Medications that facilitate the metabolism of dexamethasone, such as phenobarbital, phenytoin, and rifampin, may cause false-positive results with the dexamethasone suppression test.

urothelial tumour should be treated with neproureterectomy.

IT IS NOT NEPHRECTOMY,

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.

left side affect more than right

may present with knee pain

supra condyler fracture

The clinical presentation is that of a painful swollen elbow that the patient is hesitant to move. The elbow may appear angulated and the upper extremity shortened. Some series report that open wounds are present in as many as 30% of these fractur

Erb's palsy affects nerves arising from C5 and C6.

erb's palsy

absent moro reflex

c5 c6 injury

arm hangs limp in adduction

rotated internally at shoulder

extened and pronated at elbow

flex at wrist

cocaine intoxication

most differentiating feature is very high gread fever 41c

anxiety

 agitation

pania

aggression

confusion headache blured vition

dialated pupils

heightened reflexus

abdominal pai vomiting muscle twitching treamers loss pf cordination elevated BP arrythmia

restlessness,yawning,tears, runny nose, goose bumps

law bp diarrhea, abdominal crams

leg cramps

herroin withdrowal symptoms worst after 4 days

but subsided after 7 days

todlers has highest risk of iron def aneamia due to weaning

bening brest ca fibroadenoma investigation by tripple

1.clinical hx

2. imagine..  here uss

 3.cytology,.. here FNAC and hisyology here core bx

Paranoid personality disorder (PPD) is a mental disorder characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others.

Grandiosity refers to an unrealistic sense of superiority

pinhole

occluder is a simple way to focus light, as in a pinhole camera, temporarily removing the effects of refractive errors such as myopia

renal atery stenosis is a hdriditory dx which affecting to young women

Depersonalization disorder is marked by periods of feeling disconnected or detached from one's body and thoughts (depersonalization). The disorder is sometimes described as feeling like you are observing yourself from outside your body or like being in a dream.

The Capgras delusion (or Capgras syndrome) (/kæpˈɡrɑː/, US dict: kăpgrâ′)[1] is a disorder in which a person holds a delusion that a friend, spouse, parent, or other close family member (or pet) has been replaced by an identical-looking impost

Temporal lobe epilepsy is a chronic neurological condition characterized by recurrent, unprovoked epileptic seizures (epilepsy) which originate in the temporal lobe of the brain. The seizures involve sensory changes; for example, smelling an unusual odor that is not there (an olfactory illusion), or a memory disturbance.

dislocated acromir claviculer joint

step deformity of dislocqted acromier vlabiculer jnt

2nd dgree heart block and digitalis toxicity

morbitz type 1  comonly  due to digitalis

morbitz type 2 rarely due to that

poly cystic kidney Dx is autosomal dominenet condition

analgesic nepropathy present in 5th and 6th decade of life

tamoxifen cause endometrial atropy

first line antibiotic for bacterial conguntivitis is CHLORAMPHENICOL

secondline gentamicine..streptomycine..

tobamicine is broadsprectum antibiotic for bacyirial conjuntibitis

Colposcopy (Ancient Greek: κόλπος kolpos "hollow, womb, vagina" + skopos "look at") is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva.[1] Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination. It is done using a colposcope,

Most women undergo a colposcopic examination to further investigate a cytological abnormality on their Pap smears.

anaroxia nervisa

hypothermia

 bradicardia

 parotid gland hypertopy

urechal cyst

 congemital

 lower abdominal swelling

 some time urine pass through bladder

peptic ulcer

66% h.pylori

33% due to NSAID

normal elderly dementia minimental score more than 26

side effect of thiaside diuretic isSIADH..it cause law potassium

sorry..should be law Na

moter neurone disease vomonly affect after 50 years specially for men

fetal lung maturity can be done by amniocentasis

no spleeenomehaly in ITP

SLE cause ITP and spleenomegaly

measure endometrial thinkness (4mm)  following post menoposal bleeding is aprpriate fornyounger post menoposal women.nif pt is more than 70 dirwctly do hysteroscopy and D and c

hydated cyst.. by echinovocus granulosus

echinococus granulosus contral by dog, and sheep ect dewormin..no vacination

brow presentation with nulliparus women almost always obstructed labour

mild hyperhydrosis manage by antipersprrants contaning alminium clorid

more sever cases tx with sympatholytic,anxiolytic and sedative

longer term side effect of stellate ganglian block are Honer syndrome and gustatory sweting

Scarlet fever (known as scarlatina in older literature references) is a syndrome characterized by exudative pharyngitis (see the image below), fever, and bright-red exanthem. It is caused by streptococcal pyrogenic exotoxins (SPEs) types A, B, and C produced by group A beta-hemolytic streptococci (GABHS) found in secretions and discharge from the nose, ears, throat, and skin. Scarlet fever may follow streptococcal wound infections or burns, as well as upper respiratory tract infections. Food-borne outbreaks have been reported

scarlet fever

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.

Iron deficiency is a common health problem. High-risk groups include menstruating women, pregnant and lactating women, babies and toddlers, teenage girls and female athletes. Without intervention, a person whose dietary intake of iron is inadequate to meet their body’s needs will eventually deplete their iron stores and develop iron deficiency anaemia

Primary tumours most frequently encountered as metastases to the skull include 2:

breast cancer

lung cancer

melanoma

prostate cancer

thyroid cancer (usually follicular)

renal cell cancer

lymphoma

leukaemia

multiple myeloma

In children both neuroblastoma (skull metastases are not infrequently the first sign of disease) and Ewing sarcoma are encountered.

Microscopic analysis in pseudogout shows calcium pyrophosphate (CPP) crystals

Pityriasis rosea (PR) is a benign rash first described by Gilbert in 1860; the name means “fine pink scale.” It is a common skin disorder observed in otherwise healthy people, most frequently children and young adults. Other types of similar skin eruptions include lichen planus, psoriasis, and pityriasis rubra pilaris.

PR manifests as an acute, self-limiting, papulosquamous eruption with a duration of 6-8 weeks. It evolves rapidly, usually beginning with patch that heralds the eruption, the so-called “herald patch” (see the image below). It may sometimes occur in atypical variants or may mimic other skin disorders, such as tinea corporis and secondary syphilis.

The most common origins of brain metastasis are systemic cancer of the lung, breast, skin, or GI tract. In 2700 cases from the Memorial Sloan-Kettering Cancer Center in New York, the distribution of primary cancers was as follows: 48% lung, 15% breast, 9% melanoma, 1% lymphoma (mainly non-Hodgkin), 3% GI (3% colon and 2% pancreatic), 11% genitourinary (21% kidney, 46% testes, 5% cervix, 5% ovary), 10% osteosarcoma, 5% neuroblastoma, and 6% head and neck tumor. Of note, renal, GI, and pelvic cancers tend to metastasize to the cerebellum, whereas breast cancer most commonly affects the posterior pituitary. Cancer-cell trafficking may not be entirely random, and factors produced by stromal cells may guide their final destination in the brain.

Table 1 shows other data for sources of brain metastases.

Table 1. Sources of Primary Tumor in Brain Metastases (Open Table in a new window)

Primary lung tumors account for 50% of all metastatic brain tumors. Lung cancer is the most common origin of metastatic disease. Of lung cancer patients who survive for more than 2 years, 80% will have brain metastases.

The average time interval between the diagnosis of primary lung cancer and brain metastases is 4 months. Interestingly, small cell carcinomas, which are only 20% of all lung cancers, account for 50% of brain metastases from lung cancer. In a retrospective study, 6.8% of the first cancer recurrence was in the

Medications to treat constipation include the following:

Bulk-forming agents (fibers; eg, psyllium): arguably the best and least expensive medication for long-term treatment

Emollient stool softeners (eg, docusate): Best used for short-term prophylaxis (eg, postoperative)

Rapidly acting lubricants (eg, mineral oil): Used for acute or subacute management of constipation

Prokinetics (eg, tegaserod): Proposed for use with severe constipation-predominant symptoms

Stimulant laxatives (eg, senna): Over-the-counter agents commonly but inappropriately used for long-ter

methilnaltexone

Although Raynaud phenomenon has been described with various autoimmune diseases, the most common association is with progressive systemic sclerosis (90% in individuals with scleroderma) and mixed connective-tissue disease (85% prevalence). Raynaud phenomenon has also been described with such diverse diseases as systemic lupus erythematosus and other disorders not classified as autoimmune, including frostbite, vibration injury, polyvinyl chloride exposure, and cryoglobulinemia.

protein C deficiency

rare autosomal dominent genetic disoder .increase insident of venous thrombo embolism

The main function of protein C is its anticoagulant property as an inhibitor of coagulation factors V and VIII.

Protein C is vitamin K-dependent. Patients with Protein C deficiency are at an increased risk of developing skin necrosis while on warfarin.

IgA nephropathy is most often associated with microscopic hematuria or recurrent macroscopic hematuria, and spontaneously resolving acute kidney injury can occur

), persistent depressive disorder (dysthymia) represents a consolidation of DSM-IV defined chronic major depressive disorder and dysthymic disorder

The classic presentation of a cSCC is that of a shallow ulcer with heaped-up edges, often covered by a plaque, usually in a sun-exposed area. Typical surface changes may include the following:

Scaling

Ulceration

Crusting

A cutaneous horn

3rd day blues

Women who report inadequate social supports, marital discord or dissatisfaction, or recent negative life events, such as a death in the family, financial difficulties, or loss of employment, are more likely to experience postpartum depression

Furthermore, women with a previous history of postpartum depression or psychosis have a risk of recurrence of up to 90%

Postpartum blues, also known as "baby blues," affect approximately 50% to 80% of new mothers

Postpartum blues, also known as "baby blues," affect approximately 50% to 80% of new mothers. Symptoms may include mood swings with times of feeling anxious, irritable, or tearful interspersed with times of feeling well. Sleeping difficulties may also occur. The symptoms usually begin 3-4 days after delivery, worsen by days 5-7, and tend to resolve by day 12. For symptoms that last longer than 2 weeks, it is important for the individual to seek medical attention, since approximately 1 in 5 women with postpartum blues develop postpartum major depression

Postpartum blues, also known as "baby blues," affect approximately 50% to 80% of new mothers. Symptoms may include mood swings with times of feeling anxious, irritable, or tearful interspersed with times of feeling well. Sleeping difficulties may also occur. The symptoms usually begin 3-4 days after delivery, worsen by days 5-7, and tend to resolve by day 12. For symptoms that last longer than 2 weeks, it is important for the individual to seek medical attention, since approximately 1 in 5 women with postpartum blues develop postpartum major depression.

Sjögren's syndrome or Sjögren syndrome (pronounced /ˈʃoʊɡrᵻn/ or /ˈʃɜːrɡrɛn/[1] in English, the latter to approximate the Swedish pronunciation [ˈɧøːɡreːn]) is a chronic autoimmune disease in which the body's white blood cells destroy the exocrine glands, specifically the salivary and lacrimal glands, that produce saliva and tears, respectively.[2] The immune-mediated attack on the salivary and lacrimal glands leads to the development of xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes), which takes place in association with lymphocytic infiltration of the glands.[3] That inflammatory process eventually severely damages or destroys the glands.

Presbycusis is the loss of hearing that gradually occurs in most individuals as they grow older. Hearing loss is a common disorder associated with aging. About 30-35 percent of adults age 65 and older have a hearing loss.

common causes for senso neuronal hearing loss is presbycusis(aging),meniers dx, acostic neuroma

hiv infect2d patient should take influ3nza vacine ..but not freee

REGRESSION.....,.2nd  sibling family ekata avata passe loku baba choo daagannava vage

Regression (German: Regression), according to psychoanalyst Sigmund Freud, is a defense mechanism leading to the temporary or long-term reversion of the ego to an earlier stage of development rather than handling unacceptable impulses in a more adult way. The defense mechanism of regression, in psychoanalytic theory, occurs when an individual's personality reverts to an earlier stage of development, adopting more childish mannerisms.[

reaction formation

Reaction Formation occurs when a person feels an urge to do or say something and then actually does or says something that is effectively the opposite of what they really want.

It also appears as a defense against a feared social punishment. If I fear that I will be criticized for something, I very visibly act in a way that shows I am personally a long way from the feared position.

A common pattern in Reaction Formation is where the person uses ‘excessive behavior’, for example using exaggerated friendliness when the person is actually feeling unfriendly.

Example

A person who is angry with a colleague actually ends up being particularly courteous and friendly towards them.

A man who is gay has a number of conspicuous heterosexual affairs and openly criticizes gays.

A mother who has a child she does not want becomes very protective of the child.

An alcoholic extols the virtues of abstinence.

Discussion

regression

Regression involves taking the position of a child in some problematic situation, rather than acting in a more adult way. This is usually in response to stressful situations, with greater levels of stress potentially leading to more overt regressive acts.

Regressive behavior can be simple and harmless, such as a person who is sucking a pen (as a Freudian regression to oral fixation), or may be more dysfunctional, such as crying or using petulant arguments..

Example

A wife refuses to drive a car even though it causes the family much disorganization. A result of her refusal is that her husband has to take her everywhere.

A person who suffers a mental breakdown assumes a fetal position, rocking and crying.

A child suddenly starts to wet the bed after years of not doing so (this is a typical response to the arrival of a new sibling).

A college student carefully takes their teddy-bear with them (and goes to slee

Description

'Acting out' means literally means acting out the desires that are forbidden by the Super ego and yet desired by the Id. We thus cope with the pressure to do what we believe is wrong by giving in to the desire.

A person who is acting out desires may do it in spite of their conscience or may do it with relatively little thought. Thus the act may be being deliberately bad or may be thoughtless wrongdoing.

Where the person knows that they are doing wrong, they may seek to protect themselves from society's eyes by hiding their action. They may also later fall into using other coping mechanisms such as Denial to protect themselves from feelings of shame.

Example

An addict gives in to their desire for alcohol or drugs. A person who dislikes another person seeks to cause actual harm to them.

Discussion

compensation

Where a person has a weakness in one area, they may compensate by accentuating or building up strengths in another area. Thus when they are faced with their weakness, they can say 'ah, but I am good at...', and hence feel reasonably good about the situation.

Compensation may also occur in ad hoc situations, for example where a person does not get a joke, they may compensate by hearty laughter or by feigning disinterest.

Example

People who feel inferior because they are short may train hard to be very strong.

People who are not intellectually gifted may turn their attention to social skills.

placenta previa gread 1 and 2bcan deliver vaginaly

Acute fatty liver of pregnancy (AFLP) is a serious complication unique to pregnancy first described by Sheehan in 1940.[1] It is characterized by microvesicular steatosis in the liver. The foremost cause of AFLP is thought to be due to a mitochondrial dysfunction in the oxidation of fatty acids leading to an accumulation in hepatocytes. The infiltration of fatty acids causes acute liver insufficiency, which leads to most of the symptoms that present in this condition.

schizophrenia

late onset sp is after 45 ers of age

they hv more persecutory delusions

negative symptoms and thought disorder are less

no remissions

resposnce to law dose of antipsychotic

persecure mean karadara hinda karanava

Community-acquired pneumonia (CAP) is one of the most common infectious diseases and is an important cause of mortality and morbidity worldwide. Typical bacterial pathogens that cause the condition include Streptococcus pneumoniae (penicillin-sensitive and -resistant strains), Haemophilus influenza (ampicillin-sensitive and -resistant strains), and Moraxella catarrhalis (all strains penicillin-resistant). See the images below.

CAP may be treated with monotherapy or combination therapy. Effective monotherapy antibiotics include the following[15, 16, 17, 18] :

Doxycycline

Respiratory quinolones

Combination therapy usually consists of ceftriaxone plus doxycycline or azithromycin. Immunocompromised hosts who present with CAP are treated in the same manner as otherwise healthy hosts but may require a longer duration of therapy.

Inpatient therapy for CAP is usually with IV antibiotics, followed by an oral course of therapy for a total of 14 days

An instinct is something you don't need to learn — it happens naturally, without you even thinking about it. Babies cry by instinct, and ducks follow their mother by instinct. Animals and humans learn a lot of things from other animals and humans.

Intellectualization is a defense mechanism where reasoning is used to block confrontation with an unconscious conflict and its associated emotional stress where thinking is used to avoid feeling. It involves removing one's self, emotionally, from a stressful event.

haemocromayosis

iron overload disorders is to remove the iron before it can produce irreversible parenchymal damage.[8]  This is achieved via chelation therapy or venesection, depending on the underlying cause.[8

Phlebotomy is venesection

Cirrhosis reversibility after iron removal has been reported, usually early in the course of liver disease, although reversal of advanced liver disease with varices has also been reported