Forensic Medicine Mnemonics
Dr K Chaudhry

FIRST Author of Jaypee Brothers

 

 

My teacher’s Family History :-

Dr SH Rizwi was Lecturer & HOD Forensic Medicine.

His younger brother Abdul Hamid Rizwi was my senior.

AH Rizwi appeared in I professional Examination, passed Anatomy and failed in Physiology.

He appeared in Supplementary examination and failed again in Physiology.

As per rules, he had to appear in both the subjects again next year.

Next year, he passed Physiology and failed in Anatomy.

He appeared in Supplementary examination and failed again in Anatomy.

As per rules, he was not allowed any further attempts and was expelled from the college.

Perhaps a year spent in Courts.

The Court eventally upheld AH Rizwi as having passed both Anatomy and Physiology, and set aside expulsion from JN Medical College. He was promoted in accordance with the period elapsed. That way my senior AH Rizwi became my batchmate and VERY close friend.

 

Forensic Medicine

Abortifacients

 

 

Drugs

 

 

Mifepristone

 

 

Misoprostol

 

 

Oxytocin

 

 

Oleanders

 

 

Aconite

 

Herbal

 

 

Pill aloes et myrrh – A WONDER substitute for Methergin

 

 

Calotropes

 

 

..

.

 

 

Medicine

 Chapter 01 : Haemopoietic System

Anaemia - Causes

Boring

A. Blood loss (Haemorrhagic anaemia)

 

Prick

1. Postoperative

 

And

2. Accidents

 

Pain

3. Peptic ulcer

 

Have

4. Haemorrhoids

 

Made

5. Menstruation

 

History

6. Hookworm infestation

Dames

B. Deficiency of haemopoietic factors (Dyspoietic anaemia)

 

1. Iron deficiency anaemia

 

2. Pernicious anaemia

Don’t

C. Destruction of erythrocytes (Haemolytic anaemia)

 

Some

1. Spherocytosis

 

Secret

2. Sickle-cell anaemia

 

Enemy

3. Erythroblastosis foetalis

Love

D. Lowered activity of haemopoietic tissue (Aplastic anaemia)

 

Tapeworm

1. Toxic anaemia 

 

Bachelor

a. Benzene derivatives

 

Computer

b. Chloramphenicol

 

Applications

c. Arsenic

 

In

2. Irradiation anaemia

 

- X-rays

 

Infected

3. Infections

 

a. Typhoid

 

b. Diphtheria

 

Men

4. Marrow replacement

 

Love

a. Leukaemias

 

My

b. Multiple myeloma

 

Husband

c. Hodgkin's disease

 

Investigation of a Case of Anaemia 

 

 

A. History

 

 

 

(a) Age and sex

 

 

 

 

1.  Infants. Prematurity

 

 

 

 

2. School children. Worm infestation

 

 

 

 

3. Young ladies. Menstrual disorders

 

 

 

 

4. Old age. Malignancies

 

 

 

(b) Onset acute in :-

 

 

 

 

1.  Haemarrhage

 

 

 

 

2.  Acute leukamia

 

 

 

 

3. Haemolysis

 

 

 

(c) Occupation

 

 

 

 

1.  Agriculture. Hookworm

 

 

 

 

2. Industry. Toxic chemicals

 

 

 

(d) latrogenic

 

 

 

 

1.  Salicylates

 

 

 

 

2.  Radiotherapy

 

 

 

(e) Diet

 

 

 

 

(f) Family history

 

 

 

 

1.  Congenital haemolytic anaemias

 

 

 

 

2.  Pernicious anaemia

 

 

 

(g) Haemorrhage

 

 

 

 

1.  Haematemesis

 

 

 

 

2.  Melaena

 

 

 

 

3.  Haemorrhoids

 

 

 

 

4.  Menorrhagia and metrorrhagia

 

 

 

 

5.  Haematuria. 

 

 

 

 

6.  Haemoptysis

 

 

 

(h) Gastrointestinal Symptoms

 

 

 

 

1 . Peptic ulcer

 

 

 

 

2.  Liver cirrhosis

 

 

 

 

3.  Malignancies

 

 

 

 

4.  Hiatus hernia

 

 

 

 

5. Diarrhoea and vomiting (chronic)

 

 

 

 

6.  Glossitis

 

 

 

(i) Bleeding tendency

 

 

 

 

1.  Bruises

 

 

 

 

2.  Petechiae

 

 

 

 

3. Prolonged bleeding at multiple sites

 

 

B. Physical examination

 

 

 

(a) Skin

 

 

 

 

1. Lemon yellow tint. Pernicious anaemia

 

 

 

2.  Ashen tint. Acute leukaemia

 

 

 

3.  Coarse and dry. Myxoedema

 

 

 

4.  Petechiae

 

 

 

 

(i) Aplastic anaemia

 

 

 

 

(ii) Leukaemia

 

 

(b) Nails

 

 

 

 

1. Brittleness

 

 

 

 

2. Ridging

 

 

 

 

3. Koilonychia

 

 

(c) Conjunctivae

 

 

 

 

1.  Pallor

 

 

 

 

2. Icterus suggests haemolytic anaemia or hepatic disease ; mild icterus may suggest pernicious anaemia. 

 

 

(d) Mouth

 

 

 

 

1. Gums. Hypertrophy in leukaemia (monocytic)

 

 

 

 

2. Tongue. Smooth tongue in megaloblastic or occasionally iron­deficiency anaemia

 

 

 

 

3. Mucous membrane. Petechiae in aplastic anaemia and leukaemia

 

 

 

 

4. Pharynx. Ulceration in acute aplastic anaemia and leukaemia

 

 

 

 

5. Angular stomatitis. Iron dcficiency anaemia

 

 

(e) Cardiovascular system

 

 

 

 

1 . Hypertension. Renal disease

 

 

 

 

2. Cardiac murmur. Subacute bacterial enclocarditis, rheumatic fever, congenital heart disease

 

 

 

 

3. Haemic murmur. Nonspecific anaemia

 

 

(f) Abdomen

 

 

 

1.  Splenomegaly

 

 

 

 

(i) Leukaemia

 

 

 

 

(ii) Haemolytic anaemias

 

 

 

 

(iii) Megaloblastic anaemias

 

 

 

 

(iv) Multiple myeloma

 

 

 

 

(v) Myelosclerosis

 

 

 

 

(vi)  Severe iron deficiency anaemia

 

 

 

2  Abdominal mass

 

 

 

 

(i)  Gastric carcinoma

 

 

 

 

(ii) Retro-peritoneal malignant lymph nodes

 

 

 

 

(iii) Malignant lymphoma

 

 

 

 

(iv) Chronic lymphatic leukaemia

 

 

 

3. Localised tenderness

 

 

 

 

- Peptic ulcer

 

 

(g) Lymph nodes enlarged in :-

 

 

 

 

1. Leukaemia

 

 

 

 

2. Malignant lymphoma

 

 

 

 

3. Secondary carcinoma

 

 

(h)  Bones - Tenderness, particularly sternal, in :-

 

 

 

 

1. Leukaemia

 

 

 

 

2. Malignant lymphomas

 

 

 

 

3. Metastatic bone carcinoma

 

 

 

 

4. Multiple myeloma

 

 

 

 

5. Myelosclerosis

 

 

(i)  Breast  - Evidence of breast carcinoma

 

 

(j) Rectal examination

 

 

 

 

1. Haemarrhoids and fissure

 

 

 

 

2. Prostatic carcinoma

 

 

(k)  Pelvic examination - Female genital disorders

 

 

(1) Fonclus examination

 

 

 

 

1. Infiltration. Leukaemia

 

 

 

 

2. Retinitis. Chronic renal failure

 

Iron Deficiency Anaemia - Causes

A. Deficient intake

B. Improper utilisation

C. Excessive demand

1. Children 6 months - 2 years

2. Adolescents

3. Menstruation

4. Pregnancy and lactation

D. Blood loss

1. External haemorrhage

2. Menorrhagia

3. Gastrointestinal bleeding

i. Peptic ulcer

ii. Portal hypertension

iii. Oesophageal varices

iv. Ulcerative colitis

v. Amoebic dysentery

vi. Carcinoma of stomach, rectum

4. Urinary track bleeding

i. Haematuria

ii. Haemoglobinuria

5. Other bleeding

i. Epistaxis

ii. Haemoptysis

6. Parasitic infestations

- Ankylostomiasis

E. Iron loss without bleeding

- Exfoliative dermatitis

Iron Deficiency Anaemia - Symptoms

1. Weakness and lassitude

2. Dyspnoea on exertion

3. Palpitation

4. Headache, bodyache

5. Pallor

6. Precordial pain

7. Oedema of ankles

8. Gastrointestinal symptoms

i. Abdominal pain

ii. Anorexia and pica

 

Iron Deficiency Anaemia - Diagnosis

 

1. Blood picture

 

 

(i) Erythrocyte count low

 

 

(ii) Colour index low

 

 

(iii) Mean corpuscular diameter smaller

 

 

(iv)  No evidence of haemolysis

 

 

(v) Leucopenia with relative lymphocytosis

 

 

(vi)  Thrombocytopenia

 

2. Serum iron depressed ; total iron binding capacity elevated

 

3. Serum ferritin concentration depressed

 

4. Erythrocyte protoporphyrin elevated

 

5. Bone-marrow 

 

 

(i) Normoblastic hyperplasia with normoblasts of varying maturity comprising majority of total nucleated cell count

 

 

(ii)  Frequent malformed cells

 

 

(iii)  Haemoglobinization deficient in proportion to nuclear maturity

 

 

(iv)  Micronormoblasts numerous, in severe cases

 

6. Stool examination 

 

 

(i)  Ova of ankylostoma and amoebic cysts

 

 

(ii)  Voluminous fatty stools in malabsorption

 

 

(iii)  Occult blood

 

7. Barium meal X-ray, may show gastrointestinal bleeding disorder

 

8. Endoscopy. Proctoscopy, sigmoidoscopy

 

9. Urine examination and I.V.P. , if haematuria

 

Megaloblastic Anaemia

Conditions associated

I

1. Intrinsic factor deficiency

i. Pernicious anaemia

ii. Postgastrectomy syndrome

D

2. Diet deficiency

B

3. Blind or stagnant loop

I [IDBI]

4. Infancy and pregnancy

Pernicious Anaemia - Symptoms

1. Onset insidious with progressive weekness

2. Pallor

3. Dyspnoea on exertion

4. Palpitation

5. Anginal pains (occasionally)

6. Tongue sore

7. Numbness and tingling

8. Vomiting and diarrhoea

9. Vision diminished

10. Weight loss

Signs

1. Tongue smooth and atrophic

2. Curtaneous pigmentation with leucoderma and petechiae

3. Spleen palpable

4. Patchy anaesthesia of leg

5. Muscle weakness and extensor plantar response

6. Depressed tendon reflexes

7. Oedema of ankles

8. Cardiomegaly

9. Optic atrophy

Aplastic Anaemia

Causes

A. Chemical agents

1. Benzene derivatives

2. Chloramphenicol

3. Arsenic and heavy metals

4. Sulphonamides

5. Chlorpropamide

B. Physical agents

X-ray and radium

C. Infections

1. Typhoid

2. Diphtheria

3. Miliary tuberculosis

4. Malignant endocarditis

D. Replacement causes

1. Leukaemias

2. Multiple myeloma

3. Hodgkin's disease

4. Ewing's disease

5. Osteosclerosis

6. Multiple secondary carcinomatous deposit

Haemolytic Anaemia

Etiology

A. Intrinsic defects in red cells

a. Inherited

1. Familial acholuric jaundice (Spherocytosis

2. Non-spherocytic haemolytic anaemia

3. Hereditary elliptocytosis

4. Haemoglobinopathies

i. Sickle cell anaemia

ii. Thalassaemia

b. Acquired

1. Paroxysmal nocturnal haemoglobinuria

2. Dyspoietic anaemia

B. Pathological haemolytic mechanisms

a. Obscure antibodies

1. Idiopathic acquired haemolytic anaemia

2. Secondary haemolytic anaemia

i. Carcinomatosis

ii. Reticulosis

b. Isoglutinins and lysins

1. Rh incompatibility

2. Transfusion reaction

3. Cold haemoglobinuria

c. Parasitic disease

Malaria

d. Haemolytic poisons

1. Bacterial

i. Clostridium welchii

ii. Streptococcus pyogenes

2. Chemical

i. Phenylhydrazine

ii. Potassium chlorate

iii. Lead

3. Vegetable

Saponin

Clinical picture

1. Anaemia

2. Fever

3. Jaundice

4. Spleen enlarged and tender

Polycythaemia

Etiology

A. Relative polycythaemia (dehydration)

1. Vomiting

2. Diarrhoea

3. Traumatic shock

4. Excessive burns

B. True polycythaemia (polycythaemia rubra)

a. Primary or idiopathic (polycythaemia vera)

b. Compensatory polycythaemia

1. High altitudes

2. Chronic pulmonary disease

i. Emphysema

ii. Chronic pulmonary fibrosis

iii. Chronic pulmonary congestion

3. Increased erythropoietin production

i. Renal lesions

Tumours

Cysts

Hydronephrosis

ii. Carcinoma of liver

iii. Cerebellar haemangioblastoma

iv. Uterine myomata

Symptoms

1. Headache and vertigo

2. Weakness and lassitude

3. Dyspnoea with haemoptysis

4. Diplopia

5. Left upper abdominal pain

6. Bone pains

7. Dyspepsia and neuralgia

8. Neurological symptoms

i. Hemiplegia

ii. Transitory unconsciousness

iii. Epileptiform fits

iv. Paraesthesia

v. Insomnia

vi. Tingling of extremities

vii. Psychic disturbances

9. Intolerance to cold and heat

10. Haemorrhages

11. Pruritus

Signs

1. Face congested with prominent malar bones

2. Ecchymoses, purpura and haemorrhages

3. Eyes blood shot, retinal vessels tortuous, papilloedema

4. Complexion dusky

5. Cyanosis

6. Signs of thrombosis at any site

7. Hypertension

8. Spleen enlarged

Transfusion Reactions

1. Febrile reactions

2. Allergic reactions

3. Circulatory reactions

4. Haemolytic reactions

5. Reactions due to infected blood

6. Thrombophlebitis

7. Air embolism

8. Transmission of disease

9. Transfusion haemosiderosis

10. Immunological sensitization

Leucocytosis

Causes

A. Physiological

1. After meals

2. Exercise

3. Emotional stimuli

4. Pregnancy

B. Pathological

1. Infection

2. Haemorrhage

3. Malignancies

4. Trauma

i. Surgical operations

ii. Crush injuries

iii. Burns

5. Myocardial infarction

6. Drugs

i. Phenacetin

ii. Digitalis

iii. Quinine

iv. Adrenalin

v. Organic arsenicals

vi. Metals, eg mercury, lead

vii. Carbon monoxide

7. Metabolic disorders

i. Renal failure

ii. Diabetic coma

iii. Acute gout

iv. Eclampsia

8. Collagen disease

i. Polyarteritis nodosa

ii. Rheumatoid arthritis

iii. Disseminated lupus erythematosus

iv. Dermatomyositis

9. Miscellaneous

i. Acute intravascular haemoptysis

ii. Serum sickness

iii. Acute anoxia

iv. Spider venom poisoning

Polymorphonuclear Leucocytosis

Causes

1. Pneumococcal pneumonia

2. Empyemia

3. Furunculosis

4. Perinephric abscess

5. Osteomyelitis

6. Appendicular abcess

7. Septicaemia

8. Bacterial endocarditis

Lymphocytosis

Causes

I. Absolute lymphocytosis

A. Chronic infections

1. Tuberculosis

2. Syphilis

3. Undulant fever

4. Malaria

B. Acute infections

1. Infectious mononucleosis

2. Pertussis

C. Lymphosarcoma

D. Thyrotoxicosis

E. Obesity

F. Diabetes mellitus

II. Relative lymphocytosis

1. Viral infections

a. Influenza

b. Measles

2. Typhoid

3. Neutrophilic leucopenia

4. High altitudes

Eosinophilia

Causes

1. Parasitic infestations

i. Ascariasis

ii. Ankylostomiasis

iii. Hydatid cysts

iv. Filariasis

2. Allergic conditions

i. Bronchial asthma

ii. Hay fever

iii. Drug allergy

iv. Serum sickness

v. Angioneurotic oedema

vi. Milk allergy (in infants)

3. Skin disease

i. Urticaria

ii. Eczema

iii. Pemphigus

iv. Exfoliative dermatitis

v. Psoriasis

vi. Dermatitis multiformis

vii. Scabes

4. Drugs

i. Liver extract

ii. Penicillin

iii. Chlorpromazine

iv. Pilocarpine

5. Acute infections

i. Scarlet fever

ii. Chorea

6. Blood dyscrasias and malignant lymphomas

i. Chronic myeloid leukaemia

ii. Polycythaemia

iii. Hodgkin's disease

iv. Multiple myeloma

7. Idiopathic familial eosinophilia

8. Eosinophilic granulomatosis

9. Post-splenectomy

Eosinopenia

Causes

1. Drugs

i. Corticosteroids

ii. Adrenaline

iii. Ephedrine

iv. Insulin

2. Stress

i. Acute infections

ii. Traumatic shock

iii. Surgical operations

iv. Burns

3. Endocrine disorders

i. Cushing's disease

ii. Acromegaly

4. Aplastic anaemia

5. Disseminated lupus erythematosis

Monocytosis

Causes

1. Bacterial infections

i. Tuberculosis

ii. Subacute bacterial endocarditis

iii. Typhoid

2. Protozoal infection

i. Malaria

ii. Kala azar

iii. Trypanosomiasis

iv. Rocky-mountain spotted fever

v. Infectious mononucleosis

vi. Hodgkin's disease

Basophilia

Causes

1. Chronic myeloid leukaemia

2. Myelosclerosis

3. Polycythaemia vera

4. Irradiation

Agranulocytosis

Etiology

1. Acute lymphatic leukaemia

2. Drugs

i. Amidopyrine

ii. Neomercazole

iii. Antihistaminics

a. Pyribenzamine

b. Promethazine

c. Chlorpheniramine

iv. Tranquilizers

a. Chlorpromazine

b. Meprobamate

c. Trifluopromazine

d. Thiethylperazine

v. Antibiotics

a. Chloramphenicol

b. Tetracycline

c. Streptomycin

d. Methicillin

vi. Anticoagulants

a. Phenindione

b. Dicoumarole

vii. Antitubercular drugs

a. Isoniazid

b. Thiacetazone

c. Paraaminosalicylic acid

viii. Miscellaneous

a. Phenytoin sodium

b. Amodiaquin

c. Dinitrophenol

d. Procainamide

e. Mercurial diuretics

d. Carbutamide

3. Bacterial infections

i. Pneumonia

ii. Osteomyelitis

4. Aplastic anaemia 

5. Hypersplenism

6. Idiopathic

Clinical picture

A. Constitutional symptoms

1. Onset sudden

2. Fever with chills

3. Sweating

4. Headache

5. Muscle pains

6. prostration

7. Nausea and vomiting

8. Jaundice

9. Delirium

B. Infective lesions

1. Sore throat

2. Stomatitis

3. Dysphagia

4. Haematemesis and malaena

5. Tongue dry and furred

6. Recurrent infection at site

Leucopenia

Causes

1. Infection

a. Bacterial

1. Typhoid

2. Paratyphoid

3. Brucellosis

4. Fulminant tuberculosis

b. Viral

1. Influenza

2. Measles

3. Infective hepatitis

4. Atypical viral pneumonia

c. Rickettsial typhus

d. Protozoal

1. Malaria

2. Kala-azar

2. Subleukaemic leukaemia

3. Drugs

1. Chloramphenicol

2. Amidopyrine

3. Arsenicals

4. Barbiturates

4. Aplastic anaemia

5. Hypersplenism

6. Bone marrow affections

1. Secondary carcinomas

2. Malignant lymphomas

3. Myelosclerosis

7. Megaloblastic anaemias

8. Disseminated lupus erythematosus

9. Miscellaneous

i. Anaphylactoid shock

ii. Myxoedema

iii. Thyrotoxicosis

iv. Hypopituitarism

v. Liver cirrhosis

vi. Paroxysmal nocturnal haemoglobinuria

Leukaemia

Types

A. Acute leukaemia

1. Lymphoblastic leukaemia

2. Myeloblastic leukaemia

3. Monoblastic leukaemia

4. Stem cell leukaemia

B. Chronic leukaemia

1. Lymphatic leukaemia

2. Myeloid leukaemia

3. Monocytic leukaemia

C. Miscellaneous (rare acute and chronic leukaemia

1. Erythroleukaemia (Di Guglielmo's disease)

2. Eosinophilic leukaemia

3. Megakaryocytic leukaemia

4. Plasma cell leukaemia

5. Chloroma

Acute leukaemia

Clinical picture

1. Sudden onset

2. Anaemia

3. Haemorrhage

4. Upper respiratory infections

5. Other infections

i. Cellulitis

ii. Paronychia

iii. Bacteraemia

iv. Pyaemia

v. Otitis media

6. Constitutional symptoms

i. Fever

ii. Malaise

iii. Prostration

iv. Generalized pains

7. Lymph nodes enlarged

8. Liver and spleen enlarged

9. Bone and joint pains

10. Tachycardia, arrhythmia, signs of pericarditis

11. Signs of intracerebral haemorrhage and meningeal irritation

Chronic myeloid leukaemia

Symptoms

1. Onset insidious

2. Weakness - pallor, dyspnoea

3. Malaise, weight loss, night sweating

4. Left hypochondrial pain

5. Gastrointestinal symptoms

i. Dyspepsia

ii. Flatulence

iii. Fullness after eating

iv. Swealling of abdomen

v. Diarrhoea or constipation

vi. Vomiting and nausea

6. Haemorrhages

7. Bone and joint pains

8. Amenorrhoea

9. Priapism

10. Symptoms of cerebral haemorrage

11. Skin lesions and pruritus

12. Fever (late)

Signs

1. Anaemia

2. Spleen highly enlarged

3. Liver enlarged, with smooth surface

4. Lymph nodes enlarged

5. Muscle wasting

6. Ascites

7. Buising of skin

8. Bone tenderness

Bleeding Disorders

A. Due to defects in intrinsic clotting mechanism

1. Haemophilia

2, Christmas disease

3. Hypothrombinaemia

4. Fibrinogenopenia (congenital and acquired)

B. Due to deficiency of platelets

1. Idiopathic thrombocytopenic purpura

2. Secondary thrombocytopenic purpura

C. Due to defects in capillary endothelium

1. Anaphylactoid purpura (Henoch-Schoenlein purpura)

2. Drug purpura

i. Iodides

ii. Belladonna alkaloids

iii.Cinchona alkaloids

iv. Ergot

v. Salicylates

vi. Snake venom

3. Infections

i. Meningococcal meningitis

ii. Bacterial endocarditis

iii. Rheumatic fever

iv. Septicaemia

v. Measles

4. Ascorbic acid deficiency

5. Senile purpura

6. Metabolic purpura

i. Uraemia

ii. Cholaemia

7. Hereditary

i. Von Willebrand disease

ii. Hereditary haemorrhagic telangectasia

 

 

Chapter 02 : Endocrine disorders

Causes of Thyroid Enlargement

A. Toxic goitres

1. Primary

2. Secondary to nodular goitre

B. Toxic

1. Physiological hyperplasia

i. Puberty

ii. Pregnancy

iii. Menopause

2. Colloid goitre

i. Multiple

a. Endemic

b. Sporadic

ii. Solitary

C. Neoplasms

1. Carcinoma

2. Reticulosarcoma

3. Secondary tumour

D. Thyroiditis

1. Hashimoto's disease

2. Riedel's thyroiditis

3. de Quervain thyroiditis

4. Acute thyroiditis

D/D Dwarfism

1. Pituitary dwarfism

2. Cretinism

3. Turner's syndrome

4. Sexual precocity

5. Achondroplastic dwarfism

6. Primordial dwarfism

Complications of Diabetes Mellitus

1. Generalised arteriosclerosis involving particularly

i. Coronary arteries

ii. Cerebral arteries

iii. Arteries of the extremeties

2. Diabetic nephropathy

i. Intercapillary glomerulosclerosis

ii. Acute or chronic pylonephritis

iii. Papillitis necroticans

iv. Renal arteriosclerosis

3. Diabetic retinopathy

i. Punctate haemorrhages and exudates

ii. Venous distension and tortuosity

iii. Arteriosclerotic changes when associated with hypertension

iv. Retinitis proliferans

v. Capillary microaneurysms

4. Diabetic neuropathy

a. Peripheral neuritis

b. Autonomic visceral neuropathies

i. Nocturnal diarrhoea

ii. Constipation

iii. Urinary incontinence

iv. Atonic bladder

v. Myotic sluggish pupils

vi. Peripheral oedema

vii. Impotence

viii. Charcot's degenerative joint disease

5. Pregnancy complications

1. Dystocia

2. Repeated abortions

3. Stillbirths

4. Deformed baby

5. Eclampsia

Causes of Tetany

1. Parathyroid deficiency

i. Damage during thyroidectomy

ii. After parathyroidectomy

iii. Congenital

2. Deficient calcium absortion

i. Rickets

ii. Coeliac disease

iii. Sprue

iv. Cholera

v. Megacolon

3. Alkalosis

i. Pyloric stenosis

ii. Overuse of antacids

iii. Persistent vomiting

iv. Intestinal obstruction

v. Nephritis

4. Hyperpnoea

i. Hysterical

ii. Voluntary

iii. Excessive exercise

5. Poisons

i. Chloroform

ii. Lead

iii. Morphine

iv. Arsenic

6. Nervous

i. Syringomyelia

ii. Cerebral tumours

7. Pregnancy and lactation

8. Idiopathic

03 Alimentary System

Tongue

 

Senior

A. Size

 

Students

B. Shape

 

Come

C. Colour changes

 

Along

D. Altered hydration

 

Andhra

E. Abnormal furring

 

Pradesh

F. Papillae

 

Union

G. Ulcers

 

To

H. Taste sensation

 

Continue

I. Consistence

 

Movement

J. Movements and articulation 

Tongue - Size

a. Large tongue

(i) Uniform

Please

1. Primary amyloidosis

Give

2. Glycogen storage diseases

My

3. Mucopolysaccharoidosis

Compli-

4. Congenital heart disease

Ments

5. Mongolism

And

6. Angioneurotic oedema

Congrats

7. Cretinism and Myxoedema

And

8. Acromegaly

Thanks

9. Tumours of muscle tissue

And

10. Anaemia

Love

11. Ludwig's angina

(ii) Localised

Central

1. Congenital hemiatrophy of face

Pay

2. Plexiform neurofibroma of the trigeminal nerve

Office

3. Oedema due to

Tumbler

i. Trauma

Is

ii. Infections

A

iii. Allergy

Little

iv. Lymphatic Obstruction

Vessel

v. Venous Obstruction

Means

4. Median rhomboid glossitis

Central

5. Congenital cysts

Service

6. Suprahyoid cysts

Relating

7. Ranula

To

8. Tuberculous infiltration

Give

9. Gumma

And

10. Actinomycosis

Take

11. Tumours of nerves and vessels

b. Small tongue

(i) Symmetrical

Patient

1. Pseudobulbar palsy

People

2. Progressive bulbar palsy

Drive

3. Dehydration

Slowly;

4. Starvation or malnutrition

Hence

5. Haemorrhage

Are

6. Atrophic glossitis

Truly

7. Typhus

Safe

8. Simmond's disease

(ii) Asymmetrical

Copper

1.Congenital hemiatrophy of face

Heavy

2. Hypoglossal palsy

Metal

3. Myasthenia gravis

Tongue - Shape

Some

1. Sickle-Shaped 

- Ipsilatral lower motor neurone lesion

Salary

2. Small-pointed 

- Pseudobulbal palsy

Plus

3. Plication

- Melkersson's syndrome

Allowances

4. Alligator

- Diabetes mellitus

Tongue - Colour

Generally

1. Greyish

- Normal

Common

2. Chalky white

- Ankylostomiasis

People

3. Pale

- Iron deficiency anaemia

Rely

4. Red or magenta

Some

a. Sprue

Teachers

b. Tropical macrocytic anaemia

Love

c. Liver cirrhosis

Poetry

d. Pernicious anaemia

Upon

5. Uniform blue

- Central cyanosis e.g., Fallot's tetrology

Purity

6. Patchy blue (in apicomarginal zone)

- Prolonged bismuth therapy

Yet

7. Yellow

- Jaundice

Bombayites

8. Black

Call

a. Congenital melanoglossia

An

b. Addison's disease

Able

c. Ankylostomiasis

Physician

d. Pernicious anaemia

Drink

9. Dirty-brown

Can

a. Chronic uraemia

Eat

b. Excessive smoking

Mango

c. Mouth breathing

Diet

d. Dehydration

Far

10. Fiery red

- Nicotinamide deficiency

Poor

11. Purple

- Polycythaemia

Standard

12. Strawberry

- Scarlet fever

Wines

13. White

To

a. Thrush

See

b. Syphilis (Secondary stage)

Look

c. Leukaemia

Carefully

d. Carcinoma

Tongue - Hydration

(i) Excessive moisture

1. Irritative lesions

Local

Sharp

a. Stomatis

Edge

b. Epithelioma of tongue

Cutter

c. Carious teeth

Nervous

a. Trigeminal neuralgia

b. Herpes zozter of trigeminal nerve

2. Increased salivary production

- Hyperacidity

3. Defective swallowing

a. Parkinsonism

b. Hydrophobia

(ii) Excessive dryness

D (3Ds)

1. Diminished salivary secretion

Some

a. Sarcoidosis

Silly

b. Sjogren's syndrome

Men

c. Mikulicz's syndrome

Live

d. Lymphatic leukaemia

Like

e. Lymphosarcoma

Bandits

f. Belladonna preparations

D

2. Depletion of body fluids

Physiological

Dance

a. Diminished intake

Every

b. Excessive output

Moment

c. Mouth breathing

Pathological

Can

a. Cholera

Pay

b. Polyuria

Daily

c. Diarrhoea

Visits

d. Vomiting

D

3. Defective development

- Endocrinal dysplasia

 Tongue - Furring

Bombay

(i) Bilateral accessive furring

1. Local infections

State

a. Stomatitis

Trading

b. Tonsillitis

Corpn

c. Colds

Sale

d. Sinusitis

Purchase

e. Pneumonia

Branch

f. Bronchitis

2. Dehydration of mouth

Good

a. General dehydration

People

b. Pyrexia

May

c. Mouth breathing

Stay

d. Smoking

United

e. Uraemia

University

(ii) Unilateral furring

Heavy

1. Hypoglossal furring

Traffic

2. Trigeminal neuralgia

Hazards

3. Herpes zoster of trigeminal nerve (mandibular branch)

Closed

(iii) Centripetal furring

- Typhoid fever

Again

(iv) Absence of fur

Visit

1. Vitamin B deficiency

Any

2. Anaemia

Small

3. Subacute combined degeneration of cord

Station

4. Sprue

 Tongue - Papillae

1. Smooth tongue

- Riboflavin deficiency

2. Smooth red raw tongue

Soft

a. Steatorrhoea

Spoken

b. Sprue

Chartered

c. Chronic dysentery

Accountant

d. After gastroenterostomy

 Tongue - Ulcers

 

All

1. Aphthous ulcers

 

Service

2. Syphilitic ulcers

 

Doctors

3. Dental ulcers

 

To

4. Tuberculous ulcers

Come

5. Chronic nonspecific ulcers

Closer

6. Carcinomatous ulcer

 Tongue - Taste sensation

Long

A. Loss of taste sensation (ageusia)

A

1. Anterior 2/3 (Lesions of...)

Central

a. Chorda tympani

Govt

b. Geniculate ganglion

Men

c. Mandibular branch of trigeminal nerve

Pigeon

2. Posterior 1/3 

- Lesions of Glossopharyngeal nerve

Under

3. Unilateral

- Lesions of Tractus

Bucket

4. Bilateral

- Lesions of Middle of Pons

Travel

B. Taste hallucinations and parageusia

- Irritative lesion in neighbourhood of uncus

Makes

C. Metallic taste

1. Arsenic and Bismuth therapy

2. Prolonged antibiotic therapy

Giddy

D. Garlic taste

- Phosphorus poisoning

 Tongue - Consistence

Seen

1. Soft - Normal

From

2. Flabby - Lower motor neurone paralysis

Front

3. Firm - Upper motor neurone paralysis

Window

4. Woody - Lipoid proteinosis

 Tongue - Movement and articulation

Pretty

A. Protrusion delayed

My

1. Mentally retarded patients

Lovely

2. Lowered conscious state

Party

3. Parkinson's disease 

Trick

4. Thick tongue

Dancer

2. Deviation of tongue

1. Apparent deviation

i. Facial palsy

ii. Trigeminal palsy

2. True deviation (in relation to central incisors

- Hypoglossal palsy

Doing

3. Diminished or absent normal movements

1. Without motor disorders

i. Malignant infiltration

ii. Apraxia

iii. Myasthenia gravis

2. With motor disorders

a. Nuclear or infranuclear lesions

(i). Progressive bulbar palsy

(ii). Syringobulbia

(iii). Infiltration of hypoglossal nerve by a tumour

b. Supranuclear lesion

- Pseudobulbar palsy

A

4. Abnormal movements

1. Extraneurological

A

i. Anxiety and fever

Happy

ii. Habit spasm

Scene

iii. Senility

At

iv. Alcoholism

Theatre

v. Thyrotoxicosis

2. Neurological

i. Chorea (bizarre movements)

ii. Parkinsonism (tremor)

iii. GPI (trombone movements

iv. Degerative lesions of lower motor neurone (fibrillation)

Dance

5. Difficulty in articulation - big, thick, dry tongue

 Symptoms of Big Tongue

The

1. Thick speech

First

2. Frequent tongue biting

Day

3. Dysphagia

Play

4. Protrusion out of the mouth

Ends

5. Excessive salivation

Stomatitis
Types

Same

1. Simple catarrhal stomatitis

Day

2. Deficiency stomatitis

Same

3. Stomatitis in blood dyscrasias

Bankers

4. Bacterial stomatitis

Found

5. Fungal stomatitis (thrush)

Them

6. Viral stomatitis

Attacking

7. Allergic stomatitis

Them

8. Toxic stomatitis

Inside

9. Idiopathic stomatitis (aphthous stomatitis)

Anorexia
Causes

Guys

A. Gastrointestinal

Can

1. Carcinoma of stomach

Count

2. Chronic gastritis

People

3. Pernicious anaemia

In

B. Infections

Pakistan

1. Pulmonary tuberculosis

International

2. Infective hepatitis

Airlines

3. Acute febrile illness

Emergency

C. Endocrine disorders

A

1. Addison's disease

Second

2. Simmond's disease

Hand

3. Hyperparathyroidism

Machine

4. Myxoedema

Never

D. Nervous

1. Anorexia nervosa

2. Anxiety and depression

Pay

E. Physiological

Zebra

1. Zinc deficiency

And

2. Avitaminosis

Horse

3. High carbohydrate diet

Inside

4. Irregular meals

More

F. Miscellaneous

1. Uraemia

2. Digitalis toxicity

Nausea & Vomiting
Causes

Rita

A. Reflex causes

a. Abdominal

Generally

1. Gastric ulcer

Good

2. Gastritis

People

3. Pylorospasm or stenosis

Feel

4. Food poisoning

It

5. Intestinal obstruction

A

6. Acute appendicitis

Privilege

7. Acure peritonitis

Caring

8. Acute cholecystitis

People

9. Acute pancreatitis

Rain Hit

10. Renal and biliary colics

11. Helminths

b. Extra-abdominal

Indian

1. Irritation of pharynx and fauces

Standard

2. Shock

Time

3. Travel sickness

Can

B. Central causes

Heavily 

1. Hydrocephalus

Bred

2. Brain tumour or abscess

Mosquitoes

3. Meningitis

Can

4. Concussion

Cause

5. Cerebral haemorrhage

Malaria

6. Migraine

To

7. Tabes dorsalis

Often

8. Offensive taste

Make

C. Metabolic

His

1. Hepatic disorders

Doctor

2. Diabetic acidosis

Understands

3. Uraemia

Aikment

4. Alkalosis

And

5. Adrenal crisis

Treats

6. Toxaemia of pregnancy

Meticulously

7. Morning sickness in pregnancy

Pudding

D. Psychogenic or hysterical

Weight Loss
Causes

A. With diminished appetite

Pay

a. Psychogenic

Aone

1. Anorexia nervosa

Article

2. Anxiety and depression

Genuine

b. Gastrointestinal

Call

1. Chronic diarrhoea

Every

2. Enzyme deficiencies

Armed

3. Achlorhydria

Man

4. Malabsorption syndrome

In

5. Intestinal parasites

Dues

c. Debilitating states

Two

1. Tuberculosis

Make

2. Malignancy

Company

3. Cardio-vascular disease

My

d. Metabolic

Unions

1. Uraemia

Are

2. Addison's disease

High

3. Hypercalcaemia

Headed

4. Hypokalaemia

Boy

e. Blood disorders

Look

1. Leukaemia

Here

2. Hodgkin's disease

Mister

3. Mylofibrosis

Keep

f. Kidney diseases

1. Chronic glomerulonephritis

2. Pyelonephritis

Lowering

g. Liver disorders

Long

1. Liver cirrhosis

Life

2. Liver abscess

Dues

h. Diarrhoea and vomiting

B. With increased appetite

a. Diminished absorption

Don't

1. Diarrhoea and vomiting

Invite

2. Intestinal fistulae

Him

3. Hypermotility carcinoid

b. Increased utilization

1. Thyrotoxicosis

2. Diabetes mellitus

Dysphagia
Causes

Police

A. Painful diseases of mouth and pharynx

Some

1. Stomatitis

Thing

2. Tonsillitis

Queen

3. Quinsy

Tring

4. Tuberculous laryngitis

To

5. Tumours

Probe

6. Pharyngo-oesophageal pouch

Never

B. Nervous disturbances

Don't

(i) Diphtheritic neuritis

Mind!

(ii) Myasthenia gravis

Bulky

(iii) Bulbar paralysis

Girls

(iv) Globus hystericus

Are

(v) Achalasia cardia

Obstinate

(vi) Oesophageal spasm

Enter

C. Extrinsic oesophageal compression

Tom

(i) Thyroid enlargement

Makes

(ii) Mediastinal adenitis

A

(iii) Aneurysm of aorta

Paper

(iv) Peticardial effusion

Boat

(v) Bronchial neoplasms

Inside

D.  Intrinsic oesophageal lesions

(i) Congenital short oesophagus

(ii) Inflammatory and degenerative process

Police

a. Peptic oesophagitis

Carry

b. Corrosive oesophagitis and stenosis

The

c.  Traction diverticulum

Sticks

d. Sideropenic dysphagia (Plummer-Vinson Syndrome)

(iii) Neoplasms

Cigarette

a.  Carcinoma of Oesophagus

Case

b.  Carcinoma of stomach

Stolen

c.  Sarcoma and benign tumours of the oesophagus

Dyspepsia
Causes

Our

A. Organic disease

One

1. Oesophageal tumour

Can

2. Cardiospasm

Date

3. Diaphragmatic hernia

A

4. Achlorhydria

Good

5. Gastritis

Pretty

6. Peptic ulcer

Chap

7. Carcinoma stomach

Radio

B. Reflex dyspepsia

A

1. Appendicitis

Cunning

2. Cholecystitis

Pet

3. Pancreatitis

Ate

4. Amoeblasis

Some

5. Steatorrhoea

Sweet

6. Spastic colon

Apple

7. Helminthiasis

Seldom

C.  Systemic disease

Can

1. Cardiac failure

Papa

2. Pulmonary tuberculosis

And

3. Anaemia

An

4. Addison's disease

Uncle

5. Uraemia

Hide?

6. Hyperparathyroidism

Fails

D.  Functional

Friends

1. Faulty eating habits

Never

2. Nervous exhaustion

Attack

3. Anxiety and depression

History

One

1. Onset

Day

2. Duration of symptoms

The

3. Type of pain

Aged

4. Anorexia

Nurse

5. Nausea and vomiting

Had

6. Haematemesis

Bruised

7. Bowel action

Her

8. Heartburn

Forearm

9. Flatulence

On

10.Occupation

Front

11. Family history

Physical examination

Get

1. General appearance

Out

2. Oral cavity

And

3. Abdomen

Direct

i. Distention

People

ii. Peristalsis

To

iii. Tenderness

Leave

iv. Lump

Houses

v. Hepatomegaly

Cry

4. Chest

Lab investigations

Great

1. Gastric analysis

Soldiers

2. Stool examination

Under

3. Urine examination

His

4. Haemogram

Able

5. Absorption studies

Leadership

6. Liver function tests

Kept

7. Kidney function tests

People

8. Pancreatic function tests

Live

9. Liver biopsy

Visual tests

Every

1. Endoscopy

Lady

2. Laparoscopy

Pretty

3. Proctoscopy

Oesophageal Spasm
Types

Pack

1. Primary

Red

2. Reflux

Piece

3. Plummer-Vinson syndrome

Clinical picture

A

1. Age - Middle aged woman or old man

Doctor

2. Dysphagia

Received

3. Retrosternal pain

The

4. Tongue smooth or sore

Patient

5.Phyarynx pale and dry

So

6. Skin pale

Kindly

7. Koilonychia

My

8. Mouth angles cracked

Heavens

9. Hepatosplenomegaly

Achalasia Cardia
Treatment

Be

1. Bland semisolid diet

Sensible

2. Sedative

And

3. Anticholinergic

Deliver

4. Dilatation

Some

i. Stark's dilator

Never

ii. Negar's bag

Marry

iii. Mercury bougies

Chairty

5. Cardiomyotomy or Hellor's operation

Goods

6. Gastrostomy

Hiatus Hernia
Types

Central

1. Congenital short oesophagus

Post

2. Para-oesophago-gastric hernia

Office

3. Oesophago-gastric hernia

Differential diagnosis

Can

1. Coronary insufficiency

Become

2. Biliary colic

Public Property

3. Pancreatitis

4. Peptic ulcer

Indications of surgery

I

1. Intermittent obstruction

Can

2. Cardiorespiratory symptoms

Play

3. Perforation

Some

4. Strangulation

Humour

5. Haemorrhage

Haematemesis
Causes

People

A. Peptic ulcer

1. Duodenal ulcer

2. Gastric ulcer

And

B. Acute gastric erosions

Indians

1. Idiopathic

Are

2. Aspirin and phenylbutazone

Admired

3. Alcohol

Frequently

4. Food allergy

People

C. Postoperative

1. Gastroenterostomy

2. Gastrectomy

Enter

D. Erosions and ulcers associated with hiatus hernia

Open

E.  Oesophageal varices 

Race

F. Rare causes

Indian

(i) Ingested epistaxis

Civil

(ii) Carcinoma of stomach

Service

(iii) Sarcoma of stomach

Owns

(iv) other gastric tumours

Benign

(v) Blood disorders

Honest

(vi) Hereditory telangiectasia

Polite

(vii) Pseudoxanthona elasticum

Men

(vii) Mallory-Weiss syndrome.

Lower Gastrointestinal Bleeding

 Causes

A. Anal lesions

1. Haemorrhoids

2. Anal fissures

B. Diseases of large bowel

Upon

1. Ulcerative colitis

A

2. Amoebi and bacillary dysentery

Rat

3. Rectal polyp

Cat

4. Carcinoma of rectum and colon

Nips

5. Nonspecific colitis

Chronic Diarrhoea
Causes

Good

A. Gastric

Her

1. Hypersecretion of gastric juice

Cousin

2. Chronic gastritis

Can

3. Carcinoma of stomach

Pay

4. Pyloric obstruction 

Premium

5. Pernicious anaemia

Speeches

B. Small intestinal 

In

1. Intolerance to lactose or sucrose

Comparison

2. Coeliac disease

To

3. Tropical sprue

Well

4. Whipple's disease

Attired

5. Amyloidosis

Ladies

6. Lymphoma

Terribly

7. Tuberculosis

Clad

8. Crohn's disease

Hubbies

9. Hypogammaglobinaemia

Can

10. Carcinoid.syndrome

Cause

11. Carcinoma

Many

12. Mesenteric vascular disease

Serious

13. Systemic lupus erythematosus

Problems

14. Polyarteritis

Some

15. Scleroderma 

Really

16. Radiation enteritis

Generate

17. Giardiasis

Funny

18. Food allergy

Scenes

19. Severe protein malnutrition

Can

C. Colonic

Indian

1. Irritable bowel syndrome (spastic colon) 

Universities

2. Ulcerative colitis

Can

3. Carcinoma of colon

Manage

4. Multiple polyposis

CAT

5. Chronic bacillary infection

And

6. Amoebic colitis

Allied

7. Actinomycosis

Examinations

8. Endomettiosis

Developed

9. Diverticulitis 

Indigenously

10. ischaemic colitis

Render

D. Rectal

Case

1. Carcinoma of rectum

Under

2. Ulcerative proctitis 

Very

3. Villous adenoma

Aged

4. Antibiotic proctitis 

Lady

5. Lymphogranuloma venereum

His

E. Hepato-biliary

1. Biliary obstruction

2. Portal hypertension

Party

F. Pancreatic

Can

1. Chronic pancreatitis

Control

2. Carcinoma of pancreas

Central

3. Cystic fibrosis 

Zone

4. Zollinger-Ellison syndrome

Men

G. Metabolic

His

1. Hyperthyroidism

Details

2. Diabetes mellitus

Are

3. Addison's disease

Hidden

4. Hypoparathyroidism

Under 

5. Uraemia

Some

6. Severe malnutrition

Protection

7. Pellagra 

Doubly

H. Drug induced

Central

1. Cathartics

Armed

2. Antacids

Police

3. Parasympathomimetics

Gave

4. Ganglion blocing agents

An

5. Antibiotics

Attack

6. Alcohol

To

7. Thyroid

Delhi

8. Digitalis

Cricket

9. Contraceptives - Oral

Club

10. Colchicine

Polite

I. Postoperative

Very

1. Vagotomy

Dull

2. Dumping syndrome

And

3. Afferent loop syndrome

Boring

4. Blind loop syndrome

Ground

5. Gastroileostomy

Fielding

6. Fistulae

In

7. Ileal resection - Subacute

India

8. Intestinal obstruction

Hepatomegaly
Causes

I

A. Infectious

Very

a. Viral 

I

1. Infective hepatitis

Saw

2. Serum hepatitis

Yellow

3. Yellow fever

Inkpot

4. Infectious mononucleosis

Big

b. Bacterial

Every

1 Enteric fever

Big

2 Brucellosis

Shop

3. Septicaemia

Pays

4 Pyogenic abscess

Shops

c. Spirochaetal 

1. Syphilis

Can

(a) Congential syphilis

Send

(b) Secondary syphilis

Samples

(c) Syphilitic gumma

2. Leptospirosis

Pay

d. Protozoal

A

1. Amoebic hepatitis

Lady

2. Liver abscess

May

3. Malaria

Kill

4. Kala-azar

Plenty

e. Parasitic

1. Hydatid cyst

2. Schistosomiasis

Funds

f. Fungal

1. Actinomycosis

2. Histoplasmosis

Visited

B. Vascular or Congestive 

Central

1 . Congestive heart failure

Trading

2. Tricuspid valvular disease

Company

3. Constrictive pericarditis

New

C. Neoplastic

Hand

1. Hepatoma

Some

2. Secondary carcinoma of liver

Man

3. Melanotic sarcoma

Delhi

D. Degenerative

1. Fatty liver

2. Amyloidosis

(i) Primary

(ii) Secondary

To

E. Toxic

Can

1. Carbon tetrachloride

Chinese

2. Chloroform

People

3. Phosphorous

Hit

4. Halothane

The

5. Tetrachlorethylene

Mosquitoes

6. Mepacrine

And

7. Arsenic

Attack

8. Antimony

Golden

9. Gold

Scabes

10. Sulphonamides 

Insects

11. Isoniazid

Producing

12. Phenylbutazone

Terror

13. Thiouracil

Meet

F. Metabolic

Director

1. Diabetes mellitus

General

2. Glycogen storage disease

Health

3. Haemochromatosis

Her

G. Haemopoietic

Lone

1.  Leukaemia

Student

2.  Splenic anaemia

Has

3.  Hodgkin's disease

Learnt

4.  Lymphosarcoma

Under

5. Upoid storage diseases

(i) Xanthomatosis

(ii) Gaucher's disease

(iii) Niemann-Pick disease

Me

6. Myeloid metaplasia

(i)  Multiple myeloma

(ii)  Myelosclerosis

(iii)  Myelofibrosis

Little

H. Liver cirrhosis

Child

I. Chronic obstruction in common bile duct 

Count

1.  Calculi

And

2.  Ascariasis

Boil

3.  Bile duct carcinoma

Chick

4.  Carcinoma of pancreas

Eggs

5. Enlarged portal lymph nooes

My

(i) Metastatic deposits

House

(ii) Hodgkin's disease

Lies

(iii) Leukaemia

Toward

(iv) Tuberculosis. 

South

(v) Syphilis

v/s Other swellings

Can't

1. Carcinoma stomach -features

(i) Marked anorexia

(ii)  Cachexia

(iii)  Lump tender ; often mobile

(iv) Visible peristalsis, if pyloric obstruction

(v) Left superaclavicular and axillary lymph nodes usually palpable.

(vi) Gastric analysis and radiological. evidence.

Close

2. Carcinoma colon-features : 

(i)  Hard nodular lump ; often mobile

(ii)  Visible peristalsis and distention

(iii)  Faecal impaction in bowel

(iv)  Lump disappears after enema

The

3. Tumour of right kidney - features

(i)  More lateral

(ii)  Bimanually palpable and ballotable

(iii) Smooth and rounded

Tap

4. Tuberculous peritonitis (rolled up omentum)

(i) Tender

(ii) Does not move with respiration

(iii) Band of resonance between lump and subcostal margin

(iv)  Other signs of tuberculosis

Jaundice
.Causes

I. Pre-hepatic

An

1. Abnormal haemoglobins

(i) Sickle-cell disease

(ii) Thalassaemia

Acrylic

2. Abnormal red blood cells
- Congenital spherocytosis

Doll

3. Drugs and poisons

Some

(i) Sulphonamides

Learned

(ii) Lead

Scholar

(iii) Snake venom

Inside

4. Infections

Prasanna

(i) Protozoal   Malaria

Bowled

(ii) Bacteria[   Gas gangrene

Venkat

(iii) Viral   Smallpox

5. Hypersplenism- Hodgkin's disease

6. Haemolytic antibodies

Riding

(i) Rh incompatibility

In

(ii) incompatible transfusions

Auto

(iii) Auto-immune haemolytic disease

II. Intra-hepatic

In

1. Infections

I

(i) Infective hepatitis

Saw

(ii) Serum hepatitis

Wonderful

(iii) Weil's disease

Insect

(iv) Infectious mononucleosis

Deed

2. Drug hepatitis

Public

(i) Para-aminosalicylic acid

Prosecutor

(ii) Phenylbutazone

Can

(iii) Chlorpromazine

Name

(iv) Norethandrolone

Many

(v) Methyltestosterone

Criminals

(vi) Chlorpropamide

Common

3. cirrhosis with liver cell failure

Patients

4. Pregnancy (last trimester)

Not

5. Neoplasms and reticulosis

(i) Hepatoma

(ii) Hodgkin's disease

Cured

6. Congenital hyperbillrubinaemias

New

(i) Najjar and Grigler type

Director

(ii) Dublin-johnson type

General

(iii) Gilbert type

Reporting

(iv)  Rotor type

III. Post-hepatic

Never

1. Neoplasms

(i) of ampulla of Vater

(ii) of head of pancreas and neighbouring organs 

(iii) of bile-ducts and gall bladder

Give

2. Gall stones in common bile-duct.

 

Silly

3. Strictures in common bile duct.

 

Comments

4. (Rarely) Chronic pancreatitis

 

Chapter 04 : Nervous System

Reflexes

A. Deep reflexes

1. Jaw reflex

2. Biceps reflex

3. Brachioradialis reflex

4. Triceps reflex

5. Finger-flexion reflex

6. Patellar reflex (knee jerk)

7. Achille's reflex (ankle jerk)

B. Superficial reflexes

1. Corneal reflex

2. Abdominal reflex

3. Cremasteric reflex

4. Anal reflex

5. Plantar reflex

C. Abdominal reflexes

1. Babinski's sign

a. Chaddock reflex

b. Oppenheim reflex

c. Gordon reflex

d. Gonda reflex

2. Rossolimo's sign

3. Patellar clonus

4. Ankle clonus

5. Hoffman reflex

6. Wrist clonus

CSF Examination

A. Pressure raised in

1. Intracranial tumours

2. Intracranial haemorrhage

3. Hypertensive encephalopathy

4. Hydrocephalus

5. Intracranial sinus thrombosis

6. Meningitis

7. Meningism

8. Encephalitis

9. Uraemia

10. Emphysema

B. Pressure lowered in

1. Lumbar puncture - repeated

2. Spinal subarachnoid block

i. Spinal tumour

ii. Localised meningitis

C. Appearance

1. Turbid

- Pyogenic meningitis

2. Fine clot

i. Tuberculous meningitis

ii. Poliomyelitis

3. Thick clot

- Pyogenic meningitis

4. Blood stained

i. Needle trauma

ii. Ruptured intracranial aneurysm or angioma

iii. Trauma of spinal cord

iv. Bursted intracerebral haemorrhage

5. Xanthochromia

i. Subarachnoid haemorrhage of some duration

ii. Massive pus in CSF

iii. Intracerebral haemorrhage

iv. Cerebral infarction

v. Brain tumours

vi. Spinal subarachnoid obstruction

vii. Cauda equina tumours

viii. Jaundice - long standing

D. Protein

Normal 20-40 mg/100 ml

a. Moderate rise

Upto 100 mg/dl

1. Inflammatory conditions

i. Meningitis

ii. Encephalitis

iii. Poliomyelitis

iv. Syphilis

v. Disseminated sclerosis

vi. Myelitis

2. Intracranial tumours

3. Cerebral haemorrhage

4. Cerebral infarction

b. Marked rise

Over 500 mg/100 ml)

1. Chronic syphilis meningitis

2. Spinal subarachnoid block

3. Acute infective polyneuritis

4. Cauda equina tumour

E. Cell count

Normal 0-5 cells/cu.mm

a. Mild rise (5-100)

1. Neurosyphilis

2. Encephalitis

3. Poliomyelitis

b. Moderate rise (100-500)

1. Tuberculous meningitis

2. Meningosyphilis

3. Viral meningitis

c. Severe rise (beyond 500)

- Pyogenic meningitis

Paraplegia
Causes

The

A. Traumatic

1. Fracture dislocation of vertebrae

2. Prolapsed disc

Visitors

B. Vesicular

1. Haematomyelia

2. Superio sagittal sinus thrombosis

3. Thrombosis of anterior spinal arteries

Not

C. Neoplastic

1. Metastatic carcinoma of vertebrae

2. Vascular tumours of spinal cord

Trained

D. Toxic

In

E. Infective, inflammatory and demyelinating

1. Tuberculosis spine

2. Epidural pyogenic abscess

3. Spinal syphilis

4. Poliomyelitis

5. Disseminated sclerosis

6. Infective polyneuritis - Acute

7. Disseminated myelitis with optic neuritis

8. Acute transverse myelitis

9. Meningitis

10. Subacte combined degeneration

Hygienic

F. Hysterical

Manners

G. Miscellaneous

1. Decompression syphilis

2. Intermittent porphyria - Acute

3. Functional

Spastic paraplegia
History

A. Age

a. Children

1. Hydrocephalus

2. Meningitis

3. Spina bifida

4. Superior sagittal sinus thrombosis

b. Adults

1. Syphilitic meningomyelitis

2. Tuberculosis spine 

3. Acute transverse myelitis

4. Disseminated sclerosis

5. Lathyrism

6. Spinal tumour

c. Old age

1. Subacute combined degeneration of cord

2. Metastatic tumours

B. Familial incidence

1. Lathyrism

2. Subacute combined degeneration of cord

C. Onset

a. Sudden

1. Acute transverse myelitis

2. Fracture dislocations

3. Haematomyelia

4. Lathyrism

b. Gradual

1. Meningomyelitis

2. Subacute combined degeneration of cord

3. Spinal tumour

4. Disseminated sclerosis

D. Trauma - History of

E. Syphilis - History of

F. Pain 

- Extramedullary spinal tumour

G. Numbness and tingling

1. Subacute combined degeneration of cord

2. Spinal tumours

3. Fracture dislocation

H. Course

a. Intermittent

1. Disseminated sclerosis

2. Syringomyelia

b. Rapid

Malignant tumours

Physical examination

1. Dysarthria

a. Disseminated sclerosis

b. Syringomyelia

2. Nystagmus

Disseminated sclerosis

3. Ataxia

a. Subacute combined degeneration of cord

b. Disseminated sclerosis

4. Associated involuntary movements

Tremor

Disseminated sclerosis

Muscular twitching

Syringomyelia

Choreo-athetoid

Cerebral diplegia

Investigations

1. CSF

2. Plain X-ray

3. Myelography

4. Blood examination

5. Fundoscopy

Flaccid paraplegia
Onset

1. Rapid onset after fever

Acute poliomyelitis

2. Gradual onset after fever

a. Diphtheritic neuritis

b. Acute febrile polyneuritis

3. Weakness following atrophy

a. Motor neurone disease

b. Other spinal lesions

4. Weakness preceding atrophy

Polyneuritis

Associated Clinical features

Distribution of paralysis

1. Distal and asymmetrical

a. Motor neurone disease

b. Other spinal lesions

2. Nerve root distribution

- Nerve root lesions (commonly unilateral

3. Peripheral nerve distribution

- Peripheral nerve lesions

Fibrillation of affected muscles

1. Motor neurone disease

2. Syringomyelia

3. Peroneal muscular atrophy

Tenderness in affected muscles

1. Polyneuritis

2. Poisoning

Alcohol

Arsenic

Lead

Sensory loss

1. Spinal cord disease

2. Nerve root lesions

3. Peripheral nerve lesions

Vertigo
Causes

Coma

A. Central

1. Epileptic aura

2. Basilar migraine

3. Vertibrobasilar insufficiency

4. Multiple sclerosis

5. Intracerebellar haemorrhage

6. Syringobulbia

And

B. Aural

1. Labyrinthitis due to

a. Ototoxic drugs

Streptomycin

Quinine

b. Head injury with haemorrhage into labyrinth

c. Suppurative otitis media

2. Meniere's disease

3. Eustachian tube obstruction

4. Ear wax

Visit

C. Vestibular

1. Vestibular neuronitis

2. Accoustic neuroma

3. Meningo-vascular syphilis

Our

D. Ocular

1. Travel sickness

2. Muscle palsies

3. Lack of adaptation of fresh glasses

Place

E. Psychogenic

Epilepsy
Etiology

A. Congenital and developmental disorders

a. Complications during pregnancy

1. Eclampsia

2. Maternal infections

3. Trauma during gestation

4. Chronic diseases

5. Placental abnormalities

b. Complication during delivery

1. Asphyxia

2. Trauma

c. Prematurity

d. Abnormal neonatal conditions

1. Cardiorespiratory disorders

2. Infectious diseases

3. Metabolic disturbances

B. Postnatal head injuries

C. Ingfections

1. Bacterial meningitis

2. Syphilis

3. Brain abscess

4. Granuloma

5. Parasitic invasions

D. Vascular disorders

1. Adam \-Stokes syndrome (cerebral anoxia)

2. Hypertensive encephalopathy

3. Embolism

4. Cerebral haemorrhage

5. Cerebral arteriosclerosis

E. Cerebral tumours

F. Toxic and metabolic disorders

1. Acute alcoholic intoxication

2. Chronic alcoholism

3. Convulsant drugs

4. Excessive hydration

5. Lead encephalopathy

6. Hypocalcaemia

7. Uraemia

8. Pyridoxine

9. Morphine

10. Hypoglycaemia

G. Degenerative disease

1. Alzheimer's disease

2. Pick's disease

Cranial Nerves

1. Olfactory nerve

2. Optic nerve

3. Oculomotor nerve

4. Trochlear nerve

5. Trigeminal nerve

6. Abducent nerve

7. Facial nerve

8. Auditory nerve

9. Glossopharyngeal nerve

10. Vagus nerve

11. Accessory nerve

12. Hypoglossal nerve

Facial Palsy
Clinical features

A. Nuclear lesions

1. Affect contralateral side of the face

2. Lower part of the face more severely involved than the upper. Forhead may completely escape depending upon the extent of bilateral innervation

3. Palpebral fissure slightly wider on the affected side but can be closed forcefully

4. Nasolabial fold less prominent on affected side

5. Corner of mouth tends to droop and, on voluntary effort, the lips on affected side are not raised as promptly as on the other side.

6. Voluntary movements often involved more than emotional movements

B. Nuclear lesions

1. Ipsilateral paralysis of the upper and lower parts of face.

2. Muscular atrophy with reaction of degeneration

3. Paralysis of the external rectus due to involvement of VI nucleus

4. Contralateral spastic hemiplegia, if pyramidal tract is involved.

C. Infranuclear lesions (Bell's palsies

a. Between the pons and geniculate ganglion

1. Ipsilateral paralysis of the entire face

2. Eighth nerve involvement with deafness and tinnitus

3. Fifth nerve involvement with paralysis or sensory disturbances

4. Taste not affected unless nervous intermedius is involved

b. At the geniculate ganglion (Ramsay Hunt's syndrome)

1. Ipsilateral paralysis of entire face

2. Pain in region of the ear and mastoid process

3. Deafness and tinnitus (8th nerve involvement)

4. Loss of taste on anterior 2/3 of tongue

c. Between the geniculate ganglion and the vchorda tympani nerve

1. Ipsilateral paralysis of entire face

2. Loss of taste on anterior 2/3 of tongue

3. Tinnitus and hyperacusis

4. Diminished lacrimation

d. Distal to the chorda tympani nerve (usual Bell's palsy)

1. Inability to move affected side of the face

2. Pain or tenderness behind the ear in initial phases

3. Eye on the affected side cannot be closed; on attempting, eyeball rolls up (Bell's phenomenon)

4. Mouth drawn over to the opposite side; saliva or fluid may run from the angle of mouth; food may collect between the teeth and the paralysed cheek.

5. Ipsilateral paralysis of entire face

6. Inability to wrinkle the brow, whistle, or retract angle of the mouth.

7. Inability to blow out cheeks and to smile.

8. Loss of emotional facial movements

9. Nasolabial fold less prominent

10. Corneal reflex absent

11. Tinnitus and hyperacusis

Spinal Compression
Causes

A. In the vertebral column

1. Fracture dislocations

2. Acute massive disc herniation

3. Cervical spondylosis

4. Tuberculosis

5. Myelomatosis

6. Osteitis fibrosa cystica (hyperparathyroidism)

7. Metastatic tumours

B. In the spinal meninges

1. Epidural abscess

2. Epidural and subdural haemorrhage

3. Tumours

Meningioma

Neurofibroma

4. Syphilitic leptomeningitis

5. Arachnoiditis

6. Infiltration with Hodgkin lymphogranuloma and leukaemic deposits

C. In the spinal cord

1. Glioma

2. Ependymoma

3. Metastatic carcinoma

Intracranial Tumours

Classification 

 

1. Tumours of the skull

 

 

(i) Osteoma

 

 

(ii) Haemangioma

 

 

(iii) Metastatic tumours

 

2. Tumours of.the meninges

 

 

(i) Meningioma

 

 

(ii) Sarcoma

 

 

(iii) Metastatic tumours

 

3. Tumours of suportive tissues (gliomas)

 

1.      Tumours of the ductless glands

 

 

(i) Pituitary tumours

 

 

(ii) Pineal tumours

 

2.      Tumours of the cranial nerves

 

 

(i) Optic nerve gliomas

 

 

(ii) Neurofibromas

 

3.      Congenital tumours

 

 

(i) Craniopharyngiomas

 

 

(i)                 Cholesteatomas

 

 

(iii) Chordomas

 

 

(iv) Teratomas

 

7. Blood vessel tumours

 

 

(i) Haemangioblastomas

 

 

(ii) Angiomas

 

Localising features

I. Cerebral hemisphere

A. Frontal lobes

a. Precentral area (motor)

1. Paralysis of the upper extremity with claspknife spasticity; hyperactive tendon reflexes.

2. Comparatively less involvement of lower extremity with spastic hemiplegic gait. Hyperactive tendon reflexes; plantar extensor

3. Paralysis of the lower part of face

4. Jacksonian convulsions

5. Todd's paresis

b. Anterior part

1. Disinterest in the surroundings; lack of attention to family or business; loss of normal emotional reactions

2. Carelessness; lack of hygiene; may urinate and defecate in bed or in public

3. Loss of memory for recent events

c. Posterior part

1. Apraxia

2. Dysarthria

3. Hemiparesis

d. Upper part of area 6

Forced grasping (Foster Kennedy syndrome) 

e. Ventral surface

1. Anosmia

2. Blindness with primary optic atrophy (ipsilateral)

3. Papilloedema (contralateral)

B. Temporal lobes

1. Psychic disturbances

2. Contralateral homonymous hemianopia (involving macular area)

3. Formed visual hallucinations

4. Uncinate fits

5.Aphasia (in left sided tumours)

6. Associated features

i. Weakness of lower part of face (precentral gyrus)

ii. Contralateral paralysis of extremities (internal capsule)

iii. Ptosis of upper eyelid and dilatation of pupil (third nerve)

iv. Ipsilatral hemiplegia (cerebral peduncle

C. Parietal lobes

1. Raised threshold for tactile, thermal and pain sensations

2. Perversion of sensations

3. Ideational apraxia

4. Disorientation of space

5. Agnosia

6. Sensory Jacksonian fits

7. Contralateral homonymous hemianopia

8. Absia (in left sided lesions)

D. Occipital lobes

1. Contralateral homonymous hemianopia (sparing macular area)

2. Generalised epileptiform convulsions

3. Unformed visual hallucinations

E. Carpus callosum and septum pellucidum

1. Headache

2. Papilloedema

3. Psychic disturbance

4. Amnesia

5. Disturbances of vision and hearing

II. Brain stem

1. Lower cranial nerve palsies (VI-VII)

2. Hemisensory deficit or hemiplegia due to involvement of long tracts

3.Ataxia

4. paraplegia

III. Midbrain

1.Paralysis of the upward conjugate deviation and convergence of eyes

2. Dilated pupils not reacting to light

3. Ptosis of the upper eyelids

4. Severe ophthalmoplegia

5. Unilateral or bilateral anaesthesia of body

6. Unilateral or bilateral spastic paralysis

7. Action tremor

8. Sleepy states

III. Medulla oblongata and pons

a. Fourth nerve paralysis

1. Diplopia

2. Slight deviation of eye

b. Fifth nerve paralysis

1. Ipsilateral absence of corneal reflex. 

2. Hemianaesthesia of face

3. Paralysis of the muscles of mastication

IV. Cerebellum

Increased intracranial pressure

1. Stumbling 
2. Gait imbalance 
3. Prominent morning headaches 
4. Nystagmus 
5. Dizziness 
6. Visual symptoms due to papilledema

V. Midline lesions (vermis)

Truncal and gait ataxia

 

Intracranial aneurysms - Localizing signs 

 

(i)                 Internal carotid

 

 

(a) Partial or complete internal and external ophthalmoplegia

 

 

(b) Sensory loss-over forehead and eye

 

 

(c) Hemianopia

 

 

(d) Optic atrophy

 

 

(e) Non-pulsating exophthalmos

 

(ii)               Middle cerebral

 

 

(a) Jacksonian fits

 

 

(b) Herniplegia or monoplegia

 

(iii)             Anterior cerebral

 

 

(a) Jaksonian fits

 

 

(b) Conjungate deviation of the eyes, away from the affected side

 

 

(c) Paralysis of an arm, leg or part of the face

 

 

(d) Aphasia, in left sided lesion

 

(iv)             Vertebral

 

 

(a) Ataxia

 

 

(b) Anaesthesia of trunk and contralateral limbs

 

 

(c) lpsilateral dissociated anaesthesia of the face

 

 

(d) Paralysis of palate and vocal cords

 

(v)               Basillar

 

 

-          Affection of III, V, VI, VII VIII cranial nerves

 

(vi)             Arteriovenous aneurysm between internal carotid and covernous sinus

 

 

-          Pulsating exophthalmos

 

Intracerebral Haemorrhage - Clinical Picture 

The onset is usally sudden, the patient falling unconsciou with apoplectic stroke. Less often, there are prodromal symptoms such as headache, giddiness, vomiting, disturbance of speech or tingling, and weakness in a limb. The results produced depend upon the site of the lesion. 

 

1. Capsular haemorrhage. This is the commonest variety, the bleeding starting external to the internal capsule.

 

 

(i) Unconsciousness

 

 

(ii) Face usually flushed, cyanosed and sweating, rarely it is pale.

 

 

(iii) The breathing sterotorous and the cheek on the paralysed side may be blown in and out with respiration.

 

 

(iv) No movement of the limbs which are flaccid; on lifting up an arm or leg a greater degree of flaccidity may be detected on the paralysed side.

 

 

(v) Conjugate deviation of eyes, looking away from the side of lesion in the initial stages and towards the side of lesion later.

 

 

(vi) Superficial and deep reflexes lost

 

 

(vii) Incontinence or retention of urine and incontinence of faeces

 

 

(viii) Pulse full and bounding ; slow or rapid

 

 

(ix) Subnormal temperature, in early stages

 

 

(x) Blood pressure raised

 

 

(xi) Albuminuria with occasional glycosuria

 

 

(xii) Blood in CSF, if haemorrhage extends to the lateral ventricle

 

2. Cortical haemorrhage

 

 

(i) Patient generally remains conscious

 

 

(ii) Convulsions

 

 

(iii) Paralysis of one or more limbs

 

 

(iv) Aphasia or hemianopia, according to the exact site of lesion

 

3. Thalemic haemorrhage : Thalamic syndrome

 

 

(i) Weakness of the opposite side of the body

 

 

(ii) Choreiform or athetoid movements

 

 

(iii) Severe pain on the opposite side of the body

 

 

(iv) Exaggerated response to stimuli, e.g. tickling, scrapping and extremes of heat or cold

 

 

(v) Loss of postural sense on opposite side

 

4. Mid brain haemorrhage

 

 

(i)                 Weber's syndrome : (a) Paralysis of the oculomotor nerve (b) Hemiplegia on the opposite side 

 

 

(ii) Anaesthesia on the paralysed side ofthe body

 

5. Pontine haemorrhage

 

 

(i) Palient comatose

 

 

(ii) Convulsions of the legs with vomiting

 

 

(iii) Cheyne-Stokes breathing

 

 

(iv) Pin-point pupils ; may dilate before death

 

 

(v) Conjugate deviation of eyes towards the side of lesion

 

 

(vi) Contralateral hemiplegia

 

 

(vii) Hyperpyrexia, the patient dies within a few hours

 

6. Medullary haemorrhage

 

 

(i) Death in coma within a few hours

 

 

(ii) If patient survives for some time, signs of bulbar paralysis

 

7. Ventricular haemorrhage : Usually secondary to capsular haemorrhage causing rapid death

 

 

(i) Head retraction

 

 

(ii) Rigidity or spasm of the arms or legs

 

8. Cerebellar haemorrhage

 

 

(i) Severe vertigo, pain in occipital region and vomiting

 

 

(ii) The patient often lies with the side of face- corresponding with the side, of lesion, on the pillow

 

 

(iii) Spontaneous nystagmus with slow movements away from the side of the lesion and sharp short movement in the opposite direction

 

 

(iv)Skew deviation of the eye, the eye on the affected side looking downwards and inwards and the other eye upwards and outwards

 

 

(v) Loss of pain and temperature sensation ; ipsilateral on face and head, and contralateral on the body and limbs

 

 

(vi) Interference with swallowing and speech

Subarachnoid haemorrhage - Etiology 

 

 

1. Rupture of congenital or mycotic cerebral aneurysm

 

2. Leak from an angioma

 

3. Effusion from intracerebral haemorhage

 

4. Head injuries

 

5. Haemorrhagic encephalitis

 

6. Bleeding disorders

 

 

(i) Haemophilia

 

 

(ii) Purpura

 

 

(iii) Leukaemia

Hemiplegia

A. Sudden onset

a. Vascular causes

i. Haemorrhage

1. Arteriosclerosis

2. Mycotic aneurysm

3. Haemorrhagic infections

4. Toxic agents

5. Trauma

6. Blood disorders

7. Hypertension

ii. Thrombosis

1. Arteriosclerosis

2. Syphilitic arteritis

3. Polyarteritis nodosa

4. Postpartum phlebothrombosis

iii. Embolism

1. Auricular

2. Cardiac infarct

3. Subacute bacterial endocarditis

4. Atheroma of aorta or carotid artery

5. Surgery on neck and thorax

6. Caisson's disease

b. Infective causes

1. Encephalitis

2. Meningitis

c. Trauma

d. Hypertensive encephalopathy

e. Postepileptic paralysis

d. Disseminated sclerosis

e. Uraemia

f. Hysterical

B. Slow onset

1. Cerrebral tumour

2. Cerebral abscess

3. Occlusion of internal carotid artery

4. Chronic subdural haematoma

5. Meningitis and encephalitis

Speech Disorders
Classification

A. Mental speech disorders

1. Neoglossia

2. Echolalia

3. Echopraxia

B. Aphasia or dysphasia

a. Expressive dysphasias

1. Perseveration

2. Broca's aphasia

b. Receptive aphasias

1. Wernicke's aphasia

2. Conduction aphasia

c. Global aphasia

C. Dysarthria

D. Dysphonia or aphonia

Causes of dysarthria

A. Cerebral

a. Bilateral extrapyramidal lesion

1. Pseudobulbar palsy

2. Motor neurone disease

3. Upper brain stem tumours

b. Unilateral thalamic lesion

B. Extrapyramidal

1. Parkinsonism

2. Athetosis

C. Cerebellar disease

D. Lower motor neurone lesions

1. Facial paralysis

2. Tongue paralysis

3. Palatal paralysis

E. Myasthenia gravis

 


 

05 Cardiovascular System

Pulse
Examination

1. Rate

2. Rythm

3. Character

4. Volume

5. Condition of vessel wall

Synchronosity with other pulses

Causes of Tachycardia

A. Physiological

1. Menstrual period

2. Menopause

3. Exercise

4. Emotional states

5. After meals

B. Pathological

1. Pyrexia

2. Bacterial infections

a. Streptococcal

b. Pneumococcal

c. Tuberculosis

3. Endogenous toxaemias

a. Grave's disease

b. Uraemia

c. Degenerative malignancies

d. Blood disorders

- Haemoglobinopathies

- Leukaemias

4. Exogenous toxaemias

a. Tobacco

b. Alcohol

c. Tea & coffee

d. Thyroid extract

e. Atropine

5. Nervous states

a. Neurasthenia

b. Anxiety neurosis

c. Neurocirculatory asthenia

6. Heart disease associated with heart failure

Causes of Bradycardia

1. Convalescence from severe illness

2. Starvation

3. Nervous exhaustion

4. Cerebral abscess or haemorrage

5. Meningitis

6. Myxoedema

7. Jaundice

8. Uraemia

9. Overdose of digitalis

1. Myocardial degeneration

Character of Pulse

A. Anacrotic pulse

- Aortic stenosis

B. Pulsus bisferiens

- Combined aortic stenosis and incompetence

C. Dicrotic pulse

- Enteric fever

D. Water hammer pulse

a. Physiological

1. Meat

2. Exercise

3. Emotional disturbance

4. Pregnancy

b. General

1. Thyrotoxicosis

2. Anaemia

3. Beriberi

4. Hepatic failure

5. Anoxic cor pulmonale

c Cardiac

1. Patent ductus arteriosus

2. Aortic incompetence

3. Mitral incompetence

4. Ventricular septal defect

5. Heart block

E. Pulsus alternans

1. Severe hypertension

2. Left ventricular failure

F. Pulsus paradoxicus

1. Chronic constrictive pericarditis

2. Pericardial effusion

 Pulsus parvus
Low output
Causes

A. Physiological

1. Cold

2. Anxiety

B. Pathological

1. Hypertension - severe

2. Aortic stenosis

3. Cardiac infarction

4. Mitral stenosis

5. Pulmonary stenosis - extreme

6. Pulmonary stenosis - Severe

7. Tricuspid stenosis

8. Pick's disease

9. Pericardial effusion

10. Myocarditis

Heart Sounds

A. First heart sound

a. Accentuated in

1. Mitral stenosis

2. Tachycardia

i. Emotion

ii. Thyrotoxicosis

iii. Hypertension

b. Diminished in

1. Mitral incompetence

2. Rheumatic carditis

3. Severe cardiac failure

c. Split in

- Normal hearts

B. Second heart sound

a. Accentuated in

1. Hypertension

2. Atherosclerosis

3. Syphilitic aortitis

4. Portal hypertension

i. Mitral stenosis

ii. Left ventricular failure

b. Diminished in 

1. Pulmonary stenosis

2. Aortic stenosis

C. Third heart sound in

1. Children

2. Mitral incompetence

3. Left ventricular failure

Cardiac Murmurs

A. Diastolic murmurs

1. Mitral stenosis

2. Aortic incompetence

3. Tricuspid stenosis

4. Pulmonary incompetence

5. Atrial septal defect

B. Systolic murmurs

1. Mitral incompetence

2. Tripuspid incompetence

3. Ventricular septal defect

4. Aortic stenosis

5. Pulmonary stenosis

C. Continuous murmurs

1. Patent ductus arteriosus

2. Aortic sinus perforation

Syncope
Causes

A. Vasomotor

1. Psychogenic

2. Pain

3. Postural hypotension

4. Post-sympathectomy

5. Adrenergic blocking agents

6. Pressure on hypersensitive carotid sinus

7. Strain on coughing or micturition

B. Cardiac

1. Adam-Stokes attacks (heart block) 

2. Tachycardia - high

3. Paroxysmal arrhythmia

4. Valvular stenosis

5. Cyanotic congenital heart disease

C. Miscellaneous

1. Anaemia

2. Hypoglycaemia

3. High altitudes

Cardiac Arrest
Causes

1. Anaesthesia

2. Surgical operations

3. Drug sensitivity or toxicity

4. Myocardial infarction

5. Heart block

6. Electrocution

Chest Pain
Causes

A. Cardiovascular disorders

1. Angina pectoris

2. Coronary insufficiency

3. Coronary occlusion

4. Cardiac contusion

5. Aortic aneurysm

6. Pericarditis

7. Myocarditis

8. Dissecting aneurysm

9. Arrhythmias

10. Coarctation

B. Pulmonary disorders

1. Bronchogenic carcinoma

2. Pulmonary hypertension

3. Pulmonary abcess

4. Pulmonary embolism

5. Spontaneous pneumothorax

6. Pleurisy

C. Gastrointestinal disorders

1. Oesophagitis and spasm

2. Hiatus hernia

3. Splenic flexure syndrome

4. Gastritis

5. Pylorospasm

6. Cardiospasm

7. Peptic ulcer

D. Diaphragmatic lesions

1. Diaphragmatic hernia

2. Diaphragmatic  pleurisy

E. Mediastinal lesions

1. Mediastinal emphysema

2. Tumours

F. Spinal metastases

1. Spinal metastases

2. Spinal cord tumours

G. Breast disorders

1. Cystic disease

2. Mammary duct ectasia

3. Fat necrosis

H. Neuroskeletal disorders

1. Arthritis of shoulder

2. Bursitis

3. Sprain

4. Pectoralis minor tendon injury

5. Intercostal neuritis

6. Myositis

7. Fibrositis

8. Tumours of chest wall

9. Costochondritis

I. Central lesions

1. Psychic disturbances

2. Epilepsy

J. Reflex cause

Hypersensitive carotid sinus

Angina Pectoris
Etiology

A. Occluded coronary vessels

1. Syphilitic aortitis

2. Atherosclerosis

3. Coronary angitis

4. Coronary embplism

B. Diminished coronary flow

1. Aortic stenosis

2. Gross aotic incompetence

3. Mitral stenosis

4. High pulmonary vascular resistance

C. Anoxaemia

1. Anaemia

2. High altitude

D. Increased work load of heart

1. Hypertension

2. Valvular disease

3. Hyperkinetic circulatory states

Myocardial Infarction
Complications

1. Abrupt death

a. Ventricular fibrillation

b. Asystole

2. Shock

3. Heart failure

4. Rupture

a. of heart

b. of septum

c. of papillary muscle

5. Cardiac aneurysm

6. Pericarditis

7. Thromboembolism

a. Pulmonary

b. Systemic (chiefly cerebral)

8. Cardiac arrhythmias

a. Atrial fibrillation

b. Atrial flutter

c. Ventricular tachycardia

d. Complete heart block

9. Neuroliogical complications

a. Coma

b. Hemiplegia

c. Syncope

d. Convulsions

Cardiac Arrhythmias

1. SA node dysfunction

a. Sinus arrhythmia

b. Sinus tachycardia

c. Sinus bradycardia

d. Sino-atrial block

e. Nodal rhythm

f. Reciprocal rhythm

2. Heart block

a. Prolonged PR interval

b. Partial heart block with dropped beats

c. Partial heart block with A-V relationship

d. Complete heart block

3. Ectopic beats

4. Parasystole

5. Paroxysmal tachycardia

a. Supraventricular paroxysms

i. Atrial

ii. Nodal

6. Auricular flutter

7. Auricular fibrillation

8. Ventricular fibrillation

06 Respiratory System

Common Symptoms & Signs

 

Symptoms

1. Cough

2. Expectoration

3. Haemoptysis

4. Chest pain

5. Dyspnoea

General signs

1. Cyanosis

2. Hypercapnia

3. Clubbing of fingers and toes

Chest signs

1. Diminution of movement

2. Mediastinal displacement

3. Altered percussion note

4. Abnormal breath sounds

5. Adventitious sounds

6. Altered vocal resonance

Clubbing of Fingers

 

A. Asymmetrical

a. Pulmonary

1. Lung cancer

2. Bronchiectasis

3. Lung abscess

4. Empyema

5. Fibrocaseous pulmonary tuberculosis

6. Arterio-venous fistula

b. Cardiac

1. Subacute bacterial endocarditis

2. Congenital heart disease (cyanotic)

c. Abdominal

1. Crohn's disease

2. Malabsorption syndrome

3. Liver cirrosis

d. Familial

--------

B. Unilateral

1. Aneurysm of aorta 

2. Pancoast tumour

C. Unidigital

1. Median ulnar palsy

2. Tophaceous gout

Causes of Cough

 

Virus infections

 

 

Respiratory tract infections

 

 

 

Sinusitis

 

 

Pharyngitis

 

 

Tonsillitis

 

 

Pneumonia

 

Allergy

 

 

Irritants

 

 

 

Dust

 

 

Fumes

 

 

Chemicals

 

Bronchial asthma

 

 

Airway blockage

 

 

 

Foreign body

 

Smoking

 

Haemoptysis

 

A. True haemoptysis

1. Pulmonary tuberculosis

2. Mitral stenosis associated with pulmonary infarct

3. Congestive heart failure

4. Pneumonia and bronchopneumonia

5. Pulmonary infarct

6. Bronchiectasis

7. Bronchial tumours

i. Adenoma

ii. Carcinoma

iii. Angioma

8. Pneumolith

9. Blood disorders

i. Haemophilia

ii. Purpura

iii. Leukaemia

10. Metabolic disorders

- Scurvy

11. Hamorrhagic infections

i. Measles

ii. Infective hepatitis

iii. Diphtheria

12. Vicarious menstruation

13. Pulmonary siderosis (idiopathic)

B. Spurious haemoptysis

1. Scurvy

2. Wounds inflicted from teeth

Causes of Cor Pulmonale

 

A. Pulmonary

1. Chronic airway obstruction

i. Chronic bronchitis

ii. Bronchial asthma

iii. Emphysema

2. Diffuse pulmonary interstitial disease

i. Pneumoconiosis

ii. Tuberculosis

iii. Bronchiectasis

3. Pulmonary vascular disease

i. Pulmonary embolism 

ii. Pulmonary hypertension

B. Disorders of chest movement

1. Kyphoscoliosis

2. Severe obesity

Etiology of Pulmonary Oedema

 

A. Acute pulmonary oedema

1. Heart failure

i. Left ventricular failure

ii. Coronary

iii. Mitral stenosis

iv. Acute cor pulmonale

2. Nervous disorders

i. Head injuries

ii. Cerebral vascular accidents

iii. Space occupying brain lesions

3. Lung irritants

- Phosgene

B. Subacute pulmonary oedema

1. Left ventricular strain

i. Rheumatic carditis

ii. Uraemia

iii. Polyarteritis nodosa

2. Fluid imbalance

i. Corticosteroids

ii. Stillboesterol

iii. Transfusion

3. Infection

i. Pneumonia

ii. Viral infections

4. Industrial irritants

C. Chronic pulmonary oedema

1. Chronic venous congestion

2. Chronic infections

Chronic Bronchitis

Etiology

 

1. Respiratory infections

2. Industrial environment

3. Cold or damp conditions

4. Overcrowding

5. Smoking

6. Heredity

7. Occupational irritants

8. Temperate climate

Symptoms

 

1. Cough

2. Dyspnoea

3. Haemoptysis

Signs

 

1. Chest movement restricted

2. Vocal fremitus diminished

3. Percussion note hyperresonant

4. Breath sounds harsh or weak

5. Vocal resonance diminished

6. Right sided cardiac dilatation

Differential diagnosis

 

1. Pulmonary tuberculosis

2. Mitral disease

3. Bronchiectasis

4. Bronchial carcinoma

Complications

 

1. Emphysema

2. Bronchial asthma

3. Bronchiectasis

4. Cardiomegaly

Treatment

 

1. Preventive

2. Expectorant

3. Antibiotic

4. Inhalations

5. Breathing exercises

Etiology of Bronchial Asthma

 

A. Spasm of bronchi

1. Vagus nucleus stimulation

i. Emotions

ii. Fatigue

iii. Sight of artificial flowers

2. Reflex stimulation from

i. Nose

ii. Eyes

iii. Stomach and intestines

3. Bronchial stimulation

- Cold air or fog inhalation

4. Injected substances

i. Acetylcholine

ii. Histamine

5. Hormonal

i. Adrenal corticoids

ii. Progesterone deficiency

B. Oedema of bronchi

1. Inhaled allergens

i. Pollen

ii. Room dust

iii. Book dust

iv. Orris root powder

v. Animal and flower emanation 

vi. Drugs

vii. Gum acacia

2. Haematogenous allergic substances

i. Food allergy

ii. Drugs 

iii. Bacterial products

iv. Serum therapy

3. Relaxation of bronchi

i. Sympathetic stimulation

ii. Sympathomimetic drugs

Bronchiectasis

Causes

 

Childhood infections

 

 

 

1.      Severe pneumonia

 

 

2. Whooping cough

 

 

3. Tuberculosis

 

 

4. Measles

 

Immunodeficiency

 

 

 

Weak immune system

 

 

HIV infection

 

Allergic bronchopulmonary aspergillosis

 

 

Aspiration

 

 

Cystic fibrosis

 

 

Cilia abnormalities

 

 

 

Young's disease

 

 

Primary ciliary dyskinesia

 

Connective tissue diseases

 

 

 

Rheumatoid arthritis

 

 

Sjögren's syndrome

 

 

Crohn's disease 

 

 

Ulcerative colitis

 

Symptoms

Please

Persistent cough with thick mucus

Hire

Haemoptysis

Waiters

Wheezing sounds with breathing

During

Dyspnoea

Cold

Chest pain

Weather

Weight loss

For

Fatigue

Common

Clubbing of fingers and toes

Festivals

Frequent respiratory infections

Diagnosis

She

Sputum test to check mucus for viruses or bacteria

Can

Chest X-ray or CT scan

Pay

Pulmonary function tests

Price

PPD skin test for tuberculosis

Surely

Sweat test for cystic fibrosis

07 Urinary System

Renal Function Test

A. Tests based upon observing the response to a load

a. With naturally ocurring substances

1. Diurnal variations

2. Water concentration test

3. Urea concentration test

b. With foreign substances

1. Phenul sulphonephthalic acid (PSP) test

2. Congo red test

B. Clearance tests

1. Urea clearance test

2. Creatinine clearance test

3. Inulin clearance test

C. Based upon composition of blood

a. Non-protein nitrogen (NPN)

1. Urea

2. Creatinine

3. Uric acid

b. Plasma protein

c. Cholesterol

Causes of Oliguria

1. Renal disease

2. Cardiac insufficiency

3. Fever

4. Diarrhoea and vomiting

5. Sweating

6. Fluid deprivation

7. Prostatic hypertrophy

8. Organic nervous disorders

Psychogenic disorders

Causes of Polyuria

1. Excessive fluid intake

2. Cold atmosphere

3. Diuretic therapy

4. Pituitary tumours

5. Hydronephrosis

6. Renal tuberculosis

7. Chronic nephritis

8. Diabetes insipidus

9. Diabetes mellitus

10. Paroxysmal tachycardia

Acute Glomerulonephritis

Signs

1. Face pale and puffy

2. Oedema

3. Ascites

4. Fever

5. Hypertension

6. Tachycardia and accentuated aortic second sound

7. Rhonchi and basal rales

Complications

1. Subacute or chronic glomerulonephritis

2. Uraemia

3. Hypertensive encephalopathy

4. Heart failure

5. Pericarditis

6. Peritonitis

7. Pulmonary oedema

Chronic Glomerulonephritis

Complications

1. Pulmonary oedema

2. Cerebral oedema

3. Pyogenic infection

4. Hypertensive encephalopathy

5. Renal vein thrombosis

Acute Pyelonephritis

Predisposing factors

1. Urinary obstruction

2. Hydronephrosis

3. Diabetes mellitus

4. Pregnancy and infancy

5. Enteritis

Clinical picture

1. Pain in loin

2. Dysuria

3. Vomiting

4. Fever with rigor

5. Lumbar tenderness

Nephrotic Syndrome

Etiology

1. Idiopathic

2. Systemic disease

i. Diabetes mellitus

ii. Amyloidosis

iii. Systemic lupus erythematosus

iv. Syphilis

3. Kidney disoders

i. Chronic glomerulonephritis

ii. Subacute glomerulonephritis

4. Poisons

i. Trimethadione

ii. Gold salts

iii. Mercury

iv. Bee stings

v. Poison oak

Constituents

1. Proteinuria, principally albuminuria

2. Hypoproteinaemia with reversal of albumin globulin ratio

3. Hypercholestraemia

4. Lipiduria with oval fat bodies, liquid masses and cystals in urine

5. Oedema (occasional)

6. Haematuria

7. Hypertension

8. Pyuria

9. Azotaemia

Uraemia

Causes

A. Renal

1. Acute interstitial nephritis

2. Glomerulonephritis - acute, subacute, chronic

3. Bilateral cortical necrosis

4. Infarcts (massive)

5. Malignant nephrosclerosis

6. Polycystic kidneys

7. Suppurative pylonephritis

8. Diabetic glomerulosclerosis

B. Extra-renal

1. Diabetic coma 

2. Protracted vomiting and diarrhoea

3. Addison's disease

4. Intestinal obstruction

5. Disseminated sclerosis

6. Poisons

i. Mercury bichloride

ii. Diethylene glycol

iii. Potassium chlorate

Clinical picture

A. Nervous system

1. Headache

2. Vertigo

3. Muscular weakness and twitchings

4. Apathy

5. Restlessness

6. Neuralgic pains

7. Thick speech

8. Drowsiness or insomnia

9. Disorientation or delerium

10. Reflexes exaggerated

B. Alimentary tract

1. Dryness of mouth

2. Tongue brown or grey

3. Ulcerative stomatitis

4. Purpura and loosening of teeth

5. Anorexia, polydipsia, nausea, and vomoiting

C. Respiratory system

1. Ammoniacal odour of breath

2. Breath sounds dry and harsh

3. Hypertension

D. Circulatory system

1. Serofibrinous pericarditis

2. Hypertension

E. Skin

1. Dry, waxy, yellowish brown

2. Pruritus

3. Uraemic frost

4. Skin eryptions

F. Miscellaneous

1. Temperature subnormal

2. Haemorrhagic ulcerative vaginitis

3. Anaemia

Haemorrhagic diathesis

Acute Renal Failure

Causes

A. Pre-renal

1. Circulatory failure

i. Cardiac

ii. Peripheral

iii. Occlusion of renal vessel

2. Fluid and electrolyte imbalance

i. Diarrhoea and vomiting

ii. Burns

iii. Crush injuries

3. Allergies

4. Toxaemias (overwhelming)

5. Addisonian crisis

B. Renal

1. Glomerulonephritis (acute)

2. Anoxic tubular nephrosis

3. Toxic tubular nephrosis

4. Pyelonephritis (acute)

5. Pyemic kidney

6. Papillitis necroticans

7. Bilateral cortical necrosis

8. Eclampsia

9. Malignant nephrosclerosis

10. Radiation nephritis

C. Post-renal

1. Ureteric obstruction

2. Bladder obstruction

3. Urethral obstruction

 

Chapter 08 : Infectious & Tropical Diseases

 

Diphtheria

Clinical types

 

1. Tonsillar diphtheria

2. Pharyngeal diphtheria

3. Laryngeal diphtheria

i. Primary

ii. Tracheo-bronchial

iii. Mixed

4. Nasal diphtheria

5. Haemorrhagic diphtheria

6. Cutaneous or wound diphtheria

7. Diphtheria involving

i. Conjunctivae

ii. Ears

iii. Umbilicus

iv. Genitalia

Clinical picture

 

A. Tonsillar and pharyngeal diphtheria

1. Headache

2. Pain in extremities

3. Diarrhoea and vomiting (rare)

4. Toxaemic look

5. Exudate

6. Bleeding spots.

7. Lymph nodes enlarged

8. Tongue furred

9. Tachycardia

B. Laryngeal diphtheria

1. Hoarseness of voice

2. Dyspnoea (paroxysmal)

3. Cough

4. Signs of laryngeal obstruction 

i. Cyanosis

ii. Laboured breathing

iii. Intercostal recession

5. Membrane formation

C. Nasal diphtheria

1. Nasal discharge

2. Membrane formation

3. Follicular spots on upper lip

Differential diagnosis

 

1. Acute tonsillitis

2. Vincent's angina

3. Streptococcal sore throat

4. Infectious mononucleosus

5. Catarrhal laryngitis

Complications

 

1. Peritoneal abscess

2. Myocarditis

3. Peripheral nerve paralysis

i. Palatal - 10th day onwards

ii. Oculomotor - 3rd week onwards

iii. Ciliary - 3rd week onwards

iv. Facial - 3rd-6th week

v. Pharyngeal - 3rd or 4th week

vi. Laryngeal - 3rd-5th week

vii. Extremities - 5th or 6th week

viii. Diaphragm - 5th or 6th week

4. Acute laryngeal obstruction

5. Pneumonia

6. Allergic shock

Whooping Cough

Clinical picture

 

A. Catarrhal stage

1. Onset insidious, duration 12 weeks

2. Dry cough

3. Vomoting

4. Anorexia and insomnia

5. Sneezing, coryza and lacrimation

6. Fever

B. Paroxysmal stage

1. Duration 2-4 weeks

2. Paroxysmal cough

3. Expectoration

4. Vomiting

Complications

 

A. Respiratory

1. Pneumonia

2. Atelectasis

3. Emphysena

4. Bronchiectasis

5. Pneumothorax

B. Nervous

1. Convulsions

2. Meningitis

3. Toxic encephalitis

4. Cerebral haemorrhhage

C. Gastrointestinal

1. Umbilical hernia

2. Prolapse of rectum

3. Frenal ulcer 

4. Enteritis

D. Others

1. Otitis media

2. Acute nephritis

3. Fulminant tuberculosis

Chickenpox

Complications

 

1. Secondary infections of skin

2. Encephalitis

3. Pneumonia

4. Pulmonary infacrtion

5. Otitis media

6. Bullous impetigo

7. Orchitis and testicular atrophy

Smallpox

Complications

 

1. Furunculosis

2. Abscess

3. Cellulitis

4. Gangrene

5. Pneumonia

6. Laryngitis

7. Pleurisy

8. Empyema

9. Otitis media

10. Blindness

Measles

Complications

 

1. Otitis media

2. Mastoiditis

3. Pneumonia

4. Appendicitis

5. Bronchitis

6. Cervical lymphadenitis

7. Catarrhal laryngitis

8. Encephalitis

9. Encephalomyelitis

Typhoid

Clinical picture

 

A. Stage of invasion

1. Face flushed

2. Tongue white, furred at surface, edges clean

3. Pupils dilated

4. Fever

5. Relative bradycardia with dicrotic pulse

6. Tympanites

7. Spleen just palpable

8. Rose spots

B. Stage of fastigium

1. Prostration

2. Headache

3. Deafness, occasional

4. Tongue white, furred at surface, edges clean

5. Insomnia or delirium

6. Sustained fever (101-103°F)

C. Stage of defervescence

1. Exhaustion

2. Delirium and muscular twitching

3. Tongue dry and shiny

4. Muscular wasting

5. Haemorrhage and perforation

6. Abdomen distended

7. Temperature falls by lysis

D. Convalescent stage

1. Temperature normal during morning

2. Abdominal reflexes reappear

3. Spleen not palpable

Complications

 

1. Intestinal

i. Haemorrhage

ii. Perforation and peritonitis

2. Venous thrombosis - left femoral vein usually affected

 

3. Respiratory

i. Laryngitis and ulceration of laryngeal cartilages

ii. Bronchitis

iii. Pneumonia

iv. Pleural effusions

4. Cardiac

i. Myocardial degeneration

5. Neuritis, especially causing tender toes

ii. Endocarditis and pericarditis

6. Otitis and parotitis

7. Meningitis

8. Cerebral thrombosis or embolism

9. Myelitis

10. Nephritis

11. Periostitis

12. Acute cholecystitis

13. Infarction of the spleen

Mumps

Complications 

1. Orchitis - rare before puberty

2. Oophoritis

3. Myocarditis

4. Acute pancreatitis

5. Mastitis

6. Otitis media

7. Labyrinthitis

8. Peripheral neuritis

9. Neuritis of II, VI, VIII, III cranial nerves

10. Meningoencephalitis

11. Meningism

12. Meningitis

 

Chapter 09 : Nutritional Disorders

 

Obesity - Etiology

 

 

1.      Exogenous obesity

 

 

(i) Over-eating

 

 

(ii) Sedentary life

 

2.      Endogenous obesity

P

 

(i) Pituitary - Frohlich's syndrome

H

 

(ii) Hypothalamus - Laurence-Moon-Biedl syndrome

S

 

(iii) Simple hypogonadal - Eununchoid obesity

A

 

(iv) Adrenogenital - Associated with adrenal tumours

H

 

(v) Hypothyroid - Usually following  thyroidectomy

P

 

(vi) Pluriglandular obesity

 

Obesity - Complications 

 

M

 

1.      Mechanical disability

M

 

2.      Malnutrition

L

 

3.      Liver cirrosis

H

 

4.      Hypertension

C

 

5.      Cardiac disease

A

 

6.      Arteriosclerosis

E

 

7.      Endocrine disorders

 

Same

 

(i)                 Sex organ disorders

 

Day

 

(ii)               Diabetes

 

Noon

 

(iii)             Nervous disorders

 

Conditions association with Avitaminosis 

 

Vitamin A

 

R

 

(i) Retarded growth

H

 

(ii) Hyperkeratosis

N

 

(iii) Night blindness

X

 

(iv) Xeropethalmia

 

Vitamin D

 

R

 

(i) Rickets

I

 

(ii) Infantile tetany

O

 

(iii) Osteomalacia

A

 

(iv) Abnormal dentition

 

Vitamin C

 

S

 

(i) Scurvy

G

 

(ii) Gingivitis

H

 

(iii) Haemorrhage

 

Vitamin K

 

P

 

(i) Prothrombin deficiency

H

 

(ii) Haemorrhagic disease of newborn

 

Thiamine

 

B

 

(i) Beri-beri

P

 

(ii) Polyneuritis

A

 

(iii) Anorexia

W

 

(iv) Wernicke's encephalophathy

 

Riboflavin

 

C

 

(i) Cheilosis

G

 

(ii) Glossitis

C

 

(iii) Corneal vascularization

P

 

(iv) Photophobia

S

 

(v) Scrotal dermatitis

 

Nicotinic acid

P

 

(i) Pellagra

D

 

(ii) Dermatitis

G

 

(iii) Glossitis

D

 

(iv) Diarrhoea

E

 

(v) Encephalopathy

 

Folic acid

 

 

 

- Macrocytic anaemia

 

Chapter 10 : Diseases of Children

Table : Smallpox Vs. Chickenpox

Smallpox

Chickenpox

Incubation period

8-12 days

14-21 days

Prodromal stage :

Duration

2-4 days

0-2 days

Symptoms

Severe

Mild or moderate

Temperature

High

Moderately elevated

Eruptive stage :

Appearance

2nd-4th day

0-2nd day

Temperature

About normal; Secondary rise during postulation

Same level

Distribution

Centrifugal

Centripetal

Character

Monomorphous

Polymorphous

 

Neonatal jaundice - Etiology

 

P

 

1.      Physiologic jaundice of the newborn

H

 

2.      Haemolytic jaundice

 

 

 

(i)                 Blood group incompatibility

 

Rat

 

 

(a)    Rh incompatibility

 

Ate

 

 

(b)   ABO incompatibility

 

Rat

 

 

(c)    Rare incompatibilities

 

 

 

(ii) Other haemolytic mechanisms

 

An

 

 

(a) Abnormal haemoglobins

 

Animal

 

 

(b) Abnormal red blood cells

 

Has

 

 

(c) Haemolytic drugs, toxins and infections

 

Enemies

 

 

(d) Enzyme defects

O

 

3.      Obstructive jaundice

 

 

 

(i) Congenital obstructive jaundice

 

 

 

 

(a) Extrahepatic biliary atresia

 

 

 

 

(b) Intrahepatic biliary atresia

 

 

 

(ii) Acquired obstructive jaundice

 

 

 

 

(a) Inspissated bile syndrome - Cholangitis

 

 

 

 

(b) Cysts and tumours

H

 

4. Hepatogenous jaundice

 

N

 

(i) Neonatal hepatitis

 

L

 

(ii) Liver cirrhosis

 

V

 

(iii) Viral hepatitis

 

F

 

(iv) Familial non-haemolytic jaundice

 

D

 

(v) Dubins-Johnson syndrome

 

G

 

(vi) Galactosaemia

 


 

11 Mental Disorders

 

Mental disorders - Classification

F

 

A. Functional psychosis

 

 

 

1. Manic-depressive illness

 

 

 

2. Schizophrenia

O

 

B. Organic psychosis

C

 

C. Neurosis (psychoneurosis)

 

A

 

1. Anxiety states

 

H

 

2. Hysteria

 

O

 

3. Obsessional neurosis

D

 

D. Personality disorders

 

D

 

1. Drug addiction

 

A

 

2. Alcohol addition

 

P

 

3. Psychosexual disorders

E

 

E. Mental subnormality

 

Organic psychosis - Causes

 

I

 

 

A. Infections of brain and meninges

 

 

 

 

(a) Acute and subacute infections

 

 

 

 

 

1. Meningitis

 

 

 

 

 

2. Encephalitis

 

 

 

 

(b) Chronic infection (syphilis)

 

 

 

 

 

1. Tabes dorsalis

 

 

 

 

 

2. Generai paralysis of the Insane

M

 

 

A.    Metabolic and toxic diseases

 

Very

 

 

(a)    Vitamin deficiencies

 

 

Peeping

 

 

1. Pellagra

 

 

With

 

 

2. Wernicke's encephalopathy

 

 

Vision

 

 

3. Vitamin B12 encephalopathy

 

Honest

 

 

(b) Hypoxia

 

 

 

 

 

- Carbon monoxide poisoning

 

Human

 

 

(c) Hypoglycaemia

E

 

 

C. Endocrine disorders

 

Meethaa

 

 

 

1. Myxoedema

 

To

 

 

 

2. Thyrotoxicosis

 

Hota

 

 

 

3. Hyperadrenalism

 

Hai

 

 

 

4. Hypoadrenalism

P

 

 

D. Pregnancy and child-bearing

H

 

 

E. Head injury

V

 

 

F. Vascuiar disorders

D

 

 

G. Degenerative conditions

 

His

 

 

 

1. Huntington's chorea

 

Pants

 

 

 

2. Pick's disease

 

Are

 

 

 

3. Alzheimer's disease

 

Stitched

 

 

 

4. Senile dementia

 


 

12 Skin Disorders

Superficial lesions

 

 

A.    Primary lesions

My

 

Macules

Peon

 

Papules

Never

 

Nodules

Visits

 

Vesicles

Bharat

 

Bullae

Prasad

 

Pustules

Wadhera’s

 

Wheals

Shop

 

Scales

Before

 

Burrows

Beating

 

Blackheads

Pet

 

Plaques

 

B.     Secondary lesions

Fibre

 

Fissures (Rhagades)

Underwears

 

Ulcers

Shrink

 

Scar

Casually

 

Crust – Blood crusts, pus crusts, serum crusts

 

 

Chapter 13 : Sexually Transmitted Diseases

 

Sexually Transmitted Diseases - Varieties

 

 

A. Venereal diseases

S

 

1. Syphilis

G

 

2. Gonorrhea

C

 

3. Chancroid

L

 

4. Lymphogranuloma venereum

G

 

5. Granuloma inguinale

 

B. Non-venereal diseases

N

 

1. Nonspecific urethritis

R

 

2. Reiter's disease

F

 

3. Fungal infections viz. moniliasis

T

 

4. Trichomonal infection

H

 

5. Herpes progenitalis

G

 

6. Genital warts

H

 

7. Hepatitis B

 

Sexually Transmitted Diseases - Etiology 

 

1. Direct

 

 

(i) Kissing

 

 

(ii) Bites 

 

 

(iii) Licking out foreign body in eye

 

 

(iv) Feeding some one else's child from breasts

 

2. Indirect

 

 

(i) Common towels and clothes

 

 

(ii) Common utensils

 

 

(iii) Common spoons and drinking cups

 

 

(iv) Cigarette sharing

 

 

(v) Licking pens and pencils

 

 

(vi) Children whistles and toys

 

3. Occupational

 

 

(i) Shoe makers and carpenters lick nails and put them back into common box

 

 

(ii) Doctors spread infection through instruments

 

 

(iii) Blood transfusion

 

4. Congenital

 

 

 

Chapter 14 : Miscellaneous Topics

 

Ocular signs in systemic disorders 

 

I. Nervous system

 

 

 

A. Circulatory disorders

 

 

 

1. Intracranial aneurysms

 

 

 

2. Cerebral thrombosis and haemorrhage

 

 

 

3. Hydrocephalus

 

 

B. Infection

 

 

 

1. Meningitis

 

 

 

2. Brain abscess

 

 

 

3. Encephalitis

 

 

C. Syphilitic affections

 

 

 

1. Cerebral syphilis

 

 

 

2. Tabes dorsalis

 

 

 

3. General paralysis of the insane

 

 

D. Demyelinating diseases

 

 

 

1. Disseminated sclerosis

 

 

 

2. Diffuse sclerosis (Schilder's disease)

 

 

E. Intracranial tumours

 

 

F. Head injuries

 

II. Other systems

 

 

1. Infectious diseases

 

 

2. Circulatory disorders

 

 

3. Blood disorders

 

 

4. Metabolic diseases 

 

 

5. Collagen diseases

 

 

6. Muscular diseases

 

 

7. Deficiency diseases

 

 

8. Diseases of the kidney

 

 

9. Alimentary diseases

 

 

Ocular signs in systemic disorders - Infective Diseases 

 

A. Bacillary infections

 

 

1. Typhoid fever

 

 

 

(i) Optic Neuritis

 

 

 

(ii) Infective retinitis with haemorrhage

 

 

 

(iii) Metastatic choroiditis

 

 

2. Whooping cough. Conjunctival, retinal and orbital haemorrhages

 

 

3. Diphtheria

 

 

 

(i) Membranous conjunctivitis

 

 

 

(ii) Cycloplegia

 

 

 

(iii) Lateral rectus palsy

 

 

4. Brucellosis. Uveitis

 

 

5. Tularemia. Nodular conjunctivitis

 

 

6. Leprosy

 

 

 

(i) Cutaneous, nodules on the lids

 

 

 

(ii) Conjunctivitis

 

 

 

(iii) Superficial or interstitial keratitis

 

 

 

(iv) Lepromatous lesiont in the cornea and sclera

 

 

 

(v) Granulomatous uveitis

 

 

7. Tuberculosis. Granulomatous uveitis

 

 

8. Tetanus. Ophthalmoplegia

 

B. Coccal infections 

 

 

 

(i) Metastatic infections

 

 

 

(ii) Allergic responses

 

 

 

(iii) Abscess and gangrene of the lids

 

 

 

(iv) Orbital cellulitis

 

C. Viral infections 

 

 

1. Measles

 

 

 

(i) Mucopurulent conjunctivitis 

 

 

 

Corneal ulcers

 

 

 

Endophthalmitis

 

 

2. Smallpox. Corneal ulcers

 

 

3. Chickenpox. Corneal ulcers

 

 

4. Mumps

 

 

 

Dacroadenitis

 

 

 

Keratitis

 

 

5. Influenza

 

 

 

(i) Conjunctivitis

 

 

 

(ii) Optic neuritis

 

 

 

(iii) Endophthalmitis

 

 

6. Dengue fever

 

 

 

(i) Keratitis

 

 

 

(ii) Iridocyclitis

 

 

 

(iii) Ocular palsies

 

 

7. Rubella. Congenital cataract

 

D. Rickettsial infections 

 

 

Typhus fever

 

 

 

(i) Conjunctivitis

 

 

 

(ii) Subconjunctival

 

 

 

(iii) Corneal ulcers

 

 

 

(iv) Iritis

 

 

 

(v) Optic neuritis

 

 

 

(vi) Ocular palsies

 

E. Spirochaetal infections

 

 

1. Syphilis

 

 

 

(i) Conjunctivitis

 

 

 

(ii) Superficial or interstitial keratitis

 

 

 

(iii)-Uveitis

 

 

2. Relapsing fever 

 

 

 

(i) iritis

 

 

 

(ii) Optic atrophy

 

 

 

(iii) Ocular palsies

 

 

3. Weil's disease

 

 

 

(i) Conjunctivitis

 

 

 

(ii) Subconjunctival haemorrhages

 

 

 

Surgery


A. General surgery

Wounds - Types

I

1. Incised wound

Like

2. Lacerated wound

Consent

3. Contused wound

Separately

4. Sprain

From

5. Fracture

6. Puncture wound

3 Partners

7. Perforating wound

8. Penetrating wound

Burn

Local effects

Paying

1. Pain

Fairly

2. Fluid, electrolyte and protein loss

Heavy

3. Heat loss

Income

4. Infection

Tax

5. Thrombosis

Systemic effects

Heavy

1. Haemolysis

Investment

2. Increased capillary permeability

With

3. Water and electrolyte loss

Companies

4. Cardiac output diminished

Often

5. Oliguria and renal failure

Causes

6. Curling's ulcer

Real

7. Respiratory failure

Concern

8. Catabolism

 

General management

Send

1. Sedation and analgesia

A

2. Airway maintenance

Fast

3. Fluid balance

Bowler

4. Blood

To

5. Tetanus prevention

Attack

6. Antibiotics

A

7. Antacids

New

8. Nutrition

Run

9. Reassurance

Rioter

10. Rehabilitation

Local management

Doctors

1. Debridement

Always

2. Antiseptic

Have

3. Haemografts

An

4. Autografts

Emergency

5. Escharotomy

Duty

6. Deformity prevention

Complications of Middle Ear Disease

Men

1. Mastoiditis - Acute and chronic

Evade

2. Extradural brain abscess

The

3. Thrombosis of lateral sinus and jugular vein

Doctor

4. Deafness

Living

5. Labyrinthitis with vertigo

Second

6. Sternomastoid abscess

Floor

7. Facial palsy

B. Clinical surgery


Examination of Swelling

History

Daily

1. Duration

Many

2. Mode of onset

Shopkeepers

3. Situation

Send

4. Shape

Precious

5. Progress

Packets

6. Pain

Some

7. Secondary changes

Shopkeepers

8. Similar swellings elsewhere

Lose

9. Loss of body weight

Receipts

10. Recurrence

Physical examination

Not

1. Number

Single

2. Situtation

Service

3. Shape

Station

4. Size

Can

5. Colour

Serve

6. Surface

Every

7. Edge

Person

8. Pulsation

In

9. Impulse on coughing

Same

10. Skin over the swelling

Polite

11. Pressure effects

Loving

12. Local temperature

Tone

13. Tenderness

Examination of an Ulcer

History

Decent

1. Duration

Men

2. Mode of onset

Pay

3. Pain

Due

4. Discharge

Price

5. Past history

Physical examination

Indian

A. Inspection

New

1. Number

Persons

2. Position

Specially

3. Size

Sought

4. Shape

For

5. Floor

Every

6. Edge

Day

7. Discharge

Short

8. Surrounding area

Visits

9. Varicose veins

People

B. Palpation

Tried

1. Tenderness

Even

2. Edge

Better

3. Base

Makes

4. Mobility

Like

C. Lymph nodes

Imported

D. Impairment of circulation

Nuts

E. Nerve lesions

C. Tumours

Common Benign Tumours

People's

1. Papilloma

Liking

2. Lipoma

For

3. Fibroma

Kites

4. Keloid

Not

5. Neurofibroma

Always

6. Angiomas    a. Capillary   b. Cavernous

Concealed

7. Chondroma   a. Enchondroma   b. Ecchondroma

Malignant Tumour

Etiology

Common

1. Chemical

People

2. Physical

Visit

3. Viral

Great

4. Genetic

Monuments

5. Miscellaneous (diet)

Spread

Dim

1. Direct extension

Light

2. Lymphatic

Vision

3. Vascular

Thin

4. Transcoelomic

Local effects

Evening

1. Expansive   a. Obstruction   b. Lump

In

2. Infiltrative   a. Pain      b. Fixation

Newzealand

3. Necrosis    a. Bleeding    b. Infection

Metastatic effects

Lady

1. Lymphadenopathy

Dancers

2. Dyspnoea (lung)

Join

3. Jaundice (liver)

Fun

4. Fracture (bone)

Every

5. Epilepsy (brain)

Night

6. Nodules (skin)

Systemic effects

College

1. Constitutional

Cachexia and weight loss

Anaemia

Fever

Can

2. Cutaneous

Acantosis nigricans

Dermatomyositis

Hire

3. Haematological

Polycythaemia

Very

4. Vascular

Thrombophlebitis

Huge

5. Hormonal and metabolic

Cushing's disease (lung) 

ADH secretion (lung)

Hypercalcaemia (lung, breast)

Hypoglycaemia (liver

Grand

6. Gout (lymphomas

Net

7. Neuromuscular

Cerebellar degeneration (lung)

Myasthenia gravis (thymus)

Complications of Radiotherapy

Now

1. Nausea, vomiting, malaise

Some

2. Skin ulceration

Beautiful

3. Bowel stricture, ulceration or perforation

New

4. Nephritis

Girls

5. Gonadal atrophy

Present

6. Pancytopenia

Poetry

7. Pneumonitis and fibrosis

Please

8. Pericarditis

Come

9. Conjunctivitis and cataract

Closer

10. Cerebral oedema

Beauty

11. Bone necrosis

Lovers

12. Leukaemia

D. Cardiovascular System

Cardiac Arrest

Causes

My

1. Myocardial infarction

Heavens!

2. Hypoxia

Did

3. Drugs e.g. adrenaline, anaesthetics

He

4. Hypothermia

Ever

5. Embolism

Have

6. Haemorrhage and shock

Flat?

7. Fright

Everyone

8. Electrocution

Enquired

9. Electrolyte imbalance

As

10. Acid base imbalance

He

11. Hypercapnoea

Vanished

12. Viscerocardiac reflexes

Signs

Union

1. Unconsciousness

People

2. Pulse not palpable

Giving

3. Gasping or apnoea

Posters

4. Pupils dilated

Management

Rupee

1. Raise foot end

Coins

2. Clear airway

Are

3. Artificial respiration

Every

4. External cardiac massage

Day

5. Drugs

A

Adrenaline 1 ampoule i.v.

Curly

Calcium gluconate 10 ml i.v.

Haired

Hydrocortisone 100 mg i.v.

Spy

Sodium bicarbonate 6-10 ml i.v.

In

6. Internal cardiac massage

Demand

7. Defibrillation

Every

Electric defibrillation

Saint

Sodium bicarbonate 100 ml i.v.

Prays

Procainamide 200 mg i.v.

Lord

Lignocaine 50-100 mg i.v.

Shock - Clinical Picture

Please

1. Pallor

Send

2. Skin cold and moist

Red

3. Respiration rapid and shallow

Carpets.

4. Cyanosis

People

5. Pulse weak and rapid

Have

6. Hypotension

Often

7. Oliguria

Played

8. Polydipsia

A

9. Apprehension and restlessness

Demon

10. Diminished senses

Gangrene - Causes

Cops

A. Cardiovascular

An

Arteriosclerosis (senile)

Evening

Endarteritis obliterans (syphilis)

Real

Raynaud's disease

Brothers

Buerger's disease

Can

Cervical rib

Emerge

Ergot poisoning

Enemies

Embolic

Now

B. Nerve Disease

Short

Syringomyelia

Thin

Tabes dorsalis

People

Peripheral neuritis

Like

Leprosy

Him

Hemiplegia

Please

Paraplegia

Trying

C. Traumatic

Tissue injury

Vascular injury

To

D. Thermochemical

He

Heat

Can

Cold

Complete

Corrosives

X-ray

X-ray

Reporting

Radium

Indict

E. Infective 

a. Acute

Bose

Boil

Can

Carbuncle

Complete

Cancrum oris

Project

Postoperative

b. Gas gangrene

Doctor

F. Diabetic

Chronic Peripheral Ischaemia

Central

1. Claudication

Hip pain (bilateral iliac)

Thigh pain (common femoral)

Calf pain (superficial femoral)

Park

2. Pulses diminished or lost

Has

3. Hair absent, nails brittle or opaque

Many

4. Muscle atrophy

Pretty

5. Pallor on elevation

Damsels

6. Dependent rubor

Coming

7. Capillary return slow

With

8. Wound healing slow

Pistols

9. Pain at rest

Under

10. Ulceration and Gangrene

Acute Arterial Occlusion - Effects

1. Pain

2. Pallor

6

3. Pulseless

P's

4. Parasthesia

5. Paralysis

6. Perishing cold

E. Urinary System

Urinary Obstruction - Causes

A. In pelvis

Come

1. Congenital

Tomorrow

2. Tumour

Shop

3. Stone

Closed

4. Clot

B. In ureter

She

1. Stone

Can

2. Clot

Try

3. Tumour

Samples

4. Stricture

Under

5. Ureterocoele

Company

6. Carcinoma

Colon

Rectum

Cervix

Rules

7. Retroperitoneal fibrosis

C. In urethra

Please

1. Prostate

Send

2. Stricture

Female

3. Foreign bodies

Coach

4. Congenital valves

Urolithiasis

Causes

a. Stasis

His

1. Hydronephrosis

Brother

2. Bladder diverticulum

Really

3. Retroprostatic pouch

Living

4. Large residual volume

In

5. Immobilityt

Distress

6. Dehydration

b. Excess of normal constituents

1. Hyperparathyroidism (calcium)

2. Gout (urate)

3. Crohn's disease (oxalate, urate, calcium)

c. Abnormal urine constituents

1. Foreign body

2. Epithelial debris (infection)

Radiological D/D

Call

1. Calcified lymph node

Girl

2. Gall stones

Pulled

3. Phleboliths

The

4. Tuberculosis

Curtain,

5. Calcified adrenal

Confessed

6. Calcified pancreas

Real

7. Radioopaque pills

Crime

8. Calcified fibroids

F. Gastrointestinal System

Ulcers of Tongue

Doctor

1. Dental ulcer

Can

2. Chronic nonspecific ulcer

Inject

3. Infective ulcer

Some

4. Syphilitic ulcer

Tested

5. Tuberculous ulcer

Medicine

6. Malignant ulcer

Tumours of Tongue

Benign

Physicians

1. Papilloma

And

2. Angioma

Lawyers

3. Lymphangioma

Never

4. Neurofibroma

Let

5. Lipoma

Loose

6. Lingual thyroid

Malignant

Carcinoma

Dysphagia - Causes

Boys

A. Bucco-pharyngeal

I

1. Inflammations

Undertake

2. Ulceration

Low

3. Labioglossolaryngeal paralysis

Budget

4. Bulbar paralysis

Schemes

5. Spasm

For

6. Foreign bodies

Routine

7. Retropharyngeal abscess

Treatment

8. Tumours

Like

B Laryngeal

A

1. Acute laryngitis

Complaint

2. Chronic laryngitis

To

3. Tuberculosis

Station

4. Syphilis

Master

5. Malignancy

Only

C. Oesophageal

Can

1. Congenital malformations

International

2. Inflammation - acute or chronic

Funds

3. Foreign body

Department

4. Diverticula

Offer

5. Oesophagectasia

Some

6. Simple stricture

Money?

7. Malignant stricture

New

D. Neck

G

1. Goitre

A

2. Aneurysm

T

3. Tumours

E

4. Enlarged lymph nodes

Teacher

E. Thorax

Middle

1. Mediastinal tumours

Men

2. Medistinal lymph nodes

Assist

3. Aneurysms

Carcinoma of Stomach

Etiology

Poor

1. Peptic ulcer

Men

2. Macrocytic anaemia

Generally

3. Gastric polyposis

Cursed

4. Chronic gastritis

Clinical features

Deaf

1. Dyspepsia

And

2. Anorexia

Dumb

3. Discomfort after food

First

4. Flatulence

Lived

5. Loss of weight

Desperately

6. Dyspnoea and palpitation (anaemia)

Now

7. Nausea

People 

8. Pain in stomach and back - relieved by vomiting

Delivering

9. Dysphagia, heartburn

Generous

10. Gastric Distention

Aid

11. Anaemia and cachexia

Diagnosis

Boring

1. Barium radiography

Gossip

2. Gastroscopy

From

3. Fractional test meal

Short

4. Stool examination for occult blood

Wave

5. Weight chart

Treatment

Girls 

1. Gastroenterostomy

Generally

2. Gastrostomy

Join

3. Jejunostomy

Inside

4. Insertion of  radon seeds or short lengths of radioactive gold wire

Postgastrectomy syndrome

A. Ulceration

1. Jejunal ulcer

2. Gastric ulcer

3. Zollinger-Ellison syndrome

B. Altered function

a. Postcibal symptoms

1. Early postcibal syndrome (Dumpimg syndrome)

2. Late postcibal syndrome (hypoglycaemic syndrome)

3. Bile vomiting

b. Nutritional disturbances

Why

1. Weight loss and sreatorrhoea

Is

2. Iron deficiency anaemia

My

3. Megaloblastic anaemia

Vehicle

4. Vitamin B Deficiency

Stopped?

5. Severe malnutrition

Chronic Peptic Ulcer

Etiology

Please

1. Personality predisposition

Assist

2. Acid factor

The

3. Traumatic factor

Very

4. Vascular factor

Tall

5. Toxic factor

New

6. Neurogenic factor

Visiting

7. Vitamin deficiency factor

Doctor

8. Diet factor

Clinical features

Pushing

1. Pain

Very

2. Vomiting

Heavily

3. Haematemesis

My

4. Melaena

Loaded

5. Loss of weight

Truck

6. Tenderness

Differential diagnosis

Carrying

1. Cholecystitis

A

2. Appendicitis

Rocking

3. Renal colic

Horse

4. Hiatus hernia

On

5. Oesophagitis

Car

6. Chronic pancreatitis

And

7. Angina pectoris

Coming

8. Carcinoma of stomach, colon or liver

Immediately

9. Idiopathic dyspepsia

Complications

Her

1. Haemorrage

Parents

2. Perforation

Paid

3. Perigastric inflammation

Some

4. Stenosis

Pyloric stenosis

Hour-glass stomach

Amount

5. Anastomotic ulcer

Treatment

Very

1. Vagotomy

Great

2. Gastrojejunostomy

Person

3. Partial gastrectomy

Appendicitis

Etiology

Pretty

1. Poor blood supply

Big

2. Bacteria within the lumen and lymphoid follicles

Guns

3. Greater length, direction and position

Seen

4. Short mesentery

Busy

5. Blocked opening into caecum

In

6. Intestinal infection and foreign bodies

Indian

7. Inflammation of caecum and colon

Equity

8. External trauma

Clinical types

College

1. Catarrhal appendicitis

Guys

2. Gangrenous appendicitis

Are

3. Appendicular abscess

Only

4. Obstructive appendicitis

Roaming

5. Recurrent appendicitis

At

6. Appendicular gastralgia

College

7. Chronic appendicitis

Clinical Features (of Catarrhal type)

Police

1. Pain in right iliac fossa

Force

2. Fever

Not

3. Nausea and vomiting

Caring

4. Constipation - diarrhoea in children

To

5. Tongue furred with foul breath

Attend

6. Abdominal wall rigid, right thigh flexed

The

7. Tenderness at McBurney's point - Rebound tenderness

Lone

8. Lump

Crying

9. Cutaneous hyperaesthesia

Lady

10. Leucocyte count over 12,000/cu.mm.

Differential Diagnosis

Many

1. Mesenteric adenitis

People

2. Pneumonia (in children)

Even

3. Enteritis

Admire

4. Acute pyelitis

Prime

5. Perforation of duodenum or stomach

Minister

6. Mucous colitis

Serving

7. Salpingitis and oophoritis

Social

8. Spinal tuberculosis

Service

9. Suppuration of deep iliac nodes

Cause

10. Carcinoma of caecum

Peritonitis

Etiology

Great

1. Gastrointestinal

Please

a. Peptic ulcer perforation

Teach

b. Traumatic rupture

First

c. Foreign body impaction

Step

d. Strangulation and volvulus

Again

e. Appendicitis

People

2. Puerperal peritonitis

Preach

3. Perforating wounds and operations

Good

4. Gonococcal salpingitis

To

5. Tuberculosis

Mankind

6. Mechanical or chemical

Extravasation of bile 

Intraperitoneal rupture of gall bladder

Bleeding from liver, spleen, ectopic pregnancy

Clinical Picture - Localised peritonitis

Fallopian

1. Fever

Tube

2. Tachycardia

Pregnancy

3. Pain

Very

4. Vomiting

Rare

5. Rigidity of abdominal wall

Clinical Picture - Diffuse peritonitis

Early stage :

Patients

1. Pain spreading all over abdomen

Very

2. Vomiting bile-stained and effortless

Pained

3. Patient supine with knees flexed

To

4. Temperature raised - subnormal in fulminant cases

Pay

5. Pulse rising

The

6. Tongue moist

Fee

7. Face flushed

Are

8. Abdominal wall without respiratory movements

Demonstrating

9. Diffuse rigidity of abdomen

Now

10. No peristaltic sounds

Intermediate stage (3rd day) : 

1. Abdomen acutely tender

2. Pulse rate falls in recovering cases

3. Rigidity gives place distention in bad cases

Later stage :

General

1. Gross distention

Public

2. Pulse rapid and thready

Entry

3. Eyes sunken but bright

Not

4. Nose pinched

Too

5. Tongue dry and shrivelled

Far

6. Forehead and hands cold and clammy

From

7. Facies drawn and anxious (Hippocratic facies)

School

8. Semiconsciousness in final stages

Treatment

Riots

1. Rest to alimentary canal

Ryle's tube aspiration

Nothing orally except 30 ml water every hour

Flatus tube - No enema

Soon

2. Sedation - Morphine 10-15 mg i.m. every 4-hours as necessary 

Initiated

3. Intravenous fluids

At

4. Antibiotics

The

5. Treatment of cause

Poll

6. Peritoneal toilet (sucking)

Paralytic Ileus - Causes

Patient

1. Postoperative

Practically

2. Peritonitis

Remained

3. Retroperitoneal haemorrhage - Fractured vertebrae

Under

4. Ureteric colic

Him

5. Hypokalaemia

Until

6. Uraemia

Doctor

7. Diabetic coma

Declared

8. Drugs - Probanthine

Him

9. Hypothyroidism

Safe

10. Spinal cord injury

Intestinal Obstruction

Clinical types

All

1. Acute intestinal obstruction

Injured

2. Intestinal strangulation

Patients

3. Paralytic ileus

Invariably

4. Intussusception

Visit

5. Volvulus

General

6. Gall stone ileus

Medical

7. Mesenteric thrombosis and embolism

Clinics

8. Chronic intestinal obstruction

Causes

a. Intraluminar

May

1. Meconium

I

2. Intussception

Get

3. Gall stones

In?

4. Impaction

Four

Faecolith

Wealthy

Worms

Boys

Barium

Have

Hair

Failed

Food

b. Bowel wall

Copper

1. Congenital

An

Atresia or stenosis

Italian

Imperforate anus

Diplomatic

Duplications

Mission

Meckel's diverticulum

T

2. Traumatic

Haematoma

Stricture

In

3. Inflammatory

Crohn's disease

Diverticulitis

Newly

4. Neoplastic

Married?

5. Miscellaneous

Potassium induced stricture

Radiation stricture

Endometriosis

c. Extraluminal

A

Adhesions or bands

House

Hernia

At

Annular pancreas

A

Anomalous vessels

Height

Haematoma

Never

Neoplasms

Visited

Volvulus

Treatment

Lady

1. Lysis of adhesions

Robber

2. Reduction or resection of intussception

Reached

3. Reduction of hernia

Every

4. Enterotomy

Remote

5. Resection

Building

6. Bypass

Under

7. Untwisting of volvulus

Dark

8. Decompression with

Ileostomy

Caecostomy

Colostomy

Acute Cholecystitis

Clinical picture

People

1. Pain in right hypochondrium

Now

2. Nausea and vomiting

May

3. Malaise

Find

4. Fever

Taxation

5. Tachycardia

Really

6. Rigidity of abdominal wall

Meaningful

7. Murphy's sign positive

Differential diagnosis

Pale

1. Peptic ulcer

Patients

2. Pancreatitis

May

3. Myocardial infarction

Have

4. Hepatitis

A

5. Appendicitis

Post

6. Pneumonia

Partum

7. Pleurisy

Haemorrhyage

8. Herpes zoster

Treatment

All

1. Antibiotics

In

2. I.V. fluids

Company

3. Cholecystectomy

Cholelithiasis

Types of stones

Milk

1. Mixed stones

Can

2. Cholesterol stones

Produce

3. Pigment stones

Curd

4. Calcium carbonate stomes

Clinical picture

Doctor

1. Dyspepsia

Found

2. Flatulence

A

3. Aversion to fatty food

Nurse

4. Nausea

Even

5. Epigastric pain

Standing

6. Subcostal pain referred to shoulder

Still

7. Subcostal tenderness

Sites of Impaction

Good

1. Gall bladder

Cases

2. Cystic duct

Coming

3. Common bile duct

Predisposing factors

Late

1. Lithogenic bile

Sittings

2. Stasis

In

3. Infection

Heart

4. Haemolysis

Disease

5. Diabetes mellitus

Have

6. Hyperlipidaemia

Often

7. Oral contraceptives

Increased

8. Intestinal parasites

Cardiac

9. Crohn's disease

Pain

10. Phaeochromocytoma

Chronic cholecystitis

Differential diagnosis

New

1. Nervous dyspepsia

Patients

2. Peptic ulcer

Generally

3. Gastritis

Can

4. Chronic pancreatitis

Call

5. Carcinoma of stomach

Him

6. Hepatic flexure disease

Late

7. Liver abscess

General complications

A

1. Acute cholecystitis

Car

2. Common bile duct stone

Can

3. Cholecystenteric fistula

Pull

4. Pancreatitis

Car

5. Carcinoma of gall bladder

Complications in gall bladder

Some

1. Silent stones

Dying

2. Dyspepsia

Cases

3. Colic

May

4. Mucocoele

Come

5. Acute cholecystitis

Casually

6. Chronic cholecystitis

Complications in bile duct

Come

1. Colic

On

2. Obstructive jaundice

Anne

3. Acute pancreatitis

Complications in intestine

Intestinal obstruction

Acute Pancreatitis

Etiology

Even

1. Extrahepatic biliary disease

At

2. Alcoholism

The

3. Trauma

Posh

4. Postoperative

Gastrectomy

Biliary surgery

Afferent loop obstruction

Hospitals

5. Hyperparathyroidism

Departments

6. Drugs

Thiazides

Frusemide

Corticosteroids

Have

7. Hypothermia

Hired

8. Hypercholestraemia

Various

9. Viral

Mumps

Coxsackie

Machines

10. Miscellaneous

Polyarteritis nodosa

Malignant hypertension

Clinical features

1. Epigastric pain radiating to back

2. Vomiting

3. Distention

4. Jaundice

5. Glycosuria

6. Carpopedal spasm

7. Ecchymosis in flanks and around unbilicus

Differential diagnosis

Poor

1. Penetrating duodenal ulcer

Patients

2. Perforated duodenal ulcer

Are

3. Acute cholecystitis

In

4. Ischaemic bowel

Mesenteric embolus

Strangulation

Maximum

5. Myocardial infarction

Distress

6. Dissecting aneurysm

Splenectomy

Indications

Resident

1. Ruptured spleen

Reading

2. Radical gastrectomy

Bed

3. Blood disorders

Idiopathic thrombocytopenia

Hereditory spherocytosis 

Head

4. Hodgkin's disease

Ticket

5. Tumours and cysts

Complications

He

1. Haemorrhage

Sees

2. Stomach dilatation

Lady

3. Lung collapse (left lower lobe)

Patients

4. Pancreatitis

Sitting at

5. Subphrenic abscess

Some

6. Splenic vein thrombosis

Safe

7. Septicaemia

Distance

8. Deep vein thrombosis

Hernia

Congenital causes

First

1. Funicular process nonobliteration

Time

2. Testes descended late

A

3. Abdominal muscles and parieties weak

Pre

4. Patency of rings usually more

Marital

5. Mesentery or omentum abnormally long

Evacuation

6. Extreme phimosis

Causes

7. Congenital apertures in linea alba or linea semilunaris

Ultra

8. Umbilicus imperfectly developed

Distress

9. Diaphragm defective, occasionally

Acquired causes

Please

1. Postoperative

Decorate

2. Direct trauma

Central

3. Chronic strain

Weight lifting occupations

Chronic cough

Enlarged prostate or stricture

Constipation

Registration

4. Relaxation of abdominal parieties

Pregnancy, imperfect involution

Old age

Office

5. Obesity

Contents

I

1. Intestines (enterocoele)

Only

2. Omentum (epicocoele)

Can

3. Caecum

Advise

4. Appendix

U

5. Urinary bladder

Extraperitoneal

Paraperitoneal

Intraperitoneal

On

6. Ovary and fallopian tube

Marriage

7. Meckel's diverticulam

 

Types

I

1. Inguinal hernia

One

a. Oblique inguinal hernia

A

Acquired

Cunning

Congenital

Inspector

Infantile or cystic

Day

b. Direct inguinal hernia

Invite

c. Interstitial hernia

Intraparietal

Interparietal

Extraparietal

Her

d. Hernia-en-Glissade

Firmly

2. Femoral hernia

Under

3. Umbilical hernia

a. Infantile

b. Adult

Valued

4. Ventral hernia

a. Epigastric hernia

b. Divarication of recti

Lady

5. Lumber hernia

Dancing

6. Diaphragmatic hernia

a. Congenital diaphragmatic hernia

b. Traumatic diaphragmatic hernia

c Hiatus hernia

Over

7. Obturator hernia

Rope

8. Rare types

Please

a. Pudic hernia

Pay

b. Pudendal hernia

Visit

c. Vaginal hernia

Soon

d. Sciatic hernia

 

Complications

1. Incarcerated hernia

2. Strangulated hernia

3. External strangulated hernia

G. Nervous System

Regional Anaesthesia - Types

Short

1. Surface anaesthesia

Ladies

2. Local infiltration

Not

3. Nerve block

Really

4. Refrigeration anaesthesia

Energetic

5. Extradural anaesthesia

H. Breast

Mastitis - Types

I

1. Infantile mastitis

Paid

2. Puberty mastitis

My

3. Mumps Mastitis

Every

4. Engorgment mastitis

Buck

5. Bacterial mastitis

Breast Carcinoma - Spread

A. Direct extension

Skin

Underlying fascia, muscles and chest wall

B  Lymphatic extenstion

An

1. Axillary nodes

Can

Central

Police

Pectoral

Say

Subcapsular

Something?

Subclavicular or apical

Agent

2. Anterior mediastinal nodes

Seen

3. Supraclavicular nodes

On

4. Opposite breast

Aeroplane

5. Abdominal wall, liver and peritoneal cavity

C. Vascular

Very

1. Vertebrae

Rough

2. Ribs

Surface

3. Skull

Breast Carcinoma - Symptoms and Signs

Little

1. Localised mass, stony hard with irregular surface

A

2. Adhesions to skin

While

3. Whole breast may be infiltrated or shrunken

Before

4. Breast adherent to pectoral fascia and muscle

Ladies

5. Lymph nodes enlarged and stony hard - later matted and ulcerated

Often

6. Opposite breast may show secondary deposit 

Practiced

7. Paralysis of arm with severe pain in extremities

Low

8. Later, induration, discoloration and ulceration

Monthly

9. Metastatic symptoms

Just

Jaundice

Drink

Dyspnoes and pleural effusion

A

Ascites

Bit

Bone pain

Costs

10. Cachexia and emaciation

Breast Carcinoma - Clinical Varieties

Even

1. Extraduct cancer

Send

Scirrhous

A

Acute encephaloid

Line

Lactational

Atlas

Adenocarcinoma

I

2. Intraduct cancer

May

3. Metaplastic cancer

Manage

4. Male breast cancer

Breast Carcinoma - Treatment

Rogues

1. Radical mastectomy

Live

2. Local mastectomy

Every

3. Endocrine operations

Bilateral oophorectomy

Adrenalectomy

Hypophysectomy

Room

4. Radiotherapy

High voltage therapy

Radium therapy

Isotope therapy

Here

5. Hormone therapy

Testosterone

D/D Breast Discharge

Big

1. Blood stained

Indian

Intraductal papilloma or carcinoma

Defence

Duct ectasia

Force

Fibroadenosis with cysts

Shops

2. Serous

Pregnancy

Buy

3. Brown-green

Fibroadenosis

Many

4. Milky

Following lactation

Galactocoele

Products

5. Purulent

Abscess

I. Orthopaedics

Fractures

Types

Some

1. Simple

Cunning

2. Compound

College

3. Comminuted

Girl

4. Greenstick

Paid

5. Pathological

Short

6. Stress

Clinical features

Please

1. Pain and tenderness

Send

2. Swelling

Doctor

3. Deformity

A

4. Abnormal mobility

Call

5. Crepitus

Causes of nonunion

I

1. Improper immobilisation

Injected

2. Infection

A

3. Avascularity

Safe

4. Soft tissue interposition

Drug, 

5. Distraction

Man

6. Malnutrition and severe anaemia

General complications

Surely

1. Shock

A

2. Aseptic traumatic fever

Harm

3. Hypostatic pneumonia

Ful

4. Fat embolism 

Drug

5. Delirium tremens (in alcoholics)

Local complications - Immediate

1. Nerve injury

2. Vascular injury

3. Muscle and tendon injuries

4. Visceral injury

5. Joint injury

6. Infection

Local complications - delayed

Dog

1. Delayed union or nonunion

Makes

2. Malunion

A

3. Avascular necrosis

Very

4. Volkmann's ischaemic contracture

Mighty

5. Myositis ossificans

Jump

6. Joint stiffness due to :-

Riot

a. Reactional oedema and adhesions

Is

b. Intra- and periarticular adhesions

Most

c. Myositis ossificans 

Ominous

d. Osteoarthritis

Sight

e. Sudeck's osteodystrophy

Joint Injuries - Types

Definitely

1. Dislocations

Some

2. Subluxations

School

3. Sprains

Function

4. Fracture dislocations

Bone Tumours - Classification

One

1. Osteogenic tumours

Beauty

a. Benign osteoblastoma

Often

b. Osteosarcoma

Pays

c. Parosteal sarcoma

Can

2. Chondrogenic tumours

a. Chondroma

b. Chondrosarcoma

Consume

3. Collagenic tumours

Osteoclastoma

Milk

4. Myelogenic tumours

a. Ewing's tumour

b. Reticulum cell sarcoma 

c. Multiple myeloma

Pott's Disease - Clinical features

Patient

1. Pain and tenderness

Reads -

2. Rigidity

Doctor

3. Deformity

Can

4. Cold abscess

Not !

5. Nervous phenomena

Paraplegia

Root pains

Low Backache - Causes

The

1. Traumatic

Sprain

Disc prolapse

Fracture

Indian

2. Inflammatory

Rheumatoid arthritis

Ankylosing spondylitis

Doctor

3. Degenerative

Osteoarthritis

Disc prolapse

Osteoporosis

Now

4. Neoplastic

Primary tumours

Metastases

In

5. Infectious

Tuberculosis

Osteomyelitis

Foeign

6. Functional

Postural

Pregnancy

Leg shortening

Service

7. Structural

Spondylosis

Spondylisthesis

Sacralisation


 


 

 

Obstetrics & Gynaecology

A.Gynaecology

Causes of Pruritus Vulvae

Very

1. Vaginal discharge

Too

a. Trichomoniasis

Many

b. Moniliasis

Nurses

c. Nonspecific vaginitis and cervicitis

Talented

2. Toxaemic states

Joining

a. Jaundice

University

b. Uraemia

Hostel

c. Hodgkin's disease

Doctors

3. Deficiency diseases

I

a. Iron deficiency anaemia

Purchased

b. Pernicious anaemia

A

c. Achlorhydria

Horse

d. Hypovitaminosis A & B

Doing

4. Diabetes mellitus

Surgery

5. Skin conditions

To

a. Tinea

See

b. Scabes

Picture,

c. Pediculosis

They

d. Threadworms

Have

e. Herpes

Come

f. Contact dermatitis

Definitely

g. Dermatitis medicamentosa

Late;

h. Localised neurodermatitis

So

i. Seborrhoeic dermatitis

Losing

j. Lichen planus

Place

k. Psoriasis

In

l. Intertrigo

Consequence

m. Chronic epithelial dystrophy

Can

6. Carcinoma of vulva

Produce

7. Psychogenic

Infection

8. Idiopathic

Inflammations of Vulva

A. Primary inflammations of vulva

Please

1. Pyogenic infections of hair follicles

a. Folliculitis

b. Furunculosis

Invite

2. Infected sebacious cysts

The

3. Traumatic infections

Any

a. Accidental

Casualty

b. Coital

Officer

c. Obstetric

Operates

d. Operative

Very

4. Venereal infections of vulva

Eminent

5. Eryseplas

Vascular

6. Vulvo-vaginitis in children

Urinary Symptoms

Please

1.        

2.       Pain on micturition

 

Can

Cystitis

Girls

Gonoccal urethritis

Enter?

E. coli urethritis

Repair

 

2. Retention of urine

 

Ruined

Retroverted gravid uterus

My

Myomata incarcerated in pelvis

Huge

Haematocolpos

Plaster

Pelvic haematocele

Of

Ovarian cyst impacted in pelvis

Paris

Postoperative

Duly

 

3. Difficulty in micturition

 

 

 

 

Cystocele

 

 

 

Complete procedentia

The

 

4. True incontinence

 

 

 

 

Urinary fistula

Faculty

 

5. False (stress) incontinence

 

 

 

 

Prolapse

Fan

 

6. Frequency of micturition

 

 

Even

 

Early pregnancy

 

The

 

Term pregnancy

 

Union

 

Urinary infections

 

People

 

Prolapse

 

Pay

 

Pelvic tumours

Types of Vaginitis

See

 

Specific vaginitis

 

 

Go

Gonococcal and other venereal diseases

 

To

Trichomoniasis

 

Mummy

Moniliasis

 

New

 

Nonspecific vaginitis

 

 

Sleep

Streptococci

 

Saves

Staphylococci

 

Energy

E. coli

 

Officer

 

Oestrogen deficiency vaginitis

 

 

 

Very

 

Vulvovaginitis in children

 

 

Simple

 

Senile vaginitis

 

Soon

 

Secondary vaginitis

 

 

 

Face

 

Foreign body

 

 

 

 

 

Vaginal pessary

 

 

 

 

Contraceptive

 

 

 

 

Tampon

 

Is

 

Infective conditions of the cervix

 

 

 

 

 

Endocervicitis

 

 

 

 

Childbirth injuries

 

Under

 

Urinary and rectal fistulae

 

 

My

 

Malignancy of genital tract

 

 

Veil

 

Vaginitis medicamentosa

 

Vaginal Discharge

 

Physiological

 

 

 

Only

 

Ovulation

 

 

Sick

 

Sexual stimulation

 

 

People

 

Premenstrual congestion

 

 

Please

 

Pregnancy

 

 

 

Pathological

 

 

 

Not

 

 

Non-irritating non-odorous white discharge

Police

 

 

Puberty

People

 

 

Pregnancy

Can

 

 

Cervical polyp

Even

 

 

Endocervical infection (mild)

Challan

 

 

Cervical lacerations

Vehicles

 

 

Vaginal infection

In

 

 

Irritating discharge

 

 

 

Trichomonas vaginalis

 

 

 

Candida albicans

Your

 

 

Yellow discharge

Boss

 

 

Bacterial infections of vagina

Is

 

 

Infective cervical polyp or erosion

A

 

 

Acute gonorrhea

Sound

 

 

Septic abortion

Paid

 

 

Puerperal sepsis

Person

 

 

Pyometra

Office

 

 

Offensive discharge

Commonly

 

 

Carcinoma of cervix

Some

 

 

Septic myomatous polyp

Senior

 

 

Septic abortion

Specialist

 

 

Sarcoma of uterus

Comes

 

 

Carcinoma of vagina

For

 

 

Foreign bodies

Treatment

 

 

Trichomonas infection

But

 

 

Blood stained discharge

Obstruction

 

 

Oestrogen deficiency (Senile vaginitis)

Can

 

 

Carcinoma of uterus

Cause

 

 

Cervical polyp

Intense

 

 

Infected submucous fibroid polyp

Ureteric

 

 

Ulcerative lesions

Pain

 

 

Placental polyp

Way

 

 

Watery discharge

Uncle

 

 

Urinary fistula

Has

 

 

Hydrops tubae profluens

Come

 

 

Carcinoma of fallopian tube

Again

 

 

Amniotic fluid leakage

Far

 

 

Faecal discharge

 

 

 

Rectovaginal fistula

Menstrual Abnormalities

Many

 

Menorrhagia

 

 

Fibroid

 

Polyp

 

Pelvic inflammatory disease

Patients

 

Polymenorrhoea (epimenorrhoea)

 

 

Ovarian congestion

 

Ovarian dysfunction

May

 

Metrorrhagia

 

 

 

 

Polyp

 

 

 

Carcinoma of uterus

Create

 

Continuous bleeding

 

 

An

 

Abortion

 

Enema

 

Ectopic pregnancy

 

Cures

 

Carcinoma of cervix or endometrium

 

Many

 

Metropathia haemorrhagica

 

Patients

 

Polyp

Petty

 

Pregnancy haemorrhages

 

 

Sauce

 

Suppressed periods during first few months

 

And

 

Abortion

 

Eggs

 

Ectopic pregnancy

 

Have

 

Hydatidiform mole

 

Arrived

 

Antepartum haemorrhage

Problems

 

Postmenopausal haemorrhage

 

4 Constables

 

 

Carcinoma of cervix

 

 

Carcinoma of body

 

 

Carcinoma of vagina

 

 

Carcinoma of ovaries

Under

 

 

Urethral Caruncle

Some

 

 

Senile vaginitis

Pretext

 

 

Pressure ulcers (from retained ring pessaries)

Punished

 

 

Polyp

Every

 

 

Erosions

Man

 

 

Myoma

Standing

 

 

Sarcoma of uterus

On

 

 

Ovarian tumours

Opera

 

 

Oestrogen administration

D/D Genital Sore

Some

Syphilis

 

Primary sore

Secondary lesions

Gumma

Care

Chancroid

 

Less

Lymphogranuloma venereum

 

 

 

Primary lesion

 

 

Late ulceration

Guys

Granuloma venereum

 

Can

Carcinoma

 

 

 

Of vulva

 

 

Of cervix

Take

Trauma

 

 

 

Physical

 

 

Chemical

A

Acute vulval ulcer (Behcet’s syndrome)

 

Second

Scabes

 

Hand

Herpes simplex

 

Heavy

Herpes zoster

 

Tyre

Tuberculosis

 

Causes of Dyspareunia

 

In the male

Can

 

Congenital abnormality of the penis

I

 

 

Impotence

 

 

Peep

 

 

Premature ejaculation

 

 

In?

 

 

Ignorance in coital technique

 

 

In the female

 

 

 

Painful lesions

Very

 

 

 

Vulvitis

 

Under

 

 

 

Urethral caruncle

 

Built

 

 

 

Bartholin’s cyst or abcess

 

Thin

 

 

 

Tender operative scars

 

Adult

 

 

 

Anal fissure

 

 

 

 

Obstructive lesions at introitus

Ravindra

 

 

 

Rigid or imperforate hymen

Nath

 

 

 

Narrow ineroitus

 

 

 

 

 

Obstetrical injury or scarring

 

 

 

 

 

Painful episiotomy scar

 

 

 

 

 

Tightly repaired perineal tear

Tagore

 

 

 

Traumatic stenosis

 

 

 

 

 

Congenital hypoplasia

 

 

 

 

 

Kraurosis

 

 

 

 

 

Lichen sclerosis

Seldom

 

 

 

Scar due to chemical burn

 

 

 

 

 

Potassium permanganate

 

 

 

 

 

Lysol

Felt

 

 

 

Functional spasm (vaginismus)

Lonely

 

 

 

Large, tender Bartholin’s cyst

 

 

 

Obstructive lesions above the vagina

 

C

 

 

Congenital stenosis of vagina

 

 

A

 

 

Acquired stenosis

 

 

 

 

 

 

Surgical operations

 

 

 

 

 

Chemical burns

 

T

 

 

Tumours of vagina

 

 

 

 

Uterine conditions

 

 

Cold

 

 

 

Cervicitis

 

Creams

 

 

 

Chronic parametritis

 

Rarely

 

 

 

Retroverted uterus

 

Cold

 

 

 

Chronic pelvic inflammatory disease

 

 

 

Lesions of uterine appendages

 

 

 

Please

 

 

Prolapsed ovaries with retroversion

 

Send

 

 

Salpingo-oophoritis

 

 

Eggs

 

 

Endometriosis

 

 

 

 

Extragenital lesions

 

 

 

 

 

 

Diverticulitis of the sigmoid colon

Methods of Contraception

 

A.      General

 

 

Total abstinence

 

 

 

Abstinence during fertile phase

 

 

B.      Female

 

 

Sub

 

Spermicidal substances

 

Divisional

 

Douching

 

Officers

 

Occlusive diaphragms

 

Are

 

Altering cervical mucus

 

In

 

Intrauterine contraceptive devices

 

Superior

 

Suppression of ovulation

 

Service

 

Surgical sterilization

 

 

C.      Male

 

Can

 

 

Coitus interruptus

Carry

 

 

Condom

Small

 

 

Suppression of spermatogenesis

Vessel

 

 

Vasectomy

Classification of Amenorrhoea

 

 

Physiological

 

 

 

Papa

 

Prebubertal

 

 

 

Presented

 

 

Pregnancy

 

 

 

Lovely

 

 

Lactation

 

 

 

Pen

 

 

Postmenopausal

 

 

 

 

 

Primary pathological

 

 

 

3 Cars

 

 

Congenital obstructive defects

 

 

 

 

 

 

Noncanalisation of cervix

 

 

 

 

 

 

Noncanalisation of vagina

 

 

 

 

 

 

Imperforate hymen

 

 

 

 

 

Congenital absence of hypoplasia of uterus

 

 

 

 

 

Congenital aplasia of ovaries

 

 

 

 

 

 

 

Turner’s syndrome

 

 

 

In

 

 

Intersexualism

 

 

 

 

 

 

 

Pseudohermaphroditism

 

 

 

His

 

 

Hypopituitary dwarfism

 

 

 

House

 

 

Hypothyroid cretinism

 

 

 

 

 

Secondary pathological

 

 

 

 

And

 

Acquired obstruction

 

 

 

 

 

 

 

Operative injury

 

 

 

 

 

 

 

Chemical burns

 

 

 

 

How

 

Hysterectomy

 

 

 

 

Often

 

Ovarian dysfunction

 

 

Delhi

 

 

 

 

Destruction of both ovaries

 

 

 

 

 

 

 

 

Disease

 

 

 

 

 

 

 

Radiation

 

 

 

 

 

 

 

Surgical removal

 

Population

 

 

 

 

Primary ovarian failure

 

 

Has

 

 

 

 

Hyperhormonal

 

 

 

 

 

 

 

 

Metropathia (early phases)

 

 

 

 

 

 

Hormone administration

Slowly

 

 

 

 

Stein-Leventhal syndrome

Multiplied

 

 

 

 

Masculinizing ovarian tumours

 

Aspirin

 

 

 

 

Arrhenoblastoma

 

 

Has

 

 

 

 

Hilus cell tumour

 

 

Many

 

 

 

 

Masculinising luteoma

 

Advantages

 

 

 

 

Adrenal like tumours

 

 

Picture

 

Pituitary disorders

 

 

Please

 

 

 

 

Psychological

 

 

 

 

 

 

 

Anorexia

 

 

 

 

 

 

Pituitary shock

Buy

 

 

 

 

Basophil adenoma

 

 

 

 

 

 

Cushing’s disease

A

 

 

 

 

Acidophil tumours

Pen

 

 

 

 

Pituitary failure

 

 

 

 

 

 

 

Chromophobe adenoma

 

 

 

 

 

 

Cysts

 

 

 

 

 

 

Simmond’s disease

 

 

 

 

 

 

Postpartum pituitary necrosis

 

 

 

 

 

 

Chiari-Frommel syndrome

 

 

At

 

Adrenal dysfunction

 

 

 

 

 

 

 

Adrenal cortical hyperplasia (Adrenogenital syndrome)

 

 

 

 

 

Adrenal cortical tumours

 

 

 

 

 

 

Addisson’s disease

 

 

 

The

 

Thyroid dysfunction

 

 

 

 

 

 

 

Hyperthyroidism

 

 

 

 

 

 

Hypothyroidism (late stages)

 

 

Door

 

Diabetes mellitus

 

 

 

 

Darshan

 

Debilitating general disease

 

 

 

 

Not

 

Nutritional

 

 

 

 

Colourful

 

Chromosomal anomalies

 

 

 

 

 

 

 

Turner’s syndrome

 

 

 

 

 

 

Klinefelter’s syndrome

 

 

 

 

 

 

Super-female

 

Indications of Progestogen Therapy

In

Inhibition of evulsion, ovulation pain and ovulation bleeding

Charge

Contraception

S

Spasmodic dysmenorrhoea

P

Premenstrual tension

M

Metropathia haemorrhagica

Department

Dysfunctional uterine bleeding

Puts

Puberty menorrhagia

Purse

Pregnancy test

And

Amenorrhoea

Pen

Pituitary rebound

Mostly

Menstrual irregularities

In

Infertility

An

Abortion

Emergency

Endometriosis

Unit

Uterine carcinoma

Causes of Menorrhagia

General

 

Blood dyscrasia

Severe anaemia

Local

 

Film

Fibroid uterus

Stars

Salpingo-oophoritis

Retain

Retroverted uterus

Charm

Chocolate cyst of ovary

Endlessly

Endometriosis

Endocrine disorders

 

He

Hyperthyroidism (early stages)

Met

Myxoedema

A

Acromegaly (early stages)

Doctor

Diabetes mellitusw

Operative Complications of Prolapse Uterus

Early

Renal

Retention of urine

Colic?

Cystitis and pyelonephritis

Have

Haemorrhage

I

Infection

V

Visceral injuries

P

Phlebothrombosis and pulmonary embolism

Late

Ration

Recurrence of prolapsed

Delivery

Dyspareunia

Assistant

Abortion, premature labour, and dystocia

Degenerative Changes in Fibroid

A

Atrophic changes

High

Hyaline degeneration

Class

Cystic degeration

F

Fatty degeration

R

Red degeneration

C

Calcareous degeneration

S

Sarcomatous degeneration

Effects of Fibroid

On pregnancy

 

Send

Sterility

A

Abortion or miscarriage

Male

Malpresentation

Person

Placenta praevia

Preferably

Premature labour

On labour

 

Unions

Uterine inertia

Often

Obstructed labour

Demand

Delayed labour

Repeat

Retained placenta

Poll

Postpartum haemorrhage

On puerperium

 

Please

Puerperal sepsis

Supply

Subinvolution

Pant

Puerperal retroversion

Piece

Postpartum haemorrhage (secondary)

Immediately

Inversion of uterus

Ovarian Tumours

Arising from surface epithelium of ovaries

 

Benign

Sensible

 

Simple serous cystedenoma

 

People

 

Paillary serous cystedenoma

 

Play

 

Pseudomucinous cystedenoma

 

Badminton

 

Brenner tumour

 

Malignant

Some

 

Serous cystadenocarcinoma

 

People

 

Pseudomucinous cystadenocarcinoma

 

See

 

Solid carcinoma

 

Match

 

Mesonephroma

 

Metastatic tumours

 

Typical from :-

Selected

 

 

Stomach

In

 

 

Intestine

Bombay

 

 

Breast

University

 

 

Uterus

Atypical

 

Krukenberg tumour

 

Arising from connective tissue of ovary

 

Fibromata (benign)

 

 

Sarcomata (malignant)

 

 

Arising from ovum

 

Disco

Dermoid cyst

 

 

Star

Solid teratoma

 

 

Coming

Chorion epithelioma

 

 

Soon

Struma ovarr

 

 

Arising from primitive mesenchyme

 

Feminising

 

 

Great

 

Granulosa cell tumour

 

True

 

Theca cell tumour

 

Lovers

 

Luteoma

 

Neuter

 

 

 

Dysgerminoma (seminoma)

 

Virilising

 

 

A

 

Arrhenoblastoma

 

Splendid

 

Suprarenal cortical tumour

 

Home

 

Hilus cell tumour

 

Mixed

 

 

 

Gyneandroblastoma

 

Signs of Developing Secondary Toxaemia

A

1.       Albuminuria and oliguria

Person

2.       Persistent tachycardia

May

3.       Marked loss of flesh

Find

4.       Furring of tongue

Judgement

5.       Jaundice

Never

6.       Nystagmus, central scoloma and retinal haemorrhages

Before

7.       Bulbar and limb palsies

Delivered

8.       Delirium

Diagnostic Value of X-rays

Daily

Differential diagnosis of pregnancy

Some

Suspected vascular mole

Passengers

Pregnancy with fibroids

Pay

Pregnancy denied by patient

Cancellation

Confirmation of lie and presentation

Charges

Confirmation of hydramnios, multiple pregnancy, breech presentation, etc

Railway

Risk of prematurity at caesarean section

Staff

Suspected anencephaly

Found

Foetal age

Definitely

Dead foetus

Punishing

Pelvimetry

Poor

Progress of labour

People

Placentography

B. Obstetrics

Classification of Abortion

A. Depending upon degree

Ticket

1. Threatened abortion

Inspector

2. Inevitable abortion

Is

3. Incomplete abortion

Cunning

4. Complete abortion

Man

5. Missed abortion

B. Depending upon cause

Senior

1. Spontaneous abortion

High

2. Habitual abortion

Court

3. Criminal abortion

Lawyer

4. Legal abortion

C. Depending upon infection

Serial

1. Septic abortion

Number

2. Nonseptic abortion

Complications of Evacuation

Some

1. Sock

Solid

2. Sepsis

Thing

3. Thrombophlebitis

Inside

4. Injuries

a. Laceration of cervix

b. Perforation

Causes of Abortion

An

A. Abnormalities of foetus

1. Maldevelopment

2. Intrauterine death

I

a. Infections

Praise

b. Poisons

Experts

c. X-rays

Anti

B. Abnormalities of placenta and membranes

Having

1. Hydatidiform mole

A

2. Acute hydramnios

Painful

3. Placenta praevia

Period

4. Placental infarction

Malarial

C. Maternal diseases

Take

1. Toxic states with high fever

A

2. Anoxic states

Suit

a. Severe shock or anaemia

Case

b. Congestive heart failure

Ready

c. Respiratory failure

(i) Bronchial asthma

(ii) Anaesthesia

Car

3. Chronic disease

Some

a. Syphilis

Take

b. Tuberculosis

Heavy

c. Hypertension

Commission

d. Chronic glomerulonephritis

Tablet

D. Trauma

Do

1. Direct blows or kicks in abdomen

Surgery

2. Severe fall and other accidents

In

3. Instrumentation

Severe

4. Surgical operations on gravid uterus

Cases

5. Coitus in retroverted uterus

Every

E. Emotional

Get

1. Grief or fright

One

2. Overfatigue

Sample

3. Schizophrenia

Again

4. Anxiety neurosis

Day

F. Drugs

Long

1. Lead

Queue

2. Quinine

Everyday

3. Ergot

Helps

G. Hypovitaminosis

1. Vitamin deficiency

2. Folic acid deficiency

Even

H. Endocrine disorders

1. Hypothyroidism

2. Diabetes mellitus

Greatly

I. Genital tract abnormalities

1. Displacement of uterus

- Retroflexion

2. Malformations of uterus

3. Cervical incompetence

4. Acute red degeneration

a. Bicornuate uterus

b. Septate, subseptate and arcuate uterus

Causes of Postpartum Haemorrhage

Thermal

 

Trauma

 

 

Liquidated

Laceration of clitoris

 

Lone

Laceration of bulbocavernous area of vestibule

Rebel

Ruptured varix of vulva or vagina

 

Police

Perineal or vaginal tears

 

Constable

Cervical tear

 

Unit

 

Uterine atony

 

 

Every

Exhaution from prolonged labour

 

Analyst

Anaesthesia

 

Got

Grand multiparity

 

One

Overdistension of uterus

 

 

 

Twins

 

 

Hydramnios

 

 

Large foetus

 

 

Abruptio placentae

Unit

Uterine anomalies

 

 

 

Tumours

 

 

Operative scars

At

 

Abnormalities at placental site

 

 

 

 

Retained placental piece

 

 

Cornual placenta

Azam

 

Abnormal uterine action

 

 

Call

Constriction rings

 

In

Improper conduct of labour

 

Police

Precipitate labour

 

Post

Premature attempts to remove placenta

Bagh

 

Bleeding disorders

 

 

 

Afibrinogenaemia

 

 

Scurvy

 

 

Purpura

 

Hypertensive States of Pregnancy

1.       Gestational oedema

3Giants

2.       Gestational proteinuria

 

3.       Gestational hypertension

Pushed

4.       Pre-eclampsia

Every

5.       Eclampsia

Student

6.       Superimposed pre-eclampsia or eclampsia

Causing

7.       Chronic hypertensive disease

Unrest

8.       Unclassified hypertensive disorders

Indications of Induction of Labour

Maternal

 

 

Papa

Pre-Eclampsia

 

Has

Hypertension

 

Returned

Renal disorders

 

Duck

Diabetes mellitus

 

Eggs

Erythroblastosis

 

And

Abruptio placentae

 

Container

Contracted pelvis (mild)

 

As

Accidental haemorrhage

 

He

Hydramnios

 

Had

Hyperemesis gravidarum

 

Chosen

Chorea

 

Many

Medical termination of pregnancy (12-20 weeks)

 

Foetal

 

 

Please

Past history

 

 

Large babies

 

Recurrent intrauterine deaths at term

Deliver

Dead  foetus

 

Pink

Postmaturity

 

Rose

Rh incompatibility

 

Manually

Malformation

 

Methods of Induction of Labour

Papa

 

Physical stimulation

 

 

 

Breast massage

 

 

Uterus massage per abdomen

 

Makes

 

Mechanical methods

 

 

 

Amniotomy

 

 

 

High rupture of membranes

 

 

Low rupture of membranes

 

Stripping the membranes from cervix

Us

 

Uterotonic agentsExchange aspiration

One

Oxytocin

 

Sample

Sparteine sulphate

Of

Oestrogen (for dead foetus)

Powder

Prostaglandins (for dead foetus)

 

Exchange aspiration

 

Hypertonic saline

 

High concentration glucose

Complications of Induction of Labour

Tetanic contractions

Rupture of uterus

Abruptio placentae

Amniotic embolism

Postpartum haemorrhage

Cervical laceration

Foetal distress

Anoxaemia

Birth injuries

Foetal death

Maternal death

Maternal anxiety

Prolonged labour

Prolapsed cord

Pelvic infection

Prematurity

Hypofibrinogenaemia

Antidiuretic water intoxication

Contraindications of Version

He

Hypertensive states

Had

Hydrocephalus

Put

Placenta praevia

Plenty

Placental dysfunction

On

Operative scars

Poor

Presenting part engaged

Risk

Ruptured membranes

Complications of Version

I

Injury to the uterus

Shall

Separation of placenta

Keep

Kinking or prolapse of cord

Red

Rupture of membranes

Piece

Premature labour

Causes of Uterine Inertia

Police

Psychological

 

Officer

Overdistention

 

Hydramnios

Twins

Failed

Full bladder or rectum

 

To

Too early confinement to bed

 

Feed

Fibrous or elastic tissue excess

 

Pets

Premature induction of labour

 

Causes of Obstructed Labour

Maternal

 

 

Central

Contracted pelvis

 

Tent

Tumours of pelvic bones

 

Of

Ovarian or uterine tumours

 

Cricket

Cervical or vaginal stenosis

 

Club

Constriction ring

 

Foetal

 

 

Malpresentation

 

Be

 

Brow presentation

Fair

 

Face presentation

Sanitary

 

Shoulder presentation

Inspector

 

Impacted breech presentation

Locked twins

 

Abnormal foetus

 

Hey

 

Hydrocephalus

Guys

 

Gigantism

Add

 

Abdominal tumours

And

 

Ascites

Deduct

 

Double monsters

Causes of Delayed Involution

Punish

Puerperal sepsis

These

Thrombophlebitis

Persons

Puerperal haemorrage

Under

Urinary infection

Charges

Choriocarcinoma

Made

Mastitis and breast abscess

Now

Neuritis and puerperal mania

Causes of puerperal sepsis

Prime

 

Prolonged labour

 

Minister

 

Manipulation and instrumentation

 

Returns

 

Retention of placental pieces and blood clots

 

Home

 

Haemorrhage

 

Late

 

Lowered resistance

 

An

Anaemia

M

Malnutrition

D

Dehydration

Doctor

Debilitating diseases

Causes of Prematurity

Little

Lady under 20 years of age

Master

Multiple pregnancy

Made

Malnutrition

Hundred

Hypertensive states

Runs

Renal disorders

Did

Diabetes mellitus

See

Syphilis

Through

Toxaemia of pregnancy

A

Accidental haemorrhage

Pace

Placenta praevia

Attack

Acute infections

Complications of Prematurity

I

Infections

Have

Hypoxia

To

Trauma

Have

Haemorrhage

A

Anaemia

Coffee

Cyanosis

Just

Jaundice

On

Oedema

Rising

Retinopathy

Causes of Infertility

Never

Nutritional

 

Iron deficiency anaemia

Hypovitaminosis

Enter

Endocrinal

 

Pituitary dysfunction

Hypothyroidism

Hyperadrenalism

Vein

Vaginal

 

 

 

Imperforate or cribriform hymen

 

 

Vaginitis

Through

Tubal

 

 

 

Salpingitis

 

 

Congenital atresia

 

 

False passages

Un

Uterine

 

 

 

Tumours

 

 

Hypoplasia

Clean

Cervical

 

 

 

Pinhole cervix

 

 

Cervical tumours or polyps

 

 

Cervicitis

Open

Ovarian

 

 

 

Oophoritis

 

 

Tumours

Prick

Psychic

 

 

 

Anorexia nervosa

 

 

Schizophrenia

Causes of Rupture of Uterus

Spontaneous

 

Can

Cephalopelvic disproportion

Some

Shoulder dystocia

Male

Malpresentations

M

Malpositions

D

Delayed rotation of head

Operate

Obstruction by tumours

His

Hydrocephalus

Maid

Myomectomy scars

In

Interstitial pregnancy

Grief

Grand multiparity

Traumatic

 

Foreceps

Podalic version

Oxytocics

Postcaesarean

 

Indications of Dilatation & Curettage

Therapeutic

 

I

Incomplete abortion

May

Missed abortion

Very

Vesicular mole

Soon

Spasmodic dysmenorrhoea

Find

Functional uterine bleeding

Image

Implantation of radium needles

Diagnostic

 

Came

Choriocarcinoma

From

Functional uterine bleeding

England

Endometrial tuberculosis

And

Amenorrhoea

Staying

Sterility

Comfortably

Carcinoma of body of uterus

Modes of Actions of Foreceps

The

Traction

Children

Compression of head

Really

Rotation of head

Like

Lever action

Dalima

Dilatation of passage

Sweets

Stimulation of uterine contraction

Indications of Caesarean Section

Papa

Previous caesarean section

First

Foetopelvic disproportion

Has

Hypertensive heart disease

Daily

Diabetes mellitus

Morning

Malpresentations

Paper

Pelvic tumours

Other

Operative scars

People

Placenta praevia

Press

Pre-eclampsia

Us

Uterine inertia

Really

Rigid cervix

For

Foetal distress

Common

Cord prolapse

Paper

Post-mortem (agonal caesarean section)

Minor Disturbances in Pregnancy

Lone

Leg cramps

Some

Syncope or dizziness

Bombay

Backache

Vetern

Varicose veins

Truly

Thrombophlebitis

Has

Haemorrhoids

Enjoyed

Epistaxis

Free

Frequency of mictuirition

Housing

Headache

In

Insomnia

Delhi

Drowsiness

On

Oedema

Very

Vaginal discharge

Prestigious

Palpitation

Position

Pica

Classification of Pelvis

Get

 

Gynaecoid pelvis

 

 

Rounded or oval shape

 

Well rounded anterior and posterior segment

An

 

Android pelvis

 

Wait

Wedge shaped or heart shaped

Till

Transverse diameter equals antero-posterior diameter

We

Widest transverse diameter closer to sacrum.

Pass

Posterior segment short and flattened

Aheade

Anterior segment narrowed

Apple

 

Anthropoid pelvis

 

 

Elongated antero-posterior diameter

Piece

 

Platypelloid pelvis

 

 

Transverse diameter relatively widened

Calculation of EDD

Doctors

Date of fruitful coitus – Count 266 days after that date.

Date

Date of onset of last menses  - Count 280 days from that date.

Quickly

Quickening – Count 22 weeks in primigravida and 24 weeks in multipara, after first recognition of foetal movement.

For

Fundal height

Fair

Foetal size

Lady

Lightening (in primigravida)

Patients

Pre-labour pelvic changes

Diagnosis of Foetal Death

Curious

Cessation of foetal movements

Surgeon

Sudden cessation of nausea and vomiting (in early pregnancy)

Sent

Symptoms identical to previous abortions at a particular month of gestation.

A

Absence of foetal heart sounds

Call;

Cessation of uterine growth

Surgeons

Softened and macerated foetal head on palpation

Generally

Gas in foetal circulation seen in roentgenograms

Don’t

Discharge of dark, milky, or bloodyamniotic fluid

Like

Loss of weight

Playing

Pregnancy tests

Fun

Foetal electrocardiography

Diagnosis of Pregnancy

 

First trimester

 

Subjective symptoms

 

 

Cessation of menstruation

 

 

Nausea and vomiting

 

 

Urine frequency

 

 

 

Objective signs

Book

 

 

 

Breast enlargement with tingling or burning sensation

My

 

 

 

Mucosal discoloration

Statement

 

 

 

Softening of cervix and vagina

Here

 

 

 

Hegar’s sign

Under

 

 

 

Uterus changes

 

Second

 

 

 

Size enlarged

 

Class

 

 

 

Consistency spongy or soft

 

Passenger

 

 

 

Position anteflexed

 

Booking

 

 

 

Basal body temperature 98.9 -99.9° F for more than 16 days after ovulation

 

 

Second trimester

Que

 

 

Quickening

 

 

In

 

 

Intermittent uterine contractions

For

 

 

Foetal movements

Free

 

 

Foetal ballottement

Passes

 

 

Palpation of foetus

And

 

 

Auscultatory signs

 

 

 

 

Foetal heart sounds

 

 

 

 

Foetal soufflé

 

 

 

 

Uterine souffle

Front

 

 

Fundal height

 

 

Seats

 

 

Skin changes

 

 

 

I

 

 

Increased pigmentation

 

May

 

 

Mask of pregnancy

 

Arrive

 

 

Abdominal striae

 

Soon

 

 

Secondary areola

 

 

 

Third trimester

 

 

 

 

 

Lightening

Causes of Breech Presentation

Has

Hydrocephalus

Himachal

Hydramnios

Pradesh

Placenta praevia

Congress

Contracted pelvis

Party

Pelvic tumours

Passed

Premature labour

It?

Idiopathic

Causes of Shoulder Presentation

Many

Multiparity

Of

Obliquity of uterus

Upper

Uterus subseptus

Class

Contracted pelvis

People

Premature foetus

Deny

Dead foetus

Having

Hydramnios

Paid

Placenta praevia

Penalty

Pelvic tumours

Causes of Face Presentation

A

Anencephaly

Tiny

Tumours of front of neck

Suction

Spasm of muscles of the back of neck

Apparatus

Arms folded immediately under the chin

Unit

Umbilical cord coiled around the neck

Can

Contracted pelvis

Offer

Obliquity of the uterus

Less

Long narrow head

Painful

Premature or dead foetus

M

Monsters

T

Tumours of uterus

P

Placenta praevia

Causes of Death in Eclampsia

In

Intensity of toxemia

England

Exhaustion and heart failure

People

Pulmonary oedema and pneumonia

Can’t

Cerebral haemorrhage

Pay

Pulmonary embolism

Police

Puerperal sepsis

Officers

Operative mortality

 

 

Ophthalmology

Gradual painless vision loss

Very

Vitreous hemorrhage 

 

 

 

Diabetes mellitus

 

 

Trauma

Muscular

Macula elevations

 

 

 

Choroidal neovascular membranes

 

 

Senile macular degeneration

Rat

Retinal detatchment

 

rotates

Retinal-vein occlusion

 

 

 

Intraretinal hemorrhages


Protection of the Eye

E

 

Eyelids

 

 

 

 

 

Skin

 

 

 

 

Muscles

 

 

 

 

 

Orbicularis oculi

 

 

 

 

Levator palpebrae

 

 

 

 

Muller’s muscle

 

 

 

Torsal plates

 

C

 

Conjunctiva

 

 

 

T

 

Tarsal conjunctiva

 

 

B

 

Bulbar conjunctiva

 

 

F

 

Fornix

 

L

 

Lacrimal apparatus

 

Lone

 

Lacrimal gland

 

 

Person

 

Punctum

 

 

Can

 

Canaliculi

 

 

Never

 

Nasolacrimal sac

 

 

Nail

 

Nasolacrimal duct

 

O

 

Orbital bone

 

 

 

 

 

Roof

 

 

 

 

 

Frontal bone

 

 

 

 

Sphenoid bone

 

 

 

Floor

 

 

 

 

 

Zygomatic

 

 

 

 

Maxillay

 

 

 

 

Palatine

 

 

 

Medial

 

 

 

 

 

Ethimoid

 

 

 

 

Frontal

 

 

 

 

Lacrimal

 

 

 

 

Sphenoid

 

 

 

Lateral

 

 

 

 

 

Zygomatic

 

 

 

 

Sphenoid

 

Functions of Tear film

 

1.      Provides moist environment for the surface epithelial cells of the

conjunctiva and cornea

 

2.    Along with the lids, it washes away debris

 

3.    Transport metabolic products (oxygen, carbon dioxide) to and from

the surface cells

 

4.      Antimicrobial actions

 

5.    Provides a smooth refracting surface over the cornea

Lacrimal sac

Globe or Eyeball has 3 coats :

 

Outer coat (fibrous)

 

Some

 

Sclera

Cunning

 

Cornea

 

Middle layer (vascular)

 

Indian

 

Iris

Could

 

Ciliary body

Catch

 

Choroids

 

Inner layer (neural)

 

Spy

 

Sensory retina

Plane

 

Pigment epithelium

 

Extraoccular Muscles

S

Superior rectus for upward movement of the eye

I

Inferior oblique inward and up ward movement of the eye

M

Medial rectus inward movement of the eye

Lying

Lateral rectus outward movement of the eye

In

Inferior rectus for downward movement of the eye

Sleeve

Superior oblique - inward and downward movement of the of the eye

-

-

Diseases of the Eyelids

 

I

A. Internal Hordeolum

Enjoy

B. External Hordeolum or stye

Cursing

C. Chalazion

My

D. Molluscum contagiosum

Boss

E.Blepharitis

 

 

1. Staphylococcal blepharitis

 

 

2. Seborrheic blepharitis

 

 

Community Medicine

Diseases of Global Eradication

Same

Smallpox

Persons

Polio

Meeting

Measles

Daily

Dracunculiasis

Manifestations of Rheumatic fever

 

Major

 

 

 

 

Carditis

 

 

 

Polyarthritis

 

 

 

Chorea

 

 

 

Erythema marginatum

 

 

 

Subcutaneous nodules

 

 

Minor

 

 

 

 

Clinical findings

 

 

 

 

Arthralgia

 

 

 

Fever