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Tampon toxic shock syndrome

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Usually caused by staphylococcal exotoxin associated with high-absorbency tampon use. Strep. pyogenes can also cause it. The rare syndrome usually begins within 5 days of the onset of the period.

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Clinical features include sudden onset fever, vomiting and diarrhoea, muscle aches and pains, skin erythema, hypotension progressing to confusion, stupor and sometimes death.

++ Management
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Active treatment depends on the severity of the illness. Cultures should be taken from the vagina, cervix, perineum and nasopharynx. The patient should be referred to a major centre if ‘shock’ develops. Otherwise the vagina must be emptied, ensuring there is not a forgotten tampon, cleaned with a povidone–iodine solution tds for 2 d, and di(flu)cloxacillin or vancomycin antibiotics administered for 8–12 d.

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Tearduct (nasolacrimal duct) blockage in child

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  • If conjunctivitis present: neosporin or chloramphenicol eye drops

  • Perform regular massage from inner canthus to base of nose (teach mother) at least twice daily

  • If persistent in infant: requires nasolacrimal probing at 4–6 mths—otherwise leave to 6 mths or more as it may resolve

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Teething

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Babies usually cut their teeth from 6 mths until 2–3 yrs with discomfort usually caused by the molars (ages 1–3).

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Precautions: exclude other possible causes of irritability in a teething child (e.g. UTI, meningitis, otitis media). Teething doesn't cause fever.

++ Treatment
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  • Reassure parents that the problem will soon settle.

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Image not available.

++ Chewing soothing methods
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  • Teething ring (kept cold in the refrigerator) or

  • Baby can chew on a clean, cold, lightly moistened facewasher (a piece of apple can be placed in the facewasher) or

  • Parent can massage gum with forefinger wrapped in a soft cloth or gauze pad (Oro-Sed gel can be massaged into gums every 3 h if extremely troublesome)

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Temporomandibular joint dysfunction

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Refer to the techniques on Image not available. treatment of TMJ dysfunction. Most effective and simplest method is placing a piece of soft wood (e.g. carpenter's pencil) firmly against back molars and biting rhythmically on the object with a grinding movement for 2–3 mins at least 3 times a day.

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Testicular tumours

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A mass that is part of the testis, and solid, is likely to be a tumour.

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Table Graphic Jump Location
Table T1

Comparison of the common testicular cancers

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