Cause by varicella – zoster virus (human herpes virus 3)
Mode of transmission is by droplet infection from the upper respiratory tract or from the discharged by ruptured lesions on the skin.
The disease is contagious till pustules disappear.

Clinical Features

Prodromal Phase – low grade fever, malaise, headache and anorexia.

Rash on the Trunk
  • First appears on the trunk and then face and finally on the limbs. The lesions are maximum on the trunk and minimum on the limbs.
  • Appears as macules and then progress to papules, vesicles and pustules. The lesions finally dry up to form scales.
  • These lesions are very itchy
  • New lesions occur in every 2 – 4 days, each crop associated with fever.


  • Myocarditis
  • Hepatitis
  • Meningitis
  • Acute glomerulonephritis
  • Secondary bacterial infection
  • Cerebellar ataxia
  • Pneumonitis
  • Arthritis
  • Congenital varicella


  • Mainly clinical.
  • A Tzanck smear of vesicular fluid demonstrates multinucleated giant cells and epithelial cells with eosinophilic intranuclear inclusion bodies.
  • Isolated the virus – culture
  • Direct immunofluorescence test
  • PCR – identify viral gene


  • No treatment required in majority of cases.
  • Symptomatic treatment – antihistaminic and calamine lotion.
  • Acyclovir (15 mg/kg 5 times a day for 7 days) – for adults and immunocompromised patients. It reduces the complications of chickenpox if given within 24 hours.
  • Secondary bacterial infection is treated with local antiseptic or systemic antibiotics like cloxacillin.


  • Live Attenuated Vaccine is given to prevent chickenpox in immunocompromised children and adult who are at high risk of infections. It should not be given to pregnant and immunocompromised patients.
  • Passive Prophylaxis for immunocompromised patient or pregnant women with history of significant exposure within last 96 hours.


All forms of tobacco smoking including cigarettes, cigar, pipes and hookahs can produce ill health effects and addiction.
There are more than 4000 substances in cigarette smoke
It contains:
  • Carcinogens – Tar, polynuclear aromatic hydrocarbons, benzopyrene, nickel, arsenic, nitrosamine, hydrazine, vinyl chloride
  • Co-carcinogens – Phenol, cresol, catechol
  • Addicting Agents – Nicotine
  • Other – Carbon monoxide

Main stream smoke – smoke emerging from mouthpiece during puffing
Side stream smoke – smoke emitting between puffs at the burning end and from mouth end. Contains more carcinogens than main stream smoke.

Smoking Index

Number of cigarettes/ day X number of years smoked
  • Mild smoker - <100
  • Moderate smoker – 100 to 300
  • Heavy smoker - >300

Pack Year

Number of packs of cigarette/day X number of years smoked (1 pack = 20 cigarette)

Passive Smoking

  • Also known as second hand smoking, involuntary smoking and environmental tobacco smoke exposure.
  • Occurs when smoke from one person’s burning tobacco product is inhaled by others.
  • It increases the risk of CAD, cancer, respiratory illness and death.

Health Effects of Chronic Smoking

Effects of Smoking
  • Cancers
    • Lung
    • Oral cavity
    • Larynx
    • Esophagus
    • Stomach
    • Urinary bladder
    • Kidney
    • Colon
    • Cervix
  • Coronary artery disease
  • Stroke
  • Chronic obstructive lung disease
  • Infertility
  • Aortic aneurysm
  • Peripheral vascular disease
  • Periodontitis

Nicotine Withdrawal Symptoms

Withdrawal symptoms in chronic users begin to appear approximately 30 minutes after every dose.
Features includes-
  • Confusion
  • Restlessness
  • Anxiety
  • Insomnia
  • Dizziness
  • Depression
  • Feeling of frustration and anger
  • Nightmares
  • Poor concentration
  • Headache
  • Increased appetitie

Smoking Cessation

Nicotine Replacement Therapy
  • Use of nicotine patches, nicotine gums, lozenges and nasal sprays.
  • Contraindicated in unstable coronary artery disease, untreated peptic ulcer, recent MI and recent stroke.

Methods of gum use:
  • Chew slowly until a strong taste or tingling sensation felt.
  • Stop chewing and place the gum between cheek and gums.
  • Chew again wen intensity of tingling decreases.
  • Repeat this cycle of “park and chew” for about 30 minutes or until the tingling sensation subsides.

  • Antidepressant
  • Dose is 75-150 mg twice a day
  • Side effects include dry mouth, insomnia and skin rash

  • More effective than nicotine and bupropion
  • Contraindicated in pregnancy and lactation
  • Side effects include nausea, insomnia, abnormal dreams, agitation, depressed mood, suicidal ideation, visual disturbances and alteration in consciousness.

Other medications – Clonodine and Nortryptyline

Electronic Cigarettes
  • A battery-powered vaporizer which contains nicotine derived from tobacco plant and gives the feeling of smoking a cigarette.
  • Reduces various health effects of cigarette smoking.


Depressive disorders are characterized by persistent low mood, loss of interest and enjoyment and reduced energy. They often impair day-to-day functioning.
It is characterized by one of more major depressive episodes for at least 2 weeks


The term obesity implies excess of the fat (adipose tissue) in the body.


Body Mass Index (BMI)
It is defines as person’s weight (kg) divided by the square of person’s height (meters).
BMI (kg/m2) is classified as the following:-
  • Normal: 18.5 – 24.9
  • Underweight: < 18.5
  • Overweight: 25 – 29.9
  • Obesity Class I : 30 – 34.9
  • Obesity Class II : 35 – 39.9
  • Obesity Class III : >40


It is the acute viral infection characterized by painful enlargement of salivary gland (Parotid gland).
Caused by the paramyxovirus.
Mode of the spread is droplet infection, direct contact and fomites containing saliva and urine
Incidence high in winter and spring

Clinical Features

Parotid Swelling
  • Malaise
  • Anorexia
  • Fever
  • Headche
  • Unilateral / bilateral swelling of angle of mouth
  • Ear ache
  • Jaw tenderness
  • Dryness of mouth
  • Earlobe appears to be pushed outward and backward due to the swelling


  • Raised serum amylase
  • Isolation of virus (throat, spine and urine)
  • PCR
  • IgM raised


  1. Epididymo-orchitis
  2. Oophoritis
  3. Pancreatitis
  4. Aseptic meningitis
  5. Encephalitis
  6. Myocarditis
  7. Nephritis
  8. Mastiits


  • Symptomatic treatment
  • Antipyretic drug
  • Warm saline mouthwash
  • Steriods – Prednisolone (orchitis and arthritis)
  • Prevention by the Mumps Vaccine at the age of 15 month