MedicoNotebook: 2013

Anterior cruciate ligament

MCQ 158

Q. Anterior cruciate ligament is ?

a. intracapsular and intrasynovial

b. intracapsular and extrasynovial

c. extracapsular and intrasynovial

d. extracapsular and extrasynovial

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

MCQ 157

Q. On a chest X-Ray, if the patient is rotated to left, then ?

a. left side becomes more radiolucent
b. right side becomes more radiolucent
c. both the sides become less radiolucent
d. radiolucency of both sides is not affected

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Bat's wing shadowing - CXR

Bat's wing shadowing - CXR

Can be seen in

Pulmonary oedema (Most common cause)

Pneumocystis infection

Alveolar cell carcinoma

Alveolar proteinosis

Goodpasture's syndrome

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Smoking related ILDs

MCQ 156

Q. Which of the folowing is not a smoking related Interstitial lung disease (ILD) ?

a. Acute interstitial pneumonia

b. RB-ILD

c. Desquamative interstitial pneumonia

d. Pulmonary Langerhans cell histiocytosis

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Fahr disease

MCQ 155

Q. In Fahr disease there is ?

a. abnormality in calcium metabolism

b. abnormality in phosphate metabolism

c. abnormality in both calcium or phosphate metabolism

d. no abnormality in calcium or phosphate metabolism

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

DNB Thesis - Front cover page format

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THESIS TOPIC

A DISSERTATION SUBMITTED TO THE

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EXAMINATION TO BE HELD IN month,year

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DEPARTMENT OF ____________

____________ INSTITUTE OF MEDICAL SCIENCES

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Front cover for summary : Everything is same except for addition of the word SUMMARY.

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SUMMARY

A DISSERTATION SUBMITTED TO THE

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MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Spinal meningeal cysts

MCQ 154

Q. Which of the following is type 2 spinal meningeal cyst ?

a. extradural spinal arachnoid cyst

b. tarlov cyst

c. intradural spinal arachnoid cyst

d. sacral meningocoele

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One Liners 301 - 310

301. Thrombospondins (TSP) has anti-angiogenic abilities

302. Infectious diseases communicable during the later part of the incubation period are - Measles, chickenpox, whooping cough, hepatitis A.

303. Fredericson classification - medial tibial stress syndrome

304. Bismuth-Corlette classification - perihilar cholangiocarcinoma

305. Luftsichel sign & juxtaphrenic peak sign - Left Upper Lobe collapse
Flat waist sign - Left Lower Lobe collapse.

306. Most common hepatic malignancy in children is Hepatoblastoma.

307. Most common anomaly associated with coarctation of aorta is bicuspid aortic valve.

308. 4th Ventricle Ependymoma vs Meduloblastoma

Ependymoma - usually from Floor of 4th ventricle (Mnemonic - Alphabetic order EF)
Meduloblastoma - usually from Roof of 4th ventricle

309. Most common tumor of mediastinum - neurogenic tumor.

310. Most common causes of renal artery stenosis

Old age - Atherosclerosis
Young (India) - Takayasu arteritis
Young (Western world) - Fibromuscular dysplasia.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical one liners 291 - 300

291. Ulcerative colitis causes inflammatory diarrhoea
Pancreatic exocrine insufficiency causes Steatorrheal diarrhoea

292. Metastases -

MC intracranial metastasis from Carcinoma lung
MC hepatic metastasis (overall) from Bronchogenic carcinoma
MC hepatic mets from GIT from Colonic carcinoma

293. Isotonic exercise : Cardiac output increases
Isometric exercise : Cardiac output decreases.

294. The repolarisation wave in heart starts from epicardial surface of apex.

295. Glucocorticoids increase the number of RBCs, platelets and neutrophils in the circulation.

296. Acute rheumatic fever - There is no residual damage to the joint.

297. Live vaccines are contraindicated in pregnancy.

298. Screening is effective for cervical cancer, breast cancer & oral cancer.

299. CTEV correction : 1st - forefoot adduction, then - inversion, then - equinus.

300. Receptor proteins for Parathyroid hormone (PTH) are present on both osteoblasts and osteocytes.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Energy sources

Energy sources

Well fed state :

Glucose - for brain, liver and muscle
Fatty acid - for heart

Fasting state :

Glucose - for brain
Fatty acid - for heart, liver and muscle

Starvation :

Ketones - for Heart and brain
Amino acid - for liver
Fatty acid - for muscle

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One Liners 281 - 290

281. Nucleus ambiguus - cranial nerves IX, X and XI.

282. Black pleural sign - Pulmonary Alveolar Microlithiasis

283. Nernst potential across cell membrane :

for K+ ion is -90 mV
for Na+ ion is +60 mV
for Cl- ion is -70 mV

284. Small cell Ca of lung is most common variety of lung cancer associated with paraneoplastic syndrome.

285. Meissner and Pacinian corpuscles - rapidly adapting (phasic) receptors.
Merkel cells and Ruffini endings - slowly adapting (tonic) receptors.

286. Abdominal cocoon = Sclerosing encapsulating peritonitis.

287. Apple core sign - on barium studies of circumferential growth in colon cancers.

288. Celery stalk metaphysis - in osteopathia striata , and congenital rubella.
Celery stalk sign - in ACL mucoid degeneration.

289. Champagne glass pelvis - in Achondroplasia

290. Coffee bean sign - sigmoid volvulus.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Banana

Banana Sign : shape of cerebellum in cases of Arnold chiari II malformation.

Banana shaped Left ventricle - seen in HOCM (hypertrophic obstructive cardiomyopathy)

Banana fracture - Paget disease

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One Liners 271 - 280

271. Gluteus

maximus: inferior gluteal nerve
medius and minimus: superior gluteal nerve

272. Piriformis - lateral rotator of thigh

273. Short head of biceps and coracobrachialis originate from tip of coracoid process.

274. Positive benzidine test in : Hemoglobin and Myoglobin

275. Drug that increases QT interval - Amiodarone, Ebastine, Sotatol

276. SIADH is euvolemic hypoosmolality with increased Urine Na+ , Urine osmolality

277. Muscles related to eustachian tube - Tensor veli palatini, Levator veli palatini and Salpingopharyngeus.

278. Brain cells sensitivity to hypoxia :Neurons > Oligodendrocytes > Astrocytes > Endothelial cells
Among Neurons most sensitive are - Pyramidal cells in area CA1 of hippocampus - known as Sommer's sector.

279. Stratosphere sign on M - mode ultrasound - suggests Pneumothorax.

280. Killian’s dehiscence (also known as gateway of tears) - Between thyropharyngeus and cricopharyngeus.

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Radiology Quiz 1

ANSWERS :

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One Liners 261 - 270

261. Puff of smoke sign is seen in Moya moya disease.

262. Onodi cells are sphenoethmoidal air cells and are in close relation to optic nerve (usually) or internal carotid artery (less commonly)

263. Haller cells are maxilloethmoidal air cells that may be in close relation to infra-orbital nerve.

264. Hepatoportoenterostomy, or Kasai portoenterostomy is a surgical treatment performed on infants with biliary atresia to allow for bile drainage.

265. Denis Browne operation is used for surgical repair of hypospadias.

266. Corpora arenacea - Pineal gland
Corpora amylacea - Prostate gland

267. Crypts of Leiberkuhn and Brunner’s glands are seen in Duodenum.

268. Anorectal ring is formed by – Puborectalis, Internal anal sphincter and Deep external anal sphincter. (Mnemonic PID or DIP )

269. Gantzer's muscles - accessory heads of flexor pollicis longus and flexor digitorum profundus.

270. Last carpal bone to ossify is pisiform.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Caput medusae sign

Caput medusae sign is seen in :

developmental venous anomaly (on Contrast enhanced CT or MRI)

portal venous hypertension (Portosystemic shunt - engorged paraumbilicus veins)

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One liners 251 - 260

251. Most common type of disproportionate dwarfism : Achondroplasia

252. Commonest fatal neonatal dysplasia : Thanatophoric dwarfism.

253. Platyspondyly with central vertebral beaking is the diagnostic hallmark of Morquio's disease.

254. PNDT act - 1994, But PCPNDT act (amendment in PNDT act ) - 2003.

255. Pulmonary hypertension : Main pulmonary artery > 28.6 mm,
Right descending pulmonary artery > 16mm

256. Speed of ultrasound in soft tissue : 1540 m/sec.

257. Natural global radiation : Average yearly radiation dose is 2.7 mSv

258. International commission on radiological protection (ICRP) was founded in 1928

259. Atomic energy act - 1962

260. Radionuclides K40 and C14 are present in human body.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Comet tail artifact

MCQ 153

Q. Comet tail artifact is a type of

a. reverberation artifact
b. side lobe artifact

c. posterior acoustic enhancement

d. posterior acoustic shadowing

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Skull and achondroplasia

MCQ 152

Q. Skull is not involved in all except :

a. Achondroplasia
b. Hypochondroplasia
c. Pseudoachondroplasia
d. All of the above

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Permissible radiation dose

Radiation dose permissible in mSV/year

to radiation-occupational worker is 20
to lens is 150
to skin is 500
to hands and feet is 500
to fetus (during entire pregnancy) is 2

1SV = 100REM
1Gy = 100RAD
For X-Rays and Gamma rays 1Roentgen = 1RAD = 1REM

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One Liners 241 - 250

241. Lytic expansile bone metastases from - Kidney & Thyroid malignancies.

242. Paraduodenal hernias - the most common type of internal hernias.

243. Comet Tail on USG - Adenomyomatosis of the gallbladder
Comet Tail on CT - Round atelactasis

244. The term " Chasing the dragon " is used for imaging of heroin inhalation leukoencephalopathy.

245. Double layered patella is characteristic for Multiple epiphyseal dysplasia.

246. Linguine sign - intracapsular rupture of a breast implant.

247. Lyre sign - splaying of the internal and external carotid by a carotid body tumour.

248. Dysplasia epiphysealis hemimelica = Trevor's disease, characterized by irregular overgrowth of part of an epiphysis.

249. Urinomas are most commonly in the perirenal space.

250. Wilhelm Conrad Röntgen was born on - 27 March 1845.
On 8 November 1895, produced and detected electromagnetic radiation in a wavelength range today known as X-rays.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Segond fracture

Segond fracture = avulsion of the anterolateral aspect of the lateral tibial plateau

Mechanism - internal rotation of tibia + varus stress

Originally postulated - avulsion of the lateral capsular ligament,
Recent MR study suggests - it occurs at the distal attachments of the iliotibial tract or Lateral Collateral Ligament. (ref: CT and MRI of the Whole Body, Fifth Edition, John R. Haaga)

Most common ASSOCIATED injury - ACL tear (75-100%)
2nd MC - Meniscal tear (medial or lateral, mostly posterior horn)(66-75%).

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One Liners 231 - 240

231. Chief artery supplying breast - Lateral thoracic artery

232. Wheel within a wheel and Bull’s eye lesion is seen in hepatic ultrasound of - Liver candidiasis.

233. Berger's hernia - hernia in Pouch of Douglas

234. Petit's hernia - hernia through Petit's triangle = inferior lumbar triangle

235. Grynfeltt's hernia - hernia through Grynfeltt-Lesshaft triangle =superior lumbar triangle.

236. During muscle contraction H zone disappears, width of I band reduced ,A band remains unchanged.

237. Maximum potassium ion concentration in Colonic Fluid.
Maximum Potassium secretion is by saliva.

238. Gantzer's muscle is accessory belly of the flexor pollicis longus muscle.

239. Cella media index > 4 is normal

240. Distal part of the tendon of Adductor magnus detaches and becomes the medial collateral ligament (Tibial collateral ligament) of the knee.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical one liners 221 - 230

221. HMG-CoA-reductase catalyzes the rate-limiting step in cholesterol metabolism.

222. Agger nasi air cells are the most anterior ethmoidal air cells.

223. Hidebound bowel sign or the stack of coins - seen on barium study of small bowel in scleroderma.

224. Bigliani classification is used for acromion morphological types.

225. Climber's muscle - Latissmus dorsi.

226. Tailor’s muscle - Sartorius.

227. The endocervical canal measures 7 to 8 mm.

228. Crypts of Lieberkuhn are seen in Duodenum.

229. Corpora arenacea (or Brain sand) are calcified structures in the pineal gland and other areas of the brain such as the choroid plexus.

230. Oligodendrocytes and Schwann cells are involved in myelin formation around axons in the CNS and peripheral nervous system, respectively.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Subdivisions and Derivatives of Neural Tube

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One Liners 211 - 220

211. Garland's triad (also known as the 1-2-3 sign) is suggestive of thoracic sarcoidosis.

212. The marginal vein of Servelle is pathognomonic for Klippel-Trenaunay-Weber syndrome.

213. Castellvi classification is used for Lumbosacral Transitional Vertebrae (LSTV).

214. Kohler disease - avascular necrosis of the navicular bone.

215. Kienbock disease - avascular necrosis of lunate.

216. Lateral end of clavicle appears at 5 wks intra-uterine life, Medial end of clavicle appears at 15 years of life.

217. Ball on tee sign - seen in papillary necrosis on IVU.

218. Metaphyseal blanch sign of Steel is seen in SCFE (Slipped Capital Femoral Epiphysis)

219. Aneurysmal bone cysts (ABC) occur before the fusion of epiphysis and are usually metaphyseal in location.

220. Osteoid osteoma has male preponderance, cause night-pain that is relieved by Aspirin.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Posterior acoustic shadowing and enhancement

Posterior enhancement seen posterior to fluid filled cyst.

Posterior shadowing seen posterior to calculus at PelviUretric Junction

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Medical One liners 201 - 210

201. Most common site of iatrogenic esophageal perforation is Cricopharynx ( as its the narrowest part of GIT , with exception of vermiform appendix )

202. Important 25 cm structures :

Oesophagus
Duodenum
Thoracic duct
Ureter.

203. Accordion sign is seen with pseudomembranous colitis.

204. Most commonly symptomatic Plica is Medial Patellar plica.
Plica is embryological remnant of synovial membrane at patello-femoral joint.

205. The commonest cause of anterior knee pain is softening of the cartilage on the underside of the patella = Chondromalacia patella = Patellofemoral syndrome.

206. Most common congenital anomaly of urinary tract is Duplex collecting system.

207. Central dot sign is seen in Caroli disease.

208. The bear's paw sign is seen in xanthogranulomatous pyelonephritis.

209. Coins in the oesophagus are oriented in the coronal plane whereas coins in the trachea are oriented sagittally.

210. Portomesenteric vein gas is most commonly caused by mesenteric ischemia.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Urachal anomalies

MCQ 151

Q. Which of the following urachal anomalies is usually associated with urethral obstruction ?

a. Patent urachus

b. Urachal cyst

c. Urachal sinus

d. Urachal diverticulum

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Base of the 5th metatarsal

Fractures and normal variants to remember at base of the 5th metatarsal :

Fractures -

Jones fracture
Stress fracture
Avulsion fracture

Non-fracture mimics -

Normal apophysis of the proximal 5th metatarsal
Os peroneum

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Suspicious malignant breast mass shape

MCQ 150

Q. Which of the following is suspicious malignant breast mass shape ?

a. taller than wider

b. wider than taller

c. elliptical

d. round

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Infrarenal IVC development variation

MCQ 149

Q. In a person with infrarenal IVC developing from subcardinal vein, which of the following will be seen ?

a. Duplex collecting system

b. Aberrant renal artery

c. Supernumerary kidney

d. Retrocaval ureter

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Todani classification

MCQ 148

Q. Caroli's disease is considered under which type of cysts in Todani's classification ?

a. Type 2

b. Type 3

c. Type 4

d. Type 5

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Testicular torsion - arterial occlusion

MCQ 147

Q. Testicular Torsion of at least ______ degrees is necessary for complete arterial occlusion ?

a. 180

b. 360

c. 540

d. 720

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Not a true diaphragmatic opening

MCQ 146

Q. Which of the following is not a true opening in diaphragm ?

a. Vena caval hiatus

b. Esophageal hiatus

c. Aortic hiatus

d. All are true apertures

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Open ring sign

MCQ 145

Q. Open ring contrast enhancement (Open ring sign) is seen in ?

a. Demyelination

b. Cerebral abscess

c. Granuloma

d. Low grade glioma

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Boerhaave's syndrome vs Mallory–Weiss syndrome

Boerhaave's syndrome vs Mallory–Weiss syndrome

Boerhaave's syndrome	Mallory–Weiss syndrome
Site : Lower thoracic oesophagus	Site: Vertical tear in cardia of stomach , may extend to distal oesophagus.
There is vertical perforation, and all gastric content goes into mediastinum. No history of foreign body. Mackler's triad may be seen : Chest pain, vomiting and subcutaneous emphysema	Mucosa and submucosa are involved, NOT a complete perforation. Presentation : Hematemesis (Not pain)
Reason : Vomiting / Retching against closed cricopharynx. i.e barotrauma	Reason : Vomiting , Increased LES (Lower esophageal sphincter) pressure. – can cause tear.
Sign : Air in mediastinum Hamman’s Sign (seen with any cause of pneumomediastinum.) – On auscultation , because of air around heart. Investigation of Choice : Water soluble contrast study ( DO NOT USE BARIUM)	Diagnosis : Upper GI endoscopy.
Treatment : Immediate surgery (via LEFT thoracotomy ) If >24-48 hrs – Let heal with secondary intention , do not suture , Just put a drain.	Treatment : Conservative (95 % cases)

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Esophageal ring

Site : Lower oesophagus.

A-Ring = Lower esophageal muscular ring

Mostly asymptomatic.
Symptoms if present : Dysphagia for both solids and liquids in absence of food impactions.
Situated few centimeters proximal to Schatzki's location (see below)

B-Ring = Lower esophageal mucosal ring = Schatzki ring

There is fibrous thickening in submucosa, it is symmetrical. Mucosa is normal histopathologically.
Most patients are asymptomatic.
Symptoms if present : Dysphagia, more for solids , and food impactions.
Has association with hiatus hernia
Seen in Lower oesophagus above diaphragm at Squamocolumner junction
Treatment : Balloon when needed.

DYSPHAGIA if present is NON-PROGRESSIVE

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Esophageal web

Esophageal web (acquired)

Site : Cricopharynx / Postcricoid.

Usually in association with Plummer–Vinson syndrome (PVS) = Paterson–Brown–Kelly syndrome = sideropenic dysphagia --which is a triad of

dysphagia ,
esophageal webs, and
iron deficiency anemia.

Seen mostly in post-menopausal ladies.

Treatment : Iron supplementation, Balloon dilatation.

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Ligamentum teres hepatis

Ligamentum teres hepatis

Ligamentum teres hepatis is obliterated left umblical vein. (MCQ Point )

The umblical veins take oxygenated blood and join to the left and right branches of portal vein. (MCQ Point )

In embryo , normally , the right umblical vein completely disappears by about 8th week (intrauterine life) and only left umblical vein is present thereafter. ( can be remembered as "Left is Left in body" ) (MCQ Point )

This left umbilical vein usually closes in <7days after birth, and forms round ligament of liver = ligamentum teres hepatis.

It results in the ligamentum teres joining to the left branch of the portal vein. (MCQ Point )

Author : DrShiviMudgal

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

Ligamentum teres hepatis (MCQ)

MCQ 143

Q. Ligamentum teres hepatis normally and usually joins to which of the following ?

a. Right branch of portal vein

b. Left branch of portal vein

c. Hepatic vein

d. IVC

ANSWER:

MedicoNotebook - Founder : DrShiviMudgal , Co-Founder : DrAyushGoel

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