Friday, 28 February 2014

Microbiology Mnemonics

Urease positive organisms
PUNCH :
P roteus (leads to alkaline urine)
U reaplasma (renal calculi)
N ocardia
C ryptoccocus (the fungus)
H elicobacter pylori

Listeria: motility
Istanbul sounds like Listambul = list + tumble .
Listeria has tumbling motility.

Staphylococci: novobiocin test to distinguish
coagulase negative staphylococci
Staph epi dermidis stays away from the
novobiocin disc like an epi demic.
· Therefore, epidermidis is sensitive to novobiocin.
Staph saprophyticus, much friendlier, comes up to the disc and says, " 'sap? '" [short for "whassup?", ie "what's up"].
· Therefore, saprophyticus is novobiocin resistant.

C/i in renal

Antibiotics contra indicated in renal diseases-
Funda- My New Santa Claus gives me TV
M-methanamine
N-nitrofurantoin & nalidixic acid
S-sulfonamides
C-cidofovir
T-tetracyclin
V-voriconazole

NAMED SURGERIES N GYNAEC

McIndoe's vaginoplasty- vaginal atresia
strassman's utriculoplasty-bicornuate uterus
jone's&tomkins-septate uterus
latzkos,chassar moir,martius' graft-VVF
boari flap-ureteric fistulae
kelley,pacey,marshall marchetti krantz,burch colposusp,razz n stamey modified slings-stress incontinence
fentons perineotomy-rigid hymen causing vaginissmus
mayos hysterectomy,fothergills/manchester,shirodhkar,Leforts, slings-purandre&mhatre,shirodkar,khanna, virkud,neeta warty,mangeshkar's- uterine prolapse
pomeroy,uchida,madlener,irwing,aldridge-sterilization
moschowitz-enterocele
gilliams,baldy webster- retroverted uterus
o sullivans method, spinnellis- inverted uterus
hysterectomy-wertheim's, meig obayashi,schauta, taussigs lymphadenectomy-ca cervix

Psychiatry

✒Johann weyer-father of psychiatry
✒Gockel-coined psychology
✒Leo kanner-childhood autistic disorder
✒Carl gustav jung-introvert n extrovert-analytical psychology
✒Jean piget-childhood devlpmt&milestones
✒Johann christiam reil- coined psychiatry
✒Alfred adler-sup&inf complexes
✒Jones maxwell-alcoholics anonymous
✒Hecker ewald-1st described heb scz
✒Hippocrates-father of medicine
✒Emil kraeplin-father of modern psychiatry,Scz,MDP,alzheimers
✒Peirre janet-psychasthenia
✒Eugene bleuler-dementia precox
✒Pavlov-classical condtng
✒Skinner-founder of operant condtng
✒Kahlbaum karl-catatonic scz,cyclothymia
✒Anna freud-ego n mechanisms of defence except repression regression sublimatn
✒Carl koller-cocaine
✒Cohen-poetically described datura poisoning
SIGMUND FREUD-free associatn, electra edipus complexes, psychoanalysis, pleasure&reality principle,ego defence mechanisms-rep reg sub,interpretation of dreams
✒Franz alexander-father of psychosomatic meds
✒George miller-neurasthenia
✒Alfred binet-intelligence scale
✒James braid-hypnosis
✒William cullen-coined neurosis
✒Ernst von-coined psychosis
✒Erik erikson-stages of life
✒Beck-cognitive theory
✒William osler-modern medicine
✒Leo kanner-oprerant cntng-reinforcement&punishment

Saints in medicine

1) St.Vitus dance: @Sydenhams chorea...acute rheumatic fever caused by "S.pyogenes"      

2) St.Anthony's fire : ergotism / ergot alkaloid poisoning caused by "Claviceps purpura"

3) St.Louis encephalitis : Encephalitis caused by "St.louis encephalitis virus"

Bacteria - St.Vitus
Fungus   - St.Anthony
Virus       - St.Louis
                                      
4) Saint's triad :  Hiatal hernia + Diverticulosis + Gall bladder disease

Respiratory Failure

Type I Respiratory failure:
causes:
Alveolar flooding:
  1. pneumonia
  2. pulm edema,embolism and fibrosis
  3. pneumothorax
  4. ARDS
  5. aspiration
  6. lung collapse
  7. asthma
  8. blunt chest trauma
  9. diseases of vasculatures rt to lft shunts
  10. lymphangitis carcinomatosa


Type II respiratory failure:
alveolar hypoventilation:
  1. upper airway obstruction(edema,infection ,foreign body)
  2. decrease in central respiratory drive(head injury,meningitis and drug overdose)
  3. COPD
  4. impaired respiratory muscle function(myasthenia gravis,polio,kyphiscoliosis)
  5. flail chest


Type III respiratory failure:
  1. perioperative respiratory failure resulting due to lung atelectasis


Type IV respiratory failure:
  1. hypoperfusion of respiratory muscles in shock.....

Thursday, 27 February 2014

Flaps

Types of flaps:
Random flap - flap based on an unknown
vessel. Ex: Rhomboid flap, VY flap
Axial flap - flap rotated on a known blood
vessel. Examples: Delto-pectoral flap - based
on the perforators of internal mammary
vessels. LD flap - based on the thoracodorsal
vessels. PMMC flap - based on the pectoral
branch of thoracoacromial artery. TRAM flap -
based on the superior or inferior epigastric
artery. Abbey estlander flap - based on the
labial artery. Forehead flap - based on the
superficial temporal artery.
Free flap - flap based on a known vessel,
disconnected from the donor site and
anastomosed to the recipient vessel. Ex: DIEP
flap - based on the deep inferior epigastric
artery perforator (used for breast
reconstruction). Fibular flap - based on the
peroneal vessels (used for mandibular
reconstruction).
Delto-pectoral flap is the most commonly used
flap used by head and neck surgeons!

Wednesday, 26 February 2014

Orange

ORANGE time *orange placenta---- syphilis
*orange tonsils --- Tangiers disease
*peau'd orange appearance--- carcinoma breast
*Reddish orange discolouration of  urine--rifampicin,
furazolidone, sulfosalazine, Rifabutin,Entac
apone,Clofazimine
*orange discolouration of skin--carotenoderma
*orange/saffron coloured amniotic fluid-- post maturity
*Orange skin cornea is seen in Mustard Gas poisoning
used in biological warfare...
*orange cylinder - - Cyclopropane
*orange book --- related to bioequivalence [pharmac ]

Tuesday, 25 February 2014

Endocrinology

Endocrine Hormones and Disorders

Hyposecretion of Anti-Diuretic Hormone - Diabetes insipidus

    Due to decreased production of anti-diuretic hormone in the supraoptic nucleus of the hypothalamus.  Often associated with a head injury.

Symptoms:  Excessive diuresis and thirst (polyuria and polydipsia).

Hyposecretion of Growth hormone - Pituitary dwarfism

    Due to decreased production of growth hormone from the somatotropic cells of the anterior pituitary.  Generally due to a nonmalignant adenoma of the non-somatotropic tissue of the anterior pituitary.

Symptoms:

1.  Pronounced hypoglycemia.

2.  In Lorain dwarfism:
    a.  arrested sexual development
    b.  stunted growth
    c.  normal intelligence

3.  In Frolich's dwarfism:
    a.  arrested sexual development
    b.  stunted growth
    c.  mental retardation

Hypersecretion of growth hormone - Giantism and Acromegaly

    Pituitary giantism is due to overproduction of growth hormone during childhood.  Usually caused by an adenoma of the somatotropic cells.

Symptoms:  Excessive growth, hyperglycemia, diabetes mellitus, osteoporosis and high basal metabolic rate (BMR).

Tuesday, 18 February 2014

👛 uterine artery assesed in -uteroplacental flow

👛fetoplacental flow-umblical artery

👛s/d ratio less dan 3

👛 if more dn 3 termination of pregnancy has to b done

👛middle cerebral artery-normally high resistance

Drug of Choice for Different Diseases :

For MRSA Infection-Vancomycin
For Malaria in Pregnancy-Chloroquine
For Whooping Cough or Perteusis- Erythromycin
For Kawasaki disease-IV Ig
For Warferin Overdose-Vit-K
For Heparin Overdose-Protamine
For hairy Cell Leukemia-Cladirabine
For Multiple Myeloma- Melphalan
For CML-Imatinib
For Wegner's granulomatosis-Cyclophosphamide
For HOCM- Propranolol
For Delirium Tremens-Diazepam
For Drug Induced Parkinsonism-Benzhexol
For Diacumarol Poisoning-Vit-K
For Type-1 Lepra Reaction-Steroids
For Type- 2 Lepra Reaction-Thalidomide
For Allergic Contect Dermatitis-Steroids
For PSVT- 1st-Adenosine, 2nd-Verapamil, 3rd-Digoxin
For Z-E Syndrome- Proton Pump Inhibitor
For Chancroid-Cotrimoxazole
For Dermatitis Herpetiformis-Dapsone
For Spastic Type of Cerebral Palsy-Diazepam
For Herpis Simplex Keratitis-Trifluridine
For Herpes Simplex Orolabialis-Pancyclovir
For Neonatal Herpes Simplex-Acyclovir
For Pneumocystis carinii Pneumonia- Cotrimoxazole
For Nodulo Cystic Acne-Retinoic acid
For Trigeminal Neuralgia-Carbamezapine
For Actinomycosis-Penicillin For Plague- Streptomycin
For Opioid Withdrawal- Methadone 2nd-Clonidine
For Alcohol Withdrawal- Chlordiazepoxide 2nd-Diazepam
For Post Herpetic Neuralgia- Fluphenazine
For WEST Syndrome-ACTH
For Diabetic Diarrhoea- Clonidine
For Lithium Induced Neuropathy-Amiloride

Sutures: Information and Types

Information About Sutures in the Operating Room:-

When asking for a suture generally three peices of information are included; suture size, suture type and suture needle.

a surgeon would say, "Give me a 4-0 Vicryl on a PS-2".

4-0 (pronounced 4-oh) refers to the size of the suture fiber. Vicryl is the type of suture. And finally a PS-2 is the type of needle the suture is attached to.

Suture Size

Smallest

10-0 Typically used in the most delicate surgeries. Common in both Ophthalmic (eye)
9-0 surgery and for repairing small damaged nerves often due to lacerations in the
8-0 hand.

7-0 Used for repairing small vessels and arteries or for delicate facial plastic surgery.
6-0 Common for use in vascular graft sewing such a carotid endarterectomy.

5-0 Used for larger vessel repair such as an Abdominal Aortic Aneurysm or
4-0 skin closure.

3-0 Skin closure when there is a lot of tension on the tissue, closure of muscle layers
2-0 or repair of bowel in general surgery.

0 For closing of the fascia layer in abdominal surgery, the joint capsule in knee and
1 hip surgery or deep layers in back surgery.

2 For repair of tendons or other high tension structures in large orthopedic surgeries.

Suture Type

There are many different types of suture, the two most important properties are...
Absorbable Vs Non-Absorbable
and
Braided Vs Non-Braided

Absorbable Suture

Absorbable suture breaks down over time in the body. Examples of absorbable suture include
Monocryl,

Vicryl,

Chromic,

PDS.

The amount of time it takes a suture to break down in the body depends on a few factors such as suture type, size and the location it is placed. The list to follow includes the most common absorbable sutures in most operating rooms listed from shortest to longest break down time.

*Complete breakdown of strength times of various Ethicon Sutures:
Vicryl Rapide – 2 weeks
Undyed Monocryl – 3 weeks
Dyed Monocryl – 4 weeks
Coated Vicryl – 4 ½ weeks
PDS – 9 weeks
Panacryl – 70 weeks

Note – Suture absorption rates can increase in patients with fever, infection or protein deficiency. Also, the strength to a suture will decrease significantly prior to its complete breakdown time. Therefore a suture with higher tissue tension will have a greater chance of failure prior to the amount of time listed above

Non-Absorbable Suture

Nylon (Ethilon)

Gortex

Silk

Fiberwire

Ethibond

Prolene
Steel

are all example of non absorbable suture. When used on the skin, these sutures will be removed however when used in the body they will be retained inside the tissue.

Common uses for non absorbable suture:
Interrupted skin suturing when sutures will be removed later, 4-0 Nylon
Securing drains to skin, 2-0 Silk
Repair stitches for blood vessels, 6-0 Prolene
Vessel graft stitches for AAA, Fem-Pop or Carotid Artery grafts 5-0, 6-0 prolene or gortex
Bowel repair stitch, 3-0 silk
Achilles Tendon Repair, #5 Ethibond or Fiberwire

Braided or Non-Braided Suture

Braided suture have a number of strands woven together like a string. Examples of braided suture are; Silk, Vicryl and Ethibond.

Non-Braided or Monofilament Sutures have a single strand such as Monocryl, PDS,and Ethilon Nylon.

Often times it will be surgeon preference when choosing a braided or non-braided suture. 4-0 vicryl and 4-0 monocryl are by far the most common sutures used from sewing the skin. Both are absorbable however vicryl is braided and monocryl is non-braided.

It is thought that non-braided sutures cause less reactivity in the body and are not as prone to becoming infected because they lack the grooves and rough surface for things to adhere. However non-braided sutures can have a greater tendency to loosen at the surgical knot with the lack of grip.

Type of Forceps

Outlet, low, mid or high
The accepted clinical standard classification system for forceps deliveries according to station and rotation was developed by ACOG and consists of:

Outlet forceps delivery, where the forceps are applied when the fetal head has reached the perineal floor and its scalp is visible between contractions.[8] This type of assisted delivery is performed only when the fetal head is in a straight forward or backward vertex position or in slight rotation (less than 45 degrees to the right or left) from one of these positions.[9]
Low forceps delivery, when the baby's head is at +2 station or lower. There is no restriction on rotation for this type of delivery.[9]
Midforceps delivery, when the baby's head is above +2 station. There must be head engagement before it can be carried out.[9]
High forceps delivery is not performed in modern obstetrics practice. It would be a forceps-assisted vaginal delivery performed when the baby's head is not yet engaged.[9]

CD molecules

CD1a, CD207: Langerhan cell histiocytosis cells

CD2, CD3, CD4, CD5, CD7, CD8: T cells

CD10: Early pre-B cells (immature B cells)

CD11c, CD25, CD103, CD123: Hairy cell leukemia cells

CD13, CD33, CD117: Myeloid cells

CD14, CD64: Monocytic cells (positive in AML-M4 and AML-M5)

CD15: Reed-Sternberg cells, neutrophils

CD16, CD56: Natural killer cells

CD19, CD20, CD21, CD22 : B cells

CD23 and CD5 : Chronic lymphocytic leukemia/small lymphocytic lymphoma

CD23 negative and CD5 positive: Mantle cell lymphoma cells

CD30 and CD15: Reed-Sternberg cells

CD30 positive and CD15 negative: Anaplastic large cell lymphoma cells

CD31: Endothelial cells (positive in angiosarcoma)

CD33: Myeloid cells and precursors

CD34: Stem cells (also positive in angiosarcoma)

CD41, CD61: Megakaryocytes and platelets (positive in AML-M7)

CD45 : All leukocytes (except Reed-Sternberg cells!)

CD45 RO: Memory T cells

CD45 RA: Naive T cells

CD68: Histiocytes (positive in malignant fibrous histiocytosis)

CD99: Ewings sarcoma cells

CD117: Gastrointestinal stromal tumor (GIST) cells, mast cells (positive in mastocytosis), myeloid cells.

50 One liners

1. Heart size is Normal in : TOF and TAPVC( infracardiac form )
2. Visual reflex formation or Macula mature by 5-6 months life
3. Gardasil -- 16 , 18 , 6 , 11
Cervarix -- 16 , 18
4. Renal tubular acidosis -- Normal Anion gap Hyperchloremic Metabolic Acidosis
Point to remember --
its NORMAL in Serum
but POSITIVE anion gap
in Urine
5. Ectopic ACTH Syndrome -- Hypokalemic
Alkalosis
6. Anatomical Closure of
Ductus arteriosus -- 1-3
months after birth. 1-3
months after birth. (ref:
Langman's embryology & Guyton)
7. Corneal donor -- till 6 hour after death
8. Nerve fibers -- A and B are Myelinated ; 
A to C - Diameter and Velocity
decrease
9. For Congenital hypothyroidism -- TSH ,
best done >48 hrs - 6
days life
10. Child of HIV positive Mother -- Cant use IgG
for 1st 18 months to
diagnose as that comes
from
mother. So p24
assay , PCR , Viral Culture
are used.
11. Neomycin is present
in Polio Vaccine
12. TORCH infectivity --
All at time of birth BUT
Rubella has 2 peaks i.e
10 -11 wks and delivery.
13. Unchanged during
child birth -- Diameter
between Sacral
promontary and Pubic
Symphisis.
14. RAIU -- I 123 ;
RIA ---- I 125
15. CO poisoning -- PO2
Normal but O2 saturation
is less.
16. Fetal distress -- S/D ratio-- increases in Umblical Artery , decreases in MCA.
17. All Myopathies are
Proximal except Myotonic
Dystrophy (type 1)
18. All Neuropathies are
Distal except GBS and
SMA.
19. Glysine is the
smallest and simplest
Amino Acid.
20. Adder Head on IVP --
Ureterocele
21. Flower vase /
shaking hand sign --
Horseshoe kidney
22. Ligament of
Struthers .-- remnant of
3rd head of
coracobrachialis , runs
from supracondylar spur
on anteromedial humerus
to medial epicondyle,
median n and brachial a
may run beneath it.
23. Shortest Colon -
Ascending
Longest Colon -
Transverse
24. Trigeminal Neuralgia
rarely involves
Ophthalmic division
If in a young / if it
is Bilateral -- then
Multiple Sclerosis is a
key consideration
25. After overnight
fasting , levels of glucose
transporters are reduced
in Muscle .
26. Pacini Corpuscles --
detects gross pressure
changes and vibration
27. Epiphyseal dysgenesis
-- in Hypothyroidism
28. In Hypothyroidism ---
Increased CSF protein
29. Most characteristic
cutaneous manifestation
of FMF (Familial Medit.
fever) -- Erysipelas like
erythema.
30. Two halves of
Mandible join together by
2yrs of Life
31. Syphilitic Aortitis --
Proximal Ascending
Aorta
32. Superficial spreading
melanoma -- Buckshot
appearance (Pagetoid
cells)
33. Seborrheic Keratoses -- Stuck on lesion
34. Finger prints can be taken in cases of advanced decomposition and drowning But NOT in case of
corrosion
35. Generally all bones ossify earlier in females
Skull sutures obliterate earlier in Males.
36. Anterior neuropore closes by 25th day, and posterior one closes by 27th day of IUL.
37. Gittre cells are modified CNS macrophages.
38. Hirano Bodies in Hyppocampus -- Alzheimer's
39. Acrocentric
Chromosomes -- 13 , 14 ,
15 , 21 , 22 , Y
40. LAP increased in -- Leukamoid reaction , Polycythemia Vera decreased in -- CML , PNH
41. Schistiocyte -- MicroAngiopathic Hemolytic anaemia
42. Tear Drop cell -- Myelofibrosis
43. Target cell -- Thallesemia , HbC disease , Liver disease.
44. Good ALL -- Female , 2-10 years ,
Hyperdiploidy , B-ALL
(NOT preB-ALL)
45. Pregnancy tumor of gums = Granuloma pyogenicum
46. RCC = Hypernephroma = Grawitz Tumor
47. Holly leaf mesangial deposits -- FSGN
48. Spike & Dome , String of Popcorn -- Membranous GN
49. Wire loop -- Class IV Lupus Nephritis
50. Post Mortem staining is well developed in 4 hrs and becomes fixed in 6-12 hrs

Monday, 17 February 2014

#Banana sign aeen in spina bifida
Cl bottulinum causes
           food poisoning in canned food
               food poisoning in infants due to honey
floppy baby synd
remember NaCl for myotonia:
1.Na--Paramyotonia congenita
2.Cl--myo.congenita and gen.myotonia

rem NaCa for periodic paralysis
1.Na--Hyperkalemic
2.Ca--Hypokalemic

PoCa for Episodic ataxia
K--type1
Ca--type2 nd 6

Henoch scholein purpura
mc leukocytoclastic vasculitis in children
cf arthalgia purpura abdominal pain

glycogen storage diaorder not seen im ms
type i =von gierke disease g6pd def ms dont contain g6pd enzyme

Mc cune albright synd
precious puberty multiple cystic bone lesions nerve deafness and endocrinopathies

Triad of Alports Syndrome
Sensorineural deafness
Progressive renal failure
Ocular anomalies

Triad of Behcet's Syndrome
Recurrent oral ulcers
Genital ulcers
Iridocyclitis

Beck’s Triad
Muffled heart sound
Distended neck veins
Hypotension

Charcot’s Triad
Pain + fever + jaundice

Gradenigos Triad
Sixth cranial n. Palsy
Persistent ear discharge
Deep seated retro orbital pain

Triad of Hypernephroma
Pain + hematuria + renal mass

Hutchinson’s Triad
Hutchison's teeth
Interstitial keratitis
Nerve deafness

Triad of Kwashiorkar
Growth retardation
Mental changes
Edema

Saint's Triad
Gall stones
Diverticulosis
Hiatus hernia

Trotter's Triad
Conductive deafness
Immobility of homolateral soft palate
Trigeminal neuralgia

Whipple's triad
symptoms consistent with hypoglycemia, a low plasma glucose concentration, relief of symptoms after the plasma glucose level is raised

Neuro blastoma
mc malignancy in infancy
origin =adrenals mediastinum neck
presents as abd mass calcifications on xray proptosis sutural separation and multiple skeltal secondaries

Among the inhalational agents max rise in ICT is with enflurane followed by Halothane and minimum in Isoflurane

Immotile cilia synd kartagener syn
              situs inversus bronchiestasis rhino sinusitis

opiods in spinal cord acts on substantia gelatinosa of dorsal horn cells

Colour synd
Red baby vancomycin
bronze baby phototherapy
grey baby chloramphenicol
blue eyes fair skin pku
blue sclera path fractures osteogensis imperfect

Dyslexia learning disability
alexithymia inability to recognise and describe feelings
Pseudoparalysois frog like position wimberger sign
white line of frankel seen in scurvy

Mtp act 1971
Transplantation act 1994
Nrhm started 5/4/2005
SYNDROMES...
• BROWN-SEQUARD SYNDROME: Damage(injury) to half of spinal cord ------> symptoms:Loss of pain and temperature sensation oncontra lateral side of body. Loss of proprioception and discriminatorytouch on ipsilateral side of body.

CARDIO Syndrome`s• FLOPPY-VALVE SYNDROME: MitralIncompetence due to myxomatous degenerationof theleaflets.

• LERICHE'S SYNDROME: Occlusion of distalaorta ------>Hip, thigh, and calf fatigue.Impotence

• BEHCET'S SYNDROME: Vasculitis ------>secondary symptoms:Oral and genital ulcersUveitisOptic atrophy

• SHOULDER-HAND SYNDROME: Pain inshoulder and swelling in hand, sometimes occurringafter Myocardial Infarction.

• SICK SINUS SYNDROME: Chaotic atrial activity;continual changes in P-Waves. Bradycardia,alternating with recurrent ectopic beats and runs oftachycardia.

• SUPERIOR VENA CAVA SYNDROME: Causedby a tumor. Obstruction of SVC ------>EdemaEngorgement of the vessels of face,neck, and arms.Nonproductive coughDyspnea

• TAKAYASU'S SYNDROME: Arteritis of theAortic Arch, resulting in no pulse. Seen in youngwomen.

• WOLF-PARKINSON WHITE SYNDROME:ECG pattern of Paroxysmal Tachycardia.Short PR intervalDelta wave = early QRS complex.IATROGENIC (or Secondary to Medical Treatment)

• ASHERMAN'S SYNDROME: Adhesionswithin the endometrial cavity, causingamenorrhea and infertility.Adhesions probably were caused bysurgery.

• CARCINOID SYNDROME: Carcinoid tumorproducing Bradykinin Serotonin ------>secondary symptoms:Cyanotic flushingDiarrheaBronchial spasmEdema, ascites.

• GARDNER'S SYNDROME: Multipleinherited tumors, hereditary dominant trait.Skull osteomas, Fibromas,EpidermoidcystsColonic polyposis (APC gene) ------>predisposition to colonicadenocarcinoma.

• LAMBERT-EATON SYNDROME:Progressive proximal muscle weaknesssecondary to a carcinoma.

• MEIGS' SYNDROME: Fibroma of ovary withascites and hydrothorax

• PANCOAST SYNDROME: Tumor nearpulmonary apex ------>Neuritic pain of chest and armMuscle atrophy of the armHorner's Syndrome (impaired cervical

• PEUTZ-JEGHERS SYNDROME: Polyposis(hamartomas) of small intestineAlso see melanin pigmentation of buccalmucosa and skin around mouth and lips

Some CONGENITAL Syndromes-

• CERVICAL SYNDROME: Supernumerary C7 rib ------> Pressure on brachial plexus ------> painradiating over shoulder, arm, and forearm over C7distribution.

• DIGEORGE SYNDROME: Congenital absence of3rd and 4th Branchial Arches (Thymus and ParathyroidGlands) ------> secondary symptoms:No cell-mediated immunity ------> Frequentviral and fungal infectionsCharacteristic facial deformities

• DOWN SYNDROME: Trisomy 21. Mentalretardation, characteristic facial features, Simeoncrease in hand.

• FANCONI'S SYNDROME Type I: Bone-marrowhypoplasia ------> refractory anemia, pancytopenia.

• FETAL ALCOHOL SYNDROME: Fetalmalformations, growth deficiencies, craniofacialanomalies, limb defects.

• GOODPASTURE'S SYNDROME: Autoantibodiesagainst basement membranes ------>Glomerulonephritis (kidney) and hemoptysis (lungs).Often, death by renal failure

• KLINEFELTER'S SYNDROME:Trisomy XXY ------> testicular atrophy, increase in gonadotropins inurine.

• LESCH-NYHAN SYNDROME:Deficiency ofHGPRT (Hypoxanthine-Guanine Phosphoribosyltransferase------>Hyperuricemia, uric acid kidney stonesChoreoathetosisMental retardation, autism, spasticcerebral palsyX-Linked recessive

• MARFAN SYNDROME: Connective Tissuedisorder ------>Arachnodactyly: Abnormally longdigits and extremitiesSubluxation of lensDissecting aortic aneurism

• TURNER'S SYNDROME: XO monosomy.DwarfismWebbed neckValgus of elbow.Amenorrhea

• WILSON SYNDROME: Congenital defect inCeruloplasmin, leading to buildup of copper ------> mental retardation, cirrhosis, hepatolenticulardegeneration.

ENDOCRINE, REPRODUCTIVE Syndrome• CONN'S SYNDROME: PrimaryHyperaldosteronism ------> muscular weakness,hypertension, hypokalemia, alkalosis.

• CUSHING'S SYNDROME: Hypersecretion ofcortisol ------> secondary symptoms andcharacteristics:o Fatness of face and trunk.

Sunday, 16 February 2014

Wells criteria

Well's criteria?
Clinical Characteristic Score
Previous pulmonary embolism or deep vein thrombosis + 1.5
Heart rate >100 beats per minute + 1.5
Recent surgery or immobilization (within the last 30 d) + 1.5
Clinical signs of deep vein thrombosis + 3
Alternative diagnosis less likely than pulmonary embolism + 3
Hemoptysis + 1
Cancer (treated within the last 6 mo) + 1
Clinical Probability of Pulmonary Embolism Score
Low 0-1
Intermediate 2-6
High ≥6

Saturday, 15 February 2014

Classification of inguinal hernias (Nyhus)

Type 1
Indirect hernia with normal internal ring

Type 2
Indirect hernia with dilated internal ring. Posterior wall intact

Type 3
Posterior wall defect

A
Direct inguinal hernia

B
Indirect inguinal hernia. Internal ring dilated. Posterior wall defective

C
Femoral hernia

Type 4
Recurrent hernia


Thursday, 13 February 2014

India census

Total population (India)� 1.21 billion

World Population- 7 billion

Sex ratio- all ages- 940 females/1000 males

Child sex ratio(0-6) � 914f/1000m

Sex ration in adult- 933/1000

Population density- 389/km2

Literacy rate- 74%
Male- 82%
Female- 65%

Life Expactancy M= 62.6 yr F=64.2 yr

Sample Resgistration Survey data- Birth Rate 22.5/1000midyearpopulation
Death Rate- 7.3/1000midyear population
Census Data- Birth rate-21.8/1000midyearpopulation
Death rate- 6.4/1000midyearpopulation

Infant mortality rate= 50/1000 live birth (highest in MP and Lowest in Goa)

MMR= 230/Lac live births(SRS data); 212/lac live birth(census)

TFR= 2.6

GRR= 1.3

NRR= 1.295

Placenta

Velamentous cord insertion is the insertion of the umbilical cord into the membranes of the placenta before reaching the placental margin

and it occurs in 1.5% of term singleton placentas;

. Velamentous cord insertion is associated with preterm labor-delivery, low birth weight, fetal growth restriction, abnormal intrapartum fetal heart rate patterns, low APGAR scores at 1 and 5 minutes, neonatal deaths and placental abruption [2, 3].

Furcate umbilical cord insertion is the separation of umbilical vessels prior to their attachment into the placenta. It is a very rare entity with the risk of intrapartum hemorrhage

🎋. Placenta accreta is the invasion of the decidual surface of the myometrium with placental villi.

Wednesday, 12 February 2014

Ect

💥Ect files💥

Effective non dom side
Premed-atropine/glycopyrolate
Produces gtcs fr 25-30sec
Pathway bet diencephalon n limbic systm
Dose- 110volt fr 0.6 sec
1600 ma curent
Modified ect-retrogde amnesia vth recvry in 6-9 mnth>anterograde amnesia resolve in 5 hrs
Direct ect-headache bodyache cmn fb incr ict n decr iot n t4 to t8 thoracic spine#;humerus n femur#
Not effct in chrnic schizo

Contrain in
Absol in raised ict eg brain tumour
Relatve r recent mi, sevre htn n pulm ds, pheochromo
cva n retinal detachment

indicn-
Major dep with suicidal stupor melanchil
Sevr fucn catatonia schizo
postpartum or sevre psychosis
delusional depression

ect incr productn of brain derv neurotropic factor bdnf cause new neuron genrn in hippocampus

🌞useful in depresve phase of mdp shorten duratn of depr episode

ect discovrd by cerletti n bini in 1938
modifid ect durng anesthsia

nonpsy indicn fr ect
parkinson ds vth rigidity n bradykinesia
intractable seizures
neuroleptic malig syndrome

spacing/intrvl
💥bi/ thrice weekly
💥6-12 deprsion
💥1-4 delrium n catatonia
💥8-20 fr mania n schizophrnia
al the best frnz

Ossification centres

Maxillary bone
5 ossification centres
🔹Alveolar
🔹Palatine
🔹Zygomatic
🔹Frontal
🔹Floor of orbit
Ethmoid bone
3 oss centres
🔹For each labyrinth
🔹Perp plate of eth
🔹Crista galli
frontal bone
2 oss centres
sphenoid bone
🔹Pre sph portion-6 oss centres
🔹Post sph part-8 oss centres

LARYNX&TRACHEOBRONCHI


********************************
AL TREE
********
4th wk laryngo tracheal tube- cranial portion forms larynx n trachea,caudal- right n left tracheal buds
caudal part of hypobr eminence-epiglottis
Laryn mucosa-endoderm
Laryn cartilage-mesenchyme
Arytenoid n corniculate-6th arch
Cuneiform-derivative of epigl
Thyroid-4th branchial arch
Cricoid&tracheal cartilage-6th arch-6wks
Bronchial tree fully dev at 6-10wks
Upper part of thy cart-4th arch
6th arch
🔹Lower part of thy cart
🔹Cricoid
🔹Corniculate cuneiform
🔹Intrinsic muscles of larynx
2nd arch
🔹Upper part of body of hyoid
🔹Lesser cornua
🔹Stylohyoid lig
3rd arch
🔹Lower part of body of hyoid
🔹Greater cornua
Alveoli develops after birth upto 8yrs
vocal cord
🔹Childhood-6mm n female,8mm in male
🔹adults-15-19mm female,17-23mm male

biomarkers of acute coronary syndrome

Emerging biomarkers of acute coronary
syndrome(not to be confused with predictors of CAD):
1.von willebrand factor(mediates platelet
adhesion)
2.Erythrocyte membrane bound IL-8(Increases
inflammatory response on release from
erythrocyte membrane during intraplaque
hemorrhage)
3.Platelet collagen receptor glycoprotein6(e
nhance platelet aggregability)
4.Linoleic acid (decreased levels associated
with high LDL chol)
5.Platelet bound stromal cell derived
factor1(mediate vascular and myocardial
remodelling).

Blood Banking

BLOOD- BANKING
SAGM additive solution provides
optimum red Cell viability
1) Sodium Chloride provides isotonicity
2) Adenine maintains ATP for red cell
viability
3) Glucose supports red cell metabolism
4) Mannitol helps reduce red cell lysis
• Shelf life (whole blood / red cells ) in :
1) ACD( acidified citrate dextrose) = 21
days
(> 70% transfused cells viable after 24
hours)
2) CPD( Citrate phosphate dextrose) = 28
days
3) Citrate Phosphate Dextrose Adenine
(CPDA) = 35 days
4) SAGM ( Saline Adenine Glucose
Mannitol)= 42 days
• Whole blood:
Storage temp.= 2-6 0c
1 unit raises Hb by ---1gm/dl and
haematocrit by 3%.
After collection from donor ,blood should
be processed for component separation
within 6 hrs
• Storage and duration
1) Whole blood / packed red cells--- 2-6
0c for 42 days
2) Platelets----22-24 0c for 3 days with
continuous agitation
3) Fresh frozen plasma---below -25 0c
for 1 year
4) Cryoprecipitate------ below -25 0c for
1 year
• Transfusion protocols:
Transfusion should commence within 30
minutes of removing blood bag from
refrigerator of blood bag.
(after that it will increase risk of bacterial
contamination)
1) Whole blood /packed rbc --
transfusion must be completed within 4
hrs.
2) Platelet and FFP----within 20
minutes.
Transfusion set should have standard
filter of 170 micron meter pore size
Usual needle size =18-19 gauge
Not necessary to warm blood before
transfusion
Patient should be monitored during 1st
15 minutes, following this every hour, at
the end and after 4 hrs after end of
transfusion.

Tuesday, 11 February 2014

1.Halls criteria : Downs syndrome 2.Dukes criteria:
Endocarditis/Heart failure
3.Butchers criteria :mesothelioma
4.Ann Arbours classifiacation :Hodgki.s lymphoma
5.Bismuth classification: tumors of hepatic ductal
system 6.Nazers Index: Wilsons disz
7.Pagets Index : Abruptio placentae
8.Quetlet index: BMI -wt in kg/ht in meter square
9.Ponderial Index: ht in cm/cube root of body wt in
kgs 10.Brocas index : Ht in cms-100 11.Corpulence
index : Actual wt/desired wt 12.Milans crjteria: for liver transplant in HCC
13.Mayers n cottons grading system: Subglottic
stenosis
14.Spaldings criteria: abdominal pregnancy 15.GCS/
Ransons criteria/APACHE score: Pancreatitis
16.Ennekings staging : Bone tumors 17.Mc Donald's criteria: Multiple Sclerosis
18.Epworths criteria : Sleep apnea
19.Framminghams criteria/Boston's criteria: CHF
20.Durie salmon system of staging: Multiple
myeloma
21.Lights criteria: pleural effusion 22.GOLD's criteria :COPD 23.OKUDA staging : HCC 24.Child's
Turcott pug score/MELD/PELD- Cirrhosis

Glycosaminoglycans

distribution of various glycosaminoglycans:

1. hyaluronic acid-
synovial fluid
vitreous humor
loose connective tissue

2.chondroitin sulfate-
cartilage
bone
cornea

3. keratan sulfate I :
cornea

4. keratan sulfate II :
loose connective tissue

5. heparin-
mast cells

6. heparan sulfate-
skin fibroblasts,
aortic wall

7. dermatan sulfate-
has wide distribution

Red flag signs of low backache

-progressive neuro deficit
-saddle anaesthesia
-loss of anal tone
-bowel bladder incontinence
-thoracic pain
-age less than 16 n more than 50yr
-previous h/o malignancy
-prolonged steroid use
-HIV

Tumors that metastasize to skin 

-Breast
-Lung 
-Ovary
-Colon
-Kindney
Mn: BLOCK

Lovsets maneuvre for extended arms
Pinards maneuvre for extended legs
Marshall burn and mauriceau smellie viet for aftercoming head
Pipers forceps used in breech
MCC of breech-prematurity
MC type of breech-frank/extended
Cord prolapse MC in footling type
MC type in primigrav-extended
MC type in multipara-flexed
Chin to pubis -prague maneuvre
Baby pushed back into uterus and LSCS-zavanelli maneuvre
Impacted breech in incompletely dilated cx-duhrssens incision

Suspensory ligament of axilla - Gerdy's
ligament

Suspensory ligament of duodenum -
ligament of Treitz

Suspensory ligament of eyeball -
Lockwood's ligament

Suspensory ligament of lens - zonule of
Zinn or zonular fibre

Opth

🌂Sudden painless loss of vision
🔺Central retinal artery occlusion
🔺Massive vitreous haemorrhage
🔺Retinal detachment involving macular area 🔺Ischacmic central retinal vein occlusion

🌂Sudden painless onset of defective vision
🔺Central serous retinopathy
🔺Optic neuritis
🔺Methyl alcohol amblyopia
🔺Non-ischacmic central retinal vein occlusion

🌂Sudden painful loss of vision
🔺Acute congestive glaucoma
🔺Acute iridocyclitis
🔺Chemical injuries to the eyeball
🔺Mechanical injuries to the eyeball

🌂Gradual painless defective vision 🔺Progressive pterygium involving pupillary area 🔺Corneal degenerations 🔺Corneal dystrophies 🔺Developmental cataract 🔺Senile cataract
🔺Optic atrophy 🔺Chorioretinal degenerations
🔺Age-related macular degeneration
🔺Diabetic retinopathy 🔺Refractive errors

🌂Gradual painful defective vision

🔺Chronic iridocyclitis 🔺Corneal ulceration 🔺Chronic simple glaucoma

🌂Transient loss of vision (Amaurosis fugax)
🔺Carotid artery disease 🔺Papilloedema
🔺Giant cell arteritis 🔺Migraine
🔺Raynaud’s disease 🔺Severe hypertension 🔺Prodromal symptom of CRAO

🌂Night blindness (Nyctalopia )
🔺Vitamin A deficiency 🔺Retinitis pigmentosa and other tapetoretinal degenerations
🔺Congenital night blindness
🔺Pathological myopia 🔺Peripheral cortical cataract
🌂Day blindness (Hamarlopia)
🔺Central nuclear or polar cataracts
🔺Central corneal opacity 🔺Central vitreous opacity 🔺Congenital deficiency of cones (rarely)

🌂Diminution of vision for near only
🔺Presbyopia
🔺Cycloplegia
🔺Internal or total ophthalmoplegia 🔺Insufficiency of accommodation
Whch antigen of salmona used in Epidemiological typimg???

Interleukin

Il 2 growth factor for T cepp
Il 4 stimulates diffn to Th2 pathway
Il 12 stimulates diffn to TH1 PATHWAY
IL 15 stimulates growth n activity of NK cells
IL 10 n tgf beta dwnregulates immune cells
Il 2 &15 stimulates growth n prolifern of nk cells
Il 12 stimulates NK cells to secrete IFN gamma
IFN gamma cause macrophage activn
Pyrogenic cytokines il 1 il 6 ifn alpha TNK ciliary neurotrophic factors

Malaria

MALARIA
• Six primary Malaria vectors in India:
o Anopheles culicifacies: Rural and peri-urban areas [Species A-P, vivax & P, falciparum; Species B-
P.falciparum]
o Anopheles stephensi : Urban and industrial areas
o Anopheles fluviatilis: Hilly, forest and forest fringe areas
o Anopheles minimus: Foot-hills of NE states
o Anopheles dirus : Forests of NE states
o Anopheles epiroticus: Andaman & Nicobar islands
• Diagnosis of Malaria in India:
o Microscopy: Thick smear (High sensitivity in searching for parasite, parasite load estimation) + Thin file (for species identification, stages)
o Serological testing: Malaria Fluorescent Antibody Test (MFAT) becomes +ve after 2 weeks of
infection (not indicative of current infection)
o Rapid diagnostic test (RDT): Detect circulating parasite antigens.
MALARIA GUIDELINES 2010
• Active intervention measures for Malaria control:
o Micro-stratification of problem
o Vector control strategies
1) Anti-adult measures: Indoor residual spray (DDT/ Malathion,Fenitrothion), Space
2) Anti-larval measures: Larvicides (temephos), Source reduction, Integrated control.
• Changes in WHO recommendations for Malaria control [2010] :
Parasitological confirmation must before t/t
FIVE ACT’s recommended by WHO
1) Arthemether + Lumefanthraine
2) Artesumate + Amodiaquine
3) Artesunate + Mefloquine
4) Artesunate +Sulphadoxine Pyrimethamine
5) Dihydroarthimisinin + Piperaqunie
Integrated Community Case Management is pivot now for t/t of malaria
o Artemisin derivatives should not be used as monotherapies for uncomplicated malaria
o Single dose of Primaquine (anti- gametocyte) added to ACT treatment of P, falciparum.

Psychiatry

✒Johann weyer-father of psychiatry
✒Gockel-coined psychology
✒Leo kanner-childhood autistic disorder
✒Carl gustav jung-introvert n extrovert-analytical psychology
✒Jean piget-childhood devlpmt&milestones
✒Johann christiam reil- coined psychiatry
✒Alfred adler-sup&inf complexes
✒Jones maxwell-alcoholics anonymous
✒Hecker ewald-1st described heb scz
✒Hippocrates-father of medicine
✒Emil kraeplin-father of modern psychiatry,Scz,MDP,alzheimers
✒Peirre janet-psychasthenia
✒Eugene bleuler-dementia precox
✒Pavlov-classical condtng
✒Skinner-founder of operant condtng
✒Kahlbaum karl-catatonic scz,cyclothymia
✒Anna freud-ego n mechanisms of defence except repression regression sublimatn
✒Carl koller-cocaine
✒Cohen-poetically described datura poisoning
SIGMUND FREUD-free associatn, electra edipus complexes, psychoanalysis, pleasure&reality principle,ego defence mechanisms-rep reg sub,interpretation of dreams
✒Franz alexander-father of psychosomatic meds
✒George miller-neurasthenia
✒Alfred binet-intelligence scale
✒James braid-hypnosis
✒William cullen-coined neurosis
✒Ernst von-coined psychosis
✒Erik erikson-stages of life
✒Beck-cognitive theory
✒William osler-modern medicine
✒Leo kanner-oprerant cntng-reinforcement&punishment

Most common

Most Commons in Medicine
M/c congenital anomaly of GI tract- Meckel's diverticulum
M/c C.N. to b paralysed in Malignant Otitis Externa- Facial N.
M/c malignancy of Endocrinal system- Thyroid carcinoma
M/c systemic association of scleritis- RA
M/c side effect of ketamine- Hallucination(auditory n visual)
M/c site of leiomyoma- Stomach
M/c primary for kruckenberg tumour aises from- Stomach
M/c site for sister Mary Joseph nodule- Stomach
M/c conduit for transplant after esophagectomy- Stomach
MCC of death in PNH : Thrombosis
MCC of death in polycythemia vera : Pulmonary thromboembolism
MCC of death in klienfelters: Infections
MCC of death in Downs : Cardiac defects
MCC of death in Amyloidosis: Renal failure
MCC of death in cirrhosis: HRS

Most common organisms

meningitis

neonatal--group b streptococcus
children--neisseria(meningococcus)
adults--e.coli

pneumonia

neonates &children--group b streptococci
adults--streptococcus pneumonia
nosocomial-gram -ve bacilli
icu--pseudomonas

sepsis

early onset-group b streptococcus
late onset--coagulase negative staphylococci

endocarditis

prosthetic valve - staph aureus,candida
native valve-staph aureus
iv drug abusers--staph aureus

1.Most common site of oral cancer
among Indians - Alveobuccal
complex .
(Buccal mucosa>Anterior
tongue>Lower alveolus) .
Most common site of oral cancer worldwide - Lip
2.Most common malignant tumor
of adult males in India -
Oropharyngeal Ca.
3.Most common site of intestinal
obstruction in Gall stone ileus -ileum (ileocaecal valve) .
4.Most common cause of non
gonococcal urethritis - Chlamydia
trachomatis .
5.Most common inherited
blindness due to mitochondrial chromosomal anomaly -
Leber's hereditary optic
neuropathy .
6.Most common cause of tricuspid
regurgitation is 2ndary -Dilatation
of rt.ventricle and Tricuspid annulus .
7.Most common presentation of
neurocysticercosis - Seizures .
8.Most common cuase of sporadic
viral encephalitis - HSV I
Most common cause of epidemic viral encephalitis- Arbovirus .
Most common cause of viral
meningitis/encephalitis - Enteroviris .
9.Most commonly injured nerve
during McBurney's incision - Iliohypogastric .
Most common hernia following
McBurney(Grid iron) incision -
Rt.inguinal .
10.Most common cause of
obliterative stricture of membranous urethra -RTA with
Fracture pelvis and rupture
urethra .
Most common cause of bulbar
urethral stricture- Gonococcal
infection . Fall astride injury usually involves
Bulbar urethra.
Prolonged catheterization may
involve any part of urethra .
11.Most common cause of
abdominal mass in neonates- Multicystic renal dysplasia .
12.Most common primary intra
ocular tumor in 5th/6th decade -
Malignant melanoma .
13.Most common cause of
recurrent genital ulcer in males - Herpes genitalis .
14.most commonly affected organ in
Amyloidosis - Kidney>Heart .
Most common cause of death in
Amyloidosis - CARDIAC
15.most comon stain used-congo red1.Most common tumor of
salivary glands - Pleomorphic
Adenoma .
2.Most common site of Peptic ulcer - 1st part of duodenum .
3.Most common site of GOO/
stenosis in peptic ulcer - 1st part of
duodenum .
4.Most common genetic cause of
liver disease in children -
5.Most common cause of
ambiguous genetalia in newborn-
Congenital adrenal hyper
plasia due to 21 hydroxylase
deficiency
6.Most common cause of female pseudo hermaphroditism -
Congenital adrenal hyper
plasia due to 21 hydroxylase
deficiency .
7.Most common genital prolapse -
Cystocoele .
8.Most common cause of Carpel
tunnel syndrome - Idiopathic .
9.Most common nerve involved
in fracture of surgical neck of
humerus- Axillary nerve .
10.Most common etiological agent of Acute osteomyelitis - Staph
aureus .
Most common site of Acute
osteomyelitis - Metaphysis .
Earliest sign to appear on X-ray -
Periosteal new bone formation . 11.Most common cause of Acute
otitis media in children -
Streptococcus pneumoniae .
12.Most common fungal infection
in febrile neutropenia - Candida .
13.Most common site of osteogenic sarcoma - Lower end of femur .
14.Most common cause of Tinea
capitis - Trichophyton tonsurans .
15.Most common cause of U/L
parotid swelling in young adult-
Pleomorphic Adenoma.

267.Most common form of
Xeroderma pigmentation is due to -
Absence of UV specific
Endonuclease .
16.Pond fracture is most
commonly seen in - Children(due to elasticity of skull bones) .
17.Ring fracture(around foramen
of Magnum) is most commonly-
Direct violence .
18.Most common manifestation of
Mumps - Parotitis(Bilateral) . (70-90%)
Most common manifestation(after
parotitis) in post pubertal males -
Orchitis .(30%)
Most common manifestation(after
parotitis) in females - Oopheritis (5%)
Most common manifestation(after
parotitis) in children - Aseptic
meningitis .
19.Most common cause/form of
Thyoiditis -Hashimoto's thyroiditis
20.Most common surgical cause of
Obstructive jaundice - CBD stone .

Most common cause of Hypergonadotrophic Hypogonadism in males- Klinefelter’s syndrome.
Most common Renal vascular Anomaly -Supernumerary renal arteries.
Most common site of Urethral carcinoma in men-Bulbomembranous urethra .
Most common Histological subtype of Urethral carcinoma-Squamous cell Ca .
Most common cysts of the spleen –Hydatid cysts .
Most common cause of Abdominal aortic Aneurysm – Atherosclerosis .
Most common cause of Meningoencephalitis in children – Enterovirus
Most commom cause of neonatal sepsis in india- klebsiella
most common cause of neonatal sepsis in western- E.coli

Most common cause of morbidity and mortality in patient undergoing major vasculr surgery is CARDIAC COMPLICATIONS....

Most common cause of sporadic viral encephalitis is HSV-1
Most common cause of viral meningitis or aseptic meningitis is ENTERO VIRUS
MOST COMMON CAUSE OF EPIDEMIC OF VIRAL MENINGITIS IS ARBOVIRUSES
Most common cause of neonatal sepsis in hospitals in India is KLEBSIELLA
The MOST COMMON abnormal opthalmoscopic findings on fundoscopy in AIDS pt r COTTON WOOL SPOTS.....
MOST C/M severe ocular complication of AIDS is CMV RETINITIS.....

MOST C/M cause of NOSOCOMIAL inf is STAPH. AUREUS.......
MOST C/M cause of TRAVELLER'S DIARROHEA is ENTEROTOXIGENIC E.COLI
MOST C/M sinusitis in children is ETHMOIDAL......
MOST C/M sinusitis in adults is MAXILLARY.....
MOST C/M Site of ca tongue is MIDDLE OF LATERAL BORDER or VENTRAL ASPECT of tongue....
MOST C/M MALIGNANT TU of adult males in india-ORAL CANCER
MOST C/M MALIGNANT TU of adult males in WORLD IS-LUNG CA
MOST C/M MALIGNANT TU of female in india is - CA CERVIX
MOST C/M MALIGNANT TU OF female in WORLD IS -CA BREAST
MOST C/M organism for ACUTE OTITIS MEDIA IN ANY AGE GROUP ID- STREPT PNEUMONIAE>H.INFLUENZA>M.CATARRHALIS.........
Most common indication for splenectomy is splenic trauma....

Most common cause of cholangitis is CBD stone....
Most common cause of pancreatitis is gall stone....
Most common cause of pancreatic pseudocyst is pancreatitis......
mc c/c myeloproliferative d/s --Polycythemia vera
mc cause of stroke -- Embolism
mc of RBC enzyme def. -- G6PD def.
mc variant of HL in INDIA -- Mixed cellulatity
Mc urinary fistula-VESICOVAGINAL Mc cause of VESICOVAGINAL FISTULA in india- Obstructed labour
Mc side effect of IUCD- BLEEDING 2ND MC side effect is PAIN
Mc site of ENDOMETRIOSIS is Ovary ..2nd mc site is POUCH OF DOUGLAS
Mc cause of Post menopausal bleeding in DEVELOPED COUNTRIES is -CA ENDOMETRIUM... Mc cause of post menopausal bleeding in DEVELOPING COUNTRIES(INDIA) is- CA CERVIX
Mc site of genital TB-FALLOPIAN TUBE.. Mc symptom of genital TB is INFERTILITY
Most common lobe involved in BPH is MEDIAN.... Mc long term complication of TURP IS RETROGRADE EJACULATION

Bartter’s Syndrome
Pathophysiology: Described in 1962 by Bartter. Autosomal recessive disorder. Genetic defect involving the transporter’s in the thick ascending limb of the glomerulus. Defects in Na-K-2Cl cotransporter, K or Cl channels result in lack of concentrating ability.
Clinical presentation: Early in life. Often with sensorineural deafness (has to due with potassium-secreting dark cells of inner ear), triangular facies with drooping mouth and large eyes and pinnae, and renal failure. Pts c/o polyuria and polydi psia.
Lab data: Chloride resistant metabolic alkalosis and hypokalemia (due to increased distal flow causing hyperaldo state and wasting of potassium and hydrogen). Normal serum magnesium. Hypercalciuric so at risk for kidney stones.

Deadly night shade- atropine
Gods own medicine- morphine
Black beauty-
amphetamine
Blue devil amobarbital
Mother pearl -Heroine
School boy-codeine

IPC Section

-Important IPC sections from forensic

IMPORTANT IPC SECTIONS
44. Injury
82. Act of a child under seven years of age
83. Act of a child above seven and under twelve of immature understanding
84. Act of a person of unsound mind
85. Act of a person incapable of judgment by reason of intoxication caused against his will
86. Offence requiring a particular intent of knowledge committed by one who is intoxicated

IPC SECTIONS RELATED TO CONSENT
87. Act not intended and not known to be likely to cause death or grievous hurt, done by consent 
88. Act not intended to cause death, done by consent in good faith for person's benefit
89. Act done in good faith for benefit of child or insane person, by or by consent of guardian
90. Consent known to be given under fear or misconception
91. Exclusion of acts which are offences independently of harm caused
92. Act done in good faith for benefit of a person without consent
SECTIONS RELATED TO FALSE EVIDENCE/ FALSE CERTIFICATES
191. Giving false evidence (Perjury)
192. Fabricating false evidence
193. Punishment for false evidence (Perjury)
194. Giving or fabricating false evidence with intent to procure conviction of capital offence
195. Giving or fabricating false evidence with intent to procure conviction of offence punishable with
imprisonment for life or imprisonment 
196. Using evidence known to be false
197. Issuing or signing false certificate
198. Using as true a certificate known to be false
199. False statement made in declaration which is by law receivable as evidence
200. Using as true such declaration knowing it to be false
201. Causing disappearance of evidence of offence, or giving false information to screen offender
202. Intentional omission to give information of offence by person bound to inform- The doctor knowing
or having the reason to believe that an offence has been committed by a patient whom he is treating,
intentionally omits to inform the police, shall be punished with imprisonment upto 6 months.
203. Giving false information respecting an offence committed
204. Destruction of document or electronic record to prevent its production as evidence
IPC SECTIONS RELATED TO MURDER, SUICIDE ETC
299. Culpable homicide, definition.
300. Murder, definition
302. Punishment for murder
304. Punishment for culpable homicide not amounting to murder
304A. Causing death by negligence,punishment upto 2 years.
304B. Dowry death, punishment upto 7 years.
305. Abetment of suicide of child or insane person
306. Abetment of suicide
307. Attempt to murder
308. Attempt to commit culpable homicide
309. Attempt to commit suicide

SECTIONS RELATED TO ABORTION
312. Causing miscarriage
313. Causing miscarriage without woman's consent
314. Death caused by act done with intent to cause miscarriage-
315. Act done with intent to prevent child being born alive or to cause it to die after birth
316. Causing death of quick unborn child by act amounting to culpable homicide
317. Exposure and abandonment of child under twelve years, by parent or person having care of it.
318. Concealment of birth by secret disposal of dead body.
SECTIONS RELATED TO HURT AND GRIEVOUS HURT 
319. Hurt.
320. Grievous hurt.
321. Voluntarily causing hurt.
322. Voluntarily causing grievous hurt.
323. Punishment for voluntarily causing hurt
324. Voluntarily causing hurt by dangerous weapons or means 
325. Punishment for voluntarily causing grievous hurt
326. Voluntarily causing grievous hurt by dangerous weapons or means
328. Causing hurt by means of poison, etc. with intent to commit an offence
SECTIONS RELATED TO TORTURE
330. Voluntarily causing HURT to extort confession, or to compel restoration of property is punishable
for imprisonment upto SEVEN YEARS
331. Voluntarily causing GRIEVOUS HURT to extort confession, or to compel restoration of property
punishable for imprisonment upto TEN YEARS
339. Wrongful restraint
340. Wrongful confinement.
341. Punishment for wrongful restraint
342. Punishment for wrongful Confinement
343. Wrongful confinement for three or more days
344. Wrongful confinement for ten or more days
345. Wrongful confinement of person for whose liberation writ has been issued
346. Wrongful confinement in secret
347. Wrongful confinement to extort property, or constrain to illegal act
348. Wrongful confinement to extort confession, or compel restoration of property
351. Assault
352. Punishment for assault or criminal force otherwise than on grave provocation
353. Assault or criminal force to deter public servant from discharge of his duty
354. Assault or criminal force to woman with intent to outrage her modesty
355. Assault or criminal force with intent to dishonour person, otherwise than on grave provocation
356. Assault or criminal force in attempt to commit theft of property carried by a person
357. Assault or criminal force in attempt wrongfully to confine a person
358. Assault or criminal force on grave provocation
359. Kidnapping
360. Kidnapping from India
361. Kidnapping from lawful guardianship
362. Abduction
363. Punishment for kidnapping
363A. Kidnapping or maiming a minor for purposes of begging
364. Kidnapping or abducting in order to murder
364A. Kidnapping for ransom, etc.
365. Kidnapping or abducting with intent secretly and wrongfully to confine person
366. Kidnapping, abducting or inducing woman to compel her marriage,etc.
366A. Procreation of minor girl 
366B. Importation of girl from foreign country
367. Kidnapping or abducting in order to subject person to grievous hurt, slavery, etc.
368. Wrongfully concealing or keeping in confinement, kidnapped or abducted person
369. Kidnapping or abducting child under ten years with intent to steal from its person
372. Selling minor for purposes of prostitution, etc.
373. Buying minor for purposes of prostitution, etc.
374. Unlawful compulsory labour
375. Rape
376. Punishment for rape
376A. Intercourse by a man with his wife during separation
376B. Intercourse by public servant with woman is his custody
376C. Intercourse by superintendent of jail, remand home, etc.
376D. Intercourse by any member of the management or staff of a hospital with any woman in that
hospital
377. Unnatural offences
493. Cohabitation caused by a man deceitfully inducing a belief of lawful marriage
494. Marrying again during lifetime of husband or wife
495. Same offence with concealment of former marriage from person with whom subsequent marriage is
contracted
496. Marriage ceremony fraudulently gone through without lawful marriage
497. Adultery
498. Enticing or taking away or detaining with criminal intent a married woman
498A. Husband or relative of husband of a woman subjecting her to cruelty
509. Word, gesture or act intended to insult the modesty of a woman
510. Misconduct in public by a drunken person

Fm

Mickey Finn is chloral hydrate
Hot shot--

Opium+ strychnine
Speed ball = cocaine + heroine
Amphetamine also known as speed whiz
Amyl nitrate-Gold rush,poppers
Amphetamine - also - liquid gold
Knock out drops - chl hydrte
Angel dust - phencyclidine
Special k - ketamine
Methadone - mud
White heroine- China white
amotivational syndrome-marijuna/canabis

Monday, 10 February 2014

 Gestational Diabetes Screening
should be performed between 24 and 28 weeks in those women
not known to have glucose intolerance earlier in pregnancy.

🔹This evaluation is usually done in two steps. In the two-step
procedure, a 50-g oral glucose challenge test is followed by a
diagnostic 100-g oral glucose tolerance test (OGTT) if initial
results exceed a predetermined plasma glucose concentration.

🔹Plasma glucose level is measured 1 hour after a 50-g glucose
load without regard to the time of day or time of last meal.

🔹 A value of  140 mg/dL (7.8 mmol/L) identifies 80 percent of all
women with gestational diabetes.

🔹 Using a value of  130
mg/dL (7.2 mmol/L) increases the yield to greater than 90 percent.

🔹However, 20 to 25 percent of women will have false positive
test results compared with only 14 to 18 percent when the
 140 mg/dL cutoff value is used.

Features

Aviator#-neck of talus–due to Dorsiflexation
Bankarts#–anterior glenoid–shoulder abduction
and ext rotation
Bartons#–distal radius with radio carpal
dislocation
Bennets#–1st metacarp–pull of abductor pollicis
longus
Boxer#-5th metacar-punching
Boxworht#–distal fibula due to foot extern
rotation
bumper#–lat condy of tibia due to forced valgus
of knee
Chance#–horizontal # of vert body
Chaueffuer#–radial styloid
Chopart#—joints involved
1)talonav
2)cal-cub due to ankle twist–rx -non weight bear
cast
Clay shovel#—c6c7T1 spinous process avulsion
Colles–also distal radius but with dorsal
angulation,ipaction and radial drift
Cottons#–trimalleolar # of ankle
Duverny#-iliac wing#
Essex lopresti–radius head +inteross memb
+distal radio ulna jt
Gallezia–radius shaft+distal radio ulna jt
Gosselin-distal tibia#
Hangman–pedicles of c2–neck extension
Hill sach–post humeral head
Holdsworth#–thoracolumbar dislocation of
vertebrae
Hume—-olecranon#
Jefferson#– burst # of c1
Jones#–base of 5th Metatarsal– per brevis
muscle pull due to inversion
Le fort–distal fibula + medial mall avulsion
Lis franc–midfoot # and disloc
Maisonneuve#—spiral# of prox fibula
Malgaignes#—vertical pelvic #
March #–2nd 3rd metatars—shaft
Montagia–prox ulna +dislocation of radial head
Moores–distal radius + ulnar dislocation
Pilon#–distal fibula with communited articular #
Pipkin #– post dislocation of hip wid femoral
head avulsion due to lig teres
Potts–bimalleolar# of ankle
Rolando-t shape or y shape # of 1st MC(benetts
is also 1st MC)
Runner#- stress# of distal fibula
Salter harris__growth plate#
Segonds#–ACL tear +lateral tibial plateua
avulsion
Shepard#-lat tubercle of posterior process of
talus
Smith#–distal radius with volar displacement
Steidia #–medial femo condyle avulsion near
MCL
Teillaux#–salter harris # of tibia
Toddler#–distal tibia# –spiral undisplaced for
under 8yr old

Anticoagulation solutions

Anticoagulation solutions
Acd...21 days
Cpd...28 days
Cpd a...35 days
Cpd a and SAGM...42 days

Lung sounds

💨Lung Sounds: Differential Diagnosis

☑Rales(crackles)
🔺Simulated by rolling hair near ear between two fingers.
🔺Best heard on inspiration in lower bases.
🔺Unrelieved by coughing.
🔺Associated with bronchitis, CHE and pneumonia.

☑Wheezes
🔺High—pitched, squeaky sound.
🔺Best heard on expiration over all lung fields.
🔺Unrelieved by coughing.
🔺Associated with asthma, bronchitis, CHF, and emphysema.

☑Rhonchi
🔺Coarse, harsh, loud gurgling.
🔺Best heard on expiration over bronchi and trachea.
🔺Often relieved by coughing.
🔺Associated with bronchitis and pneumonia.

☑Stridor
🔺Harsh, high—pitched, audible sound.
🔺Easily heard without stethoscope during inspiration and expiration

Intestine malabsorption tests

Best test for intestinal malabsorption? D Xylose test

Best test for generalised malabsorption? Fecal fat estimation

Gold std for fat maabsorption? Fecal fat estimation

Test to diagnose pancreatic exocrine def?NBT PABA test

Test to detect B12 malabsorption? SCHILLING test

Staging

Ann Arbor staging @ Lymphoma

DUKES Colon ca
Clark & BreslowMelanoma
Butchart Mesothelioma
Durie Salmon Multiple myeloma
Evans  Neuroblastoma
Robson Renal cell ca
Gleason  Prostate
Rye Hodgkins
Modified Bell's Necrotising Enterocolitis

Named Surgeries

Hard plaque of corpora
cavernosa
peyronies
Nesbitts operation for peyronies

Swensons op hirschprungs

Jones Tendon transfer of radial N
palsy

Duhamel hirschprung

Soave n park op hirschprungs

Delormes op rectal prolapse

Sistrunks thyroglossal fistula

Ramstedt CHPS

Billroth 1 gastric ulcer

Milligan morgan hemorroidectomy

Mayos op umbilical hernia

Nesovic op sports hernia

Cheatle henry op obturator hernia

Sebrocks op parotid duct fistula

Bentalls op aortic root aneurysm repair

Belsey mark 4 op hiatus hernia

Hill's op hiatus hernia
Psoas hitch op ureteral inj

Opthalmology points

Most sensitive part retina - fovea centralis
Most thinnest part retina - ora serrata
Most radiosensitive part retina - rods nd cones
Most radiosensitive part eye - lens
Most radioresistant part eye - sclera
Most radioresistant part retina - ganglion cells
Radiation cataracts are posterior subcapsular

Syndrome

Pigmentation syndromes
#LEOPARD syndrome
Lentigines
ECG abn
Ocular hypertelorism
Pulmonary stenosis
subAortic valvular stenosis
Abnormal genitalia
Retardation of growth
Deafness

#LAMB syndrome
Lentigines
Atrial myxomas
Mucocutaneous myxomas
Blue nevi

#NAME syndrome
Nevus
Atrial myxomas
Myxoid neurofibroma
Ephelides

#CALM syndrome
Cafe au lait spots
Atrial myxomas
Lentigines
Myxoid neurofibroma

Cranial Nerves

Tolosa hunt(SOF) 3,4,5,6

Gradenigo(apex of petrous bone) 5,6

Acoustic neuroma(int audit meatus) 7,8

Raymond syndrome(jugular foramen) 9,10,11

Horners(retropharyngeal space) 9,10,11,12

Foramen ovale mandibular

Foramen rotundum maxillary

Foramen spinosum middle meningeal artery

Vidian canal vidian nerve

Carotid canal ICA
Jugular foramen IJV, 9,10 11

Stylomastoid foramen 7

Hypoglossal canal 12

Vitamin deficiencies

MARKERS OF VITAMIN DEFICIENCIES

B1 RBC transketolase
B2 RBC glutathione peroxidase
B6 Urine xanthurenic acid
Folic acid Urine FIGLU
B12 Urine methylmalonic acid

🔎Racquet cells are seen in??
Rhadomysarcma

🔎tennis racket cells
LCH

Banding

•Types of banding in cytogenetics

▪G-banding - obtained with Giemsa stain following digestion of chromosome with trypsin. The dark regions tend to be heterochromatic, late replicating AT rich and inactive. The light regions tend to be euchromatic , early replicating and GC rich

▪R-banding - reverse of G-banding(R stands for reverse)

▪C-banding - stains Centromeres

▪Q-banding - fluoresecent pattern obtained using quinacrine for staining. Pattern of bands is very similar to that seen in G-banding

▪T-banding - visualize telomeres

Channel defects

Channel defects -

1]gordon's syndrome - chloride channel defect leading to hyper kalemia and hypertension

2]bartters syndrome - epithelial sodium channel defect

3]morwan's syndrome - potassium channel defect

4]dravet syndrome - voltage gated sodium channel

Ring enhancing

Causes of Cerebral Ring Enhancing lesions
"MAGIC DR"

M-Metastasis
A-Abscess(including tuberculoma)
G-Glioblastoma multiformae
I-infarct(Subacute phase)
C-contusion
D-Demyelinating disease (eg:tumefactive MS)
R-Radiation necrosis

Opth

🌂Sudden painless loss of vision
🔺Central retinal artery occlusion
🔺Massive vitreous haemorrhage
🔺Retinal detachment involving macular area 🔺Ischacmic central retinal vein occlusion

🌂Sudden painless onset of defective vision
🔺Central serous retinopathy
🔺Optic neuritis
🔺Methyl alcohol amblyopia
🔺Non-ischacmic central retinal vein occlusion

🌂Sudden painful loss of vision
🔺Acute congestive glaucoma
🔺Acute iridocyclitis
🔺Chemical injuries to the eyeball
🔺Mechanical injuries to the eyeball

🌂Gradual painless defective vision 🔺Progressive pterygium involving pupillary area 🔺Corneal degenerations 🔺Corneal dystrophies 🔺Developmental cataract 🔺Senile cataract
🔺Optic atrophy 🔺Chorioretinal degenerations
🔺Age-related macular degeneration
🔺Diabetic retinopathy 🔺Refractive errors

🌂Gradual painful defective vision

🔺Chronic iridocyclitis 🔺Corneal ulceration 🔺Chronic simple glaucoma

🌂Transient loss of vision (Amaurosis fugax)
🔺Carotid artery disease 🔺Papilloedema
🔺Giant cell arteritis 🔺Migraine
🔺Raynaud’s disease 🔺Severe hypertension 🔺Prodromal symptom of CRAO

🌂Night blindness (Nyctalopia )
🔺Vitamin A deficiency 🔺Retinitis pigmentosa and other tapetoretinal degenerations
🔺Congenital night blindness
🔺Pathological myopia 🔺Peripheral cortical cataract
🌂Day blindness (Hamarlopia)
🔺Central nuclear or polar cataracts
🔺Central corneal opacity 🔺Central vitreous opacity 🔺Congenital deficiency of cones (rarely)

🌂Diminution of vision for near only
🔺Presbyopia
🔺Cycloplegia
🔺Internal or total ophthalmoplegia 🔺Insufficiency of accommodation
Whch antigen of salmona used in Epidemiological typimg???

Larynx appearances

Larynx appearances

mouse nibbled- tb
wash leather appearance-syphilis
knob like epiglottis- leprosy
v shaped epiglottis- lupus

🔹376 A:: punishment for causing death or resulting in
persistent vegetative state of victim. (min 12 yrs max
life imprisonment or death)
🔹376 B ::sexual intercourse by husband upon his wife
during separation (min 2yrs max 7yrs punishment)
🔹376 C:: sexual intercourse by a person in authority
like public servant,management of hospital (min 5yrs
max 10 yrs)
🔹376 D:: GANG RAPE (min 20 yrs max life or death
sentence)
🔹376 E:: Punishment for repeat offenders life
imprisonment or death sentence
🔹354 A:: sexual harassment
🔹354 B:: assault or use of criminal force to women
with intent to disrobe
(min 3yrs max 7yrs punishment)
🔹354 C:: peeping tom or voyeurism
(min 3yrs max 7yrs)
🔹354 D:: stalking
(1st time 3yrs 2nd time upto 7yrs)
upcoming aiims questions
🔹326 A:: voluntary causing grievous hurt by using acid
(min 10yrs max life imprisonment)
🔹326 B:: voluntary throwing or attempting to throw
acid (min 5yrs max 7yrs)

Bacteriology

❄friedlander's bacillusk.pneumonie

❄Abel's bacillusk.ozaenae

❄Frisch's bacillusk.rhinoscleromatis

❄Battey's bacillusM.intercellulare

❄Johne's bacillusM.paratuberculosis

❄Pfeiffer's bacillusH.influenza

❄Koch weeks bacillusH.aegypticus

❄Nicolaire's bacillusC.tetani

❄Klebs loeffler's bacillusC.diphtheria

❄Preisz nocard's bacillusC.pseudotuberculosis

❄Whitmore's bacilluspseudomonas pseudomallei

❄Eaton agentmycoplasma

Obstertrics Points

Lovsets maneuvre for extended arms
Pinards maneuvre for extended legs
Marshall burn and mauriceau smellie viet for aftercoming head
Pipers forceps used in breech
MCC of breech-prematurity
MC type of breech-frank/extended
Cord prolapse MC in footling type
MC type in primigrav-extended
MC type in multipara-flexed
Chin to pubis -prague maneuvre
Baby pushed back into uterus and LSCS-zavanelli maneuvre
Impacted breech in incompletely dilated cx-duhrssens incision

Joints

most common join involved in❄❄

OADIP
RAMCP
ASSACROILIAC
PADIP
GOUTFIRST MTP
PSEUDOGOUTKNEE

👛 uterine artery assesed in -uteroplacental flow

👛fetoplacental flow-umblical artery

👛s/d ratio less dan 3

👛 if more dn 3 termination of pregnancy has to b done

👛middle cerebral artery-normally high resistance

"acantholysis---seen in epidermis , &pemphigus" "condyloma acuminata---org.-HPV, Rx podophyllin -dermatophyte infec.-civatte bodies seen
 "donovanosis---pseudobubes , calmmatobacterium granulomatis"---dapsone---dose=1-2mg/kg ,commenest side efeect-hemolytic anemia" epidermolysis bullosa→genetic cause
clofazimine→ commonest s/e hyperpigmentation

Behcet Disease

Behcets :Remember 5
HLA DR5/B5 systemic vasculitis
5 major -
Oral ulcers(major minor and herpetiform thrice a year,heal without scars)the pat invariably shpuld have this
Genital ulcers ( heal with scars,donot involve urethra and glans)
Skin-Erythema nodosum n acne;pseudofolliculitis
Pathergy test
Eye- Recurrent b/l hypopyon;post uveitis;retinal vasculitis

Systemic 5 -
thrombophlebitis
Pulmonary vein thrombosis
Dural vein thrombosis
Crohns like inflamm of git mucosa
Arthritis non erosive migratory sero negative
Rx: steroids

Murmurs

Named murmurs & their corresponding
conditions::

Duroziez murmur - Aortic
Regurgitation..

Austin Flint murmur - Aortic
Regurgitation..

Siegle's murmur - Aortic
Regurgitation..

Cole Cecil murmur - Aortic
Regurgitation..

:)Graham Steel murmr- pulmonary
regurgitan

Gibson's murmur - PDA

Carvallo's murmur - tricuspid
regurgitatn

carey coomb's murmur- in mitral
valvulitis due to acute rheumatic fever

Tests

Ascoli Thermoprecipitation Test--
For B.Anthracis.
* VDRL/Kahn Test -- Syphilis
*Elek's Gel precipitation test--
Diptheria
* Eiken Precipitation Test-- E.coli
toxin
* Widal test -- Typhoid
* Weil - Felix test-- Typhus
* Paul bunnel test-
Inf.mononucleosis
* Coombs Test - Rh incompatibility
..* Sereny Test - Enteroinvasive
E.coli
* Schick Test-- susceptibility to
C.diptheriae
* Diick Test - Scarlet fever diagnosis
* ASO test- Rheumatic fever
* Rose bengal card test -
Identification of Brucella
contamination of milk..
* Fairley test-- Schistosomiasis
* Frei Test - Lymohogranuloma
verenum
* Casoni Test-- Hydatid cyst
* Montegro/Leishman test-
Leishmaniasis
strauss test-burkholderia mallei
anton test-listeria

Committees

BHORE COMMITTEE. 1946.- Health
survey and development committee.
short term- set up one PHC for every
40000 with 2 doc, 1 nurse and 4
public nurse and 2 sanitory
inspectors and secondary centres.
Long term- Set up primary health
units with 65 bedded hospital for
10000-20000
Major changes in medical education
which includes 3 - month training in
preventive and social medicine to
prepare “social physicians”.
MUDALIAR COMMITTEE. 1962.-
Health survey and Planning
commitee. Strenghten present PHC
and divisional and sub-divisional
hospital. Create All India health
service
CHADAH COMMITTEE, 1963- This
committee was appointed under
chairmanship of Dr. M.S. Chadah,
the then Director General of Health
Services, to advise about the
necessary arrangements for the
maintenance
phase of National Malaria
Eradication Programme. The
committee suggested that the
vigilance activity in the NMEP should
be carried out by basic health
workers (one per 10,000 population),
who would function as multipurpose
workers and would perform, in
addition to malaria work, the duties
of family planning and vital statistics
data collection under supervision of
family planning health assistants.
MUKHERJEE COMMITTEE. 1965- The
recommendations of the Chadah
Committee, when implemented, were
found to be impracticable because
the basic health workers, with their
multiple functions cound do justice
neither to malaria work nor to family
planning work.
The Mukherjee committee headed by
the then Secretary of Health Shri
Mukherjee, was appointed to review
the performance in the area of
family planning. The committee
recommended separate staff for the
family planning programme.
The family planning assistants were
to undertake family planning duties
only. The basic health workers were
to be utilised for purposes other
than family planning. The committee
also recommended to delink the
malaria activities
from family planning so that the
latter would received undivided
attention of its staff.
MUKHERJEE COMMITTEE. 1966-
Multiple activities of the mass
programmes like family planning,
small pox, leprosy, trachoma, NMEP
(maintenance phase), etc. were
making it difficult for the states to
undertake these effectively because
of shortage of funds.
A committee of state health
secretaries, headed by the Union
Health Secretary, Shri Mukherjee,
was set up to look into this problem.
The committee worked out the
details of the Basic Health Service
which should be provided at the
Block level,
and some consequential
strengthening required at higher
levels of administration.

Path

Apple jelly nodules-Lupus vulgaris
Anchovy sauce pus - amoebic abscess
Bunch of Grapes-Ethmoidal polyp
Chinese fried rice-B.cereus
Champagne glass pelvis-
Achondroplasia
Champagne leg deformity-Varicose
vain
Cherry red lip- CO poisoning
Cauliflower ear-Hamartoma
Chocolate cyst - endometriosis
Dinner Fork deformity-Colle's
Fracture
Egg on side appearance-TGA
Egg cell calcification-
Silicosis,Sarcoidosis
Egg on string - transposition of great
vessels with intact ventricular
septum
Fried egg colony-Mycoplasma
Garlic smell-Arsenic poisoning.
Honey comb lung - pulmonary
fibrosis
Honey coloured crusts-Impetigo
Contagiosum
Inverted cups- Large intest
Obstruction
Nutmeg liver - CHF
Onion skinning - ewings sarcoma
Port wine stain - hemangioma
Pea soup diarrhea-Typhoid
Potato nose-Rhinophyma
Popcorn cells-HL(5th type-Nodular
lymphatic predominant)
Popcorn calcification-Pulmonary
hamartoma
Red current jelly stools-
Intussusception
Rice water diarrhea-Cholera
Red current jelly sputum - klebsiella
Salt n pepper Retinopathy-
Congenital Rubella Syndrome
Strawberry polyp-Rhinosporidiosis
Strawberry tongue - kawasaki ,
scarlet fever , toxic shock syndrome
Tomato ketchup fundus-CRVO

Scoring

Scoring systems/ Staging:
o Ann Arbor: HL
o Reese Kells: Retinoblastoma
o Alvarado score: Appendicitis
o Seddon Classification: Nerve
regeneration
o Bismuth Corlette: CholangioCa
o Forrest classification: Peptic ulcer
o Breslow/ Clark: Malignant
melanoma
o Denis: Spinal injuries
o Silverman/ Anderson: Neonatal
resp distress; upper chest, lower
chest, xiphoid, nares, grunt
o Chang Staging: Medulloblastoma
o Gleason score: Prostate (1-5,
higher – worse)
o Reid’s Index: Chr Bronchitis

OBG criteria

OBG
o Rubin’s criteria: Cx pregnancy
o Studford criteria: Abdomianl criteria
o Speigelberg criteris: Ovarian pregnancy
o Bethesda: Ca Cx
o Amsel Criteria: Bacterial vaginosis

Syndromes

Ormond disease: Idiopathic
retroperitoneal fibrosis
o Mondor’s disease: Superficial
thrombophlebitis (Breast and chest)
o Paget’s disease of nipple: Skin
manifestation of underlying Ca in
breast
o Stewart Treve syndrome: Lymphatic
sarcoma 2° to lymphatic stasis after
radical mastectomy
o Ritter’s disease: Pemphigus
neonatorum (SSSS)
o Reaven syndrome: Syndrome X

Fevers

o Break bone fever: Dengue
o Gaol fever: Epiemic typhus (R.
prowazekii – louse)
o Pontaic fever: Mild form of
infection (flu-like illness) by
Legionella pneumophila, few
respiratory symptoms
o Haverhill fever: Streptobacillus
moniliformis
o Oraya fever: Bartonella
bacilliformis (Carrion’s ds)
o Malta fever/ Undulant fever:
Brucellosis
o Relapsing fever: B. Recurrentis
o Erysepeloid: Erysepeloid
rusiopathiae
o Monkey fever: KFD
o Oriental spotted fever: R. japonica

Obg

OBG (inclusions):
o Call Exner body: Granulosa cell
tumour
o Schiller Duval bodies: Yolk sac
tumour/ Endodermal sinus (aFP,
α1AT)
o Reinke’s crystals: Hilus cell
tumour, Leydig cell tumour
o Hobnail cells: Clear cell Ca
o Signet ring cell: Gastric Ca/
Krukenberg tumour
o Walthard/ Puffed wheat cell:
Brenner tumour
o Rokitansky body: Teratoma

Blood Coagulation factors

1, 2, 5, 7, 9, 10 Produced in liver
2, 7, 8, 9, 10 Levels increased with
oral contraceptives
2, 7, 9, 10 Vitamin K required
2, 7, 10 Prothrombin time helps to
know the deficiency state
1. 2. 10 Both PTT and PT increased
in deficiency
5, 8 unstable in stored blood
5, 10 good for growth of hemophilus
organisms

Hemophilias Deficient Factor


Hemophilia A Factor VIII Deficiency
Hemophilia B Factor IX Deficiency
Hemophilia C Factor XI Deficiency
Para hemophilia Factor V Deficiency
Pseudohemophilia (Vascular
Hemophilia)Von Willebrand’s disease

Notes

Hiv 1 subtype c is mc in india
Mc in world-hiv 1, polio1
Mc in west africa hiv 2.
Subtype e in north east
india,Thailand
Vaccine ass polio-type 2

BBB absent in
1.pineal body
2.post.lobe of pituitary
3.tubercinerium
4.supra optic recess of 3rd ventricle
5.OVLT
-area postrema
-subforniceal organ
-Lamine terminalis
-median eminence

Wimberger sign,trumerfeld zone,
frankel line and pelkan spur seen in
SCURVY..

Drugs

.ABCIXIMAB-chimeric monoclonal
ab againt 2a-3b receptors--anti
platelet
2.RITUXIMAB-NHL
3.TRAZTUZUMAB-breast ca
4.BORTEOZUMAB-M.myeloma
5.NATALIZUMAB-M.sclerosis
6.OMALIZUMAB-B.asthma
7.PALIVIZUMAB-RSV
8.GEMTUZUMAB-AML
9.PEGABTINIB-D.retinopathy
10.DONEZUMAB-osteoporosis(against
RANK ligand)
Multiple exostosis/osteochondroma
is diaphyshyseal aclasis..
Multiple enchondroma -oliers
Multiple enchondroma +
haemangioma= mafuci syndrome
Multiple lipoma = derkumstasis

CD Makers

Important CD markers:
1.CD1-langherans histiocyto
2.CD3-T cell marker
3.CD4-helper T cell
4.CD8-cytotoxic T cell
5.CD10-ALL
6.CD19-B cell marker
7.CD21-EBV
8.CD16&56-NK cell
9.CD11c-hairy cell leukemia
10.CD 15-reed sternberg cell (was
recently ASKED)
11.CD 23-, CD5+ mantle cell
lymphoma
12.CD 23+,CD5+ CLL

Degenerated parts

Degenerated parts
Oblique popliteal lig-semi
membranosus
SacroTuberour lig-long head biceps
femoris
Sacrospinous lig-coccygeus
Tmj articlr disc-lat pterygoid
Fibulr collatrl lig-peroneus LONGUS
Tibial coll lig-adductr Mgnus
Median umb fold-obliterated urachus

Sunday, 9 February 2014

Obs

OBSTETRICS AND
GYNAECOLOGY:🔵🔵
Bagel sign:
Ultrasonographic sign. Gestational
sac in the adnexa with hyperechoic
ring
Ball Sign:
Radiological sign of intrauterine
fetal death. X-ray shows crumpled
up spine of the fetus..
Banana Sign:
Ultrasound sign in open spina
bifida. Shows abnormal anterior
curvature of cerebellum. Due to the
associated Arnold-Chiari
malformation.
Chadwick’s Sign:
Bluish hue to the vestibule and
anterior vaginal wall. Seen in first
trimester of pregnancy. Cause is
increased blood flow to the pelvic
organs. Also known as jacquemier’s
Sign.
Cullen Sign:
Bluish discoloration of skin around
umbilicus. Occurs due to intra
peritonealhemorrhage. Seen in
ruptured ectopic pregnancy.
Double Bubble Sign:.
Useful in prenatal diagnosis of
duodenal atresia. Duodenal atresia
usually presents with
polyhydramnios and produces
dilatation of stomach and first part
of duodenum
Double decidual sac Sign:
Normal Ultrasonographic
appearance of intrauterine
gestational sac. Seen as
twoconcentric echogenic rings
separated by a hyperechoic space.
Goodell Sign:
Marked softening of the cervix in
contrast to non pregnant state.
Also due toincreased blood flow.
Hegar Sign:
An indication of Pregnancy.
Softening of the lower parts of the
uterus enablesapproximation of
vaginal and abdominal fingers in
bimanual pelvic examination.
Vaginalfingers are placed in the
posterior fornix and abdominal
hand pressed down behind
theuterus.
Jacquemier’s sign: Refer
Chadwick
SignKustner’s Sign:
Sign of placental separation. On
pushing the uterus upwards does
not move thecord with it due to
the separation.
Ladin’s Sign:
Softening in the midline of the
uterus anteriorly at the junction of
the uterus andcervix. It occurs at
about 6 weeks gestation
Lambda Sign:
Ultrasonographic sign seen in
dichorionic pregnancies. Due to
the chorionic tissuein between the
two layers of the membrane
between the twins.
Lemon Sign:
Ultrasound sign in open spina
bifida. Shows abnormal anterior
curvature of cerebellum. Due to the
associated Arnold-Chiari
malformation.
Osiander’s Sign:
Pulsations in the lateral fornix due
to the increased vascularity.
Palmer’s Sign:
Regular rhythmic contractions of
uterus felt as early as 6-8 weeks .
It is a sign of pregnancy.
Piskacek’s Sign:
Asymmetric growth occurs to the
uterus in initial stages of
pregnancy due to thelateral
implantation of the blastocyst. The
area of implantation feels soft
compared tothe other parts.
Robert’s Sign:
Radiological sign of intrauterine
fetal death. X-ray shows presence
of gas in thefetal great vessels.
Earliest radiological sign of
intrauterine fetal death
Schroder’s Sign:
A sign of placental separation.
Uterus rises up when the
separated placenta ispassed
downwards.
Spalding Sign:
Sign of intrauterine fetal death.
Overlapping of skull bones after
fetal demise.Observed by
ultrasonogrm.
Stallworthy’s Sign:
Slowing of fetal heart rate on
pressing the head down I to the
pelvis and promptrecovery on
release of pressure is termed
Stallworthy’s sign. This sign is
suggestive of posterior placenta
praevia.
Stuck Twin Sign:
Seen in twin to twin transfusion
syndrome. Due to the severe
oligohydramniossmaller twin is
held in a fixed position along the
uterine wall. This is called stuck
twinsign.
‘T’ Sign:
Ultrasonographic sign seen in
monochromic twins. As the
intertwin membranedoes not have any chorionic tissue it gives rise to ‘T’ sign in ultrasound