فين الطالب الذكي اللي هيعرف إجابة أهم ٣ أسئلة في الحالة دي ؟ حالة جديدة تانية

[@BeboBsher-t2z]

Q1) Pallor in this case is due to 2 causes (anemia and low cardiac output state) : 1) Anemia of chronic disease (ACD) dut to TB ( decrease EPO production and action on BM and low iron release from Macrophages!!) 2) Low cardiac output due to cardiac compression Q2) the ascitec fluid obtained will reveal transudative characters in the form of : a- Low protein level below 3 gm b- low LDH c- low or no WBCs Q3) Treating this patient : a- First step should be would be could be periicardiocentesis to relif dyspnea and compression b- steroids undercover of anti TB drugs to prevent fibrosis and reduce inflammation of pericardium. c- tetracyclines also can be injected in the preicardium to obliterate this potential space so reaccumulation is prevented !!! 6- Anti TB drugs for pulmonary TB مظبوط الكلام.

[@mohammednoor6356]

أعظم من شرح الباطنة وتعلمها وعلمها.

[@AdelMostafa-y7u]

Causes of pallor in this case is due to anemia of chronic disease (TB) that was explained that interlukins 1,6 &TNF stimulate hepcidin so that reduce iron absorption, also cytokines inhibit BM. Another cause for pallor is low cardiac output due to HF (pericardial tamponade ) Aspiration of ascitic fluid : transudate Proteins

[@muhammedwahdan45]

4- venous congestion due to right sided heart failure ( enlarged tender liver ) Decreased circulation volume also tb increases hepcidin production which inhibits iron absorption leading to iron deficiency anemia 5- elevated wbcs count > 1000 Elevated protein level Cloudy fluid or white Low glucose level ( due to consumption of macrophages and neutrophils for energy ) Elevated LDH 6- first tb therapy ( 4 drugs ) for 2 months ( rifampin isoniazid ethambutol pyrazinamide ) followed by 4 months of 2 drugs isoniazid rifampin then for follow up Second for pericardial effusion Pericardiocentesis with u/s Thirdly ascites Paracentesis Diuretics: mix of Lasix and spironolactone to avoid electrolyte imbalance Fourthly we can use oxygen therapy

[@MedoFayez-ww1vv]

(1) In this case pallor may be due to : 1- Anaemia of chronic disease (TB) 2- systemic congestion ( gastroenteropathy and liver congestion ) which leads to decreased absorbtion and storage of iron . 3-Also cardiac tamponade causes decrease in cop . (2) Lab finding of the "ascitic" fluid in this case : # according to the "light's criteria " it will be a transudate : 1- Ascitic fluid protein < 3 gm 2- (Ascitic fluid/serum )protein

[@MrMuwaffak]

رجاء أسماء كتب د شريف الهواري ،كيفيه الحصول عليها مع الشكر

[@hazemmohamed2215]

Q1) Pallor due to decreased cardiac output due to cardiac tamponade and anemia of chronic disease Q2) The ascitic fluid obtained will be a transudate as it is caused by cardiac ascites: SAAG ratio greater than or equal 1.1 g/dl Q3) Treatment: 1- Careful U/S guided pericardiocentesis for the pericardial effusion 2-Corticosteroids to prevent pericarditis 3-Anti-TB drugs

[@walaeldeenbabiker9876]

1. Anemia of chronic disease. Normal MCV with normal RDW. 2. protein is greater than 2/3 of plasma protein. Glucose is lesser than 2/3 of plasma glucose. Lympocytosis. LDH elevated. and zel Nelson stain positive. 3. treatment include pericadiocentsis if the pericardium is calcified needs pericardioctomy. Treating the underlying TB with antituberculus according to sensitivity test by PCR.

[@magedali4081]

1- Patient has palor and toxemia with probable diagnosis of TB pleruitis and effusion Indicating anemia which is due to multifactorial causes including nutritional, gastropathy and toxemia with bone marrow supression by inflammatory cytokines like TNFalpha which causes anorexia as well 2- Pericardial fluid will be exudative ( high Protein - high LDH) lymphocytic predominant with high ADA AFB in fluid is unlikely as it represents Hypersensitivity reaction rather than infection but we can add gene xpert and IGRA tests 3- treatment includes relieving Tamponade by pericadiocentesis which is both diagnostic and theraputic in this patient as well as treatment of the cause with CAT 1 regimen 2HRZE/4 HR plus short course of corticosteroid to avoid development of constrictive pericarditis Other DD like malignancy ( lymphoma) and CTD like RA and SLE should be considered

[@KhaledMohamed-pm9jn]

لو سمحت ي دكتور عايزين كيسات مهمه لانه الامتحانات قربت وجزاك الله خير

[@heshamkhamis1351]

1- anemia: Due one or mixed etiology A-ACD B-chronic toxemia -->BM - - pancyto C-pallor due low CO 2: ascites Protein>3gm or fluid serum >0.5 LDH > 200 or F/S > 0.6 Wbc>1000 And other as glu,LDL 3-urgent pericardiocentisis And stabilized the pt Then treat the cause 1-anti TB drug 2-steroid under cover of ab

[@minhebrahim6386]

Q1-, pallor due to toxemia of TB Q2ascitic fluid is exudative due to Tuberculosis Q3-ttt of cardiac tamponade it's emergency by pericardiocetesis and ttt of congestion and edema by dieurics (Lasix) Then ttt of the cause (TB) 3 months INH. Rifampicin. Ethambitol. Pyrizolamide then continue other 6 months with INH and Rifampicin

[@rashadomara1628]

4 due to decrease venous return and co and tissue perfusion 5transudate resulted from increase hydrostatic preasure 6 withdraw pericardial fluid

[@lubnamohamed432]

Q4: causes of pallor 1- because of cardiac temponade (pericardial effusion) as the venous return is decreased so the COP is decreased 2- Because of severe toxemia of TB 3- IDA due to nutritional deficiency because of loss of appetite and may be because malabsorption syndrome because of TB enteritis common in ileocecal region which may cause ulceration and bleeding per rectum or malabsorption syndrome or may be there is because of low immunity may be associated with co-helminthic infections that causes malabsorption 3- Anemia of chronic disease because of inflammatory process as short erythrocyte life span, poor erythrocyte iron incorporation, and decreased sensitivity to or supply of erythropoietin 4- may be normocytic normochromic anemia when there's acute bleeding as hemoptysis 5- IDA in chronic bleeding as ulceration in the ileocecal region Q5: criteria of exudative fluid by light criteria -Ptn: fluid ptn/ serum ptn >.5 -Ptns >3 gm% -LDH >200 IU/L -Fluid LDH/serum LDH >.6 -Specific gravity>1016 -Cells (WBCs) >1000/cmm * Characteristics of TB effusion: * 1- exudate rich in lymphocytes and RBCs * 2- TB can be detected by staining: ZN stain * culture: Lowenstein-Jensen medium or BACTEC mor rapid * PCR for TB DNA * Adenosine deaminase : increased activity Q6: ttt 1- O2 therapy and IV fluids 2- diagnostic and therapeutic Pericardiocentesis if it massive pericardial effusion and Subxiphoid pericardial tube under general anaesthesia if the patient is stable and free not encysted fluid And if the patient is unstable it done under local anaesthesia 3- Anti-TB drugs First-line therapy for MTB is 6 months of isoniazid and rifampin, with the addition of pyrazinamide and ethambutol for the initial 2 months. 4- Corticosteroids injection

[@taha.yemen0]

1.##Cause of pallor by: 1. Anemia of Chronic Disease (ACD) 2. Nutritional deficiency : cause malnutrition due to poor appetite. 3. Hemodynamic cause: ◦ Low cardiac output in cardiac tamponade leads to tissue hypoperfusion. 2.## The type of ascites associated with cardiac tamponade caused by tuberculosis is typically transudative ascites. But it maybe show characteristics ofexudative ascites. #Explanation: 1.Transudative Ascites: Increased systemic venous pressure due to impaired cardiac filling and reduced cardiac output. *Clear fluid in appearance. * Protein Level: Low protein content (1.1 g/dL), consistent with venous congestion. 2. Exudative Ascites (Less common): Associated with peritoneal involvement by tuberculosis. *Cloudy in appearance * Protein Level: High protein content (>2.5 g/dL). * SAAG: Low (

[@solimantarabay6175]

4 ) pallor is due to low cardiac output may be due to congestive heart failure , chronic TB infection, and anemia due to weight loss 5 ) laboratory findings : Turbid fluid Low protein and high SAAG Increase of lymphocytes Positive TB 6 ) Treat cause which is treat TB Treat cardiac tamponade by pericardiocentesis Or pericardial window

[@mahmoudnasserbadr1029]

1) pale is due to anemia for chronic disease and may be due to systemic congestion which decrease blood supply to skin. 2) Ascitic fluid: SAAG >1.1 and Total protein >2.5 3) treatment should be urgent needle aspiration of fluid guided by ultrasound and anti-TB medication..

[@gggfgfbghhfghgf4658]

Causes of pallor in This Case: 1. Low Cardiac output due to diastolic heart failure due to Cardiac Tamponade. 2. Activation of Sympathetic system as a compensatory mechanism. 3. Anaemia due to chronic infection. Characters of ascitic fluid include: 1. Straw colored/ Bloody/ turbid , may be clear. 2. Low Sugar 3. High protein 4. High WBCs >500/mm3 with predominant lymphocytes >50% 5. Low SAAG

[@MujahidAbdullah-s2x]

Excellent👏❤❤❤ ...+ steroids,,,,, & always don't forget to investigate for HIV coinfection and others in a such case & age👍

[@shreenzohdy7646]

Pericardial effusion

[@khaldoonalkadasi1417]

Causes of anemia in case 1- d.t anorexia associated with t.b infection 2-chronic infection causing anemia Descrebtion fluid Exudative whiche appears couldy , increase LDH, increase protin , low glucose, high wBC especialy in D.C lymphocyte, +ve culture AFB Treatment : paracentasis is diagnostic and therpeutic , accroding to the cause If cause t.b Rx anti T.b for 6m

[@HaneenGamal-w4u]

possible explanations of pallor in this patient:- 1 cardiac temponad cause reduction in cardiac relaxation and cardiac filling therefore it will lead to low cardiac output 2 TB infection cause toxic inhibition of bone marrow 3 animia of chronic disease 4 may heamatological spread of TB causing myelophisic animia (TB in bone marrow) 5 malnutrition (anroxia,nuesea ,vomiting) and git congestion so decreasing absorption may be due to shock so to confirm I need to count her RR and pulse lab finding of fluid obtained on tapping the ascites ascites before oedema of lower limb (ascites precox ) which is commonly accur with pericardial effusion it will be transudative proteins : low less tha 3 gm % fluid protein/ serum protein less than 0.5 specific gravity less than 1016 LDH less than 200 IU /L fluid LDH/ serumLDH less than 0.6 WBCs less than 1000/cmm but may be TB peritonitis accur and it will be exudative rich in lymphocytes and RBCs proteins : more than 3 gm % fluid protein/ serum protein more than 0.5 specific gravity more than 1016 LDH more than 200 IU /L fluid LDH/ serumLDH more than 0.6 WBCs more than 1000/cmm mainly lymphocytes and by staining ZN stain culture lowenstain- jensen medium PCR for TB DNA I will confirm I would treat this patient by :- General measures rest in bed proper nutrition antipyretics, analgesics Treat the cause 1 anti tuberculous drugs INH and Rifampicine for 9-12 months plus Ethambutol for first 2 months only 2 corticosteroids under cover of anti-TB drugs to prevent constrictive pericarditis Pericardiocentesis to relieve dyspnea and compression (withdrawal of only 50 to 75 ml eliminate tamponade in most cases ) ttt of systemic congestion diuretics (torasemide) and venodilator must be used with caution (avoid excessive preload reduction)

[@mariambadr972]

First question Possible causes of pallor (anemia or pallor with normal Hb as low cop,tb toxemia,generalized edema ) Anemia may due to ACD or bone marrow suppression or malnutrition if there is history of tb before (chronic) Second question Laboratory findings in ascitic fluid : 1. Gross Appearance: The fluid is often cloudy 2. Biochemical Characteristics: High protein concentration: >3g/dL, indicating exudative ascites. Low glucose levels:

[@Ahmedbasoodan99]

Q4: Potential causes of pallor? • Low COP due to ↓ S.V by the pericardial effusion • Hypotension • Anemia of chronic disease due TB • Hypoxemia due to obstructive shock Q5: Ascitic fluid analysis if TB is the cause • ↑↑ lymphocytes • Low SAAG 2.5 • Fluid color: Cloudy, turbulent • Microbiology: acid fast stain, PCR, culture • ↑ Adenosine deaminase Q6: Treatment approach to this patient • Tamponade: - Investigation: Echo (+ve pericardial effusion, Diastolic collapse of RA/RV) - Treatment: - US guided pericardiocentesis - GIVE IV fluid (careful because overfilling can worsen tamponade) - GIVE +ve inotropes: Doputamin - AVOID vasoconstrictors because will ↓ S.V - AVOID PPV because it ↓ V.R • Tuberculosis: - Investigation: Microbiological studies + CT chest - Treatment: RIPE TB regimen as Pulmonary TB

[@AhmedSamir-wl2us]

1) Pallor in this patient may be due to acute or chronic cause:- A: acute cause most probably due to obstructive shock caused by tamponading effect of effusion B: chronic cause most probably due to anemia of chronic disease resulting in iron trapping. 2)lab fluid of ascites most probably show: A:Grossly: exudate or may be bloody. B:Biochemical: protein >2.5gm Glucose 30:60mg SAAG

[@صفاءشاكرتومانشياع]

1- causes of pallor in this case may be due to * anemia especially anemia of ch. disease du to Tb * low COP * stressful event itself can lead to pallor due to vasoconstriction 2- ascetic fluid analysis in heart f. Show SAAG level (≥1.1 g/dL) and high ascites protein levels (≥2.5 g/dL). 3- firstly decompress the pericardium after confirm dx. By ECHO or even on your clinical finding By Pericardiocentesis Give O2 for patient And if the cause is TB Should be give him anti TB medications 4 drugs ( first 2 months ) rifampin, isoniazid, pyrazinamide, and ethambutol Then continue on 2 drugs only ( ifampin, isoniazid) for 4 months and steroids should be given to patient. ( Prednisolone ) 5-7 days then tapering over 6-8 wks.

[@shreenzohdy7646]

Weak apex dullness outside apex

[@AbdulazizAL-Absi]

Palor is due to anemia caused by TB by and also due to decrease heart contractility causig decrease in circulating volume. serosanguinous pericardial fluid Low G high prt HIgh Lymphocte High LDH Biopsy : TB granloma Life safing pericardiocentsis Antituberculous therapy should be commenced as soon as possible Treatment regimens recommended for pericardial TB are the same as for pulmonary TB, consisting of rifampicin, isoniazid, ethambutol, and pyrazinamide for two months, followed by rifampicin and isoniazid for four months corticosteroids, colchicine, and fibrinolytic therapy