Pilot ®

I Love programming everyday. Practice compassion and kindness to all. Striving to be a better person and father. Love giving back and helping others.

[Mo Imam @MoAImam]

Shoulder dislocations

[Internal Medicine @pgMedicine]

Upper vs Lower Zone Pulmonary Fibrosis

[🦠 Dr. Ahmed Alanazi @o_o_dr]

A chest tube can be the difference between life and death in emergency situations 🫁🚨

📌 Confirm the indication
📌 Identify the Triangle of Safety
📌 Local anesthesia
📌 Blunt dissection
📌 Finger sweep before tube insertion
📌 Connect and secure the tube
📌 Confirm with Chest X-ray

Remember:

⚠️ Always insert just above the rib to avoid the neurovascular bundle.

For pneumothorax → direct the tube anteriorly and superiorly.
For hemothorax or pleural effusion → direct it posteriorly and inferiorly.

Mastering chest tube insertion means understanding both the anatomy and the procedure.

A practical review of indications, anatomy, insertion steps, drainage systems, complications, and high-yield emergency medicine pearls 📚🩺

https://t.co/1dSdJ0pv1C

[MedicoNotes @MedicoNotes]

🚨 7 Causes of Acute Abdomen

1️⃣ Appendicitis
🔹 Periumbilical → RIF pain
🔹 Nausea, fever
💎 McBurney tenderness

2️⃣ Cholecystitis
🔹 RUQ pain
🔹 Fever, vomiting
💎 Positive Murphy sign

3️⃣ Pancreatitis
🔹 Severe epigastric pain → back
🔹 Nausea, vomiting
💎 ↑ Lipase/Amylase

4️⃣ Small Bowel Obstruction
🔹 Colicky pain
🔹 Distension, vomiting
🔹 Constipation
💎 Air-fluid levels on X-ray

5️⃣ Perforation
🔹 Sudden severe pain
🔹 Guarding, rigidity
💎 Free air under diaphragm

6️⃣ Abdominal Aortic Aneurysm (AAA)
🔹 Abdominal/back pain
🔹 Pulsatile mass
🔹 Hypotension if ruptured
💎 Think AAA in older smokers

7️⃣ Mesenteric Ischemia
🔹 Severe pain out of proportion
🔹 Nausea, vomiting
💎 AF + raised lactate

⸻

🩺 Acute Abdomen Approach

➊ History
Pain site, onset, radiation

➋ Examination
Vitals, guarding, rigidity

➌ Investigations
FBC, CRP, LFT, Lipase, Lactate
US/CT Abdomen

➍ Management
IV fluids → Analgesia → Surgical review

⸻

🚩 Red Flags

🔴 Shock/Hypotension
🔴 Guarding & Rigidity
🔴 Persistent Vomiting
🔴 Fever & Tachycardia
🔴 Abdominal Distension

⸻

🧠 Mnemonic: ACPSPAM

A – Appendicitis

C – Cholecystitis

P – Pancreatitis

S – SBO

P – Perforation

A – AAA

M – Mesenteric Ischemia

⸻

📚 Master Surgery the High-Yield Way with the MedicoNotes Surgery Book.

🌐 https://t.co/2UQyCbb6in

#Surgery #AcuteAbdomen #MRCS #USMLE #PLAB

[MedicoNotes @MedicoNotes]

🧠 7 STROKE SYNDROMES

Know the Syndrome → Find the Artery.

⸻

1️⃣ MCA Stroke

📍 Lateral hemisphere

🔹 Face & arm weakness > leg
🔹 Hemisensory loss
🔹 Homonymous hemianopia
🔹 Aphasia (dominant)
🔹 Neglect (non-dominant)

💎 Face & Arm > Leg = MCA

⸻

2️⃣ ACA Stroke

📍 Medial frontal/parietal lobe

🔹 Leg weakness > arm
🔹 Leg sensory loss
🔹 Abulia
🔹 Urinary incontinence

💎 Leg > Arm = ACA

⸻

3️⃣ PCA Stroke

📍 Occipital lobe

🔹 Homonymous hemianopia
🔹 Visual agnosia
🔹 Alexia without agraphia
🔹 Memory impairment

💎 PCA = Vision Problems

⸻

4️⃣ Lateral Medullary (Wallenberg)

📍 PICA occlusion

🔹 Vertigo & nystagmus
🔹 Dysphagia & hoarseness
🔹 Ipsilateral facial pain loss
🔹 Contralateral body pain loss
🔹 Ataxia

💎 Don’t Pick Up Candy
➡️ PICA → Dysphagia

⸻

5️⃣ Medial Medullary Syndrome

📍 Anterior spinal artery

🔹 Tongue deviates to lesion
🔹 Contralateral weakness
🔹 Loss of vibration/proprioception

💎 “12-Weak-Touch”
➡️ CN XII + Weakness + Touch loss

⸻

6️⃣ Lacunar Stroke

📍 Small penetrating arteries

🔹 Pure motor stroke
🔹 Pure sensory stroke
🔹 Ataxic hemiparesis
🔹 Dysarthria-clumsy hand

💎 No cortical signs

⸻

7️⃣ Basilar Artery Occlusion

📍 Brainstem infarction

🔹 Altered consciousness
🔹 Quadriparesis
🔹 Vertical gaze palsy
🔹 Dysarthria
🔹 Locked-in syndrome

💎 Basilar = Brainstem Emergency

⸻

📚 Master Neurology the High-Yield Way with the MedicoNotes Neurology Book.

🌐 Visit our website: https://t.co/2UQyCbb6in

[Seduction Coach @Seduction1Coach]

9 sex positions every couple should try at least once.

The happiest couples know that great relationships require great intimacy, playfulness, and variety.

If your bedroom has become predictable, start with these 9:

1. The Butterfly

[Mo Imam @MoAImam]

Femoral Triangle:

Key Contents (Lateral to Medial):
A common medical mnemonic to remember the contents from lateral to medial is "NAVeL":

● N - Femoral Nerve: The largest branch of the lumbar plexus, providing motor and sensory innervation to the anterior thigh.
● A - Femoral Artery: Shown branching into the Superficial and Profunda femoris (deep) arteries. This is a primary site for feeling a pulse or performing arterial catheterization.
● V - Femoral Vein: Positioned medially to the artery; it receives the Great saphenous vein within this region.
● e - "Empty" Space: Refers to the Femoral canal, which allows the vein to expand.
● L - Lymphatics: Deep inguinal lymph nodes located within the femoral canal.

》The Femoral Sheath:

The femoral artery, vein, and canal are enclosed in the femoral sheath (a funnel-shaped fascial tube), but notably, the femoral nerve is excluded from this sheath and lies just lateral to it.

[Internal Medicine @pgMedicine]

Ascites: Clinical evaluation and management

[MedicoNotes @MedicoNotes]

🟡 JAUNDICE MADE SIMPLE

A high-yield approach to jaundice that helps you diagnose the cause in seconds by combining bilirubin type, urine color, and stool color.

⸻

1️⃣ Bilirubin Pathway

➊ RBC breakdown → Unconjugated bilirubin

➋ Liver conjugates bilirubin (UGT1A1)

➌ Conjugated bilirubin enters bile → intestine

💎 Pearl:
Indirect = Water insoluble
Direct = Water soluble

⸻

2️⃣ Indirect (Unconjugated) Jaundice

🔴 Causes
• Hemolysis
• Gilbert syndrome
• Crigler–Najjar syndrome

🔍 Features
• Normal urine
• Normal stool
• No bilirubin in urine

💎 Remember:
Indirect bilirubin is NOT found in urine.

⸻

3️⃣ Direct (Obstructive) Jaundice

🟢 Causes
• Gallstones
• Pancreatic cancer
• Cholangiocarcinoma
• PSC

🔍 Features
• Dark urine
• Pale stools
• Pruritus

💎 Exam Pearl:
Dark urine + Pale stool = Obstruction until proven otherwise.

⸻

4️⃣ Hepatocellular Jaundice

🟠 Causes
• Viral hepatitis
• Alcoholic hepatitis
• Drug-induced liver injury
• Cirrhosis
• NAFLD/NASH

🔍 Features
• Mixed bilirubin elevation
• AST/ALT ↑
• Jaundice + RUQ pain

💎 Pearl:
Very high AST/ALT suggests hepatocellular injury.

⸻

5️⃣ Neonatal Jaundice

👶 Physiologic
• Starts after 24 hours
• Peaks day 3–5
• Resolves by 1–2 weeks

🚨 Pathologic
• Within first 24 hours
• Persists >2 weeks
• Rapidly rising bilirubin

💎 Red Flag:
Dark urine + Pale stool = Think biliary atresia.

⸻

🎯 Quick Exam Trick

🟡 Indirect → Normal urine + Normal stool

🟢 Direct (Obstructive) → Dark urine + Pale stool

🟠 Hepatocellular → Mixed pattern + AST/ALT ↑

👶 Neonatal → Check timing of onset

⸻

📚 Master Gastroenterology & Hepatology the High-Yield Way with the MedicoNotes Gastroenterology Book.

🌐 Visit our website: https://t.co/2UQyCbb6in

#Gastroenterology #Jaundice #Hepatology #MedicalEducation #MedicoNotes

[د. محمد المنصور @123mMohammed]

🚨من حالات عيادة طب الأسرة

♦️ نزيف الرحم غير الطبيعي
(Abnormal Uterine Bleeding - AUB)

ملخص من الأكاديمية الامريكية لطب الاسرة AAFP لاهم الاسباب و نسبة انتشارها
التشخيص و علاج الحالات الحادة و المزمنة

🔹 متى نأخذ عينة من بطانة الرحم ��
_ لجميع النساء بعمر ≥45 سنة.
_ الأصغر سناً إذا وُجد تاريخ مهم من التعرض للإستروجين (Unopposed estrogen exposure).

🔹 ما هو الفحص التصويري المفضل ؟
_ الأشعة التلفزيونية عبر المهبل

🩸 علاج النزيف الحاد :
_ الإستروجين الفموي (Oral estrogen).
_ حبوب منع الحمل عالية الجرعة المحتوية على الإستروجين والبروجستين
_ البروجستين الفموي (Oral progestins).
_ حمض الترانيكساميك الوريدي (Intravenous tranexamic acid).

💊 أفضل علاج طويل المدى لغزارة الطمث :
_ اللولب الهرموني المطلق لليفونورجيستريل

🔹 خيارات أخرى طويلة المدى :
_ حبوب الإستروجين والبروجستين.
_ البروجستين الفموي.
_ حمض الترانيكساميك الفموي.
_ مضادات الالتهاب غير الستيرويدية (NSAIDs).
_ حقنة ميدروكسي بروجستيرون طويلة المفعول (Depot medroxyprogesterone).

🔺 العلاج النهائي :
_ استئص��ل الرحم (Hysterectomy).

📌 أسباب نزيف الرحم : (PALM-COEIN):

🔹 P = اللحميات الرحمية (Polyp)
_ نسبة الانتشار : 8–35%.
_ تزداد مع التقدم في العمر.
_ أكثر الأعراض شيوعاً : النزف بين الدورات (Intermenstrual bleeding).

🔹 A = العضال الغدي الرحمي (Adenomyosis)
_ وجود نسيج بطانة الرحم داخل عضلة الرحم.
_ تصل نسبتها حتى 70%
_ قد تكون بلا أعراض.
_ الأعراض الشائعة :
⬅️ طمث مؤلم بشدة.
⬅️ غزارة الطمث.
⬅️ طول مدة النزيف.

🔹 L = الأورام الليفية الرحمية (Leiomyoma/Fibroids)
_ أورام حميدة تنشأ من عضلة الرحم.
_ قد توجد لدى ما يصل إلى 80% من النساء.
_ غالباً بلا أعراض.
_ أكثر عرض شائع :
⬅️ غزارة الطمث أو إطالته.

🔹 M = السرطانات وفرط التنسج (Malignancy & Hyperplasia)
_ نزيف الرحم غير الطبيعي هو العرض الأكثر شيوعاً لسرطان بطانة الرحم.
_ نحو ربع الحالات الجديدة تُشخّص لدى نساء أقل من 55 سنة.

🔹 C = اضطرابات التخثر (Coagulopathy)
_ حوالي 20% من المصابات بغزارة الطمث لديهن اضطراب نزفي.
_ النسبة أعلى لدى المراهقات.
_ الأكثر شيوعاً:
⬅️ داء فون ويلبراند (Von Willebrand disease).
⬅️ اضطرابات وظيفة الصفائح الدموية.

🔹 O = اضطرابات الإباضة (Ovulatory Dysfunction)
_ قد تنتج عن اضطرابات هرمونية متعددة.
_ عدم انتظام أو غياب الإباضة شائع خلال السنوات الأولى بعد البلوغ وحول سن انقطاع الطمث، وليس بالضرورة مرضياً.

🔹 E = أسباب بطانية (Endometrial)
_ تحدث رغم وجود دورات إباضية منتظمة.
_ قد تنتج عن :
⬅️ اضطراب انقباض الاوعية الدموية.
⬅️ الالتهاب.
⬅️ العدوى.

💊 I = أسباب دوائية (Iatrogenic)
_ أكثر الأسباب شيوعاً :
⬅️ وسائل منع الحمل الهرمونية
(Breakthrough bleeding).
_ أسباب أخرى:
⬅️ العلاج الهرموني غير المانع للحمل.
⬅️ التاموكسيفين (Tamoxifen).
⬅️ مضادات التخثر.
⬅️ مضادات الدوبامين مثل بعض مضادات الاكتئاب ثلاثية الحلقات وبعض مضادات الذهان.

[𝙎𝙔𝙀𝘿 𝙃𝘼𝙈𝘼𝘿 𝘼𝙃𝙈𝘼𝘿 @SyedHamadAhmad3]

Easy

[MedicoNotes @MedicoNotes]

❤️ MYOCARDIAL ISCHEMIA & INFARCTION

Recognizing ECG changes can help you identify ischemia, localize infarction, and save myocardium.

⸻

1️⃣ Ischemia vs Infarction

➊ Ischemia
• Reduced coronary blood flow
• Reversible myocardial injury

➋ Infarction (MI)
• Prolonged ischemia
• Irreversible myocardial necrosis

💎 Pearl:
All infarctions start with ischemia, but not all ischemia progresses to infarction.

⸻

2️⃣ ECG Signs of Ischemia

➊ ST-segment depression
➋ T-wave inversion

🚨 Think:
• ST depression = Ischemia
• T-wave inversion = Ischemia

⸻

3️⃣ STEMI Localization

🫀 Septal → V1–V2

🫀 Anterior → V3–V4

🫀 Lateral → I, aVL, V5–V6

🫀 Inferior → II, III, aVF

🫀 Posterior → ST depression in V1–V3

💎 Pearl:
Match the leads to the artery and localize the culprit lesion.

⸻

4️⃣ NSTEMI

➊ ST depression ± T-wave inversion
➋ Elevated troponin
➌ No ST elevation

💎 Pearl:
NSTEMI = Myocardial infarction without ST elevation.

⸻

5️⃣ Remember the Progression

🟢 Ischemia
→ ST depression
→ T-wave inversion

🟠 Injury
→ Hyperacute T waves
→ ST elevation

🔴 Infarction
→ Pathological Q waves
→ Persistent T-wave inversion

⸻

🎯 High-Yield Exam Tip

Ischemia = ST Depression

Injury = ST Elevation

Infarction = Q Waves

⸻

📚 Master ECG Interpretation, Acute Coronary Syndromes & Interventional Cardiology with the MedicoNotes Cardiology Book.

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#Cardiology #ECG #STEMI #NSTEMI #MedicoNotes

[Fatimah Alshehri🇸🇦 @Banitoto]

معهد (NIH) هو المعهد الوطني للصحة في أمريكا ومقدم كورسين مجانية و تنتهي يوم 31 جولاي 2026 وهي:

1️⃣ دورة الدراسات الإكلينيكية (Clinical Research)💊💊 و تشرح أساسيات البحث الإكلينيكي وكيف تُدار التجارب السريرية. تغطي تنظيم التجارب بما يشمل اللوائح والقوانين مثل (FDA) و(ICH-GCP). كما تشمل أخلاقيات البحث وحماية المرضى، بما في ذلك الموافقة المستنيرة (Informed Consent).

2️⃣ دورة الكلينيكال فارماكولوجي (Clinical Pharmacology) تركز على فهم تأثيرات الأدوية💊 على الإنسان وكيفية تقييم سلامتها وفعاليتها. تغطي الجرعات، والامتصاص، والتوزيع، والأيض، والإخراج (ADME)، بالإضافة إلى أساسيات الحرائك الدوائية وتطوير الأدوية.

الدورة مجانية بالكامل، والاختبار النهائي يسمح بالرجوع للمحتوى التعليمي أثناء الحل (Open Book)، ويتم منح شهادة إتمام عند اجتياز الاختبار بدرجة النجاح المطلوبة.

عشان تسجل فيها لازم أول شي تسوي حساب عن طريق هذا الرابط 🔗 إنشاء حساب عبر (NIH Training Portal):

https://t.co/mMD43I2nHi

🔗 جميع دورات (NIH) هنا :
NIH Clinical Research Courses

https://t.co/s00t8DaYtC

[MedicoNotes @MedicoNotes]

💡 5 ELECTROLYTE EMERGENCIES YOU MUST NEVER MISS

⸻

1️⃣ Hyperkalemia (↑ K⁺)

➊ Clinical Features
• Muscle weakness
• Palpitations
• Life-threatening arrhythmias

➋ ECG Changes
• Peaked T waves
• PR prolongation
• Wide QRS
• Sine-wave pattern (pre-terminal)

➌ Emergency Treatment
• IV Calcium Gluconate → Stabilize myocardium
• Insulin + Dextrose → Shift K⁺ intracellularly
• Salbutamol
• Dialysis if severe

💎 Pearl:
Calcium protects the heart but does NOT lower potassium.

⸻

2️⃣ Hypokalemia (↓ K⁺)

➊ Causes
• Vomiting
• Diarrhea
• Loop/Thiazide diuretics
• Insulin excess

➋ ECG Changes
• Flattened T waves
• Prominent U waves

➌ Treatment
• Oral or IV potassium replacement

💎 Pearl:
Refractory hypokalemia? Always check magnesium.

⸻

3️⃣ Severe Hyponatremia (↓ Na⁺)

➊ Clinical Features
• Confusion
• Seizures
• Coma

➋ Causes
• SIADH
• Excess water intake
• Heart failure
• Cirrhosis

➌ Emergency Treatment
• 3% Hypertonic Saline for severe symptoms

⚠️ Critical Pearl:
Correct slowly to avoid Osmotic Demyelination Syndrome (ODS).

⸻

4️⃣ Hypercalcemia Crisis (↑ Ca²⁺)

➊ Classic Presentation
🦴 Bones
��� Stones
🤢 Groans
🧠 Psychiatric overtones

➋ ECG Changes
• Short QT interval

➌ Treatment
• IV Normal Saline
• Calcitonin
• Bisphosphonates
• Dialysis if severe

💎 Pearl:
The two most common causes are:
• Primary Hyperparathyroidism
• Malignancy

⸻

5️⃣ Hypocalcemia & Hypomagnesemia

➊ Clinical Features
• Tetany
• Seizures
• Perioral numbness
• Chvostek sign
• Trousseau sign

➋ ECG Changes
• Long QT interval
• Torsades de Pointes (low Mg²⁺)

➌ Treatment
• IV Calcium Gluconate
• IV Magnesium Sulfate for torsades

💎 Pearl:
Alcohol misuse + low K⁺ + low Ca²⁺ = Check magnesium immediately.

⸻

⸻

📚 Master electrolyte disorders, acid-base balance, renal physiology, and emergency medicine with our comprehensive Nephrology Book.

🌐 Visit: https://t.co/2UQyCbb6in

#Nephrology #Electrolytes #Hyperkalemia #Hyponatremia #usmleprep

[🦠 Dr. Ahmed Alanazi @o_o_dr]

Liver Function Tests are not just numbers on a report 🩸🫀

📌 ALT & AST → Hepatocellular injury
📌 ALP & GGT → Cholestatic pattern
📌 Bilirubin → Jaundice assessment
📌 Albumin → Synthetic function
📌 INR → Severity of liver dysfunction

The key is recognizing the pattern, not memorizing isolated values.

When you understand LFTs, you can quickly differentiate hepatitis, cholestasis, cirrhosis, and liver failure 🩺📚

A practical review of LFT interpretation covering hepatocellular vs cholestatic injury, bilirubin patterns, synthetic function markers, and high-yield clinical pearls.

https://t.co/1dSdJ0pv1C

[Medicine Refresher @notes4medicine]

Nephrotic Syndrome vs Nephritic Syndrome

[MedicoNotes @MedicoNotes]

🧠 BRAINSTEM STROKE LOCALIZATION

Master the classic crossed brainstem syndromes that frequently appear in exams and clinical practice.

⸻

1️⃣ Weber Syndrome (Midbrain)

➊ Lesion
• Cerebral peduncle (CN III + corticospinal tract)

➋ Features
• Ipsilateral CN III palsy
 – Ptosis
 – Mydriasis
 – “Down & out” eye
• Contralateral hemiparesis

💎 Pearl:
CN III palsy + opposite-sided weakness = Weber syndrome.

⸻

2️⃣ Millard–Gubler Syndrome (Pons)

➊ Lesion
• Ventral pons

➋ Features
• Ipsilateral CN VI palsy
 – Inability to abduct eye
 – Horizontal diplopia
• Contralateral hemiparesis

💎 Pearl:
Can’t abduct eye + opposite weakness = Millard–Gubler syndrome.

⸻

3️⃣ Wallenberg Syndrome (Lateral Medullary Syndrome)

➊ Vessel
• PICA occlusion

➋ Features
• Ipsilateral facial pain & temperature loss
• Dysphagia, hoarseness (CN IX, X)
• Vertigo, nystagmus, ataxia
• Horner syndrome
• Contralateral body pain & temperature loss

💎 Pearl:
“Don’t PICA horse that can’t eat”
→ PICA infarct = Dysphagia + Hoarseness.

⸻

4️⃣ Medial Medullary Syndrome

➊ Vessel
• Anterior spinal artery (ASA)

➋ Features
• Ipsilateral CN XII palsy
 – Tongue deviates toward lesion
• Loss of vibration/proprioception
• Contralateral body weakness & sensory loss

💎 Pearl:
Tongue weakness + contralateral deficits = Medial medullary syndrome.

⸻

🚨 Exam Trick

🔹 Midbrain → CN III → Weber

🔹 Pons → CN VI → Millard–Gubler

🔹 Lateral Medulla → PICA → Wallenberg

🔹 Medial Medulla → ASA → Medial Medullary Syndrome

⸻

📚 Master Neuroanatomy, Stroke Localization & Neurology Exams with the MedicoNotes Neurology Book.

🌐 Visit our website: https://t.co/2UQyCbb6in

#Neurology #Stroke #BrainstemStroke #Neuroanatomy #MedicoNotes

[Scene that go hard @Scenethatgohard]

THE FALLING WORLD Full Movie 🍿🎬

https://t.co/EFpfwWPSk3