Thursday, 23 June 2016

REM Sleep

REM Sleep

REM sleep is characterized by three things: (a) Muscle atonia (b) Rapid eye movement and (c) Desynchronized mixed frequency waves are seen
Saw tooth appearance of waves are seen in REM sleep- REM sleep is commonly not seen in regular EEG readings (takes about 20 minutes, normal REM latency is 90 minutes or so)
Appearance of REM sleep in regular recordings or much earlier than expected is called as SOREM period (Sleep Onset REM period). Very suggestive of Narcolepsy, but can also be seen in significantly sleep deprived individuals

Live vaccines

Live attenuated vaccines

Mnemonics - BOYs Love The CRIME


High yield

Most common cause of morbidity and mortality in patient undergoing major vasculr surgery is- CARDIAC COMPLICATIONS

Most common cause of sporadic viral encephalitis is-HSV-1

Most common cause of viral meningitis or aseptic meningitis is- ENTERO VIRUS


Most common cause of neonatal sepsis in hospitals in India is- KLEBSIELLA

The Mc abnormal opthalmoscopic findings on fundoscopY in AIDS pt is- COTTON WOOL SPOTS

Mc severe ocular complication of AIDS is- CMV RETINITIS

Mc cause of NOSOCOMIAL inf is- STAPH. AUREUS.


Mc sinusitis in children is- ETHMOIDAL.

Mc sinusitis in adults is -MAXILLARY.

Mc Site of ca tongue is MIDDLE OF LATERAL BORDER or VENTRAL ASPECT of tongue.

Mc MALIGNANT TU of adult males in india-ORAL CANCER

Mc MALIGNANT cancer of adult males in WORLD IS-LUNG CA

Mc MALIGNANT cancer of female in india is – CA CERVIX

Mc MALIGNANT cancer of female in WORLD IS -CA BREAST


Most common indication for splenectomy is -Splenic trauma.

Most common cause of cholangitis is -CBD stone

Most common cause of pancreatitis is- Gall stone

Most common cause of pancreatic pseudocyst is -Pancreatitis

Mc cause of myeloproliferative disorder –Polycythemia vera

Mc cause of stroke — Thrombosis >Embolism

Mc of RBC enzyme def. — G6PD def.

Mc variant of HL in INDIA — Mixed cellulatity

Mc urinary fistula-VESICOVAGINAL

Mc cause of VESICOVAGINAL FISTULA in india- Obstructed labour

Mc side effect of IUCD- BLEEDING   2ND MC side effect is PAIN

Mc site of ENDOMETRIOSIS is Ovary   2nd MC site is POUCH OF DOUGLAS

Mc cause of Post menopausal bleeding in DEVELOPED COUNTRIES is -CA ENDOMETRIUM.

Mc cause of post menopausal bleeding in DEVELOPING COUNTRIES(INDIA) is- CA CERVIX

Mc site of genital TB-FALLOPIAN TUBE.

Mc symptom of genital TB is- INFERTILITY

Most common lobe involved in BPH is- MEDIAN.

Mc long term complication of TURP IS- RETROGRADE EJACULATION


1. Most common cause for HCC= Hep-b
2. Most common hepatitis associated with chronicity= Hep-C>Hep-B
3. Most common cause for chronic carrier state= hep-B>Hep-c
4. Most common acute viral cause for fulminant hepatitis= Hep-D

5. Most common hepatitis associated with mortality in pregnancy= Hep-E( last trimester)
6. Most common transfusion related hepatitis= Hep-b( 1 in 2 lakhs) >Hep-C( 1in 18 lakhs).
7. Most common cause for acute viral hepatitis in children= hep-A
8. Most common cause for acute viral hepatitis in adults= Hep-E
9. Most common cause for chronic hepatitis is= hep-B
10. Most common  cause for acute viral hepatitis in pregnancy= hep-E
11. Most common cause for viral hepatitis in pregnancy= hepatitis-B.


Farbers- mimicks rheumatoid arthritis

Fabry's- angiokeratomas, debilitating pain, Maltese crosses, Fabry Crises/cries

Gm1 gangliosidosis- Angiokeratomas, HSM, typical facial features like frontal bossing, long philtrum, wide set ears,cherry red spot, blind n deaf by 1yr and death by 3-4 yrs

Taysach's disease- macular pallor, cherry red spot, Macrocephaly, seizures, death by 4-5 yrs

Sandhoff- similar to taysachs except with having HSM, cardiac and bone involvement in sandhoff.

Gaucher's- pancytopenia, bleeding, Bone crises (severe swelling n pain), No cherry red spot n No MR.pathological hallmark is Gaucher cell in BM, Xray femur shows erlen meyer flask deformity..



🐝Calcifying lung metastasis:(<1%)
Mucinous adeno ca(colon)

Scirrhous ca of stomach
Radiation therapay
Acids(corrosive ingestion)
Granulomatous ds(tb,sarcoidosis,crohn)
Eosinophilic gastroenteritis

Obstrucive uropathy
Sickle cell ds
Analgeaic nephropathy
Renal vein thrombosis

Choroid plexus papilloma

Chronic hydrocephalus
Optic glioma
Normal variant

🐝Osteoblastic bone metastatis:
Brain (medulloblastoma)
Bowel(especially carcinoid)

Reacrion of periosteum may occur
Indistinct cortex
Coarse trabeculation
Knees+wrists+ankles mainly affected
Epiphseal plates widened+irregular
Tremendous metaphysis(fraying,splaying,cupping)

Ewing sarcoma,eosinophilic granuloma
Multiple myeloma

Congenital infections(rubella,syphilis)
Metaphyseal dysostosis

Aneurysmal bone cyst
Giant cell tumor
Eosinophilic granuloma

Fibrous dysplasia
Eosinophilic granulom
Ewings sarcoma

Pyle disease
Diaphyseal aclasis
Ollier ds
Gaucher ds

Dilanthin therapy
Peripheral edema

🐝Occurance of bone centres at elbow:
Capitellum   1 year
Radial head  4 yr bybuy
Internal humeral epicondyl 7 yr
Trochlea 10 yr
Olecranon 10 yr
External humeral epicondyl 11 yr

Drug of Choice for different diseases

Drug of Choice for different diseases


D.M , Renal failure with chest infection....Cipro in full dose
D.M with psuedomonal infection....Cipro
D.M type 1 with increased morning glucose...regular
& intemediate insuline twicw daily
D.M with intermittent claudication , weak pulses & HTN..... Ca channel blockers
Sulphonylurea induced hypoglycemia....Glucagon
Hypeglycemic Coma....Regular Insuline

Terminal cancer patients with pain...Morphine
Pain of MI....Morphine

2 yrs old with 3rd episode of wheezing in last 6 months....Salbutamol Nebulization
Occasional intermittent asthma....Salbutamol
Emergency measure for hyperkalemia...Salbutamol
Renal failure, K 6.8 , HCO3 15 , ECG tall T waves.... I/V Ca Gluconate ( Hyperkalemia)
Malignant pleural effusion...Tetracyclin
High grade fever , chills, headache, myalgia, WORKING NEAR ANIMALS...... Tetracyclin
Enteric fever ....Cipro
Pulmonary Anthrax....Cipro
Traveler's diarrhoea....Norfloxacin
Fvere with coated tongue and leucopenia....Ofloxacin
Systemic fungal infection....Amphotericin B
PCR positive HCV....Interferone & Ribavarin
Atypical Pneumonia....Macrolide ( Erythromycin)
6o yrs old with Meningitis ( Polymorphs)...Ceftriaxone
Meningococcal meningitis in elderly with no drug allergy....Penicillin
Acute lobar pneumonia....Gentamycin
Rheumatic Valvular Disease plus fever....Inj. Penicillin & Gentamycin
Amoebic liver abscess....Tinidazole
Tapeworm infestation...Niclosamide

Breathless on exertion with b/L basal crepts.... Diuretic & ACE inhibitor
CCF with previous IHD...Diuretic & ACE inhibitor
B/L Basal crept, Orthopnea and raised JVP ( CCF)...Furosemide
B/l Crepts with MI....Furosemide
Acute left Ventricular Failure...Furosemide I/V
Increased Ventricular rate( Sinus Tachycardia ) .....Verapamil
Dyspnea withh irregular pulse, B.P 130/70, Atrial fibrillation....Digoxin with Diuretic
Cardiogenic shock....Dopamin & Dobutamine
IHD with palpitation, dyspnea, syncope. QRS( 140 to 200 / min) ....Lignocain
Wolfparkinson Atrial Fibrillation....Radiofrequency Ablation
Chest pain with acute Q wave for 6 hours....I/V Streptokinase followed with Heparin

Organophosphate poisoning....Paralidoxime
Diabetic Gastroparesis....Metoclopramide
To reduce IOP....Pilocarpine
62 Years old with HTN , Hypelipidemia & Prostatism.....Alpha Blockers
62 Years old with HTN , Hypelipidemia & Prostatism.....Alpha Blockers
Ascending mountain sickness...Acetzolamide
PreOperative B.P control in Pheochromocytoma....Both Alpha and Beta Blocker
Penicillin reaction...Adrenaline

Anti convulsant for pre eclampsia....MgSO4
HTN in Pregnancy...Methyldopa
Mitral stenosis with atrial fib. ( in pregnancy)....I/V Heparin
Thyrotoxicosis in pregnancy...PTU
Post Delivery uterine bleeding....Ergometrine
Post Delivery uterine bleeding with ATONY....Oxytocin
Nursing mother with HSV genitalis...Acyclovir
HCV keratoconjunctivitis...Trifluridine

Breast C.A post menopausal....Tamoxifen
Pget's disease...Calcitonin
Resting tremors and loss of facial expressions....Orphenadrine
CRF with anemia, Hb 6.5...Erythropoeitin with I/V Iron

Feritin 1000 micro gram / L with Hb 8 and pigmentation...Deferroxamine
Warfrin reversal....FFP

Acute Rheumatoid Arthritis...Methotrexate
Relapsing minimal change disease .... Immunosuppresants
Partial Abscence seizures...Ethusuximide
Acute Attack of Ulcerative colitis.....I/V Corticisteroids
GI Bleed with CLD ... Inj Terlipressin >>>> Inj Octreotide
Mast cell stabilization ...Disodium Cromoglycate
Achalasia cardia in 34 yrs old.....Pneumatic dilatation
Hematemesis, Jaundice with mild spleenomegally.... Best is Band ligation

TOP 100 SECRETS about Cardiology

TOP 100 SECRETS about Cardiology

1. Coronary flow reserve (the increase in coronary blood flow in response to agents that lead to
microvascular dilation) begins to decrease when a coronary artery stenosis is 50% or more luminal
diameter. However, basal coronary flow does not begin to decrease until the lesion is 80% to 90%
luminal diameter.
2. The most commonly used criteria to diagnose left ventricular hypertrophy (LVH) are R wave in V5 or
V6 + S wave in V1 or V2 > 35 mm, or R wave in lead I plus S wave in lead III > 25 mm.
3. Causes of ST segment elevation include acute myocardial infarction (MI) as a result of thrombotic
occlusion of a coronary artery, Prinzmetal angina, cocaine-induced MI, pericarditis, left ventricular (LV)
aneurysm, left bundle branch block (LBBB), LVH with repolarization abnormalities, J point elevation,
and severe hyperkalemia.
4. The initial electrocardiogram (ECG) manifestation of hyperkalemia is peaked T waves. As the hyperkalemia
becomes more profound, there may be loss of visible P waves, QRS widening, and ST segment
elevation. The preterminal finding is a sinusoidal pattern on the ECG.
5. The classic carotid arterial pulse in a patient with aortic stenosis is reduced (parvus) and delayed
6. The most common ECG finding in pulmonary embolus is sinus tachycardia. Other ECG findings that
can occur include right atrial (RA) enlargement (P pulmonale), right axis deviation, T-wave inversions
in leads V1 to V2, incomplete right bundle branch block (IRBBB), and a S1Q3T3 pattern (an S wave in
lead I, a Q wave in lead III, and an inverted T wave in lead III).
7. The major risk factors for coronary artery disease (CAD) are family history of premature CAD (father,
mother, brother, or sister who first developed clinical CAD at age younger than 45 to 55 for males and
at age younger than 55 to 60 for females), hypercholesterolemia, hypertension, cigarette smoking,
and diabetes mellitus.
8. Important causes of chest pain not related to atherosclerotic CAD include aortic dissection, pneumothorax,
pulmonary embolism (PE), pneumonia, hypertensive crisis, Prinzmetal angina, cardiac
syndrome X, anomalous origin of the coronary artery, pericarditis, esophageal spasm or esophageal
rupture (Boerhaave syndrome), and shingles.
9. The Kussmaul sign is the paradoxical increase in jugular venous pressure (JVP) that occurs during
inspiration. JVP normally decreases during inspiration because the inspiratory fall in intrathoracic
pressure creates a sucking effect on venous return. Kussmaul sign is observed when the right side of
the heart is unable to accommodate an increased venous return, such as can occur with constrictive
pericarditis, severe heart failure, cor pulmonale, restrictive cardiomyopathy, tricuspid stenosis, and
right ventricular (RV) infarction.
10. Other causes of elevated cardiac troponin, besides acute coronary syndrome and myocardial infarction,
that should be considered in patients with chest pains include PE, aortic dissection, myopericarditis,
severe aortic stenosis, and severe chronic kidney disease.
11. Prinzmetal angina, also called variant angina, is an unusual angina caused by coronary vasospasm.
Patients with Prinzmetal angina are typically younger and often female. Treatment is based primarily
on the use of calcium channel blockers and nitrates.
12. Cardiac syndrome X is an entity in which patients describe typical exertional anginal symptoms,
yet are found on cardiac catheterization to have nondiseased, normal coronary arteries.
Although there are likely multiple causes and explanations for cardiac syndrome X, it does
appear that, at least in some patients, microvascular coronary artery constriction or dysfunction
plays a role.
13. The three primary antianginal medications used for the treatment of chronic stable angina are
β-blockers, nitrates, and calcium channel blockers. Ranolazine, a newer antianginal agent, is
used only as a third-line agent in patients with continued significant angina despite
antianginal therapy who have CAD not amenable to revascularization.
14. Findings that suggest a heart murmur is pathologic and requires further evaluation include the
presence of symptoms, extra heart sounds, thrills, abnormal ECG or chest radiography, diminished
or absent S2, holosystolic (or late systolic) murmur, any diastolic murmur, and all continuous
15. The major categories of ischemic stroke are large vessel atherosclerosis (including embolization from
carotid to cerebral arteries), small vessel vasculopathy or lacunar type, and cardioembolic.
16. Hemorrhagic strokes are classified by their location: subcortical (associated with uncontrolled
hypertension in 60% of cases) versus cortical (more concerning for underlying mass, arteriovenous
malformation, or amyloidosis).
17. Common radiographic signs of congestive heart failure include enlarged cardiac silhouette, left atrial
(LA) enlargement, hilar fullness, vascular redistribution, linear interstitial opacities (Kerley lines),
bilateral alveolar infiltrates, and pleural effusions (right greater than left).
18. Classic ECG criteria for the diagnosis of ST elevation myocardial infarction (STEMI), warranting thrombolytic
therapy, are ST segment elevation greater than 0.1 mV in at least two contiguous leads (e.g.,
leads III and aVF or leads V2 and V3) or new or presumably new LBBB.
19. Primary percutaneous coronary intervention (PCI) refers to the strategy of taking a patient who presents
with STEMI directly to the cardiac catheterization laboratory to undergo mechanical revascularization
using balloon angioplasty, coronary stents, and other measures.
20. The triad of findings suggestive of RV infarction are hypotension, distended neck veins, and clear
21. Cessation of cerebral blood flow for as short a period as 6 to 8 seconds can precipitate syncope.
22. The most common causes of syncope in pediatric and young patients are neurocardiogenic syncope
(vasovagal syncope, vasodepressor syncope), conversion reactions (psychiatric causes), and primary
arrhythmic causes (e.g., long QT syndrome, Wolff-Parkinson-White syndrome). In contrast, elderly
patients have a higher frequency of syncope caused by obstructions to cardiac output (e.g., aortic
stenosis, PE) and by arrhythmias resulting from underlying heart disease.
23. Preexisting renal disease and diabetes are the two major risk factors for the development of contrast
nephropathy. Preprocedure and postprocedure hydration is the most established method of reducing
the risk of contrast nephropathy.
24. During coronary angiography, flow down the coronary artery is graded using the TIMI flow grade (flow
grades based on results of the Thrombolysis in Myocardial Infarction trial), in which TIMI grade 3 flow
is normal and TIMI grade 0 flow means there is no blood flow down the artery.
25. The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) recommends
that all adults age 20 years or older should undergo the fasting lipoprotein profile every 5 years. Testing
should include total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein
(HDL) cholesterol, and triglycerides.
26. Important secondary causes of hyperlipidemia include diabetes, hypothyroidism, obstructive liver
disease, chronic renal failure or nephrotic syndrome, and certain drugs (progestins, anabolic steroids,
27. The minimum LDL goal for secondary prevention in patients with established CAD, peripheral vascular
disease, or diabetes is an LDL less than 100 mg/dL. A goal of LDL less than 70 mg/dL should be
considered in patients with CAD at very high risk, including those with multiple major coronary risk
factors (especially diabetes), severe and poorly controlled risk factors (especially continued cigarette
smoking), and multiple risk factors of the metabolic syndrome and those with acute coronary
28. Factors that make up metabolic syndrome include abdominal obesity (waist circumference in men
larger than 40 inches/102 cm or in women larger than 35 inches/88 cm); triglycerides 150 mg/dL
or higher; low HDL cholesterol (less than 40 mg/dL in men or less than 50 mg/dL in women); blood
pressure 135/85 mm Hg or higher; and fasting glucose 110 mg/dL or higher.
29. Although optimal blood pressure is less than 120/80 mm Hg, the goal of blood pressure treatment
is to achieve blood pressure levels less than 140/90 mm Hg in most patients with uncomplicated
30. Up to 5% of all hypertension cases are secondary, meaning that a specific cause can be identified.
Causes of secondary hypertension include renal artery stenosis, renal parenchymal disease, primary
hyperaldosteronism, pheochromocytoma, Cushing disease, hyperparathyroidism, aortic coarctation,
and sleep apnea.
31. Clinical syndromes associated with hypertensive emergency include hypertensive encephalopathy,
intracerebral hemorrhage, unstable angina or acute myocardial infarction, pulmonary edema, dissecting
aortic aneurysm, or eclampsia.
32. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment
of High Blood Pressure (JNC-7) recommends that hypertensive emergencies be treated in an
intensive care setting with intravenously administered agents, with an initial goal of reducing mean
arterial blood pressure by 10% to 15%, but no more than 25%, in the first hour and then, if stable, to
a goal of 160/100 to 160/110 mm Hg within the next 2 to 6 hours.
33. Common causes of depressed LV systolic dysfunction and cardiomyopathy include CAD, hypertension,
valvular heart disease, and alcohol abuse. Other causes include cocaine abuse, collagen vascular disease,
viral infection, myocarditis, peripartum cardiomyopathy, acquired immunodeficiency syndrome
(AIDS), tachycardia-induced cardiomyopathy, hypothyroidism, anthracycline toxicity, and Chagas
34. The classic signs and symptoms of patients with heart failure are dyspnea on exertion (DOE), orthopnea,
paroxysmal nocturnal dyspnea (PND), and lower extremity edema.
35. Heart failure symptoms are most commonly classified using the New York Heart Association (NYHA)
classification system, in which class IV denotes symptoms even at rest and class I denotes the ability
to perform ordinary physical activity without symptoms.
36. Patients with depressed ejection fractions (less than 40%) should be treated with agents that block the
rennin-angiotensin-aldosterone system, in order to improve symptoms, decrease hospitalizations, and
decrease mortality. Angiotensin-converting enzyme (ACE) inhibitors are first-line therapy; alternate or
additional agents include angiotensin II receptor blockers (ARBs) and aldosterone receptor blockers.
37. The combination of high-dose hydralazine and high-dose isosorbide dinitrate should be used in
patients who cannot be given or cannot tolerate ACE inhibitors or ARBs because of renal function
impairment or hyperkalemia.
38. High-risk features in patients hospitalized with acute decompensated heart failure (ADHF) include
low systolic blood pressure, elevated blood urea nitrogen (BUN), hyponatremia, history of prior heart
failure hospitalization, elevated brain natriuretic peptide (BNP), and elevated troponin I or T.
39. Atrioventricular (AV) node reentry tachycardia (AVNRT) accounts for 65% to 70% of paroxysmal
supraventricular tachycardias (SVTs).
40. Implantable cardioverter defibrillators (ICDs) should be considered for primary prevention of sudden
cardiac death in patients whose LV ejection fractions remains less than 30% to 35% despite optimal
medical therapy or revascularization and who have good-quality life expectancy of at least 1 year.
41. The three primary factors that promote venous thrombosis (known together as Virchow triad ) are (1)
venous blood stasis; (2) injury to the intimal layer of the venous vasculature; and (3) abnormalities in
coagulation or fibrinolysis.
42. Diastolic heart failure is a clinical syndrome characterized by the signs and symptoms of heart failure,
a preserved LV ejection fraction (greater than 45% to 50%), and evidence of diastolic dysfunction.
43. The four conditions identified as having the highest risk of adverse outcome from endocarditis, for
which prophylaxis with dental procedures is still recommended by the American Heart Association,
are prosthetic cardiac valve, previous infective endocarditis, certain cases of congenital heart disease,
and cardiac transplantation recipients who develop cardiac valvulopathy.
44. Findings that should raise the suspicion for endocarditis include bacteremia and/or sepsis of unknown
cause, fever, constitutional symptoms, hematuria and/or glomerulonephritis and/or suspected renal
infarction, embolic event of unknown origin, new heart murmurs, unexplained new AV nodal conduction
abnormality, multifocal or rapid changing pulmonic infiltrates, peripheral abscesses, certain cutaneous
lesions (Osler nodes, Janeway lesions), and specific ophthalmic manifestations (Roth spots).
45. Transthoracic echo (TTE) has a sensitivity of 60% to 75% in the detection of native valve endocarditis. In
cases where the suspicion of endocarditis is higher, a negative TTE should be followed by a transesophageal
echo (TEE), which has a sensitivity of 88% to 100% and a specificity of 91% to 100% for native valves.
46. The most common cause of culture-negative endocarditis is prior use of antibiotics. Other causes
include fastidious organisms (Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans,
Cardiobacterium hominis, Eikenella corrodens, and various species of Kingella [HACEK group]; Legionella;
Chlamydia; Brucella; and certain fungal infections) and noninfectious causes.
47. Indications for surgery in cases of endocarditis include acute aortic insufficiency or mitral regurgitation
leading to congestive heart failure, cardiac abscess formation or perivalvular extension,
persistence of infection despite adequate antibiotic treatment, recurrent peripheral emboli, cerebral
emboli, infection caused by microorganisms with a poor response to antibiotic treatment (e.g., fungi),
prosthetic valve endocarditis (particularly if hemodynamic compromise exists), “mitral kissing infection,”
and large (greater than 10 mm) mobile vegetations.
48. The main echocardiographic criteria for severe mitral stenosis are mean transvalvular gradient
greater than 10 mm Hg, mitral valve area less than 1 cm2, and pulmonary artery (PA) systolic pressure
greater than 50 mm Hg.
49. The classic auscultatory findings in mitral valve prolapse (MVP) is a midsystolic click and late systolic
murmur, although the click may actually vary somewhat within systole, depending on changes in LV
dimension, and there may actually be multiple clicks. The clicks are believed to result from the sudden
tensing of the mitral valve apparatus as the leaflets prolapse into the LA (LA) during systole.
50. In patients with pericardial effusions, echocardiography findings that indicate elevated intrapericardial
pressure and tamponade physiology include diastolic indentation or collapse of the RV, compression
of the RA for more than one third of the cardiac cycle, lack of inferior vena cava (IVC) collapsibility
with deep inspiration, 25% or more variation in mitral or aortic Doppler flows, and 50% or greater
variation of tricuspid or pulmonic valve flows with inspiration.
51. The causes of pulseless electrical activity (PEA) can be broken down to the H’s and T’s of PEA, which
are hypovolemia, hypoxemia, hydrogen ion (acidosis), hyperkalemia or hypokalemia, hypoglycemia,
hypothermia, toxins, tamponade (cardiac), tension pneumothorax, thrombosis (coronary and pulmonary),
and trauma.
52. Hemodynamically significant atrial septal defects (ASDs) have a shunt ratio greater than 1.5, are usually
10 mm or larger in diameter, and are usually associated with RV enlargement.
53. Findings suggestive of a hemodynamically significant coarctation include small diameter (less than
10 mm or less than 50% of reference normal descending aorta at the diaphragm), presence of collateral
blood vessels, and a gradient across the coarctation of more than 20 to 30 mm Hg.
54. Tetralogy of Fallot (TOF) consists of four features: right ventricular outflow tract (RVOT) obstruction, a
large ventricular septal defect (VSD), an overriding ascending aorta, and RV hypertrophy.
55. The three Ds of the Ebstein anomaly are an apically displaced tricuspid valve that is dysplastic, with a
right ventricle that may be dysfunctional.
56. Systolic wall stress is described by the law of Laplace, which states that systolic wall stress is equal to:
(arterial pressure (p) × radius (r))/2 × thickness (h) , or σ = (p × r)/2h
57. Echocardiographic findings suggestive of severe mitral regurgitation include enlarged LA or LV, the
color Doppler mitral regurgitation jet occupying a large proportion (more than 40%) of the LA, a
regurgitant volume 60 mL or more, a regurgitant fraction 50% or greater, a regurgitant orifice
0.40 cm2 or greater, and a Doppler vena contracta width 0.7 cm or greater.
58. The seven factors that make up the Thrombolysis in Myocardial Infarction (TIMI) Risk Score are: age
greater than 65 years; three or more cardiac risk factors; prior catheterization demonstrating CAD;
ST-segment deviation; two or more anginal events within 24 hours; aspirin use within 7 days; and
elevated cardiac markers.
59. The components of the Global Registry of Acute Coronary Events (GRACE) Acute Cardiac Syndrome
(ACS) Risk Model (at the time of admission) are age; heart rate; systolic blood pressure, creatinine;
congestive heart failure (CHF) Killip class, ST-segment deviation; elevated cardiac enzymes and/or
markers; and presence or absence of cardiac arrest at admission.
60. Myocarditis is most commonly caused by a viral infection. Other causes include nonviral infections
(bacterial, fungal, protozoal, parasitic), cardiac toxins, hypersensitivity reactions, and systemic disease
(usually autoimmune). Giant cell myocarditis is an uncommon but often fulminant form of myocarditis
characterized by multinucleated giant cells and myocyte destruction.
61. Initial therapy for patients with non–ST segment elevation acute coronary syndrome (NSTEACS)
should include antiplatelet therapy with aspirin and with either clopidogrel, ticagrelor, or a
IIb/IIIa inhibitor, and antithrombin therapy with either unfractionated heparin, enoxaparin,
fondaparinux, or bivalirudin (depending on the clinical scenario).
62. Important complications in heart transplant recipients include infection, rejection, vasculopathy (diffuse
coronary artery narrowing), arrhythmias, hypertension, renal impairment, malignancy (especially
skin cancer and lymphoproliferative disorders), and osteoporosis (caused by steroid use).
63. The classic symptoms of aortic stenosis are angina, syncope, and those of heart failure (dyspnea,
orthopnea, paroxysmal nocturnal dyspnea, edema, etc.). Once any of these symptoms occur, the
average survival without surgical intervention is 5, 3, or 2 years, respectively.
64. Class I indications for aortic valve replacement (AVR) include (1) development of symptoms in patients
with severe aortic stenosis; (2) an LV ejection fraction of less than 50% in the setting of severe aortic
stenosis; and (3) the presence of severe aortic stenosis in patients undergoing coronary artery bypass
grafting, other heart valve surgery, or thoracic aortic surgery.
65. The major risk factors for venous thromboembolism (VTE) include previous thromboembolism, immobility,
cancer and other causes of hypercoagulable state (protein C or S deficiency, factor V Leiden,
antithrombin deficiency), advanced age, major surgery, trauma, and acute medical illness.
66. The Wells Score in cases of suspected pulmonary embolism (PE) includes deep vein
(DVT) symptoms and signs (3 points); PE as likely as or more likely than alternative
diagnosis (3 points); heart rate greater 100 beats/min (1.5 points); immobilization or surgery in
previous 4 weeks (1.5 points); previous DVT or PE (1.5 points); hemoptysis (1.0 point); and cancer
(1 point).
67. The main symptoms of aortic regurgitation (AR) are dyspnea and fatigue. Occasionally patients
experience angina because reduced diastolic aortic pressure reduces coronary perfusion pressure,
impairing coronary blood flow. Reduced diastolic systemic pressure may also cause syncope or
68. The physical findings of AR include widened pulse pressure, a palpable dynamic LV apical beat that
is displaced downward and to the left, a diastolic blowing murmur heard best along the left sternal
border with the patient sitting upright and leaning forward, and a low-pitched diastolic rumble heard
to the LV apex (Austin Flint murmur).
69. Class I indications for aortic valve replacement in patients with AR include (1) the presence of symptoms
in patients with severe AR, irrespective of LV systolic function; (2) chronic severe AR with LV
systolic dysfunction (ejection fraction 50% or less), even if asymptomatic; and (3) chronic, severe AR
in patients undergoing coronary artery bypass grafting (CABG), other heart valve surgery, or thoracic
aortic surgery.
70. Cardiogenic shock is a state of end-organ hypoperfusion caused by cardiac failure characterized by
persistent hypotension with severe reduction in cardiac index (less than 1.8 L/min/m2) in the presence
of adequate or elevated filling pressure (LV end-diastolic pressure 18 mm Hg or higher or RV
end-diastolic pressure 10 to 15 mm Hg or higher).
71. The rate of ischemic stroke in patients with nonvalvular atrial fibrillation (AF) is about two to seven
times that of persons without AF, and the risk increases dramatically as patients age. Both paroxysmal
and chronic AF carry the same risk of thromboembolism.
72. In nuclear cardiology stress testing, a perfusion defect is an area of reduced radiotracer uptake in the
myocardium. If the perfusion defect occurs during stress and improves or normalizes during rest, it is
termed reversible and usually suggests the presence of inducible ischemia, whereas if the perfusion
defect occurs during both stress and rest, it is termed fixed and usually suggests the presence of scar
73. The main organ systems that need to be monitored with long-term amiodarone therapy are the lungs,
the liver, and the thyroid gland. A chest radiograph should be obtained every 6 to 12 months, and
liver function tests (LFTs) and thyroid function tests (thyroid-stimulating hormone [TSH] and free T4)
should be checked every 6 months.
74. The target international normalized ratio (INR) for warfarin therapy in most cases of cardiovascular
disease is 2.5, with a range of 2.0 to 3.0. In certain patients with mechanical heart valves (e.g., older
valves, mitral position), the target is 3.0 with a range of 2.5 to 3.5.
75. Lidocaine may cause a variety of central nervous system symptoms including seizures, visual disturbances,
tremors, coma, and confusion. Such symptoms are often referred to as lidocaine toxicity.
The risks of lidocaine toxicity are increased in elderly patients, those with depressed LV function, and
those with liver disease.
76. The most important side effect of the antiarrhythmic drug sotalol is QT-segment prolongation leading
to torsades de pointes.
77. The major complications of percutaneous coronary intervention (PCI) include periprocedural MI,
acute stent thrombosis, coronary artery perforation, contrast nephropathy, access site complications
(e.g., retroperitoneal bleed, pseudoaneurysm, arteriovenous fistula), stroke, and a very rare need for
emergency CABG.
78. The widely accepted hemodynamic definition of pulmonary arterial hypertension (PAH) is a mean
pulmonary arterial pressure of more than 25 mm Hg at rest or more than 30 mm Hg during exercise,
with a pulmonary capillary or LA pressure of less than 15 mm Hg.
79. Acute pericarditis is a syndrome of pericardial inflammation characterized by typical chest pain, a
pathognomonic pericardial friction rub, and specific electrocardiographic changes (PR depression,
diffuse ST-segment elevation).
80. Conditions associated with the highest cardiac risk in noncardiac surgery are unstable coronary
syndromes (unstable or severe angina), decompensated heart failure, severe valvular disease (particularly
severe aortic stenosis), and severe arrhythmias.
81. General criteria for surgical intervention in cases of thoracic aortic aneurysm are, for the ascending
thoracic aorta, aneurysmal diameter of 5.5 cm (5.0 cm in patients with Marfan syndrome), and
for the descending thoracic aorta, aneurismal diameter of 6.5 cm (6 cm in patients with Marfan
82. Cardiac complications of advanced AIDS in untreated patients include myocarditis and/or cardiomyopathy
(systolic and diastolic dysfunction), pericardial effusion/tamponade, marantic (thrombotic)
or infectious endocarditis, cardiac tumors (Kaposi sarcoma, lymphoma), and RV dysfunction from
pulmonary hypertension or opportunistic infections. Complications with modern antiretroviral therapy
(ART) include dyslipidemias, insulin resistance, lipodystrophy, atherosclerosis, and arrhythmias.
83. The radiation dose of a standard cardiac computed tomography (CT) angiography depends on a
multitude of factors and can range from 1 mSv to as high as 30 mSv. This compares to an average
radiation dose from a nuclear perfusion stress test of 6 to 25 mSv (or as high as more than 40 mSv
in thallium stress/rest tests) and an average dose from a simple diagnostic coronary angiogram of
approximately 5 mSv.
84. The ankle-brachial index (ABI) is the ankle systolic pressure (as determined by Doppler examination)
divided by the brachial systolic pressure. An abnormal index is less than 0.90. The sensitivity
is approximately 90% for diagnosis of peripheral arterial disease (PAD). An ABI of 0.41 to 0.90 is
interpreted as mild to moderate peripheral arterial disease; an ABI of 0.00 to 0.40 is interpreted as
severe PAD.
85. Approximately 90% of cases of renal artery stenosis are due to atherosclerosis. Fibromuscular
dysplasia (FMD) is the next most common cause.
86. In very general terms, in cases of carotid artery stenosis, indications for carotid endarterectomy
(CEA) are: (1) symptomatic stenosis 50% to 99% diameter if the risk of perioperative stroke or death
is less than 6%; and (2) asymptomatic stenosis greater than 60% to 80% diameter if the expected
perioperative stroke rate is less than 3%.
87. The most common cardiac complications of systemic lupus erythematosus (SLE) are pericarditis,
myocarditis, premature atherosclerosis, and Libman-Sacks endocarditis.
88. Cardiac magnetic resonance imaging (MRI) can be performed in most patients with implanted cardiovascular
devices, including most coronary and peripheral stents, prosthetic heart valves, embolization
coils, intravenous vena caval filters, cardiac closure devices, and aortic stent grafts. Pacemakers and
implantable cardioverter defibrillators are strong relative contraindications to MRI scanning, and scanning
of such patients should be done under specific delineated conditions, only at centers with expertise
in MRI safety and electrophysiology, and only when MRI imaging in particular is clearly indicated.
89. The clinical manifestations of symptomatic bradycardia include fatigue, lightheadedness, dizziness,
presyncope, syncope, manifestations of cerebral ischemia, dyspnea on exertion, decreased exercise
tolerance, and congestive heart failure.
90. Second-degree heart block is divided into two types: Mobitz type I (Wenckebach) exhibits progressive
prolongation of the PR interval before an atrial impulse (P wave) is not conducted, whereas Mobitz
type II exhibits no prolongation of the PR interval before an atrial impulse is not conducted.
91. Temporary or permanent pacing is indicated in the setting of acute MI, with or without symptoms, for
(1) complete third-degree block or advanced second-degree block that is associated with block in the
His-Purkinje system (wide complex ventricular rhythm) and (2) transient advanced (second-degree or
third-degree) AV block with a new bundle branch block.
92. Cardiac resynchronization therapy (CRT) refers to simultaneous pacing of both ventricles (biventricular,
or Bi-V, pacing). CRT is indicated in patients with advanced heart failure (usually NYHA class III
or IV), severe systolic dysfunction (LV ejection fraction 35% or less), and intraventricular conduction
delay (QRS less than 120 ms) who are in sinus rhythm and have been on optimal medical therapy.
93. Whereas the left internal mammary artery (LIMA), when anastomosed to the left anterior descending
artery (LAD), has a 90% patency at 10 years, for saphenous vein grafts (SVGs), early graft stenosis or
occlusion of up to 15% can occur by 1 year, with 10-year patency traditionally cited at only 50% to
94. Myocardial contusion is a common, reversible injury that is the consequence of a nonpenetrating
trauma to the myocardium. It is detected by elevations of specific cardiac enzymes with no evidence
of coronary occlusion and by reversible wall motion abnormalities detected by echocardiography.
95. Causes of restrictive cardiomyopathy include infiltrative diseases (amyloidosis, sarcoidosis, Gaucher
disease, Hurler disease), storage diseases (hemochromatosis, glycogen storage disease, Fabry
disease), and endomyocardial involvement from endomyocardial fibrosis, radiation, or anthracycline
96. Classical signs for cardiac tamponade include the Beck triad of (1) hypotension caused by decreased
stroke volume, (2) jugulovenous distension caused by impaired venous return to the heart, and
(3) muffled heart sounds caused by fluid inside the pericardial sac, as well as pulsus paradoxus and
general signs of shock, such as tachycardia, tachypnea, and decreasing level of consciousness.
97. The most common tumors that spread to the heart are lung (bronchogenic) cancer, breast cancer,
melanoma, thyroid cancer, esophageal cancer, lymphoma, and leukemia.
98. Primary cardiac tumors are extremely rare, occurring in one autopsy series in less than 0.1% of
subjects. Benign primary tumors are more common than malignant primary tumors, occurring
approximately three times as often as malignant tumors.
99. The Westermark sign is the finding in pulmonary embolism of oligemia of the lung beyond the
occluded vessel. If pulmonary infarction results, a wedge-shaped infiltrate (Hampton’s hump) may be
100. Patients with cocaine-induced chest pain should be treated with intravenous benzodiazepines,
which can have beneficial hemodynamic effects and relieve chest pain, and aspirin therapy, as well
as nitrate therapy if the patient remains hypertensive. β-blockers (including labetalol) should not be
administered in the acute setting of cocaine-induced chest pain


types of cataract :
1. sunflower cataract : chalcosis n Wilson's disease

2.rosset shaped cataract : blunt trauma

3.snow flak cataract : diabetes

4.senile cataract : MC acquired cataract.

5.oil drop cataract : galactosemia

6.Christmas tree cataract : myotonic dystrophy subcapsular causes
--drug induced
---radiation induced
---max.visual handicapped
---complicated cataract.

8.MC type of congenital cataract : blue dot

9.MC type of congenital cataract  diminision of vision : lameller cataract or zonular cataract

10.cataract seen in rubella :
neuclear pearly followed by zonular cataract.

Malignancies Of Nose:

*MC benign tumor- PAPILLOMA

*MC site of mc benign tumor-VESTIBULE

*MC site of capillary hemangioma-LITTLES AREA

*MC site of cavernous hemangioma-INF TURBINATE

*MC type of malignancy-SQ.C.C

*MC site of mc type of malignancy-LAT.WALL OF NASAL CAVITY

Paediatrics seizures

-- Drug of choice for absence seizures is Ethosuximide. No relation with age. And it is NOW AVAILABLE in India and has been marketed for clinical use.
-- Drug of choice for Infantile spasm/West syndrome is ACTH. And it is also easily available in India since past many years.
Vigabatrin is used as DOC only in Tuberous sclerosis associated infantile spasm.
-- Drug of choice for ADHD is Methylphenidate. Atomoxetine is used only in refractory cases or some assc disorders like CVS problems in ADHD. Methylphenidate is also available in India.
-- All natural Surfactant prep are available in India. Synthetic surfactant are not available in India. Natural are superior to synthetic preparations.
-- Pyridoxine is drug of choice for empirical therapy in refractory neonatal seizures. Its not biotin, as mentioned in some of the guides in the market.
-- TOF does not cause cyanosis at birth. Only TOF with pulm atresia does ( which is different from TOF).
-- I.V. Ceftriaxone is Drug of choice in meningitis caused by H.influenzae, even if the bacteria is beta lactamase producing.
-- Carbamazepine & Oxcarbazepine are first line drugs for partial epilepsy in children. Lamotrigine is not first line drug, as in adults.



🔑In Greek means, “inability to sit”
🔑It is characterized by state of inner restlessness and shifting of weight. Hightened lower limb movements are quite characteristic
🔑It is an acute extrapyramidal symtom which typically is seen within 7-10 days of initiation of the antipsychotic
🔑Most common extrapyramidal side effect after starting an antpsychotic
🔑First generation older antipsychotics have higher chance of producing Akathisia compared to second generation antipsychotics
🔑Among the second generation antipsychotics, Clozapine has the least and Aripiprazole has the highest chance of causing Akathisia
🔑Management of Akathisia is:
💊If possible, the first step is to decrease the dose of antipsychotic
💊The commonly used drugs are Propranolol(most preferable), Benzodiazepines and Anticholinergics(least preferable)

Various types of haemoglobin

Various types of haemoglobin :-

Adult haemoglobin :-

Hb A - two alpha and two beta chains

Hb A2- two alpha and two delta chains 

Fetal haemoglobin :-

Hb F- two alpha and two gamma chains 

Embryonic haemoglobin :-

Gower 1- two zeta and two epsilon chains 

Gower 2- two alpha and two epsilon chains 

Portland - 1 - two zeta and two gamma chains 

Portland 2- two zeta and two beta chains 

In alpha thalessemia :-

Hb Bart - tetramer consisting of four gamma chains 

HbH - tetramer consisting of four beta chains

Miscellaneous :-

Haemoglobin S - glutamic acid is replaced by valine at 6 th position of beta chain 

Haemoglobin C - glutamic acid is replaced by lysine at 6 th position of beta chain 

Haemoglobin E - glutamic acid is replaced by lysine at 26 th position of beta chain

Haemoglobin M. Iwata - histidine is replaced by tyrosine at 87th position at alpha chain; associated with methhaemoglobinemia

HEMOGLOBIN M (Milwaukee) is a rare dominant hereditary disorder where glutamate replaces valine in position 67 on the beta chain of the hemoglobin molecule

Haemoglobin lepore :-

Two alpha and two ( delta - beta fusion ) chains

Haemoglobin produced by yolk sac- Gower 1 Gower 2 and Portland

By liver- HB F

By bone marrow- HB A

At term 70% is HB F

Quick Revision


👹1.  Hallucination  and  illusion  are  disorders  of  perception

🤖2.  Delusion is a  disorder  of  thought  content

👨🏻3.  Eugen Bleuler coined  the  term  Schizophrenia

👴🏼4.  Sigmund Freud  is the  father  of  psychoanalysis

🕵5.  First  rank  symptoms  of  schizophrenia  was  given  by Schneider

👤6.  Delusion of  persecution  and  reference  are  seen  in schizophrenia

😈7.  Delusion of  grandiosity is  seen  in  Mania
😲8.  Delusion of  guilt  and  nihilism  are  seen  in  depression
🅰9.  Four As of schizophrenia  include  Autism, Ambivalence,  Affective  flattening,  Loosening  of Association
❤10.  Good  prognostic  factors  in  schizophrenia  –  late  age  of onset,  positive  symptoms,  paranoid  subtype,  normal imaging  

♌11.  Waxy flexibility and  posturing  are  features  of catatonic  schizophrenia

💕12.  Loosening  of  association  is a  formal  thought  disorder in  schizophrenia

✈13.  Flight of  ideas  and  Pressure  of  speech are  features  of mania

😶14.  Core  features  of  depression  includes  pervasive sadness,  anhedonia  and  anergia

🔼15.  Cognitive  triad  of  depression  (hopelessness, helplessness  and  worthlessness)  was  given  by  Aaron Beck

👌🏼16.  Delusion  of  persecution  and  Delusional  parasitosis are  seen  with cocaine  abuse

🕷17.  Tactile  hallucinations  or  formication  or  magnus symptoms are  seen  with  cocaine  abuse

🏃🏼18.  Run  amok is seen  with  cannabis abuse

🍺19.  CAGE questionnaire  is a  screening  questionnaire  for alcohol  dependence

🤔20.  Delirium  is also  known  as  acute  confusional  state

🌚21.  Sundowning,  sleep  wake  cycle  reversal  are  seen  in delirium

22.  Mini  Mental  State  Examination  is a  screening  tool  for dementia

23.  Step  latter  pattern  of  memory decline  is  seen  with Vascular  dementia

24.  Myoclonus,  EEG  abnormalities  are  specific  to  CJD dementia

25.  Pseudodementia  is  depressive  dementia  and  is reversible

26.  Spontaneous  anxiety  attacks  with  anticipatory anxiety  are  features  of  panic  disorder 🤕27.  Unconscious  conflicts  presenting  as  physical symptoms  –  conversion  disorder

28.  Conscious  feigning  of  symptoms to  assume  sick  role or  attention  –  Factitious  disorder

29.  Conscious  feigning  of  symptoms for  external gain/benefit  –  Malingering 😳30.  Drug  of  Choice  for  OCD is Fluoxetine

31.  Drug of  choice  for  alcohol  withdrawl  is Chlordiazepoxide  (benzodiazepine)

32.  Drug of  choice  for  bipolar  disorder  is  Lithium ⭐33.  Therapeutic  serum lithium  level  is  0.8  –  1.2meq/L 34. 
⭐Drug of  choice  for  treatment  resistant  schizophrenia –  Clozapine 😶35.  Treatment  of  choice  for  severe  depression  with suicidal  risk  –  Electroconvulsive  therapy ⚡

36.  Drug of  choice  for  nocturnal  enuresis  –  Imipramine

37.  Drug of  choice  for  ADHD  –  Methyl  phenidate ⭐38.  Drug of  choice  for  neuroleptic  malignant  syndrome  – Dantrolene

39.  Drug induced  extrapyramidal  symptoms include dystonia,  akathisia,  pseudoparkinsonism,  tardive dyskinesia

40.  Exposure  response  prevention  is  the  behavior therapy for OCD


All patient of breast lump should undergo triple assessment as it has very high PPV(positive predictive value). The first step is clinical examination- and determine if the lump is likely to be benign or malignant (clinical suspicion).
The next should be radiology, before proceeding to tissue diagnosis. Options are mammogram if the age is >30yrs and USG for younger patients of <30 yrs of age.
The idea of doing imaging before tissue diagnosis is to avoid change in morphology and size of tumor after tissue diagnosis (FNAC or CNB), a hematoma may form which will alter the architecture and size of the primary tumor, both of which are very important in making decisions in management and follow-up of patient. if clinical suspicion is benign, it can be followed up and if doesnt resolve then subjected to radiology investigation.
In the above question, 45 yrs old lady with hard lump- clinical suspicion should be of malignancy --> next step is MMG.


"Hook like osteophytes" are regarded as a characteristic feature of arthropathy of hemochromatosis.

Arthropathy occurs in 20–40% of patients with hemochromatosis

It usually begins after the age of 50 and may be the first clinical feature of hemochromatosis.

The arthropathy is an osteoarthritis-like disorder affecting the small joints of the hands and later the larger joints, such as knees, ankles, shoulders, and hips.

The second and third metacarpophalangeal joints of both hands are often the first and most prominent joints affected

Hooklike osteophytes are regarded as a characteristic feature of hemochromatosis but are not specific

In approximately half of patients, there is evidence of calcium pyrophosphate deposition disease, and some patients late in the course of disease experience episodes of acute pseudogout

Hypertensive treatment

When to initiate treatment for hypertension ??
---> For those more than or equal to 60 years, when SBP more than or equal to 150 mmHg or DBP more than or equal to 90 mmHg
--->For those with age less than 60 years, when SBP more than or equal to 140 mmHg or DBP more than or equal to 90 mmHg
---> For those with CKD and / or DM, when SBP more than or equal to 140 mmHg or DBP more than or equal to 90 mmHg (irrespective of age)

Tyrosine Kinase Inhibitors

1.Erlotinib-pancreatic ca,non small cell  ca  lung

2.Geftinib-non small cell ca lung


4.sunitunib - RCC,GIST


6.Pazopanib -RCC

7.Imatinib-CML, GIST,hyperesosnophilic  syndrome, dermatofibrosarcoma

8.Lapatinib -breast ca

9.Vandetanib-medullary  ca thyroid

10.cobazitinib -medullary  ca thyroid

11.Imatinib,dasatinib, nilotinib,bosutunib -CML

12.Regorafinib -colorectal ca ,GIST

13.Ruloxotinib -Myelofibrosis

14.Toctafinib -RA

15.Vemurafenib -Malignant  melanoma

Microbiology Tests

👉🏻 snip test _onchocerciasis
👉🏻2.frenkel skin test _toxoplasmosis
👉🏻3.sabin feldman dye test _toxoplasmosis.                                                      👉🏻4.fairley test _schistosomiasis
👉🏻5.casoni test _hydatid cyst 👉🏻6.montenegro test _leishmania
👉🏻7.dum dum fever _kala azar.                👉🏻8.baghdad boil _cutaneous leishmaniasis
👉🏻9.s.japonicum _katayama fever
👉🏻10.brain eating amoeba _Naegleria fowleri.


🏈   ZINC  🏉
("Hamari Desh ki Shaan")

⚽ MetalloEnzymes :

⚽MICROMINERAL, RDA in children of Age
  <6 months: 5 mg/day
>6 months : 10mg/day

⚽Chiefly distributed in skeletal muscles 💪 and
bones🍖 ( Highest concentration: Hippocampus & Prostate)

⚽Zinc deficiency :
Mild - stunted growth,  hypoguesia, impaired immunity
Severe - dwarfism, hypogonadism, hypopigmented Hair

⚽ Diagnosis of Zn deficiency -
Levels <12M (<70g/dL)

⚽Early indicator of Zn deficiency -
Reduced THYMULIN levels

⚽Zinc containing protein in Saliva:


⚾2-6 months: 10 mg / day
⚾>6  months: 20 mg / day

High yield Facts- June

Number of bones - 206
Number of muscles - 639
Number of kidneys - 2
Number of milk teeth - 20
Number of ribs - 24 (12 pairs)
Number of chambers in the heart - 4
Largest artery - Aorta
Normal Blood pressure - 120 - 80
Ph of blood - 7.4
Number of vertebrae in the spine - 33
Number of vertebrae in the Neck - 7
No of bones in middle Ear - 6
Number of bones in Face - 14
Number of bones in Skull - 22
Number of bones in Chest - 25
Number of bones in Arms -
Number of bones in each human ear - 3
Number of muscles in the human arm - 72
Number of pumps in heart - 2
Largest organ - Skin
Largest gland - Liver
Smallest cell - Blood cell
Biggest cell - Egg cell (ovum)
Smallest bone - Stapes
First transplanted organ - Heart
Average length of small intestine - 7 m
Average length of large intestine - 1.5 m
Average weight of new born baby - 2.6 kg.
Pulse rate in one minute - 72 times
Body Temperature - 36.9o C (98.4o F)
Average blood volume - 4 - 5 liters
Average life of RBC - 120 days
Pregnancy period - 280 days
Number of bones in human foot - 33
Number of bones in each wrist - 8
Number of bones in hand - 27
Largest endocrine gland - Thyroid
Largest lymphatic organ - Spleen
Largest cell - Nerve cell
Largest part of brain - Cerebrum
Largest &amp; strongest bone - Femur
Smallest muscle - Stapedius (Middle ear )
Number of chromosomes in human cell - 46 (23
Number of bones in New born body - 300
Largest muscle - Buttock (Gluteus Maximus)

100 important points

100 important points
1. Potassium is mainly regulated by - Aldosterone.
2. Tip of scapula at level – T7.
3. Oblique fissure of the lung at level - T3 to T6 Costochondral.
4. Decussating of medial lemniscuses - Internal Arcuate Fibers.
5. Superficial temporal artery relation with which nerve - Auriculotemporal nerve.
6. Correct about Thyroid gland - lymph drainage to deep cervical lymph nodes.
7. Anemic hypoxia occur in – Methemoglobulenemia.
8. In cerebral circulation brain arteries - Do not anastomose once entered in the brain (controvertial).
9. Phase 1 of transformation of drug metabolism – Oxidation.
10. Standard deviation shows - Variability of individual observation.
11. Counseling in patients is - To help themselves.
12. A young girl who is going to die and asks you “Am I going to die?” Doctor response should be – “What your parents have told you?”
13. In whole wheat – Thiamine.
14. Cholesterol enriched diet – Egg.
15. Origin of peroxisomes – SER.
16. Organelle where protein combines with carbohydrates, packed and released - Golgi complex.
17. Correct about DNA – Euchromatin is transcriptionally active.
18. ADPKD associated with – Renal failure (vs) Cerebral haemorrhage (controversial) here most probable Renal failure.
19. Cause of delay in healing – Infections.
20. PaO2 decreased, PCO2 increased, hydrogen ion increased; manifestation (looked like kind of COPD) – Hypoventilation.
21. PCO2 31, HCO3 19, pH increased (Metabolic alkalosis scenario) - Hyperventilation
22. Person with tachycardia, and heat intolerance with low level of TSH, on giving TRH; level of TSH and thyroid hormones increases. Diagnosis – Hyperthyroidism with thyroid problem.
23. Origin of oxytocin and ADH – Hypothalamus.
24. Difference between systemic and pulmonary circulation - Low resistance in pulmonary circulation.
25. Mean systemic filling pressure is regulated by - Venous return.
26. Systolic pressure is directly related to which one of the following – Renin.
27. ADH responds to – Osmolarity.
28. Osmoreceptors – ADH.
29. Right border of heart on X-ray also visible a part of – SVC.
30. In MI sensitive cardio marker – Tropinin T.
31. Diabetic nephropathy investigation - Urine albumin.
32. Young boy with generalized edema and proteinuria - Lesion of basement membrane.
33. Lesion of parasympathetic system affects mostly - GI muscles.
34. Stress hormone of our body - ACTH.
35. S2 sound heard on - Closure of aortic and pulmonary valve.
36. A patient with history hemorrhage (trauma) receives a bag stored for 2 weeks mainly contains – RBCs.
37. Due to inspiration – Decreased negative intrapleural pressure.
38. Important buffer of blood - HCO3-.
39. Max increase in ECF due to infusion of - Hypertonic NaCl.
40. Auscultation of tricuspid valve best heard at – Right lower end of the body of sternum.
41. GVE vagus nerve for preganglionic fiber arises from – Dorsal nucleus.
42. Thorn prick in left lower limb caused abscess - Staph aureus.
43. Diabetic female after abdominal surgery; dyspnea and cough - Pulmonary embolism.
44. MCC of pulmonary embolism – DVT.
45. Typhoid fever 1st week test – Blood culture
46. Typhoid fever 2nd week test – Blood culture and Widal test.
47. Typical feature of falciparum - Black water fever.
48. Alcoholic patient with deranged LFTs; on biopsy – Mallory bodies.
49. Councilman bodies seen in – Apoptosis.
50. Natural self-defense against tumors – Apoptosis.
51. P53 gene absent results in - cell survival.
52. Pain mediator - Bradykinins.
53. Metaplasia – Functional change in cells.
54. Female with infection of HPV, comes after 2 years, Pap smear shows prominent nucleoli and increased nucleus size – Dysplasia.
55. Gas exchange occur - Simple squamous epithelial layer.
56. Patient with granulomatous disease, biopsy done. Microscopic finding that suggests TB – Epitheloid cells.
57. The spindle fibers will decrease in discharge of impulses when - Muscle contracts (vs) When efferent gamma discharge occurs. (controversial) here most probable “muscle contracts”
58. Diagnosis for leprosy, initial investigation - Nasal scrapping.
59. Benign neoplasm – Adenoma.
60. 3 germ layers tumor – Teratoma.
61. When adrenalin release from medulla, causes vasodilation by acting on - Beta 2 adrenergic receptors.
62. Increased GFR and increased plasma flow occur due to - Dilation of afferent arteriole.
63. Charateristic of cerebellar lesion - Dymetria
64. Emax of a drug depends on – Efficacy
65. Study in which every person of a population has equal chances of being selected – Random sampling.
66. Amniocenthesis is done - After 14th weeks.
67. 1st response against acute inflammation in tissue – Macrophages.
68. In dark granules containing cells; IgE attaches to – Basophils.
69. Opsonization - C3b.
70. Exudate - more than 3g of proteins.
71. About active transport of drug all are true except - All drugs pass via active transport.
72. Pulmonary artery supply to – Alveoli.
73. Muscles of back innervated by - Dorsal rami.
74. In young boy dyspnea produced on lying - Retrosternal goiter.
75. Most important cause of bronchogenic cancer – Smoking.
76. Edema caused by - Increased hydrostatic pressure.
77. Edema caused by - Lymphatic blockage.
78. BP 210/180mmHg and creatinine 8% damaged part – Juxtaglomerular apparatus.
79. Female with blood group A, have 2 children; one with O and other with AB, blood group of father is – B.
80. Genetically true hermaphrodite – XX/XY.
81. DNA replication occur in – Interphase.
82. Glycogenolysis caused by deficiency of which hormone - Insulin
83. Investigation for liver amoebic abscess – Serology.
84. Surgery of submandibular gland; nerve damaged - marginal mandibular branch of facial.
85. On posterior surface of oblique and transversalis fascia - Arcuate line.
86. Aspirin overdose causes – Coma.
87. Cardiac output measurement via thermodilution – Temperature change downstream with CO.
88. Father with defective gene on one autosomal chromosome, develops disease later in his life; chances of getting disease in children – Half of the children will be affected.
89. If left circumflex artery occluded - Infarction of left atrium and left ventricle.
90. MCC of multiple fractures in adult – Osteoporosis.
91. Patient with fracture of many bones and low BP immediate treatment - Volume replacement.
92. Most common fracture of long bone - Tibia.
93. Collagen fibers – Eosin stain
94. Gamma efferent supply to – Intrafusal muscle spindles.
95. Micturition – Self generating.
96. Hallmark of HIV – Proliferation of virus in T-Cells.
97. 1g protein gives energy – 4 kcalories.
98. Isotonic and isometric contraction difference is that isotonic contraction – consumes more phosphate bond.
99. Autonomic nervous system – parasympathetic increase salivary secretion.
100. Protrusion of mandible – Lateral pterygoid.

Saturday, 18 June 2016

Tests- High yield

1. Barberios test ? Semen.

2. schik test ? C. Diphtheria.

3. Dick test ? Scarlet Fever.

4. florence test ? Semen.

5. Gettler test ? Drowning.

6. Dermal nitrate test? Gun powder.

7. Benzedine test ? old blood Stain.

8. Guthrie test?  PKU.

9. Rothera test ? Ketone Bodies.

10 . For Dna test , which tissue sample is taken in  autopsy?
b. spleen

11. Confirmatory test for blood is ? Teichmann Test.

13. Marsh test ? Arsenic.

17. Gerhardts test? Ketone bodies in urine.

18.  Fouchets test/ Gmelin test  ?Bilirubin in Urine.

32. Casoni test ? Hydatis cyst.

33. Selivanoffs test ? Fructose in urine.

34. Xanthoproteic test ? Benzene Ring.

35 .Zwengers test ?Cholestrol.

40. Millons test?Phenol ( Tyrosine ).

41. Nitroprusside test ? Sulfhydryl test ( Cysteine).

42. Paulys test ?Imidazole ( Histidine ).

43. Sakaguchis test ? Guanidium (Arginine).

44. Ferric chloride test ?PKU.

37. Cyanide Nitroprusside test ? Homocystinuria.

38. A type of glucose tolerance test?
Exton Rose test.

39. Stengers test ? Malingering.