Tuesday, 29 September 2015


Wernicke’s encephalopathy

An acute reaction to severe thiamine deficiency mostly d/t chronic alcohol use.

C/b ocular signs (nystagmus & external ophthalmoplagia)

Higher mental function disturbance(disorientation, confusion, recent memory disturbances)

Apathy & ataxia. Peripheral neuropathy & malnutrition may be co-existent.

Korsakoff’s psychosis

Also d/t severe thiamine deficiency d/t chronic alcohol use.

C/b amnestic syndrome with gross memory disturbances, Confabulation. Insight often impaired.

Marchiafava-Bignami syndrome

A rare disorder most probably d/t alcohol-related nutritional deficiency.

C/b disorientation, personality & intellectual deterioration, hallucinations, epilepsy, dysarthria,

ataxia & spastic limb paralysis.

Holiday Heart

Atrial or ventricular arrhythmias, especially paroxysmal tachycardia, after drinking a binge of alcohol

in individuals showing no other evidence of heart disease.

Hemp insanity (cannabis psychosis)

Asso with cannabis.

Acute schizophreniform disorder with disorientation & confusion. Good prognosis.

Amotivational syndrome

Lethargy, apathy, loss of interest, anergia, reduced drive & lack of ambition d/t chronic cannabis use.

Van Gogh syndrome

Dramatic self-mutilation occurring in schizophrenia.

Pfropf schizophrenia

A syndrome of schizophrenia occurring in presence of mental retardation.

Oneiroid schizophrenia

A subtype of schizophrenia with acute onset, clouding of consciousness, disorientation, dream-like

states & perceptual disturbances with rapid shifting.

Alice in Wonderland syndrome

Perceptual distortion of shape, size, colour& reciprocal position of objects. seen with schizophrenia,


PAD syndrome

Phobic-Anxiety-Depersonalization syndrome.

Commoner in women 20-40 years.

C/b diffuse anxiety, multiple phobias, panic attacks, depersonalization, derealization & depressive Features.

Othello syndrome (conjugal paranoia)

A psychosis in which the content of delusions is predominantly jealousy (infidelity) involving spouse.

Clerambault’s syndrome (erotomania)

A psychosis in which the content of delusions is erotic.

Most often in women with erotic conviction that a person with higher status is in love with the


Kadinsky-Clerambault’s syndrome

A syndrome of mental automatism

Folie a deux

Induced delusional disorder c/b sharing of delusions b/w 2 persons.

So is folie a trios, folie a quatre, folie a famille

Capgras’ syndrome (delusion of doubles)

C/b delusional conviction that other persons in environment are not their real selves but are their

own doubles.

There are 4 types

1. Typical Capgras’ syndrome(illusion des sosies)- pt sees a familiar person as a stranger who is

imposing as the familiar person.

2. Illusion de Fregoli pt falsely identifies strangers as familiar persons.

3. Syndrome of subjective doubles pt’s own self is perceived as being replaced by a double.

4. Intermetamorphosis pt’s misidentification is complete including both external appearance &


Fregoli’s phenomenon

Delusion that a persecutor is taking on a variety of faces like an actor.

Cotard’s syndrome

Delusion that one has lost everything- possessions, strength & even bodily organs such as heart.

Seen in severe depression where pt has extreme nihilistic delusion (e.g. may think that his bowels

are rotting and he will never pass stools again)

Ganser’s syndrome (hysterical pseudodementia)

Commonly found in prison inmates.

C/b vorbeireden- approximate answers- person understands nature of questions but answers wrong.


Lack of concern towards symptoms despite apparent severity of disability produces.

Seen in patients with conversion & dissociation disorder (hysteria).

Briquet’s syndrome (Somatisation disorder)

A chronic or recurrent illness with either a dramatic or complicated medical history.

A pt with at least 25 unexplained medical symptoms for a diagnosis or with 20-25 unexplained

symptoms for a probable diagnosis.

Munchausen syndrome (Factitious disorder, Polysurgis, Professional patients, Hospital hoboes,

Hospital addiction)

Pt repeatedly simulates or fakes diseases for sole purpose of obtaining medical attention.

Munchausen syndrome by proxy

Pt intentionally produces physical signs & symptoms in another person who is under pt’s care.

Charles bonnet syndrome phantom visual images

Ekbom syndrome (Restless Legs syndrome)

Pt experiences extremely uncomfortable feeling in leg muscles during walking.

Asso with insomnia.

Gelineu’s syndrome

Narcolepsy. Associated with hypersomnia.

Pickwickian syndrome

Sleep apnea commoner in elderly & obese persons, associated with hypersomnia.

Kleine-Levin syndrome

C/b hypersomnia, hyperphagia, hypersexuality

Clumsy Child syndrome (Motor dyspraxia, Motor skills disorder, Developmental coordination


C/b poor coordination in daily activities of life.

Idiot Savant syndrome

Pervasive impairment of functions but certain islets of precocity or splinter functions may remain.

Heller’s syndrome (Disintegrative psychosis)

A type of childhood psychosis with age of onset 3-5 years.

C/b rapid downhill course leading to deterioration & development of neurological deficits.

Asperger’s syndrome

Predominantly in boys.

Less severe form of pervasive developmental disorder

Autism without significant delay in language & cognitive development.

schizoid personality

pedantic speech

preoccupation with obscure facts

Rett’s syndrome

Occurs in girls.

After an apparently normal early development & normal head circumference at birth, there is

deceleration of head growth b/w age of 5-30 months.

Loss of purposive hand movements & acquired fine motor manipulative skills with subsequent

development of stereotyped hand movements.

Strauss syndrome

Attention deficit hyperkinetic disorder, Minimal brain dysfunction, Organic drivenness.

Gilles de la Tourette’s syndrome

C/b multiple motor tics

Multiple vocal tics

Duration of >1 year

Kanner syndrome

Failure to develop attachment with a parenteral figure & pre-occupation with inanimate objects.

Culture-Bound Syndromes are as follows

Dhat syndrome

A culture-bound syndrome prevalent in Indian subcontinent.

C/b complaint of passage of ‘dhat’ in urine.

Multiple somatic symptoms.


May be anxiety, depression or sexual dysfunction associated.


Prevalent in Asia including India.

Affected male pt believes that his penis is shrinking & may disappear into his abdominal wall & he

may die.

Females affected infrequently, believing that their breasts & vulva are shrinking.


Prevalent in South-East Asia.

C/b sudden, unprovoked episode of rage in which affected person runs about & indiscriminately

injures or kills any person who in encountered on the way.

Latah (Startle reaction)

Prevalent in South-East Asia & Japan.

More in women, c/b automatic obedience, echolalia & echopraxia.

Windigo (Wihtigo)

Prevalent in native American Indians.

Pt believes that he has been transformed into a wihtigo, a cannibal monster, occurring especially

during times of starvation.


A defense syndrome, mainly of anxiety but with obsessive features occurring in young Japanese

thrown into a modern industrial society for which they are not equipped. They feel inadequate, lost

& unloved.


Occurs in Latin America.

Pt believes that his body is entered by a magical substance & that he is altered. It takes on a

delusional quality.

Piblokto (Arctic Hysteria)

Occurs in Askimos.

Often female, who screams & tears off her clothes, throw herself on ice in extremely cold conditions.

She may imitate the cry of a bird or an animal.

The episode lasting for 1-2 hours, f/b amnesia of events.

COUVADE's Syndrome: Seen in husbands of pregnant women. the prospective father develops

symptoms similar to pregnancy & symptoms r relieved by delivery.

STOLKHOLM Syndrome: Identification with the aggressor usually seen in kidnap victims who try to

protect their kidnappers.

JACTATIO CAPITIS NOCTURNA: Nocturnal head banging

DEJA VU: Recognition of events that are in fact new

JAMAIS VU: Opposite of Deja vu where patient fails to recognise events that have occured before


SUNDOWNER SYNDROME: Drowziness, confusion, ataxia, accidental falls, in older patients who are

over sedated & in old patients with Dementia who react adversly to even small dose of psychoactive

drug. It also occurs in demented patients when external stimuli such as light & interpersonal

orienting cues are diminishd. Most commonly occurs as result of Rx with BZD's

RABBIT SYNDROME: Extra pyramidal side effect of chronic anti-psychotic treatment. Rapid & regular

perioral tremors like chewing movements, tongue & other body parts not involved.

NEUROLEPT MALIGNANT SYNDROME: EPS. Hyperthermia, severe muscular rigidity, autonomic

instability, changes in mental status, increased CPK, liver transaminase, leucocyte function,


ANTI-CHOLINERGIC SYNDROME: Phenothiazines, TCAD's, Anti-Parkinson drugs all have anticholinergic

properties, when these r administered in combination patient shows evidence of organic

brain syndrome including difficulty in concentration, impaired short term memory, disorientation,

dry SKIN due to inhibition of sweating, more noticable at night.

SSRI DISCONTINUATION SYNDROME: Abrupt discontinuation of SSRI causes dizziness, nausea,

vomiting, lethargy, flu-like symptoms, sensory & sleep disturbances, irritability, anxiety, crying spells.

SSRI's with short half life like Paroxetine & Sertraline more likely causes

SEROTONIN SYNDROME: Abdominal pain, Diarrhoea, excessive sweating, fever, tachycardia,

hypertension, alteration of mental status including delirium, myoclonus, increased motor activity,

mood changes Severe cases may show hyperpyrexia, shock & death. It is due to overactivity of

serotoninergic receptors by excess of serotonin due to combination of MAO, SSRI or TCAD.

DA COSTA's SYNDROME: Irritable heart syndrome. has as many as 20 different names. Was seen

first in soldiers of civil war. Chief complaints are all related to cardiac Pathology in which the subject

has fear of a heart ailment which may progress to hypochondriasis & sometimes to circulatory


Syndromes associated with dementia

Alzheimer’s disease

Pick’s disease

Parkinson’s disease

Shy-Drager syndrome (Multisystem degeneration)

Huntington’s chorea

Steel-Richardson syndrome (progressive Supranuclear palsy)

Binswanger’s disease (subcortical arteriosclerotic encephalopathy)

Wilson’s disease

Leigh’s disease

Creutzfeldt-Jacob disease

Gerstmann-Straussler-Scheinker disease

ALS-Parkinson’s-Dementia complex of Gaum

Syndromes associated with mental retardation

Down’s syndrome

Turner’s syndrome

Kleinfelter’s syndrome

Cri du chat syndrome

Fragile X syndrome

Hartnup’s disease

Tay-Sachs disease

Gaucher’s disease

Niemann-Pick disease

Lesch Nyhan syndrome

Hurler’s disease

Hunter’s disease

Sanfillipo’s disease

Renpenning’s syndrome

Sturge-Weber syndrome

Crouzon’s syndrome

Apert’s syndrome

De Lange syndrome (Amsterdam dwarfism)

Saturday, 26 September 2015

Cardioselective betablockers

cardioselective betablockers mnemonic...

"Betablockers Acting Exclusively At Myocardium"

Cardioselective betablockers are:

Thursday, 24 September 2015

Ulcer Edges

Five common types of ulcer edge are seen in surgical practice.

i. Undermined edge-is mostly seen in tuberculosis.

ii. Punched out edge-is mostly seen in a gummatous ulcer or in a deep trophic ulcer.

iii. Sloping edge is seen mostly in healing traumatic or venous ulcer.

iv. Raised and pearly-white beaded edge-is a feature of rodent ulcer.

v. Rolled out (Everted) edge-is a characteristic feature of squamous cell carcinoma.


Gibbon's hernia- hernia with hydrocoele
Bergerg's hernia - hernia in Pouch of Douglas
Grynfelt/s hernia- Upper lumbar triangle hernia
Petit's hernia - Lower lumbar triangle hernia
Cloquet's hernia- hernia through pecteineal fascia
Narath's hernia - behind femoral artery
Hesselbach's hernia - lateral to femoral artery
Serofini's hernia - behind femoral vessels
Laugier's hernia - through lacunar ligament
Tealse's hernia - in front of femoral vessels
Richter's hernia - part of circumference of bowel wall is gangrenous
Littre's hernia - hernia with Meckels's Diverticulum
Sliding hernia - Posterior wall of sac is formed by colon or bladder
Maydl's hernia - 'w' hernia
Phantom hernia - Localised muscle buldge following muscular paralysis
Spigelian hernia - through spegelian fascia
Obturator hernia - through obturator foramen
Femoral hernia - hernia medial to femoral vein
Beclard's hernia - femoral hernia through saphenour opening

Pharma High yield

Mechanism of Action
1-DNA Dependent RNA Polymerase– Rifampcin
2- RNA Dependent DNA Polymerase– Zidovudine
3-Proetin Synthesis Blocker– Erythromycin,     Chloramphenicol & Tetracycline
4-ACE Inhibitor– Captopril
5-Ca Channel Blocker– Nifedipine, Diltiazem
6-COX Inhibitor– Asprin
7-GABA Facilitator– Benzodiazepines
8-Antimetabolites– Methotrexate
9-Loop Diuretics– Frusemide
10-High Ceiling Diuretics– Spironolactone
11-Alteration of bacterial DNA– Choloroquine
12-Inhibition of Viral replication– Amantidine, Acyclovir
13-H1 blocking agent– Mepyramine, Loratadine
14-H2 Blocking agent– Rantidine, Cimetidine, Famotidine, Cyprohaptidine
15-Proton Pump inhibitor– Omeprazole
16-DNA Metabolism Inhibitors– Quinacrine (Mepacrine)
17-Spindle Poison– Vinca, Griesofulvin
18-Folic acid synthesis inhibitor– DDS
19-GABA Inhibitor– Sodium Valproate
20-DNA Synthesis Prevention – Nalidixic Acid
21-Prostaglandin Synthesis Inhibition– Oxyphenbutazone, Ibuprofen
22-Mycolic acid synthesis inhibition– INH
23-Folic acid antagonist- MTX, PAS, DDS & Primethamine
24-Desruption of DNA structure– MNZ
25-Inhibition of cell wall synthesis– Beta lactam antibiotics (penicillin)
26-Release of nor epinephrine– Ephedrine
27-Ergosterol Biosnythesis Inhibitors– Clotrimazole, Miconalzole, Ketoconazole
28-Ach esterase inhibitors– Physostigmine, Neostigmine, Edrophonium, Metrifonate
29-Reverse Transcriptase Inhibitors– Stavudine, zidovudine
30-Inhibition of HIV Protease– Amepranavir
31-DNA Gyrase Inhibitor– Cinoxacin
32-Inhibition of DNA Polymerase-Gossypol
33-NMDA Receptor Antagonist– Amantadine, Ketamine, Dextromethorphan, Memantine & Nitrous Oxide
34-DNA intercalating agent– Daunorubicin, Doxorubicin, Ellipticin & Ethidium Bromide
35-Antim mitotic agent– Amphethenile
36-Alkylating agent- Thiotepa
37-Alpha receptor antagonist- Phentolamine
38-Beta receptor antagonist- Propanolol, Aplrenolol
39-Alpha receptor agonist- Norepinehrine
40- Beta receptor agonist- Isoproterenol & Salbutamol
41-DNA Adduct Formation– Procarbazine
42-Carbonic anhydrase inhibitor- Acetazolamide
43-Phosphodiestrase Inhibitor- Theophylline
44-Thrombin action prevention- Heparin
45-Xanthine oxidase inhibitor- Allopurinol
46-Cholinergic Blockade- Ipratropium
47-Adenosine Deaminase inhibitor- Crisnatapase
48-Immunomodulation– Imiquimod
49-Amino acid transfer interference– Econazole
50-Mast Cell Stabilization– Ketosifen

Wednesday, 23 September 2015


Completely occluded artery – T1M1 0

Marked occluded artery – T1M1 1

Mild occluded artery – T1M1 2

Normal coronary flow – T1 M1 3

Anatomy lengths

4 cm long structures in the body
   Inguinal canal
   Female urethra
   Anal canal
   Auditory tube
   Cystic duct
   Optic nerve
   Prostatic urethra
   Left principle bronchus

5 cm long structures in the body
    Male larynx
    Left main bronchus
    Parotid duct
    Submandibular duct
    Lateral lobe of thyroid gland
    First part of duodenum
    Neck of femur
    Medial wall of bony orbit
    Lateral wall of bony orbit

7.5 cm long structures in the body
    Anterior wall of vagina
    Virgin uterus
    Second part of duodenum
    Bile duct 

9 cm long structures in the body
    Multiparous uterus
    Posterior wall of vagina 

11 cm long structures in the body
     Uterine tube
     Third part of duodenum 

12 cm long structures in the body
15 cm long structures in the body
    Adductor canal
    Ascending colon
    Root of mesentry

25 cm long structures in the body
    Descending colon
45 cm long structures in the body
    Spinal cord
    Thoracic duct
    Vas deferens
    Transverse colon 


Urease positive
Lack of fermentation
Inositol positive
Phenol oxidase positive
Pigment- niger seed agar (black)
Positive gram stain

Clonorchis sinesis
Chinese liver fluke
Cholangio ca
Ca pancreas
Cypriloid fish(intermediate host)

Capillaria philiphianses

-from class notes

Monday, 21 September 2015


Radiation dose (for 5 years) safe for occupational workers?

100 mSievert

Maximum dose for an year for occupational worker can be 30 mS

Radiation dose (for 5 years) safe for general public?
5 mSievert

🔹Maximum dose in a year for this can be 1 mS

Radiation dose (for whole pregnancy) safe for pregnant occupational workers?

2 mSievert

🔹Maximum exposure to lower abdomen of female is 2 mS which is same as 1 mS to the fetus.

Hyperintrnse T weighed MRI

3 F


Abscopal Effect

Splenectomy is an effective secondary or tertiary treatment for two chronic B cell leukemias, hairy cell leukemia and prolymphocytic leukemia, and for the very rare splenic mantle cell or marginal zone lymphoma.

Splenectomy in these diseases may be associated with significant tumor regression in bone marrow and other sites of disease.

Similar regressions of systemic disease have been noted after splenic irradiation in some types of lymphoid tumors, especially chronic lymphocytic leukemia and prolymphocytic leukemia.

This has been termed the abscopal effect. Such systemic tumor responses to local therapy directed at the spleen suggest that some hormone or growth factor produced by the spleen may affect tumor cell proliferation.

Optic Nerve Drussen

Optic Nerve Drusen:

These are refractile deposits within the substance of the optic nerve head.

They are unrelated to drusen of the retina, which occur in age-related macular degeneration. Optic disc drusen are most common in people of northern European descent.

Their diagnosis is obvious when they are visible as glittering particles upon the surface of the optic disc. However, in many patients they are hidden beneath the surface, producing pseudo-papilledema.

It is important to recognize optic disc drusen to avoid an unneccessary evaluation for papilledema.

Ultrasound or computed tomography (CT) scanning is sensitive for detection of buried optic disc drusen because they contain calcium.

In most patients, optic disc drusen are an incidental, innocuous finding, but they can produce visual obscurations.

On perimetry they give rise to enlarged blind spots and arcuate scotomas from damage to the optic disc. With increasing age, drusen tend to become more exposed on the disc surface as optic atrophy develops. Hemorrhage, choroidal neovascular membrane, and aion are more likely to occur in patients with optic disc drusen. No treatment is available.

Newborn Electrolytes

Hypoglycemia in new born:-
Operational threshold fr hypoglycemia-<40mg/dl

WHO definatn of hypoglycemia-<45mg/dl

Hyperglycemia in newborn->125mg/dl

Mx of asymptomatic hypoglycemia-Trial of oral feed-5g glucose/100ml

Symptomatic hypoglycemia(<20mg/dl)
IV 10% dextrose
2ml/kg bolus then 6mg/kg/min infusion
Never use glucose>12.5% to peripheral veins

Total sr ca <7mg/dl
Ionised ca <4mg/dl
Rx-IV calcium glucobate 10%
Precaution-causes bradycardia n arrythmias
Therefore slowly given
Diluted with 5%dextrose 1:1

Vitamin D levels

Based on serum levels of Vitamin D, classified into;
Deficient: less than 10ng/ml
Insufficient: 10-20
Optimal: 20-60
High: 60-90
Toxic: greater than 90
(Ref:O.P Ghai 8th edition page 114)

NRTI Revision

NRTI revision:

Max pancreatitis? Didanosine✅

Max peripheral Neuropathy? Stavudine✅

Max lipodistrophy? Stavudine✅

Best tolerated NRTI? Lamivudine emtricitabine✅

Causes fulminant hepatic failure? Didanosine✅

Causes Nail hyperpigmentation? Zidovudine✅

Among NRTI Diarrhea more common with? Didanosine✅

Apthous ulcers caused by? Zalcitabine✅

Least effective NRTI? Zalcitabine✅

NRTI with ↑ risk for M.I ?abacavir✅

Non renal metabolism among NRTI? Abacavir✅

Also useful against Hep B? Lamivudine , emtricitabine, tenofovir✅

Dermatology Questions


1) Most common organism causing tinea- Trichophyton rubrum

2) Most common organism causing tinea capitis- Trichophyton violaceum

3) Most common cranial nerve involved in Hansens- facial

4) Most common nerve taken for nerve biopsy in Hansens- radial cutaneous (upper limb), sural (lower limb)5

) Most common cause of mononeuritis multiplex - Hansen (India), DM (world)

6) Most common cause of ENL- LL> BL7) Most common cause of a negative  Slit skin smear in Hansen- neural leprosy

8)  Cause of Type 1 reaction- BB> BT> BL

9)  DOC for type 1 and type 2 reaction- steroids

10) DOC for chronic, recurrent ENL- thalidomide

11) Most common side effect of dapsone- hemolytic anemia

12) Most common side effect of clofazimine- pigmentation

13) Most common cause of inverted saucer lesion- borderline leprosy

14) Most common cause of leonine facies- LL

15) Earliest sensation lost- temperature

16) Most common Hansen- Borderline Tuberculoid

17) Commonest site for Fixed drug eruption (FDE)- lips

18) DOC for tinea - terbinafine

19) DOC for tinea capitis- griseofulvin

20) Most common type of onychomycosis – Distal and lateral onychomycosis (In HIV, the most common type is proximal subungual onychomycosis and superficial whiteonychomycosis)

21) DOC for sporotrichosis- itraconazole> potassium iodide

22) Most common cause of reactive arthritis- Chlamydia> Shigella

23) Most common Psoriatic arthritis- oligoarticular, asymmetric.

24) DOC for psoriatic arthritis- Methotrexate

25) DOC for arthritis mutilans- etanercept

26) DOC for guttate ps- antibiotics

27) DOC for erythrodermic psoriasis- Methotrexate

28) DOC for pustular psoarisis- Acitretin

29) DOC for early mycosis fungoides- Electron beam therapy > Phototherapy

30) Most common type of pemphigus- pemphigus vulgaris

31) Rarest type of pemphigus- pemphigus vegetans

32) DOC for Dermatiis herpetiformis- Dapsone

33) Most classical joint involved in Psoriatic Arthritis- DIP

34) Most common cause of non bullous impetigo- strepto> staph

35) Most common cause of bullous impetigo- staph

36) Most common underlying disease in kaposis varicelliform eruption - atopic dermatitis

37) Most common site of adult atopic dermatitis- ante cubital fossa

38) Most common site of pediatric atopic dermatitis- cheek

39) Most common cause of cumulative Irritant contact dermatitis- detergents, Wet work

40) Most commonest cause of Allergic contact dermatitis-nickel

41) Most common cause of air borne contact dermatitis- parthenium

42) DOC for air borne contact dermatitis - azathioprine

43) Most common layer of epidermis for lamellar body presence- granular layer

44) Most common layer for synthesis of vitamin D ( Also same answer for presence of langerhans cells)- spinous layer

45) Thickest layer of epidermis- corneum

46) Thinnest layer of epidermis- granular

47) Most common cause of acute paronychia- staph

48) Most common cause of chronic paronychia-candida

49) Most common syphilis transmitted by sexual route- primary

50) Most common syphilis transmitted from infected mother- secondary

51) Most infectious lesion in syphilis- mucous patches

52) Most sensitive test in syphilis- Enzyme Immunoassay> TPPA > FTA-abs

53) Most specific test in syphilis- TPPA> TPHA

54) DOC for chancroid- azithro

55) DOC for LGV and donovanosis- doxy

56) DOC for syphilis in pregnancy- penicillin

57) DOC for urethral discharge and cervical discharge (syndromic management)- azithro+ cefixime

58) DOC for vaginal disch (syndromic management)- fluconazole + secnidazole/metro/tinidazole

59) DOC for bubo (syndromic management)- azithro+ doxy

60) DOC for genital ulcer (syndromic management)- if vesicle - acyclovir,  if not azithro+ benzathine penicillin

61) DOC for neurosyphilis- crystalline aqueous penicillin

62) DOC for penicillin allergy in syphilis- doxy

63) DOC for penicillin allergy in syphilis in pregnancy- desensitization

64) DOC for penicillin allergy in neurosyphilis- desensitization

65) DOC for Impetigo herpetiformis- steroids

66) Investigation of choice in primary syphilis- dark ground illumination

67) Most common cutaneous TB- lupus vulgaris (In children, it is Scrofuloderma)

68) Test of choice for lupus vulgaris- biopsy

69) Most common organism for p versicolor now in India- Malassezia globosa

70) Most common  internal organ inv in leprosy- testis

71) Organ never inv in leprosy- uterus> CNS72) Sensation never lost in hansens- propioception, vibration

73) DOC for Post herpetic neuralgia- Gabapentin

74) Most characteristic of LP on histopathology- basal cell degeneration

75) Best time to read patch test- 4 days

76) Commonest drug for FDE- sulphonamides

77) Commonest cause of Erythema Multiforme- HSV

78) Commonest cause of SJS/TEN- drugs (NSAIDS, anti epileptic,  sulphonamides,  penicillin)

79) DOC for scabies- 5% permethrin

80) DOC for scabies in pregnancy- 5% permethrin

81) DOC for nodular scabies- permethrin+ steroids

82) DOC for nerve abscess- I and D

83) DOC for nodulocystic acne- oral isotretinoin

84) DOC for hormonal acne- OCP with  drosperinone+ estrogens

85) DOC for pediculosis corporis- disinfection of clothes

86) DOC for head louse- 1% permethrin

87) DOC for norwegian scabies- ivermectin

88) Most common shape of burrow in  scabies- S-shaped

89) Most common and earliest manifestation of tuberous sclerosis- ash leaf macule> adenoma sebaceum

90) Earliest manifestation of congenital syphilis- snuffles

91) Best blood test for congenital syphilis- FTA-ABS IgM

92) Most common site for morphoea- limbs

93) Most common cause for salt and pepper skin pigmentation- scleroderma

94) Most common cause of acanthosis nigricans- obesity

95) Most severe form of psoriasis- Von zumbusch

96) Most common melanoma-  superficial spreading melanoma

97) Poorest prognosis in melanoma- nodular

98) Most common type of BCC- noduloulcerative

99) Most common cause of hypopigmented, scaly patches on cheek of children- Pityriasis alba

100) Most common cause of hypopigmented, nonscaly, atrophic patches on cheek of endemic area children- indeterminate hansens

101) Investigation of choice for neurosyphilis- CSF-VDRL

102) Most common type of oral LP- reticulate / white lacy pattern

103) DOC for localised alopecia areata- intralesional steroids

104) Most effective drug in alopecia areata- contact sensitizers

105) commonest autoimmune association in vitiligo- thyroid

106) Commonest agent for leucoderma- paratertiary butyl phenol (PTBP)

107) Commonest agent for hair dye allergic contact dermatitis- paraphenylene diamine (PPD)

108) Commonest agent for footwear allergic contact dermatitis- Mercaptobenzothiazole (MBT)

109) Investigation of choice for Air borne contact dermatitis- photo patch test

110) Commonest extra genital site for primary chancre- lips

111) Commonest cause of recurrent blisters on genitals (healing with hyperpigmentation- FDE) ( if not then herpes genitalis)

112) Commonest vitiligo- Vitiligo vulgaris

113) Most common cause of erythema nodosum- Strepococcus.

114) Most common cause of patchy alopecia- Alopecia areata

115) DOC for rosacea- Metronidazole (topical), Doxy (Oral)

116) Commonest site for primary syphilis chancre- Coronal sulcus

117) First test to become positive in primary syphilis- FTA-Abs

118) Characteristic nail change in LP- Pterygium

119) Commonest cause of apple jelly nodules- Lupus vulgaris

120) Commonest cause of hypopigmented, minimally scaly macules and patches on chest and back of young adults- P. versicolor


True ribs 1 to 7
False ribs 8 to 12
Floating ribs 11, 12
Typical ribs 3 to 9
Atypical ribs 1,2,10,11,12

Atypical intercostal space- only 1st (arrangement of VAN is not followed). Rest all are typical

Typical intercostal nerve- 3 to 6 ICN

7 th rib is the longest
1st rib is the shortest, widest, and most curved
9th rib is the most oblique


Stable and light sensitive Vitamin K and !
Vitamin required for electron Transport
(Coenz. Q) K1, B2
Dopa and Gaba : Metabolism depend on Pyridoxine
For the Function of Co.A Pantothenate
Folic acid is Pteroyl Glutamic acid
Folinic Acid is Citrovorum factor
Erythrocyte Maturation Factor B 12
Vitamins Stored in Liver A, D, K, B 12, Folate
Vitamin Stored in fat D
Richest Source of 
Vitamin A Codliver Oil
Vitamin E Halibut Liver oil
Prophylactic Dose of Vitamin A 66,000 Micrograms
Main Source of Thiamine in Indian Diet Cereals
P.E. T and Achalasia are expected to be due to deficiency of Thiamine
Yellow Crystalline Substance Riboflavine
Red Crystalline Substance B 12
White Crystalline Substance Ascorbic Acid
Vitamins Which are present in animal Foods only B12, D

Heat Labile Vitamins Vitamin C and Folic acid
Vitamins That are synthesised in Gut
(Flora) B2, B12 ( Not useful) and Vitamin K
In body (Skin) Vitamin D
F.I.G.L.U excretion is secreted in deficiency of B 12
Methylmalonic acid Excretion is increased in deficiency of B 12
Worm infestation causing B 12 deficiency Diphyllobothrium Latum
Vitamin which is an antoxidant Vitamin E
Vitamin useful in the treatment of methemoglobinemia Vitamin C ( Methylene Blue also useful)
Vitamins with which Hypervitaminosis occurs A and D
Vitamin deficiency which leads to convulsions Pyridoxine
Vitamin useful in treatment of Homocystinuria Pyridoxine
Vitamin useful in treatment of Alcaptonuria Vitamin C
Vitamin that is used peripheral vascular disease Vitamin E. ( For intermittent Claudication)
Vitamins that causes Hemolysis Vitamin K
Vitamin that causes Neonatal Jaundice Vitamin K
Vitamin that causes sensory polyneuropathy in megavitamin doses Pyridoxine
Vitamin deficiency that causes pseudo paralysis Vitamin C, Vitamin D
Vitamin for wound healing Vitamin C
Magenta red tongue is due to deficiency of Riboflavine
Raw beef tongue is due to deficiency of Niacin
Cataract formation and Corneal
vascularisation are due to deficiency of Riboflavine
Vitamin that does not cross placenta Vitamin D
Vitamin Destroyed by Ultra – Violet Light


Under India Newborn action plan
  • Main worker - ASHA
  • Institutional delivery - 6 visits (day 3,7,14,21,28,42)
  • Home deliveries - 7 visits (day 1,3,7,14,28,42)
  • LBW babies, Special newborn care unit (SNCU) babies to be followed for one year
  • Incentive for ASHA on 45th day if

Record of birth weight in card
Immunization with BCG, OPV1, DPT1 entry in card
Registration of birth done
Both baby n mother safe till 42nd day of delivery
Source - Latest edition park

Sunday, 20 September 2015

Tyrosine Metabolic Disorders

Tyrosine Metab Disorders :-
Tyrosinemia type-1
Enzyme Defect - Fumaryl AcetoAcetate
Inheritence AR
Tyrosinemia type-2
Enzyme Defect - Tyrosine Transaminase
Inheritence - AR
Tyrosinemia type-3
Enzyme Defect - 4 Hydroxyphenylpyruvate
Inheritence - AR
Hawkinsinuria - 4 HydroxyPhenylPyruvate
Inheritence - AD
Enzyme Defect- Homogentisic Acid oxidase
Inheritence - AR
Enzyme Defect - Tyrosinase
Inheritence - AR
Disorders of PhenylAlanine Metab :-
PKU Type 1
Enzyme Def :- PhenylAlanine Hydroxylase
Inheritence AR
PKU Type 2
Enzyme Def :- Dihydropteridine reductase
Inheritence :- AR

Criteria and Classification

Criteria & classifications

Agatson score : CAD

Austin - kartush classification - middle ear risk index ( MERI)

Alanzolej classification : chloledochal cyst

Amsel's criteria: bacterial vaginosis

Ann Arbours staging: Hodgkin's lymphoma & Non Hodgkin's lymphoma

Ashbury criteria : GBS

Astler collar:colorectal cancer

Belthazar scoring : acute pancreatitis

Bent criteria : allergic fungal sinusitis

Butcher's criteria: Mesothelioma

Berlin's criteria : ARDS

Bismuth classification: tumors of hepatic ductal system

Bosniak classification : renal cyst

Broca's index : Ht in cms-100

Boreman classification : Gastric carcinoma

Child's Turcott pug score/MELD/PELD- Cirrhosis of liver

Chang staging: Medulloblastoma

cierney & millar classification : chronic osteomyelitis

Corpulence index : Actual wt/desired wt

Cottle's classification --> nasal septum

De meester criteria : GERD

Duke staging : colorectal cancer

Duke's criteria: Endocarditis/Heart failure

Durie salmon system of staging: Multiple myeloma

Epworth's criteria : Sleep apnea

Enneking's staging : Bone tumors

Evan's stagng: Neuroblastoma

Forrest classification: peptic ulcer bleed

Framminghams criteria/Boston's criteria: CHF

FAB: Leukemias

Fisch - glomus tumor

Glisson's staging: Prostrate

Gartland's classification: Supracondylar # Humerus

Glasgow Blatch ford score : Upper GI bleed for medical intervention

GOLD's criteria :COPD

Glassgow scale/Ransons criteria/APACHE score: Pancreatitis

Hess & Hunt Scale: subarachnoid hemorrhage

Hall's criteria : Down's syndrome

Harvard criteria : brainstem death

Jackson's staging:Penile Carcinoma

jones criteria.- Rheumatic fever

killip classification-MI with HF

LEEFORDT's classification : facial #

Light's criteria: pleural effusion

Lauren's classification: Gastric Ca

Levenson's criteria :- also in congenital cholesteatoma and malignant otitis externa

Mac afee protocol : Placenta previa

Mallampati scoring: for intubation

Milan's crjteria: for liver transplant in HCC

Mantrles criteria/Alvarado score: Appendicitis

Mayers n cottons grading system: Subglottic stenosis

Manson's classification: Radial head #

MASAOKA -Thymoma

MELD Criteria- model for end stage liver disease

Mc Donald's criteria: Multiple Sclerosis

MIDAS score : migraine

morry & peterson criteria -acute osteomyelitis

Neer's classification: supracondylar# femur

NADA's criteria: ASD assesment of child for heart disease

Nazer's Index: Wilsons disz

OKUDA staging : HCC

Oschner sherren regime : Appendicular Mass

Paget's Index : Abruptio placentae

paalman criteria : Ectopic pregnancy

Pretext -Hepatoblastoma

Ponderal Index: ht in cm/cube root of body wt in kgs

Quetlet index: BMI -wt in kg/ht in meter square

Quintero staging -TTTS

Quebeck's grading: severity of reflex

Richertson bloom scoring : Breast ca.
1.tubule formation
2.Mitotic index
3.Cell size(nuclear pleomorphism)

Robson's staging : RCC

Rye classification: Hodgkin's lymphoma

Rotterdam's criteria : Polycystic ovarian syndrome

Rockall scoring: adverse out come after GI bleed

Rule of wallace/Rule of 9: Burns

Seddon's classification: Nerve injury n regeneration

sernath staging -Hypoxic ischaemic encephalopathy

Stanford classification: Aortic dissection

SPIGELBREG criteria= OVARIAN ectopic

STUDDIFORD criteria= ABDOMINAL ectopic (pain)

Spalding's criteria: abdominal pregnancy

Todeni classification : chloledochal cyst

Van Nuys prognostic index : DCIS

Waterson criteria : TEF

Well's criteria: pulmonary embolism

wright & moll classification - psoriatic arthritis

Saturday, 19 September 2015


Atrial Septal Defect (ASD)

MC- Secundum (Center)✅
Primum (big on medial side)✅
Sinus Venosus (at insertion of SVC, IVC)✅

Seen in
Down's Syndrome✅
Lutembacher's syndrome ( ASD + MS/MR)✅
Ellis van creveld syndrome ( ASD + Polydactyly)✅
Holt oram syndrome ( Autosomal Dominant )✅

🍀Holt Oram Syndrome = Hand heart syndrome :

🌱Familial ASD syndrome

🌱With - VSD , Primary heart block , Atrial fibrillation, Bony Abnormality ( Thumb - absent / rudimentary)

🌱Pleiotropy - Multiple effects due to defect in single gene ( here TBX5)
🌱Can have absent radius.

🍀ASD Secundum :
1. Asymptomatic
2. S2 - Wide and fixed split
3. Grows up -
Adult -
Eisenmenger syndrome

🌱ECG : Right axis deviation.

Treatment : Closure at 3-5yrs age by Dacron Patch

🍀ASD Primum :

1. Big cleft on the medial side
2. Also has MR (always)
Pansystolic at Apex
Radiate to axila and back
3. S2 - Wide and fixed split
4. It is severe ASD


Clinical features at 6 - 10 wks
Failure to thrive
Recurrent infections
Feeding difficulties
ECG : Left axis deviation.

Treatment : Early surgery.

Friday, 18 September 2015

Half lives

Half life
Rbc. Adults?120 days✔
Newborn? 100 days✔
Fetus? 80 days✔
Half life eryrhopoitin? 1 hour✔
Digitalis?36 hrs✔
I131? 8 days✔
I123? 13 hours✔
I132?2.3 hours✔

Tuesday, 15 September 2015



1⃣Jones Criteria▶Diagnosis of Rheumatic Fever

2⃣Bence Jones Proteinuria▶Occurs in myeloma, leukemia, and Hodgkin’s disease. They can be detected by positive Bradshaw’s test, heat test and electrophoresis

3⃣Jones Mote Reaction▶Cutaneous Basophilic Hypersensitivity-Type IV HSR

4⃣Jones Surgery in OBG▶Unification of Septate Uterus

5⃣Jones Surgery in Opht▶Bloodless repair of Senile Entropion by plication of inferior retractors

6⃣Jones Surgery in Ortho▶Claw hallux deformity

7⃣Watson Jones Approach▶Hip replacement

8⃣Watson Jones Procedure▶Chronic lateral ankle instability

9⃣Jones Compression▶Posterior Lower leg Splint for Knee and Calf injuries

1⃣0⃣Jones Tendon Transfer▶Radial nerve palsy

1⃣1⃣Jones #▶Base of 5th Metatarsal # due to pull of Peroneus brevis during inversion

1⃣2⃣Maxwell Jones▶Concept of Therapeutic Community

1⃣3⃣Jones Dye Test▶Lacrimal pump failure

Sunday, 13 September 2015

Dead End Infections

When a pathogen infects a species that it does not normally infect, it is often unable to spread effectively from that host, this situation is known as dead end infection or dead end transmission.

Dead end infections are,

Endemic typhus
Human rabies
Japanese Encephalitis
Echinococcus granulosus and Trichinella spiralis

Saturday, 12 September 2015


Calculation For Energy (Atp ) Generated By Fatty Acid Oxidation , Tca Cycle , Glycolysis & Pdh System

I) Basic Rules-

A) Energetics Of Glycolysis-

1. Energy Production Steps-

     2nadh2= 2× 2.5 Atp (New) &  2× 3 Atp (Old)= 5 Atp (New) &  6 Atp (Old) - For Aerobic Glycolysis

     Substrate Level Phosphorylation = 2× 2atp = 4 Atp

     Total= 9 Atp (New) &  10 Atp (Old)-aerobic Glycolysis

                   = 4 Atp - Anerobic Glycolysis

2. Energy Utilizing Steps-
     2× 1atp = 2atp

3. Net Atp Produced-

     For Aerobic Glycolysis-   9 Atp (New) &  10 Atp (Old) - 2atp= 7 Atp (New) &  8 Atp (Old)

     For Anerobic Glycolysis - 4 Atp - 2atp = 2atp

B) Energetics Of Pyruvate Dehydrogenase Complex-
      Energy From Conversion Of 2 Moles Of Pyruvate To Acetyl Coa (Aerobic Respiration) = 2× 1nadh2= 2nadh2

      Net Energy Yield= 2nadh2 = 2× 2.5 Atp (New) & 2 × 3 Atp (Old) = 5 Atp (New) & 6 Atp (Old)

C. Energetics Of Tca Cycle-each Cycle With 1acetyl Coa Metabolism Produces-

        3nadh2 =  3 × 2.5  Atp (New) & 3×3 Atp (Old) = 7.5  Atp (New) & 9 Atp (Old)

        1fadh2 =   1× 1.5  Atp (New) & 1×2 Atp (Old)  = 1.5 Atp (New) &  2 Atp (Old)

         Substrate Level Phosphorylation- 1 Gtp Formed Which Is Converted To Atp Via Adp
          Gtp + Adp = Atp + Gdp
        Thus 1atp
Net Yield Of Atp Per Turn ( 1mol Of Acetyl Coa) =  10 Atp (New) &  12 Atp (Old)

Thus Total Atp In Tca Cycle  Per  Molecule Of Glucose = 2 Acetyl Coa =2× 10/12= 20 Atp (New) &  24 Atp (Old)

D) Thus Net Yield Of Atp When 1molecule Of Glucose Is Completely Oxidised  Aerobically-

   1. From Aerobic Glycolysis= 7 Atp (New) &  8 Atp (Old)

   2. From Pdh Complex= 5 Atp (New) & 6 Atp (Old)

   3. From Tca Cycle= 20 Atp (New) &  24 Atp (Old)

  Net Atp Produced= 32 Atp (New) &  38 Atp (Old)

E) Energetics Of Fatty Acid Oxidation-

1. Initial Activation Req 2 Atp= (-2atp)

2. Each Cycle Removes 1acetyl Coa & Produces-

                 1fadh2=1.5 Atp (New)  & 2 Atp (Old)

                 1 Nadh2= 2.5 Atp (New) & 3 Atp (Old)

                   Total = 4  Atp (New) & 5 Atp (Old)

3. Thus Each Cycle Produces 4 Atp (New) & 5 Atp (Old) & 1 Acetyl Coa

4. Each Mole Of Acetyl Coa Produces 10 Atp (New) &  12 Atp (Old) In Tca Cycle

5. Now Taking  Example Of Say Palmitic Acid- (C16) Saturated Fatty Acid

     It Undergoes  7 Cycles Of Beta Oxidation To Produce 8 Moles Of Acetyl Coa

     Thus Atp From 7 Cycles = 7× 4 Atp (New) & 5 Atp (Old)= 28 Atp (New) & 35 Atp (Old)

     And Atp From 8 Acetyl Coa Via Tca Cycle= 8× 10 Atp (New) &  12 Atp (Old)= 80 Atp (New) &  96 Atp (Old)

    ★★★finally Net Atp From 1 Palmitic Acid=
    28 Atp (New) &  35 Atp (Old) + 80 Atp (New) &  96 Atp (Old) - 2atp (For Initial Activation)= 106 Atp (New) &  129 Atp (Old) ★★★

Friday, 11 September 2015

Myelodisplastic Syndrome

MC cytogenetic change in Myelodysplastic Syndrome in adult - 5q deletion
Cytogenetic change in Myelodysplastic Syndrome in children - Monosomy 7
Common age group affected by Myelodysplastic syndrome - >50
Ringed sideroblast characteristically seen in - Myelodysplastic syndrome
Pawn ball megakaryocytes is characteristic of - Myelodysplastic syndrome
NOT true about Myelodysplastic syndrome - Hypocellular bone marrow
Act by hypomethylation - Decitabine
Harrison Points :
Megaloblastoids are seen in - Myelodysplasia

Ringed sideroblast - Mitochondria encrusted iron
International prognostic scoring system for - Myelodysplasia
Drug used for myelodysplastic syndrome - Lenalidomide
Additional Points :
Treatment of MDS with 5q deletion - Lenalidomide


🌴 Thomas splint is for?-# FEMUR

🌴Dennis brown splint?-CTEV

🌴 cock up splint?- RADIAL NERVE PALSY

🌴 knuckle bender splint?-ULNAR N PALSY

🌴 aeroplane splint?-BRACHIAL PLEXUS INJ

🌴63 von Rosen splint?-  cdh                                                                  🌴Minerva cast for?-CERVICAL SPINE DISEASE 

  🌴turn buckle cast. ?-SCOLIOS

🌴 Rissers cast?-SCOLIOSIS

  🌴milwaukees brace?-SCOLIOSIS


  🌴frog leg cast?-CDH

  🌴cylinder cast?#PATELLA

🌴 hip Spica?-FEMUR #

🌴 hanging cast?- HUMERUS #

🌴tube cast?- KNEE



Reiter syndrome triad :

Triad of Alports Syndrome
Sensorineural deafness
Progressive renal failure
Ocular anomalies

Triad of Behcet’s Syndrome
Recurrent oral ulcers
Genital ulcers

Beck’s Triad of Cardiac Tamponade
Muffled heart sound
Distended neck veins

Charcot’s Triad For Cholangitis
Fever with rigors
Right hypochondriac pain

Charcots triad of Multiple sclerosis
Intention tremor
Stacato or scanning speech

Wilms tumor Triad –hematuria+ fever+ abd mass

Wilsons disease ( Neuro manifestation )Triad-Dystonia, inco-ordination, tremor

Triad of Hypernephroma (Renal Cell Ca)
Pain + hematuria + renal mass

Hutchinson’s Triad Of Congenital syphillis
Hutchison’s teeth
Interstitial keratitis
Nerve deafness

Triad of Kwashiorkar
Growth retardation
Mental changes

Saint’s Triad
Gall stones
Hiatus hernia

Trotter’s Triad Of Nasopharyngeal Carcinoma
Conductive deafness (blockade of Eustachian tube)
Immobility of homolateral soft palate (X th CN nerve involved)
Trigeminal neuralgia (V th CN nerve involved)

Virchow’s Triad
Vessel injury

Hemolytic Uremic Syndrome Triad
Renal failure

Pentad of TTP
Microangiopathic haemolytic anaemia
Disturbed neurological function
Renal failure

Fanconi Syndrome Triad

Tetany in Children – Triad
Carpopedal spasm

Pentalogy of Fallot
Fallot’s tetralogy with, in addition, a patent foramen ovale or
Atrial septal defect

Vogt’s triad of Congenital Toxoplasmosis (3C)
Cerebral calcification.

Vogt’s triad of Post congestive glaucoma –
Glaucoma flecken,
Pigments on endothelium
Iris atrophy

VOGT triad of tuberous sclerosis
Facial nevus (Adenoma sebaceum)
Mental retardation

Vogt’s triad of Buphthalmos: (BPL) = Lacrimation, photophobia, Blepharospam

Triad of sandblom (for Hemobilia)-(MOB)
M: Melena
O: Obstructive Jaundice
B: Biliary colic.

Samters triad:
Aspirin intolerance
Nasal polyp

Carney triad
Pulmonary chondroma
Paraganglioma (Extra adrenal)

Anderson Triad
Cystic fibrosis
Vitamin A deficiency

Beck’s triad of Para pharyngeal Abscess
External cervical swelling (at the submandibular region which is tender)
Trismus due to spasm of the medial pterygoid
Internal swelling: of the lateral pharyngeal wall,pushing the tonsil medially

Beck’s cognitive triad (negative thought in depression)
Negative thought of self
Negative thought of environment
Negative thought of future

Cushing’s triad is a late sign of increase intra-cranial tension
Respiratory depression

Ecological triad of disease
Causative Agent

Gradenigo’s triad of Petrositis

Persistent otorrhea
Ipsilateral retro-orbital pain due to irritation of the nearby trigeminal ganglion(CN-V)
Ipsilateral squint and diplopia due to paralysis of the 6th nerve•

Trotter’s triad is diagnostic for nasopharyngeal carcinoma
Unilateral conductive hearing loss(secretory otitis media)
Ipsilateral earache and facial pain(trigeminal nerve)
Ipsilateral paralysis of the soft palate

Atta’s triad of bilharzia dysentery
Bleeding per rectum
Clubbing of fingers

VOGT triad of tuberous sclerosis
Facial nevus (Adenoma sebaceum)
Mental retardation

WHIPPLE’S triad of insulinoma
Signs &symptoms of Hypoglycemia
Serum glucose < 2.5 m moles/lit
Relief of symptoms on administration of glucose

O’ Donoghue Triad:Twisting force in a weight bearing knee joint causes injury to
Medial collateral ligament
Anterior cruciate ligament
Medial meniscus

Triad of Mercury poisoning
Excessive salivation and Gingivitis
Danbury tremors (very severe= Concussio mercurialis)
Neuropsychiatric illness (Erethism)

Triad of Meig’s syndrome
Benign tumor of ovary (fibroma)
Pleural effusion

Thursday, 10 September 2015


Asked Points :
Influenza A - Hemagglutinin and neuraminidase is strain specific
Influenza - Primary infectious pneumonia is less common than secondary bacterial pneumonia
Influenza - Major epidemics are due to antigenic SHIFT, Antigenic drift is gradual antigenic
change over a period of time, Antigenic shift is due to genetic recombination of virus, Influenza
A is subjected to frequent antigenic variations Segmented RNA - Influenza

H5N1 - Bird flu virus
Gradual and sequential change in antigenic structure at regular intervals - Antigenic drift
Influenza causes new epidemic by - Antigenicndrift
Antigenic shift - Gradual
Antigenic variation NOT seen in - Influenza C
Influenza - Affects all sexes and ages, Incubation period 18 – 72 hours
Immunofluorescence - Detection of influenza
Amantidine is most effective for - Influenza A
Which is a Neuraminidase Inhibitor - Oseltamivir
Avian influenza treated by - Oseltamivir
Oseltamivir is used to treat - Influenza A & B
Newer influenza vaccine - Split virus vaccine,
Neuraminidase, Recombinant vaccine

Harrison Points :
H1N1 swine flu was found on - 2009
Influenza is associated with - Myositis and rhabdomyolysis
Most serious complication of Influenza B - Reye syndrome
Amantidine and rimantidine are active against - Influenza A only
Oseltamivir inhibit - Neuraminidase

Additional Points :
Segmented RNA virus - Influenza virus
M protein in orthomyxovirus maturation - Serves as a recognition site for nucleocapsid at the
inner face of plasma membrane
All pandemic of influenza by - Influenza A only
Pandemic of influenza is caused by - Antigenic shift
Shift occurs only with - Influenza A
Reye syndrome is associated with - Influenza B
Mechanism of action of oseltamivir - Inhibition of a viral enzyme that aids the spread of virus
through respiratory mucus and is required for release of progeny virus
Dose of oseltamivir in adults - 75 mg BD

Malaria Epidemiology

Malaria Epidemiology
• MC species of Plasmodium in India- P.falciparum>P.vivax
• MC species of Plasmodium in world- P.vivax
• P.malariae found in which place in India- Tumkur (Karnataka) 
• P.ovale found in which place in India- Delhi, Orissa,Gujrat, Assam, Kolkatta
• Most endemic state in India- Orissa
Life cycle of Plasmodium-
1. Definitive host- Female anapheles
2. Intermediate host-man 
3. Modes of transmission other than mosquito bite- blood transfusion, vertical
4. Infective form -sporozoite
5. Infective form if transmitted by other than mosquito bite- merozoites
6. Infective form to mosquito-Gametocyte
7. Minimum gametocyte need to transit the infection to mosquito- 12/cmm


Placenta 10 points [MRP=must remember points]
1. Weighs 500gm, 20 cms, 3cm thick. Placenta is from both maternal and fetal tissue; at term 80% is fetal origin
2. Maternal placenta:
1. 20% of placenta weight
2. Made of decidua basalis, margins of spongy decidua, cotyledons
3. Fetal portion placenta
1. Made of villi
2. Fetal surface is covered by amnion
4. Circumvillete:
1. circum marginate
2. Predispose to premature marginal seperation, IInd TM APH
5. Succenturate lobe:
1. Accessory cotyledon
2. Cause for PPH
6. placenta previa
1. Implanted lower than normal, in lower uterine segment, near zone of effacement
2. Mostly in parous females
3. Present as sudden painless profuse bleeding in IIIrd TM
7. Battledore placenta
1. Umbilical cord inserted in margins
2. Cord entanglement is risky
8. Membraneacea placenta
1. Decidua capsularis is vascularised, chorion does not show atrophy
9. Bi partite placenta
1. Divided placenta
2. Retention may lead to PPH, sepsis
10. Placenta accreta
1. Abnormal adherence to uterine muscle, decidua deficiency
2. Seen in Placenta previa, prev CS, prev DC, grand multi para
3. Placenta increta: invade myometrium
4. Placenta percreta: perforate myometrium


1.vocal cord  post 1/3rd cartilaginous. n ant 2/3rd membranous part.
2.angle. between 2 lamina of thyroid cartilage : male. 90degree. female : 120 degree.
3.lenghth of. vocal cord in male : 24-25 mm. n in female 16-17 mm.
4.length of larynx :  vocal cord + 12 mm
5.distance. between 2 vocal cord : 19 mm.
6. focal. lenght of objective lens. ear : 200-250 nm.   nose. 300 nm.    throat. 400 nm
7. position of larynx in child. c2-c3.  n. in adult. c3-c6.
8. size. of  subglottic in preterm is less than 3 mm n. full term 4. mm. you can remember from latter itself pre. 3. n. full 4.
9. ca larynx. male. female ratio :  10:1.
10.tracheotomy. reduced the dead space. upto. : 50 percent.

Monday, 7 September 2015


TRALI ( Transfusion related acute lung injury )
1. Definition - it is acute lung injury which occurs within 6 hours of completion of transfusion of blood components.
Pathogenesis - two hit hypothesis.
First hit is the priming event like endothelial activation which leads to increased sequestration and
sensitisation of neutrophils in the micro vasculature of lung. Second hit can be the antibodies in
the transfused blood product that recognise antigens expressed on neutrophils. Most common
antibodies can be those that bind MHC antigens.
2. TRALI can occur with all plasma containing products but more common with transfusion of FFP and platelets.
3. Clinically - dyspnea, tachypnea, fever, hypotension.
4. Chest X Ray - bilateral pulmonary infiltrates or white out lung. That is why most important differential diagnosis is ARDS.

Friday, 4 September 2015

Myelodysplastic Syndrome

Asked Points :
MC cytogenetic change in Myelodysplastic Syndrome in adult - 5q deletion
Cytogenetic change in Myelodysplastic Syndrome in children - Monosomy 7
Common age group affected by Myelodysplastic syndrome - >50
Ringed sideroblast characteristically seen in - Myelodysplastic syndrome
Pawn ball megakaryocytes is characteristic of - Myelodysplastic syndrome
NOT true about Myelodysplastic syndrome - Hypocellular bone marrow
Act by hypomethylation - Decitabine
Harrison Points :
Megaloblastoids are seen in - Myelodysplasia
Ringed sideroblast - Mitochondria encrusted iron
International prognostic scoring system for -
Drug used for myelodysplastic syndrome -
Additional Points :
Treatment of MDS with 5q deletion - Lenalidomide



Urban- Stephensi

Rural- Culicifacies

Brackish water- Sundaicus

Moving water- Fluviatilis

Most efficient- Fluviatilis

Overhead tanks- Stephensi

Anthrophilic- Fluviatilis

Isolation period

Isolation period of some infectious diseases-

👌🏾Chicken pox Until all lesions crusted,
usually 6 days after onset of rash

👌🏾Measles-From onset of catarrhal stage to the
3rd day of rash

👌🏾German measles/rubella None

👌🏾Hepatitis A 3 wks

👌🏾Influenza 3 days onset

👌🏾Polio 2 weeks adult, 6 wks pediatric

👌🏾Tuberculosis Until 3 wks of effective

👌🏾Herpes zoster 6 days after onset of rash

👌🏾Mumps Until swelling subsides

👌🏾Meningococcal meningitis Until 1st 6 hrs of
effective antibiotic therapy

Functional and Non Functional enzymes

Functional enzymes -enzy which have specific function in plasma.
Examples of functional enzyme-
🔺coagulation enzyme
🔺lipoprotein lipase

Non -functional enzymes-
🔺have nonsoecific function in serum.
🔺Comes out from tissue as a result of normal wear n tear.
🔺There level is very low in serum
🔺level rises during tissue injury
🔺hence help to diagonse the site of tissue injury
🔺Creatine kinase
🔺Alakline phosphatase

Coombs Test


(also known as the direct antiglobulin test or DAT)

● detect antibodies or complement bound to RBC surface antigens in vivo.

●used for:-
1) immune-mediated hemolytic anemia
2) Hemolytic disease of the newborn
3) Rh D hemolytic disease of the newborn
4) ABO hemolytic disease of the newborn
5) Drug-induced immune-mediated hemolysis
6) Transfusion reaction, such as one due to improperly matched units of blood


(also known as the indirect antiglobulin test or IAT)
●detect in-vitro antibody-antigen reactions

●used for:-

1) detection of very low concentrations of antibodies present in a patient's plasma/serum prior to a blood transfusion
2) in antenatal care, the IAT is used to screen pregnant women for antibodies that may cause hemolytic disease of the newborn
3) compatibility testing
4) antibody identification
5) RBC phenotyping
6) titration studies.

?☺: Tumor Lysis Syndrome

* Most commonly seen with acute leukemias, Burkitt lymphoma and other lympho-reticular malignancies (uncommon in solid tumors).
* Chemotherapy results in death of large quantities of cells, which leads to release of massive amounts of potassium, uric acid and other breakdown products into the blood.
* It develops within hours to few days of initiation of chemotherapy.

* Features:
- hypocalcemia
- renal failure due to precipitation of uric acid crystals or calcium phosphate crystals in the kidney
- hyperkalemia leading to arrhythmias
- hyperphosphatemia

* Management
- vigorous IV hydration with half normal saline
- correction of metabolic abnormalities
- hemodialysis in severe cases

Thursday, 3 September 2015

Eggs in Medicine

• Oligodendroglial components are characterized
histologically by a moderately cellular collection of cells
with round nuclei and perinuclear halos ("fried egg"
• The mycoplasmas are typically slow growers with a
generation time of 1-6 hours. They produce small
colonies typically described as a fried-egg appearance.
• Diphtheria 'Intermedius colonies' are small, 2 mm in size,
lustreless with domed centre and irregular margin with
'frog egg' appearance.
• Crumbled egg---> Hydatid Liver Cyst
• Scrambled egg---> Pancreatic cancer; Best Disease
• Egg in cup appearance Constrictive pericarditis
• Egg on side appearance TGV ( transportation of great
vessels )
• Egg on a string : Appearance of the heart that may be
seen with transposition of great arteries.
• Odour in poisoning: H2S--> Rotten egg
• Egg cell calcification of the hilar node: Silicosis >
• Schistosome Eggs::
Egg with
Terminal spine--> S.Hemotabium (TSH)
Lateral Spine---> S.Mansoni (LSM)
Lateral Knob--> S.Japonicum (LKJ)

• Non-bile stained egg:
Necator americanus
Enterobius vermicularis
Ancylostoma duodenale



Definition: Diseases and infections which are naturally transmitted between vertebrate animals and man.


Anthropozoonoses: Diseases in animals that can be transmitted to man (eg. rabies).

Zooanthroponoses: Diseases in humans that can be transmitted to animals (eg. tuberculosis in cats, monkeys).

Amphixenoses: Diseases affecting humans and animals that can be occasionally transmitted from one to another (eg. staphyloccocal infection).

Euzoonoses: Diseases in which humans are an obligatory host of the agent (eg. Taenia solium or T. saginata)


Some Major Bacterial Etiologic Agents of New Zoonoses

E. coli O157:H7
Borrelia burgdorferi (Lyme disease)
Helicobacter pylori and other spp.
Ehrlichia chaffeensis (HME)
Bartonella henselae (Cat scratch Disease)
Rickettsia felis (Murine typhus like)
E. Equi/A. phagocytophila (HGE)

Some Major Viral Etiologic Agents of New Zoonoses

Guanarito virus (Venezuelan hemor. fever)Sin nombre virus (Hantavirus Pulm.Syndr.)Sabia virus (Brazilian hemorrhagic fever)Hendra virus (Equine morbillivirus)Australian bat Lyssavirus (Rhabdovirus)Menangle virus (paramyxovirus)Influenza virus H5N1 (Hong Kong)Nipah virus (Paramyxovirus)Influenza virus H9N2 (Hong Kong)SARS (Coronavirus)


Types on the basis of Epidemiological cycle/Modes of transmission:

Orthozoonoses: Disease transmission cycle can be completed with only one vertebrate reservoir (eg. rabies).
Cyclozoonoses: Diseases whose maintenance cycle requires more than one vertebrate species, but no invertebrate host (eg., hydatid disease, taeniasis).
Pherozoonoses (or Metazoonoses): Diseases whose maintenance cycle requires both vertebrates and invertebrates to complete their transmission cycle (eg. arboviruses).
Saprozoonoses: Diseases that depend upon inanimate reservoirs or development sites, as well as upon vertebrate hosts (eg. listeriosis)

Depending on Clinical manifestations:

Phanerozoonoses: Zoonoses for which symptoms are observed in animals and humans. They may be Iso-symptomatic (Symptoms are the same in humans and animals eg. Rabies, tuberculosis) or Aniso-symptomatic (Symptoms are different in humans and animals eg. Q fever, anthrax)
Cryptozoonoses: Zoonoses for which there is only infection without symptoms in animals and/or humans. eg.Infection in animals/disease in humans: ornithosisInfection in humans/disease in animals: Ebola

Tuesday, 1 September 2015


Vit. A prophylaxis program --ministry of health and family
Prophylaxis against nut.anrmia--mohfw
Iodine deficiency disorder Ctrl program.-mohfw
Special nutrition prog--ministry of social welfare,mosw
Balwadis nutrition prog--mosw
Mid meal programme--ministry f education
Mid meal scheme--ministry f HRD
A.water born dises--
diarrhoea,cholera,typhoid,dysentery,polio,hepatitis A and e
B.water based disease--snails--schistosomiasi,cyclops--
C.water related vector di--malaria,filaria,he,sleep in sickness
D. water source/washed di-
trachoma,scabies,conjuntuvitis,bacillary and amoebic dysentry,skin
sepsis,lice,salmonellosis,worm infestation

��Hardness of Water
--soap destroying power of water
A.temporary h.--d/t bicarbonates of Ca and Mg
B. permanent h.--d/t sulphate,chloride,nitrate of Ca and Mg

��Hardness of Water
Classification of hard water ( as mg/l of caco3)__
Soft--0-50 mg/ l (<1 meq/l)
Mod hard--51-150(1-3)
��Very hard-->300(>6)

A.sewage--wasts water + excreta
B.sullage--waste water not contaminated with excreta e.g
kitchen,bathroom waste
C.scum--after prim sedimntn f sewage ,organic matter settle
down as sludge and fatty layer float know as scum
D.dry weather flow--avg amount f sewage which flows through sewerage system in 24 hr

A.anemometer-fr low air velocity
B.kata thermometer-cooling power f air
C.assman sling psychrometer--humidity f air
D.Symons rain gauze--measurs ppt. f rain,snow,hail,dew,frost
E.dial thermometer-cold chain temp monitoring
F.salter scale--measure b. at
G.Winchester quart bottle--asses physical and chemical quality f
drinking water
H.chloroscope--measur residual cl in water
I.colorimeter--determine colour f water
J.chloronome--mixing cl in water

����Family cycle
��A.formation--marriage to birth f 1 st child
��B.extension--birth f 1 st child to birth f last child
��C.complete extension--birt f last child to 1 st child leave home
��D.contraction--1 st child leave home to last child left home
��E.completed contraction-last child left home to 1 st spouse dies
��F.dissolution--1 st spouse dies to death f survivor
Comfort Zones
��A.pleasant and cool--20
B.comfortable and cool --20-25
D.hot and uncomfortable--27-28
E.extremely hot--28+
��F.intolerable hot--30+

����Overcrowding and Accepted standards
��FLOOR SPACE--accepted standards r--
>=110 sq ft.--2 persons
90-100 sq ft--1 and 1/2 person
70-90 sq ft--1 person
50-70 sq ft--1/2 person
<50 sq ft--nil
---baby < 12 month is not counted.children b/w 1-10 yr as half

����Persons per room--accepted standards r--
1 room--2 persons
2 room--3 persons
3 rooms--5 persons
>5 rooms--10 persons( addnl 2 fr each further room)