Notes

Outline

U.S.M.L.E STEP1 DANIL HAMMOUDI.MD SINOE MEDICAL ASSOCIATION

Iron deficiency anemia Increased free erythrocytes protporphyrin [FEP] Increased iron binding capacity

In  a non stimulated cycle, the maximum normal size of the dominant follicule prior to ovulation is: 25mm

Higher than normal level of chorionic [Hcg] are seen in Multiple gestation

The most common complication of pregnancy Spontaneous abortion

Causes of spontaneous abortion include Leiomyomas Trisomies Viral infection Antiphospholipid syndrome

Spontaneous abortion occurs Sporadically reccurently

Spontaneous abortion Chromosomal abnormalities have been identified in up to 60% of spontaneous aborted fetus Chromosomal defects are seen commonly in spontaneous abortion , especially those that occur between 4 and 8 weeks gestation

Spontaneous abortion The aging oocyte has been identified as the primary cause of spontaneous abortion

Complication of spontaneous abortion Complications of anesthesia Post abortion triads Hematometra Hemorrhage Retained products of conception Uterine perforation Bowel or bladder injury Failed abortion Septic abortion Cervical shock Cervical laceration Dic

Pathophysiology mechanism of complicaion abortion Incomplete evacuation and uterine atony , which lead to hemorrhagic complication Infection Instrumental injury

Complication of abortion signs Vaginal bleeding Severe abdominal cramping Abdominal or back pain Passage of large blood clots Vaginal discharge with foul odor fever

Hydatiform moles Previous mole results in an increased risk for reccurence It is associated with markettely elevated hCG levels The sonographic appearance is similar to a degenerating myoma They are often associated with theca lutein cysts

In the twin to twin transfusion syndrome , abnormalities in fetal growth and development can occur, these change are represent by : Evidence of IUGR in one fetus

Hydradinitis suppurativa Disease of apocrine sweat glands that involves axillas, inguinal and the pubic area

Labial adhesion in infants is best treated with Estrogen cream

Anencephaly is associated with Prolonged labor and postmaturity

Anencephaly associated with Polyhydramniosis Elevated alpha fetoprotein Spina bifida meningomyelocele

The most common cause of anterior uveitis is: idiopathic

Chediak higashi syndrome Autosomal recessive disorder Tendency to develop repeated infections Oculocutaneous albinism Neutropenia Abnormal white blood cells Cranial and peripheral neuropathy Deficiency secretion of myeloperoxidase by lysosomes [degranulation disorder] Death before age 10

Chediak higashi cause of death Bacterial infection Hemorrhage Lymphoma development

Both male and female are affected equally in : Autosomal dominant

Treated with chemotherapy Ewing’s tumor Rhabdomyosarcoma Testicular teratoma Acute lymphoblastic leukemia in children

Vomiting in the first day of life [ immediately after birth] in a new born is more likely to be caused Volvulus Meconium ileus Duodenal atresia Annular pancreas

String sign on x ray is associated with: Pyloric stenosis/ Crohn colitis

Causes of erythema nodosum Sarcoidosis Laptospirosis Crohn’s disease Visceral malignancies

Following are absolute contreindications for birth control pills: Coronary artery disease Impaired hepatic function Thromboembolic disease Breast cancer

Alkaptonuria [ochronosis] is due to deficiency of the enzyme: Homogentistic oxidase

Primary syphilis is characterized by Indurated, painless ulcer [chancre]

Management of severe bilateral renal artery stenosis should include Surgery Weight reduction Ptca [angioplasty]

Cause of peripheral cyanosis Mitral stenosis Venous stenosis Arterial stenosis Congestive heart failure

Etiology of cardiogenic shock 1/ Acute or successive myocardial infatction 2/ Inadequate ventricular function 3/ Cardiac obstruction or compression

ACUTE OR SUCCESSIVE MYOCARDIAL INFARCTION CARDIOGENIC SHOCK ETIOLOGY I] DEPRESSED LEFT VENTRICULAR FUNCTION VENTRICULAR SEPTAL RUPTURE ACUTE MITRAL REGURGITATION RIGHT VENTRICULAR INFARCTION

INADEQUATE VENTRICULAR FUNCTION TACHY OR BRADYARRHYTHMIAS MYOCARDITIS/CARDIOMYOPATHY HYPOVOLEMIA DRUGS : BETA ADRENERGICS CALCIUM CHANNEL BLOCK ANTIARRHYTHMICS NITRATES SEVERE VALVULAR HEART DISEASE AORTIC STENOSIS MITRAL STENOSIS AORTIC REGURGITATION MITRAL REGURGITATION

CARDIAC OBSTRUCTION OR COMPRESSION PERICARDIAL TAMPONADE OR CONSTRICTION SEVERE PULMONARY HYPERTENSION [PULMONARY EMBOLISM] ATRIAL MYXOMA HYPERTROPHIC CARDIOMYOPATHY

CAUSE OF BLADDER CARCINOMA INCLUDE SMOKING NAPHTYLAMINE SCHISOSTOMIASIS CYCLOPHOSPHAMIDE CHRONIC CYSTITIS NITROSAMIDES PELVIC RADIATION THERAPY

DEATH FROMDIABETES IS USUALLY DUE TO CORONARY ARTERY DISEASE

CAUSE OF PAINFUL RED EYES CORNEAL ULCER ACUTE IRITIS ACUTE GLAUCOMA FOREIGN BODY

THE DIAGNOSIS OF MYCOSIS FUNGOIDES [CUTANEOUS T CELL LYMPHOMA ] IS CONFIRMED BY: SKIN BIOPSY

PERICARDIAL TAMPONADE MUFFLED HEART SOUNDS

Slide 41

Ulcerative colitis Inflammatory disease of the large bowel Begins in rectum and extend in continuity to the left colon [10% involvement of the ileum] 45-50% rectum , rectum sigmoid, 20% entire colon 10% backwash ileitis Punctate hemorrhage and ulcerations Ulceres extend laterally to the submucosa Creation of bridges = pseudopolyps No fistula no fissures friability

Ulcerative colitis Friability Acute colitis with acute cryptitis Crypt ulceration and crypt abscess formation Granulomas are not present with chronicity Mucosa thin and atrophic

Ulcerative colitis inflammation involves Mucosa Submucosa Muscularis and mesentery none affected Bowel wall none thickened Entire large bowel can be involved Small intestine rarely involved

Ulcerative colitis Diffuse infiltrate of lymphocytes, plasma cells, histiocytes, present in the lamina popria The hallmark of active disease is:  a neutrophilic infiltrate in the lamina propria , walls of crypts [cryptitis] Crypt lumen [crypt abscess]

Ulcerative colitis Bloody diarrhea Stringy mucous Cramps Lower abdominal pain Fever 75% mild and readily controlled medically

Ulcerative colitis fulminant course 25% Fluid/electrolytes imbalance Systemic toxicity Toxic megacolon

Types of ulcerative colitis Ulcerative proctitis Proctosigmoditis Left sided colitis Pan ulcerative colitis

Ulcerative colitis: extracolonic manifestations Iritis Erythema nodosum Pyoderma gangrenosum Perocholangitis Chronic active hepatitis Primary sclerosing cholangitis Fatty liver Spondylitis Peripheral arthritis Coincidental rhumatoid arthritis Thrombotic complications

Slide 50

Ulcerative colitis

Ulcerative colitis

Ulcerative colitis

Ulcerative colitis