tinitus is the commonest side effect of asprin

appendicitis often mistakenly diagnose with mescentric lymphadenitis

pneumocystic carinii infection treated with trimethoprium and sulphersalacin

mirtazapine does not cause to agitation , sexual dysfunction which usually ocuer in all SSRI

Mirtazapine (brand names: Avanza, Axit, Calixta, Mirtaz, Mirtazon, Remeron, Zispin) is an atypical antidepressant with noradrenergic and specific serotonergic activity. It works by blocking the α2 adrenergic auto- and heteroreceptors

purtusis tx i

1st line =azithromycin

2nd line =trimethoprium and suphersalacine

bupropion has very less effect on sexual dysfuntion than SSRI

Bupropion

Medication

Bupropion or bupropion hydrochloride, also known formerly as amfebutamone, is a medication primarily used as an antidepressant and smoking cessation aid. It is marketed as Wellbutrin and Zyban among other trade names.

in asperger syndrome all the autistic fx are there. but his lanuage and cognitive development is  normal

kawasaky dx caould deferentiate with scarlet fever and toxic shock syndrom by fissured lips

general sensation of the anterior 2/3 of toung supply bylingual nerve  which is 3rd devisionnof trigeminal nerve

taste sensationnof the anterior 2/3 of tounge supply by corda tympany branch of facial nerve

morter supply to the toung by  Hypoglossal n

glossopharingial nerve via the lingual tonciler branch supplies general sensationnof posterior 1/3

maxillary nerve supply to palate

BNP indicate of HF

up yo 400 mild HF

400-600 moderate HF

more than 900 sever HF

BTW other condition like lung cance, cor pulmonale, and pumanary embolism can increse BNP level

older patient most of the time present with perforated appendix while childern present withgarding, ect

ketoconazole (Nizoral) is the treatment for resistent seboratic dermatitis

anti endomysial Ab....posive for caeliac dx

if pt present with manipulation foul smelling diarrhea, aneamia, iron deficiency born pain always think about cealica dx

c-ANCA for wegeners granulomatosis

anti mitocrindial Ab -primary billiary cirrhoris

anti centromere Ab-CREST syndrome (limited screroderma)

anti smith ab for SLE

Acne neonatorum due to maternal androgen. typically due forhead , cheak and norse.. closed comdones

MEN 1 syndrome is heriditory multiple tumours over parathyroids , pancreatic iletes cells and pitutary gland

hallopridol IV the drug of choice for pt who are having dilurium in ICU

dexa scan normal range -

Finkelstein's test is used to diagnose De Quervain's tenosynovitis in people who have wrist pain. To perform the test, the examining physician or therapist grasps the thumb and ulnar deviates the hand sharply, as shown in the image. If sharp pain occurs along the distal radius (top of forearm, close to wrist; see image), de Quervain's tenosynovitis is likely.[1

paraesophageal hernia - Google Search

cystic hygroma, also known as cystic lymphangioma and macrocystic lymphatic malformation, is an often congenital multiloculated lymphatic lesion that can arise anywhere, but is classically found in the left posterior triangle of the neck and armpits. This is the most common form of lymphangioma.

branchial cleft cyst is a congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.

Harrison's groove, also known as Harrison's sulcus, is a horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm; It is usually caused by chronic asthma or obstructive respiratory disease.

Hashimoto's thyroiditis or chronic lymphocytic thyroiditis is an autoimmune disease in which the thyroid gland is attacked by a variety of cell- and antibody-mediated immune processes, causing primary hypothyroidism

Hashimoto’s disease is about seven times more common in women than in men. It can occur in teens and young women, but more commonly shows up in middle age, particularly for men.

Murphy's sign refers to a maneuver during a physical examination as part of the abdominal examination and a finding elicited in ultrasonography. It is useful for differentiating pain in the right upper quadrant. Typically, it is positive in cholecystitis, but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.

Venous thromboembolism (VTE) is the formation of blood clots in the vein. When a clot forms in a deep vein, usually in the leg, it is called a deep vein thrombosis or DVT. If that clot breaks loose and travels to the lungs, it is called a pulmonary embolism or PE.

turner syndrome - Google Search

Alendronic acid (INN) or alendronate sodium (USAN) — sold as Fosamax by Merck — is a bisphosphonate drug used for osteoporosis, osteogenesis imperfecta, and several other bone diseases. It is marketed alone as well as in combination with vitamin D (2,800 IU and 5,600 IU, under the name Fosamax+D).

Bisphosphonates are a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases. They are the most commonly prescribed drugs used to treat osteoporosis. They are called bisphosphonates because they have two phosphonate (PO(OH)) groups.

A solar keratosis is the most common skin condition resulting from skin damaged by the sun over many years. Solar keratoses (also known as actinic keratoses) are usually rough, scaly patches on sun-exposed areas such as the head and face. They are common, especially in older people, many of whom have more than one.

Swan neck deformity is a deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it (DIP hyperflexion with PIP hyperextension).

Guttate psoriasis is a skin condition in which small, red, scaly teardrop-shaped spots with a silvery scale appear on the arms, legs, and middle of the body. Guttate means "drop" in Latin.

Flexor digitorum profundus rupture, commonly called jersey finger, is a condition where a person is unable to bend his or her own finger, without assistance. This is caused by injury to the tendon that bends the last joint of the finger. The tendon tears (ruptures), and sometimes pulls a piece of bone off with it.

Guttate psoriasis is a skin condition in which small, red, scaly teardrop-shaped spots with a silvery scale appear on the arms, legs, and middle of the body. Guttate means "drop" in Latin.

antibody–mediated hypothyroidism is suspected, maternal and neonatal antithyroid antibodies may confirm the diagnosis.[2] Such antibodies are an uncommon cause of congen

who survive a pulmonary embolism, recurrent embolism and death can be prevented

Vertical transmission of the HPV virus from infected mother to her infant can occur

classification scale for evaluating medical findings of suspected sexual abuse lists ano-genital warts/condyloma in a child younger than 2 years of age as a nonspecific finding for sexual abuse—perinatal transmission must be considered.

Vertical transmission can occur through the bloodstream prior to birth, or at the time of birth, as the infant passes through the infected birth canal

Delivery via caesarean section does not eliminate the possibility of vertical transmission of HPV

HPV transmission can occur in utero through semen, ascending infection from the mother's genital tract, or transplacentally. Vertical transmission of the HPV virus does not mean that warts must be present at birth or shortly after birth. HPV is a latent virus and can reside in the skin and mucous membranes without causing warts. The warts may not appear until months or even years after birth

It is important to understand that the absence of visible ano-genital warts in the mother during pregnancy does not eliminate the possibility of vertical transmission to the child

no-genital warts (HPV) also can be transmitted via autoinoculation..

Autoinoculation is a procedure in which cells are removed from the body, treated or medically changed, and then placed back into the body. It is done to help prevent an immune reaction or to help diagnose a medical condition or illness

indicated that HPV can remain dormant for up to 5 years without causing lesions if transmitted vertically.

Frazier (1998) states that studies have indicated that HPV can remain dormant for up to 5 years without causing lesions if transmitted vertically. However, other professionals have concluded that 2 years is the longest period that the HPV virus lays dormant following vertical transmission

Treatment of children with ano-genital warts also is controversial. Without treatment, the rate for spontaneous remission of HPV may be as high as 67% (Frazier, 1998). Some clinicians opt not to treat the warts because of the high rate of spontaneous remission. Treatment failure rates for HPV can be from 25% to 50% (Frazier). Treatment options are based on the location and extent of the lesions and include burning, freezing, laser treatment, surgery, and chemical treatment.

CTG Interpretation

Written by: Anli Yue Zhou from Manchester University,

Indications

Cardiotocograms (CTG's), are performed for a number of reasons. They can be done continuously if the mother is defined as high risk, otherwise they are done every 15 minutes in the first stage of labour, and every 5 minutes in the second stage.

Interpretation

Use the DR C BRAVADO method

1.Demographics of the patient

2.indication of CTG

3.Any obvious abnormalities

DR - Define Risk  -? Pre-eclampsia, diabetes, IUGR, smoker etc

C - Contractions -  in the 2nd stage of labour - ideally <5 contractions in 10 minutes

BRA - Baseline rate  -  110-160bpm

V - Variability -  5-25 beats

A - Accelerations - 2 in 20 minutes

D - Decelerations  - abnormal

O - Overall risk:

• Normal

• Suspicious - <110 OR >160bpm, reduced variability, <90 minutes of uncomplicated early or variable deceleration.

- Re-do the CTG and reassess in one hour

• Abnormal - Immediate management to deliver baby

 - if the head is engaged- usually instrumental delivery

 - if the head is not engaged- emergency caesarean section

A 'normal' CTG trace

Abnormalities

1.Flat trace (reduced variability)

•Sleep phase of baby

•Depressants e.g opiates

•Thumb sucking

•Maternal dehydration

2.Early deceleration

Occurs at the beginning of uterine contractions

Heart rate returns to baseline rate by the end of contractions

Usually decelerates <40bpm

Most commonly due to head compression causing vagal nerve stimulation, hence the temporary reduction in heart rate

Can also be due to cord compression or fetal hypoxia

3.Variable deceleration

Occurs at variable time during contraction

Has irregular shape usually >50bpm deceleration

*usually an indication for fetal blood sampling- if <7.2 then baby is delivered immediately

Due to cord compression

4.Late deceleration

Deceleration trough is past the peak of the contraction

- associated with Fetal hypoxia

Prognosis

The CTG is felt to have a poor prognosis if the following are present:

• Loss of variability

•Fetal tachycardia>160bpm

•Late deceleration

This usually indicates fetal hypo

The shoulder is the most commonly dislocated joint in the bod

Although most shoulder dislocations occur anteriorly, they may also occur posteriorly, inferiorly, or anterior-superiorly.

shoulder is anteriorly dislocated, the arm is in slight abduction and external rotation. In patients who are thin, the prominent humeral head can be felt anteriorly and the void can be seen posteriorly in the shoulder.

Posterior shoulder dislocations can be easy to miss, because the patient usually keeps his or her arm in internal rotation and adduction

Posterior shoulder dislocations can be easy to miss, because the patient usually keeps his or her arm in internal rotation and adduction (ie, the patient holds the arm up against his or her abdomen). In patients who are thin, the prominent head can be seen and palpated posteriorly.

akathisia

Akathisia, or acathisia (from Greek "to sit", a- indicating negation or absence, lit. "inability to sit") is a movement disorder characterized by a feeling of inner  restlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting. People with akathisia are unable to sit or keep still, complain of restlessness, fidget, rock from foot to foot, and pace

Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases

Neuroleptic malignant syndrome (NMS) is a rare, but life-threatening, idiosyncratic reaction to neuroleptic medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction. NMS often occurs shortly after the initiation of neuroleptic treatment, or after dose increases.

 Signs and symptoms

 The key to diagnosis is that NMS occurs only after exposure to an neuroleptic drug. On average, onset is 4-14 days after the start of therapy; 90% of cases occur within 10 days. However, NMS can occur years into therapy. Once the syndrome starts, it usually evolves over 24-72 hours.

Cardinal features are as follows:

Severe muscular rigidity

Hyperthermia (temperature >38°C)

Autonomic instability

Changes in the level of consciousness

Eg of neuroleptic drug is haloperidol

Tardive dyskinesias (TDs) are involuntary movements of the tongue, lips, face, trunk, and extremities that occur in patients treated with long-term dopaminergic antagonist medications. Although they are associated with the use of neuroleptics, TDs apparently existed before the development of these agents. People with schizophrenia and other neuropsychiatric disorders are especially vulnerable to the development of TDs after exposure to conventional neuroleptics, anticholinergics, toxins, substances of abuse, and other agents.

Tardive dyskinesia /ˈtɑːrdᵻv ˌdɪskᵻˈniːʒə/ (TD) is a difficult-to-treat and often incurable form of dyskinesia, a disorder resulting in involuntary, repetitive body movements. In this form of dyskinesia, the involuntary movements are tardive, meaning they have a slow or belated onset.[1] This neurological disorder most frequently occurs as the result of long-term or high-dose use of antipsychotic drugs,or in children and infants as a side effect from usage of drugs for gastrointestinal disorders

Levodopa-induced dyskinesia is a form of dyskinesia associated with levodopa used to treat Parkinson's disease. It often involves hyperkinetic movements, including chorea, dystonia, and athetosis.[

Patients who have had a stroke are at increased risk for vascular dementia. Recently, vascular lesions have been thought to play a role in AD.

there should be a high prevalence of Dx  in the community if u are going to introduce a new screen test for that dx

pap smear testing should commence from age 18 to 20

of after 1st sexual intercause

then do every 2 yearly

tetanus prophylaxis is a primary prevenyion

screening sigmodescopy, pap , bp screening are secondary prevention test

chlamidial infection testing has recommended pt who are younger than 25 years. or at the age of 25

it is the commenst age having infection

or pt who are having , multiple sexual partnesa

Squarmus cell carcinoma  groin nodes can be due to perineum, scrotum and anus aor legs.but sun expose legs are more likely cause .testicular and rectal CA are not squarmus tupe and drain to para aortic nodes. testiculer tumors are seminoma or nonseminomas germ celle tumours.rectum adenocarcinoma

tumus below the dentate line of anus are squamurs cell type

entamoiba hystolitica... is treted by metronidazole orr tinidazole one to 2 week

less than 5 year death most common due to neonatal problem in world wide

Important sign of heart failure in infants. An infant’s liver is normally palpable 1–2 cm below the costal margin.

Wilms’ tumour – renal mass, sometimes visible, does not cross midline

Neuroblastoma – irregular firm mass, may cross midline; the child is usually very unwell

multiple sclerosis cause to optic nerve demyalination and pale optic disc and blindness

1st line tx for pead ezceama is corticosteroid.

 secondline tx is CALCINEURIN INHIBITOR such as pimecrolimus

Trazodone can be add with a pt who complain insomnia who alreday on antidepresant. can use long term.but benzodiazepine can not use

prevalence of physical abuse by spose during pregnancy is higher than non pregnent period

chronic compartment syndrome occur in young specially female pation who are doing excersice and running. complain paiin over legs . due to increse presser. diagnosis by cheacking pressure

in the compartment clomipramine

cause of OCD is serotonine reduction in frontL lobe.treat vith SSRI  or some time  clomiphine

restless leg syndrome neurologic movement disoder

secondary RLS treated with Fe supplement

shift work insomnia can be treated with bright light therapy

Glycopyllorate use in pliative care to reduce respiratoy secretions

Capture Apr 1, 2016

bacterial vaginosis cause clue cell ..its vaginal wall cell.. ALSO

also gardenella vaginalis in 100m%

treat with metronidazole and clindamicine

Hemophelia x link recessive

duchenne mus dystropy xlink recessive

HIGH IgA level in monoclonal gam

high level of IgA in monoclonal gammopathy cause high ananic gap

boerhaave syndrome .. alcoholoic pt pressent with vomiting , subcutenious empheseama..

Boerhaave first described the spontaneous rupture of the esophagus in 1724. It typically occurs after forceful emesis. Boerhaave syndrome is a transmural perforation of the esophagus to be distinguished from Mallory-Weiss syndrome, a nontransmural esophageal tear also associated with vomiting.

post heretic pain reduce by acyclovior and famcyclovior... BUT NOT BY AMITRIPTALIN

best clinical sign of uterine rupture is fetal bradycardia

lower back pain can be due to spinal stenosis  or disc herniation.

in spinal stenosis , sitting releave pain and standing increase pain.

high cardiac out put cardiac failure can be due to thyroxicosis. so pls exclude

visual hallucinations are more commoner than auditory hallucination in delirium tremens.

motality ratev35% if untreated

juvenile polyposis presented with painless bleeding.. not mucus secretion

nicotine patch

noun

a patch impregnated with nicotine, which is worn on the skin by a person trying to give up smoking. Nicotine is gradually absorbed into the bloodstream, helping reduce the craving for cigarettes.

paranoid delusions i  schizophrenia response to nati psychotic very nicely

Munchausen syndrome, referred to as factitious disorder, is a mental illness that involves the sufferers causing or pretending to have physical or psychological symptoms in themselves.

Adults aged 20-40 years are most likely to develop Munchausen syndrome. Women with knowledge of health care and men with few family relationships are particularly vulnerable to developing this disorder.

mittelschmerz =mid cycle pain

ephiglottitis cause by H.influenza B

Gamekeeper's thumb (also known as skier's thumb or UCL tear) is a type of injury to the ulnar collateral ligament (UCL) of the thumb. The UCL is torn at (or in some cases even avulsed from) its insertion site into the proximal phalanx of the thumb in the vast majority (approximately 90%) of cases.

Boxer's Fracture is a colloquial term for a fracture of one of the metacarpal bones of the hand. Classically, the fracture occurs transversely across the neck of the bone, after the patient strikes an object with a closed fist.

boxurs fracture

3:56 PM

The term mallet finger has long been used to describe the deformity produced by disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint.[1, 2, 3, 4] It is the most common closed tendon injury seen in athletes, though it is also common in nonathletes after "innocent" trauma. Mallet finger has also been referred to as drop, hammer, or baseball finger (though baseball accounts for only a small percentage of such injuries).

mallat finger =baseall finger

olanzipine and clozapine like 2nd genaretion antipsychotic cause wiight gain and diabetic

elavate trigliceride too

thyroiditis treat with prednisolon

Li excreted by kidney . so RFT should do every 3 months

also ECG should be check, Li case sinus node deprestion and T flataning

hypothyroidism, high WBC

Paranoia   

 A person may believe that friends, family, government agencies, or others are trying to bother him or harm him even when it is not true.

 Example:  Andre is convinced that his roommate is trying to poison his food and refuses to eat anything that he does not prepare himself.

Thought broadcasting. A person may believe that other people can hear or read her thoughts.

 Example:  Tamika has been avoiding her friends because she believes they can read her thoughts, especially when she is angry or thinking about something embarrassing.

Thought insertion. A person may have thoughts that feel foreign to him and seem as if they have been inserted by an outside force or person.

 Example: John has been finding himself thinking of highly offensive comments about women that he would never say out loud.  He is convinced that his cell phone is somehow implanting these thoughts in his mind.

Grandiose/religious delusions

A person may develop a belief that she has a supernatural power, is famous, or that she is the messiah or a chosen person with a special mission.

 Example:  Julietta believes that she owns the internet and has been chosen by God to save the world by deciphering codes on web pages.

euphoria

a feeling or state of intense excitement and happiness.

cyclothymia

a mental state characterized by marked swings of mood between depression and elation; bipolar disorder.

cyclothymic disorder, moods swing between short periods of mild depression and hypomania, an elevated mood. The low and high mood swings never reach the severity of major depression or full mania. People with cyclothymic disorder have milder symptoms than occur in full-blown bipolar disorder.

Somatization disorder (also Briquet's syndrome) is a mental disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms

Hysteria, in its colloquial use, describes ungovernable emotional excess. Generally, modern medical professionals have abandoned using hysteria as a diagnostic category, replacing it with more precisely defined categories, such as somatization disorder.

Bulimia nervosa, also known as simply bulimia, is an eating disorder characterized by binge eating followed by purging. Binge eating refers to eating a large amount of food in a short amount of time. Purging refers to the attempts to get rid of the food consumed. This may be done by vomiting or taking laxatives. Other efforts to lose weight may include the use of diuretics, stimulants, water fasting, or excessive exercise.] Most people with bulimia are at a normal weight.

BMI

20 to 24 normal

25 to 29 over weight

30 to 39 obese

 more than 40 morbid obese

thought disorder

a disorder of cognitive organization, characteristic of psychotic mental illness, in which thoughts and conversation appear illogical and lacking in sequence and may be delusional or bizarre in content.

Thought disorder (TD) or formal thought disorder (FTD) refers to disorganized thinking as evidenced by disorganized speech. Specific thought disorders include derailment, poverty of speech, tangentiality, illogicality, perseveration, neologism, and thought blocking.

Pressure of speech is a tendency to speak rapidly and frenziedly, as if motivated by an urgency not apparent to the listener

idiosyncrotic alcohol intoxication as known as pathlohical alcohol intoxication due yo LITTLE AMOUNT OF ALCOJOL

Pathological alcohol intoxication is an extraordinary severe response to alcohol, especially to small amounts marked by apparently senseless violent behavior, usually followed by exhaustion, sleep and amnesia for the episode.

Intermittent explosive disorder (sometimes abbreviated as IED) is a behavioral disorder characterized by explosive outbursts of anger and violence, often to the point of rage, that are disproportionate to the situation at hand (e.g., impulsive screaming triggered by relatively inconsequential events). Impulsive aggression is unpremeditated, and is defined by a disproportionate reaction to any provocation, real or perceived. Some individuals have reported affective changes prior to an outburst (e.g., tension, mood changes, energy changes, etc.).[1]

Asperger syndrome (AS) is a developmental disorder characterized by significant difficulties in social interaction and nonverbal communication, along with restricted and repetitive patterns of behavior and interests.[1] It is an autism spectrum disorder (ASD) and differs from other disorders by relatively normal language and intelligence.[2] Although not required for diagnosis, physical clumsiness and unusual use of language are common

Malingering is fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation (often tied to fraud); avoiding school, work or military service; obtaining drugs;

conversion disorder

present with neurological symptoms, such as numbness, blindness, paralysis, or fits, which are not consistent with a well-established organic cause, and which cause significant distress. It is thought that these symptoms arise in response to stressful situations affecting a patient's mental health or an ongoing mental health condition such as depression

Autobiographical memory is a memory system consisting of episodes recollected from an individual's life, based on a combination of episodic (personal experiences and specific objects, people and events experienced at particular time and place) and semantic (general knowledge and facts about the world) memory.

Buprenorphine is used to treat dependence/addiction to narcotics (opioids). Buprenorphine belongs to a class of drugs called mixed narcotic agonist-antagonists. It helps prevent withdrawal symptoms caused by stopping other opiate-type narcotics. It is used as part of a complete treatment program for drug abuse (such as compliance monitoring, counseling, behavioral contract, lifestyle changes).

Naltrexone is a drug that reverses the effects of opioids and is used primarily in the management of alcohol dependence and opioid dependence

Melancholic depression, or depression with melancholic features, is a DSM-IV subtype of clinical depression requiring at least one of the following symptoms: Anhedonia (the inability to find pleasure in positive things) Lack of mood reactivity (i.e. mood does not improve in response to positive events)

Melancholic depression, or depression with melancholic features, is a DSM-IV subtype of clinical depression requiring at least one of the following symptoms: Anhedonia (the inability to find pleasure in positive things) Lack of mood reactivity (i.e. mood does not improve in response to positive events)

At the age of 3 to 7 years baby girls having on and off NONSPECIFIC VULVOVAGINIYIS , specially due to law circulatiry oestrogen level in the blood cause to thin vaginal epithelium

Low serum iron level is not a hood indicator of iron deficiency. Serum iron is a acute phase reactant and may be low after infection,.  But iron store (ferattin) which is good indicator of body iron state will be normal. so.. We can reassure parent about iron deficiency aneamia is not there

IgA nepropathy present with haematuria usually at presence or wane of URTI

Galactosemia (British galactosaemia) is a rare genetic metabolic disorder that affects an individual's ability to metabolize the sugar galactose properly. Galactosemia follows an autosomal recessive mode of inheritance that confers a deficiency in an enzyme responsible for adequate galactose degradation.

vomiting, jundice, catrect, liver failiure

developmental delay, chronic liver failiure

DDH more common in childen who are bone BREECH

DDH is more common in girls. Strong FHx is there.

herpers simplex ulcers/vesivles  occur in oropharynx and pvesivles +

entrovirus infection also cause  mouth ulcer  .

There is NO petechiae in Haemophilia A or von willebrand dx.. bleeding usually occur with miner trauma

ABO incompayibality usually mosrtly occur in O mother and A baby.. Sometimes B baby

diagnosis by Coombs test

Diastolic murmur always  should investigate

Drug of choice for meningitis  is ceftriaxone

 If ceftriaxone not available use benzyle penicillin

Oral trimethoprium is the drug of for UTI  which is not sever

Bacterial tonsilitis  with exudate.

Usually due to group A streptococcal dx

drug if choicevis phenoxy methylpenicillin

IMN cause tonsilitis and amoxacillin cause rash

infective skin leasion with cellulitis drug of choice would be IV flucloxacillin

medulloblastoma  are infra tentorium midline

 pt prestent with morning headache, ataxia due to cerebeller involvement

glioblastoma rare in children and it is supratentorial

meningiomas are supratenyoria

Pelvic harness use for DDH to prevent dislocation

bronchiectasis Xray shows Perihyler infiltrate and

gastroenteritis in children in Australia  in winter due to rotavirus

Don’t do lumber puncture to diagnosed clinically suggest meningitis. Do blood culture and start treatment.

PROM

if vaginal swab are notnpositive for pathogenic organism , propylactic antibiotic can be stop

iv salbutamol and nifidipine use to prevent contraction till give dexamethazone  in PROM

stress fracture can occur

athlatis necknof 2nd meta tarsal

spinal vertebrae

1st rib neck.. chronic empbeseama

Left Occiput Transverse (LOT

fetal distress is more likely when syntocinon infusion is use and epidural anaesthesia is used

heparine is large molicule and not cross the placenta

Reverse by protamine silphate

coumarian derivative(wafarin) contraindicated in 1st trimester.. but can use in 13 to 36 weeks

vasa previa

Vasa praevia (vasa previa AE) is an obstetric complication in which fetal blood vessels cross or run near the internal orifice of the uterus.

vasa previa - Google Search

when vomiting ketone urea indicate significant dehydratiom

in postpartem period dyspatonea is common and its usually due yo atropic vaginal epithelium due yo low oestrogen levelndue yo high prolactin level due to breast feeding

when OCP stop  ovulayion occur

 in 2 weeks 50%of women

in 6 weeks later in 90%of women

1 % in 12 months later

continues fetal heart rate monitoring is reduce the risk of fetal motality in high risk pregnancy,,

 but Not in low risk pregnancy, intermittent phenad monitoring is enough

now genital  herpes is most  commonly type 1

in past it was typen2

acyclovir can be given in pregnancy

Actinic keratosis (AK) is a UV light–induced lesion of the skin that may progress to invasive squamous cell carcinoma. .

Actinic keratoses (AK), also called solar keratoses, are scaly, crusty growths (lesions) caused by damage from the sun’s ultraviolet (UV) rays

weight/standed weight may be a more reliable indicator of obesity if children than just BMI

iItis not reliable in children as  child height change very rapidly

meso5helioma is CA of plura and pt presented with SOB

SSRI antidepression (fluoxetine,sertralin,paroxetine,clomipramine) dramatically improve the premature ejeculation

also these drugs can be tKe on demand few hours b4 the treatment or reguler dose.

topical anaesthetic cream also helpfil in premature ejeculation

Hypervigilance is an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors whose purpose is to detect threats. Hypervigilance is also accompanied by a state of increased anxiety which can cause exhaustion.

perseveration [per-sev″er-a´shun]

the inappropriate persistence or repetition of a thought or action after the causative stimulus has ceased or in response to different stimuli; for example, a patient answers a question correctly but incorrectly gives the same answer to succeeding questions. Perseveration is most often associated with brain lesions but is also seen in schizophrenia.

perception. : the way you think about or understand someone or something.

delusional perception

person believes that a normal percept (product of perception) has a special meaning for him or her. For example, a cloud in the sky may be misinterpreted as meaning that someone has sent that person a message to save the world. While the symptom is particularly indicative of schizophrenia, it also occurs in other psychoses, including mania (in which it often has grandiose undertones

passivity experience

Where the outside agency is identified the term is delusions of passivity. Passivity experiences are usually symptoms of schizophrenia and rarely arise in 'normal' persons, and then only in stressful situations. Delusions of passivity, although also symptoms of schizophrenia, are more common than passivity experience in 'normal' persons and have been compared with: extra-sensory perception;

passivity experience kiyanne pt kiyana karana hemadema venath balayakin (eg..computer, microwave,alian, ect)  control venava kiyala pt hithan enna eka.

Common Types of Delusions

Ideas of reference  

A person may believe she is receiving special messages from the TV, radio, or music.  Alternatively, she may believe that colors, words, or other things in the environment have special meaning just for her.

Example: Whenever Jenny sees a blue car, she believes that God is sending her a message to leave school early.