Author Archives: M Osman Gani

Picture Challenge 09

Category : Picture Challenge

Bells FB OK This is Right sided lower motor facial palsy (Bell`s palsy) evidenced by Bell`s sign

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Picture Challenge 05

Category : Picture Challenge

Abdominal finding is splenomegaly as part of hemolysis triad ( Jaundice, Anemia, Splenomegaly)

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Picture Challenge 06

Category : Picture Challenge

Acanthosis nigricans. This patient having it from his childhood. 2 Common causes are PCOS  and Abdominal malignancy

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Picture Challenge 07

Category : Picture Challenge

08052009045 FB OK

This is Herpes Zoster involving Ophthalmic division of trigeminal nerve. So very chance of eye involvement with consequent vision loss.  So urgently patient should be referred to ophthalmologist.

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Picture Challenge 4

Category : Picture Challenge

This drug  container for geriatric patient specially for those who are forgetful ( Dementic). There are other types of   container with various color to identify morning , evening and night medicine. Career of the patient usually arrange in such manner earlier for the patient.

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Heart Failure in MRCP Part 1

Category : Heart Failure , MRCP Part 1

Heart Faluire Infographics

Introduction
It means failure of pumping action of the heart. Heart failure may be Diastolic (less filling) or Systolic (less output) or both. Echocardiogram findings of Ejection Fraction (EF) indicates mostly systolic function of the heart. Normal EF does not exclude diastolic dysfunction. Symptoms (Breathlessness, Fatigability, Palpitation) of heart failure are very important.

Clinical Presentation
May be of Left or Right heart failure or both. Peripheral edema is the common presentation of right heart failure. Breathlessness is the common presentation of left heart failure.

Diagnosis
Symptoms are the main indicator of diagnosis. But subclinical heart failure can be diagnosed by investigation eg BNP (B type Natriuretic peptide) level.

Stage/ Grade of Heart Failure
Staging is very important to design treatment plan. Heart failure is categorized as Stage A, B, C, D. Treatment is mainly designed according to this staging. NYHA functional classification of heart failure well accepted one and this classification has great impact on further therapeutic decision making.

Investigation of Heart Failure
1) To diagnose heart failure: (BNP level)
2) To identify causes of heart failure eg IHD
3) To identify complications eg renal function
4) To identify prognostic factor/ aggravation factor or co morbidities

Management
Depends on stage (A, B, C, D) of heart failure. Some drugs are chosen according to NYHA functional classification. 4 groups of drug are important for mortality outcome and these drugs are introduced step by step. There are multiple drugs which act at different pathophysiologic (neurohumoral) mechanism of heart failure. General management is very important. Some patient may need CRT.

For further details see NICE guideline of Heart Failure.

DOAMSmrcp suggestion of heart failure

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