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Medical FunNotes

Volume 1
Use for Exams Like AIPGMEE AIIMS-PG,
DNB-CET, PGI USMLE and various state
medical PG entrance exams

Collection of important topics presented


in very interesting ways

Mnemonics, Images, Clinicals etc.


to build more interest

Author
Dr. Vinay Yadav

Rs. 350/-

A collection of most important medical topics for medical PG entrance exams like AIPGMEE,
FMGE, USMLE, all state medical PG entrance exams in India and abroad.
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Medical FunNotes
Volume-1

1st Edition
August 2014

Disclaimer
The editors have checked the information provided in the book and to the
best of their knowledge, it is as per the standards accepted at the time of
publication. However, in view of the changes in medical knowledge and the
possibility of human error, there could be variance. Hence readers are
requested to confirm information particularly laboratory values and drug
dosages from other sources as well, the reader is also strongly urged to
consult the drug companys printed instructions before administering any of
the drugs recommended. This book is Intended only for Medical Students and
Doctors. This book cant be used as substitute for medical advice of a Medical
professional.

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Index
S. No. Particular Page No.
1. 500 Most Common Diseases 01
2. Cerebral salt wasting 02
3. Lines & Rings in Ophthal... 03-04
4. hCG important points 05
5. Microbio 75 important Points 05-10
6. Medical Kisses 11
7. Ophtha Sports & Dots 11
8. X-RAY FINDINGS-Abdomen 12
9. Rate Limiting Enzymes 13
10. Lysosomal (sphingolipids) Storage disease 14
11. Biochemical Tests For Proteins 14
12. Biochemical Tests - Carbohydrates 15
13. Biochemistry Tests - Miscellaneous 15
14. Days To be Remembered 16
15. Differences - Marasmas and Kawashiorkor 17
16. How to take medicines 17
17. Best View In Radiology 18
18. Important Criterias and Classifications 18
19. Syphilis-(serological) 19
20. Named Diseases with Organism 19
21. Medical Salt and Pepper 20
22. Fetus important events 20
23. Named ulcers 21
24. Onions of Medicine 21
25. Important points for toxicology 21
26. Poison Detecting tests 22
27. Forensic 175 Important Points 22-29
28. Medical Fathers 30
29. Named Fevers 30
30. Snowstorm appearance 31
31. Cars in Medicine 31
32. Medical Smells 31
33. Medical Soap bubbles 31
34. Brachial plexus 32
35. Important points genetics 33
36. Fetal Structures & Adult Remnants 34
37. Important Ducts 34
38. Femoral triangle : arrangement of contents 35
39. CD Markers 35
40. Operations in Ophtha 36
41. Important Dermatology Points 37
42. Tongue changes in vit deficiency 37
43. Colony Appearance in Culture Organism 38
44. Blood donors are deferred if: 38
45. Terms Related with Charcot 39
46. POET vs DOCTOR 39
47. Syndrome quick review 40-50
48. Facies 51-56
49. History-taking sequence 57-62
50. Occupations and hobbies linked to disease 62
51. Smoking and clinical associations 63
52. Alcohol (ethanol) abuse and clinical associations 63
53. Sulfonamides: common characteristics 64
54. Important HLA 65
55. Skills in history-taking 65
56. Consciousness disorders and their diagnostic value 66
57. Examination of Lymph Node 67
58. HIV PEP (Post-exposure prophylaxis): 68
59. Pathognomonic Signs of diseases: 68
60. Normal form of the chest 69
61. Pathological Forms of chest 70
62. Respiration Rhythm 71
63. Classification of Conjunctivitis 72
64. Vocal Fremitus 73-75
65. Percussion Tones 75
66. Mechanisms and Examples of Hypersensitivities 76
67. Anaphylaxis Management 77
68. Medical love at mbbsdost 77
69. Vectors of Few Well Known Diseases 78
70. Adverse effect of Phenytoin (anti-epileptic drug) 78
71. Symptoms of Senile cataract... 79
72. Uses of mineralcorticosteroids 79
73. Operations in Surgery 79
74. Causes of Gynaecomastia: 80
75. Nephrotic Syndrome 80
76. Prostaglandin in Obstetrics 80
77. Mydriatics 81
78. Forensic important sections 81-86
79. Important Signs of Obstetrics and Gynaecology 86-89
80. Imp points about rotavirus 89
81. Bad Smells 89
82. Drugs causing lichenoid eruption 90
83. Shoulder Joint 90
84. Strawberrys in Medicine 90
85. Energy of different types of food ingredients 91
86. Extra malarial uses of chloroquine 91
87. Medical HUTCHINSONS 91
88. Pleural Fluid Volumes 91
89. Allergy Management 92
90. Postmortem Staining 92
91. Soft Tissue Sarcomas 93
92. Side effects of drugs 94
93. Lobes of lungs 94-96
94. Special Muscles 97
95. Disorders of the respiration 97
96. Mechanism of labour: 98
97. Form to Order / Pre-book Medical FunNotes 99
98. Courses & Services offered at mbbsdost.com 100
500 Most Common Diseases
1. Most common aortic branch involved in Takayasu Left subclavian
arteritis
2. Most common cause of respiratory distress in Transient tachypnea of the
newborn newborn
3. Most common location to see Asbestosis sequelae Posterior lower lobes.
4. Most common karyotype / chromosomal Down's syndrome
abnormality in USA
5. Most common osseous lymphoma, primary and Diffuse large B-cell lymphom
secondary
6. Most common primary malignant orbital tumor Rhabdomyosarcoma
in childhood
7. Most common type of fluid collection in scrotum Hydrocele
8. Most common type of liposarcoma to affect Myxoid liposarcoma
children
9. Most common abdominal emergency of early Intussusception
childhood
10. Most common acetabular fracture HiddenPosterior
Content.acetabulum
11. Purchase
Most common affected bowel segment in the
TB Full Bookareain Rs. 350/-
Ileocecal
12. on
Most common affected joint www.mbbsdost.com/funnotes
in gout First MTP
13. Most common AIDS-related neoplasm Kaposi Sarcoma
14. Most common allergic aspergillosis syndrome Allergic bronchopulmonary
aspergillosis
15. Most common anatomic variant of pancreas Pancreas divisum
16. Most common anomalous course of Right Interarterial
coronary artery
17. Most common appearance of Legionella at the Bilateral airspace consolidation
peak of the disease
18. Most common association with fracture of great Osteomyelitis
toe distal phalanx with physeal involvement
19. Most common associated anomaly with
Bicuspid valve
coarctation
20. Most common association of Partial Anomalous
Sinus venosus type ASD
Pulmonary venus return.

This article is about 25 pages long. Hence to save space and to provide you more
articles we have included the entire list of 500 at www.mbbsdost.com/500common/
Medical FunNotes at http://www.mbbsdost.com/funnotes 01
Cerebral salt wasting
The term cerebral salt wasting (CSW) was introduced to describe an entity seen

with certain cerebral disorders that can impair the ability of the kidneys to

conserve Na+, with resultant salt wasting and polyuria. CSW is defined as the renal

loss of Na+ with intracranial disease, which leads to hyponatremia and a decrease

in extracellular fluid volume.

Vasopressin-resistant polyuria with hyponatremia, particularly in the setting of

cerebral injury or cerebral disease or when accompanied by dehydration, should

prompt consideration of CSW in the differential diagnosis. CSW must be

distinguished from SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)


Hidden Content.
because management of these 2 conditions differs significantly.
Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
The differences and similarities in findings for CSW and SIADH are itemized as

follows:

Hyponatremia : Present in both CSW and SIADH

Urine Na : #
Increased in both CSW and SIADH

Volume : Reduced in CSW and normal or #


increased in SIADH

Salt wasting : Gross in CSW and self-limited in SIADH

Urine output : Polyuria in CSW and variable in SIADH

Hypouricemia : Occasionally in CSW and frequent in SIADH

02 Medical FunNotes at http://www.mbbsdost.com/funnotes


Lines & Rings in Ophthal..
Arlts Line = conjunctival scar in sulcus subtarsalis in Trachoma.

Ehrlich-Turck Line = linear deposition of Keratic Precipitates in uveitis.

Ferrys Line = corneal epithelial iron line at the edge of filtering blebs.

Hudson-Stahil Line= Horizontal corneal epithelial iron line at the inferior


one third of cornea due to aging.

Khodadoust Line = corneal graft endothelial rejection line composed of


inflammatory cells.

Patons Line = Circumferential retinal folds due to optic nerve edema.

Sampaoelesi line = #
Increased pigmentation anterior to Schwalbes line
in pseudoexfoliation syndrome. Hidden Content.

Purchase the Full Book in Rs. 350/-


Zentmeyer line (Scheies Line) = on the equatorial surface of the lens
on www.mbbsdost.com/funnotes
pigment dispersion syndrome.

Schwalbes Line = Angle structure representing peripheral edge of


Descemets membrane.

Stockers Line = Corneal epithelial iron line at the edge of pterygium

White lines of Vogt = Sheathed or sclerosed vessels seen in Lattice


degeneration.

Fingerprint lines = The map-dot fingerprint dystrophy.

LASIK Iron Line = After LASIK for myopia, the central corneal curvature
is flatter than before surgery. The tear film distribution is therefore altered,
allowing some pooling centrally. This pooling can cause iron deposition in the
central epithelium. A similar effect can be seen after steeping of the cornea

Medical FunNotes at http://www.mbbsdost.com/funnotes 03


from treatment of hyperopia. In the case of hyperopia, a pseudo-Fleischers
ring of iron deposition can be seen. These iron lines do not affect vision.

Vogts striae = occur centrally in a patient with keratoconus. By applying


digital pressure on the eye while looking through the slit lamp, these striae in
the deep cornea, mostly Descemets membrane, disappear, which is
characteristic of keratoconus.

The Descemets breaks or Haabs striae = from birth trauma tend to be


vertical, while the Descemets tears associated with congenital
glaucoma tend to be horizontal or curvilinear.

Ring Keratitis = The hallmark of Acanthamoeba keratitis.

Kayser-Fleischers ring = Wilsons disease.

Corneal rust ring = A small, reddish brown, circular opacity remained in


Hidden Content.
the cornea after the removal of an iron foreign body.
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Coats ring = remnantson
of www.mbbsdost.com/funnotes
a foreign body. The remnants are fine iron
deposits in the cornea.

Fleischers ring = visible all around the base of cone in Keratoconus.

Pseudo-Fleischers ring = iron deposition can be seen in Hyperopia.

Soemmerings ring = early opacification of lens capsule in cataract.

Vossius ring = on lens in concussion injury to eye.

Weiss ring = epipapillary glial tissue torn from the optic disc in Posterior
vitreous detachment (PVD).

Double ring sign = with the peripheral margin of the encircling ring
corresponding to the border of a normal-sized optic disc. Seen in Hypoplasia
of the Optic Disc.

04 Medical FunNotes at http://www.mbbsdost.com/funnotes


hCG important points
hCG source
placental synsytiotrophoblast;

in blood 10 days after fertilization

peaks 9-10weeks, falling to plateau in 20-22 weeks


hCG structure
Hidden Content.
alpha subunit similar to LH, FSH, thyrotropin
beta subunit is specificPurchase the Full Book in Rs. 350/-
hCG functions

on www.mbbsdost.com/funnotes
maintain corpus luteum production of progesterone until placenta
regulate steroid synthesis in placenta and fetal adrenals
stimulate testosterone production in fetal male testes
excess hCG
T - twin pregnancy
E - embryonal carcinoma Mnemonic - TECH
C - choriocarcinoma
H - hydatiform mole

Microbio 75 important Points


1. Causative agent of nausea, vomiting Staphylococcus aureus
(onset < 6 hr) after eating cold cuts, or
potato salad, or mayonnaise, or custards
2. Rapid-onset food poisoning is mediated by Enterotoxin
what component of staphylococcus
3. Treatment of staphylococcal food poisoning Rehydration
Hidden Content.
4. Microbial cause of nausea and vomiting, +/- Bacillus cereus
diarrhea (onset < 6 Purchase the
hr) after eating Full Book in Rs. 350/-
reheated
rice on www.mbbsdost.com/funnotes
5. Bacterial spores are resistant to heat due to Dipicolinic acid core
what component
6. Microbial cause of nausea, vomiting, watery Clostridium perfringens
diarrhea with rapid (onset >6 hr) after
eating reheated meat or gravy
7. Most likely cause of persistent dyspepsia in a Helicobacter pylori
patient not receiving NSAIDs is
8. Increased risk of gastric adenocarcinoma and H. pylori colonization
Medical FunNotes at http://www.mbbsdost.com/funnotes 05
MALT lymphoma
9. Indications to treat H. pylori-associated Presence of organism
Peptic ulcer disease(PUD)
10. Standard first-line treatment for Peptic ulcer Proton pump Inhibitors +
disease(PUD) due to H. pylori is clarithromycin + amoxicillin
11. Cause of acute onset of diarrhea with rice- Vibrio cholerae
water stools, vomiting, dehydration during
travel to South America
12. Pathophysiology of cholera is due to what A-B toxin causes increased
mechanism cAMP
13. Cholera pathogen is isolated from stool by thiosulfate-citrate-buffered
culture on selective medium called sucrose (TCBS) agar
14. The comma-shaped cholera organisms are Campylobacter
microscopically similar to
15 Treatment of cholera involves Rehydration
Hidden
16. Secretory diarrhea, fever and vomiting duringContent.
Enterotoxic E. coli
travel are caused by Purchase the Full Book in Rs. 350/-
17. Secretory diarrhea with
on fatty, foul-smelling Giardia lamblia
www.mbbsdost.com/funnotes
stools in campers, hikers; also day-care
outbreaks is caused by
18. Following ingestion of 15-25 cysts, excysted Giardiasis
trophozoites adhere at brush border of
enterocytes and contribute to malabsorption
19. Diagnosis of giardiasis is confirmed by Stool antigen (+)
20. Giardiasis is specifically treated with Metronidazole
21. Protracted, secretory diarrhea with large fluid Cryptosporidium >>
loss in AIDS is caused by (clue: acid-fast Cyclospora > Isospora
organisms)
22. Frank bloody diarrhea, after eating E. coli O157:H7
undercooked meats or drinking fruits drinks,
is caused by prepared foods or water,
contaminated with
23. Pathogenesis of hemorrhagic enterocolitis Shiga toxin (a cytotoxin)
caused by E. coli involves
24. Complication of hemorrhagic enterocolitis in hemolytic uremic syndrome

06 Medical FunNotes at http://www.mbbsdost.com/funnotes


children
25. Profuse diarrhea, fever, vomiting, and Rotavirus
dehydration in infants is caused by
26. Mechanism of rotaviral diarrhea involves Villus destruction

27. Infantile watery diarrhea and fever are Adenovirus 40,41


caused by
28. Outbreak of nausea, vomiting, fever in adults Norovirus
is caused by
29. Cause of nausea/vomiting, abdominal Non-typhoidal Salmonella
cramps, diarrhea +/- bloody 12-48h after
eating eggs or poultry or peanut butter
30. Antibiotic treatment in acute gastroenteritis carrier (in bile ducts) state
due to Salmonella species is not warranted to
avoid
Hidden
31. Antibiotic used only to treat septic phase ofContent.
ciprofloxacin
salmonella gastroenteritis is
Purchase the Full Book in Rs. 350/-
32. Cause of fevers (>103), headaches; macular Salmonella typhi
on www.mbbsdost.com/funnotes
rash on torso (rose spots) abdominal pain
and little diarrhea later; On Examination:
bradycardia; hepatosplenomegaly (+/-) in a
patient with history of travel (to tropics)
33. Cause of diarrhea with occult blood, Campylobacter jejuni
abdominal cramping and fever, 2 days after
ingestion of poultry-contaminated salad
34. Antibiotic to treat campylobacter enteritis Erythromycin
with high fevers in pregnancy, and HIV is
35. Cause of dysentery-like illness with fever + Shigella sonnei
abdominal cramps, tenesmus + blood &
mucus in children
36. Dysentery due to invasive Shigella species in Ciprofloxacin
elderly is treated with
37. Cause of dysentery-like illness (+/ Yersinia enterocolitica
pseudoappendicitis or pseudo-crohn
syndrome) in the northern region after eating
cheese

Medical FunNotes at http://www.mbbsdost.com/funnotes 07


38. Cause of dysentery-like illness in a patient Clostridium difficile
with history of broad-spectrum antibiotic use
39. Clostridium difficile-associated diarrhea A (enterotoxin) + B (cytotoxin)
(CDAD) is mediated by toxins
40. Lab confirmation of CDAD does not require Enzyme immunoassay (EIA)
stool Culture, but is based on for stool toxins A or B
41. Besides rehydration and cessation of inciting Metronidazole (mild) or oral
mededicines, Clostridium difficile-associated vancomycin (severe/relapse)
diarrhea (CDAD) is treated with
42. Health-care associated (nosocomial) spread Fecal-oral and/or contact with
of Clostridium difficile diarrhea and environmental spores
protracted outbreak is due to
43. History of abdominal pain, tenesmus, stools Amebic dysentery
with mucus + blood in a patient, who recently
traveled to tropics; CBC: eosinophilia
44. Stool microscopy to confirm amebic endocytosed RBCs(distinction
Hidden Content.
dysentery should reveal characteristic from luminal ameba)
trophozoites of Entamoeba histolytica with
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45. Treatment of amebic on
dysentery involves Metronidazole + iodoquinol
www.mbbsdost.com/funnotes
46. Abscesses in liver or peritonitis in travelers Serology for E. histolytica
with or without history of amebic dysentery is
confirmed by
47. A boar hunter develops dysentery after Balantidium coli
eating meat at campsite; Ova & Parasite test
should reveal a ciliate parasite, known as
48. Most likely cause of chronic abdominal pain, Ascaris lumbricides
diarrhea; intestinal obstruction; cholangitis;
liver abscess, in children
49. Ova & Parasite test using microscopy for oval ascariasis
eggs (with a thick coarse shell) in stool
confirms
50. A child has stomach ache, distended IgE
abdomen, poor appetite. Pearl-colored
earthworm-like organisms in the stool.
Major immune response against this
infection

08 Medical FunNotes at http://www.mbbsdost.com/funnotes


51. Drug of choice of ascariasis is Mebendazole
52. Vomiting, cramping, diarrhea, epigastric pain, Strongyloides stercoralis
weight loss in an immigrant from developing
country is caused by
53. Drug of choice of strongyloidosis is Ivermectin
54. Patient with AIDS (low CD4+ counts) develops Invasive strongyloidosis
pulmonary infiltrates (+ eosinophilia) and/or
gram negative sepsis.
55. Weakness, fatigue, lightheadedness, Hookworm (Necator
dyspnea, pruritis; pallor; iron-deficiency americanas) infection
anemia; eosinophilia (history of outdoor
activity).

56. Fever, periorbital edema, subconjunctival Trichinellosis


hemorrhages, muscle weakness, and rash,
after eating undercooked pork (Lab:
eosinophilia., CPK, LDH ). Hidden Content.
Purchase
57. Abdominal pain, bloating, the
altered Full Book
appetite in Rs. 350/-
Diphyllobothriasis (fish
after ingestion of sushi. CBC: megaloblastic tapeworm)
on www.mbbsdost.com/funnotes
anemia; leukocytosis/eosinophilia.
58. Diagnosis of tape worm infection is confirmed Proglottids in stool
by
59. Tape worm infections are treated with broad- Praziquantel
spectrum agent
60. C a u s e o f fe ve r, l y m p h a d e n o p at hy, Schistosoma mansoni (Africa)
hepatosplenomegaly in an immigrant from S. japonicum (Far East)
Africa or Orient; Patient recalls wading in
stagnant water. Right Upper Quadrant
ultrasound (+); CBC: eosinophilia
61. Microscopy of stool in chronic stage of Large eggs with lateral spine.
schistosomiasis reveals
62. Chronic stage of schistosomiasis is treated Praziquantel
with
63. Patient with acute jaundice is Hepatitis A Inactivated Hepatitis A virus
virus(HAV) IgM (+); household contact should vaccine
receive for prophylaxis

Medical FunNotes at http://www.mbbsdost.com/funnotes 09


64. Patient with jaundice for < 1 week has HBsAg Acute Hepatitis B virus
(+), Anti-HBc IgM (+) infection
65. Multiple sex partners, IDU, infants born to Hepatitis B virus
infected mothers are risk groups for which
hepatitis virus
66. This is an enveloped, double stranded DNA Hepatitis B virus
virus with ss-break; transmitted by infective
body fluids
67. This asymptomatic man has hepatitis Resolved hepatitis B
serology profile of HBsAg (-), Anti-HBs (+),
Anti-HBc IgG (+), Anti-HBc IgM (-)
68. This man has jaundice and is HBsAg (+) > 6 Chronic active hepatitis B
months, Anti-HBs (-), HBeAg (+), Anti-HBc IgG
(+), HBV DNA > 20,000 IU/ml
69. This man has jaundice and is HBsAg (+) > 6 Peginter feron alpha 2a +
months, HBeAg (+) and evidence of Lamivudine (or cidofovir)
necroinflammation. He should receive
Hidden Content.
70. This man has no jaundice, but HBsAg (+) >6 Inactive HBsAg carrier
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months, Anti-HBs (-), Anti-HBc IgG (+), HBeAg
( - ) , p e r s i s t e non
t l y www.mbbsdost.com/funnotes
normal Alanine
Aminotronsferase
71. This man, at the time of annual physical exam, HBV immunized
reveals Anti-HBs (+) and other markers are (-)
72. Virologic confirmation of chronic jaundice in a HCV RNA > HCV IgG
HBV-immunized patient with IDU or
hemodialysis is based on
73. More chronicity of HCV (than HBV) is due to error-prone HCV RNA virus
immune-evasive quasispecies generated
during replication (in blood) of
74. Fulminant hepatitis in a patient, who has HDV superinfection.
multiple sexual partners and is HBsAg (+);
HBcIgM (-), can be fatal due to what
75. Cause of acute onset of jaundice, nausea, HEV
right-upper quadrant pain, hepatomegaly in
pregnant women in India

10 Medical FunNotes at http://www.mbbsdost.com/funnotes


Medical Kisses
Kissing disease glandular fever/inferior mononucleosis
Kissing ulcer anterior & posterior duodenal ulcers/vulval ulcer
Kissing tonsils hypertrophied parenchymtous tonsils(grade 4)
Hidden Content.
Kissing virus PurchaseVirus
Ebrtein-Barr the(EBV)
Full Book in Rs. 350/-
Kissing peptide on www.mbbsdost.com/funnotes
Gonadotropin-releasing hormone. (GnRH)
Kissing lesion donovanosis
Kissing arthritis T.B. knee
Kissing appearance on x-ray-bladder papilloma

Ophtha Spots & Dots


Leopard spots : in Fundus Flourescein Angiography, resulting from patchy
subretinal infiltrates in a patient with reticulum cell sarcoma.

Histo spot : Punched-out chorioretinal scars in Presumed ocular


histoplasmosis syndrome (POHS)

Cotton-Wool Spots : Diabetic retinopathy is the most common cause of


cotton-wool spots. Cotton-wool spots have been associated with
numerous other abnormalities, such as systemic arterial hypertension,
collagen vascular diseases, cardiac valvular disease, carotid artery
Hidden Content.
obstructive disease, coagulopathies, metastatic carcinoma, trauma, and
Purchase
human immunodeficiency the Full Book in Rs. 350/-
virus infection.
on www.mbbsdost.com/funnotes
Bitots spot : White, foamy area of keratinising squamous metaplasia

of bulbar conjunctiva, seen in vitamin A deficiency.

Brushfield spot : Whitish grey spot in peripheral iris, seen in Downs


syndrome.

Elschnig spot : Yellow patches overlying area of choroidal infarction in


hypertension.

Fischer-Khunt spot : Senile scleral paque, area of hyalinised sclera anterior


horizontal rectus muscle insertion. Seen in old age.

Medical FunNotes at http://www.mbbsdost.com/funnotes 11


Foster Fuchs spot : Pigmented (Retinal Pigment Epithelial hyperplasia)
macular leisons in pathological myopia.

Gunns dot : light reflections from internal limiting membrane around disc and
macula

Horner-Trantras Dot : Collections of eosinophils at limbus in vernal


conjunctivitis.

Kayes dot (Krachmers spot) : subepithelial infiltrates seen in corneal graft


rejection
Hidden Content.
Purchase
Mittendorfs dot : whitish the Full
spot at posterior lensBook inremnant
surface, Rs. 350/-
of hyaloid
artery. on www.mbbsdost.com/funnotes
Roth spots : haemorrhages with white centers, seen in subacute bacterial
endocarditis, severe anaemia, collagen vascular disorders.

Cherry red spot : Central retinal artery occlusion, Commotio retinae (Berlins
oedema),Tay-Sachs disease, Niemann-Picks disease, Gauchers disease

Cream-colored spots : The classic diagnostic feature of bird-shot


vitiliginous chorioretinitis is cream-colored spots, often as large as
0.5 to 1 disc diameter, that are scattered throughout the fundus.

Kopliks spots : on conjunctiva in measles

X-RAY FINDINGS - Abdomen


Bird's Beak deformity of lower oesophagus Achalsia cardia (Barium Swallow)
Rat tail tapering of lower Oesophagus Carcinoma oesophagus (Barium
Swallow)
Cork screw oesophagus Diffuse oesophageal spasm
Hidden(Barium Swallow)
Content.
Commonest radiological Appearance filling defect in antrum /
Purchase
of gastric carcinoma (in barium meal the Full
body Book in Rs. 350/-
of stomach
follow through) is on www.mbbsdost.com/funnotes
Trifoliate duodenum Chronic duodenal ulcer with
scarring (Barium Meal)
Hour Glass stomach Peptic ulcer
Cup & Spill / Cascade stomach Volvulus of stomach

12 Medical FunNotes at http://www.mbbsdost.com/funnotes


Rate Limiting Enzymes
1. Glycolysis Phosphofructokinase-1
2. Pyruvate Metabolism Pyruvate dehydrogenase complex
3. TCA cycle Isocitrate dehydrogenase
4. Citric acid cycle Citrate synthase
5. Glycogenesis Glycogen synthase
6. Glycogenolysis Glycogen phosphorylase
7. Gluconeogenesis Phosphoenolpyruvate carboxykinase
& Fructose 1,6-Biphosphotase
8. Hexose Monophosphate Glucose 6 phosphate dehydrogenase
Shunt
9. Pentose phosphate Glucose-6-phosphate dehydrogenase
10. Cholesterol synthesis HMG-CoA reductase
11. Ketone body synthesis HMG-CoA lyase
12. Fatty acid synthesis Acetyl CoA carboxylase
13. Beta oxidation of fatty acids Carnitine acyl transferase [CPT-1]
14. Lipogenesis Hidden Content.
Acetyl-CoA-carboxylase
15. Phospholipid synthesis Purchase the Full Book
Cytidyltransferase in Rs. 350/-
16. Sphingolipid synthesis on www.mbbsdost.com/funnotes
3 ketosphiganine synthase
17. Eicosanoid synthesis Phospholipase A2
18. Prostaglandin synthesis Phospholipase A2
19. Steroidogenesis CSCC (27 desmolase)
20. Heme synthesis Aminolevulinate synthase
21. Bilirubin metabolism Active transport into bile ducts
22. Bile acid synthesis Colesterol 7a hydroxylase
23. DNA synthesis Ribonucleotide reductase
24. Purine synthesis Glutamine Prp transferase
25. Pyrimidine synthesis Carbamoyl phosphate synthetase II
26. Urea cycle Carbamoyl phosphate synthetase I
27. Lipolysis Hormone sensitive lipase
28. Fructose metabolism Aldolase B
29. Galactose metabolism Galactose 1-Phosphate Uridyltransferase
30. Heme Synthesis ALA synthase
31. Heme catabolism UDP glucoronyl transferase

Medical FunNotes at http://www.mbbsdost.com/funnotes 13


Lysosomal (sphingolipids) Storage disease
1. Tay-sachs Disease : Acute Respiratory Disease, Hexoaminidase Deficiency,
Ganglioside Gm2 accumulation, mental retardation, blindness, cherry red
spot on macula & death by age 3.
2. Gauchers Disease : Acute Respiratory Disease, Glucocerebrosidase
deficiency, glucocerebroside Hidden Content.
accumulation, hepatosplenomegaly, bone
erosion, mental retardation.
3. Purchase
Nieman-Pick Disease : Acutethe Full Book
Respiratory in Sphingomyelinase
Disease: Rs. 350/-
on www.mbbsdost.com/funnotes
deficiency Sphingomyelin accumulation hepatosplenomegaly, mental
Retard.
4. Fabrys Disease : X : linked disease, galactosidase A deficiency Ceramide
trihexoside accumulation Angiokeratoma like skin lesion, kidney
failure, lower extremities pain.
5. Krabbes Disease (Globoid Cell Leukodystrophy) : Galactosylceramide
galactosidase deficiency Galactocerebroside accumulation mental
retardation, absent myelin.

Biochemical Tests
Biochemical Tests For
For Proteins
Proteins
1. Biuret test Proteins
2. Ninhydrin test Amino acids, peptones, peptides, proteins give
purple due to formation of Rheumann purple
& amine acids (Proline, OH-proline) give yellow
3. Xanthoproteic acid test Aromatic amino acids
4. Millon test Phenylalanine and tyrosine
5. Pauly's Diazo test Hidden
Histidine Content.
(cherry red) & Tyrosine (orange red)
6. Hopkins Cole test Purchase the(Indole
Tryptophan Full Book
group) in Rs. 350/-
7. Sakaguchi test
on www.mbbsdost.com/funnotes
Arginine
8. Sulfur test Cysteine
9. Nitroprusside test SH group
10. Knoop test Histidine
11. Lead sulfide test Cysteine and cystine
12. Sullivan and
McCarthy test Methionine
13. Isatin test Proline
14 Medical FunNotes at http://www.mbbsdost.com/funnotes
Biochemical Tests - Carbohydrates
1. Molisch test Carbohydrates larger than tetroses
2. Iodine test Polysaccharides/Starch
3. Fehling test Reducing sugar
4. Benedict test Reducing sugar
Hidden Content.
5. Barfoed test Reducing monosaccharide (vs disaccharide)
6. Seliwanoff test
Purchase the Full Book in Rs. 350/-
Ketoses (vs aldoses)
7. Bial test on www.mbbsdost.com/funnotes
Pentoses (vs hexoses)
8. Osazone test Needle shaped : Glucose/Fructose/Mannose
Hedgehog shaped/
Mushroom shaped : Lactose
Sunflower shaped : Maltose

Biochemistry Tests - Miscellaneous


1. Silver nitrate test Free Hcl
2. Gunzberg test Free Hcl
3. Ufflemann test Lactic acid
4. Kelling test Lactic acid
5. Haly's sulfur flower test Bile salts
6. Pettenkoffer test Bile salts
7. Gmelin test Bile pigment
8. Coles test
Hidden Content.
Bile pigment
9. Fouchet test
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Bile pigment
10. Hypobromite test
on www.mbbsdost.com/funnotes
Urea
11. Specific urease test Urea
12. Schiff test Uric acid
13. Murexide test Uric acid
14. Jaffe test Creatinine
15. Hellers nitric acid test Proteins
16. Gerhardt test Acetoacetate
17. Rothera test Acetone and acetoacetate
Medical FunNotes at http://www.mbbsdost.com/funnotes 15
Days To be Remembered :
30th January Anti Leprosy Day
th
4 February World Cancer day
nd
2 March No smoking day
th
8 March International Women's Day
th
24 March Anti TB Day
7th April health Day
25th April World Malaria day
st
1 May Labour day
1stweek of May Malaria week in INDIA
2nd week of May thalassemia week
2nd sunday of May Mother's Day
rd
3 M ay World Asthma day
8th May world Red Cross day
25th May World multiple sclerosis Day
31 Mayth
Hidden Content.
No Tobacco day
th
5 June
Purchase theWorld
FullEnvironment
Book inDay Rs. 350/-
26th June International Day against Drug abuse
on www.mbbsdost.com/funnotes
and Illicit trafficking
1st July Doctors Day
th
11 July World population Day
th
28 July World hepatitis Day
st
1 week of August World Breast feeding week
th
8 September World literacy Day
28th September World Rabies Day
10th October World Mental health day
nd
2 Wednesday of October World Disaster Reduction Day
th
16 October World anaesthesia Day
th
10 November International Immunization Day
th
14 November World Diabetic day
th
25 November International Day for Elimination of
Violence against Women
1st December World AIDS Day
th
10 December Human rights day
16 Medical FunNotes at http://www.mbbsdost.com/funnotes
Differences-Mrasmas and Kawashiorkor
Mnemonic (WE-HALFFS ) Marasmus Kawashiorkor
W-weight <60% >60%
E-edema Absent Present
H-hair changes Hidden Content.
Absent Present
A-apetite Purchase the
Present Full Book in Rs. 350/-
Absent
L-look
on www.mbbsdost.com/funnotes
Alert Apathetic
F-face Monkey Face Puffy Face
F-fat Absent Present
S-skin Normal Flaky

How to take medicines


Some medicines need to be taken with or after food. The six main reasons for this
are outlined below:
1. To reduce side effects of nausea or vomiting.
Its better to take some medicines that can cause nausea or vomiting after a
meal to reduce these side effects. Examples include allopurinol,
bromocriptine and madopar.
2. To reduce side effects of stomach irritation, including indigestion, stomach
inflammation or ulcers.
Some medicines can irritate the stomach, and taking them with food will help
to reduce this effect. Food such as biscuits or a sandwich or a glass of milk is
usually enough. Examples include aspirin, NSAIDs (diclofenac & ibuprofen..),
steroid medication (prednisoloneHidden
and dexamethasone).
Content.
3. To treat problems suchPurchase
as heartburn,
thereflux or indigestion.
Full Book in Rs. 350/-
Medicines called antacids on www.mbbsdost.com/funnotes
are taken to prevent heartburn, reflux and
indigestion, which usually occur when acid is produced as food enters your
stomach. Therefore, these medicines are most effective if taken immediately
after, or during, a meal. For example Pantoprazole & Ranitidine.
4 . To ensure the medicine is not washed away.
Preparations such as mouthwashes, liquid nystatin and miconazole gel for
oral thrush, and preparations - or mouth ulcers - must be used after meals.
This is because eating food washes the medicine away too quickly.
5 . To ensure the medicine is absorbed into the bloodstream properly.
Some medications require food in the stomach and gut in order for the body
to absorb them properly. For example, the HIV medicines ritonavir,
saquinavir and nelfinavir.
Medical FunNotes at http://www.mbbsdost.com/funnotes 17
6. To help the body process the meal.
Hidden Content.
Medicines for diabetes, if taken by mouth, should usually be taken around
Purchase the Full Book in Rs. 350/-
meal times to reduce blood sugar levels after eating, and to avoid
on www.mbbsdost.com/funnotes
hypoglycaemia (very low blood sugar).
Enzyme supplements, which can be used to help people with chronic
pancreatitis, should also be taken with food to help the body process the
meal.

Best View In Radiology


Pneumothorax PA(EXPIRATION)
PITUITARY CONED DOWN LATERAL VIEW
ORBIT Caldwell view
Hidden Content.
Recurrent shoulder dislocations STRYKERS
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Full Book in Rs. 350/-
CERVICAL INTERVERTEBRAL FORAMEN OBLIQUE VIEW
on www.mbbsdost.com/funnotes
LEFT ATRIAL ENLARGEMENT B A R I U M S WA L LO W S C A P H O I D
OBLIQUE
PETROUS BONE Towns/STENVERS VIEW
Maxillary sinus Waters view

Important Criterias and Classifications


1. Halls criteria Downs syndrome
2. Dukes criteria Endocarditis/Heart failure
3. Butchers criteria mesothelioma
4. Ann Arbours classification Hodgkins lymphoma
5. Bismuth classification tumors of hepatic ductal system
6. Nazers Index Wilsons disease
7. Pagets Index Hidden Content.
Abruptio placentae
weight kg
8. Quetlet index Purchase the
BMI= Full Book in Rs. 350/-
(height in m.) 2

on www.mbbsdost.com/funnotes
height in cm
9. Ponderial Index BMI=3
weight in kg
10. Brocas index Height in cms-100
11. Corpulence index Actual weight/desired weight
12. Milans crjteria for liver transplant in Hepatocelluar
carcinoma
13. Mayers n cottons grading Subglottic stenosis
system
14. Spaldings criteria abdominal pregnancy
18 Medical FunNotes at http://www.mbbsdost.com/funnotes
15. GCS/Ransons Pancreatitis
criteria/APACHE score
16. Ennekings staging Bone tumors
17. Mc Donald's criteria Multiple Sclerosis
18. Epworths criteria Hidden
Sleep apneaContent.
19. Purchase the Full
Framminghams criteria/ Chronic Book
heart failurein Rs. 350/-
Boston's criteria
20.
on www.mbbsdost.com/funnotes
Durie salmon system of Multiple myeloma
staging
21. Lights criteria pleural effusion
22. GOLD's criteria Chronic Obstructive Pulmonary Disease
23. OKUDA staging Hepatocellular Carcinoma

Syphilis---(serological)
1. First test to be Positive : FTA Abs (Fof first...F of FTA Abs)
2. Rapid diagnostic-RPR (R for Rapid)...hence it can also screen large samples in
small time Hidden Content.
3. Sensitive and Specific- TPPAPurchase the both
(see it has Full Book in Rs.sensiTv...and
't' from 350/- 'p' from
sPcific) on www.mbbsdost.com/funnotes

4. Response to therapy- VDRL


5. Congenital Syphilis- 195IgM Fta Abs or Capita M test

Named Diseases With Organism


Piroplasmosis/texas fever : Babesia
Katayama disease : Schistosoma japonicum
Omsk fever : flavivirus
Gaol fever : Rickettsia prowazeki
Carrions disease Hidden
: Content.
Bartonella bacilliformis
Hebra nose Purchase the
: Full Book
Klebsiellain Rs. 350/-
rhinoscleromatis
Milkers node : paravaccinia
Vagabond disease
on www.mbbsdost.com/funnotes
: pediculosis corporis
Buruli ulcer : Mycobacterium ulcerans
Coconut cake rectum : trichuris
Pseudohemoptysis : Serratia
Walking pneumonia : Mycolplasma
Pontiac fever : Legionella

Medical FunNotes at http://www.mbbsdost.com/funnotes 19


Canicola fever : Leptospira
Duncans disease : EBV
Red diaper syndrome : HiddenSerratia
Content.marcesans
Haverhill fever Purchase
: the Full
ratBook in Rs. 350/-
bite fever
on www.mbbsdost.com/funnotes
Sudoku fever : Spirillum minus
Brill Zinsser disease : Recrudescent typhus
White plague : tuberculosis
Shanghai fever : pseudomonas

Medical salt and pepper


Salt and pepper appearance on MRI is seen in Glomus tumors, Vertebral
hemangiomas, Juvenile Nasopharyngeal angiofibroma.
Salt and pepper appearance in skull X-ray is seen in Hyperparathyroidism
Salt and pepper hair is seen in Kwashiorkor
Hidden
Salt and pepper appearance of skin is seen inContent.
Scleroderma.
Purchase
Salt and pepper appearance the Full
of chromatin Book
is seen in Rs.
in Small 350/-
Cell Carcinoma
lung on www.mbbsdost.com/funnotes
Salt and pepper appearance of Parotid gland is seen in Sjogrens syndrome
Salt and pepper retinopathy is seen in :
Congenital Rubella,
Congenital syphilis,
Phenothiazine toxicity,
Fundus Flavimaculatus.

Fetus important events


0 hr fertilization
th
4 day morula
th
5 day blastocyst
th
Hidden Content.
7 day interstitial implantation
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21st-22nd day placenta fully established/fetal circulation
8 weeks
on www.mbbsdost.com/funnotes
internal gonads formed
10-12 weeks swallowing starts
11weeks fetal breathing movements
12 weeks external gonads formed
12weeks urine formation
20 Medical FunNotes at http://www.mbbsdost.com/funnotes
Named ulcers
Rodent ulcer : basal cell carcinoma
Marjolinsulcer : Hiddencell
squamous Content.
carcinoma
Purchase the Full Book in Rs. 350/-
Maleneys ulcer : micro aerophilic streptococci
on www.mbbsdost.com/funnotes
Kissing ulcer : benign ulcer in urinary bladder
Hunners ulcer : Interrtitial cystitis
Buruli ulcer : micobacterium marinum

Onions of Medicine:
Onion skin appearance in kidney seen in Hyperplastic Arteriosclerosis
Onion skin like lesions due to arteritis
Hiddenseen in Lymes and Systemic lupus
Content.
Erythemaposus & Motions Purchase the Full Book in Rs. 350/-
Onion skin fibrosis aroundon
bile ducts seen in Primary Scleraring
www.mbbsdost.com/funnotes
Onion skin pattern of deposition of reactive bone in Ewing's Sarcoma
Onion bulb appearance in sural nerves seen in CIDP due to recurrent
demyelination and remyelination

important points for toxicology


1. Pin point pupils Opium poisning
2. Dilatation of pupils Dhatura, Cyanide poisning
3. Constriction of pupils Opium, phenol, organo-phosphorus,
physostigmine, chloral hydrate poisning
4. Cumulative poisons are Barbiturates, and methyl alcohol
5. Habit forming poisons are Caffeine and Nicotine.
6. Addiction drugs are
Hidden Content.
Alcohol, Barbiturates, Coccaine,
Purchase the Full Book
Cannabis, Chloralin Rs. 350/-
hydrate, Opium,
on www.mbbsdost.com/funnotes
Pethidine
7. Hemodialysis is good value in Salicylate, methanol, barbiturate, and
aspirin (except kerosene oil and
diazephem)
8. 1st sign of intra-uterine death Gas shadow in aorta (as early as 12
hours).
9. Increased anion gap is seen in Salicylate poisoning, lactic acidosis,
starvation.

Medical FunNotes at http://www.mbbsdost.com/funnotes 21


10. Ideal suicide poison Cyanide
11. Ideal homicide poison Thallium, fluoride compounds.
12. Commonly used homicidal Arsenic, aconite
poisons
Hidden Content.
13. Commonly used suicidal Endrine, Opium, Barbiturates,
poisons
Purchase theOrganophosphorus
Full Book in compounds.
Rs. 350/-
14.
on www.mbbsdost.com/funnotes
Poison resembling cholera Arsenic
15. Poison resembling tetanus Strychnine
16. Poison resembling natural death Thallium
17. Poison resembling fading measles Arsenic
18. Poison resembling thyrotoxicosis Bi-nitro compounds.

Poison Detecting tests


Arsenic Marshs test, Reinschs test
Opium Marquis test Hidden Content.
Purchase the Full Book in Rs. 350/-
Alcohol Mcevans test on www.mbbsdost.com/funnotes
Datura Mydriatic test
Phenol Green urine.

Forensic 175 Important Points


1. The Percentage of blood alcohol in the stage of "dead drunk" is 0.5%.
2. Pisiform gets ossified by 12 yrs of age.
3. By 14 years patella gets ossified.
4. Anterior fontanelle closes by 18 months of age.
Hidden Content.
5. The height of a child is double of birth
Purchase theheight
Full by 4 years
Book in of
Rs.age,
350/-
6. on 7www.mbbsdost.com/funnotes
Under IPC, a person below years is not criminally responsible.
7. Fatal period of Datura poisoning is 24 hours.
8. In India, rigor mortis sets within 1-2 hours.
9. While dispatching blood and urine for chemical analysis, sodium fluoride is
added as preservative in concentration of 50 mg/10ml.

22 Medical FunNotes at http://www.mbbsdost.com/funnotes


10. Critical level of alcohol in blood is 0.15%.
11. The minimum age for giving consent for surgery is 18 years.
12. In fractured ends of bone, soft provisional callus is formed by 15 hours.
13. The minimum time required for adipocere formation in a dead body is 21
days.
14. Indian Medical Council Act was enacted in 1956.
15. Mental retardation is I.Q. Below 70.
16. Ratio between ethyl alcohol in blood to urine is 1 : 1.33
17. Gas rigidity appears after 72 hours.
18. Marbling is noticed by 36 hours.
19. Full development of rigor mortis takes about 12 hours.
20. In exhumation, 6-7 samples of earth are collected.
21. Intercourse with wife below 15 years of age is considerable rape.
Hidden
22. Fatal period of aconite is usually 1-5 hours. Content.
23. Purchase
Cooling of body is gradual upto 1-3the Full Book in Rs. 350/-
hours.
24. Hypostasis is mottledon www.mbbsdost.com/funnotes
within first 3 hours of death.
25. Killing range of a military rifle is 3000 yards.
26. Juvenile offender is a person under 16 years
27. The dispersion of pellets is seen usually at distance beyond 10 feet.
28. In a gunshot wound, the presence of singeing of hair or charring of skin
denotes a fire up to 18 inches.
29. Dispersion of pellets in shotgun injury is calculated as dispersion in inches =
1.5 times the dispersion in yards.
30. An infant born before 210 days is not legally considered capable of
maintaining a separate existence.
31. A bruise showing bluish black discolouration is 4 days old.
32. The upper limit of safety for carbon monoxide in air is 0.01%.
33. Rh positivity in India is 93%.
34. In an abrasion, the scab usually dries and falls between 4-6 days.
35. Fatal dose of opium is 2 gm.

Medical FunNotes at http://www.mbbsdost.com/funnotes 23


36. The range of an air rifle is about 90 yards.
37. Mixed dentition is seen in children between 6-12 years of age.
38. Basisphenoid unites the basi-occiput at the age to 22 years.
39. First permanent molar appears at age of 6-7 years.
40. Judicial first class Magistrate can pass a sentence of imprisonment upto 3
years.
41. Age of maturity for those under court of wards is 21 years. In India, sexual
maturity is gained at 14 years of age.
42. The degree of accuracy in determining sex from long bones is 80%.
43. Fatal period of sulphuric acid poisoning is 18-24 hours.
44. Multiplying factors for estimating stature from humerus and femur in males
are 5-5.3 and 3.6-3.8 respectively.
45. Colliquative liquefaction is seen within 1 week after death.
46. A contusion assumes green colour by 6 days.
Hidden Content.
47. Marriage age for boys and girls are 21 years and 18 years respectively.
Purchase the Full Book in Rs. 350/-
48. Internal organs take on
24 hours to cool. A person becomes major at the age of
www.mbbsdost.com/funnotes
18 years. Eruption of temporary teeth is completed by 2 to 2.5 years.
49. Foetal parts can be detected on plain X-ray usually by 16 weeks.
50. Child below 12 years is not required to take an oath.
51. Xiphoid process unites with sternum at age of 40 years.
52. Cranial capacity is 10% less in females.
53. Nuclear features persist in decomposition for a period of 2-3 years.
54. Precipitin test is positive to be opium in dead body upto 10 years.
55. After death, benzidine test is positive upto 150 years. Bones begin to
decompose after death in 3-10 years.
56. Less than 7 amino acids in bone suggest age of bone after death as more than
100 years. The rate of cooling of body in first 6 hours is 2.5F and in next 6
hours as1.5-2.0F.
57. Center of ossification for pisiform bone appears at an age of 10-12 years.
58. The floatation time in summer for a dead body after drowning is one day.
59. The age of 15 years old female is best determined by the radiography of

24 Medical FunNotes at http://www.mbbsdost.com/funnotes


upper end of radius and ulna.
60. Maggots in a dead body do not appear before 48 hours.
61. Hairs become loose after 72 hours of death.
62. Epiphyseal union of sternal end of clavicle occurs at age of 22 years.
63. Washer woman's hands and feet usually occur within 12-18 hours.
64. Saponification in drowning occurs in about 5 weeks.
65. Death ensues in about 5 minutes of complete submersion.
66. By ABO, RH, MN systems the exclusion of Paternity is about 50%.
67. Gustafson's method for estimation age of adult over 21 years.
68. In poisoning by salicylates, the Gastric lavage is useful upto 24 hours.
69. The age of consent for medical examination in cases of rape is minimum 12
years.
70. If a person is absent from his usual haunts, and has not been heard for 7
years, he is presumed to be dead.
Hidden Content.
71. Infanticide means unlawful destruction of child below 1 year of age.
Purchase the Full Book in Rs. 350/-
72. Histologically, reticulumon
fibers in an abrasion are seen after on 8 days
www.mbbsdost.com/funnotes
73. Estimation of Age from eruption of teeth is possible upto 17 to 21 years of age
74. In poisoning by salicylates, the Gastric lavage is useful upto 24 hours
75. The age of consent for medical examination in cases of rape is minimum 12
years
76. In sin of Gomorrah, buccal swabs are useful upto 9 hours
77. In most countries, breath alcohol concentration 35 mg/100 ml is considered
an offence
78. Widmark's formula for urine analysis of alcohol is 3/4 prq
79. Pancreas constitute 0.1% of body weight
80. Punishment for false evidence is given under section 193 of IPC
81. Length of a female larynx is about 3.8 cm
82. Calcification of third molar begins at 8-10 years.
83. Lip prints on cheiloscopy are divided into 8 patterns
84. Gm tablet of aluminium phosphide is able to liberate 1.0 gm

Medical FunNotes at http://www.mbbsdost.com/funnotes 25


85. The diameter of "human hair at 15 years of age is 0.053 ram
86. Alcohol gaze nystagmus is produced at an average blood levels of 80 mg%
87. The residual alcohol in mouth takes about 20 min to disappear and within
this period breath analyzer test may be false positive
88. Skeletal muscles constitute about 29% of body weight
89. Term 'under the influence' of alcohol is used when blood concentration is 80-
100mg%
90. Statutory rape is rape under 15 years of age
91. Weight for occluding internal jugular vein hanging is 2 kg
92. Majority of deaths due to aluminium phosphide occurs in within 24 hours
93. During sleep, rectal temperature is 0.5-1.0C lower
94. Drowned body floats in about 12-18 hours in summer.
95. Bones constitute about 12% of body weight
Hidden Content.
96. Absence of III molar tooth indicates that the person is definitely under the
age of 17 years Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
97. In a dead body, maggots in rainy day are seen in 6 hours.
98. Arsenic, Aconite and Dhatura are generally used as homicidal poisons.
99. Ricin is the active principle of croton oil seed.
100. Abrin is the active principle of abrus precatorius.
101. Soneryl is a coloured babriturate.
102. Breath alcohol can be measured by Alcometer or Drunkometer.
103. The fatal dose of Dhatura is about one grain.
104. Physostigmine can be regarded as the specific antidote of Dhatura.
105. Amygdaline is the glucosides of vegetable origin found in cyanides.
106. The process of putrefaction can be retarded by carbon monoxide gas.
107. Euthanasia means "Mercy killing".
108. Joule burn is seen in electrocution.
109. Amyl nitrate is an antidote for poisoning due to hydrocyanic acid.
110. Olive green discoloration of urine on exposure to air is seen in poisoning due
to carbolic acid.

26 Medical FunNotes at http://www.mbbsdost.com/funnotes


111. Overlying is a type of smothering.
112. Optic atrophy is the characteristic feature of poisoning by methyl alcohol.
113. Dryness of mouth, dilated pupils and delirium are symptoms of Dhatura
poisoning. (All 'D's)
114. The first permanent tooth to erupt is first molar.
115. Dying declaration can be recorded by a medical officer.
116. Presence of fine white leathery froth in mouth and nostrils is seen in
drowning.
117. Privation of any member of joint is a grievous hurt.
118. Victim of drowning in a state of suspended animation can be revived as long
as 10-20 minutes.
119. Dying declaration should be recorded by Magistrate.
120. Nalorphine is an antidote for morphine.
121. Locard's principle states that every contact leaves a trace.
122. The strongest corrosive poison is sulphuric acid.
Hidden Content.
123. Arborescent markings arePurchase the Full Book in Rs. 350/-
seen in lightening.
on www.mbbsdost.com/funnotes
124. Before performing Postmortem examination, body should be identified by
Policemen.
125. Warrant case means a case relating to an offense punishable with death,
imprisonment for life or for a term exceeding two years.
126. In civil cases, a reasonable sum for traveling expenses is generally tendered
when the summons is served. This is known as conduct money. It is paid by
the party that has called his as a witness.
127. Hair cells are of special interest in cell sexing since both Barr body and Y
chromosome can be demonstrated.
128. Nails, hairs and long bones are preserved in cases of chronic arsenic
poisoning.
129. Postmortem fibrinous clots in heart are known as "Cardiac polyp".
130. The surest sign of death is putrefaction.
131. The rigor mortis start first at upper eye-lids.
132. Dribbling of saliva from the angle of the mouth is generally considered as the
surest sign of hanging.

Medical FunNotes at http://www.mbbsdost.com/funnotes 27


133. Presence of soot in respiratory tract is the surest sign of burn.
134. Strong sulphuric acid when thrown on the face of a person is known as
"Vitreol throwing".
135. Black gun powder consists of potassium nitrate, sulphur, and charcoal.
136. Nitrocellulose or Nitroglycerine is used as a smokeless gun powder.
137. Ricochet bullet is one which strikes any other surface before striking the
object.
138. The pulmonary lesion in the injury of air blast is called "Blast lung".
139. Loss of virginity is called defloration.
140. The Buccal coitus is called "Sin of Gomorrah".
141. The commission of sexual assault upon a dead body is called "Necrophily".
142. "Testamentary capacity" is the capacity of a person to make a valid will.
143. Malpraxis is defined as want of reasonable skill and or willful negligence on
the part of doctor resulting in deterioration of patients' health or his death.
Hidden
144. Copper sulphate is used as an antidote Content.
to phsophorus.
Purchase
145. 'Gyroget' are cartridges the Full
or miniature Book
rockets in Rs.
driven 350/-
by solid fuel, which
produces considerableon www.mbbsdost.com/funnotes
heat and smokeless gas on burning.
146. Forensic means usable in courts of law.
147. Deposition means a statement on oath made by a witness in a judicial
proceeding. It is taken down in writing and signed by the witness and
magistrate.
148. Document means any matter expressed or described upon any substance by
means of letters, figures or marks, or by more than one of these means.
149. Evidence includes all legal means which help to prove or disprove any matter
of fact, the truth of which is submitted to judicial investigation. It can be oral
(direct, indirect or hearsay), documentary & circumstantial.
150. Hurt is defined as bodily pain, disease or infirmity caused to any person.
151. Injury includes every inquiry other than a trial, conducted by a Magistrate or
court.
152. Investigation includes all the proceedings for the collection of evidence
conducted by a Police officer or by any person other than a magistrate who is
authorized by a magistrate on his behalf.
153. Jury means a body of persons sworn to render verdict in a court of justice. It is
composed of uneven number and not less than 7 and more than 9 persons.
28 Medical FunNotes at http://www.mbbsdost.com/funnotes
154. Metropolitan area means any area in the state comprising a city or a town
whose population exceeds one million.
155. Offense means any act of omission made punishable by law for the time
being in force.
156. Perjury means willful utterance of falsehood under oath.
157. Plaintiff is one who brings an action in a court of law.
158. Summons case means a case relating to an offense punishable with
imprisonment for a term not exceeding two years
159. Testimony means the evidence, oral or written, of a witness under oath.
160. Warrant means a written authority under "hand and seal". It is used for the
arrest of persons or for their forcible production in a court of law
161. Traumatic rupture of hymen is seen on posterolateral aspect.
162. Taylor gave a formula on rate of decomposition of dead body in air, water and
earth.
Hidden Content.
163. Most reliable method of determining personal identity is Dactylography.
Purchase the Full Book in Rs. 350/-
164. Contre-Coupe injury is seen in head injury.
on www.mbbsdost.com/funnotes
165. Strychnine acts on anterior horn cells.
166. Last organ to putrefy in male is prostate whereas in female it is ungravid
uteus.
167. In Carboluria, urine turns green on exposure to air.
168. Cyanide poisoning produces cherry red colour.
169. McEwen's sign is seen in alcoholism.
170. Cutis anserina is seen in drowning.
171. Shaking palsy or 'mad Hatters' is seen with mercury poisoning.
172. Poison which can be detected in burnt bodies in arsenic.
173. Cephalic index helps in identification of race.
174. Tentative cuts are seen in suicides.
175. Pugilistic attitude is seen in antemortem or postmortem burns due to
coagulation of proteins

Medical FunNotes at http://www.mbbsdost.com/funnotes 29


Medical Fathers
Anatomy Herophilus of chalcedon
Physiology claude bernard
Microbiology louis pasteur
Bacteriology robert koch
Chemotherapy paul ehrlich
Pharmacology oswald schmiedberg
Modern pathology rudolf virchow
Forensic medicine bernard spillsbury
Modern epidemiology john snow
Occupational health ramazzini
Modern medicine hippocrates
Indian medicine charaka
Hidden Content.
American medicine william osler
Modern surgery
Purchase the Full Bookambroise
in Rs. pare
350/-
Indian surgery on www.mbbsdost.com/funnotes
sushruta
Antiseptic surgery joseph lister
Modern inguinal hernia surgery bassini
Thyroid surgery emil kocher
Genetics gregor mendel
Modern human genetics dr.victor a . Mckusick
Psychoanalysis sigmund freud
Porphyrin chemistry hans fischer
Percutancous Transhuminal Coronary Angioplasty Andreas Roland Gruentzig
Modern psychiatry johann weyer
American psychiatry benjamin rush
Biology aristotle
Diagnostic imaging roentgen

Named Fevers
Pontiac fever Legionella pneumophila
Shanghai fever Pseudomonas Brazilia
Hidden Content.
Purpuric fever Hemophilus
Purchase theaegyptius (pink
Full Book in Rs. eye)
350/-
Havernhill fever on www.mbbsdost.com/funnotes
Streptobacillus monoliformis
Oroya fever Bartonella bacilliformis (Carrions disease)
Q fever Coxiella burnetti
30 Medical FunNotes at http://www.mbbsdost.com/funnotes
Colorado Tick fever Orbivirus
Trench fever Rochalimae
Hidden Content.
Yellow Fever Purchase the Full Book in Rs. 350/-
Flavivirus
on www.mbbsdost.com/funnotes
Rabbit Fever Francisella tularensis
Hay Fever Allergic rhinitis

Snowstorm appearance
1. Hydatiform mole on USG
2. Silicone granuloma breast on USG
Hidden Content.
3. Diabetic cataract Purchase the Full Book in Rs. 350/-
4. Total Anomalous Pulmonary VenusonConnection
www.mbbsdost.com/funnotes
5. Fat embolism in X-ray chest
6. Synovial chondromatosis

Cars in medicine
Racing car sign : Corpus callosum agenesis
Honda sign : sacral insufficiency
Hidden Content.fractures
Purchase the Full Book in Rs. 350/-
Mercedes Benz sign : gall stone X ray
on www.mbbsdost.com/funnotes

Swift sign : mercury poisoning

Medical Smells
Musty/mousy phenylketonuria
Boiled cabbage tyrosinemia, hypermethioninemia
Hidden Content.
Maple syrup Purchase
maple the urine
syrup Full Book in Rs. 350/-
disease
on www.mbbsdost.com/funnotes
Rotting fish trimethylaminuria
Sweaty feet isovaleric academia, glutaric academia (type II)

Medical Soap
Medical Soap bubbles
bubbles
Soap bubble appearance in abdominal X-ray Meconium ileus
Hidden Content.
Soap bubble appearance in head CT:Purchase
cryptococcal meningitis
the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Soap bubble calcification Osteoclastoma
Soap bubble cerebral calcification in head CT -Toxoplasmosis

Medical FunNotes at http://www.mbbsdost.com/funnotes 31


Brachial plexus
1. Comprises of C5678 T1 nerve roots B
2. Consists of Root, trunk, division, Cord.
3. Two branches are given from root i.e.
DORSAL SCAPULAR nerve supplies rhomboides major and minor
LONG THORACIC NERVE supplies Serratius anterior
4. Trunks give of two branches that too superior trunk
SUPRASCAPULAR N. supply supraspinatus and infraspinatus
Nerve TO SUBCLAVIUS
5. No nerve given from division
6. CORDS
Lateral cord
a. Lateral pectoral nerve
b. musculocutaneous
c. Hidden
Content.
Lateral cord of median nerve
POSTERIOR CORD
Purchase the Full Book in Rs. 350/-
A. Upper scapular
B. on www.mbbsdost.com/funnotes
Lower scapular
C. Nerve to latissmus dorsi
D. Axillary nerve
E. Radial nerve
MEDIAL CORD
A. Medial cord of median nerve
B. Medial pectoral nerve
C. Medial cutaneous n of arm
D. Medial cutaneous n of forearm
E. ulnar nerve
7. End nerves are
Musculocutaneous
Axillary
Radial
Median
Ulnar
32 Medical FunNotes at http://www.mbbsdost.com/funnotes
important points genetics
1. 1000 fold risk of developing skin cancer :- xeroderma pigmentosum

2. alcoholics -> B1 def --> neurologic defects pyruvate dehydrogenase


deficiency

3. abnormal collagen type 1 synthesis osteogenesis imperfecta

4. absence of HGPRTase lesch nyhan

5. deficiency of aldolase B fructose intoleranse

6. defective excision repair --> thymidine dimer formation xeroderma


pigmentosa

7. deficiency of cystathionine synthase homocystinuria

8. heinz bodies deficiency G6PD

9. musty/mousy odor, albinism, MR, eczema Phenyl Ketonuria


Hidden-->Content.
10. galactose I-P uridyl transferase deficiency MR, HSM, cataracts
galactosemia Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
11. deficiency of tyrosinase albinism

12. hyperextensible skin, loose joints, bleeding tendency ehler danlos

13. decreased NADPH due to lack of HMP enzyme G6PD deficiency

14. inherited defect in tubular AA transporter cystinuria

16. deficiency in homogentisic acid oxidase alkaptonuria

17. hypoglycemia + jaundice + cirrhosis fructose intolerance

18. self-mutilation, gout, agression, choreoathetosis lesch nyhan

19. blocked degradation of branched chain amino acids maple syrup urine
disease

20. bloating, cramps, osmotic diarrhea lactose intolerance.

21. deficiency results in a combined B and T cell deficiency SCID (ADA


deficiency)

22. multiple fractures + blue sclera osteogenesis imperfecta

Medical FunNotes at http://www.mbbsdost.com/funnotes 33


Fetal Structures & Adult Remnants
1. Ductus arteriorus : Ligamentum arteriosum
2. Ductus venosus : Ligamentum venosum
3. Left umbilical vein Hidden
: LigamentumContent.
teres of liver
Purchase the Full Book in Rs. 350/-
4. Right umbilical vein : Disappears
on www.mbbsdost.com/funnotes
5. Vitellointestinal duct : Meckel's diverticulum
6. Urachus : Median umbilical ligament
7. Proximal part of umbilical artery : Superior vesical artery

Important Ducts
Bellinis duct : Straight collecting tubules of the kidney.

Bartholins duct : the major duct of the sublingual gland.

Cystic duct : excretory duct of gall bladder.

Gartners duct : a remnant of Wolffian duct.

Mullerian duct : bilateral ducts in the embryo that form the uterus, vagina
and fallopian tubes.

Wirsungs duct : pancreatic duct.

Santorinis duct : accessory pancreatic duct. Content.


Hidden
Whartons duct : Purchase
duct of the gland.
submandibular Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Vitelline duct : the narrow duct in the embryo that connects the yolk sac
with the intestine.

Ducts of Rivinus : 5 to 15 ducts that drain the posterior portion of the


sublingual gland.

Stensens duct : parotid duct.

Pecquets duct : Thoracic duct.

Hensens duct : ductus reunions.

Hoffmans duct : pancreatic duct or Wirsungs duct.

Bernards duct : Accessory pancreatic duct or Santorinis duct

34 Medical FunNotes at http://www.mbbsdost.com/funnotes


Femoral triangle: arrangement of contents
Nerve (directly behind sheath)
A rtery (within sheath)
Hidden Content.
V ein (within sheath) Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Empty space (between vein and lymph) Mnemonic - NAVEL
Lymphatics (with deep inguinal node)
-> Nerve/Artery/Vein are all called Femoral.

CD Markers
Cd1a, Cd207 Langerhan cell histiocytosis cells
CD2, CD3, CD4, CD5, CD7, Cd8 T cells
Cd10 Early pre-B cells (immature B cells)
CD11c, CD25, CD103, Cd123 Hairy cell leukemia cells
CD13, CD33, Cd117 Myeloid cells
CD14, Cd64 Monocytic cells (positive in AML-M4 &
AML-M5)
Cd15 Reed-Sternberg cells, neutrophils
CD16, Cd56 Natural killer cells
CD19, CD20, CD21, Cd22 B cells
CD23 and Cd5 Chronic lymphocytic leukemia/small
lymphocytic lymphoma
Hidden Content.
CD23 negative and CD5 positive Mantle cell lymphoma cells
CD30 and Cd15 Reed-Sternberg cells
Purchase the Full Book in Rs. 350/-
CD30 positive and CD15 negative Anaplastic large cell lymphoma cells
Cd31 on www.mbbsdost.com/funnotes
Endothelial cells (positive in angiosarcoma)
Cd33 Myeloid cells and precursors
Cd34 Stem cells (also positive in angiosarcoma)
CD41, Cd61 Megakaryocytes and platelets (positive in
AML-M7)
Cd45 All leukocytes (except Reed-Sternberg
cells!)
CD45 RO Memory T cells
CD45 RA Naive T cells
Cd68 Histiocytes (positive in malignant fibrous
histiocytosis)
Cd99 Ewings sarcoma cells
Cd117 Gastrointestinal stromal tumor (GIST) cells,
mast cells (positive in mastocytosis),
myeloid cells
Medical FunNotes at http://www.mbbsdost.com/funnotes 35
Operations in Ophtha
Fucalas operation: Removal of clear crystalline lens for unilateral very high
myopia
McReynolds operation: Transplantation of pterygium in the lower fornix,
not performed now.
Cicatricial entropion.
1. Resection of skin and muscle
2. Resection of skin, muscle and tarsus
3. Modified Burows operation
4. Jaesche-Arlts operation
5. Modified Ketsseys operation
Senile entropion. Commonly used surgical techniques are as follows:
I. Modified Wheelers operation:
ii. Bicks procedure with Reehs modification:
iii. Weiss operation.
iv. Tucking of inferior lid retractors (Jones, Reeh and Wobig operation):
Hidden Content.
Mechanical ectropion. It is corrected by treating the underlying cause.
i. V-Y operation.
Purchase the Full Book in Rs. 350/-
ii. on www.mbbsdost.com/funnotes
Z-plasty (Elschnigs operation)
iii. Excision of scar tissue and full thickness skin grafting.
Congenital ptosis. It almost always needs surgical correction. In severe ptosis,
surgery should be performed at the earliest to prevent stimulus deprivation
amblyopia. However, in mild and moderate ptosis, surgery should be delayed
until the age of 34 years, when accurate measurements are possible.
Congenital ptosis can be treated by any of the following operations :
1. Fasanella-Servat operation. ( ans: Horners Syndrome)
2. Levator resection. (A)Conjunctival approach (Blaskowics operation):
(B)Skin approach (Everbuschs operation):
The classical technique of lateral orbitotomy using S-shaped brow skin
incision is called Kronleins operation, done for AXIAL PROPTOSIS.
Seton operation: In this operation, a valvular synthetic tube is implanted
which drains the aqueous humour from the anterior chamber into the
subconjunctival space. It is performed for neovascular glaucoma and
intractable cases of primary and other secondary glaucomas where medical
treatment and conventional filtration surgery fail.
TRIPPLE SNIP operation for Punctum Block.

36 Medical FunNotes at http://www.mbbsdost.com/funnotes


Important DERMATOLOGY POINTS
1. HSV type 1 at mouth, type 2 in genitalia. Recurrent erythema nodosum
is characteristic. Diagnosed by Tzank, Treatment with acyclovir
2. Herpes zoster (shingles) dermatomal, reactivated at dorsal nerve root,
Treatment with acyclovir
3. Varicella (chickenpox) lesions in all stages of development, Treatment with
benadryl. In1st TM, causes microcephaly, chorioretinitis, IUGR and cataracts.
Treat neonates with VZIG if mom contracted varicella within 5 days of
delivery.
4. Impetigo honey-crusted lesions. S aureus and B-hemolytic strep.
Treatment with mupirocin
5. Hidden Content.
Rubella 3 days of cervical/suboccipital/postauricular node enlargement,
prevention best with immunization before 1st trimester to prevent triad:
Purchase the Full Book in Rs. 350/-
visual (cataracts), hearing loss, heart(PDA) defects.
6. on looks
Measles (Rubeola) www.mbbsdost.com/funnotes
like spilled red paint over your head (rash spread
behind ears and over forehead to neck to trunk and extremities), prevent
with immunization
7. Roseola 3-5 days of fever, and THEN rash after (never together). No
treatment
8. Erythema infectiosum 5th dz slapped cheek appearance, parvo B19,
causes aplastic crisis in sickle cell patients, no treatment
9. Rocky Mountain Spotted Fever fever, rash on wrists then palms and soles,
Diagnosed by weil-felix test, treatment with tetracycline (chloramphenicol if
pregnant)
10. Lyme disease erythema chronicum migrans with central clearing, tx is
doxycycline (amoxicillin if pregnant and children <9yo).

Tongue changes in vit deficiency


1. Riboflavin deficiency : Magenta tongue
2. Niacin deficiency : Hidden Content.
Beefy / fiery red tongue
Purchase the Full Book in Rs. 350/-
3. B12 deficiency on www.mbbsdost.com/funnotes
: Baldness of tongue
4. Folic acid deficiency : Painful tongue

Medical FunNotes at http://www.mbbsdost.com/funnotes 37


Colony Appearance in Culture Organism
1. Draughtsman ( Concentric Rings) Pneumococci
2. Medusa head (Nutrient Agar)
Frosted glass (Agar Plates) B.Anthracis
Inverted Fig Tree (Stab Culture)
3. Swimming Growth ( Fishy or Seminal Smell) Proteus
4. Swarm of Gnats Or Fish in Stream, darting motility V.Choleraenu
5. Stalactite growth, safety pin appearance Yersinia Pestis
6. Hidden
Thumb print appearance, Bisected pearls orContent.
mercury drops , Aluminium Paint appearance B. Pertussis
Purchase the Full Book in Rs. 350/-
7. Cigar bundle ( globi ) appearance M.Leprae
8. Fried egg
on www.mbbsdost.com/funnotes
Mycoplasma
9. Bread crumb Actinomyces israelii
10. Oil Paint Staphylococci
11. School of Red fish H. ducreyi
12. Stately Motility Clostrida
13. Daisy head colonies Corynbact gravis
14. Frogs egg colonies Corynbact
intermedius
15. Poached egg colonies Corynbact mitis

Blood donors are deferred if:


1. they are less than 17 years of age or under 50 kg in weight.
2. They are also deferred for 12 months after body piercing or tattoos, and
3. now only for 6 months following the incident if the antihepatitis B core test is
negative. Hidden Content.
4. They are deferred forPurchase thetravel
6 months after FulltoBook in Rs.
an endemic 350/-
malarial area, or
on www.mbbsdost.com/funnotes
longer if they fell ill abroad or were resident for a period of 6 months or more
in Sub-Saharan Africa.
5. They will be deferred for a period after pregnancy.
6. Absolute deferral now occurs if they have had any organ transplant or blood
transfusion after 1980 in the UK because of the risk of variant
CreutzfeldtJakob disease.

38 Medical FunNotes at http://www.mbbsdost.com/funnotes


Terms Related with Charcot
*Charcot Bouchard aneurysm tiny aneurysms of the penetrating
branches of middle cerebral a.
*Charcot's triad in Multiple Sclerosis nystagmus, intentional tremor,
dysarthria
*Charcot's triad of acute cholangitis right upper quadrant pain, fever,
jaundice
*Charcot leyden crystals due to lysis of eosinophil in allergic
Hidden Content.
reactions
Purchase thea Full
*Charcot gombault necrosis biliaryBook
infarct in Rs. 350/-
*Charcot's artery on www.mbbsdost.com/funnotes
lenticulostriate artery
*Charcot's joint diabetic arthropathy
*Charcot's disease amyolateral sclerosis
*Charcot Marie tooth disease peroneal muscular atrophy
*Charcot wilbrand syndrome visual agnosia & loss of ability to
revisualise images
*Charcot's intermittent hepatic fever intermittent jaundice, intermittent
fever, intermittent pain, loss of weight

"POET vs DOCTOR
Jhuki jhuki Palkein Kapkapate hath
(Ptosis) (Parkinson's)

Gulabi Aankhein Chand sa chehra


(Conjunctivitis) (Cushing's Syndrome)
Hidden Content.
Tirchi Nazar Kaala
Purchase the Til Book in Rs. 350/-
Full
(Squint) (Melanoma)
on www.mbbsdost.com/funnotes
Khamosh se lab Har Taraf Ussi Ka Chehra
(Aphasia) (Hallucinations)

Gulabi Gaal
(Plethora)

Medical FunNotes at http://www.mbbsdost.com/funnotes 39


Syndrome quick review
Fragile X Syndrome
Autism, Retardation, MacroOrchidism, Protruding Ears,
Narrow Jaw, FMR 1 gene
*X-linked Dominant, but females can still get partial
penetrance

Congenital Syphilis
Hepatomegaly, Splenomegaly, Hutchinsons Teeth,
Mulberry Molars, Snuffles, Saddle Nose, Seizures,
Interstitial Keratitis, Pseudo Paralysis, Frontal Bossing

Beckwith-Wiedemann Syndrome
Hidden Content.
Macroglossia Macrosomia Midline Abdominal defect
Purchase the Full Book in Rs. 350/-
(ompholocele) WILMS TUMOR!!! check Alpha Fetoprotein
and look for heamaturia Nevus Flammus Ear Creases / Pits
on www.mbbsdost.com/funnotes
Hypoglycemia

Glycogen storate diseases


Hepatomegaly, hypoglycemia
CHERUBIC FACE (doll like)
Treatment=cornstarch

Wolf Hirschhorn
Greek helmet head
Mental Retardation
severe growth defect
Autosomal deletion defect

40 Medical FunNotes at http://www.mbbsdost.com/funnotes


Pierre Robin Sequence
Micrognathia Glossoptosis Cleft Palate Upper Airway
Obstruction Associated with Velocardiofacial syndrome,
Fetal Alcohol Syndrome and Treacher Collins Syndrome

Turner Syndrome
XO, Shield Chest, Hyopgonadism, Ammenorrhea, Webbed
neck, Coartation Aorta, Bicuspid Aortic valve, Micrognathia,
HYPOTHYROIDISM IS COMMON IN ADOLESCENCE Cubitus
valgus (turned out elbows) Treatment with Growth
hormone +/- Androgen for height, and Estrogen for 2nd
sexual characteristic development Dignosis= FSH/LH,
karyotype, TSH
Downs Syndrome
Trisomy 21, microgenia, round face, macroglossia, almond
eyes 2nd to epicanthic fold of the eyelid, upslanting
palpebral fissures , short limbs, (a single instead of a double
crease across one or both palms (Simian crease), poor
Hidden Content.
muscle tone, and a larger than normal space between the
big and second toe, short neck, White spots on Iris
Purchase the Full Book in Rs. 350/-
(brushfield spots) Ventricular Septal Defects,
Gastroesophageal Reflux Disease recurrent ear infections,
on www.mbbsdost.com/funnotes
Obstructive sleep apnoea, and thyroid dysfunctions. Life
Expectancy 40-50, increased. risk neoplasm, and certain
Alzheimers. HIRSHPRUNGS / DUDENAL ATRESIA
Cri Du Chat
5p deletion syndrome, 1/20,000 - 50,000
Usually spontaneous, (80% fathers mutation)
* Cry that is high-pitched and sounds like a cat
* Downward slant to the eyes
* Low birth weight and slow growth
* Low-set or abnormally shaped ears
* Mental retardation, Severe
* Partial webbing or fusing of fingers or toes
* Single line in the palm of the hand (simian crease)
* Skin tags just in front of the ear
* Slow or incomplete development of motor skills
* Small head (microcephaly)
* Small jaw (micrognathia)
* Wide-set eyes
Medical FunNotes at http://www.mbbsdost.com/funnotes 41
Williams Syndrome
Deletion 26 genes from chromosome 7, 1/10,000 Cocktail
Party Personality, Ellfin face, Love Music, Perfect Pitch!,
Mental Retardation, but excellent language skills.
supravalvular aortic stenosis, pulmonary stenosis, and
pulmonary artery stenosis
* Farsightedness
* High blood calcium level (hypercalcemia)
* High blood pressure
* Hypermobile joints --> Ossify
* Unusual pattern ("stellate" or star-like) in iris of the eye

DiGeorge Syndrome / Velo-Cardio-Facial Syndrome


CATCH22, deletion of part of chromasome 22, 1/4000
Cardiac Abnormality (especially tetralogy of Fallot),
Ventriwlas Septal Defects, int erupted aortic arch, persisten
Truncus Arteriosus
Abnormal facies Thymic aplasia (T-cell deficiency) freq.
infxn Cleft palate Hypocalcemia (seizures may be present
sign!) decreased PTH Mental Retardation, 20 fold inc
Schizophrenia
Kleinfelters Syndrome
47 XXY, 1/1000, Non disjunction during miosis Marfanoid
Hidden Content.
(long legs, short trunk, shoulder equal to hip size)
gynecomastia Hypogonadism, MicroOrchidism Less than
Purchase the Full Book in Rs. 350/-
normal amount of pubic, armpit, and facial hair
Tall height
on www.mbbsdost.com/funnotes
Cornelia DeLang Syndrome
Slow Growth, skeletal abnl arms, hands Severe Mental
Retardation Unibrow, Hirsuite long eyelashes; low-set ears;
small, widely spaced teeth; and a small, upturned nose.

Treacher Collins Syndrome


1/10,000 AD, 5q32, TCOF1 gene Micrognathia, Cleft Palate
Conductive hearing loss drooping eyes absent/drooping
ears Colomba

42 Medical FunNotes at http://www.mbbsdost.com/funnotes


Angleman Syndrome
Maternal chrome 15 deletion "Happy Puppett Ataxia Dev
and speech delay Hyperactivity Insomnia

Prader-Willi Syndrome
Paternal Chromosome 15 deletion
* Infant Failure to Thrive
* Speech delay / Mental Retardation
* Poor physical coordination
* Hyperphagia (over-eating)
* Excessive weight gain / Obesity
* Sleep disorders
* Scoliosis

Rett Syndrome
Only in females (x-linked males die)
normal until 6-18 months, then regress. MECP2 gene defect
Hidden Content.
Chorea, Bruxism
Purchase the Full Book in Rs. 350/-
# screaming fits
# panic attack
on www.mbbsdost.com/funnotes
# inconsolable crying
# avoidance of eye contact
# lack of social/emotional reciprocity
# general lack of interest
# loss of speech

Smith-Lemli-Opitz Syndrome
Microcephaly, Polydactyly, Hypotonia, Syndactaly, 7-
dehydrocholesterol reductase deficiency, Pale Mentally
Retarded
Lethargy Respiratory failure
Hearing loss Visual loss
Vomiting Feeding difficulties
Failure to thrive Constipation
Cyanosis Congestive heart failure
Photosensitivity

Medical FunNotes at http://www.mbbsdost.com/funnotes 43


Phenyl Ke to Nurio
low phenalanin diet
Rx=tetrahydrobiopterin (BH4) 20% effective
Mental retardation, autosomal recessive

Langerhans cell Histiocytosis


a rare disease involving clonal proliferation of Langerhans
cells, abnormal cells deriving from bone marrow and
capable of migrating from skin to lymph nodes. Clinically, its
manifestations range from isolated bone lesions to
multisystem disease. Eosinophilic Granuloma Diabetes
insipidus, exopthalmos, and lytic bone lesions is known as
the Hand-Schller-Christian triad.

Tay Sachs Disease


Hexosaminadase deficiency

Hidden Content.
Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Leuokdystrophy
N-acetly-aspartic acid

Metachromatic Leukodystropy
arylsulfatase A

44 Medical FunNotes at http://www.mbbsdost.com/funnotes


Inherited causes of hearing loss
Alport = Glomerulonephritis and Hearing Loss
Waardenberg = Auditory Dyssynchrony, hearing loss,
pigment changes
Jarvelle Lang-Nielson= Autosomal Recessive, prolonged QT,
Hearing loss
Connexin 26=Autosomal Recessive

Hiccough in Utero
Non-Ketotic hyperglyceinenemia,
seizure first hour of life

Sweet urine, Burnt sugar, curry urine


Maple Syrup Urine disease
Menenites!!! 1/750
Hidden Content.
Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Sweet free urine
Isovaleric Acidemia
Glutaric Acidemia

Cats Urine Smell


3-Methylcrotonyl-glycinuria

Medical FunNotes at http://www.mbbsdost.com/funnotes 45


Menkes Syndrome
Steele wool hair (pili torti)
Intractable Seizures
Hypotonia
TEMPERATURE INSTABILITY

Argininosuccinic aciduria
trichorrexis nodosa
(short breakable hair)

Acrodermatitis enteropathica

Hidden Content.
Purchase
alopecia the Full Book in Rs. 350/-
(zinc deficiency)
on www.mbbsdost.com/funnotes
Argininosuccinic aciduria trichorrexis nodosa
(short breakable hair)
Metachromatic Leukodystropy

Neonatal Hypotonia
Congenital Hypothyroidism Urea cycle defect, amino acid,
organic acid defect Maple Syruph Vrine disease Glycogen
storage disease (type II pompe's, type III debrancher)
Mitorchondria encephalomyopathies Menkes syndrome
Peroxisomal disorder (Zellweger syndrome)

46 Medical FunNotes at http://www.mbbsdost.com/funnotes


Glutaric Aciduria Type I
Macrocephaly

Facial dysmorphism and renal cysts


Zellweger syndrome
Glutaric aciduria Type II

Cataracts in neonate
Galactosemia
Lowe's syndrome

Hidden Content.
Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Non-Ketotic Hyperglycinemia
Apneic / Bradycardic episodes +/- Seizures
(may have hiccough in utero!!!)
elevated GLYEINE IN URINE and CSF!
EEG=hips arrythmia

Tyrosinemia II
Occulocutaneous tyrosinemia
Keratosis soles of feet

Medical FunNotes at http://www.mbbsdost.com/funnotes 47


Glycogen Storage Disease 1a
nephromegaly
bleeding diathesis

GSD IIa
Pompe's Disease, massive QRS, Autosomal recessive
NORMAL GLUCOSE
LARGE HEART!!!
DEATH BY AGE 2

GSD3
Skeletal / Cardio myopathy
hyperlipidemia

Hidden Content.
Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
GSD4
Severe Failure to thrive
Cirrhosis
Death by age 5

Crouzon Syndrome
cranial synostosis, brachycephaly Exophthalmos
hypertelorism (greater than normal distance between the
eyes) psittichorhina (beak-like nose)
strabismus hypoplastic maxilla
CHOANAL ATRESIA

48 Medical FunNotes at http://www.mbbsdost.com/funnotes


VACTERL
* V - Vertebral anomalies
* A - Anal atresia
* C - Cardiovascular anomalies
* T - Tracheoesophageal fistula
* E - Esophageal atresia
* R - Renal (Kidney) and/or radial anomalies
* L - Limb defects

CHARGE syndrome
* C - Coloboma of the eye, CNS anomalies
* H - Heart defects
* A - Atresia of the choanae
* R - Retardation of growth and/or development
* G - Genital and/or urinary defects (Hypogonadism)
* E - Ear anomalies and/or deafness

Bardet-Biedl syndrome
evere Prader-Will-like Obesity
Retinitis pigmentosa
Hidden Content.
Polydactyly
mental retardation
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hypogonadism, and renal failure.
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PHACE Syndrome
P - Posterior fossa abnormalities
H - Hemangioma(s) of the cervical facial region
A - Arterial cerebrovascular anomalies
C - Cardiac defects / aortic coarctation
E - Eye anomalies

Apert Syndrome
acrocephalosyndactyly also Craniosynostosis with resultant
midface hypoplasia

Medical FunNotes at http://www.mbbsdost.com/funnotes 49


Edwards Syndrome
Trisomy 18 ROCKER BOTTOM FEET (congenital
Methotrexate exposure mimics this)

Patau's Syndrome
Trisomy 13 PUNCHED OUT
SCALP LESIONS
congenital methotrexate exposure mimics this

Pena-shokeir
autosomal recessive
IUGR
arthogyroposis
Hidden Content.
pulm hypoplasia
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CNS anomalies

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Bloom Syndrome
don't repair DNA well
defect in DNA helcase
BIRD LIKE FACE

Fanconi Anemia
dont repair DNA well
Autosomal Recessive
Abnormal thumb/radial defects
short
microcephaly

50 Medical FunNotes at http://www.mbbsdost.com/funnotes


Facies
1. Mask like facies = parkinsonism.
Lack of expressivity and poor definition of the nasolabial
fold. Scaling seborrhea is also common.

2. Elfin facies = william's syndrome.

Most individuals with WS have similar facial features


including a small, upturned nose, long philtrum, wide
mouth, full lips, small chin (micrognathia), a flat, nasal
bridge, and puffiness around the eyes. They also
present with epicanthal folds, microdontia,
malocclusion, enamel hypoplasia, dental aplasia, and
Hidden Content.
fan-shaped orientation of the front teethThese facial
characteristics become more prominent with age. Light
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eyed individuals with WS may have a starburst or white lacy pattern on their iris.
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2. Moon facies = cushing's syndrome
Moon facies occurs when extra fat builds up on the sides
of the face. It is often related to obesity but can be from
Cushing's syndrome. That's why people sometimes
refer to it as a Cushingoid appearance. Cushing's
syndrome occurs when the body is exposed for long
periods to high levels of a hormone called cortisol.

4. Snarling facies = myasthenia gravis.


Myasthenic facies is characterized by a tired
expressions, poor gestures, with tight lips, half-closed
eyes and the disappearance of physiological folds. Nasal
twang to the voice and nasal regurgitation of food,
specially liquids, appear due to palatal muscle
weakness. Chewing may become difficult and severe
jaw weakness may cause the jaw to hang open (the
patient may support his chin with the hand ). Fluid
Medical FunNotes at http://www.mbbsdost.com/funnotes 51
aspiration may occur, causing coughing or choking while drinking. Tongue mobility
disorders occur rarely and may cause the appearance of furcus myasthenicus
(three longitudinal grooves on the tongue surface).

5. Mitral facies = mitral stenosis.

Mitral facies is one of the cutaneous manifestations of


systemic diseases. The pathology in question here is
mitral stenosis. Mitral facies refers to rosy cheeks (bright
circumscribed flush over the malar bones) with a bluish
tinge. The rose colour is because of the dilatation of
malar capillaries while the bluish tinge is because of the
cyanosis.

6. Chipmunk facies Untreated Thalassemia major,


Bullimia nervosa, Parotid sweling

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7. Mouse facies = chronic renal failure (crf)

8. Adenoid facies = adenoid hypertrophy

Adenoid facies is the long, open-mouthed, dumb-looking


face of children with adenoid hypertrophy. Hypertrophy
of the nasopharyngeal pad of lymphoid tissues (the
adenoids) is the most common cause of nasal
obstruction in children. The mouth is always open
because upper airway congestion has made patients

52 Medical FunNotes at http://www.mbbsdost.com/funnotes


obligatory mouth breathers. Persistent mouth breathing due to nasal obstruction
in childhood may be associated with the development of craniofacial anomalies
such as the adenoid facies ( also called the long face syndrome. The most
common presenting symptoms are chronic mouth breathing and snoring The
most dangerous symptom is sleep apnea.

9. Leonine facies = lepromatous leprosy

Saddle nose deformity. The patient also shows typical


Leonine facies & Madarosis (loss of eyebrows) seen in
leprosy and had complaints of Anosmia & recurrent
Epistaxis.

10. Bird facies = pierre robin syndrome

Pierre Robin syndrome/Bird Facies- is genetic defect,


which gives rise to a very small lower jaw, cleft palate and
a condition called as retroglossoptosis, where the tongue
appears to fall into the throat
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Mongoloid facies down's syndrome

Child with Down syndrome. Note up-slanting palpebral


fissures, bilateral epicanthal folds, small nose with flat
nasal bridge, open mouth with tendency for tongue
protrusion, and small ears with overfolded helix

12. Coarse facies = most of the inborn errors of


metabolism (iem) viz. The muco- polysaccharidoses
(mps), mucolipidoses (ml), fucosidoses mannosidoses,
sialidoses, aspartylglycosaminuria, generalised
ga n g l i o s i d o s i s ( g m l ) & a u st i n ' s va r i a nt o f
metachromatic leukodystrophy due to multiple
sulfatase deficiency (mld-msd) have similar appearing
facies.
Coarse facial features or "'coarse facies"' describes a
constellation of facial features that are present in many
inborn errors of metabolism.

Medical FunNotes at http://www.mbbsdost.com/funnotes 53


Features include: large, bulging head, prominent scalp veins, "saddle-like, flat
bridged nose with broad, fleshy tip", large lips and tongue, small, widely spaced
and/or malformed teeth, hypertrophic alveolar ridges and/or gums. Heads tend to
be longer than normal from front to back, with a bulging forehead. This is because
of the earlier than normal or premature fusion of skull bones in an affected
individual
13. Syphilitic facies = congenital syphilis ( bull dog
jaw)
Hepatomegaly, Splenomegaly, Hutchinsons Teeth,
Mulberry Molars, Snuffles, Saddle Nose, Seizures,
Interstitial Keratitis, Pseudo Paralysis, Frontal Bossing

14. Hippocratic face= advanced peritonitis, sign


portends death
The nose sharp, the eyes sunken, the temples fallen in,
the ears cold and drawn in and their lobes distorted, the
skin of the face hard, stretched and dry, and the colour
of the face pale or dusky.
The Hippocratic face (facies Hippocratica in Latin) is the
Hidden Content.
change produced in the face by impending death or long
illness, excessive evacuations, excessive hunger, and the
like.
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Potter facies- oligohydramnios
This baby demonstrates the typical "Potter's facies"
with prominent infraorbital folds resulting from
oligohydramnios in utero. This is an example of a
deformation sequence in which an anomaly (here the
lack of normal kidneys) leads to lack of fetal urine
output with resultant oligohydramnios that causes
deformation through constraint.
16. Amiodarone facies
Long-term administration of amiodarone (usually more
than eighteen months) is associated with a light-
sensitive blue-grey discoloration of the skin; such
patients should avoid exposure to the sun and use
sunscreen that protects against ultraviolet-A and -B.
The discoloration will slowly improve upon cessation of
the drug, however, the skin color may not return
completely to normal.
54 Medical FunNotes at http://www.mbbsdost.com/funnotes
17. Acromegalic facies- acromegaly
prominent orbital ridges, large nose,
prominent lower jaw and thickening of
the lips

18. Marfanoid facies- marfan's syndrome


prominent orbital ridges, large nose, prominent
lower jaw and thickening of the lips

Hidden Content.
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19. Myotonic/ Hatchet facies- myotonic


dystrophy
The characteristic physiognomy of advanced
myotonic dystrophy; the face is drawn and
lugubrious, with hollowing of the muscles
around the temples and jaws; eyes are
'hooded', lower lip droops, and global weakness
of facial muscles causes sagging of lower face,
accompanied by marked wasting of the neck
muscles, especially the flexors, which imparts a
'swan-neck' appearance. The hatchet face may
also be seen in amyotrophic lateral sclerosis, and
in Curschmann-Batten-Steiner syndrome

Medical FunNotes at http://www.mbbsdost.com/funnotes 55


20. Torpid or Myxedematous facies Myxedema

Skin generally thickened,


alopecia, periorbital oedema,
xanthelasma, coolness and
dryness of skin and hair,
thinning of scalp hair, tongue
swelling.

21. Gargoyle facies- hurler's syndrome


The characteristic facies of gargoylism, now
known as mucopolysaccharidoses (MPS); the
classic gargoyle face is seen in MPS type I-
H/Hurler syndrome and MPS type IV/Morquio
Hidden Content.
syndrome and characterised by thickening
and coarsening of facial features due to
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subcutaneous deposition of MPS, most
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commonly seen after the first year of age; the
head is large and dolichocephalic, with frontal
bossing and prominent sagittal and metopic
sutures, and the face exhibits mid-face
hypoplasia, depressed nasal bridge, flared nares, a prominent lower third,
thickened facies, widely spaced teeth with attenuated dental enamel and gingival
hyperplasia

22. Monkey facies- marasmus


The monkey facies, caused by loss of the
buccal fat pad,

56 Medical FunNotes at http://www.mbbsdost.com/funnotes


History-taking sequence
1. Presenting (principal) symptom (PS)
2. History of the presenting illness (HPI)
Details of current illnesses
Details of previous similar episodes
Extent of functional disability
Effect of the illness
3. Drug and treatment history
Current treatment
Drug history (dose, duration, indication, side effects): prescription, over-
the-counter and alternative therapies
Past treatments
Drug allergies or reactions
4. Past history (PH) Hidden Content.
Past illnesses
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Surgical operations (dates, indication, procedure)
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Menstrual and reproductive history for women
Immunizations
Blood transfusions (and dates)
5. Social history (SH)
Upbringing and education level
Marital status, social support, living conditions and financial situation
Diet and exercise
Occupation and hobbies
Overseas travel (where and when)
Smoking and alcohol use
Analgesic and illicit (street) drug use
Mood and sexual history
6. Family history (FH)

Medical FunNotes at http://www.mbbsdost.com/funnotes 57


7. Systems review (SR)
The systems review
Enquire about common symptoms and three or four of the common
disorders in each major system listed below. Not all of these questions should
be asked of every patient. Adjust the detail of questions based on the
presenting problem, the patients age and the answers to the preliminary
questions.
denotes symptoms for the possible diagnosis of an urgent or dangerous
(alarm) problem.
Cardiovascular system
Have you had any pain or pressure in your chest, neck or arm? (Myocardial
ischaemia)
Are you short of breath on exertion? How much exertion is necessary?
Have you ever woken up at night short of breath? (Cardiac failure)
Can you lie flat without feeling breathless?
Hidden
Have you had swelling of your ankles? Content.
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Have you had blackouts www.mbbsdost.com/funnotes
warning? (Stokes-Adams attacks)
Have you felt dizzy or blacked out when exercising? (Severe aortic stenosis or
hypertrophic cardiomyopathy)
Do you have pain in your legs on exercise?
Do you have cold or blue hands or feet?
Have you ever had rheumatic fever, a heart attack or high blood pressure?
Respiratory system
Are you ever short of breath? Has this come on suddenly? (Pulmonary
embolism)
Have you had any cough?
Is your cough associated with shivers and shakes (rigors) and breathlessness
and chest pain? (Pneumonia)
Do you cough up anything?
Have you coughed up blood? (Bronchial carcinoma)
What type of work have you done? (Occupational lung disease)

58 Medical FunNotes at http://www.mbbsdost.com/funnotes


Do you snore loudly? Do you fall asleep easily during the day? When? Have
you fallen asleep while driving? Obtain a sleep history.
Do you ever have wheezing when you are short of breath?
Have you had fevers?
Do you have night sweats?
Have you ever had pneumonia or tuberculosis?
Have you had a recent chest X-ray?
Gastrointestinal system
Are you troubled by indigestion? What do you mean by indigestion?
Do you have heartburn?
Have you had any difficulty swallowing? (Oesophageal cancer)
Have you had vomiting, or vomited blood? (Gastrointestinal bleeding)
Have you had pain or discomfort in your abdomen?
Hidden
Have you had any abdominal bloating Content.
or distension?
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Has your bowel habit the Full
changed recently? Bookofin
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colon)
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How many bowel motions a week do you usually pass?
Have you lost control of your bowels or had accidents (faecal incontinence)?
Have you seen blood in your motions? (Gastrointestinal bleeding)
Have your bowel motions been black? (Gastrointestinal bleeding)
Have you lost weight recently without dieting? (Carcinoma of the colon)
Have your eyes or skin ever been yellow?
Have you ever had hepatitis, peptic ulceration, colitis or bowel cancer?
Tell me (briefly) about your diet recently.
Genitourinary system
Do you have difficulty or pain on passing urine?
Is your urine stream as good as it used to be?
Is there a delay before you start to pass urine? (Applies mostly to men)
Is there dribbling at the end?
Do you have to get up at night to pass urine?

Medical FunNotes at http://www.mbbsdost.com/funnotes 59


Are you passing larger or smaller amounts of urine?
Has the urine colour changed?
Have you seen blood in your urine? (Urinary tract malignancy)
Have you any problems with your sex life? Difficulty obtaining or maintaining
an erection?
Have you noticed any rashes or lumps on your genitals?
Have you ever had a sexually transmitted disease?
Have you ever had a urinary tract infection or kidney stone?
Are your periods regular?
Do you have excessive pain or bleeding with your periods?
Haematological system
Do you bruise easily?
Have you had fevers, or shivers and shakes (rigors)?
Do you have difficulty stopping a small Content.
Hidden cut from bleeding? (Bleeding
disorder)
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Have you noticed any lumps under your arms, or in your neck or groin?
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(Haematological malignancy)
Have you ever had blood clots in your legs or in the lungs?
Musculoskeletal system
Do you have painful or stiff joints?
Are any of your joints red, swollen and painful?
Have you had a skin rash recently?
Do you have any back or neck pain?
Have your eyes been dry or red?
Have you ever had a dry mouth or mouth ulcers?
Have you been diagnosed as having rheumatoid arthritis or gout?
Do your fingers ever become painful and become white and blue in the cold?
Endocrine system
Have you noticed any swelling in your neck?
Do your hands tremble?

60 Medical FunNotes at http://www.mbbsdost.com/funnotes


Do you prefer hot or cold weather?
Have you had a thyroid problem or diabetes?
Have you noticed increased sweating?
Have you been troubled by fatigue?
Have you noticed any change in your appearance, hair, skin or voice?
Have you been unusually thirsty lately? Or lost weight? (New onset of
diabetes)
Reproductive and breast history (women)
How many pregnancies have you had?
Have you had any miscarriages?
Have you had high blood pressure or diabetes in pregnancy?
Were there any other complications during your pregnancies or deliveries?
Have you had a Caesarean section?
Have you had any bleeding or discharge from your breasts or felt any lumps
there? (Carcinoma of the breast)
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Neurological system and mental state
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Do you get headaches?
Is your headache very severe and did it begin very suddenly? (Subarachnoid
haemorrhage)
Have you had fainting episodes, fits or blackouts?
Do you have trouble seeing or hearing?
Are you dizzy?
Have you had weakness, numbness or clumsiness in your arms or legs?
Have you ever had a stroke or head injury?
Have you had difficulty sleeping?
Do you feel sad or depressed, or have problems with your nerves?
Have you ever been sexually or physically abused?
The elderly patient
Have you had problems with falls or loss of balance? (High fracture risk)
Do you walk with a frame or stick?

Medical FunNotes at http://www.mbbsdost.com/funnotes 61


Do you take sleeping tablets or sedatives? (Falls risk)
Do you take blood pressure tablets? (Postural hypotension and falls risk)
Have you been tested for osteoporosis?
Can you manage at home without help?
Are you affected by arthritis?
Have you had problems with your memory or with managing things like
paying bills? (Cognitive decline)
How do you manage your various tablets? (Risk of polypharmacy and
confusion of doses)
Concluding the interview Hidden Content.
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Is there anything else you would like to talk about?
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When recording the systems review, list important negative answers
(relevant negatives). Remember: if other recent symptoms are unmasked,
more details must be sought; relevant information is then added to the
history of the presenting illness.
Before completing the history, it is often valuable to ask what the patient
thinks is wrong and what he or she is most concerned about. General and
sympathetic questions about the effect of a chronic or severe illness on the
patients life are important for establishing rapport and for finding out what
else might be needed (both medical and non-medical) to help the patient.
Major presenting symptoms for each system are described in the following
chapters. Examples of supplementary important questions to ask about past
history, social history and family history are also given there for each system.

Occupations and hobbies linked to disease


1. Farmers mouldy hayhypersensitivity pneumonitis
2. Bird fanciers birdshypersensitivity pneumonitis, psittacosis
3. Welders eye flash burns, pacemaker malfunction
4. Stone masons silicosis
Hidden Content.
5. Shipyard workers, builders, asbestosis
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6. Coal miners pneumoconiosis and silicosis
7. Timber workers asthma
8. Electronic workers berylliosis
9. Healthcare workers needle-stick HIV, hepatitis B, tuberculosis (TB)

62 Medical FunNotes at http://www.mbbsdost.com/funnotes


Smoking and clinical associations
Cardiovascular disease
Premature coronary artery disease
Peripheral vascular disease, erectile dysfunction
Cerebrovascular disease
Respiratory disease
Lung cancer
Chronic obstructive pulmonary disease (chronic airflow limitation)
Increased incidence of respiratory infection
Increased incidence of postoperative respiratory complications
Hidden Content.
Other cancers
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Larynx, oral cavity, oesophagus, nasopharynx, bladder, kidney, pancreas,
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Gastrointestinal disease
Peptic ulceration, Crohns disease
Pregnancy
Increased risk of spontaneous abortion, fetal death, neonatal death, sudden
infant death syndrome
Drug interactions
Induces hepatic microsomal enzyme systems, e.g. increased metabolism of
propranolol, theophylline

Alcohol (ethanol) abuse and clinical associations


Gastrointestinal system
Acute gastric erosions
Gastrointestinal bleeding from varices, erosions, Mallory-Weiss tear, peptic
ulceration
Hidden
Pancreatitis (acute, recurrent or chronic) Content.
Diarrhoea (watery, due to Purchase the
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chronic alcoholic
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pancreatitis or, rarely, liver disease)
Hepatomegaly (fatty liver, chronic liver disease)
Chronic liver disease (alcoholic hepatitis, cirrhosis) and associated
complications
Cancer (oesophagus, cardia of stomach, liver, pancreas)

Medical FunNotes at http://www.mbbsdost.com/funnotes 63


Cardiovascular system
Cardiomyopathy
Cardiac arrhythmias
Hypertension
Nervous system
Blackouts
Nutrition-related conditions, e.g. Wernickes encephalopathy, Korsakoffs
psychosis, peripheral neuropathy (thiamine deficiency), pellagra (dementia,
dermatitis and diarrhoea from niacin deficiency)
Withdrawal syndromes, e.g. tremor, hallucinations, rum fits, delirium tremens
Cerebellar degeneration
Alcoholic dementia
Hidden Content.
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Autonomic neuropathy
Haematopoietic system
Anaemia (dietary folate deficiency, iron deficiency from blood loss, direct toxic
suppression of the bone marrow, rarely B12 deficiency with chronic
pancreatitis, or sideroblastic anaemia)
Thrombocytopenia (from bone marrow suppression or hypersplenism)
Genitourinary system
Erectile dysfunction (impotence), testicular atrophy in men
Amenorrhoea, infertility, spontaneous abortion, fetal alcohol syndrome in
women
Other effects
Increased risk of fractures and osteonecrosis of the femoral head

Sulfonamides: common characteristics


Mnemonic- SULFA :
S teven-Johnson syndrome/ S kin rash / S olubility low
Hidden Content.
U rine precipitation/ U sefulPurchase
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L arge spectrum (gram positives and negatives)
F olic acids synthesis blocker (as well as synthesis of nucleic acids)
A nalog of PABA

64 Medical FunNotes at http://www.mbbsdost.com/funnotes


Important HLA
Myasthenia gravis : HLA B8
Behcet's disease : HLA B5
CAH : HLA B47
psoriasis vulgaris :
Hidden Content. HLA Cw6
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: HLA Dr3
Pemphigus Vulgaris : HLA DR4/DQ1
Bullous pemphigoid : HLA Dq7
Rheumatoid Arthritis : aHLA DR4

Skills in history-taking
1. Several skills are important in obtaining a useful and accurate history
Establish rapport and understanding.
Ask questions in a logical sequence. Start with open-ended questions.
Listen to the answers and adjust your interview accordingly.
Observe and provide nonverbal clues carefully. Encouraging, sympathetic
gestures and concentration on the patient that make it clear he or she has
your undivided attention are most important and helpful, but are really a
form of normal politeness.
Proper interpretation of the history
Hidden is crucial.
Content.
2. A good grounding in history taking will stand you in good stead for the rest of
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your career in medicine.
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3. A successful consultation with a patient, based on a good history-taking
manner, is satisfying and even enjoyable for both parties.
4. Repeated practice in history taking makes it an accurate and quite rapid
process (usually).
5. Not taking a proper history (a regrettably common event) can lead to an
incorrect differential diagnosis, the wrong tests and often the wrong
treatment.
6. No test is accurate enough (sensitive and specific enough) to be useful if it is
ordered for the wrong reason (e.g. as a result of poor history taking).
7. Screen for alcohol and drug use routinely using standard questions.

Medical FunNotes at http://www.mbbsdost.com/funnotes 65


Consciousness disorders and their diagnostic value
Patients consciousness may be clear or deranged. Depending on the degree of
disorder, the following psychic states are differentiated.
1. Stupor. The patient cannot orient himself to the surroundings, he gives
delayed answers. The state is characteristic of contusion and in some cases
poisoning.
2. Sopor. This is an unusually deep sleep from which the patient recovers only
for hort periods of time when called loudly, or roused by an external stimulus.
The reflexes are preserved. The state can be observed in some infectious
diseases and at the initial stage of acute uraemia.
3. Coma. The comatose state is the full loss of consciousness with complete
absence of response to external stimuli, with the absence of reflexes, and
deranged vital functions. The causes of coma are quite varied but the loss of
consciousness in coma of any aetiology is connected with the cerebral cortex
dysfunction caused by some factors, among which the most important are
disordered cerebral circulation and anoxia. Oedema of the brain and its
membranes, increased intracranial Hidden
pressure,Content.
effect of toxic substances on the
brain tissue, metabolic and hormone
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equilibrium are also very important for the onset of coma. Coma may occur
suddenly or develop ongradually,
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through various stages of consciousness
disorders. The period that precedes the onset of a complete coma is called the
precomatose state. The following forms of coma are most common.
Alcoholic coma. The face is cyanotic, the pupils are dilated, the respiration
shallow, the pulse low and accelerated, the arterial pressure is low; the
patient has alcohol on his breath.
Apoplexic coma (due to cerebral haemorrhage). The face is red, breathing is
slow, deep, noisy, the pulse is full and rare.
Hypoglycaemic coma can develop during insulin therapy for diabetes.
Diabetic (hyperglycaemic) coma occurs in non-treated diabetes mellitus.
Hepatic coma develops in acute and subacute dystrophy and necrosis of the
liver parenchyma, and at the final stage of liver cirrhosis.
Vraemic coma develops in acute toxic and terminal stages of various chronic
diseases of the kidneys.
Epileptic coma. The face is cyanotic, there are clonic and tonic convulsions,

66 Medical FunNotes at http://www.mbbsdost.com/funnotes


the tongue is bitten. Uncontrolled urination and defecation. The pulse is
frequent, the eye-balls are moved aside, the pupils are dilated, breathing is
hoarse.
4. Irritative disorders of consciousness may also develop. These are
Hiddennervous
characterized by excitation of the central Content.system in the form of
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pneumonia, especially in alcoholics; quiet delirium in typhus, etc.).
General inspection can also give information on other psychic disorders
that may occur in the patient (depression, apathy).

Examination of Lymph Node


Lymph Nodes are generally examined in the following order:
1. Anterior Cervical (both superficial and deep): Nodes that lie both on top of
and beneath the sternocleidomastoid muscles (SCM) on either side of the
neck, from the angle of the jaw to the top of the clavicle. This muscle allows
the head to turn to the right and left. The right SCM turns the head to the left
vice versa. They can be easily identified by asking the patient to turn their
head into your hand while you provide resistance. Drainage: The internal
structures of the throat as well as part of the posterior pharynx, tonsils, and
thyroid gland.
2. Posterior Cervical: Extend in a line posterior to the SCMs but in front of the
trapezius, from the level of the mastoid bone to the clavicle. Drainage: The
skin on the back of the head. Hidden Content.
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the angle of the mandible. Drainage: The
tonsilar and posterior pharyngeal regions.
4. Sub-Mandibular: Along the underside of the jaw on either side. Drainage: The
structures in the floor of the mouth.
5. Sub-Mental: Just below the chin. Drainage: The teeth and intra-oral cavity.
6. Supra-clavicular: In the hollow above the clavicle, just lateral to where it joins
the sternum. Drainage: Part of the throacic cavity, abdomen.
A number of other lymph node groups exist. However, palpation of these
areas is limited to those situations when a problem is identified in that specific
region (e.g. the pre-auricular nodes, located in front of the ears, may become
inflamed during infections of the external canal of the ear).

Medical FunNotes at http://www.mbbsdost.com/funnotes 67


HIV PEP(Post-exposure prophylaxis):
Post-exposure prophylaxis (PEP) has its greatest effect if begun within two hours
of exposure, it is essential to act immediately. The prophylaxis needs to be
continued for four weeks. Exposure must be immediately reported to designated
authority and therapy administered. Never delay start of therapy due to debate
Hidden
over regimen. Begin with basic 2-drug regimen Content.
& expanded 3-drug regimn.
Purchase
Basic regimen : Zidovudine 300mg thea day)
BD(twice Full +Book in Rs. 350/-
Lamivudine 150mg BD(twice
a day) on www.mbbsdost.com/funnotes
Expanded regimen : Zidovudine 300mgBD + Lamivudine 150mg BD + Lopinavir
400mg BD
Expanded regimen should be used if there is cut or needle stick injury penetrating
gloves, inserting a cathether which was previously used for a HIV infected patient.

Pathognomonic Signs of diseases:


1. COPD - Barrel-Chest
2. Pneumonia - Greenish Rusty Sputum
3. Pernicious Anemia - Beefy Red Tongue (Schillings Test)
4. Kawasaki Disease - Strawberry Tongue
5. Typhoid - Rose Spot
6. Tetany - Chvostek Sign (Muscle Twitching Face) - Trosseaus Sign (Jerky
Movements
7. Pancreatitis - Cullen Sign (Bluish discoloration preumbilical area)
8. Appendicitis - McBurneys Point (rebound tenderness) - Rovsing Sign (Right
Lower quadrant pain with palpation Hidden in Content.
Left lower quadrant) - Psoas
Sign(pain on lying down putting pressure on Mc Burneys point)
9. Thrombophlebitis -Purchase
Homans Sign the Full Book in Rs. 350/-
10. on(yellowish
Hepatitis - Icteric Sclera www.mbbsdost.com/funnotes
discoloration of sclera)
11. Meningitis - Burdzinski Sign (Pain on nape) - Karnig Sign (pain on leg/ knee
area)
12. Pyloric Stenosis - Olive-Shaped Mass
13. Hyperthyroidism - Exopthalmus
14. Addisons Disease. - Bronze-like skin
15. Cushing Syndrome- Boffalo Hump
16. Cholera - Rice Watery Stool
17. Systemic Lupus erythematorus - Butterfly Rashes
18. Leprosy - Leoning Face (contracted face)
19. Bulimia Nervosa - Chipmunk Face

68 Medical FunNotes at http://www.mbbsdost.com/funnotes


20. Liver Cirrhosis - Spider Angioma
21. Asthma - Wheezing Inspiration
22. Hyperpituitarism - CAROTENEMIA (Discoloration of skin) - XANTHAMIA
23. Down Syndrome- Single Crease on Palm
24. Tetralogy of fallot - Clubbing of Fingernails Ventricular Septal Defect
Pulmonary Stenosis Overriding of AortaHidden
RightContent.
Ventricular Hypertrophy
25. Cataract - Blurry Vision /Purchase
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26. Glucoma - Tunnel-like Vision
on www.mbbsdost.com/funnotes
27. PTB - Low grade fever in a ternoon
28. Cholecystitis- Murphys Sign (pain RU Right upper quadrant)
29. Myasthemia Gravis (MG) Ptosis (inability to open upper eyelids)
30. Dengue - Petechiae
31. Parkinsons Diease. - Pill Rolling Tremors
32. Measles - Koplicks Spot

Normal form of the chest


1. Normosthenic (conical) chest in subjects with normosthenic constitution
resembles a truncated cone whose bottom is formed by well-developed
muscles of the shoulder girdle and is directed upward. The anteroposterior
(sterno vertebral) diameter of the chest is smaller than the lateral (transverse)
one, and the supraclavicular fossae are slightly pronounced. There is a distinct
angle between the sternum and the manubrium (angulus Ludowici); the
epigastric angle nears 90. The ribs are moderately inclined as viewed from
the side; the shoulder blades closely fit to the chest and are at the same level;
the chest is about the same heightHidden Content.
as the abdominal part of the trunk.

2. Hypersthenic chestPurchase the


in persons with Full Book
hypersthenic in Rs. 350/-
constitution has the shape
of a cylinder. The on www.mbbsdost.com/funnotes
anteroposterior diameter is about the same as the
transverse one; the supraclavicular fossae are absent (level with the chest).
The manubriosternal angle is indistinct; the epigastric angle exceeds 90;

the ribs in the lateral parts of the chest are nearly horizontal, the intercostal
space is narrow, the shoulder blades closely fit to the chest, the thoracic part
of the trunk is smaller than the abdominal one.

3. Asthenic chest in persons with asthenic constitution is elongated, narrow


(both the anteroposterior and transverse diameters are smaller than normal);
the chest is flat. The supra- and subclavicular fossae are distinctly

Medical FunNotes at http://www.mbbsdost.com/funnotes 69


pronounced. There is no angle between the sternum and the manubrium: the
sternal bone and the manubrium make a straight "plate". The epigastric angle
is less than 90. The ribs are more vertical at the
Hidden sides, the tenth ribs are not
Content.
Purchase the Full Book
attached to the costal arch (costa decima fluctuens); in Rs.
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intercostal spaces
on www.mbbsdost.com/funnotes
are wide, the shoulder blades are winged (separated from the chest), the
muscles of the shoulder girdle are underdeveloped, the shoulders are sloping,
the chest is longer than the abdominal part of the trunk.

Pathological Forms of chest


1. Emphysematous (barrel-like) chest resembles a
hypersthenic chest in its shape, but differs from it
by a barrel-like configuration, prominence of the
chest wall, especially in the posterolateral
regions, the intercostal spaces are enlarged. This
Hidden Content.
type of chest is found in chronic emphysema of
the lungs. ActivePurchase
participationthe Full Book in Rs. 350/-
of accessory
respiratory muscles oninwww.mbbsdost.com/funnotes
the respiratory act
(especially m. sternocleidomastoideus and m.
trapezius), depression of the intercostal space, General appearance of a patient
elevation of the entire chest during inspiration with pulmonary emphysema
and relaxation of the respiratory muscles and
lowering of the chest to the initial position during expiration become evident
during examination of emphysema patients.

2. Paralytic chest resembles the asthenic chest. It is


found in emaciated patients, in general asthenia
and constitutional underdevelopment; it often
occurs in grave chronic diseases, more
Hidden Content.
commonly in pulmonary tuberculosis and
pneumosclerosis. Purchase the Full Book
During examination of in Rs. 350/-
onchest,
patients with paralytic www.mbbsdost.com/funnotes
marked atrophy of
the chest muscles and asymmetry of the clavicles
and dissimilar depression of the supraclavicular
Paralytic chest
fossae can be observed along with typical signs
of aslhenic chest. The shoulder blades are not atone level either, and their
movements during breathing are asynchronous.

70 Medical FunNotes at http://www.mbbsdost.com/funnotes


3. Rachitic chest (keeled or pigeon chest). It is
c h a ra c te r i ze d by a m a r ke d l y g re ate r
anteroposterior diameter (compared with the
transverse diameter) due to the prominence of
the sternum (which resembles the keel of a
boat.) The anterolateral surfaces of the chest are
as if pressed on both sides and therefore the ribs
meet at an acute angle at the sternal bone, while
the costal cartilages thicken like beads at points
of their transition to bones (rachitic beads). As a
rule, these beads can be palpated after rickets
only in children and youths.
Hidden Content.
4. Funnel chest has a funnel-shaped depression in the lower part of the
Purchase the Full Book in Rs. 350/-
sternum. This deformity can be regarded as a result of abnormal development
of the sternum or prolonged compressing effect. In older times this chest
on www.mbbsdost.com/funnotes
would be found in shoemaker adolescents.
5. Foveated chest is almost the same as the funnel chest except that the
depression is found mostly in the upper and the middle parts of the anterio
surface of the chest. This abnormality occurs in syringomyelia, a rare disease
of the spinal cord.
The chest may be abnormal in subjects with various deformities of the spine
which arise as a result of injuries, tuberculosis of the spine, rheumatoid
arthritis (Bekhterev's disease), etc. Four types of spine deformities are
distinguished: lateral curvature of the spine, called scoliosis;
forward and backward curvature of the spine (gibbus and kyphosis,
respectively); forward curvature of the spine, generally in the lumbar region
(lordosis); combination of the lateral and forward curvature of the spine
(kyphoscoliosis).

Respiration Rhythm
Respiration of a healthy person is rhythmic, of uniform depth and equal length of
the inspiration and expiration phases. Rhythm of the respiratory centre can be
inhibited, in some types of oedema. Derangement of the respiratory function can
(pause oedema in which a series of respiratory
Hiddenmovements
Content. alternates with a
pronounced (readily detectable)Purchase
elongationthe
of the respiratory pause
Full Book in Rs. (lasting from
350/-
a few seconds to a minute) or toona temporary arrest of respiration (apnoea). This
www.mbbsdost.com/funnotes
respiration is known as periodic.
Biot's respiration is characterized by rhythmic but deep respiration movements
which alternate (at approximately regular intervals) with 1ong| respiratory

Medical FunNotes at http://www.mbbsdost.com/funnotes 71


pauses (from few seconds to half a minute). Biot's respiration occurs in meningitis
patients and in agony with disorders of cerebral circulation.
Cheyne-Stokes' respiration is characterized by periods (from seconds to a minute)
of cessation of respiration, followed by noiseless shallow respiration, which
quickly deepens, becomes noisy to attain its maximum at the 5-7th inhalation, and
then gradually slows down to end with a new short respiratory pause. During such
pauses, the patient often loses his sense of orientation in the surroundings or even
faints, to recover from the unconscious condition
Hidden after respiratory movements are
Content.
restored. This respiratory disorder occurs in diseases causing acute or chronic
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insufficiency of cerebral circulation and brain hypoxia, and also in heavy
poisoning. More frequentlyon thiswww.mbbsdost.com/funnotes
condition develops during sleep and is more
characteristic of aged persons with marked atherosclerosis of the cerebral
arteries.
Undulant (wave-like) Groccos respiration somewhat resembles Cheyne-Stokes
respiration except that a weak shallow respiration occurs instead of the
respiratory pause with subsequent deepening of the respiratory movement,
followed by slowing down. This type of arrhythmic dyspnoea can probably be
regarded as the early stages of the same pathological processes which are
responsible for resembles Cheyne-Stokes respiration.

Classification of Conjunctivitis
INFLAMMATIONS OF CONJUNCTIVA
Inflammation of the conjunctiva (conjunctivitis) is classically defined as
conjunctival hyperaemia associated with a discharge which may be watery,
mucoid, mucopurulent or purulent.
Etiological classification
1. Infective conjunctivitis: bacterial,Hidden Content.
chlamydial, viral, fungal, rickettsial,
spirochaetal, protozoal, parasitic etc.
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2. Allergic conjunctivitis.
on www.mbbsdost.com/funnotes
3. Irritative conjunctivitis.
4. Keratoconjunctivitis associated with diseases of skin and mucous membrane.
5. Traumatic conjunctivitis.
6. Keratoconjunctivitis of unknown etiology.
Clinical classification Depending upon clinical presentation, conjunctivitis can be

72 Medical FunNotes at http://www.mbbsdost.com/funnotes


classified as follows:
1. Acute catarrhal or mucopurulent conjunctivitis.
2. Acute purulent conjunctivitis
3. Serous conjunctivitis
4. Chronic simple conjunctivitis
5. Angular conjunctivitis
Hidden Content.
6. Membranous conjunctivitis
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7. Pseudomembranous conjunctivitis
on www.mbbsdost.com/funnotes
8. Papillary conjunctivitis
9. Follicular conjunctivitis
10. Ophthalmia neonatorum
11. Granulomatous conjunctivitis
12. Ulcerative conjunctivitis
13. Cicatrising conjunctivitis

Vocal Fremitus
Palpation is used for determining the strength of voice conduction to chest
surface (fremitus vocalis s. pectoralis). Vocal fremitus depends on the conduction
of voice sounds through the respiratory tract.
The palms of the hands placed on the symmetrical parts of the chest and the
patient is asked to i loudly a few words (with the letter 'r' in them to intensify
Hidden Content.
vibration). The doctor can ask the patient to repeat words, such as "ninety-nine",
Purchase the Full Book in Rs. 350/-
"one, two, three," "eee-eee". The patient should speak the words with a voice of
on should
uniform intensity. The voice www.mbbsdost.com/funnotes
be as low as possible since voice vibrations are
better transmitted by the air column in the trachea and the bronchi to the chest
wall in this case. Vibrations are felt as the hands move symmetrically on either side
of the sternum and vertebral column.
Fremitus vocalis can also be determined by one hand as well: the palm of the
examining hand should be placed alternately on the symmetrical parts of the
chest.

Medical FunNotes at http://www.mbbsdost.com/funnotes 73


In general vocal fremitus is the most intense in the regions of the thorax where the
trachea and bronchi are the closest to the surface, particularly along the sternum
between the first and second ribs and posteriorly between the scapulae.
Progressing downward, the sound decreases and is least prominent at the base of
the lungs.
Vocal fremitus is of about the same intensity in the symmetrical parts of the chest
of a healthy person. Vocal vibrations are louder in the upper parts of the chest and
softer in its lower parts. Moreover, voice conduction is better in men with low
voice and thin chest; the vibrations are weaker in women and children with higher
voice (and also in persons with the well developed subcutaneous fat tissues).
Hidden Content.
Vocal fremitus can be stronger or weaker (or in some cases it can even be
Purchase
impalpable) in pathological theofFull
conditions the Book in Rs.
respiratory 350/-
organs. In focal
affections, vocal fremitus becomes unequal over symmetrical parts of the chest.
on www.mbbsdost.com/funnotes
Vocal fremitus is intensified when a part of the lung or its whole lobe becomes
airless and more uniform (dense) because of a pathological process. According to
the laws of physics, dense and uniform bodies conduct sound better than loose
and non-uniform. Induration (consolidation) can be due to various causes, such as
acute lobar pneumonia, pulmonary infarction, tuberculosis, accumulation of air
or fluid in the pleural cavity, etc. Vocal fremitus is also intensified in the presence in
the pulmonary tissue of an air cavity communicated with the bronchus.
Vocal fremitus becomes weaker:
1. When liquid or gas are accumulated in the pleural cavity; they separate the
lung from the chest wall to absorb voice vibrations propagating from the
vocal slit along the bronchial tree;
2. In complete obstruction of the bronchial lumen by a tumour which interferes
with normal conduction of sound waves to the chest wall;
3. In asthenic emaciated patients (with weak voice);
4. In significant thickening of the chest wall in obesity.
Low-frequency vibrations due to pleural friction (friction fremitus) in dry pleurisy,
crepitation sounds characteristic of subcutaneous emphysema of the lungs,
vibration of the chest in dry, low (low-pitch buzzing) rales can also be determined
by palpation.
74 Medical FunNotes at http://www.mbbsdost.com/funnotes
Decreased vocal fremitus in the upper airway may indicate
a. the obstruction of a major bronchus,
b. pneumo-, hydro-, haemothorax,
c. emphysema of lungs,
d. adiposity can also be the cause of decreased vocal fremitus.
The voice of fremitus is increased
a. in pneumonia,
b. in abscess, Hidden Content.
b. in atelectasis, Purchase the Full Book in Rs.
350/-
c. in cavern.
on www.mbbsdost.com/funnotes
Absence of fremitus usually indicates obstruction of a major bronchus, which may
occur as the result of aspiration of a foreign body.

Decreased or absent fremitus is always recorded and reported for further


investigation. During palpation other vibrations that indicate pathologic
conditions are noted. One is a pleural friction rub, which has a grating sensation. It
is synchronous with respiratory movements and is the result of opposing surfaces
of the inflamed pleural lining rubbing against one another,

Percussion Tones
ORGANS
INTENSITY PITCH DURATION DUALITY
PERCUSSED

lungs Loud Low Long Hollow

bone and
sofe HighHidden Content.
Short Extremelydul
muscle
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spleen and Medium
Mediumon www.mbbsdost.com/funnotes
Medium Thudlike
liver borders high
stomach and
gas bubbles - Loud High Medium Drumlike
intestines
air trapped
in lung Very loud Very low Longer Booming
(emph-ysema)

Medical FunNotes at http://www.mbbsdost.com/funnotes 75


Mechanisms and Examples of Hypersensitivities
TYPE 1 : IMMEDIATE

Hay fever Allergic asthma Anaphylaxis

Reaction of IgE antibody on mast cells with antigen, which results in release of
mediators

TYPE II : CYTOTOXIC

Autoimmune hemolytic anemia

Goodpasture's syndrome Myasthenia gravis

Reaction of IgG with host cell membrane or antigen adsorbed by host cell
membrane

TYPE III : IMMUNE COMPLEX-MEDIATED

Serum sickness Vasculitis Systemic lupus


Hidden Content.
Purchase
erythematosus Rheumatoid arthritis the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Formation of immune complex of antigen and antibody, which deposits in walls of
blood vessels and results in complement release and inflammation

TYPE IV : DELAYED

Poison ivy Graft rejection Tuberculosis Sarcoidosis

Reaction of sensitized T-cells with antigen and release of lymphokines, which


activate macrophages and induce inflammation

Graves' disease B-cellgammopathies

TYPE V : STIMULATED

Reaction of autoantibodies with normal cell-surface receptors, which stimulates a


continual overreaction of the target cell

IgE, Immunoglobulin E; IgG, immunoglobulin G.

76 Medical FunNotes at http://www.mbbsdost.com/funnotes


Anaphylaxis Management
Promotion of adequate ventilation & tissue perfusion for a client with a severe
allergic (antigen-antibody) reaction

Place client in Fowler's or high Fowler's position.

Apply tourniquet immediately proximal to the allergen point of entry (e.g.,


injection site, IV site, insect bite, etc.), when possible.

Administer aqueous epinephrine 1:1000 (0.3-0.5 mL) subcutaneously at the


contact site, if applicable, and proximal to the tourniquet and repeat every 3
minutes, as needed.

Hidden
Establish and maintain a patent airway. Content.
Administer oxygen byPurchase
mask. the Full Book in Rs. 350/-
Start an IV infusion on www.mbbsdost.com/funnotes
of normal saline, lactated Ringer's, or a plasma volume
expander, as appropriate.

Reassure the client and family members.

Monitor for signs of shock, airway obstruction, cardiac arrhythmia, aspiration


of gastric contents, and seizures.

Administer spasmolytics, antihistamines, or cortico- steroids as indicated if


urticaria, angioedema, or bron chospasm present.

Monitor for recurrence of anaphylaxis within 24 hours.

Medical love at mbbsdost


Husband : Wow, you are looking so pink tonight?

Wife : When I hear your lovely words they stimulate the bundle branches of the
circulation system of my heart, it starts beating faster & increased output is
Hidden Content.
transmitted to adrenals which Purchase
start secreting glucagon
the Full Bookto
inincrease blood glucose
Rs. 350/-
level & to combat this emergency, Pituitary output also increases which raises
on www.mbbsdost.com/funnotes
blood estrogen level, Causing vasodilation & I look PINK.

MORAL : there is medicine in love as well.

Medical FunNotes at http://www.mbbsdost.com/funnotes 77


Vectors of Few Well Known Diseases
Anopheles Malaria
Culex Japanese encephalitis, west nile fever, bancroftian
filariasis, viral arthritis
Aedes Yellow fever, dengue, chikungunya, rift valley fever
Mansoinoides Brugian filariasis
Sandfly Kala azar, oriental sore, oraya fever, sandfly fever
Tse-Tse fly Sleeping sickness
Louse Hidden Content.
Epidemic typhus, relapsing fever, trench fever, pediculosis
Rat flea Bubonic plague, endemis plaque, chiggerosis,
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hymenolepis diminut
Black fly on www.mbbsdost.com/funnotes
Onchocerciasis
Reduviid bug Chagas disease
Hard tick Tick typhus, viral encephalitis, Viral hemorrhagic fever,
KFD, tularemia, tick paralysis, babesiosis
Soft tick Qfever, relapsing fever
Trombiculid mite Scrub fever, rickettsial pox
Itch mite Scabies
Cyclops Guinea worm disease, fish tape worm (D.latum)

Adverse effect of Phenytoin (anti-epileptic drug)


Mnemonic- "HOT MALIKA"
H- hirsutism, hypertrophy of gum
O- osteomalacia
T- teretogenicity Hidden Content.
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M- megaloblastic anemia
A- ataxia (cerebellar) on www.mbbsdost.com/funnotes
L- lymphedenopathy
I- inhibit insulin release (hyperglycemia)
K- vitamin K deficiency (bleeding)
A- arrhythmia

78 Medical FunNotes at http://www.mbbsdost.com/funnotes


Symptoms of Senile cataract...
Mnemonic - "LIC BUG"
Hidden Content.
L-Loss of vision, B-Black spots,
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I-Image blur, on www.mbbsdost.com/funnotes
U-Uniocular polypopia,
C-Colored halo, G-Glare..

Uses of mineralcorticosteroids
Mnemonic CORTICOSTEROID
C-Cushing syndrome S-Serum sickness
O-Optic neuritis T-Tenosynovitis
Hidden Content.
R-Rheumatoid arthritis E-Edema
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T-Tenosynovitis on www.mbbsdost.com/funnotes
R-Renal disorder
I-Inflammatory condition O-Optic neuritis
C-Conjunctivitis I-Infection
O-Organ transplant D-Dermatitis

Operations in Surgery
Jones operation tendon transfer for radial nerve palsy
Swenson's operation hirschprungs disease
Soave and parks operation hirschprungs disease
( coloanal anastomosis)
Delormes operation rectal prolapse
Billroth 1 operation fractal prolapse
Hidden Content.
Milligon Morgan operation haemorrhoidectomy
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Mayos operation hiatus hernia
Nesovics operation
on www.mbbsdost.com/funnotes
sports hernia
Cheatle henry operation obturater hernia
Sebrocks operation parotid duct fistula
Bentails operation aortic roots aneurysum repairs
Belsey mark IV operation hiatus hernia
Hills operation hiatus hernia
Psoas hitch operation little loss of length in ureteric injury

Medical FunNotes at http://www.mbbsdost.com/funnotes 79


Causes of Gynaecomastia:
Mneumonic: "GYNAECOMASTia in LaD
G- Gonadotropins M-Methyldopa
Y- hYperthyroidism, Hidden Content.
A- Adrenal disease
hYperprolactinemia. Purchase the Full Book in Rs. 350/-
S- Spironolactone
N ketocoNazole Tia-TestIcular tumours
on www.mbbsdost.com/funnotes
A- Androgens L- Leprosy, Liver disease,
E- Estrogens Lung ca( small cell type).
C- Cimetidine, Clomiphene D- Digitalis
O- Orchitis

Nephrotic Syndrome
Mnemonic - "NEPHROTIC
Na+ water retention
Edema
Proteinuria>3.5/24hrs Hidden Content.
Hyperlipidemia Purchase the Full Book in Rs. 350/-
Renal vein thrOmbosis on www.mbbsdost.com/funnotes
Thrombotic &thrombo embolic complications
Infection with staph.N pneumococci
hyper coagulable state

Prostaglandin In Obstetrics
Mnemonic- Govt Medical College Delhi

Gemeprost- useful for inducing labour


Hidden Content.
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Misoprostol- abortion, postpartum heamorrhage
on www.mbbsdost.com/funnotes
Carboprost-mid term abortion, postpartum haemorrhage

Dinoprost- mid term abortion.

80 Medical FunNotes at http://www.mbbsdost.com/funnotes


Mydriatics
Mnemonic -PATCH
Hidden Content.
P - Phenylephrine C - cyclopentolate
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on www.mbbsdost.com/funnotes
A - Atropine H - Homatropine
T - Tropicamide

Forensic important sections


IMPORTANT IPC SECTIONS

44. Injury

82. Act of a child under seven years of age

83. Act of a child above seven and under twelve of immature understanding

84. Act of a person of unsound mind

85. Act of a person incapable of judgment by reason of intoxication caused


against his will

86. Offence requiring a particular intent of knowledge committed by one who


is intoxicated Hidden Content.
Purchase
IPC SECTIONS RELATED TO CONSENTthe Full Book in Rs. 350/-

87. on and
Act not intended www.mbbsdost.com/funnotes
not known to be likely to cause death or grievous
hurt, done by consent

88. Act not intended to cause death, done by consent in good faith

for person's benefit

89. Act done in good faith for benefit of child or insane person, by or by
consent of guardian

90. Consent known to be given under fear or misconception

91. Exclusion of acts which are offences independently of harm caused

92. Act done in good faith for benefit of a person without consent

Medical FunNotes at http://www.mbbsdost.com/funnotes 81


SECTIONS RELATED TO FALSE EVIDENCE/ FALSE CERTIFICATES

191. Giving false evidence (Perjury)

192. Fabricating false evidence

193. Punishment for false evidence (Perjury)

194. Giving or fabricating false evidence with intent to procure conviction of


capital offence

195. Giving or fabricating false evidence with intent to procure conviction of


offence punishable with imprisonment for life or imprisonment

196. Using evidence known to be false

197. Issuing or signing false certificate

198. Using as true a certificate known to be false

199. False statement made in declaration which is by law receivable as


evidence Hidden Content.
200. Purchase
Using as true such the Full
declaration knowing it to Book
be false in Rs. 350/-

201. on www.mbbsdost.com/funnotes
Causing disappearance of evidence of offence, or giving false information
to screen offender

202. Intentional omission to give information of offence by person bound to


inform- The doctor knowing or having the reason to believe that an offence
has been committed by a patient whom he is treating, intentionally omits
to inform the police, shall be punished with imprisonment upto 6 months.

203. Giving false information respecting an offence committed

204. Destruction of document or electronic record to prevent its production as


evidence

IPC SECTIONS RELATED TO MURDER, SUICIDE ETC

299. Culpable homicide, definition.

300. Murder, definition

302. Punishment for murder

304. Punishment for culpable homicide not amounting to murder

82 Medical FunNotes at http://www.mbbsdost.com/funnotes


304a. Causing death by negligence, punishment upto 2 years.

304b. Dowry death, punishment upto 7 years.

305. Abetment of suicide of child or insane person

306. Abetment of suicide

307. Attempt to murder

308. Attempt to commit culpable homicide

309. Attempt to commit suicide

SECTIONS RELATED TO ABORTION

312. Causing miscarriage

313. Causing miscarriage without woman's consent

314. Death caused by act done with intent to cause miscarriage-


Hidden Content.
315. Act done with intent to prevent child being born alive or to cause it to die
after birth Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
316. Causing death of quick unborn child by act amounting to culpable

homicide

317. Exposure and abandonment of child under twelve years, by parent or


person having care of it.

318. Concealment of birth by secret disposal of dead body.

SECTIONS RELATED TO HURT AND GRIEVOUS HURT

319. Hurt.

320. Grievous hurt.

321. Voluntarily causing hurt.

322. Voluntarily causing grievous hurt.

323. Punishment for voluntarily causing hurt

324. Voluntarily causing hurt by dangerous weapons or means

Medical FunNotes at http://www.mbbsdost.com/funnotes 83


325. Punishment for voluntarily causing grievous hurt

326. Voluntarily causing grievous hurt by dangerous weapons or means

328. Causing hurt by means of poison, etc. with intent to commit an offence

SECTIONS RELATED TO TORTURE

330. Voluntarily causing HURT to extort confession, or to compel restoration of


property is punishable for imprisonment upto SEVEN YEARS

331. Voluntarily causing GRIEVOUS HURT to extort confession, or to compel


restoration of property punishable for imprisonment upto TEN YEARS

339. Wrongful restraint

340. Wrongful confinement.

341. Punishment for wrongful restraint

342. Punishment for wrongful Confinement


Hidden Content.
343. Wrongful confinement for three the
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344. on for
Wrongful confinement www.mbbsdost.com/funnotes
ten or more days

345. Wrongful confinement of person for whose liberation writ has been issued

346. Wrongful confinement in secret

347. Wrongful confinement to extort property, or constrain to illegal act

348. Wrongful confinement to extort confession, or compel restoration of


property

351. Assault

352. Punishment for assault or criminal force otherwise than on grave


provocation

353. Assault or criminal force to deter public servant from discharge of his duty

354. Assault or criminal force to woman with intent to outrage her modesty

355. Assault or criminal force with intent to dishonour person, otherwise than
on grave provocation

84 Medical FunNotes at http://www.mbbsdost.com/funnotes


356. Assault or criminal force in attempt to commit theft of property carried by
a person

357. Assault or criminal force in attempt wrongfully to confine a person

358. Assault or criminal force on grave provocation

359. Kidnaping

360. Kidnaping from India

361. Kidnaping from lawful guardianship

362. Abduction

363. Punishment for kidnaping

363A. Kidnaping or maiming a minor for purposes of begging

364. Kidnaping or abducting in order to murder

364A. Kidnaping for ransom, etc. Hidden Content.


365. Purchase
Kidnaping or abducting the Full
with intent Book
secretly and in Rs. 350/-
wrongfully to confine
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366. Kidnaping, abducting or inducing woman to compel her marriage, etc.

366A. Procreation of minor girl

366B. Importation of girl from foreign country

367. Kidnaping or abducting in order to subject person to grievous hurt,


slavery, etc.

368. Wrongfully concealing or keeping in confinement, kidnaped or abducted


person

369. Kidnaping or abducting child under ten years with intent to steal from its
person

372. Selling minor for purposes of prostitution, etc.

373. Buying minor for purposes of prostitution, etc.

374. Unlawful compulsory labour

Medical FunNotes at http://www.mbbsdost.com/funnotes 85


375. Rape

376. Punishment for rape

376a. Intercourse by a man with his wife during separation

376b. Intercourse by public servant with woman is his custody

376c. Intercourse by superintendent of jail, remand home, etc.

376d. Intercourse by any member of the management or staff of a hospital with


any woman in that hospital

377. Unnatural offences Hidden Content.


493. Cohabitation Purchase
caused thedeceitfully
by a man Full Book in Rs.
inducing 350/-
a belief of lawful
marriage on www.mbbsdost.com/funnotes
494. Marrying again during lifetime of husband or wife

495. Same offence with concealment of former marriage from person with
whom subsequent marriage is contracted

496. Marriage ceremony fraudulently gone through without lawful marriage

497. Adultery

498. Enticing or taking away or detaining with criminal intent a married woman

498a. Husband or relative of husband of a woman subjecting her to cruelty

509. Word, gesture or act intended to insult the modesty of a woman

510. Misconduct in public by a drunken person

Important Signs of Obstetrics and Gynaecology


Bagel sign:
Ultrasonographic sign. Gestational sac in the adnexa with hyperechoic ring
Hidden Content.
Ball Sign: Purchase the Full Book in Rs. 350/-
Radiological sign of intrauterine fetal death. X-ray shows crumpled up spine of
on www.mbbsdost.com/funnotes
the fetus.

Banana Sign:

86 Medical FunNotes at http://www.mbbsdost.com/funnotes


Ultrasound sign in open spina bifida. Shows abnormal anterior curvature of
cerebellum. Due to the associated Arnold-Chiari malformation.

Chadwicks Sign:

Bluish hue to the vestibule and anterior vaginal wall. Seen in first trimester of
pregnancy. Cause is increased blood flow to the pelvic organs. Also known as
jacquemiers Sign.

Cullen Sign:
Bluish discoloration of skin around umbilicus. Occurs due to intra peritoneal
hemorrhage. Seen in ruptured ectopic pregnancy.

Double Bubble Sign:


Useful in prenatal diagnosis of duodenal atresia. Duodenal atresia usually
presents with polyhydramnios and produces dilatation of stomach and first part
of duodenum
Hidden Content.
Double decidual sac Sign:Purchase the Full Book in Rs. 350/-
Normal Ultrasonographic appearance of intrauterine gestational sac. Seen as
on www.mbbsdost.com/funnotes
two concentric echogenic rings separated by a hyperechoic space.

Goodell Sign:
Marked softening of the cervix in contrast to non pregnant state. Also due
toincreased blood flow.

Hegar Sign:
An indication of Pregnancy. Softening of the lower parts of the uterus enables
approximation of vaginal and abdominal fingers in bimanual pelvic examination.
Vaginal fingers are placed in the posterior fornix and abdominal hand pressed
down behind theuterus.

Jacquemiers sign:

Refer Chadwick

SignKustners Sign:

Sign of placental separation. On pushing the uterus upwards does not move the

Medical FunNotes at http://www.mbbsdost.com/funnotes 87


cord with it due to the separation.

Ladins Sign:

Softening in the midline of the uterus anteriorly at the junction of the uterus
and cervix. It occurs at about 6 weeks gestation

Lambda Sign:
Ultrasonographic sign seen in dichorionic pregnancies. Due to the chorionic
tissue in between the two layers of the membrane between the twins.

Lemon Sign:
Ultrasound sign in open spina bifida. Shows abnormal anterior curvature of
cerebellum. Due to the associated Arnold-Chiari malformation.

Osianders Sign:
Pulsations in the lateral fornix due to the increased vascularity.

Palmers Sign:
Regular rhythmic contractions of uterusHidden Content.
felt as early as 6-8 weeks . It is a sign of
pregnancy. Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Piskaceks Sign:
Asymmetric growth occurs to the uterus in initial stages of pregnancy due to the
lateral implantation of the blastocyst. The area of implantation feels soft
compared to the other parts.

Roberts Sign:
Radiological sign of intrauterine fetal death. X-ray shows presence of gas in the
fetal great vessels. Earliest radiological sign of intrauterine fetal death

Schroders Sign:
A sign of placental separation. Uterus rises up when the separated placenta
is passed downwards.

Spalding Sign:
Sign of intrauterine fetal death. Overlapping of skull bones after fetal demise.
Observed by ultrasonogram.

Stallworthys Sign:

88 Medical FunNotes at http://www.mbbsdost.com/funnotes


Slowing of fetal heart rate on pressing the head down I to the pelvis and prompt
recovery on release of pressure is termed Stallworthys sign. This sign is
suggestive of posterior placenta praevia.

Stuck Twin Sign: Hidden Content.


Purchase
Seen in twin to twin transfusion the Due
syndrome. FulltoBook in Rs.
the severe 350/-
oligohydramnios
onposition
smaller twin is held in a fixed www.mbbsdost.com/funnotes
along the uterine wall. This is called stuck
twinsign.

T Sign:
Ultrasonographic sign seen in monochromic twins. As the intertwin membrane
does not have any chorionic tissue it gives rise to T sign in ultrasound

Imp points about rotavirus


not cultivable

no latency seen

more common cause of infantile diarrhoea


Hidden Content.
encapsulated ds RNA genomePurchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Incubation period 2 days

commonly effect terminal ileum

Bad smells
Musty/mousy : phenylketonuria

Boiled cabbage : tyrosinemia, hypermethioninemia


Hidden Content.
Maple syrup : maple syrup the
Purchase urineFull Book in Rs. 350/-
disease
on www.mbbsdost.com/funnotes
Rotting fish : trimethylaminuria

Sweaty feet : isovaleric academia, glutaric academia (type II)

Medical FunNotes at http://www.mbbsdost.com/funnotes 89


Drugs causing lichenoid eruption
Mnemonic-CNG Prices Kill Delhi People Constantly
Hidden Content.
Chloroquine Ketoconazole
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NSAIDS on www.mbbsdost.com/funnotes
Dapsone
Gold Penicillamine
Phenothiazine Captopril

SHOULDER JOINT
ABDUCTION
initiator : supraspinatus
next : middle deltoid fibers
upto120 :
infraspinatus
subscapularis
t.minor Hidden Content.
120-180 : trapezius Purchase the Full Book in Rs. 350/-
serratus anterior
on www.mbbsdost.com/funnotes
ADDUCTORS AND MEDIAL ROTATORS:
T.major
P.major
L.dorsi ant deltoid fibers
LATERAL ROTATORS:
infraspinatus
T.minor

Strawberrys in Medicine
Strawberry tongue kawasaki disease,scarletfever
Strawberry gums wegener's granulomatosis
Strawberry hemangioma Hidden Content.
capillary hemangioma
Strawberry vagina in Purchase the Full Book in Rs. 350/-
trichomoniasis.
on www.mbbsdost.com/funnotes
Strawberry skin n nasal mucosa sarcoidosis
Strawberry nasal mass rhinosporidiosis
Strawberry shaped skull edward syndrome
Strawberry gallbladder cholestrolosis

90 Medical FunNotes at http://www.mbbsdost.com/funnotes


Energy of different types of food ingredients
Mbbsdost tip: good way to remember is to revise these values whenever you eat a
meal and discuss with your friends and family.
Dietary fiber :: 2 kcal(dnb 2013)
Dextrose :: 3.4 kcal
Glucose ::
Hidden Content.
4 kcal Protein
In vitro :: Purchase
5.3 kcal the Full Book in Rs. 350/-
In vivo :: on www.mbbsdost.com/funnotes
4 kcal
Alcohol :: 7 kcal
ATP :: 7.3 kcal
Fat :: 9 kcal
All values per gram

Extra malarial uses of chloroquine


Mnemonic - REDLIp Discoid lupus
erythromatous
Hidden Content.
Purchase the Full Book in Rs. 350/-
Rhematoid arthrithis
Lepra reaction
on www.mbbsdost.com/funnotes

Extra intestinal ameobiasis


Infectous mononucleousis

Medical HUTCHINSONS
1. HUTCHINSONS FRECKLES : Lentigo maligna.
Hidden Content.
2. HUTCHINSONS PUPIL : Blown pupil
Purchase theinFull
uncal
Bookherniation.
in Rs. 350/-
3. HUTCHINSONS TEETH : on www.mbbsdost.com/funnotes
Congenital syphilis.
4. HUTCHINSONS SIGN : Herpes Zoster Opthalmicus.
5. HUTCHINSONS TRIAD : Congenital Syphilis

Pleural Fluid Volumes


Normal level of pleural fluid is 5-10 ml and it can be detected in the following
investigations with the respective amount
X-ray chest PA view ... 200 ml
Hidden Content.
X-ray chest Lateral view ... 100 ml
Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes
Ultrasound chest ... 50 ml
CT scan ... 25 ml

Medical FunNotes at http://www.mbbsdost.com/funnotes 91


Allergy Management
Identification, treatment, and prevention of allergic responses to food,
medications, insect bites, contrast material, blood, or other substances
Identify known allergies and usual reaction (e.g., medication, food, insect,
environmental).
Notify care givers and health care providers of known allergies.
Document all allergies in clinical record, according to protocol.
Place an allergy band on client, as appropriate.
Monitor client for allergic reactions to new medications, formulas, foods,
and/or test dyes.
Hidden Content.
Encourage client to wear a medical alert tab, as appropriate.
Purchase the Full Book in Rs. 350/-
Provide medication to reduce or minimize an allergic response.

on www.mbbsdost.com/funnotes
Assist with allergy testing, as appropriate.
Administer allergy injections, as needed.
Instruct client to avoid allergic substances, as appropriate.
Instruct client to avoid further use of substances causing allergic responses.
Discuss methods to control environmental allergens (e.g., dust, mold, and
pollen).
Instruct client and care giver(s) on how to avoid situations that put them at
risk and how to respond if an ana phylactic reaction should occur.
Instruct client and care giver on use of epinephrine pen.

Postmortem Staining
CO poisoning : Cherry red
HCN, Burn : Bright red
Nitrites, Aniline, Potassium bicarbonate : Hidden
Chocolate brown
Content.
Phosphorus Purchase: the
Dark brown
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Asphyxia on www.mbbsdost.com/funnotes
: Bluish violet or purple
Septic abortion : Bronze
Refrigerated body : Bright pink
Mummification : turns from Brown to Black

92 Medical FunNotes at http://www.mbbsdost.com/funnotes


Soft Tissue Sarcomas
Rare unusual neoplasm of soft tissues
MC site: Extremity (lower >upper) > Trunk >
Retroperitoneum >Head & Neck
MC type: Malignant fibrous histiocytoma >Liposarcoma >Leiomyosarcoma
>Synovial sarcoma >Malignant peripheral nerve sheath tumor
MC pediatric soft tissue sarcoma: Rhabdomyosarcoma Histopathological
Type of STS is Site Dependent Extremity
Malignant fibrous histiocytoma >Liposarcoma Retroperitoneum
Liposarcoma Viscera
GIST Pathology: STS tends to grow along fascial planes, with the surrounding
soft tissue compressed to form a pseudocapsule.
Clinical behavior of STS is determined by: Anatomic location (depth), grade &
size
MC route of spread in soft tissue sarcoma: Hematogenous
MC site of metastasis: Lung; Lymphatic metastasis is rare
Clinical Features:
Hidden Content.
MC symptom of STS: Painless mass
Purchase the Full Book in Rs. 350/-
Size at presentation is dependent on the location of tumor.
on www.mbbsdost.com/funnotes
Smaller tumors are located in distal extremities
Larger tumors are detected in proximal extremity & retroperitoneum.
Retroperitoneal STS almost always present as large asymptomatic mass
Diagnosis of Soft Tissue Sarcoma
Core-cut or true-cut biopsy (CT or USG guided) is diagnostic
Incisional biopsy is done if core-cut biopsy is non-diagnostic
FNAC: To confirm or rule out presence of metastatic focus or local recurrence
MRI: IOC for assessing extremity STS
CECT: IOC for assessing retroperitoneal sarcoma
Treatment:
Adequate excision + adjuvant radiotherapy with or without adjuvant
chemotherapy.
Prognosis:
Best prognostic factor of soft tissue sarcoma: Grading
Best prognosis is seen in: Extremity STS
MC cause of death in STS: Metastasis; 5-year survival rate for STS (all stages):
50-60%

Medical FunNotes at http://www.mbbsdost.com/funnotes 93


Side effects of drugs
Agranulocytosis Clozapine
Aplastic Anemia Chloramphenicol NSAIDs Benzene
Atropine-like Side Effects Tricyclics
Cardiotoxicity Doxorubicin Daunorubicin
Cartilage Damage in children Fluoroquinolones (Ciprofloxacin &
Norfloxacin)
Cinchonism Quinidine
Hidden Content.
Cough ACE Inhibitors
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Diabetes Insipidus Lithium
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Disulfiram-like effect Metronidazole Sulfonylureas (1st generation)
Extrapyramidal Side Effects Antipsychotics (Thioridazine, Haloperidol,
Chlorpromazine)
Fanconi's Syndrome Tetracycline
Fatal Hepatotoxicity (necrosis) Valproic Acid Halothane Acetaminophen
Gingical Hyperplasia Phenytoin
Gray Baby Syndrome Chloramphenicol
Gynecomastia Cimetidine Azoles Spironolactone Digitalis

Lobes of lungs
Key points of projection of the lungs low borders on the anterior and posterior
chest include the following:
Topographic line The right lung The left lung
Parasternal The Vth intercostal space -
Midclavicular The VIth rib Hidden Content.-
Anterior axillary
Purchase the Full Book
The VIIth rib
in Rs. 350/-
The VIIth rib
on www.mbbsdost.com/funnotes
Midaxillary The VIIIth rib The VIIIth rib
Posterior axillary The IXth rib The IXth rib
Scapular The Xth rib The Xth rib
Paravertebral At the level of the 11th At the level of the 11th
thoracic spinous processus thoracic spinous processus
94 Medical FunNotes at http://www.mbbsdost.com/funnotes
Hidden Content.
Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes

Medical FunNotes at http://www.mbbsdost.com/funnotes 95


Hidden Content.
Purchase the Full Book in Rs. 350/-
on www.mbbsdost.com/funnotes

96 Medical FunNotes at http://www.mbbsdost.com/funnotes


Special Muscles
Boxer's muscle : serratus anterior

Muscle of marriage : medial rectus

Muscle of divorce : lateral rectus

Swimming muscle : pronator quadratus

Climbing muscle : latissimus dorsi


Hidden Content.
Tailor muscle Purchase
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sartorius
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Red muscle : postural muscle

White muscle : extra occular muscle

Spurt muscle : biceps

Shunt muscle : brachioradialis

Disorders of the respiration


Disorders of the respiratory rate

Tachypnea is the increase of the respiratory rate.


Bradypnea is the decrease of the respiratory rate.
Hidden Content.
Dyspnea is the distress during breathing.
Apnea is the cessation ofPurchase
breathing. the Full Book in Rs. 350/-
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Disorders of the respiratory depth

Hyperpnea is an increased depth.


Hypoventilation is a decreased depth and irregular rhythm.
Hyperventilation is an increased rate and depth.

Medical FunNotes at http://www.mbbsdost.com/funnotes 97


Mechanism of labour:
Mnemonic - Every Decent Female I choose to Employ Rises Extremely
Every-Engagement
Decent-Descent
Female-Flexion Hidden Content.
Purchase the Full Book in Rs. 350/-
I-Internal rotation
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Choose to-Crowning
Employ-Extension
Rises-Restitution
Extremely-External rotation

98 Medical FunNotes at http://www.mbbsdost.com/funnotes


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