Muhammad Yakubu

||MD ||ABU Alumnus🎓 || Madridista✌||Northerner||

[Muhammad Yakubu @muhd_yy]

@Algeria_FC Admin took it personal🤣🤣🤣

[Dr M Shujat Rasool @DrMShujat]

Approach to PUO (Pyrexia of Unknown Origin)👇

A patient has been febrile for weeks. Multiple antibiotics have failed. Cultures are negative. What next?

The biggest mistake is ordering random investigations without a diagnostic framework.

Think of PUO in 5 major categories:

1. Infections

Still the most common cause in many developing countries.

Never miss:

Tuberculosis (pulmonary or extrapulmonary)
Infective endocarditis
Deep-seated abscess
Brucellosis
HIV-related infections
Osteomyelitis

Clues:
✔ Weight loss
✔ Night sweats
✔ Travel history
✔ Animal exposure
✔ Prosthetic valves or cardiac murmurs

2. Malignancy

Especially when fever is associated with constitutional symptoms.

Think:

Lymphoma
Leukemia
Renal cell carcinoma
Metastatic cancers

Clues:
✔ Lymphadenopathy
✔ Splenomegaly
✔ Unexplained anemia
✔ Elevated LDH
✔ Significant weight loss

3. Autoimmune / Inflammatory Diseases

Important differentials:

SLE
Vasculitis
Adult-onset Still disease
Rheumatoid arthritis
Giant cell arteritis

Clues:
✔ Rash
✔ Arthritis
✔ Oral ulcers
✔ Very high ESR/CRP
✔ Multisystem involvement

4. Drug Fever

Always review medications before ordering expensive tests.

Common offenders:

Beta-lactam antibiotics
Sulfonamides
Anticonvulsants
Allopurinol

Clue:
Patient looks surprisingly well despite persistent fever.

5. Miscellaneous Causes

Don’t forget:

Pulmonary embolism
Sarcoidosis
Thyroiditis
Inflammatory bowel disease
Factitious fever👇

[Dr M Shujat Rasool @DrMShujat]

For Residents/House officers/Interns/Medical officers:

🩺 URINALYSIS INTERPRETATION IN NUTSHELL👇

1️⃣ Proteinuria
➡️ Glomerular disease
➡️ Diabetic nephropathy
➡️ Nephrotic syndrome

2️⃣ Blood
➡️ Stones
➡️ UTI
➡️ Malignancy
➡️ Glomerulonephritis

🚨 RBC casts = Glomerulonephritis until proven otherwise.

3️⃣ Leukocyte Esterase + Nitrites
➡️ Suggest UTI

⚠️ Nitrite-negative UTI can still occur.

4️⃣ Glucose + Ketones
➡️ Think DKA

5️⃣ Casts Matter
🩸 RBC casts → Glomerulonephritis
🦠 WBC casts → Pyelonephritis
⚡ Muddy brown casts → ATN
🧂 Fatty casts → Nephrotic syndrome

6️⃣ Crystals
💎 Calcium oxalate → Stones/Ethylene glycol
💎 Uric acid → Gout/Tumor lysis
💎 Struvite → Urease-positive UTI

Pattern Recognition

🦠 UTI = LE + Nitrite + Pyuria

🩸 GN = Proteinuria + Dysmorphic RBCs + RBC Casts

🍬 DKA = Glucose + Ketones + Acidic Urine

⚡ ATN = Muddy Brown Casts

🧂 Nephrotic Syndrome = Heavy Proteinuria + Fatty Casts

[Dr M Shujat Rasool @DrMShujat]

Approach to Hypertension for House Officers, Interns & Residents 👇

1. First Confirm It Is Actually Hypertension

One high reading ≠ diagnosis.

Correct BP Technique

Patient rested for 5 min
Back supported
Feet on floor
Correct cuff size
No caffeine/smoking 30 min before
Measure in both arms initially
Take 2 readings

➡️ Classification

Normal: <120/80
Elevated: 120–129 / <80
Stage 1 HTN: 130–139 or 80–89
Stage 2 HTN: ≥140 or ≥90
Hypertensive crisis: ≥180 and/or ≥120

2. Ask the MOST Important Question

“Is this emergency, urgency, or stable hypertension?”

This single step changes everything.

3. Rule Out Hypertensive Emergency

Severe BP + END ORGAN DAMAGE

➡️ Symptoms you MUST ask

Chest pain
Dyspnea
Neuro deficit
Confusion
Visual loss/blurring
Seizures
Decreased urine output
Severe headache
Pregnancy symptoms

➡️ Examine for

Pulmonary edema
Stroke signs
Papilledema
Heart failure
Aortic dissection findings

➡️ Investigations

ECG
Troponin
CXR
Creatinine
Urine protein
Fundoscopy
CT brain if neuro symptoms

4. Differentiate Emergency vs Urgency

➡️ Hypertensive Emergency

BP usually >180/120 + organ damage

➡️ Management

Admit
IV antihypertensives
Reduce MAP gradually
Avoid rapid overcorrection

➡️ Common IV Drugs

Labetalol
Nicardipine
Nitroglycerin
Nitroprusside (selected cases)

➡️ Hypertensive Urgency

Very high BP WITHOUT organ damage

➡️ Management

Oral drugs
Slow reduction over 24–48 hrs
No aggressive IV treatment
Restart missed meds if noncompliant

➡️ Common Oral Drugs

Amlodipine
Captopril
Labetalol

5. If Stable HTN → Take Proper History

Important History

➡️ Duration

Newly diagnosed or chronic?

➡️ Drug history

NSAIDs
Steroids
OCPs
Decongestants
Cocaine/amphetamines

➡️ Comorbidities

Diabetes
CKD
CAD
Stroke
OSA

➡️ Symptoms suggesting secondary HTN

Episodic headache/sweating → pheochromocytoma
Muscle weakness → hyperaldosteronism
Snoring/daytime sleepiness → OSA
Renal disease symptoms
Young patient with severe HTN

6. Examine Properly

Don’t just write “CVS normal”

Look specifically for:

BMI/obesity
Fundoscopy
Radio-radial delay
Renal bruit
Edema
Signs of Cushing syndrome
Thyroid signs
Heart failure signs

7. Baseline Investigations Every Resident Should Order

➡️ Basic Workup

CBC
Creatinine/eGFR
Electrolytes
Urine R/E
Urine ACR if possible
HbA1c
Lipid profile
ECG

➡️ Optional

Echo
Renal ultrasound
TSH
Aldosterone/renin ratio

8. Think About Secondary Hypertension

Especially if:

Young age
Resistant HTN
Sudden onset
Severe HTN
Hypokalemia
Renal dysfunction

➡️ Common Causes

CKD
Renal artery stenosis
Primary hyperaldosteronism
OSA
Thyroid disease
Pheochromocytoma
Cushing syndrome

9. Choosing Antihypertensives (VERY Important)

➡️ First-Line Drugs

ACE inhibitors
ARBs
Calcium channel blockers
Thiazide diuretics

10. Drug Selection Based on Patient

➡️ Diabetes/CKD with proteinuria

→ ACEi/ARB

➡️ CAD/Post MI

→ Beta blocker + ACEi

➡️ Heart failure

→ ACEi/ARB + beta blocker + diuretics

➡️ Elderly isolated systolic HTN

→ CCB/thiazide

➡️ Pregnancy

→ Labetalol, nifedipine, methyldopa

➡️ Avoid in pregnancy:

ACEi
ARBs

[Dr M Shujat Rasool @DrMShujat]

APPROACH TO HYPERNATREMIA FOR HOs &amp; RESIDENTS 👇

When you see Na⁺ &gt;145, don’t panic. Think in 4 steps:

1) FIRST ASK: IS THE PATIENT DRY OR WET?
Most hypernatremia patients are volume depleted.

Look for:
- Hypotension
- Tachycardia
- Dry mucosa
- Low urine output

[Muhammad Yakubu @muhd_yy]

You have the chance to write your name in history

[Crystal Palace F.C. @CPFC]

Arsenal are next at Selhurst 🔜

[Muhammad Yakubu @muhd_yy]

You can do it Burnley

[Burnley FC @BurnleyOfficial]

On the road for the final time this season 🛣️

#BurnleyFC

[Muhammad Yakubu @muhd_yy]

@ChampionsLeague Haram football

[Muhammad Yakubu @muhd_yy]

This is real definition of back to sender.... Sunyi abun ya shausu kai😂😂😂

[Instablog9ja @instablog9ja]

Kano State Governor allegedly distributes underwear to women for campaign

[Dr. Kipkoech Cheruiyot @kipkoecheruiyot]

Some time ago, I begged someone to consent to a cesarean section. There was a clear fetal indication for CS. She declined. She ultimately gave birth normally, but the baby didn’t score well.

She even celebrated that she had been coerced into a CS but ultimately gave birth normally, that is what she told fellow mothers in labour.

A year later, I met her, the child hasn’t even sat without support. I felt sad. I couldn’t even talk with her. Some things drain you emotionally.

[Muhammad Yakubu @muhd_yy]

@ibn_Mukhtaarr 🤣🤣🤣🤣

[Muhammad Yakubu @muhd_yy]

@PharmWise Chie is that you?🤣

[Muhammad Yakubu @muhd_yy]

@Adesunkanmifiz 🤣🤣🤣

[Muhammad Yakubu @muhd_yy]

@drabdulhameed07 @Shawn5210372768 😂😂😂

[Muhammad Yakubu @muhd_yy]

@FENTCOM Na everything be toilet issue for una side?

[Muhammad Yakubu @muhd_yy]

@HonAbdullahiM12 😂😂😂

[Muhammad Yakubu @muhd_yy]

My guy even paid elon for more visibility😂😂

[surdtorp @surdtorp1]

Abacha time is more better than Tinubu time

Big love to Mr sani Abacha
They said Abacha embezzled Trillions, but people are living fine and happily no single inflation until 1998, but they said Tinubu is working but we are facing x14 hardship of that Muhammad Buhari time

Big shout out to Sani Abacha, rest well ❤️
(I will never keep shut because I can afford my daily needs, I'm down for any betterment idea, God created Life without no Government policy or law or system, so it means better days can still show for we Nigerian citizens ❤️

@elonmusk

[Muhammad Yakubu @muhd_yy]

@Waspapping_ 🤣🤣🤣🤣

[Muhammad Yakubu @muhd_yy]

@Waspapping_ Su Malam Sani anji maza😂😂😂😂

[Muhammad Yakubu @muhd_yy]

@Nostre_damus 😂😂😂