-Coxsackievirus is the most common identified cause of both pericarditis and myocarditis.

#Cardiology

•Uses of diuretics during CKD :

- Stages 1&2 = Thiazides.
- Stage 3 eGFR<60 = Thiazides or loop diuretics (Ex. furosemide)
- Stage 4 eGFR<30 = loop diuretics or combination therapy.
- Stage 5 eGFR <15 = loop diuretics or combination therapy.

#Nephrology

•Diabetic cardiomypathy:

-It is the structural, functional & metabolic changes that occur in cardiac muscles in noncontrolled diabetes patients in the absence of other comorbidities like CAD, hypertension leading to acute, acute, LV systolic dysfunction.

#Cardiology

-Depressed ankle reflex with extensor plantar response :

• Peripheral neuropathy + stroke
• Peripheral neuropathy + cervical myelopathy
• Cervical & lumbar spondylosis
• SCD of cord
• Motor neuron disease
• Syphilitic tabes dorsalis
• Friedrich ataxia
• Lesion of conus medullaris

#Neurology

-Anterior STEMI Vs RV infraction:

How to differentiate between Anterior STEMI and isolated RV infarction (as both can shows ST elevation from V1-V3)?
-In patients with anterior left ventricular infarction, ST segment elevation is the lowest in lead V1, increasing in amplitude toward lead V5.
On the other hand, patients with an occluded RCA and RV infarction display the greatest amplitude of ST segment elevation in lead V1, which progressively decreases toward lead V5.

#Cardiology

-Relations of ECG to area of myocardium & C.vessele affected in CAD.

#Cardiology

-IgA Nephropathy (Berger’s disease):

-It is the most common type of Primary GN in developed countries.

-When IgA affect the kidney only this is called IgA nephropathy, while HSP is systemic IgA disorder, in which the skin, kidney and other organs will be affected.

#Nephrology

-Nephrotic syndrome is the combination of nephrotic-range proteinuria with a low serum albumin level and edema.

-Nephrotic-range proteinuria is the loss of 3 grams or more per day of protein into the urine or, on a single spot urine collection, the presence of 2 g of protein per gram of urine creatinine.

#Nephrology

-The first sign of nephrotic syndrome in children is usually swelling of the face; this is followed by swelling of the entire body.

-Adults can present with dependent edema. Fatigue and loss of appetite are common symptoms.

#Nephrology

•Urinary protein measurement

-Urinary protein is measured by a timed collection or a single spot collection.

-A timed collection is typically done over a 24-hour period, starting at 7 am and finishing the next day at the same time. In healthy individuals, less than 150 mg of total protein is present in a 24-hour urine collection.

-A single spot urine collection is much easier to obtain. When the ratio of urine protein to urine creatinine is greater than 2 g/g, this corresponds to 3 g of urinary protein per day or more.

#Nephrology

•Indications of Admission in Malaria:

1-ARDS
2-Shock
3-Anemia, Hb <5mg /dl
4-Hyperparasitaemia >10٪
5-Pregnancy
6-Renal failure
7-Hypoglycemia(<2mmol)
8-CNS affection
9-Bleeding tendency, DIC
10- Jaundice,(Bilirubin >5mg/dl).

#Infections

-Causes of Bilateral Ptosis :

• MG
• Dystrophia myotonica
• Tabes dorsalis
• Congenital
• Bilateral Horner's.

#Neurology

•In linitis plastica:
-The mucosa is often spared malignant infiltration, making endoscopic diagnosis extremely difficult.
-Therfore,multiple endoscopic biopsies are recquired.

#Stomach

-In gastric linitis plastica
Most of the patients presenting with symptoms have an advanced form of the disease.

#Stomach

•Main features of graves disaese include :

-Diffuse goiter
-Thyroid eye disease
-Pretibial myxoedema
-Thyroid acropathy.

#Thyroid
#Endocrine

•Parameters indicate severe diabetic ketoacidosis:

-pH < 7
-Blood ketone > 6 mmol/L
-Bicarbonate < 5 mmol/L
-Anion gap >16 mmol/l
-Potassium < 3.5 mmol/L on admission
-Tachycardia or bradycardia
-Systolic blood pressure <90 mmHg
-Oxygen saturation <92% on air
-GCS < 12.

#Diabetes

•Indications of DC cardioversion in AF are:

1-Blood pressure less than 90 mmHg
2-Chest pain
3-Heart failure
4-Impaired consciousness.
5-HR > 200 bpm.

#Cardiology

-The tendency of breast cancer to metastasize to the spine is explained by the free communication of posterior intercostal veins with vertebral venous plexus.

#Breast

-Cancer Antigen 15-3 (CA 15-3 )is the tumor marker for breast cancer .

-It is elevated in large or disseminated tumors.

-It is not useful for diagnosis but it is used to monitor response to breast cancer treatment and disease recurrence .

#Breast

Arm edema after breast cancer treatment

◼️Axillary lymph node dissection combined with radical radiotherapy causes destruction of the lymphatic drainage of the upper limb with consequence lymphatic edema.

◼️The condition is now uncommon because radical radiotherapy and axillary lymph node dissection are rarely combined together, but it still can occasionally occur even if either modalities are used alone.

◼️It may take months or years to develop, but when it develops it is very essential to exclude recurrence of cancer which infilerate the axilla and cause both lymphatic and venous occlusion.

◼️Axillary infilteration by tumor cells can be so painful, because of brachial plexus nerve involvement.

◼️Treatment is by arm elevation, elastic arm stockings and pneumatic compression devices, it can prove difficult to treat.

◼️The above is a patient who is suffering from left arm lymph edema following radical axillary dissection.

#Breast