Immunoglobulins

1. Smallest If- IgG

2. Largest Ig- IgM
3. Maximum serum concentration- IgG
4. Minimum serum concentration- IgE
5.Heat Labile- IgE
6. Earliest to be Synthesised (primary immune response)- IgM
7. Secondary immune response- IgG
8. Crosses Placenta- IgG
9. Minimum half Life- IgE
10. Maximum half life- IgG
11. Protects Surfaces- IgA
12. Warm Antibodies- IgG
13. Cold Antbodies- IgM
14. Present in Milk- IgG and IgA
15. Fix complements via classical pathway- IgM & IgG
16. Fix complements via alternative pathway- IgA & IgD
17. Primary allergic response- IgE
18. Maximum sedimentation cofficient- IgM
19. Reagin activity - IgE
20. Antigen recognition by B cells - IgD
21. Prausnitz kustner reaction - IgE
22. Homocytotropism - IgE
23. Present in milk - IgA & IgG
24. Highest carbohydrate - IgE
25. Lowest carbohydrate - IgG

Bodies

1. Ferruginous bodies – Asbestosis
2. Schaumann’s bodies - Sarcoidosis
3. Asteroid bodies – Sarcoidosis
4. Psammoma bodies – Meningiomas,
Papillary carcinoma thyroid, Serous
cystadenocarcinoma of ovary, Renal
cell carcinoma
5. Pick’s bodies – Pick’s disease
6. Paschen bodies - Small pox
7. Gunari bodies – Small pox
8. Negri bodies – Rabies
9. Russel bodies – Multiple myeloma
(cytoplasmic)
10. Dutcher bodies – Multiple
myeloma (nuclear)
11. Mooser’s bodies – Endemic
typhus fever
12. Miyagawa’s bodies – Chlamydia
trachomatis
13. Lafora bodies – Familial myoclonic
epilepsy
14. Donovan bodies – Klebisella
Granulomatosis
15. Call Exner bodies – Granulosa cell
tumor of ovary
16. Aschoff bodies – Rhemautic
carditis
17. Tuftstone bodies – Metachromatic
leukodystrophy
18. Heinz bodies – G6PD deficiency,
alpha thalassemia, NADPH deficiency,
Chronic liver disease
19. Howell Jolly bodies –
Splenectomy, Autosplenectomy as in
Sickle cell anaemia
20. Dohle bodies – Toxic granulations,
Burns, Infections, Wissler disease,
Chiedak Higashi syndrome, Neoplasm
21. Gandy gammna bodies – Sickle
cell anaemia
22. Hirano bodies – Alzheimers
disease, Creutzfold Jacob disease
23. Bunina bodies – Amyotrophic
lateral sclerosis
24. Lewy bodies – Parkinson’s disease
25. Trigoid bodies(normal) – Nissl
granules/Nissl bodies that is large
rough endoplasmic reticulum in soma
& dendrites of neuron.
26. Cystoid bodies – CMV retinitis
27. Schiller-Duval bodies –
Endodermal sinus tumor(yolk sac tumor)
28. Michaelis Gutamann bodies –
Malakoplakia
29. Hematoxylin bodies – SLE
30. Creola bodies – Bronchial Asthma

HLA

Multiple sclerosis- HLA DR2
Narcolepsy- HLA DR2
Goodpasture’s syndrome- HLA DR2
Sjogrens- HLA DR3
Dermatitis herpetiformis- HLA DR3
Celiac disease- HLA DR3
Rheumatoid arthritis- HLA DR4
Behcets disease – HLA B5
Congenital adrenal hyperplasia – HLA B47
SLE- HLA DR2,DR3
Type 1 Diabetes – HLA DR2,DR3,DR4
Hyperthyroidism – HLA B8,DR3
Myasthenia gravis- HLA B8,DR3
Tuberculoid leprosy- HLA B8,DR3
VKH syndrome- HLA DW 15,DR4

Degenerated parts

Degenerated parts
oblique popliteal ligament-semimembranous
sacrotuberous ligament-long head biceps femoris
sacrospinous ligament-coccygeus
TMJ articular disc-Lateral pteygoid
fibular collateral ligament-peroneus longus
tibial collateral ligament-adductor magnus
median umbilical fold-obliterated urachus


Pharmacology

ALL RECENT DRUGS , YOU WILL EVER FIND ANYWERE

Vismodegib- adults with metstatic bcc . .
Vipazodone- major depressive disorder . .
Vemurafenib-- unresectable metastatic melanoma . .
Tocilizumab-- active systemic juvenile idopathic arthrtis . .
Ticagrelor-- acute coronary syn . .
Telaprevir& boceprevir-- genotype 1 HCV in adiots with compensated liver disease. .
Tafluprost -- open angle glaucoma . .
Sunitinib-- rcc ..
Ezogabine --- partial onset seizure in adults. .
Fidaxomicin -- adults for rx of clos diff assoc diarrhoea..
Glucarpidase -- delayed mtx clerance in case of renal failure .
Icatibant -- acute atrack of hereditary angioedema in adults ..
Indacaterol --- airway obstrucn in copd pt.
Ivacaftor -- cystic fibrosis in pt 6 yrs n above who have G551D mutatiin in CFTR gene.
Linagliptin -- type-2 DM .
RILPIVIRINE-- new NNRTI ..
RIVAROxaban- px for dvt in pt whi underwent knnee or hip replacement sx.

Brentuximab vedotin -- hodg lymphoma after failure of autologus stem cell transplant & sys anaplastic large cell lymphoma . Gvn IV .
Crizotinib -- small cell metstatic ca Ie anaplastic lymphoma kinase .
Eculizumab -- atypical HUS. N PResently being used for PNH.

EVErolimus-- prog neuroendocrine tumor of pancreas ie unresectable . .
Ulipristal acetate-- prog agonist/antag emergency contraceptive . .
Ustekinumab--- mod to severe plaque psoriasis . .

Vandetanib-- unresectanble thyroid ca . .
Vinorelbine-- vinka alkaloid . .
Zaleplon - new hypnotic that decreases sleep latency withiut distrb sleep architecture.

Zoledronic acid -- only once yrly osteoporosis rx apprvd for prev of fractures after hip fracture .. .
Ranolanzine &trimetazidine-- chr angina .
Torcetrapib -- inc hdl cholesterol . .
Tipranavir & darunavir -- new protease inh (hiv) . .
Tetrabenazine -- rx of chorea in huntingtons disease .
Tocilizumab - RA .
TESAMORELIN -- reduce abd fat in hiv inf pt . .
Naftigine -- antifungal .
Teriparatide -- osteoporosis .
Tapentadol -- mod to sev pain.
Telavanacin -- sim to vancomycin used for bth MRSA & MSSA .
PAlivizumab-- rsv . .
Palioeridone-- schizophrenia .
Oritavancin -- MRSA .
PAZOpanib-- adv rcc. .
Pegloticase - hyoeruricemia .
Pegvisomant - rx for acromegaly . .
Pemetrexed -- in combn with cisplastin for adv non small cell lung ca . .
Phosphiramidone- pul htn . .
Pitavastatin -- pri rx for hyoercholesterolemia n comb dyslipidemia . .
plerixafor -- to mobilize hematopoietic stem cells to bloodstream so that can be collected for autologous transpln in pt of nhl n MM

RANIBIzumab -- age related macular edema . .
Relcovaptan -- v1 antgnst of vasopressin . .
Romidepsin -- cutaneous t cell lymp . .
Rilonacept -- long term rx of cryopyrin ass periodic syn - CAPS

Romiplostim - ITP .
Rufinamide -- lennoaux gustat syn .

Sargramostim & molgramostim -- leucopenia .

Sermorelin & hexarelin -- pit dwarfism . .
Silodosin -- BPH .
Spinosad -- tooical rx of head lice infestation .
Somatrem -- aids related wasting ..
Tadalafil - single daily dose for PAH .
OFatumumab -- CLL .
molsidomine -- nitrate with no tolerance ..
Acrivastine -- sec gen antihistamine. Also mizolastine, ebastine .
Natalizumab - multiple sclerosis . .
Fomivirsen -- CMV retinitis.
Frovatriotan, riza, zolmi, ele, almotriptan - acute atack of migraine. .
Ganaxolone -- absence seizure, catamenial epilepsy , inf spasm.
Erlotinib & geftinib-- nin small cell ca of lung ..
Glatiramer -- MS .
GOLIMUMAB-- once mnthly for RA , psoriatric arthritis & ank spondylitis . .
Granisetron & tropisetron -- chemo induced vomiting . .
Guanfacine -- ADHD .
Ibopamine -- peripheral domapine agonist for CHF & as a mydriatic .
Fedotozine -- diarrhiea dominanr IBS .

fingolimod -- relapsing mode of multiple sclerosis . .
Fesoterodine -- over active bladder .
Eribuoin mesylate -- mets breast cancer . .
Ibritumomab-- b cell Nhl .
Uradipil & indoramin -- hypertensive emergencies ..

Ivabradine-- chr stable angina by slowing heart rate . .

Ixabepilone -- with capecitabine for resistant breast cancer . .
Laronidase -- hurler disease .
Levoleucovorin -- for high dose mtx in osteosarcoma
Levosimendan -- CHF .
lisdexamfetamine dimesylate -- first n onky once daily for ADHD in adults .
Lorqcarbef -- carbacepham grp of b lactam antibiotic .
Maraviroc - hiv -1 .
Memantine -- slow prog of alzhemiers disease .
Methlynaltrexone bromide - opiod induce constioation .
Milnacipran -- fibromyalgia.
Miltefosine & sitamaquine- kala azar . .
Docosanol - herpes labialis .
Doloxifene & toremifene - breast cancer . .
Dornase alpha -- purulent pulm secretion in cystic fibrosis .
Dronabinol -- anti emetic . .
Dronedarone - anti arrythmic , similar to amidarone...
Drotrecogin alfa - severe sepsis in protein c pt . .
Efalizumab - psoriasis against cd 11
Eltrombopag -- ITP
DEXLANsoprazole -- ppi . .
Daptomycin - against streptogramin & linezolid resistant s. Aureus .
Daltroban & sultroban - anti agretory effects on platelets .
Cinacalcet -- osteoporosis .

Clevidipine butyrate -- ultra shirt acting CCB . .
DALFAMPRIDINE -- improve walking ability in multiole sclerosi pt .
Certolizumab- severe chrohns disease . .in adults . .

Cilomilast & roflumist -- bronchial asthma . .
Cabazitaxel - mets prostate ca .

Bimatoprost -- rx of hypotrichiosis . .
Berctant & poractant -- neonatal RDS . .
abatacept -- DMARD resistant RA .

Aliskiren, remikiren, enalkiren -- oral renin inh in htn rx . .
Alvimopan -- post op paralytic ileus ..
Apafant & lexipafant -- acute pancreatitis(PAF antagonist)

Atosiban -- delay premature labour . .
Avasimibe -- hypolipdemic drug .

Aviptadil - erectile dysfuntion.
Azilsartan medoxomil - arb for htn . .
Abobotulinumtoxin A - cervical dystonia in adults n to reduce d severity of abnrml head position n neck pain & temoorary improvmnt in mod to severe gkabellar lines . .

Microbiology

Bacillus anthrax : it is a gram + bacilli in bamboo stick or box car shape. on staining with polychrome methylene blue it shows MAC FADYEANS reaction which represent capsular material [ AiiMS 04,06,07].

Corynebacterium diptheriae : is a gram positive non motile rod. it contains granules called as Babes Ernst /volutin granules which r more strongly gram + . on staining with loeffers methylene blue granule shows metachromatism( AIIMS 07, PGI 2000). special stains to see granules are ALBERT, NEISSER,PONDER (JIPMER03).

MYCOBACTERIUM TUBERCULOSIS: ZN STAIN is used and it is acid fast. Auramine Rhodamine stain in which organism show reddish yellow fluorescence is used in  fluorescent microscopy( this is more sensitive than ZN staining).

NON LACTOSE FERMENTATER : ie colourless on mac conkey agar ; shigella ( except s. sonnei) . salmonella, proteus.

CHOLERA RED REACTION : it is due to nitrate reduction & sucrose ferfentation in v.cholerae

YERSINEA PESTIS : bipolar safety pin appearance with WAYSON STAIN (AI 2006), GIEMSA,  METHYLENE

T.PALLIDUM: silver impregnation method by using warthin starry silver stain. Fontana method is for staining  films and levaditi for tissue sections.

MYCOPLASMA: Colony is biphasic with “fried egg appearance”. when stained by. dienes method (PGI 95, 99)

CRYPTOCOCCUS NEOFORMANS:  it has polysaccharide capsule which is stained by india ink preparation. This is method of choice for detecting crypto in csf.(AI05,PGI 02)

FUNGAL STAIN: best ( most sensitive) fungal stain is gomori methamine silver stain. Best stain for fungal detection in biopsy sample is PAS ( Aiims 06)

Heppy holi to all of u 

Strings

➰〰STRINGS〰➰
〰Normal synovial fluid shows string sign
〰Radial artery graft used for CABG.. string sign on angio
〰CHPS
〰Ileal carcinoids,crohns,colonca
〰leishmaniasis string test
〰seborrheic keratosis
〰carotid string sign in ICA thrombosis,ICA dissection on angio

Opthal

Ophthal points. .

OPHTHAL  ....
💥size of the disc 1.5mm
💥size of macula :5mm
💥thinnest part of retina : ora serrata:  .1mm
💥capacity of orbit:30cc
💥length of optic nerve: 3.5-5.5cm..mark 5cm in all india
💥axial length: 24mm by A scan
💥depth Ob AC: 2.4mm
💥infant is hypermetropic: +2.5to+3D
💥axial length at birth:17mm
💥 total power of eye/ reduced eye: 58to60D
💥lens: 16-17D
       Cornea: 45to50 D
💥 RI  of cornea: 1.37,
        lens: 1.39, max at centre of lens1.4to1.41
💥direct ophthamoscopy :magnification 15times , 2DISC DIAMETERS seen at a time , virtual erect image , central retina seen
💥indirect : image magnified 5times,8 disc diameters seen at a.time , real.inverted image ,.peripheral retina.seen
💥diameter of lens: 9-10mm
       <9mm: microphakia
💥diameter of cornea: 11-11.75mm
       Megalocornea: >13mm, microcornea:<10mm
💥distant direct ophthalmoscopy: done @25cm

Esophageal cancer

Esophageal cancer :
Can be squamous cell carcinoma or adenocarcinoma.

Typically presents with progressive dysphagia (first solids, then liquids) and weight loss

poor prognosis

Risk factors include:
ƒ Achalasia
ƒ Alcohol—squamous
ƒ Barrett esophagus—adeno
ƒ Cigarettes—both
ƒ Diverticula (e.g., Zenker)—squamous
ƒ Esophageal web—squamous
ƒ Familial
ƒ Fat (obesity)—adeno
ƒ GERD—adeno
ƒ Hot liquids—squamous

Squamous cell—upper 2 ⁄3. (some books mention middle 1/3rd)

Adenocarcinoma—lower 1 ⁄3.

Most common intracranial tumour in children-cerebellar astrocytoma

Second most common intra cranial tumour in children-medulloblastoma

Most common infratentorial tumour in children-cerebellar astrocytoma

Second most   infratentorial tumour in children-medulloblastoma

Most common supratentorial tumour in children-craniopharyngioma

cystathionemia- cystathionase def
cystinosis-defective efflux of cysteine 4m lysosomes
cystinuria-defective cystine transport across renal tubular cells & intestine
pompes-acid maltase
gauchers-acid ß glucosidase
wolmans-acid lipase
farbers-acid ceramidase

quetiapine-constipation somnolescence wt gain
trazadone-priapism
head halter traction& crutchfield traction for cervical spine injuries
Daily requirement of iron in???
1.adult male-1mg

2.menstruating female-2mg

3.pregnant female-3 to 5mg
Active forms of vit b12??
deoxyadenosyl cobalamin
methyl cobalamin
Only vegetable source of vit b12-soyabeans
Carvallo’s murmur : pan systolic murmur of AV valve regurgitation (mitral and tricuspid)
Ritan's murmur : Complete heart block
Docks murmur: diastolic murmur in lad stenosis
Combined immunodeficiency mnemonic:
C:SWAN-combined
🔸SCID
🔸Wiskot Aldrich
🔸Ataxia telangiectasia
🔸Nezelof syndrome
B cell defects:
🔸X.linked agammaglobulinemia or Brutons dis
🔸Common variable immunodef
🔸Selective Ig def
T.cell def:
🔸Digeorge
🔸Ch. Mucocutaneous Candidiasis
EDWARDS
Edwardsiella tarda is a member of the Enterobacteriaceae family. The bacterium is a facultatively anaerobic, small, motile, gram negative, straight rod with flagella.Infection causes Edwardsiella septicemia (also known as ES, edwardsiellosis, emphysematous putrefactive disease of catfish, fish gangrene, and red disease) in channel fish, eels, and flounder.
Edwards syndrome (also known as Trisomy 18 [T18]) is a genetic disorder caused by the presence of all or part of an extra 18th chromosome. This genetic condition almost always results from nondisjunction during meiosis.
💥Dancing carotids - AR
💥Dancing eyes & dancing feet - neuroblastoma
💥Saint vitus dance - sydenham chorea
💥Dance sign - intussusception
💥Hilar dance-asd
💥St.vitus aka dancing mania or dancing plague
The Dancing Plague (or Dance Epidemic) of 1518 was a case of dancing mania that occurred in Strasbourg, Alsace (then part of the Holy Roman Empire) in July 1518. Numerous people took to dancing for days without rest, and, over the period of about one month, some of those affected died of heart attack, stroke, or exhaustion.

Microbiology

IMP DOUBT BUSTERS ABOUT BACTERIAL SKIN INFECTIONS by DR PREMANSHU BHUSHAN
• Impetigo overall: Strep
• Impetigo contagiosa (non bullous): Strep (esp in warmer climate)>Strep+Staph (staph is usually a secondary colonizer)> staph
• Bullous impetigo: Staph aureus phage gp II>>>Rarely Strep
• Ecthyma (pyogenicum): Strep> Strep+Staph>Staph
• Ecthyma gangrenosum: Pseudomonas aeruginosa
• Erysipelas: Streptococci and rarely if at all Staph
• Cellulitis: Strep> Staph (occasional cause)
• Folliculitis : staph
• Furuncle : Staph aureus
• Carbuncle : staph aureus
• Sycosis : Staph aureus
• Periporitis : Staph
• Acute paronychia : staph aureus
• Erythrasma : Corynebacterium minutissmum
• Erysipeloid : Erysipelothrix rusiopathiae
• Melioidosis : Burkholderia pseudomallei
• Glanders : Burkholderia mallei
• Rhinoscleroma : Klebsiella pneumoniae rhinoscleromatis (Klebsiella rhinoscleromatis)
• Cat scratch disease : Bartonella (Rochalimea) henselae
• Bacillary angiomatosis: B. henselae and B. quintana
• Oroya fever: Bartonella bacilliformis.
• Tropical (phagedenic) ulcer: at least two organisms, one of which is a Fusobacterium spp., usually F. ulcerans; the others include spirochetes or other anaerobic bacteria

Inner ear

💫 Angular acceleration is sensed by-- semicircular canals

💫 Horizontal linear acceleration is sensed by-- utricle

💫 Vertical linear acceleration is sensed by-- saccule

💫 Gravity and position of head in space is sensed by-- utricle and saccule

Most common cause of GVHD= bone marrow transplant
Least common cause of GVHD = liver/kidney transplant
Most common organ involved in GVHD = skin>git
Least common organ involved in GVHD = lungs >kidney

Stepladder pyrexia---typhoid
Stepladder dementia---vascular dementia
Stepladder sign usg---intracapsular breast implant rupture
Stepladder sign x ray abd---small bowel obstru
Stepladder pattern electrophoresis---apoptosis

PORPHYRIAS

AIP

Deficiency of hydroxymethyl bilane synthase
Porphobilinogen and - amino-levulinic acid accumulate in the urine
Urine darkens on exposure to light
Patients are not photo sensitive

Erythropoietic porphyria

• Deficiency of ferrochelatase
• Protoporphyria accumulates in erythrocytes, bone marrow and plasma
• Patients are photo sensitive

Varigate Porphyria

• Deficiency of protoporphyrinogen oxidase
• Proto porphyrinogen IX & other intermittent accumulate in the urine
• Patients are photo sensitive

Hereditary Corpro porphyria

• Deficiency of coproporphyrinogen oxidase
• Corproporphyrinogen III
• Patients are photosensitive

Porphyria cutanea Tarda(Commonest)

Deficiency of uroporphyrinogen decorboxylase
Uroporphyrin accumulates in urine
Photo sensitive
Congenital Erythropoietic porphyria

Deficiency of uroporphyrinogen III synthase
Uroporphyrinogen I & Corproporphyrinogen I accumulate in urine
Patients are not photo sensitive
-Erythrodontia-pink teeth
-Gunthers disease

Red Cell Distribution Width (RDW)

The RDW is an index of the variation in cell volume within the red cell population. It is a parameter provided by automated hematology analyzers and is the electronic equivalent of anisocytosis or variation in red blood cell size that is judged by smear examination. Mathematically, it is the coefficient of variation, i.e.,

RDW = (Standard deviation ÷ mean cell volume) x 100

A high RDW indicates that the red blood cells are more variable in volume than normal. This may be due to the presence of smaller or larger red blood cells or a combination of either scenario. For example, increased numbers of immature red blood cells during a regenerative response to an anemia will increase the RDW, because immature anucleate red blood cells are larger than normal. Conversely, the presence of increased numbers of smaller cells (e.g. in iron deficiency anemia) will also increase the RDW (see image below). The cause for a high RDW may be revealed by examination of a blood smear to identify the presence of small or large red blood cells. Note that low numbers of smaller or larger red blood cells may increase the RDW BEFORE you see an increase or decrease in the mean cell volume (MCV) result on the hemogram.

An RDW within reference intervals provides little information on variaton in red blood cell size. An RDW below the reference interval is not a clinically relevant finding.

Red blood cell volume histograms from an impedance-based hematology analyzer (left images) and representative pictures (right images) of Wright's-stained peripheral blood smears from a dog with iron deficiency anemia before (top images) and after transfusion (bottom images). 

Before transfusion, there are large numbers of microcytic hypochromic red blood cells with a small degree of polychromasia and fragmentation (acanthocytes, schistocytes and keratocytes) evident in the dog's peripheral blood. The MCV (37 fL) and MCHC (28 g/dL) are markedly decreased and the RDW, which is graphically illustrated as the width of the histogram curve (delineated by the red double arrow), is also increased (24%) compared to a healthy dog. After transfusion, there are two populations of red blood cells in the dog's peripheral blood: the dog's own microcytic hypochromic fragmenting cells and normocytic normochromic transfused red blood cells. This results in two peaks on the red blood cell volume histogram, with the left peak representing the dog's own microcytic red blood cells and the right peak respresenting the transfused cells. The transfusion has naturally increased the MCV and MCHC to 49 fL and 32 g/dL, respectively. The RDW has almost doubled as seen by the much larger width of the combined curves on the histogram.

Pedigree Chart

Types of Pelvis

Normal Pelvis

Naegele's pelvis(congenital oblique pelvis)..

one ala of sacrum is absent.

Robert's pelvis (congenitaly contracted) both ala of sacrum is absent

Rachitic pelvis=flat
- softening of the bone
- dec ant post dia of the inlet.
- increased AP diameter of outlet
- increased AP diameter of outlet and increased TV diameter due to baby delayed walking and sitting on ischial tuberosities.

Osteomalacic pelvis
- softening of bone due to Ca and vit D def in elderly ES multipara.
- in the standing position
- head of femur and sacral promaontary is pushed.
- rectus abdominus pull
-triradiate pelvis.

Ministries function

Minister of health&family welfare~vit A prophylaxis program,Iodine deficeincy control program

minister of social welfare~ICDS,spl nutrition programs

minister of education~mid day meal program

minister of human resources development~mid day meal scheme

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

Management Of Foreign Body In Respiratory Tract

Nature of Foreign Bodies
(a) Non-irritating type. Plastic, glass or metallic foreign
bodies are re latively non-irritating and may remain
symptomless for a long time.
(b) Irritating type. Vegetables or foteign bodies like
peanuts, beans, seeds, etc. set up a diffuse violent
reaction leading to congestion and oedema of the
tracheobronchi al mucosa-"vegetal bronchitis".
They also swell up with time causing ai rway obstruction
and later suppurat ion in the lung.
Clinical Features
Symptomatology of foreign body is divided into 3 stages:
1. Initial period of choking, gagging and wheezing.
This las ts for a short time. Foreign body may be coughed
out or it may lodge in the larynx or further down in the
tracheobronchial tree .
2. Symptomless interval. T he respiratory mucosa
adap ts to the presence of foreign body and initial symptoms
disappear. Symptomless interval will vary with the
size and nature of the foreign body ..
3. Later symptoms. They are caused by obstruction
to the airway, inflammation or trauma induced by the foreign
body and would depend on the site of its lodgement.
(a) Laryngeal foreign body A large foreign body may
totally obstruct the airway lead ing to sudden death
unless resuscitative measures are taken urgently. A
partially obstructive foreign body will cause discomfort
or pain in the throat, hoarseness of voice,
croupy cough, aphonia, dyspnoea, wheezing and
haemoptysis.

(b) Tracheal foreign body. A sharp foreign body will only
produce cough and haemoptysis. A loose foreign body
like seed may move up and down the trachea between
the carina and the undersurface of vocal cords causing
"audible slap" and "palpatory thud". Asthmatoid
wheeze may also be present. It is best heard at patient's
open mouth
(c) Bronchial foreign body. Most foreign bodies enter the
right bronchus because it is wider and more in line
with the tracheal lumen. A foreign body may totally
obstruct a lobar or segmental bronchus causing atelectasis
or it may ptoduce a check valve obstructionallowing
only ingress of air but, not egress, lead ing to
obstructive emphysema. For pathogenesis and clinical
picture of bronchial foreign body (see Fig. 63.2).
Emphysematous bulla may ruptu re causing spontaneous
pneumothorax. A foreign body may also shift from
one side to the other caUSing change in the physical
signs. A retained foreign body in the lung may la ter give
rise to pneumonitis, bronchiectasis or lung abscess.
Diagnosis
It can be made by detailed history of the foreign body
"ingestion", physical examinat ion of the neck and
chest and radiographs. X-rays of the following areas are
advised:
1. Soft tissue posteroanterior and lateral view of the
neck in its extended pOSition. T his can show radioopaque
and sometimes even the rad io lucent foreign
bodies in the larynx and trachea
2. Posteroanterior and lateral view of the chest.

3. X-ray chest at the end of inspiration and expiration .
Atelectasis and obstructive emphysema can be seen.
They also give indirect evidence of radiolucent
foreign bodies.
4. Fluoroscopy / videofluoroscopy. Evaluation during
inspiration and expiration can be made.
5. Bronchograms. To delineate radiolucent foreign bodies
or to evalu ate bronchiectasis.

Laryngeal foreign body. A large bolus of food
obstructed above the cords may make the patient totally
aphonic, unable to cry for help. He may die of asphyxia
unless immediate first aid measures are taken. The measures
consist of pounding on the back, turning the patient
upside down and foll owing Heimlich manoeuvre. These
measures should not be done if patient is only partially
obstructed, for fear of causing total obstruction.
Heimlich's manoeuvre. Stand behind the person, and
place your arms around his lower chest and give four
abdominal thrusts. The res idual air in the lungs may dislodge
the foreign body providing some airway.
Cricothyrotomy or emergency tracheostomy should
be done if Heimlich's manoeuvre fails. Once acute respiratory
emergency is over, foreign body can be removed
by direct laryngoscopy or by laryngofissure, if found
impacted.
Tracheal and bronchial foreign bodies can be removed
by bronchoscopy with full preparation and under general
anaesthesia. Emergency removal of these foreign bodies is
not indicated unless there is airway obstruction or they are
of the vegetable nature (e.g. seeds) and likely to swell up.
Methods to remove tracheobronchial foreign body:
1. Conventional rigid bronchoscopy.
2. Rigid bronchoscopy with telescopic aid.
3. Bronchoscopy with C-arm fluoroscopy.
4. Use of Dormia basket or Fogarty's balloon for rounded
objects.
5. Tracheostomy first and then bronchoscopy through
the tracheostome.
6. Thoracotomy and bronchotomy for peripheral foreign
bodies.
7. Flexible fibre optic bronchoscopy in selected adult
patients.

Thought Disorder

THOUGHT DISORDER

DISORDER OF FORM
(Form is the structure of thought)
🔸 loosening of association
🔸 derailment
🔸 tangentiality
🔸substitution
🔸omission
🔸 transitory thinking
🔸 driveling
🔸 desultory thinking
🔸 neologisms
Poverty of speech
🔸 poverty of content of speech

DISORDER OF STREAM
(Flow of thought)
🔹Flight of ideas
🔹Thought block
🔹Circumstantiality
🔹Prolixity
🔹Thought retardation
🔹Perseveration

DISORDER OF POSSESSION
( Control of thought)
🔸Obsession and compulsion
🔸 thought insertion
🔸 thought withdrawal
🔸 thought broadcast

DISORDER OF CONTENT
(Themes)
🔹 delusion of reference
🔹persecution
🔹 grandiosity
🔹 guilt
🔹nihilism
🔹 depressive cognitions
🔹overvalued ideas