DR ABBAS IQBAL

[ Case # 6 ]
✓ SCABIES (50% of patients in skin opd)

On Examination:
1) Lesions will be multiple and can involve any part of the body especially look for Inter digital region & pelvic region involvement. .

2) Lesion may be primary (white burrows having scratch mark or infected (red pustular type rash)

Questions to be asked to make Dx...
1) itching will increase at night
2) other family members will also be having same problem.

Dx : Scabies

Rx : 1) Permethrin lotion (Scabrid/scabion/salicare plus/ scabfree) on 0-7-14th night each time after taking bath, dry ur skin, apply at night & take bath next morning

2) Tab/syp Lorin Nsa/ Rigix (oD for 10 days)
3) if infected then add Fudic H Cream/mupir ointment on delicate parts (BD)
+ syp Ampiclox 250mg/5ml TDs for children/ cap Ampiclox 500mg TDS for adults for 5 days.

4) In resistant scabies(more than 2 attacks+ ask about if proper protocol was followed or not for scabies Rx) or in Norwegian scabies (Pustular/crusted and severe type)

Add
5) Ivermectine(tab ivermite 6mg)
{dose adjustment according to weight}

[ Case # 5 ]
Female from Madyan

Hx of prolonged cold exposure (Rain + wet socks)

On Examination : colour changes (peripheral cyanosis), Cold on touch, numbness

Pathophysiology : Extreme vasoconstriction leads to peripheral cyanosis leading to ischemia and death of tissue.

Dx: Frost bite ( stage 4)

Rx : Reversal of vasoconstriction to vasodilation.
✓ if tissue is viable then send on conservative managment like CCB's (Nifidipine) + Pain killers
(Soaking into warm water upto 40*C for 20 to 30 mins & see if colour changes reverses or not.)

✓ If not viable then send for surgical opinion to check for viability of tissue or amputation etc.

[ Case # 3 ]
Hx of fever & malaise & then
Multiple crops of rash in different stages + mucosal involvement...

Dx : Chicken pox/ Varicella