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.