SURGERY

RECTAL PROLAPSE
Perineal-
Thiersche cerclage
Altemier’s procedure
Delorme procedure
Abdominal-
Ripstein rectopexy
Wells

SPLIT/ THIERSCH FULL / WOLFE

Site:

Contracture:

Cosmesis:

SIRS –2 or more +:

Core Temperature ˂36oC or ˃ 38oC

HR >90bpm
RR ˃20/min or Pco2 ˂32 mmHg
WBC count ˃12,000 /μL, <4000/μL, 10% bands
Appropriate mesh for use in hernioplasty:
Adequate thyroid FNAC sampling:
Max risk of malnutrition in fistula:
Waxing waning jaundice:
Class 2 hemorrhagic shock:
Inability to extubate post thyroid surgery-
Hypocalcemia post surgery-
Rigler triad:
LN removed: GB CREStomach

Blind testicular vessels/ B/L UDT with negative HCG:

Operate torsion within:
Perineural invasion:
Sign in-Time out-Sign out
Thoracoscore-Not complication of surgery
Ideal graft for vascular repair:
MCC of intra-op thyroid storm
SBO vs LBO first organ to see:
MYOPECTINEAL ORIFICE:
Sup:Conjoint tendon
Lat: Iliopsoas muscle
Med: Rectus sheath
Inf: Lacunar ligament
CO SVR CVP

Cardiogenic

Hypovolemic

Obstructive
Luminal HER2 TNBC
Distributive (ER+, PR+) (HER2+) (ER-, HER2-)
Ki67:Low Ki67: High Ki67: High Ki67: High
Neurogenic HER2 - HER 2 -/ +

Latest ATLS burns:

Adults:
<14yr:
Electrical injury:
 BISAP Score
BUN • BUN ˃ 25 mg/dL (8.9 mmol/L)

Impaired mental status • Glasgow coma score ˂ 15

SIRS • Evidence of SIRS

Age • Age ˃ 60 years old

Pleural effusion • Pleural effusion

INTEGRATED SYSTEMS-
MEDICINE
 Intravascular hemolysis
Pancytopenia
Thrombosis-Budd Chiari
syndrome
LAP score low
Aplastic anemia, Leukemia
Rx-Eculizumab

IDA vs Thalassemia minor

Mentzer index
RDW:
Confirmatory test for thalassemia minor:

Glu -> Valine:

Glu -> Lysine
Chr 16 deletion:
Chr 11 Splicing mutation NS1-5 G-> C:
RA: Acute Gout
DOC in pregnancy: NSAIDS
BIOLOGICALS in RA Colchicine
TNF-apha inhibitors: Chronic gout:
Adalimumab Tophi/ stones/ >2 attack/year
Certolizumab DOC:
Etanercept AVOID WITH:
Infliximab
Golimumab
IL-1R Antagonist:
IL-6 inhibitor:
B-cell depletor/CD20-:
Co-stimulation inhibitor/CTLA4-:
JAK inhibitors: Tofacitinib, Baricitinib
 Subtype Features Electrodiagnosis

Acute inflammatory anti GM1 antibodies Demyelinating

demyelinating polyneuropathy
(AIDP)
Acute motor axonal Children and young adult; Axonal
neuropathy (AMAN)
anti -GD1a antibodies
Acute motor sensory axonal Mostly adults; recovery Axonal
neuropathy (AMSAN) slow, often incomplete
Miller fisher syndrome (MFS) Ophthalmoplegia, ataxia, Axonal and
3Hz Spike and slow wave pattern and areflexia demyelinating

Anti GQ1b antibodies

(90%)
3-6 Hz generalized polyspike and
wave discharge GBS Rx: IVIG + PLASMAPHERESIS
STEROIDS
Class Description

I Normal Sx w/ physical activity

Normal functional activity

II Mild limitation of physical activity

Ordinary physical activity causes symptoms

III Marked limitation of ordinary physical activity

Less than ordinary activity causes Symptoms

IV Severe symptoms
Breathless at rest
Pacemaker of breathing:
Golgi tendon:
Baroreceptor:
Most sensitive to
Location:
Chemoreceptor:

Bainbridge reflex

Bezold-Jarisch reflex

J Reflex: Apnea followed by rapid breathing, bradycardia, and

hypotension due to J receptor (C-receptor, juxta-pulmonary capillary
receptor) stimulation

Weber-Fechner law
 Preload reduce ( Valsalva/Standing): DYSLIPIDEMIC DRUGS:
Statins-HMG coA reductase inhibitor
Preload increase ( Passive leg raise / Squatting):
Ezitimibe-Absorption –
Afterload reduce ( amyl nitrite): Fibrates-PPAR alpha –
Niacin-HSL –
Afterload increase (Handgrip): Alirocumab, Evolocumab-PCSK9-
INCLISIRAN: PCSK synthesis -
Inspiration: Lomitapide: MTP –
JAI VIGYAN MISSION MODE PROJECT Anacetrapib: CETP –
Mipomersen: Apo b100 antisense
Evinacumab: AL3p

CURB-65 Scoring

Symptom Points
Antiarrhythmic drugs Confusion 1
I Urea: BUN>19 mg/dL (>7 1
IA: K-: Quinidine, Procainamine, Disopyramide mmol/L)
Respiratory rate>30 breaths 1
IB: K +: Lignocaine, Phenytoin
IC: K no: Fleicanide, Propafenone /min
Systolic BP <90 mm Hg or 1
II
III-Amiodarone, Ibulitide Dofetilide, Sotalol diastolic BP <60 mm Hg
IV Age> 65 years 1
Adenosine
If chest wall removed:
 PaO2 normal Obesity +
during day Hypoventilation
PaCo2 high during
day and night

RV:
Body plethysmography
Helium dilution
N2 washout method
K Ca pH Nephrolithiasis
 Stomach-4
Duodenum-12
Jejunum-11
Ileum-8
Cecum-2
Sigmoid-6

Alcoholic + ANA, SMA:

CK 8/18 LKM-1, SLA, LC:
Intermediate
filaments
G-protein Receptor and Second
pathway ligand messenger
G- protein (Gq-alpha “Hav1 M and M - ↑IP3
subunit) GOT” ↑DAG

G-protein (Gs-alpha FSH, LH, ACTH, TSH, ↑cAMP

subunit) CRH, hCG, ADH-V2,
MSH, PTH,
Calcitonin, H2,
Glucagon, GHRH All
B receptors
G-protein (Gi-alpha MAD 2 ↓cAMP
subunit)

Receptor Guanyl “BAN” ↑cGMP

cyclase

Metabolic syndrome: NCEP-ATP III

1. Central obesity:
>102 cm (India-90cm) in men
>88 cm (India-80cm) in women
2. Elevated triglycerides: >150 mg/dL
3. HDL
< 40 mg/dL in men
< 50 mg/dL in women.
4. Blood pressure: >130/85 mm Hg
5. Fasting glucose: >100 mg/dL
 Agent Mechanism of action Side effects
Sulfonylureas Increases insulin secretion by inhibiting B- Hypoglycemia , Weight gain
Chlorpropamide cell K+ ATP channels Chlorpropamide:
Glipizide, Glyburide
Meglitinides
Repaglinide, Nateglinide
Biguanides Stimulates AMP kinase, decreasing insulin Lactic acidosis, Weight loss, Vit B12 deficiency
Metformin resistance Max reduction in HbA1c
Thiazolidinediones Activates transcription regulator PPAR-g, Weight gain, Heart failure, Hepatotoxic,
Pioglitazone decreasing insulin resistance Fractures
Rosiglitazone Risk of bladder cancer -
MI-
GLP-1 agonists Increases glucose- dependent insulin Increase satiety, Weight loss
Exenatide, Liraglutide-SC secretion, decreases glucagon secretion, Pancreatitis –
Semaglutide-Oral delays gastric emptying Nasopharyngitis-
DPP4 inhibitors * Safe in renal failure:
Sitagliptin, Linagliptin
Amylin Analogue Decreases glucagon secretion, delays Increase satiety
Pramlintide gastric emptying
α-glucoside inhibitors Reduces intestinal disaccharide Diarrhea, Flatulence
Acarbose , Miglitol absorption CI in IBD
SGLT2 Inhibitors Increases renal glucose excretion Urinary tract infections , Polyuria (osmotic
Canagliflozin, Dapagliflozin diuresis)
Weight loss
Riluzole
Edavarone
Sodium phenylbutyrate-Turursodiol
Tofersen
PATHOLOGY
Tumor markers AND IHC Amyloidosis Fibril protein
AFP Primary amyloidosis
HCG Secondary amyloidosis
CD30- Dialysis-related
LDH, PLAP, HCG, OCT3/4, NANOG- Alzheimer disease
Call-Exner bodies, FOXFL2- Type 2 diabetes mellitus
CA 15-3, CA 27-9 Medullary thyroid cancer
CA-19-9 Isolated atrial
CA 72-4 amyloidosis
NMP22 Systemic senile
MIB1/Ki67 amyloidosis
MIC2/ CD99 Amyloid polyneuropathy
Cytokeratin-
Vimentin
Desmin-
Squamous cell-
Small cell/Neuroendocrine-
Adenoca-

Aflatoxin-
Arsenic
Vinyl chloride
Aromatic dyes (Benzidine)-
Benzene-
1L-2, IL-12, INF-G:
IL-4, IL-5, IL-13:
IL-1, IL-6, TNF-A:
1L-10, TGF-B, Lipoxin:
IL-8, C5a, LTB4:
C3b, IgG:
CD16, 56, 94:
1L-2, 1L-12, 1L-15:
CD41, 42, 61:
CD38, CD 138
Daratumumab
Leukocyte common Ag:

Terminal comp /MAC def:

CD55/59 deficiency:
C1 INH def:
Thrombocytopenia Facies
Infections Abscess-Cold
Eczema- High IgE Teeth
Eczema-IgE high

Bombay blood Delayed separation of

group cord
Recurrent infections No pus
since Birth
Absent germinal
centers/ thymus ABSENT CD40:

Lyst, Light
Microtubule
Neurodegeneration
phagOlysosome
Platelet, Neutrophil dense granules
PHYSIOLOGY
D20 / T20/ Antipyrine During contraction:
Prominent-
Disappear-
Shorten-
Constant-

RISA
Evans Blue
(T-1824) Na: +60 mV
Ca: +100 mV
Mannitol
Sucrose
Inulin
Cl: -70mV
Na thiosulfate
K: -90V
PHARMACOLOGY
 Enzyme inducers Enzyme inhibitors CYP2C19:
All anti-epileptics except Ciprofloxacin, Erythromycin, CLOPIDOGREL
valproate Chloramphenicol Ketoconazole
CYP2C9:
All anti-tubercular drugs Amiodarone, verapamil, WARFARIN
except isoniazid diltiazem /PHENYTOIN

Griseofulvin Omeprazole, Cimetidine

Nevirapine
Smoking, Chronic Ethanol Ritonavir
Grape juice
Schedules:
Under medical supervision: Essential drugs :
With prescription only: Cost effective
Cannot be treated: Prevalent diseases
Addictive potential: Available easily
Category X: No combination
Full agonist: Morphine, Heroin, Meperidine, Methadone, Codeine, Fentanyl
Partial agonist: Buprenorphine

Mixed agonist/antagonist: Nalbuphine, Pentazocine, Butorphanol

Antagonist: Naloxone, Naltrexone
 TABLE OF DRUGS NOT EFFECTIVE AGAINST MICROORGANISMS
MYCOPLASMA Cell wall inhibitors (beta-lactams, vancomycin)
PSEUDOMONAS Vancomycin
ANAEROBES Aminoglycosides
MRSA Beta lactams (except fifth generation cephalosporins)
SALMONELLA Aminoglycosides

VRSA: Anti-obesity Approved Drug Typical Study Sample Purpose

Linezolid drugs: Trials
Daptomycin Phentermine + topiramate Phase I Small number of healthy “Is it Safe?”
Quinpristine-Dalfopristine Bupropion + zonisamide volunteers Assesses safety, toxicity,
Ceftarolin Liraglutide pharmacokinetics, and
Semaglutide pharmacodynamics.
SICKLE CELL ANEMIA:
Tirzepatide Phase Moderate number of “Doses it work?”
Glutamic acid
Orlistat, Cetilistat II patients with disease of Assesses treatment efficacy, optimal
Hydroxyurea interest dosing, and adverse effects.
Voxelotor
Phase Large number of “Is it an Improvement over existing
Crizanlizumab
III patients randomly drug?”
Cyclophosphamide
assigned
Busulfan
Bleomycin Phase Post marketing “Can it stay?”
Vincristine Carmustine IV surveillance of patients Detects rare or long-term adverse
Bleomycin Methotrexate after treatment effects
L-aspararginase Amiodarone (e.g., black box warnings)
 DOC
Septic shock, Neurogenic shock
Cardiogenic shock-refractory

Cardiogenic shock

Cardiogenic shock + oliguria

CPR, Anaphylactic shock

Postural hypotension

Spinal induced hypotension

NEW DRUGS Matzke normogram
Vismodegib
Vemurafenib
Gefitinib, erlotinib : L858R mutation
Osimertinib : T790M mutation
Emicizumab:
Belimumab:
Teprotumumab:
Sparsentan:
Elacestrant, Fluvestrant:
Teplizumab:
Omavexolone:
Palivizumab, Nirsevimab:
Ravulizumab, Rozanolixizumab:
Daprodustat:
Vanoprazan:
PEDIATRICS
 NADA’S CRITERIA
MAJOR MINOR
1. Systolic murmur ≤ Grade 2
1. Systolic murmur Grade ≥ 3
2. Abnormal Second hear sound
2. Diastolic murmur
3. Abnormal ECG
3. Cyanosis
4. Abnormal Chest Xray
4. Congestive Heart Failure
5. Abnormal Blood pressure

Bone Age ˂ Chronological Age

1.Kangaroo position (skin to
skin) Bone = Chronological Age
2.Kangaroo nutrition
3.Kangaroo support
LCH: Vinblastine
4.Kangaroo discharge
Puberty:
FEMALES: MALES:
CF: Chromosome:
-MC mutation:
-MC class of mutation:
-Trikafta: Elexacaftor + Tezacaftor + Ivacaftor
 Gestational Maturation of feeding Initial feeding
age skills skills
<28 weeks Inadequate sucking IV fluids
efforts Lack of gut
motility
28-31 Sucking burst develop Orogastric or
weeks Lack of coordination nasogastric
between suck, swallow feeding
and breathing
32-34 Coordination between Spoon feeding
weeks breathing and
swallowing begins
>34 weeks Mature sucking pattern Breastfeeding

Parameters No Dehydration Some Dehydration Severe Dehydration

Appearance Well, alert Restless, irritable Lethargic, unconscious

Eyes Normal Sunken Very sunken

Thirst Drinks normally, Thirsty, drinks eagerly Drinks poorly or not able to drink
not thirsty
Skin pinch Goes back quickly Goes back slowly Goes back very slowly
(˂1 second ) (1 second) (2 seconds)
75ml/kg over 4 hours
ZINC: 14days 100ml/kg
<6mon: 10mg 30ml/kg 70ml/kg
>6mon: 20mg
Age Gross motor Milestone Age Fine motor milestone

Neck holding Bidextrous approach

Rolls over Unidextrous approach

Immature pincer grasp
Sits in tripod position
Mature pincer grasp
Sits without support
Imitates scribbling, tower of 2 blocks,
Stands without support drinks from cup

Walks alone Scribbles, tower of 3 blocks, feeds with

spoon
Runs
Tower of 6 blocks, verticular and
Walks up and downstairs, 2 feet step circular strokes, undresses

Rides tricycle, alternate feet going Tower of 9 blocks, copies circle,

upstairs dresses
Hops on one foot, alternate feet going Copies cross, bridge with blocks
downstairs
Copies triangle, gate with blocks
Age Social Milestone Age Language milestone

Social smile Alerts to sound

Recognizes mother Coos

Stranger anxiety, inhibits to no Laugh loud

Waves bye-bye, repeats activity when Monosyllables

appreciated
Bisyllabes
Comes when called, plays simple ball
game 1-2 words with meaning
Jargon, points to objects of interest 8–10-word vocabulary
Copies parents in task
2-3 word sentences, uses pronouns
Asks for food, drink, toilet Asks question
Shares toys, knows full name and
Sings song, tell stories
gender
Plays cooperatively in group, goes to Asks meaning of words
toilet alone
Helps in household tasks