Wednesday, 20 November 2013

Exam points 2

The Asboe-Hansen sign (also known as "indirect Nikolsky sign" or "Nikolsky II sign") refers to the extension of a blister to adjacent unblistered skin when pressure is put on the top of the bulla.
The distal part of the ACL is vascularized by branches of the inferior geniculate artery
The major blood supply of the ACL arises from the middle geniculate artery. The distal part of the ACL is vascularized by branches of the inferior geniculate
Chandipura virus has been isolated from sandflies in India and West Africa and is probably spread through its bite
in Rajasthan, was India's last reported case of guinea worm disease in July 1996
Trautmann triangular space - the area of the temporal bone bounded by the sigmoid sinus, the superior petrosal sinus, and a tangent to the posterior semicircular canal
Trautmann's triangle is defined as the area limited by the anterior border of the sigmoid sinus posteriorly, the petrous ridge superiorly, and a line connecting the jugular bulb to the petrous apex anteriorly. Its size is important for transpetrosal approaches and variants
Pontiac fever is an acute, non-fatal respiratory disease caused by various species of gram negative bacteria in the genus Legionella. It causes a mild upper respiratory infection that resembles acute influenza. The infectious process is known commonly as legionellosis. It can induce pneumonia and is known to often have spontaneous resolution often goes undiagnosed
Bullous keratopathy is a pathological condition in which small vesicles, or bullae, are formed in the cornea due to endothelial dysfunction.
According to the US National Marfan Foundation, in 2010 the Ghent Nosology was revised, and new diagnostic criteria superseded the previous agreement made in 1996. The seven new criteria can lead to a diagnosis:

In the absence of a family history of MFS:
1. Aortic root Z-score ≥ 2 AND ectopia lentis
2. Aortic root Z-score ≥ 2 AND an FBN1 mutation
3. Aortic root Z-score ≥ 2 AND a systemic score* > 7 points
4. Ectopia lentis AND an FBN1 mutation with known aortic pathology

In the presence of a family history of MFS (as defined above):
1. Ectopia lentis
2. Systemic score* ≥ 7
3. Aortic root Z-score ≥ 2
The Medulla, Pons and Midbrain areas receive their major sources of blood. supply from several important branches of the Basilar artery.
Time period.     Bones affected

Third month of embryonic development Ossification in long bones beginning
Fourth month Most primary ossification centers have appeared in the diaphyses of bone.
Birth to 5 years Secondary ossification centers appear in the epiphyses
5 years to 12 years in females, 5 to 14 years in males Ossification is spreading rapidly from the ossification centers and various bones are becoming ossified
17 to 20 years Bone of upper limbs and scapulae becoming completely ossified
18 to 23 years Bone of the lower limbs and os coxae become completely ossified
23 to 25 years Bone of the sternum, clavicles, and vertebrae become completely ossified
By 25 years Nearly all bones are completely ossified
Nasopharyngeal cancer is relatively rare and accounts for about 2 percent of all head and neck cancers in the United States.
Long-term beta-blocker therapy improves diastolic function even without the therapeutic effect on systolic function in patients with reduced ejection fraction.
ketamine with midazolam offers a safe and effective means of anaesthesia at very high altitude, without the need for specialist equipment or training, by careful clinicians experienced in basic airway management
Jai Vigyan Mission : For the Commoners' Benefit
    India has made considerable progress in the field of science and technology in the last fifty years. The Department of Science and Technology, through its multifaceted approach in furthering advanced research,has given a definite thrust to sectors like agriculture, human health, livestock, environment and industrial development
From the medial lip of the linea aspera and its prolongations above and below, the Vastus medialis originates.
From the lateral lip and its upward prolongation, the Vastus lateralis takes origin.
The Adductor magnus is inserted into the linea aspera, and to its lateral prolongation above, and its medial prolongation below.
Between the Vastus lateralis and the Adductor magnus two muscles are attached: the Gluteus maximus inserted above,
and the short head of the Biceps femoris originating below.

Between the Adductor magnus and the Vastus medialis four muscles are inserted: the Iliacus and Pectineus above;
the Adductor brevis and Adductor longus below.
Due to the high birth rate in India a very large number of infants with genetic disorders are born every year almost half a million with malformations and 21,000 with Down syndrome.
salt-pepper appearance of the skin as one of the earliest features in systemic sclerosis.
Cataract is the leading cause of blindness in India while refraction error and glaucoma are the second and third leading causes of blindness respectively in India.
Zygomycete hyphae may be coenocytic, forming septa only where gametes are formed or to wall off dead hyphae.
The hair cells have a resting membrane potential of approximately -65 mv, compared to the endolymph
classification of human prion diseases:
Form Phenotype (Clinical and Pathological Features)
Sporadic Creutzfeldt-Jakob Disease (sCJD), Sporadic Familial Insomnia (sFI)

Familial Creutzfeldt-Jakob Disease (fCJD), Fatal Familial Insomnia (FFI), Gerstmann-Sträussler-Scheinker Syndrome (GSS)

Iatrogenic Creutzfeldt-Jakob Disease (iCJD), variant Creutzfeldt-Jakob Disease (vCJD), Kuru
Foramen of winslow
anterior: the free border of the lesser omentum, known as the hepatoduodenal ligament. This has two layers and within these layers are the common bile duct, hepatic artery, and hepatic portal vein. A useful mnemonic to remember these is DAVE: Duct, Artery, Vein, Epiploic foramen.
    posterior: the peritoneum covering the inferior vena cava
    superior: the peritoneum covering the caudate lobe of the liver
    inferior: the peritoneum covering the commencement of the duodenum and the hepatic artery, the latter passing forward below the foramen before ascending between the two layers of the lesser omentum.
    left lateral: gastrosplenic ligament and splenorenal ligament.
The most common associated finding in horseshoe kidney is ureteropelvic junction obstruction, which occurs in up to 35% of cases and is often the cause of problems
The most common indication for vitrectomy was vitreous hemorrhage n=30 [45.5%].Complication of cataract surgery such as dropped intraocular lens 7 [10.7%], sclera fixated intra ocular lens 6 [9.2%], and dropped nucleus 5 [7.5%] were emerging indications. Other indications noted include complicated retinal detachments 4 (6.1%), membranectomy for posterior capsule opacity from pediatric cataract surgery 3 (4.5%) and congenital lens subluxation 2 (3.0%).
Boundaries.—The popliteal fossa or space is a lozenge-shaped space, at the back of the knee-joint. Laterally it is bounded by the Biceps femoris above, and by the Plantaris and the lateral head of the Gastrocnemius below; medially it is limited by the Semitendinous and Semimembranosus above, and by the medial head of the Gastrocnemius below. The floor is formed by the popliteal surface of the femur, the oblique popliteal ligament of the knee-joint, the upper end of the tibia, and the fascia covering the Popliteus; the fossa is covered in by the fascia lata.   
Contents.—The popliteal fossa contains the popliteal vessels, the tibial and the common peroneal nerves, the termination of the small saphenous vein, the lower part of the posterior femoral cutaneous nerve, the articular branch from the obturator nerve, a few small lymph glands, and a considerable quantity of fat.
Thickness of membrane - 10 nm; Viruses - 100 nm; Bacteria - 1 µm; Organelles - up to 10 µm; Most cells - up to 100 µm
SARS is caused by a member of the coronavirus family of viruses (the same family that can cause the common cold). It is believed the 2003 epidemic started when the virus spread from small mammals in China.
Sacrocotyloid diameter: It is the distance from the midpoint of sacral promontory to the iliopectineal eminence on either side. It measure 9.5 cm.
Acute chest syndrome

This occurs when there are blocked blood vessels in the lungs and can sometimes occur with a lung infection.

The symptoms can include chest pain, fever and shortness of breath. Babies and young children may have more vague symptoms and look generally unwell, be lethargic, restless or have fast breathing. Acute chest syndrome is very serious and, if it is suspected, you should be treated urgently in hospital.
The ASOT helps direct antimicrobial treatment and is used to assist in the diagnosis of scarlet fever, rheumatic fever, and post infectious glomerulonephritis.

A positive test usually is >200 units/mL
A Hill–Sachs lesion, also Hill-Sachs fracture, is a cortical depression in the posterolateral head of the humerus bone
Hemoglobin (Hb) M Boston is a variant in which the distal
histidines in the heme pockets of the a chains are replaced by
tyrosines [His E7(58) -- Tyr]
The ratio of the amount of carbon dioxide produced to the amount of oxygen consumed in tissues of the body (compare respiratory exchange ratio). The RQ can be used to determine which food is being metabolized during cellular respiration.
The RQ for fat metabolism is 0.7;
for protein metabolism, 0.9;
and for carbohydrate metabolism 1.0.
An RQ greater than 1.0 indicates anaerobic metabolism.
"Sleep drunkenness" consists of prolonged confusion when awakening, usually from the deeper non-REM stages of sleep. Complex behaviors may be undertaken without conscious awareness (13). Patients (typically children) may arise from bed, stumble while walking, have slurred or incomprehensible speech, and have no memory of the event. The occurrence of sleep drunkenness is increased by factors that deepen sleep (such as sleep deprivation and hypnotic medication) or disturb sleep (as in sleep apnea; 14). Potential confusion with seizures occurs because the awakening may be unwitnessed, and the subsequent, transient confusion is consistent with a complex partial seizure or postictal state.
Somnolence (or "drowsiness") is a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods (cf. hypersomnia).
Section 174 in The Indian Penal Code, 1860

174. Non- attendance in obedience to an order from public servant.-- Whoever, being legally bound to attend in person or by an agent at a certain place and time in obedience to a summons, notice, order, or proclamation proceeding from any public servant legally competent, as such public servant, to issue the same, intentionally omits to attend at that place or time, or departs from the place where he is bound to attend before the time at which it is lawful for him to depart, shall be punished with simple imprisonment for a term which may extend to one month, or with fine which may extend to five hundred rupees, or with both; or, if the summons, notice, order or proclamation is to attend in person or by agent in a Court of Justice, with simple imprisonment for a term which may extend to six months, or with fine which may extend to one thousand rupees, or with both. Illustrations
(a) A, being legally bound to appear before the 1[ High Court] at Calcutta, in obedience to a subpoena issuing from that Court, intentionally omits to appear. A has committed the offence defined in this section.

(b) A, being legally bound to appear before a 2[ District Judge], as a witness, in obedience to a summons issued by that 2[ District Judge] intentionally omits to appear. A has committed the offence defined in this section.
Section 174 in The Code Of Criminal Procedure- Police to enquire and report on suicide, etc.
Eligible couples: An eligible couple refers to a currently married couple wherein the wife is in the reproductive age, which is generally assumed to lie between the ages of 15-45 years. There will be at least 150-180 such couples per 1000 populations in India. These couples are in need of family planning services. About 20 percent of eligible couples are found in the age group 15-24 years. On an average 2.5 million couples are joining the reproductive group every year. The eligible couple register is a basic document for organizing family planning work
A caul (Latin: Caput galeatum, literally, "head helmet") is a thin, filmy membrane, the amnion, that can cover a newborn's head and face immediately after birth
The major blood supply of the ACL arises from the middle geniculate artery
Sandifer's syndrome is associated with gastro-oesophageal reflux disease (infant GERD) and commonly seen in infants
Direct occipito-posterior (face to pubis): occurs in about 6% of cases. the head can be delivered spontaneously or by aid of outlet forceps
*Tache noir is one of the important postmortem changes seen in the eye after death.

*If the eyes remain open after death, the areas of the sclera exposed to the air dry out, which results in a first yellowish, then brownish-blackish band like discoloration zone called TACHE NOIRE.

*It is seen mostly after 7 to 8 hours after death.
The characteristic symptoms of bilateral abductor vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction.
Sandifer syndrome (or Sandifer's syndrome) is a [1][2] paediatric medical disorder, characterised by gastrointestinal symptoms and associated neurological features[2][3] There is a significant correlation between the syndrome and gastroesophageal reflux disease (GERD), however it is estimated to occur in less than 1% of children with reflux.
1-fluoro-2,4-dinitrobenzene, or Sanger's reagent (commonly called dinitrofluorobenzene or DNFB), is a chemical used for polypeptide sequencing
Centers for Disease Control's Criteria for Chronic Fatigue Syndrome

Clinically evaluated, unexplained, persistent, or relapsing fatigue that is:
•Of new or definite onset
•Not a result of ongoing exertion
•Not alleviated by rest
•Results in a substantial reduction in previous levels of occupational, social, or personal activity
Four or more of the following symptoms that persist or recur during 6 or more consecutive months of illness and that do not predate the fatigue: •Self-reported impairment of short-term memory or concentration
•Sore throat
•Tender lymph nodes
•Muscle pain
•Multijoint pain without swelling or redness
•Headaches of a new type, pattern, or severity
•Unrefreshing and/or interrupted sleep
•Postexertion malaise (a feeling of general discomfort or uneasiness) lasting more than 24 hours
Ezetimibe localises at the brush border of the small intestine, where it inhibits the absorption of cholesterol from the intestine. Specifically, it appears to bind to a critical mediator of cholesterol absorption, the Niemann-Pick C1-Like 1 (NPC1L1) protein on the gastrointestinal tract epithelial cells as well as in hepatocytes. In addition to this direct effect, decreased cholesterol absorption leads to an upregulation of LDL-receptors on the surface of cells and an increased LDL-cholesterol uptake into cells, thus decreasing levels of LDL in the blood plasma which contribute to atherosclerosis and cardiovascular events
Ezetimibe is one of the newer agents that have been approved for the treatment of hyperlipidemia. Unlike other cholesterol-lowering agents, ezetimibe works by selectively inhibiting the intestinal absorption of cholesterol and related phytosterols. Its mode of action has been found to be complementary to that of statins. A review of the clinical studies that have been done on ezetimibe indicates that it does have efficacy in reducing LDL cholesterol when used as monotherapy as well as when coadministered with statins. Because combination therapy with other cholesterol-reducing agents (e.g., bile acid sequestrants, nicotinic acid, and fibrates) has not been studied, the use of ezetimibe with these other drugs is not recommended
Pyonephrosis - High-dose excretion urography is the investigation of choice since not only may the diagnosis be established but also there precise pathological state of the involved kidney.
CT, especially with arterial contrast enhancement (CTA) is the investigation of choice, able not only to diagnose and classify the dissection, but also evaluate for distal complications. It has reported sensitivity and specificity of nearly 100%
Zona pellucida (ZP) is a glycoproteinaceous translucent matrix that surrounds the mammalian oocyte and plays a critical role in the accomplishment of fertilization. In humans, it is composed of 4 glycoproteins designated as ZP1, ZP2, ZP3 and ZP4
Renal papillary necrosis usually occurs with analgesic nephropathy. However, a number of other conditions can cause it, including:
•Diabetic nephropathy
•Kidney infection (pyelonephritis)
•Kidney transplant rejection
•Sickle cell anemia
•Urinary tract blockage

Sickle cell anemia is a common cause of renal papillary necrosis in children.
The relative potency of cephalosporins against Staphylococcus aureus in decreasing order is cephaloridine, cephalothin, cefazolin, and cephalexin.
There are four recognized class generations of cephalosporins based on spectra of activity.6 First-generation cephalosporins are active against Gram-positive cocci; second-generation agents retain this Gram-positive activity and have increased activity against Gram-negative organisms. Third-generation cephalosporins have decreased activity against Gram-positive organisms relative to first- and second-generation agents, but improved Gram-negative coverage. Spectrum of activity is further expanded in the fourth-generation agents, which have increased activity against Gram-negative organisms compared with first- and second-generation agents and greater coverage of Gram-positive organisms than third-generation agents, as well as activity against Pseudomonas spp. and some Enterobacteriaceae, including those that produce β-lactamases.

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