FGME
ANATOMY Umbilical cord: 2 arteries (deoxygenated blood away from foetus) ! "ein (oxygenated blood to foetus) remnants of yol# sac and allantois $%arton&s 'elly t% eft aortic arc% artery → Arc% of Aorta *urface ectoderm → lens Notoc%ord → nucleus +ul+osis Mesoderm → trigone of urinary bladder *e+tum +rimum → fossa o"alis All , germs layers → Tym+anic membrane True True di"erticulum: di"erticulum: all layers layers of intestinal intestinal wall e-ge-g- Mec#el&s Mec#el&s eft umbilical "ein of foetus → ligamentum teres Umbilical arteries → median umbilical ligament .uctus arteriosus closes at !/, mont%s Mesenteric cysts: ecto+ic lym+%atics 0emnant of "itello/intestinal duct: umbilical +oly+1sinus1Mec#el&s lastocyst im+lantation: .ay 3 *+erm attains motility: e+ididymis 4enital tubercle → clitoris1+enis runner&s glands: in duodenum owman&s membrane: cornea 5assal&s cor+uscles: t%ymus 6eyer&s +atc%es: ileum lood/testes barrier: *ertoli cells 4oblet cells (secretory cells): small intestine colon trac%ea bronc%us bronc%ioles con'uncti"a (not oeso+%agus) *im+le cuboidal e+it%elium: t%yroid o"ary surface c%oroid +lexus inner surface lens +igment cell layer retina 6eriarticular lym+%oid s%eat%s (T cells): s+leen Uterus +re menarc%e: ciliated columnar- ose cilia +ost menarc%e 65Y*7OO4Y Monocytes in circulation for 82%rs 9O2 mostly as 59O , (carbonic an%ydrase) it ; clotting factors: 2 8 < != 7ron stores > ferritin 5b**: glutamate → "aline at β/3 !gm 5b binds wit% !-,,ml O 2 6lasma > serum ? @brinogen ? clotting factors 2 B 5aemo+%ilia A: Cactor B 5aemo+%ilia : Cactor <
Acti"ation of extrinsic system: t%rombo+lastin (8 < != ) Acti"ation of intrinsic system: (!2 !! < B !=) 5agemann factor > Cactor !2 (glass factor) 6lasma > D -$ 5e+arin in%ibits: < != !! !2 (intrinsic system) 7ntrinsic system > a6TT16TT Extrinsic system > 6rot%rombin time 96 > +ressure in rig%t atrium !st %eart sound > A "al"e closure 0eticulocytosis NOT seen in c%ronic renal anaemia *+ectrin de@ciency → %ereditary s+%erocytosis
7O95EM7*T0Y Essential amino acids: T%ese Ten aluable Amino acids 5a"e ong 6reser"ed ife 7n Man (T%reonine Try+to+%an aline Arginine 5istidine ysine 6%enylalanine eucine 7soleucine Met%ionine) A*T > *4OT (serum glutamine oxaloacetic transaminase) Fant%ine oxidase co/factor: molybdenum 6%os+%ofructo#inase reGuires magnesium Ammonia in brain detoxi@ed by glutamine Try+to+%a Try+to+%an n → niacin Tyrosin Tyrosine e → t%yroxine Adr Norad do+amine melanin 4lutamine: only AA to cross Nitrogen donors in urea cycle: N5, and As+artate 9/+e+tide: +art of +ro/insulin 4lutat%ione > tri+e+tide UbiGuitin: label +roteins for degrade imiting AA in foods: o $%eat: ysine and T%reonine o 0ice: ysine o egumes: Try+to+%an Try+to+%an or Met%ionine o 6ulses: Met%ionine o MaiHe: ysine and Try+to+%an o Egg: none Tyrosin Tyrosine: e: essential AA in 6%enyl# 6%enyl#etonuria etonuria Mousy urine odour: 6%enyl#etonuria 9ysteine → Taurine 4lutat%ione 9o/enHyme A
6AT5OO4Y Macro+%ages form granuloma 0ed infarct:
5aemorr%agic o enous occlusion o oose organs: lungs li"er o"ary testis 47 tract o Tissues wit% dual blood su++ly o 6re"iously congested tissue o 0e+erfusion in'uruy (e-g- M7 stro#e burn organ trans+lant) $%ite infarct: o Anaemic o *olid organs: s+leen %eart #idneys o 7sc%aemic necrosis Metastatic calci@cation: blood "essel lungs #idney gastric mucosa Amyloid: 9ongo red stain green birefringence Tumour su++ressor genes: NC! +0b *MA. +, 5yaline arteriosclerosis: %y+ertension 9all/exner bodies: 4ranulosa cell tumour 9alci@cation wit% normal 9a le"els: dystro+%ic 9alci@cation in normal tissues: metastatic Myositis ossi@cans (+ost trauma in young): meta+lastic bone C70*T sign of acute inIammation: "asoconstriction 5aemorr%age: o 6rimary: at time of in'ury o 0eactionary: /3%rs o *econdary: 8/! days Ceature of irre"ersible cell in'ury: formation of amor+%ous densities in mitoc%ondrial matrix ence/Jones +rotein: lig%t monoclonal c%ains 9EA: colon ca AC6: %e+atocellular ca li"er mets 9A!2: o"arian ca 9.!/,: breast ca 9a!
M790O7OO4Y est 57 test: $estern lot 9ulture mediums: o lood agar → bot% anaerobic and aerobic o 0obertson&s coo#ed meat → anaerobes o *abouraud .extrose agar → fungi Enric%ment media: o Al#aline +e+tone water → "ibrio c%olera o Monsour&s tauroc%olate → "ibrio c%olera o *elenite C brot% → dysentery bacilli
lood agar medium: enric%ed medium 5aemolysis: o Al+%a: %alo around colony o eta: com+letely bro#en down o 4amma: no %aemolysis *terilisation o 6asteurisation of mil#: 6%os+%atase test o *teriliHation of mil#: Turbidity test o Autocla"e: !2! 9 for !min biological indicator is Bacillus stearothermophilus o T%eatre steriliHation: formalde%yde fumigation o 5ot air o"en: glass instruments force+s scissors scal+els o 9old sterilisation: ionising radiation o Endosco+e sterilisation: glutalde%yde (9idex) Coxiella burnetti : moist %eat resistant o o *%ar+s: blue bag o 6%enol co/eKcient > eKciency of disinfectant 9om+lement @xation test > $asserman reaction 7gA: reast mil# 7gM: +rimary res+onse 7gM > recent infection 7g4: secondary res+onse re+laces 7gM intra"ascular %aemolysis 7gE: ana+%ylaxis AcGuired %umoral immunity > cells AcGuired cellular immunity > T cells Ty+e 7 %y+ersensiti"ity: ana+%ylaxis w%eals Ty+e 77 %y+ersensiti"ity: drug induced %aemolytic anaemia drug induced t%rombocyto+aenia %aemolytic disease of newborn Ty+e 777 %y+ersensiti"ity: art%us reaction Ty+e 7 %y+ersensiti"ity: contact sensiti"ity 9%edia#/5igas%i syndrome: im+aired bacteriolysis 9,: acti"ation of com+lement t%roug% alternati"e +at%ways
6A0A*7TOO4Y Leishmania donovani → eis%maniasis o Transmitted by sandIy Phlebotomus argentipes o .og is commonest reser"oir o 6romastigote (Iagellate) form of eis%mania found in 47T of sandIy o ;nown as #ala aHar o *een in bone marrow as+irate intracellular in 0E* (eis%man/ .ono"an body) o est test: immunoIuorescent antibody test (.AT) Toxo+lasma gondii dx by *abin/Celdman dye1E7*A abesiosis: s+read by tic#s
Coxiella burnetti → L fe"er Clu#es: Paragonismus westermani > lung Iu#e o o Fasciola hepatica = li"er Iu#e o Gastrodiscoides hominis = large intestinal Iu#e Clonorchis sinensis = biliary tract Iu#e o Ta+eworm: Diphyllobothrium latum → megaloblastic anaemia (!2) o Taenia solinum → cysticercus cellulosae o o chinococcus granulosus → %ydatid cyst 5oo#worm: o !ncylostoma duodenale → microcytic %y+oc%romic anaemia "ecator americanus o 6inworm1T%readworm: o nterobius vermicularis → +ruritis in +erineal region- Cound in caecum 0oundword: o !scaris lumbricoides Calci+arum malaria o 9rescentic microgametocyte o lac# s+ot 9yclo+s (small crustacean): infected in .racunculosis14uinea worm disease No"y/McNeal/Nicolle (NNN) medium: leis%mania 9ommonest +arasitic infection in A7.*: #trongyloides stercolaris 6arasites +roducing non/bile stained eggs: NE5A "ecator americanus o nterobius vermicularis (6inworm) o o $ymenolepis nana (.warf ta+eworm) o !ncylostoma duodenale (5oo#worm) Brugian malayi% 2 nuclei at tail ti+ 5uman as intermediate %ost: o Malaria o 5ydatid cyst 7nfecti"e form of malarial +arasites: s+oroHoites Micro@lariae: not in lym+%atics *een in +eri+%eral malarial smear: early tro+%oHoites and gametocytes (not mature tro+%oHoites or sc%iHonts 9ry+tos+oridium: best test is immunoIuorescence 4iardiasis → malabsor+tion (not %oo#worm roundworm ta+eworm) 9%agas disease > American try+anosomiasis ( Trypanosoma cru&i)
65A0MA9OO4Y 6ro/drugs:
Enala+ril o Acyclo"ir o e"odo+a o 9odeine 6%armacodynamics: eect of drug on body 6%armaco#inetics: eect of body on drug T%era+eutic index: safety margin Area under time and +lasma concentration cur"e > +lasma clearance st ! order #inetics (=/order): elimination +ro+ortional to serum conc *teady state > / %alf li"es Or+%an drugs > used to treat rare diseases .e+ot > subcut17M .o+amine agonists: o romocri+tine o 9abergoline o 6ergolide o 6rami+exole o A+omor+%ine o 0otigotine .o+amine antagonists: o Anti+syc%otics: 9loHa+ine 0is+eridone OlanHa+ine i+rasidone o Antiemetics: Metoclo+ramide .om+eridone .ro+eridol o T9A: Amoxa+ine Acetylation metabolisation: %ydralaHine isoniaHid +rocainamide 5ydroxylation metabolism: +%enytoin A9Ei: good for diabetic %y+ertensi"es *%ort acting β bloc#er: Esmolol 9a c%annel bloc#er crossing : Nimodi+ine Meto+rolol: β! selecti"e 6ulmonary artery %y+ertension: *ildena@l (6.E/i) Non selecti"e 9a c%annel bloc#er: Nifedi+ine 6ositi"e inotro+e: dobutamine do+amine amrinone Negati"e inotro+e: 9a c%annel bloc#ers β bloc#ers Na c%annel bloc#ers *T: adenosine or "era+amil *alicylate toxicity: al#aline diuresis Arterial AN. "eno dilator: sodium nitro+russide used in %y+ertensi"es wit% aortic dissection .o+amine at renal dose: renal1coronary1mesenteric "asodilation .o+amine at +ressor dose: systemic "asoconstriction oo+ diuretics: in%ibit Na/;/9l trans+ort o
CO0EN*79 ME.797NE AN. TOF79OO4Y
5anging → +ressure abrasion *ec ,2= 769 4rie"ous in'ury: o Emasculation o 6ermanent loss of Eye Ear Member1'oint 6ower of member1'oint 6ermanent dis@guration of %ead or face o o Cracture1dislocation of bone1toot% o Endanger life1se"ere +ain1unable to follow ordinary +ursuits 2= days Abrasion collar > margin of bullet entry 5anging → +ressure abrasion Teet% mar#s → +ressure abrasion 5yoid fracture > t%rottling 6olice inGuest: o Accident o Murder o *uicide o .eat% under sus+icious circumstances Magistrate inGuest: o .owry deat% *ec ,=/ 769 o 9ustodial deat% o .eat% due to +olice @ring o .eat% in +rison o .eat% in +syc%iatric %os+ital o Ex%umation 9riminal res+onsibility: o"er 8yrs No time limit for ex%umation *ection tra"el ex+enses for witnesses eading Guestions: allowed in cross/examination or for %ostile witness 5ydrocution > deat% due to cardiac arrest due to falling in water s%oc# NOT electrocution in water lood grou+ in blood stains: o Absor+tion/in%ibition o atte&s crust met%od o Absor+tion elution test o atex met%od lood detection o 9rystal: Ta#ayama test o 6in# stain: ;astle Meyer test o 9arcinogenic: enHidine test
4lowing bluis%: uminol test .NA sam+le: cannot use 9*C Teet%: o .eciduous teet% until 3yrs o !st +ermanent toot%: molar o Mixed dentition from 3 /!yrs o All +ermanent teet% at !yrs Medical Termination of 6regnancy: o P!2w#s: single doctor !2/2= w#s: 2 doctors agree ! doctor to do o o 2=w#s in emergency: single doctor can do o .onQt need %usband&s consent rain deat% > absent brainstem reIexes i"or mortis: discolouration due to ca+illary distension 0igor mortis: stiening of muscles Arborescent burns1@ligree burns1ic%tenburg @gure1ferning > lig%tning *oot in airway > ali"e during @re 6ostmortem wounds: o No bleeding o No clot1coagulation o Edges donQt ga+e No enHyme acti"ity o 9*C test: alco%ol +oisoning one test: arsenic +oisoning *+inal cord test: stryc%nine and gelsemium rain test: o+iates and organo+%os+%ates 6ugilistic attitude in burning: due to coagulation of muscle +rotein %a++ens if ali"e1dead itreous %umour: slow +utrefaction useful in alco%olic1diabetic deat% can test bioc%emistry +reser"ed in Iuoride 9or+us delicti > essence of crime 9afR coronary > as+%yxia w%ile eating colla+se 5eat stro#e: no sweating tem+ =-3 degrees 5eat ex%austion: %ea"y sweating +recursor to %eat stro#e 5eat ras%: s#in irritation due to %ea"y sweating 5eat tetany: stress in %eat muscle s+asms %y+er"entilation numbness .eat% due to star"ation: o Translucent intestine walls o 9ontracted and em+ty stomac% o rain same siHe ot%er organs smaller o Caecolit%s in colon o Cull and distended gallbladder wit% stones o
60EENTAT7E AN. *O97A ME.797NE True +ositi"es: sensiti"ity True negati"es: s+eci@city 6re"ention: o 6rimordial: +re"ention of ris# factors e-g- 5TN obesity o 6rimary +re"ention: +re"ention of disease e-g- sunscreen o *econday +re"ention: +re"ention of disease +rogression (before +atient notices) e-g- screening o Tertiary +re"ention: +re"ention of com+lications (+atient %as sym+toms) 6assi"e immunity: Maternal antibodies across +lacenta o o 4i"ing antibodies Acti"e immunity: o 4etting infectious disease o accination 7ncubation +eriod im+ortant for: o Tracing source of infection o 6eriod of sur"eillance1Guarantine (NOT isolation S already #now are ill) o 7mmunisation o 6rognosis 6re"alence is a +ro+ortion Odds ratio: case/control study and retros+ecti"e studies 0is# ratio: co%ort study and 09Ts 9o%ort: most reliable way of s%owing association between ris# factor and outcome can be retros+ecti"e or +ros+ecti"e attributable ris# incidence rates 9ase/control: low cost odds ratio only ris# of bias 0elati"e ris# > incidence of disease in ex+osed1incidence of disease in non/ ex+osed 7ncidence +ro+ortion (cumulati"e incidence) > no of new cases in a time +eriod1total +o+ulation initially at ris# *entinel sur"eillance: detect missed cases can only su++lement routine noti@cation system 5erd immunity: only in contagious i-e- not tetanus 9ase fatality rate: o No of deat%s due to disease x !==1No of cases due to disease o Not useful for c%ronic disease o 0e+resents "irulence 79. re"ised e"ery != yrs
;u++uswamy socio/economic status S , factors: occu+ation education income
EA0* NO*E AN. T50OAT 5y+eracusis: NOT seen in otosclerosis o Ex+osure to %ig% decibel le"els o Migraine o 5ead trauma o .amage to ner"e to sta+edius (facial ner"e) o yme disease o Meniere&s disease o ell&s +alsy Meniere&s triad: "ertigo tinnitus +rogressi"e %earing loss st ! sign of acoustic neuroma: "estibulococ%lear sym+toms 0%inne&s +ositi"e > A9 9 > normal1sensorineural 0%inne&s negati"e > conducti"e 0%inne&s negati"e: minimum air/bone ga+: o 235H: ! !25H: ,= o o !=25H: 5earing testing: !2 5H Malignant otitis externa: necrotiHing com+lication of swimmer&s ear 2ry to pseudomonas aeruginosa 9ommonest cause of conducti"e deafness P!2yrs: *erous otitis media 9ommonest cause of c%ronic ear infection in de"elo+ing countries: 9%ronic su++urati"e otitis media 0eferred +ain ear: e-g- carcinoma tongue o t% cranial ner"e (auriculotem+oral branc%): dental oral TMJ o Macewen&s triangle (im+ortant for cortical mastoidectomy) cribiform +late → 9*C r%inorr%oea
Atro+%ic r%initis → Young&s o+eration Antroc%oanal +ol+s → Endosco+ic sinus surgery Olfactory dysfunction: o ;allmann syndrome (%y+ogonadism ? anosmia) o Coster ;ennedy syndrome (+a+illoedema ? unilateral anosmia ? o+tic atro+%y due to olfactory groo"e meningioma) o Neurodegenerati"e: 6ar#inson&s AlH%eimer&s 5untingdon&s c%orea o O9. 6aranasal sinuses: o Et%moid: +resent at birt% o Maxillary: +resent at birt% o Crontal: de"elo+ 2yrs o *+%enoid: de"elo+ ,yrs 0%ino+%yma > %y+ertro+%y of sebaceous glands Naso+%aryngeal @broma: "ascular benign but fast growing tumour in young males Malignancy in sinus: B=D maxillary et%moid frontal s+%enoid mets rare carcinoma sarcoma men women Unilateral foul smelling nasal disc%arge in c%ild: foreign body Crontal sinus: o+ens into middle meatus Outer trac%eostomy tube s%ould not be remo"ed for ,/ days to allow tract to form 9ommon com+lication of trac%eostomy: %aemorr%age 9ommonest cause of stridor in infant: laryngomalacia (8=D)
O65T5AMOO4Y 03(*O), Eye of newborn: %y+ermetro+ic Axial lengt%: o Newborn: !Bmm o ,yrs: 2,mm o ,/!yrs: increases by !mm Emmetro+ic eye: o Axial lengt% 2mm o 9orneal refracting +ower: , dio+ters o enticular refracting +ower: 2= dio+ters o 6ower of eye > ,?2= → 3= . Maximum refracti"e +ower: anterior surface of cornea !mm c%ange in axial lengt% → ,. refracti"e c%ange (increase → myo+ia decrease → %y+ermetro+ia) !mm c%ange in radius of cur"ature of cornea → 3. refracti"e c%ange (cur"ed → myo+ia Iatter → %y+ermetro+ia)
lind s+ot of Mariotte > o+tic disc Co"ea > centre of retina Ora serrate > 'unction between retinal cells and ciliary body (+%otosensiti"e) .e+t% of anterior c%amber of eye: 2-mm 0adius of anterior c%amber: Bmm 0adius of +osterior c%amber: !2mm +5 of tears: 8- .irect o+%t%almosco+y: o Magni@es by x! (more t%an indirect) o 7ndirect %as larger @eld of "iew o 7mage is erect o 5y+ermetro+ia S largest "iew least magni@ed o Myo+ia S least area most magni@ed 0etinosco+y: o Estimate refracti"e error o 6erformed at !m o 9onsists of +lane and conca"e mirror o Myo+es: against& mo"ement o 5y+ero+es: wit%& mo"ement Test for closed angle glaucoma: dar# room test Test for dry eye: *c%irmer&s test 9ongenital dacrocystitis > nasolacrimal duct obstruction relie"e wit% massage ;eratometer: measures anterior corneal cur"ature 6rednisolone: 97 in glaucoma (#nown to cause glaucoma) 6ilocar+ine: 97 in malignant glaucoma Eye dro+s o β bloc#ers: reduce +roduction of aGueous %umour (glaucoma) e-gtimolol o V agonists: reduce +roduction of aGueous %umour and increase drainage e-g- brimonidine o 9arbonic an%ydrase in%ibitors: reduce +roduction of aGueous %umour e-g- dorHolamide o 6rostaglandin li#e com+ounds: increase outIow e-g- latano+rost o 9%olinergic agents: increase outIow e-g- +ilocar+ine NOT to use in malignant glaucoma o E+ine+%rine com+ounds: increase outIow e-g- di+i"efrin st ! line treatment o 57 ?"e 9M retinitis: ganicyclo"ir o To+ical antibiotics for eye: tetracyclines o Anterior u"eitis: !D atro+ine S mydriasis and +re"ention of formation of +osterior synec%iae
Trac%oma: aHit%romycin o A"oid recurrence of +terygium: Mitomycin 9 9yto+legics (antimuscarinic): tx of iridocyclitis +u+il dilation u"eitis 9orneal de+osits: *E of amiodarone Guinine (antimalarials) o
4ENE0A ME.797NE 5aemolytic anaemia: see decreased %a+toglobulin 9ommonest s%oc#: %y+o"olaemic .ialysis: NOT digoxin o *alicylates o Alco%ols o arbiturates o 9a ; Na i 5aemolytic uraemic syndrome (5U*) > microangio+at%ic %aemolytic anaemia ? fragmented 09s in @lm ? t%rombocyto+aenia ? A0C T%alassemia o V t%alassemia carrier1minima (!1) → normal 5bC and 5bA2 o V t%alassemia trait1minor (21) → mild anaemia low M9 and M95 o V t%alassemia ma'or15b5 (,1) → %ig% 5b 5 o β t%alassemia → ele"ated 5bA2 ONY condition wit% increased M959: %ereditary s+%erocytosis *+%erocytosis: o Autosomal dominant o .ecreased 09 surface area Cis% ta+eworm and +%enytoin: causes megaloblastic anaemia 7f only gi"e folate wit%out !2 in megaloblastic anaemia → worsening neurology 6T and 7N0: extrinsic +at%way a6TT: intrinsic +at%way lood transfusion: %y+o9a and %y+oMg %y+er; Myelo@brosis o Ty+ical Wdry ta+X M as+iration o =yrs o Massi"e s+lenomegaly .79: long 6T a6TT %ig% ./dimer low @brin t%rombocyto+aenia CC6: coagulation factors and 777 on $illebrand: normal 6T +rolonged T1a6TT Most im+ortant factor for O2 consum+tion: myocardial @bre tension .ressler&s syndrome: following transmural infarct1o+en %eart surgery (+ericardial and +leural eusions)
J6 a/wa"e > atrial systole o c/wa"e > bulging of tricus+id into 0A isol"olumic o "/wa"e > "entricular systole o x/wa"e > atrial diastole y/wa"e > triscus+id o+ening blood into 0 o o dominant a/wa"e > 6* +ulm 5TN T* o cannon a/wa"e > 95 +aroxysmal nodal tac%ycardia "entricular tac%ycardia o dominant "/wa"e > T0 o absent x > AC o exaggerated x > tam+onade constricti"e +ericarditis o s%ar+ y > T0 constricti"e +ericarditis o slow y > rig%t atrial myxoma Cixed s+litting of *2 > A*. !==D O2 not eecti"e in tetralogy of Callot 6ro+%ylaxis in c%ild wit% carditis: until 2yrs (lifelong if %a"e damage to "al"es) *e"erity of M* by auscultation % duration of diastolic murmur o
4ENE0A *U04E0Y Cluid resus in burns !=D c%ild !D adult st Cluid > x weig%t (#g) x DT*A gi"e in ! B%rs in next !3%rs 6erineum !D +alm !D nd 2 degree1dee+ dermal: %eal by scarring re/e+it%elialisation at ,w#s *u+er@cial t%rombo+%lebitis: abdo cancers Cactor eiden .T uerger&s irc%ow&s triad: coagulability blood Iow e+it%elial disru+tion uerger&s disease > t%romboangitis obliterans: aects medium "cssels S +lantar tibial radial *clerot%era+y drugs: et%anolamine oleate +oliocanol sodium tetradecyl sul+%ate .e@ciency of 6rotein 9 * antit%rombin 777 → /!=D .Ts .T rarely causes lung infarct (dual blood su++ly) 0aynaud&s: w%ite → blue → red Nicoladoni ran%am&s sign: slowing of 50 in re+onse to com+ression of A @stula 5emangioma of s+leen: commonest benign s+lenic tumour may transform to %emangiosarcoma *ym+at%ectomy of lumbar s+ine / s+are ! for sexual function *eldinger a++roac% S used for arteriogra+%y rodie/Trendelenburg test / sa+%eno/femoral incom+etence
*%oc# treatment indicator S urine out+ut Tests for "aricose "eins: 6ert%e&s test TourniGuet test Trendelenburg test (not Adson&s)
O0T5O6AE.79* 5ill/*ac%s lesion S recurrent dislocation of s%oulder Neuro"ascular in'uries o Cemoral "essel / fracture lower !1, rd of femur o 0adial ner"e / %umeral s%aft fracture o *ciatic ner"e / +osterior dislocation of %i+ o 6o+liteal "essel / su+racondylar femoral fracture o Median ner"e / su+racondylar %umeral fracture (can also %a"e radial ner"e) o Extensor +ollicus longus tendon / fracture distal radius e-g- 9olle&s *alter/5arris classi@cation S for e+i+%yseal fractures: o Ty+e 7 S entire e+i+%ysis o Ty+e 77 S entire e+i+%ysis ? +art meta+%ysis o Ty+e 777 S +art e+i+%ysis o Ty+e 7 S +art e+i+%ysis ? +art meta+%ysis o Ty+e S com+ression of e+i+%yseal +late 9olle&s fracture > COO*5 dorsal dis+lacement dinner for# deformity *mit%&s fracture > re"erse 9olle&s "olar dis+lacement garden s+ade deformity arton&s fracture > always intra/articular always car+al subluxation o .orsal arton&s > same mec%anism as 9olle&s intra/articular fracture in"ol"ing dorsal as+ect of distal radius o 6almar arton&s > same mec%anism as *mit%&s subluxation of wrist more common intra/articular fracture in"ol"ing +almar as+ect of distal radius 9%aueur&s fracture > direct axial com+ression of sca+%oid into radial facet fracture of radial styloid ? a"ulsion of radial collateral ligament 4aleaHHi fracture/dislocation > radial fracture wit% dislocation of distal radio/ulnar 'oint (wrist) Monteggio fracture/dislocation > ulnar fracture wit% dislocation of +rox radio/ulnar (elbow) nd rd Marc% fracture > 2 1, metatarsal stress fracture 9om+lications of 9olle&s: *ude#&s osteodystro+%y mal/union ru+ture of E6 tendon acute car+al tunnel (not non/union) 9om+lications of %umeral lateral e+icondylar fracture: non/union cubitus "algus deformity → tardy ulnar ner"e +alsy 9ommonest com+lication of extra ca+sular femoral fracture S mal/union
Most serious com+lication of long bone fracture S fat emboli 7ntraca+sular1CNOC: small external rotation of %i+ Extraca+sular1intertroc%anteric: se"ere external rotation of %i+ 6osterior dislocation of %i+: Iexion adduction and internal rotation of %i+ Tests o McMurray&s test: meniscus in'ury o ac%man test: A9 best test also anterior drawer test o 6osterior drawer test: 69 o arus instability test: 9 o algus instability test: M9 9asts and braces o 5anging cast: lower %umeral s%aft fracture o Milwau#ee brace: scoliosis o oston brace: scoliosis o 9ylindrical cast: fracture +atella T art%ritis → @brous an#ylosis M96 and 676: r%eumatoid art%ritis .76: osteoart%ritis and +soriatic art%ritis 7leac crest in"ol"ement (ent%esis): an#ylosing s+ondylitis Celon > terminal +ul+ s+ace infection st 6ott&s s+ine > s+inal T ! com+laint is localised bac# +ain 4out > negati"ely birefringent monosodium urate 9%arcot&s 'oint S commonest cause is .M T art%ritis S monoarticular OA commonest 'oint in"ol"ed: o $estern countries / %i+ o 7ndia S #nee (medial com+artment)
6AE.7AT079* .aily maintenance Iuid: o P!=#g: !==ml1#g o !=/2=#g: !== ? add in =ml1#g for e"ery #g abo"e != o 2=#g: !== ? = (abo"e !=) ? 2=ml1#g for e"ery #g abo"e 2= Nocturnal enuresis S normal u+ to 3yrs .aytime enuresis S normal u+ to yrs engt% increase (term baby): o 7ncreases by ,=D by mnt%s o =D by !2 mont%s o 4row 2cm in !yr o .ouble birt% lengt% at yrs o !==cm at -y (7ndian) $eig%t increase:
.oubles at 3mnt%s o Tri+les at !yr o Luadru+les at 2yrs o Annual increase from 2/
2m → , word +%rase sentences (2/,3m) o ,/y → #now age (,y) #now some colours (,y) *ocial emotion and be%a"iour: o Newborn → n1a o 3 w#s → smile res+onsi"ely o ,/m → n1a o 3m → can +ut solid food in mout% 8/Bm → se+aration anxiety (Bm) o o !=m → wa"e bye +ee#aboo o !2/!m → can drin# from cu+ (!2m) o !Bm → can feed safely wit% s+oon symbolic +lay (!B/2m) o 2=m → n1a o 2m → can remo"e own clot%es dry by day own1+arallel +lay o ,/y → interacti"e +lay (,y) imit ages: o No res+onsi"e smile → B w#s o No good eye contact → ,m No reac%ing for ob'ects → m o o No sitting unsu++orted → !== x mental age1c%ronological age !st sign of sexual maturity in boys > testicular enlargement !st sign of scur"y > +erifollicular %y+er#eratotic +a+ules (s%in) → ecc%ymoses 6ro+%ylactic itamin A: o !===== 7U at weig%t for %eig%t o 9%ronic > %eig%t for age ;was%ior#or (oedema) "s marasmus 0ig%t to left s%unts > cyanosis e-g- TOC tricus+id atresia Ebstein&s T4 (not A*.1*.16.A S left to rig%t) 9orticosteroids for foetal lung maturity: o owers A0.* intra"entricular %aemorr%age necrotising enterocolitis o
7ndicated in +reterm labour 2/,w#s o A"oid multi+le courses o A"oid in eclam+sia and c%orioamnitis Coetal lung maturity S NOT measured by maternal AC6 is measured by let%icin:s+%ingomyelin ratio foam stability index amniotic Iuid +%os+%atidylc%oline le"el A64A0: A > a++earance (colour) 6 > +ulse 4 > grimace (reIex irritability) A > acti"ity 0 > res+iratory eort 6%ysiological 'aundice S a++ears 2/82%rs disa++ears in ! days Jaundice P2%rs S %aemolytic disease (0% incom+atibility) 6%otot%era+y S tx of c%oice for neonates wit% uncon'ugated 'aundice Uncon'ugated > indirect con'ugated > direct (%e+atic causes) st Jaundice in ! wee# of life S usually indirect Jaundice 82%rs S biliary atresia breast mil# 'aundice metabolic disorders neonatal %e+atitis 9ommonest cause of neonatal deat% worldwide > +rematurity 9ommonest c%ild%ood e+ile+sy > generalised tonic clonic 9ommonest cause of seiHures in newborn > %y+oxic isc%aemic ence+%alo+at%y o
O*TET079* A6 diameters: o True con'ugate: !!cm ti+ of sacral +romontory → u++er sym+%ysis +ubis o Obstetric con'ugate: !=cm ti+ of sacral +romontory → bulge on sym+%ysis +ubis shortest !P diameter o .iagonal con'ugate: !2cm ti+ of sacral +romontory → lower sym+%ysis +ubis o External con'ugate: 2=cm last lumbar s+ine → u++er sym+%ysis +ubis Trans"erse diameters: o Anatomical trans"erse diameter: !,cm ileo+ectal line largest pelvic diameter o Obstetric trans"erse diameter: slig%tly P!,cm bisects true con'ugate ObliGue diameters: o 0ig%t obliGue diameter: !2cm 0 sacroiliac 'oint → ileo+ectal eminence o eft obliGue diameter: !2cm sacroiliac 'oint → 0 ileo+ectal eminence o *acro/cotyloid diameter:
argest foetal %ead diameter > mento"ertical !cm Naegele&s +el"is > ala absent one side 0obert&s +el"is > ala absent bot% sides
4YNAE9OO4Y
.E0MATOO4Y
ANAE*T5E*7A
6*Y957AT0Y
0A.7O.7A4NO*7*
0A.7OT5E0A6Y
