PART 3 …PEARLS
☆¤Haemorrhages
¤Extradural haemorrhge=middle minengeal artery
¤subdural haemorrhage =diploic vein
¤subarchnoid haemorrahge=rupture on berry aneursm
☆tennis ball injury to eye=circulis iridis major
☆epistaxis=sphenopalatine artery
☆during tonsilectomy= para tonsillar vein,tonsillar and ascending palatine artery
☆tracheostomy=isthmus and inferior thyroid vein
☆heamoptysis=bronchial artey
☆gastric ulcer=left gastrc and splenic artery
☆dudenal ulcer=gastrodudenal artery
☆hemmorhoids=submucosal rectal venous plexuses formed by superior rectal vein and inferior rectal vein
☆retropubic proastatectomy=drsal venous plexuses
¤¤
☆Turner = 45XO
☆KF= 47XXY
☆True hermaphrodite =XXy
☆peudohermaphrodite =46Xy or 45X
¤¤Mole
☆complete hydatidfm mole -46XX
☆partial mole -69XXy
¤¤¤Chromosomes n Dna both replicate in interphase
¤Studied in Metaphase
¤¤¤¤Trisomy
21 > Down syndrome
13 > Ptau
18 > edvert
16 > spontaneous abortion
¤¤¤ Lumber Pucture
☆Most common loccation ==L4L5
☆LP Best Site ====above L4
☆IF pt e miningitis LP site ===below L3
¤¤¤Epidural anesthesia ==L3-4
☆widest epidural space > L2
☆Cauda Equina (CHILDren) === L3
☆Conus medullaris (Adult) = L1
☆Subarchnoid space == S2
☆Chorea > caudate
☆Athetosis > putamen
☆Pco2 rises upto 12mmhg in first minute of apnea
☆ Increased alpha feto protein plus increased albumin = Anencephaly.
☆Vitamin A prevents squamous cell carcinoma.
☆Right border of heart is made by right atrium.
☆Right border of heart on XRAY made by SVc +Rt Atrium
☆ Trephine biopsy Indicates = aplastic anemia > ALL.
☆In anesthesia halothane is always given with Nitric oxide.
☆Most diagnostic test for TB = PCR > AFB > Caseous.
☆Down syndrome occurs 1/100.
☆Common genital vesicle is herpes simplex virus.
☆Inferior orbital fissure contents are maxillary nerve and its zygomatic branch, inferior ophthalmic vein and sympathetic nerves and this fissure communicates with pterygo palatine fossa.
☆Superior orbital fissure communicates with middle cranial fossa and it transmits lacrimal nerve, frontal nerve, trochlear nerve, oculomotor nerve, abducent nerve, nasociliary nerve and superior ophthalmic vein.
☆Thyroid is the only endocrine gland that stores its secretions outside the cell.
☆Sensations from the tip of nose are carried by ophthalmic division of trigeminal nerve.
☆Tensor tympani is supplied by mandibular division of trigeminal nerve.
☆Stapedius is supplied by facial nerve.
¤¤Nucleus raphe synthesize serotonin.
¤¤ Locus Ceruleus = Nor epinephrine.
☆At term CRL = 36 cm and CHL = 50 cm.
¤¤CRL used b/w 7 – 14 weeks.
☆☆BPD is used 16 – 30 weeks.
☆Sperm life in genital tract is 24 to 72hours.
¤¤¤Active ===24- 48hrs
¤2nd most common cause of osteoporosis in old age is Cushing syndrome.
¤Prenatal chromosome is detected at 14 -18 weeks.
¤Bronchial asthma plus hypertensive patient > Best drug Verapamil.
¤Aphasia and facial nerve palsy > damage to middle meningeal artery.
☆Diabetic plus hypertensive patient > Best drug Captopril.
☆Inferior wall MI > Right marginal artery block.
☆ Epidermis of partoid gland is derived from ectoderm.
☆To kill spores of surgical instrument > moist heat at 160 C for 1 hr.
☆Food poisoning caused by Staph. Aureus is through entertoxin.
☆Least positive value for Widal is 1:120.
☆Trigeminal ganglion is completely covered by dura.
☆ Tactile sensation is carried by dorsal white column to medial leminiscus.
☆ Anti HBcAg = positive window period.
☆MAP = diastolic +1/3 pulse pressure.
☆ Insulin secretion is inhibited by beta blocker.
☆Increased By Glucagon
☆Highest triglyceride =Chylomicrons >VLDL > Chylomicrons remanents
☆Highest cholesterol = LDL.
☆ Highest lipoprotein = HDL.
☆ Which is not a phospholipid = Plasmalogen.
☆ Best way to check bone density is the scan of spine.
☆End break down of glucose is pyruvate.
☆☆In pre eclamptic patient hydralazine is the drug of choice before surgery.
☆In down syndrome: Triple test (alpha feto protein is decreased, b-HCG is increased and estriol is decreased) and if we add up inhibin which is increased then it will be called as .
☆Bar body diagnostic for Tuners syndrome
☆scant bodies in KF
☆PLAP (Placental Alkaline Phosphatase) is a tumor marker in seminoma and ovarian carcinoma.
☆Tubo ovarian abscess by IUCD – most causative agent is Actinomycosis.
☆Major intracellular buffer is Hb.
☆ DVT more common in popliteal vein but pulmonary embolism is through femoral veins.
☆Investigation of DIC D-dimers, FDPs, Platelet count and PT (except clotting time).
☆Referred pain:
¤¤Cervix S2-S3
¤ Ovary -T10-T11
¤Testis -T10
¤ Umbilicus -T10
¤Kidney T12-L2.
☆Trimethoprim (co-trimoxazole ) side effect > megaloblastic anemia plus leukopenia.
☆ Sacrospinous ligament does NOT contribute in wall of perineum.
☆ Lesser omentum connects with duodenum.
“☆Sphincteric urethra is known as external urethral sphincter and is supplied by pudendal nerves where as internal os is supplied by inferior hypo gastric plexus.
☆Nerve supply of rectum is hypogastric plexus.
☆Uterine tube is 10 cm long.
“☆Urachal cyst is the remanant of allantois.
☆Thyroid gland is derived from endoderm.
☆Thymus and inferior parathyroid develops from 3rd branchial pouch.
☆Superior para thyroid is developed from 4th brachial pouch.
☆ Diaphragmatic hernia occurs due to absence of pleuro peritoneal membrane.
☆Superior thyroid artery is related to external laryngeal nerve which supplies posterior cricothyroid muscle of larynx. Injured during Thyroidectomy
☆Inferior thyroid artery is also related to recurrent laryngeal nerve which runs b/w trachea and esophagus and its most common injury is in Traceostomy.
☆ In papillary carcinoma of thyroid > it occurs in young age and involves cervical lymph nodes.
☆ Tracheostomy is done at 2nd tracheal ring by pulling the isthmus inferiorly.
☆ Nonfunctional nodule or cold nodule has high chances of malignant transformation.
☆Erythropoiesis in middle trimester is in the liver.
☆ Levator ani muscle is supplied by L2, L3 & L4.
☆Defect in Bulbus Cordis results in VSD, hypertrophy of Right ventricle, congenital cyanosis, transposition of great vessels (but not ASD)
☆Endocardial cushion is important for the formation of four chambers of heart.
☆Thirst is least stimulated by blood pressure.
☆Important hormone involved in gluconeogenesis is Cortisol.
☆Apoptosis is inhibited by bcl-2 inhibition.
☆Apoptosis ~ Actuvation of caspases
☆Low serum complement in SLE.
☆C3b & IgG are Opsonins
☆C5a is chemotactic protein.
☆ Urea is an important indicator for muscle protein loss.
☆ESR is decreased when albumin is increased.
☆ESR increased during Infection
” Drug which does not cause gynecomastia is Androgen & drugs which cause gynecomastia are Digoxin, Girsoefulvin, Cimetidine, Androgens, Spironolactone and Ketoconazole.
☆Tx of hirstuism is Cyproterone Acetate.
☆Pyruvic acid is intermediate from glucose to acetyl coA.
☆Epinephrine .nor epinephrine & dopamine are derived from tyrosine.
☆End product of Purine is Uric acid.
☆RBCs have glycolytic enzyme activity.
☆End product of glucose gives 2 Pyruvate.
Alanine should be taken in diet.
☆Cisplatin is more notorious to cause renal toxicity.
☆Dysplasia is seen in epithelia.
☆MRNA has a codon.
☆HSV is associated with vulvar papules.
☆Wart on the lateral wall of introitus it is caused by HPV.
☆Plaque like lesion on posterior superior wall of vagina is squamous cell carcinoma.
☆ German Measles causes Congenital Cataract.
Anterior abdominal wall swelling with umbilical cord attached to it in a new born baby is known as Omphalocele.
☆Beta-lactam acts on the Cell Wall.
¤¤¤ ATT Drugs
☆Streptomycin=== ototoxity.
☆Isoniazid ==Hepatotoxicity.
☆Pyrazinamide == Gout
☆Rifampacin=Orange red color urine
☆ Opportunistic organism ~E. Coli Kleibeslla
☆Pseudomembranous colitis is caused by C. difficile.
☆Most common organism involved in gynecological & abdominal procedures is Bacteriods .
☆Vulvular itching = Chlamydia
☆ fish like smell; Bacterial Vaginosis.
☆ Vitamin K dependent: Factors 2, 7,9,10, Protein C, Protein S, Fibrinogen and Prothrombin.
☆Intrinsic and Extrinsic pathways of coagulation converge at factor 10.
☆Threonine does not contain Sulfa group.
☆Autosomal dominant is hereditary Spherocytosis & Poly cystic kidney disease.
☆Lens opacity causing drugs >Chlorpromazine, Amidarone, Tamoxifen, Gold & Iron toxicity.
☆Drugs causing corneal opacity > Amiodarone, Chloroquine, Mepacrine & Copper.
☆ Ribosome have purple color on Eosin & Methylene blue staining
☆High energy content > Starch.
☆High energy compound > ATP
☆Antidote of warfarin is vitamin K but if action is more quickly required then FFP.
☆Olfactory cells are the only neurons in the body that regenerates.
☆Projectile vomiting greenish in color means bilious vomiting so it is due to duodenal atresia but if projectile vomiting non bilious then it is hypertrophic pyloric stenosis.
☆ Pulmonary trunk relation with the bronchus at the hilum of the lung-mnemonic is RALSR- Right Anterior & Left Superior.
☆Rhino sinusitis is caused by Strep Pneumonia, H. Influenza, M Catarrahalis.
☆ Homan’s sign is present in DVT in which if you dorsiflex the foot there will be pain in calf muscles.
☆ Classic triad of Pulmonary Embolism: –
☆☆Neurological manifestations.
-Petechial rash.
-Hypoxemia.
☆Nitrogen bubbled precipitator in ascending divers and can be treated with hyperbaric oxygen.
☆CT pulmonary angiography is the best test to detect Pulmonary Embolism.
☆The most common infectious agent transmitted by blood transfusion is cytomegalovirus (CMV), which is present in donor lymphocytes.
☆Before blood is transfused into newborns or patients with T-cell deficiencies, it must be irradiated to kill donor lymphocytes. This prevents the patient from developing a graft-versus-host reaction or a CMV infection.
☆Yersinia enterocolitica, a pathogen that thrives on iron, is the most common contaminant of stored blood.
☆ Iron is stored in bone macrophages.
☆ Structures passing thru superior orbital fissure….
NOT-FAL
¤NASOCILLIARY¤OPTHALIMIC VEIN¤TROCHLEAR¤FRONTAL
☆☆Suture Removal:
¤Head 5-7days
¤Face 3-5days
¤Eyelid & eyebrow 3-5days
¤Trunk 5-7days
¤Extremities 7-10days
¤Surface of joint 10-14days
¤Hand ==7days
☆☆Absorption
☆iron nd divalents absorb in duodenum.
☆Folic acid, maximum water, max electrolytes, long chain fatty acids in jejunum.
☆Bile nd B12 absorb in ileum.
☆water nd electrolytes absorb in colon but less than jejunum. Short chain fatty acids absorb in colon.
¤¤Buffers
☆Major intracellular buffer is protein.
☆Major extracellular buffer is bicarb.
☆If only major buffer asked then Bicarb.
☆Major renal buffer is still bicarbonate if depleted theb
¤Phosphate ==Qualitative
¤Ammonia == Quantitative
☆Buffer in blood is H2co3 > Hb
¤¤Uterus
☆Uterosacral felt on PR
☆Main support is cardinal(also named transverse cervical ligament )
☆Round ligament of uterus keeps it anteverted anteflexed
☆broad ligament has very lessor role in support
☆Best way to “measure” gfr is inulin clearance.
☆best way to “estimate” gfr is creatinine clearance.
☆best way to “clincally” measure gfr is creatinine clearance.
☆best way to measure renal plasma / blood flow is PAH .
☆best test for renal falilure is creatinine clearance.
☆☆☆☆ blood transfusion
Part 4: Next Page
