Important knowledge

⚡️Jaundice is visible when Bilirubin level > 3 mg/dl (> 2.92 mg/dl in macloid)

Causes of hepatomegaly مهم

⚡️ Cause of haematemesis in pt. with excessive alcohol ingestion : ▪︎ erosive gastritis ▪︎ Mallory–Weiss tear (repeated vomiting) ▪︎bleeding oesophagogastric varices in cirrhotic patients Macloid

⚡️Risk of mortality in patients with upper gastrointestinal bleeding depends on : ▪︎Age ▪︎Hemodynamic stability ( shock or not ) ▪︎Comorbidites (DM ,HT , ...) ▪︎Diagnosis ▪︎endoscopic finding

Causes of massive splenomegaly

ملفات اكزامنيشن ( محسن الحاج ) ينصح بها

⚡️Mx of Acute heart failure (pulmonary odema) Mx =تكعد المريض وتنطي دولمة (DOLMA ) زين هسه نكعد المريض افتهمنا حتى ليختنك بس شنو هاي الدولمة ؟ DOLMA ▪︎D = dobutamine (esp. if hypotensive ) ▪︎O = Oxygen ▪︎L = Lasix ( loop diuretic ) ▪︎M = Morphin ( opiod) ▪︎A = Angised ( GTN) [ Iv or buccal]

⚡️Hypoglycaemia should be considered in all comatose patients (even if there is an apparently obvious cause, such as hemiplegic stroke or alcohol intoxication.) Davidson

⚡️Differentiate between Mysthenia gravis & Lambert Eaton Syndrome : 1) due to autoantibodies to acetylcholine receptors [or autoantibodies to a muscle- specific kinase (MuSK) ] in MG vS antibodies to voltage gated calcium channels in LES 2) proximal muscle weakness in MG vs distal muscle weakness in LES 3) weakness is better at morning and worse with day in MG vs weakness improved with repeatative movement in LES 4) autonomic feature is rare in MS (pupil is spared ) vs common in LES (pupil is affected) 5) bulbar involvement is commen in MG vs less common in LES 6)the reflexes is normal in MG vs hypo or areflexia in LES 7) in Nerve conductive study there is decremental response in MG vs inceament response in LES 8)steroid and acetylcholineesterase inhibitors is treatmen of choice in MG vs ineffective in LES

Delta sign ▪︎normal varient ▪︎superior sagital sinus thrombosis

⚡️Phenytoin /phosphenytoin / phenobarbital كلهن ال rate of infusion = 50 mg / min.

⚡️absent deep tendon reflexs in pt. With symptomatic hypoglycemia indicate permanent brain damage

⚡️Causes of left bandle branch block 🚫 ------------------------------ ▪︎MI ▪︎heart failure & cardiomyopathy ▪︎Aortic valve stenosis ▪︎hypertension

⚡️Alarm signs of hemolysis in blood transfusion :- ▪︎arm pain ▪︎lion pain --- ▪︎dark urine ▪︎jaundice