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- 1. Target PG Sample Chapter Embryology Pharyngeal Arch Derivatives Arch Nerve (Neural Ectoderm) Artery Muscles (Mesoderm) Skeletal (Neural Crest) 1 Mandibular arch V3 Mandibular nerve Maxillary artery • Muscles of mastication (Masseter, Temporalis, Medial and Lateral pterygoid) • Anterior belly Digastric and Mylohyoid muscle • Tensor tympani, Tensor palati • Maxilla (Meckel’s cartilage) • Mandible • Malleus • Incus • Sphenomandibular ligaments 2 • Hyoid arch • Reichert’s cartilage VII Facial nerve Stapedial artery • Muscles of facial expression • Stapedius muscle • Stylohyoid muscle • Digastric—posterior belly • Stapes • Superior part of hyoid • Smaller horn of hyoid • Styloid process • Stylohyoid ligament 3 IX Right and Left Common and Internal Carotid artery Stylopharyngeus muscle • Hyoid bone—inferior part • Greater horn of hyoid 4 X Superior laryngeal nerve • Right subclavian artery • Arch of aorta • Cricothyroid muscle • All palatine muscles except Tensor Palati • All Pharyngeal muscles except Stylopharyngeus • Lower part of thyroid cartilage • Cricoid, Corniculate, and Cunieform cartilages 6 X Recurrent laryngeal nerve Right and Left pulmonary artery, Ductus arteriosum All intrinsic muscles of larynx (except cricothyroid muscle) Upper part of thyroid and Epiglottis Muscles of myotome origin Occipital myotome Hypoglossal nerve XII All tongue muscles except palatoglossus Preoptic myotome Oculomotor nerve All extraocular muscles except superior oblique (IV nerve) and lateral rectus (VI nerve) XI nerve • Sternocleidomastoid • Trapezius Scapula Skull SAMPLE_NEET.indd 1 28/09/17 2:01 PM
- 2. Target PG Anatomy Male Urethra Part of Urethra Length Transverse Section Epithelium Significance Preprostatic 1 cm Stellate Prostatic 3 cm Semilunar Transitional • Widest part • Most dilatable Membranous 1.5–2 cm Stellate Pseudostratified columnar • MC site of CA urethra • Shortest part Bulbar Transverse MC site of urethral injury Penile/Spongiose 15 cm Transverse Pseudostratified columnar Longest part External meatus Sagittal Stratified squamous Narrowest part Neuroanatomy Structures Passing Through Various Foramens A) Anterior cranial fossa Foramen caecum Nasal emissary vein Cribriform plate of ethmoid Olfactory nerve Anterior and Posterior ethmoidal foramina Anterior and Posterior ethmoidal vessels and Nerves B) Middle cranial fossa Optic canals Optic nerve, Ophthalmic artery Superior orbital fissure Middle Oculomotor nerve, Nasociliary nerve, Abducent nerve Lateral Trochlear nerve, Frontal nerve, Lacrimal nerve, Superior ophthalmic vein Medial Inferior ophthalmic vein, Internal carotid artery Inferior orbital fissure Zygomatic branch of maxillary nerve, Infraorbital nerves and vessels, Inferior ophthalmic veins Foramen rotundum Maxillary nerve Foramen ovale Mandibular nerve, Accessory meningeal nerve, Lesser petrosal nerve, Emissary vein Foramen spinosum Middle meningeal artery, Nervous spinosus Foramen lacerum Some meningeal veins and arteries SAMPLE_NEET.indd 2 28/09/17 2:01 PM
- 3. Target PG C) Posterior cranial fossa Foramen magnum Anterior Apical ligament of Dens, Membrana tectoria Posterior Medulla oblongata, Meninges Subarachnoid space Spinal part of 11th nerve, Anterior and Posterior spinal arteries, Vertebral artery Jugular foramen Anterior Inferior petrosal sinus Middle 9th, 10th, 11th cranial nerves Posterior Internal jugular veins, Meningeal branches of ascending Pharyngeal artery Hypoglossal canal (Anterior condylar canal) 12th nerve, meningeal branches of ascending pharyngeal and occipital artery Posterior condylar canal Emissary veins D) Miscellaneous canals Carotid canal Internal carotid artery with sympathetic plexus around it, Emissary veins Pterygoid canal Vidian nerve, Vidian artery Stylomastoid foramen Facial nerve, Stylomastoid branch of posterior auricular artery Internal acoustic meatus Facial nerve, Nervus intermedius of Weisberg, Vestibulocochlear nerve, Labyrinthine vessels Mastoid canaliculus Auricular branch of vagus nerve Greater palatine foramen Greater palatine vessels, Anterior palatine nerve Lesser palatine foramen Middle and Posterior palatine nerves Tympanic canaliculus Tympanic branch of glossopharyngeal nerve (Jacobson nerve) Physiology Action Potential The sequence of changes that take place in the membrane potential when a threshold stimulus is applied following its restoration to the resting level is called action potential. SAMPLE_NEET.indd 3 28/09/17 2:01 PM
- 4. Target PG • Parts of action potential Part of Action Potential Feature Depolarization Na+ influx Firing level After initial 15 mV of depolarization (once it reaches the threshold) the rate increases. This is firing level. Upstroke phase Rapid depolarization phase caused by rapid Na+ influx Overshoot Part of action potential during which the membrane potential is positive Repolarization or down stroke phase Rapid return of membrane toward RMP. It is due to • Closing of Na+ channels • Opening of K+ channels Undershoot or hyperpolarization Membrane potential becomes more negative than its initial RMP. It is due to leaky potassium channels Biochemistry Phenylalanine Metabolism • Essential aromatic amino acid • Hydrophobic partial glucogenic and partial ketogenic amino acid • Rate limiting enzyme—Phenylalanine hydroxylase • End products—Phenyl acetate, Phenyl lactate, and Phenyl pyruvate • Mousy urine odor in Phenylketonuria is due to Phenyl acetyl glutamine Types of Phenylketonurias Types of Phenylketonuria Defects Classical PKU Type I Phenylalanine hydroxylase Non classical PKU Type II Dihydrobiopterin reductase Type III 6 Pyruvoyl tetra hydropterin synthase Types IV and V Dihydrobiopterin biosynthesis (Continued) SAMPLE_NEET.indd 4 28/09/17 2:01 PM
- 5. Target PG Types of Phenylketonuria Defects Maternal PKU When woman with PKU who is not on low PA diet becomes pregnant Transient benign hyperphenylalaninemia Pterin 4 carbinolamine dehydratase Clinical Features of Phenylketonurias • Hypopigmentation of hair, skin, and eyes • Mental retardation, seizures, hyperactivity, and tremors • Mousy odour urine ++ Diagnosis • Antenatal prenatal diagnosis—DNA probes and Tandem mass spectrometry • Neonatal screening by elevated blood levels of PA • Rapid screening test called Guthrie test by Bacillus subtilis strains • FeCl3 test produces green color with PKU Treatment • Limit the intake of substrate • Lifelong dietery restriction of PA by maintaining 2–6 mg/dl Genetics Post-Transcriptional Modification • Addition of 7-methylguanosine cap at 5ʹ terminal • Poly (A) tailing at 3ʹ terminal • Secondary methylation of 2ʹ hydroxy and N7 adenyl residues • Splicing of introns and exons ligated which converts hn-RNA to m-RNA (Continued) SAMPLE_NEET.indd 5 28/09/17 2:01 PM
- 6. Target PG Difference Between DNA Replication and Transcription DNA Replication Differences Transcription DNA molecule serves as a template for formation of daughter DNA molecule Definition mRNA synthesized from DNA template Deoxyribonucleotides used in DNA synthesis Nucleotides Ribonucleotides used in RNA synthesis – Bases “U”replaces“T”as complementary base pair for“A” Entire genome copied Genome copied Only a small genome copied Proof reading in 3’→ 5’end (Exonuclease activity) Proof reading No proof reading Present in DNA polymerase Endonuclease and Exonuclease activity Absent in RNA polymerase Initiation of DNA synthesis requires Primer Primer Not needed Molecular Biology Polymerase Chain Reaction • PCR reaction is invented by Karry B Mullis in 1989 • PCR is a test tube method for amplifying a selected DNA sequence • Exponential amplification of the sample • One cycle of PCR requires 20–30 seconds • 20 cycles result in million fold of amplification of target DNA • Prerequisites of PCR –– Sample DNA to be amplified –– Deoxynucleotides –– Taq polymerase obtained from Thermophilus aquaticus –– Primer –– Magnesium chloride MgCl2 Steps of PCR Cycle Denaturation of DNA sample into single strands by heating to 94°C ↓ Annealing of primers to ss DNA by cooling to 50°C ↓ Extension of primer by heating again to 72°C SAMPLE_NEET.indd 6 28/09/17 2:01 PM
- 7. Target PG Microbiology Special Media Organism Differential Media Selective Media Enrichment/Enriched Media Anaerobes • Thioglycolate • Robertson cooked meat medium Bacillus anthracis PLET Bacillus cereus MYPA Bordetella pertusis Lacey’s Regan Low Bordet Gengou Borrelia Kelly’s (BSK) medium Corynebacterium diphtheria Tinsdale medium Potassium Tellurite Loefflers (Continued) SAMPLE_NEET.indd 7 28/09/17 2:01 PM
- 8. Target PG Organism Differential Media Selective Media Enrichment/Enriched Media Cympylobacter spp Campy BAP/Skirrow’s Hemophilus spp Blood, Chocolate, Levinthals, Fildes Legionella spp BCYE medium Leptospira EMJH/Fletcher/Korthoff Listeria spp PALCAM Myco TB Lewenstein Jensen Mycoplasma spp PPLO Neisseria spp – • Thayer Martin • New York Chocolate Pseudomonas spp Cetrimide agar S.aureus – Mannitol salt – Salmonella spp and Shigella spp Xylose Lysine deoxycholate agar, Eosin Methylene Blue agar, MacConkey agar • Salmonella Shigella agar • Wilson and Blair • Gram negative broth • Selenite F broth Streptococcus spp – Crystal Violet – Vibrio cholerae and others – • TCBS • Monsur’s GTTA • Alkaline bile salt Alkaline peptone water Immunology Classification of T Cells Types of T Cells Surface Markers Target Cells Functions Helper/Inducer T cell CD 4+ T cells MHC class II Growth of T cells and Macrophages Suppressor T cell CD 8+ T cells MHC class I Downregulate immune response Cytotoxic/Cytolytic/Killer T cell CD 8+ T cells MHC class I Kill and lyse target cells carrying foreign antigen Memory cell CD 4+ T cells and CD 8+ T cells MHC class I Provide memory and anamnestic response (Continued) SAMPLE_NEET.indd 8 28/09/17 2:01 PM
- 9. Target PG Types of CD 4+ Helper Cells TH 1 Cell TH 2 Cell TH 17 Cell IL – 2, INF – γ ↓ Activation of macrophage Delayed hypersensitivity Defense against intracellular microbes IL – 4, IL – 5 ↓ Production of Ig E Defense against helminthic parasites IL – 17 ↓ Recruitment of neutrophils & monocytes Defense against fungi & extracellular bacteria Parasitology Habitat of Amoeba Alimentary Canal Free Living • Entamoeba histolytica • Entamoeba coli • Entamoeba gingivalis (Extra-intestinal) • Naegleria fowleri • Acanthameba culbertsoni • Balamuthia mandrillaris Habitat of Flagellates • Intestinal flagellates—Giardia lamblia, Dientamoeba fragilis • Hemoflagellates—Trypanosoma, Leishmania • Oro-Vaginal flagellates—Trichomonas tenax, Trichomonas vaginalis Sporozoa • Coccidian parasites—Cyclospora cayetanensis, Isospora belli, Toxoplasma gondii, Sarcocystis spp, Cryptosporidium parvum • Noncoccidian parasite—Plasmodium (Species: falciparum, vivax, ovale, malariae) Trematodes Dioecious Blood Flukes Hermaphrodite Flukes Schistosoma hematobium • Involves vesical and pelvic plexus Liver flukes • Clonorchis sinensis • Fasciola hepatica • Opisthorchis spp Schistosoma mansoni • Involves inferior mesentric vein Intestinal flukes • Fasciolopsis buski • Gastrodiscoides hominis Schistosoma japonicum • Involves superior mesentric vein Lung flukes • Paragonimus westermani SAMPLE_NEET.indd 9 28/09/17 2:01 PM
- 10. Target PG Pathology Apoptosis Extrinsic Pathway Intrinsic Pathway (Mitochondrial Pathway) TRAIL ↓ Binds to DR 4 and DR 5 Fas ligand ↓ Binds to CD 95 Cytochrome C release from mitochondria to cytoplasm ↓ Binds to APAF-1 ↓ Wheel like hexamer ↓ Activation of caspase 9 Release of SMAC /DIABLO from mitochondria ↓ Binds and neutralises IAPs Association of FADD and procaspase-8 to death domain ↓ Activation of caspase 8 (Caspase 10 in humans) Activation of effector caspases ( Caspase 3 and 7 ) ↓ Substrate cleavage ↓ Cell shrinkage Peripheral chromatin condensation Formation of apoptotic bodies and cytoplasmic blebs Phagocytosis of apoptotic cells Intact plasma membrane Regulators of Apoptosis • Antiapoptotic—Bcl-2, Bcl-XL, Mcl-1 • Apoptotic—Bad, Bim, Bid, Puma, p53, Noxa Diagnosis of Apoptosis • Chromatin condensation seen by hematoxylin, Feulgen, and acridine orange staining • Estimation of Annexin V and activated caspases • Gel electrophoresis shows stepladder pattern Hematology Stages of Erythropoiesis Stages of Erythrpoiesis Salient Features Mitosis Nucleus Cytoplasm Proerythroblast Contains large number of erythropoietin receptor + Large nucleus with fine reticular chromatin and nucleoli Deeply basophilic Early normoblast + • Large nucleus with chromatin strands • Nucleoli disappears Basophilic (Continued) SAMPLE_NEET.indd 10 28/09/17 2:01 PM
- 11. Target PG Stages of Erythrpoiesis Salient Features Mitosis Nucleus Cytoplasm Intermediate normoblast (Polychromatic cell) Polychromatic + Condensed nucleus • Basophilic RNA • Acidophilic hemoglobinzation of cytoplasm Late normoblast (Orthochromatic cell) Hemoglobin increases – Orthochromatic with pyknotic nucleus with dark chromatin Acidophilic with basophilic hue Reticulocyte • Flat disc shaped • Larger than mature erythrocyte • More hemoglobin than mature erythrocyte – Absent nucleus Normal RBC • Biconcave disc shaped • 7.2 microns • 1–2 days for maturation of RBC – Absent nucleus Lab Medicine Liver Function Tests Excretory function tests • Serum bilirubin • Urine bilirubin • Blood ammonia • Urine urobilinogen Tests for hepatocellular damage • Alanine aminotransaminase • Aspartate aminotransaminase Tests for cholestasis • Serum alkaline phosphatase • 5’Nucleotidase • Gamma glutamyl transferase Tests for biosynthetic function • Serum albumin • Serum globulin • Prothrombin time • ALT → More specific for liver • AST/ALT ratio < 1 in non-alcoholic liver disease • AST/ALT ratio > 1 in alcoholic liver disease Markers for Alcoholic Hepatitis • AST/ALT ratio –– AST/ALT > 1 suggestive of probable alcoholic hepatitis –– AST/ALT > 2 suggestive of alcoholic hepatitis –– AST/ALT > 3 highly suggestive alcoholic hepatitis • GGT increased • Marked elevation of serum bilirubin in spite of moderate elevation of SAP (Continued) SAMPLE_NEET.indd 11 28/09/17 2:01 PM
- 12. Target PG • PMN > 5500/UL • Markedly elevated bilirubin • Decreased albumin (<2.5 mg/dl) • Prolonged prothrombin time • Hypertriglyceridemia and Hypercholesterolemia • Discriminant function –– Prognostic indicator of alcoholic hepatitis –– DF = 4.6 × (Prolongation of PT) + S. bilirubin –– DF > 32—Poor prognosis of alcoholic hepatitis Pharmacology Classification of Antihypertensives Class of Antihypertensives Drugs Diuretics Thiazides Hydrochlorthiazide, Chlorthalidone, Bendroflumethiazide, Indapamide Loop diuretics Furosemide, Torsemide, Bumetanide, Indacrinone Potassium sparing diuretics Spironolactone, Epleronone, Amiloride, Triamterene Sympathoplegics Central anticholinergics Clonidine, -methyl dopa 2 agonists Moxonidine, Rilmenidine Ganglion blockers Hexamethonium, Trimethaphan, Mecamylamine Adrenergic neuron blockers Reserpine, Guanethidine, Bretylium blockers Phenoxybenzamine, Phentolamine, Tolazoline b blockers Nevibolol, Metoprolol, Esmolol, Atenolol, Acetutolol, Betaxolol, Bisoprolol, Celiprolol a + b blockers Labetolol, Carvedilol Vasodilators Potassium channel openers Hydralazine, Minoxidil, Diazoxide NO releasers Sodium nitroprusside, Hydralazine Dopamine agonist Fenoldopam Calcium channel blockers Verapamil, Diltiazem, Nifedipine, Nicardipine, Nimodipine, Nisoldipine, Niterndipine, Isradipine, Lacidipine, Felodipine, Amlodipine Drugs decreasing the action of RAAS Renin inhibitors Aliskiren, Remikiren, Enalkiren ACE inhibitors Captopril, Enalapril, Lisinopril, Ramipril, Perindopril, Trandopril, Fosinopril, Moexipril Angiotensin receptor blockers Losartan, Valsartan, Irbesartan, Candesartan, Telmisartan, Eprosartan SAMPLE_NEET.indd 12 28/09/17 2:01 PM
- 13. Target PG Clinical Condition Preferred Antihypertensive Drugs Angina b-blockers, CCB Asthma Diuretics, CCB, ACE inhibitors, ARB BPH a-blockers CHF ACE inhibitors, Diuretics Diabetes and Hyperlipidemia ACE inhibitors, ARB, CCB, a-blockers Elderly and Isolated systolic HTN Diuretics, CCB High renin HTN ACE inhibitors, ARB, b-blockers Low renin HTN Diuretics, CCB Post MI b-blockers, ACE inhibitors Pregnancy b-blockers (Cardioselective, Labetalol), Methyl dopa, Clonidine, Dihydropyridine, CCB, Hydralazine, Prazosin PVD CCB, a-blockers Thyrotoxicosis b-blockers Chemotherapeutics Tetracyclines • Classification of tetracyclines a) Group I—Tetracycline, Chlortetracycline, Oxytetracycline b) Group II—Demeclocycline, Lymecycline c) Group III—Doxycycline, Minocycline • Uses of tetracyclines –– Tetracycline—DOC for LGV, Granuloma inguinale, Chlamydial pneumonia, Cholera, Brucellosis, Plague prophylaxis, H. pylori –– Doxycycline—DOC for Relapsing fever, Lyme’s disease, Rickettsial and Chlamydial infections, Malaria prophylaxis, Amoebiasis –– Minocycline—Meningococcal carrier state, Leprosy (ROM regime) –– Demeclocycline—DOC for SIADH –– Tigecycline—MRSA, VRSA • Side effects of tetracyclines –– Demeclocycline and Doxycycline cause photosensitivity –– Minocycline causes dose-dependent vestibular toxicity Classification and Uses of Macrolides Macrolides Uses Erythromycin Chancroid, Diphtherial infections, Campylobacter infections Legionella infections, Atypical pneumonia, Whooping cough Azithromycin and Roxithromycin • H. influenza and Neisseria infections • Urogenital infections • Chlamydia, MAC, Toxoplasma (Continued) SAMPLE_NEET.indd 13 28/09/17 2:01 PM
- 14. Target PG Macrolides Uses Clarithromycin Rx and prophylaxis of MAC, Peptic ulcer by H. pylori Spiramycin Toxoplasmosis in pregnancy Tacrolimus Immunomodulator Forensic Medicine Time Scale of PM Changes Time Scale Significant Changes Moment of death CNS, CVS, RS failure; insensibility; loss of voluntary power 20–30 minutes Dull red patch of 1–2 cm (PM lividity) Half an hour Intra ocular tension falls < 3 g Half to 1 hour No fall in rectal temperature; PM lividity starts to become visible First 1 hour Heat loss is by radiation; Adrenal medulla, Pancreas, intestinal lining autolyze 1–2 hours Rigor Mortis begins (Temperate countries 3–6 hr) About 2 hours Intra ocular tension becomes zero 1–4 hours Confluence of patchy livor mortis For first 2 hours Pale retina with raised temperature of body (PM caloricity) 2–4 hours Rigor Mortis well developed (Temperate countries 6–8 hr) 4 hours Bacterial multiplication beings within 4 hours 3–4 hours Tache noir becomes brown & black 4 hours PM lividity is well developed 6–12 hours Maximal lividity (or Primary Lividity); Fixity of PM hypostasis 7–10 hours Optic disc becomes blurred 8–24 hours Larvae or Maggots of flies appear in body (Summer) >12 hours RM starts disappearing 12–16 hours Linear cooling of body (0.4–0.6°C/hour in tropics; 1°C in temperate zone) 12–18 hours Green discoloration of abdomen; Gases collect in intestines (Summer) 12–24 hours Mucous membrane of Larynx & Trachea becomes brown red and later into green; Liver becomes flabby and soft 18–24 hours Petechiae seen in hypostatic area (Rupture of small vessels); Blisters appear 24 hours Marbling of vessels begin 18–36 hours RM disappears (Summer); Gas in tissue, cavity and viscera cause bloating; PM purge 24–36 hours Blisters in Liver; Advanced decomposition and Stomach decomposes (Summer) (Continued) (Continued) SAMPLE_NEET.indd 14 28/09/17 2:01 PM
- 15. Target PG Time Scale Significant Changes 24–48 hours Scrotal swelling, bulging eye and protruded tongue by gas; RM disappears (Winter) 36–48 hours Marbling is prominent 1–2 days Green coloration of abdomen; Gases collect in intestines (Winter) 30 hours Rectal temperature is near environment temperature (Moderate body) 40 hours Rectal temperature is near environment temperature (Heavy built body) 2–3 days RM lasts for 2 to 3 days in temperate countries; Skin slippage; Mucous membrane of larynx & trachea change color (Winter); Gas stiffening of body; Sphincters relax; Prolapse of rectum and uterus 3–4 days RM lasts for 3 to 4 days in refrigerated conditions; Body becomes black 3–5 days Teeth fall out; Sutures separate in children; Glove & Stock skin loss; Stomach decomposes in winter; Maggots become pupae; Body lice dies First 100 hours Hypoxanthine and K conc. of vitreous gives time since death 5–6 days Complete life cycle of fly in Summer; 8–20 days in winter 5–10 days Colliquative putrefaction (Burst abdomen and liquefied tissues) Adipocere needs 3 weeks (Summer); 3–6 months; Mummification needs 3 months to a year Toxicology Antidotes Poisons Antidotes Acids b-aminoproprionitrile Alpha adrenergics Phentolamine Amantins Benzyl penicillin Arsenic Dimercaprol, Unithiol Benzodiazepines Flumazenil Beryllium Aurintricarboxylic acid, Sodium salicylate Beta adrenergics Propranolol Beta blockers Glucagon, Isoprenaline Botulism Guanidine Carbon monoxide Hyperbaric oxygen, Tocopherol Central anticholinergics Physostigmine Chloroquine Diazepam Cholinergic agents Atropine Copper Penicillamine, Trientine (Continued) (Continued) SAMPLE_NEET.indd 15 28/09/17 2:01 PM
- 16. Target PG Poisons Antidotes Coumarin derivatives Vitamin K Cyanide Amyl nitrite, Dicobaltedetate, Hydroxocobalamine, Sodium nitrite, Sodium thiosulfate Cyanide, CO, H2S Oxygen Digitalis Digoxin-specific antibody fragments Ergotism Sodium nitroprusside Heparin Protamine sulfate Insulin Glucose Iron, Aluminium Desferrioxamine Isoniazid Pyridoxine Lead, Mercury Succimer Malignant hyperthermia Dantrolene Mercury N-Acetyl penicillamine Methanol, Ethylene alcohol Ethanol, 4-methylpyrazole Opiates Naloxone Organic peroxides Ascorbic acid Organophosphates Oximes Oxalates, Fluorides Calcium salts Paracetamol Acetyl cysteine, Methionine Peripheral anticholinergics Neostigmine Radioactive metals Pentetic acid Thallium Potassium hexacyanoferrate Community Medicine Vitamin Deficiency Diseases Vitamins RDA Chemical Names Deficiency Diseases Vitamin A 600 mcg retinol • Retinol • Retinoid • Carotenoid Xerophthalmia Vitamin B1 0.5 mg per 1000 kcal of energy intake Thiamine • Beriberi • Wernickes Korsakoff psychosis Vitamin B2 0.5 mg per 1000 kcal of energy intake Riboflavin Ariboflavinosis (Continued) (Continued) SAMPLE_NEET.indd 16 28/09/17 2:01 PM
- 17. Target PG Vitamins RDA Chemical Names Deficiency Diseases Vitamin B3 6.6 mg per 1000 kcal of energy intake Niacin Pellagra Vitamin B5 10 mg Pantothenic acid Burning feet syndrome Vitamin B6 2 mg • Pyridoxine • Pyridoxamine • Pyridoxal Anemia Vitamin B7 Biotin Dermatitis Enteritis Vitamin B9 100 mcg Folic acid Folinic acid • Megaloblastic anemia • Neural tube defects Vitamin B12 1 mcg • Cyanocobalamine • Hydroxycobalamine • Methylcobalamaine Megaloblastic anemia Vitamin C Ascorbic acid Scurvy Vitamin D 100 IU • Ergocalciferol • Cholecalciferol • Rickets • Osteomalacia Vitamin E 0.8 mg per gm of essential fatty acid • Tocopherols • Tocotrienols Hemolytic anemia in newborn Vitamin K 0.03 mg per kg • Phylloquinone • Menaquinone Hemorrhagic disease of newborn Epidemiology Association and Causation—Hill’s (Surgeon General’s) Criteria of Causal Association Criteria of Causal Association Inference Temporal association (Most important criterion of causal association) • Cause precedes effect or effect follows cause • Considers order of appearance and length of interval between exposure and disease • Established by concurrent cohort study Strength of association • Relative risk—cohort study • Odds ratio—case control study Specificity of association • Disease under study is caused only by risk factor under study • Most difficult criteria to establish • Weakest criterion of causal association Consistency of association Results are replicable in different settings and by different methods Biological plausibility Existence of biological credibility of association (Continued) (Continued) SAMPLE_NEET.indd 17 28/09/17 2:01 PM
- 18. Target PG Criteria of Causal Association Inference Coherence of association Causal association must be coherent with relevant facts and related studies Dose–response relationship Increase in dose of cause increases incidence/prevalence of effect Cessation of exposure Removal of possible cause reduces the risk of disease Health Programmes Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy, 2013 (RMNCH+A) Goals for RMNCH+A Strategy • Reduction of IMR to 25 per 1,000 LB by 2017 • Reduction of MMR to 100 per 1 lakh LB by 2017 • Reduction in TFR to 2.1 by 2017 Priority Interventions at Various Levels Adolescents • Nutrition—IFA tablets • Adolescent health clinics • Menstrual hygiene • Health checkups Reproductive health • Community-based promotion and delivery of contraceptives • Promotion of spacing methods • Sterlization methods • Abortion services • Control of RTI and STI Newborn and child health • Home-based newborn care and referral • Micronutrients supplementation • Immunization • Facility based care of sick newborn • Early detection and management of 4Ds Pregnancy and child birth • AN care and tracking of high-risk pregnancies • Skilled obstetric care • Essential newborn care and resuscitation • Emergency obstetric and newborn care • Postpartum care, IUCD, and sterilization 5 x 5 Matrix of RMNCH+A Reproductive Health Maternal Health Newborn Health Child Health Adolescent Health Focus on spacing methods Ensure early registration of pregnancy and full ANC Exclusive breast feeding IFA supplementation Increase contraceptive prevalence among adolescents Focus on interval IUCD at all facilities Detect high-risk pregnancies Home-based newborn care through ASHA Diarrhea management by ORS and zinc Community-based services through peer educators Home delivery of contraceptives and Birth spacing through ASHAs Equip delivery points with highly trained HR and access to EmOC services Essential newborn care and resuscitation at all delivery points Pneumonia management Strengthen AYUSH clinics (Continued) (Continued) SAMPLE_NEET.indd 18 28/09/17 2:01 PM
- 19. Target PG Reproductive Health Maternal Health Newborn Health Child Health Adolescent Health Pregnancy testing kits and safe abortion care Review of maternal, child, and infant deaths Special newborn care units Immunization coverage Roll out National Iron plus Initiative Quality sterilization services Distribute misoprostol to selected women in 8th month of pregnancy for consumption during third stage of labour Community level use of Gentamycin by ANM Rashtriya Bal Swasthya Karyakram—screening of child health Promote menstrual hygiene Ophthalmology Ophthalmoscopy Features Direct Ophthalmoscopy Indirect Ophthalmoscopy Condensing lens Not required Required Examination distance As close to patient’s eye as possible At an arm’s length Image Virtual, erect Real, inverted Magnification 15 times 2–5 times (depends on lens used) Illumination Not so bright Bright Area of field in focus About 2 disc diameter About 8 disc diameter Stereopsis Absent Present Accessible fundal view Slightly beyond equator Up to ora-serrata Examination through hazy media Not possible Possible • Distant direct ophthalmoscopy—Performed at a distance of 22 cm (20–28 cm) • Biomicroscopic ophthalmoscopy—Both central and peripheral fundal regions are visualized. IOC for macular lesions Important Corneal Examinations and Its Significance Important Corneal Examinations Clinical Significance Campimetry Field of vision Fluorescein, Alacian blue, and Bengal rose stain Corneal staining Gonioscopy Angle of anterior chamber Keratometry, Corneal topography Curvature of cornea Pachymeter Thickness of cornea Placido’s disc Corneal sheen, corneal curvature Slit lamp Corneal opacity Specular microscopy Corneal endothelial density, morphology, distribution Window reflex, Slit lamp biomicroscopy, Placidos’disc Corneal surface (Continued) SAMPLE_NEET.indd 19 28/09/17 2:01 PM
- 20. Target PG Otorhinolaryngology Anatomy of Paranasal Sinuses Features Maxillary Sinus Frontal Sinus Ethmoidal Sinus Sphenoid Sinus Significance Largest sinus called Antrum of Highmore Capacity—15 ml Most functionally active sinus MC involved in cavernous sinus thrombophlebitis At birth Present Absent Present Absent Full development 15 years 14 years 12 years 15 years Radiological visibility 4 months 6 years 1 year 4 years Best X ray view Water’s Caldwell Caldwell Lateral MC site • Bacterial sinusitis in adults • Non-invasive fungal sinusitis • Pott’s puffy tumor • Ivory osteoma • Mucocele • Bacterial sinusitis in children • Adenocarcinoma in wood worker Sinusitis Periodicity of Sinusitis Acute sinusitis <4 weeks Subacute sinusitis 4–12 weeks Chronic sinusitis >12 weeks Recurrent sinusitis 4 or more episodes of sinusitis each year, lasting for more than 10 days Neoplasms of Nose and PNS Benign Tumors Tumor MC Site Features Treatment Benign tumors of nose Papilloma Skin of nasal vestibule MC benign neoplasm of nose • Cautery • Cryotherapy Inverted papilloma Lateral nasal wall in middle meatus Agent factor—HPV Finger-like epithelial invasions into underlying stroma U/L tumor with local aggressiveness Recurrent after surgical removal Maxillectomy (Continued) SAMPLE_NEET.indd 20 28/09/17 2:01 PM
- 21. Target PG Tumor MC Site Features Treatment Benign tumors of PNS Osteoma Frontal > Ethmoid > Maxillary sinus Clinically silent tumors Formation of mucocele ++ X-ray—Groundglassappearance Excision by Lynch Howarth approach Fibrous dysplasia Maxilla > Mandible Internal Medicine Abnormalities of JVP Type Condition Raised JVP with normal waveform • Fluid overload • Right heart failure Raised JVP with absent pulsation SVC obstruction Large a wave • Tricuspid stenosis • Pulmonary stenosis • Pulmonary artery Hypertension Cannon a wave • Heart block • Junctional rhythm • Atrioventricular dissociation Absent a wave Atrial fibrillation Giant v wave Tricuspid regurgitation Slow y descent Tricuspid stenosis Prominent y descent • Constrictive pericarditis • Severe RHF • High venous pressure Prominent x descent • Constrictive pericarditis • Cardiac tamponade • Descent is reversed in TR Tropical Medicine Meningitis Acute Bacterial Meningitis Age Group and Predisposing Factors Bacterial Pathogens <1 month S. agalactiae, E. coli, L. monocytogenes, Klebsiella spp. 1–23 months S. agalactiae, E. coli, H. influenzae, S. pneumoniae, N. meningitides (Continued) (Continued) SAMPLE_NEET.indd 21 28/09/17 2:01 PM
- 22. Target PG Age Group and Predisposing Factors Bacterial Pathogens 2–50 yrs S. pneumoniae, N. meningitides >50 yrs S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram negative bacilli Basilar skull fracture S. pneumoniae, H. influenzae, group A b hemolytic streptococci CSF shunts CONS (S. epidermidis), P. acnes, C. jeikeium Head trauma and post-neurosurgery S. aureus, CONS (S. epidermidis), aerobic gram negative bacilli (including P. aeruginosa) Immunocompromised state S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram negative bacilli Chronic Bacterial Meningitis • Mycobacterium tuberculosis (Tb meningitis) • Treponema pallidum (Neurosyphilis) • Borrelia burgdorferi (Lyme disease) • Nocardia spp. • Actinomyces spp. Parasitic Meningo-encephalitis • Toxoplasma gondii • Acanthamoeba culberstoni (GAME) • Naegleria fowleri (PAME) • Angiostrongylus cantonensis (Eosinophilic ME) • Gnathostoma spp (Eosinophilic ME) • Trypanosome cruzi Viral Acute Meningoencephalitis Viral Meningitis Viral Encephalitis • Enteroviruses—Coxsackie viruses, ECHO viruses, enteroviruses 68- 71 • Herpes simplex virus 2 • Arthropod-borne viruses • HIV, EBV • Varicella Zoster virus • Herpes viruses—HSV 1, EBV, VZV • Arthropod-borne viruses- La Crosse virus, West Nile virus, St. Louis encephalitis virus • Rabies virus • EEE virus and WEE virus • Powassan virus Diabetology Maturity Onset Diabetes in Young (MODY) • Non-insulin-dependent DM • Autosomal dominant transmission • Occurs in patients younger than 25 years • Patients are non-obese • Easily under control of OHA • H/o of similar DM in at least two generations (Continued) SAMPLE_NEET.indd 22 28/09/17 2:01 PM
- 23. Target PG • Types of MODY Types of MODY Description MODY 1 Loss of function mutation in hepatocyte nuclear factor 4a (HNF-4a) gene MODY 2 • Mutation in Glucokinase (GCK) gene • No treatment required MODY 3 • Mutation of hepatocyte nuclear factor 1a (HNF-1a) gene • Responsive to sulfonylureas • Low renal threshold for glucose MODY 4 • Mutation of insulin promoter factor 1 (IPF-1) gene • Associated with pancreatic agenesis MODY 5 Defect in hepatocyte nuclear factor 1b MODY 6 Mutation of neurogenic differentiation 1 MODY 7 Mutation of Kruppel-like factor 11 MODY 8 Bile salt–dependent lipase dysfunction MODY 9 Mutation of PAX-4 gene MODY 10 Mutation in insulin gene and associated with neonatal DM MODY 11 Mutation of B lymphocyte tyrosine kinase Glycosylated Hemoglobin (HbA1C) • HbA1C or glycosylated hemoglobin indicates the control of blood sugar for the past 8–12 weeks. The lifespan of RBC is 120 days. Any conditions which make the RBC to lyse early will affect the reliability of HbA1C • Normal HbA1c is 5.8–6.4% • Interpretation of HbA1C values HbA1C Values Interpretation <5.5% Normal 5.5–7% Adequate control 7–8% Inadequate control 8–9% Poor control Rheumatology Giant Cell Arteritis • Salient features –– Large vessel vasculitis –– Age > 55 years –– MC in women and whites –– Granulomatous inflammation –– Affects extracranial branches of ECA (Temporal artery) –– Anemia, raised ESR SAMPLE_NEET.indd 23 28/09/17 2:01 PM
- 24. Target PG • Vasculitis of systems Vasculitis of Temporal artery Vasculitis of Ophthalmic artery Polymyalgia Rheumatica Temporal region headache—dull type of pain Jaw claudication—prolonged chewing Irreversible blindness—Occlusion of posterior ciliary branch of Ophthalmic artery Diplopia Pain and stiffness in neck, shoulder, pelvic girdle Criteria for PMR • Age > 50 yrs • Aching and stiffness for 1 month • Morning stiffness for at least 1 hour • ESR > 40 mm/hr • Rapid response to prednisolone Systemic Lupus Erythematosis Malar rash Fixed erythema, flat or raised, over the malar eminences Discoid rash Erythematous circular raised patches with adherent keratitic scalling and follicular plugging; atrophic scarring may occur Photosensitivity Exposure to ultraviolet light causes rash Oral ulcers Includes oral and nasopharyngeal ulcers, observed by physician Arthritis Nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion Serositis Pleuritis or pericarditis documented by ECG or rub or evidence of effusion Renal disorder Proteinuria >0.5 g/d or ≥3+, or cellular casts Neurologic disorder Seizures or psychosis without other causes Hematologic disorder Hemolytic anemia or leucopenia (<4000/µL) or lymphonia (<1500/µL) or thrombocytopenia (<100,000/µL) in the absence of offending drugs Immunologic disorder Anti-ds, DNAm anti-Sm, and/or anti-phospholipid Antinuclear antibodies An abnormal titer of ANA by immunofluorescence or an equivalent assay at any point in time in the absence of drugs known to induce ANAs Diagnosis of SLE • Four or more of the above criteria, well documented, and present at any time in a patient’s history Tuberculosis Laboratory Diagnosis of Active Pulmonary TB Specimen Collection 2 sputum specimen (spot and early morning samples) and gastric aspirate in children Concentration of specimen—Petroff’s method or N-acetyl-L-cysteine SAMPLE_NEET.indd 24 28/09/17 2:02 PM
- 25. Target PG A) Staining method • Acid fast staining by Ziehl Neelsen technique • Sputum Microscopy is the method of choice case finding tool for TB under RNTCP • Minimum bacillary load for a AFB positive - >104 bacilli per ml of sputum • Quantification of AFB Criteria Grading No bacilli per 100 OIF 0 1–9 bacilli per 100 OIF Scanty 10–99 bacilli per 100 OIF 1+ 1–10 bacilli per OIF 2+ >10 bacilli per OIF 3+ • Kinyoun’s cold AFB staining • Auramine phenol technique B) Conventional culture method • LJ media—Culture may take 6 to 8 weeks for TB bacilli to grow • Culture is more sensitive with detection limit of 10–100 viable bacilli C) Automated culture method • BACTE MGIT uses oxygen sensitive fluorescent compound to detect TB bacilli growth and resistance to first line ATT D) Molecular methods • PCR detects IS6110 gene • Line probe assay detects drug resistance from samples • Gene Expert detects growth and resistance to rifampicin Laboratory Diagnosis of Latent TB A) Tuberculin test B) Interferon gamma release assay General Surgery Classification of Surgical Wounds Surgical Wounds Criteria Infection Rate Examples Clean uncontaminated wounds • Elective procedure without infection • No viscus opened • No breach in aseptic precautions 2.1% Excision of fibroadenoma, Hernia repair Clean contaminated wounds • Minor breach in aseptic precautions • Viscus entered with minimum spillage 3.3.% Lap cholecystectomy (Continued) SAMPLE_NEET.indd 25 28/09/17 2:02 PM
- 26. Target PG Surgical Wounds Criteria Infection Rate Examples Contaminated wounds • Major breach in aseptic precautions • Gross spillage with alimentary / urinary / genital tract 6.4% Bowel anastomosis Dirty wounds • All traumatic wound of >4 hour duration • Pre-op contamination with visceral contents 7.4% • I & D of abscess • Perforation • Peritonitis Complications of Total Parenteral Nutrition (TPN) Metabolic Complications Electrolyte Abnormalities • Azotemia • Essential fatty acid deficiency • Fluid overload • Metabolic bone disease • Liver dysfunction • Glucose imbalance (hyperglycemia, hypoglycemia) • Trace element and vitamin deficiency • Hyper/hyponatremia • Hyper/hypokalemia • Hyper/hypophosphatemia • Hyper/hypomagnesemia • Hyper/hypocalcemia • High/low serum zinc • High/low serum copper • Hyperchloremic metabolic acidosis TPN complications • Catheter-related sepsis • Infection • Injuries –– Pneumothorax (MC), Hydrothorax –– Cardiac tamponade –– Injury to artery and vein –– Injury to thoracic duct, nerves • Thrombosis • Air embolism, catheter embolism Surgical Oncology Nerve Sheath Tumors Schwannoma • Arise from neural crest derived Schwann cell • Associated with Neurofibroma type 2 • Antoni A and B areas are seen • Verocay bodies ++ • Rx of B/L Schwannoma—Brainstem implant (Continued) SAMPLE_NEET.indd 26 28/09/17 2:02 PM
- 27. Target PG Neurofibroma • Involve dermis and subcutaneous fat • NF-1 is associated with optic glioma and low-grade astrocytoma • NF-2 is associated with acoustic neuroma and meningioma • MC tumour spreading to neural sheath • Malignant transformation arte is very low Spinal Tumors • Constitutes about 20% of all CNS • MC spinal tumor—Extradural metastases • MC primary spinal cord tumor—Nerve sheath tumor (Dumb bell tumor) • MC intradural spinal tumor—Schwannoma • MC intramedullary spinal tumor—Ependymoma Dural Relationship Extramedullary Intramedullary Extradural (60%) • Metastatic tumor (MC) • Sarcoma • Meningioma, Neurofibroma • Lipoma, Chordoma Rare Intradural (30%) • Neurilemoma (30%) • Meningioma • Schwannoma • Ependymoma (MC) • Astrocytoma • Hemangioblastoma Orthopaedics Crush Syndrome • Due to prolonged compression of limb, results in massive crushing of soft tissues → Releases large amounts of myoglobin • Treatment –– Maintain high urine output by infusing large volumes of IV crystalloids –– Forced mannitol alkaline diuresis –– If oliguria persists, renal dialysis is indicated Components of Crush Syndrome • Rhabdomyolysis • Hypocalcemia • Hyperuricemia • Hyperphosphatemia • Hyperkalemia • Metabolic acidosis • Myoglobinemia • Myoglobinuria • Acute tubular necrosis • Acute renal failure SAMPLE_NEET.indd 27 28/09/17 2:02 PM
- 28. Target PG Pathological Fracture • MCC of pathological fracture—Osteoporosis followed by metastasis • MC bones involved in pathological fracture—Thoracolumbar vertebra > Neck of femur > Distal end of radius • MC local cause of pathological fracture—Metastasis (MC in thoracic vertebra) • MC generalized cause of pathological fracture—Osteoporosis • Scoring criteria—Mirel’s criteria Mirel’s Criteria for Pathological fractures Variable 1 2 3 Site of pathological fracture Upper limb Lower limb Peritrochanteric region Pain Mild Moderate Severe Lesion Osteoblastic Mixed Osteolytic Size of bone involvement < 1/3rd of bone diameter 1/3–2/3rd of bone diameter >2/3rd of bone diameter Score < 7—Observation and Score > 8—Prophylactic internal fixation • Treatment –– Surgical stabilization with internal fixation –– Poor bone quality—Augmentation of fixation with grafting or bone cement –– Proven malignancy—Radiotherapy Anesthesia Color, Pressure, and Pin Index System of Anesthetic Gases Gases Physical Form Pin Index Pressure (psi) Cylinder Color Air Gas 1, 5 1900 Grey body with white shoulder Oxygen Gas 2, 5 1900 Black body with white shoulder Nitrous oxide Liquid 3, 5 745 Blue Nitrogen Gas 1, 4 Black Carbon dioxide Liquid 1, 6 (>7.5%) 2, 6 (<7.5%) 838 Grey Cyclopropane Gas 3, 6 Orange Helium Gas 4, 6 (>80.5%) 2, 4 (<80.5%) Brown Entonox Gas 7 1900 Blue body with white shoulder SAMPLE_NEET.indd 28 28/09/17 2:02 PM
- 29. Target PG Obstetrics Anatomical Features of Female Pelvis • Normal female pelvis—Gynaecoid pelvis • Male type pelvis—Android pelvis • MC type of pelvis—Gynaecoid pelvis • Least common type of pelvis—Platypelloid pelvis • The only pelvis with AP diameter more than transverse diameter—Anthropoid pelvis • Broad flat pelvis—Platypelloid pelvis • Engagement by exaggerated posterior asynclitism occurs in Platypelloid pelvis Type Relationship of Transverse to AP Diameter Inlet Subpubic Angle Outcome Gynaecoid M/C type (50%) Transverse > AP Rounded Wide Vaginal delivery is possible without any difficulty Anthropoid (25%) Transverse > AP AP-oval shape Slightly • Direct OAP or OPP • Non-rotation is common • Face to pubis delivery Android (20%) AP > Transverse Triangular Narrow Difficult delivery with delay in engagement DTA and perineal injuries Platyploid (Rarest type) Transverse > AP Transversally oval Very wide No difficulty in VD Ant. rotation occurs late Gynecology Menstrual Cycle Features Menstrual Phase Proliferative Phase Secretory Phase Alternate names • Destructive phase • Blooding phase • Preovulatory phase • Postmenstrual phase • Follicular phase • Postovulatory phase • Premenstrual phase • Progestational phase • Luteal phase Days of idealized menstrual cycle 1st to 5th day 6–14th day 15–27th day Predominant gonadotropin Falling LH, rising FSH FSH LH Predominant ovarian hormone Transition from progesterone to estrogen Estrogen Progesterone Thickness of stratum functionale Absent Thin to thick Thickest (Continued) SAMPLE_NEET.indd 29 28/09/17 2:02 PM
- 30. Target PG Features Menstrual Phase Proliferative Phase Secretory Phase Appearance of endometrial glands Portions of glands in stratum basale Straight Highly coiled Degree of coiling of coiled arteries Absent Less coiled Highly coiled Viscosity of cervical secretions Difficult to determine Thinnest at day 14 Increasing viscosity Paediatrics Pubertal Development in Boys and Girls Tanner Stages • Sequential somatic and physiological changes during puberty Tanner Sexual Stages in Girls • First sign: Breast bud • Peak growth velocity: SMR stages 2 and 3 • Thelarche → Pubarche → Peak growth velocity → Menarche • Growth spurt in girls occurs at 10–11 years • Stages of growth Stage Pubic Hair Breasts 1 Preadolescent Preadolescent 2 Sparse, straight hair medial border of labia Breast papilla elevated as small secondary mound 3 Darker beginning to curl • Breast areola enlarged • No contour separation 4 Coarse curly abundant Secondary mound 5 Feminine triangle spread to medial thigh Nipple projects Tanner Sexual Stages in Boys • First sign: Testicular enlargement. • Peak growth velocity: SMR stags 3 and 4 • Testicular development → Pubic hair → Axillary hair → Beard • Growth spurt in boys occurs at 12–13 years • Stages of growth Stage Pubic Hair Testis 1 Preadolescent Preadolescent 2 Scanty hair at penile base • Testicular volume 4 ml • Length 2.5 cm (Continued) (Continued) SAMPLE_NEET.indd 30 28/09/17 2:02 PM
- 31. Target PG Stage Pubic Hair Testis 3 Hair begin to curl and darken • Testicular volume 10 ml • Length 4 cm • Increase length of penile shaft 4 Coarse curly abundant hair • Testicular volume 16 ml • Length 4.5 cm • Increase girth of penis and glans 5 Adult type hair spreading to medial thigh • Testicular volume 25 ml • Length > 4.5 cm Sexual Staging Between Girls and Boys Feature Girls Boys Onset 10–12 years 12–14 years First sign Breast development Testicular enlargement Growth spurt Early (Tanner I and II) Late (Tanner III and IV) Sexual maturity Menarche (14 years) Spermarche (15 years) Order of maturity Thelarche → Pubarche → Peak growth velocity → Menarche Testicular development → Pubic hair → Axillary hair → Beard Vaccination Vaccine Strains Vaccines Strains Used BCG Danish 1331 strain OPV/IPV P1, P2, P3 strains Measles • Edmonston Zagreb strain • Schwartz strain • Moraten strain Mumps Jeryll Lynn strain Rubella RA 27/3 strain Yellow fever 17 D strain (Tsibi strain) Varicella OKA strain Japanese encephalitis • Nakayama strain • Beijing P3 strain • SA 14 – 14 – 2 Swine flu A7/California/2009 (Continued) (Continued) SAMPLE_NEET.indd 31 28/09/17 2:02 PM
- 32. Target PG Vaccines Strains Used Malaria • SPf 66 strain (Lytic cocktail) • Pf 25 strain HIV vaccines • mVA (modified vaccinia Ankara) strain • rAAV strain • Cytotoxic T lymphocytic strain • AIDSVAX strain • Subunit vaccine strain Psychiatry International Classification of Disease-10 (ICD-10) • ICD-10 is WHO classification for all diseases and health problems (and not only psychiatric disorders). • ICD-10 uses alpha numeric code made of an alphabet (in contrast, DSM-IV uses numerical coding) → ‘F’ is for mental disorders. There are 10 main categories denoted by digits 0 to 9. Code Category F0 Organic, including symptomatic mental disorders F1 Mental and behavior disorders due to psychoactive substance use F2 Schizophrenia, schizotypal, and delusional disorders F3 Mood (affective) disorders F4 Neurotic, stress-related, and somatoform disorders F5 Behavioral syndromes associated with physiological disturbances and physical factors F6 Disorders of adult personality and behavior F7 Mental retardation F8 Disorders of psychological development F9 Behavioural and emotional disorders with onset usually occurring in childhood or adolescence Models of Mind Topographic Model Structural Model Conscious (Secondary thinking process based on reality principle) ↓ Preconscious (Maintain repressive barrier & to censor unacceptable wishes & desires) ↓ Unconscious (Primary thinking process based on pleasure principle) Id (Primary thinking process based on pleasure principle) ↓ Ego (Secondary thinking process based on reality principle) ↓ Super ego (Based on idealism principle) (Continued) SAMPLE_NEET.indd 32 28/09/17 2:02 PM
- 33. Target PG Dermatology Types of Erythema Erythema annulare centrifugum Caused by drugs, DM, infections Erythema chronicum migrans Lyme disease caused by Borrelia burgdorferi Erythema gyratum repens Malignancy Erythema induratum Bazin’s disease Erythema infectiosum Fifth day disease caused by Parvovirus B19 Erythema marginatum Rheumatic fever Erythema toxicum Seen in normal neonate Erythema nodosum Streptococcal infection, TB, Leprosy, Sarcoidosis Erythema perino Chilblains Ecthyma Group A Streptococci Ecthyma gangrenosum Pseudomonas aeruginosa Erythrasma Corynebacterium minutissimum Location of Dermatological Lesions Disease MC Location Acne, Impetigo Face Atopic dermatitis Antecubital and Popliteal fossa Fordyce spots Lips Herpes genitalis Periumbilical region Herpes simplex Face Herpes zoster Thorax Mongolian spots Sacral > Gluteal > Lumbar region Morphea Forehead Necrobiosis diabeticorum Front of legs Peutz Jegher syndrome Lips and Oral mucosa Richl’s melanosis Face and Neck Shagreen patch Lumbosacral region SAMPLE_NEET.indd 33 28/09/17 2:02 PM
- 34. Target PG Radiology Calcifications Calcifications Disease Conditions Arc calcification Dermoid B/L symmetrical, stipelled, periventricular calcification CMV Basal ganglia calcification Idiopathic with age, Hypoparathyroidism Lead and CO poisoning, Wilson’s disease Cysticercosis, Cockayne syndrome Bladder calcification Calculus, Foreign body, Schistosomiasis, TB, Transitional and Squamous cell CA, Cyclophosphamide induced cystitis Bracket calcification Corpus callosum lipoma Calcifications in lungs TB, Histoplasmosis, Coccidioidomycosis Calcifications in pleura Old empyema, Talc exposure, Asbestosis, Silicosis Diffuse nodular flecks like calcification Intrauterine toxoplasmosis Egg shell calcification Silicosis, Sarcoidosis, Tuberculosis, Histoplasmosis, Coccidioidomycosis, Lymphoma, Coal worker pneumoconiosis Fibrosing mediastinitis Intervertebral disk calcification Alkaptonuria (MC), Ankylosing spondylitis Pseudogout, Gout, Hemochromatosis, DISH, Forestier disease Neoplasms showing calcification Craniopharyngioma, Oligodendroma Meningioma, Astrocytoma, Medulloblastoma Papilloma of choroid plexus, Pinealoma, Chordoma Dermoid, Epidermoid, Teratoma, Lipoma Physiological calcification in skull X-ray Choroid plexus, Pineal gland in elderly, Petroclenoid ligament, Falx cerebri, Lateral edges of diaphragm sellae Pinna calcification Ochronosis, Gout, Frost bite, Cockayne’s syndrome Popcorn-like dural calcification Chronic TB meningitis Ribbon like/Dense nodular/Serpentine calcification Oligodendroma Rice grain/Starry sky calcification Neurocysticercosis Scattered flakey calcification Neurotoxoplasmosis Soap bubble calcification Neuroparagonimiasis Spongy appearance with central sunburst calcification Serous cystadenoma of pancreas Sunray/Ball-like calcifications Meningioma Sunburst calcification Insulinoma Suprasellar arc like/Punctate/Curvilinear calcification Craniopharyngioma Tram track calcification Struge Weber syndrome SAMPLE_NEET.indd 34 28/09/17 2:02 PM
- 35. Target PG Nuclear Medicine Radionuclide Scans Radionuclides Uses Cr 52 For red cell survival studies Ga-67 nitrate To detect tumors, concentrated in abscess cavity, Inflammation I-123 MIBG, I-123 Iodocholesterol Adrenal medullary tumour I-131 and Selenium Thyroid I-131 orthohippurate Kidney Iodine-131, 132 Placental functioning MIBG scan Extra adrenal/Ectopic/Metastatic/Locally recurrent Pheochromocytoma Selenium-75 Pancreas Tc 99 MDP Metastasis Tc 99m DMSA For renal scarring Tc 99m DTPA Measures GFR, Renal tract obstruction Tc 99m labelled HIDA Hepatobiliary tree Tc 99m labelled RBCs Imaging spleen, GI bleeding, Ventriculography Tc 99m labelled serum albumin Pulmonary embolism Tc 99m MAG3 Vesicoureteric reflux, Transplant rejection Tc 99m pyrophosphate Myocardial infarction Tc albumin Myocardial ventriculography Tc labeled RBC Splenic diseases Tc Thallium subtraction scan Parathyroid gland Technetium 99 Ventriculography, Bone scan, Liver scan, Kidney Thallium-201 Myocardial perfusion Transfusion Medicine RBC Blood Group Systems and Alloantigens RBC Blood Group System Antigen Alloantigen Clinical Significance Rh (D, C/c, E/e) RBC protein Ig G Hemolytic transfusion reaction; Hemolytic disease of newborn Lewis (Lea, Leb) Oligosaccharides Ig M/Ig G Rare hemolytic transfusion reaction (Continued) SAMPLE_NEET.indd 35 28/09/17 2:02 PM
- 36. Target PG RBC Blood Group System Antigen Alloantigen Clinical Significance Kell (K/k) RBC protein Ig G Hemolytic transfusion reaction; Hemolytic disease of newborn Duffy (Fya , Fyb ) RBC protein Ig G Hemolytic transfusion reaction; Hemolytic disease of newborn Kidd (Jka, Jkb) RBC protein Ig G Delayed hemolytic transfusion reaction; Mild hemolytic disease of newborn I/i Carbohydrate Ig M None MNSsU RBC protein Ig M/Ig G Anti M rare hemolytic disease of newborn Lifespan of Blood Cells Blood Components Lifespan Half-Life Normal RBCs 120 days 60 days Fetal/Neonatal RBCs 90 days Platelets 7–12 days 2–3 days Transfused platelets 36 hours 1 day Polymorpho neutrophils 6–8 days Recent Advances Zika Virus • Agent factor—Zika virus (Flavi virus) • Vector—Aedes aegypti and Aedes albopticus • Transmission –– Through bite of infected mosquito –– Vertical transmission through placenta –– Sexual transmission • Epidemiology –– Current outbreak began in April 2015 in Brazil –– In February 2016, WHO declared Zika virus outbreak as Public health emergency –– In India, no case has been reported till date • Clinical features –– Incubation period—1 week –– Fever, rash, conjunctivitis –– Myalgia and arthralgia –– Congenital transmission causes microcephaly • Diagnosis –– Most specific test—Plaque reduction neutralization test –– Other modalities—Ig M ELISA and RT-PCR (Continued) SAMPLE_NEET.indd 36 28/09/17 2:02 PM
- 37. Target PG • Immunoprophylaxis Vaccine Description DNA based vaccine (Under trial) • Genetically engineered plasmid—A small circular piece of DNA which encodes Zika virus protein • Phase 1 trial—Induce a neutralizing antibody response against Zika virus • Phase 2 trial—Evaluation of safety and immunogenicity of the vaccine and assessment of optimal doses for administration ZPIV vaccine (Under trial) • Purified inactivated Zika vaccine • Acts as a boosting vaccine to DNA based Zika vaccine Live Zika vaccine (Under trial) • Live attenuated Zika virus vaccine • Another version of vaccine offers protection against Zika and 4 dengue serotypes (Phase 3 trial) mRNA vaccines Under trial to identify immunogenicity and scalable candidate Investigational Zika vaccine • Genetically engineered version of vesicular stomatitis virus • To evaluate Zika vaccine candidate in tissue culture and animal models AGS-v vaccine • To protect against multiple mosquito-borne diseases • To trigger an immune response to mosquito salivary proteins • Vaccine contains 4 synthetic proteins from mosquito salivary glands which induces antibodies in vaccinated individual which prevent infection caused by mosquito SAMPLE_NEET.indd 37 28/09/17 2:02 PM