ACUTE CORYZA (COMMON COLD)

The onset is usually sudden with a burning and tickling sensation in the nose accompanied by sneezing. The throat often feels dry and sore, the head feels 'stuffed' and there is profuse watery nasal discharge. These symptoms last for one or two days, after which, with secondary infection,

AORTIC ANEURYSM

An aortic  aneurysm is an abnormal dilatation of the aortic wall. Aneurysm may be due to atheromatous disease, connective tissue disease, or syphilis, Dissecting aneurysm has a different pathology and is considered separately. Atheromatous aortic aneurysm is the commonest form.

RAYNAUD'S PHENOMENON

This is an intense vasospasm of peripheral arteries. On exposure to cold the fingers (and less commonly the toes) becomes initially very pale from vasoconstriction.

EISENMENGER'S SYNDROME

This is pulmonary hypertension complicating an initial left-to-right shunt. Progressive changes take place in the pulmonary vessels, and once established the increased resistance is irreversible.

ATRIAL SEPTAL DEFECT

Atrial septal defect is more common in female. Since the normal right ventricle is much more complaint than the left, a large volume of blood shunts through the defect from the left to right atrium and then to the right ventricle and pulmonary arteries.

COARCTATION OF THE AORTA

Narrowing of the aorta most commonly occurs in the region where the ductus arteriosus joints the aorta, i.e. just below the origin of the left subclavian artey. The condition is more common in males, and is sometimes associated with other abnormalities, Of which the most frequent is a bicuspid aortic valve.

CHRONIC PERICARDIAL CONSTRICTION

Tuberculosis is a frequent cause. some cases accompany rheumatoid arthritis and other follow a haemopericardium or, rarely, acute pericarditis. Often the cause is obscure. A slowly progressive fibrosis of the pericardium develops and constricts the movement of the heart,so that it cannot expand in diastole.

PULMONARY STENOSIS

Virtually always congenital. It may be isolated or associated with other abnormalities such as fallot's tetralogy.

TRICUSPID REGURGITATION

Tricuspid regurgitation is common. The most frequent causes are:

• Right ventricular dilatation secondary to pulmonary hypertension
• Rheumatic heart disease
• Endocarditis, particularly in intravenous drug abusers
• Right ventricular infarction

TRICUSPID STENOSIS

Tricuspid stenosis is usually rheumatic in origin, and nearly always occurs in association with mitral and aortic valve disease. Isolated rheumatic tricuspid stenosis is very rare. Tricuspid valve disease may also be associated with the carcinoid syndrome.

CLONAL FACIAL (HEMIFACIAL) SPASM

This disorder presents mostly after middle age.

Clinical features
Symptoms usually start with intermittent twitching around the aye. Over the course of months or years, clonic twitches increase in frequency and severity so that the eye may close for a few seconds at a time, and gradually the movements begin to affect the lower face.

BULBAR AND PSEUDOBULBAR PALSY

Lesions of cranial nerves IX, X, XI AND XII often occur together, frequently because of vascular disease affecting the medulla. The resultant palatal, pharyngeal and tongue weakness causing dysphonia, dysphagia and dysarthria is known as 'bulbar palsy'. Bilateral supra nuclear lesions affecting the pyramidal tracts (e.g. due to diffuse vascular disease, motor neuron disease, multiple sclerosis) cause loss of voluntary palatal and pharyngeal movements, but the gag reflex is preserved. The tongue is small (spastic) and shows poor rapid movement, this resulting in indistinct speech (spastic dysarthria). The jaw jerk is brisk. This state is known as 'pseudobulbar palsy'.

SQUINT (STRABISMUS)

Squint occurs when the two eyes fail to move in a coordinated fashion. Diplopia results unless one has very poor vision or the defect has been of long-standing since childhood,

MENIERE'S DISEASE

This is a disorder of the inner ear in which there is excessive pressure and dilatation of the endolymphatic system. This results in damage to both the vestibular and cochlear sense organs. The cause is unknown, although there is some overlap with other functional vasospastic disorders such as migraine.

VESTIBULAR NEURONITIS

This is common disorder affecting mainly young adults. The aetiology is presumed to be due to viral infection, and occasionally occurs in small epidemics.

CONGENITAL TALIPES EQUINOVARUS (CTEV)

Club foot is a congenital contracture of he joints of the foot. The main clinical signs of congenital talipes equinovarus are

ARTHROGRYPOSIS MULTIPLEX CONGENITA

Arthrogryposis multiplex congenita is a non-progressive disorder of congenital origin; characterised by marked stiffness and contracture of joints affecting the limbs and trunk.

OSTEOARTHRITIS

Osteoarthritis is characterized by thinning and destruction of the hyaline cartilage of joints, followed by remodelling of underlying bony surfaces. It is essentially noninflammatory.

VARICOSE VEINS

Incompetence of valves and reflux of blood from the deep venous system subjects the superficial veins to excessive pressure not only when standing or sitting at rest but also during exercise.

LYMPHEDEMA

Swelling of an extremity or other body part secondary to a malformation or obstruction of lymphatic channels.

PSORIATIC ARTHRITIS

Psoriasis is a relatively common skin condition. A number of HLA antigens are associated with psoriasis. When psoriatic patients carry the antigen HLA-B27, there is a high risk to develop psoriatic spondylitis. When they are positive for the antigen HLA DR4 they are more liable to develop an arthritis. Psoriatic arthritis a common complication occurring in 5% of psoriatics.

REITER'S SYNDROME

It is a seronegative arthritis consisting of a traid of

• Reactive arthritis
• Nonspecific urethritis and
• Conjunctivitis

Two types are recognised.

• Following a gastrointestinal infection (dysentery) with Yersinia, Salmonella or Shigella.
• Following nonspecific urethritis.

MONGOLISM (DOWN'S SYNDROME)

Down's syndrome is one of the common causes of mental subnormality in children; occurring in 1.3 out of every thousand live births. This was described by Dr. John Langdon Down in 1866.

MICROCEPHALY

Microcephaly is defined as a head circumference that measures less than 3 standard deviation below the measure for age and sex.

CONGENITAL TORTICOLLIS

Congenital torticollis is an asymmetric deformity of the neck resulting from unilateral contracture of sternocleidomastoid muscle.

FOOT DROP

Foot drop results from damage to the common peroneal nerve trunk and the consequent paralysis of the anterior and lateral group of leg muscles which dorsiflex and evert the foot respectively.

RADIAL NERVE PARALYSIS

The wrist hangs loosely in flexion (wrist drop) and the metacarpophalangeal joints are also flexed. The hand is pronated.

MEDIAN NERVE PARALYSIS

The median nerve may be injure:

• In the axilla, or above the elbow, although this is rare.
• At the elbow, where it may be involved in a fracture, though far less frequently than the ulnar nerve.
• Low in the forearm, or at the wrist, the most common site of injury, since the nerve is in a superficial position.

ULNAR NERVE PARALYSIS

The ulnar nerve may be injured at the elbow, where it may be torn or lacerated when a fracture or dislocation takes place, later compressed by callus or scar tissue, or at the wrist, generally by direct injuries, such as cuts, or wounds. It may also be damaged in any part of its course by wounds or tumors.

ERB'S PLASY

The causes of Erb's palsy are:

1.Undue strectching of the head from the shoulder as in a manoeuvre to deliver the baby in breech presentation (birth injury).
2.In an adult it may follow a blow or fall on shoulder.

HALLUX RIGIDUS

Hallux rigidus occurs as two distinct varieties.

1. The adolescent type is due to synovitis of the metatarsophalangeal joint following injury,

CALCANEAN SPUR

Calcanean spur is a result of plantar fascitis following foot strain, Which is perhaps aggravated by some focus of infection.

SPRENGEL'S SHOULDER

Congenital elevation of the shoulder is a condition in which the scapula is smaller than normal and situated at a higher level. The inferior angle is rotated inwards, and abduction is restricted.

CONGENITAL ABSENCE OF THE RADIUS

Congenital absence of the radius occasionally occurs, in which case growth of the ulna pushes the hand to the radial side.

MADELUNG'S DEFROMITY ( MANUS VALGA)

Manus valga is a radial displacement of the carpus with abnormal prominence of the lower end of ulna. It is a term for a deformity and comprises many etiological conditions.

CUBITUS VALGUS

Normally the forearm lies in a slightly abducted position in relation to the axis of the humerus ( the 'carrying angle'). This varies from about 10 degrees in men to 15 degrees in women ( because of the greater width of the female pelvis in relation to the shoulders).

CHOLECYSTECTOMY

The gall bladder is removed in cases of chronic cholecystitis, with or without the presence of gallstones. Disease of the gall bladder is common in women than in men.

TUBEROUS SCLEROSIS (Bourneville disease)

Tuberous sclerosis is an autosomal dominant disorder involving multiple systems.

NEUROFIBROMATOSIS (Von Reckilinghausen disease)

Neurofibromatosis, another autosomal dominant neurocutaneous disorder, is characterized by cafe-au-lait spots (irregular hyper pigmented areas: more than 6 spots, each measuring at least 1.5 cm.),

INCONTINENTIA PIGMENTI ( Bloch-Sulzberger disease)

Incontinentia pigmenti, an X-linked dominant disorder, lethal to the males, is characterized by multi system involvement. CNS manifestations include seizures, developmental delay, microcephaly, spasticity and paralysis.

LINEAR NEVUS SYNDROME

Linear nevus syndrome, a sporadic condition is characterized by a facial nevus over middle of and forehead and nose and neurodevelopmental defects.

ATAXIA TELANGIECTASIA

Ataxia telangiectasia, a defect of embryogenesis, is characterized by cerebeller ataxia, ocular and cutaneous telangiectasia, chronic sinopulmonary infection, endocrinal abnormalities and immunodeficiency of B and T cell ( most frequently IgA and IgE deficiency, singly or together).

VON HIPPEL-LINDAU DISEASE

Von Hippel-Lindau disease is characterized by visual loss and manifestations related to cerebellar or spinal cord dysfunction. The basic lesion is angioma of retina, usually accompanied by hemangioblastoma of cerebellum, hemangioma of spinal cord, hypernephroma and cystadenomas of viscera may occur but are less frequent. Paradoxically, skin is not involved. This condition appears at adolescence or later.

STURGE-WEBER DISEASE

Sturge-weber disease, a nonfamilial disorder results from a unilateral congenital capillary hemangioma invoving face and neck (facial nevus involving usually opthalmic division of trigeminal nerve) mucous memberane, meninges and choroid plexus.

Neurologic manifestations include seizures, mental defect, hemiparesis, or hemianopsia, rarely subarachnoid hemorrhage, glaucoma, and railroad track pattern of calcification on X-ray skull.

DEMYELINATING DISEASE

Demyelinating disease are characterized by breakdown of myelin in CNS only and are supposed to be secondary to an autoimmune or viral etiology. Three types are known:

FRIEDREICH ATAXIA

Friedreich atxia, the commonest of the spinocerebellar degenerations, usually has autosomal recessive inheritance.

HEPATOLENTICULAR DEGENERATION (WILSON DISEASE)

Hepatolenticular degeneration, an autosomal recessive disorder of copper metabolism, is characterized by triad of cirrhosis, neurologic manifestations and Kayser-Fleischer rings. Hepatomegaly, due to excessive accumulation of copper, is the earliest manifestation.

METACHROMATIC LEUKODYSTROPHY

Metachromatic leukodystrophy, the commonest of the leukodystrophies, is an autososmal disorders due to deficiency of aryl sulfatase A in brain and other tissue.

KINKY HAIR (MENKES) DISEASE

Kinky hair disease, a sex- linked recessive disorder of copper metabolism, is characterized by poor weight gain, proneness to infection and , latter, hair becoming sparse and brittle, and myoclonic seizures.

RETT SYNDROME

Rett syndrome, occurring exclusively in females, is characterized by regression of motor milestones and language after 1 year of age, ataxic gait or fine tremors of hands,

SUBACUTE SCLEROSING PANENCEPAHILITIS(SSPE)

SSPE manifests, on an average, 7 years after the primary infection with measles. The peak incidence occurs at 7 to 15 years though it has been reported in the subjects aged 6 months to 30 years.

CAVERNOUS SINUS THROMBOSIS

This uncommon condition occurs as a complication of a septic focus over face, orbit, nose, teeth etc. The infection spreads from facial veins to ophthalmic vein and finally to the cavernous sinus. Intracranial extension may be accompanied by meningitis.

SPASMUS NUTANS

This disorder of unknown etiology is characterized by rhythmic jerking movements of head in the form of intermittent head nodding, usually in the lateral or horizontal direction, together with intermittent rapid pendular nystagmus.

SUBDURAL EFFUSION IN PEDIATRICS

Subdural effusion usually occurs in infants as a complication of pyogenic meningitis. The usual site is frontal or parietal region.