MALLORY WEISS SYNDROME

Severe prolonged vomiting --> longitudinal tear in the mucosa of stomach at & just below the cardia -->
severe hematemesis.
Violent vomiting often may be due to migraine or vertigo or following a bout of alcohol.
Severe vomiting and later hematemesis.
Melena (10%).
Features of shock.
Common in one Oclock position.
Only 10% of cases involve lower esophageal mucosa.

Investigations
Hb%
PCV
Blood grouping.
Gastroscopy

Dierential diagnosis
Bleeding peptic ulcer
Esophageal varices
Erosive gastritis
Carcinoma stomach

by Koh Zhi Rou ! of 8

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SUPPURATIONS LUNG DISEASES

Bronchiestasis
Empyema
Lung abscess

COPD LUNG FINDINGS

Features of hyperinflation

translucency ( vascular marking).

Low flat diaphragm.

Tubular heart.
Widening of intercostal space.
Emphysema bullae.

by Koh Zhi Rou ! of 8

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SIGNS OF COR PULMONALE

Pulmonary hypertension.
Right ventricular hypertrophy (RVH).
RV failure.

Inspection chest diameter.

Retractions of the chest wall.

Distended neck veins.
Prominent a / v waves.
Cyanosis may be seen.

Palpation Left parasternal / subxiphoid heave.

Percussion Hyperresonance of the lungs (underlying COPD).

Auscultation Wheezes & crackles (pulmonary edema).

Systolic bruit in lungs (turbulent flow through recanalized vessels in chronic
thromboembolic pulmonary hypertension)
Splitting of the 2nd heart sound with accentuation of the pulmonic component in the
early stages.
Systolic ejection murmur + sharp ejection click over pulmonary artery (advanced disease)
along with a diastolic pulmonary regurgitation murmur.
RV 3rd & 4th sounds or the systolic murmur of tricuspid regurgitation.

Others Hepatojugular reflux and pulsatile liver are signs (Systemic venous congestion)
As cites
Ankle edema

by Koh Zhi Rou ! of 8

3 !
MANAGEMENT APPROACH IN ADULT BASE ON ASTHMA CONTROL

by Koh Zhi Rou ! of 8

4 !
FUNCTION OF NSAID

by Koh Zhi Rou ! of 8

5 !
by Koh Zhi Rou ! of 8
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TIA VS STROKE
Transient ischemic attack: A stroke in which symptoms resolve within 24 hours an arbitrary cutoff that has little
value in practice, apart from perhaps indicating that underlying cerebral haemorrhage or extensive cerebral
infarction is extremely unlikely.

by Koh Zhi Rou ! of 8

7 !
AUTOIMMUNE DISEASES

by Koh Zhi Rou ! of 8

8 !