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Any recurrent or persistent chest infection irreversibly dilated bronchi act as sumps for persistently infected mucus which is expectorated daily. H.influenza and P.aerniginosa are commonest pathogens.
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CAUSES:
Congenital: cystic fibrosis, kartagener’s sy.
Post infection: TB, measles, pertusis, pneumonia.
Others: bronchial obstruction, ABPA, hypogammagloblulinemia.
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Signs & symptoms:
Chronic bronchial sepsis with exacerbations persistent, sputum, haemoptysis, clubbing, low pitched ‘leathery’ inspiratory and expiratory crackle, wheeze.
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Tests:
CXR: A cystic shadows with fluids levels, thickened bronchial walls (tramline & ring shadows); spertum culture; spirometry, serum immunoglobulins, sweat test, skin prick test for aspergillus, bronchography, CT scan.
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?Management:
Physiotherapy – daily postural drainage.
Antibiotics
Bronchodilators
Surgical excision (only for localized disease).
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Complications:
Acute infective exacerbations; haemoptysis, pulmonary hypertension; pneumothorax; brain abscess.
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During REM sleep there is generally hypotonia. But there is rapid movement of the eyes. This stage of sleep is associated with dreaming. The EEG shows rapid, low voltage, irregular activity which resembles those seen in animals and humans. The teeth grinding or bruxism that occurs in some individuals is also associated with dreaming. Bruxism is often believed to be due to stress. Benzodiazepines may help.
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Chronic inflammation or constant friction may lead to bursitis with accumulation of excessive fluid inside the bursa leading to swelling at the site of bursa.
There are several bursa in our body. Many are located around the knee joints. They are prone to inflammation due to constant friction.
Some important locations of bursitis are
Semimembraneous bursitis: lies on the medial part of poplitial forsa. Swelling is fluctuant and transilluminant. Swelling lies between semi membranous tendons & medial head of gastrocnemius.
Prepatellar bursitis:
Called house maid’s knee. Prevents as swelling in front of the lower half of the patella.
Milder cans will be relieved by aspiration and hydrocortisone infiltration. Larger swelling will need excision.
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It is a syndrome of compression neuropathy of the median nerve at the wrist. Carpel tunnel is a fibro osseous tunnel formed by the palmar hollow of the articulated carpal ligament. The tunnel contains all the flexor tendons and the median nerve passing from the wrist into the palm.
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Etiology:
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Clinical:
Numbness and tingling in the thumb, index and middle fingers. In the later stages, there may be wasting and weakness of lunar muscles with sensory deficiency in the area.
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Treatment:
Treat the cause in any. In sever cases, surgical division of the transverse carpel ligament.
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Ataxia is defined as incoordination due to errors in the rate, range, force and direction of movement. It can occur due to lesion in the cerebellum or in the long tract of spinal cord with circumscribed lesions, the ataxia may be localized to one part of the body. If only the cortex of the cerebellum is involved, the movement abnormalities gradually disappear as compensation occurs. Lesions of the generalized defects and the abnormalities are permanent.
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Chancroid or soft sore is a veneral disease caused by haemophilus ducreyi characterized by tender, non-indurated, irregular ulcers on the genitalia. The infection remains localized, spreading only to the regional lymph nodes, which are enlarged and painful.
Autoinoculation lesions may be produced by contact. There is no immunity following infection, but a hypersensitivity result, which can be demonstrated by intradermal inoculation of killed bacilli. (ITO test)
Treatment:
Erythromycin or cotrimoxazole.
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Chondroma is a bony swelling arising from the ends of long bones. This is the most common among the tumour like lesions of bone. It is noticed first during the age of 5 to 15 years. Its common sites are the distal end of femur, proximal end of tibia and upper end of humerus.
The adolescent child presents with a complaint of a hard swelling, usually near the knee. Patient may also present with any of the complications.
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Treatment:
Small asymptomatic: no treatment
Large ones: excision preferably at the end of growth period.
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Any inflammation involving costochondral junction of the ribs. The idiopathic form is called Tietze syndrome. There is pain in the costal cartilage, often localized. It is enhanced by motion, coughing or sneezing. The second rib is most commonly affected. Tenderness is a prominent feature.
Treatment:
Simple analgesia, eg: aspirin. Its importance is that it is a benign cause of what at first seems to be alarming (eg: cardiac) chest pain. In protracted illness local steroid injections may be needed.
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Endemic cretinism is a disorder associated with endemic goiter and severe iodine deficiency with characteristic clinical features which include deaf-mutism, squint, mental retardation and characteristic spastic or rigid neuromotor disorder. Two types of endemic cretinism are described. ?????? ??????????????????????? ??????????????????????? ??????????????????????? ??????????????????????? ?Neurological cretinism: is characterized by deaf-mutism. Squint, proximal spasticity and rigidity more in the lower extremis, disorders f stance and gait with preservation of vegetative functions, occasional signs of cerebellar or oculomotor disturbance and severe mental deficiency.
Myxedematous cretinism:
Characterised by retarded psychomotor development, severe short stature, coarse facial features and myxedema without deaf-mutism. The pathogenesis of endemic cretinism is poorly understood.
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Chronic inflammatory disorder affecting any part of the gut, especially terminal ileum, colon and the anorectum with ulcer, fistulae and granulomata.
Clinical features:
Fever, diarrhea, cramping abdominal pain, subacute GI obstruction, weight loss and slowing of growth in children. Rectal involvement and rectal bleeding is less common. Anal and perianal lesions are characteristic. Granulomata may occur in skin, epiglottis mouth, vocal cord, liver, nodes, mesentery, peritoneum, even bones, joints, muscles o kidney.
Treatment:
1.????? prednisolone
2.????? netrinidazole
3.????? azothiprin
4.????? sulphasalazine
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???????????????? ???????????????? ???????????????? ???????????????? ???????????????? ???????????????? ???????????????? ???????????????? ???????????????? ???????????????? ???? ???? ???? CUSHINGS SYNDROME
?Adrenal cortex produces: glococorticoids (eg: cortisol which affect metabolic function), mineralocarticoids, androgens and estrogens.
Cushing’s syndrome is due to chronic glucocorticoid excess. Clinical features are: wasting of tissues, myopathy, thin skin, purple abdominal strain, easy bruising, osteoporosis, water retention (plethoric moon face, hyper tension, edema), obesity of trunk, head, neck (buffalo hump), predisposition to infection, poor wound healing, hirsutism, amenorrhea, hyperglycemia.
?Cause:
1.????? corticosteroid administration
2.????? Cushing’s disorder (adrenal hyperplasia due to excess ACTH from pituitary tumour)
3.????? Alcohol excess
4.????? Adrenal gland adenoma or carcinoma
5.????? Ectopic ACTH production
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?Bluish colouration of skin and mucosa. May be central or peripheral.
Central cyanosis:
?Represents a concentration of reduced HB of atleast 2.5g/dl, hence it occurs more readily in polycythemia than anemia.
Causes:
1.??? Lung disease resulting in inadequate oxygen transfer (e.g.: COPD, severe pneumonia) – usually correctable by increasing the inspired O2.
2.??? Shunting from pulmonary to systemic circulation (eg: R-L shunting USD, PDA, TGA) not reversed by increased O2.
3.??? Condition that do not allow adequate O2 uptake (eg: met- or sulph- haemoglobinemia).
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Peripheral:
Apart from the above causes, it can also be induced by changes in peripheral and cutaneous vascular systems in patients with normal oxygen saturation. It occurs in the cold, in hypovolaemia and arterial disease and is therefore not a specific sign.
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