DSM - IV classification - What - DSM - IV classification -
1.Axis I- Clinical psychiatric diagnosis
2.Axis II- Personality disorder and mental retardation
3.Axis III- Physical disorder and general medical condition
4.Axis IV- Psychological and environment problems
5.Axis V- Global assessment of functioning
• Total circulating blood is 8% of total body weight
• Active bone marrow forming the blood cells is called red marrow and inactive marrow is called yellow marrow. Inactive marrow is filled with fats.
• 75% bone marrow belongs to white blood cells producing myloid series
• Neutrophils and monocytes are produced from single precursor. There are se[arate pools for proginators of megakaryocytes, lymphocytes, erythrocytes, eosinophils, and basophils
• Mast cells, kupffer cells, dendritic cells, osteoclasts and langerhans cells also originate from bone marrow
• Best source of hematopoitic stem cells is umbilical cord blood
• Average half life of nutrophils in circulation is 6 hours
• Nutrophils, eosinophols and basophills are collectively called granulocytes/polymorphonuclear cells
• Eosinophils are abundant in GIT and respiratory mucosa
• Mast cells are abundant in areas rich in connective tissue eg beneath epithelium
• Monocyte leave the circulation and become macrophages in tissues. They donot reenter the circulation.
• Pluripotent uncommitted stem cells become committed by the action of IL1, IL6 followed by IL3(I,3,6 commits the stem cells, kind of love guru )
• Cytokines are hormone like molecules that act generally in paracrine fashion
• IL1 increases slow wave sleep and reduces apetite
• Platelets don’t have nuclei.They have half life of 4 days and life span of 8 to 10 days..
Remember the above difference between life span n half life of platelets
• Splenectomy causes increase in circulation platelets.
• Cytoplasm of platelets contains actin, myosin, glycogen, lysosomes, and two types of granules
a. Dense granules: they have nonprotein substances. They contain serotoninand ADP
b. Alpha granules: contain clotting factors, PDGF
• Platelet production is controlled by colony stimulating factor and thrombopoitin. Thrombopoitin controls the maturation of megakaryocytes and is produced by kidney and liver.
• Osmotic fragility of RBC starts at 0.5% saline. Almost half the RBCs are lysed at 0.40 to 0.42% saline. Complete lysis occurs at 0.35% saline.
• 2.5 % hb in adults is HbA2
• Hb F has the ability to decrease the polymerization of deoxygenated HbS. Hydroxyurea causes HbF production and is used in treatment of HbS
• Blood group antigens are called aglutinogens
• Blood group antibodies are called agglutinins
• Blood group antigens are also present in salivery gland, saliva, kidney, pancrease, liver, lungs, testes, semen, and amniotic fluid
• A and B antigens are actually oligosaccharides that differ in their terminal suger. In RBCs they are mostly OLIGOSPHINGOLIPIDS and in other tissues they are glycoprotiens.(past MCQ)
• An antigen called H antigen is present in all RBCs in all individuals. In blood group A the A antigen is attached to H antigen, in blood group B the B antigen is attached to H antigen where as in blood group O no antign is attached to H antigen i.e terminal part of blood group O is H antigen(past MCQ). Blood group AB has both antigens at the terminal.
• Bilirubin rarely penetrates Blood brain barrier in adults. But in neonates and fetus the BBB is permeable to it an in erythroblastosis feotalis it causes KERNICTERUS
• If whole blood is allowed to clot and clot is removed, remaining is called serum. (plasma minus factor 2,5,8,fibrinogen is called serum)(past MCQ)
• Serum has high serotonin level due to breakdown of platelets.
• Thrombomodulin is produced by all endothelial cells except that of microcicculation of brain
• Thombin is procoagulant in circulation blood. It becomes anticoagulant when it binds to thrombomodulin
• Lymph has lower protein content than plasma..
Must Know Points Before Exams
•William Roentgen discovered X-rays
•Father of Interventional Radiology : Charlies Dotter
•Father of medical USG : John Wild
•Father of Obstetric USG : Sir Ian Donald
•Attenuation of x ray depend on Absorption Coefficient
•Radiation exposure is measured by Dosi Meter
•GRID used in X ray to reduce scattered radiation
•Contrast in x ray depend on Kv
•Radioactivity was discovered by Curie (1896)
•Pantomography : is a special radiographic technique used for CURVED SURFACES
•GAMMA RAYS : Discovered by Henry Becquerel , high energy ionizing radiation , maximum penetrating power . radiation sickness is mostly due to gamma rays
•Cesium -137, cobalt and Radium predominantly emit gamma rays , natural soure : Phosphorus 40.
•Most ionizing radiation are Alpha rays .
•Infra Red Rays are used in Placental localization , Thermography , Orbital pneumotography , intra cerebral infract diagnosis
•USG is sound with frequency > 20,000 cycles/sec , MC used frequency 1MHz to 20 MHz , principle : PIEZO ELECTRIC CRYSTAL ACTIVATION
•USG is non mutagenic , contrast used is sonavist
•Echocardiography uses high frequency sound waves .
•Transesophageal echocardiography is used to evaluate patients with suspected aortic dissection
•CT scan was invented by Hounsfield
•Spiral CT uses Slip ring technology , in routine spiral CT splice thickness is 10mm , Routine spiral CT : 1rotation/1section/1sec
•Multi Detector CT scan : IOC for Pulmonary Embolism , Aortic aneurysm, Aortic dissection
•Most accurate investigation for Aortic Dissection : MRI
•CEREBRAL ANEURYSM IOC : Angiography
•CARDIC CT SCAN : Coronary calcium scoring or AGATSON scoring is done for patients with asymptomatic CAD
•HRCT is specialized technique used to evaluate lung parenchyma which uses Bone Algorithm
•HRCT IOC : ILD , Miliary TB, Bronchectasis
•Box car ventricles or Butter fly ventricles : on MRI is seen in HUNTINGTONS CHOREA
•Eye of tiger appearance on MRI : HALLEVORDEN SPATZ DISEASE
•Brain infract earliest detected by dw- MRI
•IOC Acute brain hemorrhage : CT SCAN
•IOC Acute head injury : CT-SCAN
•IOC stroke : CT-SCAN
•Pop corn calcification on chest x ray : Hamartoma
•Pop corn calcification on mammography : Fibroadenoma
•Cancer missed on mammography : LCIS
•MRI discovered by SIR PETER MANSFIELD & PAUL LATENBEUR
•MRI works on principle of Gyro Magnetic Property of Proton
•MC contrast agent used in MRI Gadolinium DTPA, magnetic field strength : 0.2-7 tesla , routine MRI : 1.5 tesla
•Time of flight technique : MRI
•Salt and pepper skull : Hyperthyroidism
•Salt and pepper appearance on MRI : Glomus Tumor
•Carotid body tumor : LYRE sign on angiography
•Corpus callosum agenesis on MRI : Racing car appearance
•Corpus callosum Lipoma on X ray : Bracket shaped calcification
•Elevated NAA levels on MR Spectroscopy : CANAVANS DISEASE
•MRCP is initial investigation for : Biliary stricture, Carolis disease, Choledochal cyst
•SCIWORA : spinal cord injury with out obvious radiological abnormality
•MRI IOC for stress fracture , Bone Bruise, occult bony injury
•CT SCAN IOC : ankle , temporal bone, acetabular fractures
•Minimum amount of pleural fluid identified in lateral decubitus postion : 25 ml
•Right heart border : RA,SVC,IVC
•Left heart border : LV, Auricle, PA , Aortic Knuckle
•Left atrial enlargement : BED FORD SIGN
•LV enlargement : HOFFMAN RIGLER SIGN
•CT finding of Endo-Bronchial spread of TB : TREE IN BUD SIGN
•Scadding criteria : grading criteria for Sarcoidosis
•FACE OF GAINT PANDA ON MRI of Brain : Wilsons disease
•Aspergillus : air cresent sign / Mondas sign
•ABPA : Gloved Finger of Simon app
•HALO sign on CT scan : invasive Aspergillosis
•Reverse Halo Sign : Cryptogenic organizing pneumonia
•Hydatid Cyst : USG – Cart wheel app , CXR – water lily sign , Cumbo sign
•Dropping lily sign on IVP : Duplication with non functional upper pole
•Polo Mint sign on CT scan : Portal vein thrombosis
•Safe and accurate for fetal viability at 6 wks : USG
•Doppler- pregnancy for IUGR
•MOYA MOYA disease PUFF OF SMOKE app
•IOC for Blunt abdominal trauma : CECT
•FAST : focused assessment & sonography in trauma
•PACS : picture archiving & communication system
•Minimum Blood detected by FAST 200ml
•USG – Pneumothorax :STRATOSPHERE SIGN
•MCU IOC for VUR , PUV , posterior urethral evaluation
•IOC for renal and splenic injury : CECT
•IOC urinary stones : NCCT , Stones detected only on Ureteroscopy : INDINAVIR stones
•RENAL TB : IOC – CECT
•Renal TB on IVP : moth eaten calyces , thimble bladder , Putty /cement kidney / Auto –nephrectomy
•Egg in a cup app on IVP : Papillary Necrosis
•AR – PCKD – sun ray appearance / Striated Nephrogram
•AD-PCKD- Swiss cheese Nephrogram
•ADPCKD on IVP : Spider leg app
•Multi cystic dysplastic kidney on IVP : is not visualized , on USG : Soap Bubble app
•Horse Shoe kidney on IVP : Flower Vase app , Hand-shake sign
•Bouquet of flowers on IVP : Medullary Spongy Kidney
•Multiple sclerosis MRI : Dawson’s Fingers
•On MRI Metachromatic Leuko-dystrophy shows : TIGROID PATTERN LEOPARD SKIN APP
•Parkinsons disease –MRI – Absene of swallow tail app
•Progressive Supranucler Palsy – MRI – HUMMIMG BIRD App
•Medulloblastoma has CSF drop metastasis , MRI : Sugar Coating App
•Ring Enhancing Lesion of brain : Toxoplasmosis , brain abscess, tuberculoma, metastasis, Neurocysticercosis
•Solid Homogenous Enhancing Lesion in Brain : Lymphoma (AIDS)
•Meningioma : MRI : Dural tail sign , X ray – shows calcification and hyperosteosis of skull bone
•Vestibular schwannoma MRI : ICE CREAM CONE app
•Spinal Neurofibroma : MRI – DUMBELL SHAPED NEUROFIBROMA
•Osteosarcoma : Codman triangle , Sun Ray app on x ray
•Chondroblastoma HPE : chicken wire calcification
•Enchondroma : x ray – O’Ring sign
•Fibrous Dysplasia : x ray- Ground Glass app
•Vertebral Haemangioma : X ray : corduroy app , vertical striations are present . CT scan POLKA DOT sign
•Simple bone cyst : fallen leaf sign on x ray
•Beveled Edges of skull on x ray : Histocytosis
•Punched out lytic lesions of skull : Multiple Myeloma
•Earliest X ray finding of TB spine : Rarefaction of end plate -> disc space narrowing
•Spool shaped vertebrae is feature of – Pyknodysostosis
•Molten candle wax appearance seen in- Melorheostosis
Paget’s disease:
oCotton wool skull
oIvory vertebra (also seen in – metastasis)
Ankylosing spondylitis:
oBamboo spine
oRomanus sign/ Dagger sign
oSquaring of vertebrae (picture frame vertebra)
oIntervertebral disc calcification.
•Bare orbit sign seen in – Neurofibromatosis
•Earliest seen in rickets – Loss of provisional zone of calcification
•Looser’s zones or pseudo fractures is the hallmark feature of – Osteomalacia.
•Rugger jersey spine seen in Renal osteo-dystrophy, Osteopetrosis.
•Achalasia cardia : Bird beak app , Pencil tip app
•Ca Esophagus : Rat tail app
•IOC for swallowing disorder : Videoscopy
•Duodenal ulcer : Trifolate Duodenum
•IOC CHPS : USG
•Bening Gastric Ulcer : spoke wheel app
•Malignant Gastric Ulcer : Carmen’s meniscus sign / Carmen kirkliv complex
•Acute Pancreatitis –IOC CECT
•Chronic Pancreatitis –IOC : MRCP ( chain of lake app)
•Periampullary ca of pancreas : Frost Berg Reverse 3 Sign
•Bowel TB : string sign , Inverted Umbrella sign / fleschner’s sign , conical ceacum , goose neck ileum .
•Ulcerative Colitis : Earliest barium finding : Mucosal granularity , collar button ulcer , lead pipe app colon
•Crohn’s disease : Earliest barium finding : Apthous Ulcer , rose thorn app, string sign of kantor
•IOC Meckel’s Diverticulum : Tc 99 Per technetate scan
•Ischemic Colitis : Ba Enema : thumb print sign
•Thumb sign on neck X ray : Epiglottis
•Sigmoid volvus : X ray : coffee bean sign , bird of prey sign on Ba enema
Radiation and Radiotherapy:
o1Particulate/corpuscular: alpha, beta ,proton , neutron
o2Electro magnetic: X-rays’s , gamma rays , cosmic rays .
oMost common cause of outdoor radiation – cosmic.
oMost common cause of indoor radiation – radon.
oMost common cause of endogenous (human body)– potassium
Radiation exposure limits:
oNatural radiation / anum: 0.1 rad / anum
oFatal dose – single exposure – 500 REM
oMinimum dose required for systemic effect: 100 Rem
oMaximum permissible dose for normal population – 5 rads / anum
oMaximum permissible dose for a pregnant female who is occupationally exposed: 0.5 rads /anum .
oMinimum dose required for teratogenicity: 5 rads
Sensitivity and resistance:
oMost radio sensitive tissue: bone marrow
oLeast radio sensitive tissue: brain / nervous tissue
oMost radio sensitive cell: lymphocyte
oMost radio resistant: platelets / RBC
oMost radio sensitive stage of cell cycle – G2 M > M
oMost radio resistant stage of cell cycle – late S phase
*Laryngomalacia*
Laryngomalacia (literally, "soft larynx") is the most common cause of stridor in infancy, in which the soft, immature cartilage of the upper larynx collapses inward during inhalation, causing airway obstruction.
It can also be seen in older patients, especially those with neuromuscular conditions resulting in weakness of the muscles of the throat.
However, the infantile form is much more common. Laryngomalacia is one of the most common laryngeal congenital disease in infancy and public education about the signs and symptoms of the disease is lacking.
*Epidemiology*
Although this is a congenital lesion, airway sounds typically begin at age 4–6 weeks. Until that age, inspiratory flow rates may not be high enough to generate the sounds. Symptoms typically peak at age 6–8 months and remit by age 2 years.
Late-onset laryngomalacia may be a distinct entity, which can present after age 2 years.
*Presentation*
In infantile laryngomalacia, the supraglotticlarynx (the part above the vocal cords) is tightly curled, with a short band holding the cartilage shield in the front (the epiglottis) tightly to the mobile cartilage in the back of the larynx(the arytenoids).
These bands are known as the aryepiglottic folds.
The shortened aryepiglottic folds cause the epiglottis to be curled on itself.
This is the well known "omega shaped" epiglottis in laryngomalacia.
Another common finding of laryngomalacia involves the posterior or back part of the larynx, where the arytenoid cartilages or the mucosa/tissue over the arytenoid cartilages can collapse into the airway and cause airway obstruction.
Laryngomalacia results in partial airway obstruction, most commonly causing a characteristic high-pitched squeaking noise on inhalation
(inspiratory stridor).
Some infants have feeding difficulties related to this problem.
Rarely, children will have significant life-threatening airway obstruction.
The vast majority, however, will only have stridor without other more serious symptoms such as dyspnea.
*Causes*
Although laryngomalacia is not associated with a specific gene, it is evidence that some cases may be inherited. Relaxation or a lack of muscle tone in the upper airway may be a factor.
It is often worse when the infant is on his or her back, because the floppy tissues can fall over the airway opening more easily in this position.
*Diagnosis*
The physician will ask some questions about the baby’s health problems and may recommend a flexible laryngoscopy to further evaluate the infant's condition.
*Prognosis*
Laryngomalacia becomes symptomatic after the first few months of life (2–3 months), and the stridor may get louder over the first year, as the child moves air more vigorously. Most of the cases resolve spontaneously and less than 15% of the cases will need surgical intervention.
Parents need to be supported and educated about the condition.
*Treatment*
Time is the only treatment necessary in more than 90% of infant cases. In other cases, surgery may be necessary.
Most commonly, this involves cutting the aryepiglottic folds to let the supraglottic airway spring open.
Trimming of the arytenoid cartilages or the mucosa/ tissue over the arytenoid cartilages can also be performed as part of the supraglottoplasty. Supraglottoplasty can be performed bilaterally (on both the left and right sides at the same time), or be staged where only one side is operated on at at time.
Treatment of GERD can also help in the treatment of laryngomalacia, since gastric contents can cause the back part of the larynx to swell and collapse even further into the airway. In some cases, a temporary tracheostomy may be necessary.
Nowadays, we can do Laryngoplasty surgery & also put T-Tube in the larynx via a Tracheostomy opening.
Calcium supplements are usually given to children with Laryngomalacia upto the age of 12-14 years, till the puberty changes in the larynx takes place.
Frequently asked Dermatological signs
•Asboe Hansen Sign (Bulla Spread Sign): Pemphigus
• Carpet Tack sign: DLE
•Cerebiform Tongue sign: Pemphigus Vegitans
•Coup D Lounge sign: Tinea Versicolor
•Crowe sign: Axillary freckling in Neurofibromatosis
•Fitzpatrick sign: Dermatofibrosarcoma Protuberans
•Dubios sign: Congenital syphilis
•Hertoghes sign: Loss of lateral 1/3 of eyebrow in Atopic Dermatitis
•Leser Trelat sign: Appearance of large number of Seborrheic keratoses
•Ollendroff sign: Tender papule in Secondary syphilis
•Pillow sign: Patient sees hair on pillow on getting up at morning. (ALOPECIA)
• Shawl sign: Erythema overback and shoulders in Dermatomyositis
•Pseudomonas in ‘ Hot-tub folliculitis’
•Pseudomonas in ‘Ecthyma gangrenosum’
•HSV (Herpes simplex virus) on the head and neck of young wrestlers ‘Herpes gladiatorum’
•HSV Eczema
•HSV (Herpes simplex virus) on the digits of health care workers ‘Herpetic whitlow’
•‘Impetigo contagiosa’ is caused by Strep Pyogenes
•‘Bullous impetigo’ is due to S aureus
•‘Swimmer’s itch’ in skin surface is exposed to water infested with freshwater avian schistosomes.
•‘Bacillary angiomatosis’ by Bartonella henselae.
•‘Verruca peruana’ is caused by Bartonella bacilliformis
•Human papillomavirus may cause singular warts ‘verruca vulgaris’
•Human papillomavirus with warts in the anogenital area ‘condylomata acuminata’
•‘Erysipelas is due to Strep Pyogenes
• Mycobacterium leprae may be associated with cutaneous ulcerations in patients with lepromatous leprosy related to ‘Lucio’s phenomenon’
•‘Cellulitis’ may be caused by indigenous flora colonizing the skin and appendages by S aureus and S pyogenes
• ‘Necrotizing fasciitis’, formerly called streptococcal gangrene, may be associated with group A Streptococcus or mixed aerobicanaerobic bacteria or may occur as part of gas gangrene caused by Clostridium perfringens.
SUGGESTED NORMS
🔹1 Doctor
👉3500 population
🔹nurse
👉5000
🔹HWM/HWF
👉5000 in plains & 3000 in hilly areas
🔹trained dai
👉1 for each village
🔹HA male/HA femle
👉30000 in plains & 20000 in hilly area
🔹pharmacist
👉10000
🔹lab tech
👉10000
🔹asha
👉1000
Ovarian cysts:
Follicular cyst -
Associated with hyperestrogenism, endometrial hyperplasia.
Theca-lutein cyst -
Due to gonadotropin stimulation.
Associated with choriocarcinoma and hydatidiform moles.
Ovarian neoplasms
Risk increase with -
. advanced age,
. infertility,
. endometriosis,
. PCOS,
. genetic predisposition (BRCA-1 or BRCA-2 mutation, Lynch syndrome, strong family history).
Risk decreses with -
. previous pregnancy,
. history of breastfeeding,
. OCPs,
. tubal ligation.
Benign ovarian neoplasms
1) Serous cystadenoma
. Lined with fallopian tube–like epithelium.
2) Mucinous cystadenoma
. Lined by mucus-secreting epithelium .
3) Endometrioma
Endometriosis (ectopic endometrial tissue) within ovary with cyst formation.
“Chocolate cyst”— endometrioma filled with dark, reddish-brown blood.
4) Mature cystic teratoma (dermoid cyst)
Germ cell tumor.
A monodermal form with thyroid tissue(struma ovarii) uncommonly presents with hyperthyroidism .
5) Brenner tumor
Looks like Bladder ( both contains B )
“Coffee bean” nuclei on H&E stain.
6) Fibromas
Bundles of spindle-shaped fibroblasts.
Meigs syndrome—triad of ovarian fibroma, ascites, hydrothorax.
7) Thecoma
Like granulosa cell tumors, may produce estrogen.
Usually presents as abnormal uterine bleeding in a postmenopausal woman.
Malignant ovarian neoplasms
1) Granulosa cell tumor :
- Most common malignant stromal tumor.
- Often produces estrogen and/or progesterone and presents with postmenopausal bleeding,
- sexual precocity (in pre-adolescents),
- breast tenderness.
- Histology shows Call-Exner bodies (granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles).
2) Serous cystadenocarcinoma
Most common malignant ovarian neoplasm,
Psammoma bodies.
3) Mucinous cystadenocarcinoma
Pseudomyxoma peritonei–intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.
4) Immature teratoma
Aggressive, contains fetal tissue, neuroectoderm.
5) Dysgerminoma
Equivalent to male seminoma .
Sheets of uniform “fried egg” cells .
hCG, LDH = tumor markers.
6) Yolk sac (endodermal sinus) tumor
Aggressive, in ovaries or testes (boys) and sacrococcygeal area in young children.
Schiller-Duval bodies (resemble glomeruli) .
AFP = tumor marker.
7) Krukenberg tumor
GI malignancy that metastasizes to ovaries > mucin-secreting signet cell adenocarcinoma.
