Presents 600 high quality mnemonics

Enhances quick recall and recollection ofhigh value facts

Provides “cutting-edge” technique inremembering “long-winding”statements/particulars/facts

Packs mnemonics that count

MNEMONICSfor Sure Success in

PG Medical Entrance Examinations

Second Edition

Presents 600 high quality mnemonics

Enhances quick recall and recollection ofhigh value facts

Provides “cutting-edge” technique inremembering “long-winding”statements/particulars/facts

Packs mnemonics that count

Arun Kumar MBBS DNB(s)

CBS Publishers & Distributors Pvt Ltd

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MNEMONICSfor Sure Success in

PG Medical Entrance Examinations

Second Edition

ISBN: 978-93-85915-33-8

Copyright © Author and Publisher

First Edition: 2015Second Edition: 2016

All rights reserved. No part of this book may be reproduced or transmitted in any formor by any means, electronic or mechanical, including photocopying, recording, orany information storage and retrieval system without permission, in writing, from the

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Science and technology are constantly changingfields. New research and experience broadenthe scope of information and knowledge. Theauthor has tried his best in giving informationavailable to him while preparing the material forthis book. Although, all efforts have been madeto ensure optimum accuracy of the material, yetit is quite possible that some errors might havebeen left. The publisher, the printer and theauthor will not be held responsible for anyinadvertent errors or inaccuracies.

MNEMONICSfor Sure Success in

PG Medical Entrance Examinations

To

my elder brotherAjay Kumar Ajit

who shaped my career and life

???

Preface to the Second Edition

This book on mnemonics has been writen in view of problemsfaced by PG aspirants and MBBS students. All the hard

work comes to naught if a student confuses while givingexamination. Mnemonics has been prepared to eliminate theconfusion one encounters during memorizing the points in atopic. This book is sure to improve your rank in any PGentrance examination especially the one based on factualquestions like DNB and state PG entrance examinations. Only600 mnemonics has been included in this edition to enablestudents to complete and revise the book in a short time.

Students are also encouraged to point out the mistakes inthis book for which they will be given the incentive of ` 50/-recharge done in their mobile number provided they are thefirst to point out the mistake and give reference for the same.

One lucky student will also get to avail free discussion andexplanation with the author every week. For this they need toprovide their name, college name, batch of MBBS admission toauthor’s contact number.

Readers are also advised to give their valuable opinions andsuggestions which will be appreciated and acknowledged.

Arun KumarContact: 9718161947

Email.id: drarunkumarjamui@yahoo.co.in

Preface to the First Edition

First I want to thank all my teachers in both school and collegewho have encouraged and inspired me for hard work.

I also want to thank Dr Nitish, Dr Aporva, Dr Rajdeep andDr Puneet who have been very supportive of me to write thisbook. I took the inspiration to write the book from my teacher‘Dr Arup Kumar Kundu’ who has been a leading writer inmedical field.

My heartfelt thanks to my fiancée who contributedsignificantly in writing this book.

I also like to take this opportunity to thanks my parents, sisters,my brothers, brothers-in-law and all family members who havealways had faith in my abilities.

I would also like to thank CBS Publishers & Distributors,Mr YN Arjuna (Senior Vice President—Publishing, Editorial and Publicity),Mrs Ritu Chawla (Assistant General Manager—Production) andMr Vikrant Sharma (DTP Operator) to help me realize my dream ofwriting the book and publishing the book so beautifully.

I would also like to thank my friend Pawan, Bipulji and DrPradeep for their valuable support.

I would also like to thank my teachers Dr MP Sharma for hisguidance. Finally with all my humbleness and sincerity, I thankone and all who have helped me directly and indirectly incompleting this book.

Arun Kumar

Acknowledgements

Preface to the Second Edition vii

Preface to the First Edition ix

1. Anatomy 1

2. Biochemistry 17

3. Physiology 26

4. Pharmacology 35

5. Microbiology 72

6. Pathology 81

7. Forensic Medicine and Toxicology (FMT) 93

8. Preventive and Social Medicine (PSM) 99

9. Eye 111

10. Ear, Nose and Throat (ENT) 117

11. Medicine 122

12. Surgery 152

13. Gynecology and Obstetrics (G and O) 162

14. Pediatrics 170

15. Skin 177

16. Anesthesia 180

17. Radiology 184

18. Psychiatry 186

19. Orthopedics 189

Contents

• Floor of third ventricle (formed primarily by hypothalamicstructures)

Optic chiasmaInfundibular recess (which extends into pituitary stalk)Tuber cinereumMammillary bodiesPosterior perforated substanceTegmentum of the midbrain

Mnemonic: Opin Tuma Posteg

• Muscles of gluteal region

Gamellus superior—Nerve to obturator internus (L5, S 1, S2)

Mnemonic: GSOI 512Gamellus inferior—Nerve to quadratus femoris (L4, L5, SI)

Mnemonic: IQ 451

• Foramen magnum—Structures passing through its anteriorpart

Apical ligament of DensVertical band of cruciate ligamentMembrane tectoria

Mnemonic: AVM

• Foramen ovale

Mandibular nerveAccessory meningeal artery (A for Artery)Lesser petrosal nerveEmissary vein (cavernous sinus to pterygoid plexus)

Mnemonic: MALE

1

Anatomy

1

Mnemonics2

• Foramen spinosum

Middle meningeal artery and vein (posterior trunk)Emissary veinNervus spinosus (meningeal branch of mandibular nerve)

Mnemonic: MENS

• Foramen rotundum—Maxillary nerve

Mnemonic: Maxm roundMaxillary nerve passes through fossa, fissure and foramen

Foramen Foramen rotundum

Fissure inferior orbital fissure

Fossa pterygopalatine fossa

Mnemonic: RIP

• Internal acoustic meatus

Facial N (VIIIth/7th)Vestibulocochlear N (VIIIth/8th)Nervus intermedius or pars intermedia of WrisburgLabyrinthine vessels

Mnemonic: 78 Intermediate Lab

• Foramen lacerum

Meningeal branch of ascending pharyngeal arteryEmissary vein

Mnemonic: MAPEL

• Jugular foramen

Anterior part Middle part Posterior part

Inferior petrosal 9th cranial nerve Internal jugular veinsinus 10th cranial nerve Sigmoid sinus junction

11th cranial nerve Emissary vein (sigmoidMeningeal branch sinus to occipital veins)of ascending Occipital arterypharyngeal (meningeal branch)artery

Mnemonic: IPS IS evaluating Our 9, 10, 11 MAP

3Anatomy

• Anatomical snuff box—when thumb is fully extended,depression seen on lateral aspect of wrist, immediately distalto radial styloid process

Content—Cephelic veinSuperficial radial nerve

Radial artery

Mnemonic: CSR

Floor—Base of first metacarpal

Radial styloidScaphoid

Trapezium

Mnemonic: BRST

Note: Proximal to distal order is RSTB.

Boundaries:Lateral wall (anterior wall): Abductor pollicis longus

Extensor pollicis brevisMedial wall (Posterior wall): Extensor pollicis longus

Mnemonic: EPL is MP

• Secretomotor pathway for parotid gland

PonsInferior Salivatory nucleusGlossopharyngeal nerveTympanic branch and plexusLesser petrosal nerveOtic ganglionAuriculo temporal nerveParotid gland

Mnemonic: PINS

GLOTY LEPO ATP

• Structure passing through superior orbital fissure

Lateral to annulus of Zinn: Lacrimal nerveFrontal nerveTrochlear nerveSuperior ophthalmic vein

Mnemonics4

Meningeal branch of lacrimalartery

Mnemonic: LFT

Through annulus of Zinn: Nasociliary nerveOculomotor nerve (superior andinferior division) (3rd CN)Abducens nerve (6th CN)

Mnemonic: NOA 36Inferomedial to annulus—inferior ophthalmic vein

• Anterior and Middle superior alveolar nerves are branches ofInfraorbital (terminal branch of maxillary nerve)

Posterior superior alveolar nerve is direct branch of maxillarynerve

Mnemonic: IAMAppendices epiploicae are small sacs of peritoneum filledwith fat (adipose projections) over the whole colon exceptcaecumappendix (vermiform)rectum

Mnemonic: CAR

Note: Taenia coli are absent in distal sigmoid colon andrectum.

• Femoral triangle content

Lateral to medialFemoral nerveFemoral arteryFemoral veinLymphatic vessels and deep inguinal lymph node of Cloquet

Mnemonic: NAVEL

Boundaries

Laterally—medial border of sartoriusMedially—medial border of adductor longusSuperiorly—inguinal ligament

Mnemonic: SAILBranches of third part of maxillary arteryInfraorbital A

5Anatomy

Posterior superior alveolar APharyngeal A

Artery of pterygoid canal A

Greater palatine ASphenopalatine A

Mnemonic: Inferoposterior pharyngeal artery of greatersphenoid

• Bipolar neurons are located in the retina, olfactory epithe-lium, cochlear and vestibular ganglia (all three are sensorypathway for vision, smell and hearing)

• Triangle of auscultation

ScapulaLatissimus dorsiTrapezius

Mnemonic: Scalattra

• Alar plate derivatives become sensory nuclei while basalplate derivatives become motor nuclei

Mnemonic: Sailor/Ala senses

• Branch of first part of subclavian artery

Vertebral arteryInternal thoracic arteryThyrocervical trunk

Mnemonic: VIT

• Branch of thyrocervical trunk

Suprascapular AInferior thyroid A

Transverse cervical A

Mnemonic: SIT

• Axillary artery

First part—Superior thoracic arterySecond part—Acromiothoracic arteryLateral thoracic artery

Mnemonic: SALT

Mnemonics6

• Adductor magnus is a composite muscle and is doublyinnervated by the obturator nerve and tibial nerve

Mnemonic: MagOT

• Biceps femoris: Long head—Tibial nerve

Short head—common peroneal nerve

Mnemonic: Long tibial

• Bronchial artery

Left—two bronchial arteries arising directly from descendingthoracic aorta

Mnemonic: Directly descending

Right—One bronchial artery arises indirectly from descendingthoracic aorta either from

i. Third posterior intercostal arteryii. Upper left bronchial artery

• Branches of anterior division of internal iliac artery

Superior vesical arteryObturator arteryMiddle rectal arteryUterine artery (only in females)Inferior vesical artery (replaced by vaginal in females)Inferior gluteal arteryInternal pudendal artery

Mnemonic: SOMU and 3IV

• Nasal septum—osseous part

VomerSphenoidNasal boneFrontal boneEthmoidPalatineMaxillary

Mnemonic: Very special news for Ethiopian PM

• Large opening of diaphragm

T8—Venacaval openingT10—Oesophageal opening

7Anatomy

T12—Aortic opening

Mnemonic: Voice of America

Aortic openingAortaThoracic ductAzygos vein

Mnemonic: ATA

Vena caval opening—Right phrenic nerveInferior vena cava

Mnemonic: RP in CaveOesophageal opening—Left vagus

Right vagusOesophagusOesophageal branch of left gastricartery

Mnemonic: Vagus, phagus, gas

• Supports of uterus

Muscular supports/active supportsPerineal bodyUrogenital diaphragmLevator ani (pelvic diaphragm)

Mnemonic: PULP

Mechanical supportsTransverse cervical ligament (Mackenrodt’s ligament)Uterosacral ligament (most strong)Round ligament of uterusUterine axisPubocervical ligament

Mnemonic: TURUP (T and P are cervical)

• Branches of cerebral part of internal carotid artery

Anterior cerebral arteryMiddle cerebral arteryOphthalmic arteryAnterior choroidal arteryPosterior communicating artery

Mnemonic: AM OCP

Mnemonics8

• Branches of cavernous part of internal carotid artery

Meningeal branchesCavernous branchesHypophyseal branches

Mnemonic: MCH

• Secondary curves: Adult curvatures of spinal cord

Anteriorly Mn

Cervical spine Convex X LordosisThoracic spine Concave Cave KyphosisLumbar spine Convex X LordosisPelvic curve Concave Cave Kyphosis(sacrococcygeal)

Lumbar: Lordosis (L for L)Convex anteriorly: Lordosis

Mnemonic: XL

• Shoulder abduction

0–15° Supraspinatus (suprascapular nerve)15°–90° Deltoid (axillary nerve)90°–120° Deltoid (+ short external rotators) (axillary nerve)120°–180° Serratus anterior (nerve to serratus anterior)

Trapezius (spinal accessory nerve)

• Subclavian triangle

Nerve contentsThree trunks of brachial plexusNerve to serratus anteriorNerve to subclaviusSuprascapular nerve

Mnemonic: 3S in subclavian Triangle

• Maxillary A (branch of external carotid artery)

Branches of first partMiddle meningeal arteryAccessory meningeal arteryInferior alveolar arteryDeep auricular artery

9Anatomy

Anterior tympanic artery

Mnemonic: MAIDABranches of second partDeep temporalPterygoidMassetericBuccal

Mnemonic: All muscular branches

• Prostate

Median lobe—benignPosterior lobe—Malignant/carcinomatous transformation

Mnemonic: PMC (Patna Medical College)

• Least dilatable and narrowest part of male urethra =Membranous (except external urethral orifice)

Mnemonic: LMN

• Branches of external carotid artery

Anterior: Superior thyroid arteryFacial arteryLingual artery

Posterior: Occipital arteryPosterior auricular artery

Medial: Ascending pharyngeal arteryTerminal: Maxillary artery

Superficial temporal artery

Mnemonic: SFL (Safal) OP Ascends Max STep

• Primary cartilaginous joint/hyaline cartilaginous joint/synchondrosis

Joint between epiphysis and diaphysis of long boneSpheno-occipital jointFirst chondrosternal jointCostochondral joint

Mnemonic: PHC

• Secondary cartilaginous joint/fibrocartilaginous joint/symphysis

– Symphysis pubis– Symphysis menti

Mnemonics10

– Intervertebral joint between vertebral bodies (sacro-coccygeal joint)

– Manubriosternal Joint– Xiphisternal Joint

Mnemonic: 2SIMa–X

Fibrous jointsSutures: SkullGomphosis: Tooth in its socketsSyndesmosis: Inferior tibiofibular joint, middle radioulnar joint,

tympanostapedial joint

Mnemonic: Iti Mira Tysta

• Synovial joint

Plane synovial joint: Joint between articular process ofvertebraIntercarpal and intertarsal

Mnemonic: Art of car and tar are planeHinge jointInterphalangealElbowAnkle

Mnemonic: HIPEAPivot (trochoid)Median atlanto-axial jointInferior and superior radioulnar joint

Mnemonic: MAA and ISRUEllipsoid: Metacarpophalangeal jointAtlanto-occipital jointWrist joint

Mnemonic: MCP AO, wristCondylar (bicondylar): Knee joint

Right and left jaw joint

Mnemonic: J and K are bicondylar

Saddle (sellar): Sternoclavicular joint1st carpometacarpal jointCalcaneocuboid joint

Mnemonic: Stern 1st CM of Calca is sad

Ball and socket: Shoulder joint

11Anatomy

Hip jointTalocalcaneonavicular joint

• EpiphysisPressure epiphysis: Head of femur

Condyles of tibiaLower end of radius

Mnemonic: Press HCLTraction epiphysis: Tubercles of humerus—Mastoid process

Trochanters of femur

Mnemonic: TMTAtavistic epiphysis: Coracoid process of scapula

Osmium trigonumAberrant epiphysis: Head of first metacarpal

Base of other metacarpals

• Veins of heart

Contents of coronary sulcus:Great cardiac veinCoronary sinusSmall cardiac vein

Mnemonic: GCSAnterior cardiac vein drains directly into right atrium

Mnemonic: ADDRASmallest cardiac vein/Thesbian veins/venae cordis minimidrains directly into the cavity in all four chambers.Rest drains into coronary sinus, i.e, great cardiac vein(Anterior Interventricular septum)Middle cardiac vein (Posterior interventricular septum)

Mnemonic: Middle PostSmall cardiac veinPosterior vein of LVOblique vein of LARight marginal vein

• Muscles of mastication

Pterygoid—lateral and medialMasseterTemporalisMnemonic: PMT

Mnemonics12

• Structures derived from the neural crestC-cells of thyroidConotruncal septum(Chromaffin tissue) (adrenal medulla)Neurons: The neurons of

Spinal dorsal root gangliaSensory ganglia of 5th, 7th, 8th, 9th and 10thcranial nerves

Sympathetic gangliaPia-arachnoid materSchwann cellsMelanoblasts (mesenchyme of dental papilla and pharyngealarches)

Mnemonic: 3C 3S PSM

• Yellow elastic cartilage forms: External ear

External auditory canalEustachian tubeEpiglottisTip of arytenoidsTip of noseCorniculate cartilageCuneiform cartilage

Mnemonic: E4T2C2

• Hyaline cartilage forms: (Type 2 collagen)

CostalNasalSome laryngealTracheobronchialAll temporary and most articularcartilages

Mnemonic: ATMA

• Femoral artery: Superficial branches

Superficial external pudendalSuperficial epigastricSuperficial circumflex iliac

Deep branchesProfunda femoris

13Anatomy

Deep external pudendalMuscular branches

Mnemonic: PDMExternal iliac artery:Branches

Inferior epigastric arteryDeep circumflex iliac artery

Note: 1. Inferior epigastric artery anastomoses withsuperior epigastric artery (a branch of internalthoracic artery).

2. Profunda femoris is the largest branch of femoralartery. It is the chief artery to supply all 3compartments of thigh. lts branches

1. Medial circumflex femoral artery2. Lateral circumflex femoral artery3. Four perforating arteries

• Sites of narrowing of normal ureter

Ureteric orificeUreterovesical junctionJuxtaposition of the vas deferens or broad ligamentCrossing of the iliac arteryUreteropelvic junction

Mnemonic: Ureteric orifice is VVIP

• Anterior belly of digastric is supplied by mandibular nerve

Postserior belly of digastric is supplied by facial nerve

Mnemonic: ADM and PDF• Mandibular nerve (lst arch): Mylohyoid

Muscles of masticationAnterior belly of digastricTensor tympaniTensor veli palati

Mnemonic: My Mast Ant digest Tension

• Facial Nerve (2nd arch): Stapedius

StylohyoidPosterior belly of digastricMuscles of facial expression

Mnemonic: Stupid style Dip muscles of facial expression

Mnemonics14

• Glossopharyngeal nerve (3rd arch): Stylopharyngeus

Mnemonic: Gloss style-pharyngeal common)

• Superior laryngeal nerve (4th arch)

Muscles of pharynx(except stylopharyngeus)Muscles of palate(except tensor veli palati)

• Recurrent laryngeal nerve (6th arch): Muscles of larynx(except cricothyroid)

Note: Cricothyroid muscle is supplied by external branch ofsuperior laryngeal nerve.

Mnemonic: Ex Cricketer

• Stapes—Smallest

Mnemonic: S for SMalleus: Largest

• Direction of nasolacrimal duct: Downward, backward andlaterally.

Mnemonic: DBL, i.e. double

• Inferior meatus: Nasolacrimal duct

Mnemonic: INLDMiddle meatus: 4 openings:

Middle ethmoidal air cellsMaxillary sinusAnterior ethmoidal air cellsFrontal sinus

Superior meatus: Posterior ethmoidal sinus.

Mnemonic: SuPES

Sphenoethmoidal recess—Sphenoid air cells.

Mnemonic: SERS

• Coronal suture—between 2 ears (Can in hindi)

Mnemonic: C for CSagittal suture—between 2 parietal bones.Asterion—parietomastoid occipital (PMO).

15Anatomy

Bregma—Anterior fontanelle

Mnemonic: ABLambda—Posterior fontanelle

• Routine opening of mouth: Lateral pterygoid.Forceful opening of mouth: Digastric

GeniohyoidMyelohyoid

Mnemonic: DGM

• Infrahyoid muscles— also known as strap muscles:SternohyoidOmohyoidSternothyroidThyrohyoid

• Ansa cervicalis is nerve supply of: OmohyoidSternothyroidSternohyoid

Mnemonic: OH Anshu SiT on Shoe

• C1 is the nerve supply of: ThyrohyoidGeniohyoid

Mnemonic: C1 is The GHar

• Male internal genitalia

S: Seminal vesiclesE: EpididymisE: Ejaculatory ductD: Ductus deferens (Vas deferens)

Mnemonic: SEED

• Paranasal sinusesMaxillary sinus—develops at birthEthmoidal sinus—develops at birthFrontal sinus—develops at 2 yearsSphenoid sinus—develops at 3–5 years.

Mnemonic: MEFS

• The inferior turbinate is a separate bone, while rest of theturbinates are a part of ethmoidal bone.

Mnemonic: Inferior—Independent

Mnemonics16

• CerebellumCerebellar cortex—five cells:

Granule cellsGolgi cellsPurkinje cellsStellate cellsBasket cells

Mnemonic: Garm gol puri in steel basketDeep cerebellar nuclei:DentateEmboliformFastigialGlobose

Mnemonic: DEFG

Note: The axons of Purkinje cells are the only output fromthe cerebellar cortex, generally pass to the deep nuclei.

• Appendix of testis—Paramesonephric duct

Mnemonic: ATP

Appendix of epididymis—Mesonephric duct

Mnemonic: MEA

• Inhibitors of TCA cycle

Fluoroacetate inhibits aconitase (non-competitive >competitive)Arsenite inhibits α-Ketoglutarate dehydrogenase (non-competitive)Malonate inhibits succinate dehydrogenase (competitive)

Mnemonic: FAM inhibits AKS

• Transamination reaction

Aspartate + α-ketoglutarate → oxaloacetate + glutamate

Mnemonic: ASOAlanine + α-ketoglutarate → pyruvate + glutamate

Mnemonic: PyAlG for G—Glutamate–ketoglutarate

• Sphingolipidosis: X-linked recessive → Fabry’s disease

Mnemonic: Fab X

• Biochemical tests

• Sugars (reducing sugars)

Fehling’s testBenedict’s test

Mnemonic: FBS (or fasting blood sugar)

• Bile pigments

Gmelin testFouchet testRosenbach’s test

Mnemonic: Pig GFR

17

Biochemistry

2

Mnemonics18

Also remember

Ketone bodiesRothera test (Nitroprusside test)—Roth NiteGerhardt test (Ferric chloride test)

Mnemonic: GF

• SGPT – ALT – Cytosolic

Mnemonic: CLPAlso remember: SGOT (AST)—80% mitochondrial and 20%cytosolic

• Water soluble vitamins: Vitamins B and C

Mnemonic: WBCVit. B complex energy releasingThiamine (B1)Riboflavin (B2)Niacin (B3)

Mnemonic: 123-TRN (Tarun in Hindi)BiotinPantothenic acidPyridoxine B6

Mnemonic: six pyre

• Blot transfer techniques

Southern blot DNANorthern blot RNAWestern blot Protein

Mnemonic: South – Dakshin – DNA

Western – Paschim – Protein

• Respiratory chain inhibitors

Complex IV inhibitors: Cyanide (CN)Carbon monoxide (CO)Hydrogen sulphide (H2S)Sodium azide

Mnemonic: ides are complex IV inhibitors

• Location of major glycosaminoglycans

Hyaluronic acid: Synovial fluidLoose connective tissue

19Biochemistry

Vitreous humorCartilage

Mnemonic: Hy SyL Vi in CarChondroitin sulphate: Cartilage

BoneCornea

Mnemonic: CBCKaratan sulphate: Cornea (KS I)

Loose connective tissue (KS II)Heparin: Mast cellsHeparan sulphate: Aortic wall

Skin fibroblastsDermatan sulphate: Wide distribution

• Catabolism of carbon skeletons of amino acids

Oxaloacetate forming amino acid—Asparagine (aspartate)

Mnemonic: Ox in spaFumarate forming amino acids—Phenylalanine, tyrosine

Mnemonic: PheTyr fumesSuccinyl CoA: Threonine, valine, isoleucine, methionine

Mnemonic: Three successful VIM

• Ketoglutarate: Proline, histidine, arginine, glutamine

Mnemonic: ααααα PHAGPyruvate: Cystine, threonine, glycine, alanine, serine

Mnemonic: CT GAS in Peru

Acetyl CoA /Acetoacetyl CoA forming amino acids: Leucine,isoleucine, lysine, tryptophan, phenylalanine, tyrosine

Mnemonic: Lily Try Phe Tyr in AC

• Transport of ammonia to liver

Muscle—uses alanine

Mnemonic: Amma ki MalaOther tissues use glutamine

• Metabolic role of vitamin B12

Methylation of homocysteine to methionine

Isomerization of methyl malonyl CoA to succinyl CoA

Methylation of pyrimidine ring to form thymine

Mnemonics20

Interconversion of glutamate and β-methyl aspartate inbacteriaConversion of ribonucleotides to deoxyribonucleotides inDNA synthesisMetabolism of diols

Mnemonic: HMP and GRD in B12

• HGPRTase deficiency

Partial def: Kelly Siegmiller’s syndromeNo CNS involvementComplete def: Lesch-Nyhan syndrome

Mnemonic: Kelly is Partial

• Classification of amino acids

Amino acids with aliphatic side chainGlycine

Alanine

ValineLeucine

Isoleucine

Mnemonic: GAVLI

With side chain containing OH (hydroxyl) group

TyrosineThreonineSerine

Mnemonic: oh tie three Sari

With side chain containing sulphur atoms

MethionineCysteine

Mnemonic: MSCContaining aromatic rings

HistidineTryptophan

Phenylalanine

TyrosineMnemonic: Histry Phe Tyr

21Biochemistry

• RNA polymerase transcribes

Type 1—rRNATypes 2—mRNAType 3—tRNA

Mnemonic: RMT = Remote

• Homozygous substitution with other amino acids in place of

Valine at position 67 of β-chainGlutamate—Hb milwaukee

Mnemonic: Gala MiloAspartic acid—Hb bristol

Mnemonic: BrassAlanine—Hb sydney

Mnemonic: Alan border of sydney

• CPK-1-CPK BB—brain (Mnemonic: BB no. 1)

CPK-2-CPK MB—myocardium

Mnemonic: MB Heart attackCPK-3-CPK MM—skeletal muscleCPK-MB 1—extra cardiac formCPK-MB 2—cardiac form

Mnemonic: Heart attack especially in 2nd MB

• Fructose 2, 6-bisphosphate

+ ve on PFK 1– ve on PFK 2– ve on fructose 1, 6-bisphosphatase

Note: PFK 2 is bifunctional (2 is bi.)

• Ehrlich’s aldehyde reagent test

Chloroform layer turns pink—Urobilinogen (Mnemonic: CPU)Aqueous layer turns pink—porphobilinogen

• Mg2+ (Magnesium) is required in covalent modification ofenzymes by phosphorylation, dephosphorylation of serylresidues.

It is required in:Ribonuclease

Mnemonics22

KinaseTransketolasePeptidasesCa carboxylaseAdenyl cyclasePhosphatase

Mnemonic: RiKi Trap Car, add phos

• Tryptophan → Serotonin → MelatoninNiacin (nicotinic acid/nicotinamide)

Tryptophan contains indole functional group.

• Tyrosine is formed from phenylalanine (Enz-phenylalaninehydroxylase)Tyrosine is also precursor forDopaDopamineEpinephrineNorepinephrineThyroxineTriiodothyronineMelamine

Note: Codon for tyrosine are UAC and UAU.

In Papaver somniferum, the opium poppy, tyrosine is used toproduce the alkaloid morphine.

• Substrate level phosphorylation

1, 3-bisphosphoglycerate to 3-phosphoglycerate (phospho-glycerate kinase), glycolysisPhosphoenol pyruvate to pyruvate (pyruvate kinase)-glycolysisSuccinyl CoA to succinate (succinyl CoA synthetase orsuccinate thiokinase), Kreb’s cycle

• Basic amino acid Pka of ‘R’Histidine 6Lysine 10.8Arginine 12.5

23Biochemistry

Higher the Pka, more basic will be amino acid.

Mnemonic: Increasing order HLA

• Guanine to cytosine G ≡ C (3 hydrogen bonds) adenosine tothymidine A = T (2 hydrogen bonds)

Mnemonic: 3G

• Named mutationsNonsense mutation: Sense codon to change into nonsensestop codon, causing premature termination of translation.Missense mutation: Change of one sense codon into anothersense codon, for different amino acidsMnemonic: Different MissSilent mutation: Change of one sense codon into anothersense codon for same amino acids (Mnemonic: S for S)Null mutation: Leads to no functional gene product (completeloss of function)Loss of function mutation: Results of gene product having lessor no function.Gain of function mutation: Change the gene product such thatit gains a new and abnormal function.Neutral mutation: Different but chemically similar aminoacid.

• Insulin receptor: Two subunits• α subunit: It is extracellular and its function is to bind insulin.• β subunit: It is a transmembrane protein and its function is

signal transduction.

Note: The cytoplasmic portion of subunit has tyrosinekinase activity (enzymatic receptor).

• Three steps in glycolysis that are physiologically irreversible.These reactions are catalyzed by– Hexokinase–glucokinase (glucose to glucose 6-phosphate)– Phosphofructokinase (fructose 6 phosphate to fructose 1,

6-bisphosphate)– Pyruvate kinase (phosphoenol pyruvate to pyruvic acid)To remember: All three are kinases.One involves glucose, another fructose and third onepyruvate.

Mnemonics24

• Metabolic fuels

Organ Fed Fasting Starvation Mnemonics

Brain Glucose Glucose Ketone bodies Gul Gul Ke

Heart Fatty acid Fatty acid Ketone bodies FFK (Fafakna inHindi)

Liver Glucose Fatty acid Amino acid GFA (Girl FriendAyi rahne)

Muscles Glucose Fatty acid Fatty acid GFF (is muscil inHindi)

RBC Glucose Glucose Glucose Only glucose

• DNA

Purines—Adenine, guanine

Pyrimidines—Cytosine, thymine

Mnemonic: Y for Y

• Amino acidsKetogenic— Leucine

Lysine

Mnemonic: KiLL

Both glucogenic and ketogenic—Isoluecine

Tryptophan

Phenylalanine

Tyrosine

Mnemonic: GK Is trying phenyl on tyre

• Protein degeneration in eukaryotes

1. Protein degeneration in lysosomes—involves lysosomalproteins. This process does not involve ATP.

2. Protein degradation in proteosomes—involves ubiquitin-proteosome pathway. This process requires ATP, i.e. ATPdependent.

Mnemonic: UPA

• Trypsin—a proteolytic enzyme (proteinase)

It acts in an alkaline medium.

25Biochemistry

Activators: Enterokinase

Calcium

Trypsin itself

Mnemonic: ECT

Inhibitors: Human and bovine colostrums

Egg white (contains water soluble mucoprotein)

Raw soyabean

Alpha antiproteinase/α-1 antitrypsin

Diisopropyl flurophosphate (DFP)

Mnemonic: HERALD

• Helicase—Unwinds dsDNA to provide ssDNAMnemonic: HU

Topoisomerase—Relieves torsional strain that results fromhelicase induced unwinding.

Mnemonic: T for T

• Papez circuit

Cingulate gyrus Anterior thalamic(limbic system) nucleus (thalamus)

↓ ↑Hippocampus Mammillary body(limbic system) (hypothalamus)

Mnemonic: HiMaAnCi

• Limbic system

Cingulate gyrus (rim of cortical tissue around hilum ofcerebral hemisphere)AmygdalaSeptal nucleiHippocampus formation

Mnemonic: CASH

• Precursors of

Clotting factors Carboxylase Mature clottingII, VII, IX and X factors II, VII, IX, X(inactive- Vitamin K (active γ-carboxy-glutamyl glutamyl) Glaresidues) (Hydroxyquinone) residues

This reaction requires CO2 and hydroxyquinone form of vit. K

Mnemonic: CHK

• Phase of minimum cardiac motion

At low/intermediate heart rates—Mid-diastoleMnemonic: Mid day minimumAt high heart rates: Late systole

26

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←

→

Physiology

3

27Physiology

• Nitric oxide synthase

NOS 1 (Endothelial NOS): Constitutive/Calcium dependentNOS 2 (Inducible NOS): Inducible/Calcium IndependentNOS 3 (Neuronal NOS): Constitutive/Calcium dependent

Mnemonic: EIN—Alphabetically and In for In

• Intestinal hormone stimulating insulin secretion

GastrinGastric inhibitory peptide (GIP)GlucagonGlucagon like peptide (GLP)Cholecystokinin (CCK)Secretin

Mnemonic: 4GCS

• Features of cerebellar function/lesion

Past pointingHypotoniaCerebellar nystagmusDysmetriaDysarthriaDysdiadochokinesiaIntention tremorAtaxia

Mnemonic: PHC D3I2A1

• Pain insensitive structure

Parenchyma of brainPlexus (choroid)EpendymomaPia-arachnoidDura over convexity of skull

Mnemonic: PCS is insensitiveAlso remember: Vasomotor center (VMC)

Excitatory: CortexPain pathwayCarotid and aortic chemoreceptors

Direct stimulators: CO2

Hypoxia

Mnemonics28

• Cells within gastric glands

Chief Zudge fund of pepsi—chief cells/zymogenic cells—fundus of stomach—pepsinOx and Pari are intrinsic to HCL—oxyntic cells or parietalcells—secrete HCL.

• Abnormal Hb with decreased solubility

HbS (β6-GLU-VAL)HbC (β6-GLU-LYS)HbD (β6-GLU-GLM)

Mnemonic: Supreme Court Decision-Very Long Gap

• Parasympathetic fibres carrying cranial nerves—3, 7, 9, 10

Pure motor—3, 4, 6, 11, 12Pure sensory—1, 2, 8

• The Dorsal spinocerebellar tract enters the cerebellumthrough inferior cerebellar peduncle. The ventral tract entersinto the cerebellum through superior cerebellar peduncle.

Mnemonic: DIN

• Medullary respiratory centres:

Dorsal respiratory group (DRG), located in the dorsal portionof the medulla, which mainly causes inspiration

Mnemonic: DinVentral respiratory group (VRG) located in the ventrolateralpart of the medulla, which mainly causes expiration.

• Hormones with second messenger cGMP

Atrial natriuretic factorNitric oxide

Mnemonic: NAG

Hormones with second messenger Creatine Kinase

Growth hormoneErythropoietinProlactinInsulinInsulin like growth factors I and IIChorionic somatomammotropin

Mnemonic: Growing EPICK

29Physiology

Hormones with second messenger cAMPα2 adrenergic catecholaminesβ adrenergic catecholaminesAdrenocorticotropic hormone (ACTH)—pituitaryAntidiuretic hormone (V2)—2 ampouleCalcitonin—parafollicular ‘C’ cell of thyroidChorionic gonadotropin, humanCorticotropin release hormoneDopamineGlucagon—pancreasFSH—pituitaryLH—pituitaryMSHPTH—parathyroidSomatostatinTSH—pituitary (FLAT)

Mnemonic: ACD GF LM PST

Second messenger is Ca2+/PIPOxytocinADH (V1A and V1B)TRHGonadotropin releasing hormoneGastrinCholecystokininAcetylcholineα1-adrenergic catecholamine

• Intrinsic muscle control

Golgi tendon organ—detects muscle tension—inverse stretchreflex—lengthening reaction

Mnemonic: T for T

Muscle spindle—detects muscle length—stretch reflex

Mnemonic: S for S

• Vestibular cerebellum—equilibriumspinocerebellum—Smoothens and coordinates

Mnemonic: S for S

Neocerebellum—planning and programming

Mnemonics30

• Trichromatic theory

Red—protanomalyGreen—deuteranomalyBlue—tritanomalyMnemonic: Red-Green-Blue (Ragbi)

• General somatic efferents: Motor functions of skeletal musclesderived from somites: Cranial nerves

III (Oculomotor nucleus)IV (Trochlear nucleus)VI (Abducens nucleus): Supplies extraocular musclesXII (Hypoglossal nucleus): Supplies tongue muscles

Mnemonic: Tongue muscles and Extraocular muscles

• General visceral efferents: Motor function of smooth musclesand glands of head and viscera that receive parasympatheticsupply

Cranial nervesSuperior salivatory nucleus (VII) Superior SevenInferior salivatory nucleus (IX) Inferior NineDorsal motor nucleus (X) Dorsal ~ Das (Hindi)Edinger-Westphal nucleus (III)

Mnemonic: SIDE

• Bronchial efferents/special visceral efferents

Ambiguous nucleus (IX, X, XI)Masticatory nucleus (V)Spinal accessory nucleus (XI)Facial nucleus (VII)

Mnemonic: Ambi Ka Mast Special accessory face

• Axon reflex contributes only to the Flare component of tripleresponse.

Mnemonic: Flaxon

• Sarcolemmal proteins localized to the cytoplasmic side ofsarcolemmaDysferlinDystrophinCalpain

Mnemonic: Fer pin Pain

31Physiology

Also remember: Transmembrane sarcolemmal proteinsDystroglycans, integrins, sarcoglycans and caveolin

Mnemonic: DISC

• The dorsal column ascends such that it remains ipsilateralalong the entire length of spinal cord (its branch cross over inmedulla)

Mnemonic: DCM-Dorsal column cross over in medulla

Sensations transmitted by spinothalamic tractAnterior spinothalamic tract

Mnemonic: Crude ATP-Crude touch and pressure in anterior

Spinothalamic tractLateral spinothalamic tract

Pain (pin prick)Temperature

Mnemonic: PLT

Note: The spinothalamic tract crosses more or less at pointof entry itself such that it remains contralateral along thewhole length of spinal cord.

• When compared to plasma

Serum has no fibrinogen, clotting factors II, V and VIII but hashigher serotonin content because of platelet breakdown inserum

Mnemonic: S for S

• Frequency of sleep waves

Gamma oscillations 30–80 Hz GreatBeta waves 18–30 Hz B

Alpha waves 8–12 Hz A

Theta waves 4–7 Hz TDelta waves < 4 Hz Dance

Awake personEyes opened Beta waves

Mnemonic: Opening batsmanEyes closed Alpha waves

Mnemonics32

• Oxygen toxicityAcute—Bert effect—CNS effects are predominant (muscletwitching, convulsions, coma) (Mnemonic: ABC)Chronic—Smith effect—pulmonary effects (pulmonaryedema, lung atelectasis)

• Hormones produced in kidneyReninErythropoietin1, 25-Dihydroxycholecalciferol—vit. D

Mnemonic: RED

• TestisInterstitial cells of Leydig—secrete testosterone

Mnemonic: LeteMost other functions—Sertoli cellsY-Chromosome—small acrocentric

Mnemonic: Yac

• Naturally occurring estrogens

Estrone: Major estrogen in postmenopausal women

Mnemonic: NMEstradiol: Major and most potent estrogen in womenEstriol: Major estrogen in pregnancy, marker for fetoplacentalunit.

Mnemonic: PT

• Clasp knife spasticity: Upper motor neuron lesion(corticospinal pyramidal system involved)Mnemonic: Up in SpaLead pipe and cogwheel rigidity occurs in extrapyramidalsyndrome, e.g. Parkinsonism.

Mnemonic: Extra rigid in ParkinsonismParatonia/gegenhalten—bilateral frontal lobe damage

Mnemonic: FGCerebrovascular disease.

• Sympathetic outflow: Thoracolumbar outflow

Mnemonic: SLTParasympathetic outflow: Craniosacral outflowMnemonic: PCS

33Physiology

• LH surge: Ovulation—hormone picture

High estrogenLow progesterone

Mnemonic: HELP

• IRV + TV = Inspiratory capacity (Mn: ITI)

ERV + RV = Functional residual capacity (Mnemonic: FER)IRV + TV + ERV = Vital capacityIRV + TV + ERV + RV = Total lung capacityVC + RV = TLC (Mnemonic: VRT)

• Positive feedback mechanisms

ParturitionAction potential initiationBlood clotting/clot formationLH surgeCa2+ mediated contractionShock

Mnemonic: PABLCS

• Sympathetic cholinergic system serves two importantfunctions:

a. Sweat gland—secretion of sweat.b. Vasodilatation in skeletal muscles—a part of the neurons

to blood vessels in skeletal muscles is anatomicallysympathetic but secrete acetylcholine. Stimulation of thissystem of neurons produces vasodilatation in skeletalmuscles.

• Stimulus for CCK-PZ secretion:

a. Presence of peptides and amino acids in contact withmucosa of small intestine.

b. Presence in the duodenum of fatty acids having morethan 10 carbon atoms.

Stimulus for secretin secretion:a. Acidity of chyme

b. Products of protein digestion

• Stage IV: NREM sleep disorders:

Sleep walking (somnambulism)

Mnemonics34

Sleep terorr or night terror (pavor nocturnus)Sleep related enuresis (bed wetting)Bruxism (tooth grinding)Sleep talking (somniloquy)

• REM sleep disorders:RBD-REM sleep behaviour disorderNightmaresNarcolepsy (hallmark—decreased sleep latency)

Note: Penile tumescence is seen in REM sleep.

Mnemonic: RML Pens REM

• Difference between T3 and T4T3 is more potent.T3 has faster onset of action.T3 binds more avidly to nuclear receptors.T4 is more secreted by thyroid.T4 is major circulating hormone.T4 binds more avidly to plasma proteins (15 times).T4 has more plasma t½To remember: T4 = PharmacokineticsT3 = Pharmacodynamics

Note: About 1/3 of T4 is converted to T3 in peripheraltissues.

• Ions predominant in ICF:

PotassiumPhosphate (organic)ProteinMagnesium

Mnemonic: 3PMIons predominant in ECF—Na+/Cl–/HCO3

–/Ca2+

• Therapeutic Index =D50

D50

L

E or LD50/ED50

Mnemonic: TILE

• Selective phosphodiesterase 4 (PDE4) inhibitors

RoflumilastCilomilastTofimilast

Mnemonic: RCT-Milast

• Small molecule tyrosine kinase inhibitors

HER1 (EGFR) Erb B1: Erlotinib (reversible)Canertinib (Irreversible)Gefitinib

Mnemonic: I Can do ECG

• VGFR TK inhibitors—Sorafenib—Renal cell cancer

Sunitinib—Renal cell cancer

Mnemonic: VRS

• Drugs used for acute gout

NSAIDSColchicineCorticosteroids

Mnemonic: NCC

• Relative potency of same steroid at equivalent concentrationsin different formulation

Ointment > Emollient > Gel > Cream > Lotion

Mnemonic: OEGCL

35

Pharmacology

4

Mnemonics36

• Anticancer cells: Cell cycle specificG2 phase specific: Daunorubicin

EtoposideBleomycinTopotecan and Irinotecan

Mnemonic: DEBTS-phase specific agent: AntimetabolitesMtx6MP6TG5-FUCytarabineHydroxyureaM-phase specific: Vinca alkaloids

Paclitaxel and DocetaxelG1 phase: Vinblastine

• Drugs causing hyperuricemia

L-DopaEthambutolAspirinDiureticCyclosporineAlcoholNicotinic acidPyrazinamide

Mnemonic: LEAD CAN poison

• Anti-TNF-α drugs

EtanerceptAdalimumabInfliximab

Mnemonic: Etalion adalat Ka Insaf

• Clomiphene citrate

Enclomiphene—trans-antagonistZuclomiphene—cis-weak agonistMnemonic: N for N

• Anti-anxiety Benzodiazepines

DiazepamChlordiazepoxide

Pharmacology 37

OxazepamLorazepamAlprazolam

Mnemonic: Dia Ka CHOLA

• Anti-pseudomonal penicillins

AzlocillinMezlocillinCarbenicillinPiperacillinTicarcillin

Mnemonic: (Az) (Mez) pe Car Ka Pipe Tica

• Penicillinase susceptible penicillins

Penicillin G: Acid labilePenicillin V: Acid stable

Mnemonic: Galib

• Penicillinase resistant

NafcillinMethicillinFlucloxacillinOxacillinCloxacillinDicloxacillin

Mnemonic: Name Flu of OCD (last four are—oxa)

• Intramuscular penicillins

Benzathine penicillin GProcaine penicillin G

Mnemonic: BP (measured on muscle)Intravenous intramuscular

Penicillin G

Crystalline penicillin G or sodium penicillin G

• Anti-fungal drugs

Systemic azoles ItraconazoleVoriconazoleFluconazole

Mnemonic: IVF

Mnemonics38

Note: Ketoconazole is both topical and systemic.

• Side effects: Tacrolimus versus cyclosporine

Tacrolimus causes moreNeurotoxicityNephrotoxicityDiabetes mellitusDiarrhoea

Mnemonic: N2D2: ND TiwariCyclosporine causes moreHirsutismHyperplasia of gumsHypertensionHepatotoxicity(4H: First two are absent in tacrolimus)

• Management of PSVT

Adenosine > beta (β) blocker > calcium channel blocker(verapamil) > digoxin

Mnemonic: ABCD

• Beta agonists—side effects

ToleranceTachycardiaTremor

Mnemonic: 3T

• Effects mediated through β2 receptor agonists

Relaxation of smooth musclesAirway (bronchial muscles) Bronchodilatation (relaxation)Blood vessels Vasodilatation (relaxation)(Arterioles and Veins)Ciliary muscles in eye RelaxationDetrusor muscles in bladder RelaxationGall bladder and duct RelaxationGastrointestinal tract RelaxationUterus RelaxationSplenic capsule Relaxation

Mnemonic: ABCD G2US (i.e. ABCD GO TO US)

Pharmacology 39

• Oral drug therapy for treatment of erectile dysfunction

P PentoxyfyllineO Opoid antagonist (naltrexone)D Dopamine agonist (bomocriptine, apomorphine)A Alpha blockers (yohimbine, idaxozan)

Mnemonic: PODA

• Prostaglandin E1 (PGE1) analogues

RiopristilAlprostadilMisoprostol

Mnemonic: RAM

Prostaglandin F2α (PGF2α) analogues

DinoprostCarboprostLatanoprost

Mnemonic: Prost

• Hormones acting through cell membrane receptors

G protein coupled receptorsEnzymatic receptors

• G protein coupled receptors act either

Through alteration in CAMP concentration, orThrough IP3/DAG generationCAMP altering hormones are (another Mnemonic: ABCD GFLMPST)Pancreas: Glucagon, somatostatin (delta cells)Pituitary: FSH, LH, ACTH, TSH (Mnemonic: FLAT—CAMP)Parathyroid: PTHParafollicullar C cells of thyroid: CalcitoninPosterior pituitary: Vasopressin (V2)Plus hypothalamic releasing hormones (CRH, dopamine)Placenta: hCGPeptide of intermediate pituitary: MSH

Through IP3/DAG: Oxytocin TRH gastrin AcetylcholineVasopressin Gn RH Angiotensin II(V1)

Mnemonics40

Through cGMP—NOANF

Mnemonic: NAG (NO, ANF through cGMP)

• Rapid acting human insulin analogues

Insulin aspartInsulin lisproInsulin glulisine

Mnemonic: Asli GluAlso Remember: Long acting human insulin analoguesInsulin glargineInsulin detemir

• Mechanism of action of antiepileptic agents

Facilitation of GABA mediated chloride channel openingBarbituratesBenzodiazepines

Gabapentin

TiagabineTopiramate

Vigabatrin

Valproate

Mnemonic: BaBe Girl Tia Top in Viva of GABA class

• Inhibition of T type Ca2+ current

ValproateTrimethadione

Ethosuximide

Mnemonic: Vallore try ethical current

• Prolongation of Na+ channel inactivation

Valproate

Lamotrigine

ZonisamidePhenytoin

Carbamazepine

Topiramate

Mnemonic: Very long zone of Na+ in PCT

Pharmacology 41

• Gp II b/III a antagonist

EptifibatideTirofibanAbciximab

Mnemonic: EpTiAb

• All Navirs are protease inhibitors

• NNRTI: EfavirenzEtravirineNevirapineDelaviridine

Mnemonic: 2END

• Didanosine Stavudine Zalcitabine

(20%) (71%) (15%)

Similar toxic profilesPeripheral neuropathy (% in bracket)Lactic acidosisPancreatitisLiver: Hepatomegaly with steatosis

Mnemonic: PLPL

• Anti-metabolite acting by hypomethylation (inhibit DNAmethyl transferase)

AzacitidineDecitabine

Mnemonic: Hypo Aza D

• Thymine less death (inhibit DNA synthesis by blockingsynthesis of thymidylate) causing anti-metabolites

5-Fluorouracil (5-Fu)Capecitabine (5-Fu analogues)

• Anti-metabolite acting by inhibition of DNA elongation (DNAintercalating agent)

Cytarabine or cytosine arabinoside (pyrimidine-cytidineanalogue)

Gemcitabine (Pyrimidine-cytidine analogue)

Mnemonic: Arab Gem inhibit elongation

Mnemonics42

• Filgrastim is recombinant GCSF (glycoprotein) produced in

E. coli

Mnemonic: EFG

• High dose methotrexate is used for osteosarcoma, braintumors and hematological malignancies.

Mnemonic: Bone, Brain, Blood

• Filgrastim: GCSF/(Gra for granulocyte)

Sargramostim GM-CSF (Gramo for granulocyte monocyte)

• Drugs associated with SIADH

Vasopressin or desmopressinChlorpropamideOxytocin, high doseVincristineCarbamazepineNicotinePhenothiazinesCyclophosphamideTCAMAO inhibitorsSSRI

Mnemonic: VCO VCN PC, TMS

• Drugs causing constipationAluminium hydroxideBarium sulphateCalcium carbonateFerrous sulphateGanglionic blockersIon exchange resinsOpiatesPhenothiazinesTricyclic antidepressantsVerapamil (calcium channel blockers)

Mnemonic: ABC, FGI, OP, TV)

Note: Mg2+ is laxative.

Pharmacology 43

• Benzodiazepines that do not produce active metabolites

OxazepamMidazolamLorazepamTamazepamTriazolam

Mnemonic: OMLTT (Omlette)

• Drugs acting on GABA A (intrinsic ion channel receptors)

Agonist: MuscimolAntagonist: BicucullineAgonist: Baclofen (B for B)Antagonist: SaclofenDrugs acting on GABA B (G protein coupled receptors) (Mn:GB)

Mnemonic: MBBS(Muscimol, Bicuculline, Baclofen, Saclofen)

• Absence seizure: Drug of choice

< 3 yrs of age: Ethosuximide> 3 yrs of age: Valproic acid

• Interactions of valproate

May precipitate phenobarbitone toxicity by inhibitingmetabolismMay precipitate phenytoin toxicity by displacing it fromprotein binding sites and inhibiting metabolism.May precipitate absence status when used with clonazepam.

• Immunosuppression with triple therapy: Nice guidelinesCyclosporine (calcineurin inhibitor)Azathioprine (anti-proliferative agent)Prednisolone (corticosteroid)

Mnemonic: CAP

Note: Azathioprine may be replaced by mycofenolatemofetil.

• Adverse effects of amiodarone (iodine containing long actinganti-arrhythmic belong to class III)

Thyroid—hypothyroidism and hyperthyroidism

Mnemonics44

Peripheral neuropathyMyocardial depressionPulmonary alveolitis and fibrosis (lung)—dry coughCorneal microdepositsLiver toxicityPhotosensitization

Mnemonic: The Periphery of My lung cornea live withphotosensitivity

• Fluoroquinolones excreted primarily by non-renalmechanism

PefloxacinTrovafloxacinGrepofloxacinNalidixic acid

Mnemonic: Petro Grenal

Note: Sparfloxacin has 50% renal and 50% fecal route ofexcretion.

• Anti-pseudomonal cephalosporins

CeftazidimeCefoperazoneCefepimeCefotaxine

• Second line anti-tubercular drugs

Old drugsPASEthionamideCycloserineThioacetazone

Mnemonic: PECTAmikacinKanamycinCapreomycin

Mnemonic: Ami KCNew drugsCiprofloxacinOfloxacin

Pharmacology 45

ClarithromycinAzithromycinRifabutin

Mnemonic: COCA-Rafa

• Chelating agents in heavy metal poisoning

Dimercaprol (BAL): BismuthAntimonyLeadMercuryArsenicCopperNickelGold

Mnemonic: BALMA CNG

• Calcium disodium edetate (CaNa2EDTA)

Lead poisoning

Mnemonic: LedtaZn, Cd, Mn, Cu, Fe poisoning

• Penicillamine

CopperMercuryLead

Mnemonic: CML

Note: BAL: Not in iron and cadmium poisoningMnemonic: BANICEDTA: Not in mercury poisonMnemonic: ENMPenicillamine: Not in iron poisoningMnemonic: PNI

• Phenytoin—side effects

Hyperplasia of gumsHyperglycemiaHirsutismHypersensitivity reactionHydantoin syndrome: Teratogenicity

Mnemonics46

LymphadenopathyMegaloblastic anaemiaNeurological symptomsOsteomalacia

Mnemonic: 5H + LMNOP

• Valproate—side effectsAnorexia, vomitingAlopecia (transient)Ataxia, sedationAmmonemia (hyper)ThrombocytopeniaTremorHepatotoxicityNeural tube defectWeight gain

Mnemonic: VAT + HNW

• Antidote of warfarin (oral anticoagulants): Vitamin K1

(phytonadione)

Antidote of heparin—protamine sulphate

• Drugs acting on cell membrane and promoting leakage frommembranes

Polyenes: Amphotericin BHamycin

Nystatin

Polypeptides: PolymyxinColistin

Mnemonic: AB HaNy and PoCo leak membrane

• Mechanism of action of anti-microbial agents

Inhibition of DNA gyrase: Fluoroquinolones

Mnemonic: FGMisreading of mRNA code: Aminoglycoside (Mn:Aminamisread code)Inhibition of protein synthesis

Chloramphenicol 50SErythromycin 50S

Pharmacology 47

Clindamycin 50S

Mnemonic: CEC 50Tetracycline 30SAminoglycoside 30S

• Beta adrenergic agonists, nitrates, digitalis and diuretics arebest avoided during treatment of HOCM.

Mnemonic: BeNi DiDi avoid HOCM

• Contraceptive failure may occur if any of the following drugsis used concurrently:

Enzyme inducers: Phenytoin, phenobarbitone primidone,carbamazepine, rifampicin, griseofulvin.Suppression of intestinal microflora tetracycline, ampicillin

• Drugs following zero order kinetics

WarfarinEthyl alcoholTheophyllineTolbutamidePhenytoinAspirin (salicylate)Propranolol

Mnemonic: Zero WATT PAP

• Adrenaline: α1 + α2 + β1 + β2

Noradrenaline: α1 + α2 + β1 (no β2 action)Dopamine: D1 + D2 + α1 + α2 + β1 (no β2)Isoprenaline: β1 + β2 (no α action)Dobutamine relatively β1 selective (no dopamine receptoraction)

Mnemonic: DONO has no B2 action

• Adrenaline: Systolic BP increased

Diastolic BP decreasedHeart rate increased

Noradrenaline: Systolic BP increased

Diastolic BP increasedHeart rate decreased

Mnemonics48

Isoprenaline: Systolic BP normal/decreasedDiastolic BP decreased

Heart rate increased

• Dopamine: D1 receptors in renal and mesenteric bloodvessels are very sensitive

IV infusion of low doses of DA dilates mesenteric vessels andimproves renal perfusion.

Dobutamine: Inotropic action

• Selective MAO-A inhibitor: Clorgiline

MaclobemideSelective MAO-B inhibitor: Selegiline

Non-selective MAO inhibitor Isocarboxazid

TranylcyprominePhenelzine

Mnemonic: ITP

• Hemodialysis is not used in

Benzodiazepines (BZD)

Digitalis

OrganophosphatesCopper sulphate

Kerosene

Mnemonic: BZD DOCK

• Diagnostic test for myasthenia gravisa. Ameliorative test: Edrophonium (anti-cholinesterase)b. Provocative test—d-tubocurarine

• Pheochromocytoma

α-blockage is the basis of management in preoperativeperiod. Phenoxybenzamine is the agent of choice.β-blockers should not be employed prior to establishingeffective α-receptor blockage, since unopposed β receptorblockage could theoretically cause blood pressure elevationfrom increased vasoconstriction.

Atenolol however is a selective β1 agonist, and acts on theheart and not on peripheral blood vessels.

Pharmacology 49

• Diuretics, which do not promote bicarbonate excretion

Thiazide like diuretics, e.g. metazoline, indapamide,chlorthalidone, Ethacrynic acid (unlike other loop diuretics)Mnemonic: MICEMost marked kaliuresis: Acetazolamide

Mnemonic: AKMost marked natriuresis: Furosemide

Mnemonic: FuNa

• PharmacokineticsADMEAbsorptionDistributionMetabolismExcretion

• Plasma protein binding is associated with—DurationDistributionDisease (hypoalbuminemia)DisplacementDialysis

• Area outside blood–brain barrier (circumventricular organs)Subfornical organOVLT (organum vasculosum of lamina terminalis)Area postremaPosterior pituitary

Mnemonic: SOAP

Note: CTZ (Chemoreceptor trigger zone) is also outsideblood–brain barrier and responsible for vomiting.

• Enzyme inducers—G—GriseofulvinP—Phenytoin, PrimidoneR—RifampicinS—Smoking (PAH—polycyclic aromatic hydrocarbons)Car—CarbamazepinePhone—phenobarbitone

Mnemonics50

• Enzyme inhibitors—

Valla’s—ValproateKit—KetoconazoleCan—CimetidineCause—CiprofloxacinEnzyme—ErythromycinInhibition—INH (Isoniazid)

• Order of kinetics

First order— CHF constantClearanceHalf lifeFraction excreted

Zero order—RA constantRate of eliminationAmount eliminated

• Nuclear hormones—

S—Sex hormones (Estrogen, Progesterone and Testosterone)A—Vitamin AT—Thyroid hormones

Mnemonic: SATurday Night

Cytoplasmic receptor hormones—CorticosteroidsVitamin D

Mnemonic: CCD

• Drugs metabolized by acetylation—S—Sulfonamide including dapsoneH—HydralazineI—INH (Isoniazid)P—Procainamide (antiarrhythmic drug)

Note: They can cause SLE.

• Parasympathetic fibres are long in preganglionic.

Mnemonic: Para-Pre—long

• Preganglionic fibres release acetylcholine in both sympatheticand parasympathetic systems.

Pharmacology 51

• Sympathetic system—

Postganglionic fibres release noradrenalineExceptions—Sympathetic nerve fibres going to kidney secrete dopamine.Sympathetic nerve fibres going to sweat glands releaseacetylcholine (sympathetic cholinergic)

Mnemonic: Kid is sympathetic to dopa

• Heart rate—Chronotropic

Mnemonic: HR

Conduction—Dromotropic

Mnemonic: D for D

Contractility—Ionotropic

• Hemicholinium—inhibits uptake of choline.

Vesamichol—inhibits entry of acetylcholine in the vesicleBotulinum toxin—inhibits release of acetylcholine.

• M1—Stomach (increases acid secretion)

M2—Heart (Bradycardia)M3—Rest organs like eye, GIT, urinary bladder, bronchus,glandsM4—CNSM5—CNS

Mnemonic: Ma says—First eat, Second heart and rest worklater on

• Drugs directly acting on parasympathetic system

Pilocarpine acts on Pupil (M3)—miosis in glaucoma.

Mnemonic: P for P

Bethanichol acts on Bladder (M3)—contracts urinary bladderin urinary retention.

Mnemonic: B for BMethacholine acts on Myocardium (M2)—used in tachyarrhy-thmia.Carbachol action—Common action—acts both on nicotinicand muscarinic receptors.

Mnemonic: C for C

Mnemonics52

• Oximes (enzyme reactivators) are acetylcholinesterasereactivators.

Oximes are used only for organophosphorous poisoning.

Mnemonic: OOO

For example,Pralidoxime (PAM)—acts only in periphery.

Mnemonic: P for PDiacetyl monoxime (DAM)—acts on both sites.

• Anticholinergic drugs act as cycloplegic.

Ciliary muscle contracts to cause accommodation.

Its nerve supply is short ciliary nerve—branch of oculomotornerve (3rd cranial nerve). So, it is a part of parasympatheticsystem.That is why anticholinergic drugs cause cycloplegia byblocking ciliary muscle contraction and causing loss ofaccommodation.

Anticholinergic drugs are—

Atropine—strongest cycloplegic drug. Very long acting. Usedfor refraction testing in children.Homatropine

Cyclopentolate

Tropicamide (Shortest acting. Preferred in adults.)

Mnemonic: D for adult

• Anticholinergic drugs acting on urinary bladder (M3)—block—less contraction.

Cause urinary retention (side effect)

Used in overactive bladder/incontinence/detrusser instability.Drugs used are—

S—Solifenacin

O—OxybutyninF—Flavoxate

T—Tolterodine, Trospium

bladder—Darifenacin

Mnemonic: SOFT bladder

Pharmacology 53

• Belladonna poisoning = Atropine poisoning = Dhaturapoisoning.

Mnemonic: BAD

• β1: Heart

Mnemonic: Heart is 1 in number

β2: Lungs

Mnemonic: Lungs are 2 in number

• α1: Vasoconstriction

α2: Vasodilatation

Mnemonic: A 1–CB 2–D

• M3: Circular muscles—Constrictor pupillae—supplied byshort ciliary nerve—active miosis—parasympathomimetic.

Mnemonic: MCC MAO

α1: Radial muscles—dilator pupillae—supplied by long ciliarynerve—active mydriasis—sympathomimetics.

• Dopamine acts on: μg/kg/min

D1: Low dose < 2β1 + D1: Intermediate dose 2–10

α1 + β1 + D1: High dose > 10

Mnemonic: DBA

• Dopa in name stimulates D1

For example, Dopamine

Fenoldopam

Note: Dobutamine mainly acts on β1.

• Adrenaline acts on all 4 receptors (α1, α2, β1 and β2)

Noradrenaline—not all (α1, α2, β1)Isoprenaline—only β—β1and β2

• β2 agonistsSalbutamol

Terbutaline

Mnemonics54

SalmetrolFormetrol

Mnemonic: Metro is long acting.Salmetrol is slow onset (S for S)Formetrol is fast onset (F for F)

Side effects—TremorTachycardiaTolerance

Mnemonic: 3T

• Selective α1 blocker—Zosine

• α1A—Prostateα1B—Blood vessels

Mnemonic: B for blood vessels

Note: Selective α1A blocker—Tamsulosin, Silodosin.

• β1 blockers/cardioselective/2nd generationNew—Nebivolol

Beta—Betaxolol

Blockers—BisoprololAct—Acebutolol

Exclusively—Esmolol

At—AtenololMyo—Metoprolol

Cardium—Celiprolol

• β blockers with intrinsic sympathomimetic activity (partialagonist)

Contain—Celiprolol

Partial—PindololAgonistic—Alprenolol

Activity—Acebutolol

Mnemonic: All pind sell ace intrinsically

• β blockers with membrane stabilizing propertyPossess—PropranololMembrane stabilizing or—Metoprolol

Pharmacology 55

Local—LabetalolAnesthetic—AcebutololProperty—Pindolol

• Water soluble β blockers—contraindicated in renal failure:

A—AtenololN—NadololS—Sotalol

Mnemonic: SoNaAta

• Nadolol is the longest acting β blockerEsmolol is the shortest acting β blocker.

• 3rd generation β blockers: β blockers with any additionalcardiovascular advantage (vasodilatation)

a. α + β blockade—Labetalol, Carvedilolb. NO release—Nebivolol.

Mnemonic: N for Nc. Ca2+ channel blocker—Carvedilol

Mnemonic: C for Cd. K+ channel blocker—Tilisilole. β2 agonist—Celiprolol

• Carvedilol—α blocker

Ca2+ channel blockerAntioxidant

• Celiprolol— β2 agonist

CardioselectiveIntrinsic sympathomimetic activity.

• Loop and thiazide diuretics

Na+, K+, Mg2+, H+—decreaseSugar, lipid, uric acid—increase

Mnemonic: Loop looses calcium. It causes hypocalcemia.But thiazides cause hypercalcemia

• Digoxin—contraindicated in renal failure.Digitoxin—contraindicated in hepatic failure.

Mnemonic: Toxin is metabolized in liver

Mnemonics56

• Drugs causing gynaecomastia—

Di—DigitalisS—SpironolactoneC—CimetidineO—Oestrogen

• Drug interactions of digitalis—

QuinidineVerapamilAmiodaroneThiazides

Mnemonic: Queen’s VAT digitally

• Vasodilators

Mainly vein—NitratesMainly artery—Hydralazine

Mnemonic: Hydra is artistBoth— α blockers

ACE inhibitorsAT receptor blockersSodium nitroprusside

• Drugs causing hirsutism—

CyclosporinePhenytoinMinoxidil

Mnemonic: CPM ka Hero

• Diazoxide—decrease Insulin

• Ca2+ channel—

L type—in CVST type—in Thalamus (brain)

Mnemonic: T for T

• Renin inhibitor

Approved for the treatment of hypertensionCan be given orally

Aliskiren

Pharmacology 57

RemikirenEnalkiren

Mnemonic: Inhibitor of Renin

• Prils are ACE inhibitors.Depines are calcium channel blockers.

Mnemonic: CD

• ACE inhibitors

A—ActiveC—CaptoprilL—Lisinopril

• ACE inhibitors—Captopril

C—CoughA—AngioedemaP—Prodrug (except Captopril and Lisinopril)T—Taste alteration (dysguesia)O—Orthostatic hypotension/Postural hypotensionP—Pregnancy is absolute contraindicationR—Renal artery stenosis (bilateral) is absolute contraindicationI—Increase in K+—hyperkalemia is contraindicationL—Lowers the risk of diabetic complications

Note: Angiotensin receptor blockers also follow theseexcept first 3 (CAP).

• Sartans are angiotensin receptor blockers (block AT1 only).Sartans are selective AT1 receptor antagonist.

• Drugs safe in pregnancy

Better—Beta blockersMother—MethyldopaCare—ClonidineDuring—DihydroperidineHypertensive—HydralazinePregnancy—Prazosin

Note: Antihypertensive drugs contraindicated in pregnancyare ACE inhibitors and ARB.

Mnemonics58

• Nitrate with minimum first pass metabolism—IMNMnemonic: Iska Metabolism Nahi hota

Longest acting nitrate—PETN

Mnemonic: Longest name

Shortest acting nitrate—ANMnemonic: Shortest name

• Coronary steal phenomenon can be caused by—

HydralazineDipyridamolIsoflurane

Mnemonic: HDI steal from Heart

• Ivabradine

I—IF blocker (funny current, which opens in hyperpolarisationinstead of depolarization)Va—Visual field defectBradi—cause bradycardiaNe—Na+ channel blocker

• Rho kinase inhibitor—Fasudil

Mnemonic: Dil me fas—ro mat

• Myocardial infarction

Non-ST elevation MI—M—MorphineO—OxygenN—NitratesA—AspirinST elevation MI—S—StreptokinaseO—OxygenN—NitrateA—AspirinM—Morphine

• Antiarrhythmic drugs—Vaughan William classification:

I—Sodium channel blockersII—Beta blockers

Pharmacology 59

III—Potassium channel blockersIV—Calcium channel blockersV—Others

Mnemonic: SBP

• Class III antiarrhythmic drugs

B—BretyliumI—IbutilideD—DofetilideA—AmioderoneS—Sotalol

Note: They can cause Torased des pointes.

• Benzodiazepines

GABA facilitatoryIncreases frequency of chloride channel openingDRC flatSpecific antidote—Flumazenil

Mnemonic: 4F

• Short acting benzodiazepines

T—Triazolam, TemazepamO—OxazepamL—LorazepamE—Estazolam

Note: Short acting BZD are—safe in elderly, liver disease,no hangover and no active metabolite.

• Vigabatrin

Vi—Visual field defectGaba—GABA

Tr—Transaminase

In—inhibitor. ‘In’ also stands for infantile spasm

Note: Vigabatrin is the drug of choice for infantile spasmwith tuberous sclerosis. ACTH is drug of choice for infantilespasm.

Mnemonics60

• Tiagabine

Mnemonic: Transport inhibitor of GABAIt is GABA reuptake inhibitor by inhibiting GAT1

• Drug decreasing alcohol craving—

N—NaltrexoneA—AcamprosateT—TopiramateO—Ondansetron

• Atypical antipsychotics—5HT2A/2C blockers, e.g. pine, doneand aripiprazole.

• Uses of topiramate—all seizures except absence.

Migraine prophylaxisObesitySmokingAlcohol addiction

Mnemonic: MOSA

• Uses of antipsychotic drugs—Anti—Antiemetic propertyPsy—psychosisCho—chorea (Huntington’s chorea)Tic—Tic disorder like Gille de La Tourette syndrome

• Agonist (κ)—antagonist (μ)P—PentazocineN—NelbuphineD—Dezocine

• Partial agonist—Buprenorphine, Butorphenol.

Mnemonic: 2B

• Drugs inhibiting cell wallFirmly—FosfomycinBind to—BacitracinBacterial—β lactumCell—CycloserineWall—Vancomycin

Pharmacology 61

Note: β lactum antibiotics—PenicillinsCephalosporinsCarbapenemsMonobactum

• Penicillinase inhibitor or β lactumase inhibitor

C—Clavulanic acid—with amoxicillinS—Sulbactum—with ampicillinT—Tazobactum—with piperacillin

• Uses of penicillin G

L—ListeriaA—ActinomycesS—SyphilisT—TetanusM—MeningococcusAn—AnthraxGo—Gonococcus (drug of choice is ceftriaxone)

Mnemonic: A men act on the list of gone sipohi

• No β lactum is effective against MRSA except 5th generationcephalosporin.

• 1st generation cephalosporin

CefazolinCefalexinCefadroxilCefalothinCefaloridine

Mnemonic: CefaException: Cefaclor is 2nd generation.

• 4th generation cephalosporinCefepimeCefpirome

• 5th generation cephalosporinCeftarolineCeftibiprole

Mnemonic: rol

Mnemonics62

• Cephalosporins secreted by bile

CeftriaxoneCefoperazone

Mnemonic: Bile per try

• Cephalosporins effective against pseudomonas—

CefepimeCefepiromeCefoperazoneCeftazidime

Mnemonic: 3P and ziddi

• Cefoperazone—

Secreted by bileEffective against pseudomonasDisulfiram like reactionhypoprothrombinemia

• Mechanism of action of tetracycline—prevents tRNA to bindto A site.

Mnemonic: T for T

• Antimicrobial drug preventing translocation—

M—MacrolidesC—ClindamycinQ—Quinapristin

• Buy AT 30S

SELL @ 50SAT— Aminoglycoside

TetracyclineSELL— Streptogramin (Quinapristine)

Erythromycin (Macrolides)LinezolidLincosamide

• Uses of tetracycline

S—SIADHR—Rickettsial infection

Pharmacology 63

I—Inguinale granulomaL—Lymphogranuloma venerumA—AtypicalN—pNeumoniaC—CholeraA—Amoebiasis

• Tetracyclines—contraindications and adverse effects—

K—contraindicated in Kidney failureA—Antianabolic actionP—PhototoxicityI—Insipidus—DIL—Liver failure is C/ID—Dental—affects growing bone and teeth. C/I in pregnancyand child < 8 years.E—Expiry date—causes Fanconi syndrome after expiry dateV—Vestibular dysfunction

• Macrolides is the drug of choice for—

C—Chancroid

L—Legionella

A—Atypical pneumoniaP—Pertussis

Can also be used for—C—Corynebacterium diphtheria

H—Haemophilus influenzae

A—Atypical mycobacteriaT—Toxoplasmosis

Side effects of macrolides—M—Motilin receptor stimulation

A—Allergy

C—Cholestatic jaundiceR—Reversible

O—Ototoxicity

Note: Vancomycin and aminoglycosides cause irreversibleototoxicity.

Mnemonics64

• Aminoglycoside

Neomycin— Most nephrotoxicMost neuromuscular blockadeUsed only topically

After neomycin,Gentamycin is most nephrotoxicMnemonic: G affects GFR

Streptomycin affects neuromuscular blockadeMnemonic: S affects Skeletal muscle

Note: Maximum hearing loss—Amikacin

Mnemonic: A affects auditoryMaximum vestibular damage—Streptomycin

• Side effects of Sulfonamide—A—Aplastic anemiaB—Bilirubiun displacement—KernicterusC—CrystalluriaR—RashA—AcetylationS—SLEH—Hemolysis in G6PD deficiency

• Pyrimethamine—Antiparasite

Mnemonic: P for P

Methotrexate—AnticancerMnemonic: M for M

Trimethoprim—Antibacterial

• Fluoroquinolones are contraindicated in renal failure except—

P—PefloxacinM—MoxifloxacinT—Trovafloxacin

• Respiratory flouroquinolones—can kill any bacteria causingrespiratory tract infectionO—Ofloxacin and levofloxacinM—MoxifloxacinG—Gemifloxacin

Pharmacology 65

• Gatifloxacin—Glucose—withdrawn because it causeshypoglycemia and hyperglycemia.

Mnemonic: G for G

• Multibacillary leprosy—treatmentOCD—Once daily Clofazimine (50 mg) and Dapsone (100 mg)RCM—Rifampicin (600 mg) and Clofazimine (300 mg)

Note: Monthly dose are supervised.

Paucibacillary leprosy—Treatment -????

• Bactericidal drugs— β lactumAminoglycosideFlouroquinolonesVancomycin

• Fast acting antimalarial drugs—M—MefloquineA—AtovaquineC—ChloroquineH—Halofantrine, lumefantrineA—Artemisin groupR—Res Q (Quinine)Slow actingProguanilPyrimethamineSulphadoxineTetracycline

• Fluconazole—DOC for Candida, Cryptococcus

Mnemonic: Flue can treat cry

Note: Fluconazole is also the DOC for prophylaxis of febrileneutropenia in immunosuppressants.

• Terbinafine—DOC for dermatophytosis.• Posaconazole—DOC for mucormycosis• Voriconazole—DOC for invasive aspergillosis, treatment of

febrile neutropenia.• Itraconazole—DOC for all non-serious fungal infection

except Candida and Cryptococcus.

Mnemonics66

• Hepatitis B—DOC—EntecavirAlternate drugs— oral—

LamivudineEmtricitabineTenofovir

Injectable—Interferon α

• NRTI used in hepatitis B—

L—LamivudineE—Emtricitabine

T—Tenofovir

• Hepatitis C—DOC—Interferon and ribavarin

• NNRTI—1st generation

E—EfavirenzN—Nevirapine

D—Delaviridine

2nd generationEtravirine

Rilpivirine

• Metronidazole is DOC for

G—Giardiasis

U—Ulcer—peptic ulcerP—Pseudomembranous colitis

T—Trichomoniasis

A—Anaerobic bacterial infectionG—Gardenella vaginalis (bacterial vaginosis)

• Antihelminthic drugs

Platyhelminths—Flukes and tapeworm—DOC—Praziquentel.

Mnemonic: P for P

Nemathelminthes—DOC—Albendazole

Exceptions to platyhelminthes—Liver fluke (Fasciola hepatica)

Dog tapeworm (Echinococcus)

Pharmacology 67

Exceptions to Nemathelminthes—Filaria—DOC—DECStrongyloides—DOC—Ivermectin

Onchocerca (river blindness)—DOC—Ivermectin

Mnemonic: iver for river

• Pulsatile GnRH is indicated in—

C—CryptoorchidismH—Hypogonadotrophic hypogonadismA—Anovulatory infertilityN—uNdescended testisD—Delayed puberty

Note: Continuous GnRH is indicated inPrecocious pubertyCancer like breast carcinoma, prostate carcinomaEndometriosisFibroid liomyoma (symptomatically)

• GnRH agonist

Leuprolide—First drugGonadorelin

Nafarelin—Nasally

Mnemonic: N for NGosarelinBusurelinHistarelin

• GnRH antagonist—relix

CetrorelixGanirelixAbarelixDegarelix

Mnemonic: X means cross means antagonist

• Thyroid inhibitors

Peripheral conversion inhibitors— 5’ deiodinase inhibitors—Propylthiouracil

Mnemonics68

PropranololPrednisolone

Mnemonic: 3P

• Metformin—used for Obese patient

Sulfonylurea—used for Thin patient

Mnemonic: MOST

• PTH causes partiality—

Increases serum Ca2+

Decreases serum phosphate

Note: Vitamin D decreases both while calcitonin increasesboth.

• Tamoxifen is a SERM and has beneficial action on

Bone—increases formation

Blood—decreases LDL, increases HDLBreast—decreases risk of carcinoma

Note: Doloxifen and Toremifen has similar action.

Raloxifen—only unfavorable action is thromboembolism.

• Thromboxane A2—aggregate platelets

Mnemonic: A for A

Prostaglandin I2—Inhibits aggregation of platelets

Mnemonic: I for I

• Uses of colchicine—

G—GoutC—Cirrhosis

M—Acute Mediterranean fever

S—Sarcoidosis

• Acute gout—

N—NSAIDSC—Colchicine

C—Corticosteroids

Pharmacology 69

• Indications of chloroquine—

R—RA

E—Extraintestinal amoebiasis

D—DLE

L—Lepra reaction

I—Infectious mononucleosis

P—Photogenic reactions

Mala—Malaria

G—Giardiasis

• Anakinra—IL 1 receptor antagonist.

Mnemonic: A1

• Oprelvekin is IL 11 used in anticancer drug induced thrombo-cytopenia.

Mnemonic: Eleven kin

• Ticlopedine causes thrombocytopenia

Mnemonic: T for T

• Side effects of heparin—

A—Alopecia

B—Bleeding

H—Hyperkalemia

O—Osteoporosis

T—Thrombocytopenia

• Mast cell stabilizers

K—Ketotifen

N—Nedocromil

S—Sodium cromoglycate

• Busulfan—side effects—

S—Skin pigmentation

U—Uric acid increased

LF—Lung fibrosis

A—Adrenal insufficiency

Mnemonics70

• TOC for Hodgkin’s lymphoma—Earlier:

M—Mechlorethamine

O—Oncovin (Vincristine)P—Prednisolone

P—Procarbazine

Now preferred:A—Adriamycin/Doxorubicin

B—Bleomycin

V—VinblastinD—Dacarbazine

• TOC for NHL—

C—CyclophosphamideH—Hydroxydaunorubicin/DoxorubicinO—Oncovin/VincristineP—Prednisolone+/– R—Rituximab

• TOC for colorectal carcinoma—

FOLFOX or FOLFIRIFOL—Folinic acidF—5FUOX—Oxaliplatin orIRI—Irinotecan

• Uses of methotrexate—

C—ChoriocarcinomaA—AbortionN—NHLC—Crohn’s diseaseE—Ectopic pregnancyR—RA

• Etoposide is used in—

T—Testicular carcinomaO—Oat cell carcinoma

P—Prostate carcinoma

Pharmacology 71

• Side effects of cytotoxic drugs—

B—Bone marrow suppressionA—AlopeciaD—DiarrheaH—Hyperuricemia

• Hypolipidemic drugs—bile acid binding agent

CholestyramineCholestipol

Cholesevalam

Mnemonic: Chole

• Ketamine

K—Kids. Induction agent of choice in children.

E—Emergency reactionT—Thalamocortical junction is site of action causing dissociativeanesthesia

A—Analgesia (profound)

M—Meals—can be given after mealsI—Increase all pressures (BP, IOP, ICP)

N—NMDA receptor blocker of glutamate

E—Excellent bronchodilator—preferred in asthamatics.

• Class I MHC molecules: CD8 T cells 1 × 8 = 8

Class II MHC molecules: CD4 T cells 2 × 4 = 8Peptide binding site on Class IMHC molecules is located in agroove between distal domains of α subunits (between α1 andα2 domains)

Mnemonic: 1dααααα

• Mechanism of resistance

Production of βββββ-lactamase: Both gram +ve and gram –ve

Alteration in PBP: Gram-positiveImpaired permeability: Gram-negative

Mnemonic: Beta both

PBP: Positive (2P is positive)

• Hepatitis virus

Hep A Hep B Hep C Hep D Hep E Hep G

Picorna Hepa DNA Flavivirus Incomplete Calcivirus Calcivirus

Mnemonic: PH FICC (Pic of Hema Fall In Class)

• Dengue hemorrhagic fever

Serotype 1 followed by serotype 2 is more dangerous thanSerotype 4 followed by:Serotype 2

Mnemonic: 12 >42

Also remember: Serotype 2 is more dangerous than otherserotypes.

• Lysogenic conversion

Salmonella typhi

72

Microbiology

5

Microbiology 73

Clostridium botulinumCorynebacterium diphtheriae

Mnemonic: Salmon bottles corn for lysogeny

• Nuclear inclusion bodies

Cowdry type A: HerpesvirusYellow fever virus

Mnemonic: HAYCowdry type B: Adenovirus

Poliovirus

Mnemonic: BAP

• Methods for sterilization of endoscopes

Rigid endoscopeAutoclave

Mnemonic: RiA

Flexible endoscopeGlutaraldehyde peracetic acid (20% cidex)

Mnemonic: EFG

• Dimorphic fungi

Penicillium marneffeiBlastomycesHistoplasma capsulatumParacoccidiomycesCandida albicans (not other Candida)Sporothrix

Mnemonic: Dimorphic Penicillin Blast his Para’s albi spores

• Culture media for isolation of Leptospira

Korthof mediumEMJH mediumFletcher mediumStuart medium

Mnemonic: KEFS

• Man is the definitive host in most of the parasitic infectionsexcept the following parasites where it is an intermediate host

Hydatid worm (Echinococcus granulosus)Malaria (Plasmodium)

Mnemonics74

Taenia solium (both definitive and intermediate host)Toxoplasma gondiiSarcocystis lindemanii

Mnemonic: HMT goli

• Parasites malabsorption

Common to adults and children:Entamoeba histolyticaGiardia lamblialHymenolepis nana

Mnemonic: EGHOnly adultsStrongyloidesCyclospora

Mnemonic: Strong Cycle of adultsOnly Children: Ancylostoma duodenale

Isospora belliCryptosporidium

Mnemonic: An Iso Cry of Children

• Antigen–antibody reaction

Ascending part: Prozone or zone of antibody excessPeak—zone of equivalenceDescending part—post zone or zone of antigen excess

Mnemonic: A Probe

• Oocyst size of acid fast parasites causing malabsorption

Cryptosporidium—5 μmCyclospora—10 μmIsospora—25 μm(Alphabetically arranged, size increases)

• Parasite causing autoinfection

Mnemonic: Strong Heman cryptically enters Philippines forTaenia solium auto infection.

Strongyloides stercoralisHymenolepis nanaCryptosporidium parvumEnterobius vermicularis

Microbiology 75

Capillaria PhilippinensisTaenia solium

• Worms that do not multiply in host.

Ancylostoma duodenaleEnterobius vermicularisWuchereria bancrofti

Mnemonic: Duodenum bans entry and multiplicationAlso rememberWorms that crawl out

Enterobius vermicularisT. saginata

Mnemonic: Crawling entry of saginata

• Microaerophilic bacteria

Helicobacter pyloriBorrelia burgdorferiCampylobacter

Mnemonic: Hell Boy in Micro Camp

• Viruses associated with blood transfusion

Parvovirus B-19Hepatitis BHepatitis CHepatitis GHIV type 1HTLV type 1Cytomegalovirus

Mnemonic: 19 BCG transfuses type 1 of Cytomegalovirus

• Transport media for Vibrio cholerae

Venkatraman Ramkrishnan (VR) mediaAlkaline peptone waterMonsur’s taurocholate tellurite peptone water

Mnemonic: Venkat transport Alkaline water to Maissur

• Obligate intracellular parasite

VirusChlamydiaRickettsiae

Mnemonics76

LegionellaMnemonic: VCRL (Viru Chalne ke liye Rickshaw lega)

• Selective media in which substances that inhibit or poison allbut a few microorganisms are added to a solid media (S for S).

Enrichment media are produced by adding selectivesubstances to liquid media.Enriched media are basal media enriched with blood, serumor egg.

• Classification of streptococci: Hemolytic (P) streptococci areclassified by Lancefield classification—based on nature of acarbohydrate ‘C’ antigen (Group A to K without I and J)

Griffith typing—‘M’ Protein

Mnemonic: GMP

• 01 Vibrio cholerae

Classical: Polymixin, Phage 4

Mnemonic: Polyphagic classEltor: Eltor, chick embryo

• Mycobacterium tuberculosis complex

No environmental sourceM. tuberculosisM. bovisM. africanumM. microti

• Non-tuberculous mycobacteria

(Atypical mycobacteria)Environmental source is postulatedM. avium intracellulare complexM. kansasiiMnemonic: Kans ka avium in atypical environment

• Enteropathogenic E.coli or Enteroadhesive E. coli—attachesintimately to enterocyte membrane, Infants and Children,Epidemic

Mnemonic: Infant attaches ad for epidemic in Patho.Enterotoxigenic E.coli: Traveller’s diarrhea

Mnemonic: T for T—Produces enterotoxin (Labile/Stable)

Microbiology 77

Enteroaggregated E.coli: Persistent diarrhea—heat stableenterotoxin EAST IMnemonic: Aggregate persistsEnteroinvasive resembles shigellosisDetected by Sereny tests, penetration of the Hela and Hep2cells.

Mnemonic: H2 S2 invades

• Leptospira: Three Rs

Rat, Rice, Rainfield.

• Treponema palladium, Syphilis

endemicum: Bejel

Mnemonic: BendPertunae: Yaws (Mnemonic: Ytune)Caratium: Pinta (Mnemonic: Pintu ki Car)

• Chlamydia trachomatis

Serotype A, B, Ba, C: Endemic blinding trachomaSerotype D–K: Inclusion conjunctivitis, genital chlamydiasis,Infant pneumonia

Mnemonic: IGISerotype L1, L2, L3: Lymphogranuloma venereum

Mnemonic: L for L

• Immunoglobulin IgG IgA IgM IgD IgE

Percentage of 75–85% 7–15 5–10 0.3 0.019total serum IgSerum half-life days 23 6 5 3 2.5

Mnemonic: In decreasing order GAMDEClassical complement activation: IgM and IgG (Mnemonic:Mahatma Gandhi Classical)Alternate complement activation: IgAMnemonic: A for AIg present in milk: IgA and IgG (Mnemonic: AG in milk)

• Epitope: Antigen

Paratope: Antibody

• Toxin acting by inhibiting protein synthesis

Shiga toxin

Mnemonics78

Pseudomonas toxinDiphtheria toxin

Mnemonic: Antiprotein ships dipp-pilli are pyelonephritis associated pilli that are found onuropathic strains ofE. coli.Mnemonic: P for P

• Gram-positive coccobacilli: Listeria

• Gram-negative coccobacilli: Bordetella

BrucellaCampylobacter

Chlamydia

HelicobacterHaemophilus

RickettsiaMnemonic: BCHR

• Bacteria acquiring characteristics

Transformation (free DNA soluble DNA): PneumococcusBacillusHaemophilus

Mnemonic: BPH/PnBahaTransduction (bacteriophage): Method of genetic engineeringT/t of inborn errors of metabolism

Mnemonic: DIGConjugation (actual physical contact): Episomes and plasmidsfor resistance.Lysogenic conversion (phage DNA itself is new geneticelement)

Corynebacterium diphtheriaeSalmonella typhiClostridium botulinum

• Thymus dependent tissues (collection of T-lymphocytes)

Spleen: Malpighian corpuscle in white pulp (periarterial)Lymph node: Paracortical area between follicles in cortex andmedullary cords in medullaMnemonic: Para Mal dependentBursa dependent (collection of B-lymphocytes)

Microbiology 79

(Thymus independent)Spleen: Germinal centreMantle layerPerifollicular region

Mnemonic: German Man around follicle are independentLymph nodes: Medullary cordsCortical folliclesGerminal centres

Mnemonic: Medulla and cortex in Germany are alsoindependent

• Property S. aureus S. epidermidisCoagulase Positive NegativeMannitol Ferments Non-fermentingPathogenicity Pathogenic Non-pathogenic

• Susceptibility tests

Shick test: DiphtheriaDick test: Scarlet fever

Mnemonic: S for D and D for S (opposite)

• Spirochete: BorreliaLeptospiraTreponema

Mnemonic: BLT (Balti in Hindi)

• Combined immunodeficiency

SCID (severe combined immunodeficiency)—def. of ADAWiskott-Aldrich syndromeAtaxia-telangiectasiaNezelof syndrome

Mnemonic: SWANDefective Phagocytosis

Chronic granulomatous disease (def. of NADPH oxidase)Chediak-Higashi syndromeMyeloperoxidase def.Job’s syndrome

• Two pigments produced by Pseudomonas aeruginosaPyocyanine: Bluish green pigment

Mnemonic: BCPyoverdin (fluorescein): Greenish yellow pigment

Mnemonics80

• Visceral larva migrains—Toxocara canis

Cutaneous larva migrains—A—Ancylostoma duodenaleN—Necator americanusS—Strongyloides stercoralis

• Human is the dead end host for

L—LeptospirosisT—TetanusT—Taenia solinumE—Endemic typhusJapan—Japanese encephalitisL—LegionellaE—Echinococcus, trichinellaH—Human rabies

• Characteristic features of Staphylococcus pneumoniaePneumatocele (thin walled cystic spaces that may contain airfluid levels)Pleural effusionPyopneumothorax (bronchopleural fistula)Abscess formationCavitation (single or multiple thick-walled cavities) (may bebilateral)Empyema

Mnemonic: 3P and ACE

• Actin: AD FSGS

CD2AP: Adult proteinuriaSteroid sensitive: NPHS I-Nephrin-19q. Finish congenitalnephrotic syndromeSteroid resistant: NPHS 2-Podocin-lq: AR acquired FSGS

Mnemonic: 2R-lq-AP

• Type III (pauci immune) RPGN

ANCA small vessel vasculitisWegener’s granulomatosisMicroscopic polyangiitisChurg-Strauss syndrome

Mnemonic: WMC

• Cox 1 Constitutive

Cox 2 Inducible

• Large vessel vasculitis

Giant cell arteritis (temporal arteritis)Takayasu arteritis

81

Pathology

6

Mnemonics82

Cogan syndrome

Mnemonic: Large giant taka of cogan

• Medium vessel vasculitis

PANKawasaki diseaseBuerger’s diseaseMnemonic: Pan per kabab aur burger)

• DNA repair defects

HNPCC (mismatch repair): Colon ca.Bloom syndrome: Developmental defectsFanconi anaemia: Bone marrow aplasiaAtaxia-telangiectasia: Neural symptomsXeroderma pigmentosa (nucleotide excision repair)—skin ca.

Mnemonic: HB FAX

• Bcl-1: Mantle cell lymphoma

Bcl-2: Follicular lymphomaBcl-6: Burkitt lymphoma

Mnemonic: My favourite Band is Bcl-126Diffuse large B cell lymphoma—Bcl-2 and Bcl-6

Mnemonic: D-26

• HLA B27 is associated withJuvenile rheumatoid arthritisPsoriatic spondylitisAnkylosing spondylitisInflammatory bowel diseaseReactive arthritis/Reiter’s syndrome

Mnemonic: Juvenile PAIR at 27 yrs of age

• Risk factors for atherosclesosis in decreasing order

Total cholesterol: HDLCApoprotein B 100: HDLCLDL cholesterol: HDLC

Mnemonic: TBL ratioH

• Classification of hyperlipoproteinemias

Lipoproteins elevated

Pathology 83

I: chylomicronsIV: VLDLV: (1+ 4 = 5)—chylomicron and VLDLIII: (4 – 1 = 3)—chylomicron and VLDL remnantII: LDL (lla—LDL, IIb—LDL and VLDL)

• Radical scavenging enzymes

– Glutathion peroxidase– Catalase– Superoxide dismutaseMnemonic: GCS

Note: Superoxide dismutase also generates free radicals(H2O2).

• Amyloid proteins and their clinical settings

Transthyretin (ATTR)Familial amyloidotic neuropathyMnemonic: FATSystemic senile amyloidosisMnemonic: SSTβ2 microglobulin (Aβ2m): Hemodialysis associated amyloidosis

Mnemonic: Dial M for amyloid

β2: amyloid protein (Aβ): Alzheimer’s diseaseSenile cerebral disease

Mnemonic: Sc and Ad

• Flexner-Wintersteiner rosettes are characteristic ofretinoblastoma

May also be seen inMedulloblastoma and pineoblastoma

Mnemonic: Flexible RMP (All are blast)

• Glomerulonephritis without proliferative changes

Minimal change diseaseAmyloidosisMembranous glomerulonephritisDiabetic nephropathy± FSGS

Mnemonic: Minimum Amul for membranous Dia

Mnemonics84

• Fibromatosis represent a group of fibrous benign or tumour-like conditionsDeep fibromatosis: Desmoid tumors

Mnemonic: Deepa ka DesSuperficial fibromatosisPalmar fibromatoses (Dupuytren’s contracture)Plantar fibromatosesPenile fibromatoses (Peyronie’s disease)

• Prader-Willi syndrome: Clinical features

Mental retardationDiminished fetal activityHypotoniaObesityShort statureHypogonadotrophic hypogonadism

Mnemonic: Pradip MDHOSH

• Angelman–Willi syndrome

SeizuresHypotoniaInappropriate laughter (Happy puppets)Mental retardationAtaxia

Mnemonic: Happy puppet SHIMA

• Multiple myeloma

Dutcher bodies—nuclear

Mnemonic: Multiple nuclear DutchRussell bodies: Cytoplasmic (Mnemonic: Russell Crowe)

• Mooser’s bodies: Endemic typhus

Mnemonic: Moosa is endemicMiyagawa bodies: Chlamydia trachomatis

Mnemonic: Miya KalamLafora bodies: Familial myoclonic epilepsy

Mnemonic: Lofar in Family

Pathology 85

• Pancytopenia with cellular bone marrow

Myelodysplastic syndromeMyelofibrosisMyelophthisisBone marrow lymphomaAleukemic leukemiaHairy cell leukemiaMnemonic: Cellular bone marrow M3 ka BAP hai

• Cold antibody hemolytic anaemia—usually IgM

Mnemonic: CM – Class Mate• Proteins defective in hereditary spherocytosis

Ankyrin > protein 3 (anion transport channel) > α-spectrin >protein 4.2 (palladin)

Mnemonic: AP3 ααααα S P4.2First memorize APSPThen AP3SPThen AP3 α SPThen AP3 α SP4.2

• Prader-Willi syndrome:(Chromosome 15) Paternal deletion

Maternal imprintingMaternal disomy

AngeIman syndrome: Maternal deletion(Chromosome 15) Paternal imprinting

Paternal disomy

• Mechanism of apoptosis

Caspase 9 (Nine): Intrinsic pathway

Mnemonic: In for InCaspase 8 (Eight): Extrinsic pathway

Mnemonic: E for E

• Histochemical staining of amyloid with Congo red observedunder ordinary light—pink red colour. Observed underpolarized light: Green birefringence

Mnemonic: PG

• Genes regulating apoptosis

Anti-apoptotic Pro-apoptotic

Mnemonics86

bcl-2 baxbcl-XL bad

bakbimbcl-xs

Mnemonic: L and LXL are anti-apoptotic

• Chronic manifestations of splenectomy

AnisocytosisBasophilic stipplingHowell-Jolly bodies (nuclear remnants)Heinz bodies (denatured Hb)Nucleated erythrocytes in peripheral blood, occasionallyPoikilocytosis

• Howell-Jolly bodies occur most frequently after

SplenectomyMegaloblastic anaemiaSevere hemolytic anaemia

Mnemonic: Jolly SMS

• Inactivation of free radical reactions

Enzymes: Glutathione peroxidaseCatalaseSuperoxide dismutase

Mnemonic: GCSNon-enzymatic system: Endogenous/exogenous anti-oxidantsa. Vitamin E, vitamin Cb. Sulfhydryl containing compounds: glutathione, cysteinec. Serum protein: Albumin

CeruloplasminTransferrin

Mnemonic: EC GC ACT

• Renal lesions in SLE (WHO classifications)

Class I: Normal by light, electron and immunofluorescentmicroscopyClass II: Mesangial lupus GN(Mildest clinical variant proteinuria, microscopic hematuriarare)

Pathology 87

Class III: Focal proliferative GN(Moderate, presents with proteinuria and hematuria)Class IV: Diffuse proliferative GN(Haematuria, nephrotic range proteinuria, mild to severe renalfailures)Class V: Membranous GN(Massive proteinuria and nephrotic syndrome)Class VI: End stage of proliferative lupus nephritis

Mnemonic: No Money FD ME

Note: GN—glomerulonephritis

• Location of epitheloid—Testis

Ovary (tunica)Pancreas (Islet)

Mnemonic: TOPPathologically found in granuloma.

• Antigen presenting cells (APC)

Professional (MHC II, GVHD)—Dendritic cellsLangerhans’ cellsFollicular dendritic cells.

Mnemonic: DLF is Very professionalNon-professional (MHC I, graft rejection)—Macrophages

B-lymphocytesGlial cellsEndothelial cellsThymic epithelial

cells.

• Autosomal dominant (AD)

H—Hypercholesterolemia (familial)Hereditary spherocytosisHuntington’s chorea

E—Ehlers-Danlos syndromeA—AchondroplasiaV—von Willebrand’s disease (type I and II)Y—PseudohypoparathyroidismD—Dystrophica myotonica

Mnemonics88

O—Osteogenesis imperfectM—Marfan’s syndromeI—Intermittent porphyriaN—Noonan’s syndromeA—AD PKDN—NF I and NF IIT—Tuberous sclerosis

• Marfan’s syndromeM—Mitral valve prolapseA—Arachnodactyly (long fingers)R—Retinal detachmentF—Fibrillin I deficiency

Family historyA—Ascending aorta aneurysmN—Negative nitroprusside testS—Superotemporal subluxation of lens

• Neurofibromatosis I (17q)N—NeurofibromaO—Optic nerve gliomaS—Sphenoid dysplasia (most common skeletal deformity)P—Plexiform NF

Positive family historyA—Axillary frecklingC—Café-au-lait spotsE—Eye (Lisch nodules on iris)

• Neurofibromatosis II (22q)M—MultipleI—InheritedS—SchwannomaM—MeningiomaE—Ependymoma

• Autosomal recessiveA— Alkaptonuria

AlbinismB—Beta thalassemia, sickle cell anemiaC—Cystic fibrosis

Pathology 89

D—Deafness (sensorineural)E—Emphysema (Panacinar-α1 antitrypsin deficiency)F—Friedrick’s ataxiaG—Gaucher’s diseaseH—Hurler’s disease

HemochromatosisI—Inborn errors of metabolismOthers—Niemann-Pick’s diseaseTay-Sachs diseaseWilson’s disease

• X linked recessive

Less—Lesch-Nyhan syndromeChronic—Chronic granulomatous diseaseHunter—Hunter’s diseaseHemophilic—Haemophila A and BGirls—G6PD deficiencyDon’t—Duchenne muscular dystrophyDent’s diseaseColor—Color blindnessFragile—Fragile X syndromeFab—Fabry’s diseaseBrutun—Brutun’s X linked agammaglobulinemiaWisely—Wiskott-Aldrich syndrome

• X linked dominantRat me—Rett syndrome (only seen in females)Char—Charcoat Mari tooth diseasePig—Incontinenta pigmenti (only seen in females)Airport pe—Alport syndromePhosphate kha raha tha—X linked hypophosphatemic rickets

• Mitochondrial inheritanceK—Kearns Sayre syndromeL—Leber’s hereditary optic neuropathyM—MERRF (myoclonic epilepsy with ragged red fibres)MELAS (mitochondrial encephalopathy with lactic acidosiswith stroke like syndrome)N—NARP (neurologic ataxia with retinitis pigmentosa)

Mnemonics90

O—Ophthalmoplegia (chronic external ophthalmoplegia)P—Pearson syndrome

• Multiple myeloma

SymptomsC—HypercalcemiaR—Renal failureA—AnemiaB—Bone lytic lesion (on X-ray or bone scan)

• ALL

Testicular infiltrationMediastinal lymph node involvementCNS infiltration

Mnemonic: TMC

• Supravital stains—Brilliant cresyl blue

New methylene blueCrystal violet

Mnemonic: BNC

• Stain

Acidic BasicCytoplasm DNA

• Warm antibody—IgGCold antibody—IgM

Mnemonic: ClassmateException—PCH (Donath Landsteiner antibody)-IgG

• Differential diagnosis of microcytic hypochromic anemiaSideroblastic anemiaIron deficiency anemiaThalassemiaAnemia of chronic disease

Mnemonic: SITA

• Migratory thrombophlebitis (Trousseau syndrome)S—StomachL—Lung

Pathology 91

A—AdenocarcinomaP—Pancreas

• Mutation of p53 Li-Fraumeni syndrome.

It is the most common gene mutation causing human cancer.S—Stomach cancerB—Breast cancerB—Brain cancerA—Adrenal cancerL—Lung cancer (squamous cell carcinoma)

Mnemonic: SBBAL

• Flea bitten kidney found in

We—Wegener’s granulomatosisHate—HSPP—PolyngitisS—Subacute endocarditisM—Malignant hypertension

• Posterior fossa anomalies

Dandy-Walker syndrome—Dilatation of 4th ventricle becauseof midline arachnoid cyst. Posterior fossa volume is increased.

Mnemonic: D for D. D is 4th letterArnold-Chiari malformation—cerebellar herniation.

• Myelin formation

CNS—OligodendrocytesPNS—Schwann’s cells.

Mnemonic: COPS

• Serology in hepatitis B—

s—HbsAge—HbeAgc—anti HBc abe—anti HBe abs—anti HBs ab

Note: c antigen lacks soluble surface receptor. So, do notappear in serum.

Mnemonics92

• Hepatitis D virus

Delta virusDefective virus (HDV RNA)Dependent (on HBV)

• Causes of Mallory-Denk body—

Indian childhood cirrhosisWilson’s diseaseHepatocellular carcinomaAlcoholismα1 anti-trypsin (AT) deficiencyPrimary biliary cirrhosis

Mnemonic: Indian child wil have alcohol AT primary bill

• Focal nodular hyperplasia

Females more commonly affected (ten times)OCP use is associatedAsymptomaticSingle

Mnemonic: FOCAl

• Mechanism of Injury caused by lightening flash as describedby Cooper and Andrews (1995)Direct strikeSide flashStep voltageSledge hammer effect (blunt trauma)Surface arc discharges and touch voltage

Mnemonic: 5SAlso remember: Four factors of SpencerBurning by superheated airSledge hammer and blow death by compress pushed beforethe currentDirect effect of high voltage currentEffect of expanded and repelled air

Mnemonic: BCDE

• Drug used for narcoanalysis (truth serum drugs)

ScopolamineSodium pentathalSodium amytalSodium seconal

Mnemonic: PAS Sodium and Scopolamine

• Exception to general rule of professional secrecy

C CrimeI Infectious diseaseV Venereal diseaseI Interest (Self)C Courts of LawS Servants and employees

93

Forensic Medicine and

Toxicology (FMT)

7

Mnemonics94

I Interest (Patient’s)N Negligence suits notifiable disease.CIVIC SIN InP.S .Interest: Patient’s and self

• Anti-cholinergic (atropine dhatura) poisoning

Dry as a bone (dryness of mouth and skin)Red as a beet (flushed face)Blind as a bat (dilated pupil)Hot as a hare (hyperpyrexia)Mad as a wet hen (delirium)OrDryness of mouth and anus (i.e. constipation)DysphagiaDilated pupilsDry hot skinDrunken gaitDeliriumDrowsinessDeath due to respiratory failure

• Seminial stain is identified by UV light (physical methods)

Mnemonic: SUV

• Constituents of a typical embalming solution

FormalinGlycerin

Mnemonic: EFG

• Methods of torture

suspension by the wrist: La bandera (Mnemonic: Wrist band)Beating with the palm on both ears simultaneously—telephone

Mnemonic: We pickup telephone to ear

• Hanging versus strangulation

Hanging features:Stretched neckSaliva (often runs out of mouth)Seminal fluid at glandsCarotid artery damage may be seen

Forensic Medicine and Toxicology (FMT) 95

Oblique ligature mark

Mnemonic: Hang SSS and CO

• Fatty liver is found in

Phosphorus > arsenic > mercury poisoningMnemonic: Fatty PAM

• Mercury poisoning: Diphtheritic colitis

Mnemonic: Mercury Dips in Cold

• Clinical feature of chronic lead poisoning—acute mani-festations

Anemia (with punctate basophilia)Burtonian lineColic and constipation: First symptom to arouse suspicion oflead poisoningDrop of wrist and footEncephalopathy in childrenFacial pallor: Earliest symptomGenitourinary system: Menstrual disorders, abortions still-births, degenerate off-springs and sterility.

• Forensic tests to detect seminal stain

Acid phosphatase testBarberio testCreatine phosphatase testELISA testFluorescence test

Mnemonic: ABCEF

• Fingerprint patterns

Loops 67%Whorls 25%Arches 6–7%Composite 1–2%

Mnemonic: LWAC

• Cephalic index

70–74.9 Pure aryans(Dolichocephalic) Aborigins

Mnemonics96

NegroesIndians

Mnemonic: PANI in Doli75–79.9 Europeans(Mesaticephalic) Chinese

Mnemonic: European in Chinese mess80–84.9 Mongols(Brachicephalic) Oriental Asians

Native Americans

Mnemonic: MONADolichocephalic RectangularMesaticephalic TriangularBrachicephalic Rounded

Mnemonic: DMB in increasing order

• Screening tests for blood stains

BenzidineOrthotoluidineLeucomalachite greenPhenolphthalein

Note: All these works on the principle of Hb as peroxidase,which in presence H2O2 turns odourless bases into colouredsalts.

• Blood /urine alcohol levels

Alcohol dehydrogenase method (ADH method)Breath analysisCavett method/Kozelka and Hinc methodGas chromatography—most desirable for medicolegalpurpose

Mnemonic: ABC-GK

• Snake venomsVasculotoxic Vipers (V for V)Neurotoxic Cobra (Convulsion) (C for C)

Krait (paralysis)Coral

Mnemonic: CKCMyotoxic: Sea snake

Forensic Medicine and Toxicology (FMT) 97

• Gustafson method of age determination by inspection ofindividual teeth:Root transparency: Precise measurementRoot resorptionAttritionParadentosisSecondary dentin formationCementum opposition

Mnemonic: TRAP SC

• Harrison and Gilroy test: Antimony, barium, lead

Mnemonic: AnbaleAtomic absorption spectroscopy (AAS): Antimony, Copper,barium

Mnemonic: Ancoba

Neutron activation analysis: Antimony, copper

• Getters test is done for drowning. It estimates chloride contentof blood from both sides of the heart.

A difference of 25% in chloride content is considered.Significant features seen

Fresh water drowning: HemodilutionLysis of RBC with liberation of potas-siumChloride content of left side of heartdecreased

Salt water drowning : HemoconcentrationRBCs are crenatedChloride content of left side of heartincreased

• Sign of death from typical drowning

Persistent profuse fine froth from the mouth and noseMaterials (that could be obtained from water only) grasped inthe hand

Fine typical froth from the air passageIncreased volume and edematous condition of the lungs.Finding of diatoms in the tissues, especially brain and bonemarrow.

Mnemonics98

• Permanent teeth Eruption time

First molar 6–7 yearsCentral incisor (6–8 years) 7–8 yearsLateral incisor 8–9 yearsFirst premolar 9–11 yearsSecond premolar 10–12 yearsCanines (11–12 years) 11–13 yearsSecond molars 12–14 yearsThird molars 17– 25 years

• Magnan’s symptoms: Feeling as if grains of sago are lyingunder skin

Feeling as if small insects (cocainebugs) are creeping on the skin.

It is seen in chronic cocaine poisoning.Macewan sign: An indication of hydrocephalus in whichpercussion of the skull generates a cracked pot sound.

• Putrefaction is delayed after death due to poisoning by

Carbolic acidArsenicAntimonyNux Vomica (strychnine)Zinc chloride

Mnemonic: CARAN Vomit Zinc to delay putrefaction

• Dactylography (Galton system)—Study of finger prints.

Mnemonic: DaGa

Poroscopy (Locard’s system)—Study of number, sizes anddistribution of pores of sweat glands on ridges (used onlywhen a part of finger print is available).

Mnemonic: PoLoPodogram—Study of foot print.Cheiloscopy (queiloscopy)—Study of lip prints.Rugoscopy (palatoprints)—Study of anterior part of palate.

Mnemonic: RuPa

• White vitriol—Zinc sulphate

Blue vitriol—Copper sulphate.

• World health report 2008 Primary health care: now more thanever—the report proposes four sets of reformsPublic policy reformsLeadership reformsUniversal coverage reformsService delivery reforms

Mnemonic: PLUS

• Eight essential components of primary health care (Alma-Atadeclaration)Education concerning prevailing health problems andmethods of preventing and controlling them.Prevention and control of locally endemic diseasesImmunization against major infection diseasesMaternal and child health care including family planningEssential drugs provisionsPromotion of food supply and proper nutritionTreatment of common diseases and injuriesAdequate supply of safe water and sanitation.

Mnemonic: ELIMENTS

• Ratio: PrevalenceStandardised mortality ratioCase fatality ratio

Mnemonic: PSC (Public Service Commission)

• National health policy 20022005—Polio, leprosy and yaws

Mnemonic: POLY

2015 (fifteen) – filaria.Mnemonic: f for f

99

Preventive and Social

Medicine (PSM)

8

Mnemonics100

• lMCI—five major illnesses

DiarrhoeaRespiratory tract infection (including otitis media)MalariaMeaslesMalnutrition

Mnemonic: DRM3

• Chemoprophylaxis

Plague: TetracyclineCholera: TetracyclineMnemonic: PCTInfluenza A: AmantadineBacterial conjunctivitisErythromycin ophthalmic ointmentDiphtheria: Erythromycinpertussis: Erythromycin

Mnemonic: BCDEP

• National programme for control of blindness 2001:Targetdiseases under vision 2020 (India)

Refractive errors and low visionCataractChildhood blindnessTrachomaDiabetic retinopathyCorneal blindnessGlaucoma

Mnemonic: Refree Catch Track of DCG of India

Vision 2020—WHO, Geneva, 19995 major blinding diseasesRefractive errors and low visionCataractChildhood blindnessOnchocerciasis (River blindness)Trachoma

Mnemonic: Refree Catch river track of WHO.

• Arthropod Borne diseases

Aedes Dengue haemorrhagic fever, dengue

Preventive and Social Medicine (PSM) 101

Rift valley feverChikungunya feverYellow fever

Mnemonic: DARCY

Culex Japanese encephalitisBancroftian filariasisWest nile feverViral arthritis

Mnemonic: Japan Ban West Virus for culex

Sandfly Kala-azarOriental soreOraya feverSandfly fever

Mnemonic: KOOS

Louse PediculosisEpidemic typhusRelapsing feverTrench fever

Mnemonic: LEPRT

Rat flea Bubonic plagueEndemic typhusChiggerosisHymenolepsis diminuta

Mnemonic: Rat on BEnCH

Trombiculid mite Scrub typhusRickettsial pox

Mnemonic: SR Mite

• Lepromin test

Early reaction: Fernandez reaction (48 hours reading > 10 mmarea of redness.Mnemonic: EF

Late Mitsuda reaction (21 days nodule > 5 mm)

• Breeding habits of mosquitoes

AlphabeticallyAedes: Artificial waterMnemonic: A for A

Mnemonics102

Anopheles: Clean water

Mnemonic: Clean–Anna

Culex: Dirty water

Mnemonic: CD

Mansonioides: Plant (vegetation) water

Mnemonic: Plant Man

• Biological transmission of arthropod-borne diseases

Propagative: Plague bacilli in rat flea.

Mnemonic: P for P

Cyclopropagative: Malarial parasites in mosquito

Mnemonic: CPM

Cyclodevelopmental: Filarial parasite in culex mosquito andguinea worm embryo in cyclops.

Mnemonic: CDFG

• Indian reference female: Approximate energy requirement

Light work—1900Moderate work—2200 (i.e. + 300)Heavy work—2800 (i.e. + 600)

• SAFE strategy for trachoma

SurgeryCorrection of entropion and trichiasis

Mnemonic: ENT surgery

Chemoprophylaxis is given for

Meningococcal meningitis (rifampicin) MyDiphtheria Dear

Malaria (chloroquine) Mother

Pertussis PrepareConjunctivitis Cool

Influenza A (amantadine) Ice

Cholera Cream inTetanus (penicillin) Ten

Leprosy (dapsone) Litre

Pneumonic plague Pocket

Preventive and Social Medicine (PSM) 103

• Parathion: Aryl phosphate

Mnemonic: R for R

Malathion: Alkyl phosphate

• HDI

KnowledgeIncomeLongevity (life expectancy at birth)

Mnemonic: KILO

• BCG vaccine: Normal saline

Measles vaccine: Distill water

Mnemonic: MD

• Types of data

Nominal data: No implication of order or ratioOrdinal data: Meaningful order but interval connot bemeasuredInterval data: Meaningful order, interval can be measured butratio of scores are not meaningful.Ratio data: Meaningful order, interval can be measured andratio of scores are meaningful.

Mnemonic: NOIR

First two are qualitative data and last two are quantitativedata.

• Mosquito control: Anti-adult measures

Residual spray: MalathionOMS-33LindaneDDT

Mnemonic: MOLD

Space spray: PyrethrumResidual insecticide: Ultra low volume space spray (feni-trothion, malathion)

Note: Malathion is not recommended as a larvicidal agent.

• Pertussis component in DPT enhances the potency ofdiphtheria toxoid.

Mnemonics104

Diphtheria toxoid increases the immunogenicity of Hibvaccine.

• Five cleans for control/prevention of neonatal tetanus

Clean bladeClean cord careClean delivery surfaceClean handsClean tie for the cord

Mnemonic: BCD-HT

• Factors determining sample size

Design of studyAccuracy of measurementsPrecision (degree of) requiredPlan of statistical analysisPrevalence of disease in cohort study or ratio of case tocontrol in case control study

Mnemonic: DAS3P

• Insect Rickettsial disease Agent Mnemonic

Vector

Louse Epidemic typhus R. prowazeki LEPRO

Louse Trench fever Rochalimaea Lottery Queen

quintana

Flea Endemic typhus R. typhi FLENTY(Murine typhus)

Tick Rocky Mountain R. rickettsii TIMORIspotted fever

Tick Indian tick typhus R. conorii TIINCON

Mite Rickettsial pox R. akari MIRIAKA

Mite Scrub typhus R. tsutsugamushi MISTSU

• HIV screening— ELISARapid testSimple testi.e. ERS battery

Confirmatory test—Western blot (protein based)

Preventive and Social Medicine (PSM) 105

• 2 screening tests used in—

Series ParallelSensitivity ↓ ↑Specificity ↑ ↓PPV ↑ ↓NPV ↓ ↑Mnemonic: P letter words ↓↓↓↓↓ in parallel

• Disease control—reduction of transmission of any disease sothat it stops to be a public health problem.

It implies— ↓ complication↓ duration of disease↓ financial burden↓ incidence

Mnemonic: CDFI

• Index case—1st case coming to the notice of investigator.

Mnemonic: I for I

Primary case—First case of a disease in a community.Secondary case—All cases who develop the disease from theprimary cases.In India, index cases are usually secondary cases.

• MUFA—Maximum in groundnut (Moongfali).

• RBSK—Rashtriya Bal Swasthya Karyakarm

Target beneficiary—0–18 years of ageServices— Diseases

DeficiencyDisability and developmental delaysDefects

Mnemonic: 4D

• RKSK—Rashtriya Kishore Swasthya KaryakarmAdolescent—10–19 yearsComponents— Clinics

CommunityCommunicationContent

Mnemonics106

ConvergenceCoverageCounseling

Mnemonic: 7C

• Skewed distribution

Tail on Right side is Positive skewness.Mean > Median > Mode.

Mnemonic: TRP

• Type I error—Null hypothesis True and Rejected.

Mnemonic: NTR is no. 1

Type II error—Null hypothesis false and accepted.P value = Probability of doing type I error.α—maximum permissible limit of type I error (usually 5%)β—probability of type II error

Note: Confidence level in a study = 1–αPower of study = 1–β

For significant results, confidence level > 0.95 or 95%.

• Parametric tests are used to compare mean and SD (standarddeviation) in

Paired data (1 group)—Paired test (before and after)Unpaired data of 2 groups—Unpaired testUnpaired data of 3 or more groups—ANOVA

Mnemonic: PUA

• Non-parametric tests are used to compare percentage orfraction in:

Sign test—Paired data (1 group)Chi-square test—Unpaired data (2 or more groups)

Mnemonic: chai ki quality

• Statistical graphs

Qualitative—PictogramPie chart

Preventive and Social Medicine (PSM) 107

Bar chartMap

Mnemonic: Pic pie bar map

Quantitative—Frequency polygonFrequency curveLine diagramLine chartOgive (frequency cumulative curve)Scatter diagramHistogram

Mnemonic: (FL)2OSH

• Hospital waste management

1—Human anatomical waste2—Animal waste3—Microbiology and biotechnology4—Waste sharps5—Cytotoxic drugs and discarded medicines6—Solid waste (cotton/cloth)7—Solid waste (plastic/rubber)8—Liquid waste9—Incineration ash10—Chemical waste

Mnemonic: HAM Share drugs and SoSo LIC

• ObesityBest indicator—Body mass index = Weight in kg/(height inmeter)2.Other indicators—Height in cm—Hundred = Broca’s index.

Mnemonic: HHB

Corpulence index = Actual weight/Desired weight

Mnemonic: CAD

Ponderal index = Height/cube root of weight.

Mnemonic: Pin Hai CRoW

Mnemonics108

• Impact indicators of ASHA—IMR—major

TB cases

Leprosy casesPEM rates

Mnemonic: PITL

• Focussed group discussion (FGD)—6–12

Mnemonic: 6 is F

Panel discussion—4–8

• Lecture—ideal audience size < 40

Role play/socio drama < 25

• SPIKES—done for cancer prognosis communication

S—Set up interview

P—Perception is assessed

I—Invitation to explanation

K—Knowledge

E—Emotions

S—Summary and strategy

Note: P- SPIKES—for Ca breast. P stands for protocol.

• GATHER approach is used for contraceptive counseling inRCH

G—Greet the couple

A—Ask the contraceptive requirement

T—Tell available methods

H—Help choose best methods

E—Explain the usage of contraception

R—Return visit

• Doctor–patient communication

3 levels— Intellectual

CulturalEmotional

Preventive and Social Medicine (PSM) 109

4 types— DefaultPaternalisticConsumeristicMutualistic

• Kuppuswamy scale is based on—

EducationIncome

Occupation

Mnemonic: EIO. All 3 are vowels

• International health regulation 2005 guidelines of WHO

Diseases notifiable to WHO—

SmallpoxSARS

Wild polio

Yellow feverPlague

Human influenza

Cholera

Mnemonic: SSP Wild yellow PHC

• NPCB—supported by World bank

Mnemonic: Blindness-Bank

RNTCP—supported by WHORCH (family planning)—UN fund for population activity

Mnemonic: family-Fund

• UNICEF

HQ—New York.

Mnemonic: New Chef

GOBI—For reduction of under 5 mortality rate

Growth monitoring

ORS

Breast feedingImmunization

Mnemonics110

New additions— Female educationFamily planningFood supplementation

• WHO low osmolarity ORS

Sodium—75 mmol/LGlucose—75 mmol/LChloride—65 mmol/LPotassium—20 mmol/LCitrate—10 mmol/LTotal osmolality—245

Mnemonic: SGCl PCi-75/75/65/20/10

Glucose—13.5 gmTrisodium citrate—2.9 gmNaCl—2.6 gmKCl—1.5 gmTotal—20.5 gm

• Essential healthcare—4A

AvailableAcceptableAccessibleAffordable

• Function of extraocular muscle

Superior obliqueLateral (abduction)IntorsionDepression

Mnemonic: SOLID

• Argyll Robertson pupil (ARP) (also called light neardissociation)

Accommodation reaction present (ARP)Pupillary reaction absent (ARP-PRA) (both direct andconsensual)Seen in several conditions affecting midbrain (pretectalnucleus)

• RAPD (Marcus Gunn pupil) is most characteristic of lesion inoptic nerve

Mnemonic: Rapid Nervous Gun

• Anterior surface of cornea has highest refractive power (2/3rdof eye’s refractive power)

Centre of lens has highest refractive index.

Mnemonic: COP (Cornea-Power)

• Visual pathway and site of lesion

Optic nerve: Ipsilateral blindnessProximal part of optic nerve: Ipsilateral blindness withcontralateral hemianopia or superior quadrantanopiaCentral level of chiasma: Bitemporal hemianopia

Mnemonic: Hum Bite central Cheese

111

Eye

9

Mnemonics112

Optic tract: Homonymous hemianopia.Temporal lobe: Quadrantopic homonymous defect

Mnemonic: Tample queen

Optic radiation: Homonymous hemianopia

Anteriorly in occipital cortex: Contralateral temporalcrescentic field defectOccipital lobe: Homonymous hemianopia (usually sparingthe macula)

Mnemonic: HRT—Homonymous hemianopia in opticradiation and optic tract

• Primordial tissue and derivatives

Surface ectoderm: Conjunctival epitheliumCorneal epithelium

Lacrimal glandsTarsal glands

Lens

• Various grades of visual defects

Low vision—< 6/18 to 6/60—Cat 1

Economic blindness—< 6/60 to 3/60—Cat 2Social blindness—< 3/60 to 1/60—Cat 3

Manifest blindness—< 160 to only light perception—Cat 4

Absolute blindness—No light perception—Cat 5

Mnemonic: LESMA-631 LN

Note: WHO grade: Low vision—Cat 1 and 2Blindness—Cat 3, 4 and 5

• Causes of persistent hyperplastic primary vitreous (PHPV)Patau syndrome (Trisomy 13)Norries diseaseWalker Warburg syndrome

Mnemonic: Norries persistently walks to pataya

• Visual pathway from retina to visual cortex

Ganglion cells: M (Magno cells)lateral geniculate body: Magnocellular lamina—

(lamina 1, 2)

Eye 113

Visual cortex: Superficial layer 4CFunction: Movement, depth, location and flicker

Mnemonic: MSM

• Vogt triad: Tuberous sclerosis and congenital glaucoma

Islet of Vogt—pterygium

• CMV retinitis occurs in HIV patients with < 50 CD4 T cells

• Ophthalmoscopy

Indirect: Inverted, real, 5 times magnification, ora serrata isseenMnemonic: I for IDirect: Erect, virtual, 15 times magnification.

• Medication for treatment of open angle glaucoma

Decrease in aqueous secretion: Beta blocker (timolol)Clonidine congeners(Brimonidine, Apraclonidine)Carbonic anhydrase inhibitors(Acetazolamide, Dorzolamide)

Mnemonic: ABCDIncrease in trabecular outflow: Pilocarpine (miotics)Mnemonic: Tray Se Pilo

Increase in uveoscleral outflow: Prostaglandins (latanoprost)

Note: Only acetazolamide is oral, others mentioned aretopical.

Atropine is C/I in all types of glaucoma. Pilocarpine is also C/Iin uveitis

• Bilateral subluxation of lens

Marfan’s syndrome: Downward and temporally (Harrison,17th edition)Homocysteinuria: Downward and nasally.

• Most common ocular infection in AIDS patients—CMV

MC cause of chorioretinitis in AIDS patients—CMVMC ocular lesion in AIDS—HIV microvasculopathy(involving conjunctiva and retina)MC ocular neoplasm in AIDS—Kaposi sarcoma

Mnemonics114

Earliest and most consistent finding in HIV retinopathy—cotton wool spots.CMV retinitis occurs in HIV patients with < 50 CD4 T cells

• Predisposing factors for sympathetic ophthalmitis

InjuryIncarceration of irisInfection is absent

Mnemonic: 3I

• Indication of LASIK surgery—criteria

Cornea should not be excessive flat or steep.Central corneal thickness > 500 micronRefraction must be stable for 18 monthsAge > 18 yearsMyopia – 1 to – 20 diopters

Mnemonic: CT RAM

Contraindication of LASIK

Diabetic retinopathyAutoimmune diseaseDry eyeMonocular patientInfections, e.g. conjunctivitis, keratitisGlaucomaKeratoconusPoor endothelial cell count <1500Thin cornea <450 micron

Mnemonic: DAD MIG KPT

• Management of senile entropion

Bick’s operationWobin, Jones and Rech operation (plication of inferior lidretractors)Modified Wheeler’s operation.Weiss operation

Mnemonic: Bick’s 3W

• The extent of normal visual field with a 5 mm white colorobject is

Eye 115

Superiorly 50°Nasally 60°Inferiorly 70°Temporally 90°

Mnemonic: SNIT (in increasing order)

• Tonography is a non-invasive technique for determining thefacility of aqueous outflow.Tonometry is measurement of intraocular pressure by aninstrument called tonometer, this process is called tonometry.

• Protanomalous—defective red color perception

Deuteranomalous—defective green color perception

Tritanomalous—defective blue color perception

Mnemonic: RGB

• Superior oblique: IVth cranial nerve

Mnemonic: SO4

Lateral rectus: VIth cranial nerveMnemonic: LR6

Rest extraocular muscles—IIIrd cranial nerve

• Pupil in different conditions.

Acute conjunctivitis—normalAcute uveitis—constricted/irregularAcute congestive glaucoma—dilated vertically ovalRetrobulbar neuritis—normal

• Open angle glaucoma is characterised by the triad of

Typical visual field defects (earliest visual field defects inglaucoma are small isolated paracentral scotomas between2° and 10°)Raised intraocular pressureOptic disc changes/cupping of disc (vertical cup/disc ratiobecomes greater than horizontal)

Mnemonic: VIC

• Wernicke’s hemianopic pupillary reaction—optic tractlesion.

Marcus Gunn pupil—optic nerve lesionArgyll Robertson pupil—Pretectal neucleus involved

Mnemonics116

Mnemonic: ARP-Pre

Holmes Adie—ciliary muscle involvement.

• Congenital glaucoma (buphthalmos)—characteristic triad ofsymptoms

BlepharospasmPhotophobiaLacrimation

Mnemonic: BPL

Signs: Mild proptosisEnlarged corneaHaab’s stria (opacity due to rupture in Descemet’smembrane)Deep anterior chamberLens subluxation

Note: In megalocornea, eye is absolutely normal except forthe large cornea.

• Fast or saccadic horizontal eye movements—abducensnucleus

(ipsilateral)—PPRF (ipsilateral)—contralateral frontal lobe

Mnemonic: F for F

Smooth/persuit eye movement—Parietal lobe

Mnemonic: P for P

Note: Cerebral structures determine when and where eyemove, while brainstem determine how they move.

• Primary optic atrophy: It is caused by lesions affecting thevisual pathways from retrolaminar portion of the optic nerveto the lateral geniculate body.

CausesHereditary optic neuropathy

Toxic and nutritional optic neuropathies

Traumatic optic atrophyRetrobulbar neuritis

Compressive lesions (Tumors and aneurysms)

Mnemonic: HTN TRAT

• Trotter’s triad

Mnemonic: CD 105

CD: Conductive deafness10: Palatal paralysis due to involvement of CNX5: Temporoparietal neuralgia due to ipsilateral involvementof CNV

• Endoscopic cordectomy: Classification by European laryngealsociety

Type I Subepithelial cordectomy

Type II Subligamental cordectomy

Type III Transmuscular cordectomy

Type IV Total Cordectomy

Mnemonic: ELMT (like element)

Extended cordectomy encompassing

Type IVa— Contralateral fold

Type IVb—arytenoids

Type IVc—ventricular fold

Type IVd— subglottis

Mnemonic: CAVES

• Structures fully developed at birth

– Mastoid antrum– Auditory ossicles– Tympanic cavity– Internal ear structures

Mnemonic: MATI

117

Ear, Nose and Throat (ENT)

10

Mnemonics118

• Pathophysiology of Romberg test

Equilibrium (central postural control) is dependent on inputfrom three peripheral modalities:Proprioception (joint position sense) carried in posteriorcolumn of spinal cord.

Vision

Vestibular apparatus

Mnemonic: PVR Vision

• Vestibular schwannoma/acoustic neuroma can arise from anycranial nerve except optic and olfactory nerve because theyare myelinated by oligodendroglia rather than Schwann cells.

• Syndromes associated with sensorineural deafness

Bartter’s syndromeAlport’s syndromeDistal renal tubular acidosis

Mnemonic: BAD

• Siegel’s pneumatic speculum: Uses

To test mobility of tympanic membraneTo see magnified view of small perforation

To introduce medicine into middle ear

Fistula test for vestibular function.

Mnemonic: 3MF

• Isshiki’s categorization of thyroplasty

Type 1 Medial displacementType 2 Lateral displacement

Type 3 Shortening (relaxation)—female to male

Type 4 Lengthening (tensioning)—male to female(low to high pitch)

Mnemonic: Mela ka Shole

• Weber test

Conductive deafness—lateralised to diseased earSensorineural deafness—lateralised to better ear

Mnemonic: LCD—Lateralised in conductive deafness todiseased ear

Ear, Nose and Throat (ENT) 119

• Rinnie’s test:Positive Rinnie AC > BC—Normal person and

sensorineural deafness

Mnemonic: PoRi AB Normally Sensed

• Meniere’s disease

Tinnitus (fluctuating)VertigoSensorineural hearing loss

Mnemonic: TVS

• Fistula test: Induction of nystagmus (vertigo) by producingpressure changes in the external canal, which are thentransmitted to the labyrinth.

Normal condition—negative (as pressure cannot betransmitted)Positive inCholesteatomaSurgically created window in the horizontal canal(fenestration operation)In abnormal opening:In oval window (post stapedectomy fistula)In round window (rupture of round window membrane)False positive: Congenital syphilis

Meniere’s disease (Hennebert’s sign)False negative: Cholesteatoma fills the site of fistula

Note: It is absent when labyrinth is dead.

• Etiology

Malignant otitis externa PseudomonasOtitis externa Staphylococcus aureusOtomycosis Aspergillus niger, A. fumigatus,

Candida albicansOtitis externa hemorrhagica—viralAcute otitis media in paediatric age groupStreptococcus pneumoniae > H. influenzae > M.catarrhalis.

• Water’s (occipito mental)—maxillary sinus (best seen)Caldwell’s (occipito frontal)—frontal sinus (best seen)

Mnemonic: Front OF Well

Mnemonics120

• Neoplasm showing calcification:Craniopharyngioma (75%)

Oligodendroglioma—glioma (50%)

Choroid plexus papilloma (25%)Astrocytoma (posterior fossa tumor) (20%)

Meningioma (20%)

Ependymoma (unusual but if seen dense)

Mnemonic: CO CAME

Note: Most common cause of intracranial calcification ispineal calcification.

• Acute pancreatitis—X-ray abdomenGasless abdomenColon cut off signSentinel loopRenal halo sign

Mnemonic: Halo GCS

• Chronic pancreatitis—ERCPBeaded appearanceString of pearls appearanceChain of lake appearanceRat tail stricture of CBD

Mnemonic: Be strong chained rat

• Rasmussen aneurysm—pulmonary artery

Mnemonic: PR

Physical quantity SI unit Non-SI unit

Radioactivity Becquerel (Bq) CurieAbsorbed dose Gray (Gy) RadDose equivalent Sievert (Sv) Rem

Radiation exposure Columns/kg Roentegen

Mnemonic: ABC

Ab gray is redShiv and Ram are equivalentEx colonel Rungta

Ear, Nose and Throat (ENT) 121

• Malampatti grading—inspection of oral cavity (for assessmentof difficult airway)I—Faucial pillars, soft palate, uvulaII—Faucial pillars, soft palate, uvula masked by base of tongueIII—Only soft palateIV—Hard palate

Mnemonic: UMSH. Like Umesh

• ASA physical status scale(American Society of Anesthesiologist)1—Healthy patient2—Mild to moderate systemic disease3—Severe systemic disease4—Severe systemic disease that is Constant threat to life5—Moribund patient not expected to survive without surgery6—Declared brain dead patient whose organ is beingremoved for donor purpose.

Mnemonic: HMS CMD

• Facial artery—From cervical part: Submental

TonsillarAscending palatineGlandular (to lymph nodes and sub-mandibular gland)

Mnemonic: STAG

From facial part: Superior labial

Inferior labial

Unnamed posterior branchesLateral nasal

Mnemonic: SILa ko UP me LaNa

• Developmental dysplasia of hipDAD—Adduction to dislocate—Barlow maneuver

RAB—Abduction to reduce—Ortolani maneuver

Mnemonic: O rab

• Bacterial pneumonias associated with cavitation

StaphylococcusKlebsiellaPseudomonasAnaerobic bacteria

Mnemonic: Staph Klub main Pseudo Anna ka Cave

• Bronchogenic carcinoma

Cavitatory variant : Squamous cell (most common)Large cell

Mnemonic: Squat in Large Cavity

Central location: Squamous cellSmall cell

Mnemonic: SSC

Peripheral location: AdenocarcinomaLarge cell

Mnemonic: PAL

• ARF: Prerenal versus intrinsic

Mnemonic: FRU Na+ is less in Pre-renal ARF

Fractional excretion of Na+(%) <1.

Renal failure index Na Na

cr cr

+ +U P

<1U P

Urinary sodium concentration <10 mmol/L or < 20 mEq/L.

• Coagulation factor def.—treatment

II, V, X, VII and XI—FFPVIII—F VIII concentrate

122

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11

Medicine 123

IX—F IX concentrateFibrinogen, XIII—Cryoprecipitate

Mnemonic: Cry in First and thirteenth

• Paraneoplastic syndrome

Small cell (lung) Ca : CalcitoninACTHANFAVP (vasopressin)Gastrin releasing peptide

Mnemonic: Small CAG

Squamous cell CA—PTH

Mnemonic: Squat Pith

• Restless leg syndrome

Drugs causing it: AlcoholAntipsychoticsBarbituratesBenzodiazepinesCaffeine

Mnemonic: ABC

Also remember: Common causes: Idiopathic/familialIron def. anaemiaChronic renal failure

• Bacteria associated with invasive diarrhoea

Plesiomonas Listeria monocytogenesAeromonas Yersinia pestisShigella SalmonellaEntero invasive E. coli

Mnemonic: PLAY SIS

• Type of LKM antibodies

Anti-LKM 1 Chronic hepatitis C

Autoimmune hepatitis 2

Anti-LKM 2 Drug induced hepatitis

Anti-LKM 3 Chronic hepatitis D

Mnemonic: A1 C1 Dr2 D3

Mnemonics124

• Reiter’s syndrome characteristic triad (found in one-third ofpatients)

Reactive arthritisConjunctivitisUrethritis

Mnemonic: RCU

• Strawberry gingivitis—Wegener’s granulomatosis

Strawberry tongue—Kawasaki diseaseStrawberry vagina—Trichomonas

• Temporal arteritis worsens on exposure to cold

Multiple sclerosis worsens on exposure to heat (Uthoff’s)

Mnemonic: CT

• Zona glomerulosa—mineralocorticoid

Zona fasciculata—glucocorticoidZona reticularis—Sex steroid

Mnemonic: GFR-MGS

• Normal peressure hydrocephalus triad

Dementia (mild to moderate)Urinary incontinenceAtaxic or apractic gait

Mnemonic: NPH has DUA

• Motor neuron disease

UMN and LMN: Amylotropic lateral sclerosisUMN only: Primary lateral sclerosis

Mnemonic: Upper Primary or UPri

LMN only: Progressive spinal muscular atrophy (progressiveLondon or lower progressive)

• Treatment of visceral leishmaniasis

First linePentavalent antimony

Sodium stibogluconate

Meglumine antimonateAmphotericin B

Medicine 125

ParomomycinPentamidineMiltefosine

Mnemonic: SPAM

Cutaneous leishmaniasisFirst line

Pentavalent antimonyParenteral alternativeAmphotericin BPentamidine

Mucosal leishmaniasisFirst line

Pentavalent antimonyAmphotericin BAlternativePentamidine

• Omphalocele

Chromosomal abnormalitiesCongenital abnormalities (including cardiac and CNS)Carnell’s pentalogyBeckwith-Wiedemann syndrome

Mnemonic: 3 COMB

• Hypoxic ischemia

Preterm infants—Periventricular leucomalacia—spasticdiplegia

Mnemonic: Pre Peri dip

Term infants—Subcortical white matter and basal ganglia—status marmoratus—Spastic quadriplegia(Basal ganglia and thalamus)

Mnemonic: Term = 3 SQ

Modified Jones’ criteria for rheumatic fever

Major critera CarditisArthritis (migratory polyarthritis)Sydenham’s choreaSubcutaneous nodulesErythema marginatum

Mnemonic: CASSEt

Mnemonics126

• HSP is characterized by a tetrad of

PurpuraArthritisGlomerulonephritisAbdominal pain

Mnemonic: PAGlA

• Renal papillary necrosis: Associated conditions

(underlying mechanism is ischaemia)Diabetes mellitusObstruction of urinary tract with infectionSickle cell diseaseAnalgesic abuse (aspirin)

Mnemonic: DOSA

Note: Alcohol also ca uses RPN.

• Virchow’s triad for venous thrombosis

Hypercoagulability of bloodInjury to endotheliumStasis of blood

Mnemonic: HIS

• Nitroblue tetrazolium test is used for phagocytosis

Mnemonic: Phani

• Framingham major criteria for congestive heart failure

PNDNeck vein distensionRalesPositive hepatojugular refluxIncreased venous pressure (> 16 cm H2O)CardiomegalyAcute pulmonary oedema, andS3 gallop

Mnemonic: PNR PICASo

• Burn-curling ulcer-duodenum

Mnemonic: BCD

Medicine 127

Cushing’s ulcer—Stress ulcer

Mnemonic: S for S

Peripheral aneurysm—Popliteal artery (70%)

Mnemonic: P for P

Central dot sign—Carolis disease

Mnemonic: C for C

• Achalasia cardia—Bird’s beak appearance

Diffuse esophageal spasm—Corkscrew esophagus

Mnemonic: AB-CD

Ca esophagus—Rat tail appearance (Mn: Carat)

• Antiviral therapy in chronic hepatitis B is indicated in

HBsAg (+), HBeAg (±), and HBV DNA high levels and ALTelevated

Note: In above case, if HBeAg is – ve, it is called precore-mutant.

Viral hepatitis—ALTAlcoholic hepatitis—AST (S for Sharab)

• Hypocellular bone marrow ± cytopenia

StarvationQ feverLegionnaire’s diseaseAnorexia nervosaMycobacteria

Mnemonic: Starving QLAM is Hypo

• C-ANCA—Cytoplasmic proteinase 3 is the target antigen.

P-ANCA—Perinuclear myeloperoxidase is the major targetantigen.

Mnemonic: CP-MP

• Pontine syndromes

Ventral pontine syndrome—Millard-Gubler syndrome

Mnemonic: VM

Lower dorsal pontine syndnome—Fovilles syndrome

Mnemonic: FOLD

Mnemonics128

Upper dorsal pontine syndrome—Raymond-Cestan syndrome

Mnemonic: Ray UDP

• Features of pontine stroke

HyperpyrexiaHyperhydrosisHyperventilation/Hyperapnoea (severe)Quadriplegia and comaPin point pupil, occulocephalic manoeuvre/doll’s head,ocular blobbingDecerebrate rigidity

Mnemonic: 4H + Quadriplegia + Ocular features +Decerebrate rigidity

• Damage to red nucleus causes contralateral involuntarymovementsChoreaAthetosisTremor

Mnemonic: Red CAT

• Benedikt’s syndrome—Ipsilateral oculomotor palsy +contralateral involuntary movement—chorea, athetosis,tremor

Nothnagel’s syndrome—Ipsilateral oculomotor palsy +contralateral cerebellar ataxiaClaude’s syndrome = Benedikt + Nothnagel

• Laurence–Moon–Biedl syndrome

Autosomal recessiveMental retardationObesityRetinitis pigmentosaPolydactylyHypogonadism

Mnemonic: MORPH

• CNS tumours

Intra-axial Neuronal tumorAstrocytoma (glioma)Lymphoma

Medicine 129

Mnemonic: NALy

Extra-axial Pituitary tumorSchwannomaMeningioma (dura based)

Mnemonic: PSM. Also, dura matter is a Meninge. (PSM isextra-axial)

• Contrast nephropathy is more common in individuals withpre-existing

MetforminMultiple myelomaCRF (chronic renal failure)CCF (congestive cardiac failure)Diabetes mellitusDehydration (hypovolemia)

Mnemonic: (MCD)2

• Obstructive lung disease versus restrictive lung diseases

In obstructive lung disease, vital capacity and FEVI/FVCdecrease, others remain normal (diffusion capacity), increases(residual volumes) or normal to increases (total lung capactiy).– In restrictive lung disease, VC, RV,TLC, DLCO, all dec-

reases except FEVI/FVC which is normal to increase.

• Obstructive lung disease

AsthmaBronchiectasisBronchiolitisCystic fibrosisCOPD (chronic bronchitis and emphysema)

Mnemonic: ABC

• Lower motor neuron (LMN) palsy

Flaccidity (hypotonia)FasciculationFlexor plantarIndividual muscle paralysisDegeneration reactionAtrophy (wasting) is marked (cardinal feature)

Mnemonic: 3FIDA

Mnemonics130

Upper motor neuron (UMN) palsyExtensor plantarClonusClasp knife spasticity (hypertonia)Group of muscles affected

Mnemonic: ECG

Note: Loss of superficial reflexes are found in both UMNand LMN.

• Wernicke’s encephalopathyTriad of: Global confusion

Ophthalmoplegia (due to LR palsy)Ataxia

Mnemonic: GOA

• Seven adverse prognostic factors for Hodgkin’s disease

Leukocytosis with WBC > 15,000Serum albumin level < 4 g/dlLymphocytopenia with either oneAbsolute lymphocyte count < 6000/mlStage IV diseaseHb < 10.5 g/dlAge > 45 yearsMaleLymphocytes < 8% of WBC

Mnemonic: LAL SHAMA

Thrombotic thrombocytopenic purpura (TTP)Decreased renal functionDisturbed neurological functionThrombocytopeniaFeverMicroangiopathic hemolytic anaemiaPathognomonic of TTP—pentad + normal coagulation tests

Mnemonic: RNT Fever in MAHA, TTP

• Jodbasedow disease—iodine induced hyperthyroidismCaused by: Diet

Radiographic contrast materialIodine containing drug like amiodarone

Medicine 131

Wolff-Chaikoff effect—iodine dependent transient sup-pression of thyroid. Prevents iodide organification.

Mnemonic: Wolf are decreasing

• Wegener’s granulomatosis

Characteristic triad ofUpper respiratory tract infectionLower respiratory tract infectionRenal involvement

Mnemonic: ULR

• ATP 7B—Chromosome 13—Wilms’ disease

ATP 7A disease—kinky hair disease.

• Pure motor neuropathies

Hereditary spinal muscular atrophy

Lower motor neuron form of amylotropic lateral sclerosis

Lambert-Eaton myaesthenic syndromePoliomyelitis

Lead intoxication

Dapsone intoxicationAdult variant of hexosaminidase deficiency

Acute intermittent porphyria (occasionally)

Tick bite paralysis

Mnemonic: Here, a lamba and lower pole is leading dapsoneto adult variant of porphyria by the tick bite

• Malignant melanoma—Clark level.

I Restricted to epidermisII Invading papillary dermisIII Impinging reticular dermisIV Invading reticular dermisV Invading subcutaneous tissue

Mnemonic: EPRRS

Impinges before invasion

• MEN2A (Sipple)

MTC

Mnemonics132

PheochromocytomaParathyroid hyperplasia or adenomaCutaneous lichen amyloidosisHirschsprung’s diseaseFMTCMnemonic: MP ke Para main FM se Clah

• MEN2B

MTCMucosal and gastrointestinal neuromasMarfanoid featuresPheochromocytoma

Mnemonic: 2MP

• Noonan’s syndrome versus Turner’s syndrome

Noonan’s syndromeAutosomal dominant (seen in both sexes)Pectus carinatum/pectus excavatumCardiac defect—pulmonary stenosis, HOCM, ASDMental retardation.

Mnemonic: Ad PCM at Noon

• Turner syndrome

Phenotypically females onlyBroad chest with widely spread nipples.Coarctation of aortaBicuspid aortic valveShort fourth metacarpal

Mnemonic: Turn broad, CoBi to short.

• Metabolic acidosis

Normal anion gap

Fistula

CholeraMineralocorticoid deficiency

Ureterosigmoidostomy

DiarrhoeaRenal tubular acidosis

Medicine 133

Ammonium chloride ingestion

Mnemonic: FC MUDRA

Increased anion gap

KetoacidosisExogenous substanceRenal failureLactic acidosis

Mnemonic: KERLLactic acidosis (shock, cardiopulmonary arrest, severeanaemia, carbon monoxide or cyanide poisoning)Ketoacidosis (Diabetics, alcoholics, starvation)

Mnemonic: DAS

Exogenous substances (Ethylene glycol, methanol, salicylates)

Mnemonic: EMS

• Amount of sodium bicarbonate given in metabolic acidosis is= 1/2 × body weight

(kg) × [Desired HCO3– measured HCO3]

Half of this quantity should be administered within first ½ hr.Desired HCO3

= 25 mEq/L.

• Acute pericarditis—after several days T waves becomeinverted but this occurs only when ST segments return tobaseline.

Acute myocardial infarction—T wave inversion occurs withinhours before ST segment returns to baseline.

• Osborne wave/J wave/Late delta wave/Camel hump sign is anECG finding usually seen in hypothermia

Mnemonic: CaJOL

• Shortly before S1–S4

Mnemonic: 41

Shortly after S1—ejection click (high pitched)Between S1 and S2—midsystolic clickShrotly after S2–S3Tumor plop, opening snap, pericardial knock

Mnemonic: S3TOP

Mnemonics134

• Ejection click

Semilunar valves (AS, PS, HTN)Opening snap—AV Valves (MS > TS)Pericardial knock—constrictive pericarditis tumor plop—atrial myxoma

• Pansystolic murmur—VSD, MR, TR and aortopulmonaryshunts.

Mnemonic: MTVMidsystolic murmur—aortic (AS, COA, aneurysm, PDAPulmonary (PS, P.hypertension, P.artery dilatation)Early systolic murmur TR (in absence of Pul. HTN), MR (in anoncompliant left atrium), VSD (V.small muscular VSD, largeVSD with Pul. HTN)

• Allergic bronchopulmonary aspergillosis

Main diagnostic criteriaClinical history of asthmaPulmonary infiltrates (transient/fixed)Precipitating antibodies to Aspergillus fumigatusImmediate skin reactivity to Aspergillus antigen (wheal andflare response)Peripheral eosinophiliaElevated serum IgE levelsCentral/proximal bronchiectasis.

Mnemonic: All India Exam 2 times, i.e.

(AIE) 2 + Bronchiectasis

• Causes of transudative pleural effusion

Cirrhosis of liverNephrotic syndromeMyxoedemaCHFSVC obstruction

Mnemonic: CNMC in SVC is transudative

• Exudative pleural fluid

Light criteria: Pleural fluid protein / serum protein > 0.5Pleural fluid LDH/serum LDH > 0.6Pleural fluid LDH > 2/3 upper limit of serum LDH

Medicine 135

With increased amylase: Pancreatic pleural effusionEsophageal ruptureMalignancy

Mnemonic: Amylase increases in PEM

With decreased glucose: Bacterial infectionMalignancyRheumatoid pleuritis

Mnemonic: Glucose decreases in BMR

• The MC cause of sporadic viral encephalitis—HSV-1

The MC cause of epidemic viral encephalitis—arbovirus (JEvirus)The MC cause of viral meningitis—enterovirus

• Charcot’s joint /neuropathic joints

Joints involvedSyringomyelia Glenohumeral joint, elbow and wristTabes dorsalis Knee, hip and ankleDiabetes mellitus Tarsal and metatarsal joints

Mnemonic: STD from above downwards—position of joints

• Disorders associated with Charcot’s joint

SyringomyeliaTabes dorsalisDiabetes mellitusPeroneal muscular atrophyAmyloidosisLeprosyMeningomyeloceleCongenital insensitivity to pain

Mnemonic: STD PALM CO

• Down’s syndrome: Transient myeloproliferative syndromeAML (FAB M7—acute magakaryocyticsubtype)

• Extraintestinal manifestation occurs more commonly withCrohn’s disease than with ulcerative colitis. Those speciallyassociated with Crohn’s disease include:

Digital clubbingOral aphthous ulcers

Mnemonics136

Peripheral arthritisErythema nodosumEpiscleritisRenal stones (uric acid oxalate)Gallstones

Mnemonic: DOPE ERG in Crohn’s

• Approach to diagnosis of arthritis in a single joint

Associated with fever Septic arthritisNot associated with fever Acute: Trauma

HemarthrosisHemophilia

Chronic: JRATraumaTuberculosisLegg-Perthes disease

Mnemonic: JTTL (like Jatil in hindi)

• Tubulopathy/ tubulitis

PCT—RTA2, Fanconi syndrome

Mnemonic: 2 Fan for PC

Thick ascending—Bartter syndrome

Mnemonic: BaTA

DCT—Gitelman syndromeCollecting duct : RTA1

Liddle’s syndromeD(Nephrogenic)

Renal papilla—Renal papillary necrosisMajor calyx/pelvis—hydronephrosis, pyonephrosis, refluxnephropathyAny/all—acute tubular necrosis

Mnemonic: 1 Little DIN in CD-Collecting Duct

• Syndrome Most likely congenital cardiac lesion

Down’s syndrome ASD of endocardial cushion type(ostium primum type)

Turner’s syndrome Coarctation of aorta, bicuspid aorticvalve

Medicine 137

Noonan’s syndrome Pulmonic stenosisHolt-Oram syndrome (ASD with bony abnormalities)

Familial ASD

(Strongest association)Marfan’s syndrome Aortic or pulmonary artery dilatation,

mitral or aortic regurgitation

Ellis-van Creveld syndrome ASD + single atrium

Rubella PDA > PS > VSD

• X-linked recessive X-linked dominant

Hemophilia A Hypophosphatemic ricketsG6PD deficiencyDuchenne-Becker muscular dystrophyFragile X syndromeFabry’s disease

• LAP scores are decreased in PNH and CML

LAP scores are increased inInfectionPolycythemiaLeukemoid reaction

Mnemonic: IPL

• Myeloproliferative syndrome

Polycythemia veraIdiopathic myelofibrosisEssential thrombocytosisCML

• a wave: Right atrial contraction

c wave: Bulging of tricuspid valve into right atriuma-x descent: Atrial relaxation and downward displacement

of tricuspid valvev wave: Increasing volume of blood in the right atriumv-y descent: Opening of tricuspid valve and subsequent

rapid in flow of blood into right ventricle.

• a waves: Due to distension produced by right atrialcontractionLarge a waves Tricuspid stenosis

Mnemonics138

(atria is contracting Pulmonic stenosisagainst increased resistance)

Pulmonary hypertensionCannon a waves Regularly—during junctional rhythmIrregularly—AV dissociation with ventricular tachycardia,complete heart blockAbsent a waves—atrial fibrillation

• a-x descent—due to both atrial relaxation and the downwarddisplacement of the tricusupid valve during ventricularsystole. Accentuated in: Constrictive pericarditis

Restrictive cardiomyopathy

Cardiac tamponade

Mnemonic: PRT

Reduced with Right ventricular dilatationReversed with Tricuspid regurgitation

• v-y descent—by the opening of the tricuspid valve andsubsequent rapid flow of blood into the right ventricle

Accentuated in:Tricuspid regurgitation

Constrictive pericarditisReduced with: Tricuspid stenosis

Right atrial myxoma

(suggest obstruction to right ventricularfilling)

• Tricuspid regurgitation causes the v waves to be prominent.When TR becomes severe, the combination of a prominentv waves and obliteration of x-descent results in a single largepositive systolic wave.

• Pheochromocytoma has been called the 10% tumor. 10% oftumor are:

Bilateral Malignant

Occur in children Multiple

Extra adrenal

Familial

Mnemonic: BCEF MM

Medicine 139

• Type 1 respiratory failure

PaO2—low (< 60 mmHg)PaCO2—normal/low (≤ 49 mmHg)PA-aO2—increasedOxygenation affected:Parenchymal disease (V/Q mismatch)Diseases of vasculature/shuntsInterstitial lung diseasesExamplesRight to left shuntsARDSPneumoniaEmphysema

Mnemonic: RAPE

Type 2 respiratory failurePaO2—decreased (< 60 mmHg)PaCO2—increased (> 49 mmHg)PA-aO2—normal

Ventilation affected:

Obstructive lung disease—COPD, foreign bodyDecreased central respiratory driveBrain injury, meningitisWeakness of respiratory muscleMyasthenia gravisInterstitial lung diseasePolymyositisKyphoscoliosis

• Tumors associated with polycythemia vera

HypernephromaUterine fibromyomaMeningiomaPheochromocytomaAdrenal adenomaCerebellar hemangioblastomaHepatoma

Mnemonic: HUM PACH

Mnemonics140

• Normal total bilirubin is 0.3 to 1.0 mg/dl

Conjugated—0.1 to 0.3 mg/dlUnconjugated—0.2 to 0.7 mg/dlNormal alkaline phosphatase3 to 13 KA/U (30 to 120 lU/L)

• Clinical significance of different casts (urinary casts)Hyaline casts—normal constituent of urine and no attachedsignificance. Tomm-Horsfall protein is the protein secreted byepithelial cells of loop of Henle. This protein may be excretedas hyaline castsRBC cast—glomerular injuryWhite cell cast—interstitial injury seen in interstitial nephritisor pyelonephritisBroad granular cast—interstitial fibrosis and dilatation oftubules, seen in CRFPigmented muddy brown granular casts—ischaemic ornephrotoxic injury, i.e. tubular necrosis

• Parkinsonism is characteristically associated with a triad ofBradykinesiaTremor at restRigidity

Mnemonic: BTR (like Butter in hindi)

• The clinical hallmarks of ‘Huntigton’s disease

Behavioural disturbanceChoreaDementia (late onset)

Mnemonic: BCD

• MigraineFrontotemporal usually (lateralised)FemalesFamily historyFocal neurological symptoms like clumsiness and weaknessPain preceded by auraPhotophobiaPhotopsia and fortification spectraParesthesia with tingling and numbness

Mnemonic: 4F4P

Medicine 141

Other—all age group affectedPain builds up

• Cluster headache

Periorbital or less commonly temporalAll ages above 10 years with peak at 30–50 yearsMale preponderance (90%)No hereditary factorPain (periodic attacks 1–21 days)

Begins without warningReaches crescendo within 5 minutesLasts for 45 minutes

Excoriating, deep, explosive pain but only rarely pulsatileAwakens the patients from sleepHomolateral lacrimationReddening of eye

Nasal stuffinessPtosis

Nausea

• Gastrointestinal lymphoma—modified Ann Arbor classification

IE Tumor confined to small intestine

IIE Spread to regional lymph nodesIIIE Spread to non-resectable nodes beyond regional nodes

IVE Spread to other organs

Mnemonic: SRNO

• Basal ganglia and lesions

Chorea—Caudate nucleus and putamen (striatum)

Mnemonic: C for C

Athetosis — Lantiform nucleus (globus pallidus)

Mnemonic: Lathi

Hemi ballismus — Subthalamic nucleus

Mnemonic: Hemi-Sub

Parkinsonism —substantia nigra

• All porphyrias except congenital erythropoietic porphyria(which is autosomal recessive) are autosomal dominant.

Mnemonics142

• P24 antigen assay is the earliest marker for HIV infection. It ismost useful as a screening test for HIV infection in patientpresents prior to development of antibodies.

Antibodies to HIV (detected by ELISA or Western blot)generally appear in circulation 4 to 8 weeks after circulation.

The MC screening test used for HIV—ELISA

The MC confirmatory test—Western blot

Screening test in window period of acute HIV infection is P24antigen

The gold standard for diagnosis is PCR(in a patient with positive or indeterminate ELISA test and anindeterminate Western blot or in patients in whom serologicaltesting is unreliable (patients with hypogammaglobulinemia)

• Progression to chronicity in various types of hepatitis

Hepatitis A—noneHepatitis B—occasional (1–10%), 90% in neonatesHepatitis C—common, 50–70% chronic hepatitis; 80–90%chronic infection.Hepatitis D—relatively common: In coinfection with HBV, itis same as that for HBVIn superinfection it is variableHepatitis E—none

Note: Hepatitis B, C, D Parenteral spreadHepatitis A, E Non-parenteral spread.

• Anti-HbSAg positive alone indicates

Immunization with HBsAgRemote past infectionFalse positive

• Chronic arsenic exposure is associated with greatly elevatedrisk of skin cancer (both basal cell and squamous cellcarcinoma)

Lung cancerCa liver (angiosarcoma)Bladder CaKidney CaColon Ca

Medicine 143

• Portal HTN in absence of cirrhosis may result from alterationin hepatic architecture produced by

Vitamin AExposure to vinyl chlorideArsenic intoxicationAdministration of thorium dioxide

Mnemonic: VAVA-thorium

• Descending motor paralysis

3 important causesDiphtheriaBotulinumPolio

Mnemonic: Descending Bottle Paralysis

• Subdural empyema: The major pathogen

Aerobic and anaerobic streptococci (about 50%)Staph (about 12–16%)Aerobic gram-negative bacilli (3–10%)Other anaerobes (5%)

Note: H. influenzae is the most common causativeorganism in children only.

• Order of involvement of adrenals from various primaries indecreasing order: Melanoma > lung and bladder > breast,cervix and colorectal Ca > ovary and kidney > prostate.

• Particle size and respiratory tract

Particle with size 10–15 mm in diameter—do not penetratebeyond the upper airways.Particle of size 2.5–10 mm—deposit relatively high intracheobronchial treeParticle of size <2.5 mm can be carried to lower airways.

• Low serum iron with increased TIBC—iron deficiencyanaemia

Low serum iron with decreased TIBC—anaemia of chronicdisease

• Condition giving false positive reaction with the modern RPRand VDRL tests include:

Mnemonics144

Acute false positive reactions (<6 months)Recent viral illness or immunization Genital Herpes

HIVMycoplasma pneumoniaMalariaParenteral drug useChronic false positive reactions (> 6 months)AgingAutoimmune disorders (SLE, RA)Parenteral drug use

Mnemonic: AAP

• Non-specific tests for syphilis which use cardiolipin antigen(Reagin antibody)WassermannKahn’s flocculation testVDRLRPR (rapid plasma reagin)Advantage: Become negative after effective treatment ofsyphilis and hence can be used inDetecting reinfectionIndicating stage of diseaseMonitoring treatment response

Mnemonic: RST

DisadvantageLack of specificityFalse positive cases

• Low pitched sound—S3, S4 and tumor plop. (heard by bell)

• Mitral valve prolapsed—most common cause is Myxomatousdegeneration—mid-systolic click on examination.

• Orthopnea:Acute CHFBilateral diaphragmatic palsy(GB syndrome/myesthenic crisis/transverse myelitis)Platypnea:ARDSHepatopulmonary syndromeAtrial myxoma

Mnemonic: AHA

Medicine 145

• RCM—most common cause—amyloidosisDCM—most common cause—alcohol

Mnemonic: DCM-Daru

• S3—Ventricle gallopS4—Atrial gallop

Mnemonic: V3S

• Atrial fibrillation—treatment:R—Rate control (Esmolol)A—Anticoagulation (Warfarin, debigatran, rivoraxaban)C—Chemical cardioversion/rhythm control (IV ibutilide/amiodarone)E—Electrical-DC shock.

• Stroke identification:S—Smile—asymmetryT—Talk—aphasiaR—Raise arm—inability to raise arm

• Most common blood vessels involved in atherosclerosis—Abdominal aorta > Coronary artery > Carotid artery >Popliteal artery.

Mnemonic: AA CoCa Pi

• Infective endocarditis

ABE (< 2 weeks)—Staph. aureus.IV drug abuse—Right-sided endocarditis—Staph. aureus

Mnemonic: acute, abuse-aureus

SABE (> 2 weeks): Streptococcus viridens > EnterococcusProsthetic valve endocarditis: CONS (Coagulase negativeStaphylococcus)

Mnemonic: Pros and cons

Streptococcus viridian: SABE (> 2 weeks)Prosthetic valve endocarditis (> 12months)

Mnemonic: viridians for more

Left-sided endocarditis (R to L shunt)—Patent fossa ovalis—Enterococcus.

Mnemonics146

• Modified Duke’s criteria for infective endocarditis

Major:1. Echocardiography— Vegetations on the heart valves

Oscilating mass in the atriaValve ring abscess

2. Blood culture positive3. New onset murmur due to valve perforation

Minor:1. Predisposition to IV drug abuse2. Fever > 101°F3. Immunological manifestations:

R—Roth spotO—Osler’s nodeG—Glomerulonephritis (post-infectious)

4. Vascular phenomenon—Janeway lesion, mycotic aneurysm5. Echocardiography—small vegetations (0.5 mm)

Mnemonic: P-FIVE

Diagnosis—2 major or 1 major + 3 minor or 5 minor

• Carey Coombs murmur: Delayed diastolic murmur—Charac-teristic murmur of rheumatic myocarditis

Mnemonic: cc is dd

• Early diastolic murmur

G—Graham Steell’s murmurA—AR (mild)P—PR (mild)

Mnemonic: GAP is ED

• Mid-diastolic murmur

Austin Flint murmur (severe AR)MS (with secondary spike)Flow murmur of ASD

Mnemonic: MDM is Flea flow MS

• Framingham heart risk score

AgeTotal cholesterol

Medicine 147

GenderCigarette smokingSBP

Mnemonic: AT GCS

• Sheehan’s syndrome—order of loss of hormone—G—GHF—FSHL—LHT—TSHA—ACTH

Mnemonic: GFLTA

• Migraine

Pulsating headacheOne day illnessUnilateral headacheNauseaDisabling.

Mnemonic: POUND

• Sturge-Weber syndrome

S—SeizureT—Trigeminal nerve distribution—Hemangioma/Portwine stainU—unilateral weaknessR—mental RetardationG—GlaucomaE—Eye problems—Buphthalmos.

• Anencephaly—

PolyhydramniosPost-dated deliveryPituitary hypoplasia

Mnemonic: 3P

• Diagnostic criteria of SLEM—Malar rashD—Discoid rashS—Serositis

Mnemonics148

O—Oral ulcerA—Antinuclear antibody (ANA)P—PhotosensitivityB—Brain (lupus cerebritis)R—Renal (lupus nephritis)A—AIHA (Auto-immune hemolytic anemia)I—Immunological criteria (dsDNA/anti-cardiolipin antibody/anti-β2 glycoprotein)N—Non-erosive arthritisDiagnosis—4 out of 11 (immunological criteria is must)

• PAN—Poly arteritis nodosa

It is necrotizing vasculitis of small to medium vessels.

Mnemonic: PAN: Pulmonary Artery Never involved

Note: PAN can never lead to renal artery stenosis.

• Wegener’s granulomatosis is now known as granulomatosiswith angitis. It is a granulomatous vasculitis.

Blood vessels of upper respiratory tract—EpistaxisLower respiratory tract—HemoptysisKidney—Hematuria

CT scan chest—multiple Cavities in lungIOC-C-ANCATreatment—cyclophosphamide.

Mnemonic: 3C

• Atypical pneumonia is caused by:

Mycoplasma

Coxiella burnetti

ViralLegionella

Chlamydia

Mnemonic: My cox vi leg se chalte hain

• Child Pugh criteria of cirrhosis of liver:

Bilirubin ↑Albumin ↓

Medicine 149

Ascites +/↑Asterixis +/↑PT with INR ↑

Note: BAAAP

• Pautrier’s microabscess—Mycosis fungoides

Munro microabscess—Psoriasis

Mnemonic: P for M and M for P

• Psoriasis

Auspitz signBulkely membraneCandle grease signDIP joint in psoriatic arthropathyExtensor surface of knee, elbow and scalpFace uncommonGrattage signGuttate psoriasis (Eruptive psoriasis)Histopathology—parakeratosisInverse psoriasis (flexor surface involved)Itching uncommonKoebner phenomenon (isomorphic phenomenon)Never involved—Mucosa, CNS, alopeciaOnycholysis, thimble pitting of nail plate

Papules and plaquesRupoid psoriasis

Silvery mica scales

T cell mediated chronic inflammatory diseasevon Zombusch disease (generalized pustular psoriasis)

Wornoff ring (white halo around lesion).

• Hand-Schüller-Christian disease triad:

Calvarial defect in scalp

Diabetes insipidus

Exophthalmos

Mnemonic: CDE

Mnemonics150

• Congenital syphilis: Hutchinson’s triad:

Hutchinson’s teethInterstitial keratitis

8th nerve deafness.

Mnemonic: HI8

• Solid raised area

Papule < 1 cm

Nodule 1–5 cmTumor > 5 cm.

Mnemonic: PNT

• Pemphigus vulgaris:

Nikolosky sign

Intraepidermal bullae

Mucosal involvementAcantholysis

Poor prognosis

Upper part of body (Trunk > limbs)Row of tombstone

40–60 years age group

Mnemonic: NIMAPUR

• Pemphigoid:

Subepidermal and tense bulla

Lower part of body (limbs > trunk)Good prognosis

60–80 years old

• Inclusion body myositis

Familial

Fine motor involvement—earlyFacial muscle involvement

Falling

Chronic course (years)

Mnemonic: 4F

Medicine 151

• Microsporum does not infect nails.

Mnemonic: MN

Epidermophyton does not infect hair.

Mnemonic: EH

• Gonococcus involves epididymis, infection spreadingthrough urethrae

Syphilis involves testis, infection spreading blood.

Mnemonic: ST

• Kawasaki disease—presents with

NC—Non-purulent conjunctivitis

C—Children

S—Strawberry tongueU—Unilateral cervical lymphadenopathy

R—Rash (polymorphic)

E—Edema in hands and feet

• Esophageal dysphagia

Solid and liquid Progressive systemic sclerosis—progressive(motility) Achalasia—progressive

Diffuse esophageal spasm—non-progressive

Mnemonic: PaDi Motile

Solid only Cancer—progressive(mechanical) Stricture (peptic)—progressive

Ring (lower esophageal)—non-progressive

Mnemonic: CaSRi is Mechanical

• MBC fail ESWL test—stones that are not broken by ESWL are

Calcium oxalate monohydrateBrushiteCysteine

Mnemonic: MBC

• Whole liver orthotopic transplantation require five sequentialanastomoses.

Suprahepatic lVClnfrahepatic lVCPortal veinHepatic arteryBile ducts

Mnemonic: SIPoHe Bill

• Factors indicating possibility of malignancy in gallbladderpolyps

Single polypSize of polyp > 1.0 cm

152

Surgery

12

Surgery 153

Size of polyp change rapidlySessile polypStones (gall) associated50 yrs or more age

Mnemonic: S/50

• Radiolucent ureteric stones are

Uric acid stonesTriamterene stoneIndinavir stoneXanthine stones

Mnemonic: UTI-X

• Risk factors for cholangiocarcinoma

Primary sclerosing cholangitisCholedochal cystUlcerative colitisClonorchis sinensisChronic typhoid carriers

Mnemonic: 5c

• Revised trauma score

Respiratory rateGlasgow Coma ScaleSystolic BP

Mnemonic: RTS-RGS

Trauma and injury severity score (TRlSS)Mechanism of injury—blunt or penetratingInjury severity score (ISS)Revised trauma score (RTS)Age

Mnemonic: MIRA

• The structures injured by the primary blast wave in order toprevalence are the

Middle earLungsBowel

Mnemonic: MLB

Mnemonics154

• Glasgow Coma Scale

E Eye opening 4V Verbal response 5M Motor response 6

Mnemonic: EVM (Electronic voting machine)

Eye opening SpontaneousTo voiceTo painNone

Mnemonic: SVP

Verbal response OrientedConfusedInappropriate wordsIn Comprehensible soundNone

Mnemonic: OrC InAC

Motor response Obeys commandsLocalises painWithdrawsFlexion (abnormal)Extension (abnormal)None

Mnemonic: OLWFEN (Just remember)

• Psammoma bodies

Papillary Ca of thyroidPapillary type of renal cell CaProlactinoma (pituitary adenoma)Serous cystadenoma of ovaryMeningiomaAppendical carcinoid (rarely)

Mnemonic: 3PSMA

• Sister Mary Joseph nodule

Most common tumours to present with this signStomach (20%)Colon (14%)Ovary (14%)

Surgery 155

Pancreas (11%)

Mnemonic: SCOP

• Phosphate or struvite stones are infection stones associatedwith urea splitting organisms

ProteusPseudomonasProvidenciaKlebsiellaStaphylococciMycoplasma

Mnemonic: P3KSM

• Syndrome associated with Wilms’ tumour

Denys-Drash syndromeMale pseudohermaphroditeMesangial sclerosisMissense mutation in WT1 gene

Mnemonic: Denys ki MaMMi

Beckwith-Wiedemann syndromeHemihypertrophyMacroglossiaVisceromegalyOmphaloceleWilms’ tumour

Mnemonic: BHMV of Wilms’

• Papillary Ca thyroid

CalcificationRadiation inducedOrphan-Annie eye nuclei

Mnemonic: CROP

• Hashimoto’s thyroiditis

Hürthle cells are virtually pathognomonic

Mnemonic: H for H

• Posterior urethra (membranous urethra) is injured in pelvictrauma and fracture

Mnemonic: P for P

Mnemonics156

Anterior urethra (bulbar urethra is injured in fall astride injury)Mnemonic: A for A

• Lynch syndrome

Colon CaEndometrial CaOvarian Ca

Mnemonic: CEO

• Choledochal cyst—classification

Type 1 Fusiform dilatation of bile ductType 2 Diverticulum protruding from the wall of the

CBDType 3 Dilatation of the bile duct within the duodenum

(choledochocele)Type 4A Multiple dilatations of intrahepatic and extra-

hepatic bile ducts (both)Type 4B Multiple dilatations involving only the extra-

hepatic bile ductsType 5 Multiple dilatations of intrahepatic bile ducts

also called Caroli’s disease

Mnemonic: Fausi dives due 2 extra care

• MEN 1 syndrome

Parathyroid tumours > Pancreatic endocrine tumours >Pituitary tumours.

Mnemonic: Para No.1, Pan-2nd, Pitu-3rd

Among pancreatic tumours: In order to decreasing frequencyin MEN 1:

Pancreatic polypeptide tumourZollinger-Ellison syndrome (gastrin)InsulinomaGlucagonomaVIPomaSomatostatinoma

Mnemonic: PZI GVS

• MEN I: Chromosome 11

MEN II: Chromosome 10

Surgery 157

• Absorbable suture materials

Natural-Catgut-chromic/plainCollagen

Synthetic—polydiaxononePolyglactin (Vicryl)

PolyglycapronePolyglyconate

Polyglycolic acid

Mnemonic: Cat Call Vicky DAGA

• Hereditary gastrointestinal polyposis syndromes

Gardner’s syndromeOsteomaDesmoid tumourLipomasEpidermal cystAmpullary CaFibroma

Mnemonic: GOD LEAF

Turcot’s syndrome—Brain tumors

Mnemonic: Rain Coat

• Nigro regimen for anal canal tumors

Chemotherapy—5-FU + MitomycinOr

Bleomycin, Cisplatin

• Types of hiatus hernia

Type 1 Sliding hernia: 70–80% (i.e. hernia en glissade)

Type 2 Paraoesophageal rolling hernia: 8–10%Type 3 Mixed: 10%

Mnemonic: SRM

• Lateral swellings of the neck

Ranula

Bronchogenic cyst

Cystic hygroma

Mnemonic: RBC

Mnemonics158

• Tumors of urothelium, i.e. pelvis, ureter and bladder are mostcommonly transitional cell carcinoma. But tumours of urethraare most commonly squamous cell carcinoma.

• Cardinal manifestations of bowel obstruction

– Pain is most pronounced in small bowel obstruction– Vomiting is most pronounced in high small bowel

obstruction– Distension is most pronounced in large bowel obstruction

• Pain of ureteric colic from different regions of ureter

Site Pain referred toUpper ureter TestisMiddle ureter McBurney’s point

Simulates appendicitis on right sideSimulates diverticulitis on left side

Lower ureter Inner side of thighLabia majora in females.

Intramural part of ureter Stranguary

Mnemonic: From above downwards Test McBurger with thestranger

• Ligation in arterial aneurysm

Ligation applied just proximal to sac Anel’s method.Ligature applied just proximal to Bractor’s methodbranch of an arteryDouble ligature applied just distal Anlylus methodto the branchLigature proximal to first collateral Hunter’s operationof aneurysm

Mnemonic: Anal SacProximal BracDouble ‘L’Collateral hunting

• Early gastric cancer—cancer limited to the mucosa,submucosa with or without lymph node involvement

Late gastric cancer—it involves the muscularis

• Acute intussusception

Idiopathic (peak incidence 3–9 months)

Surgery 159

Hyperplasia of Peyer’s patches in the terminal ileum is usuallythe initiating event.Known cause/lead point (older children)DuplicationMeckel’s diverticulumPolypMnemonic: DMP

• Cushing syndrome– Petrous sinus sampling for ACTH is the best method of

differentiating a pituitary adenoma from an ectopic ACTHproducing tumor.

– Adrenal CT scan reliably differentiates cortical hyperplasiafrom tumor.

– T2-weighted MRI is more specific, reliably distinguishingadrenal adenoma from carcinoma.

• Esophageal carcinoma

MC type in India Squamous cell carcinomaMC type in west AdenocarcinomaMc site of squamous Middle 1/3rdMC site of adenocarcinoma lower 1/3rdMC type of upper 2/3rd Squamous

• Hyperplastic TB

Radiology/barium swallow shows– Long narrow filling defect in terminal ileum– Fleshner sign: Thickening of the ileocaecal valve, a wide

open valve accompanied by narrowing ofterminal ileum

– Sterling sign: Fibrotic terminal ileum opening into acontracted caecum.

Mnemonic: SFL (Safal in Hindi)

• Marjolin’s ulcer squamous cell carcinoma which arises inamino acid

Chronic benign ulcer, e.g. a venous ulcer, orA scar, e.g. scar of an old burnCharacteristics– Grows slowly (relatively avascular)– Painless (no nerves)

Mnemonics160

Does not spread to regional lymph nodes as lymphatic vesselshave been destroyed

• Triple assessment of breast lump suggestive of carcinoma:Clinical assesmentRadiological imagingTissue sampling for either cytological or histologicalexaminationMnemonic: CRT

• Radical neck dissection Structure preserved

Carotid arteriesCranial nervePhrenic nerveRadical neck dissection Structures removedOmohyoidSternomastoidInternal jugular veinSubmandibular glandAccessory nerve

Mnemonic: O-SISA

Structures preserved in modified radical neck dissectionInternal jugular veinSternomastoidAccessory nerve

Mnemonic: ISA

• Common causes of acute lower gastrtointestinal bleeding over55 years of age (in decreasing order)

Anorectal disease (haemorrhoids and fissures)DiverticulosisAngiodysplasiaPolyps and cancerEnterocolitis

Mnemonic: ADAPE

• MC site of colonic diverticula Sigmoid colon (left colon)

MC site of bleeding diverticula Ascending colon (right colon)

Mnemonic: CDS and AB

Surgery 161

• Wilkie’s syndrome (superior mesenteric syndrome)

Compression of third part of duodenum, by mesentericartery.

• Hemobilia—classic triad

Obstructive jaundiceAbdominal pain (biliary colic)Malena or occult blood in stool

Mnemonic: JAM

• MC benign tumor of spleen—hemangioma

MC cause of neoplastic enlargement of spleen—lymphoma

• Spleen phagocytose encapsulated bacteria. Splenectomizedpatients are at increased risk of septicemia due to pneumococcus(MC), meningococcus, H. influenzae, Babesia microti

Note: MC complication of splenectomy is pulmonarycomplications (left basal atelectasis).

• Penetrating neck injury—breach of platysma

Mnemonic: P for P

• Congenital rubella syndrome

Eye defects Cataract and congenital (CC) glaucomaHeart defect PDA and Pulmonic (PP) stenosis

CNS—Microcephaly, milestone delay (developmental)meningoencephalitis (MMM) pigmentary retinopathy,purpura (PP)

Mnemonic: CMP

• Pain pathways during labour

Prelabour pains are mediated through T11–T12

Mnemonic: Prelabour-Pre L1

It eventually involves T10– L1 dermatomes during labour.

• Genital Ridge—Ovary, testis

Mnemonic: ROT

Tubercle—clitoris, glans

Mnemonic: Clitoris and glans like tube

Swelling—Labia majora, scrotum

Fold—Labia minora, ventral part of penile urethra

Mnemonic: Major Scrotal swelling

Minor ventral fold

• Puberty sequential changes

ThelarchePubarchePeak height velocityMenarche

Mnemonic: The Pub Peaks for Men

162

Gynecology and Obstetrics

(G and O)

13

Gynecology and Obstetrics (G and O) 163

• HPV 16 is the most prevalent HPV type in squamous cellcancer cervix

HPV 18 is the most prevalent HPV type in adenocarcinormacervix

Mnemonic: Sweet 16

• Head compression—Early deceleration

Cord compression—Mid deceleration (Mn: CM)Placental compression—Late deceleration (Mn: PL)

• The drug of choice for acute control of hypertension in severepre-eclampsia is Hydralazine > labetalol > nifedipine

Mnemonic: HelaN

• OCP is a risk factor for

Breast CaCervical CaHepatocellular CaPituitary adenoma

Mnemonic: Bihar PHC

• Indication of antenatal steroids

To reduce incidence of respiratory distress syndrome—whenpregnancy is less than 34-betamethasone is preferred.To prevent virilization of female fetus in case of previous babywith congenital adrenal hyperplasia—as soon as pregnancyis confirmed– Dexamethasone is prefered.

Mnemonic: CD

• Bishop’s score

Cervix-Consistency (soft/medium)Dilatation (1–2 cm/3–4 cm/5–6 cm)Effacement (40–50%/60–70%/80%)Position (middle/anterior)+ Station of presenting part (–1, –2/0/+1, +2)

Mnemonic: Cx-CDEP + Station

• Fetal hydantoin syndrome

– Cardiac defects

Mnemonics164

– Hypoplastic phalanges– Nail dysplasia– Facial dysmorphism– Cleft lip and palate– Microcephaly

Mnemonic: Heart, Hand, Head

• Neonatal complications of diabetic mothers

– Hypoglycemia– Hypocalcemia– Hypomagnesemia– Hypothermia– Hyperbilirubinemia– Polycythemia– RDS– Cardiomyopathy.

Mnemonic: Only these two increases—bilirubin and blood

• MC ovarian neoplasm during pregnancy

Benign cystic teratoma (dermoid) (21%) > Serous cystadenoma (21%) > Cystic corpus luteum (18%)

Mnemonic: BSC

• Bacterial vaginosis

– Few leucocytes

– No/few lactobacilli

– Clue cells– Gram variable micro-organism including

Gardnerella vaginalis (Gram-negative)

Haemophilus vaginalis (Gram-negative)

Moblincus (Gram-positive)

Mnemonic: Lactobacilli and leukocytes are low in number

• Neural tube defect Ventral wall defect

↑ Acetylcholinesterase ↓ Acetylcholinesterase

↓ Pseudocholinesterase ↑ Pseudocholinesterase

Mnemonic: PV

Gynecology and Obstetrics (G and O) 165

Note: AFP is raised in both.

• Conjugate diameters of pelvic inletDiagonal conjugate can be measured directlyMnemonic: D for D

True conjugate diameter Midpoint of sacral promontoryto inner margin of upper bor-der of symphysis pubis (11cm)

Obstetric conjugate diameter Midpoint of sacral promontoryto prominent bony projectionon inner surface of pubic sym-physis

Diagonal conjugate diameter Midpoint of sacral promontoryto inner margin of lowerborder of symphysis pubis(12 cm)

Mnemonic: On inner margin of symphysis pubis, from abovedownward order is TOD

• Gestational trophoblastic neoplasia is classified as a high risktumour if it has any of the following factors:

Antecedent term pregnancyBrain or liver metastasisPrior chemotherapy failureDuration > 4 monthsPretherapy HCG level > 40,000 mIU/ml

Mnemonic: ABCD and H

• Criteria for medical management of ectopic pregnancy:

– Hemodynamically stable patient– Size of ectopic mass < 4 cm– Gestation preferably < 6 weeks– Fetus preferably dead (no fetal cardiac activity on USG)– Serum beta-hCG levels preferably < 1500 mIU

Note: Active intra-abdominal hemorrhage is a contraindi-cation to chemotherapy.

• Pure gonadal dysgenesis: It is a disorder in which phenotypicfemales have

Mnemonics166

– Gonads and genitalia characteristic of gonadal dysgenesis– Bilateral streak gonads– Infentile uterus and fallopian tubes

– Sexual infantilism

– Normal height– Normal somatic development

– Normal 46, XX or a 46, XY karyotype

Note: Swyer syndrome is pure gonadal dysgenesis 46, XY.

• All the elements of Virchow’s triad is circulatory stasis,vascular damage and hypercoagulability of the blood arepresent during pregnancy. Vascular stasis is due to increasein the calibre of capacitance vessels and blood. Hyper-coagulability is due to increased amounts of factors VII, VIIIand X.

• Cephalhematoma Caput succedaneum

– Collection of blood between Swelling due to stagnation

the pericranium and flat of fluid in between layers ofbone of skull scalp beneath the girdle of

contact

– Usually unilateral May be bilateral– Limited by suture line Not limited by suture line

– Develops after 12–24 hrs Present at birth

(never present at birth)– Swelling disappears in Swelling disappears in

6–8 wks 24 hrs

– Good prognosis Good prognosis– No impulse on crying No impulse on crying

Note: Meningocele always lies over a suture line orfontanelle and variation in tension of swelling with crying (cryimpulse) is suggestive of a meningocele.

• Contraindication of ergometrine

– Suspected multiple pregnancies

Gynecology and Obstetrics (G and O) 167

– Organic cardiac diseases– Severe pre-eclampsia and eclampsia (there may be sudden

rise in BP)– Rh negative mothers – More chances of fetomater-

nal microtransfusion

• Risk of abnormal off-spring for carriers of a balanced trans-location: Risk percentage

Translocation Carrier father Carrier mother

Centric fusion 13 : 14 1 1

Centric fusion 14 : 21 1 15

Centrtic fusion 21 : 22 5 10

Centric fusion 21 : 21 100 100

Reciprocal (Any) 10 10

• Oligospermia: Mild—when the count is 10–20 million/ml

Moderate—when the count is 5–10 million/mlSevere—when the count is <5 million/ml

• WHO criteria

Volume > 2 mlSperm count > 20 million/mlTotal sperm count > 40 million/ejaculatePercent mobility> 50% with forward progression> 25% with rapid linear progressionForward progression > 2 (Scale 0–4)Normal morphology > 50% normalRound cells < 5 million/mlSperm agglutination < 2 (Scale 0–3)WBC fewer than 1 million.

• Mother with glycosylated HbA1c before 14 weeks ofgestational values less than or equal to 8.5% have got leastchance of severe malformation of the fetus.

9.5% or more have greater chance of major congenitalmalformation.

Mnemonics168

• Types of pelvis

Naegele’s pelvis Ala on one side is absent

Mnemonic: N for N

Robert’s pelvis Ala on both sides is absent

Mnemonic: B for B

Rachitic pelvisIncreased interspinous diameter of the false pelvisReniform shape of inlet with shortened AP diameterWidened transverse diameter of the outlet and pubic archinlet is typically triradiateOsteomalacic pelvis

• Side effects of OCP—

Mild—continue the OCP

N—NauseaO—Oedema

R—Recurrent headache

M—MastalgiaA—Abnormal bleeding (breakthrough bleeding)

L—Loss of bleeding (withdrawal bleeding)

Moderate—AcneWeight gain

Chloasma

If patient is worried, stop the OCP.Severe—stop the OCP.

Cholestasis

Cardiovascular—thromboembolismCNS—depression

Cancer—increased risk of breast carcinoma and cervicalcarcinoma

• Non-contraceptive benefits of OCP—Decreases risk of

Other—Ovarian cyst and carcinomaB—Benign breast disease (like fibroadenoma)

E—Endometriosis

N—Neoplasia like ovarian and endometrial carcinoma

Gynecology and Obstetrics (G and O) 169

E—Ectopic pregnancyF—Fibroid

I—Iron deficiency anemia

T—Tension—pre-menstrual tensionS—Skeletal—osteoporosis and rheumatoid arthritis.

• Hereditary hyperbilirubinemiasUGC—Unconjugated

Gilbert’s syndromeCrigler-Najjar syndrome I and II

• Downe’s score

– Cyanosis– Air entry– Respiratory rate– Grunting– Retraction

Mnemonic: CARGR

• Silverman-Anderson index

– Grunting– Nasal flaring– Retraction—Upper chest– Retraction—Lower chest– Retraction—Xiphoid

Mnemonic: GFR 3–LUX–Silver

• Fallot’s triad RVH

ASDPulmonic stenosis

Mnemonic: RAP

Fallot’s tetralogy Pulmonic stenosisRVHOverriding of aortaVentricular septal defect

Mnemonic: PROVe

170

Pediatrics

14

Pediatrics 171

• A newborn is classified as vigorous if he has all the following:

Heart rate > 100 / minRespiratory effort (strong)Tone of muscles (good)

Mnemonic: HRT

• Classification systems for PEM based on weight-for-age

Gomez classificationIndian academy of pediatrics (IAP) classificationWellcome trust classification (also considers presence orabsence of edema)

Mnemonic: India Welcome Weight of Gomez

• Glycogen storage disease

Anderson disease—Branching enzyme defect (Type IV)Cori Forbe or limit dextrinosis)—Debranching enzyme defect(Type III)

Mnemonic: 4 AB and CD3

• Muscle glycogenases

Type II (Pompe’s)—Lysosomal acid α-glucosidaseType V (McArdle)—Muscle phosphorylase (M for M)

Type VII (Tarui)—Phosphofructokinase

Mnemonic: 257–PMT–LMP

• Timing of selected primitive reflexes

Reflex present at birth (in bracket age at appearance inintrauterine life)– Palmar grasp (23)– Crossed extensor reflex (28)– Moro’s reflex (32)– Asymmetric tonic neck reflex (35) (ATNR)– Rooting/suckling reflex

Mnemonic: PCMARt

Reflexer developing after birth– Parachute reflex– Symmetric tonic neck reflex (STNR)

Mnemonics172

– Neck righting reflex– Landau reflex

Mnemonic: PSNL

Note: ATNR—fencing reflex, STNR—Cat’s reflex.

• Hereditary associations with acute myeloid leukemia (AML)

– Fanconi’s anaemia– Ataxia-telangiectasia– Bloom syndrome– Down’s syndrome– Patau syndrome– Klinefelter’s syndrome– Kostmann syndrome

Mnemonic: FAB DiPika Ko AML

• Autosomal recessive disorders that have occurred due touniparental disomy (UPD)

– Alpha thalassemia– Spinal muscular atrophy– Beta thalassemia– Bloom syndrome– Cystic fibrosis– Cartilage hair hypoplasia

Mnemonic: A2B2C2

• Autism Triad of impaired

ImaginationCommunicationSocial interaction

Mnemonic: ICS

• Standard ORS versus ReSoMal (rehydration solution forseverely malnourished child)

Standard ORS ReSoMal New WHO–ORS

111 Glucose 125 75 (Anhydrous)90 Sodium 45 7520 Potassium 40 20

Pediatrics 173

80 Chloride 70 6510 Citrate 7 10

Magnesium 3Zinc 0.3Copper 0.045

311 300

Mnemonic: Mazic in ReSoMal

• Agents responsible for bronchiolitis

MC agent Respiratory syncytial virus (RSV)Other Parainfluenza virus 3,1

AdenovirusInfluenza virusMycoplasma pneumonia

Mnemonic: MYC PAIR in bronchiolitis

• Surgical management of tetralogy of Fallot

Waterson shunt—Ascending Aorta to Pulmonary arteryBlalock-Taussig shunt—Subclavian artery to pulmonary arteryPott’s shunt—Descending aorta to pulmonary artery

Mnemonic: Water’s Black Pot–ASD

• Target cells are seen in

Haemoglobin C, S, etc.ThalassemiaLiver diseases

Mnemonic: HaThali Target

• Total anomalous pulmonary venous connection (TAPVC)

Type 1 (45%) SupracardiacType 2 (25%) CardiacType 3 (25%) InfracardiacType 4 (5%) Multiple levels

Mnemonic: SCIM

• Assessment of dehydration in patients with diarrhoea andPLANNo sign of dehydration Treatment plan A (home avai-

lable food, ORS)Some sign of dehydration Treatment plan B

Mnemonics174

Rehydration therapy75 ml/kg ORS in first 4 hrsMaintenance therapy10–20 ml/kg ORS for each liquidstool

Severe dehydration Treament plan CIV fluid (RL best, NS can be given)

< 12 months 30 ml/kg in 70 mI/kg in1 hr 5 hr

> 12 months 30 ml/kg in 70 ml/kg into 5 yrs 30 minutes 2½ hrs

• Congenital rubella syndrome

The common manifestations are:Growth retardationCardiac anomalies PDA > PS > VSDSensorineural deafnessOcular Microphthalmia, cataract, glaucoma,

retinitisCerebral Chronic encephalitisHematological Thrombocytopenia

LymphopeniaBluberry muffin rash, i.e. dermal nests ofextramedullary hematopoiesis or purpura.

• β-thalassemia or Cooley’s anaemia

Peripheral blood picture shows Microcytic hypochromicanaemiaAnisocytosis (marked)Target cellsReticulocytosisNucleated red cells

Mnemonic: MATRN

• Endemic cretinism includes two different overlappingsyndromesNeurological syndrome—Goitre, severe mental retardation,deaf mutism, cerebral diplegia, squint

Mnemonic: CDS GS

Myxedematous syndrome: Hypothyroid (T4, TSH) severegrowth retardation, physical signs—coarse dry skin, husky

Pediatrics 175

voice reflex (delayed relaxation), ECG—small voltage QRS,epiphyseal dysgenesis

• Hemangioma (vascular malformations) : Classification

Capillary hemangioma Salmon patchStrawberry angiomaPortwine stain

Venous or cavernous hemangiomaArterial or plexiform hemangiomaSpontaneous regression Salmon patch (regresses by 1

year of age)Strawberry angioma (regressesby 7–8 yrs of age)

Mnemonic: S for S

• Down’s syndrome

P—Protruding tongue

R—Round faceO—Open wide fontanelle/occiput flat

B—Brachycephaly/Brachydactyly

L—Low set ear/Low (depressed) nasal bridgeM—Mangolian slant/Mental retardation

A—Acute leukemia (AML M7 > ALL)/Alzheimer’s disease/Atresia of duodenum

T—Trisomy 21/Thyroid problem (hypothyroidism)I—Iris-Brushfield’s spot

C—Congenital heart disease

• Noonan syndrome

Autosomal dominantNormal karyotypeFertileShort statureWebbed neckCubitus valgusClinodactylyCryptoorchidism

Mnemonic: 3C

Mnemonics176

• Principle of phototherapy—

SI > PI > POStructural isomerisation > Photoisomerisation > Photooxidation.

• T-series are cyanotic—

TAPVC

Truncus arteriosusTetralogy of Fallot

Tricuspid atresia

TGA with VSDTGA with VSD with PS.

• Causes of non-cicatricial alopecia

Primary cutaneous disordersTelogen effluviumAnagen effluviumTraumatic alopeciaAndrogenic alopeciaAlopecia areataTinea capitis

Mnemonic: 3T and 3A

• Epidermolysis bullosa and targeted protein

Epidermolysis bullosa simplex—Keratin 4 and 14Junctional epidermolysis bullosa—Laminin 5Dystrophic epidermolysis bullosa—Collagen VII

Mnemonic: SK Jha LDC Clerk

S K 4J L 5D C 7

• Tinea capitis Caused by:

TrichophytonMicrosporum

Mnemonic: TMC

• Salmon’s patch is seen in Still’s disease

Mnemonic: S for S

• Dannie’s fold—AD (atopic dermatitis)

Mnemonic: DA–AD

177

Skin

15

Mnemonics178

• Darrier sign—Urticaria pigmentosa

Mnemonic: Dirty pig

• Lymphogranuloma venereum

AsymptomaticBubo (usually unilateral)Chlamydia trachomatis (L1L2L3)Doxycycline (DOC)

Estheiomine—vaginal and rectal stricture and elephantiasis ofvulvaFries test—intradermal test for hypersensitivity to chlamydialantigensGroove’s sign—enlarged LN on both sides of inguinalligament.

Mnemonic: ABCDEFG

• Lepra reaction

Type I: Reverse lepra reaction, is Type IV hypersensitivityType II: ENL, is Type III hypersensitivity

Mnemonic: I + IV = V

II + III = V

• Pityriasis rosea = Characteristic features

Herpesvirus (suspected etiology)TrunkCigarette paper scalesHerald patchFir tree pattern

Mnemonic: HT + CHF (Rose ko HT and CHF)

• Cutaneous tuberculosis (non-tuberculides)

Lupus vulgarisScrofulodermaMetastatic tuberculosisTuberculosis cutis verrucosusTuberculosis cutis orificialisMiliary tuberculosis

Mnemonic: Vulgar derma met cute Mili

Skin 179

Tuberculides:Papulonecrotic tuberculides

(Acne scrofulosorum)Lichen scrofulosorumRosaceous tuberculideErythema induratumLupus miliaris disseminatus faccei

Mnemonic: ALi Rose Indure Lupus Miliaris

Pityriasis ClassificationTrunk involvement P. versicolor

P. rosea—erythematous (rose red)

Mnemonic: VeROT

Face involvement P.albaP.rubra—erythematous (rubra red)

• Fordyce’s spots Ectopic sebacious glands (if on head ofpenis—Tyson glands)

Fox-Fordyce (apocrine miliaria)—blockage of sweat glandsForcheimer’s spots—German measles (rubella)

Infectious mononucleosisScarlet fever

• Gluten restriction in diet Celiac sprueDermatitis herpetiformis

Note: Gluten is found in Barley: Rye, oat and wheat, i.e. Brow.

• All pemphigus cases are characterized by the formation of anintraepidermal acantholytic split, located at the followinglevels:

Stratum granulosum—P.foliaceous and P.erythematosus

Mnemonic: EFG

Between Str. basale and prickle cell layer—P.vulgaris andP.vegetans

Mnemonic: V2

• Non-anesthetic hypopigmented, non-scaly macule on face– Indeterminate leprosy

Note: Omitting non-scaly, diagnosis becomes Pityriasisalba.

• Anatomical dead space is decreased in

HyperventilationIntubationTracheostomyBronchoconstrictionFlexion of neck

Mnemonic: HITCornflex decreases dead space

• Sites of absorption of local anesthetics in decreasing order

IntrapleuralIntercostalPudendalCaudalEpiduralBrachial plexusInfiltration

Mnemonic: Pleco Puca Epi Brain

• Relative potency of inhalational agents

Nitrous oxideCyclopropaneDesfluraneSevofluraneEther Potency increasesEnfluraneIsofluraneChloroformHalothane

180

Anesthesia

16

Anesthesia 181

TrieleneMethoxyflurane

Mnemonic: NCD SEE ICH of TM–In increasing order ofpotency.

Note: Ether is between sevoflurane and enflurane, chloro-form is between isoflurane and halothane

• Blood gas partition coefficient

DesfluraneCyclopropaneNitrous oxideSevofluraneIsoflurane B/G partition coefficientEnflurane IncreasesHalothaneChloroformTrieleneEtherMethoxyflurane

Mnemonic: DCNS IEN HCTEM (Recall 10 times in mind)

• Amide linked local anesthetics

Lidocaine/LignocaineBupivacaineDibucainePrilocaineRopivacaine

Mnemonic: I In Amide, I in Amide linked LA (besides inCaine)

Ester-linked LACocaineProcaineChlorprocaineTetracaineBenzocaine

• Monitoring of respiration

Intubated patient CapnographyInfrared end tidal CO2 measurement

Mnemonics182

Mnemonic: Cap into infra

Non-intubated patient Impedance pulmonometryPulse oximetryTranscutaneous gas analysis (infants)

• Faster, pleasant and smooth induction with no significantsystemic toxicity makes sevoflurane the agent of choice forinduction especially in children.

Mnemonic: Smooth, Sweet Sevoflurane for seven year old(i.e. child)

• Anesthetic agents

Bronchospasmodics(contraindicated in asthmatics)

EtherN2OThiopentone

Mnemonic: ENT

• Gas Colour of cylinder

Oxygen Black body, White shoulder

Mnemonic: Black and White OX

Air Gray body, black and white shoulderN2O Blue

Mnemonic: Blue nitrous

Entonox Blue body, white and blue quarteredshoulder

Cyclopropane Orange

Mnemonic: Cycle per oranges

Carbon dioxide Gray

Mnemonic: Grey Carbon

Thiopentone Yellow

Mnemonic: Yellow Pant

Halothane Amber (purple red)

Mnemonic: Hello Amber

• Agents used in day care anesthesia

Seroflurane, Isoflurane and Desflurane

Anesthesia 183

Alfentanyl, RemifentanylEtomidateMethohexitonePropofolThiopentone

Mnemonic: SID ARe EMPTy

• Rapid sequence anesthesia (crash induction)

PreoxygenationInduction agentSuxamethoniumSellick’s maneuver (cricoid pressure)

Mnemonic: PISS

• Concept of balanced anesthesia (Lundy)

Thiopental for InductionN2O for AmnesiaMepridine (or other opioid) for AnalgesiaCurare for Muscle relaxation

Mnemonic: TNMC

• Drugs sensitizing the heart to arrhythmogenic action ofadrenaline include:

HalothaneMethoxyfluraneTrichlorethyleneCyclopropaneChloroform

Mnemonic: Halo Metri, Cycle se Chalo

• CSF spreading tumours

Germ cell tumourMedulloblastomaEpendymomaPrimary CNS lymphomaHigh grade astrocytomaChoriocarcinoma

Mnemonic: German MELA Chor

• HRCT-ILD, bronchiectasis and CSF leak

• Radiation effects

Deterministic effects—Severity of effect is dependent upondoseThese effects have a threshold

Mnemonic: DTS

Stochastic effects—probability of effect is dependent upondose

Note: S is not S

• Pure beta emitters P 32

Sr 90Y 90H 3

Mnemonic: HSPY

• 1–125 60 days

1–131 8 days1–123 13 hrs1–132 2.3 hrs

184

Radiology

17

Radiology 185

• Superior rib notching

HyperparathyroidismConnective tissue diseases RA, SLE, Scleroderma

Sjögren syndrome

Mnemonic: RS3

PoliomyelitisOsteogenesis imperfectaRestrictive lung diseaseMarfan’s syndromeNeurofibromatosis

Mnemonic: Parathyroid connect, Post and restrict Marfan toneuro

• Inferior rib notching

Coarctation of aortaPulmonary oligemiaAortic thrombosisSubclavian obstructionBlalock-Taussig operation

Mnemonic: CAPAST

• Prophylactic craniospinal irradiation is useful in CNSmalignancy which shows dissemination via CSF or anymalignancy with high risk of CNS spread.

MedulloblastomaGlioblastomaGerminomaSmall cell Ca of lungALLNon-Hodgkin’s lymphoma

• Groundglass appearance of the lung—differential diagnosis

TAPVC (obstructive)Persistent pulmonary hypertensionRespiratory distress syndromePneumonia (bacterial and meconium aspiration)Pulmonary lymphangiectasia

• Level of intelligence Mental age

Idiot 0–24 < 3 yrs life supportImbecile 25–49 3–7 yrs trainableMoron 50–69 7–10 yrs educableBorder line 70–79

Mnemonic: IIM Bangalore

• Intelligence quotient

Profound <20Severe 20–35Moderate 35–50Mild 50–70

• Disorganized schizophrenia

Attention deficits and cognition defectsDisorganized behaviourDisorganized speech

Mnemonic: ABCDS

• Disorder Most common type of delusion

Mania Delusion of grandeurDepression Nihilistic delusionDelirium Transient delusionSchizophrenia Delusion of persecution/reference /control/infidelity/passivity

• Patients with multiple somatic complaints that cannot beexplained may haveHypochondriasisSomatization disorderMalingeringFactitious illness

186

Psychiatry

18

Psychiatry 187

• Difference between anorexia nervosa and bulimia nervosa

Anorexia nervosa Bulimia nervosa

Feature Refusal to maintain Irresistible craving forbody weight above food with episodes ofa minimum normal overeating in less time

(binge eating)

Method Very less eating Attempts to counteractof weight the effects of overeatingcontrol byself-induced vomi-

tings purgative abuseperiods of starvationappetite suppressants

Ritualized Common RareexerciseAmenorrhea 100% 50%Decreased Common UncommonvitalsBP, pulseHypothermia Common RareSkin changed Common Rare(hirsutism)Medical Hypokalemia Hypokalemiacomplications Cardiac arrhythmias Cardiac arrhythmias

Note: In bulimia, Dental caries are frequent because of highcarbohydrate content in the diet.Antisocial behaviour, e.g. stealing, alcohol, drug abuse iscommonPrognosis is worse.

Mnemonic: DAW

• Difference between delirium and dementia

Delirium DementiaOnset Acute InsidiousConsciousness Clouded NormalOrientation Grossly disturbed Disturbed only, in late

stagesMemory Immediate and Immediate is normal

Mnemonics188

recent disturbed recent and remote

disturbedPerception Visual illusion and Hallucination may

hallucination is occurcommon

Diurnal Marked Absentvariation (Sundowning)

• Dissociative fugue

Sudden onset of complete amnesia for his earlier lifePatient usually wander away from homeAdopts a new purposeful identityAbsence of awareness of amnesia

• Catatonic signs

Mutism Absence of speechRigidity Maintenance of rigid posture against efforts to

be movedPosturism Voluntary assumption of bizarre, inappropriate

posture for long period of timeNegativism Resistance to all commands and attempts to be

movedEcholalia Repetition, mimicking of actions observedWaxy Parts of body can be placed in positions thatflexibility will be maintained for long periods of time

even if very uncomfortable flexible like waxMannerismAutomatic Commands are followed automatically,obedience irrespective of their nature.

• Mechanism of depression—Deficiency of monoamines—

Serotonin (5 HT) > Noradrenaline > Dopamine

Mnemonic: SeND

• Klippel-Feil syndrome

Triad—Short (web) neckLow hair line

Restriction of neck motion

Mnemonic: SLR

• Risk of progression of vertebral anomalies in decreasing order

Unsegmented bar

HemivertebraWedge vertebra

Block vertebra

Mnemonic: Unique History of West Bengal (UH of WB)

• Reconstruction of an amputated limb: Order of repair

Bone

Extensor tendonsFlexor tendons

Arteries

NervesVein

Mnemonic: BE FAN Vein

• Test for anterior shoulder instability

Anterior shoulder instability

Apprehension test (Crank test)

Relocation test

Fulcrum test

Mnemonic: FRANK–CRANK

189

Orthopedics

19

Mnemonics190

• Tests for posterior shoulder instability

Jahnke testJerk testPosterior drawer testPosterior apprehension testPush-pull testCircumduction test

Mnemonic: JPC

Also remember: Test for inferior shoulder instability—sulcustest

• Albright-McCune syndrome

Polyostotic fibrous dysplasiaPseudo precocious pubertyPigmentation

Mnemonic: 3P

• Mazabraud syndrome

Myxoma of soft tissuesPolyostotic fibrous dysplasiaSulcus test

• Tarsal tunnel syndrome may be caused by rheumatoidarthritis

Mnemonic: Tunnel in room

• Metastasis distal to knee and elbow is rare and usually arisesfrom a primary tumours of the

BladderBronchusColon

Mnemonic: BBC: One from thorax, abdomen and pelvis each

• Casts and splintsMinerva cast—Cervical spine fracture

Mnemonic: Mice

Scoliosis—Risser’s localiser cast, Turn buckle castMilwaukee braceBoston brace

Mnemonic: Ritu Mili Boss

Orthopedics 191

• Risk factors associated with shoulder dystocia

DiabetesObesityPost-termExcess weight gain during pregnancy

Mnemonic: DOPE

• Non-odontogenic cysts

Nasolabial cystsNasopalatine cysts

Mnemonic: N for N

Pseudocysts

Static bone cystsTraumatic bone cysts

Aneurysmal bone cyst

Ganglion cysts

Mnemonic: STAN GAN

• Ossicular joints

Incudo-Malleolar joint—Saddle type of synovial joint

Incudo-Stapedial joint—Ball and socket type of synovial joint

Mnemonic: Ball IS MISS

• Ligament of Humphrey—Anterior menisco-femoral ligament

Ligament of Wrisberg—Posterior menisco-femoral ligament

Mnemonic: Humpy Antie

• Knee joint

Unlocking is brought about by popliteus muscle

Mnemonic: UP

Locking—Quadriceps femoris

Mnemonic: Q-locked

• Myositis ossificans progressiva

Muscles that are characteristically sparedSmooth musclesCardiac musclesDiaphragm

Mnemonics192

Extraocular muscles

Mnemonic: Smooth CDE

• O’Donogues triad (unhappy triad)

Anterior cruciate ligament ACMedial collateral ligament MCMedial meniscus MM

Mnemonic: AC MC MM

• Plaster casts and their uses

Humerus fracture—Hanging cast and U slab.

Mnemonic: Hu-Hu

A spica is a cast where a limb and a part of the trunk areincluded, e.g. hip spica (fracture femur)

Shoulder spica (shoulder immobilization)Patellar tendon bearing cast—fracture of tibiaCylinder cast (tube cast)—fracture patella (fracture aroundknees)

• Common sites for bone tumors

Epiphysis—ChondroblastomaGiant cell tumor

Mnemonic: ECG (GC–CB)

Diaphysis AdamantinomaMultiple myelomaEwing’s sarcomaEosinophilic granuloma (Langerhans’ cellhistiocytosis)Osteoid osteoma

Mnemonic: Dia add multiple wing to Eosinophil of osteoma

• Markers of bone formation

– Serum bone specific alkaline phosphatase– Serum propeptide or type I procollagen– Serum osteocalcin

Mnemonic: Alka Type Osteocalcin for bone formation

• Management of idiopathic clubfoot

So Soft tissue release <3 yrs

Orthopedics 193

Evans Evans 4–8 yrsWas Wedge resection 8–11yrsTreated Triple arthrodesis > 12 yrsIntelligently Ilizarov Old/neglected

club foot

• Erb’s palsy Klumpke’s palsy

Upper obstetric palsy Lower obstetric palsy

Mnemonic: L for L

C5–C6 roots affected C8–Tl, roots affectedWaiter’s tip deformity Generalized wasting of all intrinsic

muscles and claw hand deformityIpsilateral Horner syndrome (due to TI)

• Pyogenic arthritis—bony ankylosis

(B for bacteria, B for bony)Tubercular arthritis—fibrous ankylosis(Exception—tubercle spine has bony ankylosis)

• Idiopathic osteoarthritis

Herbeden’s nodes—bony enlargement of DIP joint

Mnemonic: HerDip (herdip)

It is also MC form of idiopathic osteoarthritis.Bouchard’s nodes—bony enlargement of PIP joint

• Common sites of avascular necrosis

Head of femur Fracture through neck of femur, post-dislocation of hip

Proximal pole of scaphoid—fracture through waist ofscaphoidBody of talus—fracture through neck of talusLunate—dislocationCommon sites of non-union of fractureScaphoidNeck of femurTalusLateral condyles of humerusLower third of UlnaLower third of tibia

Mnemonic: SNT LUT

Mnemonics194

Common sites of malunion of fractureSupracondylar fracture

Colles’ fracture

Intertrochanteric fracture

Mnemonic: SCIT

• Osteochondritis: A group of miscellaneous affection of thegrowing epiphysis, which cause them to be temporarilysoftened and liable to be deformed by pressure.

Common osteochondritis

Crushing osteochondritis (due to avascular necrosis)

Perthes disease Femoral head (commonest)Pannr’s disease Capitulum

Mnemonic: Pan in Cap

Keinbock’s disease Lunate

Mnemonic: Luna Keino

Kohler’s disease Navicular bone

Mnemonic: Navi Kohli

Freiberg’s disease Head of metatarsal

Mnemonic: HMT Free

Scheumann’s disease Ring epiphysis of vertebrae

Mnemonic: Man in Ring

Calves’ disease Central bony nucleus of vertebralbody

Mnemonic: Central cave

Traction osteochondritis (due to chronic strain or apophysitis)Osgood-Shlatter disesase—Tibial tubercle

Mnemonic: tt = tt

Sever’s disease Calcaneal tuberosity

Mnemonic: Severe Calca

Larsen-Johansson disease—lower pole of patella

Mnemonic: Patel Son Sen

Splitting osteochondritis (trauma plays major role)

Osteochondritis dessican MC site is femoral condyle

Orthopedics 195

• Hip deformity following a history of severe trauma

Posterior dislocation of hip—Flexion + Adduction + InternalRotation + Shortening (FADIR)Fracture neck of femur—Flexion + Adduction + ExternalRotation + Shortening (FADER)Fracture intertrochanteric femur—FADER (exaggerated)Anterior dislocation of lip—Flexion + Abduction + ExternalRotation + Shortening (FABER)Tuberculosis hipStage of synovitis FABER (apparent lengthening)Stage of arthritis FADIR (apparent shortening)Stage of erosion FADIR (true shortening)

• Rheumatoid arthritis

Swan-neck deformity Hyperextension at PIP jointHyperflexion at DIP joint.

Mnemonic: HEPIP of Swan

Boutonniere deformity Hyperflexion at PIP jointHyperextexnsion at DIP joint

Mnemonic: BDE-PF

• Impacted fractures are commonly seen in

Surgical neck of humerusNeck of femurLower end of radius

Mnemonic: Impacted SuNiL

• Triple arthrodesis Fusion of three joints of foot

Talonavicular jointSubtalar jointCalcaneocuboid joint

Mnemonic: TN ST CaCu

• Common sites of origin of osteosarcoma in decreasing orderof frequency:

Lower end of femurUpper end of tibiaUpper end of humerus

• Involvement of joints in different types of arthritis

Mnemonics196

Osteoarthritis Sparing of wrist and metacarpophal-angeal joints (MCP joint) with involvementof base of thumb is characteristic feature

Mnemonic: Sparing of WM in OA

Joints involved DIP: Heberden’s nodes MC form of idio-pathic osteoarthritis

Mnemonic: Her DIP

– PIP: Bouchard’s nodes– Thumb base (carpometacarpal joint)

(second MC joint)– Knee– Spine

• Rheumatoid arthritis: DIP is not involved.Axial involvement is limited to upper cervicalspine, usualy lumbar spine is not involved.

14 possible joint areas involved (left and right)WristAnkleKneeElbowMetatarsophalangealMCPPIP

Mnemonic: DIP joint is not involved in RA–DNRWake MMP

• Psoriatic arthritis: Any joint may be involvedDisease limited to involvement of a single/few small joints(70%)Seronegative, RA like symmetrical arthritisInvolvement of DIPSevere destructive arthritis with development of arthritismutilansDisease limited to the spine.

• Pivot shift test is used in cases of anterolateral instabilitywhere injured structure include:Anterior cruciate ligamentLateral capsuleLateral–collateral ligament

Orthopedics 197

• Swelling of joint—

X-rayMRIAspiration (for culture)Swelling of joint

Mnemonic: X MAS

• Epithelial tumors of bone

Adamantinoma—Tibia

Mnemonic: Ad on Tb

Ameloblastoma—Mandible

Mnemonic: Mandi ka mela

• Bone metastasis

BPL—Breast carcinoma, Prostate carcinoma, Lung carcinomaPure osteoblastic—Prostate carcinomaCarcinoid tumor

Medulloblastoma

Mnemonic: PCM

Breast carcinoma—MixedOsteolytic (2/3rd) > osteolytic (1/3rd)

• Ollier’s syndrome—Only enchondroma

Mnemonic: O for O

Maffucci syndrome—Multiple enchondroma and cavernoushemangiomaMnemonic: M for M

• Coast of Maine—McCune-Albright syndrome (margins areirregular)

Mnemonic: M for M

Coast of California—Neurofibromatosis (margins are regular)

• Poor factors of rheumatoid arthritis:

RFAcute phase reactants/advanced ageOne year

Mnemonics198

NodulesErosion/ESR

Mnemonic: RA—ONE

• MESS—Mangled extremity severity score. It tells about thesurvival of a limb after crushing injury.

V—Velocity of traumaI—IschemiaS—ShockA—Age.

• Housemaid knee—Prepatellar bursitis

Clergyman knee—Infrapatellar bursitis

Mnemonic: Pre-maid, i.e. Pramod

• Nerve injury in supracondylar humerus fracture—Anteriorinterosseous > Median > Radial > Ulnar nerve.

Mnemonic: AMRU

• Colles’ fracture—Extra-articular fracture of distal end of radiuswith

S—Supination of distal fragmentL—Lateral displacement (tilt, shift)I—ImpactionP—Posterior displacement (tilt, shift)Treatment—Hand shaking cast.

• Trendelenberg test

Normal hip—NegativeHip abductors—Gluteus medius > Gluteus minimusSuperior gluteal nerve

Drop of pelvis on opposite side—Positive

Mnemonic: DROP

If bilateral drop—Waddling gait

• Kocher’s maneuver is the most common maneuver used toreduce shoulder dislocation. It involves—

Traction

Orthopedics 199

External rotationAdductionInternal rotation

Mnemonic: TEDI

• Vertebra plana—Coin like vertebra. Seen in

M—MetastasisE—Eosinophilic granulomaL—LymphomaT—Trauma and very rarely TB