Pure Medicine Dr. Mussab M.

Abdullatef

Medicine In 5 Hours Plus+

Case solving & Main MCQ Points

Plus more keywords for

new cases

BY
Dr. Mussab M. Abdullatef

Pure Medicine
easy … simple .. clear
Pure Medicine Dr. Mussab M. Abdullatef

Key words in Cardiology

 Splitting S2,S4 at Apex, Chest Pain, Dyspnea, Congested Neck Veins, Basal
Inspiratory Crackles, Ejection Systolic Murmur at upper right sternal Border >
(Chronic heart failure due to Aortic Stenosis).

Chest Pain, Dyspnea, Congested Neck Veins, Basal Inspiratory Crackles, S3 at

Apex >> (Chronic heart failure due to Ischemic Cardiomyopathy).

Old age male, DM, HTN, Central chest pain, sweeting , st segment elevation
>> ( Acute MI )
Elevation lead 2,3,AVF >> Inferior MI
Elevation lead V2,3,4,5,6 >> Extensive anterior MI

 Rheumatic Heart Diseases in patient develops; Tachycardia, Coughing,

Shortness of breath, irregular Rhythm = (Rheumatic Heart Disease, Mitral
Stenosis, Atrial Fibrollation).

 Bilateral basal crepitation, syncope, angina, dyspnea >> ( LSHF due to AS )

 History of URTI, Bilateral Basal Crepitation's, Pan systolic Systolic Murmur to

Axilla >> (Rhumatic heart complicated with Mitral Valve Disease )

 Tachycardia, HTN, Palpable LV, Loud S2, S3, S4 >> (LSFH due to hypertensive
cardiomyopathy).

 Severe Retrosternal Pain, Elevated Cardiac Enzymes, Depressed ST Segment

(Acute Non ST Segment Elevation Myocardial Infarction ).

 Chest Pain when taking breath, FHMA (Fever, Headache , Malaise, Anoraxia),
Pericardium Rub, Elevated ST in all leads >> (Pericarditis).

 History of sore throat, fever, joint pain, pansystolic Murmur >> (Rheumatic
Fever).
Pure Medicine Dr. Mussab M. Abdullatef

 Diabetic Patiant, Epigastric Pain not relieved by antacids, Nausea, Vomiting

(Inerior MI).

 MS=mid diastolic localized to apex &MR=Systolic and radiating to Axilla.

 AR= Diastolic in 2nd Aotic Area & AS = Systolic radiating to Carotid Apex +
Syncope.
 Irregular Pulse & Stroke = Af

 Persistent ST elevation in patient with MI >> (Myocardial Aneurysm {Late

Comp of MI })

 Symptoms of low COP + Muffled HS + low voltage ECG (Pericardial Effusion).

 Chest Pain & ST Elevation in all leads (Pericarditis).

 Chest Pain + Cough + Dyspnea + Hemoptysis (Pulmonary Infraction).

 Acute Shock + cyanosis + Dyspnea +LOW COP (Massive Pulmanory
Embolisim).

 Long standing severe HTN + Disturbed Conscious Level without lateralization

(Hypertensive Encepholopathy).

 Anorexia + Nausea, Vomiting & Blurring of vision in patient with HF (Digitalis

Toxicity).

 Fever + Arthritis of big joints + Tic Tac Rhythm (Rheumatic Fever).

 Sudden Severe Chest pain radiating to the back + Murmur (Dissecting Aortic
Aneurisim).
Pure Medicine Dr. Mussab M. Abdullatef

Key words in Respiratory

 Female, Wheezy Chest in young age (Bronchail Asthma).

 Dyspnea , Chest Tightness, Cough, Clear Sputum, Triggered by Exercise (

Exercise induced Asthma)

 Dyspnea, Cough, Whezz 1 hour after Aspirin (Asprin Induced Asthma

 Known case of asthma + SOB + wheezy chest + unable to complet 1

sentaces = ( acute severe asthma )

 Known case of asthma, confused, silent chest + Rised co2 >> ( life
threatening asthma )

 Cough, Yellow Sputum, Dyspnea, Heavy Smoker, Hyper-Resonance of lung,

Expiratory Wheezes. = (COPD)

 Acute Dyspnea, Shortness of breath, Sitting Too much time in bed or bus,
taking CCPs = (Pulmonary Embolisim).

 Tall, thin, sudden Dyspnea, smoker, right sided chest pain (1ry
spontaneous Pneumothorax).

 Yellow sputum, dullness, bronchial breathing CXR; Infiltration of left lower

lobe (Community Acquired Pneumonia).

 Hemoptysis , chronic Bronchitis, weight loss, heavy smokers, clubbing

(Bronchogenic Carcinoma ).

 History of pneumonia, Dullness, Blunt Costophrenic Angles + Nuetrophils

(Exudative Para pneumonic Effusion).

 Dyspnea, Dry Caugh, Facial congestion, Bluish Tinge >> (Superior

Mediastinal Syndrome)
Pure Medicine Dr. Mussab M. Abdullatef

 COPD Patiant Develops Sudden Stabbing Chest Pain (Simple

Pneumothorax).

 Sputum:
 Smoker (Chronic Brochitis) + Hemoptysis (Bronchogenis Carcinoma).
 Smoker (Chronic Bronchits ) + Dyspnea + May Be Wheezes & Excessive
Sputum.
 Hemoptysis + loss of body weight + Night sweating (TB).
 Purulent sputum=Suppurative, If after Oparation (1ry lung Abcess).
 Hemoptysis, fever, bad mouth oder + Clubing >> ( Bronchiactisis )

 Progresive dyspnea, fine crepitations, wheez >> ( ILD )

 Black race, Erythema, dyspnea + Bilateral hiller lymphadenopathy >> (

Sarcoidosis )
Pure Medicine Dr. Mussab M. Abdullatef

Key words in Neurology

Old age + DM + HTN + Hemiparesis more than 24 hours >> CVA ( infarction ) less
than 24 hours TIA )

Taking any increase bleeding drugs + Hemiparesis >> CVA ( Hemorrhagic )

Sudden severe headache or Comatose + Xnathechromia >> Subarchinoid

hemorrhage

Middle age female + Recurrent multiple neurological manifestation ( UMNL +

ATAXIA ) + Diplopia = MS

Male + Hx of previous infection + ascending poly neuropathy (tingling +

parasthesia + Weekness starts in LL then UL ) = GBS

Old age male + mixed ( UMNL + LMNL ) + no sensory or autonomic symptoms =

MND ( ALS )

Old age + unilateral tremors + Mask face + Hypertonia ( Ridgidity ) >>

Parkinsonism

Middle age female + weakness of muscles at end of the day ( Unable to combine
her hair + Diplopia + Dysphagia ) >> Mysenthenia Graves

Female + Unilateral Head ache throbbing in nature aggravating with light, smell
or noise + aura + Nausea & vomiting >> Migraine

Middle age + Unilateral headache around the orbital + lacrimation + nasal

congestion >> cluster Headache

Sings of increase ICP + No evidence of space occupying lesion >> Psudo Tumor
cerebri

Head ache + Fever + Maculopapular rash + neck stiffness >> Bacterial

Meningitis …. Viral meningitis without rash + Lymphocytes

Patient complaining of difficult reading or claiming down steers >> 4 th CN palsy

Pure Medicine Dr. Mussab M. Abdullatef

Key words in Hematology

 Pallor, Fatigue, Low Hb, Low MCV + MCH, Low ferritin >> (Iron Deficiency
Anemia ).
 Causes
If middle age female >> ( menstrual problems )
If old age male >> ( Colorectal carcinoma )
If middle age male >> ( Peptic ulcer )

 Pallor, Fatigue, Occult Blood in Stool, Oesinophilla, Reddish Worms in

Duodenum, Low Hb, Low MCV. (Iron Deficiency Anemia with Eosinophilia
due to Hookworm Infection).

 Pallor, fatigue, low Hg, Low MCV + MCH, Raised ferritin >> ( sideroblastic
anemia )

 Low Hb, Low , Low RBC, High MCV + MCH, Low WBCs >> (Megaloblastic
Anemia most likely pernicious Anemia).

 Grey hair blue eyes, High MCV + MCH >> ( pernicious Anemia )

 Hx of fauvism + Low Hb, Reticulocytosis, Heinz Bodies >> (GBPD Deficiency).

 Black race, +ve family Hx + Low Hb, Reticulocytosis, Pain all over the body >>
(Sicke Cell Anemia).

 Young Female, Low Hb, Reticulocytosis >> (Autoimmune Hemolytic Anemia).

 Low Hb 7 WBCs & Platlates (or 2 of them) , Decreased Bone Marrow Celluraty
>> (Aplastic Anemia).
Pure Medicine Dr. Mussab M. Abdullatef

 Old age male, Lymphadenopathy, low Hb Very High Lymphocytosis >>

(Chronic Lymphocytic Leukemia CLL).

 Old age male, Massive Splenomegaly, low HB + Myeloblasts + Pheladelphia

chromosome (Chronic Myelliod Leukemia CML).

 Old age, constitutional symptoms + low HB, blast cells more than 20% >> (
Acute leukemia )

Aura rods present >> AML

Aura rods absent >> ALL

 Prolonged Fever, Lymhadenopathy, Hepatosplenomegaly >> (Lymphoma).

 If red Sternberg cell present >> ( Hodjken lymphoma )
 If absent red strenberg cells >> ( Non – Hodjken )

 Old age, black male, recurrent infections, bone pain + low HB, Plt and high ESR
+ benc jones protein >> ( Multiple myloma )

 Fever, night sweets, low HB + boin pain + teardrop giant Plt + pianfull
splenomegaly >> ( Myelofibrosis )

 Bleeding Tendency:
 Middle age female, low Plt + Petechial or rash >> (ITP).
 Severe Hemoptysis, Hematemesis >> (Dissecting Intravascular Coagulopathy
or Vit K Deficiency).
 Male, internal bleading ( post curcumsition or heamarthosis ), High CT + APTT
>> ( hemophilia )
 +ve family Hx, epistaxis, menoraghia, High BT + APTT + CT >> ( VWD )
Pure Medicine Dr. Mussab M. Abdullatef

Key words in Hepatology

 Alcoholic, Jaundice, LL Edema, shifting Dullness, Low Albumin >> (Liver

Cirrhosis )

 History of blood Transfusion, Jaundice, shifting Dullness, Abominal

Distension, Low Albumin, High Bilirubin >> (Ascites caused by portal
hypertension as a complication of cirrhosis).

 Chronic HCV years ago, jaundice, Ascites (Liver Cirrhosis due to HCV).

 Patient Jaundiced & Cachexia, Hepatomegaly, Distended GB, Dilated Billary

Ducts (Malignant Obstructive Jaundice).

 Jaundice
 Ascites + Flapping tremors, Coma >> ( Encephalopathy )
 If Dark Urine, Clay color stool >> (Obstructive or hepatocellular jaundice).
 If Dark Stools, Normal Urine >> (Hemolytic Jaundice).
 If Jaundice, LL Edema, Ascites, Decreased Albumin >> (Liver Cirrhosis)
 All + Hematemesis >> (Complicated by Portal HTN).
 IF all + Spider Nevi, Palmer Erythema, Gynecomastia, Bleeding
Tendency..etc >> (Liver Cell Failure).

 Ascites, Abdominal Pain, Tenderness, Fever & may be Encepaholpathy >>

(Spontaneous Bachterial Perotonitis).

 If fever + Rt Hypochondrial Pain + increase ferritin + increased in liver

enzymes (Acute Hepatits).
Pure Medicine Dr. Mussab M. Abdullatef

 Middle age female, jaundice, increase AST + ALT, +ve ANA + ALKA >>
(autoimmune hepatitis )

 Middle age female, Pruritis + Featured of Obstuctive Jaudice, +ve AMA

(1ry Billiary Cirrohsis).
If +ve ANCA >> ( 1ry sclerosing cholangitis )

 Middle age, Jaundice + Abnormal Movements + Family H/O >> (Wilson

Disease).

 Male, jaundice + skin discoloration + DM + feritine more than 1000 >> (

Hemochromatosis )

Key words in Gastrology

 Heart Burn 4 years developed Dysphagia & Bolus Impaction (GERD, Also
Esophageal Cancer Due to Barrett's Esophagus).

 Recurrent Epigastric Pain When fasting awakesPatiant from sleep

&Microcytic Anemia >> (Peptic Ulcer Complicated by bleeding as
suggested by Anemia).

 Repeated Epigatric Pain with Fullness for 5 years with No organic cause >>
(Functional Dyspepsia).

 Patient Receiving NSAIDs Now vomiting small cup of blood >> (Drug
Induced gastritis & possibly Ulcer).

 Bloody Diarrhea, Vomiting, Pallor, Fissure, Hemorrhiods, Previos

Radiotherapy,, D.D?
((Uicerative Colitis, Crohns Colitis, Infectious Colitis, Ischemic colitis,
Neoplasia, Irradaition).
Pure Medicine Dr. Mussab M. Abdullatef

 Large volume, Greasy Diarrhea, contains Undigested food (small bowel

Diarrhea with Malabsorption).

 Abdominal pain & Diarrhea with visible blood + Tenusmus + dilated air-
filled colon = (Ulcerative Colitis).

 Diabetic Patient develops diahrrea D.D

(Autonomic Neuropathy, Bacterial, Metformin induced, Autoimmune).

 Diarrhea with history of ciprofloxacin intake (Antibiotic Associated Colitis).

 Watery diarrhea related to food + anemia + LL edema + clubbing = ( celiac

disease )

 Fever, Night sweats, watery Diarrhea, bowel thickness, Enlarged

Mesenteric LNs >> (Tuberculosis Enteritis).

 Old Patient, Constipation, Weight loss, blood in stool >> (Cancer Colon).

 Bright red blood in stool, positive family history of bleeding per Rectum
(Inherited Familial Polyposis syndrome).

 Abdominal pain+ GIT symptoms without organic abnormality =

(Functional Dyspepsia).

 Alcoholic sudden epigastric pain, staping in nature + elevated amylase =

(Pancreatitis).

 Bulky Diarrhea + Loss of Vitamins = (Malabsorption).

 Abdominal pain increasing by meal & Relieved by defecation >> (IBD).

Pure Medicine Dr. Mussab M. Abdullatef

 Female, Lower quadrant Abdominal pain + mass + Non bloody diahrea +

Urinary Tract Fistula (Chrons disease ).

 Occult blood in stools + Anemia + Progressive Constipation (Cancer Colon).

 Bleeding per rectum + Positive Family H/O + No other Abnormality

(Familial Polyposis).

`
Pure Medicine Dr. Mussab M. Abdullatef

Key words in Endocrine

 Middle age female + tremors + exophthalmos + loss of wight + High T3,T4

+ low TSH = ( Graves ( thyrotoxicosis ))

 Obease, sleepy, hair loss, felling cold + bradycardia + High TSH + Low T3, T4
= ( Hypothyrodisim )

 Bones, stones, mones, abdominal growns >> ( hypercalcemia )

 Post-Partum Hemorrhage + Failure to lactate her baby, Lack Hair Growth =

(Sheehan's syndrome).

 Diabetic, moon shape face , High Na, Low K, Inverted Cortisol Rhythm >>
(Cushing syndrome).

 Middle age female + viteligo, low Na + glucose, High K + Ca >> (Adrenal

Crisis).

 Middle age, Recurrent Episode of Hypertension with headache &

palpitation + sweeting = (Pheochromocytoma)

 Changing in shoes size, large Face, High Prolactin >> (Acromegaly).

 Obese Male developed Burning Sensation in Leg & Cellulitis, Nocturia

polydipsia >> (Diabetes Mellitus).

 Diabetic Patient receiving Insulin found Comatosed D.D

(Hypoglycemic Coma, DKA Coma,).
Pure Medicine Dr. Mussab M. Abdullatef

 Female, Polyuria, Polydipsia then Abdominal pain, Dehydration, Vomiting

>> (DKA).

 Fasting Sugar 115, 2 hours postprandial 186 (Impaired Glucose

Intolerance).

 Middle Aged hypoglycemia, High Insulin, High C- peptide = (Insulinoma).

 Hypoglycemia + High insulin levels, C peptide not detected = ( exogenous

insulin )
Pure Medicine Dr. Mussab M. Abdullatef

Key words in Nephrology

 Anorexia , Nausea, Fatigue, High Urea, High Creatinine, Hyperkalemia,

Hypocalcemia >> (End Stage Renal Failure).

 Severe 3 days Diarrhea Oliguria, High Creatinine, High Urea (Pre-renal

Acute Kidney injury).

 Trauma + elevated cretinine + CK more than 1000 = Rhabdomyolysis

 LL edema, Puffiness of Eyelids, High Albumin in urea, High Cholestrol

(Nephrotic Syndrome).

 History of Methicilline Intake followed by oiliguria, rash , fever >> (Drug

Induced Interstitial Nephritic Syndrome).
 History of sore throat, Oliguria, blood Pressure, & Protiens in Urine >>
(Acute post-streptococcal Nephritic Syndrome).

 Family history of cerebrovascular accident, painless hematuria then renal

failure (Polycytic Renal Disease)., If no family history of same illness = Medulary
spongy kidney disease

 Hypertension, itching, Protien in urine, High Urea &Creatinine (chronic

renal failure).

 Young Patient with proteins in urine, low albumin in serum, LL edema,

puffy eyelids (Minimal change Nephrotic Syndrome)
Pure Medicine Dr. Mussab M. Abdullatef

Key words in Rheumatology

 Female +small joint pain+ Morning joint stiffness = Rheumatoid arthritis

 Joint pain + Numbness in fingers >> carpal tunnel syndrome

 Female, Mala Rash, mouth ulcers, Alopecia >> (SLE)

 Butterfly Rash, Pericardial Rub, Shortness of breath >> (SLE with Pericardial
effusion).

 SLE develop + LL edema & Puffiness of Eyelids (Lupus Nephritis).

 Female with SLE + Recurrent Abortions = (Ant phospholipid Syndrome).

 Female + headache + muscle pain in shoulders (polymyalgia rheumatic ) =

Giant Cell Arthritis

 Heartburn + Finger Pain + Raynaud's + Telangiectasia = (Scleroderma).

 Diabetic Patient, Developed swollen tender Lt foot D.D >> (Septic Arthritis -
Gouty Arthritis, Cellulitis).

 The Same Case with the history of thiazide Intake (Gouty Arthritis).

 Old women Diabetic with Knee pain, Rt Knee is Tender & Swollen (septic
Osteoarthritis).

 Repeated Oral ulcers, Scrotal Ulcers, Positive Pathargy Test (Behcets disease).
 Rich man, Renal Stones + Pain of big toe >> (Gout)
 Postmenopausal Female + Low Back Pain (Osteoparosis).
Pure Medicine Dr. Mussab M. Abdullatef

Main Anti Bodies in Rheumatology

Anti – cyclic certiullated peptide Ab Rhumatoid Arthritis

Anti-nuclear anti body ANA dsDNA SLE
Anti histon antibody Drug induced lupus
Pregnancy lupus Anti Ro
Renal + skin Involvment Anti smith Ab

Anti ribo nuclec Ab CTD SLE, systemic sclerosis, polymyostis

Anti centromere Ab limited : type of systemic sclerosis
Topo isomerase Tab diffuse: : type of systemic sclerosis
Anti scl 70 scleroderma

Anti RO
Anti LA sjogrens

Anti-synthase (anti Jo Ab ) ANA +ve Polymyocytis

C- ANCA wegeners granulomatosis

P-ANCA Polyarteritis nodosa