•Abdominal X-ray signs :

1. Single bubble sign : pyloric atresia .

2. Double bubble sign : duodenal atresia .

3. Triple bubble sign : jejunal atresia .

4. Bird beak sign : esophageal achalasia .

5. Eaten apple sign ( apple core sign ) : cancer colon .

#Surgery

-Hypercalcemia is treated initially with hydration and loop diuretics and then with bisphosphonates , if all failed consider Dialysis .

#Medicine

•What drugs should be avoided in heart failure?

1- Antiarrhythmic drugs
2- Non-dihydropyridine calcium antagonists, e.g. verapamil, diltiazem in patients with systolic chronic heart failure
3- Tricyclic antidepressants
4- Non-steroidal anti-inflammatory drugs (NSAIDs)
5- Cyclo-oxygenase 2 inhibitors
6- Corticosteroids
7- Doxorubicin and trastuzamab
8- Thiazolidinediones.

#Medicine

•What is Kussmaul’s sign?


-Normally there is an inspiratory decrease in JVP.
-In constrictive pericarditis, there is an inspiratory increase in JVP.
-Kussmaul’s sign is also seen in
severe right heart failure regardless of aetiology.
-It is caused by the inability of the heart to accept the increase in right ventricular volume without a marked increase in the filling pressure.

#Medicine

•What is the relation between thrombolysis and onset of symptoms in MI?

-Thrombolytic therapy reduces mortality and limits infarct size.
-The shorter the interval between the onset of symptoms and the initiation of thrombolysis, the greater is the survival.
-The greatest benefit occurs if the treatment is initiated within the first 3 h, when a 50% or greater reduction in mortality rate can be achieved.
-The magnitude of benefit declines rapidly thereafter, but a 10% mortality reduction can be achieved up to 12 h after the onset of pain.

#Medicine

•The Global Registry for Acute Coronary Events (GRACE) system:

-This is a risk score for prediction of death and myocardial infarction that incorporates renal dysfunction.

#Medicine

•Killip (or Killip–Kimball) classification:

-The Killip classification is used to. characterize heart failure following MI:


Killip I: absent third heart sound and absence of crackles.
Killip II: third heart sound or crackles in <50% of lung fields.
Killip III: crackles in greater than 50% of lung fields.
Killip IV: cardiogenic shock.

#Medicine

•Mention some causes of elevated troponin not the result of acute coronary syndrome:

-Myocarditis
-Heart failure
-Thromboembolism.

#Medicine

•What is Levine’s sign?

-In acute myocardial infarction the patient often describes the pain by
illustrating a clenched fist.

#Medicine

-About 90% of gallbladder cancers are  accompanied with biliary stones , this is due to the fact that stones are very commonly associated rather than that they are a direct cause of the malignancy .

#Surgery

•What are the causes of absent radial pulse?

1-Aberrant radial artery or congenital anomaly (check the brachials and
BP)
2-Tied off at surgery or previous surgical cut-down
3-Catheterization of the brachial artery with poor technique
4-Following a radial artery line for monitoring of blood gases or arterial pressure
5-Subclavian artery stenosis
6-Blalock–Taussig shunt on that side (shunt from subclavian to pulmonary artery)
7-Embolism into the radial artery (usually caused by atrial fibrillation)
8-Takayasu’s arteritis (rare).

#Medicine

•What do you understand by a Blalock–Taussig shunt?

-It is the anastomosis of the left subclavian artery to the left pulmonary artery with the intention to increase pulmonary blood flow.

#Medicine

•What is the age of onset of Eisenmenger syndrome?

-In the case of PDA and VSD, about 80% occur in infancy, whereas in the case of ASD over 90% occur in adult life.

#Medicine

•At what age does COA case manifest?

-It is particularly likely to produce significant symptoms in early infancy (presenting as cardiac failure) or between the ages of 20 and 30 years.

#Medicine

•Which condition has the most common association with hypertrophic cardiomyopathy?

-Friedreich’s ataxia.

#Medicine

•What is the most characteristic pathophysiological abnormality in hypertrophic cardiomyopathy?

-Diastolic dysfunction.

#Medicine

•Is the loudness of the murmur related to the size of the defect?

-No; in fact, very small defects cause loud murmurs.

#Medicine

•What is Fallot’s triology?

-ASD, pulmonary stenosis and right ventricular enlargement.

#Medicine

•What is Lutembacher syndrome?

-ASD with an acquired rheumatic mitral stenosis.

#Medicine

•How would you treat a patient suspected to have endocarditis?


-Until the bacteriology results are available, with intravenous benzylpenicillin and gentamicin.

#Medicine

•Mnemonic to remember Duke’s criteria for bacterial endocarditis,

BE FEVER:

Major:
B, blood culture positive at least twice, 12 h part
E, endocardial involvement from echocardiogram.
Minor:
F, fever
E, evidence from microbiology
V, vascular findings
E, evidence from immunology
R, risk factors/predisposing factors, e.g.drug abuse, valvular diseases.

#Medicine