renal plasma flow - 625 ml / min
glomerular capillary pressure - 45 mmhg
peri tubular capillary pressure - 8 mmhg
pressure in renal vein - 4 mmhg
cortical blood flow - 5 ml per gm of kidney tissue per minute
medullary blood flow- outer 2.5 ml
Inner 0.6 ml
AV oxygen difference - 14 ml / l blood
po2 cortex - 50 mmhg
po2 medulla - 15 mmhg
👫PUBERTAL DEVELOPMENT👫
📌 DEVELOPMENT OF 2° SEXUAL CHARACTERS:
👩 In Females:
✔ T (Thelarche) ➡ P (Pubarche) ➡ M (Menarche)
▶ Thelarche - Breast enlargement
▶ Pubarche - Development of pubic hair
▶ Menarche - Onset of menstrual cycles
👨 In Males:
✔ T (Thelarche) ➡ P (Pubarche) ➡ A (Adrenarche)
▶ Thelarche - Testicular enlargement
▶ Pubarche - Penile enlargement
▶ Adrenarche - Features of maleness
📌 TANNER STAGING OF THELARCHE IN FEMALES:
🔰 Stage 1 - prepubertal elevation of papilla only
🔰 Stage 2 - elavation of breast tissue & papilla as a small mound, enlagement of areola
🔰 Stage 3 - further enlargement of breast & areola
🔰 Stage 4 - projection of areola & papilla to form a secondary mound
🔰 Stage 5 - secondary mound disappears, adult breast with typical contours develops
📌 STAGING OF PUBARCHE IN FEMALES:
🔰 Stage 1 - no sexually stimulated pubic hair present, some non-sexual hair maybe seen in the genital area
🔰 Stage 2 - appearance of coarse, long, crinkly hair along labia majora
🔰 Stage 3 - coarse, curly hair extending onto mons pubis
🔰 Stage 4 - adult hair in thickness & texture, extending laterally onto mons pubis giving the vulva an inverted triangular appearance
🔰 Stage 5 - hair may extend further laterally onto inner aspects of thighs & perineum
👉 Axillary hair appears a little later in sequence.
👉 Secondary hair growth is under control of adrenal cortex.
📌 SEXUAL MATURITY RATING (SMR):
👩 In females:
💃 Stage 1 -
● prepubertal,
● no terminal hair
💃 Stage 2 -
● appearance of breast bud;
● sparse straight hair along the labia majora
💃 Stage 3 -
● generalised breast enlargement (extending beyond the areola);
● pigmented, coarse pubic hair, begins to curl
💃 Stage 4 -
● nipple & areola form a second mound over breast;
● hair increases in amount & spread over entire mons
💃 Stage 5 -
● mature adult type breast, nipple projects & areola recedes;
● adult type pubic hair in triangle shaped area, spreading over to medial thighs
👨 In males:
🏃 Stage 1 -
● testicular size <2.5cm, vol. <3ml;
● prepubertal
🏃 Stage 2 -
● testicular size 2.5-3.2cm, vol. reaching 4ml, reddening of scrotum;
● scanty hair at penile base
🏃 Stage 3 -
● testicular size 3.3-4.0cm, further increase in vol. to 10ml
● increase in length of penile shaft
● hair begins to curl & darken
🏃 Stage 4 -
● testicular size 4.1-4.5cm, vol. 16ml
● increase in girth of penis & glans, darkening of scrotum
● coarse, abundant & curly hair, less than in adult
🏃 Stage 5 -
● testicular size >4.5cm, vol. 25ml
● adult size scrotum & penis
● adult type hair, spreading over to medial thighs
📚 References:
📖 Shaw's TB of Gynaecology, 15th Edition
📖 Ghai Essential Pediatrics, 8th Edition
Mineral Stored With Insulin In Beta Cell Granules :- Zinc
Mineral Which Increases Insulin Sensitivity And Alleviates Insulin Resistance :- Chromium
One Gram Of Insulin Neutralizes 2.5 Grams Of Glucose
Insulin Works By
Tyrosine Kinase Receptor Pathway
Fetal Hyperinsulinemia Due To Maternal Hyperglycemia Is Called -" Pederson Hypothesis"
Discovered By Banting And Best
Chemical Structure Given By -" Sanger"
Only Insulin Sensitive Area Of Brain Is -" Satietary Centre / Venteromedial Nucleus Of Hypothalamus
Insulin Secretion Begins At 11-12 Weeks Of Intrauterine Life
Anti-Arrhythmics:
Ia: PDQ: Procainamide, Diisopyramide,
Quinidine
Ib: MeLT: Mexiletine, Lidocaine, Tocainaide
Ic: PrEF: Propafenone, Flecainide, Encainide
III: DIBS: Dofetilide, Ibutilide, Bretylium,
Sotalol.
🍍ANTLER LIKE/STAG HORN APPEARANCE- downling degos disease
🍍BOX SHAPED/SQUARED OFF APPEARANCE- indurative stage of morphea/localised scleroderma
🍍BUSY DERMIS APPEARANCE- histiocytoma
🐪CAMEL FOOT APPEARANCE/ACANTHOSIS-plaque type psoriasis
🏀CANNON BALL APPEARANCE-angioblastoma
🍗CHICKEN WIRE/🐠FISH NET PATTERN-p.vulgaris
🍍CHURCH SPIRE APPEARANCE-hyperkeratotic seborrheic keratosis
🍍CLAW CLUTCHING BALL APPEARANCE-lichen nitidus
🍍CLOCK FACE/CART WHEEL-plasma cell
🍍COAT SLEEVE APPEARANCE- primary and secondary lesions of syphilis
🍍CRIBRIFORM APPEARANCE-trichoepithelioma
🍍DILAPIDATED BRICK WALL-hailey hailey disease
🍍FESTOONED PAPILLAE-prorphyria cutaneous tarda
🍍FLAME THROWER LIKE-vertical section of telogen hair shaft
🍳FRIED EGG-mastocystosis,neurofibroma
🍍JIG SAW PUZZLE-cylindroma
🍍MARINERS PILOT WHEEL-brazilian blastomycosis
🍍MORULA LIKE-protothecosis
🔮ONION SKIN LIKE-pacinian corpuscle
👀OWLS EYE APPEARANCE-verucca plana
🎨PAINT BRUSH LIKE-penicilium marneffei
🍍PALISADING APPEARANCE-BCC
🍍PICKET FENCE APPEARNACE-dermatitis herpetiformis
🍍RAVELLED WOOL-pseudoxanthoma elasticum
🍍SAFETY PIN-donovanosis
🍍SAW TOOTH APPEARANCE-lichen planus
🍅SEPTATE TOMATO APPEARANCE-molluscum contagiosum
🍍SIEVE LIKE-kaposis
🍖SPAGHETTI AND MEAT BALL/🍌BANANA $🍇GRAPE LIKR-pitryasis versicolor
🍍STORIFORM-dermatofibrosarvoma protuberance
🍍SWARM OF BEES-alopecia areata
🍣SWISS CHEESE-sclerosing lipogranuloma
🍍TADPOLE/COMMO SHAPED-syringoma
📞TELEPHONE HANDLE-deep nucleus of eosinophil
🍍TISSUE CULTURE LIKE-nodular fascitis
🍍TOMB STONE-p.vulgaris
🍍TRILAYERED/STRIPED-lichen sclerosis
🍍WIND BLOWN-bowens disease
mnemonic for porphyria👉
Mnemonic for the Hereditary porphyrias...
All---------------Acute Intermittent Porphyria
Congenital------Congenital erythropoetic Porphyria
Porphyrias------Porphyria Cutanea Tarda
Have------------Hereditary Coprophyria
Variable---------Variegate Porphyria
Presentation----Protoporhyria
Now all u got to do is memorize the pathway......
the first enzyme.....ALA synthase and ALA dehydrase have no deficincies that i know of and even if they did then they wldn't cause porphyria.....
then you got the next enzyme
Uroprophyrinogen I synthase..............Acute I.Porphyra
Uroporphyrinogen III co-synthase.......Congenital erythropoetic Porphyria
Uroporphyrinogen III decarboxylase....Porphyria Cutanea Tarda
Coprophyrinogen III oxidase...............Hereditary Coprophyria
Protoporhyrinogen oxidase.................Variegate Porphyria
Ferrochelatase....................................Protoporhyria
Orthopaedic imp II
From newer edition f maheshwari
-inferior capsule is weakest portion of shoulder joint
-tests for anterior glenohumeral instability are apprehension test,fulcrum test,crank test,jobe's relocation test and surprise test
-test for posterior glenohumeral instability is jerk test
-sulcus test done for multi-directional and inferior stability
-lift off test evaluates subscapularis muscle activity.
-anconeus triangle formed by radial head,lateral epicondyle, and tip of olecranon
-mc cause f volkman's ischaemic contracture (VIC) in a child is supracondylar fracture f humerus n mc muscle involved in VIC is flexor digitorum profundus
-head f radius excision leads to valgus deformity at elbow.
-fracture of both bones f forearm abv insertion of pronator teres is immobilised in supination below insertion of pronator teres is immobilised in mid-neutral position.
-the proximal fragment of scaphoid fracture is more prone to avascular necrosis due to retrograde blood blow to proximal fragment
-lunate dislocation cn lead to medial nerve injury.
-incidence f injury in carpal bones is scaphoid>triquentral>trapezium>lunate.
-bennett:'s fracture is difficult to maintain in a reduced position due to pull of abductor pollicis longus.
-skiers thumb/gamekeepers thumb is n injury to ulnar collateral ligament of the metacarpo-pharyngeal joint.it is injured during skiing,holding a catch and twisting the neck of small animals.an incomplete rupture is treated conservatively with a thumbs spica or functional cast brace.a complete rupture is treated by surgical repair
-stener lesion occurs whn the adductor pollicis aponeurosis becomes interposed BTW the retracted ligament and this hinders healing.
-in pelvis fracture blood loss is 4-8units.
-jumpers fracture is a type f pelvic fracture
-kocher langenbeck approach is for posterior caudal exposure
-ilioinguinal approach is for internal or anterior approach.
-extended iliofemoral approach is to expose both the anterior and posterior columns.
-main blood supply to head f femur in adults is the lateral ascending cervical or retinacular and epiphyseal branches f medial circumflex femoral artery
-the commonest hip injury in the elderly patient is intertrochanteric (extra capsular fractures)
-occult fracture neck f femur best diagnosed by MRI
-maximum chances f avascular necrosis is subcapital fracture.
-fracture head f femur classified by Pipkin classification.
-femoral head palpable on per rectal examination in central dislocation f hip.
-paralysisf gluteus medius/minimus supplied by superior gluteal nerve causes trendelenburgs gait.
-upper 1/3rd shaft f femur mc fracture at birth
-maximum shortening f lower limb is seen in fracture shaft f femur and posterior dislocation f hip.
-in 90° flexion f knee the tibial tuberosity is in line with centre f patella on extension it moves towards the lateral border due to screw home mechanism
-people with anterior cruciate deficient knees have problem climbing downhill.
-dial test,tests posterolateral corner and positive cruciate ligaments
1)posterolateral corner deficiency positive at 30° flexion.
2)posterior cruciate ligament positive at both 30° and 90° flexion.
-physiological locking occurs with internal rotation f femur over fixed tibia by the quadriceps,unlocking refers to lateral rotation f femur over a stabilized tibia by the popliteus
-rotation force is most imp in causing meniscal injury.
TUMORS OF THE MEDIASTINUM:
# Anterior Mediastinum: Thymoma
# Middle Mediastinum: Pericardial Cyst
# Posterior Mediastinum: Neurofibroma
# Superior Mediastinum: Lymphoma
# OVERALL Most Common Mediastinal Tumor is: NEUROFIBROMA
-----------------------
Most Common Mediastinal Tumors::
1. Anterosuperior Mediastinum :
Most common Tumor/Mass: Thymoma
Most common mediastinal germ cell tumor: Teratoma
2.Middle Mediastinum:
Majority are Cysts
Most common cysts are congenital cysts, especially Bronchogenic Cyst
3. Posterior Mediastinum:
Most common Tumor/Mass is Neurogenic
Overall most common mediastinal mass: Neurogenic > Thymoma.
CELL CYCLE-
Cancer cell depends on AEROBIC GLYCOLYSIS for growth
Serine/threonine Akt oncogene stomulates glycolysis in malignant cells
Most variable phase- G1
DNA doubling- S phase
CELL doubling- mitotic phase
Most critical phase? G1👉S
CYCLINS
Sequence of cyclins appears D👉E👉
A👉B
First cyclin to appear in cell cycle CYCLIN D( mid G0 phase)
Cyclin E appearances in which phase- late G1
Cyclin A in which phase? Mid S phase
Cyclin B in which phase? M phase
Which cyclin involves in G1/S transition? E
Whivh cyclin involved in G2/M transition? A
Which cyclin initiates mitosis? B
CELL CYCLE INHIBITORS
💁cip/kip family? P21 p27 p57
💁INK 4a/ARF family? P16ink 4a and p14 Arf
DRUGS ACTING ON CELL CYCLE
Vinblastine- G1
Mtx,mitomycin c,Doxorubicin,Cytarabine,Hydroxy urea,5-FU- S PHASE
Daunorubicin,Bleomycin,Etoposide,Topotecan-G2 phase
💁Vincristine,Paclitaxel-M phase
CHECK POINTS
💁two check points of cell cycle- G1S TRANSITION and G2M transition
💁chromosomal abnormalities occurs in cells irradiated in which phase- G1 phase
💁chromatid abberation occurs in cells irradiated in G2 PHASE
RADIO AND CHEMOSENSITIVE
💁most radio sensitive phase? M> G2M
💁Most radio resistant phase? End of S phase
💁most chemosensitive? S phase
💁 Most Radiosensitive Tissue – Bone Marrow
💁 Least Radiosensitive Tissue – Nervous Tissue
💁Most Radiosensitive blood cell – Lymphocyte
💁Least Radiosensitive blood cell – Platelet
💁Most Radiosensitive organ – Skin
💁Least Radiosensitive organ – Vagina
💁Most Radiosensitive mucosa – Interstitial Mucosa
💁most radiosensitive layer of retina-rods and cones
most radioresistant layer of retina-ganglion layer
Cell cycle specific -
G1 S topoisomerase - 2
S antimetabolite
G2 M topoisomerase 2 and bleomycin
M vinca alkaloids
Taxanes , estrogen
Cell cycle non specific
topoisomerase 1 inhibitors
alkylating agents
All anti ca antibiotics except bleomycin
platinum group
most sensitive se cardiac marker of MI ? CK MB
most specific marker ?troponin I
marker to test re infarction? CK MB
marker for early detection of MI ? Myoglobin
JERGERS CURVE ON IMPEDANCE AUDIOMETRY
🍉A CURVE-
🍍normal
🍍ET obstruction in some cases
🍉As CURVE/FIXATION OF OSSICLES-decreased compliance at ambient pressure
🍍otosclerosis
🍍tumors of middle ear
🍍fixed malleus
🍍tympanosclerosis
🍉Ad CURVE-increased complieance at ambient pressure
🍍ossicular discontinuty
🍍post stapedectomy
🍍monomeric ear drum
🍍lax TM
🍉B CURVE/FLAT/DOME SHAPED CURVE-lack of compliance
🍍fluid in middle ear/SOM/AOM
🍍TM perforation
🍍grommet in ear
🍍thickened TM
🍉C CURVE/ROUNDED-max compliance at pressures>100mm H2O
🍍retracted TM
🍍Faulty function of ET
RETINAL LAYERS
RETINAL PIGMENT EPITHELIUM
PHOTORECEPTORS(RODS $CONES)
EXTERNAL LIMITING MEMBRANE
OUTER NUCLEAR LAYER
OUTER PLEXIFORM LAYER
INNER NUCLEAR LAYER
INNER PLEXIFORM LAYER
GANGLION CELL LAYER
RETINAL NERVE FIBER LAYER
INTERNAL LIMITING LAYER
RETINAL.LAYERS INVOLVED IN EYE DISEASES
🐾TYPICAL RETINOSCHISIS-split at outer plexiform layer
🐾RETICULAR RETINOSCHISIS-split at level of nerve fibre layer
🐾DIABETIS RETINOPATHY-(mainly affects capillaries which are DEEPLY located) b/w outer plexiform and inner nuclear layer
👉MICROANEURYSM-b/w outer plexiform and inner nuclear layer(compact middle layers of retina)
👉HARD EXUDATES/TRUE/LEKAGE OF LIPOPROTENOUS MATERIAL IN TO RETINA- b/w outer plexiform and inner nuclear layer
👉DOT $ BLOT HEMORRHAGES-
➰From microaneurysms-b/w outer plexiform and inner nuclear layer(compact middle layers of retina)VERTICAL BLEED
➰superficial flame shaped hemorrhages-located in nerve fiber layer
➰SOFT EXUDATES-due to retinal ischemia of arterioles in nerve fiber layer
🐾HYPERTENSIVE RETINOPATHY(mainly affects arterioles which are SUPERFICIAL)
➰SOFT EXUDATES/COTTON WOOL SPOTS/NOT TRUE-due to edema of Nerve fiber layer
➰FLAME SHAPED HAEMORRHAGES-bleed in nerve fiber layer which is HORIZONTALY arranged
{📌Although soft exudates and flame hemorhages more common in HT retinopathy these findings also seen in DM retinopathy📌}
🐾CHERRY RED SPOTS-in NFL and ganglion cell layer
🐾 MOST RADIOSENSITIVE layer of retina-rods and cones
🐾MOST RADIORESISTANT layer of retina-ganglion layer
🐾ARMD-RPE dysfunction
🐾CYSTOID MACULAR OEDEMA-accumulation fluid in outer plexiform layer due to defect in inner blood retinal barrier
🐾ANGIOID STREAKS-crack b like dehisence of brush membrane of choroid with secondary changes in RPE
IMP ANGLES
👐Renal angle: Formed b/w 12th rib and erector spinae.
👐Sternal angle: Second costal cartilage joins to stenum at this level (also k/as angle of Louis)
👐Citelli's angle: also k/as Sinodural angle, situated btwn the sigmoid sinus and middle fossa dura plate.
👐Solid angle: Area where three bony semicircular canals meet.
👐Alpha angle: The angle between the visual and the optic axes as they cross at the nodal point of the eye
👐Kappa angle: The angle formed by pupillary axis and visual axis at the pupil.
👐Cobb angle: Angle measuring scoliosis on a radiograph.
👐Angle of inclination: Angle formed by intersecting femoral neck angle (NA) with axis drawn through shaft of femur (SA). This angle normally varies b/w 90° and 160°.with an average of 135°
👐Urethrovesical angle is the angle b/w female urethra and the posterior vesical wall, normally about 90°-100. narrowing of this in cystocoel predisposes to stress urinary incontinence.
👐Aperture/ angle of female pubic
arch subpubic angle is 80°-85° in female & 50°-60° in male.
👐Greater sciatic notch is wider in female (75°) than male (60).
👐Subpubic angle is 80°-100 ° in gynaecoid pelvis.
Numbers in Human Body
================
Number of bones – 206
Number of ribs – 24
Number of bones in skull – 22
Number of bones in face – 14
Number of bones in neck – 7
Number of bones in Vertebral column –
26
Number of bones in hand – 30
Respiratory rate – 16-20 times / minute
Number of heart beat – 70-72 times/
minute
Number of pulse- 70-72 times / minute
Blood pressure – 120/80 mm of Hg
Number of Cranial nerves – 12 pairs
Number of spinal nerves – 31 pairs
Life span of R.B.C – 120 days
Life span of W.BC – 10-15 Days
Life span of platelets – 5-9 days
Amount of blood – 5-6 L
✂✂CUSHING IN MEDICINE✂✂
📌FIRST NEUROSURGEON- HARVEY WILLIAMS CUSHING
📌CUSHING ULCER-A gastric ulcer produced by elevated intracranial pressure. It is also called von Rokitansky syndrome. Apart from in the stomach, it may also develop in the proximal part of the duodenum and the distal esophagus.
📌CUSHING REFLEX/EFFECT/REACTION-is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and a reduction of the heart rate. It is usually seen in the terminal stages of acute head injury and may indicate imminent brain herniation. It can also be seen after the intravenous administration of epinephrine and similar drugs
📌CUSHINGS TRIAD- (not to be confused with the Cushing reflex) is a sign of increased intracranial pressure. It is the triad of:
1. Hypertension (progressively increasing systolic blood pressure)
2. Bradycardia
3. Widening pulse pressure (an increase in the difference between systolic and diastolic pressure over time)
Cushing's triad suggests a cerebral hemorrhage in the setting of trauma or an space occupying lesion (e.g. brain tumor) that is growing and a possible impending fatal herniation of the brain.
📌CUSHINGS SYNDROME-hypercortisolism, , and , is a collection of signs and symptoms due to prolonged exposure to cortisol.Signs and symptoms may include: high blood pressure, abdominal obesity but with thin arms and legs, reddishstretch marks, a round red face, a fat lump between the shoulders, weak muscles, weak bones, acne, and fragile skin that heals poorly. Women may have more hair andirregular menstruation. Occasionally there may be changes in mood, headaches, and achronic feeling of tiredness.
📌CUSHINGS DISEASE-characterised by increased secretion of adrenocorticotropic hormone (ACTH) from the anterior pituitary (hypercortisolism). This is most often as a result of a pituitary adenoma (specifically pituitary basophilism) or due to excess production of hypothalamus CRH (Corticotropin releasing hormone) (hypercortisolism/hypercorticism) that stimulates the synthesis of cortisol by the adrenal glands. Pituitary adenomas are responsible for 80% of endogenous Cushing's syndrome,when excluding Cushing's syndrome from exogenously administered corticosteroids.
1. An acoustic neuroma first distorts the eighth cranial nerve. The slowly enlarging tumor protrudes from the internal auditory canal into an area behind the temporal bone called the cerebellopontine angle.
2.It then assumes a pear shape, with the small end in the canal. The tumor presses on adjacent nerves, such as the fifth cranial nerve.
3. Ultimately, the tumor can involve other nerves. And press on the brainstem and become life threatening.
4. Its origin is INFERIOR vestibular n. And not supr vestib... nor auditory N.
5. Still 90% pts present with hearing loss and tinnitus. Not as vertigo or balance problems.. ...... bcoz auditory part more succeptible to pressure.
1)Best screening test SLE-anti nuclear
2)SLE specific-anti ds DNA,anti-smith
3)anti histone ab-drug induced lupus
4)anti ro(SS-A)-neonatal lupus
5) anti ribosomal ab-cns lupus
6)high titres of ds DNA is associated with-active renal diseases
7)death in SLE- most commonly by cvs(renal if it occurs less than 10y)
8)MC cardiac prbl-pericarditis
9)MC PULMONARY PRBL-pleuritis
10)MC CNS PRBL-cognitive dysfunction
11)life threatening pulmonary prbl-shrinking lung syndrome
12)most serious cardiac prbl-myocarditis n libman sacks endocarditis
13)MC HAEMOTOLOGICAL PRBL- anaemia
most common nosocomial infection is UTI
most common organism causing nosocomial UTI is E.coli
organism causing early onset nosocomial pneumonia is Pneumococci
organism causing late onset nosocomial pneumonia is Staph.aureus
organism causing surgical site infection is Staph.aureus
organism infecting burns is pseudomonas
Hair on end appearance is seen in -
sickle cell anemia,G6PD deficiency.Hereditary spherocytosis
Gamma Gandy Bodies is seen in Sickle cell anemia, CML, Liver cirrhosis
most common cause of native valve endocarditis is Staph.aureus
cause of early onset prosthetic valve endocarditis is coagulase negative Staphylococcus
cather induced UTI COMMONLY DUE TO PSEUDOMONAS
cause of late onset prosthetic valve endocarditis is Strptococcus viridans
endocarditis in IV drug users Staph.aureus
Cutaneous Anthrax is known as hide porters disease ,the pustule that develos is painless and is known as Malignant pustule.
pulmonary anthrax is known as wool sorters disease,it causes hemorrhagic pneumonia
laryngeal diptheria is the most severe form...tracheostomy may be required but not in all cases
toxigenicity of diptheria is not chromosomally mediated but is phase mediated
Microbial theory of fermentation
Anthrax, cholera, Rabies vaccine
Principle of sterilization
Streptococci
Father of modern microbiology
Flagella
They are organs of locomotion.
They are made up of a protein flagellin.
Flagellar antigen induces specific antibodies in high titers. These
antibodies are not protective but are useful in serodiagnosis.
Types:
1. Peritrichous all around cell, e.g. Typhoid bacillus.
2. Polar at one or both ends:
a. Single monotrichous, e. g. Cholera
b. Tufts lophotrichous, e.g. Spirilla
c. Both poles amphitrichous
Flagella may be seen under dark ground illumination.
They can be visualized by special staining techniques or by electron
microscopy. Their presence can be observed on the semisolid agar
medium by noting spreading type of growth due to motility.
Skin test--
Ito test-chanchroid
Farley t.-schistosomiasis
Frets t.-lgv.
Casino i.d test-echinococcus.
Kveim sitzback test-sarcoidosis.
Montenegro t.-leshmaniasis.
1.(a)Plague
(b)Donovania Granulomatis -------Safty Pin appearance
2.Meningococci--------------------------Half moon
3.Gonococci-----------------------------Kidney
4.Pneumococci--------------------------Lanceolate
5.Cl.Tetani------------------------------Drumstick
6.Cl.Welchi------------------------------Spindle
7.Rabies virus---------------------------Bullet
Runyon Classification of Mycobacteria.
classification Organism
TB complex ---M tuberculosis
---M africanum
---M bovis
Photochromogens - M asiaticum
-M kansasii
-M marinum
-M simiae
Scotochromogens - M flavescens
-M gordonae
-M scrofulaceum
-M szulgai
Nonchromogens- - M avium complex
-M celatum
-M haemophilum
-M gastri
-M genavense
-M malmoense
-M nonchromogenicum
-M shimoidei
-M terrae
-M trivale
-M ulcerans
-M xenopi
Rapid growers - M abscessus
-M fortuitum group
-M chelonae group
-M phlei
-M smegmatis
-M vaccae
Oct 27, 2012
guest2011
Moderator
BASIS of classifications
Streptococci
1.on o2 requimnt--a.aerob and facultatv anaerbes
b.obligate anaerobe(peptostreptoco)
2.hemolysis--a.alpha--s.viridans,s.sanguis,s.mutants
b.beta--on c carbohydrate in cell wall--1.Lancefield 20 gp e.g strep.pyogenes of A
2.Griffith types
c.gamma--enterococci and star.bovis
RELATIVE BRADYCARDIA is seen in the following conditions
1.Typhoid fever
2.Yellow fever
3.Leptospirosis
4.Diphtheria
5.Dengue fever
BASIS of classifications
Pneumococus-
On capsular polysacch at gp.I,ii,iii,iv
Meningococcus-
On capsular antigen in A B C etc.a and c has vaccine.b has no vaccine.
Gonococcus--
On outer member proteins
C.diptheriae
On colony morphology on tellurite blod agar--gravis,mitis,intrmidius(McLeod classifictn)
On agglutintn test--gravis 13 types,intermedius 4 types,mitis 40 types
Clostridium---
A.perfringens--on toxin basis A to E
B.botulinum--on toxin a b c1 c2 d e f g.all r neurotoxin except c2 which is cytotoxin
C.tetani--on agglutination I to x
Enterobactriace
A.lactose fermntr--klebsiella,e.coli
B.late lactose fer--shigella sonnei,Edwards Ella,citrobacter,serratia,providencia etc
C.non lac fer--all shigella except s.sonnei,salmonella,proteus
Shigella--on basis of mannitol frmnt as A B C D.all r mannitol fermntr xcpt a.
Salmonella--a.in serological gp--by O antigen
b.in serotype--by H ag
Vibrio--
A.heiberg gping-on fermntn f sucrose,arabinnose,mannose
B.Gardner and venkatraman--a.on flagella r H at as A( v.chlorea) and B( heterogenous vibrio)
b.A go is further classyfyd on basis of O ag as O1 and non O1
c.O1 as agglutinble vibrio divide in classical n el tor which is further sub divide in serotype ogawa,inaba,hikogima
PS.aeruginosa
--on basis f LPS
Y.pestis--fermntation f glycerol
H.inluenzae--capsulr polysacc as a to f
Influenza virus--on basis f antigenic nature f internal ribonucleoprtin at as A B C
Dermatophytes--
on nature f mAcroconidia as tricophyton,microsporum,epidermophyton
1.Hepatitis B Virus--causes Primary hepatocellular carcinoma
2.Herpes Viruses
(a)Epstein-Barr virus-Burkitts lymphoma
(b)Nasopharyngeal carcinoma
(c)B-cell lymphoma
(d)Infectious mononucleosis
3.Herpes simplex virus II
causes- uterine cervical cancer
4.Cytomegalovirus
causes-Ca- Prostate
Kaposi's sarcoma
Septic shock-------- Pseudomonas spp., gram-negative enteric bacilli, Staphylococcus spp., Streptococcus spp. Vancomycin (plusGentamicin (5 mg/kg per day) plus eitherPiperacillin/tazobactam
or
Cefepime
Adjust treatment when culture data become available. Drotrecogin alfa (activated)a or low-dose hydrocortisone and fludrocortisoneb may improve outcome in patients with septic shock.
,
Overwhelming post splenectomy sepsis ---------------Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis Ceftriaxone plusVancomycin1 If a -lactam-sensitive strain is identified, vancomycin can be discontinued.
Babesiosis ---------Babesia microti (,B. divergens (Europe)
Meningococcemia----------------N. meningitidis ---------Penicillin
or
Ceftriaxone
Consider protein C replacement in fulminant meningococcemia.
Rocky Mountain spotted fever (RMSF--------------Rickettsia rickettsii
Doxycycline If both meningococcemia and RMSF are being considered, use ceftriaxone plus doxycycline or
chloramphenicol alone .If RMSF is diagnosed, doxycycline is the proven superior agent.
Purpura fulminans---------------------- S. pneumoniae, H. influenzae, N. meningitidis Ceftriaxone
Vancomycin
If a -lactam–sensitive strain is identified, vancomycin can be discontinued.
Erythroderma: toxic shock syndrome ---------Group A Streptococcus, Staphylococcus aureus
DNA VIRUS
ICOSAHEDRAL-NAKED
PARVO,POLY,PAPI,ADENO-PNEUMONIC-naked poly,papi,adeno,paro
RNA VIRUS NAKED
PICORNA
CALCI
REO
ASTRO
PNEUMONIC-ASTRO PCR
DNA ENVELOPED ICOSAHEDRAL
HERPES
HEPADNA
PNEUMONIC enveloped means in house so HH
COMPLEX DNA
POX IS COMPLOX
RNA ENVELOPED ICOSAHEDRAL
TOGA
RNA ENVELOPED HELICAL
BUNYA,BORNA
PARA
ORTHO
FILO
RHABDO
PNEUMONIC
BRING POLYMERASE OR FAIL REPLICATION
segmented rna
BUNYA
ORTHOMYXO
RETRO
ARENA
NEGATIVE STRAND VIRUS
BRING POLYMERASE OR FAIL REPLICATION
BUNYA
PARAMYXO
ORTHOMYXO
FILO
RETRO
ALL DNA VIRUS ARE DOUBLE STRANDED EXCEPT
paro
ALL RNA SINGLE EXCEPT
REO
circular dna virus
poly
papi
hepa
1.Bugs with exotoxins:-
"Some Say Cobra Venom Entering Buttocks
Could Cause Complete Blindness So ^*&^*"
[S aureus/pyogenes SuperAgs]
[C. diptheria , V. Cholera, E. coli, B.
pertusis----ADP ribosylation/A- B toxin]
[C.perfringens, C. tetani, C. botulinum,
B.antrhax, Shigela, S. pyogenes---- other
toxins]
2.some toxins encoded by lysogenic phages:-
ABCDE
- shigA- like toxin
- Botulinum toxin
- Cholera toxin
- Diphtheria toxin
- Erythrogenic toxin of - Streptococcus
pyogenes
3.examples of Obligate anaerobes
Anearobes know their ABC's
-Actinomyces
- Bacterioides
- Clostridium
4.Catalase :-what it does and why it's bad
Catalase degrades H2O2, an antimicrobial
product of PMNs. H2O2 is a substrate for
myeloperoxidase.
5. what makes coagulase
S. aureus makes coagulase,
whereas S. epidermidis
and S. saprophyticus do not.
6.bacterial cAMP inducers:-cAMP
- Choerae
-Anthrax
- E.coli (imagine the heat (h eat - labile) has
caused the E to faint and as fallen over to
make an M
- Pertussis
7.Zoonotic bacteria:-Big Bad Bugs From Yer Pet
- Bartonella henselea
- Borrelia burgdorferi
- Brucella spp.
- Francisella tularensis
-Yersinia pestis
- Pasteurella multocida
8.Cat scratch fever aka Bartonella henselae
Bartonella henselae
disease states
cat scratch fever
lymphadenopathy (swelling of the lymph
nodes) and fever. and Peliosis Hepatis
9.Peliosis Hepatis
is an uncommon vascular condition
characterised by randomly distributed
multiple blood -filled cavities throughout
liver.
1.Gram-negative coccobacilli:-Haemophilus influenzae
2.Toxic shock syndrome toxin (TSST):-Staphylococcus aureus
3.Oxidase positive seudomonas aeruginosa
4.Enterotoxin :-Staphylococcus aureus
5.Exfoliatin (scalded skin syndrome) :-Staphylococcus aureus
6.Optochin sensitive :-Streptococcus pneumoniae
7.Bacitracin sensitive :-Streptococcus pyogenes
8.Spe toxins:-Streptococcus pyogenes
9.C-substance/CRP:-Streptococcus pneumoniae
10.Club-shaped bacilli in palisades:-Corynebacterium diphtheriae
11.Toxin that ADP-ribosylates EF-2:-Corynebacterium diphtheriae, Pseudomonas aeruginosa
12.Exotoxin A seudomonas aeruginosa
13.Toxin that ADP-ribosylates Gi protein:-Bordetella pertussis
14.Tumbling motility :-Listeria monocytogenes
15.IgA protease :-Streptococcus pneumoniae, Haemophilus influenzae
16.Quellung reaction :-Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis
17.Iron/cysteine supplement (charcoal-yeast agar):-Legionella pneumophila
18.Cold-agglutinin titer:-Mycoplasma pneumoniae
19.Bacterial membrane contains cholesterol:-Mycoplasma pneumoniae
20.Fried egg shaped colony:-Mycoplasma pneumoniae
21.Cord factor:-Mycobacterium tuberculosis
22.Niacin production:-Mycobacterium tuberculosis
some stains and media
1.Giemsa’s Stain :-Borrelia, Plasmodium, Trypanosomes, Chlamydia
2.PAS Stain (periodic acid-Schiff) :-Whipple’s Disease. Stains glycogen & mucopolysaccharides.
3.Ziehl-Neelsen Stain :-Acid-fast bacteria
4.India ink :-Cryptococcus neoformans
5.Silver Stain :-Fungi, Leigonella
6.Chocolate agar :-H flu: Factor V (NAD) & X (hematin)
7.Thayer-Martin Media :-N. gonorrhoeae
8.Bordet-Gengou Agar ertussis. Potato-based agar.
9.Tellurite Plate, Loeffler Medium :-Corynebacterium Diptheriae -> black colony
10.Lowenstein-Jensen Agar :-TB
11.MacConkey’s Agar :-Lactose fermenting enteric bacteria -> Pink (Kleb, E coli , Entero > Citro, Serratia)
12.Charcoal Yeast Extract :-Leigonella, buffered with iron & cysteine
13.Sbouraud’s Agar :-Fungi
-Typhoid fever=Salmonella typhi
- C.trachomatis=bacteria, STD.
-Trichomonas vaginalis=protozoan, STD.
-Trichinella spiralis=worm in pork.
-Trypanosoma=Chagas ’ disease or African ss
-Treponema=spirochete; causes syphilis (T.
pallidum) or yaws (T. pertenue).
Mnemonic: CASE of bloody diarrhea
C: Campylobacter Jejuni
A: Amoeba
S: Shigella
E: EIEC
Watery Diarrhea
Mnemonic: Watery Diarrhea "Can Not Rehydrate Easily"
C: Cholera
N: Norwalk
R: Rotavirus
E: ETEC
Persistant Diarrhea
P: Parasites
1.Cave spelunking, causes pneumonia :-Histoplasmosis
2.Broad based buds :-Blastomycosis
3.Captain wheel formation fungus aracoccidiodomycosis
4.Spherule w/ endospores (no yeast form):-Coccidiodomycosis
5.Skin and bone dissemination of fungus :-Blastomycosis
6.Intracellular fungal growth (inside macrophages) :-Histoplasmosis
7.Dimorphic fungal forms in cold? in heat? :-
cold = mold, heat = yeast (except coccidiodomyc->spherule)
8.San Joaquin valley, SW united states :-coccidiodomycosis
9.Latin America fungus aracoccidiodomycosis
10.Cutaneous fungal infxn, "spaghetti n meatballs" on KOH prep :-
Tinea versacolor (caused by Malassezia furfur)
11.What 3 fungi cause tinea pedis/cruris/corporis/captis?
Microsporum, Trichophyton, Epidermophyton MOLD FORMS ONLY...don't form yeast!
12.V shaped septate hyphae :-Aspergillus (A<-->V)
13.Narrow based unequal budding :-Cryptococcus neoformans
14.Pseudohyphae + Germ tubes of Candida are at what temps?:-
Pseudohyphae= 20C Germ Tubes= 37C (body temp)
15.L shaped hyphae :-Mucor/Rhizopus species
16.Allergic bronchopulmonary rxn after inhalation of what fungus?:-
Aspergillus
1.IL-1 Secreted by macrophages. Causes acute inflammation (1 = alpha)A = acute inflammation (Increase pg), L = Leukocytosis = (activate with chemokines)F= fever, A = adhesion molecules are put on endothelial cells
2.IL-2 Secreted by Th cells. Stimulates growth of Th and CTL cells.
3.IBD is caused by - due to a deficiency in (IBD) = T cell dysregulation following IL-2 deficiency
4.Drugs against IL-2. What are they called, function and uses Basiliximab, daclizumab (transplantation) anti-IL-2 monoclonal antibodies, Cylcosporine = T cell response blocker (decreases IL-2) = transplantation, rheumatoid arthritis
5.IL-3 Secreted by activated T cells. Supports the growth and differentiation of bone marrow stem cells, has a function similar to GM-CSF
6.IL-4 Secreted by Th2 cells. Promotes growth of B cells. Enhances class switching to IgE and IgG. (B means 2 in order = 4 Equals 2 in order) B cell + 2(Th2) = (IgEquals) IL4.
7.IL-5 Secreted by Th2 cells. Promotes differentiation of B cells. Enhances class switching to IgA. Stimulates production of acute-phase reactants and eosinophils (Give the high-five for the person who got an AcE) = IgA, Eosinophil
8.IL-6 secreted by Th cells and macrophages. Stimulates production of acute phase reactants and immunoglobulins. (Sick with a fever at 6).
9.Fever is caused by 3 pyrogens: TNF-alpha, IL-1, IL-6
10.IL-8 (CXCL8): Secreted by macrophages. "What I 8 is Neutritious. (Attract neutrophils via chemotaxis)
11.IL-10 :Secreted by regulatory T cells. inhibits activation of activated T cells.
12.IL-12 :Secreted by B cells and macrophages. Activates natural killer cells and Th1 cells. (The 12V bulb on macrophage wants TELLs 1 helper (TH1) and 2 killers (CTL and NK) to produce IFN-gamma (1 + 2= gamma = 3 by order).
13.Decrease in IFN-gamma caues Increased infections by intracellular microbes such as listeria monocytogenes and mycobacteria
14.IFN gamma: Secreted by Th1 cells. Stimulates macrophages. Mediates septic schok, causes leukocyte recruitment, vascular leak
15.Helper T cells :CD4, TCR, CD3, CD28, CD40L
16.Cytotoxic T cells :CD8, TCR, CD3
17.B cells :IgM, B7, CD19, CD20, CD21, CD40, MHC II
18.Which Cell surface proteins is the receptor for EBV? CD21
19.Macrophages MHC II, B7, CD40, CD14, Receptors for Fc and C3b
20.NK Receptors for MHC1, CD16 (binds Fc of IgG), CD56,
21.All cells except RBC MHC1
🚦🚦WARTS $ HPV TYPES🚦🚦
🚦DEEP PLANTAR/PALMAR(MYRMECIA) WART- HPV 1(MOST COMMON),2,4,60
🚦MOSAIC WART-2
🚦COMMON WART/VERRUCA VULGARIS(MC)- HPV 2(MC),4>27,29
🚦PLANE WART- HPV 3,10>28,41(RISK OF SQUAMOUS CELL CARCINOMA),49
🚦EPIDERMODYSPLASIA VERRUCIFORMIS-HPV 5,8(BOTH R RISK OF SCC)>9,12,14(RISK OF SCC),15,17,19,20(RISK OF SCC),25,36,38,47,50,51
🚦LARYNGEAL PAPILLOMA-HPV 6,11,30(LARYNGEAL CARCINOMA)
🚦ANOGENITAL WART/CONDYLOMA ACCUMINATA-HPV 6,11(LOW ONCOGENIC),30,42,43
16,18,31,33,35,39,40,45,52-60 ARE HIGH ONCOGENIC $ CAUSES INVASIVE TYPE OF CERVICAL/PENILE/VULVAL NEOPLASIA
🚦BUTCHERS WART-7
🚦BUSCHKE LOWENSTEIN TUMOR IN HPV 54
1) most common tumor of the pediatric lung ---metastases
( most commonly from
a) osteosarcoma
b) wilms tumour
2) most common benign tumor of the pediatric lung (both infants and children) is----- inflammatory myofibroblastic tumor
3)most common benign lung tumor in infants
-----pleuropulmonary blastoma
4) most common primary malignant tumor of the pediatric lung is----bronchial carcinoid
Recent Advances in the treatment of Rheumatoid Arthritis:
1. Biologicals
Anti TNF alpha drugs are:
i. Infliximab
ii. Golimumab
iii. Adalimumab
iv. Certolizumab
v. Etanercept
Side effects - (AIIMS Nov 2009)
i. Serious infections, including disseminated tuberculosis;
ii. Pancytopenia;
iii. Demyelinating disorders;
iv. exacerbation of congestive heart failure;
v. systemic lupus erythematosus
vi. hypersensitivity
vii. severe liver disease.
Transport or binding proteins in plasma
Ceruloplasmin: Binds & transport copper ion in plasma
Transferrin: Transports iron
Ferritin: Storage form of iron in tissues
Transthyretin (Prealbumin): Binds transports thyroxine (TBG) & retinol
Transcortin: Binds cortisol (cortisol binding globulin, CBG)
Haptoglobin: Binds extracorpuscular Hb (levels are in low in hemolytic anemias)
Hemopexin: Binds heme
Breast feeding: contraindicated
drugs BREAST :
B romocriptine/ B enzodiazepines
R adioactive isotopes/ R izatriptan
E rgotamine/ E thosuximide
A miodarone/ A mphetamines
S timulant laxatives/ S ex hormones
T etracycline/ T retinoin
RECOMBINANT CYTOKINES & THEIR CLINICAL USES
Filgrastim (G-CSF) -- Cyclic neutropenia, results best in Rx of Kostmann syndrome.
Sargramostim (GM-CSF) -- Cyclic neutropenia.
Oprelvekin (IL-11) -- Thrombocytopenia.
Aldesleukin (IL-2) -- RCC, Metastatic melanoma.
Alpha-interferon -- Hepatitis B & C, Kaposi sarcoma, Leukemias, Malignant melanoma.
Beta-interferon -- Multiple sclerosis.
Gamma-interferon -- Chronic granulomatous disease.
Classification of Some Causes of Lactic Acidosis (Cohen & Woods, 1976)
Type A Lactic Acidosis : Clinical Evidence of Inadequate Tissue Oxygen Delivery
- Anaerobic muscular activity (eg sprinting, generalised convulsions)
- Tissue hypoperfusion (eg shock -septic, cardiogenic or hypovolaemic; hypotension; cardiac arrest; acute heart failure; regional hypoperfusion esp mesenteric ischaemia; malaria8,9)
- Reduced tissue oxygen delivery or utilisation (eg hypoxaemia, carbon monoxide poisoning, severe anaemia)
Type B Lactic Acidosis: No Clinical Evidence of Inadequate Tissue Oxygen Delivery
type B1 : Associated with underlying diseases (eg ketoacidosis, leukaemia, lymphoma, AIDS)
type B2: Assoc with drugs & toxins (eg phenformin, cyanide, beta-agonists, methanol, nitroprusside infusion, ethanol intoxication in chronic alcoholics, anti-retroviral drugs)
type B3: Assoc with inborn errors of metabolism (eg congenital forms of lactic acidosis with various enzyme defects eg pyruvate dehydrogenase deficiency
Quick revision of some important ducts :
Bellini’s duct - Straight collecting tubules of the kidney.
Bartholin’s duct - the major duct of the sublingual gland.
Cystic duct - excretory duct of gall bladder.
Gartner’s duct - a remnant of Wolffian duct.
Mullerian duct - bilateral ducts in the embryo that form the uterus, vagina and fallopian tubes.
Wirsung’s duct - pancreatic duct.
Santorini’s duct - accessory pancreatic duct.
Wharton’s duct - duct of submandibular gland.
Vitelline duct - the narrow duct in the embryo that connects the yolk sac with the intestine.
Ducts of Rivinus - 5 to 15 ducts that drain the posterior portion of the sublingual gland.
Stensen’s duct - parotid duct.
Pecquet’s duct - Thoracic duct.
Hensen’s duct - ductus reunions.
Hoffman’s duct - pancreatic duct or Wirsung’s duct.
Bernard’s duct - Accessory pancreatic duct or Santorini’s duct.
De Quervain's Tenosynovitis
✅In this condition, inflammation involves the abductor pollicis longus and the extensor pollicis brevis as these tendons pass through a fibrous sheath at the radial styloid process.
✅The usual cause is repetitive twisting of the wrist. It may occur in pregnancy, and it also occurs in mothers who hold their babies with the thumb outstretched.
✅Patients experience pain on grasping with their thumb, such as with pinching. Swelling and tenderness are often present over the radial styloid process.
✅The Finkelstein sign is positive, which is elicited by having the patient place the thumb in the palm and close the fingers over it.
✅The wrist is then ulnarly deviated, resulting in pain over the involved tendon sheath in the area of the radial styloid. ✅Treatment consists initially of splinting the wrist and an NSAID.
✅When severe or refractory to conservative treatment, glucocorticoid injections can be very effective.
Disorders Associated with Hypertrophic Osteoarthropathy
Pulmonary
Bronchogenic carcinoma and other neoplasms
Bronchogenic carcinoma and other neoplasms
Lung abscesses, empyema, bronchiectasisChronic interstitial pneumonitisCystic fibrosis
Chronic obstructive lung disease
Sarcoidosis
Gastrointestinal
Inflammatory bowel disease
Sprue
Neoplasms: esophagus, liver,
bowel
Cardiovascular
Cyanotic congenital heart disease
Subacute bacterial endocarditis
Infected arterial graftsa
Aortic aneurysmb
Aneurysm of major extremity arterya
Patent ductus arteriosusb
Arteriovenous fistula of major extremity vessela
Thyroid (thyroid acropachy)
Hyperthyroidism (Graves' disease
Pharmacologic Agents Effective for Treatment of Fibromyalgia
Antidepressants: balanced serotonin:norepinephrine reuptake inhibition
Amitryptiline
Duloxetinea
Milnaciprana
Anticonvulsants: ligands of the alpha-2-delta subunit of voltage-gated calcium channels
Gabapentin
Pregabalina
CEPHALOSPORINS
These are ß-lactam antibiotics having 7-aminocephalosporanic acid nucleus, classified into 5 generations of drugs.
None of the cephalosporins are active against-
Enterococci (E.fecalis)
Listeria monocytogenes [DOC is ampicillin (not amoxycillin), sulphonamides (in case of penicillin resistance)]
Legionella
MRSA
[Mn: ELLM, as in 'elm' trees]
Most cephalosporins are excreted via kidney through tubular secretion, except Ceftriaxone & Cefoperazone (3rd generation) which are secreted in bile.
1st Generation:
✏ None of the cephalosporins are as effective as 1st gen. against gram +ve organisms (esp. cocci).
✏ Cephazolin is the DOC for Sx prophylaxis.✅
▶ Oral- cePHAlexin, cePHAradine, ceFAdroxil
▶ Parenteral- ceFAzolin, cePHAlothin
[Mn: 'Fa', 'Pha', in name/ having 'A' after 'cef-' (except- Cefaclor, 2nd gen.)]
2nd Generation:
Spectrum is extended to include H.influenzae.
Subgroup cefamycins (ceFOXitin, ceFOTetan, cefMETazole) are effective against Bacteroides fragilis.
✏ Cefuroxime attains higher CSF levels than other 2nd gen. cephalosporins.
▶ Oral- ceFAClor, cefPROzil, ceFURoxime axetil, loraCARbef
▶ Parenteral- ceFURoxime, ceFOXitin, ceFOTetan, cefMETazole
[Mn: Fur Fox Met Car Pro & Fot FACe]
3rd Generation:
✏ Spectrum is extended to include Enterobacteriacea & Pseudomonas.
✏ Penetrate BBB except ceFOperazone & ceFIxime.
✏ Ceftizoxime is most active against B.fragilis.
✏ Ceftazidime is DOC for melioidiosis by Burkholderia pseudomallei.
✏ Anti-pseudomonal are ceFTazidime & ceFOperazone (extended 3rd gen. drugs).
✏ Ceftriaxone-
DOC for gonorrhoea, salmonellosis (including typhoid), E.coli sepsis, proteus, serratia, haemophilus & empirical therapy for bacterial meningitis.
As it passes through bile, it complexes with Ca++ present in bile & causes pseudolithiasis, so is C/I in cholelithiasis.
It has the longest plasma half-life.
✏ Active metabolite of cefotaxime is desacetyl-cefotaxime.
▶ Oral- ceFIxime, ceFDinir, ceFDitoren, ceFPodoxime proxetil, ceFTibuten
▶ Parenteral- ceFOtaxime, ceFOperazone, ceFTazidime, ceFTizoxime, ceFTriaxone, mOXalactam
[Mn: 'cef-' followed by a,e,i,o,u- optional, & then either d, p or t (except- mOXalactam)]
4th Generation:
✏ Spectrum same as extended 3rd gen. drugs.
✏ Advantage is; these are extremely resistant to bacterial hydrolysis.
✏ Not effective against anaerobes.
Parenteral- cefePIme, cefPIrome
[Mn: 'Pi' in their names]
5th Generation:
✏ Approved for Rx of community acquired pneumonia & MRSA infections.
Parenteral- ceftaROLine, ceftobipROLe
[Mn: 'cef-' followed by 'Rol' in their name]
Oral/Parenteral
Mnemonic- cefotaxime, ceftriaxone, cefuroxime & anything that start with 'cef-' or 'ceph-' & have 'tin', 'thin', 'z' or 'pi' in the name are parenteral, rest all are oral.
NOTE:-
Ceftazidime + aminoglycoside - Rx of choice for pseudomonas.
Disulfiram-like reaction & hypo-prothrombinaemia is seen with those that have methyl-thio-tetra-zole (MTT) side chain group. Seen with-
2nd gen.~ ceFAMandole, ceFOTetan, cefMETazole
3rd gen.~ ceFOperazone, mOXalactam
Neutropenia is seen with - ceFTazidime.
CNS penetration is good with-
3rd gen.~ ceFOtaxime, ceFTazidime, ceFTizoxime, ceFTriaxone
4th gen.~ cefiPIme
Others have poor CNS penetration.
A. Quarternary compounds -
propantheline,
oxyphenonium
Clidinium
Glycopyrrolate
B. Tertiary amines -
Dicyclomine
Valethamate
Pirenzepine
C. Vasoselective -
Oxybutynin
Tolterodine
Flavoxate
D. Drotaverine
All r anticholinergics except Drotaverine.
Drotaverine is nonanticholinergic smooth muscle antispasmodic. It inhibits PDE4 (selective for smooth muscle). So cAMP/cGMP increased.
Used in intestinal biliary renal n uterine spasm n IBS.
