ANESTHESIA Failed intubation: Causes "INTUBATION" A- amber bottle to store it N- hepatic Necrosis E- eraser, erodes rubber Day care

anaesthesia PROSIDAS P Propofol R Remifentanil O n2O S Sevoflurane I Isoflurane D Desflurane A Alfantanil S Succinylcholin Endotracheal intubation: diagnosis of poor bilateral breath sounds after intubation DOPE: Displaced (usually right mainstem, pyreform fossa, etc.) Obstruction (kinked or bitten tube, mucuous plug, etc.) Pneumothorax (collapsed lung) Esophagus Respiratory complications of anaesthesia: patients at risk COUPLES: COPD Obese Upper abdominal surgery Prolonged bed rest Long surgery Elderly Smokers Anesthesia: quick check SOAP: Suction Oxygen Airway Pharmacology Anesthesia machine/room check MS MAID: Monitors (EKG, SpO2, EtCO2, etc) Suction Machine check (according to ASA guidelines) Airway equipment (ETT, laryngoscope, oral/nasal

y y y

Infections of larynx Neck mobility abnormalites Teeth abnormalties (loose tooth, protuberant tooth) Upper airway abnormalties (strictures or swellings) Bull neck deformities Ankylosing spondylitis Trauma/tumour Inexperience Oedema of upper airway Narrowing of lower airway Spinal anesthesia: Agents

y y y y y y

"Little Boys Prefer Toys"

y y y y

Lidocaine Bupivacaine Procaine Tetracaine

PREANAESTHETIC MEDICATION OH! SANA O Opiods H H2 blockers S Sedatives antianxiety drugs A Antiemetics N Neuroleptics A Anticholinergics Halothane H- malignant Hyperthermia A- anaesthesia without analgesia L- decomposed by Light O- vasOdilatOr, brOnchOdilatOr, uterine relaxtant TH- thymol as preservtive

airway) IV equipment Drugs (emergency, inductions, NMBs, etc) Xylocaine: Where not to use with Adrenaline? "Digital PEN"

y y

Ear Nose tip

y y

Digits (Fingers and toes) Penis

Adrenaline causes vasoconstriction which helps to trap Xylocaine (anaesthetic) locally prolonging its duration of action. The two are not used together at sites supplied by end arteries as the vasoconstriction produced by adrenaline can cause ischemic necrosis of the tissues. Adrenaline is also referred to as Epinephrine.

ANATOMY Branches of Vagus nerve Branches of Medical Cord "APE-SCRAP" M4U A- Auricular nerve P- Pharyngeal nerve E- Esophageal plexus S- Superior laryngeal nerve (Gives internal 'sensory' and external 'motor' LN) C- Cardiac branches R- Recurrent laryngeal nerve A- Anterior Vagal Trunk P- Posterior Vagal Trunk Brachial plexus: Branches of posterior cord " ULTRA " Medial Pectoral nerve, Medial Cutaneous N. of Arm, Medial Cutaneous N. of Forearm, Medial root of Median N. Ulnar Nerve Medial malleolus: order of tendons, artery, nerve behind it "Tom, Dick, And Nervous Harry": From anterior to posterior: Tibialis Digitorum Artery Nerve Hallicus Full names for these are: Tibialis Posterior, Flexor Digitorum Longus, Posterior Tibial Artery, Posterior Tibial Nerve, Flexor Hallicus Longus. Sperm pathway through male reproductive tract SEVEN UP: Seminiferous tubules Epididymis Vas deferens Ejaculatory duct Nothing Urethra Penis

y y y y y

Upper subscapular nerve Lower subscapular nerve Thoracodorsal nerve Radial nerve Axillary nerve

Branches of lateral cord "LML"

y y y

Lateral pectoral nerve Musculocutaneous nerve Lateral root of median nerve

Spleen: dimensions, weight, surface anatomy "1,3,5,7,9,11": Spleen dimensions are 1 inch x 3 inches x 5 inches. Weight is 7 ounces. It underlies ribs 9 through 11. Broad ligament: contents BROAD: Bundle (ovarian neurovascular bundle) Round ligament Ovarian ligament Artefacts (vestigial structures) Duct (oviduct) Genu valgum vs. genu varum Genu valGUM (knock-knee): knees are GUMmed together. Varum (bowleg) is the other by default, or Far rhymes with Var, so knees are farapart. Scrotum layers "Some Damn Englishmen Called It The Testis": From superficial to deep: Skin Dartos External spermatic fascia Cremaster Internal spermatic fascia Tunica vaginalis Testis Diaphragm apertures: Spinal levels "AEI-OU" Aorta: T12 Esophagus: T10 Inferior Vene cava: T8 OU can be used to remember that its On moving Up from T12. Or, "Voice Of America" In order, from lower to higher vertebral levels, Bifurcation vertebral landmarks

T4: bifurcation of trachea L4: bifurcation of aorta External jugular vein: tributaries PAST: Posterior external jugular vein Anterior jugular vein Suprascapular vein Transverse cervical vein Palmaris longus: location, relative to wrist nerves "The Palmaris between two Palmars": Palmaris longus is between the Palmar cutaneous branch of Ulnar nerve andPalmar cutaneous branch of Median nerve. Tibia vs. fibula: sizes The Fibula is thin like a Flute. The Tibia is thick like a Tuba. Cranial bones "PEST OF 6": Parietal Ethmoid Sphenoid Temporal Occipital Frontal The 6 just reminds that there's 6 of them to remember. Abdominal muscles "Spare TIRE around their abdomen": Transversus abdominis Internal abdominal oblique Rectus abdominis External abdominal oblique Carpal bones She Looks Too Pretty. Try To Catch Her '

y y y

Scaphoid Lunate Triquetral Pisiform Trapezium

A bifurcation occurs on 4th level of each vertebral column: C4: bifurcation of common carotid artery

y y

y y y

Trapezoid Capitate Hamate

Elbow joint: radius vs. ulna ends CRAzy TULips: Capitalum = Radius Trochlear = ULnar COMMUNITY MEDICENE Protein content of milk For ease it can be remembered as multiples of 1.1 '

Also 'lmd' for remembering the 3 carpals beginning with T. The carpus is made up of 8 carpal bones arranged in two rows. The proximal row is comprised of (from lateral to medial aspect): the scaphoid, the lunate, the triquetral and the pisiform. The distal row has in the same order: the trapezium, the trapezoid, the capitate and the hamate carpal bones. Erector spinae muscles "I Long for Spinach" From lateral to medial, the muscles forming erector spinae are:

y y y y

Human: 1.1 Cow: 3.3 Goat : 3.3 Buffalo: 4.4 Polio virus strains

y y y

Illiocostalis Longissimus Spinalis

There are 3 strains of polio virus .type 1 2 and 3.just remember vaccine opv type 1 = O = outbreaks of paralytic polio type 2= P = potent antigenic strain type 3= V = vaccine associated polio Migraine: prophylaxis drugs "Very Volatile Pharmacotherapeutic Agents For Migrai ne Prophylaxis": Verpamil Valproic acid Pizotifen Amitriptyline Flunarizine Methysergide Propranolol Bare bones version [eg Lippincott's two], just Migraine Prophylaxis, as above. Notifiable disease Yellow CuP is notifiable. Yellow-Yellow fever C-Cholera P-Plague SOYABEAN... To remember max. content of iron in soyabean among pulses....just imagine sombody hitting a person xyz with IRON rod while xyz is SLEEPING

Inguinal canal: walls "MALT: 2M, 2A, 2L, 2T": Starting from superior, moving around in order to posterior: Superior wall (roof): 2 Muscles: internal oblique Muscle transverse abdominus Muscle Anterior wall: 2 Aponeuroses: Aponeurosis of external oblique Aponeurosis of internal oblique Lower wall (floor): 2 Ligaments: inguinal Ligament lacunar Ligament Posterior wall: 2Ts: Transversalis fascia conjoint Tendon Femoral artery deep branches "Put My Leg Down Please": Profundus femoris (deep femoral artery) Medial circumflex femoral artery Lateral circumflex femoral artery Descending genicular arteries Perforating arteries

principles of primary health care

BOY IS MMR mnemonic for live vaccines B-BCG O-OPV Y-yellow fever I-influenza S-salmonella M-mumps M-measles R-Rubella ASHA( ACCREDITED SOCIAL HEALTH ACTIVIST)ROLES "ASHA will do INFORMATIVE CME on PDA PROVIDED VILLAGES PROMOTE it." Informative - Inform about birth, death, diseases C - Counsel mothers M - Mobilise the ppl for better access to health facilities E - Escort preg to facilitate institutional delivery P - Primary medical care D - Depot holder A - Awareness about diseases, health care Provided - Provider of care for child health etc Villages - Village Health plan formulation Promote - Promote construction of sanitary toilets etc Antegenic variation seen in A BorING TRY AIDS VIRUS Bor Borrelia Influenza NEISSERIA GONORRHOEA TRY TRYPANOSOMA Prevalance of disease Prevalance = Incidence x Duration Remember PID Polio vaccines

All

Indians

Can

Enjoy

A- appropriate technology I- intersectoral co- ordination C- community participation E- equitable distribution louse transmitted d/s louse transmited d/s (LET) epidemic typhus and trench fever dropsy, lathyrism S-sanguirine A-argemone mexicana, D-dropsy B-boaa S-sativum NL-Neurolathyrism COPRA includes

COPRA includesMn- CHESS I C- right to Choose H- right to Heard E- right to Education S- right to Safety S- right to Seek redressal I- right to Information Remember: it doesnt include right to Speak... Cohort study I C(see) a PEARL INCIDENCE Cohort study PROSPECTIVE STUDY EXPENSIVE ATTR risk RELATIVE risk can b calculated LARGE nunmber of subjects and LONG follow up

SalK = Killed Polio vaccine OraL (Sabin) = Live Polio vaccine Indicators of fecal water pollution Which of these is a bio indicator of past pollution with fecal matter? a) Faecal Streptococci b) Clostridium perfringens c) both d) none The answer is b. How to remember: Cl. perfringes is an indicator of past water pollution Also remember that the indicator of recent water

pollution is Faecal Streptococci ( Recent = Short term - Streptococci ) Passively immunized diseases with antisera DetecTive BRG !' 1. 2. 3. 4. 5. Diptheria Tetanus Botulism Rabies Gas gangrene

Dengue

ENT
CHARGE SYNDROME Coloboma Heart defects choanal Atresia Retarded growth Genital hypoplasia Ear anomalies Types of DNS (Deviated Nasal Septum)

Cereals and pulses-and their lacking Amino acid CMPL' Just remember cereals and pulses form complete food. ie Cerelas have Methinone and Pulses have Lysine. And so when it comes to the deficient amino acid, just reverse it. Live attenuated vaccines

y y y y y y y y y y

Rubella Oral polio vaccine Measles Epidemic typhus Influenza Mumps BCG Plague Typhoid oral vaccine Yellow fever Diseases caused by aedes aegypti 'SCAN your nose'

y y y y

S -shaped deformity C -shaped deformity Anterior dislocation Nasal spur

Deviation may involve only the cartilage,bone or both. S -shaped deformity may cause bilateral nasal obstruction. Recurrent laryngeal nerve injury Recurrent laryngeal nerve injury can cause 'ABCD' (besides hoarsness of voice) Aphonia Bronchopneumonia (due to aspiration) Cough (ineffective) Dysphonia

'Rosy Cheeks.....Yellow Dimple!'

y y y

Rift valley fever Chikungunya Yellow fever

Indications for Tonsillectomy Tonsillectomy is indicated when a Tonsil 'HARMS' Hypertrophy with hoarseness Abscess (Peritonsillar - Quinsy) Recurrent sore throat Malignancy is suspected Seizures (Febrile seizures due to Tonsillitis) Otogenic Brain Abscess : stages "INLET" Stage of INvasion - headache, low grade fever, malaise and drowsiness Stage of Localisation - formation of a capsule to localise the pus Stage of Enlargment - zone of edema around the abscess, raised intracranial tension Stage of Termination - ruptures into the ventricle or subarachnoid space Tubercular otitis media : clinical features 5 P's Painless ear discharge Perforation Profound hearing loss Paralysis of face Pale granulation Rinne's test

NNN - Normally Rinne's test is Not Negative it's BACkwards test (Bone conduction better than Air Conduction) Embryology of ear ossicles

Maleus and Incus forms from mesoderm of I arch Stapes from Second arch. Fluctuating hearing loss in . . . "SPAM" Syphilic labyrinthitis Perilmph fistula Autoimmune disorder of inner ear Meniere's disease

Tonsils: Blood supply

'Love Father And Mother'

Lingual artery

y y y

Facial artery Ascending pharyngeal artery Maxillary artery Little's area: Arteries

Auditory Pathway

E.COLI-MA'

y y
" LEGS "

Eighth nerve Cochlear nuclei Olivary complex Lateral lemniscus Inferior colliculus Medial geniculate body Auditory cortex

y y y y y

y y y y

L - superior Labial artery E - anterior Ethmoidal artery G - Greater palatine artery S - Sphenopalatine artery

The four arteries anastamose at Little's area to form a vascular plexus called Kiesselbach's plexus.

The area of cortex, concerned with hearing is Brodmann's area located in the Superior temporal gyrus. Each ear is represented in both cerebral hemispheres. Oropharyngeal cancers: aetiology

6 S's: Smoking Spicy food Syphilis Spirits [booze]

Sore tooth Sepsis SEQUELAE OF CSOMO - CART Ossicular necrosis Cholesterol granuloma Atrophic tympanic membrane and atelactatic middle ear Retraction pockets and cholesteatoma Tympanosclerosis D/D of membrane over the tonsil M2-VIDAAL (form Widal test for Typhoid) It is: - Membranous tonsillitis - Malignancy - Vincent's angina - Infectious mononucleosis - Diptheria - Apthous ulcers - Agranulocytosis - Ludwig's angina - T: Trauma Indications of tympanoplasty ABCDES Age should be above 10yrs when sufficient resistance develops Benign (tubotympanic disease) can be corrected Conductive deafness can corrected Dry perforation gives best results Eustachian tube should be functioning properly Stapes should be mobile causes of SNHL

Infections Trauma to labyrinth/ VIIITH nv Ototoxic drugs Presbyacusis Systemic Dz. Sequelae of Otitis media SCALP COST S-SNHL C-Cholesteatoma A-Atelectasis L-Learning Disability P-Perforation of TM C-Conductive HL O-Ossicular Necrosis S-Speech Impairment T-Tympanosclerosis 5's' abSolute indications of tonsillectomy. Sore throat (recurrent). quinSy. Suspected malignancy. Seizure (febrile). Speech affected due to hypertrophy of tonsil. GASTROENTEROLOGY Ulcerative colitis: definition of a severe attack A STATE: Anemia less than 10g/dl Stool frequency greater than 6 stools/day with blood Temperature greater than 37.5 Albumin less than 30g/L Tachycardia greater than 90bpm ESR greater than 30mm/hr Pancreatitis: criteria

1.Congenital -Prenatal factors -Paranatal factors 2.Acquired Nakshatra Makes FANSI TOPS Noise induced HL Meniere's dz Familial Prog HL Ac. Neuroma Noise Induce HL Sudden HL

PANCREAS: PaO2 below 8 Age >55 Neutrophils: WCC >15 Calcium below 2 Renal: Urea >16 Enzymes: LDH >600; AST >200 Albumin below 32 Sugar: Glucose >10 (unless diabetic patient) Crohn's disease: morphology, symptoms CHRISTMAS: Cobblestones

High temperature Reduced lumen Intestinal fistulae Skip lesions Transmural (all layers, may ulcerate) Malabsorption Abdominal pain Submucosal fibrosis Cirrhosis: differential: common and rarer Common causes are ABC: Alcohol B (Hepatitis) C (Hepatitis) Rarer are also ABC: Autoimmune Biliary cirrhosis Copper (Wilson's) Charcot's triad (gallstones) "Charge a FEE": Charcot's triad is: Fever Epigastric & RUQ pain Emesis & nausea Ulcerative colitis: complications "PAST Colitis": Pyoderma gangrenosum Ankylosing spondylitis Sclerosing pericholangitis Toxic megacolon Colon carcinoma Hereditary Nonpolyposis Colorectal Cancer (HNPCC) cause is DNA mismatch repair DNA mismatch causes a bubble in the strand where the two nucleotides don't match. This looks like the ensuing polyps that arise in the colon. Dry mouth: differential "DRI": 2 of each: Drugs/ Dehydration Renal failure/ Radiotherapy Immunological (Sjogren's)/ Intense emotions

Splenomegaly: causes CHIMP: Cysts Haematological ( eg CML, myelofibrosis) Infective (eg viral (IM), bacterial) Metabolic/ Misc (eg amyloid, Gauchers) Portal hypertension Diabetic ketoacidosis: precipitating factors 5 I's: Infection Ischaemia (cardiac, mesenteric) Infarction Ignorance (poor control) Intoxication (alcohol) Cholangitis features CHOLANGITITS: Charcot's triad/ Conjugated bilirubin increase Hepatic abscesses/ Hepatic (intra/extra) bile ducts/ HLA B8, DR3 Obstruction Leukocytosis Alkaline phosphatase increase Neoplasms Gallstones Inflammatory bowel disease (ulcerative colitis) Transaminase increase Infection Sclerosing Vomiting: extra GI differential VOMITING: Vestibular disturbance/ Vagal (reflex pain) Opiates Migrane/ Metabolic (DKA, gastroparesis, hypercalcemia) Infections Toxicity (cytotoxic, digitalis toxicity) Increased ICP, Ingested alcohol Neurogenic, psychogenic Gestation Pancreatitis: Ranson criteria for pancreatitis at admission LEGAL: Leukocytes > 16.000 Enzyme AST > 250 Glucose > 200 Age > 55 LDH > 350

Constipation: causes DOPED: Drugs (eg opiates) Obstruction (eg IBD, cancer) Pain Endocrine (eg hypothyroid) Depression Haemachromatosis complications "HaemoChromatosis Can Cause Deposits Anywhere" : Hypogonadism Cancer (hepatocellular) Cirrhosis Cardiomyopathy Diabetes mellitus Arthropathy Hepatic encephalopathy: precipitating factors

Liver failure (chronic): signs found on the arms CLAPS: Clubbing Leukonychia Asterixis Palmar erythema Scratch marks GYNECOLOGY Ovarian cancer: Risk factors "Bright FILM"

y y y y

Breast cancer Family history of ovarian cancer Infertility Low parity Mumps Endometriosis: Symptoms

ABCDEFI: Alcohol withdrawal Bleeding (GI) Constipation Drugs: withdraw any sedatives/narcotics Electrolyte imbalances Fluid depletion: stop diuretics Infections: treat vigorously Dysphagia: differential DISPHAGIA: Disease of mouth and tonsils/ Diffuse oesophageal spasm/ Diabetes mellitus Intrinsic lesion Scleroderma Pharyngeal disorders/ Palsy-bulbar-MND Achalasia Heart: eft atrium enlargement Goitre/ myesthenia Gravis/ mediastinal Glands Infections American trypanosomiasis (chagas disease) Dysphagia: causes MOON: Mouth lesions Obstruction Oesophageal stricture Neurological (eg stroke, Guillain-Barre, achalasia)

5 Ds

y y y y y

Dysmenorrhoea Disorders of menstruation Dyspareunia Dyschezia Dull ache of abdomen

Pelvic Inflammatory Disease (PID): complications I FACE PID: Infertility Fitz-Hugh-Curitis syndrome Abscesses Chronic pelvic pain Ectopic pregnancy Peritonitis Intestinal obstruction Disseminated: sepsis, endocarditis, arthritis, meninigitis

RLQ pain: brief female differential AEIOU: Appendicitis/ Abscess Ectopic pregnancy/ Endometriosis Inflammatory disease (pelvic)/ IBD Ovarian cyst (rupture, torsion) Uteric colic/ Urinary stones Dysfunctional uterine bleeding (DUB): 3 major causes DUB: Don't ovulate (anovulation: 90% of cases) Unusual corpus leuteum activity (prolonged or insufficient) Birth control pills (since increases progesteroneestrogen ratio) postmenopausal bleeding postmenopause P-olyp(cervical) O-ovarian cancer(also ca uterus ,vagina, cervix,) S-enile vaginitis,endometritis T-rauma M-yoma E- ndometrial hyperplasia N-ot removed pessary leading 2 ulceration O-estrogen therapy P-yometra(intermittent) A-fter radiation ulceration U-rethral carbuncle S-arcoma uterus E-rosion in cervix Histology in ovarian tumors signet ring cells-krukenberg walthard cell rests-brenners tumor reinkes crystals-hilus cell tumor call-exner bodies-granulosa cell tumor schill-duoval bodies-endodermal sinus tumors psammoma bodies-seros epithelial tumor Vaginal pH Vagina has 4 labia and normal pH of vagina is about 4. Left iliac fossa: Causes of pain SUPER CLOT:

y y y y y y y y

Ureteric colic PID Ectopic pregnancy Rectus sheath haematoma Colorectal carcinoma Left sided lower lobe pneumonia Ovarian cyst (rupture, torture) Threatened abortion/ Testicular torsion Rise in serum amylase: Causes

Serum amylase rises in Acute pancreatitis. Other causes are : ' SAM MUST MERRy '

y y y y y y y y y

Serum Amylase Mesenteric infarction Upper gastrointestinal tract perforation Salivary gland inflammation Torsion of intra-abdominal viscus Macroamylasaemia Ectopic pregnancy Retroperitoneal haematoma Renal failure

Absolute C/I for IUCD "PLEASE DONT EVER PUT CONTRACEPTIVES" Please-Pregnancy(suspected/confirmed) Dont-DUB Ever-Ectopic Put-PID Contraceptive-Ca cervix Alfa feto protein alfafeto protein in pregnancy down in downs-syndrome high in 2O-- O-OPEN NEURAL TUBE DEFECT O-OMPHALOCELE

Sigmoid diverticulitis

Omental caking: Causes "Omental CAking = Ovarian CA"

P- Pulse rate increase: 100-200/min P- Purulent vaginal discharge P- Pelvic findings: Patulous os or a boggy feel of the uterus Antihypertensives contraindicated in pregnancy DARSAN '

In gynecology, omental caking almost always signifies ovarian cancer. Omental caking is the radiological (CT) finding indicative of thickened greater omentum. It is caused due to neoplastic infiltration of the greater omentum, most commonly by metastatic ovarian, gastric, colonic, or pancreatic carcinoma. Secondary amenorrhea: causes

y y y

Diuretics Angiotensin I antagonists Reserpine Sodium nitroprusside ACE inhibitors Non selective blockers

SOAP: Stress OCP Anorexia Pregnancy Pelvic Inflammatory Disease (PID): causes, effects "PID CAN be EPIC": Causes: Chlamydia trachomatis Actinomycetes Neisseria gonorrhoeae Effects: Ectopic Pregnancy Infertility Chronic pain OBSTETRICS Prenatal diagnosis with weeks of pregnancy (shared by 'Target pg') can any one make coffee for {me} 10-12-14-16-18 chorionic villus sampling.-10-12 [transabdominally from 10 wk to term] amniocentesis 14-16 maternal blood 16-18 cordocentesis fetal blood 18-20 5 P's of Septic Abortion

y y y

Alpha feto protein in blood, is seen in "TOLD"

y y y y

Testicular tumours Obituary - foetal death Liver - hepatomas Defects - neural tube defects

lymphatic supply of uterus,cervix mnemonic is- USA, ME, LIES U Upper-S superficial inguinal A aortic M middle- E external iliac L lower- I internal iliac, E external iliac, S sacral(lower part of uterus can also be asked as - lymphatic supply of cervix) Miscarriage: recurrent miscarriage causes RIBCAGE: Radiation Immune reaction Bugs (infection) Cervical incompetence Anatomical anomaly (uterine septum etc.) Genetic (aneuploidy, balanced translocation etc.) Endocrin Multiple pregnancy complications

5 P's of Septic Abortion ( clinical features) P- Pyrexia P- Pain in abdomen

HI, PAPA: Hydramnios (Poly)

IUGR Preterm labour Antepartum haemorrhage Pre-eclampsia Abortion Shoulder dystocia: management HELPER: Call for Help Episiotomy Legs up [McRoberts position] Pressure subrapubically [not on fundus] Enter vagina for shoulder rotation Reach for posterior shoulder and deliver posterior shoulder/ Return head into vagina [Zavanelli maneuver] for C-section/ Rupture clavicle or pubic symphysis Postpartum hemorrhage: Risk factors "PARTUM"

PROSTAGLANDINS confusion A)All have "1 MISS" means MISoprostol is PGE1. B)cErviprimE has 2E so cErviprimE is PGE2. C)DInoproSTONE DI=2 Remember that "stonE" in both(2) kidney n "stonE" has "E". So DINOPROSTONE is PGE2. D)DINO mario has 2 FArari CAR. DINO-DINOPROST 2 FArari-F2A [A for Alpha] CAR-CARBOPROST so DINOPROST n CARBOPROST r PGF2alpha Note: DINOPROSTONE is PGE2 which is remember by 2 kidney stonE bt DINOPROST is PGF2alpha. Spontaneous abortion: definition "Spontaneous abortion" has less than 20 letters [it's exactly 19 letters]. Spontaneous abortion is defined as delivery or loss of products of conception atless than 20 weeks gestation. pge1

Prolonged labour/ Polyhydramnios/ Previous caesarean APH Recent history of bleeding Twins (Multiple pregnancy) Uterine fibroids Multiparity Criteria for FORCEPS:delivery

y y y y y

Foetus alive Os dilated Ruptured membrane, Rotation complete Cervix taken up Engagement of head Presentation suitable Sagittal suture in AP diameter of inlet Preeclampsia: classic triad PREeclampsia: Proteinuria Rising blood pressure Edema

USES OF PGE1- (MISOPROST) P-PATENT DUCTUS ARTERIOSIS G-GASTRIC ULCER EEXPULSION OF FOETUS i.e. MTP 1-IMPOTENCY "Spontaneous abortion" has less than 20 letters [it's exactly 19 letters]. Spontaneous abortion is defined as delivery or loss of products of conception atless than 20 weeks gestation. Alpha-fetoprotein: causes for increased maternal serum AFP during pregnancy "Increased Maternal Serum Alpha Feto Protein": Intestinal obstruction Multiple gestation/ Miscalculation of gestational age/ Myeloschisis Spina bifida cystica

Anencephaly/ Abdominal wall defect Fetal death Placental abruption Oral contraceptive complications: warning signs ACHES: Abdominal pain Chest pain Headache (severe) Eye (blurred vision) Sharp leg pain CVS and amniocentesis: when performed "Chorionic" has 9 letters and Chorionic villus sampling performed at 9 weeks gestation. "AlphaFetoProtein" has 16 letters and it's measured at 16 weeks gestation. Postpartum collapse: causes HEPARINS: Hemorrhage Eclampsia Pulmonary embolism Amniotic fluid embolism Regional anaethetic complications Infarction (MI) Neurogenic shock Septic shock Gestation period, oocytes, vaginal pH, menstrual cycle: normal numbers 4 is the normal pH of the vagina. 40 weeks is the normal gestation period. 400 oocytes released between menarche and menopause. 400,000 oocytes present at puberty. 28 days in a normal menstrual cycle. 280 days (from last normal menstrual period) in a normal gestation period. OPTHALMOLOGY Examination technique of senile cataract V- DOTS *Visual acuity testing *Distant direct ophthalmoscopic examination * Oblique illumination examination

* Test fr iris shadow * Slit lamp examination "DWARF" for describing Nystagmus Direction=plane of movement-horizontal,vertical Waveform= Pendular or Jerky Amplitude= fine or coarse Rest=At primary position or gaze evoked Frequency= How often the eye moves UVEITIS Systemic Features of Sarcoid: FILLED BAGEL Facial nerve palsy Infiltrates of lung parenchyma, Insufficiency of pituitary Lymphadenopathy (esp lung hilae) Liver & spleen enlargement Elevated ACE & calcium Dilated cardiomyopathy Bone cysts Arthralgia Granulomata of skin Erythema nodosum Lupus pernio

Features of Behcet's Disease: ORAL UPSET Occlusive periphlebitis Retinitis Anterior uveitis Leakage from retinal vessels Ulceration (aphthous/genital) Pustules after skin trauma (Pathergy test)

Scratching leaves lines (dermatographism) Erythema nodosum Thrombophlebitis

Causes of lid retraction 4M= Myasthenia Gravis, Marcus Gunn jaw winkling syndrome, Myotonic causes like dystrophica myotonica. Metabolic causes like uraemia,cirrhosis 4P= Perinauds syndrome, Parkinson's Disease/ Progressive supranuclear palsy,Ptosis of other eye, Palsy (aberrant III cranial nerve regeneration) Causes of retinal detachment Mnemonic: SITS Secondary to some intraocular problem (melanoma) Idiopathic Trauma Surgery for cataract Nerves passing through superior orbital fissure Live Frankly To See Absolutely No Insult

Clinical features of Reiters: PLUCKING Plantar Fasciitis Urethritis Conjunctivitis Keratoderma blenorrhagica Inflamed joints Nail dystrophy Gum ulceration Ophthalmic features of TB: BCG GP Busacca & Koeppe nodules on iris Choroiditis Granulomata in choroid Granulomatous uveitis (with mutton fat KPs) Periphlebitis Stye and Chalazion STYE is Hordeolum externum (STAY OUT) ; Moll's gland / Zeis gland affected Chalazion is Hordeolum INternum - Chronic Inflammatory granuloma ofMEiBOMian glands (Remember : See (C) me in Bombay) Cataracts: causes CATARAct: Congenital Aging Toxicity (steroids, etc) Accidents Radiation Abnormal metabolism (diabetes mellitus, Wilson's) Surgeries for Ptosis FLUFFY F- fasanella servat operation L- levator resection {blaskovics n everbush's} F- frontalis sling operation

y y y y y y

Lacrimal nerve Frontal nerve Trochlear nerve Superior division of oculomotor nerve Abducens nerve Nasociliary nerve (branch of ophthalmic nerve) Inferior division of oculomotor nerve

Etiology of Neovascular Glaucoma RUBEOTIC Retinopathy and Retinal vein occlusion (PDR, CRVO) Retinal detachment Uveitis BRVO Eale's Disease Ocular Ischemic Syndrome Trauma Intraocular tumours (choroidal melanoma) Carotid Cavernous Fistula ANGLE SRUCTURES "I Can See Till Schwalbe's Line"

Iris root Cilliary Body

Characteristics of congenital nystagmus with CONGENITAL Convergence & eye closure dampens

Scleral spur Oscillopsia absent Trabecular Meshwork Schwalbe's Line ACROMEGALY & MARFANS Remember ocular features of acromegaly with ACROM Angiod streaks Chiasmal syndrome Retinopathy Optic atrophy,papilloedema Muscle enlargement Remember the systemic features of Marfan syndrome with MARFANS Mitral prolapse Wernicke's Encephalopathy Aortic dissection Neoplasm or paraneoplastic cerebeller degeneration Regurgitant aortic valve Brainstem disease (Syringomyelia) Fingers long (arachnodactyly) Encephalitis Arm span>height Arnold-Chiari malformation Nasal voice (high arched palate) Trauma or Toxin Sternal excavation characteristics of Perinaud's Dorsal Midbrain Syndrome with "CLUES" Convergence retraction nystagmus Lightnear Dissociation Upgaze paralysis Eyelid retraction Skew deviation Content & veins draining the Cavernous Sinus with Rule of 3 3 Afferent veins: Sphenoparietal sinus (Vault veins), Supf Middle cerebral Vein (Brain), Ophthalmic vein (Orbit) 3 Efferent Veins: Superior petrosal sinus, Inferior Petrosal Sinus, Communicating vein to pterygoid plexus 3 Contents; Cranial Nerves (III,IV, V1,V2 & VI) 3 Areas Drain into it: Vault Bones, Brain (Cerebral Hemisphere), Orbit 3 Nerves: Motor(III,IV,VI),Sensory (V1,V2), Sympathetic Null zone that is present,increases foveation time which results in increased acuity Gaze poisition doesnot change the horizontal direction of nystagmus Equal amplitude and frequency in each eye Near acuity is good Inversion of optokinetic response Turning of head to acheive null point Abolishes in sleep Latent (occlusion) nystagmus occurs Causes of downbeat nystagmus with DoWNBEAT Degeneration,Demyelination or Drugs (Lithium)

Structures derived from surface ectoderm with S1L2E3 Skin of Eyelids and its derivatives viz. cilia, tarsal glands, conjunctival gland Lens, Lacrimal Gland, Epithelium of Conjunctiva, Epithelium of Cornea, Epithelium of lacrimal passage Ocular structures derived from neuroectoderm Muscles of pupil Optic Nerve Retina (with RPE) Epithelium of Iris Epithelium of Cilliary Body Sterilization in ophthalmology with ABCDEFG

D=D vitamin E=estrogens F=fluoride G=gradual increase in weight bearing H=High protein diet Arthritis: Causes "HINTS"

y y

Hemorrhage (due to trauma/hemophilia) Inflammatory (rheumatoid arthritis, crystals due to gout, psoriasis) Noninflammatory (osteoarthritis) Trauma/Tumour Septic arthritis

y y

AUTOCLAVE BOILING CHEMICALS like Alcohol (Rectified spirit), Isopropyl alcohol/CIDEX: 2% Glutaraldehyde DRY HEAT temperature of 150C is used for 90 minutes ETHYLENE OXIDE for sterilization of IOL etc. FUMIGATION of operation theatre/ FORMALIN vapour GAMMA-IRRADIATION: Gamma rays from Cobalt-60 Causes of trabecular pigmentation "PIGMENT" Pseudoexfoliation & Pigment dispersion syndrome Iritis Glaucoma (Post angle closure Glaucoma) Melanosis of angle (oculodermal melanosis) Endocrine (Diabetes & Addisons Syndrome) Naevus (Cogan-reese syndrome) Trauma ORTHOPEDICS Osteoporosis treatment A to H A= alandronate androgen B=braces C=calcitonin calcium supplement

Carpal tunnel syndrome: treatment WRIST: Wear splints at night Rest Inject steroid Surgical decompression Take diuretics GEOMED Tumours- site of origin G-Giant cell tmr E-Epiphysis O-Osteosarcoma M-Metaphysis E-Ewings tmr D-Diaphysis Growing end of bones towards the knee(distal end femur ,upper end tibia),we flee. away from elbow(upper end humerus,distal end radius &ulna),we go. osteoblastic bone metastasis 5 BEES LICK POLLEN Brain(medulloblastoma) Bronchus

Breast Bowel Bladder Lymphoma Prostrate triple deformity causes

Carpal tunnel syndrome: Causes MEDIAN TRAP"

y y y

Myxoedema Edema premenstrually Diabetes mellitus Idiopathic Acromegaly Neoplasm Trauma Rheumatoid arthritis Amyloidosis Pregnancy

triple deformity t-trauma.tb r-RA i-iliotibial contracture p-polio l e-extravasation of blood i.e hemarthrosis Nonunion of bones: differential You need a SPLINT: Soft tissue interposition Position of reduction (too much traction, immobilization, or movement) Location (eg. lower third of tibia slow to heal) Infection Nutritional (damaged vessels or diseased bone) Tumor (pathological fracture) Sacroiliitis: causes

y y y y y y y

Bryant's traction: position BrYant's traction: Bent Y. Patient's body is the stem of the Y laying on the bed, and legs are the ends of the Y up in the air. Fractures: principles of management

PUB CAR: Psoriasis Ulcerative colitis Behcet's disease Crohn's disease Ankylosing spondylitis Reiter's disease Diaphyseal lesions

FRIAR: First aid Reduction Immobilisation Active Rehabilitation Paget's disease of bone: clinical features "PANICS"

FEMALE "

y y y y y y y
Fibrous dysplasia

Pain Arthralgia Nerve compression/Neural deafness Increased bone density Cardiac failure Skull/Sclerotic vertebrae

y
Eosinophilic granuloma

y
Metastasis

y
Adamantinoma

y
Leukaemia, Lymphoma

y
Ewing's sarcoma

Salter Harris fracture classification

Fracture: describing (short version) DOCTOR: Displaced vs. non-displaced Open vs. closed Complete vs. incomplete Transverse fracture vs. linear fracture Open Reduction vs. closed reduction Forearm: fractures "Break the forearm of the MUGR (mugger)": Monteggia=Ulna Galeazzi=Radius PEDIATRICS

Salter Harris, modified to SALTR: type 1: Slipped epiphysis type 2: Above the eiphyseal plate type 3: Lower than the eiphyseal plate type 4: Through both above and below eiphyseal plate type 5: Raised epiphysis, as in a compression injury Salter Harris classification utilises visualising long bone distal portion with diaphysis superiorly placed and epiphysis inferiorly placed. CAVE- correction of club foot stepwise C-cavus A-adduction V-varus E-equinus Fracture: how to describe PLASTER OF PARIS: Plane Location Articular cartilage involvement Simple or comminuted Type (eg Colles') Extent Reason Open or closed Foreign bodies disPlacement Angulation Rotation Impaction Shortening Bone Ache Question: Do u know what happens if Tomato Paste Mixture Is Nasty? Answer: Chronic bone ache How?? Here it is .. Tomato .TUMOR (mostly secondary) Paste..PAGETS DISEASE Mixture..METABOLIC CAUSES Ischronic INFECTIONS Nasty..osteo-NECROSIS

Causes of nocturnal cough shared by Sunita Biradar BPL-ACT 1)Bronchial asthma 2)Post nasal drip 3)Left side heart failure 4)Aspiration 5)Chronic bronchitis 6)Tropical eosinophila Hematuria: differential in children ABCDEFGHIJK:

Anatomy (cysts, etc) Bladder (cystitis) Cancer (Wilm's tumour) Drug related (cyclophosphamide) Exercise induced Factitious (Munchausen by proxy) Glomerulonephritis Haematology (bleeding disorder, sickle cell) Infection (UTI) In Jury (trauma) Kidney stones (hypercalciuria) Protein content of milk For ease it can be remembered as multiples of 1.1 '

y y y y

Human: 1.1 Cow: 3.3 Goat : 3.3 Buffalo: 4.4

potter syndrome POTTER: Pulmonary hypoplasia Oligohydrominios Twisted skin (wrinkly skin) Twisted face (Potter facies) Extremities defects Renal agenesis (bilateral) Osteomalacia: Radiological features "Loose Penicillin Fish"

Ejection systolic murmur: Occurs in Think " P.A.S.D " This is a tricky one. The lesions which cause ESM can be written down using the 4 letters.

y y y y

PS: Pulmonary stenosis AS: Aortic stenosis ASD: Atrial septal defect and SA: Severe anemia Croup: symptoms "3 S's"

y y y

Looser's zone (pseudo fractures) Penicilling in of vertebral bodies

y
Codfish vertebrae

Stridor Subglottic swelling Seal-bark cough

y
CHAMP SMALL FOR GESTATIONAL AGE BABY GETS FOLLOWING PROBLEMS: [CHAMP] - REMEMBER THAT SGA BABY WILL BECOME A CHAMP. C - CONGENITAL ANOMALIES H - HYPOGLYCEMIA, HYPOCALCEMIA, A - ASPHYXIA M - MECONIUM ASPIRATION SYNDROME P - POLCYTHEMIA, PUL. HEMORRHAGE * Duodenal atresia vs. Pyloric stenosis: site of obstruction Duodenal Atresia:

Nephrotic syndrome ..its NEPHROTIC NEPHROTIC Na+water retention Edema Protienuria>3.5g/24hrs Hypertension+hyperlipidaemia Renal vein thrombosis Thrombotic n thromboembolic complications Infection with staphylococci n pneumococci C-hyperCoagulable state Noonans syndrome NOONans is 12q and autosomal dominant..............................................................in noonans NOON sounds like after NOON , so noon is 12 and at that time it will be sunny so sun is dominant at that time Kawasaki Disease My Heart Mucosal involvement like dry chapped lips and strawberry tongue

Distal to Ampulla of vater.

Pyloric stenosis:

Proximal to it. Fetal alcohol syndrome (FAS): Features

"FAS"

y y

Facial hypoplasia, Forebrain malformations Attention deficit disorder (ADD), Altered joints Short stature, Septal defects, Small(low) IQ

Hands and feet with edema and desquamation (late in the disease) Eyes non purulent bilateral conjunctivitis Adenopathy often cervical unilateral > 1.5 cm lymph nodes enlargement Rash usually truncal and pleomorphic Temperature non remitting fever for at least five days Rickets Vs. Scurvy

S pino cerebellar ataxia DiGeorge syndrome CATCH-22 -congenital heart disease -Abnormal facies -Thymic aplasia -Cleft palate -Hypocalcemia -22q deletion Neonatal Emergencies "THE MISFITS"

"R"achitic rosary is Round... "S"corbutic rosary is Sharp.... zinc deficiency HIDA HHyperpigmentation,Hypogonadism,Hepatosplenomeg aly I-Iron deficiency anemia D-Dwarfism,diarrhoea,dermatitis,decreased immunocompetence,delayed (poor)wound healing A-Acro dermatitis loss of hair and taste alteration can also occur VIRAL LIVE VACCINES ViralLiveVacines MY MR VIP M-Mumps Y-YellowFever M-Measles R-Rubella V-V aricella I-Influenza P-Pox Vaccines contraindicated in HIV! BOY BCG,ORAL TYPHOID,YELLOW FEVER Trinucleotide repeat disorders! My Fragile Huntington has spino cerebellar ataxia! M yotonic dystrophy F ragile X syndrome H untington disease

Given the fact that signs and symptoms are usually non specific and the presentation is usually subtle in newborns it is a wise idea to think of a mnemonic that reminds us of all the possible neonatalemergencies. T = Trauma (Accidental and Non Accidental) H = Heart Disease, Hypovolemia, Hypoxia E = Endocrine (Congenital Adrenal Hyperplasia, Thyrotoxicosis) M = Metabolic (Electrolyte Imbalance) I = Inborn Errors of Metabolism S = Sepsis (Meningitis, Pneumonia, UTI) F = Formula Mishaps (Under or Over dilution) I = Intestinal Catastrophes (Intussusception, Volvulus, NecrotizingEnterocolitis) T = Toxins / Poisons S = Seizures

PSYCHIATRIC
Symptoms of Mania Symptoms of Mania (shared by Ismail Ibrahim) DIG FAST Distractibility Indiscretion (DSM-IV's "excessive involvement in pleasurable activities) Grandiosity Flight of ideas Activity increase Sleep deficit (decreased need for sleep) Talkativeness (pressured speech) Schizophrenia: negative features 4 A's: Ambivalence Affective incongruence

Associative loosening Autism The diagnostic criteria for Anorexia nervosa "CIDA" C=chooses not to eat,leading to a potentially dangerous weight loss. I=Intense fear of being obese,even when underweight D=disturbance of weight perception( i.e feeling fat when thin) A=Amenorrhoea for 3 or more consecutive cycles ( when not on the pill ) SUBTYPES OF SCHIZOPHRENIA P- CURD Paranoid Catatonic Undifferentiated Residual Disorganised Neuroleptic side effects onset The rule of 4's: Dystonia: 4 hours-4 days Akathesia: 4 days-40 days Extrapyramidal symptoms: 4 days-4 weeks Tardive dyskinesia: 4 months (greater than) Note that tardive is obviously the latest one to happen (tardive=tardy/late). Note that the first letters of these four classic symptoms spell "DATE" Depression criteria/symptoms A SAD FACE: Appetite, weight changes Sleep changes / suicidal tendency Anhedonia Dysphoria (low mood) Fatigue Agitation (psychomotor) Concentration Esteem Depression: symptoms and signs (DSM-IV criteria) AWESOME: Affect flat Weight change (loss or gain) Energy, loss of Sad feelings/ Suicide thoughts or plans or attempts/ Sexual inhibition/ Sleep change (loss or

excess)/ Social withdrawal Others (guilt, loss of pleasure, hopeless) Memory loss Emotional blunting Mania: diagnostic criteria Must have 3 of MANIAC: Mouth (pressure of speech)/ Moodl Activity increased Naughty (disinhibition) Insomnia Attention (distractability) Confidence (grandiose ideas) Conduct disorder vs. Antisocial personality disorder Conduct disorder is seen in Children. Antisocial personality disorder is seen in Adults. PANIC DISORDER CRITERIA PANIC DISORDER CRITERIA STUDENTS FEAR the 3 C's sweating trembling unsteadiness,dizziness depersonalization,derealization excessive heartrate,palpitations nausea tingling shortness of breath FEAR of dying,losing control,going crazy 3 C'S CHEST PAIN CHILLS CHOKING MENTAL STATUS EXAM MENTAL STATUS EXAM ISASEPTIC Appearence and behaviour Speech Emotion (mood and affect) Perception Thought content and process Insight and judgement Cognition

Histrionic Personality PRAISE ME: P - provocative (or seductive) behaviour R - relationships, considered more intimate than they are A - attention, must be at center of I - influenced easily S - speech (style) - wants to impress, lacks detail E - emotional ability, shallowness M - make-up - physical appearance used to draw attention to self E - exaggerated emotions - theatrical Dementia: main causes VITAMIN D VEST: Vitamin deficiency (B12, folate, thiamine) Intracranial tumour Trauma (head injury) Anoxia Metabolic (diabetes) Infection (postencephalitis, HIV) Normal pressure hydrocephalus Degenerative (Alzheimer's, Huntington's, CJD, etc) Vascular (multi infarct dementia) Endocrine (hypothyroid) Space occupying lesion (chronic subdural haematoma) Toxic (alcohol) Anxiety disorders: physical illnesses mimicking them "Physical Health Hazards That Appear Panciky": Phaeochromocytoma Hyperthyroidism Hypoglycaemia Temporal lobe epilepsy Alcohol Paroxysmal arrhythmias Ganser

Appetite Libido Energy Diurnal mood variation Depression: melancholic features (DSM IV) MELANcholic: Morning worsening of symptoms/ psychoMotor agitation, retardation/ earlyMorning wakening Excessive guilt Loss of emotional reactivity ANorexia/ ANhedonia Tetrad of narcolepsy CHeSS '

y y y y

Cataplexy Hypnagogic hallucinations Sleep paralysis Sleep atttacks

Narcolepsy is a chronic sleep disorder characterized by overwhelming drowsiness and sudden attacks of sleep. The condition is most characterized by excessive daytime sleepiness(EDS), in which a person experiences extreme tiredness and possibly falls asleep at inappropriate times, such as at work or school. Cataplexy, a sudden muscular weakness brought on by strong emotions, is a medical condition which may also affect narcoleptics. Lithium: Uses ' LIBRA '

y y

Leukopenia Inappropriate ADH secretion syndrome (SIADH) Bipolar disorder Recurrent neuropsychiatric syndrome Agranulocytosis

Ganser syndrome: key diagnostic feature The word "Ganser" is close to but not quite the word "Answer". Ganser's syndrome is when patient gives an answer that is close to, but not quite. For example 2+2=5.. Biological symptoms in psychiatry SCALED: Sleep disturbance Concentration

y y y

Differential diagnosis of dementia D: neuroDegenerative disorders E: endocrine M: metabolic E: exogenous N: neoplasm T: trauma I: infection A: affective disorders S: stroke/structural

C- Cardiac branches R- Recurrent laryngeal nerve A- Anterior Vagal Trunk P- Posterior Vagal Trunk

SURGERY
Ameloblastoma...definition "UNIAC" unicystic non-functional intermittant in growth anatomically

Causes of asterixis (flapping tremor) ' DRUGS (ABC) FAILED Helping Him ' DRUGS (ABC) : - Alcohol ...- Barbiturate - carbamazepine FAILED : - respiratory failure - liver failure - renal failure Helping : [[[ H = HYPO ]]] - hypoglycemia - hypokalemia - hypomagnesemia Him : [[[ H = HEMORRHAGE ]]] - intracerebral hemorrhage - subarachinoid hemorrhage - subdural hematoma Branches of Vagus nerve "APE-SCRAP" A- Auricular nerve P- Pharyngeal nerve E- Esophageal plexus S- Superior laryngeal nerve (Gives internal 'sensory' and external 'motor' LN)