digitalis

DIGITALIS

·         Digitalis acts in atrial fibrillation by:- Increase in AV node refractoriness.

·         Major electrophysiological effect of digitalis is: 1) hyperpolarization

                                                                                                   2) shortening of atrial action potential

                                                                                                   3) increase in AV node refractoriness.

·         Increase in AV node refractoriness is also responsive for termination of reentrant arrhythmias involving the AV node.

·         Inhibition of Na+  K+ ATPase is responsible for inotropic action of digitalis.

 

ANTIANDROGENS:- Danazol , Cyproterone acetate , Flutamide

ANTIESTROGEN:-Clomiphene citrate , Tamoxifen citrate

ANTIPROGESTINS:-Mifepristone (RU486)

 

Even in large dosages used in malaria, quinine does not cause toxicity because :-elevates plasma alpha1 acid glycoprotein .

About quinine:-

·         It is an erythrocytic schizontocide.

·         Used for t/t of multidrug resistant strains of P.falciparum

·         Associated with a triad of dose related toxicities-  a)cinchonism b)hypotension c)hypoglycemia

TIANEPTINE

·         5 HT1 uptake enhancer

·         Atypical  antidepressants

·         Neither sedative nor stimulant

·         Other atypical antidepressants are – trazodone , mianserin

classification of OVARIAN TUMOR

1.       EPITHELIAL

·         Serous

·         Mucinous

·         Endometrioid

·         Brenner

·         Mixed

2.       SEX CORD STROMAL

·         Granulose cell

·         Theca cell

·         Fibroma

·         Sertloli Leydig cell (androblastoma , arrhenoblastoma )

·         Gyandroblastoma

3.       GERM CELL

·         Dysgerminoma

·         Endodermal sinus tumor

·         Embryonal carcinoma

·         Poly embryoma

·         Chorio carcinoma

·         Teratoma

·         Struma ovary

·         Carcinoid

4.       GONADOBLASTOMA

5.       METASTATIC TUMOR

 

HENOCH SCHOLEIN PURPURA

  • purpura in Henoch scholein purpura is due to vasculitis and not due to thrombocytopenia.
  • small and medium sized vessels involved.
  • usally seen in children (infact it is the most common small vessel vasculitis in children ).
  • vasculitis is caused by immune complex deposition.
  • most common antibody seen in these immune complexes is IgA(IgA levels are elevated.)
  • platelet count is normal
  • sr complement level is normal
 

clinical pentad of TTP

  1. Microangiopathic Hemolytic Anemia (Coomb's negative) :- Haemolysis , Fragmentation of RBC's , Increased LDH (elevated due to intravascular hemolysis)
  2. Thrombocytopenia :- ( due to consumptions of platelets)
  3. Decreased renal function:-(due to deposits in the Renal Vasculature)
  4. Disturbed NEUROLOGICAL function:-characteristically diffuse and non focal eg-confusion,aphasia,alteration in consciousness
  5. Fever
 
 
 

Advantages of PRAZOSIN

Prazosin (selective a1 blocker)
Advantages:-
------------------
  • improved carbohydrate metabolism
  • symtomatic improvement in PVD and BPH
  • favorable effect on lipid profile
  • no impairment in cardiac contractility 

PROSTAGLANDINS and their use

· PGF2a (carboprost) ---- abortifacient , postpartum hemorrhage

· Latanoprost ----- glaucoma

· PGE2 (dinoprost) ----- induction of labour , abortifacient , bronchodilator , cervical ripening

· PGE1 (alprostadil) ---- to maintain patency of ductus arteriosus , intravenous injection for impotence

· PGE1 (misoprostol) ---- gastric peptic ulcer NSAID induced

· PGI2 (epoprostinol) ---- to avoid damage to platelets , primary pulmonary hypertension

Alkaline Phosphatase-importance in bone diseases

sources of Alkaline Phosphatase-
  • bone
  • intestine
  • liver
  • placenta
importance of alkaline phosphatase in bone disesese:
-----------------------------------------------------------------------------
  • Serum alkaline phosphatse is the most valuable enzyme for assessment of bone disesases and serves as index of osteoblastic activity.
  • Increased level of alkaline phosphatase are seen in-
                         a.Pagets diseases:-level of alkaline phosphatase are higher in Pagets disease than in any other condition. (excpt hereditary hypophosphatasia).
                         b.Hyperparathyroidism:-serum alkaline phosphatase may be raised depending upon degree of involvement of bone. 

ECG

Hyperkalemia
  • narrowing and peaking of T waves
  • AV conduction  delay
  • diminution of P waves
  • prolonged PR interval and widening of QRS interval
  • sine-wave pattern
Hypokalemia
  • flattening or inversion of T waves
  • prominent U waves
  • ST segment depression
  • prolonged QU  interval
  • severe hypokalemia-prolonged PR interval, decreased voltage and widening of QRS complex
Hypermagnesemia
  • changes similar to those of hyperkalemia
Hypomagnesemia
  • changes similar to those of hypokalemia
Hypercalcemia
  • shortening of QT interval
Hypocalcemia
  • prolongation of QT interval
Uraemia
  • changes similar to those of hypocalcemia in association with hyperkalemia
Hypothermia
  • prolongs repolarization, usually with a distinct convex elevation of the J point ( Osborn Wave)
Pericarditis
  • in acute phase , there is ST segment elevation with convexity upwards diffusely in all leads except aVR and there is no reciprocal ST depression.
Digitalis effect
  • the T wave is flattened at therapeutic levels and there is no reciprocal ST depression
SAH
  • marked QT prolongations with deep , wide T wave inversions  ( CVA-T wave pattern)
WPW syndrome
  • wide QRS , short PR interval and slurring of the initial part of the QRS (delta wave) 
Pulmonary thromboembolism
  • sinus tachycardia ( most common manifestation) , S wave in lead I , a Q wave in lead III and an inverted T wave in lead III ( S1 Q 3 T3)

IMMUNOSUPPRESSANTS

             Specific T cell inhibitor (calcineurin inhibitor)---

          cyclosporine , tacrolimus

             Cytotoxic drugs(antiproliferative drugs)---azathioprine , cyclophosphamide , methotrxate , chlorambucil , mycophenolate mofetil

             Glucocorticoids----prednisolone & others

             Antibodies----muromonab cd3 , antithymocyte globulin , rho Ig

             DRUGS CAUSING CHOLESTATIC JAUNDICE---chlorpropamide , erythromycin , rifampicin , amocillin , nitrofurantoin , methimazlole , ocp's , chlorpromazine , carbamezipine , nifedipine , verapamil

             IMP. ADVERSE EFFECTS OF ORAL HYPOGLYCEMICS-----hypersensitivity ( rashes , photosensitivity , agranulocytsis , cholestatic jaundice [ only by cholrpropamide] ) ; disulfiram like effect---chlorpropamide , not safe in pregnancy [sulfonylureas ] , secreted in mmilk

             DRUGS CAUSING HEMOLYSIS IN G6PD DEF----sulfonamides , nitrofurantoin , antimalarials eg- primaquine , chloramphenicol , cotrimoxazlole , dapsone , aspirin , phenacetin , probenicid

             ABOUT BROMOCRIPTINE------bromocriptie is a dopmine analogue which decrases prolactin release , it has greater affinity on D2 receptors , increase GH release in normal indivudals but decrease the same from pituitary tumor causing acromegaly , can be used in parkinsonism , stimulates dopaminergic receptors in ctz---therefore produces emesis

HERDITARY DISORDER---DEFECTIVE ENZYME

o   Tay sachs------------hexaminidase

o   Niemann picks------sphingomyelinase

o   Gaucher;s-----------b glucocerebrosidase

o   Alkaptonuria--------homogentisateoxidase

o   Homocystinuria----cystathion synthetase

o   Phenylketonuria---phenylalaninehydroxylase

o   Hartnup dis--------tryptophan pyrolase

o   Albinism------------tyrosinase

o   Galactosemia------galactose 1 PO4 uridyl transferaaase

o   Maple syrup urine dis------branched chain a keto acid dehydrogenase

CLASSIFICATION OF DISORDER OF SEXUAL DEVELOPMENT

• DISORDER OF CHROMOSOMAL SEX------this occurs when the no. or structure of the X , Y chromosome is abnormal. Eg---klinefelter synd 47 XXY , XX male (46XX) , turner synd (gonadal dysgenesis) 45 XO , 46 , XX/45X ; mixed gonadal dysgenesis46 , XY/45X ; true hermaphroditism 46 , XX or 46,XY or mosaics
• DISORDER OF GONADAL SEX-----disorder of gonadal sex result when chromosomal sex is normal but differentiation of the gonads is abnormal. Eg---pure gonadal dysgenesis ; dysgenetic testes ; absent testes synd
• Disorser of phenotypic sex----in these disorders the individuals with normal gonads and normal chromosomal pattern but with abnormal urogenital tract. Eg.---1.female pseudohermaphrodite---congenital adrenal hyperplasia , nonadrenal female pseudohermaphroditism , developmental disorders of mullerian ducts 2..male pseudohermaphrodite------abnormalities in androgen synthesis , abnormalities in androgen action , persistent mullerian duct synd , developpmental defects of male genitalia

LEUKOCORIA (AMAUROTIC CATS EYE REFLEX)

             Retinoblastoma

             Congenital cataract

             Inflammatory deposits in the eye

             Coloboma of the choroid

             Retrolental fibroplasia

             Persistent hyperplastic primary vitreous

             Toxocara endopthalmitis

             Exudative retinopathy of coats

             Tuberculoma of choroid

             Retinal detachment

most common

MOST COMMON
 
• Type of thyroid cancer after radiation----papillary ca
• Thyroid ca associated with dystrophic calcification---papillary ca
• Psammoma bodies are seen in---papillary ca
• Orohan annie eyed nuclei are seen in---papillary ca
• Best prognosis of which thyroid ca---papillary ca
• Type of thyroid cancer assoc with MEN synd---medullary ca
• Thyroid ca assoc with amyloidosis----medullary ca
• Latent period for radiation induced thyroid ca----about 30 years
• Ca derived from the C cells of thyroid----medullary
• Benign tumour of salivary gland-----pleomorphic adenoma
• Tumour of major salivary gland-----pleomorphic
• Tumour of minor salivary gland-----malignant tumour
• Site of pleomorphic adenoma in parotid is----superficial lobe
• Common in female----pleomorphic adenoma
• Type of malignant melanoma----superficial spreading
       type
 
• Most malignant type of melanoma------nodular type and acral lentiginous melanoma
• Most common site of malignant melanoma---
                                  in female----lower leg
                                  in male-------front or back of trunk
                                  of lentigo maligna melanoma----face
                                  of acral lentiginous melanoma----- sole of foot
• Least common type of m.m.---------lentigo maligna melanlma
• Least malignant type----------lentigo maligna melanoma
• Most common pure malignant germ cell tumor of the ovary ---dysgerminoma
• Abdominal tumour in children----neuroblastoma
• Tumour in children-----brain tumor
• Post fossa tumor in child---astrocytoma
• Tumor in infant---neuroblastoma
• Lung ca—SQAMOUS CELL CA---mc lung ca in india , cavitates , best       prognosis , central in location , hypercalcemia d/t PTH like substance
                     ---ADENOCARCINOMA---mc lung ca in the world , young pt , metastasize to opposite lung , thrombophlebitis , peripheral in location
     SMALL CELL CA---mc histologic variety to metastasize , clubbing least common , worst prognosis , most responsive to chemotheray , most responsive to radiotherapy , cushing's synd
     LARGE CELL CA---gynaecomastia
 
• Most common fibroma-----intramural ( 75 %)
• Most frquent complication during pregnancy----red degeneration
• Most common age group affected----20-30 years
• Most common menstrual symptom seen-----menorrhagia
• Least common complication-----sarcomatous change ( 0.5 %)
• Mc symptom of genital tuberculosis----hematogenous
• Mc site of genital tb----fallopian tube
• Mc route of transmission of genital tb---hematogenous
• Mc Posterior fossa tumor in childhood------cerbellar astrocytoma
• 2nd mc posteriorfossa tumor in childhood--- medulloblastoma
• CMV is the mc opportunistic infection in a renal transplant [ or any transplant ] patient.

BIOCHEMISTRY

ENZYME DEFICIENCY

HMG CoA reductase---cholesterol synthesis
 Phosphofructokinase---glycolysis
Acetyl CoA carboxylase---fatty acid synthesis
 Tyrosinase hydroxylase---catecholamine synthesis
 7 alpha hydroxylase---bile acid synthesis
Glycogen synthtase---glycogen synthesis
 Glycogenphosphorylase---glycogenolysis
 Carbamoyl transferase---urea synthesis
 HMG CoA synthetase---ketone body synthesis
 Isocitrate dehydrogenase---TCA cycle

RADIOLOGY

 IMP RADIOLOGICAL FEATURE
• Spider leg appearance----polycystic kidney
• Cobra head appearance---ureterocele
• Flower vase appearance of ureters---horse shoe kidney
• Sandy patches---schistosomiasis of bladder
• Soap bubble appearance---hydronephrosis
• Apple core lesion on barium ---ca colon
• Claw appearance on barium enema—intussusception
• Saw tooth appearance----diverticula of colon
• Birds beek appearance of esophagus on ba meal---achalasia
• Cork screw appearance of esophagus on barium meal---diffuse esophageal spasm
• String sign of cantor----crohn's dis
• Thumb printing sign---ischemic colitis
• EGG SHELL CALCIFICATION----silicosis , sarcoidosis , scleroderma , histoplasmosis , amyloidosis , lymphoma following radiotherapy