1ANATOMY

Umbilical cord - 2 arteries + 1 vein, right umbilical vein disappear first, length is about 50 cm. 3rd branchial pouch - inferior parathyroid glands. 4th branchial pouch - superior parathyroid glands. Testes- 7th month- deep inguinal ring - 8th month -superficial inguinal ring - 9th months scrotum. Phrenic nerve- C3/C4/C5 ( keeps the diaphragm alive). Ulnar nerve- (C7) /C8/T1 Axillary nerve- C5/ C6 Radial nerve- C5/C6/C7/C8/T1 Musculo-cutaneous- C5/C6/C7 Femoral nerve- L2/ L3/ L4 Musicians nerve- Ulnar nerve. Eye of the hand- Median nerve. Laborers nerve- Median nerve. Wrist drop - Radial nerve. Saturday nerve palsy- Radial nerve. Claw hand - Ulnar nerve. Carpel tunnel syndrome- Median nerve. Foot drop- Common peroneal nerve. Tarsal tunnel syndrome- Posterior tibial nerve. Fromets sign/ Card test- Ulnar nerve. Pointing index- Median nerve. First and second lumbricals supplied by median nerve. Third and fourth lumbricals supplied by ulnar nerve. Palmer interossei - Adduction of fingers.(PAD)

Dorsal interossei - Abduction of fingers. (DAB). Palmer and dorsal interossei are supplied by ulnar nerve. Hypothenar eminence supplied by ulnar nerve. Prostate - venous plexus is present between true and false capsules. Thyroid - venous plexus is present inside the true capsule. Ductus arteriosus- Ligamentum arteriosus. Palmaris longus is frequently absent in hand. Spinal nerves - Cervical -Thoracic - Lumbar - Sacral - coccygeal 8 12 5 5 1 -------------------------------------------------------Vertebral bone 7 12 5 5 4

Peau d orange - due to the obstruction of subcuticular lymphatics and oedema which deepens the mouth of sweat glands and hair follicules. Ribs- True ribs 1st to 10th ribs. - False ribs - 8th , 9th, and 10th ribs. - 11th and 12th ribs are floating ribs. - 3rd to 10th ribs are typical ribs. - 1st, 2nd , 11th and 12th ribs are atypical ribs. Sternum - sternum manibrium - body 4 pieces - xiphi sternum/ xiphoin process. Colon Shortest- Ascending colon , 5 inches. Longest- Transverse colon, 20 inches. Breadth more than length in cecum. Middle meningeal artery is a branch of maxillary artery. Epidural hematoma occurs due to rupture of middle meningeal artery. Convex

shape. C7 is also know as vertebra prominence. Structures in free boarder of lesser omentum are ( anterior to posterior) are 1) Duct- Commom bile duct. 2) Artery- Hepatic artery. 3) Vein - Portal vein (DAV) Calots triangle- formed by hepatic artery, cystic duct and lower surface of the liver. Kochs triangle- formed by tendon of Todaro, septal leaflet of tricuspid valve and orifice of coronary sinus. It is present in right atrium. Hesselbachs triangle- lateral boarder or rectus, inferior epigastric artery and inguinal ligament. Direct hernia through this triangle. Soleus muscle - peripheral heart. Brocas area- inferior frontal lobe, area 44/45. Motor aphasia- broken speech. Wornickes area- superior temporal gyrus, area 21/22. Sensory aphasiawordy and senseless speech. Primary auditory cortex -inferior temporal lobe, area 41/42. Principal visual cortex in occipital lobe, area 17. Most common donor nerve for nerve graft is sural nerve. Stensens duct of parotid gland opens opposite to upper second molar tooth. Angle of jaw is supplied by greater auricular nerve. Tip of nose is supplied by---Eustachian tube- Pharyngo-tympanic tube. Trigone of bladder arises from mesoderm. Base of the heart - formed by 2/3 LA and 1/3 RV.

- T5- T8 Lying down position - T6- T9 Standing position. Peg cell in fallopian tube. Hofbauer cell in placenta. Clue cell is epithelial cell in bacterial vaginosis. Clara cell in terminal bronchioles. PATHOLOGY P53 arrest cell cycle in G1 phase. Cell cycle G0 - resting phase. G1 - pre-synthetic phase S - synthetic phase G2 - post synthetic phase M - mitotic phase. Cellular content of DNA doubles in synthetic phase. Social phobia treat with exposure and behavioral therapy Laugh in one moment and cry in another moment is Labile effect. Cytarabine- (Ara-C) - chemotherapeutic agent that is infused continuously. Radioactive iodine emits- beta rays. Platelets can be stored at 20- 24 degree centigrade for 5 days. I 125 is used for diagnostic purpose only. WHO blindness criteria is visual acuity less than 3/60. Primary sclerosing cholangitis does not respond to colectomy in ulcerative colitis , however , episcleritis, pyoderma gangrenosum and peripheral arthralgia respond well to colectomy. Narrowest part of ureter is uretero- vescical junction. Most common histological variant of renal cell carcinoma is clear cell type.

Hepatocellular carcinoma- Alpha feto-protein is increased. Malignant germ cell tumor- b-HCG, LDH, CA125 all are increased. Component of visual pigment rhodopsin is retinal. Defect in DNA repair mechanism gives rise to Xeroderma pigmentosum, Fanconis syndrome, Hereditary non- polyposis cancer. Cholera during pregnancy - treat with FURAZOLIDINE. Multiple myeloma - blood viscosity increases. At physiological PH the carboxyl terminal of a peptide is negatively charged. Risk of damage to fetus by maternal rubella is maximum when mother gets infected during 6-12 weeks of pregnancy. VAGTUS UTERINUS - cry of unborn baby in uterus. Dermal nitrate test - to detect the gun-shot residue. Interstitial lung disease- reduced vital capacity - reduced diffusion capacity. - reduced total lung capacity. - normal FEV1/ FVC Liver granuloma caused by - allopurinol, phenylbutazone, sulfonamides, quinidine. Auto immune diseases continue to affect liver even after the liver transplant. Tacrolims causes nephrotoxicity. All nephrotoxic drugs cause hyperkalemia, but amphotericin causes hypokalemia. Lead poisoning- Constipation, pain abdomen, microcytic hypochromic anaemia with basophilic stippling.

Leptospirosis- high grade fever, conjunctival hemorrhage, hyperbilirubinemia, renal failure and coma. Child-Turcotte -Pugh scoring in liver disease, components are Albumin, Bilirubin, PT,INR, Ascites, Encephalopathy. ( No creatinine) HIV +ve patients dressing disposal- Treat with 1% hypochlorite and then send for incineration in an appropriate bag. Iron deficiency anaemia- best parameter to be measured is serum ferritin level. Serum iron and ferritin level are decreased and total iron binding capacity is increased. Foetal hemoglobin synthesis switches to adult type after 30 weeks. In apoptosis no inflammation occurs. Macropolycytes in peripheral blood smear - megaloblastic anaemia. Hypersegmented polymorphocytic cell in megalobalstic anaemia. Familial retinoblastoma patient - second tumor to occur is osteosarcoma. RPGN- Crescent in glomerulus. Peutz - Jeghers syndrome- polyps are hamartomatous. Incomplete mole - triploid karyotype. Early gastric carcinoma is confined to mucosa and submucosa only. Hepatitis C - remains in chronic form to cause cirrhosis. Rabies vaccine- Human diploid cell vaccine. Pigment producing colonies- Pseudomonas- blue green. - Staphylococcus aureus- yellow. - Serratia marcescenes- red. Germ tube - diagnostic of candida. PH of Sabourauds dextrose agar - 4 to 6. Painless hematuria- bladder carcinoma, Schistosoma hematobium.

Babesiosis- Tick Dendue- Ades mosquito. Ades- dengue, yellow fever, Culex- Japanese encephalitis, filariasis, West Nile fever. Epiglottitis in children is caused by Hemophilus influenza. Gowers sign- Use the support of hands to get up from sitting position in Duchenne muscular dystrophy. Clozapine - atypical anti-psychotic, causes agranulocytosis. Fluoxetine- selective serotonin re-uptake inhibitor(SSRI). Miltefosin - New drug against Kalazar. Elevated androgen or exaggerated response to androgen causes alopecia, acne and hirsutism. Valvulus- radiological signs are- Inverted U shaped bowel loop. - Liver overlap sign. - Bird of prey sign. USG frequency - 1-2 MHZ. In Ransons criteria serum amylase is not a determinant. Operative wound after surgery for gangrenous perforated appendicitis is by delayed primary closure. Intra-capsular fracture in 60 year old man Hemiarthroplasty. Barlows test and Ortilinis test for congenital dislocation of hip. Osteochondritis of lunate- Keinbocks disease. Osteochondritis of navicular bone is - Kohlers disease. Spine ventosa- Tuberculosis of spine, potts disease- most common site is thoraco- lumbar. Intervertebral disc calcification in Alkaptonuria. Multiple myeloma A/G ratio is reversed.

Bone cyst - treated with bone grafting. Osteochondroma- most common bone tumor, it is exostosis. Naso- tracheal intubation contraindication in basal skull fracture. Common cause of epistaxis in children is nose picking. In adult most common cause is hypertension. Acoustic neuroma arises from cerebro-pontine angle. 8th Cranial nerve. Most important component of Bishops score- Cervica dilatation. Laproscopic hysterectomy causes injury of urinary tract most commonly. In endometrosis the severity of pain depends upon the depth of invasion of lesion. Endometrosis - most conviencing theory for peritoneal endometrosis is embryonic rest. Leg cramps that occurs in pregnancy can be treated by calcium 1 gm BD. Skin is the best dressing,- Joseph Lister. Minimum urine output is 30- 50 ml. Focused abdominal sonogram for trauma(FAST)- checks Epigastrium, right hypochondrium, left lower chest, and hypogastrium. Branchial cyst develops from second branchial cleft. Poland syndrome- Amazia+ absence of pectoralis major. Odynophagia- pain on swallowing. In CNS myelin formed by Oligodendrocytes. In PNS myelin is formed by Schwann cells. Salivary amylase is activated by chloride. REFSUM syndrome- accumulation of phytanic acid.

Propylthiouracil- anti-thyroid safe in pregnancy and breast feeding. Vancomycin- ADR - Red man syndrome. Hoffmanns degradation of Atracuronium so safe in renal failure. Ethambutol is not hepatotoxic. Amytropic lateral sclerosis- treatment is riluzole. Absence seizure - drug of choice is Ethosuxomide. Valproic acid is second line drug. Primary generalized tonic clonic seizure with absence seizure is treated with valproic acid. Complication of Pagets disease - pathological fracture, osteogenic sarcoma, and high cardiac output failure. Turners syndrome- 45 XO. Pheochromocytoma- treat with alpha adrenergic blocking agent. PHENOXYBEZAMINE. Rule of 10- 10% malignant, 10% bilateral, 10% calcify, 10% extra adrenal, 10% kids and 10% familial. Nelsons syndrome- Complication after B/L adrenalectomy for hyperplasia. Takayasus arteritis- most commonly involved is subclavian artery. Pneumocystis carnii- treatment is TMP-SMX( Co-trimoxazole) , Dapson,Clindamycin. Hepatitis is treated by alpha- interferon. Abnormal D-xylase test suggestive of mucosal abnormality of proximal small intestine. Generation time- time interval between the receipt of infection by the host and maximum infectivity of ths host.

Pulse polio immunization- All children of age 0 to 5years are given OPV irrespective of their previous immunization status. Temporary hardness of water is due to presence of bicarbonate of calcium and magnesium. Kata thermometer- measures the air temperature, humidity and air movement. Area for one person in a factory is 50- 100 meter square. Tolerable sound - 85 decible. Maximal permissible radiation/year- 5 rad. Kerosine poisoning- Gastric lavage is contraindicated. Popliteal muscle- intra-capsular, forms the floor of popliteal fossa. Length of mature spermatozoa - 50-60 microns. Foramen spinosum- middle menigeal artery. Foramen ovalae- mandibular nerve. Hassals corpuscles- in thymus. Functional unit of kidney is Nephron. Arch of aorta- at T4. Glans penis is drained by- deep inguinal nodes of Cloquet. Pretectal nucleus- light reflex. Hyaline cartilage - most common to ossify. Space of Disse - Liver. Cavernous sinus > Superior sagittal sinus > Transverse sinus. CN III, IV, V1, V2 and VI are in close relation to cavernous sinus. Internal carotid artery is surrounded by sympathetic plexus. External nose- 2 paired and 2 unpaired cartilage. Adrenal gland average weight = 5 gm. Rupture of supraspinatus - difficulty in initiating the abduction of

shoulder. Vein of Galen- formed by fusion of superior sagittal sinus and straight sinus. In sitting position the body weight is supported by ischial tuberosity. Safety muscle of tongue is genioglossus. Conjoint tendon is formed by fusion of internal oblique and transverse abdominis fibres. Brain, eyes and internal ear have no lymphatic drainage. Complete sulcus in brain is Calcarine sulcus. Middle cerebral peduncle- pontocerebellar pathway. ( only pathway). Morulla- 16 cell stage. Decidua basalis - Placenta. Iliac crest highest point corresponds to L4. Epiglottis made up of elastic cartilage. Accessory cervical rib causes compression of first thoracic nerve and subclavian artery. Knee joint is the largest synovial joint in the human body. Iris - ectodermal origin. Single umbilical artery- renal system abnormality associated with trisomy 18( Edward syndrome). Median nerve supplies -1) Abductor pollicis brevis. -2) Flexor pollicis brevis. -3) Opponens pollicis brevis. -4) First and second lumbricals. Ulnar nerve- Adductor pollicis.

Payers patch in ileum. Appendix epiploica -present in colons except in aapendix, rectum and sigmoid colon. Deep inguinla ring is a defect in fascia transversalis, it is oval and is lateral to inferior epigastric artery. Ciliary ganglion- Preganglionic > Edinger- Westphal nucleus. Sinus of Morgagni is present in between superior constrictor muscle and base of the skull. Structure passing are Auditory tube, levator palati muscle and ascending palatine artery. Jugular foramen- CN IX, X, XI and internal jugular vein. Ovarian fossa bounded by- anteriorly- obliterated umbilical artery and posteriorly- ureter, internal iliac artery. Apex of the heart is formed by left ventricle, is present in 5th intercostal space 1 cm medial to mid-clavicular line. Liver blood supply - 80% from portal vein and 20% from hepatic artery. Falciform ligament is present in the inferior surface of the liver. Trigone of bladder arises from mesoderm. Cystic artery is a branch of right hepatic artery. Trendelenbergs sign is positive in paralaysis of gluteus medius and gluteus minimus which are supplied by superior gluteal nerve. Gluteus maximus is innervated by inferior glteal nerve. Ligamentum teres - left umbilical vein. Dorellos canal- in temporal bone and 6th cranial nerve is present. Pointing index is due to median nerve injury. Apex of the heart is supplied by left coronary artery.

Spermatic cord - testicular artery, cremasteric artery, and artery to vas. - Pampiniform plexus of vein - genital branch of genitofemoral nerve, testicular plexus of sympathetic nerve. - vas deferens, lymphatic of testis, remains of processus vaginalis. Filum terminale- 20 cm long, made up of spinal connective tissue. Corpus luteum -if ovum is fertilized it remains up to 3 to 4 months. - if ovum is not fertilized it remains up to 14+/ 2 days. Isthmus of thyroid gland- opposite to 2nd and 3rd tracheal ring. Foramen of Monro -communicates third and lateral ventricle. Foramen of Magendie( medial) and foramen of Luschka(lateral)communicate the fourth ventricle to subarachnoid space. Dorsal branch of abdominal aorta- lumbar artery and median sacral artery. Somites develop from para-axial mesoderm. Nasolacrymal duct opens into inferior meatus. Pancreas- main duct of Wirsung, and accessory duct of Santorini. Number of pulmonary segments in right lung = 10, left lung = 8. First bone to ossify- Clavicle. Sub- arachnoid space ends at S2. Spinal cord ends at L1/L2 in adults, and upper boarder of L3 in children. Implantation occurs at the stage of BLASTOCYST on 5th to 7th day. Fabella- lateral head of gasrocnemus. Elbow joint is a hinge joint.

Horners syndrome- compression of sympathetic chain, leads to ptosis, miosis, enophthalmos and anhydrosis. Shoulder joint abduction- First 15 degree- Supraspinatus - 15 to 90 degree- Deltiod - beyond 90 degree- serratus anterior and trapezius. Auditory area - Middle cerebral artery. Visual area- Posterior cerebral artery. Palpation of parotid duct when anterior margin of masseter is tensed. TM anterio-inferior part- Auriculotemporal nerve. TM postero-superior part- auricular branch of Vagus. Middle ear cavity supplied by glossopharyngeal nerve. Cysterni chyli opens in T12. Mental foramen is present near the premolar teeth. In Mac Burneys incision the nerve severed is Iliohypogastric nerve. Ureteric colic pain in groin is due to genito-femoral nerve. Spring ligament is calcaneo-navicular ligament. Orbit- strongest wall- lateral, and the weakest is floor. Male urethra- 18 to 20 cm. Prostatic part is 3 cm and is the widest part. Membranous part is 1.5 to 2.0 cm and is the shortest part. Spongy part is 15cm long. Female urethra= 4 cm. Trachea- Pseudostratified ciliated columnar cells. Largest CN is trigeminal(V) nerve. Wards triangle related to hip joint. Ectrodactylism Absence of digit.

Liver clotting factors are 2/7/9/10 which are vitamin K dependent. Bohrs effect- shifting O2 curve towards the right due to increase in H+ ion. Menopausal hot flushes - due to LH surge. Vomiting center is present in medulla oblangata. Ruffinis corpuscle- warmth sensation. RBC life 90-120 days. Basal ganglion- planning and programming of movements. GFR - Inulin Renal Plasma flow- PAH D2O used for total body water estimation. Evans blue- Plasma volume. Inulin- Extra cellular fluid. NE metabolite in urine is VMA. Calcium binding protein is calmodulin. Cholagogues cause contraction of GB- Cholecystokinin. Cholerectics- cause bile secretion- Bile salt. ECF ph- 7.4 Auto regulation of blood flow- kindey, brain, liver, skeletal muscles, mesesntry. Anterior cruciate ligament injury- difficulty in downhill walk. Attico-antral CSOM treatment- Mastoidectomy. Antrochoanal polyp- treatment is intranasal polypectomy. Cough reflex while cleaning the ear is due to stimulation of auricular branch of vagus. Meningitis complication- Seizures, Raised ICT, subdural effusion.

Extra- hepatic biliary atresia- hepatic SCINTIGRAPHY. For transpyloric feeding measure the length of tube from the tip of the nose. Stratum corneum is under developed in low birth weight infant. Up to the age of 6 years interosseous infusion can be done. Organophosphate poisoning- confusion, salivation, lacrymation, fasciculations, miosis, tachycardia, hypertension. Juvenile polyp has a little risk for carcinoma colon. Wegeners granulomatosis- cough with hemoptysis, glomerulonephritis, C-ANCA raised. Normal morphogenesis is by homeobox gene. Flocculent densities in mitochondria in electron microscopy is a feature if irreversible cell injury. Ferrous oxide > Ferric oxide. This reaction is called as Fentons reaction which releases the free radical Familial amyloidotic polyneuropathy - deposition of mutant transthyretin in nerve. Lardaceous spleen- Amyloid deposition in sinusoids in red pulp. Dystrophic calcification occurs in injured tissue, e.g. Atheromatous plaque. Metastatic calcification in hypercalcemia. Sphyngomyelin deposition- Neimann-Pick disease. RHD- Aschoff bodies- which consists of Antischow cell, epitheloid cells and fibrinoid necrosis.

Amantidine - faster action than levodopa in Parkinsonism, but less effective. Levodopa reduces hypokinesia/rigidity first and then tremor last. ADR- livido reticularis. TXA2- Vasoconstriction, platelet aggregation. PGE1 inhibit platelet aggregation. PGE2 relaxes arteriolar smooth muscles. Bronchodilatation PGF2- vasoconstriction.Tocolytic action. PGI2 relaxes arteriolar smooth muscles.Inhibit platelet aggregation. Frusemide decrease the renal lithium clearance. Mycoplasma- binary fission, grows in cell free culture, requires sterol for growth, sensitive to macrolides. In asthma inhibition of 5-lipo-oxygenase pathway helps to relieve the symptoms. Rapid induction by sevoflurane. Suxamethonium- ADR- raised ICT and hyperkalemia. Bleomycin- pulmonary fibrosis. Doxorubicin- Cardiotoxicity. Succinylcholine is contraindicated in tetanus, head injury, and stroke, renal failure. Cryptococcal meningitis - treatment by amphotericin B. Prednisone given to patient of lymphocytic leukemia leads to lymphocytopenia due to massive lymphocyte apoptosis. Dopamine inhibits prolactin secretion. Mucous in cervix production is stimulated by estrogen. Ferning of cervical mucous is due to action of estrogen. Left hemisphere infarct leads to aphasia. Oculocardiac reflex - done during strabismus correction surgery by holding the medial rectus. Emergency transfusion O+ve blood, colloid, crystalloid.

Neurones are irreversibly damaged by hypoxia for 3 to 5 minutes. Lack of insight in mania, reactive psychosis, schizophrenia. Haloperidol/metochorpropamide - Extrapyramidal reaction- treatment is trihexyphenedyl, diphenhydramine, diazepam. Dementia - old age, forgetfulness, visual hallucination, suspiciousness, poor self care, progressive deterioration. 16 years old girl slashed the wrist to commit suicide, marked mood fluctuation- boarder-line personality. Early renal TB diagnosed by- IVU. Bronchopulmonary segment has 2 arteries(bronchial and pulmonary) with 1 terminal bronchiole inside it and pulmonary veins lie in between the two segments. Extra adrenal pheochromocytoma is found by MIBG scan. Most radiosenstive phase of cell cycle is G2M. X ray - Tungsten. Posterior subcapsular cataract is most handicapping visually. For sutureless cataract with IOL incision is 3.5mm. Retinoblastoma- Leukocoria, reetinal detachment, heterogenous subretinal mass with calcification, treatment is enucleation. Lacrymal pump failure diagnosed by dacroscintigraphy. In premature babies eye fundus examination is done after 6 weeks. Injury to eye with leaf 5 days back; pain, redness and photophobia for last 2 days - Fungal corneal ulcer. Congenital aganglionosis- failure to pass meconium with in 48 hours of birth without any obvious external abnormality.

Arachnoid villi responsible for CSF absorption, protrude in superior sagittal sinus. Post traumatic epilepsy occurs after many years of head injury. In gasrtic lymphoma surgery is indicated when there is excessive bleeding, perforation, residual disease following chemotherapy. Catgut culture- Isopropyl alcohol is preservative. Cardaic temponade- treatment is pericardial effusion. Dysgerminoma= Seminoma Germ cell tummor (CDTY) - Choriocarcinoma -Dysgerminoma -Teratoma -Yolk sac tumor. Peyronies disease- painful erection, associated with Dupytrens contracture and spontaneous regression in 50% cases. T.T is effective in 80 - 100% cases. Crush syndrome- Myoglobinuria, massive crushing of muscles, ATN. Cerebral protection by Etomide anaesthetic. Non invasive cardiac output monitoring by Electrical impidence cardiographic technology. Tennis elbow- Lateral side / common extensor origin. Lateral pterygoid - opens the mouth. Winged scapula- due to paralysis of serratus anterior muscle due to involvement of long thoracic nerve of Bell. Carcinoma prostate metastasize to vertebral plexus bone through the internal vertebral plexus of veins.

Number of genes in human genome= 80,000 Km=1/2 V max Same reading for same sample on repeated testing= PRECISE test. DPT vaccine- avoid exposure to direct sunlight, can be stored for 3 months in PHC, half used vial should be disposed. When more than 10% of school going children are affected by goitre then there is endemic iodine deficiency. Chemoprophylaxis in plague is by- Tetracycline. Water borne disease- feco-oral route- e.g. Polio Water based disease- fish tape worm, guinea worm Water washed disease- skin and eye infection. Reed Sternberg cell- Hodgekins disease. In viral hepatitis- ALT> AST. Alcoholic hepatitis- AST>ALT(2:1). Wilson disease- Ceruloplasmin is reduced. MI LDH1>LDH2 Urinary retention due to neuroleptic agent - treatment by- bethanechol. Cyclosporine toxicity is increased by ketoconazole. TCA( tricyclic antidepressant)- Mydriasis and constipation. Clindamycin- increases the growth of Clostridium difficle and then causes pseudomembranous colitis which can be treated by metronidazole or vancomycin. MOA inhibitor along with tyramine rich food like cheese or wine causes- Hypertensive crisis. Niacin ADR- rash, pruritis, GI upset. Carbamazepine use - monitor LFT.

Captopril- increases bradykinin so it causes cough. PHARMACOLOGY Volume of distribution = Amount of drug in body(LD) Plasma concentration(Pc) Clearance = Rate of elimination of drug Plasma concentration. T1/2 = 0.7* Vd CL ZerO order elimination= constant amOunt of drug is eliminated. First order elimination = constant Fraction is eliminated. Penicillin G i.v Penicillin V- oral Methicillin ADR- interstitial nephritis. Amoxycillin has greater bio-availability than that of ampicillin. Fluoroquinolones inhibits DNA gyrase( topoisomerase II) Flucytosine- Antifungal blocks the purine formation. Griesofulvin disrupts the microtubules. Anti-viral Gamma globulins- inhibits viral absorption/ penetration. Amantidine- inhibit uncoating. Fomivirsen- blocks the early protein synthesis. Nucleic acid synthesis blocked by purine and pyramidine analogs, and reverse transcriptase inhibitor. Zanamavir- inhibits influenza neuraminidase. Ribavarin- inhibits synthesis of guanine nucleotidase.

Ganciclovir- inhibits the phosphorylation of viral kinases. Acyclovir- inhibits the viral DNA polymerase. Protease inhibitor- SaquinaVIR, ritonaVIR, indanaVIR, nelfinaVIR. Reverse transcriptase- inhibitor- zidovudINE, zalcitabINE, didanosINE, stavidINE. Interferon blocks the various stages of RNA/DNA synthesis. Bed wetting - treat with IMIPRAMINE. OCD- Clomipramine. Local anaesthetic MOA- sodium channel blockade. Small diameter nerve fibres affected faster than large diameter fibres. Myelinated fibres more than unmyelinated fibres. Pain to lose first then temperature then touch then pressure at last. Cocaine - Arrhythmia. Cough suppression - Dextromethorphan. Indomethacin- for the closure of patent ductus arteriosus. Heparin- activates anti-thrombin III, decrease thrombin and Xa. Check aPTT. Antidote is protamine. Warfarin- interferes with normal synthesis of vitamin K dependent clotting factors like 2/7/9/10. Check- PT. Antidote is vitamin K Amino caproic acid- inhibits fibrinolysis Clopidogrel/ ticlopidine inhibit platelet aggregation by irreversibly inhibiting the ADP pathway. Abciximab- binds to glycoprotein Iib/IIa in activated platelets. Aspirin inhibits COX1/COX2. Metformin inhibits gluconeogenesis, increases the glycolysis.

Acarbose/ miglitol inhibit alpha glucosidase in intestinal brush boarder. Leuprolide- GnRH analog- when used in pulsatile fashion it acts as AGONIST, but when used continuously it acts as ANTAGONIST. Glucocorticoids- inhibits phospholipase A2. Mifepristone- RU 486- competitive inhibitor of progestines at progesterone receptor, used as abortificient. Colchine- depolymerizes the microtubules, impair the leucocyte chemotaxis, and degranulation. Allopurinol inhibits the xanthine oxidase. Mean arterial pressure- CO times TPR = Systolic+2 diastolic/ 3 Pulse pressure= Systolic - diastolic pressure. Venous dilator - Nitroglycerine- decrease the prelaod. Arteriolar dilator - Hydralazine - decrease the afterload. Starling law- Force of contraction is proportional to the initial lenght of cardiac muscle fibres. Ejection fraction = EDV- ESV = SV EDV EDV Isovolumetric contraction- period between AV valve closure and semilunar valve opening, it is the period of maximum O2 consumption. Mobitz I-(Wenkebach phenomenon) progressive PR lengthening and a dropped beat. Mobitz II- Dropped beat with out any change is PR length. Either 2:1 0r 3:1.

Arterial baro- receptor Aortic arch- Vagus nerve- medulla - respondes to increased BP. Carotid sinus- glossopharyngeal nerve- medullaresponds to hypotension Chemoreceptors- 1) Peripheral- Carotid bodies and aortic bodiesrespond to increased level of PCO2 and H+ 2) Central -changes in pH/ PCO2 of brain interstitial fluid. PCWP = LA pressure. < 12mmHg Total body water= 60% 1/3- extracellular fluid- 1/4 plasma+ 3/4 interstitial 2/3 -intracellular fluid GFR = Urine inulin by Volume Plasma inulin. Renal plasma flow = Urine (PAH) by Volume Plasma(PAH) Functional unit of kidney is nephrone. Power house of nephrone is PCT, proximal convoluted tube. Renin relaesed when BP in kidney falls down. ANP- released in response to increased atrial pressure, and acts to decrease sodium level and increase GFR. Parathyroid hormone secreted by chief cell of parathyroid gland.

Calcitonin is secreted from parafollicular cells of thyroid. Ovary secretes- Estradiol Placenta- Estriol Potency Estradiol> estrone>estriol Dihydrotesterone> testosterone> androstenedione hCG secreted for syncytiotrophoblast of placenta. In menopause- estrogen is decreased, FSH is increased, LH is increased and also GnRH is increased. Finasteride inhibit 5-alpha-reductase CO2 transported in three forms- Bicarbonate 90%, bound to Hb 5%, dissolved to blood- 5%. Parietal cell / Oxyntic cell - Intrinsic factor and H+ Chief cell/ Zymogen cell- Pepsinogen Gastrin- stimulates acid secretion. Papillary carcinoma of thyroid- most common and good prognosis. Follicular carcinoma of thyroid has the poorest prognosis. Philadelphia chromosome- t9:22 - CML. Roulex formation, Russel bodies Multiple myeloma. Thumb sign in x-ray -epiglottitis. Wireloop nephropathy , Libmann Sach endocarditis- SLE. Most common cause of death in SLE is renal failure. Most common cause of death in DM is silent MI. Most common brain tumor - adult- Metastasis> astrocytoma> meningioma> schwannoma.

Most common brain tumor in children is medulloblastoma- infratentorial. Most common cardiac tumor in adults - myxoma. Most common cardiac tumor in children is rhabdomyoma. Most common cardiomyopathy- Dilated cardiomyopathy. Most common congenital heart disease is VSD. Most common oesophageal carcinoma is squamous cell carcinoma. Most common cause of meningitis in New born- E. coli. Children- H. influenza-B Adolescent- N. meningitidis Elderly - Streptococcus pneumoniae. Epidural hematoma- convex shape, middle menigeal artery. Subdural hematoma-concave shpe, rupture of bridging veins. Osteomyelitis- most common organism- Staphylococcus aureus. - most common in sickle cell anaemia- Salmonella. - most common in i.v drug abusers- Pseudomonas. UTI in young women - E.coli, Staphylococcus saprophyticus. Diabetes - FBS> 126. - PPBS>200 with sign and symptoms Treatment goal in diabetes - Fasting < 130 - PPBS < 200. Glycosylated hemoglobin(HbA1c) < 7.0 HbA1c by 20 = average blood level. SOMOGYI effect- due to high evening dose of insulin patient suffers from hypoglycemic attack at around 2/3 am in the morning, and bodys reaction to hypoglycemia leads to hyperglycemia. Treatment is reduction of evening dose of insulin.

Dawn phenomenon- due to growth hormone action there is hyperglycemia, treatment is increase the evening dose of insulin. Screening for cholesterol done is every 5 years once the patient is 20 years old. In an alcoholic there is decreased level of K+, Mg++, Na+, Folate, thiamine, phosphate, and there is increased uric acid level. ABG comprises- blood pH+ CO2 value, bicarbonate. Sodium bicarbonate indicated only when blood pH < 7.0 Copper excess- Wilsons disease. Copper low- Menkes disease. Flourine- decreases the dental caries. Chromium deficiency leads to impaired glucose tolerance. Fat soluble vitamins- A/D/E/K Water soluble- B/C Vitamin K dependent factors are 2/7/9/10 protein S and C. Tests forAspirin- BT/platelet count. Warfarin- PT Heparin- aPTT and platelet count. Hemophilia A/ B - aPTT. vWF- BT/ aPTT DIC- BT/CT / PT/aPTT/ fibrin degradation product increase. - Platelet count and fibrinogen decrease. - +ve D- dimer. Fried rice- Bacillus cereus. HIV CD4 <200 prophylaxis for Pneumocystis carnii pneumonia by TMPSMX.

Tzank smear- multinucleated giant cell- Chicken pox. Seborrheic dermatitis - Cradle cap in the head. Jock itch- Tinea cruris. Scabies treatment- Permethrin/ Lindane. Louse/ Pediculosis- treat with Permethrin. Genital wart - HPV 16/18/31/33. Acne vulgaris- Benzyl peroxide, clindamycin, oral tetracycline or doxycycline or erythromycin or roxithromycin, topical tretinoin. Photosensitivity- tetracycline, doxycycline, phenothiazines, OCPs. Erythema nodosum- sarcoidosis, coccidiodomycosis, ulcerative colitis. Dermatitis herpeteformis is associated with celiac sprue. Inability to read / write/ or name or do the math- due to lesion in dominant parietal lobe. Resting tremor- Parkinsonism Intention tremor- Cerebellar disease Fine tremor- Thyrotoxicosis Flapping tremor- Hepatic encephalopathy, Uremai. Sertori cells- stimulates by FSH , secrete inhibin, forms the blood testis barrier and produce sperm. Inhibin inhibit FSH by negative feed back. Leydig cells - stimulated by LH, secretes testosterone. Rods - Dark vision, black and white vision. Cones - Color vision C1 -Atlas, C2 -Axis.

C7 is also know as vertebra prominence. FORENSIC Sodomy- anal sex. Pederasty- Anal sex with child. Gerantophilia - Anal sex with old man. Bestality- sex with lower animals. Lesbianism- Tribadism Buccal coitus- Fellatio- sucking penis - Cunnulingus - licking vagina Masochism/ Sadism Lust murder. Excessive sexual desire- Satyriasis in male - Nymphomania in female Fetishism- Sexual gratification by seeing or touching female body parts or dress especially undergarments. Transvestism- Eonism- Sexual gratification by wearing attire of opposite sex. Peeping Tom- sexual gratification by secretely observing the sexual performance by others. Troilism- Sexual gratification by seeing owns wife having sex with others. Scopophilia- Sexual gratification by secretly seeing woman taking bath.