Tuesday, 29 July 2014

Most common

• Most common: simple renal cyst
• Most common solid tumor 85%: is renal cell carcinoma (RCC)
•Autosomal dominant polycystic kidney disease, the most common "hereditary" renal cystic disease
•The most common renal mass in toddlers is
Wilms' tumor.
• The most common renal mass DETECTED (Radiologically) in the neonatal period is hydronephrosis, although multicystic disease is the most common in first day of life.
•The most common intrarenal neoplasm
manifesting at birth is congenital mesoblastic nephroma, followed by Wilms tumor.
• Mesoblastic nephroma is by far the most
common solid renal mass in neonates

Monday, 28 July 2014

One liners

1. Heart size is Normal in :TOF and TAPVC ( infracardiac form )
2. Visual reflex formation or Macula mature by5-6 months life
3.Gardasil-- 16 , 18 , 6 , 11
Cervarix -- 16 , 18
4. Renal tubular acidosis -- Normal Anion gap Hyperchloremic Metabolic Acidosis
Point to remember -- its NORMALinSerumbutPOSITIVEanion gap inUrine
5. Ectopic ACTH Syndrome --Hypokalemic Alkalosis
6. Anatomical Closure of Ductus arteriosus --1-3 monthsafter birth. 1-3 months after birth. (ref: Langman's embryology & Guyton)
7. Corneal donor -- till6 hourafter death
8. Nerve fibers -- A and B areMyelinated; A to C - Diameter and Velocitydecrease
9. For Congenital hypothyroidism -- TSH , best done>48 hrs - 6 dayslife
10. Child of HIV positive Mother -- Cant use IgG for1st 18 monthsto diagnose as that comes from
mother. So p24 assay , PCR , Viral  Culture are used.
11.Neomycinis present in Polio Vaccine
12. TORCH infectivity -- All at time of birth BUTRubella has 2 peaksi.e 10 -11 wks and delivery.
13.Unchanged during child birth-- Diameter between Sacral promontary and Pubic Symphisis.
14.RAIU--I 123;
RIA ---- I 125
15. CO poisoning-- PO2 Normal but O2 saturation is less.
16. Fetal distress --S/D ratio--increases in Umblical Artery , decreases in MCA.
17. AllMyopathies are Proximalexcept Myotonic Dystrophy (type 1)
18. AllNeuropathies are Distalexcept GBS and SMA.
19.Glysineis the smallest and simplest Amino Acid.
20.Adder Headon IVP -- Ureterocele
21.Flower vase / shaking handsign -- Horseshoe kidney
22. Ligament ofStruthers.-- remnant of 3rd head of coracobrachialis , runs from supracondylar spur on anteromedial humerus to medial epicondyle, median n and brachial a may run beneath it.
23.Shortest Colon- Ascending
Longest Colon- Transverse
24. Trigeminal Neuralgiararelyinvolves Ophthalmic division
If in a young / if it is Bilateral -- then Multiple Sclerosisis a key consideration
25. After overnight fasting , levels of glucose transporters are reduced inMuscle.
26.Pacini Corpuscles-- detects gross pressure changes and vibration
27.Epiphyseal dysgenesis-- in Hypothyroidism
28. In Hypothyroidism ---Increased CSF protein
29. Most characteristic cutaneous manifestation ofFMF(Familial Medit. fever) -- Erysipelas like erythema.
30. Two halves of Mandible join together by2yrsof Life
31. Syphilitic Aortitis --Proximal AscendingAorta
32. Superficial spreading melanoma --Buckshotappearance (Pagetoid cells)
33. Seborrheic Keratoses --Stuck onlesion
34. Finger prints can be taken in cases of advanced decomposition and drowning
But NOTin case ofcorrosion
35. Generally all bones ossify earlier in females
Skull sutures obliterate earlier in Males.
36.Anterior neuroporecloses by 25th day, andposteriorone closes by 27th day of IUL.
37.Gittre cellsare modified CNS macrophages.
38.Hirano Bodiesin Hyppocampus -- Alzheimer's
39.AcrocentricChromosomes -- 13 , 14 , 15 , 21 , 22 , Y
40.LAPincreased in -- Leukamoid reaction , Polycythemia Vera
decreased in -- CML , PNH
41. Schistiocyte-- MicroAngiopathic Hemolytic anaemia
42.Tear Drop cell-- Myelofibrosis
43.Target cell-- Thallesemia , HbC disease , Liver disease.
44.Good ALL-- Female , 2-10 years , Hyperdiploidy , B-ALL(NOT preB-ALL)
45. Pregnancy tumor of gums =Granuloma pyogenicum
46. RCC = Hypernephroma =Grawitz Tumor
47.Holly leafmesangial deposits -- FSGN
48.Spike & Dome , String of Popcorn-- Membranous GN
49.Wire loop-- Class IV Lupus Nephritis
50. Post Mortem staining iswell developedin 4 hrs and becomesfixedin 6-12 hrs
51.Three important syndromes of the first and second pharyngeal arches:
*.Treacher Collins syndrome (TCS),
*.Oculo-auriculo-vertebral syndrome (AOVS) and
*.Auriculo-Condylar syndrome (ACS) or question mark ear syndrome.
52. Achlasia Cardia - uncoordinated,non-progressive contractionwithin the esophageal body
BUT The hallmark symptom of  achalasia isprogressive dysphagia.
53. The mandible isnotpart of the craniumnorpart of the facial skeleton.
54. There are 2 things - Threshold level and a discriminatory level for theappearance of a gestational sac
on USG
The threshold level identifies the earliest one can expect to see a sac (4 weeks, 3 days), and
The discriminatory level  identifies when one should always see the sac (5 weeks, 2 days).
55.Fluoroscopyis a real-time x-ray viewed on a video monitor, provides information about moving organs.
Examples include motion of the diaphragm or chest wallduring respiration and left ventricular
contraction during systole. During fluoroscopy, the patient can be turned obliquely, to eliminate
overlapping of structures.
56. Digitalis toxicity isprecipitatedby HypoKalemia , but itsmanifestationis HyperKalemia.
57. Beta Thallesemiaminor--HbA2increased
Beta Thall interm/major -- HbF  increased
58. Theleft pulmonary artery lies above the left main bronchusbefore passing posteriorly, whereas on
the right side the artery is  anterior to the bronchus resulting in the right hilum being the lower.
59. Least CO2 -- in Anatomical Dead Space --At the END Inspiratory Phase.
60. Central Chemoreceptors arenotsensitive to Hypoxia.
61.Middle genicular arterypierces the oblique popliteal ligament of the knee joint.
62. Among Benzodiazepine -Lorazepamcauses the longest duration of antegrade amnesia.
63. Pressure relief valve isnotrequired forCyclopropane.
( Pressure relief valveis a mechanical device that eliminates system overpressure by allowing the
controlled or emergency escape  of liquid or gas from a pressurized system. The relief valve may or may
not be adjustable.)
64. Each 1ml of O2 liquid -- 840 mlgas.
65. The auricular branch of the vagus nerve is often termed theAlderman's nerve or Arnold's nerve.
66. Failure of thesinus of Histo obliterate that is believed to be the cause of the development of branchial cleft cysts, fistulas, or sinuses.
67.Red Ribbon-- Aids Awareness.
Pink Ribbon-- Breast Cancer Awareness.
68. Father of Orthopaedics --" Sir Nicholas Andre "
69.Blair's procedure-- Arthrodesis of ankle joint.
70.Darrach osteotomy-- done in Made Lung Deformity.
71. Partial or Complete loss of bone seen on X-Ray isPathognomonic of Fracture.
72.Godfrey Hounsfieldwon the 1979 Nobel Prize for Physiology or Medicine for developing CT, shared with Allan M. McCormack.
73. Theatypical ribs: 1st, 2nd, 11th, and 12th ribs.
74. Cuffed ET tube - Cuff pressure shouldnever exceed 30 cmof H2O (preferably 25cm).
75. PVC - ET tubes useHigh Volume Low Pressurecuffs. (therefore suitable for long duration).
76. FDA approvedRaxibacumabto treat" inhalational anthrax "- First monoclonal antibody approved
using the Animal Efficacy Rule.
77. Major carrier of Nitrogen by  products from most tissues in the body isGlutamine.
78. Keloid is a result of anovergrowthof granulation tissue(collagen type 3)at the site of a healed skin injury which is thenslowly replaced by collagen type 1.
79.Medianumbilical ligamentis the remnant of theurachus, which joined the apex of the fetal bladder to the umbilicus.
80.Medialumbilical ligamentsare formed byoccluded partsof theUmbilical arteries.
81.Hilarcholangiocarcinoma is the most common among Cholangiocarcinomas.
82. Maximum content oftryglycerideis found in- Chylomicrons
83. Maximum content ofExogenous tryglycerideis found in-Chylomicrons
84. Maximum content ofEndogenous tryglycerideis found in- VLDL
85. Maximum content ofCholesterolis found in- LDL
86.N2Ocan be Teratogenic
87.Central pontine myelinolysisseen withcorrectionofhyponatremia.
88. Best test for Malignant Hyperthermia -"Caffeine-halothane contracture test".
89.Neuroaxial block- INR should be < 1.4.
90. Protein intake in ICU :1 - 1.5 g/kg/day.
91. Most common ophthalmic complication during anaesthesia :Corneal abrasion.
92. History of Post dural puncture headache isNOTacontraindicationof Epidural block.
93.Flat Capnogram
*.Accidental Extubation
*.Dissociation of anaesthetic tube
*.Mechanical ventilation failing
94.O2 contentof anaesthetic mixture : 33%
95. Preanaesthetic drug which causeslongest amnesia: Lorazepalm
96. Anaesthetic with Least decrease in Systemic vascular resistance :Halothane
97.Malignant Hyperthermia :
*.Respiratory Acidosis
98.Dextrose fluid is NEVERused for Resuscitation.
99. Opioid given astransdermal: Fentanyl
100. Drug of choice forAsystole and Cardiac arrest: Adrenaline
101. Maple syrup urine disease(MSUD) is caused by a deficiency of the branched-chain alpha-keto acid dehydrogenase complex , leading to a buildup of the branched-chain amino acids(leucine, isoleucine, and valine)
102. TheSMAlies to theleftof the SMV as it crosses over the third portion of the duodenum. ( Clinical Importance : to check malrotation )
103.Meta-analysisis best for Probiotics' Trial.
104. Vertical crest in fundus of internal auditory canal is -Bill's Bar.
105. Sphincter of oddi has 3 sphincters.
106. Sheath surrounding the neurovascular bundle in axilla is derived from -Prevertebral fascia.
107.1st partof duodenum has duodenal cap/bulb.
108. Spleen projects intoGreater sac.
109. Axillary abscess is drained safely throughFloor.
110. The primary direct stimulus for excitation of central chemoreceptors -H+ increase.
111. Breast Milk isContraindicatedin Galactosemia
112. If Mother Sputum +veTB- Still givebreast milkto baby ( with 6months course of 5mg/kg INH )
113. Mother withHIV- Never mix feed i.e giveexclusivetrophic feed or give expressed milk of other women )
114. Mother to Child transmission ofHbsAg - Preventby
*.HBIG within 12 hr of life
*.Vaccine on day 1 of life.
115. Anti HbsAb Protective Titre -> 10 mIU / ml
116. Liver biopsy in Alpha 1 anti-tripsin deficiency :PAS +ve and Diastase resistant granules
117. CMV :Intranuclear Owl eye inclusion bodies.
118.Nystagmus induced by Valsalva maneuver:
*.Chiari Malformation
*.Perilymph fistula
*.Superior Canal dehiscence syndrome
119. GABA is formed fromPyridoxine.
120. If pregnant lady shows Rubella antibody +ve : It means she isimmune to rubelladuring her pregnancy and need not worry for rubella infection.
121. Various types of vasculitis produce aneurysms in many portions of the aorta and its branches, butTakayasu arteritisis the only type of aortitis that producesstenosisin the thoracic aorta.
(ref: Miller SM. Thoracic aortic diseases.)
122.Noonan Syndromehas Phenotype as that of Turner syndrome but Normal Karyotype (XX or XY).
123. Earliest disease for which enzyme supplementation / replacement therapy introduced -Gaucher's disease.
124. 1st disease for which Gene therapy introduced -SCID
125. Thedystrophin geneis the largest gene found in nature.
126. Down's syndrome in a baby of young mother is most commonly due to -Robertsonian translocation, not trisomy.
127.Maternal Lithium- Ebstein Anomaly - Box shaped heart.
128. Most common heart tumor -Atrial Myxomas
129. Umblical cord - 2 arteries 1 vein (Right umblical vein disappears).
130. ThePulmonary vascular resistancefalls fairly rapid to reach Normal adult values by 2-3 wks in normal babies.
In VSD and PDA , it takes 6-10 wks.
131.Cat eye syndrome:
*.Partial trisomy of chromosome 22
*.Vertical oval pupil due to inferior iris coloboma132.Single S2in Tetrology of fallot.
133.Allnewborns have right ventricular hypertrophy and right axis deviation.
134. AA which have apKa of 4- aspartic acid and glutamic acid
135.Topoisomerase I (relaxase)
*.makes ssDNA cuts,
*.requires no ATP,
*.relaxes supercoils, and
*.acts as the swivel in front of the replication fork136.12 ATPsare generated per acetylCoA.
137.Ketogenic AAs- Leucine and Lysine
138.Thiamine pyrophosphate (TPP)associated enzymes :

Extended torch

The acronym listed as TORCHES, for TOxoplasmosis, Rubella, Cytomegalovirus, HErpes simplex, Syphilis.

A further expansion of this acronym, CHEAPTORCHES, was proposed by Ford-Jones and Kellner in 1995

C – Chickenpox and shingles
H – Hepatitis B, C, (D), E
E – Enteroviruses
A – AIDS (HIV infection)
P – Parvovirus B19
T – Toxoplasmosis / Toxoplasma gondii
O – Other (Group B Streptococcus, Listeria, Candida, Lyme disease)
R – Rubella
C – Cytomegalovirus
H – Herpes simplex
E – Everything else sexually transmitted (Gonorrhea, Chlamydia, Ureaplasma urealyticum, Human papillomavirus)
S – Syphilis

Wednesday, 23 July 2014


Important Murmurs
Austin Flint murmur : Austin Flint murmur is
a mid-diastolic rumbling audible in subjects
with severe aortic regurgitation that is best
heard at the apex with little radiation.
Several theories have been suggested for the
origin of the murmur: (1) vibration of the
anterior mitral valve leaflet due to the
regurgitant jet, (2) collision of the jet with
mitral inflow, (3) increased mitral inflow
velocity due to narrowing of the valve orifice
by the jet, and (4) vibration from the jet
impinging on the myocardial wall. It differs
from mitral stenosis murmur in that ,it
occurs in the presence of a murmur of aortic
valve insufficiency and in the absence of the
rheumatic, mitral opening snap.
Carey Coombs murmur : Mitral valvulitis
associated with acute rheumatic fever may
cause a low-pitched mid-diastolic rumble. It
can be differentiated from the diastolic
murmur of Mitral stenosis by the absence of
(1)an opening snap, (2)presystolic
accentuation & (3)loud first heart sound.
Cruveilhier-Baumgarten murmur : Venous
hum heard in epigastric region (on
examination by stethoscope) due to collateral
connections between portal system and the
remnant of the umbilical vein in portal
Duroziez's murmur : Its a to & fro murmur
heard over the femoral artery during both
systole& diastole. It is elicited by applying
gradual arterial compression with the
diaphragm of the steth. This compression
not only produces systolic murmur(which is
the normal result of arterial compression) but
also a diastolic murmur(which is pathologic
& suggestive of aortic
regurgitation).Sensitivity of 58-100%.False
positives occur in high output states. In high
output states the double murmur is due to
forward flow. In Ar one murmur is due to
forward flow& the other due to reverse
flow.The two can be differnetiated by
applying pressure first on the more cephalad
edge of the diaphragm & then on its more
caudal edge. The murmur of forward flow is
enhanced by compressing the cephalad edge.
Conversely the reverese flow murmur is
enhanced by compressing the caudad edge.
Gibson murmur :The typical continuous
"machinery-like" murmur of patent ductus
arteriosus.train in tunnel murmur
Graham Steell's murmur : Due to pulmonary
regurgitation in patients with pulmonary
hypertension and mitral stenosis. It is a high
pitched early diastolic murmur heard best at
the left sternal edge in the second intercostal
space with the patient in full inspiration.
The murmur is heard due to a high velocity
regurgitant flow across the pulmonary valve;
this is usually a consequence of pulmonary
hypertension. The Graham Steell murmur is
often heard in patients with chronic cor
pulmonale as a result of chronic obstructive
pulmonary disease.
Means-Lerman "scratch" murmur: Increased
flow across the pulmonary valve in
Thyrotoxicosis may be associated with
ejection systolic murmur.The ejection systolic
murmur owing to hyperthyroidism may have
a scratchy quality (Means-Lerman scratch ),
and, frequently, the intensity of P2 is
increased because of mild to moderate
pulmonary hypertension.
Roger's Murmur:A loud pansystolic murmur
caused by interventricular septal defect of the
heart; maximal at the left sternal border.
Seagull murmur a raucous murmur with
musical qualities, such as that heard
occasionally in aortic insufficiency.A
"seagull’s cry murmur" is defined as a
murmur imitating the cooing sound of a
seagull. This type of murmur is typically
characterized by a musical timbre and a high
frequency, and may occur as a result of
various valve diseases. It is usually described
as a sign of tight calcific aortic stenosis,
when the murmur’s high frequency
components are transmitted to the lower left
sternal border and the cardiac apex during
most of systole (Gallavardin’s phenomenon).
In this condition, the typical harsh timbre of
the ejective murmur tends to assume a
musical high pitched quality, resembling that
of mitral regurgitation, which may be
reminiscent of the cry of a seagull. A
protodiastolic murmur with similar
characteristics, typically in decrescendo, may
occur in severe aortic valve regurgitation,
particularly when the regurgitant flow
presents high velocities. However, a seagull’s
cry murmur may also be the sign of mitral
regurgitation or prolapse. Similarly, the
musical and holosystolic sound reflects the
presence of high frequency components due
to high velocities of reflow.
Still's murmur An innocent musical murmur
resembling the noise produced by a twanging
string; almost exclusively in young children,
of uncertain origin and ultimately
disappearing.{There are five innocent
murmurs of infancy and childhood: (i)
pulmonary flow murmur, (ii) Still's murmur,
(iii) venous hum, (iv) carotid bruit, (v)
physiologic pulmonary branch stenosis
murmur of neonate}

Tuesday, 22 July 2014

Tumour markers

1. Tumours of epithelial origin - cytokeratin
2. Tumours of mesenchymal origin - vimentin
3. Tumours of smooth muscle origin - smooth muscle actin, desmin
4. Tumours of skeletal muscle origin - desmin
5. Glial origin - GFAP
6. Vascular origin - vWF, CD 31, factor viii, VEGF
7. Stem cells - CD 34
8. B cells - CD 19, 20, 21, 22
9. Pan B cells - CD 19
10. T cells - CD 1,2,3,5,7
11. Pan T cells - CD 3
12. NK cells - CD 16,56
13. Reed sternberg cell - CD 15, 30
14. Popcorn RS cell - CD 20, 45
15. Mantle cell lymphoma - cyclin d1, CD 5
16. Chronic lymphocytic leukaemia - CD 5, CD 23
17. Hairy cell leukaemia - annexin a1, CD 25, 103, 11c
18. Seminoma - PLAP, HCG
19. Choricarcinoma - HCG
20. Yolk sac tumour - AFP
21. Sertoli cell tumour - inhibin
22. Neuroendocrine tumour - NSE, synaptophysin, chromogranin
23. Medullary carcinoma thyroid - calcitonin
24. Ewing's sarcoma - CD 99, mic 2
25. Malignant melanoma - HMB 45, S 100
26. GIST - DOG 1, CD 117, CD 34
27. Apoptotic cells - annexin v


Facies special

1. Mask like facies = parkinsonism.
2. Elfin facies = william's syndrome.
3. Moon facies = cushing's syndrome.
4. Snarling facies = myasthenia gravis.
5. Mitral facies = mitral stenosis.
6. Ashen grey facies = myocardial infarction.
7. Mouse facies = chronic renal failure (crf)
8. Adenoid facies = adenoid hypertrophy.
9. Leonine facies = lepromatous leprosy .
10. Bird facies = pierre robin syndrome.
11. Mongoloid facies = down's syndrome.
12. Coarse facies = most of the inborn errors of metabolism (iem) viz. The muco- polysaccharidoses
(mps), mucolipidoses (ml), fucosidoses mannosidoses, sialidoses, aspartylglycosaminuria,
generalised gangliosidosis(gml ) and austin's variant of metachromatic leukodystrophy due to
multiple sulfatase deficiency (mld-msd) have similar appearing facies.
13. Syphilitic facies = congenital syphilis ( bull dog jaw)
14. Hippocratic face(also known as"hippocratic facies"; eyes are sunken, temples collapsed, nose is
pinched with crusts on the lips and the forehead is clammy)
15. Potter facies- oligohydramnios
16. Amiodarone facies(deep blue discoloration around malar area and nose)
17. Acromegalic facies- acromegaly
18. Marfanoid facies- marfan's syndro
19. Mesnarling facies- myasthenia gravis
20. Myotonic facies- myotonic dystrophy
21. Torpid facies- myxoedema
22. Mouse facies- chronic renal failures
23. Myxoedemamouse facies- chronic renal failure
24. Plethoric facies- cushing's syndrome and polycythemia vera
25. Ashen grey facies- myocardial infarction
26. Gargoyle facies- hurler's syndrome
27. Monkey facies- marasmus
28. Hatchet facies- myotonica atropathica
29. Guerilla like face- acromegaly
30. Bovine facies or cow face- cranio fascial dysostosis or crouzons syndrome
31. Marshall halls facies- hydrocephalus
32. Frog face- intra nasal disease

41. Bird facies (Pierre Robin Malformation)
42. Chipmunk facies ( Untreated β Thalassemia major, Bullimia nervosa, Parotid swelin
43. Leonine facies (Lepromatous Leprosy)
44. Adenoid facies (Adenoid hypertrophy)
45. Torpid or Myxedematous facies (Myxedema)
46. Mask like or Parkinsonian facies (Parkinsonism)
47. Acromegalic facies (Acromegaly)
48. Cushingoid facies (Cushing syndrome)
49. Gargoyle facies (Hurler syndrome)

Sunday, 20 July 2014

Coarction of aorta

radio femoral delay
a/w turners synd
suzzmans sign
aortic ejection systolic murmur
Dock nd 3- sign, rib notching on chest xray
t/t surgery...stenting


Hippocratic face (also known as "Hippocratic facies"; eyesare sunken, temples collapsed, nose is pinched with crusts on the lips and the forehead is clammy)
moon face (also known as "Cushingoid facies")
elfin facies - Williams syndrome
Potter facies - oligohydramnios
mask like facies - parkinsonism
Leonine facies - lepromatous leprosy
Mitral facies - mitral stenosis
Amiodarone facies (deep blue discoloration around malar area and nose)
Acromegalic facies - acromegaly
flat facies - down's syndrome
Marfanoid facies - marfan's syndrome
snarling facies - myasthenia gravis
Myotonic facies - myotonic dystrophy
torpid facies - myxoedema
mouse facies - chronic renal failure
plethoric facies - cushing's syndrome and polycythemiavera
'bird-like' facies- pierre robin sequence
ashen grey facies - myocardial infarction
gargoyle facies - hurler's syndrome
monkey facies - marasmus
hatchet facies - myotonia atrophica
gorilla-like face - acromegaly
bovine facies or cow face - craniofacial dysostosis or crouzons syndrome
marshall halls facies - hydrocephalus
frog face - intra nasal disease
Coarse facies - many inborn errors of metabolism
Adenoid facies - developmental facial traits caused by adenoid hypertrophy, nasal airway obstruction and mouthbreathing; really a form of long face syndrome .

Dots and spots in Opthalmology

Dots & Spots in Ophth
• Leopard spots: in FFA, resulting from patchy subretinal infiltrates in a patient with reticulum cell sarcoma.
• Histo spot: Punched-out chorioretinal scars in Presumed ocular histoplasmosis syndrome (POHS)
• Cotton-Wool Spots: Diabetic retinopathy is the most common cause of cotton-wool spots. Cotton-wool spots have been associated with numerous other abnormalities, such as systemic arterial hypertension, collagen vascular diseases, cardiac valvular disease, carotid artery obstructive disease, coagulopathies, metastatic carcinoma, trauma, and human immunodeficiency virus infection.
• Bitot’s spot=White, foamy area of keratinising squamous metaplasia of bulbar conjunctiva,seen in vitamin A deficiency.
• Brushfield spot=Whitish grey spot in peripheral iris,seen in Down’s syndrome.
• Elschnig spot=Yellow patches overlying area of choroidal infarction in hypertension.
• Fischer-Khunt spot= Senile scleral paque,area of hyalinised sclera anterior horizontal rectus muscle insertion. Seen in old age.
• Foster Fuch’s spot=Pigmented (RPE hyperplasia) macular leisons in pathological myopia.
• Gunn’s dot=light reflectios from internal limiting membrane around disc and macula
• Horner-Trantras Dot= Collections of eosinophils at limbus in vernal conjunctivitis.
• Kayes’ dot (Krachmer’s spot)= subepithelial infiltrates seen in corneal graft rejection
• Mittendorf’s dot= whitish spot at posterior lens surface,remnant of hyaloid artery.
• Roth spots= haemorrhageswith white centres,seen in SABE, severe anaemia,collagen vascular disorders.
• Cherry red spot: Central retinal artery occlusion, Commotio retinae (Berlin’s oedema),Tay-Sachs’ disease, Niemann-Pick’s disease, Gaucher’s disease
• Cream-colored spots: The classic diagnostic feature of bird-shot vitiliginous chorioretinitis is cream-colored spots, often as large as 0.5 to 1 disc diameter, that are scattered throughout the fundus.
• Koplik’s spots: on conjunctiva in measles
Lines & Rings in Ophth
• Arlt’s Line = conjunctival scar in sulcus subtarsalis in Trachoma.
• Ehrlich-Turck Line = linear deposition of KPs in uveitis
• Ferry’s Line = corneal epithelial iron line at the edge of filtering blebs.
• Hudson-Stahil Line= Horizonatl corneal epithelial iron line at the inferior one third of cornea due to aging.
• Khodadoust Line = corneal graft endothelial rejection line composed of inflammatory cells.
• Paton’s Line = Circumferential retinal folds due to optic nerve edema.
• Sampaoelesi line = Increased pigmentation anterior to Schwalbe’s line in pseudoexfoliation syndrome.
• Zentmeyer line (Scheie’s Line): on the equatorial surface of the lens pigment dispersion syndrome
• Schwalbe’s Line = Angle structure representing peripheral edge of Descemets membrane.
• Stockers Line = Corneal epithelial iron line at the edge of pterygium
• White lines of Vogt = Sheathed or sclerosed vessels seen in Lattice degeneration
• Fingerprint lines: The map-dot fingerprint dystrophy
• LASIK Iron Line: After LASIK for myopia, the central corneal curvature is flatter than before surgery. The tear film distribution is therefore altered, allowing some pooling centrally. This pooling can cause iron deposition in the central epithelium. A similar effect can be seen after steeping of the cornea from treatment of hyperopia. In the case of hyperopia, a pseudo-Fleischer’s ring iron deposition can be seen. These iron lines do not affect vision.
• Vogt’s striae occur centrally in a patient with keratoconus. By applying digital pressure on the eye while looking through the slit lamp, these striae in the deep cornea, mostly Descemet’s membrane, disappear, which is charac teristic of keratoconus.
• The Descemet’s breaks or Haab’s striae from birth trauma tend to be vertical, while the Descemet’s tears associated with congenital glaucoma tend to be horizontal or curvilinear.
• Ring Keratitis: The hallmark of Acanthamoeba keratitis
• Kayser-Fleischer’s ring: Wilson’s disease
• Corneal rust ring: A small, reddish brown, circular opacity remained in the cornea after the removal of an iron foreign body.
• Coats’ ring: remnants of a foreign body. The remnants are fine iron deposits in the cornea.
• Fleischer’s ring: visible all around the base of cone in Keratoconus
• Pseudo-Fleischer’s ring: iron deposition can be seen in Hyperopia
• Soemmering’s ring: early  of lens capsule in cataract
• Vossius’ ring: on lens in concussion injury to eye
• Weiss ring: epipapillary glial tissue torn from the optic disc in Posterior vitreous detachment (PVD)
• Double ring sign: with the peripheral margin of the encircling ring corresponding to the border of a normal-sized optic disc. Seen in Hypoplasia of the Optic Disc.
Signs in Ophth
• Munson’s sign, i.e. localised bulging of lower lid in Keratoconus
• Grade III HTN Retinopathy: banking of veins distal to arteriovenous crossings (Bonnet sign), tapering of veins on either side of the crossings (Gunn sign) and right-angle deflection of veins (Salu’s sign).
• TED: Lid signs: These are: Retraction of the upper lids producing the characteristic staring and frightened appearance (Dalrymple’s sign); Lid lag (von Graefe’s sign) i.e., when globe is moved downward, the upper lid lags behind; Fullness of eyelids due to puffy oedematous swelling (Enroth’s sign); Difficulty in eversion of upper lid (Gifford’s sign); Infrequent blinking (Stellwag’s sign). Convergence weakness (Mobius’s sign)
• The Bruckner test is a way to estimate near-sightedness versus hyperopia.
Ratio in Ophth
• Kesten-Baum index refers to ratio of large blood vessels versus small blood vessels on the disc. Normal ratio is 4:16. This ratio is decreased in patients with optic atrophy.
• Cup-disc ratio. Normal cup disc ratio is 0.3. (i) Large cup may be physiological or glaucomatous. (ii) Cup becomes full in papilloedema and papillitis.
• Results of EOG are interpreted by finding out the Arden ratio as follows:
Arden ratio = (Maximum height of light peak/ Minimum height of dark trough) × 100 Normal curve values are 185 or above. Subnormal curve values are less than 150. Flat curve values are less than 125.
• Normal arterioles are bright red in colour and veins are purplish with a caliber ratio of 2: 3. Following abnormalities may be detected: Narrowing of arterioles is seen in hypertensive retinopathy, arteriosclerosis, and central retinal artery occlusion. Tortuosity of veins occurs in diabetes mellitus, central retinal vein occlusion and blood dyscrasias. Sheathing of vessels may be seen in periphlebitis retinae, and hypertensive retinopathy.
Operations in Ophth
• Fucala’s operation: Removal of clear crystalline lens for unilateral very high myopia
• McReynold’s operation: Transplantation of pterygium in the lower fornix, not performed now.
• Cicatricial entropion. 1. Resection of skin and muscle 2. Resection of skin, muscle and tarsus 3. Modified Burow’s operation 4. Jaesche-Arlt’s operation 5. Modified Ketssey’s operation
• Senile entropion. Commonly used surgical techniques are as follows: i. Modified Wheeler’s operation: ii. Bick’s procedure with Reeh’s modification: iii. Weiss operation. iv. Tucking of inferior lid retractors (Jones, Reeh and Wobig operation):
• Mechanical ectropion. It is corrected by treating the underlying cause. i. V-Y operation. ii. Z-plasty (Elschnig’s operation) iii. Excision of scar tissue and full thickness skin grafting.
• Congenital ptosis. It almost always needs surgical correction. In severe ptosis, surgery should be performed at the earliest to prevent stimulus deprivation amblyopia. However, in mild and moderate ptosis, surgery should be delayed until the age of 34 years, when accurate measurements are possible. Congenital ptosis can be treated by any of the following operations: 1. Fasanella-Servat operation. ( ans: Horner’s Syndrome) 2. Levator resection. (A)Conjunctival approach (Blaskowics’ operation): (B)Skin approach (Everbusch’s operation):
• The classical technique of lateral orbitotomy using S-shaped brow skin incision is called Kronlein’s operation, done for AXIAL PROPTOSIS.
• Seton operation: In this operation, a valvular synthetic tube is implanted which drains the aqueous humour from the anterior chamber into the subconjunctival space. It is performed for neovascular glaucoma and intractable cases of primary and other secondary glaucomas where medical treatment and conventional filtration surgery fail.
• TRIPPLE SNIP operation for Punctum block

Saturday, 12 July 2014

Winging of the Scapula

Winging of the Scapula : ‪#‎HighYield‬

1.Long Thoracic N. Injury " most common" >> Medial winging of the scapula.
2.Spinal Accessory N. Injury >> Lat. Winging of Scapula w trapeius wasting.
3.Dorsal Scapular N. Injury >> Rhomboids winging of the scapula (lat. winging w arm elevation).
4.Duchene Muscular Dystrophy " Symmetrical Medial Winging " .

Gait types

Types of Gait-related disorders "Keywods" :

1) hypokinetic gait / shuffling gait / festinating gait-----Parkinson
2) spastic gait : UMN lesion.
3) antalgic gait : tarsal tunnel syndrome or any joint pain.
4) en-bloc gait : vestibular ataxia (also may be cerebellar ataxia)
5) high-steppage gait : common peroneal injury
6) waddling gait : Duchene Muscular Dystrophy.
7) staggering gait : alcoholics , Friedrich's ataxia...wernicke's??
8) scissoring gait :cerebral palsy.
9)Magnetic Gate : Hydrocephalus.

Ring Enhancing Lesions

Ring Enhancing Lesions : "DR MAGICAL"

D - demyelinating disease.
R - radiation necrosis or resolving haematoma.
M - metastasis.
A - abscess e.g toxoplasmosis / Aspergilloma
G - glioblastoma multiforme.
I - infarct (subacute phase).
A- Aspergilloma / Cryptococcoma
C - contusion.
L - lymphoma.

Friday, 11 July 2014

Mnemonic for Mucopolysacharides

Story of 4 brother...
Sexy hunter
Morque, Hurler- cool to go guy.
Sanflippo - is the most inteligent of all of them
Hunter aka SEXY HUNTER
the real pevert among them, the planner visionary ..
Sexy hunter knows abt some beautiful lady, and gets fascinated to see her.
So he call all 3 of them and ask them to accompany him.
Morque and hurler immediately agree, but   sanflippo the clever among them, warns them that she is the daughter of
Powerful KHADAK BABA.
But they don't listen and carry sanflippo also with him..
Upon arrival at the  baba house, SEXY HUNTER say u all three go and see her. I'll go alone at last.
As hunter was waiting outside, he gets caught up by khadak baba...
Angry khadak baba call rest of 3. And blast them.
And gives them SHRAP(curse)
Blindness, but hunter says he dint even see his daughter
Sanflippo say he din have bad intension,
but baba say, since u still came so more shrap for you..
There are many features in this story, u can add.
Courtesy -Thameem Saif
SEXY HUNTER- x linked d/s, rest are autosomal.
Hunter -Only one with out corneal clouding.
Rest all have corneal clouding.
Sanflippo the intelligent. So has normal IQ.

Thursday, 10 July 2014

Radiotherapy sensitivity

Info :
Highly radiosensitive tumours are:
*Wilm's tumour
*Ewing's sarcoma

Moderately radiosensitive tumours are:
*Small cell lung carcinoma
*Carcinoma of breast
*Ovarian carcinoma
*Basal cell carcinoma
*Nasopharyngeal carcinoma

Relatively Resistant tumours are:
*Squamous cell carcinoma of lung
*Hypernephroma (Renal Cell
*Rectal carcinoma and carcinoma colon
*Bladder carcinoma
*Soft tissue carcinoma such as
-Carcinoma of cervix

Highly Resistant tumours are:
*Pancreatic carcinoma


Antigliadin -- Celiac disease
Antimitochondrial -- Primary biliary cirrhosis
Antiplatelet -- Idiopathic immune thrombocytic
Anti-basement membrane -- Goodpasture’s syndrome
Anti SS-A (anti-Ro) & Anti SS-B (anti-La) -- Sjogren’s
Anti ds DNA & Anti Sm (ANAs) -- SLE
Antihistone -- Drug induced lupus
Anti-topoisomerase I (anti-Scl 70) -- Diffuse
Anticentromere -- CREST Syndrome
Anti-IgG (Rheumatoid factor) -- Rheumatoid arthritis
Antithyroglobulin & Antithyroid peroxidase
(antimicrosomal) -- Hashimoto’s thyroiditis
Anti-desmoglein 3 -- Pemphigus vulgaris
c-ANCA -- Wegener granulomatosis
p-ANCA -- Microscopic polyangitis & Churg-Strauss
Antiphospholipid -- Antiphospholipid antibody
syndrome (Ex:SLE)
Anti-perietalcell -- Pernicious anemia

Half lives of iucd

Important shelf-lives of contraceptives you need to know.
(Shelf-life is only important for IUDs)
1. Copper IUDs - 3-5 yrs
2. Progestasert - 1 year
3. CuT 200 - 4 years
4. Nova T - 5 yrs
5. LNG IUD - 7-10 yrs
6. CuT 380A - 10 yrs



1) Ig with Highest Carbohydrate content....Ig E
2) Ig with Least Carbohydrate content.....Ig G
3) Ig which crosses placenta..Ig G
4) Ig first synthesised by Fetus...Ig M
5) Ig involved in Secretory protection..Ig A
6) Ig in Primary Immune response..Ig M
7) Ig in Secondary Immune response...Ig G
8) Ig having highest molecular weight...Ig M
9) Ig having no clinical utility...Ig D
10) Ig with least molecular weight...Ig G


Bitter almond = Cyanide
Garlic odour = Arsenic poisoning
Fruity odour = Ethyl alcohol
Kerosene odour = Kerosene, OPC
Rotten eggs = Hydrogen sulphide
Fishy = Zinc phosphide
Burnt rope = Cannabis

Nerves and plexus

Arnold's nerve is the auricular branch (also known as the mastoid branch) of the vagus nerve.
Hering's nerve is the branch of glossopharyngeal nerve to the carotid sinus.
Nerve of Kuntz is a connection from the second intercostal nerve to the first thoracic ventral ramus.
The nerve of Henlé, a branch of the ulnar nerve in the forearm, is thought to deliver sympathetic innervation to the ulnar artery.
Arnold's nerve is also called Alderman's nerve.
Auerbach's plexus (or myenteric plexus) provides motor innervation to both layers of the tunica muscularis, having both parasympathetic and sympathetic input, whereas Meissner's plexus has only parasympathetic fibers and provides secretomotor innervation to the mucosa nearest the lumen of the gut.
The diagonal band of Broca is one of the forebrain nuclei that are derived from the ventral telencephalon during development. This structure forms the medial margin of the anterior perforated substance.

Oesteotomy Types

Osteotomy: Making a cut in the bone
1. Derotation osteotomy for CDH
2. Dimon-Houston osteotomy for inter-  trochanteric Fracture
3. Dwyer's osteotomy: CTEV
4. French osteotomy: Cubitus varus deformity
5. High tibial osteotomy: OA knee with varus
6. Mcmurray osteotomy: NOF
7. Pauwel's osteotomy: NOF
8. Pemperton osteotomy: CDH
9. Salter's osteotomy: CDH
10. Sandwich osteotomy: Slipped epiphysis
11. Spinal osteotomy: Ankylosing spondylosis
12. Wilson osteotomy: Congenital Coxa vara

Wednesday, 2 July 2014

Some points

Q.Hypnogogic hallucinations--->which occur before going to bed/sleep
Q.Hypnopompic hallucinations---->which occur on awakening

Q.1 FADH2 gives rise to how many ATP---->>1.5 ATP
Q.1 ATP leads to generation of----->>7000 calories

Q.Kleine–Levin syndrome ---->>
KLS or
Sleeping Beauty syndrome is a
neurological disorder characterized
by recurring periods of excessive
amounts of sleeping and eating. At
the onset of an episode the patient
becomes drowsy and sleeps for
most of the day and night

9 c in wilsons
chr involment13
copper deposition in hepatocytes
chr active hepatitis
changes(sensory) absent
corneal involvement(kayser fleischer ring)
Pgi type
Which of the following are true
Trasection above pons -respiration normal✅
Damage to pneumotaxic centre-respiration becomes slow and deep✅
Damage to pneumotaxic and vagus-apneusis✅
Damage to vagi-depth of inspiration increased✅
Damage above medulla - irregular and gasping respiration✅
Below medulla-respiration stops✅
DEJA VU- unfamiliar events feel familiar
JAMAIS VU-feeling of strangeness to familiar situations
DEJA ENTENDU-illusion that what one is hearing has heard previously
DEJA PENSE- unfamiliar thought regarded as repetition of previous thought
most common site of Congenital tb
vineyard sprayers lung disease due to--
extended sickness benefit---- 2 years
heart failure cells are stained by-- prussian blue
reilly bodies seen in hurler's ds
brassy bodies seen in malaria
MC substance absuse in pt of schizophrenia is
Nicotine 90%
Alcohol 40%
diagnostic trop I value in mi--
>.2 ng
sirtutuins associated with
mosquito found at all breading places--
(Nuisance mosquito)
aedes called as nuisance mosquito
Most common cause of pyogenic liver abcess --Biliary tract disease
The % of myomas undergoing malignant change: (AI 92)--0.5%
oyster intake assoc diarrhoe caused by
norwalk virus
The distribution of myoma in the body of the uterus is broadly classified as follows
--Intramural (interstitial) 75%
--Submucous 15%
--Subserous 10%
What are basophilic viruses--
Mcc of esophageal rupture-iatrogenic
Mc site of rupture-cricopharynx/cervical
Mc site of spontaneous rupture-left posterolateral of distal esophagus
Rheobase is the intensity of electric current of infinite duration necessary to produce minimum action potential.
Chronaxie (or chronaxy) is the time required for an electric current double the strength of the rheobase to elicite first visible action potential
Peak HCG levels are seen by what intrauterine age --8‐10 weeks
A meniere disease gene is linked to chromosome 12p12.3 but hereditary meniere disease is attributable to mutation on chromosome 6 . Transmission is reported to be autosomal dominant
thornwald's disease
--Abscess in the nasopharyngeal bursa
Bryce's sign seen in
Which poisoning
Dialysis dementia syndrome due to--Aluminium
Saturnism-- Lead
diwali poison--white phosphorus
Legally MTP is defined upto

Synthesis of complements :
C1: intestinal epithelium
C2,4: macrophages
C5,8: spleen
c3,6 9: liver
C7: not known

Martel's sign is seen in--Gout
Martel sign also known as--
A.G sign
B.Rat bite sign

duration of action of flumazenil--20 minutes
half life of digoxin--36 hours
brown tumor of bone- hyperparathyroidism , osteitis fibrosa cystica
brown's sign in-- glomus jugulare
procalcitonin is a marker for neonatal sepsis
   while calcitonin is a marker for medullary carcinoma of thyroid...
lines of zain  is found in arterial clot ... mostly when formed in heart and in aorta
CDH1 GENE associated wit vch malignancy-- gastric cancer
Iodination...15ppm at consumer level
, 30ppm at production level.
0.5-0.8mg/L permissible fluoride level.
mixed lymphocyte culture is used to identify HLA CLASS II
hematoxylin bodies and le cells are seen in SLE
syphilytic aneurysm is called as LEUTIC ANEURYSM
chediak higashi syndrome is due to mutation of LYST GENE
 honey coloured crusts seen in impetigo contagiosum
mcc of post operative late endophthalmitis--
 mc cause of mycotic aneurysm--staph aureus
serous delumiens occurs in sublingual nd submaxillary glands
splashed tomato ketchup fundus appearance in CRVO
cauliflower ear in hamartoma
popcorn calcification seen in
A.pulmonary hamartoma
Molotov cocktail = petrol bomb
Thickest nerve of the body--sciatic nerve
thickest cranial nerve-- trigeminal nerve
Martel sign also known asgout
Mother in law sign seen inmenigioma
Mexican hat sign seen ingi polyp
Hockey stick sign seen intb bladder
KHILKHILAT" run by which programme  nrhm
Katayama test ::  for carbon monoxide
Katayama fever :: due to schistostoma
Takayama test::  for blood stain
kanagawa phenomenon::  vibrio parahemolyticus
Miyagawa bodies::  elementary body of
Nagayama spot:: In roseola infantum
Nakayama strain:: Japanese encephalitis