MIDNIGHT TOPICS SS 1 Cannula, Kawasaki, Viral exanthems, Mitochondrial disorders Tumor markers, Named Xray views, CAH Foley's catheter, Ca lung, Paraneoplastic syndrome Central lines, |HC, PNS anatomy Trinucleotide repeats, NG tube and PEG, Pulmonary embolism TB focus, Biomedical waste management, Fogarty catheter, Temporal # Vacutainers, Clinical trials, MEN syndrome LP needle, CSF findings, Spirometry, Flow volume curves © ®N OO Fw HN Personality disorders, LCH, Lymph node enlargement syndromes, Post-op drains 10 SSI, Post op fever, DVT stockings, ASEPSIS scores, ILD17 18 19 20 Porphyria, Occupational lung diseases CORADS, BIRADS, all RADS, CEAP score and varicose veins Vascular anatomy, Fibroscan, Trauma scores Darrow Yannet diagram, Dermatome and myotomes, Cauda vs conus, RENAL score Cranial nerve columns, Cranial nerve foramina with radiology sectional anatomy Embryology-Pharyngeal derivatives, Germ cell derivatives, Urogenital, Eye, Ear, CVS, venous embryology Immunodeficiency, Variceal bleed balloons Scopes, Chicago classification, endocrine receptors, psychiatric neurotransmitter, aspergillus ‘Sensory receptors, nerve fibres, nerve injuries and compression, STI kits Lysosomal, Glycogen storage disorders, Dyslipidemia, Syndromes24 25 26 27 28 29 30 eeea irri Acid-base, electrolytes, pituitary, Barther-Gittleman, RTA Soft tissue infections, JVP, pulses, Triads, 10 images Developmental milestones, Capnography, Types of respiration, soft tissue lesions, malignant hyperthermia DDS Scorings-Bell, Bosniak, Gurd, Renal AST, Ann Arbor ‘Scorings-Fong, Masaoka-Koga, Miami, Rosenberg, Bent, Chang, Spetzler Martin All instruments in one place Erythemas, Approach to amenorrhea, GU trauma and urine extravasation Mapleson circuits, amyloidosis, MTP act 2021, Doctors protection act Leprosy —Derma + PSM + Pharma Lung cysts, orbital apex syndromes, POCSO actees ie 3 32 33 34 35 36 37 38 39 40 41 TEG, RAISED ICP MX, Herniations, Brain death Contraception, Pleural effusion, CSF analysis Torture, FMT convention, PSM committee, Pedigree, Neonatal reflex, Bone age POCUS, evidence-based medicine, SAAG Anatomy, surgery of Hernia, named hernias, Thalamic and hypothalamic nuclei Orthopedic splints, orthosis, tractions with named fractures Gl surgery + Radiology Crash course HPB surgery + HCC + Liver transplant Image bank-1 Image bank-2 Image bank-3Midnight Express-31 Special class Pg Dr. Zainab Vora + May 28, 2021‘Wunacademy } THROMBOELASTOGRAPHYQ. Rapid assessment of all the steps of coagulation pathway in an emergency (fHhbinoge eeary Perr) Parr ere ss. a cup fre oe “ft ren 1-3min Rom thes = L Figen ® 50-70 bak, HL ben eo (rom) tig FO ae x 1 :Wunacademy } INTRACRANIAL HERNIATIONHEANIANIONS : 1) Gub falleip. a flee ee 2) ee “a fom "C ?) Tons A) Transcranial loo deleckSUGFALCINE vale ) 1) Aca 2)U1ev Comptsuw 3) Oostuctive HCP 1S eeea, A (cel Gr Olt nuk ye Ane San ~\e !) Duret hemorrhage 4 Pea Wforct 4) Yenchan % notch = Fale wcakinls sige cae 4) GCN comprenvinnPCED eRe ee ened pee ey oe Cushing triad HAgsert CP monitor yventiculastomy versus parenchyma device nwT-——. BOATS: maintain ICP ¢ AbmmHg and CPP >f mmHg. For ICP Tor — ; 520-25 mm form ; warox ‘\W/Elevate head of the bed; midline head positior | + (Lont- Sete sag ae OD) oS Aygo ly & oe erby nm as needed (maintain serum| L — osmolality <320 mosmel) or mL, 23.4% NaCl BoTu bok TUT _ oisconaticoids dexamethasone + mg gh for vasogenic edema from “wumor, abscess (avoid glucocorticoids in head trauma, ischemic and ‘ | jOCYor raced ich:* =e %., morphine, propofol, or midazolam); add neuromuscular’ if necessary (patient will require endotracheal intubation and nical ventijagion at this point, if not 4o Paco, 30-35 mmHg Khof F skip this step) Ut % ZA. ray \enylephrine, dopamine, ornorepinephriné to maintain eal © seme ere ‘CPP 260 ming (maintalyCuvolemia to minimize a x jous systemic effects of pressors). May adjust target CPP in individual patients based on autoregulation status. 8. Consider secondttier therapies for refractory elevated ICP a. Decompressive craniectomy eT war b. High-dose eis es (pete 8 7 ae c. Hypothermia to 33°Ccee “Mere ati LE GIs) cin CB Sid os i il =} Vaxsyrins eee Z Unenattor) | Yee (HyePin-point pupil: Ye cence opioid a ies ta eT (fn) - ie nT — WeBrain deat eh Brainstem reflexes?~ Apnea testing : & [0d Prerrwen” sire Twitchin DTR: ()Conjugate gaze :o (Gossine: | — Basile A pede DIPPING: p — Deep eta nani 7nit on the same side or less commonly the pons ‘on the or side, zures involving the frontal lobe drive the eyes to the opposite se, simulating a pontine destructive lesion. The eyes may occasionally tum paradoxically away from the side of a deep hemispheral lesion (‘wrong-way eyes”). The eyes turn down and inward with tha- lamic and upper midbrain lesions, typically thalamic hemorrhage. “aig describes brisk downward and slow upward movements of the eyes associated with loss of horizontal eye antythmic downward novenet tfolowed by @ faster upward movem horizontal gaze; it usually indicates diffuse cortical anoxiMidnight Express-32 Special class Pg Dr. Zainab Vora + June 2,2021Wunacademy 3 CONTRACEPTIVESNatural methods:(:) 2Oed— Ryhin Ogino- Car TU IS} satsrelay = (8-14) Thumel beads Biting w 606 tw; vPOSTPARTUM Ideal: (207) >ivin RULE OF(3}: al CoO CY -Breastfeeding: > 6v-~v -Non-breastfeeding: > 6. The hed a IUCD; 9 (3 Gl) - Inder Ue DRemove after: Ghns 5 iS upto: Gy) O we Protection against STI? “ms Sperraivide Remove after: @® Upto: Qn Protection against sity) HIV?(**)Remove after: 64 Upto: 4s Protection against STI? HIV? x»‘pepbeeors aa i. ArqDnovuale catheter Effective after : e ESSUREEmergency contraception an + ECPs te wna unprotected vaginal intercourse are 85% effective. aed is more e Within 12-24 hours of unprotected intercour: * The delay in taking the pills decreases the efficacy of ECP ea to clients within the reproductive years irrespective of their + If intercourse has occurred within the previous 72 hours (days) then ECPs can be prescribed and provided. Even if the client is breast-feeding, then ECPs can still be given, as the progestin pills do not affect the quantity or the quality of breast milk >ALLn Sq |, insertion of bea better choice and she may + commended time limit of this stage, depending on férred to an appropriate health centre + If the woman has 6 if there is a possibility that she may be pregnant, she should bi the next menses starts. A pregnancy test can be conducted to confirm her pregnancy status =Most effective emergency contraceptive: luchellaONe so metavie — ulipristal acetate ad aoe GPR 4 Eno eed Take one tablet as soon as possible after unprotected sex or contraceptive failureWoman on anticoagulation for DVT CID ~ |Woman with heart disease (>)= a a Contraception for: Agent of choice: Ocr lar CY 00 — neeosSo tee 2 GA fue SAE dwt Missed pill concept COct100 women used OCP for 2 yrs- 10 ae pregnancies | {Ons lor > x 200 a |ox x24 >aa Calender method a= PD FEMALE CONDOM : ld Vaginal sponge Male condom cae lucD chs ( ocp —~ Sterilisation wayWunacademy } PLEURAL EFFUSIONMost sensitive: u——.. 05g > CT , X= IL Wb dearhe oudlinrDiagnostic Pleural Aspiration © Position Site selectign Site_sferilization.or pleural effusions = Transudate 505 (pleural/serum) | Pleural LDH < two-thirds upper || Pleural LDH > two-thirds upper limit of normal serum LDH limit of normal serum LDH fection (parapneumonic, 8, fungal, empyema) lalignancy Lo Brey selon Bemre Gye Sa neigs (4- ~ wy a * Hypoalbuminemia (GTROSIS-nephrotic syndrome) * Congestive heart failureNormal pleural pH? oe 4.4 - 4-6 aeroIndication of in effusion?? —— “pH <9 leach 5) P oo" "Wd = Lpebsed + Spl plan yeGncomplicated parapneumonic g effusion Movement of fluid from pneumonia into visceral pleura Pleural fluid | pH > 7.20, Jtonormal analysis | glucose, LDH ratio > 0.6 Pleural fluid Maul Gram stain cs Pleural fluid Negative culture 2 Bacterial colonization, en purulent fluid pHEEZ20:4 glucose, LDH ratio> 06 = tube drainagecect Split pean sylemorrhagic effusion? )CSF analysis rere y Dem eke ss oer ul To) (Pro) OPENING atau fo) 0. <40 50-180 sons fal gt ULM , Ont me i ee. a 4 =\_@ i w ae @) Gao)? GBS =} Allama baud MS => ally Amek bandsP FAILS— markers lp SPERIMINDINE-tererpns POLYAMINE- Lutensin DEMOSTEROL- 6\ ViewsMIDNIGHT EXPRESS-33 Special class Dr. Zainab Vora + June 3, 2021unacademy — TORTURE METHODSEl merciefags> et(> 330 ~(hsTokyo, Istanbul Protocol, Hamburg a Se am el alu venice a its illness oe i Aisin Nuremberg code | — Haag ie eo 4 , Ottawa aa Chita an cate ~~ Bvtin Geneva Hippraoke 6 ted Kile gq dockno iy hunger Sheunacademy — PSM COMMITTEES-PHC 1/40,000 Bhwe (Ahh iedyy gang? fy_>Juew Jenteal taka cag -€) Kahne, —> Ry — A\l India Health Service ee ~1 basic health worker/10,000: malaria, vital stats, family planning Delink FP from malaria -Equal pay for equal work -Special pay for specialized work -No private practice - Female and.male health workers -> Health supervisor (for 4) = -PHC 1/50,000 Poe -RRRRR: Semi-and paraprofessional workers -Referral servi “ROME - aur 4me -Rural health scheme: 3 tigr Urban revamping scheme National medical and healthcare policy‘Wunacademy NEONATAL REFLEXES NN Alter bubsPlace your fingers Maneuve: I> into the baby’s hands and press against the pal- mar surfaces. The baby will flex all ? fingers to grasp your fingers. Touch the sole at the base of the toes. 32uls The toes curl. = Stroke the perioral skin at the cor- ners of the mouth. The mouth will open gpl and baby will turn the head toward the stimulated sideariel aucHold the baby ® ) v 4 supine, support- ~Y ing the head, ‘ = wre back, and legs. ley 2B ido 5 {bum re Abruptly lower = the entire body x about 2 feet. Comaglete - 3744 4 fi ial a The armsabduct and ef wpe I-16 Earliest joint to f Last joint to fus (My)Order of appearance of elbow ossification centres C4 i reo a" seeks stage ba os A med Tay ler - g 4 e % [> |lyAPPEARANCE: 2 mon: HaAG 3 mon: Te Byr: 71 4yr: Ls ee 5-6yr: ——__» ¢-T 9-12yr: PisinAPPEARANCE AND FUSION lyr: head 4yr: aT 14yr: LT oe aay: RoadyAge?APPEARANCE AND FUSION AROUD THE KNEE LOWER END OF FEMUR “ UPPER END OF TIBIA PATELLA ————"_—_ |- do ye lt \ Sy USION:Wunacademy } MITOCHONDRIAL DISORDERSMitochondrial disorders “ Sods -MELAS acl gokt) -MERRF = Myo dont bi - Age -CPEO -Kearn-Sayre-yndromeMus 25 toot! 0.4-00 pk — 7" FAM: 74h ned a inka ys A wane i= aehal eee ~ AV block V bo_Meuropathy Ataxia N antMIDNIGHT EXPRESS-34 Dr. Zainab Vora + June 4, 2021‘Wunacademy POCUS Print “l Gt vs4 %# MUST-KNOW: LUNG Gs@sIGns Bat sign —> 0 le ung sliding — 6 hey Stratosphere sign, Barcode sign — M-wide Phy Lung point sign, Absent lung sliding —\ 2-wede Phy Shred sign, Tissue sign, Air bronchogram sign = — Cos ly Leo Sud. —_(Qp A Starry sky appearance Gop) SRE i aeThe say Shue 7EFAST- brinded Fo cuareea Pasenererd Sono LAM FALLS (Hoa Deliainadloud, laewted L une RUSH aid 054 Shum La ve) @e CPLAPS) ireniaet ee flegs % a oe Consol fhmThe FALLS-protocol {1) Ruling out obstructive shock Simple emergency cardiac sonography: Pericardial tamponade Right ventricle dilatation” BLUE- protocol: Peumoth ‘a‘protie) —~x = 12) Ruting out (ef) cardiogenic shock *] [= UE-protocol: Pulmonary edema (B-profile) '3) Ruling out hypovolemic shock profi) | Correction ofc sof shock under fluid administration (4) Detecting distributive shock (septic shock us Fluid therapy not able circulation a B-profileWunacademy } EVIDENCE-BASED MEDICINEFather of EBM D1, St6) Meta-Analyses: summarize results using quantitative methods 5) A systematic review: systematic approach to literature reviews to reduce randonyerors and bias. Y, 4) CAT: Short summary of evidence on a topic 3) Randomized Controlled Trials (RCT): assesses a variable (i.e. drug or treatment). Clinical Trials fait in this category. , ~ P unfiltered 2) Cohort Studies & Information Case Control Studies: Observational studies. 1) Case Report/Series: Report of an individual patient Background Information & Expert Opinion .AS iHavahc NAO T_Sengle sty — Dyeous \ SeMaha -amelygds pov led cK hy Koniwore Ave ‘cochrang \Embase Dakabesee =evidence GE a ‘controlled tials YZ; individual ranaonaned comeied tral 2 Systematic review of cohort studies | Individual cohort study | Systematic review of case-control studies Zeppraisal or based on physiology or benchReview > Neurosurg Rev. 2021 May 19, doi: 10.1007/s10143-021-01532-2. Online ahead of print. Efficacy of antimicrobial medicated ventricular catheters: a network meta-analysis with trial sequential analysis Revanth Goda * 1, Akshay Ganeshkumar * ", Varidh Katiyar ", Ravi Sharma *, Hitesh Kumar Guriar 2, Aprajita Chaturvedi 3, Roshan Sahu ", Hitesh Inder Singh Rai *, Zainab Vora * Affiliations + expand PMID: 34009522 DOI: 10.1007/s10143-021-01532-2Smith et al. 1991 Jones etal. 1993 Smith et al. 1999 Nget al. 2004 Chuet al. 2009, ‘Summary measure 3.0 &@ 1.3(05, 26) 231034) » st Inslyn 1.8 (0.9, 3. 2.3 (1.9, 2.7) 2.1(18, G rope sly 2.2 (1.9, S> Br J Radiol. 2021 Jan 1:94(1117):20201069, dl: 10:1259)/bj.20201069. Epub 2020 Nov 6. Normalized apparent diffusion coefficient: a novel 2 a paradigm for characterization of endometrial and subendometrial lesions 4 Zainab Vora *, Smita Manchanda *, Raju Sharma 1, Chandan Jyoti Das ®, Smt Har *, Sandeep Mathur 2, Sunesh Kumar #, Garima Kachhawa 2, Maroof Ahmad Khan # Aifiitions: + expand PMID: 33125267 PMCID: PMC7774697 (available on 2022-01-01) DO: 1 mia Ap i ty ‘Objectives: To assess the role of normalized apparent diffusion coefficient (ADC) in ‘characterization of endometrial and subendometrial masses, measured as a ratio of the mean a ‘ofthe pathology to mean ADC of two diferent internal controls, normal myometrium and gluteus ‘maximus muscle, referred to aS nADCm and nADC, respectively ‘Methods: 55 females with pathologically proven endometrial and subendometrial lesions, including 27 cases of endometrial carcinoma, and 28 cases of benign masses were enrolled in this prospective study and assessed with single-shot echoplanardifusion-weighted imaging. The ‘normalized and absolute ADC of the lesions, measured by two radiologists, were compared in oy Ange \\te> "NN Ou } sus \ edbass?ne EP) Medel Gp PP por PF futel erdaperitrodMC nerve injured: LENT RENE lingenatview wotsNiyspechol ovif 4 fred he Sup Int Sayre | CT Le = ilioprss bd > Usp by acunan. hySchematic view of right femoral region B fe hernia (prevascular) c D, 's hernia Serafin hernia (rewovascular) F. Ciaget’s herniaLitter Hernia ind Hernia nia Pantaloon Hernia Garren Richter Hernia jlive Herni Laugier Hernia Narath Hernia = Meulel’s aivechorlian ir Apieden . vale + Aemin 9) 2h = sigud din (xt) ve) Tig anepea)~d ea ete — Dod + Lepnesety 2 oe Velpeao Hernia @prdte Hernia — Pre bey tony Berger Hernia. —— fod f-- B “Np Grynfeltt Hernia. — i se Petit Hernia = Inpeneepews " renmenGscimn) belter La puik ‘Inguinal igament ___, Soe i Hale “ i nly Hernia that mimics Peptic ulcer disease dSpigelian herniaPunacademy — THLAMIC AND HYPOTHALAMIC NUCLEInucue, wout brass) Ventral wal Postero- : wir went STDC ML eas poopy Sy 2. nucleus = , Lyia te amen Ventral v a = Guan u |, Lipsty Png | TRO YL wn ‘nt " (01) @ ridin Claunt O clk C “ x nN aaa eat * —_°"s" = es £ a”<8 henge Sy shal (Remenr A aty GS Lt Anterior nucleus “nh BS et) She prs ha Posterior nucleus Awake —a— por G5 OE ? uy th a4 So a mit nuclei “Sap x’ Seems — fu Hd AD f a — — Pxbuy oot Preoptic nucleuS > an ( ei ae fii Kallanan ¢Midnight Express-36 Special class Pg Dr. Zeinab Vora + June 9, 2021‘Wunacademy ORTHOPEDIC SPLINTS av : ae oe 707 + SPLINT a emo, oa nakl fire G a) — CO heenah stanlixrTea) ana TRACTION BET Nea sco). Indication Mild to Moderate to moderate force severe force Weight -4kg Upto 20kg permitted Z Applied with Adhesive tape /Steinmann oe pin,Kwire ude“ Glin vache a =New peg ‘a "hy é y wl cite ae Trt sat (caus hand on N CE" Pld?c Sf Ut shetunh Coun Weg warditGouin sis Soin is Cochea pat (‘)rules des? up fa linnr fermiona [beerCrammer-wire splint —> Udi) - peg Thomas splint 0 ~) a four Ht - eensrtirw Bohler-Braun splint ~glh + det dic? # few. Aluminium splint | Troy yt - Dennis Brown splint — cTeV aS Cock-up splint — Wyact dp Knuckle bender splint ~ Uw hand Toe-raising splint - rot dup Volkmann’s splint or Turn Buckle splint ie)+ Fout-postoolar > C- SPIKE at + Aeroplane splint — bf ‘ panviacia liens brace) — C-qpne H + (ASHE (Anterior spinal hyper extension) brace. — DL. Spre th = Spl ypu “vale ees) — Salhi + Boston brace — Saline — Geet Lumbar corset = fat athe.eee + RGsel's traction» GD Buck's traction ys J, ha ha Perkins traction — Gd-lt tear Dunlop traction Smith's traction ] Seer nd Heact-halter traction ~ C- Sy e, Crutchfield traction — C “Spit Halo-patyéotraction - C -Spve Ninnerva cas, NaB@aies ————* oir» Risser’s cast, Mivaukee brace, Boston brace) Palvic hamess, Von Rosen splint Ifeld or Craig splint__ bduWunacademy —Teruel JUDET and LETOURNEL - Atdubl # YOUNG AND BURGESS, TILE — Pelvic # DENIS — ae qt & SANDERS - SCHATZKER — Se Keamemee NEER — oe Lae GARTLAND ~ BADO ~~ FTN ——3 fi PIPKIN, GARDEN, PAUWEL EVAN eS DANIS- WEBER es Uc fad KUWADA — fyijlla wl Jewk2 whl W nrope Posen tape fractire. eo <- paves ne15 base of thumbhx © InsaitSaivati method Patella baja: <0.8 Patella alta: >1.2 i — (ieee ee SS sand index QMidnight Express-37 Special class Pg Dr. Zainab Vora + June 10, 2021Phenomenon: Husl prenmnonan eS iso o& EMS 4 Perret ig 0 —_ Endl sales Bed leak Aa halaiieNed dtfiee (NOYES: Tran tnnat Endo seapic Sy POEM :Cm from naresHem : VGIt 7Pagal al ve kel an hgetere C : T Swale + z Maule Veh ne pe S Se Hen (Gs CECT 4 wal tate)“ham ger! Soryg Ath fn i" = 7 pay Crp) * Npiedence mortem- T staging: bk), N staging: - M staging:Esophagectomy & -Conduit: Gonucs) rt ee -McKeown™ #2" > (Kee) -Ivor Lewis ~ anscheniy > meduthrwa orringer — taut SPrzteatenli ate nee, 3 Huodensd tlie peste Ant pallAdmissio® risk marker Blood urea (mmol/L) 0 wu eo mS aoa 22s Hb g/t) Men 20.130 1004129 10/min Hotery und comoxbldton teow Syncope Hepatic disease’ Cardiac failure’ big) Dedied se ew Arde Variables ‘Age (in years) Shock Co-morbidity ochall Ome” Responses <60 079 320 No shock Tachycardia (SBP > 100 mmHg, Pulse > 100 beats/minute) Hypotension (68° < 100 mmHg, Pulse > 100 beats/minute) None Cardiac failure, IHD, ‘any major co-morbidity Renal/lver failure, metastatic malignancy Mallory Weiss tears Al other diagnoses Malignancy of the upper Gi tractfercenttn Stage Characteristics Re-bleeding — Spurting Bleed 60 - 100% —_ Oozing Bleed 50% Ma Non-Bleeding Visible Vessel 40 - 50% lib ~ Adherent Clot 20 - 30% le Flat Spot in ulcer crater 7-10% Hl Clean Base Ulcer la ib ila ib Tie i Spurting | Oozing bleed | Non-bleeding | Adherent clot | Flat spot in | Clean base bleed visible vessel QQ, | ulcer crater ulcerMetastasis outside surgical resection field ee sd TEA URE es] oz iympnadenectomy ee Reus PérigastHeb Is 4-6 (7) D1 lymphadenectomyeh yal aMC C/F Child- eed Adult- shshecs — lel prot = \E es Incidentally detected Mx: ~ Vide hem 4 ho he doko Rule of 2: v'!. etn | Ring | o ta. Ur de cL. | DecorsTeduglutide, Bianchi, Step, Kimura i procedure Ca th Ss leaghens r_-S- a> Definition: Adults- <2 mom Children— '< j* oi ——+ Ldlor le jo —- > Zp ve] (acc) Ch | mesentat iechenes ae ignla Hinchey Classification inflammation, no fluid collectio: 1b [ Pericolonic phlegmon and i n Pericolonic abscess <4cm | Pelvic or inter-loop &bscess) OR —— abscess >4cm ~—Purulent peritonitis e) fe ~/Feculent peritonitisAlvarado score Feature Migration of pain Tendemess in ight lower quadrant ~ Rebound pain Elevated temperature Leucocytosis ‘Shiff oF white blood cell count to the left Total2S ory © (apt) ~ Dogev V hhepatocystic triangle (Budde-Rocko)a err AA SOMAMidnight Express-38 Special class Pg Dr. Zainab Vora + June 13,2021Wunacademy } INTEGRATED HBP SYSTEMIrate — Choleyhucs / he CO Muban -— UDA (isnTokyo classification ns Grade Criteria 1 Mild__ Acute cholecystitis that does not meet the criteria for a more severe grade Mild gallbladder inflammation, no organ dysfunction 2 Moderate The presence of one or more of the following: Elevated white blood cell count (>18,000 cells/mm’) alpable, tender mass in the right upper quadrant lock ion STE larked local inflammation Ppcluding biliary peritonitis, pericholecystic abscess, hepatic abscess, gangrenous cholecystitis, ‘emphysematous Cholecystitis Ges) The presence of one or more of the following: Candiovascular dysfunction (hypotension requiring treatment with dopamine at >S yig/kg body weight per minute or ‘any dose of dobutamine) Neurologic dysfunction (decreased level of consciousness)Ss VS ~ Ciendes I, e- \ ath Bee? -Panees Due [aah kdMIC NET: Newft > hasan MC NET in MEN MEN1: Gacwmons 1OC for yr Insulinoma: Iitya -op VG 1oc for gthe NETs: v1 a vgn PT v @ L_/)rtenod ) PeAge Pathology Appearance Calcification Hemorrhage Pancreatic duct Epithelium Aspirate Grand mother Mother Benign 30% malignant Microcysts <2 cm; > 6 Larger cysts, septations No 30%, scar Rare, peripheral Rare Rare Normal Dilatation +/- Glycogen-rich Cuboidal Columnar mucin- producing Low CEA, amylase High CEA, Low amylase Grand father 65% at $ yrs Pleomorphic, nodules Rare Rare Dilated; communication*+ Columnar mucin-producing High CEA, High amylase- E606, PV bn “hoa Mancuy F Ptah prtrduce [\Wubs| REE mo) | Early stage (A) neeneeeTy] ‘Advanced stage (C) Portal invasion, = Pso NIMH PSI? ene Liver transplantation (CLTUDLT)Child-Pugh Classification Finding 1 Point 2 Points 3 Points lopathy grade Mild Severe ites Absent Miki to moderate Severe, refractory bilirubin (mgidL)* <2 23 >3 Serum albumin (g/dL) >3.5 28-3.5 <28 INR <7 1.71-2.20 >2.20 Note —Dhid-Pugh classi asessed according tothe folowing ceria (7: A, S-6 pons; 8, 7-9 pons; C, 10-15 points. therePEEDISCORE Y GR | ween hie- Dd 1 CE set Gls @ En copy Lorsola fala SU cue = hes Dige 6.5 (PT >100 seconds) Ri ii Serum creatinine >300 umol/ ili Grade 3 or 4 hepatic encephalopathyod“ Pr gy NR >6.5 (PT >100 seconds) Of Any three of the following: i Age <11 or >40 years ii Aetiology non-A, non-B hepatitis, or idiosyncratic drug reaction ili Time from onset of jaundice to encephalopathy >7 days e. not hyperacute) a iv INR >3.5 (PT >50 seconds) v Serum bilirubin >300 umolIndications for listing patients with chronic liver disease for liver transplantation MELD score of 14 or PELD of 16 or T c of $ or more c Pazients with lower disease score with Refractory ascites hydrotho: Refractory portal hypertensive hemorrhage ontancous bacterial peritonitis urrent hepatic encephalopathy Heparctenalsyadrone Hepato-pulmon ndrome Biliary cirrhosis Diuretic induced nephropathy Partial portal vein thrombosis Compromised quality « intractable pruritus, tiredness Growth retardation or failure to thrive in children PELD: Pediatric end-stage liver disease, MELD: Medical end-stage liver disease. CTP. Child-Turcotte-PuglWunacademy } LIVER TRANSPLANTMC indication- Adults: (uses ~HeY > far Children: (Zig) MC metabolic disorder- ., AT MCC cause of emergency transplant?) \ ree =Spann Orthotopic vs Heterotopic # «% Complete vs partial pa Auxillary (Ey) les HALT: Hetevdpic tvaltay Lr APOLT: Awl Patel Do L1 a, Split LT: put @P>o Domino LT: mnie’: 2 (‘190) Piggyback LT: = (jvc)£Donor inferior Liver graft a veva cava ipient Retrohepatie cavaGraft Types in Liver Transplantation Right lode Left lobe Right lobe (60-70%) LargeteenagerOrthotopic LT Sequence: . Sup eahe Ive “leer VC vay | 26 OE OGContraindications Bodie taiy > Active or uncontrolled erat > Active substance or alcohol abuse Pe atc sritueluclleae > Diffuse hepatic tumor invasion > Thrombosis of the entire portal and SMV system > Severe cardiopulmonary disease or other comorbid conditions vane ye NoncomplianceContraindications ro) Relative Contraindications va in} olangiocarcinoma aa Pea AI) mbosis > Chronic or refractory infection Pen Wanicredlela) > Morbid obesity > Previous malignancy Pee e en cltiene elne (1mPost-transplant complicationsPg G Midnight Express-39 : Image Bank 1 Dr. Zainab Vora + June 14, 2021Wunacademy } MUST KNOW IMAGES-Placenta types -Skull Xray Pattern based approach -Breast Integrated -Spine Xray Patten based approach -Snakes -Hand X-ray -ENT signs -Intestinal obstruction -DM -Peds GI -PE"Vell, Hous > Peapial J > ee iy est wi Ant@F™ j Le Yose. poe Swccorbuaheae O82 ah a 2 PAS aie glyMine Gt = weocett Jueale aie z) (AN GW Bsmchiedass bs) —— : HA cI wig) —_—— 6 16 =| Were SSReni 7 2 | e enhams Nay Sncebitily > Let tees revo gesgym Sot + Yan rire — TpnsiewPg c Midnight Express-40 : Image Bank 2 Dr. Zainab Vora + June 15, 2021Wunacademy } MUST KNOW IMAGESpAYC2 eo] ‘weMb oO Ihe) oso 01 count “tt aTram auk pyfj olla | i lino, & “ow oe a awal Zz aRAILS5 oe} inky soni”Want. § — foes ~ kek Firms —Vifma M4 - =e pischiclPg G Midnight Express-41 : Image Bank 3 Dr. Zainab Vora + June 16, 202Wunacademy } MUST KNOW IMAGES. ele : ' abs = . a dal is Heche imre) oe A Rute he ' hk pate BY de ane lve Vo s (int a i ENDhens 7 a pase E 1 pene prellt eiAcke SimZVenrry vl Presure sud Area between the lower _| Pressure points, toes and of foot, tip | Bony prominences, heel calf and the medial af, Tateral malleolus of the toe, lateral een Te malleolus and tibial areas to fifth metatarsal Shallow and flat margins, | Punched out and deep, Deep, often macerated moderate-to-heavy irregular shape, unheal- exudate, slough at base | thy wound bed, presence with granulation tissue | of necrotic tissue, mini mal exudate unless infected9 Relationship to contraction Relationship to contraction «» Syrmetic to contacton Oe Recovery + Delayed compared to contraction '* Nadir of deceleration comesponds: sec ‘+ Nadir of deceleration occurs after veasoan pa 2 potatoe © Gradual (230 sec from onset to nadir) t ‘© Gradual (230 sec from onset to nadir) Nate tology + Ucroplcentalinsficency logy eee © Contraction £ can be normal fetal racing : Relationship to contraction yy Recovery + Can bebutnotnecessanly ib sourced wa coecns + Arp ee tom ott ae) ZN * Decrease tS dren 218s arnt Variable | but<2min hah ae’ =