A 60-year-old woman presents to her GP experiencing intermittent palpitations for several weeks. She is in good overall health and has not reported any episodes of chest pain.
She has hypertension, which is effectively managed with a single antihypertensive medication. Otherwise, she is well and has no other previous medical history.
Upon conducting an ECG, it was discovered that she was in atrial fibrillation. All other observations are within normal range.
What anticoagulation strategy would you recommend?

1-
"- Optic atrophy; Ethambutol ..... exclude MS
2- Methotrexate induced lung fibrosis
3- ACI .... Dry cough
* Dyspnea induced by Ticagrelor .... UK
5 Dizziness due to postural hypotension due to melena =
NSAIDs... anemia, heart burn, melena
6 Warfarin induced hematuria
7- Cyclophosphamide ..... hemorrhagic cystitis
8-
Analgesic nephropathy
• Gum swelling due to cyclosporine in organ transplantation
10- Phenytoin induced gum hypertrophy
11- AML
.............. in young patient
12- Carbimazole induced agranulocytosis
When examine ask the patient ... Show me your teeth if not
obvious pull down the lips

من جبل أزمر خطر على بالي موضوع طبي جراحي هو " hypothermia"?
فنسولف شوية عنه
أول شي نعرفه بشكل مبسط كالاتي:
Core body temperature less than 35 degree C
ثاني شي ماهي طرق انتقال الحرارة ?
1_ Conduction: direct transfer of heat to the table
2_ Convection:by worming of cool air
3_ radiation: radiation to the cold bodies in the theatre
4_ Evaporation: heat from open wond
السؤال كيف ممكن أنخفاض الحرارة يأثر على الجسم؟ الجواب?
1_ Cardio: decrease COP and arrhythmia
2 _ Respiratory : increase V/Q mismatch and vascular resistance
3- Renal : decrease GFR and renal blood flow
4_ hemato : decrease PLT function and most important lead to" DIC"?
5_ neurology: DLOC and COMA
6_ GIT & metabolic: decrease gut motality and hyperglycaemia and acidosis
كيف نتجنب هذا الموضوع من وجهة نظر جراحية ?
1_ avoid prolonged fasting
2_ patient exposed as needed only
3_ theatre T maintained 21C
4_ don't induct till core T 36C
5_ post Op patient should not leave the recovery room till T 36C
و أخيراً نحتاج بطانيات حتى نمنعها وبس ?

N.B. if hypothyroidism is primary (thyroid gland problem)....
Weight gain and menorrhagia
If hypothyroidism is secondary (pituitary gland problem) ......
weight loss and loss of cycles

اصعب مواضيع ممكن تواجهك هو chronic fatigue syndrome The combination (tiredness + mood changes + un-refreshed sleep) is present in both fibromyalgia and chronic fatigue syndrome شلون نميز بينهم Chronic fatigue syndrome Can come persistent sore throat and…

اصعب مواضيع ممكن تواجهك هو
chronic fatigue syndrome
The combination (tiredness + mood changes + un-refreshed
sleep) is present in both fibromyalgia and chronic fatigue
syndrome
شلون نميز بينهم
Chronic fatigue syndrome
Can come persistent sore throat and tender lymph node
طبعا الاسباب الاخرى مهمة جدا ونحطها تحت تقسيمة كبيرة
Chronic disease
Chronic infection
Connective tissue disease

Heparin does two things outside the clotting cascade:

-DECREASES the level of aldosterone, which causes HYPERkalemia and HYPOnatremia

-INCREASES the level of PTH, which causes HYPERcalcemia and osteoporosis