Internal medicine Batch (4)

Hematology #الدكتور محمد داوود .

Anti arrhythmia drugs

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Summary Addison's disease: Addison's disease is primary chronic adrenocortical insufficiency caused by autoimmune destruction or granulomatous disease of the adrenal cortex, resulting in cortisol, aldosterone, and androgen deficiency. Presenting with profound fatigue, weight loss, orthostatic hypotension, salt craving, and characteristic cutaneous hyperpigmentation, diagnosis is confirmed by a subnormal cortisol response (< 18\text{ mcg/dL}) on a short cosyntropin stimulation test, combined with elevated plasma ACTH. Management requires lifelong daily oral Hydrocortisone and Fludrocortisone replacement, supported by strict patient sick-day stress-dosing rules and emergency intravenous hydrocortisone and saline resuscitation for life-threatening Addisonian crises.

Summary: cushing syndrome Cushing's Syndrome is a clinical disorder defined by prolonged, chronic exposure to excess circulating glucocorticoids, most commonly caused by iatrogenic long-term systemic corticosteroid therapy or endogenous hypercortisolemia (ACTH-dependent or ACTH-independent). Presenting with central weight gain, moon facies, facial plethora, purple abdominal striae, proximal muscle weakness, and hypertension, diagnosis is confirmed using 24-hour urinary free cortisol or a 1-mg dexamethasone suppression test, followed by plasma ACTH measurement to differentiate ACTH-dependent from ACTH-independent causes. Management centers on supervised tapering of exogenous steroids or definitive surgical resection of endogenous sources (pituitary adenoma, adrenal tumor, or ectopic source), supported by medical steroidogenesis inhibitors (ketoconazole, metyrapone) and glucocorticoid receptor blockers (mifepristone), while maintaining constant vigilance for acute postoperative or withdrawal adrenal crisis.

Summary: Diabetes Mellitus is a chronic metabolic disease defined by persistent hyperglycemia due to absolute insulin deficiency (Type 1) or insulin resistance combined with progressive beta-cell failure (Type 2). Clinically presenting with the classic triad of polyuria, polydipsia, and polyphagia alongside fatigue and weight loss, diagnosis is established using HbA1c (\ge 6.5\%) or fasting plasma glucose (\ge 126\text{ mg/dL}). Management is centered on lifestyle modification, first-line oral Metformin (\le 2550\text{ mg/day}), organ-protective second-line therapies (SGLT2 inhibitors and GLP-1 receptor agonists), sulfonylureas, and comprehensive basal-bolus insulin regimens. Long-term care requires rigorous monitoring and management of microvascular (retinopathy, nephropathy, neuropathy) and macrovascular complications, alongside constant vigilance for acute metabolic emergencies like DKA and HHS.

Diabetes Mellitus vs. Diabetes Insipidus: • ​Best Confirmation: Hyperglycemia with glucosuria in DM; normal glucose/HbA1c with dilute polyuria and hypernatremia in DI. • ​Management: Antidiabetic drugs for DM; desmopressin and hydration for central DI.

SUMMARY SAIDH: Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is a disorder of impaired water excretion caused by unregulated ADH release, resulting in hypotonic euvolemic hyponatremia. Diagnosed via Bartter-Schwartz criteria (serum osmolality < 275, inappropriate urine concentration > 100, clinical euvolemia, and urinary sodium > 40\text{ mEq/L} after excluding adrenal and thyroid failure), management centers on first-line fluid restriction (500\text{--}1000\text{ mL/day}), oral salt, tolvaptan, and hypertonic saline (3\% NaCl) for severe neurological emergencies, maintaining strict vigilance never to raise serum sodium faster than 8\text{--}10\text{ mEq/L} per 24 hours to avoid osmotic demyelination syndrome.

5. 25 years old male presented with polyuria and polydipsia and hypernatremia, the water deprivation test shows no changes in urine osmolality, The most likely diagnosis is: A-DM B- Diab. insipidus C-SIADH E.non of the abovestitic

5. 25 years old male presented with polyuria and polydipsia and hypernatremia, the water deprivation test shows no changes in urine osmolality, The most likely diagnosis is: A-DM B- Diab. insipidus C-SIADH E.non of the abovestitic

✅✅✅✅✒🖊✒🖊✒🖊✅✅✅✅✅ In cardiac tumor:- ملخص ملزمة الدكتورة امه الرحيم القهالي دفعه 6 Q-Most common primary benign in age more than 35 y:- A-Myxoma (autosomal dominant less than 30 years) Common in L.atrium. Q-Most common primary benign in age less than 30 y & in the child:- A-Rahypdomyoma(associated with Tuberous sclerosis). Q-Most common primary benign in age more than 60 y:- A-Papillary fibroelastoma(valvular cancer rarely on endocardial surface).in adult affected on: Aortic valve &in child:- Tricuspid valve. Q-Most common primary malignancy :- A-Angiosarcoma(most affected on Rt.heart and pericardium, malignant from vascular channels). Q-Most common primary malignancy in adult:- A-Rahypdomyosarcoma. Q-Affected on:- 1_ septal myocardium:- fibromas 2_pericardium and myocardium:- Primary benign:-lipoma Primary malignancy:- mesothelioma( rarely affected on heart chambers). 3_intra pericardial cancer:- pheochromocytoma (primary malignancy).

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للإطلاع

KDIGO criteria for statin use in CKD هذا من الاسئله الذي تجيبها الدكتوره .. وهذا السؤال According to KIGIO criteria for treatment with statin in those with aged 18 - 48 are all of the following except : A. Those with coronary artery disease. B. DM C. HTN D. CKD with dialysis

SBA- Pneumonia-Organism (10000%) 1. Pneumonia + Alcoholic/Diabetic + Cavitation = Klebsiella 2. Pneumonia + Prior Flu/Influenza = Staph Pneumonia 3. Pneumonia + Chicken Pox Rash = Varicella Pneumoniae 4. Pneumonia + Hemolytic Anemia/Young/Erythema multiforme/Cold agglutination positive = Mycoplasma 5. Pneumonia + Hyponatraemia + Travel History/ Local outbreaks/Cooling tower in hotel/hospital/urinary antigen positive = Legionella 6. Pneumonia + Fleeting opacities = Cryptogenic Pneumonia 7. Penumonia + Fits/LOC = Aspiration Pneumonia 8. Pneumonia + HSV oral lesion/Rusty sputum = Strept Pneumonia 9. Pneumonia + parrot =C. psitatssi 10. Pneumonia + farm animals = Q fever (coxillea) 11. Pneumonia + HIV = think PCP but if straight forward case strep pneumonia is still most common 12. Pneumonia + Cystic fibrosis = consider pseudomonas 13. Pneumonia + COPD/old age/ Bronchiectasis = Haemophilus Influenza

مقارنه رائعه ل ankylosing spondylitis reactive arthritis polymyalgia rheumatica

AUTOIMMUNE ( DMARDs ) Drugs

BNP investigation