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We at AFMG put in a constant effort to provide you the best quality education material as
part of our wholesome coverage of course modules for FMGE.
We have been associated with this examination in the form of a coaching institute since
2004 and are very well aware of the constant changes in exam pattern over the years .
The book has 100 pages with most relevant must know information has been provided.
Book has been developed keeping in mind the recent trends in exam patterns.
We at AFMG thank to all our brilliant teachers our PG students, DR. MILIN SHINDE, DR.
VINAYAK MEHETRE, DR. RAHUL VYAS, DR SUGAT for putting their sincere efforts to
provide the most relevant material which will be useful for the students before Exam.
Best of Luck
ARTERIES
Formed by union of 2 vertebral arteries: Basilar A.
Inferior vesical artery is a branch of: Anterior division of internal iliac artery
Uterine A. is a branch of: Anterior division of internal iliac A.
Inferior thyroid A. is a branch of: Thyrocervical trunk
Ascending pharyngeal A. is a branch of: External carotid A.
Internal pudendal A. is a branch of: Anterior division of internal iliac A.
Left gastro-epiploic A. is a branch of: Splenic A.
Splenic A. is a branch of: Coeliac trunk
Cystic A. is a branch of: Right hepatic A.
Cilio-retinal A. is a branch of: Choroidal A.
Middle meningeal A. is a branch of: Maxillary A.
Anterior spinal A. is a branch of: Vertebral A.
Ophthalmic A. is a branch of: Internal carotid A.
Medially, superior thyroid artery is related to: External branch of superior laryngeal nerve
EMBRYOLOGY
Prochordal plate & primitive streak is seen on: 14th day
Oogonia & germ cell are derived from: Yolk sac
1st polar body is formed during: Oogenesis
1st polar body is extruded: At the time of ovulation
Y chromosome is: Acrocentric
Sperms are stored in: Epididymis
Length of human sperm: 50-60 microns
Number of chromosomes are reduced down to half in: 1st meiotic division
In humans, implantation begins on the: 6th day after fertilization
Initiation and maintenance of primitive streak is because of: Nodal gene
Primitive streak develops in which week: 3rd week
Structure developed from cloaca:
o The cloaca develops into the rectum and upper 2/3 of the anal canal,
o While its anterior subdivision, the urogenital sinus, develops into the bladder and
o In the female, the urethra and vestibule,
o While in the male the prostatic urethra.
TONGUE
Muscle of tongue develops from: Occipital myotomes
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EPITHELIUM
Mesothelium of pleura, peritoneum & pericardium is lined by: Simple squamous epithelium
Nasal cavity, nasal air sinuses, nasopharynx, larynx (EXCEPT vocal cords), trachea & bronchi are lined by: Ciliated pseudo-
stratified columnar epithelium
True vocal cords, cornea, tonsil & vagina are lined by: Non keratinized stratified squamous epithelium
Epithelium with extra reserve of cell membrane: Transitional epithelium
Calyces, Ureter, ureterovesical junction & urinary bladder have: Transitional epithelium
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HENNEBERT'S SIGN : false positive fistula test(congenital suphylis)
LIGHT HOUSE SIGN: Acute suppurative otitis media<acute mastoditis
(small pin hole perforation with a pulsatile ear discharge)
OMEGA SIGN: LARINGOMALACIA (epiglottis)
PHELP’S SIGN : glomus jugulare
RISING SUN SIGN : glomus tumour
SCHWARTZ SIGN : active phase of otosclerosis(otospongiosis)
STEEPLE SIGN: Acute laryngotracheobronchitis
TEAR DROP SIGN : Orbital floor fracture
THUMB SIGN : Epiglottitis
TEA POT SIGN: CSF rhinorrhoea
CAUSE OF NPC – EBV VIRUS
- Trotter's triad – U/L CONDUCTIVE DEAFNEES
-TRIGEMINAL NEURALGIA( d/t-5th c.n.)
- palatal palsy ( d/t-10th c.n.)
Nerve involved in Frey’s syndrome –Auriculotemporal
MCC of malignant otitis exterua-pseudomonas aeroginosa
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Hornor syndrome- is caused due to compression of sympathetic nerve plexus by an apical tumor called as pancast tumor
panjabi- ptosis
M-miosis
E-enophthalmos
A -anhidrosis
L-loss of ciliospinal reflex
- Max. cones are seen in fovea centralis
- 1 mm change in the axial length of the eyeball produce a change in refractive index by 3 diopter.
- Depth of anterior chamber of eye 2-3 mm.
- Normal ph of tear 7.5 .
- Max.refractive power of eye structure- anterior surface of cornea.
- Thinnest part of eye- posterior
- Thinnest part of lens – posterior
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In apoptosis Apaf -1 is activated by release of which of the following substance from mitochondria-Cytochrome C
A simple bacterial test for mutagenic carcinogens is-AMES test
Stain specific for Amyloid –Congo red
Type of Amyloidosis is caused by mutation of the transthyrting protein –Familial amyloidotic polyneuropathy
In famillal mediterorean fever the gene the following protein undergoes mutation –pyrin
The classification purposed by the international lymphoma study group for NHL is-REAL classification
Sub type of Hodgkin’s disease which is geniticancy district from are the other sub types is- lymphocyte psedominant
The membrane protein clathrin is involved in –receptor mediated endocytosis
Lipoxins belongs to family of-Arachidonic acid metaboullites
Genes favoring Apaptosis-bax,bad ,bcl-X5
Genes that inhibit apoptosis-bcl2,bcl-xl
Most common cytogenetic abnormality in adult MDS-nonosomy 7
Most abundant glycoprotein present in basement membrane-type IV
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The blood in the vessels normally doesn’t clot bec2-vascular endothelium is smooth and coated with glyocalxy
The correct sequence of cell cycle is-Go –GI-S-G2-M
Routine technique for karyotyping using light microscopy-G banding
Gluten sensitive enteropathy is most strongly associated with which HLA system-HLA
Pan T lymphocyte marker –CD3
Memory T cells can be identified by using marker-CD45RO
NHC class III gene encodes –TNF and are important elements in governing susceptibility to auto immuue disease
Raised level of lipoprotein a is a predictor of –atherosclerosis
The epithelliod cell and multinucleated giant cells of granulomatous inflammation are derived from-Monocytes
macrophages
The following feature is common to both cytotoxic T cells and NK cells –effective against virus infected cells
A myocardial infarct showing early granulation tissue has most likely occurred –within 1 week
Enzyme that protects brain from free radical injury –Superoxide dismutase
Autoimmuue hemolytic anemia is seen in –CLL
Massive blood transfusion result is –Metabolic Alkalosis
The marker for B lymphocyte is -- CD19
Firm warty vegetation along the line of closer of valves is due to –Rheumatic heart disease
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Hyper functioning of Epithelial Na+ channel in collecting duct lead to-Liddle’s syndrome
Mutation of Ryanodine receptor leads to –Malignant hyperthermia
Bell magendie low-
o Sensory –
o Dorsal horn
o Motor –ventral Horn
Bipolar neurons are seen in –Retina ,olfactory sensory nerves, cochlea
Rest membrane potential of neuron is-70mv
Mutation of voltage gated calcium channels in nerve leads to –hypokalemic periodic paralysis
Myelin sheath in peripheral nervous system is formed by-schwann cell
Blood brain barrier is formed by- Astrocytes
MC fracture in all age groups –Clavicle fracture
Nerve supply to serratus anterior muscle(boxer’s muscle)-long thoracic nerve (palsy resulting winging scapula)
Accessory nerve(11th cranial nerve)Supplies two muscles-Trapezius ,sternocleidomostoid muscles
Lattisimus dorsi muscle is supplied by-Thoracodorsal nerve
Rhomboideus major ,minor levator scapulae are supplied by-Dorsal scapula nerve
Adhesive tendinitis of rotats to cuff muscles is known as-Frozen shoulder
Axillary nerve supplies two muscles –Teres minor,deltoid muscles
Biceps brachii,coracibrachialis ,brachiates muscles are supplied by-Musculocutaneous nerve
The short head of biceps and coracobrachialis muscle have a common origin from-Tip of coraccid process
Student’s elbow is- Olecranon bursiti’s
Pulled elbow or nerve maid elbow-Subluxation of head of radius from annular ligament
Golfer’s elbow is known as-Medial epicondylitis
Tennis elbow is known as –Lateral epicondylitis
Hinge joints –Elbow Joint, Ankle joint interphalangeal joint
Main abductor of arm-Deltoid muscles
Book test card test ,froment’s sign done in –Ulnar nerve palsy
Structures having length of 45cms –Spinal cord ,vas deferens adult femurs thoracic duct
Motor supply of diaphrasm-Phrenic nerve
Most common type of congenital diaphragmatic hernia-Bochdalek most common left side
Thoracic part of Esophagus is supplied by artery-Esophageal branch of thoracic aota, bronchial artery
Little’s area is formed by-Anterior ethmoidal artery ,sphenopalatine artery superior labial branch of facial artery
Structures opening into middle meatus -frontal sinus, maxillary sinus ,anterior ethmoidal sinus, middle ethmoidal sinus
Largest branch of external carotid artery-Maxillary artery
Middle cerebral artery is a branch of –Internal carotid artery
The muscle which opens the mouth-Lateral pterygoid muscle
All the muscles of mastication are supplied by-Mandibular nerve (masseter, Temporalis, medical pterygoid ,lateral
pterygold)
Waldeyer’s ring around the oral cavity is formed by-Adenoids ,tubal tonsils, palative tonsils ,lingual tonsils
Tensor palatine muscle of soft palate is supplied by-mandibular nerve
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Middle rectal and inferior rectal arteries are branches of –Internal iliac artery
Maxillary artery and Mandibular nerve are derived from which bronchial arch-1st arch(mandibuls arch)
Internal pudeudal artery is a brancle of-Internal iliac artery
Muscles of facial expression and stapedial artery are derived from which branchial arch-2nd arch
Common carotid artery and stylopharyngeus muscle are derived from which branchial arch-3rd arch
Cricothyroid muscle and aortic arch are derived from which branchial arch-4th arch
Muscles of larynx and duct arteriosus are derived from which branchial arch-5th arch
Remnant of ductus venosus-Ligamentum venosus
Remnant of left umbilical vein-Ligamentor teres
Physiological closure of ducts arteriosus takes place within -1-3days
Shortest cranial nerve is-olfactory nerve
Total no of spinal nerve-12pairs
Cranial nerve with largest intracranial nerve-IV CN
The neurotransmitter released at preganglionic fibres of sympathetic nerve system is-Acetylcholine
The pre and postganglionic fibres release which neurotransmitter-Acetylcholine
The largest ganglion of parasympathetic nervous system supplying the lacrimal gland via greater superficial petrosal
nerve is-Pterygopalatine ganglion
IF damage to area 22 wernicke’s area-Lead to SENSORY APHASIA
If damage occurs to area 41,42 (Auditory area)leads to-Motor Aphasia
Pyramidal tracts are –Corticospinal tract ,corticobulbur or corticonuclear tracts
Extra pyramidal tract are-Vestibulospinal, olivospinal,Reticulospinl rubrospinal ,tectospinal tracts
MC vessel involved in extradural hemorrhage-Middle muscle artery
MC vessel involved Intracerebral hemorrhage in hypertensive bleed is-Lenticulostriate branch of middle cerebral artery
Site of formation of CSF is –Lateral ventricles of brain
Which is longest muscle of body (Tailor’s muscle)-Sartorius
Lateral compartment muscle of leg are supplied by which nerve-Superficial personal nerve
Muscle which is caused as Peripheral heart of body - “Soleus”
Strongest ligament in the body-Iliofemoral
Strongest tendon in the body-Tendoachilles
Locking muscle of knee joint –Quadriceps femoris
Unlocking muscle of knee joint –Popliteus
Main flexor muscle of knee joint –hamstring muscles
Popliteal artery branches
o Anterior tibial artery
o Posterior tibial artery
Inferior epigastric artery is a branch of –External iliac artery
Superficial epigastric artery is a branch of –Femoral artery
Descending genicular artery is a branch of-Deep Branch of femoral artery
Main Flexor muscle of hip joint-Iliapsoas muscle
Main extensor muscle of hip joint-gluteus maximus
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Major depression is defined as depressed mood on daily basis for a minimum duration of -14days
Alcoholic seizures occurs after how many hours of heavy bout of drinking-24-48hours
Delirium tremens occurs within how many days of abstinous from alcohol-4days
Magnan symptoms are seen with abuse of –Cocaine
Patchy impairment of personal memory is-Dissociative amnesia
Value of IQ for profound MR -<20
A mentally in person smells odour when none is present this is an example of-Olfactory hallucination
Undue familiarity to unknow objects is-Déjà vu
Absolute C/I to ECT is-Raised intracranial tension
Most common symptom of alcohol with drawa is-Tremors
Drug used in opoid dependence to prevent relapes-Naloxane
A 30 Year old man was started on haloperidol and developed hyperpyrexia ,muscles rigidity ,alkinesia and increased BP
Likely is diagnosis –Neuroleptic malligant syndrome
A patient avoids public transport to go to his place of place as he is having fear of being in a crowd. This is
claustrophobia
A person missing from home is found wondering purposefully. Likely is – dissociative fugue
A 22 year old lady seeks plastic surgery for her nose which is normal she rarely meets her friend diagnosis is-Body
dysmorphic disorders
A 36 year old woman with a 16 year old history of vague and chronic physical complaints she says that she is always
been in pain in abdomen ,chest ,legs Diagnosis is somatization disorder.
A22 year old lady experiences a sudden loss of vision after a fight with husband but appears uncorrected (la belle
pudifference diagnosis is-Conversion disorders)
Waxy flexibility ,negativism ,echclalia ,echopraxia are a feature of which type of schizophrenia-Catatonic
Substance having same atomic mass and different atomic number is-Isobars
Most penetrating rays-gamma rays
MRI rooms are shielded by-copper/Aluminium
Sugar used in PET scan-De oxyglucose
Tram track appearance of skull on CT scan is seen in –Sturge weber syndrome
Triple bubble sign is seen in –Jejunal atresia
Radiological feature of ureterocele –Adder head appearance
IOC for chronic Subarachnoid hemorrhage –MRI
IOC for perthe’s disease –MRI
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Best method to detect minimal pleural effusion on right effusion on right effusion –USG
Claw sign is seen in –Intussusception
Measure of activity of radiation –Bec Querel (s.i unit) curie non-SI unit)
Most radio sensitive phase of cell cycle-G2M
Use of gamma knife-stereo-tactic radio surgery
Radiologjcal feature of pulmonary hamortoma-pop corn calcification
Frost berg’s reverse 3sign is seen in –ca head of pancreas
IOC for interstitial lung disease –HRCT
Coeur’eu sabot heart is seen in TOF
Rays having maximum ionizing power-Alpha rays
Earliest radiological change of mitral stenosis on radiography –Straightening of left border of heart
Investigation which itself can lead to acute pancreatitis –ERCP
Air crescent sign is seen in which lung pathology –Aspergilloma
Signet ring sign is associated with which lungs pathology-Bronchiectasis
Hampton hump is a radiological feature of –Pulmonary embolism
IOC for osteoporosis-DEXA SCAN
Shepherd crook deformity of femur is a radiological feature of –Fibrous dysplasia
Figure of 3’ on chest x-ray is suggestive of –Co arctation of aorta
Dropping flower sign is suggestive of –Ectopic/Duplication of ureter
Water lily sign is suggestive of –Hydatid cyst lung
Right border of heart on –x-ray is formed by-superior vena cava, right atrium ,inferior vanacava
Frog eye appearance in USG is suggestive of –Anencephaly
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STD
Single painless INDURATED ulcer with RUBBERY , SHOTTY lymphnodes – syphilis
First test to become positive in syphilis – FT-ABS
Best test to monitor patient for followup – VDRL
Test for Neurosyphilis performed in CSF is – VDRL
Patient of latent syphilis shows chancre like lesions on the site of previous chancer – CHANCRE REDUX(spirochete can
be isolated from chancre)
Patent of tertiary syphilis shows chancre like lesions at the site of previous cancre – PSUEDO CHANCRE (spirochete cant
be isolated from chancre)
Treatment in neurosyphilis – crystalline penicillin or procaine penicillin
Unilocular bubo is found in – Chancroid caused by hemophylusducreyi
Multilocular bubo found in – LGV
Groove sign seen in – LGV
Donovanosis has no lymphadenopathy, PSUEDOBUBO +
DOC of genital warts – podophyllin
DOC of genital warts in pregnancy – Cryotherapy
Criteria for Bacterial vaginosis – Amsel criteria
Chlamydia trachomatis causes which STD-Lymphogranulomavenereum
Soft chancre is caused by –Hemophilusducreyi
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VASCULAR LESIONS
9. Urticaria – red dermatographism
10. White dermatographism seen in –Atopic Dermatitis
11. Hereditary angioedema has C1 esterase deficiency
12. DOC f hereditary angioedema – Danazol
13. Most common cause of erythema multiforme is HSV 1 virus
14. Target lesions seen in – erythema multiforme
SCABIES
1. Scabies mite burrows till stratum corneum
2. Incubation period of scabies – 4 weeks
3. Itching area – circle of hebra
4. DOC of scabies – permethrin 5%
5. Oral ivermectin dose in scabies – 200 microgram/kg or cap 12 mg stat
Pediculosis
6. Pediculosishumaniscorporis also known as Vagabond disease
7. MACULAE CERRULAE seen in pediculosiscorporis and pediculosis pubis
8. Eyelashes involved in pubic louse not head louse
FUNGAL INFECTIONS
9. Dermatophytes infect stratum corneum
10. Most common cause of Tineacapitis – Microsporumcanis
11. Scutula are seen in – Favus(inflammatory Tineacapitis)
12. Furfuraceous or Rice powder scales seen in -Pityriasisversicolor
13. 10% KOH of P.versicolor – Sphagetti and meat ball appearance
14. Commonest fungal infection of genetalia in diabetes is Candida
15. cigar shaped bodies and asteroid bodies- sporotrichosis
16. Malasezzia furfur causes-pityriasisversicolor
17. Best diagnostic test for fungal skin infection-KOH amount
BACTERIAL INFECTIONS
LEPROSY
Virchow lepra cells or foamy macrophages found in – LL Hansen
Mc cranial nerve involved- facial nerve(7)
Ulnar nerve>common peronial>posterior tibial
Unmyelinated c fibres affected first
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Cold>hot>pain>touch>pressure
Most common type of leprosy in india – BT HANSEN
saucer right side up– TT hansen
TB
1. Most common cutaneous TB is Scrofuloderma
2. Second most common is Lupus vulgaris
3. Annular lesion with central scarring – Lupus vulgaris
4. Apple jelly nodule on Diascopy seen in Lupus Vulgaris
VIRAL INFECTION
1. DOC OF WART – PODOPHYLLIN
2. DOC of wart in pregnancy – cryotherapy
3. Condyloma is caused by-Human papilloma virus
PAPULO-SQUAMOUS DISEASE
1. Grattage test and Auspitz sign positive in psoriasis
2. only indication of systemic steroids in psoriasis - Impetigo herpetiformis
3. Most specific nail sign in psoriasis – oil drop sign -Focal onycholysis at the centre of nail
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4. 5 P’s: pruritic, purple, polygonal, plane topped, papules& plaques – lichen planus
5. Dorsal pterygium: wing like extension of proximal nail Seen in lichen planus
6. Civatte bodies are seen in-Lichen planus
7. Collarette scales are seen in – Pityriasisrosea
8. Von Zumbusch –lakes of pus - acute generalised pustular psoriasis
9. TOC of erythrodermic psoriasis - Methotrexate
VESICULO-BULLOUS DISEASE
1. Row of tombstone appearance seen in- Pemphigus vulgaris
2. Cluster of jewels appearance or string of pearl appearance - Linear IGA disease
3. corpronds and grains in skin biopsy seen in – Darier disease
4. Dilapidated brick wall appearance in skin biopsy seen in haileyhailey disease
5. Skin condition associated with gluten sensitive enteropathy-Dermatitis herpetiformis
6. Chronic familial benign pemphigus is also known as-Hailey Hailey disease
Pasteurella multocida is oxidase and catalase positive and does not grow on macconkey agar. It is commensal in URT of
several animals, eg. Dogs/cats. It causes wound infections of cat and dog bites
Francisella tularensis is a gram negative bacillus which causes tularaema/rabbit fever, voles, rabbits, and muskrats are
reservoir hosts. Most common type ulceroglandular (60-70%)
About 50% of world population affect 80-85% of population is infected in some developing countries.
H. aegyptius causes pink eye and brazilain purpuric fever
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Appeal against the professional death sentence after exhausting all the remedies in state medical council is made to
central health ministry.
Infamous conduct is serious professional misconduct.
Receiving commission for referring case is known as Dichotomy.
Privileged communications means exception to the general rule of professional secrecy.
A medical practitioner can be charged of criminal negligence if he exhibits gross lack of competency.
Section of IPC in which a doctor is punishable if convicted of criminal negligence is 304 A
For age estimation from skull sutures the most reliable is sagittal.
For estimation of age 16 years x-raysis best advised is elbow
At the end of 1 year ,the number of carpal bones seen in x-ray of hand is 2
The best single criterion for determining age from 3rd to 5th decades of life symphysis pubis.
Cortex thickness of human hair in comparison with medullary thickness is five times (4to 10times)
Human hairs have scales.
Human hair differs from animal hair by medulla is thin.
Hasse rule is used for age estimation (foetus)
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Post –mortem staining is seen in both in internal organs and skin of dependent parts.
Nysten’s rule is related to rigor mortis.
Rigor mortis is simulated by cadaveric spasm.
When group of muscles of a dead body were in state of strong contraction immediately prior to death and remain so
even after death ,the condition is termed as cadaveric spasm.
If a woman died due to some unnatural cause within 7 years of her marriage-inquest is done under 176 crPC
punishment in 304B IPC
In an unconscious patient with head injury requiring emergency surgery, if there are no relatives to give consent the
doctor should operate without consent (sec 92IPC)
An accused person can be forcefully examined if requested by an investigating officer not below the rank of sub
inspector under section 53 CPC
Grievous injury is defined under section 320IPC
The 6th cause of section 320 IPC (grievous hurt)permanent weapon or means is punished under section 326 IPC
Section 304-B of Indian pancel code is related to dowry deaths
Section 302 of Indian penal code is related punishment of murder
Adultery is punishment under section 497 IPC
Outrage of modesty of a woman is punishable under section 354 IPC
Sexual harassment is punishable under section 354 A IPC
Stalking is punishable under section 354 D IPC
Under section 376 IPC minimum punishments for committing rape is 7 year of rigorous imprisonment
The punishment of a repeat offender of rape is given under section 376 E IPC (
Disclosure of name of rape victim is punishable under section 228A IPC
Section 377 IPC deals with sodomy (unnatural sexual offence)
Unnatural sexual acts are punishable under section 377 IPC
Causing voluntary miscarriage is punishable under section 312 IPC
McNaughton’s rule is accepted in india and included in section 84 IPC
Vitriolage is punishable under section 326-A IPC
Diatoms in bone marrow of long bones are suggestive of death due to –drowing Burking is – homicidal
Crocodile skin is seen in – electrical burn
Lichtenburg/filigree figure are due to – superficial burn of skin resembling branches of tree like pattern due to ELECTRICAL
DISCHARGE from cloud
CEPHELIC INDEX
1 D DOLICO CEPHALIC (long head ) – 70-75 eg. Africans,aaryon, nigro
2 M MESTI CEPHALIC (medium head ) – 75-80 eg. Europian (indian , chinese)
3 B BRACHY CEPHALIC (round head) – 80-85 eg . mangolian ( max c.index but short head )
SMELL OF DIFFERENT POISONS
1.Garlic like – phosphorus and arsenic
2. burn rope – cannabis poisoning
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ARSENIC POISON:-
A-Alderich mess line ON NAIL
R-4R- Rain drop pigmentation, red velvety mucosa of stomac , rash , rice waterly diarrhea
S- Subendocardial hemorrhage , sentation (tingling) , skin>hair>nail>bone
E-excessive pigmentation of palm and soles
N- Neuritis
I-iron oxide + BAL ( TREATMENT)
C- mimics CHOLERA , some time use for CRIMINAL ABORTION
m- marsh test done for detection
LEAD POISONING:-
A-Anemia (MCHC)
B-BURTONION LINE(on gum), BASOPHILIC stippling
C-CONSTIPATION, colic
D-drop :- 1. Foot drop , 2. Wrist drop
E-Encephlopathy
F-FACIAL PALLOR ( earliest sign)
G –GUM LINE ( burtonian)
H- hormonal problems
MERCURY POISON:-
HATTER SHAKING / GLASS BLOWER’S/SHAKER’S PALSY
DANBURY TREMORS
Salivation
Membraneous colitis, MGN, minimatas disease
Lens deposition( mercuria lentis)
Mercurial erethism
Acrodynia
For Infants
0.1ml (0.05ml
At birth or as early as possible till one
BCG until 1 month of Intra -dermal Left Upper Arm
year of age
age)
Vitamin A,
At 9 months with measles 1 ml (1 lakh IU) Oral -
1st Dose
For children
Anterolateral side of
DPT 1st booster 16-24 months 0.5 ml Intramuscular
mid thigh-LEFT
Measles 2nd dose 16-24 Months 0.5 ml Subcutaneous Right Upper Arm
DPT 2nd Booster 5-6 years 0.5 ml. Intramuscular Left Upper Arm
Minimum time gap between two doses of any vaccine must be 4 weeks; two live vaccines can be given at the same time but at
different sites.
14.7.2 Introduction of Inactivated Polio Vaccine (IPV)
The planned introduction of IPV for polio eradication will represent the fastest global introduction of any routine vaccine in
recent history by a factor of 4—5X. From January 2013 to May 2015, the number of countries making a commitment to
introduce IPV has increased by 126.
In January 2013, as we have already read above, the Global Polio Eradication Initiative (GPEI) launched the Polio Eradication &
Endgame Strategic Plan 2013-2018 which was developed with an approach to tackle both wild and vaccine virus eradication in
parallel rather than sequential manner. A coordinated withdrawal of the type 2 component of trivalent oral polio vaccine (tOPV)
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from immunization programmes by April 2016 was recommended. For countries which use only tOPV in their routine infant
immunization programmes, this will require switching from tOPV to bOPV (containing only types 1 and 3) for that purpose. Prior
to this switch, it is recommended that all countries introduce at least one dose of inactivated poliovirus vaccine (IPV) into their
infant immunization schedules as a risk mitigation measure by providing immunity in case a type 2 poliovirus re-emerges or is
reintroduced.
Initially, introduce IPV at least 6 months in advance to the proposed switch date in order to provide adequate time to
enhance population immunity against type 2. It is recommended that one dose of IPV should be administered at or after 14
weeks of age through routine immunization (RI), in addition to the 3-4 doses of OPV.
Three main risks are identified following type 2 poliovirus removal. These include immediate time-limited risk of circulating
vaccine-derived poliovirus type 2 (cVDPV2) emergence; medium- and long-term risks of type 2 poliovirus re-introduction from a
vaccine manufacturing site, research facility, diagnostic laboratory or a bioterrorism event; and spread of virus from rare
immune-deficient individuals who are chronically infected with OPV2. All these risks have the potential to cause substantial polio
outbreaks or even re-establishment of polio virus transmission in polio-free regions.
GOVERNMENT OF INDIA INITIATIVES: Government of India (GoI) has taken following decisions regarding polio immunization
during implementation of endgame strategies in India:
• Introduction of at least single dose (0.5 ml) of intramuscular IPV (IM-IPV) administration on antero-lateral aspect of
right thigh at 14 weeks or first contact afterwards in the Routine Immunization along with 3rd dose of DTP and OPV in 6
states viz Bihar, Uttar Pradesh, Madhya Pradesh, Gujarat, Punjab and Assam;
• Nationally coordinated switch from tOPV to bOPV all over the country on 25th April 2016 associated with cessation of
use, withdrawal, destruction and validation of all available tOPV stocks from all over the country.
• Introduction of fractional dose (0.1 mL) intradermal IPV (ID-fIPV) at 6 and 14 weeks in Orissa, Andhra Pradesh,
Telangana, Tamil Nadu, Kerala, Karnataka, Maharashtra and Puducherry from April, 2016. This change in approach from
single-dose intramuscular IPV to fractional-dose intradermal IPV is mainly due to scarcity of IPV.
Inactivated Polio Vaccine (IPV) is an injectable form of polio vaccine which can be administered alone or in combination with
other vaccines like OPV (oral polio vaccine), diphtheria, tetanus, pertussis, hepatitis B, and haemophilus influenza.
Contraindications for IPV:
There are two contraindications for IPV:
- If anyone has a history of an allergic reaction
- If any infant has known allergy to streptomycin, neomycin, or polymyxin B as these are inactive components for IPV
Safety of IPV: IPV is safe for premature infants. IPV can be safely administered to children with immune deficiencies (e.g., HIV,
congenital or acquired immunodeficiency, sickle cell disease). In fact, because of the elevated risk of vaccine-associated paralytic
polio after the use of OPV in patients with immune deficiencies, IPV is universally recommended in these children.
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New focus areas for SDG in contrast to MDG are: Non-communicable disease, Road traffic accidents, Substance abuse, Universal
health coverage, Hazardous chemicals & Indoor air pollution.
SDG : Goal 3. Ensure healthy lives and promote well-being for all at all ages
3.1 by 2030 reduce the global maternal mortality ratio to less than 70 per 100,000 live births
3.2 by 2030 end preventable deaths of newborns and under-five children
3.3 by 2030 end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases and combat hepatitis, water-borne
diseases, and other communicable diseases
3.4 by 2030 reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and
treatment, and promote mental health and wellbeing
3.5 strengthen prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol
3.6 by 2020 halve global deaths and injuries from road traffic accidents
3.7 by 2030 ensure universal access to sexual and reproductive health care services, including for family planning, information
and education, and the integration of reproductive health into national strategies and programmes
3.8 achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services,
and access to safe, effective, quality, and affordable essential medicines and vaccines for all
3.9 by 2030 substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution
and contamination
3.a strengthen implementation of the Framework Convention on Tobacco Control in all countries as appropriate
3.b support research and development of vaccines and medicines for the communicable and non-communicable diseases that
primarily affect developing countries, provide access to affordable essential medicines and vaccines, in accordance with the
Doha Declaration which affirms the right of developing countries to use to the full the provisions in the TRIPS agreement
regarding flexibilities to protect public health and, in particular, provide access to medicines for all
3.c increase substantially health financing and the recruitment, development and training and retention of the health workforce
in developing countries,
3.d strengthen the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management
of national and global health risks
1) The Swachh Bharat Abhiyan, which is already in place, would be supported, and whose success would be measured by the
reduction of water and vector borne diseases and declines in improperly managed solid waste.
2) Balanced and Healthy Diets: This would be promoted through action in Anganwadi centers and schools and would be
measured by the reduction of malnutrition, and improved food safety.
3) Addressing Tobacco, Alcohol and Substance Abuse: (Nasha Mukti Abhiyan) Success would be judged in terms of measurable
decreases in use of tobacco, alcohol and substance abuse.
4) Yatri Suraksha: Deaths due to rail and road traffic accidents should decline through a combination of response and
prevention measures that ensure road and rail safety-. This concept could be expanded to include injuries on account of other
causes.
5) Nirbhaya Nari- Action against gender violence ranging from sex determination, to sexual violence would be addressed
through a combination of legal measures, implementation and enforcement of such laws, timely and sensitive health sector
responses, and working with young men.
6) Reduced stress and improved safety in the work place would include action on issues of employment security, preventive
measures at the work place including adequate exercise and movement, and occupational health- strengthening understanding
of occupational disease epidemiology and demonstrate measurable decreases.
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7) Promotion of Yoga at the work-place, in the schools and in the community would also be an important form of health
promotion, that has a special appeal and acceptability in the Indian context.
Avoidable blindness: The sum total of preventable or curable blindness is often referred to as avoidable blindness.
“MISSION--INDRADHANUSH” : “To achieve full immunization coverage for all children by 2020 through a Catch-Up
campaign” depicting seven colours of the rainbow, aims to cover all those children by 2020 who are either
unvaccinated, or are partially vaccinated against seven vaccine preventable diseases which include diphtheria,
whooping cough, tetanus, polio, tuberculosis, measles and hepatitis B.
2015 onwards three new vaccines to be included are rotavirus, rubella and inactivated poliovirus vaccine (IPV) will be
made available to all children through India’s Universal Immunization Programme (UIP), while Japanese encephalitis
vaccines will be introduced in 179 endemic districts across nine states.
IMPORTANT DATA
1. HDI, : 0. 640
2) GFR: 2.3
3) SR in India= 940/1000 / 4) 0-6 Sex ratio= 914/100
5) Lowest Sex Ratio overall= Delhi
6) Highest Sex Ratio overall= Kerala
7) Highest Sex Ratio 0-6 = Mizoram
8) Birth Rate= 20.4 9) Death Reate = 6.4
10) Growth Rate= 1.4 %
11) IMR=34/1000 LB
12) MMR=134 /Lac LB
13) < 5 Mortality = 52/1000 LB
14) % Expenditure of GDP on Health = 4.05
16) The prevalence of HIV among Pregnant women aged 15-24 years 0.39% in 2010-11.
17) The annual incidence rate (cases of malaria/1000 population) of Malaria 0.88 cases per 1000 population in 2012.
18 ) The malaria death rate in the country was 0.04 deaths per lakh population in 2012.
19) Prevalence rate of TB 249 in 2011 per 100, 000 population.
20) Mortality due to TB has reduced from 24 per lakh population in 2011.
21) During 2012, in rural India, 88.5% households had improved source of drinking water while in urban India 95.3%
households had improved source of drinking water.
22) HIV prevalence :0.27 % (2013)
23) Prevalence of Blindness = 1.1% (2012) TARGET is to be 0.3% by 2020
24) RSBY : Funded by Ministry of Health and F Welfare
25 ) SC = 148366 , PHC = 24049 , CHC = 4833 , Medical College= 356
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Attitudes are acquired characteristics of an individual. They are more or less permanent ways of behaving. Attitudes are not
learnt from books, they are acquired by social interaction, e.g., attitude towards persons, things, situations and issues. Once
formed attitudes are difficult to change. (AIIMS May 2018)
6. Belief is the psychological state in which an individual holds a proposition Values are considered subjective, vary across
people and cultures and are in many ways aligned with belief and belief systems. Types of values include ethical/moral values,
doctrinal/ideological (religious, political) values, social values, and aesthetic values. It is debated whether some values are
intrinsic.
hould be. They involve what is important to us. Values are applied
appropriately when they are applied in the right area. For example, it would be appropriate to apply religious values in times of
happiness as well as in times of despair. "A way of measuring what people value is to ask them what their goals are.
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2. At state level
a. State ministry of health
b. State Health Directorate
3. At district level
It is the principal unit of administration in India. Within district there are 6 types of administrative areas –
a. Sub-divisions
b. Tehsils
c. Community Development Blocks in rural areas (100,000 population)
d. Municipalities and Corporations in urban areas
e. Villages
f. Panchayats
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a. Relative reduction in prevalence of current tobacco use by 15% by 2020 and 30% by 2025.
b. Reduction of 40% in prevalence of stunting of under-five children by 2025.
c. Access to safe water and sanitation to all by 2020 (Swachh Bharat Mission).
d. Reduction of occupational injury by half from current levels of 334 per lakh agricultural workers by 2020.
e. National/ State level tracking of selected health behaviour.
3. Policy Thrust
3.1 Ensuring Adequate Investment The policy proposes a potentially achievable target of raising public health expenditure to
2.5% of the GDP in a time bound manner. It envisages that the resource allocation to States will be linked with State
development indicators, absorptive capacity and financial indicators. The States would be incentivised for incremental State
resources for public health expenditure. General taxation will remain the predominant means for financing care. The
Government could consider imposing taxes on specific commodities- such as the taxes on tobacco, alcohol and foods having
negative impact on health, taxes on extractive industries and pollution cess. Funds available under Corporate Social
Responsibility would also be leveraged for well-focused programmes aiming to address health goals.
3.2 Preventive and Promotive Health The policy articulates to institutionalize inter-sectoral coordination at national and sub-
national levels to optimize health outcomes, through constitution of bodies that have representation from relevant non-health
ministries. This is in line with the emergent international “Health in All” approach as complement to Health for All. The policy
prerequisite is for an empowered public health cadre to address social determinants of health effectively, by enforcing
regulatory provisions.
The policy identifies coordinated action on seven priority areas for improving the environment for health:
o The Swachh Bharat Abhiyan
o Balanced, healthy diets and regular exercises.
o Addressing tobacco, alcohol and substance abuse
o Yatri Suraksha – preventing deaths due to rail and road traffic accidents
o Nirbhaya Nari –action against gender violence
o Reduced stress and improved safety in the work place
o Reducing indoor and outdoor air pollution
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Drug Indication
Imatibi mesylate - GIST * CML
- 1st line treatment for advance & unresectable DFSP (dermatofibrosarcoma
protuberans
Sunitinib - - Imatinib resistant GIST, Advanced renal cancer, Refractory metastatic breast
cancer
Sorafenib - Unresectable HCC
Lapatinib - - Inhibitor of Her-2neu and EGFR tyrosine kinase * second line Her-2-neu therapy
Vandetanib 9EGFR inhibitor) - - Only drug approved by US FDA for treatment of advanced & progressive MTC
OPOIDS
Prime –physical dependence
Minister-miosis
Caring -constipation
Adorable-analgesic
Ruthless –resp.suppression
Energetic-euphoria
Shri narendra modi-sedation
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Mycology
Only pathogenic yeast Cryptococcus neoformans
Pseudomycelium Candida
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High-dose intravenous acyclovir can cause crystalluria with renal tubular obstruction. Administering intravenous fluids
concurrently with the drug can help reduce the risk of acute kidney injury.
Hydration is the cornerstone of therapy for renal stone disease. A detailed metabolic evaluation is not needed when a
patient presents with his first renal stone.
Muddy brown granular cast -Acute tubular necrosis
RBC casts - Glomerulonephritis
WBC casts - Interstitial nephritis and pyelonephritis
Fatty casts - Nephrotic syndrome
Broad and waxy casts - Chronic renal failure
Physical examination in patients with pleural effusion usually shows decreased tactile fremitus, dullness to percussion,
and decreased breath sounds over the effusion.
Hydrocele is the accumulation of fluid around the testis and spermatic cord and between theparietal and visceral layers
of the tunica vaginalis. Communicating hydroceles usually present in infancy and are frequently reducible but may also
increase in size with the Valsalva maneuver. Noncommunicating hydroceles do not usually change in size with
positional changes.
Rapid treatment with calcium gluconate is necessary in a patient with hyperkalemia who develops significant EKG
changes.
Acyclovir can cause crystalline nephropathy if adequate hydration is not also provided.
Glomerular hyperfihrationis the earliest renal abnormality seen in diabetic nephropathy. It is also the major
pathophysiologic mechanism of glomerular injury in these patients. Thickening of the glomerular basement membrane
is the first change that can be quantitated.
Nephrotic syndrome is a hypercoagulable condition which manifests as venous or arterial thrombosis, and even
pulmonary embolism. Renal vein thrombosis is the most frequent manifestation. Complications of nephrotic syndrome
include: protein malnutrition, iron-resistant microcy1ic hypochromic anemia, increased susceptibility to infection, and
vitamin D deficiency.
Obstructive uropathy causes flank pain, low volume voids with or without occasional high volumevoids, and (if bilateral)
renal dysfunction
Drugs with anticholinergic properties can cause acute urinary retention by preventing detrusor muscle contraction and
urinary sphincter relaxation. The treatment involves urinary catheterization and discontinuing the medication.
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Important tables
GLUT 6 Pseudogene
GLUT 7 Liver
Hormones acting through cAMP: - LH, FSH,TSH, PTH, GH, ACTH (corticotrophin), MSH
- Somatostatin
- Glucagon
- Vasopressin V2
- Calcitonin
- Epinephrine
- Dopamine
- Nor Epinephrine
Hormones acting through cGMP - Nitric oxide (NO) - derived from endothelium; binds to
guanylyl cyclase that converts GTP to cGMP; vasodilator;
derived from arginine by nitric oxide synthase
- ANP
Hormones acting through IP3/DAG: - Angiotensin II
- Nor Epinephrine—α1
- CCK
- Gastrin
- Oxytocin
- Vasopressin V1a and V1b
- Endothelin
HEART SOUNDS
HS1 - Due to sudden closure of AV valves
HS3 - Due to vibration of cardiac walls by the rapid filling of ventricles during
ventricular diastole proper.
- Best heard with the bell piece of the stethoscope.
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HS4 - Due to inrush of blood into ventricles (which are in ventricular filling phase)
caused by atrial systole.(The fourth heart sound is a low pitched presystolic
sound produced in ventricles during ventricular filling - Harrison).
- Low frequency (< 20 cycles per sec), low pitched sound.
- Not audible to the unaided ear.It can sometimes be heard before the first
heart sound when atrial pressure is high or the ventricle is stiff in conditions
such as ventricular hypertrophy.
- Best heard with the bell piece of the stethoscope.
SITES OF ERYTHROPOIESIS
Extravascular phase
5-9 months
After birth
Up to 5 years All bones with red marrow (mainly long and flat bones),
liver and spleen
>20 years
Cells Secretions
G cells Gastrin
S cells Secretin
MO cells Motilin
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pressure
Effects of Insulin
Insulin increases Insulin decreases
1. Glycolysis 1. Gluconeogenesis
2. Glucose uptake 2. Glycogenolysis
3. Glycogen synthesis 3. Lipolysis
4. Protein synthesis 4. Ketogenesis
5. Fat synthesis
XLD (Xylose Lysine Deoxycholate) agar Salmonella and Shigella from stool
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Types of hypersensitivity-
Marker Meaning
HBeAg Replicating/dividing/infectivity
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Pseudomonas green
Vitiligo White
TRICHOPHTON + + +
MICRSPORUM + _ +
EPIDERMOPHYTON + + -
Adult 100 mg daily 600 mg once a month 50 mg given daily + 300mg once a
month under supervision
50-70 kg
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Child 50 mg daily 450 mg once a month under 50 mg daily + 150 mg once a month
supervision under supervision
10-14 years
MORPHOLOGY PATHOLOGY
complicated
ROSETTE TRAUMATIC
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Causes : trauma, lattice and other Diabetic retinopathy, Retinal/ choroidal tumours,
degenarations, post surgery , psuedophakia, trauma , eales disease
aphakia Hypertensive retinopathy, pregnancy
induced hypertension, VKH syndrome
Lid cancers-
5%
LOCAL DESTRUCTION
LYMPH NODES -
LESIONS AFFECT
OPTIC ATROPHY
NO OPTIC ATROPHY
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Stages of labour-
Stage Remark
Suboccipito-bregmatic 9.5
Submento-bregmatic 9.5
Suboccipito-frontal 10
Occipito-frontal 11.5
Submento-vertical 11.5
Mento-vertical 14
BURNS
Most important cause of death in Burns in the early period Hypovolemic shock
Iced water should NOT be used on burns because It can cause cutaneous vasoconstriction and can
extend thermal damage
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Hernia-
Straw
Purulent Chorioamnionitis
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Rx-Metronidazole
STD
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Jacquemier’sor Chadwick’s sign 8W -Duskyhue of the vestibules and ant vaginal wall
Breast milk
Bile salt stimulated lipase ( BSSL) Is cidal toward Amoeba and Giardia
Transitional milk Milk secreted during 3 days to 2 weeks, low proteins more
fat
DISEASES ANTIBODIES
Anti Sm {Smith}
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Henoch-Schonlein purpura
Ulcerative colitis
Microscopic polyangitis
Polyarteritis nodosa
WAVES CAUSES
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ICTHYOSIS VULGARIS
COLOR BLINDNESS
AGAMAGLOBULINEMIA
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TYPE EXAMPLE
SYNTHETIC / DEFINED Media from pure chemical substances eg: peptone water
ENRICHED MEDIA (SOLID MEDIA) BLOOD, SERUM, EGG ADDED TO BASAL MEDIA EG:
BLOOD AGAR, CHOCOLATE AGAR
ENRICHMENT MEDIA (LIQUID MEDIA) SUBSTANCE WHICH HAVE STIMULATING EFFECT ON THE
BACTERIA TO BE GROWN AND INHIBITORY EFFECT ON
OTHERS EG: TETRATHIONATE BROTH FOR S.TYPHI
SELENITE F BROTH FOR SHIGELLA
BACTERIALSPORES AUTOCLAVING
Glass syringes, test tubes, forceps, scalpels, liquid Hot air oven
paraffin
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N20 Blue
Cyclopropane Orange
CO2 Grey
Oxygen (2,5)
Entonox (7)
C02 (1,6)
Air (1,5)
Circuits
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REM NREM
Total duration 25 75
EEG Ponto geniculooccipital spike depend on stage ( stage 2 –sleep spindle and k complex )
Bruxism -stage 2
bleeding Source
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Anderson Branching
teratogenicity
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Most common radiation induced bone tumor- Osteosarcoma >Fibrosarcoma> Malignant fibrous histiocytoma
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Pulsatile bone tumors include Osteoclastoma (GCT), Telengiectatic osteosarcoma, Metastasis from follicular
carcinoma thyroid and renal cell carcinoma.
Fibrous dysplasia- Ground glass appearance, Rind sign (sclerotic margin around tumor), Shephard crook
deformity (collapse of medial part of femoral neck so that proximal femur becomes hook shaped)
Simple bone cyst- Fallen leaf sign (can be seen in ABC but less often)
Ewing sarcoma- Onion peel appearance (intense periosteal reaction in layers), Codman’s triangle
Types of Epiphysis:
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-Neural tube(CNS) – All neurons in the brain & -Neurons in the ganglia*
spinal cord
-Schwann cells
-Astrocytes, oligodendrocytes,
ependymocytes, tanycytes -Head and neck mesenchyme
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-Carotid body
-Adrenal medulla
-Aorta-pulmonary(cono-truncal) septum
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SURGERY AT A GLANCE
Sutures
JENKINS Rule*- Suture material length must be in the ratio of 4:1 to the wound length*
Polypropylene is a non-absorbable suture.
Catgut is prepared from submucosal layer of intestine of sheep.
Polydiaxonone (PDS) is absorbed within 225 days. (Longest Absorbable)
Polyglycolic acid, polyglyconate, PDS-Absorbable materials.*
Half life of polyglycolic acid (Vicryl)-60-90 days*
Catgut is surgery was introduced by john hunter.
Isopropyl alcohol is used as preservative for packing catgut suture**
Ethylene oxide – used in pasteurization of suture material
Scalp suture are removed on 7th day.
Disparity of bowel ends during end to end anastomosis is corrected by cheatle’s maneuver**
Lembert suture refers to sero-muscular suture of bowel.
Carrel’s triangle isused in vascular anastomosis.
Intestinal anastomosis strenght is provided by submucosa (the strongest layer**)
Memory is the name given for recoling of suture. Highest memory is seen with prolene.
Prolene has very poor knotting capacity due to memory and monofilament*
Vicryl is polyglcolic acid made of multifilament of polyglycolic acid**(Violet color)
Monocryl is also polyglycolic acid made of monofilament of polyglycolic acid. (White color).
Transplant Rejecion
Hyper Acute Rejection
Occurs within minutes to days
Mediated by preformed antibody*
Prior exposure to antigens pretransplant
Prior transplantation, Transfusion or pregnancy
Immediate graft thrombosis occurs
HPE shows platelet and thrombin thrombi, early neurtrophil infiltration and positive staining of C4d.
Largest preventable by crossmatch assay
Acute Rejection
Cab be effectively reversed with immunosuppression.
Occurs within first few weeks to months (m/c within first 6 months)
Mediated by T cells*
Massive infiltration of T cells and monocytes into allograft, leading to destructon of the organ through direst cytolysis
and generalized parenchymal dysfunction and endothelial injury resulting in thrombosis.
Mostly asymptomatic, but when its symptomatic secondary to organ dysfunction it is quite irreversible.
Biopsy – lymphocytic infiltration, antibody depostion and parenchymal necrosis
Chronic Rejection
Most common cause of long-term allograft loss.
Indolent fibrotic process secondary to both T and B cell process and also non immune process
Occurs during months to years
Chronic inflammatory insults evoke a process of epitheliaal to mesenchymal differentiation, ledaing to epithelial cells
regress into fibrocytes.
Glssgow coma scale (EVM-456)
Eye opeining: Verbal Motor
Spontaneous -4 Normal oriented-5 Obeys commands-6
To loud voice-3 Confused-4 Localizes to pain-5
To pain stimuli-2 Inappropriate words-3 Withdrawal flexion-4
Do not open-1 Sounds only-2 Abnormal flexion-3
No sounds-1 (decorticate)
Extenstion-2 (decerebrate)
No motor response-1
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Investigations
IOC for Esophageal perforation-Burium swallow (thin diluted)
1st investigation we do for perforation of Esophagus-Gastrograffin swallow
IOC for diverticulum – barium swallow
IOC for achalasia, DES, NCE- manometry
Gold standard for GERD-24 hours anbulatory pH monitoring
IOC for GERD in bedridden iICU cases- impedance manometry
IOC for cancer Esophagus T-staging- EUS
Bird beak/penciltip/abrupt cut off/hurtst phenomenon on barium swallow achalasia
Eat tail/irregular narrowing with proximal dialted esophagus-cancer esophagus.
Cork screw Esophagu- Diffuse Esophageal pasm.
Absent fundus gas shadow- achalasia
ONE LINERS
Snail tract ulcers-seen in oral cavity in syphilis.
Hutchinson’s warts – secondary syphilis producing condyloma in tongue
Epulis- swelling arising in gums
Oral cancer common in india – buccal mucosa cancer
Oral cancer common in worls – tongue cancer
Oral cancer with skip mets in neck nodes – tongue cancer
Oral cancer for which surgery is the only option and RT can’t be given-alveolus cancers
MC sire of cancer in lip-lower lip
Best prognosis among oral cancers- lip cancer
Most important prognostc factor in oropharyngeal cancer- cervical nodal extracapsular spread
Flap used for oral cavity reconstruction after cancer surgery- pectoralis major myocutaneous acromical artery
Abbe’s flap- centre of lip reconstruction
Estlander’s flap- angle of lip reconstruction
Speckled leukoplakia has the highest rate of malignant transformation
Investigations
IOC to diagnose Meckel’s in children preoperatively- Tc99m pertechnate scan
IOC to diagnose Meckel’s and other diverticulum in adults-enteroclyis
IOC to diagnose the carcinoid tumors of GIT -24 hours urinary 5- HIAA
IOC to localise carcinoid tumor- octreoscan (somatostatin receptor scintigraphy)
Contrast finding to LEAD PIPE APPEARANCE*- ulcerative colitis
Contrast finding to STRING SIGN OF KANTOR* - crohn’s disease and TB
IOC to diagnose hirschsprung diseas – full thickness rectal biopsy above dentate line.
Intussusception – USG findings: target sign, pseudo kidney sign, bulls eye sign
Intussusception – barium enema finding – claw sign
Whirl pool sign* in CECT scan- malrotation of GUT
Step ladder appearance in X ray – small intestinal obstruction
Apple core appearance* in barum enema – carcinoma colon
Bird beak sign in barium enema –sigmoid volvulus
Saw tooth appearance in barium in barium enema- ischemic colitis
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One Liners
Inguinal hernia m/c on right side*
MC hernia in elderly- direct hernia
MC hernia in children – umbilical hernia
MC inguinal hernia in children – indirect hernia
Femoral hernia is m/c in females than males
Indirect inguinal hernia is the m/c type of hernia in females**
Cryptorchidism is associated with indirect hernia*
Femoral hernia is the one most liable for strangulation because of narrow neck.
Only congenital direct hernia is ogilvies hernia* [hernia via a defect in conjoined tendon]
MC nerve of injured in Laparoscopic hernia repair – Lateral cutaneous nerve of thigh*
MC type of mesentric cyst – chylolymphatic cyst*
Mc organism in spontaneous bacterial peritonitis – E. coli and bacterioids
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Tumors in kidney
Grawitz tumor: clear cell adenocarcinoma is MC renal cancer
Von hippel-Lindan (VHL)n chromosome 3 is the MC gene affected in renal cell cancer (RCC)
MC site of RCC- Upper pole
MC paraneoplastic syndrome in RCC – ESR increase
MC site of distal metastasis is lung*
Investigation of choice for RCC – CT scan**
Treatment of choice for RCC- Radical nephrectomy
Stauffer’s syndrome- Nonmetastatic liver enzyme elevation in RCC.
Wunderlich syndrome- Angiomyolipoma kidney producing retroperitoneal hemorrhage
Wilm’s tumor- MC abdominal mass noted in babies accidentally during bath.
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Pathologic features
Crohn’s disease Ulcerative colitis
Transmural inflammational as the disease progresses, the mucosa begin to
Non-caseating granulomas erode leaving only small islands of mucosa that
Apthous ulcers are the earliest resemble polyps but are actually
manifestation** pseudopolyps**
Serpiginous / bear claw linear ulcers crypt abscesses
Cobblestone apperance confined to the mucosa and submucosa, in the
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Investgation of choices
hepatic venography showing spider web apperance – budd chiari syndrome**
caudate lobe hypertrophy (central hot spot) – budd chiari syndrome*
water lilly apperance – Hydatid cyst*
rosette like apperance/ calcification – hydatid cyst*
tumr of liver which appear as hot spot in sulphur colloid scan – FNH
tumor of liver which shows slow enhancement on CECT scan – hemangioma
hemangioma on T2 weighted MRI- light bulb sign**
tumor of liver showing central stellate scar on CECT scan – FNH**
the only tumor which has normal kupffer cel and hence visible on sulphur
early enchancement with early wash out on CECT on liver is seen in HCC*
cystic lesion of liver with septations which are enchancing in contrast cystic
Chicago classificaton
Achalasia and esophagogastric junction disorders
Type 1 Achalasia (classic) mean IRP> 15 mmHg
100% failed peistalsis
Distal contractile integral (DCI) <450
Type 2 Achalasia with Esophageal compression Mean IRP> 15mm Hg
100% failed peristalsis
Pan esophageal pressurization**
Type 3 (spastic Achalasia) Mean IRP>15 mmHg
No normal peristalsis
Spastic contractions with distal contractile
integral (DCI) > 450mm Hg.s. Cm
Major disorders of peristalsis
Distal Esophageal spasm Mean IRP- Normal
DCI > 450 mm Hg.S.Cm
> 20 premature contractions
Jackhammer Esophagus (Hypercontractile Esophagus) DCI >8000*** for atleast 2 swallows**
ONE LINER
CT is the gold standard to diagnose intraabdominal injuries in stable patients.
USG is used to diagnose intraabdominal injuries in ubstable patients
MC organ injured in seat belt injury- Mesentery
Leg compartment – Fasciotomy at 30 mm Hg
Abdominal compartment – Laparostomy at 35 mm Hg
Intubation must be done if GCS score less than or equal to 8.
MC cause of SAH- Trauma> berry aneurysm rupture
MC site of berry aneurysm rupture- Anterior circulation
Fullen, zones- superior mesenteric artery injury
Hunt and hess scale- subarachnoid hemorrheage
TRISS and MESS- injury scoring systems.
Denver criteria – Blunt cerebrovascular injuryin neck*
BERGVIST TRIAD: Fracture Rib+ Fracture spine or pelvis+ Diaphragam Rupture*
Catell manuever- Right medial visceral rotation to expose inferior venacava (IVC)
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OBS/GYANE AT A GLANCE
Wolffian / Mesonephric Duct in males gives rise to – seminal vesicles, ejaculatory duct, vas deferens and epididymis
External genitalia :
Vulva and the lower part of the vagina is supplied by the Internal Pudendal Artery (branch of anterior division of
internal iliac artery)
Lymphatic drainage of the vulva is to the superficial inguinal LNs, which then drain into the deep inguinal LN
Pain during early labor which occurs due to uterine contractions is referred all over abdomen (T10 – L1 segments)
Pain due to cervical dilatation is referred to the back (pelvic splanchnic nerves S2,S3, S4)
Pain from the lower vagina is transmitted via Pudendal Nerve (S2,S3,S4)
Best analgesia during labor – Epidural. The level of block is T10, it is a sensory block.
For LSCS – the level of sensory block is T4.
- Nulliparous – conical
- Multiparous – cylindrical
Shape of the external os :
The round ligament & ovarian ligaments are remnants of the gubernaculum.
In females the round ligaments passes through the superficial inguinal ring to attach to the anterior end of the labia majora.
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Nulliparous – 50 to 70 gm
Weight of pregnant uterus at term – 1100 gm
Weight of uterus immediately after delivery – 1000 gm
Weight of the uterus 4 weeks after delivery – 100 gm
Lower uterine segment is formed by the isthmus - the area between the anatomical & histological internal os
Length of LUS at term = 5 cm
Length of LUS during labor = 10 cm
Danger area – 2cm lateral to the cervix (1.5 cm lateral to the fornix)
Uterine artery crosses over the ureter at this location (water under the bridge)
MC site of ureter injury during gyne surgery
2nd MC site of ureter injury – pelvic brim
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Implantation :
Vagina :
Length – 7 to 10 cm
Posterior wall is longer than the anterior wall by about 2 cm
Deepest fornix – posterior fornix
Vagina on cut section is H shaped
Vaginal epithelium does not have glands
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Important points :
From beginning of 3rd week after fertilization till 8 weeks after fetilisation
Fetal hematopoisesis :
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NAME REMARKS
Mitha vish ( sweet poison) Aconite
Siddhi / Bhang Leaves and stems of cannabis sativa ( 2% cannabinol)
Majun Sweetmeat preparation of Bhang
Ganja flowering tops of female plants of c. sativa (5-10% cannabinol)
Reefer cigarette preparation of Ganja
Charas resinous extract from leaves and flowers of c. sativa (20-50%
cannabinol)
Blue pill LSD
Kasoomba Opium decoction
Madak / Chandu Opium vapours
Bhujri Fried ripe capsule of poppy plant
Angel dust , Elephant Phencyclidine
Crack Cocaine
Speed ball Heroin
Brown sugar
Smack
XTC / Ecstasy / Football Amphetamine
Heavenly blue Morning glory seeds
School boy Codeine
Speed ball Mixture of heroine and cocaine
Sukhi sharaab/ dry liquor Methaqualone
44 Injury
46 Definition of death
318 Concealment of birth
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AFMG-LAST MINUTE REVISION FACTS 2020
1. ResIpsaLoquitur:Thingorfactsspeakforitself
2. Novus Actus Interveniens : A person is not only responsible for his action but alsofor logical consequences
ofactions.
3. ArborescentorFiligreeburns(Lichtenberg’sflowerspattern)areseen in–lightening 4.Crocodile / Flash
burns/joule burns / arc eye burn / splits & wrinkling are seen in - Electrocution
5.ACIDPHOSPAHTASETESTisusedforidentificationofseminalfluid.
6.LDHISOENZYMEisbestthebesttestforidentificationofseminalfluid. 7.Mechanism abrin and ricin –
inhibition of proteinsynthesis.
8. Hippocraticoathdoesn’tapplyto–children<12yearsofage
9. Fracture of anterior cranial fossa causes – perioccular bruising called as – SPECTACLE HEMORRHAGE/BALCK
EYE/RACONSEYE
10. Artificial bruising is caused by- calotropis, semi carpus anacardium.
11.Railtrackbruisingresultsfrom–blowbyawhip
12. Incisedlookinglacerationoccursat–loosetissueslike–scrotumandaxilla
13. MostcommontypeoforganinjuredinAirblastinjury:Tympanicmembrane>Lung ( cause of life threatening injury)
14. Most common organ to be damaged in under water blast is gastrointestinaltract.
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AFMG-LAST MINUTE REVISION FACTS 2020
Dear students last 15 day when you are supposed to only study the important and high yield topics from all 19 subjects Team
AFMG Team AFMG have prepared list that will help you with the important topics please go through one before one week exam
HOT TOPICS
1.HEMISECTION OF SPINAL CORD
2.- PHARYNGEAL CLEFT, ARCH, POUCH
- BRAIN AND BONES RADIOLOGICAL PICTURES
3. parkland formula
4.GSD TYPES AND THERE DEFECTIVE ENZYMES
5.HIV, D.M.,T.B.( READ FROM ALL SUBJECTS)
6.MC TYPES OF CANCERS A/C ORGANS, GENDERS, AGE,
7.MIDDLE EAR ANTOMAY
8. PSM – TP, TN , FP,FN, PPV, NPV, ODD’S RATIO
9.VACCINE
10. TYPES OF #
11. PATHOLOGICAL FINDING OF DIFFERENT BODIES IN DIFFERENT DIS.
12.GENERAL PATHO, kidney, blood
13.GENERAL PHARMA AND GENERAL SURGERY, anticancer, endo
15.hypersensitivity rxn
16.genetic disoder classification
17. Blood cells cancer classification
Obs/gynae: Breif overview everything
*BEST OF LUCK*
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