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Medical FunNotes
Volume 1
Use for Exams Like AIPGMEE AIIMS-PG,
DNB-CET, PGI USMLE and various state
medical PG entrance exams
Collection of important topics presented
in very interesting ways
Mnemonics, Images, Clinicals etc.
to build more interest
Author
Dr. Vinay Yadav
Rs. 350/-
A collection of most important medical topics for medical PG entrance exams like AIPGMEE,
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Medical FunNotes
Volume-1
1st Edition
August 2014
Disclaimer
The editors have checked the information provided in the book and to the
best of their knowledge, it is as per the standards accepted at the time of
publication. However, in view of the changes in medical knowledge and the
possibility of human error, there could be variance. Hence readers are
requested to confirm information particularly laboratory values and drug
dosages from other sources as well, the reader is also strongly urged to
consult the drug company’s printed instructions before administering any of
the drugs recommended. This book is Intended only for Medical Students and
Doctors. This book can’t be used as substitute for medical advice of a Medical
professional.
Distributed by :
Published by : Vinay Heartbeat Education Pvt. Ltd.
House No. 94, Block-A, Nasirpur Colony, New Delhi-110045
C
Vinay Heartbeat Education Pvt. Ltd.
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Index
S. No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
Particular
500 Most Common Diseases
Cerebral salt wasting
Lines & Rings in Ophthal...
hCG important points
Microbio 75 important Points
Medical Kisses
Ophtha Sports & Dots
X-RAY FINDINGS-Abdomen
Rate Limiting Enzymes
Lysosomal (sphingolipids) Storage disease
Biochemical Tests For Proteins
Biochemical Tests - Carbohydrates
Biochemistry Tests - Miscellaneous
Days To be Remembered
Differences - Marasmas and Kawashiorkor
How to take medicines
Best View In Radiology
Important Criterias and Classifications
Syphilis-(serological)
Named Diseases with Organism
Medical Salt and Pepper
Fetus important events
Named ulcers
Onions of Medicine
Important points for toxicology
Poison Detecting tests
Forensic 175 Important Points
Medical Fathers
Named Fevers
Snowstorm appearance
Cars in Medicine
Medical Smells
Medical Soap bubbles
Brachial plexus
Important points genetics
Fetal Structures & Adult Remnants
Important Ducts
Femoral triangle : arrangement of contents
CD Markers
Operations in Ophtha
Important Dermatology Points
Tongue changes in vit deficiency
Colony Appearance in Culture Organism
Blood donors are deferred if:
Terms Related with Charcot
“POET vs DOCTOR”
Syndrome quick review
Facies
Page No.
01
02
03-04
05
05-10
11
11
12
13
14
14
15
15
16
17
17
18
18
19
19
20
20
21
21
21
22
22-29
30
30
31
31
31
31
32
33
34
34
35
35
36
37
37
38
38
39
39
40-50
51-56
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
History-taking sequence
Occupations and hobbies linked to disease
Smoking and clinical associations
Alcohol (ethanol) abuse and clinical associations
Sulfonamides: common characteristics
Important HLA
Skills in history-taking
Consciousness disorders and their diagnostic value
Examination of Lymph Node
HIV PEP (Post-exposure prophylaxis):
Pathognomonic Signs of diseases:
Normal form of the chest
Pathological Forms of chest
Respiration Rhythm
Classification of Conjunctivitis
Vocal Fremitus
Percussion Tones
Mechanisms and Examples of Hypersensitivities
Anaphylaxis Management
Medical love at mbbsdost
Vectors of Few Well Known Diseases
Adverse effect of Phenytoin (anti-epileptic drug)
Symptoms of Senile cataract...
Uses of mineralcorticosteroids
Operations in Surgery
Causes of Gynaecomastia:
Nephrotic Syndrome
Prostaglandin in Obstetrics
Mydriatics
Forensic important sections
Important Signs of Obstetrics and Gynaecology
Imp points about rotavirus
Bad Smells
Drugs causing lichenoid eruption
Shoulder Joint
Strawberrys in Medicine
Energy of different types of food ingredients
Extra malarial uses of chloroquine
Medical HUTCHINSONS
Pleural Fluid Volumes
Allergy Management
Postmortem Staining
Soft Tissue Sarcomas
Side effects of drugs
Lobes of lungs
Special Muscles
Disorders of the respiration
Mechanism of labour:
Form to Order / Pre-book Medical FunNotes
Courses & Services offered at mbbsdost.com
57-62
62
63
63
64
65
65
66
67
68
68
69
70
71
72
73-75
75
76
77
77
78
78
79
79
79
80
80
80
81
81-86
86-89
89
89
90
90
90
91
91
91
91
92
92
93
94
94-96
97
97
98
99
100
500 Most Common Diseases
1.
Most common aortic branch involved in Takayasu
arteritis
Left subclavian
2.
Most common cause of respiratory distress in
newborn
Transient tachypnea of the
newborn
3.
Most common location to see Asbestosis sequelae Posterior lower lobes.
4.
Most common karyotype / chromosomal
abnormality in USA
Down's syndrome
5.
Most common osseous lymphoma, primary and
secondary
Diffuse large B-cell lymphom
6.
Most common primary malignant orbital tumor
in childhood
Rhabdomyosarcoma
7.
Most common type of fluid collection in scrotum
Hydrocele
8.
Most common type of liposarcoma to affect
children
Myxoid liposarcoma
9.
Most common abdominal emergency of early
childhood
Intussusception
HiddenPosterior
Content.
acetabulum
Most common affected bowel
segment in the
TB Full
Ileocecal
Purchase
Bookareain Rs. 350/Most common affected joint
in gout
First MTP
on
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10. Most common acetabular fracture
11.
12.
13. Most common AIDS-related neoplasm
Kaposi Sarcoma
14. Most common allergic aspergillosis syndrome
Allergic bronchopulmonary
aspergillosis
15. Most common anatomic variant of pancreas
Pancreas divisum
16. Most common anomalous course of Right
coronary artery
Interarterial
17. Most common appearance of Legionella at the
peak of the disease
Bilateral airspace consolidation
18. Most common association with fracture of great
toe distal phalanx with physeal involvement
Osteomyelitis
19. Most common associated anomaly with
coarctation
Bicuspid valve
20. Most common association of Partial Anomalous
Pulmonary venus return.
Sinus venosus type ASD
This article is about 25 pages long. Hence to save space and to provide you more
articles we have included the entire list of 500 at www.mbbsdost.com/500common/
Medical FunNotes at http://www.mbbsdost.com/funnotes
01
Cerebral salt wasting
The term cerebral salt wasting (CSW) was introduced to describe an entity seen
with certain cerebral disorders that can impair the ability of the kidneys to
conserve Na+, with resultant salt wasting and polyuria. CSW is defined as the renal
loss of Na+ with intracranial disease, which leads to hyponatremia and a decrease
in extracellular fluid volume.
Vasopressin-resistant polyuria with hyponatremia, particularly in the setting of
cerebral injury or cerebral disease or when accompanied by dehydration, should
prompt consideration of CSW in the differential diagnosis. CSW must be
distinguished from SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)
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The differences and similarities
in findings for CSW and SIADH are itemized as
because management of these 2 conditions differs significantly.
follows:
Hyponatremia
:
Present in both CSW and SIADH
Urine Na
:
#
Increased in both CSW and SIADH
Volume
:
Reduced in CSW and normal or #
increased in SIADH
Salt wasting
:
Gross in CSW and self-limited in SIADH
Urine output
:
Polyuria in CSW and variable in SIADH
Hypouricemia
:
Occasionally in CSW and frequent in SIADH
02
Lines & Rings in Ophthal..
•
Arlt’s Line = conjunctival scar in sulcus subtarsalis in Trachoma.
•
Ehrlich-Turck Line = linear deposition of Keratic Precipitates in uveitis.
•
Ferry’s Line = corneal epithelial iron line at the edge of filtering blebs.
•
Hudson-Stahil Line= Horizontal corneal epithelial iron line at the inferior
one third of cornea due to aging.
•
Khodadoust Line = corneal graft endothelial rejection line composed of
inflammatory cells.
•
Paton’s Line = Circumferential retinal folds due to optic nerve edema.
•
Sampaoelesi line = #
Increased pigmentation anterior to Schwalbe’s line
in pseudoexfoliation syndrome.
•
•
Hidden Content.
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pigment dispersion syndrome.
Schwalbe’s Line = Angle structure representing peripheral edge of
Descemets membrane.
•
Stockers Line = Corneal epithelial iron line at the edge of pterygium
•
White lines of Vogt = Sheathed or sclerosed vessels seen in Lattice
degeneration.
•
Fingerprint lines = The map-dot fingerprint dystrophy.
•
LASIK Iron Line = After LASIK for myopia, the central corneal curvature
is flatter than before surgery. The tear film distribution is therefore altered,
allowing some pooling centrally. This pooling can cause iron deposition in the
central epithelium. A similar effect can be seen after steeping of the cornea
03
from treatment of hyperopia. In the case of hyperopia, a pseudo-Fleischer’s
ring of iron deposition can be seen. These iron lines do not affect vision.
•
Vogt’s striae = occur centrally in a patient with keratoconus. By applying
digital pressure on the eye while looking through the slit lamp, these striae in
the deep cornea, mostly Descemet’s membrane, disappear, which is
characteristic of keratoconus.
•
The Descemet’s breaks or Haab’s striae = from birth trauma tend to be
vertical, while the Descemet’s tears associated with congenital
glaucoma tend to be horizontal or curvilinear.
•
Ring Keratitis = The hallmark of Acanthamoeba keratitis.
•
Kayser-Fleischer’s ring = Wilson’s disease.
•
Corneal rust ring = A small, reddish brown, circular opacity remained in
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a foreign body. The remnants are fine iron
the cornea after the removal of an iron foreign body.
•
Coats’ ring =
deposits in the cornea.
•
Fleischer’s ring = visible all around the base of cone in Keratoconus.
•
Pseudo-Fleischer’s ring = iron deposition can be seen in Hyperopia.
•
Soemmering’s ring = early opacification of lens capsule in cataract.
•
Vossius’ ring = on lens in concussion injury to eye.
•
Weiss ring = epipapillary glial tissue torn from the optic disc in Posterior
vitreous detachment (PVD).
•
Double ring sign = with the peripheral margin of the encircling ring
corresponding to the border of a normal-sized optic disc. Seen in Hypoplasia
of the Optic Disc.
04
hCG important points
hCG source
Ø
placental synsytiotrophoblast;
Ø
in blood 10 days after fertilization
Ø
peaks 9-10weeks, falling to plateau in 20-22 weeks
hCG structure
Ø
alpha subunit similar to LH, FSH, thyrotropin
Hidden Content.
Ø
beta subunit is specificPurchase the Full Book in Rs. 350/hCG functions
Ø
maintain corpus luteum production of progesterone until placenta
Ø
regulate steroid synthesis in placenta and fetal adrenals
Ø
stimulate testosterone production in fetal male testes
Ø
excess hCG
T - twin pregnancy
E - embryonal carcinoma
Mnemonic - TECH
C - choriocarcinoma
H - hydatiform mole
Microbio 75 important Points
1. Causative agent of nausea, vomiting
(onset < 6 hr) after eating cold cuts, or
potato salad, or mayonnaise, or custards
Staphylococcus aureus
2. Rapid-onset food poisoning is mediated by Enterotoxin
what component of staphylococcus
3. Treatment of staphylococcal food poisoning
4.
Rehydration
Hidden Content.
Microbial cause of nausea and vomiting, +/- Bacillus cereus
the
Full Book in Rs. 350/diarrhea (onset < 6 Purchase
hr) after eating
reheated
rice
5. Bacterial spores are resistant to heat due to Dipicolinic acid core
what component
6. Microbial cause of nausea, vomiting, watery Clostridium perfringens
diarrhea with rapid (onset >6 hr) after
eating reheated meat or gravy
7. Most likely cause of persistent dyspepsia in a Helicobacter pylori
patient not receiving NSAIDs is
8. Increased risk of gastric adenocarcinoma and H. pylori colonization
05
MALT lymphoma
9. Indications to treat H. pylori-associated Presence of organism
Peptic ulcer disease(PUD)
10. Standard first-line treatment for Peptic ulcer Proton pump Inhibitors +
disease(PUD) due to H. pylori is
clarithromycin + amoxicillin
11. Cause of acute onset of diarrhea with rice- Vibrio cholerae
water stools, vomiting, dehydration during
travel to South America
12. Pathophysiology of cholera is due to what A-B toxin causes ↑increased
mechanism
cAMP
13. Cholera pathogen is isolated from stool by thiosulfate-citrate-buffered
culture on selective medium called
sucrose (TCBS) agar
14. The comma-shaped cholera organisms are Campylobacter
microscopically similar to
15 Treatment of cholera involves
Rehydration
Hidden
16. Secretory diarrhea, fever and vomiting
duringContent.
Enterotoxic E. coli
travel are caused by Purchase the Full Book in Rs. 350/17. Secretory diarrhea with
foul-smelling Giardia lamblia
on fatty,
stools in campers, hikers; also day-care
outbreaks is caused by
18. Following ingestion of 15-25 cysts, excysted Giardiasis
trophozoites adhere at brush border of
enterocytes and contribute to malabsorption
19. Diagnosis of giardiasis is confirmed by
Stool antigen (+)
20. Giardiasis is specifically treated with
Metronidazole
21. Protracted, secretory diarrhea with large fluid Cryptosporidium >>
loss in AIDS is caused by (clue: acid-fast Cyclospora > Isospora
organisms)
22. Frank bloody diarrhea, after eating E. coli O157:H7
undercooked meats or drinking fruits drinks,
is caused by prepared foods or water,
contaminated with
23. Pathogenesis of hemorrhagic enterocolitis Shiga toxin (a cytotoxin)
caused by E. coli involves
24. Complication of hemorrhagic enterocolitis in hemolytic uremic syndrome
06
children
25. Profuse diarrhea, fever, vomiting, and Rotavirus
dehydration in infants is caused by
26. Mechanism of rotaviral diarrhea involves
Villus destruction
27. Infantile watery diarrhea and fever are Adenovirus 40,41
caused by
28. Outbreak of nausea, vomiting, fever in adults Norovirus
is caused by
29. Cause of nausea/vomiting, abdominal Non-typhoidal Salmonella
cramps, diarrhea +/- bloody 12-48h after
eating eggs or poultry or peanut butter
30. Antibiotic treatment in acute gastroenteritis carrier (in bile ducts) state
due to Salmonella species is not warranted to
avoid
Hidden
31. Antibiotic used only to treat septic
phase ofContent.
ciprofloxacin
salmonella gastroenteritis is
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32. Cause of fevers (>103°), headaches; macular Salmonella typhi
rash on torso (“rose spots”) abdominal pain
and little diarrhea later; On Examination:
bradycardia; hepatosplenomegaly (+/-) in a
patient with history of travel (to tropics)
33. Cause of diarrhea with occult blood, Campylobacter jejuni
abdominal cramping and fever, 2 days after
ingestion of poultry-contaminated salad
34. Antibiotic to treat campylobacter enteritis Erythromycin
with high fevers in pregnancy, and HIV is
35. Cause of dysentery-like illness with fever + Shigella sonnei
abdominal cramps, tenesmus + blood &
mucus in children
36. Dysentery due to invasive Shigella species in Ciprofloxacin
elderly is treated with
37. Cause of dysentery-like illness (+/ Yersinia enterocolitica
pseudoappendicitis or pseudo-crohn
syndrome) in the northern region after eating
cheese
07
38. Cause of dysentery-like illness in a patient Clostridium difficile
with history of broad-spectrum antibiotic use
39. Clostridium difficile-associated diarrhea A (enterotoxin) + B (cytotoxin)
(CDAD) is mediated by toxins
40. Lab confirmation of CDAD does not require Enzyme immunoassay (EIA)
stool Culture, but is based on
for stool toxins A or B
41. Besides rehydration and cessation of inciting Metronidazole (mild) or oral
mededicines, Clostridium difficile-associated vancomycin (severe/relapse)
diarrhea (CDAD) is treated with
42. Health-care associated (nosocomial) spread Fecal-oral and/or contact with
of Clostridium difficile diarrhea and environmental spores
protracted outbreak is due to
43. History of abdominal pain, tenesmus, stools Amebic dysentery
with mucus + blood in a patient, who recently
traveled to tropics; CBC: eosinophilia
44. Stool microscopy to confirm amebic endocytosed RBCs(distinction
Hidden Content.
dysentery should reveal characteristic
from luminal ameba)
trophozoites of Entamoeba
histolytica
with
Purchase the Full Book in Rs. 350/45. Treatment of amebic on
dysentery
involves
Metronidazole + iodoquinol
46. Abscesses in liver or peritonitis in travelers Serology for E. histolytica
with or without history of amebic dysentery is
confirmed by
47. A boar hunter develops dysentery after Balantidium coli
eating meat at campsite; Ova & Parasite test
should reveal a ciliate parasite, known as
48. Most likely cause of chronic abdominal pain, Ascaris lumbricides
diarrhea; intestinal obstruction; cholangitis;
liver abscess, in children
49. Ova & Parasite test using microscopy for oval ascariasis
eggs (with a thick coarse shell) in stool
confirms
50. A child has stomach ache, distended IgE
abdomen, poor appetite. “Pearl-colored
earthworm”-like organisms in the stool.
Major immune response against this
infection
08
51. Drug of choice of ascariasis is
Mebendazole
52. Vomiting, cramping, diarrhea, epigastric pain, Strongyloides stercoralis
weight loss in an immigrant from developing
country is caused by
53. Drug of choice of strongyloidosis is
Ivermectin
54. Patient with AIDS (low CD4+ counts) develops Invasive strongyloidosis
pulmonary infiltrates (+ eosinophilia) and/or
gram negative sepsis.
55. Weakness, fatigue, lightheadedness, Hookworm (Necator
dyspnea, pruritis; pallor; iron-deficiency americanas) infection
anemia; eosinophilia (history of outdoor
activity).
56. Fever, periorbital edema, subconjunctival Trichinellosis
hemorrhages, muscle weakness, and rash,
after eating undercooked pork (Lab:
eosinophilia., ↑CPK, ↑LDH ). Hidden Content.
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the
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in Rs. 350/Diphyllobothriasis
(fish
57. Abdominal pain, bloating,
altered
appetite
tapeworm)
after ingestion of sushi.
CBC:
megaloblastic
anemia; leukocytosis/eosinophilia.
58. Diagnosis of tape worm infection is confirmed Proglottids in stool
by
59. Tape worm infections are treated with broad- Praziquantel
spectrum agent
60. C a u s e o f fe ve r, l y m p h a d e n o p at hy, Schistosoma mansoni (Africa)
hepatosplenomegaly in an immigrant from S. japonicum (Far East)
Africa or Orient; Patient recalls wading in
stagnant water. Right Upper Quadrant
ultrasound (+); CBC: eosinophilia
61. Microscopy of stool in chronic stage of Large eggs with lateral spine.
schistosomiasis reveals
62. Chronic stage of schistosomiasis is treated Praziquantel
with
63. Patient with acute jaundice is Hepatitis A Inactivated Hepatitis A virus
virus(HAV) IgM (+); household contact should vaccine
receive for prophylaxis
09
64. Patient with jaundice for < 1 week has HBsAg Acute Hepatitis B virus
(+), Anti-HBc IgM (+)
infection
65. Multiple sex partners, IDU, infants born to Hepatitis B virus
infected mothers are risk groups for which
hepatitis virus
66. This is an enveloped, double stranded DNA Hepatitis B virus
virus with ss-break; transmitted by infective
body fluids
67. This asymptomatic man has hepatitis Resolved hepatitis B
serology profile of HBsAg (-), Anti-HBs (+),
Anti-HBc IgG (+), Anti-HBc IgM (-)
68. This man has jaundice and is HBsAg (+) > 6 Chronic active hepatitis B
months, Anti-HBs (-), HBeAg (+), Anti-HBc IgG
(+), HBV DNA > 20,000 IU/ml
69. This man has jaundice and is HBsAg (+) > 6 Peginter feron alpha 2a +
months, HBeAg (+) and evidence of Lamivudine (or cidofovir)
necroinflammation. He should receive
Hidden Content.
70. This man has no jaundice, but HBsAg (+) >6 Inactive HBsAg carrier
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normal Alanine
Aminotronsferase
71. This man, at the time of annual physical exam, HBV immunized
reveals Anti-HBs (+) and other markers are (-)
72. Virologic confirmation of chronic jaundice in a HCV RNA > HCV IgG
HBV-immunized patient with IDU or
hemodialysis is based on
73. More chronicity of HCV (than HBV) is due to error-prone HCV RNA virus
immune-evasive quasispecies generated
during replication (in blood) of
74. Fulminant hepatitis in a patient, who has HDV superinfection.
multiple sexual partners and is HBsAg (+);
HBcIgM (-), can be fatal due to what
75. Cause of acute onset of jaundice, nausea, HEV
right-upper quadrant pain, hepatomegaly in
pregnant women in India
10
Medical Kisses
Kissing disease
glandular fever/inferior mononucleosis
Kissing ulcer
anterior & posterior duodenal ulcers/vulval ulcer
Kissing tonsils
hypertrophied parenchymtous tonsils(grade 4)
Kissing peptide
Hidden Content.
Ebrtein-Barr
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the(EBV)
Full Book in Rs. 350/on www.mbbsdost.com/funnotes
Gonadotropin-releasing
hormone. (GnRH)
Kissing lesion
donovanosis
Kissing arthritis
T.B. knee
Kissing appearance
on x-ray-bladder papilloma
Kissing virus
Ophtha Spots & Dots
•
Leopard spots : in Fundus Flourescein Angiography, resulting from patchy
subretinal infiltrates in a patient with reticulum cell sarcoma.
•
Histo spot : Punched-out chorioretinal scars in Presumed ocular
histoplasmosis syndrome (POHS)
•
Cotton-Wool Spots : Diabetic retinopathy is the most common cause of
cotton-wool spots. Cotton-wool spots have been associated with
numerous other abnormalities, such as systemic arterial hypertension,
collagen vascular diseases, cardiac valvular disease, carotid artery
Hidden Content.
obstructive disease, coagulopathies, metastatic carcinoma, trauma, and
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virus infection.
•
Bitot’s spot : White, foamy area of keratinising squamous metaplasia
of bulbar conjunctiva, seen in vitamin A deficiency.
•
Brushfield spot : Whitish grey spot in peripheral iris, seen in Down’s
syndrome.
•
Elschnig spot : Yellow patches overlying area of choroidal infarction in
hypertension.
•
Fischer-Khunt spot : Senile scleral paque, area of hyalinised sclera anterior
horizontal rectus muscle insertion. Seen in old age.
11
•
Foster Fuch’s spot : Pigmented (Retinal Pigment Epithelial hyperplasia)
macular leisons in pathological myopia.
•
Gunn’s dot : light reflections from internal limiting membrane around disc and
macula
•
Horner-Trantras Dot : Collections of eosinophils at limbus in vernal
conjunctivitis.
•
Kayes’ dot (Krachmer’s spot) : subepithelial infiltrates seen in corneal graft
rejection
•
Hidden Content.
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the Full
inremnant
Rs. 350/Mittendorf’s dot : whitish
spot at posterior
lensBook
surface,
of hyaloid
artery.
•
Roth spots : haemorrhages with white centers, seen in subacute bacterial
endocarditis, severe anaemia, collagen vascular disorders.
•
Cherry red spot : Central retinal artery occlusion, Commotio retinae (Berlin’s
oedema),Tay-Sachs’ disease, Niemann-Pick’s disease, Gaucher’s disease
•
Cream-colored spots : The classic diagnostic feature of bird-shot
vitiliginous chorioretinitis is cream-colored spots, often as large as
0.5 to 1 disc diameter, that are scattered throughout the fundus.
•
Koplik’s spots : on conjunctiva in measles
X-RAY FINDINGS - Abdomen
Bird's Beak deformity of lower oesophagus
Rat tail tapering of lower Oesophagus
Achalsia cardia (Barium Swallow)
Carcinoma oesophagus (Barium
Swallow)
Diffuse oesophageal spasm
Cork screw oesophagus
Swallow)
Hidden(Barium
Content.
filling defect in antrum /
Commonest radiological Appearance
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of stomach
of gastric carcinoma (in barium
meal the Full
follow through) is
Chronic duodenal ulcer with
Trifoliate duodenum
scarring (Barium Meal)
Peptic ulcer
Hour Glass stomach
Volvulus of stomach
Cup & Spill / Cascade stomach
12
Rate Limiting Enzymes
1.
Glycolysis
Phosphofructokinase-1
2.
Pyruvate Metabolism
Pyruvate dehydrogenase complex
3.
TCA cycle
Isocitrate dehydrogenase
4.
Citric acid cycle
Citrate synthase
5.
Glycogenesis
Glycogen synthase
6.
Glycogenolysis
Glycogen phosphorylase
7.
Gluconeogenesis
Phosphoenolpyruvate carboxykinase
& Fructose 1,6-Biphosphotase
8.
Hexose Monophosphate
Shunt
Glucose 6 phosphate dehydrogenase
9.
Pentose phosphate
Glucose-6-phosphate dehydrogenase
10. Cholesterol synthesis
HMG-CoA reductase
11. Ketone body synthesis
HMG-CoA lyase
12. Fatty acid synthesis
Acetyl CoA carboxylase
13. Beta oxidation of fatty acids
Carnitine acyl transferase [CPT-1]
14. Lipogenesis
Hidden Content.
Acetyl-CoA-carboxylase
the Full Book
15. Phospholipid synthesis Purchase
Cytidyltransferase
16. Sphingolipid synthesis
in Rs. 350/3 ketosphiganine synthase
17. Eicosanoid synthesis
Phospholipase A2
18. Prostaglandin synthesis
Phospholipase A2
19. Steroidogenesis
CSCC (27 desmolase)
20. Heme synthesis
Aminolevulinate synthase
21. Bilirubin metabolism
Active transport into bile ducts
22. Bile acid synthesis
Colesterol 7a hydroxylase
23. DNA synthesis
Ribonucleotide reductase
24. Purine synthesis
Glutamine Prp transferase
25. Pyrimidine synthesis
Carbamoyl phosphate synthetase II
26. Urea cycle
Carbamoyl phosphate synthetase I
27. Lipolysis
Hormone sensitive lipase
28. Fructose metabolism
Aldolase B
29. Galactose metabolism
Galactose 1-Phosphate Uridyltransferase
30. Heme Synthesis
ALA synthase
31. Heme catabolism
UDP glucoronyl transferase
13
Lysosomal (sphingolipids) Storage disease
1.
Tay-sachs Disease : Acute Respiratory Disease, Hexoaminidase Deficiency,
Ganglioside Gm2 accumulation, mental retardation, blindness, cherry red
spot on macula & death by age 3.
Gauchers Disease : Acute Respiratory Disease, Glucocerebrosidase
deficiency, glucocerebroside Hidden
accumulation,
hepatosplenomegaly, bone
Content.
erosion, mental retardation.
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Rs. 350/Nieman-Pick Disease
: Acutethe
Respiratory
Disease:
deficiency Sphingomyelin
accumulation hepatosplenomegaly, mental
Retard.
Fabrys Disease : X : linked disease, galactosidase A deficiency Ceramide
trihexoside accumulation Angiokeratoma like skin lesion, kidney
failure, lower extremities pain.
Krabbe’s Disease (Globoid Cell Leukodystrophy) : Galactosylceramide
galactosidase deficiency Galactocerebroside accumulation mental
retardation, absent myelin.
2.
3.
4.
5.
Biochemical Tests
Tests For
For Proteins
Proteins
Biochemical
1.
Biuret test
Proteins
2.
Ninhydrin test
Amino acids, peptones, peptides, proteins give
purple due to formation of Rheumann purple
& amine acids (Proline, OH-proline) give yellow
3.
Xanthoproteic acid test
Aromatic amino acids
4.
Millon test
Phenylalanine and tyrosine
5.
Pauly's Diazo test
Hidden
Content.
Histidine
(cherry red)
& Tyrosine (orange red)
6.
Hopkins Cole test
7.
Sakaguchi test
8.
Sulfur test
Cysteine
9.
Nitroprusside test
SH group
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Arginine
10. Knoop test
Histidine
11. Lead sulfide test
Cysteine and cystine
12. Sullivan and
McCarthy test
Methionine
13. Isatin test
Proline
14
Biochemical Tests - Carbohydrates
1.
2.
3.
4.
5.
6.
7.
8.
Molisch test
Iodine test
Fehling test
Benedict test
Barfoed test
Seliwanoff test
Bial test
Osazone test
Carbohydrates larger than tetroses
Polysaccharides/Starch
Reducing sugar
Reducing sugar
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Reducing monosaccharide (vs disaccharide)
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Pentoses (vs hexoses)
Needle shaped : Glucose/Fructose/Mannose
Hedgehog shaped/
Mushroom shaped :
Lactose
Sunflower shaped
:
Maltose
Biochemistry Tests - Miscellaneous
1.
Silver nitrate test
Free Hcl
2.
Gunzberg test
Free Hcl
3.
Ufflemann test
Lactic acid
4.
Kelling test
Lactic acid
5.
Haly's sulfur flower test
Bile salts
6.
Pettenkoffer test
Bile salts
7.
Gmelin test
Bile pigment
10.
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Bile pigment
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Bile pigment
Hypobromite test
Urea
11.
Specific urease test
Urea
12.
Schiff test
Uric acid
13.
Murexide test
Uric acid
14.
Jaffe test
Creatinine
15.
Hellers nitric acid test
Proteins
16.
Gerhardt test
Acetoacetate
17.
Rothera test
Acetone and acetoacetate
8.
9.
Coles test
15
Days To be Remembered :
30th January
Anti Leprosy Day
th
World Cancer day
nd
No smoking day
th
International Women's Day
4 February
2 March
8 March
th
24 March
Anti TB Day
7th April
health Day
25th April
World Malaria day
st
1 May
Labour day
1stweek of May
Malaria week in INDIA
2nd week of May
thalassemia week
2nd sunday of May
Mother's Day
rd
3 M ay
World Asthma day
8th May
world Red Cross day
25th May
World multiple sclerosis Day
th
31 May
th
5 June
26th June
No Tobacco
day
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Content.
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and Illicit trafficking
1st July
Doctors Day
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World population Day
th
World hepatitis Day
11 July
28 July
st
1 week of August
World Breast feeding week
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8 September
World literacy Day
28th September
World Rabies Day
10th October
World Mental health day
nd
2 Wednesday of October
World Disaster Reduction Day
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World anaesthesia Day
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International Immunization Day
th
World Diabetic day
th
25 November
International Day for Elimination of
Violence against Women
1st December
World AIDS Day
16 October
10 November
14 November
th
10 December
16
Human rights day
Differences-Mrasmas and Kawashiorkor
Mnemonic (WE-HALFFS )
Marasmus
Kawashiorkor
W-weight
<60%
>60%
E-edema
Absent
Present
H-hair changes
A-apetite
L-look
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Absent
Present
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Absent
Alert
Apathetic
F-face
Monkey Face
Puffy Face
F-fat
Absent
Present
S-skin
Normal
Flaky
How to take medicines
Some medicines need to be taken with or after food. The six main reasons for this
are outlined below:
1.
To reduce side effects of nausea or vomiting.
It’s better to take some medicines that can cause nausea or vomiting after a
meal to reduce these side effects. Examples include allopurinol,
bromocriptine and madopar.
2. To reduce side effects of stomach irritation, including indigestion, stomach
inflammation or ulcers.
Some medicines can irritate the stomach, and taking them with food will help
to reduce this effect. Food such as biscuits or a sandwich or a glass of milk is
usually enough. Examples include aspirin, NSAIDs (diclofenac & ibuprofen..),
steroid medication (prednisoloneHidden
and dexamethasone).
Content.
3.
To treat problems suchPurchase
as heartburn,
or indigestion.
thereflux
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in Rs. 350/Medicines called antacids
are taken to prevent heartburn, reflux and
indigestion, which usually occur when acid is produced as food enters your
stomach. Therefore, these medicines are most effective if taken immediately
after, or during, a meal. For example Pantoprazole & Ranitidine.
4 . To ensure the medicine is not washed away.
Preparations such as mouthwashes, liquid nystatin and miconazole gel for
oral thrush, and preparations - or mouth ulcers - must be used after meals.
This is because eating food washes the medicine away too quickly.
5 . To ensure the medicine is absorbed into the bloodstream properly.
Some medications require food in the stomach and gut in order for the body
to absorb them properly. For example, the HIV medicines ritonavir,
saquinavir and nelfinavir.
17
6. To help the body process the meal.
Hidden Content.
Medicines for diabetes, if taken by mouth, should usually be taken around
Purchase the Full Book in Rs. 350/meal times to reduce blood sugar levels after eating, and to avoid
hypoglycaemia (very low blood sugar).
Enzyme supplements, which can be used to help people with chronic
pancreatitis, should also be taken with food to help the body process the
meal.
Best View In Radiology
Pneumothorax
PA(EXPIRATION)
PITUITARY
CONED DOWN LATERAL VIEW
ORBIT
Caldwell view
LEFT ATRIAL ENLARGEMENT
B A R I U M S WA L LO W S C A P H O I D
OBLIQUE
PETROUS BONE
Towns/STENVERS VIEW
Maxillary sinus
Waters view
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Recurrent shoulder dislocations
STRYKERS
VIEW
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OBLIQUE VIEW
Important Criterias and Classifications
1.
2.
3.
4.
5.
6.
7.
Halls criteria
Dukes criteria
Butchers criteria
Ann Arbours classification
Bismuth classification
Nazers Index
Pagets Index
8.
Quetlet index
9.
Ponderial Index
BMI=3
10.
11.
12.
Brocas index
Corpulence index
Milans crjteria
13.
Mayers n cottons grading
system
Spaldings criteria
Height in cms-100
Actual weight/desired weight
for liver transplant in Hepatocelluar
carcinoma
Subglottic stenosis
14.
18
Downs syndrome
Endocarditis/Heart failure
mesothelioma
Hodgkins lymphoma
tumors of hepatic ductal system
Wilsons disease
Abruptio placentae
Hidden
Content.
weight kg
BMI= Full Book in Rs. 350/Purchase the
(height in m.)
height in cm
2
weight in kg
abdominal pregnancy
15.
16.
17.
18.
19.
20.
21.
22.
23.
GCS/Ransons
Pancreatitis
criteria/APACHE score
Ennekings staging
Bone tumors
Mc Donald's criteria
Multiple Sclerosis
Hidden
Epworths criteria
Sleep
apneaContent.
Framminghams criteria/
Chronic
heart
failurein Rs. 350/Purchase the Full
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Boston's criteria
Durie salmon system of
Multiple myeloma
staging
Lights criteria
pleural effusion
GOLD's criteria
Chronic Obstructive Pulmonary Disease
OKUDA staging
Hepatocellular Carcinoma
Syphilis---(serological)
1.
First test to be Positive : FTA Abs (Fof first...F of FTA Abs)
2.
Rapid diagnostic-RPR (R for Rapid)...hence it can also screen large samples in
small time
Hidden Content.
3.
the both
Full Book
in Rs.sensiTv...and
350/Sensitive and Specific- TPPAPurchase
(see it has
't' from
'p' from
on
sPcific)
4.
Response to therapy- VDRL
5.
Congenital Syphilis- 195IgM Fta Abs or Capita M test
Named Diseases With Organism
Piroplasmosis/texas fever
:
Babesia
Katayama disease
:
Schistosoma japonicum
Omsk fever
:
flavivirus
Gaol fever
:
Rickettsia prowazeki
Hidden
Content.
:
Bartonella bacilliformis
Hebra nose
:
Klebsiellain
rhinoscleromatis
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:
paravaccinia
Vagabond disease
:
pediculosis corporis
Carrion’s disease
Buruli ulcer
:
Mycobacterium ulcerans
Coconut cake rectum
:
trichuris
Pseudohemoptysis
:
Serratia
Walking pneumonia
:
Mycolplasma
Pontiac fever
:
Legionella
19
Canicola fever
:
Leptospira
Duncan’s disease
:
EBV
Red diaper syndrome
Haverhill fever
Sudoku fever
HiddenSerratia
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:
marcesans
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ratBook
bite fever
:
Spirillum minus
Brill Zinsser disease
:
Recrudescent typhus
White plague
:
tuberculosis
Shanghai fever
:
pseudomonas
Medical salt and pepper
Salt and pepper appearance on MRI is seen in Glomus tumors, Vertebral
hemangiomas, Juvenile Nasopharyngeal angiofibroma.
Salt and pepper appearance in skull X-ray is seen in Hyperparathyroidism
Salt and pepper hair is seen in Kwashiorkor
Hidden
Salt and pepper appearance of skin
is seen inContent.
Scleroderma.
Purchase
the Full
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of chromatin
is seen
in Small
Cell Carcinoma
lung
Salt and pepper appearance of Parotid gland is seen in Sjogrens syndrome
Salt and pepper retinopathy is seen in :
Congenital Rubella,
Congenital syphilis,
Phenothiazine toxicity,
Fundus Flavimaculatus.
Fetus important events
•
0 hr
•
th
morula
th
blastocyst
4 day
•
5 day
th
•
7 day
•
21st-22nd day
fertilization
Hidden Content.
Purchase the Full Book in Rs. 350/placenta fully established/fetal circulation
on
internal gonads formed
interstitial implantation
•
8 weeks
•
10-12 weeks
swallowing starts
•
11weeks
fetal breathing movements
•
12 weeks
external gonads formed
•
12weeks
urine formation
20
Named ulcers
Rodent ulcer
:
basal cell carcinoma
Hiddencell
Content.
squamous
carcinoma
Purchase the Full Book in Rs. 350/micro aerophilic streptococci
benign ulcer in urinary bladder
Marjolinsulcer
:
Maleneys ulcer
:
Kissing ulcer
:
Hunners ulcer
:
Interrtitial cystitis
Buruli ulcer
:
micobacterium marinum
Onions of Medicine:
Onion skin appearance in kidney seen in Hyperplastic Arteriosclerosis
Onion skin like lesions due to arteritis
in Lyme’s and Systemic lupus
Hiddenseen
Content.
Erythemaposus & Motions
Purchase the Full Book in Rs. 350/Onion skin fibrosis aroundon
bile
ducts seen in Primary Scleraring
Onion skin pattern of deposition of reactive bone in Ewing's Sarcoma
Onion bulb appearance in sural nerves seen in CIDP due to recurrent
demyelination and remyelination
important points for toxicology
1. Pin – point pupils
Opium poisning
2. Dilatation of pupils
Dhatura, Cyanide poisning
3. Constriction of pupils
Opium, phenol, organo-phosphorus,
physostigmine, chloral hydrate poisning
4. Cumulative poisons are
Barbiturates, and methyl alcohol
5. Habit forming poisons are
Caffeine and Nicotine.
6. Addiction drugs are
Hidden
Content.
Alcohol, Barbiturates, Coccaine,
Purchase the
Full Book
Rs. 350/Cannabis,
Chloralin
hydrate,
Opium,
Pethidine
7. Hemodialysis is good value in
Salicylate, methanol, barbiturate, and
aspirin (except kerosene oil and
diazephem)
8. 1st sign of intra-uterine death
Gas shadow in aorta (as early as 12
hours).
9. Increased anion gap is seen in
Salicylate poisoning, lactic acidosis,
starvation.
21
10. Ideal suicide poison
Cyanide
11. Ideal homicide poison
Thallium, fluoride compounds.
12. Commonly used homicidal
poisons
Arsenic, aconite
Hidden Content.
Endrine, Opium, Barbiturates,
theOrganophosphorus
Full Book in compounds.
Rs. 350/on www.mbbsdost.com/funnotes
Poison resembling cholera
Arsenic
13. Commonly used suicidal
Purchase
poisons
14.
15. Poison resembling tetanus
Strychnine
16. Poison resembling natural death
Thallium
17. Poison resembling fading measles Arsenic
18. Poison resembling thyrotoxicosis
Bi-nitro compounds.
Poison Detecting tests
Arsenic
Marsh’s test, Reinsch’s test
Opium
Marquis test
Alcohol
Mc’evan’s test
Datura
Mydriatic test
Phenol
Green urine.
Hidden Content.
Forensic 175 Important Points
1.
The Percentage of blood alcohol in the stage of "dead drunk" is 0.5%.
2.
Pisiform gets ossified by 12 yrs of age.
3.
By 14 years patella gets ossified.
4.
Anterior fontanelle closes by 18 months of age.
5.
The height of a child is double
of birth
4 years
Purchase
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Book
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350/-
6.
Under IPC, a person below
years is not criminally responsible.
on 7www.mbbsdost.com/funnotes
7.
Fatal period of Datura poisoning is 24 hours.
8.
In India, rigor mortis sets within 1-2 hours.
9.
While dispatching blood and urine for chemical analysis, sodium fluoride is
added as preservative in concentration of 50 mg/10ml.
Hidden Content.
22
10. Critical level of alcohol in blood is 0.15%.
11. The minimum age for giving consent for surgery is 18 years.
12. In fractured ends of bone, soft provisional callus is formed by 15 hours.
13. The minimum time required for adipocere formation in a dead body is 21
days.
14. Indian Medical Council Act was enacted in 1956.
15. Mental retardation is I.Q. Below 70.
16. Ratio between ethyl alcohol in blood to urine is 1 : 1.33
17. Gas rigidity appears after 72 hours.
18. Marbling is noticed by 36 hours.
19. Full development of rigor mortis takes about 12 hours.
20. In exhumation, 6-7 samples of earth are collected.
21. Intercourse with wife below 15 years of age is considerable rape.
Hidden
22. Fatal period of aconite is usually 1-5
hours.
23.
24.
Content.
Purchase
Full Book in Rs. 350/Cooling of body is gradual
upto 1-3the
hours.
Hypostasis is mottledon
within
first 3 hours of death.
25. Killing range of a military rifle is 3000 yards.
26. Juvenile offender is a person under 16 years
27. The dispersion of pellets is seen usually at distance beyond 10 feet.
28. In a gunshot wound, the presence of singeing of hair or charring of skin
denotes a fire up to 18 inches.
29. Dispersion of pellets in shotgun injury is calculated as dispersion in inches =
1.5 times the dispersion in yards.
30. An infant born before 210 days is not legally considered capable of
maintaining a separate existence.
31. A bruise showing bluish black discolouration is 4 days old.
32. The upper limit of safety for carbon monoxide in air is 0.01%.
33. Rh positivity in India is 93%.
34. In an abrasion, the scab usually dries and falls between 4-6 days.
35. Fatal dose of opium is 2 gm.
23
36. The range of an air rifle is about 90 yards.
37. Mixed dentition is seen in children between 6-12 years of age.
38. Basisphenoid unites the basi-occiput at the age to 22 years.
39. First permanent molar appears at age of 6-7 years.
40. Judicial first class Magistrate can pass a sentence of imprisonment upto 3
years.
41. Age of maturity for those under court of wards is 21 years. In India, sexual
maturity is gained at 14 years of age.
42. The degree of accuracy in determining sex from long bones is 80%.
43. Fatal period of sulphuric acid poisoning is 18-24 hours.
44. Multiplying factors for estimating stature from humerus and femur in males
are 5-5.3 and 3.6-3.8 respectively.
45. Colliquative liquefaction is seen within 1 week after death.
46. A contusion assumes green colour by 6 days.
Hidden Content.
Purchase the Full Book in Rs. 350/Internal organs take on
24 hours
to cool. A person becomes major at the age of
47. Marriage age for boys and girls are 21 years and 18 years respectively.
48.
18 years. Eruption of temporary teeth is completed by 2 to 2.5 years.
49. Foetal parts can be detected on plain X-ray usually by 16 weeks.
50. Child below 12 years is not required to take an oath.
51. Xiphoid process unites with sternum at age of 40 years.
52. Cranial capacity is 10% less in females.
53. Nuclear features persist in decomposition for a period of 2-3 years.
54. Precipitin test is positive to be opium in dead body upto 10 years.
55. After death, benzidine test is positive upto 150 years. Bones begin to
decompose after death in 3-10 years.
56. Less than 7 amino acids in bone suggest age of bone after death as more than
100 years. The rate of cooling of body in first 6 hours is 2.5°F and in next 6
hours as1.5°-2.0°F.
57. Center of ossification for pisiform bone appears at an age of 10-12 years.
58. The floatation time in summer for a dead body after drowning is one day.
59. The age of 15 years old female is best determined by the radiography of
24
upper end of radius and ulna.
60. Maggots in a dead body do not appear before 48 hours.
61. Hairs become loose after 72 hours of death.
62. Epiphyseal union of sternal end of clavicle occurs at age of 22 years.
63. Washer woman's hands and feet usually occur within 12-18 hours.
64. Saponification in drowning occurs in about 5 weeks.
65. Death ensues in about 5 minutes of complete submersion.
66. By ABO, RH, MN systems the exclusion of Paternity is about 50%.
67. Gustafson's method for estimation age of adult over 21 years.
68. In poisoning by salicylates, the Gastric lavage is useful upto 24 hours.
69. The age of consent for medical examination in cases of rape is minimum 12
years.
70. If a person is absent from his usual haunts, and has not been heard for 7
years, he is presumed to be dead.
Hidden Content.
Purchase the Full Book in Rs. 350/72. Histologically, reticulumon
fibers
in an abrasion are seen after on 8 days
71. Infanticide means unlawful destruction of child below 1 year of age.
73. Estimation of Age from eruption of teeth is possible upto 17 to 21 years of age
74. In poisoning by salicylates, the Gastric lavage is useful upto 24 hours
75. The age of consent for medical examination in cases of rape is minimum 12
years
76. In sin of Gomorrah, buccal swabs are useful upto 9 hours
77. In most countries, breath alcohol concentration 35 mg/100 ml is considered
an offence
78. Widmark's formula for urine analysis of alcohol is 3/4 prq
79. Pancreas constitute 0.1% of body weight
80. Punishment for false evidence is given under section 193 of IPC
81. Length of a female larynx is about 3.8 cm
82. Calcification of third molar begins at 8-10 years.
83. Lip prints on cheiloscopy are divided into 8 patterns
84. Gm tablet of aluminium phosphide is able to liberate 1.0 gm
25
85. The diameter of "human hair at 15 years of age is 0.053 ram
86. Alcohol gaze nystagmus is produced at an average blood levels of 80 mg%
87. The residual alcohol in mouth takes about 20 min to disappear and within
this period breath analyzer test may be false positive
88. Skeletal muscles constitute about 29% of body weight
89. Term 'under the influence' of alcohol is used when blood concentration is 80100mg%
90. Statutory rape is rape under 15 years of age
91. Weight for occluding internal jugular vein hanging is 2 kg
92. Majority of deaths due to aluminium phosphide occurs in within 24 hours
93. During sleep, rectal temperature is 0.5-1.0°C lower
94. Drowned body floats in about 12-18 hours in summer.
95. Bones constitute about 12% of body weight
Hidden Content.
96. Absence of III molar tooth indicates that the person is definitely under the
Purchase the Full Book in Rs. 350/age of 17 years
97. In a dead body, maggots
in rainy day are seen in 6 hours.
98. Arsenic, Aconite and Dhatura are generally used as homicidal poisons.
99. Ricin is the active principle of croton oil seed.
100. Abrin is the active principle of abrus precatorius.
101. Soneryl is a coloured babriturate.
102. Breath alcohol can be measured by Alcometer or Drunkometer.
103. The fatal dose of Dhatura is about one grain.
104. Physostigmine can be regarded as the specific antidote of Dhatura.
105. Amygdaline is the glucosides of vegetable origin found in cyanides.
106. The process of putrefaction can be retarded by carbon monoxide gas.
107. Euthanasia means "Mercy killing".
108. Joule burn is seen in electrocution.
109. Amyl nitrate is an antidote for poisoning due to hydrocyanic acid.
110. Olive green discoloration of urine on exposure to air is seen in poisoning due
to carbolic acid.
26
111. Overlying is a type of smothering.
112. Optic atrophy is the characteristic feature of poisoning by methyl alcohol.
113. Dryness of mouth, dilated pupils and delirium are symptoms of Dhatura
poisoning. (All 'D's)
114. The first permanent tooth to erupt is first molar.
115. Dying declaration can be recorded by a medical officer.
116. Presence of fine white leathery froth in mouth and nostrils is seen in
drowning.
117. Privation of any member of joint is a grievous hurt.
118. Victim of drowning in a state of suspended animation can be revived as long
as 10-20 minutes.
119. Dying declaration should be recorded by Magistrate.
120. Nalorphine is an antidote for morphine.
121. Locard's principle states that every contact leaves a trace.
122. The strongest corrosive poison is sulphuric acid.
Hidden Content.
123. Arborescent markings arePurchase
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the Full Book in Rs. 350/-
124. Before performing Postmortem
examination, body should be identified by
Policemen.
125. Warrant case means a case relating to an offense punishable with death,
imprisonment for life or for a term exceeding two years.
126. In civil cases, a reasonable sum for traveling expenses is generally tendered
when the summons is served. This is known as conduct money. It is paid by
the party that has called his as a witness.
127. Hair cells are of special interest in cell sexing since both Barr body and Y
chromosome can be demonstrated.
128. Nails, hairs and long bones are preserved in cases of chronic arsenic
poisoning.
129. Postmortem fibrinous clots in heart are known as "Cardiac polyp".
130. The surest sign of death is putrefaction.
131. The rigor mortis start first at upper eye-lids.
132. Dribbling of saliva from the angle of the mouth is generally considered as the
surest sign of hanging.
27
133. Presence of soot in respiratory tract is the surest sign of burn.
134. Strong sulphuric acid when thrown on the face of a person is known as
"Vitreol throwing".
135. Black gun powder consists of potassium nitrate, sulphur, and charcoal.
136. Nitrocellulose or Nitroglycerine is used as a smokeless gun powder.
137. Ricochet bullet is one which strikes any other surface before striking the
object.
138. The pulmonary lesion in the injury of air blast is called "Blast lung".
139. Loss of virginity is called defloration.
140. The Buccal coitus is called "Sin of Gomorrah".
141. The commission of sexual assault upon a dead body is called "Necrophily".
142. "Testamentary capacity" is the capacity of a person to make a valid will.
143. Malpraxis is defined as want of reasonable skill and or willful negligence on
the part of doctor resulting in deterioration of patients' health or his death.
Hidden
Content.
144. Copper sulphate is used as an antidote
to phsophorus.
Purchase
the Full
Book
in Rs.
350/145. 'Gyroget' are cartridges
or miniature
rockets
driven
by solid
fuel, which
produces considerableon
heat
and smokeless gas on burning.
146. Forensic means usable in courts of law.
147. Deposition means a statement on oath made by a witness in a judicial
proceeding. It is taken down in writing and signed by the witness and
magistrate.
148. Document means any matter expressed or described upon any substance by
means of letters, figures or marks, or by more than one of these means.
149. Evidence includes all legal means which help to prove or disprove any matter
of fact, the truth of which is submitted to judicial investigation. It can be oral
(direct, indirect or hearsay), documentary & circumstantial.
150. Hurt is defined as bodily pain, disease or infirmity caused to any person.
151. Injury includes every inquiry other than a trial, conducted by a Magistrate or
court.
152. Investigation includes all the proceedings for the collection of evidence
conducted by a Police officer or by any person other than a magistrate who is
authorized by a magistrate on his behalf.
153. Jury means a body of persons sworn to render verdict in a court of justice. It is
composed of uneven number and not less than 7 and more than 9 persons.
28
154. Metropolitan area means any area in the state comprising a city or a town
whose population exceeds one million.
155. Offense means any act of omission made punishable by law for the time
being in force.
156. Perjury means willful utterance of falsehood under oath.
157. Plaintiff is one who brings an action in a court of law.
158. Summons case means a case relating to an offense punishable with
imprisonment for a term not exceeding two years
159. Testimony means the evidence, oral or written, of a witness under oath.
160. Warrant means a written authority under "hand and seal". It is used for the
arrest of persons or for their forcible production in a court of law
161. Traumatic rupture of hymen is seen on posterolateral aspect.
162. Taylor gave a formula on rate of decomposition of dead body in air, water and
earth.
Hidden Content.
Purchase the Full Book in Rs. 350/164. Contre-Coupe injury is seen in head injury.
165. Strychnine acts on anterior horn cells.
163. Most reliable method of determining personal identity is Dactylography.
166. Last organ to putrefy in male is prostate whereas in female it is ungravid
uteus.
167. In Carboluria, urine turns green on exposure to air.
168. Cyanide poisoning produces cherry red colour.
169. McEwen's sign is seen in alcoholism.
170. Cutis anserina is seen in drowning.
171. Shaking palsy or 'mad Hatters' is seen with mercury poisoning.
172. Poison which can be detected in burnt bodies in arsenic.
173. Cephalic index helps in identification of race.
174. Tentative cuts are seen in suicides.
175. Pugilistic attitude is seen in antemortem or postmortem burns due to
coagulation of proteins
29
Medical Fathers
Anatomy
Herophilus of chalcedon
Physiology
claude bernard
Microbiology
louis pasteur
Bacteriology
robert koch
Chemotherapy
paul ehrlich
Pharmacology
oswald schmiedberg
Modern pathology
rudolf virchow
Forensic medicine
bernard spillsbury
Modern epidemiology
john snow
Occupational health
ramazzini
Modern medicine
hippocrates
Indian medicine
charaka
Hidden Content.
American medicine
william osler
Purchase the Full Bookambroise
in Rs. pare
350/Modern surgery
Indian surgery
sushruta
Antiseptic surgery
joseph lister
Modern inguinal
hernia surgery bassini
Thyroid surgery
emil kocher
Genetics
gregor mendel
Modern human genetics
dr.victor a . Mckusick
Psychoanalysis
sigmund freud
Porphyrin chemistry
hans fischer
Percutancous Transhuminal Coronary Angioplasty
Andreas Roland Gruentzig
Modern psychiatry
johann weyer
American psychiatry
benjamin rush
Biology
aristotle
Diagnostic imaging
roentgen
Named Fevers
Pontiac fever
Legionella pneumophila
Shanghai fever
Havernhill fever
Pseudomonas Brazilia
Hidden Content.
Hemophilus
(pink
Purchase
theaegyptius
Full Book in
Rs. eye)
350/on
Streptobacillus monoliformis
Oroya fever
Bartonella bacilliformis (Carrion’s disease)
Q fever
Coxiella burnetti
Purpuric fever
30
Colorado Tick fever
Orbivirus
Trench fever
Rochalimae
Hidden Content.
Yellow Fever
Purchase the Full Book in Rs. 350/Flavivirus
Rabbit Fever
Francisella tularensis
Hay Fever
Allergic rhinitis
Snowstorm appearance
1.
2.
3.
4.
5.
6.
Hydatiform mole on USG
Silicone granuloma breast on USG
Hidden Content.
Diabetic cataract
Purchase the Full Book in Rs. 350/www.mbbsdost.com/funnotes
Total Anomalous Pulmonary VenusonConnection
Fat embolism in X-ray chest
Synovial chondromatosis
Cars in medicine
Racing car sign
Honda sign
Mercedes Benz sign
Swift sign
:
:
:
:
Corpus callosum agenesis
Hidden Content.fractures
sacral insufficiency
Purchase the Full Book in Rs. 350/on
gall stone X ray
mercury poisoning
Medical Smells
Musty/mousy
phenylketonuria
Boiled cabbage
tyrosinemia,
hypermethioninemia
Hidden
Content.
Maple syrup
Purchase
the urine
Full Book
in Rs. 350/maple
syrup
disease
Rotting fish
trimethylaminuria
Sweaty feet
isovaleric academia, glutaric academia (type II)
Medical Soap
Soap bubbles
bubbles
Medical
Soap bubble appearance in abdominal X-ray Meconium ileus
Hidden Content.
Soap bubble appearance in head CT:Purchase
cryptococcal
meningitis
the Full Book
in Rs. 350/on www.mbbsdost.com/funnotes
Soap bubble calcification Osteoclastoma
Soap bubble cerebral calcification in head CT -Toxoplasmosis
31
Brachial plexus
1.
Comprises of C5678 T1 nerve roots B
2.
Consists of Root, trunk, division, Cord.
3.
Two branches are given from root i.e.
• DORSAL SCAPULAR nerve supplies rhomboides major and minor
• LONG THORACIC NERVE supplies Serratius anterior
4.
Trunks give of two branches that too superior trunk
• SUPRASCAPULAR N. supply supraspinatus and infraspinatus
• Nerve TO SUBCLAVIUS
5.
No nerve given from division
6.
CORDS
• Lateral cord
a.
Lateral pectoral nerve
b.
musculocutaneous
c.
Lateral cord of median nerve
Hidden
B.
Content.
Purchase the Full Book in Rs. 350/Upper scapular
Lower scapular
C.
Nerve to latissmus dorsi
D.
Axillary nerve
E.
Radial nerve
• POSTERIOR CORD
A.
• MEDIAL CORD
7.
A.
Medial cord of median nerve
B.
Medial pectoral nerve
C.
Medial cutaneous n of arm
D.
Medial cutaneous n of forearm
E.
ulnar nerve
End nerves are
Musculocutaneous
Axillary
Radial
Median
Ulnar
32
important points genetics
1.
1000 fold risk of developing skin cancer :- xeroderma pigmentosum
2.
alcoholics -> B1 def --> neurologic defects pyruvate dehydrogenase
deficiency
3.
abnormal collagen type 1 synthesis osteogenesis imperfecta
4.
absence of HGPRTase lesch nyhan
5.
deficiency of aldolase B fructose intoleranse
6.
defective excision repair --> thymidine dimer formation xeroderma
pigmentosa
7.
deficiency of cystathionine synthase homocystinuria
8.
heinz bodies deficiency G6PD
9.
musty/mousy odor, albinism, MR, eczema Phenyl Ketonuria
Hidden-->Content.
10. galactose I-P uridyl transferase deficiency
MR, HSM, cataracts
galactosemia
Purchase the Full Book in Rs. 350/11. deficiency of tyrosinase
albinism
12. hyperextensible skin, loose joints, bleeding tendency ehler danlos
13. decreased NADPH due to lack of HMP enzyme G6PD deficiency
14. inherited defect in tubular AA transporter cystinuria
16. deficiency in homogentisic acid oxidase alkaptonuria
17. hypoglycemia + jaundice + cirrhosis fructose intolerance
18. self-mutilation, gout, agression, choreoathetosis lesch nyhan
19. blocked degradation of branched chain amino acids maple syrup urine
disease
20. bloating, cramps, osmotic diarrhea lactose intolerance.
21. deficiency results in a combined B and T cell deficiency SCID (ADA
deficiency)
22. multiple fractures + blue sclera osteogenesis imperfecta
33
Fetal Structures & Adult Remnants
1.
Ductus arteriorus
:
Ligamentum arteriosum
2.
Ductus venosus
:
3.
Left umbilical vein
4.
Right umbilical vein
5.
Vitellointestinal duct
6.
Urachus
:
Median umbilical ligament
7.
Proximal part of umbilical artery
:
Superior vesical artery
Ligamentum venosum
Hidden
Content.
: Ligamentum
teres of liver
Purchase the Full Book in Rs. 350/: Disappears
: Meckel's diverticulum
Important Ducts
Bellini’s duct
:
Straight collecting tubules of the kidney.
Bartholin’s duct :
the major duct of the sublingual gland.
Cystic duct
:
excretory duct of gall bladder.
Gartner’s duct
:
a remnant of Wolffian duct.
Mullerian duct :
bilateral ducts in the embryo that form the uterus, vagina
and fallopian tubes.
Wirsung’s duct :
pancreatic duct.
Santorini’s duct :
accessory pancreatic
duct. Content.
Hidden
Wharton’s duct :
Purchase
the gland.
Full Book in Rs. 350/duct of
submandibular
Vitelline duct
:
the narrow duct in the embryo that connects the yolk sac
with the intestine.
Ducts of Rivinus :
5 to 15 ducts that drain the posterior portion of the
sublingual gland.
Stensen’s duct
parotid duct.
:
Pecquet’s duct :
Thoracic duct.
Hensen’s duct
ductus reunions.
:
Hoffman’s duct :
pancreatic duct or Wirsung’s duct.
Bernard’s duct
Accessory pancreatic duct or Santorini’s duct
34
:
Femoral triangle: arrangement of contents
Nerve (directly behind sheath)
A rtery (within sheath)
Hidden Content.
Empty space (between vein and lymph)
Mnemonic - NAVEL
V ein (within sheath)
Lymphatics (with deep inguinal node)
-> Nerve/Artery/Vein are all called Femoral.
CD Markers
Cd1a, Cd207
CD2, CD3, CD4, CD5, CD7, Cd8
Cd10
CD11c, CD25, CD103, Cd123
CD13, CD33, Cd117
CD14, Cd64
AML-M5)
Cd15
CD16, Cd56
CD19, CD20, CD21, Cd22
CD23 and Cd5
Langerhan cell histiocytosis cells
T cells
Early pre-B cells (immature B cells)
Hairy cell leukemia cells
Myeloid cells
Monocytic cells (positive in AML-M4 &
Reed-Sternberg cells, neutrophils
Natural killer cells
B cells
Chronic lymphocytic leukemia/small
lymphocytic lymphoma
Mantle cell lymphoma cells
Reed-Sternberg cells
Anaplastic large cell lymphoma cells
Endothelial cells (positive in angiosarcoma)
Myeloid cells and precursors
Stem cells (also positive in angiosarcoma)
Megakaryocytes and platelets (positive in
AML-M7)
All leukocytes (except Reed-Sternberg
cells!)
Memory T cells
Naive T cells
Histiocytes (positive in malignant fibrous
histiocytosis)
Ewings sarcoma cells
Gastrointestinal stromal tumor (GIST) cells,
mast cells (positive in mastocytosis),
myeloid cells
Hidden Content.
CD23 negative and CD5 positive
CD30 and Cd15
CD30 positive and CD15 negative
Cd31
Cd33
Cd34
CD41, Cd61
Cd45
CD45 RO
CD45 RA
Cd68
Cd99
Cd117
35
Operations in Ophtha
•
Fucala’s operation: Removal of clear crystalline lens for unilateral very high
myopia
•
McReynold’s operation: Transplantation of pterygium in the lower fornix,
not performed now.
•
Cicatricial entropion.
1. Resection of skin and muscle
2. Resection of skin, muscle and tarsus
3. Modified Burow’s operation
4. Jaesche-Arlt’s operation
5. Modified Ketssey’s operation
•
Senile entropion. Commonly used surgical techniques are as follows:
I. Modified Wheeler’s operation:
ii. Bick’s procedure with Reeh’s modification:
iii. Weiss operation.
iv. Tucking of inferior lid retractors (Jones, Reeh and Wobig operation):
•
Hidden Content.
Purchase the Full Book in Rs. 350/V-Y operation.
Z-plasty (Elschnig’s
operation)
Mechanical ectropion. It is corrected by treating the underlying cause.
i.
ii.
iii. Excision of scar tissue and full thickness skin grafting.
•
Congenital ptosis. It almost always needs surgical correction. In severe ptosis,
surgery should be performed at the earliest to prevent stimulus deprivation
amblyopia. However, in mild and moderate ptosis, surgery should be delayed
until the age of 34 years, when accurate measurements are possible.
Congenital ptosis can be treated by any of the following operations :
1. Fasanella-Servat operation. ( ans: Horner’s Syndrome)
2. Levator resection. (A)Conjunctival approach (Blaskowics’ operation):
(B)Skin approach (Everbusch’s operation):
•
The classical technique of lateral orbitotomy using S-shaped brow skin
incision is called Kronlein’s operation, done for AXIAL PROPTOSIS.
•
Seton operation: In this operation, a valvular synthetic tube is implanted
which drains the aqueous humour from the anterior chamber into the
subconjunctival space. It is performed for neovascular glaucoma and
intractable cases of primary and other secondary glaucomas where medical
treatment and conventional filtration surgery fail.
•
TRIPPLE SNIP operation for Punctum Block.
36
Important DERMATOLOGY POINTS
1.
HSV — type 1 at mouth, type 2 in genitalia. Recurrent erythema nodosum
is characteristic. Diagnosed by Tzank, Treatment with acyclovir
2.
Herpes zoster (shingles) — dermatomal, reactivated at dorsal nerve root,
Treatment with acyclovir
3.
Varicella (chickenpox) — lesions in all stages of development, Treatment with
benadryl. In1st TM, causes microcephaly, chorioretinitis, IUGR and cataracts.
Treat neonates with VZIG if mom contracted varicella within 5 days of
delivery.
4.
Impetigo — honey-crusted lesions. S aureus and B-hemolytic strep.
Treatment with mupirocin
5.
Hidden Content.
Purchase the Full Book in Rs. 350/on looks
Measles (Rubeola)—
like spilled red paint over your head (rash spread
6.
Rubella — 3 days of cervical/suboccipital/postauricular node enlargement,
prevention best with immunization before 1st trimester to prevent triad:
visual (cataracts), hearing loss, heart(PDA) defects.
behind ears and over forehead to neck to trunk and extremities), prevent
with immunization
7.
Roseola — 3-5 days of fever, and THEN rash after (never together). No
treatment
8.
Erythema infectiosum — 5th dz — slapped cheek appearance, parvo B19,
causes aplastic crisis in sickle cell patients, no treatment
9.
Rocky Mountain Spotted Fever — fever, rash on wrists then palms and soles,
Diagnosed by weil-felix test, treatment with tetracycline (chloramphenicol if
pregnant)
10. Lyme disease — erythema chronicum migrans with central clearing, tx is
doxycycline (amoxicillin if pregnant and children <9yo).
Tongue changes in vit deficiency
1.
Riboflavin deficiency
2.
Niacin deficiency
3.
B12 deficiency
4.
Folic acid deficiency
:
Magenta tongue
: Hidden Content.
Beefy / fiery red tongue
:
Baldness of tongue
:
Painful tongue
37
Colony Appearance in Culture Organism
1. Draughtsman ( Concentric Rings)
2.
Pneumococci
Medusa head (Nutrient Agar)
Frosted glass (Agar Plates)
Inverted Fig Tree (Stab Culture)
B.Anthracis
3.
Swimming Growth ( Fishy or Seminal Smell)
Proteus
4.
Swarm of Gnats Or Fish in Stream, darting motility
V.Choleraenu
5.
Stalactite growth, safety pin appearance
Yersinia Pestis
6.
Thumb print appearance, Bisected
pearls orContent.
Hidden
mercury drops , Aluminium Paint appearance
B. Pertussis
7.
Cigar bundle ( globi ) appearance
8.
Fried egg
9.
Bread crumb
Purchase the Full Book in Rs. 350/M.Leprae
Mycoplasma
Actinomyces israelii
10. Oil Paint
Staphylococci
11. School of Red fish
H. ducreyi
12. Stately Motility
Clostrida
13. Daisy head colonies
Corynbact gravis
14. Frogs egg colonies
Corynbact
intermedius
15. Poached egg colonies
Corynbact mitis
Blood donors are deferred if:
1.
they are less than 17 years of age or under 50 kg in weight.
2.
They are also deferred for 12 months after body piercing or tattoos, and
3.
now only for 6 months following the incident if the antihepatitis B core test is
Hidden Content.
negative.
4.
thetravel
FulltoBook
in Rs.
350/They are deferred forPurchase
6 months after
an endemic
malarial
area, or
longer if they fell ill abroad
or were resident for a period of 6 months or more
in Sub-Saharan Africa.
5.
They will be deferred for a period after pregnancy.
6.
Absolute deferral now occurs if they have had any organ transplant or blood
transfusion after 1980 in the UK because of the risk of variant
Creutzfeldt–Jakob disease.
38
Terms Related with Charcot
*Charcot Bouchard aneurysm
tiny aneurysms of the penetrating
branches of middle cerebral a.
*Charcot's triad in Multiple Sclerosis
nystagmus, intentional tremor,
dysarthria
*Charcot's triad of acute cholangitis
right upper quadrant pain, fever,
jaundice
*Charcot leyden crystals
due to lysis of eosinophil in allergic
*Charcot's joint
diabetic arthropathy
*Charcot's disease
amyolateral sclerosis
*Charcot Marie tooth disease
peroneal muscular atrophy
*Charcot wilbrand syndrome
visual agnosia & loss of ability to
revisualise images
*Charcot's intermittent hepatic fever
intermittent jaundice, intermittent
fever, intermittent pain, loss of weight
Hidden
Content.
reactions
Purchase thea Full
*Charcot gombault necrosis
biliaryBook
infarct in Rs. 350/on www.mbbsdost.com/funnotes
*Charcot's artery
lenticulostriate artery
"POET vs DOCTOR”
Jhuki jhuki Palkein
(Ptosis)
Kapkapate hath
(Parkinson's)
Gulabi Aankhein
(Conjunctivitis)
Chand sa chehra
(Cushing's Syndrome)
Tirchi Nazar
(Squint)
Khamosh se lab
(Aphasia)
Hidden Content.
Kaala
Til Book in Rs. 350/Purchase the
Full
(Melanoma)
Har Taraf Ussi Ka Chehra
(Hallucinations)
Gulabi Gaal
(Plethora)
39
Syndrome quick review
Fragile X Syndrome
Autism, Retardation, MacroOrchidism, Protruding Ears,
Narrow Jaw, FMR 1 gene
*X-linked Dominant, but females can still get partial
penetrance
Congenital Syphilis
Hepatomegaly, Splenomegaly, Hutchinsons Teeth,
Mulberry Molars, Snuffles, Saddle Nose, Seizures,
Interstitial Keratitis, Pseudo Paralysis, Frontal Bossing
Beckwith-Wiedemann Syndrome
Hidden Content.
Macroglossia Macrosomia Midline Abdominal defect
(ompholocele) WILMS TUMOR!!! check Alpha Fetoprotein
and look for heamaturia Nevus Flammus Ear Creases / Pits
Hypoglycemia
Glycogen storate diseases
Hepatomegaly, hypoglycemia
CHERUBIC FACE (doll like)
Treatment=cornstarch
Wolf Hirschhorn
Greek helmet head
Mental Retardation
severe growth defect
Autosomal deletion defect
40
Pierre Robin Sequence
Micrognathia Glossoptosis Cleft Palate Upper Airway
Obstruction Associated with Velocardiofacial syndrome,
Fetal Alcohol Syndrome and Treacher Collins Syndrome
Turner Syndrome
Downs Syndrome
XO, Shield Chest, Hyopgonadism, Ammenorrhea, Webbed
neck, Coartation Aorta, Bicuspid Aortic valve, Micrognathia,
HYPOTHYROIDISM IS COMMON IN ADOLESCENCE Cubitus
valgus (turned out elbows) Treatment with Growth
hormone +/- Androgen for height, and Estrogen for 2nd
sexual characteristic development Dignosis= FSH/LH,
karyotype, TSH
Trisomy 21, microgenia, round face, macroglossia, almond
eyes 2nd to epicanthic fold of the eyelid, upslanting
palpebral fissures , short limbs, (a single instead of a double
crease across one or both palms (Simian crease), poor
muscle tone, and a larger than normal space between the
big and second toe, short neck, White spots on Iris
(brushfield spots) Ventricular Septal Defects,
Gastroesophageal Reflux Disease recurrent ear infections,
Obstructive sleep apnoea, and thyroid dysfunctions. Life
Expectancy 40-50, increased. risk neoplasm, and certain
Alzheimers. HIRSHPRUNGS / DUDENAL ATRESIA
Hidden Content.
Cri Du Chat
5p deletion syndrome, 1/20,000 - 50,000
Usually spontaneous, (80% fathers mutation)
* Cry that is high-pitched and sounds like a cat
* Downward slant to the eyes
* Low birth weight and slow growth
* Low-set or abnormally shaped ears
* Mental retardation, Severe
* Partial webbing or fusing of fingers or toes
* Single line in the palm of the hand (simian crease)
* Skin tags just in front of the ear
* Slow or incomplete development of motor skills
* Small head (microcephaly)
* Small jaw (micrognathia)
* Wide-set eyes
41
Williams Syndrome
Deletion 26 genes from chromosome 7, 1/10,000 Cocktail
Party Personality, Ellfin face, Love Music, Perfect Pitch!,
Mental Retardation, but excellent language skills.
supravalvular aortic stenosis, pulmonary stenosis, and
pulmonary artery stenosis
* Farsightedness
* High blood calcium level (hypercalcemia)
* High blood pressure
* Hypermobile joints --> Ossify
* Unusual pattern ("stellate" or star-like) in iris of the eye
DiGeorge Syndrome / Velo-Cardio-Facial Syndrome
CATCH22, deletion of part of chromasome 22, 1/4000
Cardiac Abnormality (especially tetralogy of Fallot),
Ventriwlas Septal Defects, int erupted aortic arch, persisten
Truncus Arteriosus
Abnormal facies Thymic aplasia (T-cell deficiency) freq.
infxn Cleft palate Hypocalcemia (seizures may be present
sign!) decreased PTH Mental Retardation, 20 fold inc
Schizophrenia
Kleinfelters Syndrome
47 XXY, 1/1000, Non disjunction during miosis Marfanoid
(long legs, short trunk, shoulder equal to hip size)
gynecomastia Hypogonadism, MicroOrchidism Less than
normal amount of pubic, armpit, and facial hair
Tall height
Hidden Content.
Cornelia DeLang Syndrome
Slow Growth, skeletal abnl arms, hands Severe Mental
Retardation Unibrow, Hirsuite long eyelashes; low-set ears;
small, widely spaced teeth; and a small, upturned nose.
Treacher Collins Syndrome
1/10,000 AD, 5q32, TCOF1 gene Micrognathia, Cleft Palate
Conductive hearing loss drooping eyes absent/drooping
ears Colomba
42
Angleman Syndrome
Maternal chrome 15 deletion "Happy Puppett” Ataxia Dev
and speech delay Hyperactivity Insomnia
Prader-Willi Syndrome
Paternal Chromosome 15 deletion
* Infant Failure to Thrive
* Speech delay / Mental Retardation
* Poor physical coordination
* Hyperphagia (over-eating)
* Excessive weight gain / Obesity
* Sleep disorders
* Scoliosis
Rett Syndrome
Only in females (x-linked males die)
normal until 6-18 months, then regress. MECP2 gene defect
Chorea, Bruxism
# screaming fits
# panic attack
# inconsolable crying
# avoidance of eye contact
# lack of social/emotional reciprocity
# general lack of interest
# loss of speech
Hidden Content.
Smith-Lemli-Opitz Syndrome
Microcephaly, Polydactyly, Hypotonia, Syndactaly, 7dehydrocholesterol reductase deficiency, Pale Mentally
Retarded
•Lethargy
•Respiratory failure
•Hearing loss
•Visual loss
•Vomiting
•Feeding difficulties
•Failure to thrive
•Constipation
•Cyanosis
•Congestive heart failure
•Photosensitivity
43
Phenyl Ke to Nurio
low phenalanin diet
Rx=tetrahydrobiopterin (BH4) 20% effective
Mental retardation, autosomal recessive
Langerhans cell Histiocytosis
a rare disease involving clonal proliferation of Langerhans
cells, abnormal cells deriving from bone marrow and
capable of migrating from skin to lymph nodes. Clinically, its
manifestations range from isolated bone lesions to
multisystem disease. Eosinophilic Granuloma Diabetes
insipidus, exopthalmos, and lytic bone lesions is known as
the Hand-Schüller-Christian triad.
Tay Sachs Disease
Hexosaminadase deficiency
Hidden Content.
Leuokdystrophy
N-acetly-aspartic acid
Metachromatic Leukodystropy
arylsulfatase A
44
Inherited causes of hearing loss
Alport = Glomerulonephritis and Hearing Loss
Waardenberg = Auditory Dyssynchrony, hearing loss,
pigment changes
Jarvelle Lang-Nielson= Autosomal Recessive, prolonged QT,
Hearing loss
Connexin 26=Autosomal Recessive
Hiccough in Utero
Non-Ketotic hyperglyceinenemia,
seizure first hour of life
Sweet urine, Burnt sugar, curry urine
Maple Syrup Urine disease
Menenites!!! 1/750
Hidden Content.
Sweet free urine
Isovaleric Acidemia
Glutaric Acidemia
Cat’s Urine Smell
3-Methylcrotonyl-glycinuria
45
Menkes Syndrome
Steele wool hair (pili torti)
Intractable Seizures
Hypotonia
TEMPERATURE INSTABILITY
Argininosuccinic aciduria
trichorrexis nodosa
(short breakable hair)
Acrodermatitis enteropathica
Hidden Content.
Purchase
the Full Book in Rs. 350/alopecia
(zinc deficiency)
Argininosuccinic
aciduria trichorrexis nodosa
(short breakable hair)
Metachromatic Leukodystropy
Neonatal Hypotonia
Congenital Hypothyroidism Urea cycle defect, amino acid,
organic acid defect Maple Syruph Vrine disease Glycogen
storage disease (type II pompe's, type III debrancher)
Mitorchondria encephalomyopathies Menkes syndrome
Peroxisomal disorder (Zellweger syndrome)
46
Glutaric Aciduria Type I
Macrocephaly
Facial dysmorphism and renal cysts
Zellweger syndrome
Glutaric aciduria Type II
Cataracts in neonate
Galactosemia
Lowe's syndrome
Hidden Content.
Non-Ketotic Hyperglycinemia
Apneic / Bradycardic episodes +/- Seizures
(may have hiccough in utero!!!)
elevated GLYEINE IN URINE and CSF!
EEG=hips arrythmia
Tyrosinemia II
Occulocutaneous tyrosinemia
Keratosis soles of feet
47
Glycogen Storage Disease 1a
nephromegaly
bleeding diathesis
GSD IIa
Pompe's Disease, massive QRS, Autosomal recessive
NORMAL GLUCOSE
LARGE HEART!!!
DEATH BY AGE 2
GSD3
Skeletal / Cardio myopathy
hyperlipidemia
Hidden Content.
GSD4
Severe Failure to thrive
Cirrhosis
Death by age 5
Crouzon Syndrome
cranial synostosis, brachycephaly Exophthalmos
hypertelorism (greater than normal distance between the
eyes) psittichorhina (beak-like nose)
strabismus hypoplastic maxilla
CHOANAL ATRESIA
48
VACTERL
* V - Vertebral anomalies
* A - Anal atresia
* C - Cardiovascular anomalies
* T - Tracheoesophageal fistula
* E - Esophageal atresia
* R - Renal (Kidney) and/or radial anomalies
* L - Limb defects
CHARGE syndrome
* C - Coloboma of the eye, CNS anomalies
* H - Heart defects
* A - Atresia of the choanae
* R - Retardation of growth and/or development
* G - Genital and/or urinary defects (Hypogonadism)
* E - Ear anomalies and/or deafness
Bardet-Biedl syndrome
evere Prader-Will-like Obesity
Retinitis pigmentosa
Polydactyly
mental retardation
hypogonadism, and renal failure.
Hidden Content.
PHACE Syndrome
P - Posterior fossa abnormalities
H - Hemangioma(s) of the cervical facial region
A - Arterial cerebrovascular anomalies
C - Cardiac defects / aortic coarctation
E - Eye anomalies
Apert Syndrome
acrocephalosyndactyly also Craniosynostosis with resultant
midface hypoplasia
49
Edwards Syndrome
Trisomy 18 ROCKER BOTTOM FEET (congenital
Methotrexate exposure mimics this)
Patau's Syndrome
Trisomy 13 PUNCHED OUT
SCALP LESIONS
congenital methotrexate exposure mimics this
Pena-shokeir
autosomal recessive
IUGR
arthogyroposis
pulm hypoplasia
CNS anomalies
Hidden Content.
Bloom Syndrome
don't repair DNA well
defect in DNA helcase
BIRD LIKE FACE
Fanconi Anemia
dont repair DNA well
Autosomal Recessive
Abnormal thumb/radial defects
short
microcephaly
50
Facies
1.
Mask like facies = parkinsonism.
Lack of expressivity and poor definition of the nasolabial
fold. Scaling seborrhea is also common.
2.
Elfin facies = william's syndrome.
Most individuals with WS have similar facial features
including a small, upturned nose, long philtrum, wide
mouth, full lips, small chin (micrognathia), a flat, nasal
bridge, and puffiness around the eyes. They also
present with epicanthal folds, microdontia,
malocclusion, enamel hypoplasia, dental aplasia, and
fan-shaped orientation of the front teethThese facial
characteristics become more prominent with age. Light
eyed individuals with WS may have a “starburst” or white lacy pattern on their iris.
Hidden Content.
2.
Moon facies = cushing's syndrome
Moon facies occurs when extra fat builds up on the sides
of the face. It is often related to obesity but can be from
Cushing's syndrome. That's why people sometimes
refer to it as a Cushingoid appearance. Cushing's
syndrome occurs when the body is exposed for long
periods to high levels of a hormone called cortisol.
4.
Snarling facies = myasthenia gravis.
Myasthenic facies is characterized by a tired
expressions, poor gestures, with tight lips, half-closed
eyes and the disappearance of physiological folds. Nasal
twang to the voice and nasal regurgitation of food,
specially liquids, appear due to palatal muscle
weakness. Chewing may become difficult and severe
jaw weakness may cause the jaw to hang open (the
patient may support his chin with the hand ). Fluid
51
aspiration may occur, causing coughing or choking while drinking. Tongue mobility
disorders occur rarely and may cause the appearance of furcus myasthenicus
(three longitudinal grooves on the tongue surface).
5.
Mitral facies = mitral stenosis.
Mitral facies is one of the cutaneous manifestations of
systemic diseases. The pathology in question here is
mitral stenosis. Mitral facies refers to rosy cheeks (bright
circumscribed flush over the malar bones) with a bluish
tinge. The rose colour is because of the dilatation of
malar capillaries while the bluish tinge is because of the
cyanosis.
6.
Chipmunk facies Untreated â Thalassemia major,
Bullimia nervosa, Parotid sweling
Hidden Content.
7.
Mouse facies = chronic renal failure (crf)
8.
Adenoid facies = adenoid hypertrophy
Adenoid facies is the long, open-mouthed, dumb-looking
face of children with adenoid hypertrophy. Hypertrophy
of the nasopharyngeal pad of lymphoid tissues (the
adenoids) is the most common cause of nasal
obstruction in children. The mouth is always open
because upper airway congestion has made patients
52
obligatory mouth breathers. Persistent mouth breathing due to nasal obstruction
in childhood may be associated with the development of craniofacial anomalies
such as the adenoid facies ( also called the “long face syndrome”. The most
common presenting symptoms are chronic mouth breathing and snoring” The
most dangerous symptom is sleep apnea.
9.
Leonine facies = lepromatous leprosy
Saddle nose deformity. The patient also shows typical
Leonine facies & Madarosis (loss of eyebrows) seen in
leprosy and had complaints of Anosmia & recurrent
Epistaxis.
10.
Bird facies = pierre robin syndrome
Pierre Robin syndrome/Bird Facies- is genetic defect,
which gives rise to a very small lower jaw, cleft palate and
a condition called as retroglossoptosis, where the tongue
appears to fall into the throat
11.
Hidden Content.
Purchase the Full Book in Rs. 350/on= www.mbbsdost.com/funnotes
Mongoloid facies
down's syndrome
Child with Down syndrome. Note up-slanting palpebral
fissures, bilateral epicanthal folds, small nose with flat
nasal bridge, open mouth with tendency for tongue
protrusion, and small ears with overfolded helix
12. Coarse facies = most of the inborn errors of
metabolism (iem) viz. The mucopolysaccharidoses
(mps), mucolipidoses (ml), fucosidoses mannosidoses,
sialidoses, aspartylglycosaminuria, generalised
ga n g l i o s i d o s i s ( g m l ) & a u st i n ' s va r i a nt o f
metachromatic leukodystrophy due to multiple
sulfatase deficiency (mld-msd) have similar appearing
facies.
Coarse facial features or "'coarse facies"' describes a
constellation of facial features that are present in many
inborn errors of metabolism.
53
Features include: large, bulging head, prominent scalp veins, "saddle-like, flat
bridged nose with broad, fleshy tip", large lips and tongue, small, widely spaced
and/or malformed teeth, hypertrophic alveolar ridges and/or gums. Heads tend to
be longer than normal from front to back, with a bulging forehead. This is because
of the earlier than normal or premature fusion of skull bones in an affected
individual
13. Syphilitic facies = congenital syphilis ( bull dog
jaw)
Hepatomegaly, Splenomegaly, Hutchinsons Teeth,
Mulberry Molars, Snuffles, Saddle Nose, Seizures,
Interstitial Keratitis, Pseudo Paralysis, Frontal Bossing
14. Hippocratic face= advanced peritonitis, sign
portends death
The nose sharp, the eyes sunken, the temples fallen in,
the ears cold and drawn in and their lobes distorted, the
skin of the face hard, stretched and dry, and the colour
of the face pale or dusky.
The Hippocratic face (facies Hippocratica in Latin) is the
change produced in the face by impending death or long
illness, excessive evacuations, excessive hunger, and the
like.
15.
Hidden Content.
Potter facies- oligohydramnios
This baby demonstrates the typical "Potter's facies"
with prominent infraorbital folds resulting from
oligohydramnios in utero. This is an example of a
deformation sequence in which an anomaly (here the
lack of normal kidneys) leads to lack of fetal urine
output with resultant oligohydramnios that causes
deformation through constraint.
16. Amiodarone facies
Long-term administration of amiodarone (usually more
than eighteen months) is associated with a lightsensitive blue-grey discoloration of the skin; such
patients should avoid exposure to the sun and use
sunscreen that protects against ultraviolet-A and -B.
The discoloration will slowly improve upon cessation of
the drug, however, the skin color may not return
completely to normal.
54
17. Acromegalic facies- acromegaly
prominent orbital ridges, large nose,
prominent lower jaw and thickening of
the lips
18. Marfanoid facies- marfan's syndrome
prominent orbital ridges, large nose, prominent
lower jaw and thickening of the lips
Hidden Content.
19.
Myotonic/ Hatchet facies- myotonic
dystrophy
The characteristic physiognomy of advanced
myotonic dystrophy; the face is drawn and
lugubrious, with hollowing of the muscles
around the temples and jaws; eyes are
'hooded', lower lip droops, and global weakness
of facial muscles causes sagging of lower face,
accompanied by marked wasting of the neck
muscles, especially the flexors, which imparts a
'swan-neck' appearance. The hatchet face may
also be seen in amyotrophic lateral sclerosis, and
in Curschmann-Batten-Steiner syndrome
55
20. Torpid or Myxedematous facies – Myxedema
Skin generally thickened,
alopecia, periorbital oedema,
xanthelasma, coolness and
dryness of skin and hair,
thinning of scalp hair, tongue
swelling.
21. Gargoyle facies- hurler's syndrome
The characteristic facies of gargoylism, now
known as mucopolysaccharidoses (MPS); the
classic gargoyle face is seen in MPS type IH/Hurler syndrome and MPS type IV/Morquio
syndrome and characterised by thickening
and coarsening of facial features due to
subcutaneous deposition of MPS, most
commonly seen after the first year of age; the
head is large and dolichocephalic, with frontal
bossing and prominent sagittal and metopic
sutures, and the face exhibits mid-face
hypoplasia, depressed nasal bridge, flared nares, a prominent lower third,
thickened facies, widely spaced teeth with attenuated dental enamel and gingival
hyperplasia
Hidden Content.
22. Monkey facies- marasmus
The “monkey facies,” caused by loss of the
buccal fat pad,
56
History-taking sequence
1.
Presenting (principal) symptom (PS)
2.
History of the presenting illness (HPI)
Details of current illnesses
Details of previous similar episodes
Extent of functional disability
Effect of the illness
3.
Drug and treatment history
Current treatment
Drug history (dose, duration, indication, side effects): prescription, overthe-counter and alternative therapies
Past treatments
Drug allergies or reactions
4.
Hidden Content.
Past illnesses
Purchase the Full Book in Rs. 350/Surgical operations (dates, indication, procedure)
Past history (PH)
Menstrual and reproductive history for women
Immunizations
Blood transfusions (and dates)
5.
Social history (SH)
Upbringing and education level
Marital status, social support, living conditions and financial situation
Diet and exercise
Occupation and hobbies
Overseas travel (where and when)
Smoking and alcohol use
Analgesic and illicit (street) drug use
Mood and sexual history
6.
Family history (FH)
57
7.
Systems review (SR)
The systems review
Enquire about common symptoms and three or four of the common
disorders in each major system listed below. Not all of these questions should
be asked of every patient. Adjust the detail of questions based on the
presenting problem, the patient’s age and the answers to the preliminary
questions.
denotes symptoms for the possible diagnosis of an urgent or dangerous
(alarm) problem.
Cardiovascular system
Have you had any pain or pressure in your chest, neck or arm? (Myocardial
ischaemia)
Are you short of breath on exertion? How much exertion is necessary?
Have you ever woken up at night short of breath? (Cardiac failure)
Can you lie flat without feeling breathless?
Hidden
Have you had swelling of your ankles?
Content.
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Full irregularly?
Book in Rs. 350/Have you noticed your
heart racingthe
or beating
onwithout
Have you had blackouts
warning? (Stokes-Adams attacks)
Have you felt dizzy or blacked out when exercising? (Severe aortic stenosis or
hypertrophic cardiomyopathy)
Do you have pain in your legs on exercise?
Do you have cold or blue hands or feet?
Have you ever had rheumatic fever, a heart attack or high blood pressure?
Respiratory system
Are you ever short of breath? Has this come on suddenly? (Pulmonary
embolism)
Have you had any cough?
Is your cough associated with shivers and shakes (rigors) and breathlessness
and chest pain? (Pneumonia)
Do you cough up anything?
Have you coughed up blood? (Bronchial carcinoma)
What type of work have you done? (Occupational lung disease)
58
Do you snore loudly? Do you fall asleep easily during the day? When? Have
you fallen asleep while driving? Obtain a sleep history.
Do you ever have wheezing when you are short of breath?
Have you had fevers?
Do you have night sweats?
Have you ever had pneumonia or tuberculosis?
Have you had a recent chest X-ray?
Gastrointestinal system
Are you troubled by indigestion? What do you mean by indigestion?
Do you have heartburn?
Have you had any difficulty swallowing? (Oesophageal cancer)
Have you had vomiting, or vomited blood? (Gastrointestinal bleeding)
Have you had pain or discomfort in your abdomen?
Hidden
Content.
Have you had any abdominal bloating
or distension?
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the Full
Bookofin
350/Has your bowel habit
changed recently?
(Carcinoma
theRs.
colon)
How many bowel motions
a week do you usually pass?
Have you lost control of your bowels or had accidents (faecal incontinence)?
Have you seen blood in your motions? (Gastrointestinal bleeding)
Have your bowel motions been black? (Gastrointestinal bleeding)
Have you lost weight recently without dieting? (Carcinoma of the colon)
Have your eyes or skin ever been yellow?
Have you ever had hepatitis, peptic ulceration, colitis or bowel cancer?
Tell me (briefly) about your diet recently.
Genitourinary system
Do you have difficulty or pain on passing urine?
Is your urine stream as good as it used to be?
Is there a delay before you start to pass urine? (Applies mostly to men)
Is there dribbling at the end?
Do you have to get up at night to pass urine?
59
Are you passing larger or smaller amounts of urine?
Has the urine colour changed?
Have you seen blood in your urine? (Urinary tract malignancy)
Have you any problems with your sex life? Difficulty obtaining or maintaining
an erection?
Have you noticed any rashes or lumps on your genitals?
Have you ever had a sexually transmitted disease?
Have you ever had a urinary tract infection or kidney stone?
Are your periods regular?
Do you have excessive pain or bleeding with your periods?
Haematological system
Do you bruise easily?
Have you had fevers, or shivers and shakes (rigors)?
Do you have difficulty stopping
a small Content.
cut from bleeding? (Bleeding
Hidden
disorder)
Have you noticed any lumps under your arms, or in your neck or groin?
(Haematological malignancy)
Have you ever had blood clots in your legs or in the lungs?
Musculoskeletal system
Do you have painful or stiff joints?
Are any of your joints red, swollen and painful?
Have you had a skin rash recently?
Do you have any back or neck pain?
Have your eyes been dry or red?
Have you ever had a dry mouth or mouth ulcers?
Have you been diagnosed as having rheumatoid arthritis or gout?
Do your fingers ever become painful and become white and blue in the cold?
Endocrine system
Have you noticed any swelling in your neck?
Do your hands tremble?
60
Do you prefer hot or cold weather?
Have you had a thyroid problem or diabetes?
Have you noticed increased sweating?
Have you been troubled by fatigue?
Have you noticed any change in your appearance, hair, skin or voice?
Have you been unusually thirsty lately? Or lost weight? (New onset of
diabetes)
Reproductive and breast history (women)
How many pregnancies have you had?
Have you had any miscarriages?
Have you had high blood pressure or diabetes in pregnancy?
Were there any other complications during your pregnancies or deliveries?
Have you had a Caesarean section?
Have you had any bleeding or discharge from your breasts or felt any lumps
Hidden Content.
there? (Carcinoma of the breast)
Neurological system and mental state
Do you get headaches?
Is your headache very severe and did it begin very suddenly? (Subarachnoid
haemorrhage)
Have you had fainting episodes, fits or blackouts?
Do you have trouble seeing or hearing?
Are you dizzy?
Have you had weakness, numbness or clumsiness in your arms or legs?
Have you ever had a stroke or head injury?
Have you had difficulty sleeping?
Do you feel sad or depressed, or have problems with your ‘nerves’?
Have you ever been sexually or physically abused?
The elderly patient
Have you had problems with falls or loss of balance? (High fracture risk)
Do you walk with a frame or stick?
61
Do you take sleeping tablets or sedatives? (Falls risk)
Do you take blood pressure tablets? (Postural hypotension and falls risk)
Have you been tested for osteoporosis?
Can you manage at home without help?
Are you affected by arthritis?
Have you had problems with your memory or with managing things like
paying bills? (Cognitive decline)
How do you manage your various tablets? (Risk of polypharmacy and
confusion of doses)
Hidden Content.
Purchase the Full Book in Rs. 350/Is there anything else you would like to talk about?
Concluding the interview
When recording the systems review, list important negative answers
(‘relevant negatives’). Remember: if other recent symptoms are unmasked,
more details must be sought; relevant information is then added to the
history of the presenting illness.
Before completing the history, it is often valuable to ask what the patient
thinks is wrong and what he or she is most concerned about. General and
sympathetic questions about the effect of a chronic or severe illness on the
patient’s life are important for establishing rapport and for finding out what
else might be needed (both medical and non-medical) to help the patient.
Major presenting symptoms for each system are described in the following
chapters. Examples of supplementary important questions to ask about past
history, social history and family history are also given there for each system.
Occupations and hobbies linked to disease
1.
2.
3.
4.
5.
6.
7.
8.
9.
Farmers
mouldy hay—hypersensitivity pneumonitis
Bird fanciers
birds—hypersensitivity pneumonitis, psittacosis
Welders
eye flash burns, pacemaker malfunction
Stone masons
silicosis
Hidden Content.
Shipyard workers, builders, asbestosis
Purchase the Full Book in Rs. 350/emergency workers
Coal miners
pneumoconiosis and silicosis
Timber workers
asthma
Electronic workers
berylliosis
Healthcare workers
needle-stick HIV, hepatitis B, tuberculosis (TB)
62
Smoking and clinical associations
Cardiovascular disease
Premature coronary artery disease
Peripheral vascular disease, erectile dysfunction
Cerebrovascular disease
Respiratory disease
Lung cancer
Chronic obstructive pulmonary disease (chronic airflow limitation)
Increased incidence of respiratory infection
Increased incidence of postoperative respiratory complications
Hidden Content.
Purchase the Full Book in Rs. 350/Larynx, oral cavity, oesophagus, nasopharynx, bladder, kidney, pancreas,
stomach, uterine cervix on www.mbbsdost.com/funnotes
Other cancers
Gastrointestinal disease
Peptic ulceration, Crohn’s disease
Pregnancy
Increased risk of spontaneous abortion, fetal death, neonatal death, sudden
infant death syndrome
Drug interactions
Induces hepatic microsomal enzyme systems, e.g. increased metabolism of
propranolol, theophylline
Alcohol (ethanol) abuse and clinical associations
Gastrointestinal system
Acute gastric erosions
Gastrointestinal bleeding from varices, erosions, Mallory-Weiss tear, peptic
ulceration
Hidden
Pancreatitis (acute, recurrent or chronic)
Content.
Purchase
the
Full Bookfrom
in Rs.
350/Diarrhoea (watery, due to
alcohol itself,
or steatorrhoea
chronic
alcoholic
pancreatitis or, rarely, liver
disease)
Hepatomegaly (fatty liver, chronic liver disease)
Chronic liver disease (alcoholic hepatitis, cirrhosis) and associated
complications
Cancer (oesophagus, cardia of stomach, liver, pancreas)
63
Cardiovascular system
Cardiomyopathy
Cardiac arrhythmias
Hypertension
Nervous system
‘Blackouts’
Nutrition-related conditions, e.g. Wernicke’s encephalopathy, Korsakoff’s
psychosis, peripheral neuropathy (thiamine deficiency), pellagra (dementia,
dermatitis and diarrhoea from niacin deficiency)
Withdrawal syndromes, e.g. tremor, hallucinations, ‘rum fits’, delirium tremens
Cerebellar degeneration
Hidden Content.
Alcoholic myopathyPurchase the Full Book in Rs. 350/Autonomic neuropathy
Alcoholic dementia
Haematopoietic system
Anaemia (dietary folate deficiency, iron deficiency from blood loss, direct toxic
suppression of the bone marrow, rarely B12 deficiency with chronic
pancreatitis, or sideroblastic anaemia)
Thrombocytopenia (from bone marrow suppression or hypersplenism)
Genitourinary system
Erectile dysfunction (impotence), testicular atrophy in men
Amenorrhoea, infertility, spontaneous abortion, fetal alcohol syndrome in
women
Other effects
Increased risk of fractures and osteonecrosis of the femoral head
Sulfonamides: common characteristics
Mnemonic- SULFA :
S teven-Johnson syndrome/ S kin rash / S olubility low
Hidden Content.
U rine precipitation/ U sefulPurchase
for U TI the Full Book in Rs. 350/on www.mbbsdost.com/funnotes
L arge spectrum (gram positives and negatives)
F olic acids synthesis blocker (as well as synthesis of nucleic acids)
A nalog of PABA
64
Important HLA
Myasthenia gravis
:
HLA B8
Behcet's disease
:
HLA B5
CAH
:
HLA B47
psoriasis vulgaris
:
HLA Cw6
Hidden Content.
Multiple sclerosis;Narcolepsy;Good
pasture
:
Hla
Dr2 350/Purchase
the cFull Book
in Rs.
Dermatitis Herpetiformis on www.mbbsdost.com/funnotes
:
HLA Dr3
Pemphigus Vulgaris
:
HLA DR4/DQ1
Bullous pemphigoid
:
HLA Dq7
Rheumatoid Arthritis
:
aHLA DR4
Skills in history-taking
1. Several skills are important in obtaining a useful and accurate history
Establish rapport and understanding.
Ask questions in a logical sequence. Start with open-ended questions.
Listen to the answers and adjust your interview accordingly.
Observe and provide nonverbal clues carefully. Encouraging, sympathetic
gestures and concentration on the patient that make it clear he or she has
your undivided attention are most important and helpful, but are really a
form of normal politeness.
Proper interpretation of the history
is crucial.
Hidden
Content.
2. A good grounding in history taking will stand you in good stead for the rest of
Purchase the Full Book in Rs. 350/your career in medicine.
3. A successful consultation with a patient, based on a good history-taking
manner, is satisfying and even enjoyable for both parties.
4. Repeated practice in history taking makes it an accurate and quite rapid
process (usually).
5. Not taking a proper history (a regrettably common event) can lead to an
incorrect differential diagnosis, the wrong tests and often the wrong
treatment.
6. No test is accurate enough (sensitive and specific enough) to be useful if it is
ordered for the wrong reason (e.g. as a result of poor history taking).
7. Screen for alcohol and drug use routinely using standard questions.
65
Consciousness disorders and their diagnostic value
Patient’s consciousness may be clear or deranged. Depending on the degree of
disorder, the following psychic states are differentiated.
1. Stupor. The patient cannot orient himself to the surroundings, he gives
delayed answers. The state is characteristic of contusion and in some cases
poisoning.
2. Sopor. This is an unusually deep sleep from which the patient recovers only
for hort periods of time when called loudly, or roused by an external stimulus.
The reflexes are preserved. The state can be observed in some infectious
diseases and at the initial stage of acute uraemia.
3. Coma. The comatose state is the full loss of consciousness with complete
absence of response to external stimuli, with the absence of reflexes, and
deranged vital functions. The causes of coma are quite varied but the loss of
consciousness in coma of any aetiology is connected with the cerebral cortex
dysfunction caused by some factors, among which the most important are
disordered cerebral circulation and anoxia. Oedema of the brain and its
membranes, increased intracranial
pressure,Content.
effect of toxic substances on the
Hidden
brain tissue, metabolic
and hormone
disorders,
acid-base
Purchase
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Bookandinalso
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350/equilibrium are also very important for the onset of coma. Coma may occur
ongradually,
suddenly or develop
through various stages of consciousness
disorders. The period that precedes the onset of a complete coma is called the
precomatose state. The following forms of coma are most common.
Alcoholic coma. The face is cyanotic, the pupils are dilated, the respiration
shallow, the pulse low and accelerated, the arterial pressure is low; the
patient has alcohol on his breath.
Apoplexic coma (due to cerebral haemorrhage). The face is red, breathing is
slow, deep, noisy, the pulse is full and rare.
Hypoglycaemic coma can develop during insulin therapy for diabetes.
Diabetic (hyperglycaemic) coma occurs in non-treated diabetes mellitus.
Hepatic coma develops in acute and subacute dystrophy and necrosis of the
liver parenchyma, and at the final stage of liver cirrhosis.
Vraemic coma develops in acute toxic and terminal stages of various chronic
diseases of the kidneys.
Epileptic coma. The face is cyanotic, there are clonic and tonic convulsions,
66
the tongue is bitten. Uncontrolled urination and defecation. The pulse is
frequent, the eye-balls are moved aside, the pupils are dilated, breathing is
hoarse.
4. Irritative disorders of consciousness may also develop. These are
Hiddennervous
Content.system in the form of
characterized by excitation of the central
Purchase the Full Book in Rs. 350/hallucinations, delirium (delirium furibundum due to alcoholism; in
pneumonia, especially in alcoholics; quiet delirium in typhus, etc.).
General inspection can also give information on other psychic disorders
that may occur in the patient (depression, apathy).
Examination of Lymph Node
Lymph Nodes are generally examined in the following order:
1. Anterior Cervical (both superficial and deep): Nodes that lie both on top of
and beneath the sternocleidomastoid muscles (SCM) on either side of the
neck, from the angle of the jaw to the top of the clavicle. This muscle allows
the head to turn to the right and left. The right SCM turns the head to the left
vice versa. They can be easily identified by asking the patient to turn their
head into your hand while you provide resistance. Drainage: The internal
structures of the throat as well as part of the posterior pharynx, tonsils, and
thyroid gland.
2. Posterior Cervical: Extend in a line posterior to the SCMs but in front of the
trapezius, from the level of the mastoid bone to the clavicle. Drainage: The
skin on the back of the head. Hidden
Also frequently
enlarged during upper
Content.
respiratory infectionsPurchase
(e.g. mononucleosis).
the Full Book in Rs. 350/3.
Tonsillar: Located just
the angle of the mandible. Drainage: The
onbelow
tonsilar and posterior pharyngeal regions.
4. Sub-Mandibular: Along the underside of the jaw on either side. Drainage: The
structures in the floor of the mouth.
5. Sub-Mental: Just below the chin. Drainage: The teeth and intra-oral cavity.
6. Supra-clavicular: In the hollow above the clavicle, just lateral to where it joins
the sternum. Drainage: Part of the throacic cavity, abdomen.
A number of other lymph node groups exist. However, palpation of these
areas is limited to those situations when a problem is identified in that specific
region (e.g. the pre-auricular nodes, located in front of the ears, may become
inflamed during infections of the external canal of the ear).
67
HIV PEP(Post-exposure prophylaxis):
Post-exposure prophylaxis (PEP) has its greatest effect if begun within two hours
of exposure, it is essential to act immediately. The prophylaxis needs to be
continued for four weeks. Exposure must be immediately reported to designated
authority and therapy administered. Never delay start of therapy due to debate
Hidden
Content.
over regimen. Begin with basic 2-drug regimen
& expanded
3-drug regimn.
Purchase
thea day)
Full +Book
in Rs. 350/Basic regimen : Zidovudine 300mg
BD(twice
Lamivudine
150mg BD(twice
a day)
Expanded regimen : Zidovudine 300mgBD + Lamivudine 150mg BD + Lopinavir
400mg BD
Expanded regimen should be used if there is cut or needle stick injury penetrating
gloves, inserting a cathether which was previously used for a HIV infected patient.
Pathognomonic Signs of diseases:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
COPD - Barrel-Chest
Pneumonia - Greenish Rusty Sputum
Pernicious Anemia - Beefy Red Tongue (Schilling’s Test)
Kawasaki Disease - Strawberry Tongue
Typhoid - Rose Spot
Tetany - Chvostek Sign (Muscle Twitching Face) - Trosseau’s Sign (Jerky
Movements
Pancreatitis - Cullen Sign (Bluish discoloration preumbilical area)
Appendicitis - McBurney’s Point (rebound tenderness) - Rovsing Sign (Right
Lower quadrant pain with palpation
in Content.
Left lower quadrant) - Psoas
Hidden
Sign(pain on lying down putting pressure on Mc Burney’s point)
Thrombophlebitis -Purchase
Homan’s Sign the Full Book in Rs. 350/Hepatitis - Icteric Sclera
discoloration of sclera)
on(yellowish
Meningitis - Burdzinski Sign (Pain on nape) - Karnig Sign (pain on leg/ knee
area)
Pyloric Stenosis - Olive-Shaped Mass
Hyperthyroidism - Exopthalmus
Addison’s Disease. - Bronze-like skin
Cushing Syndrome- Boffalo Hump
Cholera - Rice Watery Stool
Systemic Lupus erythematorus - Butterfly Rashes
Leprosy - Leoning Face (contracted face)
Bulimia Nervosa - Chipmunk Face
68
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
Liver Cirrhosis - Spider Angioma
Asthma - Wheezing Inspiration
Hyperpituitarism - CAROTENEMIA (Discoloration of skin) - XANTHAMIA
Down Syndrome- Single Crease on Palm
Tetralogy of fallot - Clubbing of Fingernails Ventricular Septal Defect
Pulmonary Stenosis Overriding of Aorta
RightContent.
Ventricular Hypertrophy
Hidden
Cataract - Blurry Vision /Purchase
Hizzy Visionthe Full Book in Rs. 350/Glucoma - Tunnel-like Vision
PTB - Low grade fever in a ternoon
Cholecystitis- Murphy’s Sign (pain RU Right upper quadrant)
Myasthemia Gravis (MG) – Ptosis (inability to open upper eyelids)
Dengue - Petechiae
Parkinson’s Diease. - Pill Rolling Tremors
Measles - Koplick’s Spot
Normal form of the chest
1. Normosthenic (conical) chest in subjects with normosthenic constitution
resembles a truncated cone whose bottom is formed by well-developed
muscles of the shoulder girdle and is directed upward. The anteroposterior
(sterno vertebral) diameter of the chest is smaller than the lateral (transverse)
one, and the supraclavicular fossae are slightly pronounced. There is a distinct
angle between the sternum and the manubrium (angulus Ludowici); the
epigastric angle nears 90°. The ribs are moderately inclined as viewed from
the side; the shoulder blades closely fit to the chest and are at the same level;
the chest is about the same heightHidden
as the abdominal
part of the trunk.
Content.
the
Full Book
in Rs. 350/2. Hypersthenic chestPurchase
in persons with
hypersthenic
constitution
has the shape
of a cylinder. The on
anteroposterior
diameter is about the same as the
transverse one; the supraclavicular fossae are absent (level with the chest).
The manubriosternal angle is indistinct; the epigastric angle exceeds 90°;
the ribs in the lateral parts of the chest are nearly horizontal, the intercostal
space is narrow, the shoulder blades closely fit to the chest, the thoracic part
of the trunk is smaller than the abdominal one.
3. Asthenic chest in persons with asthenic constitution is elongated, narrow
(both the anteroposterior and transverse diameters are smaller than normal);
the chest is flat. The supra- and subclavicular fossae are distinctly
69
pronounced. There is no angle between the sternum and the manubrium: the
sternal bone and the manubrium make a straight "plate". The epigastric angle
Hidden
Content.
is less than 90°. The ribs are more vertical
at the
sides, the tenth ribs are not
Purchase
the
Full
Book
in Rs.
attached to the costal arch (costa decima fluctuens);
the350/intercostal spaces
are wide, the shoulder blades are winged (separated from the chest), the
muscles of the shoulder girdle are underdeveloped, the shoulders are sloping,
the chest is longer than the abdominal part of the trunk.
Pathological Forms of chest
1. Emphysematous (barrel-like) chest resembles a
hypersthenic chest in its shape, but differs from it
by a barrel-like configuration, prominence of the
chest wall, especially in the posterolateral
regions, the intercostal spaces are enlarged. This
Hidden Content.
type of chest is found in chronic emphysema of
Full Book in Rs. 350/the lungs. ActivePurchase
participationthe
of accessory
respiratory muscles
the respiratory act
oninwww.mbbsdost.com/funnotes
(especially m. sternocleidomastoideus and m.
trapezius), depression of the intercostal space, General appearance of a patient
elevation of the entire chest during inspiration with pulmonary emphysema
and relaxation of the respiratory muscles and
lowering of the chest to the initial position during expiration become evident
during examination of emphysema patients.
2. Paralytic chest resembles the asthenic chest. It is
found in emaciated patients, in general asthenia
and constitutional underdevelopment; it often
occurs in grave chronic diseases, more
Hidden Content.
commonly in pulmonary tuberculosis and
Purchase
the Full Book
in Rs. 350/pneumosclerosis.
During examination
of
patients with paralytic
marked atrophy of
onchest,
the chest muscles and asymmetry of the clavicles
and dissimilar depression of the supraclavicular
Paralytic chest
fossae can be observed along with typical signs
of aslhenic chest. The shoulder blades are not atone level either, and their
movements during breathing are asynchronous.
70
3. Rachitic chest (keeled or pigeon chest). It is
c h a ra c te r i ze d by a m a r ke d l y g re ate r
anteroposterior diameter (compared with the
transverse diameter) due to the prominence of
the sternum (which resembles the keel of a
boat.) The anterolateral surfaces of the chest are
as if pressed on both sides and therefore the ribs
meet at an acute angle at the sternal bone, while
the costal cartilages thicken like beads at points
of their transition to bones (rachitic beads). As a
rule, these beads can be palpated after rickets
only in children and youths.
Hidden Content.
4. Funnel chest has a funnel-shaped depression in the lower part of the
sternum. This deformity can be regarded as a result of abnormal development
of the sternum or prolonged compressing effect. In older times this chest
would be found in shoemaker adolescents.
5. Foveated chest is almost the same as the funnel chest except that the
depression is found mostly in the upper and the middle parts of the anterio
surface of the chest. This abnormality occurs in syringomyelia, a rare disease
of the spinal cord.
The chest may be abnormal in subjects with various deformities of the spine
which arise as a result of injuries, tuberculosis of the spine, rheumatoid
arthritis (Bekhterev's disease), etc. Four types of spine deformities are
distinguished: lateral curvature of the spine, called scoliosis;
forward and backward curvature of the spine (gibbus and kyphosis,
respectively); forward curvature of the spine, generally in the lumbar region
(lordosis); combination of the lateral and forward curvature of the spine
(kyphoscoliosis).
Respiration Rhythm
Respiration of a healthy person is rhythmic, of uniform depth and equal length of
the inspiration and expiration phases. Rhythm of the respiratory centre can be
inhibited, in some types of oedema. Derangement of the respiratory function can
(pause oedema in which a series of respiratory
Hiddenmovements
Content. alternates with a
pronounced (readily detectable)Purchase
elongationthe
of the
respiratory
pause
(lasting from
Full Book in Rs.
350/a few seconds to a minute) or toon
a temporary
arrest of respiration (apnoea). This
respiration is known as periodic.
Biot's respiration is characterized by rhythmic but deep respiration movements
which alternate (at approximately regular intervals) with 1ong| respiratory
71
pauses (from few seconds to half a minute). Biot's respiration occurs in meningitis
patients and in agony with disorders of cerebral circulation.
Cheyne-Stokes' respiration is characterized by periods (from seconds to a minute)
of cessation of respiration, followed by noiseless shallow respiration, which
quickly deepens, becomes noisy to attain its maximum at the 5-7th inhalation, and
then gradually slows down to end with a new short respiratory pause. During such
pauses, the patient often loses his sense of orientation in the surroundings or even
faints, to recover from the unconscious condition
after
respiratory movements are
Hidden
Content.
restored. This respiratory disorder occurs in diseases causing acute or chronic
Purchase the Full Book in Rs. 350/insufficiency of cerebral circulation and brain hypoxia, and also in heavy
poisoning. More frequentlyon
thiswww.mbbsdost.com/funnotes
condition develops during sleep and is more
characteristic of aged persons with marked atherosclerosis of the cerebral
arteries.
Undulant (wave-like) Grocco’s respiration somewhat resembles Cheyne-Stoke’s
respiration except that a weak shallow respiration occurs instead of the
respiratory pause with subsequent deepening of the respiratory movement,
followed by slowing down. This type of arrhythmic dyspnoea can probably be
regarded as the early stages of the same pathological processes which are
responsible for resembles Cheyne-Stoke’s respiration.
Classification of Conjunctivitis
INFLAMMATIONS OF CONJUNCTIVA
Inflammation of the conjunctiva (conjunctivitis) is classically defined as
conjunctival hyperaemia associated with a discharge which may be watery,
mucoid, mucopurulent or purulent.
Etiological classification
1. Infective conjunctivitis: bacterial,Hidden
chlamydial,
viral, fungal, rickettsial,
Content.
spirochaetal, protozoal, parasitic etc.
2. Allergic conjunctivitis.
3. Irritative conjunctivitis.
4. Keratoconjunctivitis associated with diseases of skin and mucous membrane.
5. Traumatic conjunctivitis.
6. Keratoconjunctivitis of unknown etiology.
Clinical classification Depending upon clinical presentation, conjunctivitis can be
72
classified as follows:
1. Acute catarrhal or mucopurulent conjunctivitis.
2. Acute purulent conjunctivitis
3. Serous conjunctivitis
4. Chronic simple conjunctivitis
5. Angular conjunctivitis
Hidden Content.
Purchase the Full Book in Rs. 350/Pseudomembranous conjunctivitis
6. Membranous conjunctivitis
7.
8. Papillary conjunctivitis
9. Follicular conjunctivitis
10. Ophthalmia neonatorum
11. Granulomatous conjunctivitis
12. Ulcerative conjunctivitis
13. Cicatrising conjunctivitis
Vocal Fremitus
Palpation is used for determining the strength of voice conduction to chest
surface (fremitus vocalis s. pectoralis). Vocal fremitus depends on the conduction
of voice sounds through the respiratory tract.
The palms of the hands placed on the symmetrical parts of the chest and the
patient is asked to i loudly a few words (with the letter 'r' in them to intensify
Hidden Content.
Purchase the Full Book in Rs. 350/"one, two, three," "eee-eee". The patient should speak the words with a voice of
on should
uniform intensity. The voice
be as low as possible since voice vibrations are
vibration). The doctor can ask the patient to repeat words, such as "ninety-nine",
better transmitted by the air column in the trachea and the bronchi to the chest
wall in this case. Vibrations are felt as the hands move symmetrically on either side
of the sternum and vertebral column.
Fremitus vocalis can also be determined by one hand as well: the palm of the
examining hand should be placed alternately on the symmetrical parts of the
chest.
73
In general vocal fremitus is the most intense in the regions of the thorax where the
trachea and bronchi are the closest to the surface, particularly along the sternum
between the first and second ribs and posteriorly between the scapulae.
Progressing downward, the sound decreases and is least prominent at the base of
the lungs.
Vocal fremitus is of about the same intensity in the symmetrical parts of the chest
of a healthy person. Vocal vibrations are louder in the upper parts of the chest and
softer in its lower parts. Moreover, voice conduction is better in men with low
voice and thin chest; the vibrations are weaker in women and children with higher
voice (and also in persons with the well developed subcutaneous fat tissues).
Hidden Content.
Vocal fremitus can be stronger or weaker (or in some cases it can even be
Purchase
theofFull
in Rs.
350/impalpable) in pathological
conditions
the Book
respiratory
organs.
In focal
affections, vocal fremitus becomes unequal over symmetrical parts of the chest.
Vocal fremitus is intensified when a part of the lung or its whole lobe becomes
airless and more uniform (dense) because of a pathological process. According to
the laws of physics, dense and uniform bodies conduct sound better than loose
and non-uniform. Induration (consolidation) can be due to various causes, such as
acute lobar pneumonia, pulmonary infarction, tuberculosis, accumulation of air
or fluid in the pleural cavity, etc. Vocal fremitus is also intensified in the presence in
the pulmonary tissue of an air cavity communicated with the bronchus.
Vocal fremitus becomes weaker:
1. When liquid or gas are accumulated in the pleural cavity; they separate the
lung from the chest wall to absorb voice vibrations propagating from the
vocal slit along the bronchial tree;
2. In complete obstruction of the bronchial lumen by a tumour which interferes
with normal conduction of sound waves to the chest wall;
3. In asthenic emaciated patients (with weak voice);
4. In significant thickening of the chest wall in obesity.
Low-frequency vibrations due to pleural friction (friction fremitus) in dry pleurisy,
crepitation sounds characteristic of subcutaneous emphysema of the lungs,
vibration of the chest in dry, low (low-pitch buzzing) rales can also be determined
by palpation.
74
Decreased vocal fremitus in the upper airway may indicate
a.
b.
c.
d.
the obstruction of a major bronchus,
pneumo-, hydro-, haemothorax,
emphysema of lungs,
adiposity can also be the cause of decreased vocal fremitus.
The voice of fremitus is increased
a.
b.
b.
c.
in pneumonia,
Hidden Content.
in abscess,
in atelectasis, Purchase the Full Book in Rs.
in cavern.
350/on www.mbbsdost.com/funnotes
Absence of fremitus usually indicates obstruction of a major bronchus, which may
occur as the result of aspiration of a foreign body.
Decreased or absent fremitus is always recorded and reported for further
investigation. During palpation other vibrations that indicate pathologic
conditions are noted. One is a pleural friction rub, which has a grating sensation. It
is synchronous with respiratory movements and is the result of opposing surfaces
of the inflamed pleural lining rubbing against one another,
Percussion Tones
ORGANS
PERCUSSED
INTENSITY
PITCH
DURATION
DUALITY
Long
Hollow
lungs
Loud
Low
bone and
muscle
sofe
HighHidden Content.
Short
spleen and
liver borders
stomach and
gas bubbles intestines
Extremelydul
Purchase the Full Book in Rs. 350/Medium
Mediumon www.mbbsdost.com/funnotes
Medium
Thudlike
high
Loud
air trapped
in lung
Very loud
(emph-ysema)
High
Medium
Drumlike
Very low
Longer
Booming
75
Mechanisms and Examples of Hypersensitivities
TYPE 1 : IMMEDIATE
Hay fever Allergic asthma Anaphylaxis
Reaction of IgE antibody on mast cells with antigen, which results in release of
mediators
TYPE II : CYTOTOXIC
Autoimmune hemolytic anemia
Goodpasture's syndrome Myasthenia gravis
Reaction of IgG with host cell membrane or antigen adsorbed by host cell
membrane
TYPE III : IMMUNE COMPLEX-MEDIATED
Serum sickness Vasculitis Systemic lupus
Hidden Content.
erythematosus Rheumatoid
arthritis the Full Book in Rs. 350/Purchase
Formation of immune complex of antigen and antibody, which deposits in walls of
blood vessels and results in complement release and inflammation
TYPE IV : DELAYED
Poison ivy Graft rejection Tuberculosis Sarcoidosis
Reaction of sensitized T-cells with antigen and release of lymphokines, which
activate macrophages and induce inflammation
Graves' disease B-cellgammopathies
TYPE V : STIMULATED
Reaction of autoantibodies with normal cell-surface receptors, which stimulates a
continual overreaction of the target cell
IgE, Immunoglobulin E; IgG, immunoglobulin G.
76
Anaphylaxis Management
Promotion of adequate ventilation & tissue perfusion for a client with a severe
allergic (antigen-antibody) reaction
•
Place client in Fowler's or high Fowler's position.
•
Apply tourniquet immediately proximal to the allergen point of entry (e.g.,
injection site, IV site, insect bite, etc.), when possible.
•
Administer aqueous epinephrine 1:1000 (0.3-0.5 mL) subcutaneously at the
contact site, if applicable, and proximal to the tourniquet and repeat every 3
minutes, as needed.
•
Establish and maintain a patent airway.
Hidden
•
•
Content.
Purchase
the Full Book in Rs. 350/Administer oxygen by
mask.
Start an IV infusion on
of normal
saline, lactated Ringer's, or a plasma volume
expander, as appropriate.
•
Reassure the client and family members.
•
Monitor for signs of shock, airway obstruction, cardiac arrhythmia, aspiration
of gastric contents, and seizures.
•
Administer spasmolytics, antihistamines, or cortico- steroids as indicated if
urticaria, angioedema, or bron chospasm present.
•
Monitor for recurrence of anaphylaxis within 24 hours.
Medical love at mbbsdost
Husband : Wow, you are looking so pink tonight?
Wife : When I hear your lovely words they stimulate the bundle branches of the
circulation system of my heart, it starts beating faster & increased output is
Hidden Content.
transmitted to adrenals which Purchase
start secreting
glucagon
blood glucose
the Full
Bookto
inincrease
Rs. 350/level & to combat this emergency,
Pituitary output also increases which raises
blood estrogen level, Causing vasodilation & I look PINK.
MORAL : there is medicine in love as well.
77
Vectors of Few Well Known Diseases
Anopheles
Malaria
Culex
Japanese encephalitis, west nile fever, bancroftian
filariasis, viral arthritis
Aedes
Yellow fever, dengue, chikungunya, rift valley fever
Mansoinoides
Brugian filariasis
Sandfly
Kala azar, oriental sore, oraya fever, sandfly fever
Tse-Tse fly
Sleeping sickness
Louse
Rat flea
Black fly
Hidden Content.
Purchase the Full Book in Rs. 350/on
Onchocerciasis
Epidemic typhus, relapsing fever, trench fever, pediculosis
Bubonic plague, endemis plaque, chiggerosis,
hymenolepis diminut
Reduviid bug
Chagas disease
Hard tick
Tick typhus, viral encephalitis, Viral hemorrhagic fever,
KFD, tularemia, tick paralysis, babesiosis
Soft tick
Qfever, relapsing fever
Trombiculid mite
Scrub fever, rickettsial pox
Itch mite
Scabies
Cyclops
Guinea worm disease, fish tape worm (D.latum)
Adverse effect of Phenytoin (anti-epileptic drug)
Mnemonic- "HOT MALIKA"
H- hirsutism, hypertrophy of gum
O- osteomalacia
Hidden Content.
M- megaloblastic anemia
Purchase the Full Book in Rs. 350/A- ataxia (cerebellar) on www.mbbsdost.com/funnotes
T- teretogenicity
L- lymphedenopathy
I- inhibit insulin release (hyperglycemia)
K- vitamin K deficiency (bleeding)
A- arrhythmia
78
Symptoms of Senile cataract...
Mnemonic - "LIC BUG"
L-Loss of vision,
I-Image blur,
C-Colored halo,
Hidden Content.
B-Black spots,
U-Uniocular polypopia,
G-Glare..
Uses of mineralcorticosteroids
Mnemonic CORTICOSTEROID
C-Cushing syndrome
S-Serum sickness
O-Optic neuritis
T-Tenosynovitis
Hidden Content.
R-Rheumatoid arthritis
E-Edema
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in Rs. 350/T-Tenosynovitis on www.mbbsdost.com/funnotes
R-Renal disorder
I-Inflammatory condition
O-Optic neuritis
C-Conjunctivitis
I-Infection
O-Organ transplant
D-Dermatitis
Operations in Surgery
Jones operation
tendon transfer for radial nerve palsy
Swenson's operation
hirschprungs disease
Soave and parks operation
( coloanal anastomosis)
hirschprungs disease
Delormes operation
rectal prolapse
Billroth 1 operation
fractal prolapse
Hidden
Content.
Milligon Morgan operation
haemorrhoidectomy
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hiatus hernia
on
Nesovics operation
sports hernia
Cheatle henry operation
obturater hernia
Sebrocks operation
parotid duct fistula
Bentails operation
aortic roots aneurysum repairs
Belsey mark IV operation
hiatus hernia
Hills operation
hiatus hernia
Psoas hitch operation
little loss of length in ureteric injury
79
Causes of Gynaecomastia:
Mneumonic: "GYNAECOMASTia in LaD”
G- Gonadotropins
M-Methyldopa
Hidden
Content.
A- Adrenal
disease
hYperprolactinemia. Purchase the Full
S- Spironolactone
Book in Rs. 350/N– ketocoNazole
Tia-TestIcular tumours
Y- hYperthyroidism,
A- Androgens
L- Leprosy, Liver disease,
E- Estrogens
Lung ca( small cell type).
C- Cimetidine, Clomiphene
D- Digitalis
O- Orchitis
Nephrotic Syndrome
Mnemonic - "NEPHROTIC”
Na+ water retention
Edema
Proteinuria>3.5/24hrs
Hyperlipidemia
Renal vein thrOmbosis
Hidden Content.
Thrombotic &thrombo embolic complications
Infection with staph.N pneumococci
hyper coagulable state
Prostaglandin In Obstetrics
Mnemonic- Govt Medical College Delhi
Gemeprost- useful for inducing labour
Hidden Content.
Purchase the Full Book in Rs. 350/Misoprostol- abortion, postpartum heamorrhage
Carboprost-mid term abortion, postpartum haemorrhage
Dinoprost- mid term abortion.
80
Mydriatics
Mnemonic -PATCH
P - Phenylephrine
A - Atropine
T - Tropicamide
Hidden Content.
C - cyclopentolate
H - Homatropine
Forensic important sections
IMPORTANT IPC SECTIONS
44.
Injury
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
Hidden Content.
IPC SECTIONS RELATED
TO CONSENTthe Full Book in Rs. 350/Purchase
87.
Act not intended
not known to be likely to cause death or grievous
on and
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
91.
Exclusion of acts which are offences independently of harm caused
92.
Act done in good faith for benefit of a person without consent
81
SECTIONS RELATED TO FALSE EVIDENCE/ FALSE CERTIFICATES
191.
Giving false evidence (Perjury)
192.
Fabricating false evidence
193.
Punishment for false evidence (Perjury)
194.
Giving or fabricating false evidence with intent to procure conviction of
capital offence
195.
Giving or fabricating false evidence with intent to procure conviction of
offence punishable with imprisonment for life or imprisonment
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.
201.
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the Full
Using as true such
declaration knowing
it to Book
be false in Rs. 350/on www.mbbsdost.com/funnotes
Causing disappearance
of evidence of offence, or giving false information
to screen offender
202.
Intentional omission to give information of offence by person bound to
inform- The doctor knowing or having the reason to believe that an offence
has been committed by a patient whom he is treating, intentionally omits
to inform the police, shall be punished with imprisonment upto 6 months.
203.
Giving false information respecting an offence committed
204.
Destruction of document or electronic record to prevent its production as
evidence
IPC SECTIONS RELATED TO MURDER, SUICIDE ETC
299.
Culpable homicide, definition.
300.
Murder, definition
302.
Punishment for murder
304.
Punishment for culpable homicide not amounting to murder
82
304a. Causing death by negligence, punishment upto 2 years.
304b. Dowry death, punishment upto 7 years.
305.
Abetment of suicide of child or insane person
306.
Abetment of suicide
307.
Attempt to murder
308.
Attempt to commit culpable homicide
309.
Attempt to commit suicide
SECTIONS RELATED TO ABORTION
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
Purchase the Full Book in Rs. 350/after birth
316.
Causing death of quick unborn child by act amounting to culpable
Hidden Content.
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.
SECTIONS RELATED TO HURT AND GRIEVOUS HURT
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
83
325.
Punishment for voluntarily causing grievous hurt
326.
Voluntarily causing grievous hurt by dangerous weapons or means
328.
Causing hurt by means of poison, etc. with intent to commit an offence
SECTIONS RELATED TO TORTURE
330.
Voluntarily causing HURT to extort confession, or to compel restoration of
property is punishable for imprisonment upto SEVEN YEARS
331.
Voluntarily causing GRIEVOUS HURT to extort confession, or to compel
restoration of property punishable for imprisonment upto TEN YEARS
339.
Wrongful restraint
340.
Wrongful confinement.
341.
Punishment for wrongful restraint
342.
Punishment for wrongful Confinement
344.
Hidden Content.
Wrongful confinement
for three the
or more
days
Purchase
Full
Book in Rs. 350/on for
Wrongful confinement
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
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
355.
Assault or criminal force with intent to dishonour person, otherwise than
on grave provocation
343.
84
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.
Kidnaping
360.
Kidnaping from India
361.
Kidnaping from lawful guardianship
362.
Abduction
363.
Punishment for kidnaping
363A. Kidnaping or maiming a minor for purposes of begging
364.
Kidnaping or abducting in order to murder
364A. Kidnaping for ransom, etc.
365.
Hidden Content.
Purchase
the Full
Book
Rs. 350/Kidnaping or abducting
with intent
secretly
and in
wrongfully
to confine
person
366.
Kidnaping, abducting or inducing woman to compel her marriage, etc.
366A. Procreation of minor girl
366B. Importation of girl from foreign country
367.
Kidnaping or abducting in order to subject person to grievous hurt,
slavery, etc.
368.
Wrongfully concealing or keeping in confinement, kidnaped or abducted
person
369.
Kidnaping or abducting child under ten years with intent to steal from its
person
372.
Selling minor for purposes of prostitution, etc.
373.
Buying minor for purposes of prostitution, etc.
374.
Unlawful compulsory labour
85
375.
Rape
376.
Punishment for rape
376a. Intercourse by a man with his wife during separation
376b. Intercourse by public servant with woman is his custody
376c. Intercourse by superintendent of jail, remand home, etc.
376d. Intercourse by any member of the management or staff of a hospital with
any woman in that hospital
Hidden Content.
Purchase
thedeceitfully
Full Book
in Rs.
350/caused
by a man
inducing
a belief
of lawful
377.
Unnatural offences
493.
Cohabitation
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
498a. Husband or relative of husband of a woman subjecting her to cruelty
509.
Word, gesture or act intended to insult the modesty of a woman
510.
Misconduct in public by a drunken person
Important Signs of Obstetrics and Gynaecology
Bagel sign:
Ultrasonographic sign. Gestational sac in the adnexa with hyperechoic ring
Hidden Content.
Ball Sign:
Purchase the Full Book in Rs. 350/Radiological sign of intrauterine
fetal death. X-ray shows crumpled up spine of
the fetus.
Banana Sign:
86
Ultrasound sign in open spina bifida. Shows abnormal anterior curvature of
cerebellum. Due to the associated Arnold-Chiari malformation.
Chadwick’s Sign:
Bluish hue to the vestibule and anterior vaginal wall. Seen in first trimester of
pregnancy. Cause is increased blood flow to the pelvic organs. Also known as
jacquemier’s Sign.
Cullen Sign:
Bluish discoloration of skin around umbilicus. Occurs due to intra peritoneal
hemorrhage. Seen in ruptured ectopic pregnancy.
Double Bubble Sign:
Useful in prenatal diagnosis of duodenal atresia. Duodenal atresia usually
presents with polyhydramnios and produces dilatation of stomach and first part
of duodenum
Hidden Content.
Double decidual sac Sign:Purchase the Full Book in Rs. 350/Normal Ultrasonographic appearance
of intrauterine gestational sac. Seen as
two concentric echogenic rings separated by a hyperechoic space.
Goodell Sign:
Marked softening of the cervix in contrast to non pregnant state. Also due
toincreased blood flow.
Hegar Sign:
An indication of Pregnancy. Softening of the lower parts of the uterus enables
approximation of vaginal and abdominal fingers in bimanual pelvic examination.
Vaginal fingers are placed in the posterior fornix and abdominal hand pressed
down behind theuterus.
Jacquemier’s sign:
Refer Chadwick
SignKustner’s Sign:
Sign of placental separation. On pushing the uterus upwards does not move the
87
cord with it due to the separation.
Ladin’s Sign:
Softening in the midline of the uterus anteriorly at the junction of the uterus
and cervix. It occurs at about 6 weeks gestation
Lambda Sign:
Ultrasonographic sign seen in dichorionic pregnancies. Due to the chorionic
tissue in between the two layers of the membrane between the twins.
Lemon Sign:
Ultrasound sign in open spina bifida. Shows abnormal anterior curvature of
cerebellum. Due to the associated Arnold-Chiari malformation.
Osiander’s Sign:
Pulsations in the lateral fornix due to the increased vascularity.
Palmer’s Sign:
Content.
Regular rhythmic contractions of uterusHidden
felt as early
as 6-8 weeks . It is a sign of
Purchase the Full Book in Rs. 350/pregnancy.
Piskacek’s Sign:
Asymmetric growth occurs to the uterus in initial stages of pregnancy due to the
lateral implantation of the blastocyst. The area of implantation feels soft
compared to the other parts.
Robert’s Sign:
Radiological sign of intrauterine fetal death. X-ray shows presence of gas in the
fetal great vessels. Earliest radiological sign of intrauterine fetal death
Schroder’s Sign:
A sign of placental separation. Uterus rises up when the separated placenta
is passed downwards.
Spalding Sign:
Sign of intrauterine fetal death. Overlapping of skull bones after fetal demise.
Observed by ultrasonogram.
Stallworthy’s Sign:
88
Slowing of fetal heart rate on pressing the head down I to the pelvis and prompt
recovery on release of pressure is termed Stallworthy’s sign. This sign is
suggestive of posterior placenta praevia.
Hidden Content.
Stuck Twin Sign:
Purchase
the Due
FulltoBook
in Rs.
350/Seen in twin to twin transfusion
syndrome.
the severe
oligohydramnios
onposition
smaller twin is held in a fixed
along the uterine wall. This is called stuck
twinsign.
‘T’ Sign:
Ultrasonographic sign seen in monochromic twins. As the intertwin membrane
does not have any chorionic tissue it gives rise to ‘T’ sign in ultrasound
Imp points about rotavirus
not cultivable
no latency seen
more common cause of infantile diarrhoea
Hidden Content.
encapsulated ds RNA genomePurchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes
Incubation period 2 days
commonly effect terminal ileum
Bad smells
Musty/mousy
:
phenylketonuria
Boiled cabbage
:
tyrosinemia, hypermethioninemia
Maple syrup
:
Hidden Content.
Purchase
Book in Rs. 350/maple syrup the
urineFull
disease
Rotting fish
:
trimethylaminuria
Sweaty feet
:
isovaleric academia, glutaric academia (type II)
89
Drugs causing lichenoid eruption
Mnemonic-CNG Prices Kill Delhi People Constantly
Hidden Content.
Chloroquine
Ketoconazole
NSAIDS
Dapsone
Gold
Penicillamine
Phenothiazine
Captopril
SHOULDER JOINT
ABDUCTION
initiator : supraspinatus
next : middle deltoid fibers
upto120° :
infraspinatus
subscapularis
t.minor
Hidden Content.
120-180 : trapezius
Purchase the Full Book in Rs. 350/serratus anterior
ADDUCTORS AND MEDIAL ROTATORS:
T.major
P.major
L.dorsi ant deltoid fibers
LATERAL ROTATORS:
infraspinatus
T.minor
Strawberrys in Medicine
Strawberry tongue
kawasaki disease,scarletfever
Strawberry gums
wegener's granulomatosis
Hidden
Content.
Strawberry hemangioma
capillary
hemangioma
Purchase
the
Full
Book
in Rs. 350/Strawberry vagina in
trichomoniasis.
Strawberry skin n nasal mucosa
sarcoidosis
Strawberry nasal mass
rhinosporidiosis
Strawberry shaped skull
edward syndrome
Strawberry gallbladder
cholestrolosis
90
Energy of different types of food ingredients
Mbbsdost tip: good way to remember is to revise these values whenever you eat a
meal and discuss with your friends and family.
Dietary fiber
::
2 kcal(dnb 2013)
Dextrose
::
3.4 kcal
Glucose
::
In vitro
::
In vivo
::
Alcohol
::
7 kcal
ATP
::
7.3 kcal
Fat
::
9 kcal
Hidden Content.
Purchase
5.3 kcal the Full Book in Rs. 350/on www.mbbsdost.com/funnotes
4 kcal
4 kcal Protein
All values per gram
Extra malarial uses of chloroquine
Mnemonic - REDLIp
©
Discoid lupus
erythromatous
Hidden
Content.
©
Rhematoid arthrithis
©
Lepra reaction
©
Extra intestinal ameobiasis
©
Infectous mononucleousis
Medical HUTCHINSONS
1. HUTCHINSONS FRECKLES
:
Lentigo maligna.
2. HUTCHINSONS PUPIL
:
Blown
pupil
uncal
Purchase
theinFull
Bookherniation.
in Rs. 350/-
3. HUTCHINSONS TEETH
:
Congenital
syphilis.
4. HUTCHINSONS SIGN
:
Herpes Zoster Opthalmicus.
5. HUTCHINSONS TRIAD
:
Congenital Syphilis
Hidden Content.
Pleural Fluid Volumes
Normal level of pleural fluid is 5-10 ml and it can be detected in the following
investigations with the respective amount
X-ray chest PA view ... 200 ml
Hidden Content.
Purchase the Full Book in Rs. 350/X-ray chest Lateral view ... 100 ml
Ultrasound chest ... 50 ml
CT scan ... 25 ml
91
Allergy Management
Identification, treatment, and prevention of allergic responses to food,
medications, insect bites, contrast material, blood, or other substances
•
Identify known allergies and usual reaction (e.g., medication, food, insect,
environmental).
•
Notify care givers and health care providers of known allergies.
•
Document all allergies in clinical record, according to protocol.
•
Place an allergy band on client, as appropriate.
•
Monitor client for allergic reactions to new medications, formulas, foods,
and/or test dyes.
•
Hidden Content.
Purchase the Full Book in Rs. 350/Provide medication to reduce or minimize an allergic response.
Assist with allergy testing, as appropriate.
•
Administer allergy injections, as needed.
•
Instruct client to avoid allergic substances, as appropriate.
•
Instruct client to avoid further use of substances causing allergic responses.
•
Discuss methods to control environmental allergens (e.g., dust, mold, and
pollen).
•
Instruct client and care giver(s) on how to avoid situations that put them at
risk and how to respond if an ana phylactic reaction should occur.
•
Instruct client and care giver on use of epinephrine pen.
•
•
Encourage client to wear a medical alert tab, as appropriate.
Postmortem Staining
CO poisoning
:
Cherry red
HCN, Burn
:
Bright red
Nitrites, Aniline, Potassium bicarbonate
: Hidden
Chocolate
brown
Content.
Phosphorus
Asphyxia
Dark
brown
Purchase: the
Full
Book in Rs. 350/on www.mbbsdost.com/funnotes
: Bluish violet or purple
Septic abortion
:
Bronze
Refrigerated body
:
Bright pink
Mummification
:
turns from Brown to Black
92
Soft Tissue Sarcomas
•
•
Rare unusual neoplasm of soft tissues
MC site: Extremity (lower >upper) > Trunk >
Retroperitoneum >Head & Neck
• MC type: Malignant fibrous histiocytoma >Liposarcoma >Leiomyosarcoma
>Synovial sarcoma >Malignant peripheral nerve sheath tumor
• MC pediatric soft tissue sarcoma: Rhabdomyosarcoma Histopathological
Type of STS is Site Dependent Extremity
• Malignant fibrous histiocytoma >Liposarcoma Retroperitoneum
• Liposarcoma Viscera
• GIST Pathology: STS tends to grow along fascial planes, with the surrounding
soft tissue compressed to form a pseudocapsule.
• Clinical behavior of STS is determined by: Anatomic location (depth), grade &
size
• MC route of spread in soft tissue sarcoma: Hematogenous
• MC site of metastasis: Lung; Lymphatic metastasis is rare
Clinical Features:
Hidden Content.
• MC symptom of STS: Painless mass
Purchase the Full Book in Rs. 350/• Size at presentation is dependent on the location of tumor.
• Smaller tumors are located in distal extremities
• Larger tumors are detected in proximal extremity & retroperitoneum.
• Retroperitoneal STS almost always present as large asymptomatic mass
Diagnosis of Soft Tissue Sarcoma
• Core-cut or true-cut biopsy (CT or USG guided) is diagnostic
• Incisional biopsy is done if core-cut biopsy is non-diagnostic
• FNAC: To confirm or rule out presence of metastatic focus or local recurrence
• MRI: IOC for assessing extremity STS
• CECT: IOC for assessing retroperitoneal sarcoma
Treatment:
• Adequate excision + adjuvant radiotherapy with or without adjuvant
chemotherapy.
Prognosis:
• Best prognostic factor of soft tissue sarcoma: Grading
• Best prognosis is seen in: Extremity STS
• MC cause of death in STS: Metastasis; 5-year survival rate for STS (all stages):
50-60%
93
Side effects of drugs
Agranulocytosis
Clozapine
Aplastic Anemia
Chloramphenicol NSAIDs Benzene
Atropine-like Side Effects
Tricyclics
Cardiotoxicity
Doxorubicin Daunorubicin
Cartilage Damage in children
Fluoroquinolones (Ciprofloxacin &
Norfloxacin)
Quinidine
Cinchonism
Hidden Content.
Purchase the Full Book in Rs. 350/Lithium
Cough
ACE Inhibitors
Diabetes Insipidus
Disulfiram-like effect
Metronidazole Sulfonylureas (1st generation)
Extrapyramidal Side Effects
Antipsychotics (Thioridazine, Haloperidol,
Chlorpromazine)
Fanconi's Syndrome
Tetracycline
Fatal Hepatotoxicity (necrosis)
Valproic Acid Halothane Acetaminophen
Gingical Hyperplasia
Phenytoin
Gray Baby Syndrome
Chloramphenicol
Gynecomastia
Cimetidine Azoles Spironolactone Digitalis
Lobes of lungs
Key points of projection of the lungs’ low borders on the anterior and posterior
chest include the following:
Topographic line
The right lung
Parasternal
The Vth intercostal space
Midclavicular
Hidden Content.Purchase the Full Book
in Rs. 350/The VIIth rib
The VIIth rib
Anterior axillary
The left lung
-
The VIth rib
Midaxillary
The VIIIth rib
The VIIIth rib
Posterior axillary
The IXth rib
The IXth rib
Scapular
The Xth rib
The Xth rib
Paravertebral
At the level of the 11th
thoracic spinous processus
At the level of the 11th
thoracic spinous processus
94
Hidden Content.
95
Hidden Content.
96
Special Muscles
Boxer's muscle
:
serratus anterior
Muscle of marriage
:
medial rectus
Muscle of divorce
:
lateral rectus
Swimming muscle
:
pronator quadratus
Climbing muscle
:
latissimus dorsi
Red muscle
:
postural muscle
White muscle
:
extra occular muscle
Spurt muscle
:
biceps
Shunt muscle
:
brachioradialis
Tailor muscle
Hidden Content.
Purchase
the
Full Book in Rs. 350/:
sartorius
Disorders of the respiration
Disorders of the respiratory rate
Tachypnea is the increase of the respiratory rate.
Bradypnea is the decrease of the respiratory rate.
Dyspnea is the distress during breathing.
Hidden Content.
Apnea is the cessation ofPurchase
breathing. the Full Book in Rs. 350/-
Disorders of the respiratory depth
Hyperpnea is an increased depth.
Hypoventilation is a decreased depth and irregular rhythm.
Hyperventilation is an increased rate and depth.
97
Mechanism of labour:
Mnemonic - Every Decent Female I choose to Employ Rises Extremely
•
Every-Engagement
•
Decent-Descent
•
Female-Flexion
•
I-Internal rotation
•
Choose to-Crowning
•
Employ-Extension
•
Rises-Restitution
•
Extremely-External rotation
98
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99
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