Friday, 30 March 2018
Extra edge on FAP
Please remember that Prophylactic surgery is not done for FAP or Peutz Jegher syndrome or Gardner Syndrome.
(Often repeated question).
Tuesday, 27 March 2018
Tuesday, 13 March 2018
Pneumoperitoneum: MCQ's
PNEUMOPERITONEUM (all of them have been asked)
▪First Ix to perform = USG
▪Most sensitive noninvasive Ix = USG
▪IOC = Chest X-ray Erect
▪Best Ix = Chest X-ray Erect
▪Gold standard Ix ( but usually not done ) = CT
▪An erect chest x-ray is the most sensitive plain radiograph for the detection of free intraperitoneal gasin an EMERGENCY setting. On chest X-ray, any subdiaphragmatic free gas can be seen.
Soft tissue sarcomas: One liners
🔸Most common soft tissue sarcoma in adults: Malignant fibrous histocytoma followed by liposarcoma(asked several times)
🔸Most common soft tissue sarcoma in Young adults: Synovial cell sarcoma
🔸 Most common soft tissue sarcoma in children: Rhabdomyosarcoma
🔸Most common site of Rhabdomyosarcoma: Genitourinary followed by extremities.
🔸Most common soft tissue sarcoma of the hand/ Upper extremity: Epithelioid sarcoma.
🔸Most common soft tissue sarcoma in the foot: Synovial cell sarcoma
🔸Most important prognostic factor in soft tissue sarcomas: Histological grade.
🔸Most common radiation-induced soft tissue sarcoma: Malignant fibrous histocytoma (otherwise, Most common radiation-induced sarcoma- Osteosarcoma)
Tourette syndrome: MCQ's
Tourette’s disorder is characterised by multiple motor and vocal tics that occur many times every day or intermittently for >1 year. Tics can be simple (rapid, repetitive contractions) or complex (appear as more ritualistic and purposeful), and simple tics appear first.
Mean onset is age 7 (onset must be age <18).
Male to female ratio is 3:1.
Evidence of genetic transmission: ~50% concordance in monozygotic twins
Associated with increased levels of dopamine
Associated with ADHD and OCD
Treatment: haloperidol, pimozide, or clonidine
Monday, 12 March 2018
Monday, 5 March 2018
Sunday, 4 March 2018
Sexual offences: Overview and important points
MC paraphilia: SADOMASOCHISM (BONDAGE)
TRIOLISM is different from TRIBADISM
Masturbation is called ONANISM OR IPSATION
UROLAGNIA is called UNDINISM OR UROPHILIA
PARTIALISIM is focussing on CERTAIN body parts...eg.foot fetish
SCATOLOGIA is telephone call sex torture
Sodomy: active is Pedophile / passive is catamite (child)
Lesbianism: active is butch/dyke/ passive is femme
Punishment of rape..
<15 years...10 years
15 and above...
If wife...not rape
If not wife...
Check age...
If 15/16 yrs...10 years
If 16 to 18 years...7 years
>18 yrs without consent...7 years
Rape laws to be remembered...
375...defn of rape
376...punishment of rape
166B...not treating a women during emergency after rape (1 yr)
228A...revealing identity of a rape victim (2 yrs)
327 CrPC...holding rape in trial camera
One liners...
Impotence is not a defence for rape
Hymen is examined using Glaister Keen rods
MC site of rupture...5 to 7 o clk
Microinjuries are detected using toluidine blue
POCSO act is for children less than 18 yrs
Absolute proof of sodomy is semen in PR examination
In sodomy...both active and passive agent are punished except if it is a child
Sadism is called algolagnia
Most common paraphilia is sadomasochism (bondage)
Voyeurism...354 IPC
First time 1 to 3 yrs
Later...3 to 7 yrs
Frotteurism... 290 IPC for Rs. 200
291 IPC for 6 months
Exhibitionism...Punished under
294 IPC for 3 months
Molestation...354 IPC...1 to 5 yrs
Translocations that have been asked so far !
t(x : 17 ) - alveolar soft part tumour
t(x: 18 ) - synovial sarcoma
t(11:14) - mantle cell lymphoma
t(14:18) - follicular cell lymphoma
t(11:18) - maltoma , extranodal marginal zone lymp.
t(15:17) , t (8:21) - AML M3
t(14:4) ,t(14:11) ,t(14:6) , t(14:16) - multiple myeloma
t(8:14) .t(2:8) ,t(8:22) - burkitt's lymphoma
t(2:5) - anaplastic large cell lymphoma
t(3q:v) - diffuse large B-cell lymphoma (v-variable)
t(2:13) - alveolar rhabdomyosarcoma
t(2:16) - myxoid liposarcoma
t(11:22) - pnet , askins tumour( ewings)
t(3:8) - renal adenocarcinoma , mixed parotid tumour
t(6:14) - cystadeno carcinoma of ovary
t(10:17) - papillary thyroid carcinoma
t(x:1) - peadiatric papillary RCC
t(9:22) - philadelphia chromosome
t(12:21) - ALL ( CBF alpha , ETV6)
t(1:11)- schizophrenia
Indices to differentiate between IDA and Thalassemia: JIPMER topic
Various indices to differentiate between IDA and BETA THALASSEMIA:
1. MENTZER INDEX 👉 IDA >13, BT< 13
2.SHINE AND LAL INDEX 👉 IDA>1530, BT< 1530
3.ENGLAND AND FRASER INDEX👉 IDA>0, BT<0
4.SHRIVASTAVA INDEX👉 IDA>3.8, BT<3.8
5. GREEN AND KING INDEX👉 IDA>65, BT<65
6.RED CELL DISTRIBUTION WIDTH INDEX👉 IDA> 220, BT< 220
Numbers in OBG
AbdominalTB- present in genital tb patients-45%
Patients of genital TB infertile: 40-80%(mc presenting complaint of genital tb -INFERTILITY >pain)
Incidence of genital tb in patients with infertility-17%
Mullerian anomaly association with urinary tract abnormality-30%
Risk of endometriosis is 7 times more if 1st degree relative is affeced with endometriosis
Patient with history of ovarian ca in 1st degree relatives,so risk of ovarian cancer-7%(dnb 2014)
Recurrence rate ater incision and drainage of endometrial cyst-50%(€€therefore best t/t - cystectomy)
Rate for conversion to frank cancer
cin-1 : 1%
Cin-2 :5%
Cin-3 : >12%(22)
Cin 1 conver to CIS -11%
Cin 1 time to regress to normal-2yrs
Protection rate of hpv vaccine-70%
Risk of involvement of ovaries in ca cx-11%
BSO can reduce the risk of breast ca by 50%
Dermoid always benign but risk of cancer -less than 2%
Risk for lifetime
brca 1-ovarian ca-35-45%
Hnpcc-endometrial ca-75%
Post mentrual bleeding patients developing endometrial ca-10%
any abnormal uterine bleeding above 40yrs endometrial ca should be ruled out therefore endometrial biopsy to be done rather than PAP
Endometrial hyperplasia(pre invasive)
simple withOUT atypia-1% risk for endometrial ca
Complex WITHOUT atypia-3%
Simple with atypia-8%
Complex with atypia-20%
(Without atypia progestrogens to be given for MINIMUM 14 days)
Use of OCP for 5yrs decrease the risk ovavarian ca by 50%
Molar preg
partial-90% triploidy 10% tetra
Complete 80-90% monospermic 46xx,10% 46xy
Complete mole associated with-
pre eclampsia-27%
Hyperemesis-25%
Hyperthyroidism-7%
Trophoblastic embolization-2%
Theca letin cysts -50%
Partial mole to
gtn-4%
Chorioca-<1%
Complete mole to
gtn-15-20%
Chorioca-4%
Hcg levels becum normal in
partial-7weeks
Complete-9weeks
40%ovulate after taking POP
NORMAL MC BLOOD LOSS-35ml
Blood loss after cuT-80ml
Post placental IUD insertion within 10mins
Post placental sterilization within 48hrs(ideal),can be done upto 7 days.if not done in first 7 days do after 6 weeks.
Expulsion rate
cuT 5%
IUD-10%
Memory time-5min
Mini lap-3-4cm incision
FT damaged in mod. Pomeroy-3cm
Gas for pnemoperitoneum-2L,pressure-15mmhg(co2)
Rate of ectopic post sterilization is 10%
Risk of ectopic
highest-bipolar cautery
Lowest-mod. Pomeroy
Average liquefaction time for semen-20min
Maximum time for liquefaction-60min
Speed of sperm in female tract-3mm/sec
Who parameters
Vol->1.5 ml ,ph >7.2
Sperm concentntration 15 million
Sperm count 39 million
Total motility 40%
Forward motility 32%
Wbc -lessthan 1 million
Normal morphology 4%
40% ppl taking POP ovulate normally
Safe period of POP-3hrs
Safe period of cerozette is 12hrs
Types of sequestra
Different types of sequestra:-
Ring- amputation stump
Ivory- syphilis
Feathery- TB rib
Kissing- peridiscal TB vertebra
Sandy- central body TB vertebra
Button hole- after radiation
Coke- cancellous bone
Bombay/black- due to h2s(pollution)
Dermatological infections
1) Most common organism causing tinea- Trichophyton rubrum
2) Most common organism causing tinea capitis- Trichophyton violaceum
3) Most common cranial nerve involved in Hansens- facial
4) Most common nerve taken for nerve biopsy in Hansens- radial cutaneous (upper limb), sural (lower limb)5
) Most common cause of mononeuritis multiplex - Hansen (India), DM (world)
6) Most common cause of ENL- LL> BL
7) Most common cause of a negative Slit skin smear in Hansen- neural leprosy
8) Cause of Type 1 reaction- BB> BT> BL
9) DOC for type 1 and type 2 reaction- steroids
10) DOC for chronic, recurrent ENL- thalidomide
11) Most common side effect of dapsone- hemolytic anemia
12) Most common side effect of clofazimine- pigmentation
13) Most common cause of inverted saucer lesion- borderline leprosy
14) Most common cause of leonine facies- LL
15) Earliest sensation lost- temperature
16) Most common Hansen- Borderline Tuberculoid
17) Commonest site for Fixed drug eruption (FDE)- lips
18) DOC for tinea - terbinafine
19) DOC for tinea capitis- griseofulvin
20) Most common type of onychomycosis – Distal and lateral onychomycosis (In HIV, the most common type is proximal subungual onychomycosis and superficial whiteonychomycosis)
21) DOC for sporotrichosis- itraconazole> potassium iodide
22) Most common cause of reactive arthritis- Chlamydia> Shigella
23) Most common Psoriatic arthritis- oligoarticular, asymmetric.
24) DOC for psoriatic arthritis- Methotrexate
25) DOC for arthritis mutilans- etanercept
26) DOC for guttate ps- antibiotics
27) DOC for erythrodermic psoriasis- Methotrexate
28) DOC for pustular psoarisis- Acitretin
29) DOC for early mycosis fungoides- Electron beam therapy > Phototherapy
30) Most common type of pemphigus- pemphigus vulgaris
31) Rarest type of pemphigus- pemphigus vegetans
32) DOC for Dermatiis herpetiformis- Dapsone
33) Most classical joint involved in Psoriatic Arthritis- DIP
34) Most common cause of non bullous impetigo- strepto> staph
35) Most common cause of bullous impetigo- staph
36) Most common underlying disease in kaposis varicelliform eruption - atopic dermatitis
37) Most common site of adult atopic dermatitis- ante cubital fossa
38) Most common site of pediatric atopic dermatitis- cheek
39) Most common cause of cumulative Irritant contact dermatitis- detergents, Wet work
40) Most commonest cause of Allergic contact dermatitis-nickel
41) Most common cause of air borne contact dermatitis- parthenium
42) DOC for air borne contact dermatitis - azathioprine
43) Most common layer of epidermis for lamellar body presence- granular layer
44) Most common layer for synthesis of vitamin D ( Also same answer for presence of langerhans cells)- spinous layer
45) Thickest layer of epidermis- corneum
46) Thinnest layer of epidermis- granular
47) Most common cause of acute paronychia- staph
48) Most common cause of chronic paronychia-candida
49) Most common syphilis transmitted by sexual route- primary
50) Most common syphilis transmitted from infected mother- secondary
51) Most infectious lesion in syphilis- mucous patches
52) Most sensitive test in syphilis- Enzyme Immunoassay> TPPA > FTA-abs
53) Most specific test in syphilis- TPPA> TPHA
54) DOC for chancroid- azithro
55) DOC for LGV and donovanosis- doxy
56) DOC for syphilis in pregnancy- penicillin
57) DOC for urethral discharge and cervical discharge (syndromic management)- azithro+ cefixime
58) DOC for vaginal disch (syndromic management)- fluconazole + secnidazole/metro/tinidazole
59) DOC for bubo (syndromic management)- azithro+ doxy
60) DOC for genital ulcer (syndromic management)- if vesicle - acyclovir, if not azithro+ benzathine penicillin
61) DOC for neurosyphilis- crystalline aqueous penicillin
62) DOC for penicillin allergy in syphilis- doxy
63) DOC for penicillin allergy in syphilis in pregnancy- desensitization
64) DOC for penicillin allergy in neurosyphilis- desensitization
65) DOC for Impetigo herpetiformis- steroids
66) Investigation of choice in primary syphilis- dark ground illumination
67) Most common cutaneous TB- lupus vulgaris (In children, it is Scrofuloderma)
68) Test of choice for lupus vulgaris- biopsy
69) Most common organism for p versicolor now in India- Malassezia globosa
70) Most common internal organ inv in leprosy- testis
71) Organ never inv in leprosy- uterus> CNS72) Sensation never lost in hansens- propioception, vibration
73) DOC for Post herpetic neuralgia- Gabapentin
74) Most characteristic of LP on histopathology- basal cell degeneration
75) Best time to read patch test- 4 days
76) Commonest drug for FDE- sulphonamides
77) Commonest cause of Erythema Multiforme- HSV
78) Commonest cause of SJS/TEN- drugs (NSAIDS, anti epileptic, sulphonamides, penicillin)
79) DOC for scabies- 5% permethrin
80) DOC for scabies in pregnancy- 5% permethrin
81) DOC for nodular scabies- permethrin+ steroids
82) DOC for nerve abscess- I and D
83) DOC for nodulocystic acne- oral isotretinoin
84) DOC for hormonal acne- OCP with drosperinone+ estrogens
85) DOC for pediculosis corporis- disinfection of clothes
86) DOC for head louse- 1% permethrin
87) DOC for norwegian scabies- ivermectin
88) Most common shape of burrow in scabies- S-shaped
89) Most common and earliest manifestation of tuberous sclerosis- ash leaf macule> adenoma sebaceum
90) Earliest manifestation of congenital syphilis- snuffles
91) Best blood test for congenital syphilis- FTA-ABS IgM
92) Most common site for morphoea- limbs
93) Most common cause for salt and pepper skin pigmentation- scleroderma
94) Most common cause of acanthosis nigricans- obesity
95) Most severe form of psoriasis- Von zumbusch
96) Most common melanoma- superficial spreading melanoma
97) Poorest prognosis in melanoma- nodular
98) Most common type of BCC- noduloulcerative
99) Most common cause of hypopigmented, scaly patches on cheek of children- Pityriasis alba
100) Most common cause of hypopigmented, nonscaly, atrophic patches on cheek of endemic area children- indeterminate hansens
101) Investigation of choice for neurosyphilis- CSF-VDRL
102) Most common type of oral LP- reticulate / white lacy pattern
103) DOC for localised alopecia areata- intralesional steroids
104) Most effective drug in alopecia areata- contact sensitizers
105) commonest autoimmune association in vitiligo- thyroid
106) Commonest agent for leucoderma- paratertiary butyl phenol (PTBP)
107) Commonest agent for hair dye allergic contact dermatitis- paraphenylene diamine (PPD)
108) Commonest agent for footwear allergic contact dermatitis- Mercaptobenzothiazole (MBT)
109) Investigation of choice for Air borne contact dermatitis- photo patch test
110) Commonest extra genital site for primary chancre- lips
111) Commonest cause of recurrent blisters on genitals (healing with hyperpigmentation- FDE) ( if not then herpes genitalis)
112) Commonest vitiligo- Vitiligo vulgaris
113) Most common cause of erythema nodosum- Strepococcus.
114) Most common cause of patchy alopecia- Alopecia areata
115) DOC for rosacea- Metronidazole (topical), Doxy (Oral)
116) Commonest site for primary syphilis chancre- Coronal sulcus
117) First test to become positive in primary syphilis- FTA-Abs
118) Characteristic nail change in LP- Pterygium
119) Commonest cause of apple jelly nodules- Lupus vulgaris
120) Commonest cause of hypopigmented, minimally scaly macules and patches on chest and back of young adults- P. versicolor
Tumour gradings/stagings
1. Bloom-Richardson grading- Breast Ca.
T- Tubular formation
N- Nuclear pleomorphism
M- Mitotic count
2. Nottingham prognosis index- Breast
(0.2*Tumor size+LN+Grade)
3. Chang- Medulloastoma
4. Noguchi- Adeno Ca. of Lung
5. Masoka- Thymoma
6. Shimida index- Neuroblastoma
7. Gleason- Prostate
8. Robson- Renal Cell Ca.
9. Jackson- Penile Ca.
10. Dukes- Colorectal
11. Nevin- Ca. Gall bladder
Confusing words
🔋MOST CONFUSING WORDS
🌱werMer-Men1
🌱Werner-adult progeria
🔋NOTE:
🌱MEN1 WERMER
🌱MEN2A SIPPLE
🌱MEN2B/3 WAGENMANN SYNDROME
🌱Buerger disease-TAO
🌱BErger ds-IG A NEPHROPATHY
🌱Forbes is glycogen storage disorder3 i.e cori
🌱Farber -lysosomal storage disorders with ceraminidase deficiency
🌱Fabry is also a lysosomal storage disorder with alpha galactosidase deficiency
🌱Forbes albright syndrome- an endocrine disease characterized by amenorrhea, prolactinemia, and galactorrhea, caused by an adenoma of the anterior pituitary.
🌱Wartenberg syndrome?
Compression of sensory branch of radial nerve
🌱Wardenberg syndrome?
Piebaldism, telocanthus, sensory neural deafness-Mutation in pax3
🌱Wallenberg syndrome?
Posterior inferior cerebellar artery occlusion..
🌱Nevus of Ota: periorbitalspeckled slate gray pigmentation PERSIST
🌱Nevus of Ito: similar pigmentation of the acromioclavicular areas: PERSIST
🌱TROUSSEAU SIGN-Hypocalcemia
🌱TROUSSEAU SYNDROME-paraneoplastic syndrome of pancreatic cancer
🌱TROISIER SIGN-enlarged hard left supraclavicular lymphnode(virchows) in gastriccancer
Eggs in Medicine
ALL EGGS YOU HAVE TO KNOW IN MEDICINE:
• Oligodendroglial components are characterized
histologically by a moderately cellular collection of cells
with round nuclei and perinuclear halos ("fried egg"
appearance)
• The mycoplasmas are typically slow growers with a
generation time of 1-6 hours. They produce small
colonies typically described as a fried-egg appearance.
• Diphtheria 'Intermedius colonies' are small, 2 mm in size,
lustreless with domed centre and irregular margin with
'frog egg' appearance.
• Crumbled egg---> Hydatid Liver Cyst
• Scrambled egg---> Pancreatic cancer; Best Disease
• Egg in cup appearance: Constrictive pericarditis
• Egg on side appearance TGV ( transportation of great
vessels )
• Egg on a string : Appearance of the heart that may be
seen with transposition of great arteries.
• Odour in poisoning: H2S--> Rotten egg
• Egg cell calcification of the hilar node: Silicosis >
sarcoidosis
• Schistosome Eggs::
Egg with
Terminal spine--> S.Hemotabium (TSH)
Lateral Spine---> S.Mansoni (LSM)
Lateral Knob--> S.Japonicum (LKJ)
• Non-bile stained egg:
"NEHA"
Necator americanus
Enterobius vermicularis
H.nana
Ancylostoma duodenale
NRTI: MCQ's
Max pancreatitis? Didanosine✅
Max peripheral Neuropathy? Stavudine✅
Max lipodistrophy? Stavudine✅
Best tolerated NRTI? Lamivudine emtricitabine✅
Causes fulminant hepatic failure? Didanosine✅
Causes Nail hyperpigmentation? Zidovudine✅
Among NRTI Diarrhea more common with? Didanosine✅
Apthous ulcers caused by? Zalcitabine✅
Least effective NRTI? Zalcitabine✅
NRTI with ↑ risk for M.I ?abacavir✅
Non renal metabolism among NRTI? Abacavir✅
Also useful against Hep B? Lamivudine , emtricitabine, tenofovir✅
MOA: Important questions
Mechanism of Action
1-DNA Dependent RNA Polymerase– Rifampcin
2- RNA Dependent DNA Polymerase– Zidovudine
3-Proetin Synthesis Blocker– Erythromycin, Chloramphenicol & Tetracycline
4-ACE Inhibitor– Captopril
5-Ca Channel Blocker– Nifedipine, Diltiazem
6-COX Inhibitor– Asprin
7-GABA Facilitator– Benzodiazepines
8-Antimetabolites– Methotrexate
9-Loop Diuretics– Frusemide
10-High Ceiling Diuretics– Spironolactone
11-Alteration of bacterial DNA– Choloroquine
12-Inhibition of Viral replication– Amantidine, Acyclovir
13-H1 blocking agent– Mepyramine, Loratadine
14-H2 Blocking agent– Rantidine, Cimetidine, Famotidine, Cyprohaptidine
15-Proton Pump inhibitor– Omeprazole
16-DNA Metabolism Inhibitors– Quinacrine (Mepacrine)
17-Spindle Poison– Vinca, Griesofulvin
18-Folic acid synthesis inhibitor– DDS
19-GABA Inhibitor– Sodium Valproate
20-DNA Synthesis Prevention – Nalidixic Acid
21-Prostaglandin Synthesis Inhibition– Oxyphenbutazone, Ibuprofen
22-Mycolic acid synthesis inhibition– INH
23-Folic acid antagonist- MTX, PAS, DDS & Primethamine
24-Desruption of DNA structure– MNZ
25-Inhibition of cell wall synthesis– Beta lactam antibiotics (penicillin)
26-Release of nor epinephrine– Ephedrine
27-Ergosterol Biosnythesis Inhibitors– Clotrimazole, Miconalzole, Ketoconazole
28-Ach esterase inhibitors– Physostigmine, Neostigmine, Edrophonium, Metrifonate
29-Reverse Transcriptase Inhibitors– Stavudine, zidovudine
30-Inhibition of HIV Protease– Amepranavir
31-DNA Gyrase Inhibitor– Cinoxacin
32-Inhibition of DNA Polymerase-Gossypol
33-NMDA Receptor Antagonist– Amantadine, Ketamine, Dextromethorphan, Memantine & Nitrous Oxide
34-DNA intercalating agent– Daunorubicin, Doxorubicin, Ellipticin & Ethidium Bromide
35-Antim mitotic agent– Amphethenile
36-Alkylating agent- Thiotepa
37-Alpha receptor antagonist- Phentolamine
38-Beta receptor antagonist- Propanolol, Aplrenolol
39-Alpha receptor agonist- Norepinehrine
40- Beta receptor agonist- Isoproterenol & Salbutamol
41-DNA Adduct Formation– Procarbazine
42-Carbonic anhydrase inhibitor- Acetazolamide
43-Phosphodiestrase Inhibitor- Theophylline
44-Thrombin action prevention- Heparin
45-Xanthine oxidase inhibitor- Allopurinol
46-Cholinergic Blockade- Ipratropium
47-Adenosine Deaminase inhibitor- Crisnatapase
48-Immunomodulation– Imiquimod
49-Amino acid transfer interference– Econazole
50-Mast Cell Stabilization– Ketotifen
Signature deficiencies
VITAMIN DEFICIENCIES In Different
Conditions
Alcoholics===Folate and thiamine.
Smoking===Vitamin C due to used up
by FR in smoke.
New born===Vitamin K due to sterile
gut
Bcz MC source of Vitamin K is gut
bacteria.
Hospitalized Pts===Vitamin
K>>>Biotin
Bcz of antibiotics use that kills gut
bacteria
Renal Failure ===Vitamin D.
Due to failure of 1 alpha hydroxylation.
Rice as staple diet===B1 Deficiency
That's why it has been enriched with B1
in some countries
Perniciuos anemia===Autoimmune
atrophic gastritis===B--12 deficiency.
Colostrum (Breast milk upto 4
days)=== deficient in Vitamin D.
Breast milk=== deficient in D ,K, fluoride and
pantothenic acid (Cpsp key).
Goat milk === deficient in Vitamin
B6 ,Folate .
Cow milk === deficient in Vitamin A,C ,D.
Post menopauseal wome===
deficient in vitamin D (400 IU daily intake
recommended ).
Women strict vegetarian ===B12
DEFICIENCY in her and her baby if
pregnant or not.
Pregnant lady === Folate deficiency
bcz of its more excretion due to increased
GFR
And Fetal tissue growth consumption.
Pregnant lady with alcohol
consumption ===MC Vitamin Deficiency
===Folate.
Increased NTDs risk.
People having just maize their Staple
diet===B3 NIACIN deficiency ===risk of
PELLAGRA 3D diarrhea dementia
dermatitis.
Celiac disease involves ===Jejunum
mostly===So Folate deficiency.
Crohns disease ===Involves ILEUM
===so B12 deficiency occurs.
Terminal ileal resection ===B12
&Bile salts deficiency === osmotic
diarrhea and increased water loss and bile
salts (Ganong).
Cystic Fibrosis ===ADEK fat soluble
vitamins deficiency
Total pancreatectomy === ADEK
DEFICIENCY.
Alcoholics==MC deficiency of Mg.
Scorings, criteriae and scales
A
Agatson score : CAD
Austin - kartush classification - middle ear risk index ( MERI)
Alanzolej classification : chloledochal cyst
Amsel's criteria: bacterial vaginosis
Ann Arbours staging: Hodgkin's lymphoma & Non Hodgkin's lymphoma
Ashbury criteria : GBS
Astler collar:colorectal cancer
B
Belthazar scoring : acute pancreatitis
Bent criteria : allergic fungal sinusitis
Butcher's criteria: Mesothelioma
Berlin's criteria : ARDS
Bismuth classification: tumors of hepatic ductal system
Bosniak classification : renal cyst
Broca's index : Ht in cms-100
Boreman classification : Gastric carcinoma
C
Child's Turcott pug score/MELD/PELD- Cirrhosis of liver
Chang staging: Medulloblastoma
cierney & millar classification : chronic osteomyelitis
Corpulence index : Actual wt/desired wt
Cottle's classification --> nasal septum
D
De meester criteria : GERD
Duke staging : colorectal cancer
Duke's criteria: Endocarditis/Heart failure
Durie salmon system of staging: Multiple myeloma
E
Epworth's criteria : Sleep apnea
Enneking's staging : Bone tumors
Evan's stagng: Neuroblastoma
F
Forrest classification: peptic ulcer bleed
Framminghams criteria/Boston's criteria: CHF
FAB: Leukemias
Fisch - glomus tumor
G
Glisson's staging: Prostrate
Gartland's classification: Supracondylar # Humerus
Glasgow Blatch ford score : Upper GI bleed for medical intervention
GOLD's criteria :COPD
Glassgow scale/Ransons criteria/APACHE score: Pancreatitis
H
Hess & Hunt Scale: subarachnoid hemorrhage
Hall's criteria : Down's syndrome
Harvard criteria : brainstem death
J
Jackson's staging:Penile Carcinoma
jones criteria.- Rheumatic fever
K
killip classification-MI with HF
L
LEEFORDT's classification : facial #
Light's criteria: pleural effusion
Lauren's classification: Gastric Ca
Levenson's criteria :- also in congenital cholesteatoma and malignant otitis externa
M
Mac afee protocol : Placenta previa
Mallampati scoring: for intubation
Milan's crjteria: for liver transplant in HCC
Mantrles criteria/Alvarado score: Appendicitis
Mayers n cottons grading system: Subglottic stenosis
Manson's classification: Radial head #
MASAOKA -Thymoma
MELD Criteria- model for end stage liver disease
Mc Donald's criteria: Multiple Sclerosis
MIDAS score : migraine
morry & peterson criteria -acute osteomyelitis
N
Neer's classification: supracondylar# femur
NADA's criteria: ASD assesment of child for heart disease
Nazer's Index: Wilsons disz
O
OKUDA staging : HCC
Oschner sherren regime : Appendicular Mass
P
Paget's Index : Abruptio placentae
paalman criteria : Ectopic pregnancy
Pretext -Hepatoblastoma
Ponderal Index: ht in cm/cube root of body wt in kgs
Q
Quetlet index: BMI -wt in kg/ht in meter square
Quintero staging -TTTS
Quebeck's grading: severity of reflex
R
Reese Ellsworth - retinoblastoma (exam q)
Richertson bloom scoring : Breast ca.
Include
1.tubule formation
2.Mitotic index
3.Cell size(nuclear pleomorphism)
Robson's staging : RCC
Rye classification: Hodgkin's lymphoma
Rotterdam's criteria : Polycystic ovarian syndrome
Rockall scoring: adverse out come after GI bleed
Rule of wallace/Rule of 9: Burns
S
Seddon's classification: Nerve injury n regeneration
sernath staging -Hypoxic ischaemic encephalopathy
Stanford classification: Aortic dissection
SPIGELBREG criteria= OVARIAN ectopic
STUDDIFORD criteria= ABDOMINAL ectopic (pain)
Spalding's criteria: abdominal pregnancy
T
Todeni classification : chloledochal cyst
V
Van Nuys prognostic index : DCIS
W
Waterson criteria : TEF
Well's criteria: pulmonary embolism
Important IPC's
81 - Act likely to cause harm, but done without criminal intent, and to prevent other harm
82 - Act of a child under seven years of age
83 - Act of a child above seven and under twelve of immature understanding
84 - Act of a person of unsound mind
85 - Act of a person incapable of judgment by reason of intoxication caused against his will
86 - Offence requiring a particular intent of knowledge committed by one who is intoxicated
87 - Act not intended and not known to be likely to cause death or grievous hurt, done by consent
88 - Act not intended to cause death, done by consent in good faith for person's benefit
89 - Act done in good faith for benefit of child or insane person, by or by consent of guardian
90 - Consent known to be given under fear or misconception. Consent of Insane person. Consent of child
91 - Exclusion of acts which are offences independently of harm caused
92 - Act done in faith for benefit of a person without consent
93 - Communication made in good faith
94 - Act to which a person is compelled by threats
95 - Act causing slight harm
96 - Things done in private defence
97 - Right of private defence of the body and of property
98 - Right of private defence against the act of a person of unsound mind, etc.
99 - Acts against which there is no right of private defence
100 - When the right of private defence of the body extends to causing death
101 - When such right extends to causing any harm other than death
102 - Commencement and continuance of the right of private defence of the body
103 - When the right of private defence of property extends to causing death
104 - When such right extends to causing any harm other than death
105 - Commencement and continuance of the right of private defence of property
106 - Right of private defence against deadly assault when there is risk of harm to innocent person
191 - Giving false evidence
192 - Fabricating false evidence
193 - Punishment for false evidence
194 - Giving or fabricating false evidence with intent to procure conviction of capital offense
195 - Giving or fabricating false evidence with intent to procure conviction of offense punishable with imprisonment for life or imprisonment, 195A - Threatening any person to give false evidence
196 - Using evidence known to be false
197 - Issuing or signing false certificate
198 - Using as true a certificate known to be false
199 - False statement made in declaration which is by law receivable as evidence
200 - Using as true such declaration knowing it to be false
201 - Causing disappearance of evidence of offense, or giving false information to screen offender
202 - Intentional omission to give information of offense by person bound to inform
203 - Giving false information respecting an offense committed
204 - Destruction of document or electronic record to prevent its production as evidence
205 - False impersonation for purpose of act or proceeding in suit or prosecution
206 - Fraudulent removal or concealment of property to prevent its seizure as forfeited or in execution
207 - Fraudulent claim to property to prevent its seizure as forfeited or in execution
208 - Fraudulently suffering decree for sum not due
209 - Dishonestly making false claim in Court
210 - Fraudulently obtaining decree for sum not due
228 - Intentional insult or interruption to public servant sitting in judicial proceeding, 228A - Disclosure of identity of the victim of certain offenses etc.
229 - Impersonation of a juror or assessor, 229A - Failure by person released on bail or bond to appear in Court
269 - Negligent act likely to spread infection of disease dangerous to life
270 - Malignant act likely to spread infection of disease dangerous to life
271 - Disobedience to quarantine rule
272 - Adulteration of food or drink intended for sale
273 - Sale of noxious food or drink
274 - Adulteration of drugs
275 - Sale of adulterated drugs
276 - Sale of drug as a different drug or preparation
277 - Fouling water of public spring or reservoir
278 - Making atmosphere noxious to health
279 - Rash driving or riding on a public way
280 - Rash navigation of vessel
281 - Exhibition of false light, mark or buoy
299 - Culpable homicide
300 - Murder
301 - Culpable homicide by causing death of person other than person whose death was intended
302 - Punishment for murder
303 - Punishment for murder by life convict
304 - Punishment for culpable homicide not amounting to murder, 304A - Causing death by negligence, 304B - Dowery death
305 - Abetment of suicide of child or insane person
306 - Abetment of suicide
307 - Attempt to murder
308 - Attempt to commit culpable homicide
309 - Not Applicable as per latest hearing
310 - Thug
311 - Punishment
312 - Causing miscarriage
313 - Causing miscarriage without woman's consent
314 - Death caused by act done with intent to cause miscarriage
315 - Act done with intent to prevent child being born alive or to cause it to die after birth
316 - Causing death of quick unborn child by act amounting to culpable homicide
317 - Exposure and abandonment of child under twelve years, by parent or person having care of it
318 - Concealment of birth by secret disposal of dead body
319 - Hurt
320 - Grievous hurt
321 - Voluntarily causing hurt
322 - Voluntarily causing grievous hurt
323 - Punishment for voluntarily causing hurt
324 - Voluntarily causing hurt by dangerous weapons or means
325 - Punishment for voluntarily causing grievous hurt
326 - Voluntarily causing grievous hurt by dangerous weapons or means 326A - Voluntarily causing hurt by use of acid,etc. 326B - Voluntarily throwing or attempting to throw acid
327 - Voluntarily causing hurt to extort property, or to constrain to an illegal act
328 - Causing hurt by means of poison, etc. with intent to commit an offence
329 - Voluntarily causing grievous hurt to extort property, or to constrain to an illegal act
330 - Voluntarily causing hurt to extort confession, or to compel restoration of property
331 - Voluntarily causing grievous hurt to extort confession, or to compel restoration of property
332 - Voluntarily causing hurt to deter public servant from his duty
333 - Voluntarily causing grievous hurt to deter public servant from his duty
334 - Voluntarily causing hurt on provocation
335 - Voluntarily causing grievous hurt on provocation
336 - Act endangering life or personal safety of others
337 - Causing hurt by act endangering life or personal safety of others
338 - Causing grievous hurt by act endangering life or personal safety of others
339 - Wrongful restraint
340 - Wrongful confinement
341 - Punishment for wrongful restraint
342 - Punishment for wrongful confinement
343 - Wrongful confinement for three or more days
344 - Wrongful confinement for ten or more days
345 - Wrongful confinement of person for whose liberation writ has been issued
346 - Wrongful confinement in secret
347 - Wrongful confinement to extort property, or constrain to illegal act
348 - Wrongful confinement to extort confession, or compel restoration of property
349 - Force
350 - Criminal force
351 - Assault
352 - Punishment for assault or criminal force otherwise than on grave provocation
353 - Assault or criminal force to deter public servant from discharge of his duty
354 - Assault or criminal force to woman with intent to outrage her modesty, 354A - Sexual Harassment and punishment for sexual harassment, 354B - Assault or use of Criminal force to woman with intent to disrobe, 354C - Voyeurism, 354D - Stalking
355 - Assault or criminal force with intent to dishonour person, otherwise than on grave provocation
356 - Assault or criminal force in attempt to commit theft of property carried by a person
357 - Assault or criminal force in attempt wrongfully to confine a person
358 - Assault or criminal force on grave provocation
359 - Kidnapping
360 - Kidnapping from India
361 - Kidnapping from lawful guardianship
362 - Abduction
363 - Punishment for kidnapping, 363A - Kidnapping or maiming a minor for purposes of begging
364 - Kidnapping or abducting in order to murder, 364A - Kidnapping for ransom, etc.
365 - Kidnapping or abducting with intent secretly and wrongfully to confine person
366 - Kidnapping, abducting or inducing woman to compel her marriage, etc., 366A - Procuration of minor girl, 366B - Importation of girl from foreign country
367 - Kidnapping or abducting in order to subject person to grievous hurt, slavery, etc.
368 - Wrongfully concealing or keeping in confinement, kidnapped or abducted person
369 - Kidnapping or abducting child under ten years with intent to steal from its person
370 - Trafficking in persons, 370A - Exploitation of a trafficked person
371 - Habitual dealing in slave
372 - Selling minor for purposes of prostitution, etc.
373 - Buying minor for purposes of prostitution, etc.
374 - Unlawful compulsory labour
375 - Rape
376 - Punishment for rape, 376A - Punishment for causing death or resulting in persistent vegetative state of victim, 376B - Sexual Intercourse by a man with his wife during separation, 376C - Sexual Intercourse by a person in authority, 376D - Gang Rape, Intercourse by any member of the management or staff of a hospital with any woman in that hospital, 376E - Punishment for repeat offenders
377 - Unnatural offences
493 - Cohabitation caused by a man deceitfully inducing a belief of lawful marriage
494 - Marrying again during lifetime of husband or wife
495 - Same offence with concealment of former marriage from person with whom subsequent marriage is contracted
496 - Marriage ceremony fraudulently gone through without lawful marriage
497 - Adultery
498 - Enticing or taking away or detaining with criminal intent a married woman
503 - Criminal intimidation
504 - Intentional insult with intent to provoke breach of the peace
505 - Statements conducing to public mischief
506 - Punishment for criminal intimidation
507 - Criminal intimidation by an anonymous communication
508 - Act caused by inducing person to believe that he will be rendered an object of the Divine displeasure
509 - Word, gesture or act intended to insult the modesty of a woman
510 - Misconduct in public by a drunken person
Flow Cytometry markers: Very high yield
Flow cytometry markers :
CD1a, S-100, CD-207(Langherin)- Langerhan cell histiocytosis
CD 2 3 4 5 7 8- T-cell markers,CD3 is pan T cell marker
CD10 (aka CALLA antigen) : Early pre B marker,immature B cell marker
CD 11c, 25, 103, 123 : Hairy cell lukemia (CD 123 Most specific)
CD 13,33,117, MPO: Myeloid series marker-AML
CD 14,64: Monocyte marker (AML-M4 M5)
CD 15 : RS cell,Neutrophils
CD 15,30 : RS Cell
CD 16,56: NK Cell
CD 19,20,21,22 : B Cell markers, CD 19 is pan B cell marker
CD 23+,CD 5+ : CLL/SLL
CD 23-,CD 5+ : Mantle cell lymphoma
CD 30(only) aka Ki-antigen : Anaplastic Large cell lymphoma
CD 31: Endothelial cell marker (positive in angiosarcomas)
CD 34: Stem cell (also positive in angiosarcomas)
CD 41,61: Megakaryocyte,platelet marker,positive in AML-M7
CD 45 : On all leukocytes(except RS cell)
CD 45 RO: Memory cell
CD 45RA/RB: Naive B/T Cell
CD 55(DAF), CD 59(MIRL) : Absent in PNH
CD 68,S-100+ :Histiocyte marker(+ in malignant fibrous histiocytosis)
CD 95/FAS ligand: apoptosis marker (extrinsic pathway)
CD 99/MIC-2 : Ewings sarcoma
CD 103: Hairy cell
CD 117 :GIST,Mastocytosis,AML (117 is present on mast cells also)
CD 123: New antibody in Hairy cell leukemia
CD 133:Glioma
CD 207(Langherin): LCH
CD 235(Glycophorin): AML-M6
Named classifications
1.Halls criteria : Downs syndrome
2.Dukes criteria: Endocarditis/Heart failure
3.Butchers criteria :mesothelioma
4.Ann Arbours classifiacation :Hodgki.s lymphoma
5.Bismuth classification: tumors of hepatic ductal system
6.Nazers Index: Wilsons disz
7.Pagets Index : Abruptio placentae
8.Quetlet index: BMI -wt in kg/ht in meter square
9.Ponderal Index: ht in cm/cube root of body wt in kgs
10.Brocas index : Ht in cms-100
11.Corpulence index : Actual wt/desired wt
12Milans crjteria: for liver transplant in HCC
13.Mayers n cottons grading system: Subglottic stenosis
14.Spaldings criteria: abdominal pregnancy
15.GCS/Ransons criteria/APACHE score: Pancreatitis
16.Ennekings staging : Bone tumors
17.Mc Donald's criteria: Multiple Sclerosis
18.Epworths criteria : Sleep apnea
19.Framminghams criteria/Boston's criteria: CHF
20.Durie salmon system of staging: Multiple myeloma
21.Lights criteria: pleural effusion
22.GOLD's criteria :COPD
23.OKUDA staging : HCC
24.Child's Turcott pug score/MELD/PELD- Cirrhosis of liver
25.Mantrels criteria/Alvarado score: Appendicitis
26.Evan's staging: Neuroblastoma
27.FAB: Leukemias
28.Glisson's staging: Prostrate
29.Robson's staging : RCC
30.NADA's criteria: ASD assesment of child for heart disease
31.Rye classification: Hodgkins lymphoma
32.Chang staging: Medulloblastoma
33.Jackson's ataging :Penile Carcinoma
34.Seddons classification: Nerve injury n regeneration
35.Larren's classification:Gastric Ca
36.Neer's classification: supracondylar# femur
37.Gartland's classification: Supracondylar # Humerus
38.Amsel's criteria: bacterial vaginosis
39.Mallampati scoring: for intubation
40.Forrest classification: peptic ulcer bleed
41.Hess & Hunt Scale: subarachnoid hemorrhage
42.Duke staging : colon cancer
43.Rotterdam's criteria : PCOS
44.Le Fort 's classification : facial #
45.wells criteria: pulmonary embolism
46.Rule of wallace/Rule of 9: Burns
47.Mansons classification: Radial head #
48.Stanford classifi ation: Aortic dissection
49.Rockall scoring: adverse out come after GI bleed
50.Glasgow Blatchford score : UGI bleed for medical intervention
51.Waterlows classification: Malnutrition in children
Friday, 2 March 2018
CHROMOSOMES and DISEASES
CHROMOSOME & DISEASES
✔Chromosome 1: Rh system /
neuroblastoma
✔Chromosome 2: Cystinuria/
hypobetalipoproteinemia
✔Chromosome 3: RCC/ALKAPTONURIA
✔Chromosome 4: Huntingtons chorea/
achondroplasia/parkinsons disease
✔Chromosome 5: FAP/colorectal
carcinoma/cri-du-chat syndrome
✔Chromosome 6: HLA system(short arm) /
MHA antigen/DM
✔Chromosome 7: Cystic fibrosis
✔Chromosome 8: Osteoporosis
✔Chromosome 9: ABO blood group /
friedreich’s ataxia
✔Chromosome 10:
Apert syndrome
Charcot-Marie-Tooth disease, type 1 Charcot-Marie-Tooth disease, type 4
Cockayne syndrome
Congenital erythropoietic porphyria
Cowden syndrome
Crouzon syndrome
Hirschprung disease
Multiple endocrine neoplasia type 2
Pfeiffer syndrome
Usher syndrome
Wolman syndrome
✔Chromosome 11: Sickle cell anaemia/beta thallasemia/wilms tumour/MEN -1/ataxia telengiectasia/human insulin gene/PTH gene
✔Chromosome 12: PKU/vWF/CA testes
✔Chromosome 13: Retinoblastoma/
osteosarcoma/wilsons ds
✔Chromosome 14: Familial HOCM/ alpha 1 antitripsin deficiency
✔Chromosome 15: Marfan’s syndrome/
albinism/pradder willi syndrome/
angelman syndrome
✔Chromosome 16: Alpha thallasemia/adult PKD
✔chromosome 17: Carninoma breast
(BRCA1)/medulloblastoma/
neurofibromatosis-1/ovarian tumour/ P53
✔Chromosome 18:
Erythropoietic protoporphyria/hereditary hemorrhagic telangiectasia/ Niemann-Pick disease/Type C porphyria/Selective Mutism/ Edwards syndrome (Trisomy 18)
✔Chromosome 19: Myotonia dystrophica/gene for insulin receptor
✔Chromosome 20: MODY type 1 DM /prions disease
✔Chromosome 21: Homocystinuria/
amyloidosis/folic acid transport
✔Chromosome 22: Meningioma/acoustic
neuroma/NF -2/Di-George syndrome
✔Chromosome Xq: Gene for androgen
insensitivity syndrome/ fragile X
syndrome/ Testicular feminisation/ X-
SCID/ X linked agaamaglobulinemia/
Fabry ds/ Lesch- Nyhan/ Hemophilia B/
Hemophilia A/ Hunter syndrome/ G6PD
deficiency
Add up whenever you find anything new!
Parasitic Infections Transmitted by Ova
Parasitic Infections Transmitted by Ova
🔸Enterobius vermicularis (pinworm)
🔸Ascaris lumbricoides (roundworm)
🔸Toxocara canis (visceral larva migrans)
🔸Trichuris trichiura (whipworm)
🔸Echinococcus granulosus/multilocularis
🔸Taenia solium (cysticercosis)
Mnemonic: - “EAT TrET”
All others are transmitted in larval stage.
Drug Induced Parkinsonism
Drug Induced Parkinsonism
🔸The most important group is neuroleptic drugs, which acts as dopamine antagonists.
Ex: - Phenothiazines, Thioxanthenes and Butyrophenones.
🔸Extrapyramidal effects are most likely occur with Fluphenazine, Perphenazine, Trifluopermazine and Haloperidol.
🔸Least likely to occur with Thioridazine and Molindone.
🔸Chlorpromazine, Acetophenazine, Chlorprothixene and Thiothixene are in an intermediate category.
🔸Metoclopramide, centrally active D2 receptors antagonists, is a common cause of drug-induced Parkinsonism.
🔸Reserpine and its synthetic analogue Tetrabenazine cause Parkinsonism by depletion of presynaptic stores of dopamine.
Protocols for Shock Assessment
Protocols for Shock Assessment & Abbreviations
1. ACES = abdominal and cardiac evaluation with sonography in shock;
2. BEAT = bedside echocardiographic assessment in trauma/critical care;
3. BLEEP = bedside limited echocardiography by the emergency physician;
4. ECHO = echocardiography;
5. EGLS = echo-guided life support;
6. FALLS = fluid administration limited by lung sonography;
7. FATE = focus assessed transthoracic echocardiography;
8. FEEL: RESUS = focused echocardiographic evaluation in resuscitation;
9. FEER = focused echocardiographic evaluation in resuscitation;
10. FREE = focused rapid echocardiographic examination;
11. POCUS = point of care US in the hypotensive patient;
12. RUSH = rapid US for shock and hypotension;
13. HIMAP = heart, IVC, Morison pouch, aortic aneurysm, pneumothorax;
14. UHP = undifferentiated hypotensive patient;
15. CORE = concentrated overview of resuscitative efforts;
16. CAVEAT = chest, abdomen, vena cava, and extremities for acute triage.
Trauma & Critical care:
1. FAST = Focused Assessment with Sonography in Trauma or Focused abdominal sonar for trauma
2. eFAST = extended FAST (left and right thoracic views to assess for pneumothorax and haemothorax)
New Drugs approved
Durvalumab - Stops interaction between PD1 and CD80 - Approved for unresectable Stage III Non Small Cell Lung Cancer.
Ademaciclib - As a first line in combination with aromatase inhibitor in ER + , HER2NEU -ve advanced or metastatic breast cancer.
Action - Blocks CDK 4/6.