Stummering male to female ratio is 3:1

Recovery typycally ocvur b4 the age of 16

speach and language disorder is central feature of intantile autisum

oblique palpebral fissures - Google Search

high arch palate and oblique palpebral fissure are fx of down sx

down syndrome genetics - Google Search

down syndrom

94% of cases are due to trisomi 21. due to meotic non disjunction

risk of recurrence 1%

4% due to  translocation involving cromosome 21 .subsequent risk is 1

1% due to mosaicism. subseuent risk is %. subseq

down sx

incidence (without antenatal screening) in live-born infants is about 1 in 650.

Before blood is sent for analysis, parents should be informed that a test for Down syndrome is being performed. The results may take 1–2 days, using rapid FISH (fluorescent in situ hybridisation) techniques.

down

At least 50% of affected individuals live longer than 50 years.

Children with Down syndrome are at increased risk of hypothyroidism, impairment of vision and hearing and of atlanto-axial instability.

The incidence of trisomy 21 due to non-disjunction is related to maternal age (Table 8.1). However, as the proportion of pregnancies in older mothers is small, most affected babies are born to younger mothers.

Furthermore, meiotic non-disjunction can occur in spermatogenesis so that the extra 21 can be of paternal origin

After having one child with trisomy 21 due to non-disjunction, the risk of recurrence of Down syndrome is given as 1 in 200 for mothers under the age of 35 years, but remains similar to their age-related

Huntington's disease (HD) is a neurodegenerative genetic disorder that affects muscle coordination and leads to mental decline and behavioral symptoms.[1] Symptoms of the disease can vary between individuals and affected members of the same family, but usually progress predictably. The earliest symptoms are often subtle problems with mood or cognition.

Physical abilities gradually worsen until coordinated movement becomes difficult. Mental abilities generally decline into dementia.

HD is the most common genetic cause of abnormal involuntary writhing movements called chorea, which is why the disease used to be called Huntington's chorea. The disease is caused by an autosomal dominant mutation in either of an individual's two copies of a gene called Huntingtin

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 impostor. The Capgras delusion is classified as a delusional misidentification syndrome, a

The most common syndromes are Capgras and Fregoli. Capgras syndrome is the delusional belief that a friend, family member, etc., has been replaced by a twin impostor. Fregoli syndrome is the delusional belief that different people are in fact a single person who is in disguise.

erotomania

ɪˌrɒtə(ʊ)ˈmeɪnɪə/

noun

excessive sexual desire.

PSYCHIATRY

a delusion in which a person (typically a woman) believes that another person (typically of higher social status) is in love with them.

erotomania=de clerambault syndrome

Erotomania is a type of delusional disorder where the affected person believes that another person is in love with him or her. This belief is usually applied to someone with higher status or a famous person, but can also be applied to a complete stranger

ligigation mean

Litigation. An action brought in court to enforce a particular right

In the legal profession and courts, a querulant (from the Latin querulus - "complaining") is a person who obsessively feels wronged, particularly about minor causes of action. In particular the term is used for those who repeatedly petition authorities or pursue legal actions based on manifestly unfounded grounds. These applications include in particular complaints about petty offenses.

paranoid

​feeling ​extremely ​nervous and ​worried because you ​believe that other ​people do not like you or are ​trying to ​harm you

Passivity experiences are hallmark symptoms of schizophrenia that can be characterized by the belief that one's thoughts or actions are controlled by an external agent.

3 types of auditory hallucinations... 1.

There are three main categories into which the hearing of talking voices can often fall: a person hearing a voice speak one's thoughts, a person hearing one or more voices arguing, or a person hearing a voice narrating his/her own actions.[4] These three categories do not account for all types of auditory hallucinations.

af

Rate control

Rate control to a target heart rate of 110 bpm is recommended in most people.[51] Lower heart rates may be recommended in those with left ventricular hypertrophy or reduced left ventricular function.[52] Rate control is achieved with medications that work by increasing the degree of block at the level of the AV node, decreasing the number of impulses that conduct into the ventricles. This can be done with:[13][53]

Beta blockers (preferably the "cardioselective" beta blockers such as metoprolol, atenolol, bisoprolol, nebivolol)

Non-dihydropyridine calcium channel blockers (e.g., diltiazem or verapamil)

Cardiac glycosides (e.g., digoxin) – have less use, apart from in older people who are sedentary. They are not as good as either beta blockers or calcium channel blockers.[6]

In those with chronic disease either beta blockers or calcium channel blockers are recommended.[51]

In addition to these agents, amiodarone has some AV node blocking effects (in particular when administered intravenously), and can be used in individuals when other agents are contraindicated or ineffective (particularly due to hypotension).

coronary cerculation

anterior intraventr7culer atery=left anterior decending atery LaD

coronary blood supply - Google Search

gonorrhea

urethra (the tube that drains urine from the urinary bladder)

eyes

throat

vagina

anus

female reproductive tract (the fallopian tubes, cervix, and uterus)

emedicine.medscape.com/article/218059-images?imageOrder=1

gonorrhea ix

Culture is the most common diagnostic test for gonorrhea, followed by the deoxyribonucleic acid (DNA) probe and then the polymerase chain reaction (PCR) assay and ligand chain reaction (LCR). The DNA probe is an antigen detection test that uses a probe to detect gonorrhea DNA in specimens.

Specific culture of a swab from the site of infection is a criterion standard for diagnosis at all potential sites of gonococcal infection. Cultures are particularly useful when the clinical diagnosis is unclear, when a failure of treatment has occurred, when contact tracing is problematic, and when legal questions arise.

In patients who may have DGI, all possible mucosal sites should be cultured (eg, pharynx, cervix, urethra, rectum), as should blood and synovial fluid (in cases of septic arthritis). Three sets of blood cultures should also be obtained.

uncomplicated urogenital, anorectal, and pharyngeal gonococcal infection, a drug regimen using ceftriaxone plus either azithromycin or doxycycline may be used. Antimicrobial drugs used alone or in various combinations in other gonococcal infections include the following:

Gonococcal conjunctivitis

Treatment recommendations for adults are single doses of ceftriaxone 1 g IM plus azithromycin 1 g PO with saline irrigation.[1, 51] Topical antibiotic solutions may also be considered. If the cornea is involved or if corneal involvement cannot be excluded due to lid swelling or chemosis, some physicians treat with a 3-day course of IV antibiotics (eg, ceftriaxone 1 g IV q12-24h).[52]

HPV vaccine: is for all adolescents aged between 12 and 13 years. Contact your State or Territory Health Department for details on the school grade eligible for vaccination.

Marfan syndrome (MFS) is a spectrum of disorders caused by a heritable genetic defect of connective tissue that has an autosomal dominant mode of transmission.

marfence

most severe of these clinical problems include aortic root dilatation and dissection,

ransient global amnesia (TGA) has been a well-described phenomenon for more than 40 years. Clinically, it manifests with a paroxysmal, transient loss of memory function. Immediate recall ability is preserved, as is remote memory; however, patients experience striking loss of memory for recent events and an impaired ability to retain new information. In some cases, the degree of retrograde memory loss is mild.

ma6 be due to blood flow distruptio to  brain

Brain MRI and/or CT scan

Any patient presenting with features of transient global amnesia should receive an imaging test to rule out a stroke possibility, especially if significant risk factors are present

MRI with DWI can readily demonstrate acute ischemic changes early and guide management. In one study,

If an MRI cannot be obtained readily, then at least a CT scan should be done initially if the patient is presenting to an emergency department.

ECG, EEG

These tests are important if the diagnosis of TGA is in doubt. If symptoms have occurred more than once, then at least a routine EEG should be done to help investigate a seizure possibility by demonstrating any interictal activity.

Difficulties with using the toilet, accidents and incontinence can all be problems for people with dementia, particularly as the condition progresses. These problems can be upsetting for the person and for those around them.

papuwa newginiya  malaria preventiom

CDC - Malaria - Travelers - Choosing a Drug to Prevent Malaria

ovarian cyst  managment

Treatment

Approach Considerations

Epidemiologic studies from the 1970s-1990s reported inverse relationships between oral contraceptive pill (OCP) use and surgically confirmed functional ovarian cysts. Short-term treatment with OCPs was thus used for initial management of ovarian cysts.

However, meta-analyses have since shown that there is no difference between OCP use and placebo in terms of treatment outcomes in ovarian cysts and that these masses should be monitored expectantly for several menstrual cycles. If a cystic mass does not resolve after this timeframe, it is unlikely to be a functional cyst, and further workup may be indicated.[41]

Many patients with simple ovarian cysts based on ultrasonographic findings do not require treatment. In a postmenopausal patient, a persistent simple cyst smaller than 5cm in dimension in the presence of a normal CA125 value may be monitored with serial ultrasonographic examinations.[3] {[63] Some evidence suggests that cysts up to 10cm can be safely followed in this way.

Premenopausal women with asymptomatic simple cysts smaller than 8cm on sonograms in whom the CA125 value is within the reference range may be monitored, with a repeat ultrasonographic examination in 8-12 weeks. Hormone therapy, including, as stated above, the use of the OCPs, is not helpful in resolving the cyst.[41]

Fetal and Neonatal Cysts

In female newborns, ovarian cysts are the most frequent type of abdominal tumor, with an estimated incidence of more than 30%.[19, 14]

Fetal ovarian cysts are believed to be caused by hormonal stimulation, such as fetal gonadotropins,

maternal estrogen, and placental hCG. In addition, an association between fetal ovarian cysts and maternal diabetes and fetal hypothyroidism has been identified.

Most fetal ovarian cysts are small and involute within the first few months of life and are not of clinical significance. They are generally diagnosed in the third trimester of pregnancy, and most tend to resolve at 2-10 weeks postnatally.[14]

Differential diagnoses of these cysts include urachal cysts, intestinal duplication abnormalities, cystic teratoma, and intestinal obstruction. Intrauterine ultrasonography is necessary to differentiate ovarian cysts from these other possibilities.[19]

Aspiration of these cysts can be performed but is associated with complications, such as reformation of cyst, infection, and premature labor.[14]

Once the diagnosis of a fetal ovarian cyst is made, it is important to perform serial ultrasonographic examinations to detect any structural changes in size or appearance or complications, such as hydramnios, ascites, or torsion.[19]

Of these complications, ovarian torsion is the most serious complication of a fetal ovarian cyst and may manifest as fetal tachycardia due to peritoneal irritation.

Proper management includes serial ultrasonography to look for signs of regression or postnatal surgery if the cyst is complicated or larger than 5 cm in diameter.[14]

Ovarian Cysts in Pregnancy

The corpus luteum is responsible for progesterone production during pregnancy and normally regresses at around 8 weeks’ gestation.[12]

Most pregnancy-associated cysts, such as corpus luteal and follicular cysts, resolve by gestational age 14-16 weeks and are hormonally responsive, allowing conservative management.[12] By gestational age 16-20 weeks, up to 96% of masses resolve spontaneously. Simple cysts smaller than 6 cm in diameter have a risk of malignancy of less than 1%.[23]

Corpus luteal cysts tend to be larger and more symptomatic than follicular cysts and are more prone to hemorrhage and rupture. Follicular cysts are usually smaller, with internal hemorrhage being relatively uncommon.

Masses that persist longer may warrant further workup for potential neoplastic disease based on clinical findings and radiologic evidence.[12] Serum CA125 studies are not recommended in pregnancy, as levels can fluctuate widely in normal pregnancy, particularly in the first and second trimesters, and can be elevated in many benign conditions. One group suggests observation, with postpartum surgery in select patients who have large, persistent adnexal masses in whom ultrasonographic findings are not highly suggestive of malignancy.[5] However, in situations in which cysts are symptomatic, including causing pain and discomfort, or with rapid growth on serial ultrasound, surgical removal should be considered.

If malignancy is a possibility and peripartum surgery is warranted, the risk of harming the pregnancy is weighed against a delay in treatment, but surgery is generally delayed until the mid-second trimester, when most cysts have resolved.[23]

Some ovarian conditions unique to pregnancy include the hyperstimulated ovary, ovarian hyperstimulation syndrome, hyperreactio luteinalis, theca-lutein cysts, and luteoma of pregnancy. Hyperstimulated ovaries represent a normal ovarian response to circulating hCG levels and are typically seen in women who have undergone ovulation induction.

Postmenopausal Ovarian Cysts

Most studies estimate the prevalence of simple, unilocular adnexal cysts in asymptomatic, postmenopausal women at 3-18%, with most of these cysts being smaller than 5cm in diameter.

Early studies indicated the risk of malignancy for these asymptomatic adnexal cysts in postmenopausal patients to be as high as 7%, but subsequent studies showed the prevalence to be less than 1% in small cysts.[24]

In these patients, repeat ultrasonography at 4-6 weeks can be performed along with CA125 studies in an outpatient setting. Half of asymptomatic cysts smaller than 5 cm resolve in 2 months, but rising CA125 levels or increasing cyst size or complexity may warrant surgery.

Follow-up care is important, as the risk of an ovarian neoplasm being malignant rises from 13% in premenopausal patients to 45% in postmenopausal patients.[18]

Bilateral oophorectomy

Bilateral oophorectomy and, often, hysterectomy are performed in many postmenopausal women with ovarian cysts because of the increased incidence of neoplasms in this population.

Transfer

When a female patient presents in the emergency department (ED) with abdominal pain and signs or symptoms of an intraperitoneal process of unclear etiology, transfer is indicated if any of the following conditions are met:

Backup surgical, obstetric, or gynecologic support is not available to the ED

Operative capacity is not available at the health-care delivery site

Imaging capacity is not available at the facility

Unstable patients should not be transferred unless the facility is truly unable to provide appropriate treatment or evaluation. The patient is the responsibility of the transferring physician until her arrival at the next hospital.

Laparotomy and Laparoscopy

Persistent simple ovarian cysts larger than 5-10 cm, especially if symptomatic, and complex ovarian cysts should be considered for surgical removal.

The surgical approaches include an open incisional technique (laparotomy) and a minimally invasive technique (laparoscopy) with very small incisions. Whichever method is used, the goals remain the same; they include the following:

To confirm the diagnosis of an ovarian cyst

To assess whether the cyst appears to be malignant

To obtain fluid from peritoneal washings for cytologic assessment

To remove the entire cyst intact for pathologic analysis - This may mean removing the entire ovary

To assess the opposite ovary and other abdominal organs

To perform additional surgery as indicated

The use of laparoscopic techniques is becoming widespread, and the indications are extending. Laparoscopy is preferred to laparotomy when indicated because it has less adverse effects for the patient and leads to faster recovery.[42] However, it is essential that the disease outcome for the patient not be inferior to that achieved with laparotomy.[43]

Some patients, including those with chronic lung disease who are unable to tolerate a high intra-abdominal pressure or a steep head-down position, are unsuitable for laparoscopy. Others are unsuitable because of previous surgeries causing severe adhesions. For many situations the most important factor is the skill and experience of the surgeon.

With benign cysts there is no absolute contraindication to the use of laparoscopy. Such patients include those considered to have a dermoid cyst or endometrioma, those with functional or simple cysts that are causing symptoms and have not resolved with conservative management, and those presenting with acute symptoms. The aim should be to remove all cysts intact,[44, 45] but if this is not possible, the cyst and/or affected ovary may be placed in a protective bag that allows the cyst to be ruptured and drained without contamination prior to removal.

Malignant ovarian cysts associated with widespread disease are usually managed by laparotomy.

Some controversy surrounds the surgical approach for very large, benign-appearing ovarian cysts. The traditional approach for both was a long, midline incision in order to allow removal of the intact cyst and ovary. Some now promote a laparoscopic approach with drainage of the cyst, allowing the ovary to be removed through a small incision.[46] The down side to this is the potential for the cyst to spill cancer cells into the abdominal cavity. Laparoscopy is now used to remove small to medium-sized cancerous ovarian cysts (up to about 12 cm) and to stage ovarian cancer.

Excision of a benign cyst alone—such as a dermoid or functional cyst or an endometrioma—with conservation of the ovary may be performed in patients who desire retention of their ovaries for future fertility or for other reasons.

If the ovarian cyst is benign, removal of the opposite ovary should be considered in postmenopausal, perimenopausal, and premenopausal women older than 35 years who have completed their family and are considered at increased genetic risk for subsequent development of ovarian carcinoma. These indications are all relative, and the issues should be discussed with the patient prior to any surgery.

A gynecologic cancer specialist should be available to help with any patient who undergoes surgery for a potentially malignant ovarian cyst. Whenever possible, the patient should consult with the specialist prior to the surgery to allow all issues to be addressed. This will allow the appropriate surgery to be performed on patients found to have cancer.

lower limb motor innervation - Google Search

Trichotillomania (/ˌtrɪkəˌtɪləˈmeɪniə/ trik-ə-til-ə-may-nee-ə, also known as trichotillosis or hair pulling disorder) is an obsessive compulsive disorder characterized by the compulsive urge to pull out one's hair, leading to hair loss and balding, distress, and social or functional impairment.

Methadone, a long-acting narcotic often used to attenuate withdrawal symptoms and used in narcotics recovery programs, also has extensive potential for abuse

opioid toxicity

Adequate prehospital care hinges on aggressive airway control. Expedient endotracheal intubation is indicated for patients who are unable to protect their airway.

In patients lacking spontaneous respirations, orotracheal intubation is preferred. If advanced life support (ALS) is available, intravenous naloxone (Narcan) may be given to reduce respiratory depression. Exercise caution when giving naloxone in the confines of an ambulance because it can transform a peacefully sleeping patient into an agitated, belligerent one. If naloxone is used for a suspected long-term opiate user, only an amount sufficient to return spontaneous respirations is recommended. Judicious application of restraints in a potentially violent patient is advisable in close quarters.

long acting naloxone is naltrexone.

mathiodone given for long term naloxone uses to prevent withdrowel effect of opiod

Meningococcal vaccine refers to any of the vaccines used to prevent infection by Neisseria meningitidis.

viras are th3 most common cause to meningitis in childersn. bacteria menigiyis cause by !. n. meningitis

2.s. pneumonie

3.

febrile convultion management

ct, mri, eeg not idicated

 if baby is less than 12months strongly indicated  LP.. if less tham 18  lp advisanle

Antisocial (or dissocial) personality disorder is characterized by a pervasive pattern of disregard for, or violation of, the rights of others. There may be an impoverished moral sense or conscience and a history of crime, legal problems, and impulsive and aggressive behavior.

Depersonalization (or depersonalisation) is an anomaly of self-awareness. It can consist of a reality or detachment within the self, regarding one's mind or body, or being a detached observer of oneself. Subjects feel they have changed, and the world has become vague, dreamlike, less real, or lacking in significance. It can be a disturbing experience. Chronic depersonalization refers to depersonalization/derealization disorder, which is classified by the DSM-5 as a dissociative disorder.[1]

People who have gender dysphoria feel strongly that they are not the gender they physically appear to be.

For example, a person who has a penis and all other physical traits of a male might feel instead that he is actually a female. That person would have an intense desire to have a female body and to be accepted by others as a female. Or, someone with the physical characteristics of a female would feel her true identity is male.

The term delusions of reference refers to the strongly held belief that random events, objects, behaviors of others, etc. have a particular and unusual significance to oneself.

When less firmly held or organized, these beliefs are called ideas of reference.

Examples: A person might believe that secret messages about him are broadcast in a weekly television show, to the point where he would record the programs and watch them again and again.

A woman might be convinced that all the messages on boards outside churches are aimed directly at her.

In psychiatry, delusions of reference form part of the diagnostic criteria for psychotic illnesses such as schizophrenia,[4] delusional disorder, or bipolar disorder (during the elevated stages of mania). To a lesser extent, it can be a hallmark of paranoid personality disorder.

passive aggressive personality - Google Search

passive aggressive personality - Google Search

passive aggressive personality... hitha ethule yamak thiyagena boruvata hmmmm gaga ennava.. tharaha pennanne nee..

A person with a passive-aggressive personality expresses his or her negative feelings indirectly through his or her actions. For example, someone proposes a plan. A person with a passive-aggressive personality actually opposes the plan but says that he or she agrees with it.

Narcolepsy is a chronic neurological disorder involving the loss of the brain's ability to regulate sleep-wake cycles.[1] Symptoms include excessive daytime sleepiness, comparable to how people who don't have narcolepsy feel after 24–48 hours of sleep deprivation

Cataplexy is a sudden and transient episode of muscle weakness accompanied by full conscious awareness, typically triggered by emotions such as laughing, crying, or terror.[1] It is the cardinal symptom of narcolepsy with cataplexy affecting roughly 70% of people who have narcolepsy,[2] and is caused by an autoimmune destruction of the neurotransmitter hypocretin, which regulates arousal and wakefulness. Cataplexy without narcolepsy is rare and the cause is unknown.

A Schneiderian first-rank symptom in which a 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.

ideas of reference - Google Search

pvd

Intermittent claudication typically causes pain that occurs with physical activity. Other signs and symptoms associated with peripheral arterial occlusive disease (PAOD) include the following:

Pain is reproducible within same muscle groups; pain ceases with a resting period of 2-5 minutes

The most common location of arterial lesions is the distal superficial femoral artery, which corresponds to claudication in the calf muscle area

Thigh/buttock muscle claudication predominates, with atherosclerosis distributed throughout the aortoiliac area

See Presentation for more detail.

Diagnosis

Examination of a patient with claudication should include a complete lower-extremity evaluation and pulse examination, including measuring segmental pressures. Attempt to palpate pulses from the abdominal aorta to the foot, with auscultation for bruits in the abdominal and pelvic regions. When palpable pulses are not present, a handheld Doppler device may be used to assess circulation.

A useful tool in assessing a patient with claudication is the ankle-brachial index (ABI), which is a noninvasive way of establishing the presence of PAOD and is calculated as the ratio of systolic blood pressure at the ankle to that in the arm (normal range, 0.9-1.1; PAOD, <0.9).

Lateral medullary syndrome (also called Wallenberg syndrome and posterior inferior cerebellar artery syndrome) is a disorder in which the patient has a constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis.

This syndrome is characterized by sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct. Specifically, there is a loss of pain and temperature sensation on the contralateral (opposite) side of the body and ipsilateral (same) side of the face. This crossed finding is diagnostic for the syndrome.

Clinical symptoms include swallowing difficulty, or dysphagia,[1] slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia, and

Vertebrobasilar insufficiency (VBI), or vertebral basilar ischemia (also called Beauty parlour syndrome (BPS)), refers to a temporary set of symptoms due to decreased blood flow in the posterior circulation of the brain. The posterior circulation supplies blood to the medulla, cerebellum, pons, midbrain, thalamus, and occipital cortex (responsible for vision

Vertigo, the sensation of spinning even whilst a person is still, is the most recognizable and quite often the sole symptom of decreased blood flow in the vertebrobasilar distribution.[citation needed] The vertigo due to VBI can be brought on by head turning, which could occlude the contralateral vertebral artery and result in decreased blood flow to the brain if the contralateral artery is occluded. When the vertigo is accompanied by double vision (diplopia), graying of vision, and blurred vision, patients often go to the optometrist or ophthalmologist. If the VBI progresses, there may be weakness of the quadriceps and, to the patient, this is felt as a buckling of the knees. The patient may suddenly become weak at the knee and crumple (often referred to as a “drop attack”). Such a fall can lead to significant head and orthopedic injury, especially in the elderly.

The spectrum of asbestos-related thoracic diseases includes the following[6] :

Benign pleural effusion

Pleural plaques

Diffuse pleural thickening

Rounded atelectasis

Asbestosis

Mesothelioma

Lung cancer

Asbestosis is defined as diffuse lung fibrosis due to the inhalation of asbestos fibers, and it is one of the major causes of occupationally related lung damage. Mesothelioma is a malignant pleural or peritoneal tumor that rarely occurs in patients who have not been exposed to asbestos

The clinical course of herpes simplex infection depends on the age and immune status of the host, the anatomic site of involvement, and the antigenic virus type. Primary herpes simplex virus (HSV)–1 and HSV-2 infections are accompanied by systemic signs, longer duration of symptoms, and higher rate of complications. Recurrent episodes are milder and shorter. Both HSV-1 and HSV-2 can cause similar genital and orofacial primary infections after contact with infectious secretions containing either HSV-1 (usually oral secretions) or HSV-2 (usually genital secretions).

Acute herpetic gingivostomatitis

This is a manifestation of primary HSV-1 infection that occurs in children aged 6 months to 5 years. Adults may also develop acute gingivostomatitis, but it is less severe and is associated more often with a posterior pharyngitis.[5]

Infected saliva from an adult or another child is the mode of infection. The incubation period is 3-6 days.

Clinical features include the following:

Abrupt onset

High temperature (102-104°F)

Anorexia and listlessness

Gingivitis (This is the most striking feature, with markedly swollen, erythematous, friable gums.)

Vesicular lesions (These develop on the oral mucosa, tongue, and lips and later rupture and coalesce, leaving ulcerated plaques.)

Tender regional lymphadenopathy

Perioral skin involvement due to contamination with infected saliva

Course: Acute herpetic gingivostomatitis lasts 5-7 days, and the symptoms subside in 2 weeks. Viral shedding from the saliva may continue for 3 weeks

Herpes labialis

This is the most common manifestation of recurrent HSV-1 infection. A prodrome of pain, burning, and tingling often occurs at the site, followed by the development of erythematous papules that rapidly develop into tiny, thin-walled, intraepidermal vesicles that become pustular and ulcerate. In most patients, fewer than two recurrences manifest each year, but some individuals experience monthly recurrences.[6]

Maximum viral shedding is in the first 24 hours of the acute illness but may last 5 days.

Capture Feb 11, 2016

Primary genital herpes

Primary genital herpes can be caused by both HSV-1 and HSV-2 and can be asymptomatic. The clinical features and course of primary genital herpes caused by both HSV-1 and HSV-2 are indistinguishable, but recurrences are more common with HSV-2.

Clinical features: The incubation of primary genital herpes period is 3-7 days (range, 1 d to 3 wk). Constitutional symptoms include fever, headache, malaise, and myalgia (prominent in the first 3-4 d). Local symptoms include pain, itching, dysuria, vaginal and urethral discharge, and tender lymphadenopathy.

Clinical features in women: Herpetic vesicles appear on the external genitalia, labia majora, labia minora, vaginal vestibule, and introitus. In moist areas, the vesicles rupture, leaving exquisitely tender ulcers. The vaginal mucosa is inflamed and edematous. The cervix is involved in 70%-90% of cases and is characterized by ulcerative or necrotic cervical mucosa. Cervicitis is the sole manifestation in some patients. Dysuria may be very severe and may cause urinary retention. Dysuria is associated with urethritis, and HSV can be isolated in the urine. HSV-1 infection causes urethritis more often than does HSV-2 infection.

cleft lip and cleft palate

recurrent rate for second child 2% -4%

fimily member + ur child has namd 10 %chance ekak thiyenava

amphatamine

What is amphetamine?

Amphetamine is a stimulant and an appetite suppressant. It stimulates the central nervous system (nerves and brain) by increasing the amount of certain chemicals in the body. This increases heart rate and blood pressure and decreases appetite, among other effects.

Amphetamine is used to treat narcolepsy and attention deficit disorder with hyperactivity (ADHD).

Narcolepsy is a chronic neurological disorder involving the loss of the brain's ability to regulate sleep-wake cycles.[1] Symptoms include excessive daytime sleepiness, comparable to how people who don't have narcolepsy feel after 24–48 hours of sleep deprivation,[2] as well as disturbed sleep which often is confused with insomnia.

What is a delusional disorder?

Delusional disorder refers to a condition associated with one or more nonbizarre delusions of thinking—such as expressing beliefs that occur in real life such as being poisoned, being stalked, being loved or deceived, or having an illness, provided no other symptoms of schizophrenia are exhibited.

polycythemia rv

Physical examination findings may include the following:

Splenomegaly (75% of patients)

Hepatomegaly (30%)

Plethora

Hypertension

Pruritus results from increased histamine levels released from increased basophils and mast cells and can be exacerbated by a warm bath or shower. This occurs in up to 40% of patients with PV.

Uterus didelphys (sometimes also uterus didelphis) represents a uterine malformation where the uterus is present as a paired organ when the embryogenetic fusion of the Müllerian ducts fails to occur. As a result, there is a double uterus with two separate cervices, and often a double vagina as well. Each uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

In non human species (e.g. nematodes), a didelphic genital tract may be normal rather than a malformation. Such species are described as didelphic, as opposed to monodelphic, with a single tract.

Abnormalities of the form of thought There are three main abnormalities of the ways in which thoughts are linked together:  flight of ideas, loosening of associations,  and  perseveration.

caeliac dx

A bleeding diathesis is usually caused by prothrombin deficiency, due to impaired absorption of fat-soluble vitamin K.

Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland, accounting for 30% of parotid malignancies

lymphoma =rubbery LN

Secondary syphilis

Secondary syphilis manifests in various ways. It usually presents with a cutaneous eruption within 2-10 weeks after the primary chancre and is most florid 3-4 months after infection. The eruption may be subtle; 25% of patients may be unaware of skin changes. A localized or diffuse mucocutaneous rash (generally nonpruritic and bilaterally symmetrical) with generalized nontender lymphadenopathy is typical (see the image below). Patchy alopecia and condylomata lata may also be observed.

Tertiary syphilis

Tertiary (late) syphilis is slowly progressive and may affect any organ. The disease is generally not thought to be infectious at this stage. Manifestations may include the following:

Altered mental status

Focal neurologic findings, including sensorineural hearing and vision loss

Dementia

Symptoms related to the cardiovascular system or the central nervous system (CNS)

The lesions of benign tertiary syphilis usually develop within 3-10 years of infection. The typical lesion is a gumma, and patient complaints usually are secondary to bone pain, which is described as a deep boring pain characteristically worse at night. Trauma may predispose a specific site to gumma involvement.

CNS involvement may occur, with presenting symptoms representative of the area affected (ie, brain involvement [headache, dizziness, mood disturbance, neck stiffness, blurred vision] and spinal cord involvement [bulbar symptoms, weakness and wasting of shoulder girdle and arm muscles, incontinence, impotence]).

Capture Feb 11, 2016

terunus

migrain tx in children

During the attack, advise the child to lie down in a cool, dark, quiet room and go to sleep at the time of the attack.

migrain mx i paediatric

Acute attacks

During the attack, advise the child to lie down in a cool, dark, quiet room and go to sleep at the time of the attack. Sleep is the most potent antimigraine treatment. During a migrainous attack, a child commonly can be found resting in the fetal position with the affected side of the head down.

Children should be given simple analgesics such as acetaminophen or ibuprofen. They should be taught to "give in" to their headache because activity will probably aggravate their pain. Stronger analgesic medication, such as butalbital, may be necessary. Promethazine diminishes nausea, causes drowsiness, and seems to decrease pain; therefore, it frequently is used as a rescue medication.

Some patients find that ice or pressure on the affected artery can temporarily alleviate pain. NSAIDs are effective if taken at a high, but appropriate, dosage during the aura or early headache phase. Gastric stasis occurs in most migraine patients and causes delay in absorption of oral medications. Occasionally, carbonated beverages may improve absorption.

Nonpharmacologic treatment modalities such as self-relaxation, biofeedback, and self-hypnosis may be reasonable alternatives to pharmacologic treatment in managing childhood migraine, particularly in adolescents. Response rates in children tend to be higher than in adults and show continued effectiveness over time.

Specific drugs for acute attacks include ergot preparations and triptans. Older vasoconstrictive medications (ergot preparations), such as ergotamine (Cafergot; 1mg ergotamine tartrate with 100mg caffeine), are rarely used today as rescue medications in the pediatric population.

Intravenous (IV) dihydroergotamine (DHE) is an effective abortive agent when used early in an attack and is an option for the older child. Its use in patients younger than 12 years should be questioned.

Serotonin 5-HT-receptor agonists (ie, triptans) work primarily at 2 subtypes of the serotonin receptor, 5-HT1B and 5-HT1D. Triptans are being successfully used with increasing frequency as rescue medications in young migraineurs. Several triptans are approved by the FDA for treatment of acute migraine attacks in adolescents (ie, almotriptan [Axert], zolmitriptan [Zomig Nasal Spray], naproxen/sumatriptan [Treximet]) and in children (ie, rizatriptan [Maxalt]).

Analgesic and abortive therapies are for the treatment of occasional acute headache attacks and associated symptoms. Analgesic and abortive medications should not be used frequently, because this may result in rebound headaches. In general, the earlier in an attack the pain is treated, the less severe the pain becomes. The longer the wait prior to starting therapy, the more difficult the pain is to control. Established migraines are notoriously difficult to treat successfully.

Prophylaxis

The primary goals of prophylactic drugs are to prevent migraine attacks and to reduce the frequency and severity of attacks. Half of all patients experience at most a 50% reduction in migraines. Most prophylactic migraine medications have potential adverse effects; therefore, consider only patients with 1-2 attacks per week (4 or more headache days monthly) for prophylaxis.

Possible medications for migraine prophylaxis include the following:

Amitriptyline

Propranolol

Selective serotonin reuptake inhibitors (SSRIs)

Anticonvulsants - Eg, gabapentin, valproate, divalproex, topiramate

Riboflavin

Tricyclic antidepressants (TCAs)

The agents that seem to be the most effective prophylactic medication in children are those that block the 5-HT2 serotonin receptor. These medications include beta blockers, cyproheptadine, and methysergide (Sansert). Beta blockers and cyproheptadine appear to be effective and well tolerated.

The FDA has approved topiramate (Topamax) for prevention of migraine headache in adolescents aged 12-17 years. It is the first such approval for this age group. The safety and effectiveness of topiramate in preventing migraine headaches in adolescents were established in a clinical trial of 103 participants. Frequency of migraine decreased by approximately 72% in treated patients compared with 44% in participants receiving placebo.[13, 14]

Calcium channel blockers had been used for migraine prophylaxis in children, but results have been inconsistent.

Initially administer drugs at very low dosages and slowly titrate to therapeutic efficacy. This approach lessens adverse effects and results in better long-term patient compliance. Often, several weeks are necessary before therapeutic gains are observed. No consensus exists on the duration of prophylactic medication usage, although most neurologists aim for 3-6 months of good symptom control.

Some patients must be maintained on long-term prophylactic therapy, and others tolerate drug holidays, particularly during summer when migraine attacks are less frequent for many children. Occasionally, prophylactic drugs are effective initially but become ineffective over the long term. Subsequent prophylaxis with the same agent often is not as effective. Withdraw drugs slowly to prevent relapse and withdrawal symptoms.

haemolytic urimic syndrome

Hemolytic-uremic syndrome (HUS) is a clinical syndrome characterized by progressive renal failure that is associated with microangiopathic (nonimmune, Coombs-negative) hemolytic anemia and thrombocytopenia. HUS is the most common cause of acute kidney injury in children and is increasingly recognized in adults.[1, 2]

Hemolytic-uremic syndrome (HUS) predominantly occurs in infants and children after prodromal diarrhea. In summer epidemics, the disease may be related to infectious causes.

Bacterial infections may include the following:

S dysenteriae

E coli

Salmonella typhi

Campylobacter jejuni

Yersinia pseudotuberculosis

Neisseria meningitidis

S pneumoniae

Legionella pneumophila

Mycoplasma species

Hemolytic-Uremic Syndrome

Presentation

History

History findings may include the following:

Prodromal gastroenteritis (83%) - Fever (56%), bloody diarrhea (50%) for 2-7 days before the onset of renal failure

Irritability, lethargy

Seizures (20%)

Acute renal failure (97%)

Anuria (55%)

Physical Examination

Physical findings may include the following:

Hypertension (47%)

Edema, fluid overload (69%)

Pallor, often severe

Anti-GBM Antibody Disease

Anti–glomerular basement membrane (anti-GBM) antibody disease is a rare autoimmune disorder in which circulating antibodies are directed against an antigen normally present in the GBM and alveolar basement membrane. The target antigen is the alpha-3 chain of type IV collagen. The resultant clinical syndrome encompasses a spectrum ranging from mild or no renal involvement to rapidly progressive glomerulonephritis.[1]

Many patients develop pulmonary hemorrhage, and most individuals have signs of a generalized systemic illness. The combination of glomerulonephritis and pulmonary hemorrhage is commonly referred to as Goodpasture syndrome. Pulmonary and/or renal manifestations can be encountered in various conditions, such as antineutrophilic cytoplasmic antibody (ANCA)–positive vasculitis and other autoimmune disorders. As a consequence, the identification of anti-GBM antibodies in the patient's serum or tissues is of paramount importance in the diagnosis of Goodpasture disease.