عالم الطب🌐Medicine World
🔴معلومة (#أطفال ، #باطنية): ال #acute_kidney_injury (#AKI) يشخص اذا توفر 1 أو أكثر من هاي الأمور ال 3: 1- حصول زيادة في ال serum creatinine حوالي 0.3 mg/dl أو أكثر فوگ المستوى الطبيعي baseline خلال 48 ساعة. 2- حصول زيادة في ال serum creatinine الى حوالي 1.5…
normal result is 0.7 to 1.3 mg/dL (61.9 to 114.9 µmol/L) for men and 0.6 to 1.1 mg/dL (53 to 97.2 µmol/L) for women. Women often have a lower blood creatinine level than men.
〰️♾️〰️♾️〰️♾️〰️♾️〰️♾️〰️♾️〰️♾️〰️♾️
normal UOP is approximately 0.5 to 1.0 mL/kg/h. Therefore, an average, healthy male with a body weight of 70 kg should produce around 35 to 70 mL of urine per hour.
〰️♾️〰️♾️〰️♾️〰️♾️〰️♾️〰️♾️〰️♾️〰️♾️
normal UOP is approximately 0.5 to 1.0 mL/kg/h. Therefore, an average, healthy male with a body weight of 70 kg should produce around 35 to 70 mL of urine per hour.
🟡معلومة طوارئ:
⁉️ سؤال: هواي يجونا مرضى نسويلهم #ECG يطلع عدهم #T_wave_inversion ، شنو نسوي بهاي الحالة؟ نبقيهم ، نطلعهم ، ننطيهم علاج لا ؟!!
✅ الجواب: ال T wave inversion بحد ذاتها ما الها أي أهمية not significant وتعتبر شي طبيعي normal variant أو اشارة لمشكلة قديمة مثلا old #MI ، لكن في حالات معينة تعتبر شغلة خطرة لازم ناخذها بالحسبان significant يعني قد تكون علامة لجلطة حديثة recent MI ، هاي الحالات هي:
1- اذا چانت ال inverted T wave چبيرة (أكثر من 3 مربعات صغار) !
2- اذا چانت مصحوبة بألم صدر صفاته مال ذبحة و جلطة ischemic chest pain !
3- اذا چانت مصحوبة بارتفاع في انزيمات القلب وأهمها serum cardiac #troponin !
في أي من الحالات الثلاثة في الأعلى لازم ندخل المريض للطوارئ وننطيه العلاجات الأولية المضادة لل ischemia وهي ال #aspirin tab 300mg و ال #plavix tab 300mg وال #heparin vial 1 cc SC وال #angesid tab 0.5mg SL ، بعدها نبلغ البرمننت اللي بدوره راح يتواصل مع مركز القلب المفتوح ويرسللهم التخطيط ECG ، راح يطلع أخصائي القلب cardiologist عالحالة وممكن يطلب احالة المريض من أجل اجراء عملية القسطرة #PCI.
⁉️ سؤال: هواي يجونا مرضى نسويلهم #ECG يطلع عدهم #T_wave_inversion ، شنو نسوي بهاي الحالة؟ نبقيهم ، نطلعهم ، ننطيهم علاج لا ؟!!
✅ الجواب: ال T wave inversion بحد ذاتها ما الها أي أهمية not significant وتعتبر شي طبيعي normal variant أو اشارة لمشكلة قديمة مثلا old #MI ، لكن في حالات معينة تعتبر شغلة خطرة لازم ناخذها بالحسبان significant يعني قد تكون علامة لجلطة حديثة recent MI ، هاي الحالات هي:
1- اذا چانت ال inverted T wave چبيرة (أكثر من 3 مربعات صغار) !
2- اذا چانت مصحوبة بألم صدر صفاته مال ذبحة و جلطة ischemic chest pain !
3- اذا چانت مصحوبة بارتفاع في انزيمات القلب وأهمها serum cardiac #troponin !
في أي من الحالات الثلاثة في الأعلى لازم ندخل المريض للطوارئ وننطيه العلاجات الأولية المضادة لل ischemia وهي ال #aspirin tab 300mg و ال #plavix tab 300mg وال #heparin vial 1 cc SC وال #angesid tab 0.5mg SL ، بعدها نبلغ البرمننت اللي بدوره راح يتواصل مع مركز القلب المفتوح ويرسللهم التخطيط ECG ، راح يطلع أخصائي القلب cardiologist عالحالة وممكن يطلب احالة المريض من أجل اجراء عملية القسطرة #PCI.
#مريض_الفشل_الكلوي
افضل دواء ضغط له 👈عائله ACEI
افضل مسكن له 👈 الباراسيتامول
افضل مضادات للتجلط له 👈enxoparine والهيبارين في المراحل الاخيره من الفشل الكلوي
افضل دواء للسكري له👈الأنسولين خاصه اذا GfRتحت 30
افضل مضاد الحموضة لمريض الفشل الكلوي 👈 omeprazole
✅طبعا مضاد للتجلط enoxparine اذا كان GFR اقل من ٣٠ ممكن نعطي 1.5mg/kg مره في اليوم اذا كانت جرعه علاجيه
والهيبارين في المراحل الاخيره من الفشل الكلوي
✅ادويه الضغط نعطي عائله ACEI مثل lisinopril اذا زادت scr بنسبه 30%مما كانت عليه قبل اعطاء الدواء ممكن نعطي من عائله CCB
✅بنسبه ل ادويه السكري يظل الميتوفرمين خيار اول حتى تصير GFR اقل من ٣٠ هنا نوقفه ونحوله الى انسولين
افضل دواء ضغط له 👈عائله ACEI
افضل مسكن له 👈 الباراسيتامول
افضل مضادات للتجلط له 👈enxoparine والهيبارين في المراحل الاخيره من الفشل الكلوي
افضل دواء للسكري له👈الأنسولين خاصه اذا GfRتحت 30
افضل مضاد الحموضة لمريض الفشل الكلوي 👈 omeprazole
✅طبعا مضاد للتجلط enoxparine اذا كان GFR اقل من ٣٠ ممكن نعطي 1.5mg/kg مره في اليوم اذا كانت جرعه علاجيه
والهيبارين في المراحل الاخيره من الفشل الكلوي
✅ادويه الضغط نعطي عائله ACEI مثل lisinopril اذا زادت scr بنسبه 30%مما كانت عليه قبل اعطاء الدواء ممكن نعطي من عائله CCB
✅بنسبه ل ادويه السكري يظل الميتوفرمين خيار اول حتى تصير GFR اقل من ٣٠ هنا نوقفه ونحوله الى انسولين
📑 Dyspnea Plus
(Suggestive Dx)
📝 Dyspnea + wheezing
👉 Asthma
📝Dyspnea + creption + orthopeni
👉 Pulmonary edema
📝 Dyspnea + fever +general fatigue + couph
👉 Pneumonia or Abcess
📝 Dyspnea + hemoptysis + wight loss
👉 TB or cancer
📝 Dyspnea + epigastric pain
👉 Intestinal perforation air underdiphram
📝 Dyspnea + pallor
👉 Anemia
📝 Dyspnea +chest pain +Dm + HTN
👉 MI
📝 Dyspnea + increase with inspiration
👉 Plerusity inflammatory
📝 Dyspnea + auria or hematurua or dysuria
👉 Uremia
📝 Sudden Dyspnea + hemaptsis
👉 pulmonary embolism
📝 Dyspnea + after truma
Pneumothorax
(Suggestive Dx)
📝 Dyspnea + wheezing
👉 Asthma
📝Dyspnea + creption + orthopeni
👉 Pulmonary edema
📝 Dyspnea + fever +general fatigue + couph
👉 Pneumonia or Abcess
📝 Dyspnea + hemoptysis + wight loss
👉 TB or cancer
📝 Dyspnea + epigastric pain
👉 Intestinal perforation air underdiphram
📝 Dyspnea + pallor
👉 Anemia
📝 Dyspnea +chest pain +Dm + HTN
👉 MI
📝 Dyspnea + increase with inspiration
👉 Plerusity inflammatory
📝 Dyspnea + auria or hematurua or dysuria
👉 Uremia
📝 Sudden Dyspnea + hemaptsis
👉 pulmonary embolism
📝 Dyspnea + after truma
Pneumothorax
من الشغلات المهمه بالروماتو هو Antibody ✅✅
داىما تجي mcq
🔴1- Rheumatoid arthritis
عدنا
Rheumatoid Factor (RF) highly sensitive
Low specificity
Anti cyclic citrullineted peptid AB (ACpA)
More specific
Less sensitive
لذلك بالتشخيص لازم ندز اثنينهم ✅✅
🟢SLE
Antinuclear Ab (ANA) 🔜🔜 positive in all case (sensitive 100%, low specificity)
if negative it’s not SLE
Anti ds-DNA low sensitivity highly specific 95%
Anti smith AB 👉👉 most specific for SLE specificity >99%
Anti R0= associated with neonatal lupus and congenital heart block
Antihiston = for drug induced lupes
🔴3- systemic sclerosis
ANA positive in 80%
Anti-scl-70 antibodies associated with diffuse cutaneous SSc
Anti-centromere antibodies associated with limited cutaneous SSc ( crest)
🟢sjogren syndrome
Anti Ro & anti Lo
Most specific one is anti Lo
# مفاصل ✅
داىما تجي mcq
🔴1- Rheumatoid arthritis
عدنا
Rheumatoid Factor (RF) highly sensitive
Low specificity
Anti cyclic citrullineted peptid AB (ACpA)
More specific
Less sensitive
لذلك بالتشخيص لازم ندز اثنينهم ✅✅
🟢SLE
Antinuclear Ab (ANA) 🔜🔜 positive in all case (sensitive 100%, low specificity)
if negative it’s not SLE
Anti ds-DNA low sensitivity highly specific 95%
Anti smith AB 👉👉 most specific for SLE specificity >99%
Anti R0= associated with neonatal lupus and congenital heart block
Antihiston = for drug induced lupes
🔴3- systemic sclerosis
ANA positive in 80%
Anti-scl-70 antibodies associated with diffuse cutaneous SSc
Anti-centromere antibodies associated with limited cutaneous SSc ( crest)
🟢sjogren syndrome
Anti Ro & anti Lo
Most specific one is anti Lo
# مفاصل ✅
عالم الطب🌐Medicine World
من الشغلات المهمه بالروماتو هو Antibody ✅✅ داىما تجي mcq 🔴1- Rheumatoid arthritis عدنا Rheumatoid Factor (RF) highly sensitive Low specificity Anti cyclic citrullineted peptid AB (ACpA) More specific Less sensitive لذلك بالتشخيص لازم ندز اثنينهم ✅✅…
sensitivity of RF in RA (ie, the proportion of patients with RA who are RF positive) ranges from 26 to 90 percent
specific test of rheumatoid arthritis:-
Anti-CCP antibody test (ACCP or CCP). This test is for a type of autoantibody called cyclic citrullinated peptide (CCP) antibodies, which can be found in the blood of 60% to 80% of people with rheumatoid arthritis. The test is often conducted along with an RF test
specific test of rheumatoid arthritis:-
Anti-CCP antibody test (ACCP or CCP). This test is for a type of autoantibody called cyclic citrullinated peptide (CCP) antibodies, which can be found in the blood of 60% to 80% of people with rheumatoid arthritis. The test is often conducted along with an RF test
#همياتو ✅✅
🔴 Acute leukemia 🔜🔜blast cell more than 20% in bone marrow, rapied onset of symptoms
Chronic leukemia blast cell less than 10%in bone marrow,gradually onset of symptoms
🟠old age with increase wbc very highly lymphocytes with lymphadenopathy,splenomegli 👉👉 chronic lymphocytic leukemia (assay)
🟢commonest leukemia in adults is CLL (mcq)
🔴 child with increase wbc very highly lymphocytes with lymphadenopathy,🔜🔜🔜 Acute lymphoblastic leukemia
🟢most common leukemia in children is➡️➡️ Acute lymphoblastic leukemia
🟡 middle age male with gum hypertrophy and bleeding ,fatigue,anemia CBC show pan cytopenia ,neutrophil show esinophilic inclusion body
➡️➡️➡️ Acute promylocytic leukemia
🔴Acute promylocytic leukemia or M3 leukemia associated with DIC (mcq)
Bec have granule activated clotting cascade
🟢esionophlic inclusion body (Aur body) characteristics of promylocytic leukemia (mcq and osce)
✅most accurate test for diagnosis is bone marrow examinations
🔴most important test to determine the prognosis is cytogenetic study
🟡 old age present with fatigue, low grad fever , early satiety or abdominal fullness (mean there is massive splenomegali) , sternal tenderness 👉👉👉👉
Chronic myeloid leukemia
🔴 most accurate test for diagnosis of CML is 👉👉Philadelphia chromosome
🟢 drug use for treatment of CML is imatinib
🟡 old age male with fever with chills drenching night sweat associated with wight loss and generalized lymphadenopathy, fatigue👉👉👉👉 lymphoma
🔴Lymphoma is malignant proliferation of lymphoid cell in lymphoid tissue (LN and spleen)
🟢originat from B cell or T cell
B cell better prognosis 🔜✅✅
🔴 old age black male present with low back pain polyuria, polydepsia 👉👉👉👉
Multiple myeloma more in black male older than 70 y
🟡why present with polyuria 👉👉👉 due hypercalcemia )osmotic diuretic ✅✅
#باطنيه
🔴 Acute leukemia 🔜🔜blast cell more than 20% in bone marrow, rapied onset of symptoms
Chronic leukemia blast cell less than 10%in bone marrow,gradually onset of symptoms
🟠old age with increase wbc very highly lymphocytes with lymphadenopathy,splenomegli 👉👉 chronic lymphocytic leukemia (assay)
🟢commonest leukemia in adults is CLL (mcq)
🔴 child with increase wbc very highly lymphocytes with lymphadenopathy,🔜🔜🔜 Acute lymphoblastic leukemia
🟢most common leukemia in children is➡️➡️ Acute lymphoblastic leukemia
🟡 middle age male with gum hypertrophy and bleeding ,fatigue,anemia CBC show pan cytopenia ,neutrophil show esinophilic inclusion body
➡️➡️➡️ Acute promylocytic leukemia
🔴Acute promylocytic leukemia or M3 leukemia associated with DIC (mcq)
Bec have granule activated clotting cascade
🟢esionophlic inclusion body (Aur body) characteristics of promylocytic leukemia (mcq and osce)
✅most accurate test for diagnosis is bone marrow examinations
🔴most important test to determine the prognosis is cytogenetic study
🟡 old age present with fatigue, low grad fever , early satiety or abdominal fullness (mean there is massive splenomegali) , sternal tenderness 👉👉👉👉
Chronic myeloid leukemia
🔴 most accurate test for diagnosis of CML is 👉👉Philadelphia chromosome
🟢 drug use for treatment of CML is imatinib
🟡 old age male with fever with chills drenching night sweat associated with wight loss and generalized lymphadenopathy, fatigue👉👉👉👉 lymphoma
🔴Lymphoma is malignant proliferation of lymphoid cell in lymphoid tissue (LN and spleen)
🟢originat from B cell or T cell
B cell better prognosis 🔜✅✅
🔴 old age black male present with low back pain polyuria, polydepsia 👉👉👉👉
Multiple myeloma more in black male older than 70 y
🟡why present with polyuria 👉👉👉 due hypercalcemia )osmotic diuretic ✅✅
#باطنيه
#هيماتو
🔴young femal with paller,Fatige ,Headache,dyspnea 👉👉 anemia till proven otherwise
🟣most common type of anemia worldwide is 👉👉Iron deficiency anemia
🔶Paller ,fatigue,low HB , low mcv is👉👉IDA till proven otherwise
🟣differential diagnosis of microcytic, hypochromic anemia
بكل امتحان يجي
1-IDA
2-anemia of chronic disease
3-thalassemia
4-lead poisoning
5-sideroplastic anemia
🔴شون نفرق بين
IDA & thalassemia
عن طريق RDW= Red cell distribution width
Thalassemia= normal (12-15)
لان ايرون موجود تصنع خلايا طبيعيه نفس الشكل والحجم
IDA=increase RDW
لان ايرون ماكو تصنع خلايا مختلفه الاحجام
🟡paller , fatigue,occult blood in stool , esinophilia , low HB, low MCV
Endoscope reddish worm 🪱 in deodenum 👉👉 IDA due Hook worm infection )ancylostoma duodenale
🟠best single test to confirm iron deficiency anemia is 👉👉serum ferritin
🟢low HB , low RBC ,highly MCV , 👉👉 megaloblastic anemia most likely pernicious anemia
🔴anemia +neurological manifestation 👉👉👉megloblastic anemia till proven otherwise
🟣deferential diagnosis of macrocytic (mcv more than 100Fl)
hyperchromic anemia
1-megaloblastic anemia (mcv more than 120)
2-liver diseas
3-Alcoholic
4-Hypothyroidism
5-malignancy
6-haemolytic
7-pregnancy
8-drug azithioporin (mcq)
🔴low HB , lowRBC , Reticulocytosis
Ddx مهم جدا بالامتحان
1-Acute bleeding
2-haemolytic anemia
3-IDA on start treatment
🔶low HB , lowRBC , Reticulocytosis
And Heinz body👉👉 (G6PD)
🟢. low HB , lowRBC , Reticulocytosis pain all over the body
Chest pain , joint pain 👉👉👉👉
Sickle cell disease
🟣young female low HB , lowRBC , Reticulocytosis
(Autoimmune haemolytic anemia )
🔴low RBC , low HB, low WBC , low platelets 👉👉no splenomegali 👉👉Aplastic anemia
🟢low RBC , low HB, low WBC , low platelets 👉👉no splenomegali 👉
Hypersplinism mostly due chronic liver disease
#باطنيه
🔴young femal with paller,Fatige ,Headache,dyspnea 👉👉 anemia till proven otherwise
🟣most common type of anemia worldwide is 👉👉Iron deficiency anemia
🔶Paller ,fatigue,low HB , low mcv is👉👉IDA till proven otherwise
🟣differential diagnosis of microcytic, hypochromic anemia
بكل امتحان يجي
1-IDA
2-anemia of chronic disease
3-thalassemia
4-lead poisoning
5-sideroplastic anemia
🔴شون نفرق بين
IDA & thalassemia
عن طريق RDW= Red cell distribution width
Thalassemia= normal (12-15)
لان ايرون موجود تصنع خلايا طبيعيه نفس الشكل والحجم
IDA=increase RDW
لان ايرون ماكو تصنع خلايا مختلفه الاحجام
🟡paller , fatigue,occult blood in stool , esinophilia , low HB, low MCV
Endoscope reddish worm 🪱 in deodenum 👉👉 IDA due Hook worm infection )ancylostoma duodenale
🟠best single test to confirm iron deficiency anemia is 👉👉serum ferritin
🟢low HB , low RBC ,highly MCV , 👉👉 megaloblastic anemia most likely pernicious anemia
🔴anemia +neurological manifestation 👉👉👉megloblastic anemia till proven otherwise
🟣deferential diagnosis of macrocytic (mcv more than 100Fl)
hyperchromic anemia
1-megaloblastic anemia (mcv more than 120)
2-liver diseas
3-Alcoholic
4-Hypothyroidism
5-malignancy
6-haemolytic
7-pregnancy
8-drug azithioporin (mcq)
🔴low HB , lowRBC , Reticulocytosis
Ddx مهم جدا بالامتحان
1-Acute bleeding
2-haemolytic anemia
3-IDA on start treatment
🔶low HB , lowRBC , Reticulocytosis
And Heinz body👉👉 (G6PD)
🟢. low HB , lowRBC , Reticulocytosis pain all over the body
Chest pain , joint pain 👉👉👉👉
Sickle cell disease
🟣young female low HB , lowRBC , Reticulocytosis
(Autoimmune haemolytic anemia )
🔴low RBC , low HB, low WBC , low platelets 👉👉no splenomegali 👉👉Aplastic anemia
🟢low RBC , low HB, low WBC , low platelets 👉👉no splenomegali 👉
Hypersplinism mostly due chronic liver disease
#باطنيه