CO2 uses

1-Laproscopic surgery
2-To minimise the air embolism during cardiac surgery
3-debubbling of cardiopulmonary circuits
4-carbogen/meduna mixture-95%o2+ 5% co2(for treatment of central retinal artery occlusion)
5-to facilitate vasodilatation
6-to prevent hypocapnia during hyperventilation
7-gynec inv-insuflation of fallopian tubes
8-destruction of warts by freezing
9-increases cerebral blood flow
10-stimulate respiration
11-chronic respiratory obstruction
12-increase the depth of anaesthesia
13-to facilitate blind intubation in anaesthesia practice

surgical knots

One liners from ENT

ENT

MCC of fungal esophagitis... Candida

Cotton's grading... Sub glottic stenosis

Cause of sudden death in a pt who underwent maxillary sinus irrigation..... Air embolism

Weber Ferguson approach.... Used for maxillectomy

Tobey ayer test +ve in lateral sinus thrombosis

Mucocoeles are most common in frontal sinus

In Dacryocystorhinostomy opening is done in middle meatus.

Nasal bone fracture corrected by Walsham's forceps

Artery responsible for epistaxis after ligating external carotid artery.... Ethmoidal artery

Epley's test is used for benign paroxysmal vertigo.

Schuller's and Law's view.... Mastoid air cells.

Lens

👀👓 CARDINAL DATA OF A LENS::
➡ CENTRE OF CURVATURE (C) of the spherical lens is the centre of the sphere of which the refracting lens surface is a part.
➡ RADIUS OF CURVATURE of the spherical lens is the radius of the sphere of which the refracting surface is a part.
➡ The PRINCIPAL AXIS (AB) of the lens is the line joining the centres of curvatures of its surfaces.
➡ OPTICAL CENTRE (O) of the lens corresponds to the nodal point of a thick lens. It is a point on the principal axis in the lens, the rays passing from where do not undergo deviation. In meniscus lenses the optical centre lies outside the lens.
➡ The PRINCIPAL FOCUS (F) of a lens is that point on the principal axis where parallel rays of light, after passing through the lens, converge (in convex lens) or appear to diverge (in concave lens).
➡ The FOCAL LENGTH (f) of a lens is the distance between the optical centre (O) and the principal focus (F).
➡ POWER OF A LENS (P) is defined as the ability of the lens to converge a beam of light falling on the lens. For a converging (convex) lens the power is taken as positive and for a diverging (concave) lens power is taken as negative. It is measured as reciprocal of the focal length in metres i.e. P = 1/f. The unit of power is dioptre (D). One dioptre is the power of a lens of focal length one metre.

CALCULATION OF IOL POWER

🔬 CALCULATION OF IOL POWER (BIOMETRY)::
🔰 The most common method of determining IOL power uses a regression formula called ‘SRK (Sanders, Retzlaff and Kraff) formula’.
🔰 The formula is P = A – 2.5L – 0.9K, where:
✒ P is the power of IOL.
✒ A is a constant which is specific for each lens type.
✒ L is the axial length of the eyeball in mm, which is determined by A-scan ultrasonography.
✒ K is average corneal curvature, which is determined by keratometry.
🔰 The ultrasound machine equipped with A-scan and IOL power calculation software is called ‘Biometer’.

Contributions Of Emil Theodor Kocher

CONTRIBUTIONS OF EMIL THEODOR KOCHER::

Kocher's Vein - may sometimes drain lower and middle thyroid if present.

Kocher's Forceps - has got a tooth in its tip.

Kocherisation - duodenal mobilisation.

Kocher's Right Subcostal Incision - for cholecystectomy.

Kocher's Thyroid Incision - horizontal crease incision, two finger breadth above the sternal notch, from one sternocleidomastoid to the other (posterior margin of sternocleidomastoid).

Kocher's Method - for reduction of shoulder dislocation.

Kocher's Test - when both lateral lobes of thyroid are pushed posteromedially with fingers in case of a huge or long-standing thyroid enlargement, the production of stridor indicates a positive test [signifies weakened tracheal (rings) cartilage because of constant pressure by the thyroid gland].

High yield fevers

FIRST DISEASE : ---> Measles.

SECOND DISEASE : ---> Scarlet Fever.

THIRD DISEASE :---> Rubella or German Measles.

FOURTH DISEASE :---> Duke's Disease

FIFTH DISEASE :---> Erythema Infectiosum caused by Parvovirus B19

SIXTH DISEASE :---> Exanthem Subitum / Roseola Infantum (HHV-6)(HHV-7 also mentioned)

takotsubo cardiomyopathy

Features of takotsubo cardiomyopathy/BROKEN HEART SYNDROME

1⃣Chest pain and shortness of breath
after severe stress (emotional or physical)
2⃣Electrocardiogram abnormalities that mimic those of a heart attack
3⃣No evidence of coronary artery obstruction
4⃣Movement abnormalities in the
left ventricle
5⃣Ballooning of the left ventricle
6⃣Recovery within a month

Tests for detecting various parasites

PARASITOLOGY-Tests for detecting various
parasites
Sabin Feldman Test --->Toxoplasmosis
Frenkel’s Skin Test --->Toxoplasmosis
Casoni’s Test ---> Hydatid Cyst
Montenegro Test ---> Leishmaniasis
Scotch Tape Test ---> Pinworm
NIH Swab Examination ---> Pinworm
Fairley Test ---> Schistosomiasis
Skin Snip Test ---> Onchocerciasis

Source of haemorrhage/ bleeding:

Source of haemorrhage/ bleeding:
1. Extra dural haemorrhage - middle meningeal artery
2. Sub dural haemorrhage - bridging or diploic veins
3. Sub arachnoid haemorrhage - rupture on berry aneursym
4. Tennis bal injury to eye - circulis iridis major
5. Epistaxis -
Sphenopalantine artery
6. During tonsillectomy - para tonsilaar veins, tonsilar and ascending
palantine artery
7. Tracheostomy - isthemus and inferior thyroid vein
8. Heamoptysis-bronchial artery
9. Gastric ulcer- left gastric, splenic artery
10. Duodenal ulcer - gastroduodenal artery
11. Hemmorrhoids - submucous rectal venous plexus formed by
superior rectal vein & inferior rectal vein
12. Retropubic proastatectomy - dorsal venous plexus
13. Hysterectomy - internal illac artery
14. Menstruation - spiral arteries

Bacteria and their alternative names

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

Bacterial stains

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

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

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

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

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

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

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

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

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

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

Tractions in Orthopaedics

Tractions in Orthopaedics*.
BUck's traction -Skin traction ( Remember:BUS)*.

RUSsel's traction - forTrochanteric fracture ( Remember:RUST)*.

Crutchfield traction - forCervicalspine injury*.

Dunlops Traction - forSupraCondylar fracture ( Remember:DiSCo)*.

Bryant's andGallows tractions - forShaftFemur fractures (BSF,GSF- Boys School Federation, Girls School Federation :-)

Cell Wall Synthesis Inhibitors

# Cell Wall Synthesis Inhibitors #

Fosphomycin - Acts on enol pyruvate transferase

Cycloserine - On alanine racemase

Bactoprenol - Inhibits de phosphorylation of bacetrol

Vancomycin - Inhibits chain elongation.

Beta lactams - Transpeptidase inhibitor.

Cell-Cycle Specific Agents

 Cell-Cycle Specific Agents::
 Anti-metabolites - S phase
 Epipodophyllotoxin - G1S phase
 Taxanes - M phase
 Vinca alkaloids - M phase
 Ixabepilone - M phase
 Bleomycin - G2M phase

Cancer staging

📖 CLASSIFICATIONS, CRITERIAS, SCORING & GRADING SYSTEMS AT A GLANCE::
🔰 Halls Criteria: Downs syndrome
🔰 Duke's Criteria: Endocarditis/Heart failure
🔰 Butchers Criteria: Mesothelioma
🔰 Ann Arbor's Classification: Hodgkins lymphoma
🔰 Bismuth-Corlette Classification: Tumors of hepatic ductal system
🔰 Nazer's Index: Wilsons disease
🔰 Pagets Index: Abruptio placenta
🔰 Quetlet Index: BMI - wt. in kgs/ht. in meter square
🔰 Ponderal Index: Ht. in cms/cube root of body wt. in kgs
🔰 Brocca Index: Ht. in cms-100
🔰 Lorentz's Formula: Ht. in cms-100-Ht.(cm)-150/2(women) or 4(men)
🔰 Corpulence Index: Actual wt./desired wt. should not exceed 1.2
🔰 Milan's Criteria: For liver transplant in HCC
🔰 Myer-Cotton Staging System: Subglottic stenosis
🔰 Spalding's Criteria: Abdominal pregnancy
🔰 GCS/Ranson's Criteria/APACHE Score: Pancreatitis
🔰 Enneking's Staging: Bone tumors
🔰 McDonald's Criteria: Multiple Sclerosis
🔰 Epworth's Criteria : Sleep apnea
🔰 Frammingham's Criteria/Boston's Criteria: CHF
🔰 Durie Salmon Staging System: Multiple myeloma
🔰 Light's Criteria: Pleural effusion
🔰 GOLD's Criteria: COPD
🔰 OKUDA Staging: HCC
🔰 Child's Turcott Pugh Score/MELD/PELD: Cirrhosis of liver
🔰 Mantrel's Criteria/Alvarado Score: Appendicitis
🔰 Evan's Staging: Neuroblastoma
🔰 FAB Classification: Leukemias
🔰 Gleason's Staging: Ca. Prostrate
🔰 Robson's Staging: RCC
🔰 NADA's Criteria: ASD assesment of child for heart disease
🔰 Rye Classification: Hodgkins lymphoma
🔰 Chang's Staging: Medulloblastoma
🔰 Jackson's Staging: Penile carcinoma
🔰 Seddon's Classification: Nerve injury & regeneration
🔰 Lauren's Classification: Gastric ca.
🔰 Neer's Classification: Proximal Humeral#
🔰 Gartland's Classification: Supracondylar# humerus
🔰 Amsel's Criteria: Bacterial vaginosis
🔰 Mallampati Scoring: For intubation
🔰 Forrest Classification: Peptic ulcer bleed
🔰 Hess & Hunt Scale: Subarachnoid hemorrhage
🔰 Duke Staging: Colon cancer
🔰 Rotterdam's Criteria: PCOS
🔰 Le Fort's Classification: Facial#
🔰 Wells' Criteria: Pulmonary embolism
🔰 Rule of Wallace/Rule of 9: Burns
🔰 Mason Johnson Classification: Radial head#
🔰 Stanford Classification: Aortic dissection
🔰 Rockall Scoring: Adverse outcome after GI bleed
🔰 Glasgow-Blatchford Score: Upper G.I. bleed for medical intervention
🔰 Waterlow's Classification & Gomez' Classification: Malnutrition in children

Dupyterens Contracture

💊1. is a fixed flexion contracture of the hand due to a palmar fibromatosis

💊2. It is an inherited proliferative connective tissue disorder that involves the hand's palmar fascia

💊3. The ring finger and little finger are the fingers most commonly affected.

💊4. The middle finger may be affected in advanced cases, but the index finger and the thumb are not affected as frequently [ V IMP ]

💊5. In patients with this condition, the palmar fascia thickens and shortens so that the tendons connected to the fingers cannot move freely

💊6. Incidence increases after age 40; at this age, men are affected more often than women. Beyond 80 the gender distribution is about even. [ V IMP ]

💊7. The main function of the palmar fascia is to increase grip strength; thus, over time, Dupuytren's contracture decreases patients' ability to hold objects [ V IMP ]

💊8. Patients often report pain, aching and itching. Substance P nerve fibers positively correlate to the 12-fold increase in mast cells in patients

💊9. substance P cells can impact fibroblast proliferation, and is related to Interstitial Cystitis. [ V IMP ]

💊10. Normally, the palmar fascia consists of collagen type I, but in Dupuytren sufferers, the collagen changes to collagen type III, which is significantly thicker than collagen type I. [ V IMP ]

💊11. Treatment is indicated when the so-called table top test is positive. With this test, the patient places his hand on a table. If the hand lies completely flat on the table, the test is considered negative.

💊12. Treatment using radiation therapy begins at an earlier stage. Radiation therapy is most effective when nodules and cords first appear, and before contracture begins.

💊13. Dupuytren's contracture is transferred in the family as a so-called autosomal dominant trait with incomplete penetrance and partial sex-limitation

💊14. the gene for a Dupuytren's contracture is not on an X or Y chromosome (sex chromosome) but on one of the other 44 chromosomes.

💊15. Very rarely, a Dupuytren's contracture occurs in association with an uncommon scarring condition of the penis called Peyronie'sdisease.

💊16. Previous burns or hand injury can lead to scar formation in the palm of the hand that can mimic true a Dupuytren's contracture [ V IMP ]

💊💊17. Most patients with a Dupuytren's contracture require reassurance and stretching exercises with heat application [ V IMP ]

💊18. When the palm is persistently sore with grasping, ultrasound treatments can be helpful. Sometimes local inflammation is best relieved with cortisone injection.

💊19. surgical procedures can remove the scarred tissue to free the fingers and release the tendons. These procedures can return function to a disabled hand

💊20. Sometimes the surgeon can release the scarred tissue by carefully cutting it with a needle. This procedure is referred to as a needle aponeurotomy or needle fasciotomy. [ V IMP ]

💊21. A newer treatment for a Dupuytren's contracture is collagenase (Xiaflex) injection. [ V IMP ]

💊22. Collagenase is an enzyme that breaks up the collagen, which can then loosen the contracted tissue to restore finger mobility. Collagenase is directly injected into the contracted "cord" of scar tissue that causes the Dupuytren's contracture. [ V IMP ]

💊23. The main complication of Dupuytren's contractures is loss of extension of the involved fingers

💊24. A fasciectomy involves removing the thickened connective tissue. There are three variations of the procedure: [ SURGICAL RX ]

💊25. Needle aponeurotomy can be used to treat multiple affected fingers and joints during one setting.

💊26. XIAFLEX is a prescription medicine used to treat adults with Dupuytren’s contracture when a “cord” can be felt. It is not known if XIAFLEX is safe and effective in children under the age of 18.

💊27. The most common side effects with XIAFLEX for the treatment of Dupuytren’s contracture include:swelling of the injection site or the handbruising or bleeding at the injection sitepain or tenderness of the injection site or the handswelling of the lymph nodes (glands) in the elbow or armpititchingbreaks in the skinredness or warmth of the skinpain in the armpit

💊28. Before receiving XIAFLEX, tell your healthcare provider if you have had an allergic reaction to a previous XIAFLEX injection, or have a bleeding problem or any other medical conditions. [ V IMP ]

💊29. Tendon rupture is also a risk of needle aponeurotomy [ V IMP ]

💊30. Collagenase is contraindicatedfor patients who are on anticoagulation, but that is not an issue for needle aponeurotomy because the skin stops bleeding quickly after a puncture wound. [ V IMP ]

💊31. Another potential limitation for collagenase would be lymphedema or prior lymph node surgery on the side being treated.

💊32. A percentage of people will have a lymphatic reaction after collagenase injection. The only other issue is a patient who had previous surgery and has implants in that hand.

Bodies

1.Hematoxylin body- Libman Sachs endocarditis..

2.Michalis Guttman body-malakoplekia

3.Negri bodies- Rabies

4.Gamma gandy bodies- sickle cell anemia

5.Warthin- Finkeledy body-measles

6.Parapeppenheimer body-sideroblastic anemia.

7.Russel and Dutcher body-multiple myeloma.

8.Aschoff body- Rheumatic Heart disease

9.Meyers kouvenaars body-Filariasis

10.Asteroid body &Schaumann body-- sarcoidosis

11.LD body- Leishmaniasis

12.Miyagawa body-Lymphogranuloma venereum(LGV)

13.Veruccay body- Schwanoma

Named Diseases

Abercrombie's
disease ?
Amyloid degeneration
 Albers-
Schonberg disease ?
Osteopetrosis
 Alexander disease ?
Fibrinoid leukodystrophy
 Dercum's
disease ?
Adiposa dolorosa
 Andersen disease ?
GSD -IV
 Bamberger's disease?
HPOA
 Bang's disease ?
Brucellosis
 Banti's disease?
Hypersplenism
 Barlow's disease?
Scurvy
 Basedow disease?
Graves disease

Important facts about vascular system

Important facts about vascular system

Maximum diameter - Vena cava
Maximum wall thickness - Aorta
Minimum diameter & minimum wall thickness - Capillaries
Maximum total cross sectional area - Capillaries
Minimum total cross sectional area - Aorta
Maximum blood volume in - Veins (55-60%)
Minimum blood volume in - Arterioles
Maximum vascular resistance  - Arterioles
2nd max vascular resistance (after arterioles) - Capillaries
Site of gas exchange - Capillaries
Maximum blood flow velocity - Aorta
Minimum blood flow velocity - Capillaries
Maximum flow rate - Aorta & Vena cava
Minimum flow rate - Capillaries
Maximum blood pressure - Aorta
Minimum blood pressure - Vena cava

Prescribing lens

😎👓 WHILE PRESCRIBING GLASSES::

🔍 For atropine use correction factor; deduct (-1).
🔍 For all others; deduct (-0.5).

🔍 At 1meter distance, deduct (-1).
🔍 At <1meter distance or closer, deduct (-1.5).
🔍 At arms distance (or) 2/3rd meter distance, deduct (-1.5).

🔍 While prescribing glasses, follow this rule ➡ Smallest whole number will be given as sphere.

🔍 When the power is not same in both axes after correction while prescribing glasses, it is known as HYPEROPIC ASTIGMATISM.

REQUISITES FOR RETINOSCOPY

👀🔎 REQUISITES FOR RETINOSCOPY::
🔦 Dilated cycloplegia - To relax accomodation in hypermetropes. Commonly used drug is CYCLOPENTOLATE.
🔦 Dilator without cycloplegic effect - PHENYLEPHRINE.
🔦 Longest acting dilator cycloplegic - ATROPINE (duration is 7-14days/1-2weeks).
🔦 Shortest acting dilator cycloplegic - TROPICAMIDE.
🔦 For children <3years of age - ATROPINE eye ointment.
🔦 For adults - use TROPICAMIDE.
🔦 For school going/older children - HOMATROPINE (action lasting 1-2days) [or] CYCLOPENTOLATE (action lasting 12-24hours).

Bariers

blood thymus barrier? T lymphocytes and macrophages

Blood testis barrier?seratoli cells

Blood brain barrier-astrocytes

Blood nerve barrier-
perineurial cells and endothelial cells originated from endoneurium

Questions on bladder

Shape of empty bladder👉 tetrahedral,
Shape of distended bladder👉 ovoid,
Average capacity of bladder👉 120-320 ml,
Mean capacity of bladder👉 220ml,
Sense of filling of bladder first starts at👉 100-150ml,
First desire of micturition👉 150-200ml,
Painful sensations starts wen amount reached above👉 450ml,
Micturition beyond voluntary control wen collection reaches about👉 800ml,
Most fixed part of bladder👉 neck,
Superior surface of Bladder is 👉 covered with peritoneum,
Inferolateral surfaces are👉 devoid of peritoneum..

Markers for intracellular organelles

Markers for intracellular organelles
➡Plasma membrane-Na+ K+ ATPase & 5' nucleotidase
➡Cytoplasm-LDH
➡Mitochondria-Glutamate dehydrogenase
➡Ribosome-RNA
➡Nucleus-DNA
➡Endoplasmic reticulum-Glucose 6 phosphatase
➡Lysosome-Acid phosphatase
➡Golgi apparatus-Galactosyl transferase

Viral encephalitis

Viral Meningoencephalitis::
►The pattern of slightly elevated protein,
lymphocytosis anvd normal CSF/blood glucose ratio
is most suggestive of viral meningitis.
►Viral meningitis is the most common cause of
aseptic meningitis.
►Enteroviruses (EVs) are the Most common proven
cause of viral meningitis and encephalitis (up to
85%–95% of viral meningitis and 80% of viral
encephalitis).
►Mollaret's meningitis (recurrent, benign aseptic
meningitis) mostly associated with HSV type 2
infection without signs of genital infection and
occasionally with type 1 HSV or with Epstein-Barr
virus.
►Herpes Simplex Virus: Most common focal viral
encephalitis in nonepidemic settings; most
common sporadic fatal encephalitis.
►Japanese encephalitis virus: Most common cause
of epidemic encephalitis worldwide; causes
encephalitis more than meningitis. Prevalent in
Asia and Australia; affects children more than
adults.
►More than 80% of cases of benign recurrent
aseptic meningitis are caused by HSV-2. In
contrast, HSV-1 CNS infection is almost always
manifested as encephalitis rather than aseptic
meningitis.
►Generally speaking, Viral Meningitis Most
common Causes:
Enterovirus > HSV-2
►Compared to herpes simplex encephalitis,
enterovirus infection more commonly causes global
encephalitis with generalized neurologic
depression.

Lightening burns

Lightening burn
SBI CALF
💎 S ledge hammer effect
💎 B low death
💎 I nverted tree pattern

💎 C oloured branching
💎 A rborescent marking
💎 L ichenberg flower
💎 F iligree burn

ENT ONE LINERS :

ENT ONE LINERS :
1.Best site for incision on pinna--Incissura terminalis..
2.Lobule is last structure to develop in intrauterine life.
3.Surgical reconstruction of pinnae should not be done before 6 yrs.
4.Pinna skin is tightly adherent on laretal aspect and loosely on medial.
5."Marx Classification is used for microtia of pinna.

Holi in medical field..

Holi in medical field..
[Courtesy by : - Dr. Prem Nyati ( Professor Pharmac ,MGM Medical College , Indore )

A ) Drugs affecting colour vision:
Digitalis can produce blurring of vision and white vision (inability to see red and green colour), border of white colour appears around dark objects. There can be Chromatopsia (Yellow vision), transient amblyopia (decreased vision) and scotomas (isolated areas of loss of vision).
Ethambutol can reduce visual acuity and loss of ability to differentiate red from green; hence it may produce green vision.
Sildenafil can produce visual disturbances due to Phosphodiasterae-6 inhibition that impairs the colour vision. Object may appear blue.

B ) Drugs colouring the tears & contact lens:
Rifampin gives an orange red color to different secretions like urine, faeces, saliva, sputum, tears, and sweat. Beside rifampin few other drugs such as tetracycline, nitrofurantoin, phenazopyridine, etc can change the colour of tears. Contact lenses can absorb this colouring permanently and thus there may be change in the colour of the lenses.

C ) Red man or red neck syndrome ;
Vancomycin can produce extreme flushing in face and neck region, which is referred as red man or red neck syndrome. It is due to massive release of histamine by rapid i/v infusion and can be prevented by antihistamines and slow infusion.

D ) Purple toe syndrome ;
Warfarin can produce a reversible, painful, blue tingled discoloration of plantar surfaces and side of toes, known as purple toe syndrome. It is due to release of cholesterol emboli from atheromatous plaque.

E ) Gray baby syndrome
Chloramphenicol can lead to Gray baby syndrome in premature neonates due to reduced conjugation and excretion. This has a high mortality, initiates with poor feeding, irregular breathing, cyanosis and CV collapse.

F ) Drugs affecting urine & stool colour -
Phenolphthalein- about 15% is absorbed and eliminated by kidney so urine becomes pink or red if it is alkaline.
Methocarbamol, amitryptiline and nitazoxanide may colour the urine with a green tinge.
Furazolidine can give black colour to urine.
Triamterine and methylne blue can colour the urine blue.
Orange to red coloured urine and stool is seen with rifampin.
Riboflavin and tetracyclines can colour the urine yellow.
Black coloured stool can be seen with iron & bismuth

G ) Drugs colouring the teeth ;
Tetracyclines are deposited in the calcified tissues like bones and teeth perhaps because of chelation and formation of tetra calcium orthophosphate complex. There is yellowish brown discoloration of teeth due to ultraviolet absorbing effect. This may be a permanent discoloration. The period of greatest risk is from mid pregnancy to six months of postnatal period for deciduous anterior teeth and from six months to five years of age for permanent anterior teeth.
Chlorhexidine can also lead to brownish discoloration of teeth.
Iron elixir contact can produce gray- black staining of teeth (putting the solution on the back of tongue by a dropper minimizes the risk).
Silver sulphide containing dental amalgam can also impart gray-black colour to teeth.

H ) Drugs affecting skin colour -
Clofazimine can produce red brown discoloration of skin.
Phenothiazines, chloroquine, gold salts, bleomycin, busulfan, cyclophosphamide, amiodarone can produce bluish-grey pigmentation
There may be dark brown patches on face by phenytoin, estrogens (cholasma)

Revision points

FEW RANDOM REVISION POINTS::
1. Sitting Duck shaped Heart is seen in Persistant Truncus Arteriosus.
2. Sherman paradox is seen in Fragile X syndrome. (It is Anticipation phenomenon in Fragile X syn)
3. Trethowans sign is positive in slipped femoral epiphysis.
Normally : If an anteroposterior view of the hip joint is taken then a line
drawn along the superior surface of the neck should pass through the
femoral head. ( This line is Klein's Line )
If the line remains superior to the femoral head then this is termed Trethowans sign.
4. Amrinone and Milrinone - Side effect - Thrombocytopenia.
5. In PSVT (Paroxysmal supraventricular tachycardia), QRS is normal.
6. DOC for typical absence seizures: Ethosuximide
7. DOC for atypical absence seizures: Valproate
8. Hyperventilation provokes absence seizures.
9. Ring enhancing lesion on CECT Brain - think about NCC and Tuberculomas.
10. JME (juvenile myoclonic epilepsy) never shows complete remission.
11. Physiologically both hyperplasia and hypertrophy seen in lactating breast.
12. Balthazar score / CT severity index is used for Grading Acute Pancreatitis.
13. Physiological umbilical hernia can be seen in 1st trimester ( < 12wks ) and does not persist in 2nd trimester.
14. Conjugated hyperbilirubinemia is seen in both Rotor syndrome and Dubin–Johnson syndrome but DJS has Black pigmentation of liver.
15. Most radiosensitive layer of retina - Rods and cones.
16. Most radioresistant layer of retina - Ganglion cell layer.
17. Ocular dendritic cells have HLA 2.
18. Transport of ascorbic acid to lens is done by myoinositol.
19. In PCOD : E1 increases (because of peripheral conversion of androgens) but E2 is normal.
20. Severe pancreatitis is said to be present if there is necrosis within the pancreas. Hence it is also known as necrotizing pancreatitis.
21. Coast of california sign is seen in neurofibromatosis.
22. Hippocampus and amygdala are very sensitive to hypoxia. Therefore if exposed to hypoxia, they die after 30 mins.
23. Among causes of neonatal seizures, Late onset hypocalcemia has best prognosis.
24. Sweaty feet odor : Glutaric acidemia type II , Isovaleric acidemia. (Isovaleric acidemia also Cheesy odor)
25. MC cause of pancreatic calcifications - Chronic alcoholic pancreatitis.
26. MC complication after lens extraction in PHPV is vitreous hemorrhage.
27. Adenocarcinomas do not calcify.
28. Forgotten muscle of rotator cuff - Subscapularis.
29. Rett syndrome is characterized by Microcephaly.
30. Inferior border of orbit is formed by contribution from maxilla , palatine and zygomatic bones.
31. Odor of urine for hypermethioninemia - boiled cabbage. Also Cabbage odor - in Tyrosinaemia
32. Lead toxicity - Purely motor neuropathy.
33. Malnourished child is Sodium overloaded and Potassium depleted - hence use ReSoMal (Rehydration solution for malnourished)
34. GFR of a newborn is 15 - 20ml/min/1.73 m 2
At 3 months - it is 2/3 rd of Adult Adult Values at 2years age.
35. Newborn's renal tubular concentration capacity reaches adult value at 1year of age.
36. Best method of estimating creatinine is Enzyme assay.
37. Oliguria is important sign of Renal failure.
Causes of Non-Oliguric Renal failure -
● In Newborns ,
● Aminoglycoside nephrotoxicity.
38. Total number of nephrons reaches adult value at 36 wks Intrauterine gestation. Thus after birth , there is only functional maturity.
39. In a child with CRF , if Acidosis and hyperphosphatemia is present , then these must be corrected first before introducing Growth hormone.
(GH does not act if acidosis and increased Po4 are present)
40. Membranous glomerulonephritis has been associated with Renal vein thrombosis.
41. Lead pipe appearance of colon is seen in Ulcerative colitis.
42. Tomcat urine smell is associated to multiple carboxylase deficiency.
43. Caplan's syndrome is Rheumatoid arthritis (RA) + Pneumoconiosis.
44. Most common organism for UTI is E.Coli
45. Asymptomatic bacteriuria is only treated during pregnancy
46. Best urine sample for 8 month old girl is by SupraPubic catheterization (even a single colony is UTI with this sample)
47. IOC for VesicoUretric reflux is MCU (Micturating cystourethrography) = VCUG (Voiding cystourethrography )
48. Cranberry juice prevents UTI (because of its ant-adhesion property)
49. IOC for Posterior urethral valve -> MCU = VCUG
50. Pulmonary fibrosis in longstanding cases of Ankylosing spondylitis usually involves upper lobe.

Proteinuria

Quantifying Proteinuria

💧<0.03g-normal

💧0.03-0.3g-microalbuminuria

💧0.3-0.5g-Dipsticks positive

💧0.5-2.5g-Source equivocal

💧>2.5g-likely glomerular range

💧>4g-Nephrotic range-always glomerular

White matter fibres

The fibers of white matter are classified into three types:
a) Association fibers
b) Commisural fibers
c) Projection fibers
The association fibers connect different parts of the cerebral cortex of the same hemisphere to each other. They are of two types;
a) short association fibers
b) long association fibers
The cingulum, uncinate fasciculus (arcuate fasciculus), superior longitudinal fasciculus, inferior longitudinal fasciculus are examples of long association fibers
Commisural fibers cross the midline and connect identical parts of two hemispheres.
Examples of commisural fibers are Corpus callosusm, anterior and posterior commisure, habenular commisure, HIPPOCAMPAL COMMISURE.
Projection fibres connect the cerebral cortex to other regions of central nervous system below it by corticopetal or ascending and corticofugal or descending fibres
Examples are corona radiata, internal capsule, fornix

Tumour Markers

Various Markers::
1. Tumours of epithelial origin - cytokeratin
2. Tumours of mesenchymal origin - vimentin
3. Tumours of smooth muscle origin - smooth muscle actin, desmin
4. Tumours of skeletal muscle origin - desmin
5. Glial origin - GFAP
6. Vascular origin - vWF, CD 31, factor viii, VEGF
7. Stem cells - CD 34
8. B cells - CD 19, 20, 21, 22
9. Pan B cells - CD 19
10. T cells - CD 1,2,3,5,7
11. Pan T cells - CD 3
12. NK cells - CD 16,56
13. Reed sternberg cell - CD 15, 30
14. Popcorn RS cell - CD 20, 45
15. Mantle cell lymphoma - cyclin d1, CD 5
16. Chronic lymphocytic leukaemia - CD 5, CD 23
17. Hairy cell leukaemia - annexin a1, CD 25, 103, 11c
18. Seminoma - PLAP, HCG
19. Choricarcinoma - HCG
20. Yolk sac tumour - AFP
21. Sertoli cell tumour - inhibin
22. Neuroendocrine tumour - NSE, synaptophysin, chromogranin
23. Medullary carcinoma thyroid - calcitonin
24. Ewing's sarcoma - CD 99, mic 2
25. Malignant melanoma - HMB 45, S 100
26. GIST - DOG 1, CD 117, CD 34
27. Apoptotic cells - annexin

Psychiatry syndromes

PSYCHIATRY..................
🔺Wernickes encephalopathy
An acute reaction to severe thiamine deficiency mostly d/t chronic alcohol use.
C/b ocular signs (nystagmus & external ophthalmoplagia)
Higher mental function disturbance(disorientation, confusion, recent memory disturbances)
Apathy & ataxia.
Peripheral neuropathy & malnutrition may be co-existent.

🔺Korsakoffs psychosis
Also d/t severe thiamine deficiency d/t chronic alcohol use.
C/b amnestic syndrome with gross memory disturbances
Confabulation
Insight often impaired.

🔺Marchiafava-Bignami syndrome
A rare disorder most probably d/t alcohol-related nutritional deficiency.
C/b disorientation, personality & intellectual deterioration, hallucinations, epilepsy, dysarthria, ataxia & spastic limb paralysis.

🔺Holiday Heart
Atrial or ventricular arrhythmias, especially paroxysmal tachycardia, after drinking a binge of alcohol in individuals showing no other evidence of heart disease.

🔺Hemp insanity (cannabis psychosis)
Asso with cannabis.
Acute schizophreniform disorder with disorientation & confusion
Good prognosis.

🔺Amotivational syndrome
Lethargy, apathy, loss of interest, anergia, reduced drive & lack of ambition d/t chronic cannabis use.

🔺Van Gogh syndrome
Dramatic self-mutilation occurring in schizophrenia.

🔺Pfropf schizophrenia
A syndrome of schizophrenia occurring in presence of mental retardation.

🔺Oneiroid schizophrenia
A subtype of schizophrenia with acute onset, clouding of consciousness, disorientation, dream-like states & perceptual disturbances with rapid shifting.

🔺Alice in Wonderland syndrome
Perceptual distortion of shape, size, colour& reciprocal position of objects. seen with schizophrenia, migraine

🔺PAD syndrome
Phobic-Anxiety-Depersonalization syndrome.
Commoner in women 20-40 years.
C/b diffuse anxiety, multiple phobias, panic attacks, depersonalization, derealization & depressive features.

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

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

🔺Kadinsky-Clerambaults syndrome
A syndrome of mental automatism

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

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

🔺Fregolis phenomenon
Delusion that a persecutor is taking on a variety of faces like an actor.

🔺Cotards syndrome
Delusion that one has lost everything- possessions, strength & even bodily organs such as heart.
Seen in severe depression where pt has extreme nihilistic delusion (e.g. may think that his bowels are rotting and he will never pass stools again)

🔺Gansers syndrome (hysterical pseudodementia)
Commonly found in prison inmates.
C/b vorbeireden- approximate answers- person understands nature of questions but answers wrong.

🔺La-Belle-Indifference
Lack of concern towards symptoms despite apparent severity of disability produces.
Seen in pts with conversion & dissociation disorder(hysteria).

🔺Briquets syndrome (Somatisation disorder)
A chronic or recurrent illness with either a dramatic or complicated medical history.
A pt with at least 25 unexplained medical symptoms for a diagnosis or with 20-25 unexplained symptoms for a probable diagnosis.

🔺Munchausen syndrome (Factitious disorder, Polysurgis, Professional patients, Hospital hoboes, Hospital addiction)
Pt repeatedly simulates or fakes diseases for sole purpose of obtaining medical attention.

🔺Munchausen syndrome by proxy
Pt intentionally produces physical signs & symptoms in another person who is under ptâ€s care.

🔺Ekbom syndrome (Restless Legs syndrome)
Pt experiences extremely uncomfortable feeling in leg muscles during walking.
Asso with insomnia.

🔺Gelineus syndrome
Narcolepsy.
Asso with hypersomnia.

🔺Pickwickian syndrome
Sleep apnea commoner in elderly & obese persons, asso with hypersomnia.

🔺Kleine-Levin syndrome
C/b hypersomnia
Hyperphagia
Hypersexuality

🔺Clumsy Child syndrome (Motor dyspraxia, Motor skills disorder, Developmental coordination disorder)
C/b poor coordination in daily activities of life.

🔺Idiot Savant syndrome
Pervasive impairment of functions but certain islets of precocity or splinter functions may remain.

🔺Hellers syndrome (Disintegrative psychosis)
A type of childhood psychosis with age of onset 3-5 years.
C/b rapid downhill course leading to deterioration & development of neurological deficits.

🔺Aspergers syndrome
Predominantly in boys.
Less severe form of pervasive developmental disorder
Autism without significant delay in language & cognitive development.
schizoid personality
pedantic speech
preoccupation with obscure facts

🔺Retts syndrome
Occurs in girls.
After an apparently normal early development & normal head circumference at birth, there is deceleration of head growth b/w age of 5-30 months.
Loss of purposive hand movements & acquired fine motor manipulative skills with subsequent development of stereotyped hand movements.

🔺Strauss syndrome
Attention deficit hyperkinetic disorder, Minimal brain dysfunction, Organic drivenness.

🔺Gilles de la Tourettes syndrome
C/b multiple motor tics
Multiple vocal tics
Duration of >1 year

🔺Kanner syndrome
Failure to develop attachment with a parenter al figure & pre-occupation with inanimate objects.

Wechsler's classification
IQ Range ("Deviation IQ") Intelligence Classification
130 and over Gifted
120-129 High
110-119 High Average
90-109 Average
80-89 Low Average
70-79 Borderline
Below 69 Extremely Low

✏Psychiatry one liners......

neurobiology of ocd, most important area involved is..... answer :: orbitofrontal cortex  
First drug shown to have antidepressant efficacy historically ::  isoniazid

first historical book on psychotherapy in india... answer :: d bhagvada gita  

(last dnb q)... drug very effective in intermittent explosive disorder or drug used to manage anger outbursts in conduct disorder answer is..::: carbamazepine...

  (one liner series for dnb)" Empty nest syndrome" is related to which psychiatric disorder::: answer is depression..

learned helplessness model of seligman is related to which psychiatric disorder::: answer is depression...

most prevalent psychiatric disorder anxiety disorder(total) > mood disorder(total) > major depressive episode > any other subtype of anxiety disorder.

  "low csf levels of 5 HIAA, have been linked to increased aggressive behaviour"... (important for may exams & nimhans.)
[6:23pm, 24/08/2014] manvigupta78: Syndromes associated with dementia
Alzheimers disease
Picks disease
Parkinsons disease
Shy-Drager syndrome (Multisystem degeneration)
Huntingtons chorea
Steel-Richardson syndrome (progressive Supranuclear palsy)
Binswangers disease (subcortical arteriosclerotic encephalopathy)
Wilsons disease
Leighs disease
Creutzfeldt-Jacob disease
Gerstmann-Straussler-Scheinker disease
ALS-Parkinsons-Dementia complex of Gaum

👹Syndromes associated with mental retardation

Downs syndrome
Turners syndrome
Kleinfelters syndrome
Cri du chat syndrome
Fragile X syndrome
Hartnups disease
Tay-Sachs disease
Gauchers disease
Niemann-Pick disease
Lesch Nyhan syndrome
Hurlers disease
Hunters disease
Sanfillipos disease
Renpennings syndrome
Sturge-Weber syndrome
Crouzons syndrome
Aperts syndrome
De Lange syndrome (Amsterdam dwarfism)

Some Culture-Bound Syndromes are as follows

Dhat syndrome
A culture-bound syndrome prevalent in Indian subcontinent.
C/b complaint of passage of   dhat in urine.
Multiple somatic symptoms.
Asthenia
May be anxiety, depression or sexual dysfunction associated.

Koro
Prevalent in Asia including India.Affected male pt believes that his penis is shrinking & may disappear into his abdominal wall & he may die.
Females affected infrequently, believing that their breasts & vulva are shrinking.

Amok
Prevalent in South-East Asia.
C/b sudden, unprovoked ep