Important knowledge

⚡️Femoral canal content from medial to lateral VAN V ....... vein A ....... Artery N ....... Nerve

⚡️dorsalis pedis artery is palpable only in 20% of population

⚡️causes of water humer pulse ▪︎Aortic regurgitation ▪︎hyper dynamic circulation (anemia & thyrotoxicosis) ▪︎AV fistula

⚡️5 things checked in pulse ▪︎rate ▪︎rhythm ▪︎volume ▪︎character (as Collapsing pulse) ▪︎vessel wall (cord like in atherosclerosis)

⚡️Palmer erethema (center is preserved) Causes ▪︎pregnancy ▪︎thyrotoxicosis ▪︎chronic liver disease ▪︎chronic hypoxia (>polycythemia) ▪︎chronic febrile (sapurative) disease

⚡️Anesthetic drugs that cause malignant hyperthermia ▪︎halothane ▪︎sevoflurane ▪︎desflurane ▪︎depolarizing muscle relaxant succinylcholine

⚡️Types of Gallstones د.موسى 1) pigmented stones 5% ▪︎black = excessive hemolysis (Calcium bilirubinate) ▪︎brown = ♧ infection (cholangitis) ♧foreign body ( parasite , stent ) Other types of calcium except calcium bilirubinate ) 2)cholesterol stones 3-5% 3)mixed stones 90% ( most common) (40% cholesterol + 60% calcium)

⚡️stool examination ------------------------------------ ▪︎fecal calprotectin = IBD ▪︎fecal elastase = pancreatitis

▪︎Dynamic (mechanical) obstruction = forceful vomiting ▪︎Adynamic obstruction (Paralytic illus) = forceless vomiting

⚡️most common site of metastasis & hydated cyst in liver is Rigt side ( due to direction of portal vein )

The appendicitis Cary more risk of perforation than cholysistitis because appendiculer artery is end artery and once inflamation there will be thrombosis of vessel which cause gangrene & perforation while gallbladder have rich anastmosis & cary very little risk of perforation لذلك ابو ال appendicitis نفتح كبل بينما ابو ال cholysistitis ننتضر عليه يروح الالتهاب ونفتح على راحتنا بعد ٦ اسابيع عادتا

⚡️colle's fracture is more common in postmenopausal osteoporotic women

⚡️Mx of pulled elbow is supination then sudden flexion of forearm

⚡️Indication of surgery in asymptomatic thyriod cyst : ▪︎ large (>4 cm ) ▪︎psuspicious cytology (FNA) ▪︎hemorrhagic aspiration in FNA ▪︎incomplete resolution after aspiration ▪︎recurrent twice after aspiration

⚡️history of trauma ♦️Motor vehicle accidents (بيها نقص ) 1) helmet لابس خوذة او لا 2) لابس كسارات برجله وبيدة او لا ؟ 3)velocity 4) mechanism of accident 5) mechanism of injury 6) نكمل اللست من نقطة ٥ الى ٨

⚡️history of trauma ----------------- ♦️FFH 1) the height الارتفاع الوكع منه [Scaffold سكلة ] 2)injury during fall ? مثلا من ديوكع طخ بحافة السكلة وشكت ايدة او بطنة 3) على شنو وكع ؟ على ايدة ، ضهر ، رجل ... 4) type of ground whic fall on 5) نكمل نفس اللستة الاولى من نقطة ٥ الى ٨

⚡️History of trauma ------------------ ♦️RTA 1) site of victim ▪︎inside car ونذكر وين بالسيارة سايق ، صدر ، الخانة الخلفية؟ ▪︎out side car ( passenger) 2) setbelt لابس او لا ؟ *most common cause of death is ejection from car 3) airbags طكت او لا ؟ متطك اذا مالابس حزام الامان 4)Type of car / cars 5) mechanism of RTA 6) speed of car / cars 7) mechanism of injury to victims وين نضرب؟ شلون نشمر ؟ داخل السيارة او خارجها واذا نشمر على شنو وكع ؟! واكو اصابات نتيجة السقوط ؟ 8) نكمل نفس اللستة السابقة من نقطة 5 الى 8