Antibiotics with absolute contraindications for Pregnant women

Aminoglycosides
Tetracyclines
Glycylcyclines
Chloramphenicol
Fluoroquinolones
Sulfonamides with diaminopyrimidines
Macrolides (clarithromycin and erythromycin estolate)

Antibiotics with absolute contraindications for children use

Tetracyclines: < 8 years old (except doxycycline)
Glycylcyclines: < 8 years old
Chloramphenicol
Fluoroquinolones
Sulfonamides and diaminopyrimidines: < 2 years old
Nitrofurans: < 1 month old
Ethambutol: young children who are unable to report visual changes

#splenomegaly

Normal weight of spleen is 250gm
الوزن الطبيعي للطحال  ربع الكيلو

🌼Massive splenomegaly more than 1000gm
▫️due to ⬇️
1️⃣ chronic myeloprolifertive disorders
2️⃣chronic lymphocytic leukemia
3️⃣hairy cell leukemia
4️⃣ymphoma
5️⃣malaria
6️⃣Gucher disease
7️⃣primary splenic neoplasm

🌼Moderate 500- 1000gm
▫️due to ⬇️
1️⃣Chronic congestion
2️⃣Acute leukemia
3️⃣Spherocytosis
4️⃣Thalassemia major
5️⃣Hemolytic anemia
6️⃣Amyloidosis
7️⃣Pick disease
8️⃣Chronic splenitis
9️⃣Tuberclosis
🔟Sarcoidosis
1️⃣1️⃣Typhoid
1️⃣2️⃣ Ca

🌼Mild less than 500gm
▫️due to ⬇️
1️⃣acute splenitis
2️⃣congestion
3️⃣infection mononeuclosis
4️⃣acute febrile disorder

Triad:

♣ Triad of alport's syndrome :
•Sensorineural deafness,  •progressive renal failure, 
•ocular anomalies.

♣ Triad of Behcet's syndrome :
• Recurrent oral ulcers. 
•Genital ulcers.
•Iridocyclitis .

♣ Beck's tried :
•Muffled heart sounds.
•Distended neck veins.
•Hypotension.

♣ Charcot's triad :
•Pain
•Fever
•Jaundice .

♣ Gradenigo's tried :
•6 Cranial nerve palsy.
•Persistant ear discharge. •Retro-Orbital pain. 

♣Triad Of Hypernephroma :
•pain.
•Hematuria.
•Renal Mass.

♣ Hutchinson's Triad : •Hutchison's Teeth.
•Interstitial Keratitis. •Nerve Deafness.

♣ Triad Of Kwashiorkar: •Growth Retardation.
• Mental Changes.
• Edema.

♣ Saint's Triad :
•Gall Stones. •Diverticulosis.
•Hiatus Hernia.

♣Trotter's Triad : •Conductive.
• Deafness.
•Immobility of   homolateral soft palate,
Trigeminal Neuralgia.

♣ Virchchow's tried :
• STASIS
• Hypercoagulabilty. 
• Vessel injury.

♣ Congenital Rubella syndrome :
•PDA. 
•deafness.
• cataract.

♣ Samter's trial :
• Aspirin sensitivity. 
• Bronchial asthma.
• Nasal polyp.

♣ Osler's triad :
• Telangiectasis .
• Capillary fragility .
• Hereditary hemorrhagic diathesis seen in hereditary hemorrhagic telangiectasia.

♣ Bartter's syndrome:
• Metabolic alkalosis .
• Hypokalemia.
• Normal or decrease blood pressure .

♣ Weil's Disease:
• Hepatorenal damage.
• Bleeding diathesis.
• Pyrexia .

♣ Meniere's Disease :
• Vertigo.
• Tinnitus.
• Sensorineural hearing Loss.

♣ Melkersson Rosenthal Syndrome :
• Recurrent facial Palsy.
• Plication Of Tongue.
• Facial Edema.

♣ Parkinsonism :
• Rigidity .
• Tremor.
• Hypokinasia.

♣Cushing's traid :
• Bradycardia.
• Hypertension.
• Irregular respirations in increased intracranial
pressure.

♣Kartagener’s Syndrome :
• Bronchiectasis.
• Recurrent sinusitis .
• Situs inversus.

♣Hemobilia "Triad of Sandblom" :
• Malena.
• Obstructive jaundice.
• Biliary colic.

♣ Murphy's triad " in order" :
• Pain
• Vomitting.
• Fever.

♣ Whipple's Triad of insulinoma :
• Hypoglycaemia during attacks.  
•Serum glucose <40 .
• Relief of symptoms when the glucose is
raised to normal.

1) Lethal Triad also known as The Trauma Triad of Death
Hypothermia + Coagulopathy + Metabolic Acidosis

2) Beck’s Triad of Cardiac Tamponade
Muffled heart sounds + Distended neck veins + Hypotension?

3) Virchow’s Triad – Venous Thrombosis
Hypercoagulability + stasis + endothelial damage?

4) Charcot’s Triad – Ascending Cholangitis
Fever with rigors + Right upper quadrant pain + Jaundice?

5) Cushing’s Triad – Raised Intracranial Pressure
Bradycardia + Irregular respiration + Hypertension

6) Triad of Ruptured Abdominal Aortic Aneurysm Severe Abdominal/Back Pain + Hypotension + Pulsatile Abdominal mass?

7) Reactive Arthritis
Can’t See (Conjunctivitis) + Can’t Pee (Urethritis) + Can’t Climb a Tree (Arthritis)

8) Triad of Opioid Overdose
Pinpoint pupils + Respiratory Depression + CNS Depression

9) Hakims Triad – Normal Pressure Hydrocephalus
Gait Disturbance + Dementia + Urinary Incontinence

10) Horner’s Syndrome Triad
Ptosis + Miosis + Anydrosis?

11) Mackler’s Triad – Oesophageal Perforation (Boerhaave Syndrome)
Vomiting + Lower Thoracic Pain + Subcutaneous Emphysema?

12) Pheochromocytoma
Palpitations + Headache + Perspiration (Diaphoresis)

13) Leriche Syndrome
Buttock claudication + Impotence + Symmetrical Atrophy of bilateral lower extremities

14) Rigler’s Triad – Gallstone ileus
Gallstones + Pneumobilia + Small bowel obstruction

15) Whipple’s Triad – Insulinoma
Hypoglycemic attack + Low glucose + Resolving of the attack on glucose administration

16) Meniere’s Disease
Tinnitus + Vertigo + Hearing loss

17) Wernicke’s Encephalopathy- Thiamine Deficiency
Confusion + Ophthalmoplegia + Ataxia

18) Unhappy Triad – Knee Injury
Injury to Anterior Cruciate Ligament + Medial collateral ligament + Medial or Lateral Meniscus

19) Henoch Schonlein Purpura
Purpura + Abdominal pain + Joint pain

20) Meigs Syndrome
Benign ovarian tumor + pleural effusion + ascites?

21) Felty’s Syndrome
Rheumatoid Arthritis + Splenomegaly + Neutropenia?

22) Cauda Equina Syndrome
Low back pain + Bowel/Bladder Dysfunction + Saddle Anesthesia

23) Meningitis
Fever + Headache + Neck Stiffness

24) Wolf Parkinson White Syndrome
Delta Waves + Short PR Interval + Wide QRS Complex ?

25) Neurogenic Shock
Bradycardia + Hypotension + Hypothermia

#Triad
#مهم

?Bacteremia ➡️is presence of bacteria in blood

?Sepsis ➡️ is the host response to bacteria

?Hypoglycemia is danger than hyperglycemia

?Hypotension is danger than hypertension

متى المريض يكون عنده leukocytosis بدون infection????!

▪️cirrhotic liver
▪️MI
▪️sickle cell anemia
▪️adult onset still's disease
▪️diabetic ketoacidosis
▪️ stroke

?patterns of fever :

▪️Continuous fever :
  A . Started step by step "increasing 1 degree every night" & it will decrease gradually and it's called classical fever of typhoid fever

B . Started and decreased abrupt and it diagnose pneumonia & meningitis.

▪️Remittent fever : fever increases and decreases but it doesn't reach the base , e.g : endocarditis

▪️Intermittent fever : patient has fever for specific days then disappeared and after it returns such as malaria.

▪️ Undulant fever " wavy fever" : brucellosis

▪️Relapsing fever : increased for a weak then decreased for a weak ...

هل مرة كذا سألت نفسك
ليش
Complications of DM
بتكون بالـ
Lens retina kidney PN
ليش مابتتضرر من ارتفاع السكر الكبد مثلا بالبداية أو البنكرياس أو الدماغ أو أي شي ثاني ؟
لماذا هولا تحديداً ؟?

طيب
تعرفوا إن الـ glucose بالطبيعي لما يزداد بالجسم يحصل له glycolysis وهذيك القصة الطويلة

المهم "Hexokinase" هذا الإنزيم هو الأهم بالعملية والي بيخلي الجلوكوز يمتسك بالكبد وبيبدأ التحليل

لما يكون الجلوكوز مرتفع زيادة زيادة
الإنزيم ذا ماعاد يكفي علشان يواكب الجاي

فبيرتفع الجلوكوز بالدم

من رحمة ربنا يبدأ الجلوكوز يدخل بعملية ثانية ويتحول لـ sorbitol بواسطة إنزيم اسمه "aldose reductase"
بعدها الـ sorbitol يتحول لـ fructose بواسطة إنزيم اسمه "sorbitol dehydrogenase "

والـ fructose يرجع يدخل بكم شي ويخرج ATP والدنيا سلامات

القصة وما فيها إن الإنزيم ذا موجود بالجسم عادي
"sorbitol dehydrogenase"
ولكن مش متواجد بالـ
Lens, retina, kidneys and schwann cells

فبيتحول بهذه الأماكن الـ glucose إلى sorbitol فقط

وهذا المركب يتراكم بالخلايا والاسموزية تبعه عالية جداً
فيسحب الماء ويعمل
Osmotic damage

ويحصل
Cataract, retinopathy, andperipheral neuropathy.

?So bio is more important than lunch ?