Basma - Data - Sem 8

اقرأوا بقي 🔪

Nipple Retraction = Inverted nipple = Invaginated nipple - A condition in which the nipple instead of pointing outward is retracted into the breast - Both women and men can have retracted nipple - Occur due to fibrosis and infiltration of the main milk duct - Causes :- - Since born , traumatic fat necrosis - Scars , after surgery , breast cancer - Mastitis carcinomatosis , Paget’s disease - Mammary duct ectasia , breast abscess and mastitis - Grading system :According to how easily the nipple may be protracted, the degree of fibrosis in the breast, degree of milk duct affection and possibility of breast feeding • Grade 1 :Nipple is easily pulled out by fingers , milk ducts aren’t compromised and breast feeding is possible - Sometimes called “Shy nipple “ 🙈 • Grade 2 : Nipple can be pulled out by fingers but not as easily as grade 1 and retract again after pressure is released , breast feeding is possible but baby latch may be difficult after labor • Grade 3 : Severly retracted nipple , Rarely can be pulled out physically , milk ducts are often constricted and breast feeding is difficult - Women with grade 3 nipple retraction have nipple hygiene problems and recurrent infections - Treatment is determined according to grade of nipple retraction - Methods of treatment includes 1. Hoffman technique : Manual home methods for nipple drawing out 2. Suction devices 3. Ashford operation 4. Surgical lifting of the nipple outside the breast 5. Treatment of the cause of present

هم نفس ال items بس برتبهم زي ما متعودة في باقي البرانشات احفظهم زي ما حب A B C D & Level of consciousness , orientation & Vital signs & Head and neck & extremities & abdominal examination & LN ........... Appearance ill & well B uilt ( over / under / average) & nutritional state :- Fat>> suprapupic skin fold ( normal < 1/2 inch )// Axillary ( <1 inch) // Tricips ( 1.5 inch) C omplexion اعرف أسباب ال jaundice في الشيست D ecubius & A ttitude الفرق ال decubitus و هو في السرير لكن ال attitude و هو ماشي أو وقفته اعرف دول و أسبابهم -Orthopnea -Platypnea ( only Pulmonary diseases) -Trypopnea -Talypnea Level of consciousness ليه مهم نعلق عليه ؟ عشان بيحدد ال severity of lung diseases بمعنى لو pneumonia و عنده loss of consciousness ده لازم هيتجحز عكس درجات أخف ممكن علاجه في البيت و هكذا.. ده مثال ، و لأن فيه أمراض بتأثر ع المخ و الوعي زي TB و cancer لما يعملوا metastasis Vital signs زي أي كتاب عادي بس اعرفوا الأرقام النورمال كويس و هركز ع نقطتين بس لو سألك ال respiration ده voluntary ولا لا الإجابة voluntary عشان كدا لازم أعمله تشتيت كأن بقيس ال pulse و لو سألك أهمية درجة الحرارة و ال pulse في عيان شيست لو فيه خلل فيهم بنفس فكرة ال consciousness ده محتاج يتحجز

هبدأ أكتب الجنرال اكزام سريعا كذلك هو أقل أهمية عن اللوكال بس عشان لو حد مش لحق ملخص فيديو ١ و لما النور ييجي بقا نكمل لو عرفت

Paget’s Disease of the breast - Eczema liked condition of the nipple & areola - Starts in nipple first not areola - Red , itchy , tingling of the nipple … then becomes flaky , scaly and thickened - Associated with nipple discharge ( bloody or yellowish ) - Nipple may be inverted - Palpable lump may be present - Etiology is controversy between:- 1. Cancer cells travel through duct system then reach the nipple 2. Insitue malignant transformation ( DCIS) - But the most acceptable is that it is DCIS - Triple assessment of the case :- 1. Breast examination differentiate between it and Eczema 2. US-Mammogram 3. Biopsy é cytopatholgy , sample from nipple discharge may be taken - Has late diagnosis due to similarity of its symptoms with dermatological symptoms and patient deal with it conservatively ( but it not respond ) - Managed by 1. surgical tt - With mass : Mastectomy + Axillary clearance - Without mass :WLE of nipple and areal 2. Hormonal tt : by tamoxifen - Compare () Paget’s dis & Eczema

Mastitis Carcinomatosis = Inflammatory Breast Cancer ( IBC ) - Breast cancer that presents with skin inflammatory symptoms - Resembles symptoms of inflammation of the skin infections as erysipelas - Can presents with variable signs and symptoms without lump detected by US-mamogram - Causes rapid breast enlargement, redness, itching and warm skin - Caused by invasion of local lymphatic ducts of the breast >> Impaired lymphatic drainage >> Edema - Diagnosed by mamogram, MRI ( in some cases) - The definitive diagnosis is by biopsy from suspected lesion and / or skin biopsy - It is mostly triple negative breast cancer ( so no response to hormonal therapy >> bad prognostic sign ) - Usually has high expression of P53 & E-Cadherin - Highly angiogenic and prefers vascular invasion - Starts from stage 3b 1. Stage 3b : > 1/3 skin and spread to tissues near to the breast ( skin and chest wall invasion ) 2. Stage 3c : Nodal involvement 3. Stage 4 : Distant mets - Treated by neoadjuvant chemotherapy , mastectomy , adjuvant chemo & Radio therapy - Compare () it and breast abscess

لو حد مش عارف إجابة سؤال يقول

Percusion بفحص في MCL , MAL , Scapular و special areas من اليمين الأول و نعرف الأناتومي بتاعها -kronig's isthmus rt. -Clavicle rt. -Upper border of liver -sternum Upper 2/3>> cancellous // lower 1/3>> impaired note -kronig's isthmus lt. -Clavicle lt. -2nd left ICS -Bare area -Traub's area

Questions:- Causes increase // decrease TVF Causes of shifting apex of the heart

Palpation متنساش ال back كذلك إن شاء الله .Superficial palpation ( hotness , tenderness , swelling..) .Deep palpation:- -Trachea من ادام و المفروض الصح تقعد جمبه و ثبت راسه بإيدك التانية -Apex of the heart -TVF -Expansion -Confirm inspection ( pulsations ..)

Questions:- Subcostal angle Ap// transverse diameter Normal shape Barrel Causes increase // decrease AP diameter Non symmetrical abnormalities Hoover's sign

Inspection 1.Skin 2.shape 3.Movement & RR 4.Back ▪︎Shape:- .AP( من الجنب) // Transverse diameter ( عند رجل العيان) .Subcostal angle .Ribs ▪︎Skin :- .Pigmentation .scars .swelling .Dilated veins & pulsations ▪︎Movement :- Normal or abnormal thoracoabdominal movement.

هرتب العناوين في اللوكال شيست اكزام زي ما د محسن شرحها عشان نقرأهم ليلة الامتحان بسرعة من غير لت الورق .. هكتب العناوين من غير تفاصيل المهم تكون شايف الفيديو و سامعه بتركيز أو أي مصدر تاني براحتك المهم هفكرك بيهم بس، و هكتب كذلك الأسئلة الي كان بيقولها و افتح ورقك و اقرأهم . بسم الله، المهم يعني تدعولي معاكم ان شاء الله و ربنا يوفقنا جميعا و يهدينا..

التجميعه اللي دكتور علام عملها في آخر فيديو ECG زودت عليها العلاج لو هتفيد حد ودعواتكم

للعلم بالشئ بس ده mamogram مفيش فيه أي حاجة ل breast with silicon implant كانت اتعرضت في المحاضرات مرة

كم معلومة للدردشة علي السريع • BIRADS : Breast Imaging Reporting And Data System • Screening with mammography is recommend after age of 40 annually • Screening in female patient with strong positive family hx makes the diagnosis of breast cancer earlier 10y • BIRADS is a radiological classification not pathological • One of indications of mammography : 2nd stage of triple assessment of female with breast mass كلمة triple assessment دي مهمة دايما الدكاترة بتقول انهم بيتبسطوا من صاحبها • BIRADS 4 & 5 necessitates pathological assessment by : - FNAC ( cytological , can’t differentiate () DCIS , Invasive carcinoma , can’t identify biological markers ) - Core needle biopsy (histopathological , can …. , can …) • Occult carcinoma : Mets of breast cancer in the axillary LNs or distant mets with no any clinical or radiological evident of cancer in breast itself . - Can be detected by MRI and proved when excisional biopsy is performed for axillary LN for example that will be breast cancer in nature.