Etoposide :action , indications, side effects

Etoposide :action , indications, side effects

eTOPoside

Action : inhibits TOPoisomerase II

Indications:
Testicular carcinoma
Oat cell carcinoma
Prostate carcinoma

Side effect :
Affects TOP of your head causing alopecia

Complications of herniorrhaphy :

Complications of herniorrhaphy :

HERNIO

Haemorrhage, Haematoma, Haemotocele, Hydrocele
Edema (penile edema) - rare
Recurrence
Neuralgia due to injury to ilioinguinal nerve causing hyperaesthesia over medial side of inguinal canal
Infection, Injury to urinary bladder /bowel
Osteitis pubis

Treatment options in Metastatic Breast Cancer

Treatment options in Metastatic Breast Cancer

HEROIC

Hormone therapy
Endocrine Manipulation
Radiotherapy
Oestrogen blockers
Immunotherapy
Chemotherapy

Rolling hernia (Paraoesophageal hernia) : clinical features

Rolling hernia (Paraoesophageal hernia) : clinical features

ABCDEFGH

Abdominal pain
Bloating (post prandial bloating)
Chest pain, Cardiac abnormality (arrhythmia)
Dysphagia , Dyspnoea
Elderly (common)
Features with Gangrene/bleeding/perforation
Hiccough

Causes of cholangitis

Causes of cholangitis

ABCD

Ampullary stenosis (less common)
Biliary stricture
Cancer (Neoplasms account for 15%)Choledocholithiasis, Chronic pancreatitis, Clonorchis sinensis (parasitic),
Duodenal diverticulum

Adductor Magnus innervation :

Adductor Magnus innervation :

AM SO..!!

Adductor Magnus innervated by Sciatic and Obturator

Elbow : muscles that flex it.

Elbow : muscles that flex it.

Three B's bend the elbow

Biceps
Brachialis
Brachioradialis

Elbow : which side has common flexor origin

Elbow : which side has common flexor origin

FM

Flexor Medial, so common flexor origin is on the medial side

Biceps brachii muscle

Biceps brachii muscle

"You walk shorter to a street corner. You ride longer on a superhighway"

Short head : orginates from Coracoid process
Long head : originates from Supraglenoid cavity

Serratus Anterior - innervation

Serratus Anterior - innervation

SALT
Serratus Anterior - Long Thoracic

Side effects of carbimazole

LMNOP

Liver dysfunction, Lymphadenopathy
Myalgia
Neuritis
Occasional agranulocytosis (<1 in 200 cases )
Psychosis

Quick Blood / Cardio facts

Tricuspid valve is in The Right Inside part of the heart.

Mitral is on Left side.

B Cells Bite virus, T Cells Torpedo sick cells.

Quick Peritoneum Facts

The idea is to relate key letters of related parts. E.g., stomach and omentum (which lays over the stomach) share the letters OM.

• The bacterium E. coli is found in Everybody's Colon
• The Omentum covers the stomach
• The Lesser Omentum holds the Liver and stomach
• The Mesentery holds the small intestine
• The mesoCOLON attaches the large intestine (colon) to the posterior abdominal wall
• The PERITONEUM, holds PERson's Intestines To Nearest wall.

Dystrophia Myotonica (Myotonic Muscular Dystrophy)

 Clinical features of Dystrophia Myotonica can be remembered as

' Dy. S.T.R.O.P.H.I.A '
    * Distal muscles weakness and wasting, Dysmotility of GI muscles and biliary tree, Dementia
    * Swan neck appearance of neck
    * Testicular atrophy, erectile dysfunction
    * Reflexes depressed or absent, Reduced life span
    * Obviously enlarged breast and baldness
    * Ptosis, Pulmonary infections, Pseudodrop attack due to quadriceps weakness
    * Hatchet face ,Heart diseases
    * Intrinsic muscles of hand wasting, IQ low
    * Autosomal dominant inheritance
    * Myotonia

Myocardial infarctions: treatment

INFARCTIONS:
IV access
Narcotic analgesics (eg morphine, pethidine)
Facilities for defibrillation (DF)
Aspirin/ Anticoagulant (heparin)
Rest
Converting enzyme inhibitor
Thrombolysis
IV beta blocker
Oxygen 60%
Nitrates
Stool Softeners

ECG: T wave inversion causes

INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]

Apex beat: differential for impalpable apex beat

 DOPES:
Dextrocardia
Obesity
Pericarditis or pericardial tamponade
Emphysema
Sinus inversus/ Student incompetence

Sinus bradycardia: aetiology

"SINUS BRADICARDIA" (sinus bradycardia):
Sleep
Infections (myocarditis)
Neap thyroid (hypothyroid)
Unconsciousness (vasovagal syncope)
Subnormal temperatures (hypothermia)
Biliary obstruction
Raised CO2 (hypercapnia)
Acidosis
Deficient blood sugar (hypoglycemia)
Imbalance of electrolytes
Cushing's reflex (raised ICP)
Aging
Rx (drugs, such as high-dose atropine)
Deep anaesthesia
Ischemic heart disease
Athletes

Tachycardia

Supraventricular tachycardia: treatment ABCDE:
Adenosine
Beta-blocker
Calcium channel antagonist
Digoxin
Excitation (vagal stimulation)

 

Ventricular tachycardia: treatment LAMB:
Lidocaine
Amiodarone
Mexiltene/ Magnesium
Beta-blocker

Sino-atrial node: innervation

Sympathetic acts on Sodium channels (SS).
Parasympathetic acts on Potassium channels (PS).

Coronary artery bypass graft: indications

DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease

Betablockers: cardioselective betablockers

 "Betablockers Acting Exclusively At Myocardium"
· Cardioselective betablockers are:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol

Murmur attributes

"IL PQRST" (person has ill PQRST heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing

Murmurs: innocent murmur features

8 S's:
Soft
Systolic
Short
Sounds (S1 & S2) normal
Symptomless
Special tests normal (X-ray, EKG)
Standing/ Sitting (vary with position)
Sternal depression

Depressed ST-segment: causes

DEPRESSED ST:
Drooping valve (MVP)
Enlargement of LV with strain
Potassium loss (hypokalemia)
Reciprocal ST- depression (in I/W AMI)
Embolism in lungs (pulmonary embolism)
Subendocardial ischemia
Subendocardial infarct
Encephalon haemorrhage (intracranial haemorrhage)
Dilated cardiomyopathy
Shock
Toxicity of digitalis, quinidine

Pericarditis: EKG

"PericarditiS":
PR depression in precordial leads.
ST elevation.

Murmurs: systolic vs. diastolic

PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.

Pericarditis: causes

CARDIAC RIND:
Collagen vascular disease
Aortic aneurysm
Radiation
Drugs (such as hydralazine)
Infections
Acute renal failure
Cardiac infarction
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome

ECG: left vs. right bundle block

 "WiLLiaM MaRRoW":
W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.
M pattern in V1-V2 and W in V3-V6 is Right bundle block.
· Note: consider bundle branch blocks when QRS complex is wide.

Aortic stenosis characteristics

SAD:
Syncope
Angina
Dyspnoea

CARDIAC MURMURS

PANSYSTOLIC ( M TV )

1. MR
2. TR
3. VSD

 CRESCENDO MURMURS (C.M.S)

• Mitral Stenosis

DECRESCENDO MURMURS (DARe)

• Aortic Regurgitation

CRESCENDO-DECRESCENDO MURMURS (C.DAS)

• Aortic Stenosis

THIRD HEART SOUND (CeMeNT)

• C = CCF
• e
• M = MR
• e
• N = Normal upto 30yrs
• T = TR

FOURTH HEART SOUND (4 H's)

1. Hypertension
2. Heart Block
3. Heart Failure
4. Hypertrophic Obstructive Cardiomyopathy

MID-DIASTOLIC MURMURS (M.FACT)

1. Mitral Stenosis
2. Flow Murmurs
3. Austin-Flint Murmurs
4. CAREY-COOMBS MURMUR
5. TRICUSPID STENOSIS

Aortic dissection :

Aetiology

AORTIC

AORtic atherosclerosis / AORtitis (eg : Takayasu's aortitis, tertiary syphilis)

Trauma

Increase in blood pressure (major risk factor)

Connective tissue disease (SLE, RA, Ehlers - Danlos)/ congenital cardiovascular anomalies (coarctation of the aorta)

Apex beat : abnormalities found on palpation HILT Heaving Impalpable Laterally displaced Thrushing / Tapping

HILT

Heaving
Impalpable Laterally displaced Thrushing / Tapping

Brachial plexus:

 Branches of posterior cord

" ULTRA "

• Upper subscapular nerve
• Lower subscapular nerve
• Thoracodorsal nerve
• Radial nerve
• Axillary nerve

Branches of lateral cord

"LML"

• Lateral pectoral nerve
• Musculocutaneous nerve
• Lateral root of median nerve

Branches of Medical Cord

 M4U

Medial Pectoral nerve, 
Medial Cutaneous N. of Arm,  
Medial Cutaneous N. of Forearm,
Medial root of Median N.
Ulnar Nerve

Medial malleolus: order of tendons, artery, nerve behind it

"Tom, Dick, And Nervous Harry":
· From anterior to posterior:
Tibialis
Digitorum
Artery
Nerve
Hallicus
· Full names for these are: Tibialis Posterior, Flexor Digitorum Longus, Posterior Tibial Artery, Posterior Tibial Nerve, Flexor Hallicus Longus.

Sperm pathway through male reproductive tract

 SEVEN UP:
Seminiferous tubules
Epididymis
Vas deferens
Ejaculatory duct
Nothing
Urethra
Penis

Spleen: dimensions, weight, surface anatomy

 "1,3,5,7,9,11":
Spleen dimensions are 1 inch x 3 inches x 5 inches.
Weight is 7 ounces.
It underlies ribs 9 through 11.

Renal failure (chronic): consequences

ABCDEFG:
Anemia
-due to less EPO
Bone alterations
-osteomalacia
-osteoporosis
-von Recklinghausen
Cardiopulmonary
-atherosclerosis
-CHF
-hypertension
-pericarditis
D vitamin loss
Electrolyte imbalance
-sodium loss/gain
-metabolic acidosis
-hyperkalemia
Feverous infections
-due to leukocyte abnormalities and dialysis hazards
GI disturbances
-haemorrhagic gastritis
-peptic ulcer disease
-intractable hiccups

Aneurysm types

MAD SCAB:
Mycotic
Atherosclerotic
Dissecting
Syphilitic
Capillary microaneurysm
Arteriovenous fistula
Berry

Macrocytic anaemia: differential

FAT RBC:
Fetus (pregnancy)
Alcohol
Thyroid disease(ie hypothyroidism)
Reticulocytosis
B12 and folate deficiency
Cirrhosis and chronic liver disease

Nephritic syndrome: glomerular diseases commonly presenting as nephritic syndrome

PARIS:
Post-streptococcal
Alport's
RPGN
IgA nephropathy
SLE
· Alternatively: PIG ARMS to include Goodpasture's [one cause of RPGN], Membranoproliferative [only sometimes included in the classic nephritic list].

Portal hypertension: features

ABCDE:
Ascites
Bleeding (haematemesis, piles)
Caput medusae
Diminished liver
Enlarged spleen

Mnemonic for indications of Dialysis: AEIOU

1. Acidosis
2. Electrolyte abnormalities-hyperkalemia
3. Ingestion of substances like barbiturates, salicylates, lithium, methanol, etc
4. Overload fluid (unresponsive to diuretics)
5. Uremia symptoms (pericarditis, encephalopathy

Drugs causing gynaecomastia.

‎"DESI Gossypol R Most Common Cause oF Gynaecomastia in Kommon People"

D- Digitalis
E-Ethionamide,Estrogen
S-Spirinolactone

I- INH

Gossypol-Griseofulvin
R- Reserpine
Most-Methyl dopa
Common- Cyperoterone acetate,cimitidine,
Cause-clomiphine,Calcium antagonist
oF-Flutamide
Gynaecomastia- Goserelin
Kommon-Ketoconazole
People-Phenytoin.

Sodium valproate: side effects

VALPROATE:
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Anorexia
Tremor
Enzyme inhibitor

Anti-hypertensives used in emergencies...

Antihypertensives used in emergencies.... . Singh & Gambhir HELP S-sodium nitroprusside G-GTN  H-hydralazine E-esmolol  L-labetalol P-phentolamine