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Thread: PUBLIC HEALTH : Student Note Book collection

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    Arrow PUBLIC HEALTH : Student Note Book collection

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    PUBLIC HEALTH



    1. Levels of Prevention: 1o = actions to decr. incidence of health problems (prenatal care, immunizations)

    2. 2o = interventions at early stage of disease to limit development (DM screen, PAP)

    3. 3o = interventions to treat problem and prevent further morbidity & mortality

    4. Special Tests Complement & Complement disorders C3, C4, CH50

    5. Rheumatiod - ANA, RF

    6. Lupus - DNA, Anti Smith Antibody

    7. Scleroderma - Scl-70, Anti Centromere

    8. Sjogrens -SSA Anti Ro, Anti LA

    9. Prostate = PSA, Pancreatic = CA 19-9,Ovarian=CA125; Breast = CA15-3 & CA27-29

    10. Testiclar = BHCG, AFP, Thyroid = Calcitonin

    11. 10 Biliary Cirrhosis = Anti mitochondrial antibody

    12. Wilson's Disease = Ceroluplasmin Antibody

    13. Liver = Alpha 1 antitrypsin

    14. Thyroid - Antimicrosomal antibody, Thyroglobin antibody

    15. Incidence # new cases / total population

    16. Prevalence # cases at a given time / total pop at that time

    17. Disease Frequency # people w/ disease / population at risk

    18. Case Fatality # who die in a given period/ # people w/ disease

    19. Relative Risk Only from cohort study; a/a+b divided by c/c+d; >1 positive assoc, < 1 negative association, =1 no association ==> disease if exposed /disease if not exposed

    20. Odds Ratio Only from case control; odds of getting if exposed / odds of getting if not exposed (ad/bc)

    21. Mortality Rate # people that die w/ in current population

    22. Std Mortality Rate Adjusted according to age distribution

    23. Attributable Risk exposed rate - unexposed rate

    24. Sensitivity a/a+c; accurate diagnose ; incr. False +

    25. Specificity d/b+d; Prob of neg test in those truly neg; incr. false neg

    26. OMM

    27. Fryettes Laws 1. Side bending then rotation in neutral position
    1. Flexion or extension with rotation then side bending
    2. Motion free in one direction is restricted in the other

    28. Ribs 1-5 pump handle, 6-10 bucket handle, 11-12 caliper; Elevated = expiration restricted Treat lower ribs 1st; Depressed = inhalation restriction, treat upper ribs 1st

    29. Flexion Test Standing = ilia sacral; Seated = sacroiliac; false neg = tight hamstrings on standing flexion; False positive = tight quads on standing flexion

    30. Sympathetic Innervations Head & Neck = T1-4; Lung T2-5 bilat; Heart T2-5 Left, Stomach T5-9 Left; Duodenum T10 rt; Gall Bladder T9 rt; Liver T5-9 Rt, Pancreas T6-9 bilat, Kidneys, Ovaries, Testes T10-L1 of respective side; Adrenals T10-11, Appendix T11-12 Rt, Bladder L3-4, Uterus L4-5, Rectum & Anus L4-5

    31. Parasympathetic Innervations Eyes=CN III; Nasal sinuses, Eustachian Tube=CN VII; Soft Palate, Salivary Glands=CN IX; Thyroid thru Transverse Colon=CN X (Vagus); Right Colon & Pelvis= Pelvic Splanchnic Nerves S2-4

    32. Somatic Dysfunction An altered or impaired function of related components of the somatic system

    33. Qualities: Texture chg, asymmetry, decr. ROM, tenderness

    34. Treatment Types Direct = engages restricted barrier & pushes thru it, Force takes it from where it is to where it will not go

    35. Indirect = Move away from the barrier, Leaves the structure in the position it was

    36. Direct Technique Used For: Subacute or chronic, no assoc osseous pathology post closure of epiphyseal plate, Short restrictors

    37. Indirect Technique Used For Acute, A lot of pain, a lot of restriction, non closure of epiphysis

    38. HVLA Contraindications

    39. Direct, Passive Absolute = Weak bony structure, spinal cord, nerve compressions, Danger of vascular damage;

    40. Relative: lax ligament, acute inflammation, pregnancy, Calcification of aorta, Recent MI, spondylosis, Ankylosin Spondylitis, Osteoporosis, Chronic Steroid use, Acute disk disease, Extreme scoliosis, Cauda Equina Syndrome, Adv. Degenerative disease, Severe DM, Hx or current malignancy, Agenesis Odontoid process, Vertigo

    41. Counter Strain

    42. Passive Indirect Put joint into position of greatest comfort; Agonist-Antagonist pair; Strain due to rapid stretching followed by protective immediate shortening of agonist along with rapid shortening then lengthening of antagonist

    43. Most comfort of pt (70%) Hold for 90 sec (120 secs for ribs) Reactions to Tx: generalized soreness, treat no more than 6 TP at a time, 3 days between Tx;

    44. Muscle Energy

    45. (Active then passive, direct) Type I = Joint mobilization using direct muscle force

    46. Type II = Muscle lengthening using postisometric relaxation, "Resetting the Gamma Gap or Synaptic Fatigue

    47. Type III = Muscle lengthening using Reciprocal Inhibition

    48. Type IV = Muscle relaxation using Crossed Extensor Reflex - Used w/ sever injury (flexor muscle on one extremity is contracted the flexor on opposite extremity relaxes & extensor contracts)

    49. Natural Body Rhythms Cardiac/Vascular, Ventilatory, Visceral, Cranial Rhythmic Impulse (CRI), Slow Undulating (Breath of life)

    50. Articular Mobility of Cranial Bones Newborn: Base is cartilage for stability, vault is membrane for accommodation Sphenoid motion - influences facial & frontal bones; Occipital Motion - influences temporals (mandible & hyoid) & parietals

    51. Motion of Sacrum between the Ilium Superior transverse axis, Located at S2, Only area of anterior convergence & posterior divergence of the SI joint

    52. Coordination of motion Inhalation = midline flex, paired ext rotate, sacral base post, SBS rises
    53. Exhalation = midline extension, paired int. rotation, sacral base anterior SBS falls
    54. Sacrum & Temporal follow movement of occiput; Facial bones follow motion of sphenoid

    55. Strain Patterns Torsion, Side bending rotation, Vertical Strain, Lateral Strain, Compression

    56. Naming Convention Vert unit, AP, side bending, rotation

    57. Type of Motion C0-C1 (OA) Type I; C1-C2 Rotation; C2-C7 Type II; C7-L5 Type I & II

    58. ACID BASE
    59. pH acedemia < 7.35-7.45 < alkalemia
    60. pCO2 Resp alkalosis < 35 - 45 < Resp acidosis
    61. HCO3 Metabolic Acidosis < 22-26 < Metabolic alkalosis
    62. Anion Gap = (NA) - [(Cl) + (HCO3)]
    63. Primary disorder pCO2 or HCO3 altered same way as pH


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    POISONING & ACCIDENTS


    1. Burns 1st= only epidermis, red no blister; 2nd = hyperemic, blister; partial thickness; 3rd = full thickness, leathery no pain; 4th = electrical injuries, damage to nerves & bone; entry & exit burn; Fluid resc. If > 20% Parkland formula = 3-4 ml/kg LR x % burn RULE of 9's: head = 9; ant trunk= 18 post trunk = 18, each incr. ext = 9; each decr. ext = 18, Perineum = 1

    2. Common Poisons & Antidotes: Aspirin = Dialysis; Acetaminophen =N-acetylcystine; Digitalis = lidocaine; Methanol & Ethylene Glycol = Ethanol; CO = O2; Narcotics = Narcan, Naloxone; Iron = Deferoxamine; Cu, As, Pb = Penicillamine; Cyanide = Sodium nitrite, or sodium thiosulfate

    3. Types of Fx Open(compound); Simple(closed); Greenstick (incomplete, children usually); Spiral (twisting breakage); Comminuted (multi bone fragments)

    4. Vertebral Fx Most common cause of paraplegia & quadriplegia, Compression Fx seen in elderly due to osteoporosis & DJD

    5. Hip Fx Avascular necrosis of femoral head if blood flow is compromised; Tx: immobilization, bedrest, surgery; Prevention= safety & Ca supplement in women

    6. Skull Fx Signs of Fx: 1.Battle's Sign = discoloration over mastoid bone; 2. Blood draining from ears, 3. Bruising of orbit, CN palsies, CSF leakage from ears & nose

    7. Rib Fx Most common thoracic injury; usually 5-9, local pain worse w/ inspiration

    8. Colles Fx most common wrist fx; breakage & displacement of distal radius, Attempted to break fall on outstretched hand

    9. Elbow Fx <10 yrs old, fall on outstretched hand w/ elbow in full extension; Compression or radial or median nerve or brachial artery; Improper care => Volkman's Ischemic Contracture

    10. Pelvic Fx MVA, 30% blood volume can be lost; Tx as if shock victim

    11. Tibial Fx Compartment syndrome= bleeding into tight compartments=> blood supply compression=>muscle ischemia; 6 Ps = pain, pallor, pulselessness, puffiness, parathesia & paresis (weakness) or paralysis. Surgical opening of compartment

    12. Sprains Tx = RICE => Rest, Ice, Compression, Elevation

    13. Concussion transient loss of consciousness; Coup = bruising under site of injury; Contrecoup = bruising on side contralateral to injury

    14. Blunt Eye Trauma periorbital echymosis, hyphema (bleed into anterior chamber; edema; Blowout Fx = Fx of orbital bone; Aspirin & anticholinergics are contraindicated

    15. Blunt Ear Trauma Auricular Hematoma (cauliflower ear) Tx prompt drainage to prevent dissolution of cartilage

    16. Dog & Cat Bites Pasturella multocida; Tx tetanus & rabies if needed, antibiotics

    17. Snake Bite Splint affected area & transport; In US usually pit vipers

    18. Spider Bite Black Widow: Vomiting, abd pain, shock; Tx Calcium gluconate & methocarbamol; Local bite Tx not needed
    19. Brown Recluse: bite becomes black scab w/ assoc fever, rash, vomiting & jaundice; DIC can occur; Tx: Dexamethasone, dapsone, colchcine & total excision of lesion

    20. Hypovolemic Shock Hemorrhage, Burns, Vomiting, Diarrhea; pale skin, JVD, incr. vasc resistance, incr. pulse Tx: rehydrate, transfusions,

    21. Septic Shock Infection, gangrene, necrosis,CV obstruction; pale/pink skin; flat neck veins, incr. pulse incr. or decr. vascular resistance Tx ventilation, Fluids, antibiotics

    22. Cardiogenic Shock Pale skin, flat neck veins, incr. pulse, incr. vascular resistance; Tx: medication for underlying problem, pacemaker,

    23. Neurogenic Shock Spinal cord injuries, drug OD; Pink skin, flat neck veins, normal => low pulse, low vascular resistance Tx: ventilation, fluids, drainage


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    Arrow PEDIATRICS : Student Note Book Collection


    PEDIATRICS


    1. Fetal Alcohol Syndrome IUGR, Microcephaly, Short palpebral fissures & philtrum, Cardiac Abnormalities, SGA, mental retardation, microencephaly

    2. Fetal Narcotic Exposure Hypertonicity, Sweating, Stuffy Nose

    3. Fetal Cocaine Exposure Limb reduction malformations, Intestinal Atresia, Jittery, tremors

    4. Grey Baby Syndrome chloramphenicol use, decr. metabolism due to immature liver, CV collapse, maybe fatal

    5. Erythroblastosis Fetalis Rh neg mom Rh + baby; Subsequent Rh + babies are at risk; Give RhoGam - binds to fetal RBC, prevents Antibodies from being made

    6. Beckwith Weiderman neonatal hypoglycemia d/t hyperinsulinemia, macroglossia, giantism, omphalocele, kidney anomalies, facial nevus flammus, poor prognosis

    7. Apt Test Determine cause of neonatal rectal bleed; differentiates adult vs fetal hemoglobin

    8. Dubin Johnson Chronic idiopathic jaundice

    9. Erb Duchenne C5-C6, flail arm (int rotation & abduction) due to traction on head during delivery; If c4 involved - paralytic diaphragm also present

    10. Henoch Schoenlein Pupura kids, allergic vasculitis, non-blanching petechiae or pupura on lower extremities only, arthralgias, abd pain, hematuria, proteinuria, coag & platelets are WNL; Immune mediated after virus or strep

    11. Kawasaki's look sick w/ fever > 5d, truncal rash, incr. cervical nodes, URI sx, "glove" desquamation on palms, feet, lips; Assoc w/ coronary artery aneurysm; TX: High dose asa, IV gammaglobin, Steroids contraindicated
    12. 4 out of 5 =bulbar conjunctivitis, erythematous mouth, lips & tongue; polymorphous erythematous rash, induration of hands & feet w/ erythema, solitary unilateral cervical lymph node < 1.5 cm; Thrombocytosis after 10th dy is common

    13. Kleinfeltters XXY, most common hypogonadal syndrome; + BARR body, small firm testicle, azospermia, incr. FSH

    14. Meckel's Diverticulum 2 ft from ileocoecal valve, 2 in long, 2& population, 2 tissue types (gastric or pancreatic) sx before 2 yrs old

    15. Newborn Blood 85 cc/kg, Hgb 14 - 22 gms/dl HCT 44-64%; incr. alk phos than adults & is incr. until adolescent growth spurt

    16. TORCH Toxoplasmosis, syphillis, rubella, CMV, herpes

    17. CMV maybe asymptomatic or deafness, blindness, jaundice, petechia, fever, seizure, mental retardation, IUGR; Transplacental passage of virus

    18. Cong. Rubella IUGR, cataracts, glaucoma, microphthalmia uveitis, retinitis

    19. Kernicterus unbound bili crosses blood brain barrier resulting in neuro problems or death

    20. Prolonged Hyperbili Bili > 10 at 10 days of life
    21. Photo therapy can be used as long as direct isn't > 1 mg%

    22. Hemorrhagic Disease of Newborn Deficiency of vitamin K dependent factors (2-7-9-10)

    23. Intrauterine Shunts placental, ductus venousus , foramen ovale, ductus arteriosus Ductus venosus = ligamentum venosus; Ductus Arteriosus = Ligamentum Arteriosus

    24. Growth & Development 1st teeth - 6-9 mos; Neuromuscular development in cephalocaudid direction; 4 wks regard face, smile 4-6 wks, social laugh 4-5 mos; 15 mos stack 2 blocks; 18 mos stack 3 blocks; walk up stairs 20 mos ; w/ alt feet 3 yrs;
    25. Drawing = circle 2.5-3; cross 3-4; Square 4-5; Triangle 5; Diamond 6 yr
    26. Wt Gain = BW by 10d; 15 lbs 1st yr, 6-7 lb 2nd yr
    27. Length = 10 in 1st yr, 5 in 2nd yr; < 2in / yr is abnormal
    28. Head Circumference: 0-35; 3-40, 9-45, 3-50, 9-55 cm
    29. # Alveoli increase as lungs grow; # nephrons don't increase after term

    30. ADHD 3x more male than female; inattentiveness, impulsivity, hyperactivity

    31. SIDS Peak 2-4 mos, declines after 6 mos; 60:40 male:female;
    32. Risk Factors: < 20yrs old, poverty, smoking
    33. Apnea of prematurity in infants < 34 wks gestation; Tx: tactile stimulation, decr environmental temp, incr O2, transfuse to get Hct to 45%; CPAP, theophylline, last resort = mech vent

    34. Special Human IG hepatitis B, Rabies, Tetanus, Varicella Zoster, CMV

    35. CHF in Peds cardiomegaly, tachypnea, hepatomegaly

    36. Noncyanotic Cong Heart Disease ASD, VSD, AV septal defect, PDA, coarction of aorta, aortic stenosis, MVP

    37. Cyanotic Heart Disease Tetralogy of fallot, pulm Atresia w/ VSD, tricuspid Atresia, hypoplastic left heart, transposition of great vessels, anomalous pul venous return, truncus arteriosus

    38. Rheumatic Fever carditis, polyartheritis, sydenham chorea, erythema marginatum, subcutaneous nodules; Mitral insuffucuency most common valvular residual = Carey Coombs murmur

    39. Acute Myocarditis Coxsackie B #1, Coxsackie A, CMV, mumps, herpes, adenovirus

    40. Otitis Media Moraxella Catarrhalis #1 cause of bacterial in infants < 18 mos

    41. Epiglotitis prior to vaccine H. flu most common cause; peak ages 3-8 ys

    42. Resp Infections < 5 Viral pneumonia = RSV, Bacterial pneumonia = strep; Lower resp infection = mycoplasma pneumonia ( Eaton Agent, 1o atypical pneumonia or walking pneumonia); Croup = rhino, RSV #2;

    43. Pyelonephritis poor feeding, irritability, and seizure ; r/o sepsis

    44. Hemorrhagic Cystitis Adenovirus

    45. Neurogenic Diabetes Insipidus x linked recessive, renal ADH receptors; Sx polyuria, polydipsia, FTT; r/o psychogenic polydipsia; Due to hypofunctioning hypothalamus or posterior pituitary w/ ADH deficiency

    46. Rashes Measles (rubeola); Face then body; Cough, Coryza, Conjunctivitis, Koplik's spots
    47. Scarlet Fever = red skin folds (Pastia sign), strawberry tongue, sandy exanthum on trunk => flexor surfaces
    48. German Measles (Rubella)
    49. Filatov Dukes Disease (4th. No longer used)
    50. Erythema Infectiosus (5th disease) parvo B19, slapped cheek; circumoral pallor => lacy reticular rash
    51. Roseola infantum (herpes 6)High fever then after fever get rash 1st on trunk then face
    52. Rash on face 1st = measles, 5ths, Rubella
    53. Rash on Trunk 1st = Scarletina, Roseolla, Chickenpox
    54. Rashes on Palms & Soles = Erythema Multiforme (Stevens Johnson); Hand Foot & Mouth (Coxsackie A19; Kawasaki, Rocky Mt Spotted Fever, 2o syphillis, TEN, Dermatomyositis

    55. Infectious Mono EBV, Dx by positive heterophile test (Paul Brunnel Ab); hepatosplenomegaly

    56. Conjunctivitis Neonatal infectious = Chlamydia trachomatis,minimal discharge, congestion & edema 7-14 days after birth

    57. Rocky Mountain Spotted Fever Rickettsia rickettsii, high fever, peripheral rash, Atlantic seaboard, wood & dog ticks

    58. Cat Scratch Disease R. Henselae; regional lymphadenitis; Chemical = silver nitrate

    59. PKU blonde hair, MRDD, seizures, eczemoid rash

    60. Galactosemia Auto recessive, n/v/d, jaundice, hepatomegally, cirrhosis & cataracts if untreated

    61. Homocysteinuria tall thin stature w/ MRDD sublaxation, lens, genu valgum (knock knee), pectus carinatum

    62. Lesch Nyhan Purine metabolism; normal until 6-8 mos; loss of motor milestones; incr. spasticity, self mutilation without loss of sensory feeling; Urine has orange uric acid crystals
    63. Self mutilation w/ loss of sensory = familial dysautonomia

    64. Hurler's Syndrome mucopolysaceharidosis, grotesque coarse features, skeletal anomalies, dead by age 10

    65. Glycogen Storage Disease Von Gierke, Pompe, Forbes

    66. Tay Sachs Lipid Storage, Jewish , defic of hexosaminidase A; normal at birth then loss of motor milestones & hypotonia at 6 mos, Death by age 2; Cherry red macula

    67. ALL most common malig of childhood, peak at age 4; thrombocytopenia, anemia, elevated uric acid & LDH; Dx by bone marrow biopsy showing infiltration of leukemia blast cells; CXR = mediastinal mass or widening, 2o ary to lymphadenopathy

    68. Brain Tumors most common solid tumor of childhood; < 2 intratentorial tumors > 2 supreatntorial tumors
    69. Morning vomiting = posterior fossa ependymoma
    70. Astrocytoma most common brain tumor

    71. Hodgkins Lymphoma Reed Sternberg Cells; Painless cervical lymphadenopathy

    72. Neuroblastoma Neural crest of sympathetic ganglia or adrenal medulla; 50% before age 2; 90% before age 5; and mass that crosses the midline

    73. Nephroblastoma asymptomatic abd mass; HTN, Ages 2-5; Aniridia (loss of iris) hemihypertrophy Also called Wilm's Tumor

    74. Rhabdosarcoma Most common soft tissue sarcoma; < 10yrs old; nasal, aural, anus or vaginal area

    75. Ewing Sarcoma diaphyses
    76. Osteosarcoma Metaphyses, #1 site distal femur
    77. Retinoblastoma Neuroectodermal malignancy , most occur before age 5; Leukocoria (white pupil reflex)
    78. G6PDase Defic most common red cell enzyme deficiency that causes hemolytic anemia; usually asymptomatic until exposed to stress, infection or certain foods; Cause of hyperbilirubinem

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    BIOCHEMISTRY



    Essancial amino acids (9)-phenyl alanin, lysine, lusin, isolusin, tryptophan, histadin, valine, threonin, methionin

    1. Hormones of anterior pitutery -GH, ACTH, TSH, PROLACTINE
    2. IN CEREBROSIDES PRESENT- SPHINGOSINE, GALACTOSE
    3. IN BRAIN & KIDNEY AMONIYA PRODUSED BY –GLUTAMINE(neurotransmitter)
    4. IN LIVER AMONIA FORMED-UREA
    a. KIDNEY
    5. GLUTAMINE ------------------------à AMONIA --- LIVER àUREA
    a. BRAIN
    b. 7. IN NORMAL URINE HAS- . GLUCOSE,CREATINE
    6. BLOOD BRAIN BARRIER IS MAX PERMEABLE FOR-CO2
    7. BIOTIN -IS DESTROYED BY HEAT
    8. FERRITIN –INACTIVE FORM OF IRON STORED IN –LIVER
    9. RESPIRATORY ACIDOSIS CAUSED BY-EMPHYSEMA
    10. TRYPTOPHAN-Involved in serotonin, niacin, & melaton synthesis
    11. IN TRANSCRIPTION ANTICODON SEEN IN –T RNA
    12. ENZ + COFECOTOR=HOLOENZYME
    a. ANTI CODON FOUND IN t Rna
    13. Vit. K dependent BLOOD CLOTING factor - 2, 7, 9, 10 FACTER
    14. Basic amino acid-arginin, lysine, histadine,
    15. Acidic amino acid-aspartic acid, glutamic acid
    a. Mitochondria- fatty acid oxidation, acetyl coA Production, krebs cycle
    b. Cytoplasm- fatty acid synthesis, HMP shunt, Proteni syn. ,Steroid syn.
    c. In both=Glycogenesis,urea cycle, heme syn
    d. INSULINE = 2 CHAIN 51 amino acid= A chain---21 amino cid
    i. B chain---30 amino acid
    16. BRIDGE 2INTRA CHAIN , 1 INTER CHAIN = A7+B7, A20+B19, A6+A11
    17. HALF LIFE=6 MIN
    a. Hb 2 chain (α-141 amino acid , β-146 amino acid)
    18. Cholesterol from the liver to tissue transported by-LDL
    19. TRIGLYCERIDES IN SERUM ARE TRANSPORTED BY- VLDL
    20. LIPID FROM TISSUE TO LIVER TRANSPORTED BY-VLDL
    21. ENDOGENOUS TRIGLYCERIDE CARRIER IN PLASMA IS-VLDL
    22. HIGHEST ENDOGENOUS TRIGLYCERIDE R PRASENT IN –VLDL
    23. LOWEST TRIGLYCERIDE CONTENT IN-HDL

    24. MOST ESSENSIAL FATTY ACID –LINOLEIC ACID


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    Foransic

    1. RIGOR MORTIS- DEVELOPS IN=3-6 hour ‘UPPER EYELIDS & SMALL MUSCLES OF HANDS (VOLUNTARY MUSCLE)
    2. Cadaveric spasm=immediately after death ,affect involuntary muscle
    3. Age of a 16 year old female by =upper end of radius ulna (eelbo)
    4. Gravious injurey= fracture radius, Emasculation, Permanent disfigurement,privation(loss) of any mem. Of joint, can’t dodaily routines
    5. Pugilistic attituted in burn=anti martam 7 post martam both
    6. Brown disclouration of mucosa=NITRIC OXIDE
    7. BROWN COLOUR OF URINE= NITRIC OXIDE
    8. CORBOLIC ACID ( CO) POISNING= GREENISH URINE,LEATHERY STOMACH,PUTREFICATION
    9. GREASE COLOUR IS SEEN IN=FIRE ARM EXIT
    10. TEST FOR SEMINAL STAIN IS =ACID PHOSPHATASE TEST
    11. FLORENCE TEST , berberio test,acid phosphatase test DETECT=SEMEN
    12. PRESERVATIVE USE IN ALCOHAL POISNING=NACL
    13. MTP ACT=1971
    14. BLUE LINE GUMS=Pb POISING
    15. FRACTURE OF HYOID BONE EXCEPT IN =CHOKING
    16. MORPHIN=PIN POINT PUPIL
    17. SPALDING SIGN=DEAD BORN
    18. MACERATED FOETUS=DEAD BORN
    19. Spalding sign =fetal death
    20. Dermal nitrate test= gun powder residue
    21. Colour change of putrefaction r 1st observed in =RIGHT iliac fossae
    22. Maggot ( worm)after =2-3 days
    23. GUTTER FRACTURE=BULLET INJURIES
    24. GETTER’S TEST=DROWING
    25. Human hair has =scales
    26. Thorn apple=dhatura stramonium
    27. AMYL NITRATE IS ANTIDOTE OF=CYCNIDE
    28. METHYL BLUE 4 IS ANTIDOTE OF=SODIUM NITRATE
    29. Dowry death=304B
    30. ARSENIC=BURNT BONES,VELVETY APPEARANCE OF STOMACH,HYPER PIGMETATION OF PALMS & SOLES, MARSH TEST
    31. FILIGREE BURNS=LIGHTENING
    32. ARSENIC=PUTREFICATION=FOAMY LIVER
    4D = DHATURA=Dryness of mouth, Dilated pupil, Deli

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    CARDIOVASCULAR


    1. Contraindications to BP meds Asthma/COPD = Bblockers, DM = Thiazides & Bblockers, Cardiac Failure = Bblockers & Ca Channel Blockers; Pregnancy = Thiazides & ACE

    2. Rheumatic Fever post strep infection, migratory arthritis, endocardits, subcutaneous nodules on extensor surface, chorea, erythema marginatum, incr. Sed, WBC & ASO

    3. ASD L=>R; Wide split & fixed S2; patent foramen ovale

    4. VSD L=>R; pansystolic murmur left sternal border, thrill; most common defect; Eisenmenger's Syndrome = shunt direction reversed due to incr. pulm vasc resistance

    5. Patent Ductus Arterio L=> R; Continuous machinery murmur; Indomethacin inject may close

    6. Tetralogy of Fallot VSD, RVH, Pulmonic Stenosis, Overriding Aorta

    7. Pulmonic Stenosis R=>L, Early systolic click, High pitched systolic ejection murmur, soft or absent S2

    8. Coarction of the Aorta HTN arms but not legs, murmur heard on back, X-ray scalloping of ribs,

    9. Bacterial Endocarditis Acute: S.aureus, Group A strep, N Gonh., Sub acute: Strep Viridans; New heart murmurs, petechia over incr. half of body, Splinter hemorrhages on fingernails, Osler's Nodules (nodules on fingertips) Roth's Spots (retinal hemorrhages)

    10. Noninfective Endocarditis Libman Sacks Disease associated with SLE

    11. Aortic Aneurysm Abdominal = pulsatile mass on exam, atherosclerosis, smoking HTN >4 cm = surgery Thoracic =Marfan's & syphilis >7c = surgery; Dissecting =split between medial & adventitial layers "ripping in chest" Normal EKG vs abnormal in MI

    12. Peripheral Vascular Disease Weak pulses, Atrophic skin, Little Hair growth, Nonhealing ulcers, intermittent claudication 5P's = pallor, pain, pulseless, parathesia, paralysis

    13. Raynaud's Phenomenon Pallor, cyanosis, erythema of fingers, most are idiopathic, others related to collagen vascular disease Tx vasodialators

    14. Heart Dysfunction Diastolic = difficulty filling ventricles; Systolic = problem ejecting blood from ventricle

    15. Polyarteritis Nodosa inflamed medium arteries->ischemia in tissues; men 3x> women, usually 40-50; Dx confirmed by biopsy or angiography showing aneurysm of medium arteries

    16. Giant Cell Arteritis Temporal Arteritis; women >50; severe temporal or occipital HA, Amaurosis Fugax (temp blindness 1 eye) Temporal artery swollen & tender, Dx confirmed by biopsy

    17. Cor Pulmonale COPD most common cause; Dyspnea & syncope on exertion, S/Sx Rt heart failure

    18. Mitral Stenosis Mitral facies = red rash on cheekbones, Loud S1 and opening snap after S2; Right heart failure TX with diuretics; LAH=>Pulm HTN=>RVH Bblockers & Ca Channel Blockers to decr. HR & preload; Progressive Dyspnea

    19. Mitral Regurge Midsystolic click; Harsh blowing holosystolic murmur; MVP; LAH & LVH; wide S2 that widens more with inspiration; Bblockers for Sx Valve replacement

    20. Aortic Stenosis Triad = Angina, Syncope & Dyspnea on exertion; Cong bicuspid valve, weak long pulse, LVH T wave invesions; Left sided failure; Bblockers decr. HR & incr. coronary flow

    21. Aortic Regurge Decrescendo murmur, widened pulse pressure, "Water Hammer Pulse" (rapid up & down stroke); "Pistol Shot over femoral Artery; 2o Austin Flint murmur= diastolic murmur as blood goes thru AV to hit MV. Kids = cong VSD w/ MVP

    22. Supraventricular Tachycardia Sudden attacks due to reentry rhythm, P on T on EKG; #1 AV Nodal Reentry #2 Wolff Parkinson White = reentry thru accessory muscle bundle, can cause V fib in a Pt with Afib; Torsades De Point is drug induced

    23. Left Sided Failure Dyspnea, Orthopnea, Paroxysmal nocturnal dyspnea, LVH

    24. Right Sided Failure Most common cause is Left sided failure; Neck vein distention, Liver big, Edema

    25. MI ST elevation, T wave inversion; CPK-MB 12 - 40 hr for peak; LDH peaks 3-6 days

    26. Congestive Cardiomyopathy Alcohol = chronic; Infection Coxsackie B or Trypanosoma cruzi (Chagas Disease)

    27. Hypertrophic Cardiomyopathy Cong or acquired VH with normal afterload; incr. venous pressure, JVD, ascites, edema, edema, pleural effusion, S4 on exam

    28. Chronic Pericardtis Causes right sided failure; Kussmaul's Sign ( incr. neck vein distention on exertion) Dyspnea on exertion and Orthopnea; pulsus paradoxus; Surg removal of pericardium is curative.

    29. Pericardial Effusion Friction rub, distant heart sounds, "water bottle" on x-ray; acute pericarditis = exudate; neoplasm or fibrosis =transudate; symmetrically enlarged cardiac silhouette

    30. Cardiac Tamponade Pulsus paradoxus, Kussmauls Absent; pericardial fluid compresses heart, Becks Triad = Hypotension, (ß decr. pulse pressure), JVD, Muffled heart signs

    31. Heart Murmurs AI: precordium, early diastolic, >S2, + heave; AS: 2nd R ICS & radiates to carotids, harsh, < S2; Diastolic = r/o malignancy, check BP both arms; MR: Apex radiates to axilla, + heave, assoc w/ sever anterior MI, endocarditis prophylaxisis; MS: Apex, late diastolic, opening snap after S2; MVP: Apex, blowing, holosystolic, incr. w/ valsalva; PR: 2nd L ICS, pulm HTN, clubbing, PE; PS: harsh; TR: 4th L ICS, incr. loud w/ inspiration; bounding JVD, pulsatile liver; VSD: loud holoystolic, assoc w/ Down's


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    ENDOCRINOLOGY


    1. Hypothyroid Weight gain, Lethargy, Coarse hair & dry skin, irregular menses, cold intolerance, myxedema; Acquired = Hashimoto's; Congenital = cretinism, severe I deficiency = hoarse cry; resp distress, cyanosis, poor feeding, decr bone growth, ßT4 incr. TSH
    2. Wolff Chaikoff effect = inhibition of thyroid hormone release due to high doses of I during thyroid scan
    3. Hyperthyroid 1. GRAVES: most common, autoimmune, antibodies bind to TSH receptors; incr thyroid hormone, pretibial myxedema, Incr radio I uptake
    4. 2. SUBACUTE THYROIDITIS: tender, enlarged, Decr Radio I uptake, Sed Rate up, maybe followed by period of hypothyroid
    5. 3. SILENT LYMPHOCYTIC THYRODITIS: transient, postpartum, no pain or fever, Radio I uptake decr, lymphocytic infiltration, Tx Bblockers
    6. 4. TOXIC ADENOMA: multinodular goiter; nodules function autonomously, Excess T3 & T4; Scan shows a few hot spots with cold background
    7. 5. THYROTOXICOSIS FACTITIA: exogenous thyroid hormone, no goiter
    8. 6. PLUMMERS : multinodular goiter, nodules become autonomous and secrete thyroxine

    9. Sick Euthyroid acutely ill patients; T3&T4 decr due to chgs in hormone metabolism; TSH not decreased => not truly hypothyroid

    10. Thyroid CA Papillary = most common, best prognosis, Follicular = older, hematogenous spread to bone, lung, brain, liver; Anaplastic = worse prognosis, local invasion, hoarse & dysphagia; Medullary= Calcitonin producing Cells, MEN Type II(parafollicularC cells)

    11. Diabetes Dx: elevated random glucose sx, fasting BS > 140 x 2 days; Oral challenge >200 after 2 hrs; Type I: alpha islet cells, HLADR3, HLADR4, HLADQ, ketoacidosis
    12. Type II: insulin resistance; no HLA association, endogenous production enough so no ketoacidosis but do get hyperosmolar coma(dehydrated, glucose 600-2000

    13. Parathyroid Hormone incr. Ca mobilization from bones, incr. Vit D production decr. phos reabsorption in distal tubules = decr. serum phos.

    14. Hypoparathyroidism ßPTH, ßCa, incr. Phos, Tingling, tetany, Chvostek's sign (tap on face & get muscle spasm) ; Trousseau's Sign (BP cuff up 3min => carpal tunnel sx; decr. Mg in alcoholics can lead to decr. Ca due to ßPTH secretions

    15. Hyperparathyroid Bones, stones, abd. Groans and psychic moans; 1o = excess PTH; 80% benign adenoma; 2o due to decr. serum Ca=> vit D defic, renal tube prob and Ca loss

    16. Diabetes Insipidus Lack of ADH, polyuria and polydypsia

    17. Kallman's Syndrome Male, anosmic, small testicles, azospermic d/t head trauma; decr. FSH & LH, no GNRH

    18. SIADH Excess ADH, Tumor, trauma, pulm disease, drugs; Hypoatremia, Conc. urine;

    19. Acromegaly Excess GH; bone & tissue enlargement; glucose intolerance, osteoarthritis

    20. Addison's Disease Decreased cortisol (aldosterone) Wt loss, fatigue, skin pigmentation, eosinophilia; Decr aldosterone, decr Na, incr K; Give ACTH if cortisol doesn't increase Dx made

    21. Cushing's Syndrome Incr cortisol, Buffalo hump, moon facies, central obesity, Osteoporosis, #1 Cushing disease due to pit. Adenoma, #2 Ectopic- ACTH from lung tumor, #3 Adrenal Cortical tumor- incr. cortisol, ACTH suppressible, cortisol not #4 Chronic glucocorticoid Tx

    22. Waterhouse Friedrickson Syndrome hemorrhagic infarct of adrenals, assoc w/ meningococcemia

    23. Pheochromocytoma Episodic HTN, Dx by urinary catecholamines

    24. Familial Hypercholesterolemia Autosomal dominant, Xanthomas (lipid on tendons) Xanthelasmas (lipids on eyelids) MI's in 40's, Homozygous usually has incr. total cholesterol

    25. Familial Hypertriglyceridemia Trig incr. , LDL normal, Autosomal dominant, Pancreatitis, milky serum

    26. Familial Combined Hyperlipidemia Auto dominant, incr. trig and cholesterol; no xanthomas

    27. Familial Dysbetalipo-proteinemia rare, problem with lipoproetin catabolism; palmar or tuberous xanthomas, incr. risk periph vasc disease & CAD, Abn VLDL, cholesterol & triglycerides

    28. MEN I Parathyroid , pituitary & Pancreatic tumors

    29. MEN II Pheochromocytoma, Parathyroid & medullary thyroid tumors

    30. Hemochromatosis Auto recessive, incr. GI absorption of Fe; Excessive Fe, incr. Ferritin, incr. Transferrin saturation, cirrhosis, diabetes, bronze skin

    31. Wilson's Disease Auto recessive, excessive Cu accumulation, ataxia & dementia, Kayser Fleisher rings on cornea

    32. Hyperaldosteronism Aldosterone works on distal renal tubule to facilitate incr. Na retention and incr. K loss
    33. excretion due to decr. Na, decr. BP (renin angio), incr. K
    34. 1o Conn's Syndrome = adrenal hyperplasia, adrenal adenoma Tx: spironolactone
    35. 2o incr. renin angiotensin system activity => decr. BP

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    GENTOURINARY


    1. Neurogen c Bladder Bladder control requires: intact sensation(full) motor function (start void) Cerebral control (timing)
    2. Atonic, distended with overflow= acute spinal cord injury or sensory impaired
    3. Motor defect = sense full bladder but can't start emptying
    4. Autonomous = spinal cord injuries after acute; bladder fills & empties reflexively


    5. Hydronephrosis dilation of renal pelvis, incr. pressure in urinary system w/ or w/o ureter dilation

    6. Fanconi's Syndrome renal tubule defect; Urinary excretion of glucose, phos, AA; Tx: Vitamin D

    7. Pyelonephritis & Pyelitis Pyelonephritis = dilation of renal parenchyma, pyelitis = dilation of renal pelvis; E. coli; Different from cystitis since there are WBC casts not just WBC's

    8. Cystitis WBC in spun sample, E. coli, freq, urge, dysuria & suprapubic pain

    9. Bladder Ca transitional cell CA; Risk factors = smoking, schistosomiasis, aniline dyes

    10. Renal Artery Stenosis Cause of 2o HTN; Fibromuscular dysplasia (young women) Atherosclerosis (older)

    11. Urolithiasis incr. Ca = Calcium stones; Struvite Stones = post UTI w/ urea splitting bact (proteus or pseudo) when urine basic MgNH4PO4 (struvite) stones ppt.

    12. Uremic Syndrome Symptomatic renal failure = GFR< 20 ml/min; CNS chgs, asterixis (flapping tremor) pericarditis, N/V, yellow-brown skin (uremic frost) Normochromic, normocytic anemia due to decr. erythropoietin; incr. Phos & decr. Ca = renal osteodystrophy

    13. Glomerulonephritis Hematuria, proteinuria, RBC casts: Post strep = give Antibiotics only if still strep +, steroids no help; Goodpastures- autoimmune, high dose steroids, uremia 3-9 mos.

    14. Nephrotic Syndrome Proteinuria > 3g/day, Edema, hypoalbuminemia & hyperlipidemia (milky serum); minimal chg disease in kids; idiopathic Glomerulonephritis in adults

    15. Acute Tubular Necrosis most common cause of acute renal failure; ischemia or toxins; resolves in several weeks may need dialysis

    16. Polycystic Kidney Disease Auto dominant; multiple bilateral renal cysts; gross hematuria, proteinuria, pyuria, HTN, UTI's; asymptomatic until adult; 15% have associated subarachnoid hemorrhage

    17. Alport's Syndrome X-linked, Type IV collage, deafness & renal failure in males

    18. Wilm's Tumor nephroblastoma, kids < 4yrs commonly, hematuria, abd mass; resection & chemo

    19. Renal CA adenocarcinoma; Triad: hematuria, abd mass & flank pain

    20. Chronic Renal Failure >90% glomeruli destroyed; uremia incr. K, ßNa incr. phos, ßCa = renal osteodystrophy

    21. Hypernatremia > 155 mEq/L; due to dehydration, CNS depression (neuronal shrinkage); Diabetes Insipidus= decr ADH = lots of dilute urine = dehydration = urine output incr.

    22. Hyponatremia <135 mEq/L; pseudo if lipids are incr. incr. incr. high to displace polar Na; Osmotic = diabetes incr. Na 1.6 for 100 mg/dl glucose value is above 140.; SIADH, Central Pontine Myelinosis if corrected to fast

    23. Hyperkalemia > 5.5 mEq/L; muscle weakness, cardiac arrhythmia, met acidosis, oliguria, K sparring diuretics

    24. Hypokalaemia <3.5 mEq/L; muscle weakness, cardiac arrhythmias, resp failure, GI or renal loss

    25. Urethritis GC (gram - rodds in WBC, + thayer martin culture); nonGC = chlamydial; coinfection, Ceftrixone for GC, Doxycycline for Chlamydia

    26. Epididymitis Induration & tenderness of spermatic cord; support relieves pain

    27. Torsion of the Testes adolescents, swelling & tenderness, superior displacement, support does not relieve pain, Emergent SURGERY

    28. Hydrocele Painless lump, can be transilluminated; congenital process vaginalis remains in communication w/ abdomen = indirect inguinal hernias

    29. Varicocele "bag of worms", assoc w/ infertility

    30. Seminoma Painless lump; does not transilluminate, most common testicular neoplasm in men < 30; Undescended testes at greater risk even after surgical correction

    31. Prostatitis Nonbacterial > bacterial (GI organisms); recurrent UTIs; Rectal - warm, tender, boggy prostate; Tx TMP/SMX

    32. BPH Enlarged rubbery prostate on rectal; Urinary retention, a blockers; TURP, transrectal US more sensitive for Dx; PSA can be falsely elevated

    33. Prostate Ca Firm, nodular irregular prostate, Bone mets; Alk Phos and PSA are incr.

    34. Bacters Syndrome pre-auricular skin tag and kidney agenesis


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