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Med G

a Medical doctor who graduated in 2018 and I graduated my studies in Japan. I like sharing medical education.I hope you like my page. Contact: pagemedg@gmail.com

All contents are copyrighted. I am a clinical and public health doctor. Disclaimer:
The information provided is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Do not self-medicate or use any prescription drugs without proper evaluation and prescription by a licensed healthcare professional. Always consult your physician or qualified healthcare provider before starting, stopping, or changing any medication or treatment plan.

04/01/2026

The comparison of PA vs AP chest X-ray

🧠 One-line memory

PA = standing, true heart size.
AP = supine, heart looks bigger & diaphragm higher.

🫁 Chest X-ray Views

📸 PA View (Postero-Anterior)
• Patient is standing / erect
• Scapulae outside lung fields
• Clavicles over lung fields
• Ribs seen from posterior ends
• Hands placed on hips
• Heart size looks normal (minimal magnification)
• Cardiothoracic ratio is accurate
• Diaphragm is low
• Gastric air–fluid level is visible
• Taken in deep inspiration
• Lungs fully expanded
• Lung markings normal (lower zones more visible)
• Lung volume looks normal

📸 AP View (Antero-Posterior)
• Patient is lying supine
• Scapulae overlie lungs
• Clavicles project above lung apices
• Ribs seen from anterior ends
• Hands by the sides
• Heart appears enlarged (magnified)
• Cardiothoracic ratio is falsely increased
• Diaphragm is high
• No gastric air–fluid level (only gas)
• Often taken in mid-inspiration or expiration
• Lung expansion is reduced
• Lung markings look crowded, upper zones prominent
• Lung volume appears reduced

04/01/2026

Placenta previa is a pregnancy complication where the placenta covers part or all of the cervix (uterus opening), typically causing painless, bright red vaginal bleeding after 20 weeks. Risk factors include prior C-sections, uterine surgery, multiple pregnancies, older age, and smoking. It's managed with monitoring, rest, and often requires a C-section for delivery to prevent severe maternal bleeding, though it can sometimes resolve as the uterus grows.

04/01/2026

A 30-year-old man presents with a 2-week history of small red bumps with pus on his thighs and lower abdomen. The lesions appeared after frequent shaving and sweating at the gym. He reports mild tenderness and itching, but no fever or systemic symptoms.

On examination, there are multiple discrete, monomorphic 1–2 mm pustules, each centered on a hair follicle and surrounded by a bright erythematous halo. Several lesions have a visible hair emerging from the center (as shown in the image). No nodules, abscesses, or scarring are present.

❓ Question: What is the most likely diagnosis?

A. Acne vulgaris
B. Pseudofolliculitis barbae
C. Bacterial folliculitis
D. Furunculosis

04/01/2026

measuring blood pressure – easy to remember and teach to patients or staff.

🩺 Before your BP reading

No food or drink for 30 minutes
☕ Caffeine, smoking, or heavy meals can temporarily raise BP → false high reading.

Empty your bladder
🚻 A full bladder increases BP because it stimulates the nervous system.

Rest for 5 minutes
🪑 Allows heart rate and blood pressure to return to baseline after activity.

🩺 During the BP reading

Ensure properly sized cuff
📏 Too small = falsely high BP; too large = falsely low BP.

No talking
🗣 Talking activates the sympathetic system → increases BP.

Arm resting at chest (heart) height
❤️ Arm too low = BP appears higher; too high = BP appears lower.

Cuff against bare skin
👕 Clothing under cuff interferes with artery compression → inaccurate reading.

Back is supported
🪑 Unsupported back causes muscle tension → raises BP.

Sit with feet flat on the floor
🦶 Crossing legs or dangling feet increases BP readings.

04/01/2026

Hypertension develops when blood pressure rises due to:

🔺 Increased Peripheral Vascular Resistance (PVR)
and/or
🔺 Increased Cardiac Output (CO)

These changes occur because of dysfunction in:

• Renin–Angiotensin–Aldosterone System (RAAS)
• Sympathetic Nervous System (SNS)
• Imbalances in sodium, calcium, and natriuretic hormones

⸻

💡 Key Hemodynamic Concepts

🔁 Peripheral Vascular Resistance (PVR)

The resistance blood must overcome to flow through blood vessels.

• Vasoconstriction → PVR ↑ → BP ↑
• Vasodilation → PVR ↓ → BP ↓

⸻

❤️ Cardiac Output (CO)

The volume of blood pumped by the heart each minute.

\textbf{CO = Heart Rate (HR) × Stroke Volume (SV)}

⸻

💓 Heart Rate (HR)

Number of heartbeats per minute.

⸻

🫀 Stroke Volume (SV)

The amount of blood pumped from the left ventricle with each beat.

\textbf{SV = End-Diastolic Volume – End-Systolic Volume}

⸻

📈 Blood Pressure Components

🟥 Systolic Blood Pressure (SBP)

• Peak pressure during heart contraction

🟦 Diastolic Blood Pressure (DBP)

• Lowest pressure during heart relaxation

⸻

🧠 Mean Arterial Pressure (MAP)

Represents the average pressure in arteries and tissue perfusion.

\textbf{MAP ≈ DBP + ⅓ (SBP − DBP)}

⸻

🔗 Big Picture

\textbf{BP = Cardiac Output × Peripheral Vascular Resistance}

When PVR or CO increases → Blood Pressure rises → Hypertension develops.

04/01/2026

🌬️ Asthma vs 🚬 COPD (Quick Clinical Review)

🔍 Definition
• Asthma: Chronic reversible airway inflammation with bronchial hyperresponsiveness.
• COPD (Chronic Obstructive Pulmonary Disease): Progressive irreversible airflow limitation due to chronic bronchitis and/or emphysema.

🤕 Symptoms

Asthma
• Episodic wheeze, cough, chest tightness
• Worse at night/early morning
• Triggered by allergens, exercise, cold air
• Symptoms vary day to day

COPD
• Chronic cough with sputum
• Progressive dyspnea
• Frequent infective exacerbations
• Symptoms persistent, slowly worsening
⸻

🧪 Diagnosis

Asthma
• Spirometry: ↓FEV₁ with reversibility (>12% & >200 mL after bronchodilator)
• Normal lung function between attacks

COPD
• Spirometry: FEV₁/FVC < 0.70 post-bronchodilator
• Limited or no reversibility
• Often abnormal CXR (hyperinflation)

⸻
🔎 Differential Diagnosis
• Asthma: Vocal cord dysfunction, GERD, heart failure
• COPD: Asthma, bronchiectasis, TB sequelae, heart failure

⸻
💊 Treatment

Asthma
• Inhaled corticosteroids (ICS) = cornerstone
• SABA for relief
• LABA only with ICS
• Avoid triggers

COPD
• Smoking cessation (most important)
• LABA/LAMA bronchodilators
• ICS only if frequent exacerbations
• Pulmonary rehab, oxygen if hypoxic

⸻

🔁 Follow-Up
• Asthma: Assess control, inhaler technique, step-up/down therapy
• COPD: Monitor symptoms (CAT), exacerbations, spirometry yearly, vaccinations

⸻
🧠 Easy Mnemonics
• ASTHMA = “A R E T”
Allergy related • Reversible • Episodic • Triggered
• COPD = “S P A N”
Smoker • Persistent • Airflow fixed • Not reversible

04/01/2026

DKA vs HHS (Quick Clinical Review)

🔍 Definition
• DKA (Diabetic Ketoacidosis): Acute insulin deficiency → ketosis + metabolic acidosis
• HHS (Hyperosmolar Hyperglycemic State): Relative insulin deficiency → severe hyperglycemia + hyperosmolarity, no significant ketosis

⸻
🤕 Symptoms

DKA
• Polyuria, polydipsia
• Abdominal pain, vomiting
• Kussmaul breathing
• Fruity (acetone) breath
• Altered mental status (mild–moderate)

HHS
• Profound dehydration
• Marked altered consciousness/coma
• Focal neurologic signs (seizure, hemiparesis)
• Minimal GI symptoms

⸻
🧪 Diagnosis (Key Labs)

DKA
• Glucose: 250–600 mg/dL
• pH: < 7.30
• HCO₃⁻: < 18 mEq/L
• Positive ketones
• Anion gap ↑

HHS
• Glucose: > 600 mg/dL
• pH: > 7.30
• HCO₃⁻: > 18 mEq/L
• Ketones: absent/trace
• Serum osmolality > 320 mOsm/kg

⸻
🧠 Differential Diagnosis
• Sepsis
• Acute pancreatitis
• Lactic acidosis
• Alcoholic ketoacidosis
• Uremia

⸻
💊 Treatment

Both
1. IV fluids first (0.9% NS)
2. IV insulin infusion
3. Potassium replacement (before insulin if K⁺ < 3.3)
4. Treat precipitating cause (infection, MI, missed insulin)

Specific
• DKA: Insulin early; bicarbonate only if pH < 6.9
• HHS: Slower correction; aggressive fluids; insulin after volume restored

⸻
🔁 Follow-Up
• Transition to SC insulin when stable
• Diabetes education & sick-day rules
• Review adherence, infection source, precipitating factors
• Monitor for hypoglycemia, electrolyte shifts

⸻
🧩 Mnemonics
• DKA = “3 K’s” → Ketones, Kussmaul, Ketoacidosis
• HHS = “3 H’s” → High glucose, Hyperosmolar, Hydration deficit

03/01/2026

🦠 Cellulitis

Definition
Acute bacterial infection of the dermis and subcutaneous tissue causing redness, swelling, warmth, pain, and fever.

Key Symptoms
• Localized erythema, tenderness, edema, warmth
• Fever may be present

Risk Factors
• Diabetes, renal failure, cirrhosis, HIV, cancer, chemotherapy
• Alcohol use, malnutrition
• Trauma, burns, bites, ulcers, surgical wounds
• Poor venous or lymphatic drainage (stasis dermatitis)

Common Sites
• Lower legs and ears
• Trauma or postoperative wounds

💊 Treatment

Mild / Uncomplicated (Oral – cover Streptococcus & MSSA)
• Cephalexin 250–500 mg QID
• Dicloxacillin 500 mg QID
• Amoxicillin–clavulanate 875/125 mg BID
• Penicillin allergy: azithromycin or clarithromycin

Purulent / Suspected MRSA
• TMP-SMX, doxycycline, or clindamycin

Severe / Systemic Infection (IV, admit)
• Cefazolin, nafcillin, or clindamycin

⚠️ Special Situations
• Clostridial cellulitis (gas): severe pain, swelling, toxicity, crepitus → high-dose IV penicillin + urgent surgical debridement
• Post-surgical cellulitis: risk of sepsis and wound dehiscence → cover Staph, Strep, and Gram-negatives
• Gangrenous / necrotizing cellulitis: rapidly progressive, bullae, necrosis, shock → emergency surgery + IV antibiotics
• Dog or cat bites: treat with amoxicillin-clavulanate or doxycycline for 7–10 days

🛌 Supportive Care
• Rest and elevate the affected limb

03/01/2026

A 55-year-old man presents with acute redness, swelling, and pain of his right lower leg for 2 days. He reports fever and chills. One week earlier, he noticed a small crack between his toes after prolonged walking. He has a history of diabetes mellitus.

On examination, the right leg shows a diffuse erythematous, warm, edematous patch with ill-defined borders. The area is tender to palpation and feels hot compared with the surrounding skin (as shown in the image). No bullae or necrosis are present.

❓ Question: What is the most likely diagnosis?

A. Erysipelas
B. Deep vein thrombosis
C. Cellulitis
D. Allergic contact dermatitis

03/01/2026

Peptic Ulcer Disease (PUD) vs Gastritis

🔍 Definition

Peptic Ulcer Disease (PUD)

A deep break (ulcer) in the gastric or duodenal mucosa that penetrates beyond the muscularis mucosae, most commonly due to Helicobacter pylori infection or NSAID use.

Gastritis

Inflammation of the gastric mucosa, which may be acute or chronic, without a deep ulcer crater.

⚠️ Common Causes

Both
• H. pylori
• NSAIDs / aspirin
• Alcohol
• Smoking

PUD – more likely
• Severe NSAID injury
• Zollinger–Ellison syndrome

Gastritis – more likely
• Stress (ICU, burns, sepsis)
• Autoimmune (pernicious anemia)
• Bile reflux

🤕 Symptoms

Peptic Ulcer
• Burning or gnawing epigastric pain
• Pain related to meals
• Gastric ulcer: worse after eating
• Duodenal ulcer: relieved by food
• GI bleeding (melena, hematemesis)
• Weight loss, anemia

Gastritis
• Epigastric discomfort
• Nausea, vomiting
• Bloating, early satiety
• Often milder or asymptomatic

🧪 Diagnosis

PUD
• Upper GI endoscopy (visualizes ulcer)
• H. pylori testing (urea breath test, stool antigen)
• Biopsy (to rule out malignancy in gastric ulcers)

Gastritis
• Endoscopy shows erythema, edema, erosions
• Biopsy confirms inflammation
• Labs if autoimmune cause suspected (B12, antibodies)

🔄 Differential Diagnosis
• GERD
• Gastric cancer
• Pancreatitis
• Functional dyspepsia
• Esophagitis

💊 Treatment

Both
• Proton pump inhibitors (PPIs)
• Eradicate H. pylori if present
• Stop NSAIDs, alcohol, smoking

PUD – additional
• Longer PPI course (6–8 weeks)
• Endoscopic therapy if bleeding
• Surgery (rare complications: perforation, obstruction)

Gastritis – additional
• Shorter PPI or H2 blocker course
• Treat underlying cause (stress, autoimmune)

⸻

🔁 Follow-Up

PUD
• Repeat endoscopy for gastric ulcers
• Confirm H. pylori eradication
• Monitor for complications (bleeding, perforation)

Gastritis
• Symptom resolution
• Monitor chronic gastritis for anemia or B12 deficiency

⸻

🧠 Key Takeaway
• Gastritis = inflammation
• Peptic ulcer = a hole
• PUD is more serious and prone to bleeding and perforation

03/01/2026

Septic Arthritis Vs Reactive Arthritis

🦠 Septic Arthritis

Mnemonic: “SEPSIS”

☑ S – Sudden onset severe joint pain
☑ E – Extremely painful passive movement
☑ P – Purulent synovial fluid (WBC > 50,000)
☑ S – Systemic signs: high fever, chills
☑ I – Infectious organism present (Staph aureus most common)
☑ S – Single joint (knee, hip)

Key Points
• Usually monoarticular
• Patient looks toxic
• Joint is hot, red, swollen
• Emergency! Can destroy joint in hours

Management
✔ Immediate joint aspiration
✔ IV antibiotics
✔ Surgical drainage if needed

⸻

🔄 Reactive Arthritis

Mnemonic: “CAN’T SEE”

☑ C – Conjunctivitis
☑ A – Asymmetric arthritis (knees, ankles)
☑ N – No organism in joint fluid
☑ T – Triggered after infection (GI or GU)
☑ S – Sexually transmitted / diarrhea history
☑ E – Enthesitis (heel pain)
☑ E – Extra-articular signs (mouth ulcers, rash)

Key Points
• Occurs 1–4 weeks after infection
• Joint fluid is sterile
• Often young adults
• Classic triad:
Arthritis + Conjunctivitis + Urethritis

Management
✔ NSAIDs
✔ Treat original infection
✔ Steroids if severe

02/01/2026

💉 IV Therapy Complications – Quick Guide

1️⃣ Circulatory Overload (Fluid Overload)

Cause: IV fluids given too fast
Symptoms:
• ↑ Blood pressure
• Distended neck veins
• Shortness of breath
• Wet cough, crackles in lungs

What to do:
• Slow the IV (keep vein open)
• Elevate head of bed
• Keep patient warm
• Notify doctor immediately

2️⃣ Infiltration

Cause: IV fluid leaks into surrounding tissue
Symptoms:
• Pain, swelling
• Cool skin
• Numbness
• No blood return

What to do:
• Remove IV
• Elevate the limb
• Apply warm or cold compress
• Do not rub the area

3️⃣ Infection

Cause: Microorganisms enter through IV site
Symptoms:
• Redness, swelling, warmth
• Fever, chills
• Malaise, nausea/vomiting
• Fast heart rate

What to do:
• Remove IV
• Take cultures
• Start antibiotics if prescribed

4️⃣ Air Embolism

Cause: Air enters the vein through IV line
Symptoms:
• Chest pain
• Shortness of breath
• Low blood pressure
• Confusion, cyanosis

What to do:
• Clamp the tubing
• Place patient on left side with head down (Trendelenburg)
• Notify doctor immediately

5️⃣ Phlebitis

Cause: Inflammation of the vein
Symptoms:
• Redness, warmth
• Tenderness at site
• Slowed IV flow

What to do:
• Remove IV
• Inform doctor
• Restart IV in opposite limb

6️⃣ Hematoma

Cause: Blood leaks into tissue
Symptoms:
• Bruising
• Hard, painful lump
• Swelling

What to do:
• Elevate the limb
• Apply pressure and ice

⸻

🧠 One-line memory

Swelling = Infiltration, Red vein = Phlebitis, Bruise = Hematoma, Breathless + high BP = Fluid overload, Sudden chest pain = Air embolism, Fever/red site = Infection.

住所

Hiroshima, Hiroshima