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Acne Vulgaris : Acne vulgaris is a self limiting disorder of teenagers and young adults.But 10-20% of adults may continue to experience this disorder. In adolescence, there is increased secretion of sebum from sebaceous glands. The glands get blocked with the retained sebum and kerotinous debris. Small cysts called Comedons are formed due to blockage of hair follicles. Proprionobacterium acnes is the cyst and caused production of fatty acids within the cysts. Thus causing infection of the cyst and bursting of the cyst wall. The extrusion of oily, keratinous debris triggers a foreign body reaction develops. Comedones : These are of two types- Closed comedones = White heads. Opened comedones = Black heads. The closed comedones are mostly associated with inflammatory lesions like papules , cysts and nodules. These are seen as small white heads with the naked eye or sometimes are not visible to the naked eye. The Open comedones are seen as Black heads. These are more st...

Pemphigus vulgaris is a blistering autoimmune skin lesion mostly seen in elderly patients.The disorder is characterised by a process called Acanthoysis (loss of cohesion between epidermal cells).Lesions are mostly flaccid blisters over the skin.These blisters burst out and the surounding skin gets denuded.In severe cases, substantial portions of the body get denuded.Manual pressue over these blisters can cause separation of epidermis.This is known as Nikolsky's sign. This finding is a characteristic feature of Pemphigus vulgaris but not the specific feature. Nikolsky's sign is also seen in Stevens Johnson Syndrome, Toxic epidermal necrolysis and few other skin conditions. Clinical Features: Sometimes the disorder starts with pruritis(itching).Lesions in Pemphigus vulgaris are usually seen over the oral mucosa, scalp, axilla, trunk, face, neck .Blisters are usually seen in the mouth first and then on other mucosa (pharyngeal, laryngeal, oesophageal, conjunctival, vulval or r...

Iron deficiency anemia is a condition where there is anemia and a clear evidence of iron deficiency. It is categorized under ‘Hypoproliferative Anemias’. Stages: Stage of negative iron balance – The demand (or loss) for Iron exceeds that of the body’s capacity to absorb from the diet. Most common causes of the above condition are pregnancy, blood loss from bleeding, growth spurts in adolescence. Blood loss of 25-30 micrograms/dL can exceed the total body’s capacity to absorb iron from diet. The iron from reticulo-endothelial system and other iron stores is utilized. In this condition, iron in stores like ferritin or stainable iron in bone marrow decrease. As long as iron stores are present and mobilized, serum iron, total iron binding capacity (TIBC) red cell protoporphyrin levels remain normal. At this stage, RBC morphology and indices are normal. Stage of Iron deficient erythopoiesis – When the iron stores are depleted, TIBC and red cell protoporphyrin levels increase. Marrow i...

Panic disorder is a type of anxiety disorder. Anxiety - Is defined as "Subjective sense of unease, dread or foreboding, can indicate a primary psychiatric disorder or can be a component of, or a reaction to a primary medical disease. Panic disorder - Defined as recurrent and unpredictable panic attacks which are distinct episodes of intense fear and discomfort associated with a variety of physical symptoms including palpitations, sweating, trembling shortness of breath, chest pain, dizziness and a fear of impeding doom or death,Paresthesias, gastrointestinal distress, air hunger and feelings of unreality are common. First attack is usually outside the home.Onset is usually in late adolescence to early adulthood.Anticipatory anxiety occurs in some people leading to generalized fear and avoidance of places or situations where panic attack may recur. Panic attack occurs suddenly over a period of 10 mins and resolving over a period of one hour.The attacks usually occur in an unexpec...

Most common form of Facial paralysis. Clinical features : Pain behind the ear may preced the palsy for one or two days. Onset is abrupt and maximal weakness is attained by 48 hours. Loss of taste sensation unilaterally (on one side). Hyperacusis may be present. Mild cerebrospinal fluid Lymphocytosis may be present. Presence of incomplete paralysis in first week is most favorable sign. 80% patients recover in few weeks to months. Pathophysiology : Bell's palsy is associated with presence of Herpes Simplex type I DNA in endonueral fluid and posterior auricular muscle.This indicates that reactivation of this virus may have some role.However this is not proven yet. Differenctial Diagnosis : Other causes of Facial Palsy - 1. Tumours of temporal bone - Carotid body tumor, Cholesteotoma, Dermoid cysts.The course is insidious and progressive. 2. Ramsay Hunt Syndrome - Due to Herpis zoster of geniculate ganglion.Consists of : Severe facial palsy; eruptions in pharynx, external auditory ca...

SA (Sinoatrial) node is the pacemaker of human heart.AV (Atrio-ventricular) node is the conduction junction between Atria and ventricles.It transmits the impulses originating in the SA node (present on right atrium) to the ventricles.Any conductional defects in the AV node may cause ventricular tachyarrhythmias and ventricular failure. In any suspected case of conduction disturbances, the physician must assess The site of block The risk of turning into a complete block The probability that a subsidiary escape rhythm develops distal to the block. If the escape rhythm pace maker is in the HIS bundle, the ectopic impulse is stable and the rate is usually 40 - 60 beats/min.QRS complex is normal in duration. If ectopic rhythm is present in HIS-Purkenjee system, ectopic rhythm is unstable and rate is usually 25 - 45 beats/mins.QRS complex id prolonged. Etiology : Seen in following conditions- Chronic athlets have hypervagal stimulation.Mobitz type two AV conduction block is mostly seen in th...

Systemic illness : Cardiac manifestation - Skeletal mucle Dystrophy : Cardiomyopathy, atrial fibrillations, Mitral stenosis. Stroke Mitral stenosis, Atrial fibrillation. Hemochromatosis : Myocardial Infarction, Restrictive heart disease. Congenital deafness : Prolonged QT Interval, arrhythmias. Raynaud's disease : Pulmonary hypertension, Coronary vasospasm. Conective tissue Disorder (Marfan's Syndrome) : Aortic aneurysm, Mitral valve prolapse. Hyperthyroidism : Atrial Fibrillation, Heart failure. Hypothyroidism : Coronary artery disease, pericardial effusion. Rheumatoid arthritis : Pericarditis, Aortic valve disease. Scleroderma : Cor pulmonale, pericarditis, Myocardial fibrosis. SLE : Pericarditis, Vlavulitis, Myocarditis. Sarcoidosis : Arrhythmias, Cardiomyopathy. Lyme Disease : Unexplained fluctuating AV block.

Right Atrial Overload - Leads to Increase in P wave amplitute (>2.5 mm) Left Atrial Overload - Produces biphasic P wave in V1 with a broad negative component or a broad notched P wave in 1 or more limb leads.(This pattern may also occur in left atrial conduction delays.) Right ventricular Pressure overload - Characterised by tall R wave in V1 with right axis deviation.St depression and T wave inversion in right to mideprecordial leads ( Ventricular strain pattern : attributed to repolarisation abnormalities in hypertrophied muscle.) are also often present.There may be qR pattern in V1 or V3R Right Ventricular Volume overload - is associated with complete or incomplete right bundle branch block with rightward QRS axis deviation. Acute Cor Pulmonale - Most commonly due to pulmonary embolism. QRS axis shifts to right.S1Q3T3 pattern (prominence of S wave in lead 1, Q wave in lead 3 and inversion of T wave in lead 3. Chronic Cor Pulmonale - Mostly due to pbstructive lung disease. ...