- ACR Criteria for Diagnosis of SLE.

American college of Rheumatology (ACR) Criteria

for Diagnosis of Systemic Lupus Erythematosus.

"Sharp Domain"

1. Serositis:Pleuritis, pericarditis.
2. Hematologic disorder (hemolytic anemia OR Leukopenia less than 4,000 OR Lymphopenia less than 1500 or thrombocytopenia less than 100,000).
3. Arthritis:-(nonerosive, involving 2 or more joints).
4. Renal disorder:-(persistent proteinuria > 0.5 grams per day OR cellular CASTS).
5. Photosensitivity:- Rash on exposure to sun light.
   
   

- 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

- Medical treatment of hydrocephalus.

Medical treatment of hydrocephalus

*Aim:-

Medical treatment is used to delay surgical intervention.

*Medical treatment is not effective in long-term treatment of chronic hydrocephalus. It may induce metabolic consequences and thus should be used only as a temporizing measure.

*Lines of TTT:- "Fair"

• Furosemide:1mg/kg/day.(Decreasing CSF secretion).
• Acetazolamide 5mg/kg/day.(Decreasing CSF secretion).
• Isosorbide (Increasing CSF reabsorption).
• Restriction of water and salts.

Dr Ibrahim

- Skull causes of macrocephaly.

Skull causes of Macrocephaly.

"Oscar"

Osteogenesis imperfecta.
Secondaries especially neuroblastoma.
Chronic hemolytic anemia.
Achondroplasia.
Rickets.

Dr Ibrahim

-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.
  

-Poisons with charachteristic odour.

Poisons with charachteristic odour

"Phenol"

Phenol,Phosphorus.

Hydrocarbons.
Hydrocyanic acid(Bitter almond).
Hydrogen sulphide(Rotten egg).

Ethanol and methanol.
Nicotine.

Opium.
Organophosphorus,arsenic (Garlic odour).

Liquid of salicylate"oil of winter green".

Dr Ibrahim

-Indications of heamodialysis.

Indications of heamodialysis
"Unstable"

Uraemia.
No response to conventional therapy.
Salicylates.
Theophylline.
Alcohols,Acetaminophen.
Boric acid,Barbiturates.
lithium.
Ethylene glycol.

Dr Ibrahim

-Substances not adsorbed by Activated Charcoal.

Substances not adsorbed by Activated Charcoal
"Phials"

Pesticide,potassuim
Hydrocarbons.
Iron,Insecticide.
Acids,Alkali,Alcohols.
Lithium.
Solvents.

Dr Ibrahim

-Common radiopaque medications.

Common radiopaque medications which appear in X-ray
"Cheap bit"

Chloral hydrate,Cocaine,Ca.
Heavy metals.
Enteric coated tablets.
Antihistamines,Arsenic.
Phenothiazines,potassium.

Barium.
Iodide,Iron.
Tricyclic antidepressants.

Dr Ibrahim

-Don't soil scorpion sting.

Don't soil(تلوث)scorpion sting

(Don't perform the following in scorpion sting):-

Suction of the wound.
Over treat by hypnotics (over sedation).
Immersion of injured extremity in ice.
Local incision.

Dr Ibrahim

-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

-Drugs causing constipation.

Drugs causing constipation

"Coma"

Calcium channel blockers.
Opioids.
Muscle relaxants.
Antacids,Anticholinergics,Abuse of laxatives.

Dr Ibrahim

-Treatment of urticaria.

Treatment of urticaria

"Scar"

Systemic steroids(sever cases resistant to treatment).
Soothing lotions locally.

Ca gluconate.

Adrenaline.
Antihistamines.

Removal of the cause.

Dr Ibrahim

-Risk factors of cerebral infarction.

Risk factors of cerebral infarction

A)Non-modifiable risk factors:- "Maps"
Male gender.
African-American.
Age(Old age).
Positive family history.
Prior Stroke.

B)Modifiable risk factors by medical treatment:- "Third"
Transient ischemic attacks.
Heart diseases.
Increase Blood pressure(HTN).
Raised Hematocrite.
Diabetes Mellitus.

C)Modifiable risk factors by changing lifestyle:- "chops"
Cigarette smoking.
Hyperlipidemia.
Obesity.
Physical inactivity.
Stressful life.

Dr Ibrahim

-Predisposing factors of genital candidosis in female.

Predisposing factors of genital candidosis in female

"Charge"

Chemotherapeutics(Antibiotics or immunosuppressive drugs).
Hormonal effect(e.g steroids,contraceptive pills and pregnancy)
Severe Anaemia or other debilitating diseases.
Reinfection from an infected male.
Glucosuria(Diabetes mellitus and pregnancy).
Excessive humidity (wearing of nylon tights).

Dr Ibrahim

-Mechanical causes of Impotence.

Mechanical causes of Impotence
"Hope"

Huge bilateral hydrocele or inguinal hernia.
Morbid Obesity.
Penile carcinoma.
Peyrone's disease(fibrotic scar of tunica alibuginea surrounding corpora cavernosa resulting in curvature of penis in erection)
Elephantiasis of penis or scrotum.

Dr Ibrahim

-Protozoa causing Dermatologic lesions.

Protozoa causing Dermatologic lesions.
"late"

• Leishmania donovani(Post Kala azar dermal leishmaniasis).
• Leishmania brasiliense(Ulcer).
• Leishmania donovani(oriental ulcer).
• Acanthamoeba castellanii (Skin granuloma)
• Trypanosoma cruzi(chagoma)
• Trypanosoma brucei gambiense,rhodesiense(Chancre).
• Entamoeba histolytica(Cutaneous ulcer in the right hypochondrium and perianal area.)

Dr Ibrahim

-Sites of esophageal constrictions.

Sites of esophageal constrictions are
collected in the word "Dial" at

Diaphragm (15 inches from incisor).
Inlet of the esophagus(6 inches from incisor).
Aortic arch crosses it(9 inches from incisor).
Left main bronchus crosses it (12 inches from incisor).

Importance :-

• During passage of insturments (gastroscope) along the esophagus.
• Lodging of swollen foreign bodies.

Dr Ibrahim