P450 ENZYME INDUCERS AND INHIBITORS:

P450 inducers P450 inhibitors (SECOND MKI)

Carbamazepine Sulphonamides
Rifampin Erythromycin
Griseofulvin Cimetidine
Phenytoin Omeprazole
phenobarbitone Na valproate
Disulfirum
Metronidazole
Ketoconazole
isoniazid

BACTERIAL PROTEIN INHIBITORS:

DRUG WHICH INHIBITE 50S SUBUNIT DRUG WHICH INHIBIT 30S SUBUNIT
Chloramphenicol Aminoglycoside (GANTS):
Clindamycin Gentamycin, amikacin, neomycin, tobramycin,
Linezolid streptomycin
Macrolides Tetracycline:
strptogramines Doxi,mino, and tetracycline

CANCER INCIDENCE:

MEN WOMEN CHILDREN

Prostate Breast Leukemia
Lungs Lungs Brain and cns
Colon/rectum Colon/rectum neuroblastoma

CANCER MORTALITY:

MEN WOMEN CHILDREN

lungs lungs leukemia
prostate breast brain and cns
colon colon neuroblastoma

ONCOGEN MICROBES:

EBV Burkit lymphoma, Hodgkin lymphoma, primary CNS

lymphoma, nasopharyngeal carcinoma
HBV,HCV Hepatocellular carcinoma
HHV-8 Kaposi sarcoma
HPV Cervical and penile/anal carcinoma (type 16 and 18),
head and neck ca
H.PYLORI Gastric adenocarcinoma and MALT lymphoma
LIVER FLUKE 9CLONORCHIS SINENSIS) Cholangio carcinoma
SCHISTOSOMA HAEMATOBIUM Bladder cancer 9squamous cell)

MEN 1 AND MEN 2 FEATURES:

MEN 1 Pituitary tumour, parathyroid adenoma, pancreatic endocrine tumour (zollinger –ellison syndrome)

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 MEN 2 Parathyroid hyperplasia, medullary thyroid cancer, pheochromocytoma
CARCINOGENS:

TOXIN ORGAN IMPACT

Aflatoxins (aspergilla’s) Liver Hepatocellular carcinoma
Alkylating agents Blood Leukaemia/lymphoma
Aromatic amines Bladder Transitional cell carcinoma
Arsenic Liver Angiosarcoma, lung carcinoma, squamous cell
carcinoma
Asbestos Lung Bronchogenic carcinoma
Carbon tetrachloride Liver Centrilobular necrosis, fatty change
Cigrate smoke Bladder Transitional cell carcinoma
Cervix Cervical carcinoma
oesophagus Squamous cell carcinoma/adenocarcinoma
kidney Renal cell carcinoma
larynx Squamous cell carcinoma
lungs Squamous cell and small cell carcinoma
pancreas Pancreatic adenocarcinoma

Ethanol Oesophagus Squamous cell carcinoma

liver Hepatocellular carcinoma
Ionizing radiation Thyroid Papillary thyroid carcinoma
Nitrosamine (smoked food) Stomach Gastric carcinoma
Radon Lung Lung cancer
Vinyl chloride liver Angiosarcoma

TUMOUR SUPRESSOR GENES:

APC Colorectal carcinoma

BACA1/BRCA2 Breast, ovarian and pancreatic cancer
Rb Retinoblastoma, osteosarcoma
P53 In most of human cancers, in li-fraumeni syndrome
NF1 Neurofibromatosis type 1
NF2 Neurofibromatosis type 2
MEN1 MEN1
WT1 Wilms tumour
VHL Von hippel-Lindau disease

ONCOGENS:

BCR-ABL CML, ALL

BCL-2 Follicular and diffuse large B cell lymphoma
JAK2 Chronic myeloproliferative disorders
KRAS Colon, lung and pancreatic cancer
RET MEN 2A AND 2B, medullary thyroid cancer
C-MYC Burkitt lymphoma

TYPES OF VACCINE:

KILLED/INACTIVATED VACCINE (R.I.P ALWAYS) LIVE ATTENUATED VACCINE

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 rabies , influenza (injection), polio(salk), hepatitis a bcg, influenza, measles, mumps, polio(sabin), rotavirus,
rubella, yellow fever

HPERSENSITIVITY TYPES:

Type 1 Anaphylaxis (e.g. food, drug, or bee sting allergies)

Type 2 Autoimmune haemolytic anemia, immune thrombocytopenic purpura, transfusion reactions,
haemolytic disease of new born.
Type 3 SLE, polyarteritis nodosa, post streptococcal glomerulonephritis.
Type 4 Type 1 diabetes mellitus, contact dermatitis, graft- versus-host disease, tests PPD, patch test.

EARLY FETAL DEVELOPMENT:

Week 1 Hcg secretion begins

Week 2 Epiblast and hypoblast form
Week 3 Ectoderm, mesoderm, endoderm form
Weeks 3-8 Organogenesis
Week 4 Heart begins to beat, upper and lower limb buds begins to form
Week 6 Fetal cardiac activity visible by transvaginal ultrasound
Week 8 Fetal movements start
Week 10 Genitalia have male/female characteristics.

CASTE IN URINE:

RBC CASTS Glomerulo nephritis, malignant hypertension

WBC CASTS Tubulointerstitial inflammation, acute pyelonephritis, transplant rejection
FATTY ACIDS Nephrotic syndrome
GRANULAR( Acute tubular necrosis (ATN)
muddy brown)
casts
WAXY CASTS End-stage renal disease/chronic renal failure
HYALINE CASTS Nonspecific, can be a normal finding.

ACIDOSIS AND ALKALOSIS CAUSES:

RESPIRATORY ACIDOSIS RESPIRATORY ALKALOSIS METABOLIC ALKALOSIS METABOLIC ACIDOSIS

Due to hypoventilation Due to hyperventilation Loop diuretics M.A with increase anion
because of because of Vomiting gape;
Airway obstruction Hysteria Antacid use Methanol, uremia, D.K,
Acute lung disease Hypoxemia Hyperaldosteronism lactic acidosis, salicylate
Chronic lung disease Salicylates (early) (late), INH
Opioids Tumour M.A with normal anion
Sedatives Pulmonary embolism gape;
Diarrhrea, addison
disease, spironolactone,
acetazolamide

HEART MUMURS:

PASS Pulmonary aortic stenosis= systolic murmur

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 PAID Pulmonary aortic insufficiency/regurgitation= diastolic murmur
Reverse above formula for tricuspid and mitral valve
Tricuspid mitral stenosis=diastolic, tricuspid mitral regurgitation= systolic murmur

CHARACTERISTICS OF NERVE FIBRES TYPES:

GENERAL FIBRE TYPE AND SENSORY FIBRES TYPES AND CONDUCTION VELOCITY
EXAMPLE EXAMPLE
A-alpha 1a muscle spindle afferents Fastest
1b Golgi tendon organs
A-beta 11 sec afferent of muscle spindle; Medium
touch and pressures
A-gamma Medium
A-delta 111 Medium
B medium
C 1V Slowest
Slow pain and temperature

AUTONOMIC RECEPTORS AND THEIR LOCATION:

ADRENERGIC RECEPTORS LOCATION CHOLINERGIC RECEPTORS LOCATION

Alpha 1 Smooth muscle Nm Skeletal muscle
Alpha2 Gi tract Nn Autonomic ganglia
Beta 1 Heart M1 CNS
Beta 2 Smooth muscle M2 Heart
M3 Glands, smooth muscle

SLEEP STAGE AND EEG WAVEFORM:

SLEEP STAGE EEG WAVEFORM

Awake( eye open) Beta
Awake (eyes close) Alpha
Non-REM sleep
N1 Theta
N2 Sleep spindle
N3 delta
REM sleep beta

PRIMARY BONE TUMOURS:

BENIGN TUMOUR CHARACTERISTICS POINTS

Chondrosarcoma Bony exostosis with cartilaginous cap
Giant cell tumour Present at epiphysis of long bones (often in knee region
distal femur proximal tibia), soap bubble appearance
on x-ray
MALIGNANT TUMOUR
Osteosarcoma Occur at metaphysis of long bones, bimodal
distribution,
Predisposing factors are;

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 Paget disease of bone, bone infarcts, radiation
Codman triangle on x-ray
Ewing sarcoma Occur in boys<15 years old.
Commonly occur in diaphysis of long bones.
Onion skin periosteal reaction in bone.

HAEMOGLOBIN-O2 DISSOCIATION CURVE:

SHIFT TO THE RIGHT SHIFT TO TH LEFT

Increase ph. Left Decrease ph. Right
Decrease pressure of CO2 Increase pressure of CO2
Decrease temperature Increase temperature
Decrease 2,3 BPG Increase 2,3 BPG
Haemoglobin F

RESPIRATORY CENTRES:

MEDULARY CENTRE APNEUSTIC CENTRE PNEUMOTAXIS CENTRE CEREBRAL CORTEX

DORSAL RESPIRATORY present in lower pons Present in upper pons Person can voluntarily
GROUP: stimulate inspiration Inhibits inspiration hyperventilate or hypo
Primarily responsible for ventilate
inspiration
VENTRAL RESPIRATORY
GROUP:
Primarily responsible for
expiratio

CARDIAC FORMULA:

STROKE VOLUME =end diastolic – end systolic volume

CARDIAC OUTPUT =stroke volume * heart rate
EJECTION FRACTION = stroke volume/ end diastolic volume

EFFECTS OF EXERCISE:

PARAMETER EFFECT
Heart rate raise
Stroke volume raise
Cardiac out put raise
Arterial pressure raise (slight)
Pulse pressure increase
TPR decrease9 due to vasodilation of skeletal muscle)
AV O2 difference increase

GASTRIC CELL TYPES AND THEIR SECRETION:

CELL TYPE PART OF STOMACH SECRETION PRODUCTS

Parietal cell Body (fundus) HCL , intrinsic factor
Chief cell Body (fundus) Pepsinogen
G cell antrum Gastrin
Mucous cell antrum Mucous , pepsinogen

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PACE MAKER:

SA NODE Sub epicardium

AV NODE Endocardium
CONDUCTING SYSTEM Sub endocardium

REGULATION OF INSULIN SECRETION:

FACTORS THAT INCREASE INSULIN SECRETION FACTORS THAT DECREASE INSULIN SECRETION
Increase blood pressure Decrease glucose
Increase amino acid ( arginine, lysine, leucine) Somatostatin
Increase fatty acids Nor epinephrine, epinephrine
Glucagon
GIP
Ach

TYPES OF TRANSPORT:

TYPE CARRIER MEDIATED METABOLIC ENERGY

Simple diffusion No No
Facilitated diffusion Yes No
Primary active transport Yes Yes
Co transport Yes Indirect
Counter transport yes Indirect

SHIFTS OF k BETWEEN ECF AND ICF:

CAUSES OF SHIFT OF K OUT OF CELLS-HYPERKALEMIA CAUSES OF SHIFT OF K INTO CELL HYPKALEMIA

Insulin deficiency Insulin
B-adrenergic antagonists B-adrenergic agonist
Acidosis Alkalosis
Hyper osmolarity Hypo osmolarity
Inhibitors of Na-K pump
Exercise
Cell lysis

CHROMOSOMAL ABNORMALITIES:

CRI DU CHAT Chromosome 5 abnormality , cat like cry occur

PATAU SYNDROME Chromosome 13 trisomy, cleft lip and cleft plate present
EDWARDS SYNDROME Chromosome 18 trisomy, micrognathia, pinched face.
DOWN SYNDROME Chromosome 21 trisomy, depressed nose, low set ears, slanting of eyes
DIGEORGE SYNDROME Chromosomal 22 abnormality, CATCH features

GENITAL EMBRYOLOGY:

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 PARAMESONEPHRIC DUCT DERIVATIVES MESONEPHRIC DUCT DERIVATIVES
Develops into female internal structures : Develops into male internal structures except prostate.
Fallopian tubes, uterus, upper portion of vagina, In female;
in male; Its remnant is gartner duct
remnant is appendix testis

TYPES OF NECROSIS:

COAGULATIVE NECROSIS Occur in organs supplied by end arteries with limited

collateral circulation, such as heart, kidney
LIQUAFACTIVE NECROSIS Occur most often in cns
CASEOUS NECROSIS Most common in Tb granuloma
GANGRENOUS NECROSIS Most often results from interruption of blood supply to
lower extremity or the bowel
FIBRINOID NECROSIS In immune mediated vasculitis
FAT NECROSIS Auto digestion with pancreatic enzymes, trauma to fat
cells.

TYPES OF TRANSPLANT REJECTION:

HYPER ACUTE Antibody mediated , occurs within minute

ACUTE T-cell mediated, occurs after days to weeks
CHRONIC Antibody mediated vascular damage, occurs after months to years

CARDIAC ENZYMES IMPORTANT POINTS:

MYOGLOBIN First comes first goes after mi.

LDH Comes late, goes late, raise after 24hours and remain till 14 days
TROP-I Has greatest sensitivity and specificity, disappears after 7-10 days
CKMB Investigation of choice within first hour of mi., disappears after 72 hours.

MADE BY:
DR.BILAL JAMIL KHANZADA