2025 - Page 30 of 31 - Dr Chaitanya Joshi, MD

Pneumonia and chest infections MCQ FOr 2025 : NHPC, NNC, MEC and NMC

Pneumonia and respiratory infection illness

~~Table of Contents (toc)~~

DEFINITION:

chest anatomy

Pneumonia is an infection of the pulmonary parenchyma

How to get covid card

Factors that predispose to pneumonia

Cigarette smoking
Upper respiratory tract infections
Alcohol
Corticosteroid therapy
Old age
Recent influenza infection
Pre-existing lung disease
HIV
Indoor air pollution

Classification: setting in which the person has contracted their infection

Community-acquired pneumonia (CAP) definition :

It occurs outside hospital setting or less than 48 hours after admission

Hospital-acquired pneumonia (HAP):

Hospital-acquired or nosocomial pneumonia refers to a new episode of pneumonia occurring at least 2 days after admission to hospital.

Contd…

Health care-associated pneumonia (HCAP) :

refers to the development of pneumonia in a person who has spent at least 2 days in hospital within the last 90 days, attended a haemodialysis unit, received intravenous antibiotics, or been resident in a nursing home or other long-term care facility.

Immunocompromised host :

Neutropenic, HIV +, Cancer,Mycobacterium tuberculosis, Pneumocystis jiroveci ,Immunosuppressives

Classification by site of pneumonia

Lobar pnemonia :

Infection can be localized with the whole of one or more lobes affected. >90% of the cases is due to Strep.pneumoniae

Interstitial Pneumonia

Inflammation confined to interalveolar septa

Mycoplasma pneumoniae, Pneumocystis jiroveci

Bronchopnemonia:

often due to infection centred on the bronchi and bronchioles

Staphylococcal pneumonia

CLASSIFICATION BY ETIOLOGY

• PRIMARY PNEUMONIA (due to specific pathogenic organism)

Common:

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus

Less common:

Klebsiella pneumoniae, Strep pyogenes, Pseudomonas aeruginosa, Virus: H1N1 Influenza Virus, Corona Virus

ATYPICAL PNEUMONIA)**

**Mycoplasma pneumoniae, Legionella, Chlamydophila, and Coxiella burnetii

2. SECONDARY PNEUMONIA

(absence of any specific pathogenic organism in sputum and presence of some pre-existing abnormality of respiratory system)

Aspiration of pus from nasal sinuses
Vomitus
Aspiration of gastric contents in GERD
Inhalation of septic matter during procedures like dental extraction
Community-acquired pneumonia (CAP)
World-wide, CAP continues to kill more children than any other illness.
Most cases are spread by droplet infection
Strep. pneumoniae remains the most common infecting agent
Viral infections are an important cause of CAP in children

Clinical features of CAP

The clinical presentation varies according to the immune state of the patient and the infecting agent.

Cough: In pneumococcal pneumonia, sputum is characteristically rust-coloured.

Breathlessness: Coarse crackles are often heard on auscultation, Bronchial breath sounds may be heard over areas of consolidated lung.

Fever: this can be as high as 39.5–40°C. If swinging fevers are present this often indicates empyema

Clinical features

Chest pain: this is commonly pleuritic in nature. A pleural rub may be heard early on in the illness.

Extrapulmonary features :

Haemolysis due to cold agglutinins occurs (in approximately 50% cases of Mycoplasma pneumonia). Thrombocytopenia is relatively common.

Other features: in the elderly, CAP can present with confusion or nonspecific symptoms such as recurrent fall.

Initial Assessment

INVESTIGATIONS

CBC and DLC: Leucocytosis suggests bacterial pneumonia. In viral and atypical pneumonias, total leucocyte count is often less 5000/m3.
CRP levels are raised.
Blood culture: Recommended only in hospitalized patients, particularly in case of pneumococcal pneumonia
Respiratory secretions: Do Gram Stain and Ziehl Neelsen Stain. Culture and Sensitivity.
Pulse oximetry and arterial blood gas analysis is necessary if oxygen saturation is below 94%.
HIV testing: since pneumonia is a common initial presenting illness

Investigations for pnneumonia

Chest x-ray

Strep. Pneumoniae : Consolidation with air bronchograms, effusions and collapse can be seen. Radiological abnormalities can lag behind clinical signs.

Repeat a normal chest X-ray where CAP is suspected

Mycoplasma. Usually one lobe is involved but infection

can be bilateral and extensive.

Legionella: There is lobar and then multi-lobar shadowing

Radiological examination is helpful if a complication such as parapneumonic effusion, intrapulmonary abscess formation or empyema is suspected.

General management of pneumonia

Oxygen :Supplemental oxygen should be administered to maintain saturations between 94% and 98%

Intravenous fluids : Required in hypotensive patients

showing any evidence of volume depletion.

Thromboprophylaxis. If admitted for >12 hours

Physiotherapy: Chest physiotherapy is not needed unless sputum retension

Nutritional supplementation:

Analgesics : paracetamol , Non steroidal anti-inflammatory medication helps treat pleuritic pain, thereby reducing the risk of further complication

Management continued

Antibiotics. The first dose of antibiotic should be

administered within 4 hours of presentation

– Parenteral antibiotics should be switched to oral once

the temperature has settled for a period of 24 hours

MANANGEMENT: ANTIBIOTICS

COMPLICATIONS OF PNEUMONIA

Para-pneumonic effusion-common
Empyema
Retention of sputum causing lobar collapse
Development of thromboembolic disease
Pneumothorax-particularly with Staph. aureus
Suppurative pneumonia/lung abscess
ARDS, renal failure, multi-organ failure
Hepatitis, pericarditis, myocarditis, meningoencephalitis

Prevention of further episodes

Smoking cessation advice and support

Influenza vaccination is recommended to those at high risk of mortality from influenza or pneumonia

All patients over the age of 65 who have not previously been vaccinated and are admitted with CAP should have the pneumococcal vaccine before discharge

Pneumonia MCQs

Dr Chaitanya

Most common symptom of the respiratory disease is?

a) Wheeze
b) Cough
c) Fever
d) Hemoptysis

Ans:

B cough

Common sound heard on auscultation in pneumonia is

• Rales
• Ronchi
• Wheeze
• Crackles

crackles

An old man comes to u with complaint of fever for 4 days and cough associated with chills. On examination the patient is in respiratory distress and AND HAS HIGH GRADE FEVER OF 104 DEGREE FAHRENHEIT. The most possible diagnosis is

• COPD
• PTB
• Bronchial asthma
• Pneumonia

Pneumonia

A pus sample is called purulent if

Pneumonia depiction

• Pus cells > 25 and epithelial cells < 10
• Pus cells > 15 and epithelial cells < 5
• Pus cells > 30 and epithelial cells < 10
• Pus cells > 20 and epithelial cells < 5

A. Pus cells > 25 and epithelial cells < 10

A patient who is known case of COPD under medication has complained of increased shortness of breath. He said that he could walk on plane level with his friends easily but now he needs to take break every 100 m or so due to shortness of breath. What is the mMRC grade of SOB for this patient?

6 Difficulty in breathing is called

Dyspnoea
Orthopnoea
Tachypnoea
Apnoea

Dyspnoea

Which organism causes the so called walking pneumonia (Hint: atypical pneumonia)

Streptococcus
Klebsiella
H1n1
SARS-CoV2
Mycoplasma

Mycoplasma

HAP is called if symptoms/diagnosis

Within 2 days of admission
After 48 hours of admission
2 days of admission to 2 days of discharge
If patient admitted to ICU

2 days of admission to 2 days of discharge

Common causative agent for congenital or neonatal oneumonia is

H. influenziae
Chlamydia pneumoniae
Streptococcus pneumoniae
Broup B streptococcus

Gr. B strep

In CURB 65 scoring B stands for

Blood urea nitrogen
Blood count
Blood pressure
Breathing

Blood pressure ( sys<90 or dias <60)

Lung abscess following pneumonia is caused by

Staphylococcus
Streptococcus
Pneumocystis
Coronavirus

Staphylococcus

Antibiotic of choice for CAP in OPD setting is

Amoxycillin
Ciprofloxacin
Metronidazole
Doxycycline

Amoxycillin

Pneumothorax is

Hyperexpansion of lungs
Air in thoracic cavity
No breathing by lungs
Lung mixed with ait

Air in thoracic cavity

Your patient has BP of 130/90 mm of Hg. What is his MAP

What is his pulse pressure in above case

103 and 40

Thank you

Read about COVID-19 here

Thank you for visiting the site.. waiting for your responses.

Mycoplasma pneumonia : The dangerous walking talking pneumonia

~~Table of Contents (toc)~~

Introduction

Mycoplasma pneumonia is a common cause of respiratory tract infections in
adolescents. It can present with fever, cough, and infiltrates on chest X-ray.
In some cases, mycoplasma infection can also cause skin manifestations such as
vesicles or blisters.

Presenting symtoms of mycoplasma pneumonia

The patient is presenting with symptoms suggestive of Mycoplasma pneumonia,
including fever, cough, and infiltrates on chest X-ray. The presence of
vesicles or blisters on the skin further supports the possibility of
Mycoplasma-induced skin manifestations.

57.Following drugs are effective against Mycoplasma pneumoniae except:

a. Clarithromycin

c. Amoxycillin

b. Rifampicin

d. Doxycycline

Ans: ‘c’

Solution

Mycoplasma pneumoniae lacks cell wall. Bacterial membrane contains sterol for stability.

Antimicrobial activity of Amoxycillin is via inhibition of cell wall synthesis which has no role in Mycoplasma.

Penicillin ineffective since mycoplasma have no cell wall.

Treatment (Mycoplasma)

Macrolides

Doxycycline or

Fluoroquinolone

MOA

Macrolides

Clarithromycin

Azithromycion

inhibit protein synthesis by blocking translocation: blinds to 23srRNA of 50s ribosomal subunit

Bacteriostatic

Tetracyclines

Tetracycline

Doxycycline

Bind to 30S & prevent attachment of aminoacyl-t RNA Bacteriostatic

Rifamycin

Rifampin

Inhibit DNA dependent RNA polymerase

Rifabutin

Fluroquinolones

Ciprofloxacin

Norfloxacin

Levofloxacin

Inhibit prokaryotic

enzymes topo isomerase II (DNA gyrase) & topoisomerase IV.

FAQs:

1. Can Mycoplasma pneumonia cause skin manifestations?

Yes, in some cases, Mycoplasma pneumonia can cause skin manifestations such as
vesicles or blisters.

2. How is Mycoplasma pneumonia diagnosed?

Mycoplasma pneumonia can be diagnosed through serological testing for
Mycoplasma antibodies or PCR testing for Mycoplasma DNA in respiratory
samples.

3. What is the treatment for Mycoplasma pneumonia?

The treatment for Mycoplasma pneumonia involves the use of antibiotics such as
macrolides or tetracyclines.

4. Is Mycoplasma pneumonia contagious?

Yes, Mycoplasma pneumonia is contagious and can spread through respiratory
droplets.

5. Can Mycoplasma pneumonia cause complications?

Yes, Mycoplasma pneumonia can lead to complications such as pneumonia,
bronchitis, or ear infections.

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How to read chest X ray a systematic approach guide for everyone 2025

How to read chest X ray : a systematic approach guide for everyone

How to read chest X ray

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Step-by-Step Guide: How to Read a Chest X-Ray

1. Prepare for the Interpretation

Understand the Context:
- Know the patient’s clinical history (e.g., symptoms, past medical history, and reason for the X-ray).
- Ensure you have the correct patient’s X-ray.
Positioning:
- Confirm the X-ray is in the correct orientation: the patient’s left side is typically on your right.

2. Check the Technical Quality of the X-Ray

P: Position:
- Confirm if it’s an anteroposterior (AP) or posteroanterior (PA) view.
- Lateral view may also be provided.
I: Inspiration:
- Count visible ribs: 6 anterior or 10 posterior ribs above the diaphragm indicate adequate inspiration.
R: Rotation:
- Check if the spinous processes are equidistant from the medial ends of the clavicles.
P: Penetration:
- A good X-ray allows you to see the vertebrae behind the heart faintly.

3. Systematically Analyze the X-Ray

Follow an organized approach to ensure you don’t miss anything:

A: Airways

Check for tracheal deviation or narrowing.
Ensure the carina and bronchi are in their normal positions.

B: Bones and Soft Tissues

Inspect ribs, clavicles, scapulae, and spine for fractures or deformities.
Evaluate soft tissues for masses, swelling, or air (e.g., subcutaneous emphysema).

C: Cardiac Silhouette

Assess the size and shape of the heart.
- Cardiothoracic ratio: Heart should occupy less than 50% of the thoracic width on a PA view.
Look for abnormal contours indicating conditions like cardiomegaly or pericardial effusion.

D: Diaphragm

Check the position and shape.
- The right hemidiaphragm is normally higher than the left due to the liver.
- Look for free air under the diaphragm (indicative of perforation).

E: Effusion and Pleura

Inspect for pleural effusion, thickening, or pneumothorax.
Effusions typically show a blunting of costophrenic angles.

F: Fields (Lungs)

Examine lung fields for opacities, consolidations, nodules, or masses.
Look for interstitial markings, which may indicate fibrosis, edema, or infection.
Compare the left and right lungs for symmetry.

G: Gastric Bubble

A normal gastric bubble is visible below the left hemidiaphragm.
Absence or displacement can indicate abnormality.

H: Hilar Structures

Assess for lymphadenopathy, enlargement, or masses.
Evaluate vascular markings for signs of pulmonary hypertension or congestion.

4. Correlate Findings with Clinical Context

Connect radiological findings with the patient’s symptoms and clinical history.
Example:
- Consolidation with air bronchograms: Pneumonia.
- Blunted costophrenic angles: Pleural effusion.
- Hyperinflation with flattened diaphragms: COPD.

5. Summarize the Findings

Formulate a concise and clear report:
- Mention any abnormal findings.
- Include observations about lung fields, heart size, diaphragm, and pleura.
- Suggest differential diagnoses if abnormalities are found.

6. Seek Expert Opinion if Needed

If unclear or complex findings are observed, consult a radiologist or experienced physician.

Tips for Effective Interpretation

Practice a consistent approach to avoid missing subtle findings.
Compare with previous X-rays if available for changes over time.
Be aware of common artifacts (e.g., ECG leads, clothing, or foreign bodies).

This methodical guide ensures thorough and accurate chest X-ray interpretation!

How to read chest X ray

Urinary tract infections and calculus UTI and renal stones (nepphrolithiasis), bladder stones 2025

Urinary tract infections and calculus UTI and renal stones (nepphrolithiasis), bladder stones

~~Table of contents (toc)~~

Introduction to UTI

A urinary tract infection (UTI) is an infection in any part of the urinary system, which includes the kidneys, ureters, bladder, and urethra. Most infections involve the lower urinary tract, specifically the bladder and urethra. UTIs are typically caused by bacteria, most commonly Escherichia coli (E. coli), that enter the urinary tract through the urethra and begin to multiply in the bladder.

Symptoms of uti

Symptoms of a UTI can include a strong, persistent urge to urinate, a burning sensation when urinating, passing frequent, small amounts of urine, urine that appears cloudy, or urine that has a strong odor. If the infection spreads to the kidneys, it can cause more severe symptoms, including fever, back pain, and nausea.

Treatment of UTI

UTIs are more common in women than in men, and they can usually be treated effectively with antibiotics.

Introduction to Nephrolithiasis

Nephrolithiasis, commonly known as kidney stones, refers to the formation of hard mineral and salt deposits in the kidneys. These stones can vary in size and may develop when urine becomes concentrated, allowing minerals to crystallize and stick together.

Symptoms of kidney stones

Kidney stones can cause severe pain when they pass through the urinary tract. Symptoms may include intense pain in the back or side, pain during urination, blood in the urine, and sometimes nausea and vomiting. The pain often starts suddenly and may come in waves as the stone moves.

Type of kidney stones

The main types of kidney stones include calcium stones (the most common type), struvite stones (which can form after a urinary tract infection), uric acid stones, and cystine stones (which are rare and usually occur in people with a genetic disorder).

Treatment of kidney stones

Treatment for nephrolithiasis depends on the size and type of stone. Smaller stones may pass on their own with increased fluid intake and pain management, while larger stones may require medical intervention, such as extracorporeal shock wave lithotripsy (ESWL) to break the stone into smaller pieces, or surgical removal. Preventative measures often include dietary adjustments and medications to reduce the risk of recurrence.

See the complete powerpoint presentation here.

See UTI and Dysuria Home remedy here

Female urethra dilation: things you should know before you meet your urologist in 2025

Introduction of urethral dilation in female: 30 causes of painful intercourse

~~Table of Contents(toc)~~

female genitourinary system

Urethra dilation is a delicate medical procedure done underanesthesis by a urologist or urosurgeon. The procedure is done after careful evaluation and by well trained professionals. Before going deeper into female urethra dilation lets review anatomy of female urethra in brief.

Urethral structure if pathological narrowing of urethra due to different reasons leading to difficulty passing urine and various other symptoms and consequences.

Anatomy of female urethra

Female urethra is tubular musculocutaneous organelle situation in genital region of female that connects bladder to the outer world. The urethra carries urine from bladder to the outside. The flow of urine from bladder is controlled by two valves viz. Internal and external urethral valves. The internal urethral valve is controlled by autonomic nervous system while external is under voluntary control. The overall length of fenale urethra is 4 centimetres or 1.5 inches.

(Source: Textbook of anatomy 7e, Moore et al. )

Female urinary system anatomy

Indications of urethral dilation : an introduction

Stricture
Trauma
Prostate problems
Adhesion
Mass effect
Pelvic organs prolapse

(Source: Uptodate.com)

Sex after female urethra dilation

Sexual intercourse after female urrthra dilatation may become difficult rarely. Difficult or painful sexual intercourse is called dysparaunia and it may have several other causes including vaginal infection, dry vagina and many more listed as below.

Read this also: Vitamin D and role of kidney in it

Causes of painful sexual intercourse

Painful sexual intercourse or dyspareunia can be because of external genital problems to internal vaginal, uterine or pelvic disorders. Urethra also being near vagina can be the reason for dyspareunia where as other nearby organs and structures can also be part of it. It is also called genitopelvic pain. The causes of painful intercourse can be listed as below:

Vulvovaginal atrophy
Endometriosis
Physical assault
Sexual assaults
Emotional and mental trauma
Abuse
Gastrointestinal causes
Constipation
Vulvar skin atrophy
Vulvar cancer
Lichen
Condyloma, HPV
Fibromyalgia
Musculoskeletal
Vulvodynia
Vaginismus
Vestibulodynia
Vulvitis
Vaginitis
Adenomyosis
Uterine fibroids
PID /infection
Pelvic adhesive disease
Ovarian mass
Diabetes
Thyroid disorders
Vitamin deficiency
Hormone imbalance (estrogen, progesterone)
Cancers

(Source: Medscape.com)

Anatomy of female urinary system

Extreme female urethra dilation

The flow of urine from bladder is controlled by two valves viz. Internal and external urethral valves. The internal urethral valve is controlled by autonomic nervous system while external is under voluntary control.

Extreme female urethra dikagyrefers to dilating urethra above the normal anatomical diameter as expected of that age.

This will be done in case of following indications

Severe structure
Recurring stricture
Severe trauma
Bladder infections
Prostate problems
Uncured symptoms despite previous procedure
Risk of need for repeated procedure
Co-morbidities

When to visit a doctor after urethra dilation?

Left kidney sketch

Female sexual dysfunction/disorders list

Female sexual interest disorder
Female sexual arousal disorder
Female sexual pain disorder
Female sexual penetrative disorder
Female orgasmic disorder

Aseptic Meningitis (Viral Meningitis) definition, diagnosis and treatment in 2025

Lecture on Aseptic Meningitis (Viral Meningitis) lecture 2025

~~Table of contents (toc)~~

Aseptic Meningitis (Viral Meningitis)

Definition of aseptic meningitis:

Aseptic meningitis is a clinical term for an illness comprising meningeal
irritation, fever, and alterations in consciousness of relatively acute
onset.

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The clinical course is less fulminant than in pyogenic
meningitis.
In contrast to pyogenic meningitis, examination of the CSF often shows
lymphocytosis, moderate protein elevation, and a normal glucose
level.
The disease typically is self-limiting

Causes and causative agents of viral meningitis

Viruses:

Arboviral (mosquito-borne) diseases
Influenza
LaCrosse Encephalitis virus
West Nile Virus

Common; Usually clears up in 1-2 weeks with no specific treatment

Rarely serious infection of fluid in the spinal cord or fluid that surrounds
the brain

Also called aseptic meningitis

Read otitis ecterna here

Signs and symptoms of aseptic meningitis:

Usually occur one week after exposure
Fever
Headache
Stiff neck
Tiredness
Sore Throat
Vomiting
Photophobia

Treatment and prevention of aseptic meningitis:

No specific treatment for viral meningitis
Antibiotics do not work on viruses.
Pay careful attention to personal hygiene.
Good hand-washing helps prevent spread of infection and viruses.

Danger Signs of Meningitis

The danger signs of meningitis (in both children and adults) include:

General Danger Signs:

High fever (often sudden onset)
Severe headache
Neck stiffness (difficulty bending the neck forward)
Photophobia (sensitivity to light)
Altered mental status (confusion, drowsiness, difficulty waking up)
Seizures
Nausea and vomiting
Cold hands and feet, limb pain, pale or mottled skin (signs of septicemia)

In Infants & Young Children:

Bulging fontanelle (soft spot on the head)
Poor feeding or refusing to eat
High-pitched or weak cry
Lethargy or extreme irritability
Floppy body or stiffness

Signs of Meningococcal Septicemia (Emergency):

Petechial or purpuric rash (non-blanching, red/purple spots)
Rapid breathing or respiratory distress
Shock (low blood pressure, weak pulse, altered consciousness)

⚠️ Seek immediate medical attention if any of these signs are present! Meningitis can rapidly progress to life-threatening complications.

To see the full powerpoint presentation click here

Wallace rule of 9: Shock and Burn ppt For NHPC, NNC, NMC and MEC 2025

Shock and Burn Powerpoint PPT : Loksewa, NMCLE, NNC, NHPC and MDMS MEC

~~Table of Contents(toc)~~

Introduction

Fire accidents are common type of injuries that happen in world daily basis.

Shock is a clinical condition that results due to inadequate tissue perfusion.

A critical condition brought on by the sudden drop in blood flow through the body.

May result from trauma, heatstroke, blood loss, an allergic reaction, severe infection, poisoning, severe burns or other causes.

Occurs when the metabolic needs of cells are not met because of inadequate blood flow.

These two topics are very common in emergency managent and should be well taught to medical students, graduates and paramedics.

Signs and symptoms

Cool, clammy skin
Pale or ashen skin
Bluish tinge to lips or fingernails (or gray in the case of dark complexions)
Rapid pulse
Rapid breathing
Nausea or vomiting
Enlarged pupils
Weakness or fatigue
Dizziness or fainting

Changes in mental status or behavior, such as anxiousness or agitation

Burn with Fire

Types of Shock

Hypovolemic Shock
Cardiogenic Shock
Neurogenic Shock
Anaphylatic Shock
Septic Shock

Introduction to BURN

Burns are tissue damage that results from heat, overexposure to the sun or other radiation, or chemical or electrical contact.

Wound with destruction of tissue due to coagulation necrosis.

Causes of burn

Thermal burn/heat burn: dry heat
Scald: moist heat
Electric burn: electricity
Cold burn: frost bite
Chemical burn: strong acid and alkali
Radiation burn: X-rays, Gamma rays

Degree of Burn Classification and grading

First degree – superficial thickness
Second degree – Partial or intermediate thickenss
Third degree – Full thickness
Fourth degree

Management of burn

Remove burning source immediately.
Wrap the patient in a cloth and roll him in the floor.
Immerse 10-15 minutes in water or cool down the burnt part in running water for 15 minutes
Give liquids orally. Provide analgesics and antibiotics.
Do not rupture blister.
TT injection
First-degree burns:

Run cool water over the burn. Don’t apply ice. For sunburns, apply aloe vera gel. For thermal burns, apply antibiotic cream and cover lightly with gauze. You can also take over-the-counter pain medication.

Second-degree burns:

Treatment for second- and first-degree burns is similar.

Stronger antibiotic – such as silver sulfadiazine, to kill bacteria
Elevating the burned area can reduce pain and swelling.
May need dressing to be applied
Third-degree burns:

Third-degree burns can be life-threatening and often require skin grafts. Skin grafts replace damaged tissue with healthy skin from another of the uninjured part of the person’s body.

Wallace Rule of Nine

The Wallace Rule of Nines is a method used to estimate the total body surface area (TBSA) affected by burns. It divides the body into sections, each representing approximately 9% (or multiples thereof) of the total body surface area. The distribution is slightly different for adults and children due to differences in body proportions.

Wallace Rule of Nines for Adults:

Head and Neck: 9%
Each Arm: 9% (4.5% front, 4.5% back)
Each Leg: 18% (9% front, 9% back)
Anterior Torso (Chest and Abdomen): 18%
Posterior Torso (Back and Buttocks): 18%
Perineum/Genitalia: 1%

Wallace Rule of Nines for Children:

Head and Neck: 18% (larger proportion due to the relatively larger head size in children)
Each Arm: 9% (4.5% front, 4.5% back)
Each Leg: 14% (7% front, 7% back; less than in adults because legs are relatively shorter)
Anterior Torso (Chest and Abdomen): 18%
Posterior Torso (Back and Buttocks): 18%
Perineum/Genitalia: 1%

These percentages are used to help us quickly estimate the extent of burns and its severity, which is critical for determining the severity of the injury and guiding treatment decisions, such as fluid resuscitation and transfer to a specialized burn center.

Parkland Formula:

The Parkland formula, also known as the Baxter formula, is used to calculate the amount of fluid required for resuscitation in burn patients within the first 24 hours after injury. The formula is based on the patient’s weight and the total body surface area (TBSA) burned.

Total fluid requirement:

$4 mL \times body weight (kg) \times % TBSA burned$

Administration:

First 8 hours: Administer half of the total fluid requirement.
Next 16 hours: Administer the remaining half.

Example for an Adult:

If an adult weighs 70 kg and has 30% TBSA burns:

Total fluid requirement: $4 \times 70 \times 30 = 8, 400 mL$
First 8 hours: $8, 400/2 = 4, 200 mL$
Next 16 hours: $4, 200 mL$

The Parkland formula provides an initial guideline for fluid resuscitation, but ongoing assessment and adjustments based on the patient’s clinical response (urine output, vital signs, etc.) are critical for effective management.

OTHER CONCEPTs on bubrn management

Patient may require IV antibiotics for infection prevention/control
If oral intake not possible IV fluids till oral can be started
Topical antibiotics
Vaseline gauze
Scar prevention
Contracture prevention/compartment syndrome
Deformity prevention
Scar prevention
Alkali burn is more dangerous than acid burn- deep burn in alkali
Electrolyte imbalance, fluid status and vitals and end organ monitoring in severe burns
Rhabdomyolysis
CO poisoning

UPPER AIRWAY BURNS AND UGI BURNS

Speciality vare needed
To prevent long term disability and management of complications
Do not try to neutralize acid with base or vice versa
Warer is the best method to contro

SPECIAL POPULATION

>10% BSA in <10 & >50 yrs
>20% BSA
Face, genitalia, major joints
Electrical/Chemical burns
Inhalational injury
Co-morbid diseases/injuries
Children with special needs

Shock and Burn PPT

Thank you for reading.

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Nausea or vomiting
Enlarged pupils
Weakness or fatigue
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Septic Shock”
}
},{
“@type”: “Question”,
“name”: “What are causes of Burn?”,
“acceptedAnswer”: {
“@type”: “Answer”,
“text”: “Thermal burn/heat burn: dry heat
Scald: moist heat
Electric burn: electricity
Cold burn: frost bite
Chemical burn: strong acid and alkali
Radiation burn: X-rays, Gamma rays”
}
},{
“@type”: “Question”,
“name”: “What is clasification of burn?”,
“acceptedAnswer”: {
“@type”: “Answer”,
“text”: “First degree – superficial thickness
Second degree – Partial or intermediate thickenss
Third degree – Full thickness
Fourth degree”
}
},{
“@type”: “Question”,
“name”: “What is Management of burn?”,
“acceptedAnswer”: {
“@type”: “Answer”,
“text”: “Remove burning source immediately.
Wrap the patient in a cloth and roll him in the floor.
Immerse 10-15 minutes in water or cool down the burnt part in running water for 15 minutes
Give liquids orally. Provide analgesics and antibiotics.
Do not rupture blister.
TT injection
First-degree burns:
Run cool water over the burn. Don’t apply ice. For sunburns, apply aloe vera gel. For thermal burns, apply antibiotic cream and cover lightly with gauze. You can also take over-the-counter pain medication.
Second-degree burns:
Treatment for second- and first-degree burns is similar.
Stronger antibiotic – such as silver sulfadiazine, to kill bacteria
Elevating the burned area can reduce pain and swelling.
May need dressing to be applied
Third-degree burns:
Third-degree burns can be life-threatening and often require skin grafts. Skin grafts replace damaged tissue with healthy skin from another of the uninjured part of the person’s body.”
}
}]
}

Disulfiram like Reaction Easy Mnemonics (Disulfiram-like Reaction) nhpc nmc mec

Disulfiram like Reaction (disulfiram-like reaction) Mnemonics

~~Table of Contents(toc)~~

Introduction

You can use any of the below mnemonics to remember Disulfiram like Reaction (disulfiram-like reaction).

Disulfiram is a drug commonly used to treat alcohol abude and dependance in outpatient and inpatient settings.

capsules disulfiram

How does disulfiram reaction occur?

The disulfiram reaction occurs when disulfiram inhibits the enzyme aldehyde dehydrogenase, which is responsible for metabolizing acetaldehyde, a toxic intermediate of alcohol metabolism. Normally, alcohol is metabolized in two steps: ethanol is converted into acetaldehyde by alcohol dehydrogenase, and acetaldehyde is further broken down into acetic acid by aldehyde dehydrogenase. Disulfiram blocks the second step, causing acetaldehyde to accumulate in the bloodstream. This accumulation triggers symptoms such as flushing, nausea, vomiting, headache, tachycardia, and hypotension within 10–30 minutes of alcohol ingestion. The severity of symptoms depends on the amount of alcohol consumed and the disulfiram dose.

Alcohol (Ethanol)

↓

(Alcohol Dehydrogenase)

↓

Acetaldehyde

↓

(Inhibited by Disulfiram)

↓

Accumulation of Acetaldehyde

↓

Unpleasant Symptoms (Flushing, Nausea, etc.)

What are disulfiram reaction symptoms and signs?

Disulfiram Reaction Symptoms and Signs:

Flushing of the face
Nausea
Vomiting
Headache
Sweating
Palpitations
Tachycardia (rapid heartbeat)
Hypotension (low blood pressure)
Dizziness
Weakness
Chest pain
Difficulty breathing
Blurred vision
Confusion
Anxiety

Disulfiram UK as Antabuse Agent

Many people want to buy antabuse in UK. They want to terminate their habit of abuse of alcohol and other medications.

Availability of Disulfiram in the UK

Disulfiram, commonly known by the brand name Antabuse, is available in the UK as a prescription-only medication used to support the treatment of chronic alcohol dependence. To obtain disulfiram, you must consult a healthcare professional who can assess your suitability for the medication and provide a prescription if appropriate. It’s important to note that disulfiram is typically prescribed as part of a comprehensive treatment plan, including counseling and support, to enhance its effectiveness in promoting abstinence from alcohol.

Disulfiram Dosing and Formulations According to the BNF

The British National Formulary (BNF) provides guidance on the dosing and formulations of disulfiram. Disulfiram is available in oral tablet form, with a common strength being 200 mg. The usual starting dose for adults is 200 mg daily, which may be increased if necessary, up to a maximum of 500 mg daily, depending on individual response and tolerance. It’s crucial that disulfiram is administered under medical supervision, with regular monitoring to assess efficacy and any potential adverse effects. Patients should be informed about the reactions that can occur if alcohol is consumed while taking disulfiram and advised to avoid all sources of alcohol, including those found in certain foods and medications.

Disulfiram Implants in the UK

Disulfiram implants are an alternative method of delivering the medication, involving the surgical insertion of disulfiram pellets under the skin. This method provides a sustained release of the drug over a period, potentially improving adherence by eliminating the need for daily oral dosing. In the UK, disulfiram implants are not widely available and are considered an off-label treatment option. Some private clinics may offer this service; however, it’s essential to approach such treatments with caution. The efficacy and safety of disulfiram implants are subjects of ongoing research, and they should only be considered after thorough consultation with a qualified healthcare professional who can provide guidance based on current clinical evidence and individual patient circumstances.

For more detailed information on disulfiram, including its dosing, formulations, and considerations regarding implants, consulting the BNF and seeking advice from healthcare providers is recommended.

Continue reading Disulfiram like Reaction Easy Mnemonics (Disulfiram-like Reaction) nhpc nmc mec

N Cell Balance Check: How to do these 7 things with NCell in Nepal 2025?

NCell Services in Nepal: Recharge, Data Packs, Customer Care, and More

Introduction:

Telecommunications services have become an essential part of our daily lives in recent years. NCell is a major player in this sector in Nepal. NCell, a leading telecommunications provider, provides a variety of services such as recharge options, data packs, customer care support, and much more. This article will delve into NCell’s diverse offerings and shed light on how it has emerged as a significant player in Nepal’s telecom industry.

1. NCell Recharge: A Hassle-Free Approach to Stay Connected

Keeping your phone’s credit card charged is critical for uninterrupted communication. NCell provides a simple recharge process, allowing users to recharge their phones via mobile apps, online portals, or retail outlets. We will look at the various recharge options available and how NCell has made the process easier for its customers.

1. Online Recharge:

Most service providers have online portals or mobile apps where you can log in to your account and recharge your NCell. Follow these steps:

Visit the official website or download the mobile app of your N-Cell service provider.

Look for the “Recharge” or “Top-up” section within the app or website.

Choose the amount or plan you want to recharge with.

Provide your payment details, such as credit or debit card information, or use any other available payment method.

Confirm the recharge to complete the process.

2. USSD Code Recharge:

Many service providers offer USSD codes that allow you to recharge your NCell directly from your phone. Here’s how:

Dial the USSD code provided by your NCell service provider. For example, it might be something like *123#.

Follow the on-screen instructions to select the recharge amount or plan.

Provide the necessary information, such as your mobile number and payment details if required.

Confirm the recharge to complete the process.

3. Retailer or Store Recharge:

You can also visit a nearby authorized NCell retailer or store to recharge your phone. Provide them with your mobile number and the amount you wish to recharge with, and they will do the rest.

4. Mobile Wallet Recharge:

If you have a mobile wallet like eSewa, Khalti, or other similar services available in your country, you can use it to recharge your NCell as well. Simply select the “Mobile Recharge” option within the wallet app, choose NCell as the operator, and follow the instructions to complete the recharge.

2. Unveiling the Power of NCell Data Packs

Access to mobile data is essential in today’s increasingly digital world. NCell offers a variety of data packs to meet a variety of needs, from light internet browsing to heavy video streaming. By analyzing the available data packs and their competitive pricing, we can better understand how NCell keeps its users connected to the online world.

Summary of how data packs are purchased on Ncell:

1. Check Available Data Packs:

Dial *17123# or visit the Ncell website to check the available data packs. You will receive a list of different data packs, along with their validity and prices.

2. Choose a Data Pack:

Based on your internet usage needs and budget, select the data pack that suits you best.

3. Recharge Your Account:

Make sure you have sufficient balance in your Ncell account to purchase the data pack. If not, recharge your account using the available top-up options.

4. Purchase the Data Pack:

On Ncell, there are several ways to purchase a data pack:
USSD Code:

Dial the USSD code for the data pack you wish to purchase. For example, you could dial *17123# and then follow the on-screen instructions to select and purchase the desired data pack.

SMS:

Send a specific keyword to a designated number to activate the data pack. For example, you could text “DataPack1GB” to a specific number.
Ncell App:

Download and install the official Ncell mobile app (if available) and use it to purchase data packs directly from your smartphone.
Online:

To purchase data packs from Ncell’s online portal, go to their official website and log in to your account.

5. Confirmation:

After you purchase the data pack, Ncell will send you a confirmation message indicating that the data pack has been activated on your number.

Remember to check the validity and terms of the data pack you choose, as they may vary depending on the pack’s size and cost. Additionally, it’s essential to keep an eye on your data usage to avoid unexpected charges after your data pack’s validity expires.

Always refer to Ncell’s official website or contact their customer support for the most accurate and up-to-date information on data packs and their purchase process.

3. NCell Customer Care:

Customer service is critical to any telecom company’s ability to ensure customer satisfaction and quickly resolve issues. We will look at NCell’s customer service, including the various channels through which customers can get help, their response time, and how they ensure a positive customer experience.

1. Ncell Helpline (Dial 9005 or 9007):

Dial 9005 or 9007 from your Ncell mobile number to speak with a customer care representative directly.

You can inquire about various services, data packs, account information, billing, and other related issues.

2. Ncell Customer Care Email:

You can send an email to care@ncell.axiata.com to contact Ncell’s customer care team.

Make sure to include your mobile number and a detailed description of your query or issue in the email.

3. Ncell Website:

Visit the official Ncell website (www.ncell.axiata.com) and navigate to the “Contact Us” or “Support” section.

There, you may find a web form or live chat option to communicate with their customer care team.

4. Social Media:

Ncell may have active social media accounts on platforms like Facebook and Twitter.

You can send a message or tweet to their official social media accounts for assistance.

5. Ncell Stores and Retailers:

You can visit the nearest Ncell store or an authorized retailer to get help with your queries or issues.

When contacting Ncell’s customer care, ensure that you have your mobile number and any relevant account details readily available for verification purposes. Be clear and concise while explaining your query to receive prompt and accurate assistance.

Please note that customer care contact information and methods may change over time, so it’s always a good idea to check Ncell’s official website for the most current information on how to contact their customer care team.

4. NCell in Nepal:

The presence of NCell in Nepal has had a significant impact on the country’s telecommunications landscape. We will take a closer look at the company’s evolution, from inception to dominance in the market. In addition, we will look at how NCell’s services have aided Nepal’s digital transformation.

5. Understanding Parallel Combination of NCell: A Unique Offering

The advantages of parallel combinations of NCell connections have gained popularity among users. We will look at how this feature works, what benefits it provides, and how users can use it to their advantage.

6. NCell Balance Transfer:

Running out of balance at a critical juncture can be aggravating. Fortunately, NCell users can send balance to friends and family. We will talk about the balance transfer process, its limitations, and how NCell’s customers have embraced it.

Dial the balance transfer code: *17122*<Receiver’s Mobile Number>*<Amount># on your Ncell mobile phone.

Replace <Receiver’s Mobile Number> with the recipient’s Ncell number.

Replace <Amount> with the specific amount you want to transfer (e.g., 10, 20, 50, etc.).

Confirm the transfer by following the instructions provided in the next step.

You will receive a confirmation message once the balance transfer is successful, and the transferred amount will be deducted from your account.

Please keep the following points in mind:

You can only transfer the balance in multiples of the specified amount, which usually begins at Rs. 10.

There may be a service charge for balance transfers, and it is deducted from the sender’s account.

The recipient’s number must be an Ncell prepaid number; you cannot transfer the balance to postpaid numbers or numbers from other telecom operators.

Make sure you have sufficient balance in your account to cover the amount you want to transfer, including any service charges.

7. Buy NCell Pack: The Allure of NCell Services

With a wide range of telecommunication services available, we will examine what differentiates NCell from its competitors. We will look at why customers choose NCell services, from exclusive offers to robust network coverage.

Conclusion:

As Nepal’s telecommunications sector evolves, NCell continues to be a driving force in providing dependable and innovative services to its customers. NCell has established itself as a key player in the industry, offering convenient recharge options and data packs, as well as exceptional customer care support. As we move forward, NCell’s dedication to digital connectivity and customer satisfaction ensures its position as Nepal’s leading telecom provider.

7 tips on How to Get Rid of Acne Scars Without Surgery or Toxic Chemicals?

Introduction of acne

Acne, also known as acne vulgaris is a common skin disease and disorder characterized by muliple lesions in skin. It affects mostly face area but may also affect neck chest and back in severe cases.

Acne contains both inflammatory or noninflammatory lesions spread around that area.

Acne mostly affects ‘pilosebaceous units’ you which is the name for ‘hair follicles’.

Acne affects above mentioned area because these areas contain most of the oil glands.

Pathophysiology of acne scars

Acne scars are generally formed after inflammation due acne bacterial infections.

These infections occur in hair follicles by bacteria named Cutibacterium acnes.

The inflammation can be subsided using steroids or other anti-inflammatory medications.

But this is not our goal in this article. Rather we will deal regarding subsiding inflammation without use of modern medicine and chemical.

We will deal with acne and acne scars in a natural way.

Steps of getting rid of acne scars naturally

You can follow these steps to get rid of acne scars naturally.

Do not get acne:
Yes you didn’t expect this in first but this is what we should do if we never wabt scars.
Read below for details on acne prevention.
Treat acne on time.

Acne, also known as acne vulgaris, is a prevalent skin condition affecting millions worldwide. It is characterized by the appearance of multiple lesions on the skin, which may vary in size, type, and severity. While acne primarily affects the facial area, it can extend to other regions such as the neck, chest, and back, especially in severe cases. The condition can be distressing, not just because of its physical appearance but also due to the discomfort and potential for scarring it causes.

Types of Acne Lesions

Acne lesions can be broadly classified into two types: inflammatory and non-inflammatory. Non-inflammatory lesions include comedones, which are further divided into open (blackheads) and closed (whiteheads) comedones. Inflammatory lesions, on the other hand, encompass papules, pustules, nodules, and cysts, which often lead to redness, swelling, and discomfort in the affected areas.

Why Acne Occurs in Specific Areas

Acne predominantly affects regions rich in oil glands, such as the face, neck, chest, and back. These areas contain what is known as pilosebaceous units, a term used to describe hair follicles and their associated sebaceous (oil) glands. These glands produce sebum, an oily substance that helps lubricate and protect the skin. However, excessive sebum production, combined with dead skin cells and bacterial growth, can clog these follicles, leading to acne.

Understanding Acne Scars

Acne scars are a common aftermath of inflammatory acne. These scars form due to damage to the skin tissue caused by severe inflammation and infections within the hair follicles. The bacteria responsible for this inflammation is called Cutibacterium acnes (previously known as Propionibacterium acnes). When the body attempts to heal these inflamed areas, it produces collagen to repair the damage. If too much or too little collagen is produced, scars can form.

Managing Inflammation in Acne

One of the critical steps in preventing acne scars is managing inflammation effectively. Steroids and other anti-inflammatory medications are often prescribed to reduce redness and swelling. However, some individuals prefer to explore natural methods to address inflammation and prevent scarring.

Natural Ways to Address Acne and Acne Scars

While modern medicine offers numerous solutions, some people opt for natural approaches to manage acne and reduce the risk of scarring. Below are some steps and tips to tackle acne scars naturally:

Prevent Acne from Occurring Prevention is always better than cure. To avoid scars, it is essential to prevent acne in the first place. This involves adopting a skincare routine that includes cleansing, exfoliating, and moisturizing appropriately. Maintaining a healthy diet, managing stress, and staying hydrated can also help keep acne at bay. acne scar treatment
Timely Treatment of Acne If acne does occur, it is crucial to treat it promptly. Delaying treatment increases the risk of severe inflammation, which can lead to scarring. Natural remedies such as tea tree oil, aloe vera, and honey may help reduce mild acne.
Avoid Picking or Popping Pimples Picking or popping pimples can worsen inflammation and lead to permanent scarring. Allowing the skin to heal naturally or seeking professional help is always recommended.
Use Natural Anti-Inflammatory Remedies Natural ingredients such as turmeric (known for its anti-inflammatory properties), green tea, and chamomile can help reduce redness and swelling. These can be applied topically or consumed as part of a balanced diet.
Exfoliate Gently Gentle exfoliation with natural scrubs like oatmeal or sugar can help remove dead skin cells, promoting the growth of new, healthy skin. Over-exfoliation, however, should be avoided as it can irritate the skin.
Hydrate and Protect the Skin Keeping the skin well-hydrated is essential for its overall health. Using natural moisturizers like aloe vera gel or coconut oil can help maintain the skin’s moisture barrier. Additionally, wearing sunscreen protects the skin from harmful UV rays, which can worsen scars.
Apply Natural Scar Remedies Natural ingredients like rosehip oil, vitamin E, and shea butter are known for their scar-healing properties. Regular application can help fade scars over time.

By following these natural steps, you can manage acne and its scars effectively without relying on chemical treatments. Consistency and patience are key, as natural remedies often take time to show noticeable results.