Gall Bladder Stones

                              WES triad-   Wall     of the gall bladder

                                                     Echo     of the stones

                              post acoustic  Shadow of the stones

                              

                            CAUSES OF 

         RADIO OPAQUE MATERIAL IN BOWEL

C                           H                 I                 P                             S

Chloral hydrate          Heavy               Iron            Phenothiazines       Salicylates

                                   metals

                                   

                        Drug Induced Prolactin Hypersecretion

SRI              : Serotonin Reuptake Inhibitors 

Psycho        : Atypical AntiPsychotics

     who takes

                        Opiates

     and

                       Oestrogens

IMIgrated   : Imipramines

   to

Hyderabad  : H2 Antagonists

     from

CALcutta    : Calcium Channel Blockers

     for a 

CAT            : Catecholamine depletors (Reserpine)

(And of course the DOPAMINE related drugs which we can figure out ourselves and would'nt need a mnemonic for.. :P )

    

                               J shaped SELLA seen in:

A - Achondroplasia

B - Bone metabolism disorder (Hajdu-Cheney syndrome)

C - intracellular Arachnoid Cyst

LEAVE D, E, F

G - Optic chiasm Glioma

H -  Congenital Hypothyroidism

I - PItuitary tumour

LEAVE J, K, L

M - Mucoplysaccharidoses (Hurler's syn)

N - Neurofibromatosis

O - HydrOcephalus (mild)

                DRUGS CAUSING DIABETES MELLITUS

             BeTa CeLls PRoduce INSulin

                                       Be  Beta agonists

                                        Ta   Thiazides

                                        Cells   CLozapine

                                        PRoduce    PRotease inhibitors, Phenytoin

                                         I    INF- alpha

                                         N    Nicotinic acid

                                         Sulin   Steroids

Borrelia Burgdorferi

Borrelia   - Remember  Bored for Borrelia

When u r bored u BAKE  a Burger (Burgdorferi) and drink Limca (Lymes disease) t

B-Bells palsy
A-Arthritis
K-Kardiac block
E-Erythema Migrans(Bulls Eye)


When u r bored u buk movie TICKets(Tick Borne) At ImaX (Ixodes tick) and eat BULLS EYE(erythema migrans) ice cream at imax 

Life cycle of tick (ixodes) 

Nymphs in mice and adult Ticks in deer

Erythema migrans typical BULL EYE red rash

annular spreading skin lesion with an erythematous leading edge and central clearing

INFECTIVE ENDOCARDITIS

A common mnemonic for the signs and symptoms of endocarditis is FROM JANE:
Fever
Roth's spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail hemorrhage (splinter hemorrhages)
Emboli

Janeway lesions

 Janeway lesions (nontender, macular lesions most commonly involving the palms and soles). Janeway lesions occur more frequently in endocarditis caused by Staphylococcus aureus. Janeway lesions are caused by septic emboli. Subcutaneous abscesses are found on histologic examination.

Oslers nodes

Osler nodes: Osler’s nodes are painful, palpable, erythematous lesions most often involving the pads of the fingers and toes. Caused by immune complexes

Roth spots

Roth's spots are retinal hemorrhages with white or pale centers composed of coagulated fibrin.

Roth spots are also due to immune complexes (immune vasculitis)

Splinter haemorrhage

Splinter Haemorrhages are narrow, red to reddish-brown lines of blood beneath the nails. 

They run in the direction of nail growth and are named splinter hemorrhages because they look like a splinter beneath the fingernail. 

The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails or  by vessel damage from swelling of the blood vessels (vasculitis). 

The most common cause for splinter hemorrhages is .trauma to the nail

DUKES CRITERIA

BE FEVEER
(*BE - Bacterial Endocarditis)

Major:
B = blood culture +ve >2 times 12 hr part 
E = Endocardial involvement from Echo 


Minor:
F = Fever 
E = Echo findings (not fulfilling a major) 
V = Vascular findings
EE = Evidences from microbiological/immunology (2 evidences)
R = Risk factors/predisposing factors - drug abuse, valvular diseases

RHEUMATIC FEVER

Rheumatic fever: Jones criteria · Major criteria: CANCER:
Carditis
Arthritis
Nodules
Chorea
Erythema
Rheumatic anamnesis
· Minor criteria: CAFE PAL:
CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism(Previous RF or RHD)
Leucocytosis

 Erythema marginatum  A long-lasting reddish Rash that begins on the trunk or arms as  macules which spread outward and clear in the middle to form rings, which continue to spread and coalesce with other rings, ultimately taking on a snake-like appearance. This rash typically spares the face and is made worse with heat.

Subcutaneous nodules: Painless, firm collections of collagen fibers over bones or tendons. occur commonly on extenor surfaces

    PANCREATITIS IS SEEN IN ( GET SMASHed)

                                 G  Gall stones

                                 E   Ethanol

                                 T   Trauma

                                S    Steroids

                               M    Mumps

                              A      Autoimmune d/s

                               S      Scorpion sting

                               Hed   Hyperlipidemic drugs

Got this from first aid flash cards... i'll create sumthng new tmw:p

LFT : SGOT vs SGPT, Direct BR vs Indirect BR

SGOT = AST,        SGPT = ALT

SGOT is elevated in alcholic hepatitis.
I always get confused between the two. Here's how to remember: When you drink alcOHOL, you get hepatitis and your liver gets HOLes. So there are more HOLEs in SGOT - That's why SGOT is present in mitOchOndria and cytOsOl. SGPT is present only in cytosol.

To remember SGOT = AST and SGPT = ALT, strike out the common letters on both sides. You get O = S and P = L. Now remember "The OS (operting system) of your life gets corrupted with alchol". Remember OS for O=S --> SGOT = AST.

The other confusion is between Direct and Indirect bilirubin. Which is more? The level of Indirect is more - remember the number of letters in 'Indirect' are also more as compared to 'Direct'. Indirect = Unconjugated BR.

TUBEROUS SCLEROSIS

Hamartomatous lesion-Astrocyte proliferation appears like candle stick drippings in ventricles

Angiomyolipoma in kidney

Rhabdomyoma in heart 100 % predictive of tuberous sclerosis

SYSTEMIC FUNGI

 Systemic fungi -     Blast His Coccyx
                                           Blast          BLASTOMYCES
                                           His             HISTOPLASMA
                                          Coccyx      COCCIDIODES
              
All systemic fungi are dimorphic
Cold(20) =Mold
Heat (37)=Yeast                            
All systemic fungi cause pneumonia

Blastomyces-      Broad Based Buds
                            Forms Granulomatous nodules 

                                                              

  2nd figure above shows broad based buds with double refractile cell wall (not capsule)   
                                 
 Histoplasma  -   Hides in Macrophages
                           Hepatospleenomegaly
                           Healing Calcifies lesions

histoplasma yeast forms in alveolar macrophages

Histoplasma Macro and Micro conidia

Coccidiodes -  case rate increases after Earth Crack(quake) 
                        Causes Meningitis 
                         Arthroconidia inhaled forms Sperules with                                  
                         Endospores in body 

Histoplasma In Macrophages smaller than RBC 
                             

Blastomyces  buds same size as RBC

Coccidiodes Spherules with endospores much larger than RBC

Classification of bacteria

                                     Gram positive
     Cocci - Aerobic    
                                     Staff
                                     Strep

      Rods - Aerobic
                                     Love    - Listeria
                                     Boiled  - Bacillus
                                     Corn    - Corneybacteria
                                     iN        - Nocardia
                                     Movie  - Mycobacteria
                                     Love Boiled Corn  iN  Movie
      Rods -Anerobic    
                                      C - Clostridium
                                       L - Lactobacillus
                                       A - Actinomyces
                                       P  -Propionobacterium
                                        CLAP
                                                       Gram Negative

       Cocci- aerobic      

                                        Nesseria
                                        Moraxella
       
          Rods -Aerobic        Pseudo           Pseudomonas
                                         Brucele           Brucella
                                         Boarded         Bordatella
                              flight 2 France            Francisella
                              For     Legion Movie  Legionella
                                      Pseudo Brucele Boarded flight to France for Legion movie
   
       Rods -Aerobic Helecal (Curved) - Helicobacter,Campylobacter

        Rods -Facultative Anerobes
                                        PHone       Pasteurellaceae
                                        Enters        Enterobacteriaceae
                                        Vibration    Vibrionaceae
                            Facultatively Phone Enters Vibration 

                                Pasteurellaceae- PHone    -Pasteurella,Haemophilus

                                Enterobacteriaceae-She   - Shigella
                                                               PutS - Proteus,Serratia
                                                               KEYS-Klebsiella,Escherichia coli,Yersinia,, Salmonella
                                                             2 Enter -Enterobacter

      Spirochetes     B-Borrelia
                             O
                             L-Leptospira
                             T-Treponema

                                                   BOLT has SPIRAL grooves so   

    Rickettsiaceae    RBC-Erythrocyte
                              R-Rickettsia
                              B-Bartonella
                              C-Coxiella
                               E-Ehrlichia
   
   Chlamydiacea

    Mycoplasmataceae      
                                       



                                                           

HLA subtype associated diseases

HLA diseases are mainly due to

            HLA A ,  HLA B, HLA DR

           

B27      P  soriasis 

             A  nkylosing spondylitis                 

             I   nflammatory bowel disease                
             R  eiter's syndrome.              
              PAIR

B8       Graves disease
             In GRAVE yard  maggots BITE (B8)
            so grave is B8

DR2    HeY  - Hay fever

            M     - Multiple sclerosis           
            S       - SLE           
            G      -Goodpasture's

            HeY     MSG    abt appointment  TO DR (DR2)

            

DR4    Rheumatoid arthritis

            remember it this way ,one kind  of joint we
            have at 4 places 

            ex- rt and lt shoulder plus  rt and lt hip joint     
            so total 4 

            DR4  is RA                  

            

DR5     Hush       -Hashimoto's thyroiditis

             Puppies  -Pernicious anemiaB12 deficiency,

             Hush   Puppies  Is a       Foot wear

             Hashimoto  perinicious   FIVE(DR5)

DR7     Steroid respnsive              nephroticsyndrome

             7th sense says that Nephrotic syndrome  
              respond to steroids

              DR7 Steroid Respnsive Nephrotic syndrome

  
DR3,4   Diabetis melitus type1
              

A3       Hemochromatosis

            Iron has +3 charge (fe+3)

            A 3 is Haemochromatosis

• 
  

IMMUNE DEFICIENCY DISORDERS 

classified into 

1.Phagocytic defects

2.B cell defects

3.T cell defects

4. Combined T cell and B cell 

5.Complement disorders 

A.Phagocyte defects

There are three phagocyte cells defects all start with 'C'

1.Chronic granulocyte disorder

deficiency of NADPH oxidase enzyme,infection with CATALASE positive org

'C'GD - 'C'ATALASE positive infection

2.Chediak Higashi syndrome  

granulocyte structure defect results in 

1. occulocutaneous  albinism(partial) due to defect in melanin granules

 2.basic microtubule defect causes lysosomal granules to fuse causing abnormal giant granule formation 
 This image below  shows a normally segmented neutrophils with giant azurophilic granules.

peripheral neuropathy

higashi eating PAN   Pyogenic infections

                                  Albinism
                                  Neuropathy

3.CD 18 absence (leukocyte adhesion defect)

• a common beta chain of leukocytes  integrin, recurrent chronic infections  ,failure to form pus and donot reject umblical cord stump                 

                               

at 18 yrs we start adhering to love life  ;)
 CD 18                                   leukocyte adhesion

B.B cell Diseases

there are 4 important  b cell diseases and all  have either hypo gammaglobulinemia or Ig in their name 

1.Bruton X linked "hypogammaglobulinemia"

 It is due to deficiency of tyrosine kinase so B cells dont mature , so no mature b cells in blood

Bruton is an          immature             boy
B cell           maturation defect     xlinked so more common in boys

2.X linked hyper"IgM "syndrome 

deificiency of CD40 ligand on t cells so no class switching of Igs only IgM titers no other antibody found 

  remember this way  X(girls ) linked Manohar conducts internals for 40 marks  (CD 40)

3.Selective "IgA" deficiency 

deficiency of isotype switching to IgA so we find sinopulmonary  and GIT diseases  (think mucosa) .if blood transfusion done in these pts they develop anaphylaxis by forming antibodies to IgA of donors blood 

4.Common variable B cell disease  occurs in late 20s associated with autoimmune diseases

C.T cell Diseases  

I Love 2 get JOB or will DIe

   IL2            JOB               Digeorge

1.Digeorge syndrome -thymic aplasia -22q11 chromosome defect

failure of 3rd and 4th pouch development so hypocalcemia and absent thymus

2.JOB syndrome (hyper IgE syndrome) 

only Educated get job so  JOB hyper Ig"E"

th cells fail to produce IFNgama so neutrophils dont respond to chemotactic stimuli 

"FATED" to get JOB 

F facies coarse

A Abscess

T Teeth retained primary teeth

E hyper IgE

D Dermatological Eczema 

3.IL2 receptor deficiency

D. Combined t cell and b cell 

CID saw Wiskot  And Aldrich at ATM 

1.SCID

severe combined immune deficiency  due to deficiency in adenosine deaminase,failure to produce MHC class 2,IL2 receptor def

2.Wiskot Aldrich syndrome

x linked reccesive,def in  cytoskeletal glycoproteins results in deletion of t cells and b cells 

wiskot and aldrich wear "TIE"  T Thrombocytopenic purpura

                                                I  Infections

                                                E eczema

Wiskotand aldrich wear TIE

3.Ataxia Telengiectasia     

due defect in ATM gene required for DNA repair patients have ataxia ,telengiectasia and IgA def

ATM are always under repair SO ATM Gene DNA repair

E.Complement Deficiency

1.Deficiency of C5 To C9 causes  Nesseria infections

c5 to c9 forms membrane attack complex and is defence against gram negative bacteria

C 5 to C9 (5 +9) is  14.letter N is 14th so 'N'eisseria

2.Deficiency in C3 causes pyogenic bact inf and immune complexe diseases 

immunecomplexes formed by three components 1.antigen 2.antibody 3.compliment binds 1 and 2
so C3 def associated wid immune complexes diseases

3.Deficiency of C1 esterase causes hereditary angioedema

4.Deficiency of Decay activating factor DAF causes Paroxysmal nocturnal haemoglobinuria 

 

HB decays(DAF) In NYT (Paroxysmal NOCTURNAL Hbnuria)  

DEFICIENCY OF B CELLS CAUSE  diseases by 1.Capsulated microbacteria 

2. Enteroviral encephalitis and 

3.Giardiasis

2 and 3 are due to absence of mucosal defence IgA

DEFICIENCY OF T CELLS CAUSES 

More of FUNGAL And VIRAL INFECTIONS

DEFICIENCY OF COMPLEMENT CAUSES

diseses with nesseria both meningococcus and gonococcus