Neet PG Hacker

Since we have posted  final revision points in almost all subjects along with the important high yield topics and facts , no more posts will be added for the next ten days exclusively for your final revision. Aspirants can search for the posts in the archives section. All the best for your exams !!!New posts will be added from Jan  11 th starting from anatomy  in a wholesome manner.. 

Mandibular nerve • Mandibular nerve exits skull from foramen ovale • Middle cranial fossa is supplied by maxillary and mandibular nerve • Nervous spinosus (meningeal branch) enters the skull through foramen spinosum. • Anterior division of mandibular nerve supplies Musc les of mastication mylohyoid, anterior belly of digastric,medial pterygoid , tensor tympani and tensor veli palatini & Skin and mucous membrane of the cheek • Anterior division of mandibular nerve have 4 branches Massetric,External Pterygoid, Deep Temporal & Buccinators • Lingual nerve runs across the duct of the submaxillary gland

MUSCLES OF PECTORAL REGION • pectoralis major Forms anterior axillary fold • pectoralis major is not cut in posterio lateral thoractomy • pectoralis major insert into the intertubercular sulcus of the humerus • pectoralis major blood supply is mainly from pectoral branch of the thoracoacromial artery • Pectoralis minor crosses in front of axillary artery and divides it into three parts. • Removal of pectoralis minor and preservation of pectoralis major in Patey's mastectomy • Pectoralis minor is the only shoulder girdle muscle which is not inserted on the bone in free upper limb. • Pectoralis minor inserts into the coracoid process of the scapula. • Pectoralis minor draw scapula anterioinferiorly • serratus anterior is Cut in postero lateral thoractomy • serratus anterior protracts and rotates the scapula • serratus anterior attach to the costal (rib facing) surface of the medial border of the scapula • serratus anterior holds the scapula against the rib cage(forward)...

Prophylaxis & Treatment Of Typhoid Fever • Carrier are treated by β-lactamase inhibitors • The number of doses recommended for oral Ty21a typhoid vaccine is 3 • Vi polysaccharide vaccine for typhoid is administered subcutaneously or intramuscularly • Ty21a is an oral vaccine in typhoid • Vi polysaccharide of bacterial cell used for vaccination • Treatment of choice for salmonella typhi is Ciprofloxacin • Typhoid Vi polysaccharide vaccine is usually administered in children above the age of 2 years • Vi polysaccharide is a subunit vaccine • Chemoprophylaxis is not required in Typhoid • Ty21a is the live attenuated vaccine in typhoid • Typhoid oral vaccine is given on 1, 3, 5 days • Immunity lasts for 3 years Need a booster • For a typhoid endemic country like India, the immunization of choice is Typhoral 21 A oral vaccine

Friedrich's Ataxia FRIEDREICH'S ATAXIA Etiology: • The classic form of Friedreich's ataxia has been mapped to 9q13-q21.1, and the mutant gene, frataxin, contains expanded GAA triplet repeats in the first intron. There is homozygosity for expanded GAA repeats in >95% of patients. Characteristic Diagnostic features: • Chronic Slowly progressive cerebella,- ataxia • Absent lower limb deep tendon reflexes with an extensor plantar response • Associated features of • Cardiomyopathy • Diabetes • Spine or foot deformity

PSEUDOHYPOPARATHYROIDISM Etiology: • There is tissue resistance to the effects of PTH, so PTH concentrations are markedly elevated • Type 1 a or Albright's hereditary osteodystrophy (AHO) - GNAS1 mutation is inherited on the maternal chromosome  Clinical features: • Hypocalcemia • Hyperphosphatemia • Short fourth/fifth metacarpals and metatarsals with associated Cataract

VOLKMANN'S ISCHEMIA • The muscle which is affected by Volkmann's ischaemia most commonly is Flexor digitorum profundus • The first sign of Volkman's ischemia is Pain on passive extension of fingers • In Volkman's ischemia, surgery should be done Immediately • Split open the plaster of Paris cst and bandage, Decompression by fasciotomy, Exploration are done to manage Volkmann's Ischaemia • In Volkmann's ischaemia, surgery should be done within 1hour • The most important sign in Volkman's ischemia is Stretch pain

Osteochondritis • Kienbock's disease - lunate • Freiberg's disease is a recognised osteochondritis which affects Head of 2nd and 3rd Metatarsal • Perthe’s disease Osteochondritis of femoral head, Presents at 5 – 10 years of age & Management is conservative • Locking of knee joint can be caused by Osgood shalter • Osgood schlatter disease is osteochondritis of Tibial tuberosisty

Shoulder Dislocation • In Inferior shoulder dislocation nerve most common injured is Axillary nerve • Velpeau bandage and Sling and Swathe splint are used in Shoulder dislocation • Hill Sachs lesion' is a consequence of Anterior dislocation of shoulder joint • Inferior dislocation of shoulder is referred to as Luxatio erecta • Attitude in subcoracoid dislocation of shoulder includes Limb on side of body • The position of arm in posterior dislocation of shoulder is In internal rotation • Loss of the normal contour of the shoulder and a abnormal-appearing depression below the acromion. • Recurrent dislocation are common in Shoulder • Commonest type of shoulder dislocation Subcoracoid • Recurrent dislocation of shoulder occurs, because of Crushed glenoidal labrum • Hill sachs defect ,Bankart lesion,Lax capsule are related to recurrent shoulder dislocation • The most common complication of dislocation of shoulder joint is Injury to circumflex nerve • A patient with anter...

Rickets • Defect in proximal tubular reabsorption is seen in vitamin D resistant rickets • Craniotabes, Bow legs & Increase alkaline phosphatase are findings of rickets • Rickets in infancy is characterised by Craniotabes,Rachitic rosary, Wide open fontanelles • Radiological examination of long bones are investigations showing the earliest evidence for healing in treatment of rickets • Flaring of anterior ends of the ribs is characteristically seen in Rickets • A child presented with clinical features of rickets but low level of serum alkaline phosphatase is seen in Hypophosphatasia • Any child with rickets also has osteomalacia while the reverse is not necessarily true because Osteomalacia is found within the same spectrum of rickets, but occurs in persons of any age group, not only in children. • vitamin D-resistant rickets X-linked dominant showing Defect in skeletal ossification & Reduced serum phosphorus • Triradiate pelvis is seen in Rickets • Serum marker...

Erb's paralysis • Erb's point (upper trunk of brachial Plexus) Six nerves meet here(C5 ,C6) • Nerve roots involved in erb's palsy are Mostly C5 & partly C6 • Arms: Medially Rotated (Hangs by side) owing to paralysis of teres minor & infraspinatus. • Policeman's tip hand (or) Porter's tip hand seen in erb's palsy • Abduction & lateral rotation of the arm • Flexion & Supination of the fore-arm at elbow

ULNAR NERVE INJURY • Ulnar nerve commonly seen involved In injuries at the elbow are usually associated with fractures of the medial epicondyle. • Ring & little fingers are not capable of being markedly flexed • The patient is unable to adduct and abduct the fingers and consequently is unable to grip a piece of paper placed between the fingers. • It is impossible to adduct the thumb in ulnar nerve palsy • The metacarpophalangeal joints become hyperextended in ulnar nerve palsy • In case of lesion of ulnar nerve, paralysis of interosseous muscles occurs which leads to clumsiness • claw deformity is seen in long standing case of ulnar nerve palsy • Loss of skin sensation will be observed over the anterior and posterior surfaces of the medial third of the hand • TARDY ULNAR NERVE PALSY is seen in lateral condyle # of humerus resulting in ulnar nerve injury • Cubitus valgus deformity and tardy ulnar nerve palsy is seen as the late complication of ulnar nerve injury • Hy...

Lesions of radial nerves • Injection palsy (Tetracycline injection) • Injury to radial nerve in lower part of spiral groove results in Anconeus muscle paralysis. • If lesion occurs in radial groove long head of triceps are spared & thus it leaves extensions at elbow joint intact. • Radial nerve palsy produces an inability to extend the metacarpophalangeal joints, owing to paralysis of the extensor digitorum communis muscle. • In radial nerve injury triceps (Nerve supply to the triceps is proximal to the mid shaft level) are spared. • Low radial nerve palsy occurs when the radial nerve is injured at the level of elbow, so that the muscles supplied by the radial nerve in the distal arm (Brachioradialis and Extensor Carpi radialis longus ) are not affected. The muscles affected are finger extensors, extensor carpi radialis brevis & sensation on dorsum of hand. • Radial nerve injury cause anaesthesia over anatomical snuff box • Radial nerve injury only weakens (affec...

AMELOBLASTOMA • Ameloblastoma is the Most common odontogenic tumour • Ameloblastoma is Generally benign • Ameloblastoma is Common in 3rd to 5th decade • Most common jaw tumor is Ameloblastoma

RANULA • Structure damaged most commonly during Surgery on Ranula is Submandibular duct • Ranula is Translucent, Retention cyst of minor salivary gland • Ranula is cystic swelling in the floor of mouth • Ranula is Retention cyst of sublingual gland • Plunging may be a feature in ranula

AMPUTATION • Myodesis is employed in amputations is indicated for Tumor, Ischemia & children • Myodesis is contraindicated in cases of severe dysvascularity in which blood supply to the muscle appears compromised. • Tarso Metatarsal amputation is also known as Lisfranc amputation • Amputation is required in Gas gangrene, Buerger's disease & Diabetic gangrene • In flap method of amputation, bone is kept shorter than the level of amputation • Ring sequestrum is seen in Amputation stump • MES score evaluates chances of amputation in a traumatized limb • Age, B.P & Velocity of trauma evaluate the chances of amputation in a limb • In below elbow amputation the length of stump should be 15-20 cm • Distance from Olecranon in amputation should be 15-20 cm • Phantom limb Follows amputation • Pain due to post-amputation neuroma is best treated by Surgical Excision • Most Imp. technical consideration at the time of doing below knee amputation is Post. flap should b...

Gastritis • Increased production of macrocytic red blood cells would mostly likely be associated with chronic gastritis (Type A) resulting from autoimmune destruction of parietal cells. • A patient of peptic ulcer disease, when investigated endoscopically showed chronic antral gastritis. Warthin Starry Stain will be able to stain the specimen. • Type B gastritis:It is called as antral predominant gastritis as antrum is involved predominantly. However, it is misnomer as the inflammatory process may progress to body and fundus and causing pangastritis. • Autoimmune gastritis is less common of the two forms and is characterized by :- Presence of antibodies against parietal cells and intrinsic factor and Involvement of body and fundus with sparing of antrum. • Endoscopic biopsy from a case of H.pylori related duodenal ulcer is most likely to reveal Antral predominant Gastritis. • Atrophic Gastritis is a predisposing factors for gastric carcinoma. • Erosive gastritis commonly...

Suture and Suture Materials • Kelly's suture is done in Stress incontinence. • If suture marks are to be avoided, sutures of face should be removed by 3-5 days. • In abdominal surgery Lembert sutures refers to Seromuscular Sutures. • Surgically used suture material polydioxanone (PDS) undergoes hydrolysis and complete absorption. • Vicryl is a delayed absorbable synthetic suture material and is a Co-Polymer of glycolide and lectide. • Isopropyl Alcohol is used as preservative for packing catgut suture. • Best suture for common bile duct is non synthetic absorbable. • Absorbable sutures are:Plain and Chromic Catgut,Polyglactin,Polyglyconate,Polyglycolic Acid,Polydiaxone,Polyglycaprone. • Non-absorbable sutures are:Silk,Linen,Surgical Steel,Linen,Polyester,Polybutester,Polypropylene.

Thyroid Carcinoma • Thyroid carcinoma associated with hypocalcemia is Medullary carcinoma • FNAC cannot distinguish between a Follicular Adenoma and a Follicular Carcinoma • In Medullary carcinoma thyroid Patients should be screened for RET point mutation on chromosome 10 • Medullary carcinoma thyroid Secretes calcitonin • Medullary carcinoma thyroid Contains amyloid • Papillary carcinoma of thyroid have Excellent prognosis • Amyloid deposition is seen in Medullary carcinoma thyroid • Total thyroidectomy is done in Medullary carcinoma thyroid • Parafollicular cells involved in Medullary carcinoma thyroid • Medullary carcinoma thyroid is TSH dependent • Radionuclide scan is is initial investigation of choice for a patient presenting with solitary nodule of thyroid • Percentage of cold thyroid nodules likely to be malignant are 20% • Psammoma bodies are seen in Seminaoma • Medullary thyroid carcinoma is associated with MEN II • Multiple,round figures in histopathologica...

Hydrocele • Funicular hydrocele is a communicating hydrocele • Congenital hydrocele is treated by Herniotomy • Hydrocele are Brilliantly transilluminant swellings • Edema of foot and Hydrocele is caused by W.Bancrofti • Lord's Plication is done for Hydrocele • Congenital hydrocele in infant showing inguinal swelling which is smooth, transparent, fluctuating &receives an impulse when the child coughs or struggles • Vaginal hydrocele remains in the scrotum • Hernia with hydrocele is Gibbon's hernia • No-scalpel vasectomy is for contraception is contraindicated in Hydrocele • Lord's and Jaboulay's operation is done for Hydrocele • Hydrocele is a type of Exudation cyst

PSYCHIATRY​ ​&​ ​SKIN 1. Magical​ ​thinking​ ​belief​ ​that​ ​thinking​ ​can​ ​cause​ ​action. 2. Hallucination​ ​is​ ​disorder​ ​of​ ​perception. 3. Delusion​ ​is​ ​a​ ​disorder​ ​of​ ​thought. 4. Emotion​ ​is​ ​controlled​ ​by​ ​Frontal​ ​lobe. 5. Rorschach’s​ ​test​ ​measures​ ​Personality. 6. Best​ ​test​ ​for​ ​diagnosis​ ​of​ ​Organic​ ​Mental​ ​Disorders​ ​Bender​ ​Gestalt. 7. Test​ ​which​ ​uses​ ​projection​ ​typically​ ​is​ ​Rorschach’s​ ​test. 8. Rorschach​ ​inkblot​ ​test​ ​is​ ​Projective. 9. A​ ​false​ ​belief​ ​unexplained​ ​by​ ​reality​ ​shared​ ​by​ ​a​ ​number​ ​of​ ​people​ ​is Superstition. 10. Sleep​ ​deprivation​ ​leads​ ​to​ ​Decreased​ ​mental​ ​alertness. 11. Delirium​ ​is​ ​marked​ ​by​ ​Clouding​ ​of​ ​consciousness. 12. Delusion​ ​is​ ​not​ ​present​ ​in​ ​Compulsive​ ​disorder. 13. Formed​ ​visual​ ​hallucinations​ ​are​ ​seen​ ​in​ ​lesion​ ​Temporal​ ​lobe. 14. Delusion​ ​in​ ​delirium​ ​are​ ​Transient 15. Disorientation​ ​is​ ​a​ ​...

Liver Transplantation • Hepatitis C is the Most common indication for Liver transplantation • Patient of hepatitis C treated with orthotopic liver transplantation which shows rising transaminase and bilirubin levels after an year should be given immunosuppresent to prevent T- lymphocyte mediated rejection injury to hepatic endothelial cells • Liver transplantation offers the only chance of cure in those with unresectable hepatocellular carcinoma • Donor bile duct with recipient bile duct or Roux en Y choledochojejunostomy is the best way to get bile drainage in donor liver In orthotropic liver transplantation • The best available treatment for portal hypertensive gastropathy is Liver transplantation • Indications of Liver transplantation are Biliary atresia,Sclerosing cholangitis & Cirrhosis • According to Pugh's classification moderate to severe hepatic insufficiency is managed by liver transplantation • Liver transplantation was first done by Starzl • In late s...

Sigmoid Volvulus • Coffee bean sign is seen in Sigmoid volvulus • A plain abdominal X-ray in a patient with a sigmoid volvulus will show a distended bowel loop with its apex in Rt. Hypochondrium • Bird of Prey sign is seen in the radiographic barium examination of Sigmoid volvulus • Sigmoid volvulus is more common than caecal volvulus • Sigmoid volvulus is More common in psychiatric patients • Definitive treatment of sigmoid volvulus is sigmoid colectomy • Rotation in sigmoid volvulus nearly always occur in anticlockwise direction • Age of 60-70, neurological impairment, psychiatric condition ,Band of adhesion & Long pelvic meso colon with Narrow attachment are some Predisposing factors for sigmoid volvulus

Eales disease • Eales disease is Recurrent vitreous hemorrage • Panretinal photocoagulation is done in Eales disease • Eales disease is characterized by Recurrent retinal haemorrhage, Recurrent vitreous haemorrhage & Neovascularization • A 27-yr male presents with a sudden, painless loss of vision. His ocular and systemic history is unremarkable. The most likely diagnosis is Eales’ disease • A patient with tuberculosis presents with complaints of sudden appearence of floaters in front of the eye. A diagnosis of Eales disease is made. • Retinal detachment seen in Eale's disease • In a young patient presenting with recurrent vitreous hemorrhage, diagnosis is Eale's disease. • A 25 year old male presents withpainless sudden loss of vision, ocular and systemic examination is not contributory is diagnosed with Eale's disease. • Eales disease is Recurrent periphelbitis retina. • Eale's disease is Vitreous hemorrhage • Eales' disease is best treated wit...

RETINITIS PIGMENTOSA • Primary pigmentary retinal dystrophy predominantly affects rods more than cones • Sporadic >Autosomal recessive > Autosomal dominant > X-linked recessive • Night blindness or nyctalopia is the characteristic feature — due to degeneration of rods • Tubular vision in advanced cases • Retinal pigmentary changes resembling bone corpuscles — typically perivascular • Optic disc becomes pale and waxy — consecutive optic atrophy • Annular or ring shaped scotoma is the typical visual field defect • Later only central vision is left (tubular vision) • ERG is subnormal or abolished (scotopic affected before photopic; b wave affected before a wave) • EOG - absence of light peak • Refsum's syndrome: peripheral neuropathy, cerebellar ataxia • Usher's syndrome: labyrinthine deafness

Special Hearing Tests • In Electrocochleography,action potentional is produced by outer hair cells. • Electrocochleography is mostly used in monitoring the Meniers disease. • Electrocochleography is the gold standard investigation for diagnosis of Meniers disease. • In Electrocochleograpgy,the electrode must be kept close to source of amplitude. • Otoacoustic emissions arise from Outer hair cells. • Recruitment phenomenon is seen in Presbyacusis. • Otoacoustic Emissions is the best screening test to evaluate hearing in a neonate. • Brainstem Evoked Response Audiometry(BERA) • Electrocochleography is a method of recording auditory evoked response taken from cochlea and auditory nerve is the investigation of choice in assessing hearing loss in neonates. • Auditory screening is required in children under following conditions:Before doing exchage transfusion for hyperbilirubinemia, In premature babies , Before starting aminoglycoside therapy • To distinguish between cochlear ...

Physiology of hearing • Function of Stapedius is Protects the ear from loud frequency sound. • Exposure to noise above 160 dB causes permanent loss of hearing. • Permanent privation of the hearing of either ear ,even though correctable by surgery,comes under Greivous injury. • Psycho-acoustic index of loudness is indicated by the term 'Phon'. • Sense gravity and Linear acceleration is associated with ‘otolith organs’. The limit of loudness expressed as decibels that people can tolerate without substantial damage to their hearing is 85 dB. • Foetus starts hearing by what time in intrauterine life by 20 weeks. • Sense organ for hearing is Organ of Corti. Bones of middle ear are responsible for Reduction of impedance to sound transmission. • Impedance matching occurs at Difference of surface are of tympanic membrane and foot plate. • Primary receptor cells of hearing is Hair cel

Ethmoidal Polyp • Ethmoidal polyp can cause bilateral nasal obstruction and loss of taste. • Rhinorrhea may be present with Ethmoidal polyp. • Ethmoidal polyp may be associated with Cystic Fibrosis. • All polypi should be subjected to histology,especially in old age patient as a simple nasal poylp in an old patient may masquerade a malignancy underneath. • On examination, smooth, glistening, grape-like masses which are pale in color are seen in case of Ethmoidal polyp. • A patient with Ethmoidal polyp may present with is a history of asthma and allergies. • Ethmoidal polyp is not associated with epistaxis. • Ethmoidal polyp typically occurs in middle aged individuals and not in the first decade of life. • Recurrent polyps are seen in Ethmoidal polyp. • Epinephrine,Corticosteroids and Antihistamines is the medical treatment of multiple ,bilateral nasal polyp. • Extranasal ethmoidectomy should be done in a patient who presents with an Ethmoidal polyp,6 months later after ...

Laryngeal Paralysis • Cadaveric position of vocal cords is seen in Bilateral recurrent and superior laryngeal nerve palsy. • The voice is not affected in unilateral abductor palsy. • Recurrent laryngeal nerve palsy and External branch of superior laryngeal nerve palsy may occur as a complication of hemithyroidectomy surgery. • In complete bilateral palsy of recurrent laryngeal nerves,there is preservation of speech with severe stridor and dyspnea. • Twenty-four hours following partial thyroidectomy where the inferior thyroid artery was also ligated (tied off), the patient now spoke with a hoarse voice (whisper), and had difficulty in breathing.Recurrent Laryngeal Nerve is injured in this case. • Recurrent Laryngeal Nerve injury most commonly leads to vocal cord paralysis. • Damage to the internal laryngeal nerve results in anaesthesia of the larynx. • Thyroid Ca causes laryngeal paralysis due to Recurrent Laryngeal nerve palsy. • Vocal cord palsy in thyroid surgery is due...

Nasopharyngeal Carcinoma • Treatment of choice of Nasopharyngeal Carcinoma is Radiotherapy. • Radiotherapy is the treatment of choice for Nasopharyngeal carcinoma T3N I. • Nasopharyngeal carcinoma is mostly Squamous cell carcinoma. • Trotter's triad is seen in Nasopharyngeal carcinoma. • Commonest site of Nasopharyngeal carcinoma is fossa of rosenmuller in lateral wall of nasopharynx. • Nasopharyngeal Carcinoma is associated with Epstein-Barr virus infection.IgA antibody to EBV is observed • Role of smoking and development of nasopharyngeal carcinoma is still not clear. • Concomitant chemoradiotherapy is indicated in T1 N2 M0 Nasopharyngeal Cancer. • In ulcerative form of nasopharyngeal carcinoma, epistaxis is the common symptom. • Nasopharyngeal cancer can cause conductive deafness (Eustachian tube blockage), ipsilateral (not contralateral) temporoparietal neuralgia (involvement of cranial nerve V) and palatal paralysis (CN X)- collectively called Trotter’s triad. ...

Fracture of the facial bones-Nose,Maxilla,Mandible,Zygomatic • Le Forte II facial fracture implies Fracture running through zygomatic process of the maxilla, floor of orbit, root of nose on both the sides. • Craniofacial dissociation is seen in Le Fort 3 fracture. • CSF Rhinorrhea Occurs in fracture of maxilla in Le Fort type II and type III (as cribriform plate is injured here) and also in naso-ethmoid fracture • Bone commonly fractured in facial injuries is Nasal Bones. • Most common site for fracture mandible is Condyle. • LeFort's fracture would include Maxilla,Zygoma and Nasal Bones, • Tripod fracture is the name given for Zygomatic fracture. • Pyramidal fracture of maxilla is Le Fort-2

Nasopharyngeal Angiofibroma • Nasopharyngeal angiofibromas are most frequently seen in the second decade. • Hypotensive Anesthesia in nasopharyngeal angiofibroma is/are given by Propofol and Phentolamine. • Nasopharyngeal fibroma is the most common benign tumor of nasopharynx. • Clinical features of nasopharyngeal angiofibroma are Adolescent male and Epistaxis and nasal obstruction is the cardinal symptom. • A 14 years boy presented with repeated epistaxis, and a swelling in cheek.Diagnosis is nasopharyngeal angiofibroma and Contrast CT scan should be done to see the extent. • Surgery is treatment of choice in juvenile Nasopharyngeal Angiofibroma. • The most probable diagnosis in a 14-year old boy presenting with history of frequent nasal bleeding and Hb found to be 6.4 g/dL and peripheral smear showing normocytic hypochromic anemia is Juvenile nasopharyngeal angiofibroma. • Most probable diagnosis in a child with unilateral nasal obstruction along with a mass in cheek a...

PHARMACOLOGY​ ​&​ ​MICROBIOLOGY 1. Area​ ​under​ ​the​ ​blood​ ​concentration​ ​–time​ ​reliably​ ​reflects​ ​the​ ​total​ ​amount of​ ​drug​ ​reaching​ ​the​ ​target​ ​tissue​ ​after​ ​oral​ ​administration. 2. High​ ​affinity​ ​of​ ​the​ ​drug​ ​will​ ​enable​ ​it​ ​to​ ​be​ ​used​ ​in​ ​low​ ​concentrations. 3. Heparin​ ​can​ ​be​ ​safely​ ​prescribed​ ​in​ ​pregnancy. 4. Tolazoline​ ​is​ ​used​ ​as​ ​a​ ​vasodilator​ ​before​ ​coronary​ ​catheterization. 5. Drug​ ​used​ ​to​ ​perform​ ​stress​ ​ECHO​ ​is​ ​Dobutamine. 6. Used​ ​for​ ​the​ ​treatment​ ​of​ ​migraine,​ ​the​ ​triptans​ ​act​ ​through​ ​5HT-1B. 7. Ipratropium​ ​bromide​ ​is​ ​absolutely​ ​contraindicated​ ​in​ ​urinary​ ​retention. 8. Rofecoxib​ ​is​ ​associated​ ​with​ ​highest​ ​cardiac​ ​mortality. 9. The​ ​therapeutic​ ​efficacy​ ​of​ ​antihypertensive​ ​drugs​ ​is​ ​blunted​ ​by​ ​NSAIDs because​ ​they​ ​decrease​ ​the​ ​synthesis​ ​of​ ​vascular​ ​prostacyclin. 10. Aspirin​ ​inhibits​ ​Cyclooxyg...

PSM​ ​&​ ​ENT 1. Epidemiology​ ​can​ ​be​ ​dened​ ​as​ ​the​ ​study​ ​of​ ​the​ ​distribution​ ​and determinants​ ​of​ ​frequency​ ​of​ ​disease​ ​in​ ​humans. 2. Study​ ​of​ ​time,​ ​place,​ ​person​ ​is​ ​known​ ​as​ ​descriptive​ ​epidemiology. 3. British​ ​study​ ​of​ ​Anti-asthmatic​ ​drug​ ​and​ ​death​ ​due​ ​to​ ​it​ ​is​ ​a​ ​type​ ​of ecological​ ​study. 4. Crossover​ ​study​ ​is​ ​done​ ​when​ ​control​ ​and​ ​case​ ​are​ ​the​ ​same. 5. Randomization​ ​is​ ​useful​ ​to​ ​eliminate​ ​selection​ ​bias. 6. First​ ​step​ ​in​ ​investigation​ ​of​ ​epidemic​ ​to​ ​conrm​ ​diagnosis. 7. Secular​ ​trend​ ​refers​ ​to​ ​gradual​ ​change​ ​in​ ​a​ ​particular​ ​direction. 8. Bhopal​ ​gas​ ​tragedy​ ​is​ ​an​ ​example​ ​of​ ​Point​ ​source​ ​epidemic. 9. WHO​ ​recommends​ ​Danish​ ​1331​ ​strain​ ​for​ ​BCG​ ​vaccine​ ​production. 10. Immunization​ ​against​ ​Hepatitis​ ​B​ ​is​ ​included​ ​by​ ​WHO​ ​in​ ​immunization schedule​ ​recently. 11. Perinatal​ ​mortali...

Tracheostomy • Advantages of a double lumen tracheostomy tube are easy to remove,clean and replace inner cannula. • In emergency tracheostomy the following structures are damaged: Isthmus of the thyroid,Thyroid ima and Inferior thyroid vein. • High tracheostomy is indicated in Carcinoma of Larynx. • Cardiac tamponade,Uncomplicated Bronchial Asthma,Pneumothorax is not an indication for tracheostomy. • Mid tracheostomy is done over 3rd and 4th tracheal rings. • In Pediatric tracheostomy,most common early complication is subcutaneous emphysema and 3rd & 4th tracheal rings are incised. • Indications of Tracheostomy are Flail chest,Head injury,Tetanus,Tracheal stenosis,Bilateral vocal cord palsy,Foreign body larynx,Emphysema,Bronchiectosis,Atelectasis. • A new born with a goiter large enough to cause dyspnoea may be treated with Tracheostomy.(Partial thyroidectomy is preferred over tracheostomy). • Interstitial Emphysema may be found in Tracheostomy. • A cricoid hook is...

Sensorineural Hearing loss •Sensorineural Hearing loss • Paget's Disease may present with abnormality at upper tibia,Hip and Back pain,Sensorineural Hearing loss,Elevated Alkaline Phosphatase,Ivory Vertebra and Cotton Wool Spots in Skull X Ray. • Basilar Migraine presents with intermittent headache in association with tinnitus,vertigo and hearing loss. • Ramsay Hunt Syndrome may present with facial palsy ,facial pain ,vesicles on the canal and pinna,vertigo and sensor neural hearing loss . • Exposure to noise above 160dB can cause permanent loss of hearing. • The diagnosis of classic alport syndrome is based on X-linked inheritance of hematuria, sensorineural hearing loss, and lenticonus • Psycho-acoustic index of loudness is indicated by the term 'Phon'. • In chidren suffering from meningitis,sensorineural hearing loss may occur despite prompt initiation of appropriate antimicrobial therapy. • Alport Syndrome,Nail-patella syndrome,Pendred's syndrome,Trea...

Eustachian Tube • Auditory tube formed of Elastic cartilage. • The auditory tube connects the nasopharynx with the anterior wall of the Middle ear. • Tests for Eustachian Tube Patency are Valsalva test,Methylene blue test,Sonotubometry,Politzer test,Toynbee test,Frenzel maneuver,Catheterization,Inflation - Deflation test. • Cholesteatoma invading Eustachian tube is an indication for Radical Mastoidectomy. • Eustachian tube opens behind the level of inferior turbinate. • Cartilaginous part of auditory tube is inferior to Sphenopetrosal Synchondrosis. • The length of Eustachian tube is 36 mm. • Inner 2/3rd part is Cartilaginous and outer 1/3rd part is Bony of the Eustachian Tube. • Tensor Veli Palatini and Levator veli palatini muscle causes opening of Eustachian Tube during Swallowing,yawning,sneezing. • Higher elastin content in adults in Eustachian Tube. • Eustachian Tube develops from the first and second pharyngeal arch. • Otoscopic findings of Eustachian tube dysfunc...

External Auditory Canal • Malignant Otitis externa-Ear pain and drainage in an elderly diabetic patient must raise concern about malignant external otitis.It is associated with tenderness in the pinna and swelling and inflammation of the external auditory meatus.Granulation tissue may be present in the external auditory canal.This infection is almost always caused by P. aeruginosa. • Other features -Facial palsy, not responding to antibiotics, increased uptake on technetium bone scan. • Severe Hearing Loss is absent.ESR is used for follow-up. • Antibiotic of Choice-Antipseudomonal penicillin or cephalosporin (3rd generation piperacillin or ceftazidime) with an aminoglycoside/fluoroquinolone . • Length of external auditory canal is 24 mm. • Use of Isotretinoin may lead to teratogenic effects like Cleft lip,Cleft Palate and Agenesis of the External ear canal. • Corrective surgery for a new born with microtia is usually performed at 5-7 years of age. • Mechanical stimulatio...

Breast milk: • Can be stored at room temperature For 8-10 hours • In a refrigerator For 24 hours • In a freezer -20°c for 3 months. • Breast milk transmits (with definitive evidence) (1) HIV , (2) CMV • Breast milk can rarely transmit (1) HTLV – type 1, (2) Rubella virus, (3) HBV , (4) HSV. • Premature milk contains less lactose in comparison to term milk. • The coefficient of uptake of iron in breast milk is 70%. • Calcium absorption of human milk is better that that of cow's milk. • The milk of human contains the least amount of calcium. • Human milk gives 67 kcal per 100 ml . • Protein forms 8-10% of total energy. • Carbohydrate forms 3 8-40% of total energy. • Fat forms 50-52% of total energy. • Breast milk protein is a reference protein. • Vitamin K is absent in breast milk. • Milk is a poor source of Vitamin C. • Vitamin not present in breast milk is Vitamin B. • According to WHO, exclusive breast milk is given upto 6 months. • Fat content of mil...

Cohort Study • Cohort study is a type of analytical study. • Cohort study is best to test the association between risk factor and disease. • To test the association between risk factor and disease, the weakest study design is Ecological Study. • Proceeds from cause to effect (Also seen in RCT and ecological studies). Cohort Studies are indicated when there is good evidence of an association between an exposure and disease. • It is a study is one in which the outcome (e.g. disease) has not yet occurred at the time the investigation begins. • Yields incidence rate, relative risk, attributable risk(except Odds Ratio-a measure of the strength of the association between risk factor and outcome). • Advantage of Case control studies over Cohort Study is that Odds ratio (estimate of Relative Risk) can be measured and rare disease can be studied but Chances of bias are maximum in case-control study. • Can not study many causal factors at a time as in Case Control Study. • Cohort ...

Clostridium Botulinum • Botulism is a disease of Neuromuscular transmission caused by the toxin of the bacterium clostridium botulinum • Among the toxin produced by clostridium botulinum, the non neurotoxic one is C2 • Clostridium botulinum A, B, C and F cause human disease • The gene for botulinum toxin is encoded by a bacteriophage • Clostridium botulinum comes under Category A bioterrorism agents • Preformed toxin is important in food poisoning due to Clostridium botulism • In a 6 months old baby, floppy infant syndrome is seen commonly due to infection with Clostridium botulism • Clostridium botulinum toxin mode of action is by Pr esynaptic block • Causative organism of food poisoning due to home canned food is Clostridium botulinum • Sudden infant death syndrome (SIDS) following administration of honey is due to Clostridium botulinum • Dysphagia, diplopia, dysarthria are characteristic symptoms of food poisoning due to Clostridium botulinum • Clostridium botulinum...

Corynebacterium Diphtheria • Positive Schick test indicates Susceptible to diphtheria • Schick test in diphtheria is done to know Subseceptibles in diptheria • Eleks test is done for diphtheria • Babes Ernest granules are seen in diphtheria • Post exposure prophylaxis in health care professionals is not indicated in infections with diphtheria • Skin test based on neutralization reaction in diphtheria is schik's test • Elek's Gel is a precipitation test for diphtheria • Toxin is phage mediated in diphtheria • Toxin production is dependent upon critical concentration of iron in diphtheria • Incubation period of cynobacterium diphtheria is 2-5 days • Tellurite blood agar is used in growth of cynobacterium diphtheria • The most common ophthalmic effect of diphtheria is Isolated ocular palsies • Commonest age group for diptheria is 2-5 Years • Erythematous reaction in both arms indicates Allergic type interpreted as Schick type • Diphtheria antitoxin is given intrad...

Immunoglobulin A • Immunoglobulin in peyer's patch is IgA • IgA is the main immunoglobulin in secretions • Commonest immunoglobulin deficiency is of IgA • IgA nephropathy may occur following an episode of mucus membrane infection of the respiratory or gastrointestinal tract. • IgA is formed by two monomers joined by J chain • IgA is associated with immunity of intestine and respiratory epithelium • IgA is rich in serum and body secretions • IgA activates complement by alternate pathway • Predominant type of immunoglobulin in human milk is IgA • In Protein Energy Malnutrition IgA is reduced the most • Henoch-Schonlein purpura is characterized by the deposition of IgA around the vessels • In Kwashiorkor,IgA is most affected • Acquire IgA deficiency may occur in Severe Congenital toxoplasmosis • IgA is present in local mouth secretions

AIDS defining Opportunistic infections and Neoplasms • Diarrhoea in AIDS can be caused by Mycobacterium species ; Viruses :cytomegalovirus, adenovirus, and herpes simplex; Protozoa :Cryptosporidium, Isospora belli, Microsporida, and Blastocystis hominis; Neisseria gonorrhoeae, Treponema pallidum, Chlamydia • Fungal infections associated with AIDS patient are Penicillium mameffei,Candida, Cryptococcosis, Coccidioidomycosis, Histoplasmosis ,Pneumocystis carinii • Strongyloides stercoralis is the Commonest helminthic infection in AIDS • Kaposi sarcoma is the Multifocal tumor of vascular origin • Most common opportunistic infection in AIDS in Indi a is Cryptosporidium • Cryptosporidium is the most common causative agent in diarrhea in AIDS patients • Kaposi sarcoma, Non Hodgkin lymphoma,Primary lymphoma of brain, Invasive cancer of uterine cervix ,Immunoblastic lymphoma ,Burkitt's lymphoma are the malignancies in AIDS • Protozoa commonly causing diarrhea in HIV patients an...

1. Initial investigation for breast lump: FN AC 2. Thyroid tumour, associated with MEN II syndrome: Medullary carcinoma thyroid 3. Bilateral breast carcinoma: Lobular 4. Vascular malformation which persists: Portwine stain 5. MC cause of abdominal aortic aneurysm: Atherosclerosis 6. Clinical sign indicative of deep venous thrombosis: Homan's sign 7. Gold standard method of diagnosing varicose veins: Duplex USG 8. Sign associated with arteriovenous fistula: Nicoladoni- Branham sign 9. Mode of healing in clean incised wound: Primary intention/ 1" intention 10. MC site of keloid: Sternum 11. MC site of basal cell carcinoma: Face 12. MC soft tissue tumour in a child: Rhanbdomyosarcoma 13. MC benign parotid gland tumour: Pleomorphic adenoma 14. Treatment of pleomorphic adenoma: Superficial parotidectomy 15. Cause of peau'd orange: Lymphatic permeation 16. Treatment of choice for cystic hygroma: Excision 17. Retention cyst of sublingual gland is known as: Ranula...

Diagnostic Techniques In HIV • AIDS is associated with increased p24 antibody: basis for detection in window period. • Abnormal response of T cells to mitogens is a test used in HIV • HIV causes Hypergammaglobulinemia • Methenamine silver stain is used to detect cyst of Pneumocystis carinii in AIDS • Chemokine co-receptor for HIV found on macrophage is CCR5 • During the Window period of patient with AIDS ELISA & western blot both are negative • Window period in HIV is from Infection to appearance of antibodies in serum • p24 antigen disappears from the blood after 6-8 weeks in HIV • In HIV infected individual Gram stain of lung aspirate shows yeast like morphology that indicates Candida tropicalis, Cryptococcus neoformans or Pencillium marneffi infection • Rapid progression of disease with full blown manifestation in AIDS occurs when T4 cell count falls below 200/microL • DNA-PCR, Viral culture, p24 antigen assay are used for diagnosis of HIV infection in a 2 month ol...

Anti-Parkinsonism Drugs • Carbidopa is used in the treatment of Parkinsonism because It decreases peripheral utilisation of L-dopa • Contraindication to breast milk feeding is Bromocriptine therapy for mother • Bromocriptine Inhibits prolactin release • Bromocriptine , Ropinerole & Pramipexole are dopaminergic agonists used for parkinsonism • Pyridoxine abolishes the therapeutic effect of levodopa by enhancing peripheral decarboxylation of levodopa • In Parkinsonism, phenothiazines reduces the efficacy of levodopa • Levodopa is a prodrug • Levodopa can cause On-off phenomenon • Entacapone enhances the bioavailability of levodopa • Rotigotine is intended to be delivered through transdermal patches, so as to ensure a slow and constant dosage in a 24-hour period. • Antiparkinson drug known to cause cardiac valvular fibrosis is Pergolide & cabergoline • Drug of choice for drug induced parkinsonism Anticholinergic • Benzhexol is Drug of choice in drug induced Parkin...

Enzyme inhibition (competitive, non-competitive and uncompetitive) • he presence of a noncompetitive inhibitor can Leads to a decrease in the observed Vmax • A competitive inhibitor of an enzyme will Bind to the same site as the substrate • In competitive inhibition Vmax is unchanged but Km increased • Disopropyl phosphofluoridate (DFP) reacts with serine proteases irreversibly and therefore is Non competitive inhibitor • In noncompetitive antagonism Km value decreased; V max decreased • Atropine is useful in organophosphate poisoning bec ause it Is a competitive antagonist of acetylcholine • Non competitive inhibitor of carbonic anhydrase is Acetazolamide • Non-depolarizing muscle relaxants are Competitive inhibitor of acetylcholine • Imatinib and suntinib are competitive inhibitors of tyrosine kinase • If V max decrease to 80% due to an inhibitor and Km is same as before Non competitive type of inhibition • Cyanide affects respiratory chain by Non-competitive irreversi...

• Insulin performs Glycogen synthesis, Glycolysis & Lipogenesis • Insulin clearance closely resembles G.F.R • Human insulin differs from beef insulin by 1 amino acid residue • Rapid infusion of insulin causes Hypokalemia • Insulin is Required for transport of glucose, amino acid, K+ & Na • In fetus the insulin secretion begins by 3rd month • Increased ratio of insulin to glucagon causes Decreased levels of cyclic AMP • Insulin promotes lip genesis by Decreasing intracellular cAMP, Increasing the transport of glucose into the cell & Increasing activity of acetyl-CoA carboxylase • Insulin secretion seen in Glucose, Vagal stimulation & Acetylcholine • Insulin activate lipoprotein lipase to aid fat metabolism • Insulin facilitate glucose uptake in Liver,RBC & Kidney • Insulin acts on glucose metabolism by permeability across cell membrane against glucose gradient • Sulfonylurea is shifted to insulin in pregnant lady because Insulin does not cross placenta...

• Besides its properties of decreasing intraocular pressure, timolol is preferred in the treatment of glaucoma because it Produces no miosis • Drug of choice for open angle glaucoma Timolol • Acetazolamide s contraindicated in sulfonamide hypersensitivity • Brimonidine can cause drowsiness • A patient with glaucoma is being treated with systemic beta blocker should not be given Levobunolol • Acute angle closure glaucoma first line treatment Iv mannitol • Drug used in refractory glaucoma Alpha agonist • Latanoprost used topically in glaucoma primarily acts by Increasing uveoscleral outflow • Main MOA brimonidine in glaucoma Decreased aqueous secretion • Drug kept as a last resort in the management of primary open angle glaucoma is Oral acetazolamide • Selective alpha 2 agoinst used in glaucoma is Brimonidine • Atropine should be avoided in angle closure glaucoma • Pain in absolute glaucoma is best relieved by Retrobulbar injection of steroid • Drug CONTRAINDICATED in gl...

1. Radiosensitive lung carcinoma: Small cell carcinoma 2. Lung carcinoma found in peripheral location: Adenocarcinoma 3. Koplik spots are seen in: Measles 4. Increased neuromuscular irritability is a feature of: Hypocalcemia 5. Paradoxical breathing is seen in: Diaphragmatic palsy 6. Curschmann spirals are seen in: Asthma 7. Alpha-1 antitrypsin deficiency is associated with: Panacinar emphysema 8. IOC for Bronchiectasis: High resolution CT scan 9. DOC for mycoplasma pneumoniae: Erythromycin 10. Pneumoconiosis associated with sugarcane dust: Bagassosis 11. IOC for aortic dissection: MR1 12. Ground glass appearance on chest X-ray is a feature of: ARDS 13. MC carcinoma causing superior vena cava syndrome: Lung carcinoma 14. MC manifestation of pulmonary embolism: Dyspnoea 15. Barrel shaped chest is a feature of: Emphysema 16. In JVP, a wave is due to: Atrial contraction 17. In ECG, p wave is due to: Atrial depolarization 18. DOC for PSVT: Adenosine 19. MacCallum patch i...