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