Dr. Nisreen Sa'adeh:

- A 45YO pt came to your clinic. How to know if he's diabetic?- 1st; I'll take Hx.: asking about DM Sx. (3P's, wt. loss), Family Hx. of DM, if he/she has a sedentary lifestyle ... then I'll do P/E: BMI, I may refer him/her to fundoscopy. Then Labs: Random BS (if >200 + symptoms = DM), Fasting BS post 9-12hrs fasting (if >126 then DM), HbA1c (if >6.5 then DM).

- What will you do if all these were equivocal results?- OGTT.

- How?- Let pt drinks 75g Glucose solution, then I'll measure BS immediately, post-1hr, & post-2hrs.

- Which reading is most important?- The 3rd one (after 2hrs).

- How it should be for you to diagnose DM?- More than (180-200).

- Ok, this pt is a diabetic one, how will you manage him/her?- I'll start by counselling the pt about lifestyle modification (exercise, diet, ...) then I'll prescribe him/her Oral hypoglycemic agents; namely Metformen & then Sulfonylureas (Glibinclamide).

- What's the action of metformen?- It'll sensitize insulin receptors, & help in decreasing wt.

- What's an important C/I for metformen prescription?- mmm, I don't know! ^^- 6b if ppl till pt that don't take metformen bcoz it cozes renal faluire, do you agree?- NO, it doesn't coz RF.

- If you want to start this pt on Insulin, how do you do that?- 1st I should admit the pt to educate him/her how to take it, & to reach the best control & best dose.

- Do you admit every pt?!- Yes, heek el 29el .. She said that's the Ideal way, bs e7na mesh daymn bnd5elhom.

- How much insulin will you give the pt?- I'll do sliding scale.- Starting by how?- I "think" 2U/kg!

----------------------------------------------------------Dr. Ahmad Odeh:

- While you're in the ER, a pt come with black tarry stool, what are the cozes?- 1st I should differentiate false melena from the true one.

- What cozes false melena?- Drugs such as Iron supplements, or iron-rich diet.

- Name other drug that coz black tarry stool?- The answer is Bismuth.

- Name foods that coz black tarry stool?- The answer is Liver & Spleen (I said mlo5eyyeh, sapane5, ... he replayed that hdool cozes greenish stool

rather than blackish).

- What other cozes of melena?- UGIB.

- What do you mean by Upper?- Proximal to Lig. of Treitz.

- Which means what organs?- Esophagous, Stomach & Deodenum.

- What's the amount of blood needed to coz melena?- 50ml.

- What's the most common coz of UGIB?- PUD (Gastric & deudinal ulcers).

- Which is more common?- DU 6b3n.

- What's the most common coz of PUD?- H.Pylori infection.

- Where exactly we can find H.pylori?- In the pylorus.

- What's the transmission mode of it?- Feco-oral.

- What other cozes of UGIB?- E.varesis.

- What are the cozes of E.varesis?- Liver cirrhosis, splenic vein thrombosis, & others that coz the portal HTN.

- aha, so it's not necessary to have liver cirrhosis. what are the cozes of portal HTN?- Pre-hepatic, Hepatic, & Post-hepatic.

- what's the normal portal pressure?- 6-10mmHg. & it's portanl HTN if >12mmHg.

- What other cozes of UGIB?- Malory-wiss syndrome.

- What's the meaning of Mallory-wiss syndrome?- Bleeding form the due to excessive vomiting.

- Give me the 3 common risk factors of it?- Alcoholics, Psychaitric pts (A.Nervosa), Pregnants (Hyperemesis Gravidarum).

- How to tt this pt?- 1st I should resusitate the pt by 2 large pore canulas & IVF. Then I'll see if he/she needs blood transfusion or not.