Alcohol

In alcohol intoxication, motor incoordination and judgement errors occur at blood alcohol
levels of
a.  30-80 mg/dL
b.  80-200 mg/ dL
c.  200-300 mg/dL
d.   More than 300 mg/ dL
Ans. (b)

Ethanol intoxication
Measurement of levels in exhaled air is the primary method of assessing the level of intoxication.
Blood alcohol levels are necessary to confirm the presence or absence of alcohol intoxication.
Blood ethanol levels of 20-30 mg/dL
An increased reaction time, diminished fine motor control, impulsivity, and impaired judgment
become evident when the concentration of ethanol in the blood is 20-30 mg/dL.
Blood ethanol levels of about 80 mg/dL
Blood levels of 80 mg/dL are associated with slurred speech, incoordination, unsteady gait, and
potential impairments of attention.
Levels between 80 and 200 mg/dL
Levels between 80 and 200 mg/dL are associated with mood lability and cognitive deficits,
potentially accompanied by aggressiveness, and anterorgrade amnesia (an alcoholic blackout).
Levels >200 mg/d
Blood ethanol levels >200 mg/dL can produce nystagmus and unwanted falling asleep.
Levels of 300 mg/dL and higher
Levels of 300 mg/dL and higher can produce failing vital signs, coma, and death.  In fatal cases,
the average concentration is about 400 mg/dL, although alcohol-tolerant individuals often can
withstand comparable blood alcohol levels.
Acute Ethanol Intoxication. Goodman & Gilman's The Pharmacological Basis of
Therapeutics, 12e > Chapter 23. Ethanol and Methanol
K.S Narayana Reddy: The essentials of forensic medicine and toxicology.

TAUOPATHIES :-

 TAUOPATHIES :-

• class of neurodegenerative diseases associated with the pathological aggregation of TAU PROTEIN in the human brain.
• tau protein is deposited within neurons in form of neurofibrillary tangles (NFTs).
• Tangles (NFT=a/k/a---PHF or "paired helical filaments") are formed by hyperphosphorylation of a microtubule-associated protein known as tau, causing it to aggregate in an insoluble form (also referred to as ).
• It consists of following disorder:-

1. Alzheimer disease
2. Pick's disease
3. corticobasal degeneration
4. progressive supranuclear palsy
5. Dementia pugilistica (chronic traumatic encephalopathy)
6. Frontotemporal dementia and parkinsonism linked to chromosome 17,
7. Lytico-Bodig disease (Parkinson-dementia complex of Guam)
8. Ganglioglioma and gangliocytoma
9. Meningioangiomatosis
10. Subacute sclerosing panencephalitis
11. Frontotemporal dementia
12. Frontotemporal lobar degeneration
13. lead encephalopathy,
14. tuberous sclerosis, Hallervorden-Spatz disease, and lipofuscinosis

SYNUCLEINOPATHIES:-
• group of neurodegenerative disorders characterized by fibrillary aggregates of ALPHA-SYNUCLEIN PROTEIN in the cytoplasm of neurons and glia.
• These disorders include:-
• Parkinson's disease (PD)
• dementia with Lewy bodies (DLB)
• pure autonomic failure (PAF)
• multiple system atrophy (MSA)

Lung development

Lung development: REMEMBER  the sequence as Entering [Embryonic], Professional [Pseudoglandular], Course [Canalicular],  So [Saccular] Amazing [Alveolar]....
--Develops from median diverticulum of foregut, lining epithelium is endodermal origin.
Stages:-
5 overlapping stages
1.Embryonic –D26-7thwk- lung buds.
2.Pseudo glandular-5thwk-16thwk-Terminal bronchiole.
3.Canalicular-16th-26thwk-Alv.duct.
4.Saccular-26thw-birth-Primitive alveoli.
5.Alveolar-36w-18m-Prominent alveoli.

PDE Inhibitors

Approved PDE3 inhibitors include the following:
amrinone
cilostazol
milrinone
enoximone
Pimobendane
PDE4
Apremilast, a phthalimide derivative being developed for inflammatory disorders, including psoriasis, psoriatic arthritis and ankylosing spondylitis.
Cilomilast, in clinical development
for treatment of COPD.
Diazepam, a benzodiazepine anxiolytic, amnesic, hypnotic, sedative and muscle relaxant.
Ibudilast, a neuroprotective and bronchodilator drug used mainly in the treatment of asthma and stroke. It inhibits PDE4 to the greatest extent, but also shows significant inhibition of other PDE subtypes, and so acts as a selective PDE4 inhibitor or a non-selective phosphodiesterase inhibitor, depending on the dose.
Luteolin, supplement extracted from peanuts that also possesses IGF-1 properties.
Mesembrenone, an alkaloid from the herb Sceletium tortuosum (Kanna).
Piclamilast, a more potent inhibitor than rolipram.
Roflumilast, licensed for the treatment of severe chronic obstructive pulmonary disease
Rolipram, used as investigative tool in pharmacological research.
PDE5
Sildenafil, tadalafil, vardenafil, and the newer udenafil and avanafil selectively inhibit PDE5, which is cGMP-specific and responsible for the degradation of cGMP in the corpus cavernosum. These phosphodiesterase inhibitors are used primarily as remedies for erectile dysfunction, as well as having some other medical applications such as treatment of pulmonary hypertension.
Dipyridamole also inhibits PDE5. This results in added benefit when given together with NO or statins.
Claimed newer and more-selective inhibitors are icariin, an active component of Epimedium grandiflorum,
PDE10
Papaverine, an opium alkaloid, has been reported to act as a PDE10 inhibitor. PDE10A is almost exclusively expressed in the striatum and subsequent increase in cAMP and cGMP after PDE10A inhibition
Nonselective phosphodiesterase inhibitors
Methylated xanthines and derivatives:

caffeine, a minor stimulant
aminophylline
IBMX (3-isobutyl-1-methylxanthine), used as investigative tool in pharmacological research
paraxanthine
pentoxifylline, a drug that has the potential to enhance circulation and may have applicability in treatment of diabetes, fibrotic disorders, peripheral nerve damage, and microvascular injuries
theobromine
theophylline, a bronchodilator
PDE1 selective inhibitors
Vinpocetine
Cilastatin

"MOST COMMON" FACTS -

MC invasive gynecologic malignancy : Endometrial malignancy
MC islet cell tumor in MEN 1 : Gastrinoma
MC islet cell tumor of the pancreas : Insulinoma.
MC joint involved in synovial osteochondromatosis : Knee
MC lesion to cause expansion of paranasal sinus : Mucocele
MC lethal bone dysplasia : Osteogenesis imperfecta
MC lobe affected in bronchial atresia : Left upper lobe.
MC location for a cephalhematoma : Parietal
MC location for a gastric diverticulum : Posterior wall of the gastric fundus.
MC location for a pilocytic astrocytoma : Cerebellum
MC location for a solitary myeloma of the bone : Spine
MC location for a synovial sarcoma : Knee

Psychiatry

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.

One liners

1. Cardiotoxic anticancer drug:
Adriamycin /  Doxorubicin, Donorubicin,  Cyclophosphamide,  5 - Fluorouracil

[Dilated Cardiomypathy is caused by.......:-
DoxoRubicin, DonoRubicin ---- (Rubi Dil le gayi)]

2. Digoxin is excreted Through which route (organ): Renal

3. Digitoxin is excreted mainly by which organ:Liver

4. DOC for PSVT:
1. Adenosine
2. Verapamil

5. Effect on calcium levels of Furosemide:Hypercalemia

6. DOC for motion sickness: Hyoscine (transdermal)[Hyoscine aka Scopolamine: 

also Prescribed to 'Prevent' nausea & vomiting caused by Motion Sickness & Vertigo.]

7. Commonest sife-effect of Cisapride is: Diarrhea

8. Common side-effect of Clofazimine: Red brown discoloration of skin

9. DOC for taenia: Praziquantel

10. Drug inhibiting DNA -dependent RNA polymerase in Mycobacteria is: Rifampicin

11. Common  side-effect of Cisplatin: Vomiting

12. Vitamin deficiency noticed with phenytoin use: Folic acid,Vitamin D, and some says vitamin K as well.

13. DOC for lithium induced Polyuria:  Amiloride

14. Concentration of Lidocaine used in Spinal anaesthesia: 5%

15. Local anaesthetic causing methemoglobinemia: Prilocaine

16. Longest acting local anaesthetic: Dibucaine

17. Anaesthetic agent with LEAST analgesic property: Halothane

18. Post spinal headache can last for: 7-10 days

19. Common site of post spinal headache: Occipital

20. Therapeutic index of a drug is an indicator of its: Safety 

21. Common side-effect of Captopril: Dry cough

22. Active metabolite of Enalapril: Enalaprilat

23. Which steroid can be administered by inhalation: Beclomethasone

24. Drug used for heparin induced thrombocytopenia: Argatroban, Lepirudin 

25. Estrogen acts on which receptors:  Cytoplasmic receptors

26. Mydriasis without cycloplegia: Phenyl-ephrine

27. Buprenorphine is: Partial agonist (mu) & antagonist (k) receptors

28. Drug for maintenance therapy for opioids withdrawl: Methadone 

29. DOC for diabetes inspidus: Desmopressin

30. MOA of minoxidil: Potassium Channel OPENER

31. Beta blocker with shortest plasma half-life: Esmolol

32. Pancreatitis is a common side effect of which anti-HIV: Didanosine

33. Anticancer Drug which causes pulmonary fibrosis: Busulfan, Bleomycin.

34. Drug which is used for treating brady-arrythmias: Atropine

35. MOA of Cholestyramine: Binds to bile acids

36. Antifungal which disrupts fungal cell membrane: Griseofulvin

37. Advantage of 3rd generation cephalosporins over 1st and 2nd generation cephalosporins is that they are: Effective against Gram Negative bacteria.

38. Fluoroquinolone banned in India: Gatifloxacin

39. Anti-malarial drug effective in pre-erythrocytic phase in liver is: Proguanil

40. Effect of chloroquine on eye: Bulls eye maculopathy

41. DOC for herpes simplex: Acyclovir

42. ACE inhibitors causes hyperkalemia so they should not be used with:
Potassium Sparing Diuretics

43. Anticoagulant of choice in pregnancy: Heparin

44. Antidote of heparin: Protamine sulphate

45. Profound Analgesia is related to which anaesthetic agent:  Ketamine

46. Best way to prevent hypotension during spinal anaesthesia:  Preloading with Crystalloids

47. Post spinal headache is due to:  CSF leak

48. Agent causing Malignant Hyperthermia: Succinylcholine.

[DOC for MH - Dantrolene]

49. Nerve fibre affected by Local anaesthesia first: Type C

50. Zero order kinetics at higher dose is seen with: Phenytoin

51. DOC for Scabies: 5% Permethrin ('Oral' DOC - Ivermectin)

52. Lithium monitoring is done because of:  Very low Therapeutic Index

53. MOA of pralidoxime: Cholinesterae enzyme reactivator

54. Drug used in BPH: Prazosin, Tamsulosin

55. DOC for Acute Migraine: Sumitriptan

56. Test for Myasthenia Gravis: Edrophonium Test

57. If Theophylline is used with Ciprofloxacin:  Toxicity of theophylline Increases

58. Steroid with equal Gluco-corticoid & mineralocorticoid activity: Hydrocortisone

59. Flumazenil is: Benzodiazepine Antagonist

60. Fomepizole is used in which poisoning: Methanol Poisoning.

61. MC side-effect of chronic use of Phenothiazines is: Tardive Dyskinesia

62. Side effect of Clozapine: Agranuocytosis

63. MOA of Clonidine:  Alpha2 Agonist  & Decreasing Central sympathetic outflow

64. MOA of Digoxin: Na K ATPase inhibition

65. DOC for meningitis due to listeria:  Ampicillin

66. Mode if metabolism of INH: Acetylation

67. Most common side effect of long term use of lithium: Hypothyroidism

68. DOC for MRSA infection: Vancomycin 69. ADH acts on which part of kidney:  Collecting Duct

70. Hemorrhagic Cystitis may be a side effect of: Cyclophosphamide (Rx. Of Hmg Cystitis: MESNA)

71. Metrifonate is used for: Schistosoma 

72. Anticholinergic drug used in peptic ulcer: Pirenzipine

73. Postural hypotension is commoner with which adrenergic blocker: Prazosin

74. Organ toxicity seen with bupivacaine: Cardiotoxicity.

75. LEAST cardiotoxic anaesthetic agent: Isoflurane

76. Dissociative anaesthesia is seen with: Ketamine

77. Sodium Thiopentone is Ultra-short acting due to: Rapid redistribution

78. Dipyradimole acts by inhibiting  PDE-5 79 Beta 1 agonist drug: Dobutamine

80. Beta1 selective adrenergic blocker which can be used as anti-glaucom: Betaxolol

81. Anti-adrenergic drug which crosses blood-brain-barrier minimally: Atenolol

82. Abacavir belongs to which group: NRTI

83. Prostaglandin analogue used in peptic ulcer: E1

84. Prostaglandin analogue used in glaucoma: F2alpha

85. Shortest acting neuromuscular blocking agent: Mivacurium

86. Anaethetic Drug which increase intracranial pressure: Ketamine

87. Anti-epileptic drug which acts by release of the inhibiting transmitter GABA:   Valproic Acid

88. Furosemide & thiazides have similar properties that they both are:  Well absorbed orally

89. MOA of ciprofloxacin: Inhibits DNA gyrase

90. DOC for WPW syndrome: Pracainamide/ Amiodarone

91. Anti-hypertensive which acts by producing NO Sodium: Nitroprusside

92. MOA of Dantrolene:  Sodium Acts on RyR1 receptors resulting in Decreased Calcium.

93. Interstitial nephritis is MC seen with which antibiotic: Methicillin

94. DOC for dermatitis herpetiformis:  Dapsone

95. Neuro-psychiatric symptoms can be seen with: Cycloserine

96. Oral contraceptive failure may be seen with: Rifampicin 

97. MC side-effect of 5-Fluoro-Uracil: Gastro-Intestinal toxicity

98.  MOA of omeprazole: H K ATPase inhibition

99. Prolonged use of steroids may cause: Decrease in bone matrix proteins

100. First drug to be used in anaphylactic shock: Adrenaline (Subcutaneous / IM )