DEDICATED DEDICATED TO OUR FELLOW DOCTORS IN SUDAN BADRY BADAWY
MOH SULT S ULTANAT ANATE E OF OMAN EXAMS NOV.2002 NOV.2002 Recognized com!ic"#ion o$ C%ic&en 'o( inc!)de * 'ne)moni"+ ',o!i$e,"#i-e N+ Ac)#e '"nc,e"#i#i/+ Ence%"!i#i/+ Moc",di#i/+1meningi#i/DIC)i!!i"nHenoc%mo/i#i/o,c%i# Moc",di#i/+1meningi#i/DIC )i!!i"nHenoc%mo/i#i/o,c%i#i/#,"n/-e,/e i/#,"n/-e,/e me!i#i/ ),),"3 Recognized $e"#),e/ o$ 4,)ce!!o/i/ inc!)de* inc)5"#ion e,iod o$ 6 mon#%/+ $e-e, 7i#% nig%# /7e"#/+1'UOm"!"i/e"no,e(i"-omi#ing7#.!o//con/#i"#iondi",,%e" /7e"#/+1'UOm"!"i/e"no,e(i"-omi#ing7#.!o//con/#i"#iondi",,%e" m"!gi"5"c%"c%e",#%,i#i/,"/%5),/i#i/de,e//ion3 %e"#o/!enomeg"!!+ eididmoo,c%i#i/+ Sond!i#i/+1com!ic"#ion/* o/#eome!i#i/S4E8IE 1-ec)!#),e3"5/ce// 1!i-e,/!een !)ng3meningoenc.3 Te#,"cc!ine Te#,"cc!ine T%e,"* 4"c#e,icid"! 1/#"#ic3 Con#,"indic"#ed in ,egn"nc+ Do(cc!in c"n 5e )/ed ) /ed /"$e! in ,en"! $"i!),e+ S%o)!d 5e #"&en "$#e, me"!+ Ac#i-e "g"in/# Mco!"/m" 9 4,)ce!!" +1C%!"mdi"LmeRic&e##/i"c%,onic +1C%!"mdi"LmeRic&e##/i"c%,onic 5,onc%i#i/3 Com!ic"#ion/ o$ F"!ci",)m M"!",i" inc!)de* Com" 9 de!i,i)m+ 1!"c#ic "cido/i/&)//m")!"nemi"%og!cemi")!m.edem"ARDS /%oc&"!gid15"c#e,i"! /e#icemi"3 4!"c& 7"#e, $e-e,+ Ac)#e ,en"! $"i!),e+ Ac)#e !i-e, $"i!),e+ Ac)#e c",di"c $"i!),e+ '"in o$ Angin" ind)ced 5 e(e,ci/e+1emo#ionco!d%e"- me"!/3 ,"di"#ion #o nec& 9 ",m/ 5)# no# #o :"7 ,e!ie-ed 7i#% ,e/#+ immedi"#e ,e!ie$ 7i#% Ni#,og!ce,ide/+ e(e,ci/e doe/ no# 7o,/en #%e "in C!inic"! $e"#),e/ o$ Lo7e, Lim5 DVT* co!d 9 5!)e !im5
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7",m oedem"#o)/ !im5+ c"!$ #ende,ne//+1mi!d $e-e,edem"%om"n)i,e/ '%o#o#%e,"+ o$#en e,/i/#/ $o, ? 2 7ee&/ in #%e #e,m in$"n# T%e $o!!o7ing ",e #,)e "5o)# Ac)#e 4,onc%eo!i#i/ in c%i!d,en* i# occ),/ mo/# common! in @ ;2 ,/. Age Age g,o)1;3 mo/# common! c")/ed 5 4"c#e,i" 1-i,)/3 c"no/i/ m" occ),/+ c%e/# ,e#,"c#ion i/ common+ ne5)!ized S"!5)#"mo! m" 5e %e!$)! in /ome c"/e/ +
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7",m oedem"#o)/ !im5+ c"!$ #ende,ne//+1mi!d $e-e,edem"%om"n)i,e/ '%o#o#%e,"+ o$#en e,/i/#/ $o, ? 2 7ee&/ in #%e #e,m in$"n# T%e $o!!o7ing ",e #,)e "5o)# Ac)#e 4,onc%eo!i#i/ in c%i!d,en* i# occ),/ mo/# common! in @ ;2 ,/. Age Age g,o)1;3 mo/# common! c")/ed 5 4"c#e,i" 1-i,)/3 c"no/i/ m" occ),/+ c%e/# ,e#,"c#ion i/ common+ ne5)!ized S"!5)#"mo! m" 5e %e!$)! in /ome c"/e/ +
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A /im!e $e5,i!e /eiz),e i/ )/)"!! "//oci"#ed 7i#% $e-e, 6B.@ C Mo/# common! occ),/ in c%i!d,en 5e#7een mo 9 @ ,/. U/)"!! !"/#/ $o, ? ;@ min/. I/ o$#en "//oci"#ed 7i#% meningi#i/ F,e>)en#! ,e/)!#/ in ei!e/ !"#e, in c%i!d%ood W%ooing Co)g% occ),/ mo,e common! in ,e/c%oo! #%"n in /c%oo! c%i!d,en+ i/ c")/ed 5 Re/i,"#o, Snci#i"! Vi,)/ Vi,)/ 14o,de#e!!" e,#)//i/3 i/ " 5,ig%#! in$ec#io)/ di/e"/e 1%ig%! con#"gio)/3 i/ con#,"c#ed 5 d,o!e#/+ /#",#/ 7i#% #%e ",o(/m"! co)g% in "!! c%i!d,en T%e $o!!o7ing /#"#emen#/ ",e #,)e "5o)# "c)#e "/#,oen#e,i#i/ in in$"n#/ Ro#"-i,)/ i/ #%e mo/# common c")/"#i-e o,g"ni/m+ Fe-e, i/ " common $e"#),e I/ )/)"!! c")/ed 5 ,o#ozo" in$ec#ion 4,e"/# $eeding c"n ,o#ec# "g"in/# Ro#"-i,)/ in$ec#ion+ An#imo#i!i# d,)g/ ",e -e, e$$ec#i-e in con#,o!!ing di",,%e" T%e $o!!o7ing /#"#emen#/ ",e #,)e "5o)# Do7n
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deconge/#i-e "gen#/ m" 5e )/e$)! d,)g o$ c%oice $o, #,e"#men# i/ enici!!in+ mo/# in$ec#ion/ ",e 5"c#e,i"! in o,igin T%e $o!!o7ing /#"#emen#/ ",e #,)e "5o)# innocen# c",di"c m),m), #%e in#en/i# o$ m),m), m" c%"nge 7i#% c%"nge o$ o/#),e+ #%e in#en/i# i/ )/)"!! !e// #%"n g,"de II + i# i/ o$#en "//oci"#ed 7i#% " g"!!o ,%#%m Ec%oc",diog,"m /%o)!d 5e done in "!! c"/e/ #o di$$e,en#i"#e i# $,om " #,)e c",di"c de$ec#G C"n 5e -i5,"#o, o, m)/ic"! in c%","c#e,+ T%e c!inic"! $e"#),e/ o$ Hemo%i!i" inc!)de 'e#ec%i"e Hem",#%,o/i/+ M)/c!e %em"#om"+ ',o!onged 5!eeding "$#e, #,")m" o, /),ge,+ ',o!onged 5!eeding #ime In#)//)/ce#ion/ in c%i!d%ood m" )nde,go /on#"neo)/ c),e+ %"/ "/ #%e e",!ie/# /ign #%e "//"ge o$ ,ed c),,"n# g"!!e /#oo!/ 1!"#e3 ,e>)i,e/ oe,"#i-e ,ed)c#ion in m":o,i# o$ c"/e/ 1"i, enem"3 m" 5e ini#i"#ed 5 " Mec&!
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ono,,%e"* ,e/en#/ "/ ),)!en# ),e#%,i#i/ in men+ c")/ed 5 di!ococci+1onococc)/3 /ecimen /%o)!d 5e !"#ed immedi"#e!+ c")/e/ /"!ingi#i/+ c"n c")/e/ endoc",di#i/ in di//emin"#ed in$ec#ion/+ c")/e/ o$ Ne%,i#ic /nd,ome inc!)de* Co,on", ",#e, di/e"/e Di"5e#e/ me!!i#)/+ SLE+ Am!oido/i/+ M)!#i!e Me!om"+
Com!ic"#ion/ o$ Di"5e#ic e#o"cido/i/ inc!)de* He,o/mo!", comm" L"c#ic "cido/i/ S#,o&e+ Ce,e5,"! edem"+ Moc",di"! in$",c#ion+ T%e $o!!o7ing d,)g/ c"n ,od)ce %emo!/i/ in 'D de$icienc A/i,in Ni#,o$),"n#oin ',im">)ine+ S)!$on"mide+ Vi#. C")/e/ o$ 5one !o// inc!)de* ',im", %e,","#%,oidi/m+ He",in #%e," Cig",e##e /mo&ing+ E(ce// "!co%o! in#"&e+ Vi#. C de$icienc Recognized c")/e/ o$ %emo#/i/ inc!)de Mi#,"! /#eno/i/+ T)5e,c)!o/i/+ ')!mon", AV m"!$o,m"#ion+ Me/o#%e!iom"+ ood"/#),e /nd,ome+ 4 5!oc&e,/ ",e )/e$)! in #%e m"n"gemen# o$ * Moc",di"! in$",c#ion+ T%,o#o(ico/i/+
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'%eoc%,omoc#om"+ S),"-en#,ic)!", ",,%#%mi"+ Ne),oc",diogenic /ncoe EXAM 2 A #. ,e/en#/ "# #%e 6,d #,ime/#e, 7i#% 5!eeding e, -"gin"* U8S i/ )/e$)! in di"gno/i/+ Tococ",diog,"% i/ " m)/#+ '.V e("m i/ " m)/# #o di"gno/e #%e c")/e Sn#ocinon %"/ no ,)!e in #%e m"n"gemen# A//e//men# co"g)!"#ion ,o$i!e i/ no# needed Join# /7e!!ing 7i#% "in occ),/ in* S",coido/i/+ Ac)#e o/# /#,e#ococc"! N+ Hemo%i!i"+ T%,om5oc#oenic ),)," ono,,%e" Re/i,"#o, Acido/i/ c"n occ), A/i,in oi/oning+ Se-e,e "##"c& o$ "/#%m"+ H/#e,ic"! o-e, 5,e"#%ing+ A mode,"#e! "d-"nced c/#ic $i5,o/i/ Oi"#e o-e,do/e T%e $o!!o7ing occ), mo,e 7i#% m)!#i!e ,egn"nc Congeni#"! m"!$o,m"#ion + A5,)#ion !"cen#"e+ 'ET+ 'o/#m"#),i# '' %emo,,%"ge+ '!o,ic /#eno/i/ c")/e/ $"i!),e #o #%,i-e+ ,e>)i,e 5",i)m me"! $o, di"gno/i/ m" ,e/en#/ "# 6 mo 7i#% -omi#ing c")/e/ me#"5o!ic "cido/i/ ,eonde,"nce $o, m"!e/ T%e $o!!o7ing ",e #,)e He",in c,o//e/ #%e !"cen#"+ Co,#ico/#e,oid/ ",e )/ed /"$e! in ,egn"nc Imm)no/),e//"n# c"n 5e con#in)ed d),ing ,egn"nc+ W",$",in c"n 5e )/ed #i!! #e,m+ An#i#%,oid c"n c")/e $e#"! de"#%+
A K0 ,/ o!d m"n )nde,7en# !"",o#o, $o, C" /#om"c% de-e!oed ,e(i" o$ 6K.@ C on #%e 2nd o/#oe,"#i-e d"* S%o)!d 5e gi-en An#i5io#ic/ in o,din", do/e 7i#% Amici!!in 9 en#"mcin+ S%o)!d 5e gi-en %ig% do/e/ o$ "n#i5io#ic/ e.g. "mici!!in 9 gen#"mcin In/ec#ion o$ #%e 7o)nd i/ m"nd"#o, #o e(c!)de in$ec#ion+ E",! m"ni)!"#ion 9 %/io#%e," /%o)!d 5e /#",#ed+ In/ec#ion o$ #%e !eg/ $o, /7e!!ing i/ imo,#"n# + O/#eome!i#i/ I/ c")/ed o$#en 5 di,ec#! ene#,"#ing in:),ie/ I/ c")/ed common! 5 S#,e#ococc)/ 9 S#"% "),e)/ + I!! %e"!#% 7i#% #ende,ne// in me#"%/i/ i/ o$#en di"gno/#ic+ X ," i/ di"gno/#ic in e",! d"/ Sm"#%e#ic "$$ec#ion in #%e ne", 5 :oin# e(c!)de #%e di"gno/i/ ',e/ence o$ :oin# e$$)/ion e(c!)de #%e di"gno/i/ In #%e #,e"#men# o$ m"!",i" C%!o,o>)ine i/ #%e d,)g o$ c%oice+ ',i#%"mo! 9 d"/one i/ #%e 5e/# o) c"n gi-e c%!o,o>)ine " mon#% 5e$o,e #,"-e!ing #o endemic ",e" Con#in)e #%e d,)g one 7ee& "$#e, ,e#),n $,om endemic ",e"+ D"i! ,og)"ni! i/ ,o#ec#i-e 7o,!d7ide T%oid Fe-e, '"in$)! geni#"! )!ce, '"n//#o!ic m),m), Ac)#e '"nc,e"#i#i/* S%oc& m" 5e #%e ,e/en#ing /m#om+ Li"/e inc,e"/e/+ Am!"/e i/ %ig%+ T,e"#men# 5 "n#i5io#ic/ '/e)doc/# 9 "5/ce// need /),ge,+ In ",#e,i"! He,#en/ion #%e $o!!o7ing in-e/#ig"#ion/ ",e ,e>)e/#ed* U,ine gene,"!+ 4!ood $o, ),e" 9 e!ec#,o!#e/+ U,ine $o, c)!#),e X ," C%e/#+ EC+ T%e $o!!o7ing ",e #,)e in F"!!o# Te#,o!og Inc,e"/ed JV'
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Finge, c!)55ing+ C"no/i/+ S>)"##ing+ S!i# /econd %e",# /o)nd Ho#%,oidi/m 5,"dc",di"+ ,o7#% ,e#",d"#ion+ Inc,e"/ed "e#i#e In#o!e,"nce #o %e"# E(o%#%"!mo)/ ',o%!"(i/ o$ m"!",i" c"n 5e 5 ,ime#%"mine c%!o,o>)ine+ m"!",im1 d"/one,ime#%mine3 $"n/id",+ >)inine C,ei#"#ion/ 7i!! 5e $o)nd in '!e),"! e$$)/ion+ 4,onc%iec#"/i/+ 4,onc%i#i/+ Segmen#"! co!!"/e Em%/em" S",coido/i/+ A'H A!7"/ "in$)! '!"cen#" 5,e-i" c")/e/ /e-e,e "in+ In:), c")/e/ "5,)#ion !"cen#"e+ Acciden#"! %emo,,%"ge ",e "!7"/ "in$)! T,e"#men# deend/ on "mo)n# o$ 5!ood !o//+ M)!#i!e ',egn"nc No,m"!! common in ,imig,"-id"+ 'o!%d,"mnio)/ i/ " com!ic"#ion+ ',em"#),e !"5o, m" %"en+ In"de>)"#e )#e,ine con#,"c#ion d),ing !"5o,+ ''H i/ " com!ic"#ion+ A "#ien# c"me #o o) 7i#% /e-e,e e, -"gin"! 5!eeding "# 6 7&/ ge/#"#ion"! "ge .7%"# 7i!! 5e #%e -e c")/e/G 4!ig%#ed o-)m+ R)5e!!" in$ec#ion T,")m"+
B
Ve/ic)!", mo!e+ Ce,-ic"! income#ence + A5o,#ion c")/e/ In$e,#i!i#+ M"#e,n"! mo,#"!i#+ '"in$)! 5!eeding+ A$#e, #,e"#men# ,e-ie7 /%o)!d 5e done+ Soci"! ,o5!em/+ C"c%"(i" ,e(i" + S%o)!d 5e #,e"#ed "cco,ding #o /m#om/+ T)mo,/ o$ !"cen#" c")/e/* '"in$)! 5!eeding A5o,#ion+ A$#e, #,e"#men# ,e-ie7 /%o)!d 5e done+ '"//"ge o$ mo!e i/ di"gno/#ic+ H/#e,ec#om i/ #%e #,e"#men# o$ c%oice A co)!e c"me #o o) $o, "d-i/e #%e ",e 6 mo m",,ied #%e 7"n# " c%i!d 7%"# 7i!! 5e o), ,oced),eG Do "!! in-e/#ig"#ion/ $o, $em"!e Do "!! in-e/#ig"#ion/ $o, m"!e A//" %o,mon"! /#"#)/ $o, 5o#%+ Te!! #%em #o 5e "#ien#+ Te!! #%em #o cond)c# coi#)/ in " /eci$ic #ime+ In C" C(.* I# c")/e/ !o7 5"c& "in+ Con#"c# 5!eeding+ Ce,-ici#i/ i/ " c")/e+ S),ge, i/ #%e #,e"#men#1cone 5io/3+ R"dio#%e," /%o)!d 5e gi-en "$#e, /),ge,+ In d/$)nc#ion"! )#e,ine 5!eeding* 4io/ i/ " ,oce// $o, in-e/#ig"#ion+ C),e##"ge i/ #%e #,e"#men#+ ',egn"nc "!7"/ c),e i#+ E/#,ogen 9 ,oge/#e,one i/ " #,e"#men#+ In me#,o"#%ic" %emo,,%"gic" #%e )#e,)/ i/ %e,!"/#ic+ In o$ c%i!d,en #%e $o!!o7ing /#"#emen#/ ",e #,)e* A!7"/ %e"! ,"id!+ S),"cond!", i/ #%e mo/# /e,io)/+ ,o7ing "ge c"n c",, /ome m"!)nion+ c!"-ic!e need/ no #,e"#men#+
c!"-ic!e "n"!ge/i" /%o)!d 5e gi-en+ '"ge##
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',imig,"-id" '!"cen#" 5,e-i"+ Hd,"mnio)/+ C" c( i/ common in M)!#i/e()"! ",#ne,/+ E",! /e()"! in#e,co),/eG O5e/i#+ 'i!!/ E",! men",c%e 9 !"#e meno")/e+ Con#,"ce#ion IUCD i/ com!ic"#ed 5 in$ec#ion+ IUCD i/ CI in 5ico,n"#e )#e,)/+ 'i!!/ in%i5i# o-)!"#ion+ 'i!!/ in%i5i# !"c#"#ion N"#),"! me#%od/ ",e e$$icien# W%ic% o$ #%e $o!!o7ing i/ ",e #%e commone/# c")/e/ o$ "5o,#ion $o!"#e de$icienc +1indi,ec#3 congeni#"! m"!$o,m"#ion+ 5!ig%#ed o-)m+ c%,omo/om"! "5no,m"!i#ie/+ ,oge/#e,one de$icienc UTI 7i#% ,egn"nc* Common in ,imig,"-id" Tic"!! "//oci"#ed 7i#% !oin "in. L# /ided 1@0 R#. ; L#3 I/o!"#ion o$ ),ine ;00000 5"c#e,i" 8m! i/ di"gno/#ic+ I# c"n c")/e "5o,#ion+ M"in! 5 ',o#e)/ // Re#,o-e,#ed )#e,)/ C"n 5e congeni#"!+ C"n 5e "/m#om"#ic+ I/ "//oci"#ed 7i#% !o7 5"c& "in+ Common in Neg,oid+
U#e,ine $i5,oid /),,o)nded 5 /e)do mem5,"no)/ c/#+ inc,e"/e/ in /ize 7i#% ,egn"nc+ i# c"n c")/e o5/#,)c#i-e !"5o,+ c"n 5e "/m#om"#ic+ He, eme/i/ g,"-id",)m
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N")/e" 9 -omi#ing occ), in K0 o$ "!! ,egn"ncie/ M" c")/e e!ec#,o!#e im5"!"nce+ Occ),/ in mo!", ,egn"nc+ An#ieme#ic #,e"#men# i/ e$$ec#i-e in e",! ,egn"nc+ Occ),/ in m)!#i!e ,egn"nc+ Mo!", ,egn"nc 4o#% c%,omo/ome/ ",e de,i-ed $,om $"#%e,+ S),gic"! e-"c)"#ion i/ c),"#i-e in 0 Com5ined o(#ocin 9 /)c#ion c),e##"ge i/ #%e 5e/# #,e"#men#+ Mo#%e, "d-i/ed no# #o ge# ,egn"nc+ CIN 1 ce,-ic"! in#,"ei#%e!i"! neo!"/i"3 K0 o$ CIN III goe/ #o in-"/i-e C" 16,d 3 in-"/i-e C" occ),/ 7i#%in ;0 ,/ in CIN+ cone 5io/ i/ #%e 5e/# di"gno/#ic 9 #%e,"e)#ic+ ,ec),,ence "$#e, 5io/ i/ "n indic"#ion $o, #o#"! %/#e,ec#om+ Rec),,en# "5o,#ion De$ined "/ %"-ing 2 /)cce//$)! "5o,#ion/ Emi,ic"! %o,mon"! #,e"#men# i/ indic"#ed Fe#"! &",o#e "5no,m"!i# i/ " ,edi/o/ing $"c#o,+ G 'ET I/ ,egn"nc ind)ced %e,#en/ion+ ',o#ein),i" ,ecede/ %e,#en/ion Occ),/ "$#e, 20 7&/ ge/#"#ion+ Occ),/ 5e$o,e 20 7&/ ge/#"#ion in mo!", ,egn"nc+ An#icon-)!/"n# 9 %o#en/i-e d,)g/ ",e indic"#ed in /e-e,e 'ET+ ''H Occ),/ in ;0 o$ "!! ,egn"ncie/ 1@3 M" $o!!o7 A'H+ '"/# %i/#o, o$ ''H i/ imo,#"n#+ M" occ), in !",ge 5"5 de!i-e,+ 4!eeding ?@00 m! in ;/# 2= %,/ in ,im", ''H o$ de!i-e,+ Com!ic"#ion/ o$ ,em"#),i# Ho#%e,mi"+ RDS+ Hog!cemi"+ /)/ce#i5i!i# #o in$ec#ion+ $"i!),e #o #%,i-e+ Neon"#"! meningi#i/ E co!i i/ #%e mo/# common o,g"ni/m+
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T%e,e i/ nec& ,igidi# Re!)c#"n# #o $ood+ T%e,e i/ -omi#ing+ L' /%o)!d 5e done+ In m"!",i" 5e$o,e ;0 d"/ o$ !i$e m" occ), 1congeni#"!3 mo,#"!i# ,"#e i/ %ig% in in$"n#/+ C%!o,o>)ine i/ #%e d,)g o$ c%oice + M" c")/e /e-e,e "nemi"+ Me$!o>)ine i/ gi-en in CRM+ In R% Fe-e, A!7"/ c")/ed 5 S#,e#ococc)/+ Jo%n
EXAM6 Fi5,omom" I/ " c")/e o$ in$e,#i!i#+ ',egn"nc c")/e/ %"!ine degene,"#ion S",com"#o)/ c%"nge/ i/ 0.@+ R",e! ,ec),/ T%e $o!!o7ing ",e c")/e/ o$ o!),i" A/i,in oi/oning C%,onic ,en"! $"i!),e+ DM+ '/c%ogenic 7"#e, d,in&ing+
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DI+ Common /i#e/ $o, /,e"d o$ C" endome#,i)m Rec#)m F. #)5e/+ U. 5!"dde,+ O-",ie/+ U#e,o /"c,"! !ig"men#+ Mo5i!e ,e#,o-e,/ion o$ )#e,)/ Occ),/ in 20 o$ "!! 7omen+ Re>)i,e/ oe,"#i-e #,e"#men# c")/e/ mi/c",,i"ge+ /#)c& #o e!-i/ in endome#,io/i/+ d/",)ni" i/ "//oci"#ed+ DM in ,egn"nc TT i/ " /c,eening #e/#+ Sc,eening /%o)!d 5e done "$#e, ;0 7&/ o$ ,egn"nc e/#"#ion"! di"5e#ic/ %"-e g!)co/e #o!e,"nce in non ,egn"nc e/#"#ion"! di"5e#e/ i/ ,e/en# 7%en R4S i/ @B mmo!8L "$#e, 2 %,/ $"/#ing In/)!in deend"n# #/ ,e>)i,e/ in/)!in 7%en non ,egn"n# Meno")/e Mode o$ "ge o$ on/e# i/ @; ,/+ ',em"#),e meno")/e i/ de$ined "/ occ),,ing 5e$o,e == ,/+ O/#eoo,o/i/ i/ " !ong #e,m com!ic"#ion+ Occ),/ ; 2 ,/ e",!ie, in /mo&ing 7omen+ FSH ? 20 U i/ di"gno/#ic+ A ,egn"nc in #e,m ;0 d"/ Ind)c#ion o$ !"5o, dec,e"/e/ ,i/& o$ e,in"#"! de"#%+ Inc,e"/e ,i/& o$ congeni#"! m"!$o,m"#ion i/ d)e #o o/#m"#),i#+ inc,e"/e/ ,i/& o$ in#,"",#)m "/%(i"+ G C/#ic $i5,o/i/ ene $,e>)enc i/ ;*2000 1;*@0 K03 Incidence i/ ;*@00 1;*20003 C",,ie, c"n 5e iden#i$ied 5G ',en"#"!G I/ di"gno/ed in ,en"#"! e,iod 5 /e,)m imm)no,e"c#i-e #,/in+ In-o!-e/ im"i,ed %)me,"! /ec,e#ion o$ /"!#+ En#e,oce!e A!7"/ "ccom"nie/ ,oceden#i"! de!i-e,
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Endome#,i"! in-e/#ig"#ion 1/me", 3 m)/# 5e done $i,/# 5e$o,e gi-ing #,e"#men#+ ACTH "n"!og)e )/ed in #,e"#men# m)/# 5e !imi#ed #o "n#i e/#,ogen e$$ec#/ ? B0 m! o$ 5!ood i/ !o/#+ $i5,oid co)!d 5e " c")/e+ Hd"#i$o,m mo!e Di"gno/ed in #%e $i,/# B2= 7&/ o$ ,egn"nc+ 0 ,e/o!-e /on#"neo)/! + c%o,ioc",cinom" occ),/ in 60 o$ c"/e/ Le"d/ #o $)nd"! !e-e! ? d"#e+ %C i/ -e, %ig%+ In #7in ,egn"nc T,i!e ,egn"nc i/ " ",en#"! c")/e T%e incidence o$ monozgo#ic #7in i/ e>)"! in "!! co)n#,ie/ C!inic"! e("min"#ion gi-e/ " good e/#im"#ion C")/e/ ;0 o$ e,in"#"! mo,#"!i# In #,i!e o, mo,e C8S i/ indic"#ed Di"5e#e/ 7i#% ,egn"nc on/e# occ),/ in #%e ;/# #,ime/#e, H'L 9 co,#i/o!e ",e in/)!in "n#"goni/# F"/#ing 5!ood g!)co/e i/ !o7 in #%e ;/# d"/ o$ ,egn"nc !co/),i" i/ common 7i#% ,egn"nc Con#,o! co)!d 5e 7i#% o,"! %og!cemic/ T%,o#o(ico/i/ 7i#% ,egn"nc Iodine #%e," i/ " #,e"#men# o$ c%oice C",5im"zo!e doe/ no# c,o// #%e !"cen#" ene,"!! T= T6 !e-e!/ ",e no# c%"nged T,e"#men# 7i#% c",5im"zo!e 9 #%,o(in i/ con#,"indic"#ed ',oge/#e,one on! i!!/ Ameno,,%e" occ),/ in #%e ;/# 6 mon#%/ I$ one i!! i/ mi//ed #%e,e i/ no need #o ,oceed 7i#% "no#%e, #e o$ con#,"ce#i-e i!!/ I/ " c")/e o$ c/#ic o-", in 60 o$ c"/e/ Le"d/ #o %e"- i,,eg)!", cc!e EX = 4,"in "5/ce// L' /%o)!d 5e done Mo,#"!i# i/ ;00 i$ no# #,e"#ed Common! con#"in/ "n"e,o5ic 5"c#e,i" C"n c")/e inc,e"/e in IC' C"n 5e c")/ed 5 congeni#"! %e",# di/e"/e
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"/ g"ng,ene i/ "!7"/ d)e #o C%!o/#,i)m / He,5",ic O2 i/ %e!$)! in #%e m"n"gemen# S%o)!d 5e #,e"#ed 5 7ide e(ci/ion T%e g"/ i/ d)e #o 5,e"& do7n o$ 5"c#e,i" T%e 5,e"& do7n o$ m)/c!e/ ,od)ce #%e g"/ D),ing ,egn"nc FR inc,e"/e/ T%e e(c,e#ion o$ $o!"#e inc,e"/e/ T%e e(c,e#ion o$ ),ic "cid dec,e"/e/ T%e,e i/ %e,n"#,emi"
Ac)#e ",#e,i"! occ!)/ion T%e "in dec,e"/ed 5 e!e-"#ion o$ !eg T%e common /i#e i/ #%e /)e,$ici"! $emo,"! ",#e, I$ "$$ec#/ #%e i!io"o,#ic ",#e, 5)##oc& c!")dic"#ion i/ c%","c#e,i/#ic C")/e/ e,i%e,"! ne),o"#% C")/e/ $i,/#! %e"! nec,o/i/ In Hemo%i!i" A D)e #o $"c#o, VIII de$icienc+ Inc,e"/e /&in 5!eeding #ime Inc,e"/e 'TT+ C")/e/ e#ic%e" T%e,e i/ %emo",#%,o/i/+ Congeni#"! Ad,en"! He,!"/i" #%e,e i/ "m5ig)o)/ geni#"!i" Hig% co,#i/o! !e-e! Hig% ACTH In$e,#i!i# in m"!e T%e,e i/ %on"#,emi" C")/e/ o$ c!)55ing Te#," !og o$ F"!!o# T,ic)/id "#,e/i" VSD Co",c#"#ion o$ "o,#" A/#%m" Ao,#ic /#eno/i/ Wi#%o)# o#%e, -"!-)!", !e/ion i/ d)e #o R%.F I$ no# /),gic"!! #,e"#ed i# c"n 5e $"#"! Re-e,/ed /!i# o$ S2 on e(i,"#ion
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I# c"n c")/e "ngin"! "in Hemo!#ic "nemi" inc,e"/e H"#og!o5in !e-e! %ig% con:)g"#ed 5i!i,)5in !e-e! U,o5i!inogen i/ $o)nd in ),ine #%e,e i/ ,e#ic)!oc#o/i/ #%e,e i/ %oc%,omic e,#%,oc#e/ In Ne%,o#ic /nd,ome Minim"! c%"nge N occ),/ in c%i!d,en S#e,oid/ ",e con#,"indic"#ed in c%i!d,en R",e! ,og,e// #o ,en"! $"i!),e T%e,e i/ )/)"!! /ing!e "##"c& T%e,e i/ %o,o#ienemi" '%/io!ogic"! ,e"c#ion #o %emo,,%"ge Red)c#ion im)!/e $,om c",o#id 5od 5",o,ece#o,/ Inc,e"/e ADH /ec,e#ion inc,e"/e N"#,i),e#ic e#ide inc,e"/ed /m"#%e#ic $!o7 d)e #o "c#i-"#ion o$ -"/omo#o, cen#e, T%e $o!!o7ing ",e ,em"!ign"n# J)-eni!e o! F"mi!i"! co!onic o!o/i/ Hi,/% /,)ng di/e"/e UC ",dne, /nd,ome T%e $o!!o7ing c"n c")/e %e,,o!"c#inemi" D"n"zo!e He,e/ zo/#e, Ho#%,oidi/m Si,on"!"c#one S#,e// F"!/e neg"#i-e #)5e,c)!in #e/# i/ c")/ed 5 Mi!!i", T4 S",coido/i/ T)5e,c)!o)/ meningi#i/ Hodg&in !m%om" S#e,oid/ 'ne)moc/#ic c",nii 4,onc%i"! "/#%m" c"n 5e #,e"#ed 5 #%e $o!!o7ing 7i#%in $e7 min)#e/ ACTH
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Hd,oco,#i/one Amino%!!ine N"C%,omog!c"#e S"!5)#"mo!e T%e $o!!o7ing ",e #,)e "5o)# con/#,ic#i-e e,ic",di#i/ "!7"/ c")/ed 5 T4 c"!ci$ic"#ion c"n occ), #%e,e i/ %ig% JV' 5,e"#%!e//ne// c"n occ), #,e"#ed 5 /),ge, A#,i"! $i5,i!!"#ion c"n 5e #,e"#ed 5 Lignoc"ine ',o,"no!o! Digo(in D/o,o"mide M"ni#o! Inc,e"/ed IC' co)!d 5e d)e #o Meningi#i/ T)5e,c)!o)/ meningi#i/ T)mo, E("gge,"#ed 5 /neezing In#,"c,"ni"! %emo,,%"ge T%e $o!!o7ing congeni#"! "nom"!ie/ ",e co,,ec#ed /),gic"!! )/)"!! Congeni#"! ing)in"! %e,ni" Um5i!ic"! %e,ni" C"i!!", "ngiom" C/#ic $i5,o/i/ G T%e $o!!o7ing di/e"/e/ c"n gi-e @ ,/ /),-i-"! in ?@0 i$ #,e"#ed Hodg&in di/e"/e '"i!!", c",cinom" o$ #%,oid Seminom" 4"/"! ce!! c",cinom" G Ac)#e 'U i/ "gg,"-"#ed 5 4ed ,e/# Reg),gi#"#ion o$ me"! NSAD S)c,"!$"#e Smo&ing
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Te I DM occ),/ in 0 in #7in/ #%e,e i/ HLA 4B #,e"#ed 5 /)!%on!),e" d,)g/ o/# me"! inc,e"/e o$ in/)!in JV' " 7"-e occ),/ in ')!mon", %e,#en/ion T,ic)/id /#eno/i/ Con/#,ic#i-e e,ic",di#i/ Ao,#ic /#eno/i/ ')!mon", /#eno/i/ C" 4,onc%)/ T%e,e i/ %e,c"!cemi" C"n 5e /m#om!e// C"n c")/e e,i%e,"! ne),o"#% T%e,e i/ %e,n"#,emi" T%e,e i/ SIADH
Hon"#,emi" i/ c")/ed 5 DI He,"!do/#e,oni/m C%!o,,o"mide Li-e, ci,,%o/i/ Ne%,i#ic /nd,ome ',e,en"! $"i!),e In 5!eeding di/o,de,/ Hig% 'TT c"n di"gno/e Hemo%i!i" 'TGG GG GG T%e $o!!o7ing ",e /&in m"!ign"ncie/ Me!"nom" 'em%ig)/ S&in 7",#/ Ve#i!igo G D,)g/ #o 5e "-oided d),ing !"c#"#ion ACEI Di"zeo(ide/
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Ni$eidine C",5im"zo!e O,"! %og!cemic/ Side,o!"/#ic "nemi" T%e,e i/ meg"!o!"/#ic 5one m",,o7 T%e,e i/ %ig% Fe !e-e! A no,moc%,omic "nemi" A 4;2 de$icienc G 'e,io,5i#"! edem" i/ "//oci"#ed 7i#% Mo/in !i&e m"#e,i"! C!)55ing LAST G '%en#oin c"n !e"d #o Hi,/)#i/m 4)!5", "!/ )/ed d),ing ,egn"nc ),ine ,e#en/ion S#e%en Jo%n/on /nd,ome
In 4i!i", ci,,%o/i/ I# i/ ")#oimm)ne ',edni/o!one i/ indic"#ed T%e,e %ig% coe, !e-e! An#i mi#oc%ond,i"! "n#i5od !e-e! i/ %ig% Sicc" /nd,ome i/ "//oci"#ed In #%e ;/# #,ime/#e, #%e,e i/ !o7 4' FR i/ )nc%"nged Dec,e"/ed Fe need Lo7 %C Hig% e/#,"dio! !e-e! D),ing ,egn"nc #%e $o!!o7ing co)!d %"en De,e//ion Ei!e#ic $i#/ R%. A Mig,"ine
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Amniocen#e/i/ %ig% ,i/& 7i#% "n#e,io, !"cen#" ;0 gi-e/ $"!/e ,e/)!#/ %ig% ,i/& o$ $e#"! !o// %ig% ,i/& o$ 5!eeding in e",! ,egn"nc U8S o$ $e#)/ d),ing ,egn"nc c"n di"gno/e D)oden"! "#,e/i" He,#,o%ic c",diomeg"!! Sin" 5i$id" GG SLE 7i#% ,egn"nc %o#o/en/i#i-i# c"n occ), IUR c"n occ), Ri/& o$ ,egn"nc !o// O!igo%d,"mnio)/ c"n ,e/)!# T%e $o!!o7ing d,)g/ ",e con#,"indic"#ed d),ing ,egn"nc Cc!o%o/%"mide '%en#oin Me#,onid"zo!e O,"! %og!cemic/ C",5im"zo!e #%e $o!!o7ing "n#i T4 d,)g/ ",e )/ed d),ing ,egn"nc Ri$in"% INH S#,e#omcin E#%"m5)#o!e ',"zen"mide T%e $o!!o7ing d,)g/ ",e )/ed in %e,#en/ion 7i#% ,egn"nc ACE i Ni$idiine Me#%!do" 4 5!oc&e,/ Ni#,o,)//ide
'AEDIATRICS MCP/ Fo, '/ No- 200; T%e $o!!o7ing ",e "cce#"5!e de$ini#ion/ Neon"#"! e,iod i/ #%e $i,/# 2B d"/ o$ !i$e o$ " ne75o,n o$ "n ge/#"#ion Sm"!! $o, ge/#"#ion ne75o,n/ %"-e " 5i,#% 7# o$ ;0#% cen#i!e $o, #%"# ge/#"#ion In$"nc ,e$e,,ed #o #%e ;/# #7o ,/ o$ !i$e
26
Neon"#"! de"#% i/ #%e n)m5e, o$ de"#%/ in #%e ;/# 2B d"/ e,;000 !i-e 5i,#% T%e $e#"! e,iod i/ $,om #%e ;2#% 7& ge/#"#ion #o de!i-e, In #%e ;/# 2= %,/ o$ !i$e i# i/ no,m"! #o !o/e @ o$ 5od 7# 5ecome :")ndiced %"-e " 5!ood /)g", o$ ;.K mmo!8L %"-e in& ),ine /#"in in n" %"-e e!!o78g,een -omi#ing A 2 7&/ o!d 5"5 i/ 5,o)g%# #o o), c!inic 7i#% -i/i5!e :")ndice. In-e/#ig"#ion/ ,e-e"!ed con:)g"#ed %e,5i!i,)5inemi". C")/e/ inc!)de 4,e"/# mi!& :")ndice Ho#%,oidi/m A4O incom"#i5i!i# Congeni#"! CMV c,ig!e,N"::", /nd,ome T%e $o!!o7ing 7o)!d 5e #ic"! $o, " $e5,i!e con-)!/ion D),"#ion o$ mo,e #%"n ;@ min/ Occ),,ence in " $em"!e !e// #%"n @ mo o!d 'o/#ic#"! Todd
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S%o)!d 5e ,e$e,,ed #o %i/ edi"#,ici"n He %"/ e,#%em" m)!#i$o,m m":o, A!! #%e "5o-e ",e #,)e In in$"n#i!e !o,ic /#eno/i/ T%e o5/#,)c#ion i/ d)e #o %e,#,o% o$ #%e !o,ic /moo#% m)/c!e/ Sm#om/ #ic"!! "e", 5e#7een = 9 mo T%e di"gno/i/ m" 5e e/#"5!i/%ed 5 c!inic"! e("min"#ion T%e in$"n# ,e$)/e/ #o $eed in #%e e",! /#"ge Vomi#ing g"/#,ic "cid !e"d/ #o me#"5o!ic A!&"!o/i/ Reg",ding ,e/i,"#o, #,"c# in$ec#ion/ A no,m"! ,e /c%oo! c%i!d m" %"-e ) #o ;0 URTI in " /ing!e , @0 o$ ,e/i,"#o, in$ec#ion/ in-o!-e/ #%e !o7e, #,"c# /im!e n"/"! o5/#,)c#ion m" c")/e $eeding di$$ic)!#ie/ in in$"n#/ /#,e#ococc"! %",ngi#i/ c"n 5e di"gno/ed on c!inic"! 5"c&g,o)nd #%e commone/# in$ec#i-e "gen# c")/ing common co!d ",e in$!)enz" -i,)/ A = ,/ o!d 5o i/ 5,o)g%# #o o), c!inic 7i#% " /%o,# %i/#o, o$ $e-e, 6QC. He !oo&/ "n(io)/ /i##ing ),ig%# 9 d,oo!ing. He %"/ " /o$# in/i,"#o, /#,ido, HR ;K08min. RR 608min T%e mo/# !i&e! di"gno/i/ i/ c,o) IM Ce$#,i"(one /%o)!d 5e "dmini/#e,ed 9 /%o)!d 5e ,e$e,,ed #o %o/i#"! immedi"#e! T%e #%,o"# /%o)!d 5e in/ec#ed in o,de, #o !oo& $o, " di%#%e,i#ic mem5,"ne O(gen /%o)!d 5e "dmini/#e,ed on #%e 7" #o %o/i#"! "$#e, en/),ing #%"# %e i/ m"de #o !ie do7n None o$ #%e "5o-e MEDICINE ; T%e $o!!o7ing ",e c")/e/ o$ c"no/i/ " T,)nc)/ ",#e,io/)/ 'e,/i/#en# d)c#)/ ",#e,io/)/ ')!mon", "#,e/i" Co",c#"#ion o$ "o,#" T,"n/o/i#ion o$ g,e"# -e//e!/ 7i#% "#en# $o,"men o-"!e 2 In /#"#)/ "/#%m"#ic)/ #%e $o!!o7ing $e"#),e/ /)gge/# #%"# -en#i!"#ion 7i!! 5e ,e>)i,ed " An O2 ,e>)i,emen# o$ =0 #o m"in#"in O2 /"#),"#ion "5o-e = 5 Agi#"#ion c D,o7/ine// d A,#e,i"! '" CO2 6@ mm Hg 9 H K.=6 e Wide/,e"d 7%eeze/ on ")/c)!#"#ion 6 T%e c")/e/ o$ ,ec),,en# ei/#"(i/ in 6 ,/ o!d 5o inc!)de " Hemo%i!i" A 5 Reg)!", )/e o$ ","ce#"mo!e
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