Remember:

-Aaron's "هارون" sign: is a referred pain felt in the epigastriumupon continuous firm pressure over McBurney's point. It is indicative of appendicitis.

-Aaron's sign is named for Charles Dettie Aaron, an American gastroenterologist.


#Surgery

Remember:

-The only bone in the body whole surface of it is atricular surface is talus bone.

#Surgery

Remember:
In abdominal examination in a surgical case, Never forget to examine:

-Supraclavicular lymph glands
-Hernia orifices
-Femoral pulses
-Genitalia
-Bowel sounds
-Anal canal and rectum.

#Surgery

Remember:

-The left supraclavicular nodes are the classical Virchow's node because they receive lymphatic drainage of most of the body (from the thoracic duct) and enters the venous circulation via the left subclavian vein.

-The metastasis may block the thoracic duct leading to regurgitation into the surrounding Virchow's nodes.

#Surgery

-Malignancies of the internal organs can reach an advanced stage before giving symptoms. Stomach cancer, for example, can remain asymptomatic while metastsizing.

-Troisier's sign, which is the finding of an enlarged, hard Virchow's node.

Wells score for DVT.

#Medicine

Wells score for PE.

#Medicine

DD for HSP:

- Drug rash
- ITP
- SLE
- Septicemia
- Thrombotic thrombocytopenic purpura (TTP).

#Medicine

STAGES OF DIABETIC NEPHROPATHY:

Stage 1 (hyperfiltration)
-Increase in GFR may be reversible.

Stage 2 (silent or latent phase)
-Most patients do not develop microalbuminuria for 10 years
-GFR remains elevated

Stage 3 (incipient nephropathy)
-Microalbuminuria (albumin excretion of 30 - 300 mg/day, dipstick negative)

#Medicine

Stage 4 (overt nephropathy):
-Persistent proteinuria (albumin excretion > 300 mg/day, dipstick positive)
-Hypertension is present in most patients
-Histology shows diffuse glomerulosclerosis and focal glomerulosclerosis (Kimmelstiel-Wilson nodules)

Stage 5(end-stage renal disease):
- GFR typically < 10ml/min renal replacement therapy needed.

STEMI.
#Medicine

ندي للمريض ٤ حبات Aspirin أبو 75mg يعني 300mg نطحنهن لو ماقدر أو حتى بالـ NGT
و ٤ حبات Clopidogrel نفس الجرعة، لكن في الـ Guidelines ندي له ticagrelor 180mg PO أحسن.
ندي له Morphin 5- 10 mg IV
ندي له Metocloperamide
ندي له Sublingual nitrates أو IV nitrate لو مستمر الـ pain.
ندي لها Metoprolol أو bisoprolol،لكن لو ممنوع كما في الـ asthma ندي CCB مثل verapamil 80–120mg/8h PO.

وبعدا نشوف لو شي PCI متوفرة خلال ٩٠ "١٢٠" دقيقة كان بها. المهم خلال ١٢ ساعة ممكن.
لو مش متوفرة ندي  له tPA لو مابش ممنوعات له، وهذا مايفعلوه عندنا.

إذا يعني الـ PCI متوفرة وسويناها خلال الـ٩٠ أو ١٢٠ دقيقة، ندي له معها:
PCI + GP IIb/IIIa receptor antagonists IV,as Eptifibatide ,Abciximab.
وبعدا في المستشفى يستمر على:

Maintenance in-hospital medication:
-Aspirin
-Clopidogrel
-Statin
-BB
-ACEI.

#Medicine

Fractures names.

#Surgery

Ml (STEMI/NSTEMI) is defined by evidence of myocardial necrosis and is diagnosed by arise/fall of serum markers plus anyone of :

1-Symptoms of ischemia (chest/upper extremity /mandibular/ epigastric discomfort: dyspnea)
2-ECG changes (ST-T changes, newBBB, or pathological Q waves).

3-Imaging evidence (myocardial loss of viability, wall motion abnormality ,or intracoronary thrombus).

-If biomarker changes are unattainable, cardiac symptoms combined with new ECG changes is sufficient.

-STEMI meets criteria for Ml characterized by ST elevation or new BBB.

-NSTEMI meets criteria for Ml without ST elevation or BBB.

-Toronto notes
#Medicine

PCI " the stent of life".

- Major advantages over thrombolytics:
1-Higher reperfusion rates (greater han 90% success rate of opening the occluded artery)
2-Decreased incidence of stroke
3-More effective than thrombolytics in patients with acute decompensated heart failure, cardiogenic shock, and prior bypass surgery.

Terminology:
-Primary PCI:
Patient with STEMI is taken directly to the catheterization lab for PCI instead of receiving thrombolytics.
- Rescue PCI:
Urgent PCI after failure to reperfuse with thrombolytics.
- Pharmacoinvasive PCI:
PCI after reperfusion with thrombolytics.

#Medicine

Give low flow oxygen only if SaO2 <90% or the patient is breathless.

Plain X-ray in Acute appendicitis:

May show the following:
-Lumbar scoliosis towards right due to psoas spasm which is not uncommon
-Faecolith on the right side;
-Obliteration of preperitoneal fat line due to retrocaecal appendicitis;
-Segmental ileus in caecum and terminal ileum
-Speckled extraluminal gas in right iliac fossa, gas in appendix,
-Pneumoperitoneum (very rare);
-Intestinal obstruction (occasionally only);
-Soft tissue mass in mass or abscess of appendix.

all these features are very much nonspecific. X-ray is useful to rule out DU perforation, intestinal obstruction, ureteric stone.

Also Radio-opaque appendix in a plain X-ray. It could be calcified or have calcified content.

د. فواز عمران يحب يسأل فيهن.

#Surgery