■ 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