سوالف طبية

Retained Foley’s Catheter

The consistence of a lump depends not only upon its structure but also on the tension within it. Some fluid-filled lumps are hard, some solid lumps are soft; therefore, the final decision about composition of a lump (i.e.whether it is fluid or solid) rarely depends solely upon an assessment of the consistence.

ATLS guidelines 8th edition In a hemodynamically stable patient with abdominal trauma, the investigation of choice is CECT (contrast enhanced CT scan) In a hemodynamically UNSTABLE patient with suspected abdominal trauma, the investigation of choice is FAST (focussed abdominal sonogram in trauma).

Pediatric / Neonate Doses 💯

During open hernia repair, the ilio-inguinal nerve is the most commonly injured . while the lateral femoro-cutaneous nerve is more commonly injured during laparoscopic herniorraphy . وهالشي يسبب Post Herniorrhaphy Groin Pain

Primary amenorrhea : absence of mens at age 14 without 2ry sexual development or 16 with 2ry sexual development Clinical approach رح نعتمد على شيئين -anatomic يعني اكو uterus لو لا -hormonal : يعني اكو breast لو لا (باعتبار اذا اكو بريست يعني اكو استروجين) …….. If breast ✅…. Uterus ✅ Ddx➡️ imperforated hymen, vaginal septum, pregnancy If breast ✅ uterus ❌ Ddx: mullarian agenesis testicular femminisation If breast❌….uterus ✅ Ddx: turner’s syndrome Kallman syndrome

Infection cause miscarrigae in ; First Trimester is Varicella and rubella Second Trimester is bacterial vaginosis

النقطة الثانية اهنا بس تعديل عليها Mean sac diameter ; 1- More than 25mm in transabdominal u/s 2- More than 18mm in transvaginal u/s 3- less than 4mm growth in 7 days + abscense of embryo

⚫️ Cx of surgical Management include : - Risk of GA - infection - Retained Products of Conception - Bleeding ( that’s why we give Methergine after the procedure) - Asherman Syndrome ( infertility) - Perforation

⚫️ Expectant Management of Miscarriage depends on : - Earlier Gestation - Singleton pregnancy - Social Circumstances - Counseling

⚫️ Always Remember Imagining Criteria to diagnose nonviabiality include : - Crown rump length of 7mm or more + no fetal heartbeat - mean sac diameter of 25mm or more + absence of an embryo

Cervical incompetence: السيرفكس راخي مديلزم روحه -Causes..➡️congenital weakness, acquired due to injury, cone biopsy, D&C -Dx: history of recurrent 2nd tri mes. ويكون تنازلي + U/S (less than25 length) MX➡️ cerclage elective at 13 wk removed at 37wk Emergency at 22wk Types of operation…➡️shirodkar التيب العريض •Mcdonald ابو النجمة •trans abdominal cerclage Contraindications of cerclage -bleeding -rupture membrane -uterine contractions Complications -suture disruption, -rupture membrane, -chorioamnonitis * when to remove : - at 37wk -whenever labour occurs -rupture membrane - evidence of uterine infection

2nd trimester miscarriage -when… ➡️ 12-24 wk (قبلها يعتبر 1st وراها يعتبر preterm labour) -cause…➡️ 12-15wk مثل الفرست اذا اكثر بيها 6 اسباب •ascending infection •cervical incompetence •intrauterine bleeding •epidemiology causes •increase maternal age •amniocentesis ( نسويه بعمر ال16-18 wk) Classification…➡️ threatened,missed, inevitable, septic -Tx ➡️supportive, antibiotics, tocolytics هاي كلاوات متفيد

Causes of recurrent miscarriage - structural •fetal chromosomal abnormalities • paternal chromosomal abnormalities -anatomical • uterine abnormalities ( septate most common) • cervical causes (2nd trimester) • asherman syndrome •acquired like fibroid -thrombotic •anti phospholipid syndrome (15% of RPL Tx by low dose aspirin) • thrombophilia (Tx By LDA) -immunological •anti thyroid Ab •Natural killer cells (Tx by Low dose prednisone) -endocrinological • PCOS • thyroid • DM -infection • bacterial vaginosis ( 1st tri loss & risk factor for 2nd tri loss & preterm labour) -endometrial causes (tx by aspirin, progesterone, HCG) -environmental • smoking and alcohol • pollutants -psychological

DDX of early pregnancy bleeding : -miscarriage -ectopic pregnancy - H.mole -red degeneration of fibroid -rupture ovarian cyst -polyp