Modified Canadian Cardiovascular Society grading of angina pectoris.

Modified Canadian Cardiovascular Society

grading of angina pectoris

Canadian Cardiovascular Society grading of angina pectoris contain only 4 grades and Class 0 is not an official part of the CCS functional classification of angina pectoris, however it has been mentioned in several sources, referring to myocardial ischemia without symptoms.

Grade 0	Asymptomatic Angina	Mild myocardial ischemia with no symptoms.
Grade I	Angina only with strenuous exertion	Angina with strenuous or rapid or prolonged exertion at work or recreation (Ordinary physical activity does not cause angina, such as walking and climbing stairs).
Grade II	Angina with moderate exertion	Slight limitation of ordinary activities when they are performed rapidly, after meals, in cold, in wind, under emotional stress, during the first few hours after waking up, but also walking uphill, climbing more than one flight of ordinary stairs at a normal pace and in normal conditions.
Grade III	Angina with mild exertion	Having difficulties walking one or two blocks or climbing one flight of stairs at normal pace and conditions.
Grade IV	Angina at rest	No exertion needed to trigger angina.

 Dr Ibrahim

Return to list of medical grades (click here)

- Criteria of hypersplenism.

Criteria of hypersplenism.

1. Splenomegally.
2. Cytopenias (mono or pan).
3. Hypercellular bone marrow.
4. Scanning with Cr51 labelled with RBCs>> reversed liver to spleen ratio.
5. Splenectomy will improve the condition.

(A huge spleen after splenectomy for female patient with hypersplenism)

Dr Ibrahim samaha

- Eye signs of thyrotoxicosis.

Eye signs of thyrotoxicosis.

"DR Joffroy may validate symptoms"

• Dalrymple sign:- rim of sclera is seen all around the cornea, on looking straight forward.
• Rosenbach's sign:- fine tremor of the upper eyelids on slight closure of the eye.
• Joffroy's sign:-lack of wrinkling of the forehead when a patient looks upward.
• Moebius sign:- lack of convergence on looking to near object.
• Von Graefe's sign (lid lag sign):-lagging of the upper eyelid on looking downward without movinh the head.
• Stellwag's sign:-staring look with infrequent blinking.

Dr Ibrahim,,

- Causes of gynecomastia.

Causes of gynecomastia.
Gynecomastia.

• Genetic : klinefelter syndrome.
• Young boy (puberty): due to transient increase of plasma estradiol.
• Neonate: due to persistent maternal or placental lactogens.
• Estrogen and estrogen like drugs (e.g. digitalis).
• Cirrohosis,Cimetidine,Cytotoxic drugs.
• Old age(due to conversion of androgen to estrogen in extra glandular tissue),Overactive thyroid (Hyperthyroidism)
• Myxedema,Marijuana.
• Acromrgally.
• Spironolactone,Steroids.
• Tumour (e.g. testis,adrenal,bronchogenic carcinoma).
• INH,Iron deposition in testis.
• Alcoholism.

- Malignant Mesothelioma.

Malignant Mesothelioma.

Def:-

It is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs,known as the mesothelium.

(CXR demonstrating Mesothelioma of left lower lung)

Sites:-

• Pleura. (is the most common form of the disease, accounting for roughly 70% of cases).
• Peritoneum.
• The pericardium (1).
• The tunica vaginalis.

- Exercise and COPD.

Exercise and COPD.

• Exercise and staying active are an important part of rehabilitation for chronic obstructive lung disease. 
• Regular exercise can help you feel less short of breath.
• Regular exercise improves your heart and muscles.
• It can help you feel good about yourself.

- How to use your Metered Dose Inhaler .

How to use your Metered Dose Inhaler .

Many patient don't know how to use MDI and their doctors don't learn them how to use it so it lead to non compliance to treatment and you will lose your patient,so we should learn our patient how to use MDI.

The following video is an excellent video showing us in simple steps how to use Metered Dose Inhaler.. you may need it to learn yourself and your patient.....

- Adrenergic manifestations of Hypoglycemia.

Adrenergic manifestations of Hypoglycemia

(warning signs of hypoglycemic coma).

Due to release of catecholamines when blood sugar less than 50mg%.

"chat Msn"

Coldness, Clamminess
Hunger pain.
Anxiety
Tachycardia,Tremors.


Mydriasis (Dilated pupils).
Sweating.
Nervousness

enjoy,,

Dr Ibrahim

- Anderson's triad.

Anderson's triad

The association of :-

1. Cystic fibrosis
2. Celiac disease 
3. Vitamin A deficiency

Dr Ibrahim

 

Return to other triads here.

- Meosthelioma Symptoms.

Meosthelioma Symptoms

Dr. Michael Milano explains what mesothelioma is and its symptoms..

- Whipple's triad.

Whipple's triad

or 

Whipple's criteria

Suggest a patient's symptoms result from hypoglycemia:-

1. Symptoms caused by hypoglycemia e.g. during fasting or exercise.
2. A low plasma glucose measured at the time of the symptoms.
3. Relief of symptoms with glucose administration.
    
   Dr Ibrahim
    
   Return to other triads here.

- Asbestos Lung Cancer.

Asbestos Lung Cancer.

Dr. Michael Milano explains how lung cancer can be caused by asbestos exposure.

- Hutchinson’s Triad.

Hutchinson's triad

It is a common pattern of presentation for congenital syphilis.
It consists of :-

1. Interstitial keratitis
2. Hutchinson incisors
3. Eighth nerve deafness.

Dr Ibrahim

Return to other triads here.

- Side effects of antithyroid drugs.

Side effects of antithyroid drugs.

"Charge"

Cholestatic jaundice.
Hypothyroidism.
Allergy,Agranulocytosis.
Relapse on sudden stoppage.
Goiter,Git upsets.
Exophthalmos increase.

enjoy,,

Dr Ibrahim

-Duhin-Johnson syndrome.

Duhin-Johnson syndrome.

It is Autosomal recessive disease characterized by Partial defect in excretion of conjugated bilirubin into the bile.

*Clinical picture:-It is usually asymptomatic.

1. Jaundice.
2. Good general condition.

*Investigations:-

1. Bilirubin: mild elevation of direct bilirubin
2. Biopsy (dark pigment inside hepatocytes i.e the liver is black in colour), it had been proved to be a metabolite of catecholamines.
3. +ve Bromosulphthalein (BSP) Test: Normally 90% of this dye is removed from blood within 45 minutes after I.V injection in normal liver.
In Dubin-Johnson syndrome there is a late rise in plasma SSP after an initial fall due to reflux of the dye from the liver reflecting hepatic excretion defect.
4. No evidence of obstruction.
5. No evidence of LCF.

*Treatment:-

No treatment (almost normal life span).

Dr Ibrahim

Return to list of medical syndromes here

-Local Complications of pneumonia.

Local Complications of pneumonia
"Idea"

Incomplete resolution and followed by bronchiectasis later on.
Delayed resolution.
Pleural Effusion,Empyema.
Lung Abscess,ARDS and respiratory failure.

Dr Ibrahim

- Wagner Grading System for Diabetic Foot Infections.

Wagner Grading System for Diabetic Foot Infections

• Grade 0 :- Intact Skin,but high risky foot.
• Grade 1 :- Superficial ulcer of skin or subcutaneous tissue.
• Grade 2 :- Deep Ulcers but no abscess nor bone involvement.
• Grade 3 :- Deep ulcer with osteomyelitis, or abscess.
• Grade 4 : -Gangrene of toes,heel or forefoot (localized).
• Grade 5 :- Gangrene of whole foot.

 Dr Ibrahim
Return to list of medical grades (click here) 

-Physiological loss of abdominal superficial reflexes.

Physiological Causes of loss of abdominal superficial reflexes:-

"Foams"

Faulty techniques.
Obesity.
Attentive patient,Ascites.
Multiparous.
Scar.

Dr Ibrahim Samaha

-Variants(Types)of Scleroderma.

Variants(Types)of Scleroderma.

"Sold"

A)Systemic sclerosis without Scleroderma:-
i.e internal organ involvement without cutaneous scleroderma.
B)Overlap syndrome:-
scleroderma associated with other autoimmune disease.
C)localized scleroderma:-
scleroderma without internal organ involvement.
Charachterized by Morphoea which are local patches of scleroderma.
D)Limited scleroderma(CREST Syndrome):-
There is minimal visceral involvement, positive anticentromere antibodies and good prognosis.
Skin hardening is limited to face,feet and fingers.
(Calcinosis,Raynaud's phenomenon,Esophageal dysfunction,Sclerodactly,Telangectasia.)
E)Diffuse scleroderma:-
Diffuse thickening of trunk,proximal and distal limbs with internal organ development and damage so it is life threatening.

Dr Ibrahim

-Drugs causing intrahepatic Cholestasis.

Drugs causing intrahepatic Cholestasis

"Cheap"

Contraceptive pills,Chlorpromazine.
Hypoglycemic drugs.
Erythromycin.
Anti-thyroid drugs,Anti-coagulants,Anabolic steroids.
PAS.

Dr Ibrahim