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Next step in management?

Next step in management?

Dr. Muhammad Rashid Niaz

I feel the below statement by Dr. Fauci has a great perspective and agree 100%. I stand with SCIENCE.

From Dr. Fauci:

“Chickenpox is a virus. Lots of people have had it, and probably don't think about it much once the initial illness has passed. But it stays in your body and lives there forever, and maybe when you're older, you have debilitatingly painful outbreaks of shingles. You don't just get over this virus in a few weeks, never to have another health effect. We know this because it's been around for years, and has been studied medically for years.

Herpes is also a virus. And once someone has it, it stays in your body and lives there forever, and anytime they get a little run down or stressed-out they're going to have an outbreak. Maybe every time you have a big event coming up (school pictures, job interview, big date) you're going to get a cold sore. For the rest of your life. You don't just get over it in a few weeks. We know this because it's been around for years, and been studied medically for years.

HIV is a virus. It attacks the immune system and makes the carrier far more vulnerable to other illnesses. It has a list of symptoms and negative health impacts that goes on and on. It was decades before viable treatments were developed that allowed people to live with a reasonable quality of life. Once you have it, it lives in your body forever and there is no cure. Over time, that takes a toll on the body, putting people living with HIV at greater risk for health conditions such as cardiovascular disease, kidney disease, diabetes, bone disease, liver disease, cognitive disorders, and some types of cancer. We know this because it has been around for years, and had been studied medically for years.

Now with COVID-19, we have a novel virus that spreads rapidly and easily. The full spectrum of symptoms and health effects is only just beginning to be cataloged, much less understood.
So far the symptoms may include:
Acute respiratory distress
Lung damage (potentially permanent)
Loss of taste (a neurological symptom)
Sore throat
Difficulty breathing
Mental confusion
Nausea or vomiting
Loss of appetite
Strokes have also been reported in some people who have COVID-19 (even in the relatively young)
Swollen eyes
Blood clots
Liver damage
Kidney damage
COVID toes (weird, right?)

People testing positive for COVID-19 have been documented to be sick even after 60 days. Many people are sick for weeks, get better, and then experience a rapid and sudden flare up and get sick all over again. A man in Seattle was hospitalized for 62 days, and while well enough to be released, still has a long road of recovery ahead of him. Not to mention a $1.1 million medical bill.

Then there is MIS-C. Multisystem inflammatory syndrome in children is a condition where different body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs. Children with MIS-C may have a fever and various symptoms, including abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, or feeling extra tired. While rare, it has caused deaths.

This disease has not been around for years. It has basically been 6 months. No one knows yet the long-term health effects, or how it may present itself years down the road for people who have been exposed. We literally *do not know* what we do not know.

For those in our society who suggest that people being cautious are cowards, for people who refuse to take even the simplest of precautions to protect themselves and those around them, I want to ask, without hyperbole and in all sincerity:
How dare you?

How dare you risk the lives of others so cavalierly. How dare you decide for others that they should welcome exposure as "getting it over with", when literally no one knows who will be the lucky "mild symptoms" case, and who may fall ill and die. Because while we know that some people are more susceptible to suffering a more serious case, we also know that 20 and 30-year-olds have died, marathon runners and fitness nuts have died, children and infants have died.

How dare you behave as though you know more than medical experts, when those same experts acknowledge that there is so much we don't yet know, but with what we DO know, are smart enough to be scared of how easily this is spread, and recommend baseline precautions such as:
Frequent hand-washing
Physical distancing
Reduced social/public contact or interaction
Mask wearing
Covering your cough or sneeze
Avoiding touching your face
Sanitizing frequently touched surfaces

The more things we can all do to mitigate our risk of exposure, the better off we all are, in my opinion. Not only does it flatten the curve and allow health care providers to maintain levels of service that aren't immediately and catastrophically overwhelmed; it also reduces unnecessary suffering and deaths, and buys time for the scientific community to study the virus in order to come to a more full understanding of the breadth of its impacts in both the short and long term.

I reject the notion that it's "just a virus" and we'll all get it eventually. What a careless, lazy, heartless stance.”


Patients with Chest pain ,raised JVP and B/L wheezes on chest exam, pedal edema and Tachaycardia with
irregular pulse. ECG shows Multifocal PACs etc . On ACEI, aspirin and statin. BP was normal. Deranged
Most appropriate treatment
1. Atenolol
2. DiltiazeM
3. Verapamil
4. Prazocine

15 years old child presented with fatigue, these skin lesions On examination he is pale and had a palpable firm mass on ...

15 years old child presented with fatigue, these skin lesions

On examination he is pale and had a palpable firm mass on palpation.

Case shared for educational purpose with consent of the patient. #Copied


CLL - treatment: Fludarabine, Cyclophosphamide and Rituximab (FCR)
CLL is caused by a monoclonal proliferation of B-cell lymphocytes
CML - Philadelphia chromosome - t(9:22)
COPD - LTOT if 2 measurements of pO2 < 7.3 kPa
COPD - reason for using inhaled corticosteroids - reduced exacerbations
COPD - still breathless despite using inhalers as required?FEV1 > 50%: LABA or LAMA
FEV1 < 50%: LABA + ICS or LAMACT head showing temporal lobe changes - think herpes simplex encephalitis
CTPA is the first line investigation for PE according to current BTS guidelines
CYP3A4 is the most common and important cause of P450 drug interactions
Calcium channel blockers - side-effects: headache, flushing, ankle oedema
Calcium channel blockers are now preferred to thiazides in the treatment of hypertension
Cancer patients with VTE - 6 months of LMWH
Carbon monoxide poisoning - most common feature = headache
Case-control studies - odds ratio
Cat scratch disease - caused by Bartonella henselae
Causes of raised prolactin - the p's, pregnancy prolactinoma physiological
polycystic ovarian syndrome primary hypothyroidis mphenothiazines, metoclopramide, domperidone


A 55-year-old man presents with pain and stiffness in his hands. This has been getting gradually worse over the past few months and is associated with stiffness in the mornings.

On examination, you note bilateral swelling of the metacarpal phalangeal (MCP) and distal interphalangeal (DIP). One of the digits is swollen along the whole length.

What is the most likely diagnosis?

Rheumatoid arthritis
Psoriatic arthritis
Reactive arthritis


A 47-year-old female is referred to the rheumatology clinic due to cold fingers. Which connective tissue disease is most strongly associated with Raynaud's phenomenon?

Systemic lupus erythematous
Rheumatoid arthritis
Systemic sclerosis
Sjogren's syndrome
Polyarteritis nodosa


A 54-year-old man presents to the Emergency Department with a 2 day history of an swollen, painful left knee. Aspirated joint fluid shows calcium pyrophosphate crystals. Which of the following blood tests is most useful in revealing an underlying cause?

Transferrin saturation
Serum ferritin


List Of #Bodies

1) Negri bodies ( intracytoplasmic) – Rabies
2) Guarnieri( acidophilic intracytoplasmic) – Pox
3) Owls ( Intra – nuclear and cytoplasmic) – CMV
4) Cowdry ( intranuclear) – HSV, Measles
5) Downey type II - EBV
6) LD bodies – Substantia nigra
7) Zebra bodies (lysosomal) – Neimann Picks
8) Councilman bodies - Hepatitis
9) Psammoma bodies – Meningioma, Papillary ca. thyroid, Ovarian cystadenoma
10) Call exner bodies – Granulosa cell tumor
11) Loose bodies - Osteoarthritis
12) Russell and Dutcher bodies- Lymphoplasmacytic lymphoma
13) Schiller Duval bodies – Yo;k sac tumor (testicular)
14) Verocay – Schwanoma
15) Hunter bodies – Hashimotos thyroiditis
16) Hurthle cells – Hashimotos
17) Aschoff bodies – RHD
18) Hirano bodies – Alziemers
19) Ferruginous bodies – Asbestos bodies coated with iron
20) Schaumann bodies – Sarcoidosis
21) Asteroid bodies( satellite giant cells , cytoplasmic inclusions) – Sarcoidosis
22) Mallory bodies ( cytoskeletal intermediate filament) – Alcoholic hepatitis
23) Howel Jolly bodies( remnant of nuclear chromatin) – Severe anemia, Post splenectomy
24) Pappenheiner bodies (composed of iron) – Post splenectomy
25) Heinz bodies( denaturated Hb) - G6PD defficiency, alpha thalessemia( HbH disease)
26) Dohle bodies (aggregates of RER) - Leukocytosis


24.A mother brings her three years child for his repeated chest congestion. Most
episodes needed aggressive treatment including antibiotics. The child had first
episode when he was one year old. Which of the following factors suggests that this
child with asthma will grow out of it in adulthood?
A. Family history of asthma
B. First episode of wheezing at the age of 1
C. History of atopy
D. Poor lung function tests
E. Severe asthma


. A 40 year old patient has been brought to your clinic after having ingested a large
amount of methylated spirit in a wedding party. The patient complains of nausea,
vomiting and abdominal pain.Which one of the following agent will you use as antidote?
A. Activated charcoal
B. Ethyl alcohol
C. Ethylene glycol
D. Flumazenil
E. Naloxone


64) A 24-year-old gentleman presents with a worsening headache to the emergency department. He emigrated from Sudan two weeks ago. He has had a cough for six weeks. His GP did a tuberculin skin test which was found to be negative and has not responded to oral antibiotics. He has no medical history and takes no regular medications. Blood tests demonstrate positive HIV serology but cryptococcal antigen is negative and other tests are normal. Toxoplasmosis serology is negative. CT demonstrates a single 3cm lesion and meningeal enhancement but no other abnormalities. What is the most likely organism that is responsible for his headache?

Toxoplasma gondii
Cryptococcus neoformans
Mycobacterium tuberculosis
JC virus


60-year-old man is transferred from the local psychiatric unit to the Emergency Department. Throughout the day he has complained of palpitations and feeling light-headed. The psychiatry consultant noted he was tachycardic and requested a transfer. An ECG taken following admission shows a broad complex tachycardia consistent with torsardes de pointes, rate 120/min. His blood pressure is 122/80 mmHg and there are no signs of heart failure. What is the most appropriate management?

Intravenous naloxone
Intravenous magnesium sulphate
DC cardioversion
Intravenous amiodarone
Intravenous verapamil


1. Avoid Nitrates, ACE inhibitors and Inotropes in HOCM
2. Avoid Sotalol, Adenosine, Verapamil and Digoxin in WPW
3. Avoid Beta blockers in treating Cocaïne induced chest pain or Acute MI
4. Avoid Verapamil in SVT with RBBB
5. Avoid Mediastinoscopy, Bronchoscopy or Biopsy to diagnose Sarcoidosis if CT scan is diagnostic.
6. Avoid Vitamin C supplementation in hemochromatosis

7. Avoid Lactulose to treat constipation in IBS.
8. Avoid Intraarticular steroids in patients with Sickle cell anemia.
9. Avoid highly purified or recombinant preparation in VWD.
10. Avoid Statins in rhabdomyolysis.
11. Avoid Colchicine in gout if Crcl


Erythema chronicm migrans is seen in

Acne vulgaris
Pemphigus vulgaris


Mayo Hospital




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Registration Link - Register now to attend #Session for free #Webinar on Chronic Stable Angina & Acute Myocardial Infarction by Dr. Gurpreet Singh Wander. #diginerve #medicaleducation #mrcp #crackingmrcp #medicalwebinar
Registration Link - Register now to attend #Session for free #Webinar on Chronic Stable Angina & Acute Myocardial Infarction by Dr. Gurpreet Singh Wander. #diginerve #medicaleducation #mrcp #crackingmrcp #medicalwebinar
Anyone in pakistan received admission card for sep attempt??whats the news
Can someone guide me about every detail of MRCP1, 2 n paces... Like 1. how much time does all the parts take? 2. Fee structure? 3. Centers where all the steps r conductd? . 4. Books required to clear part1? 5.Time required for part1.?
I just checked spaces in both Lahore and Karachi centres, for september diet, are filled. Is there any chance of seat availability ? Also if someone wants to cancel their exam, please let me know. Thanks
Plz any one do tell me how to apply for mrcp 1 exam when Lahore and Karachi are fully booked
AOA , plz any one do tell me how to apply for mrcp 1 exam when Lahore n Karachi are fully booked.
How many question are u needs to pass mrcp exam ?
Dear friends denmark is also taking doctors.if u need information inbox me.
Any time er****on but more at night. Unmerried. Age 23. Gender male How to get ride from this.