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Mega BTR Revision-1
SHORT SUBJECTS
PSYCHI
General Psychiatry
Delusion is a disorder of thought-
Obsession is a disorder of thought-
Hallucination is a disorder of-
MC delusion:
Capgras-
Fregoli -
DeClerembaut syndrome-
Othello syndrome-
Cotard syndrome-
Ganser syndrome-
Transference
MC obsession:
MC compulsion:
Association of OCD, anorexia:
ORIENTATION ATTENTION CONCENTRATION
Digit span test Serial 7 subtraction
OCD:
D-Displacement
U-Undoing
R-Reaction formation
I-Inhibition
I-Isolation of affect
CAGE:
SCOFF:
PANSS:
Confusion assessment method (CAM):
SPIKES:
PEARLS:
GOOD PROGNOSTIC FACTORS BAD PROGNOSTIC FACTORS
Acute onset Insidious onset
Advanced age at onset (>35 yrs) Early onset (<20 yrs)
Catatonic, paranoid subtype Simple, disorganised,
hebephrenic
Female sex Male sex
Prominent positive symptoms Prominent negative symptoms
Presence of affective symptoms Absence of affective symptoms
Family history of mood disorders Family history of schizophrenia
DOC:
RESISTANT: OCD-related disorders:
Hoarding disorder
Body dysmorphic D
Olfactory reference D
Body focused repetitive behavior D:
Trichotillomania
Excoriation D
AUTISM SPECTRUM DISORDER
-Social interaction impaired
-Repetitive behaviors
+/- Language delay
Vaccine:
Regression in girl >6mon:
Gene:
Drug:
Regression in any gender >2yrs:
Vs catalepsy
Psychi-pharmacology
-Max EPS :
AD
A
P
T
-Min EPS, Max metabolic s/e, DOC for refractory psychoses:
-Seizure, Myocarditis,Agranulocytosis :
-QT prolongation, Retinal pigmentation:
-PD induced psychosis DOC:
-Mc side effect of SSRI:
-SIADH, vivid dreams, dry mouth, sweating:
-SPARI:
-Serotonin modulator-5HT1A +, 1B PA, 1D, 3, 7-)
-Antidepressant of choice in pregnancy:
-Min sexual s/e:
-Min wt gain, sedation, Seizures in bulimic, Anti-smoking:
-Priapism:
-TCA toxicity DOC: Hemodialysis:
-Approved for Postpartum depression:
-Drugs with anti-suicide ability:
-Lecanemab:
5HT2A-:
5HT2c-:
Psychiatric emergencies
Altered mental status
Autonomic instability
Clonus, Hyperreflexia
MAO, SSRI, SNRI,
Buspiron, Tramadol,
Ondansetron, Triptans,
Linezolid, MDMA, St.
John’s wort
Tyramine-rich
foods, MAO
inhibitors
Typical antipsychotics
Altered mental status
Fever
Muscle rigidity
Raised CK
AKI, ACE inhibitors,
thiazide diuretics, NSAIDs)
Nausea, vomiting, slurred
speech, hyperreflexia,
seizures, ataxia,
nephrogenic diabetes
insipidus
Respiratory depression,
hyperpyrexia, prolonged QT
convulsions, coma,
cardiotoxicity
ALCOHOL WITHDRAWAL:
Earliest:
Alcolohic hallucinosis:
Delirium tremens:
TOC:
BZD safe in liver failure:
Anti-craving:
HEROIN
Toxicity:
DOC:
Withdrawal:
Levels:
Prophylaxis-
Acute Mania-
Toxicity-
Dialysis-
T1/2:
Measurement:
Levels of consciousness:
Alert
Lethargy=Somnolence
Obtundation
Stupor= Semi-coma
Coma
DERMA
PPD
Nickel (mc)
Neomycin
Potassium dichromate
PTBP
Mono-benzyl ether of Hydroquinone (MBEH)
Tiger tail hair
PIBIDS
(photosensitivity, ichthyosis,
brittle hair, intellectual
impairment, decreased
fertility and short stature)
RADIOLOGY
H/o RTA
Alcoholic-fall H/o RTA Sudden right hemiplegia H/o RTA, GCS-9
H/o trauma + difficulty breathing
FMT
Glaister-keene rods:
Posterolateral (4-7) hymenal tear:
Medicolegal autopsy, accused examination, emergency:
Res ipsa loquitor:
Doctrine of common knowledge:
Medical maloccurence:
Res Judicata:
Heat stroke:
Abrasion, Contusion, Laceration:
Haase, Morrison rule-
Ashley rule-
Durhan (Product test), Curren, Brawner-
Leading questions-
Superfetation VS Superfecundation:
Barberio test-
Paradoxical undressing-
Charring
Singeing
Blackening
Blisters+
Splashing+
Line of redness+
Ulcers+
Distinct
colouration +
Police inquest: Minimum rank
Sub-inspector-Sexual offences
Head constable-Others
Custodial death/ rape/ disappearance:
Dowry death:
Exhumation:
Sexual Assault case: Duties of doctor
1) Inform police
2) Consent for examination-Age:
3) Psychological counselling
4) Written refusal
5) Provide diagnosis and treatment
Time limit:
Vaginal swab-
Semen sample-
PELVIS
All large and wide in
females except:
O
S
A
Features Hanging Strangulation
Direction Oblique Transverse
Continuity Non- continuous Continuous
Level in the neck Above thyroid At or below thyroid
Base Pale, hard,
parchment-like
Soft and reddish
Hyoid fracture Abduction # Adduction #
Change Disease
Complete loss Burns, Celiac disease
Permanent impairment RT, Electrical injury, Leprosy,
Change in distance Acromegaly, Rickets
Ridge alteration Scleroderma, Eczema,
Acanthosis nigricans
SKULL
All large and wide in males except:
-F/P eminence
-Nasal aperture
-Female forehead, orbit, chin round
Putrefaction
delay:
Strychnine,
metallic poison,
Carbolic acid
PM caloricity:
Heat stroke
Pontine
hemorrhage
Sepsis
NOT BURNS
Canthardin
Priapism
Indian red scorpion –
Mesobuthus
Autonomic storm
DOC-
Tactile Hallucination CEA Garlic Odour:
CARRY NO RIGHT
No torniquet/incision/cautery/sucking/coffee/alcohol
R-Reassure
I-Immobilize
G-Go to
H-Hospital
T-Tell symptoms Neostigmine + Atropine:
Specific antidote: Polyvalent ASV: effective against Cobra,
Krait, Russel’s viper & Saw scaled viper Given within 4 hrs
PCM
Methanol
Ethylene glycol
BZD
TCA
B blocker
Cyanide
Meth Hb
Opioid
Heparin
Dabigatran
Xa inhibitors
Organophosphate
Carbamate
Datura
ANTIDOTES:
CHELATORS:
BAL-
DMSA/Succimer-
D-penicillamine-
EDTA-
Desferioxamine-
Prussian blue-
Forced alkaline diuresis Forced acidic diuresis
Hemodialysis:
Barbiturate
Lithium
Alcohol
Saliylates
Theophylline
ORTHOPEDICS
COMPLICATIONS OF FRACTURES
Dyspnea, Confusion, Petechiae:
Hyperkalemia, hypocalcemia, decreased UO post limb trauma:
Wrist flexion leading to spontaneous extension of fingers:
Fasciotomy indication:
Last sign:
Pain and burning of hand with patchy osteoporosis:
H/o Massage:
Stoss therapy:
Supracondylar fracture displacement:
Gunstock deformity:
Fish-tail:
Dinner-fork: FOOSH in:
Order of correction:
Garden-spade: FOOSH in:
FABER:
Synovitis
Septic arthritis
Iliotibial band contracture
Anterior dislocation
FADIR:
TB hip arthritis
Posterior dislocation
Phemister’s triad:
Periarticular osteopenia
Erosions
Reduced joint space
O’Donogue triad:
MCL
ACL
Medial meniscus
Terrible triad of elbow:
Elbow dislocation
Radial head #
Coronoid #
BONE FORMATION:
ALP
Osteocalcin
Osteonectin
BONE RESORPTION:
Hydroxyproline
Hydroxylysine
Deoxypridinoline
TRAP
Telopeptide
Kites method – Followed
earlier
Ponseti method
now preferred
At birth Manipulation by mother
initial weeks
Manipulation and
cast
Change of cast Every 2 weeks Weekly
Correction order C-A-V-E C-AV-E
Fulcrum while
manipulating
Calcaneocuboid joint Head of talus
Duration of
treatment
6 - 9 months 6 - 8 weeks
ANESTHESIA
MR
Depolarising, Hyperkalemia, RSI-
Most cardiostable-
Hoffman elimination(safe in RF/LF)- Byproduct-
Reversal- Sugammadex-
LA: Causing Hypertension:
Most cardiotoxic:
Max dose of lignocaine:
DOC for LAST:
MethHb:
IV anesthetic agents:
DOC for day care/ liver/ kidney/ neuroSx/TIVA/malignant hyperthermia, porphyria
Dissociative anesthesia, DOC in asthma, Cyanotic HD, Shock
CI in hypertension / epilepsy/ glaucoma
DOC in cardiac surgery, S/E Adrenal suppressant
DOC in hyperthyroidism, seizures
MAC 0.2
MAC 0.75
MAC 104
Blood/gas partition coefficient Min:
Max:
Concentration effect, second gas effect, diffusion hypoxia
MC circuit in spontaneous:
MC circuit in controlled:
Rate of breathing in CPR
Adults:
Children:
Neonates:
Epinephrine in ACLS:
O2 DELIVERY DEVICES
OPTHAL
Angle subtended by
topmost letter when
viewed from 6m:
It has 14 lines of 5
Sloan letter
optotypes in each
line in logarithmic
progression. The lines
are of equal difficulty,
and there is a
geometric
progression (LogMar)
in letter size.
Penetrating trauma-Ciliary body
Granulomatous panuveitis
Photocoagulation
Double freq Nd-Yag (523nm)
Argon laser
Photoablation
Argon fluoride Excimer (193nm)
Photodisruption
Nd-Yag (1064nm)
Femtosec laser (1053nm)
Decrease Aqueous
Production
Ocular Beta Blockers
1. Timolol
2. Betaxolol
3. Levobunolol
4. Carteolol
Nonselective Alpha Agonist
Dipivefrine
Alpha-2 Agonist
1. Apraclonidine
2. Brimonidine
Increase Trabecular
Outflow
Rho kinase inhibitor
Netrasudil
Cholinomimetic Drugs
Pilocarpine
Increase Uveoscleral
Outflow
PGF2∝ Analogues
1. Lantanoprost
2. Bimatoprost
Carbonic Anhydrase Inhibitors
1. Acetazolamide
2. Brinzolamide
3. Dorzolamide
Anti-Glaucoma Drugs
ENT
Hitzelberger sign:
Syncope:
SCM:
Digastric:
Meatal:
MC:
Indications of Simple Cortical
Mastoidectomy (Schwartz Operation)
CANAL WALL UP
Acute coalescent or masked
mastoiditis
Acute otitis media with reservoir sign
As a initial step to perform:
Endolymphatic sac surgery,
Decompression of facial nerve
Indications of Radical
Mastoidectomy=CANAL WALL DOWN
Residual cholesteatoma
Glomus tumour
Carcinoma middle ear
STAPEDIAL REFLEX:
Afferent:
Efferent:
Rinne’s Test:
Positive
AC ˃BC
Negative
BC ˃ AC
False Negative
Weber
Lateralized
Same-
C/L-
ECOG SP/AP<30%:
Hyperactive: Same side
Hypoactive: Opp side
Erosion of horizontal SCC
Fenestration surgery
Post-stapedectomy fistula
A false negative fistula :
A false positive fistula :
MIB-1 _231030_201838.pdf
MIB-1 _231030_201838.pdf
MIB-1 _231030_201838.pdf
MIB-1 _231030_201838.pdf
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MIB-1 _231030_201838.pdf

  • 3. General Psychiatry Delusion is a disorder of thought- Obsession is a disorder of thought- Hallucination is a disorder of- MC delusion: Capgras- Fregoli - DeClerembaut syndrome- Othello syndrome- Cotard syndrome- Ganser syndrome- Transference MC obsession: MC compulsion: Association of OCD, anorexia: ORIENTATION ATTENTION CONCENTRATION Digit span test Serial 7 subtraction OCD: D-Displacement U-Undoing R-Reaction formation I-Inhibition I-Isolation of affect CAGE: SCOFF: PANSS: Confusion assessment method (CAM): SPIKES: PEARLS:
  • 4. GOOD PROGNOSTIC FACTORS BAD PROGNOSTIC FACTORS Acute onset Insidious onset Advanced age at onset (>35 yrs) Early onset (<20 yrs) Catatonic, paranoid subtype Simple, disorganised, hebephrenic Female sex Male sex Prominent positive symptoms Prominent negative symptoms Presence of affective symptoms Absence of affective symptoms Family history of mood disorders Family history of schizophrenia DOC: RESISTANT: OCD-related disorders: Hoarding disorder Body dysmorphic D Olfactory reference D Body focused repetitive behavior D: Trichotillomania Excoriation D AUTISM SPECTRUM DISORDER -Social interaction impaired -Repetitive behaviors +/- Language delay Vaccine: Regression in girl >6mon: Gene: Drug: Regression in any gender >2yrs: Vs catalepsy
  • 5. Psychi-pharmacology -Max EPS : AD A P T -Min EPS, Max metabolic s/e, DOC for refractory psychoses: -Seizure, Myocarditis,Agranulocytosis : -QT prolongation, Retinal pigmentation: -PD induced psychosis DOC: -Mc side effect of SSRI: -SIADH, vivid dreams, dry mouth, sweating: -SPARI: -Serotonin modulator-5HT1A +, 1B PA, 1D, 3, 7-) -Antidepressant of choice in pregnancy: -Min sexual s/e: -Min wt gain, sedation, Seizures in bulimic, Anti-smoking: -Priapism: -TCA toxicity DOC: Hemodialysis: -Approved for Postpartum depression: -Drugs with anti-suicide ability: -Lecanemab: 5HT2A-: 5HT2c-:
  • 6. Psychiatric emergencies Altered mental status Autonomic instability Clonus, Hyperreflexia MAO, SSRI, SNRI, Buspiron, Tramadol, Ondansetron, Triptans, Linezolid, MDMA, St. John’s wort Tyramine-rich foods, MAO inhibitors Typical antipsychotics Altered mental status Fever Muscle rigidity Raised CK AKI, ACE inhibitors, thiazide diuretics, NSAIDs) Nausea, vomiting, slurred speech, hyperreflexia, seizures, ataxia, nephrogenic diabetes insipidus Respiratory depression, hyperpyrexia, prolonged QT convulsions, coma, cardiotoxicity
  • 7. ALCOHOL WITHDRAWAL: Earliest: Alcolohic hallucinosis: Delirium tremens: TOC: BZD safe in liver failure: Anti-craving: HEROIN Toxicity: DOC: Withdrawal: Levels: Prophylaxis- Acute Mania- Toxicity- Dialysis- T1/2: Measurement: Levels of consciousness: Alert Lethargy=Somnolence Obtundation Stupor= Semi-coma Coma
  • 8.
  • 9.
  • 10. DERMA
  • 11.
  • 12.
  • 14. Tiger tail hair PIBIDS (photosensitivity, ichthyosis, brittle hair, intellectual impairment, decreased fertility and short stature)
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  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25. H/o RTA Alcoholic-fall H/o RTA Sudden right hemiplegia H/o RTA, GCS-9
  • 26. H/o trauma + difficulty breathing
  • 27.
  • 28.
  • 29.
  • 30. FMT
  • 31. Glaister-keene rods: Posterolateral (4-7) hymenal tear: Medicolegal autopsy, accused examination, emergency: Res ipsa loquitor: Doctrine of common knowledge: Medical maloccurence: Res Judicata: Heat stroke: Abrasion, Contusion, Laceration: Haase, Morrison rule- Ashley rule- Durhan (Product test), Curren, Brawner- Leading questions- Superfetation VS Superfecundation: Barberio test- Paradoxical undressing- Charring Singeing Blackening Blisters+ Splashing+ Line of redness+ Ulcers+ Distinct colouration + Police inquest: Minimum rank Sub-inspector-Sexual offences Head constable-Others Custodial death/ rape/ disappearance: Dowry death: Exhumation: Sexual Assault case: Duties of doctor 1) Inform police 2) Consent for examination-Age: 3) Psychological counselling 4) Written refusal 5) Provide diagnosis and treatment Time limit: Vaginal swab- Semen sample-
  • 32.
  • 33.
  • 34. PELVIS All large and wide in females except: O S A Features Hanging Strangulation Direction Oblique Transverse Continuity Non- continuous Continuous Level in the neck Above thyroid At or below thyroid Base Pale, hard, parchment-like Soft and reddish Hyoid fracture Abduction # Adduction # Change Disease Complete loss Burns, Celiac disease Permanent impairment RT, Electrical injury, Leprosy, Change in distance Acromegaly, Rickets Ridge alteration Scleroderma, Eczema, Acanthosis nigricans SKULL All large and wide in males except: -F/P eminence -Nasal aperture -Female forehead, orbit, chin round Putrefaction delay: Strychnine, metallic poison, Carbolic acid PM caloricity: Heat stroke Pontine hemorrhage Sepsis NOT BURNS Canthardin Priapism Indian red scorpion – Mesobuthus Autonomic storm DOC- Tactile Hallucination CEA Garlic Odour:
  • 35. CARRY NO RIGHT No torniquet/incision/cautery/sucking/coffee/alcohol R-Reassure I-Immobilize G-Go to H-Hospital T-Tell symptoms Neostigmine + Atropine: Specific antidote: Polyvalent ASV: effective against Cobra, Krait, Russel’s viper & Saw scaled viper Given within 4 hrs
  • 36. PCM Methanol Ethylene glycol BZD TCA B blocker Cyanide Meth Hb Opioid Heparin Dabigatran Xa inhibitors Organophosphate Carbamate Datura ANTIDOTES: CHELATORS: BAL- DMSA/Succimer- D-penicillamine- EDTA- Desferioxamine- Prussian blue- Forced alkaline diuresis Forced acidic diuresis Hemodialysis: Barbiturate Lithium Alcohol Saliylates Theophylline
  • 37.
  • 38.
  • 39.
  • 41. COMPLICATIONS OF FRACTURES Dyspnea, Confusion, Petechiae: Hyperkalemia, hypocalcemia, decreased UO post limb trauma: Wrist flexion leading to spontaneous extension of fingers: Fasciotomy indication: Last sign: Pain and burning of hand with patchy osteoporosis: H/o Massage: Stoss therapy: Supracondylar fracture displacement: Gunstock deformity: Fish-tail: Dinner-fork: FOOSH in: Order of correction: Garden-spade: FOOSH in:
  • 42. FABER: Synovitis Septic arthritis Iliotibial band contracture Anterior dislocation FADIR: TB hip arthritis Posterior dislocation Phemister’s triad: Periarticular osteopenia Erosions Reduced joint space O’Donogue triad: MCL ACL Medial meniscus Terrible triad of elbow: Elbow dislocation Radial head # Coronoid # BONE FORMATION: ALP Osteocalcin Osteonectin BONE RESORPTION: Hydroxyproline Hydroxylysine Deoxypridinoline TRAP Telopeptide
  • 43. Kites method – Followed earlier Ponseti method now preferred At birth Manipulation by mother initial weeks Manipulation and cast Change of cast Every 2 weeks Weekly Correction order C-A-V-E C-AV-E Fulcrum while manipulating Calcaneocuboid joint Head of talus Duration of treatment 6 - 9 months 6 - 8 weeks
  • 44.
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  • 48.
  • 50. MR Depolarising, Hyperkalemia, RSI- Most cardiostable- Hoffman elimination(safe in RF/LF)- Byproduct- Reversal- Sugammadex- LA: Causing Hypertension: Most cardiotoxic: Max dose of lignocaine: DOC for LAST: MethHb: IV anesthetic agents: DOC for day care/ liver/ kidney/ neuroSx/TIVA/malignant hyperthermia, porphyria Dissociative anesthesia, DOC in asthma, Cyanotic HD, Shock CI in hypertension / epilepsy/ glaucoma DOC in cardiac surgery, S/E Adrenal suppressant DOC in hyperthyroidism, seizures MAC 0.2 MAC 0.75 MAC 104 Blood/gas partition coefficient Min: Max: Concentration effect, second gas effect, diffusion hypoxia
  • 51. MC circuit in spontaneous: MC circuit in controlled: Rate of breathing in CPR Adults: Children: Neonates: Epinephrine in ACLS:
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  • 59.
  • 60. Angle subtended by topmost letter when viewed from 6m: It has 14 lines of 5 Sloan letter optotypes in each line in logarithmic progression. The lines are of equal difficulty, and there is a geometric progression (LogMar) in letter size.
  • 61. Penetrating trauma-Ciliary body Granulomatous panuveitis Photocoagulation Double freq Nd-Yag (523nm) Argon laser Photoablation Argon fluoride Excimer (193nm) Photodisruption Nd-Yag (1064nm) Femtosec laser (1053nm)
  • 62. Decrease Aqueous Production Ocular Beta Blockers 1. Timolol 2. Betaxolol 3. Levobunolol 4. Carteolol Nonselective Alpha Agonist Dipivefrine Alpha-2 Agonist 1. Apraclonidine 2. Brimonidine Increase Trabecular Outflow Rho kinase inhibitor Netrasudil Cholinomimetic Drugs Pilocarpine Increase Uveoscleral Outflow PGF2∝ Analogues 1. Lantanoprost 2. Bimatoprost Carbonic Anhydrase Inhibitors 1. Acetazolamide 2. Brinzolamide 3. Dorzolamide Anti-Glaucoma Drugs
  • 63.
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  • 68. ENT
  • 70. SCM: Digastric: Meatal: MC: Indications of Simple Cortical Mastoidectomy (Schwartz Operation) CANAL WALL UP Acute coalescent or masked mastoiditis Acute otitis media with reservoir sign As a initial step to perform: Endolymphatic sac surgery, Decompression of facial nerve Indications of Radical Mastoidectomy=CANAL WALL DOWN Residual cholesteatoma Glomus tumour Carcinoma middle ear
  • 71. STAPEDIAL REFLEX: Afferent: Efferent: Rinne’s Test: Positive AC ˃BC Negative BC ˃ AC False Negative Weber Lateralized Same- C/L- ECOG SP/AP<30%:
  • 72. Hyperactive: Same side Hypoactive: Opp side Erosion of horizontal SCC Fenestration surgery Post-stapedectomy fistula A false negative fistula : A false positive fistula :