Dr.DV's PGMEE Notes

Dacryocystitis

noreply@blogger.com (Dr Dhanesh Vijayan) — Sun, 01 Jul 2012 20:59:00 +0000

MCC of Chronic Dacryo-cystitis is Co.N.S ( Coagulase Negative Staphlococci) >> Staph aureus > Strep. Pneumoniae.

MCC of Acute Dacryocystitis - Staph. aureus.

Cohen-Woods Classification of Lactic Acidosis

noreply@blogger.com (Dr Dhanesh Vijayan) — Sun, 01 Jul 2012 20:35:00 +0000

Classification of Some Causes of Lactic Acidosis (Cohen & Woods, 1976)

Type A Lactic Acidosis : Clinical Evidence of Inadequate Tissue Oxygen Delivery

- Anaerobic muscular activity (eg sprinting, generalised convulsions)

- Tissue hypoperfusion (eg shock -septic, cardiogenic or hypovolaemic; hypotension; cardiac arrest; acute heart failure; regional hypoperfusion esp mesenteric ischaemia; malaria8,9)

- Reduced tissue oxygen delivery or utilisation (eg hypoxaemia, carbon monoxide poisoning, severe anaemia)

Type B Lactic Acidosis: No Clinical Evidence of Inadequate Tissue Oxygen Delivery

type B1 : Associated with underlying diseases (eg ketoacidosis, leukaemia, lymphoma, AIDS)

type B2: Assoc with drugs & toxins (eg phenformin, cyanide, beta-agonists, methanol, nitroprusside infusion, ethanol intoxication in chronic alcoholics, anti-retroviral drugs)

type B3: Assoc with inborn errors of metabolism (eg congenital forms of lactic acidosis with various enzyme defects eg pyruvate dehydrogenase deficiency)

Note: This list does not include all causes of lactic acidosis

Ref : http://www.anaesthesiamcq.com/AcidBaseBook/ab8_1.php

BLASKOVICS OPERATION

noreply@blogger.com (Dr Dhanesh Vijayan) — Sun, 01 Jul 2012 17:34:00 +0000

Posterior approach blepharoptosis surgery, via the transconjunctival route, was probably the first method of surgery employed to shorten the levator muscle. In 1923 Blaskovics first described his technique of extensive dissection of the levator muscle (LPS) from its surrounding structures prior to its resection.

AMAZING SPLEEN !

noreply@blogger.com (Dr Dhanesh Vijayan) — Thu, 05 Apr 2012 06:46:00 +0000

1. Most Common location of Accessory Spleen(Splenenculi) - Splenic Hilum

2. Most Common Primary benign lesion of spleen - Cavernous Hemangioma.

3. Most Common primary malignant lesion of spleen is - Lymphoma

4. Most Commonly ruptured intra-abdominal organ in the setting of trauma - Spleen
(Why? Ans: due to its complex ligamentous attachments and spongy parenchymal consistency)

5.Most common infection involving Spleen in Immunocompromised - Candidiasis.

6. Most Common organ involved in Sickle Cell Disease - Spleen

7. Most Common cause of Splenic Vein Thrombosis - Secondary to Pancreatitis.

DV-

Sorafenib

noreply@blogger.com (Dr Dhanesh Vijayan) — Wed, 04 Apr 2012 16:08:00 +0000

HCC tumors are generally chemoresistant, and only one
drug—sorafenib, a multikinase inhibitor—
is currently approved for advanced HCC patients.

E-Books

noreply@blogger.com (Dr Dhanesh Vijayan) — Wed, 04 Apr 2012 12:49:00 +0000

You can get some of the e-books from here.

http://ebooks.aabout.info

AIPGMEE 2009 Questions and Answers : ANATOMY

noreply@blogger.com (Dr Dhanesh Vijayan) — Tue, 27 Mar 2012 19:14:00 +0000

ANATOMY MCQs
(answers given below)
Note: Topics that have been discussed in this site has been hyperlinked in the questions itself.

1. Artery in the anatomical snuff box is..
a. Radial. A
b. Brachial.A
c. Ulnar
d. Interosseous

2. Superior Gluteal Nerve supplies all of the following muscles, except
a. Gluteus Minimus
b. Gluteus Maximus
c. Tensor Fascia Lata
d. Gluteus Medius

3. All of the following are composite muscles except:
a. Flexor Carpi Ulnaris
b. Flexor Digitorum Profundus
c. Pectineus
d. Biceps Femoris

4. All of the following are branches are branches of Splenic Artery, except:
a. Short gastric Artery
b. Hilar Branches
c. Right Gastroepiploic Artery
d. Arteria Pancreatica Magna

5. Contents of Deep Perineal Pouch include all of the following except:
a. Dorsal Nerve of Penis
b. Bulbourethral glands
c. Root of penis
d. Sphincter Urethrae

6. Urogenital Diaphragm is made up of the following things, except
a. Deep Transerve Perenei muscle
b. Pereneal membrane
c. Colle’s fascia
d. Sphincter Urethrae

7. Lymphatics from the spongy urethra drain into the following lymph nodes
a. Superior Inguinal Lymph nodes
b. Inferior Inguinal Lymph Nodes
c. Deep Inguinal Lymph nodes
d. Sacral nodes

8. Middle Superior Alveolar Nerve is a branch of:
a. Mandibular Nerve
b. Lingual Nerve
c. Maxillary Nerve
d. Facial nerve

9. The parasympathetic secretomotor fibres to Parotid Gland traverse through the following except :
a. Otic Ganglion
b. Tympanic Plexus
c. Greater petrosal nerve
d. Auriculotemporal nerve

10. Which of the following is not true about the Trochlear Nerve:
a. Has longest intracranial course
b. Supplies ipsilateral superior oblique muscle
c. Only cranial nerve that arises from the dorsal aspect of brainstem
d. Enters the orbit throught the superior orbital fissure outside the annulus of Zinn

11. Area that lies immediately lateral to the anterior perforating substance is :
a. Orbital gyrus
b. Uncus
c. Optic Chaisma
d. Limen Insulae

12. Medulla Oblongata is supplied by all except :
a. Anterior spinal artery
b. Bulbar artery
c. Basilar artery
d. PICA

13. Which of the following structures is insensitive to pain:
a. Dural sheath surrounding vascular sinuses
b. Choroid plexuses
c. Falx cerebri
d. Middle meningeal artery

14. All of the following about Sternberg’s Canal are correct, excepting:
a. Located anterior and medial to the foramen rotundum
b. Located posterior and lateral to foramen rotundum
c. Represents persistent craniopharyngeal canal
d. Cause of intrasphenoidal meningocoele

15. Closure of the neural tube begins at which of the following levels
a. Cervical Region
b. Thoracic Region
c. Cephalic end
d. Caudal end

16. Within which part of a gastric gland, are the chief cells located
a. Gastric Pit
b. Neck
c. Isthmus
d. Fundus

16(2).Chief cells in the stomach are most abundant in
a. Fundus
b. Body
c. Antrum
d. Pylorus

17. All of the following statements are true regarding Paneth cells, except:
a. Rich in Rough Endoplasmic Reticulum
b. Rich in Zinc
c. Contain lysozyme
d. Foamy appearance

18. GALT ( Gut Associated Lymphatic Tissue) is primarily located in:
a. Lamina Propria
b. Submucosa
c. Muscularis
d. Serosa

Answers : AIPGMEE 2009 ANATOMY

1.A 2.B 3.A 4.C 5.C 6.C 7.C 8. B 9.C 10.B 11.D 12.B 13.B 14.B 15.A 16.D (and A FOR 16(2) ). 17.D 18.A

Gluteal Muscles - Nerve Supply AIPGMEE 2009

noreply@blogger.com (Dr Dhanesh Vijayan) — Thu, 22 Mar 2012 15:28:00 +0000

Superior Gluteal Nerve supplies
1. Gluteus Medius
2. Gluteus Minimus
3. Tensor Fascia Lata

Inferior Gluteal nerve supplies
1. Gluteus Maximus

N. to Quadratus Femoris supplies
- Inferior Gamellus and Quadratus Femoris

N.To Obturator Internus supplies
- Superior Gamellus and the obvious O.Internus.

Anatomical Snuff Box

noreply@blogger.com (Dr Dhanesh Vijayan) — Thu, 22 Mar 2012 15:12:00 +0000

ANATOMICAL SNUFF BOX (AIPGMEE 2009)

When the thumb is fully extended the tendon is separated from extensor pollicis brevis by a triangular depression or fossa, the so-called 'anatomical snuff-box'.

Bony structures can be felt in the floor of this fossa by deep palpation. In proximal to distal order they are the radial styloid, the smooth convex articular surface of the scaphoid, the trapezium, and the base of the first metacarpal.

The tendons of the APL and EPB bound the anatomical snuff box anteriorly(laterally), and the tendon of the EPL bounds it posteriorly(Medially).

Contents
1. Cephalic Vein
2. Radial Artery
3. Superficial Radial Nerve

Direct X Ray Exposure on film

noreply@blogger.com (Dr Dhanesh Vijayan) — Thu, 22 Mar 2012 14:43:00 +0000

What is the Percentage(%) of the IMAGE DENSITY attributable to the direct X-Ray Exposure (and not the visible light) in a routine X-Ray image?

Ans : It's Only 5%.

Ultimate - Radiology.com: Pantothenate Kinase-Associated Neurodegeneration (...

noreply@blogger.com (Dr Dhanesh Vijayan) — Tue, 06 Mar 2012 07:33:00 +0000

Ultimate - Radiology.com: Pantothenate Kinase-Associated Neurodegeneration (...: Previously known as Hallervorden Spatz disease, pantothenate kinase-associated neurodegeneration (PKAN) , or neurodegeneration with br...

Parkinson’s disease - Genetic Mutations

noreply@blogger.com (Dr Dhanesh Vijayan) — Tue, 06 Mar 2012 07:32:00 +0000

The cause of sporadic Parkinson’s disease is still unclear. Major risk factors include age, not smoking, and living in rural areas. Familial forms of PD are rare accounting for less than 5% of all cases of PD. However, elucidation of several genes over the last decade has shed considerable light on the pathogenesis of typical sporadic PD (Table 2).

Locus	Inheritance	Gene	Function	Pathogenesis
PARK1/4	AD	α-synuclein	Unknown	Protein aggregation
PARK2	AR	parkin	Ub E3 ligase	UPS dysfunction
PARK3	AD	Unknown	-	-
PARK5	AD	UCHL1	Ub hydrolase	UPS dysfunction
PARK6	AR	PINK1	Kinase	Mitochondrial dysfunction
PARK7	AR	DJ-1	Binds RNA?	Oxidative stress
PARK8	AD	LRRK2	Kinase	Multiple pathways?
PARK9	AR	ATP13A2	P-type ATPase	Lysosomal dysfunction
PARK10	Susceptibility locus	-	-	-
PARK11	AD	GIGYF2	Unknown	-

Postponement of Declaration of Result of AIPGMEE-2012

noreply@blogger.com (Dr Dhanesh Vijayan) — Fri, 02 Mar 2012 01:08:00 +0000

"Directorate General of Health Services has filed an I.A. before Hon’ble Supreme Court of India for seeking
permission to do on-line counseling ( on-line seat allotment) in place of counseling by personal appearance and increasing number of candidate allotment process. In this connection the result of All India PG Medical/Dental Entrance Examination 2012 will be declared in due course of time after getting
approval from the Hon’ble Supreme Court of India."

http://aiims.edu/aiims/events/AIPG_result.pdf

Radioresistance Eye

noreply@blogger.com (Dr Dhanesh Vijayan) — Thu, 29 Dec 2011 15:46:00 +0000

1. Most radioresistant structure of the eye - SCLERA.

2. Most radiosensitive structure of the eye - LENS

Ref : Essentials of Ophthalmic Oncology

Radiology Hints

noreply@blogger.com (Dr Dhanesh Vijayan) — Mon, 28 Jun 2010 03:15:00 +0000

Increasing voltage (kV) decreases contrast and increases exposure, making the film darker. Increasing milliampere-seconds (mAs) increases exposure, making the film darker.

Biochemistry Notes - Scanned

noreply@blogger.com (Dr Dhanesh Vijayan) — Sun, 27 Jun 2010 02:48:00 +0000

These scans are from my notes which ended at the beginning itself....may be of some help.

Screening for Lp(a)

noreply@blogger.com (Dr Dhanesh Vijayan) — Sun, 27 Jun 2010 02:44:00 +0000

Patients at high to moderate risk of cardiovascular disease should be screened for elevated levels of lipoprotein(a) (Lp[a]) and take niacin to bring their Lp(a) level under 50 mg/dL, according to a consensus statement from the European Atherosclerosis Society.

Lp(a) is a plasma lipoprotein consisting of a cholesterol-rich LDL particle with one molecule of apolipoprotein B-100 and a molecule of apolipoprotein A. About 20% of people are thought to have plasma Lp(a) levels over 50 mg/dL; there are no gender differences in Lp(a) concentrations, but racial differences have been observed, with whites and Asians having lower levels while black and Hispanics generally have somewhat higher levels.
Since lifestyle appears to have little impact on an individual's Lp(a) level, the EAS consensus panel recommends that 1 to 3 g of niacin (nicotinic acid) daily is the best treatment for lowering Lp(a) levels. However, the group acknowledges that there have not been randomized, controlled trials selectively targeting plasma levels of Lp(a) and calls for further studies in both primary- and secondary-prevention settings to better define which patients should be targeted for treatment and what the target level of Lp(a) should be.

Kerala Medical PG Allotment Notice

noreply@blogger.com (Dr Dhanesh Vijayan) — Sun, 27 Jun 2010 02:34:00 +0000

The final round allotment process for the PG Medical Courses
2010 which is scheduled on 26.06.2010 and 29.06.2010 is postponed, in
the light of the judgement dated 24.06.2010 of the Hon’ble High Court
in WP(c) 13474/2010. Further information regarding the allotment
process shall be published in the website later.
Since the cut-off date for admission process is 30.06.2010, as
prescribed in the time schedule approved by the Hon’ble Supreme
Court, there may even be a chance of conducting the allotment
process on 29th and 30th of June 2010 for service and non-service
candidates respectively. Therefore the candidates are advised to have
a close watch on the information provided through the website from
28.06.2010 onwards.

Brain Tumour Risk in Relation to Mobile Telephone Use: Results of the INTERPHONE International Case–Control Study

noreply@blogger.com (Dr Dhanesh Vijayan) — Fri, 25 Jun 2010 00:39:00 +0000

Abstract

Background The rapid increase in mobile telephone use has generated concern about possible health risks related to radiofrequency electromagnetic fields from this technology.
Methods An interview-based case–control study with 2708 glioma and 2409 meningioma cases and matched controls was conducted in 13 countries using a common protocol.
Results A reduced odds ratio (OR) related to ever having been a regular mobile phone user was seen for glioma [OR 0.81; 95% confidence interval (CI) 0.70–0.94] and meningioma (OR 0.79; 95% CI 0.68–0.91), possibly reflecting participation bias or other methodological limitations. No elevated OR was observed ≥10 years after first phone use (glioma: OR 0.98; 95% CI 0.76–1.26; meningioma: OR 0.83; 95% CI 0.61–1.14). ORs were <1.0 for all deciles of lifetime number of phone calls and nine deciles of cumulative call time. In the 10th decile of recalled cumulative call time, ≥1640 h, the OR was 1.40 (95% CI 1.03–1.89) for glioma, and 1.15 (95% CI 0.81–1.62) for meningioma; but there are implausible values of reported use in this group. ORs for glioma tended to be greater in the temporal lobe than in other lobes of the brain, but the CIs around the lobe-specific estimates were wide. ORs for glioma tended to be greater in subjects who reported usual phone use on the same side of the head as their tumour than on the opposite side.
Conclusions Overall, no increase in risk of glioma or meningioma was observed with use of mobile phones. There were suggestions of an increased risk of glioma at the highest exposure levels, but biases and error prevent a causal interpretation. The possible effects of long-term heavy use of mobile phones require further investigation.

http://www.medscape.com/viewarticle/723258?src=mp&spon=34&uac=126137EG

Yttrium-90 (90Y) RadioMicrosphere Therapy

noreply@blogger.com (Dr Dhanesh Vijayan) — Mon, 21 Jun 2010 06:01:00 +0000

June 16, 2010 (Salt Lake City, Utah) — Scintigraphy using single
photon emission computed tomography with an integrated x-ray computed
tomography scanner (SPECT/CT) to detect extrahepatic shunting could
help boost the safety of yttrium-90 (90Y) radiomicrosphere therapy in
the liver, according to a Cleveland Clinic study presented here at the
Society of Nuclear Medicine (SNM) 2010 Annual Meeting.

Microsphere technology has gained popularity among surgeons and
interventional radiologists as an effective organ-preserving method of
individually treating hepatic malignancies, noted lead investigator
and presenter Ron Young, technologist and manager of the nuclear
medicine department at the Cleveland Clinic in Ohio.

Mr. Young described how, in a typical procedure, the 20 to 40 μm glass
spheres imbedded with 90Y are injected into hepatic artery circulation
where they selectively embolize the tumor's microvasculature. Beta
particles emitted by the isotope kill cells in a 2.4 mm diameter
region around the tumor and spare healthy liver tissue.

Hepatic radiomicrosphere therapy is considered safe, with a
complication rate of less than 5%, Mr. Young reported. But he added
that many adverse events arise from the incomplete embolization of the
hepatic vessels under angiographic guidance before the procedure. It
can lead to severe pulmonary, gastrointestinal, and pancreatic
radiation burns after the 90Y particles are shunted from the liver.
Other complications include pancreatitis, cholestitis, and gastritis,
he told Medscape Radiology in an interview.

To minimize risk, technetium-99m (99mTc) microaggregated albumin (MAA)
imaging is performed to simulate extrahepatic shunting in the presence
of incomplete hepatic vessel embolization before the surgeon moves on
to the actual procedure, Mr. Young explained.

With guidance from staff interventional radiologist Abraham Levitin,
MD, Mr. Young and colleagues found that 99mTc-MAA SPECT/CT was 2.5
times more accurate than planar imaging in this role.

In 99 consecutive patients who underwent both imaging procedures,
extrahepatic shunting was detected in 23 patients with SPECT/CT and in
9 patients with the planar approach. The investigators did not perform
a detailed statistical analysis.

SPECT/CT also detected a hepatic thrombosis that was not observed on
planar images, Mr. Young noted. The finding led the surgical team to
minimize the lumen of the thrombosis in the inferior vena cava before
turning their attention back to liver treatment, he added.

The findings promise a significant improvement over the standard
technology, said Peter S. Conti, MD, professor of radiology, pharmacy,
and biomedical engineering at the University of Southern California in
Los Angeles. Dr. Conti was not involved with the study.

"The broader implications are that the use of SPECT/CT improves the
ability of the clinician to determine if patients are good candidates
for therapy," he said during an SNM-sponsored media briefing.

Hooman Kabiri, MD, who performs 90Y microsphere procedures at the Ohio
State University Medical Center in Columbus, said in a phone interview
that a shift to SPECT/CT would give him and other interventionist
radiologists more peace of mind.

"It can add to the sensitivity of detecting our ability to embolize
the communications between the hepatic and nonhepatic arteries. It is
a valuable tool in that respect," he told Medscape Radiology.

But shifting to SPECT/CT could also lead to unnecessary treatment
delays because of possible false positives, he cautioned. The 3%
adverse incident rate at Ohio State suggests that the actual rate of
extrahepatic shunting is much lower than the 23% rate identified with
SPECT/CT in the Cleveland Clinic study, he said about the trial.

A larger prospective study testing the relative clinical efficacy and
accuracy of the 2 imaging techniques is planned, Mr. Young told SNM
meeting attendees.

The study did not receive commercial support. Mr. Young, Dr. Conti,
and Dr. Kabiri have disclosed no relevant financial relationships.

Society of Nuclear Medicine (SNM) 2010 Annual Meeting: Abstract 2023.
Presented June 7, 2010.

Italian Scientists Find a Viral Link to Type 1 Diabetes

noreply@blogger.com (Dr Dhanesh Vijayan) — Mon, 21 Jun 2010 05:13:00 +0000

Italian researchers have found a link between a common virus and type
1 diabetes that may open the door to answers about what triggers the
disease in children.

Scientists at the University of Insurbia in Varese, Italy, tested the
blood of 112 children between two and 16 years of age immediately
after they had been diagnosed with type 1. The researchers were
looking for the presence of DNA left over from infection by an
enterovirus, a common, very mild virus that usually produces either no
symptoms or mild ones, such as aching muscles or rashes.

The scientists knew that previous studies have shown a possible link
between enteroviruses and the onset of type 2. Their study results
confirmed the link: 83 percent of the children with type 1 had
low-level enterovirus infection, compared to 7 percent of children
without the disease.

http://www.diabeteshealth.com/read/2010/06/17/6724/italian-scientists-find-a-viral-link-to-type-1-diabetes/

T-10 PROTOCOL

noreply@blogger.com (Dr Dhanesh Vijayan) — Wed, 21 Apr 2010 00:37:00 +0000

T-10 PROTOCOL is the chemotherapy regime for Osteosarcoma.

M high DOSE methotrexate
O Oncovin
A .. Actinomycin D
B .. Bleomycin
C .. Cisplatin, Cyclophosphamide
D .. Doxorubicin

Japanese Disease

noreply@blogger.com (Dr Dhanesh Vijayan) — Wed, 21 Apr 2010 00:37:00 +0000

Ossification of Posterior Longitudinal Ligament or OPLL or Japanese Disease.

* MC in mid and lower cervical spine.
* causes Spinal Cord compression.
* MRI is the investigation of choice.. Low signal on all pulse sequences. On gradient echo sequences owing to magnetic susceptibility (Blooming Effect) osteophyte size may be exaggerated resulting in overestimation of canal stenosis.

MRI FEATURES OF MESIAL TEMPORAL SCLEROSIS

noreply@blogger.com (Dr Dhanesh Vijayan) — Sat, 17 Apr 2010 03:03:00 +0000

Mnemonic - MAFIA.

M-Mammillary body atrophy
A-Amygdala atrophy and Atrophied Hippocampus.
F- Fornix atrophy
I- ipsilateral parahippocampal white matter tract atrophy
A- atrophied or small Temporal Lobe with enlarged temporal horn.

Adrenal myelolipoma

noreply@blogger.com (Dr Dhanesh Vijayan) — Fri, 16 Apr 2010 08:56:00 +0000

Unilateral adrenal mass with chunky calcification and macroscopic fat, with -15 to -25 HU is suggestive of Adrenal Myelolipoma.