Hide Mazgine - MBBSdost.com
Transcription
Hide Mazgine - MBBSdost.com
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, FMGE, USMLE, all state medical PG entrance exams in India and abroad. Online Test Series at mbbsdost.com Key Features -More than 260 tests -Detailed Explanations and Answers -All India ranking -More than 10 thousand questions Join anytime, Give test anytime, See explanations many times Special Membership available for 1st Year MBBS students 2nd Year MBBS students 3rd Year MBBS students 4th Year MBBS students MBBS Interns/Passouts To join visit www.mbbsdost.com today or Call - 09953578794 to get telephonic guidance 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. No part of this book may be reproduced, or transmitted in any form or by any means, electronic or mechanical, including photocopy without written permission from the publisher Online Coaching at mbbsdost.com Online Coaching at mbbsdost.com Special Courses available for 1st Year MBBS students 2nd Year MBBS students 3rd Year MBBS students 4th Year MBBS students MBBS Interns/Passouts Save Time, Save Money, Learn More... New Batches Starting Every Month To Join Visit www.mbbsdost.com today or Call : 09953578794 to get Telephonic Guidance 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 www.mbbsdost.com/funnotes 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) Hidden Content. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/Zentmeyer line (Scheie’s Line) = on the equatorial surface of the lens on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 Hidden Content. Purchase the Full Book in Rs. 350/remnantson of www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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, www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 Purchase the Full Book in Rs. 350/- 32. Cause of fevers (>103°), headaches; macular Salmonella typhi on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/Diphyllobothriasis (fish 57. Abdominal pain, bloating, altered appetite tapeworm) after ingestion of sushi. CBC: megaloblastic on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 Purchase the Full Book in Rs. 350/months, Anti-HBs (-), Anti-HBc IgG (+), HBeAg ( - ) , p e r s i s t e non t l y www.mbbsdost.com/funnotes 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 FunNotes at http://www.mbbsdost.com/funnotes 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 PurchaseVirus 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 Purchase the Full Book in Rs. 350/human immunodeficiency virus infection. • Bitot’s spot : White, foamy area of keratinising squamous metaplasia on www.mbbsdost.com/funnotes 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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full inremnant Rs. 350/Mittendorf’s dot : whitish spot at posterior lensBook surface, of hyaloid artery. on www.mbbsdost.com/funnotes • 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 Purchase Book in Rs. 350/body of stomach of gastric carcinoma (in barium meal the Full follow through) is on www.mbbsdost.com/funnotes Chronic duodenal ulcer with Trifoliate duodenum scarring (Barium Meal) Peptic ulcer Hour Glass stomach Volvulus of stomach Cup & Spill / Cascade stomach 12 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase Full Book in Sphingomyelinase Rs. 350/Nieman-Pick Disease : Acutethe Respiratory Disease: deficiency Sphingomyelin accumulation hepatosplenomegaly, mental on www.mbbsdost.com/funnotes 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 Purchase the(Indole Full Book Tryptophan group) in Rs. 350/on www.mbbsdost.com/funnotes Arginine 10. Knoop test Histidine 11. Lead sulfide test Cysteine and cystine 12. Sullivan and McCarthy test Methionine 13. Isatin test Proline 14 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 Hidden Content. Reducing monosaccharide (vs disaccharide) Purchase the Full Book in Rs. 350/Ketoses (vs aldoses) on www.mbbsdost.com/funnotes 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. Hidden Content. Bile pigment Purchase the Full Book in Rs. 350/Fouchet test Bile pigment on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 Hidden Content. Purchase theWorld FullEnvironment Book inDay Rs. 350/International Day against Drug abuse on www.mbbsdost.com/funnotes and Illicit trafficking 1st July Doctors Day th World population Day th World hepatitis Day 11 July 28 July st 1 week of August World Breast feeding week th 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 th World anaesthesia Day th 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 Medical FunNotes at http://www.mbbsdost.com/funnotes Differences-Mrasmas and Kawashiorkor Mnemonic (WE-HALFFS ) Marasmus Kawashiorkor W-weight <60% >60% E-edema Absent Present H-hair changes A-apetite L-look Hidden Content. Absent Present Purchase the Full Book in Rs. 350/Present Absent on www.mbbsdost.com/funnotes 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 Full Book in Rs. 350/Medicines called antacids are taken to prevent heartburn, reflux and on www.mbbsdost.com/funnotes 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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Hidden Content. Recurrent shoulder dislocations STRYKERS VIEW Purchase the Full Book in Rs. 350/CERVICAL INTERVERTEBRAL FORAMEN OBLIQUE VIEW on www.mbbsdost.com/funnotes 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.) on www.mbbsdost.com/funnotes height in cm 2 weight in kg abdominal pregnancy Medical FunNotes at http://www.mbbsdost.com/funnotes 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 Book Boston's criteria on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Purchase the Full Book Rs. 350/Milkers node : paravaccinia on www.mbbsdost.com/funnotes Vagabond disease : pediculosis corporis Carrion’s disease Buruli ulcer : Mycobacterium ulcerans Coconut cake rectum : trichuris Pseudohemoptysis : Serratia Walking pneumonia : Mycolplasma Pontiac fever : Legionella Medical FunNotes at http://www.mbbsdost.com/funnotes 19 Canicola fever : Leptospira Duncan’s disease : EBV Red diaper syndrome Haverhill fever Sudoku fever HiddenSerratia Content. : marcesans Purchase the Full in Rs. 350/: ratBook bite fever on www.mbbsdost.com/funnotes : 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 Book in Rs. 350/Salt and pepper appearance of chromatin is seen in Small Cell Carcinoma lung on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes Named ulcers Rodent ulcer : basal cell carcinoma Hiddencell Content. squamous carcinoma Purchase the Full Book in Rs. 350/micro aerophilic streptococci on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 theheight Full by Book in of Rs.age, 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. www.mbbsdost.com/funnotes 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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 seen in lightening. the Full Book in Rs. 350/- on www.mbbsdost.com/funnotes 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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes Streptobacillus monoliformis Oroya fever Bartonella bacilliformis (Carrion’s disease) Q fever Coxiella burnetti Purpuric fever 30 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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) on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes : 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. : on www.mbbsdost.com/funnotes 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 : Medical FunNotes at http://www.mbbsdost.com/funnotes Femoral triangle: arrangement of contents Nerve (directly behind sheath) A rtery (within sheath) Hidden Content. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes : Baldness of tongue : Painful tongue Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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) on www.mbbsdost.com/funnotes Har Taraf Ussi Ka Chehra (Hallucinations) Gulabi Gaal (Plethora) Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes Leuokdystrophy N-acetly-aspartic acid Metachromatic Leukodystropy arylsulfatase A 44 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes Sweet free urine Isovaleric Acidemia Glutaric Acidemia Cat’s Urine Smell 3-Methylcrotonyl-glycinuria Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes (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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 muco- polysaccharidoses (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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 22. Monkey facies- marasmus The “monkey facies,” caused by loss of the buccal fat pad, 56 Medical FunNotes at http://www.mbbsdost.com/funnotes 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) on www.mbbsdost.com/funnotes 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) Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase Full irregularly? Book in Rs. 350/Have you noticed your heart racingthe or beating onwithout www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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? Purchase the Full Bookofin 350/Has your bowel habit changed recently? (Carcinoma theRs. colon) on www.mbbsdost.com/funnotes 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? Medical FunNotes at http://www.mbbsdost.com/funnotes 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) Purchase the Full Book in Rs. 350/- Have you noticed any lumps under your arms, or in your neck or groin? on www.mbbsdost.com/funnotes (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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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) Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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? Medical FunNotes at http://www.mbbsdost.com/funnotes 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? on www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes Coal miners pneumoconiosis and silicosis Timber workers asthma Electronic workers berylliosis Healthcare workers needle-stick HIV, hepatitis B, tuberculosis (TB) 62 Medical FunNotes at http://www.mbbsdost.com/funnotes 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) on www.mbbsdost.com/funnotes Hepatomegaly (fatty liver, chronic liver disease) Chronic liver disease (alcoholic hepatitis, cirrhosis) and associated complications Cancer (oesophagus, cardia of stomach, liver, pancreas) Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes 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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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 the Full Bookandinalso Rs.upset 350/equilibrium are also very important for the onset of coma. Coma may occur ongradually, www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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). Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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, www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes blood estrogen level, Causing vasodilation & I look PINK. MORAL : there is medicine in love as well. Medical FunNotes at http://www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes Symptoms of Senile cataract... Mnemonic - "LIC BUG" L-Loss of vision, I-Image blur, C-Colored halo, Hidden Content. B-Black spots, Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 Purchase the Full Book 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 Purchase the Full Book in Rs. 350/Mayos operation hiatus hernia on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes Carboprost-mid term abortion, postpartum haemorrhage Dinoprost- mid term abortion. 80 Medical FunNotes at http://www.mbbsdost.com/funnotes Mydriatics Mnemonic -PATCH P - Phenylephrine A - Atropine T - Tropicamide Hidden Content. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. Hidden Content. Purchase 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes the fetus. Banana Sign: 86 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes Rotting fish : trimethylaminuria Sweaty feet : isovaleric academia, glutaric academia (type II) Medical FunNotes at http://www.mbbsdost.com/funnotes 89 Drugs causing lichenoid eruption Mnemonic-CNG Prices Kill Delhi People Constantly Hidden Content. Chloroquine Ketoconazole Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes Strawberry skin n nasal mucosa sarcoidosis Strawberry nasal mass rhinosporidiosis Strawberry shaped skull edward syndrome Strawberry gallbladder cholestrolosis 90 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes © Lepra reaction © Extra intestinal ameobiasis © Infectous mononucleousis Purchase the Full Book in Rs. 350/- Medical HUTCHINSONS 1. HUTCHINSONS FRECKLES : Lentigo maligna. 2. HUTCHINSONS PUPIL : Blown pupil uncal Purchase theinFull Bookherniation. in Rs. 350/- 3. HUTCHINSONS TEETH : on www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes Ultrasound chest ... 50 ml CT scan ... 25 ml Medical FunNotes at http://www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes 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. on www.mbbsdost.com/funnotes • 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% Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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 Medical FunNotes at http://www.mbbsdost.com/funnotes Hidden Content. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes Medical FunNotes at http://www.mbbsdost.com/funnotes 95 Hidden Content. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes 96 Medical FunNotes at http://www.mbbsdost.com/funnotes 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 on www.mbbsdost.com/funnotes 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/- on www.mbbsdost.com/funnotes 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. Medical FunNotes at http://www.mbbsdost.com/funnotes 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 Hidden Content. Purchase the Full Book in Rs. 350/on www.mbbsdost.com/funnotes Medical FunNotes at http://www.mbbsdost.com/funnotes Form To Order / Pre-book Medical FunNotes Name : .......................................................................... Mobile No : .......................................................................... Email : .......................................................................... Postal Address : .......................................................................... .......................................................................... State : ............................... Pin Code : ......................... Please tick the Volumes You Want to Purchase or Pre-Book Quantity Volume - 1 (Rs. 350/-) Volume - 2 (Rs. 400/-) Volume - 3 (Rs. 500/-) To get details of these volumes Visit www.mbbsdost.com/funnotes You May select one or more Volumes Your friends may photocopy this form Payment Mode : Cheque/DD in fovour of Vinay Heartbeat Education Pvt. Ltd. Payment at New Delhi Cheque / DD No. : Bank Name & Branch : Send this form along with DD/Cheque to Dr. Vinay Yadav House No.-94, Block-A, Nasirpur Colony, New Delhi-110045 Medical FunNotes at http://www.mbbsdost.com/funnotes 99 Courses & Services offered at Online test Series & Online Coaching Separate Memberships for Medical FunNotes College Study Groups Medico Talent Hunt Medical Knowledge War Medical Websites Free Clinical Training Medinotes 100 1st Year MBBS students 2nd Year MBBS students 3rd Year MBBS students 4th Year MBBS students MBBS Interns/Passouts Medical Discussions Medical Jobs Work with us Medical Conferences/Events Medical Associations Medical Friends Medical FunNotes at http://www.mbbsdost.com/funnotes Free Medical Alerts Via Whatsapp Only for Medical Students & Doctors For Detail Visit www.mbbsdost.com/whatsapp Free Clinical Training Program To teach basic clinical skills to medical students mbbsdost.com plans to start free clinical training programs at every medical college in India. See details at www.mbbsdost.com/clinical College Study Group An effort of mbbsdost.com to promote medical learning at the level of medical colleges. See details at www.mbbsdost.com/college USMLE-Step-1 Online Coaching We provide complete guidance and online coaching for USMLE step 1 exam for medical students wishing to do their post graduation from USA. Minimum Qualification Required MBBS 2nd year For Details Visit www.mbbsdost.com/usmle Releasing in October 2014... Medical FunNotes Volume-2 For Last minute revision before AIPGMEE, 2014 with more than 2000 high yielding point from all subjects Also releasing in October 2014... Medical FunNotes Volume-3 A Collection of more than 200 images To help students in solving image based questions asked in exams like AIPGMEE, AIIMS-PG, DNB-CET etc. See the form inside to pre-book your copies of Volume-1, 2, 3 Today For enquires call +91-9953578794 or Email : mbbsdost@gmail.com Website : www.mbbsdost.com/funnotes