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