-In Rolling hiatal hernia, postprandial discomfort in retrosternal area
i. e mimics ischemic heart diseases but the key of it is the presence of postprandial hiccough.

-Rolling hiatal hernia is more serious than sliding hernia because its management is only surgery.

#Surgery

-In case of corrosive esophagitis, don't elicit the vomiting and start with ingestion of water, eggs, painkiller and antiemetics.

#Surgery

•The most complications of GIT problems are:

-Hemorrhage
-Bleeding
-Stricture.

•And the first line in treatment of these complications is insertion of Ryle's tube.

#Surgery

Gustilo classification .

#Surgery

Light's criteria to differentiate between transudative vs exudative plueral effusion .

#Medicine

CURB-65 Score for Pneumonia Severity.

Estimates mortality of community-acquired pneumonia to help determine inpatient vs outpatient treatment.

#Medicine

Paraplegia with no Imaging findings in the spinal cord ?

It maybe due to parasagittal tumor "Meningiomas" which compress the medial aspect of both cortical hemisphere that responsible for the motor function of Lower limb which lead to paraplegia

This is considered a False localizating sign.

#Surgery
#Medicine

-Kartagener's syndrome

•It is s a subset of a larger group of ciliary motility disorders called primary ciliary dyskinesias (PCDs).

•Consists the triad of situs inversus, chronic sinusitis, and bronchiectasis.

#Medicine

WHY YOU SHOULD NOT SUDDENLY STOP TAKING STEROIDS?

For steroid treatments lasting longer than a few days, it is VERY important not to miss a dose , or stop the treatment abruptly.

This is because after some days or weeks of taking steroids there will be decrease in hypothalamic-pituitary-adrenal axis" (HPAA) function. And thus the body will reduce the amount of cortisol it makes.

You will need to - ‘taper’(gradually reduce) the dose to give your adrenal glands time to start making their own steroids again, and prevents the Withdrawal symptoms

- Withdrawal symptoms and signs (weakness, fatigue, decreased appetite, weight loss, nausea, vomiting, diarrhea, abdominal pain) which is similar to adrenal insufficiency.

#Medicine

Hypoxic drive:

-Normal respiration is driven mostly by the levels of carbon dioxide in the arteries, which are detected by peripheral chemoreceptors , However in cases where there are chronically high carbon dioxide levels in the blood such as in COPD patients, the body will begin to rely more on the oxygen receptors and less on the carbon dioxide receptors.

-In this case, when there is an increase in oxygen levels, the body will decrease the respirations.

-For this reason, people with hypoxic drive must not receive oxygen in high concentrations or for long periods.
-So The goal is to maintain the levels that the patient’s body is used to, a little hypoxic (low O2 level).
-A titrated oxygen therapy to achieve saturations of 88% to 92% is recommended in those patients in case of COPD Exacerbation or in acute respiratory distress.

-Arterial blood gas levels should be closely monitored via pulse oximetry.

#Medicine

•When 'The patient sees nothing and the doctor sees nothing'?

-You must think of " Retrobulbar optic neuritis " And look for multiple sclerosis which is the MOST common cause.

-Note:
25% of MS patients come with rapid painful lose of vision as the sole presention.

#Medicine

•Peptic ulcer is more frequent in patients with liver cirrhosis, Why ?

-The liver is responsible for the metabolism and degradation of the Gastrin hormone

-In case of liver cirrhosis, the gastrin is not degradated in the liver 👉🏼increase the level of Gastrin hormone 👉🏼 increase secretion of the pepsinogen and HCl from the stomach 👉🏼 Ulceration.

#Medicine

•Respiratory causes of haemoptysis:

1- Infective : bronchitis - TB - pneumonia - COPD others fungal & viral infections of the lung
2- Neoplastic : either primary or secondary
3- Vascular : lung infarction - vasculitis ( ANCA-associated, SLE, Rheumatoid arthritis )
4- Parenchymal : Diffuse Interstitial fibrosis, sarcoidosis, haemosiderosis, cystic fibrosis
5- Pulmonary Hypertension
6- Trauma or foreign body in the airway.


Massive haemoptysis causes:

1-TB
2-Bronchiectasis
3-Bronchogenic carcinoma
4-Trauma in the Airway

-Because the lesion is supplied by bronchial artery ( high pressure ).

#Medicine

•Ortner's syndrome:

Mitral stenosis 👉🏼dilatetion of the left arium leading to :

1-Compression of Left laryngeal nerve👉🏼Hoarseness of voice.
2-Compression of the esophagus 👉🏼dysphagia.
3-Compression of the trachea 👉🏼shortness of breath, risk of aspiration, cough and hemoptysis.

#Medicine

•Hemoptysis associated with Hematuria:

-We must consider Goodpasture syndrome as possible cause.

Goodpasture syndrome most often manifests as diffuse alveolar hemorrhage and glomerulonephritis together.

#Medicine

-Hemoptysis only during menstruation in female patients?

Catamenial Hemoptysis intrabronchial or parenchymal endometrial tissue deposits, and is considered a subset of extrapelvic endometriosis.

#Medicine

-Common migrine which is bilateral without aura is more common than classical migrine which is unilateral with aura.

#Medicine

•Causes of bradycardia in ER:

5H

Hypothermia
Hyperkalemia
H+ increase ( acidosis)
Hypoxia
Hypovolumia


5T

Tension pneumothorax
Tamponade ( cardiac)
Thrombosis pulmonary PE
Trombosis cardiac MI
Toxins.

#Medicine

-Infection above diaphragm is usually of Gram positive bacteria while infection below diaphram is usually of gram negative .

#Medicine

-In correction of hyperkalemia the first thing we give the patient is membrane stabilizers ( Ca gluconate to prevent caradic arrest ) which will not restore the potassium level but more importantly will counter the action of K on cardiac muscle cell membrane.

#Medicine