Sexual Abuse

Diagnostic Studies done to post abuse on postmenopausal women:-
1) Acid phosphatase
2)Gonorrohea
3)Chlamydia
4)Syphillis
5)HBV
6)HIV

7)Use wood lamp to examine emen if it happened within 72 hours.
8)Fingernail scraping
9)Pubic Hair scraping

PS:-trichomonas and condyloma acuminatum after age of 3 indicates sexual abuse

Treatment:
Councelling
Antipregnancy medication within 72 hours of intercourse.
Antibiotics to cover venereal disease risk.

Follow up:-
May turn towrads promiscuity, prostitution.
Drug addiction
Depression
Suicidal Gestures
Interrelationship problems

Child Abuse

Intentional injury

Dx:-
If Bruises:- PT ,BT,APTT
If physical abuse :- Xrays of bones in <2 yrs , at times may help even till 6 yrs of age.
Abdominal trauma:-Urine , Stool examination

DD:-
ITP
Coining
Impetigo
Insect bites

Fractures:Osteogenesis imperfecta
Scurvy
Syphillis

Sturge Weber Syndrome

Charactersitic features:-

• Port wine stain in trigeminal distribution area.(upperface, eyelids)
• Periventricular calcification
• Hemiparesis contralateral to facial lesion side
• Mental retardation
• Seizures( may develop in first year)
• Developmmental delays
• Glaucoma (Later on)

Dx:-

Skulll Radipgraphs
Ct Head

Rx:-

Portwine stain:
it doesnt resolve on its own , so either need
cosmetic coverage or
Flashlamp pulsed laser therapy.
Seizures: Need apt medication; uncontrolled seizures may be cured by hemispherectomy and hemilobectomy and may play a role in preserving mental functions .
Treatment is conservative in absence of mental retardation.

Important:- Uncontrolled seizures appearing in infancy may be associated with hemiparesis.

Paediatric NHL

St Jude system of Staging:-
Stage 1 : Disease is confined to single tumour (Extra nodal)
or single anatomic area
excluding abdominal /mediastinal tumour.

Stage 11 :Single tumour extra-nodal or regional involvement.
2 or more nodal areas same side of diaphragm
2 single extranodal areas same side of diaphragm

Staege 111:
Prmary Abdominal extensive disease.
Primary Midiastinal , thymic, pleural
Two or more nodal areas above or below the diaphragm
Two single tumours extra nodal on opposite side of diaphragm.

Stage 1v: Any CNS or bone marrow ivolvement.

Periorbital cellulitis

Highlights:-

As an extension of paranasal cellulitis

organisms:H influnenzae(non-typable), Group A beta-streptococcus, Staph aureus,

Pneumococcus,anaerobes

Dx
Clinical

CT:primarly to know the extent of involvement of paranasal sinuses

Rx
Systemic antibiotics.

Drainage of abscess if present.

Complications:

Loss of vision if involves optic nerve

meningitis,

cavernous thrombosis

brain abscess

Opthalmology

Amblyopia:-

Decrease in visual acuity
becuz of inappropriate clarity in images falling on retina
Causes:-
*Strabismus
*Visual Deprivation

Tretament:-
Remove any possible opacity present in visual axis.
Patching /Covering of normal eye.
Early diagnosis prompts good response and better prognosis.

Post partum Issues

Post partum Psychosis:

Loss of reality

Hallucination

needs

1) Hospitalization

2)Anti psychotic medication

3)Psychotherapy

Granuloma inguinale

Calymmatobacterium donovani

:-it shows up with
*painless ulcer
*Lymphatic obstruction
-hence vaginal swelling

Overflow Incontinence

Hypotonic ,Overflow Incontinence



Related to diabetic neuropathy, MS, systemic medications

Stress Incontinence

Genuine stress incontinence

Only at day , not at night

with increase in abdominal pressure by coughing sneezing etc.

Q tip positive ( it rotates more than 30 degree with increase in abd.pressure)

Urinary Incontinence

Irritative incontinence:

infection tumour stress foreign body

Ix
urinalysis
urine culture
cystometric study

Management
Antibiotics
Cystoscopy