Common Diseases 1

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CHAPTER-3
COMMON DISEASES
NON – INFECTIOUS DISEASES
PUD (PEPTIC ULCER DISEASE)
1 Definition: The peptic ulcer disease refers to an ulcer or a break in the gastric or
duodenal mucosa that arises when the normal mucosal defensive factors are impaired or are
overwhelmed by aggressive luminal factors such as acid & pepsin. The other parts of the
gastrointestinal tract that are exposed to hydrochloric acid & pepsin digestion, e.g. lower end of
the oesophagus, small intestine after surgical anastomosis to the stomach or rarely Meckel’s
diverticulum are occasionally involved.
2. Causes: 03 major causes of peptic ulcer disease are now recognized:
a. Chronic H. pylori infection.
b. NSAIDs &
c. Acid hypersecretory state.
3. Clinical Features
a. Recurrent abdominal pain: About 80% to 90% patients present with recurrent
abdominal pain, which has three remarkable characteristics
b. Pain is mostly localized in the epigastrium.
c. Relationship of pain to food – Pain occurs intermittently during day & night
usually when the stomach is empty & relieved by food; so the pain is identified as
“hunger pain”. But sometimes it is variable & not helpful in diagnosis.
Night pain- Incase of classical duodenal ulcer, pain wakes the patient from sleep at
late night & gets relief by food, drink or antacid.
d. Periodicity - Ulcer pain is usually episodic & lasts for a few days to weeks in each
episode & in between the patient is quite well.
e. Other symptoms - May include heart burn, water brush, belching & vomiting.
Vomiting is more common & typical in gastric ulcer than duodenal ulcer.
f. Haematemesis & Melaena- In peptic ulcer disease, there may be chronic
undetected blood loss, or haematemesis & melaena, or even acute perforation.
Haemorrhage may also occur incase of NSAID- induced ulcers.
4. Investigations.
4
Endoscopy of upper GI tract- This is the best diagnostic method if available.
1. Reddish & velvety – Normal mucosa
2. Pale & whitish mucosa- Ulcer presents.
Ba-Meal X-ray of stomach & duodenum with cap series. Cap deformity and ulceration
can be seen if ulcer is present.
Detection of H. Pylori-H Pylori can be determined by –
(1) Histopathology- The biopsy material obtained of endoscopy. or
(2) The presence of urease in a fresh biopsy specimen. or
(3) By a serologic test. (an ELISA test)
5. General management
5 a. Bed rest- during acute exacerbation.

6 b. Diet-
(1) Regular timing of meals.
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(2) Nutritious diet.
(3) Irritant & highly spicy food should be avoided.
(4) Tea, coffee etc. best avoided.
(5) In acute phase it is often useful to give full liquid or soft diet
7
8 c. Smoking is strictly prohibited.
9 d. Steroid Aspirin & NSAID groups of drugs should be avoided.
6. Short term Treatment - The pharmacologic agents that are used in the short term treatment
of peptic ulcers to relieve acute symptoms & enhance the healing, are divided into three
categories.
a. Acid anti-secretory agents

10
11 (1) Proton pumps inhibitors- Omeprazole, Lansoprazole.
12 (2) H2 receptor antagonists – Cemetidine, Ranitidine, Famotidine &
Nizatidine.
b. Mucosal protective Agents
13 (1) Sucralfate, Bismuth, Misoprostol & Antacids
c. Agents that promote healing through eradication of H. Pylori.
14 (1) Proton pump inhibitor-Omeprazole, Lansoprazole

15 (2) Some antibiotics- Amoxycillin, Clarithromycin, tetracycline &
metronidazole.
DYSENTERY
1. Definition: Dysentery is an acute inflammation of the large intestine characterized by

diarrhoea with blood and mucus in the stool. Its causes are bacillary or amoebic infection.
2. Types: There are two types of dysentery. Such as -
a. Amoebic dysentery.
b. Bacillary dysentery.
a. Amoebic dysentery:
(1) Definition: It is the infection of the large gut by the pathogenic species
of the protozoa parasite entamoeba histolytica.
(2) Incubation period: The incubation period varies from 02 weeks to

many years.
(3) Clinical features:
(a) In mild to moderate cases: recurrent loose or semiformed stool

with abdominal cramp.
(b) Mucus usually present, fat blood is initially absent.
(c) Often, stool has an offensive odor.
(d) In severe acute cases- blood mucoid diarrhoea may be present.
(e) There may be systemic manifestations- like nausea, vomiting,
anorexia, headache, mild fever, fatigue etc. and even patient may become
toxic.
(f) On palpation of the abdomen there may be tenderness along the
line of the colon.
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(4) Investigations:
(a) Stool for R/E- Three specimens at 02 days intervals mucus,
trophozoites RBC may be present.
(b) Sigmoidoscopy may reveal typical ulcers.
(c) Serologic testing & ELISA methods are also useful ways of
detecting amoebic dysentery now a day.
(5) Treatment:
(a) Mild to moderate intestinal infection: Metronidazole 800mg

3 times daily after meal for 5 days or, Tinidazole 800mg 3 times daily for
03 days plus Diloxanide furoate 500 mg 3 times daily with meals for 10
days (to eliminate luminal cysts).
(b) Severe intestinal amoebic dysentery: Drug of choice-
Metronidazole 800 mg 3 times daily after meals for 10 days plus
Diloxanide furoate 500 mg 3 times daily with meals for 10 days. Or
Iodoguinol 650 mg 3 times daily for 21 days.
(d) General measures in acute stage:
i. Bed rest.
ii. Adequate amount of fluid intake.
iii. Non-residual diet, e.g. Dhai & chira.
NB: - Incase of child patient dosage should be adjusted
accordingly.
b. Bacillary dysentery
(1) Definition: Bacillary dysentery or shigellosis is a common disease,

caused by shigella . It is an invasive organism leading to an acute inflammation of
the large intestine characterized by diarrhoea with blood and mucous in the stool.
(a) Abrupt onset of passage of loose stool for numberless time. No
faecal matters only blood & mucus, bright red in colour, odourless.
(b) Marked tenesmus and lower abdominal crumps.
(c) Systemic- fever, chill, anorexia, malaise, headache, lethergy.
(d) In more severe cases- thirst, dry tongue, oliguria, intense, headache
due to meningism and sometimes coma & convulsion.
(e) Tenderness- Lower abdomen.
(3) Investigations:
Stool R/E- Plenty of pus cells, RBC, ingested RBC in the macrophages.
Stool culture- Positive for shigella in most cases.
(4) Treatment:
(a) Bed rest.

(b) Specific measures:
i. Treatment of shock, restoration of circulatory blood volume
and renal perfusion (if any) are life saving measures by oral or by
IV fluid as required.
ii. Antimicrobials-
Cotrimoxazole 960 mg 12 hourly for 7 days
Or
Trimethoprim 200 mg 12 hourly for 7 days.
Or
Nalidixic acid 500 mg to 1 gm 6 hourly for 7 days.
Or
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Selexid 400 mg 6 hourly with or immediately after meal for
5-7 days.
Or
Ciprofloxacin 500 mg to 750 mg 12 hourly for 7 days may
be given.
NB:- Dosages for children should be adjusted accordingly.
(5) General measures:
(a) Loperamide 2-4 mg 6-8 hourly for controlling diarrhoea.

(b) Anti-spasmodic drugs. e.g. Hyoscine butyl bromide for abdominal
cramp or pain.
(c) Infusion- Cholera saline to combat dehydration.
(d) Adequate intake of fluid. e.g. dub water & barley.
(e) Diet should be non-residual e.g. dhai & chira.
PNEUMONIA
1. Definition: It is an inflammatory process in the lung parenchyma, caused by various

organisms. It is also associated with lower respiratory tract infection & recently developed
radiological signs.
Types of pneumonia
a. According to source of infection-
(1) Primary pneumonia- Usually community- acquired.

(2) Secondary pneumonia- (Occurs when the host or the lungs are diseased or
weakened)
(a) Acute Bronchopneumonia.

(b) Nosocomial (hospital acquired) pneumonia.
(c) Aspiration pneumonia.
(d) Pneumonia in the immunocompromised patient.
b. According to site of involvement
(1) Lobar – 20%

(2) Lobular –70%
(3) Segmental – 10%
c. According to causative organism-
(1) Bacterial (mostly pneumococcal) pneumonia.

(2) Rickettsial pneumonia.
(3) Viral pneumonia.
(4) Parasitic pneumonia.
(5) Fungal pneumonia.
(6) Other opportunistic organisms.
ACUTE LOBAR PNEUMONIA (Pneumococcal pneumonia)
1. Definition: It is characterized by homogeneous consolidation of one or more lobe or

segments of lungs. It occurs, most commonly in early & middle adult life. Highest incidence is in
winter.
2. Clinical features
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a. Sudden onset of fever with chills & rigor or vomiting or convulsion in children.
b. High continuous fever up to 1050 F.
c. Chest pain commonly on the right side associated with pleurisy; pain may be
referred
to the shoulder & abdomen.
d. Short painful cough, dry first then productive tenacious sputum, then rusty
coloured
cough, occasionally blood stained.
e. Malaise, weakness, headache, loss of appetite.
f. Aching pain in the body & limbs.
g. Patients look very ill.
h. Hurried respiration.
j. Pulse- rapid, skin hot & dry, flushed face.
k. Respiration- shallow & painful.
l. Central cyanosis may be present.
m. Movement of the chest reduced- percussion note dull.
n. Vocal resonance increased with fine or course crepitation.
3. Investigation
(1) Blood count –shows marked leukocytosis.

(2) Blood culture- positive in 25% cases.
(3) Sputum for gram stain- Red cells, white cells & pneumococci.
(4) X-ray chest- shows consolidation localized, or patchy in distribution appearing
within 12-18 hrs of the onset of illness.
Management
Rest in bed
O2 inhalation for all hypoxaemic patients.
Analgesic- to reduce temperature & chest pain.
Treatment of pleural pain- mild analgesic like Paracetamol or pathedine 50-100 mg or
Morphine 10-15 mg by I.M or I.V with extreme caution.
Paraldehyde if deteriorated.
Diet- Liquid diet to start & gradually as the temperature subsides high protein diet & high
caloric diet with plenty of fluid & electrolyte should be given.
Treatment When a clinical diagnosis is made & the patient is not seriously ill-
a. Penicillin is the drug of choice.

b. For penicillin allergic patient- Erythromycin, Cephalexin, Co-trimoxazole,
c. Azithomycin.
d. For Immunocompromised patients – Inj. Ceftriaxone 2 gm, Inj , Cefotaxime 3
gm.
e. Antibiotic therapy should be given for 14 days or longer. Treatment of
complications should be done with proper diagnosis.
MALARIA
1. Definition: Malaria is caused by protozoa of the genus plasmodium. It is transmitted

to men almost always by the infected female anopheles mosquito. Malaria may also transmitted
by blood transfusion or inoculation. There are four species of malarial parasites.
2. Types:
a. Plasmodium falciparum: Produces malignant tertian malaria or falciparum

malaria.
b. Plasmodium vivax: Produces benign tertian malaria.

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c. Plasmodium malariae: Produces quartan malaria.
d. Plasmodium ovale: Produces ovale or tertian malaria.
3. Incubation period: 10-15 days.
4. Clinical features: Clinical feature vary according to the different species of

plasmodium. Some common features are:
(a) Fever- Chill with rigor

(b) Headache, muscle pain, malaise, anaemia.
(b) Herpes labialis.
(c) Enlargement of spleen & liver.
(d) Mild jaundice.
(f) Paroxysmal attacks are characteristic of malaria except in P. falciparum
infection. There are 3 stages of fever (paroxysm) in Malaria.
A typical paroxysm may be divided into:
a. Cold stage: Temperature lasting for 20 minutes to 1 hour, followed by-

b. Hot stage- Temperature lasting for 1-4 hours. followed by-
b. Sweating stage – Which last for 2-3 hours.
6. Types of fever in Malaria
16 a. Tertian fever- (P-Virax, P. Ovale)

17
(1) Paroxysm/fever occurs on alternate days.
(2) Spleen becomes palpable.
18 b. Quartan fever (P. Malariae)
(1) Fever occurs at interval of 2 days.

(2) Scanty urine.
(3) Albuminuria and
(4) Haematuria may occur.
c. Falciparum fever (P. Falciparum): The onset may insidious & the fever
continuous remittent or irregular, typical fevers are unusual. Splenomegally & serious
complications may develop.
d. Quotidian fever : Fever recuring at intervals of 24 hours. Such type of fever

has been observed in mixed infections with P. Vivax & P. malariae due to maturation of
two generation of tertian parasites & three generation of quartan parasites.
6. Complication – ln case of P. Falciparum
a. Cerebral malaria with oedema.

b. Hyperpyrexia, haemolytic anaemia.
c. Organ damage due to anoexia.
(1) Brain-Confusion, Coma.
(2) Kidneys- Oliguria, Uraemia.
(3) Lungs- Cough, Pulmonary oedema.
(4) Heart- Cardiac dysrhythmias.
(5) Liver- Acute hepatopathy, Jaundice, Encephalopathy.
(6) Intestine- Diarrhoea, Congestion, possibly leaky to bacteria.
(7) Adrenal – adrenal insufficiency like syndrome.
d. Intravascular haemolysis- Black water fever.

e. Hypoglycaemia- Specially with quinine treatment.
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f. Septicaemia secondary to shock.
g. Hypotensive shock.
h. Metabolic acidosis.
i. Splenic rupture.
j. In pregnancy- Maternal death, abortion, still birth, low birth weight.
7. Complication- incase of P. malariae
a. Glomerulonephritis. &
b. Nephritic syndrome in children.
8. Investigations:
a. Blood for MP- If positive repeat (if necessary)
9. General management of malaria.
a. Bed rest.
b. Paracetamol 500 mg three time daily after meal.
c. Ice cap & Cold sponging.
d. Adequate diet.
e. I/V fluid should be given.
f. General nursing care should be taken.
g. Reassure the patient.
10. Treatment of malaria -The treatment schedule given by WHO & supported by DG of heath
dept. of Bangladesh in 1994.
a. Uncomplicated Malaria
Weight in kg
Day Drug
30-39 40-49 >50
1st day Tab. Chloroquine 150 mg base* 2 3 4
2nd day -do- 2 3 3
3rd day -do- 2 3 3
4th day Tab. Primamine 15 mg. 1½ 2 3
.The initial dose for children is 5-15 mg/kg of body weight.

b. Treatment failure or when there is no response with chloroquine:-
Weight in kg
Day Drug
30-39 40-49 >50
1st day Tab. Quinine (300 mg) t,d,s 1½ 2 2
2nd day -do- 1½ 2 2
3rd day Tab. Quinine (300 mg) t,d,s 1½ + 2 2 + 2½ 2+3
Tab, Fansidar
4th day Tab. Primaquine single dose 1½ 2 3
c. Incase of severe malaria
(1) A loading dose of quinine dihydrochloride 20 mg/kg body weight by I/V

infusion in 5% D/A for 4 hours. (Never by bolus IV infusion)
or
The same dose may be given by I/M injection in 2 divided doses into 2 sites i.e. In
each interior thigh at a concentration of 60 mg/ml.
(2). Maintenance dose: Should be started 12 hours after loading dose.
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Quinine dihydrochloride 10 mg/kg body weight by very slow I/V infusion as
before in D/Aqua. When patient is able to take orally treatment should be given
orally with – Tab. Quinine 2 tab 3 times daily for 3-7 days. + Tab Fansidar 3 tab
single dose on 3rd day . + Tab. Premaquine 1 ½ tab on 4th day of oral therapy.
CEREBRAL MALARIA.
1. Definition: Cerebral malaria is the most urgent & severe complication of falciparum
malaria. This is manifested by headache, mental disturbances and various neurological signs,
stiffness of neck, muscular twitching, retinal haemorrhage, convulsion, delirium & coma.
a. Eyes remain open with and unseeing state.
b. Oculogyric crisis, teeth grinding, pouting, grasp reflexes may present.
c. Stiff neck.
d. Severe headache.
e. Deep strenuous breathing with extensor posturing.
f. Stress reflexes symmetrical & brisk, planter extensor, abdominal reflexes absent.
g. Retinal haemorrhage.
3. Treatment
As before stated
Or
Tab. Chloroquine 5 mg/kg of body weight- in I.V. In fusion over (2-4) hours to avoid acute
circulatory failure & encephalopathy. The dose should be repeated 8 hourly until the patient can
take orally.
Or
Tab. Quinine 10 mg/kg of body weight-in I.V. In fusion over (2-4) hours to avoid acute
circulatory failure & encephalopathy. The dose should be repeated 8 hourly until the patient can
take orally.
4. Prevention of Malaria
a. Protection against the bite of mosquito by using mosquito net.

b. Full slip shirt to be worn.
c. Repellent oil to be applied on exposed part.
d. Adult mosquito to be destroyed by apply insecticides with Nova, Furadan,
Basudin etc at least a week. (available insecticides)
e. All dirty places like- drain, stagnant water, ponds etc areas are to be sprayed with
insecticides & cleaned the area.
f. Kerosene oil to be applied over the damp area.
g. Stagnant water to be drain out.
h. Low land to be filled up.
i. Weeds to be cut & cleaned properly.
j. Remove of all materials germ by mass control.
k. Dustbin & other dirty places to be properly cleaned.
l. Preventive drugs to be taken –
Rx.
Tab. Chloroquin 300 mg once in a week.
Or
Tab-Maloprim 100 mg once in a week.
INFLUENZA
1. Definition: It is a viral infection & mainly caused by a group of myxoviruses.

Common types are A, B, C, strains of influenza viruses. It occurs usually epidemically.
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2 Clinical features:
a. Sudden onset of malaise, headache.

b. Generalized aches & Pain.
c. Anorexia, Some times nausea & vomiting.
d. Fever up to –1040 F with chill & shivering, occasionally rigor.
e. Palate, Tonsil, conjunctiva may be congested.
f. Face is flushed & hyperemic.
g. Cough may be unproductive with harshness.
h. Complications may be- Bronchitis, Tracheitis, Bronchiolitis, Bronchopneumonia,
Post influenzal asthenia & depression etc.
i. Danger- Toxic cardiomyopathy when pre-existing cardiac disease.
3. Treatment
a. Complete bed rest

b. Analgesics- to reduce temperature.
c. Antihistamine preparations-help to reduce irritation, sneezing & secretion.
d. Xylometazoline drop- for short period- for nasal congestion.
e. If sore throat- warm saline gurgling, steam inhalation are useful.
f. Cough suppressant- Pholcodine 5-10 mg 6-8 hourly.
g. Antibiotics for bacterial complication.
h. Treatment of other complications should be given.
4. Prevention:
a. Trivalent influenza virus vaccine 0.5 ml I/M once annually- provide partial
immunity for a few months to one year. The vaccine is contra-indicated in persons with
hypersensitivity for chicken eggs or other components of the vaccine, persons with an acute
febrile illness or thrombocytopenia.
BRONCHIAL ASTHMA
1. Definition: Bronchial asthma is characterized by paroxysms of breathlessness, chest

tightness, wheezing and difficulty in breathing resulting from narrowing of the airways by a
combination of:
a. Muscle spasm.
b. Mucosal swelling or oedema due to inflammation.
c. Viscid bronchial secretion.
It is divided into 2 types:
(1) Early onset or atopic childhood asthma.

(2) Late- onset or non-atopic adult asthma.
2. Symptoms:
a. Sudden onset of severe respiratory distress.

b. Wheezing.
c. Restlessness.
d. Feeling of tightness in the chest.
e. Cough- may be unproductive or coughing up of tough viscid sputum.
f. History of previous asthmatic attack.
3. Sign:
a. Respiratory muscles- accessory respiratory muscles are prominent.
b. Prominent of supraclavicular fossa.
c. Widening & deepening of intercostal spaces.
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d. Movement of the chest wall diminished symmetrically, chest may be silent.
e. Expiratory & inspiratory rhonchi & some crepitation are present.
4. Types of Asthma
a. Episodic Asthma.
b. Chronic Asthma.
c. Severe Acute Asthma.
5. Investigations:
a. X-ray chest.
b. Pulmonary function test.
c. Skin sensitivity test.
d. Therapeutic test.
e. Blood CP.
f. Urine routine test.
6. Management:
a. Complete bed rest in propped up position.
b. O2 inhalation 4-6 liters/m if required.
c. Antibiotics- may be given to prevent secondary infection.
d. Infective allergens & other precipitation factors should be avoided.
e. Breathing exercise may be helpful.
f. Avoid cold.
g. Avoid foods which produce allergy.
h. Nebulizer may be used if required.
7. Treatment:
a. Bronchodilator.
b. Sulbutamol.
c. Corticosteroid drug.
d. Beclomethasone dipropionate.
e. Adrenoceptor agonist.
f. Theophylline.
g. Steroid therapy.
h. I/V fluid can be given as there is other dehydration.
i. Antibiotic should be given in infection- according to the severity of the case.
8. Prevention:
a. Early treatment of chest infection.
b. Discontinue cigarettes smoking.
c. Avoid drugs which increase asthma.
d. Avoid cold & allergic foods, dust, pollens, feathers, physical exercise etc.
e. Keeping the bedroom simple, dry & clean.
f. Breathing exercise.
g. Swimming may be helpful.
ACUTE BRONCHITIS
1. Definition: Acute bronchitis is a clinical condition caused by acute inflammation of

trachea & bronchi. This syndrome is usually attributed to infections agents: i.e. Influenza virus
A&B, parainfluenza virus, respiratory syncytical virus, adeno virus and rhinovirus. Bacterial
infection:- Streptococcus pneumonia.
2. Predisposing factors:
a. Common cold.
b. Damp, foggy & dusty weather & atmosphere.
c. Cigarette smoking.
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d. Chronic mouth breathing.
3. Clinical features:
a. Irritating unproductive cough.

b. Upper retrosternal discomfort.
c. Mucoid or mucopurulent sputum- occasionally with streaks of blood.
d. Sweating.
e. Tightness in the chest.
f. Wheezing respiration.
g. Dyspnoea.
h. Fever upto- 1030F-not constantly present.
i. Cyanosis occasionally.
j. Vesicular breath sound with prolonged expiration.
k. Rhonchi-Bilateral
l. Course crepitation- may be present.
4. Investigation:
a. Blood CP- Neutrophil leukocytosis, ESR –High.

b. Sputum for grams stain & culture- may be positive.
c. X-ray chest to exclude other diseases.
5. Treatment/ management:
a. Rest in bed.
b. Analgesic to be given.
c. Antibiotics to be given to those patients who are supposed to be developing
bronchopneumonia.
d. Steam inhalation with Tr. Benzoin.
e. Cough suppressant at night.
f. If there is airway obstructive –Bronchodilator to be given.
g. In urgency O2 inhalation is essential.
h. Head side of the bed to be raised.
HYPERTENSION
Definition: Systemic blood pressure of an individual or a group of population has no definite

range or level to be defined as normal and hence any rise or deviation from that range can be
considered as Hypertension.
Because, blood pressure is a characteristic of each individual & it varies with age, sex &
ethnic background. Considering all these factors, many authorities recommended some
guidelines to define normal level of blood pressure & that of hypertension for different age group
of population. On the basis of that guideline, hypertension thus defined as ‘persistent rise of
blood pressure above the generally accepted arbitrary normal’ levels for specific age groups,
such as 140/90 at the age of 20, 160/95 at the age of 50
Clinical features:
Symptoms:
(1) Symptoms due to simple rise of blood pressure- Occipital headache-
particularly in the morning, palpitation, dizziness, tiredness, insomnia.
(2) Symptoms due to aetiology- Recurrent backache, undiagnosed fever,
polyurea, polydipsia, muscle weakness, weight gain, abdominal disturbance panic
attacks, paroxysmal headache, palpitation.
(3) Symptoms due to complications- Heart failure-orthopnia, respiratory
distress Cerebral Haemorrhage or ischaemic-stroke, TIA.
Encephalopathy- Slurred speech, paraesthesia, fits.
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Feature of ischaemia- Angina.
Feature of renal failure- Anuria.
Epistaxis, haematuria, blurring of vision due to vascular involvement.
b. Signs: (1) BP- raised. There may be no other signs

(2) Apex beat- displaced, forceful & may be sustained 2nd heart sound,
early diastolic murmur.
(3) Renal Angle tenderness, kidney may be palpable, bruit over renal
artery may be present.
(4) Radial- Femoral delayed pulse, arterial pulsation in neck & low BP
in lower limb may be present.
3. Complications
a. Cerebral- haemorrhage, thrombosis, Hypertensive encephalopathy.

b. Cardiac- left ventricular hypertrophy & failure.
c. Ocular – Hypertensive retinopathy.
d. Renal- renal failure.
Diagnosis
History
a. There may be familial history of hypertension.
b. History of table salt intake.
c. History of smoking.
d. History of analgesic & steroid intake.
e. Obese person.
f. Hyperlipidaemia.
Investigation
a. Urine- Albumin, glucose, pus cells & RBC.

b. Blood urea, creatinine & electrolyte- urea- high potassium- may be low.
c. S. cholesterol & triglycerides.
d. X-ray chest- for cardiomegaly, heart failure & coarctation of aorta.
e. ECG – any ischaemic change or sign of left ventricular hypertrophy.
Special investigations for selective patients
a. Echocardiogram- to detect left ventricular hypertrophy.

b. Renal ultra sonogram- to detect any renal disorder.
5. Management:
General management or non-drug treatment:
a. Diet:
(1) Weight reduction in obese & overweight patients.

(2) Fatty diet should be avoided.
(3) Moderate sodium restriction & avoid foods with high salt content.
Avoid alcohol
b. Exercise
Regular exercise programme improves physical fitness & lowers blood pressure.
c. Smoking
Smoking should be avoided & it is to be stopped.
d. Hyperlipidaemia – Test for s. cholesterol (including HDL & LDL) &

Triglycerides & take measure accordingly
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6. Treatment by drugs
A patient (20 yrs old) having diastolic pressure <100 mm of Hg. Or a patient (50 yrs old)
having diastolic pressure <110 mm of Hg. Usually does not require any medicinal
treatment.
(1) Non – drug management follow.
(2) Tab. Diazepam 5 mg at bed time (if there is anxiety).
Mild hypertension
(1) Diuretics –Thiazide diuretics, e.g. Bendrofluazide 2.5 mg or

cyclopenthiazide 0.5 mg once daily. Or Frusemide 40 mg daily. With/or
(2) ß blocker – e.g. Metoprolol 100-200 mg once daily or Atenelol 50-100 mg
once daily Plus.
(3) Non- drug management & diazepam (if needed).
Moderate hypertension:
a. Diuretics as above. With /or

b. ß blocker- as above.
c. Calcium channel blocker- e.g. Nifedine-10-20 mg or
d. Amlodipine 5-10 mg once daily or Deltazepum 60-120 mg 8 hourly plus.
e. Non drug management with diazepam (if needed).
Severe hypertension
a. Diuretics- as above.
b. ß blocker- as above with or
c. Calcium channel blocker - as above.
d. Captopril 12.5 mg twice daily or Enalapril 20 mg daily or Lisinopril 10-20
mg daily.
e. Electrolytes & creatinine should be checked before & after 7 –10 days of
commencing therapy.
7. Stepwise management of hypertension:
Step-I: Non drug treatment
a. No change in life style.

b. Body weight reduction.
c. Salt restricted diet.
d. Avoidance of smoking, coffee, tea, alcohol & those drugs causing
hypertension.
b. Step-II Thiazide or ß blocker

Thiazide should be used in case of old patient hypertension with mild heart
failure, asthma & brittle diabetes on insulin.
ß blocker should be used in young patient associated with IHD, gout, & mild
maturity onset diabetes.
c. Step-III: Thiazide + ß blocker
(1) When the drugs therapy fails then combination of the two drugs is
advisable.
d. Step-IV
(1) Thiazide + ß blocker + Vasodilator: If the above treatment of step-III fails
then a vasodilator is added. In case of CCF, vasodilator is used in initial treatment
Step-V
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(1) Thiazide + ß blocker + Vasodilator + A centrally acting drug (e.g. methyl
dopa
or guanethidine)
(2) In resistance case when step-IV fails methyl dopa is added to it but
prognosis is poor frusemide in place of thiazide may further reduce blood
pressure.
DIABETES MELLITUS
1. Definition: Diabetes Mellitus is a clinical syndrome characterized by hyperglycaemia,

due to absolute or relative deficiency of insulin. It is the most common endocrine disorder.
2. Classification of diabetes:
Primary (idiopathic) diabetes:
Type-I (Insulin Dependent Diabetes Mellitus-IDDM)

Type-II (Non Insulin Dependent Diabetes Mellitus-NIDDM)
Non obese NIDDM.

Obese NIDDM.
b. Secondary to other pathology
1. Pancreatic pathology-Pancreatitis, carcinoma of the pancreas,

pancreatectomy, cystic fibrosis.
2. Insulin Antagonism- Steroid therapy, cushing syndrome,
Hyperthyroidism.
3. Medication with- thiazide, diuretics, corticosteroids, phenytoin. Advanced
liver disease.
Associated with genetic syndrome
e.g. – Diabetes insipidus, optic atrophy nerve deafness, lipoatrophy, etc.
3. IDDM (Type-I) : Usually occur in the thin & young. It often presents acutely with severe
systemic disease.
a. Clinical feature :
(1) Malaise, fatigue, weight loss, polyuria, polydypsia, infection & some times pre-
coma & coma.
(2) The cause remains uncommon & is usually multifactorial involving gentle
predisposition & possibility of viral infection. Wheat, milk protein & high
nitrosamine content of smoked mutton also consider as a diabetogenic, recently.
4. NIDDM (Type-II)
a. Definition: It is usually occurs after the age of 50 years over eating especially
when combined with the development of NIDDM. Repeated pregnancy also causes
NIDDM.
b. Clinical feature Diabetes may be discovered in one of several ways IDDM
usually develops in the 1st 40 years of life & NIDDM in the middle aged & elderly
patients.
(1) First noted to have glycosuria.
(2) Patient may have had few or no symptoms & no abnormal physical signs.
(3) Thirst, polydipsia, polyuria, nocturia, tiredness, loss of wt, white marks on
clothing,
pruritus vulvae or balanitis, impotence, myopia & paraesthesia in the limbs.
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(4) Fulminating ketoacidosis associated with an acute infection & epigastric pain &
vomiting may be present.
(5) The intra ocular pressure may be obviously reduced.
(6) Pulse- rapid, BP – Low.
(7) Breathing may be deep & sighing in the acidotic patient.
(8) Apathy & confusion may be found or there may be stupor or even coma.
c. Diagnosis
(1) Urine testing- reducing substance sample should be taken 2 hours after
breakfast.
(a) Glycosuria- A positive response indicates that the urinary glucose
concentration exceeds 10-20 mg/dl.
(b) Detection of ketone bodies in the urine.
(2) Random blood sugar & 2 hours after breakfast.
(3) Fasting blood sugar.
(4) Oral glucose tolerance test
d. Management
(1) Treatment should be taken regularly.

(2) To educate the patient regarding his/her disease, treatment & complications.
(3) Regularity of normal life.
(4) Diet control.
(5) Follow-up & suppression.
(6) Regular exercise.
(7) Weight reduction.
e. Methods of treatment
(1) Diet alone- 50% can be controlled adequately.

(2) Diet & oral hypoglycaemic agent 20-30% cured.
(3) Diet & insulin- 30% cured.
f. Types of diet
(1) Low energy, weight – reducing diet.
(2) Weight maintenance diet.
g. Specific dietary advice.
(1) Obese, middle aged or elderly patient with mild diabetes needs 1600 kcal
daily.
(2) Elderly diabetic but non- obese needs 1800 kcal daily.
(3) Young active diabetic patient needs 1800-3000 kcal daily.
(a) 50% of energy from CHO

30-35% of energy from fat.
15-20% of energy from protein.
(b) Amount of salt 3-6 gm daily.
(c) Sweets, sweet products & sweet fruits are restricted.
(d) Citrus fruits & one banana can be taken in a day.
h. Treatment of NIDDM.
(1) Diet control roughly (1200-1500) Kcal & weight reduction.

(2) If fails then add- oral hypoglycaemic agent.
(a) Sulphonylureas- Usually given in non-obese patients.
(I) First generation- e.g. Chlorpropamide, Tolazamide tolbutamide.
(b) Second generation- e.g glibenclamide, glipizide, gliclazide.
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(b) Biguanide- Usually indicated in the obese patients but may also
be given in non-obese one. e.g.- Metforamin can be given alone or
incombination with sulphonglureas.
(3) Care of the feet & toenails.
i. Treatment of IDDM.
(1) Diet- diabetic.

(2) Insulin therapy:-
(a) Conventional insulin therapy.
Blood glucose (mg/dl) Regular insulin units

Break fast Supper
51-100 8 4
101-150 10 5
151-200 12 6
201-250 14 7
251-300 16 8
>300 20 10
(b) Human insulin may be given when –

(I) High insulin requirements.
(II) Gestational diabetes.
(III) Local sensitivity reaction at the site of injection.
(c) In case of pancreatectomy –20-30 units are usually needed per day.
j. To educate the patient
(1) Regarding disease i.e. therapy should be continued, role of food life long
etc.
(2) Regarding insulin therapy-
(a) Injection technique.
(b) Urine testing.
(c) Home blood glucose monitoring.
(3) Care of foot, physical exercise.

(4) Regarding hypoglycaemic coma & management (i.e. always carry some
glucose) etc.
k. Follow up & supervision:
(1) Regular follow-up visit (Weekly or monthly)- Body weight , BP, blood & urine
tests, ,visual acuity & signs of neuropathy should be examined.
(2) Annual follow-up visit- Detailed eye examination, renal function tests,
assessments of cardiac functions etc should be done.
MYOCARDIAL INFARCTION
1. Definition: Myocardial infarction is defined as the myocardial tissue damage due to

ischemic necrosis, occuring as a result of occlusion of coronary artery blood supply, commonly
by thrombus formation & rarely by other causes.
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2. Causes:
a.. Commonly- Occlusion of coronary artery by thrombus formation at the site of

rupture of a pre-existing atheromatous plaque or atherosclerotic stenosis.
c. Rarely:-
(1) Prolonged coronary vasospasm.
(2) Hypotension causing inadequate myocardial blood flow. or
(3) Excessive metabolic demand.
c. Very Rarely:-
19 (1) Embolic occlusion of coronary vessels.

(2) Vasculitis.
20 (3) Aortitis.
21 (4) Aortic root or Coronary artery dissection.
d. Cocaine:- May be a cause, specially in young individual.
a. Onset- acute, and usually at rest.

b. Symptoms due to ischaemia- Pain, which starts at rest & located in the mid or
upper sternal region, constricting or pressing or crushing in character, radiates along the
shoulders & usually not relieved by glyceryl trinitrate.
c. Symptoms of heart failure – Breathlessness, cough & frothy (Sometimes bloody)
sputum. Patient cannot lie down flat in bed because of pulmonary oedema.
d. Symptoms due to cardiogenic shock - Limbs are cold, sweating severe,
restlessness, confusion & oliguria.
e. Symptoms due to muscle necrosis- fever (100-1030 F), leukocytosis, high ESR.
f. On examination- Patient is anxious restless, propped up in position, blood
pressure is low & declines, pulse is high, pulsus alternans, central cyanosis, hurried
respiration etc.
g. Heart sounds are faint & indistinguishable, soft systolic murmur, pericardial
friction sound.
4. Management:
a. Early management of acute myocardial infarction.
(1) Immediate hospitalization- if approachable (where defibrillator is

available).
(2) Rest- It should be absolute.
(3) Oral aspirin 300 mg stat & then 75-150 mg daily for at lest 4 weeks. It
improves survival (30% reduction in short- term mortality) & enhances the effect
of thrombolytic therapy.
(4) Oxygen supplement- 2-3 ltrs/minute by nasal catheter.
(5) For relief of pain- Inj morphine 10 mg or diamorphine 5 mg initially I/V
slowly is given immediately. In severe cases it may be repeated in smaller doges
in every 3-4 hours interval.
(6) Antiemetic- Inj cyclizine 50 mg or prochlorperazine (stemetil) 12.5 mg
I/V start to prevent vomiting.
(7) Thrombolytic therapy: Greatest benefit occurs if treatment can be initiated
within first 1-3 hours.
Inj: Streptokinase 1.5 million units in 100 ml of saline given as an I/V infusion
over 60 minutes (half in 20 minutes & rest in 40 minutes)
or
Inj: Alteplase- a bolus dose of 15 mg given in I/V drip over 90 minutes followed
by 0.75 mg/kg (max- 50 mg) over 30 minutes & then 0.5 mg/kg (max-35 mg)
over 60 minutes (if available).
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(8) Intravenous B-blockers-
Inj: Atenolol 5-10 mg given I/V over 5 minutes.

or
Inj: Metoprolol 5-15 mg over 5 minutes in acute attack of myocardial infarction
relieves pain, reduces tachyarrhythmia & improves short-term mortality rate if
can be administered within 12 hours of onset.
(9) Monitoring ECG- continuous monitoring if available.
(10) Treatment of complications (if any).
b. General management
(1) Diet: First 12 hours nothing by mouth, because of risk of vomiting; then
bread, milk, biscuit & on 4-5 th day normal diet.
(2) Milk of magnesia 30 ml twice daily to avoid strain at stool.
(3) If retention of urine- Catheterization should be done.
(4) Antibiotic - To prevent secondary infection.
5. Advice
a. Allow patient to sit on bed on 2nd day, to walk on 5th day, to go home after a week,
2nd & 3rd week must stay within home & from 12th week can start office work.
b. Reassurance.
c. Advice for exercise gradually & to do his work which are comfortably possible.
d. No- contra-indication of family life.
e. Weight to be reduced if possible.
f. Smoking to be avoided.
g. If hypertension, control it.
UTI (Urinary Tract Infection)
1. Definition: Acute urinary tract infection is an acute infectious inflammatory disease of

renal pelvis with adjoining renal parenchyma. Gram negative bacteria are the most common
organisms, which includes E-coli (90%), Proteus, Klebsiella, Enterobacter & Pseudomonas.
2. Clinical Features:
a. Symptoms-
(1) Sudden onset of pain in one or both loins radiating to the iliac fossa or
suprapubic area.
(2) Dysurea, strangury with frequency of micturition.
(3) Rapid rise of temperature (38-400C) with chill, rigor & vomiting
b. Signs
(1) Spiky rise of temperature, tachycardia.

(2) Tenderness over renal angle & suprapubic region.
4. Investigations:
a. Urine Routine & Microscopic Examination.

b. Urine culture.
c. Blood CP, Urea, Creatinine & electrolytes.
d. USG of renal system.
5. Management / Treatment
a. Bed rest.
b. Plenty of fluid by mouth.
c. If urine is acidic then alkali mixture to prevent bacterial growth.
d. Antibiotic should be given according to C/S report, if available.
e. Urine culture should be repeated during treatment & 07 days after.
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SCABIES
1. Definition: Scabies is a contagious skin disease caused by a mite SARCOPTES
SCABEI characterized by papulovesicular lesions & itching specially at night.
a. Papulovesicular lesions.
b. Intense itching especially nocturnal itching.
c. Family history- appearance of similar lesions in several member of the family.
d. Common sites- Finger webs, ridges, wrist, genital area, buttock, around
umbilicus, anterior axillary folds and nipple incase of females.
e. Burrows- Irregular zig-zag fine linear tract about 0.5 cm to 1 cm. long & grayish
in colour in the epidermis or above mentioned area. It is formed by the eggs & faeces of
female worm.
3. Investigations:
a. Blood for sugar.

b. Urine for R/E.
c. Stool for ova of worms.
d. Examination of skin scraping from the burrow may show eggs of female
sarcoptes.
4. Complications:
a. Impetigo, Pyoderma, hypo or Hyperpigmentation.

b. Eczematization.
c. Folliculitis
d. Furuncle, carbuncle, scar formation.
e. Acute glomerulonephritis- if the patient is untreated for more than one month or
maltreated.
f. Nephrotic syndrome (in children).
g. Exfoliative dermatitis.
5. Causative factors in Bangladesh.
a. Overcrowded living condition.

b. Poor hygiene.
c. Poor nutrition.
6. Management & treatment
a. Take a scrap bath with warm water & soap to remove crusts & to open burrows.
b. Apply any one of the following drugs throughout the body except face & scalp for
3 consecutive days without any bath. It is better to repeat the treatment after 7 days.
(1) 10% unguentum sulfuris in case of adult & 5% in children or

(2) 25% Benzyl benzoate in adult & 12.5% in children.
(3) 5% emulsion or Tetraethyl thiouracil monosulphide ( tetmosol)
(4) Gamma benzene hexachloride 1% in liquid paraffin.or
c. Crotamiton 10% cream (crotorex) – apply over the whole body omitting the head,
neck, & eyes after a hot bath & remove by washing on the following day. The application
may be repeated 24 hours later but bath should not be taken until the following day.
d. Take soap bath on 4th day.
e. Antihistamines tablet or syrup.
f. If secondary infection present give antibiotic before scabicidal drugs.
g. All other family member should be treated properly & simultaneously.
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h. All clothes should be boiled.
i. Used bedding items to be cleaned.
j. Air bedding should be done.
ECZEMA
1. Definition: Eczema is a specific pattern of non-contagious form of inflammation of

skin caused by external or internal factor clinically characterized by itching, erythema, oedema,
minute papulation, vesiculation, pastulation, oozing & crusting in early stage & later by scaling,
lichenification & often pigmentation. Skin inflammation is usually due to endogenous agents.
Hereditary tendency to develop allergic responses to various allergens.
2. Classification
a. Aetiological classification
22 (1) Exogenous or contact Eczema

23
(a) Irritant.
(b) Allergic
24 (2) Endogenous or constitutional eczema.
(a) Atopic eczema

(b) Seborrhoeic eczema
(c) Discoid eczema
(d) Exfoliative eczema
(e) Drug eruptions eczema
(f) Neurodermatitis eczema
(g) Gravitational eczema
(h) Pompholyx eczema.
b. Clinical classification
Acute weeping lesions.

Subacute or scaly lesions.
Chronic, dry lichenified lesion.
25 a. Acute weeping eczema-
The area of lesion becomes erythematous & oedematous.

Appearance of papule & vesicle.
Intense itching & oozing.
Pustule due to secondary infection.
26 b. Sub-acute eczema -
(1) Less itching.

(2) Less exudation
(3) Crust formation.
(4) Hyperpigmentation due to separation of crusts.
27 c. Chronic Eczema
(1) The area of lesion is hyperpigmented or darken or lichenified

4. Investigations:
a. Blood TC DC ESR.
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b. Urine R/E, M/E
c. Stool R/E, M/E
d. Skin scraping from margin of lesion for microscopy.
5. Management:
Local management -
(1) Acute weeping stage -
(a) Wash the lesion with- Lotion condis or potassium per manganate
(1 in 1000) once daily or Lotion 5% Alluminium subacetate.
Lotion calamina 5% aply 4 times daily after washing.
Apply steroid ointment 3-4 times daily (Betamethasone Hexamethasone).
If any infection give antibiotic
(2) Sub-Acute stage
(a) Wash one time daily with lotion calamina.
(b) Apply steroid ointment 2-3 times daily.
(3) Chronic stage -
(a) Apply steroid cream 2-3 times daily.
Systemic treatment
(1) Antihistamine 5-10 mg TDS.

(2) Tab. Diazepam 5 mg at bed time.
(3) Antibiotic to prevent infection i.e. Penicillin, Ampicillin, Cloxacillin etc.
(4) If all these measures fails then steroid to be given by mouth. i.e. tab
prednisolone 20-40 mg given in divided doses.
c. General measures-
(1) Diet should be adequate.

(2) Eggs, fish, milk, wheat, orange should be avoided.
(3) Avoid wool’s, synthetic fibres & other irritants e.g. soaps, drugs &
chemical.
(4) Try to avoid anxiety
SYPHILIS
1. Definition: Syphilis is a venereal disease caused by “TREPONEMA PALLIDUM”

leading to many structural or cutaneous lesions. It is transmitted by direct sexual contact or a
fetus may be infected in uterus.
2. Characteristics of syphilis
a. It is a chronic disease.
b. It may be infectious
c. It is systemic from the beginning.
d. It is characterized by florid features at some times..
e. Long periods of latency at other times.
f. It responds well to penicillin & certain other antimicrobials i.e. Tetracycline.
3. Classification
a. Acquired syphilis.
b. Congenital syphilis.
Acquired syphilis
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Early
(1) primary syphilis
(2) Secondary syphilis
(3) Latent syphilis
Late
(1) Latent syphilis.
(2) Tartiary (benign gummatous) syphilis.
(3) Quaternary (Cardiovascular, neuro syphilis)
Congenital syphilis
Early
(1) Clinical syphilis
(2) Latent syphilis
Late
Clinical syphilis
Latent syphilis
Stigmata (or scars) syphilis.
Clinical features:
28 a. Acquired syphilis:
(1) Primary stages :primary lesions develops at the site of infection after an
incubation period of 9 to 90 days
(a) A small pink macule appears on the genitalia which soon becomes
papular & ulcerates.
(b) The regional lymphnodes are enlarged, discrete, rubbery &
painless but non-tender.
(2) Secondary stage: Primary lesions tends to heal & 6-8 weeks after its
appearance, evidence of generalized infection appears with:
(a) Malaise.
(b) Headache.
(c) Low irregular fever.
(d) Four cardinal signs must be remembered, though any of them may
be absent.
(e) A rash is present in 75% patients.
(f) Condylomata lata.
(g) Lymphadenopathy occurring in 50% of patients
(h) Ulcers on the mucus membranes of the mouth, genital area &
throat its call SNAIL TRUCK ULCER.
(i) Mucous patches occurring 30% of the patients.
(3) Tertiary stage: This stage takes 10 or more years to develop & mainly affects
skin & subcutaneous tissues, mucous membrane & submucosa & the long bones.
(4) Quartenary stage
(a) Neuro syphilis & cardiovascular syphilis take longer to develop –

is the characteristic feature & may lead to the patient’s death.
CONGENITAL SYPHILIS
1. Definition: The foetus may contact syphilis from an infected mother with early
acquired syphilis. There is no primary stage.
The disease may be so severe that the child is born dead, or skin eruption is present at
birth.
The child may appear to be normal at birth but fails to thrive & within a few months
develop a rash & signs of syphilitic disease of bone, liver, kidneys & other organs.
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2. Diagnosis
a. All routine tests to be done.

b. In primary & secondary stage – treponema palladium may be demonstrated in
chancre, papular rash, condylomata or mucous patches- seen under dark ground of
microscopy.
c. STS- Becomes positive from about the 4 th weeks of the disease & it is strongly
positive in secondary stage.
d. Serological tests are: Wassermann reaction (WR) Kahn & VDRL
e. For conclusive results additional tests are:
(1) FTA (Fluorescent Treponemal Antibody).

(2) TPHA (T. Pallidum Haemagglutination).
(3) TPI (T. pallidum Immobilization) tests.
(4) CSF should be examined to exclude neurological disease.
(5) Chest radiographs should be taken to exclude calcification of the
ascending aorta which indicates cardiovascular disease.
3. Treatment of syphilis
a. Primary syphilis
Inj. Procaine penicillin 600-1200 mg I.M once daily for 12 days.

Or
Cap. Oxytetracycline 500 mg 1 X 6 hourly for 15 days.
Or
Cap. Doxycycline 100 1 X 8 hourly for 15 days
b. Secondary syphilis
Inj. Procaine penicillin 600-1200 gm I.M once daily for 15 days.
Tertiary & Latent syphilis
Cap. Oxytetracycline 500 mg 1 X 6 hourly for 15 days

Or.
Cap Doxycycline 100 mg 1 X 8 hourly for 15 days.
All patients must be followed up to cure.
Followed up of syphilis
(a) Surveillance period 2½ months.

29 (b) STS- 2 monthly for 3 tests.
30 (c) CSF After 06 months.
31 (d) STS – 3 monthly for 4 tests.
32 (e) STS – 6 monthly for 2 tests.
33 (f) CSF – Last test.
GONORRHOEA
1. Definition: Gonorrhoae is the commonest venereal disease and a major epidemic

disease in the world. The organism is gram negative diplococcus “Neisseria Gonorrhoea”
typically found inside the polymorphonuclear cells. It infects columnar epithelium in the lower
genital tract. It is mostly transmitted during sexual activity. It may infect eyes, rectum & throat
also.
2. Incubation period : 2-10 days.
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a. In the male.
(1) Infection starts in the anterior urethra & tends to spread to the posterior
urethra & epididymis.
(2) Dysurea.
(3) White or yellow purulent discharge from the urethra. But symptoms may
be mild or absent.
b. In the Female
(1) The lower cervical canal is commonly infected,

(2) Urethra & rectum are also involved 50% of the patients,
(3) Vaginal discharge,
(4) Dysurea, but 50% of infected women have no symptoms.
(5) Infection of the conjunctiva of the infants form infected mother’s causes
purulent discharge & damage to sight, this condition is called opthalmia
neonatorum.
4. Investigations
a. Pus swab for GCPC.

b. Blood for VDRL & STS
c. Gram staining – gram negative intracellular diplococci may be seen in stained,
secretion from infected tracts.
d. Culture- growth of N. gonorrhoea on an appropriate media for confirms the
diagnosis.
5. Complication:
a. In case of male
(1) Urethritis, stricture urethra, epididymoorchitis, bacteraemia, septicaemia.
b. In case of female.
(1) Cervicitis, salpingitis, Oophoritis, pelvic infection.
c. In case of infant.
(1) Opthalmia neonatourm, acute purulent conjunctivitis.
34 Treatment /Management.
a. Uncomplicated gonorrhoea:
(1) Inj. Procaine penicillin 2.4 gm I/M + Tab. Probenecid 1 gm orally. Or

Cap. Ampicillin 2 gm + Tab. Probenecid 1 gm by mouth. And patient allergic in
penicillin.
(2) Tab. Cotrimoxazole 8(480mg) dispercible in a single dose. Or
Tab. Cotrimoxazole (480 mg) 12 hourly X 3 doses.
b. Complicated gonorrhoea :
(1) Inj. Procaine penicillin 4.8 gm I/M + Tab. Probenecid 1 gm by mouth. Or

Cap. Ampicillin 3.5 gm + Tab Probenecid 1 gm orally. Or Inj. Spectinomyucin 2
or 4 gm I/M for penicillin allergic patients.
Totally penicillin resistant isolates-
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Inj. Cefotaxime 0.5- 1 gm I/M, or Cap. Ciprofloxacin 250 mg orally, Or Inj
Streptomycin 2-4 gm I/M, for penicillin allergic patients.
35 Surveillance for gonorrhoea.
a. Surveillance period – 06 months.

b. WR & khan test – after 06 weeks.
c. FTC (final test for cure) –3 month.
d. Urine for R/E & C/S.
e. PS for GCPC.
f. FBT (final Blood test) after 06 months.
g. F (MD)-39 (VD card) to be maintained.
MIGRAINE
1. Definition: Migraine is characterized by episodic headaches which are typically

unilateral & are often associated with visual disturbance & vomiting. Common in female rather
than in male.
2. Types of Migraine:
a. Classical migraine
b. Common Migraine
c. Hemiplegic migraine.
d. Basilar migraine
e. Cluster headache.
3. Aetiology: The condition is believed to be due to a disturbance in the carotid or vertebro-
basilar vascular tree (an initial phase of vasoconstriction causes symptoms & is followed by
vasodilatation)
4. Precipitating factors are- Anxiety, Overwork, emotional upsets, menopause,

hypertension, cerebral tumour, Premenstrual tension, fasting state, contraceptive pills, chocolate,
cheese, alcohol etc.
a. Age – Young, adults, usually starts after puberty & continue until late middle life.
b. Sex – Common in females.
c. Temperament – Obsessional.
d. Family history – positive.
e. Attacks occur at an interval which vary from few days to several months & last
for hours to days.
6. The symptoms are divided into:-
a. Premonitory symptoms: Some patients complaints of zig- zag lines,
flashing, coloured light or defects in the visual field but others complaint of dysphagia,
hemiparesis or hemi-anaesthesias in association with headache.
b. Headache The headache is usually localized whole of one side of the head but
may become generalized. Pain is severe & throbbing, may be associated with vomiting,
photophobia pallor & prostration.
Management
General management
a. Precipitating factors should be identified & removed or avoided.

b. Oral contraceptives (if any) should be stopped in female, if the attacks are
c. Frequent.
d. During acute attacks, keep the patient in a quiet, darkened room until the
e. Symptoms subside.
f. Reassurance & relief of anxiety.
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Drug Treatment
In acute attacks
Simple analgesia with soluble aspirin 600 –900 mg or Paracetamol 1 gm
stat & 2-3 times daily.
Antiemetic – Metochlopramide 10 mg or Prochlorperazine 50-10 mg stat
& three times daily.
In recurrent severe attacks
Sumatriptan- by S.C. injection, 6 mg as soon as possible after onset. If

migraine recure- 2nd dose may be given after not less than 1 hour
maximum 2 injections ( 12 mg) in 24 hours. If patients does not respond
then by mouth 50 mg as noon as possible after onset & it is to be repeated
max. 300 mg in 24 hours and it should not be repeated in the same attack.
Ergotamine tartrate 0.5 –1 mg sublingually or rectally stat & repeat if
necessary. It should be taken as soon as visual /sensory symptoms
develop.
Or
Ergotamine tartrate 0.25 mg I.M stat.
Or
Engotamine tartrate 360 mgm by inhalation also helpful
Prevention of migraine When migraine attacks occur so frequently, that daily

work & social life is disturbed, preventive measures should be taken Useful
agents are.-
Pizotifen 0.5 mg at night for several days may be increased up to 1.5 mg at
night. or
Propranolol 10 mg 3 times daily, increasing up to 40- 80 3 time daily or
Amitriptyline 10 –50 mg at night.
Combination of ergot 0.5 mg atropine 3 mg & Phenobarbiton 15 mg 3
times daily
Chlorpromazine 50-100 mg daily for 7-10 daily (If attack is so severe &
frequently)
Methysergide- 2-6 mg/day for month.
SEA SICKNESS
1. Definition: This condition is probably due to a disturbance of the organs of balance in

the inner ear. It is not primarily a digestive disorder but complex psychological factors may well
play an important part in upsetting the balance mechanism. Such as fear of being sea sick, sight
of others being sick etc.
2. Symptoms: These are pallor, feeling of coldness, Headache, nausea, Vomiting and
mental depression.
The victims fall into three main group.
a. 1st group: Those who are sick when they first go to sea, but later acquire a
tolerance to it.
b. 2nd group: Those who are sick only in small ships or ion very rough weather.
c. 3rd group: Those who are sick under any conditions at sea in any kind of
ships.
4. Treatment: As far as compatible with duties, work in the fresh air, amidships and a
way from the smells of the engine room and galleys should be encouraged but severe degree of
sea sickness necessitates lying down if possible fore and aft.
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The condition can be caused by taking hyoscine gr or tincture of belladonna MXV in water by
mouth as soon as possible, and these drugs may be repeated at six hourly intervals in doses of
hyoscine gr or M.XV of tincture of belladonna.
In some cases use of the antihistamine drugs such as Tab. Avomine one tablet four hourly works
satisfactory. But lying down is the essential treatment and not letting the stomach become empty.
The persons in the second group may be need to be drafted to a larger ship,
The persons in the third group usually require invaliding or drafted to an establishment
IHD (ISCHAEMIC HEART DISEASE)
1. Definition: Lack of blood supply to the heart muscle (myocardial) due to coronary
spasm, thrombosis, or coronary stenosis is called IHD.
Or
Ischaemic heart disease occurs due to an imbalance between the supply of oxygen & other
nutrients and the myocardial demand. This imbalance in supply is due mostly to reduced
myocardial blood flow caused by coronary spasm, thrombosis or coronary stenosis is called IHD.
2. Types: There are three types of IHD. Such as-
a. Angina pectoris
Stable angina or classical angina.
Unstable angina.
Ducubitis angina (angina occurring on lying flat)
Nocturnal angina (Angina occurring at night and may wake the patient
from sleep).
b. Myocardial infarction.
c. Sudden death.
3. Aetiology:
a. Obstructive coronary artery disease leading to reduced myocardial blood flow:
1. Atheroma or atherosclerosis & its complication.
2. Thrombosis.
3. Embolism.
4. Spasm.
5. Coronary arterial stenosis.
6. Coronary arteritis (as in SLE)
b. Decreased oxygenated blood flow as in
1. Anaemia.
2. Hypotension causing decreased coronary perfusion pressure.
c. Increased myocardial demand.
1. Thyrotoxicosis.
2. Myocardial hypertrophy (as a result of aortic stenosis or hypertension)
3. Aortic valve disease.
4. Risk factors of coronary heart disease (IHD)
(a) Fixed factors.

(I) Positive family history.
(2) Male gender (Men are more affected then women)
(3) Age >40 (Incidence rate increases with age)
(b) Factors strongly associated
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(I) Hypertension.
(2) Hyperlipidaemia (high LDL cholesterol & Lower HDL cholesterol)
(3) Diabetes mellitus.
(4) Cigarette smoking.
(5) Diet high fat and low fibre diet intake of antioxidant vitamins.
c. Factors weekly associated

(1) Obesity.
(2) Physical inactivity.
(3) Elevated blood homocysteine level.
(4) Hypoestrogenemia (Post menopausal women)
(5) Contraceptive pill (women)
(6) Heavy alcohol consumption.
(7) Mental stress.
ANAEMIA
1. Definition: Anaemia may be defined as a state in which the blood haemoglobin level
is below the normal range for patient’s age & sex.
2. Cause of anaemia:
a. Decreased or ineffective marrow production
(1) Lack of iron, B12 or folate.
(2) Hypoplasia.
(3) Invasion by malignant cell.
b. Peripheral causes
(1) Blood loss.
(2) Haemolysis.
(3) Hypersplenism.
3. Types:
(1) Iron- deficiency Anaemia.

(2) Aplastic Anaemia.
(3) Haemolytic Anaemia.
IRON DEFICIENCY ANAEMIA
It is common type of anaemia recognized clinically.
1. Aetiology:
a. Haemorrhagic- Chronic blood loss by hook worm infestation bleeding from

G.I tract, excessive menstruation etc.
c. Low intake of iron in food as in poor people & infants.
d. Malabsorption of iron.
e. Increased requirement as in growing infants & in pregnancy.
a. General features: `Weakness, fatigue, exertional dyspnoea, giddiness,

headache, insomnia, dimness of vision, anorexia & dyspnoea. There may be anginal
attack, palpitation & tachycardia.
b. Specific features: Glossitis, angular stomatitis, Koilonychia, splenomegaly,
britle finger nails, plummer vinsion syndrome, pica (the eating of stonge items).
3. Investigations:
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Blood examinations:-
Hb%, RBC counts are low.
MCV- low (50 H-80 H)
MCH- Low (15-26 pg)
MCHC- low (24-30g/dl)
Peripheral blood film shows microcytic hypochromic anisocytosis, poikilocytosis
etc.
Reticulocyte count may be increased.
b. Blood biochemistry:
Serum iron level is below 60 mg/dl.
Iron binding capacity of serum is incresed.
c. Bone marrow: It is hypocellular with hyperplasia, Iron content of the bone

marrow is decreased or absent.
f. Investigation for detection of causes.
4. Treatment:
a. Protein rich diet- e.g. adequate fish, meat, liver & eggs.
b. When Hb% is 40-60% iron should be given in oral route e.g. Ferrous Fumerate
Gluconate 200-300 mg thrice daily after meal until Hb% level becomes
satisfactory.
c. If Hb% is below 40% then blood transfusion to be started & the iron either in oral
or injection form to be given.
d. Perenteral iron preparations:
(1) Iron dextrose IM or IV.
(2) Iron sorbital citric acid complex IM only 2cc daily till total dose is
fulfilled.
e. Indications for perenteral iron:-
(1) Intolerable by mouth.
(2) Diarrhoea & malabsorption.
(3) Patients who are unreliable in taking drugs for 3 months.
(4) Chronic bleeding causes loss of iron e.g. fibroid uterus.
(5) Treatment of cause as if iron-deficiency anemia is due to hookworm
infestation give antihelminthic drugs.
ECLAMPSIA
1. Definition: Pre eclampsia when complicated with convulsion & coma is called
eclampsia. It is characterized by the occurence of major epileptic form convulsions in patients
with signs & symptoms of:
a. Rising of blood pressure.
b. Increasing oedema.
c. Heavy proteinuria.
d. Oliguria.
e. Headache.
f. Disturbance of vision, after 28 weeks of pregnancy.
2. Eclamptic fits consists of four stages.
a. The aura: There are visual flashes of light and spots before the eyes.
b. The cry: Spasm of the respiratory muscles & larynx causes cry.
c. The tonic phase: The patient loses consciousness, has generalized muscular
spasm & becomes cyanosed.
d. The clonic phase: Violent movements occur, the tongue may be bitten,
vomiting & inhalation of vomit may occur.
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3. Differential diagnosis:
a. Tetanus
b. Epilepsy.
c. CVA.
d. Hysteria.
4. Management:
a. Pre-hospital management:
(1) Quick diagnosis by history from relatives about oedema, hypertension,

convulsion, proteinuria & previous obestetrics history & by examination of
oedema, pulse, BP, chest for pneumonia, pulmonary oedema & examination of
the patient, whether the foetus is alive or not.
(2) Anticonvulsant- Diazepam 10-20 mg IV or Pethidine 50 mg IV & 50 mg
IM to be given & patient to be kept head placed to one side with mouth down
wards to remove secretion from mouth. Pillows should be removed.
b. Hospital management
(1) Immediate hospitalization.
(2) Patient to be kept in a dark, quite room.
(3) Immediate heavy sedation with diazepam is given.
(4) A clear airway must be maintained.
(5) A mouth gag is to be placed between the jaws.
(6) False teeth must be removed.
(7) Oxygen inhalation started immediately.
(8) Bladder should be catheterized by an indwelling catheter.
(9) Hypotensive agents are used to reduce blood pressure e.g Hydralazine
10mg injected IV over a period of 15 minutes.
(10) Frusemide 40 mg IV to produce a diuresis.
(11) Anticonvulsant to control fit (if any) -Diazepam commonly used 10-20 mg
IV given previously + 40 mg in 500 ml of Dex. Aqua rate of infusion depends
upon convulsion & blood pressure.
c. Other management:
(1) Lytic cocktail: Chloropromazine 100 mg + Pethedine 100 mg +
Phenergan 50 mg in 500 ml of Dextose in Aqua IV. At first patient is sedated &
then adjusted as it ends in 4 hours.
(2) Paraldehyde- 5-10 ml deep IM repeat 6 hourly. Or 15 ml in normal saline
or olive oil per rectally.
(3) Magnesium sulphate: 20-40% solution 10-20 ml half IM & half IV if
intracranial tension is high. If jerks are exaggerated, calcium chloride to be given.
If convulsion not controlled by diazepam or cocktail then thiopental sodium 1 gm
(0.25 mg very slows IV & 0.75 mg with fluid in drip very slowly) with careful
observation of respiration (artificial aid for respiration must be ready).
After control of fit- The pregnancy should be terminated either by vaginal
delivery or by cesarean section.
LEUCORRHOEA
1. Definition: Leucorrhoea means whitish discharge per vagina or a white cream, yellow
or greenish vaginal discharge, which is often loosely called leucorrhoea.
2. Causes:
a. The most common cause is infection of the lower reproductive tract in the form of
trichomonas vaginitis, vaginal candidiasis etc. Pregnancy, diabetes in the
predisposing factors.
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b. At birth – New born babies may have a mucoid vaginal discharge for- 1-10 days
c. Puberty- usually few days before & after menarche.
d. Active & passive congestion of the pelvic organs, especially on the cervix- this is
due to increased secretory activity of the glands as in prolonged ill health, anxiety
state & neurosis, sedentary occupation, prolapse & unsatisfied sex-urge.
e. An increase of glandular elements of the cervix as in erosion.
f. Vaginal adenomatosis.
g. Oestrogen or progestogen oral contraceptives.
h. Regular douching.
i. At ovulation.
j. In some, during pre-menstrual phase.
a. Patient complains of passage of whitish, brownish, yellowish or greenish

discharge per vagina.
b. There is no itching or foul smell.
c. It stains clothing’s & causes excoriation & soreness of the vulva.
d. Pelvic discomfort.
e. Backache.
4. Investigation:
a. Blood Hb% TC, DC, ESR.

b. Vaginal smear for gram stain & cytology.
c. Vaginal swab culture- to see the growth of tricomonas.
5. Treatment & management:
a. Reassurance
b. Treatment of the cause
(1) For tricomonas vaginitis- Both partners should be treated with

metronidazole 400 mg TDS for 07 days.
(2) For candida albicans –
(a) Systemic antifungal like. Nystatin 50,000 to 1,00,000 IU 4 times

daily for 7 days.
(b) Local antifungal like-
i. Gention violet applies locally.

ii. Nystatin vaginal tablet. -1 tab daily 14 days.
iii. Canesten vaginal tablet -1 tab BD or 2 tabs at bed time for
3 days or 1 tab at bed time for 6 days
iv. Miconazole nitrate 2% applies locally at bed time for 07
days.
c. Correction of pelvic congestion by –
(1) Physical exercise.

(2) Regular bowel habit &
(3) Daily cold baths.
d. Anxiety state should be corrected.

e. Cauterization of the cervix- if there is cervical erosion.
SINUSITIS
1. Definition: The acute or chronic inflammation of the mucosa of any or all of the Para
nasal sinuses is called sinusitis.
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2. Types of sinusitis:
a. Acute sinusitis.
b. Chronic (Maxillary/ Frontal) sinusitis.
a. Acute sinusitis: This is the acute inflammation of the mucosa of any or all
of the Para nasal sinuses. Inflammation may be suppurative or non-suppurative.
(1) Causes:
(a) Secondary to bacterial infection.

(b) Dental sepsis (Maxillary sinusitis)
(c) Traumatic.
(d) Swimming in dirty water.
(e) Barrow trauma.
(2) Pre-disposing factors:
(a) Nasal obstruction, foreign body, Enlarged adenoid.
(b) Low general health, chilling fatigue.
(a) History of cold, nasal obstruction, stabbing or aching pain over the
infected sinus which is worse by bending or coughing headache, sense of
heaviness, rise of temperature, malaise, tenderness over the frontal or the
maxillary sinus etc.
(b) Radiology of the para nasal sinuses shows haziness of the sinus, in
case of empyema, fluid level can be seen.
(4) Management:
(a) For infection:
i. Inj. Penicillin 5 lac IM 8 hourly for 5 days or Amoxycillin
250 mg 8 hourly for 7 days.
(b) Symptomatic relief:
i. Rest- Diazepam 5 mg at bed time.

ii. Analgesics- Paracetamol 500 mg or Aspirin 300 mg 1 tab
thrice
daily after meal.
iii. Application of dry heat.
iv. Nasal decongestant (1% ephedrine in normal saline).
v. Good diet, vitamins & proper mouth care.
vi. Menthol or benzene inhalation is helpful.
b. Chronic (Maxillary/Frontal) sinusitis
(1) Definition: This is the chronic inflammation of the mucosa of various

groups of paranasal maxillary sinuses.
(2) Clinical features: Nasal obstruction, dull aching pain, headache which
increases after rising in the morning but gradually decreasing as the day goes on,
hawking, chronic cough, depression and apathy, trickle of PNS is seen under the
middle meatus.
X-ray of para nasal sinuses shows.
(a) Thickening of lining mucosa.

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(b) Haziness & opacity.
(c) Fluid level etc.
(4) Management:
(a) Conservative treatment: Dust, alcohol & tobacco should be

avoided, nutrition diet, carious teeth & other sepsis is treated, nasal
decongestants (1% ephedrine in normal saline) & antihistamine oral
preparation is given.
Antibiotic- an appropriate antibiotic may be prescribed.
(b) Surgical treatment:
i. Antral wash.
ii. Intranasal antrostomy.
iii. Cald well IUC operation
INFECTIOUS DISEASES
CHICKEN POX (varicella)
1. Definition: Chicken pox is a viral infectious disease, caused by the varicella zoster
virus which spreads by droplets or by contamination from the discharge form of ruptured lesions
of the skin. Chicken pox is highly infectious & chiefly affects children under 10 years of age.
2. Incubation period: 14- 21 days

a. Appearance of the rash especially on the trunk is first sign, then on face, limbs &
all over the body.
b. Fever.
c. Bodyache.
d. Burning sensation of limbs.
e. Itching may be troublesome.
f. Lesions become
(1) Macular
(2) Papular
(3) Vesicular
(4) Pustular
4. Complication:
Direct viral affects- Pneumonia, Myocarditis.
Post viral affects- Glomerulonephritis, Encephalitis
Secondary bacterial infection- Skin infection, septicaemia, osteomyelitis etc.
5. Treatment:
a. Patient should be isolated till the crusts have disappeared.
b. Antiseptic baths to reduce secondary infection.
c. Antihistaminic in adequate doses for pruritus.
d. For secondary infection appropriate antibiotics orally.
e. Bacitracin- neomycin ointment may be used locally.
f. Lotion Calamine- Apply locally.
g. Corticosteroids may be used for:-
(1) Reducing the scar marks.

(2) For varicella encephalitis & Pneumonia.
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6. Prevention of chicken pox
a. Any suspected case immediately report to hospital.

b. Patient to be isolated.
c. All crusts should not be thrown hither and thither.
d. Air bedding should be done at least once in a week.
e. All utensils, linen, beding item used by the patient it is to be separate & wash with
boiled water then dry under sun-rays. If possible burn it.
f. No visitors to be allowed.
g. All attendants must be wear musk & after returning from the patient wash their
hand, face etc.
MUMPS
1. Definition: Mumps is caused by a paramyxovirus which is spread by droplet infection

and affects mainly children of school age & young adult occasionally.
2. Incubation period: About 18 days.
3. Aetiololgy of parotid swelling:
a. Mumps,
b. Calculi with or without sepsis,
c. Sarcoidosis,
d. Mixed cell tumour,
e. Hypersensitivity to thiouracil, phenothiazine, iodide, copper, lead. Mercury.
a. Malaise, fever, trismus, cough, headache.

b. Pain near the angle of the jaw is soon by tender swelling of one or both parotid
glands.
c. The first feature is parotid swelling.
d. The submandibular salivary gland may also be involved.
e. Orchitis may occur, manifested by pain & testicular swelling.
f. Acute lymphocytes, meningitis or encephalitis (rarely) may occur.
5. Diagnosis:
It can be diagnosed on clinical grounds alone.
Treatment/ Management:
a. Patient should be isolated till the swelling subsides.

b. Bed rest till the patient becomes afebrile.
c. Both heat and cold may be comforting and applied according to the choice or
response of the patient.
d. Aspirin in the usual dosage for relief of pain.
e. For meningoencephalitis.
(1) Lumber puncture.
(2) Corticosteroids, if symptoms are severe.
f. For orchitis.
(1) Ice bag is to be applied locally.
(2) Use of suspensory bandage.
(3) Analgesics for pain i.e- Paracetamol, Aspirin or Pethidine.
(4) Prednisolone 40 mg daily in divided doses for 4 days.
Complications:
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a. Orchitis.
b. Sterility.
c. Pancreatitis.
d. Meningitis.
e. Encephalomyelitis
MEASLES
1. Definition: Measles is a viral disease which spreads by droplet infection. Most people
suffer from measles in childhood.
2. Causative organisms: The causative virus is PARAMYXO VIRUS or Measles virus.
3. Incubation period: About 10 days.
4. Sign & symptoms:
a. 1st –2nd days
(1) Common cold with fever

(2) Running nose.
(3) Face red.
(4) Watery eyes.
b. 2nd day.
(1) Cough, photophobia.
(2) Appearance of koplick’s spots.
(3) In children there may be convulsion during the appearance of rashes.
c. 3-4th days
(1) Koplik’s spot disappear.
(2) Red macular or maculo-papular rashes develop.
d. 6-7th days
(1) Fever settles.
(2) Rashes begin to fade into brown.
(3) Staining spots & finally disappear.
5. Complications:
a. Effects of Measles virus: Stomatitis, gastroenteritis, pneumonia, keratitis.
b. Secondary bacterial infection: Otitis media, Bronchopneumonia,

conjunctivitis.
c. Neurological complications:
(1) Post viral encephalitis

(2) Sub acute scelerosing panencephalitis.
6. Nutritional
Severe weight loss
Kwashiorkor (tropics)
Corneal ulceration for vitamin A deficiency.
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7. Investigation
Blood examination shows leucopenia.

Serological confirmation may make by complement fixation & haemagglutination
inhibition test.
8. Treatment
a. Curative:
(1) Patient should be isolated for about 10 days after onset of rash.
(2) Continue bed rest till patient is afebrile.
(3) Mainly symptomatic treatment given.
(a) Paracetamol for reducing temperature.

(b) Promethazine for itching.
(4) Antibiotic for secondary bacterial infection.
(a) Penicillin group or Cephalosporin in the usual dosage.
b. Prevention
Active immunization by one injection of live attenuated measles virus (vaccine) 0.5 ml. is
to be given S/C within 9 months to 2 years.
VIRAL HEPATITIS
1. Definition: Viral hepatitis is a systemic infectious disease caused by viruses known as

viral hepatitis. It spreads mainly by the faecal oral route but Hepatitis B spreads by parenteral
route.
2. Causative viruses
a. Hepatitis –A Virus.
b. Hepatitis –B Virus.
c. Hepatitis –C Virus.
d. Hepatitis –D Virus.
e. Hepatitis –E Virus.
f. Hepatitis –G Virus. (Recently identified)
3. Types of viral Hepatitis
a. Viral hepatitis – A.
b. Viral hepatitis – B.
c. Viral hepatitis – C.
d. Viral hepatitis – D.
e. Viral hepatitis – E.
f. Viral hepatitis – G.
g. Non-A, Non- B, & Non- C Viral hepatitis.
h. Cytomegalovirus hepatitis.
i. Epstein- Barr virus hepatitis.
j. Herpes simplex virus hepatitis.
k. Yellow fever virus hepatitis.
4. Incubation period
For virus – A- About 15 to 50 days.

For virus – B- 6 weeks to 6 months.
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a. General weakness.
b. Fever with chills.
c. Malaise.
d. Headache.
e. Gastrointestinal symptoms.
(1) Anorexia.
(2) Distaste of cigarettes.
(3) Nausea.
(4) Vomiting.
(5) Loss of appetite.
(6) Diarrhoea.
f. Upper abdominal pain.
g. Yellow/ dark colouration of urine & pale colouration of stool.
h. Yellow colouration of sclera, skin & mucus membrane.
j. Tenderness of liver-may or may not be readily palpable.
k. Enlargement of spleen.
l. Incase of hepatitis –B, transient rashes including urticaria may occur.
m. Arthralgia or arthritis also a common features.
n. Itching of the skin.
36 Route for transmission

a. Through transfusion- Blood & blood products.
b. Through innoculation & vaccination.
c. Through Body fluid – saliva, urine, semen, vaginal secretion & serum of infected
person.
d. Through sexual contact (Homosexuals are more).
e. Through mother to children – soon after birth, from transplacental spread.
f. Through faecal oral route (Especially hepatitis A).
37
38 Investigations
a. Serum bilirubin is variably modestly or markedly elevated.
b. Serum SGOT, SGPT is elevated up to 200-400 IU/L (Normal 35 IU/L).
c. Prothrombin time- increase in severe case.
d. Serum HbsAg, HbcAg- may be positive in hepatitis – B.
e. USG of hepatobiliary system.
f. Blood count – lymphocytosis.
g. Blood for LFT.
h. Urine for R/E – Especially bile salt & bile pigment is elevated.
39 Management / Treatment of viral hepatitis

a. Patient should be hospitalized.
b. Absolute bed rest till S. bilirubin comes down to normal level & jaundice
subsides.
c. Isolate the patient.
d. All utensils should be sperated.
e. Movement to be restricted.
f. Patient to be advised not to mixed with other patients/ persons.
g. Plenty of water & glucose by mouth.
h. If patients vomit I/V drip of 5% dextrose in Aqua 500 ml & 25% glucose 200-300
ml daily
j. All types of diet to be given except excess amount of fatty diet and alcohol.
k. Total caloric intake should be maintained within 2000-3000 Kcal.
l. Bowel should be clear by using laxative, Milk of magnesia or lactulose- 3-6 TSF
daily in the morning in empty stomach.
m. Vitamin B- complex may be given regularly.
n. If the patient has got fever or any secondary infection, a course of appropriate
antibiotic should be advised.
p. Alcohol should be restricted.
q. Drugs which are metabolized in the liver should be avoided such as:
(1) Sedative.
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(2) Antiemetics.
(3) Analgesics.
(4) Cotrimoxazole & other sulphongmides
(5) Hepatotoxic anti-TB drugs.
40 Prevention of viral Hepatitis

a. Infected persons to be isolated from others.
b. Before handling of foods /drinks hand to be washed.
c. All medical attendants & close contacts personnel are to be washed their hands
even visit or the patients.
d. Careful handling of disposable articles, bedding & clothing.
e. Foods to be covered & uncovered foods not to eat.
f. Foods & drinks are not to be taken from unauthorized/unhygienic sources.
g. Boiled chlorinated or tube-well water to be taken
h. Suspected case to be hospitalized.
j. Transfusion from infected person to be avoided.
k. Disposable syringe & needles not to be used.
l. Used syringe & needles not to be used.
m. Sexual contact to be avoided with infected person.
n. All pregnant women should be tested for HbsAg.
ENTERIC FEVER
1. Definition: Generally typhoid & paratyphoid are called Enteric fever. These are
caused by
a. Salmonella typhi.
b. Salmonella paratyphi
The organisms gain access to the body through ingestion of contaminated food, water, milk or
any other drinks. Infected shellfishes are occasionally responsible for an outbreak.
2. Incubation period:
a. Typhoid –10-14 days.

b. Para-Typhoid – Somewhat shorter.
a. Temperature rises in a step ladder fashion.
b. Malaise, headache, drowsiness, limbs ache.
c. Cough & epistaxis may occur.
d. Constipation may be present- incase of children diarrhoea & vomiting.
e. Relative bradycardia.
f. End of 1st week- Rash upper abdomen & back, rose red spot which fade on
pressure.
g. About 7-10 days of illness spleen become palpable.
h. In this time constipation is succeeded by diarrhoea.
j. Abdominal distension.
k. Tenderness in the right iliac fossa.
l. Bronchitis & delirium may develop by the end of the 2 nd weeks. The patient may
be profoundly ill unless the disease is modified by antibiotic treatment.
m. In the 3rd weeks. Toxaemia increase & the patient may pass into coma & die.
4. Complications:
a. End of 2nd & 3rd week- haemorrhage & perforation.

b. Pneumonia, thrombophlebitis, Myocarditis, Myositis, Arthritis, osteomylitis,
Meningitis etc.
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Investigations
a. 1st week-
(1) Blood count- leucopenia.

(2) Blood culture – Positive usually.
b. 2nd week
(1) Stool & urine culture.

(2) Widal test- Rising titer is characteristic.
Treatment & Management of Enteric fever.
a. Bed rest-during febrile period & for 10-14 days later.

b. In febrile period sponging to be done.
c. Diet.
(1) Sufficient fluid diet intake,
(2) Low residue diet,
(3) Chicken & vegetable soup,
(4) During febrile stage- eggs flips to be given.
(5) Gradually soft-rice, boiled fishes etc.
d. Nursing care to be taken properly.
e. Tab. Cotrimoxazole 480 mg 12 hourly for 10-14 days. or
f. Cap. Amoxycillin 750 mg 6 hourly for 14 days. Or
g. Cap. Ciprofloxacin 500 mg 12 hourly for 14 days. Or
h. Cap. Chloramphenical 200mg 6 hourly for 14 days. Or
i. In the chronic carrier should be treated with ciprofloxacin for 4 weeks.
j. Negative of consecutive six stool or urine samples indicate complete cure.
CONJUNCTIVITIS
1. Definition: It is the inflammatory condition of the conjunctiva characterized by
redness, sore ness of the eye & conjunctival discharge.
2. Classification:
a. Infective conjunctivitis
(1) Bacterial.
(2) Viral.
b. Allergic conjunctivitis.
c. Conjunctivitis following injury.
d. Conjunctivitis associated with skin diseases.
Bacterial conjunctivitis may be:-
a. Muco-purulent
(1) Acute
(2) Sub acute
(3) Chronic
b. Puruleut.
c. Membranous.
d. Pseudo-membranous and
e. Angular conjunctivitis.
Acute Mucopurulent conjunctivitis
3. Symptoms:
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a. Discomfort & foreign body sensations.
b. Photophobia.
c. Watering of the eye.
r. Sticking together of the eyelid margins during sleep.
e. Rainbow hollow around the light.
f. Conjunctival congestion.
4. Signs:
a. Chemosis of the conjunctiva.

b. Mucopurulent discharge accumulates at the inner & outer-canthus, lower fornix or
at the roots of the lashes.
5. Treatment / Management
a. Prophylaxis
(1) Towels & other belongings of the patient should not be used by the other
members of the family/ personnel.
(2) Protection of the unaffected eye.
(3) Patient should lie on the affected side.
b. Curative
(1) The eyes should be washed with normal saline thrice daily.
(2) Antimicrobial eye preparation should be applied i.e. Chloramphenicoal or
Gentamycine or sulphacetamide eye drop/ointment 4-5 times daily or according to
the severity.
(3) Broad spectrum antibiotic should be applied at bed time i.e 1%
tetracycline ointment.
(4) If cornea involved- 1% atropine sulphate twice should be used.
(5) Dark glasses should be used.
(6) There should not be used any pad.
6. Precaution Steroids are particularly contraindicated.
CHRONIC CONJUNCTIVITIS
a. Constant burning sensation.
b. Itching of the lids.
c. Scanty mucoid discharge.
d. Photophobia.
e. Valvety appearance of the conjunctiva.
8. Treatment/ Management
a. General
(1) Improvement of general health.

(2) Irritative factors, refractive errors should be eliminated.
b. Local
(1) Wash with normal saline.

(2) Antibiotic drops & ointment.
(3) Astringents- i.e. Zinc-boric acid drop.
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PULMONARY TUBERCULOSIS
1. Definition: It is the disease of lungs, caused by Mycobacterium tuberculosis.

Tuberculosis may occur in any part of the body but lungs are the commonest site. Three types of
Mycobacteria are mainly responsible.
a. Mycobacterium tuberculosis (human type).

b. Mycobacterium bovis.
c. Atypical mycobacteria (Opportunistic)
2. Aetiology/ Predisposing factors:
a. All age groups but children below 3 years are highly susceptible.
b. Diabetes, malnutrition & other devitalized condition.
c. Poor sanitation, housing state, poor nutrition.
d. Alcohol, tobacco addiction etc.
e. Silicosis, asbestosis & other occupational diseases.
f. Genetic- host resistance may be lowered by genetic factors.
g. Occupational risk factor- Doctors & nurses & medical assistant.
3. Types of pulmonary tuberculosis
a. Primary tuberculosis
b. Miliary tuberculosis
c. Post primary tuberculosis
4. Primary tuberculosis
a. Definition: This refers to the event following the first infection by tubercle
bacilli. It usually occurs in child hood & common site is lungs but other primary sites
may be tonsils, alimentary tract specially ileocaecal region.
b. Clinical features:
(1) It may produce no symptoms or signs.

(2) Febrile illness.
(3) Anorexia.
(4) Loss of weight.
(5) Night sweating.
(6) Systemic feature of tubercular infection.
(7) Slight dry cough may be present.
(8) Erythema nodosua- bluish--red raised tender cutaneous lesion on the shins
& on the thigh & associated with fever & polyarthralgia. It may be the
first clinical indication of tuberculous infection.
(9) Mild crepitation, signs of collapse, enlarged lymphnode may be present..
(10) Symptoms & signs due to complications e.g. dry pleurisy or pleural
effusion.
(11) Lobar or segmental collapse acute miliary tuberculosis
(12) Tubercular meningitis & post primary pulmonary tuberculosis may appear
c. Investigations:
(1) X-ray chest P/A view- usually shows unilateral enlargement of the hilar
lymph nodes or opacity on the lesion.
(2) Mantoux test (tuberculin test) shows strongly positive.
(3) Bacteriological examination- Sputum for AFB is positive (at least 3
smears done) in open case only.
(4) Biopsy of enlarged lymph nodes.
(5) Blood- ESR high & Lymphocytosis.
5. Post primary pulmonary tuberculosis

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a. Definition: It is the term used to describe lung disease. This is the most
important & the most frequent type of tuberculosis, It may arises as.
(1) Direct progression of primary lesion.
(2) Reactivation of a quiescent lesion.
(3) Haematogenous spread to the lungs &
(4) Rearly exogenous re-infection.
Clinical features:
(1) Onset is usually insidious.

(2) Cough is an early symptom.
(3) Sputum- usually mucous at first but may become purulent latter on.
(4) Haemoptysis- in early stage blood stained sputum.
(5) Dyspnoea on exertion.
(6) Pleuritic chest pain.
(7) Low grade afternoon fever.
(8) Sweating especially during night.
(9) Weakness, lassitude, weight loss, loss of appetite.
(10) Symptoms of complications may be present.
(11) A few medium or course crepitations may be present over the upper lobe.
(12) The crepitations may be present only after coughing.
(13) Breath sound may be vesicular with prolonged expiration.
(14) Percussion note losses its normal resonance.
(15) There may be physical signs of consolidation, cavitations, fibrosis,
pleurisy with or without effusions, spontaneous pneumothorax etc.
c. Symptoms & signs which should always raise the suspicion of TB
(1) Persistent cough.

(2) Haemoptysis.
(3) Pleural pain not associated with acute illness.
(4) Spontaneous pneumothorax.
(5) Lathergy.
(6) Weight loss.
d. Investigation
(1) X-ray chest- Hilar lymph node enlargement, fibrotic band, patchy
opacities or calcification of lesion may be seen, usually situated on upper lobe.
(2) Tuberculin test - positive.
(3) Bacteriological examination-sputum for AFB is positive (at least 3 smears
done) in open cases only.
(4) Biopsy of enlarged lymph nodes.
(5) Blood- High ESR & lymphocytosis.
e. Complications
(1) Pleurisy.
(2) Pleural effusion.
(3) Spontaneous pneumothorax.
(4) Tuberculous empyema or pyopneumorax.
(5) Tuberculous laryngitis.
(6) Tuberculous enteritis.
(7) Renal tuberculosis.
(8) Tuberculous meningitis.
(9) Respiratory failure & RVF.
(10) Secondary infection etc.
f. Treatment of tuberculosis
(1) Bed-rest – Until the acute symptoms have subsided, especially for skeletal
TB.
(2) Patient to be isolate- Until the sputum positive cases are negative.
(3) High caloric, high protein diet with vitamins to be given.
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(4) For cough- codine phosphate 8-15 mg 4-6 days
(5) Anti- tuberculosis- chemotherapy
(a) Refampicin-
i. Children- 10-20 mg/kg/day.
ii. Adult- WT> 50 kg-600mg maximum
ii. Adult WT <50 kg 450 mg maximum.
(b). INH
i. Children –10mg/kg/day
iii. Adult-200-300mg/day
iv. Intermittent regimen- 15mg/kg
v. Miliary/meningitis – 10-12 mg/kg.
(c) Pyridoxine – 10mg/day (in all cases).
(d) Ethambutal- Children & adults: initial 8 wks- 25mg/kg/day
subsequently, 15 mg/kg/day
(e) Streptomycin-
i. Children- 30mg/kg/day
ii. Adult under 40 yrs & weighing more than 45 kg-1 gm.
Adults
40-60 yrs or weighing less then 45 kg –0.75 gm intermittent
regimens- 0.75-1 gm. Adults over 60 yrs or in patients with renal
failure, the doge of streptomycin should be reduced according to
serum levels.
(f) Pyrazinamide
i. Children – 20-35 mg/kg/day.
ii. Adult WT>45 kg 1.5 gm maximum
iii. Adult wt<45 kg – 2.0 gm
DENGUE FEVER
1. Definition: Dengue is a viral febrile disease of human, caused by a FLAVI VIRUS.

The main carrier of this virus is a mosquito, known as “AEDES AEGYPTI”. It is transmitted by
the daytime biting specially in the summer season. After infection, humans are usually infective
in the first three days of the illness that is the viraemia stage of the disease. The healthy AEDES
mosquitos become infective about two weeks after feeding on an infected individual and persist
as carries for the rest part of their lives.
There are 4 antigenic serotypes of dengue virus i.e. Dengue-1, Dengue-2, Dengue-3,
Dengue-4,
This all are producing as similar clinical syndrome after infection of an individual, the
immunity develops which is life long for the same serotype of the virus infected & only a few
months for the other serotypes.
2. Incubation period: The usual incubation period is 7-10 days, but it can be as short as 2
days & as long as 15 days.
3. Types of dengue fever: Clinically 2 types of dengue fever are recognized.
a. Classic dengue fever.
b. Dengue haemorrhagic fever.
4. Clinical feature for classic dengue fever.
a. There may be a prodromal phase of malaise & headache for 2 days.
b. Then, an acute onset of
(1) High fever with headache, backache & arthralgias.
(2) Severe aching ( breakbone pain)
(3) Facial flashing.
(4) Deep eye pain & Conjunctival secretion.
(5) Sore throat.
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(6) Prostration.
(7) Depression.
(8) Lympladenopathy & relative bradycardia.
c. Acute & sudden onset of high fever with chills; fever is usually continuous or
saddleback pattern & biphasic, initial phase lasts for 3-7 days, then after a remission
period of few hours to 2 days, Second phase of fever appears & lasts for 1-2 days.
d. Rash - Appears in about 80% of the patients. Initially transient macular rashes
appear in the first 1-2 days and then followed by maculopapular, morbilliform, or
scarlatiniform or petecheal rashes from 3-5th day. The rash usually appears first on the
dorsum of the hands & feet & then spreads to the arms, legs trunk & even to the neck but
rarely to the face. It is lasts for 2 hours to a few days, followed by desquamation.
e. During remission of convalescent period, severe fatigue & a feeling of unwell
with depression are common for several weeks.
5. Clinical feature for dengue haemorrhagic fever
a. It usually occurs in children but may also occur in adults.
b. Upper respiratory tract infection which is then followed by an abrupt onset of
haemorrhage in to he skin, ear, nose & gums, & haematemesis & melaena
c. In the case of severe haemorrhagic fever hypotension & circulatory failure are the
usual consequences with features of a “capillary leak syndrome” leading to the
development of shock, known as “dengue shock syndrome”.
d. On laboratory investigation, most significant & suggestive findings are
thrombocytopenia & haemoconcentration.
6. Diagnosis:
a. Complete blood count- leukopenia, thrombocytopenia (haemorrhagic fever)
b. Isolation of dengue virus in the blood during acute phase (collecting serum
sample within 5 days the onset of illness).
c. Serological test for detecting dengue viral antibody titre (IgM ELISA test)- this
may detect cross reacting antibodies from other flavi viruses.
Management / Treatment :
There is no specific treatment for dengue fever, only symptomatic & supportive therapies
are given.
For Classic dengue fever-
a. Fever & pain- Paracetamol is the drug of choice, but in severe aching, opiates
may also be given. Aspirin (& other NSAIDS) must not be given for their antiplatelet
effect.
b. Plenty of oral fluids should be given.
41
For dengue haemorrhagic fever:
a. Immediate hospitalization.
b. Fever & pain to be reduce with Paracetamol & opiates may also be given.
c. Oral rehydration salt to be given in mild haemorrhagic fever.
d. If necessary I.V fluid may be given.
e. In severe haemorrhagic fever- Isotonic I.V fluid immediately for volume
replacement i.e. Ringers lactate, or normal saline or dextrose.
f. In significant bleeding fresh whole blood transfusions are preferable.
g. In cases of bleeding due to thrombocytopenia then concentrated platelets are more
helpful to be given if available.
h. Regular recording of vital signs i.e. TPR, BP, ABC, etc.
i. Proper nursing care should be taken in time.
j. Patient should be reassured
Prevention:
a. Isolation of the patient.
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b. Treat under mosquito net.
c. Abolishing the breeding places by an integrated approach of environmental
sanitation & biological control.
d. Destroying adult mosquito by spraying insecticides.
e. Avoiding aedes mosquito bite at day time, specially in the peak feeding period i.e.
in the morning for several hours & in the late afternoon for several hours
by using mosquito net or by using repellents containing DEET ( less than
30% ) on the exposed skin or by using mosquito coil.
f. Dengue vaccine- a live attenuated tetravalent dengue vaccine is at an advanced
stage of development, but yet not available for clinical use.
FOOD POISONING
1. Definition: Food poisoning includes a number of disorders presenting with vomiting,

diarrhoea, abdominal pain due to acute inflammation of the stomach and intestine within 48
hours of consumption of the contaminated food or drink.
Types:
a. Non-toxin type.
b. Toxin type.
Causes of food poisoning:
a. Non-toxin medicated: Salmonella species, Camphylobacter jejuni,
Bacillus cereus, Viruses (Norwalk viruses) Listeria monocytogenes (Causing meningitis)
Bacillus anthracis (anthrax)
b. Toxin-Medicated: Staphylococcus aureus, clostridium perfringens.
Clostridium botulinum, E.coli.
Clinical features:
a. The principal symptoms are nausea, vomiting, diarrhoea (may be bloody) &
abdominal colic.
b. In severe cases there may be prostration collapse & dehydration, patient may be
rapidly become shocked.
c. In the infection type, there is usually pyrexia and toxicity, patient may be ill for
several days
d. The stools are watery and offensive and may contain blood and some mucus.
e. Botulism- due to ingestion of toxin produced by clostridium bolulinum.
f. The clinical feature consists of vomiting & paresis of skeletal, ocular, pharyngeal
& respiratory muscles.
Diagnosis:
a. History: Intake of contaminated food or drinks.
b. Mode of presentation: The simultaneous occurrence of symptoms in more
than one member of a household or institution of ten simplifies diagnosis. The incubation
period is a useful indicator. If vomiting starts within 30 minutes of ingestion of suspected
food, it is likely to be due to a chemical poison, if it is arises 12-48 hours later it is
probably die to salmonella or campylobacter infection.
c. Investigation: A specimen of the patients stool or vomit together with the
suspected food if available should be sent for culture, organisms can usually be isolated.
In severe cases blood should be sent for culture.
Management:
a. During acute attack- no solid food.

b. Liquid diet to be given.
c. Oral rehydration therapy in mild to moderate cases.
d. In severe cases I.V therapy to be given immediately.
e. Loperamide or codienephosphate is useful in controlling diarrhoea.
f. Antibiotic should not be given routinely for acute diarrhoea & vomiting, but if –
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(1) Salmonella bacteraemia is suspected or confirmed or if diarrhoea is severe
or
Prolonged then – Ciprofloxacin 500mg 12 hourly or Cotrimoxazole 960 mg 12
hourly or Trimethoprim 200 mg 12 hourly should be given all are for 7 days.
(2) For camphylobacter enteritis- Erythromycin 250 mg 6 hourly, or
Ciprofloxacin 500 mg 12 hourly.
(3) Listeria monocytogenes- Ampicillin is responsive.
DIARRHOEA
1. Definition: Diarrhoea is defined as the passage of stool more than three times a day &
increased stool frequency & lose watery stool. Passage of frequent but formed stool is not
usually considered as diarrhoea. Urgency of defaecation & faecal incontinence is a common
feature of any variety of diarrhoea.
2. Types of diarrhoea
a. Acute Diarrhoea:- Passage of liquid or watery or soft bloody stools usually

more than three times a day is defined as acute diarrhoea.
b. Persistent Diarrhoea:- The diarrhoea which starts acutely & persists for more than
2 or 3 weeks with or without growth failure, is defined as persistent diarrhoea.
3. Causes of diarrhoea
a. Hosts factors
(1) Age – 90% diarrhoea under 2 years

(2) Protein energy malnutrition.
(3) Vita-A deficiency.
(4) Bottle feeding.
b. Environmental factors
(1) Lack of safe water.

(2) Over crowding.
(3) Unhygienic disposal of nightsoil
c. Aetiological factors
(1) Internal causes

(a) Viruses:- Rota virus is resonsible for up to 50% diarrhoea in
children aging 6-24 month. Norwalk virus, Entero-virus.
(b) Bacteria:-
i. Enteropthogenic E. Coli-EPEC
ii. Entero toxigenic E coli- ETEC
iii. Entero invasive E Coli- EIEC
iv. Vibrio choleriac, shigella, Non-typhoid salmonella etc.
v. Cholera.
vi. Staphylococcus.
vii. Comphylofacter.
(c) Parasites- Giardia lamblia, Entamoeba histolytica, Trichuris
trichiura, Strongyloids stercoralis.
(d) Fungi- Candida albicans.
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(2) Parenteral causes: Pneumonia, Pyelonephritis, Meningitis, Septicaemia
etc may be associated with diarrhoea.
(3) Dietary & Other causes: Food allergy, Cows milk allergy, dietary
indiscretion drugs, soyaprotein etc.
4. Investigations
a. Stool R/E, C/S & reducing substance.
b. Blood –routine count.
c. Urine – Routine test.
d. Special tests: Blood Urea, S. Creatinine, S electrolyte & TCO2 if needed.
5. Sign & Symptoms
a. Loose watery motion.
b. Frequency of motion.
c. Dehydration.
d. Loss of fluid.
e. Nausea & vomiting.
f. Pain abdomen.
g. Skin- loose.
h. Temperature- abnormal.
i. Pulse- Feeble & rapid.
j. Respiration- deep & rapid.
k. BP- Low.
l. Tongue – Dryness.
m. Sunken eye.
6. Management & Treatment.
a. ORS should be given in an amount at least equal to that lost. If the patient refuses
or cannot drink adequate amount of ORS then naso-gastric infusion may be administered.
b. I/V Therapy to be start if needed for correction of severe dehydration &
electrolyte in balance.
c. Low residual liquid diet followed by frequent semi-solid diet as the patient can
tolerate.
d. Anti- diarrhoeal drugs must be used with great cautions i.e. Cap Loperamide 4 mg
initially then 2 mg after each loose stool up to 16 mg/day is effective in acute & chronic
diarrhoea. Incase of children it should be avoided.
e. Treatment of complication accordingly.
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NON – INFECTIOUS DISEASES

PUD (PEPTIC ULCER DISEASE)

5 a. Bed rest- during acute exacerbation.

a. Acid anti-secretory agents

b. Mucosal protective Agents

13 (1) Sucralfate, Bismuth, Misoprostol & Antacids

c. Agents that promote healing through eradication of H. Pylori.

14 (1) Proton pump inhibitor-Omeprazole, Lansoprazole

1. Definition: Dysentery is an acute inflammation of the large intestine characterized by

2. Types: There are two types of dysentery. Such as -

(2) Incubation period: The incubation period varies from 02 weeks to

(a) In mild to moderate cases: recurrent loose or semiformed stool

(a) Mild to moderate intestinal infection: Metronidazole 800mg

(1) Definition: Bacillary dysentery or shigellosis is a common disease,

(a) Bed rest.

(5) General measures:

(a) Loperamide 2-4 mg 6-8 hourly for controlling diarrhoea.

1. Definition: It is an inflammatory process in the lung parenchyma, caused by various

a. According to source of infection-

(1) Primary pneumonia- Usually community- acquired.

(a) Acute Bronchopneumonia.

b. According to site of involvement

(1) Lobar – 20%

c. According to causative organism-

(1) Bacterial (mostly pneumococcal) pneumonia.

ACUTE LOBAR PNEUMONIA (Pneumococcal pneumonia)

1. Definition: It is characterized by homogeneous consolidation of one or more lobe or

(1) Blood count –shows marked leukocytosis.

a. Penicillin is the drug of choice.

1. Definition: Malaria is caused by protozoa of the genus plasmodium. It is transmitted

a. Plasmodium falciparum: Produces malignant tertian malaria or falciparum

b. Plasmodium vivax: Produces benign tertian malaria.

c. Plasmodium malariae: Produces quartan malaria.

d. Plasmodium ovale: Produces ovale or tertian malaria.

3. Incubation period: 10-15 days.

4. Clinical features: Clinical feature vary according to the different species of

(a) Fever- Chill with rigor

A typical paroxysm may be divided into:

a. Cold stage: Temperature lasting for 20 minutes to 1 hour, followed by-

6. Types of fever in Malaria

16 a. Tertian fever- (P-Virax, P. Ovale)

18 b. Quartan fever (P. Malariae)

(1) Fever occurs at interval of 2 days.

d. Quotidian fever : Fever recuring at intervals of 24 hours. Such type of fever

6. Complication – ln case of P. Falciparum

a. Cerebral malaria with oedema.

d. Intravascular haemolysis- Black water fever.

7. Complication- incase of P. malariae

a. Blood for MP- If positive repeat (if necessary)

9. General management of malaria.

.The initial dose for children is 5-15 mg/kg of body weight.

c. Incase of severe malaria

(1) A loading dose of quinine dihydrochloride 20 mg/kg body weight by I/V

(2). Maintenance dose: Should be started 12 hours after loading dose.

a. Protection against the bite of mosquito by using mosquito net.

1. Definition: It is a viral infection & mainly caused by a group of myxoviruses.

a. Sudden onset of malaise, headache.

a. Complete bed rest

1. Definition: Bronchial asthma is characterized by paroxysms of breathlessness, chest

It is divided into 2 types:

(1) Early onset or atopic childhood asthma.

a. Sudden onset of severe respiratory distress.

1. Definition: Acute bronchitis is a clinical condition caused by acute inflammation of