dubble buble appearance in duodènal atresia

Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is the most common cause of intestinal obstruction in infancy.

Hypochloremic, hypokalemic metabolic alkalosis is the classic electrolyte and acid-base imbalance of pyloric stenosis. Persistent emesis causes progressive loss of fluids rich in hydrochloric acid, which causes the kidneys to retain hydrogen ions in favor of potassium.

obstetric cholestasis has 3 clssical triaed

1, hight bile acid

2.high conjugated bilirubin

3.high ALP

its a self controling dx and presented with mild itching ,jandice and dark colour urine

but Acute fatty liver of pregnancy more  viriulant dx.

 presented witj sever vomiting in late pregnacy

acyclovior not teratogenic. famciclovir not use in prrbnancy

cluster headache

specially for young men

unilayeral

lasted for 1 to 2 hour

sever headache

agitation

daily occur for 3 months

then remission for 1 year

 again start in next year

 autonomic association of trigeminal nerve

treatment

oxigen

verapamil

infantacide and suicide are very rare in postpartem psycosis

there is no relationship witj postpartum psycosis and still birth,breast feeding,twin pregnancies,

more commn in primi

normal i cidence in 1 in 1000

 in second pregnacy 20% chance

olanzipne nad respiridone  use wih Li

intracranial problem such as cluster migrainnheadache,cerebral tumours,in the middle cranial fossa may produce a postganglionic honer syndrome

of uss scan sugest testivuler ca do

1.serum B hcG

2.alfa feto protein

acute gout tx is indomethacine 50mg tds

when renal gunction and cardiac funtion not optimise dont tx with NSAiD

allopuranot contraindicated in acute gout

also not start till 4 weeks after acute attack

prednosolon 50mg daily for 5 days is hood alternative for indomethacine

Cluster headache (CH), also known as histamine headache, is a primary neurovascular headache disorder, the pathophysiology and etiology of which are not well understood.

cluster h3adache

The patient experiences attacks of severe or very severe, strictly unilateral pain (orbital, supraorbital, or temporal pain) that last 15-180 minutes and occur from once every other day to 8 times a day

The attacks are associated with 1 or more of the following (all ipsilateral): conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, or eyelid edema

Attacks of cluster headache (CH) are typically short and occur with a clear periodicity, particularly during sleep or early morning hours, usually corresponding with onset of rapid eye movement (REM) sleep.[5, 9] Unlike migraine, CH is not preceded by aura and is not usually accompanied by symptoms such as nausea, vomiting, photophobia, or osmophobia. Typically, a patient experiences 1-2 cluster periods per year, each lasting 2 weeks to 3 months.

Induced delusional disorder (or shared paranoid disorder), also known as folie à deux, is a fairly uncommon disturbance characterized by the presence of similar psychotic symptoms in two or more individuals. Most often the symptoms are delusional.

Antenatal syphilis poses a significant threat to the pregnancy and fetus. T. pallidum readily crosses the placenta, resulting in fetal infection. Vertical transmission can occur at any time during pregnancy and at any stage of syphilis.[6] Risk of transmission correlates with the extent of spirochetal presence in the circulation. Vertical transmission of syphilis is more common in primary (50%) and secondary syphilis (50%), compared with early latent (40%), late latent (10%), and tertiary syphilis (10%). Seventy to one hundred per cent of infants born to untreated infected mothers are infected. Pregnancies complicated by syphilis may result in intrauterine growth restriction, non-immune hydrops fetalis, stillbirth, preterm delivery, and spontaneous abortion in up to 50% of pregnancies. Women who had documented treatment for syphilis in the past do not need treatment during current or subsequent pregnancie

Disseminated intravascular coagulation (DIC) is characterized by systemic activation of blood coagulation, which results in generation and deposition of fibrin, leading to microvascular thrombi in various organs and contributing to multiple organ dysfunction syndrome (MODS)

It is also important to note that the PT, not the international normalized ratio (INR), should be used in the DIC monitoring process; INR is recommended only for monitoring oral anticoagulant therapy

It is also important to note that the PT, not the international normalized ratio (INR), should be used in the DIC monitoring process; INR is recommended only for monitoring oral anticoagulant therapy

generalize anxiety disoder

Generalized anxiety disorder (GAD) is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry, that is, apprehensive expectation about events or activities.[1] This excessive worry often interferes with daily functioning, as individuals with GAD typically anticipate disaster, and are overly concerned about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties.[2][3] Individuals often exhibit a variety of physical symptoms, including fatigue, fidgeting, headaches, nausea, numbness in hands and feet, muscle tension, muscle aches, difficulty swallowing, excessive stomach acid buildup, stomach pain, vomiting, diarrhea, bouts of breathing difficulty, difficulty concentrating, trembling, twitching, irritability, agitation, sweating, restlessness, insomnia, hot flashes, rashes, and inability to fully control the anxiety

treatment for GAD

An international review of psychiatrists' management of patients with generalized anxiety disorder (GAD) reported that the preferred first-line pharmacological treatments of GAD were selective serotonin reuptake inhibitors (SSRIs) (80%), followed by serotonin–norepinephrine reuptake inhibitors (SNRIs) (43%), and pregabalin (35%). Preferred second-line treatments were SNRIs (41%) and pregabalin (36%).[34

both cognitive behavioral therapy (CBT) and medications (such as SSRIs) have been shown to be effective in reducing anxiety. A comparison of overall outcomes of CBT and medication on anxiety did not show statistically significant differences (i.e. they were equally effective in treating anxiety)

defence mechanism

Splitting: A primitive defence. Both harmful and helpful impulses are split off and unintegrated, frequently projected onto someone else. The defended individual segregates experiences into all-good and all-bad categories, with no room for ambiguity and ambivalence. When "splitting" is combined with "projecting", the undesirable qualities that one unconsciously perceives oneself as possessing, one consciously attributes to another

Scarlet fever (known as scarlatina in older literature references) is a syndrome characterized by exudative pharyngitis (see the image below), fever, and bright-red exanthem. It is caused by streptococcal pyrogenic exotoxins (SPEs) types A, B, and C produced by group A beta-hemolytic streptococci (GABHS) found in secretions and discharge from the nose, ears, throat, and skin. Scarlet fever may follow streptococcal wound infections or burns, as well as upper respiratory tract infections. Food-borne outbreaks have been reported.[

Alcohol

Alcohol passes easily through the placenta from the mother's bloodstream into the bloodstream of the fetus. Unlike adults, a fetus does not yet have a blood filtration system, and is therefore unprotected from the effects of alcohol.[4]

Potential Effects

In the first two weeks following fertilization, maternal alcohol consumption may prevent proper implantation of the fertilized egg, usually terminating the pregnancy before the mother realizes she is pregnant.[5]

Potential problems during pregnancy:

Decreased fetal breathing

Delayed development of the nervous system [4]

Facial feature abnormalities, especially during the third through sixth weeks following fertilization

Beginning in the fourth week - rapid cardiac development. Exposure to alcohol may result in atrial and/or ventricular abnormalities, issues with valve formation, and a potential increase in the risk for heart disease in adulthood.

Sixth and seventh weeks - the corpus callosum, the structure that divides the left and right hemispheres of the brain and is responsible for communication between the two hemispheres, is most vulnerable to alcohol exposure. Exposure to alcohol may lead to its incomplete development, thus resulting in issues with neural communication.

After 8 weeks gestation, the fetus is not as vulnerable to organ-specific birth defects. The central nervous system overall, however, remains vulnerable, as well as the overall growth of the fetus.

Infertility, miscarriage, stillbirth, low birth weight, preterm delivery [5]

Potential effects in children exposed to alcohol during prenatal development:

Development of a Fetal Alcohol Spectrum Disorder

Neurological disorders - ranging from attention deficit disorder (ADD), hyperactivity, mood disorders

Impaired attention, learning, memory, and information processing

Poor bonding and difficulty forming social relationships

Higher rates of antisocial and delinquent behaviors

Difficulty with executive functions

Very high risk of mental health disorders (92% of people diagnosed with Fetal Alcohol Spectrum Disorders have also been diagnosed with a mental health disorder) [6]

Fetal Alcohol Spectrum Disorder: and umbrella term used to describe a variety of potential outcomes for prenatal exposure to alcohol. These outcomes include -

Fetal Alcohol Syndrome (FAS)

Partial Fetal Alcohol Syndrome

Alcohol-Related Neurodevelopmental Disorder (ARND)

Fetal Alcohol Effects (FAE)

Alcohol Related Birth Defects (ARBD) [6]

Recreational drugs

Recreational drug use during pregnancy can cause various pregnancy complications.

Cannabis

Main article: Cannabis in pregnancy

Cannabis in pregnancy is the subject of various scientific studies, usually regarding whether it has effects on the child later in life.

Smoking

Main article: Smoking and pregnancy

A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers, and that it contributes to a number of other threats to the health of the fetus.[7][8] Smoking and pregnancy, combined, cause twice the risk of premature rupture of membranes, placental abruption and placenta previa.[9] Also, it causes 30% higher odds of the baby being born prematurely.[10]

Others

Prenatal cocaine exposure is associated with, for example, premature birth, birth defects and attention deficit disorder.

Prenatal methamphetamine exposure can cause premature birth and congenital abnormalities.[11] Other investigations have revealed short-term neonatal outcomes to include small deficits in infant neurobehavioral function and growth restriction when compared to control infants.[12] Also, prenatal methamphetamine use is believed to have long-term effects in terms of brain development, which may last for many years.[11]

Marijuana can cause low birth weight, tremors, poor eyesight, late start of breathing, and a hole in the heart. In the first six months of life babies who have been exposed to marijuana have a higher chance of having breathing problems such as asthma, chest infections, and wheezing. By the age of three or four the child might be fearful, reckless, inattentive, restless, irresponsible, and may have poor memory, verbal, and reasoning ability; at age ten these problems can continue along with depression, anxiety, reading and spelling problems

Alcohol-related dementia (ARD) is a form of dementia caused by long-term, excessive consumption of alcoholic beverages, resulting in neurological damage and impaired cognitive function.

The three components of the classic triad of WE are encephalopathy, ataxic gait, and some variant of oculomotor dysfunction. However, a complicating factor of WE identification is that its presentation may not be associated with the classical clinical triad in up to 90% of patients.

Consideration for WE should be given to patients with any evidence of long-term alcohol abuse or malnutrition and any of the following: acute confusion, ataxia, ophthalmoplegia, memory disturbance, hypothermia with hypotension, and delirium tremens.

cealiac dx

Diagnostic

Serology for anti-tTG antibodies has superseded older serological tests (anti-endomysium, anti-gliadin, and anti-reticulin) and has a strong sensitivity (99%) and specificity (>90%) for identifying coeliac disease. Modern anti-tTG assays rely on a human recombinant protein as an antigen.

uss finding of cholecystitis

The most sensitive US finding in acute cholecystitis is the presence of cholelithiasis in combination with the sonographic Murphy sign. Both gallbladder wall thickening (>3 mm) and pericholecystic fluid are secondary findings.

Other less specific findings include gallbladder distension and sludge.

Every effort should be made to demonstrate the obstructing stone in the gallbladder neck or cystic duct.

The term intestinal pseudo-obstruction denotes a syndrome characterized by a clinical picture suggestive of mechanical obstruction in the absence of any demonstrable evidence of such an obstruction in the intestine

Capture Mar 3, 2016

Rectus sheath hematoma (RSH) (see the image below) is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric arteries or their branches or from a direct tear of the rectus muscle

Oculomotor palsy can be of acute onset over hours with symptoms of headache when associated with diabetes Mellitus. Diabetic neuropathy of the oculomotor nerve in a majority of cases does not affect the pupil.[2] The sparing of the pupil is thought to be associated with the microfasciculation of the edge fibers which control the pupillomotor fibers, which control the pupil

Malingering is fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation (often tied to fraud); avoiding school, work or military service;

A factitious disorder is a condition in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms. Factitious disorder imposed on another is a condition in which a person deliberately produces, feigns, or exaggerates the symptoms of someone in his or her care.

Somatization disorder (also Briquet's syndrome) is a mental disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms.

Stable Child - Vagal Manoeuvres And Adenosine

Vagal manoeuvres. Valsalva if child old enough; gag or icepack/iced water for infants - apply to face for a maximum of 30 seconds. Do not use eyeball pressure.

Hydrops fetalis (fetal hydrops) is a serious fetal condition defined as abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin

Cancer antigen 15-3 (CA 15-3) is used to monitor response to breast cancer treatment and disease recurrence

CA 15-3 levels are most commonly used to monitor metastatic breast cancer during active therapy.

seminoma managemet

In testicular seminoma, orchiectomy provides both diagnosis and therapy. Orchiectomy alone cures most stage I seminomas. To prevent relapse, the following are standard options in stage I disease[6] :

Surveillance

Single-agent carboplatin

Radiotherapy

Preferred treatments for more advanced stages are as follows:

Stage IIA - Radiotherapy

Stage IIB - Chemotherapy with etoposide and cisplatin (EP) or bleomycin, etoposide, and cisplatin (BEP) 

Stage IIC, III - Chemotherapy with EP or BEP

After treatment, patients require lifelong follow-up. Surveillance includes the following, with the frequency determined by disease stage and duration of follow-up:

History and physical examination

Serum tumor markers (beta-hCG, LDH, AFP)

Chest radiography

CT scan of the abdomen, with or without CT scan of the pelvis

Non-contraceptive use

The hormones in "the Pill" have also been used to treat other medical conditions, such as polycystic ovary syndrome (PCOS), endometriosis, amenorrhea, menstrual cramps, adenomyosis, menorrhagia (excessive menstral bleeding), menstruation-related anemia and dysmenorrhea (painful menstruation).[

Tourette syndrome (also called Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome, GTS or, more commonly, simply Tourette's or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical (motor) tics and at least one vocal (phonic) tic. These tics characteristically wax and wane, can be suppressed temporarily, and are preceded by a premonitory urge. Tourette's is defined as part of a spectrum of tic disorders, which includes provisional, transient and persistent (chronic) tics.

Tourette (too-RET) syndrome is a disorder that involves repetitive movements or unwanted sounds (tics) that can't be easily controlled. For instance, you might repeatedly blink your eyes, shrug your shoulders or blurt out unusual sounds or offensive words.

Tics typically show up between ages 2 and 15, with the average being around 6 years of age. Males are about three to four times more likely than females to develop Tourette syndrome.

CDC recommends azithromycin and doxycycline as first-line drugs for the treatment of chlamydial infection.[33, 40] Medical treatment with these agents is 95% effective. Alternative agents include erythromycin, levofloxacin, and ofloxacin.[33] Rifalazil, a rifamycin that is highly active against C trachomatis and has a long half-life, has shown promise as a single-dose treatment for chlamydial nongonococcal urethritis and is currently being evaluated in women with uncomplicated genital infection.[48]

For many years, standard therapy for uncomplicated genital tract infection has been doxycycline 100 mg orally twice daily for 7 days. However, azithromycin given as a single 1-g dose is as effective as a 7-day course of doxycycli

Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria. The etymology behind the term "clue" cell derives from the original research article from Gardner and Dukes describing the characteristic cells. The name was chosen for its brevity in describing the sine qua non of bacterial vaginosis.[1]

They are a medical sign of bacterial vaginosis, particularly that caused by Gardnerella vaginalis,[2] a

Tinea is the name of a group of diseases caused by a fungus. Types of tinea include ringworm, athlete's foot and jock itch. These infections are usually not serious, but they can be uncomfortable

types of tinea infections - Google Search

types of tinea infections - Google Search

Dermatophytes are fungi that require keratin for growth. These fungi can cause superficial infections of the skin, hair, and nails.

dermatopytes are group of three types of fungus that commonly causes skin disease in animals and humans.[1] These anamorphic (asexual or imperfect fungi) genera are: Microsporum, Epidermophyton and Trichophyton.

discoid rash in SLE

vestibuler neuraiyis is NOT associate wiyh hearing loss

osteosclerosiss  FAMILIAL. and 2 thired of them are familial

iucd contraindicated for nullyparus due to increse std risk

herpes zoster ,,shingles,,

virus doment in sensory nerve root ganglian

AMITRIPTALIN inhibit the nociceptive sihnals

helpfu

 ajuant therpy even old (90yers )patientbwith  shingals

dosal roit ganglian can be afected encluding cranial nerve

ramsay hunt syndrom(genecu

ate ganglian)

opthalmic herpes, oropharyngial herpes

shingle valata astralia denne famciclovior or acyclovior

senna for chronic constipation

honers syndrome... ehe passata yanava

Enophthalmos is the posterior displacement of the eyeball within the orbit due to changes in the volume of the orbit (bone) relative to its contents (the eyeball and orbital fat), or loss of function of the orbitalis muscle.

pancoast syndrome due to apiacal lung CA

fx

T1 motor imparement ,, ulnar paralise small muscle of hand are gone ,, interosis, thena and hypothena

T1 sensory impare ment.. medial aspect of arm above elbow

comonest cose for die due to schizophrenia is CORONARY HEART DISEASE

prostino2 =Levenogesterone

prosteno 2 is failed to prevent 2 to 3 % of pregnacies,

if it use in first 8 days  of m cycle it wil bleed withing next 3days..

 but if prostino use in mid cyvle , it wont cause  bleeding till day 28

Laparoscopic cardiomyotomy is the best long term treatment for acalasia cardia

pneumatic dialatation, Ca channel nlockers, botilineum toxin are temporory mesures

pregnancy with verocose of vulva.. treat with vulval pad and stockings

erly pregnanacy wil give you very high value of  LH. why?

sub unit of beta hcg falsy mesure as LH  in most assey

second trimester , stage 1 breast CA .. mx would be definive sx

if u suspect oesophagial rupture UGIE is contra indicated b4 contrast study ct

acute oyitis media is most of the time due to viruses like RSV,Rhino virus, bac, pneococcus,H,influenza,Moraxella catarralis

factitious disoder

simulating or pretending of symptoms to gain medical attentionand treatment

decubetus contractures can be due to alcohol, long term drug using..eg.maxalon

camptodactyly is cingenital contraction of little finger

Hansen disease=Leprasy

can cause claw hand

seborrhetic keratosis

Dermatofibroma (superficial benign fibrous histiocytoma) is a common cutaneous nodule of unknown etiology that occurs more often in women. Dermatofibroma frequently develops on the extremities (mostly the lower leg

footling breech - Google Search

Types of breeches

See the list below:

Frank breech (50-70%) - Hips flexed, knees extended (pike position)

Complete breech (5-10%) - Hips flexed, knees flexed (cannonball position)

Footling or incomplete (10-30%) - One or both hips extended, foot presenting

Contraindications for external cephalic version

Absolute contraindications for ECV include multiple gestations with a breech presenting fetus, contraindications to vaginal delivery (eg, herpes simplex virus infection, placenta previa), and nonreassuring fetal heart rate tracing.

Relative contraindications include polyhydramnios or oligohydramnios, fetal growth restriction, uterine malformation, and major fetal anomaly.

induction of labour is best avoided in brech presentation

plantar dorsiflexion - Google Search

nerve supply of lower limb - Google Search

gynaecomastia

always look for testivuler tumours, pitutary T, adrenal T

other vause

anabolic steroid that use for muscle building

marijuan

spiaranolactone

alpha methyl dopa

obeysity

acute gout

initially treated with indomethacinen50mg tds for 4days

once reduce symptoms reduce indomethcine dose to 25mg tds for few days

after 1 or 2 weeks start allopurinol or colchicine  0.5mg bd

risk fators

 alcohol

trauma to joint

beckwith-wiedmann syndrom

hemi hypertopy of body

associate with willms tumour

ASD is a soft mid systolic mour hear uper left sternal edge

pseudomembranes colitis occur afteruse of iratinal antibiotics. eg. amoxacilin, chephalosporin,clindamycin

pt presented with abdominal cramp and lose stool,.. spevially old people

ichemic clitis

ischemic  colitis

occu4 in elderly patients

affecting the splenic plexure and decending colon

due to thombo embolism of cardiac causes

sepsis, hotention

pseudomembranus colitis due to clostredium deficile

gram positive

treated with metronidazole

cipro good for travelers diarrea..eg,.. shigella,, salmonella

moloscum contagiosum is due to pox virus

no treatmeny..conservative mx