جزاكــــــ الله خيرا ــــــــم دكتور إيم ...ربنا يتقبل إن شاء الله
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
An autoimmune symmetric inflammatory arthritis
What HLA type is RA associated with
HLA-DR4
In what sex is RA more common
Females
What classical physical examination findings can be found in RA
Boutonniere deformity; swan neck deformity; ulnar deviation; pain in theproximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints, rheumatoid nodules
What are the seven diagnostic criteria for RA
1. Morning stiffness > 1 hour
2. Three or more joints with arthritis
3. One hand joint with arthritis
4. Symmetric arthritis
5. Rheumatoid nodules
6. Elevated serum rheumatoid factor (RF)
7. Radiographic changes
How many of the criteria must be positive for a diagnosis of RA
Four
What is a boutonniere deformity
Hyperextension of distal interphalangeal (DIP) and flexion of PIP joints
What is a swan neck deformity
Flexion of DIP and extension of PIP joints
What laboratory findings could you expect in a patient with RA
RF, erythrocyte sedimentation rate (ESR)
What is the treatment for pain associated with RA
First-line: nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease inflammation
Second-line: corticosteroids
What disease modifying agents are available for patients with RA
Methotrexate, hydroxychloroquine, gold compounds
What are some newer biologic agents used to treat RA
Infliximab, etanercept, abetacept, rituxan
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 common type of arthritis
Osteoarthritis (OA)
What is the underlying cause of OA
Mainly wear and tear of the joints
What are the two classic physical examination findings in OA
Heberden nodules which affect the DIP joints
Bouchard nodes which affect the PIP joints
How do the symptoms of OA differ from RA
Morning stiffness resolves within 30 minutes; outer joints of the hand are mainly affected
(DIP joints in addition to MCP and PIP joints).
What are the x-ray findings seen in OA
Narrowed joint spaces,osteophyte formation
What is the treatment for OA
NSAIDs to relieve pain; muscle strengthening exercises; steroid joint injection; last resort is joint replacement
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
Arthropathy caused by urate crystal deposit in a single joint
What are the etiologies of gout
Decreased uric acid excretion (high-protein diet, alcohol use, diuretic use) or increased uric acid production (genetic diseases, hemolysis, cancer)
What are the signs and symptoms of gout
Acute pain accompanied by redness gout and swelling of a joint
What is the most common joint to be affected
First metatarsophalangeal joint
What is podagra
Inflammation of the first metatarsophalangeal joint of the foot which is of sudden onset
What are tophi
Aggregates of gouty crystal and giant cells secondary to chronic gout
What is the classic radiographic finding in advanced gout
“Rat-bite” appearance
How is gout diagnosed
Fluid aspirated from the joint would reveal needle-shaped monosodium urate crystals with negative birefringence
How is acute gout treated?
Colchicine and NSAIDs for pain
What is used for maintenance therapy of gout
Allopurinol to prevent production; probenecid to increase excretion; low-protein diet; refrain from alcohol
What is pseudogout
Deposition of calcium pyrophosphate crystal deposits in joints
What does joint fluid aspiration in pseudogout demonstrate
Positively birefringent rhomboid crystals
What is the treatment for pseudogout
NSAIDs
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 autoimmune disorder is characterized by systemic fibrosis secondary to excess collagen and extracellular matrix production
Scleroderma
What are the signs and symptoms of scleroderma
Tight, thick skin; Raynaud phenomenon; dysphagia; renal artery fibrosis; pulmonary hypertension 2ry to fibrosis; telangiectasias
What does CREST stand for
Calcinosis
Raynaud phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
What laboratory test is 80% sensitive for CREST syndrome
Anticentromere antibody
What laboratory test is highly specific to scleroderma
Anti-Scl-70 antibody
What is the treatment for scleroderma
CAPS
Calcium channel blocker
ACE inhibitor (captopril)
Penincillamine
Steroids
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 autoimmune disorder is associated with the following triad:
keratoconjunctivitis sicca, xerostomia, and arthritis
Sjögren syndrome
What HLA type is Sjögren syndrome associated with
HLA-DR3
What type of cancer are patients with Sjögren syndrome at high risk for
Lymphoma
What autoantibodies is Sjögren syndrome associated with
Anti-single stranded (SS)-A (Ro) and anti-SS-B (La)
What is the treatment for Sjögren syndrome
Corticosteroids
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
شكرآ لك أخي على هذا المجهود جعله الله في ميزان حسناتك
التوقيع
من أنست نفسه بالله لم يجد لذة في الأنس بغيره ... ومن أشرق قلبه بالنور لم يعد فيه متسع للظلام ... ومن سمت روحه بالتقوى لم يرض إلا سكنى السماء... ومن أحب معالي الأمور لم يجد مستقرا إلا الجنة ... ومن أحب العظماء لم يقنعه إلا أن يكون مع محمد صلى الله عليه وسلم...
ومن أدرك أسرار الحياة لم ير جديرا بالحب حق الحب إلا الله تبارك وتعالى
اللهم... ارزقنا رؤية الحبيب صلى الله عليه وسلم في الدنيا ومصاحبته في الآخرة يا ربي انى اسألك من خير ما سألك به عبدك ونبيك محمد صلى الله عليه وسلم
واعوذ بك من شر ما استعاذ به عبدك ونبيك محمد صلى الله عليه وسلم
Name the autoimmune disorder which is characterized by sacroiliitis, with fusion of adjacent vertebral bodies
Ankylosing spondylitis
What HLA type is ankylosing spondylitis associated with
HLA-B27
What joint is always affected in ankylosing spondylitis
Sacroiliac joint
What is the classic x-ray finding seen with ankylosing spondylitis
Bamboo spine
What other disorder is ankylosing spondylitis associated with
Ulcerative colitis
Name the syndrome associated with the following: conjunctivitis, uveitis, urethritis, and asymmetric arthritis
Reiter syndrome
What is the mnemonic used to remember the associated findings of Reiter syndrome?
“Can’t see. Can’t Pee. Can’t climb a tree.”
Can’t see: conjunctivitis, uveitis
Can’t pee: urethritis
Can’t climb a tree: arthritis
What HLA type is Reiter syndrome associated with
HLA-B27
What are the two forms of Reiter syndrome
1. Sexually transmitted
2. Postinfectious:Campylobacter ,Yersinia, Salmonella, Shigella
What will a urethral culture often grow out in a patient with Reiter syndrome
Chlamydia trachomatis
What is the treatment for Reiter syndrome
Doxycycline to cover forChlamydia and NSAIDs for pain
What is the autoimmune syndrome associated with the following: aphthous ulcers, genital ulcers, arthritis , uveitis, psychiatric symptoms
Behçet syndrome
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
Insulin deficiency due to autoinflammatory destruction of pancreatic B cells
What is the pathophysiology of type 2 diabetes
Insulin resistance and relative insulin deficiency
What is the age of onset of type 1 and type 2 diabetes
Type 1 usually begins in childhood/adolescence and type 2 usually begins in adulthood
Which of the two types of diabetes has a stronger genetic factor
Type 2 diabetes(seems counterintuitive)
What are the early symptoms of diabetes
“The three polys”: polyuria, polydipsia, and polyphagia;and weight loss
What are chronic complications of diabetes
Retinopathy, nephropathy, neuropathy, cerebrovascular disease, coronary artery disease
(CAD)
What type of fatal fungal infection can diabetics get
Mucor, especially sinusitis
What is the histologic description of Mucor
Nonseptate hyphae with branching at 90° (looks like the letterM )
What are the diagnostic criteria for diabetes
Both types of diabetes are diagnosed based on the same criteria.
Fasting glucose over 125 two separate times
Random glucose over 200 with symptoms of diabetes
Or
Glucose tolerance test over 200
What is the treatment for type 1 diabetes
Insulin replacement. Since these individuals do not have insulin, hypoglycemics will not work.
What is the first-line treatment for type 2 diabetes
Metformin
In what patients would metformin be avoided
In patients who have compromised kidney function; causes lactic acidosis
How do we believe metformin works
Increases sensitivity to insulin
When is it most appropriate to treat a type 2 diabetic with insulin
Refractory to oral hypoglycemic agents
What medication slows the progression of nephropathy in diabetes
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
Other than medication, what other therapy is important in diabetes
Nutrition education
What is HgA1c
Blood marker of glucose control over the last 3 months. HgA1c < 7 is ideal.
What preventative measures are recommended to minimize diabetic complications
6. Annual funduscopic examination
What is the appropriate treatment in a diabetic patient with microalbuminuria
ACE inhibitor or ARB
What is the major complication of type1 diabetes
Diabetic ketoacidosis (DKA)
What are the signs and symptoms of DKA
Severe hyperglycemia (glucose often >500), ketoacidosis, hyperkalemia, fruity breath, slow deep breaths, abdominal pain, dehydration, lethargy
What are slow deep breaths in DKA called
Kussmaul hyperpnea
What is the most important treatment in DKA
Intravenous (IV) fluid hydration(usually with normal saline)
What are the other treatments in DKA
Insulin drip. Add potassium if potassium is low or normaland add glucose when blood sugar reaches 250 because insulin needs to be continued to be given despite normal glucose until ketones are no longer present.
What are the most severe complications of DKA treatment
Cerebral edema or cardiac arrest due to hyperkalemia
What is the major complication of type 2 diabetes
Hyperosmolar hyperglycemic nonketotic (HHNK) coma; although on rare occasions type 2
diabetics can also go into DKA
What are some of the signs and symptoms of HHNK
Hypovolemia,hyperglycemia...glucose can be >1000 ,no ketoacidosis, renal failure, altered mental status, seizure, disseminated intravascular coagulation (DIC); often precipitated by acute stress such as trauma or infection
The difference between this and DKA is that in HHNK there is no ketoacidosis
What is the treatment for HHNK
The mortality is >50%; as a consequence, immediate treatment is urgent. Treatment includes rapid IV fluid resuscitation; insulin and potassium are usually needed earlier than in DKA because the intracellular shift of plasma potassium during therapy is accelerated in the absence of acidosis
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
دكتور إيم ...ربنا يتقبل إن شاء الله
دكتور أبو عمار 
stal induced arthropathy
العرض العادي
