Friday 29 August 2014

Orthopedics

1)Most common ligament injured is:  Anterior talo-fibular ligament

2)MC ligament to be repaired in body:  Anterior collateral ligament (ACL)

3)MC tendon to be injured is:  Tendo-Achiles

4)MC vessel to be injured is: Popliteal vessels

5)MC nerve to be injured is:  Radial nerve

6)MC nerve graft is from:  Sural nerve

7)MC bone graft is from:  Iliac crest > fibula

Serum Biochemistry

Serum biochemistry - Serum biochemistry
•Sodium 135-145 mEq/L

•Potassium 3.5-5.0 mEq/L

•Chloride 95-105 mg/l

•Albumin 3.5- 5.0 gm/dl

•Protein (Total) 6-8 gm/dl

•24 hr Urine protein <150 mg

•Cholesterol 150-250

•Urea 20-40 mg/dl

•Uric acid--> 2.5-8.0 mg%

•Calcium--> 8.8-10.2 mg% (Ionized calcium typically ranges from about 4.6 to 5.3 mg/dL

•Phosphate--> 3.0-4.5 mg

•Creatinine--> 0.5-1.5 mg%

•24 hr Urine creatinine excretion 1.0-1.6 gm/day

•Bicarbonate 22-26 meq/l

•Anion gap 10-12

•pH  7.36-7.44

•PaO2 80-110 mmHg

•PaCO2 31-42 mmHg

•Metabolic Acidosis Bicarbonate < 22 mEq/L

•Metabolic Alkalosis Bicarbonate > 26 mEq/L

•Serum Osmolality 270-285 mOsm/L

•BUN 7-25 mg/dl (3-7 mmol/l)

•BUN/Creatinine 6-25 Serum enzyme
•ALT (SGPT) <40 IU/L

•AST (SGOT) 12-39 IU/L

Bilirubin◦Total 0.3-1.0 mg/dl ◦Direct 0.1-0.3 mg/dl ◦Indirect0.2-0.7 mg/dl

•Alkaline phosphatase40-120 U/L(3-12 KAV)

Retina

RETINA
1. Retinal surface area – 266 mm2
2. Macula lutea – 5.5 mm in diameter
3. Fovea centralis
– 1.85 mm in diameter
– 5 degree of visual field
4. Foveola
– 0.35 mm in diameter
– Situated 3 mm from temporal edge of optic disk to 1 mm below horizontal meridian
5. Parafoveal area – 0.5 mm in diameter.
6. Perifoveal area – 1.5 mm in diameter.
7. Ora serrata – 2.1 mm wide temporally and 0.7–0.8 mm wide nasally.
8. Number of rods about – 120 million
9. Number of cones – 6.5 million
10. Highest density of cones at fovea – 199000 cones/mm2
11. Each rod – 40–60 μm long.
12. Each cone – 40–80 μm long.
13. Foveal avascular zone – 500 μm in diameter.
14. Optic disk – 1.5 mm in
diameter
15. Length of optic nerve – 47–50 mm
Intraocular – 1 mm
Intraorbital – 30 mm
Intracanalicular – 6–9 mm
Intracranial – 10 mm

Wednesday 27 August 2014

Vitamins

Important facts about Vitamins:

Heat Stable and light sensitive- Vitamin K and Riboflavine

Vitamin required for electron Transport (Coenz. Q)- Vitamin K1, B2

Dopa and Gaba Metabolism depend on- Pyridoxine

For the Function of Co.A -Pantothenate

Folic acid is Pteroyl Glutamic acid

Folinic Acid is Citrovorum factor

Erythrocyte Maturation Factor- Vitamin B 12

Vitamins Stored in Liver- Vit A, D, K, B 12, Folate

Yellow Crystalline Substance- Riboflavine

Red Crystalline Substance- Vit B12

White Crystalline Substance- Ascorbic Acid

Vitamins Which are present in animal Foods only- Vit B12

Heat Labile Vitamins- Vitamin C and Folic acid

Vitamins That are synthesised in Gut (Flora)- Vit B2, B12 (Not useful) and Vitamin K

Synthesised in body (Skin)- Vit D

Worm infestation causing B12 deficiency- Diphyllobothrium Latum

Vitamins which are antoxidant- Vit E, Vit C

Vitamin useful in the treatment of methemoglobinemia- Vit C (Methylene Blue also useful)

Vitamins with which Hypervitaminosis occurs-Vit A and D

Vitamin deficiency which leads to convulsions- Pyridoxine

Vitamin useful in treatment of Homocystinuria- Pyridoxine

Vitamin useful in treatment of Alkaptonuria- Vit C

Vitamin that is used peripheral vascular disease- Vitamin E (For intermittent Claudication)

Vitamins that causes Hemolysis- Vit K

Vitamin that causes Neonatal Jaundice- Vit K

Vitamin deficiency that causes pseudo paralysis- Vit C, Vit D

Vitamin for wound healing- Vitamin C

Magenta red tongue is due to deficiency of Riboflavine

Raw beef tongue is due to deficiency of Niacin

Baldness of tongue due to deficiency of Vit B12

Vitamin that does not cross placenta- Vit D

Saturday 23 August 2014

Forensic medicine

Fast track Revision For FMT....😎 Forensic medicine: is the application of medical and paramedical knowledge in the administration of law and justice. Legal medicine and state medicine are other names for it.
Medical jurisprudence: deals with the legal rights, privileges, duties and obligations of medical practitioner.
Points to remember
1. Pin – point pupils = Opium
2. Dilatation of pupils = Dhatura, Cyanide
3. Constriction of pupils = Opium, phenol, organo-phosphorus, physostigmine, chloral hydrate.
4. Cumulative poisons are: Barbiturates, and methyl alcohol
5. Habit forming poisons are: Caffeine and Nicotine.
6. Addiction drugs are: Alcohol, Barbiturates, Coccaine, Cannabis, Chloral hydrate, Opium, Pethidine.
7. Hemodialysis is good value in: Salicylate, methanol, barbiturate, and aspirin (except kerosene oil and diazephem)
8. 1st sign of intra-uterine death: Gas shadow in aorta (as early as 12 hours).
9. Increased anion gap is seen in Salicylate poisoning, lactic acidosis, starvation.
10. Ideal suicide poison = Cyanide
11. Ideal homicide poison = Thallium, fluoride compounds.
12. Commonly used homicidal poisons: Arsenic, aconite
13. Commonly used suicidal poisons: Endrine, Opium, Barbiturates, Organo-phosphorus compounds.
14. Poison resembling cholera = Arsenic
15. Poison resembling tetanus = Strychnine
16. Poison resembling natural death = Thallium
17. Poison resembling fading measles = Arsenic
18. Poison resembling thyrotoxicosis = Bi-nitro compounds.
Tests for detecting poisons:
• Arsenic = Marsh’s test, Reinsch’s test
• Opium = Marquis test
• Alcohol = Mc’evan’s test
• Datura = Mydriatic test
• Phenol = Green urine.

IMPORTANT POINTS TO REMEMBER
1. The Percentage of blood alcohol in the stage of “dead drunk” is 0.5%.
2. Pisiform gets ossified by 12 yrs of age.
3. By 14 yrs. patella gets ossified.
4. Anterior fontanelle closes by 18 months of age.
5. The height of a child is double of birth height by 4 years of age,
6. Under IPC, a person below 7 years is not criminally responsible.
7. Fatal period of Datura poisoning is 24 hours.
8. In India, rigor mortis sets within 1-2 hours.
9. While dispatching blood and urine for chemical analysis, sodium fluoride is added as preservative in concentration of 50 mg/10ml.
10. Critical level of alcohol in blood is 0.15%.
11. The minimum age for giving consent for surgery is 18 years.
12. In fractured ends of bone, soft provisional callus is formed by 15 hours.
13. The minimum time required for adipocere formation in a dead body is 21 days.
14. Indian Medical Council Act was enacted in 1956.
15. Mental retardation is I.Q. Below 70.
16. Ratio between ethyl alcohol in blood to urine is 1:1.33
17. Gas rigidity appears after 72 hours.
18. Marbling is noticed by 36 hours.
19. Full development of rigor mortis takes about 12 hours.
20. In exhumation, 6-7 samples of earth are collected.
21. Intercourse with wife below 15 years of age is considerable rape.
22. Fatal period of aconite isusually 1-5 hours.
23. Cooling of body is gradual upto 1-3 hours.
24. Hypostasis is mottled within first 3 hours of death.
25. Killing range of a militry rifle is 3000 yards.
26. Juvenile offender is a person under 16 years
27. The dispersion of pellets is seen usually at distance beyond 10 feet.
28. In a gunshot wound, the presence of singeing of hair or charring of skin denotes a fire up to 18 inches.
29. Dispersion of pellets in shotgun injury is calculated as dispersion in inches = 1.5 times the dispersion in yards.
30. An infant born before 210 days is not legally considered capable of maintaining a separate existence.
31. A bruise showing bluish black discolouration is 4 days old.
32. The upper limit of safety for carbon monoxide in air is 0.01%.
33. Rh positivity in India is 93%.
34. In an abrasion, the scab usually dries and falls between 4-6 days.
35. Fatal dose of opium is 2 gm.
36. The range of an air rifle is about 90 yards.
37. Mixed dentition is seen in children between 6-12 years of age.
38. Basisphenoid unites the basi-occiput at the age to 22 years.
39. First permanent molar appears at age of 6-7 years.
40. Judicial first class Magistrate can pass a sentence of imprisonment upto 3 years.
41. Age of maturity for those under court of wards is 21 years. In India, sexual maturity is gained at 14 years of age.
42. The degree of accuracy in determining sex from long bones is 80%.
43. Fatal period of sulphuric acid poisoning is 18-24 hours.
44. Multiplying factors for estimating stature from humerus and femur in males are 5-5.3 and 3.6-3.8 respectively.
45. Colliquative liquefaction is seen within 1 week after death.
46. A contusion assumes green colour by 6 days.
47. Marriage age for boys and girls are 21 years and 18 years respectively.
48. Internal organs take 24 hours to cool. A person becomes major at the age of 18 years. Eruption of temporary teeth is completed by 2 to 2.5 years.
49. Foetal parts can be detected on plain X-ray usually by 16 weeks.
50. Child below 12 years is not required to take an oath.
51. Xiphoid process unites with sternum at age of 40 years.
52. Cranial capacity is 10% less in females.
53. Nuclear features persist in decomposition for a period of 2-3 years.
54. Precipitin test is positive to be opium in dead body upto 10 years.
55. After death, benzidine test is positive upto 150 years. Bones begin to decompose after death in 3-10 years.
56. Less than 7 aminoacids in bone suggest age of bone after death as more than 100 years. The rate of cooling of body in first 6 hours is 2.5°F and in next 6 hours as 1.5″-2.0cF. Victim of drowning in a state of suspended animation can be revived as long as 10-20 minutes.
57. Centre of ossification for pisiform bone appears at an age of 10-12 years.
58. The floatation time in summer for a dead body after drowning is one day.
59. The age of 15 years old female is best determined by the radiography of upper end of radius and ulna.
60. Maggots in a dead body do not appear before 48 hours.
61. Hairs become loose after 72 hours of death.
62. Epiphyseal union of sternal end of clavicle occurs at age of 22 years.
63. Washer woman’s hands and feet usually occur within 12-18 hours.
64. Saponification in drowning occurs in about 5 weeks.
65. Death ensues in about 5 mts. of complete submersion.
66. By ABO.RH, MN systems the exclusion of Paternity is about 50%.
67. Estimation of Age from eruption of teeth is possible upto 17 to 21 years of age. Gustafson’s method for estimation age of adult over 21 years.
68. In poisoning by salicylates, the Gastric lavage is useful upto 24 hours.
69. The age of consent for medical examination in cases of rape is minimum 12 years.
70. If a person is absent from his usual haunts, and has not been heard for 7 hears, he is presumed to be dead.
71. Infanticide means unlawful destruction of child below 1 year of age.
72. By ABO, Rh, MN systems the exclusion of Paternity is about 50%
73. Estimation of Age from eruption of teeth is possible upto 17 to 21 years of age
74. In poisoning by salicylates, the Gastric lavage is useful upto 24 hours
75. The age of consent for medical examination in cases of rape is minimum 12 years
76. In sin of Gomorrah, buccal swabs are useful upto 9 hours
77. In most countries, breath alcohol concentration 35 mg/100 ml is considered an offence After absorption, the ratio of alcohol in blood and urine is constant and is 1:1.31 Histologically, reticulum fibres in an abrasion are seen on 8 days
78. Widmark’s formula for urine analysis of alcohol is 3/4 prq
79. Pancreas constitute 0.1% of body weight
80. Punishment for false evidence is given under section 193 of IPC
81. Length of a female larynx is about 3.8 cm
82. Calcification of third molar begins at 8-10 years.
83. Lip prints on cheiloscopy are divided into 8 patterns
84. 1gm tablet of aluminium phosphide is able to liberate 1.0 gm
85. The diameter of “human hair at 15 years of age is 0.053 ram *
86. Alcohol gaze nystagmus is produced at an average blood levels of 80 mg%
87. The residual alcohol in mouth takes about 20 min to disappear and within this period breath analyser test may be false positive
88. Skeletal muscles constitute about 29% of body weight
89. Term ‘under the influence’ of alcohol is used when blood concentration is 80-100mg%
90. Statutory rape is rape under 15 years of age
91. Weight for occluding internal jugular vein hanging is 2 kg
92. Majority of deaths due to Aluminium phosphide occurs in within 24 hours
93. During sleep, rectal temperature is 0.5-1.0°C lower
94. Drowned body floats in about 12-18 hours in summer S
95. Bones constitute about 12% of body weight
96. Absence of III molar tooth indicates that the person is definitely under the age of 17 years
97. In a dead body, maggots in rainy day are seen in 6 hours.
98. Arsenic, Aconite and Dhatura are generally used as homicidal poisons.
99. Ricin is the active principle of croton oil seed.
100. Abrin is the active principle of abrus precatorius.

101. Soneryl is a coloured babriturate.
102. Breath alcohol can be measured by Alcometer or Drunkometer.
103. The fatal dose of Dhatura is about one grain.
104. Physostigmine can be regarded as the specific antidote of Dhatura.
105. Amygdaline is the glucosides of vegetable origin found in cyanides.
106. The process of putrefaction can be retarded by carbon monoxide gas.
107. Euthanasia means “Mercy killing”.
108. Joule burn is seen in electrocution.
109. Amyl nitrate is an antidote for poisoning due to hydrocyanic acid.
110. Olive green discoloration of urine on exposure to air is seen in poisoning due to carbolic acid.
111. Overlying is a type of smothering.
112. Optic atrophy is the characteristic feature of poisoning by methyl alcohol.
113. Dryness of mouth, dilated pupils and delirium are symptoms of Dhatura poisoning. (All ‘D’s)
114. The first permanent tooth to erupt is first molar.
115. Dying declaration can be recorded by a medical officer.
116. Presence of fine white leathery froth in mouth and nostrils is seen in drowning.
117. Privation of any member of joint is a grievous hurt.
118. Pugilistic attitude is seen in burn death due to coagulation of proteins.
119. Dying declaration should be recorded by Magistrate.
120. Nalorphine is an antidote for morphine.
121. Locard’s principle states that every contact leaves a trace.
122. The strongest corrosive poison is sulphuric acid.
123. Arborescent markings are seen in lightening.
124. Before performing Postmortem examination, body should be identified by Policemen.
125. Warrant case means a case relating to an offence punishbale with death, imprisonment for life or for a term exceeding two years.
126. In civil cases, a reasonable sum for travelling expenses is generally tendered when the summons is served. This is known as conduct money. It is paid by the party that has called his as a witness.
127. Hair cells are of special interest in cell sexing since both Barr body and Y chromosome can be demonstrated.
128. Nails, hairs and long bones are preserved in cases of chronic arsenic poisoning.
129. Postmortem fibrinous clots in heart are known as “Cardiac polyp”.
130. The surest sign of death is putrefaction.
131. The rigor mortis start first at upper eye-lids.
132. Dribbling of saliva from the angle of the mouth is generally considered as the surest sign of hanging.
133. Presence of soot in respiratory tract is the surest sign of burn.
134. Strong sulphuric acid when thrown on the face of a person is known as “Vitreol throwing”.
135. Black gun powder consists of potassium nitrate, sulphur, and charcoal.
136. Nitrocellulose or Nitroglycerine is used as a smokeless gun powder.
137. Richochette bullet is one which strikes any other surface before striking the object.
138. The pulmonary lesion in the injury of air blast is called “Blast lung”.
139. Loss of virginity is called defloration.
140. The Buccal coitus is called “Sin of Gomorrah”.
141. The commission of sexual assalut upon a dead body is called “Necrophily”.
142. ”Testamentary capcity” is the capacity of a person to make a valid will.
143. Malpraxis is defined as want of reasonable skill and or willful negligence on the part of doctor resulting in deterioration of patients’ health or his death.
144. Copper sulphate is used as an antidote to phsophorus.
145. ‘Gyroget‘ are cartridges or miniature rockets driven by solid fuel, which produces considerable heat and smokeless gas on burning.
146. Forensic means courts of law.
147. Deposition means a statement on oath made by a witness in a judicial proceeding. It is taken down in writing and signed by the witness and magistrate.
148. Document means any matter expressed or described upon any substance by means of letters, figures or marks, or by more than one of these means.
149. Evidence includes all legal means which help to prove or disprove any matter of fat, the truth of which is submitted to judicial investigation. It can be oral (direct, indirect or hearsay), documentary & circumstantial.
150. Hurt is defined as bodily pain, disease or infirmity caused to any person.
151. Injury includes every inquiry other than a trial, conducted by a Magistrate or court.
152. Investigation includes all the proceedings for the collection of evidence conducted by a Police officer or by any person other than a magistrate who is authorised by a magistrate on his behalf.
153. Jury means a body of persons sworn to render verdict in a court of justice. It is composed of uneven number and not less than 7 and more than 9 persons.
154. Metropolitan area means any area in the state comprising a city or a town whose population exceeds one millin.
155. Offence means any act of omission made punishable by law for the time being in force.
156. Perjury means wilful utterance of falsehood under oath.
157. Plantiff is one who brings an action in a court of law.
158. Summons case means a case relating to an offence punishable with imprisonment for a term not exceeding two years
159. Testimony means the evidence, oral or written, of a witness under under oath.
160. Warrant means a written authority under “hand and seal”. It is used for the arrest of persons or for their forcible production in a court of law
161. Traumatic rupture of hymen is seen on posterolateral aspect.
162. Taylor gave a formula on rate of decomposition of dead body in air, water and earth.
163. Most reliable method of determining personal identity is Dactylography.
164. Contre-Coupe injury is seen in head injury.
165. Strychnine acts on anterior horn cells.
166. Last organ to putrefy in mate is prostate whereas in female it is ungravid uteus.
167. In Carboluria, urine turns green on exposure to air.
168. Cyanide poisoning produces cherry red colour.

169. McEwen’s sign is seen in alcoholism.
170. Cutis anserina is seen in drowning.
171. Shaking palsy or ‘mad Hatters’ is seen with mercury poisoning.
172. Poison which can be detected in burnt bodies in arsenic.
173. Cepahlic index helps in identification of race.
174. Tentative cuts are seen in suicides.
175. Pugilistic attitude is seen in antemortem or postmortem burns.
176. Death in police custody is investigated by Magistrate.
177. Precipitin test is used to identify human blood in stains.
178. Gelsimium is a spinal cord poison.
179. Desferroxamine is antidote used in iron poisoning.
180. Spalding’s sign is seen in maceration.
181. Impotence is inability to perform the sexual act.
182. Smack is crude form of heroin.
183. Ganja is obtained from flowering tops.
184. Stomach may be greenish in poisoning due to nitric acid.
185. Lines of Zahn are present in antemortem clots.
186. Conium is a peripheral poison.
187. Emphysema aqueosum is seen in wet drowning.
188. Formication (Magnan’s symptom) is seen in cocaine dependence.
189. Rigor mortis is simulated by cadaveric spasm.
190. Thorn apple is Datura stramonium.
191. Dirt collar is seen in fire arm entry wound.
192. Apoplexy is cerebral congestion.
193. Feminine of impotence is frigidity.
194. In oath taking, a medical man does not require to keep his hands on a holy book.
195. Thanatology is science that deals with death.
196. Number of hours since death is calculated by multiplying the fall in rectal temperature with 0.67.
197. Dichotomy is related to splitting of fees.
198. Fracture of hyoid bone in a case of strangulation is commonly seen in the greater horn.
199. In a fresh case of death due to ventricular fibrillation, heart at postmortem will be flabby.
200. Punctate basophilia is seen in lead poisoning.
201. Felony is a category of rape, murder or burglary.
202. Testamentary capacity is related to will.
203. McNaughten was an accused.
204. Accepted procedure of first aid for cafe coronary is Heimlich manoeuvre.
205. Mode of death from obstruction of air passages from within is anoxic anoxia.
206. Brain may be preserved in normal saline or rectified spirit.
207. CSF is preserved in poisoning due to alcohol.
208. Long bones are preserved inpoisoning due to arsenic, lead or antimony.
209. Exhumation is usually done in the early morning.
210. In India, Exhumation is done for Mohammadans and Christians.
211. Macroscopically and microscopically, there will not be any change to the heart in case of myocardial infarction death up to 8 hours.
212. Foamy liver is due to bubbing up of gas.
213. Leukocyte alkaline phosphatase level is low in CML.
214. The essential lesion of coronary atherosclerosis is found in intima.
215. The classical site of ischaemic colitis is splenic flexure.
216. The rigor mortis disappears in the order of eyelids, neck, thorax, lower lumbs (in the order of appearance).
217. Primary relaxation is stage of somatic death.
218. After death, the onset of putrefaction is in the stage of secondary relaxation.
219. Species of origin of blood is determined by precipitin test.
220. It is a criminal offence in India, for a person to drive a motor vehicle after consuming alcohol.
221. Dum dum bullet is so called because tip is chiselled off.
222. Cyanides mainly affect Cytochrome oxidase.
223. In electrocution, death is most often due to ventricular fibrillation.
224. Le facies sympathique is seen in hanging.
225. The characteristic sign of Korsakoff psychosis is amnesia.
226. Aconite is most commonly used as a homicidal poison.
227. Alcohol is maximally absorbed from small intestine.
228. Absolute alcohol has 99.95% alcohol.
229. Visceras obtained from a body due to death from alcoholic intoxication are preserved is suprasaturated saline.
230. In strychnine poisoning, rigor mortis sets in early and lasts shortly.
231. A short barreled rifle is called carbine.
232. The most fragile bone in skull to get fractured is temporal
233. The most common type of skull fracture is fissure.
234. Rigor mortis sets early in cases with deaths due to apoplexy.
235. In cadaveric spasm, stage of primary relaxation is missing.
236. Heat stiffening is due to exposure of body to temperature above 75°C.
237. The presence of blackening, tatooing and scortching in a shotgun injury indicates distance of fire upto 3 feet.
238. Lucid interval is seen in extradural haemorrhage and insanity.
239. In forgeries, oxalic acid is used as ink remover solution.
240. Pond fracture (of skull) is found in children.
241. Blasting effect is usually seen in a firearm injury from point blank range.
242. Olive oil is used in stomach wash in carbolic acid poisoning.
243. Fracture of middle cranial fossa causes injury to VII and VIII cranial nerves.
244. Histologically amyloid deposits always begin intercellularly.
245. Ischiopubic index is significantly more in females.
246. Unconsciousness occurs immediately after head injury due to concussion.
247. A female has more sternal index, ischiopubic index and sciatic notch index.
248. Ewings postulates refer to accidents as a cause of death.
249. Loss of muscular coordination and staggering gait are seen in patient with blood alcohol concentration of 150-300
250. Dinitro compounds poisoning resembles thyrotoxicosis.
251. Aconite is known as Sweet poison.
252. CuSO4 is antidote of Phosphorus.
253. Foder’s test compares weight of lungs to the body.
254. Diaphanus test denotes that after death, finger webs lose their lusture.
255. Gaping of deep incised wound is dependent on cleavage lines of Langer.
256. When a patient is injured or dies due to some unintentional act during treatment by a doctor or agent of the doctor or known as therapeutic misadventure.
257. Glass blowers shakes are seen with poisoning due to mercury.
258. ‘Run amok’ is sometimes seen with cannabis.
259. Abrus is viper-like poison.
260. Bluish green hypostasis is seen in H2S poisoning
261. Marquis test is used in opium poisoning.
262. Datura is also known as ‘Road poison’.
263. Marsh’s test and Reinsch test are used in arsenic poisoning.
264. Exposure to nickel causes carcinoma nasopharynx.
265. Best test for seminal stain is Florence test.
266. Fall of a tooth is grievous injury.
267. To conduct a postmortem, an authorisation letter is necessary from police officer, magistrate and coroner.
268. A consent is invalid of obtained from a person who is intoxicated, insane or under threat.
269. In India, exhumation has no time limit.
270. Colour changes of putrefaction are first observed in iliac fossa.

271. Dipsomania is seen with alcohol.
272. Subpoena is a seen kind of document.
273. In exhumated bodies, the poison likely to be detected most significantly is arsenic.
274. Postmortem in a newborn is done by opening first the abdominal cavity.
275. Tests for circulation are Magnus, Diaphanous and Icard’s.
276. Compressed air is used to fire lead slugs in air rifle.
277. Most important sign of defloration is ruptured hymen.
278. Cafe coronary occurs when a person is intoxicated.
279. Overlying is a type of smothering.
280. Death in fresh water in comparison to salt water is earlier.
281. Bevelling of inner table of skull is seen in fire arm entry wound.
282. In burking, cause of death is traumatic asphyxia.
283. Bansdola is a form of homicidal strangulation.
284. Convincing proof of burial alive is sand in trachea and bronchi.
285. In India. Coroner’s courts are held in Bombay.
286. Corpus delict deals with body of crime.
287. Burking is a name derived from person.
288. Bullet is picked up with hands.
289. The process which causes the drying up of tissues and internal viscera to a sufficient degree to halt putrefaction is called mummification.
290. The most important cause of temporary impotence is fear.
291. Minimum quantity of blood required to be preserved to mineral poisoning.
292. Superimposition is technique most useful for identification from skull.
293. Brown atrophy of heart is seen in starvation deaths.
294. Most common type of finger impression is loop.
295. Lead poisoning is common in children.
296. Presence of alveolar duct membrane in foetal autopsies in indicative of live birth.
297. The science of finger print was first demonstrated by Francis.
298. Karl Pearson formula is used to calculate stature of the individual from long bones.
299. Filigree burns are due to lightening.
300. The commonest homicidal poison used in India is Arsenic.
301. BAL is contraindicated in liver damage.
302. KCN is ineffective as a poison if kept for long time, patient takes excess of carbohydrate or suffers from achlorhydria.
303. Inquiry into circumstances of death is called inquest report.
304. Non-poisonous pure metals are mercury, copper and lead.
305. Phossy Jaw is produced by chronic white phosphorus poisoning.
306. Ptysalism is seen in copper poisoning.
307. Chloral hydrate is also called knockout drops or Micky Finn.
308. Chromodacryorrhoea is sometimes preapilated by organophosphorus
309. Rape is a cognizable offence.
310. To make a positive identification with the help of a partial finger print, the points of similarity should be at least 16.
311. The most striking symptoms of pregnancy is cessation of menstruation.
312. The most reliable chemical test for blood is benzidine test.
313. The position colour of tests for blood are —Benzidine test (Blue), Guiacum test (deep blue), Kastle Meyer test, Leucomalachite test (Peacock blue), Haemin Crystal (dark brown).
314. Takayama reagent is used in haemochromogen test.
315. Heat stiffening is due to coagulation of albumin.
316. Term immerssion foot is used for cases with frost bite.
317. Boxer’s attitude is seen in persons dying of burns.
318. III and IV degree of burns are most painful. •
319. Smokeless gun powder is composed of nitrocellulose.
320. Gunshot wound is a type of perforated wound.
321. Supreme Court is purely an appellate Court.
322. Police inquest can be done by a person not below the rank of sub-inspector.

323. Haemodilution occurs in fresh water drowning.
324. In chronic mercury poisoning, face is first affected.
325. Wrist drop and foot drop may be seen in poisoning with lead.
326. After taking cyanide, patient first feels numbness in extremities.
327. Nux vomica seeds contain 2 alkaloids, strychnine and brucine.
328. Lynching is a form of homicidal hanging.
329. ‘Arrow poison’ is nux vomical (also called Kuchila).
330. Commonest industrial metal poisoning is by lead.
331. Haemorrhagic spots are found in poisoning by thallium.
332. Amyl nitrate is antidote of cocaine poisoning.
333. In sea water drowning, there is steep rise in Na+ and Mg++.
334. Cadaveric spasm occurs immediately after death.
335. Least common type of finger prints is composite.
336. Preauricular sulcus is useful for identification of sex.
337. Seminal emission is common in hanging.
338. In methyl alcohol poisoning treatment recommended is ethyl alcohol and sodium bicarbonate.
339. The presence of fine white leathery froth in mouth indicates drowning.
340. Lower end of femur can help to determine the age.
341. Resipsa Loquitur means evidence speaks for itself.
342. Resorption elution technique is used for detection of blood stains.
343. In females, obturator foramen is triangular shaped.
344. Absorption of lead is mainly through lung.
345. Incised like lacerated wound appears at forehead.
346. Medical jurisprudence is the subject concerned with knowledge of law in relation to the practice of medicine. In a nutshell, it deals with legal aspects of medical practice.
347. Crime means a social harm which has been defined and made punishable by law.
348. No conduct money is paid in criminal cases, however, provision is made by the Govt under sec. 312 Cr PC for payment of reasonable expenses of an expert witness attending before any criminal court.
349. The body is exhumed only when there is a written order issued by 1st class Chief Judicial or Executive magistrate or the Coroner. There is not time limit for exhumation in India.
350. Puterfaction is the surest sign of death. The earliest sign is manifested as greenish discoluration in the right ilic fossa.
351. Heat stiffening is due to coagulation of albumin and muscle proteins.
352. Cold stiffening is due to solidfication of fats when body is exposed to very low temperatures
353. Presence of blood stained froth in the air passage and diatoms in internal visceras and bone marrow is considered surest sign of drowning.
354. The chief post mortem finding in case of starvation is distended gall bladder.
355. Heat exhaustion is caused by dehydration and salt deficiency.
356. Presence of soot in the respiratory passage is the surest sign of ante-mortem burn.
357. Diatoms resist putrefaction.
358. About 1900 cals is the minimum daily dieteic requirement below which manifestations of starvation appear.
359. For estimating surface area in burnt patient “Wallace’s Rule of Nine” has been employed.
360. The Taser Gun is a device for immoblizing vicitims by using electric current without causing death or serious injury.
361. In drowning, Paltauf ‘s haemorrhages are seen subpleurally in the lungs
362. Molecular death is more significant medico-legally than somatic death.
363. Semen contains more than double quantity of CPK than any other body fluid. Levels over 400 units are almost diagnostic. The enzyme is stable and can be demonstrated as late as 6 months after soiling.
364. Hanging is one of the common forms of suicide among men.
365. Judicial hanging is the official method of execution of death sentence. The dislocation often takes place between the 2nd & 3rd cervical vertebra.
366. Dribbling of saliva is the vital sign of ante-mortem hanging and is due to stimulation of salivary glands by ligature.
367. Lynching is homicidal hanging where several persons acting jointly overpower an individual and hang him by means of a rope to a tree or like object.
368. Strangulation is almost always homicidal.
369. In strangulation, ligature completely encricles the neck horizontally below thyroid cartilage. Injury to carotid arteries common. Bleeding from nose, mouth and ears. Emphysematous patches on lungs are commonly seen during postmortem examination, fracture of hyoid bone commonly occurs in throttling (near the greater cornua).
370. Smothering is a form of asphyxia caused by mechanical occlusion of the external air passages viz. the nose and the mouth by hands, cloth or any other material.
371. Overylaying or compression suffocation results due to compression of the chest so as to prevent breathing. It is common method of infanticide.
372. Burking is a method of homicidal smothering and traumatic asphyxia.
373. Drowning is a form of asphyxia due to aspiration of fluid into air passage, caused by submersion in water or other fluid.
374. Death ensues rapidly in fresh water than in salt water or sea water.
375. The fine froth at the mouth and nose in pathognomonic of drowning.
376. Cutis anserina or goose skin has no value as a diagnostic sign of death from drowning. Diatoms test is negative in dead bodies thrown in water or in dry drowning.
377. In a typical case of drowning, diatoms are found in brains and bone marrow.
378. Drowning is one of the commonest form of suicide amongst females.
379. Buccal coitus is Sin of Gomorrah.
380. Strychnine poisoning resembles tetanus / epilepsy / hysteria.
381. Thallium resembles natural death.
382. Exhumation is done: In presence of police officer. In the supervision of Medical Officer. Written order from 1st class Magistrate or coroner.
383. Most common mode of death in strangulation is Asphyxia.
384. The common mode of choking is Accidental.
385. Caffey syndrome is Battered baby syndrome.
386. In judicial hanging, fracture/dislocation of the vertebrae at the level of C3 and C4 vertebra.
387. In Asphyxia, the place where the Tardieu spots occur in lung is interlobar fissures. Forensic thanatology deals with Medicolegal study of death.
388. In dental fluorosis, the teeth are characterised by mottled enamel.
389. Wreden’s test—for deleting the presence of air in middle ear for determining live birth or dead foetus.
390. The rules for criminal responsibility of Insane: Mc Naughten’s rule, Durham’s rule, Current’s rule
391. Blood group of Parents, Child group possible: § OxO i.e 00×00 = 0, A x B i.e OA x OB = O, A, B, AB. All are possible, OxA i.e OOxOA = O, A.
392. Macerated body of a foetus indicates—dead-born.
393. Cadaveric spasm (Instantaneous rigor) affects voluntary muscles only.
394. The most dependent means of identification of persons is finger prints.
395. If a person survives after giving dying declaration, it can be used as corroborative evidence.
396. Paraffin test or dermal nitrate test detects Gunpowder residue on hands.
397. Knockout agents: Chloral hydrate, Potassium bromide
398. Saturday night paralysis due to pressure on the Radial nerve.
399. Leading questions are permissible in cross-examination.
400. Preservation used to preserve the urine for chemical analysis is Thymol crystals.

401. In Arsenic poisoning, putrefaction is delayed.
402. Arsenic is employed for embalming of Cadaver.
403. Subendocardial haemorrhages in Arsenic poisoning.
404. The poison which is found in maximum quantities in various organs in Postmortem is —Arsenic.
405. Poisoning resembling fading measles — Arsenic.
406. Optic atrophy occurs in Methyl Alcohol poisoning.
407. Minimum Alcohol consumed by person, estimated by — Widmarks formula.
408. Widmark’s formula, to determine — Quantity of Alcohol consumed.
409. The preservative used for viscera in Alcohol poisoning—Saturated sodium chloride solution.
410. Barbiturates increase the toxicity of Alcohol by Synergism.
411. Methylated spirit contains—95% Rectified spirit and 5% Methyl alcohol.
412. The common preservative for viscera—Rectified spirit
413. The organs that resist putrefaction—uterus (Non pregnant); Prostate.
414. The poisons which Resist putrefaction—Arsenic, Edrin, Datura, Strychnine.
415. Thick and leathery stomach wall in —Phenol poisoning.
416. Ochronosis (Pigmentation of skin and cartilages) in — Phenol poisoning.
417. In Phenol poisoning —Urine is green coloured.
418. Delicate and reliable test for Blood stains—Takayama’s test (Hemochromogen crystal test).
419. Teichman test for blood stains is —Haemin Crystal test.
420. Extremely delicate test for Blood stains—Phenophthalein test (Kastle-Mayer test).
421. The best test for Blood stains—Chromatography absorption spectroscopy.
422. Leukomalachite green test is a chemical test for —Blood.
423. In severe burns, remnant indicative of Male sex—Inguinal canal.
424. Carbonaceous soot particles in Respiratory tract suggesive of—Antemortem burns.
425. Lichetenberg’s flowers or filigree burns or Arborescent markings is seen in Lightening.
426. In chemical burns by Corrosives—Vesication does not occur.
427. Paltauf’s haemorrhages (usually in lower lobes of lungs) in —Drowning.
428. Immersion syndrome is due to—Vagal inhibition
429. Froth may be absent in case of death due to — Dry drowning.
430. The specimen used for Diatom’s test—Sternal bone marrow.
431. Salt water drowning —Increased.
432. Postmortem staining: Usually mistaken for —Contusion. Can occur before death in —Cholera.
433. Hypostasis or cadaveric lividity — Postmortem staining.
434. Purple colour in —Asphyxia.
435. Blue green colur in —Hydrogen sulphide poisoning.
436. Blue vitreol—Copper sulfate.
437. Verdigris—Copper subacetate.
438. Green line on the gums in —Copper poisoning.
439. Most potent of all preparations of cannabis is —Charas.
440. Stomach wash in opium poisoning, done with —Potassium permanganate.
441. In opium poisoning, there is loss of all secretions except sweat.
442. In opium poisoning, atropine is contraindicated.
443. Methaemoglobinaemia is caused by poisoning due to Nitrates.
444. Antidote used in common types of poisonous shakes, in India includes polyvalent antisnake venom.
445. Viperbite like poison—Abrus.
446. Sea snake venom—Myotoxic.
447. Diwali poisons are —Mercury, phosphorous.
448. Nephrotoxic poisons—Phenol, Oxalicacid, Mercury.
449. Blotting paper like stomach in sulphuric acid poisoning.
450. Sodium nitrate looks and tastes like common salt.
451. Tingling of skin and tongue by Aconite poisoning.
452. Tannic acid precipitates alkaloids.
453. Physiological antidote produce symptoms opposite to those of poison is:
454. Atropine—Physostigmine
455. Cyanide—Amyl nitrite
456. Strychnine—Barbiturate
457. In phosphorous poisoning, avoid oil and fats as they increase absorption.
458. In Endrin poisoning, the pupils are dilated.
459. Albumin helps to precipitate in Mercury poisoning.
460. Lead poisoning, causes constipation.
461. In Potassium permanganate poisoning, lesions resemble Tertiary syphilis.
462. Symptoms of Abrus precautorius poisoning resemble viperine snake bite.
463. Cocaine acts as an Aphrodisiac.
464. Charas is known as Hashish.
465. In treatment of Nuxvomica poisoning, most important is I.V. injection of Barbiturates.
466. Pupils show alternate contraction and dilatation in Aconite poisoning.
467. Charcoal acts as a mechanical Antidote.
468. Potassium ferrocyanide solution is used as gastric lavage solution of poisoning due to copper sulphate.
469. Skin and mucous membranes are colored yellow in poisoning due to nitric acid.
470. Delayed poisoning by oxalic acid is characterised by —Uraemia.
471. Large amount of water is contraindicated in —Oxalic acid poisoning.
472. Hypocalcemia can occur in —Oxalic acid poisoning.
473. Hypocalcemia can occur in —Oxalic acid poisoning.
474. Oxalic acid resembles—Magnesium sulfate.
475. Coffee ground vomitus is seen in Oxalic acid poisoning.
476. Datura seeds look like—Brinjal seeds capsicum seeds or Tomato seeds.
477. Physiological antidote for Datura poisoning—Pilocarpine
478. Stupefying poison—Datura.
479. Road poison—Datura.
480. If a person survives after giving dying declaration, it can be used as corroborative evidence
481. Arsenic is employed for embalming of Cadaver
482. Subendocardial haemorrhages are seen in Arsenic poisoning
483. The poison which is found in maximum quantities in various organs in Postmortem is – Arsenic
484. Poisoning resembling fading measles – Arsenic
485. The preservative used for viscera in Alcohol poisoning – Saturated sodium chloride solution
486. Barbiturates increase the toxicity of Alcohol by Synergism
487. Methylated spirit contains 95% Rectified spirit and 5% Methyl alcohol
488. The poisons which Resist putrefaction are— Arsenic, Edrin, Datura, Strychnine
489. Thick and leathery stomach wall is seen in Phenol poisoning
490. Ochronosis (Pigmentation of skin and cartilages) is seen in Phenol poisoning
491. Extremely delicate test for Blood stains – Phenophthalein test (‘Kastle-Mayer test).
492. The best test for Blood stains is Chromatography absorption spectroscopy
493. In severe burns, remnant indicative of Male sex is inguinal canal
494. Lichetenberg’s flowers or filigree burns or Arborescent markings are seen in Lightening
495. In chemical burns by Corrosives Vesication does not occur
496. Immersion syndrome is due to Dry drowning
497. Rule of House is used for calculating age of the fetus-
498. PM staining usually mistaken for -Contusion
499. PM staining can occur before death in – Cholera
500. Most potent of ail preparations of cannabis is Charas501. Amenorrhoea and infertility can occur in Chronic lead poisoning
502. If a person is absent from his usual haunts, and has not been heard for at least 7 years, he is presumed to be dead
503. In opium poisoning there is loss of all secretions except sweat
504. In opium poisoning, atropine is contraindicated
505. Strongest corrosive poison is sulphuric acid
506. Antidote used in common types of poisonous snakes in India includes polyvalent antisnake venom
507. Viperbite like poison is Abrus
508. Sea snake venom is Myotoxic
509. Diwali poisons are – Mercury, phosphorus
510. Blotting paper like stomach is seen in sulphuric acid poisoning
511. Spinal poisoning may be mistaken commonly for Tetanus
512. Sodium nitrate looks and tastes like common salt
513. Tingling of skin and tongue is seen in Aconite poisoning
514. In phosphorous poisoning, avoid oil and fats as they increase absorption
515. In Endrin poisoning, the pupils are dilated
516. Albumin helps to precipitate poison in Mercury poisoning
517. Lead poisoning causes constipation
518. In Potassium permanganate poisoning, lesions resemble Tertiary syphilis
519. Cocaine acts as an Aphrodisiac
520. In treatment of Nux vomica poisoning, most important is I.V. injection Barbiturates
521. Pupils show alternate contraction and dilatation in Aconite poisoning
522. Charcoal acts as a mechanical antidote.
523. Delayed poisoning by oxalic acid is characterised by Uraemia Large amount of water is contraindicated in Oxalic acid poisoning Hypocalcemia can occur in Oxalic acid poisoning
524. Coffee ground vomitus is seen in Oxalic acid poisoning
525. Datura seeds look like- Brinjal seeds, capsicum seeds or Tomato seed
526. Antidote for chlorpyriphos poisoning is. PAM.
527. Prussian blue is used in poisoning by thallium.
528. In gastric lavage, tube is passed upto 50 cm mark
529. Oleander causes heart block
530. Puppe’s rule is used for bullet injuries
531. Wredin’s test detects changes in middle ear
532. Rain drop pigmentation of skin is seen is arsenic poisoning
533. Algor mortis refers to cooling of body
534. American Law Institute Test is related to criminal responsibility
535. Poroscopy was described by Locard
536. Burrowed servant doctrine is related to vicarious liability
537. Wax-drippings or bone pearls are due to thermal injuries
538. Lichtenberg’s flowers refers to Filigree burns
539. Cutis anserina is due to exector pilae
540. Cupping’ is a method of criminal abortion
541. Crocodile flash burns are due to antemortem electric burns
542. Hospital providing defective equipment or drugs is causing Corporate, negligence Contusion collar is a proof of Gun shot entrance
543. In ‘Commando punch’, injury usually occur in neck
544. Blast lung is seen due to air explosion Thereapeutic orphans result due to experimentation
545. Thee name hatters shake is given because it is common in hat making industry
546. Trotter and Glesser’s formulae are used for estimating stature
547. Rachiotomy saw is used to remove spinal cord
548. In cases of increased intracranial pressure, Kernhan’s notch is seen on midbrain
549. In artificial insemination of Donor without husband’s consent, if the legal presumption of legitimacy be rebutted, parental rights will be vested in mother only
550. Agonal period is period between lethal occurrence and death
551. K master is responsible for the faults of his servants is known as Vicarious liability, Biliard ball ricochet effect is seen in firearm injuries
552. Cavett test is used for determing blood alcohol
553. Dactylography was first used in India by Sir W. Herschel
554. Huffling is common solvent abuse
555. Sewer gas contains CO2, methane and H25
556. Stomach-bowel test’ is used for knowing if infant respiration occurred
557. ‘Swallow tails’ are seen in lacerated wound
558. Most common type of abrasions of grazes
559. Osteometric board is used to estimate stature
560. Skull is square in Mongolians
561. In human head hair, bar bodies are found in hair follicles in a proportion of 29± 5% in females and 6+2% males
562. Curator bonis is person appointed to manage the affairs of mentally incompetent
563. “Crib deaths’ are due to asphyxia
564. Commoriants’ literally means dying together
565. For identification, palatoprints are taken from anterior part
566. Pink teeth are seen in death due to asphyxia
567. The order of appearance of rigor mortis follows Nysten’s law
568. Postmortem lividity in a case of hanging is most prominent over lower extremities
569. Postmortem staining of a dead body lying undisturbed persists till it merges with discolouration of putrefaction
570. Bleeding from nostrils, mouth and ears is relatively common in strangulation
571. Contre coup injury is seen in brain
572. In deep incised wounds, Langer’s lines determine gaping
573. Mugging by definition is homicidal
574. Ligature mark in hanging is an example of imprint abrasion
575. Immediate cause of death in burns is neurogenic shock
576. Common cause of death in crush syndrome is acute renal failure
577. Abrasion is seen in injury with rifled arm
578. Spermin in semen is detected by Barberio test
579. The impotent quoad is impotent to a particular woman
580. Seminal fluid choline originates from Leydig cell
581. To establish diagnosis of feigned insanity, the person can be observed for a maximum period of 30 days
582. Incessant sexual desire is known as satyriasis
583. Dhatura poisoning is due to intake of seeds
584. Mercury damages glomeruli and renal tubules
585. Cyanide poisoning kit contains amyl nitrite, Sodium nitrite and sodium thiosulfate
586. Chromolachryorrhoea in organophosphorus poisoning is due to porphyrin
587. A green line in gums in copper poisoning is Clepten line
588. In Eonism, there is cross dressing
589. Garrotting is used as a method of execution in some countries
590. Tardieu spots are numberous in thymus, AV junction and conjunctiva
591. In body packer syndrome, person dies of abused drug overdose
592. In drowning, emphysema aquosum is seen in 80% cases
593. In embalming fluid, the concentration of formaldehyde and methyl alcohol are 40% and 10% respectively
594. Emmenagogues are used for criminal abortion
595. McNaughten rule has been included in India in section 84 of IPC
596. Hydrocution is another term for immersion syndrome
597. Diminished responsibility is a term used for borderline mental state
598. Minisatellite or stutters are terms used for DNA finger printing
599. Section 312 IPC is related to abortion
600. Sankya or somalkhar is a compound of lead601. The compounds used for taking finger prints are French chalk, lead carbonate and mercury
602. ‘Central pocket loop’ is a variety of Composite finger print
603. Reaction phenomenon is seen drowning
604. Alcoholic palimpsests are a type of blackout
605. Arsenic poisoning may lead to thrombocytopenia, leukemia and BM suppression
606. In arsenic poisoning, bands of opacity in finger nails are called Aldrich-Mees lines
607. Affiliation cases are related to paternity dispute
608. Kennedy phenomenon results due to surgical alteration
609. Incineration, dismembement and advanced putrefaction are methods of effacement of identity
610. Moletova cocktail is a bomb
611. Medullary index is used to determine sex
612. Harrison and Gilroy test is used for firearm injury
613. After respiration, the weight of lungs increases by about 30 gm
614. The most characteristic defence injuries are those sustained during an attack by knife
615. Ploucquet’s test is used to estimate live birth
616. Weight of pineal gland is 0.1 to 0.2 gm
617. In smothering, there is abrasion on the inner side of upper lip
618. Death during anaesthesia, D.C. to be written by anaesthesist
619. Privileged communication may be used by a doctor to blackmail his patients
620. Repeated intentional advertisement by a doctor in newspaper is professional misconduct
621. Oath taking in the court is court formality
622. The inquiry into the circumstances of death is inquest report
623. 16 years age of female is an age to give valid consent for lawful sexual intercourse
624. Age of consent for medical examination is after eruption of III molar
625. Fragmentary medulla is seen in Negroid
626. For saliva, test used is alpha amylase test
627. Rule of Haase is used for estimation of foetal age
628. Wilson’s classification is used to classify burns
629. Drugs interfering in blood grouping are barbiturate, aspirin and heparin
630. Phenol also retards putrefaction
631. In strangulation, neck muscle rupture is common
632. In fresh water poisoning, there may be hyperkalemia, hemolysis and ventricular fibrillation
633. Brain stem death occurs in encephalomyelitis
634. Postmortem examination is done for all organ of the body
Historical milestones
Code of Hammurabi—oldest known medico-legal code.
Hippocrates (father of Medicine)
— discussed lethality of wounds
— formulated medical ethics

Double signs

Double bleb sign-intrauterine pregnancy
Double delta sign - bucket handle meniscal tear
Double diaphragm sign-pneumothorax in a supine patient
Double disc sign- both thickening of the LATERAL pterygoid inferior belly insertion and an anteriorly displaced TMJ disc are present
Double rim sign-early capsule stage of brain abscess
Double track sign-PYLORIC STENOSIS on barium study and pylorospasm on USG
Double wall sign-pneumoperitoneum with air outlining both sides of the bowel wall. It is seen when large amount of free air, > 1000 ml, is present.
Double oreo cookie sign-SLAP TEAR

Tuesday 19 August 2014

COLOUR CODING OF MEDICAL GAS CYLINDERS

(1)"Oxygen : Black coloured with white shoulders", while ur walking thru the Casualty of any hosp u'll find this holstered on the bars beneath a stretcher.
(2) "Carbon - Dioxide : Grey Colour" just try writing Carbon diaxoide chemical formula on a paper i.e. CO2 , putting 2 as subscript of O, you'll notice that the O and the 2 form a lowercase "g" designating CO2 :-> C for CarbonDioxide and O2 for g i.e grey
(3) " Air : Grey body and black valve" just think of the hAIR on our head, its black first and then turns grey, similarly the valve is black and the body below the valve is grey.
(4) " Nitrous Oxide : Blue" this is damn easy, if you've watched the Movie Housefull (Akshay,Ritesh, Lara, Deepika), recall the last seen where there is a switch of cylinders at the Queen's Royal Palace Gathering and the 2 goons end up connecting the wrong tank flooding the reception with Nitrous Oxide , giving the laughter riot at the end of the movie because, Nitrous Oxide is Laughing Gas.
(5) "Cyclopropane : Orange" well orange is a fruit which is rich in Vitamin C and the name Cyclopropane starts witha C, so C for Vit.C is as to Orange is as to Cyclopropane.
(6) "Ethylene : Red" Well in PUC biology we had learn't the reason behind the one-liner "a few rotten apples spoils the entire lot" lets say the few rotten apples are at the bottom of the basket , when fruits and vegges are spoilt they release "Ethylene gas" which travels up and spoils the apples which are "RED" in colour causing them to inturn release the gas hence Ethylene "->Red.
(7) "Helium : Brown" I am a big fan of brownies and recently i wanted to learn how to prepare them by myself, so i googled and founf out that the easiest Brownie to prepare is the "Float Brownie" (you too can google) now what makes the baloons float, yes its Helium, So Helium: Float :: Float Brownies : Helium :-> Brown
(8) " Entonox : Blue body with Blue Quartered Shoulders" very simple what was the 2World cup frenzy, yes it was "BLEED BLUE", to bleed blue for the men who wear blue clothing on their body with blue clothing on their shoulders, now if we have to bleed blue it means we have blue "WITHIN" us and what does ENTO mean in greek, you guessed it right, it means within, For Ex. Entropion (Ento-ro-pion) meaning the eyelid folds within or eyelid folds inwards, hence, Entonox is Blue Body with Blue Shoulders.
(9) "Halothane: Amber" I'm a fan of Halo, in Halo2 while playing the Delta level the music is In Amber Clad, its gotta quite good tune to it (type '"In Amber Clad (extended) - Halo 2 soundtrack' on you tube to listen to it) Hence HALOthane :-> Amber. 
Moral of the story " What the mind does not know, the eyes do not see" if your mind knew that medicine existed everywhere then your eyes would by default see it and help you in crisis times.

Biliary cirrhosis

1) PRIMARY BILLIARY CIRRHOSIS
• inflammatory autoimmune disease
• characterized by nonsuppurative, inflammatory destruction of medium-sized intrahepatic bile ducts
• mostly middle-aged women ( 40-50 yrs age group)
• gender predilection--- Female to male ;6:1
• symptoms and sign---- Pruritus, jaundice, malaise, dark urine, light stools, hepatosplenomegaly
• Laboratory findings-- Conjugated hyperbilirubinemia, increased serum alkaline phosphatase, bile acids, cholesterol; elevated serum IgM autoantibodies (especially M2 form of anti- mitochondrial antibody target the E2 component of the pyrurate dehydrogenase complex (PDC-E2))
• Histology--- Dense lymphocytic infiltrate in portal tracts with granulomatous destruction of bile ducts.
• Risk—micronodular cirrhosis; hepatocellular carcinoma 
• Most common cause of death --- liver cell failure > variceal bleeding
2)SECONDARY BILIARY CIRRHOSIS
• Etiology--- Extrahepatic bile duct obstruction (most common cause of obstruction in adults is extrahepatic cholelithiasis or gallstones) biliary atresia, gallstones, stricture, carcinoma of pancreatic head
• Sex predilection--- male and female equally affected
• Symptoms and signs--- Pruritus, jaundice, malaise, dark urine, light stools, hepatosplenomegaly
• Laboratory findings-- Conjugated hyperbilirubinemia, increased serum alkaline phosphatase, bile acids, cholesterol
• Histology--- Prominent bile stasis in bile ducts, bile ductular proliferation with surrounding neutrophils, portal tract edema

Monday 18 August 2014

Diabetes

Latent autoimmune diabetes of adults (LADA), often also late-onset autoimmune diabetes of adulthood or aging,[1] slow onset type 1 diabetes or diabetes type 1.5 is a form of diabetes mellitus type 1 that occurs in adults, often with a slower course of onset. Adults with LADA may initially be diagnosed as having type 2 diabetes based on their age, particularly if they have risk factors for type 2 diabetes such as a strong family history or are obese.
The diagnosis is based on the finding of high blood sugar together with the clinical impression that islet failure rather than insulin resistance is the main cause; detection of a low C-peptide and raised antibodies against the islets of Langerhans support the diagnosis. It cannot be treated with the usual oral treatments for type 2 diabetes, and insulin treatment is usually necessary, as well as long-term monitoring for complications. The concept of LADA was first introduced in 1993.
latent diabetes - a mild form of diabetes mellitus in which there are no overt symptoms but there are abnormal responses to some diagnostic procedures,A persn who becums diabetic under stressful situatn like pregnancy nd again becums non diabetic whn stress is removed ...
Brittle diabetes mellitus (or labile diabetes) is a term used to describe particularly hard to control type 1 diabetes.
🔺Those people who have brittle diabetes will experience frequent, extreme swings in blood glucose levels, causing hyperglycemia or hypoglycemia.
🔺The life expectancy for someone with brittle diabetes is no different to someone who has type 1 or type 2 diabetes.
🔺In fact, brittle diabetes can also be described poorly controlled type 2 diabetes.
🔺Brittle diabetes is rare but serious. Around 3 in 1,000 people with type 1 diabetes mellitus will develop brittle diabetes.
A person who is NOT diabetic on presentation bt 4m a strong Family history of DM 2 .. .... is calld a potential diabetic....
The following characteristics suggest the possibility of a diagnosis of MODY in hyperglycemic and diabetic patients:
🔺Mild to moderate hyperglycemia (typically 130–250 mg/dl, or 7–14 mmol/l) discovered before 30 years of age. However, anyone under 50u can develop MODY.
🔺A first-degree relative with a similar degree of diabetes.
🔺Absence of positive antibodies or other autoimmunity (e.g., thyroiditis) in patient and family.
🔺Persistence of a low insulin requirement (e.g., less than 0.5 u/kg/day) past the usual "honeymoon" period.
🔺Absence of obesity (although overweight or obese people can get MODY) or other problems associated with type 2 diabetes or metabolic syndrome (e.g., hypertension, hyperlipidemia, polycystic ovary syndrome).
🔺Insulin resistance very rarely happens.
🔺Cystic kidney disease in patient or close relatives.
🔺Non-transient neonatal diabetes, or apparent type 1 diabetes with onset before six months of age.
🔺Liver adenoma or hepatocellular carcinoma in MODY type 3
🔺Renal cysts, rudimentary or bicornuate uterus, vaginal aplasia, absence of the vas deferens, epidymal cysts in MODY type 5
Genetic defects in beta cell function caused by mutations in subunits of ATP sensitivr K channels... a form of neonatal onset diab..SUs found effective
In MODY2, oral agents are relatively ineffective and insulin is unnecessary.
In MODY1 and MODY3, insulin may be more effective than drugs to increase insulin sensitivity
After d initial clinical presentations of type1 DM a honeymoon phase may ensue during which time glycemic control s achieved wid modest doses of insulin or rarely insulin s not needed at all
DQA1*0102 DQB1*0602 dese haplotypes r extremely rare in pts wid type1DM(<1%) and appears to provide protection from typ1DM
Relatives of individuals wid type1 DM-tenfold increased risk of developing t
Parents hav diabetes-3-4% risk
Sibling5-15%
Homozygous glucokinase mutations cause a severe form of neonatal diabetes
COCAINE precipitates DKA
Monoclonal ab 4 prevention of type1 DM -CD3

Thyroid cancer

Thyroid ca quiz

1. BRAF, RET/PTC, MET, TRK1 - Papillary ca

2. MASIC score - prognosis papillary ca : Metastasis, Age, Size, Invasion, Completeness of Sx

3. RAS, P53, PTEN, PAX8/ PIPAR-1 - Follicular ca

4. Osteoblastic bone 2° : MTC , Prostate ca

5. Goitre + deafness, chr 7 = Pendrid syn

6. Euthyroid sick syn : AbN TFT in non-thyroid illness ; "low T3 syn"

7. MEN1- Wermer, AD, chr 11, MENIN gene

8. MEN2- Sipple, AD, chr 10, RET gene.

MEN2B: Marfinoid habitus

Granulomas

1)CASEATING GRANULOMA---
# T.B.(both caseating and non caseating)
# Histoplasma
# syphilis
# coccidiomycosis

2)NON -CASEATING:-
# Sarcoidosis
# Leprosy (tuberculoid type)
# crohns disease
# wegeners granulomatosis
# hodgkins lymphoma

Thursday 7 August 2014

Serology of Hepatitis

SEROLOGY OF HEPATITIS B:-
1) HBsAg— considered to be infected ( can be acute/chronic or carriers)
Persistence of HBsAg is used to differentiate acute from chronic infection.
Presence of the antigen longer than 6 months after initial exposure indicates chronic infection.
2) anti-HBs—
implies either active or passive immunization that usually persists for life.
Protected
3) Anti-HBc— (NOTE:- HbcAg is not detectable in serum)
first detectable antibody
IgM anti-HBc indicates acute infection. ( most reliable marker of acute hepatitis infection) only serologic marker detectable during the “window period “ .
IgG anti-HBc indicates previous or ongoing infection.
4) HbeAg
High infectivity and active disease higher rates of viral transmission marker of viral replication and infectivity ( HbeAg----produced only during replication of the virus)
5) anti-HBe:
low infectivity.
Loss of HBeAg and appearance of anti-HBe in serum is called “seroconversion”
Indicates clinical improvement (=remission of the disease)
6) HBV DNA (quantitative viral load) indicates viral burden and viral replication assess recovery from infection and candidacy for antiviral therapy to differentiate between inactive carrier state
and chronic active hepatitis in chronic HBV infection. cutoffs for consideration for antiviral therapy
is
A) HbeAg-positive patients with chronic hepatitis -----100,000 copies/mL (or 20,000 IU/mL)
B) HbeAg-negative patients---10,000 copies/mL ( or 2,000 IU/mL )
NOTE:-
A) imp info :-
1) Qualitative marker of HBV-replication -----HbeAg
2) Quantitative marker of HBV-replication:- Definitive is HBV-DNA >HBV-DNA polymerase
B) INACTIVE CARRIERS
Refers to HBeAg-negative with normal serum ALT levels and low (< 2000 IU/mL) or undetectable HBV DNA.
C) precore or basic core mutant HBV also referred to as HBeAg-negative, or anti- HBe-positive HBV
HBeAg-negative and anti-HBe-positive patients with high serum HBV-DNA levels (>10000 copies /ml) and persistent or intermittent elevations in alanine aminotransferase (ALT) activity represents severe and progressive form of liver disease associated with frequent development of cirrhosis and HCC.

Wednesday 6 August 2014

Side effects

..........S/E or Advr effects.......

Agranulocytosis........ Clozapine

Aplastic Anemia......· Chloramphenicol · NSAIDs

Atropine-like Side Effects............Tricyclics

Cardiotoxicity.............· Doxorubicin · Daunorubicin

Cartilage Damage in children......Fluoroquinolones

Cinchonism............Quinidine

Coronary Steal Phenomenon...........Dipyridamole

Corneal micro deposits...........· Amiodarone

Cough.........· ACE Inhibitors

Diabetes Insipidus............Lithium

Disulfiram-like effect..............Metronidazole · Sulfonylureas (1st generation)

Extrapyramidal Side Effects........Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine)

Fanconi’s Syndrome.........Tetracycline

Fatal Hepatotoxicity (necrosis)........· Valproic Acid · Halothane · Acetaminophen

Gingival Hyperplasia......· Phenytoin

Gray Baby Syndrome...........Chloramphenicol

Gynecomastia.........

Cimetidine · Azoles · Spironolactone · Digitalis · Estrogen & testosterone · INH & ethionamide · Clomiphine · Phenytoin · Reserpine & Methyldopa

Hand Foot Syndrome..........· 5-Flurouracil (5-FU)

Hemolytic Anemia in G6PD-deficiency

· Sulfonamides · Isoniazid · Aspirin · Ibuprofen · Primaquine

Hemorrhagic Cystitis

· Cyclophosphamide · Ifosamide
(Treat by Mesna & Acetylcysteine Bladder Wash)

Hepatitis...........· Isoniazid

Hot Flashes, Flushing

· Niacin · Tamoxifen · Ca++ Channel Blockers

Hypertension: Postural............· Prazocin

Hypertension: Rebound............· Clonidine withdrawal

Increased intra cranial tension ( ICT)

· Amiodarone · Hypervitaminosis A · OCP’s · Tetracycline · Quinolones

Induce CP450

· Barbiturates · Phenytoin · Carbamazepine · Rifampin

Inhibit CP450

· Cimetidine · Erythromycin · Ketoconazole · Isoniazid

Interstitial Nephritis

· Methicillin · NSAIDs (except Aspirin) · Furosemide · Sulfonamides

Milk Alkali Syndrome......· Calcium Carbonate

Nephrotoxicity.....· Cephaloridine · Gentamycin · Amphotericin

Orange Body Fluids............· Rifampin

Osteoporosis...........· Heparin · Corticosteroids

Pancreatitis............· L-Asparginase · Glucocorticoids

Photosensitivity...........· Lomefloxacin · Pefloxacin

Positive Coombs’ Test........· Methyldopa

Pulmonary Fibrosis............· Bleomycin · Amiodarone

Rabbit Syndrome (Perioral tremors).........· Phenothiazines

Red Man Syndrome.............· Vancomycin (rapid IV)

SLE- Drug Induced [Anti Histone Antibody}

· Chloropromazine · Hydralazine · Isoniazid · Methyldopa · Procainamide · Quinidine

Tardive Dyskinesia

· Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine)

Tinnitus...........· Aspirin · Quinidine

Torsades de Pontis...........Terfanadine

Angles in Orthopaedics


Cobb's Angle - Scoliosis
Kite's Angle - CTEV
Meary's Angle - Pes Cavus deformity
Hilgenreiner's Epiphyseal Angle - Congenital
Coxa Vara
Baumann's Angle - Supracondylar Fracture
Bohler's angle is decreased and Gissaine's
angle is increased in - Intra Articular fractures
of Calcaneum

Beta blockers

Beta blocker - Beta blocker
-Cardioselective - NEBIVOLOL & CELIPROLOL are the "hero"

1.Metoprolol, Atenolol, Acebutolol
2.Esmolol (UltraShortest acting)
3.Betaxolol (Antiglaucom safe used in BA)
4.Celiprolol (Safe in BA,DM,Hyperlip,PVD)
5.Bisoprolol (used in CCF)
6.Nebivolol (Most Cardioselective)

-Beta blocker with intrinsic sympathomimetic property - COP...    "hero"-pindolol

1.Celiprolol
2.Oxeprenolol
3. Pindolol (most sympathomimetic)

Copper

Why is copper  required in body ?

What if there is deficiency of copper ?

what if there is excess of copper ?

1. Copper acts as cofacter for various enzymes = TYROSINASE , LYSYL OXIDASE , SUPEROXIDE DISMUTASE, CYTOCHROME C OXIDASE, DOPAMINE BETA HYDROXYLASE. [Q]

2. If there is deficiency of copper these enzymes will not work properly as for eg in copper deficient state lysyl oxidase will not work and there will be ineffectual cross linking in collagen and elastin leading to weakened vascular wall and fragile skin.



MENKES DISEASE IS A X-LINKED RECESSIVE DISORDER DUE TO DEFICIENCY OF COPPER

PATHOGENESIS : Defect in ATP7A gene[Q] so that copper is absorbed in the intestinal eptithelial cells but cant be transported out of intestinal epithelial cells into blood stream so that the intestinal epithelial cells are loaded with copper but there is deficiency of copper in body.

CLINICS : Mental retardation , seizures , hypothermia , twisted and hypopigmented hair (pili torti) , loose skin , arterial rupture and death in early childhood.

TREATMENT : To give copper by any other route than oral becoz intestinal absorption is impaired. Subcutaneous route copper is given and show some clinical improvement in disease state.



WILSON DISEASE IS DUE TO EXCESS DEPOSITION OF COPPER IN VARIOUS PARTS OF BODY:

PATHOGENESIS : Defect in ATP7B gene( CHROMOSOME 13)[Q] leads to defective excretion of copper from hepatocytes into billiary tree leading to copper excess in body . Two most commonly effected organ is liver and brain so also known as HEPATOLENTICULAR DEGENERATION.

CLINICS : It usually presents with acute or chronic liver disease in childhood . Liver disease is progressive if left untreated. Adults develop neurological symptoms as dysarthria and diminished cordination. Copper accumulation can also lead to arthropathy , cardiomyopathy, kidney damage and hypoparathyroidism , decemets membrane formation.

TREATMENT : Chelating agents as penicillamine and ammonium tetrathiomolybdate.



so to compile

MENKES = COPPER DEFICIENCY = ATP7A GENE = X-LINKED RECESSIVE = DEFECTIVE COPPER ABSORPTION

WILSON = COPER EXCESS = ATP7B GENE = CHROMOSOME 13 = AUTOSOMAL RECESIVE = DEFECTIVE COPPER EXCRETION

Hypersensitivity reactions

List of some Hypersensitivity
pneumonitis :
1. hot tub lung - Mycobacterium avium & cladosporium species
2. tap water lung - Mycobacterium spp
3. chemical worker's lung - Isocyanates
4. air conditioner's lung - Aureobasidium
5. cheese washer's lung - penicillium casei
6. compost lung - Aspergillus
7. Detergent worker's lung - Bacillus subtilis enzymes
8. laboratory worker's lung - male rat urine
9. Japanese summer type - Trichosporon
10. Mushroom worker's lung - Thermophilic actinomycetes
11. Miller's lung - Sitophilus granarius
12. Tobaco Workers lung - aspergillus
13. Winegrowers lung - botryitis species
14. Farmer's lung - Micropolyspora faeni

Gold standards

Gold standard method of treatment of DCIS - Mastectomy

Gold standard approach for resection of anterior and middle mediastinal masses - median or lateral thoracotomy

Gold standard method of treatment of Coarctation of aorta - Surgical repair

Gold standard method for evaluation of coronary artery disease - Cardiac Catheterization

Gold standard method for culture of V. cholerae o139 - Conventional culture method

Gold standard to determine cut-off titer of widal test for diagnosis of Typhoid fever – Nested PCR

Gold standard treatment of brucellosis in adults - IM Streptomycin + Doxycyclin

Gold standard investigation for diagnosis of of chronic arterial mesentric ischemia - Angiography

Gold standard method for treatment of chronic ulcerative colitis - Total proctocolostomy with end ileostomy

Gold standard method for evaluation of imaging modalities for liver tumors - Intraoperative ultrasonography

Gold standard investigation for diagnosis of common bile duct stones - Endoscopic cholangiography

Gold standard investigation for measurement of GFR - Inulin clearance

Gold standard for treatment of organ confined, muscle invasive, bladder cancer is - Radical cystoprostatect omy in men and anterior pelvic exenteration in woman

Gold standard for treatment of femoral shaft fractures - Reamed locked intramedullary nailing

Gold standard method in case of difficult intubation - Flexible fibreoptic intubation scope

Gold standard method for diagnosis and treatment of Ventilator Associated Pneumonia (VAP) - Broncho alveolar lavage

Gold standard treatment of hyperparathyroi dism - Surgery

Gold standard investigation to differentiate follicular and papillary carcinoma of thyroid gland- Histology

Gold standard procedure for thymectomy - Trans cervical mediastinoscopy and surgery

Gold standard for treatment of adrenal tumors - Laparoscopic adrenalectomy

Gold standard investigation for diagnosis of breast cancer - Mammography

Gold standard method for staging of breast cancer - Axillary lymph node dissection

Gold standard for evaluation of a stable patient with suspected vascular injury - Angiography

Gold standard investigation for diagnosis of GERD - Ambulatory 24 hr PH monitoring

Gold standard method for treatment of GERD - Laparoccopic Nissens fundoplication

Gold standard for evaluating cure rate in duodenal ulcer patients – Vagotomy

Gold standard finding for the diagnosis of GI perforation - Finding pneumoperitoneu m

Gold standard for diagnosis of Zollinger-Ellis on syndrome - Serum gastrin levels( Most patients have serum gastrin levels above 1000pg/mL)

Gold standard investigation for diagnosis of colonic mucosal disease - Colonoscopy

Gold standard investigation for diagnosis of steatorrhoea - Timed quantitative stool fat determination

Gold standard method for treatment of incontinence with an isolated sphincter defect - Overlapping sphincteroplast y

Gold standard investigation for diagnosis and method of management of Acute arterial occlusion – Laparotomy

Gold standard method for confirmation of mesentric arterial occlusion - Mesentric angiography

Gold standard investigation for diagnosis of celiac disease – Small intestine biopsy

Gold standard for identifying choledocholithi asis – ERCP

Gold standard method of treatment of Symptomatic cholelitiasis – Lap cholecystectomy

Gold standard method for diagnosis of Primary sclerosing cholangitis - ERCP

Gold standard investigation for diagnosis of Hepatitis C – HCV RNA assay

Gold standard test for diagnosis of intraluminal bile duct abnormalities - ERCP

Gold standard method for management of hydatid disease – Surgery

Gold standard for assessing degree of liver injury and fibrosis - Liver Biopsy

Gold standard method for management of blunt hepatic trauma - Non-operative management

Gold standard test for assessment of function of sphincter of oddi – Manometry

Gold standard investigation of diagnosis of Klatskin tumor - Cholangiography

Gold standard investigation for diagnosis of invasive amoebiasis - ELISA