Functional Ovarian cyst

Functional Ovarian cyst

HCG negative

Pelvic mass in reproductive age group

USG :Fluid filled ovarian simple cyst

Management :<7 cm : Observation followed by OCPs >7 cm :Laproscopy

Lead can cause
neurologic damage (learning disabilities or hyperactivity
to mental retardation)
Routine screening is usually only recommended
for high-risk children (e.g., the child lives in old building and is a paint-chip eater or near a battery recycling plant).
If level is more than 10 micro gram only close follow up and observation is required.
Treatment is indicated at >45 microgram.
First step towards treatment should always be cessation of exposure.
Drug therapy involves treatment with succeimer or DMSA

ADPKD

A D Polycystic Kidney Disease:
Prognostic factors
Early onset of disease
Male sex
Early onset of renal dysfunction
severity of hyspertension

Follow up with regular examination of BP

only 10% of patients present with berry aneursyms.

PUD Treatment
If patient is non responsive to triple therapy..
Quadruple therapy is preferred which includes
P :proton pump inhibitor
B :bismuth
M :Metronidazole
T :Tetracycline

Dementia secondary to Parkinson disease:
It presents with classical symptoms of parkisnon disease (bradykinesia, resting tremor, rigidity ) along with dementia.
Recurrent visual hallucination is noticed.

Rx:
Rivastigmine
Donepezil

Pseudotumor cerebri
Offending agents :
Obesity
chronic lung disease
OC pills
Vitamin A toxicity
addison disease

Rx:Weight loss
remove offending agent
acetazolamide or furosemide
steroids may help

In acute cases Lumbar puncture might be needed
In refractory cases ventriculopoertinoal shunt cud be consideraton.

Primary generalised seizures :

First line treatment is
Valproic Acid
mode of action:-(icreases availability of GABA receptor)
Side effects :ataxia , hepatotoxicity, thrombocytopenia,GI irritation , hyponatremia.
Valproic acid (if not available)choices wud be :
Lamotrigine:
mode of action:decreases glutamate release
side effects: Stevens Johnson syndrome
Carbamazepine
Phenytoin

Absence seizures
first line therapy:Ethosuximide
if unavailable--> valproic acid

Myoclonic and tonic -->Valproic Acid

Pregnant best treated with Carbamazepin

Partial Seizures( Partial /Complex , with or without generalizations)
Carbamazepine and Phenytoin are first line therapy.Valproic acid and Lamotrigine are considered acceptable choices for partial seizures besides levetiracetem.Therapy may be stopped if patient never seizes for 2-3 consecutive years.Sleep deprived EEG helps us to determine if patient is at risk of recurrence.Negative EEG is associated with lower risk.

Otitis extrena:
Pain on pulling pinna
and on pressure on tragus
ear canal may be edematous, full of purulent debris

Rx:
Clean air canal with loop or cotton swab
instill topical antibiotics
neomycin
or bacitracin
steroids :to reduce inflammation

Ankylosing spondylitis :

Memorable features:
Mornig stiffness lasting more than 1 hour in young-age patient and improving with exercise.
Spinal fractures after minimal trauma in young patients rather than older

Diagnostic test :
XRays
CT scanning
Though AS is HLA B27 positive but it is not used as Diagnostic test.
Therapy:
NSAIDs
Physical Therapy
Exercise
Drug Regime :Latest is TNF alpha inhibitors
(Adalimumab,Infliximab,Etanercept-not used for axial disease)