Pancreatic Pseudocyst

PANCREATIC PSEUDOCYST

No epithelial lining hence pseudocyst
Most common site- Lesser sac
Most common part of pancreas involved- Body
Most common complication- Hemorrhage>Infection
Most common cause in children- Trauma
Most common cause in adults- Pancreatitis
Most common symptom in prodormal phase- Pain
IOC – CT scan
Acute pseudocysts are irregular,Chronic pseudocysts are circular
CEA levels- Low in pseudocysts,High in tumors

Cerebellar Nucleus

Four masses of gray matter are embedded in the white matter of the cerebellum on each side of the midline.

From lateral to medial, these nuclei are the
 dentate,
emboliform,
 globose, and
 fastigial dentate nucleus.
Mnemonic : " D on't Eat T oo G reasy Food " (lateral to medial). ‘ Too’ denotes the presence of two globose nuclei on each side.

Psuedo

Psuedohemoptysis: Serratia marcesans

Pseudoparalysis: Vit. C def

Pseudofracture: Osteomalacia

Pseudodementia: depression

Pseudolymphoma:  Sjogren syndrome

Pseudocommunity: Paranoid states

Pseudotabes: Diabetic foot

Pseudocoxalgia: Perthes disease

Hypertension

JNC 8 GUIDELINES - RECOMMENDATIONS FOR MANAGEMENT OF HYPERTENSION
Recommendation 1
In the general population aged ≥60 years, initiate pharmacologic treatment to lower blood pressure (BP) at systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg.
(Strong Recommendation – Grade A)
Corollary Recommendation
In the general population aged ≥60 years, if pharmacologic treatment for high BP results in lower achieved SBP (eg, <140 mm Hg) and treatment is well tolerated and without adverse effects on health or quality of life, treatment does not need to be adjusted. (Expert Opinion – Grade E)

Recommendation 2
In the general population <60 years, initiate pharmacologic treatment to lower BP at DBP ≥90 mm Hg and treat to a goal DBP <90 mm Hg. (For ages 30-59 years, Strong Recommendation – Grade A; For ages 18-29 years, Expert Opinion – Grade E) 

Recommendation 3
In the general population <60 years, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg and treat to a goal SBP <140 mm Hg. (Expert Opinion – Grade E) 

Recommendation 4
In the population aged ≥18 years with chronic kidney disease (CKD), initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion – Grade E) 

Recommendation 5
In the population aged ≥18 years with diabetes, initiate pharmacologic treatment to lower BP at SBP ≥140 mm Hg or DBP ≥90 mm Hg and treat to a goal SBP <140 mm Hg and goal DBP <90 mm Hg. (Expert Opinion – Grade E) 

Recommendation 6
In the general nonblack population, including those with diabetes, initial antihypertensive
treatment should include a thiazide-type diuretic, calcium channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB).
(Moderate Recommendation – Grade B) 

Recommendation 7
In the general black population, including those with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or CCB. (For general black population:
Moderate Recommendation – Grade B; for black patients with diabetes: Weak Recommendation – Grade C) 

Recommendation 8
In the population aged ≥18 years with CKD, initial (or add-on) antihypertensive treatment should include an ACEI or ARB to improve kidney outcomes. This applies to all CKD patients with hypertension regardless of race or diabetes status. (Moderate Recommendation – Grade B) 

Recommendation 9
The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treatment, increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided.
Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using only the drugs in recommendation 6 because of a contraindication or the need to use more than 3 drugs to reach goal BP, antihypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed. (Expert Opinion – Grade E)

HIV

HIV/AIDS :
MC organ system involvement as complication : Pulmonary
MC Opportunistic infection is Pneumonia.
MC cause of Pneumonia Is Pneumocystis Jiroveci.
Mc bacterial cause of Pneumonia : Pneumococcus> H.infuenzae
MC CVS manifestation is Coronary artery disease
MC CNS manifestation is HIV encephalopathy
MC Cause of blindness is CMV Retinitis
MC Malignancy is Kaposi Sarcoma
MC malignancy : SINGLE malignancy(asked once in exam) is Kaposi sarcoma
MC malignancy as a group(or in general, if not otherwise specified ) is Lymphoma
MC Sinusitis is that of Maxillary sinus.
MC Skin Infection is Seborrheic dermatitis> Folliculitis
MC Viral infection assc.with HIV is HSV-1
MC in iv drug abusers with HIV is HCV
MC cause of diarrhea is Cryptosporidium
MC fungal infection is Candida
MC cause of meningitis is Cryptococcus
MC spread by percutaneous route/ needle pricks : HBV>HCV
MC spread by blood transfusion : HCV
MC cause of Pulmonary involement in INDIA(if asked specifically) is TB.
Overall MC opportunistic infection is TB.... it affects virtually all major organ systems.
    It is also MC cause of pulm inv in INDIA;
    however, overall MC pulm inv is PCP. REf : Harrison 18th as well as NACO status paper

MC fungal infection in febrile neutropenia is Candida> aspergillus
Mc fungal infection overall, world & India : Candida albicans;
     same in Immunocompetent and immcompromised
MC cause of Systemic fungal infection in HIV is Cryptococcus.

HIGH YIELD POINTS ON MENINGITIS :
*Neonates :
India : E.coli and other gram neg> Group b Strep> Listeria
In world, it is Group B strep*2months to 2 yr is H.infuenzae
> 2 yr
it is Pneumococcus> Neisseria mening.
*Overall MC cause of menin in all age groups is Pneumococcus
*MC associated with sequelae is H.infuenzae
*Mc assc wid Sensorinueral hearing loss and Subdural effusion in meningitis : H.influenza
*Empirical treatment of choice in neonatal meningitis : Cefotaxime + Amikacin*Antibiotics
Contraindicated in meningitis : Ciprofloxacin (does not cross infamed meninges), Imipenem( Causes seizures)
*DOC for penicillin allergy in meningitis is Chloramphenicol Ref Nelson
*Duration of therapy in meningitis is 21 days
*In US, due to routine H.influenza vaccination since last 20 yrs, it is no longer a common cause.
however, in INdia as well as in whole world, it is still MC cause in 2 mth to 2 yr age group
*steroids in meningitis-
Nelson 18th ed says regarding use of steroids in meningitis:"Data support the use of intravenous dexamethasone,
0.15 mg/kg/dose given every 6 hr for 2 days,in the treatment of children older than 6 wk with
acute bacterial meningitis caused by H. influenzae type b.
However, data are inconclusive regarding the benefit, if any, of corticosteroids in the treatment
of meningitis caused by other bacteria. Therefore, their use is controversial.
Among children with meningitis due H. influenzae type b, corticosteroid recipients had less fever,
lower CSF protein and lactate levels, and a reduction in permanent auditory nerve damage,
as manifested by sensorineural hearing loss, than did placebo recipients, enrolled in randomized,
controlled trials. Corticosteroids appear to have maximum benefit if given 1-2 hr before antibiotics were
initiated. Corticosteroids are not harmless; complications of their use may include gastrointestinal bleeding,
hypertension, hyperglycemia, leukocytosis, and rebound fever, after the last dose.
"*Clinically, steroids are used in meningitis in only TB meningitis & H.influenzae
*Steroids are used in TB meningitis in both established hydrocephalus,
as well as to decrease chances ofdeveloping hydrocephalus(although this point is a controversial one )!

**For NEONATAL SEPSIS the sequence is Klebsiella>E.coli>Group B strep>Staph aureus REF : AIIMS WHO 2010 Protocols
*same organisms for early and late onset
*In young adults, yes Neisseria but questions specifically ask either about children or adults.
In adults it is Pneumococcus..
if they ask young adults/adolescents, it is Neisseria..

Numericals

vol. of eye ball--6.5ml
wt of eye ball--6.8 gms
vol of orbit--30ml
A.P  diameter --24mm
doctor-1/3500
health worker--1/5000
trained dai--1/1000
ASHA-1/1000
village health guide--1/1000
pharmacist n lab technician---1/10000
classroom--1/40student
furniture --minus desk
doors& windows---25%floor area
urinal--1/60studen
latrine--1/100studen
beds in PHC --4-6/30000
CHC--30/LAKH

Parkland Formula

1. Calculation of area of burn (By using 'Rule of nine')

Burnt area = Anterior chest (9%) + Posterior chest (9%) + Both upper limbs (18%) = Total 36%

Fluid required (By using Parkland's formula) :

Fluid to be given in 24 hours post burn = 4 x Body weight x Percentage of burnt area. = 4 x 50 x 36 = 7200 ml

Half of this amount (3600 ml) should be given in first 8 hours, and remaining half in next 16 hours. But, calculation should be made from the 'TIME of BURN' , and not from the time of hospitalization. So, since this female was hospitalized two hours after getting burnt, she should receive 3600 ml of fluid within 6 hours after hospitalization. (i.e. upto 10 pm).

2. Drops per minute :

['Drop factor' of an i.v infusion set indicates the number of drops falling in its chamber which will make ONE ml of fluid. It is variable (e.g. 10, 15, 16 or 20) for different infusion sets and is printed on the packet.]

Formula : "Drops per minute = (Amount of fluid to be given in ml / Time in minutes) X Drop factor"

Here, you have to infuse 3600 ml fluid in 6 hours (and not in 8 hours)

So, Drops per minute = (3600 ml/ 360 min) x 10 = 100

Final answer : 3600 ml fluid.... to be given @ 100 drops per minute.

Angiosarcoma

Markers of angiosarcoma
 Factor VIII related Ag
 UEA-1
 CD31(most sensitive and specific)
 CD34
❄Osmolarity of plasma: 290 mosm/l
❄Osmolarity of WHO ORS: 311 mosm/l
❄Osmolarity of low osmolar ORS: 245 mosm/l
❄Osmolarity of Resomal: 300 mosm/l
D/D os short 4th & 5th metacarpal
〰 Post traumatic
〰 Ischemic ds like sickle cell anemia
〰 Pseudohypoparathyroidism
〰 Pseudopseudohypoparathyroidism
〰 Turners syndrome
Austrian syndrome

Pneumonia➕endocarditis➕meningitis

Doc- ceftriaxone

Typical cells of pathology... -

1) Ascoff giant cells in rheumatic heart disease.
      Also called caterpillar cells
2)Asteroid bodies - sarcoidosis
3)Armani ebstein cells- epithelial cells of PCT in patients with diabetes
4)Burr cells-abnormal RBC having spines in uraemia ..
5)Creola bodies in sputum of bronchial asthma patient ..
6)Colloid or civatte bodies in LICHEN PLANUS-a disorder of skin n              mucous membrane..
7)Councilman body-yellow fever
8) Clear cells-adeno carcinomas.
9)Classic RS cells-mixed cellularity type.
10)clue cells-bacterial vaginosis
11) Dutcher bodies ( in nucleus)in multiple myeloma
12)Dohle bodies & pseudo-pegler-huet cells in myelo dysplastic syndrome
13)Foam cells ( lipid laden macrophages and smooth cells) ..... Seen in  atherosclerosis
14)Ferruginous bodies- asbestosis
15)Flame cells-multiple myeloma
16)Gamma gandy bodies -CVC spleen
17)Glitter cells-pathognomonic of pyelonephritis,leukocyte with visible movement of cytoplasmic processes.
18)Gitter cells/hortega cells-modified microglia in CNS that form complex     granular corpuscles.
19)Halberstaedar prowazek bodies- trachoma
20)Heart failure cells-CVC lung, hemosiderin-laden macrophages) also in Pulmonary edema
21) Heinz bodies, bite cells, spherocytes - hereditary spherocytosis
22)Hirano bodies in Alzheimer's disease
23)Hobnail cells-clear cell tumour of ovary
24)Hofbauer- placenta(early pregnancy)
25)Hurthle cells-hashimoto's thyroiditis (autoimmune)
       Hurthle cell in follicular carcinoma
26)Ito cell - present in space of disse in liver
27)Lacunar cells-nodular sclerosis subtype of HL.
28)Langhans cells-a type of giant cell seen in epitheloid granuloma. 29)Langerhans cells-antigen presenting cells in epidermis (modified macrophages)
30)Leishman donovan bodies- kala azar
31)Leventhal Cole Lillie bodies- psittacosis
32)LE cell-neutrophil in SLE
33)Lewy bodies are neurons containing intra cytoplasmic , eosinophilic elongated inclusions in parkinsonism
34)Mallory bodies- alchoholic hepatitis
35)Merkle cells-lower layer of epidermis.
36)Miyagawa bodies- LGV
37)Muller cells-neuroglia present in retinal epithelium.
38)Negri bodies in rabies
39)Osteoclast like giant cells - pancreatic cancers
40)Psammoma bodies seen in meningioma , papillary cystadenocarcinoma of ovary, papillary carcinoma of thyroid
41)Pick cells in pick disease a neurodegenerative disorder.
42)Popcorn cells-lymphocyte predominance type.
43)Reed Sternberg cells-Hodgkin's lymphoma
44)Rusell bodies in multiple myeloma
45)Schistocytes , burr cells , helmet cells , triangle cells - microangiopathic hemolytic anaemia
46)Sickle cells , target cells , Howell jolly bodies -sickle cell anemia
47)Signet ring cells-krukenburg tumour
48)Smudge cells - CLL/ SLL
49)Spider cells-rhabdomyoma.
50)Tadpole cells-seen in pap smear of SQCC of cervix.
51)Tart cell lymphocyte in SLE stave cells - spleen
52)Tear drop cells in megaloblastic anemia ,primary myelofibrosis
53)Virchow cells or lepra cells-lepromatous leprosy
54)Verocay bodies in schwammoma
55)Weibel Palade bodies- EM findng in tumors of vascular origin

Translocations

(x : 17 ) - alveolar soft part tumour

t(x: 18 ) - synovial sarcoma
t(11:14) - mantle cell lymphoma
t(14:18) - follicular cell lymphoma
t(11:18) - maltoma , extranodal marginal zone lymp.
t(15:17) -AML M3
t (8:21) - AML M2
t(14:4) ,t(14:11) ,t(14:6) , t(14:16) - multiple myeloma
t(8:14) .t(2:8) ,t(8:22) - burkitt's lymphoma
t(2:5) - anaplastic large cell lymphoma
t(3q:v) - diffuse large B-cell lymphoma (v-variable)
t(2:13) - alveolar rhabdomyosarcoma
t(2:16) - myxoid liposarcoma
t(11:22) - pnet , askins tumour( ewings)
t(3:8) - renal adenocarcinoma , mixed parotid tumour
t(6:14) - cystadeno carcinoma of ovary
t(10:17) - papillary thyroid carcinoma
t(x:1) - peadiatric papillary RCC
t(9:22) - philadelphia chromosome
t(12:21) - ALL 

High yield

DNB/NEET TERMED POINTS

Pringle maneuver is clamping of porta hepatis to control hemorrhage. placing an atraumatic clamp across the foramen of winslow .

Gunther’s disease is AR congenital erythropoietic porphyria from decreased URO synthase activity - hemolytic anemia - cutaneous lesions.

Marshall - vein of is oblique vein of left atrium.

Syme’s amputation is amputation at the ankle with removal of the malleoli and placement of the heel pad over the end of the remaining tibia.

Jod-Basedow phenomenon is thyroid hyperfunction induced by excess iodine ingestion in patients with various thyroid disorders.

Rasmussen’s encephalitis is progressive childhood disease characterized by severe epilepsy - hemiplegia - dementia - and inflammation of the brain potentially from autoantibodies to GluR3 antigen.

Carney syndrome (or triad) is nonfamilial disorder the includes combination of three rare tumors: gastric leiomyosarcoma - pulmonary chondroma - extraadrenal paraganglioma but no cardiac manifestations; unrelated to Carney complex.

Bergmann gliosis is in ethanol abuse - proliferation of astrocytes adjacent to lost Purkinje cells between depleted granular cell and molecular layer of cerebellum.

Prehn's sign is elevation of painful testicle decreases pain of epididymitis.

Parinaud syndrome

PARINAUD'S SYNDROME---( dorsal midbrain syndrome)
Supranuclear vertical gaze disorder caused by damage to the posterior commissure.
Causes include hydrocephalus from aqueductal stenosis,pineal region tumors, cysticercosis, and stroke.
Features include loss of upgaze, convergence-retraction nystagmus on attempted upgaze, downward ocular deviation ("setting sun" sign), lid retraction (Collier's sign), skew deviation, pseudoabducens palsy, and light-near dissociation of the pupils
PARINAUD'S OCULOGLANDULAR SYNDROME--- Granulomatous conjunctivitis, swollen painful preauricular lymph nodes
Causes include infections like Bartonella henselae,Francisella tularensis..

Alcohol

In alcohol intoxication, motor incoordination and judgement errors occur at blood alcohol
levels of
a.  30-80 mg/dL
b.  80-200 mg/ dL
c.  200-300 mg/dL
d.   More than 300 mg/ dL
Ans. (b)

Ethanol intoxication
Measurement of levels in exhaled air is the primary method of assessing the level of intoxication.
Blood alcohol levels are necessary to confirm the presence or absence of alcohol intoxication.
Blood ethanol levels of 20-30 mg/dL
An increased reaction time, diminished fine motor control, impulsivity, and impaired judgment
become evident when the concentration of ethanol in the blood is 20-30 mg/dL.
Blood ethanol levels of about 80 mg/dL
Blood levels of 80 mg/dL are associated with slurred speech, incoordination, unsteady gait, and
potential impairments of attention.
Levels between 80 and 200 mg/dL
Levels between 80 and 200 mg/dL are associated with mood lability and cognitive deficits,
potentially accompanied by aggressiveness, and anterorgrade amnesia (an alcoholic blackout).
Levels >200 mg/d
Blood ethanol levels >200 mg/dL can produce nystagmus and unwanted falling asleep.
Levels of 300 mg/dL and higher
Levels of 300 mg/dL and higher can produce failing vital signs, coma, and death.  In fatal cases,
the average concentration is about 400 mg/dL, although alcohol-tolerant individuals often can
withstand comparable blood alcohol levels.
Acute Ethanol Intoxication. Goodman & Gilman's The Pharmacological Basis of
Therapeutics, 12e > Chapter 23. Ethanol and Methanol
K.S Narayana Reddy: The essentials of forensic medicine and toxicology.

TAUOPATHIES :-

 TAUOPATHIES :-

• class of neurodegenerative diseases associated with the pathological aggregation of TAU PROTEIN in the human brain.
• tau protein is deposited within neurons in form of neurofibrillary tangles (NFTs).
• Tangles (NFT=a/k/a---PHF or "paired helical filaments") are formed by hyperphosphorylation of a microtubule-associated protein known as tau, causing it to aggregate in an insoluble form (also referred to as ).
• It consists of following disorder:-

1. Alzheimer disease
2. Pick's disease
3. corticobasal degeneration
4. progressive supranuclear palsy
5. Dementia pugilistica (chronic traumatic encephalopathy)
6. Frontotemporal dementia and parkinsonism linked to chromosome 17,
7. Lytico-Bodig disease (Parkinson-dementia complex of Guam)
8. Ganglioglioma and gangliocytoma
9. Meningioangiomatosis
10. Subacute sclerosing panencephalitis
11. Frontotemporal dementia
12. Frontotemporal lobar degeneration
13. lead encephalopathy,
14. tuberous sclerosis, Hallervorden-Spatz disease, and lipofuscinosis

SYNUCLEINOPATHIES:-
• group of neurodegenerative disorders characterized by fibrillary aggregates of ALPHA-SYNUCLEIN PROTEIN in the cytoplasm of neurons and glia.
• These disorders include:-
• Parkinson's disease (PD)
• dementia with Lewy bodies (DLB)
• pure autonomic failure (PAF)
• multiple system atrophy (MSA)

Lung development

Lung development: REMEMBER  the sequence as Entering [Embryonic], Professional [Pseudoglandular], Course [Canalicular],  So [Saccular] Amazing [Alveolar]....
--Develops from median diverticulum of foregut, lining epithelium is endodermal origin.
Stages:-
5 overlapping stages
1.Embryonic –D26-7thwk- lung buds.
2.Pseudo glandular-5thwk-16thwk-Terminal bronchiole.
3.Canalicular-16th-26thwk-Alv.duct.
4.Saccular-26thw-birth-Primitive alveoli.
5.Alveolar-36w-18m-Prominent alveoli.

PDE Inhibitors

Approved PDE3 inhibitors include the following:
amrinone
cilostazol
milrinone
enoximone
Pimobendane
PDE4
Apremilast, a phthalimide derivative being developed for inflammatory disorders, including psoriasis, psoriatic arthritis and ankylosing spondylitis.
Cilomilast, in clinical development
for treatment of COPD.
Diazepam, a benzodiazepine anxiolytic, amnesic, hypnotic, sedative and muscle relaxant.
Ibudilast, a neuroprotective and bronchodilator drug used mainly in the treatment of asthma and stroke. It inhibits PDE4 to the greatest extent, but also shows significant inhibition of other PDE subtypes, and so acts as a selective PDE4 inhibitor or a non-selective phosphodiesterase inhibitor, depending on the dose.
Luteolin, supplement extracted from peanuts that also possesses IGF-1 properties.
Mesembrenone, an alkaloid from the herb Sceletium tortuosum (Kanna).
Piclamilast, a more potent inhibitor than rolipram.
Roflumilast, licensed for the treatment of severe chronic obstructive pulmonary disease
Rolipram, used as investigative tool in pharmacological research.
PDE5
Sildenafil, tadalafil, vardenafil, and the newer udenafil and avanafil selectively inhibit PDE5, which is cGMP-specific and responsible for the degradation of cGMP in the corpus cavernosum. These phosphodiesterase inhibitors are used primarily as remedies for erectile dysfunction, as well as having some other medical applications such as treatment of pulmonary hypertension.
Dipyridamole also inhibits PDE5. This results in added benefit when given together with NO or statins.
Claimed newer and more-selective inhibitors are icariin, an active component of Epimedium grandiflorum,
PDE10
Papaverine, an opium alkaloid, has been reported to act as a PDE10 inhibitor. PDE10A is almost exclusively expressed in the striatum and subsequent increase in cAMP and cGMP after PDE10A inhibition
Nonselective phosphodiesterase inhibitors
Methylated xanthines and derivatives:

caffeine, a minor stimulant
aminophylline
IBMX (3-isobutyl-1-methylxanthine), used as investigative tool in pharmacological research
paraxanthine
pentoxifylline, a drug that has the potential to enhance circulation and may have applicability in treatment of diabetes, fibrotic disorders, peripheral nerve damage, and microvascular injuries
theobromine
theophylline, a bronchodilator
PDE1 selective inhibitors
Vinpocetine
Cilastatin

"MOST COMMON" FACTS -

MC invasive gynecologic malignancy : Endometrial malignancy
MC islet cell tumor in MEN 1 : Gastrinoma
MC islet cell tumor of the pancreas : Insulinoma.
MC joint involved in synovial osteochondromatosis : Knee
MC lesion to cause expansion of paranasal sinus : Mucocele
MC lethal bone dysplasia : Osteogenesis imperfecta
MC lobe affected in bronchial atresia : Left upper lobe.
MC location for a cephalhematoma : Parietal
MC location for a gastric diverticulum : Posterior wall of the gastric fundus.
MC location for a pilocytic astrocytoma : Cerebellum
MC location for a solitary myeloma of the bone : Spine
MC location for a synovial sarcoma : Knee

Psychiatry

Othello syndrome (conjugal paranoia)
A psychosis in which the content of delusions is predominantly jealousy (infidelity) involving spouse.

Clerambault’s syndrome (erotomania)
A psychosis in which the content of delusions is erotic.
Most often in women with erotic conviction that a person with higher status is in love with the
patient.

Kadinsky-Clerambault’s syndrome
A syndrome of mental automatism

Folie a deux
Induced delusional disorder c/b sharing of delusions b/w 2 persons.
So is folie a trios, folie a quatre, folie a famille

Capgras’ syndrome (delusion of doubles)
C/b delusional conviction that other persons in environment are not their real selves but are their
own doubles.
There are 4 types
1. Typical Capgras’ syndrome(illusion des sosies)-pt sees a familiar person as a stranger who is
imposing as the familiar person.
2. Illusion de Fregoli pt falsely identifies strangers as familiar persons.
3. Syndrome of subjective doubles pt’s own self is perceived as being replaced by a double.
4. Intermetamorphosis pt’s misidentification is complete including both external appearance & personality.

Fregoli’s phenomenon
Delusion that a persecutor is taking on a variety of faces like an actor.

One liners

1. Cardiotoxic anticancer drug:
Adriamycin /  Doxorubicin, Donorubicin,  Cyclophosphamide,  5 - Fluorouracil

[Dilated Cardiomypathy is caused by.......:-
DoxoRubicin, DonoRubicin ---- (Rubi Dil le gayi)]

2. Digoxin is excreted Through which route (organ): Renal

3. Digitoxin is excreted mainly by which organ:Liver

4. DOC for PSVT:
1. Adenosine
2. Verapamil

5. Effect on calcium levels of Furosemide:Hypercalemia

6. DOC for motion sickness: Hyoscine (transdermal)[Hyoscine aka Scopolamine: 

also Prescribed to 'Prevent' nausea & vomiting caused by Motion Sickness & Vertigo.]

7. Commonest sife-effect of Cisapride is: Diarrhea

8. Common side-effect of Clofazimine: Red brown discoloration of skin

9. DOC for taenia: Praziquantel

10. Drug inhibiting DNA -dependent RNA polymerase in Mycobacteria is: Rifampicin

11. Common  side-effect of Cisplatin: Vomiting

12. Vitamin deficiency noticed with phenytoin use: Folic acid,Vitamin D, and some says vitamin K as well.

13. DOC for lithium induced Polyuria:  Amiloride

14. Concentration of Lidocaine used in Spinal anaesthesia: 5%

15. Local anaesthetic causing methemoglobinemia: Prilocaine

16. Longest acting local anaesthetic: Dibucaine

17. Anaesthetic agent with LEAST analgesic property: Halothane

18. Post spinal headache can last for: 7-10 days

19. Common site of post spinal headache: Occipital

20. Therapeutic index of a drug is an indicator of its: Safety 

21. Common side-effect of Captopril: Dry cough

22. Active metabolite of Enalapril: Enalaprilat

23. Which steroid can be administered by inhalation: Beclomethasone

24. Drug used for heparin induced thrombocytopenia: Argatroban, Lepirudin 

25. Estrogen acts on which receptors:  Cytoplasmic receptors

26. Mydriasis without cycloplegia: Phenyl-ephrine

27. Buprenorphine is: Partial agonist (mu) & antagonist (k) receptors

28. Drug for maintenance therapy for opioids withdrawl: Methadone 

29. DOC for diabetes inspidus: Desmopressin

30. MOA of minoxidil: Potassium Channel OPENER

31. Beta blocker with shortest plasma half-life: Esmolol

32. Pancreatitis is a common side effect of which anti-HIV: Didanosine

33. Anticancer Drug which causes pulmonary fibrosis: Busulfan, Bleomycin.

34. Drug which is used for treating brady-arrythmias: Atropine

35. MOA of Cholestyramine: Binds to bile acids

36. Antifungal which disrupts fungal cell membrane: Griseofulvin

37. Advantage of 3rd generation cephalosporins over 1st and 2nd generation cephalosporins is that they are: Effective against Gram Negative bacteria.

38. Fluoroquinolone banned in India: Gatifloxacin

39. Anti-malarial drug effective in pre-erythrocytic phase in liver is: Proguanil

40. Effect of chloroquine on eye: Bulls eye maculopathy

41. DOC for herpes simplex: Acyclovir

42. ACE inhibitors causes hyperkalemia so they should not be used with:
Potassium Sparing Diuretics

43. Anticoagulant of choice in pregnancy: Heparin

44. Antidote of heparin: Protamine sulphate

45. Profound Analgesia is related to which anaesthetic agent:  Ketamine

46. Best way to prevent hypotension during spinal anaesthesia:  Preloading with Crystalloids

47. Post spinal headache is due to:  CSF leak

48. Agent causing Malignant Hyperthermia: Succinylcholine.

[DOC for MH - Dantrolene]

49. Nerve fibre affected by Local anaesthesia first: Type C

50. Zero order kinetics at higher dose is seen with: Phenytoin

51. DOC for Scabies: 5% Permethrin ('Oral' DOC - Ivermectin)

52. Lithium monitoring is done because of:  Very low Therapeutic Index

53. MOA of pralidoxime: Cholinesterae enzyme reactivator

54. Drug used in BPH: Prazosin, Tamsulosin

55. DOC for Acute Migraine: Sumitriptan

56. Test for Myasthenia Gravis: Edrophonium Test

57. If Theophylline is used with Ciprofloxacin:  Toxicity of theophylline Increases

58. Steroid with equal Gluco-corticoid & mineralocorticoid activity: Hydrocortisone

59. Flumazenil is: Benzodiazepine Antagonist

60. Fomepizole is used in which poisoning: Methanol Poisoning.

61. MC side-effect of chronic use of Phenothiazines is: Tardive Dyskinesia

62. Side effect of Clozapine: Agranuocytosis

63. MOA of Clonidine:  Alpha2 Agonist  & Decreasing Central sympathetic outflow

64. MOA of Digoxin: Na K ATPase inhibition

65. DOC for meningitis due to listeria:  Ampicillin

66. Mode if metabolism of INH: Acetylation

67. Most common side effect of long term use of lithium: Hypothyroidism

68. DOC for MRSA infection: Vancomycin 69. ADH acts on which part of kidney:  Collecting Duct

70. Hemorrhagic Cystitis may be a side effect of: Cyclophosphamide (Rx. Of Hmg Cystitis: MESNA)

71. Metrifonate is used for: Schistosoma 

72. Anticholinergic drug used in peptic ulcer: Pirenzipine

73. Postural hypotension is commoner with which adrenergic blocker: Prazosin

74. Organ toxicity seen with bupivacaine: Cardiotoxicity.

75. LEAST cardiotoxic anaesthetic agent: Isoflurane

76. Dissociative anaesthesia is seen with: Ketamine

77. Sodium Thiopentone is Ultra-short acting due to: Rapid redistribution

78. Dipyradimole acts by inhibiting  PDE-5 79 Beta 1 agonist drug: Dobutamine

80. Beta1 selective adrenergic blocker which can be used as anti-glaucom: Betaxolol

81. Anti-adrenergic drug which crosses blood-brain-barrier minimally: Atenolol

82. Abacavir belongs to which group: NRTI

83. Prostaglandin analogue used in peptic ulcer: E1

84. Prostaglandin analogue used in glaucoma: F2alpha

85. Shortest acting neuromuscular blocking agent: Mivacurium

86. Anaethetic Drug which increase intracranial pressure: Ketamine

87. Anti-epileptic drug which acts by release of the inhibiting transmitter GABA:   Valproic Acid

88. Furosemide & thiazides have similar properties that they both are:  Well absorbed orally

89. MOA of ciprofloxacin: Inhibits DNA gyrase

90. DOC for WPW syndrome: Pracainamide/ Amiodarone

91. Anti-hypertensive which acts by producing NO Sodium: Nitroprusside

92. MOA of Dantrolene:  Sodium Acts on RyR1 receptors resulting in Decreased Calcium.

93. Interstitial nephritis is MC seen with which antibiotic: Methicillin

94. DOC for dermatitis herpetiformis:  Dapsone

95. Neuro-psychiatric symptoms can be seen with: Cycloserine

96. Oral contraceptive failure may be seen with: Rifampicin 

97. MC side-effect of 5-Fluoro-Uracil: Gastro-Intestinal toxicity

98.  MOA of omeprazole: H K ATPase inhibition

99. Prolonged use of steroids may cause: Decrease in bone matrix proteins

100. First drug to be used in anaphylactic shock: Adrenaline (Subcutaneous / IM )

HIV

high yield (HIV):
HUMAN IMMUNODEFICIENCY VIRUS (HIV) :
• LENTIVIRUS (slowly replicating RETROVIRUS)
that causes the acquired immunodeficiency
syndrome(AIDS)
• a/k/a---“ Slim’s disease “ ( d/t weight loss)
• Commonest secondary immunodeficiency
disorder
• Most patients with HIV infection progress to
AIDS after a chronic phase lasting from 7 to 10
years.
• Exceptions to this typical course are :-
1) RAPID PROGRESSORS
chronic phase shortened to 2 to 3 years after
primary infection.
CD4T cell count < 200 /microL.
2) LONG-TERM NON-PROGRESSORS.
untreated HIV-1-infected individuals who
remain asymptomatic for 10 years or more
with stable CD4+ T-cell counts and low levels
of plasma viremia (usually less than 500 viral
RNA copies per milliliter).
3) ELITE CONTROLLERS.
infected individuals have undetectable plasma
virus (50-75 RNA copies/mL)
• Most common mode of spread --- (75% of all
cases)Sexual contact ( most commonly from
Male to female ).
• Risk of transmission with needle stick
injury--- 0.3%.
• Commonest cause of AIDS in children ---
Vertical transmission
• BLOOD BANK and HIV ( Harrison18/e page no
– 1513 ):-
Blood collected for transfusion is routinely
screened for both HIV-1 and HIV-2
A) HIV transmission is by-------
1) whole blood
2) packed rbc
3) platelets
4) leucocytes
5) plasma
B) No-HIV –Transmission is seen with
( processing procedure will inactivate virus in all
given products) ---
1) hyperimmune gammaglobulin
2) hepatitis B immune globulin
3) plasma derived hepatitis B vaccine
4) Rh0 immune globulin
HIV Epidemiology:-
• HIV-1 ---- most common type a/w AIDS in
the United States, Europe, and Central Africa
• HIV-2----- in West Africa and India.
• HIV-1 three subgroups
1) M(major)
2) O (outlier)
3) N (neither M nor O)
• Group M ( subtypes or clades ;A to K ) ----
most common form worldwide
1) Subtype B --- most common in western
Europe and United States
2) Subtype E --- most common in Thailand.
3) Subtype C (fastest-spreading type
worldwide) --- most common in India, Ethiopia,
and Southern Africa.
• most common cause of AIDS in India---
HIV-1 group-M , Subtype-C.
life cycle of HIV:-
• HIV infects cells by using ---- CD4 molecule
as receptor and various chemokine receptors as
coreceptors.
• CD4 receptors are required for entry of HIV in
Brain
a) macrophages /monocytes
b) dendritic cell
c) CD4T cells (worse affected cells)
• Chemokine receptors:-
HIV isolates and their chemokine receptors:-
1) R5 strains use CCR5--- expressed on
monocytes / macrophage and T-cells both
2) X4 strains use CXCR4 --- expressed on T-
cells only.
3) R5X4-- dual-tropic.
early in course of infection R5 (M-tropic) type
of HIV is the dominant virus (90%).
T-tropic viruses gradually accumulates ( R5
replaced by X4).
T-tropic viruses are “MORE
VIRULENT” ( because capable of infecting many
T cells and even thymic T-cell precursors and
cause greater T-cell depletion and
impairment) .
• infection leads to low levels of CD4+ T cells
through a number of mechanisms including:
1) Apoptosis of uninfected bystander cells
2) Direct viral killing of infected cells
3) Killing of infected CD4+ T cells by CD8
cytotoxic lymphocytes that recognize infected
cells.
HIV and GENETICS:-
• Very high genetic variability ( difference from
other viruses) due to :-
a) Fast replication cycle with generation of
about 1010 virions every day
b) High mutation rate of approximately 3 x 10−5
per nucleotide base per cycle of replication and
c) Recombinogenic properties of REVERSE
TRANSCRIPTASE
• high mutation rate of the human
immunodeficiency virus (HIV) is due to host cell
“DNA-POLYMERASE”
CD4 count and HIV:-
• Normal CD4 count ---- 500 cells/mm3 to
1,000 cells/mm3.
• Treatment is recommended for opportunistic
infections at CD4 count levels:
1) less than 500/mm3 ----- ART start
2) Less than 200/ mm3---- pneumocystis
pneumonia (PCP).
3) Less than 50 mm3/: mycobacterium avium
complex (MAC).
• Some circumstances, it is recommended to
start treatment when CD4 count is higher.
These include:
a) hepatitis B or hepatitis C
b) heart problems or kidney disease
c) having treatment for cancer
d) age over 50
• Viral load (= level of HIV in body) is measured
by------- number of copies of HIV-1 per
milliliter of blood plasma (copies/mL).
• GOAL OF HIV-THERAPY ---- to lower viral
load below 50 copies/mL within 6 months of
treatment.
• DIAGNOSES OF AIDS:-
is made in anyone with HIV infection and a “CD
4-T cell count <200 /Microlitres.”
“AIDS-RELATED COMPLEX (ARC)”:-
• Clinically recognized syndromes seen in HIV
infected patients at the end of clinical latency
• Clinical criteria to define ARC :-
1) Generalised lymphadenopathy (>2 non
inguinal sites)
2) Fatigue /malaise
3) Weight loss ( > 7kg or >10% of normal body
weight)
4) Fever
5) Diarrhoea
6) Night sweats
NOTE:- OPPORTUNISTIC INFECTIONS and
CANCERS a/w AIDS are not included in this
criteria.
CD4 -COUNT SIGNIFICANCE :-
• During asymptomatic period of HIV infection,
average rate of CD4T cell decline is ---50
cells /mm3/year.
• High risk of opportunistic infections --- CD4T
cells < 200/mm3.
• Cardiovascular diseases risk --- CD4T cells <
500/mm3.
• CD4T-cells and infections :-
1) > 350 cells/mm3 ---- HIV- associated
dementia
2) > 300 cells/mm3 – T.B.( Mycobaterium
Tuberculosis)
3) < 300 cells/mm3 –Thrush (Candidiasis); Oral
hairy leukoplakia (EBV-infections );Protozoans
(cryptosporidia; microsporidia and isospora
belli)
4) < 200 cells/mm3 ----Pnuemocystis Jirovecii
(Carinii) Pneumonia (PCP); HIV –Associated
Nephropathy ( HIVAN).; trypanosomiasis
(Chagas disease); Toxoplasmosis; Lymphomas
5) < 100 cells/mm3 – Cryptococcus
neoformans; Bartonella henselae (Bacillary
Angiomatosis);
6) < 50cells /mm3--- Cytomegalovirus (CMV-
retinitis); Mycobaterium Aviam Complex (MAC);
Histoplasmosis; IRIS (Immune Reconstitution
Inflammatory Syndrome ---parodoxical
worsening of preexisting symptoms after
starting ART treatment ); Primary CNS
Lymphomas
HIV- IMPORTANT-INFO:-
1) Most common opportunistic infection in
AIDS---- PNEUMOCYSTIS JIROVECI
2) Most common opportunistic infection in AIDS
pneumonia --- PNEUMOCYSTIS JIROVECI
3) Most common opoortunististic infection in
AIDS in INDIA--- TUBERCULOSIS
4) Most common FUNGAL infection in HIV/AIDS
in INDIA/world both----- CANDIDIASIS
5) Most common cancer in AIDS---KAPOSI-
SARCOMA
6) Most common neurological manifestation in
HIV infection--- “AIDS-DEMENTIA COMPLEX”
7) Most common skeletal muscle disorder ----
INFLAMMATORY MYOPATHY.
8) Most common organism to cause pneumonia
in HIV is---- streptococcus pneumonia
(HARRISON 18/E PAGE 1547)
HIV and LYMPHOMAS:-
• Lymphoma occurs in HIV infection when CD4T
CELL COUNT < 200 cells/mm3 .
• AIDS-DEFINING LYMPHOMAS are NON-
HODGKINS LYMPHOMAS (NHL) only .
(HODGKINS LYMPHOMA are not AIDS-
DEFINING LYMPHOMAS).
• AIDS-DEFINING NON HODGKINS LYMPHOMAS
(NHL)-
1) Immunoblastic lymphomas (60%--Most
common Lymphoma in HIV)---consists of –a)
diffuse large b cell lymphoma b) primary
effusion lymphoma
2) Burkitts lymphomas (small non cleaved cell
lymphomas)
3) Primary CNS lymphomas.
• HIV associated HODGKINS LYMPHOMA :-
1) Mixed cellularity (most common)
2) Nodular sclerosis
3) Lymphocyte depleted
• Most common type of lymphoma in HIV -----
(60%) IMMUNOBLASTIC LYMPHOMA ( diffuse
large b cell lymphoma) .(Primary CNS
Lymphoma -- 20% in HIV cases (HARRISON 18/
e page 1566.)
• Most common extranodal site for non
hodgkins lymphoma in HIV ----CNS.
(Most common extranodal site for NON
HODGKINS LYMPHOMA-------- stomach)
DIAGNOSIS OF HIV-INFECTIONS:-
• Most sensitive (=best screening method)-----
ELISA
• Most specific (=confirmatory)---- WESTERN
BLOT (positive if antibodies exist against 2 out
of 3 HIV-proteins i.e. p24; gp 41; gp120/60 )
• Window period ( 2-4 weeks)--- by PCR.

Compiled by Devesh Mishra sir