Foramina in the Base of the Skull

 Foramina in the Base of the Skull 

1. Petrotympanic fissure

■ Chorda tympani and often anterior tympanic artery. 

2. Stylomastoid foramen

■ Facial nerve.

3. Incisive canal

■ Nasopalatine nerve and terminal part of the sphenopalatine or greater palatine vessels. 

4. Greater palatine foramen

■ Greater palatine nerve and vessels. 

5. Lesser palatine foramen

■ Lesser palatine nerve and vessels. 

6. Palatine canal

■ Descending palatine vessels and the greater and lesser palatine nerves.

7. Pterygoid canal

■ Runs from the anterior wall of the foramen lacerum to the pterygopalatine fossa and transmits the nerve of the pterygoid canal (vidian nerve).

8. Sphenopalatine foramen

■ Sphenopalatine vessels and nasopalatine nerve.

A. Anterior Cranial Fossa

1. Cribriform plate

■ Olfactory nerves. 

2. Foramen cecum

■ Occasional small emissary vein from nasal mucosa to superior sagittal sinus. 

3. Anterior and posterior ethmoidal foramina

■ Anterior and posterior ethmoidal nerves, arteries, and veins.

B. Middle Cranial Fossa

1. Optic canal

■ Optic nerve, ophthalmic artery, and central artery and vein of the retina. 

2. Superior orbital fissure

■ Oculomotor, trochlear, and abducens nerves; ophthalmic division of trigeminal nerve; and ophthalmic veins.

3. Foramen rotundum

■ Maxillary division of trigeminal nerve.

4. Foramen ovale

■ Mandibular division of trigeminal nerve, accessory meningeal artery, and occasionally lesser petrosal nerve.

5. Foramen spinosum

■ Middle meningeal artery. 

6. Foramen lacerum

■ Nothing passes through this foramen, but the upper part is traversed by the internal carotid artery and greater and deep petrosal nerves en route to the pterygoid canal.

C. Posterior Cranial Fossa

1. Internal auditory meatus

■ Facial and vestibulocochlear nerves and labyrinthine artery. 

2. Jugular foramen

■ Glossopharyngeal, vagus, and spinal accessory nerves and beginning of internal jugular vein. 

3. Hypoglossal canal

■ Hypoglossal nerve and meningeal artery. 

4. Foramen magnum

■ Spinal cord, spinal accessory nerve, vertebral arteries, venous plexus of vertebral canal, and anterior and posterior spinal arteries.

5. Condyloid foramen

■ Condyloid emissary vein. 

6. Mastoid foramen

■ Branch of occipital artery to dura mater and mastoid emissary vein.

7. Carotid canal

■ Internal carotid artery and sympathetic nerves (carotid plexus)

8. Hiatus of facial canal

■ Greater petrosal nerve.

D. Foramina in the Front of the Skull 

1. Zygomaticofacial foramen

■ Zygomaticofacial nerve.

2. Supraorbital notch or foramen

■ Supraorbital nerve and vessels. 

3. Infraorbital foramen

■ Infraorbital nerve and vessels. 

4. Mental foramen

■ Mental nerve and vessels. 

Community medicine : High Yield points

 1. James Lind is related to the discovery of Prevention of scurvy 

2. Gap in time between entry of the organism and the appearance of signs and symptoms is the incubation period 

3. Time between entry of the organism and to produce maximum infection is known as generation time 

4. Time interval between disease initiation and disease detection in a noninfectious disease is known as latent period 

5. Serial interval is the time between onset of primary case and secondary case 

6. Occurrence of the polio is an example of propagated epidemic 

7. Bhopal gas tragedy is an example of Point source epidemic 

8 Endemic disease means that a disease is constantly present in a given population group 

9. Secular trends are progressive changes occuring over long period of time 

10. Point source epidemic occurs in one incubation period 

11. First case that comes to notice of physician is Index case

Psychiatry - High Yield points

 1. ASPERGER'S syndrome is: Developmental disorder

2. Tourette's disorder is characterised by: Motor tics and vocal tics of abusive language or sexually obscene words

3. Copropraxia refers to: Obscene acts

4. Macdonald triad is associated with: Sociopathic behavior

 5. Stealing and telling lies is due to: Conduct disorder 

6. DOC of night terrors: Diazepam 

7. Eneuresis is diagnosed after the age of: 5 years 

8. Feature of "anankastic personality disorder is: Rigidity and stubbornness 

9 .Personality disorder characterised by disregard for social norms and incapacity to experience guilt is: Schizoid personality disorder 

10. Personality disorders: are usually evident by adolescence 

11. Personality with traits like disciplined, parsimonious, punctuality, liking cleanliness etc. is: Anankastic 

12. Of the various personality disorders paranoid personality comes under: Cluster A 

13. Dramatic emotionality, suggestibility and overconcern with physical attractiveness is a feature of personality traits: Histrionic Personality 

14.. Personality disorders which is more common in females: Histrionic

 15. Psychiatric complications of alcohol dependence are Schizophrenia, Depression 

16. Most common symptom of alcohol withdrawl is Tremor

 17.Wernick’s encephalopathy involves Mammillary body 

18. Wernicke encephalopathy presents with confusion, nystagmus and ataxia. 

19. In alcohol withdrawl drug of choice is Chlordiazepoxide 

20. Widmark Formula is used for Alcohol 

21. Formication and delusion of persecution, both are together seen in Cocaine psychosis 

22 Dependence is best indicated by Withdrawal symptoms 

23. Antidepressant drug that is used for Nicotine addition: Bupropion 

High Yield points : Dermatology

 1. Syndromic management for genital ulcers in India is used for STI like Chancroid, chancre & herpes genitalis

 2. Most specific test for syphilis FTA-Abs

 3. In chancroid, the drug of choice is Ceftriaxone

 4. Donovanosis is caused by Calymmatobacterium granulomatis 

5. For lymphogranuloma venereum the drug of choice is Doxycycline

 6. Polycyclic erosions are seen in Herpes genitalis 

7. The most frequent cause of recurrent non-infectious oro-genital ulceration in a HIV positive male is Aphthous ulcer 

8. Sabre tibia is seen in: Syphilis

 9. Mucus patch is seen in Secondary syphilis 

10. Incubation period of syphilis is 9 to 90 days

 11. Vesicle is not a skin manifestation of secondary syphilis 

12. Primary bullous lesion is seen in Congenital syphilis 

13. In Syphilis a painless indurated ulcer over the penis is seen 

14. Yaws is caused by Treponema pertenue 

15. In primary syphilis the treatment of choice is Benzathine penicillin

 16. Podophyllin is used in Condyloma acuminate

 17. Gonococcus is: Intracellular gram-negative 

18. Main feature of gonorrhea is Purulent discharge per urethra 

19. Leprosy does not affect Ovaries

 20. The most effective drug against M.leprae is Rifampicin 

21. Most sensitive index to assess the drug effectiveness in skin smears of leprosy patient is: Morphological index 

22. Maximum suppression of cell-mediated immunity occurs in Lepromatous leprosy 

Pathology : High Yield

 1.  Damage  to  nervous  tissue  is  repaired  by  :  Neuroglia

 2.  Mycosis  fungoides  :  Cutaneous  lymphoma   

3.  Secondary  amyloidosis  complicates:  Chronic  osteomyelitis 

4.  The  earliest  feature  of  TB  is:  Lymphocytosis   

5.  The  low  grade  non-hodgkins  lymphoma  is  :  Follicular  

 6.  Liquefactive  necrosis  is  seen  in  :  Brain  

 7.  The  crescent  forming  glomerulonephritis  is:  RPGN 

8.  Earliest  feature  of  correction  of  IDA  is  :  Reticulocytosis

   9.  Kupffer's  cells  are  found  in  :  Liver   

10.  Heart  failure  cells  are  found  in  :  Lungs 

  11.  Psammoma bodies  show:  Dystrophic  calcification   

12.  Beta-microglobulin:  is  not  a  tumor  marker  

 13.  Commonest  benign  tumor  of  liver  :  Hemangioma  

 14.  Blood  when stored  at  4  degree  celcius  can  be  kept  for:  21  days   

15.  Congo-red  with  amyloid  produces:  Brilliant  pink  ccolour

  16.  Cloudy  swelling  does  not  occurs  in  :  Lungs 

17.  Gamma Gandy bodies contains  hemosiderin  and  :  Ca++   

18.  Hutchinson's  secondaries  in  skull  are  due  to  tumors  in  :  Adrenals   

19.  Albumino  -cytologic  dissociation  occurs  in  cases  of:  Guillain  Barre  syndrome   

20.  Metastatic  calcification  is  most  often  seen  in  :  Lungs   

21.  ASLO  Titres  are  used  in  the  diagnosis  of:  Acute  rheumatic  fever  

 22.  Apoptosis  is  inhibited  by  :  bcl-2  

 23.  CEA:  is  not  used  as  a  tumor  marker  in  testicular  tumours

 24.  Onion  peel  appearance  of  splenic  capsule  is  seen  in  :  SLE

ENT important points

CUSIS:

1. Hyperacusis – Bell’s palsy

2. Paracusis willisi – Otosclerosis

3. Diplacusis – Meniere’s disease

4. Presbyacusis – Age related SNHL

TRIADS:

1. Gradinego syndrome :

Ear discharge

Retroorbital pain

 Diplopia 

2. Trotter’s triad (NPC):

U/L CHL (glue ear)

Temporoparietal pain

Palatal palsy

3. Sampter’s triad

Allergy to Aspirin

Asthma 

Nasal polyps

SIGNS:

1. Heinnebert sign : Congenital Syphillus

2. Hitzelberger sign : Acoustic Neuroma

3. Rising sun/ brown sign/ Phelp sign : Glomus Juglare

4. Target/Halo sign : Traumatic CSF leak

5. Cart wheel sign : ASOM

6. Schwartz sign : Otosclerosis

7. Griessenger sign / Delta sign : Sigmoid Sinus Thrombosis

8. Reservoir Sign : Mastoiditis

9. Light House : ASOM

10. Tripod sign/ Thumb sign : Epiglotittis 

11. Steeple sign : ALTB / CROUP

12. Antral sign / Hollman miller sign : Angiofibroma CT

13. Omega shaped epiglottis : Laryngomalacia 

14. Turban/ Mouse nibbled vocal cord : TB larynx

15. Potato nose : Rhinophyma

16. Woody nose : Rhinoscleroma

17. Mulberry like nasal mass : Rhinosporidiosis

18. Mulberry like nasal mucus : Inferior turbinate hypertrophy

19. Frog face deformity : Angiofibroma

THYROPLASTY:

1. Type 1 : Medialization – Adductor palsy

2. Type 2 : lateralization – Abductor palsy

3. Type 3 : Shortning- Loosening – Puberphonia 

4. Type 4 : Lengthing- tightening – Androphonia

 

DRAINAGE points:

1. Nasolacrimal duct : Inferior meatus

2. Maxillary / frontal / anterior / ethmoidal : Middle meatus

3. Posterior ethmoid : Superior meatus

4. Sphenoid : Sphenoethmoidal recess

5. DCR : Middle meatus

Committees in PSM

The Many Committees in PSM tell a story- lets read it.
(Questions asked have been marked with *) 

The story begins in 1943.
Government of India (still under the British) appointed BHORE (SIR JOSEPH BHORE) to assess
the health situation in India and make recommendations. He took 2 years roaming around and made his recommendations in 4 volumes! Keywords we need to remember-
• Integration of preventive and curative services at all administrative levels
• Development of PHC in 2 stages- short term and longterm (called the 3 million plan) (*)
• Concept of “social physicians” (3 months training) Then we got independence and apparently got smarter. 

We decided to see if what the Goron ka Bhore had recommended is working or not! 

So came the MUDALIAR COMMITTEE in 1962 to provide afresh look. It said strengthen
what we have, don’t build more. 

Next year (1963) came the CHADAH COMMITTEE. It was
made to study arrangements for the NMEP’s maintenance
phase. It said one basic health worker should work for 10,00 population. And they should be
multipurpose health workers-malaria + family planning +
vital statistics (*) 

Then 2 years later (1965) came the MUKERJI COMMITTEE. They very smartly realized that what
Chadah ji said is not working.
Neither Malaria nor Family planning work is being done properly. So let’s separate them.
Let’s make basic health worker work for all other random stuff.
And family planning assistant to do only family planning jobs.
They also said separate malaria from family planning!
Then in 1966, same committee found that it got too much for
the states to do because of lack
of funds. So they worked out a system called “Basic Health Service” being provided at the
block-level to figure out the
administration jargon. 

JUNGALWALLA COMMITTEE came the year after that (1967).
Srinagar mein baithke they
talked about how to eliminate private practice for government
doctors and just how to integrate health services. So they came up with the idea of
“Integrated Health Services” (*) 

Next KARTAR SINGH COMMITTEE
met in 1973 (6 years later) and this committee was called the
“Committee on Multipurpose
workers under Health and
Family planning” (because we like revisiting the past!). They said
• Convert the current Auxilary Nurse-Midwives into Female Health Workers
• Convert the Basic Health Workers/Malaria Surveillance Workers/Vaccinators/Health Education Assistants/Family planning health assistants into
Male Health Workers
• Introduce MPWs first into Malaria maintenance phase and Smallpox controlled areas, then spread them out
• One PHC for 50,000 people
• Every PHC should have 16 subcentres 

• Every subcentre should have 1 male and 1 female health worker Then two years later came

SHRIVASTAV COMMITTEE (1975).
They wanted to make a plan to train all these new position people. They said we need more people (these positions aren’t enough!). So their recommendations were
• Train para and semi-professional workers- like school teachers etc to help out in the community 

• Establish 2 more cadres of health workers- Multipurpose
Health Workers and Health Assistants between the community level and doctors at PHCs 

• Develop a Referral Services Complex

• Something about medical education also

• Most importantly it said that
Primary health care should be provided within the community
itself through specially trained
people – place the health of the
people in the hands of the
people themselves! (*) Its long I know..but I hope it
helps.

Acoustic neuroma

Most common intracranial schwannoma.

80% of all cp angle tumours.

it's benign. B/l acoustic neuroma is diagnostic of NF2. 

Most common age group is 40 to 60 yrs of age. 

Tumour is radioresistant.90 % of cases are u/l. 

Most schwannomas are sporadic.

Earliest symptom: Deafness, tinnitus .retrocochlear hearing loss, true vertigo not seen due to central adaptation. Marked difficulty in speech understanding.earliest nerve involved is 5th cranial nerve.2nd nerve is facial.

Earliest sign: corneal reflex is impaired.

Histelberger sign and teal's sign +ve .

recruitment is negative.

BERA: delay in 5th wave.

MRI is gold standard investigation.

Vertebral angiography is done for differentiation from other CP tumours.

Surgery is TOC.

For hearing rehabilitation in b/l acoustic neuroma: Auditory brain stem implant.

MC in Orthopedics

MCC of B/L genu valgum in children - idiopathic > rickets
MCC of B/L genu varum in children - rickets > idiopathic
MCC of B/L genu valgum in adults - RA > OA
MCC of B/L genu varum in adults - OA> RA
MCC of windswept def in children- rickets
MCC of windswept def in adults - RA

Anatomy Actions

1) FLEXION, ADDUCTION, INTERNAL ROTATION OF ARM – PECT MAJOR
2) EXTENSION, ADDUCTION, INTERNAL ROTATION OF ARM – LATTISMUS DORSI
3) INVERSION, DORSIFLEXION OF ANKLE – TIB ANT
4) INVERSION, PLANTAR FLEXION – TIB POSTERIOR
5) FLEXION OF HIP, EXTENSION OF KNEE – RECTUS FEMORIS
6) EXTENSION OF HIP, FLEXION OF KNEE – HAMSTRING MUSCLES
7) FLEXION AND ADDUCTION OF HIP – PECTINEUS
8) ADDUCTION AND EXTENSION OF HIP – ADDUCTOR MAGNUS
9) PROTRACTION OF SCAPULA AND OVER HEAD ABDUCTION OF SHOULDER JT –SERATTUS ANTERIOR
10) FLEXION OF SHOULDER, ELBOW AND SUPINATION – BICEPS
11) FLEXION OF DISTAL INTERPHALANGEAL JOINT OF MEDIAL FOUR FINGERS DONE BY – FDP
12) FLEXION OF MCP, EXTENSION OF IP JOINT, ADDUCTION OF FINGERS – PALMAR INTEROSSEUS
13) FLEXION OF MCP, EXTENSION OF IP JOINT, ABDUCTION OF FINGERS – DORSAL INTEROSSEUS
14) EXTENSION OF HIP, LATERAL ROTATION OF HIP – GLUT MAXIMUS
15) MEDIAL ROTATION, ABDUCTION OF HIP – GLU MEDIUS, MINIMUS
16) ABDUCTION OF SHOULDER JOINT DONE BY
i. 0-150 :SUPRASPINATUS
ii. 15-90 :DELTOID
iii. 90-180 :TRAPEZIUS AND SERATTUS ANTERIOR

Respiratory System One liners

Respi system oneliners

[1] Creola bodies
In Bronchial asthma, air way epithelium is sloughed into bronchial lumen in form of CREOLA BODIES

[2] Asteroid body or Schaumann body
Nonspecific birefringent crystalline bodies in sarcoid granulomas.

[3] PULMONARY HEMORRHAGE primary causes:
[A] Good pasture syndrome
[2] Microscopic polyangitis
[C] Idiopathic pulmonary hemosiderosis

[4] Hypersensitivity pneumonitis : Important examples :-
[A] Bagassosis =  due to T actinomycetes from moldy bagasse (sugarcane)
[B] Bird fancier,s , breeder's , handler's lung = bird proteins from avian droppings.
[C] Farmers lung = T actinomycetes from moldy hey
[D] Malt workers lung = Aspergillus fumigatus from moldy barley

[5] Hypersensitivity pneumonits = Both type III and type IV hypersensivity reaction

[6] Caplan syndrome = Seropositive rheumatoid arthiritis + Progressive massive fibrosis
Initially it was described in coal workers but subsequebntly found in variety of pneumoconioses

[7] Byssinosis = (typical description to identify q) = is charecterised clinically by occasional in early stage and then regular (late stage) chest tightness toward the end of the first day of workweek (" MONDAY CHEST TIGHTNESS")

[8] Asbestosis usually affects lower lobe first then spreads upwards as disease becomes more severe whereas silocosis coal workers pneumoconiosis usually affects upper lobe.

[9] Presence of hilar lymphedenopathy or calcified hilar lymphnode " egg shell calcification" in a pneumoconioses is more suggestive of SILICOSIS among all other pneumoconiosis

[10] The single most useful clinical sign of the severity of pneumonia is ?
Ans = respiratory rate >30 /min [ref : hson]
Other scoring methods for severity of pneumonia= [a] CURB score [b] PORT risk class

[11] Guessing most likely etiological agent of pneumonia by radiological finding
[A] upper lobe cavity = tb
[B] pneumatocoele = s pneumoniae
[C] air fluid level = abscess = polymicrobial
[D] ***  CRESCENT SIGN in lung = Aspergillosis

[12] Pneumonia + hyponatremia = legionella pneumonia
[13] Hecht's pneumonia= interstitial giant cell pneumonia = measeles

[14] Triads 
SAMTER TRIAD = asthma + allergy + nasal polyposis
KARTARGENERS SYNDROME = situs inversus + bronchiectasis + sinusitis

[15] Friedlanders pneumonia = kleibsiella pneumonia = bulging fissure sign

INDIA NEWBORN ACTION PLAN

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

Ischaemic time

Neuron 3-5 min
Cardiac musc 20 min
Peripheral nerve 8 hrs
Skeletal musc 24 hrs
Bone 72 hrs

Age in days and development

Age in days and development events : 

1. 2 days – Embryo at 2 cell stage

2. 3 days – Morula is formed

3. 4 days – Blastocyst is formed

4. 8 days – Bilaminar disc is formed

5. 14 days – Prochordal plate & primitive streak seen

6. 16 days - Intra-embryonic mesoderm is formed / Disc is three germ layers

DOC Cancers

* DOC for CLL-- Fludarabin
* DOC for Brain Tumors- Temozolamide
* DOC for Pancreatic Carcinoma-- Gemcitabine
* DOC for Choriocarcinoma- Methotrexate
* DOC for Colorectal cancer-- 5-FU
*DOC for Hairy Cell Leukemia- Cladribine
*Drugs of choice for Wenger's granulomatosis-- Cyclophosphamide
*DOC for Multiple Myloma-- Bortezomib

Pregnancy Hormones

LH surge tends to occur at around 3 AM.

2. Ovulation occurs in morning between (midnight and 11 AM) in Spring

3. Ovulation occurs in evening between (4 PM and 7 PM ) in Autumn and winter .

4. Ovulation occurs more frequently from Right Ovary

5. Ovulation occurs alternatively between the two ovaries in younger women

6. In women more than 30 yrs age .. ovulation occurs frequently from the same ovary.

Remember :

1. The primitive germ cells takes origin from Yolk sac at 3rd week of gestation and migrate to the Genital ridge by 4th week of gestation .

2. 1st meiotic division – arrested in Prophase – completed just prior to Ovulation releasing the 1st polar body.

3. 2nd meiotic division – arrested in Metaphase – completed at the time of fertilization releasing the 2nd Polar body.

4. Also, Primary Oocyte – 44XX; Secondary Oocyte – 22X;

5. Primary Oocyte(44X) – undergoes 1st meotic division – Arrested in prophase –completed just prior to ovulation – releases First polar body (22X) + Secondary Oocyte (22X)

6. Secondary Oocyte (22X) – 2nd meiotic division – Arrested in Metaphase – At the time of fertilization – releases Second Polar Body (22X) + Ovum (22X)

7. In Males : Primary spermatocyte (44XX) – undergoes 1st meiotic division – forms secondary spermatocytes (2 in number)

8. Secondary spermatocytes (22X) (2 in number) – undergoes 2nd meiotic division –forms Spematids (22X)(4 in number)

9. Spermatids undergoes transformation as spermeiogenesis – forms Sperma (4 in number)

10. Developmental process from Spermatogoonia to Sperma takes 74 days (Some books 61days)and entire process till the transit to the ductal system takes 90 days (3 months)

11. So, in case of infertility of males the repeat sperm analysis is done after 3 months.

MCQs on Immunoglobulins

Only heat labile.immunoglobulin?-igE
Maximum concentration ig?-igG
Maximum weight?igM
Lowest weight?igG
Lowesr concentration?igE
Maximum intravascular ig?-igM
Maximum extraravascular ig?-igA

Rule of 2 - Tuberculosis

Rule of two

1.      2 out of 10 word cases of TB are in India
2.      Tuberculosis has 2 words T and B = TB
3.      TB can be pulmonary or extra pulmonary.
4.      Resistant TB can be MDR or XDR Tb.
5.      MDR TB is seen in 2% of new TB cases.
6.      2 patients of every 10 patients are extra pulmonary RB cases
7.      One can treat both sputum positive of sputum negative cases
8.      Sputum negative cases confirm by GeneXpert or LPA test

9.      Don’t ignore fever and cough.

10.  Don’t ignore fever of more than 2 weeks duration.

11.  Don’t ignore cough of more than 2 weeks duration.

12.  Get 2 sputum examination to rule out TB (stat and nearly morning).


13.  Collect 2 ML of sputum for examination.


14.  Sputum can be tested by Z N Stain or fluorescent microscopy.

15.  2 tests for TB to remember: Sputum AFB and Molecular tests.


16.  Molecular tests can be GeneXpert TB test or LPA (line probe assay) test.


17.  GeneXpert TB tests is for rifampicin resistance (2R)


18.  GeneXpert TB test in private sector costs 2 thousand rupees.


19.  LPA for 2 drug resistances: INH and Rifampicin


20.  GeneXpert TB test results are available in 2 hours

21.  LPA test takes more than 2 days for the results


22.  In retreatment cases do both sputum AFB and molecular test


23.  In retreatment cases before labelling as a resistant case do the GeneXpert test 2 times.


24.  2 advanced investigations to remember: HRCT Chest and Bronchoscopy

25.  MDR TB means resistance to Rifampicin and INH. (2 drugs)


26.  XDR Tb means resistance to 2+2 drugs (Rifampicin and INH + quinolone and one injectable) or to 2 group of drugs


27.  Take 2 weeks precautions if AFB is positive.

28.  Rule out HIV and Diabetes Mellitus in case of TB.

29.  Use 2 type of masks, N 95 (for doctor) and surgical mask (for patients).

30.  Notify TB and screen the contacts.

31.  Not notifying TB is a crime under 2 clauses of MCI (5.2 and 7.14).

32.  Municipal Corporation and West Bengal CEA can take action if one fails to notify TB or fails to screen the contacts.

33.  Spreading infection is punishable under IPC Sections IPC 269/270.


34.  Patients of TB can be new cases or retreatment cases.


35.  There are 2 spells of treatment Intensive phase and continuation phase.


36.  For treatment TB can be sputum conformed TB or clinical TB.

37.  Give four drugs for 2 months.


38.  When we give 5 drugs we add SM injection for 2 months.

39.  At 2 months get 2 sputum tests done to confirm if AFB is negative or not.


40.  At 2 months if sputum AFB is positive think of GeneXpert TB tests or LPA test.


41.   In health care setting masks should be available at the reception and laboratory.

42.  Avoid split ACs at 2 places - in cars and at home.

43.  Use burial method or phenol to destroy the sputum.

44.  Skin and GI are the major organs affected by ATT.

45.  Vit B 6 and Vit D should be added to ATT.

46.  Brain and bone TB involvement require long treatment.


47.  MDR TB requires 2 years treatment.


48.  In MDR TB 2 out of 10 cases will die.


49.  In MDR cases 2 out of 10 will default.

50.  Patient rights: To get free diagnostics and free drugs from the government.


51.  Acid-fast bacteria visualized on a slide may represent M. tuberculosis or nontuberculous mycobacteria (NTM).


52.  Notify both confirmed and suspected case.


53.  Collect sputum: Spontaneously (by coughing) or induced by inhalation of aerosolized hypertonic saline generated by a nebulizer.


54.  Two most common presentation of Extra pulmonary TB are TB Lymph Nodes or pleural effusion.


55.  Common test for pleural effusion are proteins and presence of lymphocytes.


56.  Tow thigs to remember in pleural effusion: GeneXpert is negative and ADA test is positive.


57.  Paradoxical reaction in TB lymph nodes occurs at 2 months.


58.   MDR TB can be both pulmonary and extra pulmonary TB.


59.  Think before you order two tests: ELIESA and Gold Interferon.


60.  All biopsy samples should be taken in saline (for IRL) and formalin.


(with inputs from Dr Ashwani Khanna)

Orthopedics Last minute revision

Revise entire Orthopedics in 3 hours with Dr. Apurv Mehra.

Bio Medical Waste

Yellow

Type of Waste

(a) Human Anatomical Waste : Human tissues, organs, body parts and fetus below the viability period
(as per the Medical Termination of Pregnancy Act 1971, amended from time to time).

(b) Animal Anatomical Waste : Experimental animal carcasses, body parts, organs, tissues, including
the waste generated from animals used in experiments or testing in veterinary hospitals or colleges
or animal houses

(c) Soiled Waste: Items contaminated with blood, body fluids like dressings, plaster casts, cotton
swabs and

(d) Expired or Discarded Medicines: Pharmaceutical waste like antibiotics, cytotoxic drugs including
all items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc.

(f) Chemical Liquid waste : Liquid waste generated due to use of chemicals in production of
biological and used or discarded disinfectants, Silver X-ray film developing liquid, discarded Formalin,
infected secretions, aspirated body fluids, liquid from laboratories and floor washings, cleaning,
house-keeping and disinfecting activities etc.
(g) Discarded linen, mattresses, beddings contaminated with blood or body fluid.

(h) Microbiology, Biotechnology and other clinical laboratory waste: Blood bags, Laboratory cultures,
stocks or specimens of microorganisms, live or attenuated vaccines, human and animal cell
cultures used in research, industrial laboratories, production of biological, residual toxins, dishes
and devices used for cultures.

Type of Bag or Container to be used :Yellow coloured non-chlorinated plastic bags

Treatment and Disposal options :Incineration or Plasma Pyrolysis or deep burial

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Red

Type of Waste

(a) Wastes generated from disposable items such as tubing, bottles, intravenous tubes and sets,
catheters, urine bags, syringes (without needles and fixed needle syringes) and vaccutainers with
their needles cut) and gloves.

Type of Bag or Container to be used :Red coloured non-chlorinated plastic bags or containers

Treatment and Disposal options: Autoclaving or micro-waving/ hydroclaving followed by shredding
or mutilation or combination of sterilization and shredding. Treated waste to be sent to registered
or authorized recyclers or for energy recovery or plastics to diesel or fuel oil or for road making,
whichever is possible. Plastic waste should not be sent to landfill sites

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White (Translucent)

Type of Waste

Waste sharps including Metals: Needles, syringes with fixed needles, needles from needle tip cutter
or burner, scalpels, blades, or any other contaminated sharp object that may cause puncture and
cuts. This includes both used, discarded and contaminated metal shar

Type of Bag or Container to be used :Puncture proof, Leak proof, tamper proof containers

Treatment and Disposal options : Autoclaving or Dry Heat Sterilization followed by shredding
or mutilation or encapsulation in metal container or cement concrete; combination of shredding
cum autoclaving; and sent for final disposal to iron foundries (having consent to operate from
the State Pollution Control Boards or Pollution Control Committees) or sanitary landfill or
designated concrete waste sharp pit

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Blue

Type of Waste

(a) Glassware: Broken or discarded and contaminated glass including medicine vials and ampoules
except those contaminated with cytotoxic wastes. Cardboard boxes with blue colored marking
Disinfection (by soaking the washed glass waste after cleaning with detergent and Sodium
Hypochlorite treatment) or through autoclaving or microwaving or hydroclaving and then sent for
recycling.

(b) Metallic Body Implants

Type of Bag or Container to be used :Cardboard boxes with blue colored marking

Treatment and Disposal options :Disinfection (by soaking the washed glass waste after cleaning
with detergent and Sodium Hypochlorite treatment) or through autoclaving or microwaving or
hydroclaving and then sent for recycling.