•Biliary tract Lesions:

•Pain = Cholelithiasis
•Pain + Pyrexia = Acute Cholecystitis
•Pain + Jaundice = Choledocholithiasis
•Pain + Pyrexia + Jaundice (Charcot's triad) = Ascending Cholangitis


#Surgery

•Elevated jugular veins:

“PQRST"

-Pericardial effusion (tamponade)
-Quantity (fluid overload)
-Right heart failure
-SVC obstruction
-Tricuspid stenosis.

#Medicine

Normal anion gap value is 8 to 14 mmol/L.

•Causes of metabolic acidosis with high anion gap:

1-Diabetic ketoacidosis
2-Renal failure
3-Lactic acidosis
4-Salicylate poisoning.

#Medicine
#Diabetes

•Causes of metabolic acidosis with normal anion gap are:

1-Renal tubular acidosis
2-Diarrhea
3-Ureterosigmoidostomy
4-Acetazolamide therapy
5-Ammonium chloride ingestion.

#Medicine
#Diabetes

-Normal osmolarity is 285 to 300 mosm/kg.

-If it is > 340 mosm, consciousness is depressed.

-Normal anion gap value is 8 to 14 mmol/L.

#Medicine
#Diabetes

•Causes of neuropathic ulcer:

1-Leprosy
2-Diabetes mellitus
3-Polyneuropathy (due to any cause)
4-Tabes dorsalis
5-Syringomyelia
6-Amyloidosis
7-Porphyria
8-Progressive sensory neuropathy.

#Medicine

•What are the causes of ulcer in DM?

-Ischemia
-Neuropathy
-Combined ischemia and neuropathy
-Secondary infection.

#Medicine

•What are the causes of loss of vision in DM?

1-Diabetic retinopathy
2-Cataract
3-Age-related macular degeneration
4-Retinal vein occlusion
5-Retinal artery occlusion
6-Nonarteritic ischemic optic neuropathy
7-Glaucoma.

#Medicine
#Diabetes

•What are the  causes of unilateral wasting of leg?

1-Diabetic amyotrophy
2-Old poliomyelitis
3-Arthritis or trauma
4-Cerebral palsy
5-Disc prolapse.

#Medicine
#Diabetes

•What is the link between obesity and diabetes mellitus?

-Fat cells release free fatty acids and also TNF-a which are responsible for insulin resistance. A new protein called resistin secreted by the fat cells, also causes insulin resistance.

#Medicine
#Diabetes

C-peptide: can help differentiate between types of diabetes:

↑ C-peptide levels may indicate insulin resistanceand hyperinsulinmia → T2DM
Q.  What are the  causes of unilateral wasting  of leg? A.  As follows: Y Diabetic amyotrophy Y Old poliomyelitis Y Arthritis or trauma Y Cerebral palsy Y Disc prolapse.
↓ C-peptide levels indicate an absolute insulindeficiency → T1DM

Diagnostic Features of Metabolic Syndrome: ( >= 3 the following):-

1. Abdominal obesity (waist circumference: men> 102 cm, women > 88 cm).
2. Hypertriglyceridemia (>= 150 mg/dL).
3. Low HDL cholesterol (men< 40 mg/dL, women< 50 mg/dL).
4. Hypertension(>= 130/85 mmHg).
5. Fasting hyperglycemia (>= 110).

#Medicine
#Diabetes

-In all breast disease, cancer must be ruled out even if the presentation initially suggests benign disease.
-The only reliable way to rule out cancer is to get tissue sample sent for histopathology.
-Age correlates best with the odds for cancer:

•Virtually unknown in the teens
•Rare in young women
•Quite possible by middle age
•Very likely in the elderly.

#Surgery

•Diabetic Ulcer

-Diabetic ulcer is typically indolent andBlocated at pressure points (heel and metatarsal head).
-It starts because of the neuropathy and does not heal because of the microvascular disease.
-It can sometimes heal with good glycemic control and appropriate wound care, but often become chronic and sometimes leads to
amputation due to osteomyelitis.

#Medicine
#Surgery

•Atelectasis is the most common source of fever on the first post-operative day.

-Assess the risk for the other causes listed above, listen to the lungs, do a chest x- ray, improve ventilation (deep breathing and coughing, postural drainage, incentive spirometry), and perform a bronchoscopy if necessary.

-Pneumonia will happen in about 3 days if atelectasis is not resolved.
-Fever will persist, leukocytosis will be present, there may be purulent sputum, and chest x- ray will demonstrate an infiltrates.
-Obtain sputum cultures and treat with appropriate antibiotics.

#Surgery

•Anterior spinal Syndrome is characterized by :
▪️Paraplegia
▪️Incontinence (bowel/bladder)
▪️Pain and temperature sensation loss.

•What is the cause of Anterior spinal Syndrome ?
-Occlusion of the great radicular artery of Adamkiewicz.

#Medicine

-TSH is the most sensitive test for thyroid disease.
-If TSH is normal , the patient is Euthyroid .

#Surgery

-Tamoxifen prevents cancer by 50% in those with more than 1 family member with breast cancer.


#Surgery

-Most common mediastinal tumor at all Neurofibroma.

#Surgery

MEN I is also known as Wermer syndrome .

MEN I is composed of : 3-Ps

-Pituitary adenoma .
-Parathyroid adenoma or hyperplasia .
-Pancreatic tumour .

#Surgery