Tuesday, 30 June 2015

Tumours sensitivity

Radioresistant Tumors (M.O.P)
   1. Melanoma.
   2. Osteosarcoma.
   3. Pancreatic Carcinoma.

Radiosensitive Tumors (W.E.L.Se.M)
   1. Wilm's Tumor.
   2. Ewing's Sarcoma.
   3. Lymphoma.
   4. Seminoma.
   5. Multiple Myeloma.
   6. Medulloblastoma.

(Remember Both as MOP-WELSeM, if you could)

Chemoresistant Tumors - (G.B.S.S)
  1. Gastric carcinoma.
  2. Bladder Carcinoma.
  3. Soft Tissue Sarcoma.
  4. Squamous Cell carcinoma of Head and Neck.

Chemosensitive Tumors - 
  1. Wilm's Tumor.
  2. Lymphoma.
  3. Teratoma.
  4. ALL in Children.
  5. Choriocarcinoma.
  6. Ewing's Sarcoma.
  7. Rhabdomyosarcoma.

Saturday, 27 June 2015

Toll Receptors

Toll like receptors
TLR-2 ➡Gram +ive bacteria,fungi & leptospira endotoxin
TLR-3➡Viruses(double stranded RNA)
TLR-4➡Gram negative bacteria
TLR-5➡Toxoplasma gondii
TLR-7➡ssRNA viruses
TLR-9➡DNA viruses


MC Cancers

MC type of odontogenic tumor : Ameloblastoma.
MC type of benign mandibular tumor : Ameloblastoma
MC type of lymphoma involving the head and neck region : Diffuse large B-cell lymphoma
MC tumor of the Minor Salivary glands : Adenoid Cystic Carcinoma
MC vascular tumor of orbit in children : Capillary Hemangioma.
MC intraocular malignant neoplasm in childhood : Retinoblastoma
MC orbital malignant neoplasm of childhood : Rhabdomyo­sarcoma.
MC intraorbital tumors found in adults : Melanoma
MC type of  Pituitary adenomas : Prolactinoma
MC benign tumor of the larynx : Squamous papilloma
MC type of Sarcoma of the larynx : Chondrosarcoma.
MC breast tumor under age 25 years : Fibroadenoma
MC cardiac tumor in children : Rhabdomyoma.
MC cardiac valvular tumor : Papillary fibroelastoma
MC malignant tumor of the Heart : Angiosarcoma
MC malignant tumor affecting ribs of children + adolescents: Osteosarcoma
MC malignant neoplasm of diaphragm : Rhabdomyosarcoma
MC benign tumor of the lung : Hamartoma
MC Ca to arise from a thvroglossal duct cyst : Papillary carcinoma
MC GI neoplasm : Adenoma
MC GI tract location for primary extranodal lymphoma : Stomach(NHL type)
MC benign tumor of the small bowel : GIST
MC benign vascular gastric tumor : Glomus tumor of stomach.
MC type of Sarcoma of the liver : Angiosarcoma
MC malignant tumor of the Duodenum : Adenocarcinoma.
MC malignant tumor of the Small bowel : Adenocarcinoma
MC benign tumor of spleen : Hemangioma
MC malignant neoplasm of the spleen : Lymphoma.
MC glial spinal cord tumor in adults : Ependymoma
MC glial tumor with microcalcifications : Oligodendroglioma
MC gynecologic neoplasm : Uterine Leiomyoma
MC malignant abdominal neoplasm in children 1-8 years old: Wilms Tumor.
MC type of malignancy in undescended testis : Seminoma
MC malignant Testicular neoplasm : Non-sem inoma tous germ cell tumors
MC bilateral testicular tumor : Lymphoma
MC germ cell tumor associated with excessive hCG production: Choriocarcinoma.
MC malignant cause of bilateral global renal enlargement : Lymphoma.
MC malignant ovarian neoplasm : Serous adenocarcinoma.
MC malignant primary bone tumor in young adults and children : Osteosarcoma
MC malignant sex cord-stromal tumor : Granulosa cell tumor
MC intramedullary spinal neoplasm in adults : Ependymoma of Spinal Cord
MC intramedullary tumor in children : Astrocytoma
MC intravascular venous tumor : Leiomvosarcoma of P/C
MC in-utero renal tumor : Mesoblastic nephroma.
MC bladder neoplasm in children younger than 10 years :
MC primary malignant orbital tumor in childhood : Rhabdomyosarcoma
MC type of liposarcoma to affect children : Myxoid liposarcoma



😓Sandfly fever Arbovirus
😓Rift valley fever A virus infecting Sheep
😓Lassa fever Arena Virus
😓Glandular fever Ebstein Barr Virus
😓Bartonneuse fever Rickettsiae Conori
😓Oroya fever Bartonella
😓Pretibial fever Leptospirosis
😓Canicola fever Leptospirosis
😓Swamp fever Leptospirosis
😓Seven day fever Leptospirosis
😓Haverhill fever Streptobacillus Moniliformis
😓Scarlet fever Streptococci
😓Pontiac fever Legionella
😓Undulant fever Malta fever, Brucellos
😓Gaol fever Epidemic typhus
Classical typhus
😓5 day fever Trench fever
😓3 day fever Sandfly fever
😓Picket fence fever - lateral sinus thrombosis
😓Breakbone fever - dengue
😓Step ladder typhoid
😓Metal fume fever - zinc fumes inhalation toxicity
😓Nervous fever-typhoid
😓Roman fever-Malaria
😓Texas fever - babesiosis

Friday, 26 June 2015

High yield points

1. Dot and fleck retinopathy seen in Alport's syndrome

2. Aphasia affecting arcuate fibers- conduction aphasia.

3. Varenicline- drug to aid smoking cessation.

4. Face to pubis delivery seen in Anthropoid pelvis

5. Irinotecan, methotrexate- S phase specific.
    Etoposide- arrests cell at   G2 phase
    Vincristine- M phase specific

6. Strong association of Bechet disease with HLAB51 allele.

7. Scrub typhus- caused by chiggers (larval stage) of O. Tsutsugamusi

8. Oral hairy leukoplakia- benign infection of oak mucosa by EBV

9. MCC of UTI in young female- E. Coli.

10. To eradicate measles
a. 96% vaccination of less than 1 year age
b. Prevent cumulation in the immunity gap.

11. Arachnoid villi responsible for CSF absorption protrude mainly into superior sagittal sinus.

12. Widal test is a classic example of Agglutination.

13. While inulin  is used to measure GFR, PAH is used to measure renal blood flow.

14. Drugs causing disulphiram like reaction in a chronic alcoholic- sulphonylurea, trimethoprim, metronidazole, some cephalosporins( cefoperazone, moxalactam, cefamandole, cefotetan).

15. BSK II medium is used to cultivate B. burgdorferi.

16. Location of chemoreceptor trigger zone in brain in brain- Area postrema.

17. Vitamin preventing autoxidation- tocopherols

18. Tetany(tetanus) is not a feature of cardiac muscles.

19. DOC for acute t/t of Addisonian crisis- hydrocortisone.

20. Commonest parasitic cause of uveitis- toxocara.

21. Health survey and development committee- Mudaliar committee.

22. Hospital beds vacant for emergency , isolation, etc are known as dead bed space.

23. Confirmed case of flourosis- floride in Udine more than 1 mg/dl.

24. Nerve compressed by posterior communicating artery- oculomotor.

25. Primary protein responsible for iron metabolism is transferrin.

WHO theme 2015

WORLD Health Day, which is celebrated every 7th of April since 1948 marks the founding anniversary of the World Health Organization.
Every year, a theme is selected to highlight a priority area of worldwide public health concern.
The 2015 World Health Day theme is Food Safety

Thursday, 25 June 2015

High Yield

1. Doughnut sign- intussusception.

2. Most common location of sub dural hematoma- frontoparietal.

3. Lateral cutaneous nerve of forearm is a continuation of- musculocutaneous nerve.

4. Brain tumor is not an important cause of seizure in neonatal period.

5. De Quervain's tenosynovitis affects- extensor pollicis brevis & abductor pollicis longus.

6. Weinberg's sign. In abdominal pregnancy, a lateral x ray may show fetal parts overlapping maternal lumbar spine.

7. MCC of otomycosis- Aspergillus Niger, and candida albicans.

8. Male sex doubles the risk of obstructive sleep apnea.

9. Hoarseness is the most common symptom of glottic cancer.

10. Recurrent chalazion can predispose to Adenocarcinoma

11. Clinical criteria for osteoarthritis:
a. Age > 50
b. Stiffness < 30 mins
c. Crepitus
d. Bony tenderness
e. Bony enlargement
f. Lack of warmth
3 out of above 6 in the pt with chronic knee pain is 95% sensitive and 69% specific.

12. Radiological finding of thimble bladder- chronic tuberculous cystitis.

13. Narrowest part during entire course of 7th cranial nerve- labyrinthine canal.

14. Amikacin had the broadest spectrum of antibiotic activity among all aminoglycosides.

15. Romiplstim acts on thrombopoetin receptors- for t/t of ITP.

16. Hemobilia t/t- arterial embolisation.

17. Probiotics have been found to be beneficial in NEC.

18. MCC of reccurent meningitis due to CSF LEAKS-  pneumococci.


High yield

1. Dot and fleck retinopathy seen in Alport's syndrome

2. Aphasia affecting arcuate fibers- conduction aphasia.

3. Varenicline- drug to aid smoking cessation.

4. Face to pubis delivery seen in Anthropoid pelvis

5. Irinotecan, methotrexate- S phase specific.
    Etoposide- arrests cell at   G2 phase
    Vincristine- M phase specific

6. Strong association of Bechet disease with HLAB51 allele.

7. Scrub typhus- caused by chiggers (larval stage) of O. Tsutsugamusi

8. Oral hairy leukoplakia- benign infection of oak mucosa by EBV

9. MCC of UTI in young female- E. Coli.

10. To eradicate measles
a. 96% vaccination of less than 1 year age
b. Prevent cumulation in the immunity gap.

11. Arachnoid villi responsible for CSF absorption protrude mainly into superior sagittal sinus.

12. Widal test is a classic example of Agglutination.

13. While inulin  is used to measure GFR, PAH is used to measure renal blood flow.

14. Drugs causing disulphiram like reaction in a chronic alcoholic- sulphonylurea, trimethoprim, metronidazole, some cephalosporins( cefoperazone, moxalactam, cefamandole, cefotetan).

15. BSK II medium is used to cultivate B. burgdorferi.

16. Location of chemoreceptor trigger zone in brain in brain- Area postrema.

17. Vitamin preventing autoxidation- tocopherols

18. Tetany(tetanus) is not a feature of cardiac muscles.

19. DOC for acute t/t of Addisonian crisis- hydrocortisone.

20. Commonest parasitic cause of uveitis- toxocara.

21. Health survey and development committee- Mudaliar committee.

22. Hospital beds vacant for emergency , isolation, etc are known as dead bed space.

23. Confirmed case of flourosis- floride in Udine more than 1 mg/dl.

24. Nerve compressed by posterior communicating artery- oculomotor.

25. Primary protein responsible for iron metabolism is transferrin.


Bone tumow

1. Osteosarcoma: 

Age: 10-20 yrs (except when its secondary e.g. in Paget's disease in old age)MetaphysealSunray periosteal reactionnote: sunburst calcification on abdominal X-ray is seen in Pancreatic serous cystadenomaCodman triangle note: codman tumor is chondroblastomaRadioresistant

2. Ewing's sarcoma

Age: 10-20 yrslaminated periosteal reaction: onion skinlocation: diaphysealRadiosensitive

3. Giant cell tumor (GCT) = osteoclastoma

Epiphysealother epiphyseal lesions - Chondroblastoma, GeodeSoap bubble appearanceMetaepiphyseal: Seen after fusion of epiphysis (age 20-50 yrs)

4. Vertebral hemangioma

X-ray and Sagittal CT: Corduroy cloth appearanceAxial CT: Polka dot appearance

5. Adamantinoma

Mandible (Ameloblastoma): 3rd-5th decadeTibial diaphysis: 10-20 yrs, typically anterior cortexPituitary (Both pituitary stalk and enamel arise from oral epithelium)

6. Above 60 years, multiple lytic lesions

Multiple myeloma Normal alkaline phosphatase, cold on bone scanpunched out lytic lesionsMetastasesIncreased alkaline phosphatase, hot on bone scan i.e. high uptake

7. Metastases

Sclerotic/osteoblasticCommonly from: Prostate and Breast (can have mixed)Other: Stomach, CarcinoidLytic and expansileCommonly from Kidney and Thyroid

8. Hyperparathyroidism

subperiosteal bone resorptionradial aspect of proximal and middle phalanges of the 2nd and 3rd fingerslamina dura: floating teethSalt and pepper skull = pepper pot skullBrown tumorerosion of lateral end of clavicalrugger jersey spine (secondary hyperparathyroidism due to renal osteodystrophy)note: picture frame vertebra is seen in Paget's disease of bone (also Cotton wool skull in Paget's)note: sandwich vertebra is seen in osteopetrosis

9. Eosinophilic granuloma

childrenbeveled edgesvertebral planafloating teeth (also seen with hyperparathyroidism)





Complete Hanging


• Hanging is that form of asphyxia which is caused by suspension of the body by a ligature, which encircles the neck, the constricting force being the weight of the body.


Partial Hanging


• The bodies are partially suspended; the weight of the head (5-6 kg) acts as the constricting force.


Typical Hanging


• In typical hanging, the ligature runs from the midline above the thyroid cartilage symmetrically upward on both sides of the neck to the occipital region.


Atypical Hanging


When the Knot is placed at site other than that seen in typical hanging.




Pressure required for closure of Neck Structures


Structure        Pressure(Kg)

Jugular Vien           2

Carotid Artery        5

Trachea                15

Vertebral Artery    30





* The usual period is 3 to 5 minutes

* Fatal hypoxia takes place when O2 Level fall below 20% of normal


Post Mortem Appearance


External Features


• The ligature mark in the neck is themost important and specific sign of death from hanging. The ligature mark is situated above the level of thyroid cartilage between the larynx and the chin in 80 percent cases, it is obliquely placed; does not completely encircles the neck.


• Face is congested, puffed up and bluish


• The eyes are frequently protruded and the conjunctiva congested the pupils are usually dilated.


• Tongue is protuded and may be caught between the teeth.


• Dribbling of saliva from the angle of mouth is the most important & surest external sign of ante mortem hanging*(opposite side to that of knot*).


• Le facies sympathique*: It is a vital sign of ante mortem hanging*

 When the knot presses the Cervical Sympathetic trunk, the eye on that side remain open and the pupil is dilated


• Seminal emission is common, in case of antemortem hanging.


Internal Features


Fracture Hyoid Bone


Abdution fracture or Anterior Compression Fracture is seen in hanging:


• Hyoid bone is fractured in 15-20% cases. Are seen in persons above 40 years.


• Most common site of fracture of hyoid bone in hanging is the at junction of the inner two third and outer third of greater cornu (cf. Inward compression fracture or Adduction fracture seen in case of throttling).


Judicial Hanging


• Legal death sentence is carried out by hanging the criminal, in India.


• The cause of death in judicial is(Brain Stem Damage) fracture dislocation at Atlanto-occipital joint*.


• The knot is placed below the chin,* the length of rope from the point of suspension is equal to the height of individual. There is a sudden drop, resulting in fracture and dislocation of Upper Cervical Vertebrae.


Metallic arsenic is not poisonous, as it is not absorbed from the alimentary canal.

     Poisonous compounds:

     1.  Arsenious oxide or Aresenic trioxide (Sankhya or Somalkar): it is known as white arsenic. It has been found to be useful in treatment of Acute Promylocytic Leukemia (APL)*

     2.  Copper acetoarsenate (paris green): It combines with sulphydryl enzymes and inter­feres with cell metabolism.

     3.  Copper Arsenate (Schcele’s green).



–   Signs and Symptoms:

     1.  The Fulminant type: Large doses of arsenic can cause death in one to 3 hrs from shock.

     2.  The Gastro enteric type: This is acute poison­ing, resembling bacterial food poisoning or cholera.

          –   This is the most common form.

          –   The stools are expelled frequently and involuntarily, are dark coloured, stinking and bloody, but later becomes colorless, odourless and water resembling rice water stools of cholera.**

          –   Sequence of symptoms:

               • Throat pain

               • Vomitting (Bile, Blood and Mucous)

               • Purging (Tenesmus present)

     3.  Narcotic form: Tenderness of the muscle, delirium, coma and death.


  •    Arsenic poisoning resembles

          –   Pre malignant condition

          –   Cholera

          –   Fading measles

          –   Addison’s disease.


–   Treatment

     1.  Freshly prepared precipitated hydrated ferric oxide (arsenic antidote)* is given. Dialysed Iron is substitute.

     2.  In arsenic poisoning BAL is an antidote. (BAL is contraindicated in cadmium and iron poisoning).

     3.  Calcium disodium versenate

     4.  Alkali is contra indicated.


–   Postmortem appearance

     •    Red Velvety* appearance of the stomach mucosa.

     •    Subendocardial haemorrhage of heart.*


–   Chronic poisoning:

     1.  CNS—Polyneuritic, optic neuritis

     2.  Skin—finely mottled brown change mostly on the temples, eyelids and neck (RAIN Drop pigmentation)

          •    There may be a rash resembling fading measles rash*

          •    Hyperkeratosis and Hyperpigmentation of the palms and soles with irregular thicken­ing of the nails is seen.

          •    Nails show ALDRICH MEE’s line (Leuko­paronychia).{Confuser*

Beau’s Lines

® Chronic Systemic Disease, also Muehrcke’s Line® hypo proteinemia}

          •    Nails show ALDRICH MEE’s line (Leukoparonychia).


–   Arsenophagists are people who take arsenic daily as tonic or as an aphrodisiac and they acquire a tolerance of up to 0.3gm or more in one dose.


Medicolegal Importance

•    Arsenic is the most popular homicidal poison.

•    Napoleon was killed using Arsenic poison (c.f. Socrates was killed using Hemlock poisoning).

•    It delays putrefaction.

•    It can be detected in completely decomposed body.

•    It can be found in bones, hair and nails for a long time.

•    It can be detected in charred bone and ashes.

•    It is sometimes used in abortion sticks.

•    Arsenic causes Black foot disease.*

•    Marsh test and Reinsch test are important Chemical tests*.

     Early stages greatest quantity in liver  Later keratin tissues: BONE, HAIR & NAILS.

     Test for Arsenic® 

    I.  Reinsch Test

  II.  Marsh Test (mARSenich)

III.  Gutzeit Test.

Skull sizes



•    Cephalic Index = (Maximum breadth of skull/Maximum length of skull) × 100

•    It divides skull into 3 categories

     •    “DuMB”

1.  Dolico-cephalic (long-headed) C.I. 70 to 75

     •    seen in pure Aryans, Aborigines and Negroes.

2.  Mesaticephalic (medium headed) C.I. 75 to 80

     •    Majority of Indians are mesaticephalic*(Not to confuse with CI of Aryans)

3.  Brachycephalic (short headed) C.I. 80 to 85

     •    seen in Mongoloids (maximum C.I.).



–   Brachial Index = (Length of Radius/Length of Humerus) × 100



–   Crural Index = (Length of Tibia/length of Femur) × 100

–   For Indians Crural Index is 85 +/--2

–   Anterior curvature of Femur is distinct in NEGROID race*

     {N.B Intermembral Index = [ (Length of Humerus +Radius)/Length of Femur + Tibia] × 100}

Finger prints

Fingerprint system ( Galton system, Dermatoglyphycs)


• Most reliable* method of identification of a person.


· First Finger Print Bureau* was established at Writer’s Building, Calcutta* ,India


• Fingerprints are impressions of pattern formed by the papillary ridges of the fingertips.


• Fingerprints are classified primarily as

1. Loops 67%(most common*)

2. Arches

3. Whorls

4. Composite forms–1-2% (least common*)


• Minimum no. of points to estd proof of identity is 8* (Supreme Court ruling*)

• The patterns are not inherited.

• The pattern is different even in identical twins. (Adolphe Quetelet’s Rule* of biological variation*)




Categories of Finger Prints

§ Latent Finger PrintsàBarely visible

§ Plastic Finger PrintsàPrints made on soft surface(Soap, cheese etc)

§ Visible Finger Printsà Stained with blood, greese etc


• In leprosy and Charring fingerprints may be lost*


[ Lambert Adolphe Jacques Quetelet aimed to do to Human Sciences what Newton did to Physics..His innovation is extensive use of probability to Human science.

Blood stains

In old blood stained fibre, blood grouping is done by :


a.        Benzidine Test                                                            

b.        Acid Elution Test

c.        Precipitin Test                                                              

d.        Hemin Crystal Test


I. Benzidine Test (No longer used as Benzidine is Carcinogenic) 

    • Most reliable chemical test for blood.

    • Add a drip of saturated solution of benzidine glacial acetic acid and then a drop of 10 volumes hydrogen peroxide.

    • If blood is present, dark blue colour is produced immediately.

    • A positive reaction is given by blood of almost any age, blood that has been exposed to heat or cold. It detects blood when present in a dilution of one part of blood in 300000. 


II  Precipitin test

• Precipitin test–This determines whether the blood is derived from human beings or from a lower animal.• Precipitin test +ive in dead body up to 10 years


III. Haemin crystal test


 • Brownish-black rhombic crystals of haemin or haematin chloride arranged singly or in clusters are seen if blood is present

• Teichman’s Test is negative if stain is old 


IV:   Acid Elution Test : 

Why Acid Elution Test is used for old stains?


To remove antibody from coated red cells.

Red cells coated with antibody are thoroughly washed to remove unbound

protein, using a special wash solution to maintain the association of bound

antibody. The washed cells are then suspended in a low pH solution (Acid

Eluting Solution) to dissociate the bound antibody. After centrifugation, the

supernatant containing any dissociated antibody is separated from the red

cells and buffered by the addition of a buffering solution (Base Buffering



The eluate is then ready to be used in antibody detection ( Blood Group)  or


Therapeutic Misadventure

Therapeutic Misadventure is an unintentional act by doctor ,staff or hospital.

-- 3 types :

Purely Therapeutic





II. Medical mal-occurrence on the other hand is act of God (absolute defence against Malpraxis, if proved )


III. Therapeutic Privilege

     –   It is an exception to rule of full disclosure.

     –   It is mainly used in cases of Frank Psychosis 

     -   In circumstances its not possible to disclose everything about the illness, procedures and T/t


IV. Sec. 90 IPC defines the criteria to give valid consent

Sec. 89 IPC : Age above 12 yrs for non invasive

Sec 88 IPC.  consent for invasive procedures/surgery18 years


Doctrine of Locoparentis : consent can be taken from accompanying person(in case parents/guardians not available)

V. Doctrine of NON-FIT-INJURIA : If an indivi­dual gives consent to suffer any harm or injury, he cannot claim damage for the same.


VI. Vicarious Liability : An employer is responsible not only for his negli­gence but also for the negligence of his employees, if such negligence occurs in course of employment and within its scope, by the principle of respon­dent superior* (let the master answer).


VII. Diminished Liability : In criminal law, diminished responsibility (or diminished capacity) is a potential defense by excuse by which defendants argue that although they broke the law, they should not be held fully criminally liable for doing so, as their mental functions were "diminished" or impaired.

Electrical injury

Electrical Injuries

 Joule Burn is specific and diagnostic of contact electrical burn.  Joule burn is endogenous burn.  Crocodile flash burns are due to high voltage burns. These are multiple disc rate lesions due to ‘Arc Effect’.

  Acro-Reaction Test: A micro chemical test for metals at the site of entry of electric current leading to deposition of metal particles in the skin.  Death occurs from ventricular fibrillation.Current Pearls and wax drippings are important autopsy finding.


Lightning Stroke


• A flash of lightning is due to an electrical discharge from a cloud to the earth.

• Arborescent burns are superficial, irregular, thin, resembling the branches of a tree*, also called Litchenberg’s flowers, Keraunographic Markings or Filligree burns.

• Most common site is shoulder flanks.

• Cause of filligree burns: Staining of tissues with haemoglobin, along the path of current


Papular urticaria is a common and often annoying disorder manifested by chronic or recurrent papules caused by a hypersensitivity reaction to the bites of mosquitoes, fleas, bedbugs, and other insects. Individual papules may surround a wheal and display a central punctum.
Although the overall incidence rate is unknown, papular urticaria tends to be evident during spring and summer months.
This eruption is primarily self-limited, and children eventually outgrow this disease, probably through desensitization after multiple arthropod exposures. However, adults can be affected, but at a much lower rate.

Papular urticaria is generally regarded to be the result of a hypersensitivity to bites from insects,such as mosquitoes, gnats, fleas, mites,bedbugs, caterpillars, and moths. However, it is unusual to identify an actual culprit in any given patient.One specific mite causing it is Peymotes ventricosus.
It is also known as the “grain itch”, “barley itch”, “straw itch”, “hay itch” and “mattress itch”.

The histopathologic pattern in papular urticaria consists of mild subepidermal edema, extravasation of erythrocytes, interstitial eosinophils, and exocytosis of lymphocytes.

Immunohistochemical evidence suggest that a type I hypersensitivity reaction plays a central role in the pathogenesis of papular urticaria. The reaction is thought to be caused by a hematogenously disseminated antigen deposited by an arthropod bite in a patient who is sensitive. This theory is supported by the fact that these lesions can and often do occur in areas away from the bites. The putative antigen is unknown.

Clinical features
The eruption is characterized by crops of symmetrically distributed pruritic papules and papulovesicles. The lesions can also appear in an area localized to the site of insect bites, but they occur on any body part. The lesions tend to be grouped on exposed areas, particularly the extensor surfaces of the extremities. Scratching may produce erosions and ulcerations. Secondary impetigo or pyoderma is common.

Its treatment is conservative and is symptomatic in most cases. Mild topical steroids and systemic antihistamines for relief of the itching. When severe enough use of short-term systemic corticosteroids is warranted. If secondary impetigo occurs, topical or systemic antibiotics may be needed.

Use of insect repellents while the patient is outside and the use of flea and tick control on indoor pets are required when these individuals are being treated for papular urticaria.
Rigorous use of an effective insecticide may prevent insect bites and, accordingly, papular urticaria. Insecticides containing diethyltoluamide (DEET) are among the most beneficial.


Vitiligo lesions are characterized as follows:
White or hypopigmented, well demarcated
(Round, oval, or linear in shape
Borders may be convex).
Centrifugal enlargement.
Initial lesions occur most frequently on the hands, forearms, feet, and face, favoring a perioral and periocular distribution.

Clinical classifications
Vitiligo can be classified as follows:

Localized vitiligo can exist in the following forms:
A.Focal: Characterized by 1 or more macules in 1 area.
B.Segmental: Manifests as 1 or more macules in a dermatomal or quasidermatomal pattern; occurs most commonly in children; more than half the patients with segmental vitiligo have patches of white hair or poliosis.
C. Mucosal: Mucous membranes alone are affected.

Generalized vitiligo can manifest as the following:
A.Acrofacial: Depigmentation occurs on the distal fingers and periorificial areas.

B.Vulgaris: Characterized by scattered patches that are widely distributed.

C.Mixed: Acrofacial and vulgaris vitiligo occur in combination, or segmental and acrofacial vitiligo and/or vulgaris involvement are noted in combination.

Universal vitiligo results in complete or nearly complete depigmentation. It is often associated with multiple endocrinopathy syndrome.

Although the diagnosis of vitiligo is made on the basis of clinical findings, biopsy is occasionally helpful for differentiating vitiligo from other hypopigmentary disorders.
Microscopic examination of involved skin shows a complete absence of melanocytes in association with a total loss of epidermal pigmentation. Superficial perivascular and perifollicular lymphocytic infiltrates may be observed at the margin of vitiliginous lesions, consistent with a cell-mediated process destroying melanocytes.

Other documented histologic findings include the following:
Degenerative changes in keratinocytes and melanocytes in the border lesions and adjacent skin.
Epidermal vacuolization.
Loss of pigment and melanocytes in the epidermis is highlighted by Fontana-Masson staining and immunohistochemistry testing.
Woods lamp examination can be done.

A. Medical treatments-
Systemic phototherapy: Induces cosmetically satisfactory repigmentation in up to 70% of patients with early or localized disease.

Steroid therapy: Systemic steroids (prednisone) have been used, although prolonged use and their toxicity are undesirable.

Topical therapies includes steroids, tacrolimus, pimecrolimus, vitamin D analogs.

Depigmentation therapy: If vitiligo is widespread and attempts at repigmentation have not produced satisfactory results, depigmentation may be attempted in selected patients.

Another innovation is therapy with an excimer laser, which produces monochromatic rays at 308 nm to treat limited, stable patches of vitiligo.

Micropigmentation: can be used to repigment depigmented skin in dark-skinned individuals.

B. Surgery
Types of repigmentation surgery are as follow:
1. Noncultured epidermal melanocytic transfer.
2. Thin dermoepidermal grafts.
3. Suction epidermal grafting.
4.Punch minigrafting.
5.Cultured epidermis with melanocytes or cultured melanocyte transfer.

Wednesday, 24 June 2015

Cornea tests

👀corneal thickness - pachymeter🔬

👀corneal endothelium - specular microscope🔬

👀corneal curvature - keratometer🔬

👀corneal surface - slit lamp biomicroscopy🔬

👀corneal sheen or shine - placido disc🔬

Timings of various tests

Timing of various tests
1. Patch 👉 2 days

2. Tuberculin induration seen after👉 3 days

3. Normal skin doubling time 👉 4 weeks

4. Normal skin doubling time in psoriasis👉 4 days

5. Kveims test👉 2 weeks

6. Lepromin early Fernandez👉 2 days

7. Lepromin late mitsuda👉 3 weeks

Blast injures

There are 4 types of blast injury & an individual patient may be injured by more than one mechanism :


Primary: Injury from over-pressurization force (blast wave) impacting the body surfaceTM rupture, pulmonary damage and air embolization, hollow viscus injurySecondary: Injury from projectiles (bomb fragments, flying debris)Penetrating trauma, fragmentation injuries, blunt traumaTertiary: Injuries from displacement of victim by the blast windBlunt/penetrating trauma, fractures and traumatic amputationsQuaternary: All other injuries from the blastCrush injuries, burns, asphyxia, toxic exposures, exacerbations of chronic illness



Primary Blast Injuries : The pressure wave hits the body and, while most of it is reflected, some of it manages to compress internal gases. As a result, the victim sustains primary blast injuries.

Spalling,( Turbulence at Air/liquid interface ) [ POTENTIAL Q. ]Implosion,Inertia,and pressure differentials are the main mechanismsinvolved in the pathogenesis of primary blast injuries.


These typically affect ears ( Tympanic membrane most common primary blast injury ), the lungs, and -- in rare cases -- intestines (esp. colon*) These gassy chambers basically implode, rupturing and fragmenting tissue.



Blast lungs refers to severe pulmonary contusion, bleeding or swelling with damage to alveoli and blood vessels, or a combination of these. It is the most common cause of death among people who initially survive an explosion.

CXR:  “ butterfly” pattern**


In air the gas & air surrounding the explosion are compressed & absorb energy from the explosion. 


In water, being incompressible, there is little absorption & the pressure wave is transmitted with greater intensity over a longer range. 


--> The lethal range of an explosion in water is far greater than the same mass of explosion in air & this increases mortality in underwater explosions.


Most Severely Affected Organs**: 

Air Blast : Lungs

Underwater : G.I.T


Most Common :


Air : Tympanic membrane

Under Water(fully submerged) T.M

Underwater ( Head is Out ) G.I.T

Lab values

#‎Reference‬ ranges
Reference ranges vary according to individual labs. All values are for adults unless otherwise stated
Full blood count
Haemoglobin Men: 13.5-18 g/dl Women: 11.5-16 g/dl
Mean cell volume 82-100 fl
Platelets 150-400 * 109/l
White blood cells 4-11 * 109/l|
Urea and electrolytes
Sodium 135-145 mmol/l
Potassium 3.5 - 5.0 mmol/l
Urea 2.0-7 mmol/l
Creatinine 55-120 umol/l
Bicarbonate 22-28 mmol/l
Chloride 95-105 mmol/l
Liver function tests
Bilirubin 3-17 umol/l
Alanine transferase (ALT) 3-40 iu/l
Aspartate transaminase (AST) 3-30 iu/l
Alkaline phosphatase (ALP) 30-100 umol/l
Gamma glutamyl transferase (yGT) 8-60 u/l
Albumin 35-50 g/l
Total protein 60-80 g/l
Other haematology
Erythrocyte sedimentation rate (ESR) Men: < (age / 2) mm/hr Women: < ((age + 10) / 2) mm/hr
Prothrombin time (PT) 10-14 secs
Activated partial thromboplastin time (APTT) 25-35 secs
Ferritin 20-230 ng/ml
Vitamin B12 200-900 ng/l
Folate 3.0 nmol/l
Reticulocytes 0.5-1.5%
D-Dimer < 400 ng/ml
Other biochemistry
Calcium 2.1-2.6 mmol/l
Phosphate 0.8-1.4 mmol/l
CRP < 10 mg/l
Thyroid stimulating hormone (TSH) 0.5-5.5 mu/l
Free thyroxine (T4) 9-18 pmol/l
Total thyroxine (T4) 70-140 nmol/l
Amylase 70-300 u/l
Uric acid 0.18-0.48 mmol/l
Arterial blood gases
pH 7.35 - 7.45
pCO2 4.5 - 6.0 kPa
pO2 10 - 14 kPa
Desirable lipid values depend on other risk factors for cardiovascular disease, below is just a guide:
Total cholesterol < 5 mmol/l
Triglycerides < 2 mmol/l
HDL cholesterol > 1 mmol/l
LDL cholesterol < 3 mmol/l

Tuesday, 23 June 2015

Most commons from OBG

Most common site for genital tb-BILATERAL ALWAYS FT-ampulla(2md mc-endometrium-direct spread(mcq)
Mc route for spread of genital tb-haematogenous>direct (least-ascending)
Lest common for genital tb-vulva vagina
Mc mentsrual irregularity in genital tb-oligo/amenn. (1st irregularity-MENORHAGIA)
Finding in patient of genital tb----
2)least common-presence of adnexal mass
Mc finding of gen tb in ADOLSCENT GIRL-bilateral adnexal mass
Mc reason for abnormal post-coital test-improper timing(DNB)
Mc method for increasing sperm conc in IUI(t/t of immunological infertility) - sperm swim up technique
Mc site of endometriosis-ovary
Mc theory explaining endometriosis-retrograde mc(sampsons theory)
2nd most accepted-coelomic theory
Endometrios mc gene assosiated(genetic theory) - K-ras
Mc symptom of endometriosis-pain>infertility
Mc mullerian anomaly -bicornuate uterus
Mc mullerian anomaly assosiated with 1)abortion-septate.  
3)highest obs complication-unicornuate
4)ectopic ovary-unicornuate
5)urinary tract anomalies-unicornuate

 Mc cancer women in india-cervical
Mc histology cx carcinoma 
sqammous cell ca 70%(specific risk factor-smoking)
Adeno ca 30%(ocp use of 5yrs)
Mc hpv ca cervix 16,18
16- more sensitive (squammous cell ca)
18-more specific (adeno)
Ca cervix mc
presenting complaint-irregular bleeding
Specific comp-post coital bleeding
Route of spread-lymphatics
LN mc-obturator (point A brachy)
Sentinel LN -paracervical (point B)
 Mc ovarian cancer-epithelial ovarian ca(serous cystadeno ca -70%)
Risk of ovarian cancer increases every year after 35yrs
epithelial-bilateral,6-7th decade,post menopausal,highest mortality rate among all gynaec ca
Mucinous-4-5 decade
Germ cell-10-20yrs of age,UNILATERAL,
Sex cord-unilateral,any age (mc-perimenopausal),risk assosiated-endomet ca
Mc ovarian tumour-serous cystadenoma
Mc ovarIan In pregnancy
Germ cell tumour which can be bilateral 20%
Frequently occurs with gonadoblastoma
Equals to seminoma in males
Best prognosis
Most rapidly growing tumour-endodermal sinus tumour(worst prog)
Highest risk of torsion-dermoid
Mc cause of post mentrual bleeding
WORLDWIDE-senile endometritis
INDIA-cervix ca
Mc cause of pyometra
WORLDWIDE-endometrial ca
INDIA- cervix ca(as its treatment may also cause pyometra)
Mc type of DUB-anovulatory
Mc GTN after molar preg-invasive
Mc surgery done for prolapse-posterior colpoperineoraphy
Mc pelvic tumour-fibroid
Mc fibroid-intramural
Mc symptom of fibroid-mennorhagia
Mc fibroid to cause uterine inversion-fundal fibroid
Mc symptom of fundal fibroid-mennorhagia
mc degeneration-hyaline
Least common-sarcomatous
Mc indiation for transabdominal hystrectomy(TAH)-fibroid uterus
Highest risk of ectopic in all IUD-progetacert
Emergency contraceptive MOST effective-IUCD
MC EC used-Lng tablet
Least failure-unilateral cautery
Highest failure-bilateral cautery
Least failure among surgical-uchida>erwing>pomeroy

Numbers in OBG

AbdominalTB- present in genital tb patients-45%
Patients of genital TB infertile: 40-80%(mc presenting complaint of genital tb -INFERTILITY >pain)
Incidence of genital tb in patients with infertility-17%
Mullerian anomaly assosiation with urinary tract abnormality-30%
Risk of endometriosis is 7 times more if 1st degree relative is affeced with endometriosis
Patient with history of ovarian ca in 1st degree relatives,so risk of ovarian cancer-7%(dnb 2014)
Recurrence rate ater incision and drainage of endometrial cyst-50%(€€therefore best t/t - cystectomy)
Rate for conversion to frank camcer
cin-1 : 1%
Cin-2 :5%
Cin-3 : >12%(22)
Cin 1 conver to CIS -11%
Cin 1 time to regress to normal-2yrs
Protection rate of hpv vaccine-70%
Risk of involvement of ovaries in ca cx-11%
BSO can reduce the risk of breast ca by 50%
Dermoid always benign but risk of cancer -less than 2%
Risk for lifetime
brca 1-ovarian ca-35-45%
Hnpcc-endometrial ca-75%
Post mentrual bleeding patients developing endometrial ca-10%
any abnormal uterine bleeding above 40yrs endometrial ca should be ruled out therefore endometrial biopsy to be done rather than PAP
Endometrial hyperplasia(pre invasive)
simple withOUT atypia-1% risk for endometrial ca
Complex WITHOUT atypia-3%
Simple with atypia-8%
Complex with atypia-20%
(Without atypia progestrogens to be given for MINIMUM 14 days)
Use of OCP for 5yrs decrease the risk ovavarian ca by 50%
Molar preg
partial-90% triploidy 10% tetra
Complete 80-90% monospermic 46xx,10% 46xy
Complete mole associated with-
pre eclamsia-27%
Trophoblastic embolization-2%
Theca letin cysts -50%
Partial mole to 
Complete mole to
Hcg levels becum normal in 
40%ovulate after taking POP
Blood loss after cuT-80ml
Post placental IUD insertion within 10mins
Post placental sterlization within 48hrs(ideal),can be done upto 7 days.if not done in first 7 days do after 6 weeks.
Expulsion rate
cuT 5%
Memory time-5min
Mini lap-3-4cm incision
FT damaged in mod. Pomeroy-3cm
Gas for pnemoperitoneum-2L,pressure-15mmhg(co2)
Rate of ectopic post sterlization-10%
Risk of ectopic
highest-bipolar cautery
Lowest-mod. Pomeroy

Average liquefaction time for semen-20min
Maximum time for liquefaction-60min
Speed of sperm in female tract-3mm/sec
Who parameters
Vol->1.5 ml ,ph >7.2
Sperm concentntration 15 million
Sperm count 39 million
Total motility 40%
Forward motility 32%
Wbc -lessthan 1 million 
Normal morphology 4%
40% ppl taking POP ovulate normally
Safe period of POP-3hrs
Safe period of cerazette is 12hrs

Sunday, 21 June 2015

Drinking water guidelines

Recommended guidelines for drinking water:
. Color < 15 TCU
. Turbidity < 5 NTU
. pH= 6.5-8.5
. Total dissolved solid (TDS)= <600 mg/L
. Zero infection virus
. Zero pathogenic microrganism
. Chlorine < 1.5 ppm
. Nitrate < 45 - 50 mg/L
. Nitrite < 3mg/L
. Gross alpha radioactivity < 0.1 becquerel/L
. Gross beta radioactivity <1 becquerel/L

Friday, 19 June 2015

Orthopedics most common

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 – Knee
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 – Iiofemoral 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


🌟All abut STAINS 🌟

1. Aldehyde Fuchsin
- can be used to stain pancreatic islet beta cell
2. Alician Blue
- a Mucin stain (a category of histology stains,
listed below)
- can stain mucins and mucosubstances blue (due
to the copper in the stain)
3. Alizarin Red S
- can be used to identify calcium in tissue
- used on the Dupont ACA analyzer to measure
serum calcium photometrically
4. Alkaline Phosphatase
- can be used to stain endothelial cells
5. Azan Stain
- can be used to differentiate osteoid from
mineralised bone
6. Bielschowsky Stain
- can be used to show reticular fibres
- used for showing neurofibrillary tangles and
senile plaques
- uses the chemical element silver (Ag)
7. Cajal Stain
- can be used on nervous tissue.
8. Congo Red
- used to stain amyloid fibres (to appear orange/
9. Cresyl Violet
- will stain both neurons and glia
- bonds with acidic parts of cells such as
ribosomes , nuclei and nucleoli
0. Eosin
- commonly used for general histology staining
when paired with haematoxylin - see Hematoxylin
and Eosin (H&E)
1. Fontana-Masson
- uses the chemical element silver (Ag)
- stains argentaffin granules and melanin black -
while also staining nuclei pink/red and cytoplasm
light pink
- a specific example of a Melanin Stain (general
category of histology stains)
2. Giemsa Stain
- a Romanowski (also written "Romanowsky") type
- used for peripheral blood smears, i.e. a thin
layer of blood smeared on a microscope slide and
used for bone marrow.
- used to study parasites and malaria
3. Golgi Stain
- can be used to stain neurons
4. Gomori Trichrome
- trichrome histology stains are formed from a
mixture of three dyes
- Gomori's trichrome stains connective tissue and
collagen (green or blue), muscle, keratin and
cytoplasm (red) and nuclei (grey/blue/black)
5. Heidenhain's AZAN trichrome stain
- trichrome histology stains are formed from a
mixture of three dyes
- can be used to distinguish cells from
extracellular components
- stains connective tissues, e.g. muscle fibres,
cartilage and bone matrices .
- a similar stain to Mallory Trichome (listed
below). These histology stains differ because
Heidenhain introduced azocarmine G in place of the
acid fuchsine of Mallory's stain. He also added
controlled destaining resulting in different colours
of cell nuclei (dark red), collagen (blue) and a
various of colours in cytoplasm.
6. Hematoxylin
- commonly used for general histology staining
when paired with eosin - see Hematoxylin and
Eosin (H&E)
7. Hematoxylin and Eosin (H&E)
- standard histology stain and the most frequently
used combination of stains used in the histology
lab for general purpose staining - often used for
routine tissue preparation
- Hematoxylin binds to acidic structures, staining
them blue-purple. Hence it binds and stains
nucleic acids ( DNA and RNA), so stains the nuclei
of cells blue.
- Eosin binds to and stains basic structures pink,
e.g. cytoplasm , muscle, connective tissue, colloid
and red blood cells are stained pink-red.
8. Iron Hematoxylin
- stains nuclei bluish/black.
9. Luna Stain
- can be used to demonstrate elastin and mast
0. Luxol Fast Blue
- the alcohol soluble equivalent of Alician Blue
(see above)
- used to observe myelin (myelin stains blue to
blue/green, neurons to violet, red blood cells to
1. Mallory Trichrome
- trichrome histology stains are formed from a
mixture of three dyes
- used on connective tissue to indicate collagen
and reticular fibers.
- uses acid fuchsine followed by a solution
containing PTA, orange G and aniline blue.
2. Masson Trichrome
- trichrome histology stains are formed from a
mixture of three dyes
- can be used to distinguish between cellular
items & extracellular items
- can be used on connective tissue.
3. Melanin Stains
- a category of histology stains used to stain
melanin (which is located in the skin, eyes, and
- can be used to study melanin pigment in cells of
malignant melanoma
- Fontana-Masson (listed above) is a specific
example of a melanin stain.
4. Movat's Pentachrome Stain
- can be used to study connective tissue.
5. Mucicarmine
- a very specific Mucin Stain
- can be used to observe epithelial mucins

Thursday, 18 June 2015


Some important muscles and their special names :

Quadrilateral - thyrohyoid.
Straplike - sternohyoid & Sartorius.
Straplike with tendinous intersections - rectus abdominis.
Fusiform - biceps, digastrics etc.
Oblique Fasciculi
Triangular - adductor longus, temporalis.
Shawl muscle - Trapezius.
Guthrie’s muscle - Sphincter urethrae.
Laughing/Smiling muscle - Zygomaticus major.
Unipennate (fibres arranged to insert in a diagonal direction onto the tendon allowing great strength ) - Flexor policis longus, extensor digitorum longus, peroneus tertius.

Multipennate (multiple rows of diagonal fibres, with a central tendon which branches into two or more tendons) - Subscapularis, deltoid.

Circumpennate - Tibialis anterior.
Spiral or Twisted fasciculi - Trapezius, Pectoralis major, Latisimus dorsi, Supinator.
Cruciate muscles - Sternocleidomastoid, Adductor magnus, Masseter.
Subcutaneous muscles - Platysma, Palmaris brevis.
Longest muscle - Sartorius (tailor muscle).
Smallest muscle - Stapedius.
Climbing muscle - Latissimus dorsi (broadest muscle of Back).
Boxer’s muscle - Serratus anterior.
Locking muscles - Popliteus.
Casser’s perforated muscle - Coracobrachialis.
Coiter’s muscle - Corrugator supercilli.
Cowl muscle - Trapezius.
Rider’s muscle - Adductor muscle of thigh.

Valsalva’s muscle - Muscle of Tragus.
Sommering’s muscle - Levator glandulae thyroideae.
Thelle’s muscle - Superficial transverse perinea muscle.
Toynbee’s muscle - Tensor tympani.
Wilson’s muscle -Sphincter urethrae.
Wrinkler muscles of eyebrow - Corrugator supercilli (Coiter’s muscle).
Sibson’s muscle - Scaleneus minimus.
Gavard’s muscle - Oblique fibres in the muscular coat of stomach.
Oehl’s muscle - Strands of muscle fibres in the chordae tendinae of the left A-V valve.

Wednesday, 17 June 2015


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

Tuesday, 16 June 2015


Osteoporosis: DEXA scan
T score: based on bone mass of young reference population
T score of -1.0 means bone mass of one standard deviation below that of young reference population
Z score is adjusted for age, gender and ethnic factors
T score
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis


Its time for babies! So a list of some babies
1) Blueberry muffin baby (indicates extramedullary
hematopoiesis) - Characteristic of Congenital rubella
syndrome, also in metastaic neuroblastoma
2) Harlequin baby - Harlequin Ichthyosis (autosomal
recessive, ABCA12 gene mutation)
3) Collodion baby - Lamellar Ichthyosis (autosomal
recessive, TGM1 gene mutation)
4) Frog faced Baby - Anencephaly
5) Floppy baby - Infant botulism
6) Grey Baby - Chloramphenicol side effect
(Immature hepatic glucuronidation enzymes)
7) Bronze baby - Conjugated hyperbillirubinemia
8) Blue Baby - Methemoglobinemia
9) Battered Baby (Caffey's whiplash shaken baby
syndrome) - Child abuse
10) Cyclops Baby (single median eye with/without
probocosis) - Holoprosencephaly (sonic hedgehog -shh gene mutation)

Diabetes drugs

Sulfonylureas (glyburide, glipizide, glimepiride)
- Increase insulin secretion
- Adverse effects: hypoglycemia, weight gain

Glucosidase Inhibitors (acarbose and miglitol)
- Reduce absorption of carbohydrates in the upper small intestine
- Can lower HbA1c levels by 0.5% to 1.0%
- Adverse effects: GI intolerance and flatulence

Thiazolidinediones (rosiglitazone and pioglitazone)
- Increase insulin sensitivity in muscle, adipose tissue, and the liver
- Can lower HbA1c levels by 0.5% to 1.3%

Biguanide (metformin)
- Decrease hepatic glucocose production and enhance insulin mediated glucose uptake in muscle and adiopose cells
- Adverse effects: transient abdominal pain, diarrhea, and nausea
- Risk of lactic acidosis if receiving IV contrast dye
- In adults, demonstrated normalizing blood glucose levels, decrease cholesterol levels, and reduce hypertension

One liners

“Thumbprint sign is seen in ischaemic colitis”
“Mercedes Benz sign is sign is seen in radiopaque gall stones”
“Double bubble sign s seen in duodenal atresia single in pyloric and multiple bubble sign is seen in ileal`jejanal atresia”
“Driven snow sign is seen in pindborgs tumor”
“Flower vase sign is seen in Horse shoe kidney”
“Vertebra plana s seen in eosinophillic granuloma”
“Rat tail oesophagus s seen in oesophagal carcinoma”
“Cork screw oesopgagus is seen in diffuse oesophagal spasm”
“Thimble bladder is seen in tb bladder”
“Sand patches in bladder are seen in schistosomiasis”
“Chain of lakes is seen in chronic pancreatitis”
“Golfhole ureter is seen in tb ureter”
“Soap bubble app is seen in osteoclastoma”
“Snowmans sign is seen in TAPVC”
“Boot shaped heart is seen in TOF”
“Tram track calcification is seen in sturge weber syndrome”
“Bilateral spider leg appearance is seen in polycystic kidneys”
“Air bronchograms are seen in consolidation”
“String of kantor is seen in crohns disease”
“Apple core sign is seen in left colon cancer”
“Snow storm appearance is seen in hydatiform mole”
“Camaleotes sign is seen in hydatid disease of liver”
“Colon cutt off sign is seen in acute pancreatitis”
“Saw tooth sign is seen in diverticulosis”
“Egg in cup appearance is seen in renal papillary necrosis”
“Codmans traingle and sunray app is seen in osteosarcoma”
“Coffee bean sign is seen in sigmoid volvulus”
“Bamboo shaped spine in ankylosing spondylitis”
“Salt and pepper skull in hyperparathyroidism”
“Strawberry gingiva is seen in wagners granulomatosis”
“Strawberry tounge is seen in scarlet fever,toxic shock syndrome and kawasakis disease"
“Strawberry cervix is seen in trachomoniasis”
“Strawberry nose is seen in rhinosporidosis”
“Strawberry skin and nasal mucosa is seen in sarcoidosis”
“Calots triangle is made superiorly by inferior border of liver,medially by common hepatic duct and inferiorly by cystic duct”
“Contents of calots triangle are lymph node of lund,right hepatic artery,cystic artery"
“Billing method of contraception is a behavioural method”
“Hasses rule is used for calculation of gestational age based on length of fetus”
“Hellens rule says twins as
1 in 80,2 in (80*80),3 in (80*80*80)
“In Mayer Rokintansky kuster Hausers syndrome ovary is normal bcos it develops from genital ridge”
“Most common cause of perinatal death in multi fetal pregnancy is prematurity”
“Most common cause of maternal death in india is hemorrhage>anemia>sepsis”
“Intersitial ectopic pregnancy ruptures later bcos of closer endometrial suppourt”
“Progesterone is common harmone in both Arias stella and decidual reaction”
“Pentoxifyline has proved to b best for treating hepatorenal syndrome”
“Amoebic ulcers are flask shaped”
“Typhoid ulcers are longitudinal”
“Tubercular ulcers are tranverse”
“Tubercular enteritis cause strictures of gut”
“Dementia is a late feature of whipples disease but bad prognostic feature”
“Ito cells containg vitamin A are present in space of disse”
“Most common site of gastrinoma is duodeneu
m psaros triangle”
“D xylose test is used to mak difference between malabsorption due to intestine and pancreas”
“D xylose will b negative in pancreatic malabsorption,malnutrition,gastrectomy”
“D xylose wl b false positive in ascites,pleural effusion,blind loop syn,renal failure”
“Alpha feto protein in normal in hepatolammelar tumour of liver but increased in h

Investigation of choice

“Investigation of choice for early renal tb is IVP”
“Inv of choice in advanced renal tb is CT”
“Inv of choice for blunt abd trauma is CT”
“Inv of choice for avascular necrosis is MRI”
“Inv of choice for cholecystitis n gall stones is ultrasound”
“Investigation of choice for bone density and osteoporosiiis DEXA bone test”
“Inv of choice for GERD is 24 hour ph metry”
“Inv of choice for VUR and posterior valves is MCU”
“Inv of choice for cytotoxic drug induced cardiotoxicity Is endomyocardial biopsy”
“Inv of choice for obstetric probs is USG”
“Inv of choice for PE is CECT>angiography>v/Q scan”
“Inv of choice for acute cerebral hemorrhage CT”
“Inv of choice for chronic cerebral hemorrhage is MRi”
“Inv of choice for posterior med tumor,pancoasts tumor,posterior cranial fossa is MRI”
“Inv of choice for subarachnoid hemmorhage diagnosis unenhanced CT”
“Inv of choice for subarachnoid hemorrhage etiology is 4vessel MR angiography”
“Inv of choice for interstitial lung disease and bronchectasis is HRCT”“
“Inv of choice for stable dissecting aneurysm is MRI”
“Inv of choice for dissecting aneurysm unstable is transoesophagal usg”
“Inv of choice for traumatic paraplegia is MRI”

Wednesday, 10 June 2015


• It is also known as Koch’s disease.
• They are acid fast due to presence of mycolic acid.
• Virulence factor is “cord factor”
Two types
a) Primary tuberculosis
• Most commonly seen in children
• It is seen in unsensitised  and unexposed  individuals
• Source of organism is exogenous.
• Most common site is lung.
• most commonly  starts  as  “latent disease”.
• Unilateral hilar lymph enlargement is seen.
• Calcification, Pleural effusion, Erythema nodosum and Phlyctenular conjunctivitis are also seen.

• Some named Lesions are :
1) Ghon’s focus:-
Subpleural fibrocaseous lesion (consolidation) of lung parenchyma
  Most commonly seen at lower part of  upper lobe
Microscopically contains epithelioid  granulomatous inflammation
2) Ghon’s complex:-
Consists of Subpleural Ghon’s focus and involved lymph nodes.
  Ghon's complex found below clavicle.
3) Ranke’s complex :
Ghon’s focus along with fibrosis and calcification.
4) Simon focus
It is a tuberculous (TB) nodule formed in  lung apex.
Due to spread of primary TB infection from elsewhere in the body to  lung apex via bloodstream.

b) Post-primary (=Secondary) Pulmonary tuberculosis
• Seen in previously sensitized host due to reactivation of latent primary lesions.
• Frequently associated with decreased immune status.
• Pulmonary fibrosis and cavitation are common.
• Lymph node involvement is rare.
• Endobronchial spread along nearby airways is relatively common finding, resulting in relatively well-defined 2-4 mm nodules or branching lesions “tree-in-bud appearance” on CT.
•   Tuberculomas and miliary TB are also recognized patterns of secondary TB.
• Lesions seen are
1) Puhl’s lesion:-
• Lesion in lung apex and supraclavicular.
• No lymph node involvement.
2) Assman focus:
• Infraclavicular lesion of chronic pulmonary T.B.
Miliary pulmonary tuberculosis
• It is uncommon but carries a poor prognosis.
• It represents hematogenous dissemination of an uncontrolled tuberculous infection.
• Most commonly seen post-primary tuberculosis.
• Miliary deposits appear as 1-3 mm diameter nodules.
• Lesions are
a) Rich focus
• It is a tuberculous granuloma occurring on brain cortex.
b) Weigert’s focus :
• Subintimal foci in pulmonary vein.
c) Simond’s focus:
• Localized foci in liver.

Congenital tuberculosis
• Infection with tubercle bacilli either during intrauterine life or before complete passage through birth canal is termed as congenital tuberculosis.
• Three possible modes of infection of fetus
1) Hematogenous infection via umbilical vein
2) fetal aspiration of infected amniotic fluid
3) fetal ingestion of infected amniotic fluid
• Most common site (overall) and most common site for  “primary complex” for “congenital Tuberculosis” is Liver.

• Revised criteria for diagnosis of congenital tuberculosis ( by Cantwell ):
Proven tuberculosis lesions in the infant plus one of the following:
1) Lesions occurring in the first week of life
2) A primary hepatic complex
3) Maternal genital tract or placental tuberculosis
4) Exclusion of postnatal transmission by thorough investigation of contacts.

Monday, 8 June 2015



1. Apple core sign - colon ( colorectal carcinoma).

2. Apple peel appearence - intestinal atresia.

3. Apple core sign - femur. (synovial chondramatosis).

4 .Apple jelly appearence - lupus vulgaris.

5. Banana sign-chiarri malformation.

6. Banana #- paget disease.

7. Berry aneurysms - saccular aneurysm of cerebral artery.
8. Berry ligament- lateral thyrohyoid ligament.
9. Blueberrymuffin baby - congential CMV. INFECTION,toxoplasmosis,rubella
10.Bunch of grapes sign- hydatiform mole.

11. Pear shaped bladder-pelvic haematoma, bilateral lymphocoele.
12. Strawberry skull- Edward syndrome.

13. Strawberry gall bladder-diffuse cholesterolosis in the mucosa of GB.

14. Strawberry nevus - capillary haemanigoma.
15. Strawberry tongue -Kawasaki disease.

16. Strawberry cervix-Trichomonas vaginalis.
17. Cherry red spot - cherry red spot myoclonus syndrome.
18. Cherry angioma - senile haemanigoma.

19. Mulberry calculus- urinary calculus.

20. Mulberry spot- abdmonial eruption in typhus fever.
21.Mulberry molar - congenital syphilis.

22.Mulberry hypertrophy - Rhinitis medicamentosa.
23.Peau d' orange appearence - Breast carcinoma.

Sunday, 7 June 2015

Nerve fibres


✔ Nerve fibers within peripheral nerves are divided into 3
types A, B and C according to their diameters,
conduction velocities, and physiologic characteristics.

✔A fibers are large, myelinated, conduct rapidly, and carry
various motor or sensory impulses.

✔B fibers are smaller myelinated axons that conduct less
rapidly than A fibers. These fibers serve autonomic

✔C fibers are the smallest and are non myelinated. They
conduct impulses the slowest and serve pain conduction
and autonomic functions.

✔A delta fibers carries pain and temperature.

✔A alpha fibers are related to motor function and reflex

✔A beta fibers innervate muscle and transmit touch and
pressure sensations.

✔A gamma fibers control muscle spindle tone.

✔B fibers are thinly myelinated preganglionic autonomic
axons that ultimately control vascular smooth muscle.

✔ A alpha and A beta fibers have maximum conduction
velocity of 30-70m/s.

✔ Conduction velocity of A gamma
fiber is 15 -30m/s and that of A delta fiber is 12-30m/s.

✔Type C fiber has a velocity of 0.5-2 m/s.

✔Type A fiber have the largest diameter, type B fibers
are smaller and type C is the smallest.

Monday, 1 June 2015

Corneal dystrophy mnemonic

Monroe --MPS----> alcian blue

Got --- Granular
Her --- Hyaline
Man---Massons trichrome

in Los-- Lattice
Angeles---Amyloid---> congo  

Schnyder's ----cholesterol-->oil red o & Sudan black

Period of development:

Period of development:

1. Spermatogenesis: 64 days

2. No.of primary oocyte
A. Before birth:- 7 millions
B. After birth:- 7 lakh to 2 million
C. At puberty:- 40,000 to 4 lakh
D. Ovulated:- less than 500

3. Meiotic division
B. M-2: just before fertilization

4. Ovulation: 14 days prior menstruation

5. Fertilization: 48-72 hrs of ovulation

6. Morula (16 cell stage): 3-4th day

7. Implantation: 5-6th day

8. USG:-
A. Gestational ring: 5th WK of LMP
B. Gestational sac: 6th WK of LMP
C. Heart activity: 7th WK of LMP
(Reduce 1 WK in each, in case transvaginal usg is performed)

9. Life span of ovum: 1 day

10. Life span of sperm: 2-3 days

11. Somite: 3rd WK

12. Intra embryonic coelom: 4th WK

13. Brain, Kidney: 5th WK

14. Liver: 5th-10th WK

15. Adrenal: 6th WK

16. Primary ossification in clavicle: 6th WK (in other bones- 8th WK)

17. Physiological hernia appears at 6th WK, reduced at 10 th wk

18. Mammary gland: 7 th WK

19. Genitalia differentiation: 12th WK

20. Liver erythropoieisis: 8-12 wks

21. Urine formation: 9-12 wks

22. Quickening: 20th WK

23. Eye movt: 14th WK

24. Respiration: 26th WK

25. Splenic hemopoeisis: 26-28 wks

26. Pupillary reflex: 30 wks