Mallory-Weiss Syndrome is diagnosed by Upper Endoscopy.
تشخص متلازمة مالوري ويس بالنتظير الهضمي العلوي
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Treat acute AF or A-Flutter in WPW with IV procainamide
Patients with WPW and a narrow complex tachycardia (rate is usually ~ 190) can be treated with : Vagal maneuvers, cardioversion, procainamide, verapamil, or adenosine-same as any SupraVentricular Tachycardia-. But, never treat acute AF or A-flutter (usually has a wide QRS) in WPW with: Digoxine, verapamil, or Beta-Blockers ( verapamil and digoxin can increase the refractory period in the AV node, but they can also decrease refractory period in the bypass bundle=> increased heart rate) . So treat acute AF or A-Flutter in WPW with IV procainamide. , shock if there are any signs of hemodynamic deterioration in any WPW tachyarrhythmia(especially watch those with ventricular rate>285, bcz they r at greatest risk of V-fib). WPW patients with AF may be cured with radioablation.
يمكن معالجة مرضى وولف باركنسون وايت "WPW" الذين لديهم تسرع قلبي ذو مركب QRS ضيق وسرعة قلب بحدود 190ً... بـ:
المناورات المبهمية، قالب النظم الكهربائي، الفيراباميل، الأدينوزين. تماماً كأي تسرع قلبي فوق بطيني.
لكن احذر.
لدى مريض WPW لااا تعالج الرفرفة الأذينية او الرجفان الأذيني " عادة يكون هنا مركب QRS عريضاً " بالديجوكسين أو الفيراباميل أو حاصرات بيتا حيث أن: "الفيراباميل والديجوكسين يسببان زيادة فترة العصيان في العقدة الاذينية البطينية" لكنهما يخفضان فترة العصيان في الحزمة الجانبية مما يؤدي لزيادة تسرع القلب.
لذلك عالج الرجفان الاذيني والرفرفة الاذينية لدى مرضى WPW بالبروكائين أميد وريدياً .
ونعالج بقالب النظم الكهربائي عند وجود أي دليل على سوء وانخفاض الوظائف الوعائية لدى أي مريض WPW لذيه تسرع قلبي "خصوصاً الذين يصل نبضهم لأكثر من 285 لأنهم في أعلى مرحلة خطورة لحدوث رجفان البطيني".
يمكن شفاء مرضى وولف باركنسون وايت بالتشعيع.
المرجع
Medstudy -Cardiology
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MRI: Microadinoma
ورم نخامي دقيق بالرنين المغناطيسي
Pelvic Avulsion Fractures Places
أماكن الكسور الانقلاعية الحوضية --
pneumonia + smokers, COPD → think of H.Influenzae pneumonia + young healthy → think of Mycoplasma pneumonia + alcoholic → think of Klebsiella pneumonia + older smokers near infected water sources (air conditions) → think of Legionellapneumonia + animals →think of Coxella burnetii (Q-fever) pneumonia + HIV patient with CD4 less than 200 → think of Pneumocystosis carinii pneumonia + after viral bronchitis (influenza) → think of S.aureus pneumonia + american southwest deserts → think of Coccidioidomycosis pneumonia + birds → think of Chlamydia psittaci pneumonia + caves exploration (bat and birds dropping) → think of Histoplasma capsulatum pneumonia + cough with whoop and post-tussive vomiting → think of Bordetella pertussis pneumonia + rabbits exposures (hunters) → think of Francisella tularensis pneumonia + travel to southeast Asia → think of Avian influenza (SARS)
ذات رئة + تدخين, مرض تنفسي انسدادي مزمن ← فكر بالمستدميات النزلية ذات رئة + شاب,من غير مرض سابق ← فكر بالمتفطرات ذات رئة + كحولي ← فكر بالكليبسيللا ذات رئة + كبار سن مدخنين بالقرب من مصادر مياه ملوثة (أجهزة التكييف) ← فكر بالليجونيلل ذات رئة + التعرض للحيوانات ← فكر بالكوكسيللاالبورنيتية (حمى Q) ذات رئة + مريض أيدز مع عدد CD4 أقل من 200 ← فكر بالمتكيسات الكارينية ذات رئة + بعد التهاب قصبات فيروسي (الانفلونزا) ← فكر بالعنقوديات المذهبة ذات رئة + في الصحارى الأمريكية الجنوبية الغربية ← فكر بالفطار الكرواني ذات رئة + التعرض للطيور ← فكر بالكلاميديا الببغائية ذات رئة + استكشاف الكهوف (التعرض لمخلفات الخفافيش والطيور) ← فكر بالنوسجات المستخفية ذات رئة + سعال وشهيق وإقياء تالي للسعال ← فكر بالبورتيديللا الشاهوقية ذات رئة + التعرض للأرانب (الصيادين) ← فكر بالفرانسيسيللا التولارينية ذات رئة + رحلة لجنوب شرق آسيا ← فكر بانفلونزا الطيور
المرجع
KAPLAN USMLE Step 2 ck 2008-2009
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bladder stones
حصيات مثانة كبيرة
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Typical form of RA, it is a symmetrical , destructive and deforming polyarthritis affecting small and large synovial joints , with associated systemic disturbance , a variety of extra-articular features , and the presence of circulating antiglobulin antibodies ( rheumatoid factor ).
الشكل النموذجي للداء الرثياني, التهاب مفاصل متعدد, متناظر , مخرب ومشوه يصيب المفاصل الزليلية الكبيرة والصغيرة, مترافق مع خلل جهازي, تنوع في المظاهر خارج المفصلية , مع وجود أضداد غلوبولينية جوالة ( العامل الرثياني).
المرجع Davidson's principles and practice in Medicine
السحار السيليسي الحاد
Acute silicosis
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Resiratory infections are the most common stimuli to cause asthma exacerbations; studies have documented that viruses (respiratory syncytial virus in young children, rhinoviruses in adults) are the major causes تعد الأخماج التنفسية هي المثير (المنبه) الأكثر شيوعاً لإحداث سورات (نوبات) الربو. وبينت الدراسات أن الفيروسات (الفيروس التنفسي المخلوي بالنسبة للأطفال الصغار، والفيروسات الأنفية لدى البالغين) هي المسببات الرئيسية. المرجع Fischer et al, Kaplan USMLE step 2 CK, 2005-2006
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The most accurate test to diagnose diffuse esophageal spasm is esophageal manometry. الاختبار الأكثر دقة لتشخيص تشنج المري المعمم هو قياس ضغوط المري. -- المرجع Fischer, C. (2008-2009) Kaplan Internal Medicine. pp. 67
PCO
مبيض عديد الكيسات
Omphalocele
قيلة سرية
Radio image shows the deformity of the joint in Hallux valgus.
صورة شعاعية تظهر التشوه المفصلي في داء إصبع القدم الروحاء.
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Drugs that cause photosensitivity are SAT
Sulfonamides
Amiodarone
Tetracycline
الأدوية التي تسبب حساسية للضوء هي (سات):
سلفاميدات
أميدارون
تتراسيكلين
المرجع: First Aid 2006
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Uric acid= Unseen
Uric acid stones are not seen on AXR.
تعد حصيات حمض البول شفافة شعاعيا. فهي لا ترى على الصورة الشعاعية للبطن.
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Foregut derivatives
"Little Embryo People Do Like Swallowing, Producing Gas":
Lungs
Esophagus
Pancreas
Duodenum (proximal)
Liver
Stomach
Pancreas
Gall bladder
مشتقات المعي الأمامي :
الرئتين
المري
البنكرياس
الاثناعشر (العفج)
الكبد
المعدة
المرارة
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The Metro(metronidazole) runs over Entamoeba histolytica,Giardia lamblia,Trichomonas vaginalis and the anaerobic cocci and bacilli including Bacteroides fragilis,Clostridium difficile and Gardnerella vaginalis.
The correct answer is D. ITP is a disorder ofprimary immune platelet destruction. Theclinical presentation is of insidious onset ofmucocutaneous bleeding. The diagnosis is oneof exclusion; a complete blood cell count usuallyshows isolated thrombocytopenia, andlarge platelets may be apparent on peripheralsmear. Other tests may include a bone marrowbiopsy to exclude aplastic anemia or drug-inducedsuppression of megakaryocytes. In children,this disease is usually self-limiting and requiresno treatment, but adults generallyrequire medical (through immunosuppressionor dialysis) or surgical (through splenectomy)management. Children with chronic ITP haveplatelet counts from 20,000–75,000/mm³ andtypically do not require treatment. Pulse orshort-course corticosteroids may be used in refractorycases, but long-term daily steroid useshould be avoided.Answer A is incorrect. Corticosteroids are theinitial treatment of choice of ITP if the diseaseproves not to be self-limiting. Fifty to seventyfive percent of adults will respond, but <20%>
CASE # 6
A is the correct answer.
An infarct describes an area of tissue undergoing coagulative necrosis resulting from decreased blood supply. Embolization of a thrombus can occlude arterial vessels, resulting in infarcted tissue in various organs. Infarcts can be classified into either red (hemorrhagic) infarcts or white (pale) infarcts based upon their gross appearance on pathology. Red infarcts usually occur in loose tissues with collateral circulation or following reperfusion of the infarcted tissue. Pale infarcts usually occur in solid tissues with a single blood supply. Of the listed organs, only the kidney (choice A) has a single blood supply without collateral circulation.Liver (choice B), Lung (choice C), Small Intestine (choice D), and Large Intestine (choice E) all have more than one blood supply. An infarct in these tissues would tend to be grossly red on pathological examination.
CASE #5
the answer is:
A.Mycobacterium tuberculosis
Explanation:
This patient’s clinical features of chronic cough, weight loss, fever and malaise along with bilateral apical consolidation is typical for reactivation tuberculosis. A history of contact with a patient with tuberculosis is found in patients with primary pulmonary tuberculosis. Mycobacterial infection occurs early in the course of disease with CD4 counts greater than 200/microL.
Bacterial pneumonias usually present acutely with high fever, rigors and chest pain. Radiographic findings are usually segmental or lobar. CD4 counts are usually greater than 200/microL.
Clinical features of fever, dry cough and exertional dyspnea along with radiographic findings of diffuse bilateral interstitial infiltrates are typical of Pneumocystitis carinii pneumonia (PCP). PCP occurs with CD4 counts less than 200/microL. Presentation of PCP is subacute.
Histoplasma capsulatum infection is endemic in Mississippi and river valley areas. Disseminated fungal infection takes place when HIV infection is advanced and radiography usually shows a miliary pattern.
HHV-8 is considered the causative agent of Kaposi’s sarcoma, which usually has cutaneous findings and pulmonary involvement, which may be asymptomatic or mild. The chest x-ray usually shows a pulmonary nodule or pleural effusions.
Educational Objective:Tuberculosis occurs early in the course of HIV when the CD 4 counts are greater than 200/microL. Upper lobe consolidation and/or cavitation is the typical X-ray finding.
CASE #4
A 40-year-old white male patient develops proximal deep vein thrombosis of the left lower extremity. Detailed history, examination and lab testing fail to reveal any obvious cause or risk factor for deep venous thrombosis. Diagnosis of idiopathic deep vein thrombosis is made and it is decided that he will receive anticoagulation therapy with warfarin for 6 months. Which of the following is the therapeutic range of INR in this patient?
A.1.0 to 1.5
B.1.5 to 2.0
C.2.0 to 3.0
D.2.5 to 3.5
E.Greater than 4
Explanation:
INR (International Normalized Ratio) is used to monitor treatment response of warfarin.
Therapeutic range of INR varies according to the clinical situation. Therapeutic range of INR for most clinical situations is 2.0 to 3.0. These conditions include venous thromboembolism, valvular heart disease, and atrial fibrillation. A higher INR of 3.0 to 4.5 is required only in ceratin clinical settings like prosthetic heart valves. The risk of bleeding in patients treated with warfarin correlates with the degree of anticoagulation and it increases substantially when INR is greater than 4.
Educational Objective:Therapeutic INR for most clinical indications of warfarin is 2.0 to 3.0.
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CASE#3
You are on rounds at the nursing home when you are asked to see an 83-year-old retiredfarmer who is bed-ridden. The aide is concerned because she has noticed an area on his coccyxthat is broken down. You examine the skin and determine that there is a partial thickness skinloss, which involves the epidermis. What stage is this pressure ulcer?
(A) Stage I (16%)
(B) Stage II (50%)
(C) Stage III (30%)
(D) Stage IV (16%)
The correct answer is (B) Stage IIThis patient has a stage II ulcer, which is a partial-thickness skin loss or ulceration that involvesthe epidermis, dermis, or both layers.
A stage I ulcer is defined as intact skin that has a change in temperature, consistency, sensation,or color. The temperature can be warm or cool; the consistency can be firm or boggy; the patientmay experience pain or itching; the color may be red, blue, or purple.
A stage III ulcer is a fullthicknessskin loss, with evidence of damage to or necrosis of subcutaneous tissue, which mayextend to, but not through, the underlying muscle.
A stage IV ulcer involves full-thickness skinloss with destruction, tissue necrosis, or damage to underlying muscle, bone, or supportingstructures.
CASE#2
21-year-old man, who was recently diagnosed with asthma, comes to see his primary care physician. The patient says that he has about two episodes of shortness of breath per week. He reports no symptoms of asthma at night. Vital signs are: temperature 36.9 C (98.4 F), pulse 78/min, blood pressure 118/66 mmHg, respiration 16/min, and oxygen saturation 96% on room air. Physical examination reveals a well-developed young man in no distress. Breath sound are clear bilaterally. Heart sound are normal with no murmur. Abdomen is soft and nontender, with normoactive bowel sound. Pulmonary function testing shows FEV1/FVC 86% of predicted. Which of the following is the most appropriate next step in management?
A. Albuterol.
B. Flunisolid.
C. Formoterol.
D. Prednisone.
E. Theophylline.
The correct answer is A. this patient has mild intermittent asthma, which is characterized by asthma symptoms occurring twice a week or less, no symptoms between exacerbation, night symptoms occurring no more than twice a month, and a FEV1/FVC that is 80% or more of predicted. Patients with mild intermitten asthma are treated with intermitten use of inhaled short-acting beta-2-agonist, like albuterol.
Flunisolid (B) is an inhaled corticosteroid, which is mainly used for persistent asthma. Inhaled corticosteroid reduce inflammation in asthma and are very safe drugs with little if any effect on the pituitary-adrenal axis.
Formoterol (C) is a long-acting, inhaled beta-agonist. It is used for moderate to sever asthma.
Prednisone (D) is an oral corticosteroid, which is only used for treatment of sever persistent asthma.
Theophylline (E) has bronchodilator effect and inflammatory activity. Once the mainstay of asthma treatment, it is now considered a third-line or even fourth-line agent because of its adverse-effect profile and potential interactions with many drugs.
CASE #1
A 34-year-old man presents to the clinic, 24 hours after he was hit in the abdomen. He has had constant abdominal pain since the altercation. He denies nausea and vomiting. His abdomen is soft, painful to palpation mostly around the umbilicus. Rebound tenderness is also present. Bowel sounds are diminished. Rectal exam is normal. Abdominal x-ray, ultrasonogram (USG), and CT are unremarkable. His vitals are, BP: 120/70mm of Hg; PR: 90/min; Hct: 40%; serum Amylase: 53 U/L. Most appropriate management is:
A. Observation
B. Angiography
C. Contrast studies of GI tract
D. Diagnostic peritoneal lavage
E. Laparotomy
answer is D
Explanation:
Major splenic and liver lacerations, bowel avulsion, and vascular tears produce significant blood loss and are unlikely in this patient because his Hct and vital signs are normal. Subcapsular splenic and liver hematomas that can produce delayed bleeding are currently excluded by the normal US and CT. Therefore he doesn’t have clear indications for laparotomy (Choice E).
He may have however, other serious traumatic lesions. Small lacerations of solid organs, mesentery, and in the serosa of the hollow viscus may give little bleeding that may stop spontaneously. In such cases intraperitoneal fluid may not be detected on USG. Small perforations of the hollow viscus may not produce gas under the diaphragm on x-ray, but still causing peritonitis. Diagnostic peritoneal lavage is the simplest method to check for these pathologies. If it is negative, the patient may be followed with observation (Choice A).
Diagnostic peritoneal lavage would be more informative than contrast studies of GI tract for this patient.
Angiography is rarely performed for abdominal trauma, as laparotomy is usually preferred.
Diffused interstitial fibrosis occurs in about 90% of patients with systemic sclerosis, it is rare in limited scleroderma.Isolated pulmonary hypertension may occur due to widespread small pulmonary arterial narrowing and fibrotic changes. Recurrent aspiration pneumonia may occur secondary to esophageal disease, pleuritis is rare.
يحدث التليف الخلالي المنتشر عند نحو 90% من المرضى بالتصلب الجهازي، ولكنه نادر في تصلب الجلد المحدود. يمكن أن يحدث ارتفاع التوتر الرئوي المعزول نتيجة للتضيق المنتشر للشرايين الرئوية الصغيرة والتبدلات التليفية. يمكن أن تحدث ذات الرئة الاستنشاقية المتكررة بشكل ثانوي للمرض المريئي، ويحدث التهاب جنب بشكل نادر.
المرجع:
NMS p.600
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The most sensitive test in thyroid diseases is the TSH . If the TSH is normal , then the patient is euthyroid
الاختبار الأكثر حساسية في الأمراض الدرقية هو الهرمون النخامي المحرض للدرق TSH ؛ عندما يكون الـ TSH طبيعياً فالمريض سوي الوظيفة الدرقية .
المرجع: Kaplan Notes 2005-2006 Internal Medicine
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Common causes of pneumonia in : 1) Young Children : * RSV ( Respiratory Syncytial Virus ). * Parainfluenza Virus 2) Adults ( 18 – 40 yrs) : * Mycoplasma pneumonia * Chlamydia pneumonia ( most often infects young adults ). * Streptococcus pneumonia. 3) Adults ( 40 – 65 yrs ) : * Streptococcus pneumonia. * Haemophilus influenza * Legionella .
Other (blood diseases, coagulopathies, tumors, angiopathy, etc.) 6%
No cause found 22%
اسباب النزف تحت العنكبوت العفوي :
امهات الدم
ارتفاع الضغط
التشوهات الشريانية الوريدية
اسباب دموية و اورام
لا سبب محدد
المرجع Sabiston Textbook of Surgery
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Such drugs are effective in the ovulation,they often produce multiple ovulations,so that the likelihood of multiple pregnancies is 10 times higher in those women than the general population.
للمخدرات تأثير على الإباضة، فهي تسبب تعدد الإباضات مما يزيد نسبة الحمل المتعدد الأجنة عشر مرات أكثر من الحالة العادية.
المرجع Sadler.T.W ( 2006) Langman's medical embryology. 10th ed pp 32
المرجع: Oxford Handbook Of Clinical Specialties 6th
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DOC for acute mania is Haloperidole
It is a typical high potency antipsychotic that block dopamin D2 receptors
الدواء المختار في علاج الهوس الحاد هو الهالوبيريدول
وهو دواء مضاد للنفاسات عالي الفعالية عن طريق تثبيطه لمستقبلات الدوبامين D2 .
High yeild psychiatry
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Cancers that metastasize tocervix:
Remember: RIB Eye steak.
Rectal
Intra-abdominal
Bladder
Endometrial
السرطانات التي تنتقل لعنق الرحم ..:
1-المستقيم
2- سرطان داخل البطن
3- المثانة
4-بطانة الرحم
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Lowe's syndrome -oculocerebrorenal dystrophy : In this syndrome there is generalized aminoaciduria combined with mental retardation, hypotonia, congenital cataracts and an abnormal skull shape متلازمة لوي ( حثل عيني دماغي كلوي ) : يوجد بيلة حموض امينية شاملة مترافقة مع : تأخر عقلي نقص مقوية ساد ولادي شكل جمجمة غير طبيعي KUMAR & CLARCK
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What is the major clinical difference between second and third degree burns ? Third degree burn is painless Second degree burn is painful ما هو الفرق الأساسي السريري بين حرق درجة ثانية وحرق درجة ثالثة ؟ حرق الدرجة الثانية مؤلم جدا
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congenital glaucoma: The clinical signs can be rememberedas “ABCDE” A xial myopia
B uphthalmos
C loudy cornea
D isc cupping
E xamination under anesthesia
الزرق الولادي :
العلامات :
1-قصر بصر
2- عين البقر
3- قرنية عكرة غير شفافة
4- تقعر القرص البصري 5
- الفحص تحت التخدير
المرجع The ophthalmology examination reviews 2001 T.wong
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Hypercalcemia is characterized by :
1- Bones (fractures)
2- Stones ( nephrolithiasis)
3- Groans ( GI symptoms)
4- Psychiatric overtones (changes in mental status)
فرط الكلس يتصف ب :
1-العظام (كسور)
2-حصيات (تحصي كلوي )
3-اعراض هضمية
4-اعراض نفسية (تغير بالحالة العقلية)
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DOC for Steroid induced osteoperosis is Bisphosphonate
الدواء المختار لتخلخل العظام المحدث بالعلاج بالستيروئيدات هو البيسفوسفونات