococci is the commonest  organism in case  of bacterial keratitis
● double therapy of antibiotics is the 1st line ttt in aggressive disease of bacterial keratitis
● heaped hypopyon is associated with fungal keratitis
● Steriods+ corneal ulcer = corneal perforation
● Keratomalacia  :
♤ there is melting of cornea & eye is quite
And TTT by topical vit A & associated with nutritional deficiency
● Corneal anaesthesia = neurotrophic keratitis :-
♧ Herpes zoster of ophthalmicus is the most common cause
♧ IT treated by median tarsorraphy
● Exposure keratopathy is affect lower 1/3 of the cornea with upper horizontal line
● Degree of corneal opacities :-
♧ nebula , macula, leucoma
♧ nebula affect vision more than macula
● 2ry glucoma :-
♧ Anterior staphyloma ♧ corneal fistula ♧ leucoma adherent 
صباح الخير دي مهمة و ركزوا عليه
دي مقارنة بين ciliary & conjunctival injection
■ الشباتر الصغيرة في الرمد :- من 5 لحد 10 صفحات
Pupil , sclera , orbit , intra ocular tumors , lens , optic nerve
■ الشباتر المتوسطة ب 17 صفحة :-
Glucoma , errors of refraction , squint
لو بديت فيهم هتخلص بدري .
■ Notes on middle ear diseases : ( part1):

● Dehiscene of the bony facial canal is the most common congenital anomaly of the middle ear
● incudostapedial joint is the most common affected joint in ossicular disruption
● Otitic barotraumas happen when the different pressure on both sides of ear drum more than 80 mmHg
● severe cases of otitic trauma ttt by myringoplasty
● longitudinal fracture base of the skull is the most common , while transverese fracture is the most serious
●Haemtympanum is one of sign of transeverse fracture
● E.T is one of the commonest route of infection in case of  otitis media
● Nose is one of the commonest source of infection in case of O.M
● Any Deafness is associated with tinnitus
● Earache with diminution of hearing after common cold may be d.t AOM
●  in case of catarrhal O.M :
♤ congested T.M  with CHL
● in case of suppuration O.M :
♤  after drum perforation : all signs of inflammation and pain & discharge decrease & there ia central perforation
● CT & PTA are most important investigation
● A child with earache or night crying after common cold = AOM
● AOM is common in infant & young children is due to E.T is short &wider& more horizontal
● OToscopy : the drum is thick & doesn't bulge easily & lusterless
● myringotomy is done after faliure of TTT for 48 hrs
● complication is more common d.t misdiagnosis as G.E & low resistence
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مساء الخير يا شباب في أكثر من حد بعت متى هنزل الجزء الثاني أنا للاسف مش هقدر انزلها اليوم لأني تعبان و مريض شوي
أنا كتبتها بس مش كلها هنزلها بكرا الصبح بإذن الله بعد ما اكملها
دعواتكم الي أني أكون بخير .
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