Viruses - Functional binding receptor SARS Virus - Angiotensin converting enzyme-2.. measles - CD 46 and CDw150 (SLAM - Signalling Leukocytes Activating Molecule ). polio virus - CD 155.. Hepatitis C - CD 81...
Bentall's operation-aortic root aneurysm capacity of renal pelvis-7ml t/t of thyroid dermopathy-steroid tear drop bladder-extraperitoneal rupture of bladder plastibel device used in-circumcision Mc site of stricture following TURP-navicular fossa Mc site of urethral carcinoma-bulbomembranous junction pfannenstiel incision-prostate surgery polychronotropism shown by-urothelial tumour star chart used in t/t of-nocturnal enuresis IPSS score-benign prostatic hyperplasia Mc organism causing emphasematous cystitis-E.coli Mini chromosome maintenance protein useful to detect-bladder cancer Mc neoplasm of infancy-mesoblastic nephroma first uretric autotransplant done by-hardy presenting symptom of sibsons hernia-neck mass Bordels line related to which artery-renal artery Meteorism-renal trauma dietl's crisis-pelviureteric junction obstruction steinstrasse-uretric obstruction due to stone fragments in ureter
First autologous renal transplantation was performed by --> Hardy (in 1963). Its a renal autotransplantation, usually to iliac fossa for reconstructing the urinary tract.
axial length of eyeball at birth is ---% of adult eye-70% tonography-helps to determine facility of outflow of aqueous facility of aqueous outflow -0.28+/-0.05microliter/min/mmHg distant direct ophthalmoscopy done at-25cm distance Intravitreous injection of drug causing macular toxicity-aminoglycosides(gentamycin) first symptom of sympathetic ophthalmitis-photophobia first sign of sympathetic ophthalmitis -keratic precipitate critical period for development of fixation reflex-2-4 month
Property pot skull, arrow head /tufted phalanges seen in primary hyper parathyroidism Rugger Jersey spine in secondary hyper parathyroidism
Dopplers in OBG 1.Uterine artery- - A. PIH screening →persistence of diastolic notch after 20 wk B. Diagnosis of fetal hypoxia →reduced<absent <reversed diastolic flow 2.Middle cerebral artery- - A.IUGR B. Rh isoimmunisation →peak systolic velocity > 1.5 -give intrauterine transfusion 3. Ductus venosus- - Abnormal flow suggests down's along with ↑nuchal translucency & nasal bone hypoplasia
fine touch - Dorsal or posterior columns vs crude touch - Ant Spinothalamic tract M/c site of adamantinoma --> tibia diaphysis M/c site of ameloblastoma --> jaw Lipoma of corpus callosum --> Bracket calcification on skul x-ray Sturge weber syndrome --> tramline calcification
Ivermectin inhibits glutamate gated chloride channels and other ligand gated chloride channels Used in scabies Pediculosis Onchocerciasis
Koenen's tumor seen in --> Tuberous sclerosis. Periungual papules or nodules are seen. C1 & C2 best visualised by --> odontoid view. C7 & T1 --> swimmer's veiw. Egg on side or egg on string appearance --> transposition of great vessels. (on X-ray) stauffers syndrome - non metastatic hepatic dysfuntion asso vt RCC
Keshan's ds --> d/t deficiency of selenium. [Mn. Kesha n Selena] Menkes kinky hair syndrome(X linked R) --> Cu deficiency. Bosentan --> endothelial receptor antagonist used in Pul HTN. Kohler dz - navicular Perthe - femur head Scheurmann dz- ring epiphysis of vertebrae Calves dz- central bony nucleas of vertebrae Frieberg - 2nd metatarsal head Islene- 5th metatarsal head Osgood shaltter's dz - tibial tuberocity Severe 's dz- calcaneum Johanson- Larsens dz - lower pole of patella Blounts dz- Tibia Panner's dz - capitulum of elbow Preiser's Synd - Scaphoid Schmier 's Dz- Pisiform Witt' s dz- triquetrum Agati dz - trapazoid Haglund dz - calcaneus Fleischner Thiemann dz- phalanges Haas dz - head of humerus Konig' s Synd - tubular bones Wegner Synd - osteochondritis with epiphyseal seperation
MOST POTENT GLUCOCORTICOID- BETAMETHASONE LEAST POTENT GLUCOCORTICOID- CORTISONE MAX GLUCOCORTICOID ACTIVITY- DEXAMETHASONE GLUCOCORTICOID WITH MAXIMUM MINERULOCORTICOID ACTIVITY- HYDROCORTISONE SELECTIVE GLUCOCORTICOID( WITH NO MINERULOCORTICOID ACTIVITY)- METHYLPREDNISALONE, TRIAMSALONE, PARAMETHASONE, DEXAMETHASONE, BETAMETHASONE MINERULOCORTICOIDS MOST POTENT MINERULOCORTICOID- FLUDROCORTISONE MAX MINERULOCORTICOID ACTIVITY- ALDROSTERONE SELECTIVE MINERULOCORTICOID ACTION ( WITH NO GLUCOCORTICOID ACTION)- DOCA
Box shaped heart - Ebstein's anomaly vs Boot shaped heart - TOF cold spots in MI - Thallium scan vs Hot spots in MI are detected with - Tc 99 scan (technetium)
Goldenhar's syndrome : 1)Craniofacial feature - malar hypoplasia, micrognathia, malformed ear with preauricular tags. 2)Vertebral anamolies
Invasive Aspergillosis - Air Crescent Sign vs Aspergilloma - Monad sign Menicus sign - hydatid cyst of lung , intussception vs Carman meniscus sign - malignant gastric ulcer
M/c asso. cardiac anamoly with coarctation of aorta --> bicuspid aortic valve. Shone complex --> coarctation of aorta + left sided obstructive lesion (M.valve abnormality and subaortic stenosis)
Triad of wernicke's encephalopathy : 1) Confusion (global) 2) Ophthalmoplegia (3rd & 6th n. palsy and nystagmus) 3) Ataxia
Normal pressure hydrocephalus triad : 1) Dementia 2) Abnormal gait (ataxic or apractic) 3) Incontinance (urinary)
Temporal arteritis --> worsen on exposure to cold Multiple sclerosis --> worsen on exposure to heat. Triad of tuberous sclerosis : 1) Epilepsy 2) Mental retardation 3) Adenoma sebacium
Biondi ring tangles --> intracellular inclusion bodies seen in choroidal epithelial cells of the choroidal plexus. May be found in 1. Elderly with aging brains 2. Alzheimer's ds
FDA approved drugs for Alzheimer's disease : Donepezil Rivastigmine-Q Galantamine and Tacrine. Q-Rivastigmine should NOT be given with TCAs bcoz it is counter productive combination.
Constrictive pericarditis --> ventricular diastolic pressure show 'dip and plateau' pattern or 'square root sign' Also show Tapping apex or Broad Bent's sign. (apical pulse is reduced and retracts in systole)
Rickets : Craniotabes (earliest manifestation) Caput quadratum or Hot cross-bun skull Rachitic cat back Bone pain and tenderness (m/c manifestation) String of pearls deformity (phalanges and metacarpals) Windswept deformity Double malleoli sign Genu valgum (knock knee) Earliest radiological changes seen around Wrist. T/t. --> Stoss regimen virulence factors commonly asked: Protien A - Staph Aureus (binds Fc region of Igs) vs IgA proteases - Strep pneumoniae (cleaves IgA) vs Protien M - Strep Pyogenes
neural tube defect --> high acetylcholinesterase,,,,, low Pseudocholinesterase ventral wall defects --> high Pseudocholinesterase,,,,,low acetylcholinesterase
Langerhans cell histiocytosis : Electron micrscopy --> Birbeck granules in cytoplasm (tennis racket app.) Immunohistochemistry --> CD1a, CD207 (langerin)
Appearance of amyloid : Electron microscopy --> nonbranching fibrils of infinite length and diameter of 7.5-10 mm. X-ray crystallography --> cross B pleated sheet conformation.
amyloid stained by congo red. primary amylodosis _amyloid light chain ( from plasma cells) secondary amyloidosis _amylod assoc protein (from reticulo endothelial cells of liver) hemo dialysis associated_beta 2 microglobulin carpel tunnel syndrome in a longterm dialysis patient commonly due to amyloid deposition
Q fever coxiella Burnett I Epidemic typhus rick prowazekii Endemic typhus rick typhi Visceral leishmanisis Kala azar. Donovani Cutaneous leishmanisis oriental sore ___tropica Muco cutaneous leishmaniasis ___ braziliensis
Prehn's sign ---> pain relief with lifting the affected testicle, which points towards epididymitis. differentiates it from acute pain of torsion where this test is negative. Initial IOC for post cholecystectomy stricture --> MRCP Imaging method of choice for post operative biliary stricture --> PTC
Diverticulosis mainly involve left side of colon but bleeding occurs mostly from right side. (Superior mesentric A.) Dietel's crisis --> after an attack of acute renal pain, a swelling in the loin is found. Following passage of urine the pain is relieved and swelling disappears.
HLA DR 3/DR 4 - type 1 diabetes HLA DR 4 - rheumatoid arthritis HLA - B 5 - bechets syndrome HLA B27 - ankylosing spondylitis HLA B 27 - post gonococcal arthritis HLA B 27 - acute anterior uveitis HLA DQ2, DQ8 - coeliac disease HLA DR 3 - type 1 diabetes, sjogren syndrome
Wilm's tr : Pre-chemotherapy staging system --> by National wilms tr study grp. (NWTSG) Post-chemotherapy staging system --> by International society of pediatric oncology (SIOP)
Urethral Ca : M/c site --> Bulbomembranous urethra f/b penile urethra M/c histological type --> Sq. cell f/b transitional cell. Grading methods used to evaluate prognosis after SAH : 1. Hess and Hunt scale 2. World federation of neurological societies (WFNS) scale [based on GCS] ANTI dote of heparin overdose - protamine sulfate anti dote of warfarin overdose - vitamin k
Liver abscess with endopthalmitis-klebsiella(in diabetics) Primary spermatocyte-Diploid. Secondary spermatocyte-Haploid Meiosis-1 : "JUST BEFORE OVULATION ". Meiosis-2 : "SOON AFTER FERTILIZATION" Zona Pellucida-prevents further entry of spermatozoa , Aids in implantation of blastocyst COMBINED OC-pills uses : "F A C E B O O K " F-fibroids reduction. A-Acne reduction,Anemia reduction by preventing excess menstrual bleeding C-contraception,Colon cancer prevention. E-endometriosis reduction,endometrial cancer reduction. B-benign breast disease reduction O-Ovarian cancer reduction. O-Osteoporosis treatment. K- Koch's (PID-mcc is TB) reduction Uses of Progestin only Pills ( Mini Pills) : "C . D E E P T H I ". C-contraception D-DUB,Dysmenorrhoea, E-Endometriosis. E-Endometrial Carcinoma. P-Pre Menstrual Tension ( DOC-fluoxetine). T-Threatened abortion. H-HRT(hormone replacement therapy). I-Infertility treatment
Few CD's CD1a---Langerhans cell histiocytosis CD117---GIST CD15 & CD30---Hodgkin's lymphoma Langerhans cell histiocytosis --> cd1a, cd207(langerin) Granulocytic sarcoma --> cd43, MPO, lysozyme Hairy cell leukemia --> cd 103(unique), HC 2+, cd25, cd116
FACIES TYPES Mask like-parkinsonism Leonine-leprosy Mouse facies - CRF* Frog like facies-ethmoidal polyps,NP angiofibroma.. Gargoyle facies - Hurler's syndro Meflat facies - Down's syndrome Moon face- Cushingoid facies Ashen Grey facies - Myocardial infarction* Potter facies-Oligohydromnia
GOODPASTURE SYNDROME 1.Triad of Diffuse pulmonary hemorrhage+rapidly progressive glomerulonephritis+anti-GBM antibodies(90%cases). 2.Type 2 hypersensitivity,HLA-DR2. 3.Antibody against - alpha-3 NC1 domain of collagen IV(Chromosome 2). 1/3rd patients with anti-GBM glomerulonephritis have no evidence of lung injury. 4.C/F-hemoptysis,dyspnea,anemia,fever,hematuria. 5.Xray- Diffuse alveolar damage,B/L Infiltrates. 6.Gold standard – Biopsy-Focal/segmental necrosis,Crescent formation in Bowman’s space 7.Immunoflourescence- Linear IgG and C3, 10-15% cases P-ANCA positive.Normal complements. 8,The diffusion capacity of carbon monoxide is markedly increased. Poor Prognosis – (a)>50%crescents on biopsy,(b)serum Creatinine>5-6mg/dl(c)Oliguria. 9.TT-8-10 treatments of Plasmapheresis+oral prednisolone and cyclophosphamide in first 2 wks 10.After tt Antibodies should fall in 6 months
RMP is mainly determined by effluent of k ions RMP in skeletal & cardiac muscle -90 mv, Smooth muscle -50 mv, SA node -60 mv, Nerve finer layer -70mv 1. Omphalitis -> Lekocyte Adhesion Deficiency (CD 18 deficiency in integrins) Gigantic Granules in Neutrophils -> Chediak-Higashi Syndrome (microtubules disorder-> no degranulation bc of failure of phagolysosomes formation) Recurrent Candida albicans Infections -> Myeloperoxidase Deficiency (immunodeficiency) Nitroblue Tetrazolium test NEGATIVE (yellow=abnormal=negative test) -> Chronic Granulomatous Disease (NADPH oxidase deficiency, no respiratory burst, catalase+ recurrent infections)
* Li-Fraumeni syndrome is characterized by: wide variety of cancer types. young age at onset of malignancies. potential for multiple primary sites of cancer. * The following 3 criteria must be met for a diagnosis A proband diagnosed with sarcoma when younger than 45 years A first-degree relative with any cancer diagnosed when younger than 45 years Another first-degree or second-degree relative of the same genetic lineage with any cancer diagnosed when younger than 45 years or sarcoma diagnosed at any age * Wide range of malignancies, with particularly high occurrences of breast cancer, brain tumors,acute leukemia, soft tissue sarcomas, bone sarcomas, and adrenal cortical carcinoma.
Most Common facts about infectious diseases 1. Most common cause of septic arthritis in a person less than 40 years old = Gonococcus 2. Most common cause of osteomyelitis in general population = S. aureus 3. Most common cause of osteomyelitis in Sickle Cell patients = Salmonella 4. Most common cause of osteomyelitis due to nail-puncture wounds = Pseudomonas (V.Imp!) 5. Most common parasitic infection of the brain = Neurocysticercosis
Cluster headache severe unilateral pain, often orbital lacrimation, red eye, nasal congestion + rhinorrhoea occasionally ptosis + horner’s syndrome 1 or more per day, for several weeks, then subside before recurring patient is restless, affects men>women (6x), alcohol may be trigger Acute —> 100% oxygen, sumatriptan Long term —> verapamil, lithium
Picrotoxin --> Inhibits presynaptic inhibition. Local anasthesia do not affect presynaptic inhibition. Weber Fechner law --> magnitude of sensation felt is proportionate to the 'log of intensity' of the stimulus. Thrombosthenin --> contractile protein found in platelets. It helps platelets to contract during clot formation. Other contractile proteins found in platelets are Actin and Myosin.
Thrombin inhibitors in normal plasma 1. Antithrombin ||| (m/imp) 2. Alpha2 macroglobulin 3. Heparin cofactor || 4. Alpha1 antitrypsin
Siggard-Anderson curve normogram --> used to plot Acid-Base characteristic of arterial blood. PCO2 on vertical axis, pH on horizontal axis. Apparent mineralocorticoid excess --> d/t inhibition or absence of 11 B hydroxysteroid dehydrogenase type 2. HIV detection : 1) nucleic acid test --> +ve in 12 days 2) p24 Ag test -------> +ve in 16 days 3) Ab test ------------> +ve in 22 days. M/c/c of Larva migrans : Cutaneous --> Ankylostoma braziliense & A.caninum. Visceral -----> Toxocara canis.
Sherrington's law of reciprocal innervation --> Increase flow of innervation to the contracting ms is accompanied by decreased flow of innervation(reciprocal inhibition) to the antagonistic ms. Herring's law of equal innervation --> Equal and simultaneous innervation flows from the brain to a pair of yolk ms. Ophthalmoplegic migrain --> Headache asso. with 3rd, 4th, & 6th N palsy. Part of sarcomere which remains constant during skeltal muscle contraction-----A band Cystoid macular edema : Ophthalmoscopy --> honeycomb app of macula Fundus flourescein angiography--> Flower petal app.
Pathergy phenomenon Pathergy phenomenon is most commonly described in pyoderma gangrenosum and Behcet's disease, and is also noted in some cases of sweet's syndrome and subcorneal pustular dermatosis. Heavy neutrophlic infiltrates or pustular reaction that develop at the site of non-specific trauma are termed as pathergy phenomenon. Pathergy phenomenon is tested by the pathergy test, and it refers to the development of a new lesion at the site of eliciting the test. An erythematous papule of more than 2 mm at the prick site with a 20-22-gauge needle (to avascular skin obliquely to the depth of 5 mm following an intradermal injection of 0.1 ml of normal saline) is called as a positive pathergy test. Positive pathergy is regarded as one of the minor criteria for the diagnosis of Behcet's disease by the International Study Group Diagnostic criteria for Behcet's disease. Meirowsky phenomenon Meirowsky in 1909 discovered that pieces of fresh human skin showed irreversible darkening of the epidermal melanin if heated. This type of heat darkening came to be known as the Meirowsky phenomenon. Meirowsky phenomenon is among the first responses of human skin to ultraviolet (UV) exposure. It is also called as immediate pigment darkening (IPD). IPD is more pronounced within a few hours of sun exposure, and is due to metabolic changes coupled with the redistribution of melanin already present in the skin. The phenomenon is seen after exposure to long-wave UVB, UVA and, to some extent, visible radiation. IPD is not photo protective as it does not lead to a hardening effect as seen in delayed tanning
Mauserung phenomenon In 1937, Siemens reported a family with features similar to, but distinct from, bullous congenital ichthyosiform erythroderma of Brocq (BCIE). This variant has been termed ichthyosis bullosa of Siemens (IBS), and has been reported to be distinguished clinically from BCIE by the absence of erythroderma, localization of dark grey hyperkeratosis to the flexural sites and areas of peeling of the skin among hyperkeratotic areas known as the "mauserung" phenomenon. A distinctive characteristic of IBS, which is not present in the other forms of ichthyosis, is called the "mauserung" phenomenon (mauserung is German for "moulting"). These are small patches of bare, apparently normal skin (due to regeneration of the epidermis) in the middle of areas of hyperkeratosis
Lubiprostone --> used for chronic constipation. Act by 1. Stimuating Cl- channel opening in the intestine 2. Increasing liquid secretion in gut 3. Decreasing transit time.
The manta ray sign is a radiographic appearance in bladder exstrophy. It describes wide midline separation of the pubic bones simulating the appearance of a manta ray swimming towards you 1. The smooth arc of the pelvis outline in bladder exstrophy is in contrast to acquired separation of the pubic symphysis seen in open book pelvic injuries.
Fishtail deformity of the elbow is characterised by a contour abnormality of the distal humerus, which develops when the lateral trochlear ossification centres fails to develop or resorbs. It is an uncommon complication usually following a distal humeral fracture in childhood. Whilst initially presumed to be a benign condition, long-term follow-up suggests that patients with fishtail deformity are prone to: functional impairment ongoing pain and the development of early osteoarthrosis.
