By Dr Bakhtawar Saleem (Diclofenac Sodium)
EXAMPLES OF HYPERSENSITIVITY TYPE IV:
( MeGa PC ) Multiple sclerosis. Mantoux test. Graft vs host disease. Guillain-Barre syndrome PPD. Contact dermatitis.
EXAMPLES OF TYPE II HYPERSENSITIVITY: (A BIG Red APPlE) Autoimmune hemolytic anemia. Bullous pemphigoid. Idiopathic thrombocytic purpura. Goodpasture syndrome. Myasthenia GRAVIS. Rheumatic fever. Acute hemolytic transfusion reactions. Pernicious anemia. Pemphigus vulgaris. Erythroblastosis fetalis
EXAMPLES OF TYPE III HYPERSENSITIVITY: (PASS) Polyarteritis nodosa. Poststreptococcal glomerulonephritis. Arthus reaction. Serum sickness. SLE.
B27 HLA ASSOCIATED WITH: (PAIR) Psoriatic arthritis. Ankylosing spondylitis. Inflammatory bowel disease arthritis. Reactive arthritis / Reiter syndrome.
ENCAPSULATED ORGANISMS: (SHiNE SKiS) Streptococcus pneumoniae. Haemophilus influenza. Neisseria meningitis. E.coli. Salmonella. Klebsiella. Streptococci (Group B)
CUSHING SYNDROME FEATURES: ( CUSHINg SyndROME) Central obesity. Cataract. Ulcer (Peptic) Subclavicular fat and buffalo hump. Hypertension. Hyperglycemia. Hypernatremia. Hypokalemia. Hirsutism. Immunosuppression. Infection. Impaired wound healing. Neutrophils increase. Straie. Round face. Osteoporosis Other (Acne, psychosis) Menstrual abnormalities. Esinophils and lymphocytes decrease.
IMMUNO-SUPPRESSANTS: (CAT BeRG) Cyclosporine. Azathioprine. Tacrolimus. Basiliximab. Rapamycin (Sirolimus) Glucocorticoids.
CYCLOSPORINE SIDE EFFECTS: (NiGHT) Nephrotoxic. Gingival hyperplasia. Hypertension. Hyperglycaemia. Hyperlipidemia. Hirsutism. Tremors.
LEUKOCYTE ADHESION DEFICIENCY: (RIDA) Recurrent bacterial infection. Increased neutrophils. Impaired chemotaxis and migration of neutrophils. Delayed wound healing. Delayed separation of umbilical cord. Absent neutrophil at site of infection. Absent pus formation.
CHEDIAK HIGASHI SYNDROME FEATURES: (PANI) Peripheral and cranial neuropathy. Pancytopenia. Albinism. Abnormal WBCs. Abnormal microtubule formation. Neutropenia. Neutrophils and platelets have giant granules. Infections (Recurrent). Impaired chemotaxis and migration. Impaired lysosomal fusion.
CATALASE POSITIVE ORGANISMS: (PLACES) Pseudomona. Listeria. Aspergillus. Candida. E.coli. S. Aureus. Serratia.
Most common tumor of oral cavity – SCC. Most uncommon tumor of oral cavity – Basal cell carcinoma. Most common benign tumor of oral cavity – Fibroma. Most common cyst of oral cavity – Radicular cyst. Most aggressive cyst of oral cavity – Dentigerous cyst. Cyst with high recurrence rate – Odontogenic keratocyst. Most common salivary gland involved in tumor – Parotid gland. Mixed tumor of salivary gland most commonly arise in – Parotid gland. Acinic cell tumor arise in – Parotid gland. Facial paralysis due to tumor of – Parotid gland. Most common malignant salivary gland tumor of children – Mucoepidermoid carcinoma. Most common salivary gland malignancy of palatal region – Adenoid cystic carcinoma. Bakhtawar Saleem.
HEPATITIS: Only hepatitis virus that can be cultured – HAV. Most common hepatitis – Hepatitis A. Least incidence of death – Hepatitis A. Common hepatitis in pregnancy – Hepatitis A. Lethal hepatitis in pregnancy – Hepatitis E. Infection most likely spread in dental OPD from patient to surgeon – Hepatitis B. Polyarteritis nodosa associated with – Hepatitis B. Perinatal transmission – Hepatitis B. Acute and chronic liver injury – Hepatitis B. Hepatocellular carcinoma – Hepatitis B > Hepatitis C. Liver cirrhosis – Hepatitis C. Increase chronic carrier stage – Hepatitis C. Post transfusion viral hepatitis – Hepatitis C. Most common cause of fatty liver in our society – Hepatitis B and C / Viral hepatitis. Hepatitis with most mortality – Hepatitis D. Bakhtawar Saleem.
EDWARD SYNDROME FEATURES: (CRIMP) Congenital heart disease. Rocker bottom feet. Index finger overlaps third and fourth. Mental retardation. Micrognathia. Prominent occiput. E = Edward, E = Eighteen (Trisomy 18). Bakhtawar Saleem.
PATAU SYNDROME FEATURES: (CRAMP) Congenital heart disease. Cleft lip and palate. Rocker bottom feet. Abnormalities of brain and kidney. Mental retardation. Microcephaly. Micropthalmia. Polydactyly. Bakhtawar Saleem.
ANGEL MAN SYNDROME / HAPPY PUPPET SYNDROME FEATURES: (MAASI) Mental retardation. Ataxia. Alteration of gene involved in ubiquitin proteasome pathway. Seizures. Inappropriate laughter. Bakhtawar Saleem.
NEUROFIBROMATOSIS TYPE 1 FEATURES: (My CLIPS) Multiple neurofibromas. Mutation of NF1 gene. Most common tumor associated with it is optic nerve glioma. (MCQ) Cafe-au-lait spots. Can become malignant. Lisch nodules (Iris hemartoma). Increased incidence of tumors (Wilms tumor, Leukemia, Fibrosarcoma, Rhabdomyosarcoma). Phoechromocytoma. Skeletal disorders (Scoliosis, Bone cysts). Bakhtawar Saleem.
NEUROFIBROMATOSIS TYPE II FEATURES: (BESt MAN) Bilateral schwannomas of vestibular nerve. Ependymoma. Subcapsular lens opacity. Meningioma. Mutation of NF2. Astrocytoma. Neurofibroma doesn’t occur. Bakhtawar Saleem.
TUBEROUS SCLEROSIS FEATURES: (GRAMS) Glial nodules and distorted neurons. Rhabdomyoma. Renal angiomyolipoma. Adenoma sebaceum. (MCQ) Mutation of TSC or TSC1. Mental retardation. Seizures. SEGA (Subependymal giant cell astrocytoma). Bakhtawar Saleem.
VON HIPPEL-LINDAU DISEASE FEATURES: (HIPPEL) Hemangioblastoma/Cavernous hemangioma of cerebellum, brainstem, and retina. Increased incidence of renal cell carcinoma (Deletion of short arm of chromosome 3). Phoechromocytoma. Port – wine stains. Eye dysfunction. Liver, kidney, and pancreas cysts and adenoma. Bakhtawar Saleem.
NIEMANN-PICK DISEASE FEATURES : (SHiFA CD) Sphingomyelinase deficiency. Sphingomyelin accumulation (Type A and B), Cholesterol accumulation (Type C). Hepatosplenomegaly. Foamy histiocytes. Fever. Anemia. CNS degeneration. Cherry red spot in macula (50%) Death by 3 years of age. Bakhtawar Saleem.
HURLER SYNDROME: (AH! DaMaGES) Alpha-L-Iduronidase deficiency. Heparin sulfate, dermatan self ate accumulation. Hepatosplenomegaly. Dwarfism. Death by 10 years of age. Mental retardation. Gorgoyle – like faces. Eye clouding. Stubby fingers. Similar to Hunter syndrome. Bakhtawar Saleem.
GAUCHER DISEASE FETAURES: (GAuCHEr Disease) Glucocerebrosidase deficiency. Glucocererebroside accumulation. Gaucher cells. Anemia. ACE and chitotriosidase increased. Ashkenazi and Jewish descent most commonly affected. CNS involvement (Type II) CNS + Visceral involvement (Type III) (Less severe than type II) Hepatosplenomegaly. Erosion of femoral head and long bones. Death occurs before one year (Type II). Bakhtawar Saleem.
CRI DU CHAT SYNDROME FEATURES: (HER MaD Little Cat) Hypertelorism. Hypotonia. Epicanthal folds. Round face. Mental retardation. Microcephaly. Micrognathia. Delayed development. Deletion of short arm of chromosome 5 (5p-) Low set ears. Low birth weight. Cat like cry. Bakhtawar Saleem.
PHENYLKETONURIA FEATURES : (ProBLEMS) Phenyalanine hydroxylase deficiency. Phenylpyruvic acid and Phenylacetic acid accumulation. Phenylalanine free diet should be given. Blue eyes, Blond hair. Lack of essential amino acids. Enamel hypoplasia. Early screening gives false positive results. Mental retardation. Mousy or musty body odor. Seizures. Screening tests done on 3rd or 4 Rd day of life. (Di – nitro – phenyl hydrazine). Bakhtawar Saleem.
ALKAPTONURIA FEATURES: (Hi DOC) Homogentisic oxidase deficiency. Homogentisic acid accumulation. Dark pigmentation of cartilage and fibrous tissues. Ochronosis (Dark colored urine on standing) Ochronotic arthritis. Cardiac value involvement. Bakhtawar Saleem.
MAPLE SYRUP URINE DISEASE FEATURES : (MAPLe) Maple syrup odor in urine. Mental and physical retardation. Alpha keto acid dehydrogenase deficiency. Problems with feeding. Protein modified diet should be given. Leucine, isoleucine, valine in urine. Bakhtawar Saleem.
CYSTIC FIBROSIS FETAURES: Cystic FIBRoSIS to Papa & Mama: CFTR gene mutation. Failure to thrive. Increased secretion of chloride in sweat. Impaired reabsorption of chloride and sodium by sweat glands. Increased viscosity of mucous. Bronchitis. Bronchiectasis. Recurrent pneumonia. Retention of mucous. Secondly infection. Infection with pseudomona auruginosa. (Cause of death) (MCQ) SIM tests (Sweat tests, Immunoreactive tyrosine assay, molecular tests). Pancreatic insufficiency. Protective effect against cholera. Muconium ileus. Malfunction of exocrine glands. Bakhtawar Saleem.
TAY-SACH DISEASE FEATURES: (TAY-SACH) Tests recommended. Accumulation of GM2 gangliosides. Young death (before 4 years). Severe mental retardation. Amaurosis. Ashkenazi and Jewish descent most commonly affected. Cherry red spot in macula. Hexosaminidase A deficiency. Heterozygotes have protective effect against TB. Bakhtawar Saleem.
TURNER SYNDROME FEATURES: (RIDA SAW A CLIP) Replacement of ovaries by fibrous streaks. Identification by karyotype. (MCQ) Increased gonadotropins. Decreased estrogen. Auto antibody mediated hypothyroidism. Short stature. Shield like chest. Webbed neck. Widely placed nipples. Wide carrying angle of arms. Amenorrhoea. Coarctation of aorta. Congenital malformations. Lymph edema of neck and extremities. Infantile genitalia. Poor breast development. Bakhtawar Saleem.
KLINEFELTER SYNDROME FEATURES : (MIND + GUT) Maternal meiotic non disjunction is cause. Most common cause of male infertility. Increased gonadotropins. No or little mental retardation. Decreased testosterone. Diagnostic feature is barr body. (MCQ) Gynaecomastia. Undiagnosed before puberty. Testicular atrophy. Tall stature. Bakhtawar Saleem.
DOWN SYNDROME FEATURES: (My CHILD HAS a PROBLEM) Mental retardation. Cataract. Congenital heart disease. (Defects of endocardial cushion, ASD, VSD). Curved 5th finger. Hypertelorism. Hyperthyroidism. Infections. Increased incidence with Maternal age. Large forehead. Low nasal bridge. Loss of hearing. Duodenal atresia. Delayed development. Hirshsprung disease. Hypotonia. Alzheimer disease. (>40 years) Alantoaxial stability. Small folded ears. Short broad hands. Short neck. Squint. Simian crease. Space between first and second toe. Protruding tongue. Rolling eyes. Round face. Oblique eye fissure. Occiput flat. Brush field spots. Behavioural difficulties. Language problem. Lung problems. Lymphoblastic Leukemia. Epicanthic folds. Myoclonus. Bakhtawar Saleem.
CARCINO-EMBRYONIC PROTEIN associated with: (BiG CaMP) Breast cancer. Gastric cancer. Colorectal carcinoma. (MCQ) Medullary thyroid cancer. Pancreatic cancer. Bakhtawar Saleem.
A-FETOPROTEIN associated with: (Hey You GiANT) Hepatocellular carcinoma. Hepatoblastoma. Yolk sac tumor. Germ cell tumor. Anaencephaly. Neural tube defects. Testicular cancer. Bakhtawar Saleem.
TUMORS CAUSED BY HYPERCALCEMIA: (SHaBiR) Small cell carcinoma of lung. Hodgkin and non hodgkin lymphoma. Breast cancer. Renal cell carcinoma. Bakhtawar Saleem.
SITES OF METASTASIS OF BRAIN: (Let’s Break Gate. OMG!) Lung > breast > Genitourinary > Osteosarcoma > Melanoma > GI. Bakhtawar Saleem.
SITES OF METASTASIS OF LIVER: (Call Some People!) Colon > Stomach > Pancreas. Bakhtawar Saleem.
SITES OF METASTASIS OF BONE: (Please, Let’s Talk!) Prostate / Breast > Lung > Thyroid. Bakhtawar Saleem.
MITRAL STENOSIS: (DOLLARS) Delayed rumbling late diastolic murmur. Opening snap. Left atrial dilation. (Chronic) LA > RA pressure during diastole. LA return (increased) increases intensity. Apex (Best heard). Rheumatic fever (Cause). S2 and opening snap interval decreases with increased severity. Bakhtawar Saleem.
MITRAL REGURGITATION: (MItRaL HAlT) MItRaL: Mitral valve prolapse, Ischemic heart disease, Infective endocarditis, Rheumatic fever, LV dilation (Causes). HAlT: Holosystolic high pitched blowing murmur. Apex (Best heard) Axilla (Radiates) TRP (increased) increases intensity. Bakhtawar Saleem.
AORTIC STENOSIS: (CLiPS) Crescendos decrescendo murmur. Carotids (Radiates) Calcific aortic stenosis, and Bicuspid aortic exertion (Cause). Loud at base. LV > Aortic pressure during systole. Pulsus parvus et tardus. (Pulse weak with delayed peak). Systolic ejection murmur. Syncope, angina, exertional dyspnoea. Bakhtawar Saleem.
AORTIC REGURGITATION: (HoW BRaVE) High pitched murmur. Hand grip maneuver increased intensity. Wide pulse pressure (Chronic). Bounding pulse + head bobbing. Bicuspid aortic valve, Rheumatic fever, Aortic root dilation, endocarditis (cause) (BRAvE) Vasodilators decrease intensity. Early diastolic murmur. Bakhtawar Saleem.
PATENT DUCTUS ARTERIOSIS: (PLuMS) Prematurity or congenital rubella (Cause) Left infraclavicular area (Best heard). Machine like murmur. S2 (Loudest). Bakhtawar Saleem.
VENTRICULAR SEPTAL DEFECT: (THAP) Tricuspid area (Loudest) Holosystolic harsh sounding murmur. Hand grip maneuver increased intensity due to increased Afterload. Pan systolic murmur. Bakhtawar Saleem.
MITRAL VALVE PROLAPSE: (BRAVe PLuM) Benign. Before s2 (loudest). Rheumatic fever, myxomatosis degeneration, chordae rupture (cause). Apex (Best heard) Venous return (decreased) increases intensity. Predispose to infective endocarditis. Late systolic murmur. Mid systolic click. Most common valvular lesion. Bakhtawar Saleem.
Diarrhea improves on fasting – Osmotic diarrhea. Diarrhea after jejunostomy – Osmotic diarrhea. Most common malaria – P.Vivax. Most severe malaria – P.Falciparum. 2/3 TBW – ICF. 1/3 TBW – ECF. Fastest conducting fibers – A alpha. Fast pain conducted by – A delta. Cervical dysphasia – Multiparity. Cervical metaplasia – IUCD. Highest amount of triglycerides – Chylomicrons. Highest amount of protein – HDL. Highest amount of cholesterol – LDL. Factor VIII deficiency – Cryoprecipitate given. Factor IX deficiency – FFP given. Antibodies produced by – Plasma cells. Antibodies produced in – Spleen. Gum bleeding – Vitamin C deficiency. Gum bleeding + Jaundice – Vitamin K deficiency. Natural Anticoagulant – Heparin. Natural Antithrombotic – Plasminogen. Border of heart formed by – Right atrium. Border of heart on XRAY is formed by – Right atrium + SVC > SVC. First heart sound produced by – Closure of AV valves. Second heart sound produced by – Closure of Semilunar valves. Collagen giving strength to scar tissue – Type 1. Collagen giving strength to wound – Type 3. Collagen present in dermis – Type 1. Collagen in PDL – Type 1. Collagen in dentine – Type 1. Acidic and neutral drug binds to – Albumin. Basic drug binds to – Alpha glycoprotein. Primary ossification centre – Diaphysis. Secondary ossification centre – Epiphysis. Highest energy compound – ATP. Highest energy content – Starch. Highest energy source – Fat. Mnemonic – Since S comes before W, so scar tissue (Type 1 collagen) and wound (Type 3 collagen). A comes before S, so S1 (AV valves), S2 (Semi lunar valves) OR S = Second, S = Semilunar. Since D comes before E, so Diaphysis (Primary) and Epiphysis (Secondary). Bakhtawar Saleem.
COMMONLY ASKED SIDE EFFECTS OF DRUGS: ACE inhibitors – Hyperkalemia, Renal artery stenosis. Acetylcholine – Overdose causes lacrimation. Alcohol – Teratogenic. Amikacin – Nephrotoxic. Amiodarone – Hepatic granuloma. Anti-psychotics – Impotency. Anti-hyperlipidemic drug therapy – GI disturbance. Aspirin – Respiratory depression. Atropine – Dryness of mouth. Biguanides – Diarrhea amd flatulence. Bupivacaine – Most toxic L.A, mycardial toxicity, cardiovascular collapse. Carbamazepine – Induce p450. Cimetidine – Inhibit p450. Chloramphenicol – Bone marrow suppression. Chloroquine – Corneal opacity. Chlorpromazine – Parkinsonism. Chlorthiozide – Increase digoxin toxicity. Clindamycin – Pseudomembranous colitis. Clonidine – Postural hypotension. Corticosteroids – Fractures, Osteoporosis. Decreased peripheral glucose utilization. Digoxin – Cardiac arrhythmia. Dipyridamole – Inhibit platelet activity. Estrogen – Thromboembolism. Ethambutol – Color blindness. Ethyl alcohol – Aphrodisiac. Ganglionic blocking drugs – Urinary retention, constipation. Guanethidine – Failure of ejaculation. Haloperidol – Aggravate parkinsonism. Hydrochlorothiazide – Hypercalcemia, Hypokalemia, Increase digoxin toxicity. Hyosine – Sedation. Lithium – Cardiac malformations in fetus. Meccamylamine – Toxicity causes choreiform movements. Metoclopramide – Extrapyramidal side effects. Morphine – Emesis, Respiratory depression, Reflex tachycardia. Metformin – Metallic taste, Diarrhea. Methyldopa – Depression. Methylsergide – Retroperitoneal fibrosis. Minoxidil – Overdose causes pericardial effusion. Nicotine – Nausea & vomiting. Nifedipine – Poatural hypotension. Nitroglycerin – Headache. Opioids – Respiratory depression. Paracetamol – Grave 4 hepatic encephalopathy. Phenobarbitone – Induce P450. Phenothiazide – Corneal opacity, Lethargy. Phenoxybenzamine – Postural hypotension, Tachycardia. Phenylbutazone – Aplastic anemia. Phenytoin – Gingival hyperplasia, Granulocytopenia, Hirsutism, Induce P450, Hypertrichosis, Cleft palate. Practolol – Sclerosing peritonitis. Prilocaine – Methemoglobinemia. Propranolol – Bradycardia, Nightmares, Sedation, Disturbed sleep, Lethargy, Depression. Pyrazinamide – Hyperuricemia. Rifampin – Dark urine, Thrombocytopenia. Sulfonamide – Kernicterus, Steven Johnaon syndrome. Spironolactone – Gynecomastia. Streptomycin – Impaired hearing. Succinylcholine – Malignant hyperthermia. Sulbutamol – Tachycardia. Suxamethonium – Hyperkalemia. TCA – Overdose causes seizures. Thalidomide – Teratogenic. Trimethaphan – Urinary retention. Theophylline – Nausea and vomiting. Valproic acid – Hepatotoxicity, Coagulation disorder, Flexing tremors. Bakhtawar Saleem.
Monotherapy for mild CCF – Captopril. Angina pectoris – Propranolol. Variant angina – Nitroglycerin. Prinzmetal angina – Diltiazem. Paroxysmal supraventricular tachycardia – Propranolol. Supraventricular arrhythmia – Quinidine. Ventricular tachycardia – Lidocaine. Narow complex tachycardia – Adenosine. Tachycardia + Thyrotoxicosis – Propranolol. Atrial fibrillation – Digoxin. Atrial fibrillation + thyrotoxicosis – Beta blocker. HTN + Diabetes – Captopril. HTN + Asthma – Varapamil. Essential HTN – ARBs. Adrenaline induced HTN – Prazocin. Hypertensive obstructive cardiomyopathy – Varapamil. Ventricular failure + Respiratory distress – I/V Frusemide. CCF + Lung crepitations – Frusemide. Acute pulmonary edema – Frusemide. Ulcerative colitis – IV Corticosteroids. Nausea and vomiting – Cyclizine. Mountain sickness – Acetazolamide. Motion sickness – Hyosine butyl bromide. Atropine overdose – Physostigmine. Mushroom poisoning – Atropine. Salicylate poisoning – NaHCO3. Digoxin toxicity – Potassium chlorate. Opioid toxicity – Naloxone. Morphine poisoning – Naloxone. Morphine addiction – Methadone. Cancer – Morphine + Paracetamol. Biliary colic – Morphine + Pethidine. Asthma – Salbutamol. Absence seizure / Petitmal seizure – Ethosuximide. Eclampsia – MgSO4. Diabeties in pregnancy – Insulin. Hyperthyroidism in pregnancy – PTU. Hypertension in pregnancy – Methyldopa. MS in pregnancy – I / V Heparin. DVT in pregnancy – Heparin. Hypertension in pre eclamptic patient – Hydralazine. Phoechromocytoma – Alpha and beta blocker. Drug induced Parkinsonism – Anticholinergic. Rhinorrhea – Cetirizine. Acute pancreatitis – Pethidine. Recurrent MI – Anticoagulant. Breast cancer – Tamoxifen. Eclampsia – MgSO4. Nocturnal enuresis – TCA. Hirsutism – Antiandrogens. Secondary amenorrhea – Bromocriptine. Prevention of endometrial carcinoma – Estrogen + Progesterone. Vaginal bleeding – Ergometrine. Iron deficiency anemia – IV Iron dextran. Drug induced Parkinsonism – Benzhexol. Schizophrenia – Chlorpromazine. Tubocurare induced muscle paralysis – Neostigmine. Muscle relaxant in asthmatics – Suxamethonium Muscle relaxant in impaired renal functiom – Atracurium. Nasal congestion – Phenylephrine, Ephiderine. Bronchospasm – Ephiderine. Metastatic carcinoid – Octreotide. Sarcoilitis – Indomethacin. Migraine – Ergotamine. Anaphylactic shock – Adrenaline. Narcolepsy – Amphetamine. BPH – Phenoxybenzamine. Myasthenia gravis – Neostigmine. Glaucoma – Sympathomimetics. Hyperkalemia – Calcium gluconate. Metastatic pleural effusion – Bleomycin. Paget’s disease – Calcitonin. Gastroparesis – Metoclopramide. Newly diagnosed diabetes – Biguanides. Hyperosmolar coma – Regular insulin. Cerebral edema – Mannitol. Acute pancreatitis – Pethidine. Sub arachnoid hemorrhage – Nimodipine. Tape worm infestation – Niclosamide. Hartnup disease – Nicotinamide. Acute gout – Indomethacin, NSAID, Colchicine. HIT – Lepirudin. Chronic alcoholism – Diazepam. Fractures – Bupivacaine. Breast cancer – Tamoxifen. Calcium stone – Thiazide diuretics. Hypercalcemia – Frusemide. Gas gangrene – Penicillin. Beta hemolytic streptococcal pharyngitis – Benzathine pencillin. Pulmonary anthrax – Ciprofloxacin. Micturition + UTI – Ciprofloxacin. Legionaire’s disease – Erythromycin. Infants with RF – Neomycin. Systemic fungal infection – Amphotericin B. Candida infection – Griseofluvin. Herpes simplex keratitis – Trifluridine. Herpes simplex infection – Acyclovir. Pseudomona infection – Ceftazidime. ITP – Corticosteroids. Bakhtawar Saleem.
CONTENTS OF INFRATEMPORAL FOSSA: (COMP) Chorda tympani. Otic ganglion. Mandibular nerve. Maxillary artery. Medial and lateral pterygoid. Pterygoid venous plexus. Bakhtawar Saleem.
AUTOSOMAL DOMINANT DISORDERS: (He’s VeRy DOMINANT) Hereditary spherocytosis. Hereditary elliptocytosis. Hereditary hypercholesterolemia. Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome). Hereditary non poliposis coli. Hereditary obstructive cardiomyopathy. Hypothyroidism (Pseudo). Huntington disease. Von willebrand disease. Von hippel lindau disease. Retinoblastoma. Dystrophia myotonia. Dentinogenesis imperfecta. Achondroplasia. Osteogenesis imperfecta. Marfan syndrome. Intermittent porphyria. Noonan syndrome. Adult polycystic kidney disease. Amelogenesis imperfecta. Neurofibromatosis type 1 (Von Recklinghausen disease). Neurofibromatosis type 2. Tuberous sclerosis. Bakhtawar Saleem.
AUTOSOMAL RECESSIVE DISORDERS: (HE Got FAINT in CLASS X) Hemochromatosis. Homocysteinurea. Ehler-danson syndrome. Emphysema. Glycogen storage disease (Type 1 Glycogenosis (Von Gierke disease / Hepatorenal glycogenosis), Type 2 Glycogenosis (Pomps disease), Type 3 Glycogenosis (Cori disease), Type 4 Glycogenosis (McArdle disease)). Fanconi’s anemia. Friedreich ataxia. Albinism. Alpha1-antitrypsin deficiency. IL-12 receptor deficiency. Neurogenic muscle atrophy. Thalassemia. Carbohydrate metabolism disorders (Galactosemia). Lysosomal storage diseases (Taysach disease (Amaurotic familial idiocy), Gaucher disease, Niemann pick disease, Hurler syndrome). Adrenal hyperplasia. Amino acid metabolism disorders (Phenylketonuria, Alkaptonuria, Cystic fibrosis, Maple syrup urine disease). Sickle cell anemia. Spinal muscle atrophy. Xeroderma pigmentosum. Bakhtawar Saleem.
X – LINKED RECESSIVE DISORDERS (He Got FAint in Day Light) Hemophilia A. Hunter syndrome. G6PD deficiency. Fabry’s disease. Fragile X syndrome. Agammaglobinemia (Bruton). Duchenne muscular dystrophy. Lesch-Nyhan syndrome. Ectodermal dysplasia. Bakhtawar Saleem.
HYPOTHALAMUS: (THe CRAB) Temperature regulation. Thirst and food intake. H20 balance. Homeostasis. Circadian rhythm. Reproductive system. Autonomic system. Anterior pituitary regulation. Behaviours. Bakhtawar Saleem.
WISKOTT-ALDRICH SYNDROME FEATURES: (wATER) Autoimmune disease and malignancy.(increased risk). Thrombocytopenic purpura. Eczema. IgE and IgA decrease. Recurrent Infections. Bakhtawar Saleem.
BRUTON AGAMMAGLOBINEMIA FEATURES: (all B) B cell maturation defect. Bacterial and enteroviral Infections after 6 months. B cell count and CD19 normal. Pro B and Ig decreased. Bakhtawar Saleem.
DIGEORGE SYNDROME (THYMIC APLASIA) FEATURES: (CATCH 22) Cardiac abnormalities. Conotruncal abnormalities. Abnormalities of face. T cell deficit. Thymic and parathyroid hypoplasia/absent. Third and fourth pharyngeal pouches fail to develop. Cleft palate. CXR – No thymic shadow. Hypocalcemia. (Tetany). Hypothyroidism. Deletion of 22q11. Bakhtawar Saleem.
HYPERIMMUNOGLOBULIN E SYNDROME FEATURES: ( FATE) coarse FACES. ABSCESS (cold staphylococcal) retained primary TEETH ECZEMA IgE increased. Bakhtawar Saleem.
C3 (Three) deficiency: Increase susceptibility to type 3 (Three) hypersensitivity reactions C5-C9 deficiency deficiency: Neisseria bacteraemia. (N=Nine, N=Neisseria). Bakhtawar Saleem.
RELATIONS OF KIDNEYS: RIGHT KIDNEY: ANTERIORLY: Liver. Right colic flexure. Right suprarenal gland. Second part of duodenum. POSTERIORLY: (TIPS DC) Twelfth rib. Iliohypogastric and ilioinguinal nerves. Psoas and quadratus lamborum muscle. Subcostal nerve. Diaphragm. Costodiaphragmatic recess of pleura. LEFT KIDNEY: ANTERIORLY: (CLIPS) Coils of jejunum. Left colonic flexure. Left suprarenal gland. Pancreas. Spleen. Stomach. POSTERIORLY: (TIPS DC) Twelfth rib. Transversus abdominis muscle. Iliohypogastric and ilioinguinal nerves. Psoas and quadratus lamborum muscle. Subcostal nerve. Diaphragm. Costodiaphragmatic recess of pleura. Bakhtawar Saleem.
Base of nose – C1. Hard palate – C1. Teeth – C2. Isthmus of thyroid – C2, C3, C4. Hyoid bone – C3. Mandible – C3. Larynx – C3 – C6. Carotid bifurcate – C4. Thyroid cartilage – C4, c5. Most common diseased cervical vertebrae – c5, c6. Erbs point – C5, C6. Trachea begins, esophagus begins – C6. Cricoid cartilage – C6. Vertebrae prominence – C7. Horner syndrome damage at – C8 – T1. First part of duodenum – L1. Pyloric sphincter – L1. Spinal cord in adult – L1, L2. Renal artery – L2. Spinal cord in neonates – L3. Conus medllaris – L3. Umblicus – L3, L4. Aorta bifurcate – L4. Lumbur puncture – L4, L5. Slip disc most commonly occur at – L4 L5. IVC – L5. Thoracic inlet – T1. Trachea bifurcate – T4. Angle of louis – T4. Azygous vein enter SVC – T5. Oblique fissure of lung – T6. Superior azygous join azygous – T7. Inferior azygous join azygoin. – T8. Caval openig – T8. Esophageal opening – T10. Esophagogastric junction – T11. Aortic openig – T12. Pia meter – S1. Subarachnoid space – S2. Filum terminale – S3. Rectum begins – S3. Bakhtawar Saleem.
Dense in dente – Lateral incisor. Dense evaginatus – Premolar. Mandibular tori – Premolar. Supernumerary teeth – Maxillary permanent teeth. Cementoblastoma – Mandibular first molar. Taurodontism – Mandibular first premolar. Ankylosed – Mandibular second molar. Missing teeth – Third molar > Lateral incisor > Mandibular premolar. Primordial cyst – Third molar area. Bakhtawar Saleem.
TOOTH MORPHOLOGY: Maximum M-D width among incisors – Maxillary central incisor. When viewed from proximal aspect, has greatest inclination relative to occlusal plane – Maxillary central incisor. Least likely to have divided pulp canal – Maxillary central incisor. Anterior tooth that shows variation in size – Maxillary lateral incisor. Most often retained decidous tooth – Maxillary lateral incisor. Last primary tooth to be replaced – Maxillary canine. Largest pulp chamber – Maxillary canine. Most steep cusp inclines – Maxillary first premolar. Mesial marginal groove – Maxillary first premolar. Pronounced concavity on mesial surface – Maxillary first premolar. Dentine islands – Maxillary second premolar, and Mandibular canine. Tubercle of carabelli – Palatal aspect of maxillary molar. Largest tooth in mouth – Maxillary first molar. First permanent tooth to calcify – Maxillary first molar. Closet relationship to zygomatic buttress – Maxillary first molar. Heart shaped outline from occlusal aspect – Maxillary second molar. Occupies centre of jaw anteriorly and posteriorly – Maxillary and mandibular first molar. Greatest variation in it’s root form – Maxillary third molar > Maxillary lateral incisor. Anterior tooth most likely to have bifurcated root – Mandibular canine. Smallest premolar – Mandibular first premolar. Mesiolingual groove – Mandibular first premolar. More occlusal surface can be seen from mesial than from distal in – Mandibular first premolar. Three cusps – Mandibular second premolar. More likely to have one root canal – Mandibular second premolar. Occlusal groove pattern that simulate letter Y – Mandibular second premolar. Maximum M-D width – Mandibular first molar. Primary tooth with transverse ridge – Mandibular first molar. Incisal wearing of mandibular teeth increases ratio of lingual surface crown length to the labial surface crown length in – All mandibular anterior teeth. Marginal ridge – All teeth. Bakhtawar Saleem.
Screw driver incisor – Congenital syphilis. Shell tooth – Dentinogenesis imperfecta. Ghost teeth – Odontogenesis imperfecta. Floating teeth – Cherubism. Saw tooth rete pegs – Lichen planus. Wickham striae – Lichen planus. Stag horn pattern – Hemangiopericytoma. Mosaic pattern – Osteitis deformans / Paget’s disease. Jigsaw puzzle – Osteitis deformans / Paget’s disease. Cotton wool appearance – Osteitis deformans. Ground glass appearance – Fibrous dysplasia and Hyperparathyroidism. Soap bubble apearance – Cherubism. Onion ring appearance – Ewings sarcoma. Snow driven appearance – Calcifying epithelial odontogenic tumor, Pindborg tumor. Lipschutz bodies – Herpes simplex. Verocay bodies – Schwannoma. Hyaline bodies / Rushton bodies – Apical periodontal cyst. Donovan bodies – Granuloma inguinale. Darling disease – Histoplasmosis. Cannon disease – White spong naevus. Marble bone disease – Osteopetrosis. Albers-Schonberg disease – Osteopetrosis. Disease of kings – Hemophilia. Garre’s osteomyelitis – Chronic osteomyelitis + Proliferative periostitis. Auspit’s sign – Psoriasis. Nikosky’s sign – Pemphigus vulgaris > Chronic desquamative gingivitis. Rubber man – Ehler danlos syndrome. Bulls eye – Erythema multiform. Bird face / Fish face – Pierre rubin syndrome. Parrot like nose – Craniofacial dysostosis. Cafe au lait spots – Von Recklinghausen disease. Monros abscess – Psoriasis. Corps rands anf grains – Keratosis follicularis. Reedsternberg cells – Hodgkin disease. Vesicle formation – Herpes virus infection. Bakhtawar Saleem.
IMMUNOGLOBULIN: Primary response – IgM. Secondary response – IgG. Most abundant / Highest concentration – IgG. Second most abundant – IgM. Lowest concentration / Least prevalent – IgE. Crosses placenta / Transferred from mother to fetus – IgG. Doesn’t cross placenta / Can’t transfer from mother to fetus – IgM. Smallest immunoglobulin – IgG. Largest / Highest molecular weight – IgM. Warm – IgG. Cold – IgM. Rh incompatibility – IgG. ABO incompatibility – IgM. Maximum sedimentation rate – IgM. Minimum sedimentation rate – IgG. Largest half life – IgG. Minimum half life – IgE. Maximum synthesis per day – IgA. Minimum synthesis per day – IgE. Major immunoglobulin in human serum – IgG. Most efficient – IgG. Memory function – IgG. Maximum in newborn – IgG. Receptor present on B cell – IgG. Pentameric structure – IgM. Earliest immunoglobulin synthesized by fetus – IgM. Neonatal rubella screened by measuring – IgM. Blood group antibodies belong to – IgM. Appear first in life – IgM. Mainly intravascular – IgM. T cell independent – IgM. Specific immunoglobulin receptor on surface of B cells – IgD and monomer IgM. In breast milk, tears, saliva and secretions – IgA. Referred to as “mucosal antiseptic paint” – IgA. Protects surface – IgA. Bind to mast cell – IgE. Released by mast cells – IgE. Heat labile – IgE. Bee venom immunoglobulin – IgE. Immunoglobulin involved in shivering after Penicillin injection – IgE. Bakhtawar Saleem.
ABSORPTION: Iron – Duodenum and Jejunum. Fat – Jejunum. Max water absorption – Jejunum. Long chain F.A. – Jejunum. Folate – Jejunum (Proximal). Vitamin B12 – Ileum. Bile salts – Ileum. Sodium – Colon. Short chain F.A – Colon. Mnemonic – Jejunum is LONG word, LONG chain F.A absorbed here. Colon is SHORT word, SHORT chain F.A absorbed here. Bakhtawar Saleem.
Blood supply to heart. SA node – RCA, sometimes LCA. AV node – RCA. AV bundle – RCA. Right bundle branch – LCA. Left bundle branch – RCA & LCA. RCA branches: Atrail – right atrium. Right conus – Upper part of right ventricle. Anterior ventricular – Anterior surface of right atrium. Posterior ventricular – Diaphragmatic surface of right atrium. Posterior interventricular – Right and left ventricular. LCA branches: Circumflex artery – Left atrium and left ventricle. Anterior interventricular – Right and left ventricle. Bakhtawar Saleem.
All the muscles of tongue are supplied by hypoglossal nerve except palatoglossus, which is supplied by Pharyngeal plexus.
All muscles of soft palate are supplied by pharyngeal plexus except Tensor vali palatini, which is supplied by Mandibular division of Trigeminal nerve.
All the muscles of pharynx supplied by pharyngeal plexus except Stylopharyngeus, which is supplied by Glossopharyngeal nerve. (Mnemonic – Stylopharyngeus is stylish, applies gloss).
All the muscles of larynx supplied by Recurrent laryngeal nerve except Cricothyroid, which is supplied by External laryngeal nerve.
(Cricothyroid is badtameez, didn’t join Recurrent so has been thrown outat home, that why External) tongue emoticon
All extrinsic muscles of eye supplied by Occulomotor nerve, except Superior Oblique which is supplied by Trochlear nerve and Lateral rectus which is supplied by Abducent nerve. (SO4, LR6)
MICROBIOLOGY: Ascitic tap – E.coli Peritonitis – E.coli. Pyogenic peritonitis – Bacteroids. Puerperal sepsis – Bacteroids. P.O abdominal and gynaecological infection – Bacteroids. Abscess – S.Aureus. Acute osteomyelitis – S.Aureus. Toxic shock syndrome – S.Aureus. Wound infection – S.Aureus > Pseudomona. Hospital acquired pneumonia – Klebsella > S.Aureus. Community acquired pneumonia – H.Influenza. Septic meningitis – Streptococcus. Initiation of dental caries – Streptococcus. Pyogenic lung abscess + Meningitis – Staphylococcus. Subacute bacterial endocarditis – S.viridians. Prosthetic valve endocarditis – S.epidermidis. Cellulitis – S.pyogenes. Multiple draining sinuses – Actinomyces. IUCD infection – Actinomycosis. Trachoma – Chlamydia. Pelvic inflammatory disease – Chlamydia. Lymphogranuloma venereum – Chlamydia. Pseudomembranous colitis – C.Difficile. Gas gangrene – C.Perfringes / C.Welchii. Fatal diarrhea – V.Cholrea. Cancrum oris – Spirochetes & Fusobacterium. Tubulo ovarian cyst – Gonococcus. Valvular itching + Pink purulent discharge – Trichomanas vaginilis. Infection in post liver transplant patient – CMV. Chorioretinitis in AIDS – CMV. Bronchogenic carcinoma – CMV. Herpangia – Coxsakie virus. Hand foot and mouth disease – Coxsakie virus Lymphoma in AIDS – EBV. Burkitt lymphoma – EBV. Non hodgkin lymphoma – EBV. Hairy tongue – EBV. Nasopharyngeal carcinoma – EBV. Infectious mononucleosis – EBV. Kaposi sarcoma – HHV8. Cervical cancer – HPV 16. Vulval papules – HSV. Meningo-encephalitis – Echovirus. Meningitis in AIDS – Cryptococcus neoformans. Black water fever – Plasmodium falciparum. Cysticercosis – Taenia solium. Cyst in liver – Teania echinococcus. SCC of bladder – Schistosomiasis. Cholangio carcinoma – Clonorchis Sinensis. Migratory lesion of foot – Cutaneous larva migrans. Toxoplasmosis – Cat. Bakhtawar Saleem
HORMONES: Hormone responsible for BRAIN development in fetal life – Thyroid hormone. Hormone responsible for SKELETAL development in fetal life – PTH. Hormone that stimulate release of HCO3 – Secretin. Hormone that stimulate release of HCO3 + pancreatic enzymes – CCK. Stress hormone – Cortisol > Epinephrine Nor epinephrine >ACTH. Most important hormone involve in gluconeogenesis – Cortisol. Hormone that triggers onset of parturition in mother – Fetal cortisol. Hormone of abundance – Insulin. Hormone that stores carbohydrates, proteins, and lipids – Insulin. Hyperglycemia caused by Glucagon, Hyperglycaemia increases Insulin. Secretion increases in darkness – Melatonin. Aldosterone release in response to Hyperkalemia, and Aldosterone causes Hypokalemia and Hypernatremia. Hormone that decrease cholesterol – Estrogen. Hormone that cause most potent protein synthesis in skeletal muscle – Testosterone. Transient bone growth – Testosterone. Polypeptide hormones – GH, Prolactin, HPL. Glycoprotein hormones – TH, FSH, LH. Decreases cholesterol – Estrogen. Human menopausal hormone – FSH. Fat deposition and ducal development of breast is function of – Estrogen. In pregnancy respiratory rate increases due to – Progesterone. Hormone responsible for respiration during leutinizing phase – Progesterone. Breast atrophy – Estrogen & Progesterone. Inhibition of ovulation is function of – Prolactin. At the end of pregnancy uterus is more sensitive to – Oxytocin. Potent stimulus for Vasopressin secretion – Increase effective osmotic pressure of plasma. Potent stimulus for PTH secretion – Decreased serum calcium. Potent stimulus for Aldosterone secretion – Increase potassium. Potent stimulus for ANP – Increase blood volume. Potent stimulus for renin secretion – Increase sympathetic activity. Dr. Bakhtawar Saleem.
NEUROTRANSMITTER: In carcinoid syndrome, there’s increased level of – Serotonin. Emotion and bhavior – Serotonin. Slow wave sleep – Serotonin. Rods and cones – Glutamate. Horizontal cells of retina – GABA Catecholamine present in body as NT – Adrenaline. Anaphylactic shock – Adrenaline. Natural sympathetic agent – NE. Bakhtawar Saleem.
Red v / s pale infarct. ( HunKS got pale after seeing that GirL in red ). Heart, Kidney, Spleen – Pale infarct. GIT , Lung, Liver – Red infarct. ( GirL in red ). Red in loose tissues , and organs with double circulation White in tight tissues. Red due to venous occlusion. Pale due to arterial occlusion. Bakhtawar Saleem.
ORGANS: Enzyme induction occur in – Liver. Most of drugs metabolized in – Liver. Tumor that doesn’t metastasize to bone – Liver. Carcinoma of stomach most likely metastasize to – Liver. Causes bone growth by releasing peptide – Liver. Least chances of infarction – Liver. Commonly involved in fatty change – Liver. Erythropoesis occur in middle trimester mainly from – Liver. Urea formation – Liver > Brain. Angiotensin 1 is converted to angiotensin 2 in – Lung. Not involved in regulating plasma calcium level – Lung. Capillary permeability is lowest in – Brain. Alcohol most likely affect – Brain. Most susceptible to ischemic necrosis – Brain. Actinomycosis doesn’t produce infection in – Brain. Minimal change in blood flow to an organ during exercise – Brain. Metaplasia doesn’t occur in – Brain. Minimum AV difference – Heart. Highest content of protein in lymph is from – Heart. Diptheria toxin has most serious effect – Heart. Metastatic calcification usually occur in – Kidney. Most common organ affected by amyloidosis – Kidney. Increased blood flow to monitor basal condition of disease of – Kidney. Targe tissue of PTH – Kidney. Least site of tumor metastasis – Spleen. Hypertrophy occurs in – Skeletal muscles. Large number of mitochondria present at apex of – Skeletal muscles. During exercise, organ that recieve inadequate oxygen supply – Skeletal muscles. Most common site of anthrax infection – Skin. Autoregulation doesn’t occur in – Skin. Source of creatinine – Muscle. Serotonin is formed by – GIT. Bakhtawar Saleem.
ARF mostly effect – PCT. Na absorbtion – PCT. 65% Na reabsorption – PCT. Glucose absorption – PCT. Bicarbonate absorption – PCT + CD. Maximum water absorption – PCT. ARF after PPH, part damaged – PCT. Diuretics act on – PCT. Parthormone increases phosphate reabsorption by acting on – PCT. Parathormone increases calcium reabsorption by acting on – DCT. Loop diuretics and thiazide diuretics enhance each other effect at – DCT. Least concentrated urine found in – DCT. Aldosterone mainly act on – CCD > DCT. ADH act on – CCD > DCT. Filterate will be isotonic to plasma in presence of ADH in – CCD. Couner current multiplier and counter current exchange – LOH and vasa recta. Part in medulla – LOH. Frusemide act on -LOH. Bakhtawar Saleem.
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