A 40-year-old female presented with 1 year of bilateral symmetrical arthritis of hand joints, wrists, elbows and toes with morning stiffness lasting 4 hours. On examination, she had pallor and arthritis of involved joints but no deformities. The most likely diagnosis is rheumatoid arthritis (RA). RA is the best fitting diagnosis given the symmetrical polyarthritis and absence of features suggesting other diagnoses.
A key diagnostic test for RA is anti-cyclic citrullinated peptide antibody (anti-CCP Ab) as it is highly specific for the disease. Normocytic normochromic anemia is an indicator of disease activity in RA. Soft tissue swelling but not bony ankylosis may be seen
TO THE SOUL OF THE PEOPLE WHO DREAMS BETTER DAYS AND PERFECT FUTURE WHO DIED THINKING THAT LIBYA IS WORTHY NOT THE LIBYAN
HOPPING OUR ALLAH ACCEPT THIS SMALL WORK
Differential diagnoses of bronchial asthmaKoktongTan3
Differential diagnoses of bronchial asthma are diverse. Not all patients with wheezing or coughing are having bronchial asthma. In this presentation, I discussed about different case scenarios to broaden our knowledge to think out of the black box.
Enjoy PMDC material on
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Download the past paper from dec 2019.
Follow the video lectures on basic subjects for step 1 on youtube channel "think with dr shadab"
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
Rheumatology
1. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
RHEUMATOLOGY:
1. A 40 year old female patient C/O bilateral symmetrical arthritis of hand joints ,wrists
,elbows ,toes of one year duration, H/O morning stiffness 4 hrs. No H/O skin rash .
No H/O raynauds phenomenon
O/E:
Pallor ++ other GE unremarkable
Locomotor system ---arthritis of involved joints . no deformities
A. The most likely diagnosis is :
a. Scleroderma
b. RA
c. Behcets disease
d. CPPD
e. Gout
B. The most specific diagnostic test is:
a. Rheumatoid factor
b. ANA
c. Anti-cyclic citrullinated peptide AB
d. CRP level
e. Anti Ds DNA
C. The following are extra-articular manifestation of the disease except:
a. Carpel tunnel syndrome
b. Interstitial lung disease
c. Pleural effusion
d. Meneingoencephlitis
e. Sjogrens syndrome
D. All the following are indicators of disease activity except:
a. Normocytic normochromic anemia
b. Increased ESR
c. Increased s.amyloid level
d. Decreased s.albumin level
e. Thrombocytopenia
E. All of the followings are expected x-ary findings of hands except:
a. Soft tissue swelling
b. Juxtaarticular osteopenia
c. Erosions
d. New bone formation
e. ankylosis .
2. A 25 year old female patient with H/O polyarthritis of hand joints ,wrists ,elbows and
toes of 2 year duration. There was H/O photosensitive facial skin rash.
She is married with 2 kids and had 2 abortions
O/E:
Pallor ++ butter fly rash ++ diffuse alopecia
Pedal edema ++ BP 170/100
Systemic examination was unremarkable
2. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
A. The most likely diagnosis is :
a. RA
b. SLE
c. ASLERODERMA
d. DM
e. ACUTE GOUTY ARTHRITIS
B. All of the following investigations are expected to be positive except:
a. ANA
b. ANTI –DsDNA
c. Low C4 level
d. APL Ab
e. Anti –scl 70 AB
C. The following are systemic manifestation of the disease except:
a. Chorea
b. Transverse myelitis
c. Diffuse alveolar hemorrhage
d. Thrombocytosis
e. Libman schs endocarditis
D. The following are cutaneous specific lesions of the disease except:
a. Discoid lupus
b. Batter fly rash
c. SCLE
d. Heliotrope rash
E. Initial therapy include all the followings except:
a. Oral prednisolone
b. Hydroxyl chloroquine
c. Salazopyrine
d. Ca and vit D
e. ACE I
3. A 30 year old male patient C/O recurrent oral and genital ulcerations of one year
duration with H/O polyarthralgia.
a. The most likely diagnosis is
i. Ankylosing spondylitis
ii. Rheumatoid arthritis
iii. SLE
iv. Behcet disease
v. PSA
b. The most specific eye manifestation of the disease is :
i. Anterior uveitis
ii. Posterior uveitis
iii. Optic neuritis
iv. Scleritis
v. Conjunctivitis
c. The following are cutaneous manifestations of the disease except:
i. Erythema nodosum
3. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
ii. Acne like rash
iii. Pseudo folliculitis
iv. Pyoderma gangrenosum
v. Erythema marginatum
d. The following are clinical mainfestaions of the disease except:
i. Recurrent DVT
ii. Arterial aneurysm
iii. Sacroilitis
iv. Sicca syndrome
v. Ileocecal ulcerations
e. The following is expected lab findings:
i. RF
ii. ANA
iii. HLA B5
iv. ANTI—CCP AB
v. ANTI CENTROMERE AB
4. A 65 year old female patient C/O right sided hemicranial headache of 3 months
associated with attacks of decreased visual acuity on right eye.
she had H/O intermittent claudication in her LL with jaw claudication on mastication.
A. The most likely diagnosis is:
a. Takayausaus arteritis
b. PAN
c. WG
d. GCA
e. GCS
B. The disease is associated with all the following except:
a. Sudden blindness
b. Pulmonary fibrosis
c. Increased alkaline phosphatase
d. Increased IgA level
e. PMR
C. The most helpful diagnostic test is:
a. Temporal artery USS
b. Temporal artery angiography
c. Temporal artery biopsy
d. CT brain
e. MRA
D. Initial investigations will reveal all of the following except:
a. N.N. anemia
b. Increased ESR
c. Increased CRP
d. Increased CK MM
E. Initial management should include :
a. Oral methotrexate 15mg/wk
b. Oral prednisolone 1mg/kg/d
4. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
c. I.V. cyclophosphamide pulse therapy
d. Cyclosporine
e. Azathioprine
5. A 40 year old female patient with H/O raynuds phenomenion of 4 years duration .
She gave H/O thickness of skin of hands and face.
O/E: mask face , multiuple telengectasia ,peaked nose ,sclerodactly
A. The most likely diagnosis is:
a. Systemic sclerosis
b. RA
c. MCTD
d. SLE
e. PM/DM
B. renal involvement characterized by all of the following except:
a. daily increase in serum creatinine
b. increased serum rennin level
c. microangipathic hemolytic anemia
d. increased blood pressure
e. urinanalysis---RBCs and WBCs casts
C. the following are common pulmonary manifestation except:
a. IDL
b. Pleurisy
c. PAH
d. Bronchalveolar ca,
e. Massive pleural effusion
D. The most important poor prognostic sign is:
a. ILD
b. Raynauds phenomenon
c. Renal involvement
d. PAH
e. CNS involvement
E. Drug of choice in treatment of renal involvement is:
a. Oral prednisolone
b. Plasmaphresis
c. IVIG
d. ACE –I
6. A 20 year old male patient C/O low back pain of 2 years duration. The pain increased
with rest and deceased with activity. It is associated with morning stiffness of 2 HR.
No H/O peripheral arthritis ,no H/O skin rash
O/E:
Pallor +++ , General examination ---NAD
Tenderness both sacroiliac joints
Restriction of lumbar spine flexsion
A. The most likely diagnosis is:
a. PSA
b. Reactive arthritis
5. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
c. Enteropathic arthritis
d. BD
e. Primary AS
B. Radiological features of the disease include all except:
a. Sacroilitis
b. Squaring of vertebrae
c. Sydesmophytes
d. Bamboo spine
e. Erosive arthritis
C. Extraarticular manifestation include all except:
a. Apical pulmonary fibrosis
b. Anterior uveitis
c. Caude equine syndrome
d. Secondary amyliodosis
e. Sicca syndrome
D. Management of choice is:
a. NSAIDS + TNT blockers
b. Methotrexate
c. Salazopyrine
d. Oral prednisolone
7. A 60 year male patient known to have HTN on atenolol & hydroxyl chlorothiazide
,aspririn 75mg/d. presented with sudden onset of swelling and pain on his right knee
joint after high protein dinner and drinking alcohol .No H/O fever or trauma. .H e
have similar history before 3 attacks.
O/E:
Temp 37.5 , BP 160/90
Right knee hot swollen and tender
A. The most likely diagnosis is:
a. septic arthritis
b. acute gouty arthritis
c. Hemochromatosis
d. TB
e.SLE
B. The most appropriate investigation to confirm the diagnosis :
a. X ray right knee
b. Blood culture
c. USS
d. MRI knee
e. Joint aspiration
C. The following are clinical manifestation except:
a. Nephrolithium
b. ARF
c. CRF
d. Punched out erosions on x ray
e. Hypercalcemia
6. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
E. The following are associated diseased except:
a. HTN
b. DM
c. Hyperlibidemia
d. Hyperthyroid
e. Cardiomyopathy