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INTERNAL MEDICINE Notes:

Causes of hematemesis:
Esophageal varices, peptic ulcer, Mallory-Weiss syndrome, cancer esophagus , cancer stomach and
general causes
Peutz-Jegher Syndrome: mucocutaneous dark freckles on the lips, oral mucosa, palms and soles GI
polyps causing bleeding or obstructions "usually hamartomas"
Angiodysplasia: submucosal arteriovenous malformations that typically presents as fresh PR bleeding
in the elderly

Abnormal ECG:
Hypokalemia: is usually associated with diuretics like frusemide, there's U waves can be noted in leads
V3 and V4
Hypocalcemia: is a usual complication of thyroidectomy
Myxedema: there's sinus bradycardia and low voltage "amplitude" ECG

Urinary tract obstruction:

Pressure flow studies are done in a case of diabetic neurogenic bladder
Dynamic scintigraphy is used to assess renal blood flow and in such a case it's used to establish the
extent of renal perfusion post-transplantation

Diagnosis of renal failure

Wegener's granulomatosis : generalized vasculitis that involved upper resp tract "rhinitis" , lungs and
kidneys
Hemolytic uremic syndrome: multi-disorder of thrombosis of microvasculature with acute G.N. , it's the
most common cause of acute renal failure in childhood
Amyloidosis: is disorder of protein metabolism. Patients present s with heart failure , nephrotic
syndrome or bleeding. "Congo red" stains the amyloid into pink. Biopsies are taken from gums or
rectum
Acute interstitial nephritis: usually occurs as hypersensitivity to some drugs as Allopurinol,
penicillamine and NSAIDS "analgesic nephopathy

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Chronic joint pain
The most common cause of post operative arthritis is gout
Pyrophosphate arthropathy: aspiration of synovial fluid reveals positively birefringent crystals
Systemic sclerosis is associated with increase of anti-nuclear antibodies
Anti-centomere antibodies :CREST syndrome (calcinosis, Raynaud phenomenon, esophageal
dysmotility, sclerodactyly, and telangiectasia) , a variant from systemic sclerosis
Anti-Ro antibodies : Sjogrens's and systemic lupus
Anti-Jo-1 : Polymyositis and dermatomyositis
ANCA : Wegener's granulomatosis and Henoch Schonline purpura
Anti-mitochondreal : primary biliary cirrosis
ANA and anti -smooth muscle antibodies (ASM): type I autoimmune hepatitis
Anti- microsomal liver kidney antibodies: type II autoimmune hepatitis

Facial nerve palsy

Longitudinal temporal bone fracture is not commonly associated with facial nerve injury and is
presented by blood in the external auditory meatus, while transverse temporal bone fracture is
associated with haemotymapnum and facial nerve palsy
Diagnosis of liver diseases
Gamma glutamyl peptidase is specific for alcoholic hepatitis
Chlorpromazine is associated with obstructive jaundice Pneumonia
Pseudomonas auregnosa is treated with tobramycin or ciprofluoxacin
Farmer's lung or extrinsic allergic alvelitis is caused by inhalation of spores of Micropolyspora faetni,
found in mouldy hay and treated with predinsolone

Sexually transmitted diseases

Lymphogranuloma venereum is caused by Chlamydia trachomatis, the groove sign which is a
depression between the inguinal and the femoral lesions is characteristic
Granuloma inguinale is caused by Calymmatobacterium granulamtis, it's associated with Donovan
bodies in the edges scarping with Giemsa staining
Chancroid is caused by Haemphilus ducreyi, painful ulcers

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Post operative complications
Halothane gas inhalation and succunyl choline may result in malignant hyperthermia , ttt with
intravenous dantrolene sodium "muscle relaxant"
Hyperkalemia is treated with insulin in dextrose
Gentamycin can enhance the action of neuromusclar blocking agent by impairing the
neurotransmission leading to breath stop, ttt with calcium gluconate
Anticonvulsants side effects:
a)phenytoin "a pt with gum hypertrophy "
b)sodium valproate "someone with liver failure "
c)carbamazepine "a pt with electrolyte distrubences "
d)vigabatrin "a pt with visual field defect " not sure
e)phenobarbitone "a pt with rash" not sure

INTERNAL MEDICINE
Checklist:
Cardiovascular Chest pain ( ACS and angina) and its management
Palpitations Peripheral arterial diseases
Oedema
Breathlessness
Diagnosis of hypertension
Respiratory
Pneumonia
Bronchiolitis
COPD
Asthma
Sleep apnea
Cough
Hemoptysis

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Wheeze/ stridor

Blood and lymphatic

Abnormal blood film (anemia)
Bleeding, bruises, purpura
Blood loss
Enlarged L.N.
Pallor

Renal
Abnormalities of urine
Groin/scrotal pain and/or swelling
Renal failure
Urethral discharge including STI
Urinary symptoms
Urinary tract obstruction (including prostate and calculas)
UTI

Digestive
Abdominal pain
Abdominal mass (generalized and localized)
Altered bowel habit (incl. constipation)
Anorexia and weight loss
Diarrhea
Dyspepsia
Dysphagia
Facial pain and swelling
GI bleeding "lower and upper"

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Nutrition
Jaundice
Nausea and vomiting
Abdominal trauma
Diagnosis of acquired liver diseases
malabsorption

Homeostasis
Abnormal blood sugar
Complications of diabetes
Acid base imbalance
Electrolyte disturbances
Shocked patient
Thyroid abnormalities
Hypercalcemia treatment and causes

Infectious diseases
Fever and PUO Serious infections as (meningitis, HIV, Hep B and TB)
Travel medicine
Tropical infections as (malaria)
HIV risk prevention

Neurology
Coma
Blackouts
Headache
Faints and falls
Cranial nerve problems

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Peripheral nerve problems
Seizures and complications of anti-epileptics
Movement disorders including (tremors and gait disorders)
Immediate treatment of meningitis and head injury
Management of stroke and TIA

Rheumatology
Rheumatoid arthritis
SLE
Gout and pseudogout
Osteoathrosis
Dermatomyosistis, scleroderma, ankylosing, Reiter's, Sjogren's, Behcet's

Seriously ill patients

Anaphylaxis
Multiple trauma
Septicemia
Serious infection
Burns

Others
Antibiotic prophylaxis
Causes of immobility
Decision making in terminal care
Management of pain in a terminal care
Poisoning Pain relief
Prescribing drugs in renal failure
Prevention and treatment of DVT