Viral hepatitis:-

Viral hepatitis:-
• MC acute viral hepatitis in the world overall--- Hepatitis A.
• MC acute viral hepatitis in children.-----Hepatitis A
• MC acute viral hepatitis (epidemic/sporadic) in Indian adults and overall ----- Hepatitis E
• MC chronic Viral Hepatitis World Wide and India ----- Hepatitis B
• MC Viral Hepatitis worldwide/ India responsible for Cirrhosis/HCC --- Hepatitis B 

• maximum number of carriers/chronicity worldwide / India------Hepatitis C
• Most common type of hepatitis associated With transfusion---Hepatitis B
(Harrison18/e page no—954 (table) 

• Fulminant hepatitis ----- co-infecton of  hepatitis b and d
• Chronicity ------superinfection of hepatitis b and d

Named tumours

KLATSKIN - cholangiosarcoma

TURBAN- cylindroma of scalp in sebaceous cyst

COCK PECULIAR TUMOR- sebaceous cyst

TEAR CANCER- BCC

BROWNS TUMOR- hyperparathyroidism

KANGRI - hot charcoal pot over abdomen  kashmiri ppl

KANG TUMOR- on buttoks and heels of tibetans who sleeping over to control cold

CHIMMNEY SWEEPER TUMOR- scrotum due to tar irritation

HURRICANE TUMORS-kills in matter of weeks seen in interstitial cell tumors

BUSCHKE LOWENSTEIN TUMOR-
Gaint condyloma
Vetucous carcinoma
Destructivr and localy invasive
Treatment- excision ndyag laser interferon alfa therapy

KRUKENBERGERS TUMOR- ovaries 2° in stomach cancer

POTTS PUFFY TUMOUR-
External swelling of scalp due to subperiosteal pus and oedema eg-frontal sinusitis

BEDNARDS TUMOR- dermatofibrosarcoma protuberances with melanin

PILOMATRIXOMA- calcifying epithelioma of malherbe-benign hair follicle derived tumor

GODWINS TUMOR- benign lymphoepithelial tumor of parotid gland

RINGERTS TUMOR- inverted papilloma or transitional cell papiloma from lateral wall of nose

Bodies

Intra neuronal inclusion bodies

Pick bodies-Pick disease

Lewy bodies-Classic brainstem lewy bodies in Parkinson's & cortical lewy bodies in Dementia with lewy body disease

Hirano bodies-In hippocampus particularly in Alzheimer's

Bunina bodies-In Motor neurons in ALS

Lafora bodies-In dentate nucleus in myoclonic epilepsy

Psoriatric Arthritis

Important points on Psoriatic Arthritis from Harrison 18th edition

1) Nail changes occur in 90% of patients with psoriatic arthritis, compared
to 40% in psoriatic patients without arthritis.
2) The subtype of psoriasis associated with severe arthritis is Pustular
Psoariasis.
3) Shortening of digitis(telescoping) because of underlying osteolysis is
characteristic of psoriatic arthritis.
4) Associated nail changes are-pitting, horizontal ridging, onycholysis, yellowish
discoloration of nail margins, dystrophic hyperkeratosis.
5) Distal interphalangeal joint involvement produces the classic “pencil in cup”
deformity.
6) The “Wright and Moll classification” as well as “CASPAR Criteria” are for Psoriatic Arthritis

Tumor Suppressor Genes

TUMOR SUPPRESSOR GENES
GENE -- ASSOCIATED TUMOR -- GENE PRODUCT
1) BRCA1 & 2 -- breast & ovarian ca -- DNA repair protein
2) NF1 -- Neurofibromatosis 1 -- RAS GTPase activating protein - neurofibromin
3) NF2 -- Neurofibromatosis 2 -- Merlin protein
4) APC -- FAP
5) WT1 & WT2 -- Wilms tumor
6) PTEN -- Cowden syndrome breast, prostate & endometrial ca
7) p16 -- Melanoma -- cyclin dependent kinase inhibitor 2A (CDKi2A)
8) p53 -- Most human cancers, Li-Fraumeni syndrome -- Transcription factor for p21, blocks G1 - S phase
9) Rb -- Retinblastoma, Osteosarcoma -- Inhibits E2F, blocks G1-S phase
10) MEN1 -- MEN type 1
11) TSC1 -- Tuberous sclerosis -- Hamartin
12) TSC2 -- Tuberous sclerosis -- Tuberin

RET Oncogene

RET proto oncogene encodes for - Tyrosine kinase receptor on cytoplasmic membrane 
RET ligand is identified as - Glial cell line derived neurotrophic factor (GDNF) 
RET - Chromosome 10 
NOT a differentiating thyroid cancer - Medullary carcinoma 
Point mutation of RET - Medullary carcinoma thyroid 
Medullary carcinoma thyroid is common in - Superior pole 
Medullary carcinoma thyroid is associated with - Osteoblastic skeletal metastasis 
Most aggressive medullary carcinoma of thyroid is associated with - MEN IIB 

Thyroid carcinoma secreting ACTH - Medullary carcinoma 
Ectopic ACTH secretion is associated with - Medullary carcinoma thyroid 
All Thyroid cancer From Follicular Cells EXCEPT - Medullary carcinoma thyroid from parafollicular cells (c cells) 
ACal - Medullary Carcinoma Thyroid 
RET Protooncogene - Medullary carcinoma 
Medullary carcinoma of thyroid arise from - Parafollicular cells 
Multiple submucosal neuroma associated with - Medullary carcinoma thyroid 
Amyloid like stroma - Medullary carcinoma 
Thyroid carcinoma associated with hypocalcemia - Medullary carcinoma 
MC Presentation of Medullary Carcinoma Thyroid - Diarrhoea 
Medullary carcinoma of thyroid NOT associated with - Antibodies 

Most important predictor of medullary carcinoma thyroid - CEA 

Treatment of medullary carcinoma thyroid - Surgery only 
Treatment of Medullary carcinoma - Total thyroidectomy 
Treatment of medullary carcinoma with lymph node metastasis - Total thyroidectomy with radiotherapy 
Palpable thyroid nodule demonstrating amyloid stroma, cervical lymphnode on the same side of lesion - Total thyroidectomy and modified neck dissection on the side of enlarged lymph node 
NOT true about diagnosis of medullary carcinoma thyroid - Histological mitochondria is essential for diagnosis

Umbilical cord

Umbilical cord

1. Length is 55 cm (Ranges from 30 – 100 cm) (so less than 30 cm is considered abnormally short )
2. 2 arteries and 1 vein (Left is left)
3. The Umbilical Arteries exhibit “Transverse intimal folds of Hoboken”
4. Extracellular matrix – Wharton’s jelly
5. Anatomically Umbilical cord is considered as fetal membrane

PLACENTA

Diameter of placenta is 15 – 20 cm
About 2.5 cm thick
Weight 500 gms
Ratio of Placenta : fetal weight = 1:6

Maternal surface of placenta :
1. Formed by Decidua basalis
2. Dull red in colour, rough and spongy
3. 15 – 20 lobes or cotyledons

Fetal surface of Placenta :
1. Formed by chorion frondosum and chorionic plate
2. Fetal surface is covered by blood vessels .

Extra Points :
1. Nitabuch’s layer : Zone of Fibroid degeneration where Decidua and trophoblast meet
2. Hoffbaeur cells : Phagocytic cells in the connective tissue of Chorionic villi of placenta.
3. Placenta separates after the birth and the line of separation is – Decidua spongiosum
4. Human placenta is – Discoid (Hemochorial + Deciduate)
5. The chorion frondosum + Decidua basalis forms placenta
6. Formation of placenta begins at 6th week and completed by 12th week

PCOD

In PCOD
E1 ⏫
E2 ⏬
E2:E1 ⏬
E1:E2 ⏫
LH ⏫
FSH N-⏬
FSH : LH ⏬
LH : FSH ⏫
Testosterone ⏫
SHBG ⏬

Kidney sizes

Contracted kidney-
Chr glomerulonephritis
Benign nephrosclerosis
Chr pyelonephritis
Renal artery stenosis
Radiation nephritis

Kidney size increased in-
Amyloidosis
Polycystic kidney disease
Diabetic nephropathy
Acute glomerulonephritis
Scleroderma

Drug Side Effects

Drugs specific adverse effect :::

Vanishing bile duct syndome -- chlorpromazine

Coronary steal phenomena -- dipyridamole and isoflurane

Toxic ambylopia --- ethambutol

Fatal myocarditis ---clozapine

Idiosyncratic hepatic necrosis in infant --sodium valproate

Pseudo porphyria -- piroxicam

Amotivational syndrome-- marijuana

Fetal aplasia cutis -- carbimazole/methimazole in pregnancy

Drug induced mysthenia gravis-- d- penicilamine

Salt and pepper fundus -- thioridazine

Blue halo effect -- sidenafil

Calciphylaxis -- warfarin use in hemodylasis pt

Livedo reticularis -- amantidine

DRESS ie drug related eosinophila and systemic symptoms -- allopurinol

Pseudolymphoma syndrome -- anticonvulsants

Delayed bone marrow suppresion --nitrosourea anticancer drugs

Predisposition to listeria infection -- fludarabine

FSGS --heroin

Peripheral neuropathy resembling motor neuron disease -- dapsone

Vacuolar myopathy -- vincristine

Acute hepatic necrosis in pregnancy -- tetracycline

Cytokine release syndrome --muromonab cd3

Hand foot syndrome -- capcitabine

Hemorragic cystitis -- ifosfamide

Haemolytic uremic syndrome -- mitomycine c

Blood storage

1- indicator for blood transfusion in chronic anemia? HEMATOCRIT

2-indicator for blood transfusion in trauma?CLINICAL EXAMINATION

3-storage time of blood with CDP-A and CDP? 35  AND 21DAYS

4-storage time of platelets?5DAYS

5-temparature for storage of platelets?20 TO 25°-ONLY BLOOD PRODUCT STORED AT ROOM TEMP

6-clotting factors reduced in storage blood? FACTOR 5 AND 8

7-only electrolyte increased in massive blood transfusion? POTTASIUM

8-rosenthal syndrome associated with which clotting factor? FACTOR 11

9-t 1/2 of transfused rbc? 60DAYS

10-synthetic oxygen carriers?FLUSOL,RECOMBINANT HB,ERYTHROPOITIN

Hypersensitivity reactions

List of some Hypersensitivity
pneumonitis :
1. hot tub lung - Mycobacterium avium
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

List of named fascia

List of named fascia
*Fascia of Gerota-Renal fascia
*Fascia of Told-anterior renal fascia
*Fascia of Zuckerkandle-Posterior renal fascia
*Fascia of Camper-Superficial fatty layer between umbilicus & pubis
*Fascia of Scarpa-Deep membranous layer between umbilicus & pubis
*Fascia of Colles-Fascia scarpa below the external inguinal ring
*Fascia Colli-Deep cervical fascia
*Fascia of Denonvilliers-Fascia between prostrate & rectum
*Fascia of Sibsons-Suprapleural membrane
*Fascia of Waldeyer-Fascia between rectum & sacrum & coccyx
*Gallaudet's fascia-External oblique fascia
*Fascia Lunata-Fascia of ischiorectal fossa
*External spermatic fascia-Extension of external oblique aponeurosis
*Internal spermatic fascia-Extension of fascia transversal is
*Fascia Cribrosa-Fascia covering saphenous opening
*Fascia Lata-Deep fascia of thigh

Halban

HALBAN IN OBG
Halban disease :: corpus luteal defect
Halban theory :: metastatic theory to explain endometriosis
Halban sign :: symmetrical enlargement of uterus in adenomyosis

Scapula Facts

Scapula FACTS

Winging scapula-injury to thoracic nerve of bell.Prominence of medial border of scapula

Pulsating scapula-CoA,dilatation & tortusity of collaterals around scapula occurs

Fracture scapula-due to violent trauma

Sprengels deformity-scapula remains elevated.failure of descent

Klippel feil deformity-b/l failure of descent of scapula.webbing of neck & limitation of neck movements due to failure of fusion of occipital bone & cervical spine defects is a feature.

Bodies

1) BASOPHILIC STIPPLING
is ribosomal inclusions in RBCs
sideroblastic anemia, lead poisoning,
megaloblastic anemia, thalassemia, Arsenic
poisoning
2) PAPPENHEIMER BODIES
are iron deposits,
seen in SIDEROCYTES (siderocytes are
intraerythrocytic PERL'S PRUSSIAN BLUE
STAIN positive iron granules)
seen in----- sideroblastic anemia, hemolytic
anemia, and sickle cell disease
3) HEINZ BODIES
are precipitated hemoglobin seen with special stain (He for Heinz and He for Hemoglobin)
seen in --- G6PD deficiency anemia, drugs like primaquine and dapsone, fava beans
4) HOWELL JOLLY BODIES
are DNA remnants
seen in------sickle cell autosplenectomy;
severe hemolytic anemia, megaloblastic
anemia, hereditary spherocytosis, and
myelodysplastic syndrome (MDS).

Soft Tissue Sarcoma

• Rare unusual neoplasm of soft tissues
• MC site: ExtremityQ (lower >upper) > Trunk >Retroperitoneum >Head & Neck
• MC type: Malignant fibrous histiocytomaQ
>Liposarcoma >Leiomyosarcoma >Synovial sarcoma >Malignant peripheral nerve sheath tumor
• MC pediatric soft tissue sarcoma:
Rhabdomyosarcoma Histopathological Type of STS is Site Dependent
Extremity • Malignant fibrous histiocytoma
>Liposarcoma
Retroperitoneum • Liposarcoma
Viscera • GIST Pathology:
• STS tends to grow along fascial planes, with the surrounding soft tissue compressed to form a pseudocapsule.
• Clinical behavior of STS is determined by:
Anatomic location (depth), grade & size • MC route of spread in soft tissue sarcoma:
Hematogenous
• MC site of metastasis: Lung; Lymphatic
metastasis is rare
Clinical Features:
• MC symptom of STS: Painless mass • Size at presentation is dependent on the location
of tumor. • Smaller tumors are located in distal extremities
• Larger tumors are detected in proximal extremity
& retroperitoneum.
• Retroperitoneal STS almost always present as
large asymptomatic mass Diagnosis of Soft Tissue Sarcoma
• Core-cut or true-cut biopsy (CT or USG guided) is diagnostic
• Incisional biopsy is done if core-cut biopsy is non-diagnostic
• FNAC: To confirm or rule out presence of metastatic focus or local recurrence • MRI: IOC for assessing extremity STSQ
• CECT: IOC for assessing retroperitoneal sarcoma
Treatment:
• Adequate excision + adjuvant radiotherapy with
or without adjuvant chemotherapy.
Prognosis: • Best prognostic factor of soft tissue sarcoma:
Grading
• Best prognosis is seen in: Extremity STS
• MC cause of death in STS: Metastasis; 5-year
survival rate for STS (all stages): 50-60%

CD Molecules

• CD51---- Endothelial cells, megakaryocytes,
osteoclasts , monocytes and macrophages,
placenta cytotrophoblast and Hofbauer cells;
fibroblasts
• CD61----- on thrombocytes.
a/w- Endometriosis and Glanzmanns
thrombosthenia
• CD71----Transferrin receptor/erythroblast /
glycophorin, mediates cellular uptake of iron.
Its a new receptor for IgA expressed on
mesangial cells.( seen in IgA nephropathy
(IgA-N) and Henoch-Schönlein Purpura (HSP)
nephritis)
• CD81 molecule --- B cells ; T cells, NK cells,
Dendritic cells,Monocytes and blood
progenitors.

Fascia

Gallaudts fascia- external oblique fascia
Fascia lunata- fascia of ischiorectal fossa
Fascia of Sibsons- suprapleural membrane
Fascia of Denonvilliers- Fascia bet prostate & rectum
Fascia coli- deep cervical fascia
Fascia of Scarpa- deep membranous layer bet umbilicus & pubis
Fascia of Told- ant renal Fascia
Fascia of Zuckerland- post renal fascia
Fascia cribrosa- Fascia covering saphenous opening

Drugs of choice for gynaecological urology

DOC for stress incontinence-  pseudoephedrine
DOC for urge incontinence-  oxybutinin
DOC for overflow incontinence-  Bethanachol
DOC for post op urinary retention-  Bethanachol