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قناة طبيه تهتم بالكتب الطبيه واي شي۽ متعلق بالطب #BRS #pathoma @Yaqob_alsomaii
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Respiratory System:
Examination of the chest (systematically—inspection, palpation, percussion and auscultation).
🔹Inspection:
▫ Shape of the chest
▫ Deformity (flattening of the chest, kyphosis, scoliosis, etc.)
▫ Drooping of the shoulder
▫Movement of the chest
▫ Intercostal space (indrawing or fullness)
▫ Visible impulse
▫Visible or engorged vein (if present, see flow)
▫ Others (scar marks, suprasternal and supraclavicular excavation, prominent accessory muscles,
gynecomastia, needle puncture mark, tattooing, radiation mark).
🔹Palpation:
▫Position of trachea
▫ Apex beat
▫ Chest expansion
▫Chest movement (symmetrical or asymmetrical)
▫ Tracheal tug
▫ Cricosternal distance
▫ Vocal fremitus
▫ Local rib tenderness.
🔹Percussion:
▫ Percussion note
▫ Liver dullness
▫ Area of cardiac dullness (not done routinely, only if emphysema is suspected).
🔹Auscultation:
▫ Breath sound
▫Vocal resonance
▫ Added sounds (rhonchi, crepitations, pleural rub, post-tussive crepitations).
❕Note
Always examine the back of the chest, systematically.
General Overview:
A. Appearance & Attachment as canula, catheter , ECG monitor .. etc
2. Built
3. Consciousness
4. Decubitus
5. Facial Expression
B. Vital signs :
1-Pulse
2- temperature
3- blood pressure
4- respiratory rate
C. Complexion
1- pallor
2- cyanosis
3- Juandice
🔹How to take History :
▫ Name, age, sex, address, marital status, occupation
▫ Date of admission
▫ Date of examination
▫ Chief complaints (in chronological order, from longest to shortest duration)
▫ History of present illness
▫ History of past illness (including any operation)
Y
▫ Family history
▫ Personal history
▫ Socioeconomic history
▫ Drug and treatment history
▫ History of allergy (to drugs, diet or anything else, skin rash associated with allergy, treatment taken
for allergy)
▫ History of immunization" speciallly in pediatric patient
▫ Menstrual and obstetric history (in female)
▫ Other history – Travelling to other places or abroad, working abroad (may be related to hepatitis B, HIV, etc.), contact with TB patient (mention, if relevant).
✓ modify hx according to each patient
*كورس طوارئ الباطنة*
*Emergency medicine course* 🩺🚨
مع دكتور أحمد رمضان
🗒️Course Content:
هنتكلم مع بعض في المواضيع الآتية:
- Vital signs
- History and examination
- Plumonary edema
- Plumonary embolism
- Approache to chest pain
- Approach to abdominal pain
- COPD exacerbation
- Respiratory failure
- AKI, CKD, ESRD.
- Approach to DCL patient and how to diagnose and mange
- stroke
- intra cranial hge
- Convulsions
- hepatic coma
- DKA
- hypoglycemic
- Hypertensive emergency and urgency doses of antihypertensive (market names )
- Cardiac arrest
- Electrolytes imbalance "diagnosis and management"
- arrthymia
- EcG ...most common
- imagine X Ray..ct
- antibiotics
🔥خصم 50 % لأطباء الامتياز
🟢التفاصيل وطريقة الاشتراك:
@YAQOB2022
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Gastrointestinal System
(Always start examining from mouth and pharynx, then abdomen).
🔸Mouth and pharynx:
▫Lips
▫ Teeth and gum
▫ Oral mucous membrane
▫ Tongue
▫ Palate and movement of soft palate
▫ Tonsils
❕Note:
Look for pigmentation, white patch, ulceration.
❇ Abdomen (Examine Systematically—Inspection, Palpation, Percussion and Auscultation)
🔹Inspection:
▫ Shape of the abdomen
▫ Flanks
▫ Movement with respiration
▫ Visible peristalsis
▫ Visible pulsation
▫ Umbilicus
▫ Engorged veins (if present, see the direction of flow both above and below the umbilicus)
▫ Striae
▫ Any scar mark
▫ Pigmentation
▫Swelling or mass (tell the site)
▫ Campbell de Morgan’s spot
▫ Groin, pubic hair and genitalia (with permission of the patient)
▫ Cough impulse.
🔹Palpation:
▫ Superficial palpation and local temperature
▫ Deep palpation (tenderness, rigidity, mass)
🔸 Liver:
▫ Size (in cm)
▫ Margin
▫Surface
▫Tenderness
▫ Consistency
▫ Upper border of the liver dullness
▫ Auscultation (to see bruit or rub).
🔸 Spleen (size in cm)
🔸Kidneys
🔸Gallbladder (if palpable, mention the size, tenderness, consistency, surface, margin)
🔸 Fluid thrill (if ascites is suspected)
🔸Any mass (if present, first see whether it is intra-abdominal or extra-abdominal). Then see the
following points:
▫ Site
▫Size
▫ Shape
▫ Surface
▫Consistency
▫Tenderness
▫ Mobility
🔸 Others: (whether pulsatile, feel for get above the swelling).
🔸 Para-aortic lymph nodes
🔸 Hernial orifice
🔸 Testis (with permission of the patient)
🔸 Per-rectal examination (though it is a part of physical examination, usually it is never done in an
examination setting).
🔹Percussion:
▫Liver dullness
▫ Splenic dullness
▫ Shifting dullness (if ascites is suspected or present).
🔹Auscultation:
▫Bowel sounds
▫ Hepatic bruit or rub
▫ Renal bruit
▫ Bruit of aortic aneurysm
▫ Splenic rub
▫Venous hum.
Systemic Examination:
Cardiovascular System
1. Pulse:
√ Rate
√ Rhythm
√ Volume
√ Character
√ Condition of the vessel wall
√ Radio-femoral delay
√ Radio-radial delay
2. Neck veins (JVP), hepatojugular reflux (if needed)
3. Blood Pressure.
🔹Precordium (Sequentially—Inspection, Palpation, Percussion and Auscultation)
🔸Inspection:
▫Any deformity of the chest
▫Visible cardiac impulse
▫ Other impulses (epigastric, suprasternal, supraclavicular or other impulse)
▫ Any scar mark (midsternal or thoracotomy)
▫ Pacemaker or cardioverter defibrillator box (mention, if any).
▫Palpation:
1. Apex beat:
▫Site (that intercostal space)
▫ Distance from midline (in cm)
▫ Nature (normal, tapping, heaving, thrusting, diffuse or double apex).
2. Thrill:
▫ Site (that intercostal space, apical or basal or other site)
▫Nature (systolic or diastolic or both).
3. Left parasternal heave
4. Palpable P2
5. Epigastric pulsation.
▫Percussion:
▫Area of cardiac dullness (Not a routine. However, it is important to diagnose pericardial effusion,
where area of cardiac dullness is increased and in emphysema, where area of cardiac dullness is
obliterated).
▫Auscultation:
1. 1st and 2nd heart sounds
2. Other heart sounds (3rd and 4th)
3. Murmur:
▫ Site
▫Nature (systolic, diastolic or both)
▫ Radiation (towards left axilla or neck)
▫Relation with respiration, posture (in left lateral position with breathing hold after expiration
or bending forward with breathing hold after expiration)
▫ Grading (1, 2, 3...)
4. Added sounds (pericardial rub, opening snap, ejection click, metallic plop)
5. Auscultate back of the chest (to see bilateral basal crepitations in pulmonary edema).
🔹PHYSICAL EXAMINATION (includes general and systemic
examination)
General Examination
▫Appearance
▫ Build
▫ Nutrition
▫ Decubitus
▫ Cooperation
▫ pallor
▫ Jaundice
▫ Cyanosis
▫nail Clubbing,Koilonychia Leukonychia
▫ edema
▫ Dehydration
▫ Bony tenderness
▫Pigmentation
▫ Lymph nodes
▫ Thyroid gland
▫ Breasts
▫ Pulse
▫ Blood pressure
▫ Temperature
▫Respiration
▫Others (if relevant) – Neck, axilla, head (alopecia, large or small). Skin lesion (if any, such as
butterfly rash in face, rash in body, scratch mark).
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🏥جالنا شاب ٢٠ سنة في الطوارىء بيشتكي من تورم بالخصية اليمين مع وجود الم
بقالها قد ايه؟
يومين ، رحت الصيدلية اخدت حقنة اتحسنت و رجعت تاني
في افرازات صفراء بتنزل من العضو مع حرقان في البول؟
ايوا
بنرفع الخصية لفوق الألم بيقل شوية positive prehn sign و ده دليل على وجود التهاب البربخ و ليس التواء بالخصية testicular torsion ، لو كان التواء بالخصية كان الألم هيزيد لما نرفعها لفوق
كمان التحسن على الحقنة اللي اخدها في الصيدلية بتأكد انه مش التواء خصية
كمان بنعمل cremasteric reflex بنجيب ظهر الhammer و بنمشيها على الجانب الداخلي للفخد حيث يوجد dermatome L1 اللي بيعمل
reflex epsilateral testicular elevation
و ده دليل على سلامة genital branch of genitofemoral nerve داخل الspermatic cord و ده بيأكد انه مش testicular torsion❌
⚠️نخلي بالنا ان الprehn sign و الcremasteric reflex مش sensitive للحالة دي
يعني ممكن يبقى شخص طبيعي و معندوش cremasteric reflex
🗨️شوية anatomy..
الgenital branch of genitofemoral nerve ده الefferent ، اما الafferent هو ilioinguinal nerve و ده ماشي جنب الspermatic cord مش جواه ، و هما الاتنين جوا الinguinal canal
الilioinguinal nerve بيخرج من الsuperficial inguinal ring عشان يغذي الجلد في ال upper thigh & anterior scrotum
التشخيص هنا هو عدوي الgonorrhea✅ اللي بتحصل بعد العلاقة الجنسية ب ٢-٥ ايام
اما الchlamydia بتحصل بعدها باسبوعين او ثلاثة
و ممكن يكون الاتنين موجودين مع بعض
بنأكد التشخيص بإننا ناخد مسحة من العضو و نعمل urine analysis & culture🧪
العدوى بتيجي من علاقة جنسية او التهاب مجرى بول او التهاب بروستاتا
و علاجهم
🔸azithromycin 1 gm or ofloxacin 400 or cifixime 800 mg signle dose for gonorrhea or single dose ceftriaxone 500 IM
🔸Azithromycin 1 gm for chlamydia
🔸Or doxycyclin 100 mg 1×2 for 7 days days for both chlamydia & Gonorrhea
مهم برضو نستبعد وجود الم مفاصل او التهابات بالعينين🦵🏻👁️ لاستبعاد Reactive Arthritis اللي بتحصل بعد الchlamydia بأسبوعين او ثلاثة .. و هنا الblood culture بتبقى negative لأن دن reaction
بس كده .. سلام❤️
د/عمر رشوان
/channel/+CRqLmho6qSM3ZmU0
High Quality information in pharmacology
Lichen planus:
6 P’s” (Purple, Pruritic, Polygonal, Planar, Papules, Plaques)
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A = Acetazolamide
B = Beta blockers
C = Carbonic anhydrase inhibitor
D = Definitive laser
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6 posts with meeting with Beta blockers :
1️⃣ Meeting with Beta Blockers
2️⃣ Beta Blockers in Heart Failure
3️⃣ Beta Blockers in Hypertension
4️⃣ Beta Blockers in Arrhythmias
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