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COMMON
DISEASES
k¥8
Respiratory
System
 Bronchial Asma airflow
airway hyperresponsiveness s inflammation

- -
- -

t
- -

,
Clinical History : cough , Dyspnea , shortness of breath
symptoms demonstrate :

I /
night / early morning rapid improvement of FEVI
at
Reversibility
-

worse r after intake of treatment

1 I
✓
Variability
Physical Exam :
-

Hyperinflation
- - - - -

wheezing
- -

Rhonchi
-

l l

broncho dilators)
Common DDx : COPD ( less / no reversibility w/
LV failure ( basilar crackles )

Upper airway obstruction by tumor / Laryngeal edema ( stridor)

Diagnostic tests : ① Spirometer : variable Expiratory Airflow Limitation

-
Decreased FEV , j FEV ,
/ FVC is reduced ( L O 75
- -
O 80 )
-

② Peak Flow meter : peak Expiratory flow ( PEF ) Variability

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Chronic Obstructive Pulmony Disease

Clinical History :

Physical Exam :

Common DDx :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Community Acquired Pneumonia
Clinical History :

Physical Exam :

Common DDx :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Pulmony Tuberculosis
Clinical History :

Physical Exam :

Common DDx :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Pleural Effusion
Clinical History :

Physical Exam :

Common DDx :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Pneumoorax
Clinical History :

Physical Exam :

Common DDx :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
Cdiovascul
System
 Ischemic He Disease
Imbalance between Oz supply s 02 demand

1-

I
SILENT ISCHEMIA CHRONIC STABLE ANGINA
I -1 Angina pectoris Stable Angina pectoris
-

i :÷÷÷÷÷÷ :÷÷÷÷÷÷÷÷÷:÷÷÷÷÷:m
.

Mx : Rest ( s -
Iom )

sublingual Nitroglycerin
Presson
=

version
ACUTE CORONARY SYNDROMES
←yµ¥ evanon

I
=

¢ NON ST ELEVATION - ACS STEMI

# Ct ) ST elevation ( ECG)
Ct) red thrombi
UNSTABLE ANGINA NON STEMI ,

( fibrin rich cell rich )

,
(f) myocardial necrosis I
give
cardiac biomarkers ) fibrinolytics

1- Ct) White thrombi ( platelet rich ) 1-

Ct ) Angina Pectoris

# /
3
t at least 1 out of the ff :

occurs at rest -

Crescendo pattern ( > Iom )

Recent onset
:
Mx : Mx

-
Bed rest w/ -
Anti -
platelet
-

PCI
continuous ECG monitoring ( Aspirin I Clopidrogel )
-

Fibrinolytics
-

Angiography
Anti Ischemic Tx Anti pharmacotherapy
coagulant
- -
- : -
-

-
Nitrates .
UFW * Look out for hypertension
-

B -
blockers
'

LM WH ( Ehoxapanin ) * Control discomfort

'
ca -

blockers -

Fondaparinux .
Morphine
Statins N B blocker
coronary Angiography
-
-
- -

+ PCI
/ CABG
-

Revascularization
 Chronic Stable Angina Pectoris
Caused the
by inadequate supply of blood flow S
oxygen to a
portion of myocardium

Clinical History : E) ANGINA -

chest discomfort ( heavy , squeezing in character )

-
assoc .
w/ physical exertion or stress
-
crescendo -
decrescendo pattern lasts 2-5 mins
,

Physical Exam : -
radiates to either / both shoulders or arms

↳ (t) Levigne
's sign

Canadian
Cardiovascular angina occurs with . . . .

Society Angina I greater than ordinary physical activity III less than ordinary physical activity
Classification : I ordinary physical activity II rest

Diagnostic tests : ① ECG -

may be normal at rest

intra ventricular
ST segment T wave changes LV hypertrophy
-

, , , conduction disturbance

② Stress test ( 12 lead ECG before ,

-

during , after exercise )

③ 2B Echo
( assess left ventricular fxn wall motion abnormalities
)
:
,
ejection fraction , thrombus , etc
.

⑨ coronary Angiography indications : ( invasive procedure )

f -

severely symptomatic despite medical therapy t considered for revascularization

ffoalndaard -

troublesome symptoms w/ diagnostic difficulties ↳ catheter inserted in

cardiac arrest
femoral a. / radial a. 1 great a
known / possible CSAP survived
.
-

who

-
known / possible CSAP w/ left ventricular dysfunction

high risk of sustaining coronary events

-

Management : ① Anti -
ischemic drugs p give
max 3 tabs sub lingually
,
5 mins apart

Nitrates -7 lsosorbide di nitrate ( IO 40mg

-
BID -
TID )
Beta blockers -7 Me to pro lol ( 50 100mg Q1 D) →

refaucemcorfajgha.ae?ne1bl0chers-verapamil
BID avoid sudden discontinuation
-
- -

( 80 -

120mg TID -
QLD ) -
%50.int#ner .

in post -
mi patients
Aml Odi pine ( 2.5 -

10mg OD)

② Other Drugs

Anti -
platelets statins

Aspirin (72
-

162mg OD) Rosvvastatin ( IO 20mg

-
OD)

clopidogrel (75mg OD
) Atorvastatin ( IO -

80mg OD )
simvastatin ( IO -

40mg OD )

④ coronary intervention ( Revascularization )

percutaneous coronary intervention ( PCI )
coronary Artery Bypass Grafting (CABG)
ADDITIONAL NOTES:
Common DDx :

Angina “equivalents” : common in women S diabetics :

Dyspnea , Nausea , Fatigue , Faintness
 NON - ST ELEVATION
Acute Corony Syndrome
Clinical History :

Physical Exam :

Diagnostic tests :

Management :

¥/µ
ADDITIONAL NOTES:
Common DDx : depression

I
-

Complications :
e. on
 ST ELEVATION
Acute Corony Syndrome
Clinical History :

Physical Exam :

Diagnostic tests :

Management :

ADDITIONAL NOTES:

-2¥
Common DDx :
Elevators

Complications :
 Acute Corony Syndrome

Clinical History :

Physical Exam :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
he:i÷÷÷
Digestive
System
 Peptic Ulcer Disease
Clinical History :

Physical Exam :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Appendicitis
Clinical History :

Physical Exam :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Cholecystitis
Clinical History :

Physical Exam :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Choleliiasis
Clinical History :

Physical Exam :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :
 Acute Pancreatitis inflammation of the pancreas

Clinical History : severe epigastric pain , steady s

boring in character , radiating to the back
more intense when supine vomiting
in
,
,
nausea ,

Physical Exam : tachypnea , tachycardia , fever , hypotension

diminished / absent bowel sounds
direct tenderness on epigastric area

Grey Turner sign ( ecchymosis flank area )

t Hemorrhagic
on

Cullen 's sign ( peri umbilical ecchymosis ) pancreatitis

* Check 02 Stat

Etiology : Gallstone , Alcohol , hyperTriglycerides ERCP , Drugs

,
Risk factor for
severe disease : > 6040
,
BMI 730 , comorbidity

Diagnostic tests : ① Pancreatic enzymes ( 3 fold increase )

-
serum Amylase -
rises wlin 6 -
12h of onset

remains elevated for 3 Sd-

serum lipase ( greater specificity ) remains elevated for 7 14 d

- -
-

② Standard blood tests ( CBC CBG ,

AST , ALP , Bilirubin )
,

CBC :
Leukocytesis ( 15 000 20000 NIL
)
-
-

ABG :
hypoxemia ( arterial poz 260 mmHg ) → onset of ARDS !!
-
serum
chemistry : A glucose bilirubin
, , ALP , AST ,
TG

TT LDH ( poor prognosis ! ! )

③ Diagnostic imaging
-

Abdominal CT scan ( most important) ,

MRI

Management :
-

usually self limited / Resolves w/ in 3 -

7d after Tx
c
NPO , Analgesics
'

IVF :
LRIPNSS at 15 -
2041kg bolus → 3mg 1kg Ihr ( maintache , Ypg hart )
.
,

↳ measure hematocrit s BUN every 8 -

12h

prophylactic antibiotics ( severe ) : Carbapenem Quinolone metronidazole

-

, ,

ADDITIONAL NOTES:
Dissecting
Common DDx : Acute cholecystitis , peritonitis 20 to ruptured appendix / peptic ulcer
,
myocardial infarction , aortic aneurysm
Complications : -

Pseudo cyst ( t 4W after onset )

-
-

GI bleeding
-

Necrotizing pancreatitis s abscess ( I -2W after onset ) →

surgical debridement

Read on : SIRS ,
APACHE ,
BISAP
Acute Pancreatitis continued...

Ranson Criteria Admission :

At 48h
↳ serum Calcium L 8mg 1dL
200mg 1dL )
'' "
GALAN Glucose 710mmol ( >

Hematocrit
" ' '
CITOBBS Age 355 decrease 710%
y

LDH > 350 Pa 02 260 mmHg

AST 3250 Base deficit > 4mEa/L

WBC > 16000 cells 1mm 's BUN increase > 8mg 1dL
Fluid Sequestration 76000mL

PROGNOSIS : ICU

SCORE 23 2 3 26

MORTALITY O -
3% 11 -
155 .
40%
 PULMONARY CARDIOLOGY INFECTIOUS DISEASES
.
Bronchial Asthma .

Hypertension measles
.

'

community Acquired Pneumonia .

Atherosclerosis S Dyslipidemia -

mumps

Angina pectoris
'

pulmonary Tuberculosis chronic stable

Rubella
-
.

-
pleural effusion
-

Acute coronary Syndrome

varicella Herpes zoster
-

Non STEM
-

pneumothorax
' -

EBV
-

STEM '
'

COPD c

Dengue
-

Heart failure .

malaria
-
Rheumatic Fever -

leptospirosis
GASTROENTEROLOGY -

valvular Disease -

Typhoid Fever
.
pub .
Pericarditis
Tetanus
.

-
viral Hepatitis .
Cardiomyopathy ^

Rabies
.

Acute pancreatitis - cardiac tamponade

Appendicitis Cor pulmonate

.
-

cholecystitis
-

peripheral Artery Disease

.
Choke lithiasis .

Atrial fibrillation
hi
 Topic Title
Clinical History :

Physical Exam :

Common DDx :

Diagnostic tests :

Management :

ADDITIONAL NOTES:
Common DDx :

Complications :