FGME

ANATOMY
Umbilical cord: 2 arteries (deoxygenated blood away from foetus), 1 vein
(oxygenated blood to foetus), remnants of yolk sac and allantois, Whartons
jelly
Left 4th aortic arch artery Arch of Aorta
Surface ectoderm lens
Notochord nucleus pulposis
Mesoderm trigone of urinary bladder
Septum primum fossa ovalis
All 3 germs layers Tympanic membrane
True diverticulum: all layers of intestinal wall e.g. Meckels
Left umbilical vein of foetus ligamentum teres
Umbilical arteries median umbilical ligament
Ductus arteriosus closes at 1-3 months
Mesenteric cysts: ectopic lymphatics
Remnant of vitello-intestinal duct: umbilical polyp/sinus/Meckels
Blastocyst implantation: Day 6
Sperm attains motility: epididymis
Genital tubercle clitoris/penis
Brunners glands: in duodenum
Bowmans membrane: cornea
Hassals corpuscles: thymus
Peyers patches: ileum
Blood-testes barrier: Sertoli cells
Goblet cells (secretory cells): small intestine, colon, trachea, bronchus,
bronchioles, conjunctiva (not oesophagus)
Simple cuboidal epithelium: thyroid, ovary surface, choroid plexus, inner
surface lens, pigment cell layer retina
Periarticular lymphoid sheaths (T cells): spleen
Uterus pre menarche: ciliated columnar. Lose cilia post menarche
PHYSIOLOGY
Monocytes in circulation for 72hrs
CO2 mostly as HCO3 (carbonic anhydrase)
Vit K clotting factors: 2, 7, 9, 10
Iron stores = ferritin
HbSS: glutamate valine at -6
1gm Hb binds with 1.33ml O2
Plasma = serum + fibrinogen + clotting factors 2, 5, 8
Haemophilia A: Factor 8
Haemophilia B: Factor 9

Activation of extrinsic system: thromboplastin (7, 9, 10, 5)

Activation of intrinsic system: (12, 11, 9, 8, 10)
Hagemann factor = Factor 12 (glass factor)
Plasma = 5% B.W
Heparin inhibits: 9, 10, 11, 12 (intrinsic system)
Intrinsic system = aPTT/PTT
Extrinsic system = Prothrombin time
CVP = pressure in right atrium
1st heart sound = AV valve closure
Reticulocytosis NOT seen in chronic renal anaemia
Spectrin deficiency hereditary spherocytosis

BIOCHEMISTRY
Essential amino acids: These Ten Valuable Amino acids Have Long
Preserved Life In Man (Threonine, Tryptophan, Valine, Arginine, Histidine,
Lysine, Phenylalanine, Leucine, Isoleucine, Methionine)
AST = SGOT (serum glutamine oxaloacetic transaminase)
Xanthine oxidase co-factor: molybdenum
Phosphofructokinase requires magnesium
Ammonia in brain detoxified by glutamine
Tryptophan niacin
Tyrosine thyroxine, Adr, Norad, dopamine, melanin
Glutamine: only AA to cross BBB
Nitrogen donors in urea cycle: NH3 and Aspartate
C-peptide: part of pro-insulin
Glutathione = tripeptide
Ubiquitin: label proteins for degrade
Limiting AA in foods:
o Wheat: Lysine and Threonine
o Rice: Lysine
o Legumes: Tryptophan or Methionine
o Pulses: Methionine
o Maize: Lysine and Tryptophan
o Egg: none
Tyrosine: essential AA in Phenylketonuria
Mousy urine odour: Phenylketonuria
Cysteine Taurine, Glutathione, Co-enzyme A

PATHOLOGY
Macrophages form granuloma
Red infarct:

o Haemorrhagic
o Venous occlusion
o Loose organs: lungs, liver, ovary, testis, GI tract
o Tissues with dual blood supply
o Previously congested tissue
o Reperfusion injuruy (e.g. MI, stroke, burn, organ transplant)
White infarct:
o Anaemic
o Solid organs: spleen, heart, kidneys
o Ischaemic necrosis
Metastatic calcification: blood vessel, lungs, kidney, gastric mucosa
Amyloid: Congo red stain, green birefringence
Tumour suppressor genes: NF1, pRb, SMAD4, p53
Hyaline arteriosclerosis: hypertension
Call-exner bodies: Granulosa cell tumour
Calcification with normal Ca levels: dystrophic
Calcification in normal tissues: metastatic
Myositis ossificans (post trauma in young): metaplastic bone
FIRST sign of acute inflammation: vasoconstriction
Haemorrhage:
o Primary: at time of injury
o Reactionary: 4-6hrs
o Secondary: 7-14 days
Feature of irreversible cell injury: formation of amorphous densities in
mitochondrial matrix
Bence-Jones protein: light monoclonal chains
CEA: colon ca
AFP: hepatocellular ca, liver mets
CA125: ovarian ca
CD15-3: breast ca
Ca19-9: pancreatic and colon ca

MICROBIOLOGY
Best HIV test: Western Blot
Culture mediums:
o Blood agar both anaerobic and aerobic
o Robertsons cooked meat anaerobes
o Sabouraud Dextrose agar fungi
Enrichment media:
o Alkaline peptone water vibrio cholera
o Monsours taurocholate vibrio cholera
o Selenite F broth dysentery bacilli

 Blood agar medium: enriched medium

Haemolysis:
o Alpha: halo around colony
o Beta: completely broken down
o Gamma: no haemolysis
Sterilisation
o Pasteurisation of milk: Phosphatase test
o Sterilization of milk: Turbidity test
o Autoclave: 121 C for 15min, biological indicator is Bacillus
stearothermophilus
o Theatre sterilization: formaldehyde fumigation
o Hot air oven: glass instruments, forceps, scissors, scalpels
o Cold sterilisation: ionising radiation
o Endoscope sterilisation: glutaldehyde (Cidex)
o Coxiella burnetti: moist heat resistant
o Sharps: blue bag
o Phenol co-efficient = efficiency of disinfectant
Complement fixation test = Wasserman reaction
IgA: Breast milk
IgM: primary response, IgM = recent infection
IgG: secondary response, replaces IgM, intravascular haemolysis
IgE: anaphylaxis
Acquired humoral immunity = B cells
Acquired cellular immunity = T cells
Type I hypersensitivity: anaphylaxis, wheals
Type II hypersensitivity: drug induced haemolytic anaemia, drug induced
thrombocytopaenia, haemolytic disease of newborn
Type III hypersensitivity: arthus reaction
Type IV hypersensitivity: contact sensitivity
Chediak-Higashi syndrome: impaired bacteriolysis
C3: activation of complement through alternative pathways
PARASITOLOGY
Leishmania donovani Leishmaniasis
o Transmitted by sandfly Phlebotomus argentipes
o Dog is commonest reservoir
o Promastigote (flagellate) form of Leishmania found in GIT of sandfly
o Known as kala azar
o Seen in bone marrow aspirate, intracellular in RES (LeishmanDonovan body)
o Best test: immunofluorescent antibody test (DAT)
Toxoplasma gondii dx by Sabin-Feldman dye/ELISA
Babesiosis: spread by ticks

 Coxiella burnetti Q fever

Flukes:
o Paragonismus westermani = lung fluke
o Fasciola hepatica = liver fluke
o Gastrodiscoides hominis = large intestinal fluke
o Clonorchis sinensis = biliary tract fluke
Tapeworm:
o Diphyllobothrium latum megaloblastic anaemia (B12)
o Taenia solinum cysticercus cellulosae
o Echinococcus granulosus hydatid cyst
Hookworm:
o Ancylostoma duodenale microcytic hypochromic anaemia
o Necator americanus
Pinworm/Threadworm:
o Enterobius vermicularis pruritis in perineal region. Found in caecum
Roundword:
o Ascaris lumbricoides
Falciparum malaria
o Crescentic microgametocyte
o Black spot
Cyclops (small crustacean): infected in Dracunculosis/Guinea worm disease
Novy-McNeal-Nicolle (NNN) medium: leishmania
Commonest parasitic infection in AIDS: Strongyloides stercolaris
Parasites producing non-bile stained eggs: NEHA
o Necator americanus
o Enterobius vermicularis (Pinworm)
o Hymenolepis nana (Dwarf tapeworm)
o Ancylostoma duodenale (Hookworm)
Brugian malayi: 2 nuclei at tail tip
Human as intermediate host:
o Malaria
o Hydatid cyst
Infective form of malarial parasites: sporozoites
Microfilariae: not in lymphatics
Seen in peripheral malarial smear: early trophozoites and gametocytes (not
mature trophozoites or schizonts
Cryptosporidium: best test is immunofluorescence
Giardiasis malabsorption (not hookworm, roundworm, tapeworm)
Chagas disease = American trypanosomiasis (Trypanosoma cruzi)
PHARMACOLOGY
Pro-drugs:

o Enalapril
o Acyclovir
o Levodopa
o Codeine
Pharmacodynamics: effect of drug on body
Pharmacokinetics: effect of body on drug
Therapeutic index: safety margin
Area under time and plasma concentration curve = plasma clearance
1st order kinetics (0-order): elimination proportional to serum conc
Steady state = 4-5 half lives
Orphan drugs = used to treat rare diseases
Depot = subcut/IM
Dopamine agonists:
o Bromocriptine
o Cabergoline
o Pergolide
o Pramipexole
o Apomorphine
o Rotigotine
Dopamine antagonists:
o Antipsychotics: Clozapine, Risperidone, Olanzapine, Ziprasidone
o Antiemetics: Metoclopramide, Domperidone, Droperidol
o TCA: Amoxapine
Acetylation metabolisation: hydralazine, isoniazid, procainamide
Hydroxylation metabolism: phenytoin
ACEi: good for diabetic hypertensives
Short acting blocker: Esmolol
Ca channel blocker crossing BBB: Nimodipine
Metoprolol: 1 selective
Pulmonary artery hypertension: Sildenafil (PDE-5i)
Non selective Ca channel blocker: Nifedipine
Positive inotrope: dobutamine, dopamine, amrinone
Negative inotrope: Ca channel blockers, blockers, Na channel blockers
SVT: adenosine or verapamil
Salicylate toxicity: alkaline diuresis
Arterial AND veno dilator: sodium nitroprusside, used in hypertensives with
aortic dissection
Dopamine at renal dose: renal/coronary/mesenteric vasodilation
Dopamine at pressor dose: systemic vasoconstriction
Loop diuretics: inhibit Na-K-Cl transport

FORENSIC MEDICINE AND TOXICOLOGY

 Hanging pressure abrasion

Sec 320 IPC Grievous injury:
o Emasculation
o Permanent loss of
Eye
Ear
Member/joint
Power of member/joint
o Permanent disfiguration of head or face
o Fracture/dislocation of bone/tooth
o Endanger life/severe pain/unable to follow ordinary pursuits >20 days
Abrasion collar = margin of bullet entry
Hanging pressure abrasion
Teeth marks pressure abrasion
Hyoid fracture = throttling
Police inquest:
o Accident
o Murder
o Suicide
o Death under suspicious circumstances
Magistrate inquest:
o Dowry death Sec 304-B IPC
o Custodial death
o Death due to police firing
o Death in prison
o Death in psychiatric hospital
o Exhumation
Criminal responsibility: over 7yrs
No time limit for exhumation
Section 498A: cruelty against married woman
Conduct money = travel expenses for witnesses
Leading questions: allowed in cross-examination or for hostile witness
Hydrocution = death due to cardiac arrest, due to falling in water, shock,
NOT electrocution in water
Blood group in blood stains:
o Absorption-inhibition
o Lattes crust method
o Absorption elution test
o Latex method
Blood detection
o Crystal: Takayama test
o Pink stain: Kastle Meyer test
o Carcinogenic: Benzidine test

o Glowing bluish: Luminol test

DNA sample: cannot use CSF
Teeth:
o Deciduous teeth until 6yrs
o 1st permanent tooth: molar
o Mixed dentition from 6 -14yrs
o All permanent teeth at 14yrs
Medical Termination of Pregnancy:
o <12wks: single doctor
o 12-20 wks: 2 doctors agree, 1 doctor to do
o >20wks in emergency: single doctor can do
o Don't need husbands consent
Brain death = absent brainstem reflexes
Livor mortis: discolouration due to capillary distension
Rigor mortis: stiffening of muscles
Arborescent burns/filigree burns/Lichtenburg figure/ferning = lightning
Soot in airway = alive during fire
Postmortem wounds:
o No bleeding
o No clot/coagulation
o Edges don't gape
o No enzyme activity
CSF test: alcohol poisoning
Bone test: arsenic poisoning
Spinal cord test: strychnine and gelsemium
Brain test: opiates and organophosphates
Pugilistic attitude in burning: due to coagulation of muscle protein, happens
if alive/dead
Vitreous humour: slow putrefaction, useful in alcoholic/diabetic death, can
test biochemistry, preserved in fluoride
Corpus delicti = essence of crime
Caf coronary = asphyxia while eating, collapse
Heat stroke: no sweating, temp >40.6 degrees
Heat exhaustion: heavy sweating, precursor to heat stroke
Heat rash: skin irritation due to heavy sweating
Heat tetany: stress in heat, muscle spasms, hyperventilation, numbness
Death due to starvation:
o Translucent intestine walls
o Contracted and empty stomach
o Brain same size, other organs smaller
o Faecoliths in colon
o Full and distended gallbladder with stones

PREVENTATIVE AND SOCIAL MEDICINE

True positives: sensitivity
True negatives: specificity
Prevention:
o Primordial: prevention of risk factors e.g. HTN, obesity
o Primary prevention: prevention of disease e.g. sunscreen
o Seconday prevention: prevention of disease progression (before
patient notices) e.g. screening
o Tertiary prevention: prevention of complications (patient has
symptoms)
Passive immunity:
o Maternal antibodies across placenta
o Giving antibodies
Active immunity:
o Getting infectious disease
o Vaccination
Incubation period important for:
o Tracing source of infection
o Period of surveillance/quarantine (NOT isolation already know are ill)
o Immunisation
o Prognosis
Prevalence is a proportion
Odds ratio: case-control study and retrospective studies
Risk ratio: cohort study and RCTs
Cohort: most reliable way of showing association between risk factor and
outcome, can be retrospective or prospective, attributable risk, incidence
rates
Case-control: low cost, odds ratio only, risk of bias
Relative risk = incidence of disease in exposed/incidence of disease in nonexposed
Incidence proportion (cumulative incidence) = no of new cases in a time
period/total population initially at risk
Sentinel surveillance: detect missed cases, can only supplement routine
notification system
Herd immunity: only in contagious i.e. not tetanus
Case fatality rate:
o No of deaths due to disease x 100/No of cases due to disease
o Not useful for chronic disease
o Represents virulence
ICD revised every 10 yrs

 Kuppuswamy socio-economic status 3 factors: occupation, education,

income
EARS, NOSE AND THROAT
Hyperacusis: NOT seen in otosclerosis
o Exposure to high decibel levels
o Migraine
o Head trauma
o Damage to nerve to stapedius (facial nerve)
o Lyme disease
o Menieres disease
o Bells palsy
Menieres triad: vertigo, tinnitus, progressive hearing loss
1st sign of acoustic neuroma: vestibulocochlear symptoms
Rhinnes positive = AC > BC = normal/sensorineural
Rhinnes negative = conductive
Rhinnes negative: minimum air-bone gap:
o 256Hz: 15
o 512Hz: 30
o 1024Hz: 45
Hearing testing: 512 Hz
Malignant otitis externa: necrotizing complication of swimmers ear, 2ry to
pseudomonas aeruginosa
Commonest cause of conductive deafness <12yrs: Serous otitis media
Commonest cause of chronic ear infection in developing countries: Chronic
suppurative otitis media
Referred pain ear: e.g. carcinoma tongue
o 5th cranial nerve (auriculotemporal branch): dental, oral, TMJ
o 9th cranial nerve (tympanic branch): oropharynx, base of tongue
o 10th cranial nerve (auricular branch): epiglottis, larynx, oesophagus
o C2 and C3: lesser occipital and greater auricular
Calorie test: lateral semi circular canals
o Fast stage of nystagmus is COWS (cold opposite and warm same)
Glomus jugulare tumours:
o Rare, slow growing
o In jugular foramen of temporal bone
o Women 50-60s
o Paragangliomas
o Sx: conductive hearing loss and pulsatile tinnitus
Working hours noise level max (India): 90dB 8hrs/day, 5 days/week
Lateral wall of mastoid antrum: suprameatal triangle = Macewens triangle
(important for cortical mastoidectomy)
# cribiform plate CSF rhinorrhoea

 Atrophic rhinitis Youngs operation

Antrochoanal polps Endoscopic sinus surgery
Olfactory dysfunction:
o Kallmann syndrome (hypogonadism + anosmia)
o Foster Kennedy syndrome (papilloedema + unilateral anosmia + optic
atrophy due to olfactory groove meningioma)
o Neurodegenerative: Parkinsons, Alzheimers, Huntingdons chorea
o OCD
Paranasal sinuses:
o Ethmoid: present at birth
o Maxillary: present at birth
o Frontal: develop 2yrs
o Sphenoid: develop 3yrs
Rhinophyma = hypertrophy of sebaceous glands
Nasopharyngeal fibroma: vascular benign but fast growing tumour in young
males
Malignancy in sinus: 80% maxillary > ethmoid > frontal > sphenoid, mets
rare, carcinoma > sarcoma, men > women
Unilateral foul smelling nasal discharge in child: foreign body
Frontal sinus: opens into middle meatus
Outer tracheostomy tube should not be removed for 3-4 days to allow tract
to form
Common complication of tracheostomy: haemorrhage
Commonest cause of stridor in infant: laryngomalacia (70%)
OPHTHALMOLOGY
LR6(SO4)3
Eye of newborn: hypermetropic
Axial length:
o Newborn: 18mm
o 3yrs: 23mm
o 3-14yrs: increases by 1mm
Emmetropic eye:
o Axial length 24mm
o Corneal refracting power: 43 diopters
o Lenticular refracting power: 20 diopters
o Power of eye = 43+20 60 D
Maximum refractive power: anterior surface of cornea
1mm change in axial length 3D refractive change (increase myopia,
decrease hypermetropia)
1mm change in radius of curvature of cornea 6D refractive change
(curved myopia, flatter hypermetropia)

 Blind spot of Mariotte = optic disc

Fovea = centre of retina
Ora serrate = junction between retinal cells and ciliary body
(photosensitive)
Depth of anterior chamber of eye: 2.5mm
Radius of anterior chamber: 8mm
Radius of posterior chamber: 12mm
pH of tears: 7.5
Direct ophthalmoscopy:
o Magnifies by x15 (more than indirect)
o Indirect has larger field of view
o Image is erect
o Hypermetropia largest view, least magnified
o Myopia least area, most magnified
Retinoscopy:
o Estimate refractive error
o Performed at 1m
o Consists of plane and concave mirror
o Myopes: against movement
o Hyperopes: with movement
Test for closed angle glaucoma: dark room test
Test for dry eye: Schirmers test
Congenital dacrocystitis = nasolacrimal duct obstruction, relieve with
massage
Keratometer: measures anterior corneal curvature
Prednisolone: CI in glaucoma (known to cause glaucoma)
Pilocarpine: CI in malignant glaucoma
Eye drops
o blockers: reduce production of aqueous humour (glaucoma), e.g.
timolol
o agonists: reduce production of aqueous humour and increase
drainage, e.g. brimonidine
o Carbonic anhydrase inhibitors: reduce production of aqueous humour
e.g. dorzolamide
o Prostaglandin like compounds: increase outflow, e.g. latanoprost
o Cholinergic agents: increase outflow, e.g. pilocarpine, NOT to use in
malignant glaucoma
o Epinephrine compounds: increase outflow, e.g. dipivefrin
1st line treatment
o HIV +ve CMV retinitis: ganicyclovir
o Topical antibiotics for eye: tetracyclines
o Anterior uveitis: 1% atropine mydriasis and prevention of formation
of posterior synechiae

o Trachoma: azithromycin
o Avoid recurrence of pterygium: Mitomycin C
Cytoplegics (antimuscarinic): tx of iridocyclitis, pupil dilation, uveitis
Corneal deposits: SE of amiodarone, quinine (antimalarials)

GENERAL MEDICINE
Haemolytic anaemia: see decreased haptoglobulin
Commonest shock: hypovolaemic
Dialysis: NOT digoxin
o Salicylates
o Alcohols
o Barbiturates
o Ca, K, Na, Li
Haemolytic uraemic syndrome (HUS) = microangiopathic haemolytic
anaemia + fragmented RBCs in film + thrombocytopaenia + ARF
Thalassemia
o thalassemia carrier/minima (1/4) normal HbF and HbA2
o thalassemia trait/minor (2/4) mild anaemia, low MCV and MCH
o thalassemia major/HbH (3/4) high Hb H
o thalassemia elevated HbA2
ONLY condition with increased MCHC: hereditary spherocytosis
Spherocytosis:
o Autosomal dominant
o Decreased RBC surface area
Fish tapeworm and phenytoin: causes megaloblastic anaemia
If only give folate without B12 in megaloblastic anaemia worsening
neurology
PT and INR: extrinsic pathway
aPTT: intrinsic pathway
Blood transfusion: hypoCa and hypoMg, hyperK
Myelofibrosis
o Typical dry tap BM aspiration
o >50yrs
o Massive splenomegaly
DIC: long PT, aPTT, high D-dimer, low fibrin, thrombocytopaenia
FFP: coagulation factors V and VIII
Von Willebrand: normal PT, prolonged BT/aPTT
Most important factor for O2 consumption: myocardial fibre tension
Dresslers syndrome: following transmural infarct/open heart surgery
(pericardial and pleural effusions)

 JVP
o
o
o
o
o
o
o

a-wave = atrial systole

c-wave = bulging of tricuspid into RA, isolvolumic
v-wave = ventricular systole
x-wave = atrial diastole
y-wave = triscuspid opening, blood into RV
dominant a-wave = PS, pulm HTN, TS
cannon a-wave = CHB, paroxysmal nodal tachycardia, ventricular
tachycardia
o dominant v-wave = TR
o absent x = AF
o exaggerated x = tamponade, constrictive pericarditis
o sharp y = TR, constrictive pericarditis
o slow y = right atrial myxoma
Fixed splitting of S2 = ASD
100% O2 not effective in tetralogy of Fallot
Prophylaxis in child with carditis: until 25yrs (lifelong if have damage to
valves)
Severity of MS by auscultation: duration of diastolic murmur

GENERAL SURGERY
Fluid resus in burns >10% child, 15% adult
Fluid = 4 x weight (kg) x %TBSA, give in 1st 8hrs, in next 16hrs
Perineum 1%, palm 1%
2nd degree/deep dermal: heal by scarring, re-epithelialisation at 3wks
Superficial thrombophlebitis: abdo cancers, Factor V Leiden, DVT, Buergers
Virchows triad: coagulability, blood flow, epithelial disruption
Buergers disease = thromboangitis obliterans: affects medium vcssels
plantar, tibial, radial
Sclerotherapy drugs: ethanolamine oleate, poliocanol, sodium tetradecyl
sulphate
Deficiency of Protein C, S, antithrombin III 5-10% DVTs
DVT rarely causes lung infarct (dual blood supply)
Raynauds: white blue red
Nicoladoni Branhams sign: slowing of HR in reponse to compression of AV
fistula
Hemangioma of spleen: commonest benign splenic tumour, may transform
to hemangiosarcoma
Sympathectomy of lumbar spine - spare L1 for sexual function
Seldinger approach used for arteriography
Brodie-Trendelenburg test - sapheno-femoral incompetence

 Shock treatment indicator urine output

Tests for varicose veins: Perthes test, Tourniquet test, Trendelenburg test
(not Adsons)

ORTHOPAEDICS
Hill-Sachs lesion recurrent dislocation of shoulder
Neurovascular injuries
o Femoral vessel - fracture lower 1/3rd of femur
o Radial nerve - humeral shaft fracture
o Sciatic nerve - posterior dislocation of hip
o Popliteal vessel - supracondylar femoral fracture
o Median nerve - supracondylar humeral fracture (can also have radial
nerve)
o Extensor pollicus longus tendon - fracture distal radius, e.g. Colles
Salter-Harris classification for epiphyseal fractures:
o Type I entire epiphysis
o Type II entire epiphysis + part metaphysis
o Type III part epiphysis
o Type IV part epiphysis + part metaphysis
o Type V compression of epiphyseal plate
Colles fracture = FOOSH, dorsal displacement, dinner fork deformity
Smiths fracture = reverse Colles, volar displacement, garden spade
deformity
Bartons fracture = always intra-articular, always carpal subluxation
o Dorsal Bartons = same mechanism as Colles, intra-articular fracture
involving dorsal aspect of distal radius
o Palmar Bartons = same mechanism as Smiths, subluxation of wrist,
more common, intra-articular fracture involving palmar aspect of
distal radius
Chauffeurs fracture = direct axial compression of scaphoid into radial facet,
fracture of radial styloid + avulsion of radial collateral ligament
Galeazzi fracture-dislocation = radial fracture with dislocation of distal
radio-ulnar joint (wrist)
Monteggio fracture-dislocation = ulnar fracture with dislocation of prox
radio-ulnar (elbow)
March fracture = 2nd/3rd metatarsal, stress fracture
Complications of Colles: Sudeks osteodystrophy, mal-union, rupture of EPL
tendon, acute carpal tunnel (not non-union)
Complications of humeral lateral epicondylar fracture: non-union, cubitus
valgus deformity tardy ulnar nerve palsy
Commonest complication of extra capsular femoral fracture mal-union

Most serious complication of long bone fracture fat emboli

Intracapsular/FNOF: small external rotation of hip
Extracapsular/intertrochanteric: severe external rotation of hip
Posterior dislocation of hip: flexion, adduction and internal rotation of hip
Tests
o McMurrays test: meniscus injury
o Lachman test: ACL, best test, also anterior drawer test
o Posterior drawer test: PCL
o Varus instability test: LCL
o Valgus instability test: MCL
Casts and braces
o Hanging cast: lower humeral shaft fracture
o Milwaukee brace: scoliosis
o Boston brace: scoliosis
o Cylindrical cast: fracture patella
TB arthritis fibrous ankylosis
MCP and PIP: rheumatoid arthritis
DIP: osteoarthritis and psoriatic arthritis
Ileac crest involvement (enthesis): ankylosing spondylitis
Felon = terminal pulp space infection
Potts spine = spinal TB, 1st complaint is localised back pain
Gout = negatively birefringent, monosodium urate
Charcots joint commonest cause is DM
TB arthritis monoarticular
OA commonest joint involved:
o Western countries - hip
o India knee (medial compartment)

PAEDIATRICS
Daily maintenance fluid:
o <10kg: 100ml/kg
o 10-20kg: 100 + add in 50ml/kg for every kg above 10
o >20kg: 100 + 50 (above 10) + 20ml/kg for every kg above 20
Nocturnal enuresis normal up to 6yrs
Daytime enuresis normal up to 4yrs
Length increase (term baby):
o Increases by 30% by 5mnths
o >50% by 12 months
o Grow 25cm in 1yr
o Double birth length at 4yrs
o 100cm at 4.5y (Indian)
Weight increase:

o Doubles at 6mnths
o Triples at 1yr
o Quadruples at 2yrs
o Annual increase from 2-9yrs is 2kg/yr
Gross motor:
o Newborn limbs flexed, head lag
o 6 wks lift head and move side to side
o 3-4m hold head up when sitting
o 6m sit unsupported, round back. Primitive (Moro) reflexes
disappear (4-6 m)
o 7-8m sit unsupported, straight back (8m). Crawling (8-9 m)
o 10m supported walking
o 12-15m walk unaided, broad gait (12m), steady walk (15m)
o 18m n/a
o 20m run, kick, hop (can weight bear on single leg)
o 24m n/a
o 3-5y ride tricycle (3y)
Fine motor and vision:
o Newborn fix and follow object, grasp reflex
o 6 wks visually alert, move head and follow
o 3-4m hand regard, reaches out (4m)
o 6m palmar grasp, handling with 2 hands, transferring
o 7-8m n/a
o 10m pincer grip
o 12-15m scribbling (14m)
o 18m building towers (18-24m)
o 20m n/a
o 24m n/a
o 3-5y copying basic shapes (2.5-4.5y), drawing basic shapes (circle
3y, cross 4y, triangle 5y), building steps and bridges (3-4y)
Speech, language and hearing:
o Newborn stills to voice, startles
o 6 wks respond to mums voice
o 3-4m vocalisation (3m), vowel sounds (4m)
o 6m constant monosyllable
o 7-8m turn to voice, dada and mama indiscriminate (7m)
o 10m dada and mama discriminate
o 12-15m say simple words (13m), understand simple commands
(13m), respond to name (13m)
o 18m know total of 10 words, know 4-6 parts of body
o 20m 2 word phrase

o 24m 3 word phrase, sentences (24-36m)

o 3-5y know age (3y), know some colours (3y)
Social, emotion and behaviour:
o Newborn n/a
o 6 wks smile responsively
o 3-4m n/a
o 6m can put solid food in mouth
o 7-8m separation anxiety (8m)
o 10m wave bye, peekaboo
o 12-15m can drink from cup (12m)
o 18m can feed safely with spoon, symbolic play (18-24m)
o 20m n/a
o 24m can remove own clothes, dry by day, own/parallel play
o 3-5y interactive play (3y)
Limit ages:
o No responsive smile 8 wks
o No good eye contact 3m
o No reaching for objects 5m
o No sitting unsupported 9m
o No walking unaided 18m
o No single words with meaning 18m
o No 2-3 word sentences 30m
Very low birthweight <1500g
Posterior and lateral fontanelles close 6m
Anterior fontanelle closes 18m, full ossification starts in 20s, finishes <50y
IQ = 100 x mental age/chronological age
1st sign of sexual maturity in boys = testicular enlargement
1st sign of scurvy = perifollicular hyperkeratotic papules (shin)
ecchymoses
Prophylactic Vitamin A:
o 100,000 IU at 9m PO
o 200,000 IU at 16-18m PO
o 200,000 IU every 6 months, up to 5y PO
Breast feeding should be initiated within 30min
Measuring childs nutritional status:
o Acute = weight for height
o Chronic = height for age
Kwashiorkor (oedema) vs marasmus
Right to left shunts = cyanosis, e.g. TOF, tricuspid atresia, Ebsteins, TGV
(not ASD/VSD/PDA left to right)
Corticosteroids for foetal lung maturity:
o Lowers ARDS, intraventricular haemorrhage, necrotising enterocolitis

o Indicated in preterm labour 24-34wks

o Avoid multiple courses
o Avoid in eclampsia and chorioamnitis
Foetal lung maturity NOT measured by maternal AFP, is measured by
lethicin:sphingomyelin ratio, foam stability index, amniotic fluid
phosphatidylcholine level
APGAR: A = appearance (colour), P = pulse, G = grimace (reflex irritability),
A = activity, R = respiratory effort
Physiological jaundice appears 24-72hrs, disappears in 14 days
Jaundice <24hrs haemolytic disease (Rh incompatibility)
Phototherapy tx of choice for neonates with unconjugated jaundice
Unconjugated = indirect, conjugated = direct (hepatic causes)
Jaundice in 1st week of life usually indirect
Jaundice >72hrs biliary atresia, breast milk jaundice, metabolic disorders,
neonatal hepatitis
Commonest cause of neonatal death worldwide = prematurity
Commonest childhood epilepsy = generalised tonic clonic
Commonest cause of seizures in newborn = hypoxic ischaemic
encephalopathy

OBSTETRICS
AP diameters:
o True conjugate: 11cm, tip of sacral promontory upper symphysis
pubis
o Obstetric conjugate: 10cm, tip of sacral promontory bulge on
symphysis pubis
shortest AP diameter
o Diagonal conjugate: 12cm, tip of sacral promontory lower
symphysis pubis
o External conjugate: 20cm, last lumbar spine upper symphysis pubis
Transverse diameters:
o Anatomical transverse diameter: 13cm, ileopectal line
largest pelvic diameter
o Obstetric transverse diameter: slightly <13cm, bisects true conjugate
Oblique diameters:
o Right oblique diameter: 12cm, R sacroiliac joint L ileopectal
eminence
o Left oblique diameter: 12cm, L sacroiliac joint R ileopectal
eminence
o Sacro-cotyloid diameter: 9-9.5cm, R/L sacral promontory to
contralateral ileopectal

 Largest foetal head diameter = mentovertical, 14cm

Naegeles pelvis = ala absent one side
Roberts pelvis = ala absent both sides

GYNAECOLOGY

DERMATOLOGY

ANAESTHESIA

PSYCHIATRY

RADIODIAGNOSIS

RADIOTHERAPY