Dr. HIGH HIGH

✅ A 67-year-old male with a history of atrial fibrillation on warfarin presents to the emergency department with sudden onset upper gastrointestinal (GI)
bleeding. The patient reports passing dark, tarry stools for the past 24 hours. Vital signs are stable; physical examination reveals mild epigastric tenderness on palpation. Laboratory tests show an elevated international normalized ratio (INR) of 4.2.
Which of the following is an effective immediate treatment for this patient?

1. IV proton pump inhibitors 😜

2.fresh frozen plasma😆

3.vitamin K 🙃

4.platelet transfusion 😄

✅ A 68-year-old male presents to the emergency department with acute-onset severe shortness of breath and chest pain. He is diaphoretic and appears to be in distress. His blood pressure is 90/60 mmHg, and his heart rate is 110 beats per minute. On auscultation, a harsh systolic ejection murmur is heard best at the right upper sternal border. An electrocardiogram shows signs of left ventricular hypertrophy. An echocardiogram confirms the diagnosis of severe aortic stenosis.
Which of the following situations is most likely to precipitate syncope or hemodynamic collapse in this patient?

1. standing up suddenly 🫠

2. Coughing forcefully 😖

3.exercise 😉

4.lying down 🙃

5. Eating a large meal 😇

Welcome back our doctors ❤️
We will start from today new beginning
We will start questions about medicine
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ACUTE APPENDICITIS
Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen.
Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe.
-Symptoms:
Sudden pain that begins on the right side of the lower abdomen
Sudden pain that begins around your navel and often shifts to your lower right abdomen
Pain that worsens if you cough, walk or make other jarring movements
Nausea and vomiting
Loss of appetite
Low-grade fever that may worsen as the illness progresses
Constipation or diarrhea
Abdominal bloating
Flatulence
-Causes
A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture.
Laboratory tests
-Tests used in the diagnosis of acute appendicitis include:
Physical examination of the abdomen
Re**al exam
Blood tests for signs of infection, such as a white blood cell count
CT scan
MRI scan
Abdominal ultrasonography
Urine test
-treatment:
*appendectomy*
Recent evidence has suggested that some cases of uncomplicated appendicitis can be treated with antibiotics instead of an appendectomy.
-Complications
Appendicitis can cause serious complications, such as:
* ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.
*A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for about two weeks, and you're given antibiotics to clear the infection.

Pneumonectomy
is a surgical procedure to remove a lung. Removal of just one lobe of the lung is specifically referred to as a lobectomy, and that of a segment of the lung as a wedge resection (or segmentectomy).
-The most common reason for a pneumonectomy is to remove tumourous tissue arising from lung cancer. In the days prior to the use of antibiotics in tuberculosis treatment, tuberculosis was sometimes treated surgically by pneumonectomy.
-complications:
Respiratory failure.
Blood clot in the lung (pulmonary embolism)
Pneumonia.
Shock.
https://www.youtube.com/watch?v=Shq4CfIm30Y

Tracheostomy
A tracheostomy is an opening created at the front of the neck so a tube can be inserted into the windpipe (trachea) to help you breathe.
-A tracheostomy may be carried out to:
1-deliver oxygen to the lungs
2-allow you to breathe if your throat is blocked
3-reduce the risk of food or fluid entering the lungs
A planned tracheostomy is usually carried out under general anaesthetic
surgeon will make a hole in your throat using a needle or scalpel before inserting a tube into the opening.
A dressing will be placed around the opening in your neck and tape or stitches will be used to hold the tube in place.
If you're unable to breathe unaided, the tracheostomy tube can be attached to a machine (ventilator) that supplies oxygen to assist with breathing to increase the flow of oxygen to your lungs.
-complications:
bleeding
damage to the tube that carries food from the throat to the stomach.
https://www.youtube.com/watch?v=d_5eKkwnIRs

"Craniotomy"
A craniotomy is a surgical operation in which a bone flap is temporarily removed from the skull to access the brain. Craniotomies are often critical operations, performed on patients who are suffering from brain lesions, such as tumors, blood clots, removal of foreign bodies such as bullets, or traumatic brain injury , and can also allow doctors to surgically implant devices, such as deep brain stimulators for the treatment of Parkinson's disease, epilepsy, and cerebellar tremor. The procedure is also used in epilepsy surgery to remove the parts of the brain that are causing epilepsy.
The bone flap is mostly removed with the help of a cranial drill and a craniotome, then replaced using titanium plates and screws or another form of fixation (wire, suture, etc.)
-Complications
Bacterial meningitis or viral meningitis occurs in about 0.8 to 1.5% of individuals undergoing craniotomy.
Decompressive craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke, Chiari Malformation, and other conditions associated with raised intracranial pressure.
A Craniectomy is similar to a craniotomy as both procedures involve removing a portion of the skull, the difference is that after a craniotomy the bone is replaced and after a craniectomy the bone is not immediately replaced.
https://www.youtube.com/watch?v=N7-wNsANn8g

Diaphragmatic hernia
A congenital diaphragmatic hernia (CDH) is due to the abnormal development of the diaphragm while the fetus is forming. A defect in the diaphragm of the fetus allows one or more of their abdominal organs to move into the chest and occupy the space where their lungs should be. As a result, the lungs can’t develop properly. In the majority of cases, this affects only one lung.
An acquired diaphragmatic hernia (ADH) is usually the result of a blunt or penetrating injury. Traffic accidents and falls cause the majority of blunt injuries. Penetrating injuries are usually due to stab or gunshot wounds. Surgery on the abdomen or chest may also cause accidental damage to your diaphragm. Rarely, the diaphragmatic hernia may occur without a known reason and go undiagnosed for a period of time, until it becomes severe enough to cause symptoms.
-factors may increase your risk of an acquired diaphragmatic hernia:
blunt injuries due to a traffic accident
surgical procedures on the chest or abdomen
falls that impact the diaphragm region
stab wounds
gunshot wounds
-symptoms of a diaphragmatic hernia:
Difficulty breathing
Tachypnea
Blue discoloration of the skin
Tachycardia
Bowel sounds in the chest area
Less full abdomen
-Doctors can usually diagnose a congenital diaphragmatic hernia before the baby is born.
-Both congenital and acquired diaphragmatic hernias typically require urgent surgery.

Amnesia
refers to the loss of memories, such as facts, information and experiences. Though forgetting your identity is a common plot device in movies and television, that's not generally the case in real-life amnesia.
Instead, people with amnesia ( also called amnestic syndrome ) usually know who they are. But, they may have trouble learning new information and forming new memories.
-Types of amnesia
Retrograde amnesia
When you have retrograde amnesia, you lose existing, previously made memories.
Anterograde amnesia
When you have anterograde amnesia, you can’t form new memories.
Transient global amnesia
Transient global amnesiais a poorly understood condition. If you develop it, you’ll experience confusion or agitation that comes and goes repeatedly over the course of several hours.
Infantile or childhood amnesia
Most people can’t remember the first 3 to 5 years of life.
Dissociative amnesia
When you have dissociative amnesia, you have difficulty remembering important information about yourself, such as your name, personal history, or family and friends.
-Causes
Stroke,Brain inflammation,Lack of adequate oxygen in the brain,Long-term alcohol ,Tumors ,Certain medications.
-Risk factors
Brain surgery, head injury or trauma,Stroke,Alcohol abuse,Seizures.
-Prevention:
Avoid excessive alcohol use.
Wear a helmet when bicycling and a seat belt when driving.
Treat any infection quickly so that it doesn't have a chance to spread to the brain.
-Amnesia treatment:
Chemically induced amnesia, from alcohol for example, can be resolved through detoxification.
Amnesia from mild head trauma may resolve without treatment within minutes or hours.
Amnesia from dementia is often incurable.

Cushing's disease
is a disorder caused by the body’s exposure to an excess of the hormone cortisol. Cortisol affects all tissues and organs in the body. These effects together are known as Cushing's syndrome.
Cortisol is a normal hormone produced in the outer portion of the adrenal glands. When functioning correctly, cortisol helps the body respond to stress and change. It mobilizes nutrients, modifies the body's response to inflammation, stimulates the liver to raise blood sugar and helps control the amount of water in the body. Cortisol production is regulated by the ACTH produced in the pituitary gland.

Pituitary Adenomas — Cushing’s Disease

Pituitary adenomas are benign tumors of the pituitary gland that secrete increased amounts of ACTH causing excessive cortisol production.
-Signs and Symptoms
Weight gain in face,Red, round face,Female balding, Muscle weakness, Hypertension,Poor wound healing, Severe depression
-Diagnosis
A patient suspected of having Cushing’s syndrome must initially have an appearance suggestive of excess cortisol production combined with an elevated 24-hour urinary excretion of cortisol.
-Treatment of Cushing’s syndrome depends on the underlying cause of excess cortisol but may perhaps include surgery, radiation, chemotherapy or the use of cortisol-inhibiting drugs.
Microsurgical resection of an ACTH-secreting pituitary adenoma is the optimum treatment for Cushing’s disease with cure rates of 80-90 percent if a tumor is found.

Right Bundle Branch Block (BBBR)
Right bundle branch block is a problem with your right bundle branch that keeps your heart’s electrical signal from moving at the same time as the left bundle branch.
Right bundle branch block can happen in healthy people. It’s more likely to happen in older people.
-causes right bundle branch block:
Myocarditis.
Trauma to your chest.
Heart attack (myocardial infarction
Diseases
-electrocardiogram (EKG) to diagnose right bundle branch block
-Treatment
Most people with bundle branch block don't have symptoms and don't need treatment. For example, left bundle branch block is not treated with medications. However, treatment depends on the specific symptoms and other heart conditions.
Medications:
If you have a heart condition causing bundle branch block, treatment might involve medications to reduce high blood pressure or reduce symptoms of heart failure.
-Surgeries and other procedures:
If you have bundle branch block and a history of fainting, your health care provider might recommend a pacemaker.

Cardiomyopathy
is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart failure.
The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy.
-Symptoms
Breathlessness, Swelling of the legs, Cough ,Chest discomfort or pressure,Dizziness
-Causes:
high blood pressure,infection,Pregnancy, Drinking too much alcohol ,Use of cocaine,Use of some chemotherapy drugs.
-Risk factors
There are a number of things that can increase your risk of cardiomyopathy:
Family history,high blood pressure,Obesity,alcohol misuse.
-Complications
Heart failure,Blood clots,Heart valve problems,Cardiac arrest.
-Diagnosis:
Chest X-ray,ECG,Treadmill stress test,Cardiac catheterization.
-Medications:
Many different types of medications are used to treat cardiomyopathy. Medications for cardiomyopathy can help:
Lower blood pressure,Slow heart rate,Prevent blood clots.
-Surgery or other procedures:
Several types of devices can be surgically implanted in the heart to improve its function and relieve symptoms, including:
Implantable cardioverter-defibrillator Ventricular assist device Pacemaker, Heart transplant.