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.