Lipids

High TG --chylomicrons
High cholesterol --LDL
HIGH PHOSPOLIPDS-HDL
LOW PHOSPHOLIPIDS-chylomicrons
High lipid contains-chylomicrons
Low lipid contains-HDL
Low cholesterol -chylomicrons
Low TG -HDL
Lowest density-chylomicrons
Max density-HDL
Large size-chylomicrons
Small size-HDL
Max protein-HDL
Low protein-chylomicrons
Max electrophoresis mobility-HDL
Least mobility-- chylomicrons

MODY

The most common MODY type is HNF1 alpha. This is responsible for 70% of MODY.

The amount of insulin produced by the pancreas becomes less as the person gets older, and MODY develops during adolescence or the early twenties.

Glucokinase is the second type of MODY, and occurs when this gene (that aids the body in recognising blood glucose levels) malfunctions.

This type of MODY can be hard to identify, and symptoms can be particularly slow in manifesting themselves.

It is usually picked up during routine testing. When a person is pregnant, it is important to screen for it.

HNF4 - alpha is a less common form of MODY that is often diagnosed at a later stage. HNF1 - beta is a type of MODY associated with renal cysts.

PDX1 and IPF1 are the same type of MODY, and are incredibly rare, affecting only one UK family to date.

NeuroD1 is another rare type of MODY, affecting only two families in the UK. Little information is available about the rarer forms of MODY.

Ducts

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.

INDIA NEWBORN ACTION PLAN

🔹 Peri conceptional folic acid
🔹Administer corticosteroids in preterm labour and Antibiotics for PROM
🔹Delayed cord clamping and vit K at birth
🔹 care of healthy newborn by ASHA for 6 wks (42 days)
🔹 care of small/sick Newborn (like inj. Gentamicin to prevent sepsis to be given by ANM)
🔹 care beyond Newborn survival

- Screen for 4 Ds  i.e. Defects or birth defects, development delays, deficiency, diseases
- Follow up of SNCU babies by ASHA for 1 year and LBW babies for 2 year

Kindly correct previous one - LBW for 2 years

AMBIGUOUS LEUKEMIA

AMBIGUOUS LEUKEMIA

3 TYPES:

1) UNDIFFERENTIATED ACUTE LEUKEMIAS:
Lack morphologic or immunologic differentiating features;
Blasts cell express HLA-DR,CD34,CD38,TdT( terminal deoxynucleotidase) and CD7.

2) BILINEAL ACUTE LEUKEMIA:
Two populations of blasts expressing distinct lineage markers of myeloid or lymphoid origin or B- and T-cell lineage

3) BIPHENOTYPIC ACUTE LEUKEMIA:
Same Blast cell coexpress myeloid and lymphoid antigen both ..usually seen in BLAST CRISES OF CHRONIC MYELOID LEUKEMIA

Wilsons Disease

Wilson's disease is an autosomal recessive disorder characterised by excessive copper deposition in the tissues. Metabolic abnormalities include increased copper absorption from the small intestine and decreased hepatic copper excretion. Wilson's disease is caused by a defect in the ATP7B gene located on chromosome 13.

Features result from excessive copper deposition in the tissues, especially the brain, liver and cornea:
• liver: hepatitis, cirrhosis
• neurological: basal ganglia degeneration, speech and behavioural problems are often the first manifestations
• Kayser-Fleischer rings
• renal tubular acidosis
• haemolysis
• blue nails

Diagnosis
• reduced serum caeruloplasmin
• increased 24hr urinary copper excretion

HHV

HHV1 - HSV1 (Herpes Simplex Virus 1 commonly known as oral herpes)
HHV2 - HSV2 (Herpes Simplex Virus 2 commonly known as genital herpes)
HHV3 - VZV (Varicella Zoster Virus commonly known as chickenpox or shingles)
HHV4 - EBV (Ebstein Barr Virus commonly known as infectious mononucleosis [mono or glandular fever])
HHV5 - CMV (Cytomegolo Virus is the most common virus transmitted to a pregnant woman's unborn child)
HHV6 - Roseolovirus more commonly known as the 6th disease or Roseola Infantum
HHV7 - Similar to HHV6 (not yet classified)
HHV8 - A type of rhadinovirus known as the Kaposi's sarcoma-associated herpesvirus (KSHV

HLA

HLA diseases are mainly due to HLA A , HLA B, HLA-DR

HLA B-27

very popular mnemonic : PAIR from first Aid

P soriasis

A nkylosing spondylitis
I nflammatory bowel disease
R eiter’s syndrome.
………………………………………

HLA B-8 : Graves disease
In GRAVE yard maggots BITE (B8), So Grave is B8

………………………………………………….
HLA-DR2 :

A person looks into his mobile and then tells to his wife : Hey MSG about Appointment to DR

HeY – Hay fever
M – Multiple Sclerosis
S – SLE
G – Goodpasture’s
……………………………
HLA-DR4 : Rheumatoid Arthritis

Rheumatoid Arthritis Affects Joints and We have Four large Joints in our body like two shoulder and two hip Joints.
……………………………………….
HLA- DR5:

Hush Puppies : very popular footwear

Hush : Hasimoto’s Thyroiditis

Puppies : Pernicious Anemia ( P for Pentad = 5 )
…………………………………………………
HLA -DR7

My 7th Sense says that Nephrotic Syndrome responds to Steroid

Steroid responsive Nephrotic Syndrome
………………………………
HLA- DR3-DR4

3 -4 I want More ( Diabetic patient Eats more )

Type 1 DM
………………………..
HLA -A3

Hemochromatosis

Iron has 3 positive charges (+3) and “He ” Sounds like “Ae” So A3 in Hemochromatosis .

IgA Nephropathy

IMPORTANT FACTS –
IgA nephropathy is the most common form of glomerulonephritis worldwide.
There is male preponderance, peak incidence is in the second & third decades of life.
Two most common clinical presentations are:
● Recurrent episodes of macroscopic hematuria.
● Persistent asymptomatic microscopic hematuria.
Renal histological features of HSP nephritis is strikingly similar to those of IgA nephropathy.

IgA Nephropathy

IMPORTANT POINTS
Aphemia is a severe form of acute speech apraxia that presents with severely impaired fluency.
‪Warfarin is not contraindicated in lactating mothers.
Serum lithium level should be checked earliest after 5 days of constant dosing.
Gamma Gandy bodies contain hemosiderin & calcium.
Internucleosomal cleavage of DNA is characteristic of apoptosis.
Most common form of dissociation hysteria is amnesia.
Relapse rate of P.vivax malaria in India is 30%.
Radiation dose of barium enema is equal to 350 X-rays.
Ram's horn & Pseudobillroth appearance on barium studies is a feature of Crohn's disease.
Thiazides decrease positive free water clearance.
Carbohydrate, protein & fat metabolism occur in TCA cycle.
Monosaccharides seperation is by chromatography technique.
Papillary hidradenoma occurs most commonly in anogenital region.
Most common location for performing endomyocardial biopsy is right ventricle.
Earliest immunoglobulin to appear in fetus is IgM.
Cow milk contains soluble radioactive substance - Strontium 90.
Earliest visual field defect in Glaucoma is isopter contraction but paracentral scotomas are more specific.

BASIC FACTS
Paracrine regulation refers to factors released by one cell that act on an adjacent cell in the same tissue.
For example, somatostatin secretion by pancreatic islet delta cells inhibits insulin secretion from nearby beta cells.
Autocrine regulation describes the action of a factor on the same cell from which it is produced. IGF-1 acts on many cells that produce it, including chondrocytes, breast epithelium & gonadal cells.

Prothrombin

Prothrombin.
☆Intrinsic and Extrinsic pathways of coagulation converge at factor 10.
☆Threonine does not contain Sulfa group.
☆Autosomal dominant is hereditary Spherocytosis & Poly cystic kidney disease.
☆Lens opacity causing drugs >Chlorpromazine, Amidarone, Tamoxifen, Gold & Iron toxicity.
☆Drugs causing corneal opacity > Amiodarone, Chloroquine, Mepacrine & Copper.
☆ Ribosome have purple color on Eosin & Methylene blue staining
☆High energy content > Starch.
☆High energy compound > ATP
☆Antidote of warfarin is vitamin K but if action is more quickly required then FFP.
☆Olfactory cells are the only neurons in the body that regenerates.
☆Projectile vomiting greenish in color means bilious vomiting so it is due to duodenal atresia but if projectile vomiting non bilious then it is hypertrophic pyloric stenosis.
☆ Pulmonary trunk relation with the bronchus at the hilum of the lung-mnemonic is RALSR- Right Anterior & Left Superior.
☆Rhino sinusitis is caused by Strep Pneumonia, H. Influenza, M Catarrahalis.
☆ Homan’s sign is present in DVT in which if you dorsiflex the foot there will be pain in calf muscles.
☆ Classic triad of Pulmonary Embolism: -
☆☆Neurological manifestations.
-Petechial rash.
-Hypoxemia.
☆Nitrogen bubbled precipitator in ascending divers and can be treated with hyperbaric oxygen.
☆CT pulmonary angiography is the best test to detect Pulmonary Embolism.
☆The most common infectious agent transmitted by blood transfusion is cytomegalovirus (CMV), which is present in donor lymphocytes.
☆Before blood is transfused into newborns or patients with T-cell deficiencies, it must be irradiated to kill donor lymphocytes. This prevents the patient from developing a graft-versus-host reaction or a CMV infection.
☆Yersinia enterocolitica, a pathogen that thrives on iron, is the most common contaminant of stored blood.
☆ Iron is stored in bone macrophages.
☆ Structures passing thru superior orbital fissure....
NOT-FAL
¤NASOCILLIARY¤OPTHALIMIC VEIN¤TROCHLEAR¤FRONTAL
☆☆Suture Removal:
¤Head 5-7days
¤Face 3-5days
¤Eyelid & eyebrow 3-5days
¤Trunk 5-7days
¤Extremities 7-10days
¤Surface of joint 10-14days
¤Hand ==7days
☆☆Absorption
☆iron nd divalents absorb in duodenum.
☆Folic acid, maximum water, max electrolytes, long chain fatty acids in jejunum.
☆Bile nd B12 absorb in ileum.
☆water nd electrolytes absorb in colon but less than jejunum. Short chain fatty acids absorb in colon.
¤¤Buffers
☆Major intracellular buffer is protein.
☆Major extracellular buffer is bicarb.
☆If only major buffer asked then Bicarb.
☆Major renal buffer is still bicarbonate if depleted theb
¤Phosphate ==Qualitative
¤Ammonia == Quantitative
☆Buffer in blood is H2co3 > Hb
¤¤Uterus
☆Uterosacral felt on PR
☆Main support is cardinal(also named transverse cervical ligament )
☆Round ligament of uterus keeps it anteverted anteflexed
☆broad ligament has very lessor role in support
☆Best way to "measure" gfr is inulin clearance.
☆best way to "estimate" gfr is creatinine clearance.
☆best way to "clincally" measure gfr is creatinine clearance.
☆best way to measure renal plasma / blood flow is PAH .
☆best test for renal falilure is creatinine clearance.
☆☆☆☆ blood transfusion
↪multiple===hemochromatosis
↪massive===hyperkalemia
↪repeated ===hypocalcemia.

Myelination mile stones

Myelination mile stones :

Before term birth - brain stem
Term birth - brain stem, cerebellum, post limb of int capsule
2 months : ant limb of int capsule
3 months : splenium of corpus callosum
6 months : genu of corpus callpsum
Cortico spinal tract : starts at 2 months of age & get completed at 2 years