Conjunctivitis occurring in the first 28 days of life (Ophthalmia neonatorum) is most commonly caused by Chlamydia trachomatis in the UK.

Lesions in different areas give rise to different symptoms. Lesions of the parietal lobe give rise to loss of two-point discrimination. Lesions to Broca’s area give rise to expressive dysphasia results from damage Lesions to the primary motor cortex give rise to contralateral weakness of the face and arm. Lesions to the prefrontal cortex give rise to personality change. Lesions to the frontal eye field give rise to conjugate eye deviation towards side of lesion.

Overdosing on calcium-channel blockers should always be taken seriously and regarded as potentially fatal. Verapamil and diltiazem are the two most lethal calcium channel blockers in overdose. These work by binding the alpha-1 subunit of L-type calcium channels, preventing calcium from entering the cell. In cardiac myocytes, vascular smooth muscle cells, and islet beta-cells, these channels play an important role.>10 tablets of verapamil (160 mg or 240 mg immediate or sustained-release capsules) or diltiazem can cause serious toxicity (180 mg, 240 mg or 360 mg immediate or sustained-release capsules)In children, 1-2 tablets of verapamil or diltiazem (immediate or sustained-release)Symptoms usually appear within 1-2 hours of ingestion with standard preparations. However, with slow-release preparations, significant toxicity may take 12-16 hours to manifest, with peak effects occurring after 24 hours.The following are the main clinical features of calcium-channel blocker overdose:Nausea and vomitingHypotensionBradycardia and first-degree heart blockMyocardial ischaemia and strokeRenal failurePulmonary oedemaHyperglycaemiaThe following are some of the most important bedside investigations to conduct:Blood glucoseECGArterial blood gasOther investigations that can be helpful includeUrea & electrolytesChest X-ray (pulmonary oedema)Echocardiography

Hyperkalaemia causes a rapid reduction in resting membrane potential leading to increased cardiac depolarisation and muscle excitability. This in turn results in ECG changes which can rapidly progress to ventricular fibrillation or asystole. Very distinctive ECG changes that progressively change as the K+level increases:K+>5.5 mmol/l – peaked T waves (usually earliest sign of hyperkalaemia), repolarisation abnormalitiesK+>6.5 mmol/l – P waves widen and flatten, PR segment lengthens, P waves eventually disappearK+>7.0 mmol/l – Prolonged QRS interval and bizarre QRS morphology, conduction blocks (bundle branch blocks, fascicular blocks), sinus bradycardia or slow AF, development of a sine wave appearance (a pre-terminal rhythm)K+>9.0 mmol/l – Cardiac arrest due to asystole, VF or PEA with a bizarre, wide complex rhythm.

The current UK childhood immunisation schedule is as follows:8 weeks:DTaP/IPV(polio)/Hib/Hep B (diptheria, tetanus, pertussis, polio,Haemophilus influenzatype b and hepatitis B) – 6-in-one injection (Infranix hexa);plus:Rotavirus gastroenteritis (Rotarix) – oral route (drops)Meningitis B (Bexsero)12 weeks:DTaP/IPV(polio)/Hib/Hep B – 2nddose: 6-in-one injection, 2nddose (Infranix hexa);plus:PCV (pneumococcal conjugate vaccine) – in a separate injection (Prevenar 13)Rotavirus gastroenteritis 2nddose (Rotarix) – oral route (drops)16 weeks:DTaP/IPV(polio)/Hib/Hep B – 3rddose: 6-in-one injection, 3rddose (Infranix hexa);plus:Meningitis B 2nddose (Bexsero)Between 12 and 13 months:Hib/Men C (combined as one injection) – 4th dose of Hib and 1stdose of Meningitis C (Menitorix);plus:MMR (measles, mumps and rubella) – combined as one injection (Priorix or M-M-RVAXPRO);plus:PCV (pneumococcal conjugate vaccine) – 2nddose in a separate injection (Prevenar 13);plus:Meningitis B 3rddose (Bexsero)From 2 to end of primary school:Nasal flu spray (Fluenz Tetra). For children aged 2,3 and 4, this is usually given in the GP surgery. Children in school years 1,2 and 3 may have this at school.3 years and 4 months:Pre-school booster of DTaP/IPV (polio) – 4-in-one injection (Repevax or Infanrix-IPV);plus:MMR – 2nd dose (Priorix or M-M-RVAXPRO) – in a separate injectionBetween 12 and 13 years:HPV (human papilloma virus types 6,11, 16 and 18) –twoinjections of Gardasil given. The second injection is given 6-24 months after the first one.14 years:Td/IPV (polio) booster – 3-in-one injection (Revaxis)Men ACWY: combined protection against meningitis A, C, W and Y (Nimenrix or Menveo)The BCG vaccination against tuberculosis is only offered to neonates in high-risk areas or with high-risk backgrounds. When required it is usually given before leaving the hospital soon after birth.

The coracobrachialis muscle is innervated by the musculocutaneous nerve (C5-C7) a branch of the lateral cord of the brachial plexus.

In skeletal muscle, blood flow is closely related to metabolic rate. Due to the contraction of precapillary sphincters, most capillaries are blocked off from the rest of the circulation at rest and are not perfused. This causes an increase in vascular tone and vessel constriction. As metabolic activity rises, this develops redundancy in the system, allowing it to cope with greater demand. During exercise, metabolic hyperaemia, which is induced by the release of K+, CO2, and adenosine, recruits capillaries. Sympathetic vasoconstriction in the active muscles is overridden by this. Simultaneously, blood flow in non-working muscles is restricted, preserving cardiac output. During exercise, muscle contractions pump blood through the venous system, raising the pressure differential between arterioles and venules and boosting blood flow via capillaries.Capillary angiogenesis is evident when muscles are used repeatedly (e.g. endurance training). It is a long-term effect, not a quick fix for increased blood flow.The local partial pressure of alveolar oxygen is the primary intrinsic control of pulmonary blood flow (pAO2). Low pAO2 promotes arteriole vasoconstriction and vice versa. The hypoxic pulmonary vasoconstriction (HPV) reflex allows blood flow to be diverted away from poorly ventilated alveoli and towards well-ventilated alveoli in order to maximize gaseous exchange.

Common side effects include diarrhoea, dizziness, headache, nausea and vomiting.Other adverse effects include: Tendon damage (including rupture), Seizures (in patients with and without epilepsy), QT-interval prolongation, Photosensitivity and Antibiotic-associated colitis

The NICE guidelines for men with lower UTIs are:1. Prescribe an antibiotic immediately, taking into account the previous urine culture and susceptibility results or avoiding antibiotics used previously that may have caused resistance 2. Obtain a midstream urine sample before starting antibiotics and send for urine culture and susceptibility – Review the choice of antibiotic when the results are available AND- change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not improving, using a narrow-spectrum antibiotic wherever possibleThe first choice of antibiotics for men with lower UTIs is:1. Trimethoprim200 mg PO BD for seven days2. Nitrofurantoin100 mg modified-release PO BD for 3 days – if eGFR >45 ml/minuteIn men whose symptoms have not responded to a first-choice antibiotic, alternative diagnoses (such as acute pyelonephritis or acute prostatitis) should be considered. Second-choice antibiotics should be based on recent culture and susceptibility results.

Blood transfusion can be a life-saving treatment with significant clinical benefits, but it also comes with a number of risks and potential complications, including:Immunological side effectsErrors in administration (episodes of ‘wrong blood’)Viruses and Infections (bacterial, viral, possibly prion)ImmunodilutionA culture of better safety procedures as well as steps to reduce the use of transfusion has emerged as a result of growing awareness of avoidable risk and improved reporting systems. Transfusion errors, on the other hand, continue to occur, and some serious adverse reactions go unreported.Transfusion-associated graft-vs-host disease (TA-GVHD) is a rare blood transfusion complication that causes fever, rash, and diarrhoea 1-4 weeks after the transfusion. Pancytopenia and liver function abnormalities are common laboratory findings.TA-GVHD, unlike GVHD following allogeneic marrow transplantation, causes profound marrow aplasia with a mortality rate of >90%. Survival is uncommon, with death occurring within 1-3 weeks of the onset of symptoms.Because of immunodeficiency, severe immunosuppression, or shared HLA antigens, viable T lymphocytes in blood components are transfused, engraft, and react against the recipient’s tissues, and the recipient is unable to reject the donor lymphocytes.The following is a list of the most common transfusion reactions and complications:1) Reaction to a febrile transfusionThe temperature rises by one degree from the baseline. Chills and malaise are also possible symptoms.The most common response (1 in 8 transfusions).Cytokines from leukocytes in transfused red cell or platelet components are usually to blame.Only supportive. The use of paracetamol is beneficial.2) Acute haemolytic reaction is a type of haemolytic reaction that occurs when theFever, chills, pain at the transfusion site, nausea, vomiting, and dark urine are all symptoms of a transfusion reaction.Early on, many people report a sense of ‘impending doom.’The most serious reaction. ABO incompatibility is frequently caused by a clerical error.STOP THE TRANSFUSION OF INFORMATION. IV fluids should be given. It’s possible that diuretics will be required.3) Haemolytic reaction that is delayedIt usually happens 4 to 8 days after a blood transfusion.Fever, anaemia, jaundice, and haemoglobinuria are all symptoms that the patient has.Positive Coombs test for direct antiglobulin.Because of the low titre antibody, it is difficult to detect in a cross-match, and it is unable to cause lysis at the time of transfusion.The majority of delayed haemolytic reactions are harmless and do not require treatment.Anaemia and renal function should be monitored and treated as needed.4) Reaction to allergensForeign plasma proteins are usually to blame, but anti-IgA could also be to blame.Urticaria, pruritus, and hives are typical allergic reactions. It’s possible that it’s linked to laryngeal oedema or bronchospasm.Anaphylaxis is a rare occurrence.Antihistamines can be used to treat allergic reactions symptomatically. It is not necessary to stop transfusions.If the patient develops anaphylaxis, the transfusion should be stopped and the patient should be given adrenaline and treated according to the ALS protocol.5) TRALI (Transfusion Related Acute Lung Injury)Within 6 hours of transfusion, there was a sudden onset of non-cardiogenic pulmonary oedema.It’s linked to the presence of antibodies to recipient leukocyte antigens in the donor blood.The most common cause of death from transfusion reactions is this.STOP THE TRANSFUSION OF INFORMATION. Oxygen should be given to the patient. Around 75% of patients will require aggressive respiratory support.The use of diuretics should be avoided.6) TACO (Transfusion Associated Circulatory Overload)Acute or worsening respiratory distress within 6 hours of a large blood transfusion. Fluid overload and pulmonary and peripheral oedema can be seen. Rapid blood pressure rises are common. BNP is usually 1.5 times higher than it was before the transfusion. It is most common in the elderly and those who have chronic anaemia.Blood transfusions should be given slowly, over the course of 3-4 hours.