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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
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