•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.

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•What is Fallot’s triology?

-ASD, pulmonary stenosis and right ventricular enlargement.

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•What is Lutembacher syndrome?

-ASD with an acquired rheumatic mitral stenosis.

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•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.

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•Compartment syndrome :

-When an injured muscle swells within a closed compartment bounded by inelastic fascia .
-Venous flow blocked 1st further increasing the edema and the pressure within the affected compartment eventually compromising the arterial supply as well .
-If this pressure is not urgently relieved, the muscles will die and is then replaced by fibrous tissue producing Volkmann's ischemic contracture as this patient in the photo due to too tight plaster .

#Surgery

•Dinner fork deformity in Colle's fracture:

-It usually occurs in old female with osteoporosis falling on outstretched hands and hyper extended wrist .

#Surgery

Autoimmune diseases that may cause Cancer:

1-Celiac disease →Gastric carcinoma or lymphoma.
2-Hashimoto's thyroiditis →Lymphoma.
3-Sjogren syndrome →NHL.
4-Pernicious anemia →MALT.

#Medicine

Physiological gastric secretions:


1•Parietal cells:

-Secrete hydrochloric acid (HCl) and intrinsic factor.
-Stimulated by acetylcholine, histamine, and gastrin.
-Inhibited by prostaglandins and somatostatin.

2•Mucosal cells:

-Secrete protective mucus
-Stimulated by acetylcholine, prostaglandins(whic inhibit HCl secretion), and secretin.

3•Chief cells:
-Secrete pepsinogen
-Stimulated by acetylcholine, gastrin, secretin, and vasoactive intestinal polypeptide (VIP).

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•Erosions are more superficial than ulcers.

•Ulcers involve damage to the gastric mucosa extending beyond the muscularis mucosa layer into the submucosa.

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Acute upper gastrointestinal haemorrhage

-This is the most common gastrointestinal emergency.
-The mortality of patients admitted to hospital is about 10%.
-Haematemesis is red with clots when bleeding is rapid and profuse, or black (‘coffee grounds’) when less severe.
-Syncope may occur and is caused by hypotension from intravascular volume depletion.
-Symptoms of anaemia suggest chronic bleeding.
-Melaena is the passage of black, tarry stools containing altered blood.
-It is usually caused by bleeding from the upper gastrointestinal tract,(about 60-100ml) although haemorrhage from the right side of the colon is occasionally responsible.
-The characteristic colour and smell of melena are the result of the action of digestive enzymes and of bacteria on haemoglobin.

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In case of Acute Upper GIT bleeding:

-Risk scoring systems have been developed to stratify the risk of needing endoscopic therapy or of having a poor outcome.

-The advantage of the Blatchford score is that it may be used before endoscopy to predict the need for intervention to treat bleeding.
-Low scores (2 or less) are associated with a very low risk of adverse outcome.

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•Mackler triad (esp. in Boerhaave syndrome) in Esophageal Perforation:

1-Vomiting and/or retching
2-Severe retrosternal pain that often radiates to the back
3-Subcutaneous or mediastinal emphysema:
crepitus in the suprasternal notch and neck region or crunching/crackling sound on chest auscultation (Hamman sign).

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•Extra-esophageal symptoms (respiratory )of GERD:

1-Reflux-induced Asthma.
2-Chronic Cough.
3-Aspiration pneumonia.
4-Recurrent laryngitis.
5-Pulmonary fibrosis.
6-Hiccups.
7-Pharyngeal & laryngeal irritation horsiness of voice.
8-Otitis media.

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•Complications of Barrett’s oesophagus:

1-Ulcerations and stricture
2-Dysphagia
3-Bleeding
4-Perforation
5-Adenocarcinoma of O-G junction (25 times more common).

#Surgery

Note:

-Normal resting LOS pressure is 10–25 mmHg.
-During swallowing, pressure drops to 1–3 mmHg for few seconds (10 seconds).

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CONTRAST STUDY OF OESOPHAGUS:

Types
1.Barium swallow using barium sulphate (thick paste).

2.Using water-soluble contrast like ‘Gastrografin’.

#Surgery

•Indications of Barium swallow:

1-Dysphagia due to motility disorder like achalasia, diffuse oesophageal spasm.
2-Dysphagia due to mechanical causes like carcinoma, benign strictures and neoplasms, external compression.
3-Pharyngeal pouch and other diverticula.
4-GORD.

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#Surgery

•Indications of Water-soluble contrast radiograph:

1-In suspected oesophageal perforation.
2-Leaking oesophageal anastomosis.

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•Important Findings in Barium Swallow


1-Achalasia cardia—‘Bird beak’ appearance, as the oesophagus is grossly dilated above an apparent narrowing at the cardia. In longstanding cases—‘sigmoid oesophagus’.
2-Diffuse oesophageal spasm—Corkscrew appearance.
3-GORD—shows reflux when done in Trendelen burg’s position.
4-Oesophageal carcinoma—irregular stenosing lesion with shouldering (‘Rat tail’ is a fluoroscopic finding).
5-Pharyngeal pouch—demonstration of the pouch.
6-External compression—indentation of barium column by superior or posterior mediastinal mass, enlarged left atria as in mitral stenosis.

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#Radiology