Foramina in the Base of the Skull

 Foramina in the Base of the Skull 

1. Petrotympanic fissure

■ Chorda tympani and often anterior tympanic artery. 

2. Stylomastoid foramen

■ Facial nerve.

3. Incisive canal

■ Nasopalatine nerve and terminal part of the sphenopalatine or greater palatine vessels. 

4. Greater palatine foramen

■ Greater palatine nerve and vessels. 

5. Lesser palatine foramen

■ Lesser palatine nerve and vessels. 

6. Palatine canal

■ Descending palatine vessels and the greater and lesser palatine nerves.

7. Pterygoid canal

■ Runs from the anterior wall of the foramen lacerum to the pterygopalatine fossa and transmits the nerve of the pterygoid canal (vidian nerve).

8. Sphenopalatine foramen

■ Sphenopalatine vessels and nasopalatine nerve.

A. Anterior Cranial Fossa

1. Cribriform plate

■ Olfactory nerves. 

2. Foramen cecum

■ Occasional small emissary vein from nasal mucosa to superior sagittal sinus. 

3. Anterior and posterior ethmoidal foramina

■ Anterior and posterior ethmoidal nerves, arteries, and veins.

B. Middle Cranial Fossa

1. Optic canal

■ Optic nerve, ophthalmic artery, and central artery and vein of the retina. 

2. Superior orbital fissure

■ Oculomotor, trochlear, and abducens nerves; ophthalmic division of trigeminal nerve; and ophthalmic veins.

3. Foramen rotundum

■ Maxillary division of trigeminal nerve.

4. Foramen ovale

■ Mandibular division of trigeminal nerve, accessory meningeal artery, and occasionally lesser petrosal nerve.

5. Foramen spinosum

■ Middle meningeal artery. 

6. Foramen lacerum

■ Nothing passes through this foramen, but the upper part is traversed by the internal carotid artery and greater and deep petrosal nerves en route to the pterygoid canal.

C. Posterior Cranial Fossa

1. Internal auditory meatus

■ Facial and vestibulocochlear nerves and labyrinthine artery. 

2. Jugular foramen

■ Glossopharyngeal, vagus, and spinal accessory nerves and beginning of internal jugular vein. 

3. Hypoglossal canal

■ Hypoglossal nerve and meningeal artery. 

4. Foramen magnum

■ Spinal cord, spinal accessory nerve, vertebral arteries, venous plexus of vertebral canal, and anterior and posterior spinal arteries.

5. Condyloid foramen

■ Condyloid emissary vein. 

6. Mastoid foramen

■ Branch of occipital artery to dura mater and mastoid emissary vein.

7. Carotid canal

■ Internal carotid artery and sympathetic nerves (carotid plexus)

8. Hiatus of facial canal

■ Greater petrosal nerve.

D. Foramina in the Front of the Skull 

1. Zygomaticofacial foramen

■ Zygomaticofacial nerve.

2. Supraorbital notch or foramen

■ Supraorbital nerve and vessels. 

3. Infraorbital foramen

■ Infraorbital nerve and vessels. 

4. Mental foramen

■ Mental nerve and vessels. 

Community medicine : High Yield points

 1. James Lind is related to the discovery of Prevention of scurvy 

2. Gap in time between entry of the organism and the appearance of signs and symptoms is the incubation period 

3. Time between entry of the organism and to produce maximum infection is known as generation time 

4. Time interval between disease initiation and disease detection in a noninfectious disease is known as latent period 

5. Serial interval is the time between onset of primary case and secondary case 

6. Occurrence of the polio is an example of propagated epidemic 

7. Bhopal gas tragedy is an example of Point source epidemic 

8 Endemic disease means that a disease is constantly present in a given population group 

9. Secular trends are progressive changes occuring over long period of time 

10. Point source epidemic occurs in one incubation period 

11. First case that comes to notice of physician is Index case

Psychiatry - High Yield points

 1. ASPERGER'S syndrome is: Developmental disorder

2. Tourette's disorder is characterised by: Motor tics and vocal tics of abusive language or sexually obscene words

3. Copropraxia refers to: Obscene acts

4. Macdonald triad is associated with: Sociopathic behavior

 5. Stealing and telling lies is due to: Conduct disorder 

6. DOC of night terrors: Diazepam 

7. Eneuresis is diagnosed after the age of: 5 years 

8. Feature of "anankastic personality disorder is: Rigidity and stubbornness 

9 .Personality disorder characterised by disregard for social norms and incapacity to experience guilt is: Schizoid personality disorder 

10. Personality disorders: are usually evident by adolescence 

11. Personality with traits like disciplined, parsimonious, punctuality, liking cleanliness etc. is: Anankastic 

12. Of the various personality disorders paranoid personality comes under: Cluster A 

13. Dramatic emotionality, suggestibility and overconcern with physical attractiveness is a feature of personality traits: Histrionic Personality 

14.. Personality disorders which is more common in females: Histrionic

 15. Psychiatric complications of alcohol dependence are Schizophrenia, Depression 

16. Most common symptom of alcohol withdrawl is Tremor

 17.Wernick’s encephalopathy involves Mammillary body 

18. Wernicke encephalopathy presents with confusion, nystagmus and ataxia. 

19. In alcohol withdrawl drug of choice is Chlordiazepoxide 

20. Widmark Formula is used for Alcohol 

21. Formication and delusion of persecution, both are together seen in Cocaine psychosis 

22 Dependence is best indicated by Withdrawal symptoms 

23. Antidepressant drug that is used for Nicotine addition: Bupropion 

High Yield points : Dermatology

 1. Syndromic management for genital ulcers in India is used for STI like Chancroid, chancre & herpes genitalis

 2. Most specific test for syphilis FTA-Abs

 3. In chancroid, the drug of choice is Ceftriaxone

 4. Donovanosis is caused by Calymmatobacterium granulomatis 

5. For lymphogranuloma venereum the drug of choice is Doxycycline

 6. Polycyclic erosions are seen in Herpes genitalis 

7. The most frequent cause of recurrent non-infectious oro-genital ulceration in a HIV positive male is Aphthous ulcer 

8. Sabre tibia is seen in: Syphilis

 9. Mucus patch is seen in Secondary syphilis 

10. Incubation period of syphilis is 9 to 90 days

 11. Vesicle is not a skin manifestation of secondary syphilis 

12. Primary bullous lesion is seen in Congenital syphilis 

13. In Syphilis a painless indurated ulcer over the penis is seen 

14. Yaws is caused by Treponema pertenue 

15. In primary syphilis the treatment of choice is Benzathine penicillin

 16. Podophyllin is used in Condyloma acuminate

 17. Gonococcus is: Intracellular gram-negative 

18. Main feature of gonorrhea is Purulent discharge per urethra 

19. Leprosy does not affect Ovaries

 20. The most effective drug against M.leprae is Rifampicin 

21. Most sensitive index to assess the drug effectiveness in skin smears of leprosy patient is: Morphological index 

22. Maximum suppression of cell-mediated immunity occurs in Lepromatous leprosy 

Pathology : High Yield

 1.  Damage  to  nervous  tissue  is  repaired  by  :  Neuroglia

 2.  Mycosis  fungoides  :  Cutaneous  lymphoma   

3.  Secondary  amyloidosis  complicates:  Chronic  osteomyelitis 

4.  The  earliest  feature  of  TB  is:  Lymphocytosis   

5.  The  low  grade  non-hodgkins  lymphoma  is  :  Follicular  

 6.  Liquefactive  necrosis  is  seen  in  :  Brain  

 7.  The  crescent  forming  glomerulonephritis  is:  RPGN 

8.  Earliest  feature  of  correction  of  IDA  is  :  Reticulocytosis

   9.  Kupffer's  cells  are  found  in  :  Liver   

10.  Heart  failure  cells  are  found  in  :  Lungs 

  11.  Psammoma bodies  show:  Dystrophic  calcification   

12.  Beta-microglobulin:  is  not  a  tumor  marker  

 13.  Commonest  benign  tumor  of  liver  :  Hemangioma  

 14.  Blood  when stored  at  4  degree  celcius  can  be  kept  for:  21  days   

15.  Congo-red  with  amyloid  produces:  Brilliant  pink  ccolour

  16.  Cloudy  swelling  does  not  occurs  in  :  Lungs 

17.  Gamma Gandy bodies contains  hemosiderin  and  :  Ca++   

18.  Hutchinson's  secondaries  in  skull  are  due  to  tumors  in  :  Adrenals   

19.  Albumino  -cytologic  dissociation  occurs  in  cases  of:  Guillain  Barre  syndrome   

20.  Metastatic  calcification  is  most  often  seen  in  :  Lungs   

21.  ASLO  Titres  are  used  in  the  diagnosis  of:  Acute  rheumatic  fever  

 22.  Apoptosis  is  inhibited  by  :  bcl-2  

 23.  CEA:  is  not  used  as  a  tumor  marker  in  testicular  tumours

 24.  Onion  peel  appearance  of  splenic  capsule  is  seen  in  :  SLE

ENT important points

CUSIS:

1. Hyperacusis – Bell’s palsy

2. Paracusis willisi – Otosclerosis

3. Diplacusis – Meniere’s disease

4. Presbyacusis – Age related SNHL

TRIADS:

1. Gradinego syndrome :

Ear discharge

Retroorbital pain

 Diplopia 

2. Trotter’s triad (NPC):

U/L CHL (glue ear)

Temporoparietal pain

Palatal palsy

3. Sampter’s triad

Allergy to Aspirin

Asthma 

Nasal polyps

SIGNS:

1. Heinnebert sign : Congenital Syphillus

2. Hitzelberger sign : Acoustic Neuroma

3. Rising sun/ brown sign/ Phelp sign : Glomus Juglare

4. Target/Halo sign : Traumatic CSF leak

5. Cart wheel sign : ASOM

6. Schwartz sign : Otosclerosis

7. Griessenger sign / Delta sign : Sigmoid Sinus Thrombosis

8. Reservoir Sign : Mastoiditis

9. Light House : ASOM

10. Tripod sign/ Thumb sign : Epiglotittis 

11. Steeple sign : ALTB / CROUP

12. Antral sign / Hollman miller sign : Angiofibroma CT

13. Omega shaped epiglottis : Laryngomalacia 

14. Turban/ Mouse nibbled vocal cord : TB larynx

15. Potato nose : Rhinophyma

16. Woody nose : Rhinoscleroma

17. Mulberry like nasal mass : Rhinosporidiosis

18. Mulberry like nasal mucus : Inferior turbinate hypertrophy

19. Frog face deformity : Angiofibroma

THYROPLASTY:

1. Type 1 : Medialization – Adductor palsy

2. Type 2 : lateralization – Abductor palsy

3. Type 3 : Shortning- Loosening – Puberphonia 

4. Type 4 : Lengthing- tightening – Androphonia

 

DRAINAGE points:

1. Nasolacrimal duct : Inferior meatus

2. Maxillary / frontal / anterior / ethmoidal : Middle meatus

3. Posterior ethmoid : Superior meatus

4. Sphenoid : Sphenoethmoidal recess

5. DCR : Middle meatus

Committees in PSM

The Many Committees in PSM tell a story- lets read it.
(Questions asked have been marked with *) 

The story begins in 1943.
Government of India (still under the British) appointed BHORE (SIR JOSEPH BHORE) to assess
the health situation in India and make recommendations. He took 2 years roaming around and made his recommendations in 4 volumes! Keywords we need to remember-
• Integration of preventive and curative services at all administrative levels
• Development of PHC in 2 stages- short term and longterm (called the 3 million plan) (*)
• Concept of “social physicians” (3 months training) Then we got independence and apparently got smarter. 

We decided to see if what the Goron ka Bhore had recommended is working or not! 

So came the MUDALIAR COMMITTEE in 1962 to provide afresh look. It said strengthen
what we have, don’t build more. 

Next year (1963) came the CHADAH COMMITTEE. It was
made to study arrangements for the NMEP’s maintenance
phase. It said one basic health worker should work for 10,00 population. And they should be
multipurpose health workers-malaria + family planning +
vital statistics (*) 

Then 2 years later (1965) came the MUKERJI COMMITTEE. They very smartly realized that what
Chadah ji said is not working.
Neither Malaria nor Family planning work is being done properly. So let’s separate them.
Let’s make basic health worker work for all other random stuff.
And family planning assistant to do only family planning jobs.
They also said separate malaria from family planning!
Then in 1966, same committee found that it got too much for
the states to do because of lack
of funds. So they worked out a system called “Basic Health Service” being provided at the
block-level to figure out the
administration jargon. 

JUNGALWALLA COMMITTEE came the year after that (1967).
Srinagar mein baithke they
talked about how to eliminate private practice for government
doctors and just how to integrate health services. So they came up with the idea of
“Integrated Health Services” (*) 

Next KARTAR SINGH COMMITTEE
met in 1973 (6 years later) and this committee was called the
“Committee on Multipurpose
workers under Health and
Family planning” (because we like revisiting the past!). They said
• Convert the current Auxilary Nurse-Midwives into Female Health Workers
• Convert the Basic Health Workers/Malaria Surveillance Workers/Vaccinators/Health Education Assistants/Family planning health assistants into
Male Health Workers
• Introduce MPWs first into Malaria maintenance phase and Smallpox controlled areas, then spread them out
• One PHC for 50,000 people
• Every PHC should have 16 subcentres 

• Every subcentre should have 1 male and 1 female health worker Then two years later came

SHRIVASTAV COMMITTEE (1975).
They wanted to make a plan to train all these new position people. They said we need more people (these positions aren’t enough!). So their recommendations were
• Train para and semi-professional workers- like school teachers etc to help out in the community 

• Establish 2 more cadres of health workers- Multipurpose
Health Workers and Health Assistants between the community level and doctors at PHCs 

• Develop a Referral Services Complex

• Something about medical education also

• Most importantly it said that
Primary health care should be provided within the community
itself through specially trained
people – place the health of the
people in the hands of the
people themselves! (*) Its long I know..but I hope it
helps.