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Murphy's sign Cholecystitis very important for all medical and Nursing students short and sweet notes please fallow and share

Complete Dose calculation , Tips, Trick and Guide for all Nursing and Medical......... Students.

Arterial supply of the Lower Limb 🫀🦵 From the abdominal aorta to the plantar arteries, the lower limb receives a well-organized blood supply that ensures proper oxygen and nutrient delivery to muscles, bones, and tissues. The main pathway includes: External iliac → Femoral artery fallow for more medical knowledge

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Electrolyte imbalances can quickly lead to arrhythmias, confusion, seizures, and cardiac arrest.

Know the ranges. Save lives.

Skeleton System – The Strong Internal Framework of the Human Body that Supports, Protects, and Helps in Movement.”

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Not all antibiotics are safe for every patient.

This is the reason Ciprofloxacin should be questioned when prescribed for a patient with a history of seizures.

Patient safety is not optional. It is our responsibility.

Clinical Features and causes of Acute Interstitial Nephritis.

Rheumatoid arthritis :

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease characterized by persistent symmetric inflammatory polyarthritis, primarily affecting small joints.

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🔬 Pathophysiology
• Autoimmune activation against synovial tissue
• Synovial inflammation → pannus formation
• Cartilage destruction + bone erosion
• Systemic inflammatory response (extra-articular involvement)

Key antibodies:
• Rheumatoid factor (RF)
• Anti-CCP (anti–cyclic citrullinated peptide) – highly specific

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🦴 Commonly Affected Joints
• MCP (metacarpophalangeal)
• PIP (proximal interphalangeal)
• Wrists
• MTP (feet)

⚠️ DIP joints are usually spared (helps differentiate from osteoarthritis).

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🧑‍⚕️ Clinical Features

Articular
• Symmetrical joint pain
• Morning stiffness > 1 hour
• Swelling, warmth
• Reduced range of motion
• Progressive deformities:
• Ulnar deviation
• Swan neck deformity
• Boutonnière deformity

Extra-articular
• Rheumatoid nodules
• Anemia of chronic disease
• Interstitial lung disease
• Pericarditis
• Vasculitis
• Sjögren syndrome

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🧪 Investigations
• ESR, CRP ↑
• RF positive (70–80%)
• Anti-CCP positive (more specific)
• X-ray:
• Joint space narrowing
• Marginal erosions
• Osteopenia near joints

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💊 Management

1️⃣ First-line: DMARDs (start early)
• Methotrexate (drug of choice)
• Sulfasalazine
• Hydroxychloroquine
• Leflunomide

2️⃣ Biologics (if inadequate response)
• TNF inhibitors (e.g., adalimumab)
• IL-6 inhibitors
• Rituximab

3️⃣ Symptomatic relief
• NSAIDs
• Short-term corticosteroids

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⚠️ Complications
• Joint deformity
• Atlantoaxial subluxation (C1–C2)
• Osteoporosis
• Cardiovascular disease risk ↑

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📌 Key Exam Points
• Symmetrical small joint arthritis
• Morning stiffness > 1 hour
• Anti-CCP most specific
• Methotrexate = first-line treatment