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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.

04/02/2026

Cervical dilation is how open the cervix is during labor, measured in centimeters (0–10 cm). It’s usually described in 3 stages/phases:

1) Latent phase (Early labor)
• 0–3 cm (some guides use 0–4 cm)
• Contractions: mild–moderate, irregular → gradually more regular
• Can last many hours (often longest phase)

2) Active phase
• 4–7 cm (some guides use 4–6 cm start)
• Contractions: stronger, more regular, closer together
• Dilation speeds up

3) Transition phase
• 8–10 cm
• Contractions: very strong, very frequent
• Often nausea, shaking, pressure, urge to push near 10 cm

✅ Second stage (pushing) begins when the cervix is fully dilated = 10 cm and ends when the baby is delivered.

04/02/2026

🧠

Which structure is damaged in carpal tunnel syndrome?
A) Ulnar nerve
B ) Median nerve
C) Radial nerve
D) Musculocutaneous nerve

03/02/2026

Branches of the facial nerve

03/02/2026

Medical student = relationship contraindicated😂

03/02/2026

🧠
Most common cause of UTI:
A) E. coli
B )S. aureus
C) Salmonella
D) TB

03/02/2026

Clinical overview of Congestive Heart Failure (CHF).

👉What it is

Heart failure = the heart can’t pump enough blood to meet the body’s needs or can only do so with high filling pressures.
“Congestive” = fluid backs up → lungs and/or legs/abdomen become congested (fluid overloaded).

👉Main types
• Left-sided HF (pulmonary congestion)
→ fluid in lungs, shortness of breath
• Right-sided HF (systemic congestion)
→ leg swelling, ascites, liver congestion
(Often caused by left HF)
• HFrEF (systolic): reduced ejection fraction (weaker squeeze)
• HFpEF (diastolic): preserved EF (stiff ventricle, poor filling)

👉Common causes
• Ischemic heart disease / prior MI
• Hypertension
• Valvular disease (mitral/aortic)
• Cardiomyopathy (dilated, viral, alcohol, toxins)
• Arrhythmias (e.g., atrial fibrillation)
• High-output states (severe anemia, hyperthyroid) (less common)

👉Symptoms (what patients feel)
• Dyspnea (especially exertional)
• Orthopnea (needs more pillows)
• Paroxysmal nocturnal dyspnea (wakes up breathless)
• Fatigue, reduced exercise tolerance
• Leg swelling, abdominal bloating, weight gain
• Cough, sometimes frothy sputum (pulmonary edema)

👉Signs (what you find)
• Crackles (lungs)
• Raised JVP
• Pitting edema
• S3 gallop (often in HFrEF)
• Hepatomegaly/ascites (right HF)
• Cool extremities, low BP (severe)

👉Key tests
• BNP/NT-proBNP (supports HF if elevated)
• ECG (ischemia, AF, LVH)
• Chest X-ray (cardiomegaly, pulmonary edema, pleural effusion)
• Echocardiogram (most important: EF, valves, structure)
• Labs: renal function, electrolytes, CBC, TSH, troponin if acute

👉Acute decompensated CHF (flash/worse suddenly): quick management
• Oxygen if hypoxic
• IV loop diuretic (e.g., furosemide) for congestion
• Nitrates if hypertensive pulmonary edema (and no contraindications)
• Non-invasive ventilation (CPAP/BiPAP) if significant pulmonary edema
• Treat trigger: MI, infection, AF, nonadherence, renal failure, high salt/fluid

👉Chronic CHF: long-term core treatment (typical)

👉Lifestyle
• Daily weight, salt restriction, fluid restriction if needed, vaccines, exercise rehab

👉Medications (especially HFrEF)
• ARNI (or ACEi/ARB)
• Beta-blocker (evidence-based types)
• MRA (spironolactone/eplerenone)
• SGLT2 inhibitor
• Diuretics for symptom relief (not mortality benefit, but crucial for congestion)
• Others selected cases: hydralazine/isosorbide, ivabradine, digoxin, iron therapy

Devices (selected)
• ICD (sudden death prevention)
• CRT (wide QRS + dyssynchrony)

👉Red flags (urgent)
• Severe breathlessness at rest, pink frothy sputum
• New confusion, syncope, chest pain
• O2 sat low, very high RR, hypotension, cyanosis

03/02/2026

Some antidotes

03/02/2026

the usual suture removal times (for non-absorbable skin sutures) by body site:
• Face (incl. eyelid/cheek): 3–5 days
• Scalp: 7–10 days
• Neck: 5–7 days
• Chest / abdomen / back (trunk): 10–14 days
• Arms / hands: 7–10 days (hands often 10–14)
• Legs / feet: 10–14 days (feet/toes often 12–14)
• Over joints (knee, elbow, knuckle) / high-tension areas:** 14 days (sometimes 14–21)

Adjust longer if: poor circulation, diabetes, steroids/immunosuppression, infection risk, high tension, or if the wound is on the lower leg/foot.
Remove earlier on the face to reduce track marks (sometimes with support like steri-strips after).

03/02/2026

Which part of ECG represents ventricular depolarization?
A) P wave
B ) QRS complex
C) T wave
D) PR segment

02/02/2026

Where does most water reabsorption happen in nephron?
A) PCT
B ) DCT
C) Collecting duct
D) Bowman space

02/02/2026

abnormal lung sounds (what they sound like + what they usually mean).

👉Crackles (rales) — “popping / Velcro”
• Fine crackles (high-pitched, end-inspiratory; like hair rubbing near ear)
→ Pulmonary edema/heart failure, interstitial lung disease/fibrosis, pneumonia (early), atelectasis (can clear with cough)
• Coarse crackles (lower-pitched, “bubbly”; can change after coughing)
→ Bronchiectasis, COPD with secretions, pneumonia, pulmonary edema (later)

👉Wheeze — “musical, high-pitched” (usually expiratory)
• Diffuse polyphonic wheeze
→ Asthma, COPD, bronchospasm (also allergic reaction/anaphylaxis)
• Monophonic/localized wheeze
→ Focal obstruction (mucus plug, tumor, foreign body)
• Silent chest (very little air movement despite distress)
→ Impending respiratory failure in severe asthma (emergency)

👉Rhonchi — “low-pitched snoring/gurgling”
• Often clears or changes with coughing
• → Large airway secretions: chronic bronchitis, bronchiectasis, pneumonia with mucus

👉Stridor — “harsh, loud” (usually inspiratory) heard over neck
• → Upper airway obstruction: croup, epiglottitis, foreign body, laryngeal edema
• Red flag if with drooling, tripod position, or severe distress.

👉Pleural friction rub — “leathery creak”, worse with deep breaths
• → Pleuritis (viral pleurisy), pneumonia near pleura, pulmonary embolism, TB, autoimmune pleuritis
• Usually doesn’t clear with cough.

👉Diminished/absent breath sounds
• Unilateral absent
→ Pneumothorax, large pleural effusion, mainstem intubation/obstruction
• Diffuse decreased
→ Severe COPD/emphysema, shallow breathing, obesity/hypoventilation

👉Bronchial breath sounds (abnormal if heard in peripheral lung)
• Loud, high-pitched, with a gap between inspiration and expiration
• → Consolidation (classically lobar pneumonia)

👉Voice transmission changes (helpful bedside add-ons)
• Egophony (“E” → “A”)
→ Consolidation, sometimes top of pleural effusion
• Bronchophony (spoken words sound louder/clearer)
→ Consolidation
• Whispered pectoriloquy (whispers sound clear)
→ Consolidation
• Decreased voice sounds
→ Pleural effusion or pneumothorax

Quick pattern recognition
• Wheeze = airway narrowing (asthma/COPD)
• Crackles = fluid or stiff alveoli (HF, pneumonia, fibrosis)
• Rhonchi = secretions (bronchitis)
• Stridor = upper airway obstruction (urgent)
• Absent sounds = air/ fluid outside lung or severe hyperinflation

02/02/2026

A patient with stridor + drooling + tripod position suggests:
A) Croup
B)Epiglottitis
C) Bronchiolitis
D) Asthma

住所

Hiroshima, Hiroshima