long head of biceps tendon rupture give bunched deformity

humurus neck fracture in elderly  treated with just arm sling .ORIF usually not need.

scapid bone fracture

scaphoid bone fracture - Google Search

Tubercle fractures -

Distal-pole fractures -

Proximal-pole fractures - The more proximally located the fracture plane is, the greater the risk of delayed union, nonunion, and  avascuer necrosis [4]

request X rays=

oblique view of carple bone with wrist with mid pronation

anteroposterior view  the wrist with maximal ulnar deviation

treated with POP

Ofen undispace fracture

Overview

The scaphoid is the most frequently fractured carpal bone, accounting for 71% of all carpal bone fractures. Scaphoid fractures often occur in young and middle-aged adults, typically those aged 15-60 years

scaphoid fracture - Google Search

A Colles' fracture, is a fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand.[1] The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm. Colles' fractures are often seen in people with osteoporosis.

Dorsal tilt

Radial shortening

Loss of ulnar inclination

Radial angulation of the wrist

Dorsal displacement of the distal fragment

slip upper femoral epiphisis

emedicine.medscape.com/article/91596-images?imageOrder=1

Slipped capital femoral epiphysis (SCFE) is one of the most important pediatric and adolescent hip disorders encountered in medical practice.[

History

See the list below:

Slipped capital femoral epiphysis (SCFE) is most common in the adolescent period (ie, boys aged 10-16 y, girls aged 12-14 y). Males have 2.4 times the risk compared with females.

The left hip is affected more commonly than the right.

Obesity is a risk factor because it places more shear forces around the proximal growth plate in the hip at risk.

Genetics may play a role

In patients younger than 10 years, SCFE is associated with metabolic endocrine disorders (eg, hypothyroidism, panhypopituitarism, hypogonadism, renal osteodystrophy, growth hormone abnormalities). [1, 21, 22] Bilaterality is more common in these younger patients.

The chronicity of the condition should be determined.

Prodromal symptoms (eg, hip or knee pain, limp, decreased range of motion) for less than 3 weeks are deemed acute.

At this time, immediate internal fixation in-situ using a single cannulated screw is the treatment of choice of SCFE

emedicine.medscape.com/article/91596-images?imageOrder=2

ostiocronditis desicancs

Osteochondritis dissecans is a joint condition whereby a variable amount of bone and its adjacent cartilage loses its blood supply(avasculer necrosis)

. Osteochondritis dissecans can involve the bone and cartilage of virtually any joint

. Elbows and knees are most commonly affected. Usually, only a small portion of the affected cartilage is involved. Osteochondritis dissecans most commonly affects boys between 9 and 18 years of age.

Osteochondritis dissecans can be suggested clinically by observing the lack of full range of motion with "locking" of the joint at a certain angle.

unknown etilogy

knee joint is most commonly affected

perthes disease

Legg-Calvé-Perthes disease (LCPD) is avascular necrosis of the proximal femoral head resulting from compromise of the tenuous blood supply to this area. LCPD usually occurs in children aged 4-10 years. The disease has an insidious onset and may occur after an injury to the hip. In the vast majority of instances, the disorder is unilateral.

unkown etiology

mild or intermittent pain in the anterior part of the thigh. LCPD is the most common cause of a limp in the 4- to 10-year-old age group, and the classic presentation has been described as a painless limp. The patient may present with limited range of motion of the affected extremity. The most common symptom is persistent pain.

perthescdx

perthes disease - Google Search

osgood_schlattercdx

age10 to 15

pain full knee

 male more

tenerness of tibial tubercal

Urge incontinence is a common form of incontinence. You have an urgent desire to pass urine and sometimes urine leaks before you have time to get to the toilet. It is usually due to an overactive bladder. Treatment with bladder retraining often cures the problem. Medication may also be advised to relax the bladder.

Types of urinary incontinence

Stress: Urine leakage associated with increased abdominal pressure from laughing, sneezing, coughing, climbing stairs, or other physical stressors on the abdominal cavity and, thus, the bladder [2, 3, 4]

Urge: Involuntary leakage accompanied by or immediately preceded by urgency

Mixed: A combination of stress and urge incontinence, marked by involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing

Functional: The inability to hold urine due to reasons other than neuro-urologic and lower urinary tract dysfunction (eg, delirium, psychiatric disorders, urinary infection, impaired mobility)

urge incontinus

due to over active bladder

treatment

bladder retraning

pelvic flore ex

anti muscarinic

oxibutamine

tolterodine

derifenacine

hyoscyamine

tetunus dose

Clinical Practice Guidelines : Management of tetanus-prone wounds

Keratoacanthoma (KA) is a relatively common low-grade tumor that originates in the pilosebaceous glands and closely resembles squamous cell carcinoma (SCC). In fact, strong arguments support classifying keratoacanthoma as a variant of invasive SCC.

Keratoacanthoma is characterized by rapid growth over a few weeks to months, followed by spontaneous resolution over 4-6 months in most cases. Keratoacanthoma may progress rarely to invasive or metastatic carcinoma.

The primary therapy for keratoacanthoma is surgical excision of the tumor. Excise tumors with adequate margins (3-5 mm) and histopathologic evaluation to exclude invasive SCC. Partial shave biopsy usually inadequately distinguishes between keratoacanthoma and invasive SCC. In some patients, smaller lesions may be treated with deep excisional shave and curettage or other destructive techniques.

emedicine.medscape.com/article/1100471-images?imageOrder=2

Tibolone is a type of hormone therapy (HT) designed to relieve menopausal symptoms and prevent osteoporosis (thinning of the bones) in post-menopausal women.

Tibolone is suitable for women who have not experienced a natural period for at least 1 year. If taken sooner, irregular bleeding may be experienced.

Usually a woman using cyclical HT and experiencing a monthly bleed can start tibolone after the oestrogen/progesterone phase of her current HT.

Postmenopausal women not currently taking HT, or who have had a hysterectomy, may start at any time.

A woman taking HT that contains the same amount of oestrogen and progestogen every day of the month can change to Tibolone at any time.

Side-effects of tibolone

Side-effects are uncommon but may include headache, dizziness, nausea, abdominal pain, swollen feet and itching. Breast tenderness is also uncommon..

Slight bleeding or spotting may commonly occur initially but tends to subside after a few months. Amenorrhea is achieved by about 80% of women after the first month of treatment with tibolone and over 90% after the third month of therapy [4].

tibalone

It is contraindicated in women who have had breast cancer.

Tibolone For Post-Menopausal Women - Australasian Menopause Society

Asperger syndrome (AS), also known as Asperger's syndrome, Asperger disorder (AD) or simply Asperger's, is an autism spectrum disorder (ASD) that is characterized by significant difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. It differs from other autism spectrum disorders by its relative preservation of linguistic and cognitive development. Although not required for diagnosis, physical clumsiness and atypical (peculiar or odd) use of language are frequently reported.[1][2

Attention deficit hyperactivity disorder (ADHD, similar to hyperkinetic disorder in the ICD-10) is a neurodevelopmental psychiatric disorder[1][2][3][4] in which there are significant problems with executive functions (e.g., attentional control and inhibitory control) that cause attention deficits, hyperactivity, or impulsiveness which is not appropriate for a person's age.[5][6][7] These symptoms must begin by age six to twelve and persist for more than six months for a diagnosis to be made.[8][9] In school-aged individuals inattention symptoms often result in poor school performance.

ADHD

Inattention, hyperactivity (restlessness in adults), disruptive behavior, and impulsivity are common in ADHD.[32][33] Academic difficulties are frequent as are problems with relationships.[32] The symptoms can be difficult to define as it is hard to draw a line at where normal levels of inattention, hyperactivity, and impulsivity end and significant levels requiring interventions begin.[34]

featues of OA

joint space narrowing

sclerosis

ostiophyts

subchondrial cyst

Return to Referring Physicians Main Page

Arthritis of the 1st Metatarso-phalangeal Joint (Hallux Limitus/Rigidus)

One of the more common symptoms of osteoarthritis in the foot is located to the first metatarso-phalangeal joint (Hallux Limitus/Rigidus).

Hallux Limitus/Rigidus usually occurs in adults between the ages of 30 and older. It may result from previous injury to the joint cartilage or abnormal foot mechanics that increases pressure on the joint.

hallux limitus x ray features - Google Search

Watch "Development of Glaucoma Animation, Open Angle vs Angle Closure Glaucoma." on YouTube

dvt can later cause to  vericause vein

superficial femoral.artery - Google Search

superficial femoral atery oclusion NOT cause to claudiaction of thigh.

thigh claudication isv due to  deep femoral or common femoral atery  obstudtion

claudication distencebimprovebwith time due to colaterl devolopment

for acute aterial embolus angiogram is wast of time

Definition of early ambulation. : a technique of postoperative care in which a patient gets out of bed and engages in light activity (such as sitting, standing, or walking) as soon as possible after an operation.

Superficial thrombophlebitis is a common inflammatory-thrombotic disorder in which a thrombus develops in a vein located near the surface of the skin. Most superficial veins that develop thrombosis also have phlebitis, in contrast to deep venous thrombosis (DVT), a sometimes asymptomatic condition in which phlebitis may be absent. (

pleabitis

inflammation of the walls of a vein.

Superficial phlebitis with infection, such as phlebitis originating at an IV catheter site, is referred to as septic thrombophlebitis,

superficial  thrombo plebitis treated with analgia,bandaging .,ambulation

vasovagal syncope=fainting

if CPR good... working pupis are good indicated

Atherosclerotic Disease of the Carotid Artery

Treatment

Approach Considerations

The following are indications for carotid endarterectomy (CEA) based on prospective randomized trials:

Symptomatic patients with greater than 70% stenosis - Clear benefit was found in the North American Symptomatic Carotid Endarterectomy Trial (NASCET); ipsilateral stroke in 2 years was 9% with surgery and 26% with medical management [1]

Symptomatic patients with greater than 50-69% stenosis - Benefit is marginal and appears to be greater for male patients

Asymptomatic patients with greater than 60% stenosis - Benefit is significantly less than for symptomatic patients with greater than 70% stenosis

Available literature includes considerable overlap in the percent of stenosis used as the threshold for CEA; in general, symptomatic patients with greater than 50% stenosis and healthy, asymptomatic patients with greater than 60% stenosis warrant consideration for CEA

Symptomatic trials include patients with transient ischemic attacks (TIAs) or minor strokes within 3 months of entry

Contraindications for CEA include the following:

Patients with a severe neurologic deficit after a cerebral infarction

Patients with an occluded carotid artery

Concurrent medical illness that would significantly limit the patient’s life expectancy

For the indications listed above, medical management was found to be inferior to CEA.

Pharmacologic Therapy

Aspirin (30-1350 mg/day) irreversibly acetylates the cyclooxygenase of platelets, thus inhibiting platelet synthesis of thromboxane A2. Prostacyclin production in the endothelium is reduced, but this effect is reversible and short-lived. A reduction in TIAs, stroke, and death in men was shown in the Canadian Cooperative Study Group.[6]

Ticlopidine (250 mg q12h) is a thienopyridine that irreversibly alters the platelet membrane and inhibits platelet aggregation. It is approximately 10% more effective than aspirin. Toxicity includes neutropenia and diarrhea. Clopidogrel (75 mg/day) is similar to ticlopidine; the risk of neutropenia is low.

Warfarin (titrated international normalized ratio [INR] 2-3) use in patients with noncardiac emboli is controversial.

carotid atery stenisis

Surgery is recommended for symptomatic patients who have carotid artery narrowing greater than 70%. Surgery may or may not be of benefit for symptomatic patients whose narrowing is between 50% and 69%.

If the carotid artery is less than 50% narrowed, medical treatment is recommended. This includes stepwise antiplatelet therapy. Platelets are blood cells that help clot blood and in patients who have had symptomatic carotid artery disease, meaning that they have experienced a TIA, and decreasing platelet stickiness may be helpful in minimizing future stroke events. The first line medication is to treat the disease is aspirin. If the patient was already taking an aspirin and still experienced a TIA, the next line medication may be dipyridamole/aspirin combination (Aggrenox) or clopidogrel (Plavix

Statins, a popular set of drugs used to lower cholesterol, can result in muscle weakness and pain, and even debilitating and life-threatening muscle damage.

tatins are much more frequently associated with “mild muscle complaints” including myalgia, cramps and weaknessRABDOMYWLISIS. Myalgia can occur with or without creatine kinase (CK) elevations, a serum marker of muscle damage

Beta-blockers and calcium channel blockers are first-line agents for rate control in AF

ntravenous diltiazem or metoprolol are commonly used for AF

igoxin can be used in the acute setting but does little to control the ventricular rate in active patients

Amiodarone has a class IIa recommendation from the ACC/AHA/ESC for use as a rate-controlling agent for patients who are intolerant of or unresponsive to other agents, such as patients with C

Symptomatic therapy is recommended for patients with acute poststreptococcal glomerulonephritis (APSGN), and it should be based on the clinical severity of the illness. The major goal is to control edema and blood pressure.

During the acute phase of the disease, restrict salt and water. If significant edema or hypertension develops, administer diuretics. Loop diuretics increase urinary output and consequently improve cardiovascular congestion and hypertension.

For hypertension not controlled by diuretics, usually calcium channel blockers or angiotensin-converting enzyme inhibitors are useful. For malignant hypertension, intravenous nitroprusside or other parenteral agents are used.

Other features of therapy are as follows:

Indications for dialysis include life-threatening hyperkalemia and clinical manifestations of uremia

Restricting physical activity is appropriate in the first few days of the illness but is unnecessary once the patient feels well

Steroids, immunosuppressive agents, and plasmapheresis are not generally indicated

A renal biopsy is indicated for patients with rapidly progressive renal failure. If the biopsy findings show evidence of crescentic glomerulonephritis with more than 30% of the glomeruli involved, a short course of intravenous pulse steroid therapy is recommended (500 mg to 1 g/1.73 m2 of methylprednisone qd for 3-5 d). However, no controlled clinical trials have evaluated such therapy. Long-term treatment with steroids or immunosuppressives is not recommended.

Specific therapy for streptococcal infection is an important part of the therapeutic regimen. Throat cultures should be performed on patients, family members, and close personal contacts, and treatment should be provided for all patients found to be infected. Treat with oral penicillin G (250 mg qid for 7-10 d) or with erythromycin (250 mg qid for 7-10 d) for patients allergic to penicillin. This helps prevent nephritis in carriers and helps prevent the spread of nephritogenic strains to others.

Patients with skin infections must practice good personal hygiene. This is essential.

During epidemics, recommend that high-risk individuals, including close contacts and family members, receive empirical prophylactic treatment.

tenia capitis

The posterior interosseous nerve (or dorsal interosseous nerve) is a nerve in the forearm. It is the continuation of the deep branch of the radial nerve, after this has crossed the supinator muscle. It is considerably diminished in size compared to the deep branch of the radial nerve. The nerve fibers originate from cervical segments C7 and C8.

It supplies all the muscles on the radial side and dorsal surface of the forearm, except the Anconæus, Brachioradialis, Extensor carpi radialis longus

interscapuler pain which radiate alone leg is a fx of aneurysm rupture

aortic

aortic desection ...decending aorta 90% of cases

aortograpy us diagnostic

more than 60 year with duadinal ulcer is a indication for early sx

panceeaticvpsudocyst may present as a mass

panceeaticvpsudocyst may present as a mass

uncomplicated young PR bleading ......25cm alone sigmoidescopy to be done b4 treating

ulcerative colitis pracence only in the colon

crohn disease affect any where in GI tract

GRANULOMAS are distinguish feature of crohns Dx.granulomatous enteritis is a synonum for crohns dx

crohns enteritis is a transmural dx. cause

acute or chronic enteritis with cobblestoning

deep fishering and strctures

UC is predominatly mucisal dx with cryptitis

and nonspecific inflamatory changers.

can cause megacolon... strctures and fistula

crohns dx

A risk-stratification model based on C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which are significantly associated with complications of Crohn disease,

Crohn disease is an idiopathic, chronic inflammatory process that can affect any part of the gastrointestinal tract from the mouth to the anus

crohns dx is a systemic dx ,,... affect all the organs

mx of crohns dx

Pharmacotherapy

Medications used in the treatment of Crohn disease include the following:

5-Aminosalicylic acid derivative agents (eg, mesalamine rectal, mesalamine, sulfasalazine, balsalazide)

Corticosteroids (eg, prednisone, methylprednisolone, budesonide, hydrocortisone, prednisolone)

Immunosuppressive agents (eg, mercaptopurine, methotrexate, tacrolimus)

Monoclonal antibodies (eg, infliximab, adalimumab, certolizumab pegol, natalizumab, vedolizumab)

Antibiotics (eg, metronidazole, ciprofloxacin)

Antidiarrheal agents (eg, loperamide, diphenoxylate-atropine)

Bile acid sequestrants (eg, cholestyramine, colestipol)

Anticholinergic agents (eg, dicyclomine, hyoscyamine, propanthelin

Risk factors for the development of a hernia include: smoking, chronic obstructive pulmonary disease, obesity, pregnancy, peritoneal dialysis, collagen vascular disease, and previous open appendectomy, among others.

sx is generally recommended in females due to the higher rate of femoral hernias which have more complications.

Direct inguinal hernias occur medial to the inferior epigastric vessels when abdominal contents herniate through a weak spot in the fascia of the posterior wall of the inguinal canal, which is formed by the transversalis fascia.

e deep inguinal ring, lateral to the inferior epigastric vessels;

indirect inguinal hernia results from the failure of embryonic closure of the deep inguinal ring after the testicle has passed through it

In the female, groin hernias are only 4% as common as in males. Indirect inguinal hernia is still the most common groin hernia for females

lympnote previously infected with TB cause radio opec calcifications in abdominal x rays

acute diveticulitis is common in old age.colon is affect

both hydrocele and epididymal cyst are transiluminent

hydrocele partialy surround the testis. large tense hydrocele often conceal the testis

The appendix testis is a small appendage of normal tissue that is usually located on the upper portion of the testis. The appendix epididymis is a small appendage on the top of the epididymis (a tube-shaped structure connected to the testicle). Torsion of an appendage occurs when this tissue twists.

divetivuler disease is the most common cause for vagina colonic fistula

Mammary Paget disease occurs almost exclusively in women; involvement of the male breast is rarely reported.[1] Patients with Paget disease frequently present with a chronic, eczematous rash on the nipple and adjacent areolar skin.

widely accepted that mammary Paget Disease is always associated with an underlying carcinoma of the breast.

Malignant epithelial (Paget) cells infiltrate and proliferate in the epidermis, causing thickening of the nipple and the areolar skin

These tumorous epithelial cells are derived from luminal lactiferous ductal epithelium of the breast tissue

Mammary Paget cells are malignant epithelial cells derived from underlying ductal adenocarcinoma of the breast that invade into the skin of nipple and areolar areas

Early symptoms and signs of mammary PD include the following:

Excoriation from itching

Resolution and recurrence of small vesicles within the skin lesion

Symptoms of pain, itching, and a burning sensation prompt patients to seek medical attention.

paget disease

Mastectomy (radical or modified) and lymph node clearance are appropriate therapies for patients with mammary Paget disease (PD) with a palpable mass and underlying invasive breast carcinoma.[25] As many as two thirds of patients are reported to have axillary lymph nodes positive for metastasis. Noninvasive breast carcinoma (in situ carcinoma) is found in about 65% of patients with mammary PD without a palpable mass.

Conservative management includes a combination of local excision of the nipple, wedge resection of the underlying breast, and radiation therapy. The number of patients treated by 1 or more conservative measures (eg, nipple excision and wedge excision of the underlying breast, cone excision, radiation therapy) is small.

Patients who underwent cone excision and elective tamoxifen therapy had recurrences after an average follow-up of 4.6 years; some developed metastases. Therefore, cone excision is not sufficient therapy for patients with disease limited to the nipple.

Wide local excision with axillary node sampling is recommended for patients with or without a clinical mass.

Radiation therapy alone does not always control occult breast cancer; however, it may be used for patients who refuse mastectomy or those who are medically unfit for surgery.

Adjuvant chemotherapy is the use of drugs as additional treatment for patients with cancers that are thought to have spread outside their original sites.

intraductal papilima may cau

intraductal papilima can cause breat lump

vericocele more commmoner in left side .

left testis venus drain to left renal vein

symtomatic pulmonary emboli usually occur in Iliofemoral vein

risk of overwelming sepsis 10 fold higher after splenectomy

peumococus , haemophylus influenza and meningococus infecgion are common .

perineum injury easily  cause  to bulbous urethral rupture.it cause Straddle injury

cause fever , extravasation of urine

pneumaturia alwas due to vesico -colic  fistula.

diverticuler dx is the most common cause.

ruptuered bladder never cause pneumat urea

pneumaturia alwas due to vesico -colic  fistula.

diverticuler dx is the most common cause.

ruptuered bladder never cause pneumat urea

Whereas osmolality (with an "ℓ") is a measure of the osmoles (Osm) of solute per kilogram of solvent (osmol/kg or Osm/kg), osmolarity (with an "r") is defined as the number of osmoles of solute per liter (L) of solution (osmol/L or Osm/L).

urine osmolality - Google Search

after supected pelvic fracture and bld in the meatus nevr pass cather directly. do urethograpy to exvlude speciallymembranus urethrzl rupture.

Never do urethoscopy,, it wil futher damage urethra.

intravenus pylogram ,,ureteric stone shows delayed urogrPhic film

ureteric stone intravenous pyelogram - Google Search

gasric out flow obstruction some where at pylorus cause to loss HCL. cause  metabolic alkalosis.  also loss Na and K via vomitus

Renal responce to this is RENAL LOSS of Na and K

 so patient has sever dehydreation with sever loss of Na, K, and Cl,,

This sould be initially replce by Nomal Saline, once reanal perfution stablish large amount of K can directly replace by KCl

DONT USE HARTMAN AS IT CONTAIN k. this K not suffient to replace sever loss of K due to vomiting

not hartman ,

normal saline contain 155mmol of Na and 155mmol of Cl

Gas gangrene (also known as clostridial myonecrosis and myonecrosis) is a bacterial infection that produces gas in tissues in gangrene. This deadly form of gangrene usually is caused by Clostridium perfringens bacteria. It is a medical emergency.

clstridium tetani cause to tetunus

tetuns immunoglobin usually give intra musculerly

accidental ruptured hydated cyst cause sever anaphylasis

blue neavus never cause to cancer ,its entirlly benign.

hamartoma

A hamartoma is a benign  tumor like malformation made up of an abnormal mixture of cells and tissues .

 It is considered a developmental error and can occur at a number of sites.

. A nonneoplastic mass can also arise in this way;

eg..

Peutz-Jeghers polyp of the bowel, juvenile or retention

Polyp of the large bowel

Bronchial hamartoma

Melanocytic nevi

Neurofibromatosis

radio therapy to cervix can esily affectvto rectem..specially colon and intestine radio sensitive

glomus tummor of nail

glomus tumor (glomangioma) is a rare benign neoplasm arising from the glomus body and mainly found under the nail, on the fingertip or in the foot.

its extremly tender

glomus tumour of nail

glomus tumor of nail - Google Search

GCTs of bone have been described as the most challenging benign bone tumors.[2] Although benign, GCTs show a tendency for significant bone destruction, local recurrence, and occasionally metastasis. The natural history of GCTs varies widely and can range from local bony destruction to local metastasis, metastasis to the lung,

Most giant cell tumors (GCTs) are located within the epiphyses of long bones, but they often extend into the metaphysis. I

Approximately 50% of GCTs are located around the knee. The most common locations are the distal femur, the proximal tibia, and the proximal humerus and distal radius

Approximately 50% of GCTs are located around the knee. The most common locations are the distal femur, the proximal tibia, and the proximal humerus and distal radius (see the image below). Most commonly, GCTs are solitary lesions;

Basal cell carcinoma (BCC) is a nonmelanocytic skin cancer (ie, an epithelial tumor) that arises from basal cells (ie, small, round cells found in the lower layer of the epidermis). The prognosis for patients with BCC is excellent,

fx of basal cell CA

Signs and symptoms

BCC occurs mostly on the face, head (scalp included), neck, and  hand

Waxy papules with central depression

Pearly appearance

Erosion or ulceration: Often central and pigmented

Bleeding:

Telangiectases over the surface

Slow growing: 0.5 cm in 1-2 years

Black-blue or brown areas

Periocular tumors most commonly involve

Lower eyelid: 48.9-72.1%

Medial canthus: 25-30%

Upper eyelid: 15%

Lateral canthus: 5%

BCC, surgery is the recommended treatment modality.[2, 3, 4] Techniques used include the following[5] :

Electrodesiccation and curettage

Excisional surgery

Mohs micrographically controlled surgery

Cryosurgery

Radiation therapy

BCCs are usually radiosensitive; radiation therapy (RT) can be used in patients with advanced and extended lesions,

pilonidal disease describes a spectrum of clinical presentations, ranging from asymptomatic hair-containing cysts and sinuses to large symptomatic abscesses of the sacrococcygeal region that have some tendency to recur.[

pinoidal sinus

It has been postulated that hair penetrates into the subcutaneous tissues through dilated hair follicles, which is thought to occur particularly in late adolescence, though follicles are not found in the walls of cysts. A sinus develops with a short tract

Pilonidal disease can present in a couple of different disease states, but the most common seen in the ED is a painful, swollen lesion in the sacrococcygeal region about 4-5 cm posterior to the anal orifice.

fournier gangrene

rapidly progressive gangrene of the penis and scrotum without apparent cause. This condition, which came to be known as Fournier gangrene, is defined as a polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas (

common microorganisms cauaing fournior gangren

mix groqth of gram poaitive ..gram negative and anarobs

Streptococcal species

Staphylococcal species

Enterobacteriaceae

Anaerobic organisms

Fungi

treatment for Fournior gangren

Treatment of Fournier gangrene involves the institution of broad-spectrum antibiotic therapy. The antibiotic spectrum should cover staphylococci, streptococci, the Enterobacteriaceae family of organisms, and anaerobes.

A reasonable empiric regimen might consist of ciprofloxacin and clindamycin. Clindamycin is particularly useful in the treatment of necrotizing soft-tissue infections because of its gram-positive and anaerobic spectrum of activity. In animal models of streptococcal infection, clindamycin has been shown to yield response rates superior to those of penicillin or erythromycin, even in the context of delayed treatment.[47]

Other possible choices include ampicillin/sulbactam, ticarcillin/clavulanate, or piperacillin/tazobactam in combination with an aminoglycoside and metronidazole or clindamycin. Vancomycin can be used to provide coverage for methicillin-resistant Staphylococcus aureus (MRSA).

In cases associated with sepsis syndrome, therapy with intravenous immunoglobulin (IVIG), which is thought to neutralize superantigens (eg, streptotoxins A and B) believed to mitigate the exaggerated cytokine response, has been shown to be a good adjuvant to appropriate antibiotic coverage and complete surgical debridement.[48]

If initial tissue stains (ie, potassium hydroxide [KOH] stain) show fungi, add an empiric antifungal agent such as amphotericin B or caspofungin.

thyroglossal cyst is a remnant of thyroglossal duct

most cyst related closely hyoid bone

thyroglossal cyst join the hyoid bone and moves upwards with tye hyoid while swallowing and when the toung is protruded

2 most common complications of TDC are infection and malignancy,

In 80% of cases, TDC carcinoma is of papillary cell origin

Lymphatic malformations, which include lymphangioma and cystic hygroma, are areas of localized abnormal development of the lymphatic system

Treatment for a thyroglossal cyst is called the Sistrunk procedure: surgical resection of the duct to the base of the tongue and removal of the central portion of the hyoid bone.

benign noduler goiter

A nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function

Radioactive iodine therapy - Radioiodine therapy of nontoxic goiters is often performed in Europe. It is a reasonable therapeutic option, particularly in patients who are older or have a contraindication to surgery

pproximately 90% of oral cancers are squamous cell carcinoma (SCC),

lowel lip cancers are much commer than upper lip cancers as it cause it the the most sun exposure lip

Oral squamous cell carcinoma (OSCC) currently is treated largely by surgery and/or irradiation, although few unequivocal controlled trials of treatment modalities have been conducted

submandibuler calculi are almost always radio opeque

sialogram for sub mandibuler stone are unnecessery in making diagnosis.

best Void. plain x ray enough

it may helpful in condition like'' sialectasis.''.!,

pharingio oesophagial diverticulaa( Zenker divericuler)

folse diverticulerm= mucos and submucosa without musculer covering

usuallu posterior midline of pharyn

dysphagia is main symptom

aspiration pneumonia common

 elderly population specially male are commo

diagnosis usualluy maid by barium swallow

ulner nerve plasy cause reduction  power of flexion of wrist

neropathic (charcot) joint czn occur due to DM, syringomilia, tebes dorsalis of syphylis( posterior collom affect)

leteral rectus=( eye move laterally)  6th nerve

superior oblique= eye move downward and in ward 4th nerve

other all mucle(superir and inferior recti ,inferior oblique,imedial recti) =by 3rd nerve

3rd nerve also suply atonomic fibersto pupillo constrictor muscle

from Edingo Wesphal neuckeus

3RD NERVE LESION CAUSE

1.Opthalmoplegia aportvrom outward lateral gaze

2.divergent squint(downward and out ward eye)

3.dialated pupils unrespose to light or accommodation

2.

Ophthalmoplegia is the paralysis or weakness of the eye muscles. I

corneal reflex given by 5th and 7 th nerve

Stress fractures are tiny cracks in a bone. Stress fractures are caused by the repetitive application of force, often by overuse

common site are

1.upper tibia

2.first rib

3.neck of the seconf metatasal

dupuytren contracture

contracture /fibrosis of palmar facia

painless

only in MEN

rarely affect foot

A Smith's fracture, also sometimes known as a reverse Colles' fracture or Goyrand-Smith's, is a fracture of the distal radius.[1] It is caused by a direct blow to the dorsal forearm[2] or falling onto flexed wrists, as opposed to a Colles' fracture which occurs as a result of falling onto wrists in extension. Smith's fractures are less common than Colles' fractures.

smith fracture - Google Search

smith fracture - Google Search

Bennett fracture is a fracture of the base of the first metacarpal bone which extends into the carpometacarpal (CMC) joint.[1] This intra-articular fracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocation of the carpometacarpal joint.