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The longitudinal arch formed by the tarsals and metatarsals antimicrobial pens cheap 0.5mg colcitrat fast delivery, evenly distribute the weight between the heel and foot when standing antibiotic z pack discount colcitrat 0.5 mg mastercard. Both the knee and ankle are commonly subject to closed injuries antibiotic questionnaire order genuine colcitrat, and the relatively superficial location of the knee renders it susceptible to open injury Although the ankle is frequently injured and is a major load-bearing joint antibiotics shelf life buy cheap colcitrat 0.5 mg, the incidence of clinically significant degenerative arthritis is surprisingly low when compared with that found in the hip and knee joints. Joints Pelvic girdle connects the lower limb to the axial skeleton via the sacroiliac joint, in which mobility has been sacrificed for stability and strength, which allows effective weight transmission from the trunk to the lower limb. Anteriorly, the pelvic girdle articulates with the contralateral girdle at the pubic symphysis, has slight degree of mobility during hip and sacroiliac movement, especially during childbirth. The hip has balanced stability and mobility and allows movement in all three orthogonal planes. The knee joint is a compound joint mainly between the femur and the tibia, and allows flexion, extension and some medial and lateral rotation of the leg. It is not a true hinge joint because its axes of flexion and extension are variable and there is coupled rotation. The tibia and fibula articulate with each other at the superior and inferior tibiofibular joints. The superior joint allows slight gliding movement only, whereas the inferior joint allows a degree of fibular rotation linked to ankle motion. The ankle (talocrural) joint is formed by the distal ends of the tibia and fibula gripping the talus, and allows dorsiflexion and plantar flexion. The multiple joints in the foot allow the complex movements as required for working as a platform for standing and for shock absorption and propulsion in gait. Movement Flexion Muscle Psoas major lliacus Pectineus Rectus femoris Adductor longus Sartorius Extension Gluteus maximus Adductor magnus Semitendinosus, semimembranosus, biceps femoris Medial rotation lliacus Gluteus medius and minimus Tensor fasciae latae Lateral rotation Superior and inferior gemelli Innervation Spinal nn. Nerve to obturator internus and nerve to quadratus femori, srespectively Nerve to quadratus femoris Nerve to piriformis Nerve to obturator internus Obturator n. L1 L2 L3 L4 L5 S1 S2 S3 Note: Blue shading denotes nerve roots from which there is a known dominant contribution. Ligaments of hip joint Capsule attaches to acetabular margin of hip bone, labrum and transverse acetabular ligament. On the femur, it is attached anteriorly to the intertrochanteric line and posteriorly 1 cm in front of (medial to) the intertrochanteric crest). It has two types of fibres-inner circular (zona orbicularis) fibres and outer longitudinal fibres (which are reflected along the neck toward the head to form the retinacula). Note: the synovial membrane lines inner aspect of the fibrous capsule, the intracapsular portion of the femoral neck, glenoid labrum (both surfaces), transverse acetabular ligament, ligamentum teres, and fat in the acetabular fossa. It has inverted Y-shaped, whose apex is attached to the lower half of the anterior inferior iliac spine and acetabular margin and the base to the intertrochanteric line. It has three parts: A lateral thick band of oblique fibres, a medial thick band of vertical fibres, and a large central thin portion. It is the strongest ligament of body and prevents the trunk from falling backward in the standing posture. Pubofemoral ligament reinforces the fibrous capsule inferiorly, extends from the pubis bone to the femoral neck, and limits abduction and extension. Ligamentum teres (round) of the head of femur is actually a flat triangular ligament with apex attached to the fovea of the head, and its base to the transverse acetabular ligament. It carries acetabular branches of the obturator and medial circumflex femoral arteries. Acetabular labrum is a fibrocartilaginous rim attached to the acetabular margin to deepen it. They also supply the head of femur, but arterial supply of the head and neck of the femur is chiefly derived from the medial these are retinacular arteries, which run along the neck of the femur through the retinaculum of the capsule. Note: Nutrient artery of the femur gives few branches to the neck and head of femur circumflex artery. Branches of the medial and lateral circumflex femoral arteries, branches of the profunda femoris artery, and the artery to the femoral head (a branch of the obturator artery) supply the head and neck of the femur. In the adult, the medial circumflex femoral artery is the most important source of blood to the femoral head and adjacent (proximal) neck A B. Few of them are discussed here: Trochanteric bursa: Between gluteus maximus and greater trochanter. It communicates with the synovial cavity through a gap between the iliofemoral and pubofemoral ligaments. Vastus lateralis Gluteofemoral bursa is present between gluteus maximus and vastus lateralis.
Emergency contraception is also known as emergency birth control virus 20 furaffinity purchase colcitrat online, backup birth control rubella virus order colcitrat 0.5mg mastercard, and the morning after pill antibiotics for uti and bladder infections effective colcitrat 0.5mg. The middle part of tube (3-4 cm away from fundus) is formed into a loop which is tied at the base with catgut and excised infection medicine discount colcitrat 0.5 mg online. The procedure is done on an outpatient basis under sedation and local anaesthesia. It is vascular in origin and its incidence can be reduced if the blood vessels adjacent to the mesosalpix are not unduly disturbed. With Falope ring = damage is 3 cm Unipolar cauterization by laparoscopy although has least failure but is not done as it leads to intestinal burns and has thus been abandoned. Hysteroscopic tubal ligation: Can be done using cauterization- failure rate 30% or by using sclerosants - failure rate, 15% 4. Essure: It is a spring-like device which is introduced via females vagina (with the help of a hysteroscope) into the fallopian tube. Before discontinuing contraceptive method, azoospermia should be confirmed by semen analysis (done either at 16 weeks or at 12 and 16 weeks) Contraindication of Laparoscopic Tubal Ligation Absolute contraindications abdominal mass (uterine or ovarian tumors) needing laparotomy. Laparoscopic sterilization should not be done soon after delivery or abortion of more than 12 weeks pregnancy. The side effects are: fatigue, decreased libido and delayed recovery of sperm count. Which natural family planning method is based on ogino knauss theory: (Neet Pattern) a. Which of the folowing statements about calendar method (Rhythm method) is false: (Neet Pattern) a. Third generation oral contraceptive pills containing norgestimate and gestodene along with estrogens: a. A 28-year-old P1L1 had Cu T inserted 2 years back, on examination Cu T threads are not seen. Characteristics of an ideal candidate for copper-T insertion include all of the following except: a. Which of the following procedure isassociated with maximum chance of recanalization during surgery for reversal of tubal ligation: a. In emergency, where sexual intercourse is done in camps in emergency like floods c. Which of the following is not an abdominal laparoscopic technique for tubal ligation Preferred method of contraception in family for a female with H/O ovarian cancer: a. Textbook of Gynae, Sheila Balakrishnan pg 352 Thefigureshowstransdermalpatch-orthoevra. This is a combination transermal patch delivering norelgestromin and ethinyl oestradiol and is not yet available in India. Hence three patches are used for three weeks with a patch-free interval in the fourth week. Textbook of Gynae, Sheila Balakrishnan pg 365 Pomeroy method: It is a method for performing abdominal sterilization in females. Avoiding the blood vessels, a round-bodied needle with 0 chromic catgut is passed through the mesosalpinx. The rationale of the procedure is that sine catgut suture is used, there will be prompt absorption of the ligature and subsequent separation of the cut ends.
Abdominal Palpation of pelvic swellings the sensitive ulnar border of the left hand is used from above downwards to palpate swellings arising from the pelvis bacteria notes order 0.5 mg colcitrat fast delivery. The upper and lateral margins of such swellings can be felt but the lower border cannot be reached antimicrobial 24 discount 0.5 mg colcitrat overnight delivery, i antibiotics gel for acne order colcitrat toronto. They have smooth surfaces which maybe slightly bossed and they are freely movable in the pelvis antimicrobial foods 0.5 mg colcitrat with mastercard. There is not tendency to form adhesions and there is no infiltration through the capsule. The tumor retains the shape of the normal ovary and has a peculiar solid waxy consistency. Microscopically, Krukenberg tumors are often characterized by cellular or myxomatous stroma with scattered mucin-secreting signet-ring cells in the tissue of. If the couple has 3 or more living children, the lower limit of age of the husband or wife may be relaxed at the discretion of the operating surgeon 4. E2/E1 ratio will low Rest all options are correct, and discussed in detail in chapter 4 of the guide 2. Shaws Gynecology 16/e p281-82 Female sterilization y Tubal ligation can be done at any convenient time to the patient. Postpartum ligation is done within the first week of delivery when the patient is already hospitalized. Interval sterilization is done when the woman is not pregnant or any time after 6 weeks of delivery. Remember: A simple funda- All hyperestrogenic conditions are M/C in nulliparous females. Leon Speroff 8/e, page 537 Testosterone in Femalesyy Testosterone production occurs from adrenals (25%), ovaries (25%) and from peripheral conversion of androstenedione (50%) Latest Papers yy Production rate is between 0. Insertion immediately after delivery or 1st trimester(Abortion, spontaneous or induced) 3. Insertion immediately after menstruation (as cervix is more open-although insertion can be done at anytime of menstrual cycle after being sure patient is not pregnant) 5. Although overall incidence of ectopic pregnancy is not increased yy Main side effect-breakthrough bleeding yy Other minor side effects-weight gain, acne and formation of follicular cysts in ovary yy Immediate return to fertility in lactating women with recent gestational diabetes yy Good choice for females in whom estrogen is C/I like smokers more than 35 years of age yy Can be used in females with previous episodes of vascular thrombosis yy It protects from endometrial and ovarian cancer Ans. Ans 14/e p1506-1508 For details of dysgerminoma- see chapter 14c of the guide Ans is a and c, i. Fractional cumettage, aspiration cytology from uterus and hysteroscopy and biopsy. Dutta Gyne, 5/e p356-357 Diagnosis of Endometrial Carcinoma yy Papanicolaou smear is not a reliable diagnostic test for endometrial carcinoma (positive only in 30% cases) yy Endometrial biopsy: Using curette or cannula has been done with reliability (90%). Aim- to study cervix when pap smear detects abnormal cells, to locate abnormal areas & take a biopsy, to study the extent of abnormal lesions, conservative surgery under colposcopic guidance & followup of conservative therapy cases. Vaginals is a flagellated protozoa, metronidazole is used for treatment, and strawberry cervix. Dutta obs 7/e p167 Infection in genital tract may be responsible for sporadic abortion but its relation to recurrent abortion is inconclusive. The stroma near the endometrial surface shows the decidual reaction typical of the premenstrual phase (Photomicrograph 85x) B. Note the short wide neck, barrel-shaped trunk, increased carrying angle, and the absence of secondary sex characters. Obstetric Cesarean section Cesarean hysterectomy Exploratory laparotomy for ruptured tuba1 ectopic pregnancy.
Lateral margins are attached on either side to the inferior rami of the pubis and ischium antimicrobial effectiveness test colcitrat 0.5mg for sale, above the crus penis infection control and hospital epidemiology buy colcitrat 0.5 mg. Base is directed toward the rectum antibiotics for uti how long does it take to work best buy for colcitrat, and connected to the perineal body antibiotics jock itch generic 0.5mg colcitrat with visa, posteriorly. Relations: It is continuous with the deep layer of the superficial fascia behind the superficial transverse perineal muscle, and with the inferior layer of the diaphragmatic part of the pelvic fascia. Perforations: It lies between the urogenital diaphragm and the external genitalia and is perforated by the urethra (and vagina). Arteries to the bulb, and the ducts of the bulbourethral glands pierce pass through it. It is also pierced by the deep arteries of the penis (or clitoris), one on either side close to the pubic arch and by the dorsal arteries and nerves of the penis (or clitoris) near the apex of the fascia. Its base is perforated by the perineal vessels and nerves, while between its apex and the arcuate pubic ligament the deep dorsal vein of the penis (or clitoris) passes upward into the pelvis. It is contributed by mainly two muscles: sphincter urethrae and deep transverse perinei. Perineal body is a fibromuscular body attached at the posterior border of perineal membrane in the midline. Other contents are: Crura of penis (males) / Crura of clitoris (females), bulb of penis (males) / Vestibular bulbs (females), Greater vestibular glands (female). It is a mixed (sensory and motor) nerve to supply skin and skeletal muscles of perineum. Anal Triangle and Ischiorectal Fossa Anal Triangle has two components: Muscles and Ischiorectal fossa Muscles of the Anal Triangle: External anal sphincter, Obturator internus, levator ani and coccygeus muscles. Boundaries: Anterior: Urogenital diaphragm (with perineal membrane) Posterior: Gluteus maximus (and sacrotuberous ligament) Superomedial: Sphincter ani externus and levator ani Lateral: Obturator internus muscle (with obturator fascia) on ischial tuberosity Floor: Skin Roof: Meeting point of obturator fascia (covering obturator internus) and inferior fascia of the pelvic diaphragm (covering levator ani muscle). Contents: Inferior rectal neurovascular bundle (nerve, artery and vein); fat; perineal branches of the posterior femoral cutaneous nerve, and the pudendal canal (with pudendal nerve, internal pudendal artery and vein). Note: Pudendal canal is formed either by the splitting of the obturator fascia (or by separation between the fascia lunata and the obturator fascia). Urinary Bladder and Urethra Urinary Bladder Urinary Bladder is the hollow viscus with prominent smooth muscle (detrusor) walls which is a temporary reservoir for It is situated below the peritoneum and extends upward above the pelvic brim as it fills; may reach as high as the umbilicus the empty bladder is tetrahedral-shaped and consists of a posterior surface, anterior surface, superior surface, apex, and neck. Relations: Posterior surface (Fundus or Base) Upper part is separated from rectum by the rectovesical pouch containing coils of the small intestine. Lower part is separated from rectum by the terminal parts of vas deferens and seminal vesicles. In females the base of bladder is separated from the cervix of uterus and by the vesicouterine pouch. Anterior surface is related to the pubic symphysis and retropubic space of Retzius. Superior surface is related to the peritoneal cavity (covered by peritoneum), sigmoid colon, and terminal coils of the ileum. In the female, the peritoneum is reflected posteriorly to the uterus forming the vesicouterine pouch. Apex is located posterior to the upper part of the pubic symphysis and is related to the one median umbilical ligament or urachus (a remnant of the allantois in the fetus). Neck is the lowest region of the bladder and is located posterior to the lower part of the pubic symphysis. In the male, the neck is related to the prostate gland and prostatic urethra and in the female, the neck is related to the urogenital diaphragm. Its limits are defined superiorly by the openings of the ureters and inferiorly by the internal urethral orifice, around which is a thick circular layer called the internal urethral sphincter (sphincter vesicae). It is always smooth-surfaced because the mucosa is tightly adherent to the detrusor muscle. Uvula vesicae, which is a small eminence at the apex of its trigone, projecting into the orifice of the urethra.
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