FCPS IMP POINTS

1. Potassium is mainly regulated by - Aldosterone.

2. Tip of scapula at level T7.
3. Oblique fissure of the lung at level - T3 to T6 Costochondral.
4. Decussating of medial lemniscuses - Internal Arcuate Fibers.
5. Superficial temporal artery relation with which nerve - Auriculotemporal nerve.
6. Correct about Thyroid gland - lymph drainage to deep cervical lymph nodes.
7. Anemic hypoxia occur in Methemoglobulenemia.
8. In cerebral circulation brain arteries - Do not anastomose once entered in the brain
(controvertial).
9. Phase 1 of transformation of drug metabolism Oxidation.
10. Standard deviation shows - Variability of individual observation.
11. Counseling in patients is - To help themselves.
12. A young girl who is going to die and asks you Am I going to die? Doctor response
should be What your parents have told you?
13. In whole wheat Thiamine.
14. Cholesterol enriched diet Egg.
15. Origin of peroxisomes SER.
16. Organelle where protein combines with carbohydrates, packed and released - Golgi
complex.
17. Correct about DNA Euchromatin is transcriptionally active.
18. ADPKD associated with Renal failure (vs) Cerebral haemorrhage (controversial)
here most probable Renal failure.
19. Cause of delay in healing Infections.
20. PaO2 decreased, PCO2 increased, hydrogen ion increased; manifestation (looked
like kind of COPD) Hypoventilation.
21. PCO2 31, HCO3 19, pH increased (Metabolic alkalosis scenario) - Hyperventilation
22. Person with tachycardia, and heat intolerance with low level of TSH, on giving TRH;
level of TSH and thyroid hormones increases. Diagnosis Hyperthyroidism with thyroid
problem.
23. Origin of oxytocin and ADH Hypothalamus.
24. Difference between systemic and pulmonary circulation - Low resistance in
pulmonary circulation.
25. Mean systemic filling pressure is regulated by - Venous return.
26. Systolic pressure is directly related to which one of the following Renin.
27. ADH responds to Osmolarity.
28. Osmoreceptors ADH.
29. Right border of heart on X-ray also visible a part of SVC.
30. In MI sensitive cardio marker Tropinin T.
31. Diabetic nephropathy investigation - Urine albumin.
32. Young boy with generalized edema and proteinuria - Lesion of basement
membrane.
33. Lesion of parasympathetic system affects mostly - GI muscles.
34. Stress hormone of our body - ACTH.
35. S2 sound heard on - Closure of aortic and pulmonary valve.
36. A patient with history hemorrhage (trauma) receives a bag stored for 2 weeks mainly
contains RBCs.
37. Due to inspiration Decreased negative intrapleural pressure.
38. Important buffer of blood - HCO3-.
39. Max increase in ECF due to infusion of - Hypertonic NaCl.
40. Auscultation of tricuspid valve best heard at Right lower end of the body of
sternum.
41. GVE vagus nerve for preganglionic fiber arises from Dorsal nucleus.
42. Thorn prick in left lower limb caused abscess - Staph aureus.
43. Diabetic female after abdominal surgery; dyspnea and cough - Pulmonary
embolism.
44. MCC of pulmonary embolism DVT.
45. Typhoid fever 1st week test Blood culture
46. Typhoid fever 2nd week test Blood culture and Widal test.
47. Typical feature of falciparum - Black water fever.
48. Alcoholic patient with deranged LFTs; on biopsy Mallory bodies.
49. Councilman bodies seen in Apoptosis.
50. Natural self-defense against tumors Apoptosis.
51. P53 gene absent results in - cell survival.
52. Pain mediator - Bradykinins.
53. Metaplasia Functional change in cells.
54. Female with infection of HPV, comes after 2 years, Pap smear shows prominent
nucleoli and increased nucleus size Dysplasia.
55. Gas exchange occur - Simple squamous epithelial layer.
56. Patient with granulomatous disease, biopsy done. Microscopic finding that suggests
TB Epitheloid cells.
57. The spindle fibers will decrease in discharge of impulses when - Muscle contracts
(vs) When efferent gamma discharge occurs. (controversial) here most probable
muscle contracts
58. Diagnosis for leprosy, initial investigation - Nasal scrapping.
59. Benign neoplasm Adenoma.
60. 3 germ layers tumor Teratoma.
61. When adrenalin release from medulla, causes vasodilation by acting on - Beta 2
adrenergic receptors.
62. Increased GFR and increased plasma flow occur due to - Dilation of afferent
arteriole.
63. Charateristic of cerebellar lesion - Dymetria
64. Emax of a drug depends on Efficacy
65. Study in which every person of a population has equal chances of being selected
Random sampling.
66. Amniocenthesis is done - After 14th weeks.
67. 1st response against acute inflammation in tissue Macrophages.
68. In dark granules containing cells; IgE attaches to Basophils.
69. Opsonization - C3b.
70. Exudate - more than 3g of proteins.
71. About active transport of drug all are true except - All drugs pass via active
transport.
72. Pulmonary artery supply to Alveoli.
73. Muscles of back innervated by - Dorsal rami.
74. In young boy dyspnea produced on lying - Retrosternal goiter.
75. Most important cause of bronchogenic cancer Smoking.
76. Edema caused by - Increased hydrostatic pressure.
77. Edema caused by - Lymphatic blockage.
78. BP 210/180mmHg and creatinine 8% damaged part Juxtaglomerular apparatus.
79. Female with blood group A, have 2 children; one with O and other with AB, blood
group of father is B.
80. Genetically true hermaphrodite XX/XY.
81. DNA replication occur in Interphase.
82. Glycogenolysis caused by deficiency of which hormone - Insulin
83. Investigation for liver amoebic abscess Serology.
84. Surgery of submandibular gland; nerve damaged - marginal mandibular branch of
facial.
85. On posterior surface of oblique and transversalis fascia - Arcuate line.
86. Aspirin overdose causes Coma.
87. Cardiac output measurement via thermodilution Temperature change downstream
with CO.
88. Father with defective gene on one autosomal chromosome, develops disease later
in his life; chances of getting disease in children Half of the children will be affected.
89. If left circumflex artery occluded - Infarction of left atrium and left ventricle.
90. MCC of multiple fractures in adult Osteoporosis.
91. Patient with fracture of many bones and low BP immediate treatment - Volume
replacement.
92. Most common fracture of long bone - Tibia.
93. Collagen fibers Eosin stain
94. Gamma efferent supply to Intrafusal muscle spindles.
95. Micturition Self generating.
96. Hallmark of HIV Proliferation of virus in T-Cells.
97. 1g protein gives energy 4 kcalories.
98. Isotonic and isometric contraction difference is that isotonic contraction consumes
more phosphate bond.
99. Autonomic nervous system parasympathetic increase salivary secretion.
100. Protrusion of mandible Lateral pterygoid.
101. After feeding the baby, diarrhea develops Gastrocolic reflex.
102. Both sides of 5th posterior intercostal spaces is supplied by - Thoracic aorta.
103. 2 years old child with medially rotated arm lesion in - Upper trunk.
104. Female with uterus cancer which travels to labia majora following which route -
Round ligament.
105. Pain in epigastrium due to ulcer, transmitted by - Greater splanchnic nerve.
106. Vesicular lesion on the tip of nose and eyelid - Ophthalmic nerve.
107. Patient cant abduct till 30 degree, which muscle is responsible Supraspinatus.
108. Nerve supply to plantar surface of foot - Posterior tibial.
109. Medial arcute ligament Psoas major muscle.
110. Bitemporal hemianopia due to lesion of - Central part of optic chiasm.
111. Ventral spinothalamic tract - Coarse touch and pressure.
112. Dorsal column Proprioception.
113. Vibration and touch via - White matter of posterior spinal cord.
114. Function of notochord - Induction of ectodermal neural plate to produce neural
tube.
115. Midbrain reticular system Unusual stimulus causes arousal.
116. Most radiosensitive tumor Medulloblastoma.
117. Hormone increased during sleep as compare to at day wakefulness Cortisol.
118. In Trigeminal neuralgia anesthesia given to block trigeminal ganglion at which site -
Middle craneal fossa.
119. Patient with intentional tremors and facial paralysis lesion at Cerebellopontine
angle.
120. Opioids produces vomiting by acting on - Chemo trigger zone in medulla.
121. Patient working in mine with tuberculin test positive. Cough, fever, weight loss with
hilar lymphadenopathy Silicosis.
122. Male working in construct factory with pleural plaques Asbestosis.
123. Neoplastic cells with continuous mitosis due to persistence of Telomerase.
124. During exercise venous return is due to - Contraction of calf muscles.
125. During exercise increased blood supply to muscles - Local metabolites.
126. Action of steroids as anti-inflammatory is due to - Inhibiting phospholipase.
127. Intermediate filaments staining with immunofluorescence to diagnose
Carcinoma.
128. VPL nucleus of thalamus when damaged cause somatosensory loss of
contralateral body.
129. Thiazide diuretic cause Hypokalemia.
130. Man living on side of a river, got blindness from nematode; organism - Onchocerca
volvulus.
131. MCC of HTN Idiopathic.
132. Adult female with breast atrophy due to decrease in Estrogen.
133. Female with hirsutism, galactorrhea, infrequent heavy menstrual cycle. U/S both
ovaries with cystic lesions and LH:FSH :: 3:1 - PCOD
134. Female with hot flushes - Increase FSH and LH.
135. Injection of atropine will cause - Dryness of mouth.
136. Female with severe loss of vibration, Investigation of choice - Stomach biopsy.
137. Child with yellow sclera and colored urine, best Investigation - Bilirubin and ALT.
138. Female with weakness and lethargy with RBCs 5.5 diameter and very thin red line
of RBC in peripheral smear - Microcytic hypochromic anemia.
139. Monitoring of Hep B Serum glutamate-pyruvate transaminase.
140. Female with reactive anti HBe and reactive total anti HBc along with non-reactive
HB IgM and non-reactive HepBs Ag - Acute recovery phase.
141. Patient with obstruction jaundice; now bleeding cause - Vit K deficiency.
142. Investigation of Hashimoto thyroiditis Antimicrosomal and anti-thyroglobulin
antibodies.
143. Cimetidine interaction with warfarin causes - Decrease hepatic clearance of
warfarin.
144. Patient using some anti-coagulant, how will you know that anticoagulant is warfarin
because it is being monitored by PT.
145. BP drops from 100mmHg to 70mmHg Decrease in carotid sinus nerve activity.
146. Erythropoietin is secreted via Mesangial cells.
147. Patient with all symptoms of Cushing along with increased ACTH cause - Cushing
disease.
148. Child with machinery like murmur PDA.
149. PaO2 is 100% in - Left to right shunt.
150. Kallmann syndrome Gene defect in Kal1 gene.
151. Diplamotoylphosphatidyl choline + carbohydrate + proteins is a content of
Surfactant.
152. In asthma - Decrease FEV1.
153. Splenectomy is most useful in - Hereditary spherocytosis.
154. Findings in glycogen storage diseases - Hepatomegaly and hypoglycemia.
155. Corynebacterium diphtheria produces Exotoxins.
156. Common specie of Corynebacterium affecting human is Diphtheriae.
157. Typical symptom of food intoxication by Clostridium botulinum - Flaccid paralysis.
158. CSF with increased proteins and polymorphs with decrease glucose the drug of
choice Ceftriaxone.
159. About the pharmacology of Neiserria gonorrhea - Pencilin G.
160. Major histocompatibility is related to HLA.
161. Kidney is transplanted, gets cyanosed in 10 minutes, type of reaction - Antibody
mediated.
162. A child with Agammaglobulinemia is prone to - Pyogenic infections.
163. Diagnostic criteria for sarcoma - Increased vascularity (Rabia Ali) / Pleomorphism
(Tumor books).
164. Soldier coming down from height, now with discoloration of fingers, dyspnea -
Secondary polycythemia.
165. Vitamin D acts on intestinal mucosa via - expression of genes.
166. Release of neurotransmitter due to - Influx of calcium in presynaptic fiber.
167. Calcium influx via slow channels in ventricle cells causes - Ventricular ejection.
168. Increased a wave in JVP due to - Tricuspid stenosis.
169. Person with HR 80/min, on ECG RR interval would be - 0.75 sec.
170. Class III Antiarrhythmics Amiodarone.
171. Increased ASO titer - Rheumatic fever.
172. In hypertrophic cardiomyopathy Myocytes disarray.
173. 5 month of pregnancy, lady with thyrotoxicosis, drug of choice Methimazol (2nd &
3rd Trimester) / PTU (1st trimester).
174. 30 years old smoker, psychotic, vomiting of fluid with visible peristaltic movements
on abdomen cause - Pyloric stenosis.
175. Myenteric system of parasympathetic is potentiated by Ach.
176. Pethidine is preferred over Morphine Fast acting.
177. Philadelphia chromosome CML.
178. Male with fever upper lobe consolidation, fever from last 3, productive cough, AST
135 and ALT 111, alkaline phosphatase normal, bilirubin 10, he died on autopsy weight
of liver increase and with fat droplets seen on hepatocytes. Diagnosis - Chronic
alcoholic disease.
179. Alpha 2 macroglobulin inhibit Trypsin.
180. Male with all symptoms of LV failure and pulmonary edema without any previous
illness and BP 125/85mmHg, on X-ray cardiomegaly; cause of heart failure - Alcoholic
cardiomyopathy/Bicuspid aortic valve?.
181. Highest potential difference in the wall of stomach is when Aspirin ingestion.
182. Calculate Alveolar ventilation where Tidal volume is 500ml/respiration. RR 10 -
3500ml/min
183. Calculate Clearance where Urinary flow 20 ml/min, Concentration of substance in
urine 10 and Plasma 10 20ml/min.
184. Excessive eversion of foot damaged which structure - Rupture of deltoid ligament.
185. About descending aorta - starts at T4 on left side.
186. Counterpart of Mullerin tubercle - Seminal colliculus.
187. Histology of cornea - Stratified squamous non-keratinized.
188. Left shift of HbO2 curve - CO poisoning.
189. Humans are intermediate host in - Hydatid cyst.
190. Clot retraction is mediated by Thrombosthenin
191. In late pregnancy the uterus is most sensitive to Oxytocin.
192. About bicep brachialis muscle attaches to supraglenoid tubercle of scapula.
193. Hyper-resonance is mostly heard at T2-T4 of right midclavicular line.
194. Conus medullaris terminates in neonates at the level of L3
195. Cimetidine is used preoperatively Inhibits H2 receptors competitively.
196. Nursing mother with herpes labialis, drug of choice Acyclovir.
197. PO4 increased, Calcium decreased and PTH increased Chronic Renal Failure.
198. Labetalol acts on Alpha and Beta receptors.
199. Women after delivery, Platelet: 70,000, aTTP normal, PT raised DIC.
200. Tumor screening test is for - Early diagnosis of a disease.

Excellent Important Pearls of Fcps Part1

Collection of different important points..!!!!

Post is a bit long but it will refresh hundreds of things...the first part is having answers of
controversial mcqs so its compulsory....the other parts are those which were previously
posted in this group but now i have compiled them all in this one single post...!!!

PART 1

DURING EXERCISE:
Inadequate blood supply:
Kidneys
Inadequate O2 delivery:
Skeletal muscles
Minimum change in blood flow:
Brain

Estrogen in Reproductive years (when a woman is like a doll)

ESTRADIOL --- Doll (di - girl n boy)
Estrogen in pregnancy:
ESTRIOL --- (tri - mom, dad, child)
Estrogen in menopause:
ESTRIONE --- (one - woman becums single again)

Estrogen containing OCPs:

Inc risk of Thromboembolism > Breast CA
High Estrogen containing OCPs:
Inc risk of endometrial CA

Low Estrogen containing OCPs:

Inc risk of Hepatic Adenoma

1)Best way to measure gfr =inulin Clearance

2) best way to estimate gfr = creatinine clearance
3) best way to measure renal plasma / blood flow = PAH
4 ) clinically by creatinine
5) highest renal clearance = pah

ECG
P Wave Atrial Depolarization
Q Septal Depolarization
R Early Vent. depolarization (potential travelling to apex of vents)
S Late Vent. depolarization (Potential travelling to base of vents)
T Vent. repolarization
U Delayed repolarization of Purkinje system or papillary muscles

Premalignant change in mouth:

Chronic ulcer

Premalignant Condition:
Lichen planus

Premalignant Lesion (Most common):

Leukoplakia

Premalignant Lesion (Most lethal):

Erythroplakia

Bettlenut chewing:.
Submucosal fibrosis

GEOMED pneumonic
Giant cell --- Epiphysis
Osteosarcoma --- Metaphysis
Ewing sarcoma --- Diaphysis
Osteoblastoma --- Vertebral bodies
Epiphyseal Lesions:
Giant cell tumor
Chondroblastoma
Chondrosarcoma

can occur Rarely in...

Osteosarcoma
Osteoblastoma

TYPHOID FEVER INVESTIGATIONS:

MNEMONIC BASU to memorize ie
B=Blood, A=Antibody, S=Stool, U=Urine
-1stweek = blood culture
-2ndweek = antibody/widal
-3rdweek = stool
-4thweek = urine culture

Barbodies diagnostic for........Turner

Barbodies absent in............Turner
Scanty Barbodies present in.....Turnere(because of mosaic pattern)
Presence of single barbodies diagonstic for......Klinefelter's(as klinefilter ve one
barbody...xxy)
Total x chromosome minus one is the number of bar bodies for example in xxx there
are 2 bar bodies

benign tumor - warthin

hamartoma - tumor LIKE benign overgrowth...(brs)

LYSOSOMES:
Arise from Golgi apparatus
Contain hydrolases
Cause degradation of unfolded proteins
Uterus and breast regress after pregnancy by lysosomes
On H & E stain: hollow structure around nuclei\
PEROXISOMES
Originate from SER
Contain OXIDASE, H2O2 AND CATALASE
Single membrane
CENTRIOLE
Microtubules
RER
Protein synthesis
Continuous with nuclear membrane
=Nissle bodies
Basophilia of cell
Absent in axon hillock
SER
Detoxification of drugs
Giver peroxisomes
Contain Calcium
MITOCHONDRIA
DNA
Energy house
GOLGI COMPLEX
Binds carbohydrate with protein, enclose them in vesicles and release
Secretary vesicles
Lysosomes arise here
NUCLEOLUS
No limiting membrane
Site of RNA synthesis and assembly
DOUBLE MEMBRANE ORGANELLES
Nucleus>Mitochondria..>Golgi complex

CYTOSKELETON
1. Cytoskeleton which connects ECM to ICM = Intermediate filament
2. Cytoskeleton connected to ECM = Proteoglycan
3. ECM connected to ICM through = Integrin

REGARDING THIRST...!!
Thirst Is Is Increased By. .

increase in Angi0tensin 2
decrease in blood v0lume
incerease in osmolarity
drynes of m0uth.
Increase in ADH.. .

THIRST is decreasd by. .

Gastric distensi0n.
Decrease in ADH,
Angi0tensin2,
Increase in BP.
Increase in blood volume.
(Reference Guyton)

Important Point Regarding Dialysis Fluid Wala question..

DIALYSING FLIUD ME SIRF
GLUCOSE AND BICARBONATES INCREASE HUN GAY PLASMA FLUID K
MUQABILAY ME ...
BAQI SUB KUCH DECREASE HOGA...
Ref Guyton..

creatinine clearance

>> 90 ....NORMAL

60-89. .....mild

45-59. ...moderate

30-44. ...damage

15-29. ....severe
< < 15. ....ESTABLISHED renal failure

radiosensitivity

seminoma > glial glioma > craniopharyngioma

highest
TG = chylomic > VLDL
cholesterol = LDL
protiens = HDL

Granuloma===Characteristic cells===Epitheloid cells

Tuberculosis granulomas ===Caseating granulomas/necrosis characteristic.

Also occur in histoplasmosis

To differentiate ===AFB.
Cervical lymph nodes biopsy done
Now characteristic ===Caseating granuloma
Cervical lymph nodes biopsy done and biopsy shows Caseating granulomas now
further
===AFB detection === definitive Dx.

Non - caseating granulomas===SARCOIDOSIS, Crohns disease etc.

STAGES OF MITOSIS
INTERPHASE
- Chromosomes are copied (doubles)
- Chromosomes appear as thread like coils (chromatin) at the start but each
chromosome and its copy (sister chromosome) changes to sister chromatids at end of
this phase
PROPHASE
- Mitosis begins (cell begins to divide)
- Centrioles (or poles) appear and begin to move to opposite ends of cell
- Spindle fibers form between the poles
METAPHASE
- Chromatids (or pair of chromosomes) attach to the spindle fiber
ANAPHASE
- Chromatids (or pair of chromosomes) seperate and begin to move to opposite ends of
the cell
TELOPHASE
- Two new nuclei form
- Chromosome appear as chromatin (threads rather than rods)
- Mitosis ends

1)Most effectve antiTb drug=Rifampicin

2)Most bactericidal antiTb drug=Rifapicin
3)Most toxic antiTB drug=IsoNiaxid
4)AntiTb DruG causing rapid sputum conversion=Isoniaxid
5)Orange urine=Rifampicin
6)ist to develop resiatnce=ISONIAXID
7)Drug contraindicated in all categories of dots=INH+Rifampicin
8)injectble antiTb drug=Rifampicin
9)OPTIC neuritis by=Ethambutol
10)Vestibular damge=Streptomycin
11) Drug with only bacteriostatc=Ethambutol

1.inferior thyroid artery ligation...damage recurrent laryngeal nerves

2. Superior thyroid artery ligation...damage external larngeal
3. Thyroidectomy...damage external laryngeal
4. Thyroidectomy with vocal cord damage....damage recurrent laryngeal
5. Tracheostomy...recurrent laryngeal

Pus = penile urethra superfascial pouch/scrotum

Bus = bulbar urethra = sup pouch
Mud = membranous urethra deep pouch

1 REST
Max blood flow at rest=
1.liver(1500ml)
2.kidneys(1260 ml)

Max bld flow/ 100gm at rest

1st.carotid bodies
2nd.kidney

EXERCISE=
Max bld supply =Skeletal muscle

least bld supply(not according to demand)=kidneys

Least oxyegen supply(not according to demand)=skeletal muscles

cystinuria b6
cystinemia b12

Implant removed,fluid leaking,type of cells.....Giant cells

Implant removed,,no leaking,type of cells.....Giant cells
Implant not removed,,leaking of fluid present,type of cells........Giant cells
Implant removed,,leaking of fluid plus signs of inflammation,type of cells.....Neutrophils
Implant not removed,,no leaking but there is tenderness r other signs of
inflammation,type of cells........Neutrophills
Only these two type of cells we ll find,,there is no roll of immunity so no plasma cells...
Points to remember....
In breast implant type of cells.....giant cells
But when inflammation mentioned then neutrophils......simple

basal cell carcinoma is Boss present on upper lip

squamous cell carcinoma is secretary so present on lower lip

TOPANATOMICAL LEVELS TO RELATED STRUCTURESBOTTOM

JUST REMEMBER THE IMP ONES LIKE ISTHMUS OF THYROID GLAND N AORTA
BIFURCATION ETC ETC

C1-C2 VERTEBRA: vocal cords

C2-oropharynx and soft palate with mouth open
C3-hyoid bone
level of larynx in infants-C2-C3
levwl of larynx in adults-C3-C6
C3-C4:bifurcation of common carotid artery
C4 &C5-thyroid cartilage
C6-cricoid cartilage
C6-begining of trachea
C6-begining of oesophagus
C7-vertebra prominence
thyroid lobe superior extent-oblique line of thyroid cartilage
isthmus of thyroid gland-2nd through 4th tracheal rings
thyroid lobe inferior extent-sixth tracheal ring
spine at root of scapula-opposite third thorasic spine
thoracic inlet-T1
superior angle of scapula-overlies part of 2nd rib-1st intercoastal space superior to
angle/T2
jugular notch-T2&T3 vertebral junction
carnia-T3-4 or T4
manubrium Sterni-T3&T4
sternal angle-T4&T5
body of sternum-T5to T9 vertebra
greater splanchnic nerve-T5-T9 sym ganglia
apex of heart/mitral value-5th intercoastal space
base of heart/supine position-T5 to T8 vertebra
base of heart/erect position-T6 to T9
oblique fissure of lung-T6
inferior angle of scapula-T7
vena caval foramen-T8
xiphoid process-T9
xiphisternal joint-T9 vertebra typicaly
esophageal hiatus-T10
termination of oesophagus-T11
lesser splanchnic nerve-T10-T11 sym ganglia
least splanchnic nerve- T12 sym ganglian
aortic hiatus-T12
coeliac trunk branch of abdominal aorta-T12
median arcuate logament of respiratory diaphragm- T12 &L1 junction
pulmonary valve-left 2nd intercoastal space medial
aortic valve-right 2nd intercoastal space
tricuspid valve-right lower sternum
nipple in male-4th intercoastal space in midclavicular line
transpyloric plane-L1
celiac trunk-L1 superior border
superior mesentric artery-L1 inferior border
pylorus of stomach-L1
1st part of duodenum-L1
left renal vein-L2
2nd part of duodenum-L1,L2,L3right side
3rd part of duodenum-L3
left crus of diagphram-L2
right crus of diagphram-L3 vertebra
inferior mesentric artery-L3
subcoastal plane-L3
spinal cord termination
L1 in adults
L3 in New borns
spleen-obliquely along axis of 10th rib
right kidney-
Superior pole-T12
Inferior pole-L3
Hilum-L1
left kidney-
Superior pole-T12
inferior pole-L3
Hilum-L1
pancrease head-L2&L3
umbilicus(in supine/recumbent position)-disc between L3-L4
bifurcation of abdominal aorta-L4
supracristal plane/higheat point on illiac crest-L4
transtubercular plane-L5
origin of inferior vena cava-L5by by
anterior superior illiac spine-S1/sacral promontary
posterior auperior illiac spine-S2
pubic symphysis-tip of coccyx

PART 2

Hypertension..JG cells affected

Dopamine BBB not crossed
Floor of 4th ventrical suprolateral scp
Protooncogen overexpresdion most common cause of neoplasm
Dorsal rami supply extensors of trunk
Cortisol extrahepatic catabolism
Hepatic anabolism of proteins
Lens never regenerate
Heart contractility depends upon calcium ions
BPS airated by tertiary brochus
Gram staining quick way to check gonococcus
Olfactory cells biopolar neurons
Adh via v1 causes sm consriction in arterioles Gq
Infraorbital artery branch of maxillary artery
Xx+pseudohermaphrodism androgenitql syndrome
Rt main bronchus lenghth 2.5
Platlets infusion contraindicated in spleenomegaly
In venous blood rbcs have more hco3
Shortening of chromosome > transcriptase
Normal resp cycle
2sec ins 3 sec exp
Pressure is dissipated at arteriolar arterioles
6th post mi day pericardial temponade common
Highest Mg stores in bones
Angiopathy neuropathy cause of ulcers in diabetics
Edema of kidney origin albuminuria and na retension
Tubercle of bacili cells comes from monocytes
Cristmas factor b> factor ix
Primordial germ cells derived from endoderm
Kidney derived from intermediate mesoderm
ureteric bud derived from caudal end of mesonephric duct
fisherman with ecchymosis on lips caused by vit c def
Trisomy 21 robertsonion translocation
premalignant lesion of vulva is condyloma
chlamydia most common cause of PID
uv prolapsed complication > chronic discharge and metaplasia
sorbitol is an alcohal sugar
HLA compatability for BMT
in deep inspiration dead space does not change
graft versus host disease is an example of apoptosis
serotonin and epinephrine are mainly metabolized by MAO
proteinuria leads to russel bodies formation
dead space is not changed in deep inspiration
metaplasia is functional change in size
virulence of bacteria depends upon type of toxin
inc in stroma and dec in glands is atrophy
patent lumen of allantois>urachal fistula
nociceptive afferents terminate in post gray column
dorsal colum enter in dorsal gray horn
only protein diet > inc glucagon
gaba mediates anxiolytic effect
parasympathetic 75% by vagus
sphingomyelin does nit contain glycerol
volume of distribution:dose upon concentration
sjogren > sialogram test assessry
thioridazone has strongest antimiscarinic effect
inc resp in pregnancy> progesterone
bradykinin > polypeptide > vasodilation
cervical spine lateral horn is missing
peroxisomes long chain fattay acids oxidation
whole wheat source of thiamine
1litre urine contains NACL =2-6 gm/litre
miscele carry products of TAG digestion to small intestine epithelium
surfactant forms macromolecular layer between water molecules
endogenous muscle relaxant is endorphin
restlessness is effect of atropine on cns
swallowing of bronchial secretions is parasympathetic action
slow pain substance p
fast pain glutamate
stimulatory neurotransmitter in cerebellum is glutamate
granular layer is the only stimulatory layer of cerebellum
clostridium does not produce endotoxin
HLA gene on chromosome 6
calcitonin congo stained
aortic notch is due to aortic valve
tubuloglomerular feedback supported by dec peritubular NA conc
submandibular surgery
Injures marginal branch of mandibular branch of facial nerve
renal artery >segmental >interlobar>arcuate
upper origin of external oblique forms digitation with serratous anterior
sarcoidosis>granuloma with asteroid bodies
mumps rna
IM dna
Endopeptidases are more imp than exopeptidases for protein digestion
deep sea divers > emboli in arteries
albino>dec melanin in choroid layer of retina
iga neohropathy mesangial deposits in gbm
igm and c3 deposits in FSGS
tracheostomy level 2-3rd tracheal ring
germinal follicles cortex of LN
IAPP endocrine type
systemic AL
secondary AA
heridity TTR
ant triangle c2,c3
Folia seen in cerebellum
acetylcholine not released at postganglionic nerves to vasoconstricting muscles
histones have arginine and lysine
nucleus is continuous with rough endoplasmic reticulumn
distributiok curve :mean and standard deviation
antidepressants:seizures
fetal cortisol major role in parturation
CPN related to biceps femoris laterall
standard deviation in normal distribution mean median mide coincide
neural tube forms cns
listeria only gram positive organism producing LpS
Thermogenesis
Earliest response inc catecholamine
Potent. Shivering
Anterior hyoothalmus main controling center
Thermogenesis via sympathetic b1 to fats
And motorneurons

Dissipation mainly via parasympathetic

IL-1 increses prostaglandin in brain to inc set point
Cogwheel or lead pipe in parkinson
Clasp knife in upper motor neyron leision
exogenous steroids> dec IL-2 release
Sturge weber >choroid hemangioma
afibrogenemia ptpttbt
Normal playlets
no granuloma in anaerobes
muscles supply
40% sens 60% motor

basiphillia to cells is bt RER

diencephalon does not include superior colliculus
b-endorphins mist abundantly in hypothalamus
most common genetic pathology is by nucleotides
lichen simplex chronicus is a/w sq neoplasia
polyclonal huperplasia > IM
insula is deep to lateral sulcus
diazepam relaxes sk muscle by inhibitory interneurons

diphenoxylate DOC for travellers diarrhea

synapses absent in dorsal root ganglion
cerebral aqueduct forms cavity of midbrain
griseofulvin not used in candid
isotonic exercise TPR remains same
chromophobes smallest cells in ant pituitary
subclavian artery arches over 1st rib
transduction genome from bacteria to virus
tip of nose ophthalmic division
release of histamine is by morphine
microaneurysm of HIv don't include hard exudates
adenoid cystic CA invades the periphral nerves sheath
forced respiration sternocleidomastoid and scalnes
spleenomegaly in hodgkins is stage 3
nuclear bag fibers carry dynamic response
pseudihypoparathyroidism is associated with hupocal dmi
birbeck granules are associated with histocytosis
conc urine is function of vasa recta
collagen amorphous abundant substance
adamstroke. High degree heart block stroke with FND
cruciate intracapsular
Lesion at l1 conus medularis
denticulate ligament extension of pia meter

PART 3 ...PEARLS

Haemorrhages
Extradural haemorrhge=middle minengeal artery
subdural haemorrhage =diploic vein
subarchnoid haemorrahge=rupture on berry aneursm
tennis ball injury to eye=circulis iridis major
epistaxis=sphenopalatine artery
during tonsilectomy= para tonsillar vein,tonsillar and ascending palatine artery
tracheostomy=isthmus and inferior thyroid vein
heamoptysis=bronchial artey
gastric ulcer=left gastrc and splenic artery
dudenal ulcer=gastrodudenal artery
hemmorhoids=submucosal rectal venous plexuses formed by superior rectal vein and
inferior rectal vein
retropubic proastatectomy=drsal venous plexuses

Turner = 45XO
KF= 47XXY
True hermaphrodite =XXy
peudohermaphrodite =46Xy or 45X
Mole
complete hydatidfm mole -46XX
partial mole -69XXy
Chromosomes n Dna both replicate in interphase
Studied in Metaphase
Trisomy
21 > Down syndrome
13 > Ptau
18 > edvert
16 > spontaneous abortion
 Lumber Pucture
Most common loccation ==L4L5
LP Best Site ====above L4
IF pt e miningitis LP site ===below L3
Epidural anesthesia ==L3-4
widest epidural space > L2
Cauda Equina (CHILDren) === L3
Conus medullaris (Adult) = L1
Subarchnoid space == S2
Chorea > caudate
Athetosis > putamen
Pco2 rises upto 12mmhg in first minute of apnea
Increased alpha feto protein plus increased albumin = Anencephaly.
Vitamin A prevents squamous cell carcinoma.
Right border of heart is made by right atrium.
Right border of heart on XRAY made by SVc +Rt Atrium
Trephine biopsy Indicates = aplastic anemia > ALL.
In anesthesia halothane is always given with Nitric oxide.
Most diagnostic test for TB = PCR > AFB > Caseous.
Down syndrome occurs 1/100.
Common genital vesicle is herpes simplex virus.
Inferior orbital fissure contents are maxillary nerve and its zygomatic branch, inferior
ophthalmic vein and sympathetic nerves and this fissure communicates with pterygo
palatine fossa.
Superior orbital fissure communicates with middle cranial fossa and it transmits
lacrimal nerve, frontal nerve, trochlear nerve, oculomotor nerve, abducent nerve,
nasociliary nerve and superior ophthalmic vein.
Thyroid is the only endocrine gland that stores its secretions outside the cell.
Sensations from the tip of nose are carried by ophthalmic division of trigeminal nerve.
Tensor tympani is supplied by mandibular division of trigeminal nerve.
Stapedius is supplied by facial nerve.
Nucleus raphe synthesize serotonin.
Locus Ceruleus = Nor epinephrine.
At term CRL = 36 cm and CHL = 50 cm.
CRL used b/w 7 - 14 weeks.
BPD is used 16 - 30 weeks.
Sperm life in genital tract is 24 to 72hours.
Active ===24- 48hrs
2nd most common cause of osteoporosis in old age is Cushing syndrome.
Prenatal chromosome is detected at 14 -18 weeks.
Bronchial asthma plus hypertensive patient > Best drug Verapamil.
Aphasia and facial nerve palsy > damage to middle meningeal artery.
Diabetic plus hypertensive patient > Best drug Captopril.
Inferior wall MI > Right marginal artery block.
Epidermis of partoid gland is derived from ectoderm.
To kill spores of surgical instrument > moist heat at 160 C for 1 hr.
Food poisoning caused by Staph. Aureus is through entertoxin.
Least positive value for Widal is 1:120.
Trigeminal ganglion is completely covered by dura.
Tactile sensation is carried by dorsal white column to medial leminiscus.
Anti HBcAg = positive window period.
MAP = diastolic +1/3 pulse pressure.
Insulin secretion is inhibited by beta blocker.
Increased By Glucagon
Highest triglyceride =Chylomicrons >VLDL > Chylomicrons remanents
Highest cholesterol = LDL.
Highest lipoprotein = HDL.
Which is not a phospholipid = Plasmalogen.
Best way to check bone density is the scan of spine.
End break down of glucose is pyruvate.
In pre eclamptic patient hydralazine is the drug of choice before surgery.
In down syndrome: Triple test (alpha feto protein is decreased, b-HCG is increased
and estriol is decreased) and if we add up inhibin which is increased then it will be
called as .
Bar body diagnostic for Tuners syndrome
scant bodies in KF
PLAP (Placental Alkaline Phosphatase) is a tumor marker in seminoma and ovarian
carcinoma.
Tubo ovarian abscess by IUCD - most causative agent is Actinomycosis.
Major intracellular buffer is Hb.
DVT more common in popliteal vein but pulmonary embolism is through femoral
veins.
Investigation of DIC D-dimers, FDPs, Platelet count and PT (except clotting time).
Referred pain:
Cervix S2-S3
Ovary -T10-T11
Testis -T10
Umbilicus -T10
Kidney T12-L2.
Trimethoprim (co-trimoxazole ) side effect > megaloblastic anemia plus leukopenia.
Sacrospinous ligament does NOT contribute in wall of perineum.
Lesser omentum connects with duodenum.
"Sphincteric urethra is known as external urethral sphincter and is supplied by
pudendal nerves where as internal os is supplied by inferior hypo gastric plexus.
Nerve supply of rectum is hypogastric plexus.
Uterine tube is 10 cm long.
"Urachal cyst is the remanant of allantois.
Thyroid gland is derived from endoderm.
Thymus and inferior parathyroid develops from 3rd branchial pouch.
Superior para thyroid is developed from 4th brachial pouch.
Diaphragmatic hernia occurs due to absence of pleuro peritoneal membrane.
Superior thyroid artery is related to external laryngeal nerve which supplies posterior
cricothyroid muscle of larynx. Injured during Thyroidectomy
Inferior thyroid artery is also related to recurrent laryngeal nerve which runs b/w
trachea and esophagus and its most common injury is in Traceostomy.
In papillary carcinoma of thyroid > it occurs in young age and involves cervical lymph
nodes.
Tracheostomy is done at 2nd tracheal ring by pulling the isthmus inferiorly.
Nonfunctional nodule or cold nodule has high chances of malignant transformation.
Erythropoiesis in middle trimester is in the liver.
Levator ani muscle is supplied by L2, L3 & L4.
Defect in Bulbus Cordis results in VSD, hypertrophy of Right ventricle, congenital
cyanosis, transposition of great vessels (but not ASD)
Endocardial cushion is important for the formation of four chambers of heart.
Thirst is least stimulated by blood pressure.
Important hormone involved in gluconeogenesis is Cortisol.
Apoptosis is inhibited by bcl-2 inhibition.
Apoptosis ~ Actuvation of caspases
Low serum complement in SLE.
C3b & IgG are Opsonins
C5a is chemotactic protein.
Urea is an important indicator for muscle protein loss.
ESR is decreased when albumin is increased.
ESR increased during Infection
" Drug which does not cause gynecomastia is Androgen & drugs which cause
gynecomastia are Digoxin, Girsoefulvin, Cimetidine, Androgens, Spironolactone and
Ketoconazole.
Tx of hirstuism is Cyproterone Acetate.
Pyruvic acid is intermediate from glucose to acetyl coA.
Epinephrine .nor epinephrine & dopamine are derived from tyrosine.
End product of Purine is Uric acid.
RBCs have glycolytic enzyme activity.
End product of glucose gives 2 Pyruvate.
Alanine should be taken in diet.
Cisplatin is more notorious to cause renal toxicity.
Dysplasia is seen in epithelia.
MRNA has a codon.
HSV is associated with vulvar papules.
Wart on the lateral wall of introitus it is caused by HPV.
Plaque like lesion on posterior superior wall of vagina is squamous cell carcinoma.
German Measles causes Congenital Cataract.
Anterior abdominal wall swelling with umbilical cord attached to it in a new born baby is
known as Omphalocele.
Beta-lactam acts on the Cell Wall.
ATT Drugs
Streptomycin=== ototoxity.
Isoniazid ==Hepatotoxicity.
Pyrazinamide == Gout
Rifampacin=Orange red color urine
Opportunistic organism ~E. Coli Kleibeslla
Pseudomembranous colitis is caused by C. difficile.
Most common organism involved in gynecological & abdominal procedures is
Bacteriodes .
Vulvular itching = Chlamydia
fish like smell; Bacterial Vaginosis.
Vitamin K dependent: Factors 2, 7,9,10, Protein C, Protein S, Fibrinogen and
Prothrombin.
Intrinsic and Extrinsic pathways of coagulation converge at factor 10.
Threonine does not contain Sulfa group.
Autosomal dominant is hereditary Spherocytosis & Poly cystic kidney disease.
Lens opacity causing drugs >Chlorpromazine, Amidarone, Tamoxifen, Gold & Iron
toxicity.
Drugs causing corneal opacity > Amiodarone, Chloroquine, Mepacrine & Copper.
Ribosome have purple color on Eosin & Methylene blue staining
High energy content > Starch.
High energy compound > ATP
Antidote of warfarin is vitamin K but if action is more quickly required then FFP.
Olfactory cells are the only neurons in the body that regenerates.
Projectile vomiting greenish in color means bilious vomiting so it is due to duodenal
atresia but if projectile vomiting non bilious then it is hypertrophic pyloric stenosis.
Pulmonary trunk relation with the bronchus at the hilum of the lung-mnemonic is
RALSR- Right Anterior & Left Superior.
Rhino sinusitis is caused by Strep Pneumonia, H. Influenza, M Catarrahalis.
Homans sign is present in DVT in which if you dorsiflex the foot there will be pain in
calf muscles.
Classic triad of Pulmonary Embolism: -
Neurological manifestations.
-Petechial rash.
-Hypoxemia.
Nitrogen bubbled precipitator in ascending divers and can be treated with hyperbaric
oxygen.
CT pulmonary angiography is the best test to detect Pulmonary Embolism.
The most common infectious agent transmitted by blood transfusion is
cytomegalovirus (CMV), which is present in donor lymphocytes.
Before blood is transfused into newborns or patients with T-cell deficiencies, it must
be irradiated to kill donor lymphocytes. This prevents the patient from developing a
graft-versus-host reaction or a CMV infection.
Yersinia enterocolitica, a pathogen that thrives on iron, is the most common
contaminant of stored blood.
Iron is stored in bone macrophages.
Structures passing thru superior orbital fissure....
NOT-FAL
NASOCILLIARYOPTHALIMIC VEINTROCHLEARFRONTAL
Suture Removal:
Head 5-7days
Face 3-5days
Eyelid & eyebrow 3-5days
Trunk 5-7days
Extremities 7-10days
Surface of joint 10-14days
Hand ==7days
Absorption
iron and divalents absorb in duodenum.
Folic acid, maximum water, max electrolytes, long chain fatty acids in jejunum.
Bile and B12 absorb in ileum.
water and electrolytes absorb in colon but less than jejunum. Short chain fatty acids
absorb in colon.
Buffers
Major intracellular buffer is protein.
Major extracellular buffer is bicarb.
If only major buffer asked then Bicarb.
Major renal buffer is still bicarbonate if depleted then
Phosphate ==Qualitative
Ammonia == Quantitative
Buffer in blood is H2co3 > Hb
Uterus
Uterosacral felt on PR
Main support is cardinal(also named transverse cervical ligament )
Round ligament of uterus keeps it anteverted anteflexed
broad ligament has very lessor role in support
Best way to "measure" gfr is inulin clearance.
best way to "estimate" gfr is creatinine clearance.
best way to "clincally" measure gfr is creatinine clearance.
best way to measure renal plasma / blood flow is PAH .
best test for renal falilure is creatinine clearance.
blood transfusion
multiple===hemochromatosis
massive===hyperkalemia
repeated ===hypocalcemia

PART 4 MICROBIOLOGY

Ascetic tap - E.coli

Peritonitis - E.coli.
Pyogenic peritonitis - Bacteroids.
Puerperal sepsis - Bacteroids.
P.O abdominal and gynaecological infection - Bacteroids.
Abscess - S.Aureus.
Acute osteomyelitis - S.Aureus.
Toxic shock syndrome - S.Aureus.
Wound infection - S.Aureus > Pseudomona.
Hospital acquired pneumonia - S.Aureus.
Septic meningitis - Streptococcus.
Initiation of dental caries - Streptococcus.
Pyogenic lung abscess + Meningitis - Staphylococcus.
Subacute bacterial endocarditis - S.viridians.
Prosthetic valve endocarditis - S.epidermidis.
Cellulitis - S.pyogenes.
Multiple draining sinuses - Actinomyces.
IUCD infection - Actinomycosis.
Trachoma - Chlamydia.
Pelvic inflammatory disease - Chlamydia.
Lymphogranuloma venereum - Chlamydia.
Pseudomembranous colitis - C.Difficile.
Gas gangrene - C.Perfringes / C.Welchii.
Fatal diarrhea - V.Cholrea.
Tubulo ovarian cyst - Gonococcus.
Abscess - S.Aureus.
Acute osteomyelitis - S.Aureus.
Toxic shock syndrome - S.Aureus.
Wound infection - S.A
Valvular itching + Pink purulent discharge - Trichomanas vaginilis.
Infection in post liver transplant patient - CMV.
Chorioretinitis in AIDS - CMV.
Bronchogenic carcinoma - CMV.
Herpangia - Coxsakie virus.
Hand foot and mouth disease - Coxsakie virus
Lymphoma in AIDS - EBV.
Burkitt lymphoma - EBV.
Non hodgkin lymphoma - EBV.
Hairy tongue - EBV.
Nasopharyngeal carcinoma - EBV.
Infectious mononucleosis - EBV.
Kaposi sarcoma - HHV8.
Cervical cancer - HPV 16.
Vulval papules - HSV.
Meningo-encephalitis - Echovirus.
Meningitis in AIDS - Cryptococcus neoformans.
Black water fever - Plasmodium falciparum.
Cysticercosis - Taenia solium.
Cyst in liver - Teania echinococcus.
SCC of bladder - Schistosomiasis.
Cholangio carcinoma - Clonorchis Sinensis.
Migratory lesion of foot - Cutaneous larva migrans.
Toxoplasmosis - Cat

IMP ABOUT THORAX

About trachea
1....starts at C6 , at inferior border of cricoid
2....bifercates at T4
3... is about 15 cm
4....has 16 to 20 incomplete cartlilage c shaped ring
5... tracheostomy opening at cartilage ring 2,3,4
Bronchi..
1... Right bronchus is
Shorter, wider and more vertical left bronchus.. therefore inhaled foreign bodies comes
into right bronchus..
2... Left bronchus is
Longer, narrower and less vertical rigjt bronchus...
Small airways...

1.... No of divisions of lower air way is 23

2.... Right lung has...
10 segments
Left lung has...
9 segments

3...Bronchopulmonary segment
i..is anatomical, functional and surgical unit of lungs..
ii..Areated by tertiary bronchioles

About diaphragm

1...Motor supply of diaphragm is through

phrenic nerve
2... sensory supply is..
central part by phrenic and Uperipheral ny intercostal nerve
3... openings of diaphragm..
Formula...
...CEA...
...8,10,12...
i...Cavel opening in diaphragm is at level of T 8.... structures passing are..
Vena cava, phrenic nerve, sympathetic nerves
ii...Esophageal opening is at level of T 10... structures passing are..
Esophagus, right and left vagas nerve and lymphatics..
iii... Avortic opening at the level of T 12...
Structure passing are
Avorta, thoracic duct and azygus vein

RIB CAGE

1... Weakest point of rib is..angle

2... True ribs are 1 to 7...
False ribs are 8, 9, 10
Floating ribs are 11,12
3... Supernumary cervical Rib
i... compression of lower trunk of brachial plexus
ii...Compression of subclavian vessels
iii.. it originates from C 8

INTERCOSTAL SPACES

1... The neuromuscular bundle present between.. Internal intercostal muscle and
innermost intercostal muscle
2... Ther order of neuromuscular bundle from above down in the coastal groove of rib
lower border is... VAN
vein, artery, nerve
3... Site for needle piercing / pleurocentesis is at MID AXILLARY LINE... near the
UPPER BORDER of ribs... 1 or 2 rib space below maximum dullness.

And also read this***

If ask .... neurovascular bundle located at ---inferior border of rib

If ask in neuromuscular lies in between ---Internal and innermost layers
if ask where Thoracocentasis advised ---upper border of lower rib
If asked space--- lower space
if asked best site of aspiration-- 4rth and 5th intercoastal space in "Mid axillary line "
kindly focus on mid axillary
If asked vessels are present in --- subcoastal groove
If Ask drain inserted which structure damaged most likely --- it will be intercoastal
nerve ... cox as u knw sequence is VAN so nerve is below and it is least protected by
subcostal groove while artery is in between and vein is superior and strongly protected
by subcostal groove
Superior to inferior (Top to bottom) ---VAN
Inferior to superior ---NAV
Sternal angle (angle of louis)----important surface landmark
2nd costal cartilage
intervertebral disc bw T4 -T5
junction of ascending aorta and arch of aorta
junction of decending aorta and arch of aorta
bifurcation of trachea
junction of superiir mediastinum and inferior mediastinum

Body of sternum is common site for bone marrow biopsy

== Atypical rib 1st rib -- close relation with nerves of brachial plexus and subclavian
artery and vein
Cervical rib -- 0.5%---arises from transverse process of C7 --connected to 1st
rib---pressure on lower trunk --subclavian artery ---Thoracic outlet syndrome

innermost intercoastal muscle--Endothoracic fascia and parietal pleura

intercostal nerves and blood vessels run bw internal and innermost intercostal muscle

Arranged above downward VAN

inferior to superior NAV
neuromuscular bundle lies between lower border in subcostal groove
Always prick in upper border of lower rib

Diaphargm --muscle of inspiration

Right crus--1st three lumber vertebra and intervertebral disc --encloses
oesophagus
Left crus ---1st two vertebra and intercostal disc
Medial arcuate ligament--L2 to transverse process of L1
Lateral arcuate ligament--transverse process of L1 to rib 12
Openings
1.Aortic ---T12 --Aorta ,thoracic duct,Azygous vein
2.Esophageal ---T10---esophagus, ryt and left vagus nerves ,oesophageal
branches of left gastric vessels,lymphatic vessels
Remember ryt vagus runs behind esophagus
left vagus inftont of esophagus
3.Caval ---T8 ---inferior vena cava,right pherenic nerve
Diaphragm --C3 C4 C5--pherenic nerve
Diaphrgm attached to
L1
xiphesternum
10th rib
7th costal cartilage
Not directly to T10
Muscle of queit respiration---Diaphragm
Contraction of diaphrgm causes--increase thoracic volume
Major inspiratory muscle--diaphragm
Diaphrgmatic hernia occurs thru
Esophageal opening
costovertebral opening
costal and sternal attachment of diaphrgm
Aortic opening
Most common site of Morgagni hernia ---Right anterior
Congenital diaphragmatic hernia--incomplete pleuriperitoneal membrane
pt cannt survive without ventilation if lession above C5
pt can survive without ventilation if lession below C 5
Medial arcuate ligament---arches over psoas muscle as it passes thru it
A stab at 6th costal cartilage just ryt will damage----Ryt atrium
best site of Aspiration of pleural fluid ---4rth intercoastal space midaxillary line
pleural tapping ---midaxillary line --muscles pierce --internal intercostal ...external
and innermost intercostal
intercostal space --1 large posterior and 2 small anterior intercostal artries

IMP ABOUT NEUROANATOMY

Nervous System: Central nervous system = Brain + spinal cord.

Peripheral nervous system = Somatic.
Autonomic system = Visceral.
Myenteric nervous system = GI, intrinsic.
Cerebral cortexs Gray matter consist externally of = (6 layers)
Fucntions of Cerebral Cortex : Motor speech (Brocas) area = (44, 45), Primary auditory
cortex = (41, 42), Associative auditory cortex (Wernickes area) = (22) , Principal visual
cortex = (17) , Principal sensory areas = (3, 1, 2) , Principal motor area = (4) , Premotor
area = (6) (part of extrapyramidal circuit) , Frontal eye movement and pupillary change
area = (8) .
Diencephalon contributes to = Rathkes pouch (forming part of posterior pituitary).
Ventral posterior medial (VPM) Nuclei of Thalamus controls =Facial sensation including
Pain.
All cranial nerves (except Cranial Nerve I and II) originate from the = brain stem.
All cranial nerve motor nuclei have unilateral corticonuclear connections except=
CN VII: Upper third
muscles of facial
expression have
bilateral innervation.
CN XII: Genioglossus
muscles have = bilateral
motor innervation.
All cranial nerve sensory nuclei have unilateral representation except = hearing.
Hearing is bilateral; Person cant go deaf in one ear from a stroke to the unilateral
temporal area.
Taste Sensation : Taste to the anterior 2/3 of the tongue is CN VII via the = chorda
tympani and the posterior 1/3 by = CN IX. CN X caries taste fibers from the = palate.
PARASYMPATHETIC GANGLIA:
1: Pterygopalatine Ganglion supplies = Lacrimal Glands and Glands in Palate & Nose
2: Otic Ganglion supplies = Parotid Gland
3: Submandibular Ganglion supplies = SubMandibular, Sublingual small Salivary
Glands.
4: Ciliary Ganglion supplies = Ciliary Muscles, Spincter pupillae, Dilator, Pupillae and
Tarsal muscles.
Trochlear nerve: The smallest cranial nerve and the only cranial nerve that exits from
the = posterior surface of the brain stem.
Blurred vision = with a lesion to any of = CN III, IV, VI.
Ptosis (drooping eyelid) and dilated pupil with = CN III injury (levator
palpebrae superioris and sphincter pupillae muscle).
Lesion CN VI = eye persistently directed toward nose (because of lateral rectus).
Horners syndrome:
Lesion of oculosympathic pathway (sympathetics dont come from CNs but run with
them; come from superior cervical ganglion, ciliospinal center of Budge); miosis, ptosis,
hemianhidrosis, apparent enophthalmos.
Argyll Robertson pupil:
Think prostitutes pupilaccommodates but does not react; also associated with
syphilis. No miosis (papillary constriction) with either direct or consensual light; does
constrict with near stimulus (accommodation-
convergence). Occurs in = syphilis and diabetes.
V1 and V2 of Trigeminal Nerve are purely = sensory and V3 Trigeminal Nerve is both =
sensory and motor.
The buccal nerve of V3 provides sensation to = the cheek; whereas the buccal branch
of CN VII is motor to the = buccinator muscle.
CN VTrigeminal Nerve: Largest cranial nerve. No parasympathetic fibers are
contained with the trigeminal nerve at its origin.
Lingual nerve: A) General sensation: Anterior 2/3rd of tongue, floor of mouth, and
mandibular lingual gingival.
B) Carries (from chorda tympani [VII]): Taste sensation: Anterior 2/3rd tongue.
C)Preganglionic parasympathetics: To submandibular ganglion.
Auriculotemporal nerve: A)Sensory: Front of ear & TMJ.
B)Postganglionic parasympathetic: To parotid gland.
Inferior alveolar nerve: A) Gives off nerve to mylohyoid and inferior dental plexus;
terminates
as mental nerve.
B) Motor to = mylohyoid.
C) Sensory to = teeth, skin of chin, lower lip.
Mental nerve: Termination of inferior alveolar nerve.
Sensory to = skin of chin, skin, and mucous membrane of lower lip.
Ophthalmic Nerve (V1) Sensory supply to = the Upper eyelid, cornea, conjunctiva,
frontal sinus, upper nasal mucosa and forehead.
Maxillary Nrve (V2) Sensory supply to = Lower eyelid, upper cheek, lip, gums, palate,
nose, tonsils, hard palate and upper teeth.
Mandibular Nerve (V3) sensory supply to = Tongue (general), temporoauricular skin,
lower face, lower teeth.
Motor Supply to = Muscles of mastication, tensor tympani, mylohyoid, anterior belly of
digastric, tensor veli palatini
IMPORTANT BRANCHES OF TRIGEMINAL NERVE V3:
A) Lingual nerve:
General sensation: Anterior 2/3rd of tongue, floor of mouth, and mandibular lingual
gingival. Carries (from chorda tympani [VII]):
Taste sensation: Anterior 2/3rd tongue.
Preganglionic parasympathetics: To submandibular ganglion.
B) Auriculotemporal nerve:
Sensory: Front of ear, TMJ.
Postganglionic parasympathetic: To parotid gland.
C) Inferior alveolar nerve:
Gives off nerve to mylohyoid and inferior dental plexus; terminates
as mental nerve.
Motor to: mylohyoid.
Sensory to : teeth, skin of chin, lower lip.
D) Mental nerve:
Termination of = inferior alveolar nerve.
Sensory to : skin of chin, skin, and mucous membrane of lower lip.
E) Motor branches: Motor to muscles of = mastication, anterior digastric, and so on.
INFERIOR ALVEOLAR NERVE BLOCK:
Anesthetize the mandibular teeth.
Block this branch of V3 as it enters the mandibular foramen.
Needle Course:
Pierces:
Buccinator (between palatoglossal and palatopharyngeal folds).
Lies lateral to = medial pterygoid at the mandibular foramen.
If the needle penetrates too far posteriorly can hit parotid gland and CN VII, it will lead
to = Ipsilateral facial paralysis.
Lingual Nerve:
The lingual nerve is found in the = pterygomandibular space with the inferior alveolar
nerve, artery, and vein.
The lingual artery does not run with = the lingual nerve. The lingual artery is = medial to
the hyoglossus muscle, whereas the lingual vein and nerve are lateral to = the
hyoglossus (as is the submandibular duct and hypoglossal nerve [XII]).
The submandibular duct is crossed twice by the = lingual nerve.
If the lingual nerve is cut after the chorda tympani joins, you lose both = taste and tactile
sensation.
The lingual nerve: can be damaged with third molar extraction because it lies close to
the mandibular ramus in the vicinity of the third molar.
TRIGEMINAL NUCLEI:
There are four paired nuclei (both motor and sensory).
Trigeminal Nerve:
All sensory information from the face is relayed through = VPM nucleus of
thalamus; sensory information from the rest of the body is through the = VPL.
From the thalamic nuclei (VPM or VPL), information relays to the = somatosensory
cortex (areas 3, 1, 2); the facial segment of the sensory homunculus
comprises a large area of the = lateral parietal lobe.
Parts of CNs VII and IX travel with = trigeminospinal tract.
All CN V afferent cell bodies are located within = trigeminal ganglion except
proprioceptive inputs.
Mesencephalic nucleus of CN V is the only case where primary sensory cell bodies are
located within the = CNS, rather than in ganglia.
Touch & Pressure is carried by = A-beta fibers.
Pain & Temperature is carried by = A-delta and C-Fibers.
Proprioception is carried by = A-alpha Fibers.
Sensation in teeth can be misinterpreted in = ear (because of the cross innervation).
Herpes zoster often affects = V1 division.
Trigeminal neuralgia (tic douloureux) : can affect V2 and V3.
SENSATION OF EXTERNAL EAR:
A) Auriculotemporal nerve (V3) supplies = Anterior half of external ear canal and facial
surface of upper part of auricle.
B) Auricular branch of vagus (CN X) supplies = Posterior half of external ear canal (so
stimulation can cause reflex symptoms: eg, fainting, coughing, gagging).
C) Greater auricular nerve (C2, C3) supplies = Inferior auricle (anterior and posterior)
D) Lesser occipital nerve (C2, C3) supplies = Cranial surface of upper auricle.
Corneal reflex: If stimulating right eye:
Lesion R V1 = neither
eye blinks.
Lesion L V1 = bilateral
blink.
Lesion R VII = only left
eye blinks (indirect).
Lesion L VII = only right
eye blinks (direct).
Levator palpebrae superioris (CN III) keeps the eyelid open; lesion results in = ptosis.
Orbicularis oculi (CN VII) closes eyelid; lesion results in inability to close, no corneal
reflex.
TRIGEMINAL LESIONS:
Sensory: Division V1, 2, 3 = Deficits along distribution (pain, temperature, touch,
pressure, proprioception)
Motor: Division V3 only =
Temporalis and masseter muscles
Ipsilateral weakness of jaw closure
Ipsilateral open bite
Pterygoid muscle
Weakness of jaw opening
Deviation to ipsilateral side on opening
Diminished/loss of reflexes.
Facial Nerve passes through = Facial Canal.
CN VII NUCLEI:
A) Main motor nucleus
B) Superior salivatory Nucleus
C) Nucleus of the solitary tract (gustatory nucleus)
IMPORTANT MUSCLES OF FACIAL EXPRESSION (ALL CONTROLLED BY CN VII):
A) Orbicularis Oris : Whistle, Pulls lips against teeth, protrudes lips.
B) Depressor anguli Oris: Frown, Pulls down angle of mouth.
C) Zygomaticus Major: Smile, Pulls angle of mouth up and back.
D) Risorius: Smile, Pulls angle of mouth laterally.
E) Orbicularis oculi: Closes eye.
OTHER MUSCLES CONTROLLED BY CN VII:
A)Buccinator: Holds food on occlusal table (accessory muscle of mastication); tenses
cheek (blowing, whistling)
B) Stapedius: Decreases vibration of the stapes (decreases perception of sound)
CN VII LESIONS:
A) Lower motor neuron lesion: Ipsilateral paralysis/weakness of upper and lower face;
loss of corneal reflex (efferent limb).
B) Upper motor neuron lesion: Contralateral lower face weakness only.
Bells palsy: Acute 7th nerve palsy.
Stroke: is an example of = an upper motor neuron lesion.
Bells palsy: is an example of a = lower motor neuron lesion.
Facial and maxillary arteries supply blood to the = buccinator.
GREATER PETROSAL NERVE
A) carries Taste from = palate via palatine nerves.
B) Greater petrosal nerve is the parasympathetic root of the = pterygopalatine ganglion.
Central hearing connections are bilateral, so a central lesion will not cause deafness in
= either ear.
Caloric test is testing the vestibuloocular reflex. COWS Cold Opposite Warm Same.
The gag reflex: is mediated by CN IX (afferent-unilateral) and CN X (efferent-bilateral).
CN IXGlossopharyngeal:
A) Carries taste from = posterior third of the tongue.
B) Parasympathetic/secretomotor: Parotid via = otic ganglion.
C) Gag reflex (afferent limb) (fauces).
D) Chemo-, baroreception (afferent limb)carotid body, carotid sinus.
Chemoreception: Carotid body; oxygen tension measurement.
Baroreception: Carotid sinus; blood pressure changes. Mediated CN IX (afferent) and
CN X (efferent).
Vagus nerves: lose their identity in the esophageal plexus. The anterior gastric nerve
can be cut (vagotomy) to reduce gastric secretion.
The cardiac branches of the vagus: (form the cardiac plexus) are preganglionic
parasympathetic nerves that synapse with postganglionic parasympathetic nerves in the
= heart.
The abdominal viscera below the left colic flexure (and genitalia and pelvic viscera) are
supplied by = pelvic
splanchnic nerves (parasympathetic preganglionics).
With CN XII paralysis, the tongue tends to fall back and obstruct the airway
(genioglossus).
CN XI LESIONS:
A) Paralysis of SCM: difficulty turning head to = contralateral side.
B) Paralysis of trapezius: Shoulder droop.
In addition to deviation to the affected side (with damage to CN XII/hypoglossal Nerve
and resultant denervation atrophy), dysarthria (inability to articulate) can be experienced
by the patient.
Hypoglossal Nerve: Passes between External Carotid Artery and Internal Jugular Vein.
CN XII LESIONS:
A) Lower motor neuron: Tongue deviates toward side of =lesion.
B) Upper motor neuron: Tongue deviates away from side of = lesion.
Spinal Cord:
A) 4045 cm long.
B) Extends to L1L2 (L3 in a child).
CSF: is located in the = subarachnoid space. This space is entered during a = lumbar
tap or puncture.
In the spinal cord, white matter is peripheral and gray matter is central, the reverse of
the = cerebral cortex.
The spinal cord is protected by the = bony and ligamentous walls of the = vertebral
canal and CSF.
The cell bodies for afferent/sensory nerves are located in the = dorsal root ganglion.
Tracts:
A) Ascending/sensory:
a) Anterior spinothalamic = Touch, pressure.
b) Lateral spinothalamic = Pain, temperature
c) Posterior columns (gracilis and cuneatus) = Proprioception, position sense.
d) Spinocerebellar = Motor coordination, proprioception.
B) Descending/motor:
a) Corticospinal = Motor
b) Tectospinal = Movement of head
c) Rubrospinal = Muscle tone, posture, head, neck, upper extremities
d) Vestibulospinal = Equilibrium (interface with CN VIII)
e) Reticulospinal = Muscle tone, sweat gland function
NERVE FIBER TYPES:
A) A Fiber:
a) A-: Proprioception & Motor
b) A-: Sensory, Touch and Pressure
c) A-: Muscle spindle
d) A-: Sharp pain, Temperature and Touch
B) B Fiber: Preganglionic autonomic.
C) C Fiber: Dull pain, Temperature, Postganglionic and autonomic.
Splanchnic nerves: are sympathetic nerves to the = viscera. They pass through the
sympathetic chain ganglia without synapse (exceptions to short preganglionic and long
postganglionic) and synapse in the effector.
Sympathetic Nervous System :
Thoracolumbar
Fight or flight
Parasympathetic Nervous System :
Craniosacral.
Rest and digest.
Postganglionic autonomic fibers: are unmyelinated = C-fibers.
Gray rami: connect sympathetic trunk to every = spinal nerve.
White rami: are limited to = spinal cord segments between T1 and L2.
Cell bodies of the visceral efferent preganglionic fibers (visceral branches of
sympathetic trunk) are located in the = interomediolateral horn of the spinal cord.
Cell bodies of visceral afferent fibers are located in the = dorsal root ganglia.....

IMPORTANT POINTS FROM ENDOCRINOLOGY

 Half life of transthyritin I s2 days
Half life of TBG is 5 days
Half life of albumin Is 13 days
Levels of TBG are increased in estrogen treated patients. Methadone, heroin, major
tranquiliers, clofiberate
Levels of TBGs are decreased by glucocorticoids, adndorgens, danazole, and L
asparginase(a chemotherapeutic drug){patient remains euthyroid coz level of T3 and T3
decrease due to feedback}
salicylates, phenytoin, mitonate(a cancer chemotherapeutic drug) and 5 florouracil
inhibit binding of T3 and T4 with the TBG and produce effects similar to decreased
TBGs{ patient remains euthyroid coz level of T3 and T3 decrease due to feedback}

Thyroid hormone binds with its receptors in nucleus via ZINC FINGERS

Thyroid hormone increase the metabolism in all metabolically active tissues except
UBLAST(uterus, brain(in adults), lymph nodes, anterior pituitary, spleen, testes)

Thyroid hormone donot increase the metabolism in uterus but is required for the
normal menstrual cycle and fertility

Yellow tinge in hypothyroidism is produced due the acconulation of carotene inblood

stream. Thyroid hormne is required for conversion of carotene to Vit A in liver.
Carotenimia os distinguished from the jaundice because it donot involves sclera

Vitamin deficiency syndromes may be precipitated in hyperthoiridism coz when

metabolic rate is increased the demand of almost all vitamins is increased

Myxedema in hypothoiridism occurs due to retention of water by osmotic effect of

protein complexes with the hyaluronic acid and chodroitin sulphate etc in the skin. With
the administration of thyroid hormone the proteins are metablised and dieresis occurs
until edema is relieved

Thyroid hormone increase the glucose absorption from the GIT and increased the
plasma glucose level rapidly after carbohydrate rich meal however it falls rapidly after
sometime

Thyroid hormone increases the LDL receptors in liver lowering the plasma cholesterol
levl

Myxedema is one disease that can be diagnosed on telephone.

Hyperthoiridosm causes increased pulse pressure

Resistin and TNF alpha increase the insulin resistant

 Leptin and adiponectin decrease it s resistance
Insulin/glucagon level ratio in different conditions
a. Large carbohydrate meal 70
b. Iv glucose 25
c. Small meal 7
d. Overnight fast 2.3
e. Low carbohydrate diet1.8
f. Strvation 0.4
(thing to remember is IV glucose has less effect on insulin release than oral glucose)
Immediately after hypophysectomy the zona fasciculate and reticularis start to
degenerate. Zona glomerulosa remains normal due to effect of angiotensin II. Ability of
excretion of aldosteron secretion and Na preservation may hamper in long standing
hypopituitrism due the absence of a pituitary factor that that maintains the
responsiveness of zona glomerulosa.
Injections of ACTH or stimuli that cause endogenous secretion cause hypertrophy of
zona fasciculate and reticularis but actually causes atrophy of zona glomerulosa
Effect of dopamine in circulation blood Is unknown but it produces vasodilation in
kidney and of mesenteric vessels. Elsewhere it produces vasoconstricton. It has a
positive ionotropic acton by action on beta 1 receptors.the net effect of ibjection of
moderated dose of dopamine is increase in systolic BP and no change in diastolic BP.
By these properties it is used in ccardiogenic and traumatic shocks.
Adrenals release norepinephrine selectively in emotional stress in which the individual
is familiar with. Epinephrine secretion increase in stress with which individual do not
know what to expect.
Glucocorticoids increase the no of neutrophils, platelets ns RBC in circulation. They
decrease the no of eiosinophils, basophils and lymphocytes. They also decrease the
size of lymph nodes and thymus.
25OH cholecalciferol is converted to 1,25diOHcholcalciferol in proximal convoluted
tubules of kidney.
Sarcoidosis is associated with increase 1,25diOHchlcalciferol produced by pulmonary
macrophages upon stimulation by gamma interferon.
PIEBALDISM: the patches of skin lacking melanin as a result of congenital defect of
migration of pigment cell precursors from the nural crest during embryonic development.
Vitelago is similar patchy loss of melanin but onset is after birth and is progressive
GH secretion Is inhibited by REM sleep, glucose, cortisol, FFA, medroxyprogesteron,
and GH.
GH secretion is increased by exercise, amino acid, glucagon, pyrogens, going to
sleep, estrogen and androgens.
Blood testes barrier is formed by sertoli cells. Germ cells pass thru this barrier by
breaking the tight junctions above them followed by reformation of junctions.
Menstrual blood is predominantly arterial. 25% is venous in origin.
 Human milk contains **ALIAN** more than cow milk. Ascorbic acid, Lactose, Iron, vit
A, Nicotinic acid

Cell CYCLE
Consists of two phases interphase and mitosis
INTERPHASE ....Chromosomes REPLICATE
INTERPHASE ....DNA REPLICATE
INTERPHASE....Barr Bodies are studied
INTERPHASE is divided into...
1.G1
2.S (SYNTHESIS Phase)
3.G2
4.Mitosis ( also called M phase & cytokinesis is a part of it )
G1...Primary Growth , Proteins , Organelles , mRNA Synthesis )
G1...Also Called growth phase
G1... Longest phase ( 8to 10 Hours)
G1 Check point...To check if DNA is damaged
S ....DNA Replicate
S....Cytotoxic & cancer drugs act here to destroy DNA
S.....5 to 6 hours
G2...Secondary growth ( between S phase & Mitosis)
G2...Short ( 3 to 4 hours)
G2 Check point... To check if DNA has replicated properly
MITOSIS / M Phase
M...Shortest (2 hours)
M... To see spindle assembly and alignment
M...nuclear content divide
M...genetic material is Chromosome (Genetic material is chromatid when NOT in M
phase)
M... Divided into Prophase, prometaphase, Metaphase, Anaphase , Telophase,
Cytokinesis
PROPHASE....Spindle fibers appear Chromosome Condensation
PROPHASE...Centriole start moving to the oposite end
PROMETAPHASE....Spindle fibers attach to chromosome & chromosome movement
PROMETAPHASE....Nuclear membrane dissolve marking the beginning of
prometaphase
METAPHASE...Chromosome Alignment
METAPHASE.....Chromosome thickest
METAPHASE......Chromosome begin to divide
METAPHASE...Karyotyping
ANAPHASE.... Division of chromatids & sister chromatids move to opposite side
ANAPHASE....NON Disjunction
TELOPHASE...Spindle fibers disappear & Decondensation of Chromosomes
TELOPHASE...Complete divison
TELOPHASE....chromosomal study
TELOPHASE....Nuclear membrane formation
CYTOKINESIS....Cytoplasm divide
Barr Bodies....Heterochromatin
Barr Bodies....have X chromosome
Barr Bodies....seen under light microscope
Barr Bodies....ABSENT in Turner
Barr Bodies....Scanty In Turner
Barr Bodies....Diagnostic for Turner
one Barr body in Klinfelter
NO. of Barr bodies in OX .....no Barr Bodies
NO. of Barr bodies in XX... 1 Barr Body
NO. of Barr bodies in XXX....2 Barr bodies
Best Test for chromosomal abnormalities is Karyotyping
Karyopiknosis index.... Index of karyopiknotic nuclei of epithelial cells which exfoliate
from vagina... Hormonal evaluation

Biochemistry points:::::
1)Highest cholesterol content=LDL.
2)richest in triglycerides=chylomicron.
3)Highest protein content=HDL.
4)Fat soluble vitamins= ADEK.vit a,d,e,k.
5)Vit B2 deficiency=2cs(Cheilosis,Corneal vascularization..
6)Vit B3 deficeincy=3ds(dirrhea,dementia,dermatitis)..
7)Antioxidants ACE=vit a,c,e.
8)Vit k(antiKagulant)=gamma carboxylation of factors(27910).
9)essential fatty acids=linolic acid & linolinec acid.
10)Malnutritions::::::::
(a)kawashiorkor::protein malnutrition result from protein deficient
MEAL(M=malnutrition,E=edema,A=anemia,L=liver fatty).
(b)Marasmus:::M=muscle wasting.
11)amino acids necessary for PURINE synthesis GAG(glycine,aspartate,glutamine).
12)Bloting proceedures:::southern blot=DNA,NORTHERN blot=RNA,western
blot=protein.
12)protein energy=4.1Kcal.
13)fat energy=9.1kcal.
14)highest energy compund=ATP.
15)renal failure z most common cause of vit D deficiency.
16)isoniazide therapy z most common cause of pyridoxine(vit b6) deficiency.
17)vit c z cofactor in conversion of dopamin to norepinephrine.
18)the most common source of vit K z colonic bacteria.
19)vit b12 deficiency=homocysteinuria.
20)hypervitaminosis A=scaly dermatitis.
21)thiamine level z best monitered by=transketolase level in RBC.
22)increase carbohydrates=increase demand of thiamine.coz thiamine z important in
ATP senthesis.
23)biotin(vit b7) z used as coenzyme in fatty acid synthesis.
24)vit b6 inovle in transamination of ALT & AST.
25)vit C(ascorbic acid) is involved in collagen synthesis.vit c deficiency result in
defective collagen.
26)zinc deficiency leads to delayed wound healing.

FA CVS

1. Coronary artery occlusion most commonly occurs in?

2. Cardiac output =??
3. Stroke Volume affected by?? Name three parameters
4. Most posterior part of heart?
5. Vasodilators decrease?? Preload/after load
6. EF is the index of?
7. Viscosity depends mostly on??
8. Fixed splitting is seen in?
9. S4 is in? Mid diastole/ late/ early
10. Period of highest oxygen consumption?
11. Isovolumetric relaxation?
12. Expiration inc intensity of which side of heart sounds? Left/right
13. Murmur of Mitral stenosis is best heard in which area?
14. Myxomatoys degeneration causes which valvular lesion?
15. Cardiac muscle action potential has plateau due to ??
16. Rapid depolarization caused by?
17. Pacemaker action potential occurs in??
18. QRS complex shows??
19. AV nodal delay is useful because??
20. Lyme disease causes which heart block?
21. Sawtooth appearance??
22. Cushing triad??
23. Aortic arch responds??? And transmits via???
24. Highest blood flow per gran of tissue???
25. Pulmonary vascular hypoxia cause?
26. Autoregulation In brain caused by?
27. Pulmonary capillary wedge pressure good approximation of which pressure?
28. Boot shape heart?
29. Preductal coarctation of aorta associated with which congenital syn?
30. Drug to close PDA?
31. Infant of diabetic mother --- > congenital defect??
32. Hyperplasia onion skinning seen in??
33. Most common site of atherosclerosis ??
34. Thoracic aortic aneurysm associated with?
35. Common cause of dear hiring first few hours after MI?
36. Marker for reinfarction?
37. V1-V2 ----> infarction location?
38. Autoimmune pericarditis after MI?
39. Sudden death in young athlete?
40. Gold standard in first 6 hours of MI?
41. Etiology of dialated cardiomyopathy?
42. Isolated right heart failure is due to???
43. Heart failure cells ? LHF/RHF
44. IV drug abusers endocarditis valves involved?
45. Colon cancer having IE?? Organism
46. In rheumatic fever early death die to??
47. RF which type of hypersensitivity ?
48. Atrial myxoma involves which site of heart?
49.early lesion in rheumatic fever ??
50. Most frequent primary cardiac tumor on children?
51. Eosinophilia is seen in which vasculitis?
52. Pulseless disease?
53. Vasculitis associated with heavy smokers?
54. Angiosarcoma associated with?
55. Benign painful , red blue tumor under finger Nails?
56. Vitamin causing hyperglycemia ?
57. Torsa de pointes caused by drug??? Name 2
58. Adenosine action time?
59. Name 2 important function of digoxin?
60. Which drugs decrease effect of bad cholesrterol ??
61. Dysphagia is caused by enlargement of which part of heart ?
62. In JVP a wave shows?
63. Carotid body responds to dec Po2 at which level ?
64. Risk of ventricular rupture on which day of post MI??? 2 / 3-7/ 10/ 14
65. In rheumatic fever antibodies are formed against which protein??
66. Patient having prosthetic valve having IE ? Agent?
67. Cardiac cirrhosis caused by?? RHF/LHF
68. Tree bark appearance ??
69. Most common heart tumors??
70. Print metal angina?? St elevation / depression
71. Dirotic notch in aortic pressure curve coincides with which heart sound?
72. Structure with richest blood supplyee?
73. Artificial pacemaker is connected to which part of heart?
74. Aj J point of ECG what happens??
75. Principal source of energy to heart in healthy individual is ???
KEYS
1. LAD
2. ??HR*CO
3. Contractility, preload, afterload
4. Left atrium
5. Afterload
6. Ventricular contractility
7. Hematocrit
8. ASD
9. n? late
10. ?isovolumetric contraction
11. Period between aortic valve closing and opening of mitral valve
12. right
13. Mitral area
14. ? MVP
15. Ca influx
16. Massive K efflux
17. SA AV node
18. Ventricular depolarization
19. Allows time for ventricular filling
20. 3rd degree
21. Latrial flutter
22. Hypertension, bradycardia and respiratory depression
23. ?? Inc Bp only -- vagus nerve
24. ?? Kidney
25. Vasoconstrictiin
26. Co2(ph)
27. Left atrial pressure
28. TOF
29. ? Turner syn
30. Indonethacin
31. ??transposition of great vessels
32. Malignant hypertension
33. Abdominal aorta
34. ? Hypertension
35. Arrhythmia
36. ?ckmb
37. ? Anterioseptal
38. ?i syn
39. HOCM
40. ECG
41. Alcohol abuse, beriberi, cocaine use, Chaga disease, doxuebecin,
hemochromatosis
42. Cor pulmonale
43. LHF
44. Tricuspid
45. . Strep bovis
46. Myocarditis
47. ? Type 2
48. Left atrium
49.MVP
50. Rhabdomyosarcoma
51. Churg Strauss sys
52. Takayasu
53. Beurgers disease ( thromboangitis obliterans )
54. chloride, thorium dioxide and arsenic
55. Glomus tumor
56. Niacin
57. quinidine, sotalol and ibutilide
58. 15sec
59. Inhibition NaK atpase and vagus nerve stimulation
60. Statins
61. left atrium
62. Steal contraction
63. <60 mmhg
64. 3-7 (in goljan ) 5-10 days in ( first aid)
65. M protein
66. Strep epidernidis
67. RHF
68. Syphilitic heart disease
69. Metastases
70. St elevation
71. S2 heart sound (second)
72. Carotid body
73. Right ventricle
74. All part of ventricles are depolarized.
75. Free fatty acids

IMPORTANT POINTS OF BLOOD PHYSIOLOGY>>>>>>

Total circulating blood is 8% of total body weight

Active bone marrow forming the blood cells is called red marrow and inactive marrow
is called yellow marrow. Inactive marrow is filled with fats.
75% bone marrow belongs to white blood cells producing myloid series
Neutrophils and monocytes are produced from single precursor. There are se[arate
pools for proginators of megakaryocytes, lymphocytes, erythrocytes, eosinophils, and
basophils
Mast cells, kupffer cells, dendritic cells, osteoclasts and langerhans cells also originate
from bone marrow
Best source of hematopoitic stem cells is umbilical cord blood
Average half life of nutrophils in circulation is 6 hours
Nutrophils, eosinophols and basophills are collectively called
granulocytes/polymorphonuclear cells
Eosinophils are abundant in GIT and respiratory mucosa
Mast cells are abundant in areas rich in connective tissue eg beneath epithelium
Monocyte leave the circulation and become macrophages in tissues. They donot
reenter the circulation.
Pluripotent uncommitted stem cells become committed by the action of IL1, IL6
followed by IL3(I,3,6 commits the stem cells, kind of love guru )
Cytokines are hormone like molecules that act generally in paracrine fashion
IL1 increases slow wave sleep and reduces apetite
Platelets dont have nuclei.They have half life of 4 days
Splenectomy causes increase in circulation platelets.
Cytoplasm of platelets contains actin, myosin, glycogen, lysosomes, and two types of
granules
a. Dense granules: they have nonprotein substances. They contain serotoninand ADP
b. Alpha granules: contain clotting factors, PDGF
Platelet production is controlled by colony stimulating factor and thrombopoitin.
Thrombopoitin controls the maturation of megakaryocytes and is produced by kidney
and liver.
Osmotic fragility of RBC starts at 0.5% saline. Almost half the RBCs are lysed at 0.40
to 0.42% saline. Complete lysis occurs at 0.35% saline.
2.5 % hb in adults is HbA2
Hb F has the ability to decrease the polymerization of deoxygenated HbS.
Hydroxyurea causes HbF production and is used in treatment of HbS
Blood group antigens are called aglutinogens
Blood group antibodies are called agglutinins
Blood group antigens are also present in salivery gland, saliva, kidney, pancrease,
liver, lungs, testes, semen, and amniotic fluid
A and B antigens are actually oligosaccharides that differ in their terminal suger. In
RBCs they are mostly OLIGOSPHINGOLIPIDS and in other tissues they are
glycoprotiens.(past MCQ)
An antigen called H antigen is present in all RBCs in all individuals. In blood group A
the A antigen is attached to H antigen, in blood group B the B antigen is attached to H
antigen where as in blood group O no antign is attached to H antigen i.e terminal part of
blood group O is H antigen(past MCQ). Blood group AB has both antigens at the
terminal.
Bilirubin rarely penetrates Blood brain barrier in adults. But in neonates and fetus the
BBB is permeable to it an in erythroblastosis feotalis it causes KERNICTERUS
If whole blood is allowed to clot and clot is removed, remaining is called serum.
(plasma minus factor 2,5,8,fibrinogen is called serum)(past MCQ)
Serum has high serotonin level due to breakdown of platelets.
Thrombomodulin is produced by all endothelial cells except that of microcicculation of
brain
Thombin is procoagulant in circulation blood. It becomes anticoagulant when it binds
to thrombomodulin
Lymph has lower protein content than plasma..

RULE of. 7, 9, 10.........

( reposted with important addition )
1)...7, 9, 10
Cranial nerves carrying taste sensation to nucleus tractus soletarius

2)... 7,9, 10
Cranial nerves with SVE fibers supplying salivery glands
(CN 10 to parotid)

3)... 2, 7, 9, 10
vit K dependent coagulation factors...

4)...3, 7, 9, 10
cranial nerves having parasympathtic fibers..

5)... 5,7,9, 10
Cranial nerves having both motor and sensory fibers..

6)... 5, 7, 9, 10
cranial nerve supply of pharyngeal pouches derivatives..
Pouch.. 1,2,3, (4+6)
CN...........5,7,9, 10
(Note: pharyngeal pouche no 5 is degenerated, and hence no 5th pharyngeal pouche)

7)... T 7, 9, 10
Dermatome levels of upper abdominal wall
T 7... xipisternal joint
T 9... in between xipisternal joint and umbilicus ( also by T 8 )
T 10... at the level of umbilical

BONE TUMORS..... important points

Site of origion
GO OO FEMOR ( go femur )

GO from Epiphysis OO from Metaphysis and FEMOR from Diaphysis...

1..Tumours of Epiphyseal origin of Bone

i..Giant cell tumour
ii.. Osteoblastoma
2..Tumours of metaphyseal origin of Bone
ii..Osteosarcoma
iii..Osteochondroma
3..Tumors of diphyseal origin of Bone
i..Fibrosarcoma
ii..Ewing sarcoma
iii..Myeloma / metastasis
iv..Osteoid Osteoma
v.. Reticulum cell tumour
/ Round cell tumour

1...Giant cell...
50 % occurs around the knee, locally aggressive, soap bubble appearnce on xray (due
to Aneurysmal Bone Cyst ABC), multinucleated giant cells, 20 to 40 years

2...Osteochondroma...( exostosis )
Most common benign tumour , males less than 25 years

3...Osteosarcoma...
2nd most common primary malignant tumour, hematogenous spread to LLB (Lung, liver
and brain) codmann triangle or sun burst pattern on xray

4...Ewing sarcoma...
Blue cell malignant tumour , extremely aggressive with early metastasis, Onion skin
periosteal reaction in bone , Associated with t11;22 translocation

5...Multiple myeloma...
Most common primary malignant bone tumour originates from plasma cells..

Note...A nemonic to remember important 3 tumours with their origin

"GEOMEDia"
GIANT CELL----EPIPHYSEAL
OSTEOSARCOMA ,
OSTEOCHONDROMA'----METAPHYSEAL
EWING SARCOMA----DIAPHYSEAL

AIDS important points

elective c.section is recomended mde of delivery in
1. who are not takin HAART therapy
2. with co existing hepititis C infection
3. viral load above 50 copies/ ml
otherwise a planned vag delivery
TRANSMISSION
best option
blood trnsfusion
then vertical transmission(highest risk at delivery)

RISK FACTORS increasing transmission

1.prematurity
2.chorioamnionitis
3.prolonged rupture of membranes
4.breast feed

200 Important Points with Definitions to Remember in General Pathology

1.Hyperplasia is an increase in the number of cells in an organ or tissue, usually

resulting in increased volume of the organ or tissue.

2. Hypertrophy refers to an increase in the size of cells, resulting in an increase in the

size of the organ. 3. Atrophy is the shrinkage in the size of the cell by loss of cell
substance. 4. Metaplasia is defined as a reversible change in which one adult cell type
(epithelial or mesenchymal) is replaced by another adult cell type. 5. Cell swelling is the
earliest sign of a reversible cell injury. 6. Free radical is a chemical species that have a
single unpaired electron in an outer orbit. 7. Necrosis is a spectrum of morphological
changes that follow cell death in a living tissue largely resulting from the progressive
degradative action of enzymes on the lethally injured cell. 8. Necrosis has six major
type; coagulative, Caseous, Liquefactive, fibrinoid,gangrenous and Fat. 9. Apoptosis
(Greek falling off) is defined as a pathway of programmed cell death that is aimed at a
highly regulated intracellular programme in which cells destined to death by activated
enzyme that degrade the cells DNA and nuclear and cytoplasmic proteins. 10.
Morphologically an apoptotic cell shows: a) cell shrinkage, b) chromatin condensation c)
formation of cytoplasmic blebs and apoptotic bodies, d) phagocytosis by macrophages.
11. Apoptosis has two phases a) Initiation phase extrinsic and intrinsic pathways
b)Execution phase c)phagocytosis of dead cell 12. Genes promoting apoptosis are:
bax,bak,bim 13. Genes inhibiting apoptosis are bcl 2 family. 14. Initiator caspase are 8
& 9, while executioner caspases are mainly 3 & 6. 15. Dystrophic calcification is always
seen in damaged tissues while metastatic calcification may occur in normal tissues
whenever there is hyperplasia. 16. Inflammation is a complex reaction to injurious
agents such as microbes and damaged, usually necrotic cells that consists of vascular
responses, migration and activation of leukocytes, and systemic reactions. 17.
Inflammatory response consist of TWO main components: vascular & cellular, and
divided into TWO main patterns: Acute and Chronic. 18. Vasodilatation is one of the
earliest manifestation of acute inflammation, if follows a transient vasoconstriction of
arterioles lasting few seconds. 19. Increased vascular permeability leading to the
escape of a protein-rich fluid (exudate) into the extravascular tissue in the HALL MARK
of acute inflammation. 20. Formation of endothelial gaps in venules is the most common
cause of vascular leakage. 21. Leukocytes Adhesion molecular families have a major
classes: a) Selectins (E,L & P types), b) Integrins, c) Immunoglobulin family of adhesion
molecules and d) Mucin like glycoproteins. 22. Selectins mainly involved in rolling of
leukocytes, PECAM in transmigration and immunoglobulin family in adhesions. 23.
Chemotaxis is defined as uni directional migration of leukocytes towards the site of
injury under chemical gradient action. 24. Most important chemotactic agents are
C5a,LTB4 and bacterial products. 25. Major opsonins are: C3b & Fc fragment of IgG
proteins 26. H202-MPO-Halide systein is the most efficient bactericidal system in
neutrophils. 27. Chediak-Higashi Syndrome is an autosomal recessive condition
characterized by failure of fusion of phagosome with lysosome. 28. Chronic
granulomatous disease of childhood results from inherited defects in the components of
NAPDH oxidase which generates superoxide, leading to body infections. 29. Vasoactive
amines are histamine and serotonin which are the main players of early inflammation.
30. Plasma Proteins are: Complement system proteins, clotting system and fibrinolytic
system. 31. Prostaglandins are vasodilators. 32. MAC (C5B6789) is the membrane
attack complex, which finally kills the bacteria. 33. Activated Hageman factor initiates
FOUR systems involved in inflammatory responses Kinin, Clotting, fibrinolytic and
complement system 34. SRS-A (slow releasing substance of anaphylaxis) constitutes
LTC4, LTD4 & LTE4 promote vasoconstriction, bronchospasm & increased vascular
permeability. 35. Lipoxins are bioactive products generated from transcellular
biosynthetic mechanisms involving neutrophils and platelets. 36. IL-1 & TNF are two of
the MAJOR cytokines that mediate inflammation. 37. Major chemokines include: IL-8,
MCP-1, eotaxin, MIP-1, Lymphotactin and RANTES. 38. Nitric oxide plays major role in
production of vasodilation by relaxing vascular smooth muscle in ischemic conditions.
39. The major mediators of pain are Bradykinin & Prostaglandins 40. Potent
vasodilators are : Vasoactive Amines, Prostaglandins & NO. 41. Acute inflammation is
defined as a rapid response to an injurious agent that serves to deliver mediators of
host defense leukocytes and plasma proteins to the site of injury. 42. Chronic
inflammation is defined as an inflammation of prolonged duration, in which active
inflammation, tissue destruction and attempts at repair are proceeding simultaneously.
43. Neutrophils are the main cells of acute inflammation (exudates) while Mononuclear
cells (with one nucleus are the main cells of chronic inflammation .Mononuclear cells
include Lymphocytes, Monocytes, Macrophages and Plasma cells. 44. Macrophages
are the prima donna (main working cell) of chronic inflammation, while lymphocytes are
present in increased number. 45. Granuloma is a focus of chronic inflammation,
consisting of microscopic aggregation of macrophages that are transformed into
epithelium like cells surrounded by a collar of mononuclear leukocytes. Dont confuse it
with Granulation tissue which has capillaries, fibroblasts, and a variable amount of
inflammatory cells. 46. Classical tuberculous granulomas is composed of epithelioid
cells, Langhans multinucleated giant cells, caseation necrosis and collar of
lymphocytes. There are two types of Granulomas: Immune & foreign body. 47. There
are 3 types of cells in the body: Continously dividing labile cells, Quiscent or stable cells
and Permanent Non-dividing cells. 48. Stem cells are cells characterized by their
prolonged self renewal capacity and by the asymmetric replication. They are of two
types: embryonic & adult stem cells. 49. VEGF & fibroblast Growth factor are mainly
involved in angiogenesis. 50. TGF-B is a growth inhibitor for most epithelial cells and
leukocytes, potent fibrogenic agent and a strong anti-inflammatory effect. 51.
Extracellualr matrix is formed of these groups of molecules : a) fibronectin b) adhesive
glycoproteins and c) proteoglycans & hyaluronic acid. 52. Collagens is the most
common protein in the animal world, with 27 types discovered so far. Types I, II, III, V &
X) are fibrillar and most common while type IV is non fibrillar. 53. Healing by 2nd
intention differs from 1st intention in three ways; a) inflammatory reaction is more
intense, b) Much more granulation tissue forms and c) wound contraction phenomenon.
54. Accumulation of excessive amounts of collagen may give rise to a hypertrophic scar
while if scar tissue grows beyond the boundaries of the original wound and does not
regress, it is called keloid. 55. Edema is defined as accumulation of fluid in the
interstitial tissue spaces and body cavities. 56. Local increased volume of blood in a
particular tissue leads to Hyperemia and congestion. Hyperemia is an active process,
resulting from augmented tissue inflow because of arteriolar dilation while Congestion is
a passive process resulting from impaired outflow from tissue. 57. Heart failure cells are
hemosiderin laden macrophages seen in chronic pulmonary congestion. 58. Petechiae
are minute 1 to 2 mm hemorrhages into skin, mucous membranes or serosa surfaces,
while >3 mm hemorrhages are called Purpura and more larger > 1 to 2 cm
subcutaneous hematomas are called Ecchymoses. 59. Virchows triad include: a)
Endothelial injury b) Stasis or turbulent blood flow & c) blood hypercoagulability. 60. Of
the inherited causes of hypercoagulability, mutation in the factor V gene and
prothrombin gene are the most common. 61. Lines of Zahn are laminated lines
produced by alternating pale layers of platelets admixed with some fibrin and darker
layers containing more red cells. 62. Fate of thrombus include: propagation
embolization, dissolution, organization and recanalization. 63. Embolus is a detached
intravascular solid, liquid or gaseous mass that is carried by the blood to a site distant
from its point of origin. The phenomenon is called embolism. 64. Infarct is an area of
ischemic necrosis caused by occlusion of either the arterial supply or the venous
drainage in a particular tissue. 65. The most dominant histologic characteristic of
infarction is ischemic coagulative necrosis. 66. Shock is the systemic hypoperfusion
caused by reduction either in cardiac output or in the effective circulating blood volume,
and resulting in hypotension followed by impaired tissue perfusion and cellular hypoxia.
67. Major types of shock include: cardiogenic, hypovolemic, septic, neurogenic and
anaphylactic. 68. Mutation is defined as a permanent change in the DNA. 69. Marfans
syndrome is a disorder of the connective tissue of the body, characterized by changes
in the skeleton, eyes and cvs. Mainly cause by defects in an extracellular glycoprotein
Firbillin-1. 70. Ehlers-Danlos Syndrome comprise a clinically and genetically
heterogenous groups of disorders that result from some defect in the syntesis or
structure of fibrillar collagen. 71. Amyloid is a pathologic proteinaceous substance
deposited between cells in various tissues and organs of the body in a wide variety of
clinical settings. 72. Neoplasm is an abnormal mass, the growth of which exceeds and
in uncoordinated with that of the normal tissue and persists in the same excessive
manner after cessation of the stimuli which evoked the change. 73. Tumor has two
basic components: Parenchyma & stroma, while tumors are of two types: Benign and
Malignant. 74. Benign tumors are well differentiated, grow slowly and dont show
invasion and metastases, while Malignant tumors range from well to undifferentiated,
grow fast and show invasion and metastasis. 75. Single most important feature to
differentiate benign from malignant tumor is METASTASIS. 76. Carcinomas mostly use
lymphatic routes and sarcomas mostly use hematogenous routes of spread. 77. Four
types of genes are normally working in human body: a) protooncogens b)
antioncogenes, c) apoptotic genes and d)DNA repair genes 78. Proto-oncogenes are
changed to oncogenes by three processes: mutation, translocation and amplification.
79. Major oncogenes are; RAS, ERB-B1, RET, KIT, ABL, C-MYC & N-MYC. 80. Major
antioncogenes are: RB, TP53, W.-1, NF-1, BRCA-1, APC. 81. Oncogenic viruses
include; Human Papilloma virus, Hepatitis B virus, Epstein Barr virus ,Kaposi Sarcoma
Herpes viruses & Human T-Cell leukemia virus (The only oncogenic RNA virus). 82.
Chemical carcinogenesis is a multistep process, divided into initiation and promotion
phases. 83. Major chemical carcinogens associated as include: Asbestos with
Mesothelioma, Aniline dyes with TCC, Nitrates-Gastric carcinoma, Aflatoxin with HCC,
Vinyl chloride with Angiosarcoma Liver. 84. Radiation induced malignancies include
leukemias and papillary carcinoma thyroid. 85. Major paraneoplastic synbdromes
include, Cushing syndrome, ADH secretion by small cell carcinoma lung, Hypercalcemia
by Squamous cell carcinoma lung, hypoglycemia by Fibrosarcoma and HCC,
Polycythemia by RCC and hypertrophia osteoarthropathy by CA lung. 86. Major tumor
markers included : HCG for Choriocarcinoma, calcitonin for medullary carcinoma
thyroid, alpha fetoprotein-HCC and Nonseminomatous germ cell tumor testis, CEA-CA
colon, PAP For CA prostate, CA-125 for Ovarian CA , Ca 19-9 for CA Colon and
pancreas ,CA 15-3 for CA breast. 87. Major immunomarkers for epithelial tumors are
cytokeratin, for mesenchymal tumor vimentin, for leukocyte origin tumor leukocyte
common antigen, S100 for neural origin tumors and for skeletal muscle tumors
desmin. 88. Type I hypersensitivity (anaphylactic) or immediate hypersensitivity) is
the result of antigen binding to IgE on the surface of mast cells and basophils. These
instantly degranulate and release active substances into the surrounding tissue. 89.
Type II cytotoxic hypersensitivity, antibodies attach to antigens on the surfaces of a cell
and then something injures or destroys the cell. 90. In type III immune-complex
hypersensitivity reaction, Soluble antigens precipitate with antibodies, usually this
happens 2-4 hours after exposure. This sort of tissue injury is mediated by
antigenantibody complexes (immune complexes). 91. Type IV Hypersensitivity
reaction is called delayed hypersensitivity. It is mediated by sensitized CD4+T
lymphocytes which process antigens in association with class II HLA molecules and
release lymphokines. 92. Immune reactions are divided into two broad categories: A)
Humoral immunity-B-cell lymphocyte mediated via production of antibody and Often
develops as a response to soluble antigens, and B) Cellular immunity-T-Cell lymphocyte
mediated. CD4+helper lymphocytes: help B cells make antibody and also help to
generate cytotoxic T cells. 93. Major histocompatibility complex is present on all
nucleated cells. 94. The HLA system is a key factor in most Transplant rejection
reactions. Reactions are mediated by either T lymphocytes or by antibody. 95. Toll like
receptors are membrane proteins that recognize a variety of microbe derived molecules
and stimulate innate immune responses against the microbes. 96. CD4 molecule is a
high affinity receptor for HIV 97. Major autoimmune disease include Hashimotos
thyroiditis, Rheumatoid Arthritis, Sjogrens syndrome, ankylosing spondylitis. 98.
Gamma interferon is one of the cytokine to activate macrophages and also play major
Role in Granuloma formation. 99. Cytokines are mediators released from one cell and
modulate the actions of another cell. 100. Squamous cell carcinoma is characterized by
sheets, groups and clusters of pleomorphic malignant epithelial cells with high N/C
ratio,hyperchromatic nuclei and pale cytoplasm.Keratin epithelial pearls,intercellular
bridges and individual cell keratinization are seen. 101. Adenocarcinoma is
characterized by back to back closely packed glands lined by pleomorphic malignant
epithelial cells with high N/C ratio,hyperchromatic nuclei and eosinophilic
cytoplasm.Wall sharing is often noted. 102. Two types of vaccines include: Live
vaccines; Measles, Mumps, Rubella, Varicella, Polio etc and Killed vaccines: Rabies,
Polio, Hepatitis A. 103. Protooncogenes are converted into oncogenes. 104. p53 works
by DNA repair and promoting apoptosis. 105. RB gene activates and Works in
hypophosphorylated form. 106. RAS gene protooncogene protein is GTP bound and
Works with GAP in cooridination with GTPase. 107. Gliomas and BCC are highly
malignant but dont usually metastasize. 108. AFB is acid fase bacillus ( Mycobacterium
tuberculosis ) and called so because it resists decolourization by Concentrated Acids.
109. Tigered lipid effect is seen in Herat. 110. Major complement proteins include :
Opsonization by C3b Chemotaxis by C5a Anaphylatoxin C3a, C4a, C5a Membrane
breakdown and killing C5b,6,7,8,9 MAC complex Enhancement of antibody production
C3b 111. FNAC and biopsy are key investigations to early diagnose a tumor. 112. Active
Immunity is the resistance induced after contact with foreign antigens eg
microorganisms, immunization with live or killed infectious agents, exposure to microbial
products (toxins, toxoids) Passive immunity is resistance based on antibodies
preformed in another host eg administration of antibody against tetanus, botulism,
diphtheria, rabies etc. 113. Sudden death is majorly linked with embolism. 114. 24 to 48
hours post acute inflammation ,monocytes start accumulating. 115. ubiquitin
proteosome pathway & autophagic vacuoles are mainly involved in atrophy. 116.
Reserve stem cells are main players in metaplasia. 117. Mechanical and trophic factors
are involved in hypertophy. 118. Eosinophils are players in allergic infections. 119.
Sequence of events in acute inflammation is : Transient asoconstriction,vasodilation
stasis, margination, rolling, adhesion, diapedesis, chemotaxis and phagocytosis. 120.
Macrophages seen as a part of reticuloendothelial system include: Osteoclasts
bone,microglia brain,kupffer cells liver,alveolar macrophages lung.Sinus
histiocytes lymph nodes. 120. Tuberculosis is the leading cause of granuloma in
Pakistan. 121. Major granulomatous causes include: sarcoidosis, leprosy, cat scratch
disease, fungal infections. 122. Grading of a tumor is based on differentiation,atypia and
mitoses. 123. Staging of a tumor is based on TNM tumor,nodes,metastasis. 124.
Major autosomal dominant disorders include: Skeletal Marfan; syndrome Nervous
Huntington disease,neurofibromatosis Gastrointestinal familial polyposis coli Urinary
polycystic kidney disease Haematopoietic hereditary spherocytosis 125. Major
intracellular accumulations are : Melanin melanoma,bile cholestasis,carbon
anthracosis,copper Wilson disease lipofuscin aging 126. Fatty change is also known
as steatosis. 127. Point mutations are often caused by chemicals or malfunction of DNA
replication, exchange a single nucleotide for another e.g RAS. 128. Giant cells are cells
containing more than one nucleus. 129. Major giant cells are : Langhan giant cells
Tuberculosis,Tuton giant cells xanthoma Warthin finkeldey giant cells measles,Reed
Sternberg cells Hodgkin Lymphoma Foreign body giant cells foreign body 130. IgG
fixes complement and crosses placenta. 131. IgM is the most heavy antibody. 132. IgE
is the allergic reaction player antibody. 133. Ig A is found in secretions. 134. ABL gene is
seen translocated in CML. 135. Lines of Zahn confirms a thrombus.They are alternate
layers of platelets with fibrin and RBCs 136. Psamomma bodies are lamellated bodies
of dystrophic calcification seen in meningioma,papillary carcinoma thyroid and serous
ovarian malignant tumors. 137. Nuclear changes in a necrotic cell include: pyknosis,
karyolysis, karryorrhexis and loss of nucleus. 138. Macrophages get accumulated in
chronic inflammation by continuous recruitment,proliferation and immobilization. 139.
Ischemic injury leads to coagulative necrosis. 140. Major sensitive cell components:
maintenance of integrity of cell membrane, aerobic respiration, protein synthesis,
genetic integrity 141. Liquefactive necrosis: Usually caused by focal bacterial infections,
because they can attract polymorphonuclear leukocytes. 142. Coagulative necrosis is
characterised by the preservation of cellular and tissue architecture 143. Fat Necrosis: A
term for necrosis in fat, caused either by release of pancreatic enzymes from pancreas
or gut (enzymic fat necrosis) or by trauma to fat, either by a physical blow or by surgery
(traumatic fat necrosis). 144. Caseous necrosis cheese like : A distinct form of
coagulative necrosis seen in mycobacterial infections (e.g., tuberculosis), or in tumor
necrosis, in which the coagulated tissue no longer resembles the cells, but is in chunks
of unrecognizable debris 145. Gangrene ("gangrenous necrosis") is not a separate kind
of necrosis at all, but a term for necrosis that is advanced and visible grossly with super
added putrefaction. 146. Fibrinoid necrosis occurs in the wall of blood vessels when
endothelium and smooth muscle cells are injured and dying. 147. Unlike necrosis,
where the cell dies by swelling and bursting its content in the area, which causes an
inflammatory response, apoptosis is a very clean and controlled process where the
content of the cell is kept strictly within the cell membrane as it is degraded. 148. The
extrinsic pathway of apoptosis is initiated through the stimulation of the transmembrane
death receptors, such as the Fas receptors, located on the cell membrane. 149. In
contrast, the intrinsic pathway of apoptosis is initiated through the release of signal
factors by mitochondria within the cell 150. In males bronchogenic carcinoma and in
females breast carcinoma are at the top. 151. Preneoplastic conditions include:
Cirrhosis of liver, Atypical hyperplasia of endometrium, Leukoplakia, Inflammatory bowel
disease, Adenomatous colonic polyps 152. Initiator chemicals - Cause irreversible
damage to DNA, but at maximum they can cause severe dysplasia. 153. Promoter
chemicals itself cannot induce cancer,they propagate or enhance the effects of initiators
154. Known chemical carcinogens include :A- Asbestos - Lung, mesothelioma. GI tract
(esophagus, stomach, large intestine) b- Arsenic - Lung, skin, hemangiosarcoma c-
Beryllium - Lung d- Cadmium - prostate e. Benzene - Leukemia mutation. random
fusion 155. Ionizing radiation leads to dysjunction 156. Exposure long term of
radiations lead to leukemia and thyroid cancers. 157. Initiation, Latent stage, Promotion
and Malignant transformation are recognizable stages in carcinogenesis. 158. Mast
cells are the main source of histamine and platelets the main source of serotonin. 159.
Thromboxane A2 (TXA2), from platelets, aggregates platelets, constricts blood vessels.
Great for hemostasis. 160. Prostacyclin (PGI2), from the vessel wall, prevents platelet
aggregation, dilates vessels. Great for whenever hemostasis is unnecessary. 161.
Suppurative or purulent inflammation is characterized by the production of large
amounts of pus or purulent exudate consisting of neutrophils, necrotic cells, and edema
fluid. 162. An ulcer is a local defect, or excavation, of the surface of an organ or tissue
that is produced by the sloughing (shedding) of inflammatory necrotic tissue 163.
Teratoma is a tumor derived from more than one germ cell layer. 164.
Seminomas,Melanomas,Hepatomas are malignant tumors. 165. Extent to which the
tumor cell resemble its parent cell is differentiation. 166. Ranges of differentiation
include: well, moderately, poorly, undifferentiated (anaplasia). 167. A malignant cells
shows: high N/C ratio,hyperchromatic nuclei, prominent nucleoli, scanty cytoplasm and
pleomorphism. 168. Carcinoma in situ is : Full-thickness dysplasia extending from the
basement membrane to the surface of the epithelium. 169. Dysplasia :Atypical
proliferation of cells characterized by nuclear enlargement and failure of differentiation
which falls short of malignancy 170. The change that occurs in the stroma as tumor
invades is called desmoplasia 171. Benign tumors never locally invade and Malignant
tumors always invade the surrounding tissues. 172. Carcinoma of the ovary spreads
through seeding of body cavities. 173. Commonest places for mets deposits are liver
and lungs. 174. Perineural spread is seen by carcinoma of prostate and pancreas (2 Ps
). 175. Nuclear damage is the hall mark of irreversible cell injury. 176. Scientific study of
structural changes and functional consequences of injurious stimuli on cells, tissues and
organs is Pathology. 177. Metaplasia is a two edges sword because it can lead to
dysplasia and the original function of cells is lost. 178. Metaplasia can lead to dysplasia.
179. ALTHOUGH ATROPHIC CELLS MAY HAVE DIMINISHED FUNCTION,THEY R
NOT DEAD. 180. Pathologic hyperplasia constitutes a fertile soil in which cancerous
proliferation may eventually arise like bph and endometrial hyperplasia. 181. Dysplasia
can regress and does not always lead to cancer. 182. Transudates are fluid
accumulations that are essentially salt-water, accumulated because of pressure
problems. Exudates are protein-rich fluid accumulations, due to leaky vessels. 183. In
disseminated intravascular coagulation, the clotting cascades are activated throughout
the body. This is bad, since it tends to shut down organs due to microthrombi, and also
causes bleeding due to consumption of clotting factors and activation of plasmin. 184.
Some people reserve the word "thrombus" for the ante-mortem kind, and call post-
mortem thrombi "clots". 185. Arterial thrombi usually occur over ruptured atherosclerotic
plaques, less often at sites of other vascular disease or old surgery. 186. Vegetations
are thrombi that occur on cardiac valves. They may be loaded with bacteria ("bacterial
endocarditis"), or sterile ("marantic", "verrucous", "bland"; also the thrombi of acute
rheumatic fever). 187. Embolus" comes from the Greek for "bottle stopper". 188.
Pulmonary embolization is one of the great killers of hospitalized patients, and that ante-
mortem diagnosis is notoriously unsatisfactory even today. 189. A paradoxical embolus
(* crossed embolus) is one from the systemic veins that passes through a right-to-left
intracardiac shunt (i.e., a birth defect), to occlude a systemic artery. 190. Long bone
fractures are the main cause of fat embolism. 191. Tumor emboli are bits of cancer that
invaded a vein and then broke off. Renal cell carcinoma is famous for this. 192. White
infarcts ("anemic infarcts", from "an-", not, and "-eme", blood) are usual when arteries
are occluded in solid organs 193. Red infarcts ("hemorrhagic infarcts", sounds like an
oxymoron but isn't) result when veins are occluded, or when arteries are occluded in
loose tissues (bowel) or with a dual blood supply, or when the organ was already very
congested. 194. Monocytes are the largest cells in blood stream. 195. Histiocytes are
mature tissue macrophages. 196. Cell membrane damage is the first sign of irreversible
cell injury. 197. Lysosomal leakage confirms irreversible cell injury. 198. Choristomas
and hemartomas are not neoplasms. 199. FGF,TGF,VEGF,EGF are main growth
factors. 200. Endothelium gets leaky in acute inflammation due to: 1) formation of
endothelial gaps in venules 2) cytoskeletal reorganization 3) increased transcytosis 4)
direct endothelial injury 5) leukocyte dependent injury 6) delayed prolonged leakage 7)
leakage from new blood vessels

Some more PEARLS of Part1 Useful Important Points.......!!!!!

Most Radiosensitive Tissue Bone Marrow

Least Radiosensitive Tissue Nervous Tissue
Most Radiosensitive blood cell Lymphocyte
Least Radiosensitive blood cell Platelet
Most Radiosensitive organ Skin
Least Radiosensitive organ Vagina
Most Radiosensitive mucosa Interstitial Mucosa
Cells are most Radiosensitive in phase G2-M
Cells are least Radiosensitive in phase S-phase

Hemodynamics of Atrial Septal Defect (ASD) >>>

1)Right atrial dilatation and

hypertrophy

2)delayed diastolic murmer and

accentuation of first heart sound

3)Right ventricular hypertrophy

4)Parasternal heave

5)Pulmonary ejection murmer

6) P2 is delayed and accentuated ,wide

split and fixed S2

7)Pulmonary plethora and pulmonary

congestion

:: MYOCARDIAL INFRACTION :: IN Brief--

CHARACTERISED BY PRESENCE OF = CAP

Evidence of myocardial necrosis with any 1 of the following:

1..(C)ardiac biomarkers (pref. Troponins) showing sudden rise or fall
2..Sudden unexpected cardiac death involving cardiac (A)rrest
3..(P)athological findings of acute MI

::SIGNS OF MI (windows VISTA) ::

1..Vagal activation (vomiting, bradycardia)

2..Impaired myocard. Func. (s1,s2 soft; hypotension; inc. JVP; Oliguria; Cold, clammy
skin)
3..Sympathetic activation (Pallor, sweating, tachycardia)
4..Tissue damage (Low grade fever)
5..A complication (MR / VSD producing pansystolic murmur

::Important Enzymes elevated in MI (TALC - talcum powder)::

1..Troponin T/I
2..AST
3..LDH
4..CK-MB

:: Complications of MI ::

((((A))) Immediate (RAILgaadi)

a) RV infarction
b) Arrythmias (VT, AF, VF) - may also be due to I.v. Xylocaine overdose
c) LHF

(((B))) Early (PSVT ka MELA laga hua hai !!)

a) Pericarditis

b) Sudden death

c) VSD

d) Thromboembolic complications (Pulmonary, Arterial)

e) MR (Papillary muscle dysfunction or rupture)

f) LV free wall rupture (Pericardial tamponade)

g) Arterial compl. (same as mentioned in d) )

(((C))) Late (PADS)

a) Psychological reaction (DADDA- Denial, Acceptance, Dependency, Depression,
Adjustment - this is from earliest change to last)

b) Arrythmias (ventricular like VF, VT)

c) Dresslers syndrome (Autoimmune phenomenon characterized by fever, pericarditis,

pleuritis, pneumonitis)

d) Shoulder (Frozen shoulder) Pain n stiffness of left shoulder

Cardiac Output

Cardiac output (CO) is the amount of blood pumped by the heart per unit of time and it
depends on 2 important variables like below;
Stroke volume (SV) = the amount of blood ejected per beat of the heart (Normally, 70
ml/beat).
Heart rate (HR) = heart beats per minute (normally, 70 beats/min).
Therefore, the cardiac output (CO) is dependent on the stroke volume (SV) and the
heart rate (HR): CO (L/min) = SV (ml/beat) HR (beats/min) = 4.9 L/min (normally).
Contents [hide]
1 Stroke volume
2 Heart Rate

Stroke volume

Stroke Volume is the difference between end diastolic volume (EDV) and end systolic
volume (ESV). ESV can be affected by 4 factors; preload, afterload, contractility, and
Heart rate, and EDV also depends on 3 factors; venous return, Heart rate, and
compliance.
Preload (ie, the EDV):The more cardiac muscle is stretched, the harder it contracts
(Frank & Starling's law).
Positive agents:
Slow heart rate,
exercise.
Negative agents:
blood loss,
rapid heart rate: when you exercise, heart rate can increase. See the graph.
Contractility: Heart muscle fibers can contract at different strengths.
Myocardial contractility is the intrinsic ability of the heart to contract independent of
preload and afterload.
Changes in the ability to produce force during contraction result from different degrees
of binding between myosin and actin filaments.
No relationship with the changes in the fiber length!
The degree of binding that occurs depends on concentration of calcium ions in the cell;.
In an intact heart, it is usually the action of the sympathetic nervous system (through
catecholamines) that determines the concentration of calcium ions in the cytosol of
cardiac muscle cells.
All factors that cause an increase in contractility work by causing an increase in
intracellular Ca2+ during contraction.
Positive agents:
Calcium of ICM by Hormones and sympathetic nervous system,
cardiac glycosides (e.g. digoxin),
drugs.
Negative agents:
extracellular K+ (Hypercalemia).
Acidosis: H+ and K+ exchange across the membrane and if one H+ is heading in, a K+
is heading out and vice versa.
Ca2+ channel blocker.
Afterload (ie, the mean arterial pressure): Resistance to blood leaving the heart. In fact,
afterload cannot be controlled by the cardiac function, but affects the cardiac out. So,
these are the positive causes for afterload;
High hematocrit,
stenosis of vessels,
high blood pressure,
constricted blood vessels,
lipids in vessels (atherosclerosis).
Compliance: a measure of the tendency of a hollow organ to resist recoil toward its
original dimensions upon removal of a distending or compressing force. It is the
reciprocal of "elastance".
Venous return: the amount of blood that enters the heart from the venous circulation
and it can be controled by skeletal muscle contraction, venoconstriction, respiratory,
venous valves, and so on.

Heart Rate

Heart rate can be determined by autonomic nervous system. An average resting heart
rate in an adult is 70 beats per minute (bpm). The normal range for heart rate is highly
variable, however. Trained thletes may have resting heart rates of 50 bpm or less.
Someone who is excited or anxoius may have a rate of 125 bpm or higher. Children
have higher average heart rates than adults. Although heart rate is initiated by
autorythmic cells in the SA node, it is modulated by neural and hormonal input.
Autonomic Nervous System
Sympathetic NS: Fight or Flight HR ( always, contractility);
Parasympathetic NS: Rest and Digest negative effect on HR.
Bainbridge reflex ( Preload) increases the HR when the cardiac muscle is over-
stretched.
The Bainbridge reflex, also called the atrial reflex, is an increase in heart rate due to an
increase in central venous pressure. Increased blood volume is detected by stretch
receptors located in both atria at the venoatrial junctions.
Venous return the pressure of vena cavae and then the right atrium stimulation
of the stretch receptor at the venoatrial junctions signaling the medullary control
centers to decrease parasympathetic tone via the vagus HR.
Drawing more blood out of the right atrium a decrease in atrial pressure and the
great veins.
This continues until right atrial blood pressure returns to normal levels, upon which the
heart rate decreases to its original level.

WAR Of PANCYTOPENIA Vs APLASTIC ANEMIA

Pancytopenia means that all of the
cell lines (white cells, red cells, and
platelets) are decreased in the
blood. Its an important blood
finding, because it often indicates
that something serious is going on
in the marrow: either the marrow
isnt making enough cells, or its so
full of other stuff (like the fibrosis
you see in the image above) that it
has no room to make normal cells).
Sometimes, too, you can see
pancytopenia with plain old
splenomegaly (because the spleen
is like a little home for the cells of
the blood, and if enough of the cells
stay at home in the spleen, you
wont see them out and about in
the peripheral blood. So if you find
pancytopenia in a patient, you need
to work it up carefully to
determine the cause (in other
words, its not a diagnosis in and of
itself it indicates the presence of
some underlying disease).
Aplastic anemia is a distinct,
definable disease. In aplastic
anemia, the bone marrow is
empty (all thats there are
scattered lymphocytes and a rare
hematopoietic precursor) and the
blood shows a pancytopenia.
Sometimes the cause can be
determined (for example, the
patient has taken a drug that can
cause marrow aplasia), but often no
particular cause can be found. In
these cases, we use the fancy words
idiopathic or primary instead of
saying we have no idea whats
causing this.

VERY VERY IMPORTANT POINTS OF CVS TAKEN....!!!!!!

A S4 heart sound CANNOT be present during atrial fibrillation (atrial kick is required).
A S3 heart sound CANNOT be present in the setting of severe mitral stenosis.
A S3 heart sound can be present in athletes, pregnant females and other young healthy
individuals.
A S3 heart sound can indicate severe systolic heart failure.
A S4 heart sound is always pathologic and can indicate diastolic heart failure, left
ventricular hypertrophy or active myocardial ischemia.
Factors that increase the intensity of the S1 heart sound include short PR interval, fast
heart rate and mild mitral stenosis.
Factors that decrease the intensity of the S1 heart sound include long PR interval, slow
heart rate and severe mitral stenosis.
A fixed split S2 heart sound can be from an atrial septal defect.
A paradoxically split S2 heart sound can be caused by aortic stenosis, hypertrophic
obstructive cardiomyopathy or a left bundle branch block.
A widened split S2 heart sound can be caused by severe mitral regurgitation, pulmonic
stenosis or a right bundle branch block.
Large systolic jugular venous pulsations can be from V waves due to severe tricuspid
regurgitation.
A holosystolic murmur at the left lower sternal border louder with inspiration is due to
tricuspid regurgitation (Carvallos sign).
The aortic stenosis murmur can radiate to the cardiac apex where it sounds holosystolic
and can mimic the murmur of mitral regurgitation (Galiveriden phenomenon).
The three physical exam findings that correlate with severity of aortic stenosis include
the timing of the murmur peak in systole (late peak is severe), the intensity of the S2
heart sound (soft or absent is severe) and pulsus parvus et tardus.
The late diastolic crescendo portion of a mitral stenosis murmur disappears when atrial
fibrillation is present due to the loss of the atrial kick.
The murmur of aortic regurgitation is located at the right upper sternal border (aortic
post) ONLY if the etiology is aortic root dilation. If valve leaflet pathology is the cause
then the murmur is heard at the left lower sternal border.
The best position to hear the murmur of aortic regurgitation is to have the patient lean
forward and listen after a forced, held expiration.
As aortic regurgitation worsens, the murmur becomes shorter in early diastole due to
the aortic and left ventricular pressure equalizing more quickly.
The two murmurs that can be heard in the patients back are mitral regurgitation and
coarctation of the aorta.
The Austin-Flint murmur is a diastolic rumble at the cardiac apex in a patient with aortic
regurgitation and occurs from the regurgitant jet striking the anterior mitral leaflet.
There are multiple peripheral physical exam findings in patients with severe aortic
regurgitation due to the high stroke volume (see Aortic Regurgitation Review)
When the mitral regurgitant jet is eccentrically directed posterior (anterior leaflet
involvement), the murmur radiates to the back. When directed anterior (posterior leaflet
involvement), the murmur radiates to the cardiac base.
The murmur of mitral regurgitation increases with handgrip and transient arterial
occlusion since these maneuvers increase afterload.
The earlier the opening snap in a patient with mitral stenosis, the more severe it is due
to higher left atrial pressures forcing the valve open immediately in early diastole.
The murmur of a small ventricular septal defect (VSD) is very loud a frequently
associated with a thrill. This murmur is referred to as maladie de Roger
The murmur of an atrial septal defect is a systolic, crescendo-decrescendo murmur at
the pulmonic listening post due to increased pulmonic valve flow. There is frequently a
fixed splitting of the S2 heart sound.
The murmur of a patent ductus arteriosus is continuous throughout systole and diastole
since the aortic pressure (normally 120/80) is ALWAYS higher than the pulmonary artery
pressure (normally 25/10) in both systole and diastole.
A right ventricular heave can be present from severe pulmonary hypertension.
Cannon A waves can be seen in the jugular venous pulsations when the atrium
contracts at the same time as the ventricle (against a closed tricuspid valve) which
occurs in the setting of AV dissociation (complete heart block or ventricular tachycardia).
Roth spots, Janeway lesions and splinter hemorrhages are all peripheral signs of
endocarditis.
Unequal radial pulses can be a sign of aortic dissection (with subclavian artery
compression) OR from atherosclerotic subclavian arm occlusion.
Always check blood pressure in both arms in acute chest pain patients to help diagnose
aortic dissection (will be markedly lower in one arm, usually the left, if the subclavian
artery is involved

IMPORTANT POINT..>>>>>>>
Heat loss walay question me agr temperature mention ho tu ans conduction plus
radiation hoga..(ganong bcq)
tempertarture mention na ho tu acoording to guyton max heat loss is through radiation..
or agr statement me ETT mention ho tu ans evaporation hoga.

Very Very Important MCQ Repeated in January 2015 & 2016 Papers taken from
Pre-Test Physiology *

* CPSP Caught Copying Controversy Resolved*

Q. During the early stages of an asthmatic attack,

a. Arterial carbon dioxide tension decreases
b. The equal pressure point moves toward the mouth
c. Lung compliance increases
d. Airway resistance decreases
e. Arterial oxygen tension increases

The answer is a. -During the early stages of an asthmatic attack, the increased airway
resistance makes it difficult to inhale and exhale rapidly, and therefore each breath is
slower and deeper.However, the accompanying dyspnea usually increases alveolar
ventilation, and, as a result, PaCO2 decreases. Arterial oxygen tension usually
decreases, despite normal alveolar oxygen levels, because of the increased V/Q
mismatch that accompanies asthma. This hypoxia may also cause alveolar ventilation
to increase. The equal pressure point moves toward the lung because of the increased
respiratory effort. Acute asthmatic attacks do not produce any direct change in lung
compliance. However, air trapping will cause functional residual capacity (FRC) to
increase, and the larger lung volumes will lead to a decrease in lung compliance.

Important MCQs points about thyroid cancer..

an easy way to REMEMBER.

1.Papillary carcinoma..
......P.....
Popular( most common) , Previous irradiation, Psammoma bodies, orPhan
Annie eye (empty appearing nuclei with central clearing), Prognosis ( is excellent),

2.. medullary carcinoma..

.......C........
C cell ( parafollicular cells) , Calcitonin production ( tumour marker ), {Congo red
staining, Common with other tumors( associated with MEN 2A and 2B)

3Follicular carcinoma
.....F....
Follicles are uniform, Follow blood( hematogenous spread) , Faulty iodine
(commen in iodine deficient areas)
Finds way through( invades capsule)

4 Anaplastic carcinoma..
' .....A.....
All ends ( very poor prognosis) , Aged (older patients ) ,invAdes local structure

5. Lymphoma
.......H......
(nonHodgkin) lymphoma, Hashimoto thyriditis

Pregnant lady with bile duct obstruction. Diagnostic investigation = GGT (FOR NON
PREG = CLICK ALP )
265. About Trichomonas vaginalis what is correct = Is sexually transmitted
266. Anion gap = Diff between measured cation and measured anion
267. Occulomotor nerve supplies = ciliary ganglion
268. Infective endocarditis diagnostic investigation = Blood culture (blood culture for
diagnosis & ASO titre FOR THE EVIDENCE OF INFECTION )
269. Essential fatty acid = Linoleic acid (Also Linolenic Acid is among essentials)
270. Patient was brought to the ER unconscious. The doctor gave Naloxone but it was
not working. What is the likely cause of toxicity = Phenobarbital
271. Patient lacerated the dorsal part of his wrist accidentally. He came in with difficulty
to adduct the fingers and difficulty abducting the thumb. Which nerve was paralyzed =
Ulnar Nerve
280. Pain from lower inferior segment of Diaphragm = Subcostal Nerves ( Phrenic
supplies central tendon of diaphragm)
281. Cingulate gyrus blood supply = Anterior cerebral Artery
IMPORTANT POINTs regarding HEPATITIS
..Here We GO FOr Hepatitis ..
In children and in pregnancy--------->Hep A
Most Lethal is in pregnancy-------->Hep E
"E" for Hep E" "E",for Epidemics...
MOst common for HCC is hepB ..(MRCP pass medicine notes).
Most lethal is ------------>Hep D
Most common for chronic hepatitis is Hep C
1)if asked acute liver failure in hepatitis than ans is prolonged PT also decrease in factor
5 has got importance
2)IF asked only necrosis in viral hepatitis than ans is increase SGPT reference goljan
page 470 4th edition..
But
if asked acute massive necrosis in hepatitis then ans is increase in neutrophils..
for example in acute Myocardial infarction..
there is coagulative necrosis and neutrophils counts raises

Important points regarding HEMATURIA

...!!

renal stones: most common upper urinary tract cause of hematuria

infections: most common lower urinary tract cause of hematuria

transitional cell carcinoma bladder: most common non infectious cause of lower urinary
tract hematuria

BPH : most common cause of microscopic hematuria in adult males

Important MCQ points about insulin and glucagon...

1)... insulin is secreted by beta cells...in.... central islets region.

2)... glucagon is secreted by alpha cells...in...outer islets region
3)...both are inhibited by somatostatin..secreted by delta cells...
4)...both secretion is stimulated by.....1@ Inc AMINO ACIDS. 2@. Ach
5)...Inc BLOOD GLUCOSE stimulates insulin secretion...but... inhibits glucagon
secretion.
6)...Inc FATTY ACIDS stimulates insulin secretion...but... inhibits glucagon secretion.
7)...norepinephrine and epinephrine stimulates glucagon secretion...but... inhibits insulin
secretion.
8)...insulin inhibits glucagon secretion...but...glucagon(growth hormone,cortisol and
GIP) stimulates insulin secretion.
9)...CCK stimulates glucagon secretion.
10) insulin decreases blood glucose (by inc glucose uptake,glycogenisis and Dec in
glycogenolysis,gluconeogenisis)..but... glucagon increase blood glucose ( by inc
glycogenolysis, gluconeogenisis)
11)...insulin decreases blood fatty acids and keto acids..but...glucagon inc blood fatty
acid and keto acids
12)... insulin decreases blood K+ concentration.
13)...glucagon increases urea production.
14)...insulin is ANABOLIC but glucagon is CATABOLIC...

Important point
REGARDING THIRST...!!
Thirst Is Is Increased By. .
Increase in Angi0tensin 2
decrease in blood v0lume
incerease in osmolarity
drynes of m0uth.
Increase in ADH.. .
THIRST is decreasd by. .
Gastric distensi0n.
Decrease in ADH,
Angi0tensin2,
Increase in BP.
Dec by barroreceptor effrnt
Increase in blood volume.
(Reference Guyton)

Important MCQs points about posterior pituitary hormones

1) includes vasopressin(ADH) and oxytocin..

2).both are nanopepide.
3) synthesized by hypothalamus(not pituitary)
4) stored and secreted by posterior pituitary gland..
5) originates from 2 nuclei..
Supraoptic and paraventricular..
but ADH is mainly originates in SUPRAOPTIC and oxytocin in PARAVENTRICULAR
nuclei.. ( formula to REMEMBER is... ADH maintains Sodium balance.. in...Supraoptic
and oxytocin causes Parturation(Labour) in Paraventricular...
6) powerful stimulus for ADH secretion is NAUSEA..
7) ADH mainly acts on late distal tubules (also on collecting ducts) via V2 receptors
acting on aquaporin 2 to increase water permeability..
8) ADH also acts via V1 receptor to cause vasoconstriction..
9) oxytocin causes milk ejection from breast... not milk production ( which is by
prolactin)..
10) oxytocin secretion is stimulated by suckling... cervical dilatation and orgasm...
<<<NOTE..Labour is induced by fetal cortisol and uterine contraction occurs by
oxytocin>>>

Some important 20 points.

1. Which induction agent produces cardiac stability? Etomidate.

2. Lead pipe rigidity is seen in -- extrapyramidal lesions
3. Cog wheel rigidity is seen -- extrapyramidal lesions
4. Claspknife spasticity is seen -- UMN lesions
5. Drugs causing SLE
SHips
Sulfasalazine
Hydralazine
Isoniazid
Procainamide
Statins
6. Rose Waaler test is done for? Rheumatoid arthritis
7. Cell best for chromosomal study? Lymphocytes
8. Edema causes by plasma protein level below? 50%
9. Acid phosphate is specific to which cell? Monocytes
10. NF1 - neurofibrin gene - chromosome 17
11. NF2- merlin gene - chromosome 22
12. VSnare protein > synaptobrevin > blocked by tetanus
13. TSnare protein > Syntaxin > Botulinum > used in reduction of wrinkles/ achalasia
cardia.
14. Trident hand ? Achondroplasia
15. Triradiate pelvis? Osteomalacia
16. Feeding, hunger, thirst center ? Lateral hypothalamus ( remember when we are
hungery we use our lateral limbs, our hands for eating)
17. Stiety center ? Ventromedial nucleus ( remember when we alot our size increases
ventromedially)
18. Lanugo hair start forming at which age of intrauterine life? 5 months
19. Common viral cause of adult encephalitis? HSV 1
20. Common viral cause of adult meningitis? HSV 2

Lcx supply left atrium

IMPORTANT POINT RMEMBER IN EXAM...

A Quick and simple way to remember MURMURS in exam..
PNEUMONICS...
PASS---------->(p)Pulmonary and (a)aortic (s)stenosis me (s) SYSTOLIC MURMUR..
Vice Versa for Mitral and Tricuspid Stenosis (DIASTOLIC MURMUR)...
PAID-------------->(p)Pulmonary and (a)Aortic (i) Insufficiency(regurgitation) me
(d)DIASTOLIC murmur
Vice versa for Mitral and Tricuspid regurgitation..(SYSTOLIC MURMUR)

IMPORTANT POINTS ABOUT CARDIAC ENZYMES >>>>>>>>

Things you should know about Cardiac markers for MI:
1)... Myoglobin first comes and first goes (rises first, disappears first)
2)...LDH is called "lazy enzyme" because it comes late, and goes late (rises after 24
hours and remain till 14 days)
3)...Trop-I has the greatest sensitivity and specificity.
4)...The investigation of choice within first hour of MI is "CKMB"
5)..."CKMB" is useful for confirmation of reinfarction as this enzyme disappears after 72
hours of MI. So, if a patient comes after 72 hours of initial infarction, and you are
suspecting a reinfarction, go for "CKMB".
- Myoglobin disappears after 24 to 48 hours.
- CKMB disappears after 72 hours.
- Trop I disappears after 7 - 10 days.
- LDH disappears after 14 days.
Scenerio 1: CKMB of patient is normal. Trop-I is raised. He is 3 - 10 days post MI
patient.
Scenerio 2: CKMB and trop - I of patient is normal. LDH is raised. He is 10 - 14 days MI
patient.
This is all you should know about cardiac enzymes, and this covers each and every
MCQ for part 1. If any thing is missing, please add. Thanks
SOME IMP POINTS OF CVS
Stimulation of Right vagus slows the heart by inhibiting the SA node an stimulation of
Left vagus nerve mainly slows the AV conduction
Stimulation of Right stallete ganglion accelerates the heart and stimulation of Left
stellate ganglion shortens the AV nodal conduction
SA node discharge increases with increase in temperature justifying tachycardia in
fever
ATRIAL FLUTTER: atrial rate is 200-350/min. mostly there is counterclockwise circus
movement in RIGHT ATRIUM. This produces SAW TOOTH appearance. It is almost
always associated with 2:1 or greater AV block. AV node cannot conduct more than 230
impulses per minute.
ATRIAL FIBRILLATION: atrial rate more than 300-500/min and in irregular way.
Ventricles also beat irregularly at 80 to 160/min. Its exact cause is still in debate but
most commonly it occurs due to multiple concurrently circulating reentrant excitation
waves in BOTH atria. Some cases may also occurs due to discharge of one or more
ectopic foci. Many of these foci appear in pulmonary veins s much as 4 cm from the
heart. Atrial muscle fibrs extend along pulmonary vein and site of origin of these foci
MURMURS: aortic/ pulmonary valves stenosis=systolic murmur,
insufficiency=diastolic
Mitral or tricuspid valves stenosis =diastolic murmur, insufficiency systolic
Sleep dont cause any change on Cardiac output(its an MCQ)
Athletes have greater end systolic volume and stroke volumes and lower heart rates
Hematocrit is %age of blood occupied by RBCs
( but according to ganong bcq ans is hemotocrit is all platelets,rbc,WBC)
BP pressure falls upto 20mmHg in sleep in HTN this fall is reduced or absent. So
normal persons are called DIPPERS and hypertensive persons are called
NONDIPPERS
Noradrenergic fibers end on the vessels in all parts of the body which are mainly
vasoconstrictor in function.. resistance vessels in skeletal muscles are innervated by
VASODILATOR fibers which although trevel thru the sympethetics but are
CHOLINERGIC.. there is some evidence that vessels in heart, lungs , kidneys, and
ureters also receive cholinergic innervations
The afferent nerve fibers from the carotid sinus and carotid body form a distinct branch
of glossopharyngeal nerve called CAROTID SINUS NERVE. The carotid sinus nerve
and vagal fibers from the aortc arch commonly called the BUFFER NERVES
During shock the vasoconstriction is most marked in SKIN
V V V IMPORTANT POINTS FOR PART1 EXAM>>>>>>>>>>>
Here is a list of commonly tested facts in FCPS Part 1 exam. They are listed in order of
importance - highest first.
1. Acromegaly Diagnosis: OGTT followed by GH conc.
2. Cushings Diagnosis: 24hr urinary free cortisol. Addisons --> short synacthen.
3. Rash on buttocks Dermatitis herpetiformis (coeliac dx).
4. AF with TIA --> Warfarin. Just TIA's with no AF --> Aspirin
5. Herpes encephalitis --> temporal lobe calicification OR temporoparietal attentuation
subacute onset i.e. Several days.
6. Obese woman, papilloedema/headache --> Benign Intercanial Hypertention.
7. Drug induced pneumonitis --> methotrexate or amiodarone.
8. chest discomfort and dysphagia --> achalasia.
9. foreign travel, macpap rash/flu like illnes --> HIV acute.
10. cause of gout --> dec urinary excretion.
11. bullae on hands and fragule SKIN torn by minor trauma --> porphyria cutanea tarda.
12. Splenectomy --> need pneumococcal vaccine AT LEAST 2 weeks pre-op and for
life.
13. primary hrperparathyroidism --> high Ca, normal/low PO4, normal/high PTH (in
elderly).
14. middle aged man with KNEE arthritis --> gonococcal sepsis (older people -> Staph).
15. sarcoidosis, erythema nodosum, arthropathy --> Loffgrens syndrome benign, no Rx
needed.
16. TREMOR postural,slow progression,titubation, relieved by OH->benign essential
TREMOR AutDom. (MS titbation, PD no titubation)
17. electrolytes disturbance causing confusion low/high Na.
18. contraindications lung Surgery --> FEV dec bp 130/90, Ace inhibitors (if proteinuria
analgesic induced headache.
21. 1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic resonance
angiogram.
22. temporal tenderness--> temporal arteritis -> steroids > 90% ischaemic neuropathy,
10% retinal art occlusion.
23. severe retroorbital, daily headache, lacrimation --> cluster headache.
24. pemphigus involves mouth (mucus membranes), pemphigoid less serious NOT
mucosa.
25. diagnosis of polyuria -> water deprivation test, then DDAVP.
26. insulinoma -> 24 hr supervised fasting hypoglycaemia.
27. Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT.
28. causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples , dec Ig,
lymphoma, trop sprue (rx tetracycline).
29. diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets.
30. hepatitis B with general deterioration -> hepaocellular carcinoma.
31. albumin normal, total protein high -> myeloma (hypercalcaemia, electrophoresis).
32. HBSag positive, HB DNA not detectable --> chornic carier.
33. Inf MI, artery invlived -> Right coronary artert.
34. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, FAMILIAL
hyperchol,Gilberts, Huntington's, Marfans's, NFT I/II, Most porphyrias, tuberous
sclerosis, vWD, PeutzJeghers.
35. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B.
36. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR.
37. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe
near S2.
38. HOCM/MVP - inc by standing, dec by squating (inc all others). HOCM inc by
valsalva, decs all others. Sudden death athlete, FH, Rx. Amiodarone, ICD.
39. MVP sudden worsening post MI. Harsh systolic murmur radites to axilla.
40. Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD,
cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia.
41. Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogen
storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy,
radiotherapy, toxins.
42. Tumor compressing Respiratory tract --> investigation: flow volume loop.
43. Guillan Barre syndrome: check VITAL CAPACITY.
44. Horners sweating lost in upper face only lesion proximal to common carotid
artery.
45. Internuclear opthalmoplegia: medial longitudinal fasciculus connects CN nucleus 3-
4. Ipsilateral adduction palsy, contralateral nystagmus. Aide memoire (TRIES TO YANK
THE ipsilateral BAD eye ACROSS THE nose ). Convergence retraction nystagmus, but
convergence reflex is normal. Causes: MS, SLE, Miller fisher, overdose(barb,
phenytoin, TCA), Wernicke.
46. Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward
gaze, normal dolls eye . i.e. Occulomotor nuclei intact, supranuclear Pathology .
47. Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior
colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes:
pineal tumor, stroke, hydrocephalus, MS.
48. demetia, gait abnormaily, urinary incontinence. Absent papilloedema-->Normal
pressure hydrocephalus.
49. acute red eye -> acute closed angle glaucoma >> less common (ant uveitis,
scleritis, episcleritis, subconjuntival haemmorrhage).
50. wheeles, URTICARIA , drug induced -> aspirin.
51. sweats and weight gain -> insulinoma.
52. diagnostic test for asthma -> morning dip in PEFR >20%.
53. Causes of SIADH : chest/cerebral/pancreas Pathology , porphyria, malignancy,
Drugs (carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs, rifampicin,
opiates)
54. Causes of Diabetes Insipidus: Cranial: tumor, infiltration, trauma Nephrogenic:
Lithium, amphoteracin, domeclocycline, prologed hypercalcaemia/hypornatraemia,
FAMILIAL X linked type
55. bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis
(vitamin D also).
56.returned from airline flight, TIA-> paradoxical embolus do TOE.
57. alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes).
Confabulation->korsakoff.
58. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for
acute.
59. painful 3rd nerve palsy -> posterior communicating artery aneurysm till proven
otherwise
60 late complication of scleroderma --> pumonaryhypertention plus/minus fibrosis.
61. causes of erythema mutliforme: lamotrigine
62. vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT typically
abnormal in this setting DO NOT give thyroxine).
63. mouth/genital ulcers and oligarthritis -> behcets (also eye /SKIN lesions, DVT)
64. mixed drug overdose most important step -> Nacetylcysteine (time dependent
prognosis)
65. cavernous sinus syndrome - 3rd nerve palsy, proptosis, periorbital swlling, conj
injectn
66. asymetric parkinsons -> likely to be idiopathic
67. Obese, NIDDM female with abnormal LFT's -> NASH (non-alcoholic steatotic
hepatitis)
68. fluctuating level of conciousness in elderly plus/minus deterioration --> chronic
subdural. Can last even longer than 6 months
69. Sensitivity --> TP/(TP plus FN) e.g. For SLE - ANA highly sens, dsDNA:highly
specific
70. RR is 8%. NNT is ----> 100/8 --> 50/4 --> 25/2 --> 13.5
71. ipsilateral ataxia, Horners, contralateral loss pain/temp --> PICA stroke (lateral
medulary syndrome of Wallenburg)
72. renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3% other). Uric
acid and cyteine stone are radioluscent.
73. hyperprolactinaemia (allactorrohea, amenorrohea, low FSH/LH) -> Da antags
(metoclopramide, chlorpromazine, cimetidine NOT TCA's), pregnancy, PCOS, pit
tumor/microadenoma, stress.
74. Distal, asymetric arthropathy -> PSORIASIS
75. episodic headache with tachycardia -> phaeochromocytoma
76. very raised WCC -> ALWAYS think of leukaemia.
77. Diagnosis of CLL --> immunophenotyping NOT cytogenetics, NOT bone marrow
78. Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC at
diagnosis.
79. pancytopenia with raised MCV --> check B12/folate first (other causes possble, but
do this FIRST). Often associayed with phenytoin use --> decreased folate
80. miscariage, DVT, stroke --> LUPUS anticoagulant --> lifelong anticoagulation
81. Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)
82. anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophic
hypogonadism)
83. diag of PKD -> renal US even if think anorexia nervosa
85. commonest finding in G6PD hamolysis -> haumoglobinuria
86. mitral stenosis: loud S1 (soft s1 if severe), opening snap.. Immobile valve -> no
snap.
87. Flank pain, urinalysis:blood, protein -> renal vein thrombosis. Causes: nephrotic
syndrome, RCC, amyloid, acute pyelonephritis, SLE (atiphospholipid syndrome which is
recurrent thrombosis, fetal loss, dec plt. Usual cause of cns manifestations assoc with
LUPUS ancoagulant, anticardiolipin ab)
88. anaemia in the elderly assume GI malignancy
89. hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed)
90. pain, numbness lateral upper thigh --> meralgia paraesthesia (lat cutaneous nerve
compression usally by by ing ligament)
91. diagnosis of haemochromatosis: screen with Ferritin, confirm by tranferrin
saturation, genotyping. If nondiagnostic do liver biopsy 0.3% mortality
92. 40 mg hidrocortisone divided doses (bd) --> 10 mg prednisolone (ie. Prednislone is
x4 stronger)
93. BTS: TB guidlines close contacts -> Heaf test -> positive CXR, negative --> repeat
Heaf in 6 weeks. Isolation not required.
94. Diptheria -> exudative pharyngitis, lymphadenopathy, cardio and neuro toxicity.
95. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair follicles
->>Discoid LUPUS
96. wt loss, malabsoption, inc ALP -> pancreatic cancer
97. foreign travel, tender RUQ, raised ALP --> liver abscess do U/S
98. wt loss, anaemia (macro/micro), no obvious cause -> coeliac (diarrhoea does NOT
have to be present)
99. haematuria, proteinuria, best investigation --> if glomerulonephritis suspected -->
renal biopsy
100. venous ulcer treatment --> exclude arteriopathy (eg ABPI), control oedema,
prevent infection, compression bandaging.
101. Malaria, incubation within 3/12. can be relapsing /remitting. Vivax and Ovale (West
Africa) longer imcubation.
102. Fever, lymphadenopathy, lymphocytosis, pharygitis --->EBV ---> heterophile
antibodies
103. GI bleed after endovascular AAA Surgery --> aortoenteric fistula
104. Young girl suspect Anorexia Nervosa linugo hair, finctional hypogonadotrophic
hypogonadism -> amennorhea. LH and FSH both low. All other hormones are usually
normal. Ferritin low.
105. Reiters Syndrome arthritis, uveitis, urethritis Chlymidia, campylobacter,
Yersinia, SALMONELLA , Shigella. Balanisits.
106. PKD aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
107. Porphyria photosensitivity, blisters, scars with millia, hypertrichosis
108. heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity
109. Vitiligo commonest assoctions pernicious anaemia >>> type 1 DM , autoimmune
addisons, autoimmune thyoid dx
110. Gout blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO
allopurinol/aspirin in acute phase
111. Peripheral neuropathy a) B12 rapid, dorsal columns (joint pos, vibration),
sensory ataxia, pseudoathetosis of upperlimbs b) diabetic slow, spinothalamic (pain,
temp?) c)alcohol slow progressive, spinothalamic d) Pb motor upper limbs
112. CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma (solitary
lesion). HIV encephalopathy, progressive multifocal leucoencephalopathy (PML
demylination in advanced HIV, low attenuation lesions)
113. Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx.
Metronidazole), SALMONELLA (serious systemic illness), E.coli (rx. Ciprofloxacin) ,
Shigella
114. Renal syndrome minimal change disease, membanous, IgA nephropathy, post-
streptococcal.
115. If you see blood on urinalysis forget about RAS
116. Thyroid Malignancy tend to be non-functional, anaplastic has worse prognosis,
local infiltration -> dysphagia, vocal cord paralysis
117.ALMOST Pathognomic for the exam
fatiguability -> myasthenia gravis
fasciculations -> Motor neurone diease
silvery white scale -> PSORIASIS
hypopigmented -> vitiligo/pityriasis versicolor
pretibial myxoedema --> Graves (NOT lid lag, NOT exopthalmus)

To determine blood group type..

First u should know the fact for blood group O u need two Same Allele means OO
And if A or B allele is either present it will express. Means for example OA will have
blood group type A.. And OB will have blood grouo B.
And if A and B both allele combines than blood group will be AB.

So if mother Blood group type is A

One child she concieved having blood goup type O. Means mother is heterozygous.
She shoud have blood group genotype of OA

we proceed further

2nd baby she conceived was having blood group type AB..

Than cpsp asks what is blood group of baby father???

Now we come to answer..

that 2nd baby having AB type should have received B from father. So blood group of
father is B type.

.
But what do u think father has which type genotype OB or BB while first baby was
Having blood group O.

O yeah father has OB genotype.

First baby receive one Allele from father one O Allele from mother for having blood
group O..

GENERAL ANATOMY>>>
Flexion and extension takes place in sagittal section
Adduction and abduction take place in coronal section
Dermis is thinner on anterior surfaces of body as compared to posterior surfaces.
Appendages of skin are nails, hair follicles, sebaceous and sweat glands.
Hair follicles are invaginations of epidermis into the dermis.
Arrector pili are the bands of smooth muscles that that connect the undersurface of
hair follicle to the superficial part of dermis. Dimpling of skin called gooseflesh is due to
the the pull of the is arrector pili muscle. It causes contraction of sebaceous gland and
its secretion.
Sebaceous glands lie within the dermis and pour their secretion, the sebem ONTO the
shaft of hairs.
Sweat glands expand full thickness of dermis and their extremity may lie in superficial
fascia. They are the most deeply placed structure of all appandeges.
Sebaceous glands are not present in lips, palms, sides of fingers, glans penis and
clitoris, labia minora and internal surfaces of labia majora, soles, sides of feet and sides
of toes.
Sweat glands are not present on red margins of lips, nail buds, glans penis, clitoris,
Boil is infection of hair follicle and sebaceous gland.
Carbuncle is staphylococcal infection of superficial fascia. It usually occurs at nape of
neck and starts as infection of hair follicle or group of follicles.
Sebaceous cyst most frequently occurs at scalp.
Patient of shock exhibits gooseflesh as a result of overactivity of sympethetics.
Partial thickness burn heals from the cells of hair follicles, sebaceous and sweat
glands and from the cells of edges of burn. A burn that extends deeper than sweat gland
heals slowly and only from edges.
Superficial fascia is devoid of adipose tissue in eyelids, auricles, penis, scrotum and
clitoris
Nerve to muscle is a mixed nerve, 60% is motor and 40% is sensory.
Primary cartilageonus joints are those n which the bones are united by plate of
hayaline cartilage. Examples are union b/w epiphysis and diaphysis and b/w first rib and
manubrium.
Secondry cartilagenou joint are those in which the bones are joined by fibrocartilage
and articular surfaces are covered by hyaline cartilage. Example are joints b/w vertebral
bodies and the symphesis pubis.
HILTONs LAW. Sensory Nerve supplying the joint also supplies the muscles that
cause movement on that joint and the skin overlying the insertion of these muscles.
In syringomylia the pain sensation is lost in joints.
Tendons invaginate the synovial sheath from a side and are suspended by
mesotendons. Mesotendons transmit the blood vessels. In areas where wide range of
movement is there these mesotendons remain as vinulae.
In certain areas of bodies especially the tips of fingers and toes the arteries and vein
connect directly without intervention of capillaries. These areas are called arteriovenous
anastomosis
Lymphatic vessels are absent in CNS, eyeball, internal ear, epidermis of skin,
cartilage, bone.
Preganglionic are myelinated adnd type B fibers.
Postganglionic are nonmyelinated and type C fibers
Two sympethetic chains end below by joining together to form a single ganglion the
GANGLION IMPAR.
In bone the extracellular matrix is calcified.
Flat bones are composed of outer and inner layer of compact bone called the TABLES
and middle layer of cancellous bone the DIPOLE. Scapula is irregular but is included in
flat bones.
V V V V IMPORTANT POINTS ARTERIAL SUPPLY OF HEART>>>>>>

RCA:
Arises from anterior aortic sinus. It goes almost vertically in right AV groove crosses
the inferior border of heart to continue posteriorly and anastomose with LCA
It supplies RA, RV and parts of LA and LV and AV septum
BRANCHES are
- Right conus artery
- Anterior ventricular branches. The marginal branch is largest and reach upto apex
- Posterior ventricular branches
- Posterior inter ventricular artery: runs towards apex and gives branches to right and
left vemtricles. It supplies the posterior part of ingter ventricular septum but NOT TO
THE APEX. A large septal branch supplies AV node
- Atrial branches. Branch to SA node supplies SA node and right and left atria
LCA:
Usually larger than RCA and supplies the major part of heart.
Supplies greater part of LA, LV and interventricular septum
BRANCHES are
- Anterior interventricular artery( in most of the people it supplies the APEX of heart) left
diagonal artery is major branch
- Circumflex artery. Left marginal art is major branch
SUPPLY OF CONDUCTIVE SYSTEM
SA node, AF node AV bundle are supplied by RCA
RBB is supplied by LCA(right is wrongO
LBB is supplied by both LCA and RCA(left doghla hota hai )
SUMMARY:
RCA supplies all of RV(except for small area to the right of anterior nterventricular
groove), variable part of diaphragmatic surface of LV, posteroinferior 3rd of ventricular
septum, RA, part of LA, SA node and AV node. Small branches to LBB are also given
LCA supplies most of LV, small area of RV to the right of Interventricular groove,
anterior 2/3rd of ventricular septum, most of LA, RBB, and LBBB

Important Points BY KHAWAJA ASIF

These points helped me. Atleast give it a read once before exam.
60)) Very Very high yield and high scoring topic 100 percent repeated in 2015 but
unfortunately Ignored by Students is...

Patterns of inheritance Especialy

Auto Dominant>>>>Auto Recessive>>>>X linked Recessive....

you should conceptualize it.... High scoring mcq

59) Some repeated True or False regarding blood supply of Heart is...

these are Truths...

SA node is supplied by RCA...

AV node is supplied by RCA

LBB is supplied by RCA....

RBB is supplied by LCA...

58)) Occupational lung diseses are repeating very much....

some repeated fact..

mine worker with AFB sputum positive Clue to Silicosis...

Ground Glass on X_Ray clue to ASBESTOSIS...

Storm like Appearance on x-ray Clue to Silicosis.....

57)) other confusing mcq but repeating all terms almost....

Known hypertensive patient with Chest Pain ECG ST segment elevation but Trop -T is
negative... most likely diagnosis is..

Myocardial Infarction not Pericarditis.....

56) very much discussed mcq in November month.. which was also repeated in January
term...

Young Female with Diffuse Loss of Vibration Sense.... Most Likely investigation is...

Gastric Biopsy..... not X-Ray spine

55) repeated august and December term.... easy but tricky o
Patient Blood Pressure became sudden high when he took

Coffee>>>>>> Chocolate
54)) Repeated Puzzle of Right and Left Oxygen Dissociation Curve.......

Remember "Right" is Right for Our Tissue to be O2 unloaded and deliver to tissue.....

2-3 BPG is Right for Us....

While L *E* ft is not right for our tissue...

F * E*tal hb is not right for fetus...

53)) Two Repeated Anatomy Facts....... Not confusing but Underestimated........

1))) deltoid ligament ...... when foot is EVERTED excessively

anterior talofibular>>>>>> calcaneofibular logament injured during excessive

INVERSION

2))) Inversion and Eversion take place at Subtalar Joint....

while Dorsi and Plantar Flexion Take Place at ANKLE joint...

52))) Another Repeated Jigsaw of CPSP solved.......

During Sleep which Hormone increases

GH>>>>>>>>>>>>Cortisol....

51)) Three Calculations U are Expected to master...... Repeated in All term...

1) Mean Arterial pressure
2) Alveolar ventilation
3) Clearance...
Repeated in august online 18 november and January terms

50) another fact........

much confuses theeetaaaas..

IgE released from

Mast Cell>>>>>>> Basophils..

Histamine releases from...

Mast cell>>>>>>Basophils

49)) 2 january online two mcqs rheumatology which were confusing.....

HLA B27 association

Ankylosing spondylitis>>>>> Psoriatic Arthritis

2)))) Complement c3b decrease in SLE.......... NOT Rheumatoid Arthritis................

Rheumatoid Arthritis it should be Normal or increase..........

48))) 2 Easy but Tricky Facts... repeated in all terms. ..

1)) Natural Defense Mechanism against Neoplasia is Apoptosis...... Not Antibodies not
Macrophage...

2)Tumor Oncogenes involved in Cell Survival. Not Shortened G1 phase

47)) Mother Blood Group A having 2 babies... one baby has o and other has AB blood
Group.
Which Blood Group Father has Having.. its. BO blood group genotype

Almost 100 percent Repeated in 2015 in each term.....

to Really Conceptualize it.....

Read it

https://m.facebook.com/groups/102979646495000?
view=permalink&id=820302118096079

46)) Kallman Syndrome Confused Many Students in 18 November 20 Novembet online

and 1 January as well. ...

D'''''nt Confuse with X or Y Chromosome........ as did it many before

Clear Cut Answer is LEsion in Arcuate Nucleus

45)) ASPIRIN INTOXICATION repeated in 18 November 12 August and 1st January.....

Many Students were Caught..... . ... due to Chronicle of Alkalosis And Acidosis.............
But the Answer is COMA.........
Aspirin can causes both Acidosis and Alkalosis........ .. it was about intoxication and
COMA is Right Answer

44) Another Repeated MCQ

Max Renal Reabsorbed Substance is GLUCOSE......
Neither Choose INULIN NOR SODIUM

43) Confusion Needs Discussion....

Facts
a) Blood Buffer HCO3
b) intraCelluar Buffer Proteins
c) RBCs Buffer HB
3 Facts

42)) CPSP.......... Nightmares for u... becoz V have Agreed on one option No
confusion.... Try next time.... with another

Repeated August and 2 Jan

Benzodiazepine Causes marked Decrease Blood Pressure in HYPOVOLUMIC

PATIENT..... NOT OLD AGE

41)) CPSP Now U can make True or False but we Will be Right... at this time...

Bile Salts Water soluble

Bile Acid Lipid Soluble..

40))) CPSP u could not make us Fool now.........

Biceps Reflex Physician when strikes tendon..... Checks Muscle Spindle......... NOT
Golgi tendon Organ..........

39)) CPSP U have Sword Of Confusion But We Have Discussion Shied Guard Power...

Repeated In Nov Dec Aug term...

When Blood Pressure Drops...... What Happens????

Ans is Decrease Stretch Baroreceptor.....

D'nt choose increase Sympathetic Activity leading to increase HR.......

38) CPSp U Have......... no power more than that of Discussion Power we Have

Premalignant Condition is

ERYTHROPLEKIA>>>>>>>LEUKOPLEKIA

37)) Much Discussed Repeated easy MCQ but Made Wrong 99 percent is

30 Year old Lady Diffuse with Vibration Loss TOC is

Gastric Biopsy....

Brcoz of Chronic Atrophic Gastritis Leading to B12 Defiency Causing Subacute

Combined Degeneration......

Students Made Answrt MRi Lumbosacral region......

Tricky one
36)) Another Repeated... 2015... with Lot of Confusion....

36) Patient With Jaundice TOC is

a) AST
b) AST plus Bilirubin
c)) ALP
D)) ALP Plus Bilirubin

its AST plus Bilirubin....

A*L*P should be on *L* side *L*ow side

35) Another Fish Of CPSP caught...

Which of following Decreases Potassium Secretion.....

a) Addison disease
b) Potassium sparing Diuretics...

All of Us 2 January Morning Session Students Were Caught By CPSP Fish... Now U
catch it....

Its Potassium Sparing Diuretics.....

D'nt choose Addison

Another Repeated and Confused Of August Term

34) Midway Point Between Anterior Superior ilac Supine and Pubic Tubercle is
FEMORAL NERVE.....

Mid way Between Anterior Superior iliac Supine and Symphysis Pubis is FEMORAL
ARTERY..

Almost repeated in August Term..

still DEBATALBE BUT TRUTH IS
33) pregnant Lady sudden expired all of following is Possibility Except...
HEPATITIS C
d'nt Choose Hepatitis B A D E

32)) Most common Cause of Bronch Carci is SMOKING not ASBESTOSIS

31) GVE vagus nerve for preganglionic fiber arises from Dorsal nucleus.

D'nt choose Nucleus Ambigus and Solitarius

30) During Inspiration. true is

Remember HR increases......
Almost discussed at this forum.....
29) Very Confusing....
Diabetic Nephropathy TOC of followings is Urine Albumin...
not choose Ultrasound and Serum Creatinine

28)) APKD is closely Associated with Cerebral Hemmorrhage....

D'nt choose Renal Failure

27)) About Cerebral Arteries is True.... once entered into Brain Substance Never
Anastomose....

26)) another confused and repeated BCQ..

most common cause of Fractures is Osteoporosis........ Not Cushing Syndrome......

26) nucleus cuneatus and nucleus gracilis lesion caises asteriognosia.......... Catch it......

Really debatable but its truth

25) true hermaphrodite genotype
Xx>>>>xxy>>>>>xx/xy

24) this MCQ can make Difference

plzz read

Barr Body is inactive X-Chromosome ..

one less of X Chromosomes in The Karyotype
for example :
XX ..One Barr Body
XXX .. two Barr Bodies
XXXX .. three Barr Bodies
It can easily be viewed under a Light microscope
it is visible when the cell is in interphase, meaning it is not currently undergoing cell
division
Barr Body DIAGNOSTIC for .... TURNER 45XO
Barr Body Absent in .... ..... .....TURNER 45XO
No Barr Body in ..... ..... ..... .....TURNER 45XO
Scanty Barr Body in ... ..... ..... ..TURNER 45XO
XO >> Only 1 X ... so No Barr Body
Scanty Means Insufficient ... not a proper Barr Body ... it is seen in MOSAICISM of
TURNER
Mosaicism means a state of being composed of cells of two genetically different types
in easy words .. Mosaic Pattern is a picture made of different small Pieces .. like a
FLoor Tile made of Different Color Pieces
Single Barr Body Diagnostic for ... .... .... Klien Filter 47, XXY
Presence of a Barr Body Diagnostic for .. Klien Filter 47, XXY
XXY ,,, So One Barr Body
Klien Filters always have a Single Barr body ...but Turner dont have it ..

23) Urethra Injuries ::::

1 Rupture of Anterior Wall ... Caused by Fracture of Pelvis >> Leads to extravasation of
Urine in Retropubic Space (Retzius Space)
(its Extraperitoneal )
2 Rupture of Posterior Wall ... Caused by Compression Injury >> Leads to extravasation
of Urine in the peritoneal cavity
3 Injury of Urehtra ABOVE the urogenital Diaphragm >> Damages the Posterior Urehtra
>>Leads to extravasation of Urine in Retropubic Space (Retzius Space)
4 Injury of Urehtra BELOW the urogenital Diaphragm >>Damages the Anterior
Urethra>> Leads to extravasation of Urine in SUPERFICIAL Perineal Pouch
...as in Below injury it will lead to damage of Both the Bulbous and Membranous Urehtra
... its the most Common type of Injury ,,e.g Boy Slips of a bicycle and falls on the
crossbar
5 Rupture of Penile Urethra >> Pure Anterior Urethral Injury >> Leads to Extravasation
of Urin in Scrotum
6 Rupture of Membranous Urethra >> Leads to Extravasation of Urin in Deep Perniral
Pouch /Space
7 Rupture of Bulbous Urethra >> Leads to Extravasation of Urin in Superficial Pouch /
Space
in a NUTSHEL ::::::
Rupture of Anterior Wall >> Urine in Retropubic Space (Retzius Space)
Rupture of Posterior Wall >> Urine in the Peritoneal Cavity
Injury of Urehtra ABOVE the urogenital Diaphragm
Injury of Urehtra BELOW the urogenital Diaphragm
you can remeber this Mnemonic for this one
PS : this Managing Director is full of Bull S
PS : this MD is full of BS
Rupture of Penile Urethra >> Extravasation of Urin in Scrotum
Rupture of Membranous Urethra >> Extravasation of Urin in Deep Perniral Pouch
Rupture of Bulbous Urethra >> Extravasation of Urin in Superficial Pouch

22) patient with Palpitations with Free T3 High and TSH is LOW... CRH is Given and
TSH becomes High.... Problem is Within Thyroid Gland...... very confusing....

21) isometric contraction is differed from isovolumetric contraction ON BASIS OF HIGH

PHOSPHATE ENERGY USAGE.....All most repeated 2015 in each Term Paper 1
20) Gastric motility is Decreased by Distension..... Gastric EMPTYING is INCREASED
by DISTESION...... REALLY REPEATED AND TRICKY

19) CLOt Retraction is Mediated by Thrombsthenin......

clot retraction means help in cloting

18) first Line of defense against foreign is TISSUE MACROPHAGE not NEUTROPHIL

17) receptor for IGE is present on BASOPHIL.. not EOSINOPHIL....

i did it wrong

16) B-12 deficiency Sensory Ataxia..... not MOTOR ATAXIA

15) major stress hormone is CORTISOL >>>>>ACTH>>>>>adrenaline

14) TB diagnostic Test is AFB not Caseous NECROSIS

13) Hallmark of HIV is Proliferation of Virus inside T-cell.... And Hallmark of AIDS is
progroessive immune system deficiency...... Tricky

12) Highest Sodium is in SOUP... not BREAD

11) HIghest Cholestrol is IN EGG not RED MEAT..... .

10) moat common Fractured Bone is TIBIA not FEMUR

8) Defecation is caused by Mass Movement.. Defecation Reflex is caused by

Gastrocolic Reflex..... hahaha tricky one..... Almost repeated in each Term 2015

7) Major Determinant of CO is VR....

VR is also Major factor for Mean Systemic Filling Pressure.......
d'nt choose Renin or Angiotensin

6) most sensitive cardiac muscle cell injury marker is Troponin -T..

plzz plzz d'nt confuse with myoglobin........

5) Intrafusal central Portion is Muscle Spindle which is sensory portion Stimulated to

STRETCH.. Deactivated When Muscle CONTRACTS........ most repeated mcq of
2015...
MNEMONIC.. *S*pindle has S.. AND *S*pin has S... spin is ALWASYS central....

5) intrafusal innervate by Gamma A neuron...

mnemonic Gamma Is END and END IS to Enter(intra) to Heaven for Muslim

4) extrafusal innervated by Alpha A motor Neuron.....

Mnemonic Extra always Gets A grade..
1) S1 isovolumetric contraction and S2 isovolumetric Relaxation..
Mneomonic... Relaxation needs time so isovolmetric Relaxation S2...
2)lack of estrogen Causes breast atrophy....... Remember only Estrogen.. D'nt confuse
with Progestrone........
3) HPV virus After 2 years causes Cervical Dysplasia.. Not Carcinoma.....

IMPORTANT POINTS ABOUT CARDIAC ENZYMES >>>>>>>>

Things you should know about Cardiac markers for MI:
1)... Myoglobin first comes and first goes (rises first, disappears first)
2)...LDH is called "lazy enzyme" because it comes late, and goes late (rises after 24
hours and remain till 14 days)
3)...Trop-I has the greatest sensitivity and specificity.
4)...The investigation of choice within first hour of MI is "CKMB"
5)..."CKMB" is useful for confirmation of reinfarction as this enzyme disappears after 72
hours of MI. So, if a patient comes after 72 hours of initial infarction, and you are
suspecting a reinfarction, go for "CKMB".
- Myoglobin disappears after 24 to 48 hours.
- CKMB disappears after 72 hours.
- Trop I disappears after 7 - 10 days.
- LDH disappears after 14 days.
Scenerio 1: CKMB of patient is normal. Trop-I is raised. He is 3 - 10 days post MI
patient.
Scenerio 2: CKMB and trop - I of patient is normal. LDH is raised. He is 10 - 14 days MI
patient.
This is all you should know about cardiac enzymes, and this covers each and every
MCQ for part 1. If any thing is missing, please add. Thanks
SOME IMP POINTS OF CVS
Stimulation of Right vagus slows the heart by inhibiting the SA node an stimulation of
Left vagus nerve mainly slows the AV conduction
Stimulation of Right stallete ganglion accelerates the heart and stimulation of Left
stellate ganglion shortens the AV nodal conduction
SA node discharge increases with increase in temperature justifying tachycardia in
fever
ATRIAL FLUTTER: atrial rate is 200-350/min. mostly there is counterclockwise circus
movement in RIGHT ATRIUM. This produces SAW TOOTH appearance. It is almost
always associated with 2:1 or greater AV block. AV node cannot conduct more than 230
impulses per minute.
ATRIAL FIBRILLATION: atrial rate more than 300-500/min and in irregular way.
Ventricles also beat irregularly at 80 to 160/min. Its exact cause is still in debate but
most commonly it occurs due to multiple concurrently circulating reentrant excitation
waves in BOTH atria. Some cases may also occurs due to discharge of one or more
ectopic foci. Many of these foci appear in pulmonary veins s much as 4 cm from the
heart. Atrial muscle fibrs extend along pulmonary vein and site of origin of these foci
MURMURS: aortic/ pulmonary valves stenosis=systolic murmur,
insufficiency=diastolic
Mitral or tricuspid valves stenosis =diastolic murmur, insufficiency systolic
Sleep dont cause any change on Cardiac output(its an MCQ)
Athletes have greater end systolic volume and stroke volumes and lower heart rates
Hematocrit is %age of blood occupied by RBCs
( but according to ganong bcq ans is hemotocrit is all platelets,rbc,WBC)
BP pressure falls upto 20mmHg in sleep in HTN this fall is reduced or absent. So
normal persons are called DIPPERS and hypertensive persons are called
NONDIPPERS
Noradrenergic fibers end on the vessels in all parts of the body which are mainly
vasoconstrictor in function.. resistance vessels in skeletal muscles are innervated by
VASODILATOR fibers which although trevel thru the sympethetics but are
CHOLINERGIC.. there is some evidence that vessels in heart, lungs , kidneys, and
ureters also receive cholinergic innervations
The afferent nerve fibers from the carotid sinus and carotid body form a distinct branch
of glossopharyngeal nerve called CAROTID SINUS NERVE. The carotid sinus nerve
and vagal fibers from the aortc arch commonly called the BUFFER NERVES
During shock the vasoconstriction is most marked in SKIN