- 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.

- 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

- 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

-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

-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

-Poor prognosis of rheumatoid disease.

Poor prognosis of rheumatoid disease
"I'm fresh"

Insidious onset.
Male patient.

Functional disability at the 1st year after start of disease.
Radiographic evidence of erosion.
Extra-articular manifestations.
Subcutanous nodules.
High positive Rheumatoid factor.

Dr Ibrahim

-Complications of Tetralogy of fallot.

Complications of Tetralogy of fallot
"Inches"

Infective endocarditis,Low I.Q.
Neurological (e.g Brain abscess,cerebrovascular accidents)
Cyanotic spell,Clubbing.
Hematological(e.g polycythemia,IDA,Thrombosis).
Hyperuracemia and gout,Heart Failure (rare).
Exercise intolerance.
Squatting,scoliosis,Stunted growth.

Dr Ibrahim

-Drugs causing hepatitis.

Drugs causing hepatitis

"CMV Hard knife"

Cytotoxic drugs,Clonazepam.
Methyldopa.
Verapamil.

Halothane.
Atenolol.
Rifampicin.
Disulfiram.

Ketoconazole.
Nitrofurantoin,Niacin.
Isoniazid.
Fenofibrate.
Enalapril,Erythromycin.

Dr Ibrahim

-Treatment of Acute pancreatitis.

Treatment of Acute pancreatitis
"Snails"

Shock managment.
Nothing by mouth (put pancreas to rest).
Aspiration of gastric contents and Analgesics for pain.
Iv fluids and Calcuim.
Lavage of peritoneum in severe cases.
Somatostatin:- decrease pancreatic secretions.

Dr Ibrahim

-Varieties of Diabetic neuropathy.

Varieties of Diabetic neuropathy
"Stamp"

Sensorimotor polyneuropathy.
Truncal neuropathy.
Autonomic neuropathy.
Mononeuropathy.
Proximal neuropathy (diabetic amyotrophy).

Dr Ibrahim

-Iatrogenic endocrinal diseases.

Iatrogenic endocrinal diseases
"TV as Milk"

Thyroxin therapy lead to thyrotoxicosis.
Vit D lead to hypercalcaemia.

Amiodarone lead to thyroid dysfunction.
ACEIs lead to hypoaldosteronism.
Sympathomimetics lead to picture like thyrotoxicosis.
Steroid therapy lead to DM and cushing syndrome.

Metoclopramide lead to hyperprolactinaemia.
Iodide lead to hyperthyrodism.
Insulin and oral hypoglycemic lead to hypoglycemia.
Lithium lead to hypothyrodism.
Ketoconazole lead to hypoadrenalism.

Dr Ibrahim

-Psychic features of Hyperthyrodism.

Psychic features of Hyperthyrodism.

"Mania"

• Mental disturbance.
• Anxiety.
• Nervousness.
• Insomnia.
• Agitation.
   

Dr Ibrahim

- Skin manifestations of Systemic Lupus Erythematosus.

Skin manifestations of Systemic Lupus Erythematosus.

"Dr Palm"

• Discoid rash.
• Raynaud's phenomenon: observed at distal digital tips.

• Photosensitivity, Purpuric lesion, Pre-ungual erythema.
• Alopecia:commonly affect the temporal regions.
• Lichen plannus like, Livedo reticularis, leucoderma.
• Malar rash.

Dr Ibrahim

- Carpal tunnel syndrome.

Carpal tunnel syndrome 

*Def:- is a medical condition in which the median nerve is compressed inside the flexor retinaculum leading to paresthesias, numbness and muscle weakness in the hand.

*Causes:-

Due to fibrosis,fluid accumulation,soft tissue or bone hypertrophy which my be due to:-

"MEDIAN TRAP"(1)

Myxoedema
Edema
Diabetes mellitus,Drugs(e.g Oral contraceptive pills)
Idiopathic
Acromegaly
Neoplasm 

Trauma,Typists(Occuptional).
Rheumatoid arthritis
Amyloidosis
Pregnancy

-Guillain Barré syndrome.

Guillain Barré syndrome

Aetiology(theories):-

• Postinfection:50% of cases have preceding respiratory or GIT viral infection.
• Post vaccination:following vaccination against swine flu virus.
• Lymphoma.
• Autoimmune theory.

Clinical Picture:-
1-Initial febrile illness.
2-Motor affection:-

• Bilateral symmetrical ascending affection of both lower limbs,trunk,upper limbs,Bulbar muscles,facial muscles then diphragm and respiratory muscles.
• The Affection is proximal more than distal in adult.
• The Affection is proximal more than distal in infant and childrens.
• Weakness is associated with hypotonia and areflexia.
  

-Vircow's triad.

Vircow's triad is the aetiology of thrombosis which is composed of :-

1-Damage of vascular endothelium(Vascular trauma):-
this damage expose the endothelial collagen which is rough surface to which platelets can stick firmly and release thromboxane A2 that help more platelet aggregation.

2-Slowing(Reduced)in the blood flow (stasis):-
these changes help thrombosis by allowing the platelets to deviate from the axial stream and cross the peripheral plasmatic zone to stick to the vascular endothelium.

3-Change in blood composition(Increased coagulability ):-
a-Increase number of blood elements.
-Increase platelets so become more sticky and agglutinate in small masses and adhere to vascular endothelium.
-Increase WBCs and RBCs increase viscosity of blood and stasis.
b-Biochemical changes that cause systemic activation of the cloting system.

"VIR chow"

Vascular trauma
Increased coagulability
Reduced blood flow (stasis)

Dr Ibrahim

Return to other triads here.

-Types of laxatives.

Types of laxatives

"Boss"

Bulk laxatives.
Osmotic laxatives.
Stimulant(irritant)laxatives.
Stool Softeners.

Or "Bios"

Bulk laxatives.
irritant(Stimulant)laxatives.
Osmotic laxatives.
Stool Softeners.

Dr Ibrahim