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DIAMS
Must Know Facts Before Exam

Target
December 2018
a final step to the next level

 Compact and concise must read hand notes.

 Based on national board of examinations.
 Focused on high yield topics which have been asked
frequently in all MCI entrance examinations.

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 TARGET DEC. 2018

1. Study is concerned with observation the 23.Injury to leads to footdrop?
distribution of disease or health related a. Common peroneal nerve
characteristics in human populates 24.The mucosa of the trigone of urinary bladder
a. Descriptive studies is derived from:
2. The specific gravity of respired lung is: a. Mosonephric ducts
a. 0.94 25.cells of the thyroid gland migrate into
3. is TRUE regarding case control studies? pharyngeal pouches?
a. Ideal for the study of rare or a. Fourth
retatively unknown disease 26.The is the muscle that abducts the vocal
4. The drugs that increase heart rates are canal
known as positive a. Posterior cricoarytenoid
a. Chronotropic

I
27.TRUE about riboflaxin?
5. statements regarding bardetellapertusis is
TRUE? a. Excessive dose rarely incapacitates
a. It infects only human the individual

C
6. Lorceserin may help to reduces weight by 28.The denominator used to calculate death
agnonistic action on receptors? rate in a region is the
a. 5HT 2c a. Mid – year population
A unit
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7. Drug parital agonist at nicotinic
aceptlycholine receptors is used in smoking a. They are usually carried out in
casation programs? healthy volunteers

-
a. Vareniciline 30.actions is mediated by acetylcholine?
8. Rum amok is frequently associated with the a. Contraction of the detrusor muscle
long term heavy use of

S
31.The infections transmitted to man from
a. Canabits vertebrate animals are known as
9. TRUE regarding case control studies?
a. Anthropozoonoses
a. Ideal for the study of rare or
32.After head injury, blood from the torm

M
retatively unknown disease
10.Antermortemdrowing is indicated by ? branches of the middle meningeal artery
a. Frothy fluid in mouth and nostrils collects between?
a. Dura mater and bone

A
11. Whiplash injury is commonly associated
with 33.The MOST rediable study to establish an

I
a. Occupant of a vehicle in road traffic association of risk factor and the disease
accident under investigation is:
12.TRUE regarding eboia virus diseases? a. Cohort

D
a. Case fatality rate may reach around 34.muscles separates the orbital and palpebral
70% parts of lacrimal gland?
13.The most commonly reproted disease in the a. Levatorpalpaberaesuperioris
post disaster period of
35.The limiting amino acid in cereals?
a. Gastrontertis
a. Lysine
14.The structures that gives rise to the
excretory position of the kidneys? 36.Falciform ligament is the derivative of
a. Metaneplvicblastoma structures?
15.The cause of urachus fistula is a. Ventral mesogastrijm
a. Patent allantosis 37.Partof the brain is responsible for relative
16.The artery that passes through foramen paralysis during REM sleep?
spinsum is a branch of ? a. Locus ceruleus
a. Maxillary 38.Acute monoarthritis of
17.The muscle which produces vertical wrinking 1stmetatarsophadangeal joint is a classical
of the skin of the forhead as in following is presentation of ?
a. Comugatorsupercilli a. Gout
18.the mainstay of laboratory diagnosis of 39.Insulin secreation is decreased by:
typhoid in the first week of fever?
a. Norepinephrine acting on ǂ2
a. Blood culture
19.The polymeras chain reaction for diphtheria adrenergic receptors
toxin gene 40.MELD score for predicting prognosis of a
a. Can be positive when culture is patient with chronic liver disease includes
negative parameters ?
20.viruses produces cytopathic effect a. Serum creatinine
resembling bunches of grapes? 41.Cystic fibrosis results from mutation in CFTR
a. Adenovirus A unit
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gene located on chromosomes?
21.Motor division of trigmental nerve leaves the a. Chromosomes 7
skull through 42.Primary peristalsis in esophagus is due to
a. Foremen ovale a. Pharyngeal phase of swallowing
22.agents is a competitive antagonist at the 43.aids iron absorption?
neuromuscular junction nicotinic a. Vitamin C
cholinoceptors? 44.The MOST common pulmonary manifestation
a. Atracurium of rheumatoid arthritis?

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 TARGET DEC. 2018
a. Pleuritis 65.A 25-year old male truck driver presents with
45.The antitubercular drug which causes lesions on the genitals of 3 months during as
orange discoloration of the urine is shown in the given image. He gives a history of
a. Refampicin unprotect sexual intercourse with a female
46.The definitive host in the lifecycle of sex worker 6 months back. is the MOST likely
Echinococcusgranulosus (hydatid disease)? causative organism
a. Dogs
47.Angioliponmas of kidney are associated with
a. Tuberous sclerosis
48.The most common for duodenal ulcer is
a. First part of duodenum
49.Seen in hypocalcemia?
a. Cardiac failure
50.The composition of sodium in low osmolality
a. Human papilloma virus type 6
oral rehydration solution (ORS) is
66.The condition shown in the given image
a. 75 mmol/L

I
51.astrocytomas is MOST common in children?
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a. Pillocytic LTT
52.Characteristic in anorexia nervosa

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differentiates it from bulemia nervous?
a. Amenorrhea
53. TRUE regarding the treatment of

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hyponatremia ?
a. A patient with severe symptoms

-
(seizures) no matter the eticlogy
should be given a bodies of hypertonic
saline a. Psoriasis

S
54.Resistance of rifampicin in mycobacterium 67.The MOST common congenital heart valve
tuberculosis is associated with mutation in defect
the a. Bicuspid aortic valve
68.Medullary cystic kidney disease type-II is

M
a. rpoB gene
55.A 7 year old infant presents with caused by mutation in
unconsciousness cyanosis and 85% oxygen a. Umod gene

A
saturation. Chest X ray reveals egg on end 69.The diagnosis test for Meniere disease
a. Electrococchleography

I
appearance. is the most likely diagnosis?
a. TGA 70.In a 15 year old patient the TSH level is
56.If a person says that his neighbors have fitted extremely low, the serum T3 and T4 level are
elevated. is the likely diagnosis

D
a machine in his brain. it is an example of:
a. Bizare delusions a. Graves’ disease
57.ECG changes is characteristic of 71.Acute necrotizing otitis media is caused by
hypokalemia? organism s
a. Flattened T wave a. Hemolytic streptococci
58.A child with severe acute malnutrion (SAM) is 72.Bitemporal hemianopia is caused by a lesion
lethargic has feeble pulses and capillary localized at the
refilling time > 3 seconds with cold hands. a. Optic chiasma
statements is not true regarding the 73.Rhinophyma is a condition of nose involving
management of SAM patients? a. Tip of nose
a. Give IV 20 ml/kg bodies over 5-15 74.The opening connecting epithympanum to
minutes using ringer lactate mastoid antrum is called
59.Wide and fixed splitting of second heart a. Aditus
around is seen 75.ParacusisWillsii is seen in patients with
a. Atrial septal defect a. Oosclerosis
60.In middle mediastinum 76.Milkulicz cells are diagnostic of
a. Bronchogenic cyst a. Rhinoscleroma
61.A live attenuated vaccine? 77.A child presents with hearing loss, white
forelock, and beterochromiairidis. is the
a. Measles
62.The antidiabetic drug that raises the plasma
A unit
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insulin level a. Waardenbug syndrome
a. Sulphonylurea group 78.Tests is diagnosis of CSF rhinorrhea
63.A management of respiratory acidosis? a. Beta 2 transerrin
a. Assisted ventilation 79.The dose of vitamin K given to a term neotnate
64.Split glomerular basement membrane on a. 1 mg
electron microscopy is associated with 80.Implantation occurs at
a. Alport t syndromee a. Blastocyst stage
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 TARGET DEC. 2018
81.Immunoglobulins is produced by the fetus 102. Vitamins is available only from animal
itself sources
a. IgM a. Vitamin B12
82.Nabothian cyst is a type of 103. The period of time for quarantine of
a. Retention cyst persons for control of any infection disease
83.Pavornocturnus is a term for disorders of a. Maximum inclubation period
sleep 104. TRUE for IgG
a. Nightmares a. It activates complement
84.The plague bacilli in rate fleas is an example 105. enzymes is synthesized in proenzyme
of biological transmission types form
a. Propagative a. Caspase

I
85.Depot contraceptive DMPA is to be given 106. According to Factories Act 1948,
every maximum permissible working hours per week
a. 3 months are

C
86.The disaster search and rescue team is a. 48
formed during 107. In reproductive and child health
a. Preparedness phage programme, districts are divided on the basis
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87.Patient becomes confused with visual of
disturbances and difficulty in walking. is the a. Crude birth rate and female literacy

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MOST likely diagnosis rate
a. Wernickleencyphalopathy 108. is MOST common site for endometriosis
88.The minimal level of total fat consumed a. Ovary

S
should be 109. is the recommended daily intake of
a. 20% of energy vitamin A during pregnancy
89.Burtonian illness are associated with a. 800 mcg

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chronic poisoning by substances 110. The mucoidoncapsulated yeasts in
a. Lead cryptococcal meningitis can be visualized in
90.TRUE regarding incidence and prevalence of CSF by

A
diagnose a. India ink

I
a. Prevalance depends on incidenence 111. Is a sophisticated measure of malaria
and duration of disease incidence in a community
91.TRUE about niacin a. Annual parasite index

D
a. Threonine serves as its precursor 112. Ranula is mucocele of
92.The sensitivity of a screening test is the a. Sublingual
ability to correctly identify 113. The framingam heart study is an
a. True positive example of epidemiologic studies
93.Giving penicillin prophytaxis to a person with a. Cohort
rheumatic fever is 114. Testicular tumor shows Schiller-
a. Secondary prevention Duval body on microscopy
94.TRUE about congenital rubella syndrome a. Yolk sac tumor
(CRS) 115. Aacts as a catalyst in the reactions of
a. Fetal damage is rare following free oxygen metabolites
infection after 16 weeks of pregnancy a. Ferric ion
95.The procedure by which study participants 116. Lines of Zahn occur in
are allocated to various study groups a. Thrombus
a. Randomization 117. Acts as a catalyst in the reactions of
96.Pro-inflammatory cytokine free oxygen metabolites
a. Tumor necrosis factor-alpha a. Ferric ion
97.Falling on the buttock from height will 118. the germline mutation that
result in predisposes to adrenal cortical carcinoma
a. Ring fracture a. p53
98.Maquals reagent is used I testing to identify 119. Glucose content of CSF is nearly
a. Opium always normal in type of meningitis
99.Primarily a cardiac poison a. Viral
a. Nicotianatabacum 120. Classes I NHC molecules are
100. The initiation of BMI as a measure of A unit
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recognized by cells of the immune system
obesity a. Cytotoxic T lymphocyte
a. Does not differentiate weight 121. is the biological indicator that is used
associated with muscle and fat in ethylene oxide sterilizer
101. Estimation of in vaginal fluid is a. Bacillus atrophaeus
helpful to establish sexual intercourse in 122. Ethiodium bromide staining is used for
case of rape detection of
a. Acid phosphatase a. Pyruvate to acetyl CoA

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 TARGET DEC. 2018
123. is the MOST common malignant 136. Keratoconjunctivitissicca is a
transformation seen in dermoid cyst of ovary condition caused by the deficiency of
a. Squamous cells carcinoma components of the lear film
124. chronic infections of hepatitis B is a. Aqueous
defined as the presence of 137. The method that is used for
a. HBsAg for more than 6 months preservation of donor cornea up to 5 days
125. Extranuclear DNA is present in a. KM Medium storage
a. Mitochondria 138. Radial keratology corrects myopia by
126. All aminotransferases require a. Flatterning the cornea
coenzymes 139. Snow balt (snow banking) vitreous
a. PLP opacities occur in
127. is the correct order of repair when a. Pars plantia
performing relmplnatation of an amputated 140. The MOST important risk factor for
finger diabetic retinopathy
a. Bone, extenosr tendon, flexor tendon, a. Long stading diabetes
artery, nerve, and vein 141. Keratometer is used for the

I
128. The two side chain modifications measurement of
A unit
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LTT
present in the peptide TRH are a. Curvature of cornea
a. Cyclization and armidation 142. The strongest risk factor for urinary

C
129. What is the diagnosis based in the a. Cigarrrate smoking
given cranial CT images 143. A noninvasive test for detection of
helicobacter pylori?

M
a. Urea breath test
144. A patient with holosystolic murmur

-
which increased on deep inspiration is
suggestive of
a. Carvallos sign

S
145. NOT a feature of Beck triad
a. Kussmual sign
a. Subdural hemortiage 146. Cerebellopontine angle tumor MOST
130. Milgnant salivary gland tumors

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commonly involve nerves
invades perineural spaces a. V, VII, VIII, IX
a. It responds to transtuzumab 147. Collapsing glomerulopathy is

A
131. Indetifies the anatomical structure associated with
marked by the arrow on the given radiograph

I
a. HIV
148. Sideroblastic anemia may respond to
supplementations of

D
a. Pyridoxine
149. Budd-Chiari syndrome is caused due to
a. Hepatic vein thrombosis
150. MOST common site for hematogenosu
a. Lesser trochanter femour spread of gastric malignancy
132. What is the diagnosis based on the a. Liver
given chest radiograph in a patient with acute 151. Tests should be used to monitor the
breadthlessness success of treatment for a patient with
pulmonary tuberculosis
a. Sputum microscopy
152. The daily sodium and potassium
requirements are
a. 3 mEq of sodium and 2 mEq of potassium
per kg body weight
a. Pneumothorax 153. A 55 year old man is diagnosed with
133. Visible spectrum of light is from adenocarcinoma right lung, lower lobe,
a. 401-700nm imaging is suggestive of 2 different lesions
134. 701-900nm is the MOST common cause approximately 2.5 x2.5 cm and 4x4 cm in size in
of vitreous hemorrhage in adults the lipilateral same lobs, is the T stage
a. Diabetes mellitus a. T3
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135. Identifies the anatomical structure 154. Child –Pugh criteria does not include
marked by the arrow on the given image a. Leukocyte count
155. MEN-2a syndrome includes tumors of
a. Medullary carcinoma thyroid,
pheochromocytoma, and primary
hyperparathyroidism
a. Left atrium
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 TARGET DEC. 2018
156. For saphenous vein cut down , the site 176. Lack of fundal fusion is seen in
of incision in relation to medial mallecolus is a. Bicornuate uterus
a. 1 cm anterior and superior 177. 26 year old woman presents with pain
157. is a proteasome inhibitors and tenosynovitis of the wrist and ankles,
a. Bertezombi and arthralgias of other joints. She notes 2
158. is MOST widely used tracer for PET-CT prior episodes similar to the present episodes.
a. F15 flurodeoxglycose She hust had her menstrual period during the
159. is the diagnostic investigation of previous week. Physical examination reveals
choice in a suspected case of renal cells ulcerated lesions overlying the wrist and
carcinoma ankles. These symptoms are likely due to
a. Contrast enhanced CT scan of deficiency of

I
abdomen a. Complement (C5-C8) components
160. Rest pain is classified as Fontaine 178. Antimulterian hormone in women is
stage secreted by

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a. III a. Granulosa cells
161. In a patient with suspected head injury, 179. is the antihypertensive drug
if the best motor response is abnormal contraindicated in pregnancy
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M
flexion, then the score assigned to M is a. Angiotensin converting enzyme
a. 3 180. Red degeneration in a fibroid occurs in
162. Insulinoma of the pancrease causes a. Pregnancy

-
triads 181. is an indication for an
a. Saint anticholinesterase

S
163. 60-year old woman presents with a a. Alzheimer dementia
history of sudden onset acute backache 182. is the adverse effect of Lithium
followed by syncope, her pulse is 160/min, BP a. Polyuria
is 80/60. Abdominal examination reveals a 183. factors affect a drugs volume of

M
tender pulsatile mass in the epigastrium. is distribution
the presumptive diagnosis a. Drug pKa

A
a. Ruptured aortic aneurysm 184. Cytotrophoblasts are
164. Net renal excretion of drugs is a. Mononuclear

I
represented by 185. The classical ultrasound finding in
a. (Glomerular filtration + tubular molar pregnancy is described as

D
secretion)- tubular reabsorption a. Snowstom
165. Nitrous oxide is 186. Buprenorphine is
a. Good analgesic a. Partial agonist at — receptor
166. The lowest risk of catheter related 187. Frothy discharge from nose which
infection is seen in increase on pressure over chest is
a. Subclavian vein characteristic of death from
167. The shortest local antimuscarinic a. Drowing
drug mean for mydriasis and cydoplegia is 188. he edematous portion of fetal scalp
a. Tropicamide immediately over the cervical os is known as
168. Treprostinil is an analog of the a. Caput succedaneum
prostaglandin subtype 189. is a high energy compound?
a. PGI2 a. 1.3 – bisphosphoglycerate
169. Gene Expert detects resistance of 190. reactions occurs during the
mycobacterium tubercutosis against conversation of pyruvate to acetyl CoA?
a. Rifampicin a. Dehydrogenation and decarboxylation
170. The appearance of green color in a 191. Insulin receptor is present on
contiusion is due to the presence of a. The cell membrane
substanes 192. Wilson disease is associated with
a. Hematoidin a. Increased liver copper
171. Widal test is a type of 193. Selenium is a cofactor in coenzymes?
a. Agglutination reaction a. Glutathione peroxidase
172. Glassware can be sterilized by 194. Stokes radius is the basis of
a. Hot air oven separation of protein in
173. is an additional pathway of complment a. Size exclusion chromatography
activation that has recently emerged 195. A unit
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Viral hepatitis is a zoonotic disease?
a. Mannan-binding lectin pathway a. HEV
174. is a live attenuated viral vaccine 196. The feature of type I endometrial
a. Rotavirus vaccine carcinoma (endometrioid carcinoma)?
175. Gene transfer in bacteria by a. PTEN and K-RAS mutation
transformation has characterized 197. The MOST common for subarachnoid
a. It can be carried out using free DNA hemorrhage?
from the donor a. Saccular aneurysm

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 TARGET DEC. 2018
198. Australia antigen is associated with ? a. Endodermal cells of hepatic bud
a. Hepatitis B virus 218. Afferents of the golgi tendon organ
199. The key microscopic feature of are
ependymoma? a. Type I B
a. Perivascular pseudorosettes 219. The enteric nervous system is mainly
200. Bilaterally enlarged kidneys are seen made up of fibers?
in : a. Postganglionic sympathetic and
a. Polycystic kidney disease
preganglionic parasympathetic fibers
201. A negative phase reactant?
220. TRUE regarding control of skin
a. Albumin
202. Taysacha disease is due to the coloration?
deficiency of a. Albinos have a congenital inability to
a. Beta hexosaminidase synthesize melanin
203. Sanger technique is a method of 221. Chorda typani enters the middle ear
a. DNA sequencing a. Posteriorly
204. Gleason system of grading is used in 222. Schirmer test is the diagnostic test
for which of the nerves?

I
types of malignancy?
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a. Prostate carcinoma a. Facial nerve
205. A deep cerebellar nucleus? 223. The 5d reductaseisoenzyme is NOT

C
a. Fastigial present in marnmals?
206. Degrades fibrin? a. Cat
a. Plasmin 224. The concentration of epinephrine used

M
207. Dryness of eye is seen with large doses in test-dose for epidural anesthesia is
of ? a. 1:200000
a. Atropine

-
225. A 15-year-old boy presents in
208. Cytopines are lacreted in sepsis and
emergency with a history of trauma with
systemic inflammatory response syndrome
tennis ball to the right eye. He complains of

S
(SIRS)by
diplopia, pain, and redness. His diplopia could
a. Neutrophils
209. tissues is mascular? be due to all of the following EXCEPT
a. Dislocation of lens in vitreous

M
a. Cartilage
210. True for focal segmental 226. Mechanical entrapment of inferior
glomerulosclerosis? rectus or inferior oblique

A
a. Loss of lock-process on electron muscleGlaukomflecken in acute angle

I
microscopy closure glaucoma presents as
211. Nerves is a content of a. Anterior subcapsular lens opacity
pterygopatatine fossa? 227. TRUE regarding Monteggia fracture?

D
a. Maxillary a. Fracture of ulna with superior radio
212. In children under the age of 2 years, ulnar joint dislocatin
nerves is prone to injury while dealing with 228. The MOST common TYPE of lesion in
postauricular abscess? Pott spine?
a. Facial a. Paradiscal
213. Pretectal nucleus is involved in ? 229. Tinnitus, vertigo, and ear ache due to
a. Light reflex abnormality of the temporomandibular joint
214. Tissues stores energy and provides is seen in ?
insulation? a. Costen syndrome
a. Adipose 230. The hardest bone in the human body?
215. Derivative of second pharyngeal a. Osseous labyrinth
arch? 231. The reason for increased carbon
a. Stylohyoid ligament dicodde tension in Bohr effect?
216. A 33-year-old man, who is nondiabetic a. Increase in P50
and nonhypertensive, first reports weakness 232. May be dangerous in failed intubation?
in the right arm and within 6months it spreads a. Relucuantintutiatin attempt
to the entire right side. Neurological 233. Hyaluronic acid is present in
examination reveals a flaccid paralysis,
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a. Vitreous humor LTT
atrophy, fasciculation, hypotonia, and absent 234. Run amok” is frequently associated
reflexes in the right arm and the right leg. with the long-term heavy use of
Higher functions are normal. The MOST a. Cannabis
likely cause is 235. Germ tube test is used for
a. Amyotrophic lateral sclerosis identification of ?
217. Parenchyma of the liver is formed by a. Candida athicans

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 TARGET DEC. 2018
236. Centrally-acting ǂ2 agonists is used as 256. Secondary amyloidosis of liver,
amyloid material is present:
a sedative in intensive care unit?
a. In space of Disse
a. Dexmedetomidine 257. Lymphoma associated with H. Pylori
237. Detergent action of bile acid is due to infection is:
the a. MALT Lymphoma
a. Amphipathic nature of bile acids 258. In a lymph node showing non
238. An inhibitor of enzyme decreases the necrotizing and non – caseating granuloma –
apparent V-max of the eruyme, but has no the following is suspected:
a. Cat scratch disease
effect on the K value it would be classified as
259. Number of girl born to a woman
a. Noncompetitive inhibition experiencing current fertility pattern is

I
239. The hardest bone in the human body? denoted by:
a. Osseous labyrinth a. Gross reproduction rate
240. In osteoporosis, the biochemical 260. Assessment of prevalence of infection

C
changes in the blood are usually for tuberculosis in community setting is done
a. Normal calcium, normal phosphate, by:
a. Tuberculin test
and normal alkaline phosphatase 261. Hepatic encephalopathy is the result
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241. Traumatic optic neuropathy is of :
associated with ? a. Excess of nitrogenous substances in

-
a. Relative afferent papillary defect blood
242. The commonest type of placentation in 262. All of the following are done
monozygotic twins is immediately for class III dog bite EXCEPT:

S
a. Monochorionicdiamniotic a. Stitch wound under antibiotic cover
243. Antihypertensive drugs is 263. BMI of pre – obese person is:
contraindicated in pregnancy: a. 25 -29.9

M
a. ACE inhibitors 264. The best measure for evaluating
244. The following drugs are used in the standards of therapy is:
management of Post PartumHemorrhage, a. Survival rate

A
EXCEPT: 265. The main objective of setting up
a. Mifepristone sentinel surveillance is to:

I
245. The shortest anteroposterior a. Identify the missing and hidden cases in
diameter between the promontory of sacrum the community
& the symphisis pubis is designated as the: 266. Major source of erythropoirtin in

D
a. Obstetric conjugate which one of the following:
246. Bishop cervical score does not a. Juxtaglomerular cells of kidney
include: 267. Insulin increases transport of
a. Fetal presentation glucose into:
247. An 18 year old girl with primary a. Adipose cells
amennorhea with normal breast the likely 268. Sperm capacitation occurs due to:
diagnosis may be: a. Decreased cholesterol content of
a. Mullerian agenesis acrosomal membrane
248. Commonest cause of first trimester 269. Trendelenberg sign is positive in
miscarriage is: paralysis of :
a. Chromosomal abnormality in the a. Gluteus medius
conceptus 270. Emulsification of lipids in the small
249. Breast milk contains all vitamins intestine requires:
except: a. Bile salts
a. Vitamin K 271. Carbamoyl Phosphate Synthase I (
250. Under the MTP Act, pregnancy can be CPSI) is
terminated up to which week of gestation: a. Hepatic mithochondrial enzyme
a. 20 Weeks 272. The following fungus can attack hair:
251. Which is the typical clinical feature of a. Microsporum
vaginmal discharge due to bacterial 273. The following is a common cause of
vaginosis: chronic meningitis:
a. Fishy odour when mixed with 10% KOH a. Cryptococcus neoformans
252. In a case of post menopausal bleeding, 274. Death in ‘ Immersion Syndrome’ is due to
which is not a very useful investigation: :
a. High vaginal swab for culture a. Vagal inhibition
253. In a case of post menopausal bleeding, 275. A unit
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of TEN PVT. LTD
LTT
The following parasite causes anemia:
which is not a very useful investigation: a. Anklyostomaduodenale
a. High vaginal swab for culture 276. Sabin – Feldmen dye test is used for
254. For coagulation studies, the diagnosis of:
anticoagulant of choice is: a. Toxoplasmosis
a. Trisodium citrate 277. Quantitative estimation of
255. For coagulation studies, the immunoglobulin in serum by immunodiffusion
anticoagulant of choice is: technique is by:
a. Trisodium citrate a. Single diffusion in two dimension

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 TARGET DEC. 2018
278. Antimicrobial agents act solely on the 299. All of the following are symptoms of
gram positive cell wall: hyponatremia EXCEPT:
a. Ciprofloxacin a. Diarrhea
279. suspected case of air embolism , 300. The commonest cause of
search for embolism is to be done in: subarachroidhemorrhage is:
a. Right ventricle of heart a. Aneurysm
280. Chinese letter arrangement is 301. Metabolic abnormality is seen in
characteristic of: Tumorlysis syndrome:
a. C. diphtheriae a. Hypocalcemia
281. Clostridium perfringens infections 302. Neuroleptic malignant syndrome is
are commonly associated with: characterized by:
a. Contamnation of wounds a. Labile blood pressure
282. Ova of the following parasite is bile 303. Most important step in management of
stained: diabetic ketoacidosis is administration of:
a. Ascarislumbricoides a. Intravenous Fluid( saline)
283. Leukotriene inhibitors are very 304. drugs may cause thrombocytopenia:
effective in which one of the following a. Aspirin

I
conditions: 305. Commonest type of schizophrenia:

284.
A unit
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a. Aspirin induced asthma
Triptans used in migraine headaches 306.
a. Paranoid
Lisch Iris nodules are seen in:

C
are agonists at which receptor: a. Neuprfibromatosis
a. 5HT ID/IB 307. The oral drug used in treatment of
285. Abductor of vocal cod is which one of scabies is:
the following: a. Ivermectol

M
a. Posterior cricoarytenoid 308. Photo ophthalmia is caused by:
286. Nerve is involved in carpal tunnel a. Ultraviolet rays

-
syndrome: 309. Bitemproal hemianopia is seen in lesion
a. Median nerve of:
287. Spondylolysis involves which one of a. Optic chiasma

S
the following: 310. Hypokalaemic, hypochloraemic
a. Pars interarticularis alkalosis is a feature of :
288. Radiations has the highest biologic a. Congenital hypertrophic pyloric
effect: stenosis

M
a. Gamma rays 311. Normal anoin gap is seen in:
289. Osteoarthritis usually involves which a. Diarrhoea
compartment of the knee joint in the 312. Cranial nerve not at risk during

A
beginning: surgery of submandibular salivary gland is:

I
a. Medical tibiofemoral a. Glossopharyngeal nerve
290. The most common Post radiation 313. Cavity formation is observed in one of
malignant bone tumor seen in: the following bronchogenic carcinoma:

D
a. Osteosarcoma a. Squamous cell
291. In India population which joint is most 314. Diagnosis investigation for lung
commonly affected in osteoarthritis: sequestration is by:
a. Knee a. Angigraphy
292. Cells are most radiosensitive in: 315. Thyroid hormone T4 is derived from
a. M -phase a. Tyrosin
293. Young’s operation is done in: 316. In sickle cell anaemia the genetic
a. Atrophic Rhinitis defect lie with amino acid residue at 6th
294. In shock, Dopamine is used in the position and replaced by
following: a. Glu by valine in Beta chain
a. 1 – 2 Pg/kg/min 317. The major hemoglobin present
295. Commonest cause of deafness in a. HbA1
children under 12 years of age: 318. Toxicity of cholera toxin in due to
a. Sectary otitis media which one of the following
296. An 18 year old man was admitted with a. ADP – ribosylation of Gs alpha sub
massive hematemesis . He had a history of unit
fever for 14 days prior to which he was 319. The main catabolic product/ products
treated with drugs. On examination, moderate of purine nucleotides in humans is which one
splenomegaly was present. The Likely cause of the following
of his condition is: a. Uric acid
a. Esophagealvarices 320. A unit
i of
of TEN PVT. LTD
LTT
Dumping syndrome is characterized by
297. Pentad of syndrome of which one of the following
pain/jaundice/fever/shock/altered mental a. Generalized weakness dizziness and
status is associated: sweating after meals
a. Cholecystitis 321. The longest living WBC is which one of
298. A 15 year old boy was stung by a bee. the following
He had difficulty in breathing and facial a. Lymphocyte
edema. What is the best treatment 322. “a” wave of the jugular venous
a. SC C Adrenalinn pressure is caused by
8 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
 TARGET DEC. 2018
a. Atrial systole 344. VenkataramanRamakrishnan medium is
323. Morphine is used in which one of the transport medium employed for the isolation
following of
a. Left ventricular failure a. Vibrio cholerae
324. The major common determinant or 345. Magnification obtained with direct
myocardial oxygen consumption is which one Ophthalmoscope is which one of the
of the following following
a. Myocardial fiber tension a. 15 times
325. Ovulation coincides with which one of 346. Which one of the following vaccines,
the following should not be kept in freezer
a. LH surge a. DPT
326. The drug of choice in 347. The corneal abrasion or an ulcer is stained

I
lymphogranulomavenereum is by which one of the following
a. Tetracycline a. Fluorescein dye
327. A prokinetic drug which lacks D2 348. The most common systemic association of

C
recept antagonism is which one of the scleritis is which one of the following
following a. Rheumatoid arthritis
a. Cisapride 349. The commonest persentatin of the fetus for
A unit
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of TEN PVT. LTD
LTT

M
328. Nicotinic receptor sites include all of vaginal delivery is
the following a. LOA
a. Bronchial smooth muscle 350. Post streptococcal glomerulonephritis in

-
329. Brunners glands are present in which children is diagnosed by
one of the following a. Mild protienuiria, hematuria, high ASO
a. Duodenum titre

S
330. Minimal change disease is 351. Triple screen for Downs syndrome includes
characterized by all except all of the following except
a. Lack of response of steroids a. Low serum HCG levels

M
331. lung cancer has the worst prognosis 352. LH: FSH ratio is raised in which one of the
a. Small cell carcinoma following
332. Alveolar exudates with fibrin broken a. Polycystic ovarian disease

A
down red cells land few neutrophils is 353. The maternal complications associated with
observed in which one of the following hydramnios are the following except

I
a. Stage of red hepatization a. Obstructed labour
333. Epstein Barr virus causes the 354. Bacterial vaginosis in pregnancy is
following diseases except associated with increased risk of all the

D
a. Adult T – cell lymphoma leukemia following EXCEPT
334. The tape worm associated with a. Abruption placentae
megaloblastic anaemia is 355. Majority of ovarian tumors originate from:
a. DIphyllobothriumlatum a. Epithelium
335. Nieman picks disease is due to 356. The most important structure
deficiency of preventing uterine prolapse is which one of
a. Sphingomyelinase the following:
336. A child with alopecia, a. Cardinal ligament
hyperpigmentation, hypogonadism and 357. A 43 year old woman presets with
dermatitis of genitals and mouth is likely to prolonged menstrual cycles with heavy
suffer from bleeding. Endometrial sampling shows simple
a. Zinc deficiency hyperiasia without atypia. The treatment of
337. Lyme disease is caused by which one of choice is :
the following a. Hysterectomy
a. Borreliaburgdoferi 358. Colposcopy is a screening tool for pre
338. Rabies virus isolated from natural malignant lesions of :
human or animal infection is termed a. Cervix
a. Street virus 359. Lung cancer is more often associated
339. Most common cause of lower respiratory with ONE of the following:
infection is which one of the following a. Asbesstosis
a. Streptococcus 360. The population served by a Community
340. 24 hrs normal fluid requirement for a one Health Center Under the Rural Health
year old child weighing 8 kg is Scheme is:
a. 800 ml a. 100000
341. Hbelectrohoresis in thalasemia trait will 361. Finding the most cost effective
show A unit
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of TEN PVT. LTD
LTT
alternate form among the available
a. Normal HbF& High HbA2 alternatives is knows as:
342. Direct demonstration of spirochaetes a. Systems analysis
may be done by all of the following 362. Investigations of delayed puberty
a. Dark field microscopy include which one of the following:
343. Argyll Robbertson pupil is characteristic a. All of the above
of which one of the following 363. The physical quality of Life Index (
a. Neurosyphilis POLI) is based on:

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 TARGET DEC. 2018
a. Life expectancy at one year of age, evidence of sacroilitis. The most likely
infant mortality and literacy diagnosis is:
364. The contraceptive of choice ( a. Ankylosing spondylitis
temporary) for an educated lady of 37 years 385. A female patient presented with
is : dysphagia and stiff fingers with
a. Diaphragm breathlessness on exertion. The Probable
365. Which one of the following countries diagnosis is:
has the fastest population growth rate in the a. Rheumatoid arthritis
world: 386. Grey turner sign is seen in which one
a. Kuwait of the following :
366. Learned behaviour which has been a. Pancreatitis
socially acquired is: 387. A 45 yr old man complains vomiting
a. Culture particles eaten a few days before breath and
367. Surveillance is: occasional dysphagia for The diagnosis is:
a. Watching with attention, authority a. Zenker’s diverticulum
and suspicion 388. Dressler’s syndrome is due to which
368. Erogonomics is a discipline that deals one of the following :
with: a. Autoimmune reaction

I
a. Fitting the job to the workers 389. The mode of inheritance in adult
369.
A unit
i of
of TEN PVT. LTD
LTT
In judging the merits of a screening polycystic of kidney is which one of the
test the ability of the test to correctly following:

C
identify the true negatives is: a. Autosomal dominant
a. Specificity 390. Secerity of mitral stenosis can be
370. All of the following statements are clinically judged by which one of the

M
true with to Rhinoscleroma EXCEPT following:
a. It is caused by gram positive cocob a. Intensity of first heart sound
371. Peritonsillar abscess is 391. Which one of the following is true

-
differentiated from acute tonsillitis by: about the beta lactam antibiotics:
a. Tonsil being pushed medially a. Are safe in pregnancy

S
372. In auditory Brain Stem evoked 392. The number of melanocyte is
response IV arises from: decreased in:
a. Superior Olivary nucleus a. Albinism
373. Wheat is deficient in ONE of the 393. Investigation of choice to demonstrate

M
following amino acids: ureteric reflux is which one of the following:
a. Lysine a. MCU
374. Early ambulation after a major 394. The filament of X – Ray tube is made up of

A
operation is an example of: element:

I
a. Disability limitation a. Tungsten
375. Of the total amount of un stimulated 395. Double bubble sign in an X – ray
whole saliva, the maximum percentage of indicative of:

D
saliva is derived form: a. Duodenal artresia
a. Minor salivary glands 396. The number of melanocyte is
376. Schwartz’s sign is seen in which one of decreased in:
the following: a. Albinism
a. Otosclerosis 397. A topical retinoid recently introduced
377. Myringitisbullosa is caused by: for the treatment of psoriasis is:
a. Influenza virus a. Adapalene
378. Haemolytic anaemias are 398. Contricted pupils area recognized
characterized by all of the following finding in acute poisoning with which one of
EXCEPT: the following:
a. Increased haptoglobulin a. Chlorpromazine
379. Which one of the Anti – tubercular 399. Gas is more famous as “Laughing Gas”
drug may precipitate gout: a. Nitrous Oxide
a. Pyrazinamide 400. The tumour marker useful in the
380. Which one of the following is true postoperative follow up of patient with
about pan coast tumor: colonic carcinoma is:
a. Causes radicular pain in upper limb a. CEA
381. A patient ABG ( Arterial Blood Gases) 401. Classical amoebic ulcers of colon are
values are as folloes pH – 7 28, pCO2 – 70 described as:
and HCO3 – 36 the condition is: a. Flask shaped
a. Respiratory acidosis with metabolic 402. A unit
i of
of TEN PVT. LTD
LTT
Collar stud abscess is seen in which
alkalosis one of the following:
382. Normal anion gap metabolic acidosis is a. Tuberculosis
caused by: 403. The diagnosis of Hirschprung’s disease
a. Cholera is confirmed by:
383. Brain death means loss of: a. AnorectalManometry
a. Corneal reflexes 404. The treatment of choice for a rectal
384. A young man present with joint pain growth 15 cms from the anal verge is:
and backache X ray of the spine shows a. Anterior r resectionn
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 TARGET DEC. 2018
405. Which one of the following can NOT 427. Investigation of choice in traumatic
be classified as a solitary nodule paraplegia is which on of the following
a. Physiological goiter a. CT scan
406. Pre – tibialmyxedema is a feature of: 428. Investigation of choice to demonstrate
a. Thyrotoxicosis vesico-ureteric reflux is which one of the
407. The commonest mode of spread for following
carcinoma of the gall bladder is which one of a. MCU
the following: 429. The filament of X-ray tube is made up of
a. Direct infiltration which one of the following element
408. Not a features of Crohn’s disease: a. Tungsten
a. Scelerosing Cholangitis 430. Isomorphic phenomenon is seen in all
409. Which one of the following is a low of the following EXCEPT

I
flow vascular malformation: a. Lichen sclerosus
a. Port wine stain 431. Hirshprung’s diseases most commonly
410. Branham’s Bradycardia sign is positive involves which one of the following

C
in which one of the following: a. Incision and Drainage
a. Large A – V Fistula 432. The tumor marker useful in the
411. Thrombophlebitis is an associated postoperative follow up of patients with
feature in which one of the following: colonic carcinoma is
A unit
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of TEN PVT. LTD
LTT

M
a. Buergers disease a. CEA
412. The commonest variety of basal cell 433. In salivary glands calculi are most

-
carcinoma is which one of the following: commonly seen in which one of the following
a. Nodular a. Parotid
413. A 50 year old lady presents with a 434. in cervical tuberculous lymphadenitis,

S
scaly lesion of the areola of the left breast the commonest source if infection is
that ulcerates and bleeds periodically. The a. Hematogenous spread
likely diagnosis is: 435. Feature of malignant change in a
a. Pagets disease pleomorphic adenoma of the parotid includes

M
414. A 50 year old lady presents with a all EXCEPT
scaly lesion of the areola of the left breast a. Cystic degeneration
that ulcerates and bleeds periodically. The 436. The commonest cause of death in

A
likely diagnosis is: neonate with TOF if left untreated is

I
a. Pagets disease a. Bronchopneumonia
415. Tinel’s sign suggests: 437. In a patient with carcinoma stomach,
a. Nerve regeneration Sister Joseph’s nodule refers to metastasis

D
416. Le Fort classification refers to: at
a. Fractures of the maxilla a. The umbilicus
417. Hill Sach’s lesion is seen in which one 438. The treatment of choice for a rectal
of the following: growth 15 cms from the anal verge is
a. Recurrent dislocation of shoulder a. Anterior resection
418. Spigelian hernia refers to: 439. which one of the following can NOT be
a. Hernia at the arcuate line classified as a solitary nodule
419. The minimum period required for post- a. Physiological goiter
exposure chemoprophylaxis for HIV is 440. spigelian hernia refers to
a. 6 weeks a. Hernia at the arcuate line
420. Dressler’s syndrome in due to which 441. Rheumatoid arthritis the
one of the following characteristic joint involvement
a. autoimmune reaction is______________ which one of the following
421. Tetany is caused by all of the a. Knee
following Except 442. Not a feature of Exudative pleural
a. Malasorptoin effusion is
422. IgGantimitochondial antibody is a. Tuberculosis
detected in which one of the following 443. haemolytic anaemias are
conditions characterized by all of the following
a. Primary biliary cirrhosis EXCEPT
423. Warfarin anticoagulants inhibits a. Hypercellular marrow
following coagulation factors 444. A young man after consuming food in a
a. II, VII, IX, X party complaint of vomiting and diarrhea
424. The phenomeonon of fixed splitting of within 1 to 5 hours. The diagnosis is food
the second heart sound is of diagnostic value poising due to
in a. Staphylococcus aureus
a. Atrial septal defect 445. A unit
i of
of TEN PVT. LTD
LTT
Which one of the following is true
425. Infection with Pseudomonas organisms about pan coast tumor
is frequently associated with a. Cause radicular pain in upper limb
a. Pyodermagangrenosum 446. The bacteria most commonly
426. True about the beta lactam antibiotics associated with toxic shock syndrome is
a. Are all based on the 6-amin- a. Staphylococcus aureus
penicillanic acid structure 447. features differentiates invasive
carcinoma from carcinoma in situ

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 TARGET DEC. 2018
a. Basement membrane invasion 469. The rate limiting enzyme in fatty acid
448. LH: FSH ratio is raised in biosynthesis is
a. Polycystic ovarian disease a. Acetly CoA carboxylase
449. The dendric configuration of corneal
470. Which nerve is likely to be injured
ulceration is characteristic of
a. Herpes while ligating superior thyroid artery
450. Major histocompatibility complex a. External laryngeal
plays a role in 471. NOT a function of vasoactive
a. Pathogenesis of auto immune disease intestinal peptide?
451. The contracetive protective against a. Constricts peripheral blood vessels
PID and STDs is which one of the following 472. Iron binding protein is
a. Condoms
a. Ferritin
452. The commonest presentation of the
fetus for vaginal delivery is 473. is implicated as a causative agent for
a. LOA angiosarcoma of liver
453. the gold standard for diagnosing a. Vinyl chloride monomers
pelvic inflammatory disease is which one of 474. Conjugated hyperbilirubinemia is seen
the following

I
in conditions
a. Laproscopy
454. A unit
i of
of TEN PVT. LTD
LTT
Q fever is caused by which one of the
a. Crigler- Najjar syndrome
following 475. Genetic factor(s) which favor

C
a. Coxiellaburnetti thrombosis is/are
455. venkataraman- Ramakrishnanmediun is a. Deficiency of proteins C and S
a transport medium employed for the 476. Which is NOT a function of Anganwadi

M
isolation of worker
a. Vibrocholerae a. Immunizing children
456. The other name for reverse

-
477. “Respirable dust” have a smaller than
transcriptase is
a. 5 microns
a. DNA dependent RNA polymerase
478. Components of active management of

S
457. The regulatory enzyme for
3rd stage of labour include all of the
cholesterol biosynthesis is
following EXCEPT
a. HMG CoA reductase
a. Fundal massage

M
458. Zink deficiency can cause which one of
479. After implantation, area of the
the following
deciduas, that is destined to form the
a. Infertility
placenta is the

A
459. Arch of aorta is hooked by
a. Deciduasbasalis

I
a. Left recurrent laryngeal nerve
480. CD 15 is used for diagnosis of
460. Stratified squamous epithelium is not
a. Hodgkin’s lymphoma – mixed
seen in
cellularity tyoe

D
a. Gall bladder
481. An enzyme catalyzing the conversion
461. Blood Agar” is an example of
of an aldose to ketose is
a. Enriched media
a. Mutase
462. Pugilistic attitude of body seen in case
482. All women with uncomplicated breech
of burn is due to
presentation at 37 weeks should be offered
a. Coagulating of proteins a. External cephalic version
463. Therapeutic drug monitoring is done 483. HMG –CoA reductase is inhibited by
for all of the following EXCPET a. Cholestyramine
a. Metformin 484. Genomics is defined as
464. The toxicity of MgSO4 used in eclampsia a. Study of all genes in the genome and
is monitored by all of the following EXCEPT their interactions
a. Heart rate 485. drugs is an antipseudomonal penicillin
465. The magnitude of action potential will a. Piperacillin
decrease if 486. The structural polysaccharide chitin
a. Sodium and calcium concentration in is a polymer of
ECF is high a. N.Aectyl glucosamine
466. Tearing of the skin and subcutaneous 487. Shick test is an example of
tissue is called A unit
i of
of TEN PVT. LTD
a. Complement fixation LTT
a. Laceration 488. Under ESI Act, sickness benefit is
467. The major contribution to human payable for a maximum of
seminal fluid is form a. 91 days
a. Bulbo-urethral glands 489. The serological marker of acute
468. One of the following structure is hepatitis B infection is
derived from all three germ layers a. HBsAg + HBeAg
a. Auditory y cavityy

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 TARGET DEC. 2018
490. During cardiopulmonary a. Onchocerciasis
resuscitation, adrenaline can be given via one 513. Blow out fracture of the orbit
of the following route if intravenous line is usually involves
not available a. The lateral wall and floor of the
a. Endotracheal tube orbit
491. After prostatectomy, sexual 514. In corticollis there is contracture of
disturbance is most likely to happen the following muscle
a. Retrograde ejaculation a. Sternomastoid
492. Virchow’s lymph node is the name given 515. Chronic renal failure is
to characterized by
a. Left supra clavicular lymph node a. Metabolic acidosis
493. The most sensitive test to detect early 516. Drug is the most useful in treating an

I
diabetic nephromy is episode of antipsychotic induced acute
a. Serum protein/ creatinine ratio dystonia
494. The negative waves in Jugular venous a. Promethazine

C
a. c and v 517. Moro’s reflex disappears at
495. Gait abnormalities in Parkinsonism not a. 3 months
include 518. The disulfarn alcohol reaction
A unit
i of
of TEN PVT. LTD
LTT

M
a. Wide bases gait occurs due to be inhibition of which enzyme
496. The most frequent organic cause of a. Aldehyde dehydrogenase
erectile dysfunction is 519. Subacute combined degeneration of

-
a. Psychogenic spinal cord is associated with deficiency of
497. Paradoxical aciduria occurs in a. Vitamin B12
a. Burns 520. non ionizing radiation

S
498. Seldinger’s needle and technique is a. Gamma rays
used to perform 521. A 40 yrs old man presents with a 20 yrs
a. Contrast angiography history of alcohol intake with a 10 yrs

M
499. Not a feature of pain during history of a dependence pattern. He presents
defecation with a 2 day history of altered behaviour,
a. Fistula in Ano restelessness, tremors, sleep disturbance,

A
500. N – acctylcysteine reduces the irritability and difficulty in walking. On
severity of hepatic necrosis in toxicity due to examination he has gaze palsy and is

I
which one of the following disoriented. What is the most likely diagnosis
a. Acetaminophen a. Wenicke’s encephalopathy
501. Horner’s syndrome is a feature of 522. Commonest cause of small bowel

D
a. Pancoasttumor intussusception in adults is
502. Fasciculations are most commonly a. Neoplastic lesions
seen in a patient having 523. Xerophthalmia refers to dry eye
a. Motor neuron disease caused by
503. Serum complement levels are reduced a. Steven Johnson syndrome
in 524. At what age does birth length double
a. Active systemic lupus erythematosis a. Three yrs
504. Type 2 respiratory failure not occurs 525. Ulnar nerve paralysis causes
in a. Claw finger deformity
a. Chronic obstructive pulmonary 526. A four month old child presents with
disease epiphora and regurgitation. The most
505. A 10 yrs old bpy starts bleeding from probable diagnosis is
the mouth 6 hrs after a tooth extraction was a. Congenital dacroyocystitis
performed. He is likely to have 527. Ulnar nerve paralysis causes
a. Anti phospholipids antibody a. Claw finger deformity
506. Secondary hemorrhage occurs 528. mania is characterized by
a. 3 days to 7 days a. Overproductivity and
507. All statements are true regarding sychomotoroveractivity
medullary carcinoma of thyroid except 529. Not in SAFE strategy for prevention
a. It is TSH dependent of trachoma includes
508. Not a criteria are used for diagnosing a. Epilation
ARDS 530. Hereditary angioedema is due to
a. PaO2/FiO2 ratio of less than 200 mmHg a. Deficiency of C1 esterase inhibitor
509. Facial twitching seen on tapping of 531. Not a feature of Gradenigo’s
preauricular area is syndrome is
a. Chvostck’s sign A unit
a. Otalgiai of
of TEN PVT. LTD
LTT
510. Acne is chronic inflammatory disease 532. The most common etiology of striodor
of in an infant is
a. Pilosebaccous unit a. Laryngomalacia
511. Otospongiosis is a primary disease of 533. The primary event in pathogenesis of
a. Ossicles hemolytic uremic syndrome
512. Disease that is included in the list of a. Endothelial cell injury
major causes of blindness in the world but is 534. Not seen in Infant with Down’s
rare in India is syndrome have

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 TARGET DEC. 2018
a. VSD a. Inhibits monoamine oxidase
535. Carhart’s notch in audiogram is seen in 560. Streptococcal Toxic shock syndrome
a. Otosclerosis is due to the following virulence factor
536. Which one of the following has a a. Pyrogenic exotoxin
tooth in the cyst 561. Inhalational anesthetics is most likely
a. Dentigerous cyst to cause fluoride ion nephrotoxicity
537. Which is not a usual feature of dengue a. Enflurane
infection 562. drugs is used to control tachycardia
a. Hepatosplenomegaly and palitations in persons with acute
538. Intra ocular lens power is calculated symptoms of hyperthyroidism ?
with a. Propranolol
a. SRK formula 563. The most important reason for
539. Not a ototoxic drugs surgical repair of a double uterus such as
a. Loop diuretics bicornuate uterus is
540. The most common quadrant in retina to a. Habitual abortion
have breaks is 564. Primary organisms in acute PID are
a. Superotemporal a. Chlamydia trachomatis
541. Contract used in barium enema study is 565. violin string like adhesions of

I
a. Barium sulphate perithepatis present in salpingitis are caused
542. A unit
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of TEN PVT. LTD
LTT
Signet ring appearance on chest CT is by
seen in a. Gonococci

C
a. Bronchogenic carcinoma 566. Unruptured ectopic pregnancy is best
543. Oral corticosteroids are used to treat diagnosed by
which one of the following a. Transvaginal ultrasonography

M
a. Panophthalmitis 567. is NOT a causative factor for placenta
544. Von Recklinghausen’s disease arises praevia ?
from gene mutation on which chromosome a. Multiparity

-
a. 17 568. Normal position of uterus is
545. LeFort classification is used for a. Anterverted and anteflexed
a. Fracture maxilla 569. Airway resistance

S
546. The vitamin involved in the synthetis of a. Is increased in asthma
the coagulation factor from prothrombin is 570. Caudate nucleus damage leads to
a. Vitamin K which movement disorder

M
547. Anaemia not seen in with this vitamins a. Chorea
a. Pyridoxine 571. The surfactant is produced by which
548. Positive trendelenburg test is noticed type of alveolar epithetialcells ?

A
when a. Type II cell
a. inferior gluteal nerve is injured 572. Receptor for inverse stretch reflex is

I
549. food poisoning has the highest case a. Golgi tendon organs
fatality rate 573. The best time to repair complete
a. Botulism perineal tear following delivery is

D
550. Glucose content of CSF remains a. Within 24 hours
unaltered in 574. Economic Benefits of a program is
a. Cryptococcal meningitis evaluated by
551. Pouch of Douglas is a peritoneal a. Cost effective analysis
pouch between 575. is a premallagnant condition in the
a. Rectum and vagina breast
552. The clavi-pectoral fascia is pierced by a. Atypical ductal hyperplasia
a. Lateral pectoral nerve 576. Not a features of Apoptosis
553. The ion that is cp-transported during a. Cells shrinkage
the active transport of glucose in the small 577. TRUE for Amyloidosis of the kidney
intestine is EXCEPT
a. K+ a. Most cases are of primary Amyloidosis
554. An example of an amphibolic pathway is 578. Targeted intervention for reducing
a. Citric acid cycle HIV transmission include all EXCEPT ONE of
555. statement is TRUE regarding the following
neuroglia a. Provision of ART
a. Are conducting neural tissue 579. BOAA (Beta Oxalyl Amino Alanine) is a
556. The lower border of the lungs lies in toxin involved in the causation of which
the mid axillary line at disease
a. 8th Rib a. Neurolathyrism
557. Downward displacement of enlarged 580. A unit
i of
of TEN PVT. LTD
LTT
The narrowest diameter of true pelvis
spleen is prevented by is
a. Phrenicocolic ligament a. Obstertric conjugate
558. Food poisoning strains of clostridium 581. Glucose reabsorption occurs in the
perfringens belongs to a. Loop of hanle
a. Type B 582. Sweating as a result of exertion is
559. Gabapentin has which mechanism of mediated through
action for its antiepileptic effect? a. Sympathetic cholinergic

14 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018
583. Vitreous humor is required to be 606. A 30 year female presents with rapidly
preserved during autopsy in poisoning of progressive renal failure, nasal discharge,
a. Arsenic ulceration of nasal septum, maxillary
584. Base NOT present in DNA is sinusitis and pulmonary infiltrates.
a. Uracil a. WegenersGranulomatosis
585. Condon is a sequence of three 607. As a screening Test for type 2 diabetes
nucleotides present in Mellitus. Which is the best screening test
a. mRNA a. Fasting glucose levels
586. Drug dependence is a term which 608. extraocular muscles performs
a. Includes drug addiction but excludes intortion of the globe in primary position
drug habituation a. superior oblique
587. Drug administration avoids first pass 609. Initial emergency surgical

I
hepatic metabolism and is used with drug management of significant bulbar urethral
preparation that slowly releases drugs for injury is
periods as long as seven days ? a. Suprapubiccystostomy

C
a. Transdermal 610. Blood stained sputum may be the only
588. is a feature of adult onset diabetes symptom in
a. Peripheral resistance to insulin a. Adenoma bronchus
A unit
i of
of TEN PVT. LTD
LTT

M
589. Tumor marker for colon CA and 611. Fournier’s gangrene of toes with
pancreatic CA a. Synergistic gangrene of scrotum
a. CA 19-9 612. Beatuex index is used for

-
590. Cruschmann’s spirals are found is a. Aedesaegypti
a. Bronchial asthma 613. Nevirapine belongs to the following
591. Bilateral contracted kidney are seen group

S
in a. NNRTI (Non-nucleoside Reverse
a. Amyloidosis Transcriptase Inhibitors)
592. Vitamin beneficial in osteoporosis in 614. Carcinoma of breast arises from

M
combination with vitamin D is a. Terminal duct lobular unit
a. Vitamin K 615. Smooth muscle relaxation is most
593. The commonest malignant lesion in the commonly associated with which one of the

A
vertebral body is following adrenoceptors:
a. Secondary deposits a. Alpha -1 receptors

I
594. Ectopialentis is not associated with 616. Peyer’s patches are present in
a. Aniridia a. Ileum

D
595. Most common form of urinary 617. House – maid’s knee is due to
incontinence in older adults is enlargement of
a. Mixed incontinence a. Sub—cutaneuos pre-patellar bursa
596. Mallory bodies are seen in 618. Reverse CAMP Test is positive for
a. Post hepatitc cirrhosis of liver a. Clostridium perfringens
597. Koplik spots are pathognomic of 619. Aspirin increase the bleeding time by
a. Measles a. Irreversible inactivation of cyclo-
598. Epley’smaneauver is useful in oxygenase
management of 620. Micro –organisms uses antigenic
a. BPPV variation as a major means of evading host
599. Dermatitis herpetiformis is associated responses?
with a. Borreliarecurrentis
a. Gluten sensitive enteropathy 621. In dengue Hemorrhagic syndrome, the
600. immunosuppressives require tourniquet test is considered positive if
monitoring of renal function on regular number of petechiae per square inch is more
basis than
a. Cyclosporine A a. 20
601. Mode of inheritance of haemophilia is 622. arteries is a content of anatomical
a. X- linked Recessive snuff box
602. sub-acute scletosingpanencephalitis is a. Radial artery
a known complication following infection by 623. Fetal adrenal cortex secretes
a. Measles virus hormones in large amount
603. is NOT a feature of “Idiopathic a. Cortisol
Nephrotic Syndrome” of childhood 624. Reverse cold chain is used by
a. Low C3 levels a. Carrying stool samples of polio
604. The following hormone is responsible
for milk secretion
A unit
i of
of TEN PVT. LTD
LTT
patients from primary health center
to Lab
a. Prolactin 625. Counter current system includes all
605. 44 year female, disappeared from her of the following except
residence without information others. Before a. Medullary interstitium
this incident she had no illness but had some 626. Prostaglandins of seminal fluid are
unpleasant events in her personal life. What secreted by
will be her diagnosis? a. Seminal vesicles
a. Dissociative Fugue 627. The components of lochia rubra

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 15

 TARGET DEC. 2018
a. Leucoytes 648. Drugs would be appropriate to
628. Pregnancy test done by prevent mountain sickness to a group of
radioimmunoassay detects the presence of young students who are planning an
hCG as early as expedition of mountain climbing trip in the
a. 8-9 days after ovulation Himalayas?
629. is not a criterion for the diagnosis of a. A carbonic anhydrase Inhibitor
bacterial vaginosis 649. The source for human chorionic
a. Plenty of lactobacilli gonadotroin (hCG) in pregnancy is
630. Most specific test for diagnosis of a. Syncytiotrophoblast
primary syphilis is 650. Arch of aorta begins and levels at
a. FTA-ABS test ______ vertebral level
631. The location of Glomus cells in human a. T4
body? 651. Telmesartan lowers blood pressure
a. Carotid body by
632. The opsonins that coat bacteria is a. Blocking AT1 receptors
a. IgG 652. Does Not act by inhibiting cell wall
633. Most common “Direct “ cause of synthesis

I
maternal mortality in India is a. Amikacin
A unit
i of
of TEN PVT. LTD
a. Hemorrhage LTT 653. Megaloblastic anemia is characterized
634. Clamping the umbilical cord after by all of the following except

C
cessation of cord pulsation results in influx a. Heinz bodies
of 654. In tuberculosis, pott’s disease involves
a. 200-250 ml of blood a. Vertebrae
635. When does the hCG level in normal 655. Oxygenation of hemoglobin lowers its

M
pregnancy reach its peak? affinity for carbon dioxide. This is known as
a. 60-70 days of pregnancy the

-
636. Oral combined contraceptive pills are a. Haldane effect
contraindicated in all of the following 656. The most important in events leading
conditions except to irreversible cell injury?

S
a. Polycystic ovaries a. Cell membrane damage
637. The enzymes which are useful 657. Autosplenectomy is a feature if
clinically in the diagnosis of myocardical a. Sickle cell anemia
infarction are 658. Numerous antibodies are found in

M
a. Creative kinase, aspartate patients with Systemic Lupus Erythematosus
transaminase (AST) and lactate (SLE). is virtually diagnostic of SLE?
dehydrogenase a. Antibody to double stranded DNA

A
638. In Hrtnup’s disease, the urine of the 659. Functional unit for implementation of

I
patient contains increased amount of National Mental Health Programme is at
a. Trytophan which level?
639. What is the primary molecular basis of a. District

D
renal rickets? 660. Gower sign is present in conditions?
a. Decreased capacity to synthesise 1, 25 a. Duchnne muscular dystrophy
dihydroxy Vitamin D3 in the kidney 661. The following electrolyte
640. The glucose transporter present in abnormalities will be found in a patient of
skeletal muscle is chronic renal failure except
a. GLUT 4 a. Hypophosphatemia
641. Hyperinfection is caused by 662. What is the most important
a. Strongyloidesstercolaris intervention that reduces infection in the
642. As example of Heterophile neonatal units?
agglutination test is a. Proper hand washing
a. Mantoux test 663. Extradural haematoma commonly
643. The indicator agent to determine occurs in
faecal pollution of dinking water is a. Temporo parietal region
a. E. coli 664. Wimburge’s sign is seen in
644. The earliest immunoglobulin to be a. Lead poisoning
synthesiaed by the fetus is 665. Live insect trapped in external
a. IgM auditory canal is usually killed by
645. Not seen in nephrotic Syndrome a. Oil
a. Hematuria 666. Sulfonylurea group of drugs produce
646. A diabetic patients developed hypoglycemia due to all of the following
cellulitis due to staphylococcus aureus, A unit
i of
of TEN PVT. LTD
mechanisms excepts LTT
which was found to be methicillin resistant a. Increase number of insulin receptors
on antibiotic sensitivity testing. Antibiotics 667. The commonest causative organisms
not used is for cellulitis is
a. Imipenem a. Streptococcus
647. Not a feature of dengue hemorrhage 668. Patient’s palmer hand surface
fever? amounts for approximately how much of total
a. Coagulopathy body surface area in burns
a. 1 %
16 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
 TARGET DEC. 2018
669. Trendelenberg operation is done for a. Extradural hemorrhage
a. Varicose vein 692. A 25 yrs man with bleeding gums fever
670. External hermorrhage is best hepatosplenomegaly and total WBC count of
controlled by 100,000/cu.mm is likely to have
a. Direct pressure a. Leukernia
671. Pulsusparadoxus is seen in 693. In burn patients, the best fluid for
a. Chronic obstructive airway disease resuscitations in fist 24 hours is
672. Peaked tall T-waves in ECG occurs in a. Ringer’s disease
a. Hyperkalemia 694. Cardiac output is low in patients with
673. Blood is stored at a. Aortic stenosis
a. 40 C 695. Cherry red spot is seen in
674. Allen’s test is done for assessing a. Central retinal artery occlusion

I
collateral from 696. Acute anterior uveitis in youg males is
a. Ulnar artery often associated with
675. True regarding Type II respiratory a. Ankylosing spondylitis

C
failure 697. Not seen in primary Sjogren’s
a. Low pO2 high pCO2 syndrome
676. Antituberculosis drugs is least a. Rheumatoid arthritis
hepatoxic? 698. Commonest site for tuberculosis of
A unit
i of
of TEN PVT. LTD
LTT

M
a. Streptomycin the skeletal system is
677. Treatment of choice for pleomorphic a. Spine

-
adenoma of parotid gland is 699. WHO garding of xerophthalamia, X2
a. Superficial parotidectomy indicates
678. Sweating is absent in heat syndromes a. Corneal xerosis

S
700. Earliest sign of diabetic retinopathy is
a. Heat stroke a. Microaneurysms
679. Rhinophyma is associated with 701. Xenograft refers to
a. Hypertrophy of sebaceous gland a. Grafts form one species to another

M
680. Caloric test with warm and cold 702. A 24-year old male is brought to the
water stimulates emergency department after taking cyanide
a. Lateral semi-circualr canal in a suicide attempts. He is unconscious on

A
681. Wood’s Lamp examination is useful in presentation. What drug should be used as

I
the diagnosis of all the following except an antidote?
a. Psoriasis a. Sodium nitrite with sodium thiosulfate
682. The most common primary orbital 703. Not a Independent clinical predictors

D
malignant tumour of childhood is of neuromuscular respiratory weakness in
a. Rhabdomyosarcoma GuillianBarre syndrome
683. A 70 yrs woman in the cardiac care a. Complete ophthalmplegia
unit has suddenly become agitated and begins 704. The most characteristic
pulling on all her intravenous lines. She says manifestation of Henochscholeinpurpura
that she cannot stay in this hotel any longer (HSP) is
and assaults the nurse. She is arousable and a. A typical rash
responsive but cannot identify the date or 705. is associated with Parkinson’s
place. What is the most likely diagnosis disease
a. Delirium a. Difficulty initiating movements
684. Graves ophthalmopathy is associated 706. Parameter is used to assess the renal
with perfusion adequacy during shock?
a. Convergence insufficiency a. Hourly urine output
685. Wickham’s striae are 707. D-Xylose test may be abnormal in
a. Seen on the surface of lichen planus a. Chronic pancreatitis
papules 708. Tumor is most commonly associated
686. Figure of “8” appearance of heart on with Tumor lysis syndrome?
plain skiagramos diagnosis of a. Burkitt’s lymphoma
a. Total pulmonary anomalous venous 709. Dermatitis herpetiformis is associated
drainage with
687. A leading theory for the a. Celiac disease
neurochemical basis of Alzheimer’s dementia 710. Commonest cause of acute nephritis in
is children is
a. A cholinergic deficiency hypothesis a. Immunologic
688. Commonest cause of lower 711. Fresh frozen plasma is used to
gastrointestinal tract bleeding in India is
a. Typhoid enteritis
correct A unit
i of
of TEN PVT. LTD
LTT
a. Coagulation factor deficiency
689. Peaud’orange in a patient with 712. Kussmaul’s sign is absent in
carcinoma breast occurs because of a. Cardiac tamponade
a. Obstruction of dermal lymphatics 713. Massive blood transfusion in a
690. High SAAG (serum ascitesalbumin previously healthy adult male can result in
gradient) is seen in ascites due to bleeding, because of
a. Portal hypertension a. Dilutional thrombocytopenia
691. Lucid interval is a feature of

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 TARGET DEC. 2018

714. All of the following are seen in
disseminated intravascular coagulopathy 722.
except
a. Decreased aPTT
715. Not be used in hemorrhagic shock
a. Albumin
716. The commonest cause of liver abscess
is
a. Amoebic infection
717. A noninvasive test for detection of
helicobacter pylori?
a. Urea breath test
718.

Candida Albicans) is a type of yeast that

I
can grow on the surface of skin
A unit
i of
of TEN PVT. LTD
LTT 723.

RHINOPHYMA

M C
-
719.

S
PNEUMOPERITONEUM
724.

M
IA
PERFORATED EARDRUM
720.

D
Life-Threatening Condition (VII): Pericardial
Effusion Causing Cardiac Tamponade.
ϳϮϱ͘ 

BLEPHARITIS
Life-Threatening Condition (I): Hyperkalemia.
721.


 A unit
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of TEN PVT. LTD
LTT


Streptococcus pyogenes 
18 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
 TARGET DEC. 2018

OBSTETRICS & GYNAECOLOGY x Progression of retinopathy,
I. DIABETES MELLITUS AND PREGNANCY nephropathy, cardiomyopathy
A. Diabetogenic effects of pregnancy E. Glucose Challenge Test
x Insulin resistance due to x Screening test
o Placental somatostatin x At 20-24 weeks
o Cortisol, estriol and progesterone x 50g glucose orally irrespective of
x Increased lipolysis previous meals
x Changes in gluconeogenesis x Look for blood glucose, Normal
B. Effects of DM on Mother values are:
x Pre eclampsia o FBS<90
x Incidence o 1 hr PPBS < 140
x High chance of LSCS o 2 HR PPBS < 120

I
x IUD F. Glucose tolerance test (GTT) – WHO
x PPH protocol
x Diagnostric test

C
C. Effects of DM on Foetus
x Hypoglycaemia, hypothermia, x 75 g glucose orally at 28 weeks
hypocalcemia x GDM is diagnosed if:
x Hyperviscosity, hyperbilirubinemia, o FBS < 125 or
A unit
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of TEN PVT. LTD
LTT

M
polycythemia o 2 hr PPBS > 140
x Congenital anomalies (Most common: G. GTT- Indian protocol
x At 16 weeks, 24 weeks, 32 weeks

-
CVS defect – Transposition of Great
vessels (TGV), characteristic: Neural x 75 g glucose orally
tube defect – Sacral agenesis) x GDM is diagnosed if

S
x Macrosomia, traumatic delivery o 2 hr PPBS> 140
x Apnoea, bradycardia, RDS, sudden H. Overt Diabetes Mellitus
death x FBS > 126
D. Effects of pregnancy on DM x HbA1c > 6.5

M
x More insulin needed x RBS > 200 with symptoms
I. White’s classification

A
Class Onset FBS PPBS Therapy
GDM

I
A1 Gestational <105 <120 Diet
A2 Gestational >105 >120 Insulin

D
Class Age of onset Duration Vascular disease Therapy
B >20 <10 None Insulin
C 10-19 10-19 None Insulin
D <10 >20 Benign Retinopathy Insulin
F Any Any Nephropathy Insulin
R Any Any Proliferative Insulin
retinopathy
H Any Any Cardiomyopathy Insulin
T Any Any Prior renal transplant Insulin
II. CVS AND PREGNANCY x Diastolic murmur
A. Normal CVS changes x Persistent arrhythmia
x Pulse rate increased x Cardiomegaly
x Apex beat shifted to 4th intercostal x Fixed split of S2
space x Loud P2
x Split S1 C. Other points:
x Systolic murmur x MC heart lesion: MS (Rheumatic)
x Cardiac output increased 40% x MC arrhythmia: PSVT
x Blood volume increased by 40% x MC cynanotic congenital heart
x RBC volume increased by 20% disease in pregnant women: TOF
x Hemodilution x Most common congenital heart disease
x Mid trimester fall in Diastolic BP in pregnant women:ASD
x Venous pressure increased x Maximum maternal mortality:
x Peripheral resistance decreased Eisenmengersyndrome:> PPH
x CXR
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x Cardiac failure maximum at: 30-32
x Shows enlarged cardiac shadow weeks
x ECG shows left axis deviation x Indications for termination of
B. Indicators of heart disease in pregnancy pregnanacy:
x Cyanosis, clubbing o Absolute: Eisenmenger, PPH, Pulm.
x Elevated JVP, Left Parasternal heave Veno occlusive disease
x Systolic murmur greater than grade 3

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 TARGET DEC. 2018

o Relative: NYHA grade III and grade
IV, grade I and grade II with history
of CCF
x Only heart lesion in which elective
LSCS is done: Coarctation of aorta
(GA)
x Ideal analgesia for LSCS in heart
disease: Epidural analgesia
III. NORMAL SIGNS IN PREGNANCY
x Placental sign: Bleeding at the time of
next period
x Hartman sign: Implantation bleeding
x Chadwick’s sign/Jacquemier’s sign: Bluish
hue of vagina
x Goodwll’s sign: Cervix becomes soft
x Piskacek’s sign: One half more firm than
the other
x Hegar’s sign: Upper part of body of uterus
B. Pre requisites for forceps
x Cervix must be completely dilated and
effected
x Head must be below ischial spines (+2)
x Completed rotation
x Cephalic (vertex presentation)
x CPD must be ruled out
x Bladder must be emptied
x Membranes must be ruptured
x Presentation and position must be
suitable
o It can be remembered easily as
FORCEPS: F-Full dilatation O-0
station, R-Rotation completed and
rupture membranes, C-Consent,
Cephalic presentation and CPD to
be ruled out, E-Evacuate bladder,
P-Pudendal block, Presentation

I
is enlarged and lower part is empty and and position suitable and S-Sepsis
soft. Seen In 6-10 weeks ruled out.
A unit
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x Osiander’s sign: Pulsations in vagina C. Complications of Forceps:
x More foetal injuries

C
x Palmer’s sign: Rhythmic uterine
contractions during bimanual x Scalp laceration
examination. x Cephalhematoma
IV. FORCEPS AND VACCUM x Neonatal jaundice

M
A. Indications x Conjunctival hemorrhage
x Delay in 2nd stage x Erb’s palsy
x Foetal distress x VI and VII nerve palsies

-
x Maternal distress D. Special contra indications for vaccum
x Maternal conditions like pre- x Non vertex presentation
eclampsia, VBAC, heart disease etc.

S
x Extreme prematurity or known
x Deep transverse arrest macrosomia
x Delay in descent of second baby of x Foetal coagulopathies
twin

M
V. DEVELOPMENT OF MALE AND FEMALE GENITAL SYSTEM
Embryonic structure Male Female
Genital ridge – Testes – Seminiferous Ovary – Ovarian

A
Cortes/Medulla tubules Rete testes follicles/Rete ovarii
Genital swelling Scrotum Labia majora

I
Genital fold Shaft of penis Labia majora
Genital tubercle Glans penis Clitoris
Urogenital sinus Bladder, prostrate, Bladder, paraurethral

D
prostatic utricle, bulbo
urethral glands
Mesonephric duct Vas deferens, ductus
epididymis, seminal vesicle
Paramesonephric duct Appendix of testes
Mesonephric tubules Ductusefferentis,
paradidymis
glands of skein, vagina,
Bartholi’s gland
Duct of epoophoron,
Gartner’s duct
Hydatid of morgagni, uterus,
cervix, tubes
Epoophoron, Paroophron

A unit
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 TARGET DEC. 2018

VI. APPROACH TO AMENORRHOEA
Amenorrhoa

Give progesterone

No bleeding if estrogen Bleeding present if

reduced or uterine estrogen normal

Give estrogen + progesterone

A unit
i of
No bleeding

of TEN PVT. LTD

LTT
Bleeding present

C I
M
Uterine abnormality Assess LH & FSH levels

-
If it is low If it is high

S
Ovarian abnormality
Give GnRH

M
LH & FSH increases LH & FSH still low

I A
Hypothalamic Pituitary
abnormality abnormalit

D
VII. FAILURE RATES OF CONTRACEPTIVES
x Natural Family planning methods: 18-21
x Condon: 12%
x ICUD
o Inert: 3%
o Medicated: 1%
x POP (Minipill): 3%
x Hormonal contraceptives (except POP): 0.1-0.4%
x Vasectomy/tuberctomy: 0.2-0.4%
VIII. VAGINAL INFECTIONS
Features Normal Bacterial vaginosis Candidiasis Trichomoiasis
Vaginal pH 3.8-4.2 >4.5 <4.5 >4.5
Organism Lactobacillus Gardnerellavaginalis Candida Trichomonasvaginalis
albicans
Discharge Clear, white, Thin homogenous White Curdy Yellow frothy
flocculant adherent
Whiff Absent Present Absent Absent
test/KOH
(amine odour)
Microscopy Lactobacillus Clue cells, no WBC Budding Trichomonads,
yeast WBC>10/Lpf
Presentation - Discharge, bad odour Itching, Discharge bad odour
discharge pruritus
Treatment - Metronidazole, A unit
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of TEN PVT. LTD
Clotrimazole LTT
Metronidazole
clindamycin LA LA,
fluconazole
IX. FIGO STAGING OF CARCINOMA OVARY

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 TARGET DEC. 2018

Stage I:Limited to ovaries
x Ia:Limited to one ovary, no ascites, capsule intact
x Ib: Limited to both ovaries, no ascites, capsule intact
x Ic:Ia or Ib with capsule rupture, ascites present with malignant cells or positive peritoneal washings
Stage II: Involving ovaries with pelvic extension
x IIa: Extension of metastasis
x IIb: Extension to other pelvic structures
x IIc: IIa or IIb with capsule rupture, ascites present with malignant cells or positive peritoneal
washings

Stage III: Involving ovaries with peritoneal implants or positive RP or inguinal nodes
x IIIa: Microscopic seeding of abdominal peritoneal surfaces
x IIIb:Macroscopic peritoneal seeding < 2cm
x IIIc: Abdominal implants >2cm of RP/inguinal nodes

I
Stage IV: Involving ovaries with distant metastasis
X. A unit
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FIGO STAGING OF CARCINOMA OF THE ENDOMETRIUM
Stage Characteristics

C
I Tumour confined to the corpus uteri.
IA Nor or less half myometrial invasion
IB Invasion equal to or more than half of the myometrium

M
II Tumor invades cervical stroma, but does not extend beyond the uterus
III Local and/or regional spread of the tumor
IIIA Tumor invades the serosa of the corpus uteri and/or adnexae

-
IIIB Vaginal and / or parametrial involvement
IIIC Metastases to pelvic and/or paraaortic lymph nodes

S
IIIC 1 Positive pelvic nodes
IIIC 2 Positive paraaortic lymph nodes with or without positive pelvic lymph
nodes
IV Tumor invades bladder and/or bowel mucosa, and /or distant

M
metastases
IV A Tumor invasion of the bladder and/or bowel muscosa
IV B Distant metastases, including Intraabdominal metastases and/or

A
inguinal lymph nodes

I
XI. FIGO STAGING OF CARCINOMA OF THE ENDOMETRIUM
Stage Characteristics
I Carcinoma is strictly confined to cervix (extension to corpus should

D
be disregarded)
IA Invasive carcinoma that can be diagnosed only by microscopy, with
deepest invasion < 5 mm and largest extension < 7 mm
IA 1 Measured invasion of stroma no greater than 3 mm in depth and no
wider than 7 mm
IA 2 Measured invasion of stroma greater than 3 mm and no greater than 5
mm in depth and no wider than 7 mm
IB Clinical lesions confined to the cervix or preclinical lesions greater
than IA.
IB 1 Clinical lesion no greater than 4 cm in size
IB 2 Clinical lesions greater than 4 cm in size
II Carcinoma extends beyond cervix but has not extended to pelvic wall;
it involves vagina, but not as far as the lower third.
IIA No obvious parametrial invasion.
IIA 1 Clinical lesion no greater than 4 cm in size
IIA 2 Clinical lesions greater than 4 cm in size
IIB Oviousparametrial involvement
Carcinoma extends to the pelvic wall; on rectal examination there is
no cancer-free space between tumor and pelvic wall; tumor involves
A unit
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lower third of vagina; all cases with hydronephrosis or non- LTT
functioning kidney should be included, unless they are known to be
due to another cause
IIIA No extension to pelvic wall, but involvement of lower third of vagina
IIIB Extension to pelvic wall and/or hydronephrosis or non-functioning
kidney due to tumor
IV Carcinoma has extended beyond true pelvic or has clinically involved

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 TARGET DEC. 2018

mucosa of bladder or rectum
IVA Spread of growth to adjacent pelvic organs
IVB Spread to distant organs
FIGO=International federation of Obstericians and Gynecologists.
XII. CA VULVA-FIGO STAGING
Stage Characteristics
I Tumor confined to the Vulva
IA Lesions < 2 cm in size, confined to the vulva or perineum and with
stromal invasion < 1.0 mma, without nodal metastasis.
IB Lesions > 2cm in size or with stromal invasion > 1.0 mma Confined to the
vulva or perineum, with negative nodes.

I
II Tumor of any size with or without extension to adjacent peritoneal
structures (1/3 Lower urethra, 1/3 lower vagina, anus) with negative
nodes.

C
III Tumor of any size with or without extension to adjacent peritoneal
structures (1/3 lower urethra, 1/3 lower vagina, anus) with positive
inguinofemoral lymph nodes.
A unit
i of
of TEN PVT. LTD
LTT

M
IIIA i) With 1 lymph node metastasis (> 5 mm) or ii) 1-2 lymph node metastasis
(es) (<5 mm)

-
IIIB i) With 2 or more lymph node metastases (> 5 mm) or ii) 3 or more lymph
node metastases (-5mm)
IIIC With positive nodes with extracapsular spread.

S
IV Tumor invades other regional (2/3 upper urethra, 2/3 upper vagina),
or distant structures
IV A Tumor invades any of the following.

M
IV i) Upper urethral and/or vaginal mucosa, bladder mucosa, rectal
mucosa, or fixed to pelvic bone or ii) Fixed or ulcerated inguinofemoral
lymph nodes.

A
IV B Any distant metastasis including pelvic lymph nodes.

I
IV B Any distant metastases, including intraabdominal metastases and/or
inguinal lymph nodes.
XIII. CA VAGINA - STAGING x Most common malignancy of ovary:

D
x I: Limited to vaginal wall Serous cystadenocarcinoma
x II: Involving subvaginal tissues but not x Most common benign tumour of ovary:
pelvic wall Serous cystadenoma
x III: Extending onto pelvic wall x Krukenbergtumours: Stomach > breast
x IV: a. Bladder and rectum involvement > colon
b. Distant organ involvement x Most common benign germ cell tumour:
XIV. OVARIAN TUMOURS: CLASSIFICATION Dermoid cyst (mature teratoma)
A. Epithelial x Most common malignant germ cell
x Serous tumour: Dysgerminoma
x Mucinous x Most common ovarian tumour
x Endometrioid diagnosed in pregnancy:Teratoma
x Brenner x Most common ovarian tumour
x Mixed undiagnosed in pregnancy: Serous
B. Sex cord stromal cystadenoma
x Granulosa cell tumour x Most common ovarian tumour
x Theca cell tumour undergoing torsion in pregnancy:
x Fibroma Dermoid cyst
x SertoliLeydig cell tumours x Most radiosensitive: Dysgerminoma
x Gynandroblastoma x Most common ovarian
C. Germ cell tumours tumourmetastasing to opposite ovary:
Granulosa cell tumour
x Dysgerminoma (LDH)
XV. SPECIAL CELLS AND BODIES
x Endodermal sinus tumour/yolk sac
x Schiller Duval bodies: endodermal sinus
tumour (AFP) A unit
i of
of TEN PVT. LTD
LTT
tumour
x Embryonal carcinoma
x Coffee bean cells: Granulsa cell tumour
x Choriocarcinoma (beta HCG)
x Signet ring cells: Krukenbergtumour
x Teratoma
x Psammoma bodies: Papillary serous
x Struma ovary cstadenoma
x Carcinoid x Rokitansky protuberance: Dermoid cyst
D. Gonadoblastoma
x Walthard cell nest: Brenner’s tumour
E. Metastasis

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 TARGET DEC. 2018

x Hobnail cells: clear cell carcinoma x Carl exner bodies: Granulosa cell tumour
x Sertoli and leydig cells:
Arrhenoblastoma
XVI. PLACENTA PREVIA VS. ABRUPTION
Features Placenta previa Abruption
Symptom Painless bleeding Painful bleeding
History Previous h/o placenta previa, D and c, previous h/o abruption,
caesarina, myomectomy etc. h/o PIH
Parity Multi >Primi Multi/Primi
General exam Pallor proportionate to bleeding Pallor out of proportion
to bleeding
Local exam Normal uterine size, non tender, Increased uterine size,
malpresentation high floating head, normal tense, tender, Foetal
FHS heart sounds FHS absent
PS Fresh blood Altered blood
PV Should not be done Can be done

I
IOC TVS> TAS TVS>TAS
A unit
i of
of TEN PVT. LTD
LTT
Management Expectant: MacAfee regime Mode of delivery depends
Definite: of fetal status If there is

C
Ǧ I, IIa: Vaginal delivery fetal distress go for CS
Ǧ IIb, III, IV: CS
DIC/Renal --- Present

M
failure
Ophthalmology

-
1. DIMENSIONS OF EYE BALL x CRAO and CRVO
x AP diameter :24mm x CSR and CRVO
x Horizontal diameter :23.5mm x CSR and RD

S
x Vertical diameter :23mm x Macular edema
x Volume :6.5ml x VH and RH
x Weight :7gm x ARMD

M
o Anterior chamber x Lens dislocation
x Normal depth : 2.5-3mm x Methanol amblyopia

A
x Normal IOP : 10-21 mm Hg iii. EXAMINATION METHODS OD EYE
x Normal production of aqueous : 2.3 ml/min x Visual acuity : Snellen’s chart

I
o Retina x Colour vision : Ishihare’s chart
x Surface area :266mm2 x Field of vision : Perimerry

D
x Thickest at Posterior pole :0.56mm / confrontation
x Thickest at Ora serrata : 0.1 mm x Pupil :
o Optic disc Transillumination
x 1.88 mm vertically x Angle : Gonioscopy
x 1.76 mm horizontally x Aqueous flow : Tonography
x 3-4 mm nasal to Fovea x IOT : Tonometry
x Fovea is 1.5 mm in diameter x Lens pathology : Purkinje images
o Dimensions of cornea x Corneal thickness : Pachymeter
x Anterior surface (Elliptical) x Corneal curvature : Keratometry
o Horizontal diameter : 11.7 mm x Corneal sheen : Placido disc
o Vertical diameter : x Corneal endothelial density :
10.7 mm Specular microscopy
x Posterior surface (Spherical) x Corneal surface : Window reflex,
o Horizontal diameter : 11.7mm Placido disc, slit lamp
o Vertical diameter : 11.7mm
x Corneal opacity : Slit lamp
x Megalocornea :>13mm
x Fundus : Direct
x Micro cornea :<10mm ophthalmoscope (Erect, Virtual
II. LOSS OF VISION image,15x)
A. Sudden painful LOV A unit
i of
of TEN PVT. LTD
LTT
: Indirect
x A/c Congestive Glaucoma ophthalmoscope(inverted,real
x A/c Iridocyclitis image,5x)
x Endophthalmitis/Panophthalmitis x Retinal vasclature : Flurescin
x Optic neuritis angiography
x Trauma x Choroidal vasculature :
B. Sudden painless LOV Indocyanin green angiography

24 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018

x Posterior segment : Optical Ͳ MCC is Staphylococcal proteins. f/b
coherence tonography tubercular proteins
x Rods and cones : A wave in ERG Ͳ Pinlish white nodules
(Negative) x Pterygium
x Inner retinal layers : B wave in ERG Ͳ Elastotic degeneration
(Positive) Ͳ Epithelial conjunctival xerosis
x Retinal pigment epithelium: C wave in Ͳ MCC is Vit. A deficiency
ERG (Positive) x Ulcer serpens
x RPE, Rodes and Cones : EOG Ͳ Hypopyon corneal ulcer caused by
IV. POWER OF EYE Pneumococcus
ଵ
Mycotic corneal ulcer

I
x Power ɲ Ͳ
஼௢௥௡௘௔௟௥௔ௗ௜௨௦௢௙௖௨௥௩௔௧௨௥௘
Ͳ MCC is Aspergillus fumigatus
x Schematic eye
Ͳ Feathery finger like projections
Ͳ Total power: +58D

C
Ͳ Pseudohypopyon (Non sterile)
Ͳ Cornea : +43D
x Herpes zoster keratitis
Ͳ Lens : +15D
Ͳ MCC is HSV-1
x Reducced Schematic eye
A unit
i of
of TEN PVT. LTD
LTT

M
Ͳ Dormant in Geographic ulcer
-Total power : +60D
Ͳ Discifrom keratitis
- Cornea : +44D
Metaherpetis keratitis

-
-Lens : +16D Ͳ
x Change in Power x Band keratopathy
-With 1 mm change in axial length Ͳ Calcium salt deposition

S
: +3D change x Photo ophthalmia
-with 1 mm change in corneal Ͳ UV light is the cause
curvature : +6D change Ͳ Snow blindness

M
x Reflective index x Photo retinitis
Ͳ Cornea : 1.376 Ͳ Due to Blur or purple light
Ͳ Lens : 1.386-1.46 Ͳ During Eclipse

A
Ͳ Highest for center of Lens x Staphyloma

I
v. IMPORTANT FEATURES IN CERTAIN EYE DISEASES Ͳ Anterior: MCC is Corneal ulcer
x A/c Mucopurulent conjunctivitis: MCC is Ͳ Posterior: MCC is Axial myopia
staph aureus. x Uveitis

D
x Ophthalmea neonatorum: MCC is Chlamydia Ͳ Anterior: Auto immune
trachomatis Ͳ Intermediate: Idiopathic
x Angular conjunctivitis: MCC is Moraxella Ͳ Posterior: Infections
Axenfield Anterior uveitis
x A/c Membranous conjunctivitis: Ͳ Keratic precipitates (Pathognomonic)
Corynebacterium diphtheria Ͳ Aqueous flare (Earliest singh)
x A/c Hemorrhagic conjunctivitis: MCC is Ͳ Festooned pupil, Iris bombae, Seclusio
enterovirus -70 pupillae
Trachoma Ͳ Koeppe and Busaccanodules:DOC -
Ͳ Caused by chlamydia trachomatis Topical stroids.
Ͳ Halbersteider: Prowazeke bodies (HP bodies) Pare planitis (Intermediate uveitis)
Ͳ Follicles on bulbar conjunctiva: Ͳ Snow ball opacities
Pathognomoic Ͳ Snow banking
Ͳ Leber cells in follicles Ͳ DOC- Systemic steroids
Ͳ Sago grain like follicles x Uveitic glaucoma
Ͳ Artl’s line due to scarring Ͳ Doc – ɴ blockers
Ͳ McCallan’s classification x Endophthalmitis
x Spring catarrh (VKC) Ͳ MCC – Intra ocular surgery
Ͳ Type IHSN Ͳ A/c Post operative: Staph epidermidis
Ͳ Common in summer Ͳ C/c Post operative: Fungi
x Itching and Ropy discharge Ͳ Endogenous: B. Cereus and S. aureus
Ͳ Cobblestone appearance of palpebral Ͳ Cat’s eye reflex.
conjunctiva A unit
i of
x Cataract of TEN PVT. LTD
LTT
Ͳ Tranta’s spots on Bulbar conjunctiva Ͳ Metabolic causes are Hypothyroidism,
Ͳ Punctate keratopathy and shield ulcer Hypo parathyroidism and Hy
Ͳ Pseudogerontoxin: Cupid bow pocalcemia.
x PhlyctenularKeratoconujctivitis Ͳ Maternal infection: CMV, Rubella,
Ͳ Type IV HSN Toxoplasmosis.
Ͳ MC site in Limbus Ͳ MC from of congenital cataract is
Punctate

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 TARGET DEC. 2018
Ͳ Rubella produnce Nuclear cataract Ͳ NPDR: Microaueurysms (Earlist
Ͳ ICCE is contra indicated cataract detectable)
Ͳ MC from of senile cataract is Ͳ PDR: Neovascularisation (Hallmark)
cuneiform cortical cataract. Ͳ MCC of visual loss in DR and NPDR is
Ͳ Cortical cataract: Polyopia, Colour CSME
shift, Index myopia and Day blindness. Ͳ MCC of visual loss in PDR is VH> RD
Ͳ Diabetic cataract is snowstorm/ Ͳ Rx of choice is Photocoagulatipon
snowflake cataract. Ͳ Screening of DR: 5yrs after onset
Ͳ MCC of 2ÛCataract is Anterior uveitis. of T1 DM
x Ectopia Lentis At the time of
Ͳ Superotemporal: Marfan syndrome diagnosis of T2 DM
Ͳ Inferonasal: Homoocystinuria x Retinitis Pigmentosa
Ͳ Forward: Well – Marchesani Ͳ X- linked recessive
syndrome Ͳ Associations: Kearn Sayre syndrome,
Ͳ Ehler – Danlos, Stickler syndrome, Usher syndrome, Cockayne
sulphite oxidase deficiency and Trauma Syndrom, Refsum disease, Friedrich’s

I
are other causes. ataxis, Laurence Moon Biedl Bardet
A unit
i of
x Lenticonus
of TEN PVT. LTD
LTT syndrome etc.

C
Ͳ Anterior: Alport syndrome x Macular edema
Ͳ Posterior: Lowe syndrome Ͳ Ophthalmoscopy: Honey comb
(Microphakia also) appearance
Ͳ Visual field changes Ͳ FFA: Flower petal appearance

M
POAG x Oguchi’s disease
x Visual field changes Ͳ Congenital stationary night blindness

-
Ͳ Isopteric contraction (Earliest) Ͳ Mizuo Nakamura Phenomenon
Ͳ Baring of blind spot x Foster: Kennedy syndrome

S
Ͳ Paracentral scotoma (Earliest Ͳ Ipsilateral pressure atrophy of optic
clinically significant defect) nerve
Ͳ Siedel’s scotoma Ͳ Contralateral Papilloedema
Ͳ Bjerrum scotoma x Optic neuritis

M
Ͳ Ring scotoma Ͳ MCC is multiple selecrosis
Ͳ Roenne’s central nasal stap Ͳ Pulfrich phenomenon

A
x Fundus changes Ͳ Uhtoff’s sing
Ͳ V ertically oval cup Ͳ MC visual field defect is central

I
Ͳ Large cup with cup-disc ratio>0.5 scotoma
Ͳ Bayonetting sing x Superior orbital fissure syndrome

D
Ͳ Pulsation of vessels(Pathognomonic Ͳ III, IV and V1 Cranial nerves are
Ͳ Lammellar dot sing involved
Ͳ Bean pot cupping Ͳ Ophthalmic division of trigeminal (Vi)
Ͳ DOC: Beta blocking (Doc for PACG is involved
Pilocarpine) Ͳ Sympathetic fiber involved
x Post congestive glaucoma x Orbital apex syndrome
Ͳ Vogt’s triad:Glaucomfleken, Iris Ͳ III, IV, VI, V, and II Cranial nerves
atrophy, Sphincter atrophy involved.
x Congenital glaucoma x Hordrolum externum
Ͳ Buphthalmos (Large eye) Ͳ Suppurative inflammation of Glands of
Ͳ Mc symptom is Photophobia zies and Moll (Modified sweat glands)
Ͳ Haab’s Striae x Chalazion
Ͳ Treatment: Goniotomy (Preferred) Ͳ Non suppurative chonic
x Hypertensive retinopathy Lipogranulomatous inflammation of
Ͳ I: Narrowing of arterioles meibomian glands.
Ͳ II: Salu’s sing x Trauma
Ͳ III: Bommet sing Ͳ Scleral rupture is MC at limbus.
Marcus Gunn sing Ͳ Voissious ring in lens
Salu’s sing Ͳ Rosette cataract
A unit
i of
of TEN PVT. LTD
LTT
Exudates (Soft and Hard) Ͳ Berlin’s edema at fundus
Copper wiring (Exaggerated light Ͳ Commotion retina
reflex) x Sympathetic ophtalmitis
IV: Grade III + Macular star Ͳ Plastic granulomatous uveitis in both
Asailver wiring (Highly exaggerated eyes
light reflex) Ͳ Dalen Fush’s nodules.
x Diabetic retinopathy Ͳ Keratic precipitates (1st sing)

26 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018
Photophobia (1st symptom) x Headlight in fog app. Of fundus:
x Stargardt’s disease Toxoplasmosisi
Loss of central vision x Bull’s eye maculopathy:
Normal ERG and EOG Chlorquine, Phenothiazine
x Best disease x Roth sport in fundus: Bacterial
Normal ERG and abnormal EEOG Endocarditis, puerperal
x Retinoblastoma septicemia
RB gene on 13q. x Snow ball opacities in vitreous:
Characteristic is Flexner- Pars planitis, candidiasis, Lyme
Wintersteiner rosette disease, sarcoidosis

I
Cell of origin is Photoreceptors IX. EOM AND ACTIONS
MC presentation is Leukocoria > Right Eye
Strabismus

C
MC 2nd tumour in RB is Osteosarcoma x SR:Elevation (1ƕ), Adduction, Intorsion
RB spread to CNS via Optic nerve x IR: Depression (1ƕ), Adduction,
RB most commonly spreads to flat Extorsion
A unit
i of
of TEN PVT. LTD
LTT

M
bones x MR: Adduction(1ƕ)
VI. LAYERS OF CORNEA AND RETINA x LR:Adduction (1ƕ)
x SO: Intorsion(1ƕ), Depression,

-
A. Cornea
x Epithelium abduction
x Bowman’s membrane(will not x IO: Extorsion (1ƕ), Elevation, Abduction

S
regenerate) X. OCULAR TUMOURS
x Stroma x MC Intraocular tumour in adults: Mets
x Descemet’s membrane x MC Primary Intraocular tumour in

M
x Endothelium (Most important for adults: Uveal melanoma
maintaining transparency) x MC Primary Intraocular tumour in
B. Retina children: Retinoblastoma

A
x RPE x MC orbital tumour in adults:

I
x Rods and Cones Cavernous hemangioma
x External Limiting membrane x MC malignant orbital tumour in
x Outer nuclear layer adults: Lymphoma

D
x Outer plexifrom layer x MC orbital tumour in children:
x Inner nuclear layer Rhabdomyosarcoma
x Ganglion cell layer x Overall MC malignant tumour of
eye:Malignant melanoma
x Nerve fiber layer
x MC epithelial tumour of lacimal gland:
x Internal limiting embrane Pleomorphic adenoma
VII. SPECIAL TYPES OF CATARACT
x MC malignant eyelid tumour: BCC of
x Christmas tree: Myotonic lower eyelid
dystrophy
x MC malignant tumour of conjunctiva
x Sun flower: Wilson disease, and cornea:SCC
Chalcosis, Trauma (Penetrating) XI. LEUKOCORIA
x Snow flake: DM, Downs syndrome
x Retinoblastoma
x Congenital lamellar (zonular):
x PHPV
Ͳ Hypocalcemia,
x Norries disease
Hypovitaminosis-D,
Hypoparathyroidism x Retinal hamartoma
x Nuclear cataract: Congenital x Coat’s disease
rubella x ROP
x Oil drop:Galactosemia x Toxoplasma/ Toxocara/CMV
x Rosette: Blunt trauma XII. XEROPHTHALMIA
x Bread crump/ Rainbow: x XN : Night blindness
Complicated cataract (Pravalence 1%)
VIII. SOME SPECIAL TERMS x X1A :Cojunctival xerosis
x Salt and Pepper fundus: x X1B A unit
i of
of TEN PVT. LTD
:Bitot spots (0.5%) LTT
Congenital Rubella and x X2 :Corneal xerosis
syphilis. x X3A :Corneal ulceration (0.01%)
x Sauce cheese app./ x X3B :Keratomalacia
Pizza pie app./ x X5 :Corneal Scarring (0.05%)
CMV retinitis XIII. LASERS IN OPHTHALMOLOGY
Brush fire app. Of fundus x Nd – YAG
Ͳ 1064mm wavelength

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 TARGET DEC. 2018

Ͳ Principle is Photodisruption x Posterior half of external auditory
Ͳ For Capsulotomy/ Iridotomy canal: Arnold’s Nerve
x FD Nd – YAG III. TUNING FORK TESTS
Ͳ 532mm wavelrnght x Ideal frequency for tuning fork for
Ͳ Photocoagulation is the principle hearing tests is 512Hz
Ͳ For Retinal photocoagulation (MC) Rinne’s test
x Argon 9 Compares AC with BC
Ͳ 532mm 9 Positive (AC>BC) in normal and
Ͳ Photoablation sensorineural deafness
9 Negative (BC>AC) in conductive
x Excimer
deafness
Ͳ 193.3mm
9 For detection; minimum deafness
Ͳ Photoablation should be 20-25 dB
Ͳ For Excising cornea in LASIK 9 False negative Rinne’s test in severe
x Krypton red unilateral SNHL
Ͳ Travels through blood x Weber test

I
XIV. SOME SPECIAL SIGNS o Most sensitive test (Detects even 5dB
A unit
i of
of TEN PVT. LTD
x Munson’s sighLTT :Keratoconus hearing differences)
x Vogt’s striae :Keratoconus o Lateralises to diseased ear in

C
x Haab’s striae :Congenital conductive deafness
glaucoma o Lateralized to normal ear in SNHL
x Fliescher’s ring o Central in normal test

M
:Keratoconus x ABC test (Modified
x KF ring :Wilson’s Schwabachs/Pomeroy’s test)
o Reduced in sensorineural deafness

-
disease
x Stocker’s Line :Pterygium o Normal in conductive deafness and
x Ferry’s Line :Post glaucoma normal ears.

S
surgery x Gelle’s test
x Coat’s ring :Metallic FB o Decrease in BC on increasing the
pressure inside external auditory

M
ENT canal using siegel’s speculum.
I. EAR STRUCTURES AT BIRTH o Positive in normal ear & SNHL
A. Adult size at birth o Negative in otosclerosis

A
x Ossicles x Bing’s test
o Increase in BC on occluding the

I
x Middle ear
meatus
x Inner ear o Positive in normal ear and SNHL
B. Fully formed at birth

D
o Negative in conductive hearing loss
x Pinna IV. NYSTAGMUS
x Tympanic membrane A. Peripheral nystagmus
x Mastoid antrum x Usually horizontal
x Ossicles x Unidirectional
x Middle ear x Has latent period
x Inner ear x Fatiguable
C. NOT present at birth x Amplitude is maximum when looking in
x Mastoid Process fast component
x Bony part of External auditory canal x Aggravates on abolishing optic
II. NERVE SUPPLY OF PINNA fixation
x Lateral surface upper half: x Associated with nausea and vomiting
Auriculotemporal nerve B. Central nystagmus
x Lateral surface lower half: Great x Bidirectional
auricular nerve x No latent period and not fatiguable
x Medial surface upper half: Lesser x Unchaged by optic fixation
occipital nerve C. Types of centalnystagmus
x Medial surface lower half: Great x Vertically down beating: Arnold
auricular nerve A unit
i of
of TEN PVT. LTD
Chiari malformationLTT
x Post auricular sulcus: Arnold’s nerve x Dissociated nystagmus: Multiple
(Auricular branch of vagus) sclerosis
x Cymba concha: Nervous intermedius x Mono ocular: INO
(Sensory branch of facial) x Sea-saw nystagmus:
x Anterior half of external auditory canal: craniopharyngioma, midbrain lesions
Auriculotemporal nerve x Direction changing: CP angle tumours
(Brun’snystagmus)
P
28 28HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
 TARGET DEC. 2018

V. TYMPANOGRAM & PTA x CHL with Otosclerosis, Blue sclera,
A. Tympanograms Osteogenesisimperfecta
x A: Normal VII. COMPLICATIONS OF CSOM
x As: Reduced compliance A. Mastoiditis
o Otosclerosis, Tympanosclerosis, x MC complication of mastoiditis
Ossicular fixity x Reservoir sign
x Ad: Increased compliance x Postaural abscess: MC type of mastoid
o Ossicular discontinuity, Lax, TM abscess
x B: Flat tympanogram x Luc’s abscess: Pus in infratemporal
o Fluid in middle ear (SOM, ASOM), fossa tracks Meastus
thick TM

I
x Bezold’s abscess: Pus beneath SCM
x C: Maximum compliance at negative muscle
pressure x Citelli’s abscess: Pus in posterior

C
x Eustachian tube dys functions, early triangle of neck
SOM B. Petrositis
B. PTA x Gradenigo syndrome-Otorrhoea +
x Acoustic dip: Dip at 4000 Hz in Noise
A unit
i of
of TEN PVT. LTD
LTT Retro orbital pain + Diplopa

M
induced hearing loss C. Brain abscess
x Carhart’s notch: Dip at 2000 Hz in x Most commonly involves temporal lobe

-
otosclerosis f/b cerebellum
x Trough shaped (U-shaped): congenital D. Lateral sinus thrombosis

S
deafness x Picket fence fever
x Air-Bone gap: CHL and Mixed hearing x Griesinger’s sign: Redness due to
loss thrombosis of emissary vein
VI. SYNDROMES WITH DEAFNESS x Tobey – Ayer test: Increase in CSF

M
A. Alport syndrome (XR) pressure on pressing IJV
x SNHL, Renal lesions, Eye problems x Crow Beck sign: Engorgement of

A
B. Pendred syndrome retinal vessels on pressing IJV
x SNHL, Goiter, Mental retardation, VIII. ORBIT

I
Mondini’s cochlea A. Bones forming orbit
C. Lange: Nielson syndrome x Frontal bone
x SNHL, QT prolongation

D
x Ethmoid bone
D. Usher syndrome x Sphenoid bone
x SNHL, Vestibular anomalies, Retinitis x Maxillary bone
pigmentosa x Lacrimal bone
E. Warrdenberg syndrome
x Zygomatic bone
x SNHL, Heterochromiairidis,
x Palatine bone
Hypopigmentation, Telecanthus
B. Medical wall of orbit
F. KlippelFeil syndrome
x Frontal process of maxilla
x SNHL, Low hair line, short neck,
vertebral lesion, Renal lesions x Lacrimal bone
G. Congenital Rubella syndrome x Ethmoid bone
x SNHL, Cataract, Cardiac defect (MC- x Sphenoid bone
VSD) C. Floor of orbit
H. Hutchison’s triad (Congential Syphilis) x Maxilla
x SNHL, Notched incisors, Interstitial x Zygomatic bone
keratitis x Palatine bone
I. Treacher Collins Syndrome D. Superior orbital fissure –contents
(Mandibulofacialdisostosis) x 3,4,6 cranial nerves
x CHL, Fish like mouth, Antimongoloid x Superior and Inferior ophthalmic vein
slant of eyes, Coloboma of lower x Ophthalmic division of Trigeminal
eyelid nerve – lacrimal, frontal and
J. Crouzon syndrome (Craniofacial Nasociliary branches
dysostosis) E. Orbital apex – contents
x CHL, Frog eyes, Parrot nose, Ear x All contents of superior orbital
deformities A unit
i of
fissure
of TEN PVT. LTD
LTT
K. Goldenhar syndrome (Oculoauriculo x Optic nerve
vertebral syndrome) x Maxillary division of Trigeminal nerve
x CHL, ocular, Anomalies, F. Optic canal – contents
Hemifacialmicrosomia, Auricular x Optic nerve
anomalies, vertebral anomalies
x Ophthalmic division of Trigeminal
L. Vander Hoeve syndrome
nerve

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 TARGET DEC. 2018

IX. RADIOLOGICAL VIEWS IN ENT 9 Absence of smell sensation
x Mandible: Orthopandamogram 9 Commonest cause is viral infection
x Nose and PNS: Coronal CT 9 Commonly accompanied by Aguesia
x Frontal sinus: Caldwell view x Hyperosmia
(occipitofrontal) 9 Increased sense of smell
x Maxillary sinus: Water’s view (30° 9 Streptomycin therapy, recovery phase
occipitomental) of viral anosmia
x Ethmoid sinus: Lateral oblique view x Phantosmia
x Mastoid: Lateral oblique view 9 This is olfactory hallucination
(Perception of smell at its absence)
x Sphenoid: Basal view (submento vertical)
9 Migraine, temporal lobe epilepsy
x Sellatursica: Lateral view skull XI. LE FORTE FRACTURES
X. OLFACTION – ABNORMALITIES A. Le Forte – I: Cause floating Palate
x Presbyosmia B. Le Forte – II: Commonest
o Age related reduction in smell (1st Pyramidal type
sensation to be impaired with age is Cause CSF Rhinorrhoea

I
smell) C. Le Forte – III: Craniofacialdysjunction
A unit
i of
of TEN PVT. LTD
x Anosmia LTT
XII. ANTROCHOANAL & ETHMOIDAL POLP

C
Antrochoanal Polyp Ethmoidal Polyp
Aka Killians’s Polyp ---
Infective etiology Allergic etiology

M
Usually unilateral Usually bilateral
From maxillary antrum From ethmoidal sinus

-
Less recurrence More recurrence
Treatment is mainly surgery Treatment is mainly medical
XIII. SOME POINTS ON JNA (Juvenile x Epley’s Maneuver: Repositioning of

S
Nasopharyngeal Angiofibroma) otoconiainto utricle and sacule as a
x Commonest benign tumour of nasopharynx treatment of BPPV
x Testosterone dependant x Fraenkel’s triad: Atrophy + Crusting +

M
x Cause frog face deformity Fetor in Atrophic Rhinitis
x Biopsy is contra indicated x Furstenberg’s sign: Pulsatile swelling at
x X-ray show antral sign/Hollmann-Miller root of nose with an impulse on coughing

A
sign or straining in Meningoenephalocele

I
x IOC is CECT x Ground glass appearance: Fibrous
x MRI shows Bag of worms appearance dysplasia
x DSA+Embolism is done for pre-Operative x Griesinger’s sign: Redness and edema in

D
shrinkage Postaural area due to thrombosis of
x Medical treatment is by Flutamide (Anti- mastoid emissary veins
androgen) x Hennebert’s sign: False positive fistula
x Treatment of choice is surgery sign in congenital syphilis and Meniere’s
XIV. NAMED SIGNS & SYNDROMES IN ENT disease
x Antral sign/Hollmann sign: Anterior x Handkerchief test: For CSF Rhinorrhoea
bowing of Posterior wall of maxillary x Ice cream cone appearance: MRI finding in
sinus in JNA Acoustic neuroma
x Battle sign:Echymosis of mastoid region x Irwin Moore’s sign: Pus fromtonsillar
seen in fractures of mastoid. crypts on squeezing; seen in c/c
x Boxer’s ear: Hematoma pinna tonsillitis
x Browne’s Sign: Blanching of TM on x Millian’s ear sign: In Erysipelas caused by
changing pressure in ear using Siegel’s strep. Pyogenes
speculum x Phelp sign: CT scan finding in
x Boyce Sign: Gurgling sensation on glomustumour
palpation in Zenker’s diverticulum x Potato nose: Rhinophyma
x Chevelliar Jackson sign: unilateral x Potato tumour:Carotid body tumour
pooling of saliva in foreign bodypyriform x Potato (Hot) voice: Quinsy
sinus.
A unit
i of
of TEN PVT. LTD
LTT
x Rising sun sign:Glomustumour seen as a
x Crow beck sign: Engorgement of retinal dome of reddish hue
vessels on compressing IJV in lateral x Samter’s triad: Asthma + Aspirin HSN +
sinus thrombosis Nasal polyposis
x Delta sign: CECT finding in Lateral Sinus x Schwartz sign: Flamingo pink
Thrombosis discolouration of TM due to
x Double density sign: Fungal sinusitis vascularization of Promontory in
otosclerosis
30 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
 TARGET DEC. 2018

x Surfer’s ear:Exostoses in auditory meatus
x Swimmer’s ear:Generalised otitis externa
caused by pseudomonas
x Soap bubble app:Amelolastoma
x Steeple sign/Pencil tip sign: A/c LTB
(laryngotracheobronchitis)
x Tear drop sign: Orbital blow out fracture
x Trotter’s triad: Trigeminal neuralgia +
unilateral palatal immobility + secretory
otitis media; seen in CA nasopharynx
x Woody nose/Hebra nose:Rhinoscleroma
Syndromes
x Adamantiades syndrome: other name of
Behcet’s syndrome; oral and genital
ulcers with uveitis
x Costen syndrome: TM joint dysfunction
producing auriculotemporal neuralgia.
A unit
i of
of TEN PVT. LTD
LTT
x Eagle syndrome:Elongated styloid
process compress on Glossopharyngeal
nerve and produce ear pain.
x Gradenigo syndrome: Otorrhea + Retro
S
orbital pain (Due to Trigeminal neuralgia)
+ Diplopia (Due to LR palsy) in Apical
petrositis
x Grisel syndrome: Atlantoaxial
M
subluxation after adenoidectomy
x Kartagener syndrome:Ciliarydysmotility +
situsinversus
A
x Lermoyez syndrome: Variant of Meniere’s
I
disease in which vertigo appears late
x Lemierre’s syndrome:Suppurative
thrombophlebitis of IJV in neck space
D
infections
x Ludwig’s angina: Infection of
submandibular space
x Melkersson – Rosenthal syndrome: R/C
alternating facial palsy + Edema of lips
and face + Glossitis + fissured tongue
x Mobius syndrome: Bilateral facial palsy +
VIth nerve palsy + Multiple – cranial
nerve abnormalities
x Pierre Robin sequence:Micrognathia,
Glossoptosis, Cleft palate
x Steakhouse syndrome: Bolus obstruction
in Schatzki’s ring
Spaces
x Boyer’s space: Pre epiglottic space
x Citelli’s angle: Sinodural angle
x Prussak’s space: Between pars flaccida
and neck of malleus in epitympanum
x Reinke space: Space beneath mucosa of
vocal cord
x Trautman’s triangle: Area of vascular
cancellous bone in mastoid
XV. MOST COMMON PRESENTING FEATURES
x Eustachian tube dysfunction: Retracted
TM
x Otosclerosis: Progressive CHL
x Ototoxicity: Tinnitus
x Meniere’s disease: Episodic vertigo
x Lermoyez syndrome: Deafness and Tinnitus
HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
x Glomustumour: Pulsatile tinnitus
x Acoustic neuroma: Unilateral progressive
SNHL
x B/L choanal atresia: A/C respiratory
obstruction with cyanosis
x Sinusitis: Facial pain
x OSAS: Snoring
x CA nasopharynx: Neck node
x Laryngomalacia: Inspiratory stridor
x Ca larynx: Hoarseness
I
x Carotid body tumour: Painless pulsatile
neck mass
XVI. IOC IN ENT
C
x Congenital malformation of ear: HRCT
x Most sensitive tuning fork test: Weber’s
test
M
x Nystagmus: Hallpike’s test
x Screening of Congenital deafness: OAE
(Otoacoustic Emission Testing)
-
x Diagnosis of Congenital deafness: BERA
x Ototoxicity/NIHL: OAE
x Malignant otitis externa: Radionucleotide
scanning (Gallium and Technetium)
x Temporal bone trauma: HRCT
x Glomustumour: Gadolinium enhanced MR
Angiography
x Acoustic neuroma: Gadolinium Enhanced
MRI
x Choanal Atresia: HRCT
x Quantitative test for smell: UPSIT
x Rhinoscleroma and Rhinosporidiosis:
Biopsy
x C/C sinusitis: Nasal endoscopy and Biopsy
x Mucormycosis: Biopsy
x Temporal arteritis: Temporal artery
biopsy
x OSAS: Nocturnal Polysomnogram
(obstructive Sleep Apnea Syndrome)
x Ca larynx: Direct laryngoscoy and biopsy
x Carotid body tumour: MR angiography.
ORTHOPEDICS
I. ARTERIES AND NERVES INJURED
x 1ST rib fracture: Subclavian artery
x Shoulder dislocation : axillary artery
x Supracondylare fracture humerus:
Brachial artery
x Elbow dislocation: brachial artery
x Pelvic fracture: Pre sacral and pelvic
vessels
x Fracture femur: Femoral artery
x Knee dislocation: Popliteal artery
x Proximal tibial fracture: Proximal
tibial artery
A unit
i of
of TEN PVT. LTD
LTT
x Fracture shaft of humerus: Radial
nerve
x Supracondylar fracture humerus:
Radial > Median> ulnar nerves
x Fracture medial condyle of humerus:
Ulnar nerve
31
 TARGET DEC. 2018
x Montaggia fracture: Posterior x Abnormal in supratrochanteric
interosseous nerve fracture and dislocations
x Hip dislocation: Sciatic nerve D. Chiene’s line
x Knee dislcoaiton : Peroneal nerve x Line joining 2 ASIS and 2 greater
x Fracture neck of humerus: Axillary trochanters are parallel to each
nerve other
II. NERVE ROOTS AND ACTION x Abnormal in supratrochanteric
x C5Æ Elbow flexion fracture and dislocation.
x C6ÆWrist extension E. Morris bitrochanteric test
x C7ÆWrist flexion x To detect inward displacement of
x C8ÆFinger flexion greater trochanter
F. Perkin’s line and Hilgenreiner’s line
x T1ÆFinger flexion
x Vertical line passing through the
x L1L2Æ Hip abduction
lateral margin of femoral head is
x L2ÆHip flexion Perkin’s line
x L3ÆKnee extension x Horizontal line passing through the

I
x L4ÆAnkle dorsiflexion upper margin of femoral head is
A unit
i of
of TEN PVT. LTD
LTT
x L5Æ Big toe extension hilgenreiner’s line
x S1ÆAnkle planter flexion x Femoral head epiphysis lies medial and

C
x S5ÆRectal tone inferior to these lines respectively.
III. FRADING OF NERVE INJURY x Lateral d isplacement occurs in CDH
a. Seddon’s classification (Von Rosen Sign)

M
x Neuropraxia G. Kliene’s line and Trithovan’s sign
o Function integrity is lost x Kleine’s line is the line passing

-
o No structure defect through the upper margin of femoral
x Axonotmesis neck which transects upper 1/3rd of
o Injury to axon femoral heat

S
o But neurilemmal sheath in x In SCFE, the line passes above femoral
intact head (Trithovan’s sign)
x Neurotmesis V. BONE TUMOURS

M
o Injury to nerve as a whole A. Classification
b. Sunderland Classification x Arising from framework cells
x 10ÆNeuropraxia o Osteobalst: Osteoma, Osteoid

A
x 20ÆAxonotmesis osteoma, osteoblastoma,

I
x 30Æ Injury to axon + endoneurium osteosarcoma
x 40ÆInjury to axon + endoneurium + o Osteoclast: Osteoclastoma,
perineurium Aneurysmal bone cyst

D
x 50Æ Injury to axon + endoneurium + o Fibrolast: Fibroma, Bone cyst,
perieurium + Epineurium Fibrous dysplasia
c. 30, 40 and 50 are coming under o Chondroblast: chondroma,
neurotmesis chondroblastoma,
d. Additional 60 is mixed pattern injury chondrosarcoma
e. 50 is complete cut of a nerve x Arising from resident cells
IV. SPECIAL MEASUREMENTS o Periosteum: Fibroma,
A. Nelaton’s line Fibrosarcoma, MFH
x Line joining ASIS and ischial tuberosity o Bone marrow: Multiple
myeloma, Hodgkin lymphoma,
x Normally passes through Greater
Ewing’s sarcoma
trochanter
Lymphosarcoma, Reticulum cell
x Abnormal I nsupratrochanteric sarcoma
fracture and dislocation o Blood vessels: Angiosarcoma
B. Briant’s triangle o Nerves: Neurofibroma
x Vertical line downward from ASIS and o Synovium: Synovial sarcoma
horizontal line from greater o Musles: Rhabdomyosarcoma
trochanter meets at right angle x Included tissues
x Abnormal in supratrochanteric o Adamantinoma
fracture and dislocation A unit
i of
of TEN PVT. LTD
o Chordoma LTT
C. Shoemaker’s line x Invaded tumors
x Line joining ASIS and greater o metastasis
trochanter when extrapolated, it
passes through umbilicus
B. Most common sites
Bone tumors Site
OS Metaphysis Lower femur> upper tibia

32 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018

EWS Diaphysis Long bones
GCT Epiphysis
OC Metaphysis
CB Epiphysis
CS Pelvis
CS – clear cell Epiphysis
Osteoid osteoma Dia> meta Femur> tibia
Adamantinous Diaphysis Mandible (tibia)
Fibrosarcoma Diaphysis
Lymphoma Diaphysis
Brown tumour Diaphysis

I
ABC Metaphysis Prox. Tibia
Enchondroma Metaphysis Hands and feet

C
UBC Metaphysis Prox. Humerus
Hemangioma Skull and spine
OB Spine and flat bones
Brodies abscess Metaphysis
A unit
i of
of TEN PVT. LTD
LTT

M
Garrie OM diaphysis
VI. OSTEOCHONDRITIS x Sun burst/ sun ray app. And Codman’s

-
A. Crushing osteochondritis triangle : Osteosarcoma
x Perthe’s disease: Femoral head x Onion peel app. : Ewing’s sarcoma

S
x Planner’s : Capitulum x Soap bubble app. : Osteoclastoma
x Kohler’s : Navicular x Honey comb app.: Adamantinoma
x Freiberg’s : Metarsal head x Cotton ball skull : Paget’s disease
x Islene disease: 5th MT head x Banana sign and Lemon sign: Spina

M
x Calve’s : Vertebral body bifida
x Scherman’s : Ring epiphysis of vertebra x Hair on end app. Of skull; thalassemia

A
x Kienbonch’s lunate x Inverted Nepolean hat sign:
B. Traction osteochondritis Spondylolisthesis (AP view)

I
x Osgood shatler’stibial tubercle x Scotty dog app. : Normal vertebra
x Severe’s : Calcaneal tubercle x Beheaded Scottish terrier app.:

D
x Johansen – Larsen: Lower pole of
patella
C. Splitting osteochondritis
x Osteochondritisdessicans; Femoral
condyle
VII. RADIOLOGICAL SIGNS IN ORTHOPEADICS
x Subperiostealresorption of
phalanges; Hyperparathyroidism
x Sausage digitis/ Liked candy stick app:
Psoriais
x Gull’s wing app.: Psoriais
x Fish mouth vertebra: Sickle cell
anemia, homocytinuria
x Cod fish vertebra: Osteopetrosis,
renal failure
x Picture frame verterbra: paget’s
disease
x Vertebra plana: Eosinophilic
granuloma (LCH)
x Calcification of IV disc: Alkaptonuria
x Cup and pencil deformity : Psoriasis
x Trummer field zone (
metaphyseallucency): Scurvy
x Pelkanspur and frankle white line:
Scurvy
x Wimberger sign: Scurvy , Rickets
x Looser’s zone: Osteomalacia
x Splaying and cupping of metaphysic :
Rickets
x Triradiate pelvis: Osteomalacia
Spondylolisthesis (lateral)
x Bone within bone app. : Osteopetrosis
x Salt and pepper skull and browns
tumors: Hyperarathyroidsim
x Driven snow app. : Epithelial
odontogenictu or (pindborg tumor)
x Wormian bones: Osteogenesis
imperfect
VIII. NAMED FRACTURES
x Jefferson fracture: Burst fracture of
atlas
x Hangman’s fracture: Fracture of
pedicle and lamina and Axis (C2)
x Burst fracture : comminuted fracture
of vertebral body
x Chance fracture: Horizontal fracture
of vertebra from body to thee
posterior element
x Clay shoveller’s fracture: Avulsion
fracture of spinous process of C7
x Barton’s fracture: intra articular
fracture of distal radium
x Bonnet’s fracture: Intra articular
fracture of 1st MC base
A unit
i of
of TEN PVT. LTD
LTT
x Boxer’s fracture: Fracture neck of 5th
MC
x Aviator’s fracture: Fracture neck of
talus
x Bumper fracture : Comminuted
fracture of lateral tibial condyle

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 33

 TARGET DEC. 2018

x Colle’s fracture: Fracture at
corticocancellous junction of distal
radium with dorsal tilt
x Chauffer fracute : Intra articular
fracture of radial styloid
x Cotton fracture: trimalleolar ankle
fracture
x Chopart fracture: fracture
dislocation of inter tarsal joints
x Dashboard fracture: Fracture of
posterior lip of acetabulum along with
posterior dislocation of hip.
x Galeazzi fracture: Fracture distal
radius with dislocation of distal
radioulnar joint
x Lisfrane’s fracture: Fracture
dislocation of taso – MT joints
A unit
i of
of TEN PVT. LTD
LTT
x Mallet finger; Avulsion of extensor
tendon from 5th phalanx
x Malgaine’s fracture I/L fracture of
pubic rami and sacro iliac joint
disruption.
x March fracture: Fatigue fracture of
shaft of 2nd and 3rd MT
x Maisonneuve’s fracture: Ankle
fracture with spiral fracture of neck
of fibula
S
x Night stick fracture; Fracture shaft
of ulna
x Montaggia fracture: Fracture
M
proximal ulna with radial head
dislocation
x Pott’s fracture ; Bimelleolar ankle
A
fracture
I
x Pilon fracture: intra articular
fracture of distal tibia
x Rolando fracture: Fracture base of
D
1stMC(Extra articular.
x Smith fracture: Fracture distal
radium with ventral tilt
x Straddle fracture: Bilateral superior
and inferior pubic rami fracture
x Game keeper’s thumb: Injury to ulnar
collateral ligament
x Rugger jursey’s finger: Avulsion of
FDP from distal phalanx
x Coach’s finger’s Dislocation of MCP
joint
x Essex – Lopresti lesion ; Combination
of montaggia and Galeazzi
IX. NERVE PALSY AND SPECIAL FEATURES
A. Radial nerve palsy
x Wrist drop
x Finger drop
x Thumb drop
B. Median nerve palsy
x Pointing index
x Ape thumb deformity
x Benediction hand
x Pen test
C. Ulnar nerve palsy
x Ulnar claw hand
34 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
x Wartenberg’s sign
x Fromen’s sign (Book test)
x Egawa test
D. Common peroneal nerve palsy
x Foot drop
E. Lateral cutaneous nerve of thigh
palsy
x Meralgiaparaesthetica
F. Long thoracic nerve palsy
x Winging of scapula
G. Erb’s palsy (upper trunk of brachial
plexus)
x Policeman tip deformity
X. SPECIAL TESTS
x Allen’s test: Patency of palmar
arterial arch
I
x Anvil test: spine tenderness
x Apley’s grinding test: meniscus injury
C
x Barlow’s test: CDH
x Bryant’s test: Anterior dislocation of
shoulder
M
x Callaway’s test: anterior dislocation
of shoulder
x Coin test: TB DL spine
-
x Cozen’s test: Tennis elbow
x Drawer test: ACL and PCL injuries
x Finkelstein’s test: de Quervian’s
tenosynovitis
x Gaenslen’s test: Sacro iliac joint
involvement (AS)
x Galeazzi test: CDH
x Gower’s sing : DMD (Duchenee
muscular dystrophy)
x Hamilton ruler test: Anterior
dislocation of shoulder
x Kanavel sign: Ulnar bursitis
x Lasegue’s test: IVDP
x Lachman test: ACL injury
x Mc Murray’s test: Meniscus injury
x Naffziger’s test: IVDP
x Ober’s test: Tight Ilio- tibial tract
x Ortolani’s test: CDH
x Phalen’s test : Carpel tunnel
syndrome
x Pivot shift test: ACL Injury
x Sulcus sign: Inferior dislocation of
shoulder
x Thomas test: Hip flexion deformity
x Trendelenberg test: Unstable hip
x Tinel’s sign : nerve injury improvement
x Volkaman’s sign: Ischemic contracture
of forearm
x Tests of rotator cuff injury
A unit
i of
of TEN PVT. LTD
LTT
o Lift of test: Subscapularis
o Internal rotation lag sign;
Subscapularis
o Belly press test: Subscapularis
o Drop sign ; Infraspinatus
o External rotation stress test:
Infraspinatus and Teres minor
 TARGET DEC. 2018

o External rotation lag sign: x Uric acid
supraspinatus and x Orotic acid
infraspinatus x Xanthine
XI. SPECIAL CASTS AND SPLINTS x Indinavir
x Colle’s cast: Facture x Triamterene
x Hip spica ; Fracture femur B. Mildly radio opaque
x Cylinder cast: Fracture patella x Cysteine
x Hanging cast : Fracture humerus C. Moderately radio opaque
x Minerva cast: C-spine disease x Calcium dioxalate
x PTB cast: Fracture tibia x Struvite stone

I
x Risser’s cast: Scoliosis D. Densely radio opaque
x Turn buckle cast: Scoliosis x Calcium mono oxalate
x U-slab: Fracture humerus x Calcium phosphate

C
x Aeroplane splint: Brachial plexus III. Radiological signs
injury A. Cardiology
x ASHE brace: DL Spinal injury x Reverse 3 sign/ E sign: Coarctation
A unit
i of
of TEN PVT. LTD
LTT

M
x Bohler –Brann splint: Fracture femur or aorta
x Boston brace; Scoliosis x Jug handle appearance: ASD

-
x Cock up splint: Radial nerve injury x Great hilar dance: ASD
x Dennis brown splint: CTEV x Box shaped heart: Tricuspid atresia
x Knuckle bender splint: Ulner nerve x Flask shaped/ water bottle heart:

S
palsy Pericardial effusion
x Milwaukee brace; Scoliosis x Figure of ‘8’ appearance of Heart:
x SOMI brace: C-spine injury TAPVC

M
x Thomas splint : Fracture femur x Boot shaped heart: TOF
x Toe raising splint : Foot drop x Egg on side appearance: TGV
x Egg in cup appearance/ Square

A
x Taylor’s brace: DL sign spine injury
x Volkmann’s splint: Volkamann’s root sign: Constrictive pericarditis

I
ischemic contracture x Sitting duck appearance of heart:
x Von rosen splint: CDH (Congenital Persistent truncus arteriosus
x Snowman’s heart: TAPVC

D
dislocation of hip)
RADIOLOGY x Tubular heart: Emphysema
I. Contrast media x Globular heart: Tricuspid atresia
A. Low osmolar contrast media (LOCM) x Double aortic knuckle: Aortic
x Non- ionic dissection
o Iohexol, Iopamidol, x Double cardiac shadow: LA
Iopramide, Ioversol enlargement
o Ioxilan, Iodixanol, Iotrolan x Stag antler’s sign: CCF
x Ionic: Ioxaglate x Glassy heart on Echo: Amyloidosis
B. High osmolar contrast media (HOCM) x Four bump heart: MS/MR
x Ionic x Goose neck deformity: ASD- Primum
o Diatrizoate, Iothalmate, type
Ioxithalmate, Metrizoate x Cardiac calcification: carcinoid
x Contrast agent for USG syndrome
o Sonavist, Imavist, Leovist, x Cardiac wall calcification:
Ecogen Endomyocardial fibrosis
o Sonagen, optison, Omalex, B. Urology
Filmix
x Christmas tree/ pine tree bladder:
C. Contrast in different procedures
Neurogenic bladder
x Cerebral angiography: Conray 280
x Rim sign/ crescent sign:
x Coronary angiography: Conray 420 Hydronephrosis
x HSG : Conray 280/420 x Saop bubble appearance :
x DSA, Myelography and Hydronephrosis
ventriculography: Iopamidol, A unit
i of
of TEN PVT. LTD
LTT
x Tree bark appearance: Squamous
Iohexol, Myodil metaplasia of ureter
x Bronchography, esophagoscopy: x Egg in cup appearance: papillary
Dionosil necrosis (Analgesic nephropathy)
x OCG: Iopanoic acid x Lobster claw sign: Papillary
x IV cholecystography: Biligrafin necrosis (Analgesic nephropathy)
II. Radio opacity of kidney stone x Spider leg appearance: PKD
A. Radiolucent

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 35

 TARGET DEC. 2018
x Flower vase appearance: Horse
shoe kidney
x Drooping water Lilly sign: ectopic
ureter/ Adrenal mass
x Cobra head app: Ureterocele
x Fish hook bladder: BPH
x Thimble bladder: Tuberculosis of
bladder
x Sandy patches: Schistomiasis of
bladder
x Dense nephrogram: A/C
obstruction
x Delayed nephrogram: Renal artery
stenosis
x Swiss cheese nephrogram: ADPKD
x Clover leaf skull: Thanatotrophic
dysplasia
x Tram track sign in orbit: Optic
nerve meningioma
x Bare orbit syndrome: Sphenoid
dysplasia (NF-1)
x Rice grain calcification:
Cysticercosis
x Silver beaten appearance of skull:
Raised ICT
x Sun ray calcification with spicules:
Meningioma
D. Respiratory system
x Continuous diaphragm sign:
Pneumomediastinum
x Displaced crus sign: Pleural

I
x Crescent nephrogram: PUJ
obstruction effusion
A unit
i of
of TEN PVT. LTD
LTT x Halo sign: Invasive aspergillosis
x Striate nephrogram: ARPKD

C
x Maiden waist deformity of ureter: x Reverse halo sign: Cryptogenic
Retroperitoneal fibrosis organizing pneumonia
C. Neurology x Batwing sign: LVF/MS

M
x Swirl sign: ongoing bleed x Reverse batwing: Eosinophilic
x Ice cream cone appearance: pneumonia
Acoustic neuroma x Fallen lung sign: Bronchial

-
x Mother in law sign: Meningioma rupture
x Dural tail sign: Meningioma x Tree in bud sign: TB>CMV, RSV, PCP,

S
x Garland type of contrast Aspergillosis
enhancement: Glioblastoma x Signet ring sign: Bronchiectasis
x Sugar icing pattern: x Rising sun sign: Ruptured hydatid

M
medulloblastoma cyst
x Tigroid appearance: x Air crescent sign: Fungal ball in a
Metachromatic leukodystrophy cavity

A
x Open ring sign: Demyelination x Wester mark sign/ melting sign/

I
x Rign enhancement lesion: Hampton’s hump: Pulmonary
Toxoplasmosis, Cysticercosis, embolism
tuberculoma, Abscess, glioma, x Women basket sign: asbestosis

D
mets, craniopharyngioma
x Dawson’s fingers: Aultiple
sclerosis
x Narrow foramen magnum:
Achondroplasia
x Crowding at foramen Magnum:
Arnold- chiari malformation
x Erosion of sella: Raised ICT
x Small sella: Cretinism, Myotonia
congenital
x Double flooring of sella: Pituitary
tumor
x Humming bird appearance: PSP
x Hot cross bun appearance: MSA
x Tramline calcification: struge-
Weber syndrome
x Supra sellar calcification:
Craniopharyngioma
x Empty delta sign: Sinus thrombosis
x Cord sign: Cortical vein
thrombosis
x Drooping penis sign: Intra cranial
hypotension
x Geographic skull: LCH (Langerhan
cell histiocytosis)
x Split pleura sign: empyema
x Thumb sign: Epiglottitis
x Upper triangle sign: Right lower
lobe collapse
x Retrocardiac triangle: Left lower
lobe collapse
x Luftsichel sign: Left upper lobe
collapse
x Golden S sign: right upper lobe
collapse
x Vanishing lung disease: SLE
x Collar sign: Diaphragmatic hernia
x Thickened crus sign: Rupture
diaphragm
x Egg shell calcification:
Sarcoidosis, Silicosis
x Popcorn calcification: Pulmonary
hamartoma
A unit
i of
of TEN PVT. LTD
LTT
x Meniscus sign: Hydatid cyst
E. GIT
x Hampton’s line: Benign gastric
ulcer
x Carman’s meniscus sign: Malignant
gastric ulcer
x Target sign: Leiomyoma of stomach

36 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018

x Whirlpool sign: Midgut volvulus x Langerhans cell :First line of
x Hat sign: Polyps immunity in skin
x Accordion sign: Pseudo :These are dendritic cells :Contain
membranous colitis Birbeck granules
x Napkin ring lesion/ Apple core :These are APC of skin(antigen
lesion: CA colon presenting cells)
x Thumb printing sign: Angiogram- : Derived from bone marrow
Fibromuscular dysplasia, ERCP-
C/C Pancreatitis, Plain X-ray- II. BULLOUS DISEASES
small bowel obstruction A. Intra corneal bullae
x Bird of prey sign/ whirl sign/ x Miliariacrystallina

I
coffee bean sign: Sigmoid volvulus x Bullous impetigo
x Gas less abdomen: A/C x SSSS
x Pemphigus foliaceus

C
Pancreatitis
x Comb sign: Crohn’s disease B. Intra epidermal bullae
x Bowel in bowel appearance: x Frictional bullae
Intussusception x Insect bite reaction
A unit
i of
of TEN PVT. LTD
LTT

M
x Chain of lakes appearance in ERCP: x 1st degree burns
C/C Pancreatitis x Herpes simplex and Herpes Zoster

-
x Saw tooth appearance: x Prickly heat(Miliariarubra)
Diverticulosis C. Immuno bullous diseases with intra

S
x Fleischner’s sign/ string sign/ epidermal bullae
Stellate sign/ Pulled up caecum: x Pemphigus group
Ileocecal TB -P.vulgaris,vegetans,foliaceus
-Fogoselvagum(Brazilian PF)

M
x Sausage pancreas: Autoimmune
Pancreatitis -Paraneoplastic pemphigus
x Colon cut off sign: A/c -Pemphigus herpetiformis

A
Pancreatitis -Hailey-Hailey disease(Benign
familial pemphigus)

I
x Lead pipe colon: Ulcerative colitis
D. Immunobullous diseases with
x Triangular cord sign: Biliary
subepidermal bullae
atresia

D
x Pemphigoid group
x Single bubbled sign: CHPS
-Bullous pemphigoid
x Double bubble sign: Duodenal -Cicatricalpemphigoid
atresia
x Dermatitis herpetiformis
x Triple bubble sign: Jejunal atresia
x Herpes gestationis
x Starry sky appearance of Liver:
x Epidermolysisbullosa and many
massive liver necrosis (Hepatitis)
others
x Central dot sign: Caroli’s disease III. IMPORTANT HYPOPIGMENTED PATCHES
x Floating water lilly/ Camelotte A. Naevusanemicus
sign: Hydatid cyst x Developmental and present ate
Dermatology birth
I. LAYERS AND CELLS OF EPIDERMIS
x Unilateral and usually on trunk
A. Layers of Epidermis
x Fails to develop erythema on
x Stratum basale
massaging
x Stratum spinosum B. Naevusachromcius
x Stratum granulosum x Congenital
x Stratumlucidum x Unilateral
x Stratumcorneum x Develop erythema on massaging
B. Cells of Epidermis C. Piebaldism
x Keratinocytes : Principal cells of x Congenital
epidermis
x Remain unchanged throughout life
: Produces keratin
:Contain Odland bodies x Bilateral
D. Albinism
:Important role in Immune function A unit
i of
of TEN PVT. LTD
LTT
x Present at birth(AR)
of skin
x Melanocytes :Protect skin from x Hypo pigmented skin and hair
UV rays x Melanin synthesis is absent due to
:Contain melanosomes deficiency of Tyrosinase
and produce melanin x No response to treatment
:Present in Stratum E. Vitiligo
basale x Usually not present at birth

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 37

 TARGET DEC. 2018

x Hypo/Depigmentedmacules with Microsporum
leucotrichia -Favus and Black dot-Trichophyton
x Melanocytes are absent -M.Canis is the MCC
x Shows Koebner’s phenomenon -Diagnosis by KOH mounts
x Best treatment is PUVA -DOC is oral Griseofulvin
IV. SCALES AND PUSTULES x Tineaunguium
A. Scales -MCC is T.rubrum
x Silvery white-Psoriasis -Treatment is oral
Teribinafine,Topicalciclopirox
x Greasy scales-Seborrhoeic
dermatitis x Tineapedis
-MCC is T.rubrum
x Collarette of scales-
-MC type in Athlete’s foot(Inter
Pityriasisrosea
digital type)
x Centrally adherent mica like
x Tineacruris(Dhobi’s Itch)
scales-
-MCC is T.rubrum
Pityriasislichenoideschronica
B. Pustules x TineaCorporis

I
-MCC is T.rubrum
A unitx Subcorneal pustule-Impetigo
i of
of TEN PVT. LTD
LTT VIII. ALOPECIA
x Pautrier micro abscess-Mycosis A. Cicatricial

C
fungoides
x Pseudo pelade
x Munro’s micro abscess-Psoriasis
x Follicular Lichen planus
x Papillary tip micro abscess-
x Sarcoidosis

M
Dernatitisherpetiformis
x Favus and Kerion(T.capitis)
x Kogoj spongiform pustule-
Pustular psoriasis x SLE-DLE

-
V. PALPABLE PURPURA B. Non-cicatricial
A. Vasculitis x Pelade(alopecia areata)
x Telogen effluvium (After 3 months

S
x HSP
x PAN,Microscopic polyangitis of stress)
x Cryoglobulinemia x Anagen effluvium(within 2-4 wks of
stress)

M
x Churg-Straus syndrome
x Androgenic alopecia
x Rheumatic vasculitis
x Black dot and Grey patch(T.capitis)
x Wegener’s granulomatosis

A
x SLE
x Waldenstorm’smacroglobulinemia
IX. KOEBNER PHENOMENON-TYPES

I
B. Infections
x True:Psoriasis,Lichenplanus,Vitilig
x Ecthymagagrenousum
o
x Meningoccemia and Disseminated

D
Gonococcal infection
x RMSF
VI. ERYTHEMA NODOSUM
x Tender non ulcerating
erythematous nodules that
appears more commonly on
extensor aspect of legs.
x Causes
-Rheumatological diseases like SLE
-Autoimmune conditions
-IBD
-Pregnancy
-Infections-Group A streptococci
,salmonella,Leprosy,Tuberculosis
-Drugs-Penicillin, Sulfonamides
VII. DERMATOPHYTOSIS
x Infection of skin by Dermatophytes
x Trichophyton-Infects skin,hair and
nail
x Microsporum-Infects skin and hair
only
x Epidermophyton-Infect skin and
nail only
Diseases
x Tineacapitis
-Grey patch and kerion-
P 38
38 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
x Pseudo:Warts
,Molluscumcontagiosum
x Reverse:Postinjuries,Granulomaan
nulare
X. SPECIAL POINTS IN LEPROSY
x MC involved structure in Male
GS:Testes
x MC involved structure in Female
GS:Ovary
x MC cranial nerve involved :Facial
nerve
x MC nerve abscess: Ulnar nerve
x 1st sensation lost:Temperature
x Sensation spared: Position and
vibration
x Systems spared: CNS and uterus
Lepra Reaction
A. Type-I
A unit
i of
of TEN PVT. LTD
LTT
x Occurs in BL & BL
x Type IV hypersensitivity
x Rx-Analgesics,steroids
B. Type-II
x Occur in LL
x Type III hypersensitivity
x Gold standard Rx-Thalidomide
 TARGET DEC. 2018

Now DOC-Steroids
x x Type III hypersensitivity
C. Type III x Rx in Exchange transfusion.
x Also called Lucio phenomenon
XI. SEXUALLY TRANSMITTED DISEASES

Features Syphilis Chancroid LGV Donovanosis Herpes

Genitals
Organism Treponema H.ducrei Chlamydia Calymmatobacteri HSV-II
pallidum trachomatis umgranulomatis
Ulcer Single Painful ulcer Evanescent,herpeti Indolent Tender

I
painless form painless painless,ulcer superficial
ulcer with ulcer at with friable beefy ulcer
Indurated inoculation site red

C
base granulomatous
base
LN Generalised Tender Painful ingunal Pseudobubo:sub Tender firm
A unit
i Lymphadeno
of
of TEN PVT. LTT
LTD

M
Lymphadeno inguinal and femoral cutaneous Lymph
pathy pathy lymphadenopa lymphnodes((Groov nodules in nodes
thy(Inflammat e sign) inguinal area

-
ory bubo)

S
Diagnosis FTA-ABS or Gram negative CFT/PCR Donovan bodies Tzcank
TPHA Anaerobic smear
bacteria
Rx Penicillin AZM-1 gm or Doxy 100 mg or Doxy 100 mg or Acyclovir

M
Ceftriaxone Erythromycin 500 AZM/Erythromyci
250 mg mg n

A
XII. TUBERCULOSIS OF SKIN x Emotional – palms, soles, axilla

I
A. Primary: In non-sensitized individuals E. Disorders
: Tuberculous chancre x Bromhidrosis – foul smell
B. Secondary: In sensitized individuals

D
(Apocrine) + hyperhidrosis
:Lupus vulgaris(MC in adult) x Osmidrosis – Foul smell (apocrine)
:Scrofuloderma(MC in children x Fox Fordyce disease (Apocrine)
in India)
x Hidradenitissuppurativa ( Apocrine)
:Tuberculosis verrucosa cutis
:Tuberculosis Cutis orificalis x Hyperthydrosis/ Anhydrosis (
C. Secondary:In sensitized individuals ecrine)
: Lupus vulgaris(MC in adult) x Miliaria ( Eccrine)
D. Tuberculids: HSN reaction XIV. NAIL ABNORMALITIES
:Lichen Scrofulosorum x Coilonychia : Iron def. anemia
:Erythema nodosum x Racquet nail : Brachyonychia
:Papulonecotictuberculid x Anonychia : Lichen planus
XIII. SWEAT GLAND x Beau’s line : Viral illness (HFMD,
A. ECCRINE Measles)
x Common sweat glands x Trachonychia (sand paper nail) :
x Maximum in soles Canaliform dystrophy of haller
x Least on back of trunk x Pterygium : Lichen planus
x First appear over palms and soles x Onycholysis : Psoriasis, reiter’s
B. APOCRINE syndrome
x Axilla,Perineum,Nipple x Onychoptosisdefluvium ( Alopecia
Periumbilical unguim): Alopecia areata
x Ceruminous glands (auditory x Koenen’speriungual fibroma:
meatus) Tuberous sclerosis
x Moll’s glands (eyelids) x Mees line : Arsenic / thalium
x Mammary gland A unit
i of
of TEN PVT. LTD
poisoning LTT
C. APO – ECCRINE x Pitting : Psoriasis, atopic
x In axilla dermatisis, alopecia areata
D. Regulation x Muehreke’s line :Hypoalbumiuemia
x Pre –optic hypothalamic area x Terry’s nail : Cirrhosis
x Hypothalamic temp. strongest x White nail : Cirrhosis
stimulus

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 39

 TARGET DEC. 2018

x Half – half nail : CRF (Chronic
renal failure)
x Yellow nail : Bronchiectasis /
pulmonary embolism C/C
bronchitis
x Green nail syndrome : Pseudomonas
XV. DRUG INDUCED PIGMENTATION
x Arsenic : Rain drop pigmentation
(brown)
x Amiodarone: Purple colouration
x Busulfan/ Bleomycin: Generalised
x Clofazimine: Orange
x Minocycline: Blue black
x Tetracycline: Yellow
x OCP : Melasma / Chloasma
Giant condyloma late or : HPV – 6 >
HPV – 11
Verrucous carcinoma
A. HPV MALIGNANCY
x Bowenoidpapullosis : HPV – 16
x Penile CA : HPV – 16 > 18
Cervical CA : HPV -16 > HPV -18
Anal CA : HPV – 16 > 18
B. WARTS –Rx
x Condylomaacuminata: Podophyllin
LA (TOC)
x Condyloma acuminate in pregnancy
: Cryotherapy (TOC)
Trichloroacetic acid LA (1st DOC)
Imiquimod LA ( 2nd DOC)
x Buschke – Lowenstein tumor:

I
(pregnancy also)
Cryosurgery
XVI. A unit
i of
of TEN PVT. LTD
LTT
DRUGS EXACERBATING PSORIASIS
x Antimalarials (Chloroquine) PSYCHIATRY

C
x -Blockers i. TYPES OF PERSONALITY
x Lithium A. Cluster – A (Odd and eccentric)
x NSAIDs x Schizoid

M
XVII. TREATMENT OF PSORIASIS - withdrawal type of behavior
x Plaque type : PUVA x Schizotypal
x Pustular

-
-odd belivers
x Psoriatic erythroderma Retinodis x Paranoid
with or w/o PUVA 2nd choice is Mtx -pervasive distrust and suspicious of

S
x AIDS &Psoriasi others
x Psoriatic arthropathy: Excessive self importance and bears
methotrexate grudges persistently

M
x Impetigo herpetiformis B. Cluster - B (dramatic, erratic and
Or Systemic steroids emotional)
x Psoriasis in pregnancy x Borderline

A
XVIII. DIRECT IMMUNOFLUORESCENCE -unstable self, affect and
relationships

I
x Fish net/ basket weave pattern
o IgG and C3 deposition -repeated suicidal threats and
intercellularly; Pemphigus attempts

D
o Linear IgG deposits in BM (Dermo – x Histrionic
epidermal jn): Bullous pemphigoid -excessive emotionality and attention
o Granular IgA deposits in dermal seeking
papillae: Dermatitis herpetiformis x Anti social
o IgA deposits in post – capillary -violation of rights of others without
venules in skin / kidney/ intestine; guilt feel
HSP x Narcissistic
o Linear IgA deposits along epidermal -extreme concern about self.
BM: Linear IgA disease C. Cluster – C (anxious and fearful)
XIX. HPV and WARTS x Obsessive compulsive (Anankastic)
x Common warts/ verruca vulgaris : Ͳ Inhibited by perfectionism
HPV – 2 (Most common type) Ͳ High moral standards and
x Deep palmar/ plantar warts ( preoccupied rules
myrmecia) : HPV – 1 x Dependant
x Mosaic wart : HPV- 2 Ͳ Depend on others for everything
x Plane wart ( verruca plana) : HPV x Anxious
–3 Ͳ Highly anxious about every
x Epidermodysplasiaverruciformis instance.
: HPV – 5 > HPV – 8 ii. SYNSROMES IN PSYCHIATRY
x Laryngeal papilloma: HPV – 6 > HPV
A unit
i of
of TEN PVT. LTD
LTT
A. Gastaut geschwind syndrome
-11 x Characterized by circumstantiality,
x Anogenital wart/ hyperphagia, hyposexulality and
Condylomaaccuminatal / venereal epilepsy
wart: HPV – 6 >HPV-11 B. Ganser syndrome
x Butcher’s wart : HPV - 7 x Also called hysterical
x Buschke- Lowenstein tumor or pseudodementria

40 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018
x Characterized by approximate and x Mixture of different words without
near miss answer meaning
(paralogia/varbeireden) x Seen in schizophrenia
x Seen in jail inmates F. Perseveration
C. Rabbit syndrome x seen in schizophrenia, cognitive
x Perioral parkinsonian symptoms but disorders
tongue is spared G. neologism
x Px is anticholinergics x use of new meaningless words
(trihexiphenedyl) x characteristic of psychosis
D. Tourette syndrome H. paraphrasia
x A type of tic disorder x one word is substituted by another

I
x 1 vocal tie + 1 motor tic abnormal word during speech
iii. SCIENTISTS IS PSYCHIATRY\ x we will not get the meaning (Treen for

C
x George engel: biopsychosocial model train)
of disease x seen in organic aphasia, schizophrenia
x Eugene bleuler: fundamental I. pressured speech
symptoms of schizophrenia, coined the
A unit
i of
of TEN PVT. LTD
LTT x rapid, loud and accelerated speech

M
term ambivalence x characteristic of mania.
x Carpenter: idea of deficit Anesthesiology

-
schiozophrenia 1. BREATHING CIRCUIT
x TJ crow: Type-I and II Schizophrenia A. Open circuits

S
x Seligman: Lerned helplessness theory x Ether
x Emil Durkhiem: Sociological theory of x Chloroform gauze
suicide x Schimmelbusch mask
x Karl meningar: Psychological theory B. Semi closed circuits

M
of suicide x Mapleson system A TO F
x Anna Fraued: child psychoanalysis, x Partial rebreathing

A
Ego psychology, Defence mechanism C. Closed circuits
x Jean piaget: cognitive development

I
x Using CO2reabosrbants
stage of children x Complete rebreathing
iv. ACRO/AEROPHOBIA: FEAR OF HEIGHT D. Mapleson A

D
x Algophobia: Fear of pain
x Ailurophobia: Fear of cats
x Cynophobia: Fear of dogs
x Agoraphobia: Fear of being alone and
away from home
x Claustrophobia: Fear of closed spaces
x Phrophobia: Fear of fire
x Sitophobia: Fear of eating E. Mapleson –D
x Thanatophobia: Fear of death
x Xenophobia: Fear of strangers
x Zoophobia: Fear of animals
v. LANGUAGE DISORDERS
A. Mutism
x Conscious and alert but will not talk
x Seen in melancholia, catatonia,
negativism etc.
B. Coprolalia F. Mapleson-E
x Involuntary use of valgar/ obscene
language G. Mapleson -F
x Seen in schizophrenia, tourette
syndrome
C. Echolalia
x Repetition of words
x Seen in schizophrenia, childhood
autism
D. Verbigeration
x Use of meaningless and stereotyped
repetition of words or phrases
x Expressive aphasia, schrenia
E. Word salad
x Example is Magill-Lack circuit
x An example for Co-axial circuit
x Best for spontaneous ventilation
x 1time minute ventilation in
spontaneous ventilation
x 3time minute ventilation in controlled
ventilation(not suited)
x Example is Bain circuit
x Best for controlled ventilation
x 2.5 times minute ventilation in
controlled ventilation
x Not useful for spontaneous
ventilation
x Pethick test is used to check inner
tube patency
x Example is Ayres t-piece
x Jackson-Reese modification of ‘E’ type
x Suitable for both spontaneous &
controlled ventilation
x 2.5-3 times minute ventilation
A unit
i of
of TEN PVT. LTD
x Best for pediatrics
LTT
E. Mapleson-C
x In post-operative recovery room
F.Co2 absorbents
x Soda lime
-94% Ca(OH)2,5% NaOH,1% KOH

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 41

 TARGET DEC. 2018
-Silica is used to harden soda x Maximum Ganglionic Block:d-TC
lime x Maximum Histamine release: d-
-Ethyl violet is used as indicator TC
x Bara lime x Maximum Vagolysis:Gallamine
-80% Ca(OH)2,20 % Ba(OH)2 x Maximum Renal S/E:Gallamine
-Water is used to harden x CI in pregnancy:Gallamine
-Ethyl violet is used as indicator
x Choice in pregnancy:d-TC
II.CYINDER COLOUR & PIN INDEX
A. Cylinder colour x Longest acting:Pipecuronium
x Helium:Brown x Shortest:Ganta>Mivacurium
x Oxygen:Black with white x Most Potent:Doxacurium
shoulder x Least potent:Gallamine
x CO2:Grey x CI in Eye injury/Myopahy:Sch
x N2O:Blue D. Volatile agent with minimum malignant
hyperthermia MH:N2O
x Entonox:Blue body with blue &
E. Volatile agent in transplant
white shoulder

I
Sx:Xenon(Ideal)
A unit
i ofx Cyclopropane:Orange
of TEN PVT. LTD
LTT F. Volatile ipungent smell:Fluranes except
B. Pin Index Sevo,Ether

C
x Air:1,5 G. Induction agent
x O2:2,5 x Fastest :Thiopentone
x N2O:3,5 x In CKD:Propofol

M
x CO2>7.5:1,6 x In poor CVS
x Co2< 7.5 : 2,6 Score:Opioids>Etomidate
x Cyclopropane : 3,6

-
x Pheochromocytoma:Opioids
x Entonox : 7 x CI in
III.ANAESTHETIC AGENT OF CHOICE AIP:Thiopentone/Etomidate

S
A. Daycare Sx x Choice in MH(Malignant
x Anesthetic : Propofol Hyperthermia)/
x MR:Miva>Cisatra>Atra curium AIP(Acute Intermittent

M
x Volatile agent: Des Porphyria):Propofol
>Sevo>Isoflurane x Total IV
x Analgesic:Alfentanyl>Remifentany anesthesia:Ketamine>propofol

IA
l x Hypotension/Asthma:Ketamine
x Narcotic: Midazolam x Hypotension i head
B. Volatile agent Injury:Ketamine
x Neurosurgrey: Isoflurane x Producing Green

D
x Myasthenia: Isoflurane urine:Propofol
x Children:Sevoflurane x With Max analgesia:Ketamine
x Renal disease: Des>Sevo>Iso H. Agent of choice in
x Cardiac disease:Des>Sevo>Iso x R To L shunt(CCHD):Ketamine
x Liver disease: Sevo>Iso>Des x L To R
x Hypertension:Halothane shunt(ACCHD):Sevoflurane
x Manual removal of Placenta: I. IV agent in Hyperthyroidism:Thiopentone
Halothane x Hypothyroidism: Ketamine
x Safest:Ether J. Local Anesthetics
x With maximum MR:Ether x Shortest:Chlorprocaine
x With maximum Analgesia:N2O x Longest:Dibucaine
x Sweet smell:N2O/Sevoflurane x SAB for LSCS:Bupivacaine
x Maximum x Epidural analgesic:Ropivacaine
MAC:N2O(104)>Xe>Desflurane x Highest binding ɲ1-
x Maximum blood gas partition co- GP:Bupivacaine
efficient:Methoxyflurane x Safest:Prilocaine
x Minimum BGP co-efficient:Des x Methemoglobinemia
(0.42)<N2O<Sevoflurane (0.69) A unitproducing:Prilocaine
i of
of TEN PVT. LTD
LTT
C. MR x IVRA:Prilocaine
x Hypotension: Pancuronium x Natural & 1st used:Cocaine
x Asthma:Vecuronium x 1stSynthetic: Procaine
x Cardiac disease:Vecuronium x Choice in
x Critically Malignanthyperthermia:
ill/CLD/CKD:Ciatra>Atracuriu Procaine
m x CI intradurally:Chlorprocaine

42 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018

x CI IVRA:Bupivacaine Ͳ Blisters are formed and are
x CI AIP: Ropivacaine painful
x CI i Ͳ Heals without scarring in 1-2
Halothane/Epinephrine:Cocain weeks
e x Deep
x EMLA cream:5% Prilocaine+ Ͳ Involves epidermis and deeper
Lidocaine layers of dermis
x Vasoconstricting :Cocaine Ͳ Mottled pink-white colour
x CI Ͳ Blisters may be seen or not
topically:Procaine/Bupi/Mepiv Ͳ Blanching usually absent
Ͳ Pain is absent but pin prick

I
acaine
xWith Allergy:Esteric LA sensation present
SURGERY Ͳ Heals with scarring in 1-2 months

C
I. BLOOD AND BLOOD COMPONENTS C. 3rd degree (Full thickness burns)
A. Whole Blood x Extends into all the layers of
x 350 ml contains 49 ml dermis
A unit
i of
of TEN PVT. LTD
LTT

M
anticoagulant x Hard black leathery eschar
x Stored at 1-60 C present
x Shelf life is 28 days with CPD and x Painless and pin prick sensation

-
35 days with CPD-A lost
x 1 transfusion will correct x No capillary blanching

S
haemoglobin by 1 gm/dl x Heals by wound contracture or
B. Packed RBC grafting
x Stored at 1-60C D. 4th degree

M
x Shelf life is 42 days x Involves all layers of skin as
x 10 transfusion will correct well as deeper tissues
haemoglobin by 3 gm/dl x Heals by reconstruction

A
C. Leukocyte reduced RBC procedures only
III. NIPPLE DISCHARGE

I
x Less number of WBC
x Stored at 1-60C A. Discharge from skin surface of nipple
x Shelf life is 24 hrs x Paget’s disease of nipple

D
D. Platelets x Skin diseases like eczema
x Stored at 20-240C B. Discharge from a single duct
x Shelf life is 5 days x Serous
x 10 transfusion will correct Ͳ Duct ectasia
platelets by 5000-10000 Ͳ Fibrocystic disease (Greenish)
E. FFP Ͳ Carcinoma
x Contains plasma, plasma proteins x Blood stained
and all coagulation factors Ͳ Intraductal papilloma
x Stored at <-300C Ͳ Duct ectasia
x Shelf life is 1 year Ͳ Carcinoma
F. Cryoprecipitate C. Discharge from multiple ducts
x Contains Fibrinogen, factors – VIII x Serous
and XIII Ͳ Duct ectasia
x Stored at <-300C Ͳ Fibrocystic disease
x Shelf life is 1 year Ͳ Carcinoma
G. Albumin x Blood stained
x Stored at room temperature Ͳ Duct ectasia
x Shelf life is 3 years Ͳ Carcinoma
II. DEGREES OF BURNS x Purulent
A. 1st degree Ͳ Abscess
x Involves only epidermis x Milk
x Erythematous and do not Ͳ Lactation
blister Ͳ Hypothyroidism
IV.
A unit
i of
of TEN PVT. LTD
MEDIASTINAL MASS
LTT
x Blanch on touch and are
painful x MC mediastinal mass:
x Heal without scarring in 1 week Neurogenic tumours
B. 2nd degree (Partial thickness burn) x MC anterior mediastinal mass:
x Superficial Thymoma
Ͳ Epidermis and superficial dermis x MC posterior mediastinal mass:
only Neurogenic tumours

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 43

 TARGET DEC. 2018
x MC middle mediastinal mass: x CA Breast
Bronchogenic cysts x Medulloblastoma
x MC mediastinal mass in x Teratoma
children: Neurogenic tumours C. Resistant
x MC malignant mediastinal mass: x CA rectum
Lymphoma x SCC lung
V. THYROID MALIGNANCY x CA bladder
x Most common: Papillary CA x CA cervix
x Least common: Lymphoma x Soft tissue sarcoma
x Most malignant: Anaplastic CA D. Highly resistant
x Least malignant: Papillary CA x Osteosarcoma
x Most common after radiation: x Melanoma
Papillary CA x CA Pancreas
x Most common in long standing IX. GASTRIC ULCERS
MNG: Follicular CA A. Types

I
x Associated with Amyloidosis: x Type I
A unit
i of
of TEN PVT. LTD
LTT
Medullary CA Ͳ Most common type
x Associated with dystrophic Ͳ Located in lesser curvature near

C
calcification: Papillary CA incisuraangularis
x Associated with Psammoma bodies: Ͳ Associated with decreased gastric
Papillary CA secretion

M
x Associated with MEN syndrome: x Type II
Medullary CA Ͳ Gastric ulcer along with duodenal

-
x Derived from ‘C’ cells: Medullary ulcer
CA Ͳ Associated with increased gastric
VI. NECK NODE STAGING secretion

S
x Nx: Unable to assess x Type III
x No: No evidence of LN mets Ͳ Located in prepyloric region
x N1: Single I/L lymph node <3 cm Ͳ Associated with increased gastric

M
x N2a: Single I/L Lymph node 3-6 cm secretion
x N2b: Multiple I/L Lymph nodes <6 x Type IV
cm Ͳ Located on lesser curvature in

A
x N2c: B/L or C/L Lymph nodes <6cm proximal stomach

I
x N3: Ktnog bides > 6cm Ͳ Associated with decreased gastric
VII. SALIVARY GLAND TUMOURS secretion
x MC major salivary gland tumour: B. Complications

D
Benign x GI bleed
x MC type of major salivary gland Ͳ MC complication
tumour: Pleomorphic adenoma Ͳ More common in duodenal ulcers
x MC site of Pleomorphic adenoma: especially posterior duodenal
Tail of Parotid ulcers
x MC minor salivary gland tumour: x Perforation
Malignant Ͳ 2nd MC complication
x MC Parotid tumour: Pleomorphic Ͳ More common in anterior duodenal
adenoma ulcers
x 2nd MC parotid tumour: x Outlet obstruction
Warthin’stumour Ͳ Least common complication
x MC malignant tumour of salivary Ͳ More common with duodenal
gland: Mucoepidermoid CA ulcers
x Tumour which is Neurotropic: x Hour glass stomach
Adenoid cystic CA Ͳ Due to cicatricial contraction at
VIII. RADIOSENSITIVITY OF TUMOUR ulcer site
A. Highly sensitive x Tea pot stomach
x Lymphoma Ͳ Longitudinal shortening due to
x Ewing’s tumour
A unit
i of
of TEN PVT. LTD
cicatrisation LTT
x Seminoma C. MC arterial bleeds in ulcers
x Myeloma x Duodenal ulcer: Gastro
x Wilm’s tumour duodenal artery
B. Moderately sensitive x Gastric Ulcer (all sites
x SCLC together): Splenic artery
x BCC

44 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018
x Gastric ulcer in body: Splenic Ͳ Inappropriate words -3
artery Ͳ Inappropriate sounds -2
x GU in greater curvature Ͳ None -1
distally: Right gastroepiploic x Motor response
x GU in greater curvature Ͳ Obeys commands -6
proximally: Left gastro epiploic Ͳ Localises pain -5
x GU in lesser curvature: Left Ͳ Withdrawal to pain -4
and Right gastric arteries Ͳ Flexion to pain -3
X. SCORING SYSTEMS Ͳ Extension to pain -2
A/C PANCREATITIS Ͳ None -1
A. Ranson’s scoring XI. COMMON SITES AFFECTED

I
x At admission (Code is ASALT) x CA oral cavity : Lateral tongue
Ͳ Age (Developed countries)

C
Ͳ Sugar (Blood sugar) Gingivobuccal sulcus (India)
Ͳ AST (SGOT) x CA Esophagus: Middle 1/3rd
Ͳ LDH x CA stomach: Antrum
Ͳ TC (Total count)
A unit
i of
of TEN PVT. LTD
LTT

M
x CA small intestine : Duodenum
x After 48 hrs (Code is BUF OCP) x Ca Colon: Rectum >Digmoid
Ͳ Base deficit x Gastric ulcer : Lesser curvature

-
Ͳ Bun near incisuraangularis
Ͳ Fluid loss x Duodenal ulcer : D1

S
Ͳ Oxygel level x Peptic ulcer : D1
Ͳ Calcium x PeutzJegar’sployp: Jejunum
Ͳ PCV x GIST : Stomach
B. Glasgow Scoring (Think: PANCREAS)

M
x SI GIST : Ileum
x Po2
x Typhoid ulcer : Terminal ileum
x Age
x TB ulcer : Terminal ileum

A
x Neutrophilia
x Crohn’s disease : Terminal ileum

I
x Calcium
x Gall stone ileus: Terminal ileum
x Renal function (urea)
x Meconium ileus: Terminal ileum
x Enzymes (ALT, LDH)
x Bleeding in Angiodysplasia: Right

D
x Albumin colon
x Sugar x Polyps in GIT: Colon
C. Atlanta criteria
x Diverticula: Sigmoid
x Organ failure
x Volvulus: Sigmoid
x Local complications
x Ulcerative colitis: Rectum
x Systemic complications
x Hirsch sprung’s disease: Rectum
D. CT scoring
x Carcinoid tumour: Ileum > Appendix
x Pancreatic inflammation
XII. RENAL CALCULI
x Pancreatic necrosis A. Types
LIVER DISEASES
x Calcium oxalate
A. Child-Pugh scoring
Ͳ Most common
x S. Albumin
Ͳ Small and Hard
x S. Bilirubin
Ͳ Radio opaque
x Ascites
x Uric acid
x Encephalopathy Ͳ Radio lucent
x PT/INR Ͳ Maximum sensitive to ESWL
B. MELD scoring
x Phosphate (Triple
x S. Bilirubin Phosphate/Struvite stone)
x S. creatinine Ͳ Formed in alkaline urine
x PT/INR Ͳ Associated with proteus infection
NEUROTRAUMA Ͳ Forms staghorn calculus
A. Glasgow Coma Scale (GCS)
x Cysteine stones
x Eye opening A unit
i of
of TEN PVT. LTD
Ͳ Seen in cystinuriaLTT
Ͳ Spontaneous – 4 Ͳ Seen in acidic urine
Ͳ To call -3 Ͳ Very hard
Ͳ To pain -2 Ͳ Resistant to ESWL
Ͳ None -1 Ͳ Radiolucent
x Eye opening x Indinavir stones
Ͳ Oriented -5 Ͳ Radiolucent
Ͳ Confused -4

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 45

 TARGET DEC. 2018

x Triamterene stones x Miscellaneous
Ͳ Radiolucent Ͳ Adenoma
x Sites of Stone and Pain Ͳ Carcinoid
Ͳ Stone at PUJ: Pain radiates to XIV. CA BREAST – STAGING
testes x To : No evidence of primary
Ͳ Stone at middle of ureter: Pain x Tis : Carcinoma in situ
radiated to McBurney’s point x T1: Tumour < 2 cm in greatest
Ͳ Stone at lower ureter and pelvic diameter
brim: Pain radiates to medial side of x T2: 2-5 cm
thigh and groin x T3: 5 cm
Ͳ Stone at intramural part of x T4: Fixed to chest wall (T4a) or
ureter: Pain as strangury skin (T4B)
x Treatment x T4C is T4A + T4B
Ͳ Renal stones < 2 cm: ESWL x T4d is inflammatory CA breast
Ͳ Renal stones > 2 cm: PCNL
x No: No lymph nodal involvemet
Ͳ Renal pelvis stone: Pyelo lithotomy

I
x N1: I/L fixed axillary nodes
Ͳ Upper ureteric stone : Open
A unit
i of
of TEN PVT. LTD
LTT
ureterostomy and Double “J” x N2: N2a –I/L fixed axillary nodes
stenting x N2b –I/L internal mammary

C
Ͳ Middle ureteric stone: nodes without axillary nodes
Ureteroscopic removal x N3: N3a- I/L infraclavicular
Ͳ Lower ureteric stone: node

M
Ureteroscopy and Dormiabasketing x N3b- I/L internal mammary nodes
Ͳ Bladder stone: Cystoscopy and with axillary nodes

-
removal x N3c- I/L supraclavicular nodes
XIII. TESTICULAR TUMOURS x Mo: No metastasis
A. Germ cell tumours (>90%) x M1: Distant metastasis present

S
x Seminomas (C/L breast and axillary node
x Non-seminomas also treated as mets)
Ͳ Embryonal cell CA A. Stage

M
Ͳ Endodermal sinus Tumour (Yolk sac x I – T1 NO MO
tumour) x IIa – TO N1 MO, T1 N1 MO, T2 NO MO
Ͳ Teratoma x IIb – T2 N1 MO, T3 NO MO

A
Ͳ Choriocarcinoma x IIIa – TO N2 MO, T1 N2 MO, T2 N2 MO, T3 N1

I
B. Others (<10%) MO, T3 N2 MO
x Sex cord Stromal tumours x IIIb– T4 NO MO, T4 N1 MO, T4 N2 MO
Ͳ Sertoli cell tumour x IIIc – Any TN3 MO

D
Ͳ Leydig cell tumour x IV – Any T Any N M1
Ͳ Granulosa cell tumour B. EBC: Stage I and II
Ͳ Theca cell tumour C. LABC: Stage III
Ͳ Fibroma D. Metastatic Breast CA: Stage IV
x Mixed tumour E. Bloom Richardson’s grading
Ͳ Gonadoblastoma x Based on Nuclear pleomorphism,
x Lymphoid and Hematopoietic Tubule formation and Mitotic index
tumours x Grade I: Well differentiated
Ͳ Leukemia x Grade II: Moderately
Ͳ Lymphoma differentiated
Ͳ Plasmacytoma x Grade III: Poorly differentiated
XV. CA THYROID-STAGING
< 45 years >45 years
Stage I Any T Any N MO T1 NO MO
Stage II Any T Any N M1 T2 T3 NO MO
Stage III ------- T4 NO MO and Any TN1 MO
Stage IV ------- Any T Any N M1
x T1: ” 1 cm x M1: Mets present
A unit
i of
of TEN PVT. LTD
LTT
x T2: 1-4 cm A. AMES scoring
x T3: > 4cm x A ĺ Age
x T4: Infiltration to adjacent x M ĺ Metastasis
structures x E ĺ Extent of primary
x No: No nodes x S ĺ Size
x N1: Nodes involved B. AGES scoring
x Mo: No mets x A ĺ Age
P 46
46 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
 TARGET DEC. 2018

x G ĺ Grade x T4ĺ Through serosa into adjacent
x E ĺ Extent organs
x S ĺ Size x Noĺ No nodes
XVI. CA STOMACH – STAGING x N1ĺ<3 nodes
A. Lauren’s Classification x N2ĺ>3 nodes
x Intestinal type (>50%) x M0ĺ No mets
x Diffuse type (30%) x M 1ĺ Mets present
x Mixed type D. Resections
B. Depending on Depth x R0ĺ N0 residual tumour after
x Early gastric cancer resection

I
Ͳ Only involving mucosa or x R1ĺ Microscopic residual tumour
submucosa irrespective of LN after resection
involvement x R2ĺ Macroscopic residual tumour

C
x Advanced gastric cancer after resection
Ͳ Involving muscular or serosa XVIII. MELANOMA – STAGING
C. Japanese classification of EGC A. Breslow’s thickness
A unit
i of
of TEN PVT. LTD
LTT

M
x Type I: Protruded x I: <0.75mm
x Type IIa: Superficial elevated x II: 0.76-105 mm

-
x Type IIb: Superficial flat x III: 1.51-4 mm
x Type IIc: Superficial depressed x IV: > 4mm
x Type III: Excavated B. Clark’s levels

S
D. Borrmann’s classification of AGC x I: Only in epidermis
(Advanced Gastric Cancer) x II: Extending into papillary
x Type I: True esophageal CA dermis

M
extending to GE junction x III: Filling papillary dermis
x Type II: True GE junction completely
carcinoma (within 2 cm) x IV: Extending into reticular

A
x Type III: CA proximal stomach dermis

I
extending to GE junction x V: Extending into subcutaneous
E. TNM staging XIX. NECK NODE STAGING
x T1: invasion of lamina Included in Topic VI

D
propria/submucosa
x T2: invasion of
muscularispropria/submucosa
x T3: Invasion of serosa
x T4: Invasion of adjacent structures
x N1: Nodes involved 1-6 number
x N2:Nodes involved 7-15 number
x N3: Nodes involved >15 number
x M1: Distant metastasis
XVII. CA COLON – STAGING
a. Modified Duke’s staging
x AÆ Tumour limited to rectal wall
x BÆ Extending to extra rectal
o B1Æ Invading muscularies
mucosa
o Invading serosa
x CÆ Lymph node involvement
x DÆ Distant metastasis
b. AstlerColler’s Staging
x AĺIntramucosal
x B1ĺ Into muscularispropria
x B2ĺ Through serosa
x C1ĺ B1 + LNs
x C2ĺ B2 + LNs
x D ĺ Distant metastasis
C. TNM staging
x T1ĺ Into mucosa and submucosa
x T2ĺ Into muscularispropria
x T3ĺ Into pericolic fat
HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
XX. NECK DISSECTION
A. Radical neck dissection
x Crile’s operation and Macafee
incision
x Remove I-V levels of LN, SCM,
Accessory nerve and Internal
jugular vein
x External carotid artery is
retained
B. Modified radical neck dissection
(MRND)
x REMOVE I-V levels of LN
x External carotid artery
retained
x MRND- I: IJV and SCM removed
but Accessory nerve retained
x MRND- II: Accessory nerve and
SCXM retained, but IJV is
removed
x MRND- III: Accessory nerve,
SCM and IJV are retained
C. Anterior neck dissection
x Removes level VI LN only
A unit
i of
of TEN PVT. LTD
LTT
D. Anterolateral neck dissection
x Remove level II, III and IV LN
E. Posterolateral neck dissection
x Remove level II, III, IV and V LN
F. Supra omohyoid neck dissection
x Remove level I, II and LN
XXI. SPECIAL HERNIAS
A. Radical neck dissection
47
 TARGET DEC. 2018
xBarth’s hernia: Between
abdominal wall and vitello
intestinal duct
x Beclard’s hernia: Femoral
hernia through saphenous
opening
x Berger’s hernia: Hernia in POD
x Cloquet’s hernia: Through
pectineal fascia
x Direct inguinal hernia:
Through Hesselbach’s triangle
x Femoral hernia: Medial to
femoral vein
x Grynfelt’s hernia: Through
upper lumbar triangle
x Gibbson’s hernia: Hernia with
A unit
i of
of TEN PVT. LTD
hydrocele LTT
x Holthouse’s hernia: Inguinal
hernia turned outward to
groin
x Hesselbach’s hernia: Lateral
to femoral artery
x Indirect inguinal hernia:
Through deep inguinal ring
x Laugier’s hernia: Through
lacunar ligament
S
x Little’s hernia: Hernia with
Appendix as content
x Littre’s hernia: Hernia with
M
Meckel’s diverticulum as
content
x Maydl’s hernia: Hernia with ‘W’
A
loop of intestine as content
I
x Mery’s hernia: Perineal hernia
x Narath’s hernia: Behind
femoral artery
D
x Obturator hernia: Through
obturator foramen
x Petit’s hernia: Through lower
lumbar triangle
x Phantom hernia: Local muscle
bulge due to paralysis
x Romberg hernia: Saddle hernia
x Richter’s hernia: A part of
circumference of bowel wall
as content
x Sciatic hernia: Through
greater or lesser sciatic
foramen
x Spigelian hernia: Through
spigelian point
x Sliding hernia: Posterior wall
of sac is formed by colon or
bladder
XXII. TRIADS AND TRIANGLES IN SURGERY
x Charcot’s triad: Pain, Fever,
Jaundice in cholangitis
x Hutchison’s triad: Notched
upper incisors, Interstitial
keratitis, SNHL in congenital
Syphilis
48 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
x Saint’s triad: Gall stone,
Diverticulosis, Hiatus hernia
x Virchow’s triad:
Hypercoagulability, stasis,
Endothelial injury
x Trotter’s triad: CHL, Palatal
palsy, Trigeminal neuralgia in
CA nasopharynx
x Triad of wilm’s tumour: Pain
Hematuria, Flank mass
x Whipple’s triad: Symptoms of
hypoglycaemia, Blood sugar <
45mg/dl, symptoms relieved by
glucose intake in Insulinoma
x Raynold’s pentad: Pain, Fever,
I
Jaundice, Altered sensorium,
shock in Ascending cholangitis
x Murphy’s triad: Pain, Fever,
C
Vomiting in A/C Appendicitis
x Triangle of Doom: Bounded by
spermatic vessels, Iliac vessels
M
and Vas deferens
x MC injury at this site is injury
to iliac vessels in Lap. Hernia
-
repair
x Triangle of Pain: Bounded by
Spermatic vessels, Iliac vessels
and Edge of skin incision
x MC injured at this site is LCN of
thigh
x Circle of death: Inferior
epigastric artery and vein get
injured in hernia repair
x Disaster of Trapezoid: Injury to
spermatic vessels, Iliac vessels
and LCN of thigh in hernia
repair
x Bouchardt’s triad: Epigastric
pain, violent vomiting and
Inability to pass NG tube in
Gastric volvulus
x Mackler’s triad: Vomiting,
chest pain and subcutaneous
emphysema in Boerhavve’s
syndrome
x Triad of Sandblom: Pain,
Jaundice and Malena in
Hemobila.
x Galeazzi triad: Dupytren’s
contracture, Rp fibrosis and
Peyronie’s disease
XXIII. SIGNS AND SYNDROMES IN SURGERY
x Bowler’s hat sign/Mexican hat
sign/ Double ring sign: Gastric
polyp, Intestinal polyp,
A unit
i of
of TEN PVT. LTD
Diverticulum
LTT
x Bald fundus sign/ H-Bomb sign:
Atrophic gastritis
x Bird prey sign/ Coffee bean
sign: Sigmoid volvulus
x Carman’s sign: Malignant
gastric ulcer in Ba meal
 TARGET DEC. 2018
x Chiladiti’s sign: Colon between x Stierlin sign: TB caecum/TB
liver and diaphragm colon
x Coiled spring sign: x String of Kantor sign: Crohn’s
Intussusception (MC), disease
Appendicitis, Mucocele of x Murphy’s sign: Cholecystitis
Appendix, Hematoma of x Trehan’s sign: Pain in scrotum
duodenum, Intestinal decreases on lifting in A/C
carcinoma Epididymoorchitis
x Cole’s sign: Chronic duodenal Syndromes
ulcer x Nut Cracker syndrome: SMA
x Colon cut off sign: A/C compress Left renal vein

I
pancreatitis x Wilkie’s syndrome: SMA
x Frostberg’s sign: CA head of obstructs 3rd part of duodenum
pancreas

C
x Youssef syndrome:
x Handek’s sign: Gastric ulcer Uterovesical fistula
x Medusa lock sign: Round worm secondary to trauma
in intestine x Nurses syndrome: Mesenteric
A unit
i of
of TEN PVT. LTD
LTT

M
x Omega sign: Sigmoid volvulus lymphadenitis
XXIV. INVESTIGATION OF CHOICE IN SURGERY

-
Disease IOC
AAA (ABDOMINAL aortic aneurysm) CECT
Small para aortic LN CT scan

S
Parotid FNAC (Imaging –MRI)
Lung sequestration CT scan
DVT Duplex

M
Accurate for DVT Fibrinogen TC99 scan
Lymphoedema Lymphoscintigraphy
Bladder rupture Retrograde cystogram

A
Zenker’s diverticulum Ba swallow lateral view

I
Esophageal perforation Thin Ba
GERD 24 hr pH monitoring
Esophageal Motility disorders Eso. Manometry

D
Barrett/CaEsophagus Endoscopy I Bx
Diaphragmatic rupture CECT
Gastric Volvulus/ Hiatus hernia/ Hour Ba meal
glass stomach
Linitis plastic EUS>Ba meal
CHPS USG
ZES (Zollinger Ellison) Gastric acid studies
H pylori Bx and staining (IOC)
Most specific Bx and culture
Screening Urea breath test
Pneumoperitoneum (Best investigation) CT scan
SI bleed CT enteroclysis
Hydatid disease 1 mm-electrophoresis
Localising CT scan
Hemobilia Arteriography
Bilhemia ERCP
Hemangioma- Liver CECT
FNH Arteriography
HCC – Best/Definite CECT
A/C Cholecystitis USG
Suspected OJ MRCP
Confirmed OJ ERCP
Staging of Biliary CA CECT
Choledochal cyst MRCP A unit
i of
of TEN PVT. LTD
LTT
Mirrizzi syndrome ERCP
Diverticulosis Ba enema
Diverticulitis CECT
Colovesical fistula CECT
Mecke’s diverticulum Tc99 scan
CA Colon Colonoscopy and Bx

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 49

 TARGET DEC. 2018

Lower GI bleed Colonoscopy
Angiodysplasia Angiography
Mesenteric ischemia Angiography
Renal stone CT scan
PUJ/VUR MCU
PUJ obstruction IVP>DTPA
Desmoid tumour MRI
Sarcoma TrucutBx (biopsy)
Intra abdominal abscess CECT
Retroperitoneal fibrosis CECT > IVP
Intestinal obstruction /Int. hernia CECT
Intussusception Doppler USG
Intestinal Fistula CECT >Fistulogram
Wilkie’s syndrome CECT
SI tumours CT enteroclysis
2. MICRO ANGIOPATHIC HEMOLYTIC ANEMIAS

I
A unit
i of
of TEN PVT. LTD
LTT A. Primary
MEDICINE x HUS

C
1. CLASSIFICATION OF ANEMIA x TTP
A. Hypoproliferative (Low Rticulocyte B. Secondary
count) x DIC
x Microcytic

M
x Vasculitis
o Iron deficiency anemia x Eclampsia/HELLP
o Thalassemia
x APLA syndrome

-
o Sideroblastic anemia
o Anemia of chronic x Prosthetic heart valves
disease x Drugs/radiation

S
o Lead poisoning x Infections
x Normocytic x Snake venom
o Aplastic anemia x Cavernous hemangioma

M
o Fanconi’s anemia 3. PANCYTOPENIA
o Marrow infiltration A. With hypocellular BM
o CDK x Aplastic anemia

A
o Chronic disease x Fanconi’s anemia/shwachmann-

I
x Macrocytic Diamond syndrome
o VIt B12 deficiency x MDS- some types
o Folate deficiency x Marrow infiltration

D
o Liver disease x Dyskratosis
o Alcoholism congenita’/reticular
o Hypothyroidism dysgenesis
o Thiamine deficiency
x Aleukemic leukemia
B. Hyperproliferative (High reticulocyte
B. With cellular BM
count)
x Primary BM disease
x Bleeding
o PNH/MDS
x Hemolysis o Myelofibrosis
o Intra vascular: o BM lymphoma
PNHm PCH o Hairy cell leukemia
Mechanical heart valves
x Secondary
Snake bite
o Hypersplenism/thymoma
Transfusion reactions
o SLE
G6PD deficiency
o B12 and folate deficiency
o Extra vascular:
o Infections-TB,
o Hemoglobinopatheis/
Brucellosis,
spherocytosis/
Sarcoidosis, EBV, HIV,
elliptocytosis
Parvovirus B12, hepatitis
DIC/TTP/HUS/HS
Auto immune hemoplysis A unit
i of
of TEN PVT. LTD
o Alcohol LTT
o Drugs and radiation
G6PD deficiency
4. AML- CLASSIFICATION
5. HODGKIN LYMPHOMA TYPES
Nodular Mixed Lymphocyte rich Lymphocyte Lymphocyte
sclerosis cellularity depleted
Classical HL Classical HL Classical HL Classical HL Non - Classical

50 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018
HL
MC HL MC HL in India Associated with M >F
HIV
RS cell type is Maximum typical Minimum RS RS Cell Type: Popcorn cells
lacunar cell RS cells cells Pleomorphic, or LH cells
Mummified,
Necrobiotic
CD 15+ CD 15+ CD 15+ CD 15+ CD 15 +, & 30-
CD 30+ CD30+ CD 30+ CD 30+ CD 20 + , BCL 6+
Not associated Associated with Associated with Associated with Non- Associated
with EBV EBV EBV EBV with EBV

I
Young adult Biphasic Old age Old age Young adult
incidence

C
PTGC (+) PTGC (+)
Excellent Very good Very good Poor prognosis Excellent
prognosis prognosis prognosis prognosis
A unit
i of
of TEN PVT. LTD
LTT

M
6. ABNORMALITIES IN COAGULATIONS TESTS o Antithrombin deficiency
A. Prolonged APTT o Protein S & C deficiency

-
x No bleeding clinical: Deficiency x Acquired
of Factor XII, HMWK and o Immobilization,
prekallikrein, APLA Pregnancy, Major

S
x Mild bleeding: Deficiency of surgery, Obesitym
Factor XI, IX, VIII Infections etc.
x Severe bleeding: Severe B. Arterial +Venopus (Mixed)

M
hemophilia A and B o Dysfibrinogenemia
B. Prolonged PT o Homocytinuria &
x Factor VII deficiency Hyperhomocytinemia

A
x Vitamin K deficiency / Warfarin x Acquired

I
therapy o Homocystinemia
C. Prolonged PT and APTT o APLA syndrome
x Deficiency of Factor II, V and X o Polycythemia vera

D
o Essential
x Severe vitamin K deficiency
thrombocythemia
x Direct thrombin inhibitors o PNH/TTP
D. Prolonged TT o HIT/DIC
x Heparin therapy 8. INFECTIONS & LYMPHOMA
x Dysfibrinogenemia (mild A. EBV : Burkitt’s lymphoma
bleeding) : Hodgkin lymphoma
x Afibrinogenemia (Severe :Primary CNS lymphoma
bleeding) : Post transplant lymphoma
E. Abnormal Clot solubility : Extranodal NK / T cell
x Factor XIII deficiency lymphoma
x Defective cross linking B. HHV-8 : Primary effusion lymphoma
F. Rapid clot lysis : Castleman’s disease.
x Deficiency of C. HTLV-1 : Adult T-cell lymphoma
Antiplasmin/Plasminogen D. Hep. C :Lymphoplasmacytic lymphoma
activator inhibitor E. HIV : Burkitt’s lymphoma.
x Fibrinolytic therapy : Diffuse large B –cell
lymphoma
x PTGC: Progressive F. H-pylori : Gastric MALToma
transformation of germinal 9. DIAGNOSTIC CRITERIA FOR GAMMOPATHIES
center A. Monoclonal Gammpathy of
x Most specific marker of RS undetermined Significance (MGUS)
cell is PAX-5 x M protein in serum < 30 g/l
x Treatment of HL is ABVD x BM plasmacytosis < 10%
(Adriamycin, Bleomycin, A unit
i of
of TEN PVT. LTD
LTT
x No myeloma related organ
Vinblastine, Dacarbazzine)
involvement.
B. Asymptomatic Myeloma (Smoldering
7. THROMBOSIS
myeloma)
A. Venous
x M protein in serum > 30 g/L:
x Inherited
BM plasmacytosis > 10%
o Factor V leiden mutation
No myeloma related organ
(MCC)
involvement
HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 51
 TARGET DEC. 2018

C. Non-secretory myeloma C: Calcium involvement
x No M protein in serum or urine R: Renal involvement
x BM plasmacytosis > 10% A: Anemia
x Plasmacytoma B: Bone lesions
x Myeloma related organ E. Solitary plasmacytoma of bone
involvement x No M protein serum and urine
D. D. Symptomatic multiple myeloma x Single area of bone destruction
x M protein in serum > 30 g/L due to plasmacytoma.
x BM plasmacytosis > 10% or x BM not suggestive of multiple
plasmacytoma. myueloma.
x Myeloma related organ x No myeloma related organ
impairment include: (Think: involvemnet
CRAB)
10.ABNORMAL HEMOGLOBINS
Hemoglobin Type: Replaced AA Replacing AA Position
x Hbs Glutamic Acid Valine 6

I
A unit
i of
of TEN PVT. LTD
x HbC LTT Glutamic acid Lysine 6
x HbE Glutamic acid Lysine 26

C
x HbM Histidine Tyrosine 87
x Koln Valine Methionine 98
x Yakima Asparate Histidine 99

M
x Kansas Asparagine Lysine 102

-
11.DIFFERENCE B/W INTRAMEDULLARY & EXTRAMEDULLARY LESIONS
Features Intramedullary Extramedullary
Origin Within the spinal cord Outside the spinal cord

S
Root pain Rare Common
Vertebral pain Not common Common
Motor weakness Occurs late Occurs early

M
Sacral sparing Sacral Sparing + (sacral Sacral sparing absent
sensations+)
Paraesthesia More common Less Common

A
Dissociative anaesthesia Present Absent

I
Bladder /Bowel Early involvement Late involvement
Lhermitte’s sign Absent Present
CSF proteins Usually normal Marketed by raised

D
Mylogram Expansion sign Mensicus sign, (Intradural)
Brush border sign (Extra
dural)

12.Syndrome o Nucleus tractus

A. Meidal medullar syndrome (Dejerine solitaries (VII, IX, X)
syndrome) o Descending sympathetic
x Structure involved firbes
o Medical lemniscus o Inferior cerebellular
o Pyramid peduncle
o Hypoglossal nucleus o Spinothalamic tract
x Features o Cuneate and Gracilis
o Posterior column nuclic
features on C/L side. o Olivocerebellar fibres.
o C/L Hemiparesis /plegia x Features
o I/L Paralysis of tongue o Loss of I/L facial
B. Lateral medullary syndrome sensations.
(Wallengberg syndrome) o Ataxia, Vertigo
x Structures affected A unit
i of
of TEN PVT. LTD
LTT
o Dysphagia, Hoarseness,
o Spinal nucleus of Palatal palsy
Trigeminal o Loss of taste (NTS)
o Vestibular nucleus o Horner’s syndrome.
o Fibres of IXth and Xth o C/L pain and
nerve temperature loss
o Nucleus ambiguous (IX, X, o I/L posterior column
XI) features.
o No weakness
52 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
 TARGET DEC. 2018
x MCC is thrombosis of vertebral o Vertical eye movements
artery (4thsegment ) then comes possible.
thrombosis of PICA. E. Midbrain syndrome (P1 segment
C. Other medullary syndromes occlusion)
x Avelli’s syndrome x Weber’s syndrome
o C/L Hemiplegia o C/L Hemiplegia + I/L 3rd
o IX, X cranial nerve palsy nerve palsy
x Schimidt’s syndrome o C/L Hemiballismus and
o C/L Hemiplegia tremor (Road Nucleus)
o IX, X , XI cranial nerve x Nothnagel Nagal syndrome
palsy o C/L Ataxia +

I
D. Pontine syndromes I/Lclanude’s syndrome
x Fovillis syndrome x Claude’s syndrome
o C/L Ataxia + I/L 3rd

C
o C/L hemiplegia
o I/L facial palsy and nerve palsy
Gaze palsy. o C/L Tremor
x Milliard Gubler syndrome x Parinaud’s syndrome
A unit
i of
of TEN PVT. LTD
LTT

M
o C/L Hemiplegia (Pretectum is Involved)
o I/L xith nerve palsy and F. Dejerine Roussy syndrome

-
facial palsy x Thalamus is affected (P1
x Raymond Cestan syndrome segment occlusion)
o C/L hemiplegia x Artery of Percheron is

S
o I/L Ataxia and Gaze affected
palsy x I/L hemisensory loss+ Burrning
x Located in syndrome pain.

M
o B/L pons lesions G. Anton’s syndrome
o Quadripelgia, unable to x B/L occipital infarcts
speak x Patient denies loss of vision

A
o Conscious but x Cortical blindness

I
unresponsive
13.CSF CHANGES IN MENINGITIS

D
Parameters Bacterial Viral Tubercular
Pressure Elevated Elevated Elevated
Gross app Turbid Clear Clear
Protein High Mildly high Very high
Glucose Very low Normal Low
Chloride Low Normal Very low
Cells Neutrophils Lymphocytosis Pleocytosis (L & N)

x Fungal: Pressure elevated, x Paraneoplastic

high protein, low glucose & x Friedrich’s ataxia
Mononuclear fells in CSF: x Taxanes
x Amoebic: Pressure elevated, Think: ‘PSC PFT’
high protein, normal or low C. Ganglionopathy (Only posterior
glucose and Neutrophils in column is involved)
CSF. x Para neoplastic
14.NEUROPATHEIS x Sjogren’s disease
A. Small fibre neuropathy (LSTT involved) x Cisplatin
x Hereditary sensory neuropathy x Pyridoxine toxicity
x Amyloidosis x Idiopathic sensory neuropathy
x Diabetes mellitus x HIV
/Dysautonomia Think: ‘PCS PIH’
x Fabry’s disease D. Autonomic neuropathy
x Infections-HIV, leprosy
x Tangier’s disease
A unit
i of
x HIVof TEN PVT. LTD
LTT
x Amyloidosis
Think: ‘HAD FITs’ x Diabetes mellitus
B. Large fibre neuropathy (posterior
x Vincristine
column involved)
x Amiodarone
x Pyridoxine tonicity
x GBS
x Sjogren’s disease
Think: ‘HAD VGUS’
x Cisplatin E. Motor neuropathy

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 53

 TARGET DEC. 2018

x Diptheria /DM : In
x Acute intermittent porphyria constrictive pericarditis,
x Lead poisoning cardiac tamponade, COPD,
x GBS Acute
severe asthma, Pulmonary
x HMSN
embolism
x Tick paralysis
x Jerky pulse : In HOCM
Think: ‘DALGHAT’
: In shock
F. Combined Motor-sensory neuropathy
17.JVP
x Vasculitis A. a wave : RA contraction
x Leprosy /Lyme’s disease B. c wave : Bulging of
x Alcohol/Arsenci tricuspid valve into atria during
x Diabetes mellitus ventricular systole
x Uremia C. v wave : RA filling
Think: ‘Vasu’s LADU’ D. x descend : Atrial relaxations
15.CHANNELOPATHEIS E. y descend : Atrial emptying

I
x Calcium : Episodic ataxia II F. Abnormalities
A unit
i of
of TEN PVT. LTD
LTT
Spinocerebellar ataxia 6 x Giant a wave : TS, PS,
Hypokalemic periodic paralysis PAH, ASD (In diastole)

C
Familial hemiplegic migraine x Cannon a wave :
Andreson syndrome Heart block, junctional rhythm
Rippling muscle disease (In systole)

M
x Sodium Hyperkalemic periodic x Absent a wave : AF
paralysis x Large v wave : TR
Paramyotonia congenital x CV wave (S wave) : TR

-
Myotonic dystrophy x Deep x descend : cardiac
Normokalemic periodic tamponade > Constrictive
paralysis

S
pericarditis
Generalized epilepsy with
x Deep y descend :
Febrile seizures
Constrictive pericarditis
x Potassium : Episodic ataxia-I

M
x Shallow y descend : TS
: Myotonia fluctuans/Myotonia
permanans x Non pulsatile JVP : SVC
obstruction
x Chloride : Myotonia congenita

A
Thompson disease x Kussmaul’s sign :
sustained rise in JVP during

I
Becker’s disease
inspiration in constrictive
x All channelopathies are AD
pericarditis and RVF.
except Myotonia congenital (AD

D
G. Non cardiac causes of elevated JVP
& AR)
16.PULSE-TYPES x Fluid overload : Cirrhosis,
Renal failure.
x Water hammer pulse : High
18.HEART SOUNDS
volume collapsing pulse : In AR
A. S1
x Pulsus parvus : Slow rising
x Low pitched
pulse
:In AS x Loud S1 : MS, ASD, TS,
Tachycardia, Hyperdynamic
x Pulsus parvus et-tardus : Slow
circulation, Epstein’s anomaly,
rising pulse with a late peak : In
WPWS, Short PR interval (Code
severe AS
is MATHEWS)
x Anacrotic pulse : Slow rising
x Soft S1 : Calcified
pulse with a very late peak
MS, Rheumatic MR, Acute AR,
: In severe AS
Failure.
x Pulses alternans: Alternating
x Variable S1 : AF, Ectopics
low & high volume : In LVF
x Split S1 : RBBB, LV
x Pulses bisferians : 2 waves
ectopics, LV pacing
prominent in systole : In AR,
AR with AS, HOCM x Reverse split S1 : LBBB, RV
pacing
x Dicrotic pulse : 2 prominent A unit
B. S2 i of
of TEN PVT. LTD
LTT
wave one each in systole &
diastole : In shock, DCM x High pitched
(Dilated cardiomyopathy) x Normal splitting is 40-80ms
x Pulsus paradoxus : Normal x Loud S2
decrease in BP in inspiration is o Loud A2-AR, systemic
accentuated HTN
o Loud P2-PS
P 54
54 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
 TARGET DEC. 2018

x Soft S2 x ASD, VSD, infective
o Soft A2- AS endocarditis
o Soft P2-PS x CHB (Ritan’s murmur)
x Single S2 : Severe AS, F. Continuous murmur
Severe PS, TOF x PDA (Machinery or Gibbson’s
x Variable split: VSD, MR, LV murmur)
pacing, PS, PAH, RBBB x AF fistula
x Fixed wide split : ASD, LVF, x RSOV, ALCAPA
ALCAPA x Coarctation of Aorta
x Reverse split : LBBB, RV pacing, x Venous hum (Devil’s murmur)

I
AS G. ESM heard normally at pulmonary
C. S3 area is called still’s murmur.
x Low pitched x All right sided cardiac events

C
x Physiological : Athelets, increases with inspiration. This
Pregnancy, young Individuals is called Decaravallo’s sign.
x Pathological : MR, AR, LVF, TR, 20.CRITERIA FOR ARF & IE
A unit
i of
of TEN PVT. LTD
LTT

M
PR. A. Acute Rheumatic Fever
D. S4 Major Criteria: Arthritis (MC)
x Always pathological : Carditis

-
x In LVH due to AS, HTN, HOCM : Erythema marginatum
Added Sounds : sydenham’s chorea

S
x Opening snap : MS Severe ( In : subcutaneous nodules
Diastole) (Least common)
x Ejection click : AS, PS. (in Minor Criteria: Fever
: Arthralgia

M
systole)
: Elevated TC
x Non-ejection click: Pericarditis
: Elevated CRP/ESR
(In diastole)
: PR Prolongation in ECG

A
x Tumour plop: Alrial myxoma (In Essential : Positive ASO titre

I
diastole) : Streptococcal culture
19.MURMURS positive
A. PSM : h/o scarlet fever

D
x MR, TR, VSD B. Infective Endocarditis
B. ESM Major criteria : Positive Blood
x AS (Radiates to carotid – Culture
carotid shudder and radiates : Endocardial
to Apex –Gallavardin involvement
phenomenon) a. Positive Echo
x PS b. Abscess
C. Late systolic murmur c. New valvular
x MVP regurgitation
D. EDM d. New dehiscence
x AR (Radiates to axilla –Cole of Prosthetic
Cecil murmur), PR vlave
x Functional PR due to PAH Minor Criteria : Prdisposing
(Graham Steel murmur) Heart lesion or IV drug abuse
E. MDHM : Fever
x MS, TS : Vascualr phenomenon
(emboli, Aneyrysm, Janeway Lesion)
x AR (Austin Flint murmur)
: Immunologic lesions
x Rheumatic fever (Carey coomb’ (AGN, RF, Osler’s nodes, Roth’s spots)
murmur) : Microbiological
evidence.
21.OBSTRUCTIVE VS RESTRICTIVE LUNG DISEASE
TLC VC RV FEV1 FVC FEV1/FVC FEF 25- DLCO
A unit
i of 50 PVT. LTD
of TEN LTTĻ/N
Obstructive Ĺ/N Ļ Ĺ ĻĻ Ļ Ļ ĻĻ
Restrictive Ļ ĻĻ Ļ Ļ ĻĻ Ĺ Ļ Ļ

22.RESPIRATORY FAILURE x PaCo2 normal or low

A. TYPE I x PAO2-PaO2 increased
x Failure of oxygenation
x PaO2 low

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 55

 TARGET DEC. 2018

x Cause are Pneumonia, ARDS, x Type most responsive to
Emphysema, Right to left shunts chemotherapy is : SCLC
etc. x Type most responsive to RT :
B. Type II SCLC
x Failure of ventilation x Type which commonly produce
x PaO2 low or normal SVC syndrome : SCLC
x PaCO2 increased
x PaO2-PaO2 normal Golden points from Pancreatic
x Cause are COPD, Foreign body Neuroendocrine tumours
obstruction, Respiratory x Most common : Insulinoma
center failure like brain injury, x MC malignancy : Gastrinoma
Respiratory muscle weakness x MC in MEN –I : Gastrinoma
like Myastheniaand x Least common :
Polymyositis, Rib cage Somatostatinoma
abnormalities etc. x Least malignant : Insulinoma
C. Type III

I
x Whipple’s triad seen in :
A unit
i of
of TEN PVT. LTD
LTT
x Mixture of Type I and II Insulinoma
x PaO2 decrease 24.MALABSORPTION SYNDROMES

C
x PaCO2 increase A. Coeliac disease
x PAO2-PaO2 increase x Gluten sensitive enteropathy
D. Type IV x HLA DQ2 and DQ8 associated

M
x Due to poor perfusion of x Predominantly involve
respiratory muscle duodenum and Jejunum
23.CA LUNG-GOLDEN POINTS

-
x Cause Iron deficiency anemia
x MC Type : x Cutaneous manifestations
Adenocarcinoma o Dermatitis herpetiformis

S
x MC Type in India : (Rx is Dapsone)
Squamous cell carcinoma o Petechiae
x MC Type in smokers : o Follicular

M
Squamous cell carcinoma hyperkeratosis
x MC Type in Nonsmokers : x Increased liver transaminases
Adenocarcinoma x Splenic atrophy and

A
x MC Type in females : Hyposplenism

I
Adenocarcinoma x Auto antibodies
x MC type in young : o Antigliadin Ab
Adenocarcinoma o Anti endomyseal Ab

D
x Type which is central in (Most specific and
location : SCC, SCLC sensistive)
x Type which is peripheral in o Anti transglutaminase
location: Adenocarcinoma, Ab (IOC for screening)
Large cell CA x Biopsy findings
x MC site of metastasis : Liver o Villous atrophy
x MC endocrine organ involved : o Crypt hyperplasia
Adrenals o Confined to mucosa and
x Type which metastasize to normal mucosal
opposite lung : Adenocarcinoma thickness
o Lamina propria
x Cancer which metastasize to
infiltrate
heart : Bronchogenic
carcinoma x Dangers
o T-cell lymphoma
x Type which is cavitating : SCC
o Small intestinal
and Large cell CA
adenocarcinoma
x Type which is present as o Esophageal SCC
Pancoast tumour : SCC
x Treatment: Steroids + Gluten
x Type which commonly produce A unit
i of
of TEN PVT. LTD
free diet LTT
Paraneoplastic syndrome: B. Whipple’s disease
SCLC
x Chronic multisystem disorder
x Type which commonly produce
x Associated with infection by
Hypokalemia : SCLC
Trophenryma whippeli.
x Type which commonly produce
x Biopsy: PAS positive
Hypercalcemia : SCLC
macrophages (confirmatory)
x Type with best prognosis : SCLC

56 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018

x Malabsorption, Neuro x Pan intestinal involvement
whipple’s, Endocarditis, x Biopsy same as celiac disease
Arrthritis, x Vit B12 deficiency predominates
x Treatment : Ceftriaxone for x Affected ileum predominantly
induction phase x Rx is tetracycline + Vit. B12 or
: Cotrimoxazole long term. Folare
C. Tropical sprue
25.CROHN’S DISEASE AND ULCERATIVE COLITIS
Feature Crohn’s disease Ulcerative colitis
Clinical
Gross blood in stool Occasional Common

I
Mucus is stool Occasional Common
Systemic symptoms Frequent Occasional

C
Perianal fistula Frequent No
Recurrence Frequent Less common
Rectal Involvement Rarely Always
Antibodies
A unit
i of
of TEN PVT. LTD
LTT

M
ANCA Rare Frequent
ASCA Frequent Rare

-
Anti Goblet Ab No Yes
Endoscopy

S
Cobble strone app. Yes No
Granuloma Yes No
Stricture Frequent Rare
Skip lesions Yes Continuous

M
Ulcers Serpigenous ulcers Superficial
Depth Transmural Mucosal and submucosal

A
Crypt abscess Rare Frequent
Complications

I
Malignancy Rare Frequent
Toxic megacolon No Yes

D
Metaplasia Pyloric metaplasia Paneth cell metaplasia
Others
Smoking Predisposing Protective
Appearance Cobble stone app. /Hose pipe app. Garden hose app./Lead pipe
colon.
Pseudopolyps No Yes
1st Lesions Aphthous ulcrs Fine granularity
Extra intestinal More common Less common
26.POLYPOSIS SYDNROMES
x FAP : Multiple (> 100) Adenomatous polyps in colon
: CA colon and other malignancies (Thyroid, Pancreas, cervix)
x Gardner’s syndrome : Adenomatopus polyps in colon
: Osteoma, Fibroma, Lipoma, Desmoid tumour, CA colon.
x Turcot’s syndrome : Adenomas in colon
: CNS tumours (cerebellar hemangioblastoma/glioblastoma)
x Peutz Jeghar’s syndrome : Hamartomatous polyps is GIT
: Mucocutaneous pigmentation
: CA Pancreas, Ovary, Breast, Uterus, Lung
x Juvenile Polyposis : Hamartomatous polyps in GIT
: Various congenial anomalies
x Ruvalcaba syndrome : Hamartomatious polyps
: Lipomas
: Dysmorphic facies, Pigmented lesions of penis.
x Cowden syndrome : Hamartomatous polyps
: Mucocutaneous lesions
A unit
i of
of TEN PVT. LTD
LTT
: Thyroid adenoma/ Leiomyoma
: CA Thyroid and Breast.
x Muir-Torre’s syndrome : Adenomatous polyps
: Sebaceous adenoma, Keratoacanthoma
: Basal cell epithelioma, sebaceous Carcinoma
: CA endometrium, CA ovary, CA stomach,

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 57

 TARGET DEC. 2018

27.URINARY CASTS
x Hyaline cast : Normal constituent
: Composed of Protein (Tam Horsfall protein)
: Tam Horsfall protein is secreted by Loop of Henle
x RBC cast : S/o AGN (Glomerular injury)
x WBC cast : Acute pyelonephritis
: Interstitial syndrome
x Waxy cast : Nephrotic syndrome
x Eosinophil cast : Acute interstitial nephritis
x Broad granular cast : CRF, chromic glomerulonephritis
x Buddy brown cast : ATN (Ischemic or toxic)
28.BILIRUBIN METABOLISM
Heme in RES
Ļ Heme oxygenase
Biliverdin

I
Ļ Biliverdin reductase
A unit
i of
of TEN PVT. LTD
LTT
Unconjugated bilirubin
Ļ

C
Binds with albumin in blood
Ļ
Reaches liver

M
Ļ
Bilirubin diglucoronide

-
Ļ
Reaches Colon
Ļ Cl. ramose

S
Urobilinogen
Enterohepatic circulation

M
Liver

Sterocobilinogen Kidney

IA
Ļ Ļ
Faeces Urobilinogen in
urine
29.AUTO ANTIBODIES IN RHEUMATOLOGY x Nucleolar : systemic sclerosis

D
A. SLE x Rim: Specific for SLE (Anti ds
x ANA Ab : Sensitive for SLE DNA)
x Anti ds DNA Ab : x Homogenous : Drug induced SLE
Specific and commonly used C. APLA
x Anti Smith Ab : Most specific x Anti cardiolipin Ab : Most
x Anti RNP Ab : Mixed connective sensitive
tissue disease x Lupus anticoagulant: Most
x Anti Ro and La Ab : Sjogren’s specific
syndrome x Anti B2 glycoprotien Ab: Most
Cutaneous lupus common
SLE with low risk for nephritis. D. RA
x Anti Histone Ab : Drug induced x RA factor : Sensitive for RA
SLE x Anti accp Ab : Specific for RA
x Anti PL Ab : APLA association E. Behcent’s disease : specific for RA
x Anti erythrocyte Ab : Anemia is x ASCA
SLE x Anti enolase Ab
x Anti platetlet Ab : F. Scleroderma
Thrombocytopenia in SLE x Anti topo isomerase Ab: Diffuse
x Anti neuronal Ab : CNS Lupus A unit
i of
of TEN PVT. LTD
LTT
Scleroderma (Systemic
x Anti ribosomal –P Ab: sclemosis)
Depression in SLE x Anti centromere Ab: Limited
B. ANA patterns scleroderma
x Speckled : Most common and
sensitive for Auto immune
disease

58 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018

30.VASCULITIS – CLASSIFCATION o Pheochromocytoma
A. Large vessle vasculitis x Other associations: Mucosal
x Temporal arteritis (Giant cell neuromas, Marfanoid habitus
arteritis) 32.ABG ANALYSIS
x Takayasu arteritis A. Essential Values
x Behcet’s disease x pH : 7.37-7.43
x Cogan’s disease x PO2 : 98-100
B. Medium vessel vasculitis x PCO3 : 40
x PAN x HCO3 : 14
x Kawasaki disease x BE : 24
x TAO B. Acidosis : +3 to -3

I
x Cutaneous PAN C. Alkalosis : <7.45
C. Small vessel vasculitis D. Respiratory : PCO2 > 40
E. Respiratory alkalosis : PCO2 < 40

C
x ANCA associated
o Wegener’s F. Metabolic acidosis : HOC3 < 24
granulomatosis (C- G. Metabolic alkalosis : HCO3 > 24
ANCA) H. Compensatory process
A unit
i of
of TEN PVT. LTD
LTT

M
o Microscopic polyangitis x In metabolic acidosis
(P-ANCA) o PCO2 decrease by 1.2 per
1 mEq HCO3

-
o Churg-strauss syndrome
(P-ANCA) x In metabolic alkalosis
o Renal limited vasculitis o PCO2 increase by 0.7 per

S
(P-ANCA) 1 mEq HCO3
x Immune complex associated x In acute respiratory acidosis
o Good Pasture’s o HOC3 inrease by 0.1 per 1
syndrome mm PCO2

M
o Henoch Schonlein x In Chronic respiratory acidosis
Purpura (HSP) o HCO3 increase by 0.35

A
o Essential mixed per 1 mm PCO2
cryoglobulinemia x In acute respiratory alkalosis

I
D. Granulomatous vasculitis o HOC3 decrease by 0.2 per
x Temporal arteritis 1 mm PCO2
x Takayasu arteritis x In Chronic respiratory by

D
x Churg-strauss syndrome
x Wegener’s granulomatosis
E. Necrotising vasculitis
x Microscopic polyangitis
x Churg-strauss syndrome,
Wegener’s ganulomatosis
31.MEN SYNDROME
A. MEN I
x Also called wermer syndrome
x Mutation of Menin gene on
chromosome 11
x Classical triad
o Parathyroid hyperplasia
> adenoma
o Pancreatic
neuroendocrine tumours
(gastrinoma > Insulinoma)
o Pituitary tumors
(prolactinoma >
Carcinoma)
x Other associations
o Foregut carcinoid
o Subcutaneous / lipomas
o Angiofibroma
o Leiomyomas (Cutaneous)
x MC presentation is
Hypercalcemia in young
B. MEN 2A
x Classical association
o Medullary thyroid
carcinoma
alkalosis
o HCO3 decrease by 0.4 per
1 mm PCO2
33.MICRO AND MACRONODULAR CIRRHOSIS
A. Micronodular cirrhosis (<3 mm nodule)
x Hemochromatosis
x Indian childhood cirrhosis
x Primary biliary cirrhosis
x Laennec cirrhosis (Alcoholic)
x Biliary atresia
x Galactosemia
x Glycogen storage disease type I
B. Macronodular cirrhosis (<3 mm
nodule)
x Alpha-1 Antitrypsim deficiency
x Chronic hepatitis – B & C
x Wilson’s disease
PEDIATRICS
I. Developmental Milestones
A. Gross motor
x New born: Complete head leg
x 1 week: Tonic neck posture
x 1 ½ months: Starts head control
A unit
i of
of TEN PVT. LTD
LTT
x 3 months: Head control (some leg)
x 4 months: Holds head erect
x 5 months: Complete head control,
Prone to supine, Sits with other’s
support
x 6 months: Supine to prone, bears
weight, Sits with own support

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 59

 TARGET DEC. 2018
x 7 months: Rolls over
x 8 months: Sit without support
Crawl
x 10 months: Stand with support
creep
x 11 months: Cruise
x 12 months: Stand without support
1-2 steps
x 15 months: Walks, Crawl upstairs
x 18 months: Runs, Walks upstairs
with other’s support
x 2 years: Jump, Walks backward,
Kicks ball, Walks upstairs with
both feet on one foot
x 3 years: Rides tricycle, stand on
one feet, Walks upstairs with one
A unit
i offoot on one step, Walks
of TEN PVT. LTD
LTT
downstairs with both feet on one
step
x 4 year: Hops, Walks downstairs
with one foot on one step
x 5 years: Skips
B. Fine motor
x 3 months: Hand regard
x 3-5 months: Hand mostly open
x 4 months: Reaching out for object
S
and overshoots
x 5 months: Bidextrous grasp
x 6 months: Unidextrous grasp
(Ulnar)
M
x 7 months: Transfer of objects,
Mouthing of objects
A
x 9 months: Immature pincer grasp,
Radial grasp
I
x 10 months: Assisted pincer grasp,
casting
x 12 months: Mature pincer grasp,
D
Feed with spill from a glass
x 15 months: Put object into bottle,
feed from glass without spill
x 18 months: Empties bottle, Feed
with spoon
x 15 months: Turn pages (2-3 at a
time), Scribbles, tower of 2 blocks
x 18 months: Vertical stroke, Tower
of 3 blocks, Unzip
x 2 years: Turns one page at a time,
Horizontal stroke, Tower of 6
blocks, Makes a train, Undress,
Unscrew lid, Turns door knobe
x 2 ½ years: Train with chimney
x 3 years: Draws circle, Imitates
cross, Tower of 9 blocks, makes
bridge, Dress and undress fully
but not buttons
x 4 years: Draws square and cross,
Draws a man with 2-4 parts other
than head, Unbuttoning, Makes
gate with cubes
x 5 years: Buttoning and shoe lace
ties, Draws triangle
C. Social smile
x 1 month: Fixates on mother
60 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
x 2 months: Social smile
x 3 months: Recognizes mother,
Anticipates feed
x 6 months: Stranger anxiety, Enjoys
mirror image
x 9 months: Waves bye-bye, Repeats
an act that evokes appreciation
x 10 months: Peek a boo
x 12 months: Comes when called,
Understands simple question
x 15 months: Jargon, points to
interested objects
x 18 months: Imitates others, Follow
simple orders
x 2 years: Shows toys o others, Hide
and seek, Points to 3-4 body parts,
I
Name 2-3 objects, Ask for toilets
and food
C
x 3 years: 3 word sentence, Knows
name and gender, Identify colours,
Begins to count, Shares toys,
Parallel play
M
x 4 years: Group play, Goes to toilet
alone
-
x 5 years: Identify 4 colours
x Helps in household tasks, Domestic
role play
D. Language
x 1 month: alert to sound
x 2 months: Vocalizes with vowels
x 3 months: Cooing sound
x 4 months: Laughing aloud
x 5 months: Babbling
x 6 months: Monosyllable, ‘Ing’
x 9 months: Bisyllables
x 1 year: 1-2 words with meaning
x 1 ½ years: 8-10 word vocabulary
x 2 years: 2 word sentences, (100
words) Asks food
x 3 years: 3 word sentences, Ask
questions
x 4 years: Poems, songs, stories
x 5 years: Ask meaning of words
E. Vision
x 1 month: 45o follows
x 1 ½ months: 90o
x 2 months: 180o
x 3 months: Grasping with eye
x 4 months: Binocular vision
x 6 months: Follows objects
x 1 year: Follows rapidly
F. Hearing
x 1 month: Alert to sound
x 3 months: Turn head at the same
A unit
leveli of
of TEN PVT. LTD
LTT
x 6 months: Turn head to side and
then downwards
x 7 months: Turn head to side and
then upwards
x 10 months: Turn head diagonally
pivoting
 TARGET DEC. 2018

II. Primitive reflexes
Moro reflex
Reflex Onset Fully Duration- Ending
developed
Palmar grasp 28 weeks 32 weeks 2-3 months after
birth
Rooting reflex 32 weeks 36 weeks 1 month after birth
Moro reflex 28-32 weeks 37 weeks 5-6 months after
birth
ASTNR 35 weeks 1 month AB 6-7 months AB
Landau reflex 3 months AB - 1 year AB

I
STNR 4-6 months - At crawl
AB

C
Parachute 7-8 months 10-11 months Remains throughout
reflex AB AB life

Components
Axunit
i of
oof Symmetric
TEN PVT.extension
LTT and abduction of upper extremities (28 weeks)
LTD

M
o Flexion of upper extremities (32 weeks)

-
o Audible cry (37 weeks)
x Asymmetric moro reflex
o Fracture clavicle

S
o Brachial plexus injury
o Hemiparesis
x Absent moro

M
o CNS dysfunction
III. CSF in Newborn
Term Preterm

A
Leukocytes 6-8 8-10

I
PMN 61% 57%
Protein 90 115
mg/dl mg/dl

D
Glucose 52 50 mg/dl
mg/dl

IV. Cerebral Palsy

Type Neuropathology Major causes
Spastic diplegia (35%) Periventricular Prematurity (main)
Leukomalacia (PVL) Ischemia, Infection
Spastic quadriplegia PVL, Multicystic Ischemia, infection (main)
(20%) encephalomalacia Endocrine, Metabolic

Hemiplegia (25%) Stroke- Infarct Thromboembolism (main)

Infections, Genetic
Extrapyramidal Scarring of Thalamus, Asphyxia (main)
(Chorioathetoid)(15%)) Putamen, Globus pallidus, Kernicterus
Hippocampus, Brain stem Mitochondrial
Genetic

V. Degenerations o Sialodosis

A. Gray matter degenerations x Without cherry red spot and HSM
x With dysmorphism and HSM o Menke kinke disease
(hepatosplenomegaly) o Alpers disease
o MPS B. White matter degeneration
o GM 1 gangliosidosis x CNS only affected
o Mannosidosis o Canavan disease
o I- Cell disease A unit
i of
of TEN PVT. LTD
LTT
o Adrenoleukodystrophy
x Without dysmorphism and HSM o Alexander disease
o Gaucher’s disease x CNS and PNS affected
o Niemann pick disease o MLD
o Sandhoff disease o ALD
x With cherry red spot o Krabbe disease
o Tay sach’s disease VI. Neurocutaneous Syndromes

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 61

 TARGET DEC. 2018

A. Neurofibromatosis 1
x Mutation of Neurofibromin gene on
chromosome 17 q
x 2 out of 7 features are needed for
diagnosis
o 6 or more Café-Au-Lait
macules (Hallmark of NF-1)
o Axillary or inguinal
freckling
o 2 or more Lisch nodules on
Iris
o 2 or more neurofibromas or
1 plexiform neurofibroma
o Bony lesions- Sphenoid
dysplasia, Cortical thinning
of long bones,
Pseudoarthrosis
A unit
i of
of TEN PVT. LTD
LTT
o Optic glioma
o First degree relative with
NF-1
B. Neurofibromatosis 2
x 1 out of 4 features is needed for
diagnosis
o B/L Acoustic neuroma
(Hallmark of NF-2)
o U/L Acoustic neuroma with
a sibling with NF-2
o U?L Acoustic neuroma with
S
any 2 of the following:
Meningioma, Schwannoma,
glioma,
M
o Posterior subcapsular
opacities in lens
o 2 or more meningiomas with
A
U/L Acoustic neuroma or
I
any 2 of the following:
Schwannoma, glioma,
neurofibroma or cataract
D
C. Tuberous sclerosis
x Major features
o Cortical tubers
o Subependymal nodule/
astrocytoma
o Facial angiofibroma
o Periungual fibroma
o Shagreen patch
o Renal hamartoma (Mulberry
tumour)
o Cardiac Rhabdomyoma
o Renal Angiomyolipoma
o Pulmonary lymphagiomyomia
x Minor features
o White matter migration
lines
o Dental pits
o Gingival fibroma
o Bone cyst
o Retinal patches
o Confetti skin lesion
o Non renal hamartoma
o Renal cyst
o Rectal hamartoma
x Diagnosis
o 2 major or 1 major + 1 minor
62 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206
D. Sturge weber syndrome
x Facial capillary malformation
(Portwine stain)
x Leptomeningeal angioma
x Abnormal blood vessels in eye
x Vascular lesions along maxillary
and ophthalmic divisions
x Pheochromocytoma
x Presents with seizures, stroke,
headache, developmental delay,
buphthalmos, glaucoma, MR Etc.
x Diagnosis by MRI with contrast and
monitor 10P
x Rx of portwine stain is Pulsed dye
laser
E. Incontinentia pigmenti
I
x Inactivation of X-linked dominant
gene
C
x Lethal in males
x Multisystem involvement- skin,
dental, ocular
M
x Features are
o Linear streaks and plaques
o Macular whorls, Reticular
-
patches
o Blaschko lines
o Scarring alopecia
o Late dentition, Hypodontia,
Conical teeth and Impaction
of teeth
o Motor and Cognitive delay,
Microcephaly, Seizures
o Ocular neovascularization,
Mcrophthalmos, Strabismus
and cataract
F. VHL syndrome
x Due to mutation in the VHL tumour
suppressor gene on 3p chromosome
x Symptoms include Headache,
Ataxia, Dizziness, weakness, vision
problems, hypertension etc.
x Features are
o Angiomatosis
o Hemangioblastoma
(cerebellar and spinal)
o Pheochromocytoma
o Renal cell carcinoma
o Pancreatic cysts
o Endolymphatic sac tumour
o Epididymal cystadenoma
o Cystadenoma of uterine
broad ligament
x An example for two-hit hypothesis
x VHL protein is involved in
regulation of a protein called
Hypoxia inducible factor (1ɲ)
VII.
A unit
i of
of TEN PVT. LTD
Causes of cherry red spot
LTT
A. Genetic conditions
x Tay sach’s disease
x Sandoff’s disease
x GM 1 gangliosidosis
x Niemann Pick’s disease
 TARGET DEC. 2018

x Farber’s disease o Holoprosencephaly,
x MLD Microcephaly
x Sialodosis o Midline structural anomaly-
x Krabbe disease Microphthalmia, Cleft lip
o Anophthalmia,
x GM 2 gangliosidosis
Synophthalmia
B. Vascular conditions
o Low set ears
x CRAO o Postaxial polydactyly
C. Trauma o VSD, PDA, ASD
x Berlin’s edema o Hydronephrosis,
D. Toxins Cryptorchidism, PKD

I
x Quinine amblyopia, CO poisoning C. Edward syndrome
VIII. Genetic syndromes x Trisomy 18
A. Down’s syndrome x Features

C
x Due to Trisomy 21 o Prominent occiput,
o Nondisjunction (95%) Micrognathia, Microcephaly
o Translocation (4%) o LBW, MR
A unit
i of
of TEN PVT. LTD
LTT

M
o Mosaicism (1%) o Hypertonia, Narrow lips
x Increased maternal age is a major o Short 4th digit, Rocker
risk factor bottom feet

-
x Features o Overlapping fingers
o Hypotonia, short stature o Cardiac malformations

S
o Mental retardation o Renal malformations
o Brachycephaly, D. Trisomy 22
Microcephaly x Cat eye syndrome
o Epicanthic folds and

M
x Vertical colobomas
Mongoloid slant of eyes E. Turner syndrome
o Brushfield spots in Iris x Genotype is 45 X0

A
o Depressed nasal bridge and
x No increased risk with maternal
low set ears

I
age
o Short neck
o Simian crease in hand x Single X is maternal origin in 70%
o Sandal gap (Increased space cases

D
between 1st and 2nd toe) x Features
o Kennedy crease in foot o Short stature, Female sex
o Endocardial cushion defect o Ovarian dysgenesis and
(MC), VSD, PDA, ASD Hypogonadism
o Duodenal atresia (MC), o Keratoconus, ptosis
Hirsch- sprung disease, o High arched palate,
Annular pancreas Prominent ears
o TEF and Hour glass trachea o Short and Webbed neck
o CDH, Atlanto axial o Broad chest with wide
subluxation spaced nipples
o Hypogonadism, Infertility o Cubitus valgus, Pectus
o AML, ALL carinatum, Scoliosis
o Hearing loss o Short 4th metacarpal
x Screening o Bicuspid aortic value (MC),
Coarctation of Aorta
x 1st trimester
o Horse- shoe kidney (MC),
o Ĺ nuchal translucency Renal pelvis duplication
o Ĺ maternal ɴ-hCG o Hypothyroidism
o Ļ Papp-A o Insulin resistance
x 2nd trimester o Normal intelligence usually
o Triple test (ĻAFP, Ĺȕ-hCG, o Pigmented naevi
Ļestradiol) F. Klinefelter’s syndrome
o Quadruple test (Triple test x MC chromosomal disorder in men
+ Ĺ inhibin – A) with hypogonadism
B. Patau syndrome A unit
i of
of TEN PVT. LTD
x Genotype is 47XXYLTT
x Trisomy 13 x Results from meiotic
x MC due to non- disjunction nondisjunction of sex
x Increased maternal age is risk chromosomes
factor x 40% during spermatogenesis and
x Features 60% during Oogenesis
o IUGR x Features
o Male sex
HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 63
 TARGET DEC. 2018

o Hypogonadism
o Loss of secondary sexual
characters
o Subnormal IQ
o Tall stature
o Gynaecomastia
o Increased risk of breast
carcinoma, germ cell
tumours
o MVP, Varicose veins
x Barr body is seen
G. Noonan syndrome
x Also called Male turner
x Commonly seen in males
x Short stature, MR, Hypertelorism,
high arched palate, low posterior
x Beckwith- Wiedemann syndrome
x Fragile X syndrome
x Homocystinuria
X. Precocious puberty
x Appearance of secondary sexual
characters before 8 years in girls and
9 years in boys
A. Central precocity
x Hypothalamic hamartoma- MC
x Encephalitis- TB meningitis,
Tuverculoma
x CNS tumours- Craniopharyngioma,
Optic glioma
B. Peripheral precocity in males
x Iso sexual
o Gonadotropin secreting

I
hair line, Webbed neck yumours
A unit
i of
of TEN PVT. LTD
LTT
x Cubitus valgus, PS, LVH, o Gonadal tumours
Cryptorchidism, Bleeding diathesis,

C
o Androgen secreting
Normal fertility adrenal tumours
IX. Short stature o CAH
A. Proportionate x Contrasexual

M
x Normal variation o Estrogen secreting
o Familial adrenal tumours

-
o Constitutional o Peutz Jeghar’s syndrome
x Prenatal o Exogenous estrogen
o IUGR C. Peripheral precocity in females

S
o IU infections x Gonadal tumours
o Chromosomal defects x Estrogen secreting adrenal
(Except Klinefelter’s) tumours

M
x Post natal x Peutz Jeghar’s syndrome
o Nutritional
x McCune- Albright’s syndrome
o Chronic disease
D. Contrasexual

A
o Emotional deprivation
o Endocrine abnormalities x CAH

I
B. Disproportionate x Androgen secreting tumours
x Short trunk

D
o MPs
o Carles spine
o Spondylo epiphyseal
dysplasia
x Short limbs
o Rickets
o Achondroplasia
o Hypothyroidism
o Osteogenesis imperfecta
C. Short stature due to GH deficiency
x Height age < Bone age <
Chronological age
D. Constitutional short stature
x Height age = Bone age <
Chronological age
E. Constitutional short stature
x Height age < Bone age +
Chronological age
F. Tall stature
x Cerebral gigantism (Soto A unit
i of
of TEN PVT. LTD
LTT
syndrome)
x Marfan syndrome
x Klinefelter’s syndrome
x Cerebral gigantism (Soto
syndrome)
x Testicular feminization

64 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 TARGET DEC. 2018
x Exogenous androgens
Disease Most common heart lesion/s
Downs syndrome ECD
Turner’s Bicuspid Aortic valve CoA
syndromesp (clinically)
Noonan syndrome Valvular PS
Fetal alcohol Septal defects
syndrome
Marfan syndrome MVP
Congenital PDA
Rubella
MPS AR
Fabry’s Danon RCM

I
syndrome
Pompe’s, Danon RCM
syndrome
Carnitine Cardiomyopathy

C
deficiency
Selenium deficiency
Friederich’s ataxia
DMD
A unit
i of
of TEN PVT. LTT
LTD

M
TS Rhabdomyoma
Gaucher’s disease Pericarditis, Arrhythmia
Homocystinuria CAD

-
Refsum’s disease Arrhythmia
Asplenia CCHS
Polysplenia ACHD

S
Leopard syndrome PS
ADPKD VSD
Carpenter- PDA
Cronzen syn

M
Ellis Van Creveld Single atria/ ASD
syn
William’s syn Supravalvular AS

A
Lithium Ebstein’s anomaly

I
ECD: Endocardial Cushion
Defect
CCHD: Cyanotic Congenital

D
Heart Disease
ACHD: Acyanotic heart
Disease

A unit
i of
of TEN PVT. LTD
LTT

HELPLINE NO. - +91 9643304340, 8587096703, 9891436206 65

 I
A unit
i of
of TEN PVT. LTD
LTT

M C
S -
A M
D I
A unit
i of
of TEN PVT. LTD
LTT

66 HELPLINE NO. - +91 9643304340, 8587096703, 9891436206

 ‘‘An Institute Where Success Begins” DIAMS

DIAMS
MCI JUNE 2018 RESULT A unit of TEN Pvt LTD
DIAMS
FMGE/MCI ENTRANCE EXAMS
TOP PERFORMER
199 199 199 198 198 198 198 198 197 197 197 197 197 196 195 194 194 193 193 193 192 192 192 192 191 191 191 190 190
Dr. Akshay Dr. Deepika Dr. Ashu Kalia Dr. Vinoth Dr. Sona Thomas Dr. Mane Dhanraj Dr. Shweta Gupta Dr. Nayana Dr. Irfan Khan Dr. Himani Dr. V Ariarasudhan Dr. Md. Abbas Dr. Leena Dr. Tanmay Dr. Arif Khan Dr. Madhumita Dr. Md Irafan Khan Dr. Jency A Dr. Ajay Yadav Dr. S Priya Dr. Vinusha Dr. Md Naveed Dr. Harish Dr. Samrit Dr. Vishal Jain Dr. N S Venkkatesh Dr. B.Elizabeth Dr. Sunanda Dr. Sachin
Davao Medical Foundation Davao Medical Foundation V N Karazin National University Davao Medical Foundation Chongqing Medical University Southern Medical University Bukovinian State Medical University Bukovinian State Medical University Jiangsu University Guangxi Medical University Davao Medical Foundation Bogomolets Medical University Davao Medical Foundation Davao Medical Foundation Kharkiv Medical University BSMU Soochow Medical University Davao Medical Foundation International School of Medicine Davao Medical Foundation Davao Medical Foundation Crimea State Medical University TVER State Medical University Kazan State Medical University Northern State Medical University David Tvildiani Medical University Davao Medical Foundation Davao Medical Foundation Bukovinian State Medical University

190 190 189 189 189 188 188 188 188 187 187 187 186 186 186 186 186 186 185 185 185 185 185 184 184 184 184 184 184
Dr. Rajeswari Dr. Aishwarya Dr. Vivek Acharya Nanchang University Dr. Sangram Dr. Yasir Hussain Dr. Suman Roy Dr. Dinesh Dr. Ananya Nair Dr. Prashant Dr. Sunil Dr. Priya Dr. Nisha Dr. Kamal Kishore Dr. Rahul Naruka Dr. Firdos Khan Dr. Arvind katiyar Dr. Barkha Vimal Dr. Komal Dr. Teenu Dr. N Ashok Dr. Jaydeep Dr. Chirag Gajera Dr. Rajesh Dr. Pradeep Dr. Jitender Dr. Benita Mathew Dr. Amal Anil Dr. Chetan Tailor
Zaporozhye Medical University Smolensk Medical University Nobel Medical College Smolensk Medical University Nanchang University Yerevan State Medical University Southern Medical University BSMU Crimea State Medical University Davao Medical Foundation Davao Medical Foundation Karaganda Medical University International School of Medicine Bogomolets Medical University Tribhuvan University Davao Medical Foundation Crimea State Medical University Southern Medical University International School of Medicine Smolensk Medical University TVER State Medical University Yerevan State Medical University David Tvildiani Medical University BSMU SSR Medical College China Three Gorges University Stavropol Medical University

228 225 218

Dr. Dhiraj Mour Dr. Pranay Gupta Dr. Gurchetan
Stavropol Medical University SSR Medical College Crimea State Medical University
184 183 183 183 183 182 182 182 182 182 181 181 181 181 181 180 180 180 180 180 180 179 179 179 179 178 178 178 178
Yerevan State Medical University Dr. Samuel Dr. Pawan Dhaka Dr. Palak Sodani Dr. Armaan Dr. Sheikh Bilal Dr. Syed Adnan Dr. Sulochana P Dr. Pawan Gupta Dr. Harsh Patel Dr. Gaurav Dr. G Abinaya Dr. Manish Dr.Geethanjali Dr. Bindhiya Dr. Jaganlal Dr. Rodhe B Dr. Santosh Dr. Priyanka Dr. Aniket Kode Dr. Balavignesh Dr. Yamini Dr. Srikanth Dr. Deepak Yadav Dr. Bhushan Dr. Menaga Sara Dr. Kanak Vats Dr. Md Faizan Dr. Anand
Lugansk State Medical University Yerevan State Medical University Jinzhou Medical University Southern Medical University Avicenna Tajik Medical University Soochow Medical University Davao Medical Foundation Harbin Medical University TVER State Medical University Soochow Medical University Davao Medical Foundation Tver State Medical University Tver State Medical University Wuhan University Stavropol Medical University Davao Medical Foundation Kharkiv Medical University Smolensk Medical University Davao Medical Foundation Sichuan University Jiamusi University International School of Medicine Smolensk Medical University Crimea State Medical University SSR Medical College BSMU Qingdao University

178 178 177 177 177 177 177 177 177 177 177 176 176 176 176 176 176 176 175 175 175 175 175 175 175 175 174 174 174
Dr. Kamal Sharma Dr. Bharat Gaud Dr. Bharath Dr. Vipula Dr. Srinivasan Dr. Rishabh Patni Dr. Siddharth Dr. Saddam Dr. Nagendra Dr. Krishnan Dr. Amit Kumar Dr. Shilpi Goel Dr. Priti Narain Dr. Nisha Sharma Dr. Manoj Saran Dr. Vijith Mg Dr. Saurav Dr. Rahul Dr. Lokesh Dr. Vikram Dr. Sonia Soni Dr. Bhushan Dr. Aasim Sha¿ Dr. Vikas Dr. Arthana Dr. Amrita Singh Dr. Madasamy Dr. Anmol kumar Dr. Mujawar
BSMU BSMU Qingdao University IFVN University BSMU Smolensk Medical University Nepalgunj Medical College National Medical College Smolensk Medical University Osh State Medical University Nantong Medical University Kharkiv Medical University Kazan State Medical University Karaganda Medical University Southern Medical University Osh State Medical University Zaporozhye Medical University Davao Medical Foundation Jiamusi University Kharkiv Medical University Smolensk State University University of Science & Technology Tver State Medical Academy Stavropol Medical University Guangxi Medical University Crimea State Medical University Tribhuvan University Davao Medical School Foundation

217 216 214 212

Dr. Imroz Khatri Dr. Aryak Singh Dr. D Venkatesan Dr. Shalika
Odessa Medical University SSR Medical College Davao Medical Foundation Davao Medical Foundation

174 174 174 174 174 174 173 173 173 173 173 173 173 173 172 172 172 172 172 172 172 172 171 171 171 171 171 171 170
Dr. Junaid Khan Dr. Atul A Moon Dr. Akash Dr. Aafreen Arif Dr. Banita kumari Dr. Subha B Dr. P Judith Dr. Md Irfan Dr. Kasif Agaz Dr. Jegannath Dr. B Selva Dr. Abroo Gupta Dr. Arjun Raj Dr. Ajay Kumar Dr. Manish kumar Dr. S Sharma Dr. Pankaj Patle Dr. Jyotsana Dr. Kamlesh Dr. Abhijeet Aman Dr. Dheeraj batra Dr. Dhivakar Dr. Qurat Ul Ain Dr. Sadhana Dr. Vinayak Dr. Srusti Girish Dr. Shubhdarshan Dr. Akshay Dr. Maheshwar
Karaganda Medical University Dalian Medical University Crimea State Medical University Anna Medical College Bukovinian Medical University Davao Medical School Foundation Davao Medical School Foundation Southern Medical University Southern Medical University Tribhuvan University of Nepal Tver State Medical Academy SSR Medical University Davao Medical School Foundation Capital Medical University Odessa Medical University Qingdao Medical Taishan Medical University Odessa Medical University Asian Medical University TVER State Medical University Davao Medical School Foundation University of Science and Technology Davao Medical Foundation Crimea State Medical University Smolensk Medical University Dagestan State Medical Academy Northern State Medical University Bukovinian Medical University

170 170 170 170 170 170 170 170 170 170 169 169 169 169 169 169 169 169 168 168 168 168 168 168 168 168 168 167 167
Dr. Sheetal Attri Dr. Shahnawaz Dr. Santhosh Ram Dr. Phalguni Dixit Dr. Nisha K Lalani Dr. Imran Khan Dr. Hayat Khan Dr. Arshee Dr. Arutselvan Dr. Anitta Dr. Vaishali Dr. Nishant Dr. Madhur kumar Dr. Maadhu Dr. Jyotsna Singh Dr. Ashutosh Dr. Ashok Dr. M.Mehetre Dr. Vinay verma Dr. Sanjay Meena Dr. P Snehal Dr. Yawar Abas Dr. Vivek Bhosure Dr. Satish Solanki Dr. Santosh Dr. Manish Dr. Abhilekh Dr. Madhu Anand Dr. Somdutt
Southern Medical University Hebei Medical University Davao Medical Foundation UCMS TVER Medical University Tribhuvan University Tribhuvan University Jahurul Islam Medical College Yerevan State Medical University Davao Medical Foundation NGMC Osh State Medical University SSR Medical College Zaporozhye Medical University Crimea State Medical University Nantong University Asian Medical Institute Kazan State Medical University Crimea State Medical University Karaganda Medical University TVER State Mendal University Yangzhou Medical University Smolensk Medical University Crimean Federal University Janaki Medical College Yerevan State Medical University Tbilisi State Medical University Guangxi Medical University Bukovinian Medical University
212 211 210 208
Dr. Ninad Dhuri Dr. Prem Raghul Dr. Bala Soundari Dr. Puja
NNSMA Davao Medical Foundation Davao Medical Foundation Davao Medical Foundation

167 167 167 167 167 167 167 167 167 167 167 166 166 166 166 166 166 166 166 166 166 166 166 165 165 165 165 165 165
Dr. Shweta Dr. Pavneet kaur Dr. Manish Dr. Pavan George Dr. Kartika Dr. G Dinesh Dr. Arun Kumar Dr. Akshay Dr. Ch. Jagdish Dr. Ch Divya Dr. Arpitha Raju Dr. Veena Dr. Sidharth Guleria Dr. Roy Romil Dr. Ishani Basu Dr. Narendra Ch Dr. Kiran Teja Dr. Dinesh Kumar Dr. Dhruv Patel Dr. Bhumika Dr. Amit Grewal Dr. Ameena Dr. Pragya Dr. Balaajit Dr. Shilpa Gupta Dr. karishma Dr. G. Femin Dr. Sai Prakash Dr. Ruby Siddiqui
Qingdao University Crimea State Medical University Kazakh Medical University China Three Gorges University Yerevan State Medical University TVER State Medical University TVER State Medical University Bashkir State Medical University Dali University TVER State Medical University Nanchang University Xiamen University BSMU Guangxi Medical University Karaganda Medical University Zaporizhia Medical University Asian Medical Institute Smolensk Medical University Karaganda Medical University Voronezh Medical University Wuhan University Davao Medical School Foundation Davao Medical School Foundation National Medical College Crimean Federal University Smolensk State University International School of Medicine Ningbo University

208 206 205 205 165 165 164 164 164 164 164 164 164 164 164 164 164 163 163 163 163 163 163 162 162 162 162 162 162 162 162 161 161
Dr. Neha Dr. Dipesh Dr. Susanskriti Dr. Riddhi Dr. Anand Gupta Dr. A Depu Dr. Devendra Dr. Deepa Yadav Dr. Ajay Kumar Dr. Reeman Younis Dr. Rishi Dr. Ruhi Dandge Dr. Vijay Dr. Rahul Singh Dr. G.Sreelekha Dr. Ramjee Dr. Minakshi Dr. B.Gayathri Dr. Anirudh Rana Dr. Sarona sharma Dr. Jayendra karn Dr. Ezhilarasi Dr. Ashish Dutta Dr. Sachin Dr.Lukmanul Dr. Anuj Sharma Dr. Ch.Venkat Dr. Shriya Dr. Hitesh
International School of Medicine OSH State University Odessa Medical University Smolensk State University Xuzhou Medical University Dali University Tribhuvan University Smolensk State University Soochow University Davao Medical Foundation Davao Medical Foundation Davao Medical Foundation Kazan State Medical University Nantong University Kazan State Medical University Kharkiv Medical University Crimea State Medical University Guangxi Medical University Hebei Medical University Davao Medical Foundation Voronezh Medical University Crimea Federal University Xuzhou Medical University Central America Health Sciences Soochow University Davao Medical Foundation
Dr. Dilip Dr. Vaibhav Dr. Y Surendra Dr. Mehtab
Davao Medical Foundation Davao Medical Foundation Guangxi Medical University Crimea State Medical University

161 161 161 161 161 161 161 161 161 161 160 160 160 160 160 160 160 159 159 159 159 159 159 159 158 158 158 158 158
Dr. Atul Vilas Dr. Nupur Goswami Dr. Nancy Peter Dr. Kiran Shinde Dr. Jeyamalar Dr. Imran khan Dr. Akshay Dr. Aaryan Saini Dr. Dhola Akshay Dr. Avinash Dr. Nakum Paresh Dr. M. Krishnam Dr. Virendra Dr. Sharmily Dr. Md Nazmuddin Dr. Begum Cindy Dr. Ashmita A Dr. Shrushti Dr. Murtaza Ali Dr. Manish Dr. Pulak Jana Dr. Dikhya Dr. Dheeraj Dr. Abhishek Dr. Vinit Dr. Tarandeep Dr. Mahaveer Dr. Kavita Dr. Vikesh
Smolensk Medical University BSMU Dali University Smolensk State University Ivano-Frankivsk National University Odessa National University Northern State Medical University TVER State Medical University BSMU Nanchang University Nantong University Tribhuvan University Janki Medical College Davao Medical Foundation Avicenna Tajik Medical University Sun Yat-sen University Davao Medical Foundation Soochow University Bogomolets Medical University National Medical College Medical College of Nanchang Zhengzhou University Stavropol Medical University Smolensk State University SSR Medical College BSMU Ryazan State Medical University Ningbo University

202 202 202 201

Dr. Sharon Rose Dr. Shwetangi Dr. Bhaswati Dr. Kanika Mathur 158 158 158 158 157 157 157 157 157 157 157 157 156 156 156 156 156 156 156 156 156 156 156 156 156 155 155 155 155
Dr. Sachin Vijay Dr. Md Fahad Dr. Gohil Rohit Dr. Bejoy Abraham Dr. Venkatesh Dr. Ramesh Dr. Khushbu Dr. Jerine R Dr. Nilesh Dr. Manish kumar Dr. Josephine Dr. Arjun Rawat Dr. Roy Jigar Dr. Prakash Dr. Poornima Dr. Nitin Dr. Vishvesh Dr. Syed Tafhiem Dr. Venkateshwara Dr. Pavadiya Adil Dr. Neelima Dr. Kanika Dr. Bhajneesh Dr. Dwipanyita Dr. V.S.Venstel Dr. Roney Dr. Nitin Tomer Dr. Keshav Gaur Dr. Dipti
Davao Medical Foundation SSR Medical College Tver state medical university SSR Medical College BSMU Odessa Medical University Davao Medical Foundation Davao Medical Foundation Smolensk State University Kazan State Medical University Southern Medical University Southern Medical University Volgograd Medical University Smolensk Medical University Odessa Medical University Jiangsu University Davao Medical Foundation Davao Medical Foundation Karaganda Medical University Jiamusi Medical College Davao Medical Foundation Smolensk State University Yerevan State Medical University BSMU Stavropol Medical University Dali University Smolensk State University Stavropol Medical University Kharkiv Medical University Yangzhou Medical University Tribhuvan University

155 154 154 154 153 153 153 153 153 153 152 152 152 152 152 152 152 152 151 151 151 151 151 150 150 150 150 150 150
Dr. Aakanksha Dr. Hemsingh Dr. Raman Dr. Arka Das Dr. Harendra Dr. E Henry Dr. Hemavathi Dr. Ravi Baliyan Dr. Nirmit Shah Dr. Md Khizer Dr. Iftikhar Dr. Hashmat Ali Dr. Raghuram Dr. Thennarasu Dr. Chandni Dr. Khushboo Dr. Gajala Qureshi Dr. Ancy A Antils Dr. Vatanvir Dr. Harshit kumar Dr. Chiranjeevi Dr. Md Musaib Dr. Nisha Munda Dr. Janmi Dr. Vishwalok Dr. Ramraj Dr. Jayashree Dr. Ashish Dr. Deepak
Crimea Federal University Yangzhou University Soochow University Jinan University Avicenna Tajik Medical University Davao Medical Foundation TVER State Medical University Stavropol Medical University Crimean Federal University Kharkiv Medical University Crimea State Medical University Xinjiang Medical University TVER State Medical University Kyrgyz State Medical Academy Crimea Federal University Karaganda Medical University Stavropol Medical University Universal College of Medical Sciences Karaganda Medical University Zaporizhia Medical University Soochow Medical University Crimean State Medical University Southern Medical University Capital Medical University Nantong University TVER State Medical University TVER State Medical University Kharkiv Medical University

200 200 200

Dr. Md Ashif Dr. Ana Kalia Dr. Ebadulla Md
BSMU Crimea State Medical University Davao Medical Foundation 150 For query :
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