Bifurcation vertebral landmarks

A bifurcation occurs on 4th level of each vertebral column:
C4: bifurcation of common carotid artery
T4: bifurcation of trachea
L4: bifurcation of aorta

Schizophrenia: negative features

4 A's:
Ambivalence
Affective incongruence
Associative loosening
Autism

The diagnostic criteria for Anorexia nervosa

"CIDA"
C=chooses not to eat,leading to a potentially dangerous weight loss.
I=Intense fear of being obese,even when underweight
D=disturbance of weight perception( i.e feeling fat when thin)
A=Amenorrhoea for 3 or more consecutive cycles ( when not on the pill )

SUBTYPES OF SCHIZOPHRENIA

P- CURD
Paranoid
Catatonic
Undifferentiated
Residual
Disorganised

Antihypertensives contraindicated in pregnancy

DARSAN '

• Diuretics
• Angiotensin I antagonists
• Reserpine
• Sodium nitroprusside
• ACE inhibitors
• Non selective β blockers

Alpha feto protein in blood, is seen in

 "OLD Test"

• Obituary - foetal death
• Liver - hepatomas
• Defects - neural tube defects 
• Testicular tumours

lymphatic supply of uterus,cervix

mnemonic is- USA, ME, LIES
U Upper-S superficial inguinal A aortic
M middle- E external iliac
L lower- I internal iliac, E external iliac, S sacral(lower part of uterus can also be asked as - lymphatic supply of cervix)

Neuroleptic side effects onset

The rule of 4's:
Dystonia: 4 hours-4 days
Akathesia: 4 days-40 days
Extrapyramidal symptoms: 4 days-4 weeks
Tardive dyskinesia: 4 months (greater than)
· Note that tardive is obviously the latest one to happen (tardive=tardy/late).
· Note that the first letters of these four classic symptoms spell "DATE"

Failed intubation: Causes

"INTUBATION"

• Infections of larynx
• Neck mobility abnormalites
• Teeth abnormalties(loose tooth,protuberant tooth)
• Upper airway abnormalties (strictures or swellings)
• Bull neck deformities
• Ankylosing spondylitis
• Trauma/tumour
• Inexperience
• Oedema of upper airway
• Narrowing of lower airway

MI: post-MI complications

ACT RAPID:
Arrhythmias (SVT, VT, VF)
Congestive cardiac failure
Tamponade/ Thromboembolic disorders
Rupture (ventricle, septum, papillary muscle)
Aneurysm (ventricle)
Pericarditis
Infaction (a second one)
Death/ Dressler's syndrome

Drugs which increase the risk of pseudotumour cerebri

MNOPQRST

Minocycline

Nalidixic acid, Nitrofurantoin

Oral contraceptive pills

Phenytoin

[Question - its cause is still unknown]

[Renal failure(chronic) is associated with this condition]

Sulfa drugs, Steroids

Tamoxifen, Tetracycline

 

The Pseudotumor Cerebri Syndrome: Pseudotumor Cerebri, Idiopathic Intracranial Hypertension, Benign Intracranial Hypertension and Related Conditions 

PAINFUL TUMOURS OF THE SKIN

BENGAL
Blue rubber bleb nevus    Eccrine spiradenoma    Neuroma    Glomus tumor    Angiolipoma    Leiomyoma

Kawasaki disease: diagnostic criteria

 CHILD:
5 letters=5 days, >5 years old, 5 out 6 criteria for diagnosis:
Conjuctivitis (bilateral)
Hyperthermia (fever) >5 days
Idiopathic polymorphic rash
Lymphoadenopathy (cervical)
Dryness & redness of (i)lips & mouth (ii) palms & soles [2 separate criteria]

Scalp Nerve Supply

Heart Valves Closure Sequence Mnemonic

External jugular vein: tributaries

PAST:
Posterior external jugular vein
Anterior jugular vein
Suprascapular vein
Transverse cervical vein

Palmaris longus: location, relative to wrist nerves

"The Palmaris between two Palmars":
Palmaris longus is between the Palmar cutaneous branch of Ulnar nerve and Palmar cutaneous branch of Median nerve.

Depression criteria/symptoms

A SAD FACE:
Appetite, weight changes
Sleep changes / suicidal tendency
Anhedonia
Dysphoria (low mood)
Fatigue
Agitation (psychomotor)
Concentration
Esteem

Miscarriage: recurrent miscarriage causes

RIBCAGE:
Radiation
Immune reaction
Bugs (infection)
Cervical incompetence
Anatomical anomaly (uterine septum etc.)
Genetic (aneuploidy, balanced translocation etc.)
Endocrin

Ejection systolic murmur: Occurs in

Think " P.A.S.D "
This is a tricky one. The lesions which cause ESM can be written down using the 4 letters.

• PS: Pulmonary stenosis
• AS: Aortic stenosis
• ASD: Atrial septal defect and
• SA: Severe anemia

Croup: symptoms

"3 S's"

• Stridor
• Subglottic swelling
• Seal-bark cough

Nephrotic syndrome ..its NEPHROTIC

NEPHROTIC

Na+water retention

Edema

Protienuria>3.5g/24hrs

Hypertension+hyperlipidaemia

Renal vein thrombosis

Thrombotic n thromboembolic complications

Infection with staphylococci n pneumococci

C-hyperCoagulable state

For hyperthyroidism diagnosis

STING

Sweating

Tremor or Tachycardia

Intolerance to heat, Irregular menstruation, and Irritability

Nervousness

Goiter and Gastrointestinal (loose stools/diarrhea)

 

Tibia vs. fibula: sizes

The Fibula is thin like a Flute.
The Tibia is thick like a Tuba.

UVEITIS

Systemic Features of Sarcoid: FILLED BAGEL

Facial nerve palsy

Infiltrates of lung parenchyma, Insufficiency of pituitary

Lymphadenopathy (esp lung hilae)

Liver & spleen enlargement

Elevated ACE & calcium

Dilated cardiomyopathy

Bone cysts

Arthralgia

Granulomata of skin

Erythema nodosum

Lupus pernio

Features of Behcet's Disease: ORAL UPSET

Occlusive periphlebitis

Retinitis

Anterior uveitis

Leakage from retinal vessels

Ulceration (aphthous/genital)

Pustules after skin trauma (Pathergy test)

Scratching leaves lines (dermatographism)

Erythema nodosum

Thrombophlebitis

Clinical features of Reiter’s: PLUCKING

Plantar Fasciitis

Urethritis

Conjunctivitis

Keratoderma blenorrhagica

Inflamed joints

Nail dystrophy

Gum ulceration

Ophthalmic features of TB: BCG GP

Busacca & Koeppe nodules on iris

Choroiditis

Granulomata in choroid

Granulomatous uveitis (with mutton fat KP’s)

Periphlebitis

Sarcoidosis summarized

SARCOIDOISIS:

Schaumann calcifications
Asteroid bodies/ [ACE] increase/ Anergy
Respiratory complications/ Renal calculi/ Restrictive lung disease/ Restrictive cardiomyopathy
Calcium increase in serum and urine/ CD4 helper cells
Ocular lesions
Immune mediated noncaseating granulomas/ [Ig] increase
Diabetes insipidus/ [D vit.] increase/ Dyspnea
Osteopathy
Skin (Subcutaneous nodules, erythema nodosum)
Interstitial lung fibrosis/ IL-1
Seventh CN palsy

Cranial bones

"PEST OF 6":
Parietal
Ethmoid
Sphenoid
Temporal
Occipital
Frontal
· The 6 just reminds that there's 6 of them to remember.

Initial Treatment Of Acute Coronary Syndromes

Patients having Myocardial Infarction MOAN in Pain...

M orphine
O xygen
A spirin
N itroglycerine

Lichen planus characteristics

 Planus has 4 P's:
Peripheral
Polygonal
Pruritus
Purple

THROMBOSIS

Causes of DVT
 
Trauma,
Hormones-OCP'S
Road traffic accidents,
Operations-cholecystectomy,
Malignancy,
Blood disorders-polycythemia,
Obesity,Old age,Orthopedic surgery,
Serious illness,
Immobilisation,
Splenctomy.

 

Indications for Tonsillectomy

Tonsillectomy is indicated when a Tonsil 'HARMS'

Hypertrophy with hoarseness
Abscess (Peritonsillar - Quinsy)
Recurrent sore throat
Malignancy is suspected
Seizures (Febrile seizures due to Tonsillitis)

Polio virus strains

There are 3 strains of polio virus .type 1 2 and 3.just remember vaccine opv type 1 = O = outbreaks of paralytic polio type 2= P = potent antigenic strain type 3= V = vaccine associated polio

The Cephalosporins

• First Generation Cephahlosporins - Remember this story:

Mr. Fazol (ceFAZOLin) is a Lorry Driver (cephaLORIdine). He works very hard and has become Thin (cephaloTHIN) He has a "Rad" Watch on his hand (cephRADine) and a "Lux" soap (cephaLEXin). He wears a bright green Drawer {i.e trousers} ( cefaDROxil)

Route of drug administration: He will put the Lux soap in his Drawer - (Cefalexin & Cefradine are given orally. The latter can also be given i.v. /.i.m.. All others- i.v. /.i.m)

• Second Generation Cephalosporins: Remember FOX, FUR, FAC - ceFOXitin, ceFURoxime, ceFAClor

• Third Generation Cephalosporins - The story goes thus:

Mr. Aziz (ceftAZIdime) is taking an Ox (ceftizOXime, cefpodOXime) in a Taxi (cefoTAXIme) for slaughtering, i.e. an Operation (cefOPERAZONE). For this purpose he is taking Three Axon blades (cefTRIAXONe). He will Fix (ceFIXime) the ox for dinner (cefDINIR) in a short time!

Route of drug administration: Fix the price and eat (only Cefixime is given oral: all others im/iv).

ADRs: Operation will cause bleeding (Cefoperazone cause bleeding)

• Fourth Generation Cephalosporins:

My wierd dream:  QUEEN of ROME who FLEW to OZONE layer, fell down and was made IP (Inpatient) by ME. Helps you to remember fourth generation cephalosporins - Cefquinome, Cefpirome, Cefluprenam, Cefozopran, Cefipime.

Contributed by Dr. Shajil from his blog  http://medicalmnemonics4u.blogspot.com/

Pancreatitis: criteria

PANCREAS:
PaO2 below 8
Age >55
Neutrophils: WCC >15
Calcium below 2
Renal: Urea >16
Enzymes: LDH >600; AST >200
Albumin below 32
Sugar: Glucose >10 (unless diabetic patient)

8 C's of cholangiocarcinoma(risk factors)

Caroli's disease
Choledochal cyst
Colitis(ulcerative colitis)
Cholangitis(sclerosing)
Clonorchis sinensis
Cong.hepatic fibrosis
C/c typhoid carrier state
Carcinogens like rubber,automotive factories.

Stye and Chalazion

STYE is Hordeolum externum (STAY OUT) ; Moll's gland / Zeis gland affected
Chalazion is Hordeolum INternum - Chronic Inflammatory granuloma of MEiBOMian glands (Remember : See (C)  me in Bombay)

Marfan syndrome : features

MARFAN'S:
Mitral valve prolapse
Aortic Aneurysm
Retinal detachment
Fibrillin
Arachnodactyly
Negative Nitroprusside test (differentiates from homocystinuria)
Subluxated lens

Depression: symptoms and signs (DSM-IV criteria)

 AWESOME:
Affect flat
Weight change (loss or gain)
Energy, loss of
Sad feelings/ Suicide thoughts or plans or attempts/ Sexual inhibition/ Sleep change (loss or excess)/ Social withdrawal
Others (guilt, loss of pleasure, hopeless)
Memory loss
Emotional blunting

Amiodarone: action, side effects 6 P's:

Prolongs action potential duration

Photosensitivity

Pigmentation of skin

Peripheral neuropathy

Pulmonary alveolitis and fibrosis

Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism

Abdominal muscles

"Spare TIRE around their abdomen":
Transversus abdominis
Internal abdominal oblique
Rectus abdominis
External abdominal oblique

Leprosy: early signs diagnostic criteria

"LEProsy":
Loss of sensation in affected skin/ Loss of function (paralysis)
Enlargement of affected superficial nerves (tender too)
Positive identification of M. leprae under microscope

Spinal anesthesia: Agents

"Little Boys Prefer Toys"

• Lidocaine
• Bupivacaine
• Procaine
• Tetracaine

Pleural effusion: investigations PLEURA:

PLEURA:
Pleural fluid (thoracentesis)
Lung, pleural biopsy
ESR
Ultrasound
Radiogram
Analysis of blood

Atrial fibrillation: causes

PIRATES "

•  Pulmonary: Pulmonary embolism, COPD
•  Iatrogenic
•  Rheumatic heart disease
•  Atherosclerotic heart disease
•  Thyrotoxicosis
•  Endocarditis
•  Sick sinus syndrome

Tetrology of Fallot

 PROVe:
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect

Lung development: Phases

"Every Premature Child Takes Air"

• Embryonic period
• Pseudoglandular period
• Canalicular period
• Terminal sac period
• Alveolar period

Ovarian cancer: Risk factors

"Bright FILM"

• Breast cancer
• Family history of ovarian cancer
• Infertility
• Low parity
• Mumps

Endometriosis: Symptoms

5  “D”s

• Dysmenorrhoea
• Disorders of menstruation
• Dyspareunia
• Dyschezia
• Dull ache of abdomen

Pelvic Inflammatory Disease (PID): complications

 I FACE PID:
Infertility
Fitz-Hugh-Curitis syndrome
Abscesses
Chronic pelvic pain
Ectopic pregnancy
Peritonitis
Intestinal obstruction
Disseminated: sepsis, endocarditis, arthritis, meninigitis

Multiple pregnancy complications

 HI, PAPA:
Hydramnios (Poly)
IUGR
Preterm labour
Antepartum haemorrhage
Pre-eclampsia
Abortion

Shoulder dystocia:

 management HELPER:
Call for Help
Episiotomy
Legs up [McRoberts position]
Pressure subrapubically [not on fundus]
Enter vagina for shoulder rotation
Reach for posterior shoulder and deliver posterior shoulder/ Return head into vagina [Zavanelli maneuver] for C-section/ Rupture clavicle or pubic symphysis

Postpartum hemorrhage: Risk factors

"PARTUM"

• Prolonged labour/ Polyhydramnios/ Previous caesarean
• APH
• Recent history of bleeding
• Twins (Multiple pregnancy)
• Uterine fibroids
• Multiparity

Criteria for FORCEPS:delivery

Foetus alive
Os dilated
Ruptured membrane, Rotation complete
Cervix taken up
Engagement of head
Presentation suitable
Sagittal suture in AP diameter of inlet

Preeclampsia: classic triad

PREeclampsia:
Proteinuria
Rising blood pressure
Edema

Crohn's disease: morphology, symptoms

 CHRISTMAS:
Cobblestones
High temperature
Reduced lumen
Intestinal fistulae
Skip lesions
Transmural (all layers, may ulcerate)
Malabsorption
Abdominal pain
Submucosal fibrosis

Cirrhosis: differential: common and rarer

· Common causes are ABC:
Alcohol
B (Hepatitis)
C (Hepatitis)
· Rarer are also ABC:
Autoimmune
Biliary cirrhosis
Copper (Wilson's)

Pedigree symbols: gender and affected

Gender: The cIRcle is a gIRl [so boys are squares].
Affected: Black plague was a disease, so black-filled symbol means an affected/diseased person [so non-filled-in is unaffected]

APKD: genetics

 ADult Polycystic Kidney Disease is
Autosomal
Dominant
· Also, "Polycystic kidney" has 16 letters and is due to a defect on chromosome 16.

Bartter syndrome: inheritance

BARtter syndrome is autosomal recessive (AR).

Down syndrome pathology

 DOWN:
Decreased alpha-fetoprotein and unconjugated estriol (maternal)
One extra chromosome twenty-one
Women of advanced age
Nondisjunction during maternal meiosis

Nucleotides: which are purines

 "Pure Silver":
· Chemical formula of Pure silver is Ag.
Therefore, Purines are Adenine and Guanine.

Exon vs. intron function

 Exons Expressed.
InTrons In Trash.

Hurler syndrome features

 HURLER'S:
Heptosplenomegaly
Ugly facies
Recessive (AR inheritance)
L-iduronidase deficiency (alpha)
Eyes clouded
Retarded
Short/ Stubby fingers

Achrondroplasia dwarfism: inheritance pattern

Achondroplasia Dwarfism is Autosomal Dominant.

DiGeorge/ Velocardiofacial syndrome: features

 CATCH 22:
Cardiac abnormalities
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia
22q11 deletion

Imprinting diseases: Prader-Willi and Angelman

"Pray to an Angel":
Prader-Willi and Angelman are the 2 classic imprinting diseases.
· Which disease results, depends on whether 15q deletion is maternal or paternal. Keep them straight by:
Paternal is Prader-Willi.

Blots: function of Southern vs. Northern vs. Western

 "SN0W DR0P":
· Match up the 1st word letter with 2nd word letter:
Southern=DNA
Northern=RNA
Western=Protein
· The 0's in snow drop are zeros, since there is no Eastern blot

Chromosome 15 diseases

Chromosome 15 has its own MAP:
Marfan syndrome
Angelman syndrome
Prader-Willi syndrome

Hurler's syndrome: symptoms

BLUFF:
Blind (corneal opacity)
Little (dwarfish)
Ugly (coarse facial features)
Fool (mental retardation
Failures (failure to thrive and hear failure secondary to coronary artery disease)

Down syndrome features: complete

 "My CHILD HAS PROBLEM!":
Congenital heart disease/ Cataracts
Hypotonia/ Hypothyroidism
Incure 5th finger/ Increased gap between 1st and 2nd toe
Leukemia risk x2/ Lung problem
Duodenal atresia/ Delayed development
Hirshsprung's disease/ Hearing loss
Alzheimer's disease/ Alantoaxial instability
Squint/ Short neck
Protruding tongue/ Palm crease
Round face/ Rolling eye (nystagmus)
Occiput flat/ Oblique eye fissure
Brushfield spot/ Brachycephaly
Low nasal bridge/ Language problem
Epicanthic fold/ Ear folded
Mental retardation/ Myoclonus

Nucleotides: purines vs. pyrimidines

"Guardian Angels are Pure, with two Wings":
G and A are Purines, with two Rings.

Nucleotides: double vs. triple bonded basepairs

 "TU bonds" (two bonds):
T-A and U-A have Two bonds.
G-C therefore has the three bonds.

Tay Sach's features

 SACHS:
Spot in macula
Ashkenazic Jews
CNS degeneration
Hex A deficiency
Storage disease
· Extra details with TAY:
Testing recommended
Autosomal recessive/ Amaurosis
Young death (<4 yrs)

Charcot's triad (gallstones)

"Charge a FEE":
Charcot's triad is:
Fever
Epigastric & RUQ pain
Emesis & nausea

Ulcerative colitis: complications

 "PAST Colitis":
Pyoderma gangrenosum
Ankylosing spondylitis
Sclerosing pericholangitis
Toxic megacolon
Colon carcinoma

Charcot's triad (gallstones)

"Charcot's Triad is 3 C's":
Color change (jaundice)
Colic (biliary) pain, aka RUQ pain
Chills and fever

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) cause is DNA mismatch repair

 DNA mismatch causes a bubble in the strand where the two nucleotides don't match.
This looks like the ensuing polyps that arise in the colon.

Dry mouth: differential

"DRI":
·2 of each:
Drugs/ Dehydration
Renal failure/ Radiotherapy
Immunological (Sjogren's)/ Intense emotions

Splenomegaly: causes

CHIMP:
Cysts
Haematological ( eg CML, myelofibrosis)
Infective (eg viral (IM), bacterial)
Metabolic/ Misc (eg amyloid, Gauchers)
Portal hypertension

Diabetic ketoacidosis: precipitating factors

· 5 I's:
Infection
Ischaemia (cardiac, mesenteric)
Infarction
Ignorance (poor control)
Intoxication (alcohol)

Cholangitis features

CHOLANGITITS:
Charcot's triad/ Conjugated bilirubin increase
Hepatic abscesses/ Hepatic (intra/extra) bile ducts/ HLA B8, DR3
Obstruction
Leukocytosis
Alkaline phosphatase increase
Neoplasms
Gallstones
Inflammatory bowel disease (ulcerative colitis)
Transaminase increase
Infection
Sclerosing

Vomiting: extra GI differential

VOMITING:
Vestibular disturbance/ Vagal (reflex pain)
Opiates
Migrane/ Metabolic (DKA, gastroparesis, hypercalcemia)
Infections
Toxicity (cytotoxic, digitalis toxicity)
Increased ICP, Ingested alcohol
Neurogenic, psychogenic
Gestation

Pancreatitis: Ranson criteria for pancreatitis at admission

 LEGAL:
Leukocytes > 16.000
Enzyme AST > 250
Glucose > 200
Age > 55
LDH > 350

Constipation: causes

 DOPED:
Drugs (eg opiates)
Obstruction (eg IBD, cancer)
Pain
Endocrine (eg hypothyroid)
Depression

Haemachromatosis complications

"HaemoChromatosis Can Cause Deposits Anywhere":
Hypogonadism
Cancer (hepatocellular)
Cirrhosis
Cardiomyopathy
Diabetes mellitus
Arthropathy

Hepatic encephalopathy: precipitating factors

 ABCDEFI:
Alcohol withdrawal
Bleeding (GI)
Constipation
Drugs: withdraw any sedatives/narcotics
Electrolyte imbalances
Fluid depletion: stop diuretics
Infections: treat vigorously

Dysphagia: differential

DISPHAGIA:
Disease of mouth and tonsils/ Diffuse oesophageal spasm/ Diabetes mellitus
Intrinsic lesion
Scleroderma
Pharyngeal disorders/ Palsy-bulbar-MND
Achalasia
Heart: eft atrium enlargement
Goitre/ myesthenia Gravis/ mediastinal Glands
Infections
American trypanosomiasis (chagas disease)

Dysphagia: causes

 MOON:
Mouth lesions
Obstruction
Oesophageal stricture
Neurological (eg stroke, Guillain-Barre, achalasia)

Liver failure (chronic): signs found on the arms

 CLAPS:
Clubbing
Leukonychia
Asterixis
Palmar erythema
Scratch marks

Celiac sprue gluten sensitive enteropathy: gluten-containing grains

 BROW:
Barley
Rye
Oats
Wheat
· Flattened intestinal villi of celiac sprue are smooth, like an eyebrow

Splenomegaly: causes

CHINA:
Congestion/ Cellular infiltration
Haematological (eg haemolytic anaemia, Sickle cell)
Infection/ Infarction (eg malaria, GF, CMV)
Neoplasia (eg CML, lymphoma, other myeloproliferative)
Autoimmune

Hepatic encephalopathy: precipitating factors

HEPATICS:
Hemorrhage in GIT/ Hyperkalemia
Excess protein in diet
Paracentesis
Acidosis/ Anemia
Trauma
Infection
Colon surgery
Sedative

Cirrhosis: Causes

" V WASH CABS "

• Viral hepatitis (10%)
• Wilson's disease
• Alcoholic liver disease (60-70%)
• Secondary biliary cirrhosis (gall stones, stricture)
• Hemochromatosis (Iron overload)
• Cryptogenic cirrhosis (Rare)
• α- antitrypsin deficiency (Rare)
• Biliary disease- primary biliary cirrhosis and secondary (stones, stricture) biliary cirrhosis
• Sclerosing cholangitis

Bowel obstruction: symptoms

 "AVOID"

• Abdominal pain
• Vomiting
• Obstipation (severe constipation, not passing gas)
• Increased bowel sounds
• Distension of the abdomen

RIGHT TO LEFT SHUNT

REMEMBER 4T

T-TETROLOGY OF FALLOT
T-TRICUSPID ATRESIA
T-TRUNCUS ARTERIOSUS
T-TRANSPOSITION OF GREAT VESSELS

PATAU SYNDROME

CRAMP

C-CLEFT LIP/PALATE
R-RENAL ABNORMALITIES
A-cArdiac defects
M-MENTAL RETARDATION
-MICROCEPHALY
P-POLYDACTYLY

Muscle cells

Nuclei location mirrors where the muscle is located in human body.
Heart muscle is in the middle of body, so heart muscle has nucleus in middle.
Skeletal muscles are at periphery of body, so nuclei are at periphery.
Also, you have 1 heart, so usually only 1 nucleus per heart muscle cell, but have many skeletal muscles, so have many nuclei per long fibre.

Vasculogenesis vs. angiogenesis

 "Vascu is new. Angi is pre":
Vasculogenesis is new vessels developing in situ from existing mesenchyme.
Angiogenesis is vessels develop from sprouting off pre-existing arteries.

First branchial arch: Overview

"The First arch IMPACTS!"
Most of the aspects associated with the first arch begin with the letter 'M' and the rest with I, P, A, C, T or S!
1. Name

• It is also known as the Mandibular arch.

2. Muscles

• Muscles of  Mastication (Masseter, Temporalis, medial & lateral Pterygoids), Mylohyoid, Anterior belly of digastric, Tensor tympani and Tensor palati are derived from the first arch.

3. Cartilage of first arch is called the  Meckel's cartilage

• It gives rise to Malleus & Incus, Sphenomandibular ligament & Anterior ligament of Malleus

4. Innervation.

• Mandibular nerve, Chorda tympani

Cartilage of Second branchial arch: Derivatives

5 S' :

• Stapes
• Styloid process
• Stylohyoid ligament
• Smaller (lesser) cornu of hyoid
• Superior part of body of hyoid

Its cartilage of the third arch that forms greater cornu of hyoid and lower part of body of hyoid.

Placenta-crossing substances

"WANT My Hot Dog":
Wastes
Antibodies
Nutrients
Teratogens
Microorganisms
Hormones/ HIV
Drugs

Heart: primitive heart chambers in fetal heart

"The Broken Vein Always Stenoses, But Veins Are Smooth":
· The order of the compartments is: runcus, bulbus
Primitive Ventricle
Primitive Atrium
Sinus venosus
·The connections are:
Bulbotruncal junctionVentriculobulbar foramen
Atrioventricular canal
Sinuatrial junction

Weeks 2,3,4 of development: Events

   Week 2 : Bilaminar germ disc
    Week 3 : Trilaminar germ disc
    Week 4 : 4 limbs appear

Vitelline veins: Derivatives

"HIPS"

• Hepatic veins
• Inferior portion of Inferior vena cava
• Portal vein
• Superior mesenteric vein

Tetrology of Fallot

"Don't DROP the baby":
Defect (VSD)
Right ventricular hypertrophy
Overriding aorta
Pulmonary stenosis

Neuroectoderm derivatives

 Neuroectoderm gives rise to:
Neurons
Neuroglia
Neurohypophysis
piNeurol (pineal) gland

Edward syndrome

ROME

R-ROCKER BOTTOM FEET
O-OVERLAPPING FLEXED FINGERS
M-MICROGNATHIA
-MENTAL RETARDATION
E-EARS(LOW SET)

Wolffian duct: Derivatives

"Gardener's SEED"

In females:

• Gartner's duct, cyst

 In males:

• Seminal vesicles
• Epididymis
• Ejaculatory duct
• Ductus deferens

Cranial and spinal neural crest: major derivatives

 GAMES:
Glial cells (of peripheral ganglia)
Arachnoid (and pia)
Melanocytes
Enteric ganglia
Schwann cells

Vitelline duct: closure time

 VItelline duct normally closes around week VI of intrauterine life.

Diagnostic criteria of Anorexia Nervosa

WADA

Weight loss of atleast 25 % of body weight
Avoidance of high Calorie food
Distortion of body image
Amenorrhea for atleast 3 months

Mesoderm components MESODERM:
Mesothelium (peritoneal, pleural, pericardial)/ Muscle (striated, smooth, cardiac)
Embryologic
Spleen/ Soft tissue/ Serous linings/ Sarcoma/ Somite
Osseous tissue/ Outer layer of suprarenal gland (cortex)/ Ovaries
Dura/ Ducts of genitalia
Endothelium
Renal
Microglia/ Mesenchyme/ Male gonad

Teratogenesis: when it occurs

 TEratogenesis is most likely during organogenesis--between the:
Third and
Eighth weeks of gestation.

Fetal alcohol syndrome (FAS): features

FAS:
Facial hypoplasia/ Forebrain malformation
Attention defecit disorder/ Altered joints
Short stature/ Septal defects/ Small I.Q

Mania: diagnostic criteria

Must have 3 of MANIAC:
Mouth (pressure of speech)/ Moodl
Activity increased
Naughty (disinhibition)
Insomnia
Attention (distractability)
Confidence (grandiose ideas)

Conduct disorder vs. Antisocial personality disorder

Conduct disorder is seen in Children.
Antisocial personality disorder is seen in Adults.

PANIC DISORDER CRITERIA

PANIC DISORDER CRITERIA
STUDENTS FEAR the 3 C's
sweating
trembling
unsteadiness,dizziness
depersonalization,derealization
excessive heartrate,palpitations
nausea
tingling
shortness of breath

FEAR of dying,losing control,going crazy

3 C'S
CHEST PAIN
CHILLS
CHOKING

MENTAL STATUS EXAM

MENTAL STATUS EXAM IS-



ASEPTIC


Appearence and behaviour
Speech
Emotion (mood and affect)
Perception
Thought content and process
Insight and judgement
Cognition

Histrionic Personality

PRAISE ME:

P - provocative (or seductive) behaviour
R - relationships, considered more intimate than they are
A - attention, must be at center of
I - influenced easily
S - speech (style) - wants to impress, lacks detail
E - emotional ability, shallowness
M - make-up - physical appearance used to draw attention to self
E - exaggerated emotions - theatrical

Dementia: main causes

 VITAMIN D VEST:
Vitamin deficiency (B12, folate, thiamine)
Intracranial tumour
Trauma (head injury)
Anoxia
Metabolic (diabetes)
Infection (postencephalitis, HIV)
Normal pressure hydrocephalus
Degenerative (Alzheimer's, Huntington's, CJD, etc)
Vascular (multi infarct dementia)
Endocrine (hypothyroid)
Space occupying lesion (chronic subdural haematoma)
Toxic (alcohol)

Anxiety disorders: physical illnesses mimicking them

 "Physical Health Hazards That Appear Panciky":
Phaeochromocytoma
Hyperthyroidism
Hypoglycaemia
Temporal lobe epilepsy
Alcohol
Paroxysmal arrhythmias

Ganser

Ganser syndrome: key diagnostic feature
The word "Ganser" is close to but not quite the word "Answer". Ganser's syndrome is when patient gives an answer that is close to, but not quite. For example 2+2=5..

Biological symptoms in psychiatry

 SCALED:
Sleep disturbance
Concentration
Appetite
Libido
Energy
Diurnal mood variation

Depression: melancholic features (DSM IV)

MELANcholic:
Morning worsening of symptoms/ psychoMotor agitation, retardation/ early Morning wakening
Excessive guilt
Loss of emotional reactivity
ANorexia/ ANhedonia

Tetrad of narcolepsy

CHeSS '

• Cataplexy
• Hypnagogic hallucinations
• Sleep paralysis
• Sleep atttacks

Narcolepsy is a chronic sleep disorder&nbsp;characterized by overwhelming drowsiness and sudden attacks of sleep. The condition is most characterized by excessive daytime sleepiness(EDS), in which a person experiences extreme tiredness and possibly falls asleep at inappropriate times, such as at work or school.

Cataplexy, a sudden muscular weakness brought on by strong emotions, is a medical condition which may also affect narcoleptics.

Lithium: Uses

' LIBRA '

• Leukopenia
• Inappropriate ADH secretion syndrome (SIADH)
• Bipolar disorder
• Recurrent neuropsychiatric syndrome
• Agranulocytosis

Suicide: Risk assessment

"SAD PERSONS"

These are the risk factors for suicide

• Sex: male
• Age: over 50
• Depression
• Previous attempts
• Ethanol: consumption of alcohol before the attempt
• Reasoning clouded (loss of ability to think)
• Social support deficit
• Organized plan
• No spouse (seperated/divorced)
• Sickness(chronic disease)

Symptoms of mania

" DIG FAST "

•   Distractability
•   Indiscretion
•   Grandiosity
•   Flight of ideas
•   Activity increased
•   Sleep reduction
•   Talkativeness (pressured speech)

Delirium: Causes

"DELIRIUM"

• Degenerative
• Epilepsy (post ictal states)
• Liver failure
• Intracranial injury
• Rheumatic chorea
• Infections- Pneumonia, Septicemia
• Uremia
• Metabolic- Electrolyte imbalance

Lithium: Adverse effects

"LITHIUM"

• Lethargy / Leucocytosis
• Intentional Tremor
• Teratogenicity
• Hypothyroidism
• Insipidus [Diabetes insipidus]
• Urine excess
• Metallic taste

Valproate: Adverse effects

"VALPROATE"

• Vomiting 
• Alopecia 
• Liver toxicity (Hepatotoxicity)
• Pancreatitis/ Pancytopenia 
• Retention of fat (weight gain) / Reduced sleep
• Oedema (peripheral oedema) 
• Allergic reactions / Abdominal cramps/ Appetite increase 
• Tremor / Thrombocytopenia
• Enzyme inducer (liver)

Schizophrenia: Schneider's first rank symptoms

"Hell and Dell Passed Together"

• Hallucinations
• Delusional perception
• Passivity phenomenon
• Thought alienation phenomenon

AUTISM

'AUTISTIC PEOPLE'

A = Affect isolation
U = Unrelated to others
T = Twiddle
I = I/You confusion in speech
S = Self-mutilation
T = Temper tantrums
I = Inconsistent development
C = Concrete thinking

P = Perceptual difficulties
E = Echolalia
O = Orderly
P = Physical motor disorder
L = Lack language skills
E = Excessive activity

PREANAESTHETIC MEDICATION

OH! SANA
O Opiods
H H2 blockers
S Sedatives antianxiety drugs
A Antiemetics
N Neuroleptics
A Anticholinergics

Halothane

H- malignant Hyperthermia
A- anaesthesia without analgesia
L- decomposed by Light
O- vasOdilatOr, brOnchOdilatOr, uterine relaxtant
TH- thymol as preservtive
A- amber bottle to store it
N- hepatic Necrosis
E- eraser, erodes rubber

Day care anaesthesia

PROSIDAS
P Propofol
R Remifentanil
O n2O
S Sevoflurane
I Isoflurane
D Desflurane
A Alfantanil
S Succinylcholin

Endotracheal intubation: diagnosis of poor bilateral breath sounds after intubation

 DOPE:
Displaced (usually right mainstem, pyreform fossa, etc.)
Obstruction (kinked or bitten tube, mucuous plug, etc.)
Pneumothorax (collapsed lung)
Esophagus

Respiratory complications of anaesthesia: patients at risk

 COUPLES:
COPD
Obese
Upper abdominal surgery
Prolonged bed rest
Long surgery
Elderly
Smokers

Anesthesia: quick check

 SOAP:
Suction
Oxygen
Airway
Pharmacology

Anesthesia machine/room check

MS MAID:
Monitors (EKG, SpO2, EtCO2, etc)
Suction
Machine check (according to ASA guidelines)
Airway equipment (ETT, laryngoscope, oral/nasal airway)
IV equipment
Drugs (emergency, inductions, NMBs, etc)

Xylocaine: Where not to use with Adrenaline?

"Digital PEN"

• Digits (Fingers and toes)
• Penis
• Ear
• Nose tip

Adrenaline causes vasoconstriction which helps to trap Xylocaine (anaesthetic) locally prolonging its duration of action. The two are not used together at sites supplied by end arteries as the vasoconstriction produced by adrenaline can cause ischemic necrosis of the tissues.

Adrenaline is also referred to as Epinephrine.

BEHCET'S SYNDROME: DIAGNOSTIC CRITERIA

Pathergy Test
Recurrent genital ulceration
Oral ulceration (recurrent)
Skin lesions (e.g. erythema nodosum, subcutaneous thrombophlebitis,
Eye lesions (e.g. iridocyclitis, chorioretinitis)

MODIFIED CRITERIA FOR THE DIAGNOSIS OF SYSTEMIC LUPUS ERYTHEMATOSUS

Antinuclear antibody
Neurologic disorder- seizures or psychosis
Thrombocytopenia or lymphopenia or leukopenia or hemolytic anemia
Immunologic disorder- positive lupus erythematosus cell prep. or anti-ds DNAor
Nasopharyngeal or oral ulcers
Urinary abnormalities - proteinuria or casts
Cutaneous discoid rash
Light sensitivity
Effusions-pleuritis or pericarditis
Arthritis of two or more joints
Rash in malar area

Black eschar differential

Clostridium
Aspergillus ( Deep Fungal e.g. fusarium)/Anthrax
Group B strep
Ecthyma gangrenosum - pseudomonas
Spider bite

DAPSONE treated conditions

Dermatitis herpetiformis
IgA, linear
Pemphigus / Pyoderma Gangrenosum
SLE, bullous variant
Other (Eosinophilic, Monocyctic)
Neutrophilic dermatoses / Vasculitis / HSP
Erythema Elevatum Diutinum

PSORIATIC ARTHRITIS - 5 TYPES

	SODAS
Spondylitis or Sacroiliac    Oligoarticular    Distal joint    Arthritis mutilans    Symmetric poylarthritis

PAINFUL SOLITARY DERMAL NODULES

	TANGLED
Traumatic neuroma    Angiolipoma    Neurilemmuma    Glomus tumor    Leiomyoma    Eccrine spiradenoma    Dercums disease (Adiposis Dolorosa)

NON-SCARRING ALOPECIA

	TOP HAT
Telogen effluvium, Tinea capitis    Out of iron, zinc    Physical - trichotillomania, traction alopecia    Hormonal - hypothyroidism, androgenic    Autoimmune - alopecia areata, anagen effluvium    Toxins - heavy metals, chemotherapy

MULTIPLE LENTIGINES SYNDROME

	CLAMP
Centrofacial Lentiginosis    LEOPARD Syndrome    Adolescent Eruptive Len.    Moynahan's Syndrome    Peutz-Jegher's

MIXED CONNECTIVE TISSUE DISEASE, SKIN MANIFESTATION

	SMEAR
Scleroderma    Myositis    Edema    Acrosclerosis    Raynauds

MENKES KINKY HAIR SYNDROME

	MENKES
MEN (XLR), MNK gene which encodes for a CU++-transporting APTase    Early death    pNeumonia (and other infections), trichorehexis Nodosa (may be seen)    Kinky hair (pili torti) -+ pili torti is more common than TN    Extra skin on palms (degen'd vessel elastic tissue)    Seizures, Skeletal changes

MELANOMA RISKS

	MMRISK
Moles that are atypical or dysplastic nevi    Moles that are many in number    Red hair    Inability to tan    Sunburn (especially severe burns before age 14)    Kindred (family history)

ICHTHYOSIS

	CORNERS
CO - Conradi's    Rud's    Netherton's    Erythrokeratoderma Variabilis    Refsum's    Sjogren-Larsson

DISEASES WITH ANGIOID STREAKS

	APPLES
Acromegally    Pseudoxanthoma elasticum    Paget's disease    Lead poisoning    Ehlers-Danlos syndrome    Sickle cell anemia

DERMATOMYOSITIS

	MUSCLE PAINS
Malignancy (breast, lung, ovary, GI)    Ungual telangiectasias    Subcutaneous calcinosis    Cardiac    Liver    Eyes (heliotrope lids, photosensitivity, retinopathy)    Poikiloderma / Polyarthritis    Aldolase    Interstitial pneumonitis    Needle biopsy    Sclerodermatomyositis

CUTANEOUS DIABETES

	DIABETES M
Dermopathy    Infection    Annulare, granuloma; Meischer's; NLD    Bullous diabeticorum    Eruptive Xanthomas    Tight waxy skin/stiff joints/Pebbles    Erythema and angiopathy    Scleredema    Motor and sensory neuropathies

CAUSES OF PERIPHERAL EOSINOPHILIA

	CHINA
Connective tissue disease (SLE, DM, Sjogren's)    Helminths (All worms, parasites, Giardia)    Idiopathic hypereosinophilic syndrome    Neoplasms    Allergies, Asthma

causes of non PigmenTed fixed drug eruptions

	PAT
Pseudoephidrine    Piroxicam    Paracetamol    Arsphenamine    Thiopentone    Triamcinolone acetonide(intraarticular injections)    Tetrazoline hydrochloride

CAUSES OF ERYTHEMA NODOSUM

	BED REST
Behcet's disease    Estrogens    Drugs    Recent infection    Enteropathies    Sarcoid    Tuberculosis

Cause of vasculitis

	VASCULITIS
Various drugs    Autoimmune    Serum Sickness    Cryoglobulinemia, cryofibrinogenemia    Urticarial    Low complement    Idiopathic    Toxins    Infection    Smoking (Berger's)

CAFÉ AU LAIT SPOTS

	BIT CAFE
Blooms    Idiopathic    Tuberous sclerosus    Congenita (dyskeratosis)    Ataxia telangiectasia    Fanconis    Elephant man (neurofibromatosis)

BLUE SCLERA

	A POEM
Anemia    PXE     Osteogenesis imperfecta    Ehlers Danlos    Marfans

BASIS FOR PROGNOSIS IN MYCOSIS FUNGOIDES

	BASIS
Blood - lymphocytopenia, Sezary cells    Age    Skin tumors & ulcers    Infection (often kills ?)    Spread - hepatosplenomegaly, lymph nodes

BASAL CELL NEVUS SYNDROME

	BASAL CE
Basal cell CA    Anatomic changes (bifid rib, frontal bossing, etc)    Skin (palmer pits)    Abnormal Mentation (less than 50%)    Loss bone (jaw cysts)    Colobomatous microphthalmia    Endocrine - ovarian ibromas, adrenal CA

AMINO ACIDS SPILLED IN CYSTINURIA

	COAL
Cystine    Ornithine    Arginine    Lysine

Albinism: type I vs. II Classification

	"One has None. Two Accumulates":
Type I: have no pigment.    Type II: No pigment at birth , but accumulates as person ages.

ABCD(E)'s OF MELANOMA

	ABCD (E)
Asymmetry    Border (irregular)    Color (heterogenous)    Diameter (greater than the diameter of a typical pencil eraser)    Elevation / Evolution (changing)