1DERMATOLOGY

Gattrons papule, civatte bodies - Dermatomyositis Helmet cell - Anaemia of hemolytic uremic syndrome(HUS) Lisch Nodule - Neurofibromatosis Row of tumbstone - Pemphigus Vitiligo patch does not have melanocytes Honey coloured patch in impetigo. Nail involved in psoriaris, lichen planus, dermatomyositis. Oil drop nail - psOriasis Rain drop nail - aRsenic Beaus line - transverse line in nail occurs few weeks after acute illness. Paronychia- inflammed and swollen nail fold. Commonest metal to cause skin hypersensitivity is nickel. Vitamin A deficiency - Phrynoderma. Herpes zoster affects most commonly thoracic region. In pregnancy it is most common in peri-umbilical region. Cradle cap - Pityriasis capitis. Genital wart treament - Podophylium

Quinkes disease - Angioneurotic oedema Gonorhhoea does not affect testes and vaginal wall. Commonest nerve to be involved in leprosy is ulnar nerve. Tinea unguim affects nail plate. Reiters syndrome - conjunctivitis+urethritis+arthritis Acrodermatitis enteropathica - zinc deficiency Rhinophyma - Potato nose - hypertrophied sebaceous gland. Pyoderma gangreonosum - ulcerative colitis Plantar wart - Myrmecia wart Dapsone - adverse reaction - hemolytic anaemia, porphyria, dermatitis, psychosis. Type 2 lepra reaction - immune complex mediated vasculitis. Type 1 lepra reaction - due to cellular hypersensitivity. Iris pearl - leprosy Burrow is scabies occurs in stratum corneum. Scabies in children is different from adult by it also affects face. Most severe form or scabies - Norwegian scabies. Atopic dermatitis diagnosed by clinical examination. Molluscum contagiosum - umbilcated pearly white asymptomatic skin

lesion. Most potent topical steroid - Clobetasol propionate (0.05%) Exclamation mark of hair - Alopecia areata. Alopecia totalis- complete loss of scalp hair. Alopecia universalis - complete loss of body hair. Genital elephantiasis - Lymphogranuloma venerum (LGV) Auspitz sign - Psoriasis- Distal inter-phalangeal joints arthritis, HLAB27, treatment are coal tar, dithranol, calcipotriol, topical corticosteroid, ultraviolet radiation. Systemic treatment- phototherapy with PUVA, retionoids, methotrexate, cyclosporins. Lichen plannus- itchy flat topped pink purplish papule in volar (flexor) surface with Wickhams striae, and Kobners phenomenon. Pityriasis rosea- herald patch, Christmas- tree distribution, delicate peripheral ( Collarette) scale. Pemphigus vulgaris- intra epidermal flaccid bullae in trunk, flexures and scalp involving oral mucosa in middle age person with poor health. IgG to epidermal intracellular substances. Pemphigoid- subepidermal tensed blood filled bullae in flexures and rare involvement of oral mucosa in an old person with good health. IgG against basement membrane. Dermatitis herpetiformis - Subepidermal, itchy bullae in elbows, knees, upper back and buttock of an adult, with rare involvement of oral mucosa, I gG against endomysium of muscles. Vitiligo associated with auto immune diseases such as diabetes, thyroid, adrenal disorders, and pernicious anaemia.

Basal cell carcinoma- most common skin cancer, most commom site eye lid, face, Rodent ulcer( nodulo- ulcerative) with Rolled margin. Squamous cell carcinoma- most common in lip, keratotic nodule, keartin pearls, predisposed by xeroderma pigmentosa, human papilloma virus,leukoplakia. Raised everted edge, indurated base, Melanoma malignancy featured by Asymmetry, Boarder irregular, Colour irregular, Diameter more than 0.5 cm, Elevation irregular, metastasize to placenta as well.( ABCDE). Neurofibromatosis- Lisch nodule( pigmented hamartomas of iris), cafeau lait spot, axillary freckling in early childhood. Autosomal dominant. Erythyema nodosum- due to vasculitits in deep dermis and subcutaneous fat. Caused by bacteria( streptococcus, tuberculosis, and brucellosis), viruses, mycoplasma, chlamydia and fungi, drugs( sulfonamides, OCPs). Erythema multiforme - Target lesion( Bulls Lesion). Generalized pruritus - Liver disease, chronic renal failure, iron deficiency, polycythemia, hypo/hyper thyroid state, Hodgkins disease and other lymphomas. Tinea pedis - Athletes foot is the most common type of fungal infection- caused by Trichophyton rubrum, T. mentagrophites . Trichophyton - Skin, hair, nail infection. Epidermopyton- Skin and nail infection. Microsporum- Skin and hair infection. Tinea capitis- Scalp Tinea unguium- Nail

Tinea cruris- groin Tinea corporis- Body/ trunk. Tinea manuum- Hand. Colour of scrapping in Pityriasis versicolar- (?) yellow OPHTHALMOLOGY Congenital toxoplasmosis- Chorioretinitis. Lens -Developed from ectoderm, oldest part at the centre. Lens dislocation occurs in Marfans syndrome, homocystinuria, trauma. Broad day light - decreased vision in central cataract. Snowflake cataract- Diabetes mellitus. Sunflower cataract- Chalcosis Zonular cataract- Riders cataract. Trauma- Rosette cataract, lens dislocation, Berlins oedema. Follicles seen in trachoma( sago grain follicles), spring catarrh(Horner Trantas spots), adenovirus conjunctivitis (acute hemorrhegic conjunctivitis) Spring catarrh- white ropy discharge, lacrymation, itchy eye, photophobia, burning sensation, Horner Trantas spots. Treatment with steroid, acetyl cystine, sodium cromoglycate.Cobble stone appearance of conjuntiva. Normal eye IOP- 15 to 22 mm Hg. Eye ball size 23 by 24 mm square.

Average volume of eye ball 30 cc. Anterior chamber depth 2 to 3 mm Visible spectrum 400 to 700 nm Eye power 58 D. Credes method Silver nitrate 1%.(AgNO3). Papilloedema- Blurred disc margin, elevated disc, cotton wool spot, but normal vision. Caused by raised ICT. New born eye hypermetropic, tears formed at the age of 3 weeks Myopia-Near sightedness, large eye ball, image from distance falls before the retina, correction by concave lens, retinal detachment occurs as complication in high myopia. Hypermetropia- Far sightedness, small eye ball, image from near object form beyond the retina so treated by convex lens. Astigmatism- Curvature ametropia, treatment by cylindrical lens. Steroids contraindicated in chronic simple glaucoma, herpetic corneal ulcer. Tylosis- hypertrophy and drooping of eye lid. Fungal keratits- cotton cheese hypopyon, and satellite lesions. Optic foramen present in lesser wing and body of sphenoid. Ethambutol- Toxic amblyopia, optic neuritis. Chloroquine- Bulls eye maculopathy. Ulcus serpens - Corneal ulcer caused by pneumococci. Foster Kennedy syndrome- Papilloedema in one side and optic atrophy in other eye.

Indirect ophthalmopathy- Image is inverted, real and magnified. Keratometry- measures the diameter of cornea. Keratoconus best treated by contact lens. Lacrymal duct opens in inferior meatus. IOP increased by ketamine and succinylcholine. Iris Bombe- Ring synechia Dalen Fuchs nodule in sympathetic ophthalmitis is proliferation in pigment iris and ciliary body. Sympathetic ophthalmitis- bilaterlal granulomatous pan-uveitis. Aqueous humor formed by ciliary body and capillaries by secretion and ultra- filtration. Aqueous circulation-posterior chamber to pupil to anterior chamber to drainage at angle to episcleral veins. Second exit is uveo-scleral outflow. Contraindication to intra-ocular lens - young diabetics, one eyed person, overt corneal dystrophy. Yoke muscle- Synergistic muscle- e.g. right superior rectus- left inferior rectus. Paralytic squint- head position is adjusted. Diabetic retinopathy- earliest change is micro aneurysm. Vortex vein drains- Uveal tract. Commonest carcinoma in lid is basal cell carcinoma. Metabolically active layer of cornea is endothelium. Central retinal vein occlusion( CRVO) -painless loss of vision. Cherry red spot- Central retinal artery occlusion(CRAO), Tay Sachs

disease, Niemann Pick disease.. Zies gland- Sebaceous gland. Molls gland- sweat gland. Eales disease- young adult vitreous hemorrhage. Finchams test- to differentiate the acute congestive glaucoma and cataract. Thyrotoxicosis- most commonly involved extra -ocular muscle is inferior rectus. Angle closure glaucoma treatment is pilocarpine and laser iridotomy. Protanopia- red cones are absent. Deuteranopia- green cones are absent. Tritanopia- blue cones are absent. Weakest wall of the human orbit- Medial. ENT CSOM- commonest complication is conductive deafness. Ototoxic drugs- Streptomycin, kanamycin,gentamycin( vestibulotoxic), Diuretics, Salicylates( tinnitus+ sesorineural deafness bilaterally). Quinine- tinnitus and sensorineural deafness due to vaso-constriction. Myringitis bullosa- virus, or mycoplasma. Myringotomy- incision in tympanic membrane. Postero-inferior incision for acute suppurative otitis media. Postero- inferior or anterioinferior incision in serous otitis media/ glue ear. Myringoplasty- plastic repair of tympanic membrane perforation. Graft material is used most commonly from temporalis fascia, perichondrium

of tragus can be used, and also vein. Tympanoplasty- eradicate middle ear disease and re-construct hearing mechanism. Ossiculoplasty- Repair of ossicular chain. Middle ear cleft- Eustachian tube, aditus, antrum and mastoid air cell. Middle ear roof- Tegmen tympani Middle ear floor- thin plate of bone to separate the jugular bulb. Middle ear anterior wall- thin plate of bone to separate the internal carotid artery. Middle ear posterior wall- mastoid air cell. Medial wall - bony labyrinth. Lateral wall-tympanic membrane. Tympanic membrane-> malleus-> incus-> stapes-> oval window. Round window - covered by secondary tympanic membrane. External auditory meatus - 32 mm length, outer cartilaginous part8mm, upward backward and medial direction( CUB). Bony part 24 mm, downward forward and medial direction. Eustachian tube- 36 mm, lateral 1/3 is 12 mm and bony part, medial fibro-cartilaginous part is 24 mm and these two parts meet at isthmus making an angle of 100 degree, tube opens at pharynx making an elevation called torus tubaris. Tympanic membrane develops from all three layers, size 9-10 mm tall,8 mm wide, 0.1 mm thick,pearly white color, two parts are pars tensa which make most part of it and forms annulus tympanicus which is a fibro-cartilaginous ring at periphery, central part tented inwards called umbo, and pars flaccida which is situated above the lateral process of malleus.

Otosclerosis - treatment is stepedectomy Cholesteatomy - treatment is radical mastiodectomy. At birth frontal sinus is not present. Maggots in nose - Chloroform drops. Tonsil blood supply -tonsillar branch of facial artery is the main artery, ascending pharyngeal artery from external carotid artery. Ascending palatine branch of facial artery, dorsal lingual branch of lingual artery, descending palatine branch of maxillary artery. Menieres disease -Vertigo, sensorineural deafness, tinnitus. Reverse of Menieres disease is Lermoyez syndrome. Peritonsillar abscess- Quinsy, tosillectomy after 6 weeks. Otomycosis- Aspergillosus niger, A. fumigatus, Candida albicans. Hematoma of auricle- Cauliflower ear. Furuncle - acute otitis externa. Malignant otitis externa- Pseudomonas infection in diabetics. Herpes zoster oticus - Ramsay Hunt Syndrome- Facial paralysis with vesciles inexternal auditory canal and pinna, hearing impairment due to 8th cranial nerve and anaesthesia of due to trigeminal nerve involvement. Littles area- Kiesselbachs plexus1. Anterior ethmoidal artery 2. Septal branch of superficial labial artery 3. Greater palatine artery. 4. Sphenopalatine artery. Littles area commonest site of bleeding area. Retro columellar vein -site of venoous bleeding in young adults.

Nasal septum- tuberculosis affects the anterior part and causes perforation in the cartilaginous part, syphilis affects bony part. Septoplasty for symptomatic DNS and septorhinoplasty for cosmetic purposes. SMR for symptomatic DNS, recurrent epistaxis due to spur, as a preliminary step of hypophysectomy and vidian neurectomy. Achalasia cardia- difficulty in swallowing liquid, but not solid. Dysphagia lusoria- dysphagia due to aberrant great vessels. Antrochonal polyp- Children and adolescent, allergic aetiology, originates in maxillary sinus, mostly unilateral, single, no recurrence after radical operation. Ethmoidal polyp- Middle age, allergic or infective aetiology, arises from ethmoidal sinus, bilateral and multiple polyps, recurrence. Rhinosporodiosis- Rhiosporidium seeberi. Treatment is excision and dapsone. Rhinoscleroma- Gram negative bacteria called Klebsiella rhinoscleromatis or FRISCH bacillus, has Mikulicz cells and Russels bodies( resembles plasma cell), treatment is strerptomycin 1gm / day for 4-6 weeks. Rhinophymoma- Potato nose is hypertrophied sebaceous gland at the tip of nose. Laryngeal stridor - Laryngomalacia, treatment is reassurance to parents. Vocal cord abductor- posterior crico-arytenoid. Vocal cord tensor- Cricothyroid/ vocalis Vocal cord adductor- Lateral crico-arytenoid Frontal sinusitis- Office headache Mastoidectomy- commonest complication is facial palsy. Tonsillectomy - commonest complication is hemorrhage. Middle meatus- Frontal sinus, Ethmoidal sinus( anterior) and Maxillary

sinus open( FEM). Alports syndrome- Sensorineural deafness with glomerulonephritis Pendreds syndrome- Sensorineural deafness with thyroid swelling. Recurrent laryngeal nerve related to inferior thyroid artery. Skin at the angle of the jaw supplied by greater auricular nerve. Caloric test- at 30 and 44 degree Celsius. Eyes movements as cold opposite and warm same side( COWS).or remember ACTH= Away from cold, towards hot. Rinne test- Positive is normal i.e. air conduction is better than bone cnduction, also positive in sensorineural deafness. Rinne negative is abnormal i.e bone conduction is better than air conduction, occurs in external ear obstruction. Vibrating tunning fork placed on mastoid bone then next to the external meatus when hearing stops on mastoid. Webers test - vibrating tunning fork placed on the vortex( forehead). Normal- sound heard equally on both side. Sound lateralized in conductive deafness towards the worse ear, and better ear in sensorineural deafness. Absolute bone conduction test is for the measurement of cochlear function, patients bone conduction is compares with that of examiner with meatus occluded. Schwabachs test- Patients bone conduction is compared to that of examiner with meatus not occluded. Pulsatile tinnitus- Glommus jugulare. Pulsatile otorrhoea- ASOM In migraine headache is due to dilatation of cranial vessels, so the treatment is ergometrine.

Hypernasality- due to cleft palate, bifid uvula, submucous cleft. Bezolds abscess- Abscess in sternocleidomastoid. Citellis abscess- pus from inner table of mastoid tip to posterior belly of digastric muscles and swelling seen in digastric triangle. Lucs abscess- pus through bony antrum and swelling is in deep part of bony meatus. CSF rhinorrhoea- Cribiform plate fracture. CSF otorrhoea- Petrous temporal bone fracture. Crooked nose- DNS+ deviated tip of nose. Freys syndrome- Gustatory sweating+ flushing Youngs operation for Atrophic rhinitis. Atrophic rhinitis- also called Ozaena caused by Klebsiella ozaenae (Perez bacilli), merciful anosmia with severe crusting. Nasal irrigation with solution made from Sodium bicarbonate 1 part, sodium biborate 1 part, sodium chloride 2 parts in 280ml water. Local antibiotic, oestradiol spray, placental extract, KI, Youngs operation. Tympanic membrane- nerve supply by auriculotemporal nerve. Cohort notch- 2000Hz. Acute tonsillitis- Jugulodigastric lymph node enlargement. Pyriform fossa drained by upper deep cervical lymph node. Larynx - Ciliated columnar epithelium except the vocal cord and upper part of vestibule which are lined by stratified squamous epithelium. Schwartzs operation= simple mastoidectomy= cortical mastoidectomy. Vidian nerve in pterygoid canal. Vidian neuronectomy in vasomotor rhinitis.

Mc Ewans triangle/ Suprameatal triangle- landmark of mastoid antrum. 15 mm deep in the suprameatal triangle. Otosclerosis- affects the round window. Stapes rests over the oval window. Cottles test for patency of nares in DNS. Laryngeal papilloma- recurrent, multiple and associated with HPV. Lateral sinus thrombosis- Toby Ayers test, papilloedema, Crowe Becks test, Griesingers sign- swelling over posterior part of mastoid. Gradinegos syndrome- CSOM, lateral rectus palsy( 6th nerve palsy) deep seated orbital or retro orbital pain.Occurs in petrositis. Presbycusis- Sensorineural deafness associated with physiological aging process. Wallenbergs syndrome- Posterior inferior celebellar artery thrombosisvertigo, diplopia, dysphagia, hoarseness, Horners syndrome, ipsilateral sensory loss in face with contralateral body and ataxia. Rotatory nystagmus. CSOM - tubotympanic is safe variety, perforation in centre, odorless discharge, no cholesteatoma; attico antral is unsafe variety, marginal perforation, fowl discharge, cholesteatoma formation. Otosclerosis- painless bilateral condutive deafness, paracusis willisii (better hearing in noisy environment). Treatment is stapedectomy. Branches of facial nerve1) Greater superficial petrosal nerve-secretomotor fibres to lacrymal gland and glands of nasal mucosa. 2) Nerve to stapedius 3) Nerve to chorda tympani.

4) Communicating branch. 5) Posterior auricular nerve 6)Muscular branch to stylohoid and posterior belly of digastric. 7) Peripheral branches/ pes anserinus- temporal, zygomatic, buccal, mandibular, and cervial. Neuropraxia-conduction block. Axonotemesis- injury to axon Neurotemesis- injury to nerve Schrimers test for comparing the lacrimation of two sides. Complication of facial palsy- exposure keratitis, incomplete recovery, synkinesis, tics and spasm, crocodile tears, Freys syndrome, psychological syndrome. Jacobson nerve- tympanic branch of 9th Cranial nerve. Acoustic neuroma- 8th Cranial nerve. Also involve 5th , 9th , 10th and 12th Cranial nerve. Inferior meatus - Nasolacrymal duct Middle meatus- frontal sinus, ethmoidal sinus(middle), maxillary sinus, bulla ethmoidalis, hiatus semilunaris, Superior meatus - posterior ethmoidal sinus and sphenoidal sinus. Rhinitis medicamentosa- due to topical decongestant, rebound phenomenon. Maxilla fractures- Le Fort 1-transverse, Le Fort 2- pyramidal always accompanied by orbital floor- blow out fracture, and Le Fort 3craniofacial. Mandible - condylar fracture is the most common, then common sites are angle, body and symphsis in decreasing order. Ethmoidal sinusitis common in childhood. Ludwigs angina- infection of submandibular space-staph, streptococci,

bacteroides, E.coli, pseudomonas Acute oral thrush- pseudomembranous erythematous mucosa. Chronic candidiasis - cannot be wiped off. Bachets syndrome- oral ulcer, genital ulcer, and uveitis. Carcinoma of lip most commonly Squamous cell carcinoma. Most common site for carcinoma of tongue is lateral aspect of anterior 2/3 of ventral surface. Most common benign tumor of salivary gland- Pleomorphic adenoma, treatment superficial parotidectomy. Warthins tumor- adenolymphoma, treatment is superficial partidectomy. Killians dehiscence- gateway of tears. Waldeyers ring -nasopharyngeal tonsil or adenoids, palatine tonsil or tonsils,lingual tonsil, tubal tonsil, lateral pharyneal band, and nodules. Adenoid facies - elongated face, open mouth, prominent and crowded teeth, hitched up upper lip, high arched hard palate, are due to chronic nasal obstruction and mouth breathing. Pulmonary hypertension develops. Nasopharyngeal fibroma( Juvenile nasopharyngeal angiofibroma)adolescent male,second decade of life so ? Testosterone dependent, recurrent profuse bleeding, nasal obstruction, conductive deafness, and serous otitis media, CT and angiogram, but no biopsy. Bed of tonsil- superior constrictor and styloglossus muscle. Lymph node drainage is upper deep cervical lymph nodes. Larynx - three unpaired cartilages are-Epiglottis, thyroid and cricoid ( ETC) , and three paired cartilages are -Arytenoid, corniculate and cuneiform( ACC).

Larynx Nerve supply - Motor- All muscles are supplied by recurrent laryngeal nerve except cricothyroid supplied by external laryngeal nerve. Sensory- Above vocal cord is by internal laryngeal nerve, below vocal cord by recurrent laryngeal nerve. Internal and external laryngeal nerve are the branches of superior laryngeal nerve. Position of vocal cordIntermediate/cadaveric- paralysis of both superior and recurrent laryngeal nerve. Median- midline, RLN paralysis. Paramedian- strong whisper, RLN paralysis. Acute epiglottitis- Hemophilus influenzae B Acute laryngo- tracheo- bronchitis- viral infection. Tuberculosis of larynx- hyperemia of vocal cord, mamillated appearance, mouse nibbled appearance, turban epiglottitis, pale surrounding mucosa. Singers nodule formed at the junction of anterior1/3 and posterior 2/3, hoarseness, vocal fatigue, treat conservatively and later surgery for large nodule. Rinkes oedema- oedema in subepithelial space of Rinke. Carcinoma larynx- Supraglottic- hoarseness is late feature. Glottic- Hoarseness is early feature. Subglottic- Stridor is the early feature. Hyponasality- Rhinolalia clausa- blockage of nose and nasopharynx Hypernasality- Rhinolalia aperta- cleft palate, paralysis of soft palate, lagre nasopharynx, submucous palate, oronasal fistula. Plummer Vinson ( Patterson Brown- Kelly) syndrome- dysphagia, iron deficiency anaemia, glossitis, angular stoamtitis, achlorhydria. 10% develops post cricoid carcinoma.

Globus hystericus- functional disorder where patient complains lump in throat, and feeling of lump mared in between the meals. Treatment is reassurance. Diffuse oesophageal spasm- dysphygia and odynophagia, cork- screw appearance in barium swallow. Achalasia- dysphigia to liquid is more than to solid. Barium swallow shows Rat tailed appearance. Manometric studies shows low pressure in body of oesophagus and very high pressure in lower oesophagus. Treatment is modified Hellers operation. Oesophageal carcinoma most common is squamous cell carcinoma in middle 1/3. Adenocarcinoma in lower 1/3. Bariun swallow shows irregular lumen and proximal dilatation. Surgery is the treatment of choice for carcinoma in lower 1/3 and radiotherapy for carcinoma in upper 2/3. Roses position for tonsillectomy. Secondary hemorrhage in 5th to 10th day due to infection.