This summer is so fun

It was dark, silent night
Just wind blew around
and hustle we heard
My plant had its leaves
green but dusty
I had watered it in the morning
but the leaves needed washing
In the hot summer day
they needed refreshment
So as it blew strong
and stronger,
It brought with it more darkness
The dark clouds,and
the bright lightening!
It was a thunderstorm!
And then it rained for
a few moments!
It poured on everything
but happiest amongst all
was my golden fistula
It showered and the greenery restored!
It showered and the happiness restored!
The days are warm
but the nights are cold,
This summer is so fun !
Long days!
Long nights!
Strong brightness &
deep darkness !
This summer is so fun!

Scheme for assessing pedigree inheritance autosomal

General eeg sketch

Rainy Lahore !

Amidst harsh summers, here are rains again !
With windy lahore, heres no need to even turn on fans !
Gentle sunshine, cloudy days , and rainy nights !
Lahore is love !

Aplastic anemia protocol kemu

CVS examination Pearls

VSD Large vs VSD Small

pericardial bulge    | no bulge
blowing character  |   harsh character
no thrill                  | thrill may be there
Lt ParaSternalHeave| no heave
Loud P2                 | S2 normal
2/6 intensity           |  Grade IV murmur(with thrill)
FTT                        | 


With all murmurs the associated heart sound is of soft or absent,
except that with MS it is LOUD S1
And so,
with MR it is soft S1,
AR soft S2
AS soft S2
PS soft S2
PR soft P2

but since PR may be associated with pulmonary hypertension, so there may be Loud P2.

And Oh, all murmurs have HIGH pitch except MS murmur which has low pitch .


ASD fixed splitting of S2
AS reverSe splitting


Pink TOF behaves like VSD., (same pneumonias?, and examiantion findings)

AR when to operate:
symptoms of Angina
symptoms of Exertional dyspnea
Falling EF

When to Operate in MR:
EF < 60%
FTT
Pul HTN
CCF refractory to medical treatment

Respiratory exam / pleural effusion

Pleural fluid d/d
Collapse with onstructed bronchus
Empyema
Parapneumonic effusions

Consolidation d/d
Collapse with patent bronshus
Fibrosis is d/d of consolidation
Fibrosis will habe chr lung disease sihlgns such clubbing, ftt, pul htn,rv hypertrophy,

My findings are localized