Remember:

-Malabsorption symptoms + macrocytosis in young patient👉🏼 coeliac disease.

-Malabsorption symptoms + improve with control of diary intake + negative endomyseal Abs👉🏼Lactose intolerance .

-Malabsorption + joint pain + Bradycardia in middle age👉🏼 Whipple's disease ( positive PAS biopsy).

-Malabsorption + macrocytosis + negative endomyseal Abs and normal IgA👉🏼 think in tropical sprue .

-Malabsorption + recurrent epigastric pain to back + positive fecal elastase 👉🏼 chronic pancreatitis .

-Malabsorption + symptoms of bronchiectasis 👉🏼 cystic fibrosis.

-MRCP
#GIT

•Factors suggesting a malignant diagnosis of a thyroid nodule:

-Age younger than 20 years or older than 70 years
-Male sex
-Associated symptoms of dysphagia or dysphonia
-History of neck irradiation
-Prior history of thyroid carcinoma
-Firm, hard, or immobile nodule, cervical lymphadenopathy.

#Surgery

•Causes of hypertension with hypokalaemia:

-Conn's syndrome
-Liddles syndrome
-Cushing syndrome
-Renal artery stenosis
-11 beta hydroxylaze defeciency
-Over diuretics in hypertensive patient
-Excessive liqour intake by hypertensive patient.

-MRCP
#Medicine

Remember:

-There may be asymmetrical enlargement of the uterus if there is lateral implantation.
-This is called Piskacek’s sign where one half is more firm than the other half.

#Obs_Gyne

Remember:

Goodell’s sign:
-Cervix becomes soft as early as 6th week of pregnancy, a little earlier in multiparae.

#Obs_Gyne

Remember:

Osiander’s sign:
-There is increased pulsation, felt through the lateral fornices at 8th week of pregnancy.

#Obs_Gyne

Remember:

Jacquemier’s or Chadwick’s sign:
-It is the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy.
-The discoloration is due to local vascular congestion.

Remember:

-Fetal heart sound (FHS) is the most conclusive clinical sign of pregnancy.

-With an ordinary stethoscope, it can be detected between 18–20 weeks.

-The sounds resemble the tick of a watch under a pillow.

-Its location varies with the position of the fetus.

-The rate varies from 110–160 beats per minute.

#Obs_Gyne

Remember:

-Active fetal movements can be felt at intervals by placing the hand over the uterus as early as 20th week.

#Obs_Gyne

Palpation of fetal parts can be felt distinctly by 20th week.

-The findings are of value not only to diagnose pregnancy but also to identify the presentation and position of the fetus in later weeks.

#Obs_Gyne

Remember:

-FHS may not be audible in cases of maternal obesity, polyhydramnios, occipitoposterior position and certainly IUD.

#Obs_Gyne

Antenatal care visits:

-Generally check up is done:
•at interval of 4 weeks up to 28 weeks;
•at interval of 2 weeks up to 36 weeks
•and thereafter weekly till delivery.

- Ideally this should be more flexible depending on the need and the convenience of patient.

-In the developing countries, as per WHO recommendation, the visit may be curtailed to at least 4; first in second trimester around 16 weeks, second between 24–28 weeks, the third visit at 32 weeks and the fourth visit at 36 weeks.

-WHO recommends a minimum of eight antenatal care visits for a healthy pregnancy.

#Obs_Gyne

•Physiological edema during pregnancy:

-The cause of physiological edema is due to increased venous pressure of the inferior extremities by the gravid uterus pressing on the common iliac veins.

-The features of the physiological edema are:
(1) Slight degree (ankle edema), usually confined to one leg, more on the right
(2) Unassociated with any other features of pre-eclampsia or proteinuria
(3) Disappears on rest alone
(4) Other pathologies of cardiac, renal and hematological are absent.

#Obs_Gyne

Remember:

-Auscultation of FHR at the earliest by 18–20 weeks using ordinary stethoscope and that using Doppler principle at 10th week.

#Obs_Gyne

ABNORMAL LABOR (DYSTOCIA):

-Any deviation from the definition of normal labor is called abnormal labor.

#Obs_Gyne

Women are informed about the warning signs of pregnancy, when they should report the hospital.

#Obs_Gyne