Professional Documents
Culture Documents
Post is a bit long but it will refresh hundreds of things...the first part is having answers of
controversial mcqs so its compulsory....the other parts are those which were previously
posted in this group but now i have compiled them all in this one single post...!!!
PART 1
DURING EXERCISE:
Inadequate blood supply:
Kidneys
Inadequate O2 delivery:
Skeletal muscles
Minimum change in blood flow:
Brain
ECG
P Wave Atrial Depolarization
Q Septal Depolarization
R Early Vent. depolarization (potential travelling to apex of vents)
S Late Vent. depolarization (Potential travelling to base of vents)
T Vent. repolarization
U Delayed repolarization of Purkinje system or papillary muscles
Premalignant Condition:
Lichen planus
Bettlenut chewing:.
Submucosal fibrosis
GEOMED pneumonic
Giant cell --- Epiphysis
Osteosarcoma --- Metaphysis
Ewing sarcoma --- Diaphysis
Osteoblastoma --- Vertebral bodies
Epiphyseal Lesions:
Giant cell tumor
Chondroblastoma
Chondrosarcoma
LYSOSOMES:
Arise from Golgi apparatus
Contain hydrolases
Cause degradation of unfolded proteins
Uterus and breast regress after pregnancy by lysosomes
On H & E stain: hollow structure around nuclei\
PEROXISOMES
Originate from SER
Contain OXIDASE, H2O2 AND CATALASE
Single membrane
CENTRIOLE
Microtubules
RER
Protein synthesis
Continuous with nuclear membrane
=Nissle bodies
Basophilia of cell
Absent in axon hillock
SER
Detoxification of drugs
Giver peroxisomes
Contain Calcium
MITOCHONDRIA
DNA
Energy house
GOLGI COMPLEX
Binds carbohydrate with protein, enclose them in vesicles and release
Secretary vesicles
Lysosomes arise here
NUCLEOLUS
No limiting membrane
Site of RNA synthesis and assembly
DOUBLE MEMBRANE ORGANELLES
Nucleus>Mitochondria..>Golgi complex
CYTOSKELETON
1. Cytoskeleton which connects ECM to ICM = Intermediate filament
2. Cytoskeleton connected to ECM = Proteoglycan
3. ECM connected to ICM through = Integrin
REGARDING THIRST...!!
Thirst Is Is Increased By. .
increase in Angi0tensin 2
decrease in blood v0lume
incerease in osmolarity
drynes of m0uth.
Increase in ADH.. .
Gastric distensi0n.
Decrease in ADH,
Angi0tensin2,
Increase in BP.
Increase in blood volume.
(Reference Guyton)
creatinine clearance
>> 90 ....NORMAL
60-89. .....mild
45-59. ...moderate
30-44. ...damage
15-29. ....severe
< < 15. ....ESTABLISHED renal failure
radiosensitivity
highest
TG = chylomic > VLDL
cholesterol = LDL
protiens = HDL
To differentiate ===AFB.
Cervical lymph nodes biopsy done
Now characteristic ===Caseating granuloma
Cervical lymph nodes biopsy done and biopsy shows Caseating granulomas now
further
===AFB detection === definitive Dx.
STAGES OF MITOSIS
INTERPHASE
- Chromosomes are copied (doubles)
- Chromosomes appear as thread like coils (chromatin) at the start but each
chromosome and its copy (sister chromosome) changes to sister chromatids at end of
this phase
PROPHASE
- Mitosis begins (cell begins to divide)
- Centrioles (or poles) appear and begin to move to opposite ends of cell
- Spindle fibers form between the poles
METAPHASE
- Chromatids (or pair of chromosomes) attach to the spindle fiber
ANAPHASE
- Chromatids (or pair of chromosomes) seperate and begin to move to opposite ends of
the cell
TELOPHASE
- Two new nuclei form
- Chromosome appear as chromatin (threads rather than rods)
- Mitosis ends
1 REST
Max blood flow at rest=
1.liver(1500ml)
2.kidneys(1260 ml)
EXERCISE=
Max bld supply =Skeletal muscle
cystinuria b6
cystinemia b12
PART 2
PART 3 ...PEARLS
Haemorrhages
Extradural haemorrhge=middle minengeal artery
subdural haemorrhage =diploic vein
subarchnoid haemorrahge=rupture on berry aneursm
tennis ball injury to eye=circulis iridis major
epistaxis=sphenopalatine artery
during tonsilectomy= para tonsillar vein,tonsillar and ascending palatine artery
tracheostomy=isthmus and inferior thyroid vein
heamoptysis=bronchial artey
gastric ulcer=left gastrc and splenic artery
dudenal ulcer=gastrodudenal artery
hemmorhoids=submucosal rectal venous plexuses formed by superior rectal vein and
inferior rectal vein
retropubic proastatectomy=drsal venous plexuses
Turner = 45XO
KF= 47XXY
True hermaphrodite =XXy
peudohermaphrodite =46Xy or 45X
Mole
complete hydatidfm mole -46XX
partial mole -69XXy
Chromosomes n Dna both replicate in interphase
Studied in Metaphase
Trisomy
21 > Down syndrome
13 > Ptau
18 > edvert
16 > spontaneous abortion
Lumber Pucture
Most common loccation ==L4L5
LP Best Site ====above L4
IF pt e miningitis LP site ===below L3
Epidural anesthesia ==L3-4
widest epidural space > L2
Cauda Equina (CHILDren) === L3
Conus medullaris (Adult) = L1
Subarchnoid space == S2
Chorea > caudate
Athetosis > putamen
Pco2 rises upto 12mmhg in first minute of apnea
Increased alpha feto protein plus increased albumin = Anencephaly.
Vitamin A prevents squamous cell carcinoma.
Right border of heart is made by right atrium.
Right border of heart on XRAY made by SVc +Rt Atrium
Trephine biopsy Indicates = aplastic anemia > ALL.
In anesthesia halothane is always given with Nitric oxide.
Most diagnostic test for TB = PCR > AFB > Caseous.
Down syndrome occurs 1/100.
Common genital vesicle is herpes simplex virus.
Inferior orbital fissure contents are maxillary nerve and its zygomatic branch, inferior
ophthalmic vein and sympathetic nerves and this fissure communicates with pterygo
palatine fossa.
Superior orbital fissure communicates with middle cranial fossa and it transmits
lacrimal nerve, frontal nerve, trochlear nerve, oculomotor nerve, abducent nerve,
nasociliary nerve and superior ophthalmic vein.
Thyroid is the only endocrine gland that stores its secretions outside the cell.
Sensations from the tip of nose are carried by ophthalmic division of trigeminal nerve.
Tensor tympani is supplied by mandibular division of trigeminal nerve.
Stapedius is supplied by facial nerve.
Nucleus raphe synthesize serotonin.
Locus Ceruleus = Nor epinephrine.
At term CRL = 36 cm and CHL = 50 cm.
CRL used b/w 7 - 14 weeks.
BPD is used 16 - 30 weeks.
Sperm life in genital tract is 24 to 72hours.
Active ===24- 48hrs
2nd most common cause of osteoporosis in old age is Cushing syndrome.
Prenatal chromosome is detected at 14 -18 weeks.
Bronchial asthma plus hypertensive patient > Best drug Verapamil.
Aphasia and facial nerve palsy > damage to middle meningeal artery.
Diabetic plus hypertensive patient > Best drug Captopril.
Inferior wall MI > Right marginal artery block.
Epidermis of partoid gland is derived from ectoderm.
To kill spores of surgical instrument > moist heat at 160 C for 1 hr.
Food poisoning caused by Staph. Aureus is through entertoxin.
Least positive value for Widal is 1:120.
Trigeminal ganglion is completely covered by dura.
Tactile sensation is carried by dorsal white column to medial leminiscus.
Anti HBcAg = positive window period.
MAP = diastolic +1/3 pulse pressure.
Insulin secretion is inhibited by beta blocker.
Increased By Glucagon
Highest triglyceride =Chylomicrons >VLDL > Chylomicrons remanents
Highest cholesterol = LDL.
Highest lipoprotein = HDL.
Which is not a phospholipid = Plasmalogen.
Best way to check bone density is the scan of spine.
End break down of glucose is pyruvate.
In pre eclamptic patient hydralazine is the drug of choice before surgery.
In down syndrome: Triple test (alpha feto protein is decreased, b-HCG is increased
and estriol is decreased) and if we add up inhibin which is increased then it will be
called as .
Bar body diagnostic for Tuners syndrome
scant bodies in KF
PLAP (Placental Alkaline Phosphatase) is a tumor marker in seminoma and ovarian
carcinoma.
Tubo ovarian abscess by IUCD - most causative agent is Actinomycosis.
Major intracellular buffer is Hb.
DVT more common in popliteal vein but pulmonary embolism is through femoral
veins.
Investigation of DIC D-dimers, FDPs, Platelet count and PT (except clotting time).
Referred pain:
Cervix S2-S3
Ovary -T10-T11
Testis -T10
Umbilicus -T10
Kidney T12-L2.
Trimethoprim (co-trimoxazole ) side effect > megaloblastic anemia plus leukopenia.
Sacrospinous ligament does NOT contribute in wall of perineum.
Lesser omentum connects with duodenum.
"Sphincteric urethra is known as external urethral sphincter and is supplied by
pudendal nerves where as internal os is supplied by inferior hypo gastric plexus.
Nerve supply of rectum is hypogastric plexus.
Uterine tube is 10 cm long.
"Urachal cyst is the remanant of allantois.
Thyroid gland is derived from endoderm.
Thymus and inferior parathyroid develops from 3rd branchial pouch.
Superior para thyroid is developed from 4th brachial pouch.
Diaphragmatic hernia occurs due to absence of pleuro peritoneal membrane.
Superior thyroid artery is related to external laryngeal nerve which supplies posterior
cricothyroid muscle of larynx. Injured during Thyroidectomy
Inferior thyroid artery is also related to recurrent laryngeal nerve which runs b/w
trachea and esophagus and its most common injury is in Traceostomy.
In papillary carcinoma of thyroid > it occurs in young age and involves cervical lymph
nodes.
Tracheostomy is done at 2nd tracheal ring by pulling the isthmus inferiorly.
Nonfunctional nodule or cold nodule has high chances of malignant transformation.
Erythropoiesis in middle trimester is in the liver.
Levator ani muscle is supplied by L2, L3 & L4.
Defect in Bulbus Cordis results in VSD, hypertrophy of Right ventricle, congenital
cyanosis, transposition of great vessels (but not ASD)
Endocardial cushion is important for the formation of four chambers of heart.
Thirst is least stimulated by blood pressure.
Important hormone involved in gluconeogenesis is Cortisol.
Apoptosis is inhibited by bcl-2 inhibition.
Apoptosis ~ Actuvation of caspases
Low serum complement in SLE.
C3b & IgG are Opsonins
C5a is chemotactic protein.
Urea is an important indicator for muscle protein loss.
ESR is decreased when albumin is increased.
ESR increased during Infection
" Drug which does not cause gynecomastia is Androgen & drugs which cause
gynecomastia are Digoxin, Girsoefulvin, Cimetidine, Androgens, Spironolactone and
Ketoconazole.
Tx of hirstuism is Cyproterone Acetate.
Pyruvic acid is intermediate from glucose to acetyl coA.
Epinephrine .nor epinephrine & dopamine are derived from tyrosine.
End product of Purine is Uric acid.
RBCs have glycolytic enzyme activity.
End product of glucose gives 2 Pyruvate.
Alanine should be taken in diet.
Cisplatin is more notorious to cause renal toxicity.
Dysplasia is seen in epithelia.
MRNA has a codon.
HSV is associated with vulvar papules.
Wart on the lateral wall of introitus it is caused by HPV.
Plaque like lesion on posterior superior wall of vagina is squamous cell carcinoma.
German Measles causes Congenital Cataract.
Anterior abdominal wall swelling with umbilical cord attached to it in a new born baby is
known as Omphalocele.
Beta-lactam acts on the Cell Wall.
ATT Drugs
Streptomycin=== ototoxity.
Isoniazid ==Hepatotoxicity.
Pyrazinamide == Gout
Rifampacin=Orange red color urine
Opportunistic organism ~E. Coli Kleibeslla
Pseudomembranous colitis is caused by C. difficile.
Most common organism involved in gynecological & abdominal procedures is
Bacteriodes .
Vulvular itching = Chlamydia
fish like smell; Bacterial Vaginosis.
Vitamin K dependent: Factors 2, 7,9,10, Protein C, Protein S, Fibrinogen and
Prothrombin.
Intrinsic and Extrinsic pathways of coagulation converge at factor 10.
Threonine does not contain Sulfa group.
Autosomal dominant is hereditary Spherocytosis & Poly cystic kidney disease.
Lens opacity causing drugs >Chlorpromazine, Amidarone, Tamoxifen, Gold & Iron
toxicity.
Drugs causing corneal opacity > Amiodarone, Chloroquine, Mepacrine & Copper.
Ribosome have purple color on Eosin & Methylene blue staining
High energy content > Starch.
High energy compound > ATP
Antidote of warfarin is vitamin K but if action is more quickly required then FFP.
Olfactory cells are the only neurons in the body that regenerates.
Projectile vomiting greenish in color means bilious vomiting so it is due to duodenal
atresia but if projectile vomiting non bilious then it is hypertrophic pyloric stenosis.
Pulmonary trunk relation with the bronchus at the hilum of the lung-mnemonic is
RALSR- Right Anterior & Left Superior.
Rhino sinusitis is caused by Strep Pneumonia, H. Influenza, M Catarrahalis.
Homans sign is present in DVT in which if you dorsiflex the foot there will be pain in
calf muscles.
Classic triad of Pulmonary Embolism: -
Neurological manifestations.
-Petechial rash.
-Hypoxemia.
Nitrogen bubbled precipitator in ascending divers and can be treated with hyperbaric
oxygen.
CT pulmonary angiography is the best test to detect Pulmonary Embolism.
The most common infectious agent transmitted by blood transfusion is
cytomegalovirus (CMV), which is present in donor lymphocytes.
Before blood is transfused into newborns or patients with T-cell deficiencies, it must
be irradiated to kill donor lymphocytes. This prevents the patient from developing a
graft-versus-host reaction or a CMV infection.
Yersinia enterocolitica, a pathogen that thrives on iron, is the most common
contaminant of stored blood.
Iron is stored in bone macrophages.
Structures passing thru superior orbital fissure....
NOT-FAL
NASOCILLIARYOPTHALIMIC VEINTROCHLEARFRONTAL
Suture Removal:
Head 5-7days
Face 3-5days
Eyelid & eyebrow 3-5days
Trunk 5-7days
Extremities 7-10days
Surface of joint 10-14days
Hand ==7days
Absorption
iron and divalents absorb in duodenum.
Folic acid, maximum water, max electrolytes, long chain fatty acids in jejunum.
Bile and B12 absorb in ileum.
water and electrolytes absorb in colon but less than jejunum. Short chain fatty acids
absorb in colon.
Buffers
Major intracellular buffer is protein.
Major extracellular buffer is bicarb.
If only major buffer asked then Bicarb.
Major renal buffer is still bicarbonate if depleted then
Phosphate ==Qualitative
Ammonia == Quantitative
Buffer in blood is H2co3 > Hb
Uterus
Uterosacral felt on PR
Main support is cardinal(also named transverse cervical ligament )
Round ligament of uterus keeps it anteverted anteflexed
broad ligament has very lessor role in support
Best way to "measure" gfr is inulin clearance.
best way to "estimate" gfr is creatinine clearance.
best way to "clincally" measure gfr is creatinine clearance.
best way to measure renal plasma / blood flow is PAH .
best test for renal falilure is creatinine clearance.
blood transfusion
multiple===hemochromatosis
massive===hyperkalemia
repeated ===hypocalcemia
PART 4 MICROBIOLOGY
About trachea
1....starts at C6 , at inferior border of cricoid
2....bifercates at T4
3... is about 15 cm
4....has 16 to 20 incomplete cartlilage c shaped ring
5... tracheostomy opening at cartilage ring 2,3,4
Bronchi..
1... Right bronchus is
Shorter, wider and more vertical left bronchus.. therefore inhaled foreign bodies comes
into right bronchus..
2... Left bronchus is
Longer, narrower and less vertical rigjt bronchus...
Small airways...
3...Bronchopulmonary segment
i..is anatomical, functional and surgical unit of lungs..
ii..Areated by tertiary bronchioles
About diaphragm
RIB CAGE
INTERCOSTAL SPACES
1... The neuromuscular bundle present between.. Internal intercostal muscle and
innermost intercostal muscle
2... Ther order of neuromuscular bundle from above down in the coastal groove of rib
lower border is... VAN
vein, artery, nerve
3... Site for needle piercing / pleurocentesis is at MID AXILLARY LINE... near the
UPPER BORDER of ribs... 1 or 2 rib space below maximum dullness.
intercostal nerves and blood vessels run bw internal and innermost intercostal muscle
Thyroid hormone binds with its receptors in nucleus via ZINC FINGERS
Thyroid hormone increase the metabolism in all metabolically active tissues except
UBLAST(uterus, brain(in adults), lymph nodes, anterior pituitary, spleen, testes)
Thyroid hormone donot increase the metabolism in uterus but is required for the
normal menstrual cycle and fertility
Thyroid hormone increase the glucose absorption from the GIT and increased the
plasma glucose level rapidly after carbohydrate rich meal however it falls rapidly after
sometime
Thyroid hormone increases the LDL receptors in liver lowering the plasma cholesterol
levl
Cell CYCLE
Consists of two phases interphase and mitosis
INTERPHASE ....Chromosomes REPLICATE
INTERPHASE ....DNA REPLICATE
INTERPHASE....Barr Bodies are studied
INTERPHASE is divided into...
1.G1
2.S (SYNTHESIS Phase)
3.G2
4.Mitosis ( also called M phase & cytokinesis is a part of it )
G1...Primary Growth , Proteins , Organelles , mRNA Synthesis )
G1...Also Called growth phase
G1... Longest phase ( 8to 10 Hours)
G1 Check point...To check if DNA is damaged
S ....DNA Replicate
S....Cytotoxic & cancer drugs act here to destroy DNA
S.....5 to 6 hours
G2...Secondary growth ( between S phase & Mitosis)
G2...Short ( 3 to 4 hours)
G2 Check point... To check if DNA has replicated properly
MITOSIS / M Phase
M...Shortest (2 hours)
M... To see spindle assembly and alignment
M...nuclear content divide
M...genetic material is Chromosome (Genetic material is chromatid when NOT in M
phase)
M... Divided into Prophase, prometaphase, Metaphase, Anaphase , Telophase,
Cytokinesis
PROPHASE....Spindle fibers appear Chromosome Condensation
PROPHASE...Centriole start moving to the oposite end
PROMETAPHASE....Spindle fibers attach to chromosome & chromosome movement
PROMETAPHASE....Nuclear membrane dissolve marking the beginning of
prometaphase
METAPHASE...Chromosome Alignment
METAPHASE.....Chromosome thickest
METAPHASE......Chromosome begin to divide
METAPHASE...Karyotyping
ANAPHASE.... Division of chromatids & sister chromatids move to opposite side
ANAPHASE....NON Disjunction
TELOPHASE...Spindle fibers disappear & Decondensation of Chromosomes
TELOPHASE...Complete divison
TELOPHASE....chromosomal study
TELOPHASE....Nuclear membrane formation
CYTOKINESIS....Cytoplasm divide
Barr Bodies....Heterochromatin
Barr Bodies....have X chromosome
Barr Bodies....seen under light microscope
Barr Bodies....ABSENT in Turner
Barr Bodies....Scanty In Turner
Barr Bodies....Diagnostic for Turner
one Barr body in Klinfelter
NO. of Barr bodies in OX .....no Barr Bodies
NO. of Barr bodies in XX... 1 Barr Body
NO. of Barr bodies in XXX....2 Barr bodies
Best Test for chromosomal abnormalities is Karyotyping
Karyopiknosis index.... Index of karyopiknotic nuclei of epithelial cells which exfoliate
from vagina... Hormonal evaluation
Biochemistry points:::::
1)Highest cholesterol content=LDL.
2)richest in triglycerides=chylomicron.
3)Highest protein content=HDL.
4)Fat soluble vitamins= ADEK.vit a,d,e,k.
5)Vit B2 deficiency=2cs(Cheilosis,Corneal vascularization..
6)Vit B3 deficeincy=3ds(dirrhea,dementia,dermatitis)..
7)Antioxidants ACE=vit a,c,e.
8)Vit k(antiKagulant)=gamma carboxylation of factors(27910).
9)essential fatty acids=linolic acid & linolinec acid.
10)Malnutritions::::::::
(a)kawashiorkor::protein malnutrition result from protein deficient
MEAL(M=malnutrition,E=edema,A=anemia,L=liver fatty).
(b)Marasmus:::M=muscle wasting.
11)amino acids necessary for PURINE synthesis GAG(glycine,aspartate,glutamine).
12)Bloting proceedures:::southern blot=DNA,NORTHERN blot=RNA,western
blot=protein.
12)protein energy=4.1Kcal.
13)fat energy=9.1kcal.
14)highest energy compund=ATP.
15)renal failure z most common cause of vit D deficiency.
16)isoniazide therapy z most common cause of pyridoxine(vit b6) deficiency.
17)vit c z cofactor in conversion of dopamin to norepinephrine.
18)the most common source of vit K z colonic bacteria.
19)vit b12 deficiency=homocysteinuria.
20)hypervitaminosis A=scaly dermatitis.
21)thiamine level z best monitered by=transketolase level in RBC.
22)increase carbohydrates=increase demand of thiamine.coz thiamine z important in
ATP senthesis.
23)biotin(vit b7) z used as coenzyme in fatty acid synthesis.
24)vit b6 inovle in transamination of ALT & AST.
25)vit C(ascorbic acid) is involved in collagen synthesis.vit c deficiency result in
defective collagen.
26)zinc deficiency leads to delayed wound healing.
FA CVS
2)... 7,9, 10
Cranial nerves with SVE fibers supplying salivery glands
(CN 10 to parotid)
3)... 2, 7, 9, 10
vit K dependent coagulation factors...
4)...3, 7, 9, 10
cranial nerves having parasympathtic fibers..
5)... 5,7,9, 10
Cranial nerves having both motor and sensory fibers..
6)... 5, 7, 9, 10
cranial nerve supply of pharyngeal pouches derivatives..
Pouch.. 1,2,3, (4+6)
CN...........5,7,9, 10
(Note: pharyngeal pouche no 5 is degenerated, and hence no 5th pharyngeal pouche)
7)... T 7, 9, 10
Dermatome levels of upper abdominal wall
T 7... xipisternal joint
T 9... in between xipisternal joint and umbilicus ( also by T 8 )
T 10... at the level of umbilical
1...Giant cell...
50 % occurs around the knee, locally aggressive, soap bubble appearnce on xray (due
to Aneurysmal Bone Cyst ABC), multinucleated giant cells, 20 to 40 years
2...Osteochondroma...( exostosis )
Most common benign tumour , males less than 25 years
3...Osteosarcoma...
2nd most common primary malignant tumour, hematogenous spread to LLB (Lung, liver
and brain) codmann triangle or sun burst pattern on xray
4...Ewing sarcoma...
Blue cell malignant tumour , extremely aggressive with early metastasis, Onion skin
periosteal reaction in bone , Associated with t11;22 translocation
5...Multiple myeloma...
Most common primary malignant bone tumour originates from plasma cells..
4)Parasternal heave
1..Troponin T/I
2..AST
3..LDH
4..CK-MB
:: Complications of MI ::
a) RV infarction
b) Arrythmias (VT, AF, VF) - may also be due to I.v. Xylocaine overdose
c) LHF
a) Pericarditis
b) Sudden death
c) VSD
Cardiac Output
Cardiac output (CO) is the amount of blood pumped by the heart per unit of time and it
depends on 2 important variables like below;
Stroke volume (SV) = the amount of blood ejected per beat of the heart (Normally, 70
ml/beat).
Heart rate (HR) = heart beats per minute (normally, 70 beats/min).
Therefore, the cardiac output (CO) is dependent on the stroke volume (SV) and the
heart rate (HR): CO (L/min) = SV (ml/beat) HR (beats/min) = 4.9 L/min (normally).
Contents [hide]
1 Stroke volume
2 Heart Rate
Stroke volume
Stroke Volume is the difference between end diastolic volume (EDV) and end systolic
volume (ESV). ESV can be affected by 4 factors; preload, afterload, contractility, and
Heart rate, and EDV also depends on 3 factors; venous return, Heart rate, and
compliance.
Preload (ie, the EDV):The more cardiac muscle is stretched, the harder it contracts
(Frank & Starling's law).
Positive agents:
Slow heart rate,
exercise.
Negative agents:
blood loss,
rapid heart rate: when you exercise, heart rate can increase. See the graph.
Contractility: Heart muscle fibers can contract at different strengths.
Myocardial contractility is the intrinsic ability of the heart to contract independent of
preload and afterload.
Changes in the ability to produce force during contraction result from different degrees
of binding between myosin and actin filaments.
No relationship with the changes in the fiber length!
The degree of binding that occurs depends on concentration of calcium ions in the cell;.
In an intact heart, it is usually the action of the sympathetic nervous system (through
catecholamines) that determines the concentration of calcium ions in the cytosol of
cardiac muscle cells.
All factors that cause an increase in contractility work by causing an increase in
intracellular Ca2+ during contraction.
Positive agents:
Calcium of ICM by Hormones and sympathetic nervous system,
cardiac glycosides (e.g. digoxin),
drugs.
Negative agents:
extracellular K+ (Hypercalemia).
Acidosis: H+ and K+ exchange across the membrane and if one H+ is heading in, a K+
is heading out and vice versa.
Ca2+ channel blocker.
Afterload (ie, the mean arterial pressure): Resistance to blood leaving the heart. In fact,
afterload cannot be controlled by the cardiac function, but affects the cardiac out. So,
these are the positive causes for afterload;
High hematocrit,
stenosis of vessels,
high blood pressure,
constricted blood vessels,
lipids in vessels (atherosclerosis).
Compliance: a measure of the tendency of a hollow organ to resist recoil toward its
original dimensions upon removal of a distending or compressing force. It is the
reciprocal of "elastance".
Venous return: the amount of blood that enters the heart from the venous circulation
and it can be controled by skeletal muscle contraction, venoconstriction, respiratory,
venous valves, and so on.
Heart Rate
Heart rate can be determined by autonomic nervous system. An average resting heart
rate in an adult is 70 beats per minute (bpm). The normal range for heart rate is highly
variable, however. Trained thletes may have resting heart rates of 50 bpm or less.
Someone who is excited or anxoius may have a rate of 125 bpm or higher. Children
have higher average heart rates than adults. Although heart rate is initiated by
autorythmic cells in the SA node, it is modulated by neural and hormonal input.
Autonomic Nervous System
Sympathetic NS: Fight or Flight HR ( always, contractility);
Parasympathetic NS: Rest and Digest negative effect on HR.
Bainbridge reflex ( Preload) increases the HR when the cardiac muscle is over-
stretched.
The Bainbridge reflex, also called the atrial reflex, is an increase in heart rate due to an
increase in central venous pressure. Increased blood volume is detected by stretch
receptors located in both atria at the venoatrial junctions.
Venous return the pressure of vena cavae and then the right atrium stimulation
of the stretch receptor at the venoatrial junctions signaling the medullary control
centers to decrease parasympathetic tone via the vagus HR.
Drawing more blood out of the right atrium a decrease in atrial pressure and the
great veins.
This continues until right atrial blood pressure returns to normal levels, upon which the
heart rate decreases to its original level.
IMPORTANT POINT..>>>>>>>
Heat loss walay question me agr temperature mention ho tu ans conduction plus
radiation hoga..(ganong bcq)
tempertarture mention na ho tu acoording to guyton max heat loss is through radiation..
or agr statement me ETT mention ho tu ans evaporation hoga.
Very Very Important MCQ Repeated in January 2015 & 2016 Papers taken from
Pre-Test Physiology *
The answer is a. -During the early stages of an asthmatic attack, the increased airway
resistance makes it difficult to inhale and exhale rapidly, and therefore each breath is
slower and deeper.However, the accompanying dyspnea usually increases alveolar
ventilation, and, as a result, PaCO2 decreases. Arterial oxygen tension usually
decreases, despite normal alveolar oxygen levels, because of the increased V/Q
mismatch that accompanies asthma. This hypoxia may also cause alveolar ventilation
to increase. The equal pressure point moves toward the lung because of the increased
respiratory effort. Acute asthmatic attacks do not produce any direct change in lung
compliance. However, air trapping will cause functional residual capacity (FRC) to
increase, and the larger lung volumes will lead to a decrease in lung compliance.
1.Papillary carcinoma..
......P.....
Popular( most common) , Previous irradiation, Psammoma bodies, orPhan
Annie eye (empty appearing nuclei with central clearing), Prognosis ( is excellent),
3Follicular carcinoma
.....F....
Follicles are uniform, Follow blood( hematogenous spread) , Faulty iodine
(commen in iodine deficient areas)
Finds way through( invades capsule)
4 Anaplastic carcinoma..
' .....A.....
All ends ( very poor prognosis) , Aged (older patients ) ,invAdes local structure
5. Lymphoma
.......H......
(nonHodgkin) lymphoma, Hashimoto thyriditis
Pregnant lady with bile duct obstruction. Diagnostic investigation = GGT (FOR NON
PREG = CLICK ALP )
265. About Trichomonas vaginalis what is correct = Is sexually transmitted
266. Anion gap = Diff between measured cation and measured anion
267. Occulomotor nerve supplies = ciliary ganglion
268. Infective endocarditis diagnostic investigation = Blood culture (blood culture for
diagnosis & ASO titre FOR THE EVIDENCE OF INFECTION )
269. Essential fatty acid = Linoleic acid (Also Linolenic Acid is among essentials)
270. Patient was brought to the ER unconscious. The doctor gave Naloxone but it was
not working. What is the likely cause of toxicity = Phenobarbital
271. Patient lacerated the dorsal part of his wrist accidentally. He came in with difficulty
to adduct the fingers and difficulty abducting the thumb. Which nerve was paralyzed =
Ulnar Nerve
280. Pain from lower inferior segment of Diaphragm = Subcostal Nerves ( Phrenic
supplies central tendon of diaphragm)
281. Cingulate gyrus blood supply = Anterior cerebral Artery
IMPORTANT POINTs regarding HEPATITIS
..Here We GO FOr Hepatitis ..
In children and in pregnancy--------->Hep A
Most Lethal is in pregnancy-------->Hep E
"E" for Hep E" "E",for Epidemics...
MOst common for HCC is hepB ..(MRCP pass medicine notes).
Most lethal is ------------>Hep D
Most common for chronic hepatitis is Hep C
1)if asked acute liver failure in hepatitis than ans is prolonged PT also decrease in factor
5 has got importance
2)IF asked only necrosis in viral hepatitis than ans is increase SGPT reference goljan
page 470 4th edition..
But
if asked acute massive necrosis in hepatitis then ans is increase in neutrophils..
for example in acute Myocardial infarction..
there is coagulative necrosis and neutrophils counts raises
transitional cell carcinoma bladder: most common non infectious cause of lower urinary
tract hematuria
Important point
REGARDING THIRST...!!
Thirst Is Is Increased By. .
Increase in Angi0tensin 2
decrease in blood v0lume
incerease in osmolarity
drynes of m0uth.
Increase in ADH.. .
THIRST is decreasd by. .
Gastric distensi0n.
Decrease in ADH,
Angi0tensin2,
Increase in BP.
Dec by barroreceptor effrnt
Increase in blood volume.
(Reference Guyton)
we proceed further
2nd baby she conceived was having blood group type AB..
that 2nd baby having AB type should have received B from father. So blood group of
father is B type.
.
But what do u think father has which type genotype OB or BB while first baby was
Having blood group O.
GENERAL ANATOMY>>>
Flexion and extension takes place in sagittal section
Adduction and abduction take place in coronal section
Dermis is thinner on anterior surfaces of body as compared to posterior surfaces.
Appendages of skin are nails, hair follicles, sebaceous and sweat glands.
Hair follicles are invaginations of epidermis into the dermis.
Arrector pili are the bands of smooth muscles that that connect the undersurface of
hair follicle to the superficial part of dermis. Dimpling of skin called gooseflesh is due to
the the pull of the is arrector pili muscle. It causes contraction of sebaceous gland and
its secretion.
Sebaceous glands lie within the dermis and pour their secretion, the sebem ONTO the
shaft of hairs.
Sweat glands expand full thickness of dermis and their extremity may lie in superficial
fascia. They are the most deeply placed structure of all appandeges.
Sebaceous glands are not present in lips, palms, sides of fingers, glans penis and
clitoris, labia minora and internal surfaces of labia majora, soles, sides of feet and sides
of toes.
Sweat glands are not present on red margins of lips, nail buds, glans penis, clitoris,
Boil is infection of hair follicle and sebaceous gland.
Carbuncle is staphylococcal infection of superficial fascia. It usually occurs at nape of
neck and starts as infection of hair follicle or group of follicles.
Sebaceous cyst most frequently occurs at scalp.
Patient of shock exhibits gooseflesh as a result of overactivity of sympethetics.
Partial thickness burn heals from the cells of hair follicles, sebaceous and sweat
glands and from the cells of edges of burn. A burn that extends deeper than sweat gland
heals slowly and only from edges.
Superficial fascia is devoid of adipose tissue in eyelids, auricles, penis, scrotum and
clitoris
Nerve to muscle is a mixed nerve, 60% is motor and 40% is sensory.
Primary cartilageonus joints are those n which the bones are united by plate of
hayaline cartilage. Examples are union b/w epiphysis and diaphysis and b/w first rib and
manubrium.
Secondry cartilagenou joint are those in which the bones are joined by fibrocartilage
and articular surfaces are covered by hyaline cartilage. Example are joints b/w vertebral
bodies and the symphesis pubis.
HILTONs LAW. Sensory Nerve supplying the joint also supplies the muscles that
cause movement on that joint and the skin overlying the insertion of these muscles.
In syringomylia the pain sensation is lost in joints.
Tendons invaginate the synovial sheath from a side and are suspended by
mesotendons. Mesotendons transmit the blood vessels. In areas where wide range of
movement is there these mesotendons remain as vinulae.
In certain areas of bodies especially the tips of fingers and toes the arteries and vein
connect directly without intervention of capillaries. These areas are called arteriovenous
anastomosis
Lymphatic vessels are absent in CNS, eyeball, internal ear, epidermis of skin,
cartilage, bone.
Preganglionic are myelinated adnd type B fibers.
Postganglionic are nonmyelinated and type C fibers
Two sympethetic chains end below by joining together to form a single ganglion the
GANGLION IMPAR.
In bone the extracellular matrix is calcified.
Flat bones are composed of outer and inner layer of compact bone called the TABLES
and middle layer of cancellous bone the DIPOLE. Scapula is irregular but is included in
flat bones.
V V V V IMPORTANT POINTS ARTERIAL SUPPLY OF HEART>>>>>>
RCA:
Arises from anterior aortic sinus. It goes almost vertically in right AV groove crosses
the inferior border of heart to continue posteriorly and anastomose with LCA
It supplies RA, RV and parts of LA and LV and AV septum
BRANCHES are
- Right conus artery
- Anterior ventricular branches. The marginal branch is largest and reach upto apex
- Posterior ventricular branches
- Posterior inter ventricular artery: runs towards apex and gives branches to right and
left vemtricles. It supplies the posterior part of ingter ventricular septum but NOT TO
THE APEX. A large septal branch supplies AV node
- Atrial branches. Branch to SA node supplies SA node and right and left atria
LCA:
Usually larger than RCA and supplies the major part of heart.
Supplies greater part of LA, LV and interventricular septum
BRANCHES are
- Anterior interventricular artery( in most of the people it supplies the APEX of heart) left
diagonal artery is major branch
- Circumflex artery. Left marginal art is major branch
SUPPLY OF CONDUCTIVE SYSTEM
SA node, AF node AV bundle are supplied by RCA
RBB is supplied by LCA(right is wrongO
LBB is supplied by both LCA and RCA(left doghla hota hai )
SUMMARY:
RCA supplies all of RV(except for small area to the right of anterior nterventricular
groove), variable part of diaphragmatic surface of LV, posteroinferior 3rd of ventricular
septum, RA, part of LA, SA node and AV node. Small branches to LBB are also given
LCA supplies most of LV, small area of RV to the right of Interventricular groove,
anterior 2/3rd of ventricular septum, most of LA, RBB, and LBBB
59) Some repeated True or False regarding blood supply of Heart is...
Known hypertensive patient with Chest Pain ECG ST segment elevation but Trop -T is
negative... most likely diagnosis is..
56) very much discussed mcq in November month.. which was also repeated in January
term...
Young Female with Diffuse Loss of Vibration Sense.... Most Likely investigation is...
Coffee>>>>>> Chocolate
54)) Repeated Puzzle of Right and Left Oxygen Dissociation Curve.......
Remember "Right" is Right for Our Tissue to be O2 unloaded and deliver to tissue.....
GH>>>>>>>>>>>>Cortisol....
Mast cell>>>>>>Basophils
1)) Natural Defense Mechanism against Neoplasia is Apoptosis...... Not Antibodies not
Macrophage...
47)) Mother Blood Group A having 2 babies... one baby has o and other has AB blood
Group.
Which Blood Group Father has Having.. its. BO blood group genotype
Read it
https://m.facebook.com/groups/102979646495000?
view=permalink&id=820302118096079
42)) CPSP.......... Nightmares for u... becoz V have Agreed on one option No
confusion.... Try next time.... with another
41)) CPSP Now U can make True or False but we Will be Right... at this time...
Biceps Reflex Physician when strikes tendon..... Checks Muscle Spindle......... NOT
Golgi tendon Organ..........
39)) CPSP U have Sword Of Confusion But We Have Discussion Shied Guard Power...
38) CPSp U Have......... no power more than that of Discussion Power we Have
Premalignant Condition is
ERYTHROPLEKIA>>>>>>>LEUKOPLEKIA
37)) Much Discussed Repeated easy MCQ but Made Wrong 99 percent is
Tricky one
36)) Another Repeated... 2015... with Lot of Confusion....
All of Us 2 January Morning Session Students Were Caught By CPSP Fish... Now U
catch it....
34) Midway Point Between Anterior Superior ilac Supine and Pubic Tubercle is
FEMORAL NERVE.....
Mid way Between Anterior Superior iliac Supine and Symphysis Pubis is FEMORAL
ARTERY..
31) GVE vagus nerve for preganglionic fiber arises from Dorsal nucleus.
27)) About Cerebral Arteries is True.... once entered into Brain Substance Never
Anastomose....
26) nucleus cuneatus and nucleus gracilis lesion caises asteriognosia.......... Catch it......
plzz read
22) patient with Palpitations with Free T3 High and TSH is LOW... CRH is Given and
TSH becomes High.... Problem is Within Thyroid Gland...... very confusing....
18) first Line of defense against foreign is TISSUE MACROPHAGE not NEUTROPHIL
13) Hallmark of HIV is Proliferation of Virus inside T-cell.... And Hallmark of AIDS is
progroessive immune system deficiency...... Tricky