-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