Fibrocystic breast disease, commonly called fibrocystic breasts or fibrocystic change, is a benign (noncancerous) condition in which a woman has painful lumps in her breasts. Fibrocystic breast disease isn't dangerous, but it can be a bothersome condition because it can cause discomfort. The condition is common.

Breast masses are broadly classified as benign or malignant. Common causes of a benign breast mass include fibrocystic disease, fibroadenoma (see the image below), intraductal papilloma, and abscess. Malignant breast disease encompasses many histologic types that include, but are not limited to, infiltrating ductal or lobular carcinoma, in situ ductal or lobular carcinoma, and inflammatory carcinoma

Fibrocystic disease, the most common breast mass in women, is found in 60%-90% of breasts during routine autopsy. Fibroadenoma, the most common benign tumor, typically affects women younger than 30 years. Infiltrating ductal carcinoma is the most common malignant tumor;

fibrocystic disease of breast uss - Google Search

: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for surgery, there is probably a therapeutic role of this contrast medium in adhesive small bowel obstruction.

diabetic retinopathy

Encourage patients with diabetes but without diabetic retinopathy to have annual dilated

eye exams. (A:

All diabetes-related foot ulcers will require a management “package” comprising:

debridement of non-viable tissue

wound dressings

pressure off-loading

antibiotics when clinical infection is present

management of peripheral arterial disease when present

management of glycaemic control and other cardiovascular comorbidities

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Charcot Foot

What Is Charcot Foot?

Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking the foot eventually changes shape. As the disorder progresses, the joints collapse and the foot takes on an abnormal shape, such as a rocker-bottom appearance.

Neuropathic arthropathy (or neuropathic osteoarthropathy), also known as Charcot joint (often "Charcot foot"), refers to progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity. Onset is usually insidious.

Nerve Injuries in Lithotomy Position

Most Commmon: common peroneal (78%)

Etiology: compression

Risk Factors: low BMI, smoking, prolonged surgery

Manifestation: common peroneal is L4-S2, responsible for foot dorsiflextion and toe extension (thus leads to foot drop)

constructional apraxia .. non dominentbparaital lobe lestion.. inability to correctly copy or drow an immage

constructional apraxia - Google Search

dominent paraital d

lobe agrapia, acalculia, right left confution and finger agnasia

High cholesterol levels normally do not cause any symptoms. Yellow deposits of cholesterol-rich fat may be seen in various places on the body such as around the eyelids (known as xanthelasma palpebrarum), the outer margin of the iris (known as arcus senilis corneae), and in the tendons of the hands, elbows, knees and feet, particularly the Achilles tendon (known as a tendon xanthoma).[1][2]

The gene for beta thalassemia is not evenly distributed among peoples. It is, for example, relatively more frequent in people of Italian and Greek origin, both of which are peoples from the Mediterranean. Because of this, thalassemia major has been called Mediterranean anemia.

splinic haematoma

splenic haematoma - Google Search

HTN

increase ischeamic strok 4 to 6 fold

increase coronary heart dx 3 fold

increase oeripheral atery dx

increase AF 20%

polyatgeriyis nodosa affect medium size ateries . usually affect kidneys, gut, nerves, and often spating the lungs

thromboangitis obliterance

non atherosclerotic, segmental disease of smallnand medium zìse ateries.

alsomst individually seen in smokers

pai  associate with pulmonay embolism is pluretic

cardiac tamponade

Thursday, March 17, 2016

12:52 PM

elevetae CVP

engorge neck vein

cardiogenic shock

cardiac tamponade

elevetae CVP

engorge neck vein

cardiogenic shock

atypycal pneumonia

leginella sp

mycoplasma sp

clamidia sp

diarrhea, mild fever or hihh fever, no cxr sign

 Rx.. macroloid  aziyhromycin

Child-Pugh score

In medicine (gastroenterology), the Child-Pugh score (sometimes the Child-Turcotte-Pugh score) is used to assess the prognosis of chronic liver disease, mainly cirrhosis. Although it was originally used to predict mortality during surgery, it is now used to determine the prognosis, as well as the required strength of treatment and the necessity of liver transplantation

child _pugh classification

Thursday, March 17, 2016

4:16 PM

ruptured aortic anuerism pain may goes alone the back or down the genitalia

most common liver tumour is haemangeoma . its 20%

liver haemangeoma

liver hemangioma - Google Search

caeliac dx is a risk factor for primary Jejunal lympjoma

small bowl tumors

chron dx increase risk of adeno Ca of ilium in 100 fold

Thursday, March 17, 2016

5:26 PM

peutz-jeghers syndrome

familial adenomatusa poliposis is vincrese the risk of duodenal and small bowel caeven after total procto colecyomy

LAMIVUDINE

lamuvudine is  the drug of choice for chronic hepatitis B. withing 12 months is normalize liver enzymes and hustology

acalasia cardia

increase tone of splictor

bag like esophagus

acumilating liqvids

 regurgitation at night

Because of excellent results, a short hospital stay, and a fast recovery time, the primary treatment is considered by many to be a laparoscopic Heller myotomy and partial fundoplication.

pnematic dilatatiom also a primary treatment

 some time botululinum toxin use for sx unfit oatient

if thebpatient does not hv ca of head of pancreas , the liver paranchyma is like to be normal and the intra hepatic and and extra hepatic billiary tree wil be dialated

Budd Chiari syndrome

thrombosis of larger hepatic veins and vena cave

maybbe secodery to polycythemia

cause ascitisand cirrosis

x ray fx of adihision obstruction pf small bowel

dialated small bowel loop wiyhnfluid level

abscence distal large bowel gas

meckels divertivulitis ... vitello intestinal duct

contaning gastric epithilium or oancreatic tissue

cause irritation and bleeding

toxic megacolon is a complication of ulcerative colitis

Gallstone ileus is a rare form of small bowel obstruction caused by an impaction of a gallstone within the lumen of the small intestine. Such a gallstone is hypothesized to enter the gut lumen via cholecysto-enteric fistula. Large stones, >2.5 cm in diameter, are thought to predispose to fistula formation by gradual erosion through the gallbladder fundus.[1] Most commonly, obstruction occurs at the distal ileum (i.e. ileocecal valve), but can occur at almost any other location in the GI tract.[2]Classically there is obstruction/impaction about 60 cm proximal to ileocaecal valve.[

vericial bleeding due to cirrosis can be temporery prevent bybputting SengstKen Blakemore tube

fa,ilial adenomataus poliposis autosomal dominent

paget dx .. i

paget dx

ix.... punch bx

histo... pagets cells in dermis..large pale.. nuclead pleomophism

associate with ductal breast ca

if no mets.. go for breat consevative sx

sentinal node /lymphatic spread identified by dye injection or isotope injection

upper outer qudrant lobe  tummour of other breast following mastectomy would be new CA

benign ductal papiloma.. blood stain single duct

mammerly duct actasia... yellowish green toothpast like dischage..

 multiple duct

asssociate duct s dialatation

plasma cell mastitis=mammary ductbectasia

ectopic ACTHsecresion (small crll ca in lung) cause to HYPOCALEAMIA

adesons dx cause to HYPERKALEAMIA

only small cell ca of lung and CARCINOID TUMOUR secrete ACTH.. squarcell CA of lung never secret ACTH

small cel CA of lung secrete vasopressin/ADH  cause SIADH

hx of partial thyroidectomy.

repeat thyroidectomy is not good.. can damage all aa nerve and parathyroid..

 so go aheadwith radio active iodine

METFORMIN contraindicated for CRF pt

Rosiglitazone( group of thiazolidinedione) can worst heart failure

calcification seen in the upper part of each breat in mamogram typical of vasculer calcifiation..

Reasuar3nce is enough

causes for macrocytic anaemia - Google Search

causes for megaloblastic aneamia

pernicious

alcohol

ect

ITP

IgG act on  plt

meningococul and pneumococal vaccin should give justbafter splenecyomy

penicillin should be commence follwing URTI, who hs uunderwent splenectomy

ochidectomy..

reduce serumntestesterone in few hours.. cause mastitis,, gynaecomastia

cause hot flushes

UNTIL PROVEN OTHERWISE TESTICULER SWELLING ARE CA. SO DO USS FOR ALL

subacute combind degeneration of cord is due to vit B12deficiency. mostly affected in posterior colom. but lateralncolom also afecting

syringomyelia occur in cervical spine

cisplastin is the best chemotherpy drug for trsticuler tummor metastatics

b4 the start of acute epidimyoochitis you should take urine for culture

if pt presented with very high level of CK , history of taking statin, red colour urine and muscle weakness diagnosisis RABDOMYALIYIS

urinary shistosomiasis cause by s. haematobium and presented with haematurea

definitive host ..man specialy egypt and arica

other host

fresh water snal

s.masoni and s.japonicum cause gi dx and liver dx

brain area concern with memory supplied by posterior (vertebrobasilar) cerculation

Transient Globle amnesia 

sudder memory loss.. specialy after excesice

that clarify s

normal urinary excretion of protine for 24 jour is less tham 150g. DM can cause , glomerulerslerosis and microalbumiurea

cruch injury cause hyper kaleamia and ARF

cananball lung deposite usually due to GI cancers

for grafting cold storage time

open angle glaucoma vs closed angle glaucoma - Google Search

open angle glaucoma vs closed angle glaucoma - Google Search

cellulitis

The vast majority of cases of cellulitis are likely caused by Streptococcus pyogenes and, to a lesser degree, by Staphylococcus aureus.

Takayasu arteritis is a rare, systemic, inflammatory large-vessel vasculitis of unknown etiology that most commonly affects women of childbearing age. It is defined as "granulomatous inflammation of the aorta and its major branches

takayasu's ateritis

The initial "inflammatory phase" is often followed by a secondary "pulseless phase".[2] The "pulseless phase" is characterized by vascular insufficiency from intimal narrowing of the vessels manifesting as arm or leg claudication, renal artery stenosis causing hypertension, and neurological manifestations due to decreased blood flow to the brain.

diabetic amyotrophy - Google Search

Neuropathic arthropathy (or neuropathic osteoarthropathy), also known as Charcot joint (often "Charcot foot"), refers to progressive degeneration of a weight bearing joint, a process marked by bony destruction, bone resorption, and eventual deformity. Onset is usually insidious.

If this pathological process continues unchecked, it can result in joint deformity, ulceration and/or superinfection, loss of function, and in the worst-case scenario, amputation or death. Early identification of joint changes is the best way to limit morbidity.

Immunise - 4.19 Tetanus

Macular degeneration, also known as age-related macular degeneration (AMD or ARMD), is a medical condition which may result in blurred or no vision in the center of the visual field.[1] Early on there are often no symptoms. Over time, however, some people experience a gradual worsening of vision that may affect one or both eyes. While it does not result in complete blindness, loss of central vision can make it hard to recognize faces, drive, read, or perform other activities of daily life. Visual hallucinations may also occur but these do not represent a mental illness.[1]

maculer degenaration

Intermediate_age_related_macular_degeneration.jpg (400×343)

Giant Cell Arteritis (Temporal Arteritis)

Presentation

History

The onset of giant cell arteritis (GCA) may be either abrupt or insidious.[48] GCA may begin with constitutional manifestations such as anorexia, fever, malaise, myalgia, night sweat, and weight loss. These prodromal symptoms may occur for a few days and may even stretch out to weeks.

The most commonly reported symptoms in patients with GCA are as follows:

Headache (initial symptom in 33%, present in 72%)

Neck, torso, shoulder, and pelvic girdle pain that is consistent with polymyalgia rheumatica (PMR; initial in 25%, present in 58%)

Fatigue and malaise (initial in 20%, present in 56%)

Jaw claudication (initial in 4%, present in 40%)

Fever (initial in 11%, present in 35%)

Less common symptoms, which are almost never the presenting complaint, include the following:

Limb claudication (8%)

Transient ischemic attacks (TIAs) or stroke (4-7%)

Scintillating scotoma (5%)

Carpal tunnel syndrome (5%) or other peripheral neuropathies

Tongue or throat claudication (4%)

Diplopia or ptosis (2%)

Tongue numbness (2%)

Myelopathic symptoms (< 1%)

Affective or psychotic symptoms [51, 52]

Facial pain (rare)

Scalp necrosis (rare) [53, 54, 55, 56]

Tongue necrosis (rare) [57, 58]

Nonspecific symptoms of cough and sore throat occur in 17% and 11% of patients, respectively, but are rarely the presenting complaints. Amaurosis fugax occurs in 10% overall (initially in 2%), and some degree of permanent visual loss occurs in 8% (initial symptom in 3%).

Sjögren syndrome is a systemic chronic inflammatory disorder characterized by lymphocytic infiltrates in exocrine organs. Most individuals with Sjögren syndrome present with sicca symptoms, such as xerophthalmia (dry eyes), xerostomia (dry mouth), and parotid gland enlargement, which is seen in the image below. (See Presentation.)

n addition, numerous extraglandular features may develop, such as the following:

Arthralgia

Arthritis

Raynaud phenomenon

Myalgia

Pulmonary disease

Gastrointestinal disease

Leukopenia

Anemia

Lymphadenopathy

Neuropathy

Vasculitis

Renal tubular acidosis

Lymphoma

About 50% of patients with Sjögren syndrome have cutaneous findings, such as dry skin (xeroderma), palpable and nonpalpable purpura,

Pulmonary function

Maximal inspiratory pressures and vital capacities are measurements of neuromuscular respiratory function and predict diaphragmatic strength. Maximal expiratory pressures also reflect abdominal muscle strength. Negative inspiratory force (NIF) is a relatively easy bedside test to measure respiratory muscle function. Normal is usually greater than 60 cm water. If the NIF is dropping or nears 20 cm water, respiratory support needs to be available.

lithium level monitoring

40% of transplant resepient wi devolop malignanviesnin 10 years

drug interation of OCP

higher dose (50micg ethileostrodiol)of estradiol should use when  using anti epileptic drugs

when u use broad spectum antibiotic , absobtion of OCP may be reduce and backup metherd should use till 1 week after ab therapy

focal migrain is a contra indication for OCP,

but generalize megrain i s relative contraindication only

contra indication for OCP

IHD

CVA

significant HTN

aterial or venous thombosis

inherited pro yjombotic tendoncy

acute sever liver dx

 oestrogen dependent CA .. eg,, breat ca

 focal migrain

positivebhealth nemifit of OVP

reduce menstrual bleading

improve premenstrual syndrome

reduve risk kf PID

protection agenst ovarian and endometrial ca ,,page 62 gyn

tx for acne

progesterne only pills ..mini pills

Wednesday, March 23, 2016

2:53 PM

there pills work  y local effect on cervical mucus(making it hostile to assending sperm)

and the endometrium(making it thin and atropic) causing prevent implNtation

failiur rate of progestrerone only pills greater than OCP

pop only pills

indi ations

1.breast feeding

2.older age

3.cvs rick

4.Dm

ingectable progesterone

depo provera od DMPA evry 12 to 13 weeks

noregisron enanthat  8 weeks

PID following gyneacologival procedure its due to , clamida,normal vaginal patjogeons and E coli

clamimydial infection is common following a termination of pregnancy

pCOS

menstrual irregulerrities

sign of androgen axcess

obeysity

Insuline resistance

elevated serum LH

type 2 DM

cardiovasaculer events

cervical ectropion

singal layer of colomner cell contain endocervix , has extendeded on to ectocervix.

this cause to traumatize the cervix and post coital  bleeding