Blood donors criteria

Blood donors are deferred if::
1) they are less than 17 years of age or under 50 kg in weight.
2) They are also deferred for 12 months after bodybpiercing or tattoos, and
3) now only for 6 months following the incident if the antihepatitis B core test is negative.
4) They are deferred for 6 months after travel to an endemic malarial area, or longer if they fell ill abroad or were resident for a period of 6 months or more in Sub-Saharan Africa.
5)They will be deferred for a period after pregnancy.
6)Absolute deferral now occurs if they have had any organ transplant or blood transfusion after 1980 in the UK because of the risk of variant Creutzfeldt–Jakob
disease.

IOC

INVESTIGATION OF CHOICE:
• Single Bone Metastasis – CT
• Multiple Bone Metastasis – Bone scan
• Spine Metasta sis – MRI
• Avascular necrosis- MRI
• Bone Density/Osteoporosis- DEXA (Dual energy x ray absorptiometry)
• Aneurysm/ AV Fistula- Angiography
• Dissecting Aneurysm (Stable) - MRI (Unstable)-Trans oesophageal USG
• Pericardial Effusion- Echocardiography
• Lobulated pericardial effusion- MRI > CT
• Minimum Pericardial Effusion- Echocardiography
• Ventricular Function- Echocardiography
• Radiotherapy/Chemotherapy induced cardiotoxicity- Endomyocardial Biopsy
• Pulmonary Embolism- CECT> Pulmonary Angiography > V/Q Scan
• Interstitial lung disease(Sarcoidosis)- HRCT
• Bronchiectasis- HRCT scan
• Solitary Pulmonary Nodule- High resolution CT (HRCT)
• Posterior Mediastinal Tumor- MRI
• Pancoast Tumor (Superior Sulcus Tumor) – MRI
• Minimum Ascites/Pericardial effusion/Pleural effusion – USG
• Traumatic Paraplegia- MRI
• Posterior Cranial Fossa – MRI
• Acute Haemorrhage- CT
• Chronic Haemorrhage- MRI
• Intracranial Space Occupying Lesion- MRI
• Primary brain tumour- contrast MRI (Gold standard however remains to be biopsy)
• Metastatic brain tumor- (Gadolinium) contrast enhanced MRI
• Temporal Bone-CT
• SAH Diagnosis- unenhanced CT
• SAH aetiology- 4 vessel MR Angiography > CT Angiography > DSA
• Nasopharyngeal angiofibroma- CECT scan
• Acoustic neuroma- Gadolinium DTPA enhanced MRI
• Obstetrics- USG
• Calcifications- CT
• Blunt abdominal Trauma- CT
• Acute Pancreatitis- CT
• GERD- pH manometer > endoscopy
• Dysphagia- Endoscopy
• Congenital hypertrophic pyloric stenosis- USG
• Extrahepatic biliary atresia- perioperative cholangiogram
• Obstructive Jaundice/GB Stones- USG
• Diverticulosis – barium enema
• Diverticulitis – CT scan
• Renal TB (early) – IVP (Late)- CT
• Posterior Urethral Valve- MCU
• Ureteric stone- non contrast CT
• Renal Artery Stenosis- Percutaneous Angiography
• Extraintestinal Amoebiasis- ELISA
• Discrete swelling(solitary nodule) of thyroid- FNAC

Gold standard

Gold standard method of treatment of DCIS - Mastectomy

Gold standard approach for resection of anterior and middle mediastinal masses - median or lateral thoracotomy

Gold standard method of treatment of Coarctation of aorta - Surgical repair

Gold standard method for evaluation of coronary artery disease - Cardiac Catheterization

Gold standard method for culture of V. cholerae o139 - Conventional culture method

Gold standard to determine cut-off titer of widal test for diagnosis of Typhoid fever – Nested PCR

Gold standard treatment of brucellosis in adults - IM Streptomycin + Doxycyclin

Gold standard investigation for diagnosis of of chronic arterial mesentric ischemia - Angiography

Gold standard method for treatment of chronic ulcerative colitis - Total proctocolostomy with end ileostomy

Gold standard method for evaluation of imaging modalities for liver tumors - Intraoperative ultrasonography

Gold standard investigation for diagnosis of common bile duct stones - Endoscopic cholangiography

Gold standard investigation for measurement of GFR - Inulin clearance

Gold standard for treatment of organ confined, muscle invasive, bladder cancer is - Radical cystoprostatect omy in men and anterior pelvic exenteration in woman

Gold standard for treatment of femoral shaft fractures - Reamed locked intramedullary nailing

Gold standard method in case of difficult intubation - Flexible fibreoptic intubation scope

Gold standard method for diagnosis and treatment of Ventilator Associated Pneumonia (VAP) - Broncho alveolar lavage

Gold standard treatment of hyperparathyroi dism - Surgery

Gold standard investigation to differentiate follicular and papillary carcinoma of thyroid gland- Histology

Gold standard procedure for thymectomy - Trans cervical mediastinoscopy and surgery

Gold standard for treatment of adrenal tumors - Laparoscopic adrenalectomy

Gold standard investigation for diagnosis of breast cancer - Mammography

Gold standard method for staging of breast cancer - Axillary lymph node dissection

Gold standard for evaluation of a stable patient with suspected vascular injury - Angiography

Gold standard investigation for diagnosis of GERD - Ambulatory 24 hr PH monitoring

Gold standard method for treatment of GERD - Laparoccopic Nissens fundoplication

Gold standard for evaluating cure rate in duodenal ulcer patients – Vagotomy

Gold standard finding for the diagnosis of GI perforation - Finding pneumoperitoneu m

Gold standard for diagnosis of Zollinger-Ellis on syndrome - Serum gastrin levels( Most patients have serum gastrin levels above 1000pg/mL)

Gold standard investigation for diagnosis of colonic mucosal disease - Colonoscopy

Gold standard investigation for diagnosis of steatorrhoea - Timed quantitative stool fat determination

Gold standard method for treatment of incontinence with an isolated sphincter defect - Overlapping sphincteroplast y

Gold standard investigation for diagnosis and method of management of Acute arterial occlusion – Laparotomy

Gold standard method for confirmation of mesentric arterial occlusion - Mesentric angiography

Gold standard investigation for diagnosis of celiac disease – Small intestine biopsy

Gold standard for identifying choledocholithi asis – ERCP

Gold standard method of treatment of Symptomatic cholelitiasis – Lap cholecystectomy

Gold standard method for diagnosis of Primary sclerosing cholangitis - ERCP

Gold standard investigation for diagnosis of Hepatitis C – HCV RNA assay

Gold standard test for diagnosis of intraluminal bile duct abnormalities - ERCP

Gold standard method for management of hydatid disease – Surgery

Gold standard for assessing degree of liver injury and fibrosis - Liver Biopsy

Gold standard method for management of blunt hepatic trauma - Non-operative management

Gold standard test for assessment of function of sphincter of oddi – Manometry

Gold standard investigation of diagnosis of Klatskin tumor - Cholangiography

Gold standard investigation for diagnosis of invasive amoebiasis - ELISA

BACTERIAL VAGINOSIS

BACTERIAL VAGINOSIS

-formerly termed nonspecific vaginitis, Haemophilus vaginitis, anaerobic vaginitis, or Gardnerella-associated vaginal discharge
-Characterized by symptoms of vaginal malodour and increased white discharge
-MC cause of vaginitis
-Not sexually transmitted
- Increased risk of other infections like HIV,C.trachomatis,N.gonorrhea and risk of preterm delivery
-Culture of discharge- G.vaginalis,Mycoplasma hominis,several anerobic bacteria like Prevotella

-Absence of Lactobacillus which is the MC organism of normal vaginal microbiota

-Criteria-AMSEL’s(any 3 of 4)
1-objective signs of increased vaginal discharge
2-discharge of pH>4.5
3-distinct fishy odor when secretions mixed with 10%KOH(Whiff test+70%cases)
4-Clue cells and absence of WBCs on microscopy of secretions with normal saline 1:1(most specific criteria)

-Modified Amsels use any 2 of 4 criteria
-Fishy odour is due to volatile amines mainly trimethylamine
-Clue cells are vaginal epithelial cells coated with coccobacillary organisms(>20% diagnostic)
-NUGENTS score>7 is diagnostic of BV

-TT-Oral metronidazole 500mg twice daily for 7 days
2%clindamycin cream or 0.75%metronidazole gel can also be used.

-Newer test BVBLUE Rapid Diagnostic test for BV- detects sialidase activity
--Only Bacteria resistant to metronidazole treatment and recurrence of BV- Atopobium vaginae

STRUCTURAL THEORY OF THE MIND

This is a concept developed by Freud, and it describes the three theories that
encompass the human mind.  These three theories are the: Id, Superego, and Ego.

These structures have different functions, they are:

Id – The Id is responsible for sexual urges, aggression, and other primal urges.

Superego – The superego encompasses the part of your mind that tells you to
control your primal urges, it acts as your conscience.

Ego – The ego is the theory that helps the mind deal with the conflict between the
‘wants’ of the Id, and the conscience of the superego.

Wounds

Classification of wounds :-
A. Class I - Clean wound :
- Wounds of elective surgery with aseptic
technique
- No hollow viscus, which normally contains
bacteria, is opened (e.g.Gastrointestinal,
Genitourinary or Respiratory tract)
Examples : Vascular surgery, Mastectomy,
Herniorrhaphy, Total hip replacement,
Exploratory laparotomy (with no bowel
involvement) etc.
[Infection rate : 2%]
B. Class II - Clean contaminated wound :
- Gastrointestinal, Genitourinary or
Respiratory tract is opened, but there is no
spillage (minimum contamination)
Examples : Appendectomy, Cholecystectomy
etc.
[Infection rate : 10 %]
C. Class III - Contaminated wound :
- Gross spillage from an unprepared organ
- Fresh, traumatic wounds
Examples : Resection of unprepared bowel,
Ruptured appendix
[Infection rate : 20 %]
D. Class IV - Dirty wound :
- Pus in operative field
- Traumatic perforation of viscus
- Dirty, traumatic wounds
Examples : Debridement, Incision & drainage
of abscess, Fecal peritonitis etc.
[Infection rate : 30-70%]

VHL disease subtypes

VHL disease subtypes

VHL disease can be subdivided according to the clinical manifestations, although these groups often correlate with certain types of mutations present in the VHL gene.

Type 1

Type one often has deletion ornonsense mutations. This group manifests mostly as hemangioblastomas whereas clear-cell renal carcinomas and pheochromocytomas are rare.

Type 2

Type 2 VHL disease is subdivided into Type 2A, B and C which are characterised mostly by missense mutations. Type 2A is at risk of hemangioblastomas and pheochromocytomas, but not clear-cell renal carcinomas. Type 2B is at risk of all three tumours, with a higher risk of clear-cell renal carcinoma. Type 2C is at risk for only pheochromocytoma.

Type 3

Type 3 VHL disease has a risk of Chuvash polycythaemia.