DR Medhat MRCP

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NB : Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (e.g. Sitagliptin[januvia]) Normal mechanism of insulin secretion & action of sitagliptin - During a meal the incretins [glucagon-like peptide 1 (GLP-1) and glucose-dependent gastric inhibitory polypeptide (GIP)] are released from the small intestine into the blood to ++ pancreas to secrete insulin & -- glucagon. - These incretins normaly are catabolised & inactivated by DPP-4 enzyme, so - - of DPP-4 by sitagliptin will → no destruction of incretins &prolonged exposure of pancreas to incretins → ↑ insulin & ↓ glucagon → ↓↓ blood sugar. ■ Advantages : - NO hypoglycemia. - NO weight gain.
■ Management of type I DM [Insulin therapy]: Candidates for insulin : 1) All patients of type I DM. Post MI→ give I.V insulin sliding scale 2) Failed oral therapy of type II DM - HbA1C >7.5 % despite maximum oral ttt (see the algorithm) - NICE recommends to start with human NPH insulin (isophan) 3) Type II DM during : Surgery, Pregnancy, Acute illness, Steroid therapy, post MI Types of insulin : Very rapidly acting o Insulin lispro (humalog®). o Insulin aspart(novorapid) o Insulin glulisine (Apidra®) Rapidly acting o Actrapid o Humalin S o Hypurin Examples Onset Peak Duration Source 15-30 1 hr 5-6 hrs Analogue min 30 min 1-2 hrs 6-8 hrs Human or animal Intermediate acting o Isophane [NPH] (insulitard,humalin 1) 2 hrs 4-6 hrs 8-12 hrs Human or animal Long acting o Insulin glargine (lantus) 1-1.5 Plateau 16-24 hr analogue o Insulin detemir(levemir) hrs Insulin mixtures o Mixtard (70/30 %) ½-1 hr biphasic 14-18 hr (NPH/short acting) o Mixtard (50/50%) Inhaled insulin o Exubera 10-20 1-2 hrs 4-6 hrs Inhaled min Mode of administration of insulin : - All types (except inhaled) are taken S.C (abdomen ,thigh ,arm & change the site) - Actrapid can be given I.V ,I.M & S.C (the only type used in emergency). - Tools are either disposable syringes, refill pen or insulin pump. Which insulin to give (insulin regemins): 1) Actrapid I.V infusion 0.1/kg/hr : in severely ill patient at diagnosis e.g DKA. 2) Twice daily s.c biphasic insulin (mixtard) : in less severely ill patient. 3) Basal bolus regemin : once daily s.c long acting (lantus) + s.c actrapid 3-4 times daily before meals → for competent/motivated patients. 4) Continuous S.C insulin infusion (CSII) :via insulin pump for type I DM patients who failed to achieve adequate glycemic control on multiple (intensive)insulin injection regimens & those in whom hypoglycemia is frequent & unpredictable. - Patient with uncontrolled DM + hyper-catabolic state (i.e losing weight سؤال متكرر spontaneously without trying) → best TTT is metformin + insulin Insulin dose : - The guidelines recommend starting with either morning or evening long-acting insulin, or with bedtime intermediate acting insulin.
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A-PDF Merger DEMO : Purchase from w
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It contains : - 46 (23 pairs) of ch
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6. Glycolipids - signal molecules.
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Eukaryotic cell cycle : - Human bod
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• Regulation of the cell cycle :
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11
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• Morphology of apoptosis (EM) :
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Ion transport - Trans-membrane ion
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Disease Signal transduction Ligands
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Example of GP-CR → Adrenergic rec
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- There are around 30,000 gene , on
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- The language used by DNA is calle
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Autosomal dominant Autosomal recess
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Modes of disease inheritance Autos
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Autosomal dominant conditions Very
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X-linked dominant inheritance - The
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Fragile X syndrome : - Trinucleotid
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Some common genetic syndromes Triso
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Edwards Syndrome - Also known as Tr
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• Prognosis of Marfan syndrome -
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Noonan Syndrome - Often thought of
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Immune system - Immunity is the lin
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Classification of immunity Innate i
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Immune response to pathogen : A) In
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Expression Structure MHC I - In all
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C) Adaptive immune response : - The
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Cytokines produced by different kin
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ANCA o There are two main types of
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Tolerance & autoimmunity : o The im
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Complement system o It`s a group of
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Inflammation o Inflammation is a no
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o Immunosuppressive therapy is used
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C. Antimetabolites Cytotoxic Mechan
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o The mode of action of sirolimus i
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Primary immunodeficiency o Primary
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o Recently, a further category has
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- Reabsorption of HCO3 - (85% in PC
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Pathogenesis: Causes : Features : T
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A) Respiratory centers depression A
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o Treatment of chronic respiratory
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Saline - Responsive metabolic alkal
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Hypertonic Isotonic Hypotonic Plasm
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Hypernatremia (Na + > 145 mmol/L) :
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Hyperkalemia (K + > 5.2 mmo/L) : -
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Hypokalemia - Potassium and hydroge
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Medical statistics • Def : • St
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MEDIAN (=mid-point) Def : It is the
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Q : A study is performed to find th
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- Whilst correlation coefficients g
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Statistics which test differences P
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B. Statistics which test confidence
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P- VALUES • Def : - The P (propab
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Q 1: Q2 : If a drug reduces the inc
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Q4 : - CER (Aspirin) = 3% - EER (ne
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SPECIFICITY = →This is the rate a
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Q : 123
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Randomised controlled trial Experim
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Case-control study • Def : - It`s
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Study Design: Evidence and Recommen
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Intention to treat analysis Q - It
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CORONARY ARTERY DISEASES Definitio
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Risk factors of CAD: High risk fac
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Stable (chronic) angina (= angina o
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A) Medical ttt of stable angina(CKS
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DVLA rules: cardiovascular disorder
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STMI NSTMI/UA ACS < 12 hrs of symto
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• Treatment : A. Medical TTT : I
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Cardiac arrhythmias I. Tachyarrhyth
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Atrial fibrillation (AF) Def : - o
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2. Echocardiography: - Significant
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Acute newly detected AF Hemodynamic
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Rate vs rhythm control : Factors fa
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Digoxin and digoxin toxicity - Digo
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Long QT syndrome Def: - Long QT syn
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Conducting system of the heart : He
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Ventricular tachycardia Ventricular
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• Treatment of shockable rhythms
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Peri-arrest rhythms A. Peri-arrest
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B. Peri-arrest tachycardia Hemodyna
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QRS Deflection Inferior leads (II,I
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B-type natriuretic peptide (BNP) :
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Hypertension Clinic BP measurement
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Stepwise approach of treatment of H
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Pulmonary arterial hypertension(PAH
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Normal pulse in young (25y) person
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Jugular venous pulse(JVP) 52
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Valvular heart disease Aortic steno
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• Features Aortic regurgitation
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• Echocardiography : A 'tight' m
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Murmur Causes Character Point of ma
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Pericarditis Pericarditis is one of
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Myocarditis • Causes Viral: Coxs
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- Most of cardiologists proceeds to
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Causes of sudden cardiac death : In
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2) Atrial Septal Defects (ASDs) - T
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Eisenmenger's syndrome - In acyanot
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- When properly positioned, the dis
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Down syndrome - Down syndrome is th
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Marfan's syndrome - Marfan's syndro
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Causes: - Streptococcus viridans (m
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Treatment of IE : A) Medical ttt :
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CVS medications Antiarrhythmic drug
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Amiodarone Class : III antiarrhyth
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‣ Β- blockers cardiotoxicity : -
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Aspirin : Mechanism of action : -
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Diuretics : Thiazides Diuretics Act
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lesions Macule Patch Papule Nodule
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Acne vulgaris - Acne vulgaris is a
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Isotretinoin - Is an oral retinoid
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Pityriasis Versicolor (= tinea vers
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Plaque psoriasis Flexural psoriasis
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- Finger tip rule 1 finger tip uni
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D. Contact dermatitis - Contact der
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Pemphigus vulgaris - Is an autoimmu
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Erythematous skin rash Erythema mul
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Erythema nodosum - Idiopathic condi
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Lichen-like diseases - Lichens are
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Scabies • Overview : - It is a pr
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Diseases of hairs Hirsuitism & Hype
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Diseases of the nails Onycholysis -
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Skin infections Impetigo - Is a hig
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Pyoderma Gangrenosum - Is a conditi
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Granuloma annulare - Papular lesion
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Molluscum contagiosum - Flesh-white
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Skin disorders associated with mali
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*Langer lines were historically use
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Pituitary gland Anatomy : - Small
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Diseases of pituitary gland Anterio
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Anterior pituitary hpofunction in a
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Anterior pituitary hyperfunction I.
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o Hands & feet : - Spade-like hands
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Prolactin is unique amongst the pit
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Very rare drug causes of gynaecomas
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Investigations : 1) High plasma osm
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Treatment of DI : Cranial DI (ie wi
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Non-functioning adenoma (chromophob
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Thyroid gland Anatomy : - Butterfl
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Control of thyroid hormones (hypoth
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o Thyrotoxic crisis (thyroid storm)
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- Graves' disease is the most commo
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Subclinical Hyperthyroidism - It is
Page 296 and 297: Myxoedema Causes : Primary hypothy
Page 298 and 299: Subclinical Hypothyroidism Basics
Page 300 and 301: Thyroiditis - i.e Inflammation of t
Page 302 and 303: - It`s the commonest endocrine mali
Page 305: Amiodarone-induced thyroid disease
Page 308 and 309: Actions of parathyroid hormone ( pl
Page 310 and 311: Latent tetany +ve Provocative tests
Page 312 and 313: ■ Clinical picture : Bones, Stone
Page 314 and 315: Hyperparathyroidism - i.e over prod
Page 316 and 317: Hypoparathyroidism - i.e decrease p
Page 318 and 319: - Histologically : bone is formed o
Page 320 and 321: • Management : (NICE 2011 ,2ndry
Page 322 and 323: 8) Hip protectors : - Evidence to s
Page 324 and 325: Osteomalacia Def : - Defective min
Page 326 and 327: Osteogenesis Imperfecta (= brittle
Page 328 and 329: • Functions of adrenal hormones :
Page 330 and 331: Primary hyperaldosteronism Causes
Page 332 and 333: Investigations : A. Diagnosis of Cu
Page 334 and 335: Adrenal insufficiency Causes : o P
Page 336 and 337: Differences between 1ry & 2ndry adr
Page 338 and 339: Def : Diabetes Mellitus (DM) - Met
Page 340 and 341: سؤال اليخلو منه امت
Page 343 and 344: 3)Other risk factor modification C
Page 345: I. Insulin sensitizers 1) Biguanide
Page 349 and 350: 5) Insulin resistance (i.e requirem
Page 351 and 352: Complications of DM : Complication
Page 353 and 354: Diabetic foot ulcers : • Classifi
Page 355 and 356: Investigations : سؤال amylase.
Page 357 and 358: Treatment of HONK : as in DKA with
Page 359 and 360: D. Post delivery : DC TTT(in GDM) ,
Page 361 and 362: Insulinoma is a neuroendocrine tumo
Page 363 and 364: Def : body mass index ( BMI) > 30 O
Page 365 and 366: ■ Sibutramine - Withdrawn January
Page 367 and 368: - Dietary fat (TG) is digested by b
Page 369 and 370: Classification of hyperlipidemia :
Page 371 and 372: • Management Referral to a speci
Page 373 and 374: • Physiology of reproductive syst
Page 375 and 376: • Def : Delayed growth & puberty
Page 377 and 378: Hypogonadism ■ Def: - A diminishe
Page 379 and 380: MRI →Absence of olfactory bulb.
Page 381 and 382: • Initial investigations Exclude
Page 383 and 384: ■ Diagnostic approach of 2ndry am
Page 385 and 386: تبدو وتتصرف ك بنت و
Page 387 and 388: ■ Diagnosis : ■ Treatment : Kar
Page 389 and 390: 3) Infertility : (under specialist
Page 391 and 392: Carcinoid tumours - Group of slowly
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Page 395 and 396: • Hormones of GIT : Hormone Gastr
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• Treatment : A. Acute treatment
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• DD (causes of heart burn sensat
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Dysphagia - The table below gives c
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Disease Achalasia Scleroderma Manom
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Oesophageal cancer - The most commo
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سؤال مهم : dyspepsia Drug-in
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Management of endoscopy proven gast
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Management of endoscopy proven non-
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• Investigations of H.Pylori : س
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• Clinical features of ZES : Zoll
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• Diagnosis: • Staging : Endosc
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Coeliac disease • Def : - An auto
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B. Jejunal biopsy (see pathology).
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• Investigations : 1) Jejuna biop
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Short bowel syndrome - Malabsorptio
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Inherited (familial) colorectal can
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Pelvi-abdominal CT/MRI/PET scan wit
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Acute Intestinal ischemia • Def :
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سؤال امتحان Melanosis col
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Inflammatory bowel diseases (IBD)
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Histology Involve whole bowel wall
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B. Management of ulcerative colitis
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هام : UC) Colo-rectal cancer on
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Acute infective diarrhea (infective
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• Management : 1) Rest ,rehydrati
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Liver diseases Hepatitis • Def :
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• Complications: Hepatitis C : 80
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Viral hepatitis B - HBV is a double
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• Immunisation (vaccination) agai
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• Risk factors of ALD : - Men : w
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Fatty liver (steatosis) - It`s live
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• Types according to the types of
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liver: hepatitis, cirrhosis lentif
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• Features Homozygous PiZZ →(A
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• Complications Malabsorption: o
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Chronic liver disease (cirrhosis)
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سؤال امتحان classificatio
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Meigs' Syndrome : = Ovarian fibroma
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Type I HRS Rapidly progressive. D
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Hepatic Encephalopathy: • Def: A
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Haemochromatosis: - Is an autosomal
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Hepatomegaly : • Common causes of
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B. Causes of conjugated (direct) hy
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Crigler-Najjar Syndrome (CNS): - (C
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Diseases of pancreas Acute pancreat
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Chronic Pancreatitis - Is an inflam
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• Diagnosis: Contrast CT is used
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Liver biopsy • Contraindications
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Diseases of RBCs Include 3 main gro
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Microcytic hypochromic anemias I. I
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II.Thalassemia - It`s an inherited
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• Pathogenesis of thalassemia : -
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Hb electrophoresis : - The major Hb
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• Management : 1) Phlebotomy (ven
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Chronic Hemolytic Anemia with acute
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Autoimmune hemolytic anemia (AIHA)
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- Hemolysis which ↑↑ during sle
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• Causes: 1. Post-infection e.g.
Page 513 and 514:
Glucose-6-phosphate dehydrogenase (
Page 515 and 516:
- These other forms of sickle-cell
Page 517 and 518:
• Investigations : CBC : normocy
Page 519 and 520:
• WHO 2008 classification of MDS
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Macrocytic megaloblastic anemias Ca
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• Incidence - Peaks in the sixth
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Hemoglobinopathies Quantitative (Im
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• Typical carboxyhemoglobin level
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Leukemoid reaction - Describes the
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Hyper Eesinophilic syndrome: - Rare
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B. Lympho-proliferative disorders (
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- Further classification of each ty
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• Management of AML : Chemothera
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Chronic Myeloid Leukemia (CML) - Th
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Chronic Lymphocytic Leukemia (CLL)
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Incdence Commonest acute leukemia
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• Ann-Arbor staging of Hodgkin's
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- Chemotherapy includes : 1. Doxoru
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Burkitt's Lymphoma : - Is a high-gr
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Multiple myeloma - It`s a neoplasm
Page 553 and 554:
Diseases of platelets 1. Thrombocyt
Page 555 and 556:
• Causes of severe thrombocytopen
Page 557 and 558:
• Normal response to vessel injur
Page 559 and 560:
Von Willebrand's disease - Von Will
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- There are two main types of hepar
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2. Warfarin - Warfarin is an oral a
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74
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Acquired Factor VIII Deficiency - I
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Thrombophilia ( = thrombotic tenden
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Hyposplenism e.g. post-splenectomy
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Graft versus host disease (GVHD) :
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Tumour markers • Tumour markers m
Page 577 and 578:
C. Antimetabolites Cytotoxic Mechan
Page 579 and 580:
Therapeutic antibodies : Monoclonal
Page 581 and 582:
• Conversion between opioids From
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Thymoma - Thymomas are the most com
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Prostate cancer - Prostate cancer i
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Oncogenes • Def : - They are endo
Page 589 and 590:
Classification of pathogens الح
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Anaerobes Aerobes G-ve bacteria G-v
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B. Whole killed organism (= inactiv
Page 595 and 596:
Necrotizing fasciitis : - Is a medi
Page 597 and 598:
A. Actinomycosis - Actynomyces is f
Page 599 and 600:
Clostridium difficile: - Is a Gram
Page 601 and 602:
1. Septic arthritis ( the most comm
Page 603 and 604:
Atypical bacteria I. Mycobacterium
Page 605 and 606:
Extra-pulmonary TB ( in immunocompr
Page 607 and 608:
هام جدا : TB Management of Ac
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III. Spirockaetes A. Leptospirosis
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IV. Ricketsiae A. African Tick Typh
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• Management : A. Uncomplicated f
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- It is again advisable to avoid tr
Page 617 and 618:
• Diagnosis : Splenic or bone ma
Page 619 and 620:
• Investigation Antibody test S
Page 621 and 622:
Cryptosporidium : سؤال - It`s t
Page 623 and 624:
Antiretroviral group NRTI Examples
Page 625 and 626:
B. Focal neurological lesions : 1)
Page 627 and 628:
• Complications : A. Common compl
Page 629 and 630:
• Complications : 1) Encephalitis
Page 631 and 632:
6) Infectious mononucleosis (glandu
Page 633 and 634:
8) Novel Coronavirus - Human corona
Page 635 and 636:
B. Trematodes (flat worms) Schistos
Page 637 and 638:
• Management (SIGN 2009) : Azyth
Page 639 and 640:
Genital ulcers : Common causes of g
Page 641 and 642:
Lymphogranuloma venereum سؤال t
Page 643 and 644:
Mechanism of action of common antib
Page 645 and 646:
Leprosy liptospirosis Lyme disease
Page 647 and 648:
(Human papilloma virus) UTI in woma
Page 649 and 650:
Osteomyelitis : - Osteomyelitis des
Page 651 and 652:
مرض األغنام Orf - Orf is
Page 653 and 654:
1
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3
Page 657 and 658:
Diseases of thick ascending limb of
Page 659 and 660:
III. According to clinical presenta
Page 661 and 662:
9
Page 663 and 664:
Minimal Change disease (MCD) - Near
Page 665 and 666:
Management Minimal change glomerulo
Page 667 and 668:
Focal Segmental Glomerulosclerosis
Page 669 and 670:
B. I.F : no immune deposits (C3 & I
Page 671 and 672:
3 rd line ttt Plasma exchange: - Th
Page 673 and 674:
Causes : 1ry ( idiopathic) MCGN .
Page 675 and 676:
New classification (according to th
Page 677 and 678:
2) Type II MCGN : 25
Page 679 and 680:
Membranous nephropathy (MN) - It`s
Page 681 and 682:
Approaching MN : - Careful history
Page 683 and 684:
Prognosis : (rule of thirds) 1/3 o
Page 685 and 686:
IgA nephropathy Basics: Also calle
Page 687 and 688:
Management of IgA nephropathy Low r
Page 689 and 690:
Renal parenchymatous diseases accor
Page 691 and 692:
NB : The antigens against which th
Page 693 and 694:
Management of nephritic syndrome :
Page 695 and 696:
Management: ACE-I ARBs Approximat
Page 697 and 698:
Acute renal failure (now termed acu
Page 699 and 700:
Causes of CKD : Common causes of CK
Page 701 and 702:
Anemia in CRF: All types of anemia
Page 703 and 704:
There is transformation among the p
Page 705 and 706:
III. Pauci-immune (ANCA+ve) nephrop
Page 707 and 708:
Hereditary renal disease I. Alport
Page 709 and 710:
NEUROLOGY DR. MEDHAT M.SLEAT 2013
Page 711 and 712:
Brain anatomy - It`s a gelatinous o
Page 713 and 714:
C. Cerebellum : o It lies behind th
Page 715 and 716:
Frontal lobe Area Site Function Les
Page 717 and 718:
Parietal lobe Cortical sensory area
Page 719 and 720:
Occipital lobe Visual sensory area
Page 721 and 722:
Upper & lower motor neurons - For a
Page 723 and 724:
U.M.N. Lesion L.M.N. Lesion Paralys
Page 725 and 726:
اللهم السهل اال ماج
Page 727 and 728:
II. Optic nerve • Pathway of visi
Page 729 and 730:
III. Oculomotor nerve - The nucleus
Page 731 and 732:
IV. Trochlear nerve : - The nucleus
Page 733 and 734:
V. Trigeminal nerve : - It`s a mixe
Page 735 and 736:
• Trigeminal nerve palsy: o Cause
Page 737 and 738:
سؤال هام فى اال متح
Page 739 and 740:
VII.Facial nerve : - it`s a mixed n
Page 741 and 742:
U.M.N.L Affects ∆ tract above fac
Page 743 and 744:
VI. Vestibule-cochlear nerve : - Th
Page 745 and 746:
VII. Glossopharyngeal nerve : - It`
Page 747 and 748:
Petrous apex syndrome : • Causes
Page 749 and 750:
Control of eye movement during head
Page 751 and 752:
Conjugate gaze palsy Supranuclear N
Page 753 and 754:
Carotid (anterior) system : Anterio
Page 755 and 756:
47
Page 757 and 758:
Basilar artery • Origin : - Forme
Page 759 and 760:
B. Total occlusion : is fatal 1. De
Page 761 and 762:
Middle cerebral artery Anterior cer
Page 763 and 764:
Posterior inferior cerebellar arter
Page 765 and 766:
IV. Carotid artery endarterectomy
Page 767 and 768:
Subarachnoid hge (rupture aneurysm)
Page 769 and 770:
• Clinical presentation : - Typic
Page 771 and 772:
Traumatic brain injury: Extradural
Page 773 and 774:
Medial pontine syndrome - e.g occlu
Page 775 and 776:
• Prognosis : - Variable prognosi
Page 777 and 778:
Incomplete lesions of spinal cord B
Page 779 and 780:
Investigations 1. Decreased red cel
Page 781 and 782:
• Management In primary care; a
Page 783 and 784:
Lewy body dementia - Is the second
Page 785 and 786:
Transient global amnesia (TGA) •
Page 787 and 788:
• Management : Riluzole 1. Anti-
Page 789 and 790:
Gower`s sign of Duchenne`s muscle d
Page 791 and 792:
• Management : - 1 st line invest
Page 793 and 794:
Pricipitating factors of myasthenia
Page 795 and 796:
- *In reality this is seen in only
Page 797 and 798:
- The basal ganglia and cerebellum
Page 799 and 800:
• Extra pyramidal tracts : Tract
Page 801 and 802:
• Main clinical features : Dyskin
Page 803 and 804:
2) Levodopa: Usually combined with
Page 805 and 806:
III. Hemiballism (subthalamus) - Oc
Page 807 and 808:
• Investigation of choice : MRI (
Page 809 and 810:
Cerebellar syndromes : Archicerebe
Page 811 and 812:
Herido-familaial ataxia : A. Friedr
Page 813 and 814:
سؤال امتحان Meniere's dis
Page 815 and 816:
Nystagmus - Oscillatory eye movemen
Page 817 and 818:
Diseases of the nerves • Def : -
Page 819 and 820:
2. Predominantly sensory : o Friedr
Page 821 and 822:
Common peroneal nerve (L4,5 & S1,2)
Page 823 and 824:
Femoral nerve o Origin : lumbar ple
Page 825 and 826:
L3 nerve root compression L4 nerve
Page 827 and 828:
Nerve supply of the upper limb Medi
Page 829 and 830:
121
Page 831 and 832:
Carpal tunnel syndrome • Def : Mo
Page 833 and 834:
Sensory to : 1. Dorsal aspect of la
Page 835 and 836:
Elbow Pain: - The table below detai
Page 837 and 838:
Reflex Biceps reflex Triceps reflex
Page 839 and 840:
131
Page 841 and 842:
Gastroparesis Symptoms include err
Page 843 and 844:
Nerve Conduction Studies (NCS) - Ar
Page 845 and 846:
- Complex partial seizures can take
Page 847 and 848:
8. It is advised that pregnant wome
Page 849 and 850:
سؤال امتحان : Cataplexy
Page 851 and 852:
• Management : o Aim: reducing th
Page 853 and 854:
Tuberous sclerosis (TS) - Autosomal
Page 855 and 856:
• General C/P : ( it`s not a must
Page 857 and 858:
Headache - Headache is the term use
Page 859 and 860:
Neuropathic pain - Neuropathic pain
Page 861 and 862:
• Management Stop antipsychotic
Page 863 and 864:
Lamotrogine (lamictal) • Uses : A
Page 865 and 866:
1
Page 867 and 868:
- Layers of the eyeball : Sclera :
Page 869 and 870:
N.B New classification of non-proli
Page 871 and 872:
Dry (geographic atrophy) macular de
Page 873 and 874:
B. Congenital causes 1. Friedreich'
Page 875 and 876:
Acute angle closure glaucoma - In a
Page 877 and 878:
سؤال هام فى االمتحا
Page 879 and 880:
Relative afferent pupillary defect
Page 881 and 882:
Homocystinuria - Homocystinuria is
Page 883 and 884:
Causes of bilateral ptosis 5. Myoto
Page 885 and 886:
1
Page 887 and 888:
- When a drug is administrated to t
Page 889 and 890:
2) Binding to plasma & tissue prote
Page 891 and 892:
- Metabolism of the drugs ccurs in
Page 893 and 894:
Metabolism of paracetamol in overdo
Page 895 and 896:
Management of paracetamol toxicity
Page 897 and 898:
NB : the most helpful test in deter
Page 899 and 900:
King's College Hospital criteria fo
Page 901 and 902:
• Time course of drug metabolism
Page 903 and 904:
Measurement of plasma drug level :
Page 905 and 906:
Digoxin and digoxin toxicity - Digo
Page 907 and 908:
Ectasy (= MDMA = Methylene-dioxy-me
Page 909 and 910:
Mood disorders Depression • Def :
Page 911 and 912:
Psychotic depression : - Major depr
Page 913 and 914:
More sedative Amitriptyline Clomi
Page 915 and 916:
• Discontinuation symptoms 1) Inc
Page 917 and 918:
• Examples of typical antipsychot
Page 919 and 920:
• Treatment of bipolar disorder :
Page 921 and 922:
Lithium - Lithium is a mood stabili
Page 923 and 924:
Post partum mental health problems
Page 925 and 926:
Functional deterioration : 1) Impai
Page 927 and 928:
B. Compulsions : - Stereotyped acti
Page 929 and 930:
Generalized anxiety disorder (GAD)
Page 931 and 932:
Somatoform disorders (unexplained s
Page 933 and 934:
Eating disorders 1. Anorexia nervos
Page 935 and 936:
Sleep disorders 1. Sleep paralysis
Page 937 and 938:
• Mechanism : • Features : Subs
Page 939:
• Diagnosis : Chronic fatigue syn
Page 942 and 943:
- Causes of defective lung perfusio
Page 944 and 945:
1) Central regulatory centres : A)
Page 946 and 947:
Lung capacities :
Page 948 and 949:
Functional Residual Capacity (FRC)
Page 950 and 951:
FEV1 Meaning (units) Description Fo
Page 952 and 953:
هام جداPFT Algorithm of inter
Page 954 and 955:
Interpretation of flow volume loope
Page 956 and 957:
Bronchial asthma - BA is a reversib
Page 958 and 959:
Diagnosis of BA in adults(British T
Page 960:
Step 4 Step 5 Consider trials of:
Page 963 and 964:
Causes : 1. Smoking (tobacco smooki
Page 965 and 966:
The severity of COPD is categorised
Page 967 and 968:
2. Bronchodilator therapy A short-
Page 969 and 970:
Bronchiolitis oblitrans(BO) - Progr
Page 971 and 972:
Extrinsic allergic alveolitis (=hyp
Page 973 and 974:
Subtypes a) Cylindrical (bronchi ha
Page 975 and 976:
Cystic fibrosis(CF) - Autosomal rec
Page 977 and 978:
Pulmonary embolism (PE) - PE is pre
Page 979 and 980:
CTPA or V/Q scan? The British Thor
Page 981 and 982:
Management of PE (The NICE guidelin
Page 983 and 984:
1- General constitutional symptoms
Page 985 and 986:
Mycoplasma pneumonia - Is a cause o
Page 987 and 988:
Investigation األهم diagnosis.
Page 989 and 990:
Aspergilloma : - A fungus ball that
Page 991 and 992:
Asbestos-related lung diseases Pleu
Page 993 and 994:
• Clinical features : Dyspnoea
Page 995 and 996:
• Investigations (NICE 2015) : Sy
Page 997 and 998:
Stage IIIb Stage IV T1 N0 - No L.N
Page 999 and 1000:
Non-small cell carcinoma : Squamous
Page 1001 and 1002:
Lung carcinoid - Neuro-endocrine tu
Page 1003 and 1004:
Pulmonary eosinophelia - Group of d
Page 1005 and 1006:
• Investigations : - There is no
Page 1007 and 1008:
Pleural diseases Pleural effusion -
Page 1009 and 1010:
3) Pleural(Abram`s) biopsy : - Indi
Page 1011 and 1012:
• Investigations : 1) Chest X-ray
Page 1013 and 1014:
- Tension pneumothorax ► Tension
Page 1015 and 1016:
Respiratory questions reveiw for MR
Page 1017 and 1018:
Q6 : A 63-year-old woman presents a
Page 1020 and 1021:
Evaluation & diagnosis of a case of
Page 1022 and 1023:
- It`s a common degenerative joint
Page 1024 and 1025:
Cervical spondylosis - It`s an age-
Page 1026 and 1027:
Rheumatoid arthritis (RA) • Def :
Page 1028 and 1029:
c) Boutonniere deformity (i.e exten
Page 1030 and 1031:
هام جدا : arthritis • Diagn
Page 1032 and 1033:
Methotrexate: - Methotrexate is an
Page 1034 and 1035:
Ankylosing spondilitis - One of HLA
Page 1036 and 1037:
• Management of AS: - Early diagn
Page 1038 and 1039:
The table below shows the organisms
Page 1040 and 1041:
Behcet's syndrome Behcet's syndrome
Page 1042 and 1043:
Crystal-induced arthritis GOUT - Go
Page 1044 and 1045:
IV. Gouty nephropathy : Acute gout
Page 1046 and 1047:
C. Lifestyle modifications: 1. Redu
Page 1048 and 1049:
Dermatomyositis • Def : - Inflamm
Page 1050 and 1051:
Inclusion body myositis (IBM) : - T
Page 1052 and 1053:
34
Page 1054 and 1055:
firm surface or flexed for extended
Page 1056 and 1057:
Ottawa rules: Def : - Are a set of
Page 1058 and 1059:
Autoimmune rheumatic diseases Syste
Page 1060 and 1061:
J. Neurological : 1. Lupus cerebrit
Page 1062 and 1063:
سؤال امتحان Discoid lupu
Page 1064 and 1065:
• Investigations : 1. Thrombocyto
Page 1066 and 1067:
• Antibodies: ANA positive in 90
Page 1068 and 1069:
Sjogren's syndrome - It is an autoi
Page 1070 and 1071:
Large vessel vasculitis Giant cell
Page 1072 and 1073:
• Investigations : ( there is no
Page 1074 and 1075:
Small vessel vasculitis ANCA +VE (
Page 1076 and 1077:
ANCA -VE vasculitis : Henoch-Schonl
Page 1078 and 1079:
Disorder Wegener`s granulomatosis G
Page 1080 and 1081:
Referral to specialist CFS : - With
Page 1082:
Leflunomide : • Mechanism of acti
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