اسباب الصداع المختلفة و كيف تعرف نوعه

Generic Drugs بدائل الأدوية غالية الثمن في مصر نفس الكفاءة: اسباب الصداع:  

ارتفاع ضغط الدم يصاحبه زغللة في العين طنين في الأذن احساس بضربات القلب  الجيوب

اضغط الرابط الأزرق لقراءة الموضوع من مصدره الاساسي و معرفة باقي الأسباب 

How to differentiate between Metabolic and Respiratory Acidosis and Alkalosis

 Very Important question face every physician every day how can I diagnose respiratory or Metabolic Acidosis and Alkalosis 

As We all know Acidosis and Alkalosis are determined through measuring PH 

And the higher PH goes the more Alkaline We are 

How to differentiate Metabolic from Respiratory Acidosis or Alkalosis

If PH is High so Alkaline and HCO3  and CO2 are high it is Metabolic Alkalosis

If PH is high and HCO3 are low it is Respiratory Alkalosis 

IF PH is low and CO2 and HCO3  is Low it is Metabolic Acidosis 

If  PH is low and CO2 and HCO3 are high it is a case of Respiratory Acidosis 

Metabolic concomitant 

Respiratory Vise Versa 

With Images Symptoms of Crest Syndrome

 

What is Dermatomyositis

long-term inflammatory disorder which affects skin and the muscles.

^[1] symptoms are  a skin rash and worsening muscle weakness over time.^[] These may occur suddenly or develop over months.^[1] Other symptoms  weight loss, fever, lung inflammation, or light sensitivity.^[1] Complications may include calcium deposits in muscles or skin.^[1]

The cause is unknown.^[1] Theories include that it is an autoimmune disease or a result of a viral infection.^[1] It is a type of inflammatory myopathy.^[1] Diagnosis is typically based on some combination of symptoms, blood tests, electromyography, and muscle biopsies.^[3]

While no cure for the condition is known, treatments generally improve symptoms.^[1] Treatments may include medication, physical therapy, exercise, heat therapy, orthotics and assistive devices, and rest.^[1] Medications in the corticosteroids family are typically used with other agents such as methotrexate or azathioprine recommended if steroids are not working well.^[1] Intravenous immunoglobulin may also improve outcomes.^[1] Most people improve with treatment and in some the condition resolves completely.^[1]

About one per 100,000 people per year are newly affected.^[3] The condition usually occurs in those in their 40s and 50s with women being affected more often than men.^[3] People of any age, however, may be affected.^[3] The condition was first described in the 1800s.^[4]

هل يساعد الجنس في فقدان الوزن - ممارسة الجنس

 أجرى باحثون عام 2013، دراسة شارك فيها مجموعة من الأزواج، تتراوح أعمارهم من 18 إلى 35 عامًا، لمعرفة عدد السعرات الحرارية التي يتم حرقها أثناء ممارسة العلاقة الحميمة.

وقام باحثو الدراسة بإلزام الأزواج بارتداء جهاز تعقب النشاط، لحساب مقدار السعرات المستهلكة أثناء الجماع، وطالبوهم بممارسة العلاقة الحميمة مرة واحدة في الأسبوع لمدة شهر.

وبعد انقضاء المدة، وجد الباحثون أن الرجال حرقوا ما يقارب من 101 سعرة حرارية أثناء الجماع، بينما حرقت النساء 69 سعرة فقط.

ومنذ ذلك الحين، بدأ التعامل مع العلاقة الحميمة على أنها تمرين رياضي متوسط الشدة، لأن الجهد المبذول أثناء الجماع كانت شدته أكبر من المشي وأقل من الجري.

العادة السرية وعلاقتها بفقدان الوزن

ترتفع ضربات القلب بشكل تدريجي عند ممارسة العادة السرية، وعند بلوغ النشوة الجنسية والوصول لمرحلة الاستمناء، وجد الأطباء أن الجسم يحرق من 200 إلى 300 سعرة حرارية، بحسب موقع "Womenday".

Signs of Lung Collapse

Lung collapse

Signs

Trachea- displaced towards the collapsed lung

Chest expansion- reduced on the affected side with flattening of the chest wall on the same side

Tactile fremitus- reduced on affected side

Percussion- dull over the collapsed lung

Breath sound- reduced +/- bronchial breath sound above the area of collapse

Cuauses of lung collapse

Intraluminal- mucus (post-operative, asthma, cystic fibrosis)

Mural- lung cancer

Extramural- peribronchial adenopathy 

Causes of Diplobia or Double Vision

 Cornea Problems 

Astigmatism - Dry Eyes - Infections like Herpes Zoster - Scars 

Lens Problems 

Cataract

Eye Muscles Problems 

Graves Disease - Strabismus or misaligned eyes

Nerve Problems 

Diabetes - Myasthenia Graves

Brain Problems 

Brain Aneurysm - Brain Tumor - Migraine Headache -Stroke 

Case Study : Bat bites and their treatment.

     A 15-year-old adolescent boy was cleaning some items in the shed in his backyard in afternoon,when he saw a bat in middle of the shed , the boy was administered to the ED (Emergency Department) With vital signs of 115/70 mm Hg BP, heart rate of 105 beats per minute , respiratory rate of 14 breaths per minute pulse oximetry of 99% on room air, and a temperature of 37.1°C (98.9°F) Inspection of the wound shows deep bite marks with a laceration close to the proximal interphalyngeal joint. The bat escaped after the boy was bitten and was not found.

What Is The Most Likely Diagnosis? 

     Unprovoked attack by a rabies-infected bat

    Analysis : The Bat shows abnormal behaviour ; It was active in the afternoon (while bats are nocturnal creatures) , and it bit the boy -while normal bats may bite when provoked , rabies infected bats are more likely to bite . The strange bat behaviour raises suspicions towards being infected by the rabies . 

Treatment And Considerations :

      Cleaning of the patient's wound should be the first priority , the medical service provider should keep in mind that the patient was bit close to the joint space of the proximal interphalengeal joint , take care of the possibility of retained teeth . The patient's tetanus status should be constantly checked . 

       In this patient’s case, postexposure prophylaxis for rabies and delayed primary closure to observe for infection are reasonable. Postexposure prophylaxis for rabies should include a combination of immediate, passive (rabies immunoglobulin) immunization and active immunization (human diploid cell vaccine). Tetanus vaccine should be administered if the patient has not received it within the last 5 years.

       The Animal Control agencies should be contacted to notify them of the loose animal so they deal with it , in order to avoid any further bite attacks .

5 Important issues in Clinical Problem Solving

 CLASSIC CLINICAL PROBLEM SOLVING 

There are typically five distinct steps that an emergency department clinician undertakes to systematically solve most clinical problems: 

 1. Addressing the ABCs and other life-threatening conditions 

 2. Making the diagnosis 

 3. Assessing the severity of the disease 

 4. Treating based on the stage of the disease 

 5. Following the patient’s response to the treatment

Definition of Azotemia

 AZOTEMIA: Presence of nitrogenous bodies, especially urea, in the blood that develops in urinary tract obstruction when overall excretion function is impaired

What to consider in Management of Acute Urinary Retention Case

Many disease processes, trauma, and medications can result in acute urinary retention  In elderly men, the most common cause is prostatic hypertrophy.

As with this patient, a thorough history and physical examination can help elucidate the etiology of the urinary retention. 

Passage of a urethral catheter to alleviate

the obstruction will bring about significant pain relief. 

Assessment of renal function is important, as is obtaining a urinalysis to rule out concomitant urinary tract infection. Imaging studies in the ED are rarely necessary for these patients, although

bedside ultrasound may help identify bladder distention or a clot in the bladder.

Depending on this patient’s renal function and physical status after drainage of his

bladder, he may require admission

Case Study Discussion : 65 years Man unable to urinate for 65 years

A 64-year-old man presents to the  (ED) because of an inability to urinate for the past 24 hours. 

In addition, he complains of an unintentional weight loss of 20 lb over the past 6 months , night sweats, and generalized fatigue. On examination, he is thin and in moderate distress. His BP is 168/92 mm Hg, heart rate is 102 beats per minute, temperature is 37.7°C (98.8°F),

and respiratory rate is 22 breaths per minute. The abdominal examination reveals

a tender mass in the suprapubic area. 

rectal examination, the prostate is firm, nontender, and somewhat irregular.

What is the most likely diagnosis

 How would you confirm the diagnosis

 What is the next step in treatment

 A 64-year-old man presents with an inability to void for the past 24 hours

and a tender mass in the lower abdomen. The patient has signs and symptoms

suggestive of prostate cancer, including unintentional weight loss, night sweats, a

decrease in energy, and an enlarged irregular firm prostate gland.

• Most likely diagnosis: Acute urinary retention likely due to prostate cancer.

• Confirming the diagnosis: Thorough history and physical examination including a rectal examination, urinalysis, electrolytes and renal function tests, along

with bedside ultrasound, if available. Prostate-specific antigen may help in the

diagnosis of neoplastic disease if results will be available in the ED.

• Next steps in treatment: Draining the bladder by inserting a urethral catheter

should relieve the patient’s pain; if not, a suprapubic catheter can be placed.

Treatment of the underlying disease process is also necessary.

Malignant causes of LBP , etiology , Clincal Picture , Diagnostics and Treatment

Aetiology

Common Cause metastatic  breast, prostate, lung 

May also be primary loke multiple myeloma, leukemia, lymphoma

Clinical Symptoms Analysis

Pain lasting longer than 1 month, worse at night, unrelieved by rest; unexplained

weight loss; 

mild tomoderate spinal tenderness

Diagnostic tools

CBC, ESR,

plain x-ray, CT,

MRI

Treatment in Emergency Departement 

intravenous dexamethasone

and  refer for radiation therapy

Spinal Infection , etiology , Clinical Picture , Diagnostics and Treatment

Etiology

Most commonly due

to Staphylococcus.aureus

Risk Factors

intravenous drug use

elderly, immunocompromised, alcoholism, recent bacterial

Signs and Symptoms

infection or back trauma

Back pain (even at rest/

night), fever, midline

cultures, tenderness

along spine.

Focal neurologic deficits as late finding

Diagnostics 

CBC, ESR,

 plain x-ray 

C.T

MRI - preferred

Treatment

Intravenous

antibiotics,

surgical drainage

and

decompression

Red Flag Signs and Symptoms of Low Back Pain LBP

 Patients younger than 18 years old or older than 50 years 

Significant trauma (or mild trauma in patients older than 50 years) 

Chronic steroid use 

Osteoporosis 

History of cancer Recent infection 

Immunocompromise 

History of intravenous drug use 

Pain worse at night, 

lasting longer than 6 weeks,

 or refractory to analgesics and rest 

Associated systemic symptoms (fever, unexplained weight loss, malaise, night sweats, diaphoresis, nausea, syncope) 

Acute onset Use of anticoagulants or coagulopathy 

Abnormal vital signs (including unequal blood pressures or pulse deficits) 

Neurologic deficits (including extremity weakness, numbness, paresthesias, loss of rectal sphincter tone, urinary retention)

Cauda Equina Syndrome Case Study , Cardinal Signs

A 57-year-old man 

  one month history of worsening low back pain 

 radiates down the back of both legs and suddenly increased yesterday.

 For the past 2 days,  have difficulty voiding

 skin around his anus feels numb when he wipes with toilet tissue. 

He denies prior trauma to or surgery on his back. 

- Most likely diagnosis: Cauda equine syndrome

Aetiology Central disk herniation multiple, involving bilateral nerve roots 

  the next diagnostic step MRI

Why Cauda Equina and not other causes of LBP because cardinal signs of Cauda equina syndrome are 

, urinary retention and overflow incontinence, decreased rectal tone, saddle anesthesia 

Past Surgical History in Clinical Examination

 Past surgical history: Date and type of procedure performed, indication, and

outcome. Laparoscopy versus laparotomy should be distinguished. Surgeon

and hospital name/location should be listed. This information should be correlated with the surgical scars on the patient’s body. Any complications should

be delineated including, for example, anesthetic complications and difficult

intubations.

Interpretation of Past History in History Taking and Clinical Examination

 Past medical history:

a. Major illnesses such as hypertension, diabetes, reactive airway disease,

 congestive heart failure, angina, or stroke should be detailed.

 i. Age of onset, severity, end-organ involvement.

 ii. Medications taken for the particular illness including any recent changes

to medications and reason for the change(s).

 iii. Last evaluation of the condition (example: when was the last stress test

or cardiac catheterization performed in the patient with angina?)

 iv. Which physician or clinic is following the patient for the disorder?

b. Minor illnesses such as recent upper respiratory infections.

c. Hospitalizations no matter how trivial should be queried.

1st Line of any Case Presentation include the following

 The first line of any presentation should include age, ethnicity, gender, and chief complaint. Example: A 32-year-old white man complains of lower abdominal pain of 8-hour duration.

Clinical Interpretation ofBasic information in Taking History

 Basic information

a. Age: Some conditions are more common at certain ages; for instance, chest pain in an elderly patient is more worrisome for coronary artery disease than the same complaint in a teenager. 

b. Gender: Some disorders are more common in men such as abdominal aortic aneurysms. In contrast, women more commonly have autoimmune problems such as chronic idiopathic thrombocytopenic purpura or systemic lupus erythematosus. Also, the possibility of pregnancy must be considered in any woman of childbearing age. 

c. Ethnicity: Some disease processes are more common in certain ethnic groups (such as type II diabetes mellitus in the Hispanic population).