اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
Chronic hepatic injury leading to fibrosis, necrosis, and nodular regeneration
What is the most common cause of cirrhosis in the west
Alcoholism
What are some nonalcoholic causes of cirrhosis
Alpha-1 antitrypsin deficiency, hemochromatosis, primary or secondary biliary cirrhosis, Wilson disease, hepatitis B, hepatitis C
What are the signs and symptoms of cirrhosis
Jaundice, ascites, asterixis, bleeding, edema, hepatomegaly, encephalopathy, palmar erythema, spider angiomata on the abdomen
What is asterixis
Downward flapping of hands when held in a dorsiflexed position
Why do cirrhotic patients get ascites
Because they have low albumin.
How can the ascite be treated
Spironolactone and paracenesis
What is a major complication of ascites
Spontaneous bacterial peritonitis
What is the most common organism causing SBP
E. coli
What is the most classic sign of SBP
Rebound abdominal tenderness in a patient with ascites
How is SBP diagnosed
Paracentesis with fluid sent for cell count and Gram stain, culture, and sensitivity
What are the diagnostic criteria for SBP
Neutrophil count > 250 or positive Gram stain or culture
What is the treatment for SBP
Third-generation cephalosporin with albumin
Why do cirrhotic patients tend to bleed
PT is elevated and platelets are low
What is the treatment for cirrhosis
Stop alcohol consumption, multivitamin including thiamine and B12, nutrition
What marker can detect an alcohol binge
Gamma-glutamyltransferase (GGT)
What is portal hypertension
Elevated portal vascular resistance 2ry to pre_, post_ , or sinusoidal obstruction
Postsinusoidal: hepatic vein thrombosis, right heart failure
Sinusoidal: cirrhosis
Internationally, what is the most common cause of portal hypertension
Schistosomiasis
What are the classic physical examination findings in a patient with portal hypertension
CHASE
Caput medusa
Hemorrhoids
Ascites
Splenomegaly
Esophageal varices
What are the treatments for portal hypertension
Decrease portal pressure with propranolol; transjugular intrahepatic portosystemic shunt(TIPS) ; last resort is a liver transplant
What is a common cause of hematemesis in a patient with portal hypertension
Varicial bleeding
How is a variceal bleed diagnosed
Esophagogastroduodenoscopy (EGD)
What is the treatment for a variceal bleed
IV fluids, fresh frozen plasma (FFP), vasopressin, sclerotherapy on banding or the varices, balloon tamponade, propranolol (although not acutely given)
What are some treatments for hepatic encephalopathy
Lactulose to decrease absorption of ammonia, neomycin, and protein-restricted diet
What is hepatorenal syndrome
Patients with advanced hepatic disease develop acute renal failure.
How is hepatorenal syndrome diagnosed
Elevated BUN/creatinine (CR), hyponatremia,oliguria, hypotension, and urine Na< 10
What are the three different etiologic categories of hepatitis
1. Viral
2. Alcoholic
3. Drug-induced (paracetamol , INH)
Name the hepatitis viruses transmitted via the fecal-oral route
Hepatitis A and E
Name the hepatitis viruses transmitted via blood and sexual contact
Hepatitis B, C, D
Name the only DNA hepatic virus
Hepatitis B
Which hepatitis viruses have a chronic carrier state
Hepatitis B, C, D
Which hepatitis viruses have a vaccine available
Hepatitis A and B (and D)
How can you detect an acute hepatitis A infection
Anti-hepatitis A virus (HAV) IgM
How can you detect immunity to hepatitis A
Anti-HAV IgG
How is hepatitis A treated
It is a self-limiting disease
Which disease state do each of the following hepatitis B markers detect
What can be given to a patient exposed to hepatitis B to prevent infection
Hepatitis B immunoglobulin (HBIG)
What is the treatment for a person infected with hepatitis B
Interferon, lamivudine, adefovir
When is the window period for hepatitis B
The time when HBsAg has become undetectable but HBsAb is not yet detectable
What is the worst complication of hepatitis B
Hepatocellular carcinoma
Which hepatitis virus carries the highest risk of developing into hepatocellular carcinoma
Hepatitis B
What is the treatment for a person infected with hepatitis C
Interferon + ribavarin
Which hepatitis virus must have concomitant infection with hepatitis B
Hepatitis D
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
يا من عدى ثم اعتدى ثم اقترف.. ثم ارعوى ثم انتهى ثم اعترف
أبشر بقول الله في آياته.. "إن ينتهوا يُغفَرْ لهم ما قد سلف"
تقبل الله منا شهر رمضان
وجعلنا من عتقائه من النار
وبلغنا ليلة القدر
What defines chronic obstructive pulmonary disease (COPD)
As the name implies, it is defined by chronic obstruction to expiratory airflow such that the forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) is decreased
What are the two main forms of COPD
Emphysema and chronic bronchitis
What is the male-to-female ratio of emphysema
Male:female = 10:1
What defines emphysema
Chronic obstructive expiratory airflow withdilation of air spaces caused by destruction of alveolar walls
What is the most common cause of emphysema
Smoking
What type of emphysema does smoking cause
Centrilobular, meaning that it affects the bronchioles (Hint: The “S” sound is in both smoking and centrilobular)
What causes panacinar emphysema
Alpha-1-antitrypsin deficiency
What is the function of alpha-1-antitrypsin in the lung
It protects the elastin in the lungs from proteolytic enzymes.
What are the pathognomonic symptoms associated with emphysema
Pursed lip breathing(with prolonged expiratory phase),barrel chest, hyperventilation; classically described as a“pink puffer,” weight loss
What is seen on a chest x-ray (CXR) in a patient with emphysema
Hyperinflation and hyperlucency of the lungs with flattening of the diaphragms; parenchymal bullae and subpleural blebs may be present; alveolar wall destruction
What do you expect to see in arterial blood gases in a person with early-stage emphysema
Low PCO2and normal/low PO2
What is the long-term treatment for emphysema
Smoking cessation!Home oxygen, bronchodilators, steroids; pneumococcal and flu vaccines should be offered
What defines chronic bronchitis
Productive cough on most days during three or more consecutive months for two or more consecutive years
What is the difference in symptomatology in chronic bronchitis vs. emphysema
Chronic bronchitis includes a persistent productive cough as well as more hypoxia than seen in emphysema, and patients are usually overweight.
What is the pathognomonic description of a person with chronic bronchitis
“Blue bloater” because of CO2retention and hypoxia
What do you expect to see in an ABG in a person with chronic bronchitis
High PCO2and low PO2, compensated respiratory acidosis
What are the potential complications associated with chronic bronchitis
Right heart failure (cor pulmonale), polycythemia, pneumonia, hepatomegaly
What is the treatment for chronic bronchitis
Treatments are the same as that for emphysema and include smoking cessation, oxygen therapy, bronchodilators, and steroids, and, also, some TTT with antibiotics in
exacerbations.
What is the only treatment proven to extend life in COPD
Oxygen therapy
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
Pathological dilatation of bronchioles caused by chronic inflammation and wall structure destruction
What are some common etiologies of bronchiectasis
Cystic fibrosis, tuberculosis (TB), lung abscess, toxin inhalation
What is the most common cause of hemoptysis
Bronchiectasis
What is the underlying pathologic problem that results because of chronic dilatation of bronchioles
The dilated bronchioles impede mucociliary clearance, favoring mucus pooling and colonization with bacteria and, therefore, further lung damage.
What are the most common pathogens that colonize the lung in an individual with bronchiectasis
SHiP:
Staphylococcus aureus
Haemophilusinfluenzae
Pseudomonas
How do you treat the organisms that most commonly infect the lung in bronchiectasis
Third-generation cephalosporin
What are the signs and symptoms of bronchiectasis
Halitosis, hemoptysis, chronic cough with sputum production
How can bronchiectasis be diagnosed
High-resolution computed tomographic (CT) scan of the lungs will demonstrate bronchial dilatation as well as destruction.
What is the pathognomonic sign seen on CXR in a person with bronchiectasis
Tram track lung markings
What is the treatment for bronchiectasis
Antibiotics for infections, bronchodilators, oxygen, and, sometimes, lung transplant
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
Reversible obstruction of airways secondary to airway inflammation, hypersecretion and, most importantly, bronchoconstriction that leads to a decreased peak flow and FEV1
What is intrinsic asthma associated with
Exercise-induced or upper respiratory infection (URI)-induced asthma
What is extrinsic asthma associated with
Asthma caused byeosinophilia or increased immunoglobulin E (IgE) levels in response to Environmental antigens
When does asthma usually start and what is its usual course
Asthma generally begins during childhood and usually resolves on its own by the early teenage years.
What is often the first symptom of asthma that a patient will often describe
Nighttime cough (for some people this is the only symptom)
What are some of the major signs and symptoms of an acute asthma exacerbation
Expiratory wheeze, shortness of breath, chest tightness, subcostal retractions, accessory muscle use, prolonged expiratory phase
What would spirometry show in an asthmatic
Decreased FEV1
What would an ABG show in an asthma attack
Hypoxia and respiratory alkalosis
How can it be confirmed that the wheezing is caused by asthma and not some other cause
The wheezing resolves with bronchodilator therapy and the FEV1will increase by 10% or more.
What is a sign of impending respiratory failure in a case of asthma
ABG that shows normalizing PCO2
What classic diagnosis should you think of if the complete blood count (CBC) of an asthmatic demonstrates eosinophilia
Churg-Strauss syndrome
What are the different categories of asthma, what are their symptoms (Sx), and what is the treatment for each
What is the first-line treatment for an acute asthma exacerbation
Oxygen, bronchodilators (includes beta-agonist and ipratropium [Atrovent]) and steroids
What is the second-line treatment for an acute asthma attack
Subcutaneous epinephrine and MgSO4
How can mild asthma refractory to aggressive beta-agonist therapy be treated
Add an inhaled steroid
When is systemic corticosteroid therapy indicated in asthma
Daily or continuous asthma that is refractory to beta-agonist and inhaled steroids
What are some alternative therapies in asthma
Leukotriene inhibitors and cromolyn sulfate or allergic desensitization in extrinsic asthma
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
Increased fluid in the pleural space
What are the two main types of pleural effusions
Exudate and transudate
What are some common causes of exudative pleural effusions
Infection such as pneumonia, malignancy, collagen vascular disease
What are some common causes of transudative pleural effusions
Congestive heart failure (CHF), cirrhosis, nephritic syndrome
What is the underlying cause of fluid buildup in an exudate
Increased capillary permeability
What is the underlying cause of fluid buildup in a transudate
Decreased oncotic pressure (fluid backups)
How can a pleural effusion be evaluated
Thoracentesis with analysis of cell counts, cultures, chemistries, and cytology
How can a pleural effusion be treated
Treating the underlying cause and thoracentesis can be both diagnostic and therapeutic.
What lab tests should be sent in order to evaluate the pleural fluid
Fluid and serum protein, glucose, lactate dehydrogenase (LDH); fluid culture and Gram stain; fluid cytology and cell count with differential and, additionally, you can send fluid amylase, AFB, ANA, RF, pH
What defines an exudative effusion
If any of the following is true, the fluid effusion is considered exudative.
Pleural protein/serum protein > 0.5
Pleural LDH/serum LDH > 0.6
Pleural LDH > 200
What does it signify if the pleural fluid has > 10,000 WBCs with polymorphonuclear neutrophils (PMNs)
Most likely a parapneumonic effusion
What is gross blood in the pleural fluid associated with
Tumor or trauma
What can low glucose (glucose < 60) in the pleural fluid be associated with
Tumor, empyema, rheumatologic etiology, parapneumonic exudate
What are high amylase levels in pleural fluid associated with
Pancreatitis but can also be malignancy, or esophageal rupture
What percentage of pleural effusions caused by malignancy will have a fluid cytology that has malignant cells
Only 40%
Summarize exudative vs. transudative analysis
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
What are the components of acute respiratory distress syndrome (ARDS)
Refractory hypoxemia, decreased lung compliance, noncardiogenic pulmonary edema
What is the etiology of ARDS
Endothelial injury secondary to aspiration, multiple transfusions, shock, sepsis, trauma
What are the criteria needed to diagnose ARDS
1. Acute onset of respiratory distress
2. PaO2: FIO2ratio < 200 mm Hg
3. Bilateral pulmonary infiltrates on CXR
4. Normal capillary wedge pressure
What is the treatment for ARDS
Treat the underlying disease and give adequate oxygen via mechanical ventilation
What is the overall mortality in ARDS
About 50%
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
A person with what body habitus is most likely to have a primary spontaneous pneumothorax
Tall and thin male
What is the most likely etiology of a primary spontaneous pneumothorax
Rupture of subpleural blebs
What are some risk factors for having a secondary spontaneous pneumothorax?
COPD, lung cancer, pneumonia, TB, HIV, cystic fibrosis, trauma
What are the signs and symptoms of case with
pneumothorax
Sudden unilateral chest pain, dyspnea, and tachypnea
What is found on physical examination in a person with a pneumothorax
Absent breath sounds on the side of the pneumothorax and hyperresonance to percussion
What is seen on CXR in a pneumothorax
Absent lung markings on the side of pneumothorax
What is the treatment of a spontaneous pneumothorax
Oxygen is the mainstay of therapy, but if the pneumothorax is symptomatic, a tube thoracostomy may be indicated. Pleurodesis can be used to make the visceral and parietal pleura adhere to each other.
What is a tension pneumothorax
A chest wall defect causes air to be trapped in the pleural space during expiration like a one-way valve
How is a tension pneumothorax treated
This is a medical emergency. Treatment includes immediate needle decompression and chest tube placement after
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
What is the most likely causative factor of lung cancer
Smoking
What are some other causes of lung cancer
Second-hand smoke, exposure to asbestos, nickel, arsenic, radon gas
What are the two main categories of lung cancer
Small cell and non small cell
What are the different types of lung tumors that are nonsmall cell lung cancers
Large cell, adenocarcinoma, squamous cell, bronchoalveolar cell
Name the type of lung cancer associated with the following
What are some signs and symptoms of lung CA?
Chronic cough, hemoptysis, weight loss, night sweats, pneumonia (postobstructive),
hoarseness, paraneoplastic syndrome
How is lung cancer diagnosed
Usually a nodule or mass is seen on CXR or CT of the chest and is diagnosed with abiopsy usually done via bronchoscopy or CT-guided fine needle aspiration
What are some of the signs and symptoms of a carcinoid tumor
Symptoms of carcinoid syndrome due to serotonin secretion, which include flushing,
asthmatic wheeze, diarrhea
What is the diagnostic test for carcinoid tumor
Test for elevated urine 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite
How is carcinoid syndrome treated
Serotonin antagonist
What is a Pancoast tumor
Superior sulcus tumor
What paraneoplastic syndromes are associated with a Pancoast tumor
Horner syndrome, superior vena cava syndrome
What is Pancoast syndrome
Shoulder and arm pain secondary to the tumor compressing the eighth cervical nerve
Name the paraneoplastic syndrome associated with signs and symptoms described below
التوقيع
اللهم إنك عفو كريم تحب العفو فاعف عنى
خللى بالكم يا شباب سادسة من الجرعات دى مهمة جدااااااااااااااااااااا فى النسا
Mg Sulfate as anticonvulsant in ttt of PET
IV 4-6 gm slowly (over 15-20 min) then 1-2 gm/hr by drip
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,, Oxytocin as ecbolic
most commonly used in (saline , dextrose , lactated ringer)
start by small dose at slow rate then gradualy increase
.5 - 2 mIU /min then increase by 1-2 mIU/30-60min
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, دكتور أبو عمار
الباطنة (سؤال & جواب ) فى السريع كده !!!!!!!!!!!
دكتور أبو عمار 
العرض العادي
