SOME IMPORTANT INFORMATION IN PEDIATRIC

• Which is not seen in hypoglycemia? dehydration

• What enzyme is missing in Nieman Pick ? sphingomyelinase

• No evidence of iron deficiency anemia Which is?

- Height of ferritin

• Which disease incubation period is the shortest? Diphtheria

• Fire, photophobia and mouth intra- mucosa salt pepper What is the most likely diagnosis in children? Measles

• What is pulmonary vascularization reduced?Tetralogy of Fallot

• Antenatal steroid use reduces the risk of respiratory distress syndrome, but the risk of bronchopulmonary dysplasia It does
not.

• Cardiovascular system anomalies most stylish seen trizomy is Edwards' syndrome.Down syndrome not!!!!

• Disease in which cyanosis is caused by age Ebstein's anomaly, increased disease Fallot tetralogy is.

• Aorta coarctation the diagnosis most sensitive laboratory method Not ECO And MRI.

• The most important factor that determines the prognosis of cystic fibrosis is AC functions.FEV 1 value in spirometry is the
most important laboratory parameter.

• The most important cause of death in homocystinuria is venous thrombosis and therefore general anesthesia, radiopaque use
and dehydration are the conditions to be avoided in these patients .

• Organic acidemia table in one in patients skin findings, alopecia the dermatitis If he is talking true reply
multiple carboxylase deficiency (biotinidas or holocarboxylase deficiency) is.

• The first clinical finding of necrotizing enterocolitis is the increase of gastric residual volume and the first radiological finding
is the expansion of the bowel loops.

• The group of metabolic diseases responsible for sudden infant death syndrome are fatty acid oxidation defects (the most
common medium chain acyl Co A dehydrogenase lack of it).

• From the left to the right shunt disease is the most important FM finding of the shunt is the hearing of the sensory and S3
hearing.

• Indomethacin used for PDA closure is ineffective in term babies.Only in premature infant PDA used.

• from trisomies most stylish cardiovascular defects seen Edwards syndrome (Trisomy 18) cardiovascular defect
in patients Down syndrome is the most common trisomy (Trisomy 21) stop.

• Atypical features of atypical measles 4 : conjunctivitis rare in the prodromal period, rare spots of rupture, rashes from
extremities and distally head true spreads, HSM Fuck.

• peroxisomaI diseases newborn the period most stylish clinical findings hypotonia and They are convulsions.

• Medicine 0 glycogen store disease glucagon Giving post- blood sugar does not rise and there is prolonged
hyperglycemia after food intake. Medicine I glycogen store disease if glucagon blood glucose does not rise after
administration, but blood lactate It rises.

• Hypochromic microcytic anemia resistant to iron therapy due to transferrin lost in urine in nephrotic syndrome It develops.

• Causes of prolonged indirect hyperbilirubinemia in newborn: Breast milk jaundice (EN SIK), Crigler-Najjar send, Intestinal
obstruction, Hemolytic diseases, Hypothyroidism (First must be ruled out ), Urinary infection, Extravasation and GH It is the lack
of.

• Chronic granulomatous Disease (KGH) , X-Linked (80%) or autosomal recessive last bacteria normal phagocyte
whether, but it is a disease that cannot be killed.NADPH Oxidase is missing. Recurrent staphylococcal neck abscesses are the most
common clinical findings. disease most stylish death Reason lung Aspergillus pneumonia .Diagnosis can be made with
Nitroblue tetrazolium (NBT) test . Most exact diagnosis flower cytometric as Amin Dihydrorodamine 123 fluorescent
test " (DHR test) with placed. Treatment: Antibiotic + INF-gamma treatment is useful.KIT is the only known curative and
treatment.

• Gluten enteropathy (Celiac that disease) infants and the most common malabsorption syndrome in children .Diarrhea
is the first sign. Feces pale, plenty quantity, oily It is fragrant. Growth and development retardation (most stylish seen
is finding) it is. Anemia most stylish iron deficiency It depends. Total Mucosa atrophy despite enterokinase is
normal.Serum IgA levels may increase. The most sensitive and most specific antibody in the diagnosis .Antiendomysium is IgA
(Second, tissue is transglutaminase IgA (tTGIgA)).Biopsy for diagnosis It is essential. biopsy villous atrophy, crypts in
expansion

and elongation (hypertrophy), infiltration of lymphocytes and plasma cells in lamina propria

• PATHOLOGICAL SENSITIVITY criteria in neonates : In the first 24 hours, if serum bilirubin level increase is more than 5
mg / dl per day, it is 12 mg / dl in term infants and 15 mg / dl in preterms. 10 days, preterm 2nd week long It took if, if
bilirubinuria is present, direct bilirubin in the serum is more than 2 mg / dl or otherwise Versa.

• Diabetic mom their baby seen problems; Makrozomi and birth trauma, birth asphyxia, RDS newborn transient
tachypnea, hypoglycemia, hypocalcemia, polycythemia, indirect hyperbilirubinemia, disorders of congenital formation ; sacral
agenesis (MOST SPECIFIC), Cardiac septal hypertrophy (Hypertrophic cardiomyopathy * most common cardiological
problem *), Small left colon syndrome and holoprosencephaly, Renal vein thrombosis and Intrauterine fetus is death.

• Iron deficiency anemia is the most common anemia of childhood.The most common reason is the lack of nutritional intake.
The most common symptom is anorexia, the most common finding is pallor. The first finding in its deficiency is the reduction of
iron stores in KC and bone marrow , while the latest finding is the reduction of intracellular enzyme activities containing Fe .The
clinical response to the replacement of the most recent disappeared feature improvement and the last corrected parameter
Download ferrite.

• The most common cause of acute leukemias in childhood and the best prognosis is cytologically L1, immunologically early
pra B cellular ALL. in all good prognosis display the translocation t: (12:21); t (4:11) d.

• Guillain-Barre Syndrome: Respiratory tract infection or gastrointestinal infections (especially Campylobacter following
jejuni); weakness starting from the lower extremities, symmetrical reflex loss, up true proceeding arms, housing and face
into gets. Physics examination symmetrical DTR loss very important.Protein increase (albuminocytological dissociation)
without increased cell growth in CSF. First choice in treatment IVIG

• Von Willebrand Disease is the most common hereditary bleeding diathesis.PTT and bleeding time were prolonged. type 1
vWh is the most common.Only type 2B has continuous or intermittent thrombocytopenia.Type 3 is the heaviest and most rare
.Dezmopressin in treatment most very used It is a drug. Tip3 in vWD is inactive and type2B in vWh contraindicated.

• The most common cause of death in Kawasaki disease is coronary ischemia and acute myocardial infarction (AMI). while
acute in the period most stylish mortality Reason Myocarditis is.Treatment of IVIG + Aspirin.Most frequently involved in
differential diagnosis it is red

• Congenital hypothyroidism most stylish Reason Thyroid Dysgenesis is.clinical most stylish finding prolonged
newborn jaundice while, most the early clinical finding is 1.5 cm above the posterior fontanel.Mainly occur during treatment
of diabetic ketoacidosis complications hypoglycemia, hypokalemia, hypocalcemic tetany, hypophosphatemia, aspiration of
stomach contents, excess fluid overload, congestive heart failure, thromboembolic complications and brain It is edema.
• Congenital adrenal hyperplasia (HR) children most stylish type 21 is the lack of hydroxylase.Hormonal examinations
which will be requested after examination in a newborn with suspected CAD are 17 OH progesterone. 17 OH progesterone is the
screening test of CAD. in CAD hypertension seen types 11th and 17 hydroxylase are.Both male and also girls
ambiguous genitalia reason KAH type 3 beta OH steroid dehydrogenase eksiklg is.

• Children portal hypertension most stylish why The SIROZs are formed.Other portal HT reasons:

• Extrahepatic presinüzoidal (PREHEPATİK) portal hypertension: the most common cause portal vein thrombosis is.

• Extrahepatic (Suprahepatik) Postsinüzoidal Portal Hypertension: Budd-Chiari syndrome

• Intrahepatic presynysoidal portal hypertension: Congenital hepatic fibrosis, lymphoproliferative diseases (Hodgkin's
lymphoma most common) and Şiştozomiasis

• Intrahepatic sinusoidal portal hypertension: CIRRHOSIS

• Intrahepatic postsynneoidal portal hypertension: Obstruction of the intrahepatic branches of the hepatic vein (VOD).After
Radiation and Bone Marrow Tx post-

• Infants born to mothers with gestational diabetes are three important differences between mothers with babies pregestastional:
Abortion, congenital malformations and SGA gestational mother with diabetes It is not visible.

Changes in the 37.2006 vaccination calendar compared to the previous one: 4 DOZ Hib vaccines (2, 3, 4 and 16-24 months), two
doses of MMR vaccine added (12. moon and primary school first in the class), 9. measles vaccination It was removed.

• Previously PDA that known one in patients just Systolic murmur means that pulmonary hypertension develops
revenue.

• Childhood era asthma long term treatment leukotriene receptor antagonists first choice that 2nd asthma tour
exercise due to asthma and aspirin It is asthma.

40.If acidosis + hyperammonemia, organic acidemia, without acidosis hyperammonemia If urea cycle defect We
think.Increasing the urea cycle defects 2 pm Please let's not forget amino acids: Alanine and glutamine.

• The most important cause of thrombosis in nephrotic syndrome is antithrombin in urine 3 It is a waste.

• Renal involvement in neonatal lupus is not an expected finding .

• Differences between Type I glycogen storage disease and Type III: lactic type I acidosis and hyperuricemia while
Medicine III LFT disorder rarely cirrhosis and cardiomyopathy It happens.

• RDS, Apnea, Anemia, Hypoglycemia, Intraventricular Hemorrhage, Retinopathy (ROP), Necrotizing enterocolitis, Patent
ductus arteriosus and Neonatal death while PRETERM problems MAS, Air leaks (Pnx), Infection, Polycythemia, Hypoglycemia,
Congenital anomaly, Persistent fetal circulation, Persistent Stamp.Hypertension and Fetal death are the main problems of SGA
babies .

• Diabetic mom baby most stylish seen cardiological While the problem of asymmetric septal hypertrophy
embryopathy (which just happens to be the mother of the baby pregestastional diabetes) induced the most frequent congenital heart
disease Is VSD.

• Retinoblastoma is the best malignancy with 5 years of surveillance in childhood and the worst is AML.Retinoblastoma also
has the highest likelihood of becoming familial, bilateral and secondary malignancy (most commonly OSTEOSARKOM).
malignancy.

• Indications for switching to subcutaneous insulin in diabetic ketoacidosis (DKA) blood gas pH> 7.3, Blood glucose <300 mg /
dl and patient goodness is. urine ketone positivity meaning no. The most common treatment in MPA complications;
hypoglycemia, hypokalemia, hypophosphatemia, hypocalcemia and brain It is edema.

• The most common type of congenital adrenal hierplasia is 21 hydroxylases.This type of girls ambigus genitalia and men
virilize macrogenitaly.There are also salt loss in both sexes of classical type. In the case of a patient with suspected CAD, the first
and most appropriate test to be asked for is blood cortisol level and 17 OH progesterone level.
• The most common cause of recurrent hematuria makrosopik İge nefropatisidir.diğer of Alport syndrome (any kind of
involvement in börbrek, progrssif bilateral hearing loss, eye anterior lenticonus and thrombocytopenia), idiopathic hypercalciuria
and thin membrane disease.

• The most common cause of death of Kawasaki disease during myocardial infarction was the most common cause of death in
the first 10-day acute period. And myocarditis.

• Cystic fibrosis should be considered in the presence of nasal polyps, meconium ileus, rectal rolapsus, recurrent lower
respiratory tract infection, bronchiectasis and exocrine pancreatic insufficiency .The diagnosis is made in CF.In the neonatal
screening of the disease, immunoreactive trypsinogen is examined in the blood .in CF sweat

frequent situation is ÖDEM.The most common infectious agent in the disease <2 years S. aureus, > 2 age on Pseudomonas
Aureginoz is.Other problem constituent agents; Burkholderia cepacia (Especially in this infection, rapid worsening of AC
and death in CF Reason)

Aspergillus fumigatus, nontuberculous mycobacteria (MAU. M. Cancer, Non-Typed H. Influenza and S. Is Maltophila.
"Pneumococcal, Hiba and M. tuberculosis problem constituent and increased incidence agents are not !!!! "

• If the mother has active CMV, only premature babies should not be breastfed.Such a restriction in miad infants They do not.

• PEM most stylish death Reason: Electrolyte imbalance with together

severe dehydration, heart failure and infection.

• influenza virus two kind envelope glycoprotein It includes; Hemaglutinin and neuraminidase.Vaccine against
hemaglutinin developed.

• symptomatic or asymptomatic HIV (+) one patients strong proposed single measles vaccine It is a vaccine.

• In the pathogenesis of allergic asthma and atopic dermatitis, the main role of IL-4-5 secreting memory is TH2-like cells.

• Hereditary tyrosinemia: the definitive diagnosis of serum and urine succinylacetoacetate and the succinylacetone that
increased with showing Threads.

• Tay Sachs in: over-reaction and excessive responses to hypotonia and funky sound in normal infants at birth (hiperakusis) first
clinical and findings.

• One male in patients limbs pain crises, Fabry's disease if angiokeratomas, unexplained proteinuria and kidney failure
It should be considered.

• Patients with Zelweger Syndrome may be confused with Down syndrome .Patients within a few months It dies.

• Convulsive apneas do not lead to bradycardia because it takes a very short time .

• Premature one baby distention + in the stool hidden blood = NEK

• Fetal from hyperinsulinemia single not affected organ It is the brain.

Most are affected by KC, heart and adrenals.

64.Polycythemia + Hematuria + Abdominal mass = Renal Vein Thrombosis

65.The most sensitive indicator of the absence of vitamin K and vitamin K deficiency increased protein (PIVKA) of the increase.

• In Çölyak'; Enterokinase activity despite total mucosa atrophy It is normal.

• RM does sucrose in the stool is not a reducing sugar, stool pH acid.

• hepatic From encephalopathy, in the brain accumulated ammonium, mercaptan, short chain fatty acids, GABA It is
responsible.
• The most common post-transplant recurrent kidney disease, MPGN Type II is the most fsgs' road leading to graft loss.

• Parvovirus B19; sickle cell anemia, beta thalassemia, hereditary spherocytosis are also the most common viral causes of
aplastic crisis. It is the agent.

• Evans Syndrome: Hemolytic anemia, neutropenia and immune thrombocytopenic purpura

• primum ASD secundum from asd brake release primum Left axis deviation in ASD It is important.

• TRH or isolated TSH deficiency due to congenital hypothyroidism It is not visible.

• diabetic in patients infection during insulin dose increased.Hypoglycemia may occur during excessive exercise, so
increased.

• Adrenal androgens metabolized in the body after 17 ketosteroid urine (17-KS) as discarded.

• The differential diagnosis of primary and secondary hyperaldosteronism is made according to the plasma renin level (primary
hyperaldosteronism in renin It is low).

• The most common cause of recurrent stridor in infants is laryngomalacia .

• Single sinus frontal developing after birth sinuses

• Increased acetyl cholinesterase in maternal serum and amniotic fluid is most sensitive in the diagnosis of NTD It is a test.

• Varicella of enfesiyon most stylish complications secondary bacterial skin due to organisms such as staphylococcal
(more frequent) or streptococcus of the infections.

• Subdural effusions in meningitis with H. influenzae type b Fuck.

• Treatment of Kawasaki disease 1- Acute period: IVIG + aspirin 2- Konvelesan Period: Aspirin

• Coronary abnormality in the presence long period treatment:

Aspirin ± Dipiradomol ± Warfarin?

• Acute coronary thrombosis: Fibrinolytic therapy (streptokinase, urokinase)

• JRA criteria

• Before the age of 16 to begin

• One or two the joint suddenly swelling and effusion together arthritis, tenderness, limitation of motion, pain with
movement, temperature increase (at least 2 of these last 3 symptoms) necessary)

• Disease duration longer than 6 weeks being

• Initial shape of disease by;

• Polyarthritis: 5 or more joints involvement

• Oligoarthritis: 4 or less joints involvement

• Systemic disease: intermittent fever arthritis.

• Kawasaki Disease complications

• Coronary artery thrombosis

• Peripheral artery aneurysm

• Coronary artery aneurysm

• Myocardial infarction (The most common death Reason)

• Myocarditis (acute death in acute period) Reason)

• Congestive heart failure

• Gall bladder hydrops

• Aseptic meningitis

• irritability

• Arthritis

• thrombocytosis (late)

• Sterile pyuria (urethritis)

• Diarrhea

• pancreatitis

• Peripheral gangrene

• Sickle cell anemia

Blood transfusion is contraindicated in voxo-crisis.

• in all

Extra medullary involvement and relapse are the most common sites of CNS and testes.

• Ductus Arteriosus desired to remain open situations

• Pulmonary atresia

• Large veins transposition

• Tricuspid atresia

• Hypoplastic Left Heart syndrome

• Infantile aorta coarctation

• Tetralogy of fallot in newborn period

• Heavy Pulmonary stenosis

• Heavy aorta stenosis

• Full discontinuous aortic arc

• In the neonatal period, HIPOURICEMIA + HYPONATREMI = Inappropriate ADH syndrome

• Goiter (+) hypothyroidism there is and antibodies (-) if; Goitrogen use, dishormonogenesis or endemic goiter It
should be considered.

• Hemosiderin-laden macrophages can be found in sputum, gastric fluid, bronchoalveolar washing fluid, or lung biopsy.

• The typical triad of West syndrome is myoclonic seizures, mental retardation, and hipsaritmium and burst suppression in
EEG .

• Tuberosklerozis skin lesions, characterized by the triad consisting of epileptic seizures and mental retardation (clinical
maximum convulsions is seen).
• Spinal Muscular Atrophy (SMA):

• Autosomal recessive transition shows.

• Tongue fasciculation has.

• Mental disorder They do not.

• Sensory and autonomic system disorder They do not.

• Duchenne Type Muscular Dystrophy

(DMD-Pseudohypertrophic muscular dystrophy): Diagnostic criteria

• Under 5 years starts

• Chair under 13 years old connects

• CPK at least 10 times increases.

• Fasciculation and sensory loss They do not.

• Symmetrical progressive eyebrow weakness has. Calf hypertrophy

• Muscle necrosis, regeneration, fat and connective tissue increase

• Dystrophin in muscle fibers loss

• X linked transition

• Dystrophin gene failure

• EBV-Related Malignancies

• Burkitt lymphoma

• nasopharyngeal CA

• X-linked immunoproliferative syndrome (Duncan's syndrome) and B-cell NHL

• In immunocompromised patients I leiomyosarcoma

• Hodgkin's Disease?

EBV-Associated Hematological Disorders

• atypical lymphocytosis

• Acquired Hemolytic Anemia (Complementary Coombs (+) Hemolytic Anemia)

• Agranulocytosis and Aplastic Anemia

• LAP, Splenomegaly

• immune thrombocytopenia

• Hemophagocytic Syndrome

• Vitamin in Metabolic Diseases Treatments:

• Vitamin B12: Methylmalonic aciduria

• Biotin: Propionic acidemia, Biotinidase deficiency (Holocarboxylase Yet)

• Thiamine (B1 vit): MSUD

• Riboflavin (B2 vit): Glutaric aciduria Type I-II

• Vitamin C : Transient tyrosinemia of newborn , Hawkinsinuria, Tyrosinemia type III

• Vitamin B6: Homocystinuria one

• Niacin: Hartnup disease

• Exchange transfusion in newborn Indications:

• Hemoglobin concentration at birth is below 12-13 g / dl if,

• Bilirubin 0.5 mg / dl per hour or faster If the rise,

• Cord bilirubin value greater than 5mg / dl if

• Termini baby asphyxia, acidosis, RDS without bilirubin of 20mg / dl over

• In a premature with asphyxia, acidosis, RDS, blood exchange is indicated if the bilirubin value is above 10-15mg / dl
.Anemia, petechia, hepatosplenomegaly at birth, cord blood values immediately without waiting for changes makes.

• Neonatal Respiratory Distress Syndromes Sol Radiologic Lung Findings "

Respituar Distres Syndrome (RDS)

• Reticulogranular appearance (Frosted glass views)

• Air bronchogram

Newborn Temporary Follow-Up (TTN)

• Pulmonary vascular images increase

• Fluid in fissures (fissure)

• Perihis fullness, increase in aeration, flattening in diaphragm

Meconium Aspiration Syndrome (MAS)

• Infiltrations and patched infiltrations atelektezali on

• Chest AP-wide increase

• Diaphragmatic Umeda flattening

Primary Persistent Pulmonary Hypertension (PPPH)

• AC graph normal

• SLE and serology:

• SLA for most good scanning test fluorescent antinuclear antibody (ANA) test.

• Anti-ds DNA antibodies (EN SPECIFIC) and low C3, 100% for SLE specific.

• CRP positivity in active SLE is mostly not observed.

• C1q and C4 (classic path activation !!!)

• Anti-Ro / SS-A: Neonatal lupus, skin, kidney and lung involvement of SLE, Sjögren syndrome.

• Anti-La / SS-B: Neonatal lupus, Sjögren syndrome.

• Anti-Histone Antibody: drug-dependent Lupus

• Anti-ribosomal P antibody Important for CNS lupus (Depression, psychosis)

• Two types of brachial plexus injuries has;

• Erb-Duchenne paralysis: birth the arm sudden It helps with traction.C5-6 has cervical nerve injury .The arm is in
extension and adduction, forearm extension, pronation and wrist flexion.The capture function of the hand is preserved. Moro reflex
on the side of the paralysis not taken.

• Klumpke's paralysis: It is caused by withdrawing your shoulders with violence .C7-8, T1 damage. Hand is low, forearm
supination, fingers It is extension, obtained edema and cyanosis has. Your hand catch function It is corrupted.Moro
reflex weak taken.

• CISTIC FIBRIOZYSTE MOST for

• Sweat testing false (+) as the most common cause of malnutrition Download.

• Pseudomoas is the most common pneumonia agent in adolescents with cystic fibrosis It is aeruginosa.

• cystic fibrosis patients in sputum most much The organism found in P.Aureginos is.

• The most common cause of nasal polyp in children is cystic fibrosis.(Good prognosis indicative of)

• Cystic fibrosis; the most common genetically transmitted chronic lung in childhood disease.

• The most common mutation in cystic fibrosis is delta-F508. 800 different mutations is defined)

• The most common cause of cor pulmonale in children is cystic fibrosis.

• The worst prognosis is core findings in cystic fibrosis lungs.

• cystic fibrosis most bad prognosis owner infection psoriasis aeruginosa infection.

• The most common cause of death in cystic fibrosis is respiratory failure.

• PULSE's

• Pulsus parvus et tardus: Small and delayed pulse.(Aorta stenosis).

• Pulsus celer et altus (corigan pulse): Large and powerful (pulsating) pulse.(Aorta failure).

• Pulsus bigeminus: Pulse is normal, one pulse my horse is weak or absent (digital intoxication).

• Pulsus alternans: A strong, weak pulse.(Congestive heart failure).

• Pulsus paradoxus: Pulse can not be taken in inspiration, expiration is taken.(Heart failure and pericardial effusion).

• Pulsus bisferiens: Aortic failure.

93
Symptoms associated with congenital heart defects

Syndrome Congenital Heart Pathology

Rubella syndrome PDA

Turner syndrome Aortic coarctation

Down syndrome Endocardial pillow defect

Trisomy 13 and 18 PDA and VSD

Marfan syndrome Aortic aneurysm, aortic valve insufficiency, MVP

Glycogen Storage (Pompe) Hypertrophic cardiomyopathy

Noonan syndrome Pulmonary stenosis, aortic stenosis

Williams syndrome Supravalvular aortic stenosis

Holt-Oram syndrome ASD

Ellis-Van Creveld syndrome ASD

Kartagener syndrome Dextrocardia, situs inversus

Homocysistinuria Arterial and venous thrombi, aorta and carotid degeneration

Tuberous sclerosis Rhabdomyoma, WPW

FORMAT_PLACEHOLDER_0

106.
Drugs used in pregnancy - teratogenicity

Drug Teratogenic Effect

Isotretinoin Fascial and eye anomalies, Heart

defects

Alcohol Congenital heart, fasial, CNS,

limb anomalies, IUGG, autism, attention deficit

Amphetamine Congenital heart defect, Deprivation Syndrome, IUGR

Carbamazepine Spina bifida, Neurodevelopmental deficiency

Chlorokine Deafness

Cocaine / Crack Microcephaly, SGA and IUGR

Hyperthermia Spina bifida

Lithium Ebstein anomaly and macrosomia

Mizoprostol Artrogriposis, Cranial neuropathy

(Mobius Syndrome), Ekinovarus

Penisilamin Cutis Laxa syndrome

Phenytoin Congenital anomaly, IUGG , Neuroblastoma, Early YDHH (k vit) Prednisone Palate-lip slit

Progesterone Girl fetisha the masculinization

Dietilstilbestrol In adolescent girl vaginal

adenocarcinoma

Tetracycline Skeletal growth retardation, Teeth meat

hyperpigmentation, enamel hypoplasia, cataract and extremity anomalies

Valproat Spina bifida, neurological evolution retardation

Vitamin D Supravalvular aortic stenosis,

hypercalcemia

Warfarin Fetal bleeding and death, nasal

hypoplasia

FORMAT_PLACEHOLDER_1

107.

• Apgar scoring

• Finding • 0 • one • 2nd

• Purple • Body pink,

• Appearence • Completely pink
or pale extremities purple

• Heart Rate
• No • <100 / min • > 100 / min
(Pulse)
• Reflex response • • • Cough-sneeze-
(Grimace) strong crying
• No • Grimace

• None • Flexion of the lower

• Tonus (Activity) • Active moving
(full body) extremities

• Laying irregular /
• Respiration • No • Regular-crying.
chin

FORMAT_PLACEHOLDER_2

108.

SOME IMPORTANT INFORMATION 95

• Vitamin K ini Glutamyl required for the synthesis of active serine proteases (eg coagulation factors II, VII, IX and X) -
carboxy-glutamyl residues carboxylationof

• SPOT SOME ABOUT VITAMINS INFORMATION

• The enzyme glutathione reductase in erythrocytes uses FAD as coenzyme .The activity of this enzyme is reduced in riboflavin
deficiency.

• Niacin is a vitamin but in limited amounts of tryptophan synthesized.

• - Ketoglutarate dehydrogenase thiamine as thiamine pyrophosphate need.This enzyme also needs lipoic acid, KoA, FAD
and NAD hears.

• pyridoxal phosphate , tryptophan niacin synthesis cofactor

lysine and proline hydroxylation for is necessary and this therefore for wound healing must.

• One of the reactions of vitamin B 12 is the conversion of methylmalonyl CoA to succinyl KoA (valine and isoleucine

is a competitive inhibitor of malonyl CoA in fatty acid synthesis, which is required for the preservation of methylmalonyl KoA
myelin sheath . secondly methylmalonyl KoA branched chain which can disrupt normal membrane structure oil of acid
formation way opens oil acid Used in synthesis.

• Vitamin K -karboksiglutamik acid specific for glutamic acid present in olu_tur to baz1 protein is needed for carboxylation
of residue.This step in the blood coagulation of preprotrombin conversion to the prothrombin for

Used as. Therefore, B 6 can increase the deficiency.

vitamin deficiency, niacin

is necessary. In the bone formation this step is osteocalcin

Calcium binding residues of protein formation

• B 12 vitamin in the absence tetrahydrofolate Lack of Pernicious anemia, methylmalonic aciduria and
hyperhomocysteinemia are seen.

• Vitamin E is the first defensive step against the peroxidation of polyunsaturated fatty acids including cellular and subcellular
membrane phospholipids.Glutathione peroxidase, an integral compound of selenium, has a second line of defense against
hydroperoxides before damaging them. creates

• Vitamin K, various clotting taktör (eg. Factor II, VII, IX and X) is essential for the synthesis.The glutamate residues on the
clotting factor precursor proteins must be carboxylated to bind with calcium.Vitamin K cofactor in this carboxylation reaction
plays the role.In the newborn infants , intestinal flora, which is an important source of vitamin K , is not yet formed and the vitamin
is from the placenta. can not pass for K vitamin lack of results hemorrhagic disease of newborn develop.

• Pyridoxine, homocysteine cystathion translates cystathionine synthase and cystathion the cysteine and -ketobütirat smashed
sistationaz enzymes cofactor is. pyridoxine deficiency of cystationinuria and homocystinuria observed.

• Vitamin A has a protective effect against some cancers.retinyl phosphate transferrin including Some glycoproteins It
acts as a glucose transmitter in its synthesis .Various carotenoids function as antioxidants .Retinol and retinoic acid can function as
steroid hormones. A rhodopsin with retinal vision pigment It is a component.

• High ascorbic acid levels lead to oxalated kidney stones can open . Ascorbic acid iron by reducing iron Helps
absorption .Ascorbic acid is essential for collagen synthesis, which is important for bone formation. Ascorbic acid AndAki
procollagen

must.

• Pantothenic acid is a component of coenzyme A.Acetyl CoA in acetylation reactions (TCA, lipid and cholesterol metabolism)
used acetate active the forms. Pantothenic acid lack of the CoA limits and in mammals to death way It can
open.However, the lack of pantothenic acid in man because it is found in large amounts in foods It is rare.

• nicotinamide adenine dinucleotide (NAD + ) niacin functional coenzyme derivative.It is the major electron acceptor in
the oxidation of molecules and transformed into NADH.NADH is the primary electron donor in the reduction reaction.
Flavoproteins (FMN and FAD) are used in some selected oxidation reactions and electron in transport it is active but NAD +
's matchless role It is not.

• Lipoamide without phosphorylated function shows

• Folic acid megaloblastic anemia why is that It happens. There are hypersegmented granulocytes and megaloblasts. It
reduces absorption by inhibiting acidic nutrients and bean conjugate enzyme .Dilantin (Phenytoin) reduces the absorption of folic
acid. Sickle cell anemia has marked hemolysis. For this reason, continuous substrate support is required for excessively increased
construction. One of the fastest depleted substrates is folate. Even aplastic crisis due to folate deficiency can occur even.that before
pass for patients folate support It is suggested to provide.Absorption is mainly in the upper third of the small intestine. The
absorbed folic acid is converted to tetrahydrofolate (THF) by the enzyme reductase. Since this enzyme is inhibited by methotrexate,
folic acid, which is the only carbon units receptor and donor in the DNA synthesis, decreases and the division in the cell slows
down. Language sensitivity and Cheilozis are seen. Neurological findings in vitamin B12 deficiency and positive Schilling test
(absorption test for B12) in folic acid deficiency It is not visible.

• Fat- soluble vitamins are bound to the carrier molecule in plasma, while water-soluble (excluding cobalamin) carrier molecule
There is no
Effects of Non-Infectious Diseases in Mother on Fetus and Baby

Disease effect Mechanism

cholestasis Preterm birth Unknown. Hepatitis E

Cyanotic heart disease Intrauterine growth retardation Fetal hypoxia

Fetal hyperglycemia increases insulin and insulin is the

most important fetal growth hormone.
Diabetes LGA, Hypoglycemia
Vascular disease, placental insufficiency

mellitus Heavy Diabetes: SGA

Direct drug effect, poor nutrition and environmental

IUBG, Neonatal withdrawal syndrome
Drug addiction conditions

Endemic goiter hypothyroidism Iodine deficiency

Graves' disease Neonatal transient thyrotoxicosis Placental transition of thyroid-stimulated antibodies

Herpes gingeralis Bullous rash Unknown

High calcium in the mother passes to the baby and prints

Hyperparathyroidism Neonatal hypocalcemia
PTH

Hypertension IUBG Infant mortality Placental insufficiency and fetal hypoxia

ITP thrombocytopenia Nonspecific antibodies from mother

Isoimmune thrombocytopenia
Specific platelet or neutrophil antibodies in the mother
or neutropenia Thrombocytopenia or Neutropenia

Malignant mela- nom Fetal Tumor Metastasis

Myasthenia gravis Transient neonatal myasthenia Ach-receptor antibodies passing through the placenta

Neonatal myotonic dystrophy,

Myotonic dystrophy
congenital contractures Genetic factors

obesity Macrosomia, hypoglycemia Unknown

Phenylketonuria CHD, Microcephaly, Mental retardation Increased fetal PhA level

IUBG, Neutropenia, thrombocytopenia, Uteroplacental insufficiency, fetal hypoxia,

Preeclampsia, eclampsia
fetal death vasoconstriction

Renal Transplant IUGR Uteroplacental insufficiency

Fetal anemia,

hypoalbuminemia,
Blood Disputes Cells undergoing hemolysis in the fetus
hydrops,

jaundice in newborn.

Sickle cell anemia IUBG, preterm labor Mother's pregnancy makes fetal hypoxia

Conj. Heart block, rash, anemia,

SLA thrombocytopenia, neutropenia
Antibodies from mother

Familial thrombophilia Dead birth, IUBG Thrombosis in uteroplacental circulation

FORMAT_PLACEHOLDER_3

THE SEPARATIVE DIAGNOSIS OF SOME MICROCITARY ANEMIA CAUSES IN CHILDREN

iron deficiency alpha-talase- mi traitBeta-thalassemia traitHemo- globin-E trait

Hemoglobin Low / very lowLow Low Low

MCV Low / very lowVery low Very low Very low

Number of erythrocytes Low High High Low

RDW High Normal Normal Normal

Free erythrocyte protoporphyrin

High Normal Normal Normal

Hemoglobin electrophoresis Normal Normal High A2 Normal

Cord blood Normal Bart Normal F, A, E

ferritin Low Normal Normal Normal

FORMAT_PLACEHOLDER_4

115. 119.

• Cephal hematoma evolving as a result of subperiosteal vascular hemorrhage haemorrhagic Download collection. Lesion
from birth 24-48 hours after It appears, unilateral and parietal area It is on.The area of cephalic hematomas is limited to
the affected bone and milk neglect. case of 15% below linearly broken also available. Small cephal hematomas in
anemia and complications such as hypovolemic shock are rare, but large cephalic hematomas DIC hyperbilirubinemia,
osteomyelitis, sepsis or meningitis why is that can. Sefalı hematomas big in 1 to 2 months spontaneously resorbed
happen.

The hood is characterized by the hemorrhagic edema of the succadenum, cuff and muscles, has no clinical significance and
disappears within a few days after birth.

• Marasmusta lack of calories , the baby's growth is noticeably slower and weighing decreases are very noticeable.Since
protein deficiency is parallel to energy insufficiency , blood albumin level does not decrease and edema It does not occur.

Kwashiorkorda does not have much calories and baby's growth normal It is near. Whereas this growth According to the
tempo amount of protein is low and therefore the blood albumin levels are reduced.

As a result, edema and abdominal distension develop. So there is little or no loss of weighing. But due to protein deficiency, hair
and skin changes are common in immunological disorders.

• DIFFERENT DIAGNOSIS IN NEWBORN HUMAN

• • KC
• Coagulation Tests • YDHH
PERPENDICULAR
• disease

• PT • Very elongated • prolonged • prolonged

• aPTT • prolonged • prolonged • prolonged

• TT • N • prolonged • prolonged
• FDP • N • increased • N or Increased

• fibrinogen • N • decreased • decreased

• Tr Number • N • decreased • N or decreased

• Vitamin K • Dramatic • Decreased

• No answer
answer response response

FORMAT_PLACEHOLDER_5

Antibodies and disease relationships in pediatrics

Antibody Associated Disease

C-ANCA

(antineutrophilic cytoplasmic antibody) Wegener's Granulomatosis, Ulcerative Colitis (Sometimes)

P-ANCA Microscopic Polianjilitis (microscopic PAN)

SLE (Screening test), JRA (oligotype1 and polyarticular RF +)

MOTHER

Anti ds DNA SLE (specific, associated with disease activity

Antismoothmuscle (Anti-SM) SLE (specific)

Anti RO Antibodies Sjögren, SLE, Neonatal Lupus

Anti LA Antibodies Sjögren, SLE, Neonatal Lupus

Antihiston Antibodies Drug-induced Lupus (the most common cause Procainamide)

Antibody Anticorrosion CREST Syndrome

Anti JO-1 Antibody DM / PM

Anti-RNP Mixed connective tissue disease

Anticardiolipin Antibody IgG, M Antiphospholipid Syndrome

Lupus Anticoagulant Antiphospholipid Syndrome

Anti LKM-1 ANA, SMA, LSP-1 OİAH (Autoimmune Hepatitis)

Antimitocondrial Anti-Cor (AMA) OIAH, Primary Bllier Cirrhosis

Antithyroglobulin Antibody Hashimato (early period)

Anti-Microzomal Anther Hashimato (more specific in the late period)

Islet Cell Antibodies Type I DM

Anti intrinsic factor Pernicious Anemia

Parietal Cell Antibodies Pernicious Anemia

Acetylcholine Receptor Antibody Myastenia Gravis

Anti-Yo antibody Subacute Cerebellar Degeneration

Factor 8 antibody Hemolifi A.

Thyroid Stimulatory immunoglobulin (TSH. Receptor antibody)

Graves' Disease

FORMAT_PLACEHOLDER_6

120.

121. Findings of congenital hypothyroidism:

• At birth ; Postmaturity, birth weight more than 4 kg, rough face, macroglossi, large posterior fontanel located.
• In the first three days; Meconium extraction exceeds 20 hours .Hypothermia, peripheral cyanosis, edema, hypoactivity,
lethargy observed.

• In the first seven days; weak absorption, fatigue, voice breathing, apnea, rough crying, abdominal distension has.

• First 28 day constipation, umbilical hernia, kretonoid appearance, prolonged jaundice It develops.

• Infant and In children, development retardation, cold intolerance, Kocher -Debne-Sanelaigne syndrome
(pseudohypertrophy in the muscles), delayed DTR relaxation time, decreased body temperature, blood pressure, pulse
.Normochromic anemia has.

Newborn knee radiographs, hand wrist radiography is requested after 3 months.

• Normal mental and engine development for L-thyroxine 3 month should be started first.

A Practical Approach to Height Grade According to the Age of Age (TY), Boy's Age (BD) and Bone Age (KY)

TYLER> BY> KY Hypothyroidism

TYLER> KY> BY Isolated GH deficiency

TY> BY Y KY Constitutional short stature

KY TY => BY Familial short stature

FORMAT_PLACEHOLDER_7

122.

123. DUKE CRITERIA

Major Criteria

• Positive Blood Culture for Infective Endocarditis (Gold Standard)

Typical microorganisms of infective endocarditis in two separate blood cultures: viridans streptococci,

Strep bovis community acquired Staph aureus or enterococci

• Positive echocardiography of infective endocarditis (abscess, vegetation, prosthetic valve degradation)

Minor Criteria

• Predisposition: Intravenous drug use or predisposing cardiac failure

• Fever 38,5 ° C over

• Vascular phenomenon: major arterial embolism, septic pulmonary infarcts, mycotic aneurysm, intracardiac hemorrhage,
conjunctival hemorrhage, Janeway lesions

• Immunological criteria, glomerulonephritis, osler nodules, Roth stains, rheumatoid factor

• Microbiological evidence, blood culture that does not meet the major criteria defined above positivity

• Echocardiography does not meet the echocardiography criteria described above The criteria

one hundred

126: SPECIFIC PHYSICS, ECG AND X-RAY FINDINGS FOR CHRONIC EDITIVE LID LESIONS

Physical Findings ECG X-ray

Pulsus parvus et tardus (may not be present

in elderly patients and aortic insufficiency), Left ventricular
Ejection murmur, longitudinally spread; hypertrophy Left Left ventricle without dilated
branch bundle block Post-stenotic aortic root
Left ventricular aperture with unchanged
favorites dilatation
long position

Aortic stenosis Rarely block the Calcification in aortic valve

A2 weak, S2 single or paradoxically coupled
transmission system region
S4 gallop
due to calcification

Pulse pressure increases

Double-notched carotid pulses Fast pulse

output and descent

Hyperkinetic and lateral slope

Diastolic decaying murmur, length is Left ventricular

Aortic insufficiency
Left ventricular and aortic
proportional to stenosis hypertrophy Narrow
dilatation
deep Q waves
Systolic current murmur, S3 favorites

Large left atrium: double

density, esophagus in the
 posterior direction, makes the
left main bronchus rises,
S1 strong Opening sound
Left atrial apendiksin The
(S2-opening sound range inversely Left atrial pathology left border of the heart flattened
proportional to degree of stenosis) Atrial fibrillation is as a result of growth
common
If the cover is calcified, S1 is not strong and Small or normal left ventricle
Mitral stenosis there is no opening tone Right ventricular
hypertrophy when Pulmonary artery large
Symptoms of pulmonary arterial pulmonary arterial pulmonary venous congestion
hypertension hypertension develops

Hyperdynamic left ventricular hit Left atrium

Holosystolic murmur spreading in the axilla abnormality Left Left atrium and left ventricle
(this murmur is acute In my, prolapsusd to ventricular large
Mitral regurgitation hypertrophy Atrial
and papillary eyebrow atypical in
fibrillation Pulmonary venous congestion
dysfunction may be)

Usually normal

One or more systolic clicks Sometimes

To the extent of valve failure
derivasyonları inferior
Mitral valve prolapse High incidence of chest skeletal anomalies: ST depression and T and the presence of additional
flat back syndrome, pectus excuseus anomaly connected
inversion

In sinus rhythm, jugular venous distension

and a wave is prominent, diastolic bearing
and tricuspid opening sound at the edge of
the left sternum Atrial fibrillation
Tricuspid stenosis favorites Right atrium
Increased bearing with tricuspid opening abnormality Large right atrium
sound and inspiration

Jugular venous distension and large

(systolic) failure waves

Increased systolic murmur on the left side of

the sternum (increased inspiration) Right atrium
abnormality Right ventricular and right
Diastolic flow bearing
Findings related to the atrium findings due to wide
Tricuspid insufficiency tricuspid regurgitation
Right ventricular S3 (increased by cause of tricuspid
breathing) Along with systolic pulsations insufficiency

02t039

FORMAT_PLACEHOLDER_8

SOME IMPORTANT INFORMATION

• Which hypoglycemic coma not seen?

• dehydration hyperosmolar nonketotic comatose more frequently encountered. diabetic Patients most stylish seen
coma hypoglycemiaThe most lethal lactic acidosis It is in a coma.

• Thrombopoite Rasligand

• Cushing's disease not seen?

• Cushing's disease tendency to diabetes creates.

• Which of the following diuretics makes metabolic alkalosis ?

• All diuretics except potassium preservative diuretics such as spironolactone and carbonic anhydrase inhibitors such as
acetozolamide metabolic alkalosis It makes.

• Continuous murmur in which heart disease seen?

• PDA.Sistolodiastolic murmur It happens.

• What is the most effective prognosis in a pregnant patient ?

• Aorta stricture.

• Membrane defect in which anemia has?

• Hereditary in spherocytosis membrane of protein spectral and ankrin defect has.

• Which does not require infective endocarditis prophylaxis prior to tooth extraction ?

• Passed bypass operation, patients with permanent pacemakers, isolated secundum ASD, repaired ASD, VSD and PDA,
isolated mitral valve prolapse.

• Which is the most common cause of the first episode of acute rheumatic fever?

• Myocarditis.

• Which is the complication of ulcerative colitis It is not?

• Alopecia

• A systolic crescendo decyroid murmur is taken in the aortic focus .The murmur is increasing with isotonic exercise. The most
probable diagnosis in this patient what?

• Hypertrophic cardiomyopathy

• Which is the independent risk factor for coronary artery disease ?

• Diabetes mellitus

• Anion gap gap increase in diabetic coma and no ketone in urine Which is?

• Lactic acidosis

• What is the first drug to treat myxedema coma or addison crisis?

• hydrocortisone

• Radioactive iodine uptake test in Graves' disease located.

• The most common increase in LDH is the development of the course of parapneumonia . Most stylish the pneumococcus
in the course parapneumonic effusion It is determined.
• The most reliable method in the diagnosis of Lejionella pneumonia, antigen in urine It is to look at.

• Lung epidermoid ca (squamoz cell ca) first diagnosis should be done phlegm It is cytology.

• Vasculitis affecting the testis PAN is.

• thrombophlebitis, erythema nodosum, pustular lesions, skin They are symptoms.

• Buerger's disease is vasculitis affecting the arteries, veins and nerves .

• Where is alpha fetoprotein not rise?

• trisomies

23. 65 aged male in patients waist pain, high if there is sedimentation , the diagnosis is multiple myeloma.Introducing the
first protein electrophoresis It should be requested.

• Factor 12 deficiency aPTT long, PT and bleeding time is normal, clinical bleeding No way.

• CD 20 antibody in treatment of which disease given?

• NHL (if the drug is It is rituximab.)

• Hodgkin's disease with best prognosis Which is?

• Nodular lymphocyte predominant type (according to WHO classification)

• The most common esophagitis medicine?

• doxycycline

• What is the most common cause of death in the earthquake survivors?

• ATN due to myoglobinuria (Crush syndrome)

• What is the most common glomerulonephritis after acute leukemia and lymphomas ?

• Minimal lesion disease is the most common cause of nephrotic syndrome in children, most often in adults membranous.)

• The most common cause of death in chronic renal failure what?

• Cardiovascular problems are the most common during oliguria are infections.)

• First choice drug in the treatment of CML Which is?

• Imatinib mesylate

• Bone marrow in multiple myeloma of cells

Must be more than 30%.

• Alkaline phosphatase, bone, liver, intestine, placenta source enzyme.

• 1º or AV full block in ECG You may be asked.

• Diastolic murmur in the heart, mitral insufficiency, aortic stenosis does not cause.

• Acute myocarditis is the most common viral (coxackie B) factor. 37.Pneumocystis abdominal pneumonia, frequent in the
course of HIV While

together with hypoxia in the room air.

• pleural effusion, pH low, LDH and protein high if diagnosis, Parapneumonic and effusion.

• pneumothorax, tachypnea young one in patients respiratory If the sounds are reduced on that side, hypersonorite on
percussion It should come.
• Distal interphalanges in rheumatoid arthritis affected.

• year-old man, coming up with back pain.Has anemia , lytic lesions , sediment high, lytic diagnosis?→ Multipe myeloma

• This patient should be asked for immunelectrophesis and bone marrow diagnosis.

• Melfelan and autologous bone marrow transplantation are performed in this patient.

• Adult in patients dermatomyositis and polymyositis especially if detected GIS adenocancer It should be investigated.

• In renal tubular acidosis type I, urine pH is> 5.5 . 44.Nephrotic syndrome grosse hematuria and hypertension

Not expected.

• If you have chronic pancreatitis, steatorrhea, presence of diabetes and slimming It should come.

• 3 hours in OGTT blood glucose is low , the diagnosis is reactive hypoglycemia.

• The most common cause of hypercalcaemia what?

- Primary hyperparathyroidism

• Diagnosis which should come to mind in the patient who has fever and bleeding in intensive care unit what?

Disseminated intra vascular coagulopathy (D I C)

- Prior to requesting a patient for suspected DIC in intensive care unit required Tests: Coagulation tests, platelet count.

- In the treatment of such a patient, erythrocyte, platelet, fresh frozen plasma is given.

• Folic acid Lack of macrocytic anemia diagnosis for most Reliable test: Figed test

• Bleeding the time, APTT long, PTZ normal one bleeding VWH in the patient It should be investigated.

• Which hemolytic transfusion reaction not seen?

Rh incompatibility

• Wilson's disease should be considered in young patients if hemolytic anemia, acute hepatitis, and extrapramidal findings .

• AST, ALT, bilirubin in the third trimester of pregnancy . PTZ elongated. What is a diagnosis ?Acute fatty liver of pregnancy

• Amoebic colitis cases: Bloody diarrhea, stool in microscopy erythrocyte is seen (Leukocyte to be attention).
colonoscopy There are flasks or bottle style ulcers .Treatment and drug dose in this patient; metronidazole; 3x750 mg 10 day

• Turcotte syndrome: adenomatous polyp + brain tumor (gliomas are common)

• DM diagnostic criteria.The best diagnostic method with OGTT is more than 200 mg / dl. is it.

• Hyponatremia in which endocrine diseases can be seen?

• hypothyroidism

• High anion gap acidosis, renal tubular acidosis in the course No way.

• Hemoptysis in the course of bronchial asthma No way.

• Acute myocardial infarction after that ACE inhibitors or ARB remodeling It prevents.

• Aortic insufficiency leads to large pulse pressure . 62.Cigaret smoker male patient, weakening, hemoptysis and
breast
comes with pain. A chest radiograph shows a cavitary mass lesion. What is your diagnosis?

• Lung squamoz cell ca

• Aortic stenosis from valve diseases in an Angina-like patient think.

• High cholesterol content in the course of rheumatoid arthritis encountered.

• Oxygen should be given before the asthma attack.As the drug, beta agonists first It is preferred.

• Sinus tachycardia and Mobitz Type 2 block in digital intoxication It is not visible.

• AA medicine amyloid who reasons, bronchiectasis, rheumatoid arthritis, FMF, tbc, chronic and osteomyelitis.

• The most common congenital anomaly of the lung is the azygos lobe.

• Heart muscle primary energy source as independent oil It uses calcium and is required for contraction of calcium
extracellular calcium.

70.The AV node is in the interatrial septum pars membranacea. 71.S1 atrioventricular, S2 semilunar (aortic and pulmonary)

the closing of the covers.

• MI course during used and mortality decrease is a drug that inhibits the development of ventricular aneurysm next to
ACE inhibitors.

• S2 paradox mating causes are left side pathologies of the heart .

• IHSS is the most common cause of sudden cardiac death in young athletes and athletes, and the murmur is reversed by venous
return It is proportional.

• Hyponatremia in the course of pneumonia = Legionella pneumonia.76.Hypotension + veins in the neck pulsus fullness +

paradoxus + teledee tent + voltage loss at EKG = Tamponad.

• Nonkazeifiye granuloma + hypercalcemia + uveitis + erythema a nodosum + AC in bilateral hilar LAP =

sarcoidosis.Prednisol in the treatment of hypercalcemia It is given.

• AC adenoma is seen most often linked to asbestos CA, but the most common cause of Mesothelioma asbestos.

• in adults coronary artery most stylish holding vasculitis PAN is.

In the child, Kawasaki disease.

• Wolf Parkinson White in young patient with short PR wide QRS and delta syndrome.

• Sudden onset chest pain shortness of immobile ECG on the patient S1 Q3 T3 pattern, ECHO in acute right failure
findings if there is no diagnosis of pulmonary It is embolism.

• Systolic ejection murmur in the aorta focus, S2 paradox couple and murmur venous return increases maneuvers with
the intensity is diminishing.Diagnosis what?

• Hypertrophic cardiomyopathy (IHSS)

• She has chest pain , heart enzymes are normal.There is concave ST elevation .What is a diagnosis ?

• pericarditis

• Pulmonary embolism, blood gas determined?

• Hypoxia, hypocapnia and respiratory alkalosis.

• Right lungs lower lobe smooth edged consolidation, increased eosinophil diagnosis?
• Cyst hydatid

• The most reliable diagnosis in the diagnosis of bronchiectasis The method?

• High-resolution tomography

• Middle old male, weakness, fatigue, weakening and Comes with palpitations.On physical examination, the mucous
membranes are pale. 2/6-degree systolic murmur is taken in the heart. Hemoglobin 7 g / dl, MCV 68 fl, leukocyte, platelet,
reticulocyte count is normal. Serum iron and iron binding capacity is low?

• Chronic disease anemia

• Fourteen years old boy, pale and spleen 6 cm palpl, hemoglobin 9 g / dl MCV 81 FL, leukocyte and platelets the
number is normal.The erythrocyte structure in the peripheral smear is found as hyperchromic microcytic. What is the diagnosis?

• Hereditary spherocytosis, splenectomy

• Which one is hypochromic macrocytic anemia not seen?

• Sideroblastic anemia (hypochromic microcytic anemia) becomes.)

• Patient in the intensive care unit.General condition is bad, blood pressure is low, pulse rate is 120 / min, fever is 39 degrees,
active bleeding from the drains and catheter locations are detected.Hemoglobin 7 gr / dl, leukocyte and platelet counts are low.
Schistocytes and fragmented erythrocytes are detected in peripheral smear .The number of reticulocytes is 5%. Bleeding time is 12
min, prothrombin time is 18 sec, aPTT is 65 sec. What is the diagnosis? treatment what?

• DIC below lying disease the middle It is removed.

Symptomatic fresh frozen plasma is given.

• She has nosebleeds and recurrent deep vein thrombosis .fM, erythromelalgia and splenomegaly there is. platelets The
number 720 thousand, leukocyte number 12 thousand, HB and reticulocytes normal. What is the diagnosis in this
patient? what?

- Primary thrombocytosis, anagralide

• Sixty-six years old, followed for 30 years with type DM type II, nausea, vomiting, loss of appetite and itching.nocturia It
describes. Hemoglobin 8 g / dl MCV 70 FL, leukocyte and platelet count is normal.Serum calcium 7 mg / dl, phosphorus 6
mg / dl creatine clearance 12 ml / min olaraka features.What is the treatment makes?

• Diagnosis of end stage CRF, treatment dialysis.

• diabetic ketoacidosis treat most important problem electrolyte disorder Which is?

• hypokalemia

• Brain bleeding because of intensive in care lying laboratory in the patient's serum sodium 120 mEq / L, serum
osmolality 250 mOsmol / kg respectively.Urine sodium and osmolarity are high. Diagnosis what?

• Improper ADH send. water loading test, first to be done liquid restriction

• Low serum calcium, phosphorus and parathormone high.

What is a diagnosis?

• I Psödohipoparatiroi

• Forty- year - old male, liver function tests AST 210, ALT 80, GGT 125 U / L, alkaline phosphatase is normal.The most
probable diagnosis in this patient what?
• Alcoholic hepatitis

97. 34 weekly pregnant one Lady liver function ALT 400, AST 200, GGT and alkaline phosphatase light test , total
bilirubin 5 mg / dl, direct bilirubin 3 mg / dl, Prothrombin time is 19 sec.your diagnosis what?

- Acute fatty liver of pregnancy

• What is the yeast used in pseudomembranous enterocolitis ?

• Saccharomyces they size

• After eating and drinking, he has abdominal pain, weakening and steatorrhea .B12 deficiency and high blood sugar, the most
specific diagnostic test which?

• Diagnosis; Chronic pancreatitis, bendromitis test

• She has acute renal failure .There are erythrocyte, tubule cells and epithelial rollers in the urine microscope .The cause of
ARF in this patient what?

• Acute tubular necrosis

• FMF, pseudogout, septic arthritis, Behçet's disease, ARA: the most common knee joint effects.

• Seronegative arthritis: hip joint effects

• A case with lupus and diagnosis and screening test you may be asked?

• ANA (screening test), anti-ds DNA (diagnosis) test).

• MI / Heart failure / digital patient showed normal QR complexes and negative T waves between the normal sinus rhythms in
the ECG.Diagnosis?

• ventricular extrasystols.

• In the diagnosis of AMI increases CKMB, LDH, troponin I, AST. 105.Right second intercostal in December diastolic
decrescendo

murmur, diagnosis, the most common cause?

• Aortic insufficiency, CALL

• Primary hypertriglyceridemia case (Cholesterol <200, HDL normal, TG 450) choice?

• Fibrates. The risk for acute pancreatitis (triglycerides higher than 400 mg / dl creates.)

• The most common cause of pyomyositis in diabetic patients ?

• Polymicrobial, anaerope streptococci.

• Dry cough, fever, interstitial pneumonic infiltration, bullous myringitis in the ear.What is a diagnosis ?Diagnosis method,
treatment?

• Mycoplasma pneumonia, cold agglutinin test, erythromycin

• Bilateral hilar LAP, erythema nodosum, uveitis?Diagnosis, diagnosis method?

• Sarcoidosis, lung biopsy

• In the examination of the patient with shortness of breath left breathing participation decreased. Vibration thoracic
increased,
decreased percussion sonority, decreased breathing sounds with listening. What is the diagnosis in this patient?

• In pneumonia and atelectasis, vibration increases thoracic .

• The patient with hypochromic microcytic anemia had low iron and iron binding capacity, increased ferritin, transferrin
saturation and storage iron.Diagnosis what?

• Chronic disease anemia

• Hot type autoimmune hemolytic anemia and hereditary spherocytosis, sickle cell anemia, thalassemia extravascular
hemolytic anemia.

• A 45-year-old female with fever, weakness, fatigue .The spleen is 14 cm large.The leukocyte count is 76,000, the platelet
count is 620,000, and the hemoglobin is 14 g / dl.Eosinophils have an increase in basophils. Diagnosis, diagnosis method, first
choice in treatment?

• CML, cytogenetic examination, imatinib mesylate

• Bleeding the time 5 min, prothrombin the time 12 sec, APPT What is the diagnosis in the patient who has a
history of bleeding for 65 sec?

• Factor 12 deficiency. also 8,9, 11 and 12 in eksikling APTT alone It is long.

• The most common cause of renal osteodystrophy and secondary hyperparathyroidism in chronic renal failure what?

• hyperphosphatemia

• The patient who came with ABY had high sodium and potassium in the spot urine .The most probable etiology what?

• Renal welded ARF

• Which of the following diseases is most likely to be hypertension It is low?

• Addison, Bartter syndrome and salt losing nephropathies hypertension do not do.

• What is the most reliable test for the diagnosis of pregnancy cholestasis ?

• GGT

• The patient who came to the clinic was Anti HBs positive, HBs AG negative, HBV DNA negative, HBe Ag negative, anti
HBc Ig G positive diagnosis?

• Past infection. Only anti-HBs are positive in vaccines.

• Reflux, the diagnosis initially diagnosis for upper gastrointestinal endoscopic examination is not required .If there is
at least one complication of reflux in the last 5 years, then endoscopic examination makes.

• Which lupus or rheumatoid arthritis most stylish seen heart involvement is a form?

• The involvement patterns pericarditis, if the cover is mitral regurgitation.

• Thirty-five years old male after car accident sudden shortness of breath blood gas respiratory alkalosis hypoxic hypocapnic
diagnosis: fat embolism, long bone fractures Fuck.

• The most common skin lesion in hepatitis C is lichen planus.Most frequent vasculitis mix UmUdUr cryoglobulinemia.

• What is the biochemical marker used in the diagnosis and prognosis of heart failure: BNP.(Brain natriuretic peptide)

• Fifty-year-old male with epididymitis, orchitis and HBs Ag positive patient with coronary vasculitis and hypertension have
diagnosis: PAN

• The patient had type 2 DM at the age of 2 years and hypertension and he had chest pain for 30 minutes.What is the
diagnosis and treatment if the patient has a r / s ratio greater than 1, TA 70/40 mmHg, NDS 53 / min in V1 : right ventricular MI and
first treatment fluid treatment is.
• Uric acid the level of drop antihypertensive agent which is: Losartan (Diuretics uric acid the level of raises
and gout cause crisis may be)

• Long QT syndrome-MVP-aortic stenosis-IHSS cardiac sudden death Why they are.

• One upper respiratory way infection following this, all petechial in the body rashes one and platelets number
20000 Diagnosis diagnosis?

• Diagnosis ITP is the most important differential diagnosis Henoch schönlein purpura.

• Middle-age male patient with recurrent sinusitis, hemoptysis and kidney failure You think?

• Wegener granülomatozus

• Which complications of chronic renal failure in patients receiving chronic hemodialysis not decreased?

• renal osteodystrophy

• Forty-year-old female patient hypertension, obesity, depression, osteoporosis, hypernatremia, hypokalemia and
polycythemia What is the first diagnostic method? what?

• Cushing's syndrome, 1 mg dexamethasone suppression test and 24 hour urine release cortisol

• Which is macrositer anemia do not do?

• Thalassemias, iron deficiency sideroblastic anemia, chronic disease anemia

• The patient has a history of lymphadenopathy in the whole body , the WBC 100.000, Hb in the hemogram, the normal
diagnosis in 90% lymphocytes method-treatment

Diagnosis CLL, treatment method bone marrow aspiration, treatment CLL also do not treat unless there is anemia and
thrombocytopenia, following

• What is the possible diagnosis in a 70-year-old patient with progressive dysphagia and weight loss?

• Esophageal cancer.

• A 40-year-old female patient with a history of itching examination normal, ALP high, USG normal. What is your
diagnosis ?Which autoantibody is desired, diagnostic method what?

• Diagnosis Primary biliary cirrhosis, antimitocondrial antibody, diagnostic method biopsy.(These patients are not seen until the
last period ikter.)

• Obese patient with postoperative intensive care palpitation, breast pain specification It is. fM, S3 galo
available.DSS: 30, Chest X-ray normal. The method?

• Diagnosis of pulmonary embolism, definitive diagnosis method angiography

• A 50-year-old male patient presented with palpitations, chest pain, shortness of breath, and 3 times syncope in the last 2
years.The systolic murmur is heard at the interval in the FM right 2nd intercostal space .It's spreading to the carotid. Possible
diagnosis - diagnosis method.

Diagnosis, Aortic stenosis, diagnostic method, echocardiography

• reticulocytopenia reasons:

• Aplastic anemia

• Puritan kinase lack of

• Paroxysmal nocturnal hemoglobinuria (late period)

• B12, folic acid lack of

• in thalassemia intramedullary hemolysis connected reticulocytes The number of normal or low can

• splenectomy contraindications

• G6PD lack of

• Wiskott Aldrich syndrome

• A granulocytosis

• Paroxysmal nocturnal hemoglobinuria

• Right ventrikal myocardial the infarktüsü treat especially Isotonic liquid should be included.Vasodilator drugs
contraindicated.

• thrombolytic treatment effective that indicative situations (in mI):

• Early in the enzyme peak being

• Your clinic is fast recovery

• ECG changes fast being

• Intranodal arrhythmias development

• Acute rheumatic fire early in the period mitral failure, The most common mitral stenosis in the late period are
complications

• Asthma similar table who bond tissue disease:

scleroderma

Charg-Strause syndrome with vasculitis similar to asthma

• Chronic obstructive lungs disease prognosis FEV 1 determines the value.

• Tuberculosis:

• virulansdan vir cord factor

• granuloma The generation cord factor

• necrosis from kazefikasyo phosphatides It is responsible.

• Vena cava superior syndrome, Horner syndrome, pankoast tumor, is the most common small cell lung carcinoma.

• Pneumonia-like consolidation P Brankoalveo on

Carcinoma Forming Multi lobular involvement tutul Brankoalveo on Smoking Carcinoma with unrelated iliş Brankoalveo
on carcinoma

Most good with prognosis progn Brankoalveo on carcinoma

• The most common cause of malabsorption in elderly is bacterial overgrowth.

• Diabetes Mellitus's pathognomic findings:

• Efferent arterioles atherosclerosis

• Insulitis ( - cells inflammation)

• retinopathy

• nodular glomerulosclerosis

• Serum Amyloid, showing the highest increase during inflammation A.

• Drug-induced lupus, arthritis and lung involvement goes away.Antihiston antibodies 100% It is positive.

• Behçet's disease includes both arterial and venous system and vein of all sizes It can hold.

• The most common cause of death in Behçet is pulmonary artery aneurysm rupture.

• Rheumatoid factor (+) is the most common type in Sjögren. (90%)

• The most reliable drug for the treatment of diabetic neuropathy is gabapentin

157.Hematuria + proteinuria = Glomerular lesion

Pyuria + proteinuria = Infection

Protein increase in blood + proteinuria = Multiple myeloma

Hypertension, heart failure, fever, epilepsy = Functional proteinuria.The amount of protein is <2 g / day.

Nephrotic syndrome = Protein> 3.5 g / day.Proteinuria is selective in minimal lesion disease.

Tubular diseases = Tubular proteins are not absorbed.The amount of protein is <2 g / day. The most important tubule protein beta 2
microglobulin

158: Cardiomyopathies

Dilated cardiomyopathy
Parameters restrictive Obstructive

second frequency
Frequency Most often Least

Etiology (most common)

idiopathic idiopathic Hereditary

Secondary (most common)

Alcohol Amyloidosis -

systolic function. broken Aortic stenosis

Pathology diastolic

Left heart failure Right heart failure

symptoms A. stenosis

Left vent. Find the hypertrophy. Short PR, VES, Q

ECG Non specific

AS

Tel cardiomegaly Heart is not big findings

4 bays of equal width Thick septum

ECHO No diagnostic value

Definitive diagnosis Biopsy Biopsy Biopsy

Septal myotomy
Treatment Transplantation Transplantation

ID: 10t0149

FORMAT_PLACEHOLDER_9
• Pulse types

Pulsus parvus et tardus (slow and late pulse): AS, hypovolemia, KKY

Pulsus seler et altus: Aortic insufficiency, hyperthyroidism, PDA

Corrigan pulse (leaping pulse, St.Vitus dance): AY, AV block, severe sinusal bradycardia

pulsus bisferiens (double peaked in): Aorta failure, aorta failure

+ aorta shortness of breath, hypertrophic cardiomyopathy, hyperkinetic situations

Dichromic pulse: dilated cardiomyopathy, cardiac tamponade, hypovolemic shock, typhoid

Pulsus alternans: when left heart failure (most frequent), mitral insufficiency, aortic insufficiency, hypertension and venous return
are reduced

Pulsus bigeminus (two peak pulses): Bigemine ventricular extrasystoles

Pulsus paradoxus: It is determined that systolic arterial pressure decreases more than 10 mmHg with inspiration .Heart tamponade,
constrictive pericarditis, extreme obesity, pregnancy, acute pulmonary embolism and shock visible.

Pulse deficit is seen in atrial fibrillation. There is a difference between the number of peripheral pulses and heart rate. The apex is
more than the periphery.

Pulsus filiformis is a fast pulse with weak amplitude seen in shock.

• ECG CHANGES IN ELECTROLYTE DISORDERS

hyperkalemia

• T wave amplitude increases, taper.The earliest of hyperkalemia It is a symptom.

• P wave height decreases and at the end deleted.

• R wave The amplitude decreases S wave depth increases, ST segment It precipitates.

• QRS expands QRS complex with T wave converge.

• Recently, ventricular tachycardia, ventricular flatter and fibrillation It develops.

hypokalemia

• T wave amplitude decreases, It is negative.

• U wave evident

• ST segment crashes

• QT range is normal or slightly extended

• P wave amplitude increases

• PR range extended

• arrhythmias develops

hypercalcemia

• QT shortens, the earliest is a sign

• PR extended

• QRS extended

• T wave expands and doming is

• arrhythmias develops

hypocalcemia

• QT prolongs.It is the most important and the earliest symptom of hypocalcemia .

• Various T-wave changes occur revenue.

hYPOMAGNESEMIA

• Ground for digital toxicity He can prepare.

• Because it causes intracellular K loss ECG

I www.tusdata.co

167: Leukemias

Diagnosis Clinic Types and features Other

AML (acute myelocytic Pancytopenia Complications of MO: indifferent: chloroma

leukemia) in CBC 90% pancytopenia; weakness,
in peripheral fatigue, bleeding diathesis
smear blast susceptibility to infections M1: undifferentiated
and auer rod Organomegaly and myeloid: Poor prognosis criteria
 cells blast in lymphadenopathy, specific M2: differentiated myeloid : - M0, M4, M5, M6, M7
KI> 30% organ involvement findings the most common type , the
most common type of auer • age <2 and> 60
rods
• LDH high, auer no

M3: Promyelocytic: best - UK> 100,000

prognosis, presentation with
DIC, t (15-17), retinoic acid (Hyperleukocytosis)
use corrects translocation
• MDR-1 gene (+)
league
M4: Myelomonocytic:
testicular, gingival, CNS • fast dividing blasts
involvement,
lymphadenopathy, • t (9-11) and
organomegaly; PAS, MPO, trisomies
esterase (+), inv16 (+)
• secondary
developing and
M5: Monocytic: increases in
CNS, testes, gum
involvement,
lymphadenopathy, Treatment: ARA-C +
organomegaly urine and daunorubicin or
serum lysozyme, idarubicin, Bone marrow
hyperleukocytosis.MDS transplantation (KIT)
becomes the most common
M5.

M6: Erythrocyteemia:
Diguglielmo send: usually
develops secondary to MDS,
coombs (+) hemolytic
anemia, ANA positivity,
synovitis visible, Glycophore
A (+)

M7: Megakaryoblastik:
Down syndrome is common,
bone marrow due to platelet-
derived cytokines fibrosis
intense

ALL (acute lymphoblastic PAS (+), Pancytopenia belonging
leukemia) CALLA (+) complications; weakness,
TdT (+) fatigue, bleeding diathesis,
susceptibility to infections,
cells, lymphadenopathy,
organomegaly, testicular
75% B cell involvement, bone pain
origin
L1: frequent, good prognosis 80% of children with
in children leukemias B cell CD19
T cell CD 2-5-7 good for
L2: frequent in adults AML prognosis
Treatment: vincristine,
prednisolone,
L3: Burkitt type: lactic cyclophosphate, L-
acidosis, tumor lysis, worst asparaginase
prognosis
90% full remission
Poor prognosis: age <1 and>
10, BK> 30,000, time for
complete remission> 4
weeks, Pre-pre B, T-cell
Negro, Philadelphia
 Chromosome (+) and t (8-
14),

CALLA (+) and early B best

prognosis

There are three stages: early (chronic), accelerated and

blastic (acute) the period THAT function It
preserves. Phi chromosome t (9-22) 95% positive
BK> 100,000 Hydroxyurea treatment,
(bcr-abl fusion). splenomegaly It is massive. the IFN-alpha +
Left shift in subfebrile fire, night There are symptoms such as cytarabine Gleevec
CML PY sweating, weakness.Leukocytase findings: blurred vision, (imitanib) by inhibiting
(chronic Myeloid leukemia) dyspnea, priapism, mental change. Blasts in KI <5% bcr- abl fusion gene
Ph chromium provides 70% cure Final
(+) LAP score There are primary fever, bone pain, splenomegaly treatment: Allogeneic
low KIT
blastic phase AML clinic has. THAT' also blasts>
30% Stop. basophils and eosinophilia is the first sign
of blastic transformation can.

The Rai classification shows

the prognosis:

Stage 0: lymphocytosis

Stage 1: lymphocytosis +
LAP
UK> 100,000 Best prognosis of
at CBC In advanced age, frequent> Stage 2: organomegaly leukemia Treatment:
60 Insidious onset, chlorambucil and
CLL (chronic lymphocytic lymphocyte> incidental diagnosis, Stage 3: anemia fludarabine used
leukemia) 75% B cell frequent organ infiltration
Splenectomy for
origin CD 19 Stage 4: thrombocytopenia
findings: LAP, HM, SM autoimmune anemia and
and 5 (+) thrombocytopenia
Autoimmune hemolytic
anemia and
thrombocytopenia Richter's
syndrome: systemic disease
stable, single lymph node
transforms into aggressive
lymphoma

In middle-age men, frequent, lymphadenopathy and

The prognosis is very
B cell TRAP hepatomegaly may occur. Massive splenomegaly,
Hairy cell leukemia pancytopenia, hairy cell in peripheral smear and KI good Cladribin used in
(+)
treatment
Bone marrow usually cannot be aspirated

ID: 10T445

FORMAT_PLACEHOLDER_10
• The half-life of some factors is below It is:

Factor V à 12 h Factor VII à 2-5 h Factor X à 20-40 hours Factor XI à 40-80 hours Factor XIII à 12 days Fibrinogen à 72-
144 hours Protrombin à 48-120 hours

• Half- life shortest: factor 7

• Half- life longest: factor 1 (fibrinogen)

• Factor not found in serum: factor one

• Factor not found in plasma: tissue factor

• Fibrin Stabilizing Factor: Factor 13

• Labil coagulation factors: 7,8,9

• Common road factor: 5 and 10

• Non-deficiency bleeding: factor 12

• Factors with bleeding in deficiency and laboratory tests normal 13

• emphysema popular region by subgroups and The features are as follows:

Sentriasiner emphysema; Lung acini (terminal bronchiole) at the distal remaining, alveolus and respiratory bronchioles,
proximal parts, ie respiratory bronchioles, alveoli It has been preserved. Most stylish seen major and subgroups.It is mainly
associated with smoking, often together with chronic bronchitis and more in the upper lobes of the lung. It is severe.

Panasiner emphysema: The whole of the acini is kept.It is most commonly seen with alpha 1 anti-trypsin deficiency.It is more
severe in the basal lung.

distal acinar emphysema (paraseptal or subpleural emphysema: Asinusun just distally so alveoli amount. localized
tend to stay and long time clinic finding You may not. Most important clinical outcome spontaneous It is pnomotoraksd.

• OGTT indications

• After 45 years of age, everyone is provided with an OGTT every 3 years.If there is a defect in the first test once a year
makes.

• OGTT regardless of age makes

• In obese (body weight greater than 120%) or body mass index> 27% persons

• First degree in their relatives diabetes mellitus ones

• OGTT for values from 100-126 makes

• Cause unknown impotence,

• Overweight baby birth

• Vulvovaginitis anemnesis If

• Essential hypertension Those

• Diabetes is common in the race be

• Previously impaired OGTT and impaired fasting glucose patients

• HDL cholesterol <35 mg / dl, Triglyceride level> 250 mg / dl patients

173: Differential diagnosis in iron deficiency

Selection Transfers of transfers

Parameter / Disease sfebkferritin Warehouse Iron

Iron deficiency anemia Low high low Low negative

Chronic disease anemia Low low high high ++

thalassemia load low high high +++

Sideroblastic anemia load Ring siderob- last

low high high

hemochromatosis load low > 1000> 60% ++++

ID: 10t0128

FORMAT_PLACEHOLDER_11

174: Blank findings in menejites

purulent Tuberculosis Aseptic

View Blurred xanthochromic Clear

200 - 1000
> 1000 Most parts 10-200 Most lymphocytes
Cell Most lymphocytes

Glucose Very low Low Normal

Protein increased increased Normal, slightly increased

FORMAT_PLACEHOLDER_12
180: ECG localization of myocardial infarction

Primary ECG Changes Participating Possible Vessels *

Field of Infarction

inferior II, III, AVF RCA

septal V1, V2 LAD

anterior V3, V4 LAD

anteroseptal V1- V4 LAD

Extensive anterior I, AVL-V1-V6 LAD

lateral I, AVL, V5-V6 RATCHET

Higher lateral I, AVL RATCHET

Posterior † Distinctive R. V1 RCA or CIRC

ST-elevation and more specifically V4R in inferior infarction

Right ventricle ‡ RCA

* This one it is a generalization and many variable has.

† Generally inferior and lateral infarction related.

‡ Usually associated with inferior infarction.

RCA = Right coronary artery; LAD = Left anterior descending coronary artery; CIRC = left circumflex coronary artery D: 10t008

ID: 10t011

FORMAT_PLACEHOLDER_13

181: Pituitary adenomas

Adenoma type Disease Secreted HormoneFrequency (%)

Hypogonadism, galactorrhea
Lactotropic (PRL) prolactin 25-40

somatotropin Acromegaly, gigantism Growth hormone 10-15

corticotropin Cushing's Disease ACTH 10-15

gonadotropin Mass effect, hypopituitarism FSH, LH 15-20

thyrotropin hyperthyroidism TSH <3

nonfunctional Mass effect, hypopituitarism - 10-25

FORMAT_PLACEHOLDER_14

• Radiological features of breast lesions Benign:

• the Makrokalsifikasyo

• Low density, smooth opacities

• Internal structure Maintaining

• Normal vascularity

• Equally or more radiologically than the clinic size

malignant:

• microcalcifications

• High density, non-homogeneous opacity

• Intermittent internal structure corruption

• Increased vascularity

• peripheral blur

• Radiological radiology size

Some specific pneumonias and their characteristics

PNEUMOCOUS PNEUMONIA: He / she makes Lober Pneumonia.The most common cause of community-acquired pneumonia,

Herpes labialis may accompany. Parapneumonic effusions are the most common cause. Bacteremia is common in splenectomy and
elderly. Penicillin is the first choice in treatment.

Staphylococci PNEUMONIA: influenza, measles, IV drug addicts stylish. PE: Quickly quality changing bronchopneumonia,

cavitation, pneumotocele, pneumothorax .Treatment: Methicillin, nafcilin and dicloxaciline.

MRSA: vancomycin, teicoplanin, rifampin.

KLEBSİELLA PNEUMONIA: Typically, upper lobes may cause lobar pneumonia.Abscess, hilar adenopathy. Alcoholics in Fuck.
volume increase the connected as fissure in thrust can be monitored .In treatment 2.Or 3rd generation cephalosporins

H. INFLUENZAE PNEUMONIA: It is common in elderly, alcoholic, chronic bronchitis and people with additional diseases.

Type-b is the most pathogen. I prefer amipicillin 1. If there is resistance, 2nd generation cephalosporins, combinations with
betalactam are given.
mYCOPLASMA PNEUMONIA: Most stylish seen atypical pneumonia.incubation time 14-21 day. URI symptoms,
ear bullz myringitis, cervical lymphadenopathy, conjunctivitis, neurological symptoms may be impaired in liver function
tests.Diagnosis: Cold aglutinin in test 4 floor titres increase with Threads. treatment erythromycin first It is preferred.

LEGİONELLAPNÖMONİSİ: The agent is Legionella pneumophiliae.waters lived for air conditioning and waters infection
why is that It happens.Dry cough, pleural pain and GIS symptoms such as nausea, vomiting, diarrhea has.

Relative bradycardia, confusion, and extrapulmonary symptoms are common. LDH and creatinine may be increased in
phosphokinase, hypophosphatemia and hyponatremia .Diagnosis: The most reliable diagnostic method is to detect antigen in
urine.Treatment: first choice Azithromycin or levofloxacin

CLAMIDIA PNEUMONIA: Bird, pneumonia and hepatosplenomegaly following upper respiratory tract infection may be
present.Skin lesion Fuck. PE: the hilum periphery extending the infiltration and hilar lymphadenopathy.Diagnosis:
Complement fixation test is used.Treatment: tetracycline used.

Pneumocystis PNEUMONIA: HIV and transplant patients frequently seen infection belongs.

in apex pneumatoceles and pneumothorax traceable. Does not perform pleural effusion. Treatment and prophylaxis: TMP /
SMX It is given.

• I TELEKARDİOGRA

• Posterior to anterior, tape and tube distance taken at 180 cm graphite.

• Cardiothoracic ratio: the largest horizontal diameter of the heart of the thorax most broad horizontal diameter rate is.
This the proportion Above 50% is the cardiomegaly It suggests.

Structures forming the heart shadow:

• right upper corner à superior vena cava

• right edge à right atrium

• right edge heme n alt ı à inferio r vena cava

• Your heart Base à right ventricle

• the bottom edge of the left edge à left ventricle

• The top of the left edge left atrium

• left upper corner à pulmonary artery and immediate

Abdominal knob on

• KRG reasons

• Diabetes mellitus 39%

• Hypertension 28%

• glomerulonephritis %11th( glomerular diseases between most common disease chronic It is glomerülonefritd.)

• The most common cause in children is vesicoureteral reflux disease.

Pathology

• Sclerosis in glomeruli

• in tubules atrophy

DIALYSIS INDICATIONS IN CHRONIC RENAL FAILURE

• Symptomatic despite treatment uremia

• Liquid loading (diuretic resistance)

• Treatment resistant nausea-vomiting

• Refractory hyperkalemia

• Fall in quality of life (long-term complications, neuropathy, pericarditis)

• Metabolic acidosis (treatment) resistant)

• Findings of end stage renal failure; glomerular filtration rate <10 ml / min serum

• 12 mg / dl above creatinine level being

• Intoxications and high-dose medication reception

• Treatment- resistant hyponatremia

• The classification of lupus nephritis is as follows; Medicine I : Normal

Type II: Minimal-Mesengial lupus nephritis (earliest and mild form)

Type III: Focal proliferative lupus nephritis (cell proliferation)

<50%)

Type IV: Diffuse proliferative nephritis (cell proliferation> 50%) (worst, most frequent)

Type V: Membranous lupus nephritis

Autoimmune events: AML M6 Bone marrow fibrosis: AML M7 DIC: AML M3

mediastinal Mass: T cell ALL

193.

The most reliable diagnostic method for lymphoma is lymph node biopsy.

Diagnosis of CML Philadelphia chromosome positive with Threads. CML bcr-abl mutation, Phi chromosome must be
looked at.Peripheral smear is the first examination. Peripheral smear is the same as bone marrow in CML. However, bone marrow
aspiration may be desired for cytogenetic study. Moreover, the data in the case may be weak, but may not require the exclusion of
AML, so bone marrow aspiration may be necessary. However, definitive diagnosis of bone marrow biopsy They do not.

Primary myelofibrosis also has fibrosis in the bone marrow.But the primer myelofibrosis exact diagnosis for Philadelphia
Cytogenetic representation of the negative chromosome must.

Hairy cell leukemia also bone marrow tartar resistance acid diagnosis of phosphatase positivity Threads.

Acute leukemias are diagnosed with a blast count of> 20% in the bone marrow.

194: Diabetic Komalar

Parameters ketoacidosis Nonketotic comaLactic acidosis

Why is that Insulin deficiencyfluid gap underlying disease.

AXLE 250-500 > 500 N/D/Y

ketones + - -

pH Low Slightly low Very low

HCO 3 Low Normal Very low

NA Low High Variable

K High High Variable

clr Normal High Variable

Urea Normal High High

Treatment Fluid + insulin Fluid + insulin treatment of the cause

ID: 10t081

FORMAT_PLACEHOLDER_15

• LİKEN PLANUS

• Itchy skin and mucous membranes disease

• HIV, hepatitis, autoimmune diseases Fuck.

• The most common hand and ankle flexor percent is seen

• It is characterized by flat, polygonal, purple , pruritic, bright paul .

• Wickham the striae

• Kobner (+)

• The most common hypertrophic medicine

• 2/3 patients in the mouth white s record

• Squamous cell carcinoma on premalignant nasal plaques develop.

• Civathte bodies and hyperkeratosis in histology available

• Heart in many systemic diseases kept

Lupus and rheumatoid arthritis make the most frequent pericarditis. They cause mitral insufficiency as the most frequent pathology.

Substance accumulations most often make restrictive cardiomyopathy in the heart. (Hemochromatosis)

Amyloidosis also makes the most common restrictive cardiomyopathy. Rarely do dilated cardiomyopathy.
Tachylaxis and paclitaxel may cause bradycardia and AV block.

197: Criteria and Diseases of Transudate and Exudate

Property exudate in transudates

Protein (pleural) > 3 g / dl <3 g / dl

Protein (pleura / serum) > 0.5 <0.5

LDH (pleura) > 200 IU / L <200 IU / L

LDH (pleural / serum) > 0.6 <0.6

Pulmonary infection

Lung tumor (most common)

GIS Causes

Pancreatic causes

Subphrenic abscess Congestive heart failure (en stylish)

Nephrotic syndrome
Esophageal perforation
Peritoneal dialysis
Diaphragmatic hernia
Urinary tract obstruction

Collagen tissue diseases Vena cava obstruction surprise

Pulmonary embolism Sarcoidosis

Medicines

Hemothorax, chylothorax

Meigs syndrome

Asbestosis, AMI

Uremia, radiotherapy,

FORMAT_PLACEHOLDER_16

ID: 10t0111
198. Multiple Sclerosis

• The most common demyelinating disease .

• The most common form of going with relapse-remission the forms.

• An autoimmune disease characterized by the development of autoantibodies against myelin and oligodendrocytes It is
incident.

Clinic:

• The most common symptom fatigue.

• The most common finding optical It is neuritis.

• Optic neuritis, retrobulbar neuritis, diplopia visible.

• Coming up to temporary settlement (Lhermitte sign)

• Achilles reflex increases, Babinski and clone may occur, superficial reflexes are lost (1.motor neuron findings)

• Bilateral internuclear ophthalmoplegia (pathognomonic)

• The most common cranial involvement Are 2.sin.

• The most common cause of optic neuritis is MS Truck

• The most common cause of optic neuritis over age 70 is temporal It is arthritis.

• It is characterized by demyelinating plaques.These plaques are mostly periventricular white ore amount.

• Periventricular white matter, optic nerve, midbrain, pons, cerebellum, spinal cord kept

• MS does not retain peripheral nerves .

• MRI also Plates, VEP slowed down, NULL t 95% oligoclonal band It is positive.

The most common antineoplastic medication is daunorobucine with cardiotoxicity. It causes dilated cardiomyopathy.

Cyclophosphamide makes more hemorrhagic myocarditis.

5 fluorouracil can cause vasospasm and acute myocardial infarction in coronary arteries.

Treatment:

• Prednisolone, prednisone, methyl prednisolone, ACTH acute attack (acute attack) steroid)

• B-IFN in chronic stage used

• Glatiramer acetate is the immunomodulatory agent used in MS .

200: Vasculitic syndromes

Diagnosis Pathology Clinic Treatment

It is the most common arteritis. It holds large

arteries, the most common are the branches of the
CRP, ESR carotid, including the temporal artery.
Polymyalgia is common in patients with
Definitive Granuloma rheumatica. Tongue and jaw cladicus are typical
diagnosis: formation and signs of blindness and paralysis. The nodules and
Temporal arteritis giant cells prednisolone
temporal tenderness in FM should be longer for biopsy due
artery bx to segmental involvement

Holds large arteries. It is common in women 15-

45 years. The aorta and branches are the most
Definitive Giant cells, frequently held place. Cladification, tension in
diagnosis: thickening of the arm, finger ischemia, absence of pulse are Prednisolone
Takayasu arteritis the vessel wall
aortography, seen in the arm. Renal artery, pulmonary arteries, Immunosuppressants
angiography coronary arteries may be involved.

Immune Medium-small diameter arteries are kept. Young

complex, men often. Renal involvement occurs most
aneurysms, frequently. The lungs are almost never held. Skin
full-fold ulcers, mononeuritis multiplex, mesenteric
Definitive inflammation ischemia, scrotal involvement, HBsAg (+). It is
diagnosis: fibrinoid the vasculitis that holds the Koraner the most.
Polyarteritis nodosa skin, necrosis The tendency to thrombosis has increased.
 kidney, Angiography is associated with lesions of Prednisolone
nerve different ages. P-ANCA in Microscopic PAN + cyclophosphamide
biopsy Hepatitis B
angiography treatment

4. dekad is common in men. The mid-sized

arteries are kept.

Pansinuzit, cavitation in the lung, crescentric in

Wegener Lung and prednisolone
Granulomatousthe kidney
kidney
vasculitis,
biopsy giant cells and
glomerulonephritis rarely occurs in the skin,
granuloma fibrinoid cyclophosphamide
c-ANCA heart, eye involvement.
(+) necrosis

the Tozin Hemoptysis, epistaxis, rapid renal function TMP-SMX

corruption. TMP-SMX reduces relapse.

ANA, RF

SLE and RA (+), skin, Middle diameter artery involvement. It is

Treatment of
sural nerve accompanied by SLE or rheumatoid arthritis.
primary disease
associated vasculitis biopsy Skin ulcers and polyneuropathy

1-Acute Term: IVIG

+ aspirin

• the Konveles
Period:

Aspirin

Small to medium artery involvement. Infants and • Long-term

infants often. Lymphadenitis, changes in mouth treatment in the
Immun
and lips, erythematous edema and glove-sock presence of coronary
complex, abnormality :
type desquamation in palms and soles,
Diagnosis Aspirin ±
acute and
according to Lymphadenitis, conjunctival hyperemia fever, Dipiradomol ±
chronic
diagnostic coronary aneurysms can cause death, Warfarin?
Kawasaki inflammation
criteria myocarditis, pericarditis
combined • Acute coronary
thrombosis:
fibrinolytic therapy
(streptokinase,
urokinase)

Small-to-medium diameter artery-vein

involvement. The most common trachea and
Eosinophil rich
pulmonary arteries are involved. Bronchial
Eosinophiliagranulomatous asthma, fever, eosinophilia. Spleen, GIS, heart
inflammation. Steroid,
Churg-Strauss C-ANCA and kidney rarely It kept.Allergic
granulomatous angititis. immunosuppressive

Immune Small veins; arterioles, venules, capillaries are

complex, kept. Palpable purpura. It may develop secondary
Microscopic PA lesions of the to drugs and systemic diseases.
same age and a
P-ANCA large number Steroid
(+) Immunsupressive

Small to medium arteries. Then the inflammation

spreads and keeps the nerve and venide.
Microabrases are microthrombs. Frequent in men
Granulomatous
Buerger thromboanjitis
inflammation, aged 25-50. Smoking is closely associated with
obliterans it. Cladding intermittence, reynoud phenomenon, Surgical
biopsy giant cell
gangrene, ulcer

Immune
complex,
Arterioles and venules are kept. Extensive
vascular
involvement, especially in the skin. HBV may be
necrosis and associated with HCV. Characterized by palpable
inflammation Treatment of
Hypersensitivity vascularity Skin bx purpura. Other name is leukocytoclastic
of leukocytes prednisolone cause
vasculitis

Small arteries, postcapillary venulitis. Fever is

Immune characterized by palpable purpura, nephritis,
Henoch Schönlein purpura complex, signs of mesenteric ischemia, arthritis, especially
Skin, kidney
leukocytoclasisat the back thigh. It develops frequently in prednisone
biopsy
children, after URI.

Granulomatous vasculitis of atypical

Lymphomatoid granulomatosis lymphocytes and plasmids. T-cell can progress to
non-hodgkin lymphoma.

ID: 10T450

FORMAT_PLACEHOLDER_17

116

201: Physical, ECG and X-ray findings specific to chronic acquired valve lesions

Physical Findings ECG X-ray

Pulsus parvus et tardus (may not

be present in elderly patients and
aortic insufficiency), Ejection Left ventricular dilate
murmur, longitudinally spread; Left ventricular hypertrophy
Post-stenotic aortic root dilatation
Left bundle bundle bundle
Left unchanged left ventricular
block Occasionally due to Calcification in aortic valve
Aortic stenosis peak pulse A2 weak, S2 single or transmission system
paradox region
calcification block
S4 gallop
 Pulse pressure increases

Double-notched carotid pulses

Fast pulse output and descent
Aortic insufficiency Left ventricular hypertrophy
Hyperkinetic and laterally sliding Narrow deep Q waves
peak pulse in diastolic decay, its Left ventricular and aortic
length is proportional to the dilatation
stricture

Systolic current murmur, S3

favorites

Large milk atrium; double

S1 strong Opening sound
(S2-opening sound range
inversely proportional to degree
of stenosis)
If the cover is calcified, S1 is not
strong and there is no opening
Mitral stenosis
tone
density, esophagus in the
posterior direction makes the
body, left main bronchus rises
Left atrial pathology Atrial
fibrillation is common The left border of the heart
Pulmonary arterial flattens as a result of the growth
of the left atrial appendix Small
right ventricular hypertrophy or normal left ventricle
when hypertension develops Pulmonary artery large

Symptoms of pulmonary arterial Pulmonary venous congestion

hypertension

Hyperdynamic left ventricular hit

Holosystolic murmur spreading in

the axilla (this murmur may be
Mitral regurgitation
atypia in prolapse and papillary
muscle dysfunction in acute MR)
Left atrium abnormality Left
Pulmonary venous congestion
ventricular hypertrophy Atrial
large left atrium and left ventricle
fibrillation

Usually normal Sometimes

One or more systolic clicks
Mitral valve prolapse High incidence of chest skeletal
anomalies; flat back syndrome,
pectus excisionus
inferior
Depending on the degree of valve
ST depression and T reversal failure and the presence of
of leads additional anomaly

In sinus rhythm, jugular venous

distension and a wave, markedly,
diastolic bearing and tricuspid
opening sound at the edge of the
left sternum Atrial fibrillation favorites
Tricuspid stenosis Large right atrium
Right atrium abnormality
Increased bearing with tricuspid
opening sound and inspiration

Jugular venous distension and

large (systolic) failure waves

Increased systolic murmur on the

left side of the sternum (increased Right atrial abnormality Right ventricular and right atrium
inspiration) Findings related to the cause findings due to wide tricuspid
Tricuspid insufficiency of tricuspid regurgitation regurgitation
diastolic flow bearing
 Right ventricle S3 (increased by
breathing)

Hepatomegaly with systolic

pulses

02t205

FORMAT_PLACEHOLDER_18

SOME IMPORTANT IN GENERAL SURGERY INFORMATION

• The septic shock is different from the hyperdynamic period: the flow is increased; due to vasodilatation, peripheral resistance
decreased; It has dry, warm, hyperemic skin appearance; arteriovenous oxygen difference It decreased.

• Treatment of all types of hypovolemia is done primarily by providing a balanced electrolyte solution , the best, the simplest
way to determine the effectiveness of fluid therapy The amount is.

• The best prognosis of breast cancer is tubular cancer, then papillary cancer, then mucinous cancer; prognosis is the worst
breast cancer infiltrative ductal cancer.The most important factor that determines the prognosis is lymph node It is metastasis.

• Thyroid nodules the evaluation most good method thin needle aspiration a biopsy.

• The most common thyroid cancer with the best prognosis is papillary cancer, most very far organ as lung metastasis
The most important factor that determines the prognosis is distant metastasis and prognosis of lymph node metastasis. It is not.

• The most common cause of upper GIS bleeding is peptic ulcer, the most common location of the duodenum on the posterior
wall, and the clinical manifestation is hematemesis .The most common cause of lower GIS bleeding is Meckel in the child , colon
diverticula in the adult , and hematoxia is the clinical sign .Column diverticula most frequently complication of diverticulitis and
It is bleeding. diverticulitis left on the side acute appendicitis, colonoscopy and colon radiography are contraindicated placed.

• While hyperplastic, inflammatory and hamartomatous polyps do not get cancerous, adenomatous polyps can become
cancerous.Cancerous polyps with villous adenoma most at risk, at least the tubular adenoma.

• Acute bellied in patients first will be asked visualization method direct abdominal X-ray is.

• The first and most important manifestation of all types of ischemia is pain, severe abdominal pain incompatible with physical
examination findings , acute mesenteric ischemia, abdominal pain after meals , chronic mesenteric ischaemia (intestinal angina)
should think. Definitive diagnostic method except for colon ischemia It is angiography.

• If the jaundice is not handled as a hydropic gallbladder, the stone should be considered as head (PANKREAS).The first
imaging method in jaundice is ultrasonography. The first method of suspected pancreatic cancer tomography.

• The most common complication of gastroesophageal reflux is esophagitis and the most serious complication is Barret which
causes adenocancer in the lower and middle segments. the esophagus.

• stomach most stylish seen benign tumors polyps and I'm leyomyo.

Hyperplastic polyps are most common in polyps.

• The three factors that determine the risk of a cancer are the structure, size and number.Villous adenomas, polyps larger than 2
cm in the large number of polyps and cancer risk increases.

• Polyps and cancers of the colorectum in gastrointestinal interventions where they occur most frequently, is of the colorectum
my rectosigmoidal.The most rare site of cancer in GIS is thin are the intestines.
• The most common site of cancer in the small intestine duodenum, duodenumda if light bulbs vateri is. Ampulle vateri
cancer opening and closing (periodic fluctuation), jaundice characterized.

• Crohn's disease most very thin intestines especially also terminal

• colorectal carcinomas most stylish metastasis his organ The liver is the liver and this metastasis occurs through the
portal venous hematogenous route .The most important factor that determines lymph node metastasis in colorectal cancers is the
depth of invasion in the wall. However, the most important prognostic factor is lymph node It is metastasis.

• Staging tomography in the esophagus , stomach and rectum cancers and endosonography with makes. T and N. to
determine the best method is endosography, but distant metastasis It does not show.

• Rectum of cancer column from cancer most important difference local recurrence is more.Radiotherapy is used to
prevent this. One also distally rectum in cancer mesenteric metastasis to inguinal lymph nodes except metastasis visible.

• Left lower the dial with appendicitis similar clinic Results especially elderly patients diverticulitis should think.
diverticulitis tomography, colon radiography and colonoscopy should not be performed . diverticulum diagnosis if column
graphy and with colonoscopy placed.

• Column diverticula most stylish seen complications diverticulitis and It is bleeding. the diverticulitis most stylish
seen complications is apses. diverticulitis connected most stylish seen fistula sigmoidovesical fistula.The most common
cause of sigmoidovesical fistulae It is diverticulitis.

• Most prevalent gastrointestinal interventions diverticula in the sigmoid place, in the small intestine I'm duodenum.

The most common true diverticulum is Meckel.

• Meckel the diverticulum most stylish seen complications obstruction in adults, children It is bleeding. Meckel
diverticulum in most often seen tumor carcinoid, Meckel the diverticulum inguinal hernia It is a hernia.

• Apendiksin most stylish seen tumor It is karsinoid't. in the appendix carcinoid It should be considered.

• Acute the appendicitis first symptoms anorexia, most important substituted symptoms of pain, the most important
finding in the lower right quadrant tenderness, acute mesenteric adenitis most implicated in disease.

• Jaundice and hidropic bile sac one in patients Firstly pancreatic head cancer and primarily tomography It should be
done.

• Eat post- abdomen pain and weight loss, most stylish chronic mesenteric ischemia due to atherosclerosis It is
getirmel.

• Physics examination findings with incompatible, severe abdomen pain acute mesenteric ischemia.The definitive
diagnosis method of acute mesenteric ischemia, angiography, first diagnosis method tomography.

• Acidosis causes an increase in serum K + and Ca ++ levels, the most common cause of hyperkalemia in surgery It is
acidosis.

• Systemic Inflammatory Response Syndrome (SIRS): Two or more of the following conditions has

• Fire> 38 0 C or <36 0 C

• Heart rate> 90 / min

• Respiration rate> 20 / min or PaCO 2 <32mmhg

• White sphere> 12000 / mm 3 or <4000 / mm 3 or>% 10

band form

• mental status change and hyperventilation sepsis first clinical manifestations

ARDS diagnostic criteria:

• Acute start
• predisposing status

• PaO: FIO ratio <200

ileum amount.Crohn's also the most dependent cancers very terminal 22

develop from ileum. Crohn's Disease is a segmentary disease characterized by stenosis (ip sign), which together with all the wall
layers also includes the mesentery, forms a cobblestone view.

• carcinoid tumor most very appendix, ileum and rectum; most rare esophagus and the pancreas located. Most
good prognosis carcinoids in the appendix, the worst prognosis ones in the column.

• Carcinoid syndrome, which is seen in 5-10% of carcinoid tumors , with common liver metastases, except for ovarian and
retroperitoneal carcinoids. related.

• The most common tumor of the liver is metastatic tumors.Among the metastatic liver tumors, the most common beneficiaries
of surgical treatment are colorectum and neuroendocrine tumor metastases.

Bilateral infiltrations

• Pulmonary artery occlusion pressure <18 mmHg

• The clinical finding of right heart failure the lack

• During trauma or stress, elevated blood levels and of tissue release Reason with, IL-6 systemic as an indicator of
inflammatory response usable

In blunt abdominal trauma, the most common is the spleen and the penetrating small intestine.

Findings suggesting necrotizing soft tissue infection and mandatory surgery

• With cellulite ecchymosis

• Find

• dermal gangrene

• Intensive edema

• crepitations

Breast cancer TNM staging phase IIIC: Tx N3 B.C, N3: Infraclavicular LN metastasis of the same side or IMLN
metastasis and axillary metastasis or

The same side supracalvikular LN metastasis

lobular carcinoma of situ (LKIS) treat two option: close observation or bilateral total mastectomy makes.

• Thyroid nodules the evaluation and operation The most important test for decision making is thyroid fine needle
aspiration biopsy

Hurthle cellular thyroid cancer Follicular from carcinomas with are separated:

• More often multifocal and It is bilateral

• Metastasis to lymph nodes more frequently (25%)

• Radioactive iodine usually repellents

In the follow-up of papillary and follicular cell thyroid cancers , thyroglobulin and CEA in medullary type thyroid cancer and
calcitonin is used.

• The first thing to be done in the trauma patient is to keep the airway open.

• Crohn's disease has a full-thickness bowel and meso involvement .In ulcerative colitis only mucosa and submucosa are
involved .

• Bloomer Shelf, Sister Joseph nodule, Virchow nodule, Irish Node inoperability for gastric cancer one of the criteria.

• Descending trauma hormones

• Insulin (Trauma most decreasing) hormone)

• Total T 3 , total T 4

• TSH

• FSH

• LH

• Testosterone, estrogen

• Like Growh Factor (IGF)

The metabolic first response after trauma is gluconeogenesis. Lipids are used as the main energy source in trauma.

Lymphocytes, fibroblasts and GI the system The most important energy source in trauma glutamine.

• The most common cause of spinal shock is spinal and trauma.

• The most important intracellular buffer system are proteins.Hemoglobin function in intracellular buffer in erythrocytes It
makes.

• Thrombocytopenia gram (-) sepsis, features in children and early burn patients It is an indicator.

• CT is the best method for evaluating spleen injuries.

• Papillary Least Breast Cancer And carcinomas.

• In particular, aromatase inhibitors are used as hormonal therapy in breast cancer resistant to tamoxifen. These;

• anastrozole

• letrazole

• formestane

• Worst prognosis with breast cancer inflammatory carcinoma.

• Radiation: Properties of papillary cancer risk It increases.

Iodine deficiency: the risk of follicular and anaplastic cancer İy

• thyroid most much augmentative disease toxic multinodular and goiter.

• ulcerative colitis most stylish surgical Indication: medical resistance to treatment

The most common surgical indication for Crohn's disease is:

obstruction
• CT is the first to be diagnosed in the diagnosis of colloidal fistula, with definitive diagnosis cystoscopy Threads.

• Transrectal USG is an effective method for demonstrating wall invasion and lymph nodes of rectal cancers. method.

• The periampullary tumor with the worst prognosis is pancreatic head cancer.

The best prognosis is periampullary tumor tumor.

• The most common cause of splenic vein thrombus and pancreatitis.

Splenectomy is performed in the treatment.

• Serous cystadenoma is the most common benign tumor of the exocrine pancreas.

The possibility of malignancy of mucinous cystadenoma is higher than others.

• Acute the cholecystitis most stylish Reason ductus you sistiku It is clogged.Duktus sistukus most (95%) stone clog.

• The most useful method for demonstrating mesenteric venous thrombus is contrast computed tomography. arteriography
diagnosis for It is not necessary.

• SEPTIC SHOCK

• Most stylish active Gr (-) bacilli are and most stylish source genitourinary infections.(Most common factor
E.coli)

• Candidina frequently in TPN areas It is found

• The most common agent after toxic shock syndrome is S.aureustur

• Burn infection secondary sepsis most stylish cause pseudomonas.

• Bowel perforations to secondary sepsis most stylish The reason is B.fragil.

• The most common cause of sepsis in patients with splenectomy are pneumococci.

• Immunocompromised patients with pseudomonas are the most common cause of sepsis.

• 2 period has:

• Hyperdynamic period: Cardiac output high, blood pressure low, peripheral vascular resistance reduction, increased
capillary permeability, increased skin temperature.Oliguria develops. Arteriovenous O2 difference decreases

• Hypodynamic period: The skin temperature decreases.Patients are cold and flicker.Blood pressure and splanknic perfusion are
necessary to ensure Because of vasoconstriction , the body temperature cannot be lowered and rises rapidly.microvascular
endothelial the damage would vCE hypovolemia observed.

• Pulmonary embolism is the most important complication of DVT .Symptoms are dyspnea, cough and bronchospasm.The
diagnosis is weighted by the presence of a filling defect in pulmonary nuclear perfusion scintigraphy .Definitive diagnosis with
pulmonary artery angiography considered.
• Intestinal obstruction

• Cardinal Symptoms

• Colic abdomen pain

• Nausea, vomiting

• Gas gay inability interests

• ADBG diagnoses more than 60% of patients.IT useful can.

• Enteroclysis partial thin bowel in obstruction definitive diagnosis method.

Ultrasonography can help in pregnant women.

Tachycardia, Fever, Leukocytosis, Continuous abdominal pain suggesting strangulation.

• COLUMN the dIVERTICULA

• The most common is in the sigmoid colon .Diverticula of this part usually cause obstruction happen.

• Diverticulum-induced hemorrhage accounts for 30 bağlı50% of lower GIS bleeding creates

• Diverticulitis usually involves local inflammation or microabscesses to

• The most common colorectal carcinoma sigmoid origin ones obstruction It makes.
• The first and most common symptom of rectal cancer is hemorrhage; It is seen.

• column adenamotöz polyps most stylish rectosigmoidal settles in the region.

• Examination of the rectal button It is important

• Appetite view in barium visible

• In terms of CEA relapse it is useful

• Operative cholangiography indications

• Repetitive jaundice story

• Stool color opening

• pancreatitis attacks

• Serum bilirubin, LDH and alkaline phosphatase increase

• The diameter of the common bile duct is greater than 10 mm. being

• Multiple small stones

• The cystic canal is 4-5 mm. wide being

• NOT FOR BILIARY PANCREATITIS the RANSON

is related to the formation; 70% of patients have left lower quadrant pain

• Intraperitoneal free air in perforation visible

• CT is very common in the diagnosis of diverticulitis it is valuable

• If symptoms of diverticulum treatment are mild, antibiotics and fluid diet given

• In 20% of patients, medical treatment cannot be answered and surgery is indicated .Despite intensive medical treatment 24-
48

First Application

• 55 years old over

• White Sphere> 16000 / mm 3

• Glucose> 200 mg / dl

• LDH> 350 II / Lt

• SGOT> 250 II / dL

48 hours later

• More than 10% in hematocrit reduction

• More than 5 mg / dl in BUN increase

• Calcium (Ca) <8 mg / dl

• PaO 2 <60 mmHg

• Base deficit> 4 mEq / Lt

• Calculated fluid deficit> 6000 ml

If there is no improvement in hours, urgent surgical treatment is required.

• Diverticulum complications include bleeding, perforation, obstruction and fistula formation.Most often colovesical

• BILIARY (GALL DUE TO STONE) pancreatitis FOR

RANSON CRITERIA

fistula It is diverticulitis.

• COLUMN CANCERS

First Application

• 70 years old over

48 hours later

• More than 10% in hematocrit reduction

• the gis most stylish a tumor, most stylish adenocarcinoma It is seen.

• White sphere> 18000 / mm 3 • More than 2 mg / dl in BUN increase

• Adenocarcinomas develop most frequently from the adenomatous polyp floor.

• K and E in 3. it is ranked

• 5.Day Fuck

• Glucose> 220 mg / dl

• LDH> 400 II / Lt

• SGOT> 250 II / dL

• Calcium (Ca) <8 mg / dl

• PaO2 <60 mmHg

• Base deficit> 5 mEq / Lt

• Calculated fluid gap> 4000 ml

• Closely related to diet (fat, western type diet)

• Most rectosigmoid It is of

• Most often perforated from the cecum would

• Nodular type on the left, ulcerated type on the right Fuck

• Most commonly sent spread

• The most common hematogen spread

• Change in the habit of defecation in the clinic would

• Left column tumors obstruction, right column tumors while with anem i revenue

• The most common cause of acute pancreatitis is bile stones are.

Post-op pancreatitis most stylish bile way operations to develop secondary.

Lipase is more reliable than amylase in diagnosis.

Direct radiograph supports the diagnosis of 'colon cut-off sign' and 'soap bubble appearance'.

The most common cause of mortality and morbidity is sepsis.

Acute pancreatitis most stylish complications pseudocyts The formation is 2-3. week with fever, pain and persistent amylase
elevation , cyst rupture is the most common cyst death is a plus.

Acute pancreatitis most important complications if pancreatic and peripancreatic tissue necrosis

Use of morphine for pain in the treatment of acute pancreatitis is contraindicated

• Drotrekogin: Activated protein is a derivative of C.It is a new drug that is used in severe sepsis .Treatment of sepsis-related
coagulopathy used.

• Preventing Spontaneous Closure of the Fistula factors

• Proximal fistulas

• High flow rate fistulas

• Fistula distal the obstruction

• If there is a foreign body in the fistula tract

• The fistula trachus has been epithelized if

• Non-drained abscess associated with fistula If

• Active granulomatous intestinal disease, cancer or radiation caused by enteritis fistulas

• Fistula trachus less than 2.5 cm if

• More than 50% of the fistulated bowel has participated

• Total parenteral Nutritional Absolute indications

• In malnourished people, oral intake is inadequate and enteral nutrition is tolerated can not be

• Short bowel syndrome

• Acute pancreatitis

• Intestinal fistulas with high output (eg Pancreas Fistula )

• Septic and burnt patients

• According to the latest information, collagen synthesis in wound healing begins at 10 hours.5-7. On days it makes the
collagen synthesis peak. Then gradually It decreases.

• Some interleukins

• The strongest stimulant in the proinflammatory stockins, the earliest secreted and the host response TNF D1.

• IL-1 is important in fever formation.Anorexia It makes.

• IL-4 and IFN , antagonize the effects of each other above the beta cells.(IL-4 ß causes cell proliferation .)

• IL-6 is used as an indicator of systemic inflammatory response . also acute Phase of protein is responsible for
synthesizing .

• IL-8 multiple organ failure the risk display as It is accepted.

• IL-12 cellular immunity the regulation important There are roles.

• IL-13 plays an important role in asthma pathogenesis play.

• INF IN acute lung inflammation can induce.

• Liver of transplantation Contraindications Final contraindications

• Portal vein thrombosis

• Hypoxia (PO 2 < 50mmhg)

• Non-liver malignancy

• Active alcoholism

• Advanced cardiovascular disease

• End stage kidney disease

relative contraindications

• > 50 years old

• hepatitis B positivity

• AIDS

• Hepatobiliary sepsis

• Alcoholism

• Fibroadenoma is a benign breast containing both stromal and epithelial elements the tumors.

• Beyne and overa most stylish metastasis who breast cancer lobular carcinoma. bone affinity most much one
breast CA lobularIn addition, the most common bone metastasis It makes.

• Gynecomastia does not increase the risk of breast cancer. increases.

• Zuska disease; Periareolar abscess and squamous in irregular ducts metaplasia is.
• The most common tumor of the stomach are malignant tumors ( not benign M ), it in 95% adenocarcinoma . Most
stylish symptoms of nausea, vomiting and proximal line in ezyon dysphagia is

121

• Stored Blood Amendments

• ATP and 2,3 diphosphoglycerate (2,3DPG) decreases

• The O 2 affinity of hemoglobin increases

• O 2 carrying capacity decreases

• Osmotic fragility increases

• Platelets after 24 hours disappears

• Hemolysis would

• Potassium, Phosphate and Ammonia rises

• Lactic acid accumulate

• pH decreases

• Factors II, VII, IX, (XI) stable has

• Hepatorenal syndrome is the most mortal complication of liver cirrhosis.

• Abnormal Mammography findings

• microcalcifications

• Density lesions (mass, structural distortion, and asymmetry)

• Calcifications and density abnormalities

Findings in favor of cancer in mammography Primer Results:

• Interspersed spots in the form of calcium foci (≥ 5)

• Spicular, calcified calcification the masses

Secondary Findings:

• Structural distortions

• ductal dilations

• Asymmetry

• fibronoduler dansities

95: Proliferative and Nonproliterative Lesions Increasing Breast Cancer Risk

Disease Cancer Risk

Non-proliferative breast diseases (Cysts and apocrine metaplasia, ductal ectasia, calcifications, fibroadenoma and
related lesions
No risk

Sclerosing adenosis No risk

Intraductal papilloma No risk

1.5-2 times
Fluoride hyperplasia
risk

Atypical lobular hyperplasia 4 times risk

Atypical ductal hyperplasia 4 times risk

Ductal involvement by atypical ductal hyperplasia cells 7 times risk

Lobular carcinoma in situ 10 times risk

Ductal carcinoma in situ 10 times risk

FORMAT_PLACEHOLDER_19

96.

LCIS DCIS

Age 44-47 54-58

incidence 2-5% 5-10%

Clinical findings No Mass, pain, nipple discharge

Mammographic findings Neighboring microcalcificationsmicrocalcifications

multicentricity 60-90% 40-80%

bilaterality 50-70% 10-20%

Axillary met. % one 1-2%

Subsequently, Ca. formation

incidence % 20-35 30-50%

laterality Bilateral ipsilateral

Intervale 15-20 years 5-10 years

Histology ductal ductal

FORMAT_PLACEHOLDER_20

93: Classification of benign breast diseases

Non-Proliferative Benign Diseases of the Breast

• Cysts and apocrine metaplasia

• ductal ectasia

• calcifications

• Fibroadenoma and related lesions

Proliferative Benign Diseases of the Breast

• sclerosing adenosis

• Radial and complex sclerosing lesions

• Ductal epithelial hyperplasia

• intraductal papilloma

Atypical Proliferative Lesions

• Atypical lobular hyperplasia (ALH)

• Atypical ductal hyperplasia (ADH)

94: Clinical features of breast benign lesions

Histopathological Diagnosis Age Palpable MassMammographic Findings

Fibrocystic Hst. 35-50 Could Could

Incidence with age

Atypical Ductal Hyperplasia incidental Rare

Incidence with age

Atypical lobular incidental Rare

Sclerosing Adenosine 25-50 Could Benign calcification

fibroadenoma 20-30 There is Could

Complex Sclerosing Adenosine Visible at all ages Often there are many
Rare

FORMAT_PLACEHOLDER_21

97: Breast cancer inoperability criteria by Columbia classification

1- Edema holding the breast skin more than 1/3

2- Elastic skin nodules

3- Inflammatory type breast cancer

4. Proven supraclavicular lymph node metastasis

5- Parasternal tumor nodules

6- Sleeve edema

7- Remote metastases

8- Have at least 2 or more bad findings of local spread

• Skin ulceration

• Holds less than 1/3 of the breast skin edema

• The chest wall of the tumor is solid fixation

• The presence of lymph nodes with a diameter of 2.5 cm in the axilla

• Axillary lymph nodes to the skin or deep fixation to structures

 SOME IMPORTANT INFORMATION 123

• Cefazolin : 1st generation cephalosporin; Clean gastrointestinal, biliary tract, head and neck surgeries used.

• In many operations aminoglycoside + amoxicillin or

1st generation cephalosporin is the ideal combination. Prophylactic antibiotics are performed 30-60 minutes before surgery.

• 2. a dose if the operation lasts more than 4 hours or more than twice the half-life of the antibiotic. makes.

• Antibiotic prophylaxis does not last longer than 24 hours .

ANTIBIOTIC PROFILACSI INDICATIONS

• High risk gastroduodenal surgeries (gastric cancer, ulcers, obstruction, bleeding surgeries ...)

• High-risk bile duct surgeries (> 60, acute inflammation, choledocholithiasis, obstructive jaundice, etc.)

• Colon or small bowel resection and anastomoses

• Cardiac interventions from median sternotomy incision

• Vascular operations of the lower extremities or abdominal aorta surgery

• An impaired limb amputation

• Vaginal or abdominal hysterectomy

• Primary cesarean

• Injury to the oral cavity and continued with dissection of the neck surgery

• craniotomy

• Any permanent prosthesis placed surgery

• Any bacterial contamination wound

• Severe contamination and tissue damage (iv antibiotic immediately should be initiated)

• Injuries to Clostridia infections (common muscle damage, excessive contamination, ...)

• Prevent bacterial endocarditis in previously existing valve diseases for...

• Sudden sensitization caused by inhalation during deep palpation of the right subcostal region , pale buying the cutting
the way opens. This It's called a Murphy sign.Positive in acute cholecystitis expected.

Rousing sign: Acute appendicitis. Pain in the right lower quadrant when pressure is applied to the left lower quadrant.

Courvasier terrier sign: Pancreatic head is seen in adenocarcinoma.25% of patients present with painless palpable gallbladder and
obstructive jaundice. malignant the obstruction suggesting that this findings Sign of Courvasier terrier It called.

Gray turner sign: Acute pancreatitis. The place is bluish color changes to given is the name and hemorrhagic pancreatitis
the findings.

Cullen 's sign: Acute pancreatitis .Around the belly bluish color changes to given hemorrhagic pancreatitis the findings.

• Dumping syndrome is a complication of Billroth II surgery .Dumping syndrome shortly after meals after developing
palpitation, sweating, diarrhea and percent with flushing characterized.

Afferent ans syndrome is also a complication of Billroth II operation.Postprandial epigastric fullness is available; Relaxed with
vomiting. Vomiting is bile, but not digested foods. Because they're already in the efferent arm.

Efferent ans syndrome may develop as a complication of Billroth II.Postprandial epigastric is characterized by fullness and pain.
Relaxed with vomiting. The vomiting material contains bile and food.

the gastroparesis stomach emptying problem It is absent; most commonly associated with autonomic neuropathy (diabetes
mellitus) as)

Zollinger-Ellison syndrome (ZES) gastrin-producing malignant islet develops due to cell tumor.

• Tumor markers of medullary trioid carcinoma: Calcitonin, carcinoembryonic antigen, histaminase, dopamine
decarboxylase, neuron specific enolase, chromogranin, calcitonin precursors (PDN-21 and CGRP).

• Increases and decreases the risk of breast cancer factors

Those who increase risk

• Family story

• Diet

• Familial polyposis

• gastric adenomas

• Hereditary nonpolyposis colorectal cancers

• Helicobacter pylori infection

• Atrophic gastritis, intestinal metaplasia, dysplasia

• Past gastrectomy or gastrojejunostomy (> 10 years ago )

• Smoking

• Menetrieris disease

risk reduce
• Aspirin

• Diet (lots of fresh fruits and vegetables reception)

• Vitamin C

• THYROID TUMORS

Most of the solitary (single) nodules in the thyroid are adenoma , nodular hyperplasia, simple cyst or thyroiditis diagnosis
gets. carcinoma this only 1% of cases creates.

adenoma

It is the most common tumor of the thyroid .The most common follicular adenoma is seen. Follicle epithelium developing good
natured tumors. Usually it is unique.Solitary, spherical, encapsulated appearance with sharp boundaries from the thyroid are
separated.

Because of the section overflow, environmental thyroid pressures, adenomas rarely can show hyperfunction. They usually attract
attention by creating mass. Most are in the form of cold nodules. 10% of the cold nodules are malignant. The differential diagnosis
between follicular adenoma and carcinoma cannot be done with FNAB. The definitive diagnosis is made by histopathological
examination. Malignant transformation is not seen in adenomas.

carcinomas

• Papillary carcinoma 75 to 80% of.

• Follicular carcinoma (10-20%)

• Medullary carcinoma (%) 5)

• Anaplastic carcinoma (<5%)

Risk factors:

• Particularly exposed to ionizing radiation in the first two decades (papillary carcinoma)

• Hashimoto's disease (lymphoma, carcinoma)

• Nodular goitre (follicular carcinoma)

• PTC oncogene mutation (papillary carcinoma)

• RET oncogen mutation (meduller carcinoma)

Radiation is the only known factor to increase the risk in well-differentiated tumors.

Papillary carcinoma

The most common thyroid cancer. Can be seen at any age, ionizing radiation exposed stay with related. Children in most
stylish seen thyroid carcinoma. thyroid cancers in women more Fuck. But males are more malignant watch.

Nuclear changes are important for diagnosis .Nüve chromatin is finely dispersed , hypochromatic , clear-frosted pine It is in
view.cytoplasm invaginations intranuclear inclusions creates.Although the papillary structure is found in most of the tumors,
some tumors can be completely composed of follicles (follicular variant ..Intense in papillary carcinoma fibrovascular roof has.
the Psammo bodies visible.Lymphatic invasion may occur, and blood vessel invasion is rare. Half of the cases have cervical
lymph node metastasis. Isolated cervical the nodal metastases prognosis It does not affect. Generally prognosis is good Next
age, thyroid capsule overcome environment tissues invasion, remote metastasis, tumor the diameter big being and
male poor prognosis They are symptoms.

Follicular carcinoma
It is seen in the second frequency. In later ages; peak It makes.iodine failure one areas Fuck. Women more Fuck. A lot
hormone expression that for hyperthyroidism clinic visible.Thyroglobulin as a tumor marker available.

Microscopically, uniform cells make small follicles Fully Hurtle from cell it occurs Hurtle cellular carcinoma It called.
.Limited lesions adenoma be separated for capsular and / or determination of vascular invasion must.

Blood way with lungs, bone and liver they spread . Local lymph node metastasis It is rare. But most very hormone
synthesizingSurgical excision makes.

Meduller Carcinoma

parafollicular C from cell developing neuroendocrine tumor.They produce calcitonin. They can produce polypeptide
hormones such as CEA, somatostatin, serotonin, VIP. 80% of the cases are sporadic and the rest are associated with non-MEN IIa,
IIb and non-MEN family syndromes.in these DENIAL protooncogene mutation It has been identified. It is common in adults
(5-6 In decades). Men II with related Those young people and can be seen in children , multicentric can.

Amyloid deposition may occur in most cases. It is a procalcitonin structure. C-cell hyperplasia can be found in environmental
thyroid tissue in familial cases.

immunohistochemistry with calcitonin positive . also all As in neuroendocrine tumors, polypeptide hormones, chromogran
A, neuron-specific enolase (NSE., synaptophysin can be shown as neuroendocrine markers .Electron-dense granules surrounded by
EMP and cytoplasmic membrane are determined. With silvery dyes, tumor cells have argirophilic properties. With Diarrhea You
can watch.

Follow the calcitonin can be used as a marker.

Men II b with related Those hematogen spread indicative aggressive tumors (5 yearly survival 50%). Men with
related who can not familial cancers slower proceeds.

Anaplastic carcinoma

Worst prognosis

125
109. trauma Growing Hormones:

• Epinephrine, Norepinephrine,

• Beta endorphin

• GH, Dopamine, prolactin

• Glucagon, Renin, Somatostatin, Angiotensin II, ADH, Histamine, ACTH, Quinins, Cortisol, Serotonin, Aldosterone,
Interleukin-1, TNF, oxytocin

Reduced Hormones in Trauma:

• insulin

• T3, T4, TSH

• LH, Testosterone, Estrogen, FSH

• Insulin-like growth hormone.

110: LABORATORY FINDINGS IN SOME THYROID DISEASES

Free T4 (13-Free Total T3 (1,2-3,1

TSH (0.3-3.5) Total T4 (60-160) 30 pmol mmol

Disease mU / L) mmol / L) / L) / L)

Primary Thyrotoxicosis

(<0.05
 mU / L)

Primary Hypothyroidism (> 10 mU / L) / Bloomington-Normal / -N N/

Secondary hypothyroidism -No / Bloomington-Normal / -N N/

T3 (<0.05
Normal Normal
- Toxicosis mU / L)

(5-10 mU
Subclinical hypothyroidism Normal Normal Normal
/ L)

Ötroid Sick Syndrome Normal / X/ Normal /X

FORMAT_PLACEHOLDER_22

111.The important features of thyroid nodules for malignancy are:

• Cold solitary nodules: Malignancy risk of cold nodules % 15-20 while this rate hot the nodules % 5 to

It is small. The possibility of malignancy in multimodular goiter is very low compared to solitary nodules. (5%

15-20%)

• Low dose radiation treatment

• Family history of familial thyroid cancer being

• Hard, adherent and fixed nodules on physical examination

• Sudden growth in the history of the nodules that cause voice changes Wealth

• The patient did not have hyperthyroidism; About 1% of the risk of malignancy in patients with hyperthyroids 'dr.

• Cystic nodule with solid or solid component of nodule: Cystic nodules with less malignancy It is risky.

• Age: Thyroid cancers with about used prognostic factor classification, women aged 50 years and men over 40 years
of age in favor of poor prognosis.In childhood, the earlier the age of the onset of the nodule, the greater the likelihood of
malignancy increasing.

112: TETANOZ PROFILACTICIS

Vaccination story (dose) Possibility of High TetanusPossibility of Low Tetanus

OR NEEDLE OR NEEDLE

Unknown, suspicious Yeah Yeah Yeah No

0 to 1 dose 2 doses Yeah No* Yeah No

≥3 doses No** No No*** No

* Yes more than 24 hours after injury

** Yes if more than 5 years have passed since the last dose

*** Yes if more than 10 years have passed since the last dose.

FORMAT_PLACEHOLDER_23

113: SPLENECTOMY INDICATIONS

To check the main disease

• Hereditary spherocytosis • ITP

• autoimmune anemia • Thrombotic thrombocytopenic purpura

• Spleen ruptures • Primary cysts and tumors

• Chronic and severe hypersplenism for

• Hairy cell leukemia

• Lymphoproliferative diseases (non-Hodgkin, CLL, CML)

• Felty syndrome

• Agnogenic myeloid metaplasia

• Thalassemia

• Sarcoidosis

• Gaucher disease

• porphyria erythropoietic to

• Splenic vein thrombosis

• Sickle cell anemia

• AIDS

• Associated with drug use thrombocytopenia

• splenectomy complications
• Left lower lobe atelectasis.The most common complication.

• subphrenic hematoma

• subphrenic abscess

• pancreatitis

• Pancreatic fistula

• Thromboembolic events: especially in patients with myeloid metaplasia.Increased platelet count after splenectomy. related.

• postsplenectomy sepsis: First pneumococcal and

Caused by encapsulated bacteria, including H.influenza, sudden beginners and fast one progressing to fatale resulting
infections.All patients with splenectomy should be given prophylactic pneumococcal and H.influenza vaccine if possible. The best
time for vaccination is 10 days before elective splenectomy. Penicillin prophylaxis for all children up to 18 years old It should
take.

• Changes in blood table after splenectomy

• Characteristic erythrocytes observed

• Howell-Jolly bodies

• Heinz bodies

• Pappenheimer bodies

• acanthocytes on

• Thin inclusions erythrocytes

• granulocytosis

• thrombocytosis

• opsonin days decreases

• IgM decreases

• Author massive splenomegaly Causes

• Chronic myeloid leukemia

• Agnogenic Myeloid leukemia

• Hairy-Cell leukemia

• Gaucher disease

• Thalassemia major

• Malaria

• Lymphatic filariasis (Kala-azar)

• splenectomy contraindications

• Acute leukemia

• agranulocytosis

• Paroxysmal nocturnal hemoglobinuria

• Wiskott Aldrich syndrome

• Polisetimi to vera

• - The worst prognosis glioma I'm astrocytoma.

- Pileocytic astrocytoma tumors with the best prognosis in all brain tumors.

- Radiosensitive Tumors: Medullablastoma, ependymoma, germ cell tumors.

• I Menengioma Estrogen progesterone receptor contained for pregnancy contraindicated.

• Renal cell Ca usually single metastasis It makes.

• Medulloblastoma, most radiosensitive tumor.

• The most commonly injured organ in blunt abdominal trauma is spleen and liver.

The most frequently injured organ in penetrating traumas is liver and small intestine.

The most frequently injured organ in intense gun traumas are small intestines.

• 124:
INDICATIONS AND COMPLICATIONS OF TPN

ABSOLUTE INDICATIONS OF TOTAL PARENTERAL NUTRITION

• In malnourished people, oral intake is inadequate and enteral nutrition is tolerated can not be

• Short bowel syndrome

• Acute pancreatitis

• Intestinal fistulas with high output (eg Pancreas Fistula)

• Septic and burnt patients

COMPLICATIONS

• Technical complications (pneumo-hemotemponam, Air embolism etc.)

• Hyperosmolar nonketotic coma

• Hyperkloremic metabolic acidosis

• Sepsis and catheter infection

• hypoglycemia

• cholestasis

• Fatty liver

• Liquid electrolyte imbalance

• Hepatic enzymes rise

• Zn and Cu lack of

• hyperglycemia

• ATP and 2,3 DPG due to hypophosphatemia reduction

SOME FEATURES

• The most commonly used route in TPN is vena subclavian is.

• The most serious complication of TPN is catheter It is sepsis.

• The most common metabolic complications in TPN (hyperglycemia) observed.

• Fasting energy sources are KC glucogen, muscle glucogen, muscle proteins, fat tissue, respectively. oils.

• ID: 11İ007

• Blood sugar levels below 50 mg / dl in symptomatic cases falls

• IV. glucose given the following symptoms improvement occurs.

• C Peptide levels are high in circulation and this is the height of endogenous insulin shows.

• Fasting hypoglycemia may also occur in non-pancreatic tumors, but plasma insulin levels It is normal.

These include: Hemangiopericytoma, mesenchymal fibrosarcoma origin tumors, hepatoma and adrenocortical carcinoma.

• Insulin / glucose ratio> 0.3 diagnostics distinctive.

Proinsulin> 50% is considered malignant insulinoma.

• Treatment surgery excision.

Gastrinoma (Zollinger-Ellison Syndrome)

• Zollinger-Ellison Syndrome in 80% of patients by secreting Gastrin from G cells It makes.

• 60% are malignant and 30% are benign.More than half of the malignant cases were locally invasive and two-thirds
metastasized.

• Serious, resistant peptic ulcers, kidney stone and calcium height has.

• Diagnosis of fasting hypergastrinemia (> 200pg / ml).

Basal acid output increased.

• Multiple ulcers are located in unusual locations.Gastrinomas duodenum, peripancreatic tissue and the pancreas It can be
accommodated. patients 90-95% of the patients have ulcers.(Duodenal / gastric = 6/1).

• Extreme gastric acid the secretion pancreatic lipase diarrhea due to fat malabsorption.

• It is the most common pancreas tumor with MEN syndromes.

• Thyroid surgery complications

• Early complications
• Bleeding

• Air embolism

• postoperative air way obstruction (bleeding, laryngospasm, laryngeal edema etc)

• Recurrent laryngeal nerve damage (unilateral damage to the voice is reduced, respiratory distress in bilateral damage it
happens)

• Superior laryngeal nerve damage (low treble it happens)

• hypoparathyroidism

• seroma

• tracheal injury

• esophageal perforation

• Shingles

• Nervous injury of neck or accessory during)

• Thyroid crisis

• Pneumothorax (substernal goiter in operation)

• Wound infection (which is rare)

• Late Complications:

• hypothyroidism

• recurrence

The first symptom of postoperative bleeding, hematoma as a result of respiratory tracheal compression shortage .

sUBTOTAL thyroidectomy will spend hyperthyroid patients high risk of hypoparathyroidism carry.

• ADACIC CELL (ISLET CELL) neoplasms

insulinomas

• Beta from cell origin area and most stylish seen islet cell It is a neoplasm.

• 80% is benign ( solitary adenoma ), 10% multiple and 10% malignant.

• They do hypoglycemia.Irritability, confusion and sometimes stupor It may occur.

• Classic Whipple triad It includes:

1- Hypoglycemic occurrence in fasting symptoms

vIPoma

• Verner-Morrison syndrome; WDHA syndrome (Watery Diare, Hypokalemia and Aklorhydri) or Pancreatic cholera It called.

• 80-90% of this syndrome is the secretory cell secreting the VIP of pancreas the tumors.

• Retroperitoneal sympathetic chain or extrapancreatic tumors in the adrenal medulla related.

• Severe diarrheal metabolic acidosis and hypokalemia develop. (pancreatic cholera)

• 50 - 60% of the tumors in the pancreas are malignant. Diagnosis with high plasma VIP concentration Threads.
• Local invasion or metastasis They did.

• VIPoma Syndrome: tumors with neural crest origin (ganglioneuroma, neuroblastoma, neurofibroma, pheochromocytoma N) +
VIPoma

glucagonomas

• Alpha 2 cells, and glucagon secreting islet cells the tumors.

• 75 - 80% are malignant (second most malignant pancreas islet tm).Usually 5 cm. It is great.

• Plasma glucagon and glucose levels It is high.

• Especially in the legs and perineum place changing characterized by necrolytic dermatitis, weight loss, stomatitis,
hypoaminoasidemia, anemia and mild DM syndrome.

• Venous thrombosis and pulmonary embolism tendency increases.

• The most common peri-postmenopausal women It is seen.

• The main treatment is surgery.Octreotide can be used in medical treatment.

Somatostatinomas to

• Somatostatin-producing islet cell tumor.D cells origin gets. Plasma somatostatin levels are high.

• 50% of the tumors are malignant.Two-thirds of the pancreas, the rest of the pancreas It is located.

• DM + malabsorption and diarrhea + dilatation of the gallbladder + cholelithiasis + hypochlorhydria.

Pancreatic carcinoid syndrome:

• Unlike localized carcinoid tumors in other places 95% It is malignant.

• The most malignant pancreatic islet cell tumors.

131: COLLECTION

cholangitis:

• Inflammation of the bile ducts and infection.

• Charcot is characterized by the triad (Fire, Jaundice, Biliary colic)

• In general, choledocholithiasis, benign biliary stricture, anastomotic stricture etc. is seen

• In general E.coli, Klepsiella, B.fragilis origin Kolanjiohepatit:

• Recurrent Biogenic it is cholangitis

• Bile stasis and bacterial inflammation It is important

• Recurrent jaundice, fever, pain would

Sclerosing cholangitis:

• Progressive inflammation and fibrosis in intra and extra hepatic biliary tract It is formed

• There are two types.The primary is the most common type and is usually Ü.colitle. It is together. Secondary with if bile
Move cholangitis, hepatic artery cytotoxic drug is seen in those given

ID: 11İ022

133: SHELF IN PORTAL HYPERTENSION

PROCEDURES

• Prophylactic shunts: Patients with varicose veins before bleeding makes.

• therapeutic shunts:

• No. selective porto shunts: All portal the blood of the system is poured into V.cava inferiora.

• End-to-side portocaval fant: Between V. porta-V.cava inferior. Liver failure risk It is high.

• Mesocaval shunt: V.mezenterica is made of shunt between the superior and the V. inferior inferior.Higher risk of liver failure
can

• Sideways pORTACAVAL whipped: liver In cases that need to be decompressed used

• Selective portosystemic shunts: lowers the pressure of gastroesophageal beds only .There is less risk of hepatic
encephalopathy .

• Proximal splenorenal whipped

• distal splenorenal whipped (Warren shunt): Acid risk of formation It is available.

ID: 11İ018

134: ACUTE CHOLESISTITIS

• K / E ratio 3-4 / 1
• 95% stone has

• The most common stones damage the mucosa and edema as a result of edema cysticusun It is clogged.

• Murphy sign (+) it is.

• fM, fire and tachycardia has. Right upper the dial sensitivity is (+).

• Leukocytosis is the most common finding)

• The first choice to be diagnosed is USG .It is important in diagnosis in scintigraphy.

• If serum amylase is elevated, it should be considered in pancreatitis.

• The most common complication and abscess

• Cholecystoenteric fistulae most very localization gallbladder and duodenum between

• 4-7% of cases are cholecystitis without stones.Trauma, burn and after operation is seen

• Acute emphysematous cholecystitis accounts for 1%.DM and male patients are more. C. perfiringens and E.coli, usually
They are active.

ID: 11İ019

• 132: LIVER
TUMORS

• - The
most common liver tumors are metastatic.The most common bronchogenic and colorectal cancers metastasize to the liver.

• Primary benign tumors:

• A-
Epithelial

• Hepatocellular structure Those

• hepatocellular adenoma

• Focal nodular hyperplasia

• nodular transformation

• cholangiocellular Those

• adenoma

• Biliary cystadenoma

• B-
Mesenchymal tumors

• Hemangiom's stylish

• lipoma

• leiomyoma

• Benign mesothelioma

• C-
Mixed Tumors

• Mesenchymal hamartoma
• Benign teratoma

• Primary malignant tumors A- epithelial

• hepatocellular carcinoma

• hepatoblastoma

• B-
Mesenchymal

• rhabdomyosarcoma

• I angiosarcoma

• Sarcoma

•
SOME FEATURES

• The most common benign primary tumor of KC hemangioma

• The most common malignant primary tumor of KC is hepatocellular carcinoma.

• Hepatoblastoma is the most common primary malignant liver in children the tumors.

• Adenomas are associated with the use of oral contraceptives.When oral contraceptives are discontinued, they may regress and
rupture frequently. Malignant change They can show.

• The most common cause of hepatocellular cancer is Chronic Hepatitis B infection and alcohol.

• hepatocellular cancer most stylish lungs and bone metastasize .

• ID: 11İ021

• Intraabdominal infections; as primary, secondary and tertiary peritonitis It is sorted.

• Primary peritonitis:

• The most common cause in children nephrosis .

• Secondary to acid due to nephrotic syndrome develops

• The most common cause of pneumococcus would

• The most common cause of primary hematogenous peritonitis is E. It is coli.

• Cirrhosis, CRF and nephrotic syndrome is seen

• Secondary peritonitis:

• Perforation in visceral organs has.

• The most common peptic ulcer perforation occurs

• Chemical peritonitis develops

• The most common cause of bacteria E.Coli and B.It has fragilis. B. fragilis colon perforations and most frequently detected in
intraabdominal abscesses and microorganisms.

• The worst prognosis and peritonitis

• Due to acute gangrenous cholecystitis peritonitis

• Reason C. It is perfringens.

• Its prognosis it is bad

130

Tertiary peritonitis:

• visceral perforation and secondary microbial from peritonitis then occurs.

* Low virulence and cause high resistant microorganisms

• Activated host defense mechanisms can begin to destroy the organ functions out of control.Tertiary peritonitis It called.

• There is no antibiotic benefit .Generally, surgical operation is required.

• We PEP ULCER

Esophagus is a disease which can be seen in the stomach, duodenum, jejunum and Meckel diverticulum. All of these are organs
adjacent to acid, pepsin-secreting cells.

In the pathophysiology of duodenal ulcer, hyperacidity and mucosal defense factors are more prominent in the pathophysiology of
gastric ulcer. In most patients with duodenal ulcer, the acid secretion is more than normal, whereas in gastric ulcers, it is normal or
less than normal.

• GASTRIC ULCER

According to localization, 4 types of gastric ulcers were identified:

Type I: It is most often localized in the proximal antrum and can be localized anywhere in the fundus, corpus and antrum (60%).

Type II: gastric ulcer due to duodenal ulcer Type III: Prepiloric and pyloric ulcers (<20%) Type IV: Cardiac ulcers (<10%)

Treatment

Recommended for today, starting treatment with H2 receptor blockers.If there is H.pylori, triple therapy is started. Control
radiological examination at 4-8 weeks of treatment or endoscopy It should be done. if ulcer completely uncured if treatment
continuation edilmeli and control studies 12 and 15. in weeks It must be repeated. This while until healing ulcer
Surgical treatment of patients It should be applied.

The indication for surgical treatment is made faster than duodenal ulcer. The reasons for this are cancer risk and gastric ulcer

more high complication speed owner, more virulent one This is the disease.

Type II and III ulcers should be treated as duodenal ulcers.Type I ulcers for if ulcers also will include the way distally
gastric resection

-Vagotomy or a non-vagotomy-effective treatment. As the secretion of acid in gastric ulcers is not a primary problem, the necessity
of vagotomy is controversial. There are advocates that anastomotic ulcer should be done to reduce the risk. Removal and
pathological examination of the entire ulcer excludes the possibility of malignancy. The preferred surgical method for proximal
gastric ulcers is total gastrectomy.

Medical treatment: Acid suppression and H. pylori eradication

Surgical treatment: Proximal gastric vagotomy (PGV) (High selective, superselective, parietal cell The vagotomy) ⇒
morbidity and mortality lowest, recurrence high

Selective vagotomy + drainage surgery Bilateral truncal vagotomy (BTV) + drainage surgery BTV + antrectomy ⇒ recurrence,
morbidity and mortality is the highest type of surgery.

139: VAGUS TYPES: A: TRUNKAL, B: SELECTIVE, C: PGV

138. CLASSIFICATION OF SURGICAL INJURIES ACCORDING TO THE INFECTION DEVELOPMENT RISK

Risk of
Class Definition Examples
infection

• Electrically sealed, non-drain wounds.

• Nontraumatic, non-infected, asphyxia,

I (Clean) respiratory, digestive, genito urinary, Herniorafi, thyroidectomy 1-2%
oropharyngeal trachea surgery

Oropharyngeal procedures, vaginal or

Non-contact minimized operations entered abdominal hysterectomy Electromagnetic
II (Clean-Contaminated)
in the respiratory, digestive, gutator, or bowel preparation or elective colon surgery
oropharyngeal tract - minimal impairment after use of intraluminal antimicrobial agent
3-4%
of the sterile operative technique.

• Large amount of endogenous

III (contamination) microflora operation

• Infected body gros field operation Resection of obstructive necrotic intestine 8%

• Traumatic wounds

• Advanced degree of sterile operative

technique corruption

• Known infection Wealth

• Devitalized tissue, foreign body,

traumatic with fecal contamination > 28-
IV (dirty) Surgical drainage of intraabdominal abscesses
wounds. 40%

• Perforated whiskey.

FORMAT_PLACEHOLDER_24

SOME IMPORTANT INFORMATION IN FEMALE BIRTH

• What is the most common cause of pseudopuberte precoxin in peripheral form ?

• Ovarian cysts or tumors

• The most common malignant ovarian tumor what?

• Serous cystadenocarcinoma

• The most common malignant ovarian tumor in pregnancy what?

• I dysgerminoma

• The most common distant metastasis in cervical cancer what?

• Liver

• in Human most much carbohydrate including glycoprotein What is the hormone?

- HCG

• The most common perinatal infection Which is?

- Cytomegalovirus infection

• Gynecological cancers and their specific body or findings cisim and tumors substances:

Some tumors of the ovary and the substances they produce are as follows:

• Dysgerminoma erm LDH

• struma ovarii Thyroxine

• Carcinoid tumor Kars serotonin

• Choriocarcinoma K hCG

• Granulosa cell tumor Gran inhibin

• Endodermal sinus tumor od Alpha the fetoprotein

• Sertoli-Leydig cell tumor Sert testosterone

• Trisomy 21 suggesting symptoms: Duodenal atresia, Double Bouble, Femur shortness, nukal edema

• Oral contraceptives in 2003 in the year to use incoming

Drospirenone

• Natural progesterone most very similar synthetic progestin

• antiandrogenic

• antimineralocorticoid

• preterm action threated so the 37th week prior to birth presence of fetal fibronectin in cervical mucus in the
determination of the action in the patient with pain It is diagnostic.

• Stage 3b of hydronephrosis clinical stage in cervical cancer It makes.

• Lungs involvement one GTN which figo It is a stage. Reply:

Stage 3b

13.The most common congenital cause in pregnancy + thrombophilia is factor 5 leiden mutation.

• The strongest uterotropin connectin 43 ' type.

• Ekstrakoryal most frequent structural abnormality of the placenta is the placenta.

• Hemokoryonik

• discoid

• The most common lesion infarcts

• Smallest subunit cotyledon

• Most stylish tumor chorioangioma to The polihidramniyozl to The relationship should be remembered.

• The first approach to ASC-H cytological diagnosis Colposcopy is.

• Levonorgesterelli IUD ectopic pregnancy It decreases.

• The most effective hormonal postcoital contraception method

LEVONORGESTEREL dir.

• HRT Indications:

• Vasomotor symptoms: first choice HRT

• Vaginal atrophy: first choice topical estrogen

• Osteoporosis: the first choice (calcium, vitamin D, calcitonin, didronate, alyncate, risotrenate), vitamin D alone osteoporosis
It increases. Flor bone intensity increases but fracture risk It increases.

• Second choice HRT.

• Tibolone 19 nortestestero alternative drug is a synthetic derivative of HRT drugs.Vasomotor symptoms and osteoporosis
good revenue. But just as HRT as breast There is a risk of cancer.Second in osteoporosis It is a drug.

• Phases of Parturization:

Phase 0: Silent and refractory myometrium during pregnancy

Phase 1: Activation (with mechanical and uterotropic stimulation)

Phase 2nd: endogenous uterotonin of effect with activated myometrium (active birth)

Phase 3: Postpartum involution

• Active Birth Action (Phase 2) Stages:

• Stage: The cervix dilatation and effacement sufficient to allow the severity and often uterus the kantraksiyon has.The
cervix lasts until it is fully dilated (10cm). First stage cervical efasman and dilatation It is a stage.

• Phase: the cervix 10 cm the dilatation (complete) fetus This is the period.

• Stage: from birth until the disposal of the fetus and placenta membrane period

• Inadequate colposcopy is an indication for conization.

• The hair follicles in the epididymis, vas deferens, seminal vesicle development (Wolfian elements), masculinization,
spermatogenesis, testosterone, external genitalia, urethra, prostate and androgen are sensitive to dihydrotestosterone.DHT sensitive
areas local as 5alpha reductase enzyme with T from DHT It is synthesized.

• The most common causes of primary amenorrhea: 1- Gonadal dysgenesis (30%)

• Mülleryen agenesis (20%)

• Testicular feminization (10%)

The most common cause of secondary amenorrhea is pregnancy.

• The most common causes of hyperandrogenism: a- Over-source (PCOS) 80%

• Adrenal origin 1-2%

• Perifer welded 15-30%

• The most common vaginitis in women and leucorrhea are bacterial vaginosis .

• Preeclampsia: Gestational proteinuric hypertension is described as .The presence of thrombocytopenia as a result of

microangiopathic hemolysis and platelet activation in endothelium in preeclampsia disease the table that heavy about first
findings One is.

• Systemic disease causing recurrent miscarriages SLE 29.Irregular bleeding and pubescence increase the why is that
one most stylish acquired

the cause of thrombophilia is SLE.

• medical abortion oriented used ideal medicine combination

mifepristone + misoprostol

• The most common cause of eosonadotropic primary amenorrhea is RKM (müllerian agenesis)
• Minimally seen tubal ectopic pregnancy cornual ectopic pregnancy

• Antineoplastic drug used in medical treatment in ectopic pregnancy methotrexate

• Oligoastenospermia after varicocele and kruger

If there are ovulation problems related to PCOS in 1% of the female , ICSI + ET ( intrastoplasmic sperm microinjection and
embriotransformation) recommended

• Metastatic Tumors of Ovarian GIS Krukenberg tumor 36.Made from an itchy white lesion in the vulva in biopsies lichen
sclerosis and atrophy incoming in cases first choice treatment potent steroid

cream

• Fibroids are the most common degeneration of hyaline degeneration.

• In which diseases is the absence of blind vagina and uterus ?

• Mullerian agenesis

• testicular feminization

• 5 alpha reductase lack of

• What are the ovarian tumors that may be the precursor to puberty ?

• Granulosa cell tumor

• Sertoli leydig cell tumor

• Embryonal carcinoma

• The most common source of null adenomas in the pituitary and its secretion what?

• Null adenomas are most common after prolactinoma (50%) adenoma (30%). Often gonadotrophin origin and FSH alpha
subunit they secrete.

• Fetus with trisomy parameters used in the first trimester screening for risk determination Which are?

• Fetal nuchal translucency measurement with transvaginal USG at first trimester (<3mm must)

• PAPP-A (lower than expected at trisomy 21 interest)

• Free hCG (trisomy 21 higher than expected interest)

• intrauterine symmetrical development the retardation which pathologies first should come?

• perinatal infections

• chromosome anomalies (Trisomy)

• constitutional deficiency

• The most common synchronous tumors in the pelvis Which are?

• Ovarian endometrioid Ca-endometrium adeno

• Over mucinous adenoCa - appendix adeno

• Which cervical cancer is the worst biological behavior ?

• Small cell adenocarcinoma (oat cell) carcinoma)

• The most common combinations of mixed germ cell ovarian tumors Which is?
• Dysgerminoma-endodermal sine tumor

• Cells formed after mitosis and meiosis of primordial germ cells It is described?

In men: from primordial germ cells (sprematogony I) is called spermatogenesis sperm formation.Spermatogonium proliferate with
mitosis in seminiferous tubules following puberty .Following this , primary spermatocytes with the largest cells in the seminiferous
tubules with morphological change form. primary spermatocytes of It consists of spermatids (23X / 23Y) with completion of
meiosis .So when primary sparmatocyte finishes first meiosis, secondary spermatocyte becomes spermatid when it completes
second meiosis. revenue. Formed spermatids if spermiyogenezis After the process of maturation, they become
spermatozoa.In this process, acrosome from golgi apparatus and tail part from centrioles It develops.

In woman: In her gonads, in the primordial germ cells (oogonium), which initiate ovarian differentiation by reaching the gonadal
protrusion, mitosis ends at the 20th week of gestation .Ovarian differentiation between the 20th week german in cell and
mitosis and also meiosis has.Whereas that 20. pregnancy the week following ovary german mitosis stops in the cells
and germ cells only have meiosis, which is only completed if there is fertilization.Meiosis I may take 40 years or longer in oocyte.
The primary oocyte profile begins in fetal life and I.The diplopen phase of meiosis prophylaxis is arrest .Meiosis I is only
completed with ovulation. Subsequently, immediately start meiosis II and complete fertilization. Women in meiosis take so long
chances increases and increased mom age with growing The relationship between the risk of cytogenetic anomaly and this
depends on it.When the primary oocyte completes Meiosis I, secondary oocytes and a polar body are formed.Meiosis II when
completed if (fertilization) ovum and 3 fleece has.

• What is malformation and deformation means?

Malformation; genetically abnormal of the fetus or a structure not, false development programmed being (diastrophic
dysplasia) anomalies).

Deformation in a genetically normal fetus, abnormal uterine the environment connected as developing structural disorder
(limb in severe oligohydramnios contracture).

Embryotoxic effect leads to malformation and fetotoxic effect causes deformation.

• What is progesterone, progestin and progestogen? Progestin effect, as a natural progesterone or as a progestogen described
as synthetic progestins with obtained It may be. Natural

progesterone The pharmaceutical form, GIS also microorganisms and

Because it is rapidly metabolised by digestive enzymes, its effectiveness in oral use is very poor. For this reason, micronized forms
of progesterone are used to increase GIS absorption.

Progestogens are two groups;

• C 21 steroids (17 With OH Progesterone related)

• 19 C nortestosterone derivatives

21C group (medroxyprogesteronacetate, megestrol, medrogestone, klormadinone)

19C nortestosterone the group if