Approximately 70% of mortality in patients with schizophrenia is caused by coronary heart disease. This is because patients with schizophrenia often have high rates of cigarette smoking, obesity, diabetes mellitus and hyperlipidaemia, with the added factors of poor diet and lack of physical activity.Although tobacco-related respiratory disease is an important co-morbidity in schizophrenia patients as 85% of this population smoke cigarettes, with 40% of those smoking more than 30 cigarettes per day, it is not a common cause of mortality.Cancer is not a major cause of mortality in this population, despite high-risk lifestyles.Suicide is a major cause of mortality in the early years after diagnosis with schizophrenia, as are accidents. Approximately 10% of this population die by suicide, but cardiovascular disease has a much bigger burden on mortality rates.Dementia praecox ( ‘praecox’ – Latin – pertaining to early maturity) is a synonym for schizophrenia. People may die with the condition of schizophrenia, but as a result of this condition.

This patient has diabetes and hypertension and has now developed an anterior circulation ischemic stroke. Stroke is one of the leading causes of death in Canada and causes significant functional impairment in survivors. Functional status is defined as the ability of the individual to perform normal activities of daily living which are essential to meet basic needs and to maintain the well-being of the patient. Functional impairment is also a consequence of a critical illness and has a tremendous impact on the quality of life. Assessment of functional status can analyze the patient’s capacity to perform activities of daily living. It has prognostic outcomes as patients with poor functional status have a guarded prognosis. Numerous scales have been devised to assess patients’ ability to perform various activities. Some of the notable ones include NYHA (used in heart failure), Rankin scale and the Barthel index. The Barthel activity of daily living index is used to analyze patients’ activities of daily living including the ability to feed, groom, toilet, transfer, urinary and fecal incontinence. The score is rated up to 100 with points for each activity and higher scores are associated with a better prognosis. The international prognostic index is incorrect. It is a tool useful in assessing prognosis in patients with non-Hodgkin’s lymphoma. Patients with a guarded prognosis or high relapse risk are identified, based on the involvement of the bone marrow, central nervous system, liver, testis, lung, and spleen. The Lumosity performance index is incorrect. It is a standardized performance metric that shows how well you are performing on Lumosity games and is not appropriate to assess patients with a stroke. Nottingham’s prognostic index is incorrect. It is a prognostic scale for postoperative breast cancer patients. As this patient does not have any malignancy, it cannot be used. The Oswestry disability index is incorrect. It is a scale used to quantify disability caused by low back pain. In the absence of any back pain, it is an unlikely possibility. Key point: Prognostic scales used in patients with stroke include the Rankin scale and the Barthel index. The Barthel activity of daily living index is a commonly used scale that helps the clinician assess the patient’s ability to feed, bathe, groom, and perform activities of daily living. The scale is rated up to 100 and higher values are predictive of a better functional outcome.

Based on the presenting history and clinical examination, this may be the case of encephalitis. To distinguish between encephalitis and meningitis, the cerebral function is accessed. There is an alteration of normal cerebral function in encephalitis, while it remains normal in meningitis. In this case, since the patient has significant alteration of cerebral function mainly changes in personality and behavioral changes, suspicion for encephalitis is high. Encephalitis is inflammation of the brain. The severity can be variable with symptoms including reduced or alteration in consciousness, headache, fever, confusion, a stiff neck, and vomiting. Complications may include seizures, hallucinations, trouble speaking, memory problems, and problems with hearing.- Cerebral function would not be affected in aseptic meningitis.- A brain abscess presents with headaches and/or neck stiffness. – As there is no history of drug or alcohol use, the suspicion for an overdose remains low. However, it certainly should be excluded in every patient.- Given the patient’s age, lack of previous medical history and presenting history, the suspicion of a cerebrovascular accident remains low.

Obstructive sleep apnea (OSA) is characterized by episodes of a complete (apnea) or partial collapse (hypopnea) of the upper airway with an associated decrease in oxygen saturation or arousal from sleep. This disturbance results in fragmented, nonrestorative sleep. Other symptoms include loud, disruptive snoring, witnessed apneas during sleep, and excessive daytime sleepiness.Pharyngeal narrowing and closure during sleep is a complex phenomenon, and likely multiple factors play a role in the pathogenesis. Sleep-related reduced ventilatory drive and neuromuscular combined with anatomic risk factors are likely to play a significant role in upper airway obstruction during sleep.The anatomic factors that promote pharyngeal narrowing include large neck circumference, soft tissue, bone, or vessels. Many of these structures can lead to increased surrounding pressure of the upper airway resulting in pharyngeal collapsibility and/or insufficient space to accommodate the airflow in a portion of the upper airway during sleep.In addition, the upper airway muscle tone plays a role as when it decreases, a repetitive total or partial airway collapse results. The most common cause of OSA in adults is obesity, male sex, and advancing age. The severity of OSA decreases with age when adjusting for BMI.Anatomic Factors:- Micrognathia, retrognathia- Facial elongation- Mandibular hypoplasia- Adenoid and tonsillar hypertrophy- Inferior displacement of the hyoidNonanatomic Risk Factors:- Central fat distribution- Obesity- Advanced age- Male gender- Supine sleeping position- PregnancyAdditional Factors:- Alcohol use- Smoking- Use of sedatives and hypnoticsAssociated Medical Disorders:- Endocrine disorders (e.g., diabetes mellitus, metabolic syndrome, acromegaly, and hypothyroidism)- Neurological disorders (e.g., stroke, spinal cord injury, and myasthenia gravis)- Prader Willi syndrome- Down Syndrome- Congestive heart failure- Atrial fibrillation- Obesity hypoventilation syndrome (OHS)

Herpes genitalis can be caused by the herpes simplex virus type 1 or type 2 and manifests as either a primary or recurrent infection. Most commonly, viral replication occurs in epithelial tissue and establishes dormancy in sensory neurons, reactivating periodically as localized recurrent lesions. It remains one of the most common sexually transmitted infections (STI) but continues to be underestimated, given the vague presentation of its symptoms. In addition to providing the reader with basic knowledge of the pathogen and clinical presentation of herpes genitalis, this review article discusses important aspects of the laboratory diagnostics, antiviral therapy, and prophylaxis.Laboratory studies of HSV may include scrapings from suspected lesions (Tzanck smear). The diagnostic cell in a Tzanck smear is the multinucleated giant cell, an epithelial cell containing numerous nuclei, nuclear molding (clustered nuclei fitted to each other’s shapes), and viral inclusions that give the nuclei a homogeneous, glassy appearance.

Sitagliptin is a dipeptidyl peptidase 4 inhibitor. It acts by decreasing inactivation of incretin hormones and therefore increases insulin release and reduces glucagon levels.Reducing the absorption of glucose in the gastrointestinal tract is the mechanism of action of SGLT1/SGLT2 (sodium-glucose linked transporter) inhibitors.Reduction of insulin resistance in the liver is achieved by Thiazolidinediones eg pioglitazone.Increased skeletal muscle glucose uptake and decrease insulin resistance at the skeletal muscle is the mechanism of action of SGLT2Is.Sitagliptin a DPP-4 inhibitors inhibit glucagon release. So the option saying it increases glucagon levels is incorrect.

Down syndrome, caused by trisomy on chromosome 21 is the most common cause of intellectual disability and gives rise to multiple complications, which form part of the syndrome. Congenital heart disease is the leading cause of mortality and morbidity in the first two years of life in patients with Down syndrome.Seeking a cardiologist review is the best option due to the grade 2-3 systolic ejection murmur. Recurrent chest infections are commonly seen due to the cardiac abnormality. A skin test-PPD is done for patients suspected to have TB. The patient is not immunocompromised, hence no need to have an immunologic test as the recurrent pneumonia is a result of cardiac disease. cystic fibrosis is not the major cause of the recurrent chest infections, therefore, a sweat chloride determination is unnecessary.

• Benign Paroxysmal Positional Vertigo (BPPV) is caused by calcium carbonate particles called otoliths.• 95% of the otoliths enter the posterior semicircular canal, while 5% are located in the horizontal semicircular canal.• The Epley maneuver is effective in treating BPPV, but 30% recur within a year.• Surgical care should be considered for recurrent cases, with options including labyrinthectomy, posterior canal occlusion, vestibular nerve section, and singular neurectomy.• The most highly recommended is posterior canal occlusion which has 95% success rate and is easier to perform.

The assessment of the breastfed infant includes an evaluation of its voiding and elimination patterns| feeding routines| jaundice| and, most importantly, weight. Furthermore, breastfeeding frequency and duration are variable and infant-dependent. This patient’s infant does not show any signs of insufficient milk intake. Therefore, when milk production and infant growth are satisfactory, feedings should be continued on demand, without any intervention.Solid food is a wrong option because it should be introduced around six months of age.Initiation of supplementation with infant formula is recommended in cases where the mother’s milk supply is limited, when the infant has lost weight, shows signs of dehydration or when stool output is abnormal. However, none of which can be seen in the index patient’s infant.Pacifier use does not generally interfere with the maintenance of breastfeeding.Switch to milk expression with a breast pump and bottle feeding is not necessary. In general, when milk production and/or infant development are not satisfactory, increasing breastfeeding frequency should be the first intervention.

– Patient almost certainly has sarcoidosis – Diagnosis supported by compatible clinical and radiographic presentation, and histologic evidence of noncaseating granulomas on biopsy – In Löfgren syndrome, probable diagnosis of sarcoidosis can be made without biopsy – In all other cases, biopsy should be performed on most accessible organ, such as skin or peripheral lymph nodes – Thorax is most common site of disease, but skin involvement occurs in at least 30% of patients – Cutaneous sarcoidosis presents as single foci or crops, and is often attributed to other causes – Careful skin examination is warranted because biopsy of a sarcoidal lesion has a high diagnostic yield

The most likely diagnosis in this case is Conn’s syndrome. This is suggested by her history of hypertension unresponsive to calcium channel blockers, her current clinical presentation of nausea and vomiting, and her laboratory tests which indicate hypokalemia and hypernatremia (possible hyperaldosteronism).Conn’s syndrome (primary aldosteronism) is a condition caused by the overproduction of aldosterone. It is one of the most common causes of secondary hypertension. It commonly presents as hypertension and its complications, weakness, abdominal distention, and an ileus caused by hypokalemia.Liver cirrhosis can present as abdominal distension, vomiting, portal hypertension, ascites and hypokalemia. However, the patient description in this case does not indicate risk factors of liver cirrhosis. Also, primary aldosteronism is far more common than secondary aldosteronism.Cushing’s syndrome can also present as hypertension, hypokalemia and extremely high levels of cortisol, but there would be other findings upon physical examination such as facial plethora, hirsutism, buffalo hump, etc.Pheochromocytoma presents as episodes of severe hypertension caused by catecholamine secretion, with 3 other classic symptoms which are diaphoresis, palpitations, and headaches. It may be associated with multiple endocrine neoplasia type II. Hypernatremia and hypokalemia more often present in cases of elevated aldosterone secretion than with increased catecholamine secretions.→ Addison’s disease is a condition caused by adrenal insufficiency and would cause opposite symptoms to those described in this case, including hypotension, hyponatremia, and hyperkalemia.Key point: Conn’s syndrome refers to hyperaldosteronism which is associated with hypertension, hypernatremia, and hypokalemia.

Based on the cause of this patient’s ascites and the severity at presentation, the most appropriate initial treatment is paracentesis. Albumin should also be supplemented to avoid serum albumin depletion.Ascites is the abnormal buildup of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity, although volumes greater than one liter may occur. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Complications can include spontaneous bacterial peritonitis.- Salt restriction and spironolactone would not be appropriate in the treatment of this patient as exudative ascites generally does not respond to manipulation of the salt balance or diuretic therapy. – As this is the underlying cause of his ascites, antibiotics, especially anti-TB drugs, should be part of the management of this patient. However, since the patient has presented with severe ascites, this should be addressed first with large volume paracentesis.- Transjugular intrahepatic portosystemic shunt is done in cirrhosis patients with recurrent ascites awaiting liver transplantation.

The brain’s ability to survive in chronic hyponatremia can make it vulnerable to injury if the hyponatremia is corrected too quickly. Osmotic demyelination syndrome can be prevented by limiting the correction of chronic hyponatremia to no more than 10-12 mmol/L in 24 hours and 18 mmol/L in 48 hours.

The most probable diagnosis is Non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease (NAFLD) is a broad term used to cover a spectrum of conditions that are characterized by evidence of hepatic steatosis on imaging or histology (macrovesicular steatosis), and absence of secondary causes of hepatic steatosis such as significant alcohol consumption, chronic use of medications that can cause hepatic steatosis or hereditary disorders.Non-alcoholic fatty liver disease (NAFLD) incidence is rapidly increasing, especially in western countries. Rising obesity levels, increasing incidence of childhood obesity, sedentary lifestyles, consumption of unhealthy quick eats, and a longer lifespan are some of the likely contributors. The incidence and prevalence of NAFLD are underestimated as ultrasonography is commonly used to screen for fatty liver disease. The prevalence of NAFLD is 80% to 90% in obese adults, 30% to 50% in patients with diabetes mellitus, 90% or more in patients with hyperlipidemia, 3 to 10% in children, and as high as 40% to 70% among obese children.Mildly elevated serum aminotransferases are the primary abnormality in non-alcoholic fatty liver disease (NAFLD), although the liver enzymes are normal in the majority of patients. The ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) is less than 1. Gamma-glutamyl transferase (GGT), when elevated in non-alcoholic fatty liver disease (NAFLD), can be a marker of increased mortality. With the progression of the disease hypoalbuminemia, hyperbilirubinemia, thrombocytopenia, and prolonged prothrombin time present due to hepatic synthetic dysfunction.Ultrasound of the abdomen is routinely used to evaluate fatty liver, but a liver biopsy is considered the gold standard for the diagnosis of NAFLD. A non-invasive clinical scoring system called NAFLD in metabolic syndrome (MS) score was developed to predict the development of NAFLD in patients with metabolic syndrome. The clinical predictors included are BMI greater than or equal to 25, AST/ALT greater than or equal to 1, type 2 diabetes mellitus, and obesity. The positive likelihood ratio of developing NAFLD is 2.32 (low when the score is less than 3), and the risk is 7.77 (high when the five or more). Some of the other scoring systems are NAFLD fibrosis score (NFS), FIB-4 (fibrosis-4) index, original ELF (enhanced liver fibrosis) test, AST-to-platelet ratio index (APRI), AAR, fibrometer, NAFLD-MS score.

Henoch-Schönlein purpura is a vasculitis involving the small vessels of the joints, kidneys, gastrointestinal tract, and skin. Henoch-Schönlein purpura can also involve the central nervous system (CNS) and the lungs| however, these findings are rare. It is an acute immunoglobulin A (IgA) mediated disorder that is typically self-limited and managed with supportive care| however, serious complications, such as renal failure, may occur as a result of the disorder.The classic presentation of Henoch-Schönlein purpura includes palpable purpura, gastrointestinal complaints, arthralgias, and renal involvement. Patients may present with rash, joint pain, abdominal pain, vomiting, subcutaneous edema, rectal bleeding, scrotal edema, headache, fever, diarrhea, hematemesis and fatigue.Skin involvement is present in all patients with Henoch-Schönlein purpura. The rash associated with Henoch Schönlein purpura is non-pruritic, and it is characterized by palpable purpura and petechiae that most commonly affect the buttocks and lower extremities – particularly the extensor surfaces. Approximately one-third of patients experience the rash in the upper extremities and trunk. The lesions have the potential to become bullous or necrotic. The lesions change from red to purple and then become rust-colored before they fade. These changes occur over approximately ten days.GI findings may occur before the rash in 10% to 40% of patients. Patients may present with nausea and vomiting that is worse after meals. Potential life-threatening complications include intussusception, bowel perforation, bowel gangrene, and massive hemorrhage. Intussusception is the most common life-threatening gastrointestinal complication, affecting 3% to 4% of patients with Henoch Schönlein purpura.Renal symptoms typically occur within 1 to 3 months after the rash in 20% to 55% of children with Henoch-Schönlein purpura. Renal manifestations include hematuria, proteinuria, nephrotic syndrome, nephritic syndrome, and renal failure. The most common renal manifestation is microscopic hematuria. Severe proteinuria may present as nephrotic syndrome, and patients with persistent proteinuria are at high risk of developing progressive glomerulonephritis. Patients may also develop ureteric obstructions. Approximately 50% of patients develop renal manifestations, with less than 1% progressing to end-stage renal failure. Death from Henoch-Schönlein purpura is rare| however, renal disease is the most common cause of death in patients with the disorder.Approximately 15% of patients with Henoch-Schönlein purpura present with arthritis as the initial symptom, and overall arthralgia or arthritis occurs in 75% of children with the disorder. Patients often present with painful swollen joints that most commonly involve the knees, ankles, hands, and feet. The arthralgias are typically transient and non-destructive.Central nervous system involvement is rare| however, when present, patients may present with headaches, dizziness, ataxia, seizures, irritability, mononeuropathy, intracranial hemorrhage, or acute motor-sensory axonal neuropathy.

Urethral syndrome is a condition characterized by dysuria and pyuria in the absence of a positive culture for uropathogens. It is usually caused by Chlamydia trachomatis, Ureaplasma urealyticum, or Mycoplasma species. Effective treatments include doxycycline, ofloxacin, levofloxacin, and macrolides such as erythromycin and azithromycin. Amoxicillin, cephalexin, metronidazole, and pyridium are not recommended for treating this condition.

Cauda equina syndrome (CES) is caused by compression or irritation of the roots of the lumbosacral nerve below the conus medullaris (below the L2 level) and by narrowing the space in the vertebral artery below L2. It is usually caused by a herniated disc with or without spinal stenosis, vertebral fracture, and tumor. Symptoms are usually intense and affect all three types of neurons (human, sensory, and autonomic). Symptoms of lower extremities include weakness/paraparesis and decreased deep tendon reflexes (patellar and/or ankle). Nerve involvement includes low back pain that radiates to the legs, loss of consciousness or pain, and sedative (S2-S5). Patients may also have urinary retention and/or fecal insufficiency due to loss of anal sphincter tone.The patient exhibits low back pain and shooting pain in his legs. This is most often seen in patients with disc herniation and/or spinal stenosis. However, when a patient has symptoms of sedative, urinary retention, and/or decreased anal sphincter tone, CES is the most likely diagnosis.CES is caused by compression or irritation of the lumbosacral nerve roots below the conus medullaris (below the L2 level) and by narrowing of the space in the vertebral artery below the L2. In the choices listed, the reduced tone of the anal sphincter is seen as a late introduction to CES (choice D). Prompt examination and decompression of the affected area are necessary to preserve the intestines, bladder, and sexual function and to prevent the possible progression of paraplegia.→ Blindness due to retinal detachment is not an observed diagnosis in patients with CES. Retinal detachment is seen in patients with diabetic retinopathy, retinal vein occlusion, sickle cell disease, and age-related macular degeneration.→ Maturity of cerebellar tones is seen in Chiari type I malformation of the brain.→ Pulmonary embolism is seen in patients with a history of inability to walk due to prolonged walking, prolonged hospital stay, and recent surgery| PE can also be detected by the use of an expanded oral contraceptive pill (OCP) for women.→ Spinal epidural hematoma may be a rare cause of CES, but not a late diagnosis.Key point:Cauda equina syndrome is caused by compression or irritation of the lumbosacral nerve roots below the conus medullaris (below the L2 level) and a narrowing of the space in the vertebral artery below the L2. The reduced tone of the anal sphincter appears to be a late introduction to this condition.

Sensitivity is the ability of surveillance to detect the health problem that it is intended to detect. It is the percentage of patients with a disease who have a positive test for the disease. – Ratios refers to the clinical impression of how well a test rules in or rules out a given disease.- Specificity is the percentage of patients without the disease who have a negative test. – The positive predictive value is the percentage of patients with a positive or abnormal test who have the disease. – The negative predictive value is the percentage of patients with a negative or normal test who do not have the disease.

The correct answer is no intervention except periodic monitoring of maternal platelet counts.Her most probable diagnosis is gestational thrombocytopenia. Gestational thrombocytopenia typically presents as an asymptomatic patient with a platelet count between 70,000/mm3 and 150,000/mm3, no previous history of bleeding or preconception history of thrombocytopenia, normal first-trimester or preconception platelet counts, and a platelet count that goes back to normal 2-12 weeks postpartum.No interventions are necessary, but periodic monitoring of maternal platelet count is required.

The guidelines for colon cancer screening is recommended for patients aged 50 – 80. A single fecal occult blood test (FOBT) is an inadequate screening method as it has low sensitivity, resulting in high rates of false-negative and false-positives. The recommendations for colon cancer screening and detection include an annual six-sample FOBT (two samples taken from three different bowel movements).If any of the six samples return positive for occult blood, a colonoscopy is recommended for diagnosis due to possibilities of a false-negative.

Hemochromatosis is a disorder associated with deposits of excess iron that causes multiple organ dysfunction. Normally, iron absorption is tightly regulated because the body is incapable of excreting excess iron. Hemochromatosis occurs when there are high pathologic levels of iron accumulation in the body. Hemochromatosis has been called “bronze diabetes” due to the discoloration of the skin and associated disease of the pancreas. Hereditary hemochromatosis is the most common autosomal recessive disorder in whites. Secondary hemochromatosis occurs because of erythropoiesis disorders and treatment of the diseases with blood transfusions. After the damage of transfused red blood cells by macrophages, iron freed from heme is accumulated in the body.Clinical signs of the condition depend on the organ system that is affected the most. Patients usually are asymptomatic until adulthood, and often a diagnosis will not be made until multiple systems are affected. Symptoms are related to the organ affected, but almost all patients complain of severe fatigue. Patients are typically symptomatic for up to ten years before diagnosis. A high index of suspicion, combined with a thorough family history, is required to diagnose this condition.Women with hemochromatosis become symptomatic later in life than men due to the blood loss and consequent iron excretion associated with regular menstruation.

Lithium is used to treat acute mania, bipolar affective disorder and prophylaxis of bipolar disorder. One side effect of lithium is hypothyroidism due to decreased tyrosine iodination and thyroxine synthesis. Patients taking lithium should get yearly TSH and total free thyroid hormone levels. Donepezil, Lisinopril, Alendronate and Glyburide do not cause hypothyroidism.

A progesterone only contraceptive implant would be the best method for her as there is no estrogen, so no increased risk of a thromboembolic event.It is important to take her age and lifestyle into account.She is a smoker over the age of 35, meaning the use of contraceptive pills will increase her risk of myocardial infarction, stroke and death.She complains of heavy and painful menses, so an IUD is contraindicated as it can increase the intensity and flow of menses.An endometrial ablation can reduce her menorrhagia, but will not have contraceptive effects.A hysterectomy will prevent pregnancy, but is not indicated as a method of contraception.

The correct answer is mice.The most likely diagnosis in this case is Hantavirus pulmonary syndrome.It can be difficult to diagnose due to similar presentations to infections from influenza virus. It is often diagnosed due to high clinical suspicion and recent exposure to mouse droppings. In Canada, the animal carrier of Hantavirus, also known as Nombrevirus, is the deer mouse. In other parts of North and South America, other rodents are carriers. The virus is transmitted through aerosolization of the animal droppings.Management usually includes supportive care with intubation and mechanical ventilation, and diuretic use. The disease maintains a high fatality rate despite adequate care.Bats are usually carriers of the rabies virus.Fleas are the vector for Yersinia pestis.Rabbits are usually a host of Francisella tularensis, a gram negative bacteria that causes tularemia.Ticks are associated with transmission of many diseases including Lyme disease and Rocky mountain spotted fever. They are not the host reservoir for Hantavirus.

Syncope is a sudden condition occurring from losing consciousness that results from an insufficient flow of the blood to the brain.Several studies reported that the severe aortic stenosis is considered a primary cause of syncope.It often occurs upon exertion when systemic vasodilation in the presence of a fixed forward stroke volume causes the arterial systolic blood pressure to decline, and might also be caused by atrial or ventricular tachyarrhythmias.

The correct answer is anterior cruciate ligament.A Lachman test involves keeping the knee in flexion at 25°-30° while grasping the distal femur in one hand and the proximal tibia in the other. Keeping the femur stationary, the tibia is then pulled anteriorly with a shucking action. A normal or negative test is one where a distinct end point is reached. A soft or indistinct end point is indicative of a positive or abnormal test. In cases of an anterior cruciate ligament injury, an anterior drawer test would also be positive.

Herpes genitalis can be caused by the herpes simplex virus type 1 or type 2 and manifests as either a primary or recurrent infection. Most commonly, viral replication occurs in epithelial tissue and establishes dormancy in sensory neurons, reactivating periodically as localized recurrent lesions. It remains one of the most common sexually transmitted infections (STI) but continues to be underestimated, given the vague presentation of its symptoms. In addition to providing the reader with basic knowledge of the pathogen and clinical presentation of herpes genitalis, this review article discusses important aspects of the laboratory diagnostics, antiviral therapy, and prophylaxis.Genital symptoms are commonly seen in the outpatient primary care setting, despite many going without a clear diagnosis. HSV-2, in particular, may present as a primary infection with painful genital ulcers, sores, crusts, tender lymphadenopathy, and dysuria. The classical features are of macular or papular skin and mucous membrane lesions progressing to vesicles and pustules that often last for up to 3 weeks. Genital lesions can be especially painful, leading to swelling of the vulva in women, burning pain, and dysuria.It is important to note that HSV-2 does not typically present with painless ulcers. Systemic symptoms can occur to include fever, headache, and malaise and are often due to concurrent viremia, which has been reported in up to 24% of patients in one study.

Capgras syndrome or delusion of doubles happens when a person holds a delusion that a spouse, a friend, parent or other close family member have been replaced by a double or an identical-looking impostor.Fregoli delusion is a delusional belief that various people are in actuality a single person who disguises himself or herself.Paranoid delusion is when a person believes wrongly that they are being persecuted.Mirrored self-misidentification is the delusional belief that one’s reflection in a mirror is someone else (often believed to be someone who is following them around). People with this delusion usually have no other delusions.Folie a deux or Induced Delusional Disorder (ICD-10), happens when symptoms of a delusional belief is passed from one individual to another individual. It is commonly seen when two or more individuals concerned live in proximity and may be socially or physically isolated with little interaction with others.

Pityriasis rosea begins in with a primary lesion called the “herald patch,” 50%-90% of patients. The primary lesion is a scaly, oval patch a few centimetres in diameter and followed a few days later with emergence of scaly, erythematous patches on the trunk along skin cleavage planes. These lesions are usually asymptomatic with only mild itching and are rarely seen on proximal extremities. Psoriasis is distinguished by an erythematous rash with macules and plaques covered in silvery scales.The rash of secondary syphilis is seen 1-2 months after the primary lesion (chancre). It appears usually as a maculopapular eruption, erythematous macules, or circular papules that take many forms. It is widespread and also involve the palms and soles.Tinea corporis appears as erythematous scaly patches with raised borders, with occasional papules and pustules.Lichen planus usually appears suddenly, is characterized by intensely pruritic lesions on the flexural surfaces of the limbs often described as small, polygonal, flat-topped, shiny, violet papules resolving into hyperpigmented macules, and often associated with a low-grade fever. It is commonest in middle-aged women.

Tetralogy of Fallot is a congenital heart defect that can cause severe cyanosis. During increased activity such as crying or having a bowel movement, the patient may turn a dark blue color, known as a hypercyanotic episode or “tet spell”. Treatment of this condition involves relieving obstruction and increasing systemic resistance, and may require rapid intervention with oxygen, morphine, intravenous propranolol, and systemic vasoconstriction (e.g., squatting, knee-chest position, vasoconstrictor drugs) to reverse the cyanosis. If left untreated, tetralogy of Fallot can lead to progressive right ventricular hypertrophy due to the increased resistance on the right ventricle, and can be life-threatening. Emergency management of tet spells should be known.