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Hypo and Hyperkalemia points Intracranial Bleeds points

Hypokalemia aggrevates digoxin toxicity Epidural hematoma===MMA injury === Pterion
& fracture ===Lucid interval present
Digoxin toxicity causes hyperkalemia ■Subdural Hematoma===Cerebral Bridging vein
Hypercalcemia cause pancreatitis injury.
& ■SAH===90 % cases berry aneurysms.
Pancreatitis causes hypocalcemia MC site=== ACA and & Anterior communicating
Acidosis causes hyperkalemia artery junction.
& Other less common causes===AVM.
hyperkalemia causes metaboilic acidosis IX of choice===CT brain.
Hypokalemia causes alkalosis Rx===Nimodipine with other protocol.
& ■Intra--Cerebral Bleed
Metabolik alkalosis causes hypokalemia Most common are Lacunae infarcts.
Hypokalemia inhibit insulin releases MC siteof BLOOD=== BASAL GANGLIA
& MC BG site==== putamen.
Insulin causes hypokalemia ■Ischemic strokes are 70%%% of all strokes.
Insulin deficiency causes hyperkalemia They are more common than Hemorrhagic.
& MC artery involved ===MCA.
Hyperkalemia causes insulin relaese.. ●●MCA lesion causes ===Contralateral
Hypokalemia causes rhabdomyolisis hemiplegia face arm leg.
& Aphasia.
Rhabdomyolisis causes hyperkalemia Best Ix====MRI brain although first CT brain
Sodium influx causes depolarization done to exclude bleed.
& ●●Pure motor stroke === Anterior 2/3rd of
Potssium efflux causes hyperpolarization posterior limb involved ===Anterior choroidal
Thirst Is Is Increased By. . artery involved.
Increase in Angi0tensin 2 ●●Vision affected most === PCA lesion.
decrease in blood v0lume CNS
incerease in osmolarity Abbreviations
drynes of m0uth. ••MC===Most common
Increase in ADH.. . ••MCC===Most common cause
THIRST is decreasd by. . UMN LESION
Gastric distensi0n.
Everything up.
Decrease in ADH,
Hyperreflxia
Angi0tensin2,
Increase in BP. Hypertonia
Increase in blood volume. Babinski positive ((in infants and sleeping
people are normal ).
●Spastic Paralysis present
●Clasp Knife spasticity present.
LMN LESION.
Everything down.
●Muscle weakness & Atrophy
●Faciculations and fibrillation present
●Hypotonia present
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B12 DEFICIENCY
●Subacute Combined Degeneration
●Demyelination of dorsal columns & L--CST &
Spinocerebellar tracts.
●Ataxia,Parasthesia
●Impaired Vibration & position sense.
HORNER SYNDROME
●Ptosis== eye sign due to sympathetic NP to
superior tarsal muscle.
●Miosis===eye sign.
●Anhydrosis ===(absence of sweating) and
flushing of face ).
●Causes are
▪▪Pancoast tumor
▪▪Brown--Square syndrome
▪▪Late stages Syringomylia.
Others given in very detail in Eye book.
PARINAUD Syndrome
●Cause===pineal gland tumor causing superior
colliculi compression
●Paralysis of conjugate vertical gaze
Superior colliculi === Conjugate vertical gaze.
Inferior colliculi===Auditory sensation.
MOST IMPORTANT POINTS about CN .
●☆●5CNP===Jaw deviates towards side of lesion.
●☆●10 CNP===Uvula deviates away from side of
lesion.
●☆●11 CNP===Shoulder droops on side of lesion.
●☆●12 CNP===Tongue deviates towards side of
the lesion.
●☆●7 UMNL===Contralateral lower face paralysis
& Sparing Forehead.
7 LMNL===Ipsilateral upper and lower face
including forehead.
Bilateral facial palsy===Lyme disease.
●☆●6 CN===MC nerve involved in
▪▪ After Optic nerve in MS.
▪▪Cavernous sinus thrombosis
■PRIMARY MOTOR AREA==BMA==4.
●●Corticobulbar &Corticospinal tracts
==Pyramidal Tracts.
●●Excitatory In Function.
●●Increase Muscle Tone.
●●Infarction/Lesion cause ==Severe paralysis(Loss
●Hyporeflexia present
●Flaccid paralysis present.
SPINAL CORD LESIONS
POLIOMYELITIS
●LMN lesions only
●Anterior horn destruction
●Flaccid muscle paralysis.
MS
●White matter of CERVICAL region
●OPTIC NEURITIS Compiled By Kool-Medic
●Scanning speech
●Intension tremors
●Nystagmus
●Uthoff phenomenon((aggravation of symptoms
on raised temperature )).
●Lhermitte's symptom (tingling in spine or limbs
on neck flexion).
●6th CNP MC.
●Postural tremors.
Etc.
AMYOTROPHIC LATERAL SCLEROSIS
●COMBINED UMN & LMN LESIONS
●no sensory or cognitive or Oculomotor deficits
●MC muscle hands atrophy and Faciculations
●Commonly known as Loughborough Gehrig
disease.
●Famous exanple== Stephen Hawking
●Riluzole Rx.
TABES DORSALIS
●Caused by Tertiary Syphilis
●Dorsal column & Roots involved
●Impaired vibration proprioception
●Progressive Ataxia
●Argyll Robertson pupil (Response to
accommodation present but to light lost).
(VIP).
●Absent DTR& Romberg+ve.
●ATONIC BLADDER== Also called TABETIC
BLADDER
●●SCHIZOPHRENIA
●●Increased Number and sensitivity of D2
receptors in Prefrontal Cortex.
●●Old Obsolete Rx
●●Frontal Leukotomy & Frontal Lobectomy
Now tranquilisers have better response.
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Of strength ) than Secondary area.
●●Most common infarction==PMA+SMA
==Complete Contralateral Paralysis.
●●Jacksonian Epileptic Seizures affect
==PMA==BMA==4.
■SECONDARY MOTOR AREA==6.
Lesions/infarction==Skilled Movements affected
with little loss of strength.
●●Send Extrapyramidal tracts (EPT) to Basal
Ganglia(BG) and Reticular Formation (RF).
●●Functions as inhibitory over pyramidal Tracts
(PT).
●●Lesions==Increase Muscle Spasticity.
●●Muscle Spasticity greater in SMA lesions than
PMA (VIP) bcz of loss of inhibition over excitatory
PMA.
■FRONTAL EYE FIELD::
●●Unilateral lesion==
==Two eyes deviate towards the side of Lesion.
==Inability to turn eyes towards opposite side.
■BROCA'S AREA
●●Left Inferior Frontal Gyrus
●●Lesion==Expressive/Fluent Aphasia.
●●Can think,Write and understand words but
●●Can not Speak.
■WERNICK SENSORY SPEECH AREA
●●Left Temporal area lesion.
●●Fluent Speech
●●Irrelevant Talking.
●●Can't understand words
■GLOBAL APHASIA
●●Both BA+WA==Involved.
■INSULA
●●Lesion==Phenomes Pronunciation difficulty.
■ANGULAR GYRUS.
●●Posterior Parietal Lobe.
●●Lesions lead to
●●Alexia==Inability to Read.
●●Agraphia==Inability to Write
■PRE--FRONTAL CORTEX
●●Functions for
ideas,thinking,judgment,Emotional Feelings and
personality Changes.
●●LESIONS==Lead to
●●Loss of Initiatives and judgment
●Emotion Liability
●Loss of care of dress and appearance
■PRIMARY SOMATOSENSORY CORTEX
●●Receives crude touch pain and temperature
sensations.
■SECONDARY SENSORY CORTEX
●●Located in Superior Parietal Lobule.
●●Fine touch,proprioception and Vibration
●●Lesion leads to ASTERIOGNOSIS.
●●●Inability to appreciate Texture,Size and form.
●●e.g inability to recognize Key etc when you put
it into pts hands when his/her eyes are closed.
■■PARIETAL LOBE
●●Posterior Part Lesion leads to inability to
recognise opposite side of body.
■PRIMARY VISUAL AREA::
●●Walls of posterior part of Calcined sulcus.
●●Lesion of one side leads to CROSSED
HOMONYMUS HEMIANOPSIA.
●●Lesion of upper half==UQHHA.
●●Lesion of lower half==LQHHA.
■Secondary Visual Area
●●Lesion== opposite side Fields Defects.
■Primary Auditory Area
●●Cochlear Sensations
■Secondary Auditory Area
●●Lesion leads to WORDS DEAFNESS called
●●ACOUSTIC VERBAL AGNOSIA
●●Inability to interpret sounds.
TEMPORAL LOBE Supplied mostly by MCA.
>>>Lesion leads to SENSORY APHASIA/WERNICK
APHASIA. Speech is fluent but irrelevant.
>>>Auditory Hallucinations == Sign of
SCHIZOPHRENIA. (Visual hallucinations sign of drug
intoxication).
>>>Contains LIMBIC SYSTEM Hippocampus
lesion===Loss of Long term memory. (Short term
memory == Function Neurotransmitter changes.
Long term memory ==Function of Synaptic
structural changes). Amygdala lesion==Emotions
loss. PAPEZ CIRCUIT involving these structures and
others lesion leads to ==memory loss.
●■●■●■●■● OCCIPITAL CORTEX. Supplied mostly
by PCA. >>>Lesion of Posterior cerebral artery
leads to PRIMARY VISUAL CORTEX damage thus
causing: ●Visual field defects sparing MACULA
( VIP). ●Visual acuity loss.
INTERNAL CAPSULE LESIONS Parts
Anterior limb Body Posterior limb. ●■●■●■●■
>●>●>Lesion of Posterior limb Anterior 2/3rd part
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CEREBRAL CORTEX BRAIN DEATH (CEREBRAL
CORTEX DEATH))). VIP POINTS. is confirmed by
■DOLL'S EYE REFLEX == This is eye reflex present
in neonates and those with brain damage. It is
ascertained by turning head of patient from one
side to another with eyes lagging behind like a doll.
If eyes lag behind death is confirmed. ■
CALORIC VESTIBULAR TEST It is illustrated by cold
water in one ear that causes change in position if
patient is alive. Other tests are light RELEX and
accommodation etc.
BRAINSTEM DEATH SIGNS LOSS OF ■CORNEAL
REFLEX ( CN 5 & 7 involved ). ■CONJUNCTIVAL
REFLEX. ■GAG RELEX Compiled
■RESPIRATORY FUNCTION. ■PULSE BP.
FRONTAL LOBE ●■●■● Mostly inferomedial part
supplied by ACA (Anterior cerebral artery ===
supplying foot/leg area ((((VIP MCQ)))). Lateral and
remaining surface by MCA supplied. Lesion leads
to >>>Personality Changes, appearance behaviour
etc. Social withdrawal and self careless.
>>>Primary motor area 4==lesion leads to Severe
CONTRALATERAL PARALYSIS. >>>Pre frontal
cortex lesion== loss of Micturition reflex control by
cerebral cortex. >>>
BROCA'S AREA LESION==MOTOR APHASIA.
Speech is AFLUENT== Can understand but can't
communicate. Can understand writing.
Severe AGITATION and Depression. Lesion of
inferior part of Prefrontal Cortex. ●>●>●>Lesion
ANTERIOR PERFORATING SUBSTANCE leads to
LOSS OF OLFACTION SENSE.
PARIETAL CORTEX. Supplied mostly by MCA.
>>>Lesions lead to somatosensory impairment like
pain temperature proprioception visual and
Auditory sensations. >>>Lesion leads to
TRANSCORTICAL APHASIA (Communication deficit
in Motor and sensory speech area. ●
INVESTIGATIONS OF CHOICES ■MG==
EMG==Electromyography== decrease in response
to repeated electrical stimulation. Confirmatory
test . ■GBS===NCS ==Nerve Conduction studies.
Diagnostic Also CSF examination == High protein
no leukocytes. ■MULTIPLE SCLEROSIS ==MRI.
■MENINGITIS ===CSF examination ■SAH== CT
BRAIN and CSF exam. ■DSF== CT BRAIN.
■ISCHEMIC STROKES ===MRI but CT BRAIN should
be done first to exclude ICB(bleed).
leads to PURE MOTOR STROKE (DENSE STROKE)
bcz it carries MOTOR Fibres to Upper and lower
limbs. (VIP MCQ). ●■●■●■● >●>●>LESION OF
BODY OF IC leads to damage to Corticobulbar
fibres to Cranial nerves. Like Facial nucleus so
causing FACIAL PALSY and may be other nerves
involvement like 3 4 6 etc. ●■●■●■● Lesion of
Anterior limb and posterior 1/3rd of posterior limb
causes SENSORY IMPAIRMENT.
STROKE ((((((VIP TOPIC).
MC===Ischemic stroke round 70 % of all cases. MC
ARTERY involved === MCA.
causing APHASIA+ FACIAL PALSY. Depending on
artery blockage it affects specific part of brain as
mentioned and will be in each individual topic.
HEMORRHAGIC STROKE. HTN ●■●■●■● Most
commonly cause Small hemorrhage in BASAL
GANGLIA esp PONS and thalamus in
lemticulostriate arteries. Berry aneurysms
●■●■●■● Closely associated with APKD. MCC of
SUBARACHNOID HEMMORHAGE 90% cases Only
10 % cases are due to AVM etc.
THALAMUS >>>Relay station of all somatosensory
stimuli except Olfactory nerve which directly
bypass it and go to Cerebral cortex.
>>>Sensations from head and neck via trigeminal
lemniscus. >>>Sensations from lower parts of body
via Spinothalamic and DC--MLS. >>>Sensations go
to CONTRALATERAL CORTEX. >>>Lesion leads to
hemianesthesia
HYPERALGIA::: Lesion. (VIP MCQ ) Very low
threshold to pain stimuli. Just touching the patient
feels agitated and irritated. Remember this point
HYPERALGIA+ HEMIANESTHESIA ((((THALAMUS
INVOLVED )))).
RETICULAR FORMATION Consists of nuclie
located in gray matter of around 3rd ventricle in
midbrain also called PERI AQUEDUCTAL GRAY
MATTER OF MIDBRAIN. It also extends down to
other parts of CNS. ●MAIN FUNCTIONS
■Important in maintaining WAKEFULNESS.
■General anesthesia works on this area to produce
unconscious. ■Recovery drugs act on this area to
regain Conciousness. ■FACIAL EXPRESSION is a
function of RETICULAR FORMATION. ■PROLONG
Coma ==periaqueductal gray matter lesion (VIP
Group consensus). ■DEEP COMA===Locus cerulus
nucleus. ■AWARENESS == FUNCTION OF
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■HEMORRHAGIC STROKE ==CT BRAIN. ■AVM OR
BERRY ANEURYSMS == ANGIOGRAPHY for lesion
site detection. ■SPINAL CORD LESIONS==MRI.
■PERIPHERAL NEUROPATHY ==NCS. ■EPILEPSY ==
EEG. ■BRAIN TUMORS== CT/MRI. ■POSTERIOR
CRANIAL FOSSA TUMORS == MRI BEST.
■CAVERNOUS SINUS THROMBOSIS == MRI AND
MR
# COARCTATION OF AORTA
>>>>Quick CATCHING points. ■■PREDUCTAL
COARCTTATION Of AORTA. ●●IF just one limb like
right upper limb has high bp. And ●●Left upper
limb, BOTH lower limbs All remain 3 have low bp.
Then Dx== PRE DUCTAL COARCTTATION of AORTA.
CLINICALLY
●●Radio--Radial Delay ●●Radio--Femoral delay on
right side more prominent.
■■POST - DUCTAL COARCTTATION ●●If two upper
limbs spared like have high bp But only lower limbs
affected Then there will be no RADIO-RADAL
DELAY But there will be ONLY RADIOFEMRAL
DELAY on each side of the body right and left. ■■
ATRIAL FIBRILLATIONS:: # AF Just few quick picking
points in mcqs. ■Clinically ●Previous RHD Hx.
●Hyperthyroidism MS etc Hx ●Now with dyspnoea
dysphagia palpitations etc Hx. ■EXAMINATION
●Irregularly irregular pulse ●Pulses Deficit. ■ECG
●IRREGULAR R--R or P--P interval. ●ABSENT P
WAVES ●●NARROW QRS complex . >>>>Some
Random points. ■■In type 1 HSR ●●IgE binds to
mast cells and basophils. ●●IgE doesn't bind to
Eosinophil which is a very wrong misconception I
often note it. ●●Blood cells that
raise==Eosinophils. ●●IL-5== Interleukin for
Eosinophil activation and differentiation.
■■Gluconeogenesis ●●Main purpose is energy
fuel availability for RBCs and BRAIN which is
glucose. ●●RBCs totally depends on GLUCOSE for
its energy bcz it lacks MITOCHONDRIA due to
which it can't use FA for its energy production
unlike other tissues. ●●Brain can use FA and
ketone bodies in case of starvation. ●●Fasting
Hypoglycemia ●Most common cause==Alcoholism
bcz of excess production of acetyl CoA which is
converted to ketone bodies due to lack of NADPH
for the process of gluconeogenesis. ●Other causes
are carnithine acyltransferase deficiency etc.
CEREBRAL CORTEX. ■■
PONS ((((VIP POINT & MCQ)))). ■Supplied mainly
by AICA ■Blockage of AICA leads to Lateral pontine
syndrome. ■Lesion involve 5 6 7 8 nerves Esp 7th
nerve with facial palsy. On same side of
lesion((VIP)). ■Loss of sensations from lower body
occurs on opposite side due to decussation of
fibres already done in medulla below pons(VIP).
MEDULLA OBLANGATA
LATERAL MEDULLARY SYNDROME (Affects greater
rostral part of medulla OBLANGATA ). ■PICA==
Posterior inferior cerebellar artery supplies this
medulla. ■Blockage affects 9 10 11 12 CN. But esp
9 10. ■CN 9 & 10 pals is cause dysphagia and
hoarseness. ■Loss of sensations on same side.
■Motor /proprioception deficits on opposite sides.
MEDIAL MEDULLA MEDIAL MEDULLARY
SYNDROME
■Caused by ASA== Anterior Spinal Artery blockage.
■Most important point is 12 nerve palsy with
tongue motor dysfunction.
LOCKED IN JAW SYNDROME (VIP for 2 MCQS on
this topic). ■Caused by blockage of BASILAR
ARTERY.
■Involves greater part of BRAINSTEM. ■Causes
Ataxia ,Nystagmus, vertigo, vomiting,breathing
difficulty. ■Loss of Conciousness. ■Needs high
intensive Care with ventilation support etc.
CEREBELLOPOBTINE ANGLE TUMOR (((VIP MCQ))).
■Course is progressive like ■Headache ■Cranial
nerve palsies ■Horner syndrome.
# PIGMENTS >>>>Regarding pigments in the body
■EXOGENOUS PIGMENTS ●●Carbon
dust==Anthracosis Silica Dust==Silicosis Iron dust
●●Plumbism==Lead poisoning ●●Argyria==Silver
poisoning and its deposition in skin & Conjunctiva.
■■ENDOGENOUS PIGMENTS ●1●BILIRUBIN
●2●MELANIN
●3●HEMOSIDERIN ==Aggregates of Ferritin.
Hemosiderin ==Insoluble form. ●Hemosiderosis==
accumulation in macrophages with no
parenchymal cells damage. ●
HEMOCHROMATOSIS ==Accumulation in
parenchymal cells with tissue damage and
scarring. ☆☆HFE gene mutation is the cause
☆☆BRONZE DIABETES is caused by
hemochromatosis which is TRIAD of
>>Micronodular Cirrhosis >>DM >>Skin
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■■CHERRY RED SPOT MACULA ●●Occurs in ●Tay
Sachs disease ●Nieman Pick Disease ●CRAO. Etc.
■■Blue Sclera ● Osteogenesis Imperfecta. Many
others. ■■LONG chain fatty acids metabolism
occurs in PEROXISOME while short chain Fatty
acids (<<10 Carbon FA ) metabolism occurs In
mitochondria.
■■REGARDING AIDS ■AIDS Defining infection==
PNEUMOCYSTIS Carinii (old Jeroveci). ●● occurs
when CD4 count less than 200 cells/dl.
●●Rx==TMP--SMZ. Compiled By Kool-Medic
■■Best HIV sensitive test==ELISA ●● But false
positive in babies born to HIV Positive mother. ●●
So in those babies best test==HIV RNA PCR. ●● In
ADULTS first 1 to 2 months Elisa is false negative
due to no anti HIV antibodies. ■HIV confirmatory
test== Westren Blot. ●● But have some false
negative results due to HIV some strains and HIV--
3 undetectable. ●● So in these cases best==HIV
RNA PCR. ●● For viral load and therapeutic
response HIV RNA PCR is
FAT EMBOLISM ●Cause is traumatic fracture of
long bones mostly Like RTA/MVA ●Emboli reach to
lungs via veins ●Death can occur 24--72 hours. ●Rx
is supportive
■AMNIOTIC EMBOLISM ●Occur after normal
delivery mostly ●Death occurs even withen One
hour. ●Cause mostly found on postmortem Biopsy
tissue contains amniotic tissue or different fetal
tissue like lanugo hairs or other tissues etc. ●Very
fatal ●Rx supportive.
■PRIMORDIAL FOLLICLE==surrounded by ●Flat
epithelial cells
■PRIMARY FOLLICLES==Surrounded by ●SIMPLE
cuboidal cells single layer. ■Vimentin ==Type 2
intermediate filament ●Mostly found in
connective tissues ●Marker of Osteosarcoma
=tumours of connective tissues. ●Bcz sarcomas are
CONNECTIVE TISSUES MALIGNANCY ●Demarcates
invasion of tissues ■Keratin==Type 1 intermediate
Filaments ●Mostly found in epithelial cells of skin
and GIT etc. ●Markers of CARCINOMAS ●Bcz
Carcinomas are epithelial cells malignancies.
1■Para - mesonephric duct ==also called
Mullerian duct Gives rise to Uterus Fallopian or
uterine tubes Upper part of vagina Appendix
testes Etc. 2■Mesonephric ducts=also called
Wolfian duct Gives rise to All male genital ductal
Pigmentation. ●4●LIPOFUSCIN ● Also called
PIGMENT of WEAR & TEAR found due to aging
process in hepatocytes and cardiomyocytes.
●BROWN ATROPHY== LIPOFUSCIN accumulation
plus organ
CRANIAL NERVES RELATED.
CN 1& 2====Cerebral cortex. CN ---2===Mostly
terminates in LGB. Some fibres=== occipital visual
cortex.
CN--1=== olfactory cortex===Postero--inferior
temporal lobe. CN 3& 4====MIDBRAIN. CN 5 6 7
8=== PONS. CN 9 10 11 12 ====MEDULLA. ■Most
common nerve injury===Common peroneal
nerve(due to more exposed location around neck
of fibula. ■CN causing sleeping leg===Sciatic nerve.
■Longest cranial nerve===Vagus nerve that starts
from upper git to urinary bladder supplying.
■Largest CN=== Trigeminal Nerve. ■CN causing
eye movements===3 4 6. ■CN carrying B.P
sensation === 9 & 10. ■Thickest nerve===Sciatic
nerve ■CN with gustatory sensations===7 9 10.
■CN passing dorsal to brain===Trochlear nerve.
■MC nerve affected in Cavernous sinus thrombosis
===CN 6==medial squint. ■Nerve located at central
part of Cavernous sinus===CN 6 (Abducents). ■CN
paralysis in making patients difficulty downstairs
going===CN 4 Trochlear nerve. ■CN paralysis
causing. Ptosis Mydriasis Lower eye ball position
and Lateral position===CN 3 Oculomotor palsy.
MC Vitamin Deficiency
1■■Alcoholics===Folate and thiamine.
2■■Smoking===Vitamin C due to used up by FR in
smoke. 3■■New born===Vitamin K due to sterile
gut Compiled By Kool-Medic
Bcz MC source of Vitamin K is gut bacteria.
4■■Hospitalized Pts===Vitamin K>>>Biotin Bcz of
antibiotics use that kills gut bacteria 5■■Renal
Failure ===Vitamin D. Due to failure of 1 alpha
hydroxylation. 6■■Rice as staple diet===B1
Deficiency That's why it has been enriched with B1
in some countries 7■■Perniciuos
anemia===Autoimmune atrophic gastritis===B--12
deficiency. 8■■Colostrum (Breast milk upto 4
days)=== deficient in Vitamin D. 9■■Breast
milk=== deficient in D ,C and pantothenic acid
(Cpsp key). 10■■Goat milk === deficient in Vitamin
B6 ,Folate . 11■■Cow milk === deficient in Vitamin
A ,C ,D. 12■■Post menopauseal wome===
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system ●Epididymous ●Vas deferens ●Retes testes
●seminal vesicles. Etc. 3■PNH best investigation
==Flow cytometry. 4■Right handed people will
have
●●Right representational cortex and ● Left
categorical cortex And Vice versa
5■CIRRHOSIS HEP C==MCC of cirrhosis in adults in
Asia especially Alpha antitrypsin deficiency ==MCC
of cirrhosis in children 6■HCC ●HEP B ==MCC of
HCC in adults in Asia HEP ●Hep C ==2nd MCC .
>>>>>>>>Follow this sequence DVT Most common
sites Deep Calf veins>>>Popliteal >>>Femoral
veins. Bcz Occurence is high in given sequence PTE
Femoral >>>Popliteal >>>Deep calf veins. Bcz more
proximal to lungs there are more chances of
embolism to lungs. >>>>Follow it. TGs
Chylomycrons>>>>VLDL>>>>Chylomicron
Remnants.
■Granuloma===Characteristic cells===Epitheloid
cells ■Tuberculosis granulomas ===Caseating
granulomas/necrosis characteristic. Also occur in
histoplasmosis ●To differentiate ===AFB. ●Cervical
lymph nodes biopsy done Now characteristic
===Caseating granuloma Compiled By Kool-Medic
●Cervical lymph nodes biopsy done and biopsy
shows Caseating granulomas now further ===AFB
detection === definitive Dx. ■Non - caseating
granulomas===SARCOIDOSIS, Crohns disease
purpose of fixation of tissue== ☆☆☆ Preserve
tissue structure. ☆It's action===stabilisation of
proteins by cross links formation b/w proteins
molecules. ☆10% Formalin is used. Pure formalin
=== 37% solution of formaldehyde gas in water.
■■For embedding process=== paraffin wax is used.
■■BASOPHILIC DYES stains acid. Like DNA
RNA===Stained with basic dye So they are
basophilic===Blue/purple color. Basophilic dye===
●●●Hemotoxylin,Toluidine blue,methylene blue.
■■ACIDIC DYE stains basic organelles Including
cytoplasm. Eg.Eosin stains cytoplasm pink.
●>●>●>Collagen fibres stains light pink with
eosinophil dye(MCQ).
■■Leydig cells of testes====Forms testosterone.
Present in Testes connective tissue interstitium.
■■ Sertoli cells present in Seminiferous
epithelium. FUNCTIONS. ☆Support ☆protection
and nutrition to spermatozoa.
REGARDING CARDIAC ENZYMES
deficient in vitamin D (400 IU daily intake
recommended ). 13■■Women strict vegetarian
===B12 DEFICIENCY in her and her baby if
pregnant or non. 14■■Pregnant lady === Folate
deficiency bcz of its more excretion due to
increased GFR And Fetal tissue growth
consumption.
15■■Pregnant lady with alcohol consumption
===MC Vitamin Deficiency ===Folate. Increased
NTDs risk.
16■■People having just maize their Staple
diet===B3 NIACIN deficiency ===risk of PELLAGRA
3D diarrhea dementia dermatitis. 17■■Celiac
disease involves ===Jejunum mostly===So Folate
deficiency.
18■■Crohns disease ===Involves ILEUM ===so B12
deficiency occur. 19■■Terminal ileal resection
===B12 &Bile salts deficiency === osmotic diarrhea
and increased water loss and bile salts (Ganong).
20■■Cystic Fibrosis ===ADEK fat soluble vitamins
deficiency
21■■Total pancreatectomy === ADEK DEFICIENCY.
22■■Alcoholics==MC metal deficiency of Mg.
Highest energy compound
ATP Highest energy content===STARCH Highest
energy molecule===STARCH Protein==4.1kcal/gm
CHO==3.8 kcal. Alcohol == 7kcal. Fats== 9 kcal
cardiovascular system. 1●Apex formed by Left
ventricle 2●Base of heart formed by=== Left
atrium 3●Posterior most part of heart=== Left
atrium 4●Cardiac vein independently draining to
right atrium===Anterior cardiac vein. 5●CHB===
Blockage of RCA 6●Posterior wall MI=== RCA
Blockage. 7●RV infarction === RCA blockage
8●RBB ===supplied by LCA. 9●MC CAD===LAD
10●LAD blockage=== LV Anterior ++Apical
infarction. 11●Overall best drug for Angina
=Nitrates Initial best therapy for Stable
angina====Beta blockers. 12●Drug of choice for
VASOSPASTIC / Prinzmetal angina ===Verapami
13●Drug contra-indicated in Vasospastic angina
===Beta blockers (((due to beta receptors blockage
in blood vessels causing alpha receptors
predominant and thus vasospasm ))).so also
contraindicated in PVD(((SS crest syndrome
raynauds phenomenon))). 14●Vessels favoured for
CABG=== Internal thoracic artery ===due to
elasticity of arteries than veins=== NO stenosis===
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■■MOST SENSITIVE ==MYOGLOBIN
BUT less specific due to Non-Cardiao specificity
Raise in trauma skeletal muscle damage etc.
■■EARLIEST TO APPEAR==MYOGLOBIN.
■■MOST CARDIOSENSITIVE== TROP T.
CPSP KEY (if not mention withen one hour).
■■MOST CARDIOSPECIFIC ==TROP I.
■■CARDIOSPECIFIC raising within one
hour===CKMB.
Microbiology Ist Aid
Ascetic 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 - S.Aureus.
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.
Tubulo ovarian cyst - Gonococcus.
Abscess - S.Aureus.
Acute osteomyelitis - S.Aureus.
Toxic shock syndrome - S.Aureus.
Wound infection - S.A
Valvular itching + Pink purulent discharge -
Trichomanas vaginilis.
Infection in post liver transplant patient - CMV.
Chorioretinitis in AIDS - CMV.
Bronchogenic carcinoma - CMV.
Herpangia - Coxsakie virus.
.
long survival. 15●Cardiac muscle pain is radiated
to the arm and shoulder === Via T1---T5 thoracic
segments === Sympathetic ANS fibres 16●Pain
from pericardium is radiated to the jaw or
shoulder via===C345 (((Somatic== phrenic nerve)).
Microbiology Points
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
How to Solve Metabolic problems?????
normal values of ABG,s
pH ... 7.35-7.45
pCO2... 35-45 mmHg
HCO3- ... 22-26 mEq/L
pO2 ... 80-100 mmHg
1)Look pH first.. if low then acidosis, if high then
alkalosis.
2) Decide z it respiratory or metabolic.
pCO2 level disturbance shows respiratory prob
if pCO2 z raised, resp acidosis n versa
HCO3 level disturbance shows metabolic prob
if HCO3 level z raised , metabolic alkalosis n vice
versa
3) Decide z it compensated or uncompensated.
if there z prob in pCO2 n HCO3 levels n pH z in
normal range, it z compensated
if pH z not in normal range , it z uncompensated.
if prob in respiratory system, lungs or chest , it will
b respiratory prob
if prob in other than lungs, i.e it will b metabolic
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