KROK 2 Trial Quiz

Probing of the uterine cavity is an operation to determine the direction of uterine cavity, its length and the state of the relief of the walls. It is performed as a diagnostic procedure before artificial abortion and also to know the length of the uterine cavity before the diagnostic curettage.

Anytime you get a Rheumatology case like this with urethritis or cervicitis, just think of Reactive arthritis (Reiters syndrome). This is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). The manifestations of reactive arthritis include the following triad of symptoms: an inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. The most common triggers are intestinal infections (with Salmonella, Shigella or Campylobacter) and sexually transmitted infections (with Chlamydia trachomatis).

Dependent personality disorder (DPD) is an anxious personality disorder characterized by an inability to be alone. People with DPD develop symptoms of anxiety when they're not around others. They rely on other people for comfort, reassurance, advice, and support.

Herniotomy by Mayo-Sapezhko is the surgical treatment of Umbilical hernia in adults. The traditional Mayo repair consists of a vertical overlap with adjacent aponeurotic structures. A curvilinear transverse incision is made in a natural skin crease and should not exceed 180°. Additionally, an elliptical incision can be used for large hernias that require excision of excess skin.

Anovular menstrual cycle is a menstrual cycle without ovulation and a luteal phase and hence causes infertility. Treatment is by lifestyle changes, nutritional changes or medication for fertility. Also surgery if it’s a case of tumor.

One of the serious complications in surgery is sepsis or infection and hence immunosuppressive medications like glucocorticoid therapy should be administered as a prophylaxis. Since patient is already on that treatment for adrenal insufficiency, dosage must be increased by 2-3 times to prevent acute adrenal insuf?ciency and sepsis.

There are 4 stages of blood loss: Stage 1 is characterized by Up to 15% (750 mL) of blood loss with normal BP, HR, RR, mental status, capillary refill, urine out but pale skin. Stage 2 is characterized by 15-30% (750-1500ml) blood loss with increased diastolic BP, slight tachycardia (>100bpm), increased respiratory rate (>20), slight anxiety and restless, delayed capillary refill, pale skin and a urine output of 20-30mL/h. Stage 3 is characterized by 30-40% (1500-2000ml) of blood loss with systolic BP <100, tachycardia (>120bpm), tachypnea (>30) altered and confused, increased diaphoresis, delayed capillary refill and urine output of 20ml/h. Stage 4 is characterized with over 40% (over 2000ml) of blood loss, systolic BP <70, extreme tachycardia (>140bpm) with weak pulse, extreme tachypnea, lethargy, coma, extreme diaphoresis, absent capillary refill and urine out is negligible.

Fats are usually digested or emulsified by bile from the gallbladder. With increased pain during its secretions and the presence of jaundice, this is Chronic cholecystitis. Chronic cholecystitis is gallbladder inflammation that has lasted a long time. It almost always results from gallstones and from prior attacks of acute cholecystitis. It is characterized by repeated attacks of pain (biliary colic) that occur when gallstones periodically block the cystic duct.

Pyelonephritis is inflammation of the kidney, typically due to bacterial infection. Symptoms most often include fever and flank tenderness. Other Symptoms may include nausea, burning with urination, and frequent urination. Analysis of the urine may show signs of urinary tract infection. Specifically, the presence of nitrite and white blood cells on a urine test strip in patients with typical symptoms are sufficient for the diagnosis of pyelonephritis, and are an indication for empirical treatment. Blood tests such as a complete blood count may show neutrophilia.

It suggests that during a woman's menstrual flow, some of the endometrial debris flow backwards through the Fallopian tubes and into the peritoneal cavity, attaching itself to the peritoneal surface (the lining of the abdominal cavity) where it can proceed to invade the tissue as endometriosis. Endometriosis is a painful disorder in which he endometrium grows outside the uterus. It commonly involves the ovaries, fallopian tubes and tissues lining the pelvis.

The hydatic cyst occurs by accidental infection of the human with the eggs of Echinococcus granulosus, followed by the development of the larvae, most commonly in the liver (50-70% of cases), and less commonly in the lungs, spleen, kidneys and brain. Echinococcus is a parasitic disease of tapeworms of the echinococcus type. Alveolar disease usually begins in the liver but can spread to the other parts of the body, such as the lungs or brain. When the liver is affected the person may have abdominal pain, weight loss, and turn slightly yellow from jaundice.

Malaria with CNS manifestation means cerebral malaria. Cerebral malaria is the most severe neurological complication of infection with Plasmodium falciparum malaria. It is a clinical syndrome characterized by coma and asexual forms of the parasite on peripheral blood smears.

Frequent urination and furunculosis (a deep infection of the hair follicle leading to abscess formation with accumulation of pus and necrotic tissue) are typical in diabetic patients and therefore glucose test should be done.

Oesophageal varices usually develop when blood flow to the liver is blocked. They often occur in people with advanced liver disease. Usually there are no symptoms unless the veins bleed. Symptoms of bleeding oesophageal varices include vomiting blood, tar-like or bloody stools and, in severe cases, shock. Treatments include beta blockers, medical procedures such as nasogastric intubation, rubber band ligation, embolization, etc to stop bleeding, and in rare cases, liver transplant.

Because the patient had a fracture in the medial malleolus, the foot should be fixed in plaster cast at right angle with Varus positioning of the foot.

Physically underdeveloped and suffering from cough attacks and dyspnea indicates cystic Fibrosis. Cystic fibrosis is a genetic disorder that affects mostly the lung, but also the pancreas, liver, kidneys, and intestine. Long term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. Lung disease results from clogging of the airways due to mucus build-up, decreased mucociliary clearance, and resulting inflammation. Inflammation and infection cause injury and structural changes to the lungs, leading to a variety of symptoms. Many of the symptoms occur when bacteria that normally inhabit the thick mucus grow out of control and cause pneumonia. The condition is diagnosed by a genetic and sweat testing.

With clotting factor VIII 5% of norm, makes it Hemophilia A which is a genetic deficiency in clotting factor VIII, which causes increased bleeding and usually affects males. In the majority of cases it is inherited as an X-linked recessive trait, though there are cases which arise from spontaneous mutations. Also three (3) basic differential diagnosis are made from increased thromboplastin time and these are hemophilia, DIC and Von Willebrand Disease.

Probing of the uterine cavity is an operation to determine the direction of uterine cavity, its length and the state of the relief of the walls. It is performed as a diagnostic procedure before artificial abortion and also to know the length of the uterine cavity before the diagnostic curettage.

Psoriasis is a skin disorder that causes skin cells to multiply up to 10 times faster than normal. They can grow anywhere, but most appear on the scalp, elbows, knees, and lower back. The most frequent manifestation is called plaque type psoriasis where the lesions characteristically consist of well-demarcated erythematous plaques covered with loosely adherent silvery scales, the silvery color of the scales becoming more prominent when attempts are made to scrape them off. The diagnosis in psoriasis can be confirmed by the grattage test or by taking a skin biopsy.

Bacterial vaginosis has fishy odor, without itching and burning. It has clue cells, no vaginal inflammation, pH >4.5 and has positive whiff test (fishy odor). Trichomonas vaginitis is characterized by vaginal discharge with itching and burning and pain with intercourse. pH > 4.5 with strawberry cervix, discharge is frothy and green. Vaginal epithelium is inflamed and edematous. In candida (yeast) vaginitis, there is itching, burning and pain with sex. Found even in non-sexual active patients with pH<4.5. Discharge is curdy and white, pseudohyphae.

Bleeding within 12-20 weeks of gestation is called spontaneous abortion (miscarriage) if it leads to pregnancy loss. It is divided into 5. These are Missed abortion (has non-viable pregnancy without vaginal bleeding, uterine cramping/cervical dilation), Threatened abortion (has viable pregnancy with vaginal bleeding but no cercal dilation and less pelvic pains), Inevitable/incipient abortion (has vaginal bleeding and uterine cramping leading to cercal dilation but no product of conception has yet been passed), Incomplete abortion (features of inevitable abortion with some product of conception been passed) and finally Complete abortion (features of inevitable abortion with all product of conception been passed).

A digital rectal examination (DRE) is a simple procedure doctors use to examine the lower rectum and other internal organs. Because Douglas pouch is the space between the uterus and the rectum, any abscess in this space can be examined using the DRE.

Times for inpatient treatment: First treatment is usually in 2 months of gestation then 5months of gestation and lastly 2 months. Therefore, 8-12 weeks, 28-32 weeks and 37 weeks of gestation.

Weight of fetus is fundal height x abdominal circumference. Hence 35x100 giving 3500 kg.

A cephalic presentation is a situation at childbirth where the fetus is in a longitudinal lie and the head enters the pelvic first. The most common form of cephalic presentation is the vertex presentation where the occiput is the leading part. All other presentations are abnormal. Vertex presentation is classified according to the position of the occiput. We have: Left Occiput Anterior (LOA), Left Occiput Posterior (LOP), Left Occiput Transverse (LOT). The same it is for the right and hence ROA, ROP, and ROT. In our question, this is posterior vertex presentation.

The Fluorescein eye stain is a test that uses orange dye (Fluorescein) and a blue light to detect foreign bodies in the eye. This test can also detect damage to the cornea. The cornea is the outer surface of the eye.

Postmenopausal bleeding can be caused by cancer of uterus, cancer of cervix/vagina, endometrial atrophy/vaginal atrophy, uterine fibroids/polyps, endometritis and so on. It is better to do more test like fractional biopsy of lining of uterus and uterine mucus to identify the cause.

Beta blockers are contraindicated in patients with symptomatic bradycardia, AV block, decompensated heart failure, and asthma. Initiation and cessation of beta-blocker therapy should always be gradual to avoid side effects or symptoms of withdrawal (e.g., rebound tachycardia, hypertension, acute cardiac death).

Mayo-Robson's point is a point on border of inner 2/3 with the external 1/3 of the line that represents the bisection of the left upper abdominal quadrant, where tenderness on pressure exists in disease of the pancreas. At this point the tail of pancreas is projected on the abdominal wall. Urine diastase is useful in diagnosing uncertain abdominal cases (especially when pancreatitis is suspected), stones in the common bile duct (choledocholithiasis), jaundice and in ruling out post-operative injury to the pancreas. From these, this could be case of Chronic pancreatitis in the exacerbation stage.

The single small hematoma on the anterior surface of the thigh is not a cause for alarm, however, this patient needs to be monitored closely and hence continue the supervision by the hospital hematologist.

Although there are functional or mental changes, there are no organic changes and hence no changes in blood formula. An organic disease is one caused by a physical or physiological change to some tissue or organ of the body. The term sometimes excludes infections. It is commonly used in contrast with mental disorders.

Rubella, also known as German measles or three-day measles, is an infection caused by rubella virus. This disease is often mild with half of people not realizing that they are infected. A rash may start around two weeks after exposure and last for three days. It usually starts on the face and spreads to the rest of the body. The rash is sometimes itchy and is not as bright as that of measles. Swollen lymph nodes are common and may last a few weeks. A fever, sore throat, and fatigue may also occur.

Hydrogen chloride gas is intensely irritating to the mucous membranes of the nose, throat, and respiratory tract. Most seriously exposed persons have immediate onset of rapid breathing, blue coloring of the skin, and narrowing of the bronchioles. Patients who have massive exposures may develop an accumulation of fluid in the lungs. Exposure to hydrogen chloride can lead to Reactive Airway Dysfunction Syndrome (RADS), a chemically- or irritant-induced type of asthma.

Conjunctivitis is usually acute which comes about due to infection, irritation or allergies and these causes can be chronic as well. In chronic it persists more than a month and usually of bacterial infection. Minor discharges in form of stringing mucus is typical of blepharitis (inflammation of the eyelid. Blepharitis is a chronic condition which can lead to chronic conjunctivitis due to constant irritation from inflamed eyelids that will cause sore to develop.

Amenorrhea and no use of contraception could be an indication for pregnancy and hence beta HCG or ultrasound is done for confirmation.

Autoimmune thyroiditis, is a chronic disease in which the body interprets the thyroid glands and its hormone products T3, T4 and TSH as threats, therefore producing special antibodies that target the thyroid’s cells, thereby destroying it. It may present with hypothyroidism or hyperthyroidism and with or without a goiter. The symptoms may vary depending on the thyroid function, i.e. hyperthyroidism or hypothyroidism. Hyperthyroidism can cause sweating, rapid heart rate, anxiety, tremors, fatigue, difficulty sleeping, sudden weight loss, and protruding eyes. Hypothyroidism can cause weight gain, fatigue, dry skin, hair loss, intolerance to cold, and constipation.

A chest tube (or intercostal drain) is the most definitive treatment of a pneumothorax. Chest tubes drain blood, fluid, or air from around the lungs, heart, or esophagus

Normally, the esophagus and the trachea are two separate tubes that are not connected. Anytime you eat the epiglottis covers the trachea to prevent food from entering into the lungs. With the history provided here, the separation between the two tubes has been compromised and hence Tracheoesophageal fistula. Tracheoesophageal fistula is an abnormal connection in one or more places between the esophagus (the tube that leads from the throat to the stomach) and the trachea (the tube that leads from the throat to the windpipe and lungs).

Antifungal medications are Fluconazol, Orungol and Nisoral.

Mercazolil is a drug used for the treatment of hyperthyroidism (diffuse toxic goiter). However, to treat the arrhythmia, a beta blocker is needed and hence Propranolol. It is also used to treat high blood pressure, thyrotoxicosis, capillary hemangiomas, performance anxiety, and essential tremors.

This is obviously a person suffering from hemophilia (a bleeding disorder) and hence platelets count need to be determined before other tests. From the blood test results, almost are parameters are in the normal range so to confirm the disorder, platelets must be known as well.

Thrombophlebitis, deep vein thrombosis in the leg, usually leads to chest pains through a process called pulmonary artery embolism. Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood.

T2 - tumor invades muscularis proper. N2 – it invades 15 regional nodes. M0 – no distant metastases. Best treatment plan will therefore be radiation therapy, operation and chemotherapy.

Cervical carcinoma occurs when abnormal cells on the cervix grow out of control. It is caused by Human Papilloma virus (HPV) and diagnosed with PAP test. Management include surgery (hysterectomy), chemotherapy and radiotherapy. The key here is, it resembles cauliflower.

The percussion dullness and auscultation reveals bilateral fine moist rales predominating on the right lung, indicating acute pneumonia. Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever and difficulty breathing. Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications or conditions such as autoimmune diseases. People with infectious pneumonia often have a productive cough, fever accompanied by shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, and an increased rate of breathing.

Acute hematogenous osteomyelitis is the most common type of bone infection. It is usually seen in children and is more common in boys. The infection generally occurs in areas of high metabolic activity and commonly affects the distal femoral and proximal tibial metaphyses.

Radar charts (also known as spider charts, polar charts, web charts, or star plots) are a way to visualize multivariate data. They are used to plot one or more groups of values over multiple common variables. Radar Charts are used to compare two or more items or groups on various features or characteristics. Example: Compare two anti-depressant drugs on features such as: efficacy for severe depression, prevalence of specific side effects, interaction with alcohol, continuation of relief over time, cost to the consumer etc

Ganglioneuroma is a rare and benign tumor of the autonomic nerve fibers arising from neural crest sympathogonia, which are completely undifferentiated cells of the sympathetic nervous system. Ganglioneuromas can be diagnosed visually by a CT scan, MRI scan, or an ultrasound of the head, abdomen, or pelvis.

Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. Cough, fever with shivering, and night sweats are often present. Cough can be productive of foul smelling purulent mucus or less frequently with blood in one third of cases. Affected individuals may also complain of chest pain, shortness of breath, lethargy and other features of chronic illness. On examination of the chest there will be features of consolidation such as localized dullness on percussion and bronchial breath sounds.

Water quality through the presence of pathogenic enteric microorganisms may affect human health. Coliform bacteria, Escherichia coli and coliphages are normally used as indicators of water quality. Coliphages are viruses that infect E. coli and over here we are talking about hepatitis caused by viruses.

Diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. Clinical diagnosis is usually made on the basis of the location and severity of the pain, which is typically colicky in nature (comes and goes in spasmodic waves). Pain in the back occurs when calculi produce an obstruction in the kidney. Physical examination may reveal fever and tenderness at the costovertebral angle on the affected side. Microscopic examination of the urine, may show red blood cells, bacteria, leukocytes, urinary casts, and crystals. Radiographic studies will show hyperechogenic mass.

The muscles of facial expression are controlled by the facial nerves. In addition, the facial nerve receives taste sensations from the anterior two-thirds of the tongue via the chorda tympani. Taste sensation is sent to the gustatory portion (superior part) of the solitary nucleus. With these, our provisional diagnosis in this patient is Neuropathy of the facial nerve.

Prevalence is a statistical concept referring to the number of cases of a disease that are present in a particular population at a given time, whereas incidence refers to the number of new cases that develop in a given period of time. From the available option, prophylactic examination (disease control) register can help us know the disease prevalence.

Menarche is the first occurrence of menstruation. Girls experience menarche at different ages. The timing of menarche is influenced by female biology, as well as genetic and environmental factors, especially nutritional factors.

The first aid to any unconscious patient is to check the person’s airway, breathing, and Circulation - (ABC). Over here we will consider controlled respiration and oxygen inhalation due to cyanosis but of what use is oxygen if there is an obstruction in the airway? Therefore, controlled respiration will be more appropriate.

Panic disorder is an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen.

Although, there is increased BP, neurologic symptoms are absent making hypertensive encephalopathy less likely. Absence of seizures also makes epilepsy, a doubt and hence migraine. A migraine is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Typically, the headaches affect one half of the head, are pulsating in nature, and last from a few hours to 3 days. Associated symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell. The pain is generally made worse by physical activity. Up to one-third of people affected have an aura: typically, a short period of visual disturbance that signals that the headache will soon occur. Occasionally, an aura can occur with little or no headache following it. This patient therefore, has migraine with aura.

There is obvious a problem with the stomach and that’s gastritis and this is a chronic form of gastritis called Atrophic gastritis. Atrophic gastritis is a process of chronic inflammation of the gastric mucosa of the stomach, leading to a loss of gastric glandular cells and their eventual replacement by intestinal and fibrous tissues. As a result, the stomach's secretion of essential substances such as hydrochloric acid, pepsin, and intrinsic factor is impaired, leading to digestive problems. Type A gastritis (autoimmune) primarily affects the body/fundus of the stomach and is more common with pernicious anemia. Type B gastritis primarily affects the antrum, and is more common with H. pylori infection. Type C is caused by chemical irritants like nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, or bile.

Pain in the muscles, especially in calf (gastrocnemius) muscles is very common in Leptospirosis. Leptospirosis is a blood infection caused by the bacteria Leptospira. Signs and symptoms can range from none to mild (headaches, muscle pains, and fevers) to severe (bleeding in the lungs or meningitis). Weil's disease, the acute, severe form of leptospirosis, causes the infected individual to become jaundiced (skin and eyes become yellow), develop kidney failure, and bleed. The bacteria are spread to humans through animal urine, or water and soil contaminated with animal urine, coming into contact with the eyes, mouth, nose or breaks in the skin.

A mastoidectomy is a procedure performed to remove the mastoid air cells, air bubbles in the skull, near the inner ears. This can be done as part of treatment for mastoiditis, chronic suppurative otitis media or cholesteatoma.

A leukemoid reaction is an increase in the white blood cell count, which can mimic leukemia. The reaction is actually due to an infection or another disease and is not a sign of cancer. Blood counts often return to normal when the underlying condition is treated. Leukemoid Reaction to Eosinophile and hypochromatic anemia points to Helminthic Invasion.

To stop bleeding in the diagnosis of subarachnoid haemorrhage, coagulants are administered. Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism of coagulation involves activation, adhesion and aggregation of platelets, as well as deposition and maturation of fibrin.

A pleurocentesis, also known as a thoracentesis or pleural effusion treatment, is a procedure used to remove excess fluid from the pleural space (the space between the lungs and the wall of the chest) for diagnostic or therapeutic purposes. The Rivalta Test is a simple test to differentiate a transudate from an exudate. A test negative test indicates a transudate and positive test indicates an exudate. Transudate is fluid buildup caused by systemic conditions (in this case cardiac failure) that alter the pressure in blood vessels, causing fluid to leave the vascular system. Exudate is fluid buildup caused by tissue leakage due to inflammation or local cellular damage.

One of the risk factors for thyroid Cancer is exposure to high levels of radiation. In this case, accident at a nuclear object exposes the person to high levels of radiation

Acute viral encephalitis is a rare but devastating complication of common virus infections and Caused by viruses such as herpes simplex virus and rabies. An antiviral agent is needed for the treatment of this and Zovirax is that agent. It is also known as acyclovir.

A sinus X-ray helps doctors detect problems with the sinuses. Sinuses are normally filled with air, so the passages will appear black on an X-ray of healthy sinuses. A gray or white area on an X-ray of the sinuses indicates a problem. This is most often due to inflammation or a buildup of fluid in the sinuses.

Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure. In case of a positive test result, there will be increased in peripheral vascular resistance and vasoconstriction. Phentolamine is a competitive alpha-adrenergic antagonist which binds to alpha-1 and alpha-2 receptors, resulting in a decrease in peripheral vascular resistance and vasodilatation.

Brain delivery trauma causes bleeding in the scalp which is seen as the cephalhematoma. Hemolysis of red blood cells after the hematoma has occurred will lead to the Jaundice.

Butterfly-type rash (erythema on the cheeks and bridge of nose) on face is a classic finding in SLE. Systemic Lupus Erythematosus (SLE), also known as lupus, is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary between people and may be mild to severe. Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a rash which is commonly on the face. This rash is termed the “butterfly” type rash.

Autoimmune thyroiditis, is a chronic disease in which the body interprets the thyroid glands and its hormone products T3, T4 and TSH as threats, therefore producing special antibodies that target the thyroid’s cells, thereby destroying it. It may present with hypothyroidism or hyperthyroidism and with or without a goiter. The symptoms may vary depending on the thyroid function, i.e. hyperthyroidism or hypothyroidism. Hyperthyroidism can cause sweating, rapid heart rate, anxiety, tremors, fatigue, difficulty sleeping, sudden weight loss, and protruding eyes. Hypothyroidism can cause weight gain, fatigue, dry skin, hair loss, intolerance to cold, and constipation.

Open epicystostomy is a surgically created connection between the urinary bladder and the skin used to drain urine from the bladder in individuals with obstruction of normal urinary flow. Urinary flow may be blocked by swelling of the prostate (benign prostate hyperplasia).

Dilation and curettage (D and C) is a procedure to remove tissue from inside the uterus. It is done to diagnose or treat uterine conditions. Indications include: abnormal uterine bleeding, bleeding after menopause, abnormal endometrial cells, excessive bleeding after delivery by clearing out any placenta that remains in the uterus, remove a molar pregnancy or remove cervical/uterine polyps etc.

Cardiac insufficiency, more commonly called heart failure, is when the heart muscle’s pump function is reduced. This leads to the heart being unable to produce the power to pump the required amount of blood throughout the body. This results in decrease of arterial pressure with compensatory mechanism of increase central venous return.

Parodynia is the rhythmic uterine contractions that under normal conditions increase in intensity, frequency and duration, culminating in vaginal delivery of the infant. This can lead to complications and hence doing C/S is the best choice.

Lactational mastitis is a condition in which a woman’s breast become painful, swollen and red. It is common in the first 3 months of breastfeeding and characterized by pain, redness, fever and malaise.

Since there is no bleeding, its harmless but need to do Manual uterus cavity revision. This is a procedure done to remove remaining ovum tissue from the uterus after spontaneous / deliberate termination of pregnancy by instrumental revision.

PaCO2 and PaO2 are the most trustworthy criterion of breath effectiveness. Because they measure the arterial blood gas in asthmatic status.

At 17 weeks of gestation, cervix must be closed. For it to be opened, the condition is called cervical insufficiency and the best treatment is to place a suture on the uterine cervix

Facial neuritis (Bell's palsy) is essentially a clinical diagnosis with acute onset unilateral facial paralysis.

Dilation and curettage (D and C) is a procedure to remove tissue from inside the uterus. It is done to diagnose or treat uterine conditions. Indications include: abnormal uterine bleeding, bleeding after menopause, abnormal endometrial cells, excessive bleeding after delivery by clearing out any placenta that remains in the uterus, remove a molar pregnancy or remove cervical/uterine polyps etc.

The clue here is a node in the left lobe of the thyroid gland and this is Toxic nodular goiter because there are few signs and symptoms of Hyperthyroidism such as irritability, muscle weakness, sleeping problems, a fast heartbeat, heat intolerance, diarrhea, enlargement of the thyroid, hand tremor, and weight loss. Simple nontoxic goiter (Nodular euthyroid goiter), which may be diffuse or nodular, is noncancerous hypertrophy of the thyroid without hyperthyroidism, hypothyroidism, or inflammation. Except in severe iodine deficiency, thyroid function is normal and patients are asymptomatic except for an obviously enlarged, nontender thyroid. Diagnosis is clinical and with determination of normal thyroid function. Treatment is directed at the cause, but partial surgical removal may be required for very large goiters.

Metformin, is the first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight. Metformin is sometimes used together with insulin or other medications, but it is not for treating type 1 diabetes.

These are early signs of pregnancy hence test for beta-hCG or ultrasonic examination.

The presence of paired papules with intensive itch, especially at night is typical for scabies. Scabies is a skin infestation caused by a mite known as the Sarcoptes scabiei. It causes intense itching in the area where the mites burrow and a pimple-like rash. For diagnosis, examine the rash elements scrape, mounting the sample in potassium hydroxide and examining it under a microscope, or using dermoscopy to examine the skin directly.

The classic triad of preeclampsia is hypertension, proteinuria, and edema. It usually begins after 20 weeks of pregnancy in a woman whose blood pressure had been normal.

To stop bleeding in the diagnosis of subarachnoid haemorrhage, coagulants are administered. Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism of coagulation involves activation, adhesion and aggregation of platelets, as well as deposition and maturation of fibrin.

Peutz-Jeghers syndrome is an autosomal dominant genetic disorder characterized by the development of benign hemartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa(melanosis).

The MSEC (Medico-social expert commission) is responsible for all medical certificate which is more than 30 days.

These are early signs of pregnancy hence test for beta-hCG or ultrasonic examination.

Somatic or somatization is a symptom characterized by an extreme focus on physical symptoms such as pain or fatigue that causes emotional distress and problems functioning. As in the question, there is no exertion whatsoever but in somatoform, there is fatigue upon exertion and usually symptoms are similar to those of heart disease.

Steatorrhea and Creatorrhea are the abnormal excretion of fats and muscle fibre in feces respectively. In the duodenum, dietary fat (primarily triglycerides) is digested by enzymes such as pancreatic lipase into smaller molecules. Bile from the gallbladder also helps in the emulsification of fats. Steatorrhea and Creatorrhea can be seen in conditions such as cholycystitis, chronic pancreatitis, cystic fibrosis, Shwachman–Diamond syndrome, celiac disease, short bowel syndrome among many others. From above, Multi-enzyme preparations such as pancreatic digestive enzymes such be administered.

Extremely high AP and increase in glucose is typical for tumor of the adrenal gland, Pheochromocytoma. The signs and symptoms are those of sympathetic nervous system hyperactivity, with three classic signs: diaphoresis (excessive sweating), headaches and elevated heart rate, including: Skin sensations, Flank pain, Elevated blood pressure, weight loss, among many others.

Ultrasound dopplerography is medical ultrasonography that employs the doppler effect to generate imaging of the movement of tissues and body fluids (usually blood) and their relative velocity to the probe. It measures the velocity of blood flow through the brain’s blood vessels. They are used as tests to help diagnose emboli, stenosis, vasospasm from a subarachnoid hemorrhage (bleeding from a ruptured aneurysm), and other problems such as recurrent transient ischemic attacks.

In the first group, they fall sick up to 2 times a year, so we have 10+30+15 making a total of 55%.

Morphine binds to opioid receptors which blocks transmission of nociceptive signals, signals pain-modulating neurons in the spinal cord, and inhibits primary afferent nociceptors to the dorsal horn sensory projection cells.

Characteristic findings in Atrial ?brillation are the absence of P waves, with disorganized electrical activity in their place, and irregular R–R intervals due to irregular conduction of impulses to the ventricles. At very fast heart rates, atrial fibrillation may look more regular, which may make it more difficult to separate from other supraventricular tachycardias or ventricular tachycardia. High blood pressure and valvular heart disease are the most common alterable risk factors for AF.

Brucellosis is a highly contagious zoonosis caused by ingestion of unpasteurized milk or undercooked meat from infected animals, or close contact with their secretions. It is also known as undulant fever, Malta fever, and Mediterranean fever.

This patient is going through depression and antidepressants are needed. Monoamine oxidase inhibitors (MAOIs) are a class of medication used to treat depression. The monoamines neurotransmitters are Dopamine, Serotonin, Noradrenaline, Adrenaline and Histamine.

The pylorus or pyloric part, connects the stomach to the duodenum. Food from the stomach, as chyme, passes through the pylorus to the duodenum. Pyloric stenosis refers to a pylorus that is narrow. This is due to congenital hypertrophy of the pyloric sphincter. The lumen of the pylorus is narrower, and less food is able to pass through. When it is present, a newborn baby may projectile vomit after eating, but despite vomiting remain hungry. Pyloric stenosis may be managed by the insertion of a stent, or through surgical cutting of the pyloric sphincter, a pyloromyotomy

Physiologic amenorrhea is the cessation of menstruation for completely normal reasons. The lack of menstruation during pregnancy and lactation are forms of physiologic amenorrhea. This can also occur before puberty, during adolescent and during menopause.