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The appearance of Blisters around lips is the most common condition experienced by almost every person a few times in his/her lifetime. Most of the people get this disease when they reach the age of 20. This is a Highly contagious infection and transfers from one person to another through intimate contact, sharing towels and other articles. Once it infects somebody, a tendency of recurrent infection always remains there. It is very difficult to eliminate this virus completely. But in the normal healthy individual, this virus doesn’t cause serious complications. It causes serious complication in only immuno-deficient person ( eg., AIDS ). The Causative virus has two subtypes, Herpes simplex type I and Herpes simplex type II. Herpes simplex type 1 causes herpes labialis and it is more common. The Herpes Simplex type II virus causes genital herpes ( see an article about genital herpes, causes and treatment )but it may cause herpes labialis as well. After the first infection, the herp...

Hyperventilation syndrome is characterized by an increase in alveolar ventilation that leads to hypocapnia. Central neurogenic hyperventilation occurs in brain stem injury presenting with a sustained pattern of rapid and deep breathing. Causes of hyperventilation may be organic or functional. Organic causes of Hyperventilation syndrome. Organic causes of Hyperventilation syndrome are pregnancy, hypoxemia, obstructive and infiltrative lung diseases, sepsis hepatic dysfunction, fever and pain Functional hyperventilation may be acute or chronic, usually due to anxiety. In the acute form of Hyperventilation syndrome, patient (usually young females) present with rapid breathing, paresthesias, carpopedal spasm, tetany (due to unionization of calcium), chest pain or discomfort, choking sensation, sweating and anxiety. In the chronic form of Hyperventilation syndrome, the patient presents with fatigue, dyspnea, anxiety, palpitation and dizziness. Diagnosis of Hyperventilation Syndrom...

SLEEP APNEA/HYPOPNEA SYNDROME Sleep apnea or Central Sleep Apnea syndrome is characterized by recurrent upper airway obstruction during sleep when the loss of normal pharyngeal tone allows the pharynx to collapse passively during inspiration Which causes Loud Snoring and Breath Pauses (apnea) in affected person Aetiology and Causes of Sleep Apnea Male gender Obesity Tonsillar hypertrophy Nasal obstruction Hypothyroidism acromegaly Ingestion of alcohol or sedatives before sleep Clinical features of Sleep Apnea If the narrowing is slight, it leads to snoring. If upper airway narrowing progresses to the point of occlusion or near occlusion, a sleeping person increases respiratory effort and try to breathe until the increased effort transiently awaken him. This recurrent cycle of apnea, awakening, apnea, awakening may repeat itself many hundreds of times per night. The patient complains of day - time sleepiness, he feels he has been asleep all night but still he does not feel fresh...

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS SCHOOL OF PHARMACY Subject: Physical Assessment Session:                 Pharm-D Total Marks:  15 Date: 12/12/12 Time Allowed:  30min Paper:                    Name: Roll No. A 50year old physician arrives at his office in the morning and is seized with crushing substernal chest pain accompanied bydiaphoresis. A sublingual nitroglycerin tablet does not relieve his symptoms so he asks his nurse to drive him to the ER. Shepulls into the ER ramp entrance when h...

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS SCHOOL OF PHARMACY Subject: Clinical Pharmacotheraputics Session:                 Pharm-D Total Marks:  15 Date: 10/1/13 Time Allowed:  45min Paper:                    Name: Roll No. A B Answers A 55-year-old man presents with increasingshortness of breath, decreased urine output,malaise, nausea, and vomiting. He has ahistoryof hy...

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS SCHOOL OF PHARMACY Subject: Clinical Pharmacotheraputics Session:                 Pharm-D IX-Semester Total Marks:  25 Date: 13/11/2012 Time Allowed:  2.hrs Paper:                    Mid-term Name: Roll No. A 56-year-old man with a history of hypertensionand cigarette smoking is admitted to the intensive careunit after 1 week of fever and nonproductive cough. Imagingshows a new pulmonary infiltrate, and urine antigentest for Legionella is positive. Each of the...

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS SCHOOL OF PHARMACY Subject: Clinical Pharmacotheraputics Session:                 Pharm-D VIII-Semester Total Marks:  25 Date: 17/11/2012 Time Allowed:  2.hrs Paper:                    Mid-term Name: Roll No. You are called to the bedside to see a patient withPrinzmetal’s angina who is having chest pain. The patienthad a cardiac catheterization 2 days prior showinga 60% stenosis of the right coronary artery with associatedspasm during coronary angiogram. The s...

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS SCHOOL OF PHARMACY Subject: Clinical Pharmacotheraputics Session:                 Pharm-D Total Marks:  10 Date: 10/1/13 Time Allowed:  30 min Paper:                    Name: Roll No. A 81-year-old man presents with pallor, glossitis,cheilitis, and vitiligo. Which of the following is the most likely diagnosis? (A) sickle cell anemia (B) cold agglutinin syndrome (C) methemoglobinemia (D) pernicious anemia (E) polycythemia A7-year-old boy has sever...

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS SCHOOL OF PHARMACY Subject: Clinical Pharmacy Session:                 Pharm-D VIII-Semester Total Marks:  15 Date: 24/10/2012 Time Allowed:  30min Paper:                    Quiz 1 Name: Roll No. A 54-year-old man complains of burning epigastric pain that usually improves after a meal, and is occasionally relieved with antacids. On examination, he appears well and besides some epigastric tenderness on palpation, the rest of the examination is normal. U...

Indication and patient selection for Lung Transplantation patient under 60 years with a life expectancy of fewer than 18 months without transplantation, no underlying malignancy and no serious systemic disease. Following diseases are treated by lung transplantation. Emphysema- smoking-induced or due to alpha- one antitrypsin deficiency. Idiopathic pulmonary fibrosis Cystic fibrosis Eisenmenger’s syndrome Primary pulmonary hypertension Lung transplantation options Single lung transplantation Emphysema Idiopathic pulmonary fibrosis Primary pulmonary hypertension Bilateral lung transplantation Cystic fibrosis Emphysema Primary pulmonary hypertension Bronchiectasis Living related lobar transplantation Cystic fibrosis Bilateral lower lobe transplantation from two Different living donors Heart-lung transplantation Congenital heart diseases with Eisenmenger’s syndrome. Left ventricular failure and end-stage lung disease Recipient selection For Lung Transplantat...

(Arterial blood gases) ABG report tells us about the level of hypoxemia and acid-base balance. A medical student must know how to interpret arterial blood gases (ABG Report) correctly and accurately and he should also know the procedure of taking the sample for arterial blood gases test. Standard Procedure: To take the arterial blood sample; 1. first of all heparinize the syringe with 0.1 ml heparin to prevent clot formation. 2. Draw blood from the radial or brachial artery (femoral artery if none of these is accessible). Prevent Air bubble otherwise, it will affect the results. 3. Immersed the sample in an ice bag immediately to prevent metabolism that can decrease PO2 and increase PCO2 Normal Values: pH: 7.35-7.45 PO2 (partial pressure of oxygen): 75-100 mm of Hg PCO2 (partial pressure of carbon dioxide): 36-46 mm of Hg HCO3 (bicarbonate ion): 22-26 mmol/L O2 saturation: 95-100% (oxygen saturation below 90 per cent produces cyanosis in a person who has a normal level o...

Chest pain is one of the most common problems which a common man may experience. It could be as serious as myocardial infarction ( to understand heart attack in simple language click here ) or just muscular pain. Chest pain may occur due to the pathology of structures present on and inside the chest. The chest is composed of skin, muscles, ribcage and important organs present inside the rib cage. Following important organs are present inside the chest cavity, and any damage to these organs may give rise to chest pain. - Intercostal Muscles, - Heart - Lungs - Blood vessels - Oesophagus - Nerves - Bones and Joints. - Breasts - Lymph nodes The following structures are not present in the chest cavity but are covered by the ribcage. - The upper end of the stomach - liver Now any abnormality or disease of the above structure can cause chest pain. Severe and localized chest pain, in which the patient can tell the exact location of the pain is mostly muscular in origin, which...

Watery Vaginal Discharge after Pelvic/Cervical Surgery/Operation (Ureter Ligation During Radical Hysterectomy): Today My paying guest came to me and said her aunt has some problem. I took her history and she said, patient has under gone Pelvic surgery a month ago for some pelvic cancer.  Operative notes were saying “radical hysterectomy performed, Cervix was barrel shaped and removed, uterus and ovaries are removed. Uterine artery ligated, Lymph nodes were normal in size shape and consistency. Specimen is sent for lab examination. Then i read the specimen examination report, it said, “Stage II Cervical Cancer”. I didn’t find any other abnormality in lab reports except slightly raised serum creatinine and urea Then i saw Intravenous Urogram where i clearly noticed dilated pelvis of right kidney, left kidney was normal and bladder was normal in size shape and contour no filling defect seen. Then i asked about her current symptoms, she said that she has fever, pain in right...

Congenital heart disease or congenital malformation of heart occur in 1 per cent of live birth. It means that 1 out of every 100 live birth will have congenital heart disease. Male babies are affected more as compared to female baby although some congenital heart diseases such as atrial septal defect (ASD) and Patent Ductus Arteriosus occur more commonly in females. Causes of Congenital Heart Diseases: Congenital heart diseases have the following associations. Maternal Rubella Infection: Congenital Patent Ductus Arteriosus, Congenital Pulmonary Stenosis, Congenital Aortic Stenosis Maternal Alcohol Abuse: Septal Defects (Ventricular and Atrial Septal Defects) Maternal Drug Treatment and Radiations Genetic Defects. Down’s Syndrome (chromosomal abnormality) Ventricular and atrial septal defects, congenital abnormalities of heart valves. Turner’s Syndrome (chromosomal abnormality) Coarc...

Q: Hello I have a question. My son has been on Suboxone (buprenorphine and naloxone) for approx 8 months. 1 8mg film daily. Finally, he has smartened up and wants to be rid of this lifestyle forever. So on December 17, 2012, he took his last half. He had a prescription of tramadol from a previous injury so in order to eliminate the withdrawal from the suboxone he has been taking the tramadol. If it has been 13 days without any suboxone will he still go through the physical withdrawals from it? If so how long do they typically last? If he were going to suffer any withdrawals wouldn't they have already kicked in? Thank you so much for taking the time to help me. A: Ok tell me for how long had he took opioids? and ( which drug he was addicted to). Suboxone is used to treat opioid addiction. Was he addicted to other stronger opioids? Has he encountered any withdrawal symptom?  What kind of symptoms did he have? and is he absolutely fine now? Q: If I were to have to guess I would ...

Abnormal heart sounds are called Murmurs. Murmurs are of various types. Here we will discuss common types of cardiac murmurs. Types of cardiac murmurs. Murmurs are grossly divided as systolic and diastolic murmurs. Murmurs heard between first heart sound and second heart sound are called systolic murmurs and murmurs heard between second heart sound and first heart sound are called diastolic murmurs. Now systolic murmurs are further divided into. 1. Mid-systolic murmurs 2. Pan-systolic murmurs 3. Late systolic murmurs and diastolic murmurs are further divided into; 1. Mid-diastolic murmurs 2. Early diastolic murmurs Murmurs can be present in both systolic and diastolic phase of the heart beat. Systolic Murmurs: Mid Systolic Murmurs: Aortic stenosis: narrowing aortic valve is called aortic stenosis. When left ventricle contracts, it forces blood into the aorta. Forced and fast movement of blood through aorta produces a harsh sound which can be heard as murmur. It is best h...

The case of the month Instructions: Watch in full screen for a better view: exit the full screen when the video ask for the name and email address as a flash player doesn't accept keyboard input in full screen Every month a clinical case is posted. This clinical case is discussed with possible answers. This case "A 35-year-old female delivered a healthy baby 15 days back presented with drowsiness for 2 days. On examination, she had 3/5 power on the left side of the body. Her MRI was performed" was presented in holy family hospital Rawalpindi Pakistan. History, Examination and investigation are done there. This case is provided by Dr Tayyab Saeed Akhtar. MO and Registrar Holy family hospital Rawalpindi Pakistan. MRI of this patient revealed a lesion. You have to identify this lesion and guess what is it. Then you should think about the type of lesion and the cause of lesion and then after determining the cause, you should think about how to eliminate this cause, Give...

A lecture on Diagnosis of Hepatitis A, B, C and E was delivered by Dr. Tayyab Saeed Akhtar in a national conference held in Chakwal Pakistan. Dr. Tayyab Saeed Akhtar is MO and Registrar at Holy family hospital Rawalpindi The lecture is password protected to limit unauthorized views. Password is medicotips.com   (Please watch in full screen for a better view): Kindly answer the Quiz at the end of the presentation and self evaluate your knowledge. You will get result instantly: diagnosis of hepatitis A,B,C and E. Summary: Hepatitis can be acute or chronic. Chronic hepatitis is associated with extensive liver fibrosis and liver dysfunction. Different viruses cause hepatitis, Most common are Hepatitis A virus, Hepatitis B virus, Hepatitis C virus and Hepatitis E virus. Other viral infections are less common and include; Cytomegalovirus and Epstein Bar Virus, Hepatitis can be present in yellow fever a herpes simplex viral infection. Liver Function Tests in hepatitis are deranged, A...