& PrepLadder Sample pages from PrepLadder notes e PrepLadder notes are structured according to the app lectures. ¢ Revision friendly, fully colored notes incorporated with images used in the lectures. ¢ Notes will be free with 2019 Video Pack. To register for the inaugural offer visit 2019.prepladder.com Ea PrepLadderFORENSIC TRAUMATOLOGY 1 MECHANICAL INJURIES CLASSIFICATION BLUNT FORCE SHARP FORCE Abrasion Light cutting Ineixed wood confusion Heovy culling > Chop ingury Lecration Pointed end = Stab ingury Frocture ABRATION > perAPE = scrope > only Epidermis if ‘involved No bleeding Types pressure, | Pressure av" ee epider QP Epidernis ‘snaury onpury permis emis > dit tangential pressure > dit perpendiowlor pressure [Epithelium crushed ] 1. serarey 1 Pressure 2. Grose, 2. Paliern Scratch Grezeo ABRASION > single linear Line abrasion > Moltiple kines of scratches over wide areal by Nail, thorn, pin 7 common RTA 7 Crescentic mall morke included Oka GRAVEL RASH / BRUSH BURN > simplest obragion dragged against a rough surface 7 me type PRESSURE ABRASLON PATTERNED] IMPRINT PBRASION > Ugature mark > Rodiater Grill Mork Bie Mark Ligakure mark Celso produces pattern] Tyre mark Bbragions will let ux Know > pirect™ oF Force — epieliad TAG belps in tr > TIME SINCE INDDRY| AGING OF ABRATION — colour of SCAB Cdried Lymph help in it GRATED ABRASION ee R= Row — Shes Ro — Reddish scab > brs, RB — Reddigh Brown — 2-3 Days B= Brown = he5 Day [)PrepLadder BB ~_ Black — 6-3 DaysHERLING, > COLOUR CHANGE © + -AGING OF CONTUSION oxy Hb 7 RED 7 Fen Hours peoxy Hb > awe 7 Fun Hours - 3 days Hemosiderin BROWN F 4-5 Dap Biliverdin > Green > 6-7 dap ate rubin > Yeu > F- 1 Day ~ Hrs 30 = colour change starts from periphery > No colour change im SUB CONJUNCTIVAL HEMORRHAGE Differential Diagnosis OF BRUISE HYPosTASES BRUISE SUE Dependent parts Any vohere BLANCHLNG Present Absent COLOR, CHANGE Absent Present MBRGINS Requlor Lrreqular ExIRAVASBTION Absent Present: INCISE {POUR Ho Wathed aman Perstats TRUE BRUISE ARTIFICAL BRUISE ETIOLOGY Trowma Iniront Plonts SITE Prywhere Acnesatble sites colour All colours ‘Brown BLISTERS Absent Pregent ANCLSE Btood ‘Berid serum TTCHING pbxent Present MARGINS Trrequlor Regular LACERATLON + incere o> TERR EPLDERMES ? Blunt force S Deamis Blood vessel > involves Epidermis & Dermiz. a, Ereqularllmargins 2. rn floor + Vessels & Hoiy bulb + GROSHEB > SERRE mon [)PrepLadderTYPES \. SPLIT LACERATION % ok bony prominences % for Noked Eye — morging looks Regwar 7 in Floor, crusHING tnt. 7 Looks bike incised wound > > Seen on Scalp forehead ‘ygorna, Toc crest Shin exe magnified Lens helpk in IdenkiFicat™ 2. STRETCH LACERRTION > Seer at Over Shedhing OF Stin 7 produad by Run over Inguries Compound frackure 3. RVULSION LACERETLON F seen Run over Inguries CRotakional Inguries) FLAPPING | FLAYING is tnt. — helps to Knew the direction oF force, F DEgIDVING TNOURY — Enkre skin comes out 4. COT LACERATEON > Geen T Heowy weapon ¢ sharp edge Coxe} - sharp edges } reser crushing Fracture OF underlying bone occurs FINCLSED WOUND / cur] StmsH] SLICE INJURY 7 Produced by fight aulting weopon tike & blade ZA surgical Slade rare Epiclermig Incited Hair Bulb Neund Dermig Blood vessels 7 Lengts is more > clean cot Margins ‘Ln the floor + Vessels & Hoir bulb are cut SmRETCH UERAT® DEG LOVING y 7 INCISED WOUND [))PrepLadderFORENSIC BALLISTICS 9 BALLISTECS 2 PROxImAL Ballistics > INTERMEDIATE BALLISTIS > TERMINAL BALLECTICS > Study OF Fre arm and Projectiles & ihe effects Study of fire arm & its ammunukion > Inkmal Bollishes Study Of motion oF bullet > Ealernal Ballizhies Study OF eFFeckt OF bullet on target > wound Ballishes 7 CALVIN GoppARD > Falher oF forensic Ballistics FIRE ARM. on bene BraREL poe 0 _— S jo > tnner biomekr of Barrel + BORE > ovker end OF Barre} + muz2Le END Inner end oF Bovrel > BREACH END components of flre Arm LerencH) PERING PIN | PERCUSSION sinmmnen "=" mamoe HABER Lend Clarsification REFLE Smoot BORED) SHOT GuN RIFLINGS = spiral groovings | = No RiFlings Rielings — Uses Ballets = ser Leod shots | pellets = Riflings will Spin the bul — Single bore * Speed Double bore Re Tees Shorter Re thon Ril Stability ange Rifled guns vaio ae [))PrepLadder‘Smoom Bored Gun | Shot Gun - ‘choking, houinnmo nr ® 7 dispersion decreans the Range > cHOKING > Marrewsing of muaale end oF barrel > bees the dispersion > ses the Range 7 Gradings 1. Onchoked gub Leylinder] > max. dispers® + nt. _ 2. Improved cylinder == 3. Modified aylinder = = A. Pally choked > lens digpers” + nt. = Range 1 Revolver 00 yards. — 2. Pistol + 00 yard 3. Military Rife —* 2000 yards 4. Shot Gun 7 8-60 yards REELED GON Hor gon calibre Gauge) Bore hess co 4 Pound Groove ww] © ay 70. OF Balle inl iF 10 — 10 bore gun Distance blu a Lands ~ CALIBRE 1S — ie Roneiganial. SHOT Gon CARIREDGE J} RIFLED GUN BULLET 4 — Gun PHODER PREMER CoP 4 no > Works as lubricant & Piston mm > mass * Netocity only cange minor bruise ke th Velodty KE Inguy [))PrepLadderMANAGEMENT © GUPRA PUBIC PRESSURE @ Mc RoBERT’S MANEOVER > Hex the hip joint +30 WOODS CORK SCRELD METHOD ZAVANELLL RESTITUTION @ASKIN MaNEuVER > fm aq Knee chest posit” @e® toons coax sexe mrenen ZANELT © cespasnn SECTION LOWER SEGMENT INCISTONS * KERR’s INCISION 7 Traneverse incis? > KRONTq INCISION vertical inci cAASSECAL KRONE UPPER SEGMENT TNCISLON > ctmsstcmL INCL? Seer ete eee en ABDOMINAL INCICLON & OTERINE INCISION HAVE NO CORRELATION 7 pbdominal iocigions are meont For cosmmebic purpores > BIKINT | PRANNENSTEEL INCISION + Tous? on Lower pork oF abdomen 7 Lower segment Incision: ore Sofer [ Louser seqment retroct€ Cnet contracts) ] — Lower Segmant cesarean seckion [Lscs] ~ chance OF rupture > 0.5 f0 al. — Bleeds Lec ~ Heals quickly — We can give TRIAL oF scAR| TRIAL OF LABOUR | VAGLNAL BIRTH AFTER CESAREAN TRIAL OF SCAR | TRIAL OF LABOUR| VAGINAL BIRTH RETER CESAREAN CAN GE DONE IN > Previoug 2 LSCS th an inghtutionol ser up Z 0 Cephalopelvic disproportion TRIAL OF LABOUR + Done In primiqravida 7 borderline cephalopdvic disproportion + can be given Triol o normal Vaginal delivery in an ingfitutionsd sup fi PrepLadder[Ree Fina 7 AGOENTRL RacmommAgE] ASSOCIATED \ITH Hypertension 5 Pre eclamptic Toxemi Smokers Mulkfporout women Twink Pre Mature Rupture oF membranes Chorio ammnionitis Previoug abrupt? Thrombo philiax. Elderly women VeVi utust SHER & PAGE CLASSLFICATION PE — Bleed seen only after delivery — NO Urine tenderness — Fetus ig olive & FHR ic @ TYPE 1 - Bleed seen during Labour - omodelkd t ofrine tetany — Fetal Heart Roki — Normal TPE ~ mort severe. — PHR Problem , dighess 7 A FF NitBOUWr DIC BF Wim DIC PRESENTATION > Painful bleeding 7 Profrack” oF Dabour > PPH MANAGEMENT 1. AT TERM — Resusscftat® — IF Feral digtrecs tnt * FHR cesarean sect” NORMAL, for Cegareon Section 7 DELIVERY NoT FETAL DISTRESS & PrepLadder> 26] FREQUENCY OF NST + Weekly after Sa wks for all pregnant 9 + Biweekly for high risk preqnandes * 2aghrs For Controlled om & Severe HTN * Daily BIO PHYSICAL PROFILE | MANNING SCORE > pone by 0sq 7 Feral movements ta Fetal tone aa Fetal breathing movements > Adequal. NST >a Armniokc Fluid Index 7 2 Goon BIOPHYSTCAL PROFILE 40 AMNIOTIC FLULD INDEX 7 Arytematic sum of 4 cord Free pockets 3 a > Normal FD -15en per =e, i + bligoarnnios < san ua % Polybydraminos = >> au am AASOLUTE AMOUNT OF LIgOR SINGLE POCKET > Normal > so00mt > oligoamniog > 500m! Poyhyctramnios = >) Bem Polyhydraminas > —aBDO MI For uncontrolled OM EXTERNAL CEPHALIC VERSION DONE AT For Primigravida at > 56 cons For Mutkigravida ot > 34 we. MODIFIED BLOPHYSLCAL PROFILE — includes AFL & NST VIBRO ACOUSTEC. STLIMULATION TEST DOPPLER oF ont, > ombilical oneriez PN KR Oferine orkriez le Ducts Verotut aa "Rent — 7 Matt important oper far omesainens | ungattent = este Few of veeplaantal Flew a Perfurion co the baby > Which OF the Following Flow patterns done by Doppler omeszment coill best signify DucTus VENOSUS Flow PATTERNS > UMBILICAL ARTERY DOPPLER [)PrepLadderIdentical Fraternal FORMATION OF TWINS. (Monozygotic) __(Dizygotic) MONOZNGOTLC | LENTECAL TWINS ee + incidana > aso pregnancies Ae a DEZVAOTEC | NON IDENTECAL | FRATERNAL TWINS e eo 7 incidence = > 2/60 — VBO Pregnancies 90 a ) (Shared placenta) (Separate placentas) SUPERFECUNDLTY — RB oocytes fp 2 cycle more common type oF Dizygotic teins SUPER FETRILON — 2 Oowyies fo cyebt Rare in humans, common in cattle & horges FATE OF MONOZYQOTIC TWINS 1 Dichorionic Diamnjotic (357) 2 Monovhorionic. siahiel ead Lesauied ee) Sse MonachorenicBamniotk 3 monochorionic. ca + = 6 FATE OF DraaoTic TWINS —* mely Dichorionic Diomniotic BEST LEAST COMPLECATED —* DICHORLONLC DEAMNIOTEC MONOZYQOTIC TWENS COMPLECATONS 1 “WEN TD TWIN TRANSFUSION SYNOROME + dit deep AV anaotamosis Fb difference, Fy sqmidt + we difference > > aor. Terminal? OF Pregnancy ab 2 DISCORDANT TWINS By wWkE oF ever BA wks [ T > Abdominal cireumfrene + > 157. Steroids] By CESAREAN > we differene > 7 201. SECTION ig advisable 3 cord entanglernent: 4 Single tal Demise 5 Abrupt? 6 PROM as -cencis | )PrepLadder ®. WD OF OMe OF Both Fetuger> ANTRAL POLLICLES. Fluid Filled follicles 67% made every month PREMORDEBL, Foucles \ anevutakory poor coaytes, No fertilizar? Poor embryos pboré” [yoy aFter 40 yeors] ero F > S5yrs Pregnancies —> ELDERLY GraveDAS. cad For Level 1 Scaning Amniocentais OVARIAN RESERVE QUPRITIELCATION @ tage @ J estrogen > Perimenopauisal women have imeqular ads dit ou follicles Fol oF reproduc:” during perimenopoutsal period Triple morkes, dual markers © J pnent fotcurar count [young - eto%, older - 1] @ J ovarin vouume Cyoung - 3.5% a.5*3um> older - 1x 15k 1om] © tes > Lyounger — 2t06 tO, Older - > 15107 © Loree mULLeRTAN HORMONE > made from granulosa Cell oF ovary 78 PREMARY Fourcle ta] SECONDARY Fourie Cy fol OvBRIAN, RESERVE eceeee bade ts [)PrepLadderoop INDICATORS a > Are > FSH > Amu Ceingle best for asgegsment ] Purpose OF FSH => = ESWogen Product? Purpose OF LH 7 _Progesteron Product” + @rsu > acer rrore > suggestive OF Menopatural women PuoT Diagnostic OF Menopause ovvlation rn =, nee fousesae pose PY @_ wren sons HORMONES ir OVAREAN BrsprTomy ovnrtnnt HoRrnontes ENoomETRLUM [8 o ~ WMGreenLaneEr GA SECRETORY PHASE, B MATNTATNANCE OF PREGNANCY > Exclusively maintained by CORPUS LUTEUM Upto 9 KE — corpus Luke remains upto WKS In preqnancy > By corpur Luteur § Zlaunta = > From 9-la wala > only by plaanta = aFter Ia weeks quote corpus uae ms | Lukearn Lottery PPlqantob” yee eh ay 7 Hyperemesis if maximum at 66m doy [95 weeKs] > Pbort™ can be R, by > Progesterones [)PrepLadder He,> > - 4 ot seminoma TYPE CELLS > Large poly qonel cells & 7 dear aytoplagm & Bark stained nuchal; ¢ > back to bock ouongerent 7 Associotid & > 4 oH 7% Ploantol Alkaline Pog > Bipha feko prolein > Not intrengest ® Your sAcJENDODERMAL SINUS TUMOR & EMBRYONAL TUMORS COMMON FEATURES Young wornn & gine Poor Prognosis * Alpha feto prokin SPICIFIC FEATURES YOLK GAC TUMOR >, anti trypsin > SCHTLLER DUVAL BODIES EMBRYONAL TUMORS > Hee SEX CORD ToMORS © GRANULOSA CELL TUMORS [me] > 1 Eshogent — Precodous Puberty — Menorrhagia — Endometrial conar Marker Inhibin CARL EXNER GODTES Contralateral Ovarian Secondaries prior to syskmic cl @ SERTOLE LEYDIGg TUMORS | ARBHENOBLASTOMAS. Hirsukicm > mob pattern baldness Virtl20£9 > Permanent changer — Hoarcness - Breast Atrophy — Clitoromegaly BB PrepLadder SCH 2 ee ‘ {ELLER DUVPL BODY CARL EXNER Bootes iverter,MYoMECTOMY SURGICAL MANAGEMENT PRE REQUISITES > Hb > > logms. > arrange blood > minimise freie? on uberur owoid posterior wall indsion [sie > Retroversion) + Technique to 4 blood loss > torniquet oxage Vasopressin sage + J handling of fallopean tube > Seman Anaby sis > FCBROLD IN PREGNANCY > Ry is CONSERVATIVE tn younger women + MyYomecromy 7% th older women > HYSTERECTOMY FLO CLASSLFLCATEON Leiomyoma subclassification ‘stem over 2 contcrendemeviem 10% ean 2 Sear pdiraases 8 otter Gpctye. cerca rae) + te Fibroid is impinging on a Iecakions at once, hen tne mucosal velok? showld mention rst & PrepLadder> pischarge won fuer if > CENTRE FOR DISEASE CONTROL > INPATLENT REGLMES > our PATIENT REGLMES > Broad spectrum antibiotics 121 > Opp REqime - ceroxi1INE aqm iv or i (bet ‘for Gonsirnia CEFOTAXImE Iqm ty — DORYCNCLINE 100gm BD x Ih Days + for chlamydia — METRONIDAZOLE SOOm_ SP x I4days > for anatrobes for Bacterial vaginosis + AZITHROMYCIN. can be given thalead OF DOKYCYCLINE > CLINDAMYCIN GN be given inglead OF METRONIDAZOLE VAgINiTts CANDIDIASIS BACTERIAL VAGINOGIS [_TRICHOMONTASTS F DiMORPHIC FONGT aka Hemophilo vaginalis | by Tridhomonan vaginalis Biastospores (Spread) Gardeneta vaginalis flagellate proteacan Mycelia. C invas” & adhurenc) mitile Organism > creamy discharge causes Geyere irritate? > curdy white discharge > water Test > tye caucet Severe pruritis plaques on vaginal wall ~ Secret” + 1GLKOH + omines| On removal + Petechiae > COLPITES macuLARZS > Fishy odour CetRAw BERRY VAGINA] > our OF proport? ProniTis | cIvE CELLS - vaqindl > complicated | uncomplicated epittelium t embeded > Greenish yellow, foamy uncomplicated bacteria disthorge ~ seen in @ women ‘Seed iprogpwsis > no prortrts oy albicons complicatect = tn immunocarpromued 7 Recurrent » Severe - ale non- albicane! > TREATMENT > TREATMENT +> TREATMENT > panies merrontoma0ue — meTRoNTOA20LE ~ oral Fuwcono2oe = Ry bot man = bom Fag nar [)PrepLadderFRULTY INSTRUMENTATION > Good inghuimintak® prevents prolapse > Fawlty inghumenrakh couses prolopse EARLY RESUMPTION of WORK > <6 WKS OF puurperium SHAWS CLASSLEICATION STAGE T > cenix ig gust below the N hue STAGE IL > cervix ig ab introitus STAGE 7 cervix i Outside stage > PROCLDENTIA Lal uterus boo prolapted] PoP sy¥sTEM > Pelvic Orgon Prolopte Quantification Systen > Reproducibility is good & good for comparision PPRTS OF PROLAPSE WHEN YOU &D FROM ANTERIOR TO POSTERIOR > anterior vaginal coal ret te nr. vaginal rocel woot cystocele “eS uferus Retkocele ne Posterior vaginal wodl Re Yoginal aL CYSTOCELE - compLtcATioNs. > DIFFiaNE in fnitiak” oF micturition Retention oF urine Infection Stone format” tad RECTOCELE — COmPLICATIONS > piffoulr initiar® > Fecelits format? REPOSIT? by PESIBK| OTHER ComPLICATIONS + Venous congest” dit vaginal band > DEOKYGENATED UTERUS > DEcUBITOUE | DEPENDENT ULCER Edit venous congest”I ~ > Repositioning T Pessary a ao 9 SIRES URINARY INCONTINENCE abr) as 7? n 1c? Drogqing Sensat me a4 tah ore Some thing coming out of Vagina Sense of inseaurity in the vagina | Perinetm [)PrepLadderMULLERIAN ABNORMALITIES as EMBRYOLOGICAL DEVELOPMENT & IT'S ABNORMALITIES > Female internal genitalia derived from MULLARLAN/ PARA meso NEPHRIC DUCT! > male internal genitalia derived from WOLFLAN | MESONEPHATC /@ARINER DUCT MOLLAREN DUCT DERIVATIVES > oterus cervix fallopean tubes 4/5% OF vagina - Lower 5m derived from UROGENITAL STNUS — ovories are derived from GENITAL RIDGE WOLFIPN OUCT DERLUATIVES > Epididyrmus > vas deferens > Seminiferous tubules > prostatic oretiro FEMALE GENITAL TRACT DEVELOPMENT Wolffian ducts Miallorian ducts Millerian ducts degrade become verne tubes fand ule — i: Wotttian: Bipotential Urinary ducts gonads )) bladder Uretna Uterus Vagina Cloaca FATE OF WOLFIAN DUCT IN FEMALES + Remanents oF woolfion duck Epeophoron — Poraoophoron eames! doce > culiteatedt at Upper Lateral vaginal wall -+ may Lead to GARTNER CYST — mostly agymptemakic — ® by SEMPLE EXCLSION BARTHOLIN ABCESS — glond present ak ankrior @I3 rd & posterior V3 rd of Vulva — Ry by MARSUPILIZATION CExterioriaot® oF canity) [)prepLadderMOLLARIAN DUCT BNOMALTES VERTICAL FUSION DEFECTS or a TRANSVERSE VAGINAL ‘sePTUM VAGINAL @TRESLA LATERAL FUSION DEFECTS | DIDELPHYS s somite Septate SEPTATE VE GICORNUATE UTERUS Angle between a cowities - — yg C obtuse] > — pistonce bleo a cavities =< yer > = Sion > Fandus ~ Broad > indented Ioimpling CERVICAL VAGINAL ATRESTA AGENESES 2 oNTCORNUATE, Unicornuate 4 BicORNUATE Bicornuate bn Hyskro salpingography + both Septal € bicormuali vlerUs look Similar Septal vierus Bicornuah uteroc Septam, uterus Bicornual uterus Septal, vierus Bicornuali oteros SEPTATE UTERUS IS THE SINGLE MosT CommON MULLERIAN DEFECT COMPLETE MULLERIAN 134 prepLadder137 MULUERIAN REENESTS [TESTICULAR FETOINI ZATION 6YNDROME! NDROGEN INSENSITINETY 6YNDRONE| KARvOTYPE > ye xx > AB xy @onae > ovary > testes orerus,Tuges | > Absent > pbsent Va@INe > shallow blind shallow blind vuLve > Normal > Normal BREAST > Feminine F Large Rminine PERtoDS > patent > pbeent ANDROGENS | 20-80 ngidi > a0 -800 ngidt Pustc jaruaRvanin) > Present: > s > an Testiatar feminizat® syndromes ae in periphery , BNDROGENS =———_ ESTROGENS. — EsTRogeNS = —? Large €mi Pubic. & axillary hair absent F TRS ig dittinguithed from Mullerian Agenesic by - mesent axillory & pubic hour [elinical suspicion] — karystyping = 46 XY — OSG reveals ondescended testes (ms in abdomen ] Occasionally in inguinal canal > ondesunded testes removed in TES of the time oF puberty [CHOLESTEROL DOSTERONE 3 sate eane x engfovn 3 2 [Feeqnenotone PROGESTERONE, yp” [eeony coarzsone_] J [consone wre nfo 3 warudefusiace 2 3 2 z VEOH PREGNENOLONE |g [Kon ProstesreRone] 5+ [vox comrtsot] —S> [conreson 20 [prooe % 20 oss x 3 DHEA | (7p of seroid TF Bor shod dehy ds logenort. ydrog, NOR. BIOL Testostenon | —f+ [Esannion ap PNOROSTENE DIONE Y ESTRONE £ sesheet [))PrepLadder> SLIMY LAYER IBIOFTIm FORMATION 7 omer forme of copsule 7 Helps fo adherence 7 BIOFLLM > Antibiotic resigance can also happen MOTILITY dit Flagella C Flageltin) + Antigenic 7 pemontrar® oF Flagella <> Monotrichovs = > Vibrio cholera <> > iemphitrichous «> Bleatigenes foucalic eae + Lopotrichous ~ Spirillos minus =k > Peritrihous E.coli, Proteus , Ligkria > MoTILITY NAMES T > Tumbling — Ge DF darting > v. cholera, S > Swarming 7 Proteus > Falling Saar Like Giardia Lamblia (4 pairs of flagella] > Spirochetes have ENDOFLAGELLA > Prige From periplasmic spoce > Treponema padjidum > corkscrew motility Borrelia Laghing moklity METHODS TO DEMONSTRATE MOTILITY 1 Hanging Drop memod 2 Semi Solid ager memod + = Mannitol motility agar ix used CULTURE MEDIA > simple compPLex SEMPLE MEDIA > Nubrient agar gor solidifying agent Caz] No nutrition provided ud Nutiet — Pepone Meak extract > Nutrient Broth = Liquid cutture media [)PrepLadder