DDx of painful mass:
1. Fibro adenosis
2. Cyst
3. Perisuctal mastitis
4.Acute abscess

DDx of painless mass:
1. Carcinoma
2. Fiboadenoma
3. chronic abscess (Antibioma)

DDx of Mastalgia and tenderness:
Relet to MC
Non cycle (Acute mastitis)

?Breast :
-Extend-upward to  2rib
-Extend downward at 6rib
-Medially:lateral border of sternum
-Laterally:anterior Axillary line

-Breast rest on :
·   Pectoralis major
·  External oblique muscle(Inferior medially )
·Serratus anterior muscle (Inferior laterally )

?Blood supply to breast :
1. Internal mammary artery
2. Intercostal artery
3. Thoraco acromial artery
4. Lateral thoracic artery
?Lymphatic drainage :
1. Axillary lymph node (MC 85%)
2. Internal mammary LN
3.Peritoneal lymphatic plexus in rectus sheath

?Congenital breast disease:
1. Athelia
2. Polythelia
3. Amazia
4. PolyMazia
5. Poland syndrome (Amazia and No pectoralis major)

?Breast trauma :
1. Fat necrosis (Hard mass ,Painless ,associated with nipple retraction )
2.Breast haematoma (Hard mass ,painless, associated with nipple retraction)
Differentiated from Cancer by biopsy

?Acute lactational mastitis
· Due to staphylococcus aureus
· Milk engorgement
· Abrasion to nipple due to suckling
·  Poor hygiene
◽️Sign :
·  Dull aching pain
·  Hotness and redness
·  Higher pyrexia
·  Tenderness
Form abscess ➡️Throbbing pain
◽️ttt ➡️Antibiotics /Incisional and drainage of abscess

?Duct ectasia(Plasma cell mastitis ):
· Abnormal dilation of major duct of breast
·  Nipple discharge: purulent (yellow,brown, green )
·  Nipple retraction
·  Periductal abscess
· Mammary fistula
· ttt➡️ Excision and biopsy

?Fibrocystic disease of breast (ANDI) (Fibroadenosis)(Mammary dysplasia )
· Most frequent breast disorder
·Multiple,psinful,small lump ,in relation to MC
· Nipple discharge (Yellow or clear )
· Mastalgia
·Ttt: Aspiration of cyst /NSAID/antiestrogen /Androgen

◽️Benign lesion :
1.Intraductal papilloma
· Blood nipple discharge
·  Retro areolar mass

2. Fibroadenoma :
· Commonest breast mass of young ?
· 15-30y
· Painless lump
· Small
· Non tender
·Firm will circumscribe
· High mobility within breast (Breast mouse)
·ttt➡️Excision
3.Phylloid’s tumor (Brodie’s sarcoma )
·Rare condition
· Slow grow swelling
·Large in size
·Skin necrosis and ulceration

?Risk factor of Breast cancer :
1.Genatic  BRCAI /BRCAII
2.Family history
3.Age
4.Early menarche
5.Late menopause
6. Unmarried
7.Nullipara
8.Non lactating
9.Long use of OCP
10. Exposure to radiation
11. Alcohol consumption
12. Cigarette smoking
13. Obesity

?Symptoms and sign of Malignant lesion :
· Painless lump ,Nipple retraction with blood discharge,Hard mass fixation to skin
· Skin dimpling
· Peu d’orang
· Skin nodule
· Skin ulceration
·Axillary and supraclavicular LN palpable

?Investigation:
1.Mammography
2.Ultrasound
3.Biopsy
· Fine needle aspiration
· True cut biopsy
· Frozen section biopsy
· Incisional biopsy
· Exesional biopsy

?Triple assessments:
1.     Clinical examination
2.     Radiological (X-ray ,USS)
3.     Pathological (biopsy)

هنا للبصمجة عنوان مش شرح معلش ع شان نحلو ال mcqs?

Ulcer➡️Discontinuity  of epithelium

◽️Causes of Ulcer:
1. Traumatic
2.Infection
3.Neurotrophic
4.Ischemia
5.Venous
6.Neoplastic
7.Haemolytic anemia (SCA )
8.CTD

1. Venous Ulcer:
·  DVT
·Varicose vein?Clinical picture :
· Ulcer around medial malleolus
· Slopping edges
·Eczema around ulcer
.Brownish pigmentation
· Varicose vein
?Complication :
· Malignancy (Marjolin ulcer)
· Periostitis
· Deformity

2.Ischemic ulcer :Due to sever chronic ischemia
·  At tip of toes
· Deeply stained with Punched out edge
· H/O atherosclerosis
3. Neurotrophic ulcer :
· In pressure area (Sole ,Heal )
·  Punched out edge
· H/O DM, peripheral neuropathy

4. Neoplastic Ulcer :
·Basal cell carcinoma (Rodent ulcer )
-Prolonged exposure to sun ray
-oval or round ulcer ,small in size ,Rolled in edge

· Squamous cell carcinoma:
-irregular shape ulcer,Rasie  everted edges

?DDx of leg ulcer :
·  Venous 60%
·  Ischemia 20%
· Neurotrophic
· CTD
· Traumatic
· Neoplastic

?Intestinal obstruction :

1. Dynamic ➡️Peristalsis is working against obstruction
2. A-dynamic ➡️Failure peristaltic waves due to failure of neuromuscular mechanism
?Clinical pictures of intestinal obstructions:
1. Vomiting
2. Visible peristalsis
3. Constipation
4. Colic
5. Distention of abdomen
6.Dehydration

مرحبتين ب جماعة باطنة?
ان شاءالله الأيامً جاية نزل باقي اورثو
وموضوع ال GBD’ vascular

Deformity in elbow :
1. Cubitus varus➡️ decrease in carrying angle less than 10 in ? and less than 13 in?.

2.Cubitus valgus ➡️increase in carrying angle more than 10in? and mire than 13 in?.
3. Flexion deformity
4. Hyperextension deformity

Examination of Elbow
1. Look for any scar ,skin changes, sinus, bruist, swelling (localized or general) ,any bony prominance ,any muscle weasting , any deformity
2. Feel (Temperature, Tenderness,Pulsation ➡️Brachial , Radial,Ulnar pulsation )
3. Movement done by active +passive (Flexion 150 degree by flexor muscle biceps ,Extension 0-5 degree by extensor muscle triceps , Pronation 40degree done by pronature teres +quadretue , Supination 40degree done by supinator muscle )
4. Special test
-Test for tennis elbow ➡️Elbow extension and wrist extension againt resistance if pain in lateral epicondyled it’s positive test.

-Test for Golf elbow➡️Elbow flexion and wrist flexion againts resistance if pain in medial epicondyled positive test.
-Varus strees test for lateral collateral lig
-Valgus stree test for medial collateral lig

Axillary nerve injury ➡️Flat shoulder
Spinal part of accesory nerve injury ➡️Drop shoulder

The most common dislocation in shoulder it’s anterior dislocation