HIV PEP(Post-exposure prophylaxis):

Post-exposure prophylaxis (PEP) has its greatest effect if begun within two hours of exposure, it is essential to act immediately. The prophylaxis needs to be continued for four weeks. Exposure must be immediately reported to designated authority and therapy administered. Never delay start of therapy due to debate over regimen. Begin with basic 2-drug regimen & expanded 3-drug regimn.

Basic regimen:Zidovudine 300mg BD(twice a day) + Lamivudine 150mg BD(twice a day)

Expanded regimen:Zidovudine 300mgBD + Lamivudine 150mg BD + Lopinavir 400mg BD

Expanded regimen should be used if there is cut or needle stick injury penetrating gloves,inserting a cathether which was previously used for a HIV infected patient.

Types of facies:

1.Moon face(Cushingoid facies)
*2.Mouse facies - CRF
*3.Ashen Grey facies - Myocardial infarction
*4.Potter facies-Oligohydromnia

5.Mask like-parkinsonism
6.Leonine-leprosy
7.frog like facies-ethmoidal polyps,NP angiofibroma..
8.gargoyle facies - hurler's syndro
9.meflat facies - down's syndrome
10.Hippocratic face (also known as "Hippocratic facies"; eyes are sunken, temples collapsed, nose is pinched with crusts on the lips and the forehead is clammy) 11.snarling facies - myasthenia gravis
12.torpid facies - myxoedema

13.chipmunk facies- untreated thalassemia major, bullimia nervosa.
14.bird facies..(typically small mandible)- Pierre Robin symdrome
15.ashen gray facies- MI
16.adenoid facies-adenoids,other causes of b/l nasl obs.
17.facies mitrale-MS

PATHOGNOMONIC SIGNS of diseases:-

Pathognomonic signs
1. COPD - Barrel-Chested
2. Pneumonia - Greenish Rusty Sputum
3. Pernicious Anemia - Beefy Red Tongue (Schilling’s Test)

4. Kawasaki Dieases - Strawberry Tongue
5. Typhoid - Rose Spot
6. Tetany - Chvostek Sign (Muscle Twitching Face)
- Trosseau’s Sign (Jerky Mov’ts)
7. Pancreatitis - Cullen Sign (Bluish discoloration preumbilical area)
8. Appendicitis - McBurney’s Point (rebound tenderness)
- Rovsing Sign (RLQ pain w/ palpation in LLQ)
- Psoas Sign(pain on lying down putting pressure on MB pt)
9. Thrombophlebitis - Homan’s Sign
10. Hepatitis - Icteric Sclera (yellowish discoloration of sclera)

11. Meningitis - Burdzinski Sign (Pain on nape)
- Karnig Sign (pain on leg/ knee area)
12. Pyloric Stenosis - Olive-Shaped Mass
13. Hyperthyroidism - Exopthalmus
14. Addison’s Disease. - Bronze-like skin
15. Cushing Syndrome- Boffalo Hump
16. Cholera - Rice Watery Stool
17. SLE - Butterfly Rashes
18. Leprosy - Leoning Face (contracted face)
19. Bulimia Nervosa - Chipmunk Face
20. Liver Cirrhosis - Spider Angioma
21. Asthma - Wheezing Inspiration
22. Hyperpituitarism - CAROTENEMIA (Discoloration of skin)
- XANTHAMIA
23. Down Syndrome- Single Crease on Palm
24.TOF - Clubbing of Fingernails
Ventricular Septal Defect
Pulmonary Stenosis
Overriding of Aorta
Right Ventricular Hypertrophy
25.Cataract - Blurry Vision / Hizzy Vision
26.Glucoma - Tunnel-like Vision
27. PTB - Low grade fever in a ternoon
28. Cholecystitis- Murphy’s Sign (pain RUQ)
29. Myasthemia Gravis (MG) – Ptosis (inability to open upper eyelids)
30. Dengue - Petechiae
31. Parkinson’s Diease. - Pill Rolling Tremors
32. Measles - Koplick’s Spot

Normal blood values

Please note: normal values may differ between hospitals.  This is simply a guide.

Full blood count

• Haemoglobin
  • Male = 13-18g/dL
  • Female = 11.5-16g/dL
• Mean corpuscular (cell) volume (MCV) = 76-96fL
• Mean corpuscular haemoglobin (MCH) = 27-31pg
• White cell count (WCC) = 4-11×10^9/L
• Platelet count = 150-400×10^9/L

Serum biochemistry

• Sodium = 135-145mmol/L
• Potassium = 3.5-5mmol/L
• Chloride = 95-105mmol/L
• Urea = 2.5-6.7mmol/L
• Creatinine = 70-150umol/L
• eGFR = >90
• Glucose (fasting) = 3.5-5.5mmol/L
• Calcium = 2.12-2.65mmol/L
• Phosphate = 0.8-1.4mmol/L
• Bicarbonate = 22-28mmol/L
• Uric acid = 0.18-0.42mmol/L
• Protein (total) = 60-80g/L
• Albumin = 35-50g/L
• Bilirubin = 3-17umol/L
• Osmolality = 280-296mosmol/L

• T4 = 70-140mmol/L
• TSH = 0.5-5.7mU/L

Enzymes

• Alkaline phosphatase = 30-150iU/L
• Aspartate aminotransferase (AST) = 5-35iU/L
• Alanine aminotransferase (ALT) = 5-35iU/L
• Lactate Dehydrogenase (LDH) = 70-250iU/L
• Gamma-glutamyl transpeptidase (GGT)
  • Male = 11-51U/L
  • Female = 7-33U/L
• Creatine kinase = 25-195iU/L
• Troponin T = <0.1ug/L

Tests for clotting

Three tests are normally carried out to assess clotting:

1) Platelet count

• Deficiencies in platelets cause purpura (3-10mm)

2) Prothrombin Time (PT)

• Normal = 12-15s
• Measures extrinsic pathway and factors V, VII and X
• Prolonged in vitamin K deficiency
• Used to monitor anticoagulation with warfarin
• International Normalised Ratio (INR)
  • Patient’s PT / Reference standard
  • e.g. 30 / 12 = 2.5 INR

3) Activated Partial Thromboplastin Time (APTT)

• Measures intrinsic pathway and factors V, VII-XII
• Used to monitor anticoagulation with heparin
• Prolonged in haemophiliacs

RESPIRATORY ALKALOSIS

High pH is characterised by a decrease pCO2,primarly due to hypdrventilation.Compdnsatory renal responses lead to increase excretion and decreased serum bicarbonate levels.Sever respiratory alkalosis may result in light headedness parasthesia ,numbness,tetany ,convulsion.

CAUSES :-
1) stimulation of respiratory centre caused by fever , anxiety or cerebral tumour.
2) drugs such as salicylates and theophylline
3) hypoxia caused by sever anemia or high altitude .
4) pulmonary disorders such as asthma , pneumonia , bronchiolitis
5) fulminant gram negative septicemia

MANAGEMENT :-
Directed at underlyin disorder.

CRANIOCYNOSTOSIS

Coronal ,saggital and lambdoid sutures of skull close during 2nd decade of life. One or more these sutures may close prematurely due to which growth of calvarium arrested  in a direction right angles to fused sutures                        classification :-)       1 primary=present  since birth with genetic basis             2 secondary=idiopathic hypercalcemia hypophosphatasia  rickets,microcephaly                                     diagnosis=prominent ridges over closed suture,  asymmetry,confirmed by x ray of skull                               effects of craniosynostosis :-  *cosmetic defects 1 dolichocephaly     2 brachycephaly     3 trigonocephaly    4 oxycephaly              *proptosis and hypertelorism=growing brain within prematurely  stenosed cranium exerts pressure causes displacement of greater wings of sphenoid bone
3) Growth of maxilla is interfered resulting in small nasopharynx.
4) arrested development of brain
5) optic atrophy.

Associated clinical syndrom:-
1) crouzon syndrome
2) alpert syndrome
3) carpenter syndrome

Treatment :-
-linear craniectomy along the affected suture should be performed early.
- orbital decompression is needed in some cases to prevent development of optic atrophy

MENTAL RETARDATION

Defined as significant sub average general intellectual function,existing concurrently with deficits in adaptive behaviour n manifest during developmental period. Classification acc 2 severity- w mild iq 50-70, moderate 35-50, severe 20-35, profound<20. Atiology-chromosomal abnormalities,metabolic n endocrine causes,multiple cong anomaly syndrome,teratogens in preg,cns malformations,perinatal difficulties-extreme prematurity,hypoglycemia,hyperbilirubinaemia.  Post natal injury 2 brain-asphyxia,head injury. Unknown etiology. Associate deficit-visual,communication deficit,seizure cerebral palsy,feeding problems. Diagnostic tests-1.Metabolic screening 2.Neuroimaging-ct mri 3.Karyotype 4.Molecular testing. Management-aim-relieve anxiety n stress,encourage development.Plan of action-assesing childs capabilities,early stimulation n education,behavioural modification technique,school placement n home educ,employment.Genetic counselling. Supporative treatment.Prevention of mr-general n socio economic improvement,nutritional improvement 2 preg mothers,prevention frm drugs n radiation,good obst care,prevent consanguineous marriages.