MNEMONICS for Su re S uccess in
PG M edical Entra nce Examinations Second Edition
Presents 600
high quality mnemonics
Enhances quick
recall and recollection of high value facts
“cutting-edge” Provides
technique in remembering “long-winding” statements/particulars/facts
Packsmnemonics
that count
600 Presents
high quality mnemonics
quick Enhances
recall and recollection of high value facts
“cutting-edge” Provides
technique in remembering “long-winding” statements/particulars/facts
Packsmnemonics
that count
MNEMONICS for Su re S uccess in
PG M edical Entra nce Examinations Second Edition
Arun Kumar MBBS DNB(s)
CBS Publishers & DistributorsPvt Ltd New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai Hyderabad • Nagpur • Patna • Pune • Vijayawada
Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The author has tried his best in giving information available to him while preparing the material for this book. Although, all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible that some errors might have been left. The publisher, the printer and the author will not be held responsible for any inadvertent errors or inaccuracies.
MNEMONICS for Sure Success in PG Medical Entrance Exam inatio ns
ISBN:
978-93-85915-33-8
Copyright © Author and Publisher
First Edition: 2015 Second Edition: 2016 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the author and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for Pvt Ltd CBS Publishers & Distributors 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India. Ph: 23289259, 23266861, 23266867 Website: www.cbspd.com Fax:011-23243014 e-mail:
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To my elder brother Ajay Kumar Ajit who shaped my career and life
Preface to the Second Edition ???
Preface to the First Edition
T
his book on mnemonics has been writen in view of problems faced by PG aspirants and MBBS students. All the hard work comes to naught if a student confuses while giving examination. Mnemonics has been prepared to eliminate the confusion one encounters during memorizing the points in a topic. This book is sure to improve your rank in any PG entrance examination especially the one based on factual questions like DNB and state PG entrance examinations. Only 600 mnemonics has been included in this edition to enable students to complete and revise the book in a short time. Students are also encouraged to point out the mistakes in this book for which they will be given the incentive of ` 50/recharge done in their mobile number provided they are the first to point out the mistake and give reference for the same. One lucky student will also get to avail free discussion and explanation with the author every week. For this they need to provide their name, college name, batch of MBBS admission to author’s contact number. Readers are also advised to give their valuable opinions and suggestions which will be appreciated and acknowledged. Arun Kumar Contact: 9718161947 Email.id:
[email protected]
Acknowledgements
F
irst I want to thank all my teachers in both school and college who have encouraged and inspired me for hard work. I also want to thank Dr Nitish, Dr Aporva, Dr Rajdeep and Dr Puneet who have been very supportive of me to write this book. I took the inspiration to write the book from my teacher ‘Dr Arup Kumar Kundu’ who has been a leading writer in medical field. My heartfelt thanks to my fiancée who contributed significantly in writing this book. I also like to take this opportunity to thanks my parents, sisters, my brothers, brothers-in-law and all family members who have always had faith in my abilities. I would also like to thank CBS Publishers & Distributors, Mr YN Arjuna (Senior Vice President—Publishing, Editorial and Publicity), Mrs Ritu Chawla (Assistant General Manager—Production) an d Mr Vikrant Sharma (DTP Operator) to help me realize my dream of writing the book and publishing the book so beautifully. I would also like to thank my friend Pawan, Bipulji and Dr Pradeep for their valuable support. I would also like to thank my teachers Dr MP Sharma for his guidance. Finally with all my humbleness and sincerity, I thank one and all who have helped me directly and indirectly in completing this book.
Arun Kumar
Conte nts Pre fa c etotheSe c o ndEd itio n
vii
Pre fa c etotheFirstEd itio n
ix
1. Anatomy
1
2. Biochemistry
17
3. Physiology
26
4. Pharmacology
35
5. Microbiology
72
6. Pathology
81
7. Forensic Medicine and Toxicology (FMT)
93
8. Preventive and Social Medicine (PSM)
99
9. Eye 10.E ar,NoseandThroat(ENT) 11. Medicine 12. Surgery 13. Gynecology and Obstetrics (G and O)
111 117 122 152 162
14. Pediatrics
170
15. Skin
177
16. Anesthesia
180
17. Radiology
184
18. Psychiatry
186
19. Orthopedics
189
1 Anatomy
• Floor of third ventricle (formed primarily by hypothalamic structures) Optic chiasma Infundibular recess (which extends into pituitary stalk) Tuber cinereum Mammillary bodies Posterior perforated substance Tegmentum of the midbrain Mnemonic: Opin Tuma Posteg • Muscles of gluteal region Gamellussuperior—Nerve toobturator internus (L5, S 1, S2) Mnemonic: GSOI 512 Gamellus inferior—Nerve toquadratus femoris (L4, L5, SI) Mnemonic: IQ 451 • Foramen magnum—Structures passing through its anterior part Apical ligament of Dens Vertical band of cruciate ligament Membrane tectoria Mnemonic: AVM • Foramen ovale Mandibular nerve Accessory meningeal artery (A for Artery) Lesser petrosal nerve Emissary vein (cavernous sinus to pterygoid plexus) Mnemonic: MALE 1
2
Mnemonics
• Foramen spinosum Middle meningeal artery and vein (posterior trunk) Emissary vein Nervus spinosus (meningeal branch of mandibular nerve) Mnemonic: MENS • Foramen rotundum—Maxillary nerve Mnemonic: Maxm round Maxillary nerve passes through fossa, fissure and foramen
Foramen Fissure Fossa
Foramen rotundum inferior orbital fissure pterygopalatine fossa
Mnemonic: RIP
• Internal acoustic meatus Facial N (VIIIth/7th) Vestibulocochlear N (VIIIth/8th) Nervus intermedius or pars intermedia Labyrinthine vessels Mnemonic: 78 Intermediate Lab
of Wrisburg
• Foramen lacerum Meningeal branch of ascending pharyngeal artery Emissary vein Mnemonic: MAPEL • Jugular foramen Anterior part
Middle part
Inferior petrosal sinus
9th cranial nerve 10thcranialnerve 11th cranial nerve Meningeal branch of ascending pharyngeal artery
Posterior part
Internal jugular vein Sigmoid sinus junction Emissary vein (sigmoid
sinus to occipital veins) Occipital artery (meningeal branch)
Mnemonic: IPS IS evaluating Our 9, 10, 11 MAP
Anatomy
3
• Ana tom ica l snuf f box —wh en th umb i s full y exte nde d, depression seen on lateral aspect of wrist, immediately distal to radial styloid process Content—Cephelic vein Superficial radial nerve Radial artery Mnemonic: CSR Floor—Base of first metacarpal Radial styloid Scaphoid Trapezium Mnemonic:
BRST
Note: Proximal to distal order is RSTB. Boundaries: Lateral wall (anterior wall): Medial wall (Posterior wall):
Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus
Mnemonic: EPL is MP
• Secretomotor pathway for parotid gland Pons Inferior Salivatory nucleus Glossopharyngeal nerve Tympanic branch and plexus Le sserganglion petrosal nerve Otic Auriculo temporal nerve Parotid gland Mnemonic: PINS G L O T Y L E PO A TP • Structure passing through superior orbital fissure Lateral to annulus of Zinn: Lacrimal nerve Frontal nerve Trochlear nerve Superior ophthalmic vein
4
Mnemonics
Meningeal branch of lacrimal artery Mnemonic: LFT Through annulus of Zinn:
Nasociliary nerve O culomotor nerve and inferior division) (3rd(superior CN) Abducens nerve (6th CN)
Mnemonic: NOA 36 Inferomedial to annulus—inferior ophthalmic vein
• Anterior and Middle superior alveolar nerves are branches of Infraorbital (terminal branch of maxillary nerve) Posterior superior alveolar nerve is direct branch of maxillary nerve Mnemonic: IAM Appendices epiploicae are small sacs of peritoneum filled with fat (adipose projections) over the whole colon except caecum appendix (vermiform) rectum Mnemonic: CAR Note: Taenia coli are absent in distal sigmoid colon and rectum. • Femoral triangle content Lateral to medial Femoral erve Femoral anrtery Femoral vein Lymphatic vessels and deep inguinal lymph node of Cloquet Mnemonic: NAVEL Boundaries Laterally—medial border of sartorius Medially—medial border of adductor longus Superiorly—inguinal ligament Mnemonic: SAIL Branches of third part of maxillary artery Infraorbital A
Anatomy
5
Posterior superior alveolar A Pharyngeal A Artery of pterygoid canal A Greater palatine A Sphenopalatine A Mnemonic : Inferoposterior pharyngeal artery of greater sphenoid • Bipolar neurons are located in th e retina, olfactory epithelium, cochlear and vestibular ganglia (all three are sensory pathway for vision, smell and hearing) • Triangle of auscultation Scapula Latissimus dorsi Trapezius Mnemonic: Scalattra • Alar plate derivatives become sensory nuclei while basal plate derivatives become motor nuclei Mnemonic: Sailor/Ala senses
• Branch of first part of subclavian artery Vertebral artery Internal thoracic artery Thyrocervical trunk Mnemonic: VIT • Branch of thyrocervical trunk Suprascapular A Inferior thyroid A Transverse cervical A Mnemonic: SIT • Axillary artery First part—Superior thoracic artery Second part—Acromiothoracic artery Lateral thoracic artery Mnemonic: SALT
6
Mnemonics
• Adductor ma g nus is a composite muscle and is doubly innervated by the obturator nerve and tibial nerve Mnemonic: MagOT • Biceps femoris: Long head—Tibial nerve Short head—common peroneal nerve Mnemonic: Long tibial • Bronchial artery Left—two bronchial arteries arising directly from descending thoracic aorta Mnemonic: Directly descending Right—One bronchial artery arises indirectly from descending thoracic aorta either from i. Third posterior intercostal artery ii. Upper left bronchial artery • Branches of anterior division of internal iliac artery Superior vesical artery Obturator artery Middle rectal artery Uterine artery (only in females) Inferior vesical artery (replaced by vaginal in females) Inferior gluteal artery Internal pudendal artery Mnemonic: SOMU and 3IV • Nasal septum—osseous part Vomer Sphenoid Nasal bone Frontal bone Ethmoid Palatine Maxillary Mnemonic: Very special news for Ethiopian PM • Large opening of diaphragm T8—Venacaval opening T10—Oesophageal opening
Anatomy
7
T12—Aortic opening Mnemonic: Voice of America Aortic opening Aorta Thoracic duct Azygos vein Mnemonic: ATA Vena caval opening—Right phrenic nerve Inferior vena cava Mnemonic: RP in Cave Oesophageal opening—Left vagus Right vagus Oesophagus Oesophageal branch of left gas tric artery Mnemonic: Vagus, phagus, gas • Supports of uterus Muscular supports/active supports Perineal body Urogenital diaphragm Levator ani (pelvic diaphragm) Mnemonic: PULP Mechanical supports Transverse cervical ligament (Mackenrodt’s ligament) Uterosacral ligament (most strong)
Round ligament of uterus Uterine axis Pubocervical ligament Mnemonic: TURUP (T and P are cervical) • Branches of cerebral part of internal carotid artery Anterior cerebral artery Middle cerebral artery Ophthalmic artery Anterior choroidal artery Posterior communicating artery Mnemonic: AM OCP
8
Mnemonics
• Branches of cavernous part of internal carotid artery Meningeal branches Cavernous branches Hypophyseal branches Mnemonic : MCH • Secondary curves: Adult curvatures of spinal cord Cervicalspine Thoracicspine Lumbarspine Pelviccurve (sacrococcygeal)
Anteriorly Convex Concave Convex Concave
Mn X Cave X Cave
Lordosis Kyphosis Lordosis Kyphosis
Lumbar: Lordosis (L for L) Convex anteriorly: Lordosis Mnemonic: XL • Shoulder abduction 0–15° Supraspinatus (suprascapular nerve) 15°–90° Deltoid (axillary nerve) 90°–120° Deltoid (+ short external rotators) (axillary nerve) 120°–180° Serratus anterior (nerve to serratus anterior) Trapezius (spinal accessory nerve) • Subclavian triangle Nerve contents Three trunks of brachial plexus Nerve to serratus anterior Nerve to subclavius Suprascapular nerve Mnemonic: 3S in subclavian Triangle • Maxillary A (branch of external carotid artery) Branches of first part Middle meningeal artery Accessory meningeal artery Inferior alveolar artery Deep auricular artery
Anatomy
9
Anterior tympanic artery Mnemonic: MAIDA Branches of second part Deep temporal Pterygoid Masseteric Buccal Mnemonic: All muscular branches • Prostate Median lobe—benign Posterior lobe—Malignant/carcinomatous transformation Mnemonic: PMC (Patna Medical College) • L east dilatable and n arrowest part of m ale urethra = Membranous (except external urethral orifice) Mnemonic: LMN • Branches of external carotid artery Anterior: Superior thyroid artery Facial artery Lingual artery Posterior: Occipital artery Posterior auricular artery Medial: Ascending pharyngeal artery Terminal: Maxillary artery Superficial temporal artery Mnemonic: SFL (Safal) OP Ascends Max STep
• P rimary cartilaginous joint/ h yaline cartilaginous joint/ synchondrosis Joint between epiphysis and diaphysis of long bone Spheno-occipital joint First chondrosternal joint Costochondral joint Mnemonic: PHC • Seco ndary carti lagin ous joint /fibr ocart ilagi nous joint / symphysis pubis – Symphysis menti
10
Mnemonics
– In tervertebral joint between vertebral bodies (sacrococcygeal joint) – Manubriosternal Joint – Xiphisternal Joint Mnemonic: 2SIMa–X Fibrous joints Sutures: Skull Gomphosis: Tooth in its sockets Syndesmosis: Inferiortibiofibular joint,middle radioulnar joint, tympanostapedial joint Mnemonic: Iti Mira Tysta • Synovial joint Plane synovial joint: Joint between vertebra Intercarpal and intertarsal
ar ticular process of
Mnemonic: Art of car and tar are plane Hinge joint Interphalangeal Elbow Ankle Mnemonic: HIPEA Pivot (trochoid) Median atlanto-axial joint Inferior and superior radioulnar joint Mnemonic: MAA and ISRU Ellipsoid: Metacarpophalangeal joint Atlanto-occipital joint Wrist joint Mnemonic: MCP AO, wrist Condylar (bicondylar): Knee joint Right and left jaw joint Mnemonic: J and K are bicondylar Saddle (sellar): Sternoclavicular joint 1st carpometacarpal joint Calcaneocuboid joint Mnemonic: Stern 1st CM of Calca is sad
Ball and socket: Shoulder joint
Anatomy
11
Hip joint Talocalcaneonavicular joint • Epiphysis Pressure epiphysis:
Head of femur Condyles of tibia Lower end of radius Mnemonic: Press HCL Traction epiphysis: Tubercles of humerus—Mastoid process Trochanters of femur Mnemonic: TMT Atavistic epiphysis: Coracoid process of scapula Osmium trigonum Aberrant epiphysis: Head of first metacarpal Base of other metacarpals
• Veins of heart Contents of coronary sulcus: Great cardiac vein Coronary sinus Small cardiac vein Mnemonic: GCS Anterior cardiac vein drains directly into right atrium Mnemonic: ADDRA Smallest cardiac vein/Thesbian veins/venae cordis minimi drains directly into the cavity in all four chambers. Rest drains into coronary sinus, i.e, great cardiac vein (Anterior Interventricular septum) Middle cardiac vein (Posterior interventricular septum) Mnemonic: Middle Post Small cardiac vein Posterior vein of LV Oblique vein of LA Right marginal vein • Muscles of mastication Pterygoid—lateral and medial Masseter Temporalis Mnemonic: PMT
12
Mnemonics
• Structures derived from the neural crest C-cells of thyroid Conotruncal septum (Chromaffin tissue) (adrenal medulla) Neurons: The neurons of Spinal dorsal root ganglia Sensory ganglia of 5th, 7th, 8th, 9th and 10th cranial nerves Sympathetic ganglia Pia-arachnoid mater Schwann cells Melanoblasts (mesenchyme of dental papilla and pharyngeal arches) Mnemonic: 3C 3S PSM • Yellow elastic cartilage forms:
External ear External auditory canal Eustachian tube Epiglottis Tip of arytenoids Tip of nose Corniculate cartilage Cuneiform cartilage
Mnemonic: E4T2C2
• Hyaline cartilage forms:
(Type 2 collagen) Costal Nasal Some laryngeal Tracheobronchial All temporary and most articular cartilages
Mnemonic: ATMA
• Femoral artery:
Deep branches Profunda femoris
Superficial branches Superficial external pudendal Superficial epigastric Superficial circumflex iliac
Anatomy
13
Deep external pudendal Muscular branches Mnemonic: PDM External iliac artery:Branches Inferior epigastric artery Deep circumflex iliac artery Note: 1. Infe rior epiga stric arte ry anas tomos es with superior epigastric artery (a branch of internal thoracic artery). 2. Profunda femoris is the largest branch of femoral artery. It is the chief artery to supply all 3 compartments of thigh. lts branches 1. Medial circumflex femoral artery 2. Lateral circumflex femoral artery 3. Four perforating arteries • Sites of narrowing of normal ureter Ureteric orifice Ureterovesical junction Juxtaposition of the vas deferens or broad ligament Crossing of the iliac artery Ureteropelvic junction Mnemonic: Ureteric orifice is VVIP • Anterior belly of digastric is supplied by mandibular nerve Postserior belly of digastric is supplied by facial nerve Mnemonic: ADM and PDF • Mandibular nerve (lst arch): Mylohyoid Muscles of mastication Anterior belly of digastric Tensor tympani Tensor veli palati Mnemonic: My Mast Ant digest Tension • Facial Nerve (2nd arch):
Stapedius Stylohyoid Posterior belly of digastric Muscles of facial expression
Mnemonic: Stupid style Dip muscles of facial expression
14
Mnemonics
• Glossopharyngeal nerve (3rd arch): Stylopharyngeus Mnemonic: Gloss style-pharyngeal common)
• Superior laryngeal nerve (4th arch) Muscles of pharynx (except stylopharyngeus) Muscles of palate (except tensor veli palati) • Recu rren t laryng eal nerv e (6th arch) : Muscles of lar ynx (except cricothyroid) Note: Cricothyroid muscle is supplied by external branch of superior laryngeal nerve. Mnemonic: Ex Cricketer
• Stapes—Smallest Mnemonic: S for S Malleus: Largest • Direction of nasolacrimal duct: Downward, backward and laterally. Mnemonic: DBL, i.e. double • Inferior meatus: Nasolacrimal duct Mnemonic: INLD Middle meatus: 4 openings: Middle ethmoidal air cells Maxillary sinus Anterior ethmoidal air cells Frontal sinus Superior meatus: Posterior ethmoidal sinus. Mnemonic: SuPES Sphenoethmoidal recess—Sphenoid air cells. Mnemonic: SERS • Coronal suture—between 2 ears ( Can in hindi) Mnemonic: C for C Sagittal suture—between 2 parietal bones. Asterion—parietomastoid occipital (PMO).
Anatomy
15
Bregma—Anterior fontanelle Mnemonic: AB Lambda—Posterior fontanelle • Routine opening of mouth: Lateral pterygoid. Forceful opening of mouth: D Gigastric eniohyoid Myelohyoid Mnemonic: DGM • Infrahyoid muscles— also known as strap muscles: Sternohyoid Omohyoid Sternothyroid Thyrohyoid • Ansa cervicalis is nerve supply of: Omohyoid Sternothyroid Sternohyoid Mnemonic: OH Anshu SiT on Shoe • C1 is the nerve supply of: Thyrohyoid Geniohyoid Mnemonic: C1 is The GHar • Male internal genitalia S: Seminal vesicles E: Epididymis E: Ejaculatory duct D: Ductus deferens (Vas deferens) Mnemonic: SEED • Paranasal sinuses Maxillary sinus—develops at birth Ethmoidal sinus—develops at birth Frontal sinus—develops at 2 years Sphenoid sinus—develops at 3–5 years. Mnemonic: MEFS • The inferior turbinate is a separate bone, while rest of the turbinates are a part of ethmoidal bone. Mnemonic: Inferior—Independent
16
Mnemonics
• Cerebellum Cerebellar cortex—five cells: Granule cells Golgi cells Purkinje cells Stellate cells Basket cells Mnemonic: Garm gol puri in steel basket Deep cerebellar nuclei: Dentate Emboliform Fastigial Globose Mnemonic: DEFG The axons of Purkinje the deep only output Note: the cerebellar cortex, generallycells passare to the nuclei. from
• Appendix of testis—Paramesonephric duct Mnemonic: ATP Appendix of epididymis—Mesonephric duct Mnemonic: MEA
2 Biochemistry
• Inhibitors of TCA cycle F luoroacetate inhibits a conitase (non-competitive > competitive) A rsenite inhibits α -K etoglutarate dehydrogenase (noncompetitive) Malonate inhibits succinate dehydrogenase (competitive) Mnemonic: FAM inhibits AKS • Transamination reaction Aspartate + α-ketoglutarate → oxaloacetate + glutamate Mnemonic: ASO Alanine + α-ketoglutarate → pyruvate + glutamate Mnemonic: PyAl G for G—Glutamate–ketoglutarate
• Sphingolipidosis: X-linked recessive → Fabry’s disease Mnemonic: Fab X • Biochemical tests • Sugars (reducing sugars) Fehling’s test Benedict’s test Mnemonic: FBS (or fasting blood sugar) • Bile pigments Gmelin test Fouchet test Rosenbach’s test Mnemonic: Pig GFR 17
18
Mnemonics
Also remember Ketone bodies Rothera test (Nitroprusside test)—Roth Nite Gerhardt test (Ferric chloride test) Mnemonic: GF • SGPT – ALT – Cytosolic Mnemonic: CLP Also remember: SGOT (AST)—80% mitochondrial and 20% cytosolic • Water soluble vitamins: Vitamins B and C Mnemonic: WBC Vit. B complex energy releasing Thiamine (B1) Riboflavin (B2) Niacin (B3) Mnemonic: 123-TRN (Tarun in Hindi) Biotin Pantothenic acid Pyridoxine B6 Mnemonic: six pyre • Blot transfer techniques Southern blot DNA Northern blot RNA Western blot Protein Mnemonic: S o u t h – D a k s h in – D N A W e s t e r n – P a s c h im – P r o t e in • Respiratory chain inhibitors Complex IV inhibitors: Cyanide (CN) Carbon monoxide (CO) Hydrogen sulphide (H2S) Sodium azide Mnemonic: ides are complex IV inhibitors • Location of major glycosaminoglycans Hyaluronic acid: Synovial fluid Loose connective tissue
Bioc he m istry
19
Vitreous humor Cartilage Mnemonic: Hy SyL Vi in Car Chondroitin sulphate: Cartilage Bone Cornea Mnemonic: CBC Karatan sulphate: Cornea (KS I) Loose connective tissue (KS II) Heparin: Mast cells Heparan sulphate: Aortic wall Skin fibroblasts Dermatan sulphate: Wide distribution • Catabolism of carbon skeletons of amino acids Oxaloacetate forming amino acid—Asparagine (aspartate) Mnemonic: Ox in spa Fumarate forming amino acids—Phenylalanine, tyrosine Mnemonic: PheTyr fumes Succinyl CoA: Threonine, valine, isoleucine, methionine Mnemonic: Three successful VIM
• Ketoglutarate: Proline, histidine, arginine, glutamine Mnemonic: α PHAG Pyruvate: Cystine, threonine, glycine, alanine, serine Mnemonic: CT GAS in Peru Acetyl CoA /Acetoacetyl CoA forming amino acids: Leucine, isoleucine, lysine, tryptophan, phenylalanine, tyrosine Mnemonic: Lily Try Phe Tyr in AC • Transport of a mmonia to liver Muscle—uses alanine Mnemonic: Amma ki Mala Other tissues use glutamine • Metabolic role of vitamin B12 Methylation of homocysteine to methionine Isomerization of methyl malonyl CoA to succinyl CoA Methylation of pyrimidine ring to form thymine
20
Mnemonics
Interconversion of g lutamate and β -methyl aspartate in bacteria Conversion of ribonucleotides to deoxyribonucleotides in DNA synthesis Metabolism of diols Mnemonic: HMP and GRD in B12
• HGPRTase deficiency Partial def: Kelly Siegmiller’s syndrome No CNS involvement Complete def: Lesch-Nyhan syndrome Mnemonic: Kelly is Partial • Classification of amino acids Amino acids with aliphatic side chain Glycine Alanine Valine Leucine Isoleucine Mnemonic: GAVLI With side chain containing OH (hydroxyl) group Tyrosine Threonine Serine Mnemonic: oh tie three Sari With side chain containing sulphur atoms Methionine Cysteine Mnemonic: MSC Containing aromatic rings Histidine Tryptophan Phenylalanine Tyrosine Mnemonic: Histry Phe Tyr
Bioc he m istry
21
• RNA polymerase transcribes Type 1—rRNA Types 2— mRNA Type 3—tRNA Mnemonic : RMT = Remote • Homozygous substitution with other amino acids in place of Valine at position 67 of β-chain Glutamate—Hb milwaukee Mnemonic: Gala Milo Aspartic acid—Hb bristol Mnemonic: Brass Alanine—Hb sydney Mnemonic: Alan border of sydney • CPK-1-CPK BB—brain (Mnemonic: BB no. 1) CPK-2-CPK MB—myocardium Mnemonic: MB Heart attack CPK-3-CPK MM—skeletal muscle CPK-MB 1—extra cardiac form CPK-MB 2—cardiac form Mnemonic: Heart attack especially in 2nd MB • Fructose 2, 6-bisphosphate + ve on PFK 1 – ve on PFK 2 – ve on fructose 1, 6-bisphosphatase Note: PFK 2 is bifunctional (2 is bi.) • Ehrlich’s aldehyde reagent test Chloroform layer turnspink—Urobilinogen (Mnemonic: CPU) Aqueous layer turns pink—porphobilinogen • Mg 2+ (Magnesium) is required in covalent modification of enzymes by phosphorylation, dephosphorylation of seryl residues. It is required in: Ribonuclease
22
Mnemonics
Kinase Transketolase Peptidases Ca carboxylase Ad enyl cyclase Phos phatase Mnemonic: RiKi Trap Car, add phos • Tryptophan → Serotonin → Melatonin Niacin (nicotinic acid/nicotinamide) Tryptophan contains indole functional group. • Tyrosine is formed from ph enylalanine (Enz-phenylalanine hydroxylase) Tyrosine is also precursor for Dopa Dopamine Epinephrine Norepinephrine Thyroxine Triiodothyronine Melamine Note: Codon for tyrosine are UAC and UAU. In Papaver somniferum, the opium poppy, tyrosine is used to produce the alkaloid morphine. • Substrate level phosphorylation 1, 3-bisphosphoglycerate to 3-phosphoglycerate (phosphoglycerate kinase), glycolysis Phosphoenol pyruvate to pyruvate (pyruvate kinase)glycolysis Succinyl CoA to succinate (succinyl CoA synthetase or succinate thiokinase), Kreb’s cycle • Basic amino acid Histidine Lysine Arginine
Pka of ‘R’ 6 10.8 12.5
Bioc he m istry
23
Higher the Pka, more basic will be amino acid. Mnemonic: Increasing order HLA • Guanine to cytosine G ≡ C (3 hydrogen bonds) adenosine to thymidine A = T (2 hydrogen bonds) Mnemonic: 3G
• Named mutations Nonsense mutation: Sense codon to change into nonsense stop codon, causing premature termination of translation. Missense mutation: Change of one sense codon into another sense codon, for different amino acids Mnemonic: Different Miss Silent mutation: Change of one sense codon into another sense codon for same amino acids (Mnemonic: S for S) Null mutation: Leads to no functional gene product (complete loss Lossof of function) function mutation: Results of gene product having less or no function. Gain of function mutation: Change the gene product such that it gains a new and abnormal function. Neutral mutation: Different but chemically similar amino acid. • Insulin receptor: Two subunits • α subunit: It is extracellular and its function is to bind insulin. • β subunit: It is a transmembrane protein and its function is signal transduction. Note: The cytoplasmic portion of subunit has tyrosine kinase activity (enzymatic receptor). • Three steps in glycolysis that are physiologically irreversible. These reactions are catalyzed by – Hexokinase–glucokinase (glucose to glucose 6-phosphate) – Phosphofructokinase (fructose 6 phosphate to fructose 1, 6-bisphosphate) – Pyruvate kinase (phosphoenol pyruvate to pyruvic acid) To remember: All three are kinases. One involves glucose, another fructose and third one pyruvate.
24
Mnemonics
• Metabolic fuels Organ
Fed
Fasting
Starvation
Mnemonics
Brain Heart
Glucose Fatty acid
Glucose Fatty acid
Ketone bodies Ketone bodies
Gul Gul Ke FFK (Fafakna in
Liver
Glucose
Fatty acid
Amino acid
Muscles
Glucose
Fatty acid
Fatty acid
RBC
Glucose
Glucose
Glucose
Hindi) GFA (Girl Friend Ayi rahne) GFF (is muscil in Hindi) Onlyglucose
• DNA Purines—Adenine, guanine Pyrimidines—Cytosine, thymine Mnemonic: Y for Y • Amino acids Ketogenic— Leucine Lysine Mnemonic: KiLL
Both glucogenic and ketogenic—Isoluecine Tryptophan Phenylalanine Tyrosine Mnemonic: GK Is trying phenyl on tyre • Protein degeneration in eukaryotes 1. Protein degeneration in lysosomes—involves lysosomal proteins. This process does not involve ATP. 2. Protein degradation in proteosomes—involves ubiquitinproteosome pathway. This process requires ATP, i.e. ATP dependent. Mnemonic: UPA
• Trypsin—a proteolytic enzyme (proteinase) It acts in an alkaline medium.
Bioc he m istry
25
Activators: Enterokinase Calcium Trypsin itself Mnemonic: ECT Inhibitors: Human and bovine colostrums Egg white (contains water soluble mucoprotein) Raw soyabean Alpha antiproteinase/α-1 antitrypsin Diisopropyl flurophosphate (DFP) Mnemonic: HERALD • Helicase—Unwinds dsDNA to provide ssDNA Mnemonic: HU Topoisomerase—Relieves torsional strain that results from helicase induced unwinding. Mnemonic: T for T
3 Physiology
• Papez circuit Cingulate gyrus ← (limbicsystem)
Anterior thalamic nucleus (thalamus)
↓ Hippocampus (limbicsystem)
↑ →
Mammillary body (hypothalamus)
Mnemonic: HiMaAnCi • Limbic system C ingulate gyrus (rim of cortical tissue around hilum of cerebral hemisphere) Amygdala Septal nuclei Hippocampus formation Mnemonic: CASH
• Precursors of Clotting factors II,VII,IXand X (inactiveglutamyl residues)
Carboxylase→ VitaminK
Mature factors II,VII,clotting IX,X (active γ-carboxyglutamyl)Gla (Hydroxyquinone) residues
This reaction requiresCO2 and hydroxyquinone form of vit.K Mnemonic: CHK • Phase of minimum cardiac motion At low/intermediate heart rates—Mid-diastole Mnemonic: Mid day minimum At high heart rates: Late systole 26
Physiology
27
• Nitric oxide synthase NOS 1 (Endothelial NOS): Constitutive/Calcium dependent NOS 2 ( Inducible NOS): In ducible /Calcium In dependent NOS 3 (Neuronal NOS): Constitutive/Calcium dependent Mnemonic: EIN—Alphabetically and In for In • Intestinal hormone stimulating insulin secretion Gastrin Gastric inhibitory peptide (GIP) Glucagon Glucagon like peptide (GLP) Cholecystokinin (CCK) Secretin Mnemonic: 4GCS • Features of cerebellar function/lesion Past pointing Hypotonia Cerebellar nystagmus Dysmetria Dysarthria Dysdiadochokinesia Intention tremor Ataxia Mnemonic: PHC D3I2A1 • Pain insensitive structure P of brain Parenchyma lexus (choroid) Ependymoma Pia-arachnoid Dura over convexity of skull Mnemonic: PCS is insensitive Also remember: Vasomotor center (VMC) Excitatory: Cortex Pain pathway Carotid and aortic chemoreceptors Direct stimulators: CO 2 Hypoxia
28
Mnemonics
• Cells within gastric glands Chief Zudge fund of pepsi—chief cells/zymogenic cells— fundus of stomach— pepsin Ox and Pari are intrinsic to HCL—oxyntic cells or parietal cells—secrete HCL. • Abnormal Hb with decreased solubility HbS (β6-GLU-VAL) HbC (β6-GLU-LYS) HbD (β6-GLU-GLM) Mnemonic: Supreme Court Decision-Very Long Gap • Parasympathetic fibres carrying cranial nerves—3, 7, 9, 10 Pure motor—3, 4, 6, 11, 12 Pure sensory—1, 2, 8 • The D orsal spinocerebellar tract enters the cerebellum through inferior cerebellar peduncle. The ventral tract enters into the cerebellum through superior cerebellar peduncle. Mnemonic: DIN • Medullary respiratory centres: Dorsal respiratory group (DRG), located in the dorsal portion of the medulla, which mainly causes inspiration Mnemonic: Din Ventral respiratory group (VRG) located in the ventrolateral part of the medulla, which mainly causes expiration. • Hormones with second messenger c GMP Atrial natriuretic factor Nitric oxide Mnemonic: NAG Hormones with second messenger Creatine Kinase Growth hormone Erythropoietin Prolactin Insulin Insulin like growth factors I and II Chorionic somatomammotropin Mnemonic: Growing EPICK
Physiology
29
Hormones with second messenger cAMP α2 adrenergic catecholamines β adrenergic catecholamines Adrenocorticotropic hormone (ACTH)—pituitary Antidiuretic hormone (V2)—2 ampoule Calcitonin—parafollicular ‘C’ cell of thyroid Chorionic gonadotropin, human Corticotropin release hormone Dopamine Glucagon—pancreas FSH—pituitary LH—pituitary MSH PTH—parathyroid Somatostatin TSH—pituitary (FLAT) Mnemonic: ACD GF LM PST Second messenger is Ca2+/PIP Oxytocin ADH (V1A and V1B) TRH Gonadotropin releasing hormone Gastrin Cholecystokinin Acetylcholine α1-adrenergic catecholamine • Intrinsic muscle control Golgi tendon organ—detects muscle tension—inverse stretch reflex—lengthening reaction Mnemonic: T for T Muscle spindle—detects muscle length—stretch reflex Mnemonic: S for S • Vestibular cerebellum—equilibrium spinocerebellum—Smoothens and coordinates Mnemonic: S for S Neocerebellum—planning and programming
30
Mnemonics
• Trichromatic theory Red—protanomaly Green—deuteranomaly Blue—tritanomaly Mnemonic: Red-Green-Blue (Ragbi) • General somatic efferents: Motor functions of skeletal muscles derived from somites: Cranial nerves III (Oculomotor nucleus) IV (Trochlear nucleus) VI (Abducens nucleus): Supplies extraocular muscles XII (Hypoglossal nucleus): Supplies tongue muscles Mnemonic: Tongue muscles and Extraocular muscles • General visceral efferents: Motor function of smooth muscles and glands of head and viscera that receive parasympathetic supply Cranial nerves Superior salivatory nucleus (VII) Superior Seven Inferior salivatory nucleus (IX) Inferior Nine Dorsal motor nucleus (X) Dorsal ~ Das (Hindi) Edinger-Westphal nucleus (III) Mnemonic: SIDE • Bronchial efferents /special visceral efferents Ambiguous nucleus (IX, X, XI) Masticatory nucleus (V) Spinal accessory nucleus (XI) Facial nucleus (VII) Mnemonic: Ambi Ka Mast Special accessory face • Axon reflex contributes only to the Flare component of triple response. Mnemonic: Flaxon • Sarcolemmal proteins localized to the cytoplasmic side of sarcolemma Dysferlin Dystrophin Calpain Mnemonic: Fer pin Pain
Physiology
31
Also remember: Transmembrane sarcolemmal proteins Dystroglycans, integrins, sarcoglycans and caveolin Mnemonic: DISC • The dorsal column ascends such that it remains ipsilateral along the entire length of spinal cord (its branch cross over in medulla) Mnemonic: DCM-Dorsal column cross over in medulla Sensations transmitted by spinothalamic tract Anterior spinothalamic tract Mnemonic: Crude ATP-Crude touch and pressure in anterior Spinothalamic tract Lateral spinothalamic tract Pain (pin prick) Temperature Mnemonic: PLT Note: The spinothalamic tract crosses more or less at point of entry itself such that it remains contralateral along the whole length of spinal cord.
• When compared to plasma Serum has no fibrinogen, clotting factors II, V and VIII but has higher serotonin content because of platelet breakdown in serum Mnemonic: S for S • Frequency of sleep waves Gamma oscillations 30–80Hz Betawaves 18–30Hz Alphawaves 8–12Hz Thetawaves 4–7Hz Delta waves Hz 4 < Awake person Eyes opened
Beta waves
Mnemonic: Opening batsman Eyes closed Alpha waves
Great B A T Dance
32
Mnemonics
• Oxygen toxicity Acute—Bert effect— CNS effects are predominant (muscle twitching, convulsions, coma) (Mnemonic: ABC) Chronic—Smith effect—pulmonary effects (pulmonary edema, lung atelectasis) • Hormones produced in kidney Renin Erythropoietin 1, 25-Dihydroxycholecalciferol—vit. D Mnemonic: RED • Testis Interstitial cells of Leydig—secrete testosterone Mnemonic: Lete Most other functions—Sertoli cells Y-Chromosome—small acrocentric Mnemonic: Yac • Naturally occurring estrogens Estrone: Major estrogen in postmenopausal women Mnemonic: NM Estradiol: Major and most potent estrogen in women Estriol: Major estrogen in pregnancy, marker for fetoplacental unit. Mnemonic: PT • Clasp kn ife s p a sticity : Up per motor neuron lesion (corticospinal Mnemonic: Uppyramidal in Spa system involved) Lead pipe and cogwheel rigid ity occurs in extra pyramidal syndrome, e.g. Parkinsonism. Mnemonic: Extra rigid in Parkinsonism Paratonia/gegenhalten—bilateral frontal lobe damage Mnemonic: FG Cerebrovascular disease. • Sympathetic outflow: Thoracolumbar outflow Mnemonic: SLT Parasympathetic outflow: Craniosacral outflow Mnemonic: PCS
Physiology
33
• LH surge: Ovulation—hormone picture High estrogen Low progesterone Mnemonic: HELP • IRV + TV = Inspiratory capacity (Mn: ITI) ERV + RV = Functional residual capacity ( Mnemonic: FER) IRV + TV + ERV = Vital capacity IRV + TV + ERV + RV = Total lung capacity VC + RV = TLC (Mnemonic: VRT) • Positive feedback mechanisms Parturition Action potential initiation Blood clotting/clot formation LH surge 2+
C a mediated contraction Shock Mnemonic: PABLCS • Symp athe tic chol iner gic syst em s erve s tw o imp orta nt functions: a. Sweat gland—secretion of sweat. b. Vasodilatation in skeletal muscles—a part of the neurons to blood vessels in skeletal muscles is anatomically sympathetic but secrete acetylcholine. Stimulation of this system of neurons produces vasodilatation in skeletal muscles. • Stimulus for CCK-PZ secretion: a. Presence of peptide s and amino a cids in conta ct with mucosa of small intestine. b. Presence in the duoden um of fatty ac ids having m ore than 10 carbon atoms. Stimulus for secretin secretion: a. Acidity of chyme b. Products of protein digestion • Stage IV: NREM sleep disorders: Sleep walking (somnambulism)
34
Mnemonics
Sleep terorr or night terror (pavor nocturnus) Sleep related enuresis (bed wetting) Bruxism (tooth grinding) Sleep talking (somniloquy) • REM sleep disorders: RBD-R EM sleep behaviour disorder Nightmares Narcolepsy (hallmark—decreased sleep latency) Note:
Penile
tumescence is seen in REM sleep.
Mnemonic: RML Pens REM
• Difference between T3 and T4 T3 is more potent. T3 has faster onset of action. T3 binds more avidly to nuclear receptors. T4 is more secreted by thyroid. T4 is major circulating hormone. T4 binds more avidly to plasma proteins (15 times). T4 has more plasma t½ To remember: T4 = Pharmacokinetics T3 = Pharmacodynamics Note: About 1/3 of T4 is converted to T3 in peripheral tissues. • Ions predominant in ICF: Potassium Phosphate (organic) Protein Magnesium Mnemonic: 3PM Ions predominant in ECF—Na+/Cl–/HCO3–/Ca2+
4 Pharmacology
• Therapeutic Index =
LD50 ED50
or LD50/ED50
Mnemonic: TILE
• Selective phosphodiesterase 4 (PDE4) inhibitors Roflumilast Cilomilast Tofimilast Mnemonic: RCT-Milast • Small molecule tyrosine kinase inhibitors HER1 (EGFR) Erb B1: Erlotinib (reversible) Canertinib (Irreversible) Gefitinib Mnemonic: I Can do ECG • VGFR TK inhibitors—Sorafenib—Renal cell cancer SMnemonic unitinib—R enal cell cancer : VRS • Drugs used for acute gout NSAIDS Colchicine Corticosteroids Mnemonic: NCC • Relative potency of same steroid at equivalent concentrations in different formulation Ointment > Emollient > Gel > Cream > Lotion Mnemonic: OEGCL 35
36
Mnemonics
• Anticancer cells: Cell cycle specific G2 phase specific: Daunorubicin Etoposide Bleomycin Topotecan and Irinotecan Mnemonic: DEBT S-phase specific agent: Antimetabolites Mtx 6MP 6TG 5-FU Cytarabine Hydroxyurea M-phase specific: Vinca alkaloids Paclitaxel and Docetaxel G1 phase: Vinblastine
• Drugs causing hyperuricemia L-Dopa Ethambutol Aspirin Diuretic Cyclosporine Alcohol Nicotinic acid Pyrazinamide Mnemonic: LEAD CAN poison • Anti-TNF-α drugs Etanercept Adalimumab Infliximab Mnemonic: Etalion adalat Ka Insaf • Clomiphene citrate Enclomiphene—tra ns-antagonist Zuclomiphene—cis-weak agonist Mnemonic: N for N • Anti-anxiety Benzodiazepines Diazepam Chlordiazepoxide
Pharmacology
Oxazepam Lorazepam Alprazolam Mnemonic: Dia Ka CHOLA • Anti-pseudomonal penicillins Azlocillin Mezlocillin Carbenicillin Piperacillin Ticarcillin Mnemonic: (Az) (Mez) pe Car Ka Pipe Tica • Penicillinase susceptible penicillins Penicillin G: Acid labile Penicillin V: Acid stable Mnemonic: Galib • Penicillinase resistant Nafcillin Methicillin Flucloxacillin Oxacillin Cloxacillin Dicloxacillin Mnemonic: Name Flu of OCD (last four are—oxa)
• Intramuscular penicillins Benzathine penicillin G Procaine penicillin G Mnemonic: BP (measured on muscle) Intravenous intramuscular Penicillin G Crystalline penicillin G or sodium penicillin G • Anti-fungal drugs Systemic azoles
Mnemonic: IVF
Itraconazole Voriconazole Fluconazole
37
38
Mnemonics
Note: Ketoconazole is both topical and systemic. • Side effects: Tacrolimus versus cyclosporine Tacrolimus causes more Neurotoxicity Nephrotoxicity Diabetes mellitus Diarrhoea Mnemonic: N2D2: ND Tiwari Cyclosporine causes more Hirsutism Hyperplasia of gums Hypertension Hepatotoxicity (4H: First two are absent in tacrolimus) • Management of PSVT Adenosine > beta ( β) blocker > c alcium channel blocker (verapamil) > digoxin Mnemonic: ABCD • Beta agonists—side effects Tolerance Tachycardia Tremor Mnemonic: 3T • Effects mediated through β2 receptor agonists Relaxation of smooth muscles Airway (bronchial muscles) Bronchodilatation (relaxation) Blood vessels Vasodilatation (relaxation) (Arterioles and Veins) Ciliary muscles in eye Relaxation Detrusor muscles in bladder Relaxation Gall bladder and duct Relaxation Gastrointestinal tract Relaxation Uterus Relaxation Spleniccapsule Relaxation Mnemonic: ABCD G2US (i.e. ABCD GO TO US)
Pharmacology
39
• Oral drug therapy for treatment of erectile dysfunction P Pentoxyfylline O Opoid antagonist (naltrexone) D Dopamine agonist (bomocriptine, apomorphine) A Alpha blockers (yohimbine, idaxozan) Mnemonic: PODA • Prostaglandin E1 (PGE1) analogues Riopristil Alprostadil Misoprostol Mnemonic: RAM Prostaglandin F2α (PGF2α) analogues Dinoprost Carboprost Latanoprost Mnemonic: Prost • Hormones acting through cell membrane receptors G protein coupled receptors Enzymatic receptors • G protein coupled receptors act either Through alteration in CAMP concentration, or Through IP3/DAG generation CAMP altering hormones are (another Mnemonic: ABCD GF LMPST) Pancreas: Glucagon, somatostatin (delta cells) Pituitary: FSH, LH, ACTH, TSH (Mnemonic: FLAT—CAMP) Parathyroid: PTH Parafollicullar C cells of thyroid: Calcitonin Posterior pituitary: Vasopressin (V2) Plus hypothalamic releasing hormones (CRH, dopamine) Placenta: hCG Peptide of intermediate pituitary: MSH Through IP3/DAG: Oxytocin TRH gastrin Acetylcholine Vasopressin Gn RH Angiotensin II (V1)
40
Mnemonics
Through cGMP—NO ANF Mnemonic: NAG (NO, ANF through cGMP) • Rapid acting human insulin analogues Insulin aspart Insulin lispro Insulin glulisine Mnemonic: Asli Glu Also Remember: Long acting human insulin analogues Insulin glargine Insulin detemir • Mechanism of action of antiepileptic agents Facilitation of GABA mediated chloride channel opening Barbiturates Benzodiazepines Gabapentin Tiagabine Topiramate Vigabatrin Valproate Mnemonic: BaBe Girl Tia Top in Viva of GABA class • Inhibition of T type Ca 2+ current Valproate Tri Ethmethadione osuximide Mnemonic: Vallore try ethical current • Prolongation of Na+ channel inactivation Valproate Lamotrigine Zonisamide Phenytoin Carbamazepine Topiramate Mnemonic: Very long zone of Na+ in PCT
Pharmacology
41
• Gp II b/III a antagonist Eptifibatide Tirofiban Abciximab Mnemonic : EpTiAb • All Navirs are protease inhibitors • NNRTI: Efavirenz Etravirine Nevirapine Delaviridine Mnemonic: 2END • Didanosine Stavudine Zalcitabine (20%) (71%) (15%) Similar toxic profiles Peripheral neuropathy (% in bracket) Lactic acidosis Pancreatitis Liver: Hepatomegaly with steatosis Mnemonic: PLPL • Anti-metabolite act ing by hypo methylation (inhibit DNA methyl transferase) Azacitidine Decitabine Mnemonic : Hypo Aza D • Thym ine less deat h (inhibi t DNA synthes is by blo cking synthesis of thymidylate) causing anti-metabolites 5-Fluorouracil (5-Fu) Capecitabine (5-Fu analogues) • Anti-metabolite acting by inhibition of DNA elongation (DNA intercalating agent) Cytarab ine or cytosine arab inoside (pyrimidine-cytidine analogue) Gemcitabine (Pyrimidine-cytidine analogue) Mnemonic: Arab Gem inhibit elongation
42
Mnemonics
• Filgrastim is recombinant GCSF (glycoprotein) produced in E. coli Mnemonic: EFG • High dose m ethotrexate is use d for os teosarcoma, bra in tumors and hematological malignancies. Mnemonic: Bone, Brain, Blood • Filgrastim: GCSF/(Gra for granulocyte) Sargramostim GM-CSF (Gramo for granulocyte monocyte) • Drugs associated with SIADH Vasopressin or desmopressin Chlorpropamide Oxytocin, high dose Vincristine Carbamazepine Nicotine Phenothiazines Cyclophosphamide TCA MAO inhibitors SSRI Mnemonic: VCO VCN PC, TMS • Drugs causing constipation Aluminium hydroxide Barium sulphate Calcium carbonate Ferrous sulphate Ganglionic blockers Ion exchange resins Opiates Phenothiazines Tricyclic antidepressants Verapamil (calcium channel blockers) Mnemonic: ABC, FGI, OP, TV) 2+
Note: Mg is laxative.
Pharmacology
43
• Benzodiazepines that do not produce active metabolites Oxazepam Midazolam Lorazepam Tamazepam Triazolam Mnemonic: OMLTT (Omlette) • Drugs acting on GABA A (intrinsic ion channel receptors) Agonist: Muscimol Antagonist: Bicuculline Agonist: Baclofen (B for B) Antagonist: Saclofen Drugs acting on GABA B (G protein coupled receptors) ( Mn: GB) Mnemonic: MBBS (Muscimol, Bicuculline, Baclofen, Saclofen) • Absence seizure: Drug of choice < 3 yrs of age: Ethosuximide > 3 yrs of age: Valproic acid • Interactions of valproate May precipitate phenobarbitone toxicity by inhibiting metabolism May precipitate phenytoin toxicity by displacing it from protein binding sites and inhibiting metabolism. May precipitate absence status when used with clonazepam. • Immunosuppression with triple therapy: Nice guidelines Cyclosporine (calcineurin inhibitor) Azathioprine (anti-proliferative agent) Prednisolone (corticosteroid) Mnemonic: CAP Note: Azathioprine may be replaced by mycofenolate mofetil. • Adverse effects of amiodarone (iodine containing long acting anti-arrhythmic belong to class III) Thyroid—hypothyroidism and hyperthyroidism
44
Mnemonics
Peripheral neuropathy Myocardial depression Pulmonary alveolitis and fibrosis (lung)—dry cough Corneal microdeposits Liver toxicity Photosensitization Mnemonic : The Periphery of My lung cornea live with photosensitivity • Fluor oquin olon es excre ted prima rily by non- rena l mechanism Pefloxacin Trovafloxacin Grepofloxacin Nalidixic acid Mnemonic: Petro Grenal Note: Sparfloxacin has 50% renal and 50% fecal route of excretion. • Anti-pseudomonal cephalosporins Ceftazidime Cefoperazone Cefepime Cefotaxine • Second line anti-tubercular drugs Old drugs PAS Ethionamide Cycloserine Thioacetazone Mnemonic: PECT Amikacin Kanamycin Capreomycin Mnemonic: Ami KC New drugs Ciprofloxacin Ofloxacin
Pharmacology
Clarithromycin Azithromycin Rifabutin Mnemonic: COCA-Rafa • Chelating agents in heavy metal poisoning Dimercaprol (BAL): Bismuth Antimony Lead Mercury Arsenic Copper Nickel Gold Mnemonic: BALMA CNG • Calcium disodium edetate (CaNa 2EDTA) Lead poisoning Mnemonic: Ledta Zn, Cd, Mn, Cu, Fe poisoning • Penicillamine Copper Mercury Lead Mnemonic: CML Note:
BAL: Not
in iron and cadmium poisoning
Mnemonic: BANIC EDTA: Not in mercury poison Mnemonic: ENM Penicillamine: Not in iron poisoning Mnemonic: PNI
• Phenytoin—side effects Hyperplasia of gums Hyperglycemia Hirsutism Hypersensitivity reaction Hydantoin syndrome: Teratogenicity
45
46
Mnemonics
Lymphadenopathy Megaloblastic anaemia Neurological symptoms Osteomalacia Mnemonic: 5H + LMNOP • Valproate—side effects Anorexia, vomiting Alopecia (transient) Ataxia, sedation Ammonemia (hyper) Thrombocytopenia Tremor Hepatotoxicity Neural tube defect Weight gain Mnemonic: VAT + HNW • Anti dote of warfa rin (ora l an ticoa gulan ts): Vita min K (phytonadione) Antidote of heparin—protamine sulphate
1
• Drugs acting on cell membrane and promoting leakage from membranes Polyenes: Amphotericin B Hamycin Nystatin Polypeptides: Po Colymyxin listin Mnemonic: AB HaNy and PoCo leak membrane • Mechanism of action of anti-microbial agents Inhibition of DNA gyrase: Fluoroquinolones Mnemonic: FG Misread ing of mRNA code : Amin oglycoside ( Mn :Amina misread code) Inhibition of protein synthesis Chloramphenicol 50S Erythromycin
50S
Pharmacology
Clindamycin Mnemonic: CEC 50 Tetracycline Aminoglycoside
47
50S 30S 30S
• Be ta avoided adrenergic agonists, nitrates, digitalis best during treatment of HOCM . and diuretics are Mnemonic: BeNi DiDi avoid HOCM
• Contraceptive failure may occur if any of the following drugs is used concurrently: Enzyme inducers: Phenytoin, phenobarbitone primidone, carbamazepine, rifampicin, griseofulvin. Suppression of intestinal microflora tetracycline, ampicillin • Drugs following zero order kinetics Warfarin Ethyl alcohol Theophylline Tolbutamide Phenytoin Aspirin (salicylate) Propranolol Mnemonic: Zero WATT PAP • Adrenaline: α1 + α2 + β1 + β2 Noradrenaline: α1 + α2 + β1 (no β2 action) α1 α+ action) α2 + β1 (no β2) Do pamine: Dβ1 1++Dβ22+(no Isoprenaline: Dobutamine relatively β1 selective (no dopamine receptor action) Mnemonic: DONO has no B2 action
• Adrenaline: Systolic BP increased Diastolic BP decreased Heart rate increased Noradrenaline: Systolic BP increased Diastolic BP increased Heart rate decreased
48
Mnemonics
Isoprenaline: Systolic BP normal/decreased Diastolic BP decreased Heart rate increased • Dopamine: D 1 rec eptors i n ren al an d mes ente ric bl ood vessels are very sensitive IV infusion of low doses of DA dilates mesenteric vessels and improves renal perfusion. Dobutamine: Inotropic action • Selective MAO-A inhibitor: Clorgiline Maclobemide Selective MAO-B inhibitor: Selegiline Non-selective MAO inhibitor Isocarboxazid Tranylcypromine Phenelzine Mnemonic: ITP • Hemodialysis is not used in Benzodiazepines (BZD) Digitalis Organophosphates Copper sulphate Kerosene Mnemonic: BZD DOCK • Diagnostic test for myasthenia gravis a. Ameliorative test: Edrophonium (anti-cholinesterase) b. Provocative test—d-tubocurarine • Pheochromocytoma α-blockage is the basis of management in preoperative period. Phenoxybenzamine is the agent of choice. β -blockers should not be employed prior to establishing effective α-receptor blockage, since unopposed β receptor blockage could theoretically cause blood pressure elevation from increased vasoconstriction. Atenolol however is a selective β1 agonist, and acts on the heart and not on peripheral blood vessels.
Pharmacology
49
• Diuretics, which do not promote bicarbonate excretion Thiazide like diuretics, e.g. m etazoline, i ndapamide, chlorthalidone, Ethacrynic acid (unlike other loop diuretics) Mnemonic: MICE Most marked kaliuresis: Acetazolamide Mnemonic: AK Most marked natriuresis: Furosemide Mnemonic: FuNa • Pharmacokinetics ADME Absorption Distribution Metabolism Excretion • Plasma protein binding is associated with— Duration Distribution Disease (hypoalbuminemia) Displacement Dialysis • Area outside blood–brain barrier (circumventricular organs) Subfornical organ OVLT (organum vasculosum of lamina terminalis) Area postrema Posterior pituitary Mnemonic: SOAP Note: CTZ (Chemoreceptor trigger zone) is also outside blood–brain barrier and responsible for vomiting. • Enzyme inducers— G—Griseofulvin P—Phenytoin, Primidone R—Rifampicin S—Smoking (PAH—polycyclic aromatic hydrocarbons) Car—Carbamazepine Phone—phenobarbitone
50
Mnemonics
• Enzyme inhibitors— Valla’s—Valproate Kit—Ketoconazole Can—Cimetidine Cause—Ciprofloxacin Enzyme—Erythromycin Inhibition—INH (Isoniazid) • Order of kinetics First order— CHF constant Clearance Half life Fraction excreted Zero order—RA constant Rate of elimination Amount eliminated • Nuclear hormones— S—Sex hormones (Estrogen, Progesterone and Testosterone) A—Vitamin A T—Thyroid hormones Mnemonic: SATurday Night Cytoplasmic receptor hormones—Corticosteroids Vitamin D Mnemonic: CCD • Drugs metabolized by acetylation— S—Sulfonamide including dapsone H—Hydralazine I—INH (Isoniazid) P—Procainamide (antiarrhythmic drug) Note: They can cause SLE. • Parasympathetic fibres are long in preganglionic. Mnemonic: Para-Pre—long • Preganglionic fibres release acetylcholine in both sympathetic and parasympathetic systems.
Pharmacology
51
• Sympathetic system— Postganglionic fibres release noradrenaline Exceptions— Sympathetic nerve fibres going to kidney secrete dopamine. Sympathetic fibres going to sweat glands release acetylcholinenerve (sympathetic cholinergic) Mnemonic: Kid is sympathetic to dopa • Heart rate—Chronotropic Mnemonic: HR Conduction—Dromotropic Mnemonic: D for D Contractility—Ionotropic • Hemicholinium—inhibits uptake of choline. Vesamichol—inhibits entryrelease of acetylcholine in the vesicle Botulinum toxin—inhibits of acetylcholine. • M1—Stomach (increases acid secretion) M2—Heart (Bradycardia) M3—Rest organs like eye, GIT, urinary bladder, bronchus, glands M4—CNS M5—CNS Mnemonic: Ma says—First eat, Second heart and rest work later on • Drugs directly acting on parasympathetic system Pilocarpine acts on Pupil (M3)—miosis in glaucoma. Mnemonic: P for P Bethanichol acts on Bladder (M3)—contracts urinary bladder in urinary retention. Mnemonic: B for B Methacholine acts on Myocardium (M2)—used in tachyarrhythmia. Carbachol action—Common action—acts both on nicotinic and muscarinic receptors. Mnemonic: C for C
52
Mnemonics
• O ximes (enzyme reactivators) are acetylcholinesterase reactivators. Oximes are used only for organophosphorous poisoning. Mnemonic: OOO For example, Pralidoxime (PAM)—acts only in periphery. Mnemonic: P for P Diacetyl monoxime (DAM)—acts on both sites. • Anticholinergic drugs act as cycloplegic. Ciliary muscle contracts to cause accommodation. Its nerve supply is short ciliary nerve—branch of oculomotor nerve (3rd cranial nerve). So, it is a part of parasympathetic system. That is why anticholinergic drugs cause cycloplegia by blocking ciliary muscle contraction and causing loss of accommodation. Anticholinergic drugs are— Atropine—strongest cycloplegic drug. Very long acting. Used for refraction testing in children. Homatropine Cyclopentolate Tropicamide (Shortest acting. Preferred in adults.) Mnemonic: D for adult • Anti cho linecontraction. rgic dru gs ac ting on ur inar y bla dder (M 3 )— block—less Cause urinary retention (side effect) Used in overactive bladder/incontinence/detrusser instability. Drugs used are— S—Solifenacin O—Oxybutynin F—Flavoxate T—Tolterodine, Trospium bladder—Darifenacin Mnemonic: SOFT bladder
Pharmacology
• B elladonna poisoning = poisoning. Mnemonic: BAD
A tropine poisoning =
53
D hatura
• β1: Heart Mnemonic: Heart is 1 in number β2: Lungs Mnemonic: Lungs are 2 in number
• α1: Vasoconstriction α2: Vasodilatation Mnemonic: A 1–C B 2–D • M3: C ircular muscles— Constrictor pupillae—supplied by short ciliary nerve—active miosis—parasympathomimetic. Mnemonic: MCC MAO α1: Radial muscles—dilator pupillae—supplied by long ciliary nerve—active mydriasis—sympathomimetics.
• Dopamineactson: DLow : 1dose β1 + D1:Intermediatedose α1 + β1 + D1High : dose
µg/kg/min 2< 2–10 >10
Mnemonic: DBA
• Dopa in name stimulates D 1 For example, Dopamine Fenoldopam Note: Dobutamine mainly acts on β1. • Adrenaline acts on all 4 receptors ( α1, α2, β1 and β2) Noradrenaline—not all (α1, α2, β1) Isoprenaline—only β—β1and β2 • β2 agonists Salbutamol Terbutaline
54
Mnemonics
Salmetrol Formetrol Mnemonic: Metro is long acting. Salmetrol is slow onset (S for S) Side effects—Formetrol Tremor is fast onset (F for F) Tachycardia Tolerance Mnemonic: 3T • Selective α1 blocker—Zosine • α1A—Prostate α1B—Blood vessels Mnemonic: B for blood vessels Note: Selective α1A blocker—Tamsulosin, Silodosin. • β1 blockers/cardioselective/2nd generation New—Nebivolol Beta—Betaxolol Blockers—Bisoprolol Act—Acebutolol Exclusively—Esmolol At—Atenolol Myo—Metoprolol Cardium—Celiprolol • β blockers with intrinsic sympathomimetic activity (partial agonist) Contain—Celiprolol Partial—Pindolol Agonistic—Alprenolol Activity—Acebutolol Mnemonic: All pind sell ace intrinsically • β blockers with membrane stabilizing property Possess—Propranolol Membrane stabilizing or—Metoprolol
Pharmacology
55
Local—Labetalol Anesthetic—Acebutolol Property—Pindolol • Water soluble β blockers—contraindicated in renal failure: A—Atenolol N—Nadolol S—Sotalol Mnemonic: SoNaAta • Nadolol is the longest acting β blocker Esmolol is the shortest acting β blocker. • 3rd generation β blockers: β blockers with any additional cardiovascular advantage (vasodilatation) a. α + β blockade—Labetalol, Carvedilol b. NO release—Nebivolol. Mnemonic: N for N c. Ca2+ channel blocker—Carvedilol Mnemonic: C for C d. K+ channel blocker—Tilisilol e. β2 agonist—Celiprolol • Carvedilol— α blocker Ca2+ channel blocker Antioxidant • Celiprolol— β2 agonist Cardioselective Intrinsic sympathomimetic activity. • Loop and thiazide diuretics Na+, K+, Mg2+, H+—decrease Sugar, lipid, uric acid—increase Mnemonic : Loop looses calcium. It causes hypocalcemia. But thiazides cause hypercalcemia
• Digoxin—contraindicated in renal failure. Digitoxin—contraindicated in hepatic failure. Mnemonic: Toxin is metabolized in liver
56
Mnemonics
• Drugs causing gynaecomastia— Di—Digitalis S—Spironolactone C—Cimetidine O—Oestrogen • Drug interactions of digitalis— Quinidine Verapamil Amiodarone Thiazides Mnemonic: Queen’s VAT digitally • Vasodilators Mainly vein—Nitrates Mainly artery—Hydralazine Mnemonic: Hydra is artist Both— α blockers ACE inhibitors AT receptor blockers Sodium nitroprusside • Drugs causing hirsutism— Cyclosporine Phenytoin Minoxidil Mnemonic: CPM ka Hero • Diazoxide—decrease Insulin • Ca2+ channel— L type—in CVS T type—in Thalamus (brain) Mnemonic: T for T
• Renin inhibitor Approved for the treatment of hypertension Can be given orally Aliskiren
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57
Remikiren Enalkiren Mnemonic: Inhibitor of Renin • Prils are ACE inhibitors. Depines are calcium channel blockers. Mnemonic: CD • ACE inhibitors A—Active C—Captopril L—Lisinopril • ACE inhibitors—Captopril C—Cough A—Angioedema P—Prodrug (except Captopril and Lisinopril) T—Taste alteration (dysguesia) O—Orthostatic hypotension/Postural hypotension P—Pregnancy is absolute contraindication R—Renal artery stenosis (bilateral) is absolute contraindication I—Increase in K+—hyperkalemia is contraindication L—Lowers the risk of diabetic complications Note: Angiotensin receptor blockers also follow these except first 3 (CAP). • Sartans are selective angiotensin (block AT 1 only). AT1receptor receptor blockers antagonist. • Drugs safe in pregnancy Better—Beta blockers Mother—Methyldopa Care—Clonidine During—Dihydroperidine Hypertensive—Hydralazine Pregnancy—Prazosin Note: Antihypertensive drugs contraindicated in pregnancy are ACE inhibitors and ARB.
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Mnemonics
• Nitrate with minimum first pass metabolism—IMN Mnemonic: Iska Metabolism Nahi hota Longest acting nitrate—PETN Mnemonic: Longest name Shortest acting nitrate—AN Mnemonic: Shortest name • Coronary steal phenomenon can be caused by— Hydralazine Dipyridamol Isoflurane Mnemonic: HDI steal from Heart • Ivabradine I—IF blocker (funny current, which opens in hyperpolarisation instead of depolarization) Va—Visual field defect Bradi—cause bradycardia Ne—Na+ channel blocker • Rho kinase inhibitor—Fasudil Mnemonic: Dil me fas—ro mat • Myocardial infarction Non-ST elevation MI— M—Morphine O—Oxygen N—Nitrates A—Aspirin ST elevation MI— S—Streptokinase O—Oxygen N—Nitrate A—Aspirin M—Morphine • Antiarrhythmic drugs—Vaughan William classification: I—Sodium channel blockers II—Beta blockers
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III—Potassium channel blockers IV—Calcium channel blockers V—Others Mnemonic: SBP • Class III antiarrhythmic drugs B—Bretylium I—Ibutilide D—Dofetilide A—Amioderone S—Sotalol Note: They can cause Torased des pointes. • Benzodiazepines GABA facilitatory Increases frequency of chloride channel opening DRC flat Specific antidote—Flumazenil Mnemonic: 4F • Short acting benzodiazepines T—Triazolam, Temazepam O—Oxazepam L—Lorazepam E—Estazolam Note: Short acting BZD are—safe in elderly, liver disease, no hangover and no active metabolite. • Vigabatrin Vi—Visual field defect Gaba—GABA Tr—Transaminase In—inhibitor. ‘In’ also stands for infantile spasm Note: Vigabatrin is the drug of choice for infantile spasm with tuberous sclerosis. ACTH is drug of choice for infantile spasm.
60
Mnemonics
• Tiagabine Mnemonic: Transport inhibitor of GABA It is GABA reuptake inhibitor by inhibiting GAT1 • Drug decreasing alcohol craving— N—Naltrexone A—Acamprosate T—Topiramate O—Ondansetron • Atypical antipsychotics—5HT2A/2C blockers, e.g. pine, done and aripiprazole. • Uses of topiramate—all seizures except absence. Migraine prophylaxis Obesity Smoking Alcohol addiction Mnemonic: MOSA • Uses of antipsychotic drugs— Anti—Antiemetic property Psy—psychosis Cho—chorea (Huntington’s chorea) Tic—Tic disorder like Gille de La Tourette syndrome • Agonist ( κ)—antagonist (µ) P—Pentazocine N—Nelbuphine D—Dezocine • Partial agonist—Buprenorphine, Butorphenol. Mnemonic: 2B • Drugs inhibiting cell wall Firmly—Fosfomycin Bind to—Bacitracin Bacterial—β lactum Cell—Cycloserine Wall—Vancomycin
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Note: β lactum antibiotics—Penicillins Cephalosporins Carbapenems Monobactum • Penicillinase inhibitor or β lactumase inhibitor C—Clavulanic acid—with amoxicillin S—Sulbactum—with ampicillin T—Tazobactum—with piperacillin • Uses of penicillin G L—Listeria A—Actinomyces S—Syphilis T—Tetanus M—Meningococcus An—Anthrax Go—Gonococcus (drug of choice is ceftriaxone) Mnemonic: A men act on the list of gone sipohi • No β lactum is effective against MRSA except 5th generation cephalosporin. • 1st generation cephalosporin Cefazolin Cefalexin Cefadroxil Cefa Cefalothin loridine Mnemonic: Cefa Exception: Cefaclor is 2nd generation. • 4th generation cephalosporin Cefepime Cefpirome • 5th generation cephalosporin Ceftaroline Ceftibiprole Mnemonic: rol
62
Mnemonics
• Cephalosporins secreted by bile Ceftriaxone Cefoperazone Mnemonic: Bile per try • Cephalosporins effective against pseudomonas— Cefepime Cefepirome Cefoperazone Ceftazidime Mnemonic: 3P and ziddi • Cefoperazone— Secreted by bile Effective against pseudomonas Disulfiram like reaction hypoprothrombinemia • Mechanism of action of tetracycline—prevents tRNA to bind to A site. Mnemonic: T for T • Antimicrobial drug preventing translocation— M—Macrolides C—Clindamycin Q—Quinapristin • Buy AT 30S SELL @ 50S AT— Aminoglycoside Tetracycline SELL— Streptogramin (Quinapristine) Erythromycin (Macrolides) Linezolid Lincosamide • Uses of tetracycline S—SIADH R—Rickettsial infection
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I—Inguinale granuloma L—Lymphogranuloma venerum A—Atypical N—pNeumonia C—Cholera A—Amoebiasis • Tetracyclines—contraindications and adverse effects— K—contraindicated in Kidney failure A—Antianabolic action P—Phototoxicity I—Insipidus—DI L—Liver failure is C/I D—Dental—affects growing bone and teeth. C/I in pregnancy and child < 8 years. E—Expiry date—causes Fanconi syndrome after expiry date V—Vestibular dysfunction • Macrolides is the drug of choice for— C—Chancroid L—Legionella A—Atypical pneumonia P—Pertussis Can also be used for— C—Corynebacterium diphtheria H—Haemophilus influenzae A—Atypical mycobacteria T—Toxoplasmosis Side effects of macrolides— M—Motilin receptor stimulation A—Allergy C—Cholestatic jaundice R—Reversible O—Ototoxicity Note: Vancomycin and aminoglycosides cause irreversible ototoxicity.
64
Mnemonics
• Aminoglycoside Neomycin— Most nephrotoxic Most neuromuscular blockade Used only topically After neomycin, Gentamycin is most nephrotoxic Mnemonic: G affects GFR Streptomycin affects neuromuscular blockade Mnemonic: S affects Skeletal muscle Note: Maximum hearing loss—Amikacin Mnemonic: A affects auditory Maximum vestibular damage—Streptomycin
• Side effects of Sulfonamide— A—Aplastic anemia B—Bilirubiun displacement—Kernicterus C—Crystalluria R—Rash A—Acetylation S—SLE H—Hemolysis in G6PD deficiency • Pyrimethamine—Antiparasite Mnemonic: P for P Methotrexate—Anticancer Mnemonic: M for M Trimethoprim—Antibacterial • Fluoroquinolones are contraindicated in renal failure except— P—Pefloxacin M—Moxifloxacin T—Trovafloxacin • Respiratory flouroquinolones—can kill any bacteria causing respiratory tract infection O—Ofloxacin and levofloxacin M—Moxifloxacin
G—Gemifloxacin
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• G atifloxacin— G lucose—withdrawn because it causes hypoglycemia and hyperglycemia. Mnemonic: G for G
• Multibacillary leprosy—treatment OCD—Once daily Clofazimine (50 mg) and Dapsone (100 mg) RCM—Rifampicin (600 mg) and Clofazimine (300 mg) Note: Monthly dose are supervised. Paucibacillary leprosy—Treatment -???? • Bactericidal drugs— β lactum Aminoglycoside Flouroquinolones Vancomycin • Fast acting antimalarial drugs— M—Mefloquine A—Atovaquine C—Chloroquine H—Halofantrine, lumefantrine A—Artemisin group R—Res Q (Quinine) Slow acting Proguanil Pyrimethamine Sulphadoxine Tetracycline • Fluconazole—DOC for Candida, Cryptococcus Mnemonic: Flue can treat cry Note: Fluconazole is also the DOC for prophylaxis of febrile neutropenia in immunosuppressants. • Terbinafine—DOC for dermatophytosis. • Posaconazole—DOC for mucormycosis • Voriconazole—DOC for invasive aspergillosis, treatment of febrile neutropenia. • Itrac onazo le—DO C for all non-se rious funga l infect ion except Candida and Cryptococcus.
66
Mnemonics
• Hepatitis B— DOC—Entecavir Alternate drugs— oral— Lamivudine Emtricitabine Tenofovir Injectable— Interferon α • NRTI used in hepatitis B— L—Lamivudine E—Emtricitabine T—Tenofovir • Hepatitis C—DOC—Interferon and ribavarin • NNRTI—1st generation E—Efavirenz N—Nevirapine D—Delaviridine 2nd generation Etravirine Rilpivirine • Metronidazole is DOC for G—Giardiasis U—Ulcer—peptic ulcer P—Pseudomembranous colitis T—Trichomoniasis A—Anaerobic bacterial infection G—Gardenella vaginalis (bacterial vaginosis) • Antihelminthic drugs Platyhelminths—Flukes and tapeworm—DOC—Praziquentel. Mnemonic: P for P Nemathelminthes—DOC—Albendazole Exceptions to platyhelminthes— Liver fluke (Fasciola hepatica) Dog tapeworm (Echinococcus)
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Exceptions to Nemathelminthes— Filaria—DOC—DEC Strongyloides—DOC—Ivermectin Onchocerca (river blindness)—DOC—Ivermectin Mnemonic: iver for river • Pulsatile GnRH is indicated in— C—Cryptoorchidism H—Hypogonadotrophic hypogonadism A—Anovulatory infertility N—uNdescended testis D—Delayed puberty
Note: Continuous GnRH is indicated in Precocious puberty Cancer like breast carcinoma, prostate carcinoma Endometriosis Fibroid liomyoma (symptomatically) • GnRH agonist Leuprolide—First drug Gonadorelin Nafarelin—Nasally Mnemonic: N for N Gosarelin Busurelin Histarelin • GnRH antagonist—relix Cetrorelix Ganirelix Abarelix Degarelix Mnemonic: X means cross means antagonist • Thyroid inhibitors Peripheral conversion inhibitors— 5’ deiodinase inhibitors— Propylthiouracil
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Mnemonics
Propranolol Prednisolone Mnemonic: 3P
• Metformin—used for Obese patient Sulfonylurea—used for Thin patient Mnemonic: MOST • PTH causes partiality— Increases serum Ca2+ Decreases serum phosphate Note: Vitamin D decreases both while calcitonin increases both. • Tamoxifen is a SERM and has beneficial action on Bone—increases formation Blood—decreases LDL, increases HDL Breast—decreases risk of carcinoma Note: Doloxifen and Toremifen has similar action. Raloxifen—only unfavorable action is thromboembolism. • Thromboxane A2—aggregate platelets Mnemonic: A for A Prostaglandin I2—Inhibits aggregation of platelets Mnemonic: I for I
• Uses of colchicine— G—Gout C—Cirrhosis M—Acute Mediterranean fever S—Sarcoidosis • Acute gout— N—NSAIDS C—Colchicine C—Corticosteroids
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• Indications of chloroquine— R—RA E—Extraintestinal amoebiasis D—DLE L—Lepra reaction I—Infectious mononucleosis P—Photogenic reactions Mala—Malaria G—Giardiasis • Anakinra—IL 1 receptor antagonist. Mnemonic: A1 • Oprelvekin is IL 11 used in anticancer drug induced thrombocytopenia. Mnemonic: Eleven kin • Ticlopedine causes thrombocytopenia Mnemonic: T for T • Side effects of heparin— A—Alopecia B—Bleeding H—Hyperkalemia O—Osteoporosis T—Thrombocytopenia • Mast cell stabilizers K—Ketotifen N—Nedocromil S—Sodium cromoglycate • Busulfan—side effects— S—Skin pigmentation U—Uric acid increased LF—Lung fibrosis A—Adrenal insufficiency
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Mnemonics
• TOC for Hodgkin’s lymphoma— Earlier: M—Mechlorethamine O—Oncovin (Vincristine) P—Prednisolone P—Procarbazine Now preferred: A—Adriamycin/Doxorubicin B—Bleomycin V—Vinblastin D—Dacarbazine • TOC for NHL— C—Cyclophosphamide H—Hydroxydaunorubicin/Doxorubicin O—Oncovin/Vincristine P—Prednisolone +/– R—Rituximab • TOC for colorectal carcinoma— FOLFOX or FOLFIRI FOL—Folinic acid F—5FU OX—Oxaliplatin or IRI—Irinotecan • Uses of methotrexate— C—Choriocarcinoma A—Abortion N—NHL C—Crohn’s disease E—Ectopic pregnancy R—RA • Etoposide is used in— T—Testicular carcinoma O—Oat cell carcinoma P—Prostate carcinoma
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• Side effects of cytotoxic drugs— B—Bone marrow suppression A—Alopecia D—Diarrhea H—Hyperuricemia • Hypolipidemic drugs—bile acid binding agent Cholestyramine Cholestipol Cholesevalam Mnemonic: Chole • Ketamine K—Kids. Induction agent of choice in children. E—Emergency reaction T—Thalamocortical junction is site of action causing dissociative anesthesia A—Analgesia (profound) M—Meals—can be given after meals I—Increase all pressures (BP, IOP, ICP) N—NMDA receptor blocker of glutamate E—Excellent bronchodilator—preferred in asthamatics.
5 Microbiology
• Class I MHC molecules: CD8 T cells 1 × 8 = 8 Class II MHC molecules: CD4 T cells 2 × 4 = 8 Peptide binding site on Class IMHC molecules is located in a groove between distal domains of α subunits (between α1 and α2 domains) Mnemonic: 1dα • Mechanism of resistance Production of β -lactamase: Both gram +ve and gram –ve Alteration in PBP: Gram-positive Impaired permeability: Gram-negative Mnemonic: Beta both PBP: Positive (2P is positive) • Hepatitis virus HepA Picorna
HepB Hepa
HepC DNA
HepD
HepE
HepG
Flavivirus Incomplete Calcivirus
Calcivirus
Mnemonic: PH FICC (Pic of Hema Fall In Class)
• Dengue hemorrhagic fever Serotype 1 followed by serotype 2 is more dangerous than Serotype 4 followed by: Serotype 2 Mnemonic: 12>42 Also remember: Serotype 2 is more dangerous than other serotypes. • Lysogenic conversion Salmonella typhi 72
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Clostridium botulinum Corynebacterium diphtheriae Mnemonic: Salmon bottles corn for lysogeny
• Nuclear inclusion bodies Cowdry type A: Herpesvirus Yellow fever virus Mnemonic: HAY Cowdry type B: Adenovirus Poliovirus Mnemonic: BAP • Methods for sterilization of endoscopes Rigid endoscope Autoclave Mnemonic: RiA Flexible endoscope Glutaraldehyde peracetic acid (20% cidex) Mnemonic: EFG • Dimorphic fungi Penicillium marneffei Blastomyces Histoplasma capsulatum Paracoccidiomyces Candida albicans (not other Candida) Sporothrix Mnemonic: Dimorphic Penicillin Blast his Para’s albi spores • Culture media for isolation of Leptospira Korthof medium EMJH medium Fletcher medium Stuart medium Mnemonic: KEFS
• Man is the definitive host in most of the parasitic infections except the following parasites where it is an intermediate host Hydatid worm (Echinococcus granulosus) Malaria (Plasmodium)
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Mnemonics
Taenia solium (both definitive and intermediate host) Toxoplasma gondii Sarcocystis lindemanii Mnemonic: HMT goli
• Parasites malabsorption Common to adults and children: Entamoeba histolytica Giardia lamblial Hymenolepis nana Mnemonic: EGH Only adults Strongyloides Cyclospora Mnemonic: Strong Cycle of adults Only Children: Ancylostoma duodenale Isospora belli Cryptosporidium Mnemonic: An Iso Cry of Children • Antigen–antibody reaction Ascending part: Prozone or zone of antibody excess Peak—zone of equivalence Descending part—post zone or zone of antigen excess Mnemonic: A Probe • Oocyst size of acid fast parasites causing malabsorption Cryptosporidium—5 μm Cyclospora—10 μm Isospora—25 μm (Alphabetically arranged, size increases) • Parasite causing autoinfection Mnemonic: Strong Heman cryptically enters Philippines for Taenia solium auto infection. Strongyloides stercoralis Hymenolepis nana Cryptosporidium parvum Enterobius vermicularis
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Capillaria Philippinensis Taenia solium • Worms that do not multiply in host. Ancylostoma duodenale Enter obius vermicularis bancrofti Wuchereria Mnemonic: Duodenum bans entry and multiplication Also remember Worms that crawl out Enterobius vermicularis T. saginata Mnemonic: Crawling entry of saginata
• Microaerophilic bacteria Helicobacter pylori Borrelia burgdorferi Campylobacter Mnemonic: Hell Boy in Micro Camp • Viruses associated with blood transfusion Parvovirus B-19 Hepatitis B Hepatitis C Hepatitis G HIV type 1 HTLV type 1 Cytomegalovirus Mnemonic: 19 BCG transfuses type 1 of Cytomegalovirus • Transport media for Vibrio cholerae Venkatraman Ramkrishnan (VR) media Alkaline peptone water Monsur’s taurocholate tellurite peptone water Mnemonic: Venkat transport Alkaline water to Maissur • Obligate intracellular parasite Virus Chlamydia Rickettsiae
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Mnemonics
Legionella Mnemonic: VCRL (Viru Chalne ke liye Rickshaw lega) • Selective media in which substances that inhibit or poison all but a few microorganisms are added to a solid media (S for S). Enrichment produced by adding selective substances tomedia liquidare media. Enriched media are basal media enriched with blood, serum or egg. • Classification of streptococci: Hemolytic (P) streptococci are classified by Lancefield classification—based on nature of a carbohydrate ‘C’ antigen (Group A to K without I and J) Griffith typing—‘M’ Protein Mnemonic: GMP • 01 Vibrio cholerae Classical: Polymixin, Phage 4 Mnemonic: Polyphagic class Eltor: Eltor, chick embryo • Mycobacterium tuberculosis complex No environmental source M. tuberculosis M. bovis M. africanum M. microti • Non-tuberculous mycobacteria (Atypical mycobacteria) Environmental source is postulated M. avium intracellulare complex M. kansasii Mnemonic: Kans ka avium in atypical environment • Enteropathogenic E.coli or Enteroadhesive E. coli—attaches intimately to enterocyte membrane, Infants and Children, Epidemic Mnemonic: Infant attaches ad for epidemic in Patho. Enterotoxigenic E.coli: Traveller’s diarrhea Mnemonic: T for T—Produces enterotoxin (Labile/Stable)
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77
Entero aggregate d E.coli : Persistent diarrhea—heat stable enterotoxin EAST I Mnemonic: Aggregate persists Enteroinvasive resembles shigellosis Detected by Sereny tests, penetration of the Hela and Hep2 cells. Mnemonic: H2 S2 invades • Leptospira: Three Rs Rat, Rice, Rainfield. • Treponema palladium, Syphilis endemicum: Bejel Mnemonic: Bend Pertunae: Yaws (Mnemonic: Ytune) Caratium: Pinta (Mnemonic: Pintu ki Car) • Chlamydia Serotype A,trachomatis B, Ba, C: Endemic blinding trachoma Serotype D–K: Inclusion conjunctivitis, genital chlamydiasis, Infant pneumonia Mnemonic: IGI Serotype L1, L2, L3: Lymphogranuloma venereum Mnemonic: L for L • Immunoglobulin Percentage of total serum Ig
IgG IgA IgM 75–85% 7–15 5–10
IgD IgE 0.3 0.019
Serumhalf-lifedays 23 6 5 3 2.5 Mnemonic: In decreasing order GAMDE Classical complement activation: Ig M and IgG (Mnemonic: Mahatma Gandhi Classical) Alternate complement activation: IgA Mnemonic: A for A Ig present in milk: IgA and IgG (Mnemonic: AG in milk) • Epitope: Antigen Paratope: Antibody • Toxin acting by inhibiting protein synthesis Shiga toxin
78
Mnemonics
Pseudomonas toxin Diphtheria toxin Mnemonic: Antiprotein ships dip p-pilli are pyelonephritis associated pilli that are found on uropathic strains of E. coli. Mnemonic: P for P • Gram-positive coccobacilli: Listeria • Gram-negative coccobacilli: Bordetella Brucella Campylobacter Chlamydia Helicobacter Haemophilus Rickettsia Mnemonic: BCHR • Bacteria acquiring characteristics Transformation (free DNA soluble DNA):
Pneumococcus Bacillus Haemophilus
Mnemonic: BPH/PnBaha Transduction (bacteriophage): Method of genetic engineering T/t of inborn errors of metabolism Mnemonic: DIG Conjugation (actual physical contact): Episomes and plasmids for resistance. Lysogenic conversion (phage DNA itself is new genetic element) Corynebacterium diphtheriae Salmonella typhi Clostridium botulinum
• Thymus dependent tissues (collection of T-lymphocytes) Spleen: Malpighian corpuscle in white pulp (periarterial) Lymph node: Paracortical area between follicles in cortex and medullary cords in medulla Mnemonic: Para Mal dependent Bursa dependent (collection of B-lymphocytes)
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79
(Thymus independent) Spleen: Germinal centre Mantle layer Perifollicular region Mnemonic: German Man around follicle are independent Lymph nodes: Medullary cords Cortical follicles Germinal centres Mnemonic : Medulla and cortex in Germany are also independent • Property S. aureus S. epidermidis Coagulase Positive Negative Mannitol Ferments Non-fermenting Pathogenicity Pathogenic Non-pathogenic • Susceptibility tests Shick test: Diphtheria Dick test: Scarlet fever Mnemonic: S for D and D for S (opposite) • Spirochete: Borrelia Leptospira Treponema Mnemonic: BLT (Balti in Hindi) • Combined immunodeficiency SCID (severe combined immunodeficiency)—def. of ADA Wiskott-Aldrich syndrome Ataxia-telangiectasia Nezelof syndrome Mnemonic: SWAN Defective Phagocytosis Chronic granulomatous disease (def. of NADPH oxidase) Chediak-Higashi syndrome Myeloperoxidase def. Job’s syndrome • Two pigments produced by Pseudomonas aeruginosa Pyocyanine: Bluish green pigment Mnemonic: BC Pyoverdin (fluorescein): Greenish yellow pigment
80
Mnemonics
• Visceral larva migrains— Toxocara canis Cutaneous larva migrains— A—Ancylostoma duodenale N—Necator americanus Strongyloides stercoralis S— • Human is the dead end host for L—Leptospirosis T—Tetanus T—Taenia solinum E—Endemic typhus Japan—Japanese encephalitis L—Legionella E—Echinococcus, trichinella H—Human rabies
6 Pathology
• Characteristic features of Staphylococcus pneumoniae Pneumatocele (thin walled cystic spaces that may contain air fluid levels) Pleural effusion Pyopneumothorax (bronchopleural fistula) Abscess formation Cavitation (single or multiple thick-walled cavities) (may be bilateral) Empyema Mnemonic: 3P and ACE • Actin: AD FSGS CD2AP: Adult proteinuria Steroid sensitive: NPHS I-Nephrin-19q. Finish congenital nephrotic syndrome Steroid resistant: NPHS 2-Podocin-lq: AR acquired FSGS Mnemonic: 2R-lq-AP • Type III (pauci immune) RPGN ANCA small vessel vasculitis Wegener’s granulomatosis Microscopic polyangiitis Churg-Strauss syndrome Mnemonic: WMC • Cox 1 Constitutive Cox 2 Inducible • Large vessel vasculitis Giant cell arteritis (temporal arteritis) Takayasu arteritis 81
82
Mnemonics
Cogan syndrome Mnemonic: Large giant taka of cogan • Medium vessel vasculitis PAN Kawasaki disease Buerger’s disease Mnemonic: Pan per kabab aur burger) • DNA repair defects HNPCC (mismatch repair): Colon ca. Bloom syndrome: Developmental defects Fanconi anaemia: Bone marrow aplasia Ataxia-telangiectasia: Neural symptoms Xeroderma pigmentosa (nucleotide excision repair)—skin ca. Mnemonic: HB FAX • Bcl-1: Mantle cell lymphoma Bcl-2: Follicular lymphoma Bcl-6: Burkitt lymphoma Mnemonic: My favourite Band is Bcl-126 Diffuse large B cell lymphoma—Bcl-2 and Bcl-6 Mnemonic: D-26 • HLA B 27 is associated with Juvenile rheumatoid arthritis Psoriatic spondylitis Ankylosing spondylitis IRnflammatory bowel disease eactive arthritis/Reiter’s syndrome Mnemonic: Juvenile PAIR at 27 yrs of age • Risk factors for atherosclesosis in decreasing order Total cholesterol: HDLC Apoprotein B 100: HDLC LDL cholesterol: HDLC Mnemonic:
TB L
ratio
H
• Classification of hyperlipoproteinemias Lipoproteins elevated
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83
I: chylomicrons IV: VLDL V: (1+ 4 = 5)—chylomicron and VLDL III: (4 – 1 = 3)— chylomicron and VLDL remnant II: LDL (lla—LDL, IIb—LDL and VLDL) • Radical scavenging enzymes – Glutathion peroxidase – Catalase – Superoxide dismutase Mnemonic: GCS Note: Superoxide dismutase also generates free radicals (H2 O2). • Amyloid proteins and their clinical settings Transthyretin (ATTR) FMnemonic amilial amyloidotic neuropathy : FAT Systemic senile amyloidosis Mnemonic: SST β2 microglobulin (Aβ2m): Hemodialysis associated amyloidosis Mnemonic: Dial M for amyloid β2: amyloid protein (A β): Alzheimer’s disease Senile cerebral disease Mnemonic: Sc and Ad • Flex ner-Wintersteiner rosettes are characteristic of retinoblastoma May also be seen in Medulloblastoma and pineoblastoma Mnemonic: Flexible RMP (All are blast) • Glomerulonephritis without proliferative changes Minimal change disease Amyloidosis Membranous glomerulonephritis Diabetic nephropathy ± FSGS Mnemonic: Minimum Amul for membranous Dia
84
Mnemonics
• Fibromatosis represent a group of fibrous benign or tumourlike conditions Deep fibromatosis: Desmoid tumors Mnemonic: Deepa ka Des Superficial fibromatosis Palmar fibromatoses (Dupuytren’s contracture) Plantar fibromatoses Penile fibromatoses (Peyronie’s disease) • Prader-Willi syndrome: Clinical features Mental retardation Diminished fetal activity Hypotonia Obesity Short stature Hypogonadotrophic hypogonadism Mnemonic: Pradip MDHOSH • Angelman–Willi syndrome Seizures Hypotonia Inappropriate laughter (Happy puppets) Mental retardation Ataxia Mnemonic: Happy puppet SHIMA • Multiple myeloma Dutcher bodies—nuclear Mnemonic: Multiple nuclear Dutch Russell bodies: Cytoplasmic (Mnemonic: Russell Crowe) • Mooser’s bodies: Endemic typhus Mnemonic: Moosa is endemic Miyagawa bodies: Chlamydia trachomatis Mnemonic: Miya Kalam Lafora bodies: Familial myoclonic epilepsy Mnemonic: Lofar in Family
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• Pancytopenia with cellular bone marrow Myelodysplastic syndrome Myelofibrosis Myelophthisis Bone marrow lymphoma Aleukemic leukemia Hairy cell leukemia Mnemonic: Cellular bone marrow M3 ka BAP hai • Cold antibody hemolytic anaemia—usually IgM Mnemonic: CM – Class Mate • Proteins defective in hereditary spherocytosis Ankyrin > protein 3 (anion transport channel) > α-spectrin > protein 4.2 (palladin) Mnemonic: AP3 α S P4.2 First memorize APSP Then Then Then
AP3SP AP3 α SP AP3 α SP4.2
• Prader-Willi syndrome: (Chromosome 15) AngeIman syndrome: (Chromosome 15)
Paternal deletion Maternal imprinting Maternal disomy Maternal deletion Paternal imprinting Paternal disomy
• Mechanism of apoptosis Caspase 9 (Nin e): Intrinsic pathway Mnemonic: In for In Caspase 8 (Eight): Extrinsic pathway Mnemonic: E for E • Histochemical staining of amyloid with Congo red observed under ordinary light—pink red colour. Observed under polarized light: Green birefringence Mnemonic: PG • Genes regulating apoptosis Anti-apoptotic
Pro-apoptotic
86
Mnemonics
bcl-2 bcl-XL
bax bad bak bim bcl-xs
Mnemonic: L and LXL are anti-apoptotic
• Chronic manifestations of splenectomy Anisocytosis Basophilic stippling Howell-Jolly bodies (nuclear remnants) Heinz bodies (denatured Hb) Nucleated erythrocytes in peripheral blood, occasionally Poikilocytosis • Howell-Jolly bodies occur most frequently after SMplenectomy egaloblastic anaemia Severe hemolytic anaemia Mnemonic: Jolly SMS • Inactivation of free radical reactions Enzymes: Glutathione peroxidase Catalase Superoxide dismutase Mnemonic: GCS Non-enzymatic system: Endogenous/exogenous anti-oxidants a. Vitamin E, vitamin C b. Sulfhydryl containing compounds: glutathione, cysteine c. Serum protein: Albumin Ceruloplasmin Transferrin Mnemonic: EC GC ACT • Renal lesions in SLE (WHO classifications) Class I: Normal by light, electron and immunofluorescent microscopy Class II: Mesangial lupus GN (Mildest clinical variant proteinuria, microscopic hematuria rare)
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Class III: Focal proliferative GN (Moderate, presents with proteinuria and hematuria) Class IV: Diffuse proliferative GN (Haematuria, nephrotic range proteinuria, mild to severe renal failures) Class V: Membranous GN (Massive proteinuria and nephrotic syndrome) Class VI: End stage of proliferative lupus nephritis Mnemonic: No Money FD ME Note: GN—glomerulonephritis • Location of epitheloid— Testis Ovary (tunica) Pancreas (Islet) Mnemonic: TOP Pathologically found in granuloma. • Antigen presenting cells (APC) Professional (MHC II, GVHD)—Dendritic cells Langerhans’ cells Follicular dendritic cells. Mnemonic: DLF is Very professional Non-professional (MHC I, graft rejection)—Macrophages B-lymphocytes Glial cells Endothelial cells Thymic epithelial cells. • Autosomal dominant (AD) H—Hypercholesterolemia (familial) Hereditary spherocytosis Huntington’s chorea E—Ehlers-Danlos syndrome A—Achondroplasia V—von Willebrand’s disease (type I and II) Y—Pseudohypoparathyroidism D—Dystrophica myotonica
88
Mnemonics
O—Osteogenesis imperfect M—Marfan’s syndrome I—Intermittent porphyria N—Noonan’s syndrome A—AD PKD N—NF I and NF II T—Tuberous sclerosis • Marfan’s syndrome M—Mitral valve prolapse A—Arachnodactyly (long fingers) R—Retinal detachment F—Fibrillin I deficiency Family history A—Ascending aorta aneurysm N—Negative nitroprusside test S—Superotemporal subluxation of lens • Neurofibromatosis I (17q) N—Neurofibroma O—Optic nerve glioma S—Sphenoid dysplasia (most common skeletal deformity) P— Plexiform NF Positive family history A—Axillary freckling C—Café-au-lait spots E—Eye (Lisch nodules on iris) • Neurofibromatosis II (22q) M—Multiple I—Inherited S—Schwannoma M—Meningioma E—Ependymoma • Autosomal recessive A— Alkaptonuria Albinism B—Beta thalassemia, sickle cell anemia C—Cystic fibrosis
Pathology
89
D—Deafness (sensorineural) E—Emphysema (Panacinar-α1 antitrypsin deficiency) F—Friedrick’s ataxia G—Gaucher’s disease H—Hurler’s disease Hemochromatosis I—Inborn errors of metabolism Others—Niemann-Pick’s disease Tay-Sachs disease Wilson’s disease • X linked recessive Less—Lesch-Nyhan syndrome Chronic—Chronic granulomatous disease Hunter—Hunter’s disease Hemophilic—Haemophila A and B Girls—G6PD deficiency Don’t—Duchenne muscular dystrophy Dent’s disease Color—Color blindness Fragile—Fragile X syndrome Fab—Fabry’s disease Brutun—Brutun’s X linked agammaglobulinemia Wisely—Wiskott-Aldrich syndrome • X linked dominant Rat me—Rett syndrome (only seen in females) Char—Charcoat Mari tooth disease Pig—Incontinenta pigmenti (only seen in females) Airport pe—Alport syndrome Phosphate kha raha tha—X linked hypophosphatemic rickets • Mitochondrial inheritance K—Kearns Sayre syndrome L—Leber’s hereditary optic neuropathy M—MERRF (myoclonic epilepsy with ragged red fibres) MELAS (mitochondrial encephalopathy with lactic acidosis with stroke like syndrome) N—NARP (neurologic ataxia with retinitis pigmentosa)
90
Mnemonics
O—Ophthalmoplegia (chronic external ophthalmoplegia) P—Pearson syndrome • Multiple myeloma Symptoms C—Hypercalcemia R—Renal failure A—Anemia B—Bone lytic lesion (on X-ray or bone scan) • ALL Testicular infiltration Mediastinal lymph node involvement CNS infiltration Mnemonic: TMC • Supravital stains— Brilliant cresyl blue New methylene blue Crystal violet Mnemonic: BNC • Stain Acidic Cytoplasm
Basic DNA
• Warm antibody—IgG Cold antibody—IgM Mnemonic : Classmate Exception—PCH (Donath Landsteiner antibody)-IgG
• Differential diagnosis of microcytic hypochromic anemia Sideroblastic anemia Iron deficiency anemia Thalassemia Anemia of chronic disease Mnemonic: SITA • Migratory thrombophlebitis (Trousseau syndrome) S—Stomach L—Lung
Pathology
91
A—Adenocarcinoma P—Pancreas • Mutation of p53 Li-Fraumeni syndrome. It is the most common gene mutation causing human cancer. S—Stomach cancer B—Breast cancer B—Brain cancer A—Adrenal cancer L—Lung cancer (squamous cell carcinoma) Mnemonic: SBBAL • Flea bitten kidney found in We—Wegener’s granulomatosis Hate—HSP P—Polyngitis S—Subacute endocarditis M—Malignant hypertension • Posterior fossa anomalies Dandy-Walker syndrome—Dilatation of 4th ventricle because of midline arachnoid cyst. Posterior fossa volume is increased. Mnemonic: D for D. D is 4th letter Arnold-Chiari malformation—cerebellar herniation. • Myelin formation CNS—Oligodendrocytes PNS—Schwann’s cells. Mnemonic: COPS • Serology in hepatitis B— s—HbsAg e—HbeAg c—anti HBc ab e—anti HBe ab s—anti HBs ab Note: c antigen lacks soluble surface receptor. So, do not appear in serum.
92
Mnemonics
• Hepatitis D virus Delta virus Defective virus (HDV RNA) Dependent (on HBV) • Causes of Mallory-Denk body— Indian childhood cirrhosis Wilson’s disease Hepatocellular carcinoma Alcoholism α1 anti-trypsin (AT) deficiency Primary biliary cirrhosis Mnemonic: Indian child wil have alcohol AT primary bill • Focal nodular hyperplasia Females more commonly affected (ten times) OCP use is associated Asymptomatic Single Mnemonic: FOCAl
7 Forensic Medicine and Toxicology (FMT) • Mechanism of Injury caused by lightening flash as described by Cooper and Andrews (1995) Direct strike Side flash Step voltage Sledge hammer effect (blunt trauma) Surface arc discharges and touch voltage Mnemonic: 5S Also remember: Four factors of Spencer Burning by superheated air Sledge hammer and blow death by compress pushed before the current Direct effect of high voltage current Effect of expanded and repelled air Mnemonic: BCDE • Drug used for narcoanalysis (truth serum drugs) Scopolamine Sodium pentathal Sodium amytal Sodium seconal Mnemonic: PAS Sodium and Scopolamine • Exception to general rule of professional secrecy C Crime I Infectious disease V Venereal disease I Interest( Self) C Courts of Law S
Servants and employees 93
94
Mnemonics
I Interest( Patient’s) N Negligence suits notifiable disease. CIVIC SIN InP.S . Interest: Patient’s and self • Anti-cholinergic (atropine dhatura) Dry as a bone (dryness of mouth andpoisoning skin) Red as a beet (flushed face) Blind as a bat (dilated pupil) Hot as a hare (hyperpyrexia) Mad as a wet hen (delirium) Or Dryness of mouth and anus (i.e. constipation) Dysphagia Dilated pupils Dry hot skin Drunken gait Delirium Drowsiness Death due to respiratory failure • Seminial stain is identified by UV light (physical methods) Mnemonic: SUV • Constituents of a typical embalming solution Formalin Glycerin Mnemonic: EFG • Methods of torture suspension by the wrist: La bandera (Mnemonic: Wrist band) Beating with the palm on both ears simultaneously— telephone Mnemonic: We pickup telephone to ear • Hanging versus strangulation Hanging features: Stretched neck Saliva (often runs out of mouth) Seminal fluid at glands Carotid artery damage may be seen
Fo re nsic M e d ic ine a nd To xic o log y (FMT)
95
Oblique ligature mark Mnemonic: Hang SSS and CO • Fatty liver is found in Phosphorus > arsenic > mercury poisoning Mnemonic: Fatty PAM • Mercury poisoning: Diphtheritic colitis Mnemonic: Mercury Dips in Cold
• Clinical feature of chronic lead poisoning—acute manifestations Anemia (with punctate basophilia) Burtonian line Colic and constipation: First symptom to arouse suspicion of lead poisoning Drop of wrist and foot Encephalopathy in children Facial pallor: Earliest symptom Genitourinary system: Menstrual disorders, abortions stillbirths, degenerate off-springs and sterility. • Forensic tests to detect seminal stain Acid phosphatase test Barberio test Creatine phosphatase test ELISA test Fluorescence test Mnemonic: ABCEF • Fingerprint patterns Loops 67% Whorls 25% Arches 6–7% Composite 1–2% Mnemonic: LWAC • Cephalic index 70–74.9 (Dolichocephalic)
Pure aryans Absrcins
96
Mnemonics
Negroes Indians Mnemonic: PANI in Doli 75–79.9 Europeans (Mesaticephalic) Chinese Mnemonic: European in Chinese mess 80–84.9 Mongols (Brachicephalic) Oriental Asians Native Americans Mnemonic: MONA Dolichocephalic Rectangular Mesaticephalic Triangular Brachicephalic Rounded Mnemonic: DMB in increasing order • Screening tests for blood stains Benzidine Orthotoluidine Leucomalachite green Phenolphthalein Note: All these works on the principle of Hb as peroxidase, which in presence H2O2 turns odourless bases into coloured salts. • Blood /urine alcohol levels Alcohol dehydrogenase method (ADH method) Breath analysis Cavett method/Kozelka and Hinc method Gas chromatography—most desirable for medicolegal purpose Mnemonic: ABC-GK • Snake venoms Vasculotoxic Vipers (V for V) Neurotoxic Cobra (Convulsion) (C for C) Krait (paralysis) Coral Mnemonic: CKC Myotoxic: Sea snake
Fo re nsic M e d ic ine a nd To xic o log y (FMT)
• Gustafson method of age determination individual teeth: Root transparency: Precise measurement Root resorption Attrition Paradentosis Secondary dentin formation Cementum opposition Mnemonic: TRAP SC
97
by inspection of
• Harrison and Gilroy test: Antimony, barium, lead Mnemonic: Anbale Atomic absorption spectroscopy (AAS): Antimony, Copper, barium Mnemonic: Ancoba Neutron activation analysis: Antimony, copper • Getters test is done for drowning. It estimates chloride content of blood from both sides of the heart. A difference of 25% in chloride content is considered. Significant features seen Fresh water drowning: Hemodilution Lysis of RBC with liberation of potassium Chloride content of left side of heart decreased Salt water drowning : Hemoconcentration RBCs are crenated Chloride content of left side of heart increased • Sign of death from typical drowning Persistent profuse fine froth from the mouth and nose Materials (that could be obtained from water only) grasped in the hand Fine typical froth from the air passage Increased volume and edematous condition of the lungs. Finding of diatoms in the tissues, especially brain and bone marrow.
98
Mnemonics
• Permanentteeth Firstmolar Central incisor Lateralincisor Firstpremolar Secondpremolar Canines Secondmolars Thirdmolars
Eruptiontime 6–7years (6–8 years) 7–8 years 8–9years 9–11years 10–12years (11–12 years) 11–13 years 12–14years 17–25years
• Magnan’s symptoms:
Feeling as if grains of sago are lying under skin Feeling as if small insects (cocaine bugs) are creeping on the skin. It is seen in chronic cocaine poisoning. Macewan sign: An indication of hydrocephalus in which
percussion of the skull generates a cracked pot sound. • Putrefaction is delayed after death due to poisoning by Carbolic acid Arsenic Antimony Nux Vomica (strychnine) Zinc chloride Mnemonic: CARAN Vomit Zinc to delay putrefaction • Dactylography (Galton system)—Study of finger prints. Mnemonic: DaGa Poroscopy ( Lo card’s system)—Study of number, sizes and distribution of pores of sweat glands on ridges (used only when a part of finger print is available). Mnemonic: PoLo Podogram—Study of foot print. Cheiloscopy (queiloscopy)—Study of lip prints. Rugoscopy (palatoprints)—Study of anterior part of palate. Mnemonic: RuPa • White vitriol—Zinc sulphate Blue vitriol—Copper sulphate.
8 Preventive and Social Medicine (PSM) • World health report 2008 Primary health care: now more than ever—the report proposes four sets of reforms Public policy reforms Leadership reforms Universal coverage reforms Service delivery reforms Mnemonic: PLUS • Eight essential components of primary health care (Alma-Ata declaration) E ducation concerning prevailing health problems and methods of preventing and controlling them. Prevention and control of locally endemic diseases Immunization against major infection diseases Maternal and child health care including family planning Essential drugs provisions Promotion of food supply and proper nutrition Treatment of common diseases and injuries
Adequate supply of safe water and sanitation. Mnemonic: ELIMENTS • Ratio: Prevalence Standardised mortality ratio Case fatality ratio Mnemonic: PSC (Public Service Commission) • National health policy 2002 2005—Polio, leprosy and yaws Mnemonic: POLY 2015 (fifteen) – filaria. Mnemonic: f for f 99
100
Mnemonics
• lMCI—five major illnesses Diarrhoea Respiratory tract infection (including otitis media) Malaria Measles Malnutrition Mnemonic: DRM3 • Chemoprophylaxis Plague: Tetracycline Cholera: Tetracycline Mnemonic: PCT Influenza A: Amantadine Bacterial conjunctivitis Erythromycin ophthalmic ointment Diphtheria: Erythromycin pertussis: Erythromycin Mnemonic: BCDEP • National programme for control of blindness 20 01:Target diseases under vision 2020 (India) Refractive errors and low vision Cataract Childhood blindness Trachoma Diabetic retinopathy Corneal blindness Glaucoma Mnemonic: Refree Catch Track of DCG of India Vision 2020—WHO, Geneva, 1999 5 major blinding diseases Refractive errors and low vision Cataract Childhood blindness Onchocerciasis (River blindness) Trachoma Mnemonic: Refree Catch river track of WHO. • Arthropod Borne diseases Aedes
Dengue haemorrhagic fever, dengue
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Rift valley fever Chikungunya fever Yellow fever Mnemonic: DARCY Culex Japanese encephalitis Bancroftian filariasis West nile fever Viral arthritis Mnemonic: Japan Ban West Virus for culex Sandfly Kala-azar Oriental sore Oraya fever Sandfly fever Mnemonic: KOOS Louse Pediculosis Epidemic typhus Relapsing fever Trench fever Mnemonic: LEPRT Rat flea Bubonic plague Endemic typhus Chiggerosis Hymenolepsis diminuta Mnemonic: Rat on BEnCH Trombiculid mite Scrub typhus Rickettsial pox Mnemonic: SR Mite • Lepromin test Early reaction: Fernandez reaction (48 hours reading > 10 mm area of redness. Mnemonic: EF Late Mitsuda reaction (21 days nodule > 5 mm) • Breeding habits of mosquitoes Alphabetically Aedes: Artificial water Mnemonic: A for A
102
Mnemonics
Anopheles: Clean water Mnemonic: Clean –Anna Culex: Dirty water Mnemonic: CD Mansonioides: Plant (vegetation) water Mnemonic: Plant Man • Biological transmission of arthropod-borne diseases Propagative: Plague bacilli in rat flea. Mnemonic: P for P Cyclopropagative: Malarial parasites in mosquito Mnemonic: CPM Cyclodevelopmental: Filarial parasite in culex mosquito and guinea worm embryo in cyclops. Mnemonic: CDFG • Indian reference female: Approximate energy requirement Light work—1900 Moderate work—2200 (i.e. + 300) Heavy work—2800 (i.e. + 600)
• SAFE strategy for trachoma Surgery Correction of entropion and trichiasis Mnemonic: ENT surgery Chemoprophylaxis is given for Meningococcal meningitis (rifampicin) Diphtheria Malaria(chloroquine) Pertussis Conjunctivitis InfluenzaA(amantadine) Cholera Tetanus(penicillin) Leprosy (dapsone) Pneumonicplague
My Dear Mother Prepare Cool Ice Cream in Ten Litre Pocket
Pre ve ntive a nd So c ia l Me d icine (P SM)
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• Parathion: Aryl phosphate Mnemonic: R for R Malathion: Alkyl phosphate • HDI Knowledge Income Longevity (life expectancy at birth) Mnemonic: KILO • BCG vaccine: Normal saline Measles vaccine: Distill water Mnemonic: MD • Types of data Nominal data: No implication of order or ratio O rdinal data: Meaningful order but interval connot be measured Interval data: Meaningful order, interval can be measured but ratio of scores are not meaningful. Ratio data: Meaningful order, interval can be measured and ratio of scores are meaningful. Mnemonic: NOIR First two are qualitative data and last two are quantitative data. • Mosquito control: Anti-adult measures Residual spray: M alathion OMS-33 Lindane DDT Mnemonic: MOLD Space spray: Pyrethrum Residual insecticide: Ultra low volume space spray (fenitrothion, malathion) Note: Malathion is not recommended as a larvicidal agent. • Pert ussi s co mpon ent in D PT enha nces the pote ncy o f diphtheria toxoid.
104
Mnemonics
Diphtheria toxoid increases the immunogenicity of Hib vaccine. • Five cleans for control/prevention of neonatal tetanus Clean blade Clean caresurface Clean cdord elivery Clean hands Clean tie for the cord Mnemonic: BCD-HT • Factors determining sample size Design of study Accuracy of measurements Precision (degree of) required Plan of statistical analysis Prevalence of disease in cohort study or ratio of case to control in case control study Mnemonic: DAS3P • Insect Rickettsial disease Agent Vector Louse Epidemic typhus R. prowazeki Louse Trench fever Rochalimaea quintana Flea Endemic typhus R. typhi Tick Tick Mite Mite
(Murine typhus) Rocky Mo untain spotted fever Indian tick typhus Rickettsial pox Scrub typhus
R. rickettsii
Mnemonic LEPRO Lottery Queen FLENTY TIMORI
R. conorii TIINCON R. akari MIRIAKA R. tsutsugamushi MISTSU
• HIV screening— ELISA Rapid test Simple test i.e. ERS battery Confirmatory test—Western blot (protein based)
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105
• 2 screening tests used in— Sensitivity Specificity
Series
Parallel
↓ ↑ ↑ ↓
↑ ↓ ↓ ↑
PPV NPV Mnemonic: P letter words ↓ in parallel
• Disease control—reduction of transmission of any disease so that it stops to be a public health problem. It implies— ↓ complication ↓ duration of disease ↓ financial burden ↓ incidence Mnemonic: CDFI • Index case—1st case coming to the notice of investigator. Mnemonic: I for I Primary case—First case of a disease in a community. Secondary case—All cases who develop the disease from the primary cases. In India, index cases are usually secondary cases. • MUFA—Maximum in groundnut (Moongfali). • RBSK—Rashtriya Bal Swasthya Karyakarm Target beneficiary—0–18 years of age Services— Diseases Deficiency Disability and developmental delays Defects Mnemonic: 4D • RKSK—Rashtriya Kishore Swasthya Karyakarm Adolescent—10–19 years Components— Clinics Community Communication Content
106
Mnemonics
Convergence Coverage Counseling Mnemonic: 7C
• Skewed distribution Tail on Right side is Positive skewness. Mean > Median > Mode. Mnemonic: TRP • Type I error— Null hypothesis True and Rejected. Mnemonic: NTR is no. 1 Type II error—Null hypothesis false and accepted. P value = Probability of doing type I error. α—maximum permissible limit of type I error (usually 5%)
β—probability of type II error Note: Confidence level in a study = 1–α Power of study = 1– β For significant results, confidence level > 0.95 or 95%. • Parametric tests are used to compare mean and SD (standard deviation) in Paired data (1 group)—Paired test (before and after) Unpaired data of 2 groups—Unpaired test Unpaired data of 3 or more groups—ANOVA Mnemonic: PUA
• Non-par ametric test s are u sed t o com pare per centage or fraction in: Sign test—Paired data (1 group) Chi-square test—Unpaired data (2 or more groups) Mnemonic: chai ki quality • Statistical graphs Qualitative— Pictogram Pie chart
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Bar chart Map Mnemonic: Pic pie bar map Quantitative— FFrequency requency polygon curve Line diagram Line chart Ogive (frequency cumulative curve) Scatter diagram Histogram Mnemonic: (FL)2OSH • Hospital waste management 1—Human anatomical waste 2—Animal waste 3—Microbiology and biotechnology 4—Waste sharps 5—Cytotoxic drugs and discarded medicines 6—Solid waste (cotton/cloth) 7—Solid waste (plastic/rubber) 8—Liquid waste 9—Incineration ash 10—Chemical waste Mnemonic: HAM Share drugs and SoSo LIC • Obesity Best indicator—Body mass index = Weight in kg/(height in meter)2. Other indicators— Height in cm—Hundred = Broca’s index. Mnemonic: HHB Corpulence index = Actual weight/Desired weight Mnemonic: CAD Ponderal index = Height/cube root of weight. Mnemonic: Pin Hai CRoW
108
Mnemonics
• Impact indicators of ASHA— IMR—major TB cases Leprosy cases PEM rates Mnemonic: PITL • Focussed group discussion (FGD)—6–12 Mnemonic: 6 is F Panel discussion—4–8 • Lecture—ideal audience size < 40 Role play/socio drama < 25 • SPIKES—done for cancer prognosis communication S—Set up interview P—Perception is assessed I—Invitation to explanation K—Knowledge E—Emotions S—Summary and strategy Note: P- SPIKES—for Ca breast. P stands for protocol. • GATHER approach is used for contraceptive counseling in RCH G—Greet the couple A—Ask the contraceptive requirement T—Tell available methods H—Help choose best methods E—Explain the usage of contraception R—Return visit • Doctor–patient communication 3 levels— Intellectual Cultural Emotional
Pre ve ntive a nd So c ia l Me d icine (P SM)
4 types— Default Paternalistic Consumeristic Mutualistic • Kuppuswamy scale is based on— Education Income Occupation Mnemonic: EIO. All 3 are vowels • International health regulation 2005 guidelines of WHO Diseases notifiable to WHO— Smallpox SARS Wild polio Yellow fever Plague Human influenza Cholera Mnemonic: SSP Wild yellow PHC • NPCB—supported by World bank Mnemonic: Blindness-Bank RNTCP—supported by WHO RCH (family planning)—UN fund for population activity Mnemonic: family-Fund • UNICEF HQ—New York. Mnemonic: New Chef GOBI—For reduction of under 5 mortality rate Growth monitoring ORS Breast feeding Immunization
109
110
Mnemonics
New additions— Female education Family planning Food supplementation • WHO low osmolarity ORS Sodium—75 mmol/L Glucose—75 mmol/L Chloride—65 mmol/L Potassium—20 mmol/L Citrate—10 mmol/L Total osmolality—245 Mnemonic: SGCl PCi-75/75/65/20/10 Glucose—13.5 gm Trisodium citrate—2.9 gm NaCl—2.6 gm KCl—1.5 gm Total—20.5 gm • Essential healthcare—4A Available Acceptable Accessible Affordable
9 Eye • Function of extraocular muscle Superior oblique Lateral (abduction) Intorsion Depression Mnemonic: SOLID • Argy ll R obert son pupi l (A RP) (also calle d ligh t nea r dissociation) Accommodation reaction present (ARP) Pupillary r eaction a bsent (ARP-PRA) (both direct and consensual) Seen in several conditions affecting midbrain (pretectal nucleus) • RAPD (Marcus Gunn pupil) is most characteristic of lesion in optic nerve Mnemonic: Rapid Nervous Gun
• Anterior surface of cornea has highest refractive power (2/3rd of eye’s refractive power) Centre of lens has highest refractive index. Mnemonic: COP (Cornea-Power) • Visual pathway and site of lesion Optic nerve: Ipsilateral blindness Proximal part of optic nerve: Ipsilateral blindness with contralateral hemianopia or superior quadrantanopia Central level of chiasma: Bitemporal hemianopia Mnemonic: Hum Bite central Cheese 111
112
Mnemonics
Optic tract: Homonymous hemianopia. Temporal lobe: Quadrantopic homonymous defect Mnemonic: Tample queen Optic radiation: Homonymous hemianopia Anteriorly in occipital crescentic field defect cortex: Contralateral temporal Occipital lobe: Homonymous hemianopia (usually sparing the macula) Mnemonic : HRT—Homonymous hemianopia in optic radiation and optic tract • Primordial tissue and derivatives Surface ectoderm: Conjunctival epithelium Corneal epithelium Lacrimal glands Tarsal glands Lens • Various grades of visual defects Low vision— < 6/18 to 6/60 —Cat 1 Economic blindness —< 6/60 to 3/60—Cat 2 Social blindness—< 3/60 to 1/60—Cat 3 Manifest blindness —< 160 to only light perception— Cat 4 Absolute blindness—No light perception—Cat 5 Mnemonic: LESMA-631 LN
Note: WHO grade: Low vision — Cat 1 and 2 Blindness — Cat 3, 4 and 5 • Causes of persistent hyperplastic primary vitreous (PHPV) Patau syndrome (Trisomy 13) Norries disease Walker Warburg syndrome Mnemonic: Norries persistently walks to pataya • Visual pathway from retina to visual cortex Ganglion cells: M (Magno cells) lateral geniculate body: Magnocellular lamina— (lamina 1, 2)
Eye
113
Visual cortex: Superficial layer 4C Function: Movement, depth, location and flicker Mnemonic: MSM • Vogt triad: Tuberous sclerosis and congenital glaucoma Islet of Vogt — pterygium • CMV retinitis occurs in HIV patients with < 50 CD4 T cells • Ophthalmoscopy Indirect: Inverted, real, 5 times magnification, ora serrata is seen Mnemonic: I for I Direct: Erect, virtual, 15 times magnification. • Medication for treatment of open angle glaucoma Decrease in aqueous secretion: Beta blocker (timolol) Clonidine congeners (Brimonidine, Apraclonidine) Carbonic anhydrase inhibitors (Acetazolamide,Dorzolamide) Mnemonic: ABCD Increase in trabecular outflow: Pilocarpine (miotics) Mnemonic: Tray Se Pilo Increase in uveoscleral outflow: Prostaglandins (latanoprost)
Note: Only acetazolamide is oral, others mentioned are topical. Atropine is C/I in all types of glaucoma. Pilocarpine is also C/I in uveitis • Bilateral subluxation of lens Marfan’s syndrome: Downward and temporally (Harrison, 17th edition) Homocysteinuria: Downward and nasally. • Most common ocular infection in AIDS patients— CMV MC cause of chorioretinitis in AIDS patients—CMV MC ocular lesion in AIDS—HIV microvasculopathy (involving conjunctiva and retina) MC ocular neoplasm in AIDS—Kaposi sarcoma
114
Mnemonics
Earliest and most consistent finding in HIV retinopathy— cotton wool spots. CMV retinitis occurs in HIV patients with < 50 CD4 T cells • Predisposing factors for sympathetic ophthalmitis IInjury ncarceration of iris Infection is absent Mnemonic: 3I • Indication of LASIK surgery— criteria Cornea should not be excessive flat or steep. Central corneal thickness > 500 micron Refraction must be stable for 18 months Age > 18 years Myopia – 1 to – 20 diopters Mnemonic: CT RAM Contraindication of LASIK Diabetic retinopathy Autoimmune disease Dry eye Monocular patient Infections, e.g. conjunctivitis, keratitis Glaucoma Keratoconus Poor endothelial cell count <1500
Thin cornea <450 micron Mnemonic: DAD MIG KPT • Management of senile entropion Bick’s operation Wobin, Jones and Rech operation (plication of inferior lid retractors) Modified Wheeler’s operation. Weiss operation Mnemonic: Bick’s 3W • The extent of normal visual field with a 5 mm white color object is
Eye
115
Superiorly 50° Nasally 60° Inferiorly 70° Temporally 90° Mnemonic: SNIT (in increasing order) • Tonography is a non-invasive technique for determining the facility of aqueous outflow. Tonometry is measurement of intraocular pressure by an instrument called tonometer, this process is called tonometry. • Protanomalous—defective red color perception Deuteranomalous—defective green color perception Tritanomalous—defective blue color perception Mnemonic: RGB • Superior oblique: IVth cranial nerve Mnemonic: SO4 Lateral rectus: VIth cranial nerve Mnemonic: LR6 Rest extraocular muscles—IIIrd cranial nerve
• Pupil in different conditions. Acute conjunctivitis—normal Acute uveitis—constricted/irregular Acute congestive glaucoma—dilated vertically oval Retrobulbar neuritis—normal • Open angle glaucoma is characterised by the triad of Typical visual field defects (earliest visual field defects in glaucoma are small isolated paracentral scotomas between 2° and 10°) Raised intraocular pressure Optic disc changes/ cupping of disc (vertical cup/disc ratio becomes greater than horizontal) Mnemonic: VIC • Wer nick e’s hem ian opic pup illa ry r eac tion— opti c tr act lesion. Marcus Gunn pupil—optic nerve lesion Argyll Robertson pupil— Pretectal neucleus involved
116
Mnemonics
Mnemonic: ARP-Pre Holmes Adie—ciliary muscle involvement.
• Congenital glaucoma (buphthalmos)— characteristic triad of symptoms Blepharospasm Photophobia Lacrimation Mnemonic: BPL Signs: Mild proptosis Enlarged cornea Haab’s stria (opacity due to rupture in Descemet’s membrane) Deep anterior chamber Lens subluxation Note: In megalocornea, eye is absolutely normal except for the large cornea. • F ast or saccadic horizontal eye movements—abducens nucleus (ipsilateral)—PPRF (ipsilateral)—contralateral frontal lobe Mnemonic: F for F Smooth/persuit eye movement—Parietal lobe Mnemonic: P for P
Note: Cerebral structures determine when and where eye move, while brainstem determine how they move. • Primary optic atrophy: It is c aused by lesions affecting the visual pathways from retrolaminar portion of the optic nerve to the lateral geniculate body. Causes Hereditary optic neuropathy Toxic and nutritional optic neuropathies Traumatic optic atrophy Retrobulbar neuritis Compressive lesions (Tumors and aneurysms) Mnemonic: HTN TRAT
10 Ear, Nose and Throat (ENT) • Trotter’s triad Mnemonic: CD 105 CD: Conductive deafness 10: Palatal paralysis due to involvement of CNX 5: Temporoparietal neuralgia due to ipsilateral involvement of CNV
• Endoscopic cordectomy: Classification by European laryngeal society Type I Sub epithelial cordectomy Type II Subligamental cordectomy Type III Transmuscular cordectomy Type IV Total Cordectomy Mnemonic: ELMT (like element) Extended cordectomy encompassing Type IVa — Contralateral fold Type IVb— arytenoids Type IVc— ventricular fold Type IVd — subglottis Mnemonic: CAVES • Structures fully developed at birth – Mastoid antrum – Auditory ossicles – Tympanic cavity – Internal ear structures Mnemonic: MATI 117
118
Mnemonics
• Pathophysiology of Romberg test Equilibrium (central postural control) is dependent on input from three peripheral modalities: Proprioception (joint position sense) carried in posterior column of spinal cord. Vision Vestibular apparatus Mnemonic: PVR Vision • Vestibular schwannoma/acoustic neuroma can arise from any cranial nerve except optic and olfactory nerve because they are myelinated by oligodendroglia rather than Schwann cells. • Syndromes associated with sensorineural deafness Bartter’s syndrome Alport’s syndrome Distal renal tubular acidosis Mnemonic: BAD • Siegel’s pneumatic speculum: Uses To test mobility of tympanic membrane To see magnified view of small perforation To introduce medicine into middle ear Fistula test for vestibular function. Mnemonic: 3MF • Isshiki’s categorization of thyroplasty Type 1 Type 2 Type 3 Type 4
Medial displacement Lateral displacement Shortening (relaxation)—female to male Lengthening (tensioning)—male to female (low to high pitch) Mnemonic: Mela ka Shole • Weber test Conductive deafness—lateralised to diseased ear Sensorineural deafness—lateralised to better ear Mnemonic : LCD—Lateralised in conductive deafness to diseased ear
Ea r, No se a nd Thro a t (ENT)
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• Rinnie’s test: Positive Rinnie AC > BC—Normal person and sensorineural deafness Mnemonic: PoRi AB Normally Sensed • Meniere’s disease Tinnitus (fluctuating) Vertigo Sensorineural hearing loss Mnemonic: TVS • Fistula test: Induction of nystagmus (vertigo) by producing pressure changes in the external canal, which are then transmitted to the labyrinth. Normal condition—negative (as pressure cannot be transmitted) Positive in Cholesteatoma Surgically created window in the horizontal canal (fenestration operation) In abnormal opening: In oval window (post stapedectomy fistula) In round window (rupture of round window membrane) False positive: Congenital syphilis Meniere’s disease (Hennebert’s sign) False negative: Cholesteatoma fills the site of fistula Note: It is absent when labyrinth is dead. • Etiology Malignant otitis externa Pseudomonas Otitis externa Staphylococcus aureus Otomycosis Aspergillus niger, A. fumigatus, Candida albicans Otitis externa hemorrhagica—viral Acute otitis media in paediatric age group Streptococcus pneumoniae > H. influenzae > M.catarrhalis. • Water’s (occipito mental)—maxillary sinus (best seen) Caldwell’s (occipito frontal)—frontal sinus (best seen) Mnemonic: Front OF Well
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• Neoplasm showing calcification: Craniopharyngioma (75%) Oligodendroglioma—glioma (50%) Choroid plexus papilloma (25%) A fossa tumor) (20%) Mstrocytoma eningioma (posterior (20%) Ependymoma (unusual but if seen dense) Mnemonic: CO CAME Note: Most common cause of intracranial calcification is pineal calcification. • Acute pancreatitis—X-ray abdomen Gasless abdomen Colon cut off sign SRenal entinel loop halo sign Mnemonic: Halo GCS • Chronic pancreatitis—ERCP Beaded appearance String of pearls appearance Chain of lake appearance Rat tail stricture of CBD Mnemonic: Be strong chained rat • R asmussen: aneurysm—p ulmonary artery PR Mnemonic Physicalquantity Radioactivity Absorbed dose Dose equivalent Radiation exposure
SIunit Becquerel (Bq) Gray (Gy) Sievert (Sv) Columns/kg
Mnemonic: ABC Ab gray is red Shiv and Ram are equivalent
Ex colonel Rungta
Non-SIunit Curie Rad Rem Roentegen
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• Malampatti grading—inspection of oral cavity (for assessment of difficult airway) I—Faucial pillars, soft palate, uvula II—Faucial pillars, soft palate, uvula masked by base of tongue III—Only soft palate IV—Hard palate Mnemonic: UMSH. Like Umesh • ASA physical status scale (American Society of Anesthesiologist) 1—Healthy patient 2—Mild to moderate systemic disease 3—Severe systemic disease 4—Severe systemic disease that is Constant threat to life 5—Moribund patient not expected to survive without surgery 6—D eclared brainpurpose. dead patient whose organ is being removed for donor Mnemonic: HMS CMD • Facial artery— From cervical part: Submental Tonsillar Ascending palatine G landular (to lymph nodes and submandibular gland) Mnemonic: STAG From facial part:
Superior labial Inferior labial Unnamed posterior branches Lateral nasal Mnemonic: SILa ko UP me LaNa • Developmental dysplasia of hip DAD—Adduction to dislocate—Barlow maneuver RAB—Abduction to reduce—Ortolani maneuver Mnemonic: O rab
11 Medicine
• Bacterial pneumonias associated with cavitation Staphylococcus Klebsiella Pseudomonas Anaerobic bacteria Mnemonic: Staph Klub main Pseudo Anna ka Cave • Bronchogenic carcinoma Cavitatory variant : Squamous cell (most common) Large cell Mnemonic: Squat in Large Cavity Central location: Squamous cell Small cell Mnemonic: SSC Peripheral location: Adenocarcinoma Large cell Mnemonic: PAL • ARF: Prerenal versus intrinsic Mnemonic: FRU Na+ is less in Pre-renal ARF Fractional excretion of Na+(%) <1. U
Renal failure index
+
Na
P Na
+
<1
Ucr Pcr
Urinary sodium concentration <10 mmol/L or < 20 mEq/L. • Coagulation factor def.—treatment II, V, X, VII and XI—FFP VIII—F VIII concentrate 122
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IX—F IX concentrate Fibrinogen, XIII—Cryoprecipitate Mnemonic: Cry in First and thirteenth • Paraneoplastic syndrome Small cell (lung) Ca :
Calcitonin ACTH ANF AVP (vasopressin) Gastrin releasing peptide Mnemonic: Small CAG Squamous cell CA—PTH Mnemonic: Squat Pith • Restless leg syndrome Drugs causing it: Alcohol Antipsychotics Barbiturates Benzodiazepines Caffeine Mnemonic: ABC Also remember: Common causes: Idiopathic/familial Iron def. anaemia Chronic renal failure
• Bacteria associated with invasive diarrhoea Plesiomonas Listeria monocytogenes Yersinia pestis A eromonas Shigella Salmonella Entero invasive E. coli Mnemonic: PLAY SIS
• Type of LKM antibodies Anti-LKM 1 Chronic hepatitis C Autoimmune hepatitis 2 Anti-LKM 2 Drug induced hepatitis Anti-LKM 3 Chronic hepatitis D Mnemonic: A1 C1 Dr2 D3
123
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• Reiter’s syndrome characteristic triad (found in one-third of patients) Reactive arthritis Conjunctivitis Urethritis Mnemonic: RCU • Strawberry gingivitis—Wegener’s granulomatosis Strawberry tongue—Kawasaki disease Strawberry vagina—Trichomonas • Temporal arteritis worsens on exposure to cold Multiple sclerosis worsens on exposure to heat (Uthoff’s) Mnemonic: CT • Zona glomerulosa—mineralocorticoid Zona fasciculata—glucocorticoid Zona reticularis—Sex steroid Mnemonic: GFR-MGS • Normal peressure hydrocephalus triad Dementia (mild to moderate) Urinary incontinence Ataxic or apractic gait Mnemonic: NPH has DUA • Motor neuron disease UMN and LMN: Amylotropic lateral sclerosis UMN only: Primary lateral sclerosis Mnemonic: Upper Primary or UPri LMN only: Progressive spinal muscular atrophy (progressive London or lower progressive) • Treatment of visceral leishmaniasis First line Pentavalent antimony Sodium stibogluconate Meglumine antimonate Amphotericin B
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Paromomycin Pentamidine Miltefosine Mnemonic: SPAM Cutaneous leishmaniasis First line Pentavalent antimony Parenteral alternative Amphotericin B Pentamidine Mucosal leishmaniasis First line Pentavalent antimony Amphotericin B Alternative Pentamidine • Omphalocele Chromosomal abnormalities C ongenital abnormalities (including cardiac and CNS) Carnell’s pentalogy Beckwith-Wiedemann syndrome Mnemonic: 3 COMB • Hypoxic ischemia Pr e term infants— Peri ventricular leucomalacia—spastic diplegia Mnemonic: Pre Peri dip Term infants—Subcortical white matter and basal ganglia— status marmoratus—Spastic quadriplegia (Basal ganglia and thalamus) Mnemonic: Term = 3 SQ Modified Jones’ criteria for rheumatic fever Major critera Carditis Arthritis (migratory polyarthritis) Sydenham’s chorea Subcutaneous nodules Erythema marginatum Mnemonic: CASSEt
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Mnemonics
• HSP is characterized by a tetrad of Purpura Arthritis Glomerulonephritis Abdominal pain Mnemonic: PAGlA • Renal papillary necrosis: Associated conditions (underlying mechanism is ischaemia) Diabetes mellitus Obstruction of urinary tract with infection Sickle cell disease Analgesic abuse (aspirin) Mnemonic: DOSA Note: Alcohol also ca uses RPN. • Virchow’s triad for venous thrombosis Hypercoagulability of blood Injury to endothelium Stasis of blood Mnemonic: HIS • Nitroblue tetrazolium test is used for phagocytosis Mnemonic: Phani • Framingham major criteria for congestive heart failure PND Neck vein distension Rales Positive hepatojugular reflux Increased venous pressure (> 16 cm H2O) Cardiomegaly Acute pulmonary oedema, and S3 gallop Mnemonic: PNR PICASo • Burn-curling ulcer-duodenum Mnemonic: BCD
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Cushing’s ulcer—Stress ulcer Mnemonic: S for S Peripheral aneurysm —Popliteal artery (70%) Mnemonic: P for P Central dot sign—Carolis disease Mnemonic: C for C • Achalasia cardia—Bird’s beak appearance Diffuse esophageal spasm—Corkscrew esophagus Mnemonic: AB-CD Ca esophagus— Rat tail appearance (Mn: Carat) • Antiviral therapy in chronic hepatitis B is indicated in HBsAg (+), HBeAg (±), and HBV DNA high levels and ALT elevated Note: In above case, if HBeAg is – ve, it is called precoremutant. Viral hepatitis—ALT Alcoholic hepatitis—AST (S for Sharab) • Hypocellular bone marrow ± cytopenia Starvation Q fever Legionnaire’s disease Anorexia nervosa Mycobacteria Mnemonic: Starving QLAM is Hypo • C-ANCA—Cytoplasmic proteinase 3 is the target antigen. P-ANCA—Perinuclear myeloperoxidase is the major target antigen. Mnemonic: CP-MP • Pontine syndromes Ventral pontine syndrome— Millard-Gubler syndrome Mnemonic: VM Lower dorsal pontine syndnome—Fovilles syndrome Mnemonic: FOLD
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Mnemonics
Upper dorsal pontine syndrome—Raymond-Cestan syndrome Mnemonic: Ray UDP • Features of pontine stroke Hyperpyrexia H yperhydrosis Hyperapnoea (severe) Hyperventilation/ Quadriplegia and coma Pin point pupil, occulocephalic manoeuvre/doll’s head, ocular blobbing Decerebrate rigidity Mnemonic : 4H + Quadriplegia + Ocular features + Decerebrate rigidity • Damage to re d nucleus causes contralateral involuntary movements Chorea Athetosis Tremor Mnemonic: Red CAT • Bene dikt’ s syndr ome— Ipsi later al ocul omoto r palsy + contralateral involuntary movement —chorea, athetosis, tremor Nothnagel’s syndrome—Ipsilateral oculomotor palsy + contralateral cerebellar ataxia Claude’s syndrome = Benedikt + Nothnagel • Laurence–Moon–Biedl syndrome Autosomal recessive Mental retardation Obesity Retinitis pigmentosa Polydactyly Hypogonadism Mnemonic: MORPH • CNS tumours Intra-axial Neuronal tumor Astrocytoma (glioma) Lymphoma
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Mnemonic: NALy Extra-axial Pituitary tumor Schwannoma Meningioma (dura based) Mnemonic : PSM. Also, dura matter is a Meninge. (PSM is extra-axial)
• Contrast nephropathy is more common in individuals with pre-existing Metformin Multiple myeloma CRF (chronic renal failure) CCF (congestive cardiac failure) Diabetes mellitus Dehydration (hypovolemia) Mnemonic: (MCD)2 • Obstructive lung disease versus restrictive lung diseases In obstructive lung disease, vital capacity and FEVI/FVC decrease, others remain normal (diffusion capacity), increases (residual volumes) or normal to increases (total lung capactiy). – In restrictive lung disease, VC, RV,TLC, DLCO, all decreases except FEVI/FVC which is normal to increase. • Obstructive lung disease Asthma Bronchiectasis Bronchiolitis ystic fibrosis COPD (chronic bronchitis and emphysema) Mnemonic: ABC • Lower motor neuron (LMN) palsy Flaccidity (hypotonia) Fasciculation Flexor plantar Individual muscle paralysis Degeneration reaction Atrophy (wasting) is marked (cardinal feature) Mnemonic: 3FIDA
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Mnemonics
Upper motor neuron (UMN) palsy Extensor plantar Clonus Clasp knife spasticity (hypertonia) Group of muscles affected Mnemonic: ECG Note: Loss of superficial reflexes are found in both UMN and LMN. • Wernicke’s encephalopathy Triad of: Global confusion Ophthalmoplegia (due to LR palsy) Ataxia Mnemonic: GOA • Seven adverse prognostic factors for Hodgkin’s disease Leukocytosis with WBC > 15,000 Serum albumin level < 4 g/dl Lymphocytopenia with either one Absolute lymphocyte count < 6000/ml Stage IV disease Hb < 10.5 g/dl Age > 45 years Male Lymphocytes < 8% of WBC Mnemonic: LAL SHAMA Thrombotic thrombocytopenic purpura (TTP) Decreased renal function Disturbed neurological function Thrombocytopenia Fever Microangiopathic hemolytic anaemia Pathognomonic of TTP—pentad + normal coagulation tests Mnemonic: RNT Fever in MAHA, TTP • Jodbasedow disease—iodine induced hyperthyroidism Caused by: Diet Radiographic contrast material Iodine containing drug like amiodarone
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Wolff -Chaikoff effect—iodine dependent transient suppression of thyroid. Prevents iodide organification. Mnemonic: Wolf are decreasing • Wegener’s granulomatosis Characteristic triad of Upper respiratory tract infection Lower respiratory tract infection Renal involvement Mnemonic: ULR • ATP 7B—Chr omosome 13—Wilms’ disease ATP 7A disease—kinky hair disease. • Pure motor neuropathies Hereditary spinal muscular atrophy Lower motor neuron form of amylotropic lateral sclerosis Lambert-Eaton myaesthenic syndrome Poliomyelitis Lead intoxication Dapsone intoxication Adult variant of hexosaminidase deficiency Acute intermittent porphyria (occasionally) Tick bite paralysis Mnemonic: Here, a lamba and lower pole is leading dapsone to adult variant of porphyria by the tick bite
• Malignant melanoma—Clark level. I Restricted to epidermis II Invading papillary dermis III Impinging reticular dermis IV Invading reticular dermis V Invading subcutaneous tissue Mnemonic: EPRRS Impinges before invasion • MEN2A (Sipple) MTC
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Mnemonics
Pheochromocytoma Parathyroid hyperplasia or adenoma Cutaneous lichen amyloidosis Hirschsprung’s disease FMTC Mnemonic: MP ke Para main FM se Clah • MEN2B MTC Mucosal and gastrointestinal neuromas Marfanoid features Pheochromocytoma Mnemonic: 2MP
• Noonan’s syndrome versus Turner’s syndrome Noonan’s syndrome A utosomal dominant (seen in both sexes) Pectus carinatum/pectus excavatum Cardiac defect—pulmonary stenosis, HOCM, ASD Mental retardation. Mnemonic: Ad PCM at Noon • Turner syndrome Phenotypically females only Broad chest with widely spread nipples. Coarctation of aorta Bicuspid aortic valve Short fourth metacarpal Mnemonic: Turn broad, CoBi to short. • Metabolic acidosis Normal anion gap Fistula Cholera Mineralocorticoid deficiency Ureterosigmoidostomy Diarrhoea Renal tubular acidosis
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Ammonium chloride ingestion Mnemonic: FC MUDRA Increased anion gap Ketoacidosis ERxogenous enal failuresubstance Lactic acidosis Mnemonic: KERL Lactic acidosis (shock, cardiopulmonary arrest, severe anaemia, carbon monoxide or cyanide poisoning) Ketoacidosis (Diabetics, alcoholics, starvation) Mnemonic: DAS Exogenous substances (Ethylene glycol, methanol, salicylates) Mnemonic: EMS • Amount of sodium bicarbonate given in metabolic acidosis is = 1/2 × body weight (kg) × [Desired HCO3– measured HCO3] Half of this quantity should be administered within first ½ hr. Desired HCO3 = 25 mEq/L. • Acu te pe ric ardi tis— afte r sev eral days T wav es be com e inverted but this occurs only when ST segments return to baseline. Acute myocardial infarction—T wave inversion occurs within hours before ST segment returns to baseline. • Osborne wave/ J wave/ Late delta wave/Camel hump sign is an ECG finding usually seen in hypothermia Mnemonic: CaJOL • Shortly before S1–S4 Mnemonic: 41 Shortly after S1—ejection click (high pitched) Between S1 and S2—midsystolic click Shrotly after S2– S3 Tumor plop, opening snap, pericardial knock Mnemonic: S3TOP
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Mnemonics
• Ejection click Semilunar valves (AS, PS, HTN) Opening snap—AV Valves (MS > TS) Pericardial knock—constrictive pericarditis tumor plop— atrial myxoma • Pansystolic murmur— V SD, MR, TR and aortopulmonary shunts. Mnemonic: MTV Midsystolic murmur—aortic (AS, COA, aneurysm, PDA Pulmonary (PS, P.hypertension, P.artery dilatation) Early systolic murmur TR (in absence of Pul. HTN), MR (in a noncompliant left atrium), VSD (V.small muscular VSD, large VSD with Pul. HTN) • Allergic bronchopulmonary aspergillosis Main diagnostic criteria Clinical history of asthma Pulmonary infiltrates (transient/fixed) Precipitating antibodies to Aspergillus fumigatus Immediate skin reactivity to Aspergillus antigen (wheal and flare response) Peripheral eosinophilia Elevated serum IgE levels Central/proximal bronchiectasis. Mnemonic: All India Exam 2 times, i.e. (AIE) 2 + Bronchiectasis • Causes of transudative pleural effusion Cirrhosis of liver Nephrotic syndrome Myxoedema CHF SVC obstruction Mnemonic: CNMC in SVC is transudative • Exudative pleural fluid Light criteria: Pleural fluid protein / serum protein > 0.5 Pleural fluid LDH/ serum LDH > 0.6 Pleural fluid LDH > 2/3 upper limit of serum LDH
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With increased amylase: Pancreatic pleural effusion Esophageal rupture Malignancy Mnemonic: Amylase increases in PEM With decreased glucose: Bacterial infection Malignancy Rheumatoid pleuritis Mnemonic: Glucose decreases in BMR • The MC cause of sporadic viral encephalitis—HSV-1 The MC cause of epidemic viral encephalitis—arbovirus (JE virus) The MC cause of viral meningitis—enterovirus • Charcot’s joint /neuropathic joints Joints involved STyringomyelia Glenohumeral joint, elbow and wrist abes dorsalis Knee, hip and ankle Diabetes mellitus Tarsal and metatarsal joints Mnemonic: STD from above downwards—position of joints • Disorders associated with Charcot’s joint Syringomyelia Tabes dorsalis Diabetes mellitus Peroneal muscular atrophy Amyloidosis Leprosy Meningomyelocele Congenital insensitivity to pain Mnemonic: STD PALM CO • Down’s syndrome:
Transient myeloproliferative syndrome AML (FAB M7—acute magakaryocytic subtype)
• Extraintestinal mani festation occu rs more comm only with Crohn’s disease than with ulcerative colitis. Those specially associated with Crohn’s disease include: Digital clubbing Oral aphthous ulcers
136
Mnemonics
Peripheral arthritis Erythema nodosum Episcleritis Renal stones (uric acid oxalate) Gallstones Mnemonic: DOPE ERG in Crohn’s
• Approach to diagnosis of arthritis in a single joint Associated with fever Septic arthritis Not associated with fever Acute: Trauma Hemarthrosis Hemophilia Chronic: JRA Trauma Tuberculosis Legg-Perthes disease Mnemonic: JTTL (like Jatil in hindi) • Tubulopathy/ tubulitis PCT—RTA2, Fanconi syndrome Mnemonic: 2 Fan for PC
Thick ascending—Bartter syndrome Mnemonic: BaTA DCT—Gitelman syndrome Collecting duct : RTA 1 Liddle’s syndrome D(Nephrogenic) Renal papilla—Renal papillary necrosis Major calyx/pelvis—hydronephrosis, pyonephrosis, reflux nephropathy Any/all—acute tubular necrosis Mnemonic: 1 Little DIN in CD-Collecting Duct • Syndrome Down’s syndrome Turner’s syndrome
Most likely congenital cardiac lesion ASD of endocardial cushion type (ostium primum type) Coarctation of aorta, bicuspid aortic valve
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Noonan’s syndrome Pulmonic stenosis Holt-Oram syndrome (ASD with bony abnormalities) Familial ASD (Strongest association) Marfan’s syndrome
Aortic artery dilatation, mitral or or pulmonary aortic regurgitation Ellis-van Creveld syndrome ASD + single atrium Rubella PDA > PS > VSD • X-linked recessive X-linked dominant Hemophilia A Hypophosphatemic rickets G6PD deficiency Duchenne-Becker muscular dystrophy Fragile X syndrome Fabry’s disease • LAP scores are decreased in PNH and CML LAP scores are increased in Infection Polycythemia Leukemoid reaction Mnemonic: IPL • Myeloproliferative syndrome Polycythemia vera Idiopathic myelofibrosis Essential thrombocytosis CML • a wave: Right atrial contraction c wave: Bulging of tricuspid valve into right atrium a-x descent: Atrial relaxation and downward displacement of tricuspid valve v wave: Increasing volume of blood in the right atrium v-y descent: Open ing of t ricu spid v alve an d subs eque nt rapid in flow of blood into right ventricle. • a waves: Due to d isten sion prod uced by ri ght atri al contraction Largeawaves Tricuspid stenosis
138
Mnemonics
(atria is contracting Pulmonic stenosis against increased resistance) Pulmonary hypertension Cannon a waves Regularly—during junctional rhythm Irregularly—AV dissociation with ventricular tachycardia, complete heart block Absent a waves—atrial fibrillation • a-x descent—due to both atrial relaxation and the downward displacement of the tricusupid valve during ventricular systole. Accentuated in: Constrictive pericarditis Restrictive cardiomyopathy Cardiac tamponade Mnemonic: PRT Reduced with Reversed with
Right ventricular dilatation Tricuspid regurgitation
• v-y desc ent—b y the opening of the tricus pid valve and subsequent rapid flow of blood into the right ventricle Accentuated in:Tricuspid regurgitation Constrictive pericarditis Reduced with: Tricuspid stenosis Right atrial myxoma (suggest obstruction to right ventricular filling) • Tricuspid regurgitation causes the v waves to be prominent. When becomes severe, the combination ofaasingle prominent v wavesTRand obliteration of x-descent results in large positive systolic wave. • Pheochromocytoma has been called the 10% tumor. 10% of tumor are: Bilateral Malignant Occur in children Multiple Extra adrenal Familial Mnemonic: BCEF MM
Medicine
• Type 1 respiratory failure PaO2—low (< 60 mmHg) PaCO2—normal/low (≤ 49 mmHg) PA-aO2—increased Oxygenation Parenchymal affected: disease (V/Q mismatch) Diseases of vasculature/shunts Interstitial lung diseases Examples Right to left shunts ARDS Pneumonia Emphysema Mnemonic: RAPE Type 2 respiratory failure PaO2—decreased (< 60 mmHg) PaCO2—increased (> 49 mmHg) PA-aO2—normal Ventilation affected: Obstructive lung disease—COPD, foreign body Decreased central respiratory drive Brain injury, meningitis Weakness of respiratory muscle Myasthenia gravis Interstitial lung disease Polymyositis Kyphoscoliosis • Tumors associated with polycythemia vera Hypernephroma Uterine fibromyoma Meningioma Pheochromocytoma Adrenal adenoma Cerebellar hemangioblastoma Hepatoma Mnemonic: HUM PACH
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Mnemonics
• Normal total bilirubin is 0.3 to 1.0 mg/dl Conjugated—0.1 to 0.3 mg/dl Unconjugated—0.2 to 0.7 mg/dl Normal alkaline phosphatase 3 to 13 KA/U (30 to 120 lU/L) • Clinical significance of different casts (urinary casts) Hyaline casts—normal constituent of urine and no attached significance. Tomm-Horsfall protein is the protein secreted by epithelial cells of loop of Henle. This protein may be excreted as hyaline casts RBC cast—glomerular injury White cell cast—interstitial injury seen in interstitial nephritis or pyelonephritis Broad granular cast—interstitial fibrosis and dilatation of tubules, seen in CRF Pigmented muddy brown granular casts—ischaemic or nephrotoxic injury, i.e. tubular necrosis • Parkinsonism is characteristically associated with a triad of Bradykinesia Tremor at rest Rigidity Mnemonic: BTR (like Butter in hindi) • The clinical hallmarks of ‘Huntigton’s disease Behavioural disturbance Chorea Dementia (late onset) Mnemonic: BCD • Migraine Frontotemporal usually (lateralised) Females Family history Focal neurological symptoms like clumsiness and weakness Pain preceded by aura Photophobia Photopsia and fortification spectra Paresthesia with tingling and numbness Mnemonic: 4F4P
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Other—all age group affected Pain builds up • Cluster headache Periorbital or less commonly temporal All ages above 10 years with peak at 30–50 years Male preponderance (90%) No hereditary factor Pain (periodic attacks 1–21 days) Begins without warning Reaches crescendo within 5 minutes Lasts for 45 minutes Excoriating, deep, explosive pain but only rarely pulsatile Awakens the patients from sleep Homolateral lacrimation Reddening of eye Nasal stuffiness Ptosis Nausea • Gastrointestinal lymphoma—modified Ann Arbor classification IE Tumor confined to small intestine IIE Spread to regional lymph nodes IIIE Spread to non-resectable nodes beyond regional nodes IVE Spread to other organs Mnemonic: SRNO • Basal ganglia and lesions Chorea—Caudate nucleus and putamen (striatum) Mnemonic: C for C Athetosis — Lantiform nucleus (globus pallidus) Mnemonic: Lathi Hemi ballismus — Subthalamic nucleus Mnemonic: Hemi-Sub Parkinsonism —substantia nigra • All por phyrias e xcept con genital er ythropoietic porp hyria (which is autosomal recessive) are autosomal dominant.
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Mnemonics
• P24 antigen assay is the earliest marker for HIV infection. It is most useful as a screening test for HIV infection in patient presents prior to development of antibodies. Antibodies to HIV (detected by ELISA or Western blot) generally appear in circulation 4 to 8 weeks after circulation. The MC screening test used for HIV—ELISA The MC confirmatory test—Western blot Screening test in window period of acute HIV infection is P24 antigen The gold standard for diagnosis is PCR (in a patient with positive or indeterminate ELISA test and an indeterminate Western blot or in patients in whom serological testing is unreliable (patients with hypogammaglobulinemia) • Progression to chronicity in various types of hepatitis Hepatitis A—none Hepatitis B—occasional (1–10%), 90% in neonates Hepatitis C—common, 50–70% chronic hepatitis; 80–90% chronic infection. Hepatitis D—relatively common: In coinfection with HBV, it is same as that for HBV In superinfection it is variable Hepatitis E—none Note: Hepatitis B, C, D Hepatitis A, E
Parenteral spread Non-parenteral spread.
• Anti-HbSAg positive alone indicates Immunization with HBsAg Remote past infection False positive • Chronic arsenic exposure is associated with greatly elevated risk of skin cancer (both basal cell and squamous cell carcinoma) Lung cancer Ca liver (angiosarcoma) Bladder Ca Kidney Ca Colon Ca
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• Portal HTN in absence of cirrhosis may result from alteration in hepatic architecture produced by Vitamin A Exposure to vinyl chloride Arsenic intoxication Administration of thorium dioxide Mnemonic: VAVA-thorium • Descending motor paralysis 3 important causes Diphtheria Botulinum Polio Mnemonic: Descending Bottle Paralysis • Subdural empyema: The major pathogen Aerobic and anaerobic Staph (about 12–16%) streptococci (about 50%) Aerobic gram-negative bacilli (3–10%) Other anaerobes (5%) Note: H. influenzae is the most common causative organism in children only. • Order of involvement of adrenals from various primaries in decreasing order: Melanoma > lung and bladder > breast, cervix and colorectal Ca > ovary and kidney > prostate. • Particle size and respiratory tract Particle with size 10–15 mm in diameter—do not penetrate beyond the upper airways. Particle of size 2.5–10 mm—deposit relatively high in tracheobronchial tree Particle of size < 2.5 mm can be carried to lower airways. • Low seru m ir on wi th i ncre ased TIBC —iron defi cien cy anaemia Low serum iron with decreased TIBC—anaemia of chronic disease • Condition giving false positive reaction with the modern RPR and VDRL tests include:
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Mnemonics
Acute false positive reactions (<6 months) Recent viral illness or immunization Genital Herpes HIV Mycoplasma pneumonia Malaria Parenteral drug use Chronic false positive reactions (> 6 months) Aging Autoimmune disorders (SLE, RA) Parenteral drug use Mnemonic: AAP • Non-specific tests for syphilis which use cardiolipin antigen (Reagin antibody) Wassermann Kahn’s flocculation test VDRL RPR (rapid plasma reagin) Advantage: Beco me negat ive afte r effect ive trea tmen t of syphilis and hence can be used in Detecting reinfection Indicating stage of disease Monitoring treatment response Mnemonic: RST Disadvantage Lack of specificity False positive cases • Low pitched sound—S3, S4 and tumor plop. (heard by bell) • Mitral valve prolapsed—most common cause is Myxomatous degeneration—mid-systolic click on examination. • Orthopnea: Acute CHF Bilateral diaphragmatic palsy (GB syndrome/myesthenic crisis/transverse myelitis) Platypnea: ARDS Hepatopulmonary syndrome Atrial myxoma Mnemonic: AHA
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• RCM—most common cause—amyloidosis DCM—most common cause—alcohol Mnemonic: DCM-Daru • S3—Ventricle gallop S4—Atrial gallop Mnemonic: V3S • Atrial fibrillation—treatment: R—Rate control (Esmolol) A—Anticoagulation (Warfarin, debigatran, rivoraxaban) C—Chemical cardioversion/rhythm control (IV ibutilide/ amiodarone) E—Electrical-DC shock. • Stroke identification: S—Smile—asymmetry T—Talk—aphasia R—Raise arm—inability to raise arm • Most common blood vessels involved in atherosclerosis— A bdominal aorta > Co ronary artery > Ca rotid artery > Popliteal artery. Mnemonic: AA CoCa Pi • Infective endocarditis ABE (< 2 weeks)—Staph. aureus. IV drug abuse—Right-sided endocarditis—Staph. aureus Mnemonic: acute, abuse-aureus SABE (> 2 weeks): Streptococcus viridens > Enterococcus Prosthetic valve endocarditis: CONS (Coagulase negative Staphylococcus) Mnemonic: Pros and cons Streptococcus viridian: SABE (> 2 weeks) Prosthetic valve endocarditis (> 12 months) Mnemonic: viridians for more Left-sided endocarditis (R to L shunt)—Patent fossa ovalis— Enterococcus.
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Mnemonics
• Modified Duke’s criteria for infective endocarditis Major: 1. Echocardiography— Vegetations on the heart valves Oscilating mass in the atria Valve ring abscess 2. Blood culture positive 3. New onset murmur due to valve perforation Minor: 1. Predisposition to IV drug abuse 2. Fever > 101°F 3. Immunological manifestations: R—Roth spot O—Osler’s node G—Glomerulonephritis (post-infectious) 4. Vascular phenomenon—Janeway lesion, mycotic aneurysm 5. Echocardiography—small vegetations (0.5 mm) Mnemonic: P-FIVE Diagnosis—2 major or 1 major + 3 minor or 5 minor • Carey Coombs murmur: Delayed diastolic murmur—Characteristic murmur of rheumatic myocarditis Mnemonic: cc is dd
• Early diastolic murmur G—Graham Steell’s murmur A—AR (mild) P—PR (mild) Mnemonic: GAP is ED • Mid-diastolic murmur Austin Flint murmur (severe AR) MS (with secondary spike) Flow murmur of ASD Mnemonic: MDM is Flea flow MS • Framingham heart risk score Age Total cholesterol
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Gender Cigarette smoking SBP Mnemonic: AT GCS • Sheehan’s syndrome—order of loss of hormone— G—GH F—FSH L—LH T—TSH A—ACTH Mnemonic: GFLTA • Migraine Pulsating headache One day illness Unilateral headache Nausea Disabling. Mnemonic: POUND • Sturge-Weber syndrome S—Seizure T—Trigeminal nerve distribution—Hemangioma/Portwine stain U—unilateral weakness R—mental Retardation G—Glaucoma E—Eye problems—Buphthalmos. • Anencephaly— Polyhydramnios Post-dated delivery Pituitary hypoplasia Mnemonic: 3P • Diagnostic criteria of SLE M—Malar rash D—Discoid rash S—Serositis
148
Mnemonics
O—Oral ulcer A—Antinuclear antibody (ANA) P—Photosensitivity B—Brain (lupus cerebritis) R—Renal (lupus nephritis) A—AIHA (Auto-immune hemolytic anemia) I—Immunological criteria (dsDNA/anti-cardiolipin antibody/ anti-β2 glycoprotein) N—Non-erosive arthritis Diagnosis—4 out of 11 (immunological criteria is must) • PAN—Poly arteritis nodosa It is necrotizing vasculitis of small to medium vessels. Mnemonic: PAN: Pulmonary Artery Never involved Note: PAN can never lead to renal artery stenosis. • Wegener’s granulomatosis is now known as granulomatosis with angitis. It is a granulomatous vasculitis. Blood vessels of upper respiratory tract—Epistaxis Lower respiratory tract—Hemoptysis Kidney—Hematuria CT scan chest—multiple Cavities in lung IOC-C-ANCA Treatment—cyclophosphamide. Mnemonic: 3C • Atypical pneumonia is caused by: Mycoplasma Coxiella burnetti Viral Legionella Chlamydia Mnemonic: My cox vi leg se chalte hain • Child Pugh criteria of cirrhosis of liver: Bilirubin ↑ Albumin ↓
Medicine
Ascites +/↑ Asterixis +/↑ PT with INR ↑ Note: BAAAP • Pautrier’s microabscess—Mycosis fungoides Munro microabscess—Psoriasis Mnemonic: P for M and M for P • Psoriasis Auspitz sign Bulkely membrane Candle grease sign DIP joint in psoriatic arthropathy Extensor surface of knee, elbow and scalp Face uncommon Grattage sign Guttate psoriasis (Eruptive psoriasis) Histopathology—parakeratosis Inverse psoriasis (flexor surface involved) Itching uncommon Koebner phenomenon (isomorphic phenomenon) Never involved—Mucosa, CNS, alopecia Onycholysis, thimble pitting of nail plate Papules and plaques Rupoid psoriasis Silvery mica scales T cell mediated chronic inflammatory disease von Zombusch disease (generalized pustular psoriasis) Wornoff ring (white halo around lesion). • Hand-Schüller-Christian disease triad: Calvarial defect in scalp Diabetes insipidus Exophthalmos Mnemonic: CDE
149
150
Mnemonics
• Congenital syphilis: Hutchinson’s triad: Hutchinson’s teeth Interstitial keratitis 8th nerve deafness. Mnemonic: HI8 • Solid raised area Papule < 1 cm Nodule 1–5 cm Tumor > 5 cm. Mnemonic: PNT
• Pemphigus vulgaris: Nikolosky sign Intraepidermal bullae Mucosal involvement Acantholysis Poor prognosis Upper part of body (Trunk > limbs) Row of tombstone 40–60 years age group Mnemonic: NIMAPUR • Pemphigoid: Subepidermal and tense bulla Lower part of body (limbs > trunk) Good prognosis 60–80 years old • Inclusion body myositis Familial Fine motor involvement—early Facial muscle involvement Falling Chronic course (years) Mnemonic: 4F
Medicine
151
• Microsporum does not infect nails. Mnemonic: MN Epidermophyton does not infect hair. Mnemonic: EH • Gono cocc us i nvolv es epid idymi s, infec tion sprea ding through urethrae Syphilis involves testis, infection spreading blood. Mnemonic: ST • Kawasaki disease—presents with NC—Non-purulent conjunctivitis C—Children S—Strawberry tongue U—Unilateral cervical lymphadenopathy R—Rash (polymorphic) E—Edema in hands and feet
12 Surgery • Esophageal dysphagia Solid and liquid Progressive systemic sclerosis—progressive (motility) Achalasia—progressive Diffuse esophageal spasm—non-progressive Mnemonic: PaDi Motile Solid only Cancer—progressive (mechanical) Stricture (peptic)— progressive Ring (lower esophageal)—non-progressive Mnemonic: CaSRi is Mechanical • MBC fail ESWL test—stones that are not broken by ESWL are Calcium oxalate monohydrate Brushite Cysteine Mnemonic: MBC • Whole liver orthotopic transplantation require five sequential anastomoses. Suprahepatic lVC lnfrahepatic lVC Portal vein Hepatic artery Bile ducts Mnemonic: SIPoHe Bill • Factors indicating possibility of malignancy in gallbladder polyps Single polyp Size of polyp > 1.0 cm 152
Surgery
153
Size of polyp change rapidly Sessile polyp Stones (gall) associated 50 yrs or more age Mnemonic: S/50 • Radiolucent ureteric stones are Uric acid stones Triamterene stone Indinavir stone Xanthine stones Mnemonic: UTI-X • Risk factors for cholangiocarcinoma Primary sclerosing cholangitis Choledochal cyst Ulcerative olitis Clonorchis csinensis Chronic typhoid carriers Mnemonic: 5c • Revised trauma score Respiratory rate Glasgow Coma Scale Systolic BP Mnemonic: RTS-RGS Trauma and injury severity score (TRlSS) Mechanism of injury—blunt or penetrating Injury severity score (ISS) Revised trauma score (RTS) Age Mnemonic: MIRA • The structures injured by the primary blast wave in order to prevalence are the Middle ear Lungs Bowel Mnemonic: MLB
154
Mnemonics
• Glasgow Coma Scale E Eye opening 4 V Verbal response 5 M Motor response 6 Mnemonic : EVM (Electronic voting machine) Eye opening Spontaneous To voice To pain None Mnemonic: SVP Verbal response Oriented Confused Inappropriate words In Comprehensible sound None Mnemonic: OrC InAC Motor response Obeys commands Localises pain Withdraws Flexion (abnormal) Extension (abnormal) None Mnemonic: OLWFEN (Just remember)
• Psammoma bodies Papillary Ca of thyroid Papillary type of renal cell Ca Prolactinoma (pituitary adenoma) Serous cystadenoma of ovary Meningioma Appendical carcinoid (rarely) Mnemonic: 3PSMA • Sister Mary Joseph nodule Most common tumours to present with this sign Stomach (20%) Colon (14%) Ovary (14%)
Surgery
155
Pancreas (11%) Mnemonic: SCOP • Phosphate or struvite stones are infection stones associated with urea splitting organisms Proteus Pseudomonas Providencia Klebsiella Staphylococci Mycoplasma Mnemonic: P3KSM • Syndrome associated with Wilms’ tumour Denys-Drash syndrome Male pseudohermaphrodite Mesangial sclerosisin WT1 gene issense mutation Mnemonic: Denys ki MaMMi Beckwith-Wiedemann syndrome Hemihypertrophy Macroglossia Visceromegaly Omphalocele Wilms’ tumour Mnemonic: BHMV of Wilms’ • Papillary Ca thyroid Calcification Radiation induced Orphan-Annie eye nuclei Mnemonic: CROP • Hashimoto’s thyroiditis Hürthle cells are virtually pathognomonic Mnemonic: H for H • Posterior urethra (membranous urethra) is injured in pelvic trauma and fracture Mnemonic: P for P
156
Mnemonics
Anterior urethra (bulbar urethra is injured in fall astride injury) Mnemonic: A for A • Lynch syndrome Colon Ca Endometrial Ca Ovarian Ca Mnemonic: CEO • Choledochal cyst—classification Type 1 Fusiform dilatation of bile duct Type 2 Diver ticulum protruding from the wall of the CBD Type 3 Dilatation of the bile duct within the duodenum (choledochocele) Type 4A Multiple dilatations of intrahepatic and extrahepatic bile ducts (both ) Multiple dilatations involving only the extrahepatic bile ducts Type 5 Multiple dilatations of intrahepatic bile ducts also called Caroli’s disease Mnemonic: Fausi dives due 2 extra care Type 4B
• MEN 1 syndrome Para thyroid tumours > Pa n creatic endocrine tumours > Pituitary tumours. Mnemonic: Para No.1, Pan-2nd, Pitu-3rd Among pancreatic tumours: In order to decreasing frequency in MEN 1: Pancreatic polypeptide tumour Zollinger-Ellison syndrome (gastrin) Insulinoma Glucagonoma VIPoma Somatostatinoma Mnemonic: PZI GVS • MEN I: Chromosome 11 MEN II: Chromosome 10
Surgery
157
• Absorbable suture materials Natural-Catgut-chromic/plain Collagen Synthetic—polydiaxonone Polyg (Vicryl) Polyglactin lycaprone Polyglyconate Polyglycolic acid Mnemonic: Cat Call Vicky DAGA • Hereditary gastrointestinal polyposis syndromes Gardner’s syndrome Osteoma Desmoid tumour Lipomas Epidermal cyst Ampullary Ca Fibroma Mnemonic: GOD LEAF Turcot’s syndrome—Brain tumors Mnemonic: Rain Coat • Nigro regimen for anal canal tumors Chemotherapy—5-FU + Mitomycin Or Bleomycin, Cisplatin • Types of hiatus hernia Type 1 Sliding hernia: 70–80% (i.e. hernia en glissade) Type 2 Paraoesophageal rolling hernia: 8–10% Type 3 Mixed: 10% Mnemonic: SRM • Lateral swellings of the neck Ranula Bronchogenic cyst Cystic hygroma Mnemonic: RBC
158
Mnemonics
• Tumors of urothelium, i.e. pelvis, ureter and bladder are most commonly transitional cell carcinoma. But tumours of urethra are most commonly squamous cell carcinoma. • Cardinal manifestations of bowel obstruction –– Pain small obstruction Vom is itimost ng i spronounced mos t pr onoinunc ed bowel in h igh sma ll bo wel obstruction – Distension is most pronounced in large bowel obstruction • Pain of ureteric colic from different regions of ureter Site Painreferredto Upper ureter Testis Middle ureter McBurney’s point Simulates appendicitis on right side Simulates diverticulitis on left side Lowerureter Innersideof thigh Labia majora in females. Intramural part of ureter Stranguary Mnemonic: From above downwards Test McBurger with the stranger • Ligation in arterial aneurysm Ligation applied just proximal to sac Ligature applied just proximal to branch of an artery Double l igature applied just distal to the branch
Anel’s method. Bractor’s method An lylus method
Ligature proximal to first collateral Hunter’s operation of aneurysm Mnemonic: Anal Sac Proximal Brac Double ‘L’ Collateral hunting • Earl y gastr ic ca ncer —canc er limit ed to t he m ucosa , submucosa with or without lymph node involvement Late gastric cancer—it involves the muscularis • Acute intussusception Idiopathic (peak incidence 3–9 months)
Surgery
159
Hyperplasia of Peyer’s patches in the terminal ileum is usually the initiating event. Known cause/lead point (older children) Duplication Meckel’s diverticulum Polyp Mnemonic: DMP • Cushing syndrome – Petrous si nus sampling fo r ACTH i s the b est me thod of differentiating a pituitary adenoma from an ectopic ACTH producing tumor. – Adrenal CT scan reliably differentiates cortical hyperplasia from tumor. – T2-weighted MRI is more specific, reliably distinguishing adrenal adenoma from carcinoma. • Esophageal carcinoma MC type in India Squamous cell carcinoma MCtypeinwest Adenocarcinoma Mc site of squamous Middle 1/3rd MC site of adenocarcinoma lower 1/3rd MC type of upper 2/3rd Squamous • Hyperplastic TB Radiology/barium swallow shows – Long narrow filling defect in terminal ileum – Fleshner sign: Thickening of the ileocaecal valve, a wide open valve accompanied by narrowing of terminal ileum Fib rotic t ermin al il eum ope nin g int o a contracted caecum. Mnemonic: SFL (Safal in Hindi) – Sterling sign:
• Marjolin’s ulcer squamous cell carcinoma which arises in amino acid Chronic benign ulcer, e.g. a venous ulcer, or A scar, e.g. scar of an old burn Characteristics – Grows slowly (relatively avascular) – Painless (no nerves)
160
Mnemonics
Does not spread to regional lymph nodes as lymphatic vessels have been destroyed • Triple assessment of breast lump suggestive of carcinoma: Clinical assesment Radiological imaging T issue sampling for either cytological or histological examination Mnemonic: CRT • Radical neck dissection Structure preserved Carotid arteries Cranial nerve Phrenic nerve Radical neck dissection Structures removed Omohyoid Sternomastoid Internal jugular vein Submandibular gland Accessory nerve Mnemonic: O-SISA Structures preserved in modified radical neck dissection Internal jugular vein Sternomastoid Accessory nerve Mnemonic: ISA • Common causes of acute lower gastrtointestinal bleeding over 55 years of age (in decreasing order) Anorectal disease (haemorrhoids and fissures) Diverticulosis Angiodysplasia Polyps and cancer Enterocolitis Mnemonic: ADAPE • MC site of colonic diverticula Sigmoid colon (left colon) MC site of bleeding diverticula Ascending colon (right colon) Mnemonic: CDS and AB
Surgery
161
• Wilkie’s syndrome (superior mesenteric syndrome) Compression of third part of duodenum, by mesenteric artery. • Hemobilia—classic triad Obstructive jaundice Abdominal pain (biliary colic) Malena or occult blood in stool Mnemonic: JAM • MC benign tumor of spleen—hemangioma MC cause of neoplastic enlargement of spleen—lymphoma • Spleen phagocytose encapsulated bacteria. Splenectomized patients are at increased risk of septicemi a due to pneumococcus (MC), meningococcus, H. influenzae, Babesia microti MC complication of splenectomy is pulmonary Note: complications (left basal atelectasis).
• Penetrating neck injury—breach of platysma Mnemonic: P for P
13 Gynecology and Obstetrics (G and O) • Congenital rubella syndrome Eye defects Cataract and congenital (CC) glaucoma Heart defect PDA and Pulmonic (PP) stenosis CNS— M icrocephaly, m ilestone delay (developmental) meningoencephalitis (MMM) pigmentary retinopathy, purpura (PP) Mnemonic: CMP • Pain pathways during labour Prelabour pains are mediated through T11–T12 Mnemonic: Prelabour-Pre L1 It eventually involves T10– L1 dermatomes during labour.
• Genital Ridge— Ovary, testis Mnemonic: ROT Tubercle—clitoris, glans Mnemonic: Clitoris and glans like tube Swelling—Labia majora, scrotum Fold—Labia minora, ventral part of penile urethra Mnemonic: Major Scrotal swelling Minor ventral fold • Puberty sequential changes Thelarche Pubarche Peak height velocity Menarche Mnemonic: The Pub Peaks for Men 162
Gynec ology a nd Ob stetr ic s (G a nd O)
163
• HPV 16 is t he most prevalent HPV t ype in squamous cel l cancer cervix HPV 18 is the most prevalent HPV type in adenocarcinorma cervix Mnemonic : Sweet 16 • Head compression—Early deceleration Cord compression—Mid deceleration (Mn: CM) Placental compression—Late deceleration (Mn: PL) • The drug of choice for acute control of hypertension in severe pre-eclampsia is Hydralazine > labetalol > nifedipine Mnemonic: HelaN
• OCP is a risk factor for Breast Ca C Ca Hervical epatocellular Ca Pituitary adenoma Mnemonic: Bihar PHC • Indication of antenatal steroids To reduce incidence of respiratory distress syndrome—when pregnancy is less than 34-betamethasone is preferred. To prevent virilization of female fetus in case of previous baby with congenital adrenal hyperplasia—as soon as pregnancy is confirmed – Dexamethasone is prefered. Mnemonic: CD • Bishop’s score Cervix-Consistency (soft/medium) Dilatation (1–2 cm/3– 4 cm/5–6 cm) Effacement (40–50%/60–70%/80%) Position (middle/anterior) + Station of presenting part (–1, –2/0/+1, +2) Mnemonic: Cx-CDEP + Station • Fetal hydantoin syndrome – Cardiac defects
164
Mnemonics
– Hypoplastic phalanges – Nail dysplasia – Facial dysmorphism – Cleft lip and palate – Microcephaly Mnemonic: Heart, Hand, Head • Neonatal complications of diabetic mothers – Hypoglycemia – Hypocalcemia – Hypomagnesemia – Hypothermia – Hyperbilirubinemia – Polycythemia – RDS – Cardiomyopathy. Mnemonic: Only these two increases—bilirubin and blood • MC ovarian neoplasm during pregnancy B enign cystic teratoma (dermoid) (21%) > S e rous cyst adenoma (21%) > Cystic corpus luteum (18%) Mnemonic: BSC • Bacterial vaginosis – Few leucocytes – No/few lactobacilli – Clue cells – Gram variable micro-organism including Gardnerella vaginalis (Gram-negative) Haemophilus vaginalis (Gram-negative) Moblincus (Gram-positive) Mnemonic: Lactobacilli and leukocytes are low in number • Neural tube defect ↑ Acetylcholinesterase ↓ Pseudocholinesterase Mnemonic: PV
Ventral wall defect ↓ Acetylcholinesterase ↑ Pseudocholinesterase
Gynec ology a nd Ob stetr ic s (G a nd O)
165
Note: AFP is raised in both. • Conjugate diameters of pelvic inlet Diagonal conjugate can be measured directly Mnemonic: D for D True conjugate diameter
Midpoint of sacral promontory to inner margin of upper border of symphysis pubis (11cm) Obstetric conjugate diameter Midpoint of sacral promontory to prominent bony projection on inner surface of pubic symphysis Diagonal conjugate diameter Midpoint of sacral promontory to inner margin of lower border of symphysis pubis (12 cm) Mnemonic: On inner margin of symphysis pubis, from above downward order is TOD
• Gestational trophoblastic neoplasia is classified as a high risk tumour if it has any of the following factors: Antecedent term pregnancy Brain or liver metastasis Prior chemotherapy failure Duration > 4 months Pretherapy HCG level > 40,000 mIU/ml Mnemonic: ABCD and H • Criteria for medical management of ectopic pregnancy: – Hemodynamically stable patient – Size of ectopic mass < 4 cm – Gestation preferably < 6 weeks – Fetus preferably dead (no fetal cardiac activity on USG) – Serum beta-hCG levels preferably < 1500 mIU Note: Active intra-abdominal hemorrhage is a contraindication to chemotherapy. • Pure gonadal dysgenesis: It is a disorder in which phenotypic females have
166
Mnemonics
– Gonads and genitalia characteristic of gonadal dysgenesis – Bilateral streak gonads – Infentile uterus and fallopian tubes – Sexual infantilism –– Normal Normal height somatic development – Normal 46, XX or a 46, XY karyotype Note: Swyer syndrome is pure gonadal dysgenesis 46, XY. • All the elements of Virchow’s triad is circulatory stasis, vascular damage and hypercoagulability of the blood are present during pregnancy. Vascular stasis is due to increase in the calibre of capacitance vessels and blood. Hypercoagulability is due to increased amounts of factors VII, VIII and X. • Cephalhematoma Caput succedaneum – Collection of blood between Swelling due to stagnation the pericranium and flat of fluid in between layers of boneofskull scalp beneaththegirdleof contact – Usually unilateral Maybebilateral – Limited by suture line Not limited by suture line – Develops after 12–24 hrs Present at birth (never present at birth) – Swelling disappears in 6–8 wks –G oodprognosis – No impulse on crying
Swelling disappears in 24 hrs Good prognosis No impulse on crying
Note: Meningocele always lies over a suture line or fontanelle and variation in tension of swelling with crying (cry impulse) is suggestive of a meningocele. • Contraindication of ergometrine – Suspected multiple pregnancies
Gynec ology a nd Ob stetr ic s (G a nd O)
167
– Organic cardiac diseases – Severe pre-eclampsia and eclampsia (there may be sudden rise in BP) – Rh negative mothers – More chances of fetomaternal microtransfusion • Risk of abnormal off-spring for carriers of a balanced translocation: Risk percentage T r a n s lo c a t i o n
Centric fusion 14:13 Centric fusion2114 : Centrtic fusion2221 : Centric fusion 21 21 : Reciprocal (Any)
Carrier father
1 1 5 100 10
Carrier mother
1 15 10 100 10
• Oligospermia: Mild—w hen the count is 10–20 million/ml Moderate—when the count is 5–10 million/ml Severe—when the count is <5 million/ml • WHO criteria Volume > 2 ml Sperm count > 20 million/ml Total sperm count > 40 million/ejaculate Percent mobility > 50% with forward progression > 25% with rapid linear Forward progression > 2progression (Scale 0–4) Normal morphology > 50% normal Round cells < 5 million/ml Sperm agglutination < 2 (Scale 0–3) WBC fewer than 1 million. • Mo th er wi th gl yc os yl at ed HbA1c before 14 weeks of gestational values less than or equal to 8.5% have got least chance of severe malformation of the fetus. 9.5% or more have greater chance of major congenital malformation.
168
Mnemonics
• Types of pelvis Naegele’s pelvis Ala on o ne side is absent Mnemonic: N for N Robert’s pelvis Ala on both sides is absent Mnemonic: B for B Rachitic pelvis Increased interspinous diameter of the false pelvis Reniform shape of inlet with shortened AP diameter Widened transverse diameter of the outlet and pubic arch inlet is typically triradiate Osteomalacic pelvis
• Side effects of OCP— Mild—continue the OCP N—Nausea O—Oedema R—Recurrent headache M—Mastalgia A—Abnormal bleeding (breakthrough bleeding) L—Loss of bleeding (withdrawal bleeding) Moderate—Acne Weight gain Chloasma If patient is worried, stop the OCP. Severe—stop the OCP. Cholestasis Cardiovascular—thromboembolism CNS—depression Cancer—increased risk of breast carcinoma and cervical carcinoma • Non-contraceptive benefits of OCP—Decreases risk of Other—Ovarian cyst and carcinoma B—Benign breast disease (like fibroadenoma) E—Endometriosis N—Neoplasia like ovarian and endometrial carcinoma
Gynec ology a nd Ob stetr ic s (G a nd O)
E—Ectopic pregnancy F—Fibroid I—Iron deficiency anemia T—Tension—pre-menstrual tension S—Skeletal—osteoporosis and rheumatoid arthritis.
169
14 Pediatrics
• Hereditary hyperbilirubinemias UGC—Unconjugated Gilbert’s syndrome Crigler-Najjar syndrome I and II • Downe’s score – Cyanosis – Air entry – Respiratory rate – Grunting – Retraction Mnemonic: CARGR • Silverman-Anderson index – Grunting – Nasal flaring – Retraction—Upper chest – Retraction—Lower chest – Retraction—Xiphoid Mnemonic: GFR 3–LUX–Silver • Fallot’s triad
Mnemonic: RAP Fallot’s tetralogy
RVH ASD Pulmonic stenosis Pulmonic stenosis RVH Overriding of aorta Ventricular septal defect
Mnemonic: PROVe 170
Pediatrics
171
• A newborn is classified as vigorous if he has all the following: Heart rate > 100 / min Respiratory effort (strong) Tone of muscles (good) Mnemonic: HRT • Classification systems for PEM based on weight-for-age Gomez classification Indian academy of pediatrics (IAP) classification Wellcome trust classification (also considers presence or absence of edema) Mnemonic: India Welcome Weight of Gomez
• Glycogen storage disease Anderson disease—Branching enzyme defect (Type IV) C ori Forbe (Type III) or limit dextrinosis)—Debranching enzyme defect Mnemonic: 4 AB and CD3 • Muscle glycogenases Type II (Pompe’s)—Lysosomal acid α-glucosidase Type V (McArdle)—Muscle phosphorylase (M for M) Type VII (Tarui)—Phosphofructokinase Mnemonic: 257–PMT–LMP • Timing of selected primitive reflexes Reflex present at birth (in bracket age at appearance in intrauterine life) – Palmar grasp (23) – Crossed extensor reflex (28) – Moro’s reflex (32) – Asymmetric tonic neck reflex (35) (ATNR) – Rooting/suckling reflex Mnemonic: PCMARt Reflexer developing after birth – Parachute reflex – Symmetric tonic neck reflex (STNR)
172
Mnemonics
– Neck righting reflex – Landau reflex Mnemonic: PSNL Note: ATNR—fencing reflex, STNR—Cat’s reflex. • Hereditary associations with acute myeloid leukemia (AML) – Fanconi’s anaemia – Ataxia-telangiectasia – Bloom syndrome – Down’s syndrome – Patau syndrome – Klinefelter’s syndrome – Kostmann syndrome Mnemonic: FAB DiPika Ko AML • Autosomal recessive disorders that have occurred due to uniparental disomy (UPD) – Alpha thalassemia – Spinal muscular atrophy – Beta thalassemia – Bloom syndrome – Cystic fibrosis – Cartilage hair hypoplasia Mnemonic: A2B2C2 • Autism
Triad of impaired Imagination Communication Social interaction
Mnemonic: ICS
• Standard ORS versus ReSoMal (rehydration solution for severely malnourished child) StandardORS 111 90
Glucose Sodium
20
Potassium
ReSoMal 125 45
40
NewWHO–ORS 75(Anhydrous) 75
20
Pediatrics
80 10
Chloride Citrate Magnesium Zinc
70 7 3 0.3
173
65 10
Copper 0.045 311 300 Mnemonic: Mazic in ReSoMal • Agents responsible for bronchiolitis MC agent Respiratory syncytial virus (RSV) Other Parainfluenza virus 3,1 Adenovirus Influenza virus Mycoplasma pneumonia Mnemonic: MYC PAIR in bronchiolitis • Surgical management of tetralogy of Fallot Waterson shunt—Ascending Aorta to Pulmonary artery Blalock-Taussig shunt—Subclavian artery to pulmonary artery Pott’s shunt—Descending aorta to pulmonary artery Mnemonic: Water’s Black Pot–ASD • Target cells are seen in Haemoglobin C, S, etc. Thalassemia Liver diseases Mnemonic: HaThali Target • Total anomalous pulmonary venous connection (TAPVC) Type 1 (45%) Supracardiac Type 2 (25%) Cardiac Type 3 (25%) Infracardiac Multiple levels Type 4 (5%) Mnemonic: SCIM • Assessment of dehydration in patients with diarrhoea and PLAN No sign of dehydration Treatment p lan A (home available food, ORS) Some sign of dehydration
Treatment plan B
174
Mnemonics
Rehydration therapy 75 ml/kg ORS in first 4 hrs Maintenance therapy 10–20 ml/kg ORS for each liquid stool Severe dehydration <12months >12months to5yrs
Treament plan C IV fluid (RL best, NS can be gi ven) 30ml/kgin 70mI/kgin hr1 hr5 30ml/kgin 70ml/kg in 30minutes 2½hrs
• Congenital rubella syndrome The common manifestations are: Growth retardation Cardiac anomalies PDA > PS > VSD Sensorineural deafness Ocular Microphthalmia, cataract, glaucoma, retinitis Cerebral Chronic encephalitis Hematological Thrombocytopenia Lymphopenia Bluberry muffin rash, i.e. dermal nests of extramedullary hematopoiesis or purpura. • β-thalassemia or Cooley’s anaemia Peripheral blood picture shows Microcytic hypochromic anaemia A nisocytosis Target cells (marked) Reticulocytosis Nucleated red cells Mnemonic: MATRN • Endemic cretinism includes two different overlapping syndromes Neurological syndrome—Goitre, severe mental retardation, deaf mutism, cerebral diplegia, squint Mnemonic: CDS GS Myxedematous syndrome: Hypothyroid (T4, TSH) severe growth retardation, physical signs—coarse dry skin, husky
Pediatrics
175
voice reflex (delayed relaxation), ECG—small voltage QRS, epiphyseal dysgenesis • Hemangioma (vascular malformations) : Classification Capillary hemangioma Salmon patch Strawberry angioma Portwine stain Venous or cavernous hemangioma Arterial or plexiform hemangioma Spontaneous regression Sa lmon patch (regresses by 1 year of age) Strawberry angioma (regresses by 7–8 yrs of age) Mnemonic: S for S • Down’s syndrome P—Protruding tongue R—Round face O—Open wide fontanelle/occiput flat B—Brachycephaly/Brachydactyly L—Low set ear/Low (depressed) nasal bridge M—Mangolian slant/Mental retardation A—Acute leukemia (AML M7 > ALL)/Alzheimer’s disease/ Atresia of duodenum T—Trisomy 21/Thyroid problem (hypothyroidism) I—Iris-Brushfield’s spot C—Congenital heart disease • Noonan syndrome Autosomal dominant Normal karyotype Fertile Short stature Webbed neck Cubitus valgus Clinodactyly Cryptoorchidism Mnemonic: 3C
176
Mnemonics
• Principle of phototherapy— SI > PI > PO Structural isomerisation > Photoisomerisation > Photo oxidation. • T-series are cyanotic— TAPVC Truncus arteriosus Tetralogy of Fallot Tricuspid atresia TGA with VSD TGA with VSD with PS.
15 Skin
• Causes of non-cicatricial alopecia Primary cutaneous disorders Telogen effluvium Anagen effluvium Traumatic alopecia Androgenic alopecia A lopecia areata Tinea capitis Mnemonic: 3T and 3A • Epidermolysis bullosa and targeted protein Epidermolysis bullosa simplex—Keratin 4 and 14 Junctional epidermolysis bullosa—Laminin 5 Dystrophic epidermolysis bullosa—Collagen VII Mnemonic: SK Jha LDC Clerk S K 4 J L 5 D C 7 • Tinea capitis
Caused by: Trichophyton Microsporum Mnemonic: TMC
• Salmon’s patch is seen in Still’s disease Mnemonic: S for S
• Dannie’s fold—AD (atopic dermatitis) Mnemonic: DA–AD 177
178
Mnemonics
• Darrier sign—Urticaria pigmentosa Mnemonic: Dirty pig
• Lymphogranuloma venereum Asymptomatic Bubo (usually unilateral) Chlamydia trachomatis (L1 L2 L3) Doxycycline (DOC) Estheiomine—vaginal and rectal stricture and elephantiasis of vulva Fries test—intradermal test for hypersensitivity to chlamydial antigens G roove’s sign—enlarged LN on both sides of inguinal ligament. Mnemonic: ABCDEFG • Lepra reaction Type I: Reverse lepra reaction, is Type IV hypersensitivity Type II: ENL, is Type III hypersensitivity Mnemonic: I + IV = V II + III = V • Pityriasis rosea = Characteristic features Herpesvirus (suspected etiology) Trunk Cigarette paper scales Herald patch Fir tree pattern Mnemonic: HT + CHF (Rose ko HT and CHF) • Cutaneous tuberculosis (non-tuberculides) Lupus vulgaris Scrofuloderma Metastatic tuberculosis Tuberculosis cutis verrucosus Tuberculosis cutis orificialis Miliary tuberculosis Mnemonic: Vulgar derma met cute Mili
Skin
179
Tuberculides: Papulonecrotic tuberculides (Acne scrofulosorum) Lichen scrofulosorum Rosaceous tuberculide Erythema induratum Lupus miliaris disseminatus faccei Mnemonic: ALi Rose Indure Lupus Miliaris Pityriasis Classification Trunk involvement P. versicolor P. rosea—erythematous (rose red) Mnemonic: VeROT Face involvement P.alba P.rubra—erythematous (rubra red) • Fordyce’s spots
Ectopic sebacious glands (if on head of penis—Tyson glands) Fox-Fordyce (apocrine miliaria)—blockage of sweat glands Forcheimer’s spots—German measles (rubella) Infectious mononucleosis Scarlet fever
• Gluten restriction in diet
Celiac sprue Dermatitis herpetiformis
Note: Gluten is found inBarley:Rye, oat andwheat, i.e.Brow. • All pemphigus cases are characterized by the formation of an intraepidermal acantholytic split, located at the following levels: Stratum granulosum—P.foliaceous and P.erythematosus Mnemonic: EFG Between Str. basale and prickle cell layer —P. vulgaris and P.vegetans Mnemonic: V2 • Non-anesthetic hypopigmented, non-scaly macule on face – Indeterminate leprosy Note: Omitting non-scaly, diagnosis becomes Pityriasis alba.
16 Anesthesia
• Anatomical dead space is decreased in Hyperventilation Intubation Tracheostomy Bronchoconstriction Flexion of neck Mnemonic: HITCornflex decreases dead space
• Sites of absorption of local anesthetics in decreasing order Intrapleural Intercostal Pudendal Caudal Epidural Brachial plexus Infiltration Mnemonic: Pleco Puca Epi Brain • Relative potency of inhalational agents Nitrous oxide Cyclopropane Desflurane Sevoflurane Ether Potency increases Enflurane Isoflurane Chloroform Halothane 180
Anesthesia
181
Trielene Methoxyflurane Mnemonic : NCD SEE ICH of TM–In increasing order of potency. Note: Ether is between sevoflurane and enflurane, chloroform is between isoflurane and halothane
• Blood gas partition coefficient Desflurane Cyclopropane Nitrous oxide Sevoflurane Isoflurane B/Gpartition coefficient Enflurane Increases Halothane C hloroform Trielene Ether Methoxyflurane Mnemonic: DCNS IEN HCTEM (Recall 10 times in mind) • Amide linked local anesthetics Lidocaine / Lignocaine Bupivacaine Dibucaine Prilocaine Ropivacaine Mnemonic : I In Amide, I in Amide linked LA (besides in Caine) Ester-linked LA Cocaine Procaine Chlorprocaine Tetracaine Benzocaine • Monitoring of respiration Intubated patient Capnography Infrared end tidal CO2 measurement
182
Mnemonics
Mnemonic: Cap into infra
Non-intubated patient Impedance pulmonometry Pulse oximetry Transcutaneous gas analysis (infants) • Faster, pleasant smooth induction noofsignificant systemic toxicity and makes sevoflurane thewith agent choice for induction especially in children. Mnemonic : Smooth, Sweet Sevoflurane for seven year old
(i.e. child) • Anesthetic agents Bronchospasmodics (contraindicated in asthmatics) Ether N2O Thiopentone
Mnemonic: ENT
•G as Oxygen
Colour of cylinder Black body, White shoulder Mnemonic: Black and White OX Air Gray body, black and white shoulder N2O B lu e Mnemonic: Blue nitrous Entonox Blue body, white and blue quartered shoulder Cyclopropane Orange Mnemonic: Cycle per oranges Carbon dioxide Gray Mnemonic: Grey Carbon Thiopentone Yellow Mnemonic: Yellow Pant Halothane Amber (purple red) Mnemonic: Hello Amber
• Agents used in day care anesthesia Seroflurane, Isoflurane and Desflurane
Anesthesia
183
Alfentanyl, Remifentanyl Etomidate Methohexitone Propofol Thiopentone Mnemonic: SID ARe EMPTy
• Rapid sequence anesthesia (crash induction) Preoxygenation Induction agent Suxamethonium Sellick’s maneuver (cricoid pressure) Mnemonic: PISS • Concept of balanced anesthesia (Lundy) Thiopental for Induction N O for (or other opioid) for Amnesia M2epridine Analgesia Curare for Musclerelaxation Mnemonic: TNMC • Drugs se nsit izin g the h eart t o arrh ythm ogen ic ac tion o f adrenaline include: Halothane Methoxyflurane Trichlorethylene Cyclopropane Chloroform Mnemonic: Halo Metri, Cycle se Chalo
17 Radiology • CSF spreading tumours Germ cell tumour Medulloblastoma Ependymoma Primary CNS lymphoma High grade astrocytoma Choriocarcinoma Mnemonic: German MELA Chor
• HRCT-ILD, bronchiectasis and CSF leak • Radiation effects Deterministic effects— Severity of effect is dependent upon dose These effects have a threshold Mnemonic: DTS Stochastic effects—probability of effect is dependent upon dose Note:
S is not S
• Pure beta emitters
Mnemonic:
• 1–125 1–131 1–123 1–132
P 32 Sr 90 Y 90 H3
HSPY
60 days 8 days 13 hrs 2.3 hrs 184
Radiology
• Superior rib notching Hyperparathyroid ism Connective tissue diseases
185
RA, SLE, Scleroderma Sjögren syndrome
RS3 : Poliomyelitis Osteogenesis imperfecta Restrictive lung disease Marfan’s syndrome Neurofibromatosis Mnemonic: Parathyroid connect, Post and restrict Marfan to neuro Mnemonic
• Inferior rib notching Coarctation of aorta Pulmonary oligemia Aortic thrombosis Subclavian obstruction Blalock-Taussig operation Mnemonic: CAPAST • Prop hyla ctic cran iospi nal irrad iatio n is u sefu l in CNS malignancy which shows dissemination via CSF or any malignancy with high risk of CNS spread. Medulloblastoma Glioblastoma Germinoma Small cell Ca of lung ALL Non-Hodgkin’s lymphoma • Groundglass appearance of the lung—differential diagnosis TAPVC (obstructive) Persistent pulmonary hypertension Respiratory distress syndrome Pneumonia (bacterial and meconium aspiration) Pulmonary lymphangiectasia
18 Psychiatry
• Level of intelligence Idiot 0–24 Imbecile 25–49 Moron 50–69 Border l ine 70–79 Mnemonic: IIM Bangalore
Mental age yrs < 3 life support 3–7yrs trainable 7–10yrs educable
• Intelligence quotient Profound < 20 Severe 20–35 Moderate 35–50 Mild 50–70 • Disorganized schizophrenia Attention deficits and cognition defects Disorganized behaviour Disorganized speech Mnemonic: ABCDS • Disorder Most common type of delusion Mania Delusion of grandeur Depression Nihilistic delusion Delirium Transient delusion Schizophrenia Delusion of persec ution/ reference /control/ infidelity / passivity • Patients with multiple somatic complaints that cannot be explained may have Hypochondriasis Somatization disorder Malingering Factitious illness 186
Psyc hia try
187
• Difference between anorexia nervosa and bulimia nervosa Anorexia nervosa Bulimia nervosa Feature Refusal to maintain Irresistible craving for body weight above food with episodes of
Method ofweight control
Ritualized exercise Amenorrhea Decreased vitals BP, pulse Hypothermia Skinchanged (hirsutism) Medical complications
a minimum normal overeating in less time (binge eating) Very less eating Attempts to counteract theeffects of overeating byself-inducedvomitings purgative abuse periods of starvation appetite suppressants Common Rare 100% Common
50% Uncommon
Common Common
Rare Rare
Hypokalemia Hypokalemia Cardiac arrhythmias Cardiac arrhythmias
Note: In bulimia, Dental caries are frequent because of high carbohydrate content in the diet. A ntisocial behaviour, e.g. stealing, alcohol, drug abuse is common Prognosis is worse. Mnemonic: DAW
• Difference between delirium and dementia Delirium Onset Acute Consciousness Clouded Orientation Grossly disturbed
Dementia Insidious Normal Disturbed only, in late stages
Memory
Immediate is normal
Immediate and
188
Mnemonics
recent disturbed
Perception
Diurnal variation
recent and remote disturbed Visual illusion and Hallucination may hallucination is occur common Marked Absent (Sundowning)
• Dissociative fugue Sudden onset of complete amnesia for his earlier life Patient usually wander away from home Adopts a new purposeful identity Absence of awareness of amnesia • Catatonic signs Mutism Absence of speech Rigidity Maintenance of rigid posture against efforts to be moved Posturism Voluntary assumption of bizarre, inappropriate posture for long period of time Negativism Resistance to all commands and attempts to be moved Echolalia Repetition, mimicking of actions observed Waxy Parts of body can be placed in positions that flexibility will be maintained for long periods of time even if very uncomfortable flexible like wax Mannerism Automatic Commands are followed automatically, obedience irrespective of their nature. • Mechanism of depression—Deficiency of monoamines— Serotonin (5 HT) > Noradrenaline > Dopamine Mnemonic: SeND
19 Orthopedics
• Klippel-Feil syndrome Triad—Short (web) neck Low hair line Restriction of neck motion Mnemonic: SLR • Risk of progression of vertebral anomalies in decreasing order Unsegmented bar Hemivertebra Wedge vertebra Block vertebra Mnemonic: Unique History of West Bengal (UH of WB) • Reconstruction of an amputated limb: Order of repair Bone Extensor tendons Flexor tendons Arteries Nerves Vein Mnemonic: BE FAN Vein • Test for anterior shoulder instability Anterior shoulder instability Apprehension test (Crank test) Relocation test Fulcrum test Mnemonic: FRANK–CRANK 189
190
Mnemonics
• Tests for posterior shoulder instability Jahnke test Jerk test Posterior drawer test Posterior apprehension test Push-pull test Circumduction test Mnemonic: JPC Also remember: Test for inferior shoulder instability—sulcus test • Albright-McCune syndrome Polyostotic fibrous dysplasia Pseudo precocious puberty Pigmentation Mnemonic: 3P • Mazabraud syndrome Myxoma of soft tissues Polyostotic fibrous dysplasia Sulcus test • Tarsal tunnel syndrome may be caused by arthritis Mnemonic: Tunnel in room
rheum atoid
• Metastasis distal to knee and elbow is rare and usually arises from a primary tumours of the Bladder Bronchus Colon Mnemonic: BBC: One from thorax, abdomen and pelvis each • Casts and splints Minerva cast—Cervical spine fracture Mnemonic: Mice Scoliosis—Risser’s localiser cast, Turn buckle cast Milwaukee brace Boston brace Mnemonic:
Ritu Mili Boss
Orthopedics
191
• Risk factors associated with shoulder dystocia Diabetes Obesity Post-term Excess weight gain during pregnancy Mnemonic: DOPE • Non-odontogenic cysts Nasolabial cysts Nasopalatine cysts Mnemonic: N for N Pseudocysts Static bone cysts Traumatic bone cysts Aneurysmal bone cyst Ganglion cysts Mnemonic: STAN GAN • Ossicular joints Incudo-Malleolar joint—Saddle type of synovial joint Incudo-Stapedial joint—Ball and socket type of synovial joint Mnemonic: Ball IS MISS • Ligament of Humphrey—Anterior menisco-femoral ligament Ligament of Wrisberg—Posterior menisco-femoral ligament Mnemonic: Humpy Antie • Knee joint Unlocking is brought about by popliteus muscle Mnemonic: UP Locking—Quadriceps femoris Mnemonic: Q-locked • Myositis ossificans progressiva Muscles that are characteristically spared Smooth muscles Cardiac muscles Diaphragm
192
Mnemonics
Extraocular muscles Mnemonic: Smooth CDE • O’Donogues triad (unhappy triad) Anterior cruciate ligament AC Medial collateral ligament Medial meniscus Mnemonic: AC MC MM
MC MM
• Plaster casts and their uses Humerus fracture—Hanging cast and U slab. Mnemonic: Hu-Hu A spica is a cast where a limb and a part of the trunk are included, e.g. hip spica (fracture femur) Shoulder spica (shoulder immobilization) Patellar tendon bearing cast—fracture of tibia Cylinder cast (tube cast)—fracture patella (fracture around knees) • Common sites for bone tumors Epiphysis—Chondroblastoma Giant cell tumor Mnemonic: ECG (GC–CB) Diaphysis Adamantinoma Multiple myeloma Ewing’s sarcoma Eosinophilic granuloma (Langerhans’ cell histiocytosis) Osteoid osteoma Mnemonic: Dia add multiple wing to Eosinophil of osteoma • Markers of bone formation – Serum bone specific alkaline phosphatase – Serum propeptide or type I procollagen – Serum osteocalcin Mnemonic: Alka Type Osteocalcin for bone formation • Management of idiopathic clubfoot So
Soft tissue release
< 3yrs
Orthopedics
Evans Was Treated Intelligently
Evans Wedgeresection Triple arthrodesis Ilizarov
193
4–8 yrs 8–11yrs >12yrs Old/neglected club foot
• Erb’spalsy K lumpke’s palsy Upper obstetric palsy Lower obstetric palsy Mnemonic: L for L C5–C6 roots affected C8–Tl, roots affected Waiter’s tip deformity Generalized wasting of all intrinsic muscles and claw hand deformity Ipsilateral Horner syndrome (due to TI) • Pyogenic arthritis—bony ankylosis (B for bacteria, B for bony) Tubercular arthritis—fibrous ankylosis (Exception—tubercle spine has bony ankylosis) • Idiopathic osteoarthritis Herbeden’s nodes—bony enlargement of DIP joint Mnemonic: HerDip (herdip) It is also MC form of idiopathic osteoarthritis. Bouchard’s nodes—bony enlargement of PIP joint • Common sites of avascular necrosis Head of femur Fracture through neck of femur, postdislocation of hip Proximal pole of scaphoid—fracture through waist of scaphoid Body of talus—fracture through neck of talus Lunate—dislocation Common sites of non-union of fracture Scaphoid Neck of femur Talus Lateral condyles of humerus Lower third of Ulna Lower third of tibia Mnemonic:
SNT LUT
194
Mnemonics
Common sites of malunion of fracture Supracondylar fracture Colles’ fracture Intertrochanteric fracture Mnemonic:
SCIT • Osteochondritis: A group of miscellaneous affection of the growing epiphysis, which cause them to be temporarily softened and liable to be deformed by pressure. Common osteochondritis Crushing osteochondritis (due to avascular necrosis) Perthes disease Femoral head (commonest) Pannr’s disease Capitulum Mnemonic: Pan in Cap Keinbock’s disease Lunate Mnemonic: Luna Keino Kohler’s disease Navicular bone Mnemonic: Navi Kohli Freiberg’s disease Head of metatarsal Mnemonic: HMT Free Scheumann’s disease Ring epiphysis of vertebrae Mnemonic: Man in Ring Calves’ disease Central bony nucleus of vertebral body Mnemonic
: Central cave Traction osteochondritis (due to chronic strain or apophysitis) Osgood-Shlatter disesase—Tibial tubercle Mnemonic: tt = tt Sever’s disease Calcaneal tuberosity Mnemonic: Severe Calca Larsen-Johansson disease —lower pole of patella Mnemonic:
Patel Son Sen Splitting osteochondritis (trauma plays major role) Osteochondritis dessican
MC site is femoral condyle
Orthopedics
195
• Hip deformity following a history of severe trauma Posterior dislocation of hip—Flexion + Adduction + Internal Rotation + Shortening (FADIR) Fracture neck of femur—Flexion + Adduction + External Rotation + Shortening (FADER) Fracture intertrochanteric femur—FADER (exaggerated) Anterior dislocation of lip—Flexion + Abduction + External Rotation + Shortening (FABER) Tuberculosis hip Stage of synovitis FABER (apparent lengthening) Stage of arthritis FADIR (apparent shortening) Stage of erosion FADIR (true shortening) • Rheumatoid arthritis Swan-neck deformity
Hyperextension at PIP joint Hyperflexion at DIP joint.
Mnemonic:
HEPIP of Swan Boutonniere deformity Hyperflexion at PIP joint Hyperextexnsion at DIP joint Mnemonic: BDE-PF • Impacted fractures are commonly seen in Surgical neck of humerus Neck of femur Lower end of radius Mnemonic: Impacted SuNiL • Triple arthrodesis
Fusion of threejoint joints of foot Talonavicular Subtalar joint Calcaneocuboid joint Mnemonic: TN ST CaCu
• Common sites of origin of osteosarcoma in decreasing order of frequency: Lower end of femur Upper end of tibia Upper end of humerus • Involvement of joints in different types of arthritis
196
Mnemonics
Osteoarthritis
Sparing of w rist and m etacarpophalangeal joints (MCP joint) with involvement of base of thumb is characteristic feature Mnemonic: Sparing of WM in OA Joints involved DIP : He berden’s nodes MC form of idiopathic osteoarthritis Mnemonic: Her DIP – PIP: Bouchard’s nodes – Thumb base (carpometacarpal joint) (second MC joint) – Knee – Spine • Rheumatoid arthritis: DIP is not involved. Axial involvement is limited to upper cervical spine, usualy lumbar spine is not involved. 14 possible joint areas involved (left and right) Wrist Ankle Knee Elbow Metatarsophalangeal MCP PIP Mnemonic : DIP joint is not involved in RA–DNR Wake MMP • Psoriatic arthritis: Any joint may be involved Disease limited to involvement of a single/few small joints (70%) Seronegative, RA like symmetrical arthritis Involvement of DIP Severe destructive arthritis with development of arthritis mutilans Disease limited to the spine. • Pivot shift test is used in cases of anterolateral instability where injured structure include: Anterior cruciate ligament Lateral capsule Lateral–collateral ligament
Orthopedics
197
• Swelling of joint— X-ray MRI Aspiration (for culture) SMnemonic welling of: joint X MAS • Epithelial tumors of bone Adamantinoma—Tibia Mnemonic: Ad on Tb Ameloblastoma—Mandible Mnemonic: Mandi ka mela • Bone metastasis BPL—Breast carcinoma, Prostate carcinoma, Lung carcinoma Pure osteoblastic—Prostate carcinoma Carcinoid tumor Medulloblastoma Mnemonic: PCM Breast carcinoma—Mixed Osteolytic (2/3rd) > osteolytic (1/3rd) • Ollier’s syndrome—Only enchondroma Mnemonic: O for O Maffucci syndrome—Multiple enchondroma and cavernous hemangioma Mnemonic: M for M • Coast of Maine—McCune-Albright syndrome (margins are irregular) Mnemonic: M for M Coast of California—Neurofibromatosis (margins are regular) • Poor factors of rheumatoid arthritis: RF Acute phase reactants/advanced age One year
198
Mnemonics
Nodules Erosion/ESR Mnemonic: RA—ONE • MESS—Mangled extremity severity score. It tells about the survival of a limb after crushing injury. V—Velocity of trauma I—Ischemia S—Shock A—Age. • Housemaid knee—Prepatellar bursitis Clergyman knee—Infrapatellar bursitis Mnemonic: Pre-maid, i.e. Pramod • Nerve injury in sup racondylar humerus fracture— Anterior interosseous > Median > Radial > Ulnar nerve. Mnemonic: AMRU • Colles’ fracture—Extra-articular fracture of distal end of radius with S—Supination of distal fragment L—Lateral displacement (tilt, shift) I—Impaction P—Posterior displacement (tilt, shift) Treatment—Hand shaking cast. • Trendelenberg test Normal hip—Negative Hip abductors—Gluteus medius > Gluteus minimus Superior gluteal nerve Drop of pelvis on opposite side—Positive Mnemonic: DROP If bilateral drop—Waddling gait • Kocher’s maneuver is the most common maneuver used to reduce shoulder dislocation. It involves— Traction
Orthopedics
External rotation Adduction Internal rotation Mnemonic: TEDI • Vertebra plana—Coin like vertebra. Seen in M—Metastasis E—Eosinophilic granuloma L—Lymphoma T—Trauma and very rarely TB
199
