usually due to staphylococus arious

oral herpes hsv1

genital herpes hsv2

There are two types of the herpes simplex virus. HSV-1, also known as oral herpes, can cause cold sores and fever blisters around the mouth and on the face. HSV-2 is generally responsible for genital herpes outbreaks.

polymyositis

immunologically mediated conevtive tissue disorder

inflamtion of the muscledificulty in climbing stair , rising from chair

femoral hernia is the most common hernia that cause to strangulation.

sliding oesophagial hernia never get strangulate,.. but paraoesophageal hiayus hernia may strangulate

gas gangren d6e to clostridial myonecrosis

If BP unusual recheck the cup size

serum sodium 120mmol/ml means decresed extracelluler osmolality

Repression

Explanations > Behaviours > Coping > Repression

Description | Example | Discussion | So what?

 

Description

Repression involves placing uncomfortable thoughts in relatively inaccessible areas of the subconscious mind. Thus when things occur that we are unable to cope with now, we push them away, either planning to deal with them at another time or hoping that they will fade away on their own accord.

Labyrinthitis is an inflammatory disorder of the inner ear, or labyrinth. Clinically, this condition produces disturbances of balance and hearing to varying degrees and may affect one or both ears

Vestibular neuronitis may be described as acute, sustained dysfunction of the peripheral vestibular system with secondary nausea, vomiting, and vertigo

Vestibular neuronitis is unlikely if any of the following findings are present. The following symptoms should be absent:

Multidirectional, nonfatiguing nystagmus suggesting vertigo of central origin

Hearing loss

Other cranial nerve deficits

Truncal ataxia (suggests cerebellar disease or another CNS process)

Inflamed tympanic membrane

Mastoid tenderness

High fever

Nuchal rigidity

Ménière disease is a disorder of the inner ear that is also known as idiopathic endolymphatic hydrops. Endolymphatic hydrops refers to a condition of increased hydraulic pressure within the inner ear endolymphatic system. Excess pressure accumulation in the endolymph can cause a tetrad of symptoms: (1) fluctuating hearing loss, (2) occasional episodic vertigo (usually a spinning sensation, sometimes violent), (3) tinnitus or ringing in the ears (usually low-tone roaring), and (4) aural fullness (eg, pressure, discomfort, fullness sensation in the ears).

Absolute contraindications for ERCP include patient refusal to undergo the procedure; unstable cardiopulmonary, neurologic, or cardiovascular status; and existing bowel perforation.

post ERCP

Patients at higher risk for development of PEP, the most common serious complication associated with this procedure, include patient-related factors, procedure-related factors, operator-dependent factors, and underlying disease or indication for performing ERCP.

Persons who inject illegal drugs with nonsterile needles or who snort cocaine with shared straws are at highest risk for HCV infection. In developed countries, most new HCV infections are related to intravenous drug abuse (IVDA).

Hereditary spherocytosis (HS) is a familial hemolytic disorder associated with a variety of mutations that lead to defects in red blood cell (RBC) membrane proteins. The morphologic hallmark of HS is the microspherocyte, which is caused by loss of RBC membrane surface area and has abnormal osmotic fragility in vitro.

pediatric cases, splenectomy ideally should not be performed until a child is older than 6 years because of the increased incidence of postsplenectomy infections with encapsulated organisms such as S pneumoniae and H influenzae in young children.

Symptoms

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Symptoms has been expanded.

Damage to the basal ganglia cells may cause problems with one's ability to control speech, movement, and posture. This combination of symptoms is called parkinsonism.

A person with basal ganglia dysfunction may have difficulty starting, stopping, or sustaining movement. Depending on which area is affected, there may also be problems with memory and other thought processes.

In general, symptoms vary and may include:

Movement changes, such as involuntary or slowed movements

Increased muscle tone

Muscle spasms and muscle rigidity

Problems finding words

Tremor

Uncontrollable, repeated movements, speech, or cries (tics)

Walking difficulty

Huntington's Disease

Huntington's disease is a hereditary disease that causes defects in behavior, cognition, and uncontrolled rapid, jerky movements. Evidence shows that the basal ganglias in patients with Huntington's Disease show a decrease in activity of the mitochondrial pathway

meningitis lumbar puncture - Google Search

Neurofibromatosis type 1 (NF1)

This affects 1 in 3000 live births. It is an autosomal dominant, highly penetrant condition. One-third have new mutations.

In order to make the diagnosis, two or more of these criteria need to be present:

Six or more café-au-lait spots >5 mm in size before puberty, >15 mm after puberty (Fig. 27.18)

More than one neurofibroma, an unsightly firm nodular overgrowth of any nerve

Axillary freckles (Fig. 27.18)

Optic glioma which may cause visual impairment

One Lisch nodule, a hamartoma of the iris seen on slit-lamp examination

Bony lesions from sphenoid dysplasia, which can cause eye protrusion

A first-degree relative with NF1.

BCC

BCC typically found sun expose are,, but can see in other ares too,

 but SCC can only see sun expose area

melanoma good prognosis less than 7mm

BCC AND MALIGNENET MELANOMA rarely involve in lips..

usually Scc in the lip

herpeas simples leasions are painful self limiting within a week

cold sore=herpes simples eruptions

adipose dolorosa( dercum disease)

diffusely paifil subcutemious fat deposision

 focal discrete lump

 middle age women

 specially in abdomen and thigh

desmoid tumour.  or epidemoid cyst

locally agressive , well differentiated, firm ovwrgroth  of fibrous tissue

locally agressive

commnly arise from rectus abdomonalis muscle

hx of trauma or sx in 1of4

ingrowing toe nail() and paranoichia are diffrent

ingrowing toe nai(onchocriptosis)

ingrowing toe nail - Google Search

amauosis fugus (fleeting transient visual loss)

thytoidbcs

1,papilary...common in young adult

2.medullary..folliculer,,dificult to diffentiate from benign adenoma.. bone mets+... bld spread..pathological fractures

3.medullary..least common,,part of the MEN

Central Retinal Artery Occlusion

Treatment

Medical Care

Immediate lowering of intraocular pressure includes acetazolamide 500 mg IV or 500 mg PO once.

Topical medications are used to lower intraocular pressure.

Further treatments are as follows:

Some physicians recommend carbogen therapy (5% CO 2, 95% O 2): CO 2 dilates retinal arterioles, and O 2 increases oxygen delivery to ischemic tissues. Perform for 10 minutes every 2 hours for 48 hours. There is no Level 1 scientific evidence that is effective however.

Hyperbaric oxygen therapy (HBOT) may be beneficial if begun within 2-12 hours of symptom onset. Institute treatment with other interventions first, as transport to a chamber may usurp precious time. There is no Level 1 evidence that the improvement noted after hyperbaric oxygen therapy is sustainable however.

Retinal Artery Occlusion

Treatment

Prehospital Care

No specific prehospital treatment is available for retinal artery occlusion. The prognosis for visual recovery is related directly to the promptness in treatment; thus, rapid transport to the ED is essential.

Emergency Department Care

The 2 phases of ED care must occur. The first phase involves rapid detection and treatment of visual loss. The second phase involves a thorough investigation for the cause of visual loss.

No randomized controlled trials to support one treatment modality over any others are underway, but anecdotal reports and case series have suggested many modalities of treatment.

Immediate lowering of IOP to a target pressure of 15 mm Hg using medical management, ocular massage, and anterior chamber paracentesis

Ocular massage

Apply direct pressure for 5-15 seconds, then release. Repeat several times.

Increased IOP causes a reflexive dilation of retinal arterioles by 16%.

A sudden drop in IOP with release increases the volume of flow by 86%.

Ocular massage dislodges the embolus to a point further down the arterial circulation and improves retinal perfusion.

Anterior chamber paracentesis

Advocated when visual loss has been present for less than 24 hours

Early paracentesis is associated with increased visual recovery.

Slit-lamp removal of 0.1-0.4 mL of aqueous humor via tuberculin syringe and a 27-gauge needle may decrease IOP to 3 mm Hg.

Decrease in IOP is thought to allow greater perfusion, pushing emboli further down the vascular tree.

Other treatments

See Medication for details and mechanisms of action for medications.

Start timolol early in the treatment of CRAO, as this is readily available in most emergency departments. Acetazolamide and mannitol should also be used when CRAO is suspected because there are few downsides to starting these medications early.

In carbogen therapy (5% carbon dioxide, 95% oxygen), carbon dioxide dilates retinal arterioles, and oxygen increases oxygen delivery to ischemic tissues.

Thrombolytics may be useful if initiated within 4-6 hours of visual loss, but they may not be much help if the embolus is cholesterol, talc, or calcific. Thrombolytics are introduced via the proximal ophthalmic artery, delivering increased concentrations directly to the retinal artery and minimizing systemic complications.[3] Results of noncontrolled retrospective studies have been mixed. As of 2007, a European controlled study is underway.[4]

Hyperbaric oxygen (HBO) therapy may be beneficial if initiated within 2-12 hours of onset of symptoms. Institute treatment with other interventions first; transport to a chamber may usurp precious time. Results from noncontrolled studies have been mixed. A 2001 controlled study in Israel showed a benefit in the treatment group.[5] In this study, all patients were treated within 8 hours of symptom onset.

Treatment with IV thrombolytics as with cerebral infarction has been discussed[6, 7, 8] but currently is not the standard of care.

Brown-Sequard syndrome

is caused by damage to one half of the spinal cord, resulting in paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion.

- Wikipedia, the free encyclopedia

papillary CA of thyroid usualy give LN mets. spread via  LN mets