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SK Original Golden 12 (All Feb + June 2021) 402

Derivatives
S Extraembryonic mesoderm derived from - Epiblast
S Extraembryonic coelom derived from - Hypoblast
S Intraembryonic coelom derived from -Lateral plate mesoderm
S -
Adrenal cortex derived from Mesoderm
S Adrenal medulla derived from - Neural crest cell
S -
Dura matter derived from Mesoderm
S Pia and arachnoid matter derived from -Neural crest cell
S Schwan cell Derived from - Neural crest cell
S -
Oligodendrocytes derived from Neural Tube
S Renal agenesis result from -Failure of ureteric bud to reach metanephric mesoderm
(Langman)
S Two kideny with two ureter and pelvis Result from - Early division of ureteric bud
(Langman)
S Hepatocyte Derived from - Endoderm
S Kuffer Ceil Derived from - Mesoderm

^S —
Transitional epithelium bladder derived from Endoderm

—
Adrenil Medulla Derived from Neural crest cell

^ -
Adrenal Cortex Derived from Mesoderm

Ulcer
v'' Curling ulcer by - Inhalation bum
S Cushing Ulcer by - Brain injury (Raised ICP)
S Marjolin Ulcer by - External Bum (Squamous cell carcinoma of Skin)
Mortorells Ulcer by - Hypertension
S Most Common location of Duodenal Ulcer - 1st part of Duodenum
S Perforation of posterior wall of duodenum Bleed by - Gastro duodenal artery
S -
Most common location of gastric ulcer near Incisura angular is on Leisure curvature .
S Perforation of lesser curvature Bleed by - Left gastric artery
S Perforation of posterior wall of stomach Bleed by - Splenic artery

Micturition / Defecation

^SInitiation of Micturition reflex - Stretch receptors in bladder wall

Micturition centre (stimulatory) - Pons
S Micturition centre (Inhibitory) - Midbrain
Processing of micturition - Cerebral cortex
S Micturition reflex / integration - Sacral segments of spinal cord
S Voluntarily Inhibition -Activation of Pudendal nerve
 - -
SK Original Golden 12 (All Feb t June - 2021) , 403

S
S
—
Pain and filling sensations of bladder are carried by Sympathetic (Guyton)
Defecation is initiated by - Mass Movement
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Defecation is Carried out by Sacral Parasympathetic
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S Defecation Reflex - RectoAnal
Defecation Reflex in Baby - Gastrocolic
s Bulbar Urethra Rupture (Below Urogenital Diaphragm) urine into Superficial Perineal
-
\
Pouch
S Membranous Urethra Rupture(At Urogenital Diaphram) urine into
Pouch
- Deep Perineal
S Prostatic Urethra Rupture(Above Urogenital Diaphram) urine into
- Retropubic Space
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S Penile Urethra Rupture Urine into Scrotum> Anterior Abdominal Wall

S Injury above Sacral Segment Cause

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Injury at Sacral Segment Cause
• Atonic Bladder
• Autonomous Bladder
9 Overflow Incontinence
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Note: Neurogenic is common term for both spastic and Atonic Bladder.
ii

Aids / HIV
S Initial Test - ELISA
Confirmatory Test - Western Blot
I
\ In children Confirmatory - PCR
t
S Hall mark of HTV - Proliferation of Virus in T Cell
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S Hall mark of AIDS - Progressive Immunodeficiency
(Decrease CD 4 Count)
S Most common opportunistic infection in HIV is
- TB
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^ Most common opportunistic infection in - AIDS Pneumocystic
Follow up is done by - CD4 Count
Jiroveci

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^ Progression from asymptomatic to Symptomatic stage can be assessed by - PCR
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i GIT
i Pancreatic Secretion Increased by — CCK (First Aid)
-
S HC03 secretion Increased by Secretin

—
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i CCK increase Calcium by - IP3 mechanism
Gastric Motility Increased by Gastrin
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Gastric Motility Decreased by - Somatostatin
 -
; : SK - Original Golden 12 (All Feb 4 June - 2021) 404

—
S Increase Salivary Flow Cranial Nerve 7 > 9
S Increase Small intestine Motility and Decrease Gastric motility - CCK
X
S Fundus removed •l Gastric compliance » Receptive relaxation
=
=
S Antrum removed i Gastric acid production
S Pylorus removed Solids pass easily
S Intrinsic factor released by - Fundus of Stomach
S Colostomy Result in - Secretory Diarrhea • *

Jejunostomy Result in - Osmotic Diarrhea

V' Hleostomy Result in - Osmotic Diarrhea

^ Jejunostomy 4 illeostomy Result in - Secretory 4 Osmotic Diarrhea

S Iron and Calcium absorption - Duodenum
S -
Max water 4 electrolytes absorption Jejunum
S Passive (Aldosterone independent) water absorption - Jejunum
S Absorption of LONG chain FA - Jejunum
S Vitamin B12 and Bile Salts Absorption - Terminal ileum
S For B12 Absorption Needed - Intrinsic Factor
J -
For B12 Transport Needed Transcobalamin 2
S Absorption of SHORT chain FA - COLON
S Active (Aldosterone Dependent) water absorption - Colon
S
S
—
Max Fluid loss Colon
Part of Gut removed that cause Fluid loss - Ilium
S —
Ilium Resection Increase water content of feces > Decrease Bile salt
absorption

Explanation: Though Max absorption occur in jejunum but Fluid loss will
always from Colon and
is remove d no Fluid loss will
part of Gut remove which cause Fluid loss is ilium as when Jejunum
then Colon will be over
occur because ilium will Start absorbing Fluid but when ilium removed
loaded so ilium Removal will cause fluid loss through Colon (Bailey and Love
).

S Carcinoid syndrome
bronchi
— Most common site is small intestine (ileum) > lungs, Trachea and

S Most common tumor of appendix - Carcinoid Syndrome

^S Most common site of Carcinoid syndrome overall GIT > Respiratory system
Sympathetic is always - Adrenergic
S Sympathetic is Cholinergic only in - Sweat glands
4 Decreased GIT
S Sympathetic is for Fight and Flight (Pupillary dilation 4 Bronchodilation
• Motility)
of stomach 4
V' Parasympathetic effect on GIT - Relaxation of fundus 4- Contraction of body
Relaxation of sphincter 4 Increased GIT motility
J Posterior Duodenal Wall and Pancreatic Rupture Fluid Leaks into
• Lesser Sac
S Anterior Duodenal Wall Rupture Fluid Leaks into
iii:
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SK Original Golden 12 ( All Feb + June - 2021)
as
405
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i e Right Posterior Subphrenic Space (Supine)
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l5 Right Paracolic Gutter > RIF (Erect)
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I Thyroid
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i S Maximum concentration of thyroid hormone - T4
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S Thyroid harmone Enter in Circulation T4
S Thyroid harmone cause fetal Brain development - T3
—
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Active form of thyroid hormone T3 (Free form or Unbound is Active)
Thyroid gland is enclosed by - Pretracheal fascia
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S Metabolism of TSH in liver Demethylation
l S Metabolism of Thyroid Harmones In Liver De -iodination-
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—
S Dyspnea on lying down Retrosternal Goiter
Superior Thyroid artery Related to ELN —
1 S Inferior Thyroid atery Related to RLN -
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S Most Common Nerve injured during Thyroidectomy ELN
—
Superior Laryngeal Artery Related to Internal Laryngeal Nerve

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Most Common Nerve injured during Tracheostomy - RLN

Isthmus
—
Most Common Cause of Bleed During Tracheostomy Inferior Thyroid Vein
—
Most Common Cause of Heavy Bleed During Tracheostomy Anterior Jugular vein>
;
%
S During Tonsillectomy Bleed due to - Tonsilar arterty , Palatine vein and ascending
%
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Pharyngeal Artery
| Buffer
|
t S Major blood / Extracellular / Interstitium / Plasma Buffer - Bicarbonate
I
si S Major RBCs buffer - Hemoglobin
: Major Intracellular Buffer - Proteins
i

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S Major Renal Buffer Phosphate
S Exclusive Renal tubular buffer -Ammonia
Major Urinary Buffer (Quantitatively) - Ammonium
Major Bone Buffer - Calcium Carbonate
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i Malignancy
Microscopic feature of malignant tumor:
Metastasis > Invasion of adjacent tissues > pleomorphism > increascad N/ C ratio

\
—
Grading Nuclear differentiation / degree of differentiation /
Staging - Extent of spread / Lymph nodes involvement
Mitosis

it ^ Pre-malignant lesion - Pleomorphism Diagnostic

i ^ Pre-malignant condition - Increased N / C ratio Diagnostic
i
^ Most Common Pre-malignant lesion - Leukoplakia <
 SK - Original Golden - 12 (All Feb + June % 2021) 406

S Most Lethal Pre-malignant lesion - Erythroplakia

S Most Common Pre-malignant Condition - Submucosal Fibrosis
Most LethaLPre-malignant Condition - Lichen Planus
-
S Locally Malignant BCO Ambleoblastoma
S Most common skin CA - BCC (nodular type )
S Most common site of BCC is - Upper lip
Most common after Basal CA - Squamous CA
^ Most common site of SCC - Lower lip
S Pre-malignant lesion which must be excised - Actinic keratosis (on cheeks)
S Blue cell tumor in children + releasing catecholamine + gene Amplification -
Neuroblastoma
S Most Aggressive CA- Melanoma
^ Most Common Navcus In Children - Junctional
S Most Common Naveus In Adult is - Intradermal
Highest Malignant Potential - Dysplastic Naveus
S Male age Less than 40 - Seminoma
v Male age more than 50 + increased LDH - Lymphoma
S Tumor containing mature cells - Teratoma
—
S AFP raised + Schiller Duval Bodies Yolk Sac Tumor
^ Call Exner Bodies - Granulosa Cell Tumor

^ Giant cell tumor (Soap bubble appearance) - Epiphysis

v Osteosarcoma (Codman triangle sunburst appearance) + Osteochondroma (most
common benign) - Metaphysis
Ewing sarcoma (onion skin) - Diaphysis
S Osteoblastoma occurs in - Vertebrae
Osteoid osteoma - Cortex of long bones + Has radiolucent osteoid core
^ -
^S Radio Resistant Phase - S Phase
Radio sensitive Phase - G2 M Phase (M> G2)

S Chenso Sensitive - S Phase

Angiosarcoma in Plastic Factory Worker — Vinyl chloride
^S Angiosarcoma in Farmer - Arsenic
Plastic Factory Worker - Liver Angiosarcoma
^S Plastic Factory worker + Smoking - Lung CA > Angiosarcoma
—
S Hydrocarbon(Tyre Factory) +Aromatic Amines Bladder CA
S Smoking + Hydrocarbon - Lung CA > Bladder
—
S Liver CA Acohol >Aflatoxin > Smoking
 - - -
SK Original Golden 12 (AU Feb + June 2021) 407

—
S Transitional Bladder CA Smoking >Amines > Hydrocarbon
S Squamous Cell Bladder CA - Schistostoma >Stones > Indwelling Catheter
S Acute Effect of Radiotherapy - Desquamation

——
S Chronic Effect of Radiotherapy Endarteritis Obliterans
;
^ Late Effect of Radiotherapy Lymphoproliferative Disorder

^ Common method to detect Tumor - Tumor marker

i; ^ Common method to detect Tumor cells - Peripheral smear
I
Regarding sensitivity to radiotherapy:
P
8 Lymph node tumor > Seminoma > Glioma > Craniopharyngioma
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S Least Radio Sensitive Blood Cell - Platlets
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S Least Radio Sensitive Organ Vagina
Most Radio Sensitive Mucosa - Intestinal
8 Radiation induced Brain malignancy - Meningioma
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^ Overall radiation induced CA - Leukemia
Chemotherapy caused cell death - Apoptosis
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Chemotherapy induced vomiting is treated by - Ondansetron
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Alteration in proto oncogene
Have / By Using - Oncogene
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1; TB
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! S Definitive - Sputum Culture(Harrison)
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Diagnostic - PCR > AFB ;
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Histological - Epitheliod Cells with Caseating granuloma
^ Type of Hyper Sensitivity - Delayed Type 4 T Cell Mediated
1 S Margins - Undermined

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^ Antibodies Cell Bound

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 - - -
SK Original Golden 12 (Ail Feb + June 2021) 408

Energy
S Garbs / Protien Give - 4kcal
S Fats Give - 9kcal
S Alcohol Give - 7kcal

——
S Carbs Required 50 60% -
/ Fats Required 25 - 35%
S
v'
—
Protiens Required 10 20% -
Major source of energy - Adipose Tissue
S Max glycogen - Skeletal Muscles
S Max glycogen concentration / per 100 gms - liver.
S Highest energy compound - ATP
S Highest energy molecule - ATP
S Highest energy content - Starch
S Highest Quantity of Unsaturated Fatty Acid - Sun Flower
id - Soya Bean

In Fasting:
© Upto 48hours - Glucose
© From 48 hours till 72 hours - Fatty acids /TGs
« After 72 hours - Proteins / amino acids

Prostate
S Median-Structurally largest lobe
Lateral-Anatomically largest lobe
S Peripheral -Largest zone
S CA prostate - Peripheral zone / Posterior lobe + Metastasize to Vertebral column and
brain by Anterior Intervertebral venous plexus
S BPH - Median lobe / Transitional zone

Hepatitis
S Orofccal Route - Hep A > Hep E
S Most lethal Hepatitis - Hep D
S Most common in pregnancy Hep A -
S Most lethal / Remote Area in pregnancy - Hep E
-
S Most Common virus after blood transfusion Hep B > Hep C
^
S Most common sexual spread Hep B
V HCC - Hep B > Hep C
— —
Most lethal after transfusion and transplant CMV

-
v' Cirrhosis Hep C > Hep B
 SK - Original Golden - 12 (All Feb + June - 2021) 409

/ Needle Stick injury Risk - Hep B (30%) > C(3%) > HIV(0.3%)
-
Hep A & E Naked Viruses

Pelvis
S Finger couldn' t reach sacral promontory - Android pelvis
S If Finger reaches Sacral promontory - Contracted Pelvis
S Pelvis in males - Android (Heart shaped )
S Pelvis is females - Gynecoid (Rounded shape)
S Most favourable pelvis for delivery - Gynecoid pelvis
s S
| Reference point for head during labour - Ischial spine
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S In CN3 palsy pupils dilation occurs 4 Ptosis *

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S In Homor syndrome Damage to cervical Sympathetic chain + pupil constriction + Ptosis

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S In CN 4 palsy Vertical Diplopia ( Superior oblique )

——
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S In CN 6 palsy Horizontal Diplopia ( lateral rectus )
s
\ In CN3 palsy both Vertical and Horizontal Diplopia
!
%
I HB / Anemias
I

——
!
\ Hemoglobin synthesis starts in Proerythroblast or Early Normoblast
I Hemoglobin First appears in Intermediate Normoblast
i
S
—
RBC Nuclei disappear in Late Normoblast > Reticulocytes
— —
I

^S Max Production Late Normoblast

Maximum concentration Reticulocytes
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S
—
Iron Transport form Transferrin
Iron Excess storage form ~ Hemosiderin
Iron Normal Storgae Form — Ferritin
^S —
Iron Fe24- in reduced form binds to Hemoglobin
— —
Heme binds with Hemopexin

—
I Hemoglobin binds with Haptoglobin
r S Iron is absorberd from Duodenum
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Diagnostic for IPA Serum Ferritin
——
Diagnostic For B12 Deficiency B12 Assay
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^ Diagnostic For Folate Deficiency RBC Folate Level
\
—
Diagnostic For Pernicious Anemia Anti Intrinsic Factor Antibodies

\
— —
Diagnostic feature of Aplastic anemia Fatty marrow > Pancytopenia
Acute Intravascular Hemolysis Decrease Hepatoglobin > Reticulocytozla
I

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 SK - Original Golden'- 12 (All Feb + June - 2021) 410

S Chronic Intravascular Hemolysis

— Hemosidrinuria >Hemoglobinuria

Defense Lines
S Tissue
—Macrophages
Blood - Neutrophils
S Surface - Skin
S
S
——
Major scavengers Macrophages
Phagocytosis done by Neutrophils
S
S
Opsonization C3b
— —
Most potent Chemo tactic Factor LTB4 > C5a
S
S
—
Pain Bradykinin > Prostaglandins E2
IL-1 and TNF - Fever mediator
S
S
—
Prostaglandins F2, E2 and D2 Vasodilation
Late mediator of Inflammation - PG Sc Leukotriens
S
—
Initial mediator of inflammation Histamine

Lesions
S Dopamine loss in Substantia nigra and Striatum -- Parkinson Disease
S
S
—
GABA loss in Caudate Nucleus Chorea
—
GABA loss in Substantia Nigra and Globus Pallidus Huntington Disease

S
S
——
GABA loss in Globus Pallidus Athetosis
GABA loss in Subthalamic Nuclei Hemiballismus

Embolism / DVT

^S Most common source of emboli - femoral vein

Most common site of DVT -Popliteal vein
—
S Most common cause Immobilization
—
D dimers Sensitive for DVT
S FDP - Specific for DVT

Neural
r
Tube Defect (NTD)

——
S AFP raised in Anencephaly
v AFP Decreased in Down syndrome
v Specific For NTD — Acetyl cholinesterase

^ Senstive For NTD AFP

—
NTD in early Pregnancy Diagnose — USG
^ NTD in Late Pregnancy Diagnose — Amniocentesis
%
 —
SK - Original Golden 12 ( All Feb 4 June
-
- 2021) 411

—
S Neural tube defects most common is Meningo-myelocele
S Neural tube defects occur due to - Folic acid Deficiency and vitamin A toxicity
!
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J. Collagen / Wound
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^ Type 1 Collagen - Fibrocartilage + bone - tendons fascia + Skin

4 4
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^ Type — Blood vessels - Uterus Reticulin Skin
Type 2 Elastic and Hyaline cartilage - vitreous body
^ Type 43 — Basement 4 4-
4
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Early wound healing - Granulation tissue Type 3 collagen
wound healing - Wound strength Type 1 collagen
4 ~
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—Ear pinna
Hyaline cartilage Larynx - articular surfaces of Synovial joints + Trachea
4
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cartilage
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* Sesamoid bone - Patella
i *
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^ Diet —
Deficient in fruits and vegetables Decreased tensile strength
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^ Vitamin C Hydroxyla
Diet having Complete
—
absence of fruits
—
and vegetables Decreased collagen synthesis. .
tion of glycine and proline residues
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^ Systemic —
LOCAL factor for delayed wound healing Infection
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factor for delayed wound healing Anemia DM &
Old age Decreased wound healing ~ Harmonal and endocrinological changes
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= Coagulation Disorder
|

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^v —
Factor V deficiency leads Bleeding
—
Factor V mutation(Laden ) leads to Thrombosis

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Factor 12 deficiency leads Thrombosis .
v
—
Most common acquired thrombotic disorder is Anti-phospholipid syndrome
i S Most common Inherited coagulopathy VWBD
—
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Natural anticoagulant and anti thrombotic -- Heparin

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Natural thrombolytic Plasminogen
Extrinsic and intrinsic pathway converge on ~ Stuart factor (Factor 10)
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Factor 8 is produced by Endothelium
Clotting factor not completely synthesized in liver is — Factor 8
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Activation of Intrinsic Pathway by Facto r!2
Vitamin k dependent factor with Shortest half-life is Factor 7
—
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 m- Original Golden -12 (All Feb + June - 2021) 412

—
S Vitamin k dependent factor having Longest half -life is Factor 2
S APTT raised only ~ Hemophilia(Intrinsic Pathway)

^ APTT and BT raised - VWBD (Intrinsic Pathway)

— ——
v APTT and PT raised Vit-K deficiency or liver disease
S All 3 raised DIC
S Only BT raised ITP (Low Platlets) or Platelets Function Defect (Platlets count
normal)
S
S
——
Heparin Inhibit factor Xa
Heparin Act by Anti-thrombin 3
S
S
—
Antidote of heparin is Protamine sulphate
—
Heparin monitoring is done by APTT (Intrinsic Pathway)
S Heparin is given -- IV
S
S
—
—
Warfarin acts on and inhibits Vitamin K Epoxide reductase
Warfarin antidote is FFP (Immediate )
v
S
— —
Warfarin action is reversed by Vitamin k (long acting )
Warfarin monitoring is INR > PT(Extrinsic Pathway)
v Warfarin in given — Orally

End Arteries
S Functional End Arteries Heart
— —
S Anatomical / True End Arteries Retinal Artery

—
S END arteries are present in Central Retinal Artery » Spleen » Heart

Neonates
S
S
—
C shaped Vertebral column
Has Circular thoracic cavity
S '
Liver has 5% of body weight (largest organ)
S Sample taken from Radial Artery > posterior tibial artery > Dorsalis
S Blood volume is 85ml / kg

Myasthenia Gravis
S Myasthenia gravis ~ Antibodies’ against postsynaptic voltage gated cannels
--
S Diagnostic test ACH receptor antibodies
S Most accurate/ confirmatory/ gold standard EMG
—
S Initial drug for Myasthenia gravis Neostigmine
—
— —
S DOC For maintained therapy Pyridostigmine
S Physostigmine Crosses BBB immediately and Increase Acetylcholine
f:
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- -
SK Original Golden 12 (All Feb + June - 2021) 413

£
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S In Lambert eaten Syndrome Antibodies are directed against Calcium channels
\
1 Exercise

—
ii
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= S During Exercise blood flow increased to Exercising skeletal muscle
1
v'' During Exercise decreased blood flow to ~ Kidneys > Splanchnic Vessels
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S During Strenous Exercise decreased blood flow to Skin
— —
During Exercise blood flow to Exercising muscles is maintained by Local Metabolites
\
5-
Cholinergic (Guyton)
—
S During Exercise blood flow to Non-Exercising Muscle is maintained by Sympathetic

—
\
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v During Exercise there is an increase in Ventricular contractility
—
S During Exercise subjective feelings of getting tired is due to Increased Heart rate
After Exercise feeling of getting tired is due to - Increased Lactic acid

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si
Pregnancy
l
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t Respiratory Changes
!: Remain Same
! Respiratory rate
t
i V Vital Capacity
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Increase
S Tidal volume
S Minute ventilation
V S Inspiratory Capacity
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l Decrease
i S TLC
l S Residual Volume
S
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Other Changes
::
{ S Increase GFR - Decrease BUN and
V

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i
Increase Cardiac output
!: S Dilutional Anemia
::

:
Hyper coagubility
li
S Increase Lipolysis
:
HCG maintain Pregnancy upto 8-10 Weeks
1
l After 10 weeks by Estriol and Progesterone of Placenta
^
——
HCG In blood UptolO days
S . HCG In Urine After 10 days

: ^ Labour Initiated by Fetal Cortisol > Fetal ACTH (Pituitary)

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 % SK - Original Golden ^ 12 (All Feb + June - 2021|
) 414

CVS
S R ventricle Pressure during Systole 25 —
S R ventricle Pressure duriiig Diastole - 0-8

—
——
S Max Aortic Pressure Reduced Ejection
S Min Aortic Pressure Isovolumetric Contraction
—
R ventricle Pressure at which Pulmonary Valve Open 8mmhg
S L ventricle Pressure at which Aortic Valve Open 80mmhg

—
S Max Ventricular Pressure Rapid Ejection
-
S Min Ventricular Pressure - Rapid Filling
—
S Max Ventricle Filled Atrial Systole
-
S Max Ventricle Filling Rapid Filling
—
S Max Pulse Pressure Dorsalis pedis > Femoral > Popliteal > Aorta
Highest Systolic Presuure - Renal Artery
S Max 02 - Pulmonary Capillaries
S
S
—
Low 02 Pulmonary Artery >SVC > Umbilical artery
—
Highest 02 Saturation Umbilical Vein
S Cardiac output unchanged in - Sleep
S Pace Maker activity of SA Node due to - Sodium Chanells
S
S
—
Action Potential of Pace Maker due to Calcium Chanells
Action Potential of Cardiac Muscle due to - Sodium Chanells
S
—
Becks Triad (Cardiac temponade) Muffled Heart sounds Hypotension and Raised
JVP
S
S
— —
Rustling Sound / Pericardial Rub Pericarditis
Pain unrelated to Respiration Myocarditis
S
—
SA node located in Upper one third Sulcus terminals
S
S
——
SA n6de located in Sub Epicardium
AV node located in Endocardium
/
—
Conducting System Sub Endocardium

Heart rate and location of pacemaker:

—— --
• -SA node 60 80
• -AV node 40 60
• -Purkinje fibers -20-40
—
S SA node Slowest pre-potential / Works as syncytium as it is able to generate impulses at
a faster rate
S Purkinje Fibers have highest speed of conduction due to
-Wide diameter > large no of gap junctions > Large no of sodium Channel >Less no of
myofibril > Short refractory period
S Speed of conduction :
-Purkinje fibers > Bundle of His > Atria > Ventricles > SA node> AV node
 SK - Original Golden - 12 (All Feb + June - 2021) WJ
S Speed of Rate
-SA Node > AV Node > Purkinji fibers
——
S First Heart Sound Isovolumetric contraction (Closure of mitral and tricuspid valve)
S Second Heart Sound Isovolumetric relaxation (Closure of aortic and Pulmonary valve)
S Third Heart Sound ~ Rapid ventricular filling (Normal in children, pregnancy and athletes)
-
S Fourth heart sound Atrial Systole
—
S Inferior wall MI (RCA) Leads 2, 3 and AVF

^
Anterior wall MI (LAD ) Leads V1-V6
—
Lateral wall MI ( LCX ) ~ Leads 1 , AVL , V5 and V6
^ Best Initial - ECG
*
S Investigation of choice in First 6 h - ECG
S l-2hr - Myoglobin

|
^ Within 4hr - CK MB
S After 4hr - Trop
| . —
S Sensitive Trop T
I
% ^ ——
Specific Trop I
S 4h Post M3 Arrhythmia
i S 4-24h Post MI - Arrhythmia
II
-
1-3 Days Post MI Fibrinous Pericarditis
!
- -
—
4-7 Days Post MI Cardiac Temponade
I
?
i
S Month Post MI Aneurysm

I
Most Common Congenital / Acyanotic Disorder Child VSD
V Most Common Acyanotic Disorder in Adults - ASD
S Most common Congenital Cyanotic Disorder - TOF
—
——
t'
Most Congenital Cyanotic anomaly at birth TGA
l S Female living at Hill or if baby is premature PDA
Cyanotic Heart Disease in Which Shunt in Necessary for Survival TGA

——
S Preload determine by EDV (Depends on Venous return)
—
S After load determine by MAP

f
—
S TPR determine by Diastolic BP

ECG
I

I
——
S Hypokalemia U wave + inverted T Waves
S Hyperkalemia Tall T Waves

^ Normal ECG is imable to record - Electrical activity of SA node

—
i
f S ECG changes can be seen in the following conditions Except Sleep

1
t
—
S Saw tooth appearance on ECG Atrial flutter

—
S P wave absent + Irregular RR Interval in Atrial fibrillation

^
——
QRS complex shows Ventricle Depolarization
ST Segment shows Complete Ventricular Depolarization / Plateau phase
 —
SK - Original Golden 12 (All Feb + June V 2021) 416

——
S Isoelectric line PR segment
S Isoelectric period ST segment
—
S TP segment Relaxation of Ventricles
S Hypoglycemia increase -- QT interval
—
S Most specific finding of Pericarditis PR depression
S Time taken by the impulse to travel from Endocardium to Epicardium QRS Complex —
/ Time taken by the impulse to travel from Epicardium to Endocardium QT Interval —
—
S Absent p waves Pacemaker In AV node(Also R Ventricle-Moderator Band)
—
S PR Segment on ECG coincides with A wave of JVP
—
S Large A wave Tricuspid Stenosis
S Cannon A wave - 3rd Degree Heart Block Sc AV dissociation
S Tall QRS complex -- Hypertrophy of Ventricles
—
Low voltage QRS complex Obesity, Old MI , COPD Sc Constrictive pericarditis
—
S P-Mitrale occurs in Mitral stenosis

Endocrinology
S Immediate action of Insulin — Entry of potassium into cells
S
'
—
Intermediate Action of Insulin Protien Synthesis
S —
Late Action of Insulin Lipogenesis
S —
Action of insulin at Cellular level is Entry of glucose into cells
S —
Insulin Independent Glucose uptake Exercising Skeletal Muscle > Brain (Guyton)
^ —
Anti Ketotic Insulin
S Ketogenic - Glucagon 1
Hypoglycemia increases:
-Glucagon > Gastrin > Secretin (Ganong)
GH is increased in:

-Hypoglycemia > Exercise > NREM (Guyton + Ganong)

S
S
—
Potent stimulant of Aldosterone Hyperkalemia & Hyponatremia
Potent stimulant of Renin - Sympathetic > Hyponatremia > Hypokalemia
S
S
—
Potent Stimulant For ADH Nausea > Increase Plama Osmolarity
Renin is Inhibited by - Increased Angiotensin 2
Thirst center is stimulated by - Angiotensin 2
Renin Increase by Hypokalemia and Decrease by Hyperkalemia (Ganong)
S —
Angiotensin 2 cause Vasoconstriction > Thirst Stimulation (Ganong)
S
S
—
Cortisol main function Gluconeogenesis
Glucagon main function — Glycogenolysis
S Cortisol Increase Neutrophil and Decrease Lymphocytes
 - -
SR Original Golden 12 (M Feb -t June - 2021) 417

i S ACTH effectively control

(Guyton)
'
—
Cortisol (Hydrocortisone) > Androgens

—
—-
i S Excessive Exercise causes Hyperkalemia
f
Early Pregnancy Endometrium Sensitive to Progesterone
I
\
\
?
S Late Pregnancy Endometrium Sensitive to Oxytocin -
i S In Pregnancy Lactation inhibited by Estrogen + Progesterone > Estrogen
i
>Progesterone
I During Lactation Amenorrhea due to -Increase Prolactin > Decrease GnRH
^S —
Milk Production Prolactin
—
i •
!
I Milk Ejaculation Oxytocin

S
—-
In Pre-menopausal Breast Atrophy Decrease Estrogen +Progesterone
In Post-menopausal Breast Atrophy Decrease Estrogen
Most Common Cause of Breast Atrophy Decreased Estrogen -
\ S -
Most Potent Anabolic Testosterone
\
i
c
I
I
S
S
—
Potency DHT > Testosterone
-
Potency Estradiol > Estron > Estriol
i; S Increase Estriol - Indicates Fetal Well Being
5
i
\l S
——
Osteoporosis Thin and wide trabeculae + long term use of Steroid
Osteoclasts in Howhship lacunae
5
/
S
—
Osteoblast Bone making cells + Produce ALP + Laid Bone Matrix
Osteoclast - Bone Resorption . *

'
i
f
i
i S
—
Osteocytes Maintain Bone Matrix & Integrity
Demineralization of bone done by - PTH
i S
\ Bone Remineralization - Vit D
S Bone Remodeling Vit C —
^ PTH directly Regulates - Vitamin D levels
?

^S —
PTH Indirectly Regulates Calcium Absorption from intestine By Vitamin D
\

\
S —
Osteon Has Concentric lamellae
Patient has cast applied now has Decreased muscle mass
Decreased no of actin and myosin
—
Disuse atrophy +
9

—
I
I
\ Estrogen Function Breast Duct Development + Endometrial Proliferation
X
Progesterone Function — Maintain Endometrial Thickness (Proliferation) > Secretory

I phase > Alveoli and lobule development

Respiratory
!
Central Chemoreceptor Respond to (Sequence wise)
1
1-CSF PH or Interstitial PH (Increase H ions)
I
\ 2-Increase C02 In Arterial Blood
Peripheral Chemoreceptor (Carotid and Aortic body) Respond to
1-Decrease 02

!
I
 SK - Original Golden - 12 (All Feb + June - 2021) 418

2-Arterial PH (H ions)
S Increase A-a Gradient Seen in
1-Fibrosis
2-V/Q Defect
3-R-L Shunt
—
S A-a Gradient Normal Value 0 -lOmmhg
—
S A/a Ratio Normal 0.8 (> 0.75)
S In Airway Obstruction
1-V/Q is Less than Normal (Guyton) called R-L Shunt
2-Composition of Systemic arterial blood approaches Mixed Venous Blood
3-Increase A-a Gradient
S In Pulmonary Embolism
*1-V/ Q is Infinite Called Dead Space
2-Composition of Alveolar Air approaches Inspired Air
S At High Altitude
1-Survival due to - Increase Hb Concentration
2-Pulmonary Vasoconstriction (Due to Hypoxia)
3- Hb-02 Curve Shift to Right
4- Increase 2,3 DPG Concentration
V Exercise Increase
1-02 Consumption
2-C02 Production
/ Small Cell CA associated with
1-ACTH (Cushing Syndrome)
2-SIADH
3-Lambert Eaton
4-Poor Prognosis
S Squamous Cell CA Associated with
1-Smoking
2-Hypercalcemia (PTHrP)
3- Keratin Pearls and Intracellular Bridges
—
/ Chloride Shift occur by Band 3
S Venous Blood have more - HC03 & PCV(PCV >HC03)
—
V RBC Venous Blood Have more Chloride Ions
V Erythropoietin Produced By - Hypoxia
S Erythropoietin Inhibited By - Theophylline
S R Shift of 02 Curve - Bohar Effect
V L Shift of 02 Curve - Haldane Effect
*

—
S 02 100 Percent in L-R Shunt
—
S Pulmonary Blood flow and Ventilation Highest at Base
S Pulmonary Blood flow and Ventilation Lowest at - Apex
\ -
s . f

!s -
SK - Original Golden 12 (All Fob + June - 2021) . 419
'

s
I
SSL

fi

\
l V' V / Q and Arterial P02 Highest at Apex -
! S V / Q and Arterial P02 Lowest at - Base
i S Pulmonary Vasoconstriction Caused By - Hypoxia
\
! S Pulmonary Vasoconstriction Accentuated by — Increase C02
i
\
i
I
i
f
S
S
Asthma Most Imp Diagnosed By FEV1/FVC
In Fibrosis FEV1 / FVC Remain Normal
——
I
I In Asthma and COPD FEV1/ FVC - Decreased
i
S —
Lung GA Smoking > Radon > Asbestos
!
S
—
Asbestos Lung CA > Mesothelioma
I S
——
Primary Tb Ghone Complex + Lower Lobe

I 1
S
S
S
Secondary Tb Cavitation 4- Upper Lobe
——
Activated in Lung Angiotensin 2
Inactivated in Lung Bradykinin (By ACE) & Serotonin
s S Sarcoidosis Characteristic - Erythma Nodosum (Davidson)
I
!
S Sarcoidosis Diagnosed Histologically by - Non Caseating Granuloma(Robins)
|
1
S Hydrocorisone differ from Dexamethasone Because they Retain Na —
I
ii Renal

——
t
s
* S Dilute Urine(Decrease Osmolarity) Early DCT(Macula Densa ) > Thick Limb §

S Dilute Urine(Decrease Osmolarity) Thick Limb » DCT

I Note: Difference between Early DCT and Only DCT

S In Dehydraion (ADH) Concentrated Urine(Increase Osmolarity) -CD (Vasa Racta)

\
I
S
— —
Erythropoeitin secreted by Peritibular capillaries > Mesangial Cells
Kidney Podocytes At visceral layer of bowman capsule
\

I
1
S
S —
Cresents formed by parietal cells lining bowman capsule
GFR measure Clinically / Best Estimated - Creatinine clearance

——
s :i S GFR best Way to Measure Inulin
I S Best way to Measure RPF PAH
\
i
\
l
S
S — —
Best test for renal failure Creatinine clearance
Clearance PAH > K > Inulin >Urea > Sodium> Amino acid and Glucose

\
I
/
S
Concentrating urine in summer or during fasting ADH
—
Loop diuretics act on Thick ascending limb
—
—
'
i
t S Thiazide diuretics act on Early DCT
S Osmotic diuretics act on - PCT
S
—
Renal columns contain Interlobar Artery
5
/
S
—
Capsule Contain Interlobular Artery
Glomerulus Contain - Interlobular Artery
j S Hilum Contain - Segmental Artery
S —
Medullary rays contain Collecting ducts

l
'
^ —
Prone to Ischemia PCT

i
!
 ^ *

— - —
SK Original Golden 12 (All Feb + June ,2021) 420

S Maximum water & sodium absorption -- PCT

S Maximum water & sodium absorption with any hormone PCT —
S Maximum potassium absorption PCT —
/ Potassium loss due to dietary irregularities -- Distal tubules
—
S ADH Increase Urea transport to DCT
—
S ADH Inhibited by alcohol
—
S ADH Regulates plasma volume / urine osmolarity
S ADH --VI receptors cause vasoconstriction
S ADH — V2 receptors act on kidney
—
S Highest Tubular transport maximum Glucose > PAH > Lactate
—
S Threshold for Glucose 200 (Guyton)

S Sodium excretion ANP—

—
Sodium Absorption Aldosterone

S Net SODIUM Absorption ~ Aldosterone & ANP

S Renin ~ Produced by JG cells
—
S Renin Long term B.P regulation
——
S Baroreceptor respond maximally to Increasing BP (Ganong)
Most Rapid Response to Decrease BP Baroreceptor
S Most Potent Response to Decrease BP CNS Ischemic
S CNS Ischemic Activate at - 60 or Below 60mmHg (Guyton)
—
S Maintain During Shock — Baroreceptor
S Maintain as a Whole RAAS-
S Long Term BP Regulation - RAAS
S Over all most important RAAS -
—
S Sub-endothelial deposits SLE, Diffuse proliferated GN ,Membrane proliferated GN
S Sub Epithelial deposits - PSGN
S Intramembranous Deposits Diffuse Proliferated GN, Membrane Proliferated GN type2
—
Focal segmental Glomerulonephritis -- Massive Proteinuria
S Mild Hypomagnesemia Stimulate Parathyroid Hypercalcemia —
^ Severe Hypomagnesemia suppress Parathyroid Hypocalcaemia —
Hypermagnesemia Cause — Hypocalcaemia
Hypokalemia is associated with - Metabolic Alkalosis
S Hyperkalemia associated with -Metabolic Acidosis
—
S Hypokalemia Decrease Nerve Excitability In RMP
S Hyperkalemia - Increase Nerve Excitability In RMP
—
S Hyponatremia Decrease Hight of Action Potential
S Hypernatremia - Increase Hight of Action Potential
Hypocalcaemia — Increase Excitability
S Hypercalcemia - Decrease Excitability
i

\ / SK - Ofigiiial Golden - 12 (All Feb + June - 2021) 421

:

i
Micro
i
—
S Ascetic Tap E-coli

i
—
S Peritonitis E-coli
Pyogenic Peritonitis - Bacterioides
S Peurperal Sepsis - Group B streptococcus > E coli > Bacterioides
S Nasopharyngeal CA EBV -
{
t
i
S Oropharyngeal CA HPV
-
S LungCA CMV
—
!
Respiratory Symptoms Ascaris —
\
i
S Fisherman With Anemia + Echymosis Vitamic C deficiency —
S Fisherman With Anemia - B12 Deficiency - Diphyllobothrium
\
\ —
S Microcytic Anemia Ankylostoma
i; ^ Conjuctival Swelling - Loa Loa
^ Global Blindness - Cataract > Chlymydia > Glucoma
\
i
—
S Rectal Prolapse Trichuris Trichura
S Muscle (Myalgia) - Trichinella Spiralis
V

—
S Portal HTN Schistosoma Mansoni + Japonicum (Lateral Spine)
i
I —
S Pulmonary HTN Schistosoma Haematobium (Terminal Spine)
S Cholangiocarcinoma - Clonorchis Sinesis
—
Hydatid Cyst Echinococus

\
I
i
I
—
S Neurocysticercosis (Brain Cyst) Tenia Solium
i

«
;
Malaria
—
S Plasmodium malarie can lead to Nephrotic syndrome (Membranous GN)
—
S Plasmodium Vivax and ovale has Hypnozoite stage (means sleep)
S Primaquine is DOC to kill - Hypnozoites.
\
5. —
Shortest pre-erythrocytic phaseSs seen in Plasmodium Falciparum.
_
S —
Longest pre erythrocytic phase is in Plasmodium Malariae
S —
Species that cause relapse are Vivax and ovale
\ S Most common non falciparum malaria is Plasmodium Vivax . —
i
\
S DOC for non-faiciparum malaria is Chloroquine. —
S —
Malignant tertian malaria is caused by Plasmodium falciparum
S Benign tertian malaria (48 hours) is caused by Ovale / vivax —
i

\ —
Quartan malaria (72 hours ) caused by Plasmodium Malariae
\
—
Quotidian malaria caused by plasmodium Knowlesi > Falciparum

^ —
Anemia in malaria is Normocytic normochromic.
S Dormant phase of malaria Hypnozoite—
Malaria enter into human body as Sporozoite —
i
1
 - -
SK - Original Golden 12 (All Feb + June 2021) 422

S
S
—
Sporozoite divide in liver as Merozoite
New species of malaria is - Knowlesi
S
S
—
STD by Chlymydia > Gonorrhea > Syphlis
Tubuovarian mass - Gonorrhea
S —
Honeymoon Cystitis E. coli

Biochemistry
Vitamins

—
S B1 Deficiency Dry Beri beri„Wet Beri beri ,Wernicke korsakoff
Measured by Transketolase activity
—
S B2 Deficiency Corneal Vascularization
S B3 Deficiency - Pellagra (Diarrhea,, Dementia , Dermatitis)
—
S B5 Required Co factor for Co enzyme A

—
S B5 Deficiency Adrenal Insufficiency
S B7(Biotin) - Bind Avidin in egg and Carrier of One carbon
-
S B7 - Role in liver Metabolism
—
S B9(Folic acid) One Carbon Transfer
V B9 Deficiency NTD
——
S B12 Deficiency Megaloblastic Anemia

—
S Vit A deficiency Early Sign Night Blindness (Lippincott)
S Vit A Toxicity - Scaly Dermatitis > Jaundice,, NTD

—
S Optic Neuritis B12 > B 6
S Peripheral Neuritis - B1 > B6 > B12
S Carbohydrate Metabolism - Thiamine
S Protien Metabolism - Riboflavin

—
S Lipid Metabolism Biotin
Amino Acids
v' Ketogenic - Leucine and Lysine
V Postive charge
S Negtive Charge
—— HAL (Histidine, Arginine & Lysine)
Aspartate and Glutamate
/
J
—
DNA has Histidine
Amino Acid deficiency causes cell injury ~ Glycine
S
S —
Amino acid cause injury to cell Choline
Amino Acid causing renal stones - Lysine (COLA)
v'
—
Amino acid in abnormal metabolism Tryptophan
 SK Original Golden - 12 (All Feb + June - 2021) 423
i
i
i

\ Cell Cycle
t
ii
S INTERPHASE ....Chromosomes REPLICATE
5
/ INTERPHASE ....DNA REPLICATE
5
t S INTERPHASE....Barr Bodies are studied
I:
INTERPHASE is divided into...
1.G1
2.S (SYNTHESIS Phase)
3.G2
S 4.Mitosis (also called M phase & cytokinesis is a part of it)
S Gl...Primary Growth , Proteins, Organelles, mRNA Synthesis)
I
..
S Gl .Also Called growth phase
i S Gl... Longest phase (8 to 10 Hours)
!
I S Gl Check point..To check if DNA is damaged
S ....DNA Replicate
! ^
S S....Cytotoxic & cancer drugs act here to destroy DNA
)
i S S 5 to 6 hours

i S G2...Secondary growth ( between S phase & Mitosis)

S G2...Short ( 3 to 4 hours)
i
$
i;
S G 2 Check point.. . To check if DNA has replicated properly
MITOSIS / M Phase
S M...Shortest (2 hours)
S M... To see spindle assembly and alignment
S M...Nuclear content divide
f
S M...gene tic material is Chromosome (Genetic material is chromatid when NOT in M phase)
i
S M... Divided into Prophase, prometaphase, Metaphase, Anaphase, Telophase, Cytokinesis
I S Prophase....Spindle fibers appear Chromosome Condensation
1
l
S Prophase.. .Centriole start moving to the oposite end & chromosomes first appear
\ S Prometaphase ....Spindle fibers attach to chromosome & chromosome movement
\i S Prometaphase . ... Nuclear membrane dissolve marking the begining of prometaphase
!
;
S Metaphase...Chromosome Allignment at Equatorial Plate
S Metaphase Chromosome thickest
S Metaphase Chromosome begin to divide
I S Metaphase...Karyotyping
lt
t: S Anaphase . ... Division of chromatids & sister chromatids move to opposite side
S Anaphase . . ..NON Disjunction
:
i
.
Telophase.. Spindle fibers disappear & Decondensation of Chromosomes
i
:
S Telophase . ..Complete divison
S Telophase . ...Nuclear membrane formation
S Cytokinesis....Cytoplasm divide
.
S Barr Bodies. ..Heterochromatin
S Barr Bodies....Have X chromosome
S Barr Bodies....Seen under light microscope
\ S Barr Bodies....Absent in Turner
S Barr Bodies....Scanty In Turner
*7
S Barr Bodies....Diagnostic for Turner
\
}

I
 -
SK Original Golden -12 (All Feb + June - 2021) 424

One Barr body in Klinfelter:

S No. of Barr bodies in OX No Barr Bodies
S No. of Barr bodies in XX . . . 1 Barr Body
S No. of Barr bodies in XXX....2 Barr bodies
S Best Test for chromosomal abnormalities is Karyotyping
—-
S Cell to Cell Cadherin
S ECM TO ICM Intermediate Filament
-
S ECM to Cytoskeleton Integrin
—
S Leukocyte Adhesion to Endothelium ICAM (CD18 Subunit)

Organelles
S Detoxification of drugs - SER
v'' Detoxification of Alcohol in Toxic Dose - SER
S Detoxification of Alcohol in Normal Dose - Peroxisomes (Oxidase and H202)
S Lysosomes Contain - Hydrolytic enzyme
S SER Originate from ~ Peroxisome
S -
Lysosome Originate from Golgi Body
S —
Continue with Nuclear membrane RER
S Nissle Substance in -RER
Lydeg Cell Has - SER
v'' Mitochondria - Power house + self-replicating + Short chains Fatty acids Metaboli
sm
S Double membrane bounded organelles - Nucleus and Mitochondria
S -
Golgi bodies Packaging of cells
S Production of proteins - Ribosomes > RER
S —
Centrioles make Basal body (basal body makes cilia and flagella)
S —
Hypertrophy Increased in size (Increased DNA content)
S -
Hyperplasia Increased in number
S Hypertrophy and Hyperplasia both together - Uterus in Pregnancy

Cancer Marker

- —
S Cytokeratin Carcinoma (Epithelial)
S Vimentin Sarcoma (Mesenchymal)
-
S Desmin Muscle

Pharmacology
' DOC for T. Solium - Praziquental > Niclosamide > Albendazole
v
S -
DOC for C. Difficile Metronidazole > Vancomycin (Levinson)
S DOC for mild C. Difficile - Metronidazole (Levinson)
S DOC for Severe and resistant C.Difficile - Vancomycin (Levinson)
S DOC for Travller Diarrhea — Norfloxacin > Metronidazole
i
\ SK - Original Golden - 12 ( All Feb + June - 2021) 425
Ii; •
[ •

!i-

!
ll
'

S
S
—
l 8 t Line in AF
Beta Blockers (Davidson)
For Rate control in AF - Beta Blockers & Digoxin (Davidson)
\
\ S For Rhythm Control in AF with no Structural Heart Disease - Flecainide (Davidson)
\
!:
t

?
l
I
S For Rhythm Control in AF with IHD or Structural heart disease Amidarone
(Davidson)
—
% S DOC For Cardiogenic Shock - Dopamine & Dobutamine
i
S DOC for Hypotension Unrecordable BP ~ Dopamine
l
l
B:
S DOC for Anaphylactic Shock - Adrenaline (Epinephrine)
!i:
r
C
I
^ DOC for Pseudomonas - Ceftazidime -
—
S DOC for UTI by Pseudomonas Ciprofloxacin
!:
-
S DOC for OCD Clomipramine

! S DOC for SAH - Nimodipine

S DOC for acute Pancreatitis - Pethidine(Davidson) > Morphine
—
S DOC for Post-Surgery Analgesia in Asthma Patient Pethidine (Oxford Anasthesia
i:
Book)
S DOC for Post-Surgery Analgesia- Ketorolac > Pethidine
i
S Drug in morning Sickness -Pyridoxine
l S Drug in motion Sickness - Meclizine
S —
Drug in Mountain Sickness Acetazolamide
l S —
DOC for Meningitis Adults Ceftriaxone > Cefotaxime
l
S
S
—
DOC for Meningitis in Baby Pencillin G
DOC in endometriosis — Medroxy progesterone > Leuprolide > Danazole (Ten
Teacher) I

S DOC for Pregnancy induced HTN - Labetalol >Methyl dopa

!:
1;
i
' -
S DOC for Pregnancy Hypertensive Emergency Hydralazine > Labetalol
i
v
i
S DOC for Eclampsia MgS04 —
DOC in Uterine Atony -- Oxytoxin > Ergometrine (Ten Teacher)
l

\
S —
Anti-Thyroid in 1 st Trimester PTU
l
; •
Anti-Thyroid in 2nd & 3rd Trimester - MethimaZole
5 S Crosses Placenta and affect Fetus - Methimazole > PTU
I

I
S —
Don’t Cross Placenta Thyroxin
I S Elderly Diabetic - Tolbutamide
E
i S —
Obese Diabetic Metformin
I
I
:

^
^S
—
Non Obese Diabetic Sulfonylurea
Organophosphate poisoning Antidote - Pralidoxime
i Organophosphate poisoning Symptoms Reversal -Atropine
\
t -
Drug in Liver Decompensation used Lorazepam &Oxazepam
-
!
•

£
i
——
Drug in liver Disease Pre operatively Fentanyle
Drug Contraindicated in Liver Disease Pentazocin > Paracetamol
^
Hepatic Encephalopathy Progress ,by Diuretic Paracetamol
'
i
.
i
5
>
 SK - Original Golden - 12 (All Feb -1- June - 2021) 426

S NM Blocker in Asthma — Cisatracurium

—— —
/ NM Blocker in Liver disease Atracurium
S Pancuronium Eliminated by Kideny (80 percent)
S Rocuronium Eliminated by Liver (75-90 percent) & Kidney
S
v''
—
Diazepam Act through Intemeuron
Morphine Release - Histamine
S -
Terbutaline cause Fetal Hypoglycemia and Maternal Hyperglycemia
S -
Analgesic effect of TCA 1-2 weeks (Davidon)

S -
Safe Analgesic dose NO 25 ppm
—
Antidepressent effect of TCA 3-4 weeks

S -
Safe Analgesic dose NO In 8h 25 ppm
S
S
Safe Analgesic dose NO In 24h 100 ppm
—
Morphine Decrease Apnea Threshold
—
S Local Anasthesia cross Placenta by - Simple Diffusion
S Scrulfate doesn’t Let Cimetidine to absorb
S Cimetidine Decrease Scrulfate Metabolism
S More Local Anesthetic in Blood in - Intercostal Block
-
Delayed Respiratory Depression Morphine >Fentanyl
/ —
Therapeutic Index Determine Drug Safety
S
S
—
Potency Determine Dose
—
Benzodiazepine Cause Hypotension in Hypovoluniia > Old age
S Highly Selective COX2 - Celecoxib
S Highly Potent COX2 - Meloxicam
S Irreversible COX 1 & COX 2 inhibitor - Aspirin
S Reversible COX 1 & COX 2 inhibitor NSAID —
S
/ —
Cardiotoxic Bupivacaine
—
Low dose Aspirin inhibit TXA2

S Priaprism by - Trazodon
S Gingival Hyperplasia by - Phenytoin
S Pulmonary Fibrosis by - Methotrexate
S
S
—
Cardiomegaiay by Adriamycin
Kernicterus by - Sulphonamide
S Reversible Oligospermia by- Salfasalazine
S —
Indirect Hyperbilirubinemia by Methyldopa
S Orange urine by - Rifampicin
S Gout by - Pyrazinamide
S
S
—
Methmoglobenemia by Procain
Red Man Syndrome by - Vancomycin
S —
Grey Man Syndrome by Amidaron
S —
Gray Baby Syndrome by Chloramphenicol
I -
SK ~ Original Golden 12 (All Feb f June - 2021) 427
£
l
I
E
:
5
I
S Aluminum hydroxide (No receptor in
Body) cause
S Magnesium Hydroxide cause ~ Diarrhea
— Constipation
i
—
S Low estrogen OCP cause Hepatic Adenom
a
!:•

.i;
5
S High Estrogen OCP Prolong Long term use
CA
/ —
cause in post menopausal Endometrial
!
I
I
S Estrogen Containing OCP Increase risk of
S HRT (Mixed) cause - Breast CA(Robins
) > DVT
—
Thromboembolism(DVT)
I S Digoxin Toxicity increase by Hypokalemia & Alkalos
\
S Digoxin Toxicity Cause Hperkalemia
— is
-
S Thiazide cause - Hypokalemia >
Hyperglycemia > Hyperlipidemia > Hyper uricemia
% > Hyper calcemia
f
S
1
-
S Thrombocytopenia by Heparin > Quinidi
S Diazepam Side effect - Loss of Beat to beat
ne > Thiazide > Chloramphenicol
l Variability > Neonatal Hypotonia
\
I
S Thiopental - Action Terminated by Redistribution
in Tissue and fat(FA)
I
I
I
—
S Ketamine Increase HR and BP (Sympathomim
etic)
I
I
E
I Ketamine
: Profound Analgesia

! ^ Anasthetic in Asthma
S Cause Bronchodilation
»
S Raised ICP( Avoided in Head Injury)
Used in Bum Patient and Haemodynamically Unstable

i Halothane
S Increase Cerebral Blood Flow
1i
Cause Malignant Hyperthermia
S Cause Skeletal Muscle Contractions
i
\ S Dissociates on Light
l
\
|
\
i Bupivacaine
l
S First Sign of toxicity - Perioral paresth
l esia > Ringing in Ear
?
?
( -
S Intermediate Sign Hypotension

—
•

- ^ Late Sign of toxicity Arrhythmias

Serious Side effect Arrhythmia
b
\
ii Safe Dose 150mg I

5 S Rupivacain preferred over it because of Less

CNS toxic
r
I
i
i Neurology
i
1
i
 SK - Original Golden — 12 (All Feb + June
— 2021) 428

S CNS - Oligodendrocytes
S PNS - Schwann cells
S Repairing cells - Astrocytes '
S
S
——
Grey matter Protoplasmic astrocytes (overall abundant)
White matter Fibrous astrocytes (abundant astrocytes)
S Adult spinal cord -- Lower border of LI or upper border of L2

—— —
S Neonates spinal cord Upper border of L3
S Endoneurium Individual nerve fiber
perineurium Bundle of nerve fibers
S Epineurium — Entire Nerve
——
S Fasciculus Gracilis Lower limb Sensations
S Fasciculus Cuneatus Upper limb Sensations
—
S Loss of light Reflex but intact accommodation reflex Pretectal Nucleus (Midbrain at the
level of superior colliculus)
S Loss of Accommodation reflex - Cerebral cortex
—
S Loss of Accommodation Cerebral cortex
—
S Loss of Accommodation + 3rd CN involvement Midbrain (Due to Edinger westphal
nucleus)
S Comeal reflex lost Pons -
S Heating + Sympathetic effect - Post Hypothalmus
—
S Cooling + Parasympathetic Ant Hypothalmus

S FOLIA - Cerebellum Fold

*
—
S Overall temperature regulation Ant Hypothalmus (Preoptic Nucleus)

—— —
S HYPERACUSIS Geniculate ganglion (medial wall of middle Ear)
S Broca aphasia Motor aphasia 4- Non-fluent + area 44 and 45 + inferior frontal gyrus
S Wernicke aphasia Sensory aphasia + fluent + area 22 + superior temporal gyrus

——
S Global aphasia Both Wernicke and broca aphasia + arcuate fasciculus
S Anomic aphasia Mild fluent aphasia + failure of word retrieval + angular gyrus
—
Lesion in DCML(Post White Column) Sensory Ataxia > Asterognosia
S Loss of Proprioception lesion in — Posterior Column (DCML)

——
S Loss of Proprioception mechanism is Lateral Inhibition (Guyton)
S Reduced motivation and depression Frontal Lobe

—
S Resting Tremor Substansia Nigra
—
S Characteristic of cerebellum lesion Dysdiadochokinesia > Dysarthria

Intentional tremors - Cerebellum

S IJV after Coming out of Jugular foramen relation -ICA
-
S IJV With in jugular foramen relation Accessory Nerve

——
S Neostriatum Caudate + Putamen
S Corpus Striatum Caudate + Lentiform

^ —
Lentiform Putamen + Globus Pallidus

-
-
S Olfactory Cortex location Posterior inferior Temporal Lobe + Uncus
S Olfactory Area location Anterior Perforating Substance
—
S Fastest fibers A alpha
—
SFast pain fibers A delta i \
 SK gOriginal Golden 12 (AH Feb + June 2021)m
- - 429 1,
S
S ——
Slow pain fibers C fibers
Preganglionic fibers Beta fibers (True Autonomic)
S
S
—
Postganglionic fibers C fibers (Autonomic)
Pain From fingertip by - A delta
S
S
Proprioception from fingertip B fiber
—
Type A> B>C affected by Pressure
—
S Type B >A>C affected by Hypoxia
——
—
S Type C > B >A affected by Anesthesia
Itching Slow C fibers
S Itching Track - Anterior Spinothalmic Track
S
S —
Sleep Centre Preoptic nucleus
—
Circadian Rhythm Suprachiasmatic nucleus
S
S
Chorea (Jerky+ quick movements) caudate nucleus
—
Athetosis (slow 4- writhing) Globus pallidus
—
S
S
—
Hemi-ballismus Sub-thalamic nuleus lesion
Fusiform gyrus (Temporal Lobe) - Face Recognition (Unable to recognize face called
propognosia)
S Cingulate gyrus (Limbic System) Emotions -
S
S ——
Sexual centre Nucleus Acumbens
Hippocampus Short - term memory + recollection in long term memory (long term
| memory formed by new Protein synthesis)
I
S Large receptive field Pain And temp
?
f:
!
e
l-
\
S
S
—
Structure close to crus cerebri Substantia nigra
——
Medial leminiscus formed by decussation of Internal arcuate fibers
t S In UMN lesion fibers decussate at the level of Pyramid
.

4
1l
S
S Bleeding from mastoid antrum -- Sigmoid sinus
—
Cerebellum connected to Midbrain by Superior cerebellar peduncle

!
l
I
5
S
*
— —
Climbing Purkinje fibers originate from Inferior olivary nucleus ’

Sub-dural hematoma Emissary veins >superior cerebral veins + common in Alcoholics

and shaken babies 4- crescent shaped
S
—
Extradural Hematoma Middle meningela artery (branch of maxillary artery) + lucid
interval (unconsciousness ) + bioconvex shaped

\j
X

l
^ increase risk for hydrocephalus
—
Subarachnoid hemorrhage Rupture of saccular aneurysm 4- werst headache of life 4-

!
^ —
Spinal nerves Mixed nerves (both sensory and motor fibers) 4- formed in intervertebral
Foramina 4 exit intervertebral Foramina
—-
*

S Spinal ganglia Pseudounipolar neurons

^S
>
l Skeletal muscle Multipolar
l
l
l
i

l
S
— —
Olfactory Bipolar
Dorsal column fine touch 4- pressure + vibrations 4- proprioception
V
•

l
\
i
I.
1:
i
 SK - Original Golden 12 (All Feb + June - 2021) 430

S Meissner corpuscles
- —
Light Touch and Low Frequency Vibration Upto 40Hz &At fingertips
Paccinian corpuscle - High frequency Vibrations (40-400Hz) and Deep Touch

——
S Rapidly Adapting Pacinian > Meissner
S Ruffini nerve endings Deep static pressure
-
S Meckle nerve endings Position + Deep Static touch + Secrete Serotonin
—
Fine movements of hand Controlled by cerebellum and carried by Corticospinal tracts
—-
S Centre for direct autonomic reflexes Hypothalamus
S MCA (upper limbs + Aphsia ) Supplies Insula and Opercula

-
TABES DORSALIS Atonic bladder
—
S AC A ( lower limbs + aphasia ) Supplies Secondary Somasthetic Area

—
S Proximal muscle Flexion Rubrospinal tracts

— —
S Proximal muscle Extension Vestibulospinal tracts
S Inhibitory output in CNS Purkinje cells

—— —
S Ptosis + Mieosis Homer syndrome
S Ptosis H-Mydriasis 3rd Nerve palsy
S Ptosissis + normal pupil Myesthenia gravis
S Site of fusion of binocular vision ~ Visual cortex
^ —
S Day vision color Vision Cones
S Night vision + increased sensitivity to low light Rods
—
—
S Anterior layer of retina contains Retinal pigment epithelium

CSF
S CSF Density is 1.0005.
S CSF Specific Gravity is 1.005.
CSF PH is 7.33.
S CSF is isotonic with serum.
S CSF has Equal sodium as compared to plasma.
S CSF has High magnesium and chloride as compared to plasma.
S CSF has More Creatinine as compared to plasma.
S Rest everything is Low in CSF as compared to plasma (Protein more Low than glucose)
-
CSF is produced by Ependymal cells
—
S CSF Provides nutrition to CNS
S Arachnoid granulations are seen by naked eye
S Indicator for CSF Leak — Beta 2 Transferrin
S CSF Has Cushion like effect
Maximum determinant of CSF composition is Ependymal cells
-
S CSF Pressure 10-20 cm H20 or 60-150mm H20 or 6-15mixiliig
S CSF production - 20ml/h
-
S CSF production 450 -500 ml / day
—
S CSF in Ventricle 150ml
S Lateral ventricle to 3rd via Interventricular Foramina of Monro
v' 3rd to 4th via cerebral aqueduct ( blockage can cause hydrocephalus )
S 4th to Subarachnoid space via Foramen Magendie and Foramen Lus.chka
 - -
SK Original Golden 12 (All Feb + June - 2021) 431
!5
£
i
P
E
^S CSF made by choroid plexus (Ependymal cells ) in 4th and lateral ventricle
CSF absorbed by arachnoid granulations and then drains into Dural venous sinus
%
\
\

\
Lamina
I
!
I -
S Lamina 1-6 Dorsal (Posterior) Horn
£
—-
S Lamina8-9 Ventral (Anterior) Horn
V Lamina 7 &10 Intermediate Horn
——
S Lamina 1 High Threshold mechanoreceptor, Noxious stimulus & A delta pain
S Lamina .2 C fiber Pain & Substantia gelatinosa

——
S Lamina 3-4 Low Threshold mechanoreceptor
S Lamina 6 Deepest Layer, Joint skin Signal
—
S Lamina 7 Largest Area, Dorsal Nucleus of Clarke
S Lamina 10 - Central Canal
i

r. Medulla
I
i
f: Upper Medulla:
1 Vestibular cochlear
1 B Inferior olivary
t a Spinal trigeminal
S
Middle Medulla:
Ii: a Nucleus ambiguas
E
a Hypoglosal Nucleus
l
1i H Dorsal motor Nucleus Vagus
l
8
: Spinal Trigeminal .
!i Lower Medulla:
£ a Hypoglosal Nucleus
S H Dorsal Motor Nucleus Vagus
8 Spinal Trigeminal
i Anatomy
s
l
I
!:
i
I
—
Most Common Bone injured in Body Clavicle
S Most Common Long Bone Fracture in Body - Clavicle
l S Most Common Long Bone Fracture in Lower Limb Tibia -
\ i
l S
——
Most Common Carpal Bone Fracture Scaphoid (Radial Artery)
Most Common Dislocated Carpal Bone Lunate (Median Nerve - Carpal Tunnel)
1 S
S
—
Fracture of Hook of Hamate Ulnar Nerve Damage (Cuboidal Tunnel)
Anatomical Snuff box Pain - Radial Artery
i S Fracture of Surgical Neck of Humerus - Axillary Nerve Damage
v
s Fracture of medial epicondyle - Ulnar Nerve Damage
£
S Fracture of Shaft of Humerus - Radia Nerve Damage
i
S Wrist Drop - Radial Nerve Damage
*
t
i
t
i
\
1
 K - Original Golden - 12 (All Feb + June - 2021) 432

S Anterior Dislocation of Shoulder joint - Axillary Nerve Damage 8c Post Circumflex

artery Damage
—
S Quadrangular Space injury Axillary Nerve Damage 8c Post Circumflex artery Damage
S Small Muscle of Hand affected lesion in - C8-T1 > Ulnar+ Median > Tl > Ulnar
S Ulnar nerve damage at Elbow - Loss of Sensations in medial 1/ 3”* palmar and dorsal
aspect + Hypothenar wasting
^ —
Ulnar nerve damage at Wrist Claw Hand
—
S Median nerve damage at Elbow Hand of Benedict
—
S Median nerve damage at Wrist Carpal tunnel Syndrome (Thenar sensation lost >
wasting) . . • . « ;
•

S In median nerve damage - Opposition and abduction is not possible

S
S
—
Abduction of Arm upto 15 Degree Supraspinatus (Suprascapular Nerve)
Abduction of Arm upto 90 Degree - Deltoid (Axillary Nerve)
S —
Abduction of Arm Above 90 Trapezius (Spinal Accessory Nerve) 8c Serratous
Anterior (Long Thoracic Nerve)
S Scratching of Back - Lattismus Dorsi (Dorsal Thoracic Nerve)
S Chief Supinator of Hand - Bicep Brachi
S Total Claw Hand - Lumbricals Paralysed
S Tendon Courses through Shoulder Joint - Long Head Bicep
—
Head of Humerus Supplied by Arcuate > Anterior Circumfex artery
S —
Neck of Humerus Supplied by Posterior Circumflex artery
S
S
—
Most commonly dislocated bone in the lower limb is Patella
Most common neuropathy in the lower limb is - Compression of commca peroneal
nerve against neck of fibula
S —
Longest muscle in the body is Sartorius
S
S —
—
Thickest nerve in the body is Sciatic nerve
Largest bone of the body is Femur
S Largest & most complicated Joint in the body is - Knee joint
S Largest sesamoid bone in body is ~ Patella
S
S
—
Strongest ligament in the body is iliofemoral ligament
Strongest tendon in the body is ~ Tendocalcaneus
S
S
S —
Largest synovial cavity in the body is synovial cavity of the ~ Knee joint
Most commonly nerve used in the body for grafting is Sural nerve

S
S —
Most commonly used vein in body for grafting is ~ Great saphenous vein
Most commonly used muscle in the body for grafting is Plantaris & Palmaris longus

S
S
S
—
Locking muscle for knee is - Quadriceps Femoris
Unlocking muscle for knee is Popliteus
ACL injured - Anterior Dislocation of Tibia
PCL injured - Posterior Dislocation of Tibia
S ACL injured — Posterior Dislocation of Femur
S PCL injured - Anterior Dislocation of Femur
S Ankle Sprain(Inversion) Ligament Injured - Lateral ligament >Anterior Talofibular
S Excessive Eversion ligament Injured - Tibial Collateral (Medial)
b
$ K - Original Golden - 12 (All Feb > June - 2021) 433
1
i
§
S Saphenous nerve accompany Great saphenous vein
i
£ S Sural nerve accompany small saphenous vein
I
t
s y Deep peronea
l nerve accompany anterior tibial artery
i '
v Head of Femur Supplied by in Adults - Retinacular > Medial Circumflex artery
i S Head of Femur Supplied by in Child Obturato
-
r artery
i
'
i
—
—
S Neck of Femur Supplied by Medial &Lateral Circumf
S Foot Drop Common peroneal nerve Injured
lex artery •

I
S Left or right dominant supply of heart is determined
I (Descending) artery .
-
by - Posterior interventricular
\
| —
S Great Cardiac vein accompany Left ant . Descend
ing Artery
i
i
E
—
S Middle Cardiac vein accompany Post. Interventricular
S Small Cardiac vein accompany - Marginal artery
artery
l
i.
i
I
S Ant. Cardiac vein drains directly into RT. Atrium
S Left lobe - 5cm —
S Right Lobe - 2.5cm
s
!

!
I
I
^ Pain of pericarditis is carried by ~ Phrenic nerve—
Pain of angina from heart is carried by Sympathetic nerves

£
Fibrous Pericardium and Parietal layer of Serous Pericardium is supplied by
s
Phrenic nerve
i
I:
=
|
—
V Mediastinal Pleura Supplied by Phrenic Nerve
Visceral layer of serous pericardium is called Epicardium
V Right border of Heart formed by Right Atrium
!:i
i
i
--
S Right border of Heart formed on X-ray by SVC Right
- + Atrium > SVC
I
— —
Base of heart is formed by Left atrium
S Left border of Heart formed by Left Ventricl
e(Apex Beat)
V Anterior (Sternocostal) Surface formed by - Right
Ventricle
S Inferior (Diaphragmatic) Surface formed by
- Left Ventricle
—
Epicardium supplied by Coronary Artery
S Pericardium supplied by - Pericardiophrenic
*i artery
S Anterior 2 / 3rd IV Septum supplied by ~ LAD
(LCA)
V Posterior 1/ 3rd IV Septum supplied by
t - PDA (RCA)
! -
S Left Circumflex supply Left and Right
Xiphisternum Vertebrae level - T9
Ventricle
i; S IVC begin at ~ L5

i
(:
V True Ribs 1-7
—
S False Ribs - 8-10
— -
!
S Floating Ribs 11 12

—-—
Upper Esophagous Inferior Thyroid artery
\ v' Middle Eophagous Descending thoracic
s aorta
; Lower Esophagous Left Gastric
\
l
^ Azygous vein anterior to Right root of lung
S Aorta posterior to Left root lung
\l ^ Phrenic nerve anterior to Root of lung
S Vagus Nerve posterior to Root of
Lung
l y IVC Blocked
Above Azygous vein dilation in - Azygous vein > Left Gastric Vein

i;

i
 —
SK - Original Golden - 12 (All Feb + June 2021)| 434

S IVC Blocked Upto Azygous vein dilation in - Right Ascending Lumber vein & Right
Subcostal Vein
—
S IVC Blocked Below Azygous vein dilation in Ascending Lumber vein
S Muscle of Quite Inspiration - Diaphram and External Intercostal
—
V Muscle of Forced Inspiration SCM & Serratous Anterior
—
Quite Expiration Passive and by Elastic Recoil of Lung
—
S Muscle of Forced Expiration Internal Intercostal
S Accessory Muscle of Expiration - External Oblique

^ T8 - Caval Opening ~ Inferior Vena Cava and Right Phrenic Nerve , Extent of IVC = T8
to L5
S
S —
T10 Umbilicus , Esophageal Hiatus (Esophagus, Esophageal vessels, and Vagus nerves)
T12 — Aortic Opening (Aorta, Azygous , and Thoracic Duct)
S T3 to T6 - Oblique Fissure of Lung
S
—— =
T4 5 - Bifurcation of Trachea, Dermatome Nipple, Extent of Trachea C6 to T4
C3 Hyoid in erect position
S - —
C2 C3 (C2>C3)Tracheal ring Tracheostomy Level Adults
S - —
C3 C4 (C3>C4)Tracheal ring Tracheostomy Level Children
S
S
——
C6 Cricoid Level (Esophagus and Trachea Starts)
C2-3 Supraclavicular
S C3-4 - Infraclavicular
S Foramen Ovale ~ Accessory Meningeal artery pass
S
S
——
Foramen Spinosum Middle Meningeal artery pass
Superior Orbital Fissure VI (Ophthalmic nerve) pass
S —
Foramen Rotandum V2 (Maxillary Nerve) Pass
V
S
—
Foramen Ovale V3 (Mandibular Nerve) pass
Jugular Foramen - CN 9, 10, 11 (Accessory part) & Sigmoid Sinus
S
S
—
Hypoglossal Canal CN 12
-
Foramen Magnum Brainstem & Spinal Part of CN11
S
S — —
Esophagous Passed through Left Crus of Diaphragm (Big Snell)
Medial Arcuate ligament formed by Psoas Muscle
S
V T12 - Celiac Trunk
—
Median Arcuate ligament formed by Right & Left Crura

S L2 - Renal Artery
S
S
——
LI Superior mesenteric artery
L3 Inferior Mesenteric Artery
—
L4 Bifurcation of Descending Aorta
S L5 -.- Start of IVC
S —
Transpyloric Plane Pylorus of Stomach, Fundus of Gallbladder, Hilum of Kidney, First
part of Duodenum , Origin of SMA, Tip of 9th Costal Cartilage, Lower end cf Spinal Cord .
S Right Kidney anteriorly Related to - Liver
V' -
nd
Right Kidney Hilum Anteriorly Related to 2 Part Duodenum
 - -
SK - Orifiinal'Golden 12 (All Feb t- June 2021) •• 435
i:

t
I
i
.S
S
—
Posterior to Right Kidney 12th Rib & Diaphragm
Anterior to Left Kidney — Stomach & Pancreas
*
S Posterior to Left Kidney - 10th -11th Ribs & Diaphragm

/
S
Right Accessory Hepatic Artery Branch of - SMA
—
2nd Part of duodenum Attached posteriorly to Transverse Mesocolon

S Superior Epigastric Artery Branch of - Internal Thoracic Artery

S Inferior Epigastric Artery Branch of - External iliac Artery
S Superficial Epigastric Artery Branch of - Femoral Artery
5 S Superior Rectal Branch of - Inferior Mesenteric artery
IV S —
Middle Rectal Branch of Internal iliac artery
$
i S —
Inferior Rectal Artery Branch of Internal Pudendal Artery
I
l
S
S
—
Bulbourethral Gland Deep Pouch
Greater Vestibular Gland - Superficial pouch
i
\ S Difficulty in Standing from Sitting - Gluteus Maximux Damage(Inferior Gluteal
\
S Nerve)
1
I S Shuffling Gate - Gluteus medius + minimus (Superior Gluteal Nerve)
s S —
Right Pelvis Sink Left Gluteus medius + minimus Damage
I:
1 —
Injection Given in Superior Lateral Compartment to avoid Damage to Sciatic Nerve
(Snell)
i S Mediolateral Episiotomy Damage to - Bulbospongiosus > Superficial Transverse
i:
Perineal Muscle
E
Mediolateral Episiotomy Structure at Risk - Levator Ani
\r
t-
i
S
S
—
Median Episiotomy Damage to External Anal Sphincter
During Episiotomy Perineal Body Damage then Muscle Injured Levator ani—
!;

:
i
S —
Major Support of Uterus Cardinal (Transverse Cervical) Ligament
Dynamic Support - Pelvic Diaphragm
I
$
1
;
I Ureter
During Hysterectomy Ureter Damage at A > B > C
Ik A-Cardinal Ligament (Uterine Vessel)
s B-Behind Broad Ligament
C-At Pelvic Brim (Ovarian artery)
S Ureter Damage at Pelvic Brim - While crossing Common iliac Vessel
S While removing Ovary damage to - Internal iliac Artery
i S Anterior to Ureter - Gonadal Vessel
I
I S Posterior to Ureter — Iliac Vessel
F-
Common Site of Lodging of ureteric stones overall /Adults - Vesico ureteric Junction
Common Site of Lodging of ureteric stones in Child — Pelvico ureteric Junction
!:
I S Ureter Narrows at — Vesico ureteric Junction > Where it enters Bladder
i
i
i
I Uterus Prolapse
P S

!
! 'r
I
:
!
:

I
 - -
SK Original Golden 12 (All Feb + June - 2021) 436

l t Degree - Decent of Cervix within Vagina

8

—
—
2nd Degree Decent of Cervix to Introitus
3rd Degree Decent of Cervix Outside Introitus
—
4th Degree(Procidentia) Whole Uterus outside Introitus
In 1st and 2nd Degree — Uterosacral Ligament Damage
3rd Degree - Uterosacral > Cardinal ligament Damage
4th Degree - Cardinal Ligament Damage

Random
S
S —
Important Test For Transplant HLA typing
Best Blood Cell for HLA Sampling- WBC
S
S
——
Best Site for HLA Sampling Bucal Mucosa
Best Tissue for HLA Sampling Bone marrow

S
S
—
Hyper acute Rejection Pre formed antibodies (Type 2 Hypersensitivity)
——
Acute Rejection CD8 Cells (Type 4 Hypersensitivity)
Chronic Rejection CD4 Cells (Type 2+4 Hypersensitivity)
S
S
—
Graft vs Host Disease Type 4 Hypersensitivity
Dense Granules and IgE receptor - Basophil
S Granules and IgE receptor - Mast cell
S Granule and Histaminasc enzyme - Eosinophil
S
S
—
Most Common complication of DM Over All Dry Gangrene
—
Most Common Complication in Limb of Diabetic Patient Dry Gangrene
S
S
—
Most Common complication of Diabetic Foot Wet Gangrene
—
Most Common Complication of 3rd Degree Burn over all Contracture
^S —
Most Common Complication of 3rd Degree Bum in Black Keloid
Most common Complication of Bum - Scar
S
S
—
Endarteritis Obliterans Associated with Syphilitic aneurysm
—
Neonatal Recurrent Infection Deficiency of IgG
S
—
Child Recurrent Infection Deficiency IgA
S
S
—
Neonatal Infection Diagnosed by IgM
—
Mother Affected with Rubella and Baby got Symptoms Diagnosed by IgM
S Mother Affected with Rubella and Baby Symptoms less to Sec immunoglobulin - IgG2
> IgGl
S Rubella in pregnancy complication overall — Deafness > Cataract
S Rubella in pregnancy complication Within 7 weeks — Cataract
S Rubella in pregnancy complication After 7 weeks - Deafness
S After Transplant most Common malignancy - Skin
V After Transplant Common malignancy in 1 or 5 Year ~ Lymphoproliferaiive
S After Transplant Common malignancy after 10-15 Years — Skin
I
I
Origin
^ Golden - 12 (M Feb + June - 202j|
) 437

E S Most Common Manifestation of autoimmune disease - Hematological

S SLE involve most commonly — Joints (90%) And Skin (85%)
l
S Potent Antioxidants - Glutathione > Vit. E > C> A
S Radicals - OH > H202 > Superoxide
t S
S
—
Uninucleate Most Cells
Binucleate - Liver Cells
f S Multinucleate - Skeletal Muscle
I
$
S Cannot Regenerate - Lens > Skeletal Muscle > Neuron > Cardiac
S Cannot Reproduce ~ RBC

f
i:
S Most Common remnant of Allantois Urachal Cyst
— •

fc
—
S Patent Lumen of Allantois Urachal Fistula
S Stratified Cuboidal — Sweat Gland Lining Duct
.

:
—
Stratified Columnar Salivary Gland Lining Duct
:
i
i
—
S Vertebral Bodies Limited by Anterior an posterior Longitudinal Ligament
Vertebral Bodies kept in position by - Anterior an posterior Longitudinal Ligament
$
i
V Vertebrae joined to Adjacent Lamina - Ligament Flavum
t
Hyperextension of neck Ligament Injured - Anterior Longitudinal Ligament
S Hyper flexion of neck Ligament Injured Ligament Nuche
I
S Drowning - Pulmonary edema
—
I

i —
Near Drowning Metabolic acidosis
l
S
i
S Emboli first go to IVC —
S Emboli first loadge in - Pulmonary artery
!
I
I
\i —
V In response to Hemorrhage Decrease venous Capacitan
ce
:
After Compensation of Hemorrhage - Decrease Heart Rate
t
—
S Least Circulate in Blood Pleuri potent Stem cell Basophil
> (Clinical Hematology
;
I<
Book)
Iv —
V Corneal Opacity Chloroquine
•

c
—
Retina Deposit Thioridazine
S Lens Deposit - Chlorpromazinc
i
Post Irifleunza Most Common Organism - Strep Pneumonae
I
! Post Infleunza Brown Rusty Sputum - Strep Pneumonae
t
%

1
'
—
Post Irifleunza Yellow thick Sputum Staph Aureus
S Post Infleunza Current jelly Sputum - Klebsiella Pneumon
t ae
—
;
V
After Meal Glycolysis occur(FA)
!
t S Between Meal - Glycogcnolysis > Gluconeogencsis
(FA)
?
S Just Lateral to Xiphistemum Structure damage - IVC
;
!
i
Just Lateral and Below to Xiphistemum Structure damage IVC —
i
?.

—
Needle passed in 6th ICS on Right damage to Right atrium
Cut end of Vagus nerve Stimulated - Decrease HR
i S Vagus nerve proximal end cut and Central Part Stimulated
:
>
- Apnea occur
 SKS Original GMcEeri ;Sl2|Ait; Fet>' 438

—
S Patient Naked heat loss by Radiation
S Patient Naked and lying on Surface (Table) heat loss by Conduction —
S Patient Naked and Temp Mention heat loss by - Radiation + Conduction
S Patient Naked and Humidity mention heat loss by Convection —
—
S Remodeling of tissue by Metalloproteinase > Collagenase > Elastase
—
S Asthma Involve Medium sized bronchioles
S Infarction Involve — Small sized Bronchi
S Line of Zahn seen in
Coraline Thrombus
r v- ;
* Pre mortem Thrombus v
• % t
•

Arterial Thrombus
S Chicken Fat Appearance seen in - Post Mortem Thrombus
S Post traumatic epilepsy - With in 2 Year (Current Medicine Textbook)
S Amoeba Produce Lesion in — Caecum (Davidson)
—
S Cavernous Sinus Infection Superior ophthalmic vein (KLM)
—
S Cavernous Sinus Thrombosis Superior ophthalmic vein (KLM)
S Cushing Syndrome Differ from Obesity by - Proximal Myopathy
—
S Longest Incubation Period Latent HIV > Hep. B > IM > HIV
—
S Pure Serous Parotid
S More Mucinous +Few Serous Sublingual —
S More Serous + Few Mucinous - Submandibular
-
True Conjugate Sacral Promontry to upper pubic Symphysis (11cm)
—
S Obstetric Conjugate Sacral Promontry to middle or posterior pubic Symphysis (12cm)
—
S Diagonal Conjugate Sacral Promontry to Lower pubic Symphysis (10.5cm)
S Antigen Presenting cells in Skin Langerhan —
S Spleen Filteration function - Red Pulp (FA)
S Spleen Immunological Function White Pulp -
S High Karyo pyknotic Index - Increase Estrogen activity > Cervical Dysplasia
—
S Cell Membrane Bond Hydrophobic + Hydrogen > Hydrophobic + Covr!&it
Integral Protein in cell membrane joined by —
Hydrogen > Hydrogen *
Hydrophobic
Integral protein in cell membrane joined to Lipid of mcmbrpn Hydrophobic
e —
S Peripheral Protien by - Electrostatic Interactions
S Coccygeal Segment - LI
S —
Coccygeal Ligament S2 - Cocyx 1
S Mural Thrombi Arise From — Left Ventricle » Left Atrium
Dialyzing Fluid has more Glucose and HC03 as compared to plasma
S Tear Has High Sodium in its composition
S Tear Compare to plasma Has Equal Sodium
S Tear Compare to plasma lias Low Glucose and Urea
i;

i
t
- -
: SK Original Golden - 12 (All I'eh + June - 2021) 439

:
I
•

S Tear Compare to plasma has More K, Cl, Ca & Amino acids

I —
Foreign Body in Supine Apical (Superior) Segment of Right Lower Lobe
Foreign Body in Sitting/ Standing (Upright) —
Posterior basal Segment of Right Lower
Lobe
—
Foreign Body in Right Lateral Posterior Segment of Right Upper Lobe
—
S Foreign Body in Left Lateral Inferior Lingular of Left Upper Lobe
S Carboxy Hb Half-life at Room Air (21%) 4 -5 H -
I
!:
•
S Carboxy Hb Half-life at 100% 02 - 90min
\
XS Carboxy Hb Half-life at Hyperbaric 02 - Less than 30 min
Zero Order Kinetic Drugs - Phenytoin , Ethanol &Aspirin ..
!i
\t
X
.

—
S Zero Order Kinetic Half Life Increase with increase Dose
S First Order Kinetic - Half Life Constant with Increase Dose
I
l
-k
5
—
Uncoupling Oxidative Phosphorylation NE > Thyroxin > Epinephrine
S Anti-Tumor Cell -NK Cells
$
V

i — —
S Anti-Cancer Nature Mechanism Apoptosis
Drug Woarsen Angina Vasopressin > Theophylline
*

i
I Glucose Transport in Placenta (Facilitated) and Kidney (Secondary Active-Biport)
If
.
Typhoid Reside in Payer patches(l -4weeks) & Gall Bladder (> 4 weeks)
I
i
£
Lymphoid Tissue and Simple Cuboidal Epithelium - Payer patches
! S Lymphoid Tissue and Simple Squamous Epithelium - Palatine Tonsil
i
I
S Ovary - Simple Cuboidal
i
I S GIT -Simple Columnar
j
i:

i
i
—
S Conjunctiva Stratified Columnar
Central Venous Pressure Increased in (Ganong)
l a Decrease HR
I
%
s H Increase Blood Volume
1
!
i
Straining .
!j a
.
Cardiogenic Shock
i a Decrease in Compliance of veins
i t
I
B
Increase peripheral vascular Resistance
S Bicep Jerk - C6
I
f S Tricep Jerk - C7
..

S Knee Jerk - L3 ..

S Knee Cap - L4
>
S Ankle Jerk - SI
(
-
Bio State
Case Control Study:
I
;
H Disease vs Non Disease
i
i
\
8
Related to ODD Ratio
i

:
 . SK - Original Golden }r;12 (All Feb -kjune - 2021) | 440

Cohort Study:
Group with Risk Factors and Group without Risk Factors
Related to Relative Risk
Cause to Effect
Forward Study
Cross Sectional Study:
Disease and Risk Factors
Sensitivity (True Positive):
* Detect Disease and Rule out Disease (FA)
Specificity (True Negative):
Detect Non Disease and Rule in Disease (FA)
-
Attrition Bias Related to follow up and Prognosis
—
Berkson Bias Related to Different Exposure
— =
Normal Distribution (Gaussian) Curve Mean Median :Mode =
——
Positive Skew Mean > Median > Mode
Negative Skew Mean <Median <Mode
-
—
Confidence Interval Mean and Standard Error
Confidence Limit Standard Error and T value
—
T Test Mean of 2 groups
—
AnovJi Test Mean of 3 or more groups
—
Clii Square 2 by 2 Table and Categorical Data
—
Pie Chart Related to Percentages
-
Confidentiality Break When Patient Allows You

Transport
S Glucose transport across membrane due to its concentration difference - Facilitated
Diffusion
—
Glucose is absorbed in renal tubules through 2ndry Active Transport
S Amino acids are absorbed from kidney to blood by - 2ndry Active Transport
S Glucose transported to placenta by - Facilitated Diffusion
S Chloride and Urea transported by — Passive Diffusion
S Oxygen taken up to lung through — Simple Diffusion > Passive Diffusion
—
S Local Anasthcsia crosses Placenta by Simple Diffusion > Passive Diffusion
•
^ —
The membrane protein Clathrin is involved in Receptor mediated Endocytosis
—
S Transport through cell membrane involving Actin, Myosin and ctethrin Pinocytosis
——
S If a drug molecular weight is less than 1003 Transport occurs via Diffusion
S If a drug molecular weight is more than 1000 Transport occurs via Pinocytosis

Endocarditis V • •

S Most common cause of Acute Endocarditis (No —

Disease) Staph Aureus
S Most common cause of Sub Acute Endocarditis (with Heart Disease) — Strep. Virdian
 SK - Original GOLDENT 12 (AllFeb + June “ 2021)
, 441

S Libman mainly Involve Mitral and aortic but can involve any valve
S Flat Small Vegetation - Libman Sac Endocarditis
S Friable small Vegetatiom - NBTE
Large Irregular Vegetation - IE
S SLE associated with Libman
—
S NBTE associated with - Terminal Neoplasm

Breast Lymph (KLM + BP)

S Axillary lymph nodes - 75%
S Internal thoracic(mammary) or Parasternal 20% - *

S Posterior intercostal 5%-

^ Axillary lymph node include Anterior or pectoral (Mainly), posterior, central, apical and
lateral
,

S Sequence of major lymph node parallel along which vessel - Anterior axillary to pectoral
Sequence of lymph node parallel along which vessel -Internal thoracic
—
Nipple drainge Ant. axillary (Pectoral)
Upper lateral -- Ant. axillary mainly
—
S Lower latcral(Inferior) Ant. axillary + Sub diaphragmatic + Internal mammary.
—
S Medial Quadrant Mainly to Internal mammary (Internal thoracic)
S Lower Inner Medial Quadrant - Inferior Phrenic (Sub Diaphragmatic)
S Tail of Breast - Posterior (Scapular) Lymph Node
S Path of Axillary lymph flow -Anterior and posterior

—
S Quadrant of Breast Lymph Medial and lateral

Prolactin
S
S
< 1000 — Stress or Drugs
Between 1000 - 5000 - Microprolactinoma
S > 5000 - Macroprolactinom
S Prolactin cause - Milk Production
S High Prolactin cause - Infertility and Glactorrhea
S High prolactin cause - Decrease GnRH so inhibit Ovulation

Pancreas .
Posterior to Head of pancreas IVC
Posterior to Uncinate process --Aorta
—
S —
Posterior to neck of pancreas Portal vein And SMV
S
S
Anterior to uncinate procress SMA
—
Superior to pancreas Splenic Artery
—
^S Most abundent cells in Pancrease B cells —
s —
Type of necrosis in pancrease FAT necrosis
Tail of pancrcasc lies in - Spleno renal (Linorenal) ligament
^ CA most common in - Head of Pancreas
 SK - Original Golden - 12 (All Feb + junc
^
2021) 442

Influenza
/ HINi Swine Flu
/ H2N1 and H3N1 Common Flu
H5N1 Avian Flu

Facial Nerve
-
S Facial nerve enters temporal region Internal acoustic meatus
—
S Facial Nerve Enter Posterior cranial Fossa Stylomastoid foramen
—
S Facial nerve exits posterior cranial fossa Internal acoustic meatus
’

Facial Nerve exits Skull — Stylomastoid foramen

S Facial Nerve give chorda tympani which carries anterior 2/ 3rd Tongue taste
V Facial Nerve normally causes closing of eye and Damage to Facial nerve result in
rd
. Opening of Eye and Vice versa for 3 Nerve

Amyloidosis
S Amyloidosis visualized by ~ Congo stain

——
V Most common organ affected in Primary Amyloidosis is Kidney
S Most Common cause of death in Primary amyloidosis is Cardiac Failure
—
S Amyloidosis best confirmed by Rectal biopsy
—
/ Dialysis & Carpal tunnel related amyloidosis Beta 2 Microglobulin
AA(Secondary) amyloidosis associated with Chronic inflammation like ~ IBD and RA,
Familial Meditermean Fever and Protracted infection
—
S Senile amyloidosis Normal (Wild Type) Trasnsthyretin
—
V Systemic (Primary) AL amyloidosis Multiple myeloma
—
V Azheimeris Disease Beta amyloid protein

—-
S Diabetes Associated - Islet Amyloid Polypeptide (Amylin)
V Familial Amyloid Cardiomyopathy Mutated Transthyretin
S Familial Amyloid Polyneuropathies Mutated Transthyretin

Dead Space
Increased Dead Space:
V Emphysema
S Pneumonia
^S ARDS
Smoking
V ETT intubation
V Bronchitis
S Asthma
S Cardiac Failure
Pulmonary Embolism
Neck Extension
S Standing
 SK Original Golden - 12 (All Feb + June
,

— .2021) 443

S Hypotension
S Bronchodilation

Decreased Dead Space:

S Atelectasis
S Tracheostomy
S Sleep
S . Maxillectomy
S Hyperventilation
S Neck Flexion .
S Supine Position e

S Bronchoconstriction

Estrogen / Progesterone
Progesterone: (1 > 2 > 3)
1. Maintain Endometrial Proliferation(Thickness)
2. Secretory Phase
i
3. Alveoli and Lobule Development
i
\ 4. Increase Basal Body Temperature
t Estrogen:
!:
f 1. Endometrial Proliferation
2. Breast Duct Development
.

S
3. Development of female Secondary Sex Characteristics
I 4. Stimulate Prolactin Secretion however it Blocks Prolactin action on Breast (During
Pregnancy)
!
5 Maintain Calcium Homeostasis (Decrease Bone resorption and increase Linear Bone
! \
*

growth)
\
%
Heat Production (Ganong)
I
1) Resting Heal: Heat Given off at Rest
2) Initial Heat: Heat produced in Excess of resting Heat during Muscle Contraction. It is
\
* made up of Activation Heat and Shortening Heat
I
:j
a) Activation Heat: Heat Produced whenever muscle Contracts
* r „
$
b) Shortening Heat: Heat Produced when Muscle shortens (Change in Structure)
i
!
3) Recovery Heat: Heat Produced when return to its Pre contraction state muscle. £t is equal
I to Initial Heat.
f 4) Relaxation Heat: Extra Heat produced in addition to Recovery Heat.
Sleep
\:
S
(Guyton. Ganong & FA )
REM sleep:
S Occur every 90 min (4-6 period occur in Night)

;
 SK - Original Golden ~ 12 (All Feb + June — 2021) 444

S Most Dream Occur (Can be recalled)

S Eye movement , Loss of Muscular Tone, pupil constriction and Penile Erection occur
Associated with Mark Brain Activity
S Difficult to arouse from Sleep
S 80% in Premature infant, 50% in Mature Neonate and 25 % in old Adult
S Sleep Centre is Locus Coeruoleus and Neurotransmitter is Acetylcholine
—
Beta waves appear (14-80Hz) High Frequency and low Amplitude
S Also Called Paradoxical Sleep because person can still be Asleep despite Marked Brain
Activity •• .
S Also Called Desynchronized Sleep Because there is lack of synchrony in firing of Neuron
Despite Marked Brain Activity . ....
>

NREM:
S Also Called Slow Wave Sleep
S Divided into 4 Stages and specifically stage 4 is more Slow Wave
S Sleep Centre is Raphe Nucleus and Neurotransmitter is Serotonin > GABA
S Dream May occur (Cannot be Recalled)
S Nl: Light Sleep
S N2: Deeper Sleep and Bruxism occur
S N3: Deepest Sleep, Sleep walking, Night Terror, Bed Wetting and loss of Vascular Tone
S N4: Maximum Slowing occur Here
-
v

EEG Waveforms:
S Awake and Eye Close : Alpha Wave
S Awake and Eye open : Beta Wave
S Nl: Theta Wave (4-7Hz)
S N2: Sleep spindles (12-14Hz) and K complexes (High Voltage biphasic waves)
S N3&4: Delta Wave (0.5-4Hz) - Low Frequency and High Voltage Wave
S Theta wave may occur during Stress, N 2 &3 but Predominantly in Nl
S Delta Wave occur during Deep sleep, Infancy and Organic Brain Disease
v Spindle may Occur During N1 but Predominantly in N2

Compliment
S Classic Pathway Activated by - IgM > IgG
S Alternative Pathaway by - Microbe Surface molecule
S Opsonization - C3b and IgG
—
S Anaphylaxis C3a, C4a ,C5a
S Neutrophil Ghemotaxis C5a —
• c
—
V Cytolysis - C5b 9 (MAC)
S Early Compliment Deficiency (Cl-4) - Increase Risk of Recurrent Pyogenic sinus ,
Respiratory infection and SLE
S Terminal Compliment Deficiency (C5 - 9) - Increase Risk of Neisseria Bacteremia
S Cl Esterase Inhibitor Deficiency - Result in Angioedema, Increase Bradykinin and Low
C4 Level

Hypersensitivity (Robins)
 ; 4
-
SK - Original Golden 12 ( All Feb + June - 2021) 445

Type 1:
Examples Include:
S Anaphylaxis
! S Bronchial Asthma
S Allergic Rhinitis(Hay Fever)
S Food Allergy
S Blood transfusion usually causes Type 2 Hypersensitivity but IgA Deficient Patient has Anti
IgA when Blood Containing IgA Transfused in such Patient Anaphylaxis Reaction occur
which is Type 1 Hypersensitivity.
Type 2:
Antibody Mediated Cellular Destruction:
1. Complement Activation or Phagocytosis
2. Antibody Dependent Cellular Cytotoxicity
Examples:
S Transfusion Reaction
S Erythroblastosis Fetalis
S Autoimmune Hemolytic Anemia
^ Immune Thrombocytopenia
Antibody Mediated Inflammation:
V Good Pasture Syndrome
V Rheumatic Fever . ,
Hyper Acute Graft Rejection
Antibody Mediated Cellular Dysfunction:
Hypo function
S Myasthenia Gravis
Hyper function
S Graves * Disease
Pemphigus Vulgaris
Other
V Type 2 DM
S Pernicious Anemia
J -
Type 3 (Immune Complex Mediated)
Examples:
^SSLE
Post Streptococus GN
'
•
S PAN '

S Reactive Arthritis
S Sexual Sickness
^ Arthus Reaction

Type 4 (Cell Mediated)

Examples:
S Multiple Sclerosis
S Contact Dermatitis
V Psoriasis
I

t
 - -
SK Original G o l d e n F e b + June 2021) 446

S IBD
S Type 1 DM

Visual Lesion:
S Middle Optic Chiasma Lesion - Bitemporal Heteronymous Hemianopia
^ Optic Track Lesion - Homonymous Hemianopia
S Right Optic Track Lesion - Left Homonymous Hemianopia
S Pituitary Tumor with Homonymous hemianopia - Optic Track lesion
—
S Pituitary Tumor with Heteronymous hemianopia . Optic Chiasma Lesion .
S Right Optic Track Lesion causes - Right Temporal and Left Nasal Fibers loss
Right Optic Track Lesion Causes -Right Nasal and Left Temporal Vision loss
S Right Optic Track is made up of - Right Temporal fibers (which See Nasal Vision) and
Left Nasal Fibers (which See Temporal Vision) so Fibers loss and vision loss are Separate
things

—
S Cortical Blindness due to Blockage in PCA —
S Patient is Blind on testing but have no Insight of Vision loss Cortical Blindness

Brain Lobe Lesion

FrciitalLobe
It Result in
S Expressive (Broca) Non-fluent Aphasia
S Poor Social Behave
S Release of Sucking and Grasp Reflex
S Lack of Concentration

Parietal Lobe .
It result in
Gerstmann Syndrome which Include .
S Right and left Confusion
^ Finger Agnosia
S Dysgraphia and Dylexia
S Dyscalculia
Othier findings
S Dressing Apraxia
S Construction Apraxia
S Asterogonosis
S Contralateral Inferior Quadrantanopia (Upper Retina Involved)

Temporal Lobe
It result in
S Receptive(Wernicke) Fluent Aphasia
S Contralateral Superior Quadrantanopia(Lower Retina Involved-Meycr Loop)
S Olfactory and Gustatory Hallucination
S Anosmia
 1 - -
ISSSK - Original Golden 12 ( All Feb + Jude 2021) 447

S Klaver Bucy Syndrome

S Prosopagnosia

Occipital Lobe
It Result in
S Bilateral Lesion causes Cortical Blindness
S Unilateral Lesion causes Contralateral Quadrantanopia

Aphasia
Motor Aphasia
S Lesion of Broca Area(Dominant) 44 and 45
S Lesion of Inferior Frontal Lobe
S Expressive or Non Fluent Aphasia
S Cannot Speak or Write
S Comprehension Intact

Sensory Aphasia
^ Lesion of Wernike area 22
S Lesion of Superior temporal Lobe
S Receptive or Fluent Aphasia
Can Speak but make No sense

Anomic Aphasia
\ S Lesion of Angular Gyrus area 39
\
\k S Lesion of Non Dominant Broca Area
S Lesoion of Arcuate Fasciculus
f S TVlild Fluent Aphasia
S Cannot express the words they want to use
:
<•
- Global Aphasia
\ S Lesion of Broca and wernike area
5

i
l
1
Jejunum Vs illium
i
5
I Jejunum Illium
t Deeper r:d Valet pink
i
\ 'thick and heavy 'thin and light
I
Greater vascularity Lesser vascularity
Few Long Vasa recta Many small Vasa recta
\ Less fat in mesentery More fat in mesentery
i
1i
Few Lymph nodules Many Lymphoid nodules(Payer patches)

l
i
\
5

i
 SS SK - Original Goldehf 12 <AU Feb June - 2021) : 448
^
'

Liver Pathology Marker

/ Viral: ALT> AST
S Drug : ALT
Alcohlic: AST>ALT
Non Alcohlic: ALT > AST
S Non Alcohlic(Cixhosis or Fibrosis): AST>ALT
S Cholestatis Plus bone disease: ALP Raised
S Hepatobilliary: Both ALP and GGT Raised
S Liver disease plus pregnancy: Check GGT always
Conjugated Hyper bilirubinemia
S Billiary disease(Stones)
S Dubin jonson
S Rotor syndrome
Un conjugated Hyper bilirubinemia
S Hemolysis
S Newborn
S Cirgler najar
S Gilbert

Mixed Hyperbillirubinemia
S Hepatitis
S Cirhosis

Cytokines
_ —
S IL_ l,IL_6,TNF alpha fever and sepsis
S Fever—ELI > IL6
S Pseudomonas Fever TNF
—
S IL1 -Osteoclast activating factor
^ ——
IL2 Stimulates T cells
S IL3 Stimulates Bone marrow
——
S IL4 Stimulate growth of B cells
/ IL4 Stimulates IgE production
——
S IL5 Stimulates IgA production
S IL6 Stimulates acute phase reactant formation ,

v ILS -Major chemotactic for neutrophil

—— —
S IL10&TGF Beta Anti inflammatory cytokines
S TNF Alpha Cachexia in malignancy
S IFN Gamma Induce granuloma formation
—_
„

S IL12 Facilitates granuloma formation

—
S TNF Alpha Maintain granuloma

Duodenum 1st Part

Arterial Supply
1. Right Gastric artery
 -
SK Original Golden - 12 (AU Feb H - June - 2021) 449

2. Supraduodenal artery of Wikie

3. Retroduodenal Branches of Gastroduodenal artery
4. Branches of Right Gastroepiploic artery
Note
Gastroduodenal has following branches
S Retroduodenal Branch which supplies lat part Duodenum
S Right Gastroepiploic which supplies 1*: part Duodenum
S Superior pancreaticoduodenal which supply 2nd part Duodenum mostly
;

Omphalocele vs Gastroschisis
\ Omphalocele
Umbilical Defect
i
• Through Umbilical
i 9 Midline
• Peritoneum covering present
• Associated with trisomy (13,18,21) , VSD , ASD and TOF
s '

Gastroschisis
i

Para umbilical defect

Lateral to Umbilical(Right mostly)
9 Not Midline
• No Peritoneum covering
• No associated Disease

Kwashiorkor VS Marasmus
Kwashiorkor Marasmus
Deficient Proteins Deficient Proteins and Calories
Hair changes present Hair changes not present
Fatty liver common No fatty liver \

Edema present Edema not present

Subcutaneous fat present Subcutaneous fat not present
I . Poor appetite Good appetite
!E No muscle wasting Severe muscle wasting
!!

E
I Thyroid CA
Papillary CA
Associated with Radiation
9 Psomomma bodies and Orphan anie eye nucleus
| 9 Slow Growing
Spread Via Lymphatic
!i
Best Prognosis
0
ii
\
\\
ii
I
 SK - Original Golden - 12 ( All Feb + June - 2021) 450

Follicular CA
• Invade Capsule
• Vascular Spread
• 2nd Best Prognosis
Medullary CA
• Release Calcitonin
• MEN 1 and MEN 2 associated
• Poor Prognosis

Anaplastic CA
• Very Poor Prognosis
• Highly undifferentiated
RECEPTORS
Ruffini
• Deep static "Pressure”
• Detect warmth
• Encapsulated
• Large receptive field

Miessner
• light "Touch”
,
• Low frequency Vibration
• Upto 40Hz Frequency
• Abundant on Fingertip
• On Hairless Skin
• Encapsulated

Pacinian
• High frequency Vibration
• From 40 to 400 Hz Frequency
• Detect Tuning fork Frequency(128Hz)
• Deep "Touch ”
• Encapsulated
• Onion like on Subcutaneous Skin
Merkel Disc
• Deep "Static Touch"
• Non Capsulated
Krause
• Detect Cold
Large Receptive Field -Ruffini
Long Receptive Field - Lateral Spinothalamic track
—
Small Receptive Field DCML
—
Maximum 2 point Discrimination on Lips
 SK - Original Goldciv - 12 ( All Fcb + junc - 2021) 451

Minimum 2 point Discrimination on -Scapula

Maximum 2 point Discrimination Distance on -Scapula
Minimum 2 point Discrimination Distance on -Lips

HB-02 Curve
Right Shift:
Right shift mean Decrease affinity for O2 and increase delivery to tissue (Bohar effect) thus increase P50,
Causes:
•
Increase CO2
•
Decrease PH
•
Increase Temperature
9 Increase 2, 3 DPG
Left Shift: / ,
1 Left shift mean Increase affinity for 02 ahd decrease delivery to tissue (Haldane effect) thus decrease P50
1i!
Causes:
! Decrease CO2
I ® Increase PH
5 • Decrease Temperature
f
9 Decrease 2, 3 DPG
• HbF
9 CO Poisning

Fibers
A Alpha
* Fastest
Largest
la(Muscle Spindle afferent)
o lb(Golgi Tendon)
A Beta
9 Detect Touch and Pressure
II Sensory Fibers
A Delta
• Detect Fast pain , Temperature , Touch and pressure
9 Carry Cold Sensation
I •
® 111 Sensory Fibers
si B Fibers
! 8
s ® Preganglionic Autonomic Fibers
i5 C Fibers
I
• Detect Slow Pain and Temperature(Unmylinated)
• Carry Itch Sensation
® Carry Warmth Sensation
• Postganglionic Autonomic Fibers
® IV Sensory Fibers
-
I
I.
l
1
 SK - Original Golden - 12 (All Feb + June — 2021) 452

JVP Waveform
C Wave
-
C wave Right ventricle contraction (Closed tricuspid valve bulging into atrium)
A Wave
-
V A wave Shows Atrial Contraction
-
S Prominent A wave Seen in T.S, P.S And Pulmonary HTN
-
S Giant A wave Seen in AV Dissociation, Complete Heart block
X Descent
S X descent - Closed Tricuspid Valve downward displacement during rapid ventricular ejection phase
v' Absent X descent - Due to RHF and T.R \

V Wave
—
v'' V wave Increase Right atrial pressure due to filling against closed tricuspid valve
-
S Prominent V wave Seen in T.R
Y Descent
-
Y descent RA emptying into RV
-
S Slow Y descent Due to T.S
-
S Rapid Y descent Due to Constrictive pericarditis
-
S Absent Y descent Due to Cardiac temponade

Heart Bands
During Contraction
• I Band Decrease
• Sarcomere Decrease
• A Band Unchanged
• H zone Disappear

Heart Conducting System (KLM + Grey’s)

SA Node - Upper 1/ 3rd of Sulcus Terminalis and Upper Right atrium
AV Node - Lower part of Inter atrial septum or Atrioventricular septum
AV Bundle ~ Membranous IV septum
—
RBB Septo Marginal Trabaculae
LBB - Muscular Part of IV septum
—
SA Node Sub Epicardium
AV Node - Endocardium ,
Conducting system - Sub Endocardium

Heart Borders and Surfaces (KLM + BD)

Borders
Four Borders
• Right Border formed by — Right Atrium and on Xray by SVC + Right atrium
 . -
SK - Original C oliU n - 12 ( All Feb + June - 2021) 453

Left Border formed by - Left ventricle

e Superior Border formed by - Right and Left Atria
Inferior Border Formed by -Right Ventricle > Left Ventricle
Surfaces
Four Surfaces
• Anterior (Sternocostal) Surface formed by - Right Ventricle
• Inferior (Diaphragmatic) Surface formed by - Left Ventricle >Right Ventricle
®
-
Right Pulmonary Surface formed by Right Atrium

Apex
* Formed by Inferolateral part of Left ventricle
—
» Left Pulmonary Surface(Cardiac Impression) formed by Left Ventricle

« Posterior to left 5th ICS 9cm from Median plane

Base
It is Heart Posterior Aspect
I: Formed by Left Atrium > Right Atrium

:
si Heart Circulation (KT ,M + BD+ SnelH
Right Coronary Artery
Oligiii: Right Aortic Sinus
Branches:
-
SA Nodal artery Supply SA Node and Pulmonary trunk
-
Right Marginal artery Supply Right ventricle and Apex
I
I -
Posterior Interventricular (Descending) Artery (67%) Supply Right and left Ventricle and
Posterior l / 3ld IVS
—
AV Nodal artery Supply AV Node

Left Coronary Artery

i Origin: Left Aortic Sinus
n Branches:
%
1 -
SA Nodal artery Supply Left atrium and SA Node
Left Anterior Interventricular (Descending) Artery - Supply Right and left Ventricle and
::
I
Anterior 2/ 3rd IVS, Bundle of His and Apex (More than Right Marginal)
Circumflex Artery -Supply Left atrium and Left Ventricle
Left Marginal- Supply Left Ventricle
i

l
—
Posterior Interventricular (Descending) Artery (33%) Supply Right and left Ventricle and
Posterior l / 3rd TVS .
I
I
I Conclusion
| RCA Supplies
i
I
t
^ Right Atrium
Most Right Ventricle
1 Part of Left Ventricle (Diaphragmatic Surface)
&

l
 SK - OriginaFGoklen — 12 ( All Feb + June* - 2021) 454

/ Posterior l / S^ IVS
SA Node (60%)
AV Node (80%)
S Some Part of Left Bundal Branch
LCA Supplies
Left Atrium
S Most Left Ventricle
S Part of Right Ventricle
S Anterior 2/ 3“* TVS including AV Bundle (Right Bundal Branch + Part of Left Bundal
Branch)
S SA Node (40%)