Normal Physiologic changes in Pregnancy

Cardiovascular Changes-
Blood Pressure: Systolic  decreases / Diastolic decreases (peripheral resistance decreases)
Femoral Vein Pressure increases(3x)- Varicosity and Hemorrhoids
Plasma volume increases(7500 ml)
Heart rate ,stroke volume and thus cardiac output increases.(CO=SV*HR)
Hematology Changes-
Red cell mass ,WBC count, ESR increases
Hypercoagulable state
Hemoglobin decreases due to dilution by increased plasma volume-Physiologic anemia
Skin Changes-
Striae Gravidarum(Stretch marks),

Palmar erythema 
spider anigomas( increased estrogen),

Chadwick sign ,
Linea nigra

Chloasma(melasma)

Gastrointestinal Changes-
Smooth muscle tone and motility decreases (progesterone)causing constipation , GERD, Cholelithiasis
Lung Changes -
Tidal Volume increases
therefore Minute ventilation increases- causing respiratory alkalosis
Renal Changes-
Kidney size increases, ureter diameter increases(right common), UTI increases
Renal Plasma Flow ,GFR, Creatinine Clearance increases.
BUN,Serum creatinine,Serum uric acid decreases
Glucose increases in urine
Endocrine Changes:
Pitutary size increases( increased blood flow)
Cortisol increases, Thyroid gland size increases, Total T3&T4 increases because there is increase in Thyroid Binding Globulin.

Normal Menstrual Cycle

Normal menstrual Cycle progresses as follows

1)Follicular Phase(1-13 days)
2)Ovulation(14th day)
3)Luteal phase(days 15-28)

Follicular Phase (1-13 days)(Proliferative phase):
Variable phase, lasts around 13-14 days. In the beginning of follicular phase after the 5th day of menses there is increase in FSH level which lead to growth of ovarian follicles which in turn increases estrogen production. This results in development of straight glands and thin secretions of the uterine lining.

Ovulation(14th day):
Just before ovulation estrogen level reaches its peak, followed by spike in LH and FSH leading to rupture of follicle and release of mature ovum. Ruptured follicular cells involutes and form the corpus luteum.

Luteal phase(15-28):
Duration is fixed(14 days), during this phase there is increase in progesterone levels, its called the secretory phase, the corpus luteum produces estrogen and progesterone allowing the endometrial lining to produce thick branching endometrial glands with thick secretions.
The corpus luteum can survive for 14 days without further LH stimulation, if fertilization doesn't occur the corpus luteum cannot be sustained and endometrial lining sloughs of at 28 th day of the cycle.

 

 

My usmle Step 1 Experience

When i started my preparation i had no idea about which books to use , so i did some research and started using following materials
 Kaplan lectures notes/video(except pathology)
Goljan audio(highly recommended)/Rapid Review Pathology Revised Reprint: With STUDENT CONSULT Online Access, 3e        
First Aid for the USMLE Step 1 2013 (First Aid USMLE)
 USMLE WORLD QBANK

Time Spent: 6 months

Started with Kaplan videos and lecture notes , finished 1st reading in 2 months, then started Goljan audio/rapid review this went very slow took 45 days to complete ( 6hrs/day).
Started First aid for step 1( very good book recommend to use it early )
Usmle world 2 months subscription (along with first aid, adding notes to first aid )
UsmleWorld-78% 
Nbme 11-238 (Took 15 days before exam)- Advice to take it 1 month before the exam date.
Usmle free questions -86%
First Aid 2nd reading-7 days, along with Uworld questions
exam day- Had trouble sleeping.
Exam difficulty was similar to NBME , had few questions which i had no clue , Overall exam was ok except last 2 blocks which i felt was little difficult.
Test score-233/84

Babesiosis

Causative agent Babesia microti an intraerythrocytic Protozoa , transmitted by Ixodes( ticks) often present along with Lymes disease .
Symptoms like fever headache is seen and patient develops hemolytic anemia.
Diagnosis : Peripheral smear with Wright or Giemsa stain , Serology testing.
Treatment: Azithromycin + Atovaquone

Chilaiditi syndrome

Chilaiditi syndrome is a rare condition when pain occurs due to transposition of a loop of large intestine (usually transverse colon) in between the diaphragm and the liver, visible on plain abdominal X-ray or chest X-ray. Normally this causes no symptoms, and this is called Chilaiditi's sign. The sign can be permanently present, or sporadically. This anatomical variant is sometimes mistaken for the more serious condition of having air under the diaphragm (pneumoperitoneum) which is usually an indication of bowel perforation. This may lead to unnecessary surgical interventions.Chilaiditi syndrome refers only to complications in the presence of Chilaiditi's sign. These include abdominal pain,torsion of the bowel (volvulus) or shortness of breath.[4]

The exact cause is not always known, but it may occur in patients with a long and mobile colon (dolichocolon), chronic lung disease such as emphysema, or liver problems such as cirrhosis and ascites. Chilaiditi's sign is generally not associated with symptoms, and is most commonly an incidental finding in normal individuals.Absence or laxity of the ligament suspending the transverse colon or of the falciform ligament are also thought to contribute to the condition. It can also be associated with relative atrophy of the medial segment of the left lobe of the liver. In this case, the gallbladder position is often anomalous as well - it is often located anterior to the liver, rather than posterior.The occurrence (incidence) on abdominal or chest X-rays is around 0.1% but it can be up to 1% in series of older adults. It has also been reported in children.Synonyms include interpositio hepatodiaphragmatica, subphrenic displacement of the colon, subphrenic interposition syndrome and pseudopneumoperitoneum.Chilaiditi's sign is named after the Greek radiologist Demetrius Chilaiditi who first described it when he was working in Vienna in 1910.