The "NO SPECS" scheme is an acronym derived from the following eye changes:
0 = No signs or symptoms
1 = Only signs (lid retraction or lag), no symptoms
2 = Soft-tissue involvement (periorbital edema)
3 = Proptosis (>22 mm)
4 = Extraocular-muscle involvement (diplopia)
5 = Corneal involvement
6 = Sight loss
Risk Factors for Thyroid Carcinoma in Patients with Thyroid Nodule(harrison 18th)
History of head and neck irradiation
Age <20 or >45 years
Bilateral disease
Increased nodule size (>4 cm)
New or enlarging neck mass
Male gender
Family history of thyroid cancer or MEN 2
Vocal cord paralysis, hoarse voice
Nodule fixed to adjacent structures
Extrathyroidal extension
Suspected lymph node involvement
Iodine deficiency (follicular cancer)
Pnemothorax is best demonstrated during expiration
Dye used in bronchography Dianosil
Solitary nodule lung lung cannot be NF
B/L calcification of lungs not found in Friendlanders pneumonia
Perihilar fluffy opacity on chest X-ray seen in pulmonary venous HTN
Rt. Lung is seen to best advantage on Rt. Anterior oblique
In Hamartoma no cavitating lesion in CXR
Best CXR are performed at 60-90 Kvp
Golden S sign seen in Rt. Upper lobe collapse
Preferred modality for Dx of pulmonary embolism is Ventilation perfusion >angiography
Well defined rounded opacity in the lung with coarse irregular calcification ---- Hamartoma
MC cause of spontaneous pneumothorax – rupture of subpleural blebs
Apex of lungs is best asses by AP view
Bulging fissure in lungs is seen in --- Klebsiella pneumonia
Tracheal bifurcation at T4-T5 level
Floating water lily sign --- Hydatid Lung
Hampton hump --- pulmonary embolism
U/L hyperlucent lung on CXR --- Poland syndrome
Mediastinal Lymph node calcification seen in Sarcoidosis
Lt. atrial enlargement(ALSO MITRAL VALVE) is seen with Barium swallow Rt. Anterior oblique view
Echocardiography can detect pericardial effusion min fluid – 15ml
Hilar dance -- ASD,VSD,TGV
Dx of acute MI hot spot seen with Tc 99
Best Dx for dissecting aorta ---- MRI
Flask shaped heart – Ebstein anomaly, TOF
Square root sign --- Constrictive pericarditis
Splenic calcification --- Brucellosis
Pancreatic scanning isotope MC used -- Selenium -75
In colitis cystic profunda whole colon can involved
No hapatomegaly in Coeliac Ds
Scalloping of the edge of sigmoid colon on barium enema seen in --- pnematosis intesinalis
Barium meal in trendelenberg position used best in Hiatal disorder
Invertogram to be done in newborn after 6 hrs
Hepatic adenoma can be Dx with high accuracy by using Nuclear imaging
Fox sign --- Acute pancreatitis
Adenolymphoma - Tc-99 scan show hot spot
Bird of prey sign ---- Sigmoid volvulus
Gold standard IOC for GIST – PETCT
Bead cystogram used in Dx of Stress incontinence
Placenta localization by Tc99
In nephrogram one see Collecting duct
Renal scan should be done in Supine postion
Rim sign – Massive hydronephrosis
Neonate has mass in kidney which on USG is seen as hypoechoic shadow ---- Mesonephroblastic tumour
Uereterocoele (IVP) --- Adder head appearance
Central stellate scar on CT --- renal oncocytoma
A tumour Trouser leg appearance on an ascending myelogram –intramedullary
Stipple sign in transitional CC of the renal collecting system best seen in retrograde pyeloureterography
ACUTE SAH < 48 Hrs - NON CONTRAST CT
CHRONIC SAH >48Hrs - MRI
DENSITY OF HEMORRHAGE DECREASES WITH TIME AND GRADUALLY APPROACHES THAT OF CSF
Basal ganlia calcification seen in Wilson ds
MC intracranial calcification is peneal calcification
Tram-line calcification --- Sturge weber syndrome
Commonest cause of intracerebral calcified shadow --- Oligodendroglioma
Most serious complication of myelogram – Allergey
Calcification in basal ganglia --- hypothyroidism, hypoparathyroidism
In fluorescein angiography dye is injected in ante cubital vein
Bracket calcification in skull X-ray – copus callosum lipoma
Periventricular calcification --- CMV
In meningioma no erosion occur
Extramedullary intradural tumour – Neurofibroma
Multiple sclerosis lesion in white matter
Banana sign --- Spina bifida
X-ray of Skull n phalanges is diagnostic in hyperparathyroidism
Dead bone on X-ray look more radio opaque
Intraosseous skeletal tumour is best Dx by CT scan
Stryker’s view is used in shoulder joint to visualize --- Recurrent subluxation
Normal metacarpal index is 5.4 – 7.9
Stenver View(Towne view) --- internal auditory meatus ,mastoid air cell(MALIS see mnemonics page)
Champagne Glass pelvis --- Achondroplasia
Umbau Zones -- osteogenesis imperfect
Caldwell view – Superior orbital fissure
H – shaped vertebra --- Sickle cell anemia
Schober ‘s sign --- Flexion of lumber spine
Vertebra plana --- EG,Malignancy
5 –FU not given in Mycosis fungoides
Karnofsky scale --- measurement of size of tumour
Sunburst calcification on X-ray -- insulinoma
Calcific hepatic metastases --- Adenocarcinoma of colon
S/E of USG in small organism --- cavitation
Isotope selectively concentrated in abscess --- Gallium
X-Ray film are least sensitive to which coloured light – red
Photoelectric interaction Primarily in K shell
Thesaurosis -- Resins in hairspray
Grid – used for reducing scattered radiation
Best Dx of nasopharyngeal angiofibroma – CECT
Medusa head in X-Ray – ascariasis
Spring water cyst – pleura pericardial cyst
USG of umbilical artery done for to know heart beat
USG frequency used in obs is 1-20 MHz
Sestamibi Scan --- parathyroid adenoma
UV A – 320-400 nm
Active ingredient in Xray film – silver bromide
“Time of Flight “ technique used in MRI
Target angle in tele therapy --- 300
T ½ of Co60 = 5.2 yrs
Radioactive gold is used in malignant ascitis
Radioactive phosphorus used in polycythemia
Isotope which replacing radium – Cs
Tc99 T ½ = 6hrs
Latest source of neutrons for radiotherapy --- Californium -256
A single whole body dose can cause death – 300 rad
In teletherapy distance is 100 cm
1st sign after Radiation is Erythema
T ½ of Rn-222 =3-6 days
1 gray(unit for absorbed)= 100 gray
Benign condition treated by radiotherapy is pituitary adenoma
Dose for total body irradiation in bone marrow transplantation – 1000 cgy – 1200 cgy
Hyperfractionation Rx (Radiotherapy) used in Lung cancer
Naturally occurring radioactive substance in the body – K40
Radioactive isotope used in gamma knife for t/t of AV malformation—Co
Not used in brachytherapy – I131
RAIU – I 123 (AI 07)
Max permissible dose of radiation for radiation worker 50 MSV per year
1Curie = 3.7 Gbq
Point B t/t of Ca of cervix by radiotherapy --- Obturator node
Commonly used in intra operative Rx – Electron
Dots in ophthalmology
Gunn’s dot= light reflections from internal limiting membrane around disc and macula
Horner-Trantras Dot=Collections of eosinophils at limbus in vernal conjunctivitis.
Kayes’ dot=subepithelial infiltrates seen in corneal graft rejection
Mittendorf’s dot=whitish spot at posterior lens surface,remnant of hyaloid artery.
Lines in Ophthalmology
Arlt’s Line = conjunctival scar in sulcus subtarsalis.
Ehrlich-Turck Line = linear deposition of KPs in ueitis
Ferry’s Line = corneal epithelial iron line at the edge of filtering blebs.
Hudson-Stahil Line= Horizonatl corneal epithelial iron line at the inferior one third of cornea due to aging.
Khodadoust Line = corneal graft endothelial rejection line composed of inflammatory cells.
Paton’s Line = Circumferential retinal folds due to optic nerve edema.
Sampaoelesi line = Increased pigmentation anterior to Schwalbe’s line in pseudoexfoliation syndrome.
Scheie’s Line = pigment on lens equator and posterior capsule in pigment dispersion syndrome.
Schwalbe’s Line = Angle structure representing peripheral edge of Descemets membrane.
Stockers Line = Corneal epithelial iron line at the edge of pterygium
White lines of Vogt = Sheathed or sclerosed vessels seen in Lattice degeneration
C2 - At least one cm lateral to the occipital protuberance at the base of the skull. Alternately, a point at least 3 cm behind the ear.
C3 - In the supraclavicular fossa, at the midclavicular line.
C4 - Over the acromioclavicular joint.
C5 - On the lateral (radial) side of the antecubital fossa, just proximally to the elbow.
C6 - On the dorsal surface of the proximal phalanx of the thumb.
C7 - On the dorsal surface of the proximal phalanx of the middle finger.
C8 - On the dorsal surface of the proximal phalanx of the little finger.
T1 - On the medial (ulnar) side of the antecubital fossa, just proximally to the medial epicondyle of the humerus.
T2 - At the apex of the axilla.
T3 - Intersection of the midclavicular line and the third intercostal space
T4 - Intersection of the midclavicular line and the fourth intercostal space, located at the level of the nipples.
T5 - Intersection of the midclavicular line and the fifth intercostal space, horizontally located midway between the level of the nipples and the level of the xiphoid process.
T6 - Intersection of the midclavicular line and the horizontal level of the xiphoid process.
T7 - Intersection of the midclavicular line and the horizontal level at one quarter the distance between the level of the xiphoid process and the level of the umbilicus.
T8 - Intersection of the midclavicular line and the horizontal level at one half the distance between the level of the xiphoid process and the level of the umbilicus.
T9 - Intersection of the midclavicular line and the horizontal level at three quarters of the distance between the level of the xiphoid process and the level of the umbilicus.
T10 - Intersection of the midclavicular line, at the horizontal level of the umbilicus.
T11 - Intersection of the midclavicular line, at the horizontal level midway between the level of the umbilicus and the inguinal ligament.
T12 - Intersection of the midclavicular line and the midpoint of the inguinal ligament.
L1 - Midway between the key sensory points for T12 and L2.
L2 - On the anterior medial thigh, at the midpoint of a line connecting the midpoint of the inguinal ligament and the medial epicondyle of the femur.
L3 - At the medial epicondyle of the femur.
L4 - Over the medial malleolus.
L5 - On the dorsum of the foot at the third metatarsophalangeal joint.
S1 - On the lateral aspect of the calcaneus.
S2 - At the midpoint of the popliteal fossa.
S3 - Over the tuberosity of the ischium or infragluteal fold
S4 and S5 - In the perianal area, less than one cm lateral to the mucocutaneous zone
Imp point's: FMT
1.Mercury poisoning
Black TEA P Le
Black - black blue line on gums
T - tremors- danberry/hatter/glass bowler
E - Erethism
A- acrodynia
P - PCT mainly involved,pink disease
Le- lentis/mercuria lentis
2.LEAD poisoning
New- neuropathy & nephropathy
A - anemia with punctate basophilia
B - burtonian or blue stippled lead line
C - colic & constipation
D - dry belly ache
E- encephalopathy
F - facial pallor
Tache noir- dessicated discolouration on sclera
on either side of iris.
Changes in eye- rise in K+ in vitreous humor.
Algor mortis- cooling of the body after death.
Post mortem caloricity- temp of body remains
for 2 hours after death.
Post mortem lividity/ livor mortis- bluish purple
discoloration of skin due to accumulation of
blood in small vessels by gravity.
Rigor mortis/ cadaveric rigidity- stiffening of muscles due to fall in ATP
Cataleptic rigidity/cadaveric spasm/
instantaneous rigor- direct stiffening widout ny relaxation
Mummification- drying of body due to evaporation.
Embalming= treatment of dead body wid antiseptics and preservatives to prevent
putrefaction leading to permanent rigidity.
Dactylohraphy- study of ridge pattern of skin and fingers
Poroscopy- pores of finger prints
Ridgeology- friction ridges
Edgeoscopy- edges of friction ridges.
Hara- kiri= unsual type of suicide whr victims falls on a short sword leading to evisceration of
intestines.
Arborescent/ filigree burns- seen in lightning
Cutis anserine- granular, puckered appearance of skin after drowning
Lynching- homicidal hanging where suspect is hanged by mob
La facie sympathiqie- when ligature knot presses on cervical sympathetic, the eye on the same
side may remain open wid pupils dilated, tongue forced against teeth, dribbling of saliva.
Bansdola- 2 bamboo sticks each placed in front and back and tied with rope
Garrotting- ligature thrown over neck and tightened by twisting over a liver or rod.
Burking- homicidal smothering and traumatic asphyxia
Cafe coronary- high alcohol content anesthetises gag reflex leading to food piece choking the larynx.
Gerontophilia- passive agent is an adult
Paedeeasty- passive agent is a child( catamite)
Algolagnia= sadism+masochism
Trolism- threesome
Mixoscopia- watching others engaged in sex
Oedipus- sexual desire of son towards mother
Electra- daughter towards father
Pharoan- brother towards sister
Maceration(aseptic autolysis)- not seen if child is
born within 24 hours of death
Spalding sign- overlapping of cranial bones
Benzidine test- best initial test for blood stain detection
Kastle Mayer test- phenolphtalein test
Haemin crystal test(Teichmann's)- not useful for old stains
Haemochromogen test(Takayama) - more specific for old stains
Seminal fluid exam
Florence test- brown crystals of choline iodide
Barberio test- yellow needle shaped rhombic crystals of spermine picrate
Acid phosphatase test- conclusive test in absence of sperms or aspermia
Arsenic poisoning
Arsenic poisoning mimics cholera
Aldrich mees lines- white lines on finger nails
seen in arsenic poisoning
Fatal dose= 0.1- 0.2 gm
Tx- ferric oxide
Post mortem app- red velvety mucosa of stomach,renal tubular necrosis
Cyanide poisoning
Sources- oil seeds, beans, bamboo shoots,almonds
Causes histotoxic hypoxia
Inhibits cytochrome oxidase
Dx- Lee Jones test
Fatal dose- 200-300 mg Na cyanide
Fatal period- 2 to 10 mins
Tx- hydroxycobalamine, na thiosulphate, amylnitrite
Post mortem app- odour of bitter almond and cherry red post mortem staining
Cannabis poisoning
Active substance- delta-9-Tetrahydrocannabinol(THC)
Run amok- impulse to murder
Fatal dose- 30 mg/kg (THC)
Tx- naloxone + glucose + thiamine, diazepam, gastric lavage , psychotherapy
H2SO4 poisning
Sx- chalky white teeth, black vomit and tongue
Fatal dose- 5 to 10 ml
Fatal period- 12 to 24 hours
Tx- avoid gastric lavage, NPO, Ca/Mg oxide, olive oil, prednisolone
Post mortem app- soft, spongy, black stomach wid perforation
Dx- barium nitrate/chloride test
Vitriolage- throwing sulphuric acid on other person
Nitric acid poisoning
Xanthoproteic reaction- yellow discoloration of tissues(picric acid)
Fatal dose- 5 to 10 ml
Fatal period- 12 to 24 hours
Tx- same as sulphuric acid
Post mortem- yellow discoloration of tissues, brown black stomach(hematin)
Dx- ferrous sulphate test
HCl poisoning
Sx- grey white mucous membrane
Fatal dose- 15 to 20 ml
Fatal period-18 to 24 hours
Tx- same as above
Post mortem- brownish folds of stomach mucosa
Dx- silver nitrate test
Carbolic acid poisoning
Sx- green urine, cns depression, pulmonary edema
Fatal dose- 1 to 2 gm
Fatal period- 3 to 4 hours
Tx- gastric lavage wid 10% glycerine, MgSO4,castor oil, activated charcoal, demulcents, saline
Post mortem- corrosion of skin,leathery mucus membrane of stomach
Oxalic acid poisoning
Sx- shock, hypocalcemia, renal tubular necrosis,
coffee colored vomitus, uraemia
Fatal dose- 15 to 20 gm
Fatal period- 1 to 2 hours
Tx- gastric lavage wid calcium gluconate
Antidote- any calcium preparation, Parathyroid extracts
Post mortem- bleached scalded app of tongue and git mucosa, renal tubular necrosis
Dx- barium nitrate test
Organophosphate poisoning
MOA- ach esterase inhibition
C/f- salivation, lacrimation, urination, defecation,
git distress, emesis( SLUDGE), muscle weakness,
tachycardia, headache, tremor, ataxia
Chromolachyrrhoea- red tears d/t pophyrin accumulation
Fatal dose- 1 gm orally
Fatal period- 24 hours
Tx- atropine sulphate 2 to 4 mg i.v.,
pralidoxime, activated charcoal
Post mortem- signs of ataxia
Carbamate poisons
Eg. Carbaryl, apocarb(baygon)
MOA- carboxylic esterase inhibition
Sx- same as organophosphates wid limited CNS toxicity
Tx- atropine
Aluminium phosphate
MOA- cytochrome oxidase & respiratory chain enzyme inhibitor
Sx- respiratory distress, arryhmias, cardiogenic shock
Fatal dose- 0.1- 0.5 gm
Fatal period- 1 to 100 hours
Tx- gastric lavage wid potassium permengnate, MgSO4, liquid paraffin
Post mortem-garlic like odour, blood stained froth, congestion of git/ liver
Alcohol poisoning
Tx- glucose, thiamine, caffeine, strychinine
Post mortem- alcoholic odour, acute
inflammation of stomach, congestion and edema of brain meningis
Chronic poisoning- deep red brown gastric mucosa, fatty liver and heart
Widmark formula- calculation of blood alcohol
based on age, sex and type of liquor
Delirium tremens- most severe alcohol withdrawal syndrome
Wernicke's- Korsakoff psychosis- thiamine def in chronic alcoholics
Marchafava- Bignami disease- degeneration of corpus callosum in chronic alcoholics
Mallory Weiss disease- esophageal tears wid mediastinitis
Salicylate poisoning
Aspirin
Fatal dose- 15 to 20 gm
Reye's syndrome- hepatic failure wid
encephalopathy
Dx- ferric chloride test
Tx- emetics, NaHCO3, vit C
Post mortem- dilated pupils, congested and eroded gastric mucosa, subpleural, subendocardial hemmorhage
Lead poisoning
Fatal dose- lead acetate 20 gm, lead carbonate
40 gm
Lead compounds- vermillion( lead tetraoxide)
Sx- basophilic stippling of erythrocytes(punctate
basophilia), burtonian lines on gums, lead palsy leading to wrist and foot drop
Dx- coproporphyrin in urine, amino levulinic acid in urine, lead in blood and urine
Tx- MgSO4 lavage, EDTA penicillamine.
Opiod poisoning
Derived from papaver somniferum(poppy plant)
Fatal dose- opium 2 gm, morphine 0.2 gm,
codeine- 0.5 gm
Tx- gastric lavage wid K permenganate, naloxone
Dx- Marqui's test
AMINO ACIDS
both keto n glucogenic- mnemonic PhyITT (pronounce FIT):
- phenylalanine
- isoleucine
- tyrosine
- Tryptophan
Only ketogenic amino acids ( remember Ketones KiLL)
- leucine
- lysine
Semi essential Amino Acids (remember Semi means HAlf)
- histidine
- arginine
Amino acids which dont take part in protein synthesis
- hydroxyproline
- hydroxylysine
AHA CPR Guidelines 2010
NOTE: Sequence has changed from airway, breathing, chest compressions (ABC) to chest compressions, airway, breathing (CAB) per the 2010 AHA Guidelines
Untrained lay rescuers should do compression-only CPR; whereas, trained lay rescuers and healthcare providers (HCP) should include compressions and breathing
Compressions
check pulse at carotid
compression landmarks: lower half of sternum, between nipples just below intermammary line
do not press on the xiphoid or the ribs
compression method: 2-finger chest compression for lone rescuer or 2-thumbs encircling hands for 2 rescuers
compression depth: approximately 1.5 inches (about 4 cm) in most infants
allow complete chest recoil after each compression
compression rate: at least 100/min
compression-ventilation ratio: 30:2 (single rescuer); 15:2 (2 HCP rescuers)
minimize interruptions in compressions; limit interruptions to <10 seconds
Airway
head tilt-chin (HCP suspected trauma: use jaw thrust)
Breathing
ventilation with advanced airway: 1 breath every 6-8 seconds (8-10 breaths/min)
asynchronous with chest compressions
about 1 second per breath
visible chest rise
avoid excessive ventilation
Defibrillation
attach and use AED as soon as available
minimize interruptions in chest compressions before and after shock
Cytokines are hormone like molecules that play a role in BOTH innate and adaptive immune responses(Recent Exam Question)
The action of cytokines may be;
1)autocrine-when target cell is the same cell that secretes the cytokine
2)paracrine-when target cell is nearby
3)endocrine-when cytokine is secreted into the circulation and acts at a distal source
The MAIN action is Paracrine
Cytokines have three major structural families;
1)Hematopoetin family-TNF,IL-1,PDGF
2)Transforming Growth Factor family
3)Chemokine family
IL-8 is the ONLY Chemokine that early on was named an Interleukin
Harrison states apart from TH1 and TH2 cells,there is a third type of T helper cell,called TH17 cell,that contributes to host defence against extracellular bacteria and fungi,particularly at mucosal sites(possible AIIMS mcq)
IL-1 is produced by macrophages(AIIMS previous question)
Most potent eosinophil activating cytokine known is IL-5(Robbins)
IL-6 is overproduced in Castleman's disease and is also an autocrine growth factor in Multiple Myeloma(previous question)
IL-11 is used to reduce chemotherapy induced thrombocytopenia in patients with cancer.
IL-12 may be useful as adjuvant in vaccines
The main cytokine involved in Erythema Nodosum Leprosum(ENL)reaction is TNF(AIIMS previous question)
Remember TNF-beta is implicated in the pathogenesis of Multiple Sclerosis,but TGF-beta is a therapeutic agent used in Multiple sclerosis...Interferon beta is also used as an immunomodulator in Multiple sclerosis
Therapeutic uses of IFN-alpha are;
1)AIDS related Kaposi Sarcoma
2)Malignant Melanoma
3)Chronic Hepatitis B and C infections
Therapeutic use of IFN-gamma-chronic granulomatous disease
IL-18 s a marker of acute Kidney injury
GASTROINTESTINAL STROMAL TUMOR (GIST)
Most common mesenchymal tumours of
STOMACH.
Most common site is stomach
interstitial cells of Cajal ( pacemaker cells of
GIT)
IHC markers -
CD 117 c kit)(80%);
PDGFR- alpha gene(15%);
CD 34, DOG 1 (MOST SPECIFIC and BEST FOR DIAGNOSIS)
associated with Carneys triad- gastric GIST,
pulmonary chondroma, extra adrenal
paraganglioma
Prognosis in GIST is dependent on- number of mitosis >>> size of tumor
Bacteria and their alternate names🐝
Bordetella-Bordet Gengou bacillus
Clostridium tetani-Nicolaires bacillus
Corynebacterium diphtheriae-Klebs-Loeffler's bacіllu
Corynebacterium pseudotuberculosis
Preisz-Nocard bacillus
Haemophilus aеgpticus-Koch-weeks bacillus
Pfeiffers bacillus-Haemophilus influenzae
Friedlander s bacillus-
Klebsiella pneumoniae
Abels bacillus-Klebsiella ozaenaе
Frischs bacillus-Klebsiella Rhinoscleromatis
Kochs bacillus-Mycobacterium tuberculosis
Battey bacillus- Mycobacterium intracellulare
Johnes bacillus-
Mycobacterium paratuberculosis
Eaton agent-Mycoplasma
Whitmores bacillus-Pseudomonas pseudomallei
CHARGE Association
Nonrandom association of
C = Coloboma (from isolated iris to anophthalmos; retinal most common)
H = Heart defects (TOF, PDA, and others)
A = Atresia choanae
R = Retardation of growth and/or development
G = Genital hypoplasia (in males)
E = Ear anomalies and/or deafness
VACTERL Association
Nonrandom association of
V = Vertebral defects
A = Anal atresia (imperforate anus)
C = Cardiac defects (VSD and others)
T = TE fistula
E = Esophageal atresia
R = Renal defects
L = Limb defects (radial)
Developmental milestone can be hard, especially if u dnt have kids
Gross Motor
2 lifts head
4 front to back 5 back to front ( just think back to front is more muscle)
6 imagine the "6" as baby sitting
9 number "9" doesnt have good base so crawls
11 "11" has 2 good base so baby is able to stand/cruise/walk
12 now good base plus 2 legs can walk for sure (alone)
15 "5" is mirror image of "2" so baby can walk backwards
2yr u need to use both legs to go up/down stairs
3 "TRI-cycle"
4 HOPS 4 letters
Fine Motor
"9ince12" = PINCER Before pincer comes raking which is more immature
9 mo = non specific ( 3 finger) also nonspecific mom and dad
12 mo = specific (2 fingers) also specific mom and dad
15 mo = 2block
18 = 3blocks
2yr = 6 blocks
Also playstation controler 0 --> X --> Square --> triangle 3 4 5 6 yrs
Language/social
2 coos and smiles because recognizes parents.
4 coos and laughs
6 babbles and anxiety, because recognizes strangers
1 yr alone so plays ALONE/ follow ONE step command, One word besides mom dad
2 yrs now 2 so PARALELL play, follows TWO step command, 2 word PHRASES
3 4 5 6 number of sentences with years
Bowel control at 4 Pee control at 5
Birthweight x 2 every 6mo/ 1 yr Then x2 the next year = so x4 by 2yrs
Lenght doubles every 4 yrs so x4 by puberty
Reflex
Palmar is first to come ( US baby always has his palm close)
Rooting is first to go
Parachute always stays
Pheochromocytoma
Clinical findings of a pheochromocytoma: 6 P's ofPheochromocytoma
Pressure/Paroxysmal bursts
Pounding Pain (headaches)
Perspiration
Pallor
Panic
Palpitations
Rule of 10's:
10% familial (Men 2a, 2b syndromes)
10% bilateral
10% malignant
10% calcify
10% located outside the medulla (a common site is the bladder. If patient gets episodic hypertension with urination, think about this possibility)
Look for urinary VMA (breakdown of NE) and plasma catecholamines!
Obligate Aerobes: Nagging Pests Must Breathe
Nocardia
Pseudomonas
Mycobacterium
Bacillus
Anaerobes: Can't Breathe Air (aka your ABC's of anaerobic bacteria)
Clostridia
Bacteroides
Actinomyces
5 bacterial produces transferred by phages: ABCDE
ShigA-like toxin (this is aka Verotoxin)
Botulinum toxin
Cholera toxin
Diphtheria toxin
Erythrogenic toxin (Strep pyogenes)
METASTASIS
Oncology2
Knowing where some cancers metastasize, and what metastases go to which organs, can be important. So I've got a few mnemonics and trends to help me memorize these places and organs associated.
First off, notice that Lung and Breast cancers are involved in all these metastases. They are, in fact, the top cancers. (Lung is the top killer, but breast is the top incidence in women)
Metastasis to the brain:
First Aid uses "Lots of Bad Stuff Kills Glia," but I like using "Cancer: Some Love Killing Brain Glia" ...I don't know why, but I can remember that one better.
Lungs
Breast
Skin
Kidney
GI
Metastasis to the liver:
GI related cancers + your most common cancers (lung and breast). Makes sense with the portal system and all.
Cancer Sometimes Penetrates Benign Liver, most common to least common:
Colon > Stomach > Pancreas > Breast > Lung
*Note that Dr. Goljan (amazing pathologist extraordinaire) says that Lung cancer is the most common, more than all the others. Take that info the way you like. I think I'm gonna go with colon cancer as more likely to metastasize to the liver through the portal circulation, it just makes sense (sorry Dr. Goljan)
Metastasis to the bone:
-Make an association with GU cancers, which are able to access the vertebral column through the batson paravertebral venous plexus. The vertebral column is the most common site of bone metastasis.
P.T. Barnum Loves Kids.
Prostate
Testes
Breasts
Lungs
Kidney
Metastasis to the lungs:
"Real Hardcore Cancers Fill Both My Lungs" (I like to read it HardCore cancers, to remind me the "core" is "choriocarcinomas)
Renal Cell Carcinoma
Hepatocellular Carcinoma (which, btw, is also known as a Hepatoma)
Choriocarcinoma
Follicular Thyroid Carcinoma
Breast
Melanoma
Metastasis FROM the liver
Loves the Adrenals. Also your common ones that receive metastasis get their revenge on the lungs: Breast, Brain, Liver.
Metastasis to the heart
You don't often think about the heart, so I thought I'd just say that Melanoma loves the heart. You also get a lot ofLymphomas metastasizing to the heart. And your two commons: Lung and Breast. Note that metastasis is more common than primary heart cancer.
Iodine 132 2 to 3 hours
Technitium 6 hours
Iodine 123 13 hours
Gold 2.7 days
Thallium chloride 3.1 days
Gallium 3.2 days
Radon 3.8 days
Xenon gas 5.2 days
Iodine 131 8 days
Phosporous 32 14.3 days
Iridium 74.5 days
Tantalum 115 days
Cobalt 69 5 years
Strontium 28 years
Caesium 30 years
Ra 1622 years
Cytokines are hormone like molecules that play a role in BOTH innate and adaptive immune responses(Recent Exam Question)
The action of cytokines may be;
1)autocrine-when target cell is the same cell that secretes the cytokine
2)paracrine-when target cell is nearby
3)endocrine-when cytokine is secreted into the circulation and acts at a distal source
The MAIN action is Paracrine
Cytokines have three major structural families;
1)Hematopoetin family-TNF,IL-1,PDGF
2)Transforming Growth Factor family
3)Chemokine family
IL-8 is the ONLY Chemokine that early on was named an Interleukin
Harrison states apart from TH1 and TH2 cells,there is a third type of T helper cell,called TH17 cell,that contributes to host defence against extracellular bacteria and fungi,particularly at mucosal sites(possible AIIMS mcq)
IL-1 is produced by macrophages(AIIMS previous question)
Most potent eosinophil activating cytokine known is IL-5(Robbins)
IL-6 is overproduced in Castleman's disease and is also an autocrine growth factor in Multiple Myeloma(previous question)
IL-11 is used to reduce chemotherapy induced thrombocytopenia in patients with cancer.
IL-12 may be useful as adjuvant in vaccines
The main cytokine involved in Erythema Nodosum Leprosum(ENL)reaction is TNF(AIIMS previous question)
Remember TNF-beta is implicated in the pathogenesis of Multiple Sclerosis,but TGF-beta is a therapeutic agent used in Multiple sclerosis...Interferon beta is also used as an immunomodulator in Multiple sclerosis
Therapeutic uses of IFN-alpha are;
1)AIDS related Kaposi Sarcoma
2)Malignant Melanoma
3)Chronic Hepatitis B and C infections
Therapeutic use of IFN-gamma-chronic granulomatous disease
IL-18 s a marker of acute Kidney injury
Steps in wound healing ::
1. Activation of coagulation cascade - formation of a clot.
2. Within 24 hrs - neutrophil come towards the clot.
3. Day 3 - macrophages come and granulation tissue forms. Collagen fibres come at incision margins.
4. Day 5 - neovascularization reaches its peak as granulation tissue fills the space.
5. 2nd week - continous collagen accumulation and fibroblast proliferation. Blanching begins.
6. End of 1st month - scar formed.
Wound strength - at 1 week is 10% of unwounded skin.
Wound strength reaches approx. 70- 80% of normal by 3 months but doesn't improve beyond that.
In healing by second intention or reunion, wound contraction mediated by myofibroblasts is seen which is not seen in primary intention.
