DIPLOMA EXAM BATCH-MARCH-21

TOPIC(1-60):GENERAL & SYSTEMIC BACTERIOLOGY

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-01
DIFFERENCE BETWEEN EUKARYOTIC & PROKARYOTIC CELL:
Traits Eukaryotic cell Prokaryotic cell
1.DNA within a nuclear Present Absent ( Cells have no true nucleus but have
membrane+DNA with nucleoid in replace)
histones,introns+Nuclear
membrabe,Nucleolus,nucleoplasm.
2.Membrane bound organelles Present Absent
(Mitochondria,Golgi
body,Plastids,lysosome)
3.Sterol Present Absent (Except mycoplasma)
4.Cromosome no. More than one (Many linear) One (Single circular)
5.Size of Ribosome 80S (60S+40 S) 70S (50S+30S);Coupled transcription &
translation
6.Cell wall containing peptidoglycan Absent (Made up of cellulose chitin) Present
7.Plasmid Absent Present
8.Cellular respiration Mitochondria Cytoplasmic membrane
9.Reproduction By mitosis By binary fusion ( Asexually)
10.Example Human cells,protozoa,fungi,plant cells All & only bacteria
 TOPIC-02

GRAM POSITIVE ORGANISM: (COCCI)

 Catalase positive:

1.Staph.aureus (Coagulase +ve)

2.Staph.Epidermidis (Coagulase –ve)

3.Staph.saprophyticus ( Coagulase –ve)

 Catalase negative:

4.Streptococcus pneumonia-- (alpha-haemolysis)

5.Viridans streptococci----------(alpha haemolysis)

6.Streptococcus pyogens-------(beta haemolysis)

7.Streptococcus agalactiae-----(beta haemolysis)

8.Enterococci------------------------(gamma haemolysis).

 GRAM POSITIVE ORGANISM:(BACILLI)—ABCDLN .

TOPIC-03
TOPIC-03
TOPIC-04-CAPSULATED BACTERIA
TOPIC-05-PLASMID
 TOPIC-06

FACULTATIVE INTRACELLULAR ORGANISM:

BACTERIA= 2B+ 2L+2N+ RYSa+Mycobacterium
FUNGUS= Histo+Crypto
 2B= Bartonella Henselae, Brucella
 2L =Listeria monocytogens, Legionella
 2N= Neisseria meningitides, Nocardia
 RYSa= R-Rhodococcus, Y-Yersinia, Sa-Salmonella typhi.
 Mycobacterium tuberculosis
 Histo=Histoplasma capsulatum
 Crypto=Cryptococcus neoformans
 TOPIC-07
Medically important bacteria that can not seen on gram staining:
1.Mycobacterium TB- too much lipid in cell wall so dye cannot penetrate
2.Treponema pallidum- too thin to see
3.Mycoplasma pneumonia- no cell wall; very small

4.Legionella pneumonia- poor uptake of red counterstain

5.Rickettsia- intracellular; very small
6.Chlamydia- intracellular; very small.
 TOPIC-08

Fastidious organism:
 Organisms that will grow only if special nutrients are presents in their culture
medium.
 Examples: 2N+ 2H+2B+ MLS.
2N= N.gonorrhea, N.meningitides
2H = H.Pylori, H.influenza
2B= Bordetella pertussis, Bacteroid fragilis
MLS=M.tuberculosis
Legionella
Spirochetes.
 TOPIC-09
NONESSENTIAL COMPONENTS OF THE BACTERIAL STRUCTURE:
Mnemonic: Cap. PG(2) & FS
 Cap=Capsule
 P=Pilus+plasmid
 G=Granule+Glycocalyx
 F=Flagellum
 S=Spore
 TOPIC-10
BACTERIAL STRUCTURE SHOWING ANTIGENIC DIVERSITY:
MNEMONIC “FCPS”
F Flagella
C Capsule
P Pilli
S Spore.
 TOPIC-11
Facultative intracellular parasites are capable of living and reproducing either inside or outside cells.
Examples: **Facultative intracellular fungus:
 Bartonella henselae,  Histoplasma capsulatum
 Francisella tularensis,  Cryptococcus neoformans.
 Salmonella typhi,
 Brucella abortus
 Legionella pneumonia
 Listeria monocytogens
 Mycobacterium
 N.meningitides
 Nocardia
 Rhodococcus
 Yersinia pestis.
 TOPIC-12
SPORE BEARING ORGANISM:
 Aerobic spore bearing organism: Bacillus species
 Anaerobic spore bearing organism: Clostridium species
+
Coxiella burnetti
 TOPIC-13
METHODS OF STERILIZATION: (Gamma Radiation + Gluteryldehyde/EO Gas)
Gamma Radiation: Disposable plastic materials=plastic syringe,plastic tube,Surgical gloves
Transfusion equipment= cannula,catheter
Arterial graft & other biological material.

Ethelene oxide/Gluteryldehyde: Endoscope,cystoscope,Heart-lung machine,drain-tube.

 TOPIC-14
 Autoclaving:

1. Suture material silk

2. Linen substances OT mask, Gown, cap, drapping sheet, bed
cover.
3. Bottle with rubber cap.
4. Agar based culture media.
5. Blunt surgical instruments.
 TOPIC-17
 Hot-air Oven 160 degree C/hour= Glass wares.

 Glass syringe, Petridish + Glass pipettes

 Test tube+ Test tube with swab stick+ Flask
 Powder, oil , fat.
 TOPIC-18
EXOTOXIN:
 Certain species of gram +ve & gram –ve bacteria
 Secreted from cell
 Polypeptide
 Highly soluble+Highly antigenic+Highly toxic
 Toxoid formation
 Heat labile----destroyed rapidly at 60 degree centigrade
 Various mode of action & various clinical effect
 TOPIC-19
EXOTOXIN PRODUCING ORGANISM:
Exotoxins are usually Heat labile except-Bacillus cereus,E.coli,Staph.aureus.
 CLUE: EBV---------BCS
 E----E.Coli
 B----Bordetella pertussis
 V----Vibrio cholerae
 B-----Bacillus anthracis
 C (5)-----Corynebacterium, Clostridium tetany, botulinum, difficile, perfringens
 S(2)----Staph.aureus, Strep.pyogens.
 TOPIC-20
Exotoxin that increases c-AMP level:
Mnemonic “PEACE”.
P Pertusis toxin
E E.coli labile toxin
A Anthrax toxin (Edema factor)
C Cholera toxin
E E.coli labile toxin.
 TOPIC-21
 PREFORMED TOXIN:

 S S.aureus enterotoxin
 B Botulinum toxin
 B Bacillus cereus enterotoxin
 TOPIC-22
LACTOSE FERMENTER:
E.Coli
Klebsiella
Enterobacter
Citrobacter.
 TOPIC-23
NORMAL VAGINAL FLORA:
CLUE: (BCG-----SLE )
B= Bacteroids fragilis
C=Candida, C.Diphtheriae
G=Group B Streptococcus (Strep.agalactiae)

S= Staph.aureus
L=Lactobacillus
E= E.Coli
 TOPIC-24
NORMAL FLORA OF NOSE:
CLUE: SSC
S=Staph.aureus
S=Staphylococcus epidermidis, Streptococci
C=C.diphtheria

N.B Normal flora of the gut  synthesis & excrete Vitamin K & B12.
 TOPIC 25
NORMAL FLORA OF THE SKIN:
 Coagulase-negative staphylococci
 Staph.aureus
 Corynebacterium spp.
 Propionobacterium spp.
 Malassezia spp.
NORMAL FLORA OF THE ORAL CAVITY:
 Oral streptococci (Alpha-haemolytic)
 Anaerobic Gram positive bacilli (Including
Actinomyces).
 Anaerobic Gram negative bacilli
 Prevotella spp & fusobacterium spp.
 Candida spp.
 TOPIC-26
Beta lactamase producing bacteria:
 E.coli +Enterobacter
 Klebsiella
 Proteus
 Pseudomonas
 N.gonorrhea
 H.influenza
 Staph.aureus
 TOPIC-27
BACTERIAL MECHANISM OF RESISTANCE:

Production of beta lactamase enzyme= penicillin, cephalosporin

Efflux pump= Tetracycline,Sulphonamide
Altered porins= penicillins,Aminoglycoside
 TOPIC-28
KILLING OF SPORES:
 Spores are killed by exposure to:
Dry heat at 160 degree centrigade for 1 hour
Ethelene oxide.

N.B. Hydrogen peroxide has been used as an antiseptic but has little role / no action on bacterial spores.
 TOPIC-29
SUPERANTIGEN PRODUCING ORGANISM:
CLUE: BCS
B=Bacillus cereus
C=Clostridium perfringens
S= Staph.aureus ( TSST,Staphylococcal Enterotoxin)
Strep.pyogens (Erythrogenic toxin)
 TOPIC-30

BLOODY DIARRHOEA (Organism):

 Campylobacter
 Shigella ,non-tyhoidal salmonella
 Enteroinvasive & Enter-haemorragic E.coli
 Clostridium difficile
 Vibrio parahaemolyticus
 Entamoeba histolytica
 TOPIC-31
VIRULENCE FACTOR OF STAPH.AUREUS:
CELL WALL FACTOR:
Peptidoglycan , Teichoic Acid, Clumping factor( bound coagulase), Protein A.
TOXINS: Haemolysins (alpha,beta & gamma haemolysin)
Leucocidins (P-V Leucocidins)
Exfoliative toxin (Epidermolytic toxin)
Enterotoxins
Toxic shock syndeome toxin
Pecuilarities of Staphylococcal enterotoxin: Preformed+ Heat stable+Acid Stable+Exotoxin+common agent
of food poisoining.
 TOPIC-32
DISEASE PRODUCED BY STAPH.AUREUS:
INFLAMMATORY:
 Skin infections=Impetigo,furuncle,curbuncle,boils,abscess,cellulitis,folliculitis,eye lid infections.
 Septicemia.
 Osteomyelitis+Endocarditis+Conjunctivitis+Antibiotic associated enteritis.
 Pneumonia,lung abscess,brain abscess,empyema.
 Post surgical wound infections+Cross infections in Hospital.
TOXIN MEDIATED:
 Food poisoining-- by enterotoxin.
 Toxic shock syndrome toxin—by TSST-1.
 Scalded skin syndrome—by Exfoliatin.
 TOPIC-33
 MRSA:

 Mediated by MecA gene= Chromosomal mediated drug resistance.

 It alters “PBP” Present on S.aureus cell membrane .
 30-40% strains of S.aureus are MRSA.
 MRSA Resistant to all beta lactum antibiotics.
 Phage typing  Differentiate between MRSA Outbreak strains.

 Drugs effective against MRSA Clindamycin, Vancomycin, Rifampicin

Linezolid, Daptomycin, tetracycline,
Tigecycline,Co-trimoxazole.
 TOPIC-34
 ASO Test:

 Measure Blood plasm alevels of Antistreptolysin Ab= Measures Ab against streptolysin ‘O’.
 High Soon after infection (Within 1-2 weeks usually)
 Diagnose Helps in the diagnosis of scarlet fever,RF, & PSGN= Not diagnostic.
Helps to direct Antimicrobial treatment.
 False positive in Liver disease & Tuberculosis.
 Positive when titre goes > 200 U/ml.
 TOPIC-35
SUPPURATIVE & NON-SUPPURATIVE MANIFESTATIONS OF STREPTOCOCCUS PYOGENS:
SUPPURATIVE:
 Respiratory=Pharyngitis+pneumonia+Empyema
 Scarlet fever
 Skin & soft tissues: Impetigo+Cellulitis+Erysipelas+Necrotizing fasciitis
 Toxic shock syndrome +Streptococcal myositis.
NON-SUPPURATIVE:
 Acute Rheumatic fever+ Reactive arthritis
 PSGN+PANDAS(Paediatric autoimmune disorders associated with strep.pyogens)
 Guttate psoriasis
 TOPIC-36

NON-TYPEABLE STREPTOCOCCI:

CLUE:Predominantly Respiratory mucosal pathogens.

-Streptococcus pneumonia
-Streptococcus viridans.
 TOPIC-63
 IgA PRODUCING BACTERIA:

CLUE: 03 important capsulated organism:

1.Streptococcus pneumonia
2.Haemophillus influenza
3.Neisseria meningitides.
 TOPIC-37
LYSOGENIC CONVERSION:
Lysogenic Toxin:
B=Botulinum Toxin
C=Cholera Toxin
D=Diphtheriae Toxin
E=Erythrogenic toxin of streptococcus pyogens
Enterotoxin of S.aureus
E.Coli—Heat labile toxin of E.coli.
 TOPIC-38
ENTEROCOCCUS:
CRITERIA:
 Gram +ve oval cocci.
 Non-motile
 Group-D Streptococcus.
 Normal flora of human GIT.
 Most common species—E.Faecalis.
 Causes—UTI +Bacteremia & Mitral Valve Endocarditis+ Intra-abdominal,Pelvic & Soft-tissue infection
 Produces non haemolytic translucent colonies in blood agar & pink colonies on Mac Conkey agar.
 Growth occurs in presence of—6.5% NaCl,40% bile & PH—9.6
 Resistant to penicillins,aminoglycosides & sulphonamides but resistant is overcome by combination therapy with
penicillin+aminoglycoside.Vancomycin also indicated in resistant cases.
 TOPIC-39

METACHROMATIC GRANULES:
CLUE: (ABC—PY)
A=Atypical mycobacteria
B=Bordetella pertussis
C=C.diphtheria
P=Pseudomans aeroginosa
Y=Yersinia Enterocolitica.
 TOPIC-40
 EFFECT OF C.DIPHTHERIAE:
1.Formation of pseudo-membrane
2.Pyrogenic Effect—fever.
3.Tissue poisoining effect:
Heart=Toxic myocarditis,Fatty degeneration,acute circulatory failure.
Blood vessels=Peripheral circulatory failure.
Kidneys=Nephrosis & Interstitial nephritis.
Adrenal gland= Fatty change & Haemorrage.
Nerve=Toxic neuritis.
 COMPLICATIONS: 1st week=laryngeal obstruction/paralysis
2nd week=Myocarditis
3rd week=Cranial nerve palsy.
 TOPIC-41
LISTERIA MONOCYTOGENS:
CRITERIA:
1.Gram +ve,Non-spore forming ,Facultative aerobs which is V/L shaped & responsible for zoonotic disease.
2.Not microaerophillic but produces beta haemolysis on blood agar.
3.Shows unusual tumbling movement at 25 degree but non—motile at 37 degree centigrade.
4.Grows in cold temperature—so storage of contaminated food in the refrigerator can increase the risk of
gastroenteritis—cold enhancement.
5.Can cross the placenta.
6.CAUSES—Meningo-encephalitis,sepsis in new born,abortion,premature delivery,Flu-like
illness,chorioamnionitis,infective endocarditis,cutaneous listeriosis.
 TOPIC-42
ATYPICAL PNEUMONIA:
 Mycoplasma pneumonia
 Chlamydia pneumonia
 Legionella pneumophila
 Chlamydia psittaci
 Coxiella burnetti
 Actinomyces israelli
 Viruses Influenza virus, Adenovirus.
 TOPIC-43
MYCOPLASMA PNEUMONIAE:
KEY FEATURES:
1.No cell wall.
2.Causes—Atypical pneumonia/walking pneumonia/Eaton agent pneumonia.
3.Causes—Autoimmune haemolytic anaemia.
4.Produces—Fried egg colonies.
5.Positive cold agglutinin test.
6.Resistant to beta lactum drugs(No cell wall).
7.Treated with—Macrolides(Azithromycin/Erythromycin).
 TOPIC-44
BACTERIA ASSOCIATED WITH FOOD POISOINING:

S=Staph.aureus
S=Salmonella Typhi
C=Clostridiu botulinum+C.Perfringens+Campylobacter

E=E.coli
B=Bacillus
V=Vibrio parahaemolyticus.
 TOPIC-45
MILK BORN PATHOGENS:

Mycobacterium Bovis
Salmonella
Streptococci
Listeria
Brucella.
 TOPIC-46
DISEASE CAUSED BY CHLAMYDIA:

1.Chlamydia Trachomatis—Trachoma+LGV(Lymphogranuloma venereum).

2.Chlamydia pneumonia —Atypical pneumonia.
3.Chlamydia psittaci—Psittacosis .
 TOPIC-47
CLASSIFICATION ANAEROBIC BACTERIA:
Gram +ve anaerobes:(Bacilli)
Spore forming—Clostridium
Non-spore forming—(PLAB—Eu )
P=Propionobacterium
L=Lactobacillus
A=Actinomyces
B=Bifido bacterium+ Eu—Eubacterium .
Gram +ve anerobes: (Cocci)= 2P=Peptostreptococcus+peptococci.
Gram-ve anaerobes:(Bacilli)=PBF=Prevotella+Bacteroids+Fusobacterium.
Gram-ve anaerobes:(Cocci)=Veilonella.
 TOPIC-48
VIRULENCE FACTOR OF TB:

1.Cord factor
2.Sulphatides
3.LAM(Lipoarabinomannan)
4.Heat shock protein
5.Exported repetitive protein.
 TOPIC-49
SITES OF PRIMARY TB & STAINS FOR IDENTIFICATION:
 Sites Lung + Intestine + Skin + Tonsil = LIST.
 Stains Acid fast stain + Zeihl nelsen stain +Auramine phenol technique+ Kinyoun’s cold acid fast
staining.
 Don’t forget Mycobacterium TB is  a facultative intracellular bacteria
 Obligate aerobe, Cell wall has high lipid content.
 Produce Catalase & peroxidase enzyme but no toxin.
 M.kansasii : Produce lung disease
 M. marinum: Swimming pool granuloma/Fish tank granuloma.
 M.scrofulacium causes cervical granulomatous lymphadenitis.
 TOPIC-50
FALSE ( –VE ) TB:
 Overhelming TB+Miliary TB+Leprosy
 Measles+Malnutrition
 Sarcoidosis+Brucellosis
 Scarlet fever+Hodgkin’s disease
 Administration of immunosuppressive drugs
 Before 6 months of age+Before 4 weeks of infection.
 TOPIC-51
PIGMENT PRODUCING BACTERIA:

 Staph.aureus—golden yellow
 Pseudomonas—pyocyanin,pyoverdin,pyorubin,pyomelanin.
 Atypical mycobacteria—Mycobacterium kansasii+marinum+scrofulaceum
 Serratirubidae—red pigment.
 TOPIC-52
 Neisseria gonorrhoea:

 Non-capsulated,Gram (–ve) +Oxidase positive  kidney shaped diplococcic.

 Transmission Sexual contact+ During birth.
 Source of infecton Genital tract infection & Anorectal,pharyngeal infection.
 Quite sensitive to dehydration & cool environment.
 Virulence factor Pili/Fimbriae, Outer membrane protein (Porin),Opacity associated protein
(Protein II),Transferrin-binding & lactoferrin binding protein,IgA protease,LOS.
 Grows in Chocolate agar & Mueller-Hinton agar media.
 Coinfection may present with Chlamydia trachomatis (10-30%).
 Has Antigenic variation like Influenza virus type A & HIV.
 TOPIC-53
 COMPLICATIONS OF GONORRHOEA:

 Male=Epididymitis+ Gonococcal arthritis+ Prostatitis+ Oedema of the penis+ Balanitis (Not circinate
balanitis)+Stricture urethra.

 Female= PID+Salpingitis+Sterility+Fitz-Hugh Curtis syndrome.

 Neonate=Ophthalmia neonatorum.
TOPIC-54
 TOPIC-55
FEATURES OF TUBERCULOID LEPROSY:
CLUE:
Asymmetrical
Good+Common+Marked+Early
Paucibacillary
Cell mediated.
 TOPIC-56
COMPLICATION OF ENTERIC FEVER:
 GIT—Haemorrage+Perforation
 Liver & Gall bladder—Hepatitis+Cholecystitis
 Lungs—pneumonia+bronchitis
 Meninges—Meningitis
 CNS—Transverse myelitis+optic neuritis+Raised ICP
 HEART—Myocarditis+Endocaritis
 Renal—Pyelonephritis
 Others—orchitis+parotitis.
 TOPIC-57
VIBRIO CHOLERAE:
 Curved,.comma-shaped bacilli.
 Gram –ve & oxidase +ve.
 Monotrichous flagella
 Prdouces exotoxin+Best grows at Ph 7.0
 0139 strains causes cholera—dehydration+No RBC,Plenty of mucous on microscopy.
 Antigenic structure—O & H Ag.
 Can cause hypovolemic shock & without Tx mortality—40%.
 Tetyracycline shortens the symptoms & reduce the excretion of organism.
 TOPIC-58
HAEMOPHYLUS REQUIRES X-FACTOR FOR THEIR GROWTH:
1.H.Influenzae—X & V
2.H.Para influenza—only V
3.H.Ducrey—only X
4.H.Haemolyticus—X & V

 Factor V—Is heat labile –NAD, Factor X—Is heat stable-heme.

 It is the normal flora of the URT.
 Gram –ve coccobacillus+IgA protease producing bacteria+Encapsulated bacteria.
 TOPIC-59
AIRBORNE TRANSMITTED INFECTIONS:
Droplet nuclei TB, Influenza, Chicken pox, Measles, Q fever,Covid-19.
Dust borne (Common in hospital acquired infection).
 Coccidiodomycosis, streptococcal & staphylococcal infection+ Pneumonia,TB, Q fever, psittacosis.
 Others Aspergillosis,Brucellosis, Inhalational anthrax, meningococcal infection.
 TOPIC-60
CLOSTRIDIUM TETANY:
 Gram positive Obligate anaerobe Motile Produces spherical & terminal spore
 Noncapsulated & IP 6-10 days.
 Widely distributed in soil,hospital & intestine of man & animals.
 Two exotoxins Tetanolysin & tetanospasmin.
 Mode of transmission Injury like RTA, Unsterile surgery/abortion/delivery & otitis media.
 Has one antigenic type+ Causes Spastic type of paralysis.
 Complications Risus sardonicus, Opisthotonus position of the body, Respiratory muscle paralysis.
 Can cause Autonomic disturbance : 2nd week of severe tetanus.
 TOPIC-61
 Streptococcus faecalis : (Smiddy)

 Is a common inhabitant of the GI tract

 Grows in long chanis False Grows in pairs looking like spectacles (In short chains)
 Florishes in bile salt lactose media.
 Is concerened in the aetiology of periodontal disease.
 Is an opportunistic rather than true pathogen.
 TOPIC-62
 Bacteria in infected wounds : (Smiddy)

 E.coli
 N.meningitides False.
 Streptococcus pyogens
 Streptococcus faecalis
 Bacteroids fragilis.
THANK YOU EVERYONE
 DIPLOMA BATCH-MARCH-21
TOPIC(64-123):PARASITOLOGY+VIROLOGY+VACCINE+MYCOLOGY

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-64

HUMAN ACTS AS AN INTERMEDIATE HOST:

CLUE: (PM—ON—ETV )
1.Plasmodium
2.Multiceps multicep
3.Echinococcus granulosus
4.Toxoplasma gondii
5.Visceral & cutaneous larva migrans.

N.B.Both definitive & intermediate host= T.solium, Trichinella spiralis.

 TOPIC-65

FREE LIVING AMOEBA:

 Naegleria fowleri
 Naegleria gruberi
 Acanthamoeba castenalli
 Hartmanella spp.
 Balamuthia mandrilaris
 TOPIC-66
PARASITES CAUSING ANEMIA:
 Protozoa:
 Leishmania,Plasmodium,Trypanosoma,Giardia.
 Helminths:
 Ancylostoma duodenale,
 Necator Americana,
 Ascaris lumbricoids,
 Diphyllobothrium latum,
 Taenia,
 Schistosoma haematobium.
 TOPIC-67

Parasites found in blood:

 RBC=Malaria parasite+ Babesia microti

 Monocyte=L.donovani
 Plasma=W.bancrofti+Brugia malayi+Trypanosoma brucei
 TOPIC-68
 Parasites seen in PBF (“BPLTM”)

 B Babesia
 P Plasmodium

 L Leishmania
 T Trypanosoma

 M Microfilaria
 TOPIC-69

 Parasites & helminth causing surgical

complications:
 E.granulosus & E.multilocularis
 Ascaris lumbricoides

 S.haematobium+ S. mansoni & japonicum

 E.histolytica

 W.bancrofti
 TOPIC-70

 Intestinal flagellates (“ERCP DT”)

 E Enteromonas Hominis
 R Tetromonas intestinalis
 C Chilomastix mesnili (caecum)
 P Penta trichomonas hominis

 D Dientamoeba fragilis
 T Trichomonas vaginalis + Trichomonas tenax+ Trichomonas
hominis.
 TOPIC-71
HAEMOFLAGELATES:
 Trypanosoma:
T.brucei—sleeping sickness
T.cruzi—chagas’ disease
T.rangeli—non-pathogenic
 Leishmania:
L.donovani
L.tropica
L.brasiliensis
 TOPIC-72

PARASITES CAUSING CANCER:

 Clonorchis sinensis—Cholangiocarcinoma .
 Opisthorchis(flukes)—cholangiocarcinoma
 Schistosoma hematobium—SCC of UB.
 TOPIC-73

PARASITES INFECTING THE HUMAN LIVER:

LIVER FLUKES: Fasciola hepatica & F.gigantica+Chlonorchis sinensis,Opisthorchis feleneus & viverrini.
OTHERS:
 Plasmodium
 Leismania+Toxoplasma
 Entamoeba+Echinococcus
 Schistosoma+Strongyloides stercoralis
 Cryptosporidia
N.B—Fasciolopsis buski is an intestinal flukes—not affecting the liver.
 TOPIC-74

PARASITES EGG FOUND IN URINE:

CLUE: MOST.
M=Microfilariae of W.bancrofti
O=Onchocerca volvulus
S=Schistosoma hematobium
T=Trichomonas vaginalis
 TOPIC-75

 Bile satined Egg  Not bile stained egg

 Cestode  Taenia solium  H.Nana

 Nematode  Ascaris lumbricoids  Enterobius vermicularis
 Trichuris trichura  Ankylostoma duodenale
 TOPIC-76

 CYST FOUND IN THE STOOL:

 Protozoan cyst  E.histolytica, hartmanni & E.coli
 Giardia intestinalis

 Coccidian cyst & sporozoite  Isospora beli

 TOPIC-77

PARASITES AFFECTING EYES:

CLUE: “TOMAL”
T=Toxocara canis,cati,gondii + Trypanosoma(orbital oedema)
O=O.Voulvulas
M=Microsporidiae
A=Acanthamoeba
L=Loa Loa.
 TOPIC-78

TRICHOMONAS VAGINALIS:
 Found only in trophozoite form—No cystic phase.
 Pear shaped—live in female genital tract.
 Sexually transmitted.
 Produce foul smelling greenish vaginal discharge with itching & burning sensation in female.
 Asymptomatic in male usually—in 10% cases may cause male urethritis
 Treated with ciprofloxacin & metronidazole.
 TOPIC-79
KALA-AZAR:
 Phlebotomas argentipes (sand fly) is the vector.
 Protozoal disease
 Promastigote (Infected form) detected in Blood culture (N.N.N media) & in infected sand fly.
 Amastigote form Detected in Splenic aspirate, Bone marrow aspirate & epitrochlear lymph node.
 Thick film Presence of parasites & thin film Amastigote form.
 Mode of transmission By sandfly during blood meal,Congenital infection in utero, Blood transfusion,
During coitus , Inoculation of cultures of L.donovani.
 Causes of anemia Increased sequestration of RBC in spleen+ Invasion of bone marrow by LD
body+Dev.of anti-red cell Ab+Intravascular haemolysis, bleeding.
 Treated with Pentavalent antimonials, liposomal amphotericin B, Miltefosin,Paromomycin,
Pentamidine isotetionate.
 TOPIC-80
 INVESTIGATION FINDINGS OF KALA-AZAR:

 Pancytopenia is the dominant feature with granulocytopenia and monocytosis.

 Polyclonal hypergammaglobulinaemia.
 Hypoalbuminaemia are seen later.
 Demonstration of amastigotes (leishman–donovan bodies) in splenic smears.
 Bone marrow or lymph node smears, are not as sensitive.
 Parasites may be demonstrated in buffy coat smears, especially in immunosuppressed patients.
 PCR for DNA detection and species identification.
 Serodiagnosis, by ELISA or immunofluorescence antibody test is employed in developed countries
 Formal gel (aldehyde) or other similar tests based on the detection of raised globulin have limited value
 IN endemic regions, a highly sensitive direct agglutination test using stained promastigotes and an equally
efficient rapid immunochromatographic k39 strip test have become popular.
 TOPIC-81
DIFFERENCE BETWEEN SPOROZOITE & TROPHOZOITE INDUCED MALARIA:

Trait Sporozoite induced malaria Trophozoite induced malaria

1.Pre-erythrocytic schizogny present absent

2.Incubation period long short
3.Latent stage (Hepatic) May be present absent
4.Relapses May occur Do not occur
5.Sczizonticidal drugs No radical cure Can be radically cured
6.Example Normal endemic infection Transfusion malaria
Congenital malaria
Malaria in drug addicts
 TOPIC-82
Anemia in malaria Normochromic normocytic Due to:

Anemia Normochromic Normocytic

Causes  Parasite induced RBC destruction Lysis of RBC due to

release of merozoites.
 Hypersplenism/Splenomegaly
 Anti-malarial therapy in G-6PD deficiency
 Autoimmune lysis
 Decreased incorporation of iron into haeme
 Increased fragility of RBC
 Bone marrow suppression Dyserythropoiesis
 Depletion of folate stores.
 TOPIC-83
DRUGS USED IN CHEMOPROPHYLAXIS OF MALARIA:
 Where chlorocuine resistance is high:
 Mefloquine
 Malarone
 Doxycycline
 Where chloroquine resistance absent:
 Chloroquine
 proguanil
 TOPIC-84

Nematodes having lung infiltrating phase during their lyfe cycle:

CLUE: E—SANA

E= E.granulosus
S=Strongyloides stercoralis
A=Ancylostoma duodenale
N=Necator Americana
A=Ascaris lumbricoides
 TOPIC-85
PARASITES INFECTING THE BRAIN:

Protozoa (ATP-N) Helminth (PSC-E)

Acanthamoeba P.westermanni
Toxoplasma S.japonicum
T.cruzi S.stercoralis
P.falciparum Cysticercus cellulosae
N.fowleri E.Granulosus (Hydatid cyst)
 TOPIC-86

 PARASITES WHICH ENTER THROUGH SKIN PENETRATION:

Nematode (SAN-W) Trematode (SSS)

S=Strongyloides stercoralis S.hematobium
A=Ancylostoma duodenale S.mansoni
N=Necator Americana S.japonicum
W=W.bancrofti (3rd stage)
 TOPIC-87

PARASITES CAUSING AUTO-INFECTION:

 CLUE: TSH—ECG
T=Taenia solium E=Enterovius Vermicularis
S=Strongyloides stercoralis C=Cryptosporidium parvum
H=Hymenolepsis nana G=???
 TOPIC-88

INTRACELLULAR PARASITES:
 Plasmodium Vivax
 Leismania donovani
 Toxoplasma gondii

Obligate intracellular parasite:

 Rickettsia
 Chlamydia
 All viruses.
 TOPIC-89
DIMORPHIC FUNGUS:
Exist in filamentous or yeast form,depending on environmental conditions.
Examples:
H= Histoplasma capsulatum P=Para-coccidioides brasiliensis
S=Sporothrix scheinkii M=Malassezia spp.
C=Coccidioides immitis TB=Talaromyces marneffi+ Blastomyces dermatidis
 Filamentous Fungus (Moulds):
 Aspergillus fumigatus + Fusarium spp +Mucorales spp +Dermatophyte fungi (Trichophyton,Microsporum
spp.)
 Yeasts:
 Candida spp. + Cryptococcus spp.
 TOPIC-90
OPPORTUNISTIC MYCOSES:
CLASSIFICATION ORGANISM

Yeast  Candida albicans

 Cryptococcus neoformans
 Pneumocystis jirovecii
 Torulopsis
 Trichosporon
 Rhodotorula
 Geotrichium

Molds  Aspergillus fumigatus

 Pseudoallescheria
 Zygomycetes(Rhizopus,Mucor,Absidia spp)
 TOPIC-91
CUTANEOUS & SUB-CUTANEOUS MYCOSES:
CLASSIFICATION ORGANISM

 Cutaneous:Affect skin,hair &  Dermatophytes Trichophyton, Epidermophyton(not hair), &

nail,can produce keratinase,as Microsporum (not nail).
keratin is their food.  Candidiasis.

 Subcutaneous mycosis:  Rhinosporidiosis

 Chomoblastomycosis
 Sporotrichosis
 Mycotic mycetoma
 Zygomycosis
 TOPIC-92

Conditions associated with Candida infection:

Conditions associated with candida infection:

1.Antibacterial antibiotic
2.Immunosuppressed individuals
3.HIV (+ve ) patients
4.Cancer patients
5.Long time systemic steroids usage
6.DM
7.Long standing catheter
 TOPIC-93

Fungal agents causing keratitis:

Fungal infections associated with keratitis:

 Fusarium spp.
 Aspergillus spp.
 Candida spp.
 Carvularia spp.
 TOPIC-94
 Most important properties of Virus:
 Viruses has either DNA/RNA—Not both.
 Obligate intracellular parasite.
 All viruses have a protein coat called a capsid that covers the genome.
 All viruses have one copy their genome except—retrovirus,which have two copies of RNA genome.
 Enveloped viruses are more sensitive to heat,drying,detergents,lipid solvents such as alcohol & ether.
 Naked viruses—transmitted via faeco-oral route.
 Produces cytopathic changes in cell culture.
 Some viruses may have outer lipoprotein envelope
 Ribosome,Mitochondria,motility,binary fission—absent in virus but contain enzymes for replication.
 Kuru+ Cjd+SSPE+PML+AIDS+GSSS+Fetal familial insomnia—slow viral diseases.
 TOPIC-95
Multinucleated Giant cell associated viruses :
Look for “V” @ the end MMP

HSV Measles
VZV Mumps
RSV Para-influenzae
CMV
HIV
 TOPIC-96
Slow viral diseases:
Caused by prions Caused by conventional virus
Kuru PML JC virus
Creutzfeldt –Jacob disease SSPE Measles virus
Gerstman-straussler-Scheinker syndrome AIDS HIV virus
Fatal familial insomnia
 TOPIC-97
HUMANS ARE THE ONLY NATURAL HOST FOR THE FOLLOWING VIRUS:

Hepatotrophic virus Herpes virus family MMR2 Small pox + Cox

HAV HSV Measles Small pox
HBV VZV Mumps Coxackie virus
HCV CMV Rubella
HDV EBV RSV
Parvo-Virus
 TOPIC-98
 VIRUS CAUSING VESICULAR RASH:

Herpes Simplex → Herpangina → Hand foot & Mouth disease

Varicella zoster/Shingles/Chicken pox → Vaccinia
Echo virus → Coxackie virus
Rickettsial pox → Monkey pox (Pox virus)

African tick typhus

 TOPIC-99
CONGENITAL ANOMALIES OF THE FETUS CAN BE CAUSED BY:

VIRUS BACTERIA PARASITE

HSV Treponema Pallidum Toxoplasma

VZV

CMV

HIV

Parvo-Virus

ZIKA Virus
 TOPIC-100

 VIRUS CAUSING LATENT INFECTION:

1.HSV1 & VZV—Thoracic & Trigeminal sensory ganglia
2.HSV2—Lumber & sensory ganglia
3.Latency is also seen in:
 CMV
 EBV
 VZV
 Adenovirus.
 TOPIC-101

VIRUS HAVING ANIMAL RESERVIOR:

CLUE: (RYSA—CHD ):
R= Rabies Virus H=Hanta virus
Y=Yellow fever virus D=Dengue virus.
S=SARS Corona virus C=California encephalitis
A=Avian influenza
 TOPIC-102
INCLUSION BODY ASSOCIATED VIRUS:

VIRUS INCLUSION BODIES

1.Rabies Negri bodies
2.Variola Paschen bodies
3.Vaccinia Gumieri bodies
4.Fowl pox Bollinger bodies
5.Molluscum contagiosum Molluscum bodies
6.Reo virus Perinuclear cytoplasmic bodies
7.Yellow fever Torres bodies
8.Herpes simplex Lipschultz bodies
9.Measles & CMV Owl’s eye
10.Polio virus Cowdry type B inclusions
 TOPIC-103
Neurotrophic Virus (CNS Invader):
 Polio virus +Picorna virus (Enterovirus)
 Herpes virus family (HSV +CMV+EBV+VZV)
 Measles +Mumps
 Arbo Virus (Toga,Bunya)
 Rabies Virus
 JC virus .
 TOPIC-104
VIRUS ASSOCIATED WITH GASTROENTERITIS:
 Rota virus
 Nor-walk virus
 Calci virus
 Astro virus
 Adeno virus.
 TOPIC-105
ENVELOPED DNA VIRUS:

DNA ENVELOPED VIRUS (PHH) DNA NON-ENVELOPED (APP)

P= Pox virus A=Adeno virus
H=Herpes virus P=Papova virus
(HSV1,2,+ EBV,CMV,HSV 6,7+HSV-8)
H=Hepadna virus P=Parvo-Virus

 All DNA viruses are Double Stranded Except—Parvo-virus which is single stranded.
 TOPIC-106
VIRUSES HAVING SEGMENTED GENOME:
CLUE: BARO
B=Bunya virus (California encephalitis,Hanta virus)
A=Arena (Lymphocytic choriomeningitis)
R=Reo virus (Rota virus)
O=Orthomyxo virus (Influenzae A,B,C)
 TOPIC-108
VIRUS REPLICATE IN THE NUCLEUS:
CLUE:
 All DNA virus Replicate in the nucleus except—Pox virus which replicate in the cytoplasm.
 All RNA virus Replicate in the Cytoplasm except—Orthomyxovirus Which replicate in the nucleus.

 So, Herpes virus +Hepadna +Adeno +Papova + Parvo-virus + Orthomyxo(Influenza virus)

=
Replicate in the nucleus.
 TOPIC-109

Following Viruses have Reverse Transcriptase Enzyme:

 HIV
 HTLV1
N.B: HBV—is a DNA virus whose replication depends on Reverse transcriptase enzyme.
 TOPIC-110
ONCOGENIC ORGANISMS:

ONCOGENIC VIRUSES ONCOGENIC BACTERIA ONCOGENIC PARASITE

1.HPV—1247 + 6,16 H.Pylori 1.S.haematobium
2.HHS-8 2.Chlonorchis sinensis
3.EBV 3.Ophisthorchis sinensis
4.HBV
5.HCV
6.HTCLV-1
7.HTCLV-2
 TOPIC-111
DISEASE PRODUCED BY HHV-8:

Kaposi’s Sarcoma

Primary effusion lymphoma

Multicentric castleman’s disease

 TOPIC-112
DISEASE PRODUCED BY EBV:

Infectious mononucleosis

Burkitt’s & other lymphoma

(B & T-cell lymphoma)
Nasopharyngeal carcinoma

Oral hairy leucoplakia

Post-transplant lymphoproliferative disorder

Glandular fever
TOPIC-113
TOPIC-114
 TOPIC-115
Virus causing chronic infection:

 Hepatitis B virus

 Hepatitis C virus

 Neonatal rubella virus

 Cytomegalo virus

 Hanta virus
 TOPIC-116
INDICATIONS OF POST-EXPOSURE PROPHYLAXIS With IMMUNOGLOBULINS:

Human normal Immunoglobulin 1.Hepatitis A (unvaccinated contacts)

(Pooled immunoglobulin) 2.Measles (exposed child with heart/lung disease)

Human Specific Immunoglobulin 1.Hepatitis-B

2.Tetanus
3.Rabies
4.Chicken-pox
 TOPIC-117
CMV:
 Herpes virus family
 Humans are the natural host
 Form giant cell, Inclusion bodies & cross the placenta—congenital anomaly
 Transmitted by—through saliva,sexual contact,blood transfusion,organ transplantation & vertically.
 Latent state—in monocytes & responsible for AGR.
 Heterophill –ve mononeucleosis
 Causes severe infection in immune-compromised individuals
 Primary infection is usually asymptomatic.
 Dx: PCR: IgM—Current infection, IgG—Past infection
 Treated with—Gancyclovir,Valgancyclovir ,Foscarnet/Cidofovir.
TOPIC-118
 TOPIC-119
Viral Vaccines –RECOMBINANT DNA Technology:

HBV

HPV

Influenza

Bacillus anthracis

Bordetella pertusis
TOPIC-120
TOPIC-121
 TOPIC-122
LIVE & KILLED VACCINES:

LIVE VACCINE 1.Oral polio +Oral vibrio cholera+BCG

2.MMR
3.Influenza & Typhoid vaccine (Also killed)
4.Chicken pox+Small pox
5.Rota virus+Adeno virus
6.Yellow fever vaccine

Toxoid (Inactivated Toxin) 1.Diphtheria

2.Tetanus toxoid (TT)
TOPIC-123
THANK YOU EVERYONE
 DIPLOMABATCH-MARCH-21
TOPIC(124-188):CELLULARADAPTATION+INJURY+INFLAMMATION+TISSUE
REPAIR+IMMUNOLOGY

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-124
CELLULAR & TISSUE RESPONSES TO DIFFERENT TYPES OF INJURY:
1.Cellular adaptations:
 Hyperplasia
 Hypertrophy
 Metaplasia
 Atrophy
2.Cell injury:
 Reversible cell injury + Irreversible cell injury(Necrosis & Apoptosis)
3.Intracellular accumulations

4.Pathological calcifications
5.Cellular ageing.
 TOPIC-125
HYPERTROPHY VS HYPERPLASIA:
TRAIT HYPERTROPHY HYPERPLASIA
1.Similar characteristics:  Adaptive changes.  Adaptive changes.
 Reversible process.  Reversible process.
 Both physiological & pathological phenomenon.  Both physiological & pathological
 Associated with hyperplasia. phenomenon.
 Associated with hypertrophy.

2.Don’t forget ,why!!  Increase production of cellular structural
proteins=Increase in the size of the cells=Increase bulk
of tissue=Hypertrophy of the organ=increase
functional capacity of an organ.
3.Examples:  Physiological—USB
U—Uterus, S—Skeletal muscle,B—Breast .
 Pathological— (Heart + Kidney+Thyroid).
Heart=LVH, Kidney=Hypertrophy of the kidney.
4.Both (Trophy & Plasia)  Uterus ,Breast,Thyroid.
 Increase in the number of
cells=precursor of malignancy=fertile
soil for cancerous proliferation.
 Physiological—UBB
+Compensatory(Hepa & nephrectomy)
U—Uterus,B—Bone marrow, B—Breast
 Pathological: Endometrium,prostate,
thyroid,skin warts,wound healing.
 Uterus,Breast,Thyroid.
 TOPIC-126
METAPLASIA:
 One differentiated cell type is replaced by another—Adaptive & Reversible change.
 No change in phenotype.
 Occurs due to reprogramming of stem cells & results from persistent irritation.
 Called double edged sword—hence fertile soil for cancer development.
 May progress to dysplasia.
 Two types:1.Epithelial—squamous & columner metaplasia.
2.Connective tissue—myositis ossificans.
 Examples:
 Squamous metaplasia=Columner to squamous.
1.Respiratory tract of habitual smoker. 2.Stone in the salivary,pancrease,bile ducts.
3.Vitamin A deficiency.
 Columner metaplasia=Squamous to columner.
1.Barrett Oesophagus.
 TOPIC-127
FREE RADICLES:
1.GENERATION/SOURCES OF FREE RADICLES:→  During normal metabolic process
 During inflammation
 By enzymatic metabolism of drugs
 By absorption of radiant energy
 From transition metals(Cu,Fe) & From NO.

2.REMOVAL OF FREE RADICLES:→  Spontaneous decay

 Anti-oxidants: Vitamin A,E,C & Glutathiones
 Iron & Cu—can catalyze the ROS by—
Transferrin,ferritin,lactoferrin,ceruloplasmin.
 Enzymatic mechanism:
Catalase—H2O2
Glutathione peroxidase—H202, OH
Superoxide dismutase—O2
TOPIC-128
 TOPIC-129
FEATURES OF REVERSIBLE CELL INJURY:
KEY PHENOMENON    OUTCOME:
↓ Oxidative 1. ↓ Na pump →  ↑ Influx of Ca2+,  Cellular swelling
phosphorylation → ↓ ATP H2O, and Na+  Loss of microvilli
 Blebs appearances
 Efflux of K+  ER swelling
 Myelin figures
2.Increased Glycolysis  ↓ PH & ↓ Glycogen  Clumping of nucleur reticulumn
→

3.Detachment of  ↓Protein synthesis  Lipid deposition.

ribosome
 TOPIC-130
ISCHAEMIA-REPERFUSION INJURY:
 Associated with restoration of blood flow to ischaemic tissues after giving therapies following
ischaemic phenomenon like myocardial infarction /cerebral infarction.
 In MI Thrombolysis  Restoration of blood flow  ( I-R INJURY).
 Can promote recovery of cells if they are  Reversibly Injured.
 M/A 1.Oxidative stress ROS
2.Intracellular calcium overload.

3.Inflammation
4.Activation of the complement system by IgM.

 N.B Not associated with apoptosis/Necrosis/Irreversible Injury.

 TOPIC-131
COAGULATIVE VS LIQUEFACTIVE NECROSIS:

TRAIT COAGULATIVE NECROSIS LIQUIFECTIVE NECROSIS

1M/A:  Denaturation of protein  Enzymatic digestion

2.Cellular outline  Preserved  Completely obliterated

3.Fixation of involved tissue  Fixed & Firm  No fixation but liquid viscus material

4.Cyst formation  No  May form

5.Pus  Absent  Present

6.Example  Hypoxic death of solid organ except brain.  Abscess & Hypoxic death of brain
=Ischaemic necrosis of the heart,kidney,liver,adrenal =Abscess,boil(bacterial inection),fungal
gland & other solid organs. infection,Hypoxia in brain.
 TOPIC-132
NECROSIS VS APOPTOSIS:
TRAIT NECROSIS APOPTOSIS
1Definition  Cell death in living tissues due to progressive  Programmed cell deathcaspases enzyme.
degradative action on the lethally injured cell.  Triggered by—p53,Fas ligand.
2.Pathogenesis  ATP depletion + Membrane damage + Free  Activation of endonucleases + Gene activation
radical injury. + Internucleosomal.
 It may co-exist with necrosis (Necroptosis)
3.Cell size  Enlarged (Swelling)  Reduced (Shrinkage)
 Chromatine are condensed.
4.Nucleus  Pyknosis karyorrhexis Karyolysis (Hallmark)  Fragmented nucleus

5.Plasma membrane  Disrupted  Intact.

6.Cellular contents  Enzymatic digestion,may leak out of cell.  Intact (may be released in apoptotic bodies)
 Death cells are rapidly cleared.
 Formation of cytoplasmic blebs & apoptot.body.
7.Adjacent inflammation  Frequent  No
8.Cause  Only pathological  Both physiological & pathological
 TOPIC-133
NECROPTOSIS:
1.CHARACTERISTICS:→  Morphologically necrosis
 Mechanically apoptosis
 Occurs both physiologically & pathologically
 Induced by viral infection
 Triggered by ligation of TNFR1
 CASPASE independent
 RIP1 &RIP3 dependent.

2.WHERE OCCURS??:→  Steato-hepatitis

 Acute pancreatitis
 Reperfusion injury
 Parkinson disease
 Formation of mammalian bone growth plate.
 TOPIC-134
SITES OF MOIST GANGRENE:
 Intestine The most common site (In strangulated hernia,intussusception,volvulus & thrombosis in
mesenteric artery).
 Mouth.
 Bed Sores.
 Vulva, Scrotum.
 Anterior abdominal wall, Thigh.
 Diabetic foot.
 TOPIC-135
DISEASE ASSOCIATED WITH ABNORMAL INTRACELLULAR DEPOSITIONS:
BLUE MARKED: They are endogenous pigment.
Substances: Conditions:
1.Triglyceride Fatty change (liver,heart,muscle,kidney)
2.Protein Amyloidosis
3.Glycogen Glycogen storage disease
4.Coal dust Coal worker’s pneumoconiosis
5.Lipofuscin Brown atrophy of the heart
6.Melanin Melanosis
7.Bilirubin Jaundice
8.Haemosiderin Chronic passive congestion of the lungs
9.Haematin Macrophages in chronic malaria
10.Cupper Wilson’s disease
11.Iron Haemochromatosis
12.Cholesterol Atherosclerosis
TOPIC-136
 TOPIC-137
CHOLESTEROL ACCUMULATION:
 Fatty changes (liver, heart, muscle, kidney)
 Atherosclerosis
 Xanthomas
 Infammation
 Neimann-pick disease type- C.
 TOPIC-138
FATTY LIVER:
1.CAUSES:→  Toxins—CCL4.
 Alcohol abuse
 Anoxia
 Obesity
 DM
 PEM
 Starvation.

2. Mechanism of action →  Increased FFA synthesis from acetate.

 Increased entry of FFA from adipose tissue.
 Increased esterification of fatty acid to TG.

 Decreased oxidation FFA due to anoxia

 Decreased synthesis of Apo-protein due to PEM,CCL4
 Impaired lipoprotein synthesis from the liver.
 TOPIC-139
DYSTROPHIC & METASTATIC CALCIFICATION:
1.Dystrophic calcification:  Necrosis
 Atheromas
 Deposition of Ca2+ occurs in dying tissues  Damaged heart valves
 Serum calcium level= Normal  Tuberculous lymph node
 Absence of derangements in Calcium metabolism.

2. Metastatic calcification:  All causes of hypercalcemia + Renal failure (2ndary

hyperparathyroidism).
 Deposition of Ca2+ occurs in normal tissues.
 Serum calcium level= hypercalcemia .  Sites:
 Disturbances in calcium metabolism. Gastric mucosa, kidneys, lungs, systemic arteries,
pulmonary veins.
 TOPIC-140
EXUDATE VS TRANSUDATE:

TRAIT EXUDATE TRANSUDATE

1.Total protein  High as in plasma.  Less tha 10 gm/l

2.Distribution of protein  As in plasma  Nearly All albumin

3.Fibrinogen  Rich in fibrinogen—tendency to clot.  Not present—no tendency to clot.

4.Specific gravity  High ( >1.020 )  Low ( < 1.020 )

5.Cells  Plenty of polymorphs  Few mesothelial cells

6.Causes  Increased vascular permeability  Hydrostatic imbalance across vascular

 Incresaed hydrostatic pressure endothelium.
 So,leakage of fluid, proteins & blood cells.
7.Occurence  Inflammatory condition  Non-inflammatory condition.
 TOPIC-141
 EVENTS OF ACUTE INFLAMMATION:
 VASCULAR EVENTS:
 Vasodilatation Histamin, Bradykinin, Serotonin +Prostaglandins +C3a,C4a,C5a +NO
 Incraesed vascular permeability:
I) Contraction of endothelial cells resulting formation of endothelial gaps  Histamin, Bradykinin, Leucotriens, Substances P
II) Endothelial Injury III) Transcytosis .
 Increase in blood flow
 Stasis
 CELLULAR EVENTS:
 Leucocytes recruitment to sites of inflammation
 Leucocyte adhesion to endothelium
 Leucocyte migration through endothelium
 Chemotaxis of leucocytes
 Phagocytosis & clearances of the offending agent.
 TOPIC-142
CHEMICAL MEDIATORS:

1.Increased Vascular permeability:→ Histamin + Serotonin +Bradykinin

C3a + C4a +C5a
Leucotriens C4 ,D4, E4
PAF + PGD2 +PGE2
Neuropeptide +Substance P

2.Fever :→  IL-1 ,IL-6,TNF, PGE2

3.Tissue Damage  O2 metabolites

 NO
 Lysosomal enzymes of neutrophils & Macrophage

4.Pain  Prostaglandins +Bradykinins+ Substances P

 TOPIC-143
MORPHOLOGIC FEATURES OF CHRONIC INFLAMMATION:

1.Infiltration with mono-nuclear cells Macrophage, Lymphocytes, & Plasma cells

2.Tissue destruction .
3.Attempts at healing & Fibrosis.

FATES OF ACUTE INFLAMMATION:

1.Complete resolution
2.Chronic inflammation
3.Healing by connective tissue replacement(fibrosis)
 TOPIC-144
PREFORMED CHEMICAL MEDIATORS OF INFLAMMATION:
1.Vasoactive Amines Histamin
Serotonin
2.Lysosomal enzymes.
 TOPIC-145
INFLAMMATORY ACTIONS OF EICOSANOIDS:

1. Vasoconstrictions→ TXA2
LTC4 , D4, E4

2.Vasodilatations→  PGE1 + PGE2

 PGI1 + PGD2

3. Increased Vascular permeability  LTC4 + D4 + E4

4.Leucocyte adhesion, Chemotaxis  LTB4, HETE, Lipoxins.

 TOPIC-146
PRODUCTS RELEASED BY ACTIVATED MACROPHAGES:
1. ENZYMES→ “PRAN” P=Plasminogen activator
R=Remodeling collagenase
A=Acid hydrolases
N=Neutral Proteases

2.PLASMA PROTEINS→  Complement (C1-C5)

 Coagulation Factor (V & VIII)

3. Cytokines + Chemokines   IL-1, TNF-alpha

4. GROWTH FACTORS   PDGF, EGF, FGF, TGF-beta

5.Angiogenesis Factors  VEGF, FGF, Angiopoietin

6.NO +ROS +ECOSANOIDS.

TOPIC-147
TOPIC-148
TOPIC-149
 TOPIC-150
 ACUTE PHASE RECTANT: NEGATIVE ACUTE PHASE REACTANT:
• 1) CRP *Albumin, Transthyretin, Transferrin
• 2) Ferritin *Retinol binding protein
• 3) Fibrinogen *Cortisol binding protein

• 4) Haptoglobin ,Lactoferrin
• 5) Complement
• 6) Pro-calcitonin

• 7) Alpha-1 Antitrypsin,Alpha-1 antichymotrypsin

• 8) Ceruloplasmin
• 9) Serum Amyloid A

• 10) Serum Amyloid P Component (It Has A More Role In Mice)

 TOPIC-151
 NO:
 Endothelium derived relaxation factor+ AUTOCOIDS + neurotransmitter+free radicle
 It is formed from l-arginine and oxygen by nitric oxide synthetase (NOS).
 An inducible form of NOS has been shown to be present in macrophages.
 Nitric oxide has a very short half-life (seconds), being inactivated by oxygen free radicals.
 Is important for brain function
 Synthesis is stimulated by TNF .
 EFFECTS:
1) Acts on guanylate cyclase receptor leading to raised intracellular CGMP levels and therefore decreasing ca2+
levels.
2) vasodilation, mainly venodilation useful in angina.
3) inhibits platelet aggregation + inhibition of bacterial population.
4)Vascular smooth muscle relaxation +Receptive relaxation of the gut
 TOPIC-152
PHAGOCYTOSIS: KILLING & DEGRADATION:
O2 DEPENDENT MECHANISM O2 INDEPENDENT MECHANISM

 H2O2-MPO-Halide system  Bactericidal permeability increasing protein

 H202  Cathelicidins
 NO  Defensins
 Elastase enzyme
 Major basic protein
 Lysozyme +Lactoferrin
 TOPIC-153
 CONDITIONS WHERE ESR IS RAISED BUT CRP IS NORMAL:

LUPAS HOME
L=Leukaemia H= Heart failure
U=Ulcerative colitis O= Old age
P=Pregnancy + Polycythaemia M= Myeloma
A=Anaemia (Macrocytic anaemia) E=ESRD

S= SLE

Granulomatous inflammation:
1.Organism→
2. Fungal infection causing
granulomatous disease
TOPIC-154
 Mycobacterium(TB+Leprosy)
 Treponema_Pallidum
 Gram_negative_bacillus(cat-scratch disease)
 Brucella_abortus
 Unknown(sarcoidosis)
 Fungus(see below)
 Aspergillus species
 Blastomyces
 Cryptococcus_neoformans
 Candida_species
 Coccidiodis imitis
 Spororhrix_schenckii
 Histoplasma_capsulatum
 Paracoccidoidis
 Rhinosporidium_seeberi
 Pneumoconiosis
 TOPIC-155
CONTINUOUSLY DIVIDING TISSUES:(Labile Cells):

1. Labile cells→ Haematopoietic stem cells  in BM

Surface epithelia Squamous epithelia

of skin,oral cavity,vagina,cervix.

Cuboidal epitheliaexocrine organs

Columner epithelia GIT,Uterus,

fallopian tube.

Transitional epithelia Urinary tract.

2.Non-Dividing (Permanent tissues)→  Neurons

 Cardiac tissue
 Skeletal muscle
 TOPIC-156

HEALING BY SECONDARY UNION:

 CLUE:
Gap +More +Much +Marked +Large +Slowly + Infection +Contraction
 TOPIC-157
Healing by Primary & Secondary Union:

Traits Primary Union Secondary Union

 Margin of wound  Apposed together  A gap between 2 margins.
 Inflammatory reaction  Less marked  More intense
 Tissue damage  Minimum  Much larger
 Bleeding  Minimum  Marked
 Exudation  Minimum  Marked
 Healing  Heals quickly  Takes time to heal
 Scar  Small  Large
 Infection  No infection  Infection may be present
 Wound contraction  No wound contraction  Contraction of surface wound occurs
TOPIC-158
 TOPIC-159
Factors influencing wound healing:
1.Local Factors:→ 1. Local infection
2. Location,size & type of the wound
3. Inadequate blood supply
4. Haematoma formation
5. Presence of necrotic tissues & foreign bodies
6. Immobilization
7. Ionizing radiation
8. Type of tissue
2. Systemic factors →  Age—healing slow in elderely
 Nutrition:
protein malnutrition (starvation)
Vitamin C deficiency
Vitamin D—essential for new bone formation
Vitamin A—essential for epithelialization

 Trace element: Zn, Ca2+, Cu2+, Mn2+

 TOPIC-160
GRANULATION TISSUES:
 Pink,soft,granular appearances
 Easily bleed on touch
 Insensible +Resistant to infection

Where found??:
 Abscess wall
 Ulcer base
 Sinus /Fistula tract/Anal fistula
 Edge of a granuloma
 Wound healing
 TOPIC-161
INNATE & ADAPTIVE IMMUNITY:

Innate Immunity Acquired immunity

 Present by birth  Develops after exposure of an Ag.
 Non-specific  Specific
 No-Memory cell  Has memory cell
 Secondary immune response occur  Secondary immune response occur
(In active immunity)
 Present in both Vertebrate & intervertebrate  Present only in vertebrate animals
animals.
 Cells 3 phill +3 M+ NK +LAK  Cells B cell +T cell + NK +MQfg
 TOPIC-162
COMPONENTS OF INNATE IMMUNITY:
1.Mechanical barrier→  Intactness of the skin & mucous membrane
 Cilia URT
 Normal flora of different anatomical sites
2. Soluble factors→  Lysozymes of tear & Saliva
 Acid Ph of stomach & vagina
 Complements
 Interferon alpha & beta
 Fatty acid in skin
3.Cellular components  3 phill Neutrophil+ Eosinophil+ Basophil
 3 M Monocyte+ Macrophage+ Mast cell
 Common NK cell & Dendritic cells.
 Others Lymphokines.
4.Genetic factors  Individuals with Deficiency of G-6PD are resistant to P.falciparum.
 TOPIC-163
 COMPONENT OF THE CELL MEDIATED IMMUNITY/ACQIURED IMMUNITY:

T cell Helper T cell & Cytotoxic T cell.

APC cell  (B cell + Dendritic cell+ Macrophage)
Common NK cell & Dendritic cell.
 TOPIC-164
ACTIVE IMMUNITY ACHIEVEMENT:
 ACTIVE IMMUNITY→ “CLUE” Clinical & Subclinical infection+ After Vaccination.

1.Naturally After clinical & subclinical infections After

measles, small pox, mumps, rubella, tetanus, Hepatitis A
infection.

2.Artificially After vaccination DPT.

 TOPIC-165
PASSIVE IMMUNITY ACHIEVEMENT:
 PASSIVE IMMUNITY→  Naturally Transmission of IgG from mother to fetus
Secretory IgA From breast milk.

 Artificially By Preformed Ab Transferred to host from another

human/animal.
 Examples are ATS (Anti-tetanus serum), ADS (Anti-diphtheria serum)
TIG, Human Ig against hepatitis B virus= Antisera &
Antitoxin.
 TOPIC-166
APC CELLS:
 B cell
 Dendritic cell
 Macrophage (Monocyte+Histiocyte+ Microglia +Alveolar MQfg +Red pulp+Kupffers cell+skin
Langerhans cell)
TOPIC-167
TOPIC-168
TOPIC-169
 TOPIC-170
CYTOTOXIC T -CELL:
 Functions→  Kills Allograft cells = Graft rejection
 Kills Tumour cells = Tumour destruction
 Kills  Virus infected cells = Lysis of virus infected cells.
TOPIC-171
 TOPIC-172
Cell surface markers of Immune cells:
Types of cells→ Surface proteins

Helper T cells  CD3, CD4, CD28 +TCR

Cytotoxic T cells  CD3, CD8 + TCR
B cells  IgM, B7
Natural killer cells  Class I MHC (receptors)
Macrophages  Class II MHC
All cells other than mature Red cells  Class I MHC
TOPIC-173
TOPIC-174
TOPIC-175
TOPIC-176
 TOPIC-177
DISEASE ASSOCIATED WITH HLA:

HLA DISAESES

HLA-A3  Haemochromatosis
HLA-B5  Behcet’s syndrome
HLA-DQ2/DQ8  Coeliac disease
HLA-DR2  Narcolepsy
 Goodpasture’s syndrome
HLA-DR3  “DPS”Dermatitis herpetiformis+Sjogren’s +PBC
HLA-DR4  Type-1 DM
 RA
HLA-B27  Ankylosing spondylitis
 Reiter’s syndrome
 Acute anterior uveitis
TOPIC-178
 TOPIC-179

REAGENIC ANTIBODIES:

CHARACTERISTICS:
1.Lowest concentration in the serum
2.Half-life: 1-5 days
3.No Transplacental passage +Antiviral activity +Complement fixation
4.Binds with Eosinophil +Basophil +Mast cell
5.Passively sensitize the skin
6.Plays a major role in allergy.
 TOPIC-180
1.Sources:→ “CLUE” LIMPS.

L=Liver ( C3,C6,C9)
COPLEMENTS:
I=Intestine (C1)
M=MQ (C2, C4)
P=Placenta
S=Spleen (C5,C8)
2. Anaphylatoxins→  C3a
 C4a
 C5a

3.Biologically active  C3a +C3b

 C4a
 C5b
TOPIC-181
TOPIC-181
 TOPIC-182
EXAMPLES OF TYPE-II HYPERSENSITIVITY:

Type-II Hypersensitivity→  Autoimmune haemolytic anemia

 Autoimmune thrombocytopenia
 Autoimmune thyroiditis
 Acute rheumatic fever
 Vasculitis caused by ANCA
 Incompatible blood transfusion
 ITP
 Pernicious anaemia
 Pemphigus vulgaris
 Goodpasture syndrome
 Hyperacute graft rejection
 TOPIC-183
TYPE-4 HYPERSENSITIVITY:

Type -4 hypersensitivity→  Type-I DM

 Contact dermatitis +Nickel hypersensitivity
 Hashimoto’s thyroiditis
 GVHD
 Acute cellular transplant rejection
 Multiple sclerosis
 GBS
 Tumour immunity
 Positive tuberculin skin test
 TOPIC-184
 PHAGOCYTE DEFICIENCY DISORDER:
 CLUE: ( ICC JML)
I= IF-gamma Receptor deficiency
C=Cyclic neutropenia
C=CGD +Chediak higashi syndrome

J= Job’s syndrome (Hyper IgE syndrome)

M=Myeloperoxide deficiency
L=Leucocyte adhesion deficiency
TOPIC-185
TOPIC-186
 TOPIC-187
Non-Organ Specific Auto-immune disease:
Clue Look for Short form Common organ specific Auto-Immune Disease.
(Non-Organ Specific)
 RA +RF +RS 1) Myasthenia gravis
 SLE +SS (CREST) +SS 2) Lambert-Eaton syndrome
 GBS+ PAN 3) Graves disease
 MCTD 4) IDDM
 GPA (WG) 5) Primary biliary cirrhosis
6) Coeliac disease
7) Addison’s disease
8) Hashimotos thyroiditis
9) Pernicious anaemia
10) Acute glomerulonephritis
11) Auto-immune haemolytic anemia
12) Idiopathic thrombocytopenic purpura
TOPIC-188
THANK YOU EVERYONE
 RESIDENCY EXAM BATCH-MARCH-21
TOPIC(189-244):HAEMODYNAMICS+NEOPLASIA+FIXATIVES+GENETICS+SYSTEMIC
PATHOLOGY

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-189
SAAG (Ascitic fluid Albumin- Serum Albumin):
1.High SAAG (Transudative)=Portal HTN= (>11g/l):  Liver cirrhosis
=(Liver+Cardiac +Malnutrition+Meig’s)→  Hepatic venous occlusion (BCS+SOS)
 Cardiac failure
 Constrictive pericarditis
 Malnutrition+Protein losing enteropathy
 Meig’s syndrome

2.LOW SAAG  TB—Abdominal+Peritoneal

=(TB+Malignancy+Kidney+Pancreas+Thyroid):→  Malignancy—Hepatic+Peritoneal
 Lymphatic obstruction
 NS
 Acute pancreatitis
 Hypothyroidism
 TOPIC-190
OEDEMA:
 Oedema occurs due to:
 Increased hydrostatic pressure in blood vessels  CCF+ Constrictive pericarditis+Liver
cirrhosis+Venous obstruction+Prolonged dependency.

 Decreased plasma colloidal osmotic pressure=Hypoproteinemia:

1.Liver cirrhosis
2.Protein-losing enteropathy
3.Malnutrition

4.Nephrotic syndrome.
 Renal retention of Na & Water.
 Lymphatic obstruction

 Inflammation
TOPIC-191
 TOPIC-192
HYPEMIA VS CONGESTION:
TRAIT HYPEREMIA CONGESTION

 Characteristics:  Active process.  Passive process.

 Produced by Arteriolar dilatation.
 Increased blood flow.
 Capillary bed Engorged with
oxygenated blood.
 Results from Impaired venous
drainage.
 Decreased blood flow.
 Capillary bed Swollen with
deoxygenated blood.

 Consequences:  Erythema.  Anasarca.

 Brown induration of the lungs.
 Nutmeg liver.
 Stasis dermatitis of leg.
 TOPIC-193
HYPERCOAGULABLE STATES:
Low Risk For Thrombosis:
 Clue: Cardio +Nehro+ Oestro (pregnancy,puerperium,OCP) +Smo+ Sickle cell.

High Risk For Thrombosis:

 MI+ AF + prosthetic cardiac valves
 DIC HIT APS
 Prolonged bed rest / Immobilization.
 Tissue Injury (Surgery,fracture,burn)
 Cancer.
TOPIC-194
 TOPIC-195
Fates of Thrombus:

FATES OF THROMBUS : →  P=Propagation

 E=Embolization
 D=Dissolution
 R=Recanalization
 O=Organization
 TOPIC-196+S197
Difference between arterial & Venous thrombosis:
TRAIT ARTERIAL THROMBOSIS VENOUS THROMBOSIS

1.Nature Frequently occlusive/Friable Invariably occlusive/Not friable

2.Composition:  RBC  Enmeshed RBC
 Degenerative leucocytes  Few platelets
 Friable meshwork of platelet (Known as Stasia/Red thrombi)
 Fibrin
3.Causes: o Endothelial injury & turbulence o Due to stasis.
o Ruptured atherosclerotic plaque/vasculitis/trauma.
4.Flow Retrograde flow Along the direction of blood
5.Attachment Firmly attached to the wall,frequently embolize. Loosely /Focally attached to the wall
6.Microscopy Distinct lines of Zahn composed of platelets,fibrin,with Lines of Zahn with more abundant RBC
entangled RBC,WBC.
7.Sites: Coronary ,cerebral & femoral artery. Veins of the lower extremity(90%),upper
extremity,periprostatic plexus,ovarian &
periuterine veins,dural sinuses,portal &
hepatic vein.
 TOPIC-198
FAT-EMBOLISM SYNDROME:
 Causes 1.Fracture of shaft of long bones which have fatty marrow.
2.Trauma of adipose tissue
3.Burn of adipose tissue.
Features:
 Pulmonary Insufficiency
 Neurological symptoms
 Anaemia Due to Red cell aggregation &/ haemolysis.
 Thrombocytopenia Due to Platelet adhesion to fat globules, Splenic sequestration.
 Diffuse petechial rash (20-50%) of cases.
 Fatal (5-15% )of cases.
 TOPIC-199
RED VS WHITE INFARCT:

TRAITS RED INFARCT WHITE INFARCT

1.Cause  Venous occlusion  Arterial occlusion

2.Organs Involved  Brain  Heart

 Lungs  Spleen
 Small intestine  Kidney
 Ovary =Solid organ.
3.Colour(After 24-48  Red  Pale
hours)
TOPIC-200
TOPIC-201
 TOPIC-202
STAGES OF SHOCK:
1.Initial Non-Progressive Stages of shock:→  Reflex compensatory mechanisms are activated.
 Perfusion of vital organs are maintained.
2.Progressive stages of shock:→  Widespread tissue hypoxia
(Survival is possible)  Anaerobic glycolysis
 Lactic acidosis/Metabolic acidosis

 Blunt vasomotor response

 Arterioles dilate
 Peripheral pooling of blood
 Anoxic injury to endothelium leads to DIC.
3.Irreversible stage  ATN=Anuria=RF=Complete renal shut down.
(Survival is not possible)  Lysosomal enzyme leakage
 Intestinal flora migrate to circulation= sepsis
 Neuronal & myocardial ischaemic loss can not revert
 Survival is not possible
 Death.
 TOPIC-203
Tumours of the Brain:
 Benign tumours of the brain→  Meningioma
 Neurofibroma

 Craniopharyngioma
 Colloid cyst

 Pineal tumours
 Pituitary adenoma
 Malignant tumours of the brain→  Ependymoma
 Glioma
 Oligodendroglioma

 Medulloblastoma
 Cdrebral lymphoma
 TOPIC-204
HAMARTOMA vs NEOPLASIA:

TRAIT HAMARTOMA NEOPLASIA

1.Definition:  Disorganized focal overgrowth of mature  Abnormal, excessive,unregulated,autonomous
tissue. proliferation of cells.

2.Behaviour  Always benign  May be benign or malignant.

3.Degree of differentiation  Well differendiated cells resembling to normal.  Well differentiated to poorly differentiated.

4.Clonality  Polyclonal  Monoclonal

6.Example  Vascular hamartoma  Squamous cell carcinoma.

 TOPIC-205
BENIGN vs MALIGNANT TUMOUR:

TRAIT BENIGN MALIGNANT

1.Differentiation  Well differentiation  Lack of differentiation.

2.Rate of growth  Progressive & slow  Erratic & slow to rapid

 Mitotic figures rare & normal.  Mitotic figures numerous & abnormal.

3.Local invasion  No invasion.  Localli invasive,infiltrating surrounding

tissue.
4.Metastasis  Absent  Frequent metastasis.
TOPIC-206
TOPIC-207
 TOPIC-208
LOCALLY MALIGNANT TUMOUR:

1.EXAMPLES:→ ( “A—BCG &—DMP “ )  A=Ameloblastoma

 B=Basal cell carcinoma

 C=Craniopharyngioma + Carcinoid tumour
 G=Giant cell tumour of the bone +Glioma

 D=Desmoid tumours (Deep seated fibromatosis)

 M=Mixed salivary tumours
 P=pleomorphic adenoma
 TOPIC-209
HORMONE PRODUCING TUMOUR:
Tumour Hormone
1.Small cell carcinoma of the lung ADH, ACTH
2.Squamous cell carcinoma of the lung PTHrP
3.Breast carcinoma PTHrP
4.Renal cell carcinoma PTHrP ,Erythropoietin
5.Hepatoma Erythropoietin
6.Cerebellar haemangioblastoma Erythropoietin
7.Fibroid uterus Erythropoietin
8.Bronchogenic carcinoma Erythropoietin
9.phaeochromocytoma Erythropoietin
10.Mesenchymal tumours FGF-23
11.Insulinoma Insulin
12.Carcinoid tumours 5-HT (Serotonin)
13.Granulosa cell tumour of the ovary Oestrogen
14.Choriocarcinoma Beta -HCG
 TOPIC-210
HORMONE DEPENDENT TUMOURS:

TUMOURS HORMONES USED AS TREATMENT

1.Papillary & follicular carcinoma of the Thyroxin
thyroid
2.Breast carcinoma Progesterone
3.Endometrial carcinoma Progeterone
4.Malignant melanoma Regress in pregnancy related hormone
6.Prostatic carcinoma Goserelin (LHRH),Bicalutamide (Anti-
androgens)
 TOPIC-211
DYSPLASIA:
 Literally means disordered growth
 Is often found adjacent to foci of invasive cancer
 Particularly common in squamous & transitional epithelium.
 Exhibits Pleomorphism + Hyper-chromatic nuclei +Abundant mitotic figures.
 Differs from cancer by lack of invasiveness & reversibility.
 Examples:
Cervix of uterus( CIN-I,II,III) Respiratory tract in smoker
Skin +Urinary blaader+Larynx Adjacent to foci of cancer
Gall bladder & Oral mucosa  (Uncommon)
 TOPIC-212
Malignant Tumour Commonly Metastasize to Bone:
Clue: All paired organ except Ovary.
Examples:
 Thyroid carcinoma
 Breast carcinoma
 Lung carcinoma
 Renal cell carcinoma
 Prostate carcinoma
 TOPIC-213
METASTASIS IN A LYMPHNODE:
Methods of Metastasis:
1.Seedling of body cavities & surface
2.Lymphatic spread
3.Haematogenous spread
Lymphatic spread:
 Common pathway for dissemination of carcinoma sarcoma may also use it but not common for
sarcoma.
 Follows the natural route of lymphatic drainage.
 First lymph node/group of nodes draining a cancer is called  “Sentinel lymph node”.
 Can be detected by FNAC & has role in TNM Staging.
 Common feature of Malignant melanoma, Seminoma, Squamous cell carcinoma (lung),Breast Ca.
 TOPIC-214
Familial Cancers/Inherited cancer syndrome:

1.Autosomal Dominant:→  Retinoblastoma

 Peutz- Zegher syndrome
 FAP+ Familial wilm’s tumour
 Von-Hippel lindau syndrome
 Li-Fraumani syndrome
 HNPCC
 Breast+Ovarian+Stomach+pancreatic cancer
 MEN-1 & 2
 NF-1 & 2
 Nevoid basal cell carcinoma syndrome

2. Autosomal recessive→  Ataxia telangiectasia

 Bloom syndrome
 Xeroderma pigmentosum
 Fanconi anemia
TOPIC-215
 TOPIC-216
TUMOUR SUPRESSOR GENE:

Tumour suppressor gene Results of mutation

1.TGF-beta Ca Colon
2.E-cadherin Familial gastric cancer
3.NF1 & NF2 Neurofibromatosis
4.APC / Beta-Catenin FAP
5.PTEN Cowden syndrome
6.RB1 Retinoblastoma
7.p53 L-fraumani syndrome
8.BRCA1 &2 Breast & Ovarian Ca
9.WT1 Wilm’s tumour
10.P16 Malignant melanoma
11.VHL Vaun-Hippel landau syndrome
TOPIC-217
TOPIC-218
 TOPIC-219
Natural plant & Microbial product causing cancer:

 Aflatoxin-B
 Betel Nuts
 Cycasin

 Griseofulvin
 Safrole
TOPIC-220
 TOPIC-221
Malignancies associated with Infection:
Malignancies Organisms
 Burkitt’s lymphoma  Epstein-Barr Virus

 Cervical carcinoma  Human papilloma virus

 Kaposi sarcoma  HHV-8

 Gastric carcinoma  Helicobacter pylori

 Hepato-cellular Ca  Hepatitis B & C Virus

 T cell- leukaemia  HTLV1

 Bladder cell cancer  Schistosoma haematobium

 Cholangiocarcinoma  Chlonorchis sinensis

 TOPIC-222
OCCUPATIONAL CANCERS:
Occupational agents Cancers
 Arsenic  Lung, Skin, Haemangiosarcoma

 Asbestos  Mesothelioma+ Oesophageal Ca+Stomach Ca +Colonic Ca

 Benzene  Leukaemia, Hoddgkin’s lymphoma

 Beryllium  Lung ca

 Cadmium  Prostate Ca
 Chromium  Lung ca

 Nickel  Nose, lung Ca

 Radon  Lung Ca
 Vinyl chloride  Angiosarcoma, liver
 TOPIC-223
GRADING & STAGING OF THE TUMOUR:

1.GRADING OF TUMOUR IS BASED ON  Degree of differentiation

 Number of mitoses

2.STAGING OF TUMOUR IS BASED ON  Size of the tumour

 Regional lymph node involvement
 Distant spread= presence/absence of metastasis
TOPIC-224
TOPIC-225
 TOPIC-226
ENDOCRINOPATHIES ASSOCIATED WITH LUNG CARCINOMA:
1.Cushing syndrome SCLC
2.SIADH SCLC
3.Hypercalcemia NSLCC (Squamous cell carcinoma)
4.Carcinoid syndrome Bronchial adenoma
5.Others Dermatomyositis, Myasthenia gravis, HPOA.
 TOPIC-227
SELECTED TUMOUR MARKERS:
Tumour markers Cancers
 HCG  Trophoblastic tumours,Non-seminomatous testicular tumours

 Calcitonin  Medullary carcinoma of thyroid

 Catecholamine & metabolites  Phaeochromocytoma

 Alpha-fetoprotein  HCC,Non-seminomatous germ cell tumours

 CEA  Ca colon, pancreas, lung, stomach

 Prostatic acid phosphatase  Prostate cancer

 Neuron specific enolase  SCLC, Neuroblastoma

 CA-15-3  Breast Ca
 CA-19-9  Colon ca, Pancreatic Ca
 CA-125  Ovarian Ca.
 TOPIC-228
PARANEOPLASTIC SYNDROMES:

1.Hypercalcemia “BARSO”  B=Breast Ca

 A=Adult T-cell leukaemia/Lymphoma
 R=Renal Cell Carcinoma
 S=Squamous cell carcinoma of the lung
 O=Ovarian Ca.

2.Hypoglycemia  Ovarian Ca
 Hepatocellular Ca
 Fibrosarcoma
 Mesenchymal sarcoma
 TOPIC-229
Lung disease caused by Air Polutants:

Silica  Silicosis
 Caplan syndrome

Asbestos  Asbestosis
 Pleural plaques
 Caplan Syndrome
 Mesothelioma
 Carcinoma of the lung,larynx,stomach,colon.

Coal dust  Anthracosis

 Macules
 Progressive massive fibrosis
 Caplan syndrome
 TOPIC-230
CA-19.9:
1.Pancreatic cancer  80%
2.Mucinous tumour of the Ovary  65%
3.Gastric cancer  30%
4.Colon Cancer  30%
N.B: No Lung Carcinoma.
 TOPIC-231
CARCINOMA IN SITU:
 Key points:
When dysplasia is marked & involve the full
thickness of the entire epithelium, the lesion is
known as carcinoma in situ.
Epithelial neoplasm Has all the cellular features
of malignancy but not yet invasion of BM.
Pre-invasive stage of carcinoma May progress
to invasive stage.
It’s a very early stage & its excision causes
complete cure of cancer.
Can be diagnosed by biopsy & Usually non-
metastatic.
 Examples:
 Adenoma of colon,
 Aktinic keratosis,
 Bowen’s disease of the skin,
 Bowenoid papulosis of penis,
 CIN,
 Carcinoma in situ of the UB,
 Carcinoma in situ in the epidermis of the skin,
 In Situ Carcinoma of the female breast,
 In situ cytological atypia in the lining epithelium
of the respiratory tract in habitual smokers,
 Dysplastic leukoplakia,
 Erythroplasia of queart.
 TOPIC-232
Pre-Cancerous conditions:
Organ Disease Organ Disease
 SKIN  Xeroderma pigmentosum  GIT & HBS   Chron’s disease
 Solar actinic keratosis  UC & FAP
 Burn ulcer,Varicose ulcer  Cirrhosis of liver
 Marjolin’s ulcer  Cholelithiasis
 Dysplastic naevi
 Leucoplakia  Lung   Bronchial metaplasia & dysplasia
 Radio-dermatitis  Thyroid   Auto-immune thyroiditis
 Bowen’s disease  Bone   Paget’s disease
 Mouth   Erythro –plakia  Breast   Small duct papilloma
 Leukoplakia  Intraductal epithelial hyperplasia
 Plummer vinson syndrome  Sclerosing adenosis
 Oesophagus   Barrete oesophagus  Penis   Leucoplakia

 Stomach   Chronic gastritis  Female genital  Cervical dysplasia

 Pernicious anaemia tract  Endometrial hyperplasia
 Chronic gastric ulcer  Dysplasia of vulva
 Adenomatous polyp
 TOPIC-233
CARCINOID SYNDROME:
 Due to carcinoid tumourArise from enterochromafin cells found in the crypts of liberkuhn.
 Commonly seen in  appendix,ileum & rectum
 Intestinal carcinoids low grade malignancy
 Serotonin (5-HT),Tachykinins,Pg,peptides is released & its(serotonin) metabolite is excreted in the urine.
 Diagnosis is confirmed by 24 hour urinary 5-HIAA estimation.
C/F:
 Flushing of face
 Diarrhoea
 Heart failure/ Right sided heart valve lesions may present(TS,PS)
 Bronchoconstriction.
 Associated with Bronchial adenoma + Gastric carcinoma +Pancreatic carcinoma.
 TOPIC-234
RADIOSENSITIVE TUMOURS:

1.Highly Radiosensitive:→ Lymphoma

Leukaemia
Seminoma
Myeloma
Dysgerminoma
Ewing’s sarcoma
Wilm’s tumour

2.Low radiosensitive tumour :→  Glioma (Astrocytoma, Ependymoma,oligodendroglioma,glioblastoma)

 Melanoma
 Osteosarcoma
 RCC
 TOPIC-235
SPONTANEOUS TUMOUR REGRESSION:
1.Retino-blastoma
2.Neuro-blastoma
3.Choreo-carcinoma
4.Osteo-sarcoma
5.HCC +RCC +MM (Malignant melanoma)
6.Lymphoma +Leukaemia
7.GIT Cancers
 TOPIC-236
FIXATIVES:

1. PURPOSE→ To keep the tissue viable

To preserve the microanatomy
To prevent autolysis & putrefaction
To prevent change of the volume & shape
To minimize any loss of molecule from the specimen

2.Commonly used fixatives→  95% Ethanol

 95% rectified spirit
 80% isopropanol
 Absolute methanol
 Ether : 95% ethanol (1:1)
 Carnoy’s fixative/Absolute alcohols
 Spray fixative (hair spray)
 10% formalin.
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 TRUE-CUT NEEDLE BIOPSY/CORE NEEDLE BIOPSY:
INDICATION:
1. Most common for soft tissue mass
2.Retro-peritoneal tumours (USG/CT Guided)
3.Breast lump
4.Prostate lesion
5.Pleural biopsy
6.Liver biopsy
 TOPIC-238
 EXFOLIATIVE CYTOLOGY:
INDICATION:
CLUE: “Secretion”:
1. Carcinoma cervix
2.Endometrial Carcinoma
3.Bronchogenic carcinoma
4.Bladder Carcinoma
5.Prostatic carcinoma
6.Gastric carcinoma
7.Identification of tumour cells in abdominal,pleural,joint & CSF fluids.
 TOPIC-239
Amyloid stain-:

Amyloid reacts with the Congo-red stain

following stain Crystal violet stain
Thioflavin T stain
 TOPIC-240
Frozen section biopsy:

Key points Open excisional biopsy

Quic Dx possible.(within 10-15 minutes)
Done perioperatively
Pre-Arrangement (Surgery team & pathologist)
Skilled histopathologist
Specimen immersed within the fixative not embedded in paraffin.
The sectioned tissue are stained with H& E stain & examine under the microscope
Categorization of tumour as benign/Malignant (over telephone)
Identification of ganglion cell in Hirschsprung disease.
Definitive Dx not possible.
See resection margins of a malignant tumour.
Done in perioperatively.
Expensive & preserve tissue substances like fat.
 TOPIC-241
X-LINKED RECESSIVE DISORDERS:

X-LINKED RECESSIVE BMD +DMD

Fragile X +Fabry’s disease

Agamma-globulinemia
Wiskott-Aldrich syndrome
Chronic granulomatous disease

Haemophilia A & B
G-6-PD deficiency

Diabetes Insipidus
Lesch-nyhan syndrome
Alport syndrome.
 TOPIC-242
MULTIFACTORIAL/POLYGENIC DISORDERS:
Multifactorial/Polygenic Neural tube defect
Disorders Cleft lip, cleft palate ,Club foot
Epilepsy ,Alzheimer’s disease, MS

Congenital heart disease

Congenital dislocation of the hip

Hirschprung disease, Pyloric stenosis, PUD.

Colorectal Ca

RA ,SLE, Gout, Osteoporosis

DM, HTN , IHD
Depression , Schizophrenia

Breast Ca +Glaucoma +Asthma

 TOPIC-243
 PRENATAL CHROMOSOME ANALYSIS:

 Chorionic villous sampling  From 11 weeks.

 Amniocentesis  From 14 weeks.
 Cordo-centesis  From 19 weeks.
 TOPIC-244
 SEX CORD-STROMAL TUMOURS:

Sex Cord-Stromal tumours

1.Granulos cell tumours
2.Fibromas
3.Fibro-thecomas
4.Thecomas
5.Sertoli-leydig cell tumours
6.Steroid (Lipid) cell tumours.
THANK YOU EVERYONE
 DIPLOMA BATCH-MARCH-21
TOPIC(245-321):RENAL PHYSIO+ACID-BASE+NEUROPHYSIO+MSK PHYSIO

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-245
ENDOCRINE FUNCTION OF THE KIDNEY:
 Endocrine Function Of The Kidney:  Erythropoietin
Secretes→  Renin
 1,25 Dihydroxy-cholecalciferol
 Prostaglandins (PGI2,PGE2)
 Thromboxanes

 Metabolic function:→  Gluconeogenesis

 Transamination
 Deamination
 TOPIC-246
 DISTAL TUBULR FUNCTION: Diluting segment of the nephron.

 Early Distal tubular Reabsorption:. Na+,Cl-,Ca2+,Mg2+.

Impermeable to H2O & Urea
 Late Distal tubular Reabsorption:
 Na+ reabsorption—by Aldosterone—in exchange of K+ (Principal cells)
 Water reabsorption—by ADH
 K+ & HCO3- reabsorption—in exchange of H+ into the lumen.(Intercalated cells)

 Secretion:
 K+ (is controlled by Aldosterone) & H+
 Forms NH4+.
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AGENTS CAUSING MESSANGIAL CELL RELAXATION:
Clue: “ABCD”
A=NP
B=BSMMU (PGE-2)
C=c-AMP
D=Dopamine
 TOPIC-250
RENIN:
 Conditions that increase renin secretion  Increased sympathetic activity
 Increased circulating catecholamines
 Prostaglandins

 Na+ depletion
 Hypotension +Haemorrhage
 Dehydration +Diuretics
 Cardiac failure+Cirrhosis
 Constriction of renal artery
 Upright posture
 Various psychogenic stimuli

 Inhibitory factor for renin secretion   Angiotensin-II, Vasopressin.

 Increased Na+ & Cl- reabsorption across
macula densa.
 Increased afferent arteriolar pressure.
 TOPIC-251
Factors decreasing GFR:

 Factors decreasing GFR: →  Glomerular capillary colloidal osmotic pressure

 Bowman’s capsule hydrostatic pressure
 Sympathetic stimulation
 Constriction of afferent arteriole
 Severe constriction of efferent arteriole
 ↓ Size of the capillary bed.

 Hormones ↓ GFR   Epinephrine

 Nor-epinephrine
 Endotheline
 TOPIC-252
Substances Reabsorbed By Renal tubules:

 Substances completely  Glucose

reabsorbed →  Amino Acid
 Proteins
 Vitamins, Acetoacetate ions.
 Substances not completely  Water & Electrolytes, Keto acids
reabsorbed  Urea, Uric acid
 Na+, K+, Ca2+, Mg2+, PO43-, HCO3-

 Substances not reabsorbed  Inulin

 Creatinine
 Mannitol
 Sucrose

APICAL TRANSPORTER:
 Proximal tubule→
 Thick ascending limb
 Distal convoluted tubule
 Collecting duct 
TOPIC-253
 Na+/glucose CT
 Na+/amino acid CT
 Na+/Pi CT
 Na+/lactate CT
 Na+/H+ exchanger
 Cl- /Base exchanger
 Na+ k+-2Cl-
 Na+/ H+ exchanger
 K+ Channels
 NaCl CT
 Na+ channel (EnaC)S
 TOPIC-254
Hormones & their site of Action on Renal tubules:

Hormones Site of action

1.Aldosterone  DCT & CT
2.ADH  DCT & CT
3.ANP  DCT & CD
4.Angiotensin-II  PCT
5.Parathormone  PCT, DCT + Thick ascending loop of henle
6.Epinephrine,Nor-Epinephrine  Afferent & Efferent arterioles.
Endotheline,Prostaglandin
 TOPIC-255
RENAL PLASMA CLEARANCE:
Uc ꭖ V
Renal Plasma Clearance= ----------------------------------
Pc
Concentration of substance in urine ꭖ Volume of urine
= ---------------------------------------------------------------------
Conc. of substance in plasma
 TOPIC-256
ANP:
 Release from the right atrium in response to atrial stretching.
 ↑ GFR
 Dilatation of afferent arteriole
 Natriuresis
 (-) Renin secretion
 (-) ADH release
 (-) Aldosterone
 TOPIC-257
ECF > ICF :
 Na Cl , HCO3-
 Ca2+, SO4-
 Glucose
 PO2
 PH
 TOPIC-258
HYPERTONIC HYPOVOLEMIA: (CLINICALLY COMMON)
FEATURES:
 Occur following hypotonic fluid loss (Osmolarity of lost fluid < 300 mosm/l)
 Relatively there is more H2O loss than salt with ECF hypertonicity.
 Na+ conc.of lost fluid is less than that of plasma
 Body Na+ content is decreased but plasma Na+ conc.is high usually
 Both ECF & ICF volume is decrease. ECF decreases  due to fluid loss & ICF decreases due to osmotic
water loss from cells because ECF is hypertonic.
 Osmolarity of both ECF & ICF  Increases.
Common Causese:
 Severe diarrhoea, Severe burn, Profuse sweating
 Persistent vomiting/ NG suction
 Salt losing nephritis, Osmotic diuresis, & Diuretic abuse
 Collecting duct dysfunction (Adrenal deficiency)

LACTIC ACIDOSIS:
Normal lactic acid conc. (1-2) mmol /l, Lactic acidosis is ≥ 5.0 mmol /l.
 TYPE-I (A)→Here, hypoxia
causes ↑ lactic acid production
due to anaerobic glycolysis.
 TYPE-II (B) Here,there is
impairment of lactic acid
metabolism & disposal—in the
setting of adequate oxygen
supply.
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 Absolute hypoxia: Hypoxic hypoxia, shock, heart
failure, respiratory failure, pulmonary edema, sepsis etc.
 Relative hypoxia: Seizures, severe exercise
 Mitochondrial dysfunction
 Gluconeogenic enzymes deficiency
 DM
 Malignancy
 Renal failure
 Hepatic failure
 Drugs & toxins Alcohol, Biguanides (Metformin)

METABOLIC ACIDOSIS:
 Normal Anion Gap Metabolic
Acidosis= Hyperchloremic
metabolic acidosis.
TOPIC-260
 NH4CL & HCL Poisoining
 Diarrhoea
 Small bowel fistula
 Urinary diversion procedure (Ureterosigmoidestomy)
 Renal tubular acidosis (Type 2 & Type 1)

 High Anion Gap Metabolic A=Aspirin poisoining +Alcoholic ketoacidosis

Acidosis = Normochloremic M=Methanol poisoining
metabolic acidosis E= Ethanol poisoining
= “AME—DSLR “
D=Diabetic keto-acidosis
S= Starvation ketosis
L= Lactic acidosis
R= Renal failure
 TOPIC-261
ACID-BASE DISTURBANCES:

Disturbances Blood PH Primary change Compensatory change Base Excess

1.Metabolic acidosis > 7.4 ↓ HCO3- ↓ PC02 Negative

2.Metabolic alkalosis < 7.4 ↑ HCO3- ↑ PCO2 Positive

3.Respiratory acidosis >7.4 ↑ PCO2 ↑ HCO3- Positive

4.Respiratory alkalosis <7.4 ↓ PCO2 ↓ HCO3- Negative


METABOLIC ACIDOSIS:
 Normal Anion Gap Metabolic
Acidosis= Hyperchloremic
metabolic acidosis.
TOPIC-262
 NH4CL & HCL Poisoining
 Diarrhoea
 Small bowel fistula
 Urinary diversion procedure (Ureterosigmoidestomy)
 Renal tubular acidosis (Type 2 & Type 1)

 High Anion Gap Metabolic A=Aspirin poisoining +Alcoholic ketoacidosis

Acidosis = Normochloremic M=Methanol poisoining
metabolic acidosis E= Ethanol poisoining
= “AME—DSLR “
D=Diabetic keto-acidosis
S= Starvation ketosis
L= Lactic acidosis
R= Renal failure

METABOlC ALKALOSIS:
 Saline (or Chloride) Responsive
TOPIC-263
 GIT causes vomiting, nasogastric suction.
 Diuretic abuse ( loop & thiazide)
 Rapid correction of chronic hypercapnia

 Saline(or Chloride ) resistant  Exogenous alkali administration

 Cushing syndrome
 Chronic hypokalemia
 Hyper-aldosteronism
 Hyper-reninism
 TOPIC-264
Causes of Respiratory Alkalosis:
 Respiratory Alkalosis→  Meningitis , Encephalitis, Encephalopathy, Cerebral hemorrhage.

 CCF +CCHD
 Pulmonary disease Severe pneumonia, Pulmonary edema, Pulmonary
embolism, ILD

 Mechanical overventilation
 Hysteria
 Salicylate poisoining.
 TOPIC-265
INCREASED K+ INFLUX:
CLUE “ HASINAA”

H Hypokalemic periodic paralysis

A Alkalosis
S Salbutamol (Beta-2 agonist)
I Insulin
N /M  MI (Acute MI)
A Aldosterone
A Alpha-blocker
 TOPIC-266
Causes of Hypercalcemia:
 With normal or elevated  Primary or tertiary hyperparathyroidism
parathyroid hormone (PTH) levels  Lithium-induced hyperparathyroidism
 Familial hypocalciuric hypercalcaemia

 With low PTH levels  Malignancy (lung, breast, myeloma, renal, lymphoma, thyroid)

 Elevated 1,25-dihydroxyvitamin D (vitamin D intoxication,

sarcoidosis, HIV virus, other granulomatous disease).

 Thyrotoxicosis
 Paget’s disease with immobilisation
 Milk-alkali syndrome
 Thiazide diuretics
 Glucocorticoid deficiency
 TOPIC-267
ECG CHANGES IN HYPO & HYPERKALEMIA:

 HYPOKALEMIA  Flat T / Inverted T

 Appearances of U wave
 Prolonged QT interval
 Prolonged PR interval
 ST segment depression

 HYPERKALEMIA  Loss of P wave

 Widened QRS
 Short—QT interval
 Prolonged PR interval
 Tall , Tented, Peak T wave
 Disappearances of ST segment
 TOPIC-268
SIADH:
 Causes:  Tumours
 Central nervous system disorders: stroke, trauma, infection,
psychosis, porphyria
 Pulmonary disorders: pneumonia, tuberculosis, obstructive lung
disease
 Drugs: anticonvulsants, psychotropics, antidepressants, cytotoxics,
oral hypoglycaemic agents, opiates
 Idiopathic

 Diagnostic Criteria  Low plasma sodium concentration (typically < 130 mmol/L)
 Low plasma osmolality (< 275 mOsmol/kg)
 Urine osmolality not minimally low (typically > 100 mOsmol/kg)
 Urine sodium concentration not minimally low (> 30 mmol/L)
 Low–normal plasma urea, creatinine, uric acid
 Clinical euvolaemia
 Absence of adrenal, thyroid, pituitary or renal insufficiency
 No recent use of diuretics
 Exclusion of other causes of hyponatraemia
 TOPIC-269
Bile Acid Sequestering agent:
 Drugs in this class include Colestyramine, Colestipol and Colesevelam.
 These prevent the reabsorption of bile acids,
 Thereby increasing de novo bile acid synthesis from hepatic cholesterol.
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ACUTE INTERMITTENT PORPHYRIA:
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Sympathetic vs Parasympathetic:
Structure Sympathetic Parasympathetic
Iris Pupil dilatation (mydriasis) Pupil constriction (meiosis)
Salivary gland ↓ saliva production ↑saliva production
Oral/Nasal mucosa ↓ mucous production ↑mucous production
Heart HR & FOC ↑ HR & FOC ↓
Lung Bronchodilataton /BSM relaxed Bronchoconstriction
Stomach Peristalsis ↓ ↑peristalsis
Small intestine Motility ↓ ↑motility
Large intestine Motility ↓ ↑motility
Liver ↑ conversion of glycogen to glucose --
Kidney ↓ urine secretion ↑
Adrenal medulla Epinephrine & nor-epinephrine secreted --
Bladder Wall relaxed, sphincter closed Wall contracted,sphincterrelaxed
Uterus  Contract pregnant uterus (alpha) --
 Relax pregnant & non preg uterus (beta-2)
Penis Ejaculation Erection
 TOPIC-288
NEUROTRANSMITTER:

EXCITATORY INHIBITORY BOTH

 Acetylcholine  Dopamine  Serotonine (5-HT)

 Adrenaline +Nor-  GABA+ Glycine  Histamine

adrenaline
 Aspartae+ Glutamate  Taurine  prostaglandine

 ATP+ADP+Adenosine  Alanine  Substance-P

 TOPIC-289
UMNL vs LMNL:
TRAIT UMNL LMNL
Inspection  Normal (may be wasting in chronic lesion)  Wasting, Fasciculation

Tone  Increased with clonus  Normal/Decreased

 No clonus

Pattern of weakness  Preferentially affects extensors in arms,flexor  Typically focal,In distribution

in legs of nerve root/peripheral
 Hemiparesis,para-paresis,tetraparesis nerve,with associated sensory
changes.

Deep tendon reflexes  Increased  Decreased/Absent

Planter response  Extensor (Babiniski sign)  Flexor

 TOPIC-300
FEATURES OF EXTRA-PYRAMIDAL LESION:
 Extrapyramidal system includes pathways through Basal ganglia+ Reticular formation+ Vestibular
nuclei+ Red nucleus.
 Power—No weakness.
 Wasting—None
 Fasciculation—None
 Tone—Rigidity (Cogwheel)
 Reflexes—Normal
 Planter responses—Flexor
 Co-ordination—Normal (But slowed).
 Tremor—Present (at rest)—Basal ganglia involvement
 Gait—bradykinesia (parkinsonian gait)
 TOPIC-301
TRACT & PATHWAYS:
PATHWAY SENSATION PASSED THROUGH
 Anterior spinothalamic tract  Light (Crude) touch & pressure

 Lateral spinothalamic tract  Pain & Temperature

 Pain (A-delta fast pain, C slow pain)
 Itching & sexual sensation +Tickle sensation

 Tract of gall  Fine touch (Discriminative touch)/Deep touch

 Joint position ,Vibration
 Visceral pain

 Spinoreticular tract  Concious sensation

 Spino –olivary tract  Proprioceptive & cutaneous information

 TOPIC-302
Causes of Absent ankle jerk with Planter Extensor:

1.CLUE→ ( “DC—MP—SI “ )  D= Diabetes Mellitus

 C=Conus medullaris lesion

 M=Motor neuron disease

 P=Peripheral neuropathy

 S=Sub-acute combined degeneration of the spinal cord

 S =Syphilitic taboparesis
 I=Fr-i-edreichs atax-i-a
 TOPIC-303
Non-capsulated receptors are:

1.Non-capsulated  Free nerve endings/Nociceptors

receptors:  Merkel’s disc
 Hair follicle receptors .
 TOPIC-304
MUSCLE SPINDLE:
 Special type of sensory receptors (Mechanoreceptor) present within the muscle fibre—present towards the
tendinious attachment of the skeletal muscle.
 Each muscle spindle consists of—about 10 muscle fibres.They are called intrafusal fibres—nuclear bag &
nuclear chain fibres.
 More in anti-gravity muscle.
 Has sensory & motor innervation.
Sensory Annulospiral endings & flower spray endings
Motor  2 gamma motor neuron & 1 beta motor neuron
Function:
1.Responsible for monosynaptic stretch reflex during muscle contraction
2.Maintain muscle tone & posture and maintains the muscle length.
3.Carries kinesthetic sensation + Mediate protective reflex when muscle vigourously contract.
 TOPIC-305
Areas of brain that devoid of Blood-brain barrier:

 No Blood-brain barrier  Wall of the supraoptic recess of the third ventricle

 Area prostrema (Vomiting centre)
 Tuber cinerium
 Pineal gland
 Posterior lobe of the pituitary gland.
TOPIC-306 CSF PATHWAY
 TOPIC-307
CSF-RODDY:

 Regarding CSF  It is actively secreted by the choroid plexus

 Brain nutrition is delivered mainly by cerebral blood flow
 PH is around 7.2 compared with 7.4 in blood
 Glucose conc. is about 2/3rd that of plasma
 Calcium conc. about half that of plasma.
 TOPIC-308
RETICULAR FORMATION:

 FOUND IN  Brainstem

 Thalamus
 Subthalamus
 TOPIC-309
Hyperkinetic disorder:

 Name   Parkinsonism.
 Catatonia
 TOPIC-310
TRACT & PATHWAYS:
PATHWAY SENSATION PASSED THROUGH
 Anterior spinothalamic tract  Light (Crude) touch & pressure

 Lateral spinothalamic tract  Pain & Temperature

 Pain (A-delta fast pain, C slow pain)
 Itching & sexual sensation +Tickle sensation

 Tract of gall (Dorsal column)  Fine touch (Discriminative touch)/Accurate touch

 Joint position ,Vibration
 Visceral pain

 Spinoreticular tract  Concious sensation

 Spino –olivary tract  Proprioceptive & cutaneous information

 TOPIC-311
REM SLEEP Vs NON-REM SLEEP:

CHARACTERISTICS REM SLEEP NON-REM SLEEP

1. Rapid eye movement  Present  Absent

2. Dreams  Present  Absent

3. Muscle twitching  present  Absent

4. HR +BP+Respiration  Flactuationg  Stable

5. Body tempearature  Flactuating  Stable

6. Neurotransmitter  Nor-adrenaline  Serotonin

7. Penile erection  Common  Rare

8. EEG  Low voltage  Spindles, V wave, slow waves.

 TOPIC-312
MUSCLE CHANNELOPATHIES:

CHANNEL MUSCLE DISEASE

1.Sodium  Paramyotonia congenital
 Potassium-aggravated myotonia
 Hyperkalemic periodic paralysis
 Hypokalemi8c periodic paralysis
2.Chloride  Thomsen’s disease
 Becker’s disease

3.Calcium  Hypokalemic periodic paralysis

 Malignant hyperthermia

4. Potassium  Andersen-Tawil syndrome

5. Rynodin receptor  Malignant hyperthermia

 Central core & multicore disease
TOPIC-313
TOPIC-314
TOPIC-315
TOPIC-316
 TOPIC-317
KEY REGULATORS OF BONE REMODELLING:

MEDIATOR EFFECT
1.RANKL ↓ bone mass

2.Sclerostin ↓ bone mass

3.Glucocorticoid ↓ bone mass

4.Osteoprotegerin ↑bone mass

5.Wnt ↑bone mass

6.Thyroid hormone ↑bone mass

7.PTH ↑bone mass

8.Oestrogen ↑bone mass

9.Testosterone ↑bone mass

 TOPIC-318
FACTORS CAUSING CARTILAGE DEGRADATION:

FACTORS

1. IL-1

2.TNF
3.Aggrecanases
4.Matrix metalloproteinases
 TOPIC-319
Synovial fluid characteristics:

NORMAL SYNOVIAL FLUID INFLAMMED SYNOVIAL FLUID

 Small volume  High volume

 Clear  Turbid

 Colourless /Pale-yellow  Cloudy

 High viscosity  Low viscosity

 Contain few cells  Contain more cells (neutrophils)

 TOPIC-320
Causes of Elevated Serum creatinine phosphokinase (CPK):
Examples:
 IM MI
 MD MND
 MM VM
 Alcohol, drugs (statins) + vasculitis.
 Hypothyroidism
 Trauma , strenuous exercise
 Prolonged immobilization after a fall.
 TOPIC-321
CONDITIONS ASSOCIATED WITH POSITIVE ANA:

CONDITIONS ANA FREQUENCY

1. SLE 100%
2. MCTD 100%
3. Autoimmune Hepatitis 100%
4. Systemic sclerosis 60-80%
5. Sjogren’s syndrome 40-70%
6. Dermatomyositis/ Polymyositis 30-80%
7.Rheumatoid arthritis 30-50%
8.Autoimmune thyroid disease 30-50%
9.Malignancy Varies widely
10.Infectious disease Varies widely
THANK YOU EVERYONE
RESIDENCY EXAM BATCH-MARCH-21
TOPIC(311-363):CVS & RESPIRATORY PHYSIOLOGY

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)

Physiological Changes during Pregnancy:
 Cardio vascular changes →
 Haematological changes
 Routine biochemistry
 Hormones
TOPIC-312
 CO (40%) + SV(27%)+ HR(17%) Increases
 Blood pressure Usually unaffected /Mid-Pregnancy drop.
 Benign heart murmur
 3rd heart sound.
 Blood volume+Plasma volume+ Red cell volume Incresaes
 Hb.Conc Increases
 Haematocrit decreases.
 GFR Increases
 Urea & Creatinine Decreases
 ALP Increases
 Glucose Decreases (Fasting), Increases Post-prandial.
 T4 Increases (First trimester), Decreases late pregnancy.
 TSHDecreases (First trimester)
 Prolactin+ Oestrogen,progesterone+HCG,HPL Increases.
 TOPIC-313
 Refractory period:
 Is the period during which ventricles are completely inexcitable.
 Corresponds to the ventricular depolarization=Ventricular contraction=QRS complexes of
ECG.Refractory period of heart is 0.30 sec.It is of two types.

 ARP Whole depolarization+ First 1/3rd of repolarization=0.25 sec

 RRP Last 2/3rd of repolarization.=0.03 sec= Hence,Coincides with ST segment also.

 Greater than the skeletal muscle

 Decreases during sympathetic stimulation of the heart Hence, Shortening of refractory

period permits higher HR.
 So,During this period Heart muscle can not be tetanized/Fatigued & Ensures enough time
for recovery of cardiac muscle by getting nutrition & O2 supply.
TOPIC-314
TOPIC-315
TOPIC-316
TOPIC-317
 TOPIC-318
FACTORS AFFECTING CO: CO=SV x HR
 Venous Return→ ↑VR ↑EDV ↑SV ↑CO  Hypothyroidism,Haemorrage,CCF,
 Force of contraction ↑FOC ↑CO Shock  ↓ CO
 HR
 Peripheral resistance Inversely proportional
 Arterial pressure Inversely proportional

 Hyperdynamic circulation→ ( Anaemia, Fever,  No changes in Sleep & Moderate

Thyrotoxicosis, AF, Beri-Beri, AV-fistula) ↑CO. changes in environmental
temperature.
 Anxiety,Excitement (50-100%),Eating (30%),Exercise
(upto 700%),High environmental temp. ↑CO.
 TOPIC-319
FACTORS SLOWING HR:
 Increased activity of arterial baroreceptors
 Increased intracranial pressure
 Stimulation of pain fibers in trigeminal nerve
 Expiration
 Fear
 Grief.
 TOPIC-320
PULSE PRESSURE:
 Pulse pressure is directly proportional to  Age
 Stroke volume
 Arteriosclerosis
 PDA
 AR

 Pulse pressure is inversely proportional to  Arterial elastic constant (HR & TPR)
 AS

Blood pressure regulatory mechanism: (Nervous mechanism):
 Short-term regulation of BP
 Intermediate term mechanism
 Long term mechanism
TOPIC-321
 Baroreceptor feedback mechanism
 Chemoreceptor feedback mechanism
 CNS iscahemic response
 Renin-angiotensin vasoconstrictor mechanism
 Capillary fluid shift mechanism
 Stress relaxation changes in vasculature
 Renal-blood pressure control mechanism
 Renin-angiotensin aldosterone mechanism
 TOPIC-322
ANP:
 Release from the right atrium in response to atrial stretching due to volume overload.
 ↑ GFR
 Dilatation of afferent arteriole
 Natriuresis
 (-) Renin secretion
 (-) ADH release
 (-) Aldosterone.
 TOPIC-323
BLOOD FLOW:
Q (blood flow)
Velocity (V)= -----------------------------------------------------
A (Cross sectional area of blood vessels)
So, Q= V x A
Remember , The more is cross sectional area the less is the velocity.
=The cross sectional area is highest at capillaries=less velocity of it.
=The cross sectional area is lowest at arterioles= High velocity of it.
So, In case of velocity, Arterioles > Capillries, & Arterioles > Venules.
Now,Factors directly related to blood flow Effective perfusion pressure +Radius of the vessel
+Velocity of blood flow +Pumping action of the heart +Total cross sectional area of the blood
vessels.
TOPIC-324
TOPIC-325
TOPIC-326
TOPIC-327
TOPIC-328
TOPIC-329
 TOPIC-330
TOTAL PERIPHERAL RESISTANCE :

Always Remember Total peripheral Resistance is directly proportional to-

1.Length of blood vessels.
2.Viscosity of blood.
 TOPIC-331
ARTERIOSCLEROSIS :

“Hardening of the Arteries” Tends to increase in-

1.Systolic BP.
2.Pulse pressure.
 TOPIC-332
Classification of blood vessels:

 Conducting vessels  Aorta , Arch of aorta

 Wind kesel (Distribution vessels)  Renal artery, Femoral artery

 Resistance vessels  Small arteries, Arterioles

 Exchange vessels  Capillaries

 Capacitance vessels  Veins & Vena cava

 TOPIC-333
Vasodilating & Vasoconstrictive agent:
Constriction Dilatation
Local factors  Decreased local temperature  ↑CO2, ↓O2
 Autoregulation  ↑K+ ,Adenosine, lactate
 ↑local temperature
 ↓Local PH

Local hormones  Serotonin, Endothelin, Thromboxane  NO, Kinins

A2
Circulating hormones↓  Epinephrine (Except skeletal muscle &
heart)+Nor-epinephrine
 AVP, PAF
 Angiotensin-II, Neuropeptide Y
 Circulating Na+-K+ATPase inhibitor
Neural factors  Increased discharge of noradrenergic
vasomotor nerves
 Baroreceptor reflex
 Epinephrine in skeletal muscle & heart
 CGRP-alpha
 Substance P
 Histamin,ANP,BNP,VIP
 Ach, Bradykinin
 Decreased discharge of NAVN
 Activation of cholinergic dilator fibers
to skeletal muscle
 TOPIC-334
Vasodilating & Vasoconstrictive agent:
Constriction Dilatation
Local factors  Decreased local temperature  ↑CO2, ↓O2
 Autoregulation  ↑K+ ,Adenosine, lactate
 ↑local temperature
 ↓Local PH

Local hormones  Serotonin, Endothelin, Thromboxane  NO, Kinins

A2
Circulating hormones↓  Epinephrine (Except skeletal muscle &
heart)+Nor-epinephrine
 AVP, PAF
 Angiotensin-II, Neuropeptide Y
 Circulating Na+-K+ATPase inhibitor
Neural factors  Increased discharge of noradrenergic
vasomotor nerves
 Baroreceptor reflex
 Epinephrine in skeletal muscle & heart
 CGRP-alpha
 Substance P
 Histamin,ANP,BNP,VIP
 Ach, Bradykinin
 Decreased discharge of NAVN
 Activation of cholinergic dilator fibers
to skeletal muscle
 TOPIC-335
DICROTIC NOTCH IN AORTIC PRESSURE CURVE:

 Dicrotic notch  Small & brief increase in arterial blood pressure that appears
when the aortic valve closes.

 Represent the closure of the aortic valve.

 During diastole,When the heart relaxes,pressure declines back

to 80 mmHg.The small 2ndary pressure increase in the
beginning of diastole is reffered to as the dicrotic notch.
 It is due to closure of the aortic valve & elastic recoil of the
aortic wall.
TOPIC-335
 TOPIC-336
LOCAL METABOLIC ACTIVITY:
Local metabolic activity is the chief factor for determining the rate of blood flow to the-
 Heart &
 Skeletal muscle.
 N.B: Local blood flow is largely determined by the vasoactive metabolites such as rising PCO2,H+
conc. & falling PO2.
 TOPIC-337
RODDIE QUESTION:

 I/V Infusion of a) Adrenaline increases & Nor-adrenaline reduces skeletal muscle

Adrenaline & Nor- blood flow.
adrenaline b) Both decreases renal blood flow
c) Both causes cutaneous vasoconstriction
d) Nor-adrenaline raises diastolic pressure, Adrenaline lowers it
e) Adrenaline increases HR, Noradrenaline raises mean arterial
pressure & causes reflex cardiac slowing.
 TOPIC-338
RODDIE QUESTION:

 Veins a) Around three-quarters, Veins are referred to as capacitance

vessels.
b) These regulates venous capacity
c) Their vasa arise from neighbouring arteries
d) This myogenic response helps to limit the degree of distension
e) Another functional adaptation to resist distension.
 TOPIC-339
Rich Capillary Network:

 Rich capillary network  S=Skeletal muscle

 C=Cardiac muscle
 K=Kidney
 L=Liver
 TOPIC-340
Biologically active substances metabolized by the lungs

 Synthesized & used in the lungs  Surfactant

 Synthesized /Stored & Released into the  P=Prostaglandins

blood (“PHK”)  H=Histamine
 K=Kallikrein

 Partially removed from the blood  B=Bradykinin, P= prostaglandins

(“BP-ANAS”)
 A=Acetylcholine
 N=Nor-epinephrine
 A=Adenine nucleotides
 S=Serotonin
 Activated in the lungs  Angiotensin I
 Angiotensin II
 TOPIC-341
 HAEMODYNAMIC EFFECTS OF RESPIRATION:

Points Inspiration Expiration

1.JVP Falls Rises

2.BP Falls (Up to 10 mmHg) Rises

3.Heart rate Accelerates Slows

4.Second heart sound Splits Fuses

 N.B:Inspiration prolongs  Right ventricular ejection,

Delaying p2
Shortens LV ejection,
Bringing forward A2.
 TOPIC-342
ROLE OF SURFACTANT:

 Surfactant 1) ↓ the surface tension of the fluid lining the alveoli, thus
preventing the collapsing tendency of the lung.
2) Expansion of the lungs of newborn
3) ↑Compliance & stability of the lung
4) Stabilizes the size of the alveoli
5) ↓pulmonary capillary filtration  Thus prevents
pulmonary edema
6) It has some bactericidal action.
 TOPIC-343
COMPLIANCE OF THE LUNGS:
 Greater in  Adults > Infants
 Standing >Lying
 Saline filled >Air filled
 Obstructive >Restrictive
 Lungs alone (0.22L/cm) >Lungs+Thorax (0.13 L/cm)
 Base >Apex of the lung.
 TOPIC-344
APEX & BASE OF THE LUNGS:
POINTS APEX BASE
1.Blood flow Lowest Highest
2.Ventilation (V) Lower Higher
3.Perfusion (Q) Lower Higher
4. V, Q V>Q V< Q
5. V/Q Highest Lowest
6. PO2 Higher Lower
7.PCO2 Lower Higher
8.Gas exchange More Less
9.Alveolar size Larger Smaller
10.Compliance Lower Higher
TOPIC-344
 TOPIC-345
FACTORS AFFECTING GASEOUS EXCHANGE:

 Directly proportional  Surface area of the membrane

 Pressure difference between two sides of the membrane
 Diffusion co-efficient It depends on solubility of gases &
the molecular weight of the gas.

 Inversely proportional  Thickness of the membrane.

 TOPIC-346
O2-Hb Dissociation Curve:
 Right sided shift:  ↑ H+, PCO2, Temperature, (2,3-DPG)
 Systemic capillary  HbS
 At tissue level  ↓ PO2, Hypoxia
 ↓ Affinity of Hb to O2  Polycythemia
 Bohr effect  Pregnancy
 Exercise

 Left sided shift:  Reverse.

 Pulmonary capillary
 At lung level
 ↑ Affinity of Hb to O2
 Halden effect
TOPIC-347
TOPIC-347
TOPIC-348
 TOPIC-349
PNEUMOTAXIC CENTER
 Situated In Upper Pons
 Formed By Nucleus Parabrachialis
 Function
 Controls Medullary Respiratory Centers
 Switch-off The Inspiratory Center
 Limits The Duration Of Inspiration
 Also Increases The Rate Of Breathing By Shorten Expiration as well (2ndary)
 TOPIC-350
CHEMICAL FACTORS REGULATING RESPIRATION:
 High CO2
 High H+
 Low O2.
TOPIC-351
TOPIC-352
TOPIC-353
 TOPIC-354
HYPOXIA:
 HYPOXIC HYPOXIA  Lung failure
 Pulmonary fibrosis
 V/Q imbalance
 Shunt, Pump failure
 Fatigue
 Mechanical defects
 Depression of respiratory controller in the brain
 Anaemic hypoxia  Lack of Hb
 CO poisoining
 Altered Hb
 Stagnant hypoxia  ↓ CO, ↓ Blood flow to the organ
 Impaired venous return
 Haemorrhage,shock
 Histotoxic hypoxia  Poisoining with KCN
 Narcotics
TOPIC-355
TOPIC-356

Type-II Respiratory failure:
 ACUTE
TOPIC-357
 Acute severe asthma
 Acute exacerbation of COPD
 Upper airway obstruction
 Acute neuropathies
 Narcotic drugs
 Primary alveolar hypoventilation
 Flial chest injury

 CHRONIC  COPD
 Sleep apnoea
 Kyphoscoliosis
 Myopathies /Muscular dystrophy
 Ankylosing spondylitis
 TOPIC-358
Features of C02 Retention are:

 CO2 Retention→  Respiratory acidosis

 Acidic urine
 Base Excess positive
 Raised HCO3-
 Raised cerebral blood flow
 Warm periphery
 Bounding pulse
 Flapping tremor
 Central cyanosis
TOPIC-359
TOPIC-359
 TOPIC-360
PULSE OXIMETER:

 Shows   Oxygen saturation (%)-SaO2

 Pulse rate
 Pulse rhythm & volume
 TOPIC-361
VALSALVA MANAEUVER:

 DURING  Increased Intra-abdominal pressure

 Increased Intrapleural pressure
 ↓ VR ↓SV ↓CO
 ↑HR
 ↑PR
 ↑BP

 Followed by  Reverse.


Respiratory changes with ageing:
CHANGES
 Reduced lung elasticity &
alveolar support
 Increased chest wall rigidity
 Incresaed V/Q mismatch
 Reduced cough & ciliary action
TOPIC-362
CLINICAL CONSEQUENCES
 Reduced vital capacity & PEF
 Increased residual volume
 Reduced IRV
 Reduced arterial oxygen saturation
 Increased risk of infection
TOPIC-363
THANK YOU EVERYONE
 DIPLOMA EXAM BATCH-MARCH-21
TOPIC(364-430):ENDOCRINOLOGY+BIOCHEMISTRY & CLINICAL NUTRITION

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-364
Sterol Nucleus containing hormone:

 Clue →  Hormones coming from 3 layers of the adrenal cortex.

-Aldosterone
-Cortisole
-Estrogen,Progesterone,Testosterone
+
 Vitamin-D (1,25 dihydroxycholecalciferol)
 Retinoic acid.
 TOPIC-365
Classification of hormone according to chemical nature:

 Protein & Polypeptide hormone  Hormones of Pituitary (GH,LH,FSH,ACTH,TSH,ADH,Oxytocin)

 Hormones of Pancreas (Glucagon,Insulin)
 Hormones of Parathyroid (Parathormone)

 Steroid Hormone  Hormones of Adrenal gland (Aldosterone,Cortisol,Sex hormone)

Except-Adrenal medullary hormone.

 Derivatives of Amino acid  Thyroid Hormones (T4,T3)

tyrosine  Adrenal medullary hormones (Epinephrine,Nor-epinephrine)
 TOPIC-366
Location of Hormone Receptors:

 In/on the surface of the cell membrane  Protein ,Peptide & Catecholamine hormones

 In the cell cytoplasm  Steroid hormone

 In the cell nucleus  Thyroid hormones

 N.B: Intracellular Cell cytoplasm+ Cell nucleus.

 TOPIC-367
Hormones uses the phospholipase C second messanger system-:

 Clue →  Releasing hormone.

-GHRH
-GnRH
+
 Angiotensin-II (Vascular smooth muscle)
 Catecholamines ( alpha receptor)
 Oxytocin
 Substance-P
 Vasopressin (V1)
 TOPIC-368
Hormones act by gene activation:

 Clue →”ST-RC” S=Steroid hormone (Androgens)

T=Thyroid hormone (T3,T4)

R= Retinoic acid
C= Calcitriole (Vitamin-D)
 TOPIC-369
Hormones increases during sleep:

 Clue →”GPA” G Growth hormone

P Prolactin
A ADH
 TOPIC-370
Hormones of pituitary gland:

 Anterior pituitary  GH
 TSH
 ACTH
 FSH
 LH
 Prolactin
 Posterior pituitary  ADH
 Oxytocin
TOPIC-370
 TOPIC-371
Stimuli that decreases growth hormone secretion-:

 Look carefully →  REM sleep

 Glucose
 Cortisol
 FFA
 Medroxyprogesterone
 Growth hormone
 TOPIC-372
 Oxytocin/Pituicin:
 Is a posterior pituitary hormone but synthesized in the supraoptic & para-ventricular nuclei
of the hypothalamus.
 Polypeptide in nature (Made up of 09 amino-acids)

 Traget tissue Myoepithelial cells of the breast & smooth muscle of the uterus.

 Oxytocin secretion is controlled by neuroendocrine reflex.

 Function:

 On pregnant uterus contraction of fundus & body and relaxation of cervix of uterus.

 On non-pregnant uterus causes receptive contraction of uterus during coitus & helps in
transport of spermatozoa.
 Breast Milk ejection.

 In male oxytocin secretion is increased during ejaculation.

 TOPIC-373
Metabolic effect & long term complications of Acromegaly :

 Metabolic effect  Glucose intolerance

 Diabetes mellitus
 Hypertension

 Long term complications   Cardiovascular disease

 Colonic cancer
TOPIC-374
 TOPIC-375
Thyroxin vs Tri-iodothyronine:

Traits Thyroxine (T4) Tri-iodothyronine (T3)

1.Amount of secretion 93% 7%
2.Potency Less potent 5 times more potent than T4
3.Onset of action Slow Rapid

4.Persistence in the blood Long (6 wks to 2 months) Short (2-3 days)

5.Plasma protein binding High affinity Less affinity

6.Conversion T4 is converted to T3 Not converted

7.Affinity to receptor Less More (10 times)

8.Found in Circulation Intracellularly

 TOPIC-376
Physiological effect of thyroid hormones:
Target Tissue Effect Mechanism
1.Heart  Chronotropic  Increases number of beta-adrenergic receptors
 Ionotropic  Enhances responses to circulating catecholamine
 Increases proportion of myosin heavy chain (With higher ATPase
activity)
2.Adipose tissue Catabolic  Stimulate lipolysis
3.Muscle Catabolic  Increase protein breakdown
4.Bone & NS Developmental  Promote normal growth & skeletal & brain development.
5.Gut Metabolic  Increases rate of CHO absorption
6.Lipoprotein Metabolic  Stimulae formation of LDL receptors

7.Other Calorigenic  Stimulate oxygen consumption by metabolically active tissues

except(Testes, uterus,lymph nodes, spleen,anterior pituitary)
 Increases metabolic rate.
 TOPIC-377
Features common in both hypo & hyperthyroidism:

 Common features →  Alopecia

 Infertility
 Impotence
 Psychosis
 Proximal myopathy
 HTN
 Fatigue
 TOPIC-378
Non-specific lab abnormalities of Hyper & Hypothyroidism:

 Thyrotoxicosis→  Increased ALT, ALP, Gamma-GGT

 Increased bilirubin
 Mild hypercalcemia
 Glycosuria

 Hypothyroidism  Increased AST, LDH, CK

 Increased Cholesterol
 Hyponatraemia
 Anemia Normochromic normocytic/Macrocytic anemia
 TOPIC-379
Functions of PTH:

 On kidney  ↑ Ca reabsorption from PCT & DCT.

 ↑Phosphate excreation through kidney

 Net effect Hypercalcemia & Hypophosphatemia

 On Bone  ↑Bone resorption by stimulating osteoclastic activity & inhibiting

the osteoblastic activity.

 Net effect bone loss ↑blood Ca++ level.

 On Intestine  ↑ Ca & phosphate absorption from intestine possibly via Vit-D
which is activated by PTH.

 Net effect ↑Ca & ↓PO43- conc.

 TOPIC-380
Factors influencing blood calcium level:

Factors Effect Factors Effect

1.Vitamin/Calcitriole  ↑ Ca++ level 1.Calcitonin  ↓Ca++ level
2.Parathormone  ↑ Ca++ level 2.Plasma phosphate  ↓Ca++ level
3.Plasma protein  ↑ Ca++ level 3.Alkalosis  ↓Ca++ level
4.Acidosis  ↑ Ca++ level 4.Hypoalbuminemia  ↓Ca++ level
5.High protein diet  ↑ Ca++ level 5.High fatty meal  ↓Ca++ level
6.Thyrotoxicosis  ↑ Ca++ level 6.Glucocorticoid  ↓Ca++ level
7.Growth hormone  ↑ Ca++ level 7.Insulin  ↓Ca++ level
 TOPIC-381
Metabolic functions of Insulin:
Increases Decreases
 CHO Metabolism:  Gluconeogenesis
 Glucose transport (Muscle,Adipose tissue)  Glycogenolysis
 Glucose phosphorylation
 Glycogen synthesis
 Glycolysis
 Pyruvte dehydrogenase activity
 Pentose phosphaqte shunt
 Lipid metabolism:  Lipolysis
 TG synthesis  Lipoprotein lipase (muscle)
 Fatty acid synthesis  Ketogenesis
 Lipoprotein lipase activity (adipose tissue)  Fatty acid oxidation (Liver)
 Protein metabolism:  Protein degradation
 Amino acid transport
 Protein synthesis
 TOPIC-382
N.B. Note:Only GLUT-4 Is Insulin Dependent & Stimulated By Insulin.
Others Are Insulin Independent.

Types of GLUT Working site

GLUT-1 RBC,neuron,kidney,colon,placenta

GLUT-2 Liver,pancreatic beta cell,small intestine,kidney

GLUT-3 Neuron,kidney,placenta

GLUT-4 Skeletal muscle,adipose tissue,cardiac muscle

GLUT-5 Intestine

SGLT-1 Small intestine,renal tubule

SGLT-2 Renal tubule

TOPIC-383
TOPIC-383
 TOPIC-384
 Biochemical Features Of Addison’s Disease/Primary Adrenal Failure:

 Biochemical features  Hyponatraemia

 Hypoglycemia
 Hyperkalemia
 Hypercalcemia
 High ACTH level
 Metabolic acidosis
 Acidic urine
 TOPIC-385
 Functions of Oestrogen:
 Oestrogen causes  Endometrial proliferationS
 Breast proliferation duct+stroma
 Genital development & lubrication
 Brain development
 Bone epiphyseal closure & mineral content
 Body fat distribution
 Skin sebum production
 Secreted prior to ovulation
 Reproductive development
 Impair blood sugar control
 Depression,headache,migraine
 ↑Risk of endometrial Ca, Breast Ca, VT
 ↑LH & ACTH Secretion
 ↑Retention of Na+ & H2O
 ↓Blood cholesterol
 Secretion is regulated by FSH
 TOPIC-386
N.B. Note:Globulin is divided into four subgroups .

Types of Globulin Examples

Alpha-1 globulin Alpha-1 anti-trypsin, Alpha-1 feto protein

Alpha-2 globulin Haptoglobin, Ceruloplasmin, Transcortin, Angiotensinogen

Beta-globulin Transferrin, hemopexin, CRP

Gamma-globulin Immunoglobulins (Antibodies)

 TOPIC-387
Coenzyme derived from vitamin B complex:

 Thiamine (B1)  Thiamine pyrophosphate (TPP)

 Riboflavin (B2)  FAD, FMN
 Niacin (B3)  NAD, NADP
 Pantothenic acid (B5)  CoA SH (Coenzyme-A)
 Pyridoxin (B6)  Pyridoxal phosphate
 Folic acid  Tetra-hydrofolate (TH4)

 Cobalamine (B12)  Methylcobalamine & deoxy-adenosylcobalamine

 TOPIC-388
ENZYME DEFICIENCY CAUSES DISEASE:
Disease Deficient enzyme
Lactose intolerance  Lactase

Hemolytic anemia  G-6 PD deficiency

Glycogen storage disease  Enzymes of glycogen metabolism

Lysosomal storage disease  Lysosomal enzyme

 TOPIC-389
N.B. Note:Only GLUT-4 Is Insulin Dependent & Stimulated By Insulin.
Others Are Insulin Independent.
Types of GLUT Working site
GLUT-1 RBC, neuron, kidney, colon, placenta
GLUT-2 Liver, pancreatic beta cell, small intestine, kidney
GLUT-3 Neuron, kidney, placenta
GLUT-4 Skeletal muscle, adipose tissue, cardiac muscle

GLUT-5 Intestine
SGLT-1 Small intestine, renal tubule
SGLT-2 Renal tubule
 TOPIC-390
DIFFERENCE:
Nuclear DNA Mitochondrial DNA
 Linear & consists of about 7000 mega base  Circular & consists of 16,500 base pair

 >99% of cellular DNA  <1% of cellular DNA

 Contain > 30,000 gene  Contain 37 gene

 Genes on both strand  Majority genes on one starnd

 Mutation rate is less  Mutation rate is high (10 times of nuclear DNA)
 TOPIC-391
DIFFERENCE:

Features Liver bile Gall bladder bile

 Water 97% 88%

 Solid 3% 12%
 pH 7.8-8.6 7.0-7.4
 Bile salt conc. 10-12 mmol/l 50-200 mmol/l
 Bile pigment conc. Low High

 Cholesterol conc. Low High

 Phospholipid conc. Low High
 TOPIC-392
Rate limiting Enzymes:
 TCA CYCLE “ACI”  Alpha-ketogluterate dehydrogenase
 Citrate synthase
 Isocitrate dehydrogenas

 Gluconeogenesis  Pyruvate carboxylase

 Phosphoenol pyruvate carboxykinase
 Fructose 1,6-bisphosphatase
 Glucose 6-phosphatase
 TOPIC-393
DIFFERENCE:

Glycolysis HMP Shunt

 Major pathway of glucose oxidation  Alternative pathway of glucose oxidation

 Produce NAD2H  Produce NADP2H

 Do not produce CO2  CO2 produced directly

 Occur in all tissues  Occur in selective tissues

 Meant for ATP production  Meant for Ribose & NADP2H production
 No ATP is consumed/Produced
 No multicycic process  Multicyclic process
 TOPIC-394
 HMP SHUNT:

 Occurs in  Adipose tissue + Adrenal cortex

 Liver +Lactating mammary gland
 RBC +MQFG
 Gonads (Testes+Ovary)
 TOPIC-395
Types of lipoprotein:
 Atherogenic  VLDL +
 CMR +++
 VLDLR/IDL +++
 LDL ++++
 TAG rich  CM
 VLDL

 Cholesterol rich  LDL

 HDL
 TOPIC-396
DIFFERENCE:

Features Lipoprotein lipase Hepatic lipase

 Site of action Capillary endothelial surface Sinusoidal surface of hepatocytes

 Reaction catalyzed Hydrolysis of TAG of chylomicron & VLDL Hydrolysis of the TAG of IDL,LDL &HDL

 Activator Apo C-II, Insulin Apo A-II

 Inhibitor Apo A-II, Apo C-III -

 Metabolic function Chylomicron & VLDL metabolism Metabolism of IDL,LDL,HDL

 TOPIC-397
METABOLIC PATHWAYS IN BRAIN:
 CLUE: “ATN-G”.
A=Amino acid metabolism

T=TCA Cycle

N=Neurotransmitter synthesis
G=Glycolysis.

 Major products exported Lactate.

 TOPIC-398
METABOLIC FUEL OF TISSUES:
Tissues Metabolic fuel
1.Brain  Glucose +Ketone body

2.Skeletal muscle  Glucose +Ketone body +Fatty acid

3.Heart  Glucose +Ketone body +Fatty acid

4.Liver  Lactate+ Keton body +Fatty acid

 TOPIC-399

OMEGA-6 FATTY ACID: OMEGA-3 FATTY ACID:

 Linoleic acid -Linolenic acid
 Arachidonic acid
 TOPIC-400
 SITES OF PRODUCTION OF ALP:

 Sites  Liver
 GI Tract
 Bone
 Placenta
 Kidney
 TOPIC-401
 Low energy phosphate compound:

 High energy phosphate  ATP+ ADP+ GTP+ GDP

compound  Creatine PO43-
 Carbamoyl PO43-
 Phosphoenol pyruvate
 cAMP
 Pyrophosphate
 13-BPG
 Low energy phosphate  AMP
 Glucose 1-P
 Glucose 6-P
 Fructose 6-P
 Glycerol 3-P
 TOPIC-402
 PRECURSORS OF GLUCONEOGENESIS:

 Substrate  Glycerol
 Dihydroxy acetone phosphate
 Lactate
 Glucogenic amino acid
 Alpha-ketoacids Pyruvate, Oxaloacetate, Alpha-ketogluterate,Proprionate
 Krebs cycle intermediates via oxaloacetate
 TOPIC-403
HMG –CoA Reductase activity:

 Increases  Insulin
 Thyroid hormone
 Decreases  Glucagon
 Glucocorticoid
TOPIC-404
TOPIC-405
TOPIC-406
TOPIC-407
TOPIC-408
 TOPIC-409
:Trace elements believed essential for life:

 Trace elements  Arsenic

 Chromium+ Cobalt+ copper
 Flourine
 Iodine
 Iron
 Manganese+ Molybdenum
 Nickel
 Selenium +Silicon
 Vanadium +Zinc
 TOPIC-410
Factors increasing iron absorption:

 Increases  Acidity
 Vitamn C (Ascorbic acid)
 Alcohol
 Fructose
 Low phosphate
 Cysteine, Ineffective erythropoiesis
 Iron deficiency anemia (2-10 times increase)
 Small peptides & amino acids
 TOPIC-411
Features of Zn deficiency:

 Features  Diarrhoea
 Mental apthy
 Eczematoid dermatitis around the mouth
 Loss of hair (Alopecia)
 Acrodermatitis enteropathica (Growth
retardation,hair loss, chronic diarrhoea)
 Impaired taste & smell ( decreased appetite)
 Night blindness ( severe zinc deficiency)
 Impaired wound healing.
 Hypogonadism Infertility
 Dwarfism
 TOPIC-412
Subsatnces having anti-oxidant properties:

 Vitamins:  Vitamin A (Beta-carotin)

 Vitamin C ( Ascorbic acid)
 Vitamin E (Tocopherol)

 Others:  Ferritin, Transferrin, lactoferrin, Ceruloplasmin

 Glutathione peroxidase
 Glutathione
 Catalase
 Super-oxide dismutase
 Selenium.
TOPIC-413
TOPIC-414
TOPIC-415
 TOPIC-416
Vitamins & minerals deficiency associated with glossitis:

 Vitamins:  Iron deficiency (painless glossitis)

 B12 deficiency
 Vitamin B1, 2,3, 6 deficiency
 TOPIC-417
Reduction of circulating homocysteine level:

 By supplementation of:  Vitamin B6 (Pyridoxine)

 Vitamin B12 /Methylcobalamine
 Folic acid.
 TOPIC-418
RISK OF VITAMIN A DEFICIENCY INCREASES IN-
 Zn deficiency
 Malabsorption syndrome.
TOPIC-419

 Features of pyridoxine deficiency (B6) :
 Neurological Features:
 Dermatological disorders:
 GIT Disorders:
 Haematological disorders:
TOPIC-420
 Peripheral neuropathy
 Personality changes
 Convulsions
 Dizziness
 Dermatitis around the eyes
 Dermatitis around the mouth
 Anorexia, nausea,vomiting
 Sideroblastic anemia
TOPIC-421
 TOPIC-422
 Features of Niacin deficiency (B3) :

 Features:  Pellagra: (Rough skin)

-Dermatitis
-Diarrhoea
- Dementia
-Death (if left untreated)

 Glossitis
 Stomatitis
TOPIC-423
TOPIC-424
 TOPIC-425
Zn is an essential component of many enzymes especially-
 Carbonic Anhydrase
 Alcohol Dehydrogenase
 And Alkaline Phosphatase.
 TOPIC-426
Avitaminosis of K is decreases synthesis of -
 Factor II (Prothrombin)
 Factor VII
 Factor IX
 Factor X.
TOPIC-427
TOPIC-428

Metabolic Classification of amino acid:
 Absolute Glucogenic amino acid:
 Amino acids having carbon skeleton that possesses
metabolic potential to produce glucose
TOPIC-429
 ATM—VH= “Arginine,Threonine,Methionine,Valine,Histidine”
 Cystine,Glutamate,Glutamine,Glycine,
 Proline
 Alanine,Aspartate,Asparagine,Serine=“CGPA-S”

 Both glucogenic & ketogenic amino acid:  I=Isoleucine

Amino acids having carbon skeleton that  T=Tryptophan
possesses metabolic potential to produce both  P=Phenyl alanine
glucose & Ketone body.

 Absolute ketogenic amino acid:  Leusine

Amino acids having carbon skeleton that  Lysine.
possesses metabolic potential to produce Ketone
body.
TOPIC-430
THANK YOU EVERYONE
RESIDENCY EXAM BATCH-MARCH-21
TOPIC(431-492):GIT+BLOOD PHYSIOLOGY+GP

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-431
Factors stimulating gastrin secretion:

 Factors stimulate 1.Luminal:

gastrin secretion →  Peptides & amino acids( Phenylalanin, tryptophan)
 Distension
2.Neural: Increased vagal discharge via GRP
3.Blood borne: Ca++, Epinephrine

 Factors inhibiting 1.Luminal :Acid, Somatostatin

gastrin secretion 2.Blood borne: Secretin, GIP, VIP, Glucagon, Calcitonin
 TOPIC-432
CCK:

 CCK  Released from “I “ cells of the duodenum & jejunum

& also from ileal & colonic nerve endings.

 Function:
 Stimulates pancreatic enzyme rich secretion
 Gall bladder contraction
 Sphincter of oddi relaxation
 Modulates Satiety
 Decreases gastric acid secretion
 Reduces gastric emptying
 Regulates pancreatic growth
 TOPIC-433
Ghrelin:

 Origin  Oxyntic gland of the stomach

 Stimulus  Fasting
 Inhibited by eating
 Function  Stimulates acid secretion
 Stimulates gastric emptying
 Stimulates appetite
 TOPIC-434
VIP:

 VIP  28 amino acids

 Found in Nerve (GIT)
 Half life about 2 minutes
 Also found in Blood,brain, autonomic nerves.
 VIPomas Severe diarrhoea+ Hypokalemia
 Normal serum level 2.540 pg/ml.
 Function  Inhibit acid secretion
 Inhibit gastric emptying
 Secret electrolyte & water
 Relax intestinal smooth muscle
 Dilatation of peripheral blood vessels.
 TOPIC-435
Factors stimulating gastric emptying:

 Factors→  Gastrin
 Ghrelin
 Motilin
 Substance P
 Neural factor Vagus nerve
 Emotional factor Excitement
 TOPIC-436
Gastrointestinal motility is increased by:

 Factors→  Gastrin
(GMC2+ 3P)  Motilin
 CCK + Cholinergic agent

 P Parasympathetic activity+
Substance P+ Prostaglandin.
 TOPIC-437
Saliva  Roddie:

 Clue → a) In absence of saliva, the mouth becomes infected & ulceration occurs.
b) If salivary enzymes are absent, other digestive tract enzymes can take
over.
c) Not necessary for liquid swallowing.
d) Keeps the mouth moist & helps in speech.
e) Helps in taste by dissolving food stuffs.
 TOPIC-438
Ionic composition of saliva:

 At low salivary Hypotonic

flows Slightly acidic
Rich in K+
Depleted of Na+ & Cl-
 TOPIC-439
 Composition of saliva:

 Composition  Water 99.5%

 Solid  0.5%

 Enzymes Ptylain (alpha-amylase), Carbonic

anhydrase, Phosphatase, lysozymes, lingual
lipase.

 Other organics--. Mucin,urea,cholesterol,amino

acids.
TOPIC-440
 TOPIC-441
Composition & Function of bile:

 Composition  Bile salt & Bile acid

 Conjugated bilirubin
 Cholesterol
 Fatty acid
 Lecithin (Phospholipid)
 Mucin
 Functions  Digestion & absorption of fat & fat soluble vitamins,iron & calcium.
 Cholagogue function↑ the secretion of bile from the liver.
 Laxative action
 Excretory function certain drugs,Cu,Zn,Hg,bilirubin,Excess cholesterol,toxin
,bacteria.
 Mucin of bile acts as buffer & lubricant.
 TOPIC-442
Factors favouring iron absorption-:

 Incresaes→  Haem iron +Hypoxia

 Ferous form (Fe++)
 Acids (HCl, Vit-C)
 Solubilizing agents ( Sugar,AA)
 Decreased Hepcidin
 Ineffective erythropoiesis
 Pregnancy
 Hereditary hemochromatosis
 Increased expression of DMT-1 in duodenal enterocyte.
 TOPIC-443
Substances absorbed in Terminal ileum:

 Terminal Ileum  Vitamin B12

 Bile salts
 TOPIC-444
Body fat Roddie:

 Clue → a) Fatty tissue contains little water.

b) Fat is the main energy store of the body
c) Favours survival by increasing skin insulation
d) Fat has a lower specific gravity than the lean body mass
e) Increases morbidity & pre-mature mortality.
 TOPIC-445
 Severe Diarrhoea & Its effect:
 Body K+ Due to loss of secretions rich in K+
 Body Na+ Sodium is the main cation lost in diarrhoea

 ECF Volume Because body Na+ is the skeleton of ECF volume

 TPR Raised to maintain arterial blood pressure
 Blood Ph Loss of intestinal HCO3- causes metabolic acidosis.
 TOPIC-446
Characteristics of stool in malabsorption :

 Stool in malabsorption  Bulky

 Frothy
 Pale
 Offensive
 Floats in the toilet
 TOPIC-447
Brush border enzymes of small intestine:

 Enzymes  Sucrase
 Lactase
 Amino-peptidase
 Nuclease
 Deoxyribonuclease
 TOPIC-448
 Goblet cells:

 Found in  Salivary glands

 Respiratory tract
 Genital tract
 Small intestine
 Large intestine

Helicobacter pylori:
 Characteristic 
 Virulence factor of H.pylori
 Associated with
TOPIC-449
 Gram (–ve ) rod Curved, Comma shaped/S shaped/ Spiral.
 Multiple flagella at one end & actively motile.
 Microaerophillic
 Oxidase & Catalase positive
 Grows at skirrows media
 Urease enzyme producing bacteria
 Urease
 Vacuolating cytotoxin
 Cytotoxin associated gene
 Adhesins
 Outer inflammatory protein A
 Phospholipases
 Porins
 PUD (Duodenal 90 % +Gastric ulcer 70%)
 Gastric lymphoma+ Gastric carcinoma
 Decreased HCL secretion
 Intestinal dysplasia+ metaplasia
TOPIC-449
 TOPIC-450
Gastric vs Duodenal ulcer:
Clinical feature Gastric ulcer Duodenal ulcer
1.Periodicity of pain Present Well marked
2.Onset of pain Just after taking food 2 hours after taking food
3.Precipitating factor Eating Missing a meal, anxiety, stress
4.Relieving factor Vomiting Taking food
5.Vomiting Considerable Absent
6.Appetite Afraid to take food Good
7.Haematesis & malena 60:40 40:60
8.Weight Loss Gain
9.Perforation Less Common
TOPIC-451
TOPIC-452
TOPIC-453
TOPIC-454
TOPIC-455
TOPIC-456
TOPIC-457
TOPIC-458
TOPIC-459
TOPIC-460
TOPIC-461
TOPIC-462
 TOPIC-463
Stem cells:
 Common  Has prolonged self renewal capacity
Features →  Have capacity to differentiate into specialized cells
 Can be used in therapeutic purposes.
 Two types 1)Embryonic stem cells 2)Adult stem cells
 Have role in tissue repair
 Embryonic stem  Can generate all tissues of the body
cells  Pleuripotent /Totipotent
 Used for production of knockout mice in experimental models
 Can be used to repopulate damaged organs
 Taken from the interior of a blastocyst (5-14 days of embryo)
 Adult stem  Also known as somatic stem cells.
cells  Multipotent & Taken from fetal tissue/umbilical cord blood & adult stem
cells.
 Lineage specific=restricted capacity to generate different cell lineage
 Transdifferentiation (from one cell type to another) & developmental
plasticity is possible.
TOPIC-464
 TOPIC-465
Normal cell counts Values
Platelets 150-400 X 10^9/L, dots appearnces

Reticulocyte 25-85 X 10^9/L or 0.5-2.0% of normal RBCs

count
Neutrophil 3000-6000, 50-70%, multilobed.

Monocyte 300-600, 2-8%, Kidney shaped.

Eosinophil 150-300, 1-4% , Bi/Tri lobed.

Basophil 0-100, 0-1%, Bilobed.

RBC 4.5-6.5 X 10^ 12/l (male), 3.8-5.8 X 1012/L (female)

 TOPIC-466
Substances secreted from platelets:

 Dense (Delta)  Ca++

granules  ATP/ADP
 5-HT, Serotonin
 Alpha granules  Fibrinogen
 VWF
 PDGF +Clotting factors
 PF4
 Beta thromboglobulin
 Lambda granules  Contains lysosomal enzymes (Acid hydrolases)
 TOPIC-467
 Neutrophils:

 Neutrophils  Known as polymorphonuclear phagocytes.

 Derived from bone marrow & circulate freely in the blood
 Half life 06 hours.
 Produced @ 10^11 cells daily.
 IL-8 helps in chemotaxis
 Contains myeloperoxidase & other enzymes in primary granules.
 Secondary granules contain collagenase, lysozyme & lactoferrin.
 Killing of organism occurs by- Oxidative, Non-oxidative & NET formation.
 Most efficient phagocytes.
 Multilobed (2-5)
 They comprise 60-70% of circulating leucocytes.
 TOPIC-468
 Causes of SKY rise ESR:

 ≥ 100 mmHg ESR  Tuberculosis.

 Kala-Azar.
 Multiple myeloma.
 Aplastic anemia.
 CT disease RA, SLE, Temporal arteritis.
 Acute Rheumatic fever.
 TOPIC-469
Macrocytosis:

 Causes  Vitamin B12 or Folate deficiency

 Liver disease/Alcohol
 Hypothyroidism
 MDS
 Drugs Zidovudine, Trimethoprime, Phenytoin, MTX,
Hydroxycarbamide.
 TOPIC-470
Normal adult Hb are-:

Normal Hb %
In adult  HbA (96%)
 HbA2 (3%)
 HbF (1%)

In Fetus  70% HbF

 30% HbA
 TOPIC-471
Catabolism of Hb:

 Clue  Occurs in spleen (RES) Liberation of CO

 The cyclic heme molecule is oxidatively cleaved to form
biliverdin.
 Protoporphyrinogen is an intermediate in the synthesis, not
degradation of heme.
 Hemoglobin & tissue cytochromes are precursor of bilirubin
 TOPIC-472
 Maturation factor for erythropoiesis:

 Factors  Vitamin B12 acts as coenzyme in DNA synthesis

 Folic acid acts as catalyst in DNA synthesis
 Intrinsic factor of castle.

 Vitamins  B1
 B2
 B6
 B12
 Vitamin C
 Vitamin E
 TOPIC-473
 Essential hormones for erythropoiesis:

 Hormones  Androgens (Testosterone, Estrogens)

 Thyroxin
 GH
 Cortisol
 Erythropoietin

 Nutritional factors  Amino acid Globin synthesis

 Fe Heme synthesis
 Vitamin B12 Nuclear division & maturation
 Folic acid Acts as catalyst in DNA synthesis
 Riboflavin Normal erythropoiesis
 Pyridoxin Heme synthesis
 Cu protoporphyrin synthesis in Hb
 Cobalt Hb synthesis
 Bile salts Absorbs heavy metals.
 TOPIC-474
Sites of Erythropoietin production:

 Sites:
 Kidney (85%)
 Liver (15%)
 Spleen
 Salivary glands
 Brain
 Uterus
 Oviducts
 TOPIC-475
Vascular spasm in hemostasis:

 Always remember
 Immediately after a blood vessel has been cut/ruptured,the trauma to the vessel wall itself
causese the vessel to contract & this contraction results from:

1. Local myogenic spasm initiate by indirect damage to the vessel wall.

2. Local autocoids (Thromboxane A2) from the traumatized tissues & blood platelets
3. Nervous reflexes Initiated by pain nerve impulses.

N.BThese phenomenon can last for many minutes/Even hours.

 Also there is Endothelin secretion responsible for constriction.
TOPIC-475
TOPIC-475
TOPIC-476
TOPIC-476
 TOPIC-477+478
Coagulation factors:
Factor Synonym Site of synthesis
Factor I Fibrinogen  Liver
Factor II Prothrombin  Liver
Factor III Tissue thromboplastin  Various tissue
Factor IV Calcium  Bones, obtained from diet also.
Factor V Labile factor  Liver ,platelet
Factor VII Stable factor  Liver
Factor VIII Anti-hemophilic globulin  Liver
Factor IX Christmas factor  Liver
Factor X Stuart –power factor  Liver
Factor XI Plasma thromboplastin antecedent  Liver
Factor XII Hagemen factor  Liver
Factor XIII Fibrin stabilizing factor  Liver ,platelets
Prekallikrein Fletcher factor  Liver
HMW Kininogen Fitzgerald factor  Liver
 TOPIC-479
VITAMIN K DEPENDENT CLOTTING FACTORS:

CLUE 1972
Factor II

Factor VII

Factor IX

Factor X
 TOPIC-480
COMMON ANTICOAGULANTS USED IN LAB:

Anticoagulants
1.EDTA

2.Na Oxalate , K-oxalate

3.Na heparin, Na fluoride

4.Trisodium citrate
 TOPIC-481

Rh antigens & Rh antibodies

 Rh antigens  There are several Rh antigens-C, D, E, c, d, e.
 D-is the most common Rh antigens.
 Rh gene is inherited from father & mother
 Persons hav ing D-antigens are called Rh +ve, Persons not having D
antigen are called Rh negative.
 Rh antibodies  Rh antibody includes Anti-D,C,E,d,c.
 TOPIC-482
CRYOPRECIPITATE:

Contains:
Fibrinogen, Fibronectin

VWF

F-VIII

F-XIII
 TOPIC-483
Transfusion transmitted infections:
 Viral agent  HIV +Hepatitis virus
 West nile virus
 CMV
 HTCLV
 Parvo-Virus
 Bacterial agent  Gram (–ve)
E.coli,Klebsiella,Pseudomonas,Yersinia,Acinetobacter,Serratia.
 Gram (+ve) Staphylococcus, Enterococcus,
Propionobacterium,Bacillus

 Protozoa  Malaria, Trypanosoma cruzi, Babesia microti, L.donovani, Prion

disease,Toxoplasma.
TOPIC-484
TOPIC-485
TOPIC-486
 TOPIC-487
FEATURES OF HAEMOLYSIS:
Hallmark of haemolysis Additional features

 Decreased haemoglobin  Decreased haptoglobin

 Increased Reticulocytes+ Unconjugated  Increased methaemalbumin+ Haemoglobinuria+

bilirubin +LDH+ Urinary urobilinogen positive urinary haemosiderin.
 TOPIC-488
 PT & APTT:

 PT Increased in  10 1257 deficiency

 Liver disease
 DIC
 Warfarin therapy

 APTT Increased in  (9-12) 1258 deficiency

 Haemophila A & B
 DIC, VWD
 Heparin therapy
 Defect in intrinsic & Common pathway
 TOPIC-489
 DIC:

 Lab findings  10 1258 deficiency

 Increased PT, APTT, BT, CT, TT, FDP, D-Dimer

 Decreased Platelet+ Fibrinogen+ (Factor V,VIII)+ TTGT

TOPIC-490
TOPIC-491
 TOPIC-492
 Factors causing platelet activation/aggregation:

 Factors  Relaease following injury ADP, Serotonin,

TxA2

 Mediate aggregation Collagen, ADP,

Thrombin, TxA2, vWf.
THANK YOU EVERYONE
 DIPLOMA EXAM -MARCH-21
TOPIC(493-531):GENERAL PHARMACOLOGY

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-493
PRODRUG:

 Definition→  Drugs which do not produce any pharmacological effect until they are
chemically altered within the body are called prodrug.

 Examples  Acyclovir + Alpha-methyldopa

 Cyclophosphamide+ Cholecalciferol
 Enalapril +Levodopa +Talampicillin
 Prednisolone+Proguanil
 Sulindac + Sulfasalazine
 Omeprazole+ Zidovudine
TOPIC-494
TOPIC-495
TOPIC-496

Factors modifying drug absorption:
1.Lipid solubility
2.Molecular weight
3.Size of the drug
4.Degree of ionization
5.Conc.of the drug
6.Formulation of drug
7.Presence of 2nd drug
8.PH of the environment & pKa
of the drug
9.Surface area of absorption
10.Vascularity
11.Peristalis
12.Presence of food in gut
13.Gastrointestinal disease
TOPIC-497
 More lipid soluble more absorption.
 Inversely related.
 Inversely related.
 Inversely related.
 Directly proportional.
 Gaseous> liquid> solid
 Dual action.
 If equal Maximum absorption.
 Directly related.
 Directly related.
 Inversely related.
 Dual action
 Dual action
 TOPIC-498
Drugs that can cross the blood brain-barrier:
 Can cross  Antibiotics Tetracyclines +Sulphonamides +Chloramphenicol.
 Anxiolytics Diazepum, Nitrazepum.
 Anti-parkinsonian Levodopa
 Alcohol +Atropine
 Thiopental Na
 Morphin, Hyoscine, Phenytoin.

 Can,t cross  Penicillin can cross when meninges inflammed.

 Neurotransmitter Dopamine,Nor-epinephrine.
 1st & 2nd generation cephalosporin except cefuroxime.
 Phenylbutazone
 Carbidopa .
TOPIC-499
TOPIC -500
TOPIC-501
TOPIC-502
 TOPIC-503
 BIOTRANSFORMATION: Molecular alteration of drug in a living body which makes lipid
soluble drug into water soluble for the purpose of excretion is called biotransformation.

 Biotransformation occurs in

 Smooth ER (mainly)

 Mitochondria
 Cytoplasm.
TOPIC-504
TOPIC-505
TOPIC-506

DRUGS METABOLIZED BY ACETYLATION:

Clue: “SHAPPIN”
S= Sulphonamide
H=Hydralazine
A=Acebutolol
P=Procainamide
P=Phenelzine
I=INH
N=Nitrazepum.
 TOPIC-507
DRUGS WHICH HAVE EXTENSIVE METABOLISM IN THE LIVER:
 Morphine
 Pethidine
 Propranolol
 Sulbutamol
 Levodopa
 Lignocaine
 GTN
 Imipramine
TOPIC-508
TOPIC-509
TOPIC-510
TOPIC-511
TOPIC-512
 TOPIC-513
1st order vs zero order kinetics:
1st order kinetics Zero order kinetics
1.Always constant fraction of drug is eliminated /unit of 1.Always constant amount of drug is eliminated /unit of time.
time.

2.A drug that follows 1st order kinetics possesses constant 2.A drug that follows Zero order kinetics possesses variable
half life. half life.

3.Excretion time is same whatever the dose of the drug
is.
4.Reaction rate is higher in high conc. & lower in low
conc.
5.Rate of elimination is proportionate to plasma conc.
3.The more the drug,the more will be the elimination time.
4.Reaction rate is not increased in proportionate to plasma
conc.Elimination rate is fixed.
5.Rate of elimination is not proportionate to plasma conc.

6.Example: Low dose aspirin (Ant-platelet 6.Example: High dose aspirin (Anti-inflammatory
effect),Phenobarbitone,carbamazepine. effect),Phenytoin,Tolbutamide,Theophylline,Warfarin.
 Most drug follow 1st order kinetics.
TOPIC-514
 TOPIC-515
Molecular targets involved in drug action:

 Targets→  Drug receptors

 Enzymes
 Ion channels
 Carrier proteins
 Structural proteins
 Plasma protein
TOPIC-516
TOPIC-517
 TOPIC-518
Partial agonist:

 Definition  It is a weak agonist (affinity+weak efficacy),but in presence of a

potent agonist,it acts as an antagonist.It may be also called partial
antagonist.
 Examples  Acebutolol
 Clonidine
 Pindolol
 Nalorphine
TOPIC-519
TOPIC-520
 TOPIC-521
Neurotransmitter of ANS:

Sympathetic Parasympathetic
Pre-ganglionic Ach Ach

Post-ganglionic Nor-Adrenaline (except Ach

those supplying sweat
glands)

Alpha-2 Receptors:
Alpha-2 receptors “PBF”
TOPIC-522
P =pre-synaptic membrane +Platelet
B=Beta cells of Islet of Langerhans
F=Fat cells

Beta-2 receptors “ASLAM” A=Alpha cells of the pancreas

S= Smooth muscles of blood vessels supplying skeletal muscle
Smooth muscles of bronchus
Smooth muscles of GIT
Smooth muscles of uterus
L=Liver
M=Muscle
 TOPIC-523
Alpha-2 Receptors:
 Beta-2 1.A=Alpha cells of the pancreas  Increase release of glucagon
receptors 2.S=
“ASLAM”  Smooth muscles of blood vessels supplying  Relaxation=Hypotension+Bronchodilatation+
skeletal muscle Constipation+Delayed labour pain.
 Smooth muscles of bronchus
 Smooth muscles of GIT
 Smooth muscles of uterus
3.L=Liver  Glycogenolysis+ Gluconeogenesis
4.M=Muscle  Promotes K+ uptake & Glycogenolysis.
 TOPIC-524
Muscarinic & Nicotinic action of Ach :

System Muscarinic Nicotinic

Respiratory  Bronchorrhoea+ Bronchoconstriction  Reduced ventilation
Circulation  Bradycardia, Hypotension  Tachycardia, Hypertension
Muscle -  Fasciculation , Paralysis
Temperature  Fever -
Eyes  Diplopia , miosis, lacrimation  Mydriasis
Abdomen  Vomiting , profuse diarrhoea -
Mouth  Salivation -
Skin  Sweating -
 TOPIC-525
GABA:
It is secreted by nerve endings in the following
structures:
 Cerebral cortex
 Cerebellum
 Basal ganglia
 Spinal cord
 Retina
TOPIC-526
 TOPIC-527
C/F of Atropine Poisoining:
1.Hot,dry & flushed skin
2.Increased body temperature (Atropine fever)
3.Restlessness
4.Talkative but can not talk due to dry mouth
5.Mydriasis
6.Tachycardia
7.Retention of urine
8.Constipation & convulsion.
 TOPIC-528
PUPIL SIZE:
 MIOSIS  OPC poisoning
 Opioids
 Clonidine
 Pontine haemorrhage

 Mydriasis  TCA, Amphetamine, Cocaine

 Atropine, Alcohol, Antihistamine, Quinine
 Datura poisoining

 Homatropine
 Cyclopentolate
 Scopolamine
 Tropicamide
TOPIC-529
TOPIC-530
 TOPIC-531
CARDIO SELECTIVE BETA-BLOCKER:

 Selective Beta-1 blocker  Atenolol

 Acebutolol
 Metoprolol
 Betaxolol
 Bisoprolol
 Esmolol
 Selective Beta-2 blocker  Butoxamine
TOPIC-532
 TOPIC-533
Competitive & Non-competitive neuromuscular blockers:

 Competitive blocker/Non-depolarizing Isoquinolone derivatives Steroid derivatives

group ---------------------------- ----------------------------
 D-tubocurarine  Pancuronium
 Gallamine  Pipecuronium
 Atracurium  Rocuronium
 Doxacurium  Vecuronium
 Mivacurium
 Non-Competitive/Irreversible  Succinocholine
depolarizing group  Suxamethonium
 Decamethonium
 TOPIC-534
SECOND GENERATION/LESS SEDATIVE ANTI-HISTAMINE:
 Fexofenadine
 Loratadine
 Cetirizine
 Kitotifen
 Levocavastin.
 TOPIC-535
DRUGS USED IN MOTION SICKNESS:
 Cinnarizine
 Cyclizine
 Diphenhydrinate
 Scopolamine
 Hyoscine
 Promethazine
 TOPIC-536
5-HT receptor antagonists:
 5-HT1 Antagonists  Spiperone

 5-HT2 Antagonists  Ketanserine

 Mainserine
 Methylsergide
 5-HT3 Antagonists  Ondansetrone
TOPIC-537
TOPIC-538
TOPIC-539
THANK YOU EVERYONE
 DIPLOMA-MARCH-21
TOPIC(539-580):SYSTEMIC PHARMACOLOGY

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
 TOPIC-540
Drugs usesd in migraine prophylaxis:

 Beta blocker  Atenolol, Metoprolol, Propranolol

 Ca2+ channel blocker  Verapamil, Flunarizine
 Tricyclic antidepressant  Amitriptyline

 Ergot derivatives  Methysergide, Ergonovine

 Anticonvulsants  Valporate, Topiramate, Gabapentine

 NSAIDs  Aspirin, Naproxen, Ibuprofen

 Riboflavin  High dose reduces frequency of migraine attack

 TOPIC-541
Pharmacological effect of Diazepum:

 On CNS
 On Respiratory system
 Sedation
 Hypnosis
 Anxiolysis
 Anticonvulsant
 Anaesthesia
 Muscle relaxation
 Respiratory depression.

 On GIT  Relief GIT disorder,such as IBS

 Reduce nocturnal HCL secrerion.
 On CVS  In High dose ↑HR, ↓BP.
TOPIC-542

Functions of Opioid receptors:
 µ (mu) receptor
 Delta receptors
 Kappa receptors
TOPIC-543
 Supraspinal & spinal analgesia
 Respiratory depression
 Sedation
 Slowed GI transit
 Modulation of hormone & neurotransmitter release
 Supraspinal & spinal analgesia
 Modulation of hormone & neurotransmitter release
 Supraspinal & spinal analgesia
 Psychomimetic effects
 Slowed
TOPIC-544
 TOPIC-545
Pharmacological effect of Aspirin:

 Effect  Anti-inflammatory
 Analgesic
 Antipyretic
 Anti-platelet
 Anti-thrombotic
 Uricosuric effect
 Respiratory stimulation
 Inhibit PGE1 Gastric erosion
 Effect on acid-base balance ↑O2 consumption & CO2 production.
 TOPIC-546
Classification of Anti-depressant:
 Tricyclic antidepressant  Amitriptyline
 Imipramin
 Dosulepine
 Clomipramine
 Selective serotonin re-uptake inhibitor  Citalopram
(SSRIs)  Escitalopram
 Fluoxetin
 Sertraline
 Paroxetine
 Monoamine oxidase inhibitor  Phenelzine
 Tranylcypromine
 Moclobemide
 Noradrenaline re-uptake inhibitors &  Venlafaxine
SSRIs  Duloxetine
 Noradrenaline & specific serotonergic  Mirtazapine
inhibitor
 TOPIC-547
S/E of TCA:

 Common Side-  Anti-cholinergic effect

effect:  Sedation
 Postural hypotension
 Lowering of the seizure threshold
 Cardiotoxicity .
 TOPIC-548
Adverse effect of antipsychotic drugs:
1.Effects due to dopamine blockade  Acute dystonia
 Akathisia (motor restlessness)
 Parkinsonism
 Tradive dyskinesia
 Gynaecomastia
 Galactorrhoea
2.Effects due to cholinergic blockade  Dry mouth, blurred vision, impotence, constipation,
Urinaruy retention.
3.Increased appetite  Weight gain

4.Hypersensitivity reactions  Blood dyscrasias

 Cholestatic jaundice
 Photosensitive dermatitis
5.Ocular complications  Corneal & lens opacities
 TOPIC-549
Mood stabilizing drugs:

 Mood stabilizer  Lithium

 Valporate
 Lamotrigine
 TOPIC-550
Anti-psychotic drugs:

 2nd generation/Atypical  Clozapine

antipsychotic  Risperidone
 Olanzepine
 Queitiapine

Drugs used in parkinsonism:
 Dopaminergic drug
 Anticholinergic drug
 MAO inhibitors
 Catechol-o-methyl transferase
inhibitors
TOPIC-551
 Levodopa, Carvidopa (Replace dopamine)
 Bromocriptine,
apomorphine,pergolide,pramipexole,ropinirole
(Dopamin agonist)
 Amantadine (release dopamine)
 Benztropine,Benzhexole,procyclidine,Orphanadrine
 Selegiline,Rasagiline
 Entacapone,Tolcapone.
 TOPIC-552
Epilepsy type & drugs:
Epilepsy type First line drug 2nd line drug

1.Focal onset & or  Lamotrigine  Carbamazepine

2ndary GTCS  Levetiracetam
 Sodium valproate
 Topiramate
 Zonisamide
 Lacosamide
2.GTCS  Valporate  Lamotrigine
 Levitiracetam  Topiramate
 Zonisamide
3.Abscence  Ethusuxamide Na valporate

4.Myoclonic  Valporate  Levitiracetam

 Clonazepum
TOPIC-553
 TOPIC-554
Inhalational anaesthetics:

 Examples  N2O
 Halothane
 Enflurane
 Isoflurane
 Desflurane
 Sevoflurane
 Cycloprofen
 Chloroform
 Ether
 TOPIC-555
Ketamine:

 Characteristics  Only I/V anaesthetic that possesses both anaesthetic & analgesic properties.
 Produce dose related cardio vascular stimulation
 Hallucinogen
 Produce dissociative anaesthetic state
 Block NMDA receptor
 Causing generalized CNS depression
 Highly lipophilic drug
 Increases HR, BP,CO.
 Increases Cerebral vblood flow,oxygen consumption,intracranial pressure.
 Decreases respiratory rate,upper airway muscle tone.
 Postoperative disorientation,Vivid dreams.
 Used in children undergoing painful procedure
 Used in high risk patient in cardiogenic/septic shock.
 TOPIC-556
K+ Sparing diuretics:

 K+ sparing  Aldosterone antagonist Spironolactone, Eplerenone.

diuretics  Na+ Channel blockers Amiloride,Triamterene.
 TOPIC-557
Adverse effect of hydrochlorothiazide:

 Major  Minor
 Hypokalaemia & Hypokalemic  Allergic reactions
metabolic alkalosis
 Hypovolemia, Hyponatraemia  Weakness

 Hyperuricemia+  Fayiguability
Hypercalcemia+Hyperlipdemia
 Impaired CHO tolerance leading to  Parasthesia
hyperglycemia
 TOPIC-558
Drugs having high Na+ content & Sodium retention:

 High Na+ content  Na retention

 Antibiotics  Carbenoxolone
 Antacids  Corticosteroids
 Alginates  Diazoxide
 Phenytoin  Metoclopramide
 Na valporate  NSAIDs
 Oestrogens
 EffervescentAspirin,PC,Calcium -
 TOPIC-559
Safr anti-hypertensive in pregnqancy:

 Examples  Methyldopa
 Labetolol
 Nifedipine
 Amlodipine
 Doxazosin
TOPIC-560
TOPIC-561
TOPIC-562
 TOPIC-563
 Drugs that reduces both preload & afterload:
 ACE Inhibitor
 GTN

 Ca++ Channel blocker

 Na-nitroprusside.
 TOPIC-564
Pharmacological effect of GTN:

Effects
GTN  Decrease preload
 Decrease afterload
 Increase coronary vasodilatation Increased perfusion to iscahemic
myocardium.
 Improved sub-endocardial perfusion
 Decreases platelet aggregation.
TOPIC-565
TOPIC-566
TOPIC-567
 TOPIC-568
Thrombolytic agents:

 Examples  Streptokinase
 Urokinase
 Alteplase
 Anistreplase
 TPA
 Reteplase
 Tenecteplase
 TOPIC-569
Hepatotoxic anti-tubercular drugs:

 Examples  INH
 Rifampicin
 Pyrazinamide
 TOPIC-570
DRUGS USED IN MALARIA PROPHYLAXIS:
 Chloroquine
 Mefloquine
 Doxycycline
 Malarone (Atovaqone-Proguanil)
 Progunail.
 TOPIC-571
I/V Anti-fungal agent:

 Examples  Amphotericin-B
 Itraconazole
 Fluconazole
 Voriconazole
 TOPIC-572
Drugs causing bronchoconstriction:

 Examples  Beta-blockers
 Aspirin, NSAIDs
 Cholinergic drugs Pilocarpine
 Cholinesterase inhibitors Pyridostigmine
 Prostaglandine F2-alpha
 Atracuronium, Fentanyl, Thiopentone, Morphine
 Any drugs causing anaphylaxis
 TOPIC-573
Drug used in Asthma:

 Reliever  Preventer

 Salbutamol  Salmetorol, Formeterol

 Ipratropium bromide  Montelukast ,Zaferlukast
 Systemic corticosteroids  Aminophylline ,Theophylline
 Omalizumab
 TOPIC-574
Euglycemic Anti-diabetic agents are-:

 Examples

 Biguanides Metformin, Phenformin, Buformin.

 Thiazolidinediones Rosiglitazone, Pioglitazone

 Alpha glucosidase inhibitors Acarbose, Miglitol

TOPIC-575
 TOPIC-576
OCP  RISK:
Always Remember “BCG”

B Breast Cancer
C Cervical cancer
G Gall bladder disease
 TOPIC-577
Anti-microbials that acts by protein synthesis inhibitor:

 Action on 50s ribosomal subunit  Chloramphenicol, Azithromycin, Erythromycin, Clindamycin,

Linezolid.

 Action on 30s ribosomal subunit  Aminoglycosides

 Tetracyclines
 TOPIC-578
Drugs causing polyneuropathy:

 Antibiotics  Dapsone, INH, Metronidazole, Ethambutol

 Antiepileptic  Phenytoin

 Antiarrythmic  Amiodarone

 Anticancer   Vincristine,Thalidomide, Cispaltin

 Antiretrovirals. -
TOPIC-579
TOPIC-580
THANK YOU EVERYONE
 DIPLOMA BATCH-MARCH-21
TOPIC(581-623):HISTOLOGY+EMBRYOLOGY & THORAX+ABDOMEN.

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
TOPIC-581 Cell membrane:
TOPIC-582
TOPIC-583
TOPIC-584
TOPIC-585
TOPIC-586
TOPIC-587
 TOPIC-588
Stratified squamous epithelium:
Keratinized:
 Epidermis, Cornea.
 Vestibule of the nasal cavity.

Non-Keratinized:
 Mouth , Oesophgus , Larynx
 Vagina, Anal canal.
 TOPIC-589
Mucous secreting glands:
 Nasal mucosa
 Palatine glands
 Gastric glands
 Buccal glands
 Bulbourethral glands
 Bartholin’s gland.
 TOPIC-590

Cells of loose connective tissue includes:

 Fibroblasts
 Chondroblast
 Osteoblast
 Macrophage
 Neutrophil
 Eosinophil
 Mast cell & basophil
 Lymphocytes
 Plasma cells
 Adipose & Fat cells.
 TOPIC-591
ELASTIC FIBERS: ELASTIC CARTILAGE:
 Lungs  Ear lobule
 Blood vessels  Epiglottis
 Vocal cord  Eustachean tube.
 Ligamentum nuchae
 Ligamentum flavae
 Internal elastic lamina of artery
TOPIC-592
 TOPIC-593
UNI-AXIAL JOINT:
 Hing joint Interphalangeal joint, Elbow & Ankle joint.
 Pivot/Trochoid joint Atlanto-axial joint, Radio-ulnar joint.
 Condylar joint Knee joint, T-M joint.
Bi-Axial joint:
 Ellipsoid joint(Wrist) Radio-carpal joint, Metacarpophalangeal joint, Atlanto-occipital joint.
 Saddle joint Sterno-clavicular joint, Carpo-metacarpal of thumb.
Poly-axial joint:
 Shoulder & Hip joint/Talo-calcaneo-navicular joint between incus & stapes.
 TOPIC-594
Rich capillary network:
 Liver
 Kiedney
 Cardiac muscle
 Skeletal muscle.
TOPIC-595
TOPIC-596:BARR BODY
TOPIC-596
TOPIC-597
TOPIC-598
TOPIC-599
TOPIC-600
TOPIC-601
TOPIC-602
TOPIC-603
TOPIC-604
TOPIC-605
TOPIC-606
TOPIC-607
TOPIC-608
TOPIC-609
TOPIC-610
TOPIC-611
TOPIC-612
TOPIC-613
TOPIC-614
TOPIC-615
TOPIC-616
TOPIC-617
TOPIC-618
 TOPIC-619
During DRE Following organs are palpable in male:

 Infront  Retained bladder

 Prostate
 Seminal vesicle
 Terminal part of ureter
 Bulb of penis
 Spongy urethra
 Behind  Sacro-coccygeal curve
 Enlarged sacral lymph nodes

 On Each side  Tenderness of right lateral wall of rectum suggests inflamed

appendix.
TOPIC-620
TOPIC-621
TOPIC-622
TOPIC-623
THANK YOU EVERYONE
 DIPLOMA-MARCH-21
TOPIC(623-665):LIMB ANATOMY+HEAD NECK & NEUROANATOMY.
.

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
TOPIC-624 Male Urethrae
TOPIC-625 Male Urethrae
TOPIC-626
TOPIC-627
TOPIC-628
TOPIC-629
TOPIC-630
TOPIC-631
TOPIC-632
TOPIC-633
TOPIC-634
TOPIC-635
TOPIC-636
TOPIC-637
TOPIC-638
TOPIC-639
 TOPIC-640
 Muscles supplied by median nerve:

 Thenar muscle:
 Abductor policis brevis
 Opponens policis + Superficial head of flexor policis brevis
 1st & 2nd lumbricals
 Pronator teres
 Pronator quadratus
 Flexor policis longus
 Flexor carpi radialis.
 Flexor digitorum superficialis
 Flexor digitorum profundus
TOPIC-641
TOPIC-642
TOPIC-643
TOPIC-644
TOPIC-645
TOPIC-646
 TOPIC-647
 All extraocular muscles are supplied by 3rd
cranial nerve except LR6,SO4.
TOPIC-648
  TOPIC-649
“STRUCTURE PASSING THROUGH THE CAVERNOUS SINUS”
 TOPIC-650
 STRUCTURE RELATED TO DEEP SURFACE OF
 Process:
PAROTID GLAND
 Styloid process with its muscles
 Vessels :
 Transverse process of Atlas
 Retromandibular vein
 Mastoid process
 Internal jugular vein
 Pterygoid process of parotid gland
 Internal carotid artery
 Muscle:
 External carotid artery
 Medial pterygoid
 Nerve:
 Masseter
 Facial nerve & Its branches
 Sternocleidomastoid
 IX, X, XI, XII Nerves
 Superior constrictor & parotid duct
 Posterior belly of digastric
TOPIC-651
TOPIC-653
 TOPIC-654
 FORAMEN LACERUM:

 Meningeal branch of ascending pharyngeal

artery.
 Emissary vein.
 Meningeal lymphatics of upper deep cervical
lymph nodes.
 TOPIC-655
 SPHENOID BONE TRANSMITS:

 Mandibular branch of the trigeminal nerve

 Middle meningeal artery
 Optic nerve.
TOPIC-656
TOPIC-657
TOPIC-658
TOPIC-659
TOPIC-660
TOPIC-661
TOPIC-662
 TOPIC-663
 Nerve arising from 2,3,4 segment of different parts of spinal cord are-

 Pudendal nerve S2,S3,S4

 Obturator nerve L2,L3,L4
 TOPIC-664
CONTRAINDICATION OF LP
TOPIC-665
THANK YOU EVERYONE
 Topic 666-780

#Total_Topic_from_lumely:115 টা।

Topic :666-780

#Lumely_suggestions:
-----------------------------------
★★lumely questions:★★

#Question_From--The structure of the body:

-------------------------------------------------------------------
★★ 3, 4, 14, 18, 19, 22, 26★★

#The vertebral column:

-------------------------------------
★★ 27, 30★★

#Thorax:
---------------
★★37, 39, 44, 56, 63, 65★★

#Abdomen:
-------------------
★★ 67, 68, 70, 76, 80, 82, 86, 88,( 90+ 91), 92, 93, 94, 95, 96, 105★★

#Pelvis_and_Perineum:
------------------------------------
★★108, 109,( 113+114), (116+117), 120, 122, 123, 126, 130, 131,
134★★
#The_upper_limb:
------------------------------
★★137, 141, 145, 147, 158, 159, 160, 163, 176,
194, 197, 198.★★

#The_lower_limb:
----------------------------
★★208, 210, 218, 222, 224, 227, 234, 243, 254,
255, 257★★

#Head_Neck:
----------------------
★★264, 266, 268, 271, 272, 278, 282, 285, 293, 295, 296, 300, 302, 303
, 308, 312, 317, 318,
326, (332+333), (339+340), 342, 343, 348, 349, 356, 357, 358, 359, 362,
363, 364, 365, 368, (369+370), 374★★

#Central_Nervous_System:
------------------------------------------
★★381, 385, 388, 389, 393, 395, 396, 398, 410, 417, 418, 423★★.

এগুল া Must solve করলেন।তাহল Anatomy আর ভয় থাকলে

না ইনশাআল্লাহ।
DIPLOMA EXAM-MARCH-21
TOPIC(781-820):RODDIE PHYSIOLOGY
.

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
TOPIC-781
TOPIC-782
TOPIC-783
TOPIC-784
TOPIC-785
TOPIC-786
TOPIC-787
TOPIC-788
TOPIC-789
TOPIC-790
TOPIC-791
TOPIC-792
TOPIC-793
TOPIC-794
TOPIC-795
TOPIC-796
TOPIC-797
TOPIC-798
TOPIC-799
TOPIC-800
TOPIC-801
TOPIC-802
TOPIC-803
TOPIC-804
TOPIC-805
TOPIC-806
TOPIC-807
TOPIC-808
TOPIC-809
TOPIC-810
TOPIC-811
TOPIC-812
TOPIC-813
TOPIC-814
TOPIC-815
TOPIC-816
TOPIC-817
TOPIC-818
TOPIC-819
TOPIC-820
THANK YOU EVERYONE
 DIPLOMA BATCH-MARCH-21
TOPIC(821-860):DAVIDSON-01(CVS+ENDO+RESPIRATORY+DERMA+PSYCHIATRY)
.

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
TOPIC-821
TOPIC-822
TOPIC-823
TOPIC-824
TOPIC-825
TOPIC-826
TOPIC-827
TOPIC-828
TOPIC-829
TOPIC-830
TOPIC-831
TOPIC-832
TOPIC-833
TOPIC-834
TOPIC-835
TOPIC-836
TOPIC-837
TOPIC-838
TOPIC-839
TOPIC-840
TOPIC-841
TOPIC-842
TOPIC-843
TOPIC-844
TOPIC-845
TOPIC-846
TOPIC-847
TOPIC-848
TOPIC-849
TOPIC-850
TOPIC-851
TOPIC-852
TOPIC-853
TOPIC-854
TOPIC-855
TOPIC-856
TOPIC-857
TOPIC-858
TOPIC-859
TOPIC-860
THANK YOU EVERYONE
 RESIDENCY EXAM BATCH-MARCH-21
TOPIC(861-900+):DAVIDSON-02(NEURO+GIT+HEPATO+HAEMATO+POISONING+NEPHRO)
.

DR.AB RAHAMAN (BIJOY)

MBBS(SSMC),BCS(HEALTH)

FCPS,MEDICINE(FINAL PART)

MD(NEPHROLOGY),COURSE

CCD(BIRDEM)
TOPIC-861
TOPIC-862
TOPIC-863
TOPIC-864
TOPIC-865
TOPIC-866
TOPIC-867
TOPIC-868
TOPIC-869
TOPIC-870
TOPIC-871
TOPIC-872
TOPIC-873
TOPIC-874
TOPIC-875
TOPIC-876
TOPIC-877
TOPIC-878
TOPIC-879
 TOPIC-880
Causes Of An Absent Knee And Ankle Reflex With Extensor Plantars Implies A Mixed Upper And
Lower Motor Neurone Lesion, And
#Causes Include:
 Subacute_combined_degeneration Of The Spinal Cord(#SCD)
 Multiple_sclerosis(MS)
 Motor_neurone_disease(MND)
 Syphilitic_taboparesis
 Friedreichs_ataxia
 Conus_medullaris
 Cauda_equina Lesion.
 Pellagra
 Dm_with_cervical_myelopathy
TOPIC-881
TOPIC-882
TOPIC-883
TOPIC-884
TOPIC-885
TOPIC-886
TOPIC-887
TOPIC-888
TOPIC-889
TOPIC-890
TOPIC-891
TOPIC-892
TOPIC-893
TOPIC-894
TOPIC-895
TOPIC-896
TOPIC-897
TOPIC-898
TOPIC-899
TOPIC-900
TOPIC-900+
TOPIC-900+
TOPIC-900+
THANK YOU EVERYONE