BIOSOFT HELP FILES

The cycle of hair growth is – anagen or growing stage (2-5 yrs), involuting stage or catagen (few days), resting stage or telogen (several months).

1)      Male pattern baldness – receding hairline, thining in the crown and later disappearance of hair, finally horseshoe ring of hair in the head, onset by 30 yrs and fully developed pattern by 60 yrs,

2)      Female pattern baldness – thining of hair all over the scalp, intact hairline, onset premenopausal and fully developed postmenopausally,

3)      Excessive shampooing or blow-drying, wearing pigtails, cornrows, tight hair rollers, traction alopecia,

4)      Emotional and physical stress,

5)      Any severe illness, childbirth – usually 3-4 months after the event,

6)      Telogen Effluvium – (N) metabolic (SLE, lymphoproliferative diseases, chronic liver/renal diseases, hypothyroidism, heavy metal poisoning, drugs like beta blockers, anticoagulants, retinoids, carbamazepine, propylthiouracil, immunizations, IDA) or physiologic stress (febrile illness, major injury, dieting, pregnancy, delivery), 1-6 months later symptoms develop, increase hair fall, decreased hair density, thin and lusterless hair, new short hairs more than the usual number, gentle hair pull give about 4/pull, forced hair pull 10-20/pull (more than 20% of hairs are telogen hairs – those hairs with a white bulb and lack of gelatinous hair sheath), hair loss confined to the scalp, no scarring, no other scalp pathology, no scalp inflammation, Mx – If there is a clear history of precipitating stress then no lab works, but if not then do tests to exclude those diseases shown in ht e metabolic stress group, usually spontaneous remission,

7)      Alopecia areata

8)      Anagen arrest -  (N ) – radiation exposure, chemotherapeutic agents,

9)      Tinea capitis

10)    Drug-induced – anticoagulants, gout medications, cancer chemo, vitamin A, antidepressants

1)      Hair fall in teens or twenties

2)      Hair fall with acne, facial hair and menstrual irregularity

3)      Male pattern baldness in a female

4)      Bald spots appearing in eyebrows, beard

5)      Weight gain, muscle weakness, cold intolerance, fatigue 

(Hughes 2006)

1)      Dietary – foods causing unusual smells like garlic, onion,

2)      Smoker’s breath

3)      Poor oral hygiene

4)      Persistent mouth breathing

5)      Tonsillitis – tonsillar crypts may contain food particles

6)      Acute ulcerative gingivitis

7)      Chronic periodontitis

8)      Infected tooth socket

9)      Pericoronitis

10)    Sinusitis chronic

11)    Bronchiectasis

12)    Lung abscess

13)    Pharyngeal pouch

14)    Esophageal diverticula

15)    Rumination syndrome

1)      Nearsightedness - myopia

2)      Astigmatism – refractive error

3)      Cataract – double or distorted vision, seeing glare or haloes around lights, blurred vision, color vision distorted, recent onset worsening of vision, disturbing brightness

4)      Acute angle closure glaucoma

5)      Corneal edema

This is assessed as follows.  Lie the patient supine and flex the hip to 90*.  Slowly extend the leg until the tightness of the hamstrings is felt.  Now draw an imaginary line through the tibial shaft and another line perpendicular to the femoral shaft.  The angle between these 2 lines is called hamstring popliteal angle

1)      Carpal tunnel syndrome

2)      De Quervain’s disease

3)      Acute/chronic paronychia

4)      Candidal intertrigo

5)      Myofascial pain syndrome - palm and finger pain in dorsal interossei MFPS, thumb pain in adductor and opponens pollicis MFPS, dorsum of hand pain spreading from anterior shoulder to the posterior aspect of arm upto the dorsum of hand in coracobrachialis MFPS, dorsum of hand pain spreading to forearm in extensor carpi ulnaris MFPS, medial 3 fingers pain apreading to the palm in flexor digitorum superficialis and profundus MFPS, thumb pain palmar in flexor pollicis longus MFPS, hand pain starting from the shoulder and wpreading down the arm in nfrapsinatus MFPS, palmar pain spreading up the anterior forearm in palmaris longus MFPS, medial hand palmar aspect pain starting from the shoulder and spreading to anterior chest wall and spreading down the inner arm and forearm in pec minor MFPS, medial hand palmar aspect pain starting from posterior chest wall and lateral chest wall spreading down the inner arm, inner forearm, medial hand and 2 medial fingers in serratus anterior MFPS, medial fingers pain starting from posterior chest wall and lateral chest wall spreading down the inner arm and forearm, hand to the medial 2 fingers in serratus anterior MFPS, lateral palm, medial 3 fingers starting from anterior chest wall pain in infraclavicular area spreading down anterior arm and lateral forarm in subclavius MFPS, firt web space dorsumof hand in supinator MFPS.  See notes under myofascial pain syndrome for diagnostic criteria and therapy.

6)     Superficial and deep palmar infections

1)      Pain following a fall on an outstretched arm (fractures around the wrist)

2)      Acute onset carpal tunnel syndrome clinical picture (? fracture)

3)      Risk factors for coronary artery disease and exertional

4)      Hand pain in extension of an ischemic chest pain

1)      Concussion – blunt trauma to the head,