Saturday, 31 August 2013

CNS tumours

Most common brain tumor in children- pilocytic astrocytoma
Most common posterior fossa tumor in children- pilocytic astrocytoma
Most common malignant brain tumor in children- medulloblastoma 
Most common suprasellar tumor in children- craniopharyngioma
Most common cause of intra cranial calcification- pineal body calcification
Must common brain tumor calcifying in children- craniopharyngioma

Various signs in ent

AQUINO'S SIGN is the blanching of the tympanic mass with gentle pressure on the carotid artery.Seen in Glomus tumors .
BATTLE SIGN - Bruising behind ear at mastoid region, due to petrous temporal bone fracture (middle fossa #)
Inflammatory edema at the tip of the mastoid process in mastoiditis
BOCCA’S SIGN - Absence of postcricoid crackle(Muir’s crackle) in Ca post cricoid
Refers to the blanching noted when applying positive pressure {with Siege's speculum } to the tympanic membrane of a patient with Glomus tumor .
BRYCE SIGN - If combined laryngocele & external laryngocele is presenting as a neck mass, compression will cause a hissing sound as the air escapes from it into the larynx. This test is fraught with danger in cases of combined laryngoceles because air from the external component may get forced into the internal component causing acute airway obstruction.

Lateral sinus thrombosis on CT or MRI with contrast shows an empty triangle appearance of the thrombosed sinus surrounded by contrast enhanced dura{since
contrast may flow around the clot to outline the periphery of the sinus}. It is also called as empty triangle sign.

X-ray finding-Crescent of air between the mass and posterior pharyngealwall. positive in AC ployp.Negative in Angiofibroma

Encephaloceles .Owing to the intracranial connection, there is pulsation and expansion of the mass with crying, straining, or
compression of the jugular vein(Furstenberg test).This is used to differentiate Nasal Encephaloceles from other congenital midline nasal masses like Nasal Gliomas.

Erythema and oedema posterior to the mastoid process resulting from septic thrombosis of the mastoid emissary vein. seen in lateral sinus thrombosis

- A finding in CSF rhinorrhea when CSF is mixed with Blood. In patients with head trauma, a mixture of blood and CSF may make the diagnosis difficult.CSF separates from blood when it is placed on filter paper, and it produces a clinically detectable sign: the ringsign, double-ring sign, orhalo sign.
CSF will separate from blood when the mixture is placed on filter paperresulting in a central area of blood with an outer ring or halo.Blood alone does not produce a ring.
The best ring is obtained with a 50: 50 mix of blood and CSF. More importantly, they found that the presence of a ring was not exclusive for CSF.Blood mixed with tap water, saline, and rhinorrhea fluid also produced a ring.
The halo sign does occur, but clearly does not clinch the diagnosis.

In Acoustic neuroma- loss of sensation in the postero-superior part of external auditory meatus supplied by Arnold’s nerve( branch
of Vagus nerve to ear )
The anterior bowing of the posterior wall of the antrum seen on lateral skull film . Pathognomic for juvenile nasopharyngeal
angiofibroma .
HONDOUSA SIGN –X-ray finding in Angiofibroma .indicating infratemporal fossa
involvement characterised by widening of gap between ramus of mandible and maxillary body.

It is a false positive fistula test when there is no evidence of middle ear disease causing fistula of horizontal semicircular canal. It is seen in 25% cases of meniere's disease or congenital syphilis.In 25% cases of Meneire’s ,fibrous bands form connecting utricular macule to stapes footplate. In
syphilis due to hypermobile stapes footplate.
Hennebert sign -pressure induced nystagmus ,
Hennebert symptom - pressure
induced dizziness]

IRWIN MOORE’S SIGN ——– positive squeeze test in chronic tonsillitis.

Blood behind the eardrum suggests basilar skull fracture .
Inflammation of the eustachian tube can produce a bright clicking sound heard by the
examiner through the otoscope while the patient experiences it as tinnitus.caused by reflex spasm of the tensor palati muscle.
A small pin hole perforation with a pulsatile ear discharge is seen in Acute suppurative otitis media.

LYRE’S SIGN - splaying of carotid vessels( at junction of External & internal carotid artery) in carotid body tumor .
Erysipelas can spread to pinna(cuticular affection), where as cellulitis cannot. Cellulitis and erysipelas manifest as areas of skin erythema, edema and warmth in the absence of underlying suppurative foci. They differ in that erysipelas involves the upper dermis and superficial lymphatics, whereas cellulitis involves the deeper dermis and subcutaneous fat.As a result, erysipelas has more distinctive anatomic features than
cellulitis; erysipelas lesions are raised above the level of surrounding skin, and there is a
clear line of demarcation between involved and uninvolved tissue. Classic descriptions of erysipelas note "butterfly" involvement of the face.Involvement of the ear (Milian's ear sign) is a distinguishing feature for erysipelas since this region does not contain deeper dermis tissue.

Infantile omega shaped epiglottis seen in laringomalacia.
Paul Dudley White's Winking Ear
Lobe Sign-
Movement of the ear lobe coincident with the pulse suggests tricuspid insufficiency.

- loss of crest of bone (as seen in CT-scan) between carotid canal and jugular canal in
glomus jugulare .

RAT TAIL SIGN /“Bird-beak” sign -
Sign in barium swallow of achalasia. The oesophagus is dilated, and contrast material
passes slowly into the stomach as the sphincter opens intermittently. The distal oesophagus has a narrow segment and the image resembles a bird's beak. This is in contrast to the rat's tail appearance of carcinoma of oesophagus.Barium swallow shows characteristic rat tail appearance
with irregular mucosa margins in carcinoma esophagus .

There is red vascular hue seen behind the intact tympanic membrane. it is seen in glomus tumour, high jugular bulb and aberant carotid artery in the floor of middle ear .

Indicate subgaleal hemorrhage,and not necessarly base of skull .

It is also called flamingo flush sign. it is seen because of increased vascularity in submucous layer of promontory in active phase of otosclerosis(otospongiosis).

X-ray finding in Acute laryngotracheobronchitis(CROUP).The steeple sign is produced by the presence of
edema in the trachea, which results in elevation of the tracheal mucosa and loss of the normal shouldering (lateral convexities) of the air column.
indicate orbital injury during FESS . fat protrude in to nasal cavity on compression of eye ball from outside .

Seen in Orbital floor fracture . It is defined as tear drop shaped opacification seen hanging from the roof of the maxillary sinus on water's view. The floor of the orbit is the most common portion of the orbit to sustain fracture. A classic radiographic finding in blow-out fractures is the presence of a
polypoid mass (the tear-drop) protruding from the floor of the orbit into the maxillary antrum
The tear-drop represents the herniated orbital contents, periorbital fat and inferior rectus muscle.

It is a thumb like impression (due to enlarged epiglottis) seen on X-ray lateral view neck in patients with acute epiglottitis. Direct
visualisation of the epiglottis by laryngoscope, if attempted, reveals a beefy red, edematous epiglottis.

In acute otitis externa there is marked tenderness when tragus is pressed against the pinna.

TEA POT SIGN is seen in CSF rhinorrhoea .This could be related to the relationship of the sphenoid ostium to the sinus floor. The
sphenoid ostium lies at an appreciable distance anterosuperior from the sinus floor. An increase in the CSF rhinorrhea therefore occurs in a case of sphenoid sinus leak when the patient bends forward as an increasing amount of CSF gains access to the ostium "teapot" sign.
uvula pointing sign - uvula points to side of palatal palsy
Uvula pointing sign - seen in
rhinoscleroma .when scleroma
involve nasopharynx ,uvula point
towards roof of nasopharynx.
WOODS SIGN —– palpable jugulodigastric lymphnodes.

Glaucoma Drugs

-Which drug used for rx of hypotrichosis?

-Which antiglaucoma drug cause lid retraction?

-Which antiglaucoma drug cause Cystoid macular odema in aphakiks.?

-Which antiglaucoma drug cause drowsiness?

-Which antiglaucoma drug asso wid anterior

Friday, 30 August 2013

Causes of rib notching:

Superior rib notching
Restrictive lung disease
Connective tissue disease
Osteogenesis imperfecta
Inferior rib notching
Thrombosis of aorta
Coarctation of arota
Blalock Taussig shunt
Occlusion of subclavian artery
Pulmonary AV malformation

Components of of ReSoMal:

Glucose 125 mmol/l
Sodium 45 mmol/l
Potassium 40 mmol/l
Chloride 70 mmol/l
Magnesium 3 mmol/l
Zinc 0.3 mmol/l
Copper 0.045 mmol/l
Citrate 7 mmol/l

Wednesday, 28 August 2013

Mammography :

It is of 2 types
a)Screening mammography – used to detect breast changes in women who has no signs and symptoms of breast abnormality – Taken from two angles of each breast (Cranio caudal view, Mediolateral oblique(MLO) view)
b)Diagnostic mammography – used to investigate the suspicious breast cancer changes such as breast lump , Breast pain, unusual skin changes and nipple discharge.
Screening mammography for women age 40 – 49 yrs every 1 – 2yrs and annually after age 50 yrs !!!! Imp !!
30% reduction in Breast cancer mortality in women 50 -69 yrs was seen who were screened annually or Biannualy by mammography
Radiation risk with mammography is there but very small ( less than 0.2rads or 0.2cGy per exposure – this is very less but theoretically risk of breast cancer is there
Mammography is not useful in young women (< 35 yrs of age ) – because of the Breast density – USG may be more useful.
35 – 50% of early Breast cancers can be discovered only by mammography
Another 40% can be detected by palpation alone


Paranoid delusions seen in --canabis
Paranoid hallucinations-- amphetamine
Paranoid pschysosis-- cocaine

Rate limitting steps key enzymes----

1:Cholesterol syntheis:- HMG CoA Reductase
2:Ketone body synthesis:- HMG CoA Synthatase
3:Gluconeogenesis:- Pyruvate carboxylase
4:Glycogenesis:- Glycogen synthetase
5:Glycogenolysis:- glycogenphosphorylase
6:Glycolysis:- PFK-1
7:TCA cycle:- Isocitrate dehydogenase
8:Fatty acid synthesis:- Acetyl CoA Carboxylase
9:Fatty acid oxidation:- Carnitine acyltransferaseI
10:In Bile Acid Synthesis:- 7Alpha hydroxylase
11:Urea cycle:- Carbamoyl phosphate Synthetase I
12: HMP shunt:- G6PD
13: De novo pyrimidine synthesis:- Carbamoyl phosphate synthetase II
14:- De novo Purine synthesis:- Glutamine-PRPPamidotransferase

Tuesday, 27 August 2013


The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:

Axis I: All diagnostic categories except mental retardation and personality disorder
Axis II: Personality disorders and mental retardation
Axis III: General medical condition; acute medical conditions and physical disorders
Axis IV: Psychosocial and environmental factors contributing to the disorder
Axis V: Global Assessment of Functioning or Children's Global Assessment Scale for children and teens under the age of 18

Monday, 26 August 2013

Hepatitis families

hep A- enterovirous
hep B- hepadna
hep C- flaviviridae
hep D- defective rna
hep E- calcivirus

Saturday, 24 August 2013

In pregnancy test for diabetes.

1)Best screening test.- glucose challenge test
2)Best diagnostic test -Glucose tolerance test
3)Best to diagnose fetal malformation -Hba1c.

Summary:: Indian government pay,

Vasectomy::1500 Rs.
Accpetor: 1100
Motivator:: 200
Dressing, surgeon, anesthesia:: 200
Tubectomy:: 1000 Rs.
Acceptor:: 600(reserved category)
Acceptor:: 250(open)
Motivator:: 150
Dressing, surgeon, anesthesia::250

Wednesday, 21 August 2013

Hypertension Drug of Choice in various coexisting conditions

*Best initial therapy= Thiazide
*Excellent treatment of systolic HTN= CCB
*HTN + Recurrent stroke= ACEI, Thiazide
*HTN + Migraine = CCB
*HTN + Raynaud's phenomena= CCB
*HTN + Essential tremor= BB
*HTN + Glaucoma= BB
*HTN + Hyperthyroidism= BB
*HTN + Depression= avoid BB
*HTN + Asthma= avoid BB
*HTN + CHF + AF from ischemia= BB
*HTN + Heart failure= ACEI, ARB, BB, Spironolactone
*HTN + Osteoporosis= Thiazide 
*HTN + Pregnancy= M.dopa , nifedipine

Tuesday, 20 August 2013


Sade classification: Retraction of pars tensa
Toss classification : Retraction of pars flaccida
Antoni classification:Acoustic neuroma
Derlacki classification: Congenital
Nelson classification: CSOM
Shea classification :Meniere's disease
Isshika classification:Thyroplasty
Wullstein classification :Tympanoplasty
Fisch classification:Glomus tumours.

Sunday, 18 August 2013

Various Fathers of Medicine

1. Father of Biology , Embryology & Zoology -ARISTOTLE .
2. Father of Anatomy - ANDREAS VESALIUS
3. Father of Comparative Anatomy - GeorgeCuvier
4. Father of Microscopic Anatomy - MorcelloMalpighi
5. Father of Histology - Francois Bichat
6. Father of Modern Embryology - Karl ErnstVon Baer
7. Father of Physiology - Aristotle
8. Father of Modern Physiology , BloodCirculation - William Harvey
9. Father of Gastric Physiology - WilliamBeaumont
10. Father of Stress Physiology - Hans Selye
11. Father of Conditioned Reflexes - Pavlov
12. Father of ECG - Einthoven
13. Father of Biochemistry - Carl AlexanderNeuberg
14. Father of ATP cycle - Lipmann
15. Father of Modern Pathology , CellularPathology - Rudolf Virchow
16. Father of Pharmacology - OswaldSchmiedeberg
17. Father of Indian Pharmacology - Sri RamNath Chopra
18. Father of Chemotherapy - Paul Ehlrich
19. Father of Antibiotics - Alexander Fleming
20. Father of Microbiology - Louis Pasteur
21. Father of Microscopy - Anton vanLeeuwenhoek
22. Father of Bacteriology - Robert Koch
23. Father of Virology - Stanley
24. Father of Mycology - Micheli
25. Father of Parasitology - Platter
26. Father of Immunolgy - Edward Jenner
27. Father of Tissue Culture - Harrison
28. Father of Legal Medicine , ForensicPsychiatry - Paulus Zacchias
29. Father of Toxicology - Mathieu Orfila
30. Father of Epidemiology - John Snow
31. Father of Medicine , Western Medicine -Hippocrates
32. Father of Endocrinology - Addison
33. Father of Transfusion Medicine , BloodGroups - Karl Landsteine
r34. Father of Modern Surgery - Ambroise Pare
35. Father of Antiseptic Surgery - Joseph Lister
36. Father of Indian Surgery - Susruta
37. Father of Modern Facial Plastic Surgery -Jacques Joseph
38. Father of Modern Neurosurgery - HarveyCushing
39. Father of Indian Paediatrics - Dr. GeorgeCoelho
40. Father of Modern Psychiatry - PhilippePinel
41. Father of Dermatology - Ferdinand vonHebra

Saturday, 17 August 2013

List of some Hypersensitivity pneumonitis :

1. hot tub lung - Mycobacterium avium
2. tap water lung - Mycobacterium spp
3. chemical worker's lung - Isocyanates
4. air conditioner's lung - Aureobasidium
5. cheese washer's lung - penicillium casei
6. compost lung - Aspergillus 7. Detergent worker's lung - Bacillus subtilis
8. laboratory worker's lung - male rat urine
9. Japanese summer type - Trichosporon
10. Mushroom worker's lung - Thermophilic

Strawberry in medicine

Strawberry tongue--kawasaki disease
Strawberry vagina-- trichomonas
Strawberry gums-- wegners
Strawberry skull-- edwards syndrome
Strawberry gall bladder-- cholesterosis
Strawberry hemangioma- capillary hemangioma
Strawberry skin-- sarcoidosis
Strawberry nasal mass--rhinosporidiosis

Hereditary Angiooedema

Hereditary angioedema (HAE) is an autosomal dominant disorder defined by a deficiency of functional C1 esterase inhibitor (C1-INH). Acquired angioedema (AAE) is caused by either consumption (type 1) or inactivation (type 2) of CI-INH. Both HAE and AAE can be life-threatening. The screening test for both conditions is complement component C4, which is low to absent at times of angioedema or during quiescent periods

Investigation of choice:

• Single Bone Metastasis – CT
• Multiple Bone Metastasis – Bone scan
• Spine Metastasis – 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

X ray

Chest Heart & Blood Vessels

Flask-shaped / Pear-shaped / Leathe- bottle / Money-bag shaped heart - Pericardial effusion
Boot-shaped heart / Coer-en-sabot - Fallot's tetralogy
Box shaped appearance - Tricuspid atresia
Jug Handle appearance - Primary pulmonary artery hypertension
"3" like appearance - Coarctation of Aorta
Egg on side appearance - Transposition of great vessels
Egg in cup appearance - Constrictive pericarditis
Snow-man heart - TAPVC (total anomalous pulmonary venous connection)
Figure of '8' - TAPVC (total anomalous pulmonary venous connection)
Cottage Leaf appearance - TAPVC
Pericardial calcification - Constrictive pericarditis
Calcification in heart wall - is seen in - Carcinoid syndrome
Calfication of ascending aorta - Atherosclerosis, Syphilis
Hilar dance on fluoroscopy - Atrial Septal Defect
Xray finding in Ebstein's anomaly - Pulmonary oligemia
Posterior displacement of trachea - seen in - aneurysm of aorta
Obliteration of left border of heart (PA view of chest) is - suggestive of - Lingular pathology (left lung)
Bat's wings appearance - Pulmonary oedema
Pruned tree appearance (of pulmonary circulation) - Pulmonary artery hypertension


Krukenbrg spindle - seen  in pigmentary glucoma
Krukenberg operation - convert forearm amputation stump into a pincer
Krukenbrg tumour- malignancy of ovary that metastasized from primary site mainly somach

Important points

1. Arlt's Line-->Fibrosis of sulcus subtarsalis .It is pathognomonic for a healed Trachoma.
2. Bone spicule pigmentation-->Retinitis pigmentosa.
3. Busaca Nodules-->granulomatous anterior uveitis.
4. Bitot spots-->a conjunctival triangular white patches.It is pathognomonic for Dry eye.
5. Black sunburst--->RPE Hyperplasia in Sickle Cell Retinopathy.
6. Bull's Eye Maculopathy-->Chloroquine ocular side effect.
7. Cobble stone papillae-->Spring catarrh.
8. Cornea verticillata-->Amiodarone ocular side effect.(most common) .Other Causes--->chloroquin,fabry's disease,Indomethacin.
9. Cherry red spots-->CRAO(most common).Other Causes-->Tay sachs disease,Gaucher's disease.nimen pick, gm-1
10. Chocked disc-->Papilloedema..
11. Candlewax drippings(Retinochoroidal exudate)-->sarcoid periphlebitis(Ocular Sarcoidosis).
12. Egg yolk appearance-->Vitelliform macular dystrophy (Best disease).
13. Eclipse sign-->shallow anterior chamber.
14. Elschig spots-->Hypertensive Retinopathy.
15. Festooned Pupil-->Iridocyclitis.
16. Floppy Iris(Intraoperative)-->Tamsulosin ocular side effect.
17. Haab's striae-->Congenital Glaucoma.
18. Hammered silver corneal endothelial appearance-->ICE(Iridocorneal Endothelial syndrome).
19. Hutschinson sign-->involvement of the tip of the nose in herpes zoster ophthalmicus.
20. Iris pearls-->lepromatous iritis.
21. Inverted hypopyon-->emulsified silicone oil.
22. Kayser-Fliesher Ring(corneal)-->Hepato-lenticular degeneration.
23. Krukenberg spindle--->pigmentary glaucoma.
24. Lisch nodules--->Neurofibromatosis-I.
25. Munson's sign-->Keratoconus.
26. Roth's spots-->Anaemic Retinopathy.
27. Retinal flower pedal pattern(FFA)-->Cystoid macular oedema.
28. Sampaolesi line-->PEX Syndrome.
29. Silver wiring of retinal vessels-->Degenerative retinoschisis.
30. Sentinel vessels-->ciliary body melanoma.
31. Sunset glow fundus-->Chorioretinal scars in Harada disease.
32. Smoke stack appearance ( FFA)-->CSR.
33. Tears drop sign(CT scan)--->Blow out fracture of Orbit.

Blood Supply to organs

Blood supply to various organs ml/min
L-liver                   1500
K-kidney               1250
M- muscle            1000
B- brain                 750
S- skin                   500
C- coronary heart 250

Duct independent flow

Ductus independent flow are just 3
Mneumonic anti tb treatment

1.Anomalous origin left coronary art from pulm art ALCAPA

2.Trunkus arteriosus

3.Total anomalous pul vein return Tapvr

Wolfram syndrome

DI.         diabetes insipidus
DM     ..diabetes mellitus
OA..     .optic atrophy
D...        Deafness

IMP Points

“Most radiosensitive cell of body is lymphocyte”
“Most radiosensitive ovarian tumour or of wholebody is dysgerminoma”
“Most common radiosensitive lung tumor is smallcell carcinoma of lung”
“Most common radiosensitive testicular tumor is seminoma”
“Most common radiosensitive bone tumours are multiple myeloma and Ewings sarcoma”
“Most common radiosensitive brain tumor medulloblastoma”
“Most common radiosensitive renal tumor willms tumor”
“Thumbprint sign is seen in ischaemic colitis”
“Mercedes Benz sign is sign is seen in radiopaque gall stones”
“Double bubble sign s seen in duodenal atresia single in pyloric and multiple bubble sign is seen in ileal`jejanal atresia”
“Driven snow sign is seen in pindborgs tumor”
“Flower vase sign is seen in Horse shoe kidney”
“Vertebra plana is seen in eosinophillic granuloma”
“Rat tail esophagus is seen in oesophagal carcinoma”
“Cork screw esophagus is seen in diffuse oesophagal spasm”
“Thimble bladder is seen in tb bladder”
“Sand patches in bladder are seen in schistosomiasis”
“Chain of lakes is seen in chronic pancreatitis”
“Golfhole ureter is seen in tb ureter”
“Soap bubble app is seen in osteoclastoma”
“Snowmans sign is seen in TAPVC”
“Boot shaped heart is seen in TOF”
“Tram track calcification is seen in sturge weber syndrome”
“Bilateral spider leg appearance is seen in polycystic kidneys”
“Air bronchograms are seen in consolidation”
“String of kantor is seen in crohns disease”
“Apple core sign is seen in left colon cancer”
“Snow storm appearance is seen in hydatiform mole”
“Camaleotes sign is seen in hydatid disease of liver”
“Colon cut off sign is seen in acute pancreatitis”
“Saw tooth sign is seen in diverticulosis”
“Egg in cup appearance is seen in renal papillary necrosis”
“Codmans traingle and sunray app is seen in osteosarcoma”
“Coffee bean sign is seen in sigmoid volvulus”
“Bamboo shaped spine in ankylosing spondylitis”
“Salt and pepper skull in hyperparathyroidism”
“Strawberry gingiva is seen in wagners granulomatosis”
“Strawberry tounge is seen in scarlet fever,toxic shock syndrome and kawasakis disease"
“Strawberry cervix is seen in trachomoniasis”
“Strawberry nose is seen in rhinosporidosis”
“Strawberry skin and nasal mucosa is seen in sarcoidosis”
“Calots triangle is made superiorly by inferior border of liver,medially by common hepatic duct and inferiorly by cystic duct”
“Contents of calots triangle are lymph node of lund, right hepatic artery, cystic artery"
“Billing method of contraception is a behavioural method”
“Hasses rule is used for calculation of gestational age based on length of fetus”
“Hellens rule says twins as
1 in 80,2 in (80*80),3 in (80*80*80)
“In Mayer Rokintansky kuster Hausers syndrome ovary is normal because it develops from genital ridge”
“Most common cause of perinatal death in multi fetal pregnancy is prematurity”
“Most common cause of maternal death in India is hemorrhage>anemia>sepsis”
“Intersitial ectopic pregnancy ruptures later because of closer endometrial support”
“Progesterone is common harmone in both Arias stella and decidual reaction”
“Pentoxifyline has proved to b best for treating hepatorenal syndrome”
“Amoebic ulcers are flask shaped”
“Typhoid ulcers are longitudinal”
“Tubercular ulcers are tranverse”
“Tubercular enteritis cause strictures of gut”
“Dementia is a late feature of whipples disease but bad prognostic feature”
“Ito cells containg vitamin A are present in space of disse”
“Most common site of gastrinoma is duodeneum pasaros triangle”
“D xylose test is used to mark difference between malabsorption due to intestine and pancreas”
“D xylose will be negative in pancreatic malabsorption, malnutrition, gastrectomy”
“D xylose wl b false positive in ascites,pleural effusion,blind loop syn,renal failure”
“Alpha feto protein in normal in hepatolammelar tumour of liver but increased in hcc”
“In mallory weiss mucosa n submucosa are involved however Boerhaave is transmural”
“In proximal short bowel syndrome symptoms wl b malabsorption,iron deficiency and calcium malabsorption”
“In terminal ileum short gut syndrom sx wl b megaloblasticanemia,malabsorption,cholesterol gall stones and oxalate kidney stones”
“Potential of malignancy is highest in UC as compared to CD”
“5-ASA is drug of choice in IBD however sulfinpyradine moeity is responsible for side effects and use in rheumatoid arthritis”
“Chronic gastritis caused by h-pylori involves fundus body and antrum but autoimmune involves fundus ,body only”
“Barrets metaplasia cause adenocarcinoma always”
"paracussis willlisi is better hearing in noisy environtment seen in otospongosis"
"Tulio phenomenom is associated with endolymphatic hydropis"
"pulsatile tinnitus is seen in glomus jugalare"
"pulsatile ottorhea is associated with Asom"
"effect of local anesthetics on nerve fibers is Type C>B>A
                                                                        Hypoxia B>A>C 
                                                                        Pressure A>B>C"
"life span of Mirena iucd is 5 yrs
                        Cu T 380 A 10 years
                               Nova T 5 yrs,,, 
                           progestert 1 year,,,
                           CU T 200 3 years,, 
                          cu T 200B 4 yrs "
"incision in tubectomy is given at isthumus"
"Bupivacaine is most cardio toxic local anesthetic"
"lermoyz syndrome is a variant of Meneries in wich sx occurs in reverse fashion"
"carraths notch in otosclerosis occurs at 2 kHz however dip in barotrauma occurs at 4 khz"
"dribbling of saliva from angle of mouth is sure sign of death due to hanging"
"Hyoid fracture is mostly seen in throttling"
"potts puffy tumor and mucocele occurs mostly in frontal sinus"
"max dose of lignocaine is 300 and 500 mg with adrenaline"
"death in drowning occurs due to ventricullar fibrillation or cardiac arrest"
"Heneberts sign is associated with Meneries disease"
"AC>BC and weber lateralised owards normal ear means normal or sensoneural deaffness or presbyccusis"
"contraceptiv of choice in emergent conditions is levonorgestral"
"lucio phenomenom is seen in LL type leprosy"
"type 1 lepra reaction type 4 type and type 2 is type 3 type hypersenstive rxn as per comb and gel classification"
"otoverrugurth fold and pseudodementia is associated with depression"
"la belle indifference is seen in conversion disorder"
"quinsy is peritonsillar abscess and citteli is in posterior digastric belly"
"sphenopalatine artery is called artery of epistaxis"
"ipc 320 defines grievous hurt"
"stockers line is seen in pterygium"
"x rays are produced by linear and beta accelerators"
"concentration of ethinyl estradiol in Mala N and Mala D is 30 microgrm
“Investigation of choice for early renal tb is IVP”
“Inv of choice in advanced renal tb is CT”
“Inv of choice for blunt abd trauma is CT”
“Inv of choice for avascular necrosis is MRI”
“Inv of choice for cholecystitis n gall stones is ultrasound”
“Investigation of choice for bone density and osteoporosiiis DEXA bone test”
“Inv of choice for GERD is 24 hour ph metry”
“Inv of choice for VUR and posterior valves is MCU”
“Inv of choice for cytotoxic drug induced cardiotoxicity Is endomyocardial biopsy”
“Inv of choice for obstetric probs is USG”
“Inv of choice for PE is CECT>angiography>v/Q scan”
“Inv of choice for acute cerebral hemorrhage CT”
“Inv of choice for chronic cerebral hemorrhage is MRi”
“Inv of choice for posterior med tumor,pancoasts tumor,posterior cranial fossa is MRI”
“Inv of choice for subarachnoid hemmorhage diagnosis unenhanced CT”
“Inv of choice for subarachnoid hemorrhage etiology is 4vessel MR angiography”
“Inv of choice for interstitial lung disease and bronchectasis is HRCT”“
“Inv of choice for stable dissecting aneurysm is MRI”
“Inv of choice for dissecting aneurysm unstable is transoesophagal usg”
“Inv of choice for traumatic paraplegia is MRI”
“Celiac sprue is malabsorption syndrome caused by gliadin protein in wheat diagnosis is based on”

1.Relief of sx on restriction of gliadin diet
2.Serology that is antiendomyseal,antireticulin,anti tissue transglutaminase,and antigliadin antibodies.antiendo and anti tissue trans are specific antibodies
3.Non specific lesion on biopsy that is absence of villi
“Specific fndings on intestinal biopsy
are seen in three malabsorption syndromes only”
Abetalipoproteinemia,Whipples disease and Agammaglobunemia
“Antisaccaromyces antibodes are seen in chrons disease”
“Anti mitochondrial in primary billiary cirrhosis”
“Anti histone in drug induced lupus”
“Anti smooth muscle in autoimmune hepatitis”
“Biopsy finding in whipples syndrome is PAS positive macrophages in lamina propria”
“IBS is associated with abdominal pain,alternate contipative n diarrhoic episodes with stress aggarvation of symptoms”

Cavernous sinus: RULE OF 3

3 Afferent veins: Sphenoparietal sinus (Vault veins), 
                            Supf Middle cerebral Vein (Brain),  
                            Ophthalmic vein (Orbit)

3 Efferent Veins: Superior petrosal sinus, Inferior Petrosal Sinus, Communicating vein
to pterygoid plexus

3 Contents; Cranial Nerves (III,IV, V1,V2 & VI)

3 Areas Drain into it: Vault Bones, Brain (Cerebral Hemisphere), Orbit

3 Nerves: Motor(III,IV,VI),Sensory (V1,V2), Sympathetic

Wednesday, 14 August 2013


Morula: The name of the embryo at the 16 to 32 cell stage.

Blastocyst: At about day 5 after implantation.

Cells are divided into the inner cell mass and trophoblast.

Inner Cell Mass: The cells on the inside.

Trophoblast: The cells surrounding the outside.

Implantation: Blastocyst travels from ampulla ------> oviduct ------> uterus to implant in the uterus. Implantation occurs around day 5. Trophoblast forms two


Syncytiotrophoblast: The cell mass at the embryonic pole (nearest the uterine wall).

Cytotrophoblast: The cell mass jutting out from the pole. Will form the extraembryonic membranes.

Inner Cell Mass: Form two layers of cells, epiblast and hypoblast. A Bilaminar Embryonic Disc is formed.

Epiblast Cells: From inner cell mass, will ultimately give rise to the three germ layers and the entire embryo.

Amniotic Cavity: Forms as the space between the Epiblast and cytotrophoblast..

Hypoblast Cells: These cells are the first to migrate and eventually disintegrate.

Progression of events after implantation: Each item represents simultaneous events.

The epiblast cells grow deeper into the wall of the uterus.

The amniotic cavity begins to form in the epiblast layer.

Amnioblasts differentiate from the epiblasts and migrate to the inner amniotic layer.

Heuser's Membrane is formed from hypoblasts (interior of cytotrophoblast layer). It will differentiate into the yolk sac.

Trophoblastic Lacunae are openings that form in the syncytiotrophoblast.

Maternal blood enters the lacunae.

Extraembryonic Reticulum forms.

Primary Yolk Sac: Epiblasts form mesoderm on the exterior of Heuser's Membrane.

Definitive Yolk Sac: New Hypoblast cells migrate to displace Heuser's membrane, pushing back the primary yolks sac to form the new definitive yolk sac.

Chorionic Cavity forms in the ECM.

The Placenta is formed from a network of villi (trophoblast cells). Villi form from trophoblast in the following order of maturation:

Primary Villus: Cytotrophoblast + a layer of syncytiotrophoblast grow into the lacunae.

Secondary Villus: Extraembryonic mesoderm grows into the primary villus.

Tertiary Villus: Extraembryonic mesoderm gives rise to blood vessels. Exchange of nutrients is now possible with mother.

Formation of Three Germ Layers:

Form by migration of epiblast cells through the primitive streak.

First Migration: Epiblasts migrate toward the midline and fold under, as they displace the hypoblast layer. This forms the true endoderm.

NOTE: True Endoderm comes from migration of 1st epiblast layer -- not from the hypoblast!

Second Migration: More epiblasts migrate to form mesoderm.

The epiblasts that remain on the dorsal surface form the ectoderm.

Axis Determination:

Buccopharyngeal Membrane: Forms in the future cephalic region, a tightly adhered region through which mesoderm cannot intrude. This is the future


Cloacal Membrane: This is the future anus.

Notochord Formation:

Notochordal Process forms from mesoderm.

Neurenteric canal is a transient opening between the amniotic cavity and the yolk sac.

Notochordal plate reforms a tube now known as the notochord.

It is the dorsal remains of the notochordal canal.

Endoderm is once again present dorsal to it, and the secondary yolk sac is again intact.

Concurrent Ectodermal Changes: Formation of the Neural Plate and Neural Crest Cells.

Notochord induces ectodermal formation of the neural plate.

As neural plate invaginates medially, forming the midline neural groove and laterally placed neural folds.

Neural Tube forms as the fusion of the neural folds.

Rostral Neuropore is leading cranial edge of this folding.

Caudal Neuropore is caudal edge of this folding.

The Amniotic Cavity repositions itself around the embryo, in preparation for flexion.

Neural Crest Cells migrate outward from the neural tube to form the Dorsal Root Ganglia and Chain Ganglia.

Other Mesodermal Structures:

Paraxial Mesoderm: Will form the somites.

It is directly adjacent to the neural tube.

It participates in formation of the axial skeleton.

Intermediate Mesoderm: Forms the urogenital system.

Lateral to the paraxial skeleton, but medial to the lateral plate mesoderm.

Lateral Plate Mesoderm: It is the most lateral of the three. Forms primitive gut, and posterior and lateral body wall. It differentiates into two layers:

Somatic Mesoderm: (Amniotic side)

Splanchnic Mesoderm: (Yolk side)

Formation of the Intraembryonic Coelom: Forms as a division of the lateral-plate mesoderm.

As opposed to the chorionic cavity, which is extraembryonic coelom.

It is horseshoe-shaped, with the base of the horseshoe extending cranial.

The horseshoe is later divided into three segments:

The Cranial Segment (base) becomes: Pericardial Coelom.

Left and Right Caudal portions become the: Peritoneal Coeloms.

The junction of the U-shapes coeloms is the pericardioperitoneal canal.

Formation of Coelom creates two mesodermal layers now:

Somatic Mesoderm -- parietal mesoderm.

Splanchnic Mesoderm -- visceral mesoderm.

Somite Development: Somites establish the segmental nature of the body. They differentiate into three layers.

Sclerotome: Forms the vertebral bone. This originates from paraxial mesoderm.

As cells migrate outward, each sclerotome splits into inferior and superior halves. The inferior half of one sclerotome merges with the superior half of the

next sclerotome to form the respective vertebrata.

Two somites from each side, for a total of FOUR DIFFERENT SOMITES, contribute to the formation of each vertebrata.

When adjacent sclerotomes merge, the remaining notochord forms the nucleus pulposus. The rest of the notochord degenerates.

Dermamyotome, consisting of myotome (medial part) and dermatome (most lateral part)

Early Somite Development:

Chorioamnionic Membrane forms, merging the chorion and amnion cavities.

Folding (flexion) of the embryo repositions the somites from the ventral-medial position to a dorsolateral position.


Dorsal Root Ganglia

Autonomic Ganglia


Chromaffin Cells of Adrenal Medulla

Enterochromaffin Cells


Celiac Ganglion

Schwann Cells (but not Oligodendrocytes)


Parafollicular cells of Thyroid


FETAL STRUCTURE ADULT STRUCTURES Umbilical Vein Ligamentum Teres Hepatis Umbilical Arteries Median Umbilical Ligament Ductus Arteriosus Ligamentum Arteriosum Ductus Venosus Ligamentum Venosum Foramen Ovale Fossa Ovalis Allantois, Urachus Median Umbilical Ligament

Monday, 12 August 2013


Sade classification: Retraction of pars tensa
Toss classification : Retraction of pars flaccida
Antoni classification:Acoustic neuroma
Derlacki classification: Congenital cholesteatoma
Nelson classification: CSOM
Shea classification :Meniere's disease
Isshika classification:Thyroplasty
Wullstein classification :Tympanoplasty
Fisch classification:Glomus tumours.
Ohngren/Lederman:Maxillary sinus carcinoma.

Sunday, 11 August 2013


Day of appearance of rash in a febrile patient:
'Very Sick Person Must Take Double Tablets'

Very- Varicella_Day 1.
Sick- Scarlet fever_Day 2.
Person- Pox-Small pox_Day 3.
Must- Measles_Day 4.
Take- Typhus_Day 5.
Double- Dengue_Day 6.
Tablets- Typhoid_Day 7.

Saturday, 10 August 2013

List of different types of facies in different conditions

1. Mask like facies = Parkinsonism.

2. Elfin facies = William's syndrome.

3. Moon facies = Cushing's syndrome.

4. Snarling facies = Myasthenia gravis.

5. Mitral facies = Mitral stenosis.

6. Ashen grey facies = MyocardialInfarction.

7. Mouse facies = Chronic RenalFailure (CRF)

8. Adenoid facies = Adenoidhypertrophy .

9. Leonine facies = Lepromatousleprosy .

10. Bird facies = Pierre Robinsyndrome.

11. Mongoloid facies = Down'ssyndrome.

12. Coarse facies = Most of the inbornerrors of metabolism (IEM) viz. themuco-polysaccharidoses (MPS),mucolipidoses (ML), fucosidosesmannosidoses, sialidoses,aspartylglycosaminuria,
generalisedgangliosidosis(GMl ) and
Austin'svariant of metachromaticleukodystrophy due to multiplesulfatase deficiency (MLD-MSD)
havesimilar appearing facies.

13. Syphilitic facies = Congenitalsyphilis (dog jaw)