■ مساء الخير يا شباب الناس اللي بتبعت ليا عشان ent غالبا هيكرر من أسئلة امتحانات سابقة
بس ضيفوا عليهم لو حب يعمل مفاجأة ال labyrinthitis & otogenic brain abscess

■ كان في case on GE :

● بس خلي بالك any women with reproductive age with abdominal pain should have urinary pregnancy test دي أول حاجة تعملها في case كان ve-

● Keywords : altered bowel habits + abd pain +nausea + increase CRP ( inflammatory condition )

● ttt : bed rest + IV fluids + analgesic

● خلي بالك if these symptoms not resolved لازم تعمل stool culture

● طيب if symptoms is persistent or recurrent لازم تفكر ف CD or UC

■ أهم notes ف كيسات النسااا :-  ( part 1 )

● torsion of ovary :
♤ keywords : unilateral lower abdominal pain associated with N & V + hx of ovarian cyst
♤ ttt : laparotomy

●  placental abruption :

♤ keywords : more common in 2nd & 3rd trimester & hypertensive 
  vaginal bleeding & associated with tender uterus & abdominal pain ( midline persistent uterine) & abnormal fetal heart tracings

♤ TTT : Delivery

● Ectopic pregnancy :

unilateral abd pain + vaginal bleeding +
  ( +ve pregnancy test )
● طبعا بنشخصه عن طريق combined US + B-HCG
● خلي بالك بنعمل salpingectomy if the tube is diseased
طيب لو contralateral tube is healthy هنشيلها salpingectomy طيب لو كانت damaged هنعمل salpingotomy

● تاني حاجة بنستخدم MTX لو كان فيه no fetal heart activity & hemodynamic stable &
  B-HCG  < 3000 & adnexal mass < 3.5 cm
 

■ part 2 :

■ complicated corpus luteal cyst into hge :

● keywords : ♡ common at time of ovulation

♡ sudden abdominal pain then  radiate to right iliac fossa & right thigh

♤ tenderness & slight rebound tenderness in right iliac fossa
( no signs of peritonism )
♤ no systemic symptoms ( no fever ) + urine analysis is negative
يبقى كداا تم استبعاد appendicitis or ureteral stone 
♤ urinary pregnancy test is +ve
♤ بنشخصها ب color doppler US هنلاقي فيه (ring of fire apperance ) hemorraghe  
♤ spider web or reticular pattern of echoes
within cyst

♤ ttt : supportive with analgesia
خلي بالك بنعطي أول حاجة paracetamol followed by codeine derivative s if necessary
اعطناها كدااا عشان ال pateint is hemodynamic stable
طيب افرض كانت hemodynamic unstable & pain not controlled & with signs of peritonsim لازم تعمل laparoscopic lavage by cystectomy or hemostatic manuever

■ أهم نوتس على كيسات النسااا :-

● ملف مجمع لكل النوتس :
https://t.me/med_Notes2/740

● part 1:
https://t.me/med_Notes2/697

● part 2 :
https://t.me/med_Notes2/699

● part 3 :
https://t.me/med_Notes2/693

● part 4 :
https://t.me/med_Notes2/703

● part 5 :
https://t.me/med_Notes2/709

● part 6:
https://t.me/med_Notes2/718

■ أهم notes على كيسات النساا :

● the earilest indicator of hypovolemic shock is tachycardia

● any patient with hypovolemic or hemorrahegic shock must be resuscitated
( ABC)

● appendicitis :
♤ the growing uterus pushing appendix superior ( right hypochodrium ) & lateral
( right flank)
♤ keywords : *abdominal pain in right iliac fossa associated with fever & N & V & leukocytosis
* tenderness on right lateral aspect at the level of umbilicus & mild right flank
But urine analysis is normal
كدا استبعدت  ureteral stone

■ cholelithiasis :
♤ keywords : ♤ right colicky abd pain in right hypochodrium with N & V & fever + leucocytosis + pain radiated to Rt shoulder
♤ FH of DM
♤ common after 1st trimester

■ pancreatitis :
♤ keywords : severe midepigastric pain radiate to the back with N , V , tenderness & diffuse rebound tenderness on Abd examination
* sr amyalse is markedly elevated 
 

■ ازاي تفرق بين ileal & jejunum IO ؟

● الاثنين في center of the abdomen دا التشابه بينهم

● خلي بالك jejunum ال mucosa بتاعتها فيها circular folds و دي هتبان معنا على شكل valvulae conniventes ف كل loop of jeunum زي ف صورة ( jeujenal IO )

● ileum
Mucosa بتاعتها is flat
وكل loop بتاعتها هتأخذ شكل straight shapeless tubes زي ف صورة ( ileal IO )

■ part 5 :-

● endometriosis :
♤ keywords : hx of dysmenorrhea & dyspareunia & cx excitation & lower abd pain
* US: kissing cyst , echo ( ground glass apperance)
ttt : surgical by ablation or laparascopy

● rupture of ovarian cyst :
♤ keywords : *hx of ovarian cyst  & POP use + no bleeding or discharge  + sudden onset abd pain in left iliac fossa
* tenderness in lt iliac fosaa & suprapubic
* Abd us : free fluid in douglas pouch
♤ ttt : supportive with analgesia + change of pop to a different contraceptive

● dermoid cyst in ovary complicated by torsion :
♤ sudden onset of lower abd pain & in lt iliac fossa
♤ pain is intermittent  & increase by excerise & gradually become more frequent & worse
♤ palpable mass in lt iliac fossa
♤ TVS : ovarian cyst with mixed echogenisty  with acoustic shadow
♤ x-ray : teeth in lt iliac fossa
♤ ttt : *ovarian cystectomy
*Asymptomatic cysts : expectant ( wait & watch )  

■ مساء الخير يا شباب درس intraoperative emergency في النساا ركزوا عليه و خاصة steps بنعمل ايه غالبا هيكرر منها ف اوسبي العملي

■ notes on orthopedic :

♤ Ant drawer test is used to assess integrity ACL & while post drawer test to assess integrity of PCL

♧ valgus stress test is used to assess intergity of MCL , while varus stress test to assess integrity of LCL

♡ McMarry test is used to assess integrity of meniscus ligament

■Part 6 :

● degeneration of fibroid :

♤ keywords :
* progressive  worsening abdominal pain  in left lower abdomen & pain is sharp & constant
*  ut size larger than dates
* localized uterine tenderness
* closed cx with no blood
* fetal parts not palpated
* US show encapsulated mass in uterus

♤ ttt : expectant management with analgesia & bedrest
♤ خلي بالك لو كان pelvic fibroid هتيجي ب malpresentation & obstructed labor