Thursday, 30 January 2014

questions
Arcuate fasciculus connects broca to werni
Donath landesteiner fr paroxymsl cold hemoglobinuria
Intestine can absorb glucose maximally? (mg/hr)
A) 120
B) 140
C)180
D)160
Intstine absorb 120
dpt vaccine..persistant cry is due to severe persistant pain.. Pain is mostly due to drug component
cholelithiasis is caused by clofibrate/chloramphenicol/cotrimaxozole
photosensutivity d/t streptomycin/demeclocycline/cindamycin..
ans 1clofib,2,demeclo
Nerve grlwth facter is neurotrophin
Methotraxate toxicity treated by folinic acid
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 is a member of the Rhabdoviridae family that is
associated with an encephalitic illness in humans.
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'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According to the US National Marfan Foundation, in 2010 the Ghent Nosology was revised, and new diagnostic criteria superseded the previous agreement made in 1996.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
Tb upper lobe focus??
Assman
Holman miller sign ca nasopharynx
Ground glass is hep b
Banana shaped app of heart
HOCM
Harmones relaxing pelvis during pregnacy??
Relaxin n Progesterone
Active human immunodeficiency virus protease is required for viral infectivity
The Medulla, Pons and Midbrain areas receive their major sources of blood. supply from several important branches of the Basilar artery.
how many mites in scabies?
10-15
Widening epiphysis in rickets
Apple jelly nodule-lupus vulgaris
Not given in glucoma latanoprost
Fol fox regime colorectal carcinoma
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

Tuesday, 28 January 2014

ACE Inhibitor Side Effects

CAPTOPRIL

C ough

A naphylaxis

P alpitations

T aste

O rthostatic hypotension

P otassium elevated

R enal impairment

I mpotence

L eukocytosis

Monday, 27 January 2014

Licheniid

Drugs causing lichenoid drug eruption
Chloroquine
NSAIDS
Gold
Phenothiazine
Ketoconazole
Dapsone
Penicillamine
Captopril
Mnemo-CNG Prices Kill Delhi People Constantly

SlE

Drugs causing SLE
Procainamide
Phenytoin
Penicillamine
Hydralazine
Isoniazid
Methyldopa
Chlorpromazine
Lithium
Carbamazepine
Mnemo- People Please Pass HIM to Clean & Little Car

Sc fracture

#supracondylar humerous
5 -8 yrs mc age
boys > girls
fall on outstretched hand hyperextension injury
left side > right side
mc injury of elbow in children
types-
1.mc extension type[97-99%] (posteromedial 70-80%;posterolateral 20-30%) distal fragnent extended (tilted backward/posterior )
2.flexion type 1-3% only
distal fragment anterior forward flexed

pain swelling of elbow
loss of movement
S shaped deformity
three point bony relationship maintained
dimple sign
Gartland classification
type 1 undispaced # -only cast for 3 week
type 2 angulated # with post cortex still in continuity -reduce under GA;wiring
type 3 displaced completly-rx of either type 2 or ORIF

complications-
early - brachial artrry injury; median nerve injury (radial /ulnar may be )

late- malunion mc
gun stock deformity
cubitus varus
elbow stiffness
VIC

rx of cubitus varus
french /modified french( close wedge lateral osteotomy)
king's osteotomy ( medial open wedge)
derotation osteotomy

Sunday, 26 January 2014

Shoulder Joint

SHOULDER JOINT
🍭ABDUCTION
initiator:supraspinatus
next:middle deltoid fibres
upto120°:
infraspinatus
subscapularis
t.minor
120-180:trapezius
serratus anterior
🍭ADDUCTORS AND MEDIAL ROTATORS:
T.major
P.major
L.dorsi
ant deltoid fibres
🍭LATERAL ROTATORS:
infraspinatus
T.minor

Postmortem Staining

CO poisoning- Cherry red

HCN, Burn- Bright red

Nitrites, Aniline, Potassium bicarbonate- Chocolate brown

Phosphorus - Dark brown

Asphyxia- Bluish violet or purple

Septic abortion- Bronze

Refrigerated body -Bright pink

Mummification-  turns from Brown to Black

Saturday, 25 January 2014

Vaginal PH

Newborn infant    4.5-7
6wk old child      7
Puberty  changes from  Alkaline to acidic
Reproductive age grp  4-5.5
Pregnancy   3.5-4.5
Late menopausal  6-8

Organisms and disease caused by them :-


Lyme disease - borrelia burgdorferi

Pontiac fever - legionella pneumophilia

Three day fever / exanthema subitum / roseola infantum - HHV 6 & 7

Erythema infectiosum/ fifth disease/ aplastic crises in SCD / hydrops foetalis in pregnant women - parvovirus B19

Weil's disease - leptospira interrogans

Fitz- Hugh Curtis syndrome / perihepatitis with violin string adhesions -N. gonorrhoea and C. Trachomatis

Five day fever / trench fever - bartonella Quintana

Cat scratch disease - bartonella henselae and afipia felis

Oroya fever / carrion's disease - bartonella bacilliformis

Kissing fever / glandular fever - infectious mononucleosis caused by CMV

Chagas' disease / mega oesophagus / mega colon / mega ureter - T. Cruzi; transmitted by reduviid bugs/ cone nose bugs

Sleeping sickness- T. Bruzi ; transmitted by tsetse fly

Haemorrhagic disease with renal syndrome - hanta virus

Epidemic typhus - rickettsia prowazeki; transmitted by louse

Endemic typhus - rickettsia TYPHI ; transmitted by rat fleas

River blindness - onchocerciasis ; transmitted by black flies

Friday, 24 January 2014

ATP- binding cassette transporter defects :-

ABCA1- Tangier's disease

ABCB4/ MDR3- Progressive familial intra- hepatic cholestasis type 3

ABCB11/FIC 2- Progressive familial intra hepatic cholestasis type 2 and bening recurrent intra hepatic cholestasis type 2

ABCC2/MRP2- defective in Dubin - Johnson syndrome leading to conjugated hyperbilirubinemia ; sea- green /bluish green liver due to accumlation of polymers of epinephrine in lysosomes

ABCC7/CFTR- defective in cystic fibrosis in bile ductal epithelial cells and not in canalicular membrane ; impaired Ph regulation of cholangiocellular bile secretion- chronic cholestasis - biliary cirrhosis

ABCG5/G8- defective canalicular transport of cholesterol and phytosterols leading to sitosterolemia

ATP7A1- menkes syndrome / kinky hair disease / steely hair syndrome

ATP7BI- Wilson 's disease / hepato- lenticular degeneration

ATP8B1/FIC1- defective aminophospholipid transferase (" flippase") activity leading to Progressive familial intra hepatic cholestasis type 1 and bening recurrent intra hepatic cholestasis type 1.

ABCD1- ATP binding cassette transporter family protein encoded by ALD gene on chromosome  Xq28
Whose mutation results in adrenoleukodystrophy

ABCA12- on chromosome 2 ; lipid transporter responsible for harlequin ichthyosis

ATP 11B - responsible for cisplatin resistance in ovarian carcinoma

Fracture

Aviator#-neck of talus–due to Dorsiflexation
Bankarts#–anterior glenoid–shoulder abduction
and ext rotation
Bartons#–distal radius with radio carpal
dislocation
Bennets#–1st metacarp–pull of abductor pollicis
longus
Boxer#-5th metacar-punching
Boxworht#–distal fibula due to foot extern
rotation
bumper#–lat condy of tibia due to forced valgus
of knee
Chance#–horizontal # of vert body
Chaueffuer#–radial styloid
Chopart#—joints involved
1)talonav
2)cal-cub due to ankle twist–rx -non weight bear
cast
Clay shovel#—c6c7T1 spinous process avulsion
Colles–also distal radius but with dorsal
angulation,ipaction and radial drift
Cottons#–trimalleolar # of ankle
Duverny#-iliac wing#
Essex lopresti–radius head +inteross memb
+distal radio ulna jt
Gallezia–radius shaft+distal radio ulna jt
Gosselin-distal tibia#
Hangman–pedicles of c2–neck extension
Hill sach–post humeral head
Holdsworth#–thoracolumbar dislocation of
vertebrae
Hume—-olecranon#
Jefferson#– burst # of c1
Jones#–base of 5th Metatarsal– per brevis
muscle pull due to inversion
Le fort–distal fibula + medial mall avulsion
Lis franc–midfoot # and disloc
Maisonneuve#—spiral# of prox fibula
Malgaignes#—vertical pelvic #
March #–2nd 3rd metatars—shaft
Montagia–prox ulna +dislocation of radial head
Moores–distal radius + ulnar dislocation
Pilon#–distal fibula with communited articular #
Pipkin #– post dislocation of hip wid femoral
head avulsion due to lig teres
Potts–bimalleolar# of ankle
Rolando-t shape or y shape # of 1st MC(benetts
is also 1st MC)
Runner#- stress# of distal fibula
Salter harris__growth plate#
Segonds#–ACL tear +lateral tibial plateua
avulsion
Shepard#-lat tubercle of posterior process of
talus
Smith#–distal radius with volar displacement
Steidia #–medial femo condyle avulsion near
MCL
Teillaux#–salter harris # of tibia
Toddler#–distal tibia# –spiral undisplaced for
under 8yr old

Surgery Names


 Jones operation - tendon transfer for radial nerve palsy.
 Swenson's operation - hirschprungs disease.
 soave and parks operation ( coloanal anastomosis)- hirschprungs disease.
 delormes operation - rectal prolapse.
 billroth 1 operation - fractal prolapse.
milligon Morgan operation - haemorrhoidectomy.
mayos operation - hiatus hernia.
 nesovics operation- sports hernia.
 Cheatle henry operation - obturater hernia.
 sebrocks operation - parotid duct fistula.
 bentails operation - aortic roots aneurysum repairs.
 belsey mark IV operation - hiatus hernia.
 Hills operation - hiatus hernia.
 psoas hitch operation - little loss of length in ureteric injury.

Thursday, 23 January 2014

VACTERAL and CHARGE

VACTERAL
v vertebral anomaly
a anal atresia
c cong. hrt diz.
te tracheo eoso. fistula
r retardation of growth
l limb deformity

CHARGE
c coloboma
h heart defect
a choanalAtresia
r renal anomalues
g genital anomalies
e ear defects

Renal Trauma

Grading of renal trauma :-

Classified according to the Organ Injury Scaling (OIS) Committee Scale :-

Minor grades

Grade 1-

Contusion-Microscopic or gross haematuria,  Urological studies normal

Haematoma-Subcapsular, nonexapnding without parenchymal laceration.

Grade II

Haematoma-Nonexapnding perirenal haematoma confined to renal retroperitoneum.

Laceration-
<1cm parenchymal depth of renal cortex without urinary extravasation.

Major grades

Grade 3 -

Laceration-
>1cm depth of renal cortex, without  collecting system rupture or urinary extravasation

Grade IV -

Laceration-Parenchymal laceration extending through the renal cortex, medulla and collecting system.

Vascular -
Main renal artery or vein injury with  contained haemorrhage.

Grade 5-

Laceration-
Completely shattered kidney.

Vascular -
Avulsion of renal hilum which devascularizes kidney.

Wednesday, 22 January 2014

Diseases caused by Parvo Virus

🔹Erythema infectiosum
🔹Seronegative arthritis
🔹Aplastic crisis in hemolytic anemia
🔹Fetal infection leading to non immune hydrops fetalis
🔹Chronic anemia in immunocompromised
🔹Hemophagocytic syndrome
🔹Severe anemia in malarial patients

WHO ORS Composition

Reduced osmolarity ORS by WHO :
In gm/lit
Sodium chloride- 2.6
Anhydrous Glucose - 13.5
Potassium chloride- 1.5
Trisodium Citrate dihydrate - 2.9

Total : 20.5 gm/lit
Reduced osmolarity ORS by WHO :
In Mmol/lit
Sodium - 75
Glucose -75
Potassium -20
Citrate -10
Chloride -65
Total : 245 mmol/lit

Anatomy

Exaggerated over-curvature of thoracic area of vertebral column: Kyphosis 
Lateral deviation of vertebral column: Scoliosis

Major feature of cervical vertebrae: Transverse foramina

Structure which regionally determines vertebral movement: Facet joints

Vertebra located at level of iliac crest: L4

Ligament that connects internal surface of laminae of vertebrae: Ligamentum flavum

Ligament that checks hyperextension of vertebral column: Anterior longitudinal

Ligament affected by whiplash injury: Anterior longitudinal

Ligament which limits skull rotation: Alar

Defective portion of vertebra with spondylolisthesis in cervical area: Pedicle

Defective portion of vertebra with spondylolisthesis in lumbar area: Pars interarticularis, Lamina

Common direction of all superior articular facets of vertebrae: Posterior

Structure in contact with posterior surface of dens: Transverse ligament of atlas (part of cruciate)

Most commonly herniated intervertebral disc: L4-5

Most common nerve compressed with herniated intervertebral disc: L5

Spinal nerve affected by protrusion of the disc between C5/6: C6

Spinal nerve affected with herniated disc at L3/L4: L4

Thoracic intercostal space located deep to triangle of auscultation: sixth

Vertebral level of lumbar puncture: L4

Muscles which extend and side-bend the spine: Erector spinae

Muscles which extend, ROTATE, and side-bend the spine: Transversospinae

Innervation of suboccipital muscles: Suboccipital nerve (Dorsal ramus C1)

Roof of suboccipital triangle: Semispinalis capitis

Floor of suboccipital triangle: Posterior arch of atlas; posterior atlanto-occipital membrane

Major vessel within suboccipital triangle: Vertebral artery 

Inferior extent of dura-arachnoid sac: SV2

Inferior extent of spinal cord: LV2

Location of internal vertebral plexus: Epidural space

Most frequently fractured bone of body : Clavicle

Most frequently dislocated carpal bone: Lunate

Most frequently fracture carpal bone: Scaphoid

Osseous structure palpated deep to “anatomical snuff boxâ€: Scaphoid

Fracture of distal radius that produces “dinner fork†appearance: Colle’s fracture

Nerve injured with fracture of surgical neck of humerus: Axillary

Nerve injured with fracture of shaft of humerus: Radial

Nerve injured that results in wrist drop: Radial

Nerve injured with fracture of medial humeral epicondyle: Ulnar

Muscle that is the chief flexor and chief extensor at shoulder joint: Deltoid

Muscles innervated by axillary nerve: Deltoid and teres minor

Muscle that initiates abduction of arm: Supraspinatus

Most commonly torn tendon of rotator cuff: Supraspinatus

Two muscles that rotate scapula for full abduction of arm: Trapezius and serratus anterior

Tendon that courses through shoulder joint: Long head of biceps

Chief supinator muscle of hand: Biceps brachii

Primary (major) flexor of the forearm: Brachialis

Orientation of structures located in the cubital fossa-Lateral to Medial: Tendon biceps brachii, brachial a., median n.

Injury to what nerve causes winged scapula: Long thoracic nerve

Spinal levels of axillary nerve: C5 and C6

Spinal levels of innervation to muscles of the hand: C8 and T1

Dermatome of thumb: C6

Nerve to thenar compartment: Recurrent branch of Median

Innervation of adductor pollicis: Ulnar (deep br.)

Innervation to all interosseous muscles: Ulnar (deep br.)

Innervation to nail bed of middle finger: Median nerve

Innervation to nail bed of ring finger: Ulnar and median

Region affected by upper trunk injury of brachial plexus (C5-C6): Shoulder

Region affected by lower trunk injury of brachial plexus (C8-T1): Intrinsic hand muscles 

Nerve compressed with carpal tunnel syndrome: Median

Nerve affected by cubital tunnel syndrome: Ulnar

Paralysis of which muscles results in total “claw†hand: Lumbricals

Boundaries of femoral triangle: Inguinal ligament, sartorius, adductor longus

Structure immediately lateral to femoral sheath: Femoral nerve

Structure immediately medial to femoral artery in femoral sheath” Femoral vein

Class 3 MHC

Class 3 MHC includes 
➰ Soluble protein of complement system
➰ C2 n C4 of classical pathway
➰ properdin factor B
➰ heat shock protein
➰ tnf alpha n beta.

Endotoxins

Staphylococcus- binds fcIg by protein A, inhibits complement fixation n phagocytosis
Corynebacterium-ADP ribosylation of EF-2
Clost.tetani-blocks glycine &GABA release 4m renshaw cells in spinal cord
C.botulinum-inhibits ach release at NM Jn-FLOPPY BABY SYNDROME
Both tetani n botulinum toxin cleaves SNARE protein required 4 neurotransmitter release
C.difficile-toxin A- enterotoxin n brush border of gut
Toxin-B- cytotoxin destroys enterocytes causing pseudomemb colitis
B.anthracis-lethal &edema factors, edema factor resembles adenylate cyclase(inc cAMP), Capsular polysacc inhibits phagocytosis
B.cereus-enterotoxin similar to e.coli toxin, emetic type resembles staph enterotoxin.causes REHEATED RICE SYNDROME
Listeria- actin rockets move 4m cell to cell
P.aeruginosa-exotoxin A inactivates EF-2
M.tb- neutrophil migration factor inhibitor, virulent strains inhibit macrophage maturation n phagolysosomal fusion
Shigella- inactivates 60S ribosomes by removing adenine 4m rRNA n evades host cells
EHEC-shigella like toxin- does not evade host cells, enhances cytokine release
ETEC- Heat labile- inc cAMP &Inc chloride secretion n gut-water efflux
Heat stable- Inc cGMP& Dec reabsorption of Nacl and water in gut
V.cholera-Inc cAMP, Inc chloride sec in gut&water efflux
Bordetella-inc cAMP disables Gi n impairs phagocytosis
C.perfringens-phospholipase c causing myonecrosis by alpha toxin
S.pyogenes- strep O degrades cell memb n lyses RBCs, M proteins inhibit phagocytosis
H.influenza,S.pneumoniae,Neisseriae- IgA protease cleaves IgA

Penicillin

Name penicillins causing

Seizure-procaine peni
Hepatitis-oxacilin
Neutropenia-nafcillin
Bleeding-Carbenicillin
Interstitial nephritis-methicillin
Diarrhoea-Ampicillin/Amoxicillin

Staph

STAPHYLOCOCCUS
G+, aerobic n faculative anaerobe
spherical cells arranged in irregular clusters.
Grows readily on mosy media.  Grow most rapidly at 37°C.
Pigment producer,  most rapidly at 20 -25°C.
▪S aureus-deep golden yellow colonies.
▪S epidermidis-grey to white.
▪No pigment production anaerobically.
MC route of infection-Skin.
MC source of infection- patients'own colonizing strains.
CULTURE
⛔ Oilpaint appearance on nutrient agar.
⛔ beta hemolysia on rabbit or sheep blood.
⛔ Mannitol fermenter anaerobically only by S aureus.
⛔ Prompt phosphatase rxn.

Most constant association of virulence is wid Coagulase.
A heat stable nuclease is characteristic of S aureus.
◼ TOXINS
➰ Beta hemolysin-  Hot cold phenomenon.
➰ delta- detergent effect.
➰ Synergohymenotropic toxin- bicomponent as Leucocidin n gamma hemolysin.
➰ Leucocidin is imp virulent factor in MRSA infection.
➰ Enterotoxin-  causes food poisoning within 6h as its preformed n acts directly on ANS(vagal stimulation ) n vomiting center.
➰ TSST 1 n Enterotoxin F =pyrogenic exotoxin C responsible for TSS.
➰ Exfoliative toxin causes SSSS has serine protease activity.
🔵 DIAGNOSIS.
🔷 Coagulase test is d standard criteria for its identification.
🔹Slide coagulase test detects clumping factor.
🔹Tube coagulase detects Coagulase.  Its more specific.
🔷 Typing is based on bacteriophage susceptibility.  Phage typing done by pattern method.
⚫ Infections caused by Staph are
➖Folliculitis
➖Faruncles (boils)
➖Carbuncle
➖Ac Paronychia
➖Bullous impetigo
➖Ecthyma
➖Cellulitis
➖Hidradenitis suppurativa
➖Sycosis barbae
➖Botryomycosis.
⚫ MC cause of
 Ac endocarditis
 Spinal epidural abscess.
 Septic intracranial thrombophlebitis
 Skin n ST infection
 Ac osteomyelitis
 Nosocomiap pneumonia
 Paronychia
 Surgical wound infection.

⚫Coagulase negative Staph are MC source of infection on any exogenous implant.
⚫ Staph epidermidis is common source of stitch abscess becos of its ability to produce slime.
⚫ Staph saprophyticus causes UTI in sexually active women.

◼ TREATMENT
✔ Penicillin sensitivity- Penicillin G
✔ Penicillinase producer but methicillin sensitivity- Nafcillin or Oxacillin
✔MRSA- Vancomycin
✔ VRSA- Quinopristin dalfopristin n linezolid.
✔ Empirical th- Vancomycin
〰 Special cases
▪TSS- Clindamycin,  reduces toxin synthesis
▪Food poisoning- No antibiotic.
⬜ Additional important points.
🔘Anterior nares is d most common site of colonisation.
🔘TSST 1 epidermolytic toxins n Enterotoxins are superantigens.
🔘Methicillin resistance located in a chromosome region called staphylococcal cassette chromosome.
🔘Tropical myositis is caused by S aureus.
🔘Pyomyositis is caused by S aureus.
🔘 Primary myositis is usually caused by Strepto.
🔘 MC mechanism of drug resistance in Staph is Transduction
🔘Staph remains on skin for long due to hyaluronidase.
🔘Selective media-  Ludlam' s or salt milk agar or Robertson cooked meat media containing 10% NaCl

Ridley logarithmic scale

Ridley logarithmic scale for lepra...
0no bacilli in any field
1+1-10 bacilli in 100 fields
2+1-10 bacilli in 10 fields
3+1-10 bacilli in each field
4+10-100 bacilli in each field
5+100-1000 bacilli in each field
6+> 1000 bacilli in each field.

KEY POINTS: Chronic Pain Management

KEY POINTS: Chronic Pain Management

Chronic pain is best treated using multiple therapeutic modalities. These include physical therapy, psychologic support, pharmacologic management, and the rational use of more invasive procedures such as nerve blocks and implantable technologies.
Patients suffering from cancer pain often exhibit complex symptomatology that includes various forms of nociceptive and neuropathic pain.
In patients suffering from chronic pain, underlying psychologic/psychiatric conditions should be addressed if any meaningful recovery is to be achieved.
Neuropathic pain is usually less responsive to opioids than pain originating from nociceptors.

Popcorn calcification

Mammography- Fibroadenoma

CXR- pulmonary hamartoma

MRI- cerebral AVM

Bone- Osteogenesis imperfecta

Salter–Harris fracture

Salter–Harris fracture is a
fracture that involves the epiphyseal plate or
growth plate of a bone. It is a common injury
found in children, occurring in 15% of
childhood long bone fractures.There are nine
types of Salter–Harris fractures; types I to V as
described by Robert B Salter and W Robert
Harris in 1963, and the rarer types VI to IX
which have been added subsequently:
Type I – A transverse fracture through the
growth plate (also referred to as the "physis"):
6% incidence
Type II – A fracture through the growth plate
and the metaphysis, sparing the epiphysis: 75%
incidence, takes approximately 2–3 weeks to
heal.
Type III – A fracture through growth plate and
epiphysis, sparing the metaphysis: 8% incidence
Type IV – A fracture through all three elements
of the bone, the growth plate, metaphysis, and
epiphysis: 10% incidence
Type V – A compression fracture of the growth
plate (resulting in a decrease in the perceived
space between the epiphysis and diaphysis on x-
ray): 1% incidence
Type VI – Injury to the peripheral portion of the
physis and a resultant bony bridge formation
which may produce an angular deformity (added
in 1969 by Mercer Rang)
Type VII – Isolated injury of the epiphyseal plate
(VII–IX added in 1982 by JA Ogden)
Type VIII – Isolated injury of the metaphysis
with possible impairment of endochondral
ossification
Type IX – Injury of the periosteum which may
impair intramembranous ossification.

dissociated sensory loss

causes of dissociated sensory loss include:
Diabetes mellitus
Syringomyelia
Brown-Séquard syndrome
Lateral medullary syndrome aka
Wallenberg's syndrome
Anterior spinal artery
thrombosis
Tangier disease
Subacute combined
degeneration
Multiple sclerosis
Tabes dorsalis
Friedreich's ataxia (or other
spinocerebellar degeneration)

Tuesday, 21 January 2014

Anal canal pressure

resting pressure in anal canal is 40 – 80mmhg.

Squeeze pressure is 40 – 80mmhg above the resting pressure.

Resting pressure in anal canal reflects function of both external and internal sphincters.

GOBI campaign

'GOBI':
'G' for growth monitoring to keep a regular check on child well-being;
'O' for oral rehydration therapy to treat bouts of childhood diarrhoea;
'B' for breastfeeding as the perfect nutritional start in life; and
'I' for immunization against the six vaccine-preventable childhood killers: tuberculosis, diphtheria, whooping cough, tetanus, polio and measles.

Vaccines reconstitution

Time limits for using vaccines after reconstitution
• Varicella = 30 min (and protect from light)
• MMRV = 30 min (and protect from light)
• Yellow fever = half hour
• BCG=3 hr
• Measles/MMR= 4 hr
• Meningococcal Polysaccharide Vaccine single dose vial = 30 min
• DTaP/Hib Combination = 30 min

Monday, 20 January 2014

Ocular manifestations of nutritional deficiencies:

VITAMIN B1(THIAMINE):
Corneal anesthesia

Conjunctival n corneal dystrophy

Acute retrobulbar neuritis

VITAMIN B2(RIBOFLAVIN):

photophobia

Burning sensation in eyes due to conjunctival irritation and vascularization of cornea.

VITAMIN C(ASCORBIC ACID):
H'age in conjunctiva, lids,anterior chamber,retina orbit.

Delays wound healing

VITAMIN D:

Zonular cataract
Papilledema
Increased lacrimation

VITAMIN A:
Xerophthalmia

Controversial questions

Final answers for some questions (discussed
after lots of heated and no-to-heated debates) :
Mechanism of edema in NS is Na retention>
Hypoalbuminemia.
MC cause of neonatal sepsis(if nothing
mentioned) is Grp.B strep,
MC cause of neonatal sepsis in india : Gram
negative bacteria (Klebsiella>E.coli)
MC cause of acute epiglottitis is Hemophilus
influenzae type B
Avoid conception after rubella vaccination for :
1 month(4 weeks)
MC cause of seizures in infant of diabetic
mothers in 1st 3 days of life: Hypoglycemia
Contraindication to Pneumonectomy in Ca lung
is PaCO2>45 mm Hg
Dose of INH in chidren for prophylaxis is : 10
mg/kg
1st to increase in Vit K def : PT, followed by
aPTT
MC organism assc with military camp crowding
is : Neisseria meningitides
Never give BCG along with measles
BCG ,opv, ipv can b given upto 5 yr unimm
child
DPT upto 7 yr child, Td after that
Most imp prognostic factor for wilms tm is :
Histology
MC cause of HTN in a child is : Renal
parenchymal disease
Exclusive breast feeding predisposes to def of :
Vit K> Thiamine
Screening for neonate with hypothyroidism:
Heel prick at 72hrs> heel prick after 48 hrs
HCV is associated coomonle with :
Cryoglobulinemia
Max risk of fulminant hepatitis with :
HDV>HEV>HBV> HCV & HAV
Least useful test for TB diagnosis in a child is :
ELISA
Dilutional hyponatremia with increased total
body sodium is seen in acute PEM
VSD is MC congenital heart disease
TOF is MC Cyanotic congenital heart disease
d-TGA is MC Cyanotic heart disease in 1st week
of life
LV output more than RV output due to :
Physiological shunt
CRF with unusually high Hb seen in : PCKD
Children with MDS: MC is monosomy 7;
Adults with MDS : MC is Del 5q;
Overall MC in MDS : del 5q.
MC virus assc with transfusion : HBV>HCV
Poor prognosis in ALL is : age<1yr, >10 yr,
Involvement of CNS & testis, TLC >1 lakh
Macrosomia is weight > 4kg
Symptomatic child with hypoglycemia : Give iv
dexrose
Bleeding from umbilical stump : Factor 13 def
Delayed fall of umbilical cord : LAD type 2
MC site of lung metastasis : adrenals> liver>
brain
MC cause of pathological jaundice in newborns
is : Rh incompatibility
A child with Low GCS and Raised ICP comes :
Intubate the child

Gyn

Dutta
Endometrl biopsy-reg cycl 21-23
Irregulr-wthn 24hrs f mens
Cervix-22
Vaginl cytology-25-26
Prog-21
Fsh,lh-2,3

Manouver

Lovsets maneuvre for extended arms
Pinards maneuvre for extended legs
Marshall burn and mauriceau smellie viet for aftercoming head
Pipers forceps used in breech
MCC of breech-prematurity
MC type of breech-frank/extended
Cord prolapse MC in footling type
MC type in primigrav-extended
MC type in multipara-flexed
Chin to pubis -prague maneuvre
Baby pushed back into uterus and LSCS-zavanelli maneuvre
Impacted breech in incompletely dilated cx-duhrssens incision

Swallow

Swallowing--Prior to the following stages of the oral phase, the mandible depresses and the lips abduct to allow food or liquid to enter the oral cavity. Upon entering the oral cavity, the mandible elevates and the lips adduct to assist in oral containment of the food and liquid.
----------------------
• Swallowing is a complex motor activity that is organized by a network of swallowing-related neurons which form the central swallowing pattern
generator located in the medulla oblongata
=============
Swallowing motoneurons and preganglionic neurons are localized within the trigeminal (V), facial(VII), and hypoglossal (XII) motor nuclei, the nucleus ambiguus (IX, X), and the dorsal motor nucleus (DMX) of the vagus (X) and at the cervical spinal level between C1 and C3

Nystagmus

NYSTAGMUS 
🔃purely torsional nystagmus:lesion of brainstem /vestibular nuclei .Ex:syringomyelia 🔃
Vertical downbeats: lesion at craniocervical region/degenerative lesion of cerebellum .Ex.:Arnold-chiari malformation 
Vertical upbeat nystagmus:lwsion at junction of pons and medulla/pons and mid brain .
➰Pendular nystagmus:
Congenital/acquired
Ex:multiple sclerosis(acquried)➰
Pendular nystagmus may also disconjugate
i.e .vertical in one eye and horizontal in other eye .

Sunday, 19 January 2014

Glucocorticoids

Mineralocorticoid with zero glucocorricoid action
Deoxycorticosterone acetate

Most potent glucocorticoid = Betamethasone

Least potent glucocorticoid = cortisone

Maximum mineralocorticoid action = aldosterone

Maximum glucocorticoid activity = dexamethasone and betamethasone

Glucocorticoid with maximum mineralocorticoid activity = hydrocortisone

Glucocorticoid with minimum glucocorticoid activity = hydrocortisone

Woods lamp

Woods lamp findings :

Golden Yellow (Tinea Versicolor)
Pale Green (Trichophyton Schoenleini)
Bright Yellow-green (Microsporum Audouini or M. Canis) 
Aquagreen To Blue (Pseudomonas Aeruginosa) 
Pink To Pink-orange (Porphyria Cutanea Tarda) 
Ash-Leaf-Shaped Spot (Tuberous Sclerosis)
Blue-white (Leprosy)
Pale White (Hypopigmentation) 
Purple-brown (Hyperpigmentation)
N also

Bright White, Or Blue-white (Depigmentation, Vitiligo) 
Bright White (Albinism)✅✅

Tongue

Various changes in tongue..

HUNTERS TONGUE/MOELLERS TONGUE - PERNICIOUS ANAEMIA
BALD TONGUEOF SANDWITH - NIACIN DEFICIENCY(PELLAGRA)
MAGENTA OR BEEFY RED TONGUE - RIBOFLAVIN DEFICIENCY
STRAW BERRY(EARLY)AND RASPBERRY(LATE) - SCARLET FEVER
SCROTAL TONGUE - FISSUREE TONGUE
BLACK HAIRY TONGUE - PROLONGED ORAL USE OF ANTIBIOTICS
CEREBRIFORM TONGUE - A FEATURE OF PEMPHIGUS VEGETANS
JET BLACK TONGUE - COCAINE ADDICTION

Saturday, 18 January 2014

Contraception

contrception of choice:
heart disease patients:vasectomy of husband if family is complete or double barrier
lactatin mother:iucd
couples livin in diff cities n meetin occasionally:barrier wit back up of emerg contraception
for hiv patients:double barrier ie both male n female
controlled DM:ocps
uncontrolled DM:condoms wit spermicides
newly married couple:ocps

Gall Stones

GALL BLADDER STONES**

MIXED STONE-80%
• Cholestrol+pigment+epithelial debris etc
• multiple small multifaceted

CHOLESTROL-10%
• Single usually
• radiolucent if pure cholestrol-so only usg can detec t it
• at times along with pigments

PIGMENT-10%
• Calcium bilirubinate
• multiple black stones

Friday, 17 January 2014

Ulcers

Curling's ulcer or a Curling ulcer is an acute
peptic ulcer of the duodenum resulting as a
complication from severe burns when reduced
plasma volume leads to ischemia and cell
necrosis (sloughing) of the gastric mucosa .
A Cushing ulcer is a gastric ulcer produced by
elevated intracranial pressure . It is also called
von Rokitansky -Cushing syndrome. Apart from in
the stomach , it may also develop in the proximal
part of the duodenum and the distal esophagus.
Cushing - stomach . Curling - 1st part of duodenum
Stress ulcers are single or multiple mucosal
defects which can become complicated by upper
gastrointestinal bleeding during the physiologic
stress of serious illness. Ordinary peptic ulcers are
found commonly in the gastric antrum and the
duodenum whereas stress ulcers are found
commonly in fundic mucosa and can be located
anywhere within the stomach and proximal
duodenum .

Syndromic treatment of STD under NACP3:

Syndromic treatment of STD under NACP3:
Kit 1(grey)- urethral discharge, anorectal discharge,cervicitis
Kit 2(green)- vaginitis
Kit 3(white)-non herpetic genital ulcer disease
Kit 4(blue)- non herpetic genital ulcer disease with penicillin allergy
Kit 5(red)- herpetic genital ulcer disease
Kit 6(yellow)- lower abdominal pain/PID
Kit 7(black)- inguinal bubo

Nf 1

MC tumor associated with NF- 1 s neurofibroma
Mc Cns tumor associated with NF-1 s optic nr glioma
Mc leukemia associated with NF -1 s juvenile myelomonocytic
leukemia

Buffer

A buffer is a solution containing substances which have the ability to minimise changes in pH when an acid or base is added to it.

Buffer systems in human body
[1] The major buffer system in the Extracellular Fluid is the CO2-bicarbonate buffer system.
This is responsible for about 80% of extracellular buffering.
It is the most important ECF buffer for metabolic acids but it cannot buffer respiratory acid-base disorders.

Then which buffer is responsible for buffering respiratory acid- base disorders ?

[2] The other buffer systems in the blood are the protein and phosphate buffer systems.
These are the only blood buffer systems capable of buffering respiratory acid-base disturbances as the bicarbonate system is ineffective in buffering changes in H+ produced by itself.

Among proteins and phosphates which one more important?

[3] The phosphate buffer system is NOT an important blood buffer as its concentration is too low.

[4] Protein buffers in blood include haemoglobin (150g/l) and plasma proteins (70g/l).
Buffering is by the imidazole group of the histidine residues which has a pKa of about 6.8. This is suitable for effective buffering at physiological pH.
Haemoglobin is quantitatively about 6 times more important then the plasma proteins as it is present in about twice the concentration and contains about three times the number of histidine residues per molecule.

Note :Deoxyhaemoglobin is a better buffer than oxyhaemoglobin.

[6] Respiratory acid base imbalance  are predominantly buffered in the intracellular compartment.
Metabolic disorders have a larger buffering contribution from the extracellular fluid.

Note : It has been estimated that at least 40% of the buffering of an acute acid load takes place in bone. Chronic acidosis can have very adverse effects on bone mineralization due to this process and can result in bone diseases such as rickets, osteomalacia and osteopenia.

So to summarise :
Major ECF Buffer = Bicarbonate system
Major ISF buffer = Bicarbonate system
Major Blood buffer = Bicarbonate system (overall)
Major Blood buffer for respiratory acid base imbalence = Hb
Major ICF Buffer = Protein buffer> phosphate buffer
Major buffer in urine = Phosphate (Responsible for most of 'Titratable Acidity')

Charcoat Crystals

Charcoat leyden crystals R seen in--
🔺 Bronchial asthma
🔺 entamoeba histolytica
🔺 whipworm dysentry
🔺 ascaris pneumonia

Muscular Dystrophies


Wadling Gaits

Waddling gait Is seen in??
muscular dytrophies
▪duchene
▪Becker's spnal muscular atrophy
▪werdnig Hoffman ds.
▪kugelberg- welander syndrome .
b/l Cong. hip displacement(rarely)


Syphilis

CONGENITAL SYPHILIS FEATURES:
  1. Syphilis Hutchison triad : 
    1. Hutchison teeth, 
    2. interstitial keratitis, 
    3. sensoryneural hearing loss
  2. Mulberry molar
  3. Clutton joints 
  4. Saber shin 
  5. Saddle nose 
  6. Bull dog jaw
  7. Salt and pepper fundus 
  8. Follman balanitis 
  9. Moth eaten alopecia
  10. Parrot nodes-mediastinal nodes
  11. Cross bun appearance of skull
  12. Snuffles-syphilitic rhinitis
  13. Rhagades-linear scars at the angle of mouth d/t bacterial infections
  14. Higoumenakis sign-enlarged sternal end of clavicle
  15. pseudoparalysis
  16. Kassowitz’s law - the greater the duration between the infection of the mother and pregnancy, the better is the outcome for the infant. Features of a better outcome include less chance of stillbirth and of developing congenital syphilis
  17. bullous skin lesions-pemphigus syphiliticus
  18. Profeta law-fetus may be normal at the time of birth but develops signs of syphilis in few weeks/months
  19. Colle's law-syphilitic infant infects others but not its own mother
  20. Worm eaten skull-gummatous periosteitis of skull
  21. Olympian brow-supraorbital thickening

Rule

Rule of 4
type 1dm-type 4hypersensitivity
type 2 dm-type2
Rule of 5
type 1 lepra reactn-type 4
type 2 -type3
Rule of8
CD4-Mhc2
CD8-Mhc1
rule of 17
10+7 cranial nerves deviate opposite
12+5 cranial nerves to same side

Thursday, 16 January 2014

Pulmonary embolism

PULMONARY EMBOLISM
Wells grading used fr pulmonary embolism
S1q3t3 pattern is seen on ecg in pulmonary embolismw
Ioc in pul embolism is ct
Gold stdd is pulmonary angiography (but it is invasive)
Hamptons hump.
Pallas sign
Westermark sign
Are seen in pulmonary embolism
Most common sourcr of emboli is calf veins
Most common sign is tachypnea
Mc symptom--dyspnea
Toc--dissolution by thrombolysis

Poisons

Poison Resembling  " Cholera"  - Arsenic
Poison Resembling  "Tetanus"   - Strychnine
Poison Resembling  "Thyrotoxicosis"-Bi nitrocompounds
Poison Resembling  "fading measles"- Arsenic
Poison Resembling  "Naturak death" - Thallium

Top 10 Causes of Death

The top 10 causes of death in the world (2011)
1) Heart disease
2) Cancer
3) Chronic lower respiratory diseases, including chronic
obstructive pulmonary disease, emphysema, and bronchitis
4) Stroke
5) Accidents or unintentional injuries
6) Alzheimer’s disease
7) Diabetes
8) Influenza and pneumonia
9) Kidney-related diseases, including nephritis, nephrotic
syndrome, and nephrosis
10) Suicide

Opthalmology

Photoretinitis is due to?shorter wave length in visible spectrum( blue/violet vth some contribution from UVA
angioid streaks in the eyes are seen in ?PXE,ehler danlos,pagers ds of bone
snow ball opacity in vitreous is seen in ?pars planitis ,sarcoidosis,candidiasis,lymes ds
roth spots are seen in ?inf endocarditis
headlight in fog appearance is seen in ?Cong toxoplasmosis
bullseye lesion seen in?chloroquine
which retinal layer is most radioresistant ?layer of rods n cones(  controversy?)
mizuo phenomenon is seen?oguchi disease
sea fan retina is seen in?many conditions r thr
Most imp is SCA
lattice retinal degeneration seen in?mc in myopia
ring scotoma seen in?RP,High myopia
most frequent cataract type seen in adult retinitis pigmentosa patient is?posterior subcapsular catarct
best diagnostic test for best disease is?eog

Tuning fork tests

Tuning fork tests

#Rinnes test

AC>BC in normal ear and in SNHL.This is rinne +
BC>AC in cond HL. This is Rinne -

#Webers test
Equally heard in both ears-normal
Lateralized to affected ear-cond HL
Lateralized to normal ear-SNHL

#Absolute bone cond test
Normal in normal ear and cond HL
reduced in SNHL

#Schwabach test
Shortened in SNHL
Lengthened in cond HL
Normal in normal ear


Ophthal points

💥size of the disc 1.5mm
💥size of macula :5mm
💥thinnest part of retina : ora serrata:  .1mm
💥capacity of orbit:30cc
💥length of optic nerve: 3.5-5.5cm..mark 5cm in all india
💥axial length: 24mm by A scan
💥depth Ob AC: 2.4mm
💥infant is hypermetropic: +2.5to+3D
💥axial length at birth:17mm
💥 total power of eye/ reduced eye: 58to60D
💥lens: 16-17D
       Cornea: 45to50 D
💥 RI  of cornea: 1.37,
        lens: 1.39, max at centre of lens1.4to1.41
💥direct ophthamoscopy :magnification 15times , 2DISC DIAMETERS seen at a time , virtual erect image , central retina seen
💥indirect : image magnified 5times,8 disc diameters seen at a.time , real.inverted image ,.peripheral retina.seen
💥diameter of lens: 9-10mm
       <9mm: microphakia
💥diameter of cornea: 11-11.75mm
       Megalocornea: >13mm, microcornea:<10mm
💥distant direct ophthalmoscopy: done @25cm

Wednesday, 15 January 2014

Plasma bound drugs

🔵 Highly Plasma Protein bound drugs
🔶Mn: Why Do Cheating to Boy Friend🔶
Why- Warfarin
Do-  Digitoxin
Cheating- Calcium channel blockers
Boy- Benzodiazepine
Friend-  Furosemide.

Clinical trials

Clinical trials
Phase 1: in normal human volunteers (mainly for toxicity n pharmacokinetics)
Phase 2: smal no of patients (20 -200), first in patient study, (both efficacy n safety can b determined.
Phase 3: large no of patients at several centres
Phase 4: post marketing surveillance.
 Recently phase 0 has been added to expedite d marketing of d drug. This is known as Microdosing Studies.
Exception to phase 1 drugs are anticancer drugs d trials for which are directly done in patients because of unacceptable toxicity.

The triad of Zollinger and Ellison

The triad as originally described by Zollinger and Ellison is
1. Hypergastrinemia, raised gastric acid output, beta cell tumor
2. Hypergastrinemia, raised gastric acid output, non beta cell tumor
3. Hyochlorhydria, raised gastric acid output, beta cell tumor
4. Tumor of papilla of Vater, hypergastrinemia, raised gastric acid output

Tuesday, 14 January 2014

Cigarette smoking and Cancers

Multiple cancers have been associated with cigarette smoking. Of all cancers, cancers of the lung, oropharynx, and larynx have strongest associations. The relative risk of lung cancer in current male cigarette smokers is as high as 23.3. However, it is only 12.7 among current female smokers.
Other cancers associated with cigarette smoking include
-esophageal,
-bladder,
-kidney,
-pancreatic,
-stomach,
-cervical, and
-acute myeloid leukemia.
Postmenopausal breast cancer is not associated with current cigarette use, although there may be a link with premenopausal breast cancer that has not yet been fully determined.



Anatomy Lenghts

All are about 45 cms or 18 inches:
Length of Vas deferens or ductus deferens
Length of thoracic duct
Length of Spinal cord
Femur (for 6 feet person)
Length of transverse colon
Distance from the incisor teeth to the cardiac end of the stomach
Umbilical cord at birth
Length of sartorius muscle

All are about 25 cms or 10 inches:
Length of Esophagus
Length of Ureter
Length of Duodenum
Length of Descending colon

All are about 10 cms or 4 inches:
Length of Trachea
Length of Fallopian or Uterine tube
Length of Common bile duct
Length of 3rd part of Duodenum (Transverse Duodenum)
Length of Posterior wall of Vagina
Anteroposterior measurement of Inlet of Pelvis
Transverse measurement of Outlet of Pelvis

All are about 4 cms or 1.5 inches:
Length of Auditory tube
Length of Anal canal
Length of Female urethra
Length of Cystic duct
Length of Common hepatic duct
Length of External acoustic/auditory meatus when measured from tragus
Length of Optic nerve
Length of Ovary
Length of Inguinal canal
Length of Femoral sheath
Thickness of Kidney
Width of Pons

All are about 1 inch or 2.5 cm
Length of Medulla
Length of Midbrain
Length of Pons
Length of 4th part of Duodenum (Ascending Duodenum)
Length of Ducts of Bartholin’s gland (Greater vestibular glands)
Diameter of Trachea
Diameter of Right main bronchus
Distance between Ureteric orifice in Empty bladder

Sjogren's syndrome

Sjogren's syndrome is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands specially that produce tears and saliva.
#Hallmark symptom of Sjogren's syndrome is a generalized dryness, typically including xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes).
# Sjogren's syndrome may cause skin, nose, and vaginal dryness, and may affect other organs of the body, including the kidneys, blood vessels, lungs, liver, pancreas, peripheral nervous system (distal axonal sensorimotor neuropathy) and brain.
#Treatment:
* No treatment is available for cure.
* Artificial tear and salive is recommended.
* Proper eye, mouth and dental hygiene must be maintained.
## It is second most common autoimmune disease after rheumatoid arthritis but remain undiagnosed.


Bunions

Hallux Abducto Valgus
Bunions are a commohn foot disorder of the inherent bone structure at the front of the foot.
Bunions are not a deformity passed on from previous generations, but certain types of feet are more prone to developing bunions.
Bunions are described as a disorder in which the deviation of the normal alignment of the upper foot begins as the big toe, or Hallux, bends inward toward the smaller toes over a period of time, causing the bone of the big toe joint to protrude towards the inner foot. The misalignment of the big toe can also cause other toes to overlap. The result of this deformity can cause extreme pain and swelling at the protrusion or "bump" and make walking difficult. 
Bunions do not always become inflamed or painful and it is possible to have the disorder without ever having to seek treatment. However, because bunions transform the foot gradually, symptoms usually appear in adults during the later stages of the disorder.

Types of Exudates


X Ray Findings - 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

Monday, 13 January 2014

Most common causes of death in

1) crohn's disease= malignancy>sepsis
2) amyloidosis(overall)=renal dysfunction
3) primary amyloidosis= cardiac dysfunction >renal
4) post total hip replacement = thromboembolism
5)lepromatous leprosy= renal failure
6)cystic fibrosis= lung infections
7)carcinoma cervix= uraemia
8)cafe coronary =reflex cardiac arrest >asphyxia
9)throttling= carotid artery occlusion >airway obstruction
10)multiple myeloma= infections

Safety pin appearance

Safety pin appearance
Calymatobacter
Bhorkodella
Vibrio parahemo
Yersinia
H ducreyi

Interstitial lung diseases

Interstitial lung diseases with episodic presentation
- eosinophilic pneumonia
- hypersensitivity pneumonitis
- vasculitis
- churg strauss

ILD with sudden onset breathlessness - -spontaneous pneumothorax  pulmonary
-Lang cell hist
-tuberous sclerosis,
-lam,
-Neurofibromatosis

ILD With obstructive pattern -
-tuberous sclerosis,
-lymphangiomyomatosis

Bone Tumours: Common Sites


Nerve supply : Head and Neck

All muscles of tongue supplied by hypoglossal except palatoglossus supplied by pharyngeal plexus
All muscles of palate supplied by pharyngeal plexus except tensor palati by mandibular nerve
All muscles of pharynx by pharyngeal plexus except stylopharyngeus by glossopharyngeal
All intrinsic muscles of larynx supplied by recurrent laryngeal nerve except cricothyroid by external laryngeal nerve

Tympanogram

TYPES OF TYMPANOGRAM
Type A- normal
Type Ad- ossicular dslocation
Type As-otosclerosis
Type B - SOM
Type C-eustachin tube dysfunction
Type D -atrophic and scarred TM
Type E - ossicle chain discontinuity


Bacterial Vaginosis

For becterial vaginosis Recommended Regimens

Metronidazole 500 mg PO bid × 7 days

Metronidazole 0.75% gel, 5 g per vagina qd × 5 days

Clindamycin cream 2%, 5 g per vagina qhs × 7 days
Alternative Regimens
Clindamycin 300 mg PO bid × 7 days

Clindamycin ovules 100 g per vagina qhs × 3 days
Pregnancy
Metronidazole 250 mg PO tid × 7 days

Clindamycin 300 mg PO bid × 7 days

Metronidazole 500 mg PO bid × 7 days

Sunday, 12 January 2014

Non Tubercular Mycobacteria

Photo chromogens

M. asiaticum
M. kansasii
M. marinum
M. simiae

Scotochromogens
M. flovescens
M. gordonae
M. scrofulaceum
M. szulgai

Non chromogens
M. avium complex
M. haemophilum
M. gastri
M. ulcerans
M. xenopi
M. nonchromogenicum

Rapid growers
M. abscessus
M. fortuitum
M chelonae
M. phlei
M. smegmatis

Pin point pupils

Pin point pupils in poisoning

1. Opium
2. Organophosphate and carbamate
3. Morphine
4. Alcohol
5. Barbiturates
6. Carbolic acid

Abused Drugs

Mickey Finn is chloral hydrate
Hot shot--

Opium+ strychnine
Speed ball = cocaine + heroine
Amphetamine also known as speed whiz
Amyl nitrate-Gold rush,poppers
Amphetamine - also - liquid gold
Knock out drops - chl hydrte
Angel dust - phencyclidine
Special k - ketamine

Diagnostic time criteria

1.late onset schizo-> 45 years
2.acute psychosis <1 month
3.schizhopherniform <6months
4.schizhophrenia> 6 months
5.delusion disorder -3 month
6.postpartum blues- 45days
7.paranoid peers disorder- <18years
8.depressive disorder-2 weeks
9.chronic depression-2 years
10.genera anxiety depress-
icd-3 weeks
           dsm4-6 months
11.panic attack-paek 10 mins(last-30 mins)
12.panic disorder-3 episodes in 3 weeks
13. adjustment disorder-within 3 months
14. acute stress disorder -within 1 month of stress
15. post traumatic stress disorder-after 1 month
16. chronic fatigue syndrome-6 months

Classification of stages of xerophthalmia

The ocular signs of vitamin A deficiencies include nightblindness, conjunctival xerosis, Bitot's spots, corneal xerosis, and keratomalacia. The classification proposed for general use is as follows:

Classification X1A
Signs -primary
Conjunctival xerosis-dryness or lack ofluster, loss of ability to re­tain moisture no matter whether tears are present or absent, loss of transparency, thickening, wrin­kling, pigmentation, accumula­tion of debris.

Classification X1B
Signs -primary
Bitot's spot with conjunctival xe­rosis-a small plaque with a sil­very gray hue and a foamy surface; it is quite superficial and is raised above the general level of the conjunctiva

Classification X2
Signs -primary
Corneal xerosis-follows con­junctival xerosis. The corneal sur­face has a rough, fine pebbly appearance and lacks luster. Later, cellular infiltration of the corneal stroma contributes to the intense haziness of the cornea, which frequently has a bluish, milky appearance.

Classification X3A
Signs -primary
Corneal ulceration wi th xerosis­involving loss of substance of a part or of the whole of the corneal thickness.

Classification X3B
Signs -primary
Keratomalacia - consists of a characteristic softening of the en­tire thickness of a part or, more often, the whole of the cornea, leading to deformation or destruc­tion of the eyeball. The process is a rapid one, the corneal structure melting into a cloudy gelatinous mass which may be dead white or dirty yellow in color.

Classification XN
Signs -secondary
Night blindness-impairment of the ability to adapt to the dark.

Classification XF
Signs -secondary
Xerophthalmia fundus-multiple lesions, sometimes glaring white, scattered profusely along the course of the vessels.

Classification XS
Signs -secondary
Corneal scars-resulting from the healing of irreversible corneal changes.

Classification XB
Signs -secondary
Bitot's spot with conjunctival xe­rosis-a small plaque with a sil­very gray hue and a foamy surface; it is quite superficial and is raised above the general level of the conjunctiva
Stage XN, or night blindness, indicates a functional impairment ofthe retina and is difficult to diagnose in the young child (1-4 yr) unless the mother is aware that the child cannot see well at night. As a method of screening, the child may be asked to walk into a darkened room.
The first sign of xerophthalmia is xerosis of the con­junctiva (stage X1A). This dryness and dullness associated with the stability of the precorneal film is considered complete alteration of the reflection of light from the conjunctiva. Night blindness (XN) and Bitot's spots (ac­cumulation of debris and fatty material near the edge of the eye) are frequently present at stage X1B. At stage X2, when there is xerosis of the cornea itself, the pre corneal film fails to cover the cornea, which now appears dry and opaque. Small erosions or perforations begin to occur if treatment with massive doses of vitamin A (100,000 IU/day, orally or intramuscularly) is not provided within 1 to 3 days of inception, and irreversible damage will soon result. However, if treated, the corneal xerosis will clear up within a short period of time.
Irreversible damage occurs once deeper layers of the cornea are involved, as in stage X3A. The cornea may liquety and melt away, resulting in large perforations and extrusion of the iris, the lens, and the vitreous (X3B). The permanent scarring effects (stage X5) may differ depend­ing on whether or not intraocular pressure was restored at stage X3B. It is essential that medical and paramedical personnel be alert to the signs of xerophthalmia and that treatment be instituted immediately when symptoms are recognized in order to prevent blindness.

ANKYLOSING SPONDYLITIS

ANKYLOSING SPONDYLITIS

Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in your spine to fuse together. This fusing makes the spine less flexible and can result in a hunched-forward posture. A severe case of ankylosing spondylitis can make it impossible for you to lift your head high enough to see forward.

CAUSES

Ankylosing spondylitis has no known specific cause, though genetic factors seem to be involved. In particular, people who have a gene called HLA-B27 are at significantly increased risk of developing ankylosing spondylitis.

As ankylosing spondylitis worsens and the inflammation persists, new bone forms as part of the body's attempt to heal. This new bone gradually bridges the gap between vertebrae and eventually fuses sections of vertebrae together. Those parts of your spine become stiff and inflexible. Fusion can also stiffen your rib cage, restricting your lung capacity and function.

SIGNS & SYMPTOMS

Early signs and symptoms of ankylosing spondylitis may include pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity.

These symptoms may come on so gradually that you don't notice them at first. Over time, symptoms may worsen, improve or stop completely at irregular intervals.

The areas most commonly affected are:
- The joint between the base of your spine and your pelvis.
- The vertebrae in your lower back.
- The places where your tendons and ligaments attach to bones, mainly in your spine, but sometimes along the back of your heel.
- The cartilage between your breastbone and ribs.
- Your hip and shoulder joints.

RISK FACTORS

- Sex: Men are more likely to develop ankylosing spondylitis than are women.
- Age: Onset generally occurs in late adolescence or early adulthood.
- Heredity: Most people who have ankylosing spondylitis have the HLA-B27 gene.

COMPLICATIONS

Ankylosing spondylitis doesn't follow a set course. The severity of symptoms and development of complications vary widely from person to person. Complications may include:
- Eye inflammation (uveitis).
- Compression fractures.
- Difficulty breathing.
- Heart problems.

There is no cure for ankylosing spondylitis, but treatments can decrease your pain and lessen your symptoms.

Saturday, 11 January 2014

THALAMIC HEMMORHAGE

C/L hemiplegia or hemiparesis
sensory deficit involving all modalities
aphasia wid preserved repetn(dominant thalamus)
constructional apraxia or mutism(nondominant thalamus)
OCULAR FEATURES
homonymous visual field defect
deviation of eyes downwards n inwards
unequal pupils
absent light reaction
I/L horners syndrome
absence of convergence
paralysis of vertical gaze
retraction nystagmus

pts later develop a chronic C/L pain syndrome
DEJERINE ROUSSY SYNDROME

Friday, 10 January 2014

Criteria and Clarification

1.Halls criteria : Downs syndrome
2.Dukes criteria: Endocarditis/Heart failure
3.Butchers criteria :mesothelioma
4.Ann Arbours classifiacation:Hodgki.s lymphoma
5.Bismuth classification: tumors of hepatic ductal system
6.Nazers Index: Wilsons disz
7.Pagets Index : Abruptio placentae
8.Quetlet index: BMI -wt in kg/ht in meter square
9.Ponderial Index: ht in cm/cube root of body wt in kgs
10.Brocas index : Ht in cms-100
11.Corpulence index : Actual wt/desired wt
12.Milans crjteria: for liver transplant in HCC
13.Mayers n cottons grading system: Subglottic stenosis
14.Spaldings criteria: abdominal pregnancy
15.GCS/Ransons criteria/ APACHE score: Pancreatitis
16.Ennekings staging : Bone tumors
17.Mc Donald's criteria: Multiple Sclerosis
18.Epworths criteria : Sleep apnea
19.Framminghams criteria/Boston's criteria: CHF
20.Durie salmon system of staging: Multiple myeloma
21.Lights criteria: pleural effusion
22.GOLD's criteria :COPD
23.OKUDA staging : HCC

Cullens Sign

Cullen's Sign
DESCRIPTION
Peri-umbilical ecchymoses.
ASSOCIATED with :
=>More common
♣Retroperitoneal bleeding
♣Post surgery
♣Iatrogenic - anticoagulation complication, postoperative
♣Rectus sheath haematoma
=>Less common
♣Ectopic pregnancy
♣Intrahepatic haemorrhage
♣Ischaemic bowel
♣Ruptured abdominal aortic aneurysm
♣Amoebic liver cyst
♣Perforated duodenal ulcer
MECHANISM/S
The final common pathway in most mechanisms is retroperitoneal bleeding. The retroperitoneum is connected to the gastro-hepatic ligament and then to the falciform ligament and finally to the round ligament (the obliterated umbilical vein), which tracks to the abdominal wall around the umbilicus. When a haemorrhage (from any cause) occurs, blood is able to move along these ligaments to the abdominal wall to produce ecchymoses.


Sleep EEG

Those who find sleep EEG difficult to remember....an effort to make it easy for all:- 
1. Alpha - A for Awake with eyes closed @ POST(PO = parieto occipital) (ST= subconscious thinking)
8- 13 hz

2. Beta - B for block alpha and return to attention @ frontal CT (frontal lobe) (CT= conscious thinking) 13-30hz ( B looks like 13)

3. Theta - T for transition to sleep (NREM 1).(cortical in humans) 4-7hz (T looks like 7).slow eye movements

4. Stage 2 NREM:- sleep spindle and K complexes .no eye movements.

5. Delta - D for deep sleep (NREM 3 n 4) .no eye movements. 3 - 5 hz( 3hz in stage 3).slow waves.

6. REM sleep- reapearance of beta waves f/b alpha waves . rapid eye movement with autonomic activity, nocturnal penile tumesence and generalized muscular atony. (REM - 20-30% of sleep--- we see horses/mares in dreams - nightmares.Also narcolepsy with cataplexy, sleep paralysis n hypnagogic hallucinations) NREM- 60-70% of sleep- all other sleep disorders) this is all we need to know from exam point of view.

Hernias

1. Bochdalek's hernia-- MC... left posterior

2. Morgagnian hernia-- LC.. right anterior

other named hernia:

1.Velpau hernia- hernia in groin in front of femoral blood vessels.

2. sports hernia-- in atheletes, hernia with dilated superficial inguinal ring

3.Pantaloon hernia-- direct + indirect hernia separated by epigastric vessels. t/t hoquet manoeuvre

4.spigelian hernia-- 6-centimeter horizontal region below the navel and to the side of the abdominal muscles.Spigelian hernias are commonly found in patients around 50 years of age and are more common in men
than in women. They also occur more often on the right side than on the left side. a simple closing of the fascia (connective tissue of the abdominal wall) with sutures can repair the hernia.

5.Cooper's hernia: A femoral hernia with two sacs, the first being in the femoral canal, and the second passing through a defect in the superficial fascia and appearing immediately beneath the skin.

6.epigastric hernia: hernia through the linea alba above the umbilicus.

7.Littre's hernia: hernia involving a Meckel's diverticulum.

8.Petit's hernia - hernia through Petit's triangle (inferior lumbar triangle).

9.Grynfeltt's hernia - hernia through Grynfeltt-Lesshaft triangle (superior lumbar triangle)

10.Richter's hernia- strangulated hernia involving only one sidewall of the bowel, which can result in bowel perforation through ischaemia without causing bowel
obstruction or any of its warning signs.

11.Gibbon's hernia- hernia with hydrocoele

12.Berger's hernia - hernia in Pouch of Douglas

13.Cloquet's hernia- hernia through pecteineal fascia

14.Narath's hernia - behind femoral artery

15.Hesselbach's hernia - lateral to femoral artery

16.Serofini's hernia - behind femoral vessels

17.Laugier's hernia - through lacunar ligament

18.Tealse's hernia - in front of femoral vessels

19.Maydl's hernia - 'w' hernia

20.Phantom hernia - Localised muscle buldge following muscular paralysis

21.Beclard's hernia - femoral hernia through saphenous opening

22.amyand's hernia- inguinal hernia with appendix involvemnt

23.gruber's hernia-- internal mesogastric hernia

24. Howship hernia-- Pain or paraesthesia in the obturator hernia on the inner aspect of the thigh down to and often most severe at the knee due to compression of n. obturatorius.

25.HERNIA IN glissade-- hernia in bladder wall.

Thursday, 9 January 2014

Histamine

Histamine is formed from the amino acid histidine and is stored in high concentrations in vesicles in mast cells, enterochromaffin cells in the gut, some neurons, and a few other cell types.
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Histamine H1 receptor—This Gq-coupled receptor is important in smooth muscle effects, especially those caused by IgE-mediated responses. Inositol trisphosphate (IP3) and diacylglycerol (DAG)are the second messengers.
============
H2 receptor—This Gs-coupled receptor mediates gastric acid secretion by parietal cells in the stomach. It also has a cardiac stimulant effect. A third action is to reduce histamine release from mast cells—a negative feedback effect.
========
H3 receptor—This Gi-coupled receptor appears to be involved mainly in presynaptic modulation of histaminergic neurotransmission in the central nervous system (CNS).

Orthopedics

🚩leg/Lorenzo/Bachelor’s cast- Congenital Dislocationof Hip(CDH)
🚩Minerva Cast- Cervical Spine disease
🚩Reissers/Turn buckle cast- Scoliosis
🚩Shoulder Spica- Fracture around shoulder
🚩Hip Spica- Fracture Femur
🚩U slab/ Hanging cast- Fracture Humerus
🚩Colles Cast – Colles fracture
🚩Cylinder cast – Fracture patella
🚩Patellar tendon bearing cast- Fracture Tibia

Anti fungal drugs

- Praziquantal is DOC for all trematodes (flukes) and cestodes(tape worms) except Faciola hepatica (Triclabendazole) and hydatid disease(Albendazole)

- Albendazole is the DOC for all Nematodes (worms) except Enterobius (Mebendazole), Wuchereria and brugia(DEC), Onchocerca and strongyloides(Ivermectin) and dracunculus (Meteonidazole)

MOST COMMON IN ORTHOPAEDICS

1.Most common bone to get fractured overall – Tibia
2.Most common bone to get fractured during childbirth / in a newly born child – Clavicle 
3.Most common bone to get fractured during childhood – Greenstick fractures of forearm bones
4.Most common bone to get fractured during childhood around elbow – Supracondylar fracture humerus
5.Most common joint to undergo Spontaneous / Traumatic / Recurrent dislocation – Shoulder
6. Least common joint to undergo dislocation – Ankle
7. Second most common joint to undergo recurrent dislocation – Patella
8. Most common ligament to undergo sprain – Anterior talofibular ligament
9. Strongest ligament of the body – Iliofemoral ligament / Ligament of Bigelow 10. Most common tendon to get injured – Tendo Achilles
11. Strongest tendon in the body – Tendo Achilles
12. Most common nerve to get injured – Radial Nerve
13. Best prognosis after nerve injury is seen in – Radial Nerve
14. Most common artery to get injured – Popliteal artery
15. Most common bone tumor – Metastasis / Secondaries
16. Most common benign bone tumor – Osteochondroma / Exostosis
17. Most common true benign bone tumor – Osteoid Osteoma
18. Most common primary malignant bone tumor – Multiple Myeloma
19.Second most common primary malignant bone tumor – Osteosarcoma

VDRL

Many condition are there for false positive VDRL
Acute false positive reaction <6 months-
-Recent viral infection or immunization
-Genital herpes
-Hiv infection
-Malaria
-Parenteral drug therapy
-Infective endocarditis
-Pregnancy

Chronic false positive reaction > 6 months
-Aging
-Autoimmune disorders
-SLE
-Rheumatoid arthritis
-Hepatitis infection
-Infectuous mononucleosis

And very imp is LEPROSY doesnt give false positive reaction with VDRL

Wednesday, 8 January 2014

Histology

Histology booster-

Gitter/hortegra cells- modified microglia in brain.
Kulchisky cells- in bronchi.
Clara cells- in bronchioles.
Pores of kohn- in alveoli.
P cells and I cells- collecting duct in kidney.
Brunners gland- duodenum.
Mucous neck cells- stomach.
Paneth/zymogen cells- duodenum.(in crypts of liberkuhn).
Peg cells- falliopian tubes.
Space of disse-liver.
Cords of billroth- Spleen(red pulp)
Hassal's corpuscle-in thymus.

Health in pregnancy

* Peripheral nerve disorder
* Bells palsy – 3 times more common in 3rd Trimester, post partum.
* Carpal tunnel syndrome. (median n)
* Meralgia paresthetica (lat. femoral cutaneous nerve)-AI-2007***
* Carpal Tunnel – pain worse in night
*Restless leg syndrome is the most common peripheral nerve and movement disorder in pregnancy. Disordered iron metabolism is the probable etiology. (18th EDITION)
*Maternal death is defined as the death occurring during pregnancy or within 42 days of completion of the pregnancy from a cause related to or aggravated by the pregnancy, but not from accident or incidental causes (18th EDITION)
Neoplasia During Pregnancy( a new chapter in 18th edition-all points given below are from 18th edition))
*The four cancers most commonly developing during pregnancy are
• cervical cancer
•breast cancer
•melanoma
• lymphomas (particularly Hodgkin's )

1)CA CERVIX
*Cervical intraepithelial neoplasia has a low risk of progression to invasive cancer during pregnancy (0.4%) and many such lesions (36–70%) regress spontaneously postpartum
*Cone biopsy should not be done within 4 weeks of delivery.
*If the disease is microinvasive, vaginal delivery can take place and be followed by definitive treatment, usually conization.
* If a lesion is visible on the cervix, delivery is best done by caesarian section and followed by radical hysterectomy.

2)Pregnancy-associated breast cancer
*Defined as cancer detected during the pregnancy and up to 1 year after delivery
*45% in the second trimester
*70% of the breast cancers found in pregnancy are estrogen receptor–negative
*Pregnancy retains its protective effects in carriers of BRCA1 mutations
*pregnancy seems to increase the risk of breast cancer among carriers of BRCA2 mutations
*28–58% of the tumors express HER-2
*Even in pregnancy, most breast masses are benign (80% are adenoma, lobular hyperplasia, milk retention cyst, fibrocystic disease, fibroadenoma)
*Lumpectomy followed by adjuvant chemotherapy is frequently used; fluorouracil and cyclophosphamide with either doxorubicin or epirubicin have been given without major risk to the fetus
*Methotrexate and other folate antagonists are to be avoided
*Trastuzumab are unsafe during pregnancy
*Estrogen increases 100-fold; progesterone increases 1000-fold during pregnancy .

3)Melanoma During Pregnancy
* melanoma is not more aggressive during pregnancy
*ipilumimab (antibody to CTLA-4), and in those with BRAF mutation V600E, a BRAF kinase inhibitor .

4)Hodgkin's Disease and Non-Hodgkin's Lymphoma
*May be accompanied by B symptoms (fever, night sweats, unexplained weight loss).
*Women diagnosed in the second and third trimester can be treated safely with combination chemotherapy, usually doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).
*If symptoms requiring treatment appear during the first trimester, evidence suggests that Hodgkin's disease symptoms can be controlled with weekly low-dose vinblastine
*Non-Hodgkin's lymphomas are more unusual in pregnancy but are usually aggressive
5) Thyroid Cancer During Pregnancy
*Patients with follicular cancer or early papillary cancer can be observed until the postpartum period
*Patient on Radioactive iodine should not become pregnant for 6–12 months after treatment.
*Demand for thyroid hormone increases during pregnancy, and doses to maintain normal function may increase by 30–50%-Total T4 levels are higher during pregnancy
*The target TSH level is lower than 2.5 mIU/L.

6) Gestational Trophoblastic Disease
*Moles are the most common
* A previous molar pregnancy makes choriocarcinoma about 1000 times more likely to occur
*Partial moles result from fertilization of an egg by two sperm, resulting in diandric triploidy.*** (???AIIMS NOV-2013)
* Complete moles usually have a 46,XX genotype;
*95% develop by a single male sperm fertilizing an empty egg and undergoing gene duplication (diandric diploidy);
* 5% develop from dispermic fertilization of an empty egg (diandric dispermy)

Obstetrics

1. If external OS seen at introitus , diagnosis is: Uterine prolapse
2. Carcinoma cervix involving upper 2/3rd of vagina are classed as :II A
3. Most common type of benign ovarian tumor during pregnancy is :Mature cystic teratoma
4. The most common type of ovarian tumor is : Cystadenoma
5. Call-Exner bodies are seen in : Granulosa cell tumor
6. Carcinoma cervix is commonest at : Squamocolumnar junction / Transformation zone.
7. Commonest malignancy in woman in India is : Ca cervix
8. Danazol NOT used in : Endometrial ca
9. Ward Mayo's operation is indicated in : Procidentia / Uterovaginal prolapse
10. Treatment of choice for endocervical polyp is: Polypectomy and D& C
11. Suction evacuation can be done upto : 10 weeks
12. In- Vitro fertilisation is indicated in: Bilateral Tubal block
13. How many days after fertilization is placental circulation established: 18-21 days
14. The folds of Hoboken are found in: The umbilical cord
15. The most common lesion of the placenta is: Infarction
16. Zygote with zona pellucida reaches uterine cavity by: 4days
17. Cardiac output during pregnancy is maximum at: 32 weeks
18. The source of HCG: Syncytiotrophoblast
19. Net weight gain in pregnancy is : 24 pounds /11Kg
20. The corpus luteum secretes: Progesterone
21. The maternal blood volume increases by nearly: 15-20%
22. The peak level of chorionic gonadotropin in normal pregnancy occurs at: 60-70 days
23. Post-term pregnancy is that which continues beyond: 294 days
24. Fetal movements can be recognised in USG as early as: 10th week
25. Implantation bleeding is called: Hartman's sign

Tuesday, 7 January 2014

Bishops Score

Modified Bishop score
According to the Modified Bishop's pre-induction cervical scoring system, effacement has been replaced by cervical length in cm, with scores as follows- 0>3 cm, 1>2 cm, 2>1 cm, 3>0 cm.
Another modification for the Bishop's score is the modifiers. Points are added or subtracted according to special circumstances as follows:
One point is added for:
1. Existence of pre-eclampsia
2. Every previous vaginal delivery
One point is subtracted for:
1. Postdate pregnancy
2. Nulliparity (no previous vaginal deliveries)
3. PPROM; preterm premature (prelabor) rupture of membranes


Methergine c/i

Contraindications to methergine in active management of 3rd stage of labour is--
🔸Eclampsia/preeclampsia
🔸Pt with heart dis
🔸Twin pregnancy
🔸Rh incompatibility

Gynaecology

🙍Most rapidly growing germ cell tumour....
yolk sac tumour

🙍Ovarian tumour with smooth surface
krukenberg
It is bilateral n most common metastasied frm stomach

🙍Pain in ovarian ca refer to??
Medial side of thigh

🙍Ascites with rt side haemothorax with fibroma of ovary....diagnosis??
Meigs Syndrome

🙍Pseudo meigh syndrome :-
 brunner n granulosa cell tumour

🙍psedo pseudomeig syndrome seen in
SLE

Cardiac enzymes Markers

1) CKMB: The MB isoenzyme of creatine phosphokinase is more specific to AMI than CK. AMI
produces a CKMB elevation that peaks approximately 20 h after the onset of coronary occlusion. A
CKMB2: CKMB1 ratio of>1.5 is highly sensitive for the diagnosis of AMI, particularly 4 to 6 h after the onset of coronary occlusion. The MB-CK fraction appears in 4 hours after onset of infarction and peaks at about 24hrs with a duration of 72 hours.
CK MB: 4h - 24h - 72h
2) Cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI) Since cTnT and cTnI are not normally detectable in the blood of healthy individuals but may increase afterAMI to levels over 20 times higher than the cutoff value. the measurement of cTnT or cTnI is of considerable diagnostic usefulness, and they are now the preferred biochemical markers for MI. Levels of cTnI may remain elevated for 7 to 10 days after AMI, and cTnT levels may remain elevated for up to 10 to 14 days. Thus, measurement of cTnT or cTnI has replaced measurement of lactate dehydrogenase (LDH) and its isoenzymes in patients with
suspected MI who come to medical attention more than 24 to 48 h after the onset of symptoms.
3) LDH on the other hand appears 12 hours after the infarct and peaks 2 days later to last 14 days. LDH has been largely replaced with the more specific cardiac troponin for patients with suspected AMI presenting after the initial 48 hours have passed. LDH: 12h - 48h - 14 days
4) CK: Creatine phosphkinase has been replaced by CKMB due to lack of specificity of CK in AMI.
5) SGOT, SGPT

Monday, 6 January 2014

GENETICS Brain tumors

NF-1:
von Recklinghausen, chromosome 17q11.2, 1/3,500 live births, NF1 encodes neurofibromin, autosomal dominant, 50% germline, 50% new mutations, peripheral nerve sheath neurofibromas, café au lait spots, optic and intracranial gliomas, and  bone abnormalities.

NF-2:
chromosome 22, 1/50,000 live births, NF2 encodes merlin, autosomal dominant, bilateral acoustic neuromas, gliomas, ependymomas, and meningiomas.

von Hippel-Lindau:
chromosome 3, autosomal dominant, renal
clear cell carcinoma, pheochromocytoma, hemangioblastoma, pancreatic tumors, and renal cysts.

Tuberous sclerosis (Bourneville’s disease): TSC1 on chromosome  9, TSC2 on chromosome 16, autosomal dominant, subependymal giant cell astrocytoma, retinal and rectal hamartomas.

Retinoblastoma:
Rb tumor suppressor gene, chromosome 13.

Li-Fraumeni syndrome:
germline p53 mutation = breast, sarcoma,
and brain CA.

Turcot’s syndrome:
primary brain tumors with colorectal CA.

Neuroblastoma:
N-myc amplication commonly seen and serves as a prognostic factor.

LASIK

For LASIK there are two forms of contraindications - definite and indefinite. Definite contraindications make the LASIK surgery impossible, indefinite contraindications must be taken into serious consideration before making the decision to undergo LASIK.

Definite contraindications of LASIK
•Diseases of the cornea (e.g. keratoconus, degeneration)
•Acute eye diseases
(e.g. diabetic retinopathy, developed glaucoma)
•Pregnancy and breastfeeding
•Patients under 18 years (eye still growing)
•Instable refraction values (increasing diopter values)
•Astigmatism > 5 Diopter
•Corneal thickness < 500 µm
Indefinite contraindications of LASIK
•Retinal defects (e.g. holes, retinal detachment)
•Eye disease
(e.g. high interocular pressure, begin of diabetic alterations, chronic infection)
•System diseases (e.g. Auto immune deficiency, rheumatism)
•General bad health

Lung involvement in various connective tissue disorders

SLE- PLEURITIS N PLEURAL EFFUSION mainly. Also alveolar edema, hemmorhage, interstitial fibrosis

Sjogren Syndrome
General dryness n lack of airway secrns cause cough hoarseness n bronchitis
Lymphocytic interstitial pneumonitis lymphoma pseudolymphoma n bronchitis n bronchiolitis obliterans

Systemic sclerosis
Diffuse- interstitial fibrosis
Limited-pulm artery htn

Wegeners-
cavitating nodules  5-10cm size
But NO CALCIFICATION

Sarcoidosis-
b/l hilar LAD
Nodules mainly in midzones
Pleural involvement in 5-7% cases
Bronchostenosis 1-2%

RA
pleural effusion wid low glucose n pH
Lung nodules dat may calcify or cavitate
Diffuse interstitial fibrosis
Caplans syndrome

Classical PAN
No lung involvement

Microscopic pan
URT invovement in 90% pts with nasal involvement as first manifestation of disease.
Both Conductive and SNHL
Lower respiratory tract 95% patients persistent pneumonitis
Mc xray finding pulmonary infiltrate and nodules

Some facts on nosocomial infection

Most common nosocomial infection ::uti

Most common organism causing uti::ecoli

Most common organism causing nosocomial infection :: staphylococci (mrsa)

Most common organism causing nosocomial blood stream infection:: cons

Mc organism causing nosocomial pneumonia:: staphylococci

Apache III SCORE  predicts The possibility of acquiring nosocomial infection