1.

ANATOMY
2. PHYSIOLOGY
3. BIOCHEMISTRY
4. OTORHINOLARYNGOLOGY
5. MICROBIOLOGY
6. ANASTHESIA
7. DERMATOLOGY
8. FORENSIC MEDICINE
9. SURGERY
10. PSYCHIATRY
11. PAEDIATRICS
12. PATHOLOGY
13. RADIOLOGY
 14. SOCIAL AND PREVENTIVE MEDICINE

ANATOMY
Table – 1 Types of Bones

Membranous bones Facial bones , skull vault bones

Pneumatic bones Maxilla , ethmoid , sphenoid ,
frontal , mastoid/temporal
Cancellous/Spongy/Trabecular Flat bones , End of long bones
bones
Cortical/Compact bones Shaft of long bones
Sesamoid bones Patella , Pisiform , Fabella

Table – 2 Cartilages

Types of cartilage Examples

Hyaline Embryonic , Epiphyseal plate
Arytenoid , Thyroid
Costal cartilages
Tracheal , Bronchial
Nose &Laryngral cartilages
Fibrocartilage Menisci
Intervertebral disc
Intraarticular disc/Labrum
Symphysis
Acromioclavicular joint
Elastic Cartilage in auricle/external
ear/external acoustic meatus
Inlet of larynx , corniculate ,
cuneiform
Epiglottis

Table – 3 Joints

Synovial joint
Hinge joint Ankle , elbow ,interphalangeal
joints
Ellipsoid joint Wrist , all MCPs , atlanto-occipital
Pivot joint (Trochoid) Superior & inferior radio ulnar joint
 , atlanto axial
Bi-condylar joint Knee , TM joints of jaw
Saddle joint Thumb , sternoclavicular ,
calcaneocuboidal , incudo-malleus
Ball & socket Shoulder , hip , talo-calcaneo-
navicular , incudo-stapedial joint

Fibrous joint
Sutures Skull
Syndesmosis Distal tibiofibular joint , foot plate
of stapes with oval window
Gomphosis (peg & socket joint) Tooth in its socket (dentatoalveolar
joint)

Cartilaginous joint
Primary (Synchondrosis/hyaline
cartilage joint)
Secondary (Symphyses or
fibrocartilaginous joint)
Growth plate , spheno-occipital
joint , first chondrosternal ,
costochondral joint
Symphysis pubis , manubriosternal
joint , intervertebral joint ,
sacrococcygeal joint ,
acromioclavicular joint

Table – 4 Contents of cranial fossa

1) Anterior cranial fossa

Foramen caecum Nasal emissary vein
Cribriform plate of ethmoid Olfactory nerve
Anterior & Posterior ethmoidal Anterior & Posterio ethmoidal vessels
foramina & Nerves

2) Middle cranial fossa

Optic canals Optic nerve , Ophthalmic artery
Superior orbital fissure Ophthalmic veins , Ophthalmic
nerve(Lacrimal , Frontal & Nasociliary
) 3rd , 4th , 6th nerves
Foramen rotundum Maxillary nerve
Foramen ovale Mandibular nerve , Accessory
meningeal nerve , Lesser petrosal
nerve , Emissary vein
Foramen spinosum Middle meningeal artery , Nervous
spinosus
Foramen lacerum Some meningeal veins & arteries

3) Posterior cranial fossa

Foramen magnum Medulla, Meninges , Vertebral arteries
, Spinal part of 11th nerve , Anterior &
Posterior spinal arteries
Jugular foramen 9th , 10th , 11th nerves , Internal jugular
veins , Inferior petrosal sinus ,
Meningeal branches of ascending
 Pharyngeal artery,
Hypoglossal canal 12th nerve, meningeal branches of
ascending pharyngealand occipital
artery

Table – 5 Embryological development of Zygote

Age Somites Characteristics
0-1 - Fertilized uncleaved zygote
2-3 - Segmentation=two cells to morula
4-5 - Unimplanted, free-floating blastocyst
6-7 - Implantation
8-11 - Progression into endometerium
12-14 - Embryonic dis, villi, and yolk sac appear
15-16 - Primitive streak appears
17-18 - Neural folds elevate.
19-20 1-3 Head fold appears
21-23 4-12 Neural fold fusion begins, heart begns to
beat
23-25 13-20 Two branchial arches, foregut, hindgut,optic
evagination
21-29 21-29 Arm buds appear, neural tube closed, optic
cup
28-30 40 Leg buds apear, heart chambers, lung buds,
(complete metanephric bud
no.)
30-32 - Lens invagination, septum primum, gonadal
ridge
32-34 - Lens vesicle closed, external ears becoming
recognizalbe
35-36 - Eye pigment appears, hand plate,
hypophysis, liver
37-40 - Finger rays, foot plate, ear defined, somites
less apparent superficially
40-42 - Eyelid, finger rays notched, toe rays, nerve
plexuses
42-44 - Head more erect, limbs extend forward,
muscles developing, duodenum closed
45-46 - Finger, scalp plexus present, optic nerve,
septum secundum
46-48 - Hands meet over heart region, corpus
striatum, thalamus, heart valves
48-50 - Fingers overlap those of opposite hand,
duodenum reopend

50-52 - Head erect and rounded, scalp plexus

reaching head vertex ossification begins
Table – 6 Embryological derivatives

Ectoderm derivatives Mesoderm derivatives

Epidermis [including hair, Connective tissue
 nails] Muscle
Nervous system Bone
Adrenal medulla Cardiovascular
Lymphatics
Urogenital structure
Serous lining of body cavities
[peritoneal]
Endoderm derivatives Neural crest derivatives
Gut tube epithelium and Melanocytes
derivatives Chromaffin cell of adrenal
Lung medulla
Liver Enterochromaffin cells
Pancreas Pia , Arachnoid & Duramater
Schwann cells
Odontoblast
Parafollicular cells of thyroid

Table – 7 Endoderm derivatives

Foregut Recess, Diverticula & glands of

pharynx
Duct cells&Follicular cells of
Thyroid
Pharyngeal pouches derivatives
Respiratory tract epithelium
Trachea, Bronchi, Bronchioles,
Alveoli
Oesophagus, stomach, Duodenum
epithelium
Hepatocytes of liver, biliary tract
Exocrine & endocrine pancreas.
Midgut Epithelial lining & glands of
Duodenum, Jejunum
Appendix, Caecum,Part of
Transverse colon (Right 2/3)
Hindgut Epithelium, Gland of part of
transverse colon (left 1/3)
Descending colon, Sigmoid colon
Rectum, upper part of Anal canal
Allantois Urinary bladder, Vagina, Urethra
Secretory cells of Prostate &
Urethral glands

Table – 8 Derivatives of neural crest

Mesoderm Endocrine cells

Odontoblast Chromaffin cells of the
Dental papillae adrenal medulla
Chondrocranium (nasal Parafollicular cells of the
capsule, Meckel's cartilage, thyroid
scleral ossicles, quadrate, Glomus cells type I/II
articular, hyoid and
columella)
Tracheal and laryngeal
cartilage
Dermato cranium
 (membranous bones
Pericytes and smooth
muscle of branchial arteries
and veins
Tendons of ocular and
masticatory muscles
Connective tissue of head
and neck glands (pituitary,
salivary, lacrimal, thymus,
thyroid)
Dermis and adipose tissue
of calvaria, ventral neck
and face
Peripheral nervous system Other structures
Sensory neurons and glia Melanocytes and iris
of the dorsal root ganglia pigment cells
Cephalic ganglia (VII and
in part, V, IX, and X)
Rohon-Beard cells
Satellite glial cells of all
autonomic and sensory
ganglia
Schwann cells of all
peripheral nerves

Table – 9 Embryology of Eye

Neural Surface Mesoderm Neural crest

ectoderm ectoderm
Ciliary Conjunctival Extraocular Orbital bones
epithelium epithelium muscles Orbital
Iris epithelium Corneal Vascular connective tissue
Smooth epithelium endothelium of Ciliary muscles
muscles of iris ( Lacrimal glands orbit & eye Ciliary ganglion
Constrictor & Tarsal glands Corneal stroma Schwann cells of
dilator papillae Lens Sclera ciliary nerves
) Iris Meningeal
Part of vitreous Choroids sheath of optic
Retinal Part of vitreous nerve
pigment Conjunctival &
epithelium uveal
Retina melanocytes
Optic vesicle & Sclera
cup Trabecular
Optic nerve meshwork
epithelium
Corneal stroma,
keratocyte.
endothelium
Iris stroma
Choroidal stroma
Part of vitreous

Table – 10 Pharyngeal Arches & Pouches

Pharyngeal cleft derivatives

Pharyngeal cleft Fate
Ist External ear, External auditory meatus
 , ear drum
IInd, IIIrd, IVth 2nd arch grows over to form cervical
sinus disappears, may persist as
brachial cyst

Fate of Endodermal Pouches

Pouch Fate
I st Pouch Ventral Part Obliterated by formation of tongue
Dorsal part Together with dorsal part of 2nd
Pouch forms tubotympanic recess
Proximal part - Eustachian tube
Distal Part - Middle ear cavity &
tympanic antrum
IInd Pouch Ventral Part Tonsil
Dorsal Part Formation of tubotympanic recess
IIIrd Pouch Thymus & Inferior Parathyroid glands
IVth Pouch Thyroid (from thyro-glossal duct) &
superior Parathyroid glands
Vth Pouch Para-follicular (C-Cells) of thyroid
from ultimo-bronchial body

Pharyngeal grooves
Pharyngeal groove 1 gives rise to epithelial lining of external auditory meatus
All other grooves obliterated
Pharyngeal arch derivatives
Arch Nerve Artery Muscles Skeletal (Neural
(Neural (mesoderm) crest)
ectoderm)
1 V3 Maxillary Muscles of Maxilla (Meckels
Mandibular Mandibular Artery mastication cartilage)
arch nerve (Masseter,Temporalis, Mandible
Medial & Lateral Malleus
pterygoid) Incus
Anterior belly Sphenomandibular
Digastirc & Mylohyoid ligaments
muscle
Tensor tymphani,
Tensor palati
2 Hyoid VII Facial Stapedial Muscles of facial Stapes,
arch nerve Artery expression Superior
Reicherts Stapedius muscle part of
cartilage Stylohyoid muscle hyoid
Digastric – posterior Smaller
belly horn of
hyoid
Styloid
process
Stylohyoid
ligament
3 IX Right & Left Stylopharyngeous Hyoid
Common muscle bone –
and Internal inferior
Carotid part
 artery Greater
horn of
hyoid
4 X Right Cricothyroid muscle Thyroid
Superior subclavian Palatine muscles all cartilage
laryngeal artery except Tensor Palati
N Arch of aorta All Pharyngeal
muscles except
Stylopharyngeous
6 X Right & Left All intrinsic muscles All other
Recurrent pulmonary of larynx (except laryngeal
laryngeal artery, cricthyroid muscle) cartilages
N Ductus
arteriosum
Muscles Occipital Hypoglossal All Tongue muscles
of myotome nerve XII except palatoglossus
myotome
Preotic Occulomotor All extra ocular
origin
myotome nerve muscles except
Superior oblique(IV
nerve) & lateral
rectus (VI nerve)
XI nerve Sternocleidomastoid Scapula
Trapezius Skull

Table – 11 Embryology of Genitals

Embryological Male Female

structure

Wolffian / Vas deferens , Epoophoron , Gartner’s

Mesonephric duct Epididymis , Seminal duct
vesicle
Mesonephrictubules Paradidymis Epoophoron ,
Paroophoron
Mullerian / Appendix of testes Uterus , Cervix , Tubes ,
Paramesonephric Upper vagina
duct
Urogenital sinus Urinary bladder , Urinary bladder ,
Urethra , Prostate , Urethra , Paraurethral
Prostatic utricle , glands , Bartholin’s
Bulbourethral glands glands , Lower vagina
Mullerian tubercle Glans of penis Clitoris
Genital swelling Scrotum Labia majora
Urogenital folds Penis , Urethra Labia minora

Vestigeal structure in the region of Testis

Vestigial structure
Appendix of Testis
Appendix of Epididymis
Superior & Inferior
absentductules and Paradidymis
Embryological remnant
Paramesonephric duct
Mesonephros
Mesonephric tubules
Vestigeal structure in the region of Ovary
Vestigial structure Embryological remnant
Epoophoron , Paroophoron Mesonephros
Duct of epoophoron Mesonephric duct

Table – 12 Histology

System Tissue Epithelium Subtype

Circulatory Blood vessels Simple squamous Endothelium
Digestive Ducts of Stratified columnar -
submandibular
glands
Attached Stratified squamous, -
gingiva keratinized
Dorsum of Stratified squamous, -
tongue keratinized
Hard palate Stratified squamous, -
keratinized
Esophagus Stratified squamous, -
non-keratinized
Stomach Simple columnar, non- Gastric
ciliated epithelium
Small intestine Simple columnar, non- Intestinal
ciliated epithelium
Large intestine Simple columnar, non- Intestinal
ciliated epithelium
Rectum Simple columnar, non- -
ciliated
Anus Stratified squamous, -
non-keratinized
superior to Hilton's
white line
Stratified squamous,
keratinized inferior to
Hilton's white line
Gallbladder Simple columnar, non- -
ciliated
Endocrine Thyroid Simple cuboidal -
follicles
Nervous Ependyma Simple cuboidal -
Lymphatic Lymph vessel Simple squamous Endothelium
Integumentary Skin - dead Stratified squamous, -
superficial keratinized
layer
Sweat gland Stratified cuboidal -
ducts
Mesothelium Simple squamous Mesothelium
of body
cavities
Reproductive Ovaries Simple cuboidal Germinal
– female epithelium
(female)
 Fallopian Simple columnar, -
tubes ciliated
Endometrium Simple columnar, -
(uterus) ciliated
Cervix Simple columnar -
(endocervix)
Cervix Stratified squamous, -
(ectocervix) non-keratinized
Vagina Stratified squamous, -
non-keratinized
Labia majora Stratified squamous, -
keratinized
Reproductive Tubuli recti Simple cuboidal Germinal
– male epithelium
(male)
Rete testis Simple cuboidal -
Ductuli Pseudostratified -
efferentes columnar
Epididymis Pseudostratified -
columnar, with
stereocilia
Vas deferens Pseudostratified -
columnar
Ejaculatory Simple columnar -
duct
Bulbourethral Simple columnar -
glands
Seminal Pseudostratified -
vesicle columnar
Respiratory Oropharynx Stratified squamous, -
non-keratinized
Larynx Pseudostratified Respiratory
columnar, ciliated epithelium
Larynx - True Stratified squamous, -
vocal cords non-keratinized
Trachea Pseudostratified Respiratory
columnar, ciliated epithelium
Respiratory Simple cuboidal -
bronchioles
Sensory Cornea Stratified squamous, Corneal
non-keratinized epithelium
Nose Pseudostratified Olfactory
columnar epithelium
Urinary Kidney - Simple cuboidal, with -
proximal microvilli
convoluted
tubule
Kidney - Simple squamous -
ascending thin
limb
Kidney - distal Simple cuboidal, without -
convoluted microvilli
 tubule
Kidney - Simple cuboidal -
collecting duct
Renal pelvis Transitional Urothelium
Ureter Transitional Urothelium
Urinary Transitional Urothelium
bladder
Prostatic Transitional Urothelium
urethra
Membranous Pseudostratified -
urethra columnar, non-ciliated
Penile urethra Pseudostratified -
columnar, non-ciliated
External Stratified squamous -
urethral orifice

Table – 13 Lymphatic drainage of pelvic organs

Pelvic organs Lymph nodes

Ovary (along ovarian artery) Lumbar

Uterine tube (except part near Lumbar

uterus) (along ovarian artery )

Uterus Upper part of the Lumbar

body

Lower part of the External iliac

body

Cervix External iliac, internal iliac, and

sacral

Region near uterine tube (along Superficial inguinal

round ligament)

Vagina Upper part ( along External and internal iliac

uterine artery )

Middle part ( along Internal iliac

vaginal artery )

Lower Internal iliac

part Sacral and common iliac
Part Superficial inguinal
below
hymen
(with
those
from
vulva and
skin of
perineum)

Testis and epididymis (along testicular Lumbar

artery )

Seminal vesicle External and internal iliac

Ductus deferens (pelvic portion) External iliac

Prostate Internal iliac mainly; sacral

and external iliac

Scrotum Superficial inguinal

Penis (clitoris) Skin and prepuce Superficial inguinal

Glans Deep inguinal and external

iliac

Ureter (lower part) External or internal iliac

Bladder Superior and inferolateral External iliac

aspects

Base External iliac mainly;

internal iliac

Neck Sacral and common iliac

Urethra Female (along internal Internal iliac mainly;

pudendal artery) external iliac

Male prostatic and Internal iliac mainly;

membranous parts (along external iliac
internal pudendal artery )

Spongy part Deep inguinal

mainly; external
iliac

Rectum Upper part Inferior mesenteric

Lower part Sacral, internal iliac,

and common iliac

Anal canal Above Internal iliac

pectinate line
(along inferior
rectal and
internal
pudendal
artery )

Below Superficial inguinal

pectinate line
Table – 14 Formation of Brachial plexus

Nerve Roots Muscles Cutaneous

Roots
Dorsal C4, C5 Rhomboid muscles; -
scapular nerve Levator scapulae
Long thoracic C5, C6, C7 Serratus anterior -
nerve
Branch to C5 - -
phrenic nerve
Upper trunk
Nerve to the C5, C6 Subclavius muscle -
subclavius
Suprascapular C5, C6 Supraspinatus ; -
nerve Infraspinatuss
Lateral cord
Lateral pectoral C5, C6, C7 Pectoralis major and -
nerve pectoralis minor
Musculocutane C5, C6, C7 Coracobrachialis; Becomes the
ous nerve Brachialis; Biceps lateral
brachii cutaneous
nerve of the
forearm
Lateral root of C5, C6, C7 Fibres to the median -
the median nerve
nerve
Posterior cord
Upper C5, C6 Subscapularis (upper -
subscapular part)
nerve
Thoracodorsal C6, C7, C8 Latissimus dorsi -
nerve (middle
subscapular
nerve)
Lower C5, C6 Subscapularis (lower -
subscapular part ) and teres major
nerve
Axillary nerve C5, C6 Anterior branch: Posterior
deltoid and a small branch
area of overlying skin becomes upper
posterior branch: teres lateral
minor and deltoid cutaneous
muscles nerve of the
arm
Radial nerve C5, C6, C7, Triceps brachii, Skin of the
C8, T1 supinator, anconeus, posterior arm
the extensor muscles as the posterior
of the forearm, and cutaneous nerve
brachioradialis of the arm
Medial cord
Medial C8, T1 Pectoralis major -
pectoral nerve ,pectoralis minor
Medial root of C6-T1 Fibres to the median Portions of
the median nerve hand not served
nerve by ulnar or
radial

Medial C8, T1 - Front and

cutaneous medial skin of
nerve of the the arm
arm
Medial C8, T1 - Medial skin of
cutaneous the forearm
nerve of the
forearm
Ulnar nerve C8, T1 Flexor carpi ulnaris, The skin of the
the medial two bellies medial side of
of flexor digitorum the hand and
profundus, the medial one and
intrinsic hand muscles a half fingers on
except the thenar the palmar side
muscles and the two and medial two
most lateral and a half
lumbricals fingers on the
dorsal side

Table – 15 Nerves of Upper limb

Ulnar nerve Median nerve Radial nerve

Root value C7-8 T1 C5C6C7 (Lateral C7,8 T1
root)
Also known as Musician Nerve laborer's Nerve, Largest branch of
(deep br) 'Eye of the hand' branchial plexus
Proximal Injury at elbow Injury at elbow Injury in axilla
lesion Tardy or late Seen in Injured d/to
ulnar n palsy supracondylar pressure of the
occurs in valgus #/lower end # crutch (crutch
deformity of humerus, palsy)
elbow (# medial pronator Results in paralysis
epicoondyle, # syndrom, of all the m/s s/by
lateral condyle application of radial n.
humerus) tight tourniquet □ Wrist drop
Results in □ Finger drop
cubital tunnel Results in hand □ Thumb drop
of Benediction # dislocation
deformity upper end
Simian hand / humerus
Ape thumb # lateralcondyle
deformity is humerus
d/to flat thenar (Ochsner clasping
eminence test +ve)
Injury at mid-
 forearm
Pointing index
(d/to paralysis
of FDS)
M/s affected FCU, FDP, Long flexors of elbow, wrist and
(motor) hypothenar wrist except finger extensors
muscles and FCU and
adductor medical half of
pollicis FDP
Sensory loss Medial 11/2 Palmar aspect + Dorsal aspect of
fingers palmar nail bed of lateral 31/2 fingers
surface lateral 31/2
fingers
Cl/finding Froment’s
thumb sign
Claw test
Tests Book test Pen test, Sign of
Card test Benediction
(Inability to fully
flex index and
middle finger)
Distal lesion Injury at wrist Injury at wrist Injury in
Radial/spiral
groove/mid arm
Causes Superficial Carpal tunnel Saturday night
injuries syndrome # palsy
lower end radius. compression on
Dislocation of OT table, I.m.
lunate/semilunar injections,
#Humerus shaft

M/s affected hypothenar thenar muscles wrist and finger

muscles and except adductor extensors
adductor pollicis
pollicis
Splints used Knuckle - Cock-up
Bender

Features Midpalmar space Thenar space

Shape Triangular Triangular
Situation Under the inner half Under the outer half
of the bellow of the of the hollow of the
palm palm
Extent Proximal Distal margin of the Distal margin of the
flexor retinaculum flexor retinaculum
Distal Distal palmar crease Proximal transverse
palmar crease

Communications Proximal Forearm space Forearm space

Distal Fascial sheaths of the Fascial sheaths of the
3red and 4th first lumbrical
lumbricals
Boundaries Anterior Flexor Short
tendons of muscle of
3rd, 4th and thumb
5th fingers Flexor
 2nd, 3rd and tendons of
4th the index
lumbricals finger
Palmar First
aponeurosis lumbrical
Palmar
aponeurosis

Posterior Fascia Transverse

covering head of
interossei adductor
and pollicis
matacarpals
Medial Medial Intermediate
palmar palmar
septum septum
Lateral Intermediate Tendon of
palmar flexor
septum pollicis
longus with
radial bursa
Lateral
palmar
septum
Drainage Incision in either the Incision in the first
3rd or 4th web space wed, posteriorly

Table – 16 Openings of diaphragm

Large openings of the diaphragm:

Opening Vertebral Part of Structures
Level Diaphiragm Passing
Vena caval T8 Central tendon IVC
Right phrenic nerve
Esophageal T10 Muscular portion Esophagus
derived from the Esophageal branch
right crus of left gastric artery
Vagus nerve

Aortic T12 Osseo-aponeurotic Aorta

opening between Thoracic duct
right and left crus Azygos vein

Small openings of the diaphragm:

Opening Location Passing Structure
Medial Behind medial arcuate Sympathetic chain
lumbocostal arch ligament
Lateral lumbostal Behind lateral arcuate Subcostal nerve and
arch ligament vessels
Foramen of Between xiphoid process and Suprerior epigastric
 morgagni costal origin of diaphragm vessels
(Larry's space)
Each crus of the diaphragm is pierced by greater and lesser splanchnic nerves. The left crus is also pierced
by the hemiazygos vein.

Table – 17 Portal circulation and Systemic circulation

Region Name of Portal Systemic

clinical circulation circulation
condition
Esophageal Esophageal Esophageal Esophageal
varices branch of left branches of Azygos
gastric vein vein
Rectal Rectal Varices Superior rectal Middle rectal veins
vein and inferior rectal
veins
Paraumbilical Caput Paraumbilical Superficial
medusae veins epigastric vein
Retroperitoneal (no clinical Right colic vein, Renal vein,
name) middle colic suprarenal vein,
vein, left colic paravertebral vein,
vein and gonadal vein

Intrahepatic Patent ductus Left branch of Inferior vena cava

venosus portal vein

Common venous anastomosis

a. Superior mesenteric vein - portal vein.
b. Inferior mesenteric vein - splenic vein - portal vein.
c. Right gastric vein - portal vein
d. Left gastric vein - portal vein
e. Right renal vein- IVC
f. Right gonadal vein – IVC
g. Splenic vein - portal vein
h. Left renal vein – IVC
Table – 18 Branches of Subclavian artery

Subclavian artery
PART Vertebral artery Internal thoracic Thyro-cervical trunk
1 artery Suprascapular
Superior Inferior thyroid
epigastric Transverse cervical
PART Costocervical
2 trunk
Deep cervical
Superior
intercostal
PART Dorsal scapular
3

Table – 19 Branches of Axillary artery

Axillary artery
PART Superior thoracic
1 a.

PART Acromio-thoracic Lateral-thoracic a. Alar-thoracic a.

2 a.

PART Subscapular a. Anterior circumflex Posterior

3 Circumflex humeral a. circumflex
scapular humeral a.
thoarcodorsal

Table – 20 Branches of External carotid artery

External carotid artery

Anterior Superior thyroid Lingual a. Facial a.
a.
Occipital a. Posterior auricular a.
Medial Ascending
pharyngeal a.
Terminal Maxillary a. Superficial temporal a.

Table – 21 Branches of Internal carotid artery

Internal carotid artery

Cervical
part
Petrous Caroticotympanic Pterygoid br.
part br. Pterygoid br.
Cavernous Cavernous br. Hypopyseal br.
part
Cerebral Ophthalmic a. Anterior choroidal Anterior
part a choroidal a

Middle cerebral is the continuation and largest branch of Internal Carotid Artery.
Cervical part of ICA has no branches.

Table – 22 Branches of Maxillary Artery

Part 1 Part 2(Pterygoid) Pari

(Mandibular) 3(Pterygopalatine)
Deep auricular Massetric Posterior superior
alveolar
Anterior tympanic Deep temporal(anterior) Infraorbital
Middle meningeal Deep temporal posterior) Greater(descending)
palatine
Accessory Pterygoid Pharyngeal
meningeal
Inferior alveolar Buccal Artery of pterygoid
canal
Sphenopalatine

Table – 23 Brain structure & function

Structure Function
Central sulcus Separates frontal from parietal lobe
Cerebellum Regulation and coordination of
 movement , posture , balance &
rhythm
Frontal lobe Planning , reasoning , impulse
control , personality
Occipital lobe Vision
Parietal lobe Orientation of body , perception of
stimuli
Temporal lobe Hearing , speech , memory
Choroid plexus Makes cerebro spinal fluid
Corpus callosum, splenium, Connects two hemispheres
body, genu

Gray matter One of the two components of the

central nervous
system, mostly consists of cell bodies
Hippocampus Learning, memory, spatial
orientation
Hypothalamus 4F’s (feeding, fleeing, fighting,
making love)
Lateral ventricle Filled with CSF
Longitudinal fissure Separates two hemisphere
Medulla oblongata Maintaining vital body functions
Olfactory bulb Senses olfactory stimuli
Olfactory nerve Conveys olfactory information from
nose to brain
Optic nerve Conveys visual information from
eyes to optic chiasma
Optic tract Conveys visual information from
optic chiasm to brain
Pons Motor control , consciousness ,
alertness
Primary motor cortex Execution of movement
Primary sensory cortex Processing information about touch
Spinal cord Conducts sensory information from
body to brain,
conducts motor information from
brain to body
Thalamus Relay station, brain region that
combines
information from different sensory
system
White matter One of the two components of the
central nervous
system, mostly consists of
myelinated axons

Table – 24 Important arteries of brain

Artery Origin Cortical Central branches

branches
Middle Largest and Orbital AL* central branches
cerebral direct Frontal arranged as medial
 branch of ICA Parietal and
Temporal lateral striate artery in
two groups
Anterior Smaller Orbital AM* central branches
cerebral terminal Frontal including a Heubner's
branch of ICA Parietal, including recurrent artery in one
paracentral artery group
Posterior Terminal Temporal PM* central branches
cerebral branch Occipital in one group
of basilar Parietooccipital PL* central branches
artery in two group
Posterior Largest branch It supplies :
inferior of Posterolateral part
cerebellar vertebral of medulla
artery Lower part of pons
Inferior surface of
cerebellum
*AL - anterolateral; AM = anteromedial; PM - posteromedial; PL - posterolateral

Table – 25 Blood supply of Brain

Site Blood Supply

Corpus striatum and internal Medial and lateral striate branches of
capsule middle cerebral artery
Thalamus Posterior communicating
Basilar artery
Posterior cerebral artery

Cerebellum Basilar artery branches

Superior ceerebellar
Ant. Inferior cerebellar
Vertebral artery branches
Posterior inferior cerebellar
Medulla Vertebral artery branches
Anterior spinal
Posterior spinal
Posterior inferior cerebellar
Direct medullary branches(
superior, middle,
inferior,lateral)
Basilar artery
Pons Basilar artery branches
Paramedian
Short and long
circumferential
Sup. Cerebellar
Ant.inferior cerebellar
Midbrain Posterior cerebral
Superior cerebellar
Basilar

Table – 26 Optic & Auditory pathway

Optic pathway Auditory pathway

Retina Vestibule cochlear nerve
↓ ↓
 Optic nerve Cochlear nuclei
↓ ↓
Optic chiasma Superior olivary nucleus
↓ ↓
Optic tract Lateral lemniscus
↓ ↓
Medial lemniscus Inferior colliculus
↓ ↓
Lateral geniculate body Medial geniculate body
↓ ↓
Optic radiation Auditory cortex
↓
Visual cortex

Table – 27 Muscles acting on Temporomandibular joint

Actions Muscles
Depression (Open mouth) Lateral pterygoid
Suprahyoid
Infrahyoid
Elevation (Close mouth) Temporalis
Masseter
Medial pterygoid
Protrusion (Protrude chin) Masseter (Superficial fibres)
Lateral pterygoid
Medial pterygoid
Retrusion (Retract chin) Temporalis
Masseter (Deep fibres)
Side-to-side movements (grinding Temporalis on same side
and chewing) Pterygoid on opposite side
Masseter

Table – 28 Intrinsic muscles of larynx

Exceptions: 1. All are paired except transverse arytenoid

2. All lie internally except cricothyroid
A) Muscles which modify rima glottidis
Posterior crico arytenoid Only openers of glottis, abductor of
vocal cord
Lateral crico arytenoid Closing ligamentous part of rima
glottis
Oblique arytenoid Weak adductors of vocal cord
Transverse arytenoid Closing cartilaginous part of rima
glottis

B) Muscles acting on vocal ligament

Cricothyroid Lengthens vocal ligament
Posterior cricoarytenoid Lengthens vocal ligament
Thyro arytenoid (Vocalis) Relaxes & shortens vocal ligament
(Posterior part)

C) Muscles that modify laryngeal inlet

Oblique arytenoid Closes laryngeal inlet
Aryepiglotticus Closes laryngeal inlet
Thyroepiglotticus Widen laryngeal inlet

Table – 29 Bronchopulmonary segments

Right lung
Lobes Segments
Upper Apical
Posterior
Anterior
Middle Lateral
Medial
Lower Superior
Medial basal
Anterior basal
Lateral basal
Posterior basal

Left lung
Lobes Segments
Upper Upper division Apical
Posterior
Anterior
Lower division Superior lingular
Inferior lingular
Lower Superior
Medial basal
Anterior basal
Lateral basal
Posterior basal

Table – 30 Actions of Extra-ocular muscles

Muscle Vertical Horizontal Anteroposterior Nerve

axis axis axis supply
Superior Elevation Adduction Intorsion Oculomotor
rectus nerve
Inferior Depression Adduction Extorsion Oculomotor
rectus nerve
Superior Depression Abduction Intorsion Trochlear
oblique nerve
Inferior Elevation Abduction Extorsion Oculomotor
oblique nerve
Medial - Adduction - Oculomotor
rectus nerve
Lateral - Abduction - Abducent
rectus nerve

Table – 31 Spinal cord level

Structure Cervico thoracic level

Tracheal bifurcation T4-T5
Arch of aorta Begins and ends at T4
Xiphoid process T9
Splenic axis Along 10th rib
Carotid bifurcation, Hyoid bone C3
Upper border of thyroid cartilage C4
Level of cricoids cartilage C6
Lumbar level
Celiac trunk T12-L1
Superior mesenteric artery L1
Transpyloric plane Lower border of L1
Termination of spinal cord Lower border of L1 in adults
and upper border of L3 in
newborn
Pancreas L1-L2
Left renal vein L2
Inferior mesenteric artery L3
Umbilicus L3
Aortic bifurcation L4
Transtubercular plane L5
Common iliac ends at L5-S1

Table – 32 Motor functions of Spinal cord

Levels Motor function

C1 – C6 Neck flexors
C1 – T1 Neck extensors
C3 , C4 , C5 Diaphragm
C5 , C6 Shoulder movement, raise arm (deltoid); flexion of
elbow (biceps); C6externally rotates the arm
(supinates)
C6 , C7 Extends elbow and wrist (triceps and wrist
extensors); pronates wrist
C7 , T1 Flexes wrist
C7 , T1 Supply small muscles of hand
T1 – T6 Intercostals and trunk above the waist
T7 – L1 Abdominal muscles
L1 , L2 , L3 , L4 Thigh flexion
L2 , L3 , L4 Thigh adduction
L4 , L5 , S1 Thigh abduction
L5 , S1 , S2 Extension of leg at hip ( Gluteus maximus )
L2 , L3 , L4 Extension of leg at knee ( Quadriceps femoris )
L4 , L5 , S1 , S2 Flexion of leg at knee ( Hamstrings )
L4 , L5 , S1 Dorsiflexion of foot ( Tibialis anterior )
L4 , L5 , S1 Extension of toes
L5 , S1 , S2 Plantar flexion of foot
Table – 33 Cranial nerves and origin
Cranial nerve
CN 1 (Olfactory nerve)
CN 2 (Optic nerve)
CN 3 (Oculomotor nerve)
CN4 (Trochlear nerve)
CN5 (Trigeminal nerve)
CN 6 (Abducent nerve)
CN 7 (Vestibulocochlear nerve)
CN 8 (Vestibulocochlear nerve)
CN 9 (Glossopharyngeal nerve)
CN 10 (Vagus nerve)
CN 11 (Spinal accessory nerve)
CN 12 (Hypoglossal nerve)
Table – 34 Cranial Nerves – Components & Function
Cranial Nerves
Number Name Components
I Olfactory Sensory (SVA) Smell
II Optic Sensory
(SSA)
III Oculomotor Motor
(GSE,
GVE)
Origin
Olfactory mucosa of the upper
portion of the nasal cavity
Ganglion cells of the retina
Midbrain at superior colliculus,
anterior periaquesductal gray
(Oculomotor nerve and Edinger
westphal nucleus)
Midbrain at Inferior colliculus,
anterior periaqueductal gray
Midpons (Chief sensory nucleus,
Motor nucleus, Nucleus of spinal
tract of trigeminal and Long
nucleus)
Midpons to Midbrain
(Mesencephalic nucleus)
Lower pons at Facial colliculus
Lateral aspect of 4th ventricle
(vestibular nerve)
Acoustic tubercle (Cochlear nerve)
Lateral aspect of 4th
ventricle(Vestibular nerve)
Medulla (Nucleus of solitary tract
and Nucleus ambiguus)
Vagal trigone, Medulla(Dorsal
motor nucleus, Nucleus of solitary
tract and nucleus ambiguus and
Nucleus of spinal tract of
trigeminal)
Medulla and cervical
segments(Nucleus ambiguus and
Disperse cell bodies)
Hypoglossal trigone, Medulla
Function Opening in
Skull
Openings in
cribriform
plate of
ethmoid
Vision Optic canal
Raises upper eyelid, Superior
turns eyeball orbital
upward, downward, fissure
and medially;
constricts pupil;
accommodates eye
IV Trochlear Motor Assists in turning Superior
(GSE) eyeball downward orbital
and laterally fissure
V Trigeminal
Ophthalmic Sensory Cornea, skin of Superior
division (GSA) forehead, scalp, orbital
eyelids, and nose; fissure
also mucous
membrane of
paranasal sinuses
and nasal cavity
Maxillary Sensory Skin of face over Foramen
division (GSA) maxilla; teeth of rotundum
upper jaw; mucous
membrane of nose,
the maxillary sinus,
and palate
Mandibular Motor Muscles of Foramen
division (SVE) mastication, ovale
mylohyoid, anterior
belly of digastric,
tensor veli palatini,
and tensor tympani
Sensory Skin of cheek, skin
(GSA) over mandible and
side of head, teeth
of lower jaw and
temporomandibular
joint; mucous
membrane of
mouth and anterior
part of tongue

VI Abducent Motor (GSE) Lateral rectus Superior

muscle turns orbital
eyeball laterally fissure
VII Facial Motor (SVE) Muscles of face Internal
and scalp, acoustic
stapedius meatus,
muscle, facial canal,
posterior belly stylomastoid
of digastric and foramen
stylohyoid
muscles
Sensory (SVA) Taste from
anterior two-
thirds of tongue,
from floor of
mouth and
palate
Secretomotor Submandibular
(GVE) and sublingual
parasympathetic salivary glands,
the lacrimal
gland, and
glands of nose
and palate
VIII Vestibulocochlear Sensory (SSA) From utricle Internal
 Vestibular and saccule and acoustic
semicircular meatus
canals—position
and movement
of head
Cochlear Sensory (SSA) Organ of Corti—
hearing

IX Glossopharyngeal Motor (SVE) Stylopharyngeus Jugular

muscle—assists foramen
swallowing
Secretomotor Parotid salivary
(GVE) gland
parasympathetic
Sensory (GVA, General
SVA, GSA) sensation and
taste from
posterior one-
third of tongue
and pharynx;
carotid sinus
(baroreceptor);
and carotid
body
(chemoreceptor)
X Vagus Motor Heart and great Jugular
(GVE, thoracic blood foramen
SVE) vessels; larynx,
Sensory trachea, bronchi,
(GVA, and lungs;
SVA, GSA) alimentary tract
from pharynx to
splenic flexure of
colon; liver, kidneys,
and pancreas
XI Accessory
Cranial root Motor Muscles of soft Jugular
(SVE) palate (except foramen
tensor veli palatini),
pharynx (except
stylopharyngeal,
and larynx (except
cricothyroid in
branches of vagus

Spinal root Motor Sternocleidomastoid

(SVE) and trapezius
muscles
XII Hypoglossal Motor Muscles of tongue Hypoglossal
(GSE) (except canal
palatoglossus)
controlling its shape
and movement
Table – 35 Ligament Features & Function

Ligament Features & Function

Coracoclavicular ligament
Costoclavicular ligament
Corco-acromial ligament
llio – Femoral ligament
Transmits weight of upper limb to
axial skeleton (mainly clavicle).
Transmit some weight of upper limb
to 1M rib
Prevents superior displacement of
humeral head
- Strongest ligament in the body
- Prevents trunk from failing
backwards.
- Prevents hyperextension of hip
joint during standing.

Ischio femoral ligament Prevents hyperextension of hip joint

Pubofemoral ligament
Phrenicocolic ligament
Leinorenal ligament
Gastrospleenic ligament
Prevents over abduction of hip joint.
Support anterior end of spleen &
prevents its downward displacement
Contains spleenic vessels & tail of
pancreas
Contains short gastric vessels.

Table – 36 Comparison between nasopharynx, oropharynx and laryngopharynx

Particulars Nasopharynx Oropharynx Laryngopharynx

Situation Behind nose Behind oral Behind larynx
cavity
Extent Base of skull Soft palate to Upper border of
(body of upper boder of epiglottis to lower
sphenoid) to epiglottis border of cricoid
soft palate cartilage
Communications Anteriorly with i) Anteriorly Inferiorly with
nose. with oral oesophagus
cavity.
ii) Above with
nasopharynx
iii) Below with
laryngopharynx
Nerve supply Pharyngeal IX and X IX and X nerves
branches of nerves
pterygopalatine
ganglion
Relations Anterior Posterior nasal Oral cavity Inlet of larynx
aperture Posterior surface
of
cricoid
Arytenoid cartilage
 Posterior Body of Bone of second Fourth and fifth
sphenoid bone and third cervical vertebrae
cervical
vertebrae
Lateral Opening of Tonsillar fossa Piriform fossa
auditory tube containing
palatine tonsils
Lining Ciliated Stratified Startified
epithelium columnar squanmous dquamous
epithelium nonkeratinised nonkeratinised
ephthelium ephithelium
Function Passage for air Passage for air Passage for food
(Respiratory and food
function)

Table – 37 Glands and nerve supply

Gland Ganglian Nerve supply

Parotid Otic Auriculotemporal branch of
mandibulor division of 5th
nerve
Plus
Lesser petrosal nerve branch
of 9th nerve
Submandibular Submandibular Chordatympani branch of
facial nerve
Sublingual Submandibular Chordatympani branch of
facial nerve
Lacrimal Pterygopalatine ganglia Greater petrosal branch of
(Sphenopalatine) facial nerve

Table – 38 Differences between the small intestine and the large intestine

Differences between the small intestine and the large intestine

Feature Small intestine Large intestine
Appendices Absent Present
epiploicae
Taeniae coli Absent Present
Sacculations Absent Present

Distensibility Less More

Fixity Greater part is freely mobile Greater part is fixed
Villi Present Absent
Transverse Permanent Obliterated when
mucosal folds longitudinal muscle
coat relaxes
Peyer's patches Present in ileum Absent
Common site a) Intestinal worms a) Entamoeba
b) Typhoid histolytica
c) Tuberculosis b) Dysentery
organisms
 c) Carcinoma
Effects of Diarrhoea Dysentery
infection and
irritation

Physiology
Table – 1: Control systems and feedback

Negative feedback Positive feedback

A pathway in which response
opposes or removes the signal
Most control systems of the body
act by negative feedback
Stabilize the variable being
regulated
Examples-ACTH
secretion,Aldosterone-
potassium,Glucose
regulation,Growth hormone
secretion,BP regulation
Response reinforces rather than
decrease or removes it. Leads to
vicious cycle.
Examples-Clotting, Calcium entry
into sarcoplasmic reticulum, LH
surge during ovulation, Action
potential(Hodgkin’s cycle),
Parturition(Ferguson reflex) ,
Shock

Table – 2: Body Fluids

Total body water (60% of body weight)- 42 liters

Intracellular fluid Extracellular fluid
rd
2/3 of TBW i.e., 1/3rd of TBW .i.e., 20% body weight (14 liters)
40% body weight
(28 liters) Interstitial fluid Plasma
75% or 3/4th of ECF or 25% or 1/4th of ECF or 5%of
15% of body weight body weight (3.5 litres)
(10.5 litres)

Table – 3: Measurement of Body Fluid Volumes

Compartment Indicator used

Total body water 2
H2O(Deuterium oxide), 3H2O(Tritium

Extracellular fluid
Intracellular fluid
Plasma volume
Blood volume
Interstitial fluid
Oxide),Antipyrine
22
Na,125I-iothalamate,
Thiosulfate,Inulin,Sucrose
Calculated as Total body water –
Extracellular fluid volume.
125I-Albumin, Evans blue dye (T-1824)
(Mn:PIE)
51Cr-labeledred blood cells, or calculated
as Blood volume = Plasma volume/ (1 -
Hematocrit)
Calculated as Extracellular fluid volume -
Plasma volume

Table – 4: Resting membrane potential and Action potential

Cells Resting Depolarization Repolarization

membrane
potential (mV)
Neuron - 90 mV Na+ influx K+ efflux
Skeletal - 90 mV Na+ influx K+ efflux
muscle

Smooth - 50 to – 60 mV Ca+ influx K+ efflux

muscle
Cardiac - 90 mV Na+ influx K+ efflux
muscle
Cardiac pace - 55 mV Ca+ influx
maker cells

Table – 5: Equilibrium Potential

Ion Equilibrium Potential(mv)

Sodium +60
Potassium -90
Chloride -70

Table – 6: Important constituents and normal values of Extracellular Fluid

Oxygen 35 - 45 mmHg
Carbon dioxide 35 - 45 mmHg
Sodium 138 - 146 mmol/L
Potassium 3.8 - 5.0 mmol/L
Calcium 1.0 - 1.4 mmol/L
Chloride 103 – 112 mmol/L
Bicarbonate 24 – 32 mmol/L
Glucose 75 – 95 mg/dl
Body temperature 98 – 98.8 ℉ or 37 ℃
Ph 7.3 – 7.5

Table – 7: Functions of cell organelles

 Cell organelle Function
Nucleolus Site of synthesis of ribosomes
Ribosomes Site of protein synthesis
Rough / granular endoplasmic Synthesis of proteins
reticulum
Smooth / agranular Synthesis of lipids and steroid
endoplasmic reticulum
Golgi bodies Processing/packaging of proteins,
Synthesizing certain carbohydrates that
cannot be formed by ER(eg;hyaluronic
acid and chondroitin sulphate),
Lysosome formation
Lysosomes Formed by breaking off from the Golgi
apparatus
Also called Intracellular digestive system
Contains hydrolases to digest proteins,
carbohydrates, lipids
Contains bactericidal agents lysozyme
and lysoferrin
Peroxisomes Physically similar to lysosomes, but
contain oxidases instead of hydrolases
Proteins are directed to peroxisomes by
protein chaperones called peroxins
Mitochondria Formation of ATP

Table – 8: Transport across biomembrane

Mechanism Mode of Kinetics Examples

transport
Active Carrier mediated Against Na+K+ ATPase ;
transport concentration & Exo/Endocytosis
electrical gradient.
Energy required
Facilitated Passive from Substance moved in Glucose
diffusion high → low the direction of transporters ,
energy. But elctro chemical Hormones
carrier is gradient
required
Simple Passive but Diffusion of lipid
diffusion carrier is not soluble drugs
required
Osmosis Passive Fluid shifts from
hypo →
hyperosmolar
compartment

Table – 9: Exocytosis Vs Endocytosis

Properties Exocytosis Endocytosis

Definition Extrusion of protein from Reverse of exocytosis
golgi apparatus
Examples Emeiocytosis (reverse Phagocytosis ;
pinocytosis) is a type of Pinocytosis ;
exocytosis responsible for Receptor mediated
 insulin secretion endocytosis via
Clathrin by endosomes
for LDL digestion
Caveolin mediates
cellular ingestion of
vitamins
Dyanamin
Require Ca++ dependent process Energy
Table – 10: Functions of Glycoprotein

Function
Structural molecule
Lubricant and protective agent
Transport molecule
Immunologic molecule
Hormone
Enzyme
Cell attachment-recognition site
Antifreeze protein
Interact with specific
carbohydrates
Receptor
Affect folding of certain proteins
Regulation of development
Hemostasis (and thrombosis)
Glycoproteins
Collagens
Mucins
Transferrin, ceruloplasmin
Immuno globins, histocompatibility
antigens
Human chorionic gonadotropin
(HCG), thyroid-stimulating hormone
(TSH)
Various, e.g., alkaline phosphatase,
patatin
Various proteins involved in cell–cell
(e.g., sperm–oocyte), virus–cell,
bacterium–cell, and hormone–cell
interactions
Certain plasma proteins of cold-
water fish
Lectins, selectins (cell adhesion
lectins), antibodies
Various proteins involved in
hormone and drug action
Calnexin, calreticulin
Notch and its analogs, key proteins in
development
Specific glycoproteins on the surface
membranes of platelets

Table – 11: Blood flow to various organs

Organs Amount of blood flow

Liver 1500 ml/min
Kidney 1250 ml/min
Muscle 850 ml/min
Brain 750 ml/min
Spleen 500 ml/min
Heart 250 ml/min

Table – 12: Glucose transporters

Function Major sites of

expression
SGLT 1 Absorption of glucose Small intestine, renal
tubules
SGLT 2 Absorption of glucose Renal tubules
GLUT 1 Basal glucose uptake Placenta, Blood-brain
barrier, Brain , RBC ,
Kidneys , Colon
GLUT 2 B-cell glucose sensor; β cells of islets, Liver,
transport out of Epithelial cells of small
intestinal and renal intestine , Kidneys
epithelial cells
GLUT 3 Basal glucose uptake Brain , Placenta , Kidneys
GLUT 4 ( Glucose Insulin-stimulated Skeletal and cardiac
dependent transport ) glucose uptake muscle , Adipose tissue
GLUT 5 Fructose transport Jejunum , Sperm
GLUT 6 Unknown Pseudogene
GLUT 7 Glucose 6-phosphate Liver
transporter in
endoplasmic
reticulum

Table – 13: Erlanger and Gasser Classification

Type of Fiber Physiological Diameter Conduction Most

role (µm) Velocity susceptible
(m/s) to
A α Proprioception 12-20 70-120 PRESSURE
Somatic motor
β Touch 5-12 30-70
Pressure
γ Motor to 3-6 15-30
muscle
spindles
δ Pain 2-5 12-30
Cold
Touch
B Preganglionic <3 3-15 HYPOXIA
autonomic
C Dorsal root Pain 0.4-1.2 0.5-2 LOCAL
Temperature ANESTHETICS
Sympathetic Postganglionic 0.3-1.3 0.7-2.3
sympathetic

Table – 14: Numerical Classification of Sensory Fibres

Number Origin Fiber type

Ia Muscle spindle Aα
Annulo-spiral ending
Ib Golgi tendon organ Aα
II Muscle spindle, Aβ
Flower-spray ending
Touch
Pressure
III Pain receptors Aδ
Cold receptors
Touch receptors
IV Pain receptors Dorsal root C
Temperature receptors

Table – 15: Sensory Physiology

Modality Stimulus Energy Receptor Cell Types

Touch Tap, flutter 5–40 Hz Meissner corpuscles
Touch Motion Hair follicle receptors
Deep pressure, vibration
Touch 60–300 Hz Pacinian corpuscles
Touch Touch, pressure Merkel cells
Touch Sustained pressure Ruffini corpuscles
Proprioception Stretch Muscle spindles
Proprioception Tension Golgi tendon organ
Temperature Thermal Cold and warm receptors
Polymodal receptors or
Chemical, thermal, and chemical, thermal, and
Pain mechanical mechanical nociceptors
Vision Light Rods, cones
Hearing Sound Hair cells (cochlea)
Hair cells (semicircular
Balance Angular acceleration canals)
Linear acceleration,
Balance gravity Hair cells (otolith organs)
Smell Chemical Olfactory sensory neuron
Taste Chemical Taste buds

Table – 16: Laws of Physiology

Boyles law At constant temperature, the volume of a given mass of

gas is inversely proportional to the pressure exerted on it
Charle’s law At constant pressure, the volume is proportional to the
absolute temperature i.e., V ∞ T
Avogadro’s Equal volumes of different gases at the same temperature
law and pressure contain the same number of molecules
Ideal gas law PV=nRT
P = the pressure in atmospheres,
V = volume in liters,
n = number of gram-moles of a gas,
R = universal gas constant,
T = temperature in Kelvin
Dalton’s law In a mixture of gases, the total pressure exerted is equal
to the sum of the partial pressures of the individual
component gases
Henry’s law At constant temperature, the amount of gas dissolved in a
liquid will be directly proportional to the partial pressure
of the gas with which the liquid is in equilibrium
Graham’s In a gas phase, the rate of diffusion of a gas is inversely
law proportional to its moleculat weight
Fick’s law of The net diffusion rate of a gas through a membrane is
diffusion proportional to the tissue area and the difference in
partial pressure between the two sides, and is inversely
proportional to the thickness
Laplace law The tension(T) in the wall of a cylinder is equal to the
product of the transmural pressure(P) and the radius(r)
divided by the wall thickness(h)
T = Pr/h,

Table – 17: Classification of skeletal muscle fibers

Type-I Type-II Type-III

Other names Slow, Fast, oxidative, Fast, glycolytic
Oxidative glycolytic
Colour Red Red White
Myosin ATPase Slow Fast Fast
activity
Ca2+ pumping Moderate High High
capacity of SR
Diameter Small Large Large
Glycolytic capacity Moderate High High
Oxidative capacity High Moderate Low
Fatigability Slow Fast Very fast
Well developed in Marathon Sprinters
runners

Table – 18: Functions & Complications of Cerebral lobes

Lobes Functions Complications

Frontal lobe Motivation Personality change
Judgment Lack of attention
Behavioral Loss of executive
choices function (planning,
Planning organizing, and
Personality reasoning)
Organization Loss of judgment
Attention Dramatic change in
Expressive behavior
language and Loss of motivation
word choice
Parietal lobe Touch Inability to identify
Size, shape, objects
color Inability to
identification associate words
Spatial with meaning
perception Inability to
Visual perception distinguish left from
right
 Loss of spatial
perception
Occipital lobe Vision Loss of visual
Process colors capability
and shapes Inability to identify
colors
Hallucinations
Temporal Memory Loss of auditory
lobe Hearing capability
Processing
language and
communication
Organization
Sequencing
Emotional
interpretation

Table – 19: EEG waves

Band Frequency Location Normally

(Hz)
Delta Up to 4 Frontally in Adult slow-wave
adults, sleep
posteriorly in In babies
children; high- Has been found
amplitude waves during some
continuous-attention
tasks
Theta 4–7 Found in Young children
locations not Drowsiness or
related to task at arousal in older
hand children and adults
Idling
Associated with
inhibition of elicited
responses
Alpha 7 – 14 Posterior regions Relaxed/reflecting
of head, both Closing the eyes
sides, higher in Also associated with
amplitude on inhibition control,
non-dominant seemingly with the
side. Central purpose of timing
sites (c3-c4) at inhibitory activity in
rest different locations
across the brain.
Beta 15 – 30 Both sides, Alert
symmetrical Active, busy, or
distribution, most anxious thinking,
evident frontally; active concentration
low-amplitude
waves
Gamma 30 – 100 Somatosensory Displays during
cortex cross-modal sensory
processing
Shown during short-
term memory
 matching of
recognized objects,
sounds, or tactile
sensations
Mu 8 – 13 Sensorimotor Shows rest-state
cortex motor neurons

Table – 20: EEG changes in Sleep

Stages Behavioural observation EEG changes

NREM ( Slow
wave ) sleep
Stage – 1 - Light Easily aroused by α waves reduced in
sleep moderate stimuli frequency and amplitude
Continuous lack of
awareness
Stage – 2 - True Further lack of Appearance of sleep
sleep sensitivity to spindles
activation and arousal
Stage – 3 Sleep deepens Sleep spindles
superimposed on a
background of δ waves
Stage – 4 - Deep Activation & arousal Slow high voltage δ waves
sleep occurs with vigorous
stimulation
When awakened ,
person does not report
dreaming
REM ( Greatest relaxation & Rapid , low voltage ,
Paradoxical ) difficulty of arousal , irregular waves (
sleep - Deepest cannot be aroused by Desynchronized EEG )
sleep sensory stimuli
Skeletal muscle tone
markedly reduced
Subjects report
dreaming

Table – 21: Postural reflexes

REFLEX STIMULUS RECEPTOR CENTRE

Stretch reflex Stretch Muscle spindle Spinal cord,
medulla
Positive supporting Contact with palm or sole Proprioceptors in Spinal cord
reaction extensors
Negative supporting Stretch Proprioceptors in Spinal cord
reacting extensors
Tonic labyrinthine Gravity Otolith organs Medulla
reflex
Tonic neck reflex Head turned to Neck proprioceptors Medulla
side/up/down
Labyrinthine righting Gravity Otolitth organs Midbrain
reflex
Neck righting reflex Stretch of neck muscles Muscle spindle Midbrain
Body on head righting Pressure on side of body Exteroceptors Midbrain
reflex
Body on body righting Pressure on side of body Exteroceptors Midbrain
reflex
Optical righting reflex Visual cues Eyes Cortex
Vestibular Placing Linear acceleration Receptors in utricle and Cortex
reactions saccule
Visual placing reactions Visual cues Eyes Cortex
Hopping reactions Lateral displacement while Muscle spindle Cerebral cortex
standing

Table – 22: Hypothalamic nuclei and their function

Nuclei Function
Medial preoptic Regulates Gn release
Anterior Osmoceptors
Senses hot and triggers sweating
Supraoptic Water balance through ADH
Suprachiasmatic Circadian rhythm/ diurnal variation
Paraventricular Oxytocin release
Conserve water
Ventromedial nucleus Satiety center
Glucostat
Reward center
Dorsomedial nuclei GI stimulation
Triggers shivering
Arcuate Neuroendocrine control
Posterior Thermal regulation by conserving
heat
Lateral Feeding / hunger center
Rage center

Table – 23: Ascending tracts

Situation Tract Function
Anterior Anterior spinothalamic “Crude” touch sensation
tract
Lateral white Lateral spinothalamic tract Pain & temperature
funiculus sensation
Ventral spino cerebellar Subconscious kinesthetic
tract sensations
Dorsal spino cerebellar Subconscious kinesthetic
tract sensations

Spinotectal tract Concerned with spino

Visual reflex
Fasciculus dorsolateralis Pain & temperature
sensations
Spino reticular tract Consciousness &
awareness
Spino olivary tract Proprioception
 Spino vestibular tract Proprioception
Posterior white Fasciculus gracilis Tactile sensation
funiculus Fasciculus cuneatus Tactile localization
Tactile discrimination
“Vibratory” sensation
“Conscious kinesthetic
sensation”
“Stereognosis”
Table – 24: Descending tracts

Situation Tract Function

Pyramidal Anterior corticospinal Control voluntary, skilled
tracts tract movements
Lateral corticospinal tract Forms upper motor neurons
Forms pyramids
Extra Medial longitudinal Coordination of reflex ocular
Pyramidal fasciculus movement
tracts Integration of movements of
eyes & neck
Anterior vestibulospinal Maintenance of muscle tone &
tract posture
Lateral vestibulospinal Maintenance of position of
tract head & body during
acceleration
Reticulospinal tract Coordination of voluntary &
reflex movements.
Control of muscle tone.
Control of respiration & blood
vessels.

Tectospinal tract Control of movement of head

Rubrospinal tract
Olivospinal tract
in response to visual &
auditory impulses.
Facilitatory influence on flexor
muscle tone.
Control of movements due to
proprioception.

Table – 25: Absortion of macromolecules

Macromolecules Site of absorption
Water Passive absorption along with other
nutrients
Long chain fatty acids Upper part of small intestine
Fat soluble vitamins Upper part of small intestine along
with lipids
Vitamin C Upper part of small intestine
Thiamine , Riboflavin , Pyridoxine , Upper part of small intestine
Niacin , Biotin
Potassium Small intestine
Iron Duodenum & Upper jejunum
Sodium Jejunum
Calcium Jejunum
Folic acid Jejunum
Cyanocobalamine Ileum

Short chain fatty acids Colon

Table – 26: Secretions of GIT

GI tract Glands / Cells Secretion
Mouth Salivary gland Amylase
Ebner’s gland Lingual lipase
Stomach Parietal cells HCl , Intrinsic factor
Chief cells Pepsinogen
Enterochromaffin Histamine
cells
D cells Somatostatin
G cells Gastrin
Intestine Brunner’s gland Thick alkaline mucus , Bicarbonates
Goblet cells Mucus
Paneth cells Mucus & contains zinc
Pancreas Exocrine part Trypsin , Chymotrypsin , Elastase ,
Lipase , Colipase , Amylase ,
Hydrolase , Phospholipase A2 ,
Ribonuclease , Deoxyribonuclease ,
Carboxypeptidase A and B
A cells (α) Glucagon
B cells (β) Insulin , Amylin
D cells (δ) Somatostatin
F cells Pancreatic polypeptide

Table – 27: Digestion & Absorption of carbohydrates, proteins & fats

Salient Digestion & Digestion & Digestion &

features Absorption of Absorption of Absorption of
Carbohydrates Proteins Lipids
Oral cavity α – amylase acts on Lingual lipase
1-4 linkages
Stomach α – amylase Pepsin splits Gastric lipase
activity continues , proteins into
HCl hydrolyse proteoses ,
sucrose peptones &
polypeptides
Small Pancreatic α – Pancreatic Pancreatic lipase ,
intestine amylase, α – proteases , Brush Colipase , Bile salt
limiting dextrinase border peptidases activated lipase
, Maltase , Sucrase , , Intra cellular
Lactase peptidases
End Monosaccharides Amino acids Fatty acids
products ( Glucose , Fructose
, Galactose )
Site of Mucosal surface of Luminal Duodenum & Mid
absorption jejunum & upper membrane of jejunum
ileum epithelial cells of
small intestine
Mechanism Sodium dependent Sodium Micelles transport
of co-transport dependent active to brush border
absorption (glucose & transport membrane
galactose) mechanism (levo
amino acids)
Simple diffusion Simple difusion Diffusion of lipids
(fructose) (dextro amino across enterocyte
acids) cell membrane
Facilitated Endocytosis Transport of lipid
diffusion (larger from inside the
(pentoses) polypeptides) enterocytes to
interstitial space

Table – 28: Facts about vascular system

Maximum diameter Vena cava
Minimum diameter Capillaries
Maximum wall thickness Aorta
Minimum wall thickness Capillaries
Maximum total cross sectional area Capillaries
Minimum total cross sectional area Aorta
Maximum blood volume Veins
Minimum blood volume Arterioles
Maximum vascular resistance Arterioles > Capillaries
Site of gas exchange Capillaries
Maximum blood flow velocity Aorta
Minimum blood flow velocity Capillaries
Maximum flow rate Aorta & Vena cava
Minimum flow rate Capillaries
Maximum blood pressure Aorta
Minimum blood pressure Vena cava

Table – 29: Heart sounds

Cause Characters Site of Phonocardiogram ECG

auscultation correlation
S1 - Long & soft Best heard Single group of 9 – Coincides
Vibrations LUBB over mitral 13 waves – with peak of
set up by Duration – and tricuspid crescendo and R wave
sudden 0.15 s area diminuendo series of
closure of AV Frequency – waves
valves at the 25 – 45 Hz
start of
ventricular
systole ,
during phase
of
isovolumetric
contraction
S2 – Short , loud Best heard Single group of 4 – 6 Coincides
Vibrations High over aortic waves having same with end of T
associated pitched and amplitude wave
with closure DUBB pulmonary
of semilunar Duration – area
valves just at 0.12 s
the onset of Frequency –
ventricular 50 Hz
diastole
S3 – Short , soft Normally 1 – 4 waves grouped Appears
Vibrations Low pitched cannot be together between T
set up in Duration – heard by and P waves
cardiac wall 0.1 s auscultation
by inrush of with
blood during stethoscope
rapid filling
phase of
ventricular
diastole
S4 – Short , low Normally 1 -2 waves Coincides
Vibrations pitched cannot be with very low with interval
set up during Duration – heard by amplitude between end
atrial systole 0.03 s auscultation of P wave
coincides Frequency – with and onset of
with last 3 Hz stethoscope Q wave
rapid filling
phase of
ventricular
diastole

Table – 30: Stages of the cardiac cycle

AV valves Semilunar Status of ventricles

valves and atria
Early Open Closed Whole heart is relaxed
diastole/joint Ventricles are expanding
diastole and filling (passive filling,
~80% of volume)
Atrial systole Open Closed Atria contract and pump
blood
Additional 10–40% filling
of ventricles due to active
contraction of atria
Isovolumetric Closed Closed Ventricular myocytes
ventricular begin to contract
contraction Ventricle volume
unchanged
Ventricular Closed Open Ventricles fully contract
ejection Pump blood to rest of body
Isovolumetric Closed Closed Ventricles relax
ventricular Ventricle volume
relaxation unchanged
Atria expand and are
filling
* AV (atrioventricular) valves:
1) Mitral valve – between the left atrium and the left ventricle
2) Tricuspid valve – between the right atrium and the right ventricle †
Semilunar valves:
1) Aortic valve – between the left ventricle and the aorta
2) Pulmonic valve – between the right ventricle and the pulmonary artery

Table – 31: ECG waves

Feature Description Duration

RR The interval between an R wave and the 0.6 to 1.2s

interval next R wave
Normal resting heart rate is between 60
and 100 bpm.
P wave Atrial depolarization 80ms
PR Reflects the time the electrical impulse 120 to 200ms
interval takes to travel from the sinus node
through the AV node and entering the
ventricles
A good estimate of AV node function.
PR The PR segment connects the P wave 50 to 120ms
segment and the QRS complex
The impulse vector is from the AV node
to the bundle of His to the bundle
branches and then to the Purkinje fibers.
QRS Rapid depolarization of the right and left 80 to 120ms
complex ventricles
Larger amplitude wave.
J-point The point at which the QRS complex N/A
finishes and the ST segment begins
Used to measure the degree of ST
elevation or depression present.
ST The ST segment connects the QRS 80 to 120ms
segment complex and the T wave
Represents the period when the
ventricles are depolarized
It is isoelectric.
T wave Repolarization (or recovery) of the 160ms
ventricles
ST Measured from the J point to the end of 320ms
interval the T wave.
QT Measured from the beginning of the QRS Up to 420ms in
interval complex to the end of the T wave heart rate of 60
bpm

U wave Repolarization of the interventricular

septum
Low amplitude, and even more often is
completely absent
Follows the T wave, and also follows the
same direction in amplitude.
J wave The J wave, elevated J-point or Osborn
wave appears as a late delta wave
 following the QRS or as a small
secondary R wave.

Table – 32: WAVES IN JVP

A wave Atrial systole

C wave Bulging of tricuspid valve into the right atrium during
isovolumic ventricular contraction
V wave Filling of the right atrium by venous return
X decent Atrial relaxation and downward displacement of closed
tricuspid valve during ventricular contraction
Y descent Blood flow from RA to RV

Table – 33: Normal values of Various pressures:

Diastole Systole
Right Atrium 0 5mm Hg
Right Ventricle 0-5 mm Hg 15-30 mm Hg
Pulmonary Artery 10 mm Hg 15-30 mm Hg
Left Atrium 4 mm Hg 12mm Hg

Table – 34: Oxygen Dissociation curve

Left shift (high affinity Right shift (low

for O2) affinity for O2)

Temperature Decrease Increase

2.3-BPG Decrease Increase
P(CO2) Decrease Increase
pH(Bohr effect) Increase (alkalosis) Decrease (acidosis)
Type of Fetal hemoglobin Adult hemoglobin
hemoglobin

Table – 35: Reflexes

Reflex Location of Stimulus Response

receptors
Cushing reflex VMC Raised ICT Hypertension ,
Decreased CBF Bradycardia ,
Bradypnea
Bain bridge Right atrium Atrial distension Reflex tachycardia
reflex
Bezold Jarisch Left ventricle Injection of Apnea
reflex serotonin Hypotension
Bradycardia
J reflex / Juxtacapillary in Hyperinflation of Hypotension
Pulmonary alveolar walls lung Bradycardia
chemoreflex
Herring Breuer Airway Steady lung Increased expiration
reflex – inflation
inflation
Herring Breuer Smooth muscle Marked deflation Decreased expiration
reflex – cells of lung
deflation

Respiratory volumes and capacities

Table – 36
RESPIRATORY VOLUMES
MEASUREMENT TYPICAL DEFINITION
VALUE
Tidal volume (TV) 500ML Amount of air that enters or leaves
lungs during one inspiration or
expiration (respiratory cycle)
Inspiratory reserve 3000ML Maximum volume of air that can be
volume (IRV) inspired over the normal TV
Expiratory reserve 1200ML Extra volume of air expired by forceful
volume (ERV) expiration after the end of normal tidal
expiration
Residual volume 1200ML Amount of air left in lungs after forced
(RV) exhalation
Closing volume lung volume above the residual volume
at which the alveoli of lung bases begin
to close off

RESPIRATORY CAPACITIES
Vital capacity 4700ML IRV+TV+ERV, maximum amount of air
(VC) that can be exhaled after a maximum
inspiration
Inspiratory 3500ML TV+IRV, maximum amount of air that
capacity (IC) can be inhaled after a normal expiration
Functional 2400 ML RC+ERV, amount of air remaining in
residual capacity the lungs after a normal tidal expiration
(FRC)
Total lung 5900ML RV+VC, maximum volume to which the
capacity (TLC) lungs can be expanded
Closing capacity RV+ the volume expired between the
beginning of airway closure and
 the RV

Table – 37: Reabsorption of various metabolites in nephron

Reabsorption of Active Passive

various metabolites
Proximal convoluted Sodium Chloride
tubule Potassium Bicarbon
Calcium ate
Magnesium Water
Glucose Urea
Amino acids
Protein
Urate
Vitamins
Henle’s loop Sodium Chloride
Potassium Bicarbon
Calcium ate
Water

Distal convoluted tubule Sodium Chloride

Potassium Bicarbon
Magnesium ate
Water Water

Table – 38: Important values

Parameters Dimension
No.of nephrons in each kidney 1 million
Glomerulus 200 µm in diameter
Filtration slits 25 nm wide
Free passage of neutral substances Up to 4nm
across glomerulus
Total area of glomerular capillary 0.8m2
endothelium for filtration
Length of proximal convoluted 15mm
tubule
Distal convoluted tubule 5mm long
Collecting ducts 20mm long
Total length of the nephrons 45 to 65mm
Volume of blood in the renal 30–40 mL
capillaries
Renal blood flow 1.2–1.3 per minute
Effective renal plasma flow 625 mL/min
(ERPF)
Glomerular capillary pressure 45 mm Hg
Peritubular capillary pressure 8 mm Hg
Pressure in the renal vein 4 mm Hg
Cortical blood flow 5 mL/g of kidney tissue/min
Medullary blood flow outer medulla(2.5 mL/g/min)
inner medulla(0.6 mL/g/min)
Arteriovenous oxygen difference 14 mL/L of blood
for the whole kidney
Po2 of the cortex 50 mm Hg
PO2 of the medulla 15 mm Hg
GFR 125 mL/min is 7.5 L/h, or 180 L/d,
Amount of protein in the urine <100mg/day
Filtration fraction 0.16–0.20
Filtration coefficient(Kf) 4.2 ml/min/mm Hg
Peristaltic contractions in ureter 1-5 times/min
Half life of vasopressin 18 min

Table – 39: Comparison of cortical and juxtamedullary nephrons

Features Cortical nephron Juxtamedullary

nephron
Location Cortex Medulla-cortex junction
Proportion of total 85% 15%
nephrons
Function Filtration and Filtration,reabsorption,
reabsorption and creation of medullary
osmolar gradient
Length of loop of Short Long
henle
Ascending limb of Thin segment only Thin and thick segments
loop
Vasa recta Absent Present, dipping into
medulla
Peritubular capillary Large Small
network

Table – 40: Three major families of G-proteins

Gs couples to Adenylate
Cyclase
Examples:
stimulates AC activity
b-adrenergic receptor increases cAMP
ACTH receptor activates Protein Kinase
FSH receptor A

Gi couples to Adenylate
Cyclase
a2-adrenergic receptor
inhibits AC activity
M2 muscarinic receptor decreases cAMP
inhibits Protein Kinase
A
Gq couples to
Phospholipase C
a1-adrenergic receptor
increases diacylgyclerol
M1, M3 muscarinic (DAG)
 receptors increases IP3
Angiotensin receptor increases intracellular
Ca2+
activates Protein Kinase
C

Table – 41: G proteins and their receptor abnormalities:

Site Type of Mutation Disease

Receptor
Cone opsins Loss Colour blindness
Rhodopsin Loss Congenital night
blindness; two
forms of retinitis
pigmentosa
V2 vasopressin Loss X-linked nephrogenic
diabetes insipidus
ACTH Loss Familial glucocorticoid
Deficiency
LH Gain Familial male
precocious puberty
TSH Gain Familial
nonautoimmune
hyperthyroidism
TSH Loss Familial hypothyroidism
Ca 2+ Gain Familial hypercalciuric
Hypocalcemia
Thromboxane Loss Congenital bleeding
A2
Endothelin B Loss Hirschsprung disease
G protein
Gs α Loss Pseudohypothyroidism
type 1a
Gs α Gain/loss Testotoxicosis
Gs α Gain (mosaic) McCune–Albright
Syndrome
Gs α Gain Somatotroph
adenomas with
acromegaly

Gi α Gain Ovarian and

adrenocortical
tumors

Table – 42: Types of secondary messenger molecules

Hydrophobic molecules Hydrophilic Gases

molecules
Water-insoluble Water-soluble Nitric oxide (NO),
molecules - molecules - cAMP, Carbon monoxide
diacylglycerol and (CO), Hydrogen
phosphatidylinositols cGMP, IP3, and sulphide (H2S)
Ca2+

Classification of second messengers

Table – 43: Group – I Lipophilic

Cytoplasmic receptors Nuclear receptors

Glucocorticoids , Thyroid hormones
Mineralocorticoids Retinoic acid
Androgens , Estrogens ,
Progesterone
Retinoic acid
Vitamin D3

Table – 44: Group – II Hydrophilic

I - cAMP – Adenyl cyclase II - cGMP

Corticotropin Adrenaline Atrial
releasing hormone α2 , β adrenergics natriuretic
Follicle stimulating Anti diuretic peptide
hormone hormone Nitric oxide
Melanocyte Vasopressin ( V2 )
stimulating Angiotensin II
hormone Secretion
Thyroid stimulating Glucagon
hormone Somatostatin
Luteinizing Lipotropin
hormone Calcitonin
Adrenocorticotropic
hormone
Parathormone
Human chorionic
gonadotropin

Table – 45
III - Calcium / IP3-DAG / Phospholipase C
Oxytocin PDGF
GnRH Substance P
GHRH Gastrin
Angiotensin - II Cholecystokinin
α1 adrenergics Muscarinic
Thyrotropin releasing Vasopressin ( V1 )
hormone
Table – 46
IV - Kinase / Phosphatase cascade
Growth hormone PDGF
Epidermal growth factor Erythropoietin
Fibroblast growth factor Prolactin
IGF – I , II Insulin
Nerve growth factor Chorionic
M – CSF somatomammotropin
Adiponectin
Leptin
Table – 47: Types of secondary messenger molecules

Hydrophobic Hydrophilic Gases

molecules molecules

Water-insoluble Water-soluble Nitric oxide

molecules - molecules - (NO), Carbon
diacylglycerol and cAMP, cGMP, monoxide
phosphatidylinositols IP3, and (CO),
Hydrogen
Ca2+
sulphide (H2S)

Classification of second messengers

Table – 48: Group – I Lipophilic

Cytoplasmic receptors Nuclear receptors

Glucocorticoids , Thyroid hormones
Mineralocorticoids Retinoic acid
Androgens , Estrogens ,
Progesterone
Retinoic acid
Vitamin D3

Table – 49: Group – II Hydrophilic

I - cAMP – Adenyl cyclase II - cGMP

Corticotropin Adrenaline Atrial
releasing hormone α2 , β adrenergics natriuretic
Follicle stimulating Anti diuretic peptide
hormone hormone Nitric oxide
Melanocyte Vasopressin ( V2 )
stimulating Angiotensin II
hormone Secretion
Thyroid stimulating Glucagon
hormone Somatostatin
Luteinizing Lipotropin
hormone Calcitonin
Adrenocorticotropic
hormone
Parathormone
Human chorionic
gonadotropin

Table – 50
III - Calcium / IP3-DAG / Phospholipase C
Oxytocin PDGF
GnRH Substance P
GHRH Gastrin
Angiotensin - II Cholecystokinin
α1 adrenergics Muscarinic
Thyrotropin releasing Vasopressin ( V1 )
 hormone

Table – 51
IV - Kinase / Phosphatase cascade
Growth hormone PDGF
Epidermal growth factor Erythropoietin
Fibroblast growth factor Prolactin
IGF – I , II Insulin
Nerve growth factor Chorionic
M – CSF somatomammotropin
Adiponectin
Leptin

Menstrual cycle
Phases of Endometrial Cycle
The endometrial cycle of 28 days can be divided into threephases:
Menstrual Phase (1-5 days).
Proliferative Phase (6-14 days).
Secretory Phase (15-28 days).

Table – 52
Features Menstrual Proliferative Secretory phase
phase phase
Thickness of Absent Thin to thick Thickest
stratum
functionale
Appearance of Portions of glands Straight Highly coiled
endometrial in stratum basale
glands
Degree of coiling Absent Less coiled Highly coiled
of coiled arteries
Predominant Falling LH, rising FSH LH
gonadotropin FSH
Days of idealized 1-5 5-14 14-28
menstrual cycle
Viscosity of Difficult to Thinnest at day 14 Increasing
cervical secretions determine viscosity
Predominant Transition from Estrogen Progesterone
ovarian hormone progesterone to
estrogen

Table – 53: Endometrial cycle

Endometrium
Characteristics Proliferative Phase
Thickness Increases due to cell division &
Cell growth.
0.5mm to3.5-5mm.
Stromal cells Proliferate & increase in size
thus increasing thickness.
Glands Straight tubular glands form
lined with columnar epithelial
cell. Produce and store large
amount of glycogen.
Spiral Arteries Increasingly vascularised and
Secretory Phase
Slightly increases and
becomes edematous.
Stromal proliferation and
cell growth continues.
Becomes increasingly tortous
and spiralised, produce great
amount of mucus.
Becomes increasingly tortous
 spiral arteries elongate
Myometrium Increase in excitability &
Contractility and increase
sensitivity to oxytocin.
Fallopian Increase ciliary activity and
tubes motility and secretory activity
of cells.
Cervix Cervical mucus is thin and
become crystalline, forming
channels that facilitate the
passage of sperm into uterus,
Alkaline in nature.
Shows ferning like effect i.e.
arborisation on drying.
and spiralised
Decrease in excitability and
decreases contractility.
Increases ciliary activity and
sensitivity and decreases
motility
Cervical mucus is thick and
sticky, tenacious and
cellular.
Does not show ferning effect.

Hormonal influence of menstrual cycle

FSH-early development of G. Follicle
Final maturation of ovum-FSH&LH
LH-ovulation, formation & maintenance of C. Luteum
A surge in LH secretion triggers ovulation, and ovulation normally occurs about 9 h after the peak of
the LH surge at midcycle
The LH surge begins about 24-36 hours before ovulation and reaches its peak about 8-10 hours before
ovulation. It is this surge that acts to trigger ovulation
Tests of Ovulation
Basal body temperature
Endometrial Biopsy
Fern Test
Ultrasound
Ultrasound has now become the standard procedure for monitoring maturation of the graffian follicle,
and in detecting imminent ovulation in in-vitro fertilization and timing intercourse.

Biochemistry
Table – 1 Site of metabolic pathway occurrence

Part of cell Site of metabolic pathways

Cytosol Glycolysis
Fatty acid synthesis
HMP shunt
Protein synthesis
Mitochondria Outer membrane CPT – I , MAO
Acetyl CoA synthatase
Phospholipase A2
Intermembranous Adenylate kinase , Creatinine
space kinase
CPT – II , Respiratory chain
Inner membrane ATP synthase
 Oxidative phosphorylation
β - oxidation of fatty acids
TCA cycle , Urea cycle
Alcohol dehydrogenase ,
PDH , SGOT
Cytosol + Mitochondria Urea cycle ( 1st 2 steps )
Gluconeogenesis
Nucleus DNA & RNA synthesis
Lysosomes Degradation of complex
molecules
Golgi apparatus Synthesis & packaging of
complex molecules

Table – 2 Energetics

Pathway Energetics
Aerobic glycolysis 8 ATP
Anaerobic glycolysis 2 ATP
Glycolysis TCA cycle via Malate 38 ATP / 32 ATP ( new )
shuttle
Glycolysis TCA cycle via 36 ATP / 30 ATP ( new )
Glycerophosphate shuttle
PDH complex reaction 5 ATP
Citric acid cycle 20 ATP
HMP shunt No ATP produced
β - oxidation of palmitic acis 129 ATP / 106 ATP ( new )
β - oxidation of stearic acid 146 ATP / 120 ATP ( new )

Table – 3 Feed fast cycle

After feeding After fasting

↑ Phosphorylation of glucose ↑ Glycogenolysis
↑ Glycogenesis ↑ Gluconeogenesis
↑ HMP shunt ↑ Fatty acid oxidation
↑ Glycolysis ↑ Ketogenesis
↓ Gluconeogenesis ↑ Degradation of TAG
↓ Glycogenolysis
↑ Protein synthesis
↑ Amino acid degradation

Table – 4 Classification of amino acids

1) Polarity & Solubility

Hydrophobic amino acid Tryptophan , Tyrosine , Methionine ,

Leucine , Valine , Isoleucine , Alanine
, Phenylalanine , Proline , Glycine
Hydrophilic Neutral amino acid Threonine , Serine , Tyrosine ,
amino acid Cysteine , Asparagine , Glutamine
Acidic amino acid Aspartic acid , Glutamic acid ,
Asparagine , Glutamine
 Basic amino acid Histidine , Hydroxy lysine , Arginine ,
Lysine

2) Side chain content

Aliphatic group Aromatic group Hydroxy group Sulphur group
Glycine Tyrosine Tyrosine Cysteine
Alanine Tryptophan Serine Methionine
Valine Phenylalanine Threonine
Leucin e Histidine
Isoleucine
Proline
Methionine

Imino acid Basic group Acidic group Amides of

acidic group
Proline Histidine Aspartate Asparagine
Arginine Glutamate Glutamine
Lysine

3) Basis of metabolism
Ketogenic Glucogenic Both glugenic &
amino acids amino acids ketogenic
amino acids
Essential aminoa Leucine Methionine Isoleucine
cids Lysine Threonine Phenylalanine
Valine Tryptophan
Semi essential - Histidine -
amino acids Arginine
Non essential Hydroxylysine Arginine Tyrosine
amino acids Alanine
Asparagine
Aspartate
Cysteine
Glutamate
Glutamine
Glycine
Proline
Hydroxyproline
Serine

Table – 5 Omega fatty acids

ω-3 fatty acid ω-6 fatty acid ω-7 fatty acid ω-9 fatty acid
Alpha linolenic Gamma linolenic Palmitoleic acid Oleic acid
acid acid Elaidic acid
Timnodonic acid Arachidonic acid
Cervonic acid Linoleic acid

Table – 6 Rate limiting enzymes

Pathways Rate limiting enzymes

Glycolysis Phosphofructokinase – 1
Glycogeensis Glycogen synthase
Glycogenolysis Glycogen phosphorylase
Gluconeogenesis PEP carboxykinase
TCA cycle Alpha ketoglutarate dehydrogenase
HMP shunt Glucose – 6 – phosphate
dehydrogenase
Fatty acid synthesis Acetyl CoA carboxylase
Cholesterol synthesis HMG CoA reductase
Ketogenesis HMG CoA synthetase
Bile acid synthesis 7 α hydroxylase
Lipolysis of adipose tissue Hormone sensitive triacylglycerol
lipase
Purine synthesis PPRP amidotransferase
Uric acid synthesis Xanthine oxidase
Urea cycle Carbamoyl phosphate synthetase I
Pyrimidine synthesis Carbamoyl phosphate synthetase II
Purine salvage pathway HGPRTase , APRTase
Heme synthesis ALA synthase
Catecholamines DOPA decarboxylase
GTP formation IMP dehydrogenase
Tetrahydro biopterin formation GTP cyclohydrolase I

Table – 7 Glycogen storage disorders

Glycogen storage Enzyme defect Manifestation

disorder
I Von Gierke’s Glucose 6 phosphatase Hypoglycemia ,
disease Hyperlipemia ,
Hypercholesterolemia ,
Lactic acidemia , Hyper
uricemia
II Pompe’s disease Acid maltase Muscle hypotonia ,
Myopathy , Muscular
dystrophy
III Forbe’s or Cori’s Debranching enzyme Hepatomegaly , Myopathy ,
disease Fasting hypogluycemia
IV Anderson’s disease Branching enzyme Hepatosplenomegaly ,
Myoglobin in urine
V Mc Ardle’s disease Muscle phosphorylase Exercise induced cramps ,
Low lactate levels in serum
, Myoglobin in urine
VI Her’s disease Liver phosphorylase Hepatomegaly , Mild
hypoglycemia
VII Tauri’s disease Phosphofructo kinase – Exercise induced cramps ,
1 Hemolytic anemia , Low
lactate levels in serum ,
Myoglobin in urine
VIII Liver phosphorylase Hepatomegaly , Mild
kinase hypoglycemia
IX Liver & Muscle Hepatomegaly , Mild
phosphorylase kinase hypoglycemia
X c-AMP dependent Hepatomegaly , Glycogen
protein kinase accumulation in liver
XI Fanconi – Bickel Glucose transporter – 2 Failure to thrive ,
Hepoatomegaly , Renal
failure , Rickets

Electron transport chain

Table – 8 Components of ETC

Components of ETC Prosthetic Features

group
Complex I NADH FMN , FeS Energy – 12 Kcal/mol
dehydrogenase / To pump 4 protons out of
NADH Co-Q mitochondria into inter
reductase / membranous space
NADH Ubiquinone
Complex Succinate FAD , FeS Not a proton pump as energy is
II dehydrogenase / liberated
Succinate Q
reductase
Coenzyme Q / Ubiquinone Q Non protein member of ETC
For transferring to complex III it accepts
hydrogen atoms from
FMNH2 produced in complex I
FADH2 produced in complex II
FADH2 produced in beta oxidation by
acyl CoA dehydrogenase & glycerol 3
phosphate dehydrogenase
Complex Cytochrome bC1 FeS , Heme Energy – 10 Kcal/mol
III complex / To pump 4 protons out of
Ubiquinone mitochondria into inter
cytochrome C membranous space
oxidoreductase /
Cytochrome
reductase
Cytochrome C Soluble carrier protein of intermembranous
space
Complex Cytochrome C 2 Heme , To pump 2 protons out of
IV oxidase / 2 Copper mitochondria into inter
Cytochrome oxidase ions of CuA membranous space
, CuB
Table – 9 Electron transport chain poisons

Inhibitors of electron transport Complex – I Amobarbital ,

chain Rotenone , Pericidin
A , Guanethidine ,
Chlorpromazine
Complex – II Malonate , Carboxin
Complex – III Antimycin A , BAL ,
Naphthoquinone ,
Phenformin
Complex – IV Carbon monoxide ,
Cyanide , Hydrogen
sulphide , Azide
Inhibitors of oxidative Blocking reentry of Oligomycin ,
phosphorylation protons through ATP Venturicidin
synthase
Inhibitors of ATP – Atractylosid ,
ADP exchange Bongregate
Ionophores Valinomycin ,
Gramicidin
Uncouplers of oxidative Physiological Thermogenin ,
phosphorylation uncouplers Thyroxine , Long
chain fatty acids ,
Unconjugated
bilirubin
Synthetic uncouplers 2,4 Dinitrophenol ,
2,4 Dinitrocresol ,
Calcium , Aspirin ,
Dicoumarol

Table – 10 Inborn errors of metabolism

Inborn error of Enzyme defect Manifestion Laoratory

metabolism diagnosis
Essential Fructokinase ( ↑ D fructose in
fructosuria Liver ) serum
Hereditary Fructose – 1 , 6 Hepatomegaly ; ↑ Fructose – 1 –
fructose bisphosphate Jaundice ; PO4
intolerance kinase B Proximal renal
( Liver , Kidney , tubular dysfunction ;
Intestine ) Intellectual
impairment
Galactossemia Galactose – 1 – Hepatosplenomegaly ↑ serum galactose
PO4 uridyl ; ;
transferase Jaundice , Ascites ; ↓ Blood glucose ;
Hypoglycemia ; MR ; Galactosuria ;
Cataract Albuminuria ;
Aminoaciduria (
Glycine , Alanine ,
Serine )
Lactase deficiency Lactase Bloating ;
Watery diarrhea ;
Failure to thrive ;
Abdominal cramps
Sucrase isomaltase Sucrase and Iso Bloating ;
deficiency maltase Watery diarrhea ;
Failure to thrive
Adenosine Adenosine Dysfunctional B &
deaminase deaminase T cells – fatal
deficiency infections in
infants
Purine nucleoside Purine nucleoside Severe deficiency
phosphorylase phosphorylase of T cells
deficiency
Lesch Nyhan Complete Gouty arthritis ; Hyperuricemia ;
syndrome deficiency of Nephrolithiasis ; Uricosuria ;
Hypoxanthine Obstructive Crystalluria
guanine phospho uropathy ; Mental
ribosyl transferase retardation ;
Aggressiveness ;
Self mutilating
behaviour
Kelley Seegmiller Partial deficiency Gouty arthritis ; Hyperuricemia
syndrome of Hypoxanthine No CNS
guanine phospho manifestation
ribosyl transferase
Cystinuria Proximal tubule’s Excretion of Cyanide –
reabsorption of cystine , ornithine Nitroprusside test
filtered cysteine & , lysine , arginine ;
dibasic amino Cysteine calculi
acids
Phenylketonuria Phenylalanine Hypopigmentation ↑
hydroxylase ; Phenylalaninemia
MR ; Seizures ; ; DNA probes ;
Hyperactivity ; Tandem mass
Tremors; spectrometry ;
Mousy odour Guthrie test
urine Ferric chloride test
Alkaptonuria Homogentisic Homogentisic Urine blackens on
oxidase aciduria ; standing
Ochronosis ;
Arthritis
Maple syrup urine Branched chain α Feeding problems Excess α keto iso
disease keto acid ; branched chain
dehydrogenase Vomiting ; amino acid in
Dehydration ; blood
Metabolic acidosis
;
Sweet maple syrup
or burnt sugar
odour of urine
Methyl malonic MMCoA mutase & Metabolic acidosis Propionaturia ;
acidemia & Vitamin B12 ; Methyl malonuria
aciduria Developmental
retardation

Table – 11 Lysosomal storage disorders

 1) Mucopolysaccharidoses
Type Syndrome Enzyme defect Urinary
metabolite
I Hurler α – L – iduronidase Dermatan sulfate
Heparan sulfate
II Hunter Iduronate sulfatase Heparan sulfate
III A Sanfilippo A Heparan sulphate N –
sulfatase
III B Sanfilippo B α – N – Acetyl
glucosaminidase
III C Sanfilippo C Acetyl CoA
α – glucosaminidase
N – Acetyl transferase
III D Sanfilippo D N – Acetyl glucosamine – 6
– sulfatase
IV A Moriquio A N – Acetyl galactosamine – Keratan sulfate
6 – sulfatase Chondroitin – 6 –
sulfate
IV B Moriquio B β – galactosidase Keratan sulfate
VI Maroteauxlamy N – Acetyl galactosamine – Dermatan sulfate
4 – sulfatase
VII Sly β – glucronidase Dermatan sulfate
Heparan sulfate
Chondroitin – 6 –
sulfate

2) Neutral glycospingolipidosis
Disease Enzyme Stored Manifestations
deficient materials
Fabry α – galactosidase Globotriacyl Cutaneous
disease A ceramide angiokeratoma ;
Corneal dystrophy ;
Painful
acroparesthesias ;
Hypohydrosis
Gaucher Acid - β – Glucosyl PAS +ve Gaucher
disease glucosidase ceramide cells in bone marrow
;
Cytopenia
Nieman Sphingomyelinase Sphingomyelin Foam cells in BM ;
Pick disease Pleomorphic
A&B inclusion of lipids in
lysosomes ;
MR , Seizures ;
Hepatosplenomegaly
;
Macular degeration

3) Mucolipidoses
Disease Enzyme defect Materials Manifestations
accumulated
I – Sialidosis Sialidase Glycoprotein Coarse facies ;
fragments; Pebbly skin lesions
Sialyloligosaccharides ;
Joint stiffness
II – I Cell disease UDP – N – acetyl Glycoprotein Coarse facies ;
glucosamine : fragments; Gingival
glucoprotein – N – Glycolipids hypoplasia
acetylglucosaminninyl
phospho transferase
III – Partial deficiency of Glycoprotein Coarse facies ;
Phosphotransferase UDP – N – acetyl fragments; Stiffness of hands
deficiency glucosamine : Glycolipids & shoulder
glucoprotein – N –
acetylglucosaminninyl
phospho transferase

4) Leukodystrophies
Disease Enzyme defect Materials Manifestations
accumulated
Krabbe’s diseae Galactosyl Galactosyl Globoid bodies in
ceramidase B ceramide ; white matter of
Galactosyl brain ;
sphingosine Mental retardation
;
Blindness &
Deafness
Metachromatic Aylsulfatase A Cerebroside Mental retardation
leukodystrophy sulfate ;
Progressive
paralysis ;
Dementia
Multiple Active site Sulfatides ; Mental retardation ;
sulfatase cysteine to C α Mucopolysaccharides Hepatosplenomegaly
deficiency formyl glycine ;
converting Retinal degeneration
enzyme

5) GM2 gangliosidosis
Disease Enzyme defect Materials Manifestations
accumulated
Tay Sach’s disease β– GM2 gangliosides Mental retardation ;
Hexosaminidase A Hepatosplenomegaly
Sandhoff’s disease β– ;
Hexosaminidase A Seizures ;
,B Macrocephaly ;
Hyperacusis ;
Cherry red spot

6) Neutral lipidosis
Disease Enzyme defect Materials Manifestations
accumulated
Wolman disease Acid lysosomal Cholesterol esters , Adrenal calcification
lipase TGL ;
Hepatosplenomegaly
 ;;
Mental retardation
Cholesterol ester Acid lysosomal Cholesteryl ester Hepatomegaly ;
storage disease lipase Cirrhosis
Farber disease Acid ceramidase Ceramide Macular
degeneration ;
Arthropathy ;
Subcutaneous
nodules
Central dogma of genetics

Molecular Genetics

Table – 12 Mutation
1) Point mutation
Silent mutation Hemoglobin 6th position of β chain
Hb Milwaukee Glutamate
Hb Bristol Aspartate
Hb Sydney Alanine
Missense mutation Acceptable mutation Hb – hikari ( β chain )
Partially acceptable Hb – S ( β chain )
mutation
Unacceptable mutation Hb – M Boston ( α chain
)
Non sense mutation Coding codon → Stop β-thalassemia
codon
Stop codon → Coding α-thalassemia
codon
 2) Frame shift mutation
Cystic fibrosis – Deletion of phenylalanine at 508th position in CFTR gene

3) Trinucleotide repeat sequence

Coding region Non coding region
Huntington’s chorea Myotonic dystrophy
Fragile X syndrome

4) Splice site mutation – Myotonic dystrophy , β-thalassemia

Table – 13 Amino acids required for special products

Special product Amino acid required

Collagen Glycine + Proline + Hydroxyproline
Elastin Glycine + Alanine + Valine + Proline
Creatine Glycine + Arginine + Methionine
Purine Glycine + Aspartate + Glutamine +
Serine
Pyrimidine Aspartate + Glutamine
Glutathione Glycine + Cysteine + Glutamate
Histone Arginine + Histidine
Carnosine β-alanine + Histidine
Hemoglobin Histidine + Arginine + Lysine
Keratin Histidine : Arginine : Lysine = 1 : 12 : 4
Choline Methionine + Glycine + Serine + B6
Carnitine Lysine + Methionine

Table – 14 End products of amino acid metabolism

Amino acid End products

Glycine Serine , Cysteine , Choline
Heme synthesis
Glutathione formation
Bile salt
Creatininr formation
C4, C5 , N7 of purine ring
Serine Formation of Sphingosine , Cysteine
, Selenocysteine
Formation of choline and
acetylcholine
Methionine and Cysteine Formation of pyruvate , Co A
Taurine and Glutathione formation
Arginine Urea , Creatinine
Formation of Nitric oxide
Phenylalanine and Tyrosine T3 and T4 formation
Production of melanin , Epinephrine
, Norepinephrine , DOPA , Dopamine
Tyramine
Tryptophan Serotonin , Melatonin , Niacin
Glutamic acid GABA and Glutathione formation

Table – 15 Vitamin deficiency disorders

Fat soluble Functions Deficiency syndromes

vitamin
Vitamin A A component of visual Night blindness ,
pigment Xerophthalmia , Blindness ,
Maintenance of specialized Squamous epithelia ,
epithelia Vulnerability to infection
Maintenance of resistance to ,particularly measles
infection
Vitamin D Facilitates intestinal Rickets in children
absorption of calcium and Osteomalacia in adults
phosphorous and
mineralization of bones
Vitamin E Major antioxidant ; scavenges Spinocerebellar degeneration ,
free radicals Peripheral neuropathy ,
Testicular atrophy ,
Retinopathy , Myopathy ,
Age related macular
degeneration
Vitamin K Co factor in hepatic Bleeding diathesis
carboxylation of
procoagulants – factors II
,VII,IX and X and protein C
and protein S

Water soluble Functions Deficiency

vitamin
Vitamin B1 As pyrophosphate , is coenzyme Dry and wet beriberi ,
( thiamine ) in decarboxylation reactions
Vitamin B2 Converted to coenzymes flavin
( riboflavin ) mononucleotide and flavin
adenine dinucleotide , cofactors
for many enzymes in
intermediary metabolism
Niacin Incorporated into nicotinamide
adenine dinucleotide and NAD
phosphate , involved in a
variety of redox reactions
Vitamin B6 Derivatives serve as coenzymes
( pyridoxine ) in many intermediary reactions
Vitamin B12 Required for normal folate
metabolism and DNA synthesis
, maintenance of myelinization
of spinal cord tracts
syndromes
Wernicke syndrome ,
Korsakoff syndrome
Ariboflavinosis,
cheilosis , stomatitis,
Seborrheic dermatitis ,
Moeller’s glossitis ,
dermatitis , corneal
vascularization
Pellagra – dementia ,
dermatitis , diarrhea
Cheilosis,
glossitis,dermatitis
,peripheral neuropathy
Combined system
disease ( megaloblastic
pernicious anemia and
degeneration of
 posterolateral spinal
cord tracts )
Vitamin C Serves in many oxidation- Scurvy
reduction reactions and
hydroxylation of collagen
Folate Essential for transfer and use of Megaloblastic anemia,
1-carbon units in DNA neural tube defects
synthesis

Pantothenic acid Incorporated in coenzyme A No experimental

syndrome recognized
Biotin Cofactor in carboxylation No clearly defined
reactions clinical syndrome

Table – 16 Vitamin B complex

Vitamin B Co-enzyme form Reactions used Activity

complex by the enzyme assessment
Thiamine Thiamine Oxidative ↓ RBC transketolase
pyrophosphate decarboxylation activity
Riboflavin Flavin adenine Oxidoreduction , ↓ RBC glutathione
dinucleotide Deamination reductase activity
Niacin Nicotinamide Oxidoreduction , Konig reaction ,
adenine Deamination Xanthurenic index
dinucleotide
Panthotenic Co enzyme A , ACP Co A derivatives ,
acid Acyl carrier proteins
Pyridoxine Pyridoxal Transamination , Tryptophan loading
phosphate Decarboxylation test,
Xanthurenic index
Biotin Biotin Carboxylation
Methylcobalamine Homocysteine Methyl
methyl transferase malonylaciduria
index

Folic acid FIGLU test

Table – 17 Molecular cytogenetics

Molecular cytogenetics Principle

Fluorescent in situ
hybridization (FISH)
Southern blot
Chromosome painting
Comparative genomic
hybridization
Hybridization to chromosomes with
fluorescently labeled probes to identify
exact loci
Hybridization with genomic probe or cDNA
probe after digestion of high molecular
DNA
Hybridization with chromosomal DNA
technique for visualizing chromosome
aberrations using fluorescently labeled
DNA probes
Used to study cryptic chromosomal
imbalances in patients with mental
retardation and multiple congenital
anomalies, prenatal diagnosis & to detect

Polymerase chain reaction
(PCR)
Reverse transcriptase PCR
(RT-PCR)
DNA sequencing
Restriction fragment
polymorphism (RFLP)
Single – strand conformational PCR of DNA segment : Mutations result in
polymorphism (SSCP)
microdeletions and microduplications in
cancer and in previously unidentified
genomic disorders.
Amplification of DNA segment
Reverse transcription, amplification of
DNA segment – absence or reduction of
mRNA transcription
Direct sequencing of PCR products
Sequencing of DNA segments cloned into
plasmid vector
Detection of altered restriction pattern of
genomic DNA ( southern blot ) or PCR
products
conformational change and altered
mobility

Denaturing gradient get PCR of DNA segment : Mutations result in

electrophoresis (DGGE) conformational change and altered
mobility

RNAse cleavage Cleavage of mismatch between mutated

Oligonucleotide specific
hybridization (OSH)
Microarrays
Protein truncation test
( PTT)
Pyro sequencing
Multiplex ligation – dependent
probe amplification (MLPA)
and wild type sequence
Hybridization of PCR products to wild-
type or mutated oligonucleotides
immobilized on chips or slides
Hybridization of PCR products to wild -
type or mutated oligonucleotides
Transcription/ translation of cDNA isolated
from tissue sample
Clonal amplification of single DNA
fragments on microparticles followed by
massive parallel sequencing
Quantification of PCR- generated
amplicons reflecting the number of copies
of a specific DNA sequence

Table – 18 Structural organization of proteins

Structure of Description Stablising Examples

organization forces
Primary Linear amino acid Peptide bonds
sequence of a protein
Secondary Configurational/ spatial Hydrogen bonds α-Helix, β-pleated
arrangement between sheets, bends,
amino acid residues turns & loops
Tertiary 3 dimensional structure Electrostatic Albumin,
of the whole proteins bonds, Myoglobin
hydrophobic
bonds, van der
Waals forces,
ionic
interactions
Quarternary Non-covalent Hydrogen bonds, Immunoglobulin,
 association of two or electrostatic hemoglobin,
more polypeptides bonds, lactate
hydrophobic dehydrogenase,
bonds, van der creatine kinase
Waals forces

Table – 19 Characteristics of apoproteins

Apoproteins Component of Functions

apo A-I HDL Activation of LCAT
Ligand for HDL receptor
Anti atherogenic
apo A-II HDL Inhibits LCAT
Stimulates lipase
apo B 100 LDL , VLDL Binds LDL receptor
apo B 48 Chylomicrons Major structural proteins of
chylomicrons
apo C-I Chylomicrons , VLDL Activation of LCAT
Anti atherogenic
apo E Chylomicrons , VLDL , Arginine rich
LDL
apo Lp(a) Lp(a) Impairs fibrinolysis
Highly atherogenic

Table – 20 Major fuel in different organs

Brain Skeletal Cardiac Adipose tissue

muscle muscle
After a meal Glucose Glucose , Glucose , Fatty acids
Fatty acids Pyruvate
Fasting Glucose Fatty acids Fatty acids Fatty acids
( Short term )
Fasting Glucose , Ketone bodies , Ketone bodies Fatty acids ,
( Long term ) Ketone Branched chain Ketone bodies
bodies amino acids
Exercise Glycogen Fatty acids

Table – 21 Hypercholesterolemia

Type Lipoprotein Cholesterol TAG Metabolic Features

fraction elevated level defect
elevated
Type I ( Familial Chylomicrons Normal ↑↑ Lipoprotein Eruptive
LPL deficiency ) lipase xanthoma ,
deficiency Hepatomegaly ,
Pain abdomen
Type II A LDL ↑↑ Normal LDL receptor Atherosclerosis ,
( Familial hyper defect , CAD ,
cholesterolemia Apo B ↑ Tuberous
) xanthoma
Type II B LDL , VLDL ↑↑ ↑↑ Apo B ↑ Corneal arcus
( Familial Apo C – II
combined
hyperlipidaemia
)

Type III Broad beta ↑↑ ↑↑ Abnormal Palmar

( Familial dys- VLDL , Apo E xanthoma ,
beta- Chylomicrons Apo C – II ↑ High incidence
lipoproteinemia of vascular
) disease
Type IV VLDL ↑↑ ↑↑ Over Associated with
( Familial hyper production of DM , Heart
tryglyceridemia VLDL disease and
) Apo C – II ↑ Obesity
Type V VLDL , Normal ↑↑ Secondary to Chronic
( Endogenous Chylomicrons other causes pancreatitis
hyper
triglyceridemia
)

Table – 22 Classification of enzymes

Enzyme class Examples

Transferases Glukokinase , Hexokinase ,
Phosphoglucomutase , Transaminases
Oxidoreductases Dehydrogenases , Xanthine oxidase ,
Oxygenases , Glutathione reductase ,
Hydroxyperoxidase , Tyrosinase
Hydrolases Glucose-6-phosphatase , Trypsinase ,
Peptidases
Isomerases Epimerase , Racemase
Ligases Synthetases , Carboxylases , DNA
ligase

Lyases Arginosuccinase , Fumarase , Aldolase

Table – 23 Glycosaminoglycans (GAGs)

Proteoglycan Repeated unit

Hyaluronic acid D-glucuronic acid and N-
acetylglucosamine
Chondroitin sulfate D-glucuronic acid and N-
acetlygalactosamine-4-sulfate
Keratin sulfate D-galactose and N-acetylglucosamine-6-
sulfate
Dermatan sulfate L-iduronic acid and N-
acetlygalactosamine
Heparan sulfate D-glucuronic acid and N-
sulfoglucosamine
Heparin L-iduronic acid and N-sulfoglucosamine

Otorhinolaryngology
Table – 1 MacEwen Triangle Vs Trautman Triangle
 Features MacEwen Triangle Trautman Triangle
Boundaries Superior Supramastoid crest Superior petrosal sinus
Anteroinferior Posterosuperior margin Body of labyrinth
of external auditory
canal
Posterior Tangent drawn from Sigmoid sinus
zygomatic arch
Importance surgical landmark for Infection into the
locating mastoid posterior cranial fossa
antrum can spread through this
triangle and can be
approached by removing
bone in between the
triangle

Table – 2 Various tests to differentiate a cochlear from a retrocochlear lesion

Normal Cochlear Retroeochlear

lesion lesion
Pure tone Normal Sensorineural Sensorineural
audiogram hearing loss hearing
Speech 90-100% Below 90% Very poor
discrimination
score
Roll over Absent Present Absent
phenomenon
Recruitment Absent Present Absent
SISI score 0-15% Over 70% 0-20%
Threshold tone O-15dB Less than 25dB Above 25dB
decay test
Stapedial reflex Present Present Absent
Stapedial reflex Normal Normal Abnormal
decay
E.R.A Normal Normal interval Wave V delayed
interval b/w b/w wave) & or absent
wave I& V VI>

Table – 3 Interpretations of tuning fork test

Tests Normal Conductive Sensorineural

hearing loss hearing loss
Rinne AC > BC (Rinne BC > AC (Rinne -) AC > BC (Rinne +)
+)
Weber Center Lateralized to Lateralized to
affected ear affected ear
Absolute bone Normal Normal Reduced
conduction
Schwabach Normal Lengthened Shortened
Bing Positive Negative Positive
Gelle Positive Negative (ossicular Positive
 lesions)

Table – 4 Types of Tympanogram

Type of Description Clinical illustration

tympanogram
Type A Normal tympanogram Normal individuals
Type As Compliance is lower at or near Otosclerosis
ambient air pressure Malleus fixation
Type Ad High compliance at or near Ossicular discontinuity
ambient pressure Thin and lax tympanic
membrane
Type B A flat or dome shaped graph. Middle ear fluid
No change in compliance with Thick tympanic
pressure changes membrane
Seen in
Type C Maximum compliance occurs Retracted tympanic
with negative pressure in membrane
excess of 100 mm of H2O.

Table – 5 Most common organism in ear condition

External ear condition Most common organism

Furunclosis Staphylococcus
Otomycosis Aspergillus niger (M/c); Candida
albicans (2nd M/c.
Otitis externa hemorrhagica Influenza virus
Myringitis bullosa Influenza virus
Less commonly
Mycoplasma pneumonia
Malignant otitis externa Pseudomonas aeruginosa
Pseudomonas
Perichondritis Impacted wax
Myringitis granulose Foreign body

Table – 6 Etiological agents for otitis media

Disorders of middle ear Agent factor

Acute suppurative otitis media
Acute necrotising otitis media
Otitis media with effusion
( Glue ear , Serous otitis media ,
Secretory otitis media , Mucoid
otitis media )
Aero otitis media
Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Streptococcus pyogenes
Staphylococcus aureus
Pseudomonas aeruginosa
β-hemolytic streptococci
Adenoid hyperplasia
Chronis rhinitis & sinusitis
Chronic tonsillitis
Failure of Eustachian tube to maintain
middle ear pressure at ambient
atmospheric level
Chronic suppurative otitis media
Tubercular otitis media
Syphilitic otitis media
Pseudomonas aeruginosa
Proteus
Esch.coli
Staphylococcus aureus
Bacteroides fragilis
Anaerobic streptococci
Mycobacterium tuberculosis
Treponema Pallidum

Table – 7 Stages of CSOM

Mucosal disease (Tubotympanic disease)

Active Inactive Healed
There is a perforation of Permanent performation is seen i.e. when tympanic
partensa with but middle ear mucosa is not membrance has healed
inflammation of mucosa inflamed & there is no discharge (in 2 layers) is atrophic
& mucopurulent & easily retracted if
discharge (chronic there is a negative
suppurative otitus pressure in middle ear.
media There may be some
areas of tympano
sclerosis present.
Squamosal disease (Atticoantral disease)
Inactive Active
Retraction pockets present Chotestealoma present. It erodes bone,
No discharge forms granulation tissue & has purulent
Also k/a atelectatic ear offensive discharge

Table – 8 Syndromes associated with Hearing Loss

Syndrome/Inheritance Features Onset/Type HL

Waardenbergs White forelock Congenital SNHL
syndrome (AD) Heterochomia iridis
Vitiligo
Dystopia canthorum
Usher syndrome Retinitis pigmentosa Delayed
(AR) Night blindness SNHL
Jervell and Lange Repeated syncopal attacks Congenital SNHL
Neilson’s syndrome Prolonged QT interval
(AR)
Pendred syndrome Goiter evident before puberty Congenital SNHL
(AR) Perchlorate discharge test shows
defect in organic binding of
iodine
Alport syndrome Hereditary progressive GN Delayed progressive
AD or Corneal dystrophy SNHL
Treacher-Collins Antimongoloid palpebral fissures Congenital
syndrome Coloboma of lower lid Conductive
(mandibulofacial Hyoplasia of mandible and malar
dysostosis) AD bones
Malformed pinna amd meatal
atresia
Malformed malleus and incus
(stapes normal)
Crouzon’s Frog eyes, Hypertelorism Congenital
syndrome (AD) Parrot beak nose Conductive or mixed
(craniofacial Mandibular prognathism
dysostosis) Mental retardation
Apert’s syndrome Syndactyly Congenital
(AD) Features of Crouzon’s syndrome Conductive(stapes
fixation)
Kipple-Feil Short neck Congenital SNHL or
syndrome (AR) Fused cervical vertebrae mixed
Spina bifida
Atresia of ear canal
Stickler’s syndrome Small jaw Delayed Conductive
(AD) Cleft palate or SNHL
Myopia, Cataract
Juvenile onset arthritis
Van der Hoeve’s Osteogenesis imperfect (h/0 Delayed CHL, SNHL
syndrome fractures) or mixed
Blue sclera
Pierre- Robin Micrognathia SNHL or conductive
sequence Glossoptosis
Cleft palate
Goldenhar’s Facial asymmetry Mixed or conductive
syndrome (facio- Low set ears
auriculo-vertebal Atresia of ear canal
dysplasia or oculo- Preauricular tags
auriculo-vertebral Cardiac abnormalities
(OAV) syndrome) Hemivertebrea in cervical region
Epibulbar dermoid
Coloboma or upper lid

Table – 9 Difference between Antrochoanal polyp Vs Ethmoidal polyp

Features Antrochoanal polyp Ethmoidal polyp

Age Common in children Common in adults
Etiology Infection Allergy
Number Solitary Multiple
Laterality Unilateral Bilateral
Origin Maxillary sinus near the ostium Ethmoidal sinuses,
uncinated process,
middle turbinate and
middle meatus
Growth Grows backwards to the choana ; Mostly grow anteriorly
may hang down behind the soft and may present at the
palate nares
Size and shape Trilobed with antral, nasal and Usually small and grape
choanal parts like masses
Choanal part may protrude
through the choana and fill the
nasopharynx obstructing both
sides
Recurrence Uncommon Common
Treatment Polypectomy;Endoscopic removal Polypectomy
FESS or
ethmoidecctomy
Role of steroids Not useful Low dose steroids and

Table – 10 Difference between Anterior Epistaxis Vs Posterior Epistaxis
Anterior Epistaxis
Blood flows out from the
front of nose
Incidence More common
Site Mostly from Little’s are or
anterior part of lateral wall
Age Mostly occus in children or
Cause young adults mostly trauma
Bleeding Usually mind, can be easily
controlled by local pressure
or anterior pack
Table – 11 Anatomy of sinuses
Maxillary sinus
Well developed at birth (1st
to develop)
Most common site of
bacterial sinusitis
Most common site of
noninvasive fungal sinusitis
On X-ray : visible at 4-5
months
Completely developed by 9
years of age (at the time of
second dentition)
Largest sinus in the body
Ethmoidal sinus
Well developed at birth
Leads to orbital cellulities
Adenocarcioma seen mostly
in wood worker
X-ray; visible at 1st year of
age & complete by puberty.
Most common cause of
acute sinusitis in children
Table – 12 Allergic fungal sinusitis
Rent and Kuhan Criteria for
Allergic Fungal sinusitis (AFS)
Type I hypersensivity
(confirmed by history, skin
test or serology most
important criteria)
Nasal polyposis
Asthma
Local steroid sprays
Posterior Epistaxis
Blood flows back into the throat
Less common
Mostly from posterosuperior part
of nasal cavity; often difficult to
localize the bleeding point
After 40 years of age
Spontaneous ; often due to
hypertension or arteriosclerosis
Bleeding is severe, requires
hospitalization postnasal packing
often required
Frontal sinus
Develops 2 years after birth
Characteristics feature-
Pott’s puffy tumor
Mucocele
Ivory osteoma
X-ray visible at 6 years of
age.
Maximum size achieved by
puberty
Sphenoidal sinus
Develops 5 years after birth
Least common sinusitis
Major cause of cavernous
sinus thrombophletbitis.
X-ray: appears by 4 year of
age.
Bones of Bertin also called
sphenoidal turbinates
initially cover the anterior
wall of sinus, but after 10
years, fuse with it.
CT Scan findings in AFS
Areas of High attenuation
surrounded by a thin zone of
low attention
CT scan reveals pansinusitis
and polyposis
 Unilateral predominance
Eosinophilic mucus
demonstrating fungal
elements, charcot-leyden
crystal
Peripheral eosinophilia
Positive fungal culture
Characteristic Radiological
findings (CT, MRI) absence
of tissue invasion by fungus
Radiographic bone erosion

Table – 13 Summary of Salivary gland Tumor

Tumor Most Important feature Management

type common
site
Pleomorphic Parotid MC benign salivary Superficial
Adenoma (mixed gland till gland tumor parotidectomy
tumor) (superficial MC tumor of major (Patey’s
lobe) salivary gland operation)
Affects women
around 40 years.
In pleomorphic
adenoma of
submandibular
gland m/c age
affected is 60 yrs.
80% of parotid
pleomorphic
adenomas arise in
superficial lobe
Encapsulated but
sends pseudopods
into surrounding
glads (so
enucleation is not
done as treatement)
Malignant
transformation
occurs in 3- 5% of
cases
Facial nerve
infiltration
indicates
carcinomatous
change
Warthin’s tumor Parotid It is the second MC Superficial
gland benign tumor of parotidectomy
exclusively salivary glands
Adenolymphoma lower part of Can also arise from Radical
parotid cervical nodes parotiedectomy
overlying Smoking – its risk followed by
angle of It never involves postoperative
mandible facial nerve radiotherapy if
It shows hot spot in margins are
99 Tcm scan which positive
is diagnostic
It shows hot spot in
99Tcm scan which
 is diagnostic
It is the only
salivary gland
tumor which is
more common in
men
Adenoid cystic Minor M/C cancer of minor Radical
Minor salivary salivary salivary gland parotidectomy
gland carcinoma gland followed by followed by
(Cylindroma) adenocarcinoa and postoperative
mucoepidermoid radiotherapy if
carcinoma margins are
Invades perineural positive
space and
lymphatics
M/C head and neck
cancer associated
with perineural
invasion
Unlike other salivary
gland tumors it is
more adiosenstive
Mucoepidermoid Parotid M/C malignant Superficial/Total
carcinoma gland salivary gland tumor parotidectomy +
in children. radical neck
M/C malignant dissection
tumour of parotid
M/C radiation
induced neoplasm of
salivery gland
carcinoma.
Consists of mixture
of squamous cells,
mucous- secreating
cells intermediate
cells and clear or
hydropic cells
Mucin producing
tumor is low-grade
type; squamous cell
T/m is high grade
type.

Acinic cell Exclusively Rare tumor with low- Radical

adeno parotid gland grade malignancy excision
carcinoma affecting
women mostly
Squamous Submandibular Tends to involve the Only tumor
cell gland regional lymph nodes which
carcinoma Arises from squamous responds to
therapy is metoplasia of the radiotherapy
useful lining epithelium of so, irradiation
the ducts

Table – 14 Functions of Laryngeal muscles

Action Muscle Responsible

Abductor Posterior cricoarytenoid
Adductor Lateral cricoarytenoid
Interarytenoid (transverse arytenoids)
 Thyroarytenoid (external part)

Tensor Cricothyroid
Internal part of the thyroarytenoid
(vocalis muscle)
Relax vocal cord Thyroarytenoid
Vocalis
Opener (of the laryngeal inlet) Thyroepiglotticus
Closure of the laryngeal inlet Aryepiglotticus
Intearytenoid arytenoids (oblique
part)

Table – 15 Causes of hyponasality and hypernasality

Hyponasality Hypernasality
Common cold Velopharyngeal insufftcuency
Nasal allergy Congenially short soft palate
Nasal polypi Submucous palate
Nasal growth Large nasopharynx
Adenoids Cleft of soft palate
Nasopharyngeal mass Paralysis of soft palate
Familial speech pattern Post-adenoidectomy
Habitual Oronasal fistula
Familial speech pattern
Habitual speech pattern

Table – 16 Order of Appearances of Disease Manifestations

Disease Parts involved ( in order )
TB larynx Intra-arytenoid folds
Ventricular bands
Vocal cords
Epiglottis
Laryngeal lupus Epiglottis
Aryepiglottic fold
Ventricular bands
Syphilis Any part of larynx involved
Only gumma of tertiary syphilis will
manifest
Leprotic larynx Epiglottis
Aryepiglottic folds
Arytenoids

Table – 17 Types of Thyroplasty

Type Procedure Indicaiton

Type 1 Medialisation of vocal Unilateral vocal cord paralysis,
cord vocal cord atrophy & sulcus
vocalis
Type 2 Laterlisation of vocal Spasmodic dysphonia
cord
Type 3 Shortening (relaxation) For lowering vocal pitch as in
or cord puberphonia
Type 4 Lengthening (Stretching) For elevating the pitch as in
of cord androphonia
Table – 18 Position of the Vocal cord in Health and Disease

Position of Location of the Situation in

the cord cord from
midline
Health Disease
Median Midline Phonation RLN Paralysis
Paramedian 1.5mm Strong RLN paralysis
Whisper
Intermediate 3.5mm. This is - Paralysis of
(cadaveric neutral position of both recurrent
cricoarytenoid and superior
joint. Abduction laryngeal
and adduction take nerves
place from this
position

Gentle 7mm Quiet Paralysis of

abduction respiration adductors
Full abduction 9.5mm Deep --
inspiration

Table – 19 Types of Laryngectomy

Type of Laryngectomy Parts Removed

Hemilaryngectomy
Supra glottis laryngectomy
Supracricoid laryngectomy
Near Total laryngectomy
Total laryngectomy
Removal of one vertical half of
larynx.
Removal of the supraglottis on the
upper part of larynx
It is a newer surgical technique in
which voice is preserved. The true
vocal cords, supra glottis, thyroid
cartilage are removed and cricoids &
arytenoids cartilage are preserved.
It is more extended partial
laryngectomy procedure in which
only one arytenoids is preserved and
a tracheosophageal conduit is
constructed for speech.
Entire larynx + Thyroid + Criocid
cartilages are removed along with
some supper tracheal rings & hyoid
bone, if possible.

Table – 20 Position of ENT Surgeries

Surgeries Position
Tonsillectomy Rose’s position – patient lies supine
Adenoidectomy with head extended by placing a
Tracheostomy pillow under the shoulders

Esophagoscopy Barking dog position – patient lies

Bronchoscopy supine with head elevated by 10 – 15
Direct laryngoscopy cms and extended at atlanto-occipital
joint neck flexed on chest
Functional Endoscopic Sinus
Surgery
Diagnostic Nasal Endoscopy
Submucosal Resection of
nasals septum Septoplasty
Caldwell Luc operation
Cortical mastoidectomy
Radical mastoidectomy
Modified radical
mastoidectomy
Myringoplasty
Reverse Trendelenburg position
Sitting or supine
Reverse Trendelenburg position
Reclining with head-end of the table
raised. Patient lies supine with face
turned slightly to the opposite side
Patient lies supine with face turned to
one side and the ear to be operated
upper-most

Table – 21 Causes of stridor

Nose Choanal atresia of newborn

Tongue Macroglossia , haemangioma , lingual
thyroid , dermoid at the base of tongue
Mandible Micrognathia , Pierre – Robbins
syndrome
Pharynx Congenital dermoid , adeno tonsillar
hypertrophy , retropharyngeal abscess ,
tumors
Larynx Congenital Laryngeal web , laryngomalacia , cysts ,
vocal cord paralysis , subglottic stenosis
Inflammatory Epiglottitis , laryngotracheitis ,
diphtheria , tuberculosis

Neoplastic Haemangioma , juvenile multiple

papillomas , carcinoma in adults
Traumatic Injuries of larynx , foreign bodies ,
oedema following endoscopy or
prolonged intubations
Neurogenic Laryngeal paralysis
Miscellaneous Tetanus , tetany , laryngismus stridulus
Trachea & Congenital Atresia , stenosis , tracheomalacia
bronchi Inflammatory Tracheobronchitis
Neoplastic Tracheal tumors
Traumatic Foreign bodies , tracheal stenosis
Lesions Congenital Vascular rings , cystic hygroma ,
outside congenital goitre , oesophageal atresia ,
respiratory trachea oesophageal fistula
tract Inflammatory Retropharyngeal & retroesophageal
abscess
Neoplastic Neck masses
Traumatic FB oesophagus
Table – 22 Head and Neck space Infections
Space Extent
Parotid space Within 2 layers of
(Parotid abscess) superficial layer of deep
cervical fascia
Submandibular space Sublingual space – oral
(Ludwig’s angina) mucosa to mylohyoid
muscle
Submandibular space –
mylohyoid muscle to
superficial layer of deep
cervical fascia extending
from mandible to hyoid
bone
Peritonsillar space Between superior
( Peritonsillar abscess constrictor & fibrous
) capsule on the lateral
aspect of tonsil
Retropharyngeal space Base of skull to tracheal
( Retropharyngeal bifurcation
abscess )
Danger space Base of skull to
diaphragm
Prevertebral space Base of skull to coccyx
( Prevertebral abscess
) muscles and prevertebral
Parapharyngeal space Base of skull to hyoid
( Parapharyngeal bone & submandibular
abscess ) gland
Massicator space Base of skull to lower
border of mandible
Table – 23 Various skull views
View Structures seen
Water (occipito- Orbit
mental view) Maxillary sinus (best view for maxillary
Location
Parotid area
Below the tongue
Submental &
submandibular triangles
Lateral to tonsil
Between alar fascia and
buccopharyngeal fascia
covering constrictor
muscles
Between prevertebral
fascia and alar fascia
Between vertebra on one
side and prevertebral
fascia on the other
Buccopharyngeal fascia
covering lateral aspect of
pharynx medially and
fascia covering pterygoid
muscles , mandible and
parotid gland laterally
Between superficial layer
of deep cervical fascia and
the muscles of mastication
– masseter , medial &
lateral pterygoid insertion
of temporalis muscle and
the mandible
 sinus)
Sphenoid sinus (if X-ray is taken with
open mouth)
Frontal sinus
Ethmoid sinuses
Infratemporal fossa
Upper & lower jaw
Zygomatic arch
Nasal cavity
Cald well Superior orbital fissure
(occipitofrontal Frontal sinus (best view for frontal sinus)
view) Maxillary sinus
Ethmoid sinus
Foramen rotundum
Orbit
Nasal cavity
Petrous bone
Lateral view Sella turcica (best view for sella turcica)
Coronal and lambdoid suture
Frontal; maxillary; middle & posterior
ethmoid sinuses
Tuberculum sellae
Sulcus chiasmaticus

Basal Sphenoid sinus (best to visualize

(submentovertical) sphenoid sinus)
view Posterior ethmoid sinus
Maxillary sinus
Greater wing of sphenoid
Foramen ovale, spinosum, and lacerum
Foramen magnum
Mastoid bone
Towne's view Foramen magnum
Dorsum sellae
Occipital bone
Internal acoustic canal
Mastoids
Condyles or mandibles

Table – 24 Facial nerve anatomy & lesions

Facial nerve is a mixed nerve that emerges from the brainstem between the pons and the medulla
Functions of facial nerve
a. Controls the muscles of facial expression
b. Conveyance of taste sensations from the anterior two-thirds of the tongue and oral cavity
c. Preganglionic parasympathetic fibers to several head and neck ganglia
Course of facial nerve
Motor part - facial nerve nucleus in the pons
Sensory and parasympathetic parts - nervus intermedius
The motor part and sensory part of the facial nerve enters the petrous temporal bone via the internal
auditory meatus (intimately close to the inner ear) then runs a tortuous course (including two tight
turns) through the facial canal, emerges from the stylomastoid foramen and passes through the
parotid gland, where it divides into five major branches. Though it passes through the parotid gland,
it does not innervate the gland (This is the responsibility of cranial nerve IX, the glossopharyngeal
nerve).
The facial nerve forms the geniculate ganglion within the facial canal at the genu, the first bend in
the canal
Branches of facial nerve
Intracranial branches

Greater petrosal nerve Parasympathetic innervation -

nasal gland, palatine gland,
lacrimal gland, pharyngeal gland
Parasympathetic innervation -
sphenoid sinus, frontal sinus,
maxillary sinus, ethmoid sinus,
nasal cavity
Nerve to stapedius Motor innervation for stapedius
muscle in middle ear
Chorda tympani nerve Submandibular gland
Sublingual gland
Special sensory taste fibers for the
anterior 2/3 of the tongue

Tables – 25 Extracranial Branchs

Posterior auricular nerve - controls movements of some of the scalp muscles around the ear
Branch to Posterior belly of Digastric muscle and Stylohyoid muscle
Five major facial branches (in parotid gland)

Temporal branch Auricularis anterior

Auricularis superior
Intrinsic muscles on lateral
side of the ear
Frontalis
Orbicularis oculi
Corrugator supercilii
Zygomatic branch Orbicularis oculi
Buccal branch Buccinator
Marginal mandibular nerve Muscles of lower lip & chin
Cervical nerve Platysma
Communicating branches with adjacent cranial and spinal nerves

Lesions of Facial nerve

Pontine lesion Cerebello pontine elsion
Facial palsy+ Strabismus + VIII Nerve paralysis + loss of taste in
Contralateral hemiplegia + Facial anterior 2/3rd of tongue + loss of
sensory loss lacrimation (involvement of petrosal
nerves) + Facial palsy
Facial canal lesions
Between At geniculate Below At Stylomastoid
internal ganglion geniculate foramen
auditory ganglion to
meatus and stylomastoid
geniculate foramen
ganglion
Loss of taste in Herpetic vesicles Loss of taste in Only Facial palsy
anterior2/3 of at external ear + anterior 2/3 of without other
tongue + loss of loss of taste in tongue + intact neurologic signs
lacrimation anterior2/3 of lacrimation +
(involvement of tongue + loss of hyperacusis +
petrosal nerves) lacrimation Facial palsy
+ Facial palsy (involvement of
 petrosal nerves)
+ Facial palsy

Middle Ear Anatomy

Roof (Tegmental wall) Floor (Jugular wall) Posterior wall (Mastoid

wall)
Tegmen tympanic of Superior bulb of Aditus to mastoid
petrous part of the internal jugular antrum.
temporal bone. vein. Pyramidal eminence
Greater superficial Tympanic branch of and stapedius
petrosal nerve. glossopharyngeal muscle.
Lesser superficial nerve. Facial nerve
petrosal nerve (vertical part).
Chorda tympani
nerve (entry).

Anterior wall Lateral wall Medial wall

(Labyrinthine wall)
Opening of tensor Formed by Tympanic
tympani muscle. tympanic membrane membrane.
Opening of auditory and bony outer attic Chorda tympani
tube (Eustachian wall called scutum nerve (passing
tube). through middle
Internal carotid fibrous layer of
artery. tympanic
Sympathetic plexus. membrane)
Chorda tympanic
nerve (exit)
 Microbiology
Table – 1 Recommended concentrations of disinfectants commonly used in the hospitals

Disinfectant Recommended concentration

Ethanol 70% (700 gm/litre)
Methylated spirit 70% (700 gm/litre)
Glutaraldehyde 2% activated (available
commercially as cidex)
Bleahing powder(calcium 14 g/litre of water
hypochlorite)
Sodium hypochlorite 1% solution,0.1% solution
Hydrogen peroxide 3% solution
Lysol 2.5% solution
Savlon 2%, 5% solution
Dettol 4% solution
Betadine 2 % solution

Table – 2 Sterlization of biomedical materials

Materials Methods of sterlisation &

disinfection
Glasswares – syringes , petri dishes , Hot air oven
test tubes , flasks , surgical
instruments
Serum , body fluids , bacterial Water bath , Vaccine bath
vaccines
Milk Pasteurization
Cystoscope , Endoscope Glutaraldehyde or ethylene dioxide
Culture media Autoclaving
Culture media with egg , serum or Tyndallisation
sugar
Rubber , plastic & polyethene tubes , Glutaraldehyde or ethylene dioxide
disposable syringes
Dressing , aprons , gloves Autoclaving
Sharp instruments 5 % cresol
Suture materials without catgut Autoclaving
Catgut Ionizing radiation
Rubber or plastic disposable goods , Ionizing radiation
disposable syringes , bone and tissue
grafts , adhesive dressing
Feces , urine , vomitus , sputum Bleaching powder , cresols , formalin
, burning , autoclaving , boiling
OT sterlisation Formaldehyde gas
Wards , laboratory , OT floor space Formaldehyde gas , cresol
Skin Tincture iodine , spirit ( 70 % alcohol
) , savlon
Table – 3 Biological controls of different sterilization methods

Methods of sterilization Biological control

Steam , Autoclave , Formaldehyde Bacillus stearothermophillus
Hot air oven Bacillus subtilis – niger
Ethylene oxide Bacillus globigii
Ionizing radiations Bacillus pumilus
Filtration Serratia marcescens , Bacillus
diminuta

Table – 4 Mechanism of action of Bacterial toxins

Organism Disease caused Mechanism of action

of toxin
C.diphtheriae Diphtheria Inactivates EF2 and shut
down protein synthesis
Cl.tetani Tetanus Inhibits glycine release
Cl.botulinum Botulism Inhibits Ach release
Cl.difficle Paeudomembranous Exotoxin B cytotoxin
colitis disaggregates actin
filaments
Cl.perfringens Gas gangrene Alpha toxin stimulator
B.anthracis Anthrax Edema factor , Lethal
factor
Staphylococcus aureus Toxic shock syndrome Superantigen binding to
MHC II
Streptococcus pyogenes Scarlet fever Superantigen
E.coli Watery diarrhea Stimulates adenylate
cyclase (Gs)
Vibrio cholera Cholera Stimulates adenylate
cyclase (Gs)
Bordetella pertussis Whooping cough Stimulates adenylate
cyclase (Gi)

Table – 5 Bipolar staining of bacteria ( Safety pin appearance )

Hemophillus ducreyi Pseudomonas mallei Pseudomonas

pseudomallei
Vibrio parahemolyticus Yersinia pestis Calymmatobacterium
granulomatis

Table – 6 Intracellular bacteria

Brucella Bordetella Listeria monocytogenes

Mycobacterium Mycobacterium leprae Legionella
tuberculosis
Rickettsia Chlamydia Yersinia pestis
Neisseria meningitidis Neisseria gonorrhea Streptococcus
pneumoniae
Salmonella Shigella Calymmatobacterium
granulomatis
Table – 7 Special Media (E-enriched, En-enrichment, S-selective, D-differential media)

Organism Medium
Enteric pathogens – for Salmonella, Hektoen enteric agar (D)
Shigella Xylose-lysin-deoxycholate agar
Deoxycholate citrate agar
Eosin Methylene blue agar (D)
MacConkeys (D)
SS agar(S)
Wilson blair for Salmonella(S)
Vibrio cholerae (likes alkaline growth TCBS (Thiosulfate citrate Bile salts sucrose
medium) agar) (S)
Mansour’s GTTTA(S)
Alkaline Bile salt agar(S)
APW(En)
S.aureus Mannitol salt agar(S)
Streptococcus Crystal violet blood agar(S)
Neisseria Chocolate agar(E), Thayer-Martin (S),
Modified New York medium(S)
Corynebacterium Loffler’s coagulated serum medium(E)
Potassium Tellurite agar (D)
B.anthracis PLET(S)
B.cereus MYPA(S)
Anaerobes Thioglycollate(En)
RCM(En)
Listeria PALCAM agar(S)
Pseudomonas Cetrimide agar(S), King’s media(for
pigment)
Haemophillus Blood agar with staph streak(E)
Chocolate agar(E)
Levinthal’s medium, Fildes agar(E)
Bordetella Regan Low
Bordet Gengou Glycerin potato blood agar
Lacey’s DFP media(S)
Mycobacterium LJ, Dorset egg(S)
Leptospira EMJH(E)

Campylobacter Skirrow’s, Butzler, Campy BAP(S)

Legionella BCYE(buffered charcoal yeast extract)(S)

Table – 8 Transport media

Organism Transport media

Streptococcus Pike’s media
Neisseria Amies, Stuart’s
Vibrio VR, Autoclaved sea water, Carry Blair
Shigella Buffered glycerol saline
Bordetella Modified Stuart’s(with casmino acid)
Mischulow’s charcoal agar
Dacron or calcium alginate swab used

Table – 9 Miscellaneous growth Requirements

Growth requirements Organisms involved

Cholesterol , Purines & pyrimidines Mycoplasma
Cysteine Francisella, Brucella , Pasteurella
X ( Protoporphyrin ) and V ( NAD ) Haemophillus (Influenzae and
factor aegypticus require both)
Pyridoxal Streptococcus abiotrophia
Erythritol Brucella
Tryptophan Salmonella
Iron Legionella
Table – 10 Mycobacterial culture medias

Solid media Egg based LJ media , Dorset egg media ,

media Petragnani
Blood based Tarshimedia
media
Agar based Middle brook 7H11 and 7H10
media
Liquid media Middle brook 7H9 , Dubos ,
Proskauer , Sula
Automated culture method BACTEC – radiomimetic detection of
14 CO2 using 14 C labeled substrates
BacT/ALERT
ESP
MGIT
Septic check system

Table – 11 Morphological classification of fungi

Yeast Yeast like fungi Moulds / Dimorphic

Filamentous fungi
fungi
Cryptococcus Candida Dermatophytes Candida albicans
neoformans Torulopsis Aspergillus Blastomycosis
Zygomycetes dermatidis
Fusarium Paracoccidioides
Cephalosporium brasiliensis
Geotrichum Coccidioides
Scopulariopsis immitis
Histoplasma
capsulatum
Sporothrix
schenckii
Penicillium
 marneffi

Table – 12 Classification of fungal spores

Sexual spores Ascospores

Basidiospores
Oospore
Zygospore
Asexual spores Vegetative spores Thallospore Mycelial fungi
Blastospore Yeast / Yeast like
fungi
Aerial spores Conidiospore Conidiophore
from special Phialide
structure Sporangiospore
Conidiospore Microconidia
directly from Macroconidia
hyphae

Table – 13 Fungal diseases in human

Superficial mycoses Subcutaneous mycoses Systemic mycoses

Dermatophytes(includes Mycotic mycetoma Blastomycosis
trichophyton,microsporum, Chromoblastomycosis Coccidiomycosis
epidermophyton) Sporotrichosis Paracoccidiod mycosis
Candida Subcutaneous Histoplasmosis
Ptyriasis/Tinea versicolor phycomycosis Opportunistic
Tinea nigra infections(Cryptococcus,
Aspergillus etc.)

Table – 14 Classification of Virus

DNA virus
DNA virus Virion Nuclei acid
Parvo virus B-19 Naked SS ( - )
Papilloma virus , JC Naked ds circular ( +/- )
virus , BK virus ,
Polyoma virus
Adeno virus Naked ds ( +/- )
Hepatitis B virus Enveloped ds with ss ( +/- ) circular
HSV – I , II , EBV , CMV Enveloped ds ( +/- )
, VZV
Variola Complex coats ds ( +/- )
,Molluscumcontagiosum

RNA virus
RNA virus Virion Nuclei acid
Polio , Coxsackie , Entero Naked SS ( + )
, Rhino , Hepatitis A
virus
Astrovirus Naked SS ( + )
HEV , Norwalk Naked SS ( + )
Rota , Reo , Orbivirus Naked ds segmented ( +/- )
Rubella Enveloped SS ( + )
HCV , HGV , Yellow fever Enveloped SS ( + )
, Dengue fever
Lassa fever virus Enveloped SS segmented ( - )
Corona virus Enveloped SS ( + )
HIV – 1 , 2 , HLTV – 1 , 2 Enveloped SS diploid ( + )
, Slow viral group
Influenza – A , B , C Enveloped SS segmented ( - )
Hanta virus ,Sandfly Enveloped SS segmented ( - )
fever virus
Bornavirus Enveloped SS
Rabies , Vesicular Enveloped SS ( - )
stomatitis virus
Parainfluenza , RSV , Enveloped SS ( - )
Mumps , Rubeola , New
Castle virus
Marburg virus , Ebola Enveloped SS ( - )
virus

Table – 15 Virus causing glomerular disease

Diseases Virus involved

Focal segmental glomerulosclerosis HIV , HBV , Parvo virus , Coxsackie
Membrane proliferative HBV , HCV , HIV , CMV , EBV
glomerulonephritis
Diffuse proliferative Coxsackie virus
glomerulonephritis
Membranous nephropathy HBV , HCV
Endocapillary proliferative GN Measles , Dengue
Mesangioproliferative GN Parvo virus , Mumps

Table – 16 Virus with latent infection

Herpes EBV Varicella CMV Kaposi

simplex zoster sarcoma
HHV – 6 HHV – 7 HHV – 8 HIV HPV

Table – 17 Clinical spectrum of HPV

HPV type Clinical lesion

1,4 Plantar warts
2 , 4 , 26 , 27 , 29 Common warts
3 , 10 , 28 , 41 Flat warts
5,8 Epidermodysplasia verruciformis
6 , 11 Anogenital condylomas
Laryngeal papillomas
Intraepithelial neoplasia
7 Hand warts
9 , 12 , 14 , 15 , 17 , 19 – 25 , 36 , 46 , Epidermodysplasia verruciformis
47
13 , 32 Oral focal epithelial hyperplasia
16 , 18 , 30 , 31 , 33 , 35 , 39 , 45 , 51 , High grade dysplasia
52 , 56 CA genital mucosa
CA Larynx & Oesophagus
34 , 40 , 42 , 44 , 53 – 55 , 58 , 59 , 61 Intraepithelial neoplasia
, 62 , 64 , 66 , 69
75 , 77 Common warts in organ transplant
patients
37 Keratocanthoma

Table – 18 Classification of Arboviruses

Family Genus Important species

Togoviridae Alphavirus Chickungunya , Sindibis and Venezuelan
equine encephalitis viruses
Flaviviridae Flavivirus Japanese encephalitis , West Nile,
Yellow fever, Dengue types 1,2,3,4,
Kyasanur forest disease
Bunyaviridae Bunyavirus California encephalitis
Phlebovirus Sandfly fever viruses , Rift valley fever
virus
Nairovirus Crimencongo hemorrhagic fever viruses
, Ganjam virus
Hantavirus Hantan , Seoul , Puumala , Prospect
Hill , Sinnombre viruses
Reoviridae Orbivirus Colorado tick fever , African horse
sickness , Blue tongue viruses
Rhabdoviridae Vesiculovirus Vesicular stomatitis virus , Chandipura
virus

Table – 19 Bacterial eponyms

Bacteria Eponyms
Corynebacterium pseudotuberculosis Nocard bacillus
Hemophilus aegypticus Koch weeks bacillus
Hemophilus influenza Pfeiffer’s bacillus
Klebsiella pneumonia Freidlanders bacillus
Mycobacterium chelonei Turtle tubercle bacillus
Mycobacterium fortuitum Frog tubercle bacillus
Mycobacterium intracellulare Battey bacillus
Mycobacterium paratuberculosis Johnes bacillus
Mycoplasma pneumoniae Eaton agent
Pseudomonas mallei Whitemores bacillus
Table – 20 Day Disease

Day disease Spectrum Inference

First day disease
Second day disease
Third day disease
Fourth day disease
Fifth day disease
Sixth day disease
Rubeola Measles – Koplik spots
Scarlet fever Circumoral pallor ,
Straw berry tongue
Rubella Forschmeirs spots ,
Posterior cervical
lymphadenopathy
SSSS Nikolskys sign
Erythema infectiosum Parvo virus B 19 –
Slapped cheek
appearance
Roseola infantum Exanthema subitum

Table – 21 Oncogenic microbes and parasites

Organism
Human papilloma virus (
Papovaviridae )
HSV type 2
Hepatitis B virus ( Hepadnaviridae )
Hepatitis c virus ( Flaviviridae )
HTLV-I ( Retroviridae )
HTLV-II ( Retroviridae )
HTLV-III ( Retroviridae )
Epstein barr virus ( Herpesviridae )
H.pylori
Neoplasm
SCC of cervix , vulva , penis
Oropharyngeal carcinoma
Cervical carcinoma
Hepatocellular carcinoma
Hepatocellular carcinoma
Lymphoplasmacytic lymphoma
Adult T-cell leukemia/lymphoma
T-cell variant of hairy cell leukemia
AIDS related malignancies
Non Hodgkins Lymphoma
Kaposi sarcoma
SCC of urogenital tract
Diffuse large B-cell lymphoma
Burkitt’s lymphoma
Mixed cellularity Hodgkin’s
Nasopharyngeal carcinoma
(anaplastic) ,
African Burkitt’s lymphoma
Post organ transplant lymphoma
Primary CNS diffuse large B-cell
lymphoma, Extranodal NK/T cell
lymphoma (nasal type)
Gastric malt lymphoma
Gastric cancer

Human herpes virus 8 Primary effusion lymphoma

Multicentric castleman’s disease
Schistosoma hematobium Bladder cancer(squamous cell)
Clonorchis Cholangiocarcinoma
Opisthorchis Cholangiocarcinoma

Table – 22 Infections after kidney transplantation

Infection site Period after transplantation

 Early(<1 month) Middle(1-4 Late(>6
months) months)
Urinary tract Bacteria(Escherichia Cytomegalovirus Bacteria;late
coli,Klebsiella, (fever alone is infections
Enterobacteriaceae, common) usually not
Pseudomonas, associated
Enterococcus) with
associated with bacteremia
bacteremia and
pyelonephritis,
candida
Lungs Legionella CMV diffuse Nocardia,
interstitial Aspergillus,
pneumonitis, Mucor
pneumocystis,
Aspergillus,
Legionella
Central nervous Listeria CMV
system meningitis, CMV retinitis,
encephalitis, Listeria
Toxoplasma meningitis,
gondii cryptococcal
meningitis,
Aspergillus,
Nocardia

Table – 23 Bacterial food poisoning

Incubation period, Symptoms Common food

Organism source
1 to 6 Hours
Staphylococcus aureus Nausea , vomiting , Ham , poultry , potato
diarrhea , egg , salad ,
mayonnaise , cream
pastries
Bacillus cereus Nausea , vomiting Fried rice
8 to 16 Hours
Clostridium Abdominal cramps , Beef , poultry ,
perfringens diarrhea(vomiting legumes , gravies
rare)
B.cereus Abdominal cramps , Meats , vegetables ,
Diarrhea , vomiting dried beans , cereals
>16 Hours
Vibrio cholera Watery diarrhea Shellfish
Enterotoxigenic E.coli Watery diarrhea Salads , cheese , meats

Enterohemorrhagic Bloody diarrhea Ground beef , raw

E.coli vegetables
Salmonella spp. Inflammatory Beef , poultry , eggs ,
diarrhea dairy products
Campylobacter jejuni Inflammatory Poultry, raw milk
diarrhea
Shigella spp. Dysentery Poato or egg salad ,
lettuce , raw vegetables
Vibrio Dysentery Mollusks , crustaceans
parahemolyticus

Table – 24 Parasites – Life cycles

Parasite Definitive host Intermediate Infective form

host
Protozoa
Entamoeba Human - Mature
histolytica quadrinucleate
cyst
Naegleria fowleri Human Amoeboid form of
trophozoite
Acanthamoeba Human Trophozoite , Cyst
culbertsoni
Giardia lamblia Human Mature cyst
Trichomonas Male / Female Trophozoite
vaginalis
Trypanosoma Human Tsetse fly Metacyclic
brucei gambiense trypomastigote
Trypanosoma Human Tsetse fly Metacyclic
brucei trypomastigote
rhodesiense
Trypanosoma Human Reduviid bug Metacyclic
cruzi trypomastigote
Leishmania Human Phlebotomus Promastigote
donovani sandfly
Plasmodium Female anopheles Human Sporozoites
mosquito
Babesia Ixodid ticks Human Sporozoites
Toxoplasma Cats Human Tissue containing
gondii ( Enteric cycle ) ( Exoenteric cycle tissue cyst &
) oocyst
Isospora belli Human Sporulated oocyst
Cryptosporidium Human Sporulated oocyst
parvum
Cyclospora Human Sporulated oocyst
cayetanensis
Sarcocystsis Human Cattle Oocyst in
hominis undercooked beef
Sarcocystis Human Pig Oocyst in
suihominis undercooked pork
Sarcocystis Human Ingestion of water
lindemani with oocyst
Balantidium coli Pig Human Cyst
Cestodes
Diphyllobothrium Man Fresh water Third stage
latum eldman plerocercoid larva
Fresh water fish
Spirometra Dog , Cat Cyclops Third stage
plerocercoid larva
 Snakes , Frogs ,
Fishes
Taenia saginata Human Cattle Cysticercus bovis
Taenia solium Human Pig Cysticercus
cellulosae
Cysticercosis Human Human Egg of T.solium
Echinococcus Dog , Wolf , Sheep , Cattle Ingestion of water
granulosus Jackal , Fox contaminated
with eggs
Hymenolepis Human Ingestion of water
nana contaminated
with eggs
Dipylidium Dogs , Cats Flea Ingestion of flea
caninum harbouring
cysticercoids larva

Trematodes
Schistosoma Humans Fresh water snails Cercaria larva
hematobium
Schistosoma Humans Fresh water snails Fork tailed
mansoni cercaria
Schistosoma Humans Fresh water snails Fork tailed
japonicum cercaria
Clonorchis Human Snail Metacercaria
sinensis Fish larva

Fasciola hepatica Sheep , Goat , Snail Metacercaria

Human Aquatic plants encysted on
aquatic vegetation
Fasciolopsis buski Man , Pigs Snail Metacercaria
Aquatic plants encysted on
aquatic vegetation
Heterophyes Humans , Cats , Snails Undercooked
Dogs Fishes fishes containing
metacercaria
Gastrodiscoides Man , Pigs Snails Metacercaria
hominis Aquatic plants encysted on
aquatic vegetation
Paragonimus Man Fresh water snail Metacercaia
westermani Fresh water crab / encysted in crab
Cray fish or cray fish

Nematodes
Trichinella Pig , Man Encysted larva in
spiralis striated muscles
Trichuris Man Embryonated
trichiura eggs containing
rhabditiform
larvae

Strongyloides Man Third stage

stercoralis filariform larvae
Ancylostoma Man Third stage
duodenale filariform larvae
Enterobius Man Embryonated
vermicularis eggs
Ascaris Man Embryonated
lumbricoides eggs with
rhabditiform larva
Wuchereria Man Culex mosquito Active motile
bancrofti third stage
filariform larvae
Brugia malayi Man Mansonia Active motile
third stage
filariform larvae
Brugia timori Man Anopheles Active motile
third stage
filariform larvae
Loa loa Man Chrysops Infective third
stage larvae
Onchocerca Human Simulium flies Infective third
volvulus stage larvae
Dracunculus Man Cyclops Infective third
medinensis stage larvae
Angiostrongylus Rats Molluscs , Slugs , Infective third
cantonensis Snails stage larvae
Capillaria Birds Fish Fish containing
philippinensis third stage larvae
Gnathostoma Dog , Cat Cyclops Infective third
spinigerum Fresh water fish & stage larvae
Frogs

Table – 25 Classification of parasites based on Habitat

Small intestine Protozoa Giardia lamblia , Cryptosporidium

parvum , Isospora belli , Cyclospora
caytenesis , Sarcocystis hominis ,
S.suihominis
Trematodes Fasciolopsis buski , Heterophyes
heterophyes , Metagonimus
yokogawai
Cestodes Diphyllobothrium latum , Taenia
solium , T.saginata , Hymenolepis
nana
Nematodes Ascaris lumbricoides , Ancylostoma
duodenale , Necator americanus ,
Strongyloides stercoralis ,
Trichinella spiralis , Capillaria
philippinensis
Large intestine Protozoa E.histolytica , Balantidium coli
Nematodes Enterobius vermicularis , Trichuris
trichiura
Lungs Paragonimus westermani ,
Capillaria aerophila , Dirofilaria
immitis , Echinococcus granulosus
Liver E.histolyitca , Plasmodium , Fasciola
hepatica , Clonorchis sinensis ,
Echinococcus granulosus ,
E.multilocularis
Kidney Dioctophyma renale
Subcutaneous tissue Loa loa , Onchocera volvulus ,
Drancunculus medinensis ,
Dirofilaria
Lymphatics Wuchereria bancrofti , Brugia
malayi , B.timori

Table – 26 Classification of Filarial worms

Lymphatic filariasis
Parasite Location in Microfilaria Periodicity Vector
humans of
microfilaria
Wuchereria Lymphatics Sheathed , Nocturnal Culex
bancrofti pointed tail tip
free of nuclei
Brugia malayi Lymphatics Sheathed , Nocturnal Mansonia
blunt tail tip
with 2
terminal
nuclei
Brugia timori Lymphatics Sheathed Nocturnal Anopheles
longer than
B.malayi

Subcutaneous filariasis
Parasite Location in Microfilaria Periodicity Vector
humans of
microfilaria
Loa loa Connective Sheathed , Diurnal Chrysops
tissue , nuclei
Conjunctiva extending
upto pointed
tail tip
Onchocerca Subcutaneous Unsheathed , Non periodic Simulium
volvulus blunt tail tip
free of nuclei
Mansonella Subcutaneous Unsheathed , Non periodic Culex
streptocerca blunt tail tip
with nuclei

Serous cavity filariasis

Parasite Location in Microfilaria Periodicity Vector
humans of
microfilaria
Mansonella Peritoneum , Unsheathed Non periodic Culex
ozzardi Pleura pointed tail tip
without nuclei
Mansonella Peritoneum , Unsheathed Non periodic Culex
perstans Pleura pointed tail tip
with nuclei

Table – 27 Morphology of Malarial parasites

Characters of Plasmodium infecting humans

Characters P.falciparum P.vivax P.malariae P.ovale
Disease Malignant Benign Quartan Ovale
pattern malaria tertian malaria tertian
malaria malaria
IP 12 days 14 days 20 days 14 days
No of 30,000 10,000 15,000 15,000
merozoites
released per
infected
hepatocyte
Duration of 48 hours 48 hours 72 hours 48 hours
erythrocytic
cycle
Red cell Young RBC RBC up to Older Reticulocytes
preference 14 days old RBCs
Pigment Black Yellow Brown Dark brown
colour brown black
Relapse Absent Present Absent Present
( Hypnozoites
)
Recrudescence Present Absent Present Absent
Characters of Plasmodium in blood smears
Characters P.falciparum P.vivax P.malariae P.ovale
Size of RBC Normal Large Large Normal
Shape Round but Round / Oval Round Round / Pear
crenated shaped
fimbriated
Stippling Maurer’s clefts Schuffner’s Ziemann’s Schuffner’s
; dots stippling dots & James
Basophilic dots
stippling
Schizonts 8 – 24 12 – 24 8 – 12 8 – 12
merozoites in merozoites in merozoites in merozoites
grape like grape like rosette form irregularly
clusters pattern arranged
Gametocytes Sausage / Round shaped Round shaped Round shaped
Crescent /
Banana shaped
Diagnostic Ring form , Large RBCs , Small RBCs , Large pear
keys Accole form , Ring form , Ring form , shaped
Gametocytes Trophozoites , Band form , fimbricated
Schizonts , Schizonts RBCs ,
Gametocytes Schizonts

Table – 28 Antigen – Antibody reactions

Precipitation reactions
Precipitation – soluble antigen + antibody at suitable temperature and pH – Insoluble precipitate
formation (Flocculation)
Ring test Ascoli’s thermoprecipitin test –
Anthrax
Lancefield grouping –
Streptococci
Slide flocculation test VDRL , RPR – Syphilis
Tube flocculation test Kahn test – Syphilis
Toxin standardization
Immunodiffusion Single diffusion in one Oudin procedure
dimension
Double diffusion in one Oakley Fulthorpe procedure
dimension
Single diffusion in two Radio immunodiffusion
dimension
Double diffusion in two Elek gel precipitation –
dimension C.diptheriae
Immunoelectrophoresis Quantification of proteins in
serum – Multiple myeloma (
Bence Jones proteins )
Electroimmunodiffusion Counter immuno Detection of alpha feto protein ,
electrophoresis specific antigens of
Cryptococcus & Meningococcus
in CSF
One dimensional single Rocket electrophoresis –
electroimmunodiffusion Quantitative estimation of
antigens
Two dimensional single Laurell’s electrophoresis –
electroimmunodiffusion Quantitative estimation of
mixture of various antigens

Agglutination reaction
Agglutination - insoluble antigen + antibody at suitable temperature and pH – Clumps formation
Slide agglutination Identification of bacterial isolates from clinical
specimens
Blood grouping , Cross matching
Tube agglutination WIDAL Typhoid
Standard agglutination Brucellosis
test
Microscopic Leptospirosis
agglutination test
Heterophile agglutination Weil Felix test Rickettsial infection
test Streptococcal MG Primary atypical
agglutination test pneumonia
Paul Bunnell test Infectious
mononucleosis
Antiglobulin test Direct Coombs test Detect fetal Rh Ab
Indirect Coombs test Detect maternal Rh
Ab
Passive agglutination test Hemagglutination Rose Waaler test
 Latex agglutination test Detection of ASO ,
CRP , RA factor , HCG
Co-agglutination test Diagnosis of
Legionellosis ,
Gonorrhea

Complement fixation test

Direct complement fixation Wasserman test Syphilis
test
Indirect complement fixation T.pallidum Syphilis
test immobilization test
Sabin Feldman dye Toxoplasmosis
test
Cytocidal test Vibrio
Immunoadherence Vibrio , T.pallidum

Neutralization test
Viral neutralization test Plaque inhibition test
Toxin neutralization Schick test C.diphtheriae toxin
Naeglers reaction Alpha toxin of
Cl.perfringens
ASO test Hemolytic activity of
streptococcal O
hemolysin

Table – 29 Hypersensitivity reactions

Hypersensitivity Mechanism Effects Examples

reaction
Type I (Immediate Ab- IgE (cytotropic) Systemic Bee sting
or reaginic HSN) Cells- IgE B cell, mast acute Insect bites
cells, basophils, anaphylaxis Anaphylactic shock
eosinophil Local Urticaria
Pivoted role- by T H2 anaphylaxis Angioedema
cell ( Atopy ) Hay fever
Most important Some forms of asthma;
vasoactive amine: eczema
Histamine Casoni’s test
Slow reacting Theobald smith
substance of phenomenon
anaphylaxis (SRS-A) Schultz dale phenomenon
= leukotrienes (LT Prausnitz kustner (PK)
B₄, C₄, D₄, E₄) reaction
Type II (Cytotoxic Ab: IgG or IgM Complement Transfusion reactions
or cytolytic) HSN Lysis or phagocytosis dependent Erythroblastosis fetalis
 by opsonization AI hemolytic anemia
Most commonly Drug induced hemolytic
involves blood cells anemia
Pemphigus syndrome
Bullous pemphigoid
Perinicious anemia
Thrombotic phenomenon
Acute rheumatic fever
Ab-usually IgG Type VI HSN Phagocytosis of tumor
sometimes IgE = Antibody cells or parasite
Cell lysis without dependent
phagocytosis by cell mediated
monocytes, cytotoxicity
neutrophil, ( ADCC )
eosinophils and NK
cells
Antireceptor antibody Type V HSN Thyrotoxicosis/grave’s
Stimulation = Antibody disease
Inhibition mediated Myasthenia gravis
cellular
dysfunction
Type III Ab- IgG or IgM Local immune PAN
(Immune Ag-Ab complex complex Farmer’s lung
complex) activate disease Hypersensitivity
HSN complement→ attack (arthus pneumonitis
neutrophil → release reaction) Arthus reaction
of lysosomal enzymes
Systemic SLE
immune Certain forms of acute
complex glomerulonephritis
(serum Rheumatoid arthritis
sickness) Hyperacute graft rejection
Infective endocarditis
Henoch-Schonlein
purpura
Schick test
Type 2 lepra reaction
(ENL)
Type IV (Cell Ab- No antibody Delayed type Tuberculin test
mediated) Initiated by by CD₄ T H1 Lepromin test
HSN specifically sensitized cells Type I DM
T lymphocytes Fairley’s (Schistosomiasis)
test
Frie’s (LGV) test
Granulomatous
inflammation
Contact dermatitis
Defence against
intracellular pathogen
Type I lepra reaction
Cell mediated Graft rejection
cytotoxicity by Resistance to virus
CD-8 T cells infection
Tumor immunity
 Anaesthesia
Table – 1 History of Anaesthesia

Discoverer Discovery
Alexander Wood Invented needle & syringe
August Bier First spinal anaesthesia
Bovet Succinylcholine synthesis
Car Koller Introduced cocaine as ophthalmic
anaesthetic
Domino & Corsen First used Ketamine
Edmund Gaskin Boyle First Boyle’s machine
Ferdinade Cathelin Caudal epidural anaesthesia
Fidel Pages Lumbar epidural anaesthesia
Harold Griffith Used curare
Horace Walls Demonstrated use of Nitrous oxide for
tooth extraction
Ivan Magill First endotracheal intubation
John Lundy First IV anaesthetic thiopentone
John Lundy & Ralph Waters Coined Balanced Anaesthesia
Joseph Pristley Introduced nitrous oxide
Lofgren Introduced Lignoaine
Niemann Introduced cocaine as local anaesthetic
Oliver Wendel Holmes Coind term Anaesthesia
Robert Liston First surgical operation under ether
anaesthesia
Simpson First to use chloroform
Stanlers Rowbothon First nasal intubation
W.E.Clarke Administered anaesthesia for dental
extraction
William T.G. Morton Demonstrated general anaesthetic
property of ether

Table – 2 Stages of anaesthesia

Stages of Extent Features

anaesthesia
I – Stage of From beginning of anaesthetic Patient remain
analgesia inhalation to loss of conscious ;
consciousness Pain abolished ;
Reflexes & respiration
normal
II – Stage of From loss of consciousness to Apparent excitement ;
delirium beginning of regular Jerky breathing ;
respiration Involuntary
micturition &
defecation occurs ;
Rise in BP & HR ;
Pupil dilates
III – Stage of From onset of regular respiration Anaesthesia passes to
surgical anaesthesia to cessation of spontaneous deeper planes ;
breathing BP falls with rise in HR
with weak pulse ;
Respiration decreases
in depth ;
Thoracic respiration
lags behind abdominal
respiration
Plane I Roving eyeballs
Plane II Loss of corneal &
laryngeal reflexes
Plane III Pupils dilate , Loss of
light reflex
Plane IV Intercostals paralysis
, Shallow abdominal
respiration , Dilated
pupils
IV – Stage of From cessation of spontaneous Widely dilated pupils ;
medullary paralysis breathing to failure of circulation Muscular flabbiness ;
& death Imperceptible pulses
with very feeble BP

Table – 3 Airway management

Ambubag Artificial manual breathing unit with 2 L capacity

Face mask Dead space & chances of aspiration are more
Oxygen delivery systems High flow system Venture mask – 28 – 60 %
Special nebulizer
Low flow system Nasal canula – 44 %
O2 mask – 60 %
Reservoir bags Neonates 250 ml
Infants & Children 500 ml
Adolescence 1000 ml
Adults 2000 ml

Table – 4 Airway assessment

Mallampatti Grade 3 & 4 – difficult intubation
classification Class I Faucial pillars , Soft palate , Uvula
visible
Class II Soft palate , Uvula visible
Class III Only soft palate visible
Class IV Soft palate not seen
Modified Cormack & Grade IIb , III , IV – difficult intubation
Lehane grading Class I Vocal cords visible
Class II Vocal cords are only partially visible
Class IIa Only partial glottis visible
Class IIb Only arytenoids visible
Class III Only epiglottis seen
Class IV Only soft palate seen
Thyromental distance <6.5 cm – difficult intubation
Sternomental <12.5 cm - difficult intubation
distance
Wilson’s risk score Score of 3 or more - difficult intubation
Prayer sign Inability to place palms flat together - difficult
intubation

Submandibular Ludwig’s angina , Radaition scarring , Burns , Neck

compliance surgery - difficult intubation
Mandible protrusion Patient able to protrude lower teeth beyond upper
incisors – straight forward intubation

Table – 5 Colour, Pressure & Pin Index system of anaesthetic gases

Gases Physical Pin Pressure ( Cylinder

form Index psi ) colour
Air Gas 1,5 1900 Grey body with
white shoulder
Oxygen Gas 2,5 1900 Black body
with white
shoulder
Nitrous oxide Liquid 3,5 745 Blue
Nitrogen Gas 1,4 Black
Carbondioxide Liquid 1,6(> 838 Grey
7.5 % )
2,6(<
7.5 % )
Cyclopropane Gas 3,6 Orange
Helium Gas 4,6(> Brown
80.5 % )
2,4(<
80.5 % )
Entonox Gas 7 1900 Blue body with
white shoulder

Table – 6 Breathing systems

Open breathing system – used with ether or chloroform
Semi closed breathing system
Mapleson class Features Spontaneous Controlled
fresh gas flow fresh gas flow
rate rate
Mapleson A / Efficient for Equal to minute Very high &
Magill system spontaneous ventilation ( mv ) difficult to predict
ventilation
Mapleson B 2 x mv 2 – 2.5 x mv
Mapleson C / Post operative 2 x mv 2 – 2.5 x mv
Water’s system recovery ; CPR
Mapleson D / Efficient for 2 – 3 x mv 1 – 2 x mv
Bain’s circuit controlled
ventilation
Mapleson E / Primarily used in 2 – 3 x mv 3 x mv
Ayre’s T piece infants & young
children
Mapleson F / Paediatric 2 – 3 x mv 2 x mv
Modofied Rees anesthesia
Ayre’s T piece
system

Adult Children
Spontaneous respiration Mapleson A Mapleson F ( E )
Controlled respiration Mapleson D ( Universal Mapleson F ( E )
circuit )

Table – 7 Closed breathing system – rebreathing circuit

Features Soda lime Barylime

Mesh size of granules 4–8 4–8
Composition 94 % Ca(OH)2 80 % Ca(OH)2
5 % NaOH 20 % Ba(OH)2
1 % KOH
Indicator Clayton yellow Mimiza Z , Ethyl red
Absorption capacity 14 – 23 CO2/100 gm 9 – 18 CO2/100 gm
Moisture 14 – 19 % Nil
Hardness Silicates Water crystallization
Advantage Less caustic
Amsorb plus – contains Ca (OH)2 , CaCl2 and water ; Hardness – calcium sulfate & polyvinyl pyrrolidine

Table – 8 American society of Anaesthesiologist physical scale

ASA – 1 Healthy patient without organic , biochemical or psychiatric

disease
ASA – 2 Patient with mild systemic disease
No significant impact on daily activity
Unlikely to have impact on anaesthesia & surgery
ASA – 3 Patient with severe systemic disease
Significant impact on daily activity
Probable impact on anaesthesia & surgery
ASA – 4 Patient with very severe systemic disease – constant threat to
life
Severe limitation of daily activity
Major impact on anaesthesia & surgery
ASA – 5 Moribund patient who is equally likely to die in next 24 hours
with or without surgery
ASA – 6 Brain dead organ donor

Table – 9 Drugs used in day care surgery

Desflurane Midazolam Sevoflurane Isoflurane

Alfentanil Propofol Mivacurium

Table – 10 Anaesthetics of choice for medical situations

Medical situations Anaesthetics of choice

Liver diseases Volatile anaesthetic Isoflurane
NM blockers Atarcurium , Cisatracurium
Renal diseases Volatile anaesthetic Isoflurane
IV anaesthetic Thiopentone , Propofol
Opioids Remifentanil , Sufentanil ,
Fentanyl
NM blockers Atarcurium , Cisatracurium
Respiratory diseases Induction agents Halothane , Sevoflurane ,
Ketamine
NM blockers Pancuronium ,
Verocuronium
Cardiac diseases Right to left shunt Ketamine
Left to right shunt Sevoflurane
Poor LV function IV Opioids
Good LV function Isoflurane , Sevoflurane
Neurosurgery TIVA Propofol with Opioids
Volatile anaesthetic Isoflurane
Paediatric age group Inhalational anaesthetic Sevoflurane , Nitrous oxide
IV anaesthetics Thiopentone , Propofol
NM blockers Rocuronium , Atracurium ,
Mivacurium ,
Succinylcholine
IM anaesthetic Ketamine ( Reserved drug )
Geriatric age group Induction agents Etomidate , Thiopentone
Inhalational anaesthetic Isoflurane , Desflurane
Obstetrics Painless labour Bupivacaine
Labour analgesia Entonox , Pethidine
Episiotomy Pudendal block
Mitral stenosis Inhalational anaesthetic Xenon , Sevoflurane
Epilepsy NM blocker Rocuronium
Induction agents Etomidate , Thiopentone
Burns Ketamine for dressings
Day care surgeries Induction agents Propofol
Volatile anaesthetic Isoflurane , Sevoflurane
Opioids Remifentanil , Sufentanil ,
Fentanyl
NM blockers Atarcurium , Mivacurium

Table – 11 Weaning from Mechanical Ventilation-Weaning Modes

Synchronized Intermittent mandatory ventilation ( Pressure support

intermittent mandatory IMV ) ventilation
ventilation ( SIMV ) ( PSV )
Weaning with a T piece or CPAP Assist control ventilation ( ACV )

Table – 12 Management of pre existing drug therapies

Drugs to be continued on the Drugs to be discontinued on the

day of surgery day of surgery
Anti depressants , Oral hypoglycemic agents (
Anxiolytics morning dose withheld)
Antihypertensives except Viagra ( stop before 24 hours )
ACE inhibitors , ARBs Warfarin ( stop before 5 days )
Anti asthmatics Heparin ( stop before 1 day )
Cardiac drugs Unfractionated heparin ( stop
COX -2 inhibitors before 6 hours )
Ophthalmic solutions LMW heparin ( stop before 12
Hypolipidaemic drugs hours )
Antithyroid medications ACE inhibitors , ARBs (
Antiepileptics morning dose withheld )
Insulin with dose Potent loop diuretics
modification Vitamins , Minerals , Iron
Aspirin ( 2011 guideliness ) Herbal supplements
Anticholinesterases Topical creams
Anti TB drugs Birth control pills ( stop before 4
Levodopa weeks )
Lithium ( stop before 48 – 72
hours )
Clopidogrel ( stop before 1 week
)
 Ticlopidine ( stop before 2
weeks )
Smoking ( stop before 6 – 8
weeks )

Table – 13 Zones of operation theatre and Operation theatre recommendations

Outer zone Clean / Sterile Aseptic zone Disposal zone

zone

Air exchanges – 20 – 30 Air recirculation – 80 % Bacteriological analysis -

exchanges per hour > 180m3
Laminar air flow – 90 % Humidity – 40 – 60 % Positive air pressure – 5
efficient cm H2O
Temperature – 20⁰ – 24⁰ C

Table – 14 Named anaesthesia

Named Site of action Inference

anaesthesia
Audio anaesthesia Anaesthesia induced by sound Inhibits pain
perception used by
dentists
Basal anaesthesia Level of unconsciousness that Patient does not
is just above the level of respond to verbal
complete surgical anaesthesia stimuli but reacts to
noxious stimuli
Bulbar anaesthesia Anaesthesia produced by
pontine lesions
Anaesthesia dolorosa Pain in an anaesthetized zone
Electric anaesthesia Anaesthesia induced by use of
electric current
Gwathmey’s Anaesthesia induced by olive
anaesthesia oil injection and ether solution
into rectum
Hypotensive General anaesthesia during
anaesthesia which blood pressure is
lowered
Hypothermic General anaesthesia during
anaesthesia which body temperature in
lowered
Hysterical Bodily anaesthesia occurring in
anaesthesia conversion disorders
Intratracheal Anaesthesia administered Laryngo tracheal
anaesthesia through a catheter passed to surgeries
level of trachea
Mixed anaesthesia General anaesthesia produced Maintenance of
by more than one drug anaesthesia
Neuroleptic General anaesthesia produced
anaesthesia by droperidol with fentanyl
Open anaesthesia Dropping of volatile
anaesthetic agent onto gauze
held over nose & mouth
Pudendal anaesthesia Anaesthetize the pudendal Used in obstetric
nerve procedures
Rectal anaesthesia Anaesthetics introduced in To manage paediatric
rectum patients
Refrigeration Anaesthesia induced by
anaesthesia lowering body temperature to
freezing either by spraying
with ethyl chloride or
immersing it in a cracked ice
container
Saddle block Anaesthetics into fourth Anaesthetize
anaesthesia lumbar interspace perineum and gluteal
region
Segmental Anaesthesia due to
anaesthesia pathologically or surgically
divided nerve root
Splanchnic Anaesthetic injection into
anaesthesia splanchnic ganglion
Tumescent Injection of large amount of Prior to liposuction to
anaesthesia diluted lignocaine , limit blood loss &
bicarbonate & adrenaline pain
subcutaneously

Table – 15 Classification of General anaesthetics

General anaesthetics Drugs

Inhalational Gases Nitrous oxide , Entonox , Xenon
agents Liquids Chloroform , Trilene , Cyclopropane ,
Ether , Halothane , Enflurane , Isoflurane
, Desflurane , Sevoflurane ,
Methoxyflurane
Intravenous Inducing agents Thiopentone, Methohexitone, Ketamine,
agents Etomidate, Propofol
Slower acting Benzodiazepines Diazepam , Lorazepam ,
drugs Midazolam
Opioids Fentanyl , Remifentanil ,
Sufentanil , Alfentanil
Neuroleptic Droperidol
agent

Table – 16 Classification of Local anaesthetics

Local anaesthetics Ester linked Amide linked

Shorter duration (< 30 Procaine , Chlorprocaine
mins)
Intermediate duration ( Lidocaine , Mepivacaine ,
30 – 90 mins) Prilocaine
Long duration (> 120 Tetracaine , Benzocaine Bupivacaine ,
mins) Ropivacaine , Dibucaine ,
Etidocaine

Table – 17 Classification of Skeletal muscle relaxants

1) Centrally acting muscle relaxants

Benzodiazepines Mephensin Baclofen Tizanidine

2) Peripherally acting muscle relaxants

Directly acting skeletal muscle Dantrolene , Quinine
relaxants
Drugs acting on Depolarizing Succinylcholine
neuro muscular blockers
junction Non depolarizing Steroidal Pancuronium ,
blockers compounds Rocuronium ,
Rapacuronium ,
Verocuronium ,
Gantacurium
Benzylisoquinoline d-Tubocurarine ,
derivatives Metocurine ,
Doxacurium ,
Atracurium ,
Cisatracurium ,
Mivacurium

Table – 18 Non depolarizing blockers

Long acting Intermediate Short acting Ultrashort

( > 50 mins ) acting ( 20 – ( 15 – 20 acting
50 mins ) mins ) ( < 10 – 12
mins )
Steroidal Pancuronium , Verocuronium
compounds Pipecuronium ,
Rocuronium
Benzylisoquinoline d- Atracurium , Mivacurium
derivatives Tubocurarine , Cisatracurium
Metocurine ,
Doxacurium
Asymmetrical Gantacurium
mixed onium
chlorofumarate
Phenolic ether Gallamine
Diallyl Alcuronium
derivative of
toxiferine

Table – 19 Pain Management

Term Description
Allodynia Perception of ordinarily non-noxious stimulus as pain
Analgesia Absence of pain perception
Anesthesia Absence of all sensation
Anesthesia dolorosa Pain in area that lacks sensation
Dysesthesia Unpleasant or abnormal sensation with or without a
stimulus
Hypalgesia Diminished response to noxious stimulation (eg.
(Hypoalgesia) pinprick)
Hyperalgesia Increased response to noxious stimulation
Hyperesthesia Increased response to mild stimulation
Hyperpathia Presence of hyperesthesia, allodynia and hyperalgesia
usually associated with over reaction, and persistence
of the sensation after the stimulus.
Hypesthesia Reduced cutaneous sensation (eg. light touch,
(Hypoesthesia) pressure, or temperature).
Neuralgia Pain in the distribution of a nerve or a group of nerve.
Paresthesia Abnormal sensation perceived without an apparent
stimulus.
Radiculopathy Functional abnormality of one or more nerve root.

Table – 20 Management of chronic pain

Patient controlled Epidural or Local anaesthetics Neurolytic blocks

analgesia intrathecal opioid – Hypobaric
alcohol /
Hyperbaric phenol
Anterolateral Anticonvulsants Antidepressants Cryoanalgesia
cordotomy using CO2 , N2O
gas cryoprobe
Serotonergic drugs Neuroleptics / α2 adrenergic Percutaneous
Opioids agonist radiofrequency
ablation
 Basic life support

Summary of Basic Life Support

Components Infant (<12 Child (>12 Adult

month) month)
Breathing rate 20 breaths / min 20 breaths / 10-12 breaths /
min min
Compression >100 / min 100 / min 100 / min
rate
Compression Two-Three Heel of one Hands interlaced
method push fingers or two hand
hard & fast and thumbs
allow complete encircling hands
recoil
Compression - 5:1 5:1 15:2
ventilation 5:1 if tracheal
ratio tube is used
Compression Approximately 1/3 - 1/2 of depth 1.5 - 2 inches
depth of chest
Pulse check Brachial / Carotid Carotid
Femoral
Foreign body Back blows & Hemlich Hemlich
obstruction chest thursts manoeuver manoeuver

New born Infants Children Adult

Compression 90/min Approx Approx Approx
rate 100/min 100/min 100/min
Compression 3:1 15 : 2 30 : 2 30 : 2
ventilation ( 2 rescuer) ( 1 rescuer ) ( 1 or 2
ratio rescuer )

Drugs used in CPR

Drugs indicated in CPR Drugs contraindicated in CPR
Vasopressores – Adrenaline , Calcium
Noradrenaline Sodium bicarbonate
Inotropes – Dopamine , Dobutamine
Beta blockers
Anticholinergics – Atropine
Vasodilators
Antiarrhythmics

Advanced Cardiac Life Support

 Dermatology
Table – 1 Central lesions

Central lesions Disease associated Diagnosis

Central clearing Tinea corporis KOH smear
Central scarring Lupus vulgaris Biopsy
Central crusting Leishmaniasis LD body demonstration

Table – 2 Types of erythema

Erythema annulare centrifugum Caused by drugs , infections ,

Erythema chronicum migrans
Erythema gyratum repens
Erythema induratum
paraneoplastic
Seen in Lyme disease caused by
Borrelia burgdorferi
Numerous mobile concentric arcs and
wavefronts that resemble grain in
wood associated with underlying
malignancy
Bazin’s disease (Panniculitis on lower
 legs in women)
Erythema infectiosum Fifth day disease , erythema of cheeks
caused by Parvovirus B19
Erythema marginatum Pink rings on trunk associated with
rheumatic fever
Erythema nodosum not seen in Infective endocarditis , Pancreatitis

Nail changes in Lichen Planus Nail changes in Psoriasis

Longitudinal grooving and Thimble pitting
ridging Onycholysis
Hyperpigmentation Subungal hyperkeratosis
Subungal hyperkeratosis Oil drop sign
Onycholysis
Nail dystrophy
Longitudinal melanonychia

Table – 3 Typical lesions of Dermatological diseases

Alopecia aerata Atopic dermatitis Dermatomyositis

Exclamatory sign Dermographism Helitrope rash
Atopy Dennie Morgan folds Gottrons papule
Pitting of nails Keratoconus Poikiloderma
Dowling’s lines

Lichen planus Pityriasis rosacea Tuberous sclerosis

Papule Herald patch Ash leaf spot
Plain topped Christmas tree pattern Adenoma sebaceum
Polygonal lesions Mother patch Shagreen patches
Wickhams striae Pautrier microabscess Infantile spasms
Civatte bodies Sezary Lutner cells Delayed mile stones
Pterygium of nails Collarette of scales

Table – 4 DD of Hypopigmented patch

Hypopigmented Primary cutaneous Systemic disorders

patch disorder
Diffuse Generalized vitiligo Oculocutaneous albinism
Phenylketonuria
Localized Pityriasis versicolor Vogt Koyanagi Harada
Vitiligo syndrome
Scleroderma
Tuberous sclerosis
Incontinent pigmenti
Sarcoidosis
Cutaneous T cell
lymphoma

Table – 5 Indian classification of leprosy

Indeterminate Tuberculoid leprosy Borderline leprosy

leprosy
Early cases 1 – 2 well defined lesion 4 or more flat or rasied
1 – 2 hypopigmented Hypopigmented or erythematous lesion
patches Anaesthetic Well or ill defined
Sensory impairment ++ Bacteriologically – ve Hypopigmented or
Bacteriologically –ve erythematous
Sensory impairment ++
Bacteriologically + ve
Progresses to
lepromatous leprosy
Lepromatous leprosy Pure neuritic leprosy
Diffuse infiltration or numerous flat or Nerve involvement ++
raised poorly defined shiny , smooth , No lesion
symmetrically distributed lesion Bacteriologically – ve
Bacteriologically + ve

Table – 6 Site of blisters in bullous disorders (Histology)

A) Intraepidermal region
Subcorneal (Granular layer) - Blister Pemphigus foliaceous and
is in granular layer or just below erythematosus
stratum corneum Staphylococcal scalded skin
syndrome
Miliaria crystallina
Bullous impetigo
Friction blister
Subcorneal pustular dermatosis
Spinous layer - Blisters are within Eczematous (atopic) dermatitis
spinous layer HSV/VZV infection
Molluscum contagiosum
Familial benign
permphigus(Hailey-Hailey
disease)
Suprabasal - Blister are between Pemphigus vulgaris
stratum basale and other superficial Darier's disease
layers of epidermis
Basal layer - Blisters are within Erythermia multiforme
basal layer Epidemolysis bullosa simplex

B) Subepidermal region
Junctional - At basal lamina Junctional epidermolysis
bullosa
Bullous pemphigoid
Toxic epidermal necrolysis
Dermolytic - Below basal lamina Epidermolysis bullosa acquisita
Epidermolysis bullosa
dystrophicans
Dermatitis herpetiformis
Deep burns
Porphyria cutanea tarda

Table – 7 Differential Diagnosis of Important Acquired Bullous Diseases

Disease Skin Lesions Mucous Distribution

Membranes
Pemphigus Flaccid bullae on Almost always Anywhere incased
vulgaris normal skin, involved, or generalized
erosions erosions
Pemphigus Crusted erosions, Rarely Exposed
foliaceous occasionally flaccid involved seborrheic
vesicles regions or
generalized
Pemphigus Granulating Almost always Intertriginous
vegetans plaques, involved, regions, scalp
occasionally vesicles erosions
at margin
Bullous Tense bullae on Mouth Anywhere,
pemphigoid normal and involved in 10- localized or
erythematous skin; 35% generalized
urticarial plagues
and papules

Epidermolysis Tense bullae and May be Traumatized

bullosa erosions, severely - regions or
acquista noninflammatory or involved (oral random
BP-, DH- or LAD- esophagus,
like presentation vagina)
Dermatitis Grouped papules, None Predilection sites:
herpetiformis vesicles, urticarial elbows, knees,
plaques, crusted gluteal, sacral,
and scapular
areas
Linear IgA Annular, grouped Oral erosions Anywhere
dermatosis papules vesicles and ulcers,
bullae
conjunctival
erosions and
scar

Immunofluorescence Pattern of Acquired Bullous Diseases

Disease Autoantigen Histology DIF microscopy
Pemphigus Desmogelin – Epidermal acantholytic Ig G deposits on
vulgaris 1,3 blister in suprabasal keratinocytes cell
spinous cell layer surface in FISH
NET/ CHICKEN
WIRE pattern
Pemphigus Desmogelin - 1 Epidermal acantholytic Ig G deposits on
foliaceous blister in superficial keratinocytes cell
granule cell layer surface
Pemphigus Desmogelin – Acantholysis Ig G deposits on
vegetans 1,3 intraepidermal keratinocytes cell
neutrophilic surface in fish net
abscesses & pattern
epidermal
hyperplasia
Bullous BPAG – 1 , 2 Subepidermal blister Linear band of Ig G
pemphigoid with eosinophilic and C3 in epidermal
infiltrate BMZ‘SHORE
LINE’ appearance
Epidermolysis Type VII Subepidermal blisters Linear band of Ig G
bullosa collagen and C3 in epidermal
acquista BMZ
Dermatitis Epidermal & Subepidermal blister Granular deposits of
herpetiformis Tissue with neutrophils in Ig A in dermal
transgulatmin dermal papillae papilla‘PICKET
ase FENCE’
appearance
Linear Ig A BPAG – 2 Subepidermal blister Linear band of Ig A
disease with neutrophils in in epidermal BMZ
dermal papillae

Table – 8 Criteria for diagnosing Tuberous Sclerosis

Major features Minor features

Facial angiofibromas or Multiple randomly distributed pits
forehead plaque in dental enamel
Non-traumatic ungual or Hamartomatous rectal polyps
periungual fibroma Bone cysts
Hypomclanotic Cerebral white matter migration
macules/ash leaf macules lines
(more than 3) Gingival fibromas
Shagreen patch Non-renal hamartoma
(connective tissue nevus) Retinal achromic patch
Multiple retinal nodular 'Confetti' skin lesions
hamartomas Multiple renal cysts
Cortical tuber
Subependymal nodule
Subependymal giant cell
astrocytoma
Cardiac rhabdomyoma,
single or multiple
Lymphangiomyomatosis
Renal angiomyolipoma

Table – 9 Nail disorders

Nail changes Disease associated

Koilonychia Iron deficiency anemia
Sideropenic anemia
Racquet nail Premature closure of epiphyseal line
Anonychia Lichen planus
Beau’s line , Viral illness
Onychomadesis Peripheral nerve injury
Kawasaki syndrome
Trachyonychia 20 nail dystrophy
External chemical treatment
Leuconychia Nail matrix dysfunction
Terry nails
Half & half nail
Onycholysis Psoriasis
Reiter’s syndrome
Onychorrhexis Lichen planus
Onychoptosis defluvium Alopecia aerate
Koenen’s periungal fibroma Tuberous sclerosis
Mee’s line Arsenic poisoning
Pitting of nails Deep & irregular Psoriasis
pits Atopic dermatitis
Superficial & Alopecia aerate
geometric pits
Melanonychia Nail matric nevus
Melanoma
Pregnancy
 Inflammatory nail disorder
Muehreke’s line Hypoalbuminemia

Table – 10 Wood Lamp’s light examination

Disease condition Colour of fluorosence

Corynebacterium minutissimum Coral red (due to coproporphyrin
(Erythrasma) III )
Porpyria cutanea tarda Pinkish red
Pseudomonas Pale blue (due to 'pyoverdin' or
'fluorescein' )
Squamous cell carcinoma Red fluorosence (application of 20%
ALA ointment to the tumor and
leaving it on for 4-6 hours under
occlusion, allowing
protoporphyrinogen IX to
accumulate, after which the area is
illuminated with Wood's light)
Tinea capitis Yellow fluorosence
Tinea versicolor Golden yellow fluorosence
Tuberous sclerosis Ash leaf spots (Blue white)
Vitiligo Chalky white
Hyperpigmentary dermatoses Epidermal pigmentation - contrast is
more pronounced
Dermal pigmentation - contrast is
less pronounced

Table – 11 Differrntiating Feature of STD’s

Features Syphilis Chancroid Lymphogranuloma Donovanosis Herpes

venereum genitalis
Agent T.pallidum Hemophilus Chlamydia Calymmatobacterium Herpes
ducreyi trachomatis (L1 , L2 , granulomatis simplex
L3)
Incubation 9 – 90 days 1 – 7 days 3 days – 6 weeks 1 – 4 weeks 2 – 7 days
period
Early Suoerficial/deep Excavated Suoerficial/deep Elevated papule Superficial
lesions seated papule pustule seated papule or vesicle
pustule
Edges Sharply, Undermined, Elevated, round or Elevated, irregular Erythemat
demarcated, ragged, oval serpiginous ous
elevated, round sloughed or
or oval irregular
Base Smooth , non Purulent , Variable , Red , velvety Serous
purulent , bleeds easily Non-vascular bleeds easily with erythematous
non-vascular exuberant , non vascular
granulation tissue
Induration Firm Soft Firm Firm None
Pain Uncommon Very tender Variable Uncommon Frequently
tender
Lymphadenopathy Firm, non Tender, Tender, Pseudobuboes Bilateral firm
tender, loculated, loculated, tender lymph
 shotty, suppurated, suppurated, nodes
bilateral unilateral unilateral
Diagnosis Dark field Gram staining Demonstration Histopathological Tzanck smear
microscopy ; of LGV as examination of ;
Serodiagnosis elementary biopsy ; Culture
andinclusion Staining with
bodies; Giemsa stain,
Frie’s test Wright’s stain,
Silver stain,
Leishman stain
Treatment Benzathine/ Azithromycin Doxycycline Doxycycline (or) Acyclovir
Procaine/ (or) (or) Tetracycline;
Aqueous Erythromycin; Tetracycline; Erythromycin
benzyl Ceftriaxone; Erythromycin
penicillin Ciprofloxacin

Table – 12 Dermatological tests

Disease Tests by which it is diagnosed

Atopic dermatitis Clinical examination
Contact dermatitis Patch test
Donovanosis Microscopic examination
Syphilis Dark field microscopy , FTA-ABS , VDRL ,
MHA-TP , TPI
Chancroid Gram staining
LGV Microscopic examination of Giemsa
stained scrapings
Dermatophytes KOH mount
Pityriasis versicolor KOH mount
Lupus vulgaris Biopsy
Grattage test Psoriasis
Skin sensation testing Hansen’s disease
Patch test Contact dermatitis, Utricaria

Table – 13 Variant forms of physical utricaria

Variant Description
forms of
physical
utricaria
Dermographis Immediate Simple immediate dermographism occurs
m in response to moderate stroking of the skin
and it is an exaggerated physiologic
response
Symptomatic dermographism is the most
common of the physical urticarial manifests
as linear wheals at sites of scratching and at
other sites of friction, such as collars and
cuffs of clothes
Delayed Appears at least 30 minutes after a stroking
stimulus.
Delayed Characterized by the development of deep erythematous
pressure swellings at sites of sustained pressure to the skin, after
 utricaria a delay of 30 minutes to 12 hours
Cholinergic Presents with multiple transient papular wheals
utricaria surrounded by an obvious flare. They occur within 15
minutes of sweat-inducing stimuli
Exercise Occur within minutes of exercise
induced
anaphylaxis
Adrenergic Induced by sudden stress
utricaria
Localized heat Presents within minutes of contact with heat from any
contact utricaria source, itching and whealing occur at the precise site of
contact, lasting up to 1 hour
Cold exposure Heterogeneous group of conditions in which whealing
utricaria occurs within minutes of rewarming after cold
exposure
Aquagenic Contact with water of any temperature induces an
utricaria urticarial eruption resembling a sparse form of
cholinergic urticaria.
Solar utricaria Itching and whealing occur within minutes of exposure
to UV or visible wavelengths of solar radiation specific
to die patient

Table – 14 Classification of cutaneous TB

Infection Disease Features

Exogenous Primary inoculation TB TB chancre & affected regional
infection lymph nodes constitutes primary
skin complex
TB verrucosa cutis Pauci bacillary disorder in previously
sensitized individual with high
immunity
Endogenous Lupus vulgaris Extremely chronic progressive form
infection with moderate immunity & high
degree of tuberculin sensitivity
Scrofuloderma Subcutaneous TB leads to cold
abscess formation
Acute military TB Auto inoculation of mycobacterium
Metastatic TB abscess from far advanced progressive TB of
Orificial TB internal organs
TB due to BCG Normal primary complex
like reaction
Perforating regional
adenitis
Post vaccination lupus
vulgaris

Tuberculides
Hypersensitivity reaction to Mycobacterrium tuberculosis or its products in a patient with significant
immunity
 Evidence of manifest or past tuberculosis and a positive response to antituberculosis drug
True tuberculides Facultative Non tuberculides
tuberculides
Lichen Erythema Lichenoid
scrofulosorum nodosum tuberculid
Papulonecrotic Erythema Rosacea like
tuberculide induratum tuberculid
Erythema Lupus miliaris
induratum of disseminates
Bazin faciei

Table – 15 Dermatophytoses

Dermatophytoses Affected Area MC causative agent

Tinea capitis Scalp M. canis , T. schoenleinii
Tinea corporis Trunk T. rubrum
Tinea cruris Groin T. rubrum , E. floccosum
Tinea manuum Hands T. rubrum
Tinea unguium Nails T. rubrum, T.
mentagrophytes,
E. floccosum
Tinea pedis Feet T. rubrum, T.
mentagrophytes,
E. floccosum
Black piedra Hair shaft Piedriae hortae.
White piedra Hair shaft Trichosporon beigelii
Majocchi’s Legs / arms T. rubrum, T.
granuloma mentagrophytes

Table – 16 Dermatological Tests

Named Dermatological Tests

Infectious diseases
Named tests Diseases
Tuberculin test Tuberculosis
Lepromin test Leprosy
Frei’s test LGV
Ito Reenstierna test Chancroid
Anthraxin test Anthrax
Foshay test Cat scratch disease
Dick’s test Scarlet fever
Trichophytin test Dermatophytosis
Candidin test Candidiasis
Histoplasmin test Histoplasmosis
Coccidioidin test Coccidioidomycosis
Leishmanin test Leishmaniasis
Onchocercin test Onchocerciasis
Non infectious diseases
Named tests Diseases
Intradermal sensitivity test for Contact dermatitis, Utricaria
common allergens
Intradermal sensitivity test for drug Testing hypersensitivity for drugs
Autologus serum skin testing (ASST) Chronic idiopathic utricaria
Kveim-Siltzbach test Sarcoidosis
Pathergy test Behcet’s disease
Autoerythrocyte sensitization test Autoerythrocyte sensitization
syndrome
Histamine test Integrity of dermal nerves in cases of
tuberculoid leprosy
Pilocarpine test Integrity of dermal nerves in cases of
tuberculoid leprosy

Table – 17 Dermnet of New Zealand classification of Acne

Mild acne Moderate acne Severe acne

<20 comedones 20-100 comedones >5 pseudocysts
<15 inflammatory lesions 15-50 inflammatory Total comedo count
Or, total lesion count lesions >100
<30 Or, total lesion count 30- Total inflammatory
125 count >50
Or, total lesion count 30- Or total lesion count
125 >125

Algorithm of treating Acne

Severity of Acne 1st choice Alternative for females
Mild Comedonal Topical retinoid Topical retinoid
Papopustular Topical retinoid + Topical retinoid + Topical
Topical antimicrobial antimicrobial
Moderate Papopustular Topical retinoid + Oral antiandrogen +
Oral antibiotic +/- Topical retinoid + Topical
BPO antimicrobial
Nodular Topical retinoid + Oral antiandrogen +
Oral antibiotic +/- Topical retinoid +
BPO Oral antimicrobial
Severe Nodular / Oral isotretinoin High dose oral antiandrogen
Conglobate +
Topical retinoid + Topical
antimicrobial

Table – 18 Treatment of Psoriasis

Local treatment Systemic treatment

PUVA Retinoids Methotrexate
Tar PUVA – Vit A DOC for
preparations photosensitive analogue – psoriatic
Vit D3 – psoralen Acitretin arthropathy
Calcipotriol Total dose – (Retinoids) Very
Dithranol 1500 J/cm2 DOC for effective in
Topical a)Psoriatic long term
steroid erythroderma management
 Topical b)Pustular of severe
retinoid psoriasis chronic
c)Psoriasis pustular
with AIDS psoriasis ,
psoriatic
erythroderma
, extensive
chronic
plaque type
psoriasis

Table – 19 Treatment of various stages of Syphilis

Stage of CSF Patterns Patients With

Syphilis finding Without Confirmed
Penicillin Penicillin Allergy
Allergy
Primary, CSF normal Benzathine Tetracycline HCl
secondary, or or not Pencillin G (single (500 mg PO qid) or
early latent examined dose of 2.4 mU Doxycycline (100 mg
IM) with PO bid) for 2 weeks
treatment of with treatment of
partner partner

CSF Treat as Treat as

abnormal neurosyphilis neurosyphilis
Late latent, CSF normal Benzathine Tetracycline HCI
cardiovascular, and patient Penicillin G (2.4 (500 mg PO qid) or
or benign not infected mU IM weekly for dexycycline (100 mg
tertiary with HIV 3 weeks) PO bid) for 4 weeks

CSF normal Desensitization and

and patient treatment with
infected penicillin if
with HIV compliance cannot be
ensured
CSF Treat as Treat as
abnormal neurosyphilis neurosyphilis
Neurosyphilis Aqueous Desensitization and
(asymptomatic/ crystalline treatment with
symptomatic) penicillin G for 10- penicillin
14 days or
Aqueous procaine
penicillin G (2.4
mU/d IM) plus
oral probenecid
(500 mg qid) both
for 10-14 days
Table – 20 Autoantibodies

Autoantibodies Clinical significance

ANA SLE
ANCA Ulcerative colitis
Anti Actin Ab Celiac disease , Autoimmune hepatitis
, CA stomach
Anti Centromere CREST syndrome
Anti Epithelial cell Pemphigus vulgaris
Anti GBM Good pasture disease
Anti Gliadin , Anti Transglutaminase Celiac disease
Anti GM 1 Traveller’s diarrhea
Anti GM - CSF Pulmonary alveolar proteinosis
Anti Histone Drug induced SLE
Anti Hu Small cell carcinoma of lung
Anti IgG Rheumatoid arthritis
Anti Jo 1 Polymyositis
Anti LKM 1 Autoimmune hepatitis
Anti Mitochondrial Primary biliary cirrhosis
Anti Sacchromyces cervessiae Crohns disease
Anti Scl 70 Scleroderma
Anti Smith , Anti ds DNA Specific for SLE
Anti SSA , Anti SSB Sjogrens syndrome

Table – 21 Koebner’s phenomenon

Isomorphic Reverse Koebner’s Pseudoisomorphic

Koebner’s phenomenon Koebner’s
phenomenon phenomenon
Appearance of lesion at Clearing of existing Due to auto inoculation of
site of minor trauma psoriatic lesions infection
usually 7 to 14 days after following trauma
injury It also obeys ALL OR
It is an ALL OR NONE NONE phenomenon
phenomenon
Lichen planus Plane warts
Psoriasis Molluscum contagiosum
Kaposi sarcoma Eczematous lesions
Vitiligo
Discoid lupus
erythematosus
 Forensic Medicine
Table – 1 Medicolegal Importance of Age

Time scale Significance

4 months IUL Sex can be recognized
>7 months IUL Infanticide
>5 yrs Criminal responsibility (Railways act)
<7yrs Not guilty of crime (Sec.82 IPC)
7-12yrs Guilty of crime if sufficient maturity present
(Sec.83 IPC)
<12 yrs Parents and guardians must given consent
<14 yrs Cannot be employed in factory jobs
14-15 yrs Non hazardous jobs in factories can be given
Boys < 16 yrs Taking away without the onset of the
parent/guardian is kidnapping
>18yrs Valid consent, attainment of majority, minimum
age to join govt service, vote, consent for sexual
intercourse, marriage age for girls
21 yrs Marriage age for boys
>25 yrs Minimum age for a MP
35 yrs Minimum age for president, VP, Governor

Table – 2 Police inquest Vs Magistrate inquest

Police inquest (S 174 Cr. PC) Magistrate inquest (S 176 Cr.

Conducted usually by SI or
Inspector, in the presence of
two or more respectable
persons (panchas) makes an
investigation (S.175, CrP.C)
The inquest report
(panchanama) is then signed
by the investigating police
officer and by the witnesses
PC)
Conducted by collector, Tahsildar,
Deputy Commissioner, Revenue
divisional officer
Death in police custody and
while under police
interrogation
Death due to police firing
Death in prisons,
reformatories, Borstal school
Death in psychiatric hospitals
Dowry deaths
Exhumation
Table – 3 Power of different criminal court

Court Imprisonment and fine

The Supreme court
The High court
The Sessions Judge
The Additional Sessions Judge
The Assistant Sessions Judge
Chief Judicial Magistrate or Chief
Metropolitan Magistrate
First class Judicial Magistrate or
Metropolitan magistrate
Second class Judicial Magistrate
Can award any punishment provided
in law
Can award any punishment provided
in law
Can award any punishment provided
in law
Can award any punishment provided
in law
Imprisonment up to 10 years
Imprisonment up to 7 years
Unlimited fine
Imprisonment up to 3 years
Fine not exceeding 5000 rupees
Imprisonment up to 1 year
Fine not exceeding 1000 rupees

Table – 4 Medical Council of India: Indian Medical Council Act 1956.

First Schedule Second Schedule Third Schedule Third Schedule

Part A Part B
Medical degrees Medical degrees Medical degrees Standard medical
offered by different offered by different conferred by qualifications of
Universities in Universities Indian foreign countries,
India, which are outside India, Universities, which which are not
recognized by the which are are not mentioned mentioned in 2nd
Council recognized by the in the 1st schedule schedule
Council

Table – 5 Grievous hurt (Section 320 IPC)

Component
Emasculation
Permanent privation of sight of
either eye
Permanent privation of the
hearing of either ear
Privation of any member or joint
Destruction or permanent
impairing of the powers of any
member or joint
Permanent disfiguration of the
head or face
Fracture or dislocation of a bone
or tooth
Any hurt which endangers life or
Description
Depriving a male of masculine power
The gravity lies in the permanency because it deprives
a person the use of the organ of sight
It deprives a man of his sense of hearing. Injury to the
tympanum or auditory nerve or by thrusting something
into the ear which causes deafness
Member means an organ or a limb being part of man
capable of performing a distinct function. It includes,
nose, mouth, hands, feet, phalanges
The use of limbs and joints of body arc essential to the
discharge of the normal functions of the body. Their
deprivation causes lifelong crippling and makes the
person defenseless and miserable.
Disfigure means to cause some external injuries, which
detract from his personal appearance but does not
weaken him
The doctor must document the dimension of fracture
and duration/age correlation with age of injury
A body injury/beating may not mutilate the sufferer or
which causes the victim to be in fracture his bones, but may be so harsh and painful,
severe bodily pain or unable to may cause even death
follow his ordinary pursuits for a
period of 20 days

Table – 6 Criminal responsibility and relevant sections under IPC

Section Related with

of IPC
82 A child under the age of seven is incapable of committing
an offence. This is so because action alobe doesnot
amount to guilt unless if is accompanied by a guilty mind.
And. a child of that tender age cannot have a guilty mind
or criminal intention with which the act is done This
presumption, however, is only confined to of Tenses
under the IPC but not to other Acts. e.g..theRailway Act.
83 A child above seven and under twelve years of age is
presumed to be capable of committing an offence it he has
obtained sufficient maturity to understand and judge the
nature and consequences of his conduct on that occasion.
The law presumes such maturity in a child of that age
unless the contrary is proved by the defence.
89 A child under 12 years of age cannot give valid consent to
suffer any harm which can occur from an act done in good
faith and for its benefit, e.g., a consent for an operation.
Only, a guardian can give such consent.
87 A person under 12 years of age cannot give valid consent,
whether express or implied, to sutlerany harm which may
result from an act no intended or not known to cause
death or grievous hurt e.g. consent for a wrestling contest.
84 Nothing is an offence which is done by a person who at
the time of doing it, by reason of unsoundness of mind, is
uncapable of knowing the nature of act (i.e. it is wrong or
contrary to law).
85, 86 Drunkness and criminal responsibility
Table – 7 Offences affecting Life (S.299 In 311)

299. Culpable homicide (not amounting, to murder)

300. Murder (definition)
301. Punishment of murder (death or life imprisonment)
302. Punishment of murder by life convict (death)
303. Punishment of culpable homicide not amounting to murder
304 Causing death by negligence (2 years imprisonment ± fine)
305 Abetment of suicide of child or insane person (10 years
imprisonment)
306 Abetment of suicide (10 years imprisonment)
307 Attempt to murder (10 years imprisonment)
308 Attempt to commit culpable homicide (10 years imprisonment)
309 Attempt to commit suicide (up to 1 year imprisonment ± fine)

Table – 8 Offences related to Dowry

304 B Dowry deaths (with in 7 years of marriage) (imprisonment not

less than 10 years which may extend to life imprisonment ±
 fine)
S.174 (3) Procedure in dowry death (suicide, suspected murder, request
Cr. P.C. by a relative; doubt of cause of death, police consider
necessary).
Police has to enquire & report.
498 A Whoever (husband or relatives) subjects such woman to
cruelty shall be punished with
imprisonment extending to 3 year ± fine. Cruelty is any willful
conduct that drives women to comit suicide or grave mental or
physical injury to her or harassment of woman with a view to
coerce her for dowry.
113 A & Deal with presumption as to abetment of suicide by a married
133 B LEA woman, and presumption as to dowry death.

Table – 9 Offences related to Hurt (S319-338)

319 Defines hurt as bodily pain disease or infirmity

320 Defines grievous hurt
323 Hurt (No provocation; Non grevious injury weapon)
324 Hurt by dangerous weapon (No provocation; Non grevious injury)
325 Grievous hurt (No provocation; No dangerous weapons)
326 Grievous hurt by dangerous weapon

Table – 10 Offences Related to Assault

351 Defines assault as use of criminal force, gesture to apprehend

352-58 Punishment for causing assault

Table – 11 Others: Rape, Criminal Negligence, Torture

375 Defines rape

376 Punishment of rape
377 Unnatural sexual offences
362 Abduction
84 Criminal responsibility
330,331, 339, Torture
341
53 An accused can be examined by a medical practitioner at
the request of police, even with out his consent and by
use of

88 Death of patient caused by surgery done

312,313 & For whoever voluntarily causes abortion. (Miscarriage)
314
304 A Death by negligence (by doing any rash or negligent (with act)
not amounting to culpable homicide shall be punished with
imprisonment extending up to 2 years or with fine or both.
Example is death of patient caused by surgery done by a
quack.
336,337, Criminal negligence
338
Table – 12 Hymenal tear

Natural notch Tear in hymen

Fimbriated type of hymen has Occurs due to sexual intercourse,
multiple nothches(mistaken tor foreign body, during accidental
tear of hymen) injury by an object
Non-tender Tender to touch
Symmetrical Asymmetrical

Anteriorly placed Posteriorly or anywhere

Do not extend to the vaginal wall Extend upto the vaginal wall

Table – 13 Types of punishments/ tortures

Terms Meaning
Autoerotic hanging Victims usually young males (with masochism or
trans vest ism) enhance sexual pleasureby
compressing the blood vessels of neck by any
means.
Lynching When several persons acting jointly and illegally
over power an individual and hang him.
Mugging (choke- Strangulation of victim's neck against the
holding) forearm.
Garrotting Victim is attacked from back without warning
and strangled by throwing a ligature overthe
neck and tightening it quickly.
Spanish windlass It is a type of garroting. It used to be the
official mode of execution in Spain. In this an
iron callar around the neck was tightened by a
screw for stangling.
Bansdola Neck is compressed between two sticks or
hard objects.
Throttling Manual strangulation effected by hand.
Burking method of Burk used to sit on chest covering with one
somethering used hand the mouth and nostril and pushing
byBurk and Hare upthe jaw with other hand and Hare used to
andtraumatic asphyxia pull him round the room by feet.
Somthering Asphyxia caused by mechanical occlusion of
external are passage.
Chocking Asphyxia caused by mechanical occlusion of
enternatare passage.
Gaging Chocking by preventing air entry through
mouth and nostril by filling cloth etc in mouth
Cafe coronary Accidental chocking by bolus of food
obstructing larynx. Death is mostly due to
asphyxia or less commonly due to reflex
cardiac arrest caused by stimulation of
laryngeal nerve endings.
Overlying(compression Compression of chest prevents breathing. It
suffocation) occurs when mother shares a bed with infant.
Table – 14 Firearm injury
 Contact shot Close shot Distant shot
The discharge from The discharge of The discharge of
the muzzle muzzle is flame powder muzzle is outside the
consisting of the etc is within the range range of entrance
flame, powder of entrance wound wound.
metallic are blown
the track taken by
the bullet.
Consequently there Consequently wound is No burning, no
may be no burring, singed by flame, tattooing, soot
no soot, no tattooing surrounded by
around the entrance soot(blackened) and
wound shows tattooing
Skin surrounding The skin surrounding The skin surrounding
the wound shows the wound shows the wound may be -
No abraded collar Abraded collar Abraded collar may be
No grease collar Urease/dirt collar present
Dirt collar or grease
collar present
Surrounding tissues Carboxyhaemoglobin is Surrounding tissues
may be cherry red in present in the wound may be cherry red due
colour owing to track in diminishing to present of
presence off concentrations. This carboxyhaemoglobin
carboxyhemoglobin explains cherry red
colour of surrounding
tissues
Wound may be - The entrance wound is The wound is circular
Small and regular or circular inverted with inverted margins
Large and irregular margins but the and may be ofsame
(triangular, stellate rebounding gases may size or even smaller
cruciate) level upor even evert than the bullet due to
Contact head wound the margin initial stretching of
result in skin.
undermined, ragged,
stellate(star
shaped), triradiate
or cruciform wound
with everted
margins from which
lacerations (tears)
over skin radiating
outward from
entrance hole
because of
expansion of gases
between scalp and
skull

Table – 15 Types of Skull fractures

Type of Description Type of force

fracture
Fissure # Linear crack in inner table or Blows with an agent
outer table or both. having a relatively
broad striking surface
or Forcible contact with
a broad hard surface
Depressed # Fracture pattern often resembles Heavy weapon with a
(fracture ala the weapon or agent which small striking surface
signature) caused it Ex:- Hammer, stone,
chopper
Comminuted # There are two or more It is often a
intersecting lines of fracture, complication of fissured
Which divide the bone into three or depressed fracture.
or more fragments.
When there is no displacement of
fragments, it resembles a spider’s
web or mosaicq.
Pond # Only in infants, as their Skull Obstetric forceps
(indented #) bones are pliable
Diastatic/ sutural Separation of sutures Blunt injury
# In young persons
Gutter # Part of thickness of bone is Oblique bullet wounds
removed
Perforating # Both tables are involved Pointed sharp weapons
like daggers, knives and
axe
Ring or foramen It is a fissure fracture which runs Fall from height on foot
# at about 3-5cm outside and or buttocks
around the foramen of magnum.

Table – 16 Dentition

Temporary teeth Permanent teeth

Smaller, lighter, narrow Heavier, stronger ,Broader
Crown is china white in color Crown is ivory white in color
Neck is more constricted Neck is less constricted
Ridge is present Ridge is absent
20 in number 32 in number
Dental formula is 1 C M : 2 1 Dental formula is I C P M :
2 2123

Temporary Dentition Age (months)

Lower central incisor 1st 6-8
Upper central incisor 7-9
Upper lateral incisor 7-9
Lower lateral incisor 10-12
Fist molar 12-14
Canine 17-19
Second molar last 20-30

Permanent dentition Age (years)

First molar First 6-7
Central incisor 6-8
Lateral incisor 7-9
First premolar 9-11
Second premolar 10-12
Canine 11-12
Second molar 12-14
Third molar Last 17-25
Note: Premolars are absent in Primary dentition
Delayed dentition Early dentition
Hypopituitarism Syphilis (Hutchinson’s teeth)
Hypothyroidism Histiocytosis X
Rickets
Down’s syndrome

GUSTAFSON'S METHOD
Age estimation of adults > 21yrs
Criteria used
Attrition
Paradentosis
Secondary dentin
Cementum apposition
Root resorption
Root transparency (most reliable)
Anterior teeth are more suitable than posterior teeth, while 3rd molar is unsuitable for Gustafson's
method

Table – 17 Sexual pervertions

Sexual perversions Description

Bestiality Sexual intercourse by a human being
with a lower animal
Bobbit syndrome Female amputates penis of her male
partner
Bondage/Algolania Sadism + Masochism
Buccal coitus Buccal-Penile intercourse is called
(sin of Gomorrah) Fellatio; the partner who performs the
act is called the Fellator; and on whom it
is performed is the Fellatee.
Caprolagnia Sexual pleasure by urinating over the
partner
Cunnilingus Oral stimulation of female genitalia
Electra complex Sexual desire of daughter towards her
father
Eunuchs Male prostitutes in India, at as passive
agents in sodomy

Exhibitionism ( S 294 IPC Exposure of genitalia in a public place to

) obtain sexual pleasure
Fellatio Oral stimulation of male genitalia
Fetichism Sexual excitement by seeing
undergarments of a woman
Frotteurism (S 290 IPC) Sexual satisfaction by rubbing his genitals
against a female in crowd
Gerontophila When the passive agent is an adult
Incest Sexual intercourse by a man with a
woman who is closely related to him by
blood (prohibited degrees of relationship)
e.g. daughter, sister, granddaughter, step
sister
In India, incest as such, is not an offence
Indecent assault (S354 Any offence committed on a female with
IPC) the intention to outrage her modesty
Lesbianism (Tribadism, Female homosexuality
Sapphism) Active lesbian is known as Butch or Dyke,
while the usually passive agent is called
Femme
Lust murder Murder serves as a stimulus for sexual act
Masochism Opposite to sadism, asking the partner to
inflict pain on himself for sexual pleasure
Mixoscopia Sexual satisfaction by the sight of
others engaged in sexual
intercourse
Narcism Self love
Necrophagia (S 297 IPC) Eating the flesh, drinking the blood
of the victim to drive sexual
pleasure
Necrophilia (S 297 IPC) Sexual intercourse with dead bodies
Oedipus complex Sexual desire of son towards his
mother

Onanism/Ipsation/Masturbation Self stimulation which effects

sexual arousal
Paederasty When the passive agent is a child
(catamite)
Paraphilias Unorthodox sex play by using
objects or parts of the body
Pedophile Adult who repeatedly engages in
sexual activities with children
Pharoan complex Sexual desire of brother towards his
sister
Pygmalionism Falling in love with an object made
by him
Pyromania Sexual pleasure by seeing flames
and destruction of a building
Sadism Sexual gratification obtained from
acts of cruelty or infliction of pain
on the partner
Scatalogia Obsence telephone calls
Sodomy/Buggery Anal intercourse
Stalking (Sec 354 D IPC) Whoever follows a person and
contacts or attempts to contact such
person to foster personal
interaction repeatedly despite
disinterest by such a person –
Punishment - 1 to 3 years
Transvestism/Eonism Desire to be identified as opposite
sex
Troilism Sexual practice by involving 3 persons; 2
of one sex and one of the opposite sex
Undinism/Urolagnia Sexual pleasure by seen the act of
urination
Uranism Sexual gratification by fingering,
fondling, licking and sucking the
 genitalia of opposite sex
Voyeurism/Scotophilia (Sec Whoever watches or captures the image
354 C IPC) of a women engaging in a private act and
obtain sexual gratification – punishment
for 1 year which may extend to 3 year

Table – 18 Tests for blood stains, seminal stains and firearms

Tests for blood stains Tests for seminal Tests for firearms
stains
Benzidine test Creatine Harrison and
Phenolphthalein phosphokinase Gilroy test
(Kastle Mayer test Nentron
test) Acid activation
Haemin crystal phosphatase analysis
test (Teichmann test Atomic
test) Florence test absorption
Haemochromogen Barberio's spectroscopy
test (Takayama teste (crystals (AAS)
test) of sperm in Flameless AAS
Immunological picrate) Dermal
test - precipitin nitrate(paraffin
test test)
Spectroscopy -
most reliable

Features Hanging Strangulation by

ligature
Ligature mark Oblique Transverse
Does not encircle the neck Encircles the neck
completely completely
Below chin and above At or below thyroid
thyroid cartilage cartilage
Base-pale, hard and Base-soft and reddish
parchment like

Bruising of neck muscles Not common Common

Neck Stretched and elongated Not common
Hyoid bone fracture Common Uncommon
Thyroid cartilage fracture Less common More common
Carotid intimal tears Present Absent
Salivary dribbling Present Absent
Bleeding from nose , Uncommon Common
mouth and ears

Table – 19 Signs of Pregnancy

Presumptive signs Probable signs Positive signs

Amenorrhea Enlargement of Fetal parts and
Breast changes abdomen movements felt
Morning sickness Hegar’s sign by placing the
Quickening Goodell’s dign hands on the
Pigmentation of (softening of abdomen
skin cervix) Fetal heart
Jackquemier’s or Braxton-Hick’s sounds
 chadwick’s sign (intermittent Placental soufflé
sign(discoloration uterine Umbilical
of vagina) contractions) soufflé
Urinary Ballotment X-ray diagnosis
disturbances Uterine soufflé (not done now)
Sympathetic Immunological Ultrasound
disturbances tests

Table – 20 Torture

Falanga Canes or rods used to beat on the soles

Telefono Repeated slapping on the side of head over ears
Wet submarine Forced immersion of head in water contaminated with urine
or feces
Dry submarine Tying a plastic bag over the head until suffocation
Parrot’s perch Head down from a horizontal pole placed under the knees
with wrists bound to ankle
Cattle prod Electric shock especially over the genitals
Chapuwa The legs and thighs are tied very tightly with bamboo sticks to
induce severe pain
Ghotna Rolling a wooden log over the things up and down, while the
long is weighed by one or two policemen standing on it
Sham execution Victim is blind folded and asked to stand before a wall and
then threatened that a vehicle is going to hit him. He hears
the sound of a vehicle very near to him, causing fear and
shock
Dunking Victim is immersed into water, taken out after some time and
given chance to confess

Table – 21 Antidotes

Poisons Antidotes
Acids β-aminoproprionitrile
Alpha adrenergics Phentolamine
Amantins Benzyl penicillin
Arsenic Dimercaprol , Unithiol

Benzodiazepines Flumazenil
Beryllium Aurintricarboxylic acid , Sodium
salicylate
Beta adrenergics Propranolol
Beta blockers Glucagon , Isoprenaline
Botulism Guanidine
Carbon monoxide Hyperbaric oxygen , Tocopherol
Central anticholinergics Physostigmine
Chloroquine Diazepam
Cholinergic agents Atropine
Copper Penicillamine , Trientine
Coumarin derivatives Vitamin K
Cyanide Amyl nitrite , Dicobalt edetate ,
 Hydroxocobalamine , Sodium nitrite ,
Sodium thiosulphate
Cyanide , CO , H2S Oxygen
Digitalis Digoxin specific antibody fragments
Ergotism Sodium nitroprusside
Heparin Protamine sulphate
Insulin Glucose
Iron , Aluminium Desferrioxamine
Isoniazid Pyridoxine
Lead , Mercury Succimer
Malignant hyperthermia Dantrolene
Mercury N-Acetylpenicillamine
Methanol , Ethylene alcohol Ethanol , 4-methylpyrazole
Opiates Naloxone
Organic peroxides Ascorbic acid
Organophosphates Oximes
Oxalates , Fluorides Calcium salts
Paracetamol Acetyl cysteine , Methionine
Peripheral anticholinergics Neostigmine
Radioactive metals Pentetic acid
Thallium Potassium hexacyanoferrate

Table – 22 Recommended emergency antidotes

Activated charcoal Amyl nitrate Antivenin

Glucagon’s Flumenazil Calcium chloride
Leucovorin Fomepizole Calcium gluconate
gel
Methylene blue Folic acid Desferrioxamine
N-acetyl cysteine Ethanol Digoxin immune Fab
Naloxone Physostigmine Polyethylene glycol
Sodium nitrite Sodium thio sulphate Pralidoxime
Vitamin K Succimer Sodium bicarbonate

Table – 23 Composition of universal antidote

Components Quantity Mechanism

Charcoal 2 parts Adsorbs poisons
Magnesium oxide 1 part Neutralizes acids
Tannic acid 1 part Precipitates
alkaloids, certain
glycosides and metals

Table – 24 Fatal Doses of Common Toxins

Aspyxiants
CO 50-70% saturation
H2S 0.2% cone
Cardiac poisons
Digitalis 15-30 mg
Nerlum (oleander) 15g
Aconite 1g root 4 mg alkaloid
Nicotine 60 mg (tobacco = 2g)
Spinal prisons
Strychnine 15-30 mg
Hallucnogens
LSD —
Metals and Non-Metals
Arsenic 120-200 mg
Mercury 1-2 o
Lead 0.5 g
Coppor 30 g
Thalluim 19
Zn 15g(ZnS04)
400g (ZnCl2)
Phosphorus 120 mg
Iodine 2g (Tincture = 2 ml)
Organic Irritants
Castor 6g (10 seeds)
Croton 20 drops (4 seeds)

Abrus(Ratti) 90-20 (1-2 seeds)

Semicarpus 5-10g
(marking nut)
Calotropis -
Opium 2 mg
Morphine 200 mg
Heroine Very low
Peripheral nerve poison
Curare 30-80 mg
Hemlock 1 cm plant
(conuim)
Deliriant 60 mg
Dhatura 100-125 seeds
(Dhatura)
Hyoscine 15-30 mg
(Henbane)
Others
Endrin 6g
Celphos 12 tab (3g)
Zinc phosphide 5g
Snakes
Elapids Cobra-15 mg
 (neurotoxic) Krait - 6 mg
Vipers 40 mg
(vacculotoxic)
Sea snakes Not fatal
(myotoxic)

Table – 25 Poisons causing miosis and mydriasis

Miosis Mydriasis
Carbolic acid Viper venom
Chloral hydrate Datura
Opium Alcohol ( constricted in coma)
OPC Aconite
Barbiturates Nux vomica
Benzodiaaepines Cocaine
Formalin Cannabis
Belladonna Carbon monoxide
Caffeine Chloroform
Clonidine Calotropis
Methyl dopa Ether
Drowning

Table – 26 Viscera preserved in poisoning

Viscera preserved Poison

Heart Strychnine, Digitalis
Brain OPC, opiates, CO, cyanide, strychnine,
barbiturates, anesthetics
Spinal cord Strychnine, gelsemium
CSF Alcohol
Bile Narcotics, cocaine, methadone,
glutathione, barbiturates
Vitreous Alcohol, Chloroform
Skin Hypodermic injection marks
Bone, nails Arsenic, antimony, thallium, radium
Fat Insecticides and pesticides

Table – 27 Colour of urine in poisoning

Poisoning Colour of urine

Carbolic acid Greenish brown
HNO Brown
Barbiturates Liquid gold

Table – 28 Snake poisons

Type of poisoning Snake

Hematotoxic Vipers
Myotoxic Sea snakes
Neurotoxic Elapids- cobra, Krait, coral

Contraindication for gastric lavage:

Absolute: alkalis, mineral acids, vegetable acids, organic acids except carbolic acid
 Relative: kerosene or volatile poisons, convubant poisons except strychinine, hypothermia, bleeding
disorder.

Table – 29 Preservatives used in poisoning

Poison Preservative
All poisons except carbolic acid Saturated saline
All acids except carbolic acid Rectified spirit
Oxalic acid, ethylene glycol Sodium citrate
Alcohol Sodium fluoride + potassium
oxalate
Carbon monoxide Liquid paraffin
Urine Thymol
Histopathological examination 10% formalin
Suspected rabies 50% glycerine

Table – 30 Color of post-mortem staining in various poisoning

POISON COLOR
Carbon mono-oxide and Cherry red
hypothermia
HCN, burns Bright red
Nitrites, potassium chlorate, Chocolate or
potassium bicarbonate
Nitrobenzene, acetanilide, Copper brown
bromates, aniline (causing
methaemoglobinuria)
Phosphorous Dark brown or yellow
Hydrogen sulphide Bluish green

Table – 31 Stomach mucosa appearance in poisoning

Poison Stomach mucosa appearance

Mercury Slate colored
Arsenic Red velvety
Strong acids Blackening, perforation, Charring and
eschar formation
Nitric acid Yellow
Carbolic acid White and shriveling
Cresols Brown
Copper Blue or green

Table – 32 Embalming fluid

Recommended composition of Embalming fluid

Formalin (60%)
Methanol (25%)
Liquid phenol (10%)
Sodium lauryl sulphate (1%)
Mercuric chloride (1%)
 Eucalyptus oil (1%)

Table – 33 Embalming fluid components

Preservatives Germicide Buffers Wetting agents

Formaldehyde Phenol Sodium borate Glycerine
Methyl alcohol Zephiran chloride Sodium bicarbonate Sorbitol
Phenol Glutaraldehyde Sodium carbonate Sodium lauryl
Magnesium carbonate sulphate

Anti-coagulants Dyes Vehicles Other agents

Sodium oxalate Eosin Water Perfumes
Sodium citrate Ponceau Glycerine Muscle relaxants
Sorbitol Disinfection
Alcohol

Burns assessment
 Surgery
Table – 1 Sutures

Suture Types Raw Tensile Absorption

material strength rate
Silk Braided or Natural Loses 20% Fibrous
twisted protein when encapsulation
multifilament Raw silk wet. 80- in body at 2-3 Table – 2 Different
Coaled from 100% lost weeks,Absorbed types of suture
(with wax or silkworm by 6 slowly over 1-2 material
silicone) or months year"
 uncoated
Catgut Plain Collagen Lost within Phagocytosis
derived from 7-10 and
healthysheep days enzymatic
or catle degradation
within 7-10
days
Catgut Chromic Tanned with Lost Phagocytosis and
chromium salts within 21- enzymatic
toimprove 28 degradationwithin
handling and days 90 days
resist
degradation in
tissue
Polyglactin Braided Copolymer of Approx. Hydrolysis minimal
(Vicryl) multifilament lactide and 60% until5-6 weeks.
glycolide0 in a remains Completeabsorption
ratio of at 2 60-90 days
90:10.coated weeks.
with polyglactin 30%
and remains
calcium stearate at 3
weeks
Polyglyconate Monofilament Copolymer of Approx. Hydrolysis minimal
Dyed or glycolic acid 70% until8-9 weeks:
undyed andtrimethylene remains Complete
carbonate at 2 absorption 180 days
weeks,
55%
remains
at 3
weeks
Polygrycaprone Monofilament Coplymer of 21 days 90-120 days
glycol lie maximum
andcaprolactone
Polyglycolic Braided Polymer of Approx. Hydrolysis0
acid multifilament polyglycolic acid 40% minimal
(Dexon) Dyed of remains at 2 weeks;
undyed at 1 significantat 4
Coated of weeks; weeks; Complete
Uncoated 20% absorption 60-90
remains days"
at 3
weeks
Polydioxanone Monofilament Polyester Approx. Hydrolysis
(PDS) dyed or polymer 70% minimal at
undyed remains at 90days:
2 weeks. Complete
50% absorption
remains at 180 days
4 weeks:
14%
remains at
8 weeks
Non Absorbable suture Special properties
materials
Silk Natural derived from silkworm
Linen
 Surgical steel
Nylon (polyamide polymer)
Polyester
Polybutester Monofilament
Polypropylene(Prolene) Monofilament

Absorbable suture materials Time of absorption

Plain catgut 7-10 days ( Derived from sheep’s
intestine)
Chromic catgut 90 days
Polyglactin

60-90 days
Polyglyconate 180 days
Polyglycolic acid ( Vicryl) 60-90 days
Polydiaxonone(PDS) 180 days( longest absorbable suture
material)
Polyglycaprone 90-120 days

Table – 3 Uses of various sutures

Clinical condition Suture material used

Vascular anastomosis Prolene
Esophageal anastomosis Nonabsorbable suture
Bowel anastomosis Vicryl
Closing peritoneal cavity Poly dioxane
Circumcision in children Catgut
Suturing muscle & fascia Chromic catgut
Hernioplasty Prolene

Preservation of suture
Isopropyl alcohol - used as preservative while packing suture.
Ethylene oxide - Used in pasteurization of suture material.

Table – 4 Glasgow Coma Scale (GCS)

Best Motor response Verbal response Eye Opening
Obeys commands 6 Oriented 5 Spontaneous 4
Localizes pain 5 Confused, 4 To loud voice 3
Flexion 4 disoriented To pain 2
(withdrawal) Inappropriate 3 No response 1
to pain) words Maximum score-
15, minimum score-3.
Abnormal flexion 3 Incomprehensible 2 Best predictor of outcome: Motor response.
posturing sounds
Patients scoring 3 or 4 have an 85% chance of
Extension 2 No response 1 dying or remaining vegetative, while scores above
posturing 11 indicate only a 5- 10% likelihood of death.
No response 1

Table – 5 Named Classification For Tumors

 Named Staging Disease Associated
Chang staging Medulloblastorma
Masoaka staging Thymoma
Shimda index Neuroblastoma
Reiss andEllsworth classification Esson prognostic Retinoblastoma
index
Bloom-Richardson grading CA breast
Naguchi classification Adenocarcinoma lung
Sullivan modification of Macfalene system Adrenocortical carcinoma
Gleason CA prostate
Nevinestaqing CAGB
Duke staging Colorectal carcinoma
Robson staging RCC
Jackson CA penis

Table – 6 Most Common Lymph Nodes Involved

CA Penis Inguinal LN
CA Testis On right: Inter-aortocaval LN
On left: Paraaortic LN
CA Bladder Obturator LN
CA Prostate Obturator LN

Table – 7 Hypertrophic Scars Vs Keloid

Hypertrophic Scars Keloid

Rise above skin level + +
Stay within contines Yes Extend beyond
of wround
Regression May regress rarely regress
Tenderness, pruritus + +
burning secretion
Time of appearance With 4 weeks of trauma 3 months to years after
initial truama
Site Across areas of tension earlabes/deltoid
joints/skin crease presternal region/upper
back
Increased TGF β + +
expression in
fibroblasts
Treatment Goals Restoration of function,
relief of symptoms and
prevention of recurrence
Treatment Conservative (Topical Surgery - (high
steriods) recurrence) debulking
Intralesional corticosteroid Intralesional
Topical retinoids corticosteroid (1st line
t/t)
Topical application of
silicone sheet
Radiation - (1500 +
 2000 rods)
External pressure (esp.
post burn)
Topical retinoides.

Table – 8 Cancer epidemiology

MC cancer in males worldwide CA Prostate > Lung > Colorectal

MC cancer in females worldwide CA Breast > Lung > Colorectal
MC cause of cancer deaths in males & CA Lung
females
MC cancer site in males & females CA Lung
MC cancer in males in India CA Upper aerodigestive tract
MC cancer in females in India CA Cervix > Breast
MC pediatric malignancy overall Leukemia > Lymphoma
MC neoplasm in children < 2 year Neuroblastoma
MC solid tumor in children Brain tumors
MC renal neoplasm in children Wilm’s tumor
MC soft tissue tumor in children Rhabdomyosarcoma

Table – 9 Sites for metastasis

Tumor Metastatic sites

CA Breast Lung > Bone > Liver > Adrenal >
Brain
CA Colon & Rectum Liver > Adrenal > Bone > Lung
CA Lung Liver > Bone > Adrenal > Brain
CA prostate Bone > Lung > Liver
Carcinomas Regional lymph node
Sarcomas Lungs via hematogenous route
Table – 10 Carcinoma Thyroid- Mode of spread and Metastasis

Type Mode of spread MC site of

Metastasis
Papillary carcinoma Lymphatic spread Lungs
Follicular carcinoma Hematogenous spread Bones
Medullary carcinoma Both lymphatic and Liver
hematogenous spread
Anaplastic Direct invasion Lungs
carcinoma

Table – 11 Uses of anticancer drugs

Diagnosis Treatment of choice

Adrenal cancer Mitotane
ALL Vincristine + Prednisolone +
Daunorubicin + L-asparaginase +
Intrathecal methotrexate
AML Cytarbine + Daunorubicin
Astrocytoma / Glioblastoma Temozolomide
muliforme
CA anal canal Radiotherapy + 5 – FU + Mitomycin
C
CA bladder Gemcitabine + Cisplatin
CA breast Tamoxifen / Aromatase inhibitors
CA cervix Paclitaxel + Cisplatin
CA colon Folinic acid + 5 – FU + Oxaliplatin
CA esophagus Cisplatin + 5 – FU
CA head & neck Cisplatin + 5 – FU
CA ovary Paclitaxel + carboplatin
CA pancreas Gemcitabine + Cispaltin
CA prostate GnRH agonist + Antiandrogen
CA rectum Radiotherapy + 5 – FU
CA stomach Epirubicin + Cisplatin + 5 – FU
CA thyroid Sorafenib
CA uterus Progestins / Tamoxifen / Aromatase
inhibitors
Carcinoid Streptozocin + 5 – FU
Choriocarcinoma Methotrexate / Dactinomycin
CLL Fludarabine
CML Imatinib
Hairy cell leukemia Cladribine
Hepatocellular carcinoma Sorafenib
Hodgkins disease Adriamycin + Bleomycin +
Vinblastine + Dacarbazine
Insulinoma Streptozocin
Kaposi sarcoma Liposomal doxorubicin
Melanoma Ipilimumab
Mesothelioma Cispaltin + Pemetrexed
Multiple myeloma Bortezomib + Dexamethasone +
Lenalidomide

Neuroblastoma Cyclophosphamide + Doxorubicin +

Cisplatin + Etoposide
Non Hodgkin disease Cyclophosphamide +
Hydroxydaunorubicin + Oncovin +
Predisolone + Rituximab
Non small cell lung CA Cisplatin + Vinorelbine +
Bevacizumab
Osteosarcoma Doxorubicin / Cispaltin / Ifosfamide
/ High dose methotrexate
Polycythemia vera Hydroxyurea
Renal cell CA Sunitinib
Small cell lung CA Cisplatin + Etoposide
Soft tissue sarcoma Mesna + Adriamycin + Ifosfamide +
Dacarbazine
Testicular cancer Bleomycin + Etoposide + Cisplatin
Waldenstorm macroglobulinemia Plasmapheresis + Bortezomib

Most Common Symptom

CA Esophagus • Dysphagia >weight loss
CA stomach • Abdominal pain >weight loss
Periampullary carcinoma (including • Jaundice
CA head of pancreas)
HCC • Abdominal pain >weight loss
Cholangiocarcinoma • Painless progressive jaundice
CA Gall bladder • Biliary colic
CA small bowel • Abdominal pain
CA colon • Abdominal pain
CA rectum • Bleeding PR
CA anal canal • Bleeding PR

Table – 12 Named Hernia

Gibbon's hernia • Hernia with hydrocele

Berger's hernia • Hernia into pouch of Douglas
Beclard's hernia • Femoral hernia through opening of saphenous
vein
Amyand's hernia • inguinal hernia containing appendix
Ogilive's hernia • Hernia through the defect in conjoint tendon
just lateral to where it inserts with the rectus
sheath
Stammer's hernia • Internal hernia occurring through window in the
transverse mesocolon after retrocolic
gastrojejunostomy
Peterson hernia • Hernia under Roux limb after Roux-en-Y gastric
bypass

Table – 13 Indirect hernia vs Direct hernia

Indirect hernia Direct hernia

Inferior epigastric Lateral Medial
artery
Zieman's test Cough impulse on Cough impulse on middle finger
Index finger
Invagination test Tip of finger Pulp of finger
Ring occulsion test Does not bulge Bulge medial to occluding
finger
Coverings (from Extraperitoneal tissue Extraperitoneal tissue
inside out) Internal spermatic Fascia transversalis
fascia Conjoint tendon
Cremasteric fascia External spermatic fascia
External spermatic Skin
fascia
Skin

Table – 14 Hernioplasty proceddures

 Hernioplasty procedures
Lichtenstein’s hernioplasty
Gilbert’s plug repair
Stoppas procedure
Inference
Strengthening of posterior inguinal
wall using a prolene mesh fixed in the
inguinal canal
Plug mesh kept in deep ring and also to
reinforce the posterior wall
For bilateral direct hernia's, a modified
Pfannenstiel incision made in the lower
abdomen and a huge mesh placed in
between the peritoneum and the fascia
transversalis (Preperitoneal mesh
repair)

Table – 15 Herniorraphy procedures

Herniorraphy procedures Inference

Modified Bassini’s repair Without opening fascia transversalis,
inguinal canal is approximatedwith
continuous locking stitch with prolene
and conjoint tendon approximated
with inguinal ligament
Shouldice technique Double breasting of fascia transversalis
McVay’s repair Approximated conjoint tendon with
iliopectineal ligament of Cooper
Darning Suturing conjoint tendon with inguinal
ligament using 1 - 0 prolene without
tension

Table – 16 Types of Renal Stones

Features Calcium Uric acid Struvite Cysteine

oxalate stone stone stone stone
Salient MC stone Also known as Hard stones;
characteristics Magnesium Resistant to
ammonium fragmentation
phosphate by ESWL
stones or triple
stones
Etiology Idiopathic Hyperuricemia Proteus or Cystinuria
hypercalciuria; Pseudomonas
Hypocitraturia; infection
Regional
enteritis
Urinary pH Acidic Acidic Alkaline Acidic
Radiopaque / Radiopaque Radiolucent Radiopaque Radiopaque
Radiolucent
stone
Shape Needle shaped Diamond/Barrel Coffin lid Hexagonal
shaped shaped

Table – 17 Most Common Sites Of Conditions In Abdomen

Important Most Common Sites

• Gastric ulcer Lesser curvature (near
 Incisuraangularis)

• Peptic ulcer 1stpart of duodenum

• Gastric outlet obstruction
• Small bowel adenocarcinoma Duodenum
• Atresia
• Polyps in PJS Jejunum
• PneumatosisIntestinalis
• Crohn's disease Terminal Ileum
• Fistula, perforation and carcinoma in
Crohn's disease
• Typhoid ulcer
• Tubercular ulcer
• Small Intestinal lymphoma
• Gall stone Ileus
• Amebic colitis Cecum and ascending colon
• Bleeding in anglodysplasia
• Bleeding in colonic diverticula
• Ischemic colitis Splenic flexure
• Colonic diverticula Sigmoid
• Stricture after Ischemic colitis
• Volvulus
• Ulcerative colitis Rectum
• Colorectal cancer
• Hirschprung's disease

Table – 18 Guidelines for Day of Suture Removal by Area

Body Regions Removal Body Regions Removal

Eyelid 3-4 Chest, abdomen 8-10
Eyebrow 3-5 Ear 10-14
Nose 3-5 Back 12-14
Up Extremities 12-14
Face (other) 3-4 Hand 10-14
Scalp 6-8° Foot, sole 12-14

Table – 19 Abdominal Examination Signs

Abdominal Examination Signs

Sign Description Diagnosis
Aaron sign Pain or pressure in epigastrium or Acute appendicitis
anterior chest with persistent
firm pressure applied to
McBurney's point
Bassler sign Sharp pain created by compressing Chronic appendicitis
appendix between abdominal
wall and iliacus
Blumberg's Transient abdominal wall rebound Peritoneal inflammation
sign tenderness0
Carnett's sign Loss of abdominal tenderness when Intra-abdominal source
abdominal wall muscles are of
contracted abdominal pain
Chandelier Extreme lower abdominal and Pelvic inflammatory
sign pelvic pain with movement of disease
cervix
Claybrook sign Accentuation of breath and cardiac Ruptured abdominal
sounds through abdominal wall viscus
Courvoisler's Palpable gallbladder In presence of Periampullary tumor
sign painless jaundice
Cruveilhier Varicose veins at umbilicus (caput Portal hypertension
sign medusae)
Danforth sign Shoulder pain on inspiration Hemoperitoneum
Fothergill'ssign Abdominal wall mass that does not Rectus muscle
cross midline and remains hematomas
palpable when rectus contracted
Mannkopfs Increased pulse when painful Absent If malingering
sign abdomen palpated
Ransohoff Yellow discoloration of umbilical Ruptured CBD
sign region
Ten Horn Pain caused by gentle traction of Acute appendicitis
sign right testicle

Table – 20 Most Common Type Of Stones

Gall bladder Cholesterol (Mixed if given in the

option)
Pancreas Calcium carbonate
Kidney Calcium oxalate
Primary Bladder Stone Ammonium urate
Secondary Bladder Stone Uric acid >Struvite
Prostate Calcium phosphate
Salivary gland (Submandibular) Calcium carbonate

Table – 21 Ideal Time For Treatment

Undesended testis 6 months

Hypospadias 6-12 months
Umbilical hernia 5 years
Cleft lip 3-6 months
Cleft palate 6-18 months

Table – 22 Most Common

Small-Bowel Neoplasm
• MC tumor of small bowel: Leiomyoma>Adenoma
• MC tumor of small bowel in children: Lymphoma
• MC malignant tumor of small bowel: Carcinoid Adenocarcinoma
• MC site of small bowel malignancy, carcinoids, lymphoma: Ileum
• MC site of carcinoid tumors or distribution (BIRACS)- Bronchus> Ileum
> Rectum > Appendix >Colon > Stomach
Table – 23 Gastric ulcer Vs Duodenal ulcer
Gastric ulcer
Etiology
Atrophic gastritis
H.pylori (70%)
Smoking, Alcohol
Lower socioeconomic
group
Altered mucosal barrier
function (NSAID)
There is either normochlorhydria
or ↓ chlorhydria
Cirrhosis
Most common site
Lesser curvature along the incisura 1st part of Duodenum
angularis
Clinical features
Equal in both sexes
Pain in the epigastrium
after taking food; relieved
by vomiting
Pain common during night
Hematcmesis common
Appetite good, but hesitant
to eat as eating inducespain
that results in loss of
weight
Barium meal X ray features
Niche on lesser curve with
notch on greater curve
Regular/round margin of
ulcer crater - stomach
spoke wheel pattern
Overhanging mucosa at the
margins of a benign gastric
ulcer projects inwards
towards the ulcer-
Hamptom's line
Converging mucosal folds
at the base of the ulcer
Complications
Hour glass contracture -
exclusively in women due
to cicatricial contracture of
lesser curve ulcer
Tea pot stomach (hand bag
stomach) -cicatrisation and
shortening of the lesser
Duodenal ulcer
Stress, anxiety - 'hurry,
'Worry, curry'
H.pylori (90%)
NSAIDs, steroids
Blood group O+ve
Endocrine: Zollinger-Ellison
syndrome, MEN-I Cushing's
syndrome,
hyperparathyroidism
Alcohol, smoking, vitamin
deficiency
Chronic pancreatitis,
Cirrhosis
More common in males
Pain is more before food, in
early morning, decreases
after food(hunger pain)
Pain is uncommon during
night
Melena common
Appetite good, eats more
frequently and there is
weight gain
Once stenosis develops, loss
of weight
Deformed or absent
duodenal cap(because of
spasm)
Appearance of trifoliate
duodenum due to secondary
duodenal diverticula
Bleeding - Me complication,
on posterior wall,
gastroduodenal artery is the
artery of bleed
Perforation - more on
anterior wall, if posterior-
into pancreas
 curvature
Bleeding (splenic A),
perforation (into lesser sac)
Malignant transformation
to adenoCA
Surgery
Partial gastrectomy with
Billroth I gastroduodenal
anastamosis
Type IV ulcer - subtotal
gastrectomy
Gastric Outlet Obstruction
due to pyloric stenosis- least
common
Duodenal ulcer will not turn
malignant
Highly selective vagotomy
Selective vagotomy with
pyloroplasty
Truncal vagotomy (TV) with
gastrojejunostomy
Posterior TV with anterior
seromyotomy- Tavlor's
operation

Table – 24 X-ray signs in duodenal ulcer perforation

Signs Significance
Cupola sign Crescent shaped radiolucency under
the diaphragm
Rigler’s sign Visualization of both aspects of bowel
wall being outlined by gas on either
side
Inverted V sign Gas on either side of falciform
ligament
Football sign Collection of gas in the centre of
abdomen like a foot ball
Triangle sign Gas between bowel loops

Table – 25 Pneumoperitoneum and Pseudopneumoperitoneum

Pneumoperitoneum
Hollow viscus perforation
Postoperative abdomen
Laparoscopy
Diagnostic procedures
involving female genital
tract
Peritoneal dialysis
Pseudopneumoperitoneum
Distended viscus
Chilaiditi's syndrome
[interposition of colon with
gas between liver and
diaphragm]
Subphrenic abscess
Sub diaphragmatic fat,
omental fat
Uneven diaphragm
Subpulmonary
pneumothorax
Curvilinear pulmonary
collapse
Intramural gas in
pneumatosis intestinalis

Table – 26 Diagnosis of Intussusception

Barium enema USG X-ray

Claw sign Target sign Meniscus sign
Coiled spring sign Pseudokidney sign Multiple air fluid levels
Bull's eye sign
Doughnut appearance
Table – 27 Imaging modality and its significance in liver

Imaging Principle indication

modality
USG Standard first line investigation
Spiral Anatomical planning for liver surgery, gold standard for
CT/MRI liver imaging
MRCP First line, noninvasive cholangiography
ERCP Imaging the biliary tract when endoscopic intervention is
needed ( e.g. ductal stones)
PTC Biliary tract imaging when ERCP is impossible of failed
High strictures in CBD
Klatskin tumor
Laproscopic To detect superficial peritoneal metastasis and superficial
USG liver metastasis

Indications of Liver Transplantation

MC indication for LT: Cirrhosis from Hepatitis C (HCV)
2nd MC indication for LT: Alcoholic liver disease
MC indication for LT in children: Biliary atresia
MC metabolic disorder requiring LT Alpha-1 antitrypsin deficiency
MC indication for LT following acute liver failure: Acetaminophen toxicity

Table – 28 Some important triads

Charcot’s Dieulafoy's mad Virchow's triad Borchardt's

triad triad
Cholangitis Acute appendicitis Thrombosis Gastric Volvulus
Fever Hypersensitiveness Hypercoagulability Acute epigastric
Jaundice of skin Stasis pain
Abdominal Reflex muscular Endothelial injury Violent vomiting
pain contraction Inability to pass
Mac Burney's NG tube
tenderness

Congenital Galezia triad Saint's triad

diaphragmatic
hernia
Respiratory distress Dupuytren's Hiatus hernia
Apparent dextrocardia contracture Gallstones
Scaphoid abdomen Retroperitoneal fibrosis Diverticulosis
Peyronie's disease of
penis

Tillaox's triad Cushing’s triad Sandblom triad

Mesenteric cyst Intracranial hypertension Hemobilia
Soft fluctuant Increased BP Jaundice
swelling in umbilical Decreased pulse rate Pain
region Decreased respiratory rate Melena
Freely mobile
perpendicular to
mesentery
Zone of resonance
all around
Table – 29 Uretheral injury

Bulbar urethral injury Membranous urethral injury

Direct blow to perineum Pelvic fracture
Superficial extravasation Vermooten's sign: High lying
Urine first collects in the (floatingprostate) on P/R
superficial perineal pouch Deep extravasation
and then in scrotum, Urine collects in the
penis and anterior perivesical space
abdominal wall
Seen in both bulbar and membranous urethral injury
Retention of urine
Blood at the meatus
Perineal hematoma

Table – 30 Testicular Tumors

Germ cell tumors Sex cord tumors Combined Germ

(95%) cell and gonadal
stromal tumor
Seminomas Leydig cell tumor Gonadoblastoma
Non seminomas Sertoli cell tumor
Teratoma Gonadoblastoma
Embryonal
carcinoma
Choriocarcinoma
Yolk sac tumor

Table – 31 Pediatric Tumors

MC malignant tumor of infancy Neuroblastoma

MC extracranial solid tumor in children
MC abdominal malignancy in children
MC primary malignant renal tumor of Wilm's tumor
childhood
MC renal tumor of infancy Congenital
mesoblasticnephroma
MC soft tissue tumor in infants and Rhabdomyosarcoma
children
MC solid tumor of childhood Brain tumor
MC cancer of childhood Leukemia (30%) >Brain tumors
(22%)
MC cancer in males (PLC): Prostate >Lung >Colorectal
MC cancer in females (BLC): Breast >Lung >Colorectal
Cancer deaths in males (LPC): Lung >Prostate >Colorectal
Cancer deaths in females (LBC): Lung >Breast >Colorectal

Increased Cancer Risk In Obese Patients Prostate

Endometrial
Esophagus
Liver
Cervix
Pancreas
Gall Bladder
Ovarian
Kidney
 Bile duel
Breast
Colon and rectum

Table – 32 Discharges from nipple

Discharge from single duct Discharge from more than one duct
Blood stained Serous Blood stained or Purulent
Intraduct Fibrocystic serous Infection
papilloma[mcc] disease Carcinoma Milk
Intraduct Duct Ectasia Lactation
carcinoma ectasia Fibrocystic Hypothyroidism
Duct ectasia Carcinoma disease Pituitary tumor
Black or
green
Duct
ectasia

Table – 33 Mammogram

Benign lesion Malignant lesion

Smooth margins III defined margins
Macrocalcification Microcalcification
Normal breast parenchyma Architectural distortion
Ducts normal Focal dilation of ducts
Less radiation exposure
Sensitivity increases with age (density decreases)
Normal mammogram does not exclude presence of carcinoma

Table – 34 Carcinoma Breast Management

TNM Classification of Breast Cancer

T0 No clinical evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor 2 cm or less in greatest dimension
T2 Tumor more than 2 cm but not more than 5 cm in greatest
dimension.
T3 Tumor more than 5 cm in greatest dimension
T4 T4a Extension to chest wall (excluding the pectoralis)
T4b Edema (including Peaud' Orange) or ulceration of the skin
of the breast, or satellite skin nodules confined to the same
breast
T4c BothT4a & T4b.
T4d Inflammatory Carcinoma
N0 No regional lymphnode metastasis
N1 Metastasis to ipsilateral axillary lymph nodes, mobile

N2 N2a Metastasis to ipsilateral axillary lymph nodes, fixed or

matted
N2b Metastasis to ipsilateral internal mammary nodes in the
absence of clinically evident axillary lymph node metastasis
N3 N3a Metastasis to ipsilateral infraclavicular lymph node
N3b Metastasis to ipsilateral internal mammary lymph node and
ipsilateral axillary lymph node
 N3c Metastasis to ipsilateral supraclavicular lymph nodes
M0 No distant metastasis
M1 Distant metastasis

Staging according to TNM Classification

Stage 0 - Tis N0 M0
Stage I - T1 N0 M0
Stage II - T0 N1 M0
T1 N1 M0
T2 N0/N1 M0
T3 N0 M0
Stage III T3 N1 M0
Any T4
Any N2, N3
Stage IV Any M1

Table – 35 Types of Mastectomy and Breast conservative surgery

Types of Mastectomy
Simple or Total Removal of breast tissue, nipple-areola
mastectomy complex, and skin0.
Extended simple Simple mastectomy + removal of level 1
mastectomy axillary LNs.
Modified radical Removes all breast tissue, nipple-areola
mastectomy complex, skin and level 1 and II axillary
LNsQ.
Halstead's radical Removes all breast tissue and skin, nipple
mastectomy areola complex, pectoralis
major and minor muscles and the level 1, II
and III axillary LNs°.
Extended radical Radical mastectomy + Removal of internal
mastectomy mammary LNs
Super radical mastectomy Radical mastectomy + Removal of internal
mammary, mediastinal and supraclavicular
LNs

Variants of MRM
Auschincloss Procedure Removes all breast tissue, nipple-areola
complex, skin and level I and IIaxillary LNs.
Patey's Procedure Pectoralis minor is removed to allow complete
dissection of level III axillary LNs
Scanlon's modification of Pectoralisminor is divided instead of
Patey's procedure removing.
Division of pectoralis minor allows complete
removal of level III axillary LNs
 Indications Contraindications
Lump < 4cm Tumor > 4cm
Clinically negative axillary Positive axillary nodes(>N1)
nodes Tumor margin +ve after breast
Mammographically conservative surgery
detected lesion Poorly differentiated tumor
Well differentiated tumor Multicentric tumor
Adequate size breast to Earlier breast irradiation
allow proper radiotherapy Tumor/Breast size ratio is
Feasibility of axillary more
dissection and RT to intact Tumor beneath nipple
breast Extensive intraductal
carcinoma

Hormone therapy in breast cancer

Premenopausal women Post menooausal women
Tamoxifen (antiestrogen) Tamoxifen
Ovarian ablation by Letrozole (aromatase
surgery, Goserelin-an inhibitor)
LHRH agonist (medical Androgens
oophorectomy) Progestogens
Fluoxymestrone (androgen) Aminoglutethamide (Medical
Medroxyprogesterone adrenalectomy)
(progestogen)

New Drugs in Ca Breast

Ixabepilone Used for antracycline and taxane resistant breast
cancer
Lapatinib Inhibitor of Her-2-neu and EGFR tyrosine Kinase
Second line Her-2-neu therapy
Sunitinib Approved for advanced renal cancer and
refractory metastatic breast cancer

Table – 36 Carcinoma of unknown primary (CUP) (TNM/AJCC 2010 STAGING)

Regional Lymph Nodes (N)
N1 Metastasis in a single
ipsilateral LN, <3 cm in
greatest dimension.
N2a Metastasis in single ipsilateral Hematoma
LN, >3 cm but <6 cm in
greatest dimension.
N2b Metastases in multiple
ipsilateral LN, none >6 cm in
greatest dimension.
N2c Metastases in bilateral or
contralateral LN, none >6 cm
in greatest dimension.
N3 Metastasis in a LN >6 cm in
greatest dimension.
Primary tumor
T0 Patients with unknown
Table – 37
Extradural primary tumor
Hematoma Vs Tx Patients whose tumor cannot
Subdural be assessed or is not assessed
Distant Metastasis
(Acute)
M0 No distant metastasis.
M1 Distant metastasis.
Mx Unknown presence or
absence of metastasis
Extradural Hematoma Subdural Hematoma
(Acute)
EDH accumulates in the SDH accumulates in the
space between bone & space between dura &
dura. arachnoid. (Most common)
Disruption of a major dural Disruption of a cortical vessel
venous sinus can result in or brain laceration
an EDH Nearly always associated with

Classical presentation:
Initial injury followed by a
lucid interval (occurring in
<1/3rd of cases)
CT appearance of EDH:
Lentiform (lens shaped or
biconvex) hyperdense
lesion
Treatment of EDH:
Immediate surgical
evacuation via a
craniotomy
Overall mortality for all
cases of EDH is about 18%
but for isolated EDH it is
about 2%
Table – 38 Graft
a significant primary brain
injury
Patients present with an
impaired conscious level from
the time of injury, but further
deterioration can occur as the
hematoma expands
CT appearance of SDH:
Concave hyperdense lesion
Treatment of SDH:
Evacuation via craniotomy
Mortality rate from SDH is as
high as 40°/o in some series

Graft
Auto graft Isograft Homograft Heterograft
(Allograft) (Xenograft)

Tissue Transplant from a Transplant from Transplant from

transplanted genetically individual of same another species
fromone site to identical species
another onthe donor, such as an
same patient identical twin

Table – 39 Organs & Tissues to be transplanted

Organs & Tissues that can be transplanted at present

Kidney Middle ear
Lung Skin
Liver Bone/tendons
Pancreas and islet cells of Bone marrow
Langerhans Blood vessels (most common
Heart and heart valves saphenous vein)
Cornea

Table – 40 Bariatric Surgery

Surgical treatment performed for morbid obesity is known as Bariatric Surgery
Eligibility criteria
BMI>40 or BMI>35 with an associated medical comorbidity worsened by obesity
Failed dietary therapy
Psychiatrically stable without alcohol dependence and illegal drug abuse

Bariatric Operation Mechanism of Action

Vertical banded gastroplasty Restrictive
Laparoscopic adjustable gastric
banding
Roux-en-Y gastric bypass(RYGB) Largely Restrictive/Mildly
Malabsorptive
Biloancreatic diversion Largely Malabsorptive/Mildly
 Duodena switch Restrictive
Sleeve gastrectomy is a part of the above preformed surgeries.

Table – 41 Composition of crystalloid and colloid solutions (mM/L)

Solution Na+ K+ Ca2+ Cl- Lactate Colloid

Hartmann's (RL) 130 4 <2.7 109 28
Normal saline 154 154
(0.9% Na CI)
Dextrose saline 30 <1 30
(4% dextrose In
0.18% saline)
Gelofusine 150 150 Gelatin 4%
Hemacel 145 5.1 <6.26 145 Polygelin 75 g/L
Hetastarch Hydroxyethyl
starch 6%
Lactated potassium 121 35 103 53
saline injection
(Darrow's solution)

Table – 42 Characteristics of Selected Blood Components

Component Volume Content Clinical Response

(mL)
Whole Blood 450 ml No elements removed Not for routine use
±45 Contains RBCs, WBCs, Used for acute
plasma andplatelets massive
(WBCs and platelets bleeding,open heart
may be non-functional) surgery and neonatal
totalexchange
Packed RBCs 180-200 RBCs with variable Increase Hb 1 gm/dL
leukocyte contentand and hematocrit 3%
small amount of
plasma
Platelets 50-70 5.5 x 1010VRD unit Increase platelet
count 5000-10,000/
µL
FFP 200-250 Plasma proteins Increases coagulation
Coagulation factors, factors about
proteins C and S,
antithrombin
Cryoprecipltate 10-15 Cold-insoluble plasma Topical fibrin glue,
proteins, fibrinogen, also 80 IU factor VIII
factor VIII, vWF

Table – 43 Named Operations

Named operation Disease associated

Duhamel Hirschsprung’s disease

Dahl man’s Zenker's diverticula

Blaskovics Ptosis
Fasanellaservat Homer's syndrome/congenital ptosis

Wheeler, Bicks &Weiss procedure Senile Entropion.

Burrow's operation cicatrical Entropion.

Charles’/Sistrunk Thompson Tit of lymph edema procedure

Sistrunk Thyroglossal fistula.

Whipple's procedure (G.B. + BD + 'Ca' pancreas.

Distal stomach + Prox. Jejunum) -
Pancreaticoduodenectomy)
Puestow procedure (longitudinal chronic pancreatitis.
Pancreatico jejunostomy)
Lloyd - Davis APR

Milligan - Morgan operation Hemorrhoids.

Young's operation Atrophic rhinitis

Cocket and Dodd's operation Subfascial ligation

Kelly suture (to plicate bladder Marchetti

neck), Burch colposuspension,
Marshall

Cody tack operation Meniere’s disease.

Ranadiers operation Petrositis.

Ball's operation Pruritus vulvae

Ward mayo operation Abdominal hysterectomy.

Strassman operation Bicornuate uterus.

Mayer's operation Intracapsular # of femur.

Glenn .shunt Tricuspid atresia.

Fontan operation Tricuspid atresia

Hunterian ligature Aneurysm.

Table – 44 Timing of primary cleft lip and plate procedures

Cleft lip alone

Laterality Number of Timing of the operation
operations
Unilateral One operation 5-6 months
Bilateral One operation 4-5 months
Cleft palate alone
Soft palate only One operation 6 months
Soft and hard Two operations Soft palate at 6 months
palate Hard palate of 15-18 months
Cleft lip and palate
Unilateral Two operations Cleft lip and soft palate of 5-6
 months
Hard palate and gum pad with
or without lip revision of 15-18
months
Bilateral Two operations Cleft lip and soft palate at 4-5
months
Hard palate and gum pad with
or without lip revision at 15-18
months

Embolization Agents
Polyvinyl alcohol (PVA) is a nonuniform mixture of amorphous plastic particles commercially
available in sizes ranging from 45 to 1180 μm.

Table – 45 Liquid Embolic Agents

Liquid Embolic Agents Inference

Cyanoacrylates (glue) Tissue adhesive materials that polymerize
rapidly once exposed to an ionic
environment such as saline or blood,
forming a cast of the vessel in which
polymerization occurs
Sclerosants Liquid embolization agents that produce
nearly immediate and complete
thrombosis and inflammation at the very
small-vessel and tissue level.
Absolute alcohol Extremely toxic to living tissues, leading to
complete vessel thrombosis/occlusion as
well as direct tissue ablation and cell death
Sodium tetradecyl sulfate (1 to Mild sclerosant used for varicose vein,
3%) spermatic vein and renal ablations, pelvic
congestion syndrome, and preoperative
arteriovenous malformations
Ethiodol Inert oil-based contrast agent – Once
injected, oil droplets break into smaller
globules to ~50 µm in diameter, leading to
a distal functional-level embolization
Lipoidal Affinity to hepatocellular carcinoma,
increasing the selectivity of the
embolization

Powder Substances
Gel foam
Microfibrillated collagen
Thrombin
Starch microspheres

Table – 46 Degrees of burns

First degree Second degree Second degree Third degree

 (Superficial) (Deep)
Involves only Involves epidermis Involves epidermis Involves epidermis
epidermis and and and full thickness
of dermis
upper part of up to reticular
papillary dermis layer of dermis
No blister Blisters formed Blisters seen Eschar formation
formation
Blanch to touch Blanch to touch Mottled pink and Black or brown
white color
because of varying
blood supply to
dermis
Painful Painful Pain absent Painless
Heal without Heal without Heals with scar 3- Heals with wound
scarring in 5-10 scarring in 7-14 9 weeks contracture only
days days or by SSG only

Table – 47 Complications of Total parenteral nutrition (TPN)

Metabolic complications Electrolyte abnormalities

Azotemia Hyper / hypo natremia
Essential fatty acid deficiency Hyper/ hypo kalemia
Fluid overload Hyper/ hypo phosphatemia
Metabolic bone disease Hyper/ hypo magnesemia
Liver dysfunction Hyper/ hypo calcemia
Glucose High/ low serum zinc
imbalance(hyperglycemia, High / low serum copper
hypoglycaemia) Hyperchloremic metabolic
Trace element and vitamin acidosis
deficiency
TPN complications
Catheter related
Infection
Injuries
Pneumothorax, Hydrothorax
Cardiac tamponade
Injury to artery and vein
Injury to thoracic duct, nerves.
Thrombosis
Air embolism, catheter embolism
Postcannulation

Psychiatry
Table – 1 International classification of disease-10 (ICD-10)

ICD-10 is WHO classification for all diseases and health problems (and not only psychiatric disorders).
ICD-10 uses alpha numeric code made of an alphabet (in contrast DSM-IV uses numerical coding) 'F' is
for mental disorders. There are 10 main categories denoted by digits 0 to 9.

Code Category
F0 Organic, including symptomatic mental disorders
F1 Mental and behaviour disorders due to psychoactive substance
use
F2 Schizophrenia, schizotypal and delusional disorders
F3 Mood (affective) disorders
F4 Neurotic, stress-related and somatoform disorders
F5 Behavioral syndromes associated with physiological disturbances
and physical factors
F6 Disorders of adult personality and behavior
F7 Mental retardation
F8 Disorders of psychological development
F9 Behavioural and emotional disorders with onset usually occuring
in childhood or adolescence

Table – 2 Contributors in Psychiatry

Name Contribution

Adler Alfred Coined inferiority complex ;

Founder of school of individual psychology

Binet Alfred Formal scale of intelligence

AT Beck Cognitive therapy

Eugen Bleuler Coined schizophrenia

Walter Dendy Coined psychotherapy

Kraepelin Emil Dementia precox

Alexander Franz Father of psychosomatic medicine

Sigmund Freud Founder of psychoanalysis ;

Coined Free association , Edipus / Electra
complex , Penis Envy ;
Concept of Id , Ego & Superego

Maxwell Jones Therapeutic community

Carl Jung Founder of school of analytical psychology ;

Coined introvert / extrovert

Anton Mesmer Coined animal magnetism

Ivan Pavlov Coined classical conditioning

Jean Piaget Stages of cognitive development

Johann Reil Coined psychiatry ;

Founded the first psychiatric journal

Table – 3 Jean Piaget Theory of Intellectual Development

Intellectual development goes hand-in-hand with the development of physical and behavioral
characteristics.

Stages of Intellectual development

Stages Extent Characters
Sensori-Motor From birth to 2 years Actions related to
stage of age suckling, orality and
assimilation of objects
Ability to think of only
one thought at a time
Inanimate objects are
given human qualities
Out of sight' means
ceasing to exist
Concrete thinking From 2 years to 7 Egocentric thought with
stage years a unique logic of its own,
involving a limited
period of view and
lacking introspection
Inability to generalize
from specific events and
to specify from general
events
Abstract or From 7 years to 11 Ability to focus on
Conceptual years several dimensions of a
Thinking stage problem at one time,
mentally.
The thought process is
flexible and reversible
Ability of abstraction, i.e.
ability to generalize from
specific and ability to
find similarities and
differences among
specific objects.
Adolescent thinking From 11 years and Ability to imagine the
or Formal continues life long possibilities inherent in a
Operational Stage situation, thus making
the thought
comprehensive
Ability to develop
complete abstract
hypotheses and to test
them

Table – 4 Topographic theory of Mind

Stages of Thinking Features

consciousness process
Unconscious Primary thinking Immediate discharge of
process (Based on drive energy
pleasure Lacks contact with
principle) reality
Lacks organisation and
logical connections
Preconscious Region of mind
between unconscious
and conscious
Preconscious mental
contents can become
conscious with
focussing of attention
Conscious Secondary Type of special sense
thinking process organ of attention
(Based on reality concerned with
principle) registration of stimuli
Table – 5 Psycho- Sexual Stages Of Development

Psycho- Sexual Stages Of Disorders

Development
1. Oral 0 - 1 ½ Year Psychosis (Schizophrenia)
Drug Dependence
2. ANAL 1 ½ - 3 Years OCD
3. PHALLIC 3-5 Years Sexual dysfunction
Oedipal & Electra Complex
Conversion disorders
4. LATENT 5- 11 Years Neurotic disorder
5. Genital Normal
Table – 6 Definitions in psychiatry

Psychiatry terms Description

Abreaction It is bringing to conscious awareness,
thoughts, affects and memories for the
time
Affect Defined as the patient's present
emotional responsiveness ; Signifies
feelings
Akinetic mutism The person lay inertly in bed mute and
almost totally unresponsive, although he
followed the movements of people
around him with his eyes
Alexithymia Inability to verbally describe emotional
feelings
Amotivation Lethargy, apathy, loss of interest,
anergia, reduced drive or lack of
ambition
Anhedonia Inability to experience pleasure in
previously pleasurable events
Apathy Lack of feeling or emotions
Appropriate affect Condition in which the emotional tone is
in harmony with the accompanying idea,
thought or speech
Automatism Automatic performance of an act or acts
generally representative of unconscious
symbolic activity
Avolition Lack of initiative
Blunted affect Disturbance in affect manifested by a
severe reduction in the intensity of
externalized feeling tone
Cataplexy Temporary loss of muscle tone and
weakness precipitated by a variety of
emotional states
Cluttering Erratic & dysarrythmic pattern of speech
with jerky and rapid spurting of words.
Unlike in stuttering (where the person is
 aware of the difficulty in speech), the
affected person in cluttering is usually
unaware of the abnormal speech pattern
Cognition It signifies thought
Compulsion Repetitive behaviour like checking, hand
washing etc
Conation It signifies action
Deja vu A sense of familiarity with unfamiliar
circumstances
Delusion A false, unshakable belief which is not
amenable to reasoning, and is not in
keeping with the patients socio cultural
and educational background
Depersonalization An alteration in the perception of self, so
that the feeling of one's reality is
temporarily changed or lost
Derealization An alteration in the perception of
external world, so that the feeling of the
reality of external world is temporarily
lost or changed
Disorientation A disturbance in orientation in time,
place or person
Ecstasy Very severe elevation of mood. Seen in
delirium or stuporous mania, stage IV
Ego alien (ego dystonic) Foreign to one's personality
Elation Moderate elevation of mood. Seen in
mania, stage I
Euphoria Mild elevation of mood. Seen in
hypomania stage I
Exaltation Severe elevation of mood. Seen in severe
mania - stage III

Flat affect Absence or near absence of any sign of

affective expression, VOIce may be
monotonus and face immobile
Hallucination A perception that occurs in the absence
of a stimulus
Illusion A misinterpretation of stimuli arising
from external world
In appropriate affect Disharmony between the emotional
feeling tone and the idea, thought or
speech accompanying it
Insight It is the degree of awareness and
understanding that the patient has
regarding his illness
Jamais Vu False feeling of unfamiliarity with a real
situation one has experienced
Labile affect Rapid and abrupt changes in emotional
feeling tone unrelated to any external
stimuli. The patient may laugh one
minute and cry the next. Without a clear
stimulus
Mannerism Ingrained, habitual involuntary
movement
Mood It is pervasive and sustained emotion
that color the person's perception of the
world
Neologism These are idiosyncratically formed new
words whose deviation cannot be
understood easily
Obsessions Defined as recurrent, persistent
thoughts, images or impulses that are
experienced as intrusive and
inappropriate
Oneroid state/ or onerism It is a dream-like state, while one is
awake, awaking dream
Panic An acute intense, overwhelming episode
of anxiety, often associated with feeling
of impending doom
Perseveration Persistent repetition of words or themes
beyond the point of relevance
Phobia An irrational fear of an object, situation
or activity
Pseudocoma or coma vigil or In this state patient appears to be asleep
locked in state or Deafferented but cart be aroused. The subject is
state conscious and aware but is unable to
respond. Responsiveness is present
Restricted or constricted affect Reduction in intensity of feeling tone,
less severe than blunted affect but
clearly reduced
Stupor It is unresponsiveness with immobility
and mutism but retention of
consciousness and often with open eyes
that follows external objects. Patient is
having slightly less awareness to given
surrounding
Stuttering Frequent repetition or prolongation of a
sound or syllable, leading to markedly to
impaired speech fluency
Twilight stage It is disturbed consciousness with
hallucinations
Verbigeration Senseless repetition of same words and
phrases over and over again

Table – 7 Ego defense mechanism

Defense Definition Clinical illustration

mechanism
Primary ego defense mechanism
Repression Unconsciously excluding from Psychogenic amnesia
conscious awareness of anxiety
provoking ideas or feelings
Psychotic/Narcissistic defense mechanism
Regression Reversion to the modes of Neurosis
psychological functioning which are Psychosis
characteristic of earlier life stages Severe and prolonged physical
like childhood years ill
Denial Involuntary exclusion of unpleasant Psychosis & terminal illness
 or painful reality from conscious
awareness
Projection Unconscious attribution of one's Persecutory delusions
own attitude & urges to other Hallucinations
person because of intolerance
Distortion Unconscious gross reshaping of Hallucination, Delusions of
external reality to satisfy inner grandiosity.
needs
Neurotic/immature defense mechanism
Conversion A repressed, forbidden urge is Conversion disorder
simultaneously kept out of (Hysteria)
awareness and also expressed in
symbolic/ disguised form of some
somatic disturbance
Dissociation Involuntary splitting or suppression Psychogenic amnesia
of a mental function from rest of Psychogenic fugue
personality Multiple persomality
Somnambulism
Possession syndrome
Displacement Unconscious shifting of emotions, Phobia
usually aroused by perceived threat
Isolation Separation of the idea of an Obsessional thought
unconscious impulse from its
appropriate affect

Reaction Unconscious transformation of Obsessive compulsive

formation unacceptable impulses into exactly personality traits and disorder
opposite attitude
Undoing Unconsciously motivated acts Compulsive act in obsession
which magically or symbolically Compulsive rituals
counteract unacceptable thought
impulses or acts
Rationalization Providing logical explanations for A universal phenomenon
irrational behaviour motivated
by unacceptable unconscious
wishes
Intelluctualization Excessive use of intellectual Impulse control disorder
process to avoid affective Schizoid personality
expression disorder
Acting out Expression of an unconscious Schizotypal personality
impulse, through action, thereby Self harm
gratifying the impulse
Schizoid fantasy Withdrawal into self to gratify Suicide
frustrated wishes by fantasy Severe depression
Retroflexion Unconscious deflection of Identification with the
hostility towards another person aggressor (sometimes seen
on to oneself resulting in lowered in victims kidnapped by
self- esteem, self criticism and at terrorists condition stock
times injury to self holm syndrome)
Introjection Unconscious internalization of Grief reaction
the qualities of an object or Depression
person
Hyponondriasis Unconscious transformation of Hypochondriasis
unacceptable impulses into Obsessive compulsive
inappropriate somatic concern disorder
Inhibition Involuntary decreased or loss of Phobias
motivation to engage in some Nymphomania
goal directed activity to prevent
anxiety arising out of conflicts
with unacceptable impulses.

Compensation Unconscious tendency to deal Keeping excessive details in

(Counterphobic with a fear or conflict by unusual a diary in patients suffering
defense) degree of effort in the opposite from dementia.
direction
Splitting Unconscious viewing of self or Borderline personality
others as either good or bad disorder
without considering the whole
range of qualities
Mature defence mechanism
Sublimation Unconscious gradual Channelization of sexual or
channelization of unacceptable aggressive impulses into
infantile impulses into personally creative activity
satisfying and socially valuable
behaviour pattern.
Suppression Voluntary postponement of It's a universal phenomenon
focusing of attention on an occurring in all intelligent
impulse which has reached person.
conscious awareness
Anticipation Realistic thinking and planning Universal phenomena.
about future unpleasurable events
Humor Overt expression of unacceptable Universal phenomena.
impulses using humor in manner
which doesn't produce
unpleasantness in self or others
Altruism Vicarious but constructive and
instinctually gratifying
services to others
Asceticism Elimination of directly Gratification is derived from
pleasurable affects attributable to renunciation
an experience

Table – 8 Components of Mini Mental Scale Examination

Category Possible Description

points
Orientation to 5 From broadest to most narrow. Orientation to
time time has been correlated with future decline
Orientation to 5 From broadest to most narrow. This is
place sometimes narrowed down to streets, and
sometimes to floor
Registration 3 Repeating named prompts
Attention and 5 Serial sevens, or spelling "world" backwards. It
calculation has been suggested that serial sevens may be
more appropriate in a population where English
is not the first language
Recall 3 Registration recall
Language 2 Naming a pencil and a watch
Repetition 1 Speaking back a phrase
Complex 6 Varies. Can involve drawing figure shown.
commands

Table – 9 Phobias

Phobias Description
Agoraphobia Irrational fear of situations
Social phobia Irrational fear of one or more social or
performance situations
Claustrophobia Fear of closed spaces
Aerophobia Fear of high places
Zoophobia Fear of animals
Pyrophobia Fear of fire
Xenophobia Fear of strangers
Algophobia Fear of pain
Thanatophobia Fear of death
Mysophobia Fear of dirt & germs
Erythrophobia Fear of blushing
Sitophobia Fear of eating
Sitaphobia Fear of dogs
Ailurophobia Fear of cats
Hydrophobia Fear of water

Table – 10 Prognostic factors of Schizophrenia

Feature Good prognosis Bad prognosis

Onset Acute or abrupt >35 yr age Insidious onset <20 yr age
onset onset
Stressor Presence of precipitating
Absence of stressor
stressor
Adjustment Poor premorbid
Good premorbid adjustment
adjustment
Subtype Disorganised, simple,
Catatonic undifferentiated chronic
catatonic
Duration Short < 6 month Chronic > 2 years
Depression Presence of depression Absence of depression
Symptoms Predominance of positive Predominance of negative
symptoms. symptoms
Family history Of mood disorder Of Schizophrenia
Episode Previous h/o
1st episode Schizophrenia
Physique Fat Thin
Sex Female Male
Social support Good Poor
Affect Presence of confusion, Flat or blunted affect
perplexity, or disorientation
in the acute phase
 CT scan Normal cranial CT
Treatment Proper, good treatment
compliance, good response
to treatment , out patient
treatment
Evidence of ventricular
enlargement
on cranial CT scan
Absence of proper
treatment and poor
response, hospitalized
treatment

Table – 11 Intelligent Quotient

IQ = Mental age/chronological age x 100

Mental Retardation IQ range
Mild 50-70
Moderate 35-50
Severe 20-35
Profound <20

Table – 12 Management of Alcohol Intoxication, Alcohol Withdrawal, Delirium Tremens

Management
Alcohol Alcohol Withdrawal Delirium Tremens
Intoxication
Lorazepam All patients High dose
(can should be given benzodiazepines
worsen the multiple oral or
vitals due Vitamin B1 antipsychotics
to CNS including 50-100 are
depression) mg of thiamine recommended.
Haloperidol daily for a week. Anticonvulsants
(can lower Replace alcohol are not given to
seizure (CNS depressant) control seizures
threshold) with any other CNS seen in delirium
Other drugs depressant tremens.
- Benzodiazepines
Ziprasidone are commonly
, used.
Olanzapine Chlordiazepoxide
is drug of choice
because of its
long half-life.

Drug of choice in withdrawal syndrome

Opium Methadone (1st choice)
Clonidine (2nd choice)
Alcohol Chlordiazepoxide (1st choice)
Diazepam (2nd choice)

Table – 13 Behaviour therapy

Behaviour therapy is based on theories of learning and aims at changing maladaptive behavior and
substituting it with adaptive behavior.

Behaviour Therapy
 Types Based on Used in
Systemic Reciprocal inhibition Phobias , OCD
desensitization
Aversion therapy Pairing of pleasant stimulus Drug abuse , Sexual
with an unpleasant response deviations
Flooding Direct exposure to phobia Phobias
but escape not possible
Operant conditioning - Positive reinforcement For augmenting
for increasing - Negative reinforcement an adaptive
behavior - Modeling behavior
Operant - Time out For demoting
conditioning for - Punishment maladaptive
decreasing - Satiation (Negative behaviour
behaviour practice procedure)

Table – 14 Indications of Electro convulsive therapy

Major severe depression Severe catatonia Severe psychoses

With suicidal risk With stupor With risk of suicide,
With stupor With poor intake of homicide or danger
With poor intake of food and fluids of physical assault
food and fluids With unsatisfactory With unsatisfactory
With melancholia response to drug response to drug
With psychotic therapy therapy
features When drugs are When drugs are
With unsatisfactory contraindicated contraindicated
response to drug Where speedier With very prominent
therapy recovery is needed depressive features
When drugs are
contraindicated
Where speedier
recovery is needed

Contraindications of Electro convulsive therapy

Absolute contraindications Relative contraindications
Raised intracranial tension Recent Myocardial infarction
Severe hypertension
Cerebra vascular accident
Severe pulmonary disease
Retinal detachment
Pheochromocytoma

Paediatrics
Table – 1 Milestones

Age Gross motor Fine motor Language Personal &

social
1 months Turns head to - - -
sound
2 - - - Social smile
months
3 Neck holding - Cooing Recognize
months mother
4 - Grasp a rattle or - -
months ring when
placed in hand
5 months Sitting with Bidextrous - -
support, Roll grasp (holds
over object with both
hands)
6 Unidextrous Monosyllables(ma; Smiles at mirror
months ba) imge
7 months - Palmer grasp - Stranger’s
anxiety
8 months Sitting without - - Plays ‘peek a
support boo’.
9 months Standing with Pincer grasp Bisyllables(data, Plays a simple
support crawling seen (picks a mam) ball game
pellet with
thumb & index
finger)
10-11 Walking without, - - Waves bye-bye
months cruising
12 Standing Pincer grasp Two words with Plays- a simple
months alone/without matures meaning ‘bye’ ball game
support
13 Walking without - - -
months support
18 Running with Can feed himself 10 words with Almost dry by
months cup with slight meaning day
spilling, spoon
feeding

24 Walking upstairs Draw a Simple sentence -

months & downstairs horizontal or
(2feet/step) vertical line
36 Riding tricylce Can draw a Telling a story Knows gender
months walking upstairs circle can dress (age,sex), full
alternative steps or undress name
himself
4 years Walking upstairs - - -
with alternative
feet

Table – 2 Development milestone in the first 2 year of life

Development milestone in the first 2 year of life

Milestone Average age of Developmental implications
 attainment
(MO)
Gross motor
Holds head 2 Allows more visual interaction
steady while
silting
Pulls to sit, with 3 Muscle tone
no head lag
Brings hands 3 Self-discovery of hands
together in
midline
Asymmetric tonic 4 Can inspect hands in midline
neck reflex gone
Sits without 6 Increasing exploration
support
Rolls back to 6.5 Truncal flexion, risk of falls
stomach
Walks alone 12 Exploration, control of proximity to
parents
Runs 16 Supervision more difficult

Fine motor
Grasps rattle 3.5 Object use
Reaches for 4 Visuomotor coordination
objects
Palmar grasp 4 Voluntary release
gone
Transfers object 5.5 Comparison of objects
hand to hand
Thumb finger 8 Able to explore small objects
grasp
Turns pages of 12 Increasing autonomy during book
book time
Scribbles 13 Visuomotor coordination
Builds tower of 2 15 Uses objects in combination
cubes
Builds tower of 6 22 Requires visual, gross, and fine motor
cubes coordination

Communication and language

Smiles in 1.5 More active social participant
response to face,
voice
Monosyllabic 6 Experimentation with sound, tactile
babble sense
Inhibits to "no" 7 Response to tone (nonverbal)

Follows one step 7 Nonverbal communication

command with
gesture
Follows one step 10 Verbal receptive language (e.g., "Give
command it to me")
without gesture
Says "mama" or 10 Expressive language
"dada"
Points to objects 10 Interactive communication
Speaks first real 12 Beginning of labeling
word
Speaks 4-6 words 15 Acquisition of object and personal
names
Speaks 10-15 18 Acquisition of object and personal
words names
Speaks 2-word 19 Beginning grammaticization
sentences (e.g., corresponds with 50 + words
"Mommy shoe") vocabulary

Cognitive
Stares 2 Lack of object permanence (out of
momentarily at sight, out of mind) [e.g., yam ball
spot where object dropped]
disappeared
Stares at own 4 Self discovery, cause and effect
hand

Bangs 2 cubes 8 Active comparison of objects

Uncovers toy 8 Object permanence
(after seeing it
hidden)
Egocentric 12 Beginning symbolic thought
symbolic play
(e.g., pretends to
drink from cup)
Uses stick to 17 Able to link actions to solve problems
reach toy
Pretend play with 17 Symbolic thought
doll (e.g., gives
doll bottle)

Table – 3 Emerging patterns of behaviour during the 1st year of life

Emerging patterns of behaviour during the 1st year of life

Neonatal period (1st 4 week)
Prone Lies in flexed attitude; turns head from side to side; head
sags on ventral suspension
Supine Generally flexed and a little stiff
Visual May fixate face on light in line of vision; "doll's-eye"
movement of eyes on turning of the body.
Reflex Moro response active: stepping and placing reflexes; grasp
reflex active
Social Visual preference for human face.
At 1 Months
Prone Legs more extended, holds chin up; turns head: head lifted
momentarily to plane of body on ventral suspension.
Supine Tonic neck posture predominates; supple and relaxed; head
 lags when pulled to sitting position.
Visual Watches person; follows moving object
Social Body movements in cadence with voice of other in social
contact; beginning to smile.
At 2 Months
Prone Raises head slightly farther: head sustained in plane of body
on ventral suspension.
Supine Tonic neck posture predominates; head lags when pulled to
sitting position
Visual Follows moving object 180 degrees
Social Smiles on social contact; lestens to voice and coos
At 3 Months
Prone Lifts head and chest with arms extended; head above plane
of body on ventral suspension
Supine Tonic neck posture predominates; reaches toward and
misses objects; waves at toy
Sitting Head lag partially compensated when pulled to sitting
position; early head control with bobbing motion; back
rounded
Reflex Typical Moro response has not persisted; makes defensive
movements or selective withdrawal reactions
Social Sustained social contact; listens to music; says "aah, ngah"
At 4 Months
Prone Lifts head and chest, with head in approximately vertical
axis, legs extended
Supine Symmetric posture predominates, hands in midline; reaches
and grasps objects and brings them to mouth
Sitting No head lag when pulled to sitting position; head steady,
tipped forward; enjoys sitting with full truncal support
Standing When held erect, pushes with feet
Adaptive Sees pellet, but makes no move to reach for it
Social Laughs out loud; may show displeasure if social contact is
broken; excited at sight of food
At 7 Months
Prone Rolls over; pivots; crawls or creep-crawls (Knobloch)

Supine Lifts hand; roll's over; squirms

Sitting Sits briefly, with support of pelvis; leans forward on hands;
back rounded
Standing May support most of weight; bounces actively
Adaptive Reaches out for and grasps large object; transfers objects
from hand lo hand; grasp uses radial palm; rakes at pellet
Language Forms polysyllabic vowel sounds.
Social Prefers mother; babbles; enjoys mirror; responds to
changes in emotional content of social contact
At 10 Months
Sitting Sits up alone and indefinitely without support, with back
straight
Standing Pulls to standing position; "cruises” or walks holding on to
 furniture
Motor Creeps or crawls
Adaptive Grasps objects with thumb and forefinger; pokes at things
with forefinger; picks up pellet with assisted pincer
movement; uncovers hidden toy; attempts to retrieve
dropped object; releases object grasped by other person
Language Repetitive consonant sounds ("mamma", "dada")
Social Responds to sound of name; plays peek-a-boo or pat-a-
cake; waves bye-bye
At 1 Year
Motor Walks with one hand held (48 wk); rises independently,
takes several steps (Knobloch)
Adaptive Picks up pellet with unassisted pincer movement of
forefinger and thumb; releases object to other person on
request or gesture
Language Says a few words besides "mama", "dada"
Social Plays simple ball game; makes postural adjustment to
dressing

Table – 4 Emerging patterns of behaviour from 1 to 5 year of age

Emerging patterns of behaviour from 1 to 5 year of age

15 Months
Motor Walks alone; crawls up stairs
Adaptive Makes tower of 3 cubes; makes a line with crayon; inserts
raisin in bottle
Language Jargon; follows simple commands; may name a familiar
object (e.g., ball)
Social Indicates some desires or needs by pointing; hugs parcents
18 Months
Motor Runs stiffly; sits on small chair, walks up stairs with one
hand held; explores drawers and wastebasket
Adaptive Makes tower of 4 cubes; imitates scribbling; imitates
vertical stroke; dumps raisin from bottle
Language 10 words (average); names pictures; identifies one or more
parts of body
Social Feeds self; seeks help when in trouble; may complain when
wet or soiled; kisses parent with pucker
24 Months
Motor Runs well, walks up and down stairs, one step at a lime;
opens doors; climbs on furniture; jumps
Adaptive Makes tower of 7 cubes (6 at 21 mo); scribbles in circular
pattern; imitates horizontal stroke; folds paper once
imitatively
Language Puts 3 words together (subject, verb, object)
Social: Handles spoon well; often tells about immediate
experiences; helps to undress; listens to stories
when shown pictures
 30 Months
Motor Goes up stairs alternating feet
Adaptive Makes tower of 9 cubes; makes vertical and horizontal
strokes, but generally will not join them to make cross;
imitates circular stroke, forming closed figure
Language Refers to self by pronoun "I"; knows full name
Social Helps put things away; pretends in play
36 Months
Motor Rides tricycle; stands momentarily on one foot
Adaptive Makes tower of 10 cubes; imitates construction of "badge"
of 3 cubes; copies circle; imitates cross
Language Knows age and sex; counts 3 objects correctly; repeats 3
numbers or a sentence of 6 syllables
Social Plays simple games (m parallel" with other children); helps
in dressing (unbuttons clothing and puts on shoes); washes
hands
48 Months
Motor Hops on one foot; throws ball overhand; uses scissors to
cut out pictures; climbs well
Adaptive Copies bridge from model; imitates construction of "gate"
of 5 cubes; copies cross and square; draws man with 2 to 4
parts besides head, identifies longer of 2 lines
Language Counts 4 pennies accurately; tell story
Social Plays with several children, with beginning of social
interaction and role-playing; goes to toilet alone
60 Months
Motor Skips
Adaptive Draws triangle from copy; names heavier of 2 weights
Language Names 4 colors; repeats sentence of 10 syllables; counts 10
pennies correctly
Social Dresses and undresses; asks questions about meaning of
words; engages in domestic role-playing

Table – 5 Difference between Marasmus and Kwashiorkar

Features Marasmus Kwashiorkor

Aetiology Decreased intake of both Decreased protein intake
proteins and calories and
other nutrients
Age Common below 1 year(0- 1-4 years
3 years)
Incidence More common Less common
History

Appetite Good Anorexia

Complementary feeding Early Late
(weaning)
 Clinical examination

Appearance Old man appearance Moon face

Sensorium/activity Alert, playful, Apathy, dull, irritable
active/apathetic
Weight Less than 60% 60%-80%
Oedema Absent Present
Mentation Alert Apathy, irritable
Mood Normal Irritable
Hair changes Absent/mild Present(flag sign)
Skin changes Absent Present(dermatosis,
ulcers)
Muscle wasting More (seen all over the Less(seen only in the
body) upper limbs as oedema
masks wasting in the
lower parts)
Organomegaly Not present Hepatomegaly (fatty
liver)
Anaemia Moderate More severe
Subcutaneous fat Grossly reduced Less reduced
Hormones
Growth hormone Normal / Increased Increased

Cortisol Increased Increased

Insulin Normal Decreased

Glucagon Normal / Variable Normal / Variable

Thyroxine Normal / Variable Normal / Variable

Investigations

Serum proteins/albumin Reduced Markedly reduced

Serum enzymes Normal Decreased
Vitamin A absorption Normal Markedly reduced
Duodenal enzymes Normal concentration Reduced
Serum enzymes amylase Normal Reduced
Urinary excretion (17- Increased Low
hydroxysteroids)
Liver biopsy No vacuolation Fatty vacuolation
Complications Less common and More common and
moderate severe
Response to treatment Good Variable
Mortality More Less

Table – 6 Classification of Acyanotic and Cyanotic heart diseases

Acyanotic Defects
↓
 ↑PBF Normal PBF
↓ ↓

↓ ↓ ↓ ↓
VSD ASD AS or AR
PDA (often RBBB) COA PS
ECD PAPVR Primary COA (in infants)
myocardial d/s
(EFE)
(endo cardial PVOD MR MS
cushion defect) (secondary to L-R
shunt lesions)

Cyanotic Defects
↓

↑PBF ↓PBF
↓ ↓
↓
LVH or CVH RVH CVH LVH RVH
↓ ↓ ↓ ↓ ↓
Persistent TGA TGA+ PS Tricuspid TOF
truncuts TAPVR Presistent atresis PVOD(secondary
arteriousus HLHS truncus Pulmonary to L-R shunt
Single arteriosus with atresisa with lesions)
ventricle hypoplastic PA hypoplastic RV Ebsteins’s
TGA+ VSD Single anomaly (RBBB)
ventricle with
PS

Table – 7 Difference b/w caput succedaneum and cephal hematoma

Difference b/w caput succedaneum and cephal hematoma

Characteristic Caput succedaneum Cephal hematoma
Incidence Common Less common
Location Subcutaneous plane Bony pnominence b/w skull
and periosteum
Time of Maximum size birth ↑ Sing size for 12-24 hrs and
presentation then stable
C/F Soften gradually and Takes 3-6 weeks to resolve.
disapper within 2-3 days. Does not cross suture line and
Diffuse crosses suture line has distinct margin
Association None (scalp edema) Fracture in 5 to 25% of cause.
Prolonged jaundice due to
hemolysis,
(hemorrhage)

Table – 8 Pathologic findings of congenital rubella syndrome

System Pathologic findings

Cardiovascular Patent ductus arteriosus
Pulmonary artery stenosis
Ventriculoseptal defect
Myocarditis
Central nervous system Chronic meningitis
Parenchymal necrosis
Vasculitis with calcification
Eye Microphthalmia
Cataract
Iridocyclitis
Ciliary body necrosis
Glaucoma
Retinopathy
Far Cochlear hemorrhage
Endothelial necrosis
Lung Chronic mononuclear interstitial
pneumonitis
Liver Hepatic giant cell transformation
Fibrosis
Lobular disarray
Bile stasis
Kidneys Interstitial nephritis
Andrenal glands Cortical cytomegaly
Bone Malformed osteoid
Poor mineralization of osteoid
Thinning cartilage
Spleen, lymph nodes Extramedullary hematopoiesis
Thymus Histiocytic reaction
Absence of germinal centers
Skin Erythropoiesis in dennis

In ear causes cochlear damage & endothelial necrosis - So it cause Sensory Neural Hearing loss.
Other finding in CRS

Table – 9 Clinical manisfestations of congenital rubella syndrome (CRS) in 376

Children following maternal rubella

 Deafness 67%
Ocular 71%
Cataracts 29%
Retinopathy 39%
Heart disease 48%
Patent ductus arteriosus 78%
Right pulmonary artery stenosis 70%
Left pulmonary artery stenosis 56%
Valvular pulmonic stenosis 40%
Low birthweight 60%
Psychomotor retardation 45%
Neonatal purpura 23%
Death 35%

Table – 10 Differential diagnosis of Short Stature

Features Constitutional Familial Hypopituitarism Hypothyroidism Turner

delay short syndrome
stature
Family Positive Positive Negative Negative Negative
History
Birth weight Normal Low Normal Normal Low
& height
Pattern of Slow from Slow from Slow from Slow from Slow from
growth infancy birth a few months birth birth
after birth
Epiphyseal Moderate Normal Progressive Severe Variable
development progressive retardation retardation
retardation
Puberty Delayed Normal Delayed Delayed Delayed
GH levels Normal Normal Low Normal Variable
Gonadotropins Normal Normal Low, except High
in isolated
GHD

Table – 11 APGAR score

Apgar scores are assigned at 1 and 5 minutes after birth
If the score is <7 it is assigned every 5 min until 20 min or till two successive scores of ≥7
Scores may be falsely low in preterm, maternal drug intake, congenital heart disease and CNS
malformations
Sign 0 1 2
Heart rate Absent <100/min >100/min
Respiration Absent Weak cry, Good strong cry
hypoventilation
Muscle tone Limp Some flexion Active motion
Reflex irritability No response Grimace Cough or sneeze
Color Blue or pale Body, pink, Completely pink
extremities blue

Table – 12 Timing of Paediatric Surgery

 Condition Time of surgery
Biliary atresia 4-6 weeks
Cleft lip 2-3 months (in the neonatal period for
good cosmetic results)
Cleft palate 10-12 months
Epispadias 1 year
Chordee correction 6 months- 1 year after chordee
Urethroplasty correction
Hypospadiasis Any time after birth
Meatotomy 6 months
Chrodee correction 18-24 months
Urethroplasty
Phimosis 1 year
Prepucial separation After 2-3 years
Circumcision
Exstropy of bladder Within 48 hrs
Bladder closure After 2 years
Bladder neck repair After achieving continence
Urethroplasty
Hirchsprung’s disease 12-15 months
Undescended testis
Tongue tie 1 year

Table – 13 Features in a new born that require no treatment

Milia White dots on face and nose

Erythema toxicum Trunk and face, appear on 2-3 days
Mongolian spots Bluish spots on buttocks and trunk,
disappear before 1st birthday
Stork bites Capillary hemangiomas on neck,
eyelid, forehead
Breast engorgement Due to transplacentally acquired
hormones; seen on 3-4 days
Epstein pearls Epithelial mucinous cyst on palate
and prepuce
Predeciduous teeth Shed before primary nutrition
Vaginal bleeding 3-7 days; due to withdrawal of
maternal hormones
Hymenal tags, physiological phimosis, Harlequin color change, pustular melanosis are also
seen in new born which require no treatment

Table – 14 Primitive Reflexes

Reflex Appearance Disappearance

Reflexes present at birth
Crossed extensor 28 weeks 1-2 months
Palmar grasp 28 weeks 2-3 months
Moro 28-32 wells 3 months
Rooting 32 weeks Less prominent after 1
month
Asymmetric tonic neck 35 weeks 6 months
Reflexes that appear after birth
Symmetric tonic neck 4-6 months 8-12 months
Parachute 8-9 months Remains throughout life
Landau 10 months 24 months

Table – 15 Extracardiac anomalies and associated cardiac lesions

Pediatric anomalies Cardiac lesions

Bony abnormalities, absence of VSD
radius/ulna syndactyly, polydactyly,
Trisomy 13-15
Trisomy 21 ASD of endocardial cushion type,
VSD
Pierre Robin syndrome, Ehler Danlos ASD
syndrome
Thrombocytopenia absent
radius(TAR) syndrome
Turner syndrome PS,AS, CDA
Ellis-Van Creveld syndrome ASD, single atrium
Rubella syndrome PDA, PS
Moon facies and hypertension PS
Holt Oram syndrome, Lutembacher ASD+MS
syndrome
Marfan syndrome MVP, aortic and pulmonary artery
dilation
Hurler syndrome MR or AR
Trisomy 17-18 VSD, PDA
William's syndrome Supravalvar AS, Peripheral PS
Noonan syndrome and Alagille Peripheral pulmonic stenosis
syndrome

Table – 16 Immunization Schedule

Age National Indian Academy of

Immunization Pediatrics
Schedule recommendation
At birth BCG , OPV0 , Hep B1 BCG , OPV0 , Hep B1
6 weeks DPT1 , OPV1 , Hep B2 , DPT1 , IPV1 , Hep B2 ,
Hib1 Hib1 , Rotavirus1 , PCV1
10 weeks DPT2 , OPV2 , Hib2 DPT2 , IPV2 , Hib2 ,
Rotavirus2 , PCV2
14 weeks DPT3 , OPV3 , Hep B3 , DPT3 , IPV3 , Hib3 ,
Hib3 Rotavirus3 , PCV3
6 months - OPV1 , Hep B3
9 months Measles , Vitamin A1 ( 1 OPV2 , Measles
Lac IU )
12 months - Hep A1
15 months MMR MMR1 , Varicella1 , PCV
 B1
16 – 24 months DPT B1 , OPV B1 , DPT B1 , IPV B1 , Hib B1 ,
Vitamin A2 Hep A2
2 years - Typhoid1
5 – 6 years DPT B2 DPT B2 , OPV3 , MMR2 ,
Varicella2 , Typhoid2
10 years TT1 TdaP / Td , HPV
16 years TT2 -
Pregnant women TT1 and TT2 ( one month -
apart )
TTBooster if TT2 doses
received in last 3 years
Vitamin A (2 Lac IU every 6 months till age of 5 years)

Table – 17 Optional vaccines given after discussion with parents

Optional vaccines Schedule

Varicella vaccine 15 months
Hepatitis A vaccine High risk selected infants , 18
months & 6 months later
Pneumococcal conjugate vaccine 6 weeks
Influenza vaccine 6 months of age to high risk selected
infants annually
Japanese encephalitis vaccine 16 – 24 months ( endemic districts )

Table – 18 Types of breastfeeding

Types
Exclusive breastfeeding
Predominant breastfeeding
Partial breastfeeding
Token breastfeeding
Intake
Only breast milk ; nothing else , not
even water
Apart from breastfeeds ,small amount
of other foods or fluids like water
Small breastfeeds and some artificial
feeds
Mostly other feeds, occasionally
breastfeeds

Table – 19 Varying composition of breast milk

Type Time Appearance Composition Function

Colostrum First 3 - 4 Yellowish More antibodies and Protection
days after and thick WBC against infection
birth Anti-infective agents Has a mild
(lactoferin, lysozyme, laxative effect
lactoperoxidase, helps to pass
complements , proline- early stools
rich polypeptides)
Rich in Vitamins A,D,E
&K
Less fats
More proteins and IG
(Ig A, Ig M, Ig G)
 Rich in growth factors
– EGF, FGF
Transitional 4 days to Thinner , More fat, sugar, Supplies
milk 10 -14 days lighter in calories & vitamins adequate calories
color Less IG & proteins needed by the
baby
Mature 2 weeks Thinner More fat, protein, Supplies all the
milk after the water, lactose, nutrients needed
baby is energy(71 cal/100 mL ) for normal
delivered growth
Preterm When a More calories, fat, Supplies more
milk preterm proteins, sodium, IG, energy which is
baby is lactoferrin, Zn , needed for rapid
delivered macrophages growth
Less lactose, calcium,
phosphorus
Foremilk At the start Watery Rich in proteins, sugar, Satisfies baby’s
of feed vitamins, minerals and thirst
water
Hind milk At the end Thick Richer in fat content Provides energy ,
of feed satisfies baby’s
hunger and
nutritional
demands

Table – 20 Guidelines for positioning and attachment of the baby during breastfeeding

Proper positioning Proper attachment

The infant’s head, neck and
body should be held in a
straight line
The whole of the baby’s body
should be supported, not just
the head and neck
The baby’s face should be
directly in front of mother’s
breast ( en face )
The baby’s body should be
close to the mother’s body
The chin should touch the
breast
The mouth of the baby should
be wide open
The baby’s lower lip should
be turned out
Most areola and nipple should
be in baby’s mouth. More
areola should be visible above
than below the baby’s mouth.

Table – 21 Criteria for response to Treatment of Nephrotic Syndrome

Response to Criteria
treatment
Remission Urinary protein excretion <4mg/m2/hour ; nil or
trace by dipstick on spot sample for 3 consecutive
days
Serum albumin more than 3.5 g/dL
No edema
Relapse Urine albumin ≥3+ by dipstick for 3 consecutive
days
Proteinuria > 40 mg/m2/hour for 3 consecutive days
specimens
Frequent relapse 2 or more episodes in 6 months of initial response
4 or more episodes in any 12-month period
Infrequent relapse Less than 3 episodes in 12 months
 Less than 2 episodes in 6 months
Steroid sensitive Disappearance of proteinuria and all clinical and
biochemical features within 8 weeks of starting a
standard course of steroid therapy
Steroid resistance Failure to achieve remission after 4 weeks of daily
therapy with oral prednisolone at a dose of 2
mg/kg/day
Persistent proteinuria after completion of treatment
Steroid-dependent Occurrence of 2 consecutive relapses during steroid
cases therapy or within 2 weeks of its cessation
Relapse after stopping the drugs
Table – 22 Criteria for Treatment Failure

Primary failure
No appetite regain Fourth day
Failure to start to lose edema Fourth day
Presence of edema Tenth day
Failure to gain weight at least 5g/day Tenth day
Secondary failure
Failure to gain weight of 5g/kg/day During rehabilitation phase
for 3 consecutive days

GOBIFFF SHAPOBI NIMFES

Growth monitoring Status for women Nutrition and growth
Oral rehydration Health education monitoring
Breastfeeding Antenatal care Immunization
Immunization Primary healthcare and Medical check-up and
Feeding (supplementary) perinatal care medical care during
Female child care Oral rehydration therapy illness
Family welfare Breastfeeding Family planning
Immunization Education –health
education regarding
 Pathology
Table – 1 Cell injury

Reversible cell injury Irreversible cell injury

Cellular swelling Flocculent , amorphous
Loss of microvilli mitochondrial densities
Formation of cytoplasmic blebs Swelling & disruption of lysosomes
ER swelling Plasma membrane damage
Ribosomal detachment Pyknosis
Myelin figures Karyolysis
Clumping of nuclear chromatin Karyorrhexis

Table – 2 Types of necrosis

Type of Pathology Examples

necrosis
Coagulative Loss of nucleus with cellular Heart , kidney , liver
necrosis outline being preserved associated
with ischemia
Liquefactive Enzymatic destruction of cells Brain
necrosis with abscess formation
Caseous Cheese like appearance of necrotic Tuberculosis
necrosis material
Fat necrosis Action of lipases on fatty tissue Breast , omentum ,
pancreas
Fibrinoid Complexes of antigen and PAN , Ascoff bodies in
necrosis antibodies are deposited in vessel rheumatic heart
wall with leakage of fibrinogen out disease , malignant
of vessels hypertension ,
Wegener’s
granulomatosis
Gangrenous Necrosis of tissue with superadded Dry gangrene similar
necrosis putrefaction to coagulative
necrosis
Wet gangrene similar
to liquefactive
necrosis

Necrosis Apoptosis
Always pathological May be physiological or pathological
Associated with disruption of Important for development ,
cellular homeostasis homeostasis & elimination of pathogens
& tumor cells
Affects contiguous group of cells Affects single cell
Cell size increased Cell size shrunken
Passive Active
Cause inflammatory reaction No inflammatory reaction
Plasma membrane disrupted Plasma membrane intact
Smear pattern on Step ladder pattern on electrophoresis
electrophoresis

Table – 3 Examples of Apoptosis

Physiological apoptosis Pathological apoptosis

Endometrial cells –
Menstruation
Cell removed during
embryogenesis
Virus infected cells and
neoplastic cells by
cytotoxic T cells
Councilman bodies – Viral
hepatitis
Gland atrophy following duct
obliteration as in cystic fibrosis
Graft versus host disease

Table – 4 Growth factors

Growth factor Source Significance

Epidermal growth Activated Mitogenic for
factor macrophages keratinocytes &
Salivary glands fibroblasts
Keratinocytes Granulation tissue
formation
Transforming growth Activated Stimulates
factor α macrophages hepatocytes
T lymphocytes replication
Keratinocytes
Hepatocyte growth Mesenchymal cells Enhances
factor proliferation of
epithelial ,
 endothelial cells &
hepatocytes
Increases cell motility
Vascular endothelial Mesenchymal cells Increases vascular
growth factor permeability
Mitogenic for
endothelial cells
Platelet derived Platelets Chemotactic for
growth factor Macrophages PMN , macrophages ,
Endothelial cells fibroblasts & smooth
Keratinocytes muscle cells
Smooth muscle cells Activates PMN ,
macrophages ,
fibroblasts
Mitogenic for
fibroblasts ,
endothelial cells &
smooth muscle cells
Stimulates production
of MMP ,
fibronectin& HA
Stimulates
angiogenesis ,&
wound remodeling

Fibroblast growth Macrophages Chemotatic for

factor Mast cells fibroblasts
T lymphocytes Mitogenic for
Endothelial cells fibroblasts &
Fibroblasts keratinocyte
Stimulate
keratinocyte
migration ,
angiogenesis , wound
contraction and
matrix deposition
Keratinocyte growth Fibroblasts Stimulates
factor keratinocyte
migration &
proliferation

Table – 5 Mediators of inflammation

Role of mediators in different reactions of Inflammation

Vasodilatation Prostaglandins
Nitric acid
Histamine
Increased vascular Vasoactive amines
permeability C3a and C5a
Bradykinin
Leukotrienes C₄ , D₄ , E₄
PAF
Substance P
Chemotaxis & leukocyte C5a
recruitment and activation Leukotriene B₄
Chemokines
IL-1 , TNF
 Bacterial products
Fever IL-1 , TNF
Prostaglandins
Pain Prostaglandins
Bradykinin
Tissue damage Neutrophil and macrophage lysosomal
enzymes
Oxygen metabolites
Nitric oxide

Table – 6 Stem cells

Stem cells located in special sites called niches

Name of the Location Function

cell
Oval cells Canals of Herring of Forming hepatocytes
liver and biliary cells
Satellite cells Basal lamina of Differentiate into
myotubule myocyte after injury
Limbus cells Canals of Schlemm Stem cells for cornea
Ito cells Subendothelial space of Stores vitamin A and
Disse source of collagen for
cirrhotic liver
Paneth cells Bottom of crypts Host defense against
microbes
Other sites for stem cells – base of crypts of colon and dendate gyrus of hippocampus

Table – 7 Cellular potency

Totipotent cell Multipotent Oligopotent Uni/Monopotent

cell cell cell
Form entire Form multiple Form more than Form a single
organism lineages but one lineage but differentiated cell
autonomously cannot form all more restricted lineage
lineages of body than multipotent
cell
Zygote Hematopoietic Neuronal stem Spermatogonial
stem cell cell stem cell

Defect in protein Example Disease

type / function
Enzyme Phenylalanine Phenylketonuria
hydroxylase
Hexosaminidase Tay-Sachs disease
Adenosine deaminase Severe combined
immunodeficiency
Enzyme inhibitor α₁-Antitrypsin Emphysema
Liver disease
Membrane receptor Low density lipoprotein Familial
receptor hypercholesterolemia
Vitamin D receptor Vitamin D resistant
rickets
Oxygen transport Hemoglobin α-Thalassemia
 β-Thalassemia
Sickle cell anemia
Ion transport Cystic fibrosis Cystic fibrosis
transmembrane
conductance regulator
Structural Extracellular Collagen Osteogenesis imperfecta
Ehlers Danlos syndromes
Fibrillin Marfan syndrome
Cell Dystrophin Duchene / Becker
membrane muscular dystrophy
Spectrin , ankyrin , Hereditary spherocytosis
protein4.1
Hemostasis Factor VIII Hemophilia A
Growth regulator Rb protein Hereditary
retinoblastoma
Neurofibromin Neurofibromatosis type 1

Table – 8 Morphology of Myocardial Infarction

Time Gross Light microscopy

Reversible injury
0 -30 min None None
Irreversible injury
20 mins to4 None Waviness of fibres at border
hr
4 – 12 hr Occasional dark mottling Beginning of coagulative necrosis
, edema & hemorrhage
12 -2 4 hr Dark mottling Ongoing coagulative necrosis ,
marginal contraction band
necrosis , beginning of
neutrophilic infiltration
1 – 3 days Mottling with yellow tan Coagulative necrosis , interstitial
infarct in center neutrophilic infiltrate
3 – 7 days Hyperemic borders , Beginning of disintegration with
central yellow tan dying neutrophils , early
softening phagocytosis by macrophages
7 – 10 days Maximum yellow tan and Early formation of fibrovascular
soft depressed red-tan granulation tissue at margins
margin
10 – 14 days Red gray depressed Well established granulation
infarct borders tissue and collagen deposition
2 – 8 weeks Gray white scar Collagen deposition , ↓
progressive from border cellularity
towards infarct core

>2 months Scarring complete Dense collagenous scar

Table – 9 Microbiology of endocarditis

Condition Microbial agent
IV drug abusers , Native cardiac valve Staphylococcus aureus
Prosthetic or artificial valve Staphylococcus epidermidis
Previously damaged valve Staphylococcus viridans
Recent tooth extraction Streptococcus mutans

Rheumatic Marantic Libman Sack’s Infective

fever Endocarditis Endocarditis Endocarditis
Small , warty Small , warty Medium sized Large
Firm Friable Flat , Verrucous Bulky
Friable Irregular Irregular
Along lines of Along lines of On surface of cusps Vegetations on
closure closure In pocket of valves valve cusps
Sterile Sterile Sterile Non sterile
(Bacteria)
Embolisation Embolisation Embolization Embolization
uncommon common uncommon very common
In rheumatic In M3 AML , In SLE In Infective
heart disease pancreatic cancer , endocarditis
Deep vein
thrombosis ,
Trousseau
syndrome

Table – 10 Types of renal stones

Stones Formation Shape Lucency

Struvite / Triple Alkaline urine Coffin lid shaped Radiopaque
stone
Calcium oxalate Acidic urine Needle / Square envelope Radiopaque
stone shaped
Cystine stone Acidic urine Hexagonal Radiopaque
Uric acid stone Acidic urine Diamond / Barrel shaped Radiolucent

Table – 11 Urinary casts

Urinary casts Significance

Hyaline casts Concentrated urine , Febrile disease
, After heavy exercise
RBC casts Glomerular injury
WBC casts Interstitial nephritis , Pyelonephritis
Broad granular casts Chronic renal failure
Pigmented muddy brown granular Tubular necrosis
casts
Lipid cast Nephritic syndrome , Renal lupus
Table – 12 Glomerular deposits

Subepithelial Acute glomerulonephritis

Membranous GN
Heymann GN
RPGN ( some cases )
MPGN type 1
Subendothelial MPGN type 1
SLE
 Acute GN
Basement membrane MPGN type 2
Membranous glomerulopathy
Mesangial Ig A nephropathy
HSP
Anti GBM diseases like RPGN and good pasture
syndrome

Table – 13 Collagen disorders

COL 1 Osteogenesis imperfect
Ehlers-Danlos syndrome types-1,2,7
COL 2 Hypochondrogenesis
Achondrogenesis type 2
Stickler syndrome
Marshall syndrome
Spondyloepiphyseal dysplasia
congenita
Spondyloepimetaphyseal dysplasia,
Strudwick type
Kniest dysplasia (see also C2/11)
COL 3 Ehlers–Danlos syndrome, types 3 &
4
Sack–Barabas syndrome
COL 4 Alport syndrome
COL 5 Ehlers–Danlos syndrome, types 1 &
2
COL 6 Bethlem myopathy
Ullrich congenital muscular
dystrophy
COL 7 Epidermolysis bullosa dystrophica
Recessive dystrophic epidermolysis
bullosa
Bart syndrome
Transient bullous dermolysis of the
newborn
COL 8 Fuchs' dystrophy 1
COL 9 Multiple epiphyseal dysplasia 2, 3, 6
COL 10 Schmidmetaphyseal chondrodysplasia
COL 11 Weissenbacher–Zweymüller
syndrome
Otospondylomegaepiphyseal
dysplasia
COL 17 Bullous pemphigoid

Table – 14 Types of Glomerular nephritis

Disease Light Fluorescence Electron

microscopy microscopy
Post streptococcal Proliferation of Ig G , Ig M , C3
GN endothelail & deposits in
mesangial cells mesangium
RPGN – I Linear GBM
deposits of Ig G &
 C3
RPGN – II Lumpy bumpy
granular pattern of
staining
RPGN – III No Ig or
Complement
deposits in GBM
Membranous Diffuse capillary Granular Ig G , C3 Subepithelial
glomerulopathy wall thickening deposits
Minimal change Lipid deposit in Negative Loss of foot
disease tubules process of
podocytes
Focal segmental Focal & segmental Focal – Ig M and Loss of foot
glomerulosclerosis sclerosis and C3 process of
hyalinosis podocytes ,
Epithelial
denudation
Membranoproliferative Mesangial Ig G + C3 and Subendothelial
glomerulonephritis proliferation , BM C1q + C4 deposits
thickening &
splitting
Ig A nephropathy Mesangial Mesangial
widening & deposition of Ig A
proliferation , C3 and
properdin

Alport syndrome Presence of foam Irregular foci of

cells in interstitial thickening &
cells thinning in GBM
with splitting and
lamination of
lamina densa (
BASKET WEAVE
appearance )
Good pasture Focal necrosis , Linear deposits of
syndrome Intra-alveolar Ig along alveolar
hemorrhage , septa and GBM
Type II
pneumocyte
hypertrophy

MEN – 1 MEN – II A MEN – II B

Pituitary Adenoma ++
Parathyroid Hyperplasia Hyperplasia ++
++
Adenoma ++
Pancreatic Hyperplasia
islets ++
Adenoma ++
Carcinoma
++
Adrenal Cortical Pheochromocytoma Pheochromocytoma
hyperplasia ++ ++
Thyroid C – cell C – cell
hyperplasia ++ hyperplasia ++
Medullary Medullary
 carcinoma ++ carcinoma ++
Endocrine Mucocutaneous
changes ganglioneuromas ,
Marfanoid habitus
Mutant gene MEN 1 RET RET
loci

Table – 15 Autoantibodies

Autoantibodies Clinical significance

ANA SLE
ANCA Ulcerative colitis
Anti – p62 , sp 100 , glycoprotein 210 Primary biliary cirrhosis
Anti Actin Ab Celiac disease , Autoimmune hepatitis
, CA stomach
Anti Centromere CREST syndrome
Anti Epithelial cell Pemphigus vulgaris
Anti GBM Good pasture disease
Anti GD 3 Guillian barre syndrome
Anti GIL Hemolytic transfusion reaction
Anti Gliadin , Anti Transglutaminase Celiac disease
Anti GM 1 Traveller’s diarrhea
Anti GM - CSF Pulmonary alveolar proteinosis
Anti GQ 1b Miller Fisher syndrome
Anti Histone Drug induced SLE
Anti Hu Small cell carcinoma of lung
Anti IgG Rheumatoid arthritis
Anti Jo 1 Polymyositis
Anti LKM 1 Autoimmune hepatitis
Anti Mitochondrial Primary biliary cirrhosis
Anti Ri Primary carcinoma of breast
Anti Sacchromyces cervessiae Crohns disease
Anti Scl 70 Scleroderma
Anti Smith , Anti ds DNA Specific for SLE
Anti SSA , Anti SSB Sjogrens syndrome
Anti Yo Oat cell carcinoma of lung

Table – 16 Pathological bodies

Inclusion bodies Diseases

Aschoff bodies
Asteroid body
Babes Ernst granules
Bodies of Arantius
Body of Highmore
Bollinger bodies
Brassy body
Rheumatic fever
Sarcoidosis & Sporotrichosis
Corynebacterium diphtheria
Aortic valve nodules
Mediastinum testis
Fowl pox
Dark shrunken blood corpuscles in malaria
Call Exner bodies Granulose theca cell tumour
Chromatid bodies Entamoeba histolytica pre-cyst
Citron bodies Clostridium septicum
Civatte bodies Lichen planus
Coccoid X bodies Psittacosis
Councilman bodies Hepatitis
Creola bodies Asthma
Donovan bodies Granuloma inguinale
Ferruginous body Asbestosis
Gamma gandy bodies Congestive splenomegaly
Guarnieri bodies Vaccinia

Heinz bodies G6PD deficiency

Henderson Peterson bodies Molluscum contagiosum
Hirano bodies Alzheimer’s disease
Keratin pearls Squamous cell carcinoma
Lafora body Myoclonic epilepsy
Leishman Donovan bodies Kala – azar
Levinthal Coles Lile bodies Psittacosis
Lewis bodies Parkinsonism
Mallory bodies Primary biliary cirrhosis , Alcoholic hepatitis
, Wilson’s disease , Chronic cholestasis ,
Hepatocellular carcinoma
Michaelis Gutmann body Malacoplakia
Miyagawa’s corpuscles Buboes from LGV
Mooser bodies Endemic typhus
Moot bodies Multiple myeloma
Owl – eye inclusions CMV and herpes
Pick body Pick’s disease
Psammoma bodies Papillary carcinoma of thyroid , serous
cystadenoma of ovary , meningioma ,
mesothelioma
Reilly bodies Hurler’s syndrome
Rokitansky bodies Teratoma
Ross’s bodies Syphilis
Rushton bodies Odontogenic cyst
Russell bodies Multiple myeloma
Sandstorm bodies Parathyroid glands
Schaumann bodies Sarcoidosis
Schiller Duval bodies Yolk sac tumour

Sclerotic bodies Chromoblastomycosis

Torres body Yellow fever
Verocay bodies Schwannoma
Warthin – Finkeldey giant Measles
cells
Winkler bodies Syphilis
Zebra bodies Metachromatic leukodystrophy

Table – 17 Stains

Type of stain Uses of staining

Acid Fast stain Mycobacterial organisms
Alcian Blue Mucins &Muco substances
Aldehyde Fuchsin Pancreatic Islet Beta Cell granules
Alizarin Red S Calcium
Bielschowsky stain Reticular fibres , Neurofibrillary tangles
and Senile plaques
Cajal stain Nervous tissue
Congo Red Amyloid
Cresyl Violet Neurons & Glia
Fontana Masson’s Melanin & Argentaffin cells
Giemsa Bone marrow
Golgi stain Neurons
Gomori Methenamine Silver Fungi
Gram Stain ( Taylor’s) Bacteria
Hematoxylin & Eosin Routine tissue sections
Luna stain Elastin & Mast cells
Luxol Fast Blue Myelin
Masson’s Trichrome Connective tissue & Collagen
Mucicarmine Epithelial Mucin
Oil Red O Lipid
Orcein stain Elastic fibres
Osmium tetroxide Lipids
Periodic Acid Schiff Glycogen & Fungi
Perl’s stain Hemisiderin
Phosphotungstic Acid- Fibrin , Cross striations of skeletal
Hematoxylin muscle fibres
Picrosirius Red Collagen
Ponder’s stain Metachromatic granules
Reticulum Silver Reticulum fibres
Safranin O Mucin , Cartilage , Mast cells
Toluidine Blue Mast cell granules
Verhoeff Vangleson Elastic fibres
Von Kossa Calcium salts

Table – 18 Types of Lymphocytes

Features B cell T cell

Origin Bone marrow Bone marrow
Maturation Bone marrow Thymus
Peripheral smear finding 15 – 25 % 65 – 85 %
Ag receptors Membrane bound Ig
CD markers CD – 19 , 20 , 21 , 22 , 23
Rosettes EAC rosette , EBV
receptors
Thymus specific antigens Absent
Surface Ig Present
Receptor for Fc fragment Present
of Ig G
Surface microvilli Present
Blast transformation Occurs by anti Ig ;
Mediated by endotoxin ,
S.aureus ( cowan I strain
) and EBV
Tolerance Negative selection –
immature B cells in bone
marrow
T cell receptors
CD – 1 , 2 , 3 , 4 , 7 , 8
SRBC rosette , Measles
receptor
Present
Absent
Absent
Absent
Occurs by anti CD 3 ;
Mediated by
Phytohemagglutinin &
Concavalin mediated
Positive selection –
mature T cells in thymic
cortex
Negative selection – self
reactive T cells in cortex ,
cortico medullary
junction & medulla of
thymus

Table – 19 HLA and disease association

HLA class Disease association

HLA – Class I
B – 27 Spondyloarthropathies
Ankylosing spondylitis
Reiter’s syndrome
Acute anterior uveitis
Reactive arthritis
Psoriatic arthritis
B–8 Graves’ disease
Myasthenia gravis
B – 51 Behcet’s disease
B – 47 Congenital adrenal hyperplasia
CW – 6 Psoriasis vulgaris
HLA – Class II
DR – 2 Japanese SLE
Multiple sclerosis
Narcolepsy
Goodpasture’s syndrome
DR – 3 Graves’ disease
Myasthenia gravis
Type I DM
Dermatitis herpetiformis
Chronic active hepatitis
Sjogren’s syndrome
DR – 4 Type I DM
Pemphigus vulgaris
Rheumatoid arthritis
DR – 5 Juvenile arthritis
DR – 8 Type I DM
DQ – 1 Pemphigus vulgaris
DQ – 2 , 8 Gluten sensitive enteropathy
DQ – 7 Bullous pemphigoid
DQ – 8 Type I DM

Table – 20 Immunoglobulin nuggets

Features Immunoglobulin responsible

Maximum sedimentation co-efficient Ig M
Maximum molecular weight Ig M
Minimum molecular weight Ig G
Maximum serum concentration Ig G > Ig A > Ig M > Ig D > Ig E
Maximum half life in days Ig G > Ig A > Ig M > Ig D > Ig E
Maximum intravascular distribution Ig M
Minimum intravascular distribution Ig A
Maximum carbohydrate Ig E
concentration
Classical complement fixation Ig M > Ig G
Alternate complement fixation Ig A > Ig D > Ig G
Maximum placental transport Ig G
Maximum concentration in milk Ig G and Ig A
Selective secretion by seromucinous Ig A
gland
Heat labile Ig Ig E
J chain present in Ig A and Ig M

Table – 21 Infectious agent in immune deficiency disorders

Pathogens T cell defect B cell defect Granulocyte Complement
defect defect
Bacteria Bacterial Staphylococci , Staphylococci , Neisseria
sepsis Streptococci , Pseudomonas
Hemophilus
Virus CMV , EBV , Enteroviral
Varicella , encephalitis
Chronic
infections with
respiratory &
intestinal
iinfections
Fungi & Candida , Intestinal Candida , Toxoplasmosis
Parasite Pneumocystis giardiasis Nocardia ,
carinii Aspergillus

Table – 22 Hypersensitivity reactions

Hypersensitivity Mechanism Effects Examples

reaction
Type I (Immediate Ab- IgE Systemic Penicillin allergy
or reaginic HSN) (cytotropic) acute Bee sting
Cells- IgE B anaphylaxis Insect bites
cell, mast Anaphylactic
 cells, shock
basophils, Local Urticaria
eosinophil anaphylaxis Angioedema
Pivoted role- ( Atopy ) Hay fever
by T H2 cell Some forms of
Most asthma; eczema
important Casoni’s test
vasoactive Theobald smith
amine: phenomenon
Histamine Schultz dale
Slow phenomenon
reacting Prausnitz kustner
substance of (PK) reaction
anaphylaxis
(SRS-A) =
leukotrienes
(LT B₄, C₄,
D₄, E₄)
Type II ( Ab: IgG or Complement Transfusion reactions
Cytotoxic or IgM dependent Erythroblastosis fetalis
cytolytic ) Lysis or AI hemolytic anemia
HSN phagocytosis Pemphigus syndrome
by Bullous pemphigoid
opsonization Perinicious anemia
Most Thrombotic
commonly phenomenon
involves blood Acute rheumatic fever
cells
Ab-usually IgG Type VI HSN Phagocytosis of tumor
sometimes IgE = Antibody cells or parasite
Cell lysis dependent
without cell mediated
phagocytosis cytotoxicity
by monocytes, ( ADCC )
neutrophil,
eosinophils and
NK cells
Antireceptor Type V HSN = Thyrotoxicosis/grave’s
antibody Antibody disease
Stimulation mediated Myasthenia gravis
Inhibition cellular
dysfunction
Type III Ab- IgG or Local immune PAN
( Immune IgM complex Farmer’s lung
complex ) Ag-Ab disease Hypersensitivity
HSN complex (arthus pneumonitis
activate reaction) Arthus reaction
complement→ Systemic SLE
attack immune Certain forms of acute
neutrophil → complex glomerulonephritis
release of (serum Rheumatoid arthritis
lysosomal sickness) Hyperacute graft
enzymes rejection
Infective endocarditis
Henoch-Schonlein
purpura
Schick test
Type 2 lepra reaction
 (ENL)

Type IV ( Cell Ab- No Delayed type by Tuberculin test

mediated ) antibody CD₄ T H1 cells Lepromin test
HSN Initiated by Type I DM
specifically Fairley’s
sensitized T (Schistosomiasis)
lymphocytes test
Frie’s (LGV) test
Granulomatous
inflammation
Contact dermatitis
Defence against
intracellular
pathogen
Type I lepra reaction
Cell mediated Graft rejection
cytotoxicity by Resistance to virus
CD-8 T cells infection
Tumor immunity

Table – 23 Functions of cytokines

Cytokines Sources Functions

IL-1 Macrophagesf, Proliferation and differentiation of T
fibroblasts, and B cells, pyrogenic
monocytes, Previously leukocyte activating factor
endothelium (LAF) and B cell activating factor (BAF)
IL-2 (T cell T cells Cytotoxicity of T and NK cells, converts
growth some null cells (LGL) into lymphokine
factor) activated killer cells (LAK) that destroys
NK scell resistant tumor cells
IL-3 T cells Multi-CSF
IL-4 (B cell Increases IgG1 and IgE production
growth
factor)
IL-5 Th cells Proliferation of eosinophils, s timulate
IgA, IgM production
IL-8 Macrophages Neurophil chemotactic factor
IL-10 T,B cells Inhibit IFN production
TNF- ( Macrophages, Tumor cytotozicity, antiviral and
cachectin) monocytes antiparasitic, endotoxic shock, capillary
Mast cells, T and B leak syndrome
cells
TNF- T and B cells Cell cytotoxicity, lymph node and spleen
development
TGF- T,B cells Inhibit T and B cell proliferation,
promote wound healing Stimulates
 angiogenesis
IFN- Leukocytes Anti-viral activity stimulates T cell,
macrophage, and NK cell activity. Direct
anti-tumor effects. Used therapeutically
in viral and autoimmune conditions
IFN- Fibroblasts, Epithelial Anti-viral activity stimulates T cell,
cells macrophage, and NK cell activity. Direct
anti-tumor effects. Used therapeutically
in viral and autoimmune conditions
IFN- T Cells, NK cells Regulates macrophage and NK cell
activations. Stimulates
immunoglobulin secretion by B cells.
Th1T cell differentiation

Table – 24 Abnormal types of RBCs

Echinocyte / Burr cells Regular spine like projections on cell surface Ex-
megaloblastic anemia / burns / hemolytic anemia
Acanthocytes / Spur Irregular thorn like projections Ex- liver disease ,
cells abetalipoproteinemia
Stomatocyte Slit like area of pallor
Schistocytes Fragmented RBCs – triangular , comma or
helmet shaped
Leptocytes Thin flat cells
Podocytes Mexican hat cells
Dacrocytes Tear drop cells / target cellsEx- liver disease ,
anemia of chronic disease
Drepanocyte Sickle cells
Elliptocyte Pencil cells or cigar cells
Keratocyte Helmet cells
Knizocytes Cells with more than one concavities

Table – 25 Cluster differentiations

Cluster differentiation Cells of distribution

CD 1a Langerhans cell
CD 2 T cell , NK cell
CD 3 Pan T cell marker
CD 4 Helper T cell , Macrophage
CD 5 T cell / B cell ( Mantle cell )
CD 8 CD8 - Cytotoxic T cell, suppressor T
cell
CD 10 Common ALL antigen, Immature B
cell
CD 11 – a , b , c Leukocyte
CD 13 , 33 Granulocyte
CD 14 Monocyte ( M5 AML )
CD 16 , 56 , 57 NK cell
CD 19 Pan B cell marker
CD 20 , 21 , 22 B cell markers
CD 21 EBV receptor
CD 23 Ig E receptor
CD 30 – Ki – I antigen Hodgkin’s lymphoma
CD31 Endothelial cells
CD 34 Pluripotent cell
CD 38 Plasma cell
CD 41 , 61 Platelet specific marker
CD 45 RB Leukocyte (pan leukocyte)
CD 45 RA , RC Subset T cell , Naive T cell , Medullary
thymocyte
CD 45 RO Subset T cell , Memory T cell ,
Cortical thymocyte

Table – 26 WHO classification of Lymphoid neoplasm

1) Precursor B – cell neoplasm 2) Peripheral B – cell neoplasm

Precursor B lymphoblastic Chronic lymphocytic

leukemia leukemia
B cell prolymphocytic
leukemia
Lymphoplasmacytic
lymphoma
Splenic & nodal marginal
zone lymphoma
Extra nodal marginal zone
lymphoma
Mantle cell lymphoma
Follicular lymphoma
Marginal zone lymphoma
Hairy cell leukemia
Plasma cell myeloma
Diffuse large B cell
lymphoma
Burkitt lymphoma
3) Precursor T – cell neoplasm 4) Peripheral T – cell neoplasm
Precursor T lymphoblastic Angioimmunoblastic T cell
leukemia lymphoma
Large granular lymphocytic
leukemia
T cell prolymphocytic
leukemia
Peripheral T cell lymphoma
Anaplastic large cell
lymphoma
Mycosis fungoides
Enteropathy associated T cell
lymphoma
Panniculitis like T cell
lymphoma
Hepatosplenic T cell
lymphoma
Adult T cell lymphoma
NK / T cell lymphoma
NK cell leukemia
5) Hodgkins lymphoma
Classic subtypes Non classical subtype
Nodular sclerosis Lymphocyte predominant
Mixed cellularity
Lymphocyte rich
Lymphocyte depletion

Table – 27 Hemostatic disorders

Diseases Platelet Bleeding PT aPTT FDP

count time
Hemophilia Normal Normal Normal Prolonged Absent
A
Hemophilia Normal Normal Normal Prolonged Absent
B
vWD Normal Prolonged Normal Prolonged Absent
Liver failure Prolonged Prolonged Prolonged Prolonged Absent
DIC Prolonged Prolonged Prolonged Prolonged Present
Vascular Normal Normal Normal Normal Absent
purpura
Aspirin Normal

Prolonged Normal Normal Absent

Warfarin Normal Normal Prolonged Prolonged Absent

Radiology
Table – 1 Important chest X ray views to visualise

View Structures visualised

Ipsilateral lateral decubitus Minimal pleural effusion
Right anterior oblique Right lung , Left atrium enlargement ,
GD , Mitral vlave
Left anterior oblique Tracheal bifurcation , Aortic window
Right posterior oblique Right retrocardiac space
Right decubitus Right middle lobe , Right pleural
effusion
Lordatic view Apex , lingual lobe
Reverse lordatic view Interlobar effusion
Lateral skull view Sella tursica
Odontoid view C1 , C2
Oblique view Spondylolisthesis
Skyline view Patella
Stryker’s view Recurrent subluxation / dislocation of
shoulder
Erect view Pneumoperitoneum
Water’s view Maxillary sinus , Antrum
Caldwell’s view Frotal sinus , Superior orbital fissure
Stenver’s / Towne’s view Mastoid air cells , Petrous cells ,
Internal acoustic meatus

Table – 2 Radionucleotides

Radionucleotide Medical significance

Tc 99m labelled serum albumin Pulmonary embolism
Tc 99m labelled RBCs Imaging spleen , GI bleeding ,
Ventriculography
Tc 99m DMSA For renal scarring
Tc 99m DTPA Measures GFR , Renal tract
obstruction
Tc 99m MAG3 Vesicoureteric reflux , Transplant
rejection
I-123 MIBG , Adrenal medullary tumour
I-123 Iodocholesterol
Tc 99m labelled HIDA Hepatobiliary tree
Ga-67 nitrate To detect tumours , concentrated in
abscess cavity , Inflammation
Iodine 131 To detect thyroid cancer
Cr 52 For red cell survival studies

Table – 3 Investigations of choice

Disease condition Investigation of choice

Early stage renal TB IVP
Late stage renal TB CT > IVP
Aortic dissection TEE
Avascular necrosis MRI
Atypical cavernous hemangioma MRI
Evaluation of breast implant MRI
Chronic subarachnoid hemorrhage MRI
Acute subarachnoid hemorrhage Non contrast CT head
Bleeding site 4 vessel X ray angio
Discrete thyroid swelling FNAC
Pelvic malignancy staging MRI
Posterior fossa tumour MRI
Meningeal carcinomatosis Gadolinium enhanced MRI
Acoustic neuroma Gadolinium DTPA enhanced MRI
Parameningeal rhabdomyosarcoma MRI
Nasopharyngeal angiofibroma CECT scan
Bronchiectasis HRCT
Interstitial lung disease HRCT
Pulmonary embolism CT chest with contrast
Solitary pulmonary nodule CT
Blunt abdominal trauma CT scan
Osteoporosis DEXA scan
Epileptogenic foci (Structural MRI , CT
imaging)
Epileptogenic foci (Functional PET , SPECT
imaging)
Haemorrhagic stroke NCCT
Ischaemic stroke MRI
Aortic aneurysm CT scan
Aortic dissection MRI
Cardiac tamponade , Pericardial 2D ECHO
effusion
DVT Venous USG
Cardiac valvular disease M mode ECHO
Anterior urethra Retrograde USG
Posterior urethra Micturating cystourethrogram
Acute ureteric colic NC spiral CT abdomen
Seminal vesicle , Ejaculatory duct Vasography
Pheochromocytoma T2 weighted MRI
Parathyroid adenoma Tc-Th substraction scan
Neuroendocrine tumors SRS
Sequestration lung Angiography
Stress incontinence Bead cystogram
Reno vascular hypertension Rapid sequence
urography/pyelography

Table – 4 Bowel appearances in erect films

Obstruction of organs Radiological findings

Small bowel Straight segments that are centrala
nd lie transversely , string of beads
Jejunum Vulvulae conniventes
Ileum Featureless
Caecum Rounded gas shadow in right iliac
fossa
Large bowel Haustral fold spaced irregularly

Table – 5 Barium swallow appearances

Clinical condition Appearances

Achalasia cardia Bird beak deformity of lower
oesophagus
CA oesophagus Rat tail tapering of lower
oesophagus
Diffuse oesophageal spasm Cork screw oesophagus

Barium meal foolow through studies

 Clinical condition
CA head of pancreas
Chronic duodenal ulcer with
scarring
Gastric carcinoma
Idiopathic HPS
Leiomyosarcoma
Barium enema
Clinical condition
CA colon
Colonic polyps
Crohn’s disease
Diverticulosis
Ileocaecal TB
Intussusception
Ischaemic colitis
Small bowel obstruction
Ulcerative colitis
Table – 6 IVU / IVP findings
Indications
Hydronephrosis
Horse shoe kidney
Ureterocele
Polycystic kidney disease
Retrocaval ureter
Ectopic ureter
BPH
Chronic TB cystitis
Renal cell carcinoma
Acute arterial renal occlusion
Cortical necrosis
Table – 7 USG frequencies in medicine
Type of USG
Trans thoracic ECHO
Abdominal
Trans esophageal ECHO
Ba meal features
Antral pad sign , Wide C loop of
duodenum
Trifoliate duodenum
Filing defect in antrum / body
String sign
Bull’s eye lesion
Radiological signs on Ba
enema
Irreugular filling defect ; Apple core
deformity
Smooth regular filling defect
String sign of cantor
Saw tooth appearance
Pulled up contracted caecum ;
Obtuse ileocaecal angle ; Filing
defect ; Incompetent ileocaecal valve
Coiled spring sign ; Pincer shaped
ending ; Claw sign
Thumb printing sign
String of beads
Loss of haustrations ; Lead pipe or
pipe stem appearance
IVP / Radiological findings
Clubbing of calyces ; Crescent sign
Flower vase appearance of ureter
Adder / cobra head appearcance
B/L spider leg appearance
Reverse J sign with hydronephrosis
Drooping flower appearance
Fish hook bladder
Thimble bladder
U/L spider leg appearance
Rim nephrogram
Reverse rim sign
Frequency
2 – 3 MHz
3 – 5 MHz
3 – 7.5 MHz
Transvaginal , Transrectal 5 – 10 MHz
Ocular B scan 10 MHz
Breast 15 MHz
Intravascular USG 30 – 40 MHz
Ocular UBM 35 – 50 MHz

Table – 8 Radiation exposure

Source of exposure Radiation dose

Dental X ray 0.005 mSv
Chest X ray 0.02 mSv
CT scan head 1 – 2 mSv
CT scan chest 5 – 7 mSv
Whole body CT scan 10 mSv
Abdomen & Pelvis CT 8 – 11 mSv
PET CT 5 – 15 mSv
SPECT 2 – 5 mSv

Table – 9 X ray views

View Best for

Water’s view ( Occipitomental view ) Maxillary sinus
Caldwell’s view ( Occipitofrontal
view )
Lateral view
Law’s view , Sculler’s view ,
Stenver’s view , Towne’s view ,
Transorbital view ,
Submentovertical view
Ballcatcher’s and Brewerton’s view
Rosenberg’s view
Anthosen’s and Isherwood view
Swimmer’s view
Lateral decubitus
Lordotic view
Superior orbital fissure
Sphenoid sinus , Orbital roof
Temporal bone pathologies
Rheumatoid arthritis of hand
OA knee
Subtalar joint
Cervical spine
Minimal pleural effusion
Lingula of lung

Reverse lordotic view Interlobar effusion

Skyline view Patella fracture
Von rosen’s view Dysplasia of hip
Stryker’s view Recurrent subluxation / dislocation
of shoulder
Rhese view Optic foramen

Table – 10 Half life of radio isotopes

Radio isotope Half life

Iodine – 132 2.3 hours
Technetium – 99 6 hours
Iodine – 123 13 hours
Radon – 222 3.8 days
Iodine – 131 8 days
Cobalt- 60 5.2 years
Tritium 12 years
Cesium – 137 30 years
Radium – 226 1622 years

Table – 11 Maximum tolerable dose

Whole organ Maximum tolerable dose TD

50/5 ( Gy )
Fetus 4
Bone marrow 4.5
Kidney 20 ( Whole strip )
25 ( Whole )
Lung 25
Liver 20 ( Whole strip )
40 ( Whole )
Brain 60

Table – 12 Radiosensitivity of cell cycle

Most sensitive Moderate Moderate Most resistant

sensitive resistant
Late G2 – M phase Late G1 – Early S Mid G1 phase Mid – Late S –
phase Early G2 phase

Table – 13 Radiosensitivity of various tissues

Very high High Intermediate Low

Bone marrow Growing skin , Adult bone Pancreas
Testis , Ovary muscle Adult cartilage Uterus
Growing cartilage Growing bones Oral mucosa Vagina
Growing plate Brain Esophagus Adrenals
Growing physis Spinal cord Urinary bladder
Breast Pituitary , Thyroid
Optic lens Salivary gland
Stomach
Small intestine
Colon , Rectum
Liver , Lung ,
Heart
Kidney , Cornea

Table – 14 Radiosensitivity of tumors

Highly sensitive Moderately Relatively Highly resistant

sensitive resistant
Ewing’s sarcoma Nasopharyngeal Renal cell CA Hepatoma
Seminoma CA Rectal / Colon CA CA Pancreas
Lymphoma Dysgerminoma CA Cervix Osteosarcoma
Wilm’s tumor Medulloblastoma CA Bladder Melanoma
Multiple myeloma Small cell CA Lung Soft tissue
 Teratoma sarcoma
CA breast SCC Lung
CA Ovary
Basal cell CA

Table – 15 Radionuclide scans

Radionuclides Use
Technetium 99 Ventriculography , Bone scan , Liver
scan , Kidney
Thallium – 201 Myocardial perfusion
Tc 99m pyrophosphate Myocardial infarction
Tc albumin Myocardial ventriculography
Tc Thallium substraction scan Parathyroid gland
Tc labeled RBC Splenic diseases
MIBG scan Extra adrenal / Ectopic / Metastatic /
Locally recurrent Pheochromocytoma
Selenium – 75 Pancreas
Iodine – 131 , 132 Placental functioning
I – 131 & Selenium Thyroid
I – 131 orthohippurate Kidney
Gallium scan Abscess

Table – 16 Cancer scan

Clinical Imaging Radionuclide Biological

condition behavior
Tumor staging Tumor imaging 18 – FDG Tumor glucose
Tumor recurrence metabolism
Tumor response
Tumor hypoxia Hypoxia imaging 18F- Trapped by hypox
Fluromisonidazole cells
SOL in brain Tumor imaging 201
TI Perfusion
Sarcoma 18 – FDG Marker of glucose
metabolism
Insulinoma Somatostatin 111In pentetreotide Binds to
Carcinoid receptor scan somatostatin
receptor
Neuroblastoma MIBD scan 123I – MIBG Uptake by NA
receptor
CA Thyroid Whole body iodine 131I– Sodium Uptake by Na/I
scan iodide transporter
Skeletal metastasis Bone scan Tc 99m – Osteoblastic
Polyphosphate response
Sentinel node Lymphoscintigraphy Tc 99m – Lymphatic uptake
detection nanocolloid and trapping

Social and Preventive Medicine

Table – 1 Categories of Bio Medical Waste Disposal (Proposed in 2011) Not yet
implemented
Category BMW
1 Human anatomical
waste
2 Animal waste
3 Microbiology and
Biotechnology waste
4 Waste sharps
5 Discarded medicines
& Cytotoxic drugs
6 Soiled waste
7 Infectious Solid
waste
8 Chemical waste
Wastes included
Human tissues , organs , body parts
Animal tissues , organs , body parts ,
carcasses , fluids , blood
Waste from lab cultures , stocks , specimens
of microbes , vaccines , cell cultures , waste
from production of biologicals , toxins
Needles , syringes , blades , scalpels , glass
Outdated contaminated & discarded
medicines
Items contaminated with blood & fluids
including cotton , dressings , soiled plaster
casts , linen , beddings
Disposable items including tubings ,
catheters , IV sets
Chemicals used in disinfection or in
production of biological

Table – 2 Days of public health importance

30th January Anti-leprosy day

2nd Wednesday of March No smoking day
8th March International Women’s day
th
15 March World disabled day
24th March Anti-TB day
7th April World health day
8th May World red cross day
31st May No tobacco day
5th June World environment day
26th June International day against drug abuse &
illicit trafficking
1st July Doctors day
11th July World population day
8th September World literacy day
1st October International day for geriatric population
1st October National voluntary blood donation day
2nd Wednesday of October World disaster reduction day
9th October World sight day
10th October World mental health day
24th October UN day
10th November Universal immunisation day
25th November International day for elimination of
violence against women
1st December World AIDS day
3rd December International day of disabled persons
10th December Human rights day

Table – 3 Instruments of public health importance

Instrument Public health importance

Ice lined refrigerator Cold chain temperature maintenance
Dial thermometer Cold chain temperature monitoring
Horrock’s apparatus Chlorine demand estimation in water
Chlorinator , Chloronome Mixing/regulating the dose of chlorine
in water
Chloroscope Measuring level of residual chlorine in
drinking water
Winchester Quart bottle Assess physical & chemical quality of
drinking water
Kata thermometer Assess cooling power of air and air
velocity
Anemometer Assess air/wind velocity
Hygrometer , Sling psychrometer & Assess air humidity
Assman psychrometer
Mercurial barometer , Anaeroid Atmospheric pressure
barometer
Wind Vane Assess air/wind direction
Salter’s scale Field instrument for Low birth weight
Infantometer Length of infants
Stadiometer Weight of adults
Shakir’s tape Mid arm circumference
Sound level meter Measure intensity of sound
Band frequency analyzer Characteristic of sound
Audiometer Assess hearing ability

Table – 4 Health legislations

The Quarantine Act 1870

The Vaccination Act 1880
The Child Marriage Restraint Act 1929
The Employees State Insurance Act 1948
The Factories Act
The Prevention of Food Adulteration Act 1954
The Immoral Traffic Act 1956
The Indian Medical Council Act
The Dowry Prohibition Act 1961
The Maternity Benefit Act
The Registration of Births and Death Act 1969
The Medical Termination of Pregnancy Act 1971
The Narcotic Drugs and Psychotropic Substances Act 1985
The Consumer Protection Act 1986
The Environmental Protection Act
The Mental Health Act 1987
The Infant Milk Substitutes , Feeding Bottles and Infant 1992
Food Act
The Protection of Human Rights Act 1993
The Pre-conception and Pre-natal Diagnostic Techniques 1994
Act
The Biomedical Management Rules 1998
The National Rural Employment Guarantee Act 2005
The Right to Information Act
The Protection of Women from Domestic Violence Act

Table – 5 Health programs of India

National Family Planning Programme 1951

National Malaria Control Programme 1953
Lymphatic Filariasis Control programme 1955
National Leprosy Control Programme 1955
National Malaria Eradication Programme 1958
National Tuberculosis Programme 1962
National Goitre Control Programme 1962
National Trachoma Control Programme 1963
Urban Malaria Scheme 1971
Integrated Child Development Services 1975
National Cancer Control Programme 1975 – 1976
National Program for Control of Blindness 1976
Kala Azar Control Programme 1977
Modified Plan of Operation 1977
National Mental Health Programme 1982
National Leprosy Eradication Programme 1983
National Guineaworm Eradication Programme 1983 – 1984
National AIDS Control programme 1987
Revised National Tuberculosis Control Programme 1992
Child Survival and Safe Motherhood Programme 1992
National AIDS Control Programme – I 1992 – 1997
National Iodine Deficiency Disorders Control Programme 1992
Yaws Eradication Programme 1996 – 1997
Revised Lymphatics Filariasis Control Programme 1996 – 1997
Enhanced Malaria Control Project 1997

Reproductive and Child Health Programme – I 1997

Modified Leprosy Elimination Campaigns 1998 – 2004
National Anti-Malaria Programme 1999
National Oral Health Project 1999
National AIDS Control Programme – II 1999 – 2004
National Vector Borne Disease Control Programme 2003 – 2004
Integrated Disease Surveillance Project 2004 – 2009
Reproductive and Child Health Programme – II 2004 – 2009
National Rural Health Mission 2005 – 2012
National AIDS Control Programme – III 2006 – 2011

Table – 6 Primary health care

Hallmarks of primary health Principles of primary health care

care
Affordability Equitable distribution
Acceptability Appropriate technology
Accessibility Community participation
Availability Intersectoral coordination

Elements of primary Functions of primary health care

health care
E Education regarding health Medical care
problems & their control MCH including family planning
L Locally endemic diseases Safe water supply and sanitation
prevention & control Locally endemic diseases
prevention and control
E Essential drugs Collection and reporting of vital
M Maternal & Child health statistics
care including Family Education concerning health
planning National health programs
Referral services
E EPI against vaccine Training of health personnels
preventable diseases Basic laboratory services
N Nutrition and promoting
proper food supply
T Treatment of common
diseases and injury
S Safe water supply &
sanitation

Table – 7 Health care system

Subcentre PHC CHC

Level of care Primary Primary Secondary
Plains 5,000 30,000 1,20,000
Populatio Hilly areas 3,000 20,000 80,000
n
Staff 3 15 30 – 31
Maintenance Central State State government
government government
Rural area covered 21 sq km 140 sq km 770 sq km
Radial distance covered 2.6 6.6 15.6
 Average no of villages 4 29 158
covered

Table – 8 Population norms for Health personnel

Health personnel Population norms

Doctor 1 per 3500
Nurse 1 per 5000
Health worker ( Male or Female ) 1 per 5000 ( Plains ) or 3000 ( Hills )
Health assistant ( Male or Female 1 per 30000 ( Plains ) or 20000 ( Hills
) )
Pharmacist 1 per 10000
Lab technician 1 per 10000
USHA 1 per 2500
ASHA 1 per 1000
Trained dai 1 per 1000
Village health guide 1 per 1000
Anganwadi worker 1 per 400 – 800 ( Plains ) or 300 –
800 ( Hills )

Millennium development goals

Baseline year for MDG – 1990
Deadline year for MDG – 2015
In total there are 8 goals, 21 quantifiable targets and 60 indicators. Out of these, 3 goals, 8 targets and
18 indicators are directly related to health.

Table – 9 Goals of MDG

Goal – 1 Eradicate extreme poverty &

hunger
Goal – 2 Universalize primary education
Goal – 3 Gender equality & women
empowerment
Goal – 4 Reduce child mortality
Goal – 5 Improve maternal health
Goal – 6 Combat HIV/AIDS , Malaria and
other diseases
Goal – 7 Ensure environmental
sustainability
Goal – 8 Develop global partnerships for
development

Table – 10 Targets within the goals

Target – 1 1a Reduce by half (he proportion of people living on

less than a dollar a day
1b Achieve full and productive employment and
decent work for all, including women and young
people
1e Reduce by half the proportion of people who suffer
from hunger
Target – 2 2a Ensure that all boys and girls complete a full
course of primary schooling
Target – 3 3a Eliminate gender disparity in primary and
secondary education preferably by 2005, and at all
levels by 2015
Target – 4 4a Reduce by two thirds the mortality rate among
children under five
Target – 5 5a Reduce by three quarters the maternal mortality
ratio
5b Achieve, by 2015, universal access to reproductive
health
Target – 6 6a Halt and begin to reverse the spread of HIV/AIDS
6b Achieve, by 2010, universal access to treatment for
HIV/AIDS for all those who need it
6c Halt and begin to reverse the incidence of malaria
and other major diseases

Target – 7 7a Integrate the principles of sustainable

development into country policies and
programmes; reverse loss of environmental
resources
7b Reduce biodiversity loss, achieving, by 2010, a
significant reduction in the rate of loss
7c Reduce by half the proportion of people without
sustainable access to safe drinking water and basic
sanitation
7d Achieve significant improvement in lives of at least
100 million slum dwellers, by 2020
Target – 8 8a Develop further an open, rule-based, predictable,
non- discriminatory trading and financial system
8b Address the special needs of the least developed
countries
8c Address the special needs of landlocked
developing countries and small island developing
States
8d Deal comprehensively with the debt problems of
developing countries through national and
international measures in order to make debt
sustainable in the long term
Table – 11 Twelfth five year plan 2012 – 2017 goals

Parameter Goal by 2017

Infant mortality rate ( IMR ) 25 per 1000 live births
Maternal mortality rate ( MMR ) 100 per 1,00,000 live births
Total fertility rate ( TFR ) 2.1
Under 3 year old malnutrition Reduction by 50 %
Anemia in 15 – 49 years old 28 %
women
0 – 6 years child sex ratio 950
Poor household’s out of pocket Reduction
expenditure
Non communicable disease Reduction
burden
Communicable Tuberculosis Reduce incidence , mortality by 50 %
diseases Leprosy Prevalence < 1/10,000
Malaria Incidence < 1/1000
Filaria Mf prevalence < 1% in all districts
Dengue Case fatality rate < 1 %
Chikungunya Containment of outbreaks

Japanese Mortality reduction by 30 %

encephalitis
Kala azar Elimination by 2015 ( < 1/10,000 )
HIV / AIDS Zero new infections ; Care & support ;
ART to all PLHA

Table – 12 Recommended daily energy and protein intake

Group Classification of Energy Proteins

human strata (Kcal/day) (g/day)
Adult male Sedentary worker 2320 60
Moderate worker 2730 60
Heavy worker 3490 60
Adult female Sedentary worker 1900 55
Moderate worker 2230 55
Heavy worker 2850 55
Pregnancy + 350 + 23
Lactation (0 – 6 m) + 600 +19
Lactation (6 – 12 m) + 520 +13
Infant 0 – 6 months 92 /kg 1.16 /kg
 6 – 12 months 80 /kg 1.69 /kg

Table – 13 Vaccines

Vaccine Strain Dosage Route Schedule Diluents Efficacy

BCG Bacille 0.1 ml Intradermal At birth Normal 80 %
( Freeze Calmette left deltoid saline
dried ) Guerin bovine
strain
DPT Diphtheria & 0.5 ml , Anterolateral Primary None Pertussis 85
Tetanus IM aspect of doses – 6 , %
toxoids , thigh 10 , 14 Diphtheria
Purified weeks . 95 %
pertussis Booster at Tetanus 100
components 18 months %
& 5 years
OPV Sabin strain 2 drops Oral Primary None 80 – 90 %
grown in doses – 6 ,
PMK cells 10 , 14
weeks .
Booster at
18 months
& 5 years
Hepatitis B Genetically 0.5 ml , Anterolateral Primary None 90 %
engineered IM aspect of doses –
recombinant thigh Birth , 6 ,
subunit 14 weeks
vaccine

Hib vaccine Conjugate 0.5 ml , Anterolateral Primary None 90 – 100 %

capsular IM aspect of doses – 6
polysaccharide thigh , 10 , 14
– b vaccine weeks .
Booster at
15 - 18
months
Measles Edmonston 0.5 ml , Thigh , 9 months Sterile 95 %
( Zagreb strain SC Anterolateral water
Lyophilised grown on aspect of
) human diploid thigh
cells
MMR Measles - 0.5 ml , Thigh , 15 Sterile 95 %
( Edmonston SC Anterolateral months water
Lyophilised Zagreb strain aspect of
) Mumps – L- thigh
Zagreb strain
Rubella – RA
27/3 strain
Varicella Oka strain on 0.5 ml , Deltoid 1 – 12 Sterile 95 – 100 %
( human diploid SC years – water
Lyophilised cells single
) dose ;
>13 years
– 2 doses
at 1
month
interval
Hepatitis A Formaldehyde 0.5 ml Anterolateral After 1 None 90 – 100 %
inactivated IM aspect of year 2
HM 175 Ag thigh doses at 6
months
interval
Typhoid Vi Inactivated 0.5 ml Deltoid None 70 %
antigen capsular IM
vaccine polysaccharide
vaccine

Meningococcal Inactivated 0.5 ml Deltoid / 2 years and Sterile 90 %

(A+C) capsular IM / SC Thigh during water
( Lyophilised ) polysaccharide epidemic
vaccine
JE vaccine Killed viral 1–3 Deltoid 2 doses at 1 Sterile 80 – 90
( Lyophilised ) vaccine mouse yrs : month water %
brain 0.5 ml; interval ,
Nakayama >3 yrs : Booster
strain 1 ml SC every 3
years
Pneumococcal Inactivated 0.5 ml Deltoid / High risk None 80 %
23 valent capsular IM / SC Anterolateral children >
vaccine polysaccharide thigh 2 yrs
vaccine
Influenza Split virion 6 mon Deltoid / 1 dose and None 80 – 90
vaccine – 3 yrs Anterolateral after 6 %
: 0.25 thigh months.
ml ; Revaccinate
>3 yrs : every year
0.5 ml with strain
IM adjusted
vaccine

Table – 14 Difference between rapid and slow sand filter

Features Rapid sand filter Slow sand filter

Space Occupies very little space Occupies large area
Rate of filtration 200 m.g.a.d 2 – 3 m.g.a.d
Effective size of sand 0.4 – 0.7 mm 0.2 – 0.3 mm
Preliminary treatment Coagulation , Plain sedimentation
sedimentation
Washing Back washing By scraping sand bed
Mechanism of action Essentially physical Physical & mechanical
Loss of head allowed 6 – 8 feet 4 feet
Removal of turbidity Good Good
Removal of colour Good Fair
Removal of bacteria 98 – 99 % 99.9 – 99.99 %
Suitability For big cities For small towns
Integrated vector control

Table – 15 Insecticides Classification

Group Compounds Examples

I Organochlorine DDT , HCH , dieldrin , chlordane ,
compounds methoxychlor
II Organophosphorous Malathion ,Fenthion , chlorpyrifos ,
compounds abate
III Carbamates Propoxur , carbaryl

Compounds Dosage Uses

DDT 100 – 200 mg/sq foot area Contact poison – Control of
lice , fleas , ticks and bugs
HCH 25 – 50 mg sqft Direct poison
Malathion 100 – 200 mg/sq.ft for Low volume UV fogging spray
every 3 months , kills adult mosquitoes
Abate Not greater than 1.0 ppm Control of A.stephensi
Diazinon 60 – 100 mg/sq.ft Direct action , Fumigant
action , Control of DDT
resistant insects
Fenthion 100 mg/sqft Larvicide
Dichlorvos Highly volatile liquid Fumigant action , disinfecting
aircraft
Propoxur Control of DDT and dieldrin
resistant anopheline
Pyrethrum 0.1% aqueous solution Direct contact , kills
mosquitoes
Rotenone 4–5% Insecticidal dust , Control of
lice , fleas , mites and ticks
Mineral oils Kills mosquito larvae and
pupa
Paris green 2% dust Stomach poison , Control of
anopheline larvae

Demographic cycle
Features Phase I Phase II Phase III Phase IV Phase V
Birth rate High High Declining Low Low
Death rate High Declining Declining Low Declining
Demographic Narrow Stationary Increasing Narrow Reversal
gap
Population Stationary Growing Growing Stationary Decreasing
Composition Young Young Young Mixed Ageing
Age pyramid Pyramidal Losing Globular Cylindrical Losing
pyramidal cylindrical
shape shape

Table – 16 Census 2011

Frequency of census in India
Legal basis of conducting census
Census organization working under
Head of census organization
Population enumeration
Revisional round
Houseless population enumeration
Census stop
First time activities ever done
No of states in India
No of districts in India
No of villages in India
Every 10 years ( Decadal )
The Census Act 1948
Ministry of Home Affairs
Registrar General and Census
Commissioner
9th – 28th February 2011
1st – 5th March 2011
Night of 28th February 2011
00.00 hours 01 March 2011
Biometry
Finger prints , Iris scan , Unique
identification number , National
population register , Photograph
35 including Union territories
640
6.41 lakh

Table – 17 RDA in pregnancy and lactation

Nutrients Pregnancy Lactation
0 – 6 months 6 – 12 months
Energy + 350 kcals + 600 kcals + 520 kcals
Proteins + 23 gm/day + 19 gm/day + 13 gm/day
Calcium 1200 mg/day 1200 mg/day 1200 mg/day
Iron 35 mg/day 21 mg/day 21 mg/day
Vitamin A 800 mcg/day 950 mcg/day 950 mcg/day

Table – 18 Cleans in safe delivery

3 cleans 5 cleans 7 cleans

Clean delivery surface Clean delivery surface Clean delivery surface
Clean hands Clean hands Clean hands
Clean cord ( cut , tie , Clean cord cut Clean cord cut
stump ) Clean cord tie Clean cord tie
Clean cord stump Clean cord stump
Clean water
Clean towel

Table – 19 Zoonoses classification

Terms Definition Examples

Anthropozoonoses Infections transmitted Rabies , Plague , Anthrax ,
from animals to man Hydatidosis , Trichinosis
Zooanthroponoses Infections transmitted Human TB in cattle
from man to animals
Amphixenosis Infection transmitted Trypanosomacruzi ,
in either direction Schistosomajaponicum
between animals and
humans
Direct zoonoses Infections transmitted Rabies , Brucellosis ,
from infected to Trichinosis
susceptible vertebrate
host by direct contact /
fomite /vector
Cyclozoonoses Involves more than Taeniasis ,Echinococcosis
one species for disease
transmission
Meta zoonoses Infections transmitted Plague ,Schistosomiasis
biologically through
invertebrate vectors
Saprozoonoses Involves non animal Mycoses , Larva migrans
developmental site or
reservoir for disease
transmission
Epizootic Outbreak of disease in Anthrax , Influenza , Rabies ,
animal population Brucellosis , Rift valley fever ,
Q fever , Japanese encephalitis
Enzootic Endemic of disease Anthrax , Brucellosis , Rabies ,
occurring in animals Bovine TB , Endemic typhus ,
Tick typhus
Epornithic Outbreak of disease in Japanese encephalitis
bird population

Table – 20 Water borne diseases classification

Water borne diseases Occur due to drinking Typhoid , Cholera , Dysentry ,

contaminated water , Viral Hepatitis A
transmitted by faeco-
oral route
Water washed Infections of outer Scabies , Trachoma , Typhus ,
diseases body surface which Bacillary dysentery , Amoebic
occur due to dysentry
inadequate use of
water or improper
hygiene
Water based diseases Infections transmitted Schistosomiasis
through an aquatic ,Dracunculiasis
invertebrate animal
Water breeding Infections spread by Malaria ,Filariasis , Dengue ,
diseases insects that depend on Yellow fever , Onchocerciasis
water

Table – 21 Incubation period of diseases

Disease Causative agent Incubation period

Chicken pox Human herpes virus 3 14 – 16 days
Mumps RNA myxovirus 14 – 21 days
Measles RNA paramyxovirus 10 – 14 days
Rubella RNA togavirus 14 – 21 days
Influenza Orthomyxovirus 18 – 72 hours
Diphtheria Corynebacterium 2 – 6 days
diphtheriae
Pertussis Bordetella pertussis 7 – 14 days
Meningococcal Neisseria meningitidis 3 – 4 days
meningitis
SARS Corona virus 3 – 5 days
Tuberculosis Mycobacterium Weeks – years
tuberculosis
Polio Poliovirus 7 – 14 days
Hepatitis A Enterovirus 72 15 – 45 days
Hepatitis B Hepadna virus 45 – 180 days
Hepatitis C Hepacivirus 30 – 120 days
Cholera Vibrio cholerae 1 – 2 days
Typhoid Salmonella typhi 10 – 14 days
Staphylococcal food Staphylococcus aureus 1 – 6 hours
poisoning
Ascariasis Ascaris lumbricoides 2 months
Ankylostomiasis Ankylostoma duodenale 5 weeks – 9 months
Malaria Plasmodium vivax 8 – 17 days
Plasmodium falciparum 9 – 14 days
Plasmodium malariae 18 – 40 days
Plasmodium ovale 16 – 18 days
Lymphatic filariasis Wuchereria bancrofti 8 – 16 months
Rabies Lyssavirus type 1 3 – 8 weeks
Yellow fever Flavivirus fabricus 2 – 6 days
Japanese encephalitis Group B arbovirus 5 – 15 days
KFD Arbovirus 3 – 8 days
Chikungunya Arbovirus 4 – 7 days
Leptospirosis Leptospira interrogans 4 – 20 days
Bubonic plague Yersinia pestis 2 – 7 days
Pneumonic plague Yersinia pestis 1 – 3 days
Septicaemic plague Yersinia pestis 2 – 7 days
Scrub typhus Orientia tsutsugamushi 10 – 12 days
Q fever Coxiella burnetti 2 – 3 weeks
Taeniasis T.solium , T.saginata 8 – 14 weeks
Leishmaniasis L.donovani 1 – 4 months
Trachoma Chlamydia trachomatis 5 – 12 days
Tetanus Clostridium tetani 6 – 10 days
Yaws Treponema pertenue 3 – 5 weeks
AIDS HIV Months – 10 years
Swine flu H1N1 type A influenza 1 – 7 days
Crimean congo fever Nairovirus 1 – 9 days

Table – 22 Period of communicability

Diseases Isolation period

Chicken pox 1 – 2 days before to 4 – 5 days after appearance of
rash
Mumps 4 – 2 days before to 7 days after appearance of rash
Measles 4 days before to 5 days after appearance of rash
Rubella 7 days before to 7 days after appearance of rash
Influenza 1 – 2 days before to 1 – 2 days after appearance of
rash
Diphtheria 14 – 28 days from disease onset
Pertussis 7 days after exposure to 3 weeks after paroxysmal
stage
Meningococcus Until absent of throat and nasal discharges
Poliomyelitis 7 – 10 days before and after onset of symptoms
Hepatitis A 2 weeks before to 1 week after onset of jaundice
Hepatitis B Till disappearance of HBsAg & appearance of anti
HBs

Table – 23 Vertical transmission of diseases

I trimester II III trimester During At any trimester

trimester delivery
Varicella Parvo virus Syphilis Hepatitis C CMV
Rubella Toxoplasmosis HIV
Hepatitis B

Table – 24 Diseases transmitted by needle stick injury

Bacteria Virus Parasite Fungi

Tuberculosis HIV Malaria Blastomycosis
Brucellosis Hepatitis B & C Cryptococcosis
Syphilis Ebola virus
Leptospirosis Herpes simplex
Diphtheria Varicella zoster
RMSF

Table – 25 Epidemiological methods

Type of epidemiological studies Unit of study

Observational Descriptive studies
studies ( Hypothesis
formulation )
Analytical studies Cohort study Individual
( Hypothesis testing Case control study Individual
)
Cross sectional Individual
study
Ecological study Population

Experimental studies Randomised Patients

( Hypothesis confirmation ) control trials
Field trial Healthy people
 Community trial Community
Clinical trial Patients

Table – 26 Framework of screening test

Screening test Diseased Not diseased Total

results
Positive a (True positive) b (False positive) a+b
Negative c (False negative) d (True negative) c+d
Total a+c b+d a+b+c+d

Table – 27 Evaluation of screening test

Tests Formula Inference

Sensitivity a/(a+c) x To identify correctly all those who
( Statistical index of 100 have the disease
diagnostic accuracy )
Specificity d/(b+d) x To identify correctly all those who do
100 not have the disease
Positive predictive value a/(a+b) x To identify correctly all those who
100 have disease , out of all those who
test positive on a screening test
Negative predictive value d/(c+d) x To identify correctly all those who do
100 not have disease , out of all those
who test negative on a screening test
Percentage of false b/(b+d) x Higher the specificity , few will be the
positives 100 number of false positives
Percentage of false c/(a+c) x Lower the sensitivity , higher will be
negatives 100 the number of false negatives

Table – 28 Important ranges in public health

Parameters Range
Correlation coefficient ( r ) -1 to +1
Coefficient of determination ( r2) 0 to +1
Physical quality of life index 0 to 100
Human development index 0 to +1
Probability 0 to +1
Sensitivity 0 % < Sensitivity < 100 %
Specificity 0 % < Specificity < 100 %
Positive predictive value 0 % < PPV < 100 %
Negative predictive value 0 % < NPV < 100 %
Table – 29 Group approach to Health Education

Approaches Components of Salient features

to Health each group
Education
Chalk and Group size < 30 ; Combine with flip charts , flannel graphs ,
Talk method Talk duration < 15 exhibits , films & charts
– 20 minutes Most economical method
Passive learning
Do not stimulate thinking or problem
solving capacity
Demonstrations Group of Carefully planned presentation to show
audience with how to perform a skill or procedure
1 demostrator Step by step demo performed in front of
audience
Based on seeing is believing and
Learning by doing
High motivational value
Group Group size 6 – 12 Aggregation of people discussing in face
discussion members to face situation
including 1 group Effective to change health behavior and
leader and 1 attitudes
recorder Unequal participation
Panel Comprises a 4 – 8 persons who are qualified to talk
discussion chairman or about the topic sit and discuss a given
moderator , 4 – 8 problem /topic in front of a target group
expert speakers or audience
Extremely effective method of education
Passive audience
Symposium Chairman , Series of speeches /lectures on a selected
Presentors and subject
small group of Each person presents an aspect briefly
audience No discussion among symposium
members
Audience may raise questions in the end
Chairman makes a comprehensive
summary at the end of symposium
Good tool for integrated teaching
Workshop Series of meetings Emphasis is on individual work within
usually >4 , the group to impart training
Total workshop Help sought from consultants and
may be divided resource personnel
into smaller Individuals solve a problem through
groups personnel effort with help of consultants
,contribute to group work and group
discussion and leave workshop with
concrete suggestions and a plain of action
on problem
Role playing Demostrator , Situation is dramatized by a group
Audience not > 25 Actively involved audience can suggest
alternative solutions at request of leader
Followed by discussion of the problem
Conferences Contains a large component of
& Seminars commercialized continuing education
Usually held on a regional , state or
national level
½ day to 1 week in length
 May cover a single topic in depth or be
broadly comprehensive
Use variety of teaching formats : self
instruction to mass media

Table – 30 Health planning committees in India

Health planning Year Features

committees
Bhore committee 1946 Short term 1 PHC per 40,000 population , 30
( Health survey & beds , 3 subcenters and 2 medical
development officers
committee ) Long term Primary health units with 75
bedded hospital per 10,000 –
20,000 population ;
Secondary health units with 650
bedded hospitals ;
Regionall health units with 2500
beds
Prepare social physicians
Mudaliar 1962 1 PHC per 40,000 population maximum
committee Constitution of All India Health Service
( Health survey &
planning
committee )
Chadah committee 1963 Maintenance phase of NMEP
Vigilance operations of NMEP should be
responsibility of general health services
1 basic health worker per 10,000 population
FP health assistants to supervise 3 – 4 basic
health worker
Mukerji 1965 Delink malaria activities from family planning
committee Separate staff for FP programme
Mukerji 1966 Basic health service provided at block level
committee

Jungalwalla 1967 Unified cadre , Common seniority , Recognition

committee of extra qualification , Equal pay for equal work ,
( Committee on Special pay for specialized work , No private
Integration of practice and good service conditions
Health Services )
Kartar Singh 1973 1 PHC for 50,000 population
committee 15 – 16 subcenters each for 3000 to 3500
( Committee on population
Multipurpose
Workers under ANMs to be replaced by Female Health Workers
Health and Family Basic health workers , Vaccinators , Malaria
Planning ) surveillance workers , Health education assistants
, FP health assistants to be replaced by Male
health workers
1 male health supervisor per 3 - 4 male health
worker and 1 female health supervisor per 3 - 4
 female health worker
Shrivastava 1975 Create bands of para professionals and semi
committee professional health workers from within the
( Group on country
Medical Education Established two cadre of health workers – Multi
& Support purpose workers and Health Assistants
Manpower )
Development of Referral services complex
Establishment of Medical and Health Education
Commission
ROME scheme
Village health guide scheme
3 tier rural health infrastructure
Krishnan 1983 Urban revamping scheme
committee
Bajaj committee 1986 Formulation of National Medical and Health
Education policy
Formulation of National Health Manpower
Policy
Education Commission
Health Manpower Cells
High Level Expert Planning Universal health coverage - 3⅟2 years MBBS course
Group commission for serving rural population
recommendations of India ,
2010 Rural doctors called Community Health
Officers
3⅟2 years degree given – B.Sc Community Health