Classifications

Important criterias & classifications in medical science:

1. Hall's criteria : Down's syndrome

2. Duke's criteria: Endocarditis/Heart failure

3. Butcher's criteria: Mesothelioma

4. Ann Arbours staging: Hodgkin's lymphoma & Non Hodgkin's lymphoma

5. Bismuth classification: tumors of hepatic ductal system

6. Nazer's Index: Wilsons disz

7. Paget's Index : Abruptio placentae

8. Quetlet index: BMI -wt in kg/ht in meter square

9. Ponderal Index: ht in cm/cube root of body wt in kgs

10. Broca's index : Ht in cms-100

11. Corpulence index : Actual wt/desired wt

12. Milan's crjteria: for liver transplant in HCC

13. Mayers n cottons grading system: Subglottic stenosis

14. Spalding's criteria: abdominal pregnancy

15. GCS/Ransons criteria/APACHE score: Pancreatitis

16. Enneking's staging : Bone tumors

17. Mc Donald's criteria: Multiple Sclerosis

18. Epworth's criteria : Sleep apnea

19. Framminghams criteria/Boston's criteria: CHF

20. Durie salmon system of staging: Multiple myeloma

21. Light's criteria: pleural effusion

22. GOLD's criteria :COPD

23. OKUDA staging : HCC

24. Child's Turcott pug score/MELD/PELD- Cirrhosis of liver

25. Mantrles criteria/Alvarado score: Appendicitis

26. Evan's stagng: Neuroblastoma

27. FAB: Leukemias

28. Glisson's staging: Prostrate

29. Robson's staging : RCC

30. NADA's criteria: ASD assesment of child for heart disz

31. Rye classification: Hodgkin's lymphoma

32. Chang staging: Medulloblastoma

33. Jackson's staging:Penile Carcinoma

34. Seddon's classification: Nerve injury n regeneration

35. Larren's classification: Gastric Ca

36. Neer's classification: supracondylar# femur

37. Gartland's classification: Supracondylar # Humerus

38. Amsel's criteria: bacterial vaginosis

39. Mallampati scoring: for intubation

40. Forrest classification: peptic ulcer bleed

41. Hess & Hunt Scale: subarachnoid hemorrhage

42. Duke staging : colorectal cancer

43. Rotterdam's criteria : Polycystic ovarian syndrome

44. LEEFORDT's classification : facial #

45. Well's criteria: pulmonary embolism

46. Rule of wallace/Rule of 9: Burns

47. Manson's classification: Radial head #

48. Stanford classification: Aortic dissection

49. Rockall scoring: adverse out come after GI bleed

50. Glasgow Blatch ford score : Upper GI bleed for medical intervention

2015 UPDATE- AHA CPR GUIDELINES

2015 UPDATE- AHA CPR GUIDELINES:
By Dr. Deepak Marwah

CHANGES FROM 2010:

●BASIC LIFE SUPPORT (BLS):

Compression rate is modified to a range of 100 to 120/min. (Should not exceed 120/min).

Compression depth for adults is modified to at least 2 inches (5 cm). (Should not exceed 2.4 inches (6 cm).

To allow full chest wall recoil after each compression, rescuers must avoid leaning on the chest between compressions.

Criteria for minimizing interruptions is clarified with a goal of chest compression fraction as high as possible, with a target of at least 60%.

For patients with ongoing CPR and an advanced airway in place, a simplified ventilation rate of 1 breath every 6 seconds (10 breaths per minute) is recommended.

For witnessed OHCA with a shockable rhythm, it may be reasonable to delay positive-pressure ventilation (PPV) by using a strategy of up to 3 cycles of 200 continuous compressions with passive oxygen insufflation and airway adjuncts.

●ADVANCE CARDIAC LIFE SUPPORT (ACLS):

Vasopressin has been removed from the Adult Cardiac Arrest Algorithm.

In intubated patients, failure to achieve an ETCO2 of greater than 10 mm Hg by waveform capnography after 20 minutes of CPR may be considered as one component of a multimodal approach to decide when to end resuscitation efforts, but should not be used in isolation.

Steroids as part of bundle with vasopressin and epinephrine may be administered in IHCA. Though routine use in not recommonded. 
(Steroids may provide some benefit when bundled with vasopressin and epinephrine in treating IHCA).

Initiation or continuation of lidocaine may be considered immediately after ROSC from VF/pulseless ventricular tachycardia (pVT) cardiac arrest.

Initiation or continuation of an oral or intravenous (IV) ß-blocker may be considered early after hospitalization from cardiac arrest due to VF/pVT.

●POST CARDIAC ARREST CARE:

Emergency coronary angiography is recommended for all patients with ST elevation and for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected.

All comatose adults patients with ROSC should have TTM (target temperature management), with a target temperature between 32 to 36 C selected and achieved, then maintained constantly for at least 24 hours. 
Actively preventing fever in comatose patients after TTM is reasonable.

Routine prehospital cooling of OHCA patients with rapid infusion of cold IV fluids after ROSC is not recommonded.

Avoid and immediately correct (systolic BP less than 90 mmHg, mean arterial pressure less than 65) during post cardiac arrest care.

Prognostication is now recommended no sooner than 72 hours after the completion of TTM; for those who do not have TTM, prognostication is not recommended any sooner than 72 hours after ROSC.

All patients who progress to brain death or circulatory death after initial cardiac arrest should be considered potential organ donors.

Fishes in Medicine

Fish
Fish Hook pattern: Capillary arrangement in hemangiopericytoma
Fish Hook bladder: BPH
Fish Mouth: Cushing's
Fish Mouthed stenosis: MS (Also button hole)
Codfish vertebra: Osteoporosis
Fish Mouth vertebra: Sickle cell anemia
Fish Mouth/shark mouth valve: Ileo ceacal
Fish Tailing: Single edge stab injury
Fish net appearance: Pemphigus vulgaris on IF
Fish like skin: Ichthyosis vulgaris
Fish In stream appearance: V.cholera
School of red fish: H.ducreyi
Fish Tapeworm: Diphyllobothrium latum

MRI T1

5 things hyperintense on T1 MRI

1. Fat (hyperintense both on T1 & T2)
2. Blood products
3. Gadolinium
4. Melanin
5. proteinicious substance

IPC sections

‪#‎FORENSIC‬ MEDICINE
2)OFFENCES RELATED TO CAUSING HURT INCLUDES (Sections 319 to 338)
Sec 319 IPC It defines hurt. Whoever causes bodily pain, disease or infirmity is said to cause hurt.
Sec 320 IPC This section designates grievous hurt.

Sec 321 IPC This section defines the term “voluntarily causing hurt”. If an act is done with the intention to cause hurt or with the knowledge that, the act is likely to cause hurt to a person then, the act amounts to “voluntarily causing hurt”.

Sec 322 IPC This section defines the term “Voluntarily causing grievous hurt”. If an act done with intention to cause grievous hurt or done with the knowledge that, the act is likely to cause grievous hurt and if actually grievous hurt is caused then, it amounts to voluntary causation of grievous hurt.

Sec 323 IPC It describes the punishment for voluntarily causing hurt, which may be imprisonment of either description which may extend up to one year and/or fine which may extend up to one thousand rupees. Exception—as provided under section 334.

Sec 324 IPC As per this section, punishment for voluntarily causing hurt by dangerous weapons or means shall be imprisonment of either description for a term which may extend up to a period of three years and or fine. Exception—as provided under section 334 IPC.

Sec 325 IPC Punishment for voluntarily causing grievous hurt shall be imprisonment of either description for a term which may extend up to seven years and also with liability to be fined. Exception—as provided under section 335 IPC.

Sec 326 IPC Punishment for causing grievous hurt by dangerous weapons or means shall be imprisonment for life or imprisonment of either description for a term which may extend up to ten years with also liability to be fined. Exception—as provided under section 335 IPC.

Sec 327 IPC Punishment for causing hurt to extort property or to constrain to an illegal act shall be imprisonment of either description for a term which may extend to ten years with or without fine.

Sec 328 IPC Punishment for causing hurt by means of poison, etc. with intent to commit an offence shall be imprisonment of either description for a term which may extend to ten years with or without fine.

Sec 329 IPC Punishment for voluntarily causing grievous hurt to extort property, etc. or to constrain to an illegal act shall be imprisonment for life or imprisonment of either term which may extend up to 10 years, with liability to be fined also.

Sec 330 IPC Punishment for voluntarily causing hurt to extort or to compel restoration of property shall be imprisonment of either description for a term which may extend to seven years with or without fine.

Sec 331 IPC Punishment for voluntarily causing grievous hurt to extort confession or to compel restoration of property shall be imprisonment of either description for a term which may extend to ten years with or without fine.

Sec 332 IPC Punishment for voluntarily causing hurt to deter public servant from his duty, shall be imprisonment of either description for a term which may extend to three years and or fine.

Sec 333 IPC Punishment for voluntarily causing grievous hurt to deter public servant from his duty, shall be imprisonment of either description for a term which may extend to ten years with or without fine.

Sec 334 IPC Punishment for voluntarily causing hurt on grave and sudden provocation without knowledge or intent to cause hurt to any person other than the person giving the provocation, shall be imprisonment of either description for a term which may extend to one month and or fine up to five hundred rupees.

Sec 335 IPC Punishment for causing grievous hurt on grave and sudden provocation shall be imprisonment of either description for a term which may extend to four years and or fine up to two thousand rupees.

Sec 336 IPC An act endangering life or personal safety of others if done rashly or negligently shall be punished with imprisonment of either description for a term which may extend to three months and or fine which may extend to two hundred and fifty rupees.

Sec 337 IPC Causing hurt by act endangering life or personal safety of others if done rashly or negligently, shall be punished with imprisonment of either description for a term which may extend to six months and of fine which may extend to five hundred rupees.

Sec 338 IPC Punishment for causing grievous hurt by rash and negligent act endangering life or personal safety of others shall be imprisonment of either description for a term which may extend to 2 years and or fine which may extend to one thousand rupees.

VITAMIN DEFICIENCIES In Different Conditions

VITAMIN DEFICIENCIES In Different
Conditions::::

1■■Alcoholics===Folate and thiamine.
2■■Smoking===Vitamin C due to used up
by FR in smoke.
3■■New born===Vitamin K due to sterile
gut
Bcz MC source of Vitamin K is gut
bacteria.
4■■Hospitalized Pts===Vitamin
K>>>Biotin
Bcz of antibiotics use that kills gut
bacteria
5■■Renal Failure ===Vitamin D.
Due to failure of 1 alpha hydroxylation.
6■■Rice as staple diet===B1 Deficiency
That's why it has been enriched with B1
in some countries
7■■Perniciuos anemia===Autoimmune
atrophic gastritis===B--12 deficiency.
8■■Colostrum (Breast milk upto 4
days)=== deficient in Vitamin D.
9■■Breast milk=== deficient in D ,K, fluoride and
pantothenic acid (Cpsp key).
10■■Goat milk === deficient in Vitamin
B6 ,Folate .
11■■Cow milk === deficient in Vitamin A
,C ,D.
12■■Post menopauseal wome===
deficient in vitamin D (400 IU daily intake
recommended ).
13■■Women strict vegetarian ===B12
DEFICIENCY in her and her baby if
pregnant or non.
14■■Pregnant lady === Folate deficiency
bcz of its more excretion due to increased
GFR
And Fetal tissue growth consumption.
15■■Pregnant lady with alcohol
consumption ===MC Vitamin Deficiency
===Folate.
Increased NTDs risk.
16■■People having just maize their Staple
diet===B3 NIACIN deficiency ===risk of
PELLAGRA 3D diarrhea dementia
dermatitis.
17■■Celiac disease involves ===Jejunum
mostly===So Folate deficiency.
18■■Crohns disease ===Involves ILEUM
===so B12 deficiency occur.
19■■Terminal ileal resection ===B12
&Bile salts deficiency === osmotic
diarrhea and increased water loss and bile
salts (Ganong).
20■■Cystic Fibrosis ===ADEK fat soluble
vitamins deficiency
21■■Total pancreatectomy === ADEK
DEFICIENCY.
22■■Alcoholics==MC deficiency of Mg.

Mnemonics

Microbiology Mnemonics

Meningitis: most common organisms NHS:
Neisseria meningitidis
Hemophilus Influenzae
Streptococcus pneumonia
·The cause of the most Severe meningitis isStreptococcus.
· Note: NHS is an acronym for National Health Service in several countries.

Syphilis vs. H. ducreyi (chancroid): which ulcer is painful
"In du-crey-i, you do cry (because it is painful)":
In H. ducreyi, the ulcer is painful, in syphilis the ulcer is painless.

Diphtheria toxin properties ABCDEF:
A/B-type toxin. Made by
Corynebacterium diphtheriae, which binds to
EF-2 (elongation factor 2).

RNA viruses: negative stranded "Always Bring
Polymerase Or Fail Replication":
Arena
Bunya
Paramyxo
Orthomyxo
Filo
Rhabdo
· Note: Negative RNA viruses need there own polymerase.

Picorna viridae: members PEECoRnA (Picorna is
pronounced 'pee-corna')
Poliovirus
Echovirus
Enterovirus
Coronavirus
"R'novirus" (Rhinovirus)
Hepatitis A

Streptococcus pneumoniae: diseases causedCOMPS:
Conjunctivitis
Otitis media
Meningitis
Pneumonia
Sinusitis

Catalase positive organims SPACE:
Staphylococcus aureus
Pseudomonas
Aspergillus
Candida
Enterobacter

Urease positive organisms PUNCH:
Proteus (leads to alkaline urine)
Ureaplasma (renal calculi)
Nocardia
Cryptoccocus (the fungus)
Helicobacter pylori

Vaccines: types STARK:
Subunit
Toxoid
Attenuated [live]
Recombinant
Killed [inactivated]

AIDS pathogens (T-cell suppression) worth knowing "The
Major Pathogens Concerning Complete T-Cell
Collapse":
Toxoplasma gondii
M. avium intracellulare
Pneumocystis carinii
Candida albicans
Cryptococcus neoformans
Tuberculosis
CMV
Cryptosporidium parvum

Tetanus: treatment for infection SAD RAT:
Sedation
Antitoxin
Debridement
Relaxant
Antibiotic
Tracheostomy

Placenta-crossing organisms/ antenatal InfectionsSTARCH:
Syphilis
Toxoplasmosis
AIDS (HIV)
Rubella
CMV
Herpes/ Hepatitis

Typhus: Epidemic Typhus: etiologic agent, vectorePidemic
typhus:
Etiological agent: Rickettsia Prowazekii.
Vector: Pediculus corporis (human body louse).
· This is in contrast to Endemic typhus.

Capsulated bacteria "Some Bacteria Have
An Effective Paste Surrounding Membrane Yielding
Pseudo Fort, Bypassing Killing":
Strep pneumonia
Bacteroides
H. influenza
Anthrax (B. anthracis)
E. coli
Pasteurella
Salmonella
Menigitidis (N. Menigitidis)
Yersinia pestis
Pseudomonas
Francisella
Brucella
Klebsiella

Hepatitis: transmission routes "Vowels arebowels":
Hepatitis A and E transmitted by fecal-oralroute.

Capsulated microbes "Some Nasty Killers
Have Some Capsule Protection":
Streptococcus pneumoniae
Neisseria meningitidis
Klebsiella pnemoniae
Haemophilus influenzae
Salmonella typhi
Cryptococcus neoformans
Pseudomanas aerigenosa

Pneumonia: causes: gram negative vs. gram positive Gram Negatives
(eg coliforms) are responsible mainly for Nosocomial pneumonia.
Gram positives (eg strep pneumonia, staph) are thus more responsible for
community acquired pneumonia.

Influenza infection: clinical manifestations"Having
Flu Symptoms Can Make Moaning Children
A Nightmare":
Headache
Fever
Sore throat
Chills
Myalgias
Malaise
Cough
Anorexia
Nasal congestion

UTI-causing microorganisms KEEPS:
Klebsiella
Enterococcus faecalis/ Enterobacter cloacae
E. coli
Pseudomonas aeroginosa/ Proteus mirabilis
Staphylococcus saprophyticcus/ Serratia marcescens

Psedomonas aeruginosa: features AERUGINOSA:
Aerobic
Exotoxin A
Rod/ Resistance
UTIs, burns, injuries
Green-blue dressings
Iron-containing lesions
Negative gram
Odor of grapes
Slime capsule sometimes (in CF pt)
Adherin pili

Toxoplasma gondii: manifestations "My Cat Eats
Mice":
Mononucleosis-like illness
Chorioretinits/ Congenital infection
Encephalitis
Myocarditis

Chlamydia: elementary vs. initial body locationElementary:
Extracellular
Initial: Intracellular

Trypanosoma brucei: disease caused "I went on aTRYP
to AFRICA":
TRYPanosoma brucei causes AFRICAn sleeping sickness

RNA enveloped viruses FORT ABC, Puerto Rico:
Flavivirus/ Filo
Orthomyxo
Retro
Toga
Arena
Bunya
Corona
Paramyxo
Rhabdo

Teratogens: placenta-crossing organismsToRCHeS:
Toxoplasma
Rubella
CMV
Herpes simplex, Herpes zoster (varicella), Hepatitis B,C,E
Syphilis
· Alternatively: TORCHES: with Others (parvo, listeria), add HIV
to H's, Enteroviruses.

E. coli: major subtypes, key point of each "HIT by E.
coli outbreak":
EnteroHemorrhagic:
· HUS from Hamburgers
EnteroInvasive:
· Immune-mediated Inflammation
EnteroToxigenic:
· Traveller's diarrhea

Obligate anaerobes: members worth knowingABC:
Actinomyces
Bacteroides
Clostridium

Common cold: viral causes "Common cold (acute infectious
rhinitis, coryza) is PRIMArily caused by":
Paramyxoviruses
Rhinoviruses
Influenza viruses
Myxoviruses
Adenoviruses

Streptococcus pyogenes: diseases causedNIPPLES:
Necrotising fasciitis and myositis
Impetigo
Pharyngitis
Pneumonia
Lymphangitis
Erysipelas and cellulitis
Scarlet fever/ Streptococcal TSS

Picornavirus: features PICORNAvirus:
Positive sense
ICOsahedral
RNAvirus

Neisseria: fermentation of N. gonorrhoeae vs. N. meningitidis
Gonorrhoeae: Glucose fermenter only.
MeninGitidis: Maltose and Glucose fermenter.
· Maltose fermentation is a useful property to know, since it's the classic test
to distinguish the Neisseria types.

RNA viruses: negative stranded "OrthodoxRhabbi's
Party Around Fine Bunnies":
Orthomyxo
Rhabdo
Paramyxo
Arena
Filo
Bunya

RNA viruses: positive stranded "Pico Called 
Flavio To Return Renzo's Corona":
Picorna
Calici
Flavi
Toga
Retro
Reo
Corona

Endocarditis: lab results suggesting it "High Tech
Lab Results Point At Endocarditis":
Hematuria
Thrombocytopenia
Leukocytosis, -penia
Red blood cell casta
Proteinuria
Anemia
Elevated ESR

Endocarditis: causes of culture negative endocarditis "With
Negative Tests, Investigators Should Focus 
Attention Somewhere Meaningful":
Wrong diagnosis
Noninfectious endocarditis
Timing (cultures drawn at end of chronic course)
obligate Intracellular organisms
Slow growing fastidious organisms
Fungal infection
Antibiotic used previously
Subacute right-sided endocarditis
Mural endocarditis

Endocarditis: indications for surgery PUS RIVER:
Prosthetic valve endocarditis (most cases)
Uncontrolled infection
Supporative local complications with conduction abnormalities
Resection of mycotic aneurysm
Ineffective antimicrobial therapy (eg Vs fungi)
Valvular damage (significant)
Embolization (repeated systemic)
Refractory congestive heart failure

Meningitis: risk factors "Can Induce Severe
Attacks Of Head PAINS":
Cancer
Immunocompromised state
Sinusitis
Age extremes
Otitis
Head trauma
Parameningeal infection
Alcoholism
Infections (systemic, esp. respiratory)
Neurosurgical procedures
Splenectomy

HIV infection: high-risk groups HIV:
Homosexuals/ Hemophiliacs
IVdrug abusers

Trichomaniasis: features · 5 F's:
Flagella
Frothy discharge
Fishy odor (sometimes)
Fornication (STD)
Flagyl (metronidazole) Rx

Nematodes: ones spreading by egg ingestion "ATE eggs":
Ascaris Lumbricoides
Trichuris trichuira
Enterobius vermicularis
spread by ingestion of eggs (vs skin invasion or insect bite)

Food poisoning: bugs inducing "EatingContaminated
Stuff Causes Very Big Smelly Vomit":
E. coli O157-H7 [undercooked meat, esp. hamburgers]
Clostridium botulinum [canned foods]
Salmonella [poultry, meat, eggs]
Vibrio parahaemolyticus [seafood]
Bacillus cereus [reheated rice]
Staphylococcus aureus [meats, mayo, custard]
Clostridium perfringens [reheated meat]
Vibrio vulnificus [seafood]

B19 virus: at-risk groups B19 affects 3 B's:
Babies (5th disease, infectiousum erythematosa)
Black Bleeders (sickle cell anemics - anaplastic anemic crisis)
Bearing Babies [pregnant women] (hydrops fetalis)

IgA protease-producing bacteria "Nice Strip ofHam":
Neisseria
Streptococcus pneumonia
Haemophilus influenza

Hemophilius: culture requirements Read Hemophilus as "HemoFive":
· Needs Heme with Factors Fiveand Ten.

DNA viruses: morphology rule of thumb DNA:
Double-stranded
Nuclear replication
'Anhedral symmetry
· Rule breakers: pox (cytoplasmic), parvo (single-stranded).

Streptococcus pyogenes: virulence factorsSMASHED:
Streptolysins
M protein
Anti-C5a peptidase
Streptokinase
Hyaluronidase
Exotoxin
DNAses

Gram positive stain Gram Positives
Stain Purple (violet-blue)
because of their thick Peptidoglycan layer

Gram+: bacterial cell wall · Gram+ has:
+hick pepidoglycan layer.
+eichoic acid in wall.

Listeria: motility Istanbul sounds like Listambul =
list + tumble.
Listeria has tumblingmotility.

Staphylococci: novobiocin test to distinguish coagulase negative
staphylococci Staph epidermidis stays away from the novobiocin
disc like an epidemic.
· Therefore, epidermidis is sensitive to novobiocin.
Staph saprophyticus, much friendlier, comes up to the disc and says, "'sap?'"
[short for "whassup?", ie "what's up"].
· Therefore, saprophyticus is novobiocin resistant.

Acute post-streptococcal glomerulonephritis: classic presentation
"Sore throat, Face bloat, Pi$$ coke":
Sore throat: 1 week ago
Face bloat: facial edema
Pi$$ coke: coke-coloured urine
· Alternatively, short version: "Throat, bloat andcoke".

Streptococci: classification by hemolytic abilityGamma:
Garbage (no hemolytic activity).
Alpha: Almost (almost lyse, but incomplete).
Beta: Best (complete lysis).

Streptococci: Quellung reaction: positive sign, Strep type confirmed
"Quell-lung":
Quell: Capsules swell [+ve test].
Lung: S. pnuemonia [type confirmed].
· You get pneumonia in your lung.

E. coli: diseases caused in presence of virulence factors 
DUNG:
Diarrhea
UTI
Neonatal meningitis
Gram negative sepsis
· Dung, since contract E. coli from dung-contaminated water.

Streptococcus pyrogenes: antibody SPAM:
Streptococcus Pyogenes: Antibody to Mprotein.

Staphylococcus aureus: diseases caused SOFT PAINS:
Skin infections
Osteomyelitis
Food poisoning
Toxic shock syndrome
Pneumonia
Acute endocarditis
Infective arthritis
Necrotizing fasciitis
Sepsis

Gram staining: mechanism "Murein gets the red out" [Allusion
to an old eye-wash slogan]:
Peptidoglycan (aka murein) remains purple during Gram staining. The Gram
negatives, devoid of murein, are red.
Thus, murein prevents redness and are purple (positive).

Entameoba histolytica: disease caused, actionEntAmoeba
causes Amoebic dysEntery.
Action: histo (cell) lytic (burst), so it bursts cells.

Clostridium difficile: disease caused "Difficult to
be in a Closet with someone having explosive foul smelling
diarrhea, because it would smell and there would beno air in there.
Clostridium Difficile causes explosive foul smelling diarrhea
and is an anaeorbe (no air).

Pneumonia: acute pneumonia infiltrates from different causes
"Pyrogenic=PMN, Miscellaneous=Mononuclear":
Acute pneumonia caused by Pyogenic bacteria: PMN infiltrate.
Acute pneumonia caused by Miscellaneous microbes: Mononuclear
infiltrate.

Klebsiella details You tell the patient: "Get UPS you
fat alcoholic":
UTI
Pneumonia
Sepsis
Fat capsule
Get up=nonmotile since no flagella.
Alcoholic=commonly seen in alcoholicand nosocomial patients.

Pseudomonas details · See diagram of patient.
Patient: bug commonly infects nosocomial.
Oxygen tank: oxidase positive.
IV bag: has glucose and lactose, so its OK to give because its a nonlactose
fermenter.
Why giving oxygen? Because it commonly caused pneumonia.
IV in the arm: supposed to signify sepsis.
The foley: UTI.
Burn on his foot: can infect burns.

Leprosy: early signs diagnostic criteria "LEProsy":
Loss of sensation in affected skin/ Loss of function (paralysis)
Enlargement of affected superficial nerves (tender too)
Positive identification of M. leprae under microscope

Kidney transplant virus "Borrowed Kidney":
BKvirus is associated with kidney transplants.

Endotoxin features ENDOTOXIN:
Endothelial cells/ Edema
Negative (gram- bacteria)
DIC/ Death
Outer membrane
TNF
O-antigen
X-tremely heat stable
IL-1
Nitric oxide/ Neutrophil chemotaxis

Mycobacterium tuberculosis: culture identification "Rough,
Tough, Buff":
Rough: colony isn't smooth but rough like breadcrumbs.
Tough: colony stuck to plate well, and tough to remove.
Buff: buff is a color, a cream/coffee shade.

Vibrio: motility "Vibrio Vibrates":
Vibrio is a genus of actively motile bacteria.

           -  Regards.
               AdminMicrobiology Mnemonics

 

 

Meningitis: most common organisms NHS:
Neisseria meningitidis
Hemophilus Influenzae
Streptococcus pneumonia
·The cause of the most Severe meningitis isStreptococcus.
· Note: NHS is an acronym for National Health Service in several countries.

Syphilis vs. H. ducreyi (chancroid): which ulcer is painful
"In du-crey-i, you do cry (because it is painful)":
In H. ducreyi, the ulcer is painful, in syphilis the ulcer is painless.

Diphtheria toxin properties ABCDEF:
A/B-type toxin. Made by
Corynebacterium diphtheriae, which binds to
EF-2 (elongation factor 2).

RNA viruses: negative stranded "Always Bring
Polymerase Or Fail Replication":
Arena
Bunya
Paramyxo
Orthomyxo
Filo
Rhabdo
· Note: Negative RNA viruses need there own polymerase.

Picorna viridae: members PEECoRnA (Picorna is
pronounced 'pee-corna')
Poliovirus
Echovirus
Enterovirus
Coronavirus
"R'novirus" (Rhinovirus)
Hepatitis A

Streptococcus pneumoniae: diseases causedCOMPS:
Conjunctivitis
Otitis media
Meningitis
Pneumonia
Sinusitis

Catalase positive organims SPACE:
Staphylococcus aureus
Pseudomonas
Aspergillus
Candida
Enterobacter

Urease positive organisms PUNCH:
Proteus (leads to alkaline urine)
Ureaplasma (renal calculi)
Nocardia
Cryptoccocus (the fungus)
Helicobacter pylori

Vaccines: types STARK:
Subunit
Toxoid
Attenuated [live]
Recombinant
Killed [inactivated]

AIDS pathogens (T-cell suppression) worth knowing "The
Major Pathogens Concerning Complete T-Cell
Collapse":
Toxoplasma gondii
M. avium intracellulare
Pneumocystis carinii
Candida albicans
Cryptococcus neoformans
Tuberculosis
CMV
Cryptosporidium parvum

Tetanus: treatment for infection SAD RAT:
Sedation
Antitoxin
Debridement
Relaxant
Antibiotic
Tracheostomy

Placenta-crossing organisms/ antenatal InfectionsSTARCH:
Syphilis
Toxoplasmosis
AIDS (HIV)
Rubella
CMV
Herpes/ Hepatitis

Typhus: Epidemic Typhus: etiologic agent, vectorePidemic
typhus:
Etiological agent: Rickettsia Prowazekii.
Vector: Pediculus corporis (human body louse).
· This is in contrast to Endemic typhus.

Capsulated bacteria "Some Bacteria Have
An Effective Paste Surrounding Membrane Yielding
Pseudo Fort, Bypassing Killing":
Strep pneumonia
Bacteroides
H. influenza
Anthrax (B. anthracis)
E. coli
Pasteurella
Salmonella
Menigitidis (N. Menigitidis)
Yersinia pestis
Pseudomonas
Francisella
Brucella
Klebsiella

Hepatitis: transmission routes "Vowels arebowels":
Hepatitis A and E transmitted by fecal-oralroute.

Capsulated microbes "Some Nasty Killers
Have Some Capsule Protection":
Streptococcus pneumoniae
Neisseria meningitidis
Klebsiella pnemoniae
Haemophilus influenzae
Salmonella typhi
Cryptococcus neoformans
Pseudomanas aerigenosa

Pneumonia: causes: gram negative vs. gram positive Gram Negatives
(eg coliforms) are responsible mainly for Nosocomial pneumonia.
Gram positives (eg strep pneumonia, staph) are thus more responsible for
community acquired pneumonia.

Influenza infection: clinical manifestations"Having
Flu Symptoms Can Make Moaning Children
A Nightmare":
Headache
Fever
Sore throat
Chills
Myalgias
Malaise
Cough
Anorexia
Nasal congestion

UTI-causing microorganisms KEEPS:
Klebsiella
Enterococcus faecalis/ Enterobacter cloacae
E. coli
Pseudomonas aeroginosa/ Proteus mirabilis
Staphylococcus saprophyticcus/ Serratia marcescens

Psedomonas aeruginosa: features AERUGINOSA:
Aerobic
Exotoxin A
Rod/ Resistance
UTIs, burns, injuries
Green-blue dressings
Iron-containing lesions
Negative gram
Odor of grapes
Slime capsule sometimes (in CF pt)
Adherin pili

Toxoplasma gondii: manifestations "My Cat Eats
Mice":
Mononucleosis-like illness
Chorioretinits/ Congenital infection
Encephalitis
Myocarditis

Chlamydia: elementary vs. initial body locationElementary:
Extracellular
Initial: Intracellular

Trypanosoma brucei: disease caused "I went on aTRYP
to AFRICA":
TRYPanosoma brucei causes AFRICAn sleeping sickness

RNA enveloped viruses FORT ABC, Puerto Rico:
Flavivirus/ Filo
Orthomyxo
Retro
Toga
Arena
Bunya
Corona
Paramyxo
Rhabdo

Teratogens: placenta-crossing organismsToRCHeS:
Toxoplasma
Rubella
CMV
Herpes simplex, Herpes zoster (varicella), Hepatitis B,C,E
Syphilis
· Alternatively: TORCHES: with Others (parvo, listeria), add HIV
to H's, Enteroviruses.

E. coli: major subtypes, key point of each "HIT by E.
coli outbreak":
EnteroHemorrhagic:
· HUS from Hamburgers
EnteroInvasive:
· Immune-mediated Inflammation
EnteroToxigenic:
· Traveller's diarrhea

Obligate anaerobes: members worth knowingABC:
Actinomyces
Bacteroides
Clostridium

Common cold: viral causes "Common cold (acute infectious
rhinitis, coryza) is PRIMArily caused by":
Paramyxoviruses
Rhinoviruses
Influenza viruses
Myxoviruses
Adenoviruses

Streptococcus pyogenes: diseases causedNIPPLES:
Necrotising fasciitis and myositis
Impetigo
Pharyngitis
Pneumonia
Lymphangitis
Erysipelas and cellulitis
Scarlet fever/ Streptococcal TSS

Picornavirus: features PICORNAvirus:
Positive sense
ICOsahedral
RNAvirus

Neisseria: fermentation of N. gonorrhoeae vs. N. meningitidis
Gonorrhoeae: Glucose fermenter only.
MeninGitidis: Maltose and Glucose fermenter.
· Maltose fermentation is a useful property to know, since it's the classic test
to distinguish the Neisseria types.

RNA viruses: negative stranded "OrthodoxRhabbi's
Party Around Fine Bunnies":
Orthomyxo
Rhabdo
Paramyxo
Arena
Filo
Bunya

RNA viruses: positive stranded "Pico Called 
Flavio To Return Renzo's Corona":
Picorna
Calici
Flavi
Toga
Retro
Reo
Corona

Endocarditis: lab results suggesting it "High Tech
Lab Results Point At Endocarditis":
Hematuria
Thrombocytopenia
Leukocytosis, -penia
Red blood cell casta
Proteinuria
Anemia
Elevated ESR

Endocarditis: causes of culture negative endocarditis "With
Negative Tests, Investigators Should Focus 
Attention Somewhere Meaningful":
Wrong diagnosis
Noninfectious endocarditis
Timing (cultures drawn at end of chronic course)
obligate Intracellular organisms
Slow growing fastidious organisms
Fungal infection
Antibiotic used previously
Subacute right-sided endocarditis
Mural endocarditis

Endocarditis: indications for surgery PUS RIVER:
Prosthetic valve endocarditis (most cases)
Uncontrolled infection
Supporative local complications with conduction abnormalities
Resection of mycotic aneurysm
Ineffective antimicrobial therapy (eg Vs fungi)
Valvular damage (significant)
Embolization (repeated systemic)
Refractory congestive heart failure

Meningitis: risk factors "Can Induce Severe
Attacks Of Head PAINS":
Cancer
Immunocompromised state
Sinusitis
Age extremes
Otitis
Head trauma
Parameningeal infection
Alcoholism
Infections (systemic, esp. respiratory)
Neurosurgical procedures
Splenectomy

HIV infection: high-risk groups HIV:
Homosexuals/ Hemophiliacs
IVdrug abusers

Trichomaniasis: features · 5 F's:
Flagella
Frothy discharge
Fishy odor (sometimes)
Fornication (STD)
Flagyl (metronidazole) Rx

Nematodes: ones spreading by egg ingestion "ATE eggs":
Ascaris Lumbricoides
Trichuris trichuira
Enterobius vermicularis
spread by ingestion of eggs (vs skin invasion or insect bite)

Food poisoning: bugs inducing "EatingContaminated
Stuff Causes Very Big Smelly Vomit":
E. coli O157-H7 [undercooked meat, esp. hamburgers]
Clostridium botulinum [canned foods]
Salmonella [poultry, meat, eggs]
Vibrio parahaemolyticus [seafood]
Bacillus cereus [reheated rice]
Staphylococcus aureus [meats, mayo, custard]
Clostridium perfringens [reheated meat]
Vibrio vulnificus [seafood]

B19 virus: at-risk groups B19 affects 3 B's:
Babies (5th disease, infectiousum erythematosa)
Black Bleeders (sickle cell anemics - anaplastic anemic crisis)
Bearing Babies [pregnant women] (hydrops fetalis)

IgA protease-producing bacteria "Nice Strip ofHam":
Neisseria
Streptococcus pneumonia
Haemophilus influenza

Hemophilius: culture requirements Read Hemophilus as "HemoFive":
· Needs Heme with Factors Fiveand Ten.

DNA viruses: morphology rule of thumb DNA:
Double-stranded
Nuclear replication
'Anhedral symmetry
· Rule breakers: pox (cytoplasmic), parvo (single-stranded).

Streptococcus pyogenes: virulence factorsSMASHED:
Streptolysins
M protein
Anti-C5a peptidase
Streptokinase
Hyaluronidase
Exotoxin
DNAses

Gram positive stain Gram Positives
Stain Purple (violet-blue)
because of their thick Peptidoglycan layer

Gram+: bacterial cell wall · Gram+ has:
+hick pepidoglycan layer.
+eichoic acid in wall.

Listeria: motility Istanbul sounds like Listambul =
list + tumble.
Listeria has tumblingmotility.

Staphylococci: novobiocin test to distinguish coagulase negative
staphylococci Staph epidermidis stays away from the novobiocin
disc like an epidemic.
· Therefore, epidermidis is sensitive to novobiocin.
Staph saprophyticus, much friendlier, comes up to the disc and says, "'sap?'"
[short for "whassup?", ie "what's up"].
· Therefore, saprophyticus is novobiocin resistant.

Acute post-streptococcal glomerulonephritis: classic presentation
"Sore throat, Face bloat, Pi$$ coke":
Sore throat: 1 week ago
Face bloat: facial edema
Pi$$ coke: coke-coloured urine
· Alternatively, short version: "Throat, bloat andcoke".

Streptococci: classification by hemolytic abilityGamma:
Garbage (no hemolytic activity).
Alpha: Almost (almost lyse, but incomplete).
Beta: Best (complete lysis).

Streptococci: Quellung reaction: positive sign, Strep type confirmed
"Quell-lung":
Quell: Capsules swell [+ve test].
Lung: S. pnuemonia [type confirmed].
· You get pneumonia in your lung.

E. coli: diseases caused in presence of virulence factors 
DUNG:
Diarrhea
UTI
Neonatal meningitis
Gram negative sepsis
· Dung, since contract E. coli from dung-contaminated water.

Streptococcus pyrogenes: antibody SPAM:
Streptococcus Pyogenes: Antibody to Mprotein.

Staphylococcus aureus: diseases caused SOFT PAINS:
Skin infections
Osteomyelitis
Food poisoning
Toxic shock syndrome
Pneumonia
Acute endocarditis
Infective arthritis
Necrotizing fasciitis
Sepsis

Gram staining: mechanism "Murein gets the red out" [Allusion
to an old eye-wash slogan]:
Peptidoglycan (aka murein) remains purple during Gram staining. The Gram
negatives, devoid of murein, are red.
Thus, murein prevents redness and are purple (positive).

Entameoba histolytica: disease caused, actionEntAmoeba
causes Amoebic dysEntery.
Action: histo (cell) lytic (burst), so it bursts cells.

Clostridium difficile: disease caused "Difficult to
be in a Closet with someone having explosive foul smelling
diarrhea, because it would smell and there would beno air in there.
Clostridium Difficile causes explosive foul smelling diarrhea
and is an anaeorbe (no air).

Pneumonia: acute pneumonia infiltrates from different causes
"Pyrogenic=PMN, Miscellaneous=Mononuclear":
Acute pneumonia caused by Pyogenic bacteria: PMN infiltrate.
Acute pneumonia caused by Miscellaneous microbes: Mononuclear
infiltrate.

Klebsiella details You tell the patient: "Get UPS you
fat alcoholic":
UTI
Pneumonia
Sepsis
Fat capsule
Get up=nonmotile since no flagella.
Alcoholic=commonly seen in alcoholicand nosocomial patients.

Pseudomonas details · See diagram of patient.
Patient: bug commonly infects nosocomial.
Oxygen tank: oxidase positive.
IV bag: has glucose and lactose, so its OK to give because its a nonlactose
fermenter.
Why giving oxygen? Because it commonly caused pneumonia.
IV in the arm: supposed to signify sepsis.
The foley: UTI.
Burn on his foot: can infect burns.

Leprosy: early signs diagnostic criteria "LEProsy":
Loss of sensation in affected skin/ Loss of function (paralysis)
Enlargement of affected superficial nerves (tender too)
Positive identification of M. leprae under microscope

Kidney transplant virus "Borrowed Kidney":
BKvirus is associated with kidney transplants.

Endotoxin features ENDOTOXIN:
Endothelial cells/ Edema
Negative (gram- bacteria)
DIC/ Death
Outer membrane
TNF
O-antigen
X-tremely heat stable
IL-1
Nitric oxide/ Neutrophil chemotaxis

Mycobacterium tuberculosis: culture identification "Rough,
Tough, Buff":
Rough: colony isn't smooth but rough like breadcrumbs.
Tough: colony stuck to plate well, and tough to remove.
Buff: buff is a color, a cream/coffee shade.

Vibrio: motility "Vibrio Vibrates":
Vibrio is a genus of actively motile bacteria.

DKA

DIABETIC KETO ACIDOSIS is life threatening complication in diabetic patients who need insulin therapy. I stress again who needs insulin therapy.....
KETOACIDOSIS occurs more often in type I diabetic patients no matter how good is the compliance with the insulin therapy. One precipitating factor and the DKA happens. Contrary to this patients with type II Diabetes Mellitus develop DKA only either when they have insulin secreating islet beta cells exhausted so on insulin therapy or when the precipitation is either multifactorial or very intense.
The pathophysiology behind is the fact that although the total insulin released in type II DM is much less compared to type I DM but whatever insulin is released is in the portal system and directly reaches the site of ketogenesis i.e liver and thus prevents ketogenesis in the mitochondria of the hepatocytes while in type I most of the insulin injected in periphery hardly reach the portal system while being utilised in the periphery especially in precipitating situations for DKA like Ischemia(Cardiovascular, Cerebrovascular and peripheral vascular), infarction, inadequate insulin , pregnancy and drugs like cocain

Stones

URINARY BLADDER STONES

🔹Primary Bladder Stones - Develop in absence of any known functional, anatomic or infectious factors & DOES NOT necessarily imply that stones have formed de novo in the bladder. They usually come down from the kidney & get enlarged here. Ammonium acid urate, calcium oxalate, uric acid & calcium phosphate are the most common components of primary bladder calculi.

🔹Secondary Bladder Stones - Develop in concert with bladder outlet obstruction, infection, impaired bladder emptying or a foreign body. It is most common bladder stone encountered throughout the western world. Bladder calculi may arise de novo  within the bladder or may result from the maturation of stone nidi that migrate from the upper tracts & subsequently fail to be spontaneously voided. The frequent absence of calcium oxalate in the nucleus of most bladder stones further suggests AGAINST an upper tract origin.
✏Most bladder calculi are formed de novo within the bladder, but some initially may have formed within the kidney.
✏Most kidney stones that are small enough to pass through the ureters are also small enough to pass through a normally functioning bladder & an unobstructed urethra.
✏In older men with bladder stones composed of URIC ACID, the stone is most likely FORMED IN THE BLADDER.
✏Stones composed of CALCIUM OXALATE  are usually initially formed in the KIDNEY.
✏In adults, MC type of vesical stone (seen in >50% of cases) is composed of URIC ACID. A large percentage of bladder stones are radiolucent (uric acid).✔✔
✏Stone analysis frequently reveals ammonium urate, uric acid, or CALCIUM OXALATE stones.✔✔
✏VESICAL CALCULI maybe single or multiple, especially in the presence of bladder diverticula, and can be small or large enough to occupy the entire bladder. They range from soft to extremely hard, with surfaces ranging from smooth and faceted to jagged & spiculated ('JACK' STONES).
These JACKSTONES are typically either of URIC ACID (if they are formed in the BLADDER) or CALCIUM OXALATE (if they are FORMED IN THE KIDNEY & have descended from there).
📝Note: MC type of kidney stone is of Calcium oxalate & MC type of bladder stone is of Uric acid.

🌰GALL BLADDER STONES🌰
🔹Primary CBD Stone - Formed within the  biliary tract, associated with biliary stasis & infection. The are soft, friable, light-brown stones or sludge in the common bile duct.
🔹Secondary CBD Stone - Formed initially in the GB, they migrate through the cystic duct into CBD & are usually cholesterol stones.
✏Most gallstones pass out of the body unnoticed, some become lodged in the CBD.
✏A frequent site of gallstone impaction is the ampulla of Vater.
✏Blockage of common channel by gallstone can induce acute pancreatitis.
✏MC type of gallstone - Mixed (Overall), Pigment stones (India).
✏MCC of acute cholangitis is CBD stones (choledocholithiasis).

Melanoma

MELANOMA

Most agreessive malignant cutaneous tumor((epidermal melanocytes))

COMMON:::

MC in whites>blacks
MC type in dark skin-acral lentiginous
MC type-superficial spreading
LESS common-lentigo malignan/hutchinson melanotic freckle
LEAST common-acral lentiginous type

SEX:::
females-lentigomaligna
males-nodular

AGE:
old age-lentigo maligna(indolent lesion on face)
young age-nodular

SITES:::
head and neck-superficial spreading
mucosa-nodular
face-lentigo maligna
palms & soles-acral lentiginous
GIT-amelanotic melanoma

RISK FACTORS:::
UVL,albinism,naevus,xeroderma pigmentosa,h/o skin cancer

SUNEXPOSURE:::
Related-superficial spreading,lentigo maligna
unrelated-acral lentiginous

MALIGNANT:::
most-nodular
least-lentigomaligna

GROWTH:::
horizintal/radial-superficial spreading,lentigo maligna,acral lentigenous
vertical /deep spreading-nodular

CLINICAL FEATURES::: ABCDE
A-asymmetry
B-border irregularity
C-colour variation
D-diameter>6mm
E-elevation

☆☆☆NOTE☆☆☆

Earliear SUBUNGUAL MELANOMA was thought to be a type of acral lentigenous but now it is considered as superficial spreading type....it involves nail plate matrix(NOT NAL PLATE) called as HUTCHINSON SIGN

☀MC spread-lymphatics
☀MC site of metastasis-liver

☀PROGNOSIS:::CLARKES & BRESLOW

Single most imp prognostic factor-depth of invasion
BEST-lentigo maligna melanoma
BETER-superficial spreading
POOREST-nodular
WORST-amelanotic melanoma>>>>acral lentigenous

TUMOR MARKERS::
MELANIN-A
S 100
VIMENTIN
HMB 45
LDH
NOTE:: NEGATIVE FOR CYTOKERATIN 20

INVESTIGATION:::

excision biopsy
FNAC
U/S abdomen
chest X-ray
SLNB

RX:::
primary-wide exicision
LN 2°-regional block dissection
recurrent melanoma-MELPHALAN

MOST AGRESSIVE-nodular melanoma✔
MOST DANGEROUS-amelanotic melanoma

Credits :Dr.@nu

Fishes

MEDICINAL FISHES:

1.fish mouth vertebra-sickle cell anemia, homocystinuria

2.fish eye disease-LCAT deficiency

3.fish tank granuloma- mycobacteria marinum

4.school of fish appearance- h.ducreyi

5.fish in stream appearance- v.cholera

6.fishy smell in culture-proteus

7.fish hook bladder- BPH

8.rotten fish urine odour- trimethylaminuria

9.fish net pattern of corneal subepithelial deposit in- Reis bucker corneal dystrophy

10. Immunoflorescence fish net pattern- pemphigus vulgaris

11.skin looking like fishy scales- icthyosis

12.fish poor source of-carbohydrates

13 world most venomous animal-box jelly fish

14. mc fish poisoning- ciguatera

15. type of anemia caused by fish tapeworm- megaloblastic anemia

16 FISHer grading- SAH 

17. richest source of-vit A,D,proteins,ca,P,fluorides

18.good source of-Iron

19.world fisheries day-nov 21

20.valve with shark mouth appearance-ileocecal valve