Dr Muhammad Omar Akram

Dr Muhammad Omar Akram This page is dedicated to fostering a vibrant online community of healthcare professionals, students,

This page contain OSPE, Past Papers, Clinical Scenarios, Viva Qs, Links to Medical Books, MCQs, of all colleges under UHS system!

22/11/2025

Jo shakhs nek sifarish karta hai, uska ajr milta hai. Aur jo buri sifarish karta hai, uska wabal usi par aata hai. Allah har cheez ka nigran hai. | Surah An-...

🎯The "RA Rule"The most helpful starting point when evaluating hand arthritis is identifying what is not there.🫆• Pearl: ...
22/11/2025

🎯The "RA Rule"

The most helpful starting point when evaluating hand arthritis is identifying what is not there.
🫆• Pearl: Rheumatoid Arthritis (RA) typically SPARES the DIP joints.
🫆• If you see significant inflammation or deformity at the DIPs, you can move RA significantly down your differential list (RA favors MCPs, PIPs, and wrists).

🎯Crucial Pearl: If you see a patient with DIP arthritis, always remove their nail polish and inspect the nails. Psoriatic nail changes correlate highly with DIP joint involvement because the nail matrix and the DIP joint are physically connected via entheses (anchoring tendons).

🎯Radiographic "Buzzwords"

If you order an X-ray of the hands, look for these specific patterns:
👉🏽• Osteoarthritis:
🫆• Joint Space Narrowing: Asymmetric.
🫆• Osteophytes: Bone spurs.
🫆• Subchondral Sclerosis: Whitening of the bone edge.
🫆• "Gull-wing" deformity: Seen in Erosive Osteoarthritis (a more aggressive subset of OA).
👉🏽• Psoriatic Arthritis:
🫆• "Pencil-in-cup" deformity: The proximal phalanx (pencil) whittles down into the distal phalanx (cup).
🫆• Periostitis: Fluffy new bone formation.

🪐The "Other" DIP Etiologies (The Zebras)
While OA and PsA are the main two, keep these in the back of your mind if the picture doesn't fit:

🎯• Gout: Tophi (uric acid crystal deposits) can form in the DIPs and may be mistaken for Heberden's nodes, but they are usually asymmetric and may appear yellow/white under the skin.
🎯• Reactive Arthritis: Can sometimes mimic the PsA distribution (Reiter's syndrome).
🎯• Multicentric Reticulohistiocytosis: A rare systemic disease that specifically targets the DIPs (causing extensive destruction/arthritis mutilans).

📌Summary Mnemonic:

To remember the nodes in Osteoarthritis:
🫆• Heberden's = High (DIP - far away)
🫆• Bouchard's = Below (PIP - closer to body)

Tumor Markers
11/11/2025

Tumor Markers

07/11/2025

Coeliac Disease

1. Definition
Autoimmune disorder triggered by gluten (wheat, barley, rye)
Causes immune-mediated damage to small-intestinal mucosa

2. Pathophysiology
Gluten → gliadin peptides
Abnormal immune response → T-cell activation
Villous atrophy
Crypt hyperplasia
Malabsorption

3. Genetics
Strong association:
HLA-DQ2 (90–95%)
HLA-DQ8

4. Risk Factors
First-degree relatives
Type 1 diabetes
Autoimmune thyroid disease
Down syndrome
IgA deficiency
Other autoimmune disorders

5. Clinical Features

A. Gastrointestinal
Chronic diarrhea
Steatorrhea
Abdominal pain
Bloating
Weight loss
Failure to thrive (children)

B. Extra-intestinal
Iron-deficiency anemia
Osteopenia/osteoporosis
Dermatitis herpetiformis
Short stature
Infertility
Neurological symptoms (neuropathy, ataxia)
Fatigue

6. Investigations

A. Blood Tests
tTG-IgA (tissue transglutaminase) – first-line
Total IgA (to rule out IgA deficiency)
EMA IgA (confirmatory)
DGP antibodies (in children)

B. Genetic Tests
HLA-DQ2 / HLA-DQ8 (to rule out disease, not diagnose)

C. Endoscopy
Duodenal biopsy:
Villous atrophy
Crypt hyperplasia
Increased intraepithelial lymphocytes

7. Complications
Malnutrition
Iron, folate, B12 deficiency
Osteoporosis
Infertility
Lactose intolerance
Small bowel lymphoma (rare)
Adenocarcinoma of small intestine

8. Management
Lifelong strict gluten-free diet
Avoid wheat, barley, rye
Oats only if gluten-free certified
Nutritional supplementation
Iron, folate, B12
Calcium, vitamin D

Monitoring:
Symptom improvement
Antibody levels
Bone density (DEXA)
Treat complications
Education & dietician support

9. Prognosis
Excellent with strict gluten-free diet
Poor adherence → persistent symptoms, complications

Approach to Metabolic Acidosis
07/11/2025

Approach to Metabolic Acidosis

Be aware of scammers.
07/11/2025

Be aware of scammers.

One crash. Three passengers. Three very different fates.Most people don’t realize how much the way they sit in a car can...
01/11/2025

One crash. Three passengers. Three very different fates.

Most people don’t realize how much the way they sit in a car can determine whether they walk away or spend months, even years, in recovery.

When airbags deploy, they don’t gently inflate; they detonate outward with explosive force. For someone sitting upright, feet planted and seatbelt fastened, that power is absorbed safely, just as engineers intended. The restraint holds, the airbag cushions, and the body survives.

But shift that posture, put a foot on the dashboard, cross your legs, or recline too far, and everything changes in an instant. The airbag that was meant to save you can drive your knee into your face, crush bones, and twist the body in ways it was never meant to bend. Pelvises shatter, hips dislocate, and lives are permanently altered, all from a position that felt harmless seconds earlier.

We tell ourselves we’re safe because it’s “just a short trip” or “just a minute of comfort,” but accidents don’t wait for us to be ready.

This chilling comparison is a powerful reminder: even at moderate speeds, posture and lack of seatbelts can turn survivable collisions into life-altering injuries. Always buckle up and keep your feet off the dash. A few seconds of awareness can be the thin line between a story you tell and one told about you.

This is a nice and simple book to draw the heart, with some simple heart drawing sitesPOCKET GUIDE TO ECG INTERPRETATION...
06/03/2025

This is a nice and simple book to draw the heart, with some simple heart drawing sites
POCKET GUIDE TO ECG INTERPRETATION
The Book:
https://ecgwaves.com/wp-content/uploads/2017/10/Pocket-guide-ECG-interpretation.pdf
The sites:
https://ecgwaves.com/pocket-guide-to-ecg-interpretation-pdf/ -toc__heading-anchor-0
https://www.healio.com/cardiology/learn-the-heart/ecg-review
https://en.ecgpedia.org/index.php?title=Main_Page
https://ecg.bidmc.harvard.edu/maven/displist.asp?ans=1
https://ecg.utah.edu/
https://www.aclsmedicaltraining.com/ecg-in-acute-myocardial-infarction/
The greatest media sites
https://litfl.com/ecg-library/
https://www.powerfulmedical.com/pmcardio-individuals/
Not all are free
https://skillstat.com/tools/ecg-simulator/
https://ecglibrary.com/ecghome.php
https://ecgmadesimple.ca/
https://medschool.co/tests/ecg-disease-patterns

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01/03/2025

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