IOCs for various conditions

• fibroid - USG
• tubal payency- HSG
• Mullerian anomalies - MRI
• Endometriosis - Laproscopy
• post coital bleeding - PAPS
• post menopausal bleeding - endometrial biopsy
• pid - USG
• adenexal mass - USG
• amenorrhoea - hormonal asessment
• molar - USG
• Ectopic - TVS
• ovulation - follicular monitoring
• hirsutism with menstrual irregularity- -serum testosterone
• AUB USG
• Adenomyosis - MRI
• ovarian reserve - FSH
• VVF - Cystoscopy

Newer antitubercular drugs:

Delamanid (OPC-67683; nitrodihydro imidazooxazole derivative) it inhibits mycolic acid synthesis with a great efficacy against multidrug-resistant strains of M. tuberculosis. No significant adverse events and no cross-resistance have been reported.

Bedaquiline ( Sirturo; Janssen Therapeutics) diarylquinoline for MDR &XDR TB, FDA Approved December 2012, it inhibits ATP synthesis (energy production) by inhibiting ATP synthase. It may produce arrhythmias and cardiac arrest.

APPEARANCE OF OSSIFICATION CENTRES AT VARIOUS JOINTS

Wrist Joint:

OSSIFICATION CENTRE	APPEARANCE	FUSION
Capitate	2 months	-
Hamate	3 months	-
Triquitral	3 years	-
Lunate	4 years	-
Traphezium, Traphezoid and Scaphoid	5-6 years	-
Pisiform	10-12 years	-
Lower end of Ulna	5-6 years	17-18 years
Lower end of Radius	2 years	18-19 Years

·         Capitate is the first carpal bone to appear.

·         Pisiform is the last carpal bone to appear.

·         2 carpal bones at the age of 1 and 2 years.

·         3 carpal bones at the age of 3 years.

·         4 carpal bones at the age of 4 years.

·         8 carpal bones at the age of 12 years.

Elbow Joint:

OSSIFICATION CENTRE	APPEARANCE	FUSION
Capitulum	1 year	-
Medial Epicondyle	5-7 years	16-17 years
Trochlea	9-11 years	-
Lateral Epicondyle	11 years	-
Conjoint Epiphysis(By the fusion of Lateral epicondyle, Trochlea and Capitulum)	Formed at 14-16 years	16-17 years
(Lower end of Humerus)	Mentioned	16-17 years

Shoulder Joint:

OSSIFICATION CENTRE	APPEARANCE	FUSION
Head	½ -1 year	-
Greater Tubercle	3 years	-
Lesser Tubercle	5 years	-
Conjoint Epiphysis	5-6 years	18-19 years
Acromion Process	14-15 years	17-18 years

Hip Joint

OSSIFICATION CENTRE	APPEARANCE	FUSION
Head of femur	½ -1 year	17-18 years
Greater trochanter	4 years	17-18 years
Lesser trochanter	12-14 years	17-18 years
Tri-radiate Cartilage	-	13-15 years
Iliac crest	14 years	18-20 years
Ischial Tuberosity	16-17 years	20-21 years

Knee Joint:

OSSIFICATION CENTRE	APPEARANCE	FUSION
Lower end of Femur	9th month of IUL	18-19 years
Upper end of Tibia	10th month (At birth)	18-19 years
Upper end of Fibula	4 years	18-19 years

Ankle Joint: 

OSSIFICATION CENTRE	APPEARANCE	FUSION
Lower end of Tibia	1 year	16-17 years
Lower end of Fibula	1 year	16-17 years

Sternum:

Sternum is made up of Manubrium, Body and Xiphisternum; The body is made up of 4 pieces.

OSSIFICATION CENTRE	APPEARANCE	FUSION
Manubrium	5th month	Fuses with First piece of body at old age
First piece of body	5th month	4th piece fuses with 3rd piece at 14 years and remaining pieces fuse with one another between 14-25 years.
2nd piece of body	7th month
3rd piece of body	7th month
4th piece of body	10th month (At birth)
Xiphisternum	3 years	Fuses with 4th piece at 40 years

Foot:

OSSIFICATION CENTRE	APPEARANCE
Calcaneum	5th month
Tallus	7th month
Cuboid	10th month (At birth)

International days

FEBRUARY
4- World cancer day [WHO]
6- International Day of Zero Tolerance to Female Genital Mutilation [WHO]
MARCH
21- World Down Syndrome Day
22- World Water Day
23- World Meteorological Day [WMO]
24- World Tuberculosis Day [WHO]
(21 is trisomy 21 day and after that comes Water, Weather and Air – 22nd, 23rd, and 24th)
APRIL
2- World Autism Awareness Day
7 -World Health Day [WHO]
25- World Malaria Day [WHO]
28- World Day for Safety and Health at Work [ILO]
MAY
15-International Day of Families
22-International Day for Biological Diversity
23-International Day to End Obstetric Fistula
31-World No-Tobacco Day [WHO]
JUNE
5- World Environment Day [UNEP]
8- World Oceans Day
12- World Day Against Child Labour
14- World Blood Donor Day [WHO]
15- World Elder Abuse Awareness Day
26- International Day against Drug Abuse and Illicit Trafficking
JULY
11-World Population Day
18- Nelson Mandela International Day
28-World Hepatitis Day [WHO]
AUGUST
12- International Youth Day
19- World Humanitarian Day
SEPTEMBER
10- World Suicide Prevention Day [WHO]
21- International Day of Peace
28- World Rabies Day [WHO]
Last Saturday in September- World Heart Day [WHO]
OCTOBER
10- World Mental Health Day [WHO]
Second Thursday in October- World Sight Day [WHO]
11- International Day of the Girl Child
13- International Day for Disaster Reduction
16- World Food Day [FAO]
17- International Day for the Eradication of Poverty
24- United Nations Day
NOVEMBER
12- World Pneumonia Day [WHO]
14- World Diabetes Day [WHO]
16- World Chronic Obstructive Pulmonary Disease Day [WHO]
DECEMBER
1- World AIDS Day
3- International Day of Persons with Disabilities
9- International Anti-Corruption
10- Human Rights Day

Angles used in orthopedics :

1. Bohler's angle - Fracture Calcaneum

2. Gissane's angle - Fracture Calcaneum

3. Cobb's angle - Scoiliosis

4. Kite's angle - CTEV

5. Meary's angle - Pes Cavus

6. Baumann's angle - Supracondylar fracture humerus

7. Hilgenreiner's angle - Congenital coxa vara

8. Pauwel's angle - fracture neck of femur

Syndromes associated with dementia

Alzheimer’s disease
Pick’s disease
Parkinson’s disease
Shy-Drager syndrome (Multisystem degeneration)
Huntington’s chorea
Steel-Richardson syndrome (progressive Supranuclear palsy)
Binswanger’s disease (subcortical arteriosclerotic encephalopathy)
Wilson’s disease
Leigh’s disease
Creutzfeldt-Jacob disease
Gerstmann-Straussler-Scheinker disease
ALS-Parkinson’s-Dementia complex of Gaum
Syndromes associated with mental retardation
Down’s syndrome
Turner’s syndrome
Kleinfelter’s syndrome
Cri du chat syndrome
Fragile X syndrome
Hartnup’s disease
Tay-Sachs disease
Gaucher’s disease
Niemann-Pick disease
Lesch Nyhan syndrome
Hurler’s disease
Hunter’s disease
Sanfillipo’s disease
Renpenning’s syndrome
Sturge-Weber syndrome
Crouzon’s syndrome
Apert’s syndrome
De Lange syndrome (Amsterdam dwarfism)

SYNDROMES IN PSYCHIATRY

Wernicke’s encephalopathy
An acute reaction to severe thiamine deficiency mostly d/t chronic alcohol use.
C/b ocular signs (nystagmus & external ophthalmoplagia)
Higher mental function disturbance(disorientation, confusion, recent memory disturbances)
Apathy & ataxia. Peripheral neuropathy & malnutrition may be co-existent.

Korsakoff’s psychosis
Also d/t severe thiamine deficiency d/t chronic alcohol use.
C/b amnestic syndrome with gross memory disturbances, Confabulation. Insight often impaired.

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

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


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

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

Van Gogh syndrome
Dramatic self-mutilation occurring in schizophrenia.

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

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

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

PAD syndrome
Phobic-Anxiety-Depersonalization syndrome.
Commoner in women 20-40 years.
C/b diffuse anxiety, multiple phobias, panic attacks, depersonalization, derealization & depressive Features.
Othello syndrome (conjugal paranoia)
A psychosis in which the content of delusions is predominantly jealousy (infidelity) involving spouse.

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

Kadinsky-Clerambault’s syndrome
A syndrome of mental automatism

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

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

Fregoli’s phenomenon
Delusion that a persecutor is taking on a variety of faces like an actor.

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

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

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

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

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

Munchausen syndrome by proxy
Pt intentionally produces physical signs & symptoms in another person who is under pt’s care.

Charles bonnet syndrome phantom visual images

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

Gelineu’s syndrome
Narcolepsy. Associated with hypersomnia.

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

Kleine-Levin syndrome
C/b hypersomnia, hyperphagia, hypersexuality


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

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

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

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

Rett’s syndrome
Occurs in girls.
After an apparently normal early development & normal head circumference at birth, there is
deceleration of head growth b/w age of 5-30 months.
Loss of purposive hand movements & acquired fine motor manipulative skills with subsequent
development of stereotyped hand movements.
Strauss syndrome
Attention deficit hyperkinetic disorder, Minimal brain dysfunction, Organic drivenness.

Gilles de la Tourette’s syndrome
C/b multiple motor tics
Multiple vocal tics
Duration of >1 year

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

Culture-Bound Syndromes are as follows

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

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


Amok
Prevalent in South-East Asia.
C/b sudden, unprovoked episode of rage in which affected person runs about & indiscriminately
injures or kills any person who in encountered on the way.

Latah (Startle reaction)
Prevalent in South-East Asia & Japan.
More in women, c/b automatic obedience, echolalia & echopraxia.

Windigo (Wihtigo)
Prevalent in native American Indians.
Pt believes that he has been transformed into a wihtigo, a cannibal monster, occurring especially
during times of starvation.

Shinkeishitsu
A defense syndrome, mainly of anxiety but with obsessive features occurring in young Japanese
thrown into a modern industrial society for which they are not equipped. They feel inadequate, lost
& unloved.

Susto
Occurs in Latin America.
Pt believes that his body is entered by a magical substance & that he is altered. It takes on a
delusional quality.


Piblokto (Arctic Hysteria)
Occurs in Askimos.
Often female, who screams & tears off her clothes, throw herself on ice in extremely cold conditions.
She may imitate the cry of a bird or an animal.
The episode lasting for 1-2 hours, f/b amnesia of events.

COUVADE's Syndrome: Seen in husbands of pregnant women. the prospective father develops
symptoms similar to pregnancy & symptoms r relieved by delivery.

STOLKHOLM Syndrome: Identification with the aggressor usually seen in kidnap victims who try to
protect their kidnappers.

JACTATIO CAPITIS NOCTURNA: Nocturnal head banging

DEJA VU: Recognition of events that are in fact new

JAMAIS VU: Opposite of Deja vu where patient fails to recognise events that have occured before

SYNDROMES ASSOCIATED WITH TREATMENT OF PSYCHIATRIC CONDITIONS

SUNDOWNER SYNDROME: Drowziness, confusion, ataxia, accidental falls, in older patients who are
over sedated & in old patients with Dementia who react adversly to even small dose of psychoactive
drug. It also occurs in demented patients when external stimuli such as light & interpersonal
orienting cues are diminishd. Most commonly occurs as result of Rx with BZD's

RABBIT SYNDROME: Extra pyramidal side effect of chronic anti-psychotic treatment. Rapid & regular
perioral tremors like chewing movements, tongue & other body parts not involved.

NEUROLEPT MALIGNANT SYNDROME: EPS. Hyperthermia, severe muscular rigidity, autonomic
instability, changes in mental status, increased CPK, liver transaminase, leucocyte function,
myoglobinuria

ANTI-CHOLINERGIC SYNDROME: Phenothiazines, TCAD's, Anti-Parkinson drugs all have anticholinergic
properties, when these r administered in combination patient shows evidence of organic
brain syndrome including difficulty in concentration, impaired short term memory, disorientation,
dry SKIN due to inhibition of sweating, more noticable at night.

SSRI DISCONTINUATION SYNDROME: Abrupt discontinuation of SSRI causes dizziness, nausea,
vomiting, lethargy, flu-like symptoms, sensory & sleep disturbances, irritability, anxiety, crying spells.
SSRI's with short half life like Paroxetine & Sertraline more likely causes
SEROTONIN SYNDROME: Abdominal pain, Diarrhoea, excessive sweating, fever, tachycardia,
hypertension, alteration of mental status including delirium, myoclonus, increased motor activity,
mood changes Severe cases may show hyperpyrexia, shock & death. It is due to overactivity of
serotoninergic receptors by excess of serotonin due to combination of MAO, SSRI or TCAD.

DA COSTA's SYNDROME: Irritable heart syndrome. has as many as 20 different names. Was seen
first in soldiers of civil war. Chief complaints are all related to cardiac Pathology in which the subject
has fear of a heart ailment which may progress to hypochondriasis & sometimes to circulatory
neurasthenia