Dr Muhammad Sajjad

01/04/2026

Walker Murdock /wrist sign, Marfan syndrome

30/03/2026

What PHARMACOLOGY tells us is even without strong trials, we rely on drug chemistry principles.

B vitamins (complex) are water-soluble but unstable and sensitive to:
1-pH changes 2-Light 3- Metal ions (like calcium).

While Ringer’s Lactate contains calcium + lactate. This can accelerate degradation of vitamins and reduce potency over time. So the concern here is loss of effectiveness not toxicity.

No any strong evidence of harming when mix RL with B- Complex but remember my first sentence.

WARNING:- Mix B. vitamins with NS or D5W as standard, avoid RL unless necessary prescribed by a doctor.

26/03/2026

Beau’s lines are transverse (horizontal) grooves or depressions seen across the nail plate.
🔍 Key Features
Run parallel to the lunula (nail base)
Usually affect multiple nails
Move distally as the nail grows
Depth correlates with severity of insult
⚙️ Pathophysiology
They occur due to a temporary arrest of nail matrix growth, typically from systemic stress or illness.
📋 Common Causes
Systemic illnesses
High fever (e.g., Typhoid fever, COVID-19)
Severe infections
Malnutrition
Chemotherapy
Major surgery or trauma
Uncontrolled diabetes
Zinc deficiency
⏱️ Clinical Insight
Distance from nail fold can estimate timing of illness
Nails grow ~1 mm per 6–10 days
🩺 Clinical Importance
Acts as a retrospective marker of systemic stress
Helps correlate with past illness timeline

25/03/2026

🩸 Approach to Purpura

🔹 First principle: What is purpura?

Purpura = bleeding into the skin (non-blanching lesions)

🚦 STEP 1: Is it palpable or non-palpable?

🔴 1. Palpable purpura → Think vasculitis
Raised lesions = inflammation of vessel wall
Strongly suggests small-vessel vasculitis

Common causes:

IgA vasculitis (Henoch–Schönlein)
ANCA-associated vasculitis
Cryoglobulinemia

🔬 Workup:

CBC, ESR, CRP
Urinalysis (renal involvement!)
ANCA, complement
Skin biopsy → gold standard

👉 Exam pearl:
✔ Palpable purpura = vasculitis until proven otherwise

🔵 2. Non-palpable purpura → Next check platelets

🟠 A. ↓ Platelets (Thrombocytopenia)
Flat lesions = no inflammation → bleeding problem

Causes:
ITP / TTP
DIC
Sepsis

🔬 Workup:

CBC + peripheral smear
PT / aPTT
D-dimer

👉 Exam pearl:

✔ Low platelets → think bleeding disorder (not vasculitis)

🟢 B. Normal platelets → Vascular fragility
Causes:
Senile purpura
Scurvy (vitamin C deficiency)
Ehlers-Danlos syndrome

🔬 Workup:

Same initial labs (CBC, coagulation)
Then clinical context (nutrition, age, connective tissue signs)

👉 Exam pearl:

✔ Normal platelets → vessel weakness, not clotting issue

🧠 High-Yield Summary (Must Remember)

Palpable purpura → Vasculitis
Non-palpable + ↓ platelets → Platelet disorder
Non-palpable + normal platelets → Vascular fragility

⚡ Extra MRCP Clinical Pearls

Purpura + renal involvement → systemic vasculitis
Symmetrical lesions on legs → small vessel vasculitis

03/03/2026

The chest X-ray shows a right sided hydropneumothorax, evidenced by a distinct air fluid level within the right pleural cavity, indicating the presence of both air and fluid in the pleural space. A chest tube is visualized in situ on the right side, consistent with therapeutic drainage. Most likely Diagnosis is Right sided hydropneumothorax secondary to infections, trauma or Iatrogenic causes...

03/03/2026

A

25/02/2026

Penal necrosis due to Lignocain +Adrenaline inj during circumcision

24/02/2026

Reed-sternberg cells pathognomonic for Hodgkin lymphoma

21/02/2026

21/02/2026