3 Facies

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1.  Mask like facies = parkinsonism.
2. Elfin facies = william's syndrome.
3. Moon facies = cushing's syndrome.
4. Snarling facies = myasthenia gravis.
5. Mitral facies = mitral stenosis.
6. Ashen grey facies = myocardial infarction.
7. Mouse facies = chronic renal failure (crf)
8. Adenoid facies = adenoid hypertrophy.
9. Leonine facies = lepromatous leprosy .
10. Bird facies = pierre robin syndrome.
11. Mongoloid facies = down's syndrome.
12. Coarse facies = most of the inborn errors of metabolism (iem) viz. The muco- polysaccharidoses (mps), mucolipidoses (ml), fucosidoses mannosidoses, sialidoses, aspartylglycosaminuria, generalised gangliosidosis(gml ) and austin's variant of metachromatic leukodystrophy due to multiple sulfatase deficiency (mld-msd) have similar appearing facies.
13. Syphilitic facies = congenital syphilis ( bull dog jaw)
14. Hippocratic face(also known as"hippocratic facies"; eyes are sunken, temples collapsed, nose is pinched with crusts on the lips and the forehead is clammy)
15. Potter facies- oligohydramnios
16. Amiodarone facies(deep blue discoloration around malar area and nose)
17. Acromegalic facies- acromegaly
18. Marfanoid facies- marfan's syndro
19. Mesnarling facies- myasthenia gravis
20. Myotonic facies- myotonic dystrophy
21. Torpid facies- myxoedema
22. Mouse facies- chronic renal failures 
23. Myxoedemamouse facies- chronic renal failure
24. Plethoric facies- cushing's syndrome and polycythemia vera
25. Ashen grey facies- myocardial infarction
26. Gargoyle facies- hurler's syndrome
27. Monkey facies- marasmus
28. Hatchet facies- myotonica atropathica
29. Guerilla like face- acromegaly
30. Bovine facies or cow face- cranio fascial dysostosis or crouzons syndrome
31. Marshall halls facies- hydrocephalus
32. Frog face- intra nasal disease

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0 Pituitary Hormones

1 = I (V1 is IP3DAG)

Anterior hormones in red are from BASOPHILS

Anterior Hormones in yellow are from ACIDOPHILS

0 Smooth Muscle

Smooth Muscle Characteristics to be remembered

• Multiple NMJ

• No Troponin

• No T Tubule

• No SR

• No Z line

• Calcium combines with Calmodulin

• Cross Bridge cycling (Latch Mech.)

1 Diagnosis of Isolated Cyclovertical Muscle Palsy

Question : A person enters the OPD with Head tilted to left side and presents with Hypertropia in Right eye which increases on Left Gaze. Name the muscle paralysed ?

Answer :  Right Superior Oblique Palsy

Method to get to the answer

• Please see that in the question Hypertropia is COMPENSATED with LEFT TILT , thus the tilt which will increase Hypertropia is RIGHT TILT (Hence for answer - EGT is RLR)

• Diagnosis of Isolated Cyclovertical Muscle Palsy

• Hypertropia More in (E,G,T)

	EYE (E)	GAZE (G)	TILT (T)	Method to remember	Answer
1.	R	L	R	More “R” , thus Right Muscle R is Alternate/Opposite – So OBLIQUE	RSO
2.	L	R	L	Using L instead of R in above method	LSO
				See the next 2 to understand where to put Superior
3.	L	L	L	When all Same then Muscle different , Therefore Now “R”	RIO
4.	R	R	R	Using above method	LIO
				In exams “all Inferior Rankers are similar but the Superior Rankers are at good gap i.e different”
5.	L	L	R	Ist two are same so Inferior , and since the opposites are not same so it is not oblique. L more so muscle is Left	LIR
6.	R	R	L	Using the above method	RIR
7.	L	R	R	Last two are same , so we reverse the method above – thus now Superior Muscle. And R is more so Right muscle Also not opposite , so Rectus.	RSR
8.	R	L	L	Using method above	LSR

The above method might seem a little complicated but trust me , if you understand it then you would never get it wrong.

Summary

• a.       EGT (order is must to remember)
• b.      Remember that Hypertropia Increases on the sides mentioned i.e RLR means Hypertropia increases/present in Right Eye ,Left Gaze ,Right Tilt.
• c.       More the L / R – same is the muscle Except if ALL SAME as in 3 , 4
• d.      If Alternate / Opposite same – then Oblique
• e.      If All same then it is Inferior (thus if opp same then Superior)
• f.        If 1^st two / last two same – then Rectus
• g.       Ist two same – Inferior (thus if last 2 same - then Superior)

0 Triple Test

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AFP	Unconjugated Estriol (UE3)	hCG	Condition
Low	Low	High	Down’s
Low	Low	Low	Edward’s

Triple test is done at 16 - 18 wks 

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0 Obstetric Confusing treatment (Simplified)

Few PG entrance questions on Treatment : (Simplified)

Treatment	PPH	Ectopic	Threatened Abortion
PGF 2alpha	+	+
Misoprost (E1)	+		+
Mifepristone	-	+	-

0 Rickets

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RICKETS - Salient Points which help in getting to the answer very easily


1. S.Phosphate is decreased in ALL TYPES OF RICKETS

2. Normal PTH is ONLY seen in VIT D resistant / Hypophosphatemic Rickets

* Increase S.Phosphate is seen in - Renal Osteodystrophy.

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

0 GS-alpha Mutation

                                                               GS alpha Mutation
                                   
                                       GAIN                                                          LOSS
               
                            1. McCune Albright                                            1. Albrghit's Osteodystrophy
                            2. Acromegaly                                                          = PseudoHypoParath 1a

0 SVC Syndrome

SVC syndrome--- MC caused by compression by Malignant tumor
                             of which MC is Bronchogenic Carcinoma
                             of which MC is Small Cell Ca

0 Drugs Causing Torse de Pointes

Drugs Causing Torse de Pointes

1. Antiarrhythmics - I a , I c , III

2. C - Cizapride
3. A - Astemizole
4. T - Terfinadine

5. Antipsychotic - Thioridazine ,
                             Resperidone ,
                             Ziprasidone

6. Antidepressant - Amitriptyline

7. Antibiotics - Erythromycin,
                         FQ- (GSM)- Gatifloxacin , Sparfloxacin , Moxifloxacin
                         Halofantrine

1 Human as the Only Reservoir

0 Renal Tubular Acidosis

Copyrights (c) DrAyushGoel

RTA is Normal Anion Gap Hyperchloremic Metabolic Acidosis

There is Normal anion gap in SERUM

But

In URINE , there is +ve anion gap

1 Pseudomonas <--- Antibiotics

• Category IV Cephalosporin

• Cat III Cephalosporins - Ceftazidime , Cefoperazone

• Imepenem

• Aztreonam

• Flouroquinolones - Cyproflox , Levoflox

• Aminoglycosides - TAG - Tobramycin , Amikacin , Gentamycin

• Polupeptide - Polymyxin , Colistin

0 Confusing gene and translocation (Simplified)

1 Translocations

• t (11,22) ----------------- Ewing's Sarcoma

• t (12,22)------------------ Clear Cell Sarcoma

• t (12,16) ----------------- Myxoid Liposarcoma

• t (2,13) ------------------- Alveolar Rhabdomyosarcoma

• t (9:22)-------------------- good prognosis in  CML , bad prognosis in ALL

• t (8:14)-------------------- Burkitt's Lymphoma

• t (11:14)------------------- Mantle Cell Lymphoma

• t (14:18)------------------- Follicular Lymphoma

• t (x:18) -------------------- Synovial Sarcoma

• t (8:21)--------------------- AML M2 (MC)

• t (15:17)--------------------AML M3

0 Oxyhaemoglobin dissociation curve

P50 -- P O2 at which Hb is 50% saturated (Typically 26.6 mm Hg)

FACTORS	LEFT  SHIFT	RIGHT  SHIFT
Ph	Increase	Decrease
P(CO)	Increase	Decrease
Temperature	Decrease	Increase
2,3-DPG	Decrease	Increase
P(CO2)	Decrease	Increase

0 Cerebral sinus thrombus

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This is an example of a question which can be solved with Presence of Mind alone. And proves that Knowledge is not necessarily required sometimes.

Q. Cerebral sinus thrombus, true are All Except ?

a. Dense delta sign on NCCT

b. Cord sign on NCCT

c. empty delta sign on contrast CT

d. empty delta sign on NCCT

ANSWER:

Option C and D are opposite of each other --- Thus one of them is True and one is false.
This means that the other two are True as the question asks All Except
Now as Option A is True so , Option D which is opposite of Option A , must be wrong... Thus the answer is Option D. :)
Medical explanation :
In contrast CT , the area where there is a thrombus will not let the contrast fill (filling defect) - hence seen as empty.
In Non contrast CT - this thrombus is seen as bright (hyperdense) - hence Dense delta sign.

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4 Neiman pick , Tay Sach , Hunter's

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This story is about a boy called Niemann who was fond of fried foods

one fine morning, he decided to have cherries fried in oil for lunch

so he set out to pick cherries from the lawn. he went riding on his pet zebra

he reached the garden & started picking up cherries



while our dude Neiman was busy picking up cherries,
he was being watched by
a old hunter

The hunter wanted to steal the zebra


But

Another boy
TaySach was in the garden picking up onions


Tay sach was a brave boy

he scared away the hunter

neiman was happy on seeing this
& befriended taysachs
as a token of friendship, he gifted taysach cherries & oil for a great lunch

he also gave taysach a ride on his zebra back home

moral of this weird story 

neiman pick dis
*zebra body
*cherry red spot
*staining with oil red o


tay sach dis
*zebra bodies
*cherry red spot
*staining with oil red o
*onion ring deposits in skin


hunter disease
*zebra bodies

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1. They're all autosomal recessive, with the exception of Fabry's and Hunter's, which are both X-linked recessive.

2. Hurler and Hunter's both start with an H, and both accumulateHeparan sulfate. (Hopefully that will help you remember that they accumulate dermatan sulfate too).

3. Ashkenazi Jews have a higher risk of Gaucher's, Niemann-Pick, and Tay-Sachs.

4. Gaucher's spares the Brain., has crummpled tissue paper appearance.

5. Remember: "globoid cells" = Krabbe's.

6. "Cherry-Red" (spot on macula) is hyphenated. So are "Niemann-Pick" and "Tay-Sachs." :)

7. Hunters is X-linked. I view a Hunter shooting his bow at a X (target).

8. Niemann-Picks - Sphingomyelinase. No man picks is nose with is Sphinger (finger).

9. As above regarding Hunter's vs Hurlers. Hurlers you get corneal clouding, so you cannot be a good hunter.

10. HurLer's is alpha-L-iduronidase. Hunters, which is a similar disease, is the other one (iduronate sulfatase). "I just remember one, then know that the other one is the other one."

11. Metachromatic Leukodystrophy : Arysulfatase A deficiency

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