I.

URTICARIA

Hives Urticaria Hives are raised, often itchy, red welts on the surface of the skin. It is a skin reaction characterized by pale, slightly elevated swellings (wheals) surrounded by an area of redness with clearly defined borders They are usually an allergic reaction to food or medicine. Causes, incidence, and risk factors When you have an allergic reaction to a substance, your body releases histamine and other chemicals into your bloodstream. This causes itching, swelling, and other symptoms. Hives are a common reaction, especially in people with other allergies such as hay fever. When swelling or welts occur around the face, especially the lips and eyes, it is called angioedema. Swelling from angioedema can also occur around your hands, feet, and throat. Many substances can trigger hives, including:

Animal dander (especially cats) Insect bites Medications (eg, penicillins, sulfonamides, salicylates, NSAIDs, codeine, antihistamines) Pollen Shellfish, fish, nuts, eggs, milk, and other foods Exposure to latex Pregnancy (ie, pruritic urticarial papules and plaques of pregnancy [PUPPP])

Hives may also develop as a result of:

Emotional stress Extreme cold or sun exposure

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Excessive perspiration Illness (including lupus, other autoimmune diseases, and leukemia Infections such as mononucleosis

Chronic urticaria can be related to all of the above as well as to the following:
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Autoimmune disorders (SLE, rheumatoid arthritis, polymyositis, thyroid autoimmunity, and other connective tissue diseases); probably up to 50% of chronic urticaria is autoimmune Cholinergic urticaria induced by emotional stress, heat, or exercise; examine for other signs of cholinergic stimulation including lacrimation, salivation, and diarrhea. Chronic medical illness, such as hyperthyroidism, amyloidosis, polycythemia vera, malignant neoplasms, lupus, lymphoma, and many others Cold urticaria, cryoglobulinemia, cryofibrinogenemia, or syphilis Inherited autoinflammatory syndromes

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Symptoms

Itching Swelling of the surface of the skin into red- or skin-colored welts (called wheals) with clearly defined edges

The welts may get bigger, spread, and join together to form larger areas of flat, raised skin. They can also change shape, disappear, and reappear within minutes or hours. The welts tend to start suddenly and go away quickly. When you press the center of a red welt, it turns white. This is called blanching.

Complications

Anaphylaxis (a life-threatening, whole-body allergic reaction that causes breathing difficulty) Swelling in the throat can lead to life-threatening airway blockage

II.

ECZEMA

Eczema is a form of dermatitis, or inflammation of the epidermis (the outer layer of the skin). The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes that are characterized by one or more of these symptoms: redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed injuries. Scratching open a healing lesion may result in scarring and may enlarge the rash. The word 'eczema' comes from Greek words, that mean 'to boil over'. Dermatitis comes from the Greek word for skin and both terms refer to exactly the same skin condition. In some languages, dermatitis and "eczema" are synonymous, while in other languages "dermatitis" implies an acute condition and "eczema" a chronic one. The two conditions are often classified together. The term eczema refers to a set of clinical characteristics. Classification of the underlying diseases has been haphazard and unsystematic, with many synonyms used to describe the same condition. A type of eczema may be described by location (e.g., hand eczema), by specific appearance (eczema craquele or discoid), or by possible cause (varicose eczema). Further adding to the confusion, many sources use the term eczema for the most common type of eczema (atopic dermatitis) interchangeably. Common

Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is an allergic disease believed to have a hereditary component and often runs in families whose members also have asthma. Itchy rash is particularly noticeable on head and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are urging doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact dermatitis. It is very common in developed countries, and rising.

Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a detergent, such as sodium lauryl sulfate, for example). Some substances act both as allergen and irritant (wet cement, for example). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable, provided the offending substance can be avoided and its traces removed from ones environment.

Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder.

Seborrhoeic dermatitis or Seborrheic dermatitis ("cradle cap" in infants) is a condition sometimes classified as a form of eczema that is closely related to dandruff. It causes dry or greasy peeling of the scalp, eyebrows, and face, and sometimes trunk. The condition is harmless except in severe cases of cradle cap. In newborns it causes a thick, yellow crusty scalp rash called cradle cap, which seems related to lack of biotin and is often curable.

Less common

Dyshidrosis only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles, thickening, and cracks are accompanied by itching, which gets worse at night. A common type of hand eczema, it worsens in warm weather.

Discoid eczema is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. Cause is unknown, and the condition tends to come and go.

Venous eczema occurs in people with impaired circulation, varicose veins and edema, and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin and itching. The disorder predisposes to leg ulcers.

Dermatitis herpetiformis causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to celiac disease, can often be put into remission with appropriate diet, and tends to get worse at night.

Neurodermatitis (scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularis is a related disorder showing multiple lumps.

Autoeczematization is an eczematous reaction to an infection with parasites, fungi, bacteria or viruses. It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection.

There are also eczemas overlaid by viral infections (e. herpeticum, e. vaccinatum), and eczemas resulting from underlying disease (e.g. lymphoma). Eczemas originating from ingestion of medications, foods, and chemicals, have not yet been clearly systematized. Other rare eczematous disorders exist in addition to those listed here.

III.

PEMPHIGUS

Pemphigus is a rare group of blistering autoimmune diseases that affect the skin and mucous membranes. In pemphigus, autoantibodies form against desmoglein. Desmoglein forms the "glue" that attaches adjacent epidermal cells via attachment points called desmosomes. When autoantibodies attack desmogleins, the cells become separated from each other and the epidermis becomes "unglued", a phenomenon called acantholysis. This causes blisters that slough off and turn into sores. In some cases, these blisters can cover a significant area of the skin. Types There are three types of pemphigus which vary in severity: pemphigus vulgaris, pemphigus foliaceus, and paraneoplastic pemphigus.

Pemphigus Vulgaris (PV) The term "vulgar" means "common," and PV is the most commonly diagnosed form of pemphigus.

Sores and blisters almost always start in the mouth. The blisters can go as far down as the vocal cords, but no further.

The lesions are painful. Sometimes there is the effect that when just touching the skin can cause it to tear.

Although pemphigus vulgaris may occur at any age, it is most common among people between the ages of 40 and 60.

PV does not cause permanent scaring unless there is infection associated with the sore.

Rarely, it is associated with myasthenia gravis.

Pemphigus Foliaceus (PF)

Crusted sores or fragile blisters usually first appear on the face and scalp and later involve the chest and back.In pemphigus foliaceus, blisters and sores do not occur in the mouth.

The blisters are superficial and often itchy, but are not usually as painful as PV.

In PF, disfiguring skin lesions can occur, but the mortality rate from the disease is much lower than in PV. Paraneoplastic Pemphigus (PNP) PNP is the most serious form of pemphigus. Fortunately, it is also the least common.

It occurs most often in someone who has already been diagnosed with a malignancy (cancer).

Sores of the mouth, lips and esophagus are almost always present; and skin lesions of different types occur. PNP can affect the lungs.

In some cases, the diagnosis of the disease will prompt doctors to search for a hidden tumor. In some cases the tumor will be benign and the disease will improve if the tumor is surgically removed.

It is important to know that this condition is rare and looks different than the other forms of pemphigus.

The antibodies in the blood are also different and the difference can be determined by laboratory tests.

IV.

ULTRASOUND

Ultrasound involves the use of high-frequency sound waves to create images of organs and systems within the body. How the Test is Performed
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An ultrasound machine creates images that allow various organs in the body to be examined. The machine sends out high-frequency sound waves, which reflect off body structures. A computer receives these reflected waves and uses them to create a picture. Unlike with an x-ray or CT scan, there is no ionizing radiation exposure with this test. The test is done in the ultrasound or radiology department. You will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the area being examined to help with the transmission of the sound waves. A handheld probe called a transducer is moved over the area being examined. You may be asked to change position so that other areas can be examined. For specific information about ultrasound examinations, please refer to the following topics:

Abdominal ultrasound Breast ultrasound Doppler ultrasound of an arm or a leg Doppler/ultrasound of the heart (echocardiogram) Duplex ultrasound Pregnancy ultrasound Testicle ultrasound Thyroid ultrasound Transvaginal ultrasound Vascular ultrasound

I.

Abdominal ultrasound

Abdominal ultrasound is an imaging procedure used to examine the internal organs of the abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys. The blood vessels that lead to some of these organs can also be looked at with ultrasound. Why the Test is Performed
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Your health care provider may order this test to:

Determine the cause of abdominal pain Determine the cause of kidney infections Diagnose a hernia Diagnose and monitor tumors and cancers Diagnose or treat ascites Learn why there is swelling of an abdominal organ Look for damage after an injury Look for stones in the gallbladder or kidney Look for the cause of abnormal blood tests such as liver function tests or kidney tests Look for the cause of a fever

II.

Doppler ultrasound exam of an arm or leg

This test uses ultrasound to examine the blood flow in the major arteries and veins in the arms and legs. How the Test is Performed The test is done in the ultrasound or radiology department or in a peripheral vascular lab. To examine the veins: A water-soluble gel is placed on a handheld device called a transducer, which directs the high-frequency sound waves to the artery or veins being tested. To examine the arteries: Blood pressure cuffs may be put around different parts of the body, including the thigh, calf, ankle, and different points along the arm. A paste is applied to the skin over the arteries being examined. Images are created as the transducer is moved over each area.
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Why the Test is Performed This test is done as an alternative to arteriography and venography. It may help diagnose:

Arteriosclerosis of the arms or legs Blood clot (deep vein thrombosis) Venous insufficiency

The test may also be used to evaluate injury to the arteries and to monitor arterial reconstruction and bypass grafts. Normal Results A normal result means the blood vessels show no signs of narrowing or closure, and the arteries have normal blood pressure. What Abnormal Results Mean Abnormal results may be due to:

Blockage in an artery by a blood clot, piece of fat, or an air bubble Blood clot in an artery or vein Spastic arterial disease (arterial contractions brought on by cold or emotion) Venous occlusion (closing of vein)

III. Thyroid ultrasound

A thyroid ultrasound is an imaging method used to see the thyroid -- a gland in the neck that regulates metabolism. How the Test is Performed Ultrasound is a painless method that uses sound waves to create images of the inside of the body. The test is usually done in the ultrasound or radiology department. You will lie with your neck extended beyond its usual limit (hyperextended). The ultrasound technician will place a lubricating gel onto your neck. Next, the technician will move a wand, called a transducer, over the area.
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The transducer gives off sound waves. The sound waves go through the body and bounce off the area being studied (in this case, the thyroid gland). A computer looks at the pattern that the sound waves create when bouncing back, and creates an image. Why the Test is Performed A thyroid ultrasound is usually done when you have a growth on your thyroid gland. The exam can help tell the difference between a sac containing fluid (cyst) and abnormal tissue that may or may not be cancerous (a tumor). Normal Results The thyroid is of normal size, shape, and position. What Abnormal Results Mean Abnormal results may be due to:

Cysts Enlargement of the thyroid gland (goiter) Thyroid nodules Tumors

IV.

Transvaginal ultrasound

Transvaginal ultrasound is a type of pelvic ultrasound. It is used to look at a woman's reproductive organs, including the uterus, ovaries, cervix, and vagina. Transvaginal means across or through the vagina. Why the Test is Performed Transvaginal ultrasound may be done for the following problems:

Abnormal findings on a physical exam, such as cysts, fibroid tumors, or other growths Abnormal vaginal bleeding and menstrual problems Certain types of infertility Ectopic pregnancy
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Pelvic pain

Transvaginal ultrasound is also used during pregnancy to:

Evaluate cases of threatened miscarriage Listen to the unborn baby's heartbeat Look at the placenta Look for the cause of bleeding Monitor the growth of the embryo or fetus early in the prgnancy See if the cervix is changing or opening up when labor is starting early

Normal Results The pelvic structures or fetus are normal. Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

V.

EMBOLISM

In medicine, an embolism is the event of lodging of an embolus ("any detached, itinerant intravascular mass (solid, liquid, or gaseous) as carried by circulation and capable of clogging arterial capillary beds at a site distant from its point of origin") into a narrow capillary vessel of an arterial bed which causes a blockage (vascular occlusion) in a distant part of the body. Embolization is a procedure that purposely creates such a lodging and occlusion of specific blood vessels with thrombo-emboli in order to deprive tumors (or other pathologic processes) of their perfusion (blood supply). There are different types of embolism, some of which are listed below. Arterial or venous Embolism can be classified as whether it enters the circulation in arteries or veins. Arterial embolism are those that follow and, if not dissolved on the way, lodge in a more distal part of the systemic circulation. Sometimes, multiple classifications apply; for instance a pulmonary embolism is classified as an arterial embolism as well, [1] in the sense that the clot follows the pulmonary artery carrying deoxygenated blood away from the heart.
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However, pulmonary embolism is generally classified as a form of venous embolism, because the embolus forms in veins, e.g. deep vein thrombosis. Arterial Arterial embolism can cause vessel occlusion in any part of the body. It is a major cause of infarction (which may also be caused by e.g. arterial compression, rupture or pathological vasoconstriction). Arterial embolis may be starting in the heart (from a thrombus in the left atrium secondary to atrial fibrillation or septic emboli from endocarditis). An embolus landing in the brain from either the heart or a carotid artery will likely cause an ischemic stroke. Emboli of cardiac origin are also frequently encountered in clinical practice. Thrombus formation within the atrium in valvular disease occurs mainly in patients with mitral valve disease, and especially in those with mitral valve stenosis with atrial fibrillation (AF). In the absence of AF, pure mitral regurgitation has low incidence of thromboembolism. Absolute risk of emboli in idiopathic AF depends on other risk factors such as increasing age, hypertension, diabetes, recent heart failure, or previous stroke. Thrombus formation can also take place within the ventricles, and it occurs in approximately 30% of anterior-wall myocardial infarctions, compared with only 5% of inferior ones. Some other risk factors are poor ejection fraction (<35%), size of infarct, and the presence of AF. In the first three months after infarction, left-ventricle aneurysms have a 10% risk of embolization. Patients with prosthetic valves also carry a significant increase in risk of thromboembolism. Risk varies, based on the valve type (bioprosthetic or mechanical); the position (mitral or aortic); and the presence of other factors such as AF, left-ventricular dysfunction, and previous emboli. Emboli often have more-serious consequences when they occur in the socalled "end circulation": areas of the body that have no redundant blood supply, such as the brain and heart. The main complication of arterial embolism is infarction, that is, tissue death (necrosis) caused by blockage of the tissue's blood supply. Venous Pulmonary embolism Assuming a normal circulation, a thrombus or other embolus formed in a systemic vein will always impact in the lungs, after passing through the right
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side of the heart. This forms a pulmonary embolism that can be a complication of deep-vein thrombosis. Note that, contrary to popular belief, the most common site of origin of pulmonary emboli are the femoral veins, not the deep veins of the calf. Deep veins of the calf are the most common site of thrombi, not emboli origin. The main complication of venous embolism is pulmonary embolism, that is, blockage of the main artery of the lung or one of its branches. Paradoxical (venous to arterial) In paradoxical embolism, also known as crossed embolism, an embolus from the veins crosses to the arterial blood system. This is generally found only with heart problems such as septal defects (holes in the cardiac septum) between the atria or ventricles. The most common such abnormality is patent foramen ovale, occurring in about 25 % of the adult population, but here the defect functions as a valve which is normally closed, because pressure is slightly higher in the left side of the heart. In certain circumstances, e.g. if patient is coughing just when an embolus is passing, passage to the arterial system may occur. Direction The direction of the embolus can be one of two types:

Anterograde Retrograde

In anterograde embolism, the movement of emboli is in the direction of blood flow. In retrograde embolism, however, the emboli move in opposition to the blood flow direction; this is usually significant only in blood vessels with low pressure (veins) or with emboli of high weight.

VI.

THROMBOSIS

Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss. Alternatively, even when a blood vessel is not injured, blood clots may form in the body if the proper conditions present themselves. If the clotting is too severe and the clot breaks free, the traveling clot is now known as an embolus.
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Thromboembolism is the combination of thrombosis and its main complication, embolism. When a thrombus occupies more than 75% of surface area of the lumen of an artery, blood flow to the tissue supplied is reduced enough to cause symptoms because of decreased oxygen (hypoxia) and accumulation of metabolic products like lactic acid. More than 90% obstruction can result in anoxia, the complete deprivation of oxygen, and infarction, a mode of cell death. Causes In classical terms, thrombosis is caused by abnormalities in one or more of the following (Virchow's triad):

The composition of the blood (hypercoagulability or thrombophilia) Quality of the vessel wall (endothelial cell injury) Nature of the blood flow (stasis, turbulence)

Hypercoagulability Thrombophilia Hypercoagulability is caused by, for example, genetic deficiencies or autoimmune disorders. Endothelial cell injury Causes of injury to the vessel's wall include trauma, surgery, infection or turbulent flow at bifurcations. The main mechanism is exposure of tissue factor to the blood coagulation system. Disturbed blood flow Causes of disturbed blood flow include stagnation of blood flow past the point of injury, or venous stasis which may occur in heart failure or after long periods of sedentary behavior for example, sitting on a long airplane flight. Also, atrial fibrillation, causes stagnant blood in the left atrium (LA) or left atrial appendage (LAA), and can lead to a thromboembolism. Cancers or malignancies such as leukemia may cause increased risk of thrombosis by e.g. external compression on a blood vessel or (more rarely) extension into the vasculature (for example, renal cell cancers extending into the renal veins). Also, treatments for cancer (radiation, chemotherapy) often cause additional hypercoagulability.
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Classification There are two distinct forms of thrombosis, each of which can be presented by several subtypes. Venous thrombosis Venous thrombosis Venous thrombosis is the formation of a thrombus (blood clot) within a vein. There are several diseases which can be classified under this category:
Deep vein thrombosis

Deep vein thrombosis (DVT) is the formation of a blood clot within a deep vein. It most commonly affects leg veins, such as the femoral vein. Three factors are important in the formation of a blood clot within a deep vein these are the rate of blood flow, the thickness of the blood and qualities of the vessel wall. Classical signs of DVT include swelling, pain and redness of the affected area.
Portal vein thrombosis

Portal vein thrombosis is a form of venous thrombosis affecting the hepatic portal vein, which can lead to portal hypertension and reduction of the blood supply to the liver. It usually has a pathological cause such as pancreatitis, cirrhosis, diverticulitis or cholangiocarcinoma.
Renal vein thrombosis

Renal vein thrombosis is the obstruction of the renal vein by a thrombus. This tends to lead to reduced drainage from the kidney. Anticoagulation therapy is the treatment of choice.
Jugular vein thrombosis

Jugular vein thrombosis is a condition that may occur due to infection, intravenous drug use or malignancy. Jugular vein thrombosis can have a varying list of complications, including: systemic sepsis, pulmonary embolism, and papilledema. Though characterized by a sharp pain at the site of the vein, it can prove difficult to diagnose, because it can occur at random.

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Budd-Chiari syndrome

Budd-Chiari syndrome is the blockage of the hepatic vein or the inferior vena cava. This form of thrombosis presents with abdominal pain, ascites and hepatomegaly. Treatment varies between therapy and surgical intervention by the use of shunts.
Paget-Schroetter disease

Paget-Schroetter disease is the obstruction of an upper extremity vein (such as the axillary vein or subclavian vein) by a thrombus. The condition usually comes to light after vigorous exercise and usually presents in younger, otherwise healthy people. Men are affected more than women.
Cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) is a rare form of stroke which results from the blockage of the dural venous sinuses by a thrombus. Symptoms may include headache, abnormal vision, any of the symptoms of stroke such as weakness of the face and limbs on one side of the body and seizures. The diagnosis is usually made with a CT or MRI scan. The majority of persons affected make a full recovery. Arterial thrombosis Arterial thrombosis is the formation of a thrombus within an artery. In most cases, arterial thrombosis follows rupture of atheroma, and is therefore referred to as atherothrombosis. Another common cause of arterial thrombosis is atrial fibrillation, which causes disturbed blood flow. In addition, it is well known that the direct current cardioversion of atrial fibrillation carries a great risk of thromboembolism, especially if persisting more than 48 hours. Thromboembolism strikes approximately 5% of cases not receiving anticoagulant therapy. The mechanism and pathogenesis of thromboembolism after cardioversion is not completely understood. Arterial thrombosis can embolize and is a major cause of arterial embolism, potentially causing infarction of almost any organ in the body.
Stroke

A stroke is the rapid decline of brain function due to a disturbance in the supply of blood to the brain. This can be due to ischemia, thrombus, embolus (a lodged particle) or hemorrhage (a bleed). In thrombotic stroke, a
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thrombus (blood clot) usually forms around atherosclerotic plaques. Since blockage of the artery is gradual, onset of symptomatic thrombotic strokes is slower. Thrombotic stroke can be divided into two categorieslarge vessel disease and small vessel disease. The former affects vessels such as the internal carotids, vertebral and the circle of Willis. The latter can affect smaller vessels such as the branches of the circle of Willis.
Myocardial infarction

Myocardial infarction (MI) is caused by an infarct (death of tissue due to ischemia), often due to the obstruction of a coronary artery by a thrombus. MI can quickly become fatal if emergency medical treatment is not received promptly. If diagnosed within 12 hours of the initial episode (attack) then thrombolytic therapy is initiated.
Other sites

Hepatic artery thrombosis usually occurs as a devastating complication after liver transplantation. An arterial embolus can also form in the limbs.

VII. BELLS PALSY

Facial palsy; Idiopathic mononeuropathy peripheral facial palsy; Cranial

Bell's palsy is a disorder of the nerve that controls movement of the muscles in the face. Damage to this nerve causes weakness or paralysis of these muscles. Paralysis means that you cannot use the muscles at all. Causes, Bell's palsy involves damage to the seventh cranial (facial) nerve. This nerve controls the movement of the muscles of the face. Bell's palsy is thought to be due to swelling (inflammation) of this nerve in the area where it travels through the bones of the skull. The cause is often not clear. A type of herpes infection called herpes zoster might be involved. Other conditions that may cause Bell's palsy include:
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HIV infection Lyme disease Middle ear infection Sarcoidosis

Symptoms Sometimes you may have a cold shortly before the symptoms of Bell's palsy begin. Symptoms most often start suddenly, but may take 2 - 3 days to show up. They do not become more severe after that. Symptoms are almost always on one side only. They may range from mild to severe. The face will feel stiff or pulled to one side, and may look different. Other symptoms can include:

Difficulty eating and drinking; food falls out of one side of the mouth Drooling due to lack of control over the muscles of the face Drooping of the face, such as the eyelid or corner of the mouth Hard to close one eye Problems smiling, grimacing, or making facial expressions Twitching or weakness of the muscles in the face

Other symptoms that may occur:

Dry eye or mouth Headache Loss of sense of taste Sound that is louder in one ear (hyperacusis) Twitching in face

Signs and tests Often, Bell's palsy can be diagnosed just by taking a health history and doing a complete physical exam.
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If your health care provider is worried that a brain tumor is causing your symptoms, you may need:

CT scan of the head Magnetic resonance imaging (MRI) of the head

Sometimes, you will need a test to check the nerves that supply the muscles of your face:

Electromyography (EMG) Nerve conduction test

VIII. PSORIASIS

Psoriasis is a common skin condition that causes skin redness and irritation. Most people with psoriasis have thick, red skin with flaky, silver-white patches called scales. Causes Psoriasis is a very common condition. The disorder may affect people of any age, but it most commonly begins between ages 15 and 35. The condition cannot be spread to others. Psoriasis seems to be passed down through families. Doctors think it probably occurs when the body's immune system mistakes healthy cells for dangerous substances. See also: Inflammatory response Skin cells grow deep in the skin and normally rise to the surface about once a month. In persons with psoriasis, this process is too fast (about 2 weeks instead of 4 weeks) and dead skin cells build up on the skin's surface. The following may trigger an attack of psoriasis or make the condition more difficult to treat: Bacteria or viral infections, including strep throat and upper respiratory infections Dry air or dry skin

Injury to the skin, including cuts, burns, and insect bites

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Some medicines, including antimalaria drugs, beta-blockers, and lithium Stress Too little sunlight Too much sunlight (sunburn) Too much alcohol

In general, psoriasis may be severe in people who have a weakened immune system. This may include persons who have:

AIDS Autoimmune disorders (such as rheumatoid arthritis) Cancer chemotherapy

Up to one-third of people with psoriasis may also have arthritis, a condition known as psoriatic arthritis. Symptoms Psoriasis can appear suddenly or slowly. In many cases, psoriasis goes away and then flares up again repeatedly over time. People with psoriasis have irritated patches of skin. The redness is most often seen on the elbows, knees, and trunk, but it can appear anywhere on the body. For example, there may be flaky patches on the scalp. The skin patches or dots may be:

Itchy Dry and covered with silver, flaky skin (scales) Pink-red in color (like the color of salmon) Raised and thick

Other symptoms may include:

Genital lesions in males Joint pain or aching (psoriatic arthritis) Nail changes, including nail thickening, yellow-brown spots, dents (pits) on the nail surface, and separation of the nail from the base
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Severe dandruff on the scalp

Psoriasis may affect any or all parts of the skin. There are five main types of psoriasis: Erythrodermic -- The skin redness is very intense and covers a large area. Guttate -- Small, pink-red spots appear on the skin.

Inverse -- Skin redness and irritation occurs in the armpits, groin, and in between overlapping skin. Plaque -- Thick, red patches of skin are covered by flaky, silver-white scales. This is the most common type of psoriasis. Pustular -- White blisters are surrounded by red, irritated skin.

Complications

Arthritis Pain Severe itching Secondary skin infections Side effects from medicines used to treat psoriasis Skin cancer from light therapy

GUTTATE PSORIASIS

Guttate psoriasis is a skin condition in which small, red, teardrop-shaped spots appear on the arms, legs, and middle of the body. Guttate means "drop" in Latin. Causes Guttate psoriasis is a relatively uncommon form of psoriasis. It is usually seen in patients younger than 30. The condition often develops very suddenly, usually after an infection, most notably strep throat. Guttate psoriasis is not contagious.
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Psoriasis seems to be an inherited disorder. That means it is passed down through families. Doctors think it probably occurs when the body's immune system mistakes healthy cells for dangerous substances. See: Inflammatory response In addition to strep throat, the following may trigger an attack of guttate psoriasis:

Bacteria or viral infections, including upper respiratory infections Injury to the skin, including cuts, burns, and insect bites Some medicines, including those used to treat malaria and certain heart conditions Stress Sunburn Too much alcohol

In general, psoriasis may be severe in persons who have a weakened immune system. This may include persons who have:

AIDS Autoimmune disorders, including rheumatoid arthritis Chemotherapy for cancer

Symptoms Symptoms include itching and spots on the skin, called skin lesions, which are pinkish-red and look like teardrops. The spots may be covered with silver, flaky skin called scales. The spots usually occur on the arms, legs, and middle of the body (the trunk), but may appear in other body areas.

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