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NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .


NIMS(Nepal Index Of Medical Specialities) has been design to provide information on drugs that are marketed in Nepal by Pharma company from around the world .

Tuesday, March 31, 2015




menstrual bleeding

Which of the following best describes irregular, prolonged, and heavy menstrual bleeding?

Uterus showing Endometrium :

a. Menorrhagia
b. Metrorrhagia
c. Menometrorrhagia
d. Polymenorrhea
e. Oligomenorrhea

The answer is c.  

Menorrhagia is excessive or prolonged menses.
Metrorrhagia or intermenstrual bleeding occurs at any time between menstrual periods.
Menometrorrhagia is prolonged and heavy menstrual bleeding that occurs at irregular intervals.
Polymenorrhea is increased frequency of menstruation and oligomenorrhea is scanty menstruation.

Monday, March 30, 2015

37-year-old woman

A 37-year-old woman in her 32nd wk of gestation (G2P1) presents with a seizure. She has been healthy and does not smoke cigarettes, drink alcohol, or use illicit drugs. She has been poorly compliant in receiving her prenatal care.


Physical examination reveals a blood pressure of 150/95 mm Hg. The patient’s face and hands appear
edematous. Other than the patient being postictal (confused and disoriented after the seizure), the neurologic examination is normal. 

The urinalysis reveals proteinuria. The rest of the patient’s laboratory data is normal.
Which of the following is the most likely diagnosis?

a. HELLP syndrome
b. Preeclampsia
c. Eclampsia
d. Essential hypertension
e. Primary seizure disorder

The answer is c.  Preeclampsia is defined as hypertension, proteinuria (>300 mg/24 h), and/or nondependent edema of the face and hands. Risk factors for preeclampsia include African American race, nulliparity, multiple gestations, extremes of age (<15 or >35), chronic hypertension, and a family history positive for preeclampsia. Eclampsia is defined as seizures in a patient with preeclampsia. The cure for preeclampsia/eclampsia is delivery. Magnesium sulfate is often used for seizure prophylaxis and management. The HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a variant of preeclampsia.

Sunday, March 29, 2015

22-year-old female presents with the sudden onset of a high fever

A 22-year-old female presents with the sudden onset of a high fever, a diffuse erythematous skin rash, and shock. She started menstruating at age 13 and for several years has used tampons. Which one of the following is the most likely diagnosis for this individual’s illness? 

a. Erysipelas caused by Streptococcus pyogenes
b. Fifth disease caused by human parvovirus B19
c. Scarlet fever caused by S. pyogenes
d. Secondary syphilis caused by Treponema pallidum
e. Toxic shock syndrome caused by Staphylococcus aureus

The answer is e. Toxic shock syndrome is caused by infection with certain types of S. aureus that secrete the toxin toxic shock syndrome toxin 1 (TSST-1). This toxin is a type ofsuperantigen that binds both class II MHC and TCR outside of the normal antigen-binding groove. As such, this toxin can react with up to 10% of peripheral T cells, which leads to massive T cell activation and shock. 

Clinically, toxic shock syndrome is most often seen in women who use certain tampons that have been colonized with Staphylococcus.

Saturday, March 28, 2015

1yr old boy

A 1-year-old boy is brought to the emergency room because of the passage of several maroon-colored stools per rectum. The abdominal exam reveals normal bowel sounds and no masses.

 Which of the following is the most likely diagnosis?

a. Biliary atresia
b. Intussusception
c. Meckel’s diverticulum
d. Zenker’s diverticulum
e. Pyloric stenosis

The answer is C Meckel’s diverticulum rarely causes symptoms, but infants may present with the painless passage of maroon-colored stools. The diverticulum is a remnant of the omphalomesenteric duct and is the most common gastrointestinal tract congenital anomaly (2% of the population). It is usually 2 cm long within 2 ft of the ileocecal valve, and males (usually <2 years old) are affected 2 times more than females. It is made of 2 kinds of ectopic tissues (stomach and pancreas) and has 2 complications (bleeding and inflammation). (Meckel’s diverticulum is called the rule of 2’s.) Pyloric
stenosis is seen in newborns. Patients present with projectile vomiting, abdominal distention, and a palpable olive-sized mass in the RUQ that appears after vomiting. Prominent persistaltic waves are often visible going from the left to the right side of the abdomen.

Intussusception (one segment of the intestine prolapses into another) is the most common cause of obstruction in the first 2 years of life. Infants present with melena, abdominal pain, vomiting, and diarrhea mixed with mucus and blood, giving it a red “currant jelly” appearance. Often a sausage-shaped mass is palpable in the upper midabdominal area.

Biliary atresia is a congenital obstruction or absence of the bile duct system. Newborns (2–3 wk old) present with light-colored stools, dark urine, hepatomegaly, pruritus, and jaundice. Zenker’s diverticulum is a disorder of adults in which the pharyngeal mucosa protrudes through an area of weakness in the musculature proximal to the upper pharyngeal sphincter.

Patients present with halitosis from retention of food and saliva in the diverticulum. 

Friday, March 27, 2015

9-year-old girl is brought into your office by her mother

A 9-year-old girl is brought into your office by her mother, who states that the daughter has been
losing weight and having difficulty at school. The mother discovered some yellow-colored discharge on  the child’s underwear.

On physical examination, you notice erythema to all parts of the patient’s vulva and to the vagina. There is some yellow discharge visible.

Which of the following is the most likely diagnosis?

a. Müllerian duct tumor
b. Wolffian duct tumor
c. Dermatitis
d. Sexual abuse
e. Straddle injury

The answer is D.  The majority of victims of sexual abuse have no physical examination
findings. Swelling and erythema of the vulvar tissue (genital trauma) should be a “red flag” for child abuse, especially if associated with bruising or a foul-smelling discharge. In addition to the anorectal and genitourinary problems, there can be significant behavioral changes, such as sexually provocative mannerisms, excessive masturbation, inappropriate sexual knowledge, enuresis, depression, social withdrawal, anxiety, school problems, and weight changes. A straddle injury, often from a bicycle seat, occurs over the symphysis pubis, whereas signs of sexual abuse are more posterior around the perineum.

Wednesday, March 25, 2015

6-year-old boy has a history of corneal opacities and relapsing polyneuropathy

A 6-year-old boy has a history of corneal opacities and relapsing polyneuropathy. Physical examination reveals the presence of large, orange-colored tonsils. The patient’s serum cholesterol is low but his triglyceride level is normal.
Which of the following is the most likely diagnosis in this patient?
orange color tonsil in tangiers disease

Polyneuropathy in tangiers

a. Malnutrition
b. Malabsorption
c. Exudative pharyngitis
d. HIV infection
e. Myeloproliferative disorder
f. Tangier disease

The answer is f.Tangier disease is a rare inherited disorder of lipoprotein metabolism.

Patients present with a low serum cholesterol level, virtually no HDL cholesterol, a normal or elevated triglyceride level, orange-colored tonsils, corneal opacities, and a relapsing polyneuropathy. The disorder does not lead to premature atherosclerosis and treatment is not required.

40-year-old male smoker presents with a history of chronic cough.

A 40-year-old male smoker presents with a history of chronic cough. He has had symptoms of an upper respiratory illness for a few months since visiting family in Arizona. Physical exam is normal. CXR is shown below in 

 The next step in management should be
a. Complete pulmonary function tests
b. Fiberoptic bronchoscopy
c. Percutaneous needle biopsy
d. Observation and repeat CXR in 6 to 8 mo

Ans :Figure This chest x-ray shows a radiographically dense nodule in the left hilum. Cardiophrenic and costophrenic angles are clear. An 0.8 × 1-cm circular solitary pulmonary nodule with peripheral yet distinct calcification in the superior aspect is seen overlying the 5th posterior rib in the right upper lung zone.

The answer is c. Based on the age of the patient, risk factors, and persistent
symptoms, further diagnostic tests are warranted. Observation for 6
 mo is inappropriate. Due to the peripheral nature of this lesion, a CT-guided needle biopsy would be the best diagnostic strategy and have a better yield than a bronchoscopy. Pulmonary function tests would be helpful if surgery is planned, but would not alter the diagnostic steps. In this case, the CT-guided biopsy revealed coccidioidomycosis. This is caused by a fungus (Coccidioidesimmitis) in the soil and is seen in desert semiarid climates with a short, intense rainy season. It is endemic in southwestern North America, Mexico,
and Central and South America. Most patients are asymptomatic or recover fully after initial flulike illness. The radiographic findings of coccidioidomycosis are variable and depend upon the severity of the disease. Most granulomas are smaller than 2 cm, and almost all are less than 3 cm in size. Besides SPNs, in the early stages of coccidioidomycosis patchy infiltrates may be accompanied by hilar and mediastinal adenopathy and less frequently bypleural effusion. In cases of persistent disease, infiltrates may enlarge.

Sunday, March 22, 2015

progressive clumsiness and difficulty walking

A 2-year-old boy presents with progressive clumsiness and difficulty walking. On physical examination, the child has large calves. He has difficulty walking on his toes and has a waddling gait.
Gower maneuver is positive.

Which of the following is the most likely diagnosis?

a. Becker muscular dystrophy
b. Myotonic dystrophy
c. Facioscapulohumeral dystrophy

d. Duchenne muscular dystrophy

The answer is d. Children with Duchenne muscular dystrophy (DMD) present between the ages of
2 and 6 years with fatigability, clumsiness, difficulty standing, difficulty walking on toes, pseudohypertrophy of the calf muscles, and a waddling gait. DMD results from a deficiency of dystrophin, while Becker MD is the result of abnormal dystrophin. Becker MD is less severe than DMD and occurs after the age of 5 years. Both Becker and Duchenne MD are X-linked
myopathies. The autosomal dominant myopathies are myotonic dystrophy and facioscapulohumeral dystrophy. Myotonic dystrophy occurs in adolescence and is characterized by diminished facial movements, cataracts, testicular atrophy, and muscle weakness.

Facioscapulohumeral dystrophy occurs between the ages of 10 and 20 years and is characterized by facial and shoulder girdle weakness. The Gower maneuver (pushing off with the hands when rising from the floor because of proximal muscle weakness) is positive in muscular dystrophy.

Wednesday, March 18, 2015

Latex anaphylaxis occurs in patients with spina bifida

A 6-year-old girl with spina bifida is admitted to the intensive care unit because of rapidly progressive
swelling of her lips, wheezing,and stridor. She had been playing with balloons at a birthday party.


Which of the following is themost likely diagnosis?

a. Food anaphylaxis
b. Latex anaphylaxis
c. Severe drug allergy
d. Exercise-related anaphylaxis
e. Idiopathic anaphylaxis

The answer is b: Latex anaphylaxis occurs in patients with spina bifida or with congenital urologic defects who have undergone repetitive surgeries. Other groups at risk include employees of rubber manufacturers and health care workers. The diagnosis is confirmed by prick skin testing for IgE to latex or by radioallergosorbent test (RAST) assay. Patients with latex-induced anaphylaxis must avoid latex during surgical procedures and live in a latex-free environment.

Tuesday, March 17, 2015

Is COPD related to asthma?

Is COPD related to asthma?

Asthma is a specific lung disease that is different from emphysema and chronic obstructive bronchitis. COPD is
often used as a kind of short and to describe emphysema, chronic obstructive bronchitis, or a combination of both,
as mentioned  COPD always refers to diseases that are not asthma.

 The COPD group of lung diseases is not related to asthma, although emphysema and chronic obstructive bronchitis exhibit similarities to asthma. Confusion seems to arise under several circumstances. In the first case, COPD can co-exist with asthma, typically in an older adult with a history of cigarette smoking, and both conditions are present together.

 Secondly, some medical practitioners in a blatant misuse of language use the word asthma to refer to the breathlessness characteristic of the COPD group of lung diseases. They tell their patients with pure emphysema or chronic obstructive bronchitis that they have “a touch of asthma” rather than explaining that the symptom of shortness of breath is a fundamental manifestation of the COPD.

 Finally, COPD and asthma are treated with inhaled medications, some of which are effective in both conditions. On occasion, two family members or friends with two different diagnoses may (correctly) be prescribed the same inhaler, and that can lead to all kinds of assumptions.

I am reminded of a 75-year-old in my care; he had smoked heavily and had marked emphysema. He had
succeeded in kicking his former cigarette habit, an  achievement of which he and I were very proud. He was
naturally quite concerned about the emphysema diagnosis.

 He explained to me that he was particularly troubled about what his prognosis and quality of life would
become over time.

 Over the course of a year, I prescribed several medications for treatment of his emphysema and he would see me in the office every few months for follow-up. On one memorable visit, he arrived in excellent spirits and shared the news that his 21-year-old grandson who had been diagnosed with asthma at the age of 6 was in town and staying over for a weekend visit.

 On that visit, my patient discovered that he was taking the identical inhaled medication that his grandson used for asthma, and announced grinning from ear to ear, “Well, Doc, I figured out then that you’re treating me not only for emphysema, but for asthma, too, and that means my prognosis isn’t that bad . . .”


Monday, March 16, 2015

The answer is d.Rubella is normally a mild self-limited illness

In the prenatal workup for a 24-year-old patient, you discover she is not immune to rubella. 

When is the best time to vaccinate her against rubella?
a. Immediately
b. In the second trimester of pregnancy
c. In the third trimester of pregnancy
d. In the early postpartum period
e. At least 4 weeks postpartum

The answer is d.  Rubella is normally a mild self-limited illness, but infection during pregnancy can result in fetal death or congenital defects known as congenital rubella syndrome (CRS). CRS is devastating, and rubella immunity is important for women considering pregnancy. If a woman is found to be rubella nonimmune, vaccination should not occur if she is pregnant or planning pregnancy in the next 4 weeks. Although the vaccine is contraindicated in pregnancy, inadvertent vaccination is not an indication for therapeutic abortion. If the patient is currently pregnant and nonimmune, she should be vaccinated as early in the postpartum period as possible.

c. Facial nerve

Which of the following cranial nerves is tested with stimulation of the anterior two-thirds of the tongue with sugar or salt while the tongue is protruded?

a. Ophthalmic branch of the trigeminal nerve
b. Vagus nerve
c. Facial nerve
d. Maxillary branch of the maxillary nerve
e. Mandibular branch of the trigeminal nerve

The answer is c.The facial nerve (cranial nerve VII) mediates taste (salty and sweet) on the anterior two-thirds of the tongue. The glossopharyngeal nerve (cranial nerve IX) mediates taste (bitter and sour) on the posterior one-third of the tongue.

Thursday, March 12, 2015

Arrhythmogenic right ventricular dysplasia (ARVD)

Arrhythmogenic right ventricular dysplasia (ARVD) is a disorder characterized by progressive replacement of the right ventricular myocardium by fibrofatty tissue.

Although this disorder usually involves the right ventricle, the left ventricle and septum also may
be affected. This dysplasia can lead to extensive wall thinning, atypical arrangement of
trabecular muscles, dilatations or aneurysms having paradoxical systolic motion, and,
in rare cases, right-sided congestive heart failure.

Although the exact prevalence of ARVD is unknown, it has been estimated to occur in
one in 5000 individuals from the general population. Several reports suggest that there
is a familial occurrence of ARVD of about 30%?0%, with mainly autosomal dominant
inheritance. It represents the second cause of sudden cardiac death in young persons,
especially athletes, after hypertrophic heart disease.

Patients with ARVD are usually men younger than 35 years who complain of chest pain
or tachycardia. In some cases, sudden cardiac death can be the fi rst presentation.
The diagnosis of ARVD is based on the presence of major and minor criteria encompassing
genetic, electrocardiographic, pathophysiologic, and histopathologic factors.

Fifty to 90 percent of persons with ARVD will have characteristic fi ndings on a resting
electrocardiogram (ventricular tachycardia with LBBB, originating from the right ventricle).
The imaging modalities used to evaluate right ventricular abnormalities include
conventional angiography, echocardiography, radionuclide angiography, ultrafast computed
tomography, and magnetic resonance (MR) imaging.

Right ventricular angiography has usually been regarded as the standard of reference
for the diagnosis of ARVD, especially for discerning abnormalities such as akinetic or
dyskinetic bulging in the infundibular, apical, and subtricuspid regions.
Echocardiography can detect regional or global changes in myocardial contractility,
enlargement of the right ventricle, and right ventricular systolic dysfunction during a
routine study. However, visibility of the apex and the right ventricular outfl ow tract is
limited, areas of wall thinning may be very diffi cult to detect, and echocardiography
lacks spatial resolution in depicting the typical fatty and fi brofatty changes in the right
ventricular myocardium.

MR imaging allows visualization of ventricular cavities and walls with an excellent
depiction of myocardial anatomy. Cine sequences detect regional motion changes such
as global or local hypokinesia, localized early diastolic bulging, or circumscribed saccular
outpouchings. T1-weighted sequences are able to detect intramyocardial fat in
some cases. MR images obtained with the delayed-enhancement technique may reveal
fi brous replacement of the right-ventricular free wall.

Because MR imaging depicts both functional and structural abnormalities, positive MR imaging fi ndings should be used as important additional criteria in the clinical diagnosis of ARVD. CMR appears to be the optimal technique for the detection and follow-up of clinically suspected ARVD.

Balanced fast fi eld-echo cine MR images performed in the 4-chamber (Fig. 2.3.1) and short-
axis (Fig. 2.3.2) projections show severe dilation of the right ventricle, along with wall thinning,
increased trabeculation, multiple bulges with dyskinetic areas, and severe global dysfunction.
The left ventricle is normal in size with mildly reduced global systolic function.
Black-blood T1-weighted MR images obtained in the 4-chamber (Fig. 2.3.3) and shortaxis
(Fig. 2.3.4) planes show the absence of areas of fatty replacement of the right ventricular

On the basis of these fi ndings, ARVD was diagnosed even though no fatty replacement
of the RV wall was observed.

Wednesday, March 11, 2015



■ Tinea corporis, also known as “ringworm,” is a dermatophyte fungal infection caused by the genera Trichophyton or Microsporum.

■ T. rubrum is the most common pathogen.

The borders of tinea corporiscan extend at variable rates, causing a lesion thatis more ovoid than annular

Annular lesion with a raised,scaly border on the forearm.

Clinical Manifestation(s)

■ Th e disease typically begins as an isolated lesion with subsequent development of satellite lesions . Vesciculation may develop if the lesion is covered.

Physical Examination

■ Annular red scaly plaques with active border are seen with some crusting and
central clearing .
■ In some cases the borders of tinea corporis can extend at variable rates, producing
a lesion that is more ovoid than annular .

Diagnostic Tests

■ Diagnosis is usually made on clinical grounds. It can be confi rmed by direct
visualization under the microscope of a small fragment of the scale using wet
mount preparation and potassium hydroxide solution; dermatophytes appear
as translucent branching fi laments (hyphae) with lines of separation appearing
at irregular intervals.
■ Biopsy is indicated only when the diagnosis is uncertain and the patient has
failed to respond to treatment.
Differential Diagnosis
■ Pityriasis rosea
■ Erythema multiforme
■ Psoriasis
■ Cutaneous SLE
■ Secondary syphilis
■ Nummular eczema
■ Eczema
■ Granuloma annulare
■ Lyme disease
■ Tinea versicolor
■ Contact dermatitis


First Line
■ Various creams are eff ective; the application area should include normal skin about 2 cm beyond the aff ected area:
● Betenafine cream, applied QD for 14 days
● Terbinafine cream applied BID for 14 days

Second Line
■ Systemic therapy is reserved for severe cases and is usually given up to 4 weeks;
commonly used agents include the following:
● Fluconazole 200 mg QD
● Terbinafine 250 mg QD

Clinical Pearl(s)
■ Th e majority of cases resolve without sequelae within 3 to 4 weeks of therapy.

Tuesday, March 10, 2015

segmental neurofibromatosis

A 4yr girl presented for  cutaneous nodules that had been present on the left side of her trunk since birth.

 She had no history of seizures or developmental delay, and there was no family history of similar cutaneous findings. Physical examination revealed numerous soft, nontender papules and nodules between 2 - 12 mm in diameter, distributed across the left upper abdomen  and wrapping around to the left back . The  physical examination was unremarkable; axillary freckles, café au lait macules, and Lisch nodules were not observed. Results in  biopsy of a nodule were consistent with a neurofibroma. The patient received a diagnosis of segmental neurofibromatosis, a variant of neurofibromatosis characterized by neurofibromas or café au lait macules (or both) that are confined to one body segment. 

Segmental neurofibromatosis results from a postzygotic mutation in the NF1 gene, leading to somatic mosaicism. The patient was scheduled for annual follow-up for surveillance of the nodules and any conditions that may be associated with neurofibromatosis. Because she has remained free from systemic complications of neurofibromatosis since birth, no specific treatment has been pursued. Her parents were offered genetic counseling on her behalf.

Monday, March 9, 2015

An asymptomatic 56-year-old gentleman presents for routine follow-up.

 An asymptomatic 56-year-old gentleman presents for routine follow-up.

1. What are the ECG fi ndings?

2. What ECG fi ndings would concern you during a preoperative evaluation?

What abnormalities are present on the ECG?

There is sinus rhythm at 66 beats/min. Th e axis is deviated left ward, evidenced by
the positive QRS complex in lead I and the negative QRS complex in leads II and
aVF. Th is left -axis deviation is associated with small q waves and large R waves in
leads I and aVL, and small r waves and large S waves in the inferior leads. Th ere is
no evidence of left ventricular hypertrophy or other chamber abnormalities. Th ere
are no pathologic Q waves suggesting prior infarction, and no ST-segment or T-wave
abnormalities. Th e presence of left ward axis deviation in the absence of left ventricular
hypertrophy or prior infarction with this pattern of qR complexes in leads I and
aVL and rS complexes in the inferior leads is consistent with left anterior hemiblock,
also known as left anterior fascicular block. Recall that the His bundle bifurcates into
the left and right bundle branches. Th e left bundle branch further branches into the
left anterior fascicle and the left posterior fascicle. Block in the left anterior fascicle is
more common than block in the left posterior fascicle. Hypertension, ischemic heart
disease, cardiomyopathy, and degenerative conduction system disease of the elderly
(Lev’s syndrome) are all associated with left anterior hemiblock. Th e QRS duration is
normal when left anterior hemiblock alone is present, although a delayed intrins icoid
defl ection (the duration between the onset of the QRS and the peak of the R wave) of
greater than 45 milliseconds should be observed in lead aVL as is present in this case.

What is the diff erential diagnosis for left-axis deviation?

Left -axis deviation can be associated with left anterior hemiblock (as in this case), left
ventricular hypertrophy, prior myocardial infarction, Wolff -Parkinson-White syndrome,
and atrial septal defect.

Thursday, March 5, 2015

(D) atrioventricular (AV) node dysfunction

A 63-year-old woman with hypertension is started on a beta-blocker.

Which of the following conditions require caution in prescribing  this medication?

(A) migraine headaches
(B) hypertrophic subaortic stenosis
(C) Marfan syndrome
(D) atrioventricular (AV) node dysfunction
(E) intermittent claudication

(D) Beta-blockers are frequently used in the treatment of hypertrophic cardiomyopathy and
for migraine prophylaxis and might prevent aortic dilatation in Marfan syndrome. It rarely
causes clinical problems in patients with claudication, but if AV conduction defects are present
(either by disease or use of other drugs), life-threatening bradyarrhythmias can occur.

Wednesday, March 4, 2015

होलि खेल्दा ध्यान दिनु पर्ने कुराहरु

होलि खेल्दा  ध्यान दिनु पर्ने कुराहरु 

  • Playing Holi, always wear old and ragged clothes that can be discarded immediately after the occasion. Brightly colored and dark colored clothes are preferable for the mood of the day. This way, you will save a lot of time in laundering your stained clothes.
  • Wear full-sleeved t-shirts or shirts and leggings that cover your legs fully, so that your sensitive body parts are not exposed to the harmful chemicals of the colors of Holi. Wearing socks on the occasion is a good idea too.
  • Since it is almost impossible to save yourself face from attack of colors on Holi, so while being attacked, keep your eyes and lips tightly closed.
  • If you are playing Holi, apply a thick layer of coconut or any oil on your body and hair until they glisten and you become slippery. The oily coat would protect you from the immediate effect of harmful chemicals of the colors of Holi. This will not only help in escaping from the frenzied mob attack, but also will help you to wash off colors easily, later on.
  • While washing off the color from your face, use lukewarm water and keep your eyes and lips tightly closed.
  • If you are traveling on Holi, keep the car windows tightly shut. It is still better to avoid traveling on the day of playing colors, because you never know, when balloons filled with colors and water might fall onto you.
  • Do not make use of harmful colors for Holi. This will not only prove harmful to your playmates, but also spoil your Holi. Make use of herbal colors for the festival.
  • Choose herbal colors that are easily available in the market, for Holi. You may also make herbal colors at home. For instance, red sandalwood powder can be used to make red color; henna powder can be put in best use to derive the bright green color, while yellow color can be made by making use of turmeric powder.
At the end Happy HOLI to everyone : wish you safe holi to you and your family .

Tuesday, March 3, 2015

A 72-year-old man is prescribed hydrochlorothiazide for hypertension.

A 72-year-old man is prescribed hydrochlorothiazide for hypertension.

Which of the following is the most likely symptomatic side effect?
(A) increased serum potassium
(B) metabolic acidosis
(C) sexual impotence
(D) respiratory alkalosis
(E) hypernatremia

(C) The most common symptomatic side effect in men is impotence, and it should be specificallylooked for. The most serious complications relate to fluid and electrolyte imbalanceand include hyponatremia, hypokalemia, and volume contraction.

Sunday, March 1, 2015

Acanthosis Nigricans

An adolescent girl with obesity and recently diagnosed type II diabetes mellitus (DM) presents to her family physician with concerns about a “dirty area” under her arms and on her neck that “couldn’t be
cleaned” (Figure). She has irregular periods that often skip several months at a time.

Acanthosis nigricans
fig :Acanthosis nigricans in the left axilla of an overweight  10-year-old girl. Note areas of dark velvety discoloration and pink filiform hypertrophy.

• Patients with AN are at higher risk of metabolic syndrome, and lipid screening should be considered along with consideration of testing for DM.

• Weight loss through diet and exercise helps reverse the process, probably by reducing both IR and compensatory hyperinsulinemia.

• Keratolytic agents (e.g., salicylic acid) can improve the cosmetic appearance. Other topical therapies, including 0.1% tretinoin cream (to lighten the lesion), combination tretinoin cream with
12% ammonium lactate cream, or topical vitamin D ointments,.

• Metformin12 and octreotide have also been used to manage AN. SOR C