🗯 تجميعات توكسو في المنهج :-

■ dilated fixed pupil with ( atropine , TCA , nutmeg , botulism )

■ bradycardia with ( OPs on M receptor , rabbit fish)

■ opsithotonus position ( high arched back ) with tetanus , Acute dystonic reactions , strchynine

■ hyperthermia with only herbicides , rabbit fish , NMS

■ HTN with tachycardia :
NMS , L.S.D , acute dystonic reactions , scorpion , strchynine

■ Gait : unsteady gait ( in atropine ) , shuffling gait ( in parkinsonism )

🗯 TTT of AF :-

■ if the patient is hemodynamic stable :

● Rate control
( slow Ventricular rate ) : BCD
♤ BBs , CCBs as verapamil & diltiazem , digoxin

● Rhythm control : (restore sinus rhythm)

◇ methods :-

1- chemical cardioversion ( oral class IC & class III , IAa agent , IV ibutilide )

2-electrical cardioversion ( DC)

♤ precautions :-

• DOACs is indicated if ( previous embolization , before DC , valvular disease as MS )

1- if AF < 48 h : immediately without DOACs

2- if AF > 48h : DOACs 3wk before & 4 wk after DC

■ if the patient is hemodynamic unstable ( hypotensive , angina , uncontrolled HF ) :
▪︎DC cardioversion

🗯 ttt of PSVT :-

■ If the patient is hemodynamic stable :-

1- vagal stimulation by carotid sinus massage or valsalva

2- slow ventricular rate ( rate control ) : IV ABCD : adenosine , BBs as propranolol , CCBs as verapamil , digitalis

■ if the pateint is hemodynamic unstable : ( hypotension , HF ) :
• DC cardioversion

■ prevention of PSVT : by evaluation by Electrophysiology for RFCA ( Radiofrequency Catheter Ablation)

🗯🗯 توقعات آخر امتحان نظري medical emergency :-

● التوكسو :-

○ C/P & ttt of organophosphorus

○ give a short note about antitode of snake venom

● الأطفال :

○ Define Respiratory faliure , its type , give in a short brief about investigation & clinical features

● الباطنة :

○ ttt of AF or ttt of VT

○ Enumerate 3 parental antihypertensive drugs used in ttt of HTN emergency with their indication & S.E

□ give a short note about HTN urgency

□ Define cardiac or CNS symptoms & examination & investigation for diagnosis of HTN emergency

■ سؤال AF اتكرر قبل كدا كثير و دايماً بجي ttt و أقل بيجي causes & presentation

■ سؤال VT جه كثير و اتكرر قبل كداا خاصة ttt & causes
دول بالمناسبة أكثر حاجة مشهورة و common

🗯 Notes on tachyarrythemia :-

■ the most common cause of AF is HTN & 2nd most common is PE & COPD

■ pulse deficits > 10/m in AF , < 10/m in ( extrasystole)

■ occational canon waves sound ( A-V dissociation ) in case of VT & CHB

■ قاعدة no p wave يبقى P-R interval can't be measured

■ saw teeth appearance in case of Atrial flutter

■ 1st DOC in VT is lidocaine & 2nd is amiodarone & procainimide

■ 1st step in management of sinus tachycardia is ttt of the cause

■ قاعدة أي arrythmia تطلع من ventricle ال QRS complex is abnormal wide

■ Any tachycardia with wide QRS complex consider VT until proven otherwise

■ ف درس TCA toxicity مكتوب ف role of NaHco3 أنه بقلل ptn binding دي مكتوبة غلط ف الكتاب
و الصح :
أنه يزود ptn binding of TCA عشان يقلل free part فيقل toxicity

امبارح كان آخر نوتس ، آخر MCQ ، آخر تجميعات ، و النهارده آخر امتحان نظري في كلية الطب ، الحقيقة أني سعيد جداً أني واحد من الدفعة أني أكون سبت ذكرى و أتمنى أكون أني قدرت اساعدكم و أني تركت أثر كويس جوا أي حد ، اتمنى أني قدرت أساعدكم وقت ما كنتم تحتاجوني و متأخرش عليكم . 😊🥰 .
ده دفتر تخرجي :
https://Berlino7as.daftarna.net/

لو حد حابب يكتب أي ذكرى أو موقف أو سؤال أو أي كلمات لطيفة 🥰❤.

🗯🗯 keywords for cases ( part 1):

■ ( Angina pectoris ):
♤old age , smoker é hyperlipidemia , retro-sternal chest pain ⬆️ é exercise & ⬇️ by nitrates & rest < 30 min
♤ ECG : ⬇️ ST segment  , inverted T wave
♤ -ve cardiac enzymes

■( AMI ) : STEMI
♤ old age somker  ، severe chest pain at rest & radiated to lt shoulder > 30 min
♤ ECG : ⬆️ ST segment

■ NSTEMI :
♤ old age smoker , severe retrosternal pain , ♤ elevated cardiac enzymes
♤ ECG : depressed ST segment

■ Aortic dissection :
♤ old male uncontrolled HTN + unequal pulse volume on both sides

♤ sudden severe chest pain radiating to the back + dyspnea + murmur

♤ CXR = wide mediastinum


■ Acute pericarditis :
♤ flu like symptoms ( FAHM )
♤  Acute localized chest pain + pericardial rub
♤ pain ⬆️ é inspiration & swalowing & ⬇️ é leaning forwad
♤ ECG : ST elevation in all leads  with upward concavity

■ Acute pleurisy :
♤ localized sharp chest pain + dry cough + pleural rub
♤ pain ⬆️ é inspiration , ⬇️ holding breathing & lying on affected side

🗯 part 2 :-

■ Massive pulmonary embolsim :
♤ hx of DVT
♤ Acute shock +  central cyanosis + dyspnea + low COP symptoms + sudden severe retrosternal chest pain
♤ ECG = S1Q3T3 & sinus tachycardia

■  Acute lobar pneumonia :

♤ FAHM , dyspnea , chest pain , cough , expectoration of MP & rusty blood stained sputum
♤ CXR = homogeneous opacity in one lobe
♤ Ausculation = bronchial breathing
ABG = Resp failure type 1

■ Acute exacerbation of COPD :

♤ hx of previous episode & hx of infection
♤  ⬆️cough ,  , cyanosis ,heavy smoker , expiratory wheezes , hyper-resonance of the lung  & worsening of dyspnea
♤  CXR = emphysema
♤ ABG = respiratory faliure type 2

■ Acute severe asthma :

♤ hx of asthma , hx of frequent hospitalization , prolonged attack 

♤ dyspnea , cough , cyanosis , unable to speak > than 1_2 words

♤ examination = silent chest
♤  investigation : CXR = hyperinflation only & ABG = resp.faliure type 2
♤ PEFR < than 30-50 % predicted

■ صباح الخير يا شباب بإذن الله هبدأ انزل أسئلة على أغلب العملي اللي معنا ، غالبا cases ال dyspnea هتكون فيها أشعة و cases ال chest pain هيكون فيها ECG في الامتحان بكرا فاعرف بقى تركز ع ايه و انتا بتقرأ و بتدرس.