“Screening test” most important series Dr.deep All important and most frequently asked points in the fmge…it really helps dr.deep 1/1/2011

Cereals---------------------threonine and lysine

Pulses----------------------methionine and cystine

Maize----------------------tryptophan and lysine

Thumb print sign on x ray---epiglottitis and ischemic colitis

Thumb sized stools—polio

Thumb print shape---b.pertussis

Onion peel----------------ewing sarcoma

Onion skin ----------------systemic lupus erythematous

Onion peel appearance in ercp------primary sclerosing cholangitis

Satellite ulcers---------------mycotic ulcers in the eye

Satellite lesions in the eye----chronic arsenic poisoning

Satellite lesions-----------borderline leprosy

FOLLOWING ARE PHOTOSENSITIVE DRUGS-------DDLP

Demeclocycline

Doxycycline

Levofloxacin

pefloxacin

SOME IMP MICROS

Microangiopathy------------hemolytic uremic syndrome

Microaneurysm--------------diabetes mellitus

Munroe micro abscess----psoriasis

Micropenis--------------mumps

Nanopththalmia------uveal effusion

SOME QUESTIONS…

1,Hydatid cyst is commonly found in

1, liver

2, lungs

3, kidney

(ans:liver )

2, Most common site of abscess formation due to Amoeba

1, liver

2, Lungs

3, kidney

(ans:liver )

3, Umblical cord has (repeated question in all previous papers)

1,2artery n 1 vein

2,2 vein n 1 art.

(Ans:2 artery n 1 vein)

4, Apoptosis

Programmed internal suicidal cell death

5, wheal and flare reaction is

1, Type 1 hyper sensitivity

2, Type 2 hyper sensitivity

3, Type 3 hyper sensitivity

4, Type 4 hyper sensitivity

(ans:Type 1 hyper sensitivity. All the anaphylactic reactions comes under type 1

hyper sensitivity)

BORED ………………………..!!!!!!!!!!!! A PICTURE PNEUMONIC FOR YOU

The above picture gives mnemonic for Ewing's tumor.

First let us analyse the picture.

Note the chick and swelling of Diaphysis of Tibia with the onion.

Chick says VAC VAC VAC VACA, VAC VAC VAC AV / CV.

The chick has fat and hence PAS stain positive.

Note the moon and star at the top, Radio streaming music and chick fluttering it's wings up and down

to the music as represented by 2 arrow marks at the left side.

See the melted snow below the bone and a blood vessel from the side ( left corner ) Now, this is what

the picture says: Ewings - the chick with wings; Arises from Diaphysis, most common bone is Tibia.

Seen in children as represented by the chick. Onion represents the onion peel appearance in X-rays.

The wings going up and down ( arrows ) represent that the size of tumor increases and decreases (

H/O Exacerbations and remissions ).

The moon & star represents the clinical feature that pain is worse at night.

Radio represents that the tumor is extremely radiosensitive - therefore melts like snow.

Spread is by blood vessels and lymphatics.

And what the chick says is the chemotherapy regimen - VAC ( Vincristine, Adriamycin,

Cyclophosphamide ), VACA ( VAC + Actinomycin ), AV alternating with CV.

BIOCHEMISTRY.MIGRAINE.COM

I know but have to remember the following read it thousand times remember it once…..in the exam atleast…till

fatty acids is very important for fmge…

Rate Limiting Enzymes

Proccess

Phosphofructokinase-1 -Glycolysis

Pyruvate dehydrogenase

complex

-Pyruvate Metabolism

Isocitrate dehydrogenase -TCA cycle

Citrate synthase -Citric acid cycle

Glycogen synthase -Glycogenesis

Glycogen phosphorylase -Glycogenolysis

Phosphoenolpyruvate

carboxykinase

-Gluconeogenesis

Glucose 6 phosphat

dehydrogenase

-Hexose Monophosphate

Shunt

Glucose-6-phosphate

dehydrogenase

-Pentose phosphate

HMG-CoA reductase -Cholesterol synthesis

HMG-CoA synthease -Ketone body formation

Acetyl CoA carboxylase -Fatty acid synthesis

Carnitine acyl transferase

[CPT-1]

oxidation of fatty acids-

Acetyl-CoA-carboxylase -Lipogenesis

Cytidyltransferase- Phospholipid synthesis

3 ketosphiganine synthase -Sphingolipid synthesis

Phospholipase A2 -Eicosanoid synthesis

Phospholipase A2 -Prostaglandin synthesis

CSCC (27 desmolase) -Steroidogenesis

Aminolevulinate synthase -Heme synthesis

Active transport into bile

ducts

-Bilirubin metabolism

Ribonucleotide reductase DNA synthesis

Glutamine Prp transferase Purine synthesis

Carbamoyl phosphate

synthetase II

Pyrimidine synthesis

Carbamoyl phosphate

synthetase I

Urea cycle

Q AND A

An 82-year-old man presents with 8 weeks of periorbital edema,

6 weeks of rash, and 2 weeks of bilateral shoulder and arm aches

and weakness. What is the diagnosis?

a. Polymyalgia rheumatica

b. Inclusion body myositis

c. Hypothyroidism

d. Polymyositis

e. Dermatomyositis

ANS. DERMATOMYOSITIS

Answer: e

• Three causes of idiopathic inflammatory myopathy:

Dermatomyositis (DM)

Polymyositis

Inclusion body myositis

• Dermatomyositis has a bimodal age distribution • Skin findings associated with DM:

HELIOTROPE HUE OF THE EYELIDS

RASH OF THE METACARPOPHALANGEAL AND PROXIMAL INTERPHALANGEAL

JOINTS (GOTTRON’S PAPULES)

Photosensitivity dermatitis of the face

• Proximal myositis with associated pain and weakness is

characteristic of DM

• The serum creatine kinase and aldolase values are usually

increased in DM

• The anti-Jo1 antibody is present in 25% of patients with DM

• The electromyogram is characteristic, but not diagnostic, of

the inflammatory myopathies

• Amuscle biopsy is suggested for all patients with inflammatory

Myopathy

• Patients with DM have an increased risk for cancer

• DM is treated with immunosuppressive drugs.

This is a dermatology question.this might not come in this way as a picture but the

most tested points are heliotrope

rash and gottrons papules.you have to at least remember these and try asking

your friends as many times as you can

….this is important…

Q . The carpal tunnel contains all of the following important structures except:

A. Median nerve.

B. Flexor pollicis longus.

C. Flexor carpi radialis.

D. Flexor digitorum superficialis.

Ans. C

This type of question can come directly as it is….remember carpal tunnel

syndrome is a anatomy question which is very important….

Q . The type of hemoglobin that has least affinity for 2,3-

diphosphoglycerate (2,3-DPG) or (2,3-BPG) is:

A. Hg A.

B. Hg F.

C. Hg B.

D. Hg A2.

Ans. B

Physiology ----2,3 dpg concept is very important.read it learn it

memorize and understand it.

TIT BITS

1.The spleen is the most commonly injured solid organ in the blunt abdominal

trauma.

2.serum ferritin:measure of iron stores..remember tin always stores..

So serum ferritin is decreased in iron deficiency anemia.

3. SKIN-LEARN LEPROSY, LEPRA TEST,PSORIASIS,LICHEN PLANUS.

4. PSYCHITRY

REMEMBER DIFENCE BETWEEN DELUSION,HALLUCAINATION,ILLUSION,

ONE Q FOR SCHIZOPHENIA IS CONFIRM.

5. Curling’s Ulcer - Acute gastric ulcer associated with severe burn.

6. Cushing’s Ulcer - Acute gastric ulcer associated with CNS trauma.

7. Autosplenectomy -- Sickle cell anemia: switch a glu to val in β chain 6th position.

Autosplenectomy was asked in sep2010 m.c.i paper …..

IN THE NEWS

A new study has found evidence of increased lung cancer risk among

people with tuberculosis. Researchers at China Medical University and Hospital in Taiwan randomly

selected 1 million patients covered under the country's National Health Insurance (NHI) programme.

All patients aged 20 years and older with a new diagnosis of tuberculosis between 1998 and 2000 were identified as the exposed cohort and all

people without tuberculosis history were the non-exposed cohort.

Results showed that patients with tuberculosis were 10.9 times more likely than non-tuberculosis patients to develop lung cancer.

"It is well known that lung cancer is causally associated with smoking. Less attention has been focused on whether people with tuberculosis are

also at higher risk of developing lung cancer," said Dr. Chih-Yi Chen, one of the researchers.

"The risk of lung cancer may increase further to almost 16 times greater if patients with tuberculosis also suffer from chronic obstructive pulmonary

disease," he said.

"This study suggests that it is also important to watch out for lung cancer prevention in the campaign against tuberculosis."

The study was published in the January issue of the Journal of Thoracic Oncology.

MOST COMMON CANCER IN SMOKERS--------SQUAMOUS CELL CANCER

MOST COMMON CANCER IN NON-SMOKERS---ADENOCARCINOMA

ABOVE POINTS ARE IMPORTANT AND HAVE BEEN TESTED IN PREVIOUS EXAMINATIONS.

NEWMONICS

1.Vitamin B3 (niacin, nicotinic acid) deficiency: pellagra

The 3 D's of pellagra: Dermatitis Diarrhea Dementia

· Note vitamin B3 is the 3 D's.

2. Na+/K+ pump: movement of ions and quantity

K+ and in each consist of 2 characters, so so 2 K+ are pumped in. Na+ and

out each consist of 3 characters, so 3 Na+ are pumped out

3. ABCD:

Anderson's=Branching enzyme.

Cori's=Debranching enzyme.

4. Preeclampsia: classic triad PREeclampsia: Proteinuria Rising blood pressure Edema

5. Uk-CAT

U............USG...............6-40WKS.

C...........CVS................9-12

A..........AMNIOCENTESIS..15-18

T............TRIPLE TEST.......16-18

6. CVS and amniocentesis: when performed "Chorionic" has 9 letters and Chorionic

villus sampling performed at 9 weeks gestation. "AlphaFetoProtein" has 16 letters and it's

measured at 16 weeks gestation.

TOPIC OF THE BOOK

Myasthenia gravis

1) 35 yr female with double vision at the end of the day, dysphagia, nasal voice,

upp ext weakness, her sx improve after a night’s sleep. Dx?

2) What is MG?

3) Best initial test for MG?

4) What is the specific test for MG?

5) What is the sensitive test for MG?

6) Most accurate test for MG?

7) Tx for MG? If primary tx fails, what to use (initial choice) for MG?

9) If initial tx after primary tx fails, what tx for MG? 10) Tx for acute MG crisis?

Answers

1) Myasthenia Gravis

2) Dis. Of NMJ, presents with weakness and fatigue. Ab to Ach receptors -> dec #

of active/functional Ach receptors at postsynaptic membrane

3) Ach receptor Ab

4) Fatigued muscle weakness plus +Ach receptor Ab test

5) Edrophonium (Tensilon) test

6) EMG (decremental dec in muscle fiber content on repetitive nerve stimulation

7) Anticholinesterase (pyridostigmine) Immunosuppressive tx with

glucocorticoids

9) Azathioprine and steroid combo 1

0) Plasmapheresis and IVIG

11) Thymectomy.

Bolly wood super star amitabh bacchan also suffered from myasthenia gravis.