9138
قناة طبيه تهتم بالكتب الطبيه واي شي۽ متعلق بالطب #BRS #pathoma @Yaqob_alsomaii
👨⚕What is Causes of localized abdominal distension ..... ?
Читать полностью…
A patient arrives in the emergency department comatose with decreased
respiratory rate in the winter. Vital signs are temperature 36°C, blood pres-
sure 128/68 mm Hg, respiratory rate 10 breaths per minute, pulse 100
beats per minute, and oxygen saturation 100% on room air. Pupils are
6 mm and reactive, and lungs are clear. What is the single most important
initial treatment?
A. High-flow O2 administered by non-rebreather mask
B. Intravenous normal saline, 1000 mL with additional boluses as
tolerated
C. Intravenous antibiotics
D. Naloxone, 0.8 mg IV
E. Immediate endotracheal intubation
منقول
❇️ANCA (Anti-Neutrophil Cytoplasmic Antibody):
✅There are 2 types➝
1) p-ANCA (perinuclear)
2) c-ANCA (cytoplasmic)
------------------------------------------------------------------------------------
✳️p-ANCA:
⚡Most Common target➝ Myeloperoxidase (MPO)
Associated Diseases➝
1️⃣ Granulomatosis with Polyangitis (Wegener's Granulomatosis)
2️⃣ Microscopic Polyangitis
------------------------------------------------------------------------------------
✳️c-ANCA:
⚡Most Common target➝ Serine Protease 3 (PR3)
Associated Diseases➝
1️⃣ Immune Crescentic Glomerulonephritis
2️⃣ Microscopic Polyangitis
3️⃣ Churg Strauss Syndrome
4️⃣ Primary
✴️Other causes of positive ANCA (Usually p-ANCA):
1️⃣ IBD
2️⃣ RA, SLE, Sjogren syndrome
3️⃣ Autoimmune Hepatitis
(FCPS, MRCP)
🔺️كبسوله Low back pain (LBP)
● LBP better with leaning forward▶️▶️ spinal stenosis.
● LBP after lifting things but not radiate ▶️▶️ lumbosacral strain.
● LBP radiate down to leg ▶️▶️ Sciatica.
م
● LBP with fever and weight loss with hx of TB▶️▶️ Pott's disease.
● LBP in teenager worse in morning▶️▶️ Ankylosing spondylitis.
● LBP in old age after trauma or even fall on ground ⏩⏩ vertebral compressive fracture.
● LBP with urine incontinence ▶️▶️ cauda equina.
● LBP with fever and local tenderness▶️▶️ spinal epidural abscess.
● LBP after conjunctivitis and urethritis ⏩⏩ Reactive arthritis.
● LBP ➕ anaemia ➕ high calcium level ➕ renal abnormality ▶️▶️ Multiple Myeloma.
● LBP at neight with weight loss and not improve by rest⏩⏩ metastatic.
👨🏻⚕ : what is your name ?
💊 : my name is ceftriaxone
👨🏻⚕: what is your work ?
💊 : Antibiotics
👨🏻⚕: Tell me about yourself
💊 : I am from third Generation cephalosporin
👨🏻⚕ : what is your mechanism of action ?
Ceftriaxone 💊 : I'm Bacteriocidal activity results from inhibiting cell-wall synthesis , broad-spectrum against gram-negative ; has lower efficacy against gram-positive organisms
👨🏻⚕ : Are there's any oral compound of You ?
Ceftriaxone 💊 : No , I am only in the form of injectable solution or powder use for IV / IM
👨🏻⚕ : what about metabolism of you ?
Ceftriaxone 💊 : metabolized in liver
👨🏻⚕ What about your elimination ?
Ceftriaxone 💊 : Urine " 33% - 67% unchanged "
👨🏻⚕ : nurse want to ask you How ceftriaxone 💊 administration ?
Ceftriaxone 💊 : this is very important point ,
🔻You must to do Test for allergy before administration very very important heart
I am incompatible with with LR ...
👨🏻⚕ : so I understand some patient have hypersensitivity reaction to you and maybe fetal , also you are incompatible with LR ,
But I have Questione also there's NEWS that say Calcium is Your Enemy ?
Ceftriaxone 💊 : when I meet calcium or any calcium containing fluids , we form parecipate which maybe fetal especially in neonates
👨🏻⚕: what is the contraindication of you ?
Ceftriaxone 💊 : do not use me in hyperbilirubinemic neonates
Don't use me with intravenous calcium-containing .
Take care drug interactions
Intravenous administration of ceftriaxone solutions containing lidocaine
Don't use ceftriaxone in neonate
👨🏻⚕ What is Warning ⚠️ or percution of your uses ?
Ceftriaxone 💊 :
🔻 Elevated INR
🔻 Superinfection especially in prolonged use
🔻 Renal/hepatic impairment (concurrent): Use with caution in patients with concurrent hepatic dysfunction (impaired biliary
excretion) and severe kidney disease .
🔻 Abnormal gallbladder sonograms reported, possibly the result of ceftriaxone-calcium precipitates; discontinue if signs or symptoms of gallbladder disease occur
👨🏻⚕ : what is your category in pregnancy ?
Ceftriaxone💊 : pregnancy category B
👨🏻⚕ : what about your distribution ?
Ceftriaxone 💊 : Distributed throughout body, including gallbladder, lungs, bone, bile, and CSF (higher concentrations achieved when meninges are inflamed); crosses placenta; enters amniotic fluid and breast milk
👨🏻⚕ : what is your Drug Interactions ?
Ceftriaxone 💊 : it's list need tim
👨🏻⚕ : What is your advers effect " significant "?
Ceftriaxone 💊 : 👉Ceftriaxone-calcium precipitation
👉 Hemolytic anemia
👉 Hypersensitivity reactions (immediate and delayed)
👉 Kernicterus
👨🏻⚕ What is other adverse effect ?
Ceftriaxone 💊 :
>10%:
Dermatologic: Skin tightness (IM; local)
1% to 10%:
Dermatologic: Skin rash (2%)
Gastrointestinal: Diarrhea (3%)
Hematologic & oncologic: 🔻🔻Eosinophilia (6%), leukopenia (2%), thrombocytosis (5%)
🔻Hepatic: Increased serum alanine aminotransferase (3%), increased serum aspartate aminotransferase (3%)
🔻Local: Pain at injection site (≤1%), tenderness at injection site (≤1%)
Renal: Increased blood urea nitrogen (1%)
👨🏻⚕ : this first part of the meeting 🤝 with Mr Ceftriaxone
👨🏻⚕ : we will compelet Tomorrow our meeting with thank you for you
Ceftriaxone 💊 : welcome 🤗 to you and to every members in this beautiful channel , don't forget to React
#meeting_drug
#first_drug
#part1
@pharmacology2017
الاطلاع على أفضل قناة باطنية على تيليجرام
⬇️⬇️⬇️⬇️⬇️⬇️
/channel/+Vor7xnYRvwg0NGM0
⭐️ Haematology
📌 case of Anemia
➡️ Classification of Anemia
➡️ Causes of microcytic anemia
➡️Causes of Macrocytic Anemia
➡️ Pallor site
➡️ Mechanism of Anemia of chronic disease
➡️ Triad of Hemaolytic Anemia
➡️ Spurious Anemia
➡️ Hx of Anemia
➡️ Examination
➡️ Lab of Anemia
➡️ Investigate of microcytic hypochromic Anemia
➡️ Mentzer index
➡️ Investigate pt of Macrocytic Anemia
➡️ Commonest Anemia
➡️ Plummer Vinson syndrome
➡️ Treatment of Iron deficiency
➡️ Response to Treatment
➡️ Pernicious Anemia
➡️ Treatment of pernicious anemia
➡️ Sideroplastic Anemia
➡️ Approach to Anemia " investigation"
⬇️
Hemolytic anemia
✅ Sickle cell anemia
✅Lab of Hemolysis
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بوت ربح عملات سيتم انزالها قريباً
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After ABG we started talking Now about ECG
😍👨⚕🌐You didn't understand ABG
I will discuss this topic here
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With real cases , join and share
قال الأصمعي: سمعتُ أعرابيًا يتضرَّعُ إلى اللّٰه، بكلماتٍ فقأت عيون البلاغة، وأيتمت جَواهر الحِكمة.. سمعته يقول:
"إلهي كفى بي عِزًا أنْ أكون لكَ عبدًا، وكفى بي فخرًا أنْ تكون لي ربًّا، أنتَ كما أُحبُّ فاجعلني كما تُحِب".
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💰 شارك هذا الرابط مع اصدقائك وكل شخص يأتي من خلال هذا الرابط الخاص بك سوف تكسب 80 ﷼ سعودي.🔥
🖲 عدد دعواتك : 11
🔗 رابط الدعوة الخاص:
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#REVERSIBLE_CARDIOMYOPATHIES:-
*tokotsobo CM
*Athlets CM
*postpartum CM
*alcholic CM
*Nitritional CM
*Tachyarrythmia induced CM
*Haemochromatosis induced CM
*some Infectious(myocarditis)CM..
*inflammatory CM
*metabolic CM..Dm,hyperthyroidisim
*chemotherapy induced CM
*some ischemic CM
للأسف لغاية دلوقتي في دكاترة بيوصفوا ال long acting Penicillin prophylaxis لأطفال عندهم tonsillitis with high ASOT أو حتي لو عمل تحليل ال ASOT كروتين لأي حاجة بيشتكي منها وطلع عالي.
مبدئياً كده لازم نعرف إن ارتفاع ال ASOT ده بيدل علي حدوث Streptococcal infection سواء Recent or old infection. ال ASOT بيرتفع بعد حدوث ال Infection بحوالي أسبوع لأسبوعين وبيوصل ال peak في خلال ٣ إلي ٤ شهور وممكن يفضل مرتفع لسنة كاملة بدون وجود أي أعراض.
ال ASOT بيرتفع في حالات ال Rheumatic fever لكن مش معني إن كل طفل مرتفع عنده ال ASOT يبقي Rheumatic fever وياخد Long acting Penicillin. كمان ارتفاع ال ASOT مش أحد ال Criteria for diagnosis of rheumatic fever. كلنا عارفين ال Criteria for diagnosis إللي هي Jones criteria.
يبقي ال Long acting Penicillin prophylaxis ميتاخدش غير لو المريض ده عنده ال Criteria for diagnosis of rheumatic fever وإللي اتشخص المريض ده علي أنه حمي روماتيزمية.
2 major criteria or 1 major and 2 minor+ evidence of recent streptococcal infection
كما في الجدول الموضح بالأسفل.
نقطة تاني مهمة لازم نعرفها. لو عندك حالة فيها Carditis واضح خالص بال examination and Echocardiography ومفيش حاجة خالص من ال other criteria for diagnosis of RF واستبعدت نهائيا كل الأسباب التانية المحتملة إللي ممكن تعمل Carditis يبقي في الحالة دي تتشخص Rheumatic heart disease. حتي لو مفيش أي criteria تانية؟؟ أيوة حتي ولو. نفس الموضوع لو جاتلك حالة ب Chorea ومفيهاش أي أعراض تانية واستبعدت نهائيا كل الأسباب التانية إللي ممكن تعمل chorea في الحالة دي تشخص علي إنها Rheumatic or Sydenham's chorea ( حصلت معايا شخصياً في فترة النيابة وبنت كانت جاية ب Typical chorea with emotional lability ومكنش فيها أي أعراض تانية وبعد كام يوم اتعمل لها Echo طلع فيها valvular heart disease).
آخر نقطة بقي في حاجة اسمها Poststreptococcal reactive arthritis or PSRA وده بيحصل بعد ال Streptococcal throat infection بأقل من ١٠ أيام (ال rheumatic fever غالبا بتاخد من أسبوعين لتلاتة ك latent period علشان تحصل بعد ال infection). ال PSRA مش معروف هل هو حالة طبية قائمة بذاتها ولا هو Variant من ال Rheumatic heart disease. ال PSRA بياخد معاه Large and small joints وبيكون non migratory (ال arthritis بتاع ال RF بيكون affecting large joints and is migratory). كمان ال PSRA ميحصلهوش Dramatic response to aspirin زي ال Rheumatic arthritis. في أحيان كتيرة ال Throat culture بيطلع Negative في حالات ال PSRA بس ال ASOT بيكون عالي.
ال PSRA عايز متابعة مستمرة لأن في حالات بيحصلها بعدين Valve lesions وبتتحول ل Rheumatic heart disease. علشان كده في حالات ال PSRA بنوصف ال Long acting Penicillin لمدة سنة مع المتابعة. بعد سنة بنعمل Echocardiography لو مفيش Valvular heart disease خلاص بنوقف ال Penicillin prophylaxis. لأ طلع فيه Evidence of valvular heart disease يبقي بنكمل Long acting Penicillin prophylaxis زي ال Rheumatic fever وبيتعامل معاملة ال Rheumatic fever بالضبط.
د /وليد علي إبراهيم المرواني.
عضو الكلية الملكية البريطانية لطب الأطفال.
Certainly! Down syndrome (Trisomy 21) is frequently associated with congenital heart defects (present at birth). Here’s a concise overview of the most common heart conditions seen in individuals with Down syndrome:
### Most Common Heart Defects in Down Syndrome:
1. Atrioventricular Septal Defect (AVSD) – ~40-60% of cases
- A large hole in the center of the heart (atrial + ventricular septal defect + abnormal valves).
- Often requires surgery in infancy.
2. Ventricular Septal Defect (VSD) – ~30%
- A hole in the wall between the heart’s lower chambers (ventricles).
3. Atrial Septal Defect (ASD) – ~10%
- A hole in the wall between the heart’s upper chambers (atria).
4. Patent Ductus Arteriosus (PDA) – ~5-10%
- Failure of the fetal blood vessel (ductus arteriosus) to close after birth.
5. Tetralogy of Fallot (TOF) – ~5%
- A combination of 4 defects, including a VSD and pulmonary stenosis.
6. Pulmonary Stenosis – ~5%
- Narrowing of the pulmonary valve, restricting blood flow to the lungs.
---
### Potential Complications if Untreated:
- Heart failure (due to excessive blood flow or pressure overload).
- Pulmonary hypertension (high blood pressure in the lungs).
- Infective endocarditis (heart valve infections).
- Developmental delays (due to poor oxygen supply).
---
### Key Facts:
✔ ~50% of babies with Down syndrome have a heart defect.
✔ Early diagnosis (fetal echocardiogram) is crucial.
✔ Most defects are correctable with surgery.
✔ Lifelong cardiac follow-up may be needed.
💙 Early intervention leads to better outcomes!
Let me know if you'd like more details on any specific condition! 😊
🔴 Triads in Medicine ::
🔸️ ثلاثيات مهمة في الطب ....
* acute coronary syndrome triad
Ischemic symptoms
Ecg changes
Cardiac enzymes.
*Pulmonary Embolism ecg changes in 20 percent of P.E. patients :
S 1
Q3
T3
*Achalasia Triad:
increased lower esophageal sphincter(LES)tone, decreased LES relaxation,
aperistalsis
* Beck's triad of cardiac tampnade :
Muffled heart sound,
Distended neck veins,
Hypotension
*Budd–Chiari syndrome :
abdominal pain,
ascites,
hepatomegaly
*Charcot's cholangitis triad:
Right Upper Quadrant Pain,
Fever,
Jaundice
*Charcot's neurologic triad of multiple sclerosis:
scanning speech,
intention tremor,
nystagmus
*Congestive Heart Failure Triad:
Tachycardia,
Tachypnea,
Tender hepatomegaly
*Cushing's triad of Increased Intracranial Pressure:
Bradycardia,
Bradypnea,
Hypertension
*Triad of opioid overdose :
Respiratory depression,
pinpoint pupils,
CNS depression
*Triad of granulomatosis with polyangiitis (Wegner سابقا ):
Focal necrotizing vasculitis,
necrotizing granulomas in the lung and upper airway, necrotizing glomerulonephritis
*Triad of normal pressure hydrocephalus :
Urinary incontinence,
Gait apraxia,
Dementia
*Triad of Meigs' Syndrome:
ascites,
pleural effusion,
benign ovarian tumor
*Hemolytic Uremic Syndrome Triad:
Anaemia,
Thrombocytopenia,
Renal failure (ايضا TTP ابحث عن خماسية)
*Horner's Syndrome Triad:
ptosis (eyelid),
miosis,
anhydrosis
*Kartagener Syndrome Triad:
bronchiectasis,
Recurrent sinusitis, and,
Situs inversus.
*Three C's of Measles:
cough,
coryza,
conjunctivitis
*Meltzer's triad of cryolobulinemia :
purpura,
arthralgias,
weakness/myalgias
*Triad of Reactive arthritis:
Urethritis,
conjunctivitis and anterior uveitis,
arthritis
*Samter's triad of aspirin exacerbated respiratory disease :
Aspirin sensitivity,
Nasal polyps,
Asthma
*Triad of Alport Syndrome:
Sensorineural deafness,
Progressive renal failure,
Ocular anomalies
*Triad of Behcet's Syndrome
Recurrent oral ulcers,
Genital ulcers,
Iridocyclitis
*Triad of Henoch–Schönlein purpura
Palpable purpura on buttock/legs,
arthralgias,
abdominal painI
*Virchow's triad of thrmobosis mechanism
Stasis,
Hypercoagulability,
Vessel injury
*Triad of Wernicke encephalopathy
Confusion,
ophthalmoplegia,
ataxia
*Whipple's Triad of insulinoma
Hypoglycaemia during attacks,
resolution of symptoms upon correction of blood glucose,
symptoms brought about by low glucose states.
*murphy triad of acute appendicitis
Pain->
Vomiting ->
Fever .
💦
Fishing all the fish in medicine
1) Fish mouth : Scleroderma
2) Fish mouth valve: Severe mitral stenosis
3) Fish in stream: Vibrio cholera microscopy
4) School of fish: Hemophilus ducreyi
5) FISH: Fluorescent in situ hybridization
6) Takotsubo:Cardiomyopathy, akin to Jap. Fishing pot
قناة تعليمية لأطباء الباطنة و فروعها
🔗 Group link;
/channel/+UyRHPq5yrjVjYWU0
🔗 Channel link;
/channel/+MV8bR4dCRdczNjQ8
🔗AccePtance form;
https://forms.gle/znCVL8x9raW1Bepd9
الرجاء الإجابة على النموذج لقبول الإنضمام
📍 t.me/c/1735204478/72
وكُلُّ بابٍ وإنْ طالتْ مَـغالِقُهُ
يومًا لهُ من جميلِ الصَّبرِ مفتاحُ
كمْ مِن كروبٍ ظنَنّا لا انفراجَ لها
إقرأ المزيد
🎙 Summary of P wave " Pearls points:
💬 Normal P Wave is monophasic positive except in V1 biphasic and Inverted in aVR .
Best to see in Lead II
Simply normal ampultide and duration is 2.5 × 2.5 small square "in standard speed and voltage"
💬 Abnormal P wave see " Lead II and V1 "
➡️ Right atrial Enlargement:
➡️ In Leed II ➡️ P Wave ampultide more than 2.5 mm " 2.5 small squares" , normal duration " less than 120ms (3 mm) "
➡️in Lead V1➡️
Amplitude " hight" more than (1.5 mm) of initial positive deflection of P wave
➡️Left Atrial enlargement :
➡️in Lead II ➡️ duration longer than 120 ms " 3 mm" 3 small squares" maybe with notch and hight is normal" ampultide "
➡️ in lead V1 ➡️
Winding> 40 ms ( small square)" and deepening> 1mm ( Small square) of terminal negative portion of P wave in V1
What about Biatrial?
If criteria meeting for both LAE and RAE
📄 No more clarity than this explanation , I wish it's helpful
I do effort to make it in simple manner 🔗
🚨🚨🚨🚨🚨🚨🚨🚨🚨🚨🚨🚨
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في زحمة الأيام وازدحام الأفكار إجعل لك من رسائلنا نصيب ...
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prophylactic cholecystectomy may be performed for asymp- tomatic cholelithiasis in the following situations:
● large (>3 cm) gallstones;
● choledocholithiasis;
● chronic haemolytic conditions (sickle cell disease, heredi-
tary spherocytosis);
● gallbladder polyps >1 cm in diameter;
● suspicion/risk of malignancy (anomalous pancreatic duc-
tal drainage);
● calcifcation of the wall (porcelain gallbladder);
● some ethnic groups or subjects living in areas with a high
prevalence of gallbladder cancer associated with gallstones (some parts of northern India, Native Americans, Mexican Americans, Colombia, Chile, Bolivia);
● transplant patients (during transplantation);
● bariatric surgery.
resource : Bailey & Love's Short Practice of Surgery 28E