স্পেশাল বিসিএস (স্বাস্থ্য) - লং কোর্স

Drugs- NSAIDs, retinoids, tetracyclines, furosemide

Mild
 Hydrocortisone 0.5%, 1%, 2.5%
 Hydrocortisone 1% and fusidic acid 2% (Fucidin H)
Potent
 Betamethasone valerate 0.1% (Betnovate)  Betamethasone valerate 0.1% and clioquinol 3% (Betnovate-C)  Fluocinolone acetonide 0.025% (Synalar)  Hydrocortisone butyrate 0.1% (Locoid)  Mometasone furoate 0.1% (Elocon)

Basal cell carcinoma
The incidence of NMSC has increased dramatically in recent decades and basal cell carcinoma (BCC) accounts for more than 70% of cases. In Europe, the ratio of BCC to SCC is 4–5:1 in immunocompetent patients. It is a malignant tumour that rarely metastasises; it is thought to derive from immature pluripotent epidermal cells and is composed of cells with similarities to basal layer epidermis and appendages. Lesions typically occur at sites of moderate sun exposure, particularly the face, and are slow-growing. The incidence increases with age and males are more commonly affected. Lesions may ulcerate and invade locally; hence the term ‘rodent ulcer’.

Bowen’s disease Clinical features
Bowen’s disease (BD) is the name given to an intra-epidermal carcinoma that usually presents as a slowly enlarging, erythematous, scaly plaque on the lower legs of fair-skinned older women  but other sites can also be involved. It can be confused with eczema or psoriasis, but is usually asymptomatic and does not respond to topical glucocorticoids. It may also be hard to distinguish from superficial BCC. Transformation into SCC occurs in 3% or less

Molluscum contagiosum is caused by a DNA poxvirus skin infection. It is most common in children over the age of 1 year, particularly those with atopic dermatitis. It also occurs frequently in immunosuppressed patients, including those with HIV. Lesions are dome-shaped, ‘umbilicated’, skin-coloured papules with central punctum . They are often multiple and found at sites of apposition, such as the side of the chest and the inner arm.

Bulimia nervosa
 Recurrent bouts of binge eating 
Lack of self-control over eating during binges 
Self-induced vomiting, purgation or dieting after binges 
Weight maintained within normal limits

ECG abnormalities: T-wave inversion, ST depression and prolonged QTc interval

 Common presentations of dissociative (conversion) disorder
 Gait disturbance  Loss of function in limbs  Aphonia
 Non-epileptic seizures  Sensory loss  Blindness

In the immediate aftermath of a significant trauma, the main aim is to provide support, direct advice and the opportunity for emotional catharsis (routine debriefing may actually be harmful).
In established PTSD, structured psychological approaches (CBT, eye movement desensitisation and reprocessing (EMDR) and stress management) are effective. Antidepressant drugs are moderately effective.

Mood disorders Mood or affective disorders include:
 unipolar depression: one or more episodes of low mood and associated symptoms
 bipolar disorder: episodes of elevated mood interspersed with episodes of depression
 dysthymia: chronic low-grade depressed mood without sufcient other symptoms to count as ‘clinically signicant’ or ‘major’ depression.

About one-third of those who develop an acute schizophrenic episode have a good outcome. One-third develop chronic, incapacitating schizophrenia, and the remainder largely recover after each episode but suffer relapses. Most affected patients cannot work or live independently. Schizophrenia is associated with suicide and up to 10% of patients take their own lives

Cardiac arrhythmias
Antipsychotic medications cause prolongation of the QTc interval, which may be associated with ventricular tachycardia, torsades de pointes and sudden death. If this occurs, treatment should be reviewed, with careful electrocardiographic monitoring and treatment of serious arrhythmias if necessary.