last minute revision.doc

MNEMONICS: Causes of right lower quadrant pain " APPENDICITIS " A ppendicitis/ A bscess P ID/ P eriod P ancreatitis E ctopic/ E ndometriosis N eoplasia D iverticulitis Intussusception C rohns Disease/ C yst (ovarian) IBD T orsion (ovary) Irritable Bowel Syndrome Stones BISHOPS SCORE: Scoring ■ Cervical Dilation 1. Cervix dilated < 1 cm: 0 2. Cervix dilated 1 -2 cm: 1 3. Cervix dilated 2 -4 cm: 2 4. Cervix dilated > 4 cm: 3 ■ Cervical Length ( Effacement) 1. Cervical Length > 4 cm ( 0 % effaced ) : 0 2. Cervical Length 2 -4 cm ( 0 to 50 % effaced ) : 1 3. Cervical Length 1 -2 cm ( 50 to 75 % effaced ) : 2 4. Cervical Length < 1 cm (> 75 % effaced ) : 3 ■ Cervical Consistency 1. Firm cervical consistency : 0 2. Average cervical consistency : 1 3. Soft cervical consistency : 2 ■ Cervical Position 1. Posterior cervical position : 0 2. Middle or anterior cervical position : 1 ■ Zero Station Notation ( presenting part level ) 1. Presenting part at ischial spines -3 cm: 0 2. Presenting part at ischial

spines -1 cm: 1 3. Presenting part at ischial spines + 1 cm: 2 4. Presenting part at ischial spines + 2 cm: 3 Modifiers ●Add 1 point to score for : 1. Preeclampsia 2. Each prior Vaginal Delivery ●Subtract 1 point from score for : 1. Postdates Pregnancy 2. Nulliparity 3. Premature or prolonged Rupture of Membranes Interpretation ★★Indications for Cervical Ripening with prostaglandins 1. Bishop Score < 5 2. Membranes intact 3. No regular contractions ★★Indications for Labor Induction with Pitocin 1. Bishop Score >= 5 2. Rupture of Membranes MNEMONICS: ★★ SIGNS OF PREGNANCY★★1st trimester George Bush’s Social Conscience Focuses From Pathetic Humor Upto Violent Heavy Poetry About Prime Minister Of Jailhouse Camp G=Goodell’s sign B=breast signs S=sonography C=cervical changes F=fatigue F=frequency of micturition P=Palmer’s sign H=Hegar’s sign U=uterine changes V=vaginal wall H=hCG levels P=Piskacek’s sign A=amenorrhea P=placental sign

M=morning sickness O=Osiander’s sign J=Jacquemier’s sign C=crown rump length 2nd trimester Bush’s Cheap Stunt For Reelection, Focused Upon Firing At Baghdad’s Locals & Society, Backfired Since Army Behaved Questionably B=Breast changes C=chloasma S=sonography F=fundal height R=radiological signs F=fetal parts palpated U=uterine changes F=FHS A=amenorrhoea B=Braxton Hicks Contractions L=linea nigra S=striae B=ballottment S=soft cervix A=active fetal movments B=blue cervix Q=Quickening 3rd trimester Feeling Freed By Firing Field Focused Completely Upon Foreigners in Baghdad, American leaders & Society Slept. F=frequency F=fetal movement B=breast changes F=fundal height F=fetal movements F=fetal parts palpated C=cutaneous changes U=uterine shape F=FHS B=Braxton Hicks contractions A=amenorrhoea L=Lightening S=Symphysis Fundal Height S=sonography

MNEMONICS: Rashes : time of appearance after fever onset "R eally Sick C hildren M ust T ake N o E xercise": ●Number of days after fever Onset that a Rash will appear: 1 Day: R ubella 2 Days: Scarlet fever/ Smallpox 3 Days: C hickenpox 4 Days: M easles (and see the Koplik spots one day prior to rash) 5 Days: T yphus & rickettsia (this is variable) 6 Days: N othing 7 Days: E nteric fever (salmonella) mc heart disease in pregnancy...... MSD worst prognosis...... ASD doc for. eclampsia.... labetalol eclampic seizure due to..... cerebral anoxia dangerous placenta previa..... central with post type 2 expulsion of 500 gm n before 20 wks called..... abortion mc complication of 3rd stage of labour...... hemorehgeic shock doc for liphoid nephrosis...... steroid mc pelvic tumor..... fibroid anticoagulant of choice in 1 st trimester...... heparin 1. sensation lost in syrngiomalia..... pain n temprature 2. unilateral swealing of leg in female.... can cervix 3. normal cross sectional area of mitral valve.... 0.4 4. SAAG. associated with...... asitic fluid 5. In primary PTB affects which part of lungs..... periphery 6. most abundant antioxidant...... vitamin e 7.Tiger mosquito is another name of..... ades 8.building block of fatty acid bio synthesis..... acetyl choine 9.dose of hepatitis vaccine ...... 05 ml im 10.maximum student allowed in a class....40

1.Strangulated hernia TOC..... hernioraphy 2. Night made in which phase ....BERM 3. Baby can swallow in which age '''''' plz ans

4. Acute hemiarthrosis TOC.... evacuation 5. TOC choledocolithiasis .....ercp 6. In TAH which structure should removed n which may preserve ...uterus n cervix, preserved ovary 7.TOC for non descended testis in children .....orchidopexy 8. TOC for Prolapse rectum ......rectopexy 9. Wat is MIPH..... minimal invasive procedure for hemoraidectomy 1.glue ear is a complication of -pre-suppurative stage of acute suppurative otitis media 2.child with glue ear have--adenoid hypertrophy 3.adult with glue ear have_nasopharynx carcinome 4.acute suppurativ otitis media--infection less then 3 week'' 5.glue ear--infection for 2-3 months 6.chronic suppurativ otits media--infection mor ethen 3 months 7..mc graft used in myringoplasty:temporal fascia 1.kussmaul sign--rise in JVPon inspiration.it's seen in some form of heart disease and is usually indicative of limited right ventricular filling. 2. kussmaul disease---its another name for polyarteritis nodosa 3.mc cause of pigment stone in gallbladder: hemolytic anemia 4.ear wax--sebum + cerumin+dust 5.landmark of tympanic membrane--umbo 6,reliable landmark of tympanic membrane--handle of malleus 7.position of umbo on tympanic membrane--right side is 5 o clock left side is 7 o cloick 8.abscess in digastric muscle--citellis 9.abscess in sternocleidomastoid muscle--benzold 10.mastoiditis on x-ray--clouded or sclerosed 11.nerves of stapedial reflex--facial.n [efferent],,,vestibocochlear.n 12.nerve supply of tensor tympani--mandibular.n

13.mcc of hearing loss in children--glue ear or serous otitis media 14.singapore ear? --another name of fungal otomycosis by aspergillous niger 1.goodells sign--is the first sign of pregnancy at 6 weeks 2.chadwick sign aka jackmear sign.seen at 8 week 3.osianger sign seen at 8 week 4.hegars sign--isthmus empty on bimanual examination..seen at 6 -10 week 5.piscack sign--asymetric enlargement of uterus amniotic fluid in terms...... 800 ml blood volume during menstruation .... 50 ml fertilization occurs at......ampula zygte reaches uterie cavity..... 16 celled CVS done at..... 10- 12 wks rythemic contraction of uerus.... palmers sign cyanosis n softing of uterus....goodell's sign pulsation lateral vaginal fornix........osiander sign congestion peviscausin lush of vaina.....Chadwick sign if CVS done before 10 WS results in...oroandibular defect DOC for brain cancers ---> Nitrosoureas (e.g. lomustine, carmustine). DOC for trypanosoma cruzi (CNS stage) ---> Milarsoprol. DOC for epilepsy ---> Phenytion. DOC for CMV retinits ---> Gancyclovir (anti viral). DOC for vomiting in-patient with migraine ---> Prochlorperazine Drug of choice for Schizophrenia is Phenothiazines (e.g. Chlorpromazine/Haloperidol) *DOC for Multiple Myloma-- Bortezomib * DOC for CLL-- Fludarabin * DOC for Brain Tumors- Temozolamide * DOC for Pancreatic Carcinoma-- Gemcitabine * DOC for Choriocarcinoma¬- Methotrexate * DOC for Colorectal cancer-- 5-FU *DOC for Hairy Cell Leukemia- Cladribine *Drugs of choice for Wenger's granulomatosis-¬- Cyclophosphamid¬e DOC for spasmodic abdominal pain ---> Drotaverine (Dortin, Droteva) Doc for diarrhea in pregnancy?loperamide Q. Methadone is useful in the treatment of heroin dependence because it : acts on the

opioid receptor Doc for acute gout:indomethacin[nsaids] Antihypertensives contraindicated in pregnancy :pneumonic --- DARSAN --D = Diuretics A = Angiotensin I antagonists R = Reserpine S = Sodium nitroprusside A = ACE inhibitors N = Non selective β blockers ANTI DOTES 1. acetaminophen - acetylcycteine 2. benzodiazepine - flumazenil 3. coumadin - vitamin k 4. curare - tensilon 5. cyanide poisoning - methylene blue 6. digitalis - digibind 7. ethylene poisoning - antizol 8. heparin - protamine sulfate 9. iron - desferal 10. lead - edetate disodium (edta), dimercaprol (bal), succimer (chemet) 11. lovenox - protamin sulfate 12. magnesium sulfate - calcium gluconate 13. morphine sulfate - naloxone hydrochloride 14. methotrexate - leucovorine 15. mestinon - atropine sulfate 16. neostigmine – atropine fishy smell, cottage cheesy discharge..... bacteria vaginosis ocp pil for lactating mother .....minipil which ca can prevented by vaccine .. ca cervix TOC for prolapse uterus in young ..... sling operation when blastocytes in uterus cavity...... cent implantation whiff test positive in.. bacteria vaginitis cystocele.... prolapse of upper 2/3rd vaginal wall decubitus ulcer due to...... venous congestion pomegry operation....isthamus n ampula portion mc site for genetial tuberculosis.... fallopian tube aviator fracture...... neck of taslus hangman fracture......fracture both Pedicle's of c2 jeffron fracture. ....brust feature cervical 1

Heinz bodies.......G6PD deficiency hirano body......alzemer's diseases moot body.....multiple myeloma ca 19-9.....pancreatic n colorectal cancer can 15-3.....breast cancer ca 72-4... pancreatic n ovarian cancer S-100 n TA- 90......Melanoma action of serrataur anterior...... pushing n punching moa of paroxetine...... SSR inhibitor indication of atomoxetine.......ADHD minimum duration to define schizophrenia...... 6 months linear balance organs of body.......urticle n saccule griesinger sign seen in ......LST vibrating area of tympoanic membrane....... 55 sq mm Mc agent in acoustic neurons.......k ozanae purpose of perimetry......field of vision cilliary muscle developed from......paraxial mesoderm cradel cap.......ptiyriasis capttis lisch nodule.....neurofibromatosis CVS,lymphatics.blood develops from..... mesoderm angel of Louis.....2nd rib alderman's nerve......auricular branch of vagus shrugging of shoulder..... trapezius Carina in adult lies in..T4 action of anconeus...... screwing movement artery accompany with radial nerve in spiral groove..... profunda brachii cubital tunnel syndrome..... ulnar nerve things speaks for it self......red IPSA loquitor pincer grasp comes at..... 9 months berloque dermatitis due to...... cosmetics effect of intubation on dead space..... decreased allen'stest.,....integrity of palmar arch diagnosis made for as topic dermatitis....clinical evaluation vagabond's diseases also known as....pediculous corporis rose spot seen in.... typhoid fever 5% guanethidine used in.....thyrotoxic opthalmopathy hyper secretory glaucoma seen in..... epidemic dropsy forniuos gangrene occurred only in....... scrotum testis entered to inguinal canal by..... 7 the week chronic lead poisoning leads to..... fine tremors peptic perforation...... D1 TOC nocturnal regurgitation....... domparadon

kher's sign is positive in..... meningitis burgen's diseases related to...... smoking in total abdominal hysterectomy..... uterus n cervix r removed TOC for D1 perforation........ closure n omentoplasty PSA related to...... CA prostate furasol DA is used to..... increase oxygen delivery to tissue bilateral retino blastoma......30%- 40% cases string bed appearance.,..,,fibromuscular dysplkasia peeper pot skull......hyper para thyroidism looser zone....osteomalasia notochord devlopes in..... 3rd week fiction of cilliary muscle....... accommodation germinal center...... lymph node apex heart formed by,.,....,left atrium early onset n worst prognosis in.....,,hebephrenic schizophrenia can pennies..... adeno wardimayo ..... prolapse or complete procedentia IOC pleural effusion.... ct scan 25 % dextrose n insulin..... DKA DKA occurs in mostly type 1 DM fracture pennies...... repair at the fracture site with vicryl TOC for non decended testis..... orchidopexy criteria for HD... hyperkalemia...pulmonary odema. Anuria more than 24 hr anti dote for organophosphorus.... inn pam 1.Argyll Robertson pupil seen in - neurosyphilis 2.marcus gunn pulil seen in - optic neuritis 3.adies pupil seen in - post viral illness un young female 4.hutchinson pupul - cause 3 rd nerve compression 5.protanopia- red colour defect 6.deutranopia- green colour defect 7.tritanopia-blue colour 8.colored halos seen in - 1 cataract,2 angle closure glaucoma,3 mucopurulent conjunctiva. 9.wrist drop caused by- a.lead poisoning,b.radial nerve palsy. 10.musician nerve- ulnar high peptic structure seen in...... Barret's oseophagus rotation of volvulus sigmoid colon....on its own axis sign of dance...... empty RIF frog hand seen in .....deep palmer abcess crisoid anerusym..... pulsating swealing of artery in fore head teddy bear walk m/c seen in.... chr rheumatoid arthritis knee

late dumping syndrome....!. after 2 hr TOC prolapse rectum..... rectopexy horse shoe fistula TOC.....high end excision m/c/ of retrobulber neuritis........... multiple sclerosis proptosis cause............1. grave's dz 2.tumor of child m/c/c of extraoccular tumor of child........rhabdomyosarcoma m/c/c occulatumor of child......... retinoblastoma dangerous area of eye.......ciliary body m/c muscle involved graves dz........ inf rectus most characteristic sign of graves dz...... stare sign cycle occurs in RBC.....glyocolysis Reticulocytes are not seen in..... chr anaemia sinus not drain in to middle meatus .....post ethmoidal OKA star in used for.... variscella Duffy antigen found in..... falciparum malaria soot in trachea..... thermal injury placenta has.... 2 artery n 1 vein best place for IOL..... capsular bag GCS for intubation...... 7 cervix erosion can be mix interpritted with CaCervix.... TB cervix ### MEDICINE ### @ damage to caudate nucleus - chorea @ damage to globus pallidus - athetosis @ damage to subtahalamic - hamiballismus @ damage to basal ganglia damage ( substantia nigra ) - parkinsonism @ damage to lower motor neurons ( anterior horn cell damages) - poliomyelitis @ anacrotic pulse ( pulsus pardus- slow rise and ET parvus - decreased amplitude) aortic stenosis @ bisfireins pulse - HOCM @ collapsing pulse - AR ( aortic regurgitation ) @ dicrotic pulse - dilated cardiomyopathy @ pulsus alterans - LVF @ DICROTIC NOTCH - aortic competence @ large A wave - Tricuspid Stenosis, - Pulmonary Stenosis , - Mitral Stenosis, - Pulmo Art Hypertension ( scleroderma and eisenmenger complex) - TOF, - ebstein anomaly ( WPW syndrome )

@ absent A wave - atrial fibrillation @ absent X wave - tricuspid regurgitation @ CV wave and steep Y descent - severe tricuspid regurgitation @ absent Y wave - Pericardial effusion ( cardiac temponade ,becks's triad ) @ canon A wave - complete heart block @ (m/c) lateral wall MI - Left CircumfleX art @ right ant wall MI - LeftAnterior Descending art @ extensive ant wall MI - Left main CA @ post wall MI - PDA @ inf wall MI - RCA @ acute pericarditis - ST elevation ( concave ) - pericardial friction rub - chest pain - treat the cause @ pericardial effusion :- electrical alterans - money bag and water bottle app - low voltage ECG ( non specific ) - TOC - echocradiography @ cardiac temponade :- beck's triad - hypotension, muffled Heart sound,congested neck vein - pulsus paradoxus + electrical alterans * other causes of Pulsus paradoxus - calcification ( constrictive pericarditis ), inf wall MI,pulmonary emobolism, status asthamaticus, COPD @ constrictive pericarditis - calcification - kussmual's sign - square root sign - pericardial shudder - pulsus peradoxus @ m/c benign brain tumor in adults - meningioma @ m/c brain tumor in child Cerebller astrocytoma @ m/c benign brain tumor in children - craniopharyngioma @ mc type of seizure in adult - GTCS @ mc type in children - febrile seizure @ mc type in adolescents - juvenile myoclonic epilepsy @ mc type in neonates - subtle seizures @ anti- B2 gylcoprotein AB - antiphospholipid antibody syndrome @ anti- ccp - rheumatoid arthritis @ Ds- DNA - SLE @ Anti- topoisomerase - Scleroderma @ anti centromere - CREST SYNDROME @ SSA AND SSB - sicca syndrome @ HLA B51, HLA B5 - behcet's disease

@ M/C/C of meningitis in neonates - GBS and in india - E.COLI > klebsiella @ M/C/C of meningitis pediatrics - S.pneumonia @ M/C/C of meningitis in adulti - S.pneumonia ( in sporadic ) - if ask in epidemic meningtis then it will be - N.meningitides. @ narrow split ( s2) - aortic stenosis, HOCM , LVF ( PDA ) @ wide split S2 - MR,VSD,ASD ( wide fixed split S2) @ fixed split s2 - ASD - DOWN SYNDROME - LUTENMBACHER SYNDROME - TAPVC ( CAUSES OF ASD HENCE CAUSES OF fixed splite s2 ) @ SAN - sick sinus syndrome @ AVN - complete heart block @ BOH - mobits 2 block @ S3 - physiologic,dilated HF ,P.shudder @ @ bundle of kent - Abberant conduction - hall mark of WPW syndrome. ### MEDICINE NOTE 2 #### @ MASSIVE PULMONARY EMBOLISM. - post surgical..iliac and gynec sx # cor-pulmonale- PAHTN, RV failure,hepeatomagely. # ECG - deep S1 = lead 1 - dilation of RV ( DEFECTIVE DEPOLARISION) - DEEP Q WAVE IN LEAD3 - INVERTED T WAVE IN LEAD 3 P/E findings - loud S1, wide fixed split, S3 ventricular gallops IOC - spiral CT or V/P scan X- ray findings - westermark signs, hampton sign. Tx - thrombolysis. @ mycoplasma causes paroxysmal cold hemoglobinuria by auto ab against RBC ( donath landstainer ab ) with atypical pneumonia @ legionella casues SIADH with pneumonia @ klebsiella pneumonia - bulging fissure sign Tx - cefotaxime+amikacin ( IV ) @ interstitial pneumonia caused by P.Jiroveci in HIV pt. Tx - cotrimoxazole. @ papillary cancer thyroid - a/w RET or NTRK1 or BRAF and ionizing rad - histopath :- psammoma bodies and ground glass or orphan annie eye nuclei ( pseudoinclusions ) @ follicular caner of thyroid - a/w RAS onco gene and N-RAS @ DOC for atrial fibrillation :- acute - ESMOLOL and chronic - digoxin @ DOC for PSVT - adenosine @ prophylaxis for PSVT - verapamil @ DOC for ventricular tachycardia :- lignocaine and prophylaxis - amiodarone @ TOC for Ventricular fibrillation - cardioversion and DOC- Lignocaine/bretylium @ DOC for WPW syndrome - flecainide and definitive treatment - laser ablation @ DOC for torsades de pointes - mgso4 and prophylaxis - propanolol @ DOC FOR digitalis induced V.A :- LIGNOCAINE[/b]

## IMP cardiovascular system radiology features :@ Shoe-man boot shaped heart ( cor-en sabot ) :- tetrology of fallot @ ' figure of 3' appearance of aortic knuckle : coarctation of aorta @ money bag/ leather bottle/ flask shaped heart :- pericardial effusion @ banana-shaped left ventricles :- Hypertrophic cardiomyopathy @ ' Egg-on-side' appearance :- Transposition of great arteries ( TGA) @ 'Snow-man' / ' figure of 8' appearance :- total anomalous pulmonary venous drainage ( TAPVC) @ Hilar dance ( fluorocscopy ) :- atrial septal defect @ ' Pruned tree' appearance :- Pulmonary arterial hypertension @ Stag-angler's sign :- mitral stenosis @ Box shaped heart - ebstain's anomaly Crocodile skin - icthyosis vulgaris, absence of stratum granulousum. Hous keeping - S.basale Palm and soles only - s.lucidum. Epidermal turn over time normal - 28 Psoriasis - 4 days Flat cells w/o any neucleus - s.cornuim 80-90 % - keratinocytes Melanocytes- synthesised melanin - s.basale Langerhans cells - antigen presenting cells- immunologically active cells- s.spinosumhorse shoe shaped - bone marrow - migratory cells Merkel cells - mechanoreceptors Saw tooth - lichen planus Rete ridges elongation - psoriasis Edema sub cutaneous - angioedema Sweat gland - eccrine gland,apocrine Most abundant palm and soles - sole Most of over body sweat gland Eccrine in nature Molls gland, cerumin gland Inflammation of eccrine sweat gland - milariasis Inflammatiom of apocrine - fox fordyces spot - axilla Sweatgland controlled by preorbital area. Sebaceous gland - all over the body except - palm and soles Attched hair follicles - pilo sebaceous unit Exception isolated - fordyces spot Oral mucosa and lips - most common anatomy notes for fmge must read 1 million - body hair 1 lakh - skull hair Skull hair - 0.4 mm

Beard - 0.2 mm Pubes - 0.1 mm Axilla - 0.2 mm Imp points of anatomy 》 Medial epicondylitis - golfer's elbow 》Lateral epicondylitis - tennis elbow # carrying angle - b/w long axis of arm and long axis of forearm 》female - 14 degree 》Male - 11 degree 》Pulled elbow - head of the ulnar bone pulled out from annular ligament 》Superior and inferior radioulnar joints are pivot 》Supinator - bicep brachii,musculo cutenous nerve 》Pronator - pronator teres and pronetor qudratur 》Flexion of the elbow - bicep brachii,brachialis,brachioradialis 》Extension - tricep brachii 》M/c type of # supracondylar frcture 》Wrist join - synovial joint of ellipsoid 》Pissiform - ossifies 12 yrs of age 》Capitate - largest bone; 2nd month of life 》Hamate - 3rd mnth 》Triquetrum - 3rd mnth 》Lunate - 4th 》Scaphoid,trep,trep - 5th 》Carpometacarpal joint - 1st - saddle ; 2nd to 5th - ellipsoid 》MCP - CONDylar 》Ip - hinge 》M/c # of carpal bone - scaphoid 》Prox seg of scaphoid - 2nd m/c avascular necrosis 》Femur m/c avscular necr 》Lunate - mst commonly dislocated 》CTS - median nerve injury

Anatomy of scapula ¤ Access of rotation is pass by inf angle ¤ Rotation of scapula decide by inf angle ¤ Shoulder joint - ball- socket joint ¤ Glenoidal labrum - fibro cartilage attched at the margin of the glenoid ¤ Supraglenoid tubercle- long head of bicep brachii ¤ Infraglenoid tubercle - longhead of tricep brachii ¤ Supraspinous fossa - same but muscle

¤ Imfraspinous fossa - infraspinous muscle ¤ Abduction at Shoulder joint 0-15 :- supraspinous muscle 15-90 :- deltoid muscle >90 :- SERATOUS ANT MUSCLE # related nerve to humerous - axillary nerve - radial nerve - ulnar nerve - behind the medical epicondyle ¤ Radial groove - radial nerve , profound brachii - nutrient artery of humerous bone Anatomy humerous Greater tubercle - supraspinous muscle - infraspinous muscle - teres minor Lesser tubercle - sub scapularis Shoulder joint - tendency - inferiorly Disclose most common at anteriorly Lips of humerous :- medial groove- teres major Lat lip - pectoralis major Latissismus dorsii floor of the groove fracture and treatment imp points 1) Humerus shaft# - CR & U Cast 2) Suprascapular# - CRIF with K wire 3) shoulder dislocation: kocher's method 4) lat. Condylar# - ORIF with K wire 5) elbow dislocation: CR 6) Indirect# - ORIF with TBW 7) Radial head# - CR/ ORIF 8) Pulled elbow: CR by supination 9) both bone forearm# :ORIF with plate (adult) CR & A/E cast (child) 10) colles# :- CR & Colles cast 11) lunate dislocation:- ORIF 12) Femur neck# :- CRIF with pin/screw 13) Femur intertrochanter# :- CRIF with DHS/PFN

orthopedics 》Duputytren'contracture - palmar aponeurosis contracture 》Tennis elbow - lateral epicondyle 》Golfer's elbow - medial epicobdyle Bursitis - bursa 》Tenosynovitis - synovial lining of tenon sheath 》Carpal tunnel syndrome - median nerve compression 》Frozen shoulder - joint capsule 》Meralgia paraesthesia - entrapped lateral cutaneous nerve 》Austin-moore prosthesis - fracture neck of femur 》Kirschner wire - small bone fixation 》Kuntscher nail - fracture shaft of femur 》Bankart' s procedure - recurrent dislocation of shoulder 》Dwyer's osteotomy - CTEV 》meyer's operation - fracture neck of femur 》Thomas splint - immobilisation of hip and thigh injuries 》Cock up splint - radial nerve palsy 》Von rosen' s splint - congenital dislocation of hip 》Dennis brown splint - CTEV 》Milwaukee brace - scoliosis 》Gallow's traction - fracture shaft of 》femur ( age below 2 years ) 》Hip spica - # shaft of femur 》Russel's traction - trochanteric fracture 》Frog's cast - cong dislocation of hip 》Batchelor's hil - cong dislocation of hip 》Hanging cast - # shaft of humerus 》Minerva jacket - immobilization of cervical spine biochem notes Mycophenolate - block IMP - DH in purine synthesis by denovo and thats how blocks B and T lymphocytes 6MP - inhibit adenylo succinate and imp-dh in purine synthesis by denovo synthesis Both drugs are antineoplastic Allopurinol - inhibit xanthine oxidase in the step of xanthine to uric acid in purine metabolism End product of purine in human being is uric acid End product of protein in human is urea Allantoin - end product of purine in non primates Adenine deaminase def can cause SCID Purine metabolism disorder :Gout - mono na+ urate Psuedo gout - ca+2 pyrophosphate SCID - ADA deficiency Lesch-nayan syndrome - lack of nucleotide salvage pathway Complete def of HGPRT

Kelley siegmiller syndrome - incomplete deficiency of HGPRT Von-gierke syndrome - g6pase def

genetics #Autosonal dominant# *Vo- von willebrand disease *Familial- familial adenomatus polyposis *Hypercholsterolemia- familial H. *Autosomal- adult polycystic kidney *D- dystrophic myotonica *O- osteogenesis imperfecta *M- marfan syndrome *I- intermittent porphyria *N- NF 1 *A- achondroplasia *N- NF 2 *T- Tuberous sclerosis *H- huntington disease & hereditary spherocytosis *E- ehler danlos syndrome #Autosomal recessive# *Fried- friedrich's ataxia *Poori- phenylketonuria *And- albinism *Garam- galactosemia *C- cystic fibrosis *H- hemochromatosis *A- alfa1 antitrypsin deficiency *W- wilson disease *A- alkeptonuria *L- lysosomal & glycogen storage disease *M- muscular atrophy *A- adrenal hyperplasia *S- sickle cell disease *T- thalesemia *Hai- homocystinuria #X link recessive disorder# *Less- lesch nyhan syndrome *H- hemophilia A, B & hunter syn. *C- chronic granulomatus disease

*G- G6PD def. *Detected- duchhene muscular dystrophy & diabetes insipidus *Clinically in- color blindness *A- agammaglobulinemia *Fragile- fragile x syn. & fabry disease *Woman- wiskott aldrich syn. #X link dominant disorder# *Hypophosphatemic type of vit D resistand ricket *Incontinentia pigmenti *Oro facial digital synd. *alport syndrome FORENSIC Mercury poisoning Black TEA P Le Black - black blue line on gums T - tremors- danberry/hatter/glass bowler E - Erethism A- acrodynia P - PCT mainly involved,pink disease Le- lentis/mercuria lentis LEAD poisoning New- neuropathy & nephropathy A - anemia with punctate basophilia B - burtonian or blue stippled lead line C - colic & constipation D - dry belly ache E- encephalopathy F - facial pallor poisoning and antidotes Dhatura - physostigmine Organo phosphate - atropine Arsenic - hydrated ferric oxide,calcium sodium edetate. C/i alkali Phosphorous- cuso4 Murcury - sodium formaldehyde sulfuresylate H2So4 - Mgo HCN - amiline nitrite(inhalatiom) +sodium nitrite+soduim thiosulphate

Lead - calcium sodium EDTA Carbolic acid ( phenol ) - gastric lavage, chelating agent Opium - naloxane Oxalic acid - calcium gluconate Cu poisoning - K+ ferro feri cyanide Snake venom - antidote - made from common krait, cobra, russel viper,saw scale viper. Methyl alcohol - hemodialysis - fomepizole - ethyl alcohol Strychinine poisoning - benzodiazepines Aconite - activated charcol IMP points in toxicology Deliriant poisons- dhatura-road poisoning- 100seeds-physostygmine @ cannabis sativa/tetra hydro cannabinol-charas is most potent form @ bhang - dried leaves @ ganja - flowering tops of female plant @ charas- resinous exudate @ majoon - sweet part of plant @ oxalic acid - coffee ground vomitus @ phenol - white leathery appearance of stomach mucosa - carboluria - ochronosis @ nitric oxide - xanthoproteic reaction @ arsenic - aldrich mees line,cholera,addison disease,raindrop pig,red valvety mucosa encapsulated bacteria A common mnemonic used to remember some encapsulated pathogens is: "Even Some Super Killers Have Pretty Nice Capsules" Escherichia coli, Streptococcus pneumoniae, Salmonella Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Neisseria meningitidis, Cryptococcus neoformans. microbiology # Virus - 20 - 200 nm # 20nm - parvo virus # 200nm - chicken pox # Joshep lister - antiseptic measure to prevent surgical sepsis

# Antony van leuwenhoeck - founder of microscopy # Karry B. Mullis - discovered PCR # Paul ehrliich - acid fast stain # Robert koch - father of medical microbiology # Louis pasteur - known as father of microbiology Microbiology High yeild notes..!!! ####### virology ####### ○MCC common cold/ URTI: >Rhino virus ○MCC bronchiolitis child: >RSV ○MCC laryngotracheobronchitis/croup/ barking cough: >parainflenza virus ○MCC aseptic meningitis: > enterovirus ○ MCC aseptic meningitis world: >echovirus ○ only single stranded DNA virus: > Parvo ○ nOn envelop DNA virus > parvO > papOva > adenO ○ only DNA virus w/ comp. symmetry > pox » enveloped virus ○ only double stranded RNA virus: > reo virus ○ virus undergo antigenic shift or genetic reassortment: [ABO & Rh grp] 1) Arena virus 2) Buniya virus 3) Orthomyxo virus= influenza (MC) 4) Reo= rota virus ○ viral diarrhea :

causes: * DNA virus cause- ADeNo virus * RNA virus Cause- [RNA C] 1) Rota 2)Norwalk 3)Astro 4)Calici

@@@ virulance factor Capsule and slime layers 1) S.pneumoniae 2) H.influenza 3. Klebseila 4. N.meningitidis 5. E.coli 6. Cryptococcus Antiphagocytic surface 1.S.pyogens M protein 2.N.gonorroeae pili 3.S.aureus protein A Obligate anerobes Actinomyces,bacteroids,clostridium #### exotoxin and bacteria tox mechanism- bacteria name C.diptheriae - protein synthesis inhibitor P.aeruginosa - same S.dysenteriae - same EHEC - Same C.botulinum - neurotoxin - flaccid paralysis - blocking of inhibitory neurotransmittors C.tetanus - neurotoxins - spastic paralysis Super antigen - s.aureus; s.pyogenes; cAMP - ETEC, v.cholerae,B.anthracia,B.pertusis, Cytolysin - C.perfringens, S.aureus. ______________________________________________ Apple jelly nodules-Lupus vulgaris Anchovy sauce pus - amoebic

abscess Bunch of Grapes-Ethmoidal polyp Chinese fried rice-B.cereus Champagne glass pelvis-Achondro plasia Champagne leg deformity-Varic ose vain Cherry red lip- CO poisoning Cauliflower ear-Hamartoma Chocolate cyst - endometriosis Dinner Fork deformity-Colle 's Fracture Egg on side appearance-TGA Egg cell calcification-S ilicosis,Sarcoi dosis Egg on string - transposition of great vessels with intact ventricular septum Fried egg colony-Mycoplasma Garlic smell-Arsenic poisoning. Honey comb lung - pulmonary fibrosis Honey coloured crusts-Impetigo Contagiosum Inverted cups- Large intest Obstruction Nutmeg liver - CHF Onion skinning - ewings sarcoma Port wine stain - hemangioma Pea soup diarrhea-Typhoid Potato nose-Rhinophyma Popcorn cells-HL(5th type-Nodular lymphatic predominant) Popcorn calcification-P ulmonary hamartoma Red current jelly stools-Intussus ception Rice water diarrhea-Cholera Red current jelly sputum - klebsiella Salt n pepper Retinopathy-Con genital Rubella Syndrome Strawberry polyp-Rhinospor idiosis Strawberry tongue - kawasaki , scarlet fever , toxic shock syndrome Tomato ketchup fundus-CRVO Pathology Must know "bodies"..!!!!

1) Asteroid bodies - Sporotrichosis 2) Councilman bodies - Yellow fever 3) Torres bodies - Yellow fever 4) Leishman’s Donovan’s bodies - Kala Azar 5) Halberstaedter -Prowazek’s bodies - Trachoma 6) Miyagava's bodies- Lymphogranuloma venereum 7) Levinthal-Cole-Lillie bodies – Psittacosis Negri bodies (intracytoplasmic, intra neuron, hippocampus) - Rabies 9) Guarnieri's bodies - Vaccinia (intracytoplasmic) 10) Bollinger's bodies - Fowl pox (intracytoplasmic) 11) Henderson-Peterson's bodies - Molluscum contagiosum 12) Cowdry type-A bodies - Yellow fever, Herpes virus infection 13) Cowdry type-B bodies - Adenovirus, Poliovirus (code-BAP) 14) Aschoff's bodies - Rheumatic fever 15) Russell’s bodies - Multiple myeloma ( Intranuclear ) 16) Schaumann’s/Conchoids bodies (calcium & iron complexes) - Sarcoidosis & Berylliosis 17) Asteroid bodies (eosinophilic inclusions) - Sarcoidosis 18) Call-Exner bodies - Granulosa cell tumor of ovary 19) Verocay bodies - Neurilemmoma 20) Civatte’s (colloid) bodies - Lichen planus 21) Michaelis-Guttmann's bodies - Malakoplakia 22) Lewy bodies - Parkinson's disease 23) Lafora bodies - Familial myoclonus 24) Hirano bodies - Alzheimer’s disease 25) Weibel-Palade bodies - storage organelles of von Willebrand’s factor in platelets & endothelium 26) Pappenheimer bodies – non heme iron pigments in siderocyte 27) Howell-Jelly bodies - splenectomy , Megaloblastic Anaemia, Hemolytic anaemia 28) Hectoid bodies - Sickle cell anemia 29) Heinz bodies - thalassemia 30) Döhle bodies - cytoplasmic inclusion bodies in neutrophils seen in bacterial infection 31) Histiocytosis-X(HX)(Birbeck's granules) - Histiocytosis-X 32) Gamma-Gandy bodies - Congestive splenomegaly 33) Mallory's bodies - hyaline inclusions in hepatocytes seen in alcoholic, indian childhood cirrhosis.. 34) Apoptotic bodies - membrane bound spherical structures in Apoptosis 35) Psammoma bodies - dystrophic calcification in meningioma, papillary serous cystadenoma of ovary & papillary carcinoma of thyroid, papillary type of RCC. 36) LE bodies (hematoxylin bodies) - SLE 37) Dumbbell shaped Asbestos bodies - asbestos fibres coated with glycoprotein & hemosiderin.

stained with Prussian blue stain 38) Luys body - subthalamic nucleus 39) Davidson’s body - sex chromatin in neutrophils (dumbbell shaped) 40) Herring bodies - pars nervosa of pituitary gland 41) Donovan body - Granuloma inguinale 42) Nissl’s bodies - cytoplasmic inclusions in neurons 43) Moser’s bodies - Typhus fever 44) Lipschütz' bodies - intra nuclear inclusions in herpes simplex infection 45) Zebra bodies - cytoplasmic inclusions in schwann cell degeneration 46) Babes-Ernest metachromatic granules - Diphtheria 47) Reilly’s bodies - Hurler's syndrome 48) Gamma-Favre bodies - LGV 49) Winkler's & Ross's bodies - Syphilis 50) Sandström’s bodies - Parathyroid gland 51. Councilman Bodies = HEP B ( dying hepatocytes ) 52. Feruginous Bodies = Asbestosis 53. Heinz BODIES = G6PD DEF 54. Pick BODIES = PICKS D/S 55. Creola BODIES = Asthma 56. Odland BODIES = Keratinosome 57. Rushton BODIES = Odontogenic CYSTS 58. Zebra BODIES = Metachromatic Leukodystrophy, Niemann Pick's Disease. 59. Brachy Wächter Bodies = Infective Endocarditis 60. Globoid bodies = Krabbes disease 61. Alder - Reilly Bodies = coarse azurophilic granules in the leukocytes in ALDER REILLY SYNDROME. 62. Bodies Of Arantius = aortic valve nodules 63. Verocay Bodies = schwannoma 64. Balbiani's Bodies = yolk nucleus 65. Bamboo Bodies = asbestos bodies 66. Brassy Body = dark shrunken blood corpuscle found in MALARIA 67. Coccoid X Bodies = psittacosis 68. Cytoid Bodies = in degenerated retinal.N fibres. seen in cotton wool spots 69. Harting Bodies = calcospherite in the cerebral capillaries 70. Body Of Highmore = mediastinum testis 71. Masson Bodies = rheumatic pneumonia 72. Mott Bodies = multiple myeloma 73. Donnes Bodies = colostrum corpuscles 74. Oken's Body = mesonephros 75. Paschen Bodies = variola or vaccinia 76. Schiller Duval's Bodies = ENDODERMAL SINUS TUMOUR

77. Residual Bodies = SARCOID AND SARCOID LIKE GRANULOMAS 78. Body Of Highmore = medullary carcinoma of testis 79. Odland Bodies = Flegel’s Disease (i.e hyperkeratosis lenticularis perstans) 80. Red Neurons = Apoptosis Lab values these is imp and should remember..!! ★Total Bilirubin: 0.3 -1 mg/dl Conjugated bilirubin: 0.1-0.3 mg/dl Unconjugated bilirubin: 0.2-0.7 mg/dl ★ALP: 3-13 KAV : 30-120 IU/L [>2x normal in obstruction] [1, >2, >3 & AST,ALT time of fibrin formation from fibrinogen in plasma > done as next step to increase PT & PTT to exclude fibrin formation abnormalities like DIC, afibrinogenemia, amyloidosis, MM, direct thrombin inhibitors and antibodies ★Activated Clotting time (ACT/CT): 80~160 sec > time of clot formation via intrinsic pathway by addition of FXII activators > done intraoperatively to monitor unfractioned heparin therapy during invasive procedure IMP points in pathology NHL>>HL MC HL: Nodular sclerosis(world) : mixed cellularity (india) MC NHL: DLBL Prelukemic: MDS, AA, PNH No splenomegaly: ITP, AA pharma Ia Quinidine Procainamide Ib Lignocaine Phenytoin Tocaimide Ic Encainide Flecainide Propafenone II: beta # III: K # Bretylium Ibutilide Dofetilide Amiodarone

Sotalol IV: Ca # Verapamil Diltiazem V: others Adenosine Digitalis Atropine 1 - fibrinogen 2 - prothrombin 3 - thrmboplastin 4 - calcium 5 - labile factor ( proaccelerin ) 6-7 - proconvertin ( SPCA ) , stable factor 8 - antihemophilic factore ( antihemopholic globulin/ antihemophilic A ) 9 - chrismas factor ( antihemophilic factor B ) 10 - sturart power factor 11 - plasma thromboplastin antecedent ( antihemophilic factor C ) 12 - hagemen factor ( glass/ contact factor ) 13 - fibrin stabilising factor ( laki lorand factor ) ☆Reversible cell injury: Na Hydropic change Myelin figure Reduce protin synthesis Clumping nuclear chromatin ☆Irreversible cell injury: Ca Cell membrane damage Mitochondrial density Karyorhexis Karyolysis Pyknosis ☆Apoptosis Chromatin condensation: pyknosis

Caspase, endonuclease, Cyt-C : intrinsic Fas-L / CD 95 : extrinsic Drug of choice..!! @belladona poisoning and dhatura - physostigmine @plague - streptomycin @hepatic coma - neomycin @dermatitis herpatiform - dapsone @pneumocystis carini - cotrimoxazole @toxoplasmosis - sulfadoxine + pyramethamine @anthrax, thyphoid fever in opd, 2nd DOC prophylaxis of meningococcal meningitis ciprofloxacin @DOC meningococcal meningitis - rifampin @brucella - doxycyclin + rifampicin @lepra reaction - steroides @atypical mycobacterium - Rifabutin + Ethambutol + Clarithro @kalaazar - amphotericin B, stibogluconate and oral - milfefosine @candida, cryptococcus, coccides - fluconazole @aspergillosis - Voriconazole @atropine poisoning - physostigmine @alzheimers disease - donepezil @myesthenia gravis and cobrabite - neostigmine+ atropine @organophosphate, morphine, pontine and phenol poisoning - Atropine @ADHD - methyl phenidate @shock with oliguria - DOPAMINE

## imp chromosomes ### 1.P53 -chr. 17 p, 2.neuroblastoma- chr. 1p 3.vhl - chr. 3p 4.adult polycystic kidney - chr. 16 5.cystic fibrosis - chr.7q 6.wilms tumor - 11p 7.retinoblastoma - chr. 13 q 8.brca 1 -chr.17q 9.brca 2-chr.13 q 10.nf 1- 17q 11.nf 2-chr. 22 q CNS PATHOLOGY..SUPER DUPER..HIGH YIELD..!!!! ### CNS pathology ### @ Neuroectodermal cells are :1) astrocytes 2) oligodendrocytes 3) ependymal cells @ SubacuteSclerosing PanEncephalitis - caused by measles - warthin frankelday giant cells @ Progressive Multifocal Leucoencephalopathy - JC polymo virus - ground glass appearance d/t infection of oligodendrocytes @ Microglial cells - gitter cells - lipid inclusion seen in sudan iv test. @ anterior fossa anomalies - neural tube defect ( m/c) - spina bifida occulta m/c type of NTD +@ lyssenecephaly - a/w trisomy 13 - agenesis of corpus callosum - bat wing deformity @ dandy walker syndrome - 4th ventricle cystic dilatation - increased posterior fossa volume @ arnold- CHiari malformation malformation -due to cerebellar herniation - TECTUM BREAKING a/k/a quadrigeminal plate damage @ CSF formation :lateral ventricles and choroid plexus >> 2nd ventricles >> foramen of munro >> 3rd ventricles >> auqeduct sylvius >> 4th ventricles >> foramen magendie and luschka >> subarachonoid space or vertebral column @ sturge weber syndrome - serpentine calcification a/k/a RAIL ROAD TRACT CALCIFICATION @tuberous sclerosis - CANDLE DRIPPING SIGN - triad of clinical presentations 1) adenoma sebaceoum (shagreen patches) 2) seizure 3) mental retardation @ Neurofibromatosis-2 :- chr-22 -> merlin and shwannomin protein seen

@ Neurofibromatosis-1 - ( chr-17 ) - € diagnostic criteria a) cafe au lait macules b) iris hemartoma ( lisch nodules ) c) axillary or inguinal freckles D) optic glioma E ) neurofibroma F) family member has nf1 @ glioblastoma-multiforme :- pseudopalisading necrosis ( serpentine necrosis and around it there is tumor cells ) @ m/C tumor of brain - metastasis @ m/c primary tumor of brain - glioma if not in option meningioma @ m/c primary brain tumor of pediatric age grp is juvenile pilocytic astrocytoma ( cerebellar astrocytoma) @ sub ependymal germcell astrocytoma - m/c/s of origin is foramen of munro @ huntigton's chorea - chr 4 - trinucleotide repeat mutation of CAG and deposition in intrastriatal areas ( caudate and putamen ) @ intracerebral hemorrhage - CHARCOAT-BOUCHARD ANEURYSM ( lipohyalinosis of vessels ) @ tubercular meningitis - COB-WEB-COAGULUM - M/C/ presentation diffuse meningoencephalitis - m/c/ complication cerebral vessel infarction @ albumino cytological dissociation - gullian barre syndrome @ viral meningitis light microscopy findings 1) microglial nodules 2) perivascular Lymphocyte infiltrates 3) white matter necrosis ( demyelination ) 4) viral inclusion :A) HSV - COWDRY 'A' TYPE - intranuclear B) rabies :- negribodies - intra -cytoplasmic C) CMV :- intracytoplasmic and intra nuclear inclusion @ prion's disease - CLUSTER OF GRAPES LIKE VACUOLES a/k/a spongiotic vacuole @ alzheimer disease :M/E 1) neuritic plaques 2) neurfibrillary tangles - tau protein collection 3) granulo vacuolar degener-ation of neurons 4) Ab type of amyloid deposition 5) hirano body (alpha actin prt ) @ pick's disease :- thin wafer like gyrus a/k/a knife edge appearance, balloned neurons @ hydrocephalus-x vacouls a/w AD and pick's disease @ parkinsons disease - lewy body ( alpha synclein protein )

Reflux esophagitis/ GERD: >fundoplication > str. Squamous change to int. Columnar epithelium ★ Achalasia cardia >Myotomy >bird beak appearance ★ Barret esophagus >rat tail appearance >esophagectomy ★ gastritis 1) Type A: autoimmune > fundus, body >neutrophil + macrophage 2) Type B: H. Pylori > antrum > plasma cell > neut + macrophage

dr.sparsh pathology notes CD3 pan T cell marker CD 19 pan B cell marker T cell: CD 1...8 except 6 B cell: CD 19..23 immature B cell/ CALLA: CD 10 EBV: CD 21 NK cell: CD 16, 56 APC: Dendritic cell, B cell, macrophage Myeloid marker: CD 117 Pan leukocyte marker: CD 45 RO Classical RS cell: CD 15, 30 + Megakaryocyte: CD 41, 42, 62 Hairy cell leukemia: CD 11, 25, 103 + CD 5 Mantle cell lymphoma: CD 5 + CD 23Follicular lymphoma: CD 5CD 10, 19 to 23,79 + dr.devesh fmge imp points..must read last min review..!!

@ Classic RS cells - CD15+ and CD30+ 1) Nodular sclerosis - lacunar RS cells 2) Lymphocyte predominant HL - simple RS cells - CD20 +VE , CD 15- and CD 30( POPCORN RS CELLS ) 3) Mix cellularity - mono nuclear RS cells 4) L poor - pleomorphic RS cells or necrobiotic cell,mummified RS cells @ AML - azurophilic granules @ Good Prognosis of ALL - CD10+ , CD 19-23, 79+ @ ALL - good prognosis if :a) hyperdiploidy b) trisomy 4,7,10 C) t ( 9:12), t ( 12: 21) @ abnormal azurophilic granules - AUERRODS @ group of auerrods :¥ FAGGOTS CELLS and A/W AML-M3 @chloroma ( myeloblastoma ) - best marker MPO, second best - CD117 +VE ¥ a/w t ( 8:21) @ most common AML in downsyndrome :¥ AML-M7 - megakaryo blast - CD41 ,42,62 € MDS cytogenetics changes - monosomy of chr 5 and 7 - deletion of chr 5 and chr 7 - a/w trisomy 8, deletion 20 ( 20-) @ m/c pediatric cytogenetic changes in AML - 7 monosomy @ m/c adult cytogenetics AML - chr 5 deletion @ m/c over all AML - chr 5 deletion. @ CLL - both must be present - CD5+ and CD23+ @ If one present only CD5+ - MANTLE CELL LEUKEMIA @ IOC of CLL - Flow cytometry - immunophenotyping @ CLL peripheral smear - smudge cell or basket cell or parachute cell @ diagnostic findings of CLL 1) prolymphocytes which are highly motile, fast division ( pathognomic of CLL ) 2) proliferation centre 3) diffuse expansion of lymphnode architecture Absent : 21-hydroxylase (MC) Inc.: ACTH --> sex steroids Dx: *Screening test: 17-ketosteroids in maternal urine *IOC: Cordocentesis (check for 17-ketosteroids) Tx:

tab. dexamethasone to mother (* 21 hydroxylase def.: MC BABYGIRL: virilization+dec.sugar+hypotension *11 hydroxylase def.: BABYGIRL: virilization+HTN *17 hydroxylase def: BABYBOY: ambiguous genitalia+ HTN *3 hydroxylase def.: BABYBOY: ambiguous genitalia + hypotension) micro Apple jelly nodules-Lupus vulgaris Anchovy sauce pus - amoebic abscess Bunch of Grapes-Ethmoidal polyp Chinese fried rice-B.cereus Champagne glass pelvis-Achondro plasia Champagne leg deformity-Varic ose vain Cherry red lip- CO poisoning Cauliflower ear-Hamartoma Chocolate cyst - endometriosis Dinner Fork deformity-Colle 's Fracture Egg on side appearance-TGA Egg cell calcification-S ilicosis,Sarcoi dosis Egg on string - transposition of great vessels with intact ventricular septum Fried egg colony-Mycoplasma Garlic smell-Arsenic poisoning. Honey comb lung - pulmonary fibrosis Honey coloured crusts-Impetigo Contagiosum Inverted cups- Large intest Obstruction Nutmeg liver - CHF Onion skinning - ewings sarcoma Port wine stain - hemangioma Pea soup diarrhea-Typhoid Potato nose-Rhinophyma Popcorn cells-HL(5th type-Nodular lymphatic predominant) Popcorn calcification-P ulmonary hamartoma Red current jelly stools-Intussus

ception Rice water diarrhea-Cholera Red current jelly sputum - klebsiella Salt n pepper Retinopathy-Con genital Rubella Syndrome Strawberry polyp-Rhinospor idiosis Strawberry tongue - kawasaki , scarlet fever , toxic shock syndrome Tomato ketchup fundus-CRVO

GENETICS IMP POINTS..!! SEQUENCES GENETICS # Alurepeat sequence :any of a family of related, repetitive, dimeric DNA sequences, named for their cleavage by the restriction endonuclease Alu I. The sequences are approximately 300 base pairs long and are interspersed throughout the primate genome in up to a million copies per haploid genome; some can generate copies of themselves, which can insert elsewhere into the genome. amniotic band sequence # consensus sequence :a sequence of nucleotides that is common to different genes or genomes, usually with some variations but showing substantial similarity; frequently, the prototype sequence that most others approach. # flanking sequence in a nucleic acid, a short stretch of nucleotides immediately adjacent to either end of the region under consideration. # gene sequence The ordered arrangement of nucleotides into codons in a gene. # insertion sequence (IS) a small bacterial transposable element containing only genes that encode transposition functions and having a short run of inverted repeated sequences at each of its termini, it causes duplication of the recipient DNA site into which it inserts, one copy of the recipient DNA flanking it on each side. It may act as an individual transposable element, or it may occur in pairs as the termini of more complex transposons. SEQUENCES IN DYSMORPHOLOGY # Definition- in dysmorphology, a pattern of multiple anomalies derived from a single known or presumed prior anomaly or mechanical factor. Called also anomalad and complex.

Few examples of sequences # oligohydramnios sequence :a group of anomalies, usually causing death shortly after birth, caused by compression of the fetus secondary to oligohydramnios, which may result from renal agenesis or other fetal urinary tract defects or from leakage of amniotic fluid; infants have characteristic flattened facies (Potter facies) and skeletal abnormalities such as clubbed feet and contracted joints, often with hypoplasia of the lungs. # Pierre Robin sequence the triad of micrognathia, cleft palate, and glossoptosis, with backward and upward displacement of the larynx and angulation of the manubrium sterni; cleft palate makes cramming and swallowing difficult, permitting easy access of fluids into the larynx. Respiratory failure secondary to upper airway obstruction can be fatal. It evolves due to abnormally hypoplastic development of the mandible between gestational weeks 7 to 11, and may appear in association with other syndromes or as an isolated entity. Called also Pierre Robin syndrome. # pulse sequence in magnetic resonance imaging, the order, spacing, and type of radio frequency pulses that produce magnetic resonance images according to changes in the gradients of the magnetic field. # signal sequence, targeting sequence :a sequence of 15 to 30 amino acids occurring at the N-terminal end of the precursors of secretory proteins; it is required for transport of the protein across the membrane of the rough endoplasmic reticulum into the cisternae, where it is immediately cleaved off by an endopeptidase. Called also leader s. and signal peptide. GENETICS IMP POINTS..!! CONTINUE.... ¬ # VACTERL Association Nonrandom association of birth defects: Vertebral anomalies Anal atresia Cardiac defect TracheoEsophageal fistula (imp) Renal anamolies Limb abnormalities ¬ # Congenital nasolacrimal duct obstruction (dacryostenosis) •lgl. Failure of canalization of duct as it enters the nose • Excessive tears, mucoid

material that is produced in the lacrimal sac,.l erythema • Treatment—.gt nasolacrimal massage 2–3×/day and warm water cleansing • Most resolve VSD > PDA, ASD; also MVP

– Gastrointestinal anomalies: duodenal atresia, Hirschprung – Atlanto-axial instability – Hypothyroidism – Acute lymphocytic leukemia – Mental ¬ TRISOMY 18 – EDWARDS SYNDROME – Mental retardation – Low-set, malformed ears; microcephaly, micrognathia; prominent occiput – Clenched hand—index over third; fifth over fourth – Short sternum – VSD, ASD, PDA, cyanotic lesions – Rocker-bottom feet, hammer toe – Omphalocele ¬ TRISOMY 13 – PATAU SYDNROME – Holoprosencephaly and other CNS defects – Severe mental retardation – Microcephaly; microphthalmia – Severe cleft lip, palate, or both – Scalp defects in parietal-occipital area (cutis aplasia) – Postaxial polydactyly ¬ KLINEFELTER SYNDROME ( XXY ) • Genetics; most common findings manifested at puberty • Findings – Mental retardation (average IQ 85−90) – Behavioral problems – Long limbs (decreased upper:lower segment ratio); arm span > height – Slim (weight/height ratio low) GI – Hypogonadism and hypogenitalism (testosterone replacement at 11−12 years of age) = hypergonadotrophic hypogonadism (increased FSH and LH, and decreased testosterone) – Gynecomastia ¬ TURNER SYNDROME -XO – Gonadal dysgenesis–streak ovaries in XO – Average IQ 90 – Congenital lymphedema, residual puffiness over dorsum of fingers and toes – Broad chest, wide-spaced pages – Low posterior hairline; webbed posterior neck – Cubitus valgus (elbow) and other joint problems – Horseshoe kidney, and other renal defects – Cardiac: ° Bicuspid aortic valve (number 1 cardiac anomaly)

° Coarctation – Estrogen treatment indicated – May increase height by 3−4 cm with growth hormone (GH) and anabolic steroids FRAGILE X SYNDROME – Mild to profound mental retardation; learning problems – Large ears, dysmorphic facial features, large jaw, long face – Large testes—mostly in puberty (macroorchidism) ¬ PRADAR WILLI SYNDROME Genetics – Most with deletion at 15q11-q13–imprinted segment – Paternal chromosome responsible – Negligible recurrence risk • Findings – Obesity—onset from 6 months to 6 years – Mild to severe mental retardation – Food-related behavioral problems (binge eating) – Small hands and feet, puffy; small genitalia – Hypothalamic—pituitary dysfunction (growth, thyroid, adrenal) hypogonadotrophic-hypogonadism ¬ Aniridia–Wilms Tumor Association (WAGR syndrome) – 1/70 with aniridia also has Wilms – WAGR syndrome: deletion of 11p13; Wilms + aniridia + GU anomalies + MR – Highest risk of Wilms’ (compared to independent aniridia or GU defect) malabsorption # Schwachman-Diamond Syndrome – Pancreatic insufficiency – Neutropenia – Malabsorption # Intestinal lymphangiectasia – Lymph fluid leaks into bowel lumen – Steatorrhea – Protein-losing enteropathy # Disaccaridase Deficiency – Osmotic diarrhea – Acidic stools # Abetalipoproteinemia – Severe fat malabsorption form birth – Acanthocyes – Very low to absent plasma cholesterol, triglycerides, etc

ophthalmolgy ultimate !!! *Acanthamoeba: 'ring ulcer' , pain out of propulsion Txoc: corneal transplantation *Bacteria: Ulcer: 'ulcer serpens', Mcc: staph aureus Mcc in India: strep pneumonia Hypopyon: Bacterial hypopyon moves in direction of gravity. *Fungal: Only orgnism dt can penetrate d descement membrane of cornea Slow growing Signs> symptoms Cause: filamentous fungi Mc: aspergillus nd fusarium Cause: prolonged topical steroidal use (glaucoma> fungal inf.) Ulcer: 'finger like projections' 'Feathery margins' 'Satellite lesions' 'Elevated surface' 'Thick nd fixed' Hypopion: non sterile nd non mobile bcz of descement membrane penetration. WORST PROGNOSIS. *Viral: Most painless (loss of corneal sensation) Mcc: HSV (true dendritic ulcer) 'Dendritic ulcers', dendritic expands-->'Geographical ulcers' 'Wessley's ring' -Neuroparalytic ulcer: 'CN7 paralysis' (eyelid cnt go dwn nd eye remains opn as 0rbicularis 0culi gets paralysed) Exposure keratitis Painless -Neurotrophic ulcer: 'CN5 paralysis' Dendritic keratitis Painless Herpes zoster (shingles)

cause: VZV Usually in older px. If young px, sign of HIV. whn eyes get affected:--->> 'HZ opthalmitis' 'HUTCHINSON'S rule' Tx : *Viral ulcers: Acyclovir/ valacyclovir/ famacyclovir *fungal ulcers: natamycin (only antifungal dt cn trt filamentous fungi) *bacterial: gentamycin/ amikacin Given topical, not systemic as cornea is AVASCULAR. *acanthamoeba: keratoplasty Doc: poly hexa methyl biguanide -propamidine *If pain: cycloplegics * non healing ulcers: Cause: 1. DM (mc) 2. Wrong diagnosis *Tx: 1. For impending perforated ulcers: keratoplasty 2. For perforated ulcers: -keratoplasty -tissue adhesive- cyanoacrylate glue (if cornea is not avlbl) >IL1 & IL2 by TH1 >IL4 & IL5 by TH2 >IL1 most imp for systemic effect of inflammation >IL10 anti inflammatory action >IL6 a/w osteoclast activity >IL8 chemotactive for neutrophil > MC complement def. is C2 > IgA responsible for activation of alternate pathway

autoinfection T.solium S.stercolis H.nana E.vermicularis Cryptosporidium parvum Capillaria philippinesis GENETICS IMP POINTS..!! CONTINUE.... *MENDELIAN GENETICS* Pedigree nd examples 1. AD Transmitted by both genders All generations affected No carrier state eg.: von willebrand ds, familial hyper cholesterolemia, familial retinoblastoma, fam. Adenomatous poliposis, , dystrophia myotonica, osteogenic imperfecta, marfan's sx, intermittent porphyria, NF 1, NF 2, Adult polycystic kidney ds, tuberous sclerosis, heredetory spherocytosis, huntingson's ds Achondroplasia, marfan's sx, polycystic kidney ds (anatomical disorders) 2 AR: transmitted by both genders Often skip generations Male & female carriers eg.: cystic fibrosis, sickle cell anemia, tay sack's ds, phenylketonuria, cong.adrenal hyperplasia, galactossemia, wilson's disease (enzyme disorders) 3.XLR No male-male transmission Skip generations Expressed only in male Female carriers eg.: leisch nyahn sx, hemophilia A & B, colour blindness, chronic granulomatous ds,

G6PD def., agammaglobulinemia, fragile X sx, wiskot aldreich sx 4.XLD: All generations affected Male & female both cn hv disorder No carrier state Mother: to daughter & son both Father: only to daughter eg.: hypophosphatemic rickets/ vit. D resistent rickets.

biochem..!! Rate limiting enzymes - Rate limiting enzymes Glycolysis - PFK-1 Gluconeogenesis - fructose 1,6 biphosphate TCA cycle - isocitrate dehydrogenase Glycogen synthesis - glycogen synthase Glycogenolysis - glycogen phosphorylase HMP shunt - G6PD Fatty acid synthesis - acetyl co-A carboxylase Fatty acid oxidation - carnitine acyl transfetase 1 Ketogenesis - HMG co-A synthase. Cholesterol synthesis - HMG co-A reductase Urea cycle - carbamoyl phosphate synthase 1 De-novo pyrimidine synthesis - carbamoyl phosphate synthase 2 De-novo purine synthesis - glutamine-PRPP amidotransferase Arachidonic acid synthesis - phospholipase A2

cardiology mnemonics..courtesy of medical student.. Aortic stenosis characteristics SAD: Syncope Angina Dyspnoea MI: basic management BOOMAR: Bed rest Oxygen Opiate Monitor

Anticoagulate Reduce clot size ECG: left vs. right bundle block "WiLLiaM MaRRoW": W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block. M pattern in V1-V2 and W in V3-V6 is Right bundle block. • Note: consider bundle branch blocks when QRS complex is wide. Pericarditis: causes CARDIAC RIND: Collagen vascular disease Aortic aneurysm Radiation Drugs (such as hydralazine) Infections Acute renal failure Cardiac infarction Rheumatic fever Injury Neoplasms Dressler's syndrome Murmurs: systolic types SAPS: Systolic Aortic Pulmonic Stenosis • Systolic murmurs include aortic and pulmonary stenosis. • Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation]. MI: signs and symptoms PULSE: Persistent chest pains Upset stomach Lightheadedness Shortness of breath Excessive sweating Heart compensatory mechanisms that 'save' organ blood flow during shock "Heart SAVER": Symphatoadrenal system Atrial natriuretic factor Vasopressin

Endogenous digitalis-like factor Renin-angiotensin-aldosterone system • In all 5, system is activated/factor is released Murmurs: right vs. left loudness "RILE": Right sided heart murmurs are louder on Inspiration. Left sided heart murmurs are loudest on Expiration. • If get confused about which is which, remember LIRE=liar which will be inherently false. ST elevation causes in ECG, ELEVATION: Electrolytes LBBB Early repolarization Ventricular hypertrophy Aneurysm Treatment (eg pericardiocentesis) Injury (AMI, contusion) Osborne waves (hypothermia) Non-occlusive vasospasm Beck's triad (cardiac tamponade) 3 D's: Distant heart sounds Distended jugular veins Decreased arterial pressure 11 MI: therapeutic treatment ROAMBAL: Reassure Oxygen Aspirin Morphine (diamorphine) Beta blocker Arthroplasty Lignocaine CHF: causes of exacerbation FAILURE: Forgot medication Arrhythmia/ Anaemia Ischemia/ Infarction/ Infection Lifestyle: taken too much salt Upregulation of CO: pregnancy, hyperthyroidism

Renal failure Embolism: pulmonary Murmurs: systolic vs. diastolic PASS: Pulmonic & Aortic Stenosis=Systolic. PAID: Pulmonic & Aortic Insufficiency=Diastolic. Murmurs: systolic vs. diastolic Systolic murmurs: MR AS: "MR. ASner". Diastolic murmurs: MS AR: "MS. ARden". • The famous people with those surnames are Mr. Ed Asner and Ms. Jane Arden. Mitral stenosis (MS) vs. regurgitation (MR): epidemiology MS is a female title (Ms.) and it is female predominant. MR is a male title (Mr.) and it is male predominant. Pericarditis: EKG "PericarditiS": PR depression in precordial leads. ST elevation. Jugular venous pressure (JVP) elevation: causes HOLT: Grab Harold Holt around the neck and throw him in the ocean: Heart failure Obstruction of venea cava Lymphatic enlargement - supraclavicular Intra-Thoracic pressure increase Depressed ST-segment: causes DEPRESSED ST: Drooping valve (MVP) Enlargement of LV with strain Potassium loss (hypokalemia) Reciprocal ST- depression (in I/W AMI) Embolism in lungs (pulmonary embolism) Subendocardial ischemia Subendocardial infarct Encephalon haemorrhage (intracranial haemorrhage) Dilated cardiomyopathy Shock Toxicity of digitalis, quinidine 22 Murmurs: innocent murmur features 8 S's:

Soft Systolic Short Sounds (S1 & S2) normal Symptomless Special tests normal (X-ray, EKG) Standing/ Sitting (vary with position) Sternal depression Murmur attributes "IL PQRST" (person has ill PQRST heart waves): Intensity Location Pitch Quality Radiation Shape Timing Murmurs: locations and descriptions "MRS A$$": MRS: Mitral Regurgitation--Systolic A$$: Aortic Stenosis--Systolic • The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic. Betablockers: cardioselective betablockers "Betablockers Acting Exclusively At Myocardium" • Cardioselective betablockers are: Betaxolol Acebutelol Esmolol Atenolol Metoprolol Apex beat: abnormalities found on palpation, causes of impalpable HILT: Heaving Impalpable Laterally displaced Thrusting/ Tapping • If it is impalpable, causes are COPD: COPD Obesity Pleural, Pericardial effusion

Dextrocardia MI: treatment of acute MI COAG: Cyclomorph Oxygen Aspirin Glycerol trinitrate Coronary artery bypass graft: indications DUST: Depressed ventricular function Unstable angina Stenosis of the left main stem Triple vessel disease Peripheral vascular insufficiency: inspection criteria SICVD: Symmetry of leg musculature Integrity of skin Color of toenails Varicose veins Distribution of hair Heart murmurs "hARD ASS MRS. MSD": hARD: Aortic Regurg = Diastolic ASS: Aortic Stenosis = Systolic MRS: Mitral Regurg = Systolic MSD: Mitral Stenosis = Diastolic 33 Mitral regurgitation When you hear holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs". Sino-atrial node: innervation Sympathetic acts on Sodium channels (SS). Parasympathetic acts on Potassium channels (PS). Supraventricular tachycardia: treatment ABCDE: Adenosine Beta-blocker Calcium channel antagonist

Digoxin Excitation (vagal stimulation) Ventricular tachycardia: treatment LAMB: Lidocaine Amiodarone Mexiltene/ Magnesium Beta-blocker Pulseless electrical activity: causes PATCH MED: Pulmonary embolus Acidosis Tension pneumothorax Cardiac tamponade Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia Myocardial infarction Electrolyte derangements Drugs Sinus bradycardia: aetiology "SINUS BRADICARDIA" (sinus bradycardia): Sleep Infections (myocarditis) Neap thyroid (hypothyroid) Unconsciousness (vasovagal syncope) Subnormal temperatures (hypothermia) Biliary obstruction Raised CO2 (hypercapnia) Acidosis Deficient blood sugar (hypoglycemia) Imbalance of electrolytes Cushing's reflex (raised ICP) Aging Rx (drugs, such as high-dose atropine) Deep anaesthesia Ischemic heart disease Athletes Rheumatic fever: Jones criteria • Major criteria: CANCER: Carditis Arthritis Nodules Chorea

Erythema Rheumatic anamnesis • Minor criteria: CAFE PAL: CRP increased Arthralgia Fever Elevated ESR Prolonged PR interval Anamnesis of rheumatism Leucocytosis JVP: wave form ASK ME: Atrial contraction Systole (ventricular contraction) Klosure (closure) of tricusps, so atrial filling Maximal atrial filling Emptying of atrium Coronary artery bypass graft: indications DUST: Depressed ventricular function Unstable angina Stenosis of the left main stem Triple vessel disease Exercise ramp ECG: contraindications RAMP: Recent MI Aortic stenosis MI in the last 7 days Pulmonary hypertension ECG: T wave inversion causes INVERT: Ischemia Normality [esp. young, black] Ventricular hypertrophy Ectopic foci [eg calcified plaques] RBBB, LBBB Treatments [digoxin] Rheumatic fever: Jones major criteria JONES: Joints (migrating polyarthritis) Obvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits) Nodes (subcutaneous nodules)

Erythema marginatum Sydenham's chorea Myocardial infarctions: treatment INFARCTIONS: IV access Narcotic analgesics (eg morphine, pethidine) Facilities for defibrillation (DF) Aspirin/ Anticoagulant (heparin) Rest Converting enzyme inhibitor Thrombolysis IV beta blocker Oxygen 60% Nitrates Stool Softeners Atrial fibrillation: causes PIRATES: Pulmonary: PE, COPD Iatrogenic Rheumatic heart: mirtral regurgitation Atherosclerotic: MI, CAD Thyroid: hyperthyroid Endocarditis Sick sinus syndrome Atrial fibrillation: management ABCD: Anti-coagulate Beta-block to control rate Cardiovert Digoxin Anti-arrythmics: for AV nodes "Do Block AV": Digoxin B-blockers Adenosine Verapamil Murmurs: systolic MR PV TRAPS: Mitral Regurgitation and Prolaspe

VSD Tricupsid Regurgitation Aortic and Pulmonary Stenosis Apex beat: differential for impalpable apex beat DOPES: Dextrocardia Obesity Pericarditis or pericardial tamponade Emphysema Sinus inversus/ Student incompetence neurology..mnemonics..!! Dementia: some common causes DEMENTIA: Diabetes Ethanol Medication Environmental (eg CO poisoning) Nutritional Trauma Infection Alzheimer's Whipple's disease: features [for neurologists] A WHIPPLES DOOM Arthralgias Whipplei (organism) Hypothalamic involvement Intestinal involvement/ Intestinal biopsy required PAS positive macrophages PCR positivity Lymphadenopathy Extrapyramidal involvement Septran treat with Dementia Ocular abnormalities (vertical gaze palsy) Oculomasticatory myorhythmia Myoclonus Neurofibromatosis: diagnostic criteria ROLANDO: Relative (1st degree) Osseous fibromas Lisch nodules in eyes Axillary freckling Neurofibromas Dime size cafe au lait spots Optic gliomas Visual loss: persistent bilateral sudden onset visual loss differential FLOP: Functional Leber's hereditary neuropathy Occipital infarctions Pituitary apoplexy Neurofibromatosis: diagnositic criteria (type-1) CAFE SPOT: Cafe-au-lait spots Axillary, inguinal freckling Fibroma Eye: lisch nodules Skeletal (bowing leg, etc) Pedigree/ Positive family history Optic Tumor (glioma) Babinski and LMN signs: conditions exhibiting them "D MASTS": Diabetes Motor neuron disease Ataxia (friedrichs) Subacute combined degeneration of

cord Tabo paresis Syringobulbia Ramsay-Hunt syndrome: cause and common feature "Ramsay Hunt": • Etiology: Reactivated Herpes zoster • Complication: Reduced Hearing Stroke risk factors HEADS: Hypertension/ Hyperlipidemia Elderly Atrial fib Diabetes mellitus/ Drugs (cocaine) Smoking/ Sex (male) Vertigo: differential VOMITS: Vestibulitis Ototoxic drugs Meniere's disease Injury Tumor Spin (benign positional vertigo) Encephalitis: differential HE'S LATIN AMERICAN: Herpesviridae Enteroviridae (esp. Polio) Slow viruses (esp. JC, prions) Syphilis Legionella/ Lyme disease/ Lymphocytic meningoencephalitis Aspergillus Toxoplasmosis Intracranial pressure Neisseria meningitidis Arboviridae Measles/ Mumps/ Mycobacterium tuberculosis/ Mucor E. coli Rabies/ Rubella Idiopathic Cryptococcus/ Candida Abscess Neoplasm/ Neurocysticercosis • Neurocysticercosis should be assumed with recent Latin American immigrant patient unless proven otherwise.

embryology mnemonics..!! Coma: conditions to exclude as cause MIDAS: Meningitis Intoxication Diabetes Air (respiratory failure) Subdural/ Subarachnoid hemorrhage

Resuscitation: basic steps ABCDE: Airway Breathing Circulation Drugs Environment Malignant hyperthermia treatment "Some Hot Dude Better Give Iced Fluids Fast!" (Hot dude = hypothermia): Stop triggering agents Hyperventilate/ Hundred percent oxygen Dantrolene (2.5mg/kg) Bicarbonate Glucose and insulin IV Fluids and cooling blanket Fluid output monitoring/ Furosemide/ Fast heart [tachycardia] Vfib/Vtach drugs used according to ACLS "Every Little Boy Must Pray": Epinephrine Lidocaine Bretylium Magsulfate Procainamide Coma causes checklist AEIOU TIPS: Acidosis/ Alcohol Epilepsy Infection Overdosed Uremia Trauma to head Insulin: too little or or too much Pyschosis episode Stroke occurred Shock: types RN CHAMPS: Respiratory Neurogenic Cardiogenic Hemorrhagic

Anaphylactic Metabolic Psychogenic Septic • Alternatively: "MR. C.H. SNAP", or "NH CRAMPS". Shock: signs and symptoms TV SPARC CUBE: Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank Fall: potential causes CLADE SPADE: Cardiovascular/ Cerebrovascular Locomotor (skeletal, muscular, neurological) Ageing (increased body sway, decreased reaction time) Drugs (esp. antihypertensives, antipsychotics) Environmental Sensory deficits (eg. visual problems) Psychological/ Psychiatric (depression) Acute illness Dementia Epilepsy Diabetic ketoacidosis management F*¢KING: Fluids (crytalloids) Urea (check it) Creatinine (check it)/ Catheterize K+ (potassium) Insulin (5u/hour. Note: sliding scale no longer recommended in the UK) Nasogastic tube (if patient comatose) Glucose (once serum levels drop to 12) Asthma: management of acute severe "O S#!T": Oxygen (high dose: >60%) Salbutamol (5mg via oxygen-driven nebuliser)

Hydrocortisone (or prednisolone) Ipratropium bromide (if life threatening) Theophylline (or preferably aminophylline-if life threatening) pharma.! Pulmonary infiltrations inducing drugs "Go BAN Me!": Gold Bleomycin/ Busulphan/ BCNU Amiodarone/ Acyclovir/ Azathioprine Nitrofurantoin Melphalan/ Methotrexate/ Methysergide MPTP: mechanism, effect MPTP: Mitochondrial Parkinson's-Type Poison. · A mitochondrial poison that elicits a Parkinson's-type effect. Antimuscarinics: members, action "Inhibits Parasympathetic And Sweat": Ipratropium Pirenzepine Atropine Scopolamine · Muscarinic receptors at all parasympathetic endings sweat glands in sympathetic. Teratogenic drugs: major non-antibiotics TAP CAP: Thalidomide Androgens Progestins Corticosteroids Aspirin & indomethacin Phenytoin Steroid side effects CUSHINGOID: Cataracts Ulcers Skin: striae, thinning, bruising Hypertension/ Hirsutism/ Hyperglycemia Infections Necrosis, avascular necrosis of the femoral head Glycosuria Osteoporosis, obesity Immunosuppression Diabetes Beta blockers with CYP2D6 polymorphic metabolism "I Met Tim Carver, the metabolic polymorph": · The following beta blockers require dose adjustment due to CYP2D6 polymorphic metabolism: Metoprolol Timolol Carvedilol (in patients with lower or higher than normal CYP2D6 activity) Beta blockers with intrinsic sympathomimetic activity

Picture diabetic and asthmatic kids riding away on a cart that rolls on pinwheels. Pindolol and Carteolol have high and moderate ISA respectively, making them acceptable for use in some diabetics or asthmatics despite the fact that they are non-seletive beta blockers. Muscarinic effects SLUG BAM: Salivation/ Secretions/ Sweating Lacrimation Urination Gastrointestinal upset Bradycardia/ Bronchoconstriction/ Bowel movement Abdominal cramps/ Anorexia Miosis Sulfonamide: major side effects · Sulfonamide side effects: Steven-Johnson syndrome Skin rash Solubility low (causes crystalluria) Serum albumin displaced (causes newborn kernicterus and potentiation of other serum albumin-binders like warfarin) Epilepsy types, drugs of choice: "Military General Attacked Weary Fighters Pronouncing 'Veni Vedi Veci' After Crushing Enemies": · Epilepsy types: Myoclonic Grand mal Atonic West syndrome Focal Petit mal (absence) · Respective drugs: Valproate Valproate Valproate ACTH Carbamazepine Ethosuximide Quinolones [and Fluoroquinolones]: mechanism "Topple the Queen": Quinolone interferes with Topoisomerase II. Beta blockers: B1 selective vs. B1-B2 non-selective A through N: B1 selective: Acebutalol, Atenolol, Esmolol, Metoprolol. O through Z: B1, B2 non-selective: Pindolol, Propanalol, Timolol. Ribavirin: indications RIBAvirin: RSV Influenza B Arenaviruses (Lassa, Bolivian, etc.) Hypertension: treatment ABCD: ACE inhibitors/ AngII antagonists (sometimes Alpha agonists also) Beta blockers Calcium antagonists Diuretics Narcotics: side effects "SCRAM if you see a drug dealer": Synergistic CNS depression with other drugs

Constipation Respiratory depression Addiction Miosis Sex hormone drugs: male "Feminine Males Need Testosterone": Fluoxymesterone Methyltestosterone Nandrolone Testosterone Ca++ channel blockers: uses CA++ MASH: Cerebral vasospasm/ CHF Angina Migranes Atrial flutter, fibrillation Supraventricular tachycardia Hypertension · Alternatively: "CHASM": Cererbral vasospasm / CHF Hypertension Angina Suprventricular tachyarrhythmia Migranes Disulfiram-like reaction inducing drugs "PM PMT" as in Pre Medical Test in the PM: Procarbazine Metronidazole Cefo (Perazone, Mandole, Tetan). Delerium-causing drugs ACUTE CHANGE IN MS: Antibiotics (biaxin, penicillin, ciprofloxacin) Cardiac drugs (digoxin, lidocaine) Urinary incontinence drugs (anticholinergics) Theophylline Ethanol Corticosteroids H2 blockers Antiparkinsonian drugs Narcotics (esp. mepridine) Geriatric psychiatric drugs ENT drugs Insomnia drugs NSAIDs (eg indomethacin, naproxin) Muscle relaxants Seizure medicines

Morphine: side-effects MORPHINE: Myosis Out of it (sedation) Respiratory depression Pneumonia (aspiration) Hypotension Infrequency (constipation, urinary retention) Nausea Emesis Therapeutic dosage: toxicity values for most commonly monitored medications "The magic 2s": Digitalis (.5-1.5) Toxicity = 2. Lithium (.6-1.2) Toxicity = 2. Theophylline (10-20) Toxicity = 20. Dilantin (10-20) Toxicity = 20. APAP (1-30) Toxicity = 200. Diuretics: thiazides: indications "CHIC to use thiazides": CHF Hypertension Insipidous Calcium calculi Migraine: prophylaxis drugs "Very Volatile Pharmacotherapeutic Agents For Migraine Prophylaxis": Verpamil Valproic acid Pizotifen Amitriptyline Flunarizine Methysergide Propranolol Adrenoceptors: vasomotor function of alpha vs. beta ABCD: Alpha = Constrict. Beta = Dilate. Antiarrhythmics: classification I to IV MBA College · In order of class I to IV: Membrane stabilizers (class I) Beta blockers Action potential widening agents

Calcium channel blockers Opiods: mu receptor effects "MD CARES": Miosis Dependency Constipation Analgesics Respiratory depression Euphoria Sedation Cancer drugs: time of action between DNA->mRNA ABCDEF: Alkylating agents Bleomycin Cisplastin Dactinomycin/ Doxorubicin Etoposide Flutamide and other steroids or their antagonists (eg tamoxifen, leuprolide) Busulfan: features ABCDEF: Alkylating agent Bone marrow suppression s/e CML indication Dark skin (hyperpigmentation) s/e Endrocrine insufficiency (adrenal) s/e Fibrosis (pulmonary) s/e Tricyclic antidepressants: members worth knowing "I have to hide, the CIA is after me": Clomipramine Imipramine Amitrptyline · If want the next 3 worth knowing, the DNDis also after me: Desipramine Norrtriptyline Doxepin Torsades de Pointes: drugs causing APACHE: Amiodarone Procainamide Arsenium Cisapride Haloperidol Eritromycin Serotonin syndrome: components Causes HARM: Hyperthermia Autonomic instability (delirium) Rigidity Myoclonus Tetracycline: teratogenicity TEtracycline is a TEratogen that causes staining of TEeth in the newborn. Patent ductus arteriosus: treatment "Come In and Close the door": INdomethacin is used to Close PDA. Physostigmine vs. neostigmine LMNOP: Lipid soluble

Miotic Natural Orally absorbed well Physostigmine · Neostigmine, on the contrary, is: Water soluble Used in myesthenia gravis Synthetic Poor oral absorption Beta 1 selective blockers "BEAM ONE up, Scotty": Beta 1 blockers: Esmolol Atenolol Metropolol Antirheumatic agents (disease modifying): members CHAMP: Cyclophosphamide Hydroxycloroquine and choloroquinine Auranofin and other gold compounds Methotrexate Penicillamine Auranofin, aurothioglucose: category and indication Aurum is latin for "gold" (gold's chemical symbol is Au). Generic Aur- drugs (Auranofin, Aurothioglucose) are gold compounds. · If didn't learn yet that gold's indication is rheumatoid arthritis, AUR- Acts Upon Rheumatoid. Antiarrhythmics: class III members BIAS: Bretylium Ibutilide Amiodarone Sotalol MAOIs: indications MAOI'S: Melancholic [classic name for atypical depression] Anxiety Obesity disorders [anorexia, bulemia] Imagined illnesses [hypochondria] Social phobias · Listed in decreasing order of importance. · Note MAOI is inside MelAnchOlIc.

SIADH-inducing drugs ABCD: Analgesics: opioids, NSAIDs Barbiturates Cyclophosphamide/ Chlorpromazine/ Carbamazepine Diuretic (thiazide) K+ increasing agents K-BANK: K-sparing diuretic Beta blocker ACEI NSAID K supplement Reserpine action: Reserpine depletes the Reserves of catecholamines [and serotonin]. Succinylcholine: action, use Succinylcholine gets Stuck to Ach receptor, then Sucks ions in through open pore. You Suck stuff in through a mouth-tube, and drug is used for intubation. Beta-blockers: side effects "BBC Loses Viewers In Rochedale": Bradycardia Bronchoconstriction Claudication Lipids Vivid dreams & nightmares -ve Inotropic action Reduced sensitivity to hypoglycaemia Cisplatin: major side effect, action "Ci-Splat-In": Major side effect: Splat (vomiting sound)--vomiting so severe that anti-nausea drug needed. Action: Goes Into the DNA strand. Vir-named drugs: use"-vir at start, middle or end means for virus": · Drugs: Abacavir, Acyclovir, Amprenavir, Cidofovir, Denavir, Efavirenz, Indavir, Invirase, Famvir, Ganciclovir, Norvir, Oseltamivir, Penciclovir,

Ritonavir, Saquinavir, Valacyclovir, Viracept, Viramune, Zanamivir, Zovirax. Phenobarbitone: side effects Children are annoying (hyperkinesia, irritability, insomnia, aggression). Adults are dosy (sedation, dizziness, drowsiness). Prazocin: usage Prazocin sounds like an acronym of "praszz zour urine". Therefore Prazocin used for urinary retention in BPH. Opioids: effects BAD AMERICANS: Bradycardia & hypotension Anorexia Diminished pupilary size Analgesics Miosis Euphoria Respiratory depression Increased smooth muscle activity (biliary tract constriction) Constipation Ameliorate cough reflex Nausea and vomiting Sedation TB: antibiotics used STRIPE: STreptomycin Rifampicin Isoniazid Pyrizinamide Ethambutol Phenytoin: adverse effects PHENYTOIN: P-450 interactions Hirsutism Enlarged gums Nystagmus Yellow-browning of skin Teratogenicity Osteomalacia Interference with B12 metabolism (hence anemia) Neuropathies: vertigo, ataxia, and headache Narcotic antagonists

The Narcotic Antagonists are NAloxone and NAltrexone. · Important clinically to treat narcotic overdose. Thrombolytic agents USA: Urokinase Streptokinase Alteplase (tPA) Routes of entry: most rapid ways meds/toxins enter body "Stick it, Sniff it, Suck it, Soak it": Stick = Injection Sniff = inhalation Suck = ingestion Soak = absorption Asthma drugs: leukotriene inhibitor action zAfirlukast: Antagonist of lipoxygenase zIlueton: Inhibitor of LT receptor Direct sympathomimetic catecholamines DINED: Dopamine Isoproterenol Norepinephrine Epinephrine Dobutamine Anticholinergic side effects "Know the ABCD'S of anticholinergic side effects": Anorexia Blurry vision Constipation/ Confusion Dry Mouth Sedation/ Stasis of urine Atropine use: tachycardia or bradycardia "A goes with B": Atropine used clinically to treat Bradycardia. Bleomycin: action "Bleo-Mycin Blows My DNA to bits": Bleomycin works by fragmenting DNA (blowing it to bits). My DNA signals that its used for cancer (targeting self cells). Aspirin: side effects ASPIRIN: Asthma Salicyalism Peptic ulcer disease/ Phosphorylation-oxidation uncoupling/ PPH/ Platelet disaggregation/ Premature closure of PDA Intestinal blood loss Reye's syndrome

Idiosyncracy Noise (tinnitus) Lupus: drugs inducing it HIP: Hydralazine INH Procanimide Vigabatrin: mechanism Vi-GABA-Tr-In: Via GABA Transferase Inhibition Morphine: effects at mu receptor PEAR: Physical dependence Euphoria Analgesia Respiratory depression Enoxaprin (prototype low molecular weight heparin): action, monitoring EnoXaprin only acts on factor Xa. Monitor Xa concentration, rather than APTT. Beta-1 vs Beta-2 receptor location "You have 1 heart and 2 lungs": Beta-1 are therefore primarily on heart. Beta-2 primarily on lungs. SSRIs: side effects SSRI: Serotonin syndrome Stimulate CNS Reproductive disfunctions in male Insomnia Ipratropium: action Atropine is buried in the middle: iprAtropium, so it behaves like Atropine. Warfarin: action, monitoring WePT: Warfarin works on the extrinsic pathway and is monitored by PT. Propranolol and related '-olol' drugs: usage"olol" is just two backwards lower case b's. Backward b's stand for "beta blocker". · Beta blockers include acebutolol, betaxolol, bisoprolol, oxprenolol, propranolol. Depression: 5 drugs causing it PROMS: Propranolol Reserpine Oral contraceptives Methyldopa Steroids

Lead poisoning: presentation ABCDEFG: Anemia Basophilic stripping Colicky pain Diarrhea Encephalopathy Foot drop Gum (lead line) Myasthenia gravis: edrophonium vs. pyridostigmine eDrophonium is for Diagnosis. pyRIDostigmine is to get RID of symptoms. Morphine: effects MORPHINES: Miosis Orthostatic hypotension Respiratory depression Pain supression Histamine release/ Hormonal alterations Increased ICT Nausea Euphoria Sedation Inhalation anesthetics SHINE: Sevoflurane Halothane Isoflurane Nitrous oxide Enflurane · If want the defunct Methoxyflurane too, make it MoonSHINE. Cholinergics (eg organophosphates): effects If you know these, you will be "LESS DUMB": Lacrimation Excitation of nicotinic synapses Salivation Sweating Diarrhea Urination Micturition Bronchoconstriction Benzodiazapines: ones not metabolized by the liver (safe to use in liver failure) LOT: Lorazepam Oxazepam Temazepam

Benzodiazepines: actions "Ben SCAMs Pam into seduction not by brain but by muscle": Sedation anti-Convulsant anti-Anxiety Muscle relaxant Not by brain: No antipsychotic activity. Botulism toxin: action, related bungarotoxin Action: "Botulism Bottles up the Ach so it can't be the released": Related bungarotoxin: "Botulism is related to Beta Bungarotoxin (beta-, not alphabungarotoxin--alpha has different mechanism). Teratogenic drugs "W/ TERATOgenic": Warfarin Thalidomide Epileptic drugs: phenytoin, valproate, carbamazepine Retinoid ACE inhibitor Third element: lithium OCP and other hormones (eg danazol) Gynaecomastia-causing drugs DISCOS: Digoxin Isoniazid Spironolactone Cimetidine Oestrogens Stilboestrol Benzodiazepenes: drugs which decrease their metabolism "I'm Overly Calm": Isoniazid Oral contraceptive pills Cimetidine · These drugs increase calming effect of BZDs by retarding metabolism. Anesthesia: 4 stages "Anesthesiologists Enjoy S & M": Analgesia Excitement Surgical anesthesia Medullary paralysis 4-Aminopyradine (4-AP) use"4-AP is For AP": For AP (action potential) propagation in Multiple Sclerosis.

Osmotic diuretics: members GUM: Glycerol Urea Mannitol Sodium valproate: side effects VALPROATE: Vomiting Alopecia Liver toxicity Pancreatitis/ Pancytopenia Retention of fats (weight gain) Oedema (peripheral oedema) Appetite increase Tremor Enzyme inducer (liver) Nitrofurantoin: major side effects NitroFurAntoin: Neuropathy (peripheral neuropathy) Fibrosis (pulmonary fibrosis) Anemia (hemolytic anemia) Zafirlukast, Montelukast, Cinalukast: mechanism, usage"Zafir-luk-ast, Monte-luk-ast, Cina-luk-ast": · Anti-Lukotrienes for Asthma. · Dazzle your oral examiner: Zafirlukast antagonizes leukotriene-4. Zero order kinetics drugs (most common ones) "PEAZ (sounds like pees) out a constant amount": Phenytoin Ethanol Aspirin Zero order · Someone that pees out a constant amount describes zero order kinetics (always the same amount out) Hepatic necrosis: drugs causing focal to massive necrosis "Very Angry Hepatocytes": Valproic acid Acetaminophen Halothane Steroids: side effects BECLOMETHASONE: Buffalo hump Easy bruising Cataracts Larger appetite Obesity

Moonface Euphoria Thin arms & legs Hypertension/ Hyperglycaemia Avascular necrosis of femoral head Skin thinning Osteoporosis Negative nitrogen balance Emotional liability Amiodarone: action, side effects 6 P's: Prolongs action potential duration Photosensitivity Pigmentation of skin Peripheral neuropathy Pulmonary alveolitis and fibrosis Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism Monoamine oxidase inhibitors: Members "PIT of despair": Phenelzine Isocarboxazid Tranylcypromine · A pit of despair, since MAOs treat depression Warfarin: metabolism SLOW: · Has a slow onset of action. · A quicK Vitamin K antagonist, though. Small lipid-soluble molecule Liver: site of action Oral route of administration. Warfarin Propythiouracil (PTU): Mechanism It inhibits PTU: Peroxidase/ Peripheral deiodination Tyrosine iodination Union (coupling) Antibiotics contraindicated during pregnancy MCAT: Metronidazole Chloramphenicol Aminoglycoside Tetracycline

Beta-blockers: nonselective beta-blockers"Tim Pinches His Nasal Problem" (because he has a runny nose...): Timolol Pindolol Hismolol Naldolol Propranolol Methyldopa: side effects METHYLDOPA: Mental retardation Electrolyte imbalance Tolerance Headache/ Hepatotoxicity psYcological upset Lactation in female Dry mouth Oedema Parkinsonism Anaemia (haemolytic) Lithium: side effects LITH: Leukocytosis Insipidus [diabetes insipidus, tied to polyuria] Tremor/ Teratogenesis Hypothyroidism Respiratory depression inducing drugs "STOP breathing": Sedatives and hypnotics Trimethoprim Opiates Polymyxins Benzodiazepenes: antidote "Ben is off with the flu": Benzodiazepine effects off with Flumazenil. some imp diseases..!! ACL Injury It prevents gliding of tibia under femur. Injury is seen after Hyperextension. A poping sensation is felt at time of injury. Commonly asso with Medial Meniscus and Medial Colateral Ligament (TRIAD). Lachman test is a test for ACL tear. Flex and pull tibia. Drawer sign also test ACL but its less sensitive. Posterior Drawer sign tests PCL. Mc murry's sign tests Meniscus injury. Valgus test is for MCL.

Acne - 2 1-Comedons (black/white heads): cuase minimal inflamation and tx is topical retinoids. If reactivation occur add topical Erythromycin or Benzoyl peroxide. 2-Papular and inflamatory acne: with moderate-severe inflamation: Oral Doxycycline. 3-Nodular or scaring acne: Oral Isotretinoin. Acromegaly Actinomycosis Cervicofacial actinomycosis presents as slowly progressing , non tender, indurated mass, which evolves into multiple abscesses, fistula, and draining sinus tracts with sulfur granules, which appear yellow. Actinomyces israelii is the agent, Tx is high dose IV peniciline for 6-12 weeks. Surgical debrement comes after penicillin therapy. Acute adrenal insufficiency: Acute onset of naseau, vomiting, abdominal pain and hypoglycemia and hypotension after a stressful event (surgery) in a pt sho is steroid dependant is typical. A clue is preoperative steroid use. Exogenous steroids depress pit-adrenal axis and a stressful situation can precipitate AAI. DDX: insulin induced hypoglycemia does not cause naseau and vomit and abdominal pain and hypotension. Acute Alkali ingestion When a pt takes Lye (alkali substance for suicide), upper GI contrast studies should be performed as eary as possible, to assess the damage and posible perforation of esophagus. Normal x-ray does not rule out a perforation. Once you know there is no perforation then you can do Diagnostic peritoneal lavage if necessary. But the first thing is to rule out perforation. Acute Appendicitis - 3 Pt who comes to hospital after 5 days of initial symptoms must be hospitalized with IV hydration and IV Cefotetan. If threre is abcess with CT, percutaneous drainage is an option.****Most pelvic abscesses are due to perforation of AA. Pt might have a 24 hour RUQ pain that resoves spontaneously and then later on in a few days he might come with anal abscess symptoms. Drainage of the abscess is tx of choice.****Experiecne has shown that right hemiclectomy with ileo-transvers anatomosis has best postoperative results when resection of part of ascending is requires. And that is when pt has shown gangrenous rupture of appendix with questionable necrotized colon. Acute Bacterial Proctatitis: MCC in young is Chlamydia and Gonococcus, in old E. Coli. To diagnose do culture of mid-stream urine sample and start empiric therapy. Prostatic massage is contraindicated due to septecemia chance. Acute GI bleeding There are three causes: 1-Diverticulosis (Painless. can be ruled out with Barium Enema), 2-Angiodysplasia (Painless. maybe seen as cherry-red sopts that maybe coagulated, dx

with labeled erythrocyte scintigraphy). 3-PUD (Painfull. Dx with endoscopy, if there is Hematochezia, red bright blood,due to lower GI bleed, then there is no need for endoscopy, the blood is from lower UGI bleeding). Acute renal transplant rejection Renal transplant rejection in the early post-operative stage can be expained by, ureteral obstruction, Acute rejection, Cyclosporine tox, vascular obstruction and ATN. To determine the cause we do US, MRI and Biopsy. If biopsy shows infiltration of lymphocytes and vasular swelling and there is increase Crt and Bun and oliguria, then the cause is Acute Rejection. Tx is high dose IV steriods. Acute Tubular Necrosis Prolonged hypotention due to any reason (Hypovolemic shock) can lead to ATN. Hallmark finding on urin analysis is Muddy brown granular cast. DDX1:RBC cast, GN. DDX2:WBC cast, Interstitial Nephritis and Pyelonephritis. DDX3:Fatty cast, NephrOtic Synd. DDX4:Broad and Waxy cast:Chronic renal failure. Acyclovir Toxicity Can cause crystalluria with renal tubular obstruction during high dose parenteral therapy, especially in inadequately hydrated pts. Addison's Disease - 2 MM-101. Aldosterone def leads to non-anion gap hyperkalemic, hyponatremic metabolic acidosis. ***80% of pt have primary adrenal deficiency due to Autoimmune adrenalitis. These pts also present with autoimmune involvement of other glands as well, like thyroid,parathyroid, ovaries.*** 70% of the Causes of Primary Adrenal Insufficiency autoimmune, mostly in developed countries. In underdeveloped countries TUBERCULOSIS, Fungal infection and CMV infection are the mcc, TB is the MCC in undeveloped countries. Adrenal Calcification is a typical feature of TB PAI. Pt presents with no rise in serum cortisol following injection of Cosyntropin (ACTH analog), CT shows calcification of adrenal glands. Tx of TB does not result in normalization of adrenal gland. PAI in HIV pt is common, mcc is CMV. Sometimes Ketoconazole can cause it. PAI is very rare with adrenal tumor metastasis, even then calcification is not seen. Adenomyosis Is defined as presence of Endometrial glands in the uterine muscle. MF in women above 49, , presents with severe dysmenorrhea, and menorrhagia. The typica lexam reveals enlarged sysmetrical uterus. If Adenomyosis is in one side of uterus then enlargment is asymetrical. DDX includes Myomatous Uterus , Leomyoma, Endometrial carcioma. For women above 35, its mandatory to perform an Endometrial curetage or even hysterectomyto rule out endometrial cancer. DDX1:Endometriosis is a benign condition, where foci of endometrial glands are found OUTSIDE of endometrium. They increase in size throgh out menstrual cycle. Asso with Adenomyosis occurs in 15% of cases. DDX2:Leomyomas, are difficult to ddx from Adenomyosis, except that consistency of

Uterus is softer in Adenomyosis. DDX3:Endometrial Carcinoma, occurs in women after menopause . DDX4:Endometritis manifest with fever, and enlarged and tender uterus, asso with vaginal discharge . It usually occurs after a septic abortion, and the mc oranism responsible is Strep. emergency medicine..!! Coma: conditions to exclude as cause MIDAS: Meningitis Intoxication Diabetes Air (respiratory failure) Subdural/ Subarachnoid hemorrhage Resuscitation: basic steps ABCDE: Airway Breathing Circulation Drugs Environment Malignant hyperthermia treatment "Some Hot Dude Better Give Iced Fluids Fast!" (Hot dude = hypothermia): Stop triggering agents Hyperventilate/ Hundred percent oxygen Dantrolene (2.5mg/kg) Bicarbonate Glucose and insulin IV Fluids and cooling blanket Fluid output monitoring/ Furosemide/ Fast heart [tachycardia] Vfib/Vtach drugs used according to ACLS "Every Little Boy Must Pray": Epinephrine Lidocaine Bretylium Magsulfate Procainamide Coma causes checklist AEIOU TIPS: Acidosis/ Alcohol Epilepsy

Infection Overdosed Uremia Trauma to head Insulin: too little or or too much Pyschosis episode Stroke occurred Shock: types RN CHAMPS: Respiratory Neurogenic Cardiogenic Hemorrhagic Anaphylactic Metabolic Psychogenic Septic • Alternatively: "MR. C.H. SNAP", or "NH CRAMPS". Shock: signs and symptoms TV SPARC CUBE: Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank Fall: potential causes CLADE SPADE: Cardiovascular/ Cerebrovascular Locomotor (skeletal, muscular, neurological) Ageing (increased body sway, decreased reaction time) Drugs (esp. antihypertensives, antipsychotics) Environmental Sensory deficits (eg. visual problems) Psychological/ Psychiatric (depression) Acute illness Dementia Epilepsy

Diabetic ketoacidosis management F*¢KING: Fluids (crytalloids) Urea (check it) Creatinine (check it)/ Catheterize K+ (potassium) Insulin (5u/hour. Note: sliding scale no longer recommended in the UK) Nasogastic tube (if patient comatose) Glucose (once serum levels drop to 12) Asthma: management of acute severe "O S#!T": Oxygen (high dose: >60%) Salbutamol (5mg via oxygen-driven nebuliser) Hydrocortisone (or prednisolone) Ipratropium bromide (if life threatening) Theophylline (or preferably aminophylline-if life threatening)

medical amnesia..!! try to remember each of them..!!! 1. Addison’s Disease - Primary adrenocortical deficiency 2. Addisonian Anemia - Pernicious anemia (antibodies to intrinsic factor or parietal cells → ↓IF → ↓Vit B12 → megaloblastic anemia) 3. Albright’s Syndrome - Polyostotic fibrous dysplasia, precocious puberty, café au lait spots, short stature, young girls 4. Alport’s Syndrome - Hereditary nephritis with nerve deafness 5. Alzheimer’s - Progressive dementia 6. Argyll-Robertson Pupil - Loss of light reflex constriction (contralateral or bilateral), “Prostitute’s Eye” – accommodates but does not react , Pathognomonic for 3°Syphilis, Lesion pretectal region of superior colliculus 7. Arnold-Chiari Malformation- Cerebellar tonsil herniation through foramen magnum = see thoracolumbar meningomyelocele 8. Barrett’s - Columnar metaplasia of lower esophagus (↑ risk of adenocarcinoma)constant gastroesophageal reflux 9. Bartter’s Syndrome - Hyperreninemia 10. Becker’s Muscular Dystrophy- Similar to Duchenne, but less severe (mutation, not a deficiency, in dystrophin protein) 11. Bell’s Palsy-CNVII palsy (entire face; recall that UMN lesion only affects lower face) 12. Berger’s Disease -IgA nephropathy causing hematuria in kids, usually following infection 13. Bernard-Soulier Disease - Defect in platelet adhesion (abnormally large platelets & lack of platelet-surface glycoprotein) 14. Berry Aneurysm - Circle of Willis (subarachnoid bleed) Anterior Communicating artery, Often associated with ADPKD

15. Bowen’s Disease - Carcinoma in situ on shaft of penis (↑ risk of visceral ca) [compare w/ Queyrat] 16. Brill-Zinsser Disease - Recurrences of rickettsia prowazaki up to 50 yrs later 17. Briquet’s Syndrome - Somatization disorder , Psychological: multiple physical complaints without physical pathology 18. Broca’s Aphasia - Motor Aphasia (area 44 & 45) intact comprehension 19. Brown-Sequard - Hemisection of cord (contralateral loss of pain & temp / ipsilateral loss of fine touch, UMN / ipsi loss of consc. Proprio) 20. Bruton’s Disease - X-linked agammaglobinemia (↓ B cells) 21. Budd-Chiari - Post-hepatic venous thrombosis = ab pain; hepatomegaly; ascites; portal HTN; liver failure 22. Buerger’s Disease- Acute inflammation of medium and small arteries of extremities → painful ischemia → gangrene, Seen almost exclusively in young and middle-aged men who smoke. 23. Burkitt’s Lymphoma - Small noncleaved cell lymphoma EBV , 8:14 translocation 24. , Seen commonly in jaws, abdomen, retroperitoneal soft tissues, Starry sky appearance 25. Caisson Disease - Nitric gas emboli 26. Chagas’ Disease - Trypansoma infection - cardiomegaly with apical atrophy, achlasia 27. Chediak-Higashi Disease - (AR) Phagocyte Deficiency = defect in microtubule polymerization, Neutropenia, albinism, cranial & peripheral neuropathy & repeated infections w/ strep & staph 28. Conn’s Syndrome - Primary Aldosteronism: HTN; retain Na+ & H2O; hypokalemia (causing alkalosis); ↓ renin 29. Cori’s Disease - Type III Glycogenosis – Glycogen storage disease (debranching enz: amylo 1,6 glucosidase def. ↑ Glycogen) 30. Creutzfeldt-Jakob - Prion infection → cerebellar & cerebral degeneration 31. Crigler-Najjar Syndrome - Congenital hyperbilirubinemia (unconjugated) , Glucuronyl transferase deficiency. Can progress to Kernicterus, Less severe form will respond to Phenobarbital therapy 32. Crohn’s - IBD; ileocecum, transmural, skip lesions, cobblestones, lymphocytic infiltrate, granulomas , (contrast to UC: limited to colon, mucosa & submucosa, crypt abscesses, pseudopolyps, ↑ colon cancer risk) , Clinically: ab pain & diarrhea; fever; malabsorption; fistulae b/t intestinal loops & abd structures 33. Curling’s Ulcer - Acute gastric ulcer associated with severe burns 34. Cushing’s - Disease: Hypercorticism 2° to ↑ ACTH from pituitary (basophilic adenoma), Syndrome: hypercorticism of all other causes (1° adrenal or ectopic) , moon face; buffalo hump; purple striae; hirsutism; HTN; hyperglycemia one of my best note OB/GYN..!! 1) Serous tumor - most common ovarian tumor - bilateral in 50% HP - psamoma body 2) mucinous tumor- largest ovarian cancer - pseudomyxomaperitonei

3) endometroid tumor - lining epithelium is like endometrial gonads 4) clear cell tumor HP - hobnail cells - protruding nucleus 5) brenners tumor - linning epi - transitional - forms a component of pseudomeig tumor - asso with ascites+hydrothorax+brenner Meig syndrm:-fibroma - ascites - hydrothorax ★★>>> Tumor marker for epithelial tumor of ovary is "CA 125 " GAUCHERS DISEASE ★ Def of alpha galactosidase - FABRY DISEASE -> x linked recessive , no mental retardation ★ Defi of beta galactosidase -> KRABBE'S DISEASE ★ Def of hexaminidase A ~> TAYSACH DISEASE ★ Def of hexaminidase A+B ~> SANDHOFF DISEASE ★ Deficiency of essential fatty acid >> phrenoderma - toad like skin ★ Defect in metabolism of short chain fatty acid - of defect in functional peroxisomes ->>> ZELLWEGR / CEREBROHEPATORENAL SYNDROME

★ defect in MCFA - SUDDENT INFANT DEATH ★ Defect in alpha rediation - accumulation of phytanic acid - REFSUM DISEASE ★ B12 deficiency >> methyl malonyl coa - megalobastic anemia/necrotizing anemia biochem..!! PHEYBIAN.. T-0 :- glycogen synthase T-1a- von gierke's :- g-6-pase - muecle are not affected T-1a G6P translocase in ER ( neutropenia and recurrant ) T-2 - poomp's - pump failure in heart failure - acid maltase {alpha ( 1-4 ) glucosidase T-3 :- cori - debranching T-4 :- anderson - branching T-5 :- mc-ardle - myo-phosphorylase T-6 :- her - hepatic phosphorylase T-7 :- Tauri - PFK in RBC and muscle T-8 :- PFK in liver . T-9 :- PFK in liver and muscle T-10 :- CAMP dependant protein kinase PHYSIO.. Lung volumes & capacities ☆Tidal Volume 500 ml ☆Inspiratory Reserve Volume 3.3L ★Inspiratory capacity- TV+IRV: 3.8L ☆Expiratory Reserve Volume 1L ★Expiratory Capacity- TV+ERV: 1.5L ☆Residual Volume 1.2L ★Vital Capacity- TV+IRV+ERV: 4.8L ★Functional Residual CapacityRV+ERV: 2.2L ★Total Lung Capacity- VC+RV: 6L ☆Max. Voluntary Ventilation >100L ☆Minute Ventilation: TV * RR ~ 7L ☆ Breathing reserve: (MVV- MV) / MVV Brachial plaxus..!! anatomy phybian.!! 》Roots 1) Dorsal scapular nerve M- Levator scapulae and rhomboids 2) Long thoracic nerve M- Serratus anterior

》 Upper trunk 1.Suprascapular nerve :M- Supraspinatus and infraspinatus 2.Subclavius nerveM- Subclavius 》 Lateral cord :1.Lateral pectoral nerve M - Pectoralis major 2.Musculocutaneous nerve M- Anterior compartment muscles of arm 》Medial cord :1.Medial pectoral nerve M- Pectoralis minor and major 2.Ulnar nerve M - Some forearm and most hand muscles 》Medial and lateral cords :1.Median nerve M - Most forearm and some hand muscles 》Posterior cord :1.Upper subscapular nerve M- Subscapularis 2.Thoracodorsal nerve M- Latissimus dorsi 4.Lower subscapular nerve M- Subscapularis and teres major 4.Axillary nerve M :- Deltoid and teres minor 5.Radial nerve :M:- Posterior compartment muscles of the arm and forearm muscles of forearm..! imp from phybian..~~ Anterior compartment superficialis 1. Pronator teres - median nerve 2.flexor carpi radialis - M 3. Flexor carpi ulnaris - ulnar nerve 4. Flexor digitorum superficialis - M 5. Palmaris longus - M

Anterior compartmenr deep muscles 1. Pronator quadratous - M 2. Flexor pollicis longus - M 3. Flexor digitorum profundus - lat half M , med half U Posterior compartmenr of superificial muscle Lateral epicondyle humerus is origin 1. Anconeus 2.brachioradialis 3.extensor carpi radialis longus 4.extensor carpi radialis brevis 5.extensor carpi digitorum 6.extensor carpi digiti minimi 7.extensor carpi ulnaris All suppilied by RADIAL NERVE and originated from LATERAL EPICONDYLE and main function is EXTENSION. Deep muscle of posterior compartment 1. Supinator 2.abductor pollicis longus 3.extensor pollicis brevis 4.extensor pollicis longus 5. Extensor indicis l - RADIAL NERVE halll mark findings ϖ Albumino-Cytologic Dissociation - Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count) ϖ Antiplatelet Antibodies - idiopathic thrombocytopenic purpura ϖ Arachnodactyly - Marfan's ϖ Aschoff Bodies - rheumatic fever ϖ Auer Rods - acute myelocytic leukemia ϖ Autosplenectomy - sickle cell anemia ϖ Babinski - UMN lesion ϖ Basophilic Stippling of RBCs - lead poisoning ϖ Bence Jones Protein - multiple myeloma free light chains (either kappa or lambda) Waldenstrom's macroglobinemia ϖ Birbeck Granules - histiocytosis X (eosinophilic granuloma) ϖ Blue Bloater - Chronic Bronchitis ϖ Boot-Shaped Heart - Tetralogy of Fallot ϖ Bouchard's Nodes - osteoarthritis (PIP)

ϖ Boutonniere's Deformity - rheumatoid arthritis ϖ Brown Tumor - hyperparathyroidism ϖ Brushfield Spots - Down's ϖ Call-Exner Bodies - granulosa cell tumor ϖ Cardiomegaly with Apical Atrophy - Chagas' Disease ϖ Chancre - 1° Syphilis ϖ Chancroid - Haemophilus ducreyi ϖ Charcot Triad - multiple sclerosis (nystagmus, intention tremor, scanning speech) ϖ Charcot-Leyden Crystals - bronchial asthma ϖ Cheyne-Stokes Breathing - cerebral lesion ϖ Chocolate Cysts - endometriosis ϖ Chvostek's Sign - Hypocalcemia facial spasm in tetany ϖ Clue Cells - Gardnerella vaginitis ϖ Codman's Triangle - osteosarcoma ϖ Cold Agglutinins - Mycoplasma pneumonia ,infectious mononucleosis ϖ Condyloma Lata - 2° Syphilis ϖ Cotton Wool Spots - HTN ATT..!! must know.for mci..!! *Latent TB: daily INH for 9 mos *cat.1: 2HRZE+4HR *cat.2: 2HRZES+1HRZE+5HRE *Tx failure & special cases: ★resistence/intolerance to H: 6RZE+Q (for extensive ds.) ★resistence/intolerance to R: 6HZEQ+S (for extensive ds.) ★resistence/intolerance to Z: 2HRE+7HR (Atypical mycobacterial inf.(MAC) *REC* regimen: 1. RIFABUTIN 2.ETHAMBUTOL 3.CLARITHROMYCIN/ AZITHROMYCIN) 1. Proprioception lost : rhomberg sign 2. Optic pathway damage: argyl robertson's pupil (prostitute's pupil) 3.peripheral neuritis: stampling gait/ high sleepage gait 4. Urinary incontinence (s2, s3, s4 damage)

Rx of syphilis: *1°: Benzathine Pen. *rest type of syphilis: Pen G IV TxOC for syphilis : PENICILLIN G IV. motility ..of organisms..!! Tumbling--Listeria Swarming-Proteus Gliding---Mycoplasma Darting--Vibrio, Campylob Jerky--Trichomonas Vagin Fallin Leaf-Giardia Sluggish- Clostridium most commons..!! MC Cause LI obstruction: colon ca MC cause SI obst : adhesions MC cause SI obst. india: TB Intestine MC cause int obst child: intususception MC cause int obs child india: ascariasis MC cause int obs newborn: duo. Atresia chemotherapy..!! $Cell cycle specificity of anticancer drugs$ *G2: bleomycin: makes complexes wid Fe & Oxygen---DNA strand scission. *M: (mitosis inhibitor) vincristine, vinblastine: inhibit pol. of microtubule paclitaxel: inhibit depol. of microtubule *G0: cisplatin, cyclophosphamide, alkylating agents, antitumor antibiotics except bleomycin, nitrosoureas (lomustine & carmustine) *S:(antimetabolites): inhibit DNA synthesis

methotrexate, hydroxyurea, etoposide, 6-mercaptopurine, 6-thioguianine, cytarabine, 5FU, azathioprine. some imp notes..!! *Colour of urine turns ✔yellow on air exposure - urochromes ✔ Black on air exposure-Alkaptonuria *cola coloured urine-hemoglobinuria *Rifampicin causes -orange coloured urine *Red coloured urine -Porphyria,trauma, clofazamine Multiple myeloma and Walden-ström's macroglobulinemia - bence jones protein @ CENTRALLY ACTING MUSCLE RELAXANTS # Chlorzoxazone # diazepam # baclofen # tizanidine # metaxalone @ PERIPHERALLY ACTING MUSCLE RELAXANTS A) Non-depolarising competitive blocker 1) long acting :- d-tubocuranine,pancuronium,doxacurium,pipecuronium 2) intermediate acting :- vecuronium,atracurium,cis-atracurium,rocuronium,rapacuronium 3) short acting - mivacurium B) Depolarizing blockers - succinylcholine - decamethonium Classic RS cells - CD15+ and CD30+ 1) Nodular sclerosis - lacunar RS cells 2) Lymphocyte predominant HL - simple RS cells - CD20 +VE , CD 15- and CD 30( POPCORN RS CELLS ) 3) Mix cellularity - mono nuclear RS cells 4) L poor - pleomorphic RS cells or necrobiotic cells 5) L rich - mummified RS cells @ AML - azurophilic granules @ Good Prognosis of ALL - CD10+ , CD 19-23, 79+ @ ALL - good prognosis if :a) hyperdiploidy

b) trisomy 4,7,10 C) t ( 9:12), t ( 12: 21) @ abnormal azurophilic granules - AUERRODS @ group of auerrods :¥ FAGGOTS CELLS and A/W AML-M3 @chloroma ( myeloblastoma ) - best marker MPO, second best - CD117 +VE ¥ a/w t ( 8:21) @ most common AML in downsyndrome :¥ AML-M7 - megakaryo blast - CD41 ,42,62 € MDS cytogenetics changes - monosomy of chr 5 and 7 - deletion of chr 5 and chr 7 - a/w trisomy 8, deletion 20 ( 20-) @ m/c pediatric cytogenetic changes - 7 monosomy @ m/c adult cytogenetics - chr 5 deletion @ m/c over all - chr 5 deletion. @ CLL - both must be present - CD5+ and CD23+ @ If one present only CD5+ - MANTLE CELL LEUKEMIA @ IOC of CLL - Flow cytometry-immunophenotyping @ CLL peripheral smear - smudge cell or basket cell or parachute cell @ diagnostic findings of CLL 1) prolymphocytes which are highly motile, fast division (pathognomic of CLL ) 2) proliferation centre 3) diffuse expansion of lymphnode architecture Honey comb lungs: *Rheumatoid arthritis. *Scleroderma. *Histiocytosis X. *Sarcoidosis. *Pneumoconiosis. Microbiology - Microbiology Pocks lesions~ Pox, Herpes virus Animal inoculation-arbovirus, cox sackie virus Amniotic cavity-influenza virus Allontoic cavity-sub culture of influenza and for vaccines Yolk sac-chlamydia, rickettsia Countinue cell line Hela-human cervical ca Kb-human pharyngeal ca Hep2- human squamous cell ca of larynx

Shared from Google Keep # FACT ABT DNA VIRUSES #

@ parvovirus - 5th disease ( erythema infectiosum ( slapped cheek ) @ HHV-6 - 6th disease ( exanthema subitum ) roseola infantum. @ Guarneri body - inclusion of small pox specially vaccinia virus @ henderson-peterson body - molluscom contagiosum @ JC virus a/w with HIV immunocompromised progressive multifocal leucoencephalopathy @ at latent stage of HSV-1 its virus site is TRIGEMINAL GANGLION ( sens nerve ) @ recurrent infection - HERPES LABIALIS, aka FEVER BLISTER aka COLD SORE @ site of HSV-2 latency is SACRAL GANGLION @ Dxc of genital herpes - Tzank test - intranuclear inclusion of multinucleated giant cells peculiar feature. @ latent site for HHV-3 ( VZV ) - spinal nerv ganglion ( single ganglion ) T3 to L3 @ recurrent infection of vericella - shingles - POST HERPETIC NEURALGIA @ HHV-3 ( HZV ) - vaccine - live attenuated - OKA strain @ test for HHV-4 (EBV) - heterophite test,paul bunnel test , monospot test. @ m/c/c of heterophile -ve mononucleosis - CMV @ m/c/site of latent infection of cmv in immunocompetent pt is - kidney and salivary gland @ m/c/c of oppurtunistic inf - CMV aftr organtransplant - PNEUMONIA @ m/c/c cause of blindness in HIV/AIDS Pts -- hemorrhagic retinitis due to CMV @ Dxc of CMV - inclusion bodies - OWL EYE INCLUSION. @ HHV-8 :- kaposi's sarcoma *Earliest sign of placental separation is change in consistency nd shape of uterus. *definate sign of placental separation is detached placenta felt in lower segment. Zinc def known as acrodermatitis enteropathicum. Essential fatty acids deficiency leads to phrenoderma or toad skin Prodrugs - Prodrugs All ACE inhibitiors except captoprilA and lisinopril Levo dopa Methyl dopa Dipivefrine Predilnisone Sulfasalazine Fluorouracil Mercaptopurine Proguanil Sulindac Minoxidil

Shared from Google Keep 3 days measles - rubella / german measles 5th dse - parvovirus B19 / erythema infectiosum/ slapped cheek appearance

6th dse - HHV 6 / exanthum subitum / roseola infantum 8th day fever - tetanus 100 day - whooping cough Q ON EMBOLI: 1.Mcc of thromboemboli:arthero sclerosis 2.Mc endogenous cause of fat emboli: # long bones(FEMUR). 3.Mc exogenous cause of fat emboli:total parental nutrition 4.Mcc of air emboli:central vein calculation 5.Mcc gas emboli:decompression sickness(CAISSONI DIS) 6.Mc site of origin art emboli:heart 7.Mcc of art emboli:arterial fibrillation 8.Mcc of venous emboli:DVT of lower limb 9.Mcc complication of venous emboli:pulmonary emboli (WESTERN MARK SIGN) GOBI FFF by UNICEF (UNITED NATION IINFANT AND CHILD EMERGENCY FUNDS) G:growth O :ors B:breast feed I :immunization F:family planning F: female education F :food suplementation ATROPINE is DOC for 1) organophosphate posioning 2) carbamate poisoning 3) irodocyclitis 4) to induce cycloplegia in children for refraction testing Phenoxybenzamine : is used to prvnt htn episodes during operative manipulation of tumor in pheochromocytoma. Labetalol & Carvedilol r useful 4 htn episodes in pheochromocytoma. most imp..!!! 3 modes of ultrasonography: A mode → used in optha dept. For biometry. B mode →routine mode, (abdomen, chest etc.) "Grey-scale mode" C mode →used in myocardium (echo) PHYSIOLOGY change in atrial pressure A - atrial systole

C - small fluctuation bcz of bulging of av wall to tricuspid vavle v - filling of right atrial when tricuspid valve is closed X - av valve comes back to original position during ventricular relaxation Y - opening of tricuspid valve 1st heart sound- starting of isovolumetric ventricular contraction 2nd heart sound - starting of isovolumetric ventricular relaxtion S3 - rapid venrticular fillinG S4 - pathological ## Methods to measure ECF > Inulin : mst accurate method to measure ECF > Mannitol > Sucrose ## method to measure plasma volume > Evans blue ( T1824) > Radio-iodinated human serum albumin (SIRA) > Radio iodinated gammaglobulin > Fibrinogen *# method to measure red cell volume > Radioactive isotopes of chromium phosphorus,iron Malignant acanthosis nigricans AN associated with internal malignancy Most common underlying cancer is tumour of the gut (90%) especially stomach cancer In 25-50% of cases, lesions are present in the mouth on the tongue and lips CUTANEOUS MECHANORECEPTORS Meissner's corpuscles - respond to change in texture and vibration Merkel cell - respond to sustain pressure Ruffini corpuscles- respond to sustained pressure Pacinian corpuscles - respond to deep pressure and fast vibration Dalen fuschs nodules found in sympathetic opthalmitis Frequency used in USG. Abdomen. *3-5 MHz Superficial tissue. *7-10MHz. Transvaginal. *5-7 MHz. Endoscopic USG or echocardiography *20MHz Athetosis: lesion in lenticular nucleus Chorea: lesion in caudate nucleus Kernicterus: lesion to globus pallidus Hamiballisms: lesion to subthalamic nucleus Wilson's disease: progressive hepaticolenticular degeneration, high copper content of substantia niagra & low ceruloplasmin. Modified koopanys test : bariturates guaicac test : haematuria Rotheras test : ketone bodies

gerhardts test : ketosis Molischs test : sugar (color test) Millons test : tyrosinosis Sulkowitch test : urinary ca+2 Biuret test : protein Haemophilia A - def of Factor VIII Haemophilia B - def of Factor IX Haemophilia C - def of Factor XI 8th march - internation women's day 15th march world disabled day 8th may - world red cross day 26th june - international day against drug abuse and illicit trafficking 1st july - doctors day 11th - world poplulation day 1st oct - international day for older persons, national voluntary blood donation day 9th oct - world sight day 10th oct - world mental health day 24th oct - UN day 10th oct - world mental health day 24th oct - UN day 10th nov - universal immunization day 25th nov - international day for elimination of violence against women 3rd dec - international day of disabled persons 10th - human rights days Frozen plasma: lack factor 8,5 and von willebrand factor. Cryoprecipitate: concentrated source of factors 8, von willebrand, fibrinogen,fibronectin. Produced by slow thawing 4degree C of frozen plasma ff by centrifugation at 4 degree C Fetal hemoglobin(hbF): structure similar to adult hemoglobin except beta chains are replaced by gamma chains. More resistant to alkalis. Greater affinity for oxygen. Lesser life span @ Legal age of marriage in india - 18 yrs for girls and 21 yrs for boys @ Legal age for voting in india - 18 yrs for both boys and girls @ Legal age for employment > 14 yrs @ legal age of consent by a girl for sexual intercourse in india - 18yrs @ Juvenile in india - boy < 18yrs , girls < 18 yrs @ Major in india - 18 yrs and above @ Tobaco product can not be sold in india - below 18 yrs

@ Alochol cannot be sold in india - below 25 yrs Short term starvation: main source of glucose is : liver glycogen Long term starvation: main source if glucose is: Fatty acids Meissner's corpuscles: respond to change in texture, slow vibration Merkel cells: respond to sustaind pressure and touch. Ruffini corpuscles: respond to sustaind pressure Pacinian corpuscles: respond to deep pressure and fast vibration " Contraceptive method and their pearl index ( per HWY ) " @ No method used - 80 @ rhythm ( calendar ) method - 24 @ Coitus interuptus - 18 @ Male condoms :- 2-14 @ Female condoms :- 5-21 @ Diaphragm :- 12 @ vaginal sponge :1) parous women - 20-40 2) Nulliparous women :- 9 -20 @ IUD :- 0.5 - 2.0 @ oral pill :- 0.1 - 0.5 @ centchroman ( saheli ) :- 1.83-2.84 *Muscle responsible for locking of the knee is quadrarus femoris. *muscle responsible for unlocking of the knee is popliteus. Nerve roots involved in erb's paralysis is C5 and C6. Klumpke's paralysis nerve roots involved is T1 and C8

some imp diseases..!! Alzheimer's disease: common characteristics ALZHEIMER'S: Anterograde amnesia is usually first sign Life expectancy increase shows more cases in recent years Zapped (loss of) acetylcholinergic neurons Hereditary disease Entire hippocampus becomes affected Identified by neurofibrillary tangles Mutation in amyloid genes associated w/ disease Entorhinal areas degenerate first Retrograde amnesia ultimaltely develops

Senile plaques are formed at synapse ABRUPTIO: Administer o2 Begin cesarean birth Replace blood loss Use recumbent position Placenta separation Third trimester Inspect FHR Observe for DIC Mnemonic for raised Alfa feto protein. "Increased Maternal Serum Alpha Feto Protein": Intestinal obstruction Multiple gestation/ Miscalculation of gestational age/ Myeloschisis Spina bifida cystica Anencephaly/ Abdominal wall defect Fetal death Placental abruption orthopedics..!!! hyeperparathyroidism Pepper-pot skull Chondrocalcinosis Rugger jersey spine Brown's tumor in maxilla Subperiosteal resorption of phalanges Scurvy Pencil thin cortex White line of frankel Zone of trummerfeld Pelkan spur Osteomalacia Looser's zone Triradiate pelvic Protrusiin of acetabuli Osteoporosis

Splaying Cupping Fraying Rachitic rosary Looser's zone Wind swept deformity Ostoeocondritis Perthes disease - epiphysis of head if femur Panner's disease - capitulum Kienbock's disease - lunate Osgood schlatter disease - tibial tuberosity Kohler disease - navicular Arachnodactyly is seen in 1.marfan syndrome 2.homocystinuria 3.ehlers danlos syndrome TRIADS --------1) TRIAD OF ALPORT'S SYNDROME -- SENSORINEURAL DEAFNESS, PROGRESSIVE RENAL FAILURE, OCULAR ANOMALIES 2) TRIAD OF BEHCET'S SYNDROME -- RECURRENT ORAL ULCERS, GENITAL ULCERS, IRIDOCYCLITIS. 3) BECK'S TRIAD -- MUFFLED HEART SOUND, DISTENDED NECK VEINS, HYPOTENSION. 4) CHARCOT'S TRIAD -- PAIN+FEVER+JAUNDICE 5) GRADENIGO'S TRIAD - SIXTH CRANIAL N. PALSY, PERSISTANT EAR DISCHARGE, DEEP SEATED RETROORBITAL PAIN 6) Triad Of Hypernephroma -- pain+hematuria+renal Mass. 7) Hutchinson's Triad --- Hutchison's Teeth, Interstitial Keratitis, Nerve Deafness. Triad Of Kwashiorkar- Growth Retardation, Mental Changes, Edema. 9) Saint's Triad --- Gall Stones, Diverticulosis, Hiatus Hernia. Trotter's Triad -- Conductive Deafness, Immobility Of Homolateral Soft Palate, Trigeminal Neuralgia. 10) VIRCHOW'S TRIAD-- STASIS+HYPERCOAGULABILTY +VESSEL INJURY. 11) Congenital Rubella syndrome-- PDA deafness cataract 12) SAMTER'S TRIAD -- ASPIRIN SENSITIVITY, BRONCHIAL ASTHMA, NASAL POLYP.

13) Grancher's triad-- lessened vesicular quality of breathing, skodaic resonance, and increased vocal fremitus; seen in early pulmonary tuberculosis. 14) Osler's triad-- telangiectasis, capillary fragility, and hereditary hemorrhagic diathesis seen in hereditary hemorrhagic telangiectasia. 15) BARTTER'S SYNDROME - METABOLIC ALKALOSIS, HYPOKALEMIA, NORMAL OR DECREASED BP. 16) Weil's Disease-- Hepatorenal Damage, Bleeding Diathesis, Pyrexia. 17) Meniere's Disease -- Vertigo, Tinnitus, Sensorineural Hearing Loss. 18) Melkersson Rosenthal Syndrome-- recurrent Facial Palsy, Plication Of Tongue, Facial Edema. 19) Parkinsonism-- Rigidity, Tremor Hypokinasia 20) Cushing's traid -- Bradycardia, hypertension & irregular respirations in increased intracranial pressure. 21) Kartagener’s Syndrome-- bronchiectasis, Recurrent sinusitis, and Situs inversus. 22) Hemobilia(Triad of Sandblom)-- Malena, Obstructive jaundice, Biliary colic. 23) Murphy's triad(in order)- Pain, Vomitting, Fever. 24) WHIPPLE'S TRIAD Of INSULINOMA-- HYPOGLYCAEMIA DURING ATTACKS, S.GLUCOSE a conjunctival triangular white patches, path gnomonic of Dry eye. 5. Black sunburst ---> RPE Hyperplasia in Sickle Cell Retinopathy. 6. Bull's Eye Maculopathy --> Chloroquine toxicity, HydroxyChloroquine toxicity, Cone dystrophy & Batten Mayou syndrome. 7. Cobble stone papillae --> Spring catarrh. 8. Cornea verticillata --> Amiodarone side effect .Other Causes -chloroquine, Fabry’sdisease, Indomethacin. 9. Cherry red macula --> CRAO 10. Chocked disc --> Papilloedema. 11. Candle wax drippings (Retinochoroidal exudates) -->sarcoid periphlebitis (OcularSarcoidosis). 12. Egg yolk appearance --> Vitelliform macular dystrophy(Best disease). 13. Eclipse sign --> Shallow Anterior chamber. Ocular Involvement in AIDS - Earliest finding in cotton wool spots - MC ocular infection is CMV chorioretinitis - drug of choice of CMV Retinitis is Ganciclovir - Most common ocular neoplasm in Kaposi sarcoma - CMV infections are seen with CD4T cell count