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Al-YAQIN DIAGNOSTIC ULTRASONIC CLINIC BAGHDAD
Al-YAQIN DIAGNOSTIC ULTRASONIC CLINIC BAGHDAD

This book on mnemonics has been writen in view of problems faced by PG aspirants and MBBS students. All the hard work comes to naught if a student confuses while giving examination. Mnemonics has been prepared to eliminate the confusion one encounters during memorizing the points in a topic. This book is sure to improve your rank in any PG entrance examination especially the one based on factual questions like DNB and state PG entrance examinations. Only 600 mnemonics has been included in this edition to enable students to complete and revise the book in a short time. Students are also encouraged to point out the mistakes in this book for which they will be given the incentive of ` 50/- recharge done in their mobile number provided they are the first to point out the mistake and give reference for the same. One lucky student will also get to avail free discussion and explanation with the author every week. For this they need to provide their name, college name, batch of MBBS admission to author’s contact number. Readers are also advised to give their valuable opinions and suggestions which will be appreciated and acknowledged. Arun Kumar

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Presents 600 high quality mnemonics Enhances quick recall and recollection of high value facts Provides “cutting-edge” technique in remembering “long-winding” statements/particulars/facts Packs mnemonics that count MNEMONICS for Sure Success in PG Medical Entrance Examinations Second Edition
Presents 600 high quality mnemonics Enhances quick recall and recollection of high value facts Provides “cutting-edge” technique in remembering “long-winding” statements/particulars/facts Packs mnemonics that count
Arun Kumar MBBS DNB(s) CBS Publishers & Distributors Pvt Ltd New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai Hyderabad • Nagpur • Patna • Pune • Vijayawada MNEMONICS for Sure Success in PG Medical Entrance Examinations Second Edition
ISBN: 978-93-85915-33-8 Copyright © Author and Publisher First Edition: 2015 Second Edition: 2016 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the author and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt Ltd 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India. Ph: 23289259, 23266861, 23266867 Website: www.cbspd.com Fax: 011-23243014 e-mail: delhi@cbspd.com; cbspubs@airtelmail.in. Corporate Office: 204 FIE, Industrial Area, Patparganj, Delhi 110 092 Ph: 4934 4934 Fax: 4934 4935 e-mail: publishing@cbspd.com; publicity@cbspd.com Branches • Bengaluru: Seema House 2975, 17th Cross, K.R. Road, Banasankari 2nd Stage, Bengaluru 560 070, Karnataka Ph: +91-80-26771678/79 Fax: +91-80-26771680 e-mail: bangalore@cbspd.com • Chennai: 7, Subbaraya Street, Shenoy Nagar, Chennai 600 030, Tamil Nadu Ph: +91-44-26680620, 26681266 Fax: +91-44-42032115 e-mail: chennai@cbspd.com • Kochi: Ashana House, No. 39/1904, AM Thomas Road, Valanjambalam, Ernakulam 682 018, Kochi, Kerala Ph: +91-484-4059061-65 Fax: +91-484-4059065 e-mail: kochi@cbspd.com • Kolkata: 6/B, Ground Floor, Rameswar Shaw Road, Kolkata-700 014, West Bengal Ph: +91-33-22891126, 22891127, 22891128 e-mail: kolkata@cbspd.com • Mumbai: 83-C, Dr E Moses Road, Worli, Mumbai-400018, Maharashtra Ph: +91-22-24902340/41 Fax: +91-22-24902342 e-mail: mumbai@cbspd.com Representatives • Hyderabad 0-9885175004 • Nagpur 0-9021734563 • Patna 0-9334159340 • Pune 0-9623451994 • Vijayawada 0-9000660880 Printed at Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The author has tried his best in giving information available to him while preparing the material for this book. Although, all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible that some errors might have been left. The publisher, the printer and the author will not be held responsible for any inadvertent errors or inaccuracies. MNEMONICS for Sure Success in PG Medical Entrance Examinations
To my elder brother Ajay Kumar Ajit who shaped my career and life
??? Preface to the Second Edition
This book on mnemonics has been writen in view of problems faced by PG aspirants and MBBS students. All the hard work comes to naught if a student confuses while giving examination. Mnemonics has been prepared to eliminate the confusion one encounters during memorizing the points in a topic. This book is sure to improve your rank in any PG entrance examination especially the one based on factual questions like DNB and state PG entrance examinations. Only 600 mnemonics has been included in this edition to enable students to complete and revise the book in a short time. Students are also encouraged to point out the mistakes in this book for which they will be given the incentive of ` 50/- recharge done in their mobile number provided they are the first to point out the mistake and give reference for the same. One lucky student will also get to avail free discussion and explanation with the author every week. For this they need to provide their name, college name, batch of MBBS admission to author’s contact number. Readers are also advised to give their valuable opinions and suggestions which will be appreciated and acknowledged. Arun Kumar Contact: 9718161947 Email.id: drarunkumarjamui@yahoo.co.in Preface to the First Edition
First I want to thank all my teachers in both school and college who have encouraged and inspired me for hard work. I also want to thank Dr Nitish, Dr Aporva, Dr Rajdeep and Dr Puneet who have been very supportive of me to write this book. I took the inspiration to write the book from my teacher ‘Dr Arup Kumar Kundu’ who has been a leading writer in medical field. My heartfelt thanks to my fiancée who contributed significantly in writing this book. I also like to take this opportunity to thanks my parents, sisters, my brothers, brothers-in-law and all family members who have always had faith in my abilities. I would also like to thank CBS Publishers & Distributors, Mr YN Arjuna (Senior Vice President—Publishing, Editorial and Publicity), Mrs Ritu Chawla (Assistant General Manager—Production) and Mr Vikrant Sharma (DTP Operator) to help me realize my dream of writing the book and publishing the book so beautifully. I would also like to thank my friend Pawan, Bipulji and Dr Pradeep for their valuable support. I would also like to thank my teachers Dr MP Sharma for his guidance. Finally with all my humbleness and sincerity, I thank one and all who have helped me directly and indirectly in completing this book. Arun Kumar Acknowledgements
Preface to the Second Edition vii Preface to the First Edition ix 1. Anatomy 1 2. Biochemistry 17 3. Physiology 26 4. Pharmacology 35 5. Microbiology 72 6. Pathology 81 7. Forensic Medicine and Toxicology (FMT) 93 8. Preventive and Social Medicine (PSM) 99 9. Eye 111 10. Ear, Nose and Throat (ENT) 117 11. Medicine 122 12. Surgery 152 13. Gynecology and Obstetrics (G and O) 162 14. Pediatrics 170 15. Skin 177 16. Anesthesia 180 17. Radiology 184 18. Psychiatry 186 19. Orthopedics 189 Contents
• Floor of third ventricle (formed primarily by hypothalamic structures) Optic chiasma Infundibular recess (which extends into pituitary stalk) Tuber cinereum Mammillary bodies Posterior perforated substance Tegmentum of the midbrain Mnemonic: Opin Tuma Posteg • Muscles of gluteal region Gamellus superior—Nerve to obturator internus (L5, S 1, S2) Mnemonic: GSOI 512 Gamellus inferior—Nerve to quadratus femoris (L4, L5, SI) Mnemonic: IQ 451 • Foramen magnum—Structures passing through its anterior part Apical ligament of Dens Vertical band of cruciate ligament Membrane tectoria Mnemonic: AVM • Foramen ovale Mandibular nerve Accessory meningeal artery (A for Artery) Lesser petrosal nerve Emissary vein (cavernous sinus to pterygoid plexus) Mnemonic: MALE 1 Anatomy 1
Mnemonics2 • Foramen spinosum Middle meningeal artery and vein (posterior trunk) Emissary vein Nervus spinosus (meningeal branch of mandibular nerve) Mnemonic: MENS • Foramen rotundum—Maxillary nerve Mnemonic: Maxm round Maxillary nerve passes through fossa, fissure and foramen Foramen Foramen rotundum Fissure inferior orbital fissure Fossa pterygopalatine fossa Mnemonic: RIP • Internal acoustic meatus Facial N (VIIIth/7th) Vestibulocochlear N (VIIIth/8th) Nervus intermedius or pars intermedia of Wrisburg Labyrinthine vessels Mnemonic: 78 Intermediate Lab • Foramen lacerum Meningeal branch of ascending pharyngeal artery Emissary vein Mnemonic: MAPEL • Jugular foramen Anterior part Middle part Posterior part Inferior petrosal 9th cranial nerve Internal jugular vein sinus 10th cranial nerve Sigmoid sinus junction 11th cranial nerve Emissary vein (sigmoid Meningeal branch sinus to occipital veins) of ascending Occipital artery pharyngeal (meningeal branch) artery Mnemonic: IPS IS evaluating Our 9, 10, 11 MAP
3Anatomy • Anatomical snuff box—when thumb is fully extended, depression seen on lateral aspect of wrist, immediately distal to radial styloid process Content—Cephelic vein Superficial radial nerve Radial artery Mnemonic: CSR Floor—Base of first metacarpal Radial styloid Scaphoid Trapezium Mnemonic: BRST Note: Proximal to distal order is RSTB. Boundaries: Lateral wall (anterior wall): Abductor pollicis longus Extensor pollicis brevis Medial wall (Posterior wall): Extensor pollicis longus Mnemonic: EPL is MP • Secretomotor pathway for parotid gland Pons Inferior Salivatory nucleus Glossopharyngeal nerve Tympanic branch and plexus Lesser petrosal nerve Otic ganglion Auriculo temporal nerve Parotid gland Mnemonic: PINS GLOTY LEPO ATP • Structure passing through superior orbital fissure Lateral to annulus of Zinn: Lacrimal nerve Frontal nerve Trochlear nerve Superior ophthalmic vein
Mnemonics4 Meningeal branch of lacrimal artery Mnemonic: LFT Through annulus of Zinn: Nasociliary nerve Oculomotor nerve (superior and inferior division) (3rd CN) Abducens nerve (6th CN) Mnemonic: NOA 36 Inferomedial to annulus—inferior ophthalmic vein • Anterior and Middle superior alveolar nerves are branches of Infraorbital (terminal branch of maxillary nerve) Posterior superior alveolar nerve is direct branch of maxillary nerve Mnemonic: IAM Appendices epiploicae are small sacs of peritoneum filled with fat (adipose projections) over the whole colon except caecum appendix (vermiform) rectum Mnemonic: CAR Note: Taenia coli are absent in distal sigmoid colon and rectum. • Femoral triangle content Lateral to medial Femoral nerve Femoral artery Femoral vein Lymphatic vessels and deep inguinal lymph node of Cloquet Mnemonic: NAVEL Boundaries Laterally—medial border of sartorius Medially—medial border of adductor longus Superiorly—inguinal ligament Mnemonic: SAIL Branches of third part of maxillary artery Infraorbital A
5Anatomy Posterior superior alveolar A Pharyngeal A Artery of pterygoid canal A Greater palatine A Sphenopalatine A Mnemonic: Inferoposterior pharyngeal artery of greater sphenoid • Bipolar neurons are located in the retina, olfactory epithe- lium, cochlear and vestibular ganglia (all three are sensory pathway for vision, smell and hearing) • Triangle of auscultation Scapula Latissimus dorsi Trapezius Mnemonic: Scalattra • Alar plate derivatives become sensory nuclei while basal plate derivatives become motor nuclei Mnemonic: Sailor/Ala senses • Branch of first part of subclavian artery Vertebral artery Internal thoracic artery Thyrocervical trunk Mnemonic: VIT • Branch of thyrocervical trunk Suprascapular A Inferior thyroid A Transverse cervical A Mnemonic: SIT • Axillary artery First part—Superior thoracic artery Second part—Acromiothoracic artery Lateral thoracic artery Mnemonic: SALT
Mnemonics6 • Adductor magnus is a composite muscle and is doubly innervated by the obturator nerve and tibial nerve Mnemonic: MagOT • Biceps femoris: Long head—Tibial nerve Short head—common peroneal nerve Mnemonic: Long tibial • Bronchial artery Left—two bronchial arteries arising directly from descending thoracic aorta Mnemonic: Directly descending Right—One bronchial artery arises indirectly from descending thoracic aorta either from i. Third posterior intercostal artery ii. Upper left bronchial artery • Branches of anterior division of internal iliac artery Superior vesical artery Obturator artery Middle rectal artery Uterine artery (only in females) Inferior vesical artery (replaced by vaginal in females) Inferior gluteal artery Internal pudendal artery Mnemonic: SOMU and 3IV • Nasal septum—osseous part Vomer Sphenoid Nasal bone Frontal bone Ethmoid Palatine Maxillary Mnemonic: Very special news for Ethiopian PM • Large opening of diaphragm T8—Venacaval opening T10—Oesophageal opening
7Anatomy T12—Aortic opening Mnemonic: Voice of America Aortic opening Aorta Thoracic duct Azygos vein Mnemonic: ATA Vena caval opening—Right phrenic nerve Inferior vena cava Mnemonic: RP in Cave Oesophageal opening—Left vagus Right vagus Oesophagus Oesophageal branch of left gastric artery Mnemonic: Vagus, phagus, gas • Supports of uterus Muscular supports/active supports Perineal body Urogenital diaphragm Levator ani (pelvic diaphragm) Mnemonic: PULP Mechanical supports Transverse cervical ligament (Mackenrodt’s ligament) Uterosacral ligament (most strong) Round ligament of uterus Uterine axis Pubocervical ligament Mnemonic: TURUP (T and P are cervical) • Branches of cerebral part of internal carotid artery Anterior cerebral artery Middle cerebral artery Ophthalmic artery Anterior choroidal artery Posterior communicating artery Mnemonic: AM OCP
Mnemonics8 • Branches of cavernous part of internal carotid artery Meningeal branches Cavernous branches Hypophyseal branches Mnemonic: MCH • Secondary curves: Adult curvatures of spinal cord Anteriorly Mn Cervical spine Convex X Lordosis Thoracic spine Concave Cave Kyphosis Lumbar spine Convex X Lordosis Pelvic curve Concave Cave Kyphosis (sacrococcygeal) Lumbar: Lordosis (L for L) Convex anteriorly: Lordosis Mnemonic: XL • Shoulder abduction 0–15° Supraspinatus (suprascapular nerve) 15°–90° Deltoid (axillary nerve) 90°–120° Deltoid (+ short external rotators) (axillary nerve) 120°–180° Serratus anterior (nerve to serratus anterior) Trapezius (spinal accessory nerve) • Subclavian triangle Nerve contents Three trunks of brachial plexus Nerve to serratus anterior Nerve to subclavius Suprascapular nerve Mnemonic: 3S in subclavian Triangle • Maxillary A (branch of external carotid artery) Branches of first part Middle meningeal artery Accessory meningeal artery Inferior alveolar artery Deep auricular artery
9Anatomy Anterior tympanic artery Mnemonic: MAIDA Branches of second part Deep temporal Pterygoid Masseteric Buccal Mnemonic: All muscular branches • Prostate Median lobe—benign Posterior lobe—Malignant/carcinomatous transformation Mnemonic: PMC (Patna Medical College) • Least dilatable and narrowest part of male urethra = Membranous (except external urethral orifice) Mnemonic: LMN • Branches of external carotid artery Anterior: Superior thyroid artery Facial artery Lingual artery Posterior: Occipital artery Posterior auricular artery Medial: Ascending pharyngeal artery Terminal: Maxillary artery Superficial temporal artery Mnemonic: SFL (Safal) OP Ascends Max STep • Primary cartilaginous joint/hyaline cartilaginous joint/ synchondrosis Joint between epiphysis and diaphysis of long bone Spheno-occipital joint First chondrosternal joint Costochondral joint Mnemonic: PHC • Secondary cartilaginous joint/fibrocartilaginous joint/ symphysis – Symphysis pubis – Symphysis menti
Mnemonics10 – Intervertebral joint between vertebral bodies (sacro- coccygeal joint) – Manubriosternal Joint – Xiphisternal Joint Mnemonic: 2SIMa–X Fibrous joints Sutures: Skull Gomphosis: Tooth in its sockets Syndesmosis: Inferior tibiofibular joint, middle radioulnar joint, tympanostapedial joint Mnemonic: Iti Mira Tysta • Synovial joint Plane synovial joint: Joint between articular process of vertebra Intercarpal and intertarsal Mnemonic: Art of car and tar are plane Hinge joint Interphalangeal Elbow Ankle Mnemonic: HIPEA Pivot (trochoid) Median atlanto-axial joint Inferior and superior radioulnar joint Mnemonic: MAA and ISRU Ellipsoid: Metacarpophalangeal joint Atlanto-occipital joint Wrist joint Mnemonic: MCP AO, wrist Condylar (bicondylar): Knee joint Right and left jaw joint Mnemonic: J and K are bicondylar Saddle (sellar): Sternoclavicular joint 1st carpometacarpal joint Calcaneocuboid joint Mnemonic: Stern 1st CM of Calca is sad Ball and socket: Shoulder joint
11Anatomy Hip joint Talocalcaneonavicular joint • Epiphysis Pressure epiphysis: Head of femur Condyles of tibia Lower end of radius Mnemonic: Press HCL Traction epiphysis: Tubercles of humerus—Mastoid process Trochanters of femur Mnemonic: TMT Atavistic epiphysis: Coracoid process of scapula Osmium trigonum Aberrant epiphysis: Head of first metacarpal Base of other metacarpals • Veins of heart Contents of coronary sulcus: Great cardiac vein Coronary sinus Small cardiac vein Mnemonic: GCS Anterior cardiac vein drains directly into right atrium Mnemonic: ADDRA Smallest cardiac vein/Thesbian veins/venae cordis minimi drains directly into the cavity in all four chambers. Rest drains into coronary sinus, i.e, great cardiac vein (Anterior Interventricular septum) Middle cardiac vein (Posterior interventricular septum) Mnemonic: Middle Post Small cardiac vein Posterior vein of LV Oblique vein of LA Right marginal vein • Muscles of mastication Pterygoid—lateral and medial Masseter Temporalis Mnemonic: PMT
Mnemonics12 • Structures derived from the neural crest C-cells of thyroid Conotruncal septum (Chromaffin tissue) (adrenal medulla) Neurons: The neurons of Spinal dorsal root ganglia Sensory ganglia of 5th, 7th, 8th, 9th and 10th cranial nerves Sympathetic ganglia Pia-arachnoid mater Schwann cells Melanoblasts (mesenchyme of dental papilla and pharyngeal arches) Mnemonic: 3C 3S PSM • Yellow elastic cartilage forms: External ear External auditory canal Eustachian tube Epiglottis Tip of arytenoids Tip of nose Corniculate cartilage Cuneiform cartilage Mnemonic: E4T2C2 • Hyaline cartilage forms: (Type 2 collagen) Costal Nasal Some laryngeal Tracheobronchial All temporary and most articular cartilages Mnemonic: ATMA • Femoral artery: Superficial branches Superficial external pudendal Superficial epigastric Superficial circumflex iliac Deep branches Profunda femoris
13Anatomy Deep external pudendal Muscular branches Mnemonic: PDM External iliac artery:Branches Inferior epigastric artery Deep circumflex iliac artery Note: 1. Inferior epigastric artery anastomoses with superior epigastric artery (a branch of internal thoracic artery). 2. Profunda femoris is the largest branch of femoral artery. It is the chief artery to supply all 3 compartments of thigh. lts branches 1. Medial circumflex femoral artery 2. Lateral circumflex femoral artery 3. Four perforating arteries • Sites of narrowing of normal ureter Ureteric orifice Ureterovesical junction Juxtaposition of the vas deferens or broad ligament Crossing of the iliac artery Ureteropelvic junction Mnemonic: Ureteric orifice is VVIP • Anterior belly of digastric is supplied by mandibular nerve Postserior belly of digastric is supplied by facial nerve Mnemonic: ADM and PDF • Mandibular nerve (lst arch): Mylohyoid Muscles of mastication Anterior belly of digastric Tensor tympani Tensor veli palati Mnemonic: My Mast Ant digest Tension • Facial Nerve (2nd arch): Stapedius Stylohyoid Posterior belly of digastric Muscles of facial expression Mnemonic: Stupid style Dip muscles of facial expression
Mnemonics14 • Glossopharyngeal nerve (3rd arch): Stylopharyngeus Mnemonic: Gloss style-pharyngeal common) • Superior laryngeal nerve (4th arch) Muscles of pharynx (except stylopharyngeus) Muscles of palate (except tensor veli palati) • Recurrent laryngeal nerve (6th arch): Muscles of larynx (except cricothyroid) Note: Cricothyroid muscle is supplied by external branch of superior laryngeal nerve. Mnemonic: Ex Cricketer • Stapes—Smallest Mnemonic: S for S Malleus: Largest • Direction of nasolacrimal duct: Downward, backward and laterally. Mnemonic: DBL, i.e. double • Inferior meatus: Nasolacrimal duct Mnemonic: INLD Middle meatus: 4 openings: Middle ethmoidal air cells Maxillary sinus Anterior ethmoidal air cells Frontal sinus Superior meatus: Posterior ethmoidal sinus. Mnemonic: SuPES Sphenoethmoidal recess—Sphenoid air cells. Mnemonic: SERS • Coronal suture—between 2 ears (Can in hindi) Mnemonic: C for C Sagittal suture—between 2 parietal bones. Asterion—parietomastoid occipital (PMO).
15Anatomy Bregma—Anterior fontanelle Mnemonic: AB Lambda—Posterior fontanelle • Routine opening of mouth: Lateral pterygoid. Forceful opening of mouth: Digastric Geniohyoid Myelohyoid Mnemonic: DGM • Infrahyoid muscles—also known as strap muscles: Sternohyoid Omohyoid Sternothyroid Thyrohyoid • Ansa cervicalis is nerve supply of: Omohyoid Sternothyroid Sternohyoid Mnemonic: OH Anshu SiT on Shoe • C1 is the nerve supply of: Thyrohyoid Geniohyoid Mnemonic: C1 is The GHar • Male internal genitalia S: Seminal vesicles E: Epididymis E: Ejaculatory duct D: Ductus deferens (Vas deferens) Mnemonic: SEED • Paranasal sinuses Maxillary sinus—develops at birth Ethmoidal sinus—develops at birth Frontal sinus—develops at 2 years Sphenoid sinus—develops at 3–5 years. Mnemonic: MEFS • The inferior turbinate is a separate bone, while rest of the turbinates are a part of ethmoidal bone. Mnemonic: Inferior—Independent
Mnemonics16 • Cerebellum Cerebellar cortex—five cells: Granule cells Golgi cells Purkinje cells Stellate cells Basket cells Mnemonic: Garm gol puri in steel basket Deep cerebellar nuclei: Dentate Emboliform Fastigial Globose Mnemonic: DEFG Note: The axons of Purkinje cells are the only output from the cerebellar cortex, generally pass to the deep nuclei. • Appendix of testis—Paramesonephric duct Mnemonic: ATP Appendix of epididymis—Mesonephric duct Mnemonic: MEA
• Inhibitors of TCA cycle Fluoroacetate inhibits aconitase (non-competitive > competitive) Arsenite inhibits α-Ketoglutarate dehydrogenase (non- competitive) Malonate inhibits succinate dehydrogenase (competitive) Mnemonic: FAM inhibits AKS • Transamination reaction Aspartate + α-ketoglutarate → oxaloacetate + glutamate Mnemonic: ASO Alanine + α-ketoglutarate → pyruvate + glutamate Mnemonic: PyAl G for G—Glutamate–ketoglutarate • Sphingolipidosis: X-linked recessive → Fabry’s disease Mnemonic: Fab X • Biochemical tests • Sugars (reducing sugars) Fehling’s test Benedict’s test Mnemonic: FBS (or fasting blood sugar) • Bile pigments Gmelin test Fouchet test Rosenbach’s test Mnemonic: Pig GFR 17 Biochemistry 2
Mnemonics18 Also remember Ketone bodies Rothera test (Nitroprusside test)—Roth Nite Gerhardt test (Ferric chloride test) Mnemonic: GF • SGPT – ALT – Cytosolic Mnemonic: CLP Also remember: SGOT (AST)—80% mitochondrial and 20% cytosolic • Water soluble vitamins: Vitamins B and C Mnemonic: WBC Vit. B complex energy releasing Thiamine (B1) Riboflavin (B2) Niacin (B3) Mnemonic: 123-TRN (Tarun in Hindi) Biotin Pantothenic acid Pyridoxine B6 Mnemonic: six pyre • Blot transfer techniques Southern blot DNA Northern blot RNA Western blot Protein Mnemonic: South – Dakshin – DNA Western – Paschim – Protein • Respiratory chain inhibitors Complex IV inhibitors: Cyanide (CN) Carbon monoxide (CO) Hydrogen sulphide (H2S) Sodium azide Mnemonic: ides are complex IV inhibitors • Location of major glycosaminoglycans Hyaluronic acid: Synovial fluid Loose connective tissue
19Biochemistry Vitreous humor Cartilage Mnemonic: Hy SyL Vi in Car Chondroitin sulphate: Cartilage Bone Cornea Mnemonic: CBC Karatan sulphate: Cornea (KS I) Loose connective tissue (KS II) Heparin: Mast cells Heparan sulphate: Aortic wall Skin fibroblasts Dermatan sulphate: Wide distribution • Catabolism of carbon skeletons of amino acids Oxaloacetate forming amino acid—Asparagine (aspartate) Mnemonic: Ox in spa Fumarate forming amino acids—Phenylalanine, tyrosine Mnemonic: PheTyr fumes Succinyl CoA: Threonine, valine, isoleucine, methionine Mnemonic: Three successful VIM • Ketoglutarate: Proline, histidine, arginine, glutamine Mnemonic: ααααα PHAG Pyruvate: Cystine, threonine, glycine, alanine, serine Mnemonic: CT GAS in Peru Acetyl CoA/Acetoacetyl CoA forming amino acids: Leucine, isoleucine, lysine, tryptophan, phenylalanine, tyrosine Mnemonic: Lily Try Phe Tyr in AC • Transport of ammonia to liver Muscle—uses alanine Mnemonic: Amma ki Mala Other tissues use glutamine • Metabolic role of vitamin B12 Methylation of homocysteine to methionine Isomerization of methyl malonyl CoA to succinyl CoA Methylation of pyrimidine ring to form thymine
Mnemonics20 Interconversion of glutamate and β-methyl aspartate in bacteria Conversion of ribonucleotides to deoxyribonucleotides in DNA synthesis Metabolism of diols Mnemonic: HMP and GRD in B12 • HGPRTase deficiency Partial def: Kelly Siegmiller’s syndrome No CNS involvement Complete def: Lesch-Nyhan syndrome Mnemonic: Kelly is Partial • Classification of amino acids Amino acids with aliphatic side chain Glycine Alanine Valine Leucine Isoleucine Mnemonic: GAVLI With side chain containing OH (hydroxyl) group Tyrosine Threonine Serine Mnemonic: oh tie three Sari With side chain containing sulphur atoms Methionine Cysteine Mnemonic: MSC Containing aromatic rings Histidine Tryptophan Phenylalanine Tyrosine Mnemonic: Histry Phe Tyr
21Biochemistry • RNA polymerase transcribes Type 1—rRNA Types 2—mRNA Type 3—tRNA Mnemonic: RMT = Remote • Homozygous substitution with other amino acids in place of Valine at position 67 of β-chain Glutamate—Hb milwaukee Mnemonic: Gala Milo Aspartic acid—Hb bristol Mnemonic: Brass Alanine—Hb sydney Mnemonic: Alan border of sydney • CPK-1-CPK BB—brain (Mnemonic: BB no. 1) CPK-2-CPK MB—myocardium Mnemonic: MB Heart attack CPK-3-CPK MM—skeletal muscle CPK-MB 1—extra cardiac form CPK-MB 2—cardiac form Mnemonic: Heart attack especially in 2nd MB • Fructose 2, 6-bisphosphate + ve on PFK 1 – ve on PFK 2 – ve on fructose 1, 6-bisphosphatase Note: PFK 2 is bifunctional (2 is bi.) • Ehrlich’s aldehyde reagent test Chloroform layer turns pink—Urobilinogen (Mnemonic: CPU) Aqueous layer turns pink—porphobilinogen • Mg2+ (Magnesium) is required in covalent modification of enzymes by phosphorylation, dephosphorylation of seryl residues. It is required in: Ribonuclease
Mnemonics22 Kinase Transketolase Peptidases Ca carboxylase Adenyl cyclase Phosphatase Mnemonic: RiKi Trap Car, add phos • Tryptophan → Serotonin → Melatonin Niacin (nicotinic acid/nicotinamide) Tryptophan contains indole functional group. • Tyrosine is formed from phenylalanine (Enz-phenylalanine hydroxylase) Tyrosine is also precursor for Dopa Dopamine Epinephrine Norepinephrine Thyroxine Triiodothyronine Melamine Note: Codon for tyrosine are UAC and UAU. In Papaver somniferum, the opium poppy, tyrosine is used to produce the alkaloid morphine. • Substrate level phosphorylation 1, 3-bisphosphoglycerate to 3-phosphoglycerate (phospho- glycerate kinase), glycolysis Phosphoenol pyruvate to pyruvate (pyruvate kinase)- glycolysis Succinyl CoA to succinate (succinyl CoA synthetase or succinate thiokinase), Kreb’s cycle • Basic amino acid Pka of ‘R’ Histidine 6 Lysine 10.8 Arginine 12.5
23Biochemistry Higher the Pka, more basic will be amino acid. Mnemonic: Increasing order HLA • Guanine to cytosine G ≡ C (3 hydrogen bonds) adenosine to thymidine A = T (2 hydrogen bonds) Mnemonic: 3G • Named mutations Nonsense mutation: Sense codon to change into nonsense stop codon, causing premature termination of translation. Missense mutation: Change of one sense codon into another sense codon, for different amino acids Mnemonic: Different Miss Silent mutation: Change of one sense codon into another sense codon for same amino acids (Mnemonic: S for S) Null mutation: Leads to no functional gene product (complete loss of function) Loss of function mutation: Results of gene product having less or no function. Gain of function mutation: Change the gene product such that it gains a new and abnormal function. Neutral mutation: Different but chemically similar amino acid. • Insulin receptor: Two subunits • α subunit: It is extracellular and its function is to bind insulin. • β subunit: It is a transmembrane protein and its function is signal transduction. Note: The cytoplasmic portion of subunit has tyrosine kinase activity (enzymatic receptor). • Three steps in glycolysis that are physiologically irreversible. These reactions are catalyzed by – Hexokinase–glucokinase (glucose to glucose 6-phosphate) – Phosphofructokinase (fructose 6 phosphate to fructose 1, 6-bisphosphate) – Pyruvate kinase (phosphoenol pyruvate to pyruvic acid) To remember: All three are kinases. One involves glucose, another fructose and third one pyruvate.
Mnemonics24 • Metabolic fuels Organ Fed Fasting Starvation Mnemonics Brain Glucose Glucose Ketone bodies Gul Gul Ke Heart Fatty acid Fatty acid Ketone bodies FFK (Fafakna in Hindi) Liver Glucose Fatty acid Amino acid GFA (Girl Friend Ayi rahne) Muscles Glucose Fatty acid Fatty acid GFF (is muscil in Hindi) RBC Glucose Glucose Glucose Only glucose • DNA Purines—Adenine, guanine Pyrimidines—Cytosine, thymine Mnemonic: Y for Y • Amino acids Ketogenic— Leucine Lysine Mnemonic: KiLL Both glucogenic and ketogenic—Isoluecine Tryptophan Phenylalanine Tyrosine Mnemonic: GK Is trying phenyl on tyre • Protein degeneration in eukaryotes 1. Protein degeneration in lysosomes—involves lysosomal proteins. This process does not involve ATP. 2. Protein degradation in proteosomes—involves ubiquitin- proteosome pathway. This process requires ATP, i.e. ATP dependent. Mnemonic: UPA • Trypsin—a proteolytic enzyme (proteinase) It acts in an alkaline medium.
25Biochemistry Activators: Enterokinase Calcium Trypsin itself Mnemonic: ECT Inhibitors: Human and bovine colostrums Egg white (contains water soluble mucoprotein) Raw soyabean Alpha antiproteinase/α-1 antitrypsin Diisopropyl flurophosphate (DFP) Mnemonic: HERALD • Helicase—Unwinds dsDNA to provide ssDNA Mnemonic: HU Topoisomerase—Relieves torsional strain that results from helicase induced unwinding. Mnemonic: T for T
• Papez circuit Cingulate gyrus Anterior thalamic (limbic system) nucleus (thalamus) ↓ ↑ Hippocampus Mammillary body (limbic system) (hypothalamus) Mnemonic: HiMaAnCi • Limbic system Cingulate gyrus (rim of cortical tissue around hilum of cerebral hemisphere) Amygdala Septal nuclei Hippocampus formation Mnemonic: CASH • Precursors of Clotting factors Carboxylase Mature clotting II, VII, IX and X factors II, VII, IX, X (inactive- Vitamin K (active γ-carboxy- glutamyl glutamyl) Gla residues) (Hydroxyquinone) residues This reaction requires CO2 and hydroxyquinone form of vit. K Mnemonic: CHK • Phase of minimum cardiac motion At low/intermediate heart rates—Mid-diastole Mnemonic: Mid day minimum At high heart rates: Late systole 26 → ← → Physiology 3
27Physiology • Nitric oxide synthase NOS 1 (Endothelial NOS): Constitutive/Calcium dependent NOS 2 (Inducible NOS): Inducible/Calcium Independent NOS 3 (Neuronal NOS): Constitutive/Calcium dependent Mnemonic: EIN—Alphabetically and In for In • Intestinal hormone stimulating insulin secretion Gastrin Gastric inhibitory peptide (GIP) Glucagon Glucagon like peptide (GLP) Cholecystokinin (CCK) Secretin Mnemonic: 4GCS • Features of cerebellar function/lesion Past pointing Hypotonia Cerebellar nystagmus Dysmetria Dysarthria Dysdiadochokinesia Intention tremor Ataxia Mnemonic: PHC D3 I2 A1 • Pain insensitive structure Parenchyma of brain Plexus (choroid) Ependymoma Pia-arachnoid Dura over convexity of skull Mnemonic: PCS is insensitive Also remember: Vasomotor center (VMC) Excitatory: Cortex Pain pathway Carotid and aortic chemoreceptors Direct stimulators: CO2 Hypoxia
Mnemonics28 • Cells within gastric glands Chief Zudge fund of pepsi—chief cells/zymogenic cells— fundus of stomach—pepsin Ox and Pari are intrinsic to HCL—oxyntic cells or parietal cells—secrete HCL. • Abnormal Hb with decreased solubility HbS (β6-GLU-VAL) HbC (β6-GLU-LYS) HbD (β6-GLU-GLM) Mnemonic: Supreme Court Decision-Very Long Gap • Parasympathetic fibres carrying cranial nerves—3, 7, 9, 10 Pure motor—3, 4, 6, 11, 12 Pure sensory—1, 2, 8 • The Dorsal spinocerebellar tract enters the cerebellum through inferior cerebellar peduncle. The ventral tract enters into the cerebellum through superior cerebellar peduncle. Mnemonic: DIN • Medullary respiratory centres: Dorsal respiratory group (DRG), located in the dorsal portion of the medulla, which mainly causes inspiration Mnemonic: Din Ventral respiratory group (VRG) located in the ventrolateral part of the medulla, which mainly causes expiration. • Hormones with second messenger cGMP Atrial natriuretic factor Nitric oxide Mnemonic: NAG Hormones with second messenger Creatine Kinase Growth hormone Erythropoietin Prolactin Insulin Insulin like growth factors I and II Chorionic somatomammotropin Mnemonic: Growing EPICK
29Physiology Hormones with second messenger cAMP α2 adrenergic catecholamines β adrenergic catecholamines Adrenocorticotropic hormone (ACTH)—pituitary Antidiuretic hormone (V2)—2 ampoule Calcitonin—parafollicular ‘C’ cell of thyroid Chorionic gonadotropin, human Corticotropin release hormone Dopamine Glucagon—pancreas FSH—pituitary LH—pituitary MSH PTH—parathyroid Somatostatin TSH—pituitary (FLAT) Mnemonic: ACD GF LM PST Second messenger is Ca2+ /PIP Oxytocin ADH (V1A and V1B) TRH Gonadotropin releasing hormone Gastrin Cholecystokinin Acetylcholine α1-adrenergic catecholamine • Intrinsic muscle control Golgi tendon organ—detects muscle tension—inverse stretch reflex—lengthening reaction Mnemonic: T for T Muscle spindle—detects muscle length—stretch reflex Mnemonic: S for S • Vestibular cerebellum—equilibrium spinocerebellum—Smoothens and coordinates Mnemonic: S for S Neocerebellum—planning and programming
Mnemonics30 • Trichromatic theory Red—protanomaly Green—deuteranomaly Blue—tritanomaly Mnemonic: Red-Green-Blue (Ragbi) • General somatic efferents: Motor functions of skeletal muscles derived from somites: Cranial nerves III (Oculomotor nucleus) IV (Trochlear nucleus) VI (Abducens nucleus): Supplies extraocular muscles XII (Hypoglossal nucleus): Supplies tongue muscles Mnemonic: Tongue muscles and Extraocular muscles • General visceral efferents: Motor function of smooth muscles and glands of head and viscera that receive parasympathetic supply Cranial nerves Superior salivatory nucleus (VII) Superior Seven Inferior salivatory nucleus (IX) Inferior Nine Dorsal motor nucleus (X) Dorsal ~ Das (Hindi) Edinger-Westphal nucleus (III) Mnemonic: SIDE • Bronchial efferents/special visceral efferents Ambiguous nucleus (IX, X, XI) Masticatory nucleus (V) Spinal accessory nucleus (XI) Facial nucleus (VII) Mnemonic: Ambi Ka Mast Special accessory face • Axon reflex contributes only to the Flare component of triple response. Mnemonic: Flaxon • Sarcolemmal proteins localized to the cytoplasmic side of sarcolemma Dysferlin Dystrophin Calpain Mnemonic: Fer pin Pain
31Physiology Also remember: Transmembrane sarcolemmal proteins Dystroglycans, integrins, sarcoglycans and caveolin Mnemonic: DISC • The dorsal column ascends such that it remains ipsilateral along the entire length of spinal cord (its branch cross over in medulla) Mnemonic: DCM-Dorsal column cross over in medulla Sensations transmitted by spinothalamic tract Anterior spinothalamic tract Mnemonic: Crude ATP-Crude touch and pressure in anterior Spinothalamic tract Lateral spinothalamic tract Pain (pin prick) Temperature Mnemonic: PLT Note: The spinothalamic tract crosses more or less at point of entry itself such that it remains contralateral along the whole length of spinal cord. • When compared to plasma Serum has no fibrinogen, clotting factors II, V and VIII but has higher serotonin content because of platelet breakdown in serum Mnemonic: S for S • Frequency of sleep waves Gamma oscillations 30–80 Hz Great Beta waves 18–30 Hz B Alpha waves 8–12 Hz A Theta waves 4–7 Hz T Delta waves < 4 Hz Dance Awake person Eyes opened Beta waves Mnemonic: Opening batsman Eyes closed Alpha waves
Mnemonics32 • Oxygen toxicity Acute—Bert effect—CNS effects are predominant (muscle twitching, convulsions, coma) (Mnemonic: ABC) Chronic—Smith effect—pulmonary effects (pulmonary edema, lung atelectasis) • Hormones produced in kidney Renin Erythropoietin 1, 25-Dihydroxycholecalciferol—vit. D Mnemonic: RED • Testis Interstitial cells of Leydig—secrete testosterone Mnemonic: Lete Most other functions—Sertoli cells Y-Chromosome—small acrocentric Mnemonic: Yac • Naturally occurring estrogens Estrone: Major estrogen in postmenopausal women Mnemonic: NM Estradiol: Major and most potent estrogen in women Estriol: Major estrogen in pregnancy, marker for fetoplacental unit. Mnemonic: PT • Clasp knife spasticity: Upper motor neuron lesion (corticospinal pyramidal system involved) Mnemonic: Up in Spa Lead pipe and cogwheel rigidity occurs in extrapyramidal syndrome, e.g. Parkinsonism. Mnemonic: Extra rigid in Parkinsonism Paratonia/gegenhalten—bilateral frontal lobe damage Mnemonic: FG Cerebrovascular disease. • Sympathetic outflow: Thoracolumbar outflow Mnemonic: SLT Parasympathetic outflow: Craniosacral outflow Mnemonic: PCS
33Physiology • LH surge: Ovulation—hormone picture High estrogen Low progesterone Mnemonic: HELP • IRV + TV = Inspiratory capacity (Mn: ITI) ERV + RV = Functional residual capacity (Mnemonic: FER) IRV + TV + ERV = Vital capacity IRV + TV + ERV + RV = Total lung capacity VC + RV = TLC (Mnemonic: VRT) • Positive feedback mechanisms Parturition Action potential initiation Blood clotting/clot formation LH surge Ca2+ mediated contraction Shock Mnemonic: PABLCS • Sympathetic cholinergic system serves two important functions: a. Sweat gland—secretion of sweat. b. Vasodilatation in skeletal muscles—a part of the neurons to blood vessels in skeletal muscles is anatomically sympathetic but secrete acetylcholine. Stimulation of this system of neurons produces vasodilatation in skeletal muscles. • Stimulus for CCK-PZ secretion: a. Presence of peptides and amino acids in contact with mucosa of small intestine. b. Presence in the duodenum of fatty acids having more than 10 carbon atoms. Stimulus for secretin secretion: a. Acidity of chyme b. Products of protein digestion • Stage IV: NREM sleep disorders: Sleep walking (somnambulism)
Mnemonics34 Sleep terorr or night terror (pavor nocturnus) Sleep related enuresis (bed wetting) Bruxism (tooth grinding) Sleep talking (somniloquy) • REM sleep disorders: RBD-REM sleep behaviour disorder Nightmares Narcolepsy (hallmark—decreased sleep latency) Note: Penile tumescence is seen in REM sleep. Mnemonic: RML Pens REM • Difference between T3 and T4 T3 is more potent. T3 has faster onset of action. T3 binds more avidly to nuclear receptors. T4 is more secreted by thyroid. T4 is major circulating hormone. T4 binds more avidly to plasma proteins (15 times). T4 has more plasma t½ To remember: T4 = Pharmacokinetics T3 = Pharmacodynamics Note: About 1/3 of T4 is converted to T3 in peripheral tissues. • Ions predominant in ICF: Potassium Phosphate (organic) Protein Magnesium Mnemonic: 3PM Ions predominant in ECF—Na+ /Cl– /HCO3 – /Ca2+
• Therapeutic Index = D50 D50 L E or LD50/ED50 Mnemonic: TILE • Selective phosphodiesterase 4 (PDE4) inhibitors Roflumilast Cilomilast Tofimilast Mnemonic: RCT-Milast • Small molecule tyrosine kinase inhibitors HER1 (EGFR) Erb B1: Erlotinib (reversible) Canertinib (Irreversible) Gefitinib Mnemonic: I Can do ECG • VGFR TK inhibitors—Sorafenib—Renal cell cancer Sunitinib—Renal cell cancer Mnemonic: VRS • Drugs used for acute gout NSAIDS Colchicine Corticosteroids Mnemonic: NCC • Relative potency of same steroid at equivalent concentrations in different formulation Ointment > Emollient > Gel > Cream > Lotion Mnemonic: OEGCL 35 Pharmacology 4
Mnemonics36 • Anticancer cells: Cell cycle specific G2 phase specific: Daunorubicin Etoposide Bleomycin Topotecan and Irinotecan Mnemonic: DEBT S-phase specific agent: Antimetabolites Mtx 6MP 6TG 5-FU Cytarabine Hydroxyurea M-phase specific: Vinca alkaloids Paclitaxel and Docetaxel G1 phase: Vinblastine • Drugs causing hyperuricemia L-Dopa Ethambutol Aspirin Diuretic Cyclosporine Alcohol Nicotinic acid Pyrazinamide Mnemonic: LEAD CAN poison • Anti-TNF-α drugs Etanercept Adalimumab Infliximab Mnemonic: Etalion adalat Ka Insaf • Clomiphene citrate Enclomiphene—trans-antagonist Zuclomiphene—cis-weak agonist Mnemonic: N for N • Anti-anxiety Benzodiazepines Diazepam Chlordiazepoxide
Pharmacology 37 Oxazepam Lorazepam Alprazolam Mnemonic: Dia Ka CHOLA • Anti-pseudomonal penicillins Azlocillin Mezlocillin Carbenicillin Piperacillin Ticarcillin Mnemonic: (Az) (Mez) pe Car Ka Pipe Tica • Penicillinase susceptible penicillins Penicillin G: Acid labile Penicillin V: Acid stable Mnemonic: Galib • Penicillinase resistant Nafcillin Methicillin Flucloxacillin Oxacillin Cloxacillin Dicloxacillin Mnemonic: Name Flu of OCD (last four are—oxa) • Intramuscular penicillins Benzathine penicillin G Procaine penicillin G Mnemonic: BP (measured on muscle) Intravenous intramuscular Penicillin G Crystalline penicillin G or sodium penicillin G • Anti-fungal drugs Systemic azoles Itraconazole Voriconazole Fluconazole Mnemonic: IVF
Mnemonics38 Note: Ketoconazole is both topical and systemic. • Side effects: Tacrolimus versus cyclosporine Tacrolimus causes more Neurotoxicity Nephrotoxicity Diabetes mellitus Diarrhoea Mnemonic: N2D2: ND Tiwari Cyclosporine causes more Hirsutism Hyperplasia of gums Hypertension Hepatotoxicity (4H: First two are absent in tacrolimus) • Management of PSVT Adenosine > beta (β) blocker > calcium channel blocker (verapamil) > digoxin Mnemonic: ABCD • Beta agonists—side effects Tolerance Tachycardia Tremor Mnemonic: 3T • Effects mediated through β2 receptor agonists Relaxation of smooth muscles Airway (bronchial muscles) Bronchodilatation (relaxation) Blood vessels Vasodilatation (relaxation) (Arterioles and Veins) Ciliary muscles in eye Relaxation Detrusor muscles in bladder Relaxation Gall bladder and duct Relaxation Gastrointestinal tract Relaxation Uterus Relaxation Splenic capsule Relaxation Mnemonic: ABCD G2US (i.e. ABCD GO TO US)
Pharmacology 39 • Oral drug therapy for treatment of erectile dysfunction P Pentoxyfylline O Opoid antagonist (naltrexone) D Dopamine agonist (bomocriptine, apomorphine) A Alpha blockers (yohimbine, idaxozan) Mnemonic: PODA • Prostaglandin E1 (PGE1) analogues Riopristil Alprostadil Misoprostol Mnemonic: RAM Prostaglandin F2α (PGF2α) analogues Dinoprost Carboprost Latanoprost Mnemonic: Prost • Hormones acting through cell membrane receptors G protein coupled receptors Enzymatic receptors • G protein coupled receptors act either Through alteration in CAMP concentration, or Through IP3/DAG generation CAMP altering hormones are (another Mnemonic: ABCD GF LMPST) Pancreas: Glucagon, somatostatin (delta cells) Pituitary: FSH, LH, ACTH, TSH (Mnemonic: FLAT—CAMP) Parathyroid: PTH Parafollicullar C cells of thyroid: Calcitonin Posterior pituitary: Vasopressin (V2) Plus hypothalamic releasing hormones (CRH, dopamine) Placenta: hCG Peptide of intermediate pituitary: MSH Through IP3/DAG: Oxytocin TRH gastrin Acetylcholine Vasopressin Gn RH Angiotensin II (V1)
Mnemonics40 Through cGMP—NO ANF Mnemonic: NAG (NO, ANF through cGMP) • Rapid acting human insulin analogues Insulin aspart Insulin lispro Insulin glulisine Mnemonic: Asli Glu Also Remember: Long acting human insulin analogues Insulin glargine Insulin detemir • Mechanism of action of antiepileptic agents Facilitation of GABA mediated chloride channel opening Barbiturates Benzodiazepines Gabapentin Tiagabine Topiramate Vigabatrin Valproate Mnemonic: BaBe Girl Tia Top in Viva of GABA class • Inhibition of T type Ca2+ current Valproate Trimethadione Ethosuximide Mnemonic: Vallore try ethical current • Prolongation of Na+ channel inactivation Valproate Lamotrigine Zonisamide Phenytoin Carbamazepine Topiramate Mnemonic: Very long zone of Na+ in PCT
Pharmacology 41 • Gp II b/III a antagonist Eptifibatide Tirofiban Abciximab Mnemonic: EpTiAb • All Navirs are protease inhibitors • NNRTI: Efavirenz Etravirine Nevirapine Delaviridine Mnemonic: 2END • Didanosine Stavudine Zalcitabine (20%) (71%) (15%) Similar toxic profiles Peripheral neuropathy (% in bracket) Lactic acidosis Pancreatitis Liver: Hepatomegaly with steatosis Mnemonic: PLPL • Anti-metabolite acting by hypomethylation (inhibit DNA methyl transferase) Azacitidine Decitabine Mnemonic: Hypo Aza D • Thymine less death (inhibit DNA synthesis by blocking synthesis of thymidylate) causing anti-metabolites 5-Fluorouracil (5-Fu) Capecitabine (5-Fu analogues) • Anti-metabolite acting by inhibition of DNA elongation (DNA intercalating agent) Cytarabine or cytosine arabinoside (pyrimidine-cytidine analogue) Gemcitabine (Pyrimidine-cytidine analogue) Mnemonic: Arab Gem inhibit elongation
Mnemonics42 • Filgrastim is recombinant GCSF (glycoprotein) produced in E. coli Mnemonic: EFG • High dose methotrexate is used for osteosarcoma, brain tumors and hematological malignancies. Mnemonic: Bone, Brain, Blood • Filgrastim: GCSF/(Gra for granulocyte) Sargramostim GM-CSF (Gramo for granulocyte monocyte) • Drugs associated with SIADH Vasopressin or desmopressin Chlorpropamide Oxytocin, high dose Vincristine Carbamazepine Nicotine Phenothiazines Cyclophosphamide TCA MAO inhibitors SSRI Mnemonic: VCO VCN PC, TMS • Drugs causing constipation Aluminium hydroxide Barium sulphate Calcium carbonate Ferrous sulphate Ganglionic blockers Ion exchange resins Opiates Phenothiazines Tricyclic antidepressants Verapamil (calcium channel blockers) Mnemonic: ABC, FGI, OP, TV) Note: Mg2+ is laxative.
Pharmacology 43 • Benzodiazepines that do not produce active metabolites Oxazepam Midazolam Lorazepam Tamazepam Triazolam Mnemonic: OMLTT (Omlette) • Drugs acting on GABA A (intrinsic ion channel receptors) Agonist: Muscimol Antagonist: Bicuculline Agonist: Baclofen (B for B) Antagonist: Saclofen Drugs acting on GABA B (G protein coupled receptors) (Mn: GB) Mnemonic: MBBS (Muscimol, Bicuculline, Baclofen, Saclofen) • Absence seizure: Drug of choice < 3 yrs of age: Ethosuximide > 3 yrs of age: Valproic acid • Interactions of valproate May precipitate phenobarbitone toxicity by inhibiting metabolism May precipitate phenytoin toxicity by displacing it from protein binding sites and inhibiting metabolism. May precipitate absence status when used with clonazepam. • Immunosuppression with triple therapy: Nice guidelines Cyclosporine (calcineurin inhibitor) Azathioprine (anti-proliferative agent) Prednisolone (corticosteroid) Mnemonic: CAP Note: Azathioprine may be replaced by mycofenolate mofetil. • Adverse effects of amiodarone (iodine containing long acting anti-arrhythmic belong to class III) Thyroid—hypothyroidism and hyperthyroidism
Mnemonics44 Peripheral neuropathy Myocardial depression Pulmonary alveolitis and fibrosis (lung)—dry cough Corneal microdeposits Liver toxicity Photosensitization Mnemonic: The Periphery of My lung cornea live with photosensitivity • Fluoroquinolones excreted primarily by non-renal mechanism Pefloxacin Trovafloxacin Grepofloxacin Nalidixic acid Mnemonic: Petro Grenal Note: Sparfloxacin has 50% renal and 50% fecal route of excretion. • Anti-pseudomonal cephalosporins Ceftazidime Cefoperazone Cefepime Cefotaxine • Second line anti-tubercular drugs Old drugs PAS Ethionamide Cycloserine Thioacetazone Mnemonic: PECT Amikacin Kanamycin Capreomycin Mnemonic: Ami KC New drugs Ciprofloxacin Ofloxacin
Pharmacology 45 Clarithromycin Azithromycin Rifabutin Mnemonic: COCA-Rafa • Chelating agents in heavy metal poisoning Dimercaprol (BAL): Bismuth Antimony Lead Mercury Arsenic Copper Nickel Gold Mnemonic: BALMA CNG • Calcium disodium edetate (CaNa2EDTA) Lead poisoning Mnemonic: Ledta Zn, Cd, Mn, Cu, Fe poisoning • Penicillamine Copper Mercury Lead Mnemonic: CML Note: BAL: Not in iron and cadmium poisoning Mnemonic: BANIC EDTA: Not in mercury poison Mnemonic: ENM Penicillamine: Not in iron poisoning Mnemonic: PNI • Phenytoin—side effects Hyperplasia of gums Hyperglycemia Hirsutism Hypersensitivity reaction Hydantoin syndrome: Teratogenicity
Mnemonics46 Lymphadenopathy Megaloblastic anaemia Neurological symptoms Osteomalacia Mnemonic: 5H + LMNOP • Valproate—side effects Anorexia, vomiting Alopecia (transient) Ataxia, sedation Ammonemia (hyper) Thrombocytopenia Tremor Hepatotoxicity Neural tube defect Weight gain Mnemonic: VAT + HNW • Antidote of warfarin (oral anticoagulants): Vitamin K1 (phytonadione) Antidote of heparin—protamine sulphate • Drugs acting on cell membrane and promoting leakage from membranes Polyenes: Amphotericin B Hamycin Nystatin Polypeptides: Polymyxin Colistin Mnemonic: AB HaNy and PoCo leak membrane • Mechanism of action of anti-microbial agents Inhibition of DNA gyrase: Fluoroquinolones Mnemonic: FG Misreading of mRNA code: Aminoglycoside (Mn:Amina misread code) Inhibition of protein synthesis Chloramphenicol 50S Erythromycin 50S
Pharmacology 47 Clindamycin 50S Mnemonic: CEC 50 Tetracycline 30S Aminoglycoside 30S • Beta adrenergic agonists, nitrates, digitalis and diuretics are best avoided during treatment of HOCM. Mnemonic: BeNi DiDi avoid HOCM • Contraceptive failure may occur if any of the following drugs is used concurrently: Enzyme inducers: Phenytoin, phenobarbitone primidone, carbamazepine, rifampicin, griseofulvin. Suppression of intestinal microflora tetracycline, ampicillin • Drugs following zero order kinetics Warfarin Ethyl alcohol Theophylline Tolbutamide Phenytoin Aspirin (salicylate) Propranolol Mnemonic: Zero WATT PAP • Adrenaline: α1 + α2 + β1 + β2 Noradrenaline: α1 + α2 + β1 (no β2 action) Dopamine: D1 + D2 + α1 + α2 + β1 (no β2) Isoprenaline: β1 + β2 (no α action) Dobutamine relatively β1 selective (no dopamine receptor action) Mnemonic: DONO has no B2 action • Adrenaline: Systolic BP increased Diastolic BP decreased Heart rate increased Noradrenaline: Systolic BP increased Diastolic BP increased Heart rate decreased
Mnemonics48 Isoprenaline: Systolic BP normal/decreased Diastolic BP decreased Heart rate increased • Dopamine: D1 receptors in renal and mesenteric blood vessels are very sensitive IV infusion of low doses of DA dilates mesenteric vessels and improves renal perfusion. Dobutamine: Inotropic action • Selective MAO-A inhibitor: Clorgiline Maclobemide Selective MAO-B inhibitor: Selegiline Non-selective MAO inhibitor Isocarboxazid Tranylcypromine Phenelzine Mnemonic: ITP • Hemodialysis is not used in Benzodiazepines (BZD) Digitalis Organophosphates Copper sulphate Kerosene Mnemonic: BZD DOCK • Diagnostic test for myasthenia gravis a. Ameliorative test: Edrophonium (anti-cholinesterase) b. Provocative test—d-tubocurarine • Pheochromocytoma α-blockage is the basis of management in preoperative period. Phenoxybenzamine is the agent of choice. β-blockers should not be employed prior to establishing effective α-receptor blockage, since unopposed β receptor blockage could theoretically cause blood pressure elevation from increased vasoconstriction. Atenolol however is a selective β1 agonist, and acts on the heart and not on peripheral blood vessels.
Pharmacology 49 • Diuretics, which do not promote bicarbonate excretion Thiazide like diuretics, e.g. metazoline, indapamide, chlorthalidone, Ethacrynic acid (unlike other loop diuretics) Mnemonic: MICE Most marked kaliuresis: Acetazolamide Mnemonic: AK Most marked natriuresis: Furosemide Mnemonic: FuNa • Pharmacokinetics ADME Absorption Distribution Metabolism Excretion • Plasma protein binding is associated with— Duration Distribution Disease (hypoalbuminemia) Displacement Dialysis • Area outside blood–brain barrier (circumventricular organs) Subfornical organ OVLT (organum vasculosum of lamina terminalis) Area postrema Posterior pituitary Mnemonic: SOAP Note: CTZ (Chemoreceptor trigger zone) is also outside blood–brain barrier and responsible for vomiting. • Enzyme inducers— G—Griseofulvin P—Phenytoin, Primidone R—Rifampicin S—Smoking (PAH—polycyclic aromatic hydrocarbons) Car—Carbamazepine Phone—phenobarbitone
Mnemonics50 • Enzyme inhibitors— Valla’s—Valproate Kit—Ketoconazole Can—Cimetidine Cause—Ciprofloxacin Enzyme—Erythromycin Inhibition—INH (Isoniazid) • Order of kinetics First order— CHF constant Clearance Half life Fraction excreted Zero order—RA constant Rate of elimination Amount eliminated • Nuclear hormones— S—Sex hormones (Estrogen, Progesterone and Testosterone) A—Vitamin A T—Thyroid hormones Mnemonic: SATurday Night Cytoplasmic receptor hormones—Corticosteroids Vitamin D Mnemonic: CCD • Drugs metabolized by acetylation— S—Sulfonamide including dapsone H—Hydralazine I—INH (Isoniazid) P—Procainamide (antiarrhythmic drug) Note: They can cause SLE. • Parasympathetic fibres are long in preganglionic. Mnemonic: Para-Pre—long • Preganglionic fibres release acetylcholine in both sympathetic and parasympathetic systems.
Pharmacology 51 • Sympathetic system— Postganglionic fibres release noradrenaline Exceptions— Sympathetic nerve fibres going to kidney secrete dopamine. Sympathetic nerve fibres going to sweat glands release acetylcholine (sympathetic cholinergic) Mnemonic: Kid is sympathetic to dopa • Heart rate—Chronotropic Mnemonic: HR Conduction—Dromotropic Mnemonic: D for D Contractility—Ionotropic • Hemicholinium—inhibits uptake of choline. Vesamichol—inhibits entry of acetylcholine in the vesicle Botulinum toxin—inhibits release of acetylcholine. • M1—Stomach (increases acid secretion) M2—Heart (Bradycardia) M3—Rest organs like eye, GIT, urinary bladder, bronchus, glands M4—CNS M5—CNS Mnemonic: Ma says—First eat, Second heart and rest work later on • Drugs directly acting on parasympathetic system Pilocarpine acts on Pupil (M3)—miosis in glaucoma. Mnemonic: P for P Bethanichol acts on Bladder (M3)—contracts urinary bladder in urinary retention. Mnemonic: B for B Methacholine acts on Myocardium (M2)—used in tachyarrhy- thmia. Carbachol action—Common action—acts both on nicotinic and muscarinic receptors. Mnemonic: C for C
Mnemonics52 • Oximes (enzyme reactivators) are acetylcholinesterase reactivators. Oximes are used only for organophosphorous poisoning. Mnemonic: OOO For example, Pralidoxime (PAM)—acts only in periphery. Mnemonic: P for P Diacetyl monoxime (DAM)—acts on both sites. • Anticholinergic drugs act as cycloplegic. Ciliary muscle contracts to cause accommodation. Its nerve supply is short ciliary nerve—branch of oculomotor nerve (3rd cranial nerve). So, it is a part of parasympathetic system. That is why anticholinergic drugs cause cycloplegia by blocking ciliary muscle contraction and causing loss of accommodation. Anticholinergic drugs are— Atropine—strongest cycloplegic drug. Very long acting. Used for refraction testing in children. Homatropine Cyclopentolate Tropicamide (Shortest acting. Preferred in adults.) Mnemonic: D for adult • Anticholinergic drugs acting on urinary bladder (M3)— block—less contraction. Cause urinary retention (side effect) Used in overactive bladder/incontinence/detrusser instability. Drugs used are— S—Solifenacin O—Oxybutynin F—Flavoxate T—Tolterodine, Trospium bladder—Darifenacin Mnemonic: SOFT bladder
Pharmacology 53 • Belladonna poisoning = Atropine poisoning = Dhatura poisoning. Mnemonic: BAD • β1: Heart Mnemonic: Heart is 1 in number β2: Lungs Mnemonic: Lungs are 2 in number • α1: Vasoconstriction α2: Vasodilatation Mnemonic: A 1–C B 2–D • M3: Circular muscles—Constrictor pupillae—supplied by short ciliary nerve—active miosis—parasympathomimetic. Mnemonic: MCC MAO α1: Radial muscles—dilator pupillae—supplied by long ciliary nerve—active mydriasis—sympathomimetics. • Dopamine acts on: μg/kg/min D1: Low dose < 2 β1 + D1: Intermediate dose 2–10 α1 + β1 + D1: High dose > 10 Mnemonic: DBA • Dopa in name stimulates D1 For example, Dopamine Fenoldopam Note: Dobutamine mainly acts on β1. • Adrenaline acts on all 4 receptors (α1, α2, β1 and β2) Noradrenaline—not all (α1, α2, β1) Isoprenaline—only β—β1and β2 • β2 agonists Salbutamol Terbutaline
Mnemonics54 Salmetrol Formetrol Mnemonic: Metro is long acting. Salmetrol is slow onset (S for S) Formetrol is fast onset (F for F) Side effects—Tremor Tachycardia Tolerance Mnemonic: 3T • Selective α1 blocker—Zosine • α1A—Prostate α1B—Blood vessels Mnemonic: B for blood vessels Note: Selective α1A blocker—Tamsulosin, Silodosin. • β1 blockers/cardioselective/2nd generation New—Nebivolol Beta—Betaxolol Blockers—Bisoprolol Act—Acebutolol Exclusively—Esmolol At—Atenolol Myo—Metoprolol Cardium—Celiprolol • β blockers with intrinsic sympathomimetic activity (partial agonist) Contain—Celiprolol Partial—Pindolol Agonistic—Alprenolol Activity—Acebutolol Mnemonic: All pind sell ace intrinsically • β blockers with membrane stabilizing property Possess—Propranolol Membrane stabilizing or—Metoprolol
Pharmacology 55 Local—Labetalol Anesthetic—Acebutolol Property—Pindolol • Water soluble β blockers—contraindicated in renal failure: A—Atenolol N—Nadolol S—Sotalol Mnemonic: SoNaAta • Nadolol is the longest acting β blocker Esmolol is the shortest acting β blocker. • 3rd generation β blockers: β blockers with any additional cardiovascular advantage (vasodilatation) a. α + β blockade—Labetalol, Carvedilol b. NO release—Nebivolol. Mnemonic: N for N c. Ca2+ channel blocker—Carvedilol Mnemonic: C for C d. K+ channel blocker—Tilisilol e. β2 agonist—Celiprolol • Carvedilol—α blocker Ca2+ channel blocker Antioxidant • Celiprolol— β2 agonist Cardioselective Intrinsic sympathomimetic activity. • Loop and thiazide diuretics Na+ , K+ , Mg2+ , H+ —decrease Sugar, lipid, uric acid—increase Mnemonic: Loop looses calcium. It causes hypocalcemia. But thiazides cause hypercalcemia • Digoxin—contraindicated in renal failure. Digitoxin—contraindicated in hepatic failure. Mnemonic: Toxin is metabolized in liver
Mnemonics56 • Drugs causing gynaecomastia— Di—Digitalis S—Spironolactone C—Cimetidine O—Oestrogen • Drug interactions of digitalis— Quinidine Verapamil Amiodarone Thiazides Mnemonic: Queen’s VAT digitally • Vasodilators Mainly vein—Nitrates Mainly artery—Hydralazine Mnemonic: Hydra is artist Both— α blockers ACE inhibitors AT receptor blockers Sodium nitroprusside • Drugs causing hirsutism— Cyclosporine Phenytoin Minoxidil Mnemonic: CPM ka Hero • Diazoxide—decrease Insulin • Ca2+ channel— L type—in CVS T type—in Thalamus (brain) Mnemonic: T for T • Renin inhibitor Approved for the treatment of hypertension Can be given orally Aliskiren
Pharmacology 57 Remikiren Enalkiren Mnemonic: Inhibitor of Renin • Prils are ACE inhibitors. Depines are calcium channel blockers. Mnemonic: CD • ACE inhibitors A—Active C—Captopril L—Lisinopril • ACE inhibitors—Captopril C—Cough A—Angioedema P—Prodrug (except Captopril and Lisinopril) T—Taste alteration (dysguesia) O—Orthostatic hypotension/Postural hypotension P—Pregnancy is absolute contraindication R—Renal artery stenosis (bilateral) is absolute contraindication I—Increase in K+ —hyperkalemia is contraindication L—Lowers the risk of diabetic complications Note: Angiotensin receptor blockers also follow these except first 3 (CAP). • Sartans are angiotensin receptor blockers (block AT1 only). Sartans are selective AT1 receptor antagonist. • Drugs safe in pregnancy Better—Beta blockers Mother—Methyldopa Care—Clonidine During—Dihydroperidine Hypertensive—Hydralazine Pregnancy—Prazosin Note: Antihypertensive drugs contraindicated in pregnancy are ACE inhibitors and ARB.
Mnemonics58 • Nitrate with minimum first pass metabolism—IMN Mnemonic: Iska Metabolism Nahi hota Longest acting nitrate—PETN Mnemonic: Longest name Shortest acting nitrate—AN Mnemonic: Shortest name • Coronary steal phenomenon can be caused by— Hydralazine Dipyridamol Isoflurane Mnemonic: HDI steal from Heart • Ivabradine I—IF blocker (funny current, which opens in hyperpolarisation instead of depolarization) Va—Visual field defect Bradi—cause bradycardia Ne—Na+ channel blocker • Rho kinase inhibitor—Fasudil Mnemonic: Dil me fas—ro mat • Myocardial infarction Non-ST elevation MI— M—Morphine O—Oxygen N—Nitrates A—Aspirin ST elevation MI— S—Streptokinase O—Oxygen N—Nitrate A—Aspirin M—Morphine • Antiarrhythmic drugs—Vaughan William classification: I—Sodium channel blockers II—Beta blockers
Pharmacology 59 III—Potassium channel blockers IV—Calcium channel blockers V—Others Mnemonic: SBP • Class III antiarrhythmic drugs B—Bretylium I—Ibutilide D—Dofetilide A—Amioderone S—Sotalol Note: They can cause Torased des pointes. • Benzodiazepines GABA facilitatory Increases frequency of chloride channel opening DRC flat Specific antidote—Flumazenil Mnemonic: 4F • Short acting benzodiazepines T—Triazolam, Temazepam O—Oxazepam L—Lorazepam E—Estazolam Note: Short acting BZD are—safe in elderly, liver disease, no hangover and no active metabolite. • Vigabatrin Vi—Visual field defect Gaba—GABA Tr—Transaminase In—inhibitor. ‘In’ also stands for infantile spasm Note: Vigabatrin is the drug of choice for infantile spasm with tuberous sclerosis. ACTH is drug of choice for infantile spasm.
Mnemonics60 • Tiagabine Mnemonic: Transport inhibitor of GABA It is GABA reuptake inhibitor by inhibiting GAT1 • Drug decreasing alcohol craving— N—Naltrexone A—Acamprosate T—Topiramate O—Ondansetron • Atypical antipsychotics—5HT2A/2C blockers, e.g. pine, done and aripiprazole. • Uses of topiramate—all seizures except absence. Migraine prophylaxis Obesity Smoking Alcohol addiction Mnemonic: MOSA • Uses of antipsychotic drugs— Anti—Antiemetic property Psy—psychosis Cho—chorea (Huntington’s chorea) Tic—Tic disorder like Gille de La Tourette syndrome • Agonist (κ)—antagonist (μ) P—Pentazocine N—Nelbuphine D—Dezocine • Partial agonist—Buprenorphine, Butorphenol. Mnemonic: 2B • Drugs inhibiting cell wall Firmly—Fosfomycin Bind to—Bacitracin Bacterial—β lactum Cell—Cycloserine Wall—Vancomycin
Pharmacology 61 Note: β lactum antibiotics—Penicillins Cephalosporins Carbapenems Monobactum • Penicillinase inhibitor or β lactumase inhibitor C—Clavulanic acid—with amoxicillin S—Sulbactum—with ampicillin T—Tazobactum—with piperacillin • Uses of penicillin G L—Listeria A—Actinomyces S—Syphilis T—Tetanus M—Meningococcus An—Anthrax Go—Gonococcus (drug of choice is ceftriaxone) Mnemonic: A men act on the list of gone sipohi • No β lactum is effective against MRSA except 5th generation cephalosporin. • 1st generation cephalosporin Cefazolin Cefalexin Cefadroxil Cefalothin Cefaloridine Mnemonic: Cefa Exception: Cefaclor is 2nd generation. • 4th generation cephalosporin Cefepime Cefpirome • 5th generation cephalosporin Ceftaroline Ceftibiprole Mnemonic: rol
Mnemonics62 • Cephalosporins secreted by bile Ceftriaxone Cefoperazone Mnemonic: Bile per try • Cephalosporins effective against pseudomonas— Cefepime Cefepirome Cefoperazone Ceftazidime Mnemonic: 3P and ziddi • Cefoperazone— Secreted by bile Effective against pseudomonas Disulfiram like reaction hypoprothrombinemia • Mechanism of action of tetracycline—prevents tRNA to bind to A site. Mnemonic: T for T • Antimicrobial drug preventing translocation— M—Macrolides C—Clindamycin Q—Quinapristin • Buy AT 30S SELL @ 50S AT— Aminoglycoside Tetracycline SELL— Streptogramin (Quinapristine) Erythromycin (Macrolides) Linezolid Lincosamide • Uses of tetracycline S—SIADH R—Rickettsial infection
Pharmacology 63 I—Inguinale granuloma L—Lymphogranuloma venerum A—Atypical N—pNeumonia C—Cholera A—Amoebiasis • Tetracyclines—contraindications and adverse effects— K—contraindicated in Kidney failure A—Antianabolic action P—Phototoxicity I—Insipidus—DI L—Liver failure is C/I D—Dental—affects growing bone and teeth. C/I in pregnancy and child < 8 years. E—Expiry date—causes Fanconi syndrome after expiry date V—Vestibular dysfunction • Macrolides is the drug of choice for— C—Chancroid L—Legionella A—Atypical pneumonia P—Pertussis Can also be used for— C—Corynebacterium diphtheria H—Haemophilus influenzae A—Atypical mycobacteria T—Toxoplasmosis Side effects of macrolides— M—Motilin receptor stimulation A—Allergy C—Cholestatic jaundice R—Reversible O—Ototoxicity Note: Vancomycin and aminoglycosides cause irreversible ototoxicity.
Mnemonics64 • Aminoglycoside Neomycin— Most nephrotoxic Most neuromuscular blockade Used only topically After neomycin, Gentamycin is most nephrotoxic Mnemonic: G affects GFR Streptomycin affects neuromuscular blockade Mnemonic: S affects Skeletal muscle Note: Maximum hearing loss—Amikacin Mnemonic: A affects auditory Maximum vestibular damage—Streptomycin • Side effects of Sulfonamide— A—Aplastic anemia B—Bilirubiun displacement—Kernicterus C—Crystalluria R—Rash A—Acetylation S—SLE H—Hemolysis in G6PD deficiency • Pyrimethamine—Antiparasite Mnemonic: P for P Methotrexate—Anticancer Mnemonic: M for M Trimethoprim—Antibacterial • Fluoroquinolones are contraindicated in renal failure except— P—Pefloxacin M—Moxifloxacin T—Trovafloxacin • Respiratory flouroquinolones—can kill any bacteria causing respiratory tract infection O—Ofloxacin and levofloxacin M—Moxifloxacin G—Gemifloxacin
Pharmacology 65 • Gatifloxacin—Glucose—withdrawn because it causes hypoglycemia and hyperglycemia. Mnemonic: G for G • Multibacillary leprosy—treatment OCD—Once daily Clofazimine (50 mg) and Dapsone (100 mg) RCM—Rifampicin (600 mg) and Clofazimine (300 mg) Note: Monthly dose are supervised. Paucibacillary leprosy—Treatment -???? • Bactericidal drugs— β lactum Aminoglycoside Flouroquinolones Vancomycin • Fast acting antimalarial drugs— M—Mefloquine A—Atovaquine C—Chloroquine H—Halofantrine, lumefantrine A—Artemisin group R—Res Q (Quinine) Slow acting Proguanil Pyrimethamine Sulphadoxine Tetracycline • Fluconazole—DOC for Candida, Cryptococcus Mnemonic: Flue can treat cry Note: Fluconazole is also the DOC for prophylaxis of febrile neutropenia in immunosuppressants. • Terbinafine—DOC for dermatophytosis. • Posaconazole—DOC for mucormycosis • Voriconazole—DOC for invasive aspergillosis, treatment of febrile neutropenia. • Itraconazole—DOC for all non-serious fungal infection except Candida and Cryptococcus.
Mnemonics66 • Hepatitis B—DOC—Entecavir Alternate drugs— oral— Lamivudine Emtricitabine Tenofovir Injectable— Interferon α • NRTI used in hepatitis B— L—Lamivudine E—Emtricitabine T—Tenofovir • Hepatitis C—DOC—Interferon and ribavarin • NNRTI—1st generation E—Efavirenz N—Nevirapine D—Delaviridine 2nd generation Etravirine Rilpivirine • Metronidazole is DOC for G—Giardiasis U—Ulcer—peptic ulcer P—Pseudomembranous colitis T—Trichomoniasis A—Anaerobic bacterial infection G—Gardenella vaginalis (bacterial vaginosis) • Antihelminthic drugs Platyhelminths—Flukes and tapeworm—DOC—Praziquentel. Mnemonic: P for P Nemathelminthes—DOC—Albendazole Exceptions to platyhelminthes— Liver fluke (Fasciola hepatica) Dog tapeworm (Echinococcus)
Pharmacology 67 Exceptions to Nemathelminthes— Filaria—DOC—DEC Strongyloides—DOC—Ivermectin Onchocerca (river blindness)—DOC—Ivermectin Mnemonic: iver for river • Pulsatile GnRH is indicated in— C—Cryptoorchidism H—Hypogonadotrophic hypogonadism A—Anovulatory infertility N—uNdescended testis D—Delayed puberty Note: Continuous GnRH is indicated in Precocious puberty Cancer like breast carcinoma, prostate carcinoma Endometriosis Fibroid liomyoma (symptomatically) • GnRH agonist Leuprolide—First drug Gonadorelin Nafarelin—Nasally Mnemonic: N for N Gosarelin Busurelin Histarelin • GnRH antagonist—relix Cetrorelix Ganirelix Abarelix Degarelix Mnemonic: X means cross means antagonist • Thyroid inhibitors Peripheral conversion inhibitors— 5’ deiodinase inhibitors— Propylthiouracil
Mnemonics68 Propranolol Prednisolone Mnemonic: 3P • Metformin—used for Obese patient Sulfonylurea—used for Thin patient Mnemonic: MOST • PTH causes partiality— Increases serum Ca2+ Decreases serum phosphate Note: Vitamin D decreases both while calcitonin increases both. • Tamoxifen is a SERM and has beneficial action on Bone—increases formation Blood—decreases LDL, increases HDL Breast—decreases risk of carcinoma Note: Doloxifen and Toremifen has similar action. Raloxifen—only unfavorable action is thromboembolism. • Thromboxane A2—aggregate platelets Mnemonic: A for A Prostaglandin I2—Inhibits aggregation of platelets Mnemonic: I for I • Uses of colchicine— G—Gout C—Cirrhosis M—Acute Mediterranean fever S—Sarcoidosis • Acute gout— N—NSAIDS C—Colchicine C—Corticosteroids
Pharmacology 69 • Indications of chloroquine— R—RA E—Extraintestinal amoebiasis D—DLE L—Lepra reaction I—Infectious mononucleosis P—Photogenic reactions Mala—Malaria G—Giardiasis • Anakinra—IL 1 receptor antagonist. Mnemonic: A1 • Oprelvekin is IL 11 used in anticancer drug induced thrombo- cytopenia. Mnemonic: Eleven kin • Ticlopedine causes thrombocytopenia Mnemonic: T for T • Side effects of heparin— A—Alopecia B—Bleeding H—Hyperkalemia O—Osteoporosis T—Thrombocytopenia • Mast cell stabilizers K—Ketotifen N—Nedocromil S—Sodium cromoglycate • Busulfan—side effects— S—Skin pigmentation U—Uric acid increased LF—Lung fibrosis A—Adrenal insufficiency
Mnemonics70 • TOC for Hodgkin’s lymphoma— Earlier: M—Mechlorethamine O—Oncovin (Vincristine) P—Prednisolone P—Procarbazine Now preferred: A—Adriamycin/Doxorubicin B—Bleomycin V—Vinblastin D—Dacarbazine • TOC for NHL— C—Cyclophosphamide H—Hydroxydaunorubicin/Doxorubicin O—Oncovin/Vincristine P—Prednisolone +/– R—Rituximab • TOC for colorectal carcinoma— FOLFOX or FOLFIRI FOL—Folinic acid F—5FU OX—Oxaliplatin or IRI—Irinotecan • Uses of methotrexate— C—Choriocarcinoma A—Abortion N—NHL C—Crohn’s disease E—Ectopic pregnancy R—RA • Etoposide is used in— T—Testicular carcinoma O—Oat cell carcinoma P—Prostate carcinoma
Pharmacology 71 • Side effects of cytotoxic drugs— B—Bone marrow suppression A—Alopecia D—Diarrhea H—Hyperuricemia • Hypolipidemic drugs—bile acid binding agent Cholestyramine Cholestipol Cholesevalam Mnemonic: Chole • Ketamine K—Kids. Induction agent of choice in children. E—Emergency reaction T—Thalamocortical junction is site of action causing dissociative anesthesia A—Analgesia (profound) M—Meals—can be given after meals I—Increase all pressures (BP, IOP, ICP) N—NMDA receptor blocker of glutamate E—Excellent bronchodilator—preferred in asthamatics.
• Class I MHC molecules: CD8 T cells 1 × 8 = 8 Class II MHC molecules: CD4 T cells 2 × 4 = 8 Peptide binding site on Class IMHC molecules is located in a groove between distal domains of α subunits (between α1 and α2 domains) Mnemonic: 1dααααα • Mechanism of resistance Production of βββββ-lactamase: Both gram +ve and gram –ve Alteration in PBP: Gram-positive Impaired permeability: Gram-negative Mnemonic: Beta both PBP: Positive (2P is positive) • Hepatitis virus Hep A Hep B Hep C Hep D Hep E Hep G Picorna Hepa DNA Flavivirus Incomplete Calcivirus Calcivirus Mnemonic: PH FICC (Pic of Hema Fall In Class) • Dengue hemorrhagic fever Serotype 1 followed by serotype 2 is more dangerous than Serotype 4 followed by: Serotype 2 Mnemonic: 12 >42 Also remember: Serotype 2 is more dangerous than other serotypes. • Lysogenic conversion Salmonella typhi 72 Microbiology 5
Microbiology 73 Clostridium botulinum Corynebacterium diphtheriae Mnemonic: Salmon bottles corn for lysogeny • Nuclear inclusion bodies Cowdry type A: Herpesvirus Yellow fever virus Mnemonic: HAY Cowdry type B: Adenovirus Poliovirus Mnemonic: BAP • Methods for sterilization of endoscopes Rigid endoscope Autoclave Mnemonic: RiA Flexible endoscope Glutaraldehyde peracetic acid (20% cidex) Mnemonic: EFG • Dimorphic fungi Penicillium marneffei Blastomyces Histoplasma capsulatum Paracoccidiomyces Candida albicans (not other Candida) Sporothrix Mnemonic: Dimorphic Penicillin Blast his Para’s albi spores • Culture media for isolation of Leptospira Korthof medium EMJH medium Fletcher medium Stuart medium Mnemonic: KEFS • Man is the definitive host in most of the parasitic infections except the following parasites where it is an intermediate host Hydatid worm (Echinococcus granulosus) Malaria (Plasmodium)
Mnemonics74 Taenia solium (both definitive and intermediate host) Toxoplasma gondii Sarcocystis lindemanii Mnemonic: HMT goli • Parasites malabsorption Common to adults and children: Entamoeba histolytica Giardia lamblial Hymenolepis nana Mnemonic: EGH Only adults Strongyloides Cyclospora Mnemonic: Strong Cycle of adults Only Children: Ancylostoma duodenale Isospora belli Cryptosporidium Mnemonic: An Iso Cry of Children • Antigen–antibody reaction Ascending part: Prozone or zone of antibody excess Peak—zone of equivalence Descending part—post zone or zone of antigen excess Mnemonic: A Probe • Oocyst size of acid fast parasites causing malabsorption Cryptosporidium—5 μm Cyclospora—10 μm Isospora—25 μm (Alphabetically arranged, size increases) • Parasite causing autoinfection Mnemonic: Strong Heman cryptically enters Philippines for Taenia solium auto infection. Strongyloides stercoralis Hymenolepis nana Cryptosporidium parvum Enterobius vermicularis
Microbiology 75 Capillaria Philippinensis Taenia solium • Worms that do not multiply in host. Ancylostoma duodenale Enterobius vermicularis Wuchereria bancrofti Mnemonic: Duodenum bans entry and multiplication Also remember Worms that crawl out Enterobius vermicularis T. saginata Mnemonic: Crawling entry of saginata • Microaerophilic bacteria Helicobacter pylori Borrelia burgdorferi Campylobacter Mnemonic: Hell Boy in Micro Camp • Viruses associated with blood transfusion Parvovirus B-19 Hepatitis B Hepatitis C Hepatitis G HIV type 1 HTLV type 1 Cytomegalovirus Mnemonic: 19 BCG transfuses type 1 of Cytomegalovirus • Transport media for Vibrio cholerae Venkatraman Ramkrishnan (VR) media Alkaline peptone water Monsur’s taurocholate tellurite peptone water Mnemonic: Venkat transport Alkaline water to Maissur • Obligate intracellular parasite Virus Chlamydia Rickettsiae
Mnemonics76 Legionella Mnemonic: VCRL (Viru Chalne ke liye Rickshaw lega) • Selective media in which substances that inhibit or poison all but a few microorganisms are added to a solid media (S for S). Enrichment media are produced by adding selective substances to liquid media. Enriched media are basal media enriched with blood, serum or egg. • Classification of streptococci: Hemolytic (P) streptococci are classified by Lancefield classification—based on nature of a carbohydrate ‘C’ antigen (Group A to K without I and J) Griffith typing—‘M’ Protein Mnemonic: GMP • 01 Vibrio cholerae Classical: Polymixin, Phage 4 Mnemonic: Polyphagic class Eltor: Eltor, chick embryo • Mycobacterium tuberculosis complex No environmental source M. tuberculosis M. bovis M. africanum M. microti • Non-tuberculous mycobacteria (Atypical mycobacteria) Environmental source is postulated M. avium intracellulare complex M. kansasii Mnemonic: Kans ka avium in atypical environment • Enteropathogenic E.coli or Enteroadhesive E. coli—attaches intimately to enterocyte membrane, Infants and Children, Epidemic Mnemonic: Infant attaches ad for epidemic in Patho. Enterotoxigenic E.coli: Traveller’s diarrhea Mnemonic: T for T—Produces enterotoxin (Labile/Stable)
Microbiology 77 Enteroaggregated E.coli: Persistent diarrhea—heat stable enterotoxin EAST I Mnemonic: Aggregate persists Enteroinvasive resembles shigellosis Detected by Sereny tests, penetration of the Hela and Hep2 cells. Mnemonic: H2 S2 invades • Leptospira: Three Rs Rat, Rice, Rainfield. • Treponema palladium, Syphilis endemicum: Bejel Mnemonic: Bend Pertunae: Yaws (Mnemonic: Ytune) Caratium: Pinta (Mnemonic: Pintu ki Car) • Chlamydia trachomatis Serotype A, B, Ba, C: Endemic blinding trachoma Serotype D–K: Inclusion conjunctivitis, genital chlamydiasis, Infant pneumonia Mnemonic: IGI Serotype L1, L2, L3: Lymphogranuloma venereum Mnemonic: L for L • Immunoglobulin IgG IgA IgM IgD IgE Percentage of 75–85% 7–15 5–10 0.3 0.019 total serum Ig Serum half-life days 23 6 5 3 2.5 Mnemonic: In decreasing order GAMDE Classical complement activation: IgM and IgG (Mnemonic: Mahatma Gandhi Classical) Alternate complement activation: IgA Mnemonic: A for A Ig present in milk: IgA and IgG (Mnemonic: AG in milk) • Epitope: Antigen Paratope: Antibody • Toxin acting by inhibiting protein synthesis Shiga toxin
Mnemonics78 Pseudomonas toxin Diphtheria toxin Mnemonic: Antiprotein ships dip p-pilli are pyelonephritis associated pilli that are found on uropathic strains of E. coli. Mnemonic: P for P • Gram-positive coccobacilli: Listeria • Gram-negative coccobacilli: Bordetella Brucella Campylobacter Chlamydia Helicobacter Haemophilus Rickettsia Mnemonic: BCHR • Bacteria acquiring characteristics Transformation (free DNA soluble DNA): Pneumococcus Bacillus Haemophilus Mnemonic: BPH/PnBaha Transduction (bacteriophage): Method of genetic engineering T/t of inborn errors of metabolism Mnemonic: DIG Conjugation (actual physical contact): Episomes and plasmids for resistance. Lysogenic conversion (phage DNA itself is new genetic element) Corynebacterium diphtheriae Salmonella typhi Clostridium botulinum • Thymus dependent tissues (collection of T-lymphocytes) Spleen: Malpighian corpuscle in white pulp (periarterial) Lymph node: Paracortical area between follicles in cortex and medullary cords in medulla Mnemonic: Para Mal dependent Bursa dependent (collection of B-lymphocytes)
Microbiology 79 (Thymus independent) Spleen: Germinal centre Mantle layer Perifollicular region Mnemonic: German Man around follicle are independent Lymph nodes: Medullary cords Cortical follicles Germinal centres Mnemonic: Medulla and cortex in Germany are also independent • Property S. aureus S. epidermidis Coagulase Positive Negative Mannitol Ferments Non-fermenting Pathogenicity Pathogenic Non-pathogenic • Susceptibility tests Shick test: Diphtheria Dick test: Scarlet fever Mnemonic: S for D and D for S (opposite) • Spirochete: Borrelia Leptospira Treponema Mnemonic: BLT (Balti in Hindi) • Combined immunodeficiency SCID (severe combined immunodeficiency)—def. of ADA Wiskott-Aldrich syndrome Ataxia-telangiectasia Nezelof syndrome Mnemonic: SWAN Defective Phagocytosis Chronic granulomatous disease (def. of NADPH oxidase) Chediak-Higashi syndrome Myeloperoxidase def. Job’s syndrome • Two pigments produced by Pseudomonas aeruginosa Pyocyanine: Bluish green pigment Mnemonic: BC Pyoverdin (fluorescein): Greenish yellow pigment
Mnemonics80 • Visceral larva migrains—Toxocara canis Cutaneous larva migrains— A—Ancylostoma duodenale N—Necator americanus S—Strongyloides stercoralis • Human is the dead end host for L—Leptospirosis T—Tetanus T—Taenia solinum E—Endemic typhus Japan—Japanese encephalitis L—Legionella E—Echinococcus, trichinella H—Human rabies
• Characteristic features of Staphylococcus pneumoniae Pneumatocele (thin walled cystic spaces that may contain air fluid levels) Pleural effusion Pyopneumothorax (bronchopleural fistula) Abscess formation Cavitation (single or multiple thick-walled cavities) (may be bilateral) Empyema Mnemonic: 3P and ACE • Actin: AD FSGS CD2AP: Adult proteinuria Steroid sensitive: NPHS I-Nephrin-19q. Finish congenital nephrotic syndrome Steroid resistant: NPHS 2-Podocin-lq: AR acquired FSGS Mnemonic: 2R-lq-AP • Type III (pauci immune) RPGN ANCA small vessel vasculitis Wegener’s granulomatosis Microscopic polyangiitis Churg-Strauss syndrome Mnemonic: WMC • Cox 1 Constitutive Cox 2 Inducible • Large vessel vasculitis Giant cell arteritis (temporal arteritis) Takayasu arteritis 81 Pathology 6
Mnemonics82 Cogan syndrome Mnemonic: Large giant taka of cogan • Medium vessel vasculitis PAN Kawasaki disease Buerger’s disease Mnemonic: Pan per kabab aur burger) • DNA repair defects HNPCC (mismatch repair): Colon ca. Bloom syndrome: Developmental defects Fanconi anaemia: Bone marrow aplasia Ataxia-telangiectasia: Neural symptoms Xeroderma pigmentosa (nucleotide excision repair)—skin ca. Mnemonic: HB FAX • Bcl-1: Mantle cell lymphoma Bcl-2: Follicular lymphoma Bcl-6: Burkitt lymphoma Mnemonic: My favourite Band is Bcl-126 Diffuse large B cell lymphoma—Bcl-2 and Bcl-6 Mnemonic: D-26 • HLA B27 is associated with Juvenile rheumatoid arthritis Psoriatic spondylitis Ankylosing spondylitis Inflammatory bowel disease Reactive arthritis/Reiter’s syndrome Mnemonic: Juvenile PAIR at 27 yrs of age • Risk factors for atherosclesosis in decreasing order Total cholesterol: HDLC Apoprotein B 100: HDLC LDL cholesterol: HDLC Mnemonic: TBL ratio H • Classification of hyperlipoproteinemias Lipoproteins elevated
Pathology 83 I: chylomicrons IV: VLDL V: (1+ 4 = 5)—chylomicron and VLDL III: (4 – 1 = 3)—chylomicron and VLDL remnant II: LDL (lla—LDL, IIb—LDL and VLDL) • Radical scavenging enzymes – Glutathion peroxidase – Catalase – Superoxide dismutase Mnemonic: GCS Note: Superoxide dismutase also generates free radicals (H2O2). • Amyloid proteins and their clinical settings Transthyretin (ATTR) Familial amyloidotic neuropathy Mnemonic: FAT Systemic senile amyloidosis Mnemonic: SST β2 microglobulin (Aβ2m): Hemodialysis associated amyloidosis Mnemonic: Dial M for amyloid β2: amyloid protein (Aβ): Alzheimer’s disease Senile cerebral disease Mnemonic: Sc and Ad • Flexner-Wintersteiner rosettes are characteristic of retinoblastoma May also be seen in Medulloblastoma and pineoblastoma Mnemonic: Flexible RMP (All are blast) • Glomerulonephritis without proliferative changes Minimal change disease Amyloidosis Membranous glomerulonephritis Diabetic nephropathy ± FSGS Mnemonic: Minimum Amul for membranous Dia
Mnemonics84 • Fibromatosis represent a group of fibrous benign or tumour- like conditions Deep fibromatosis: Desmoid tumors Mnemonic: Deepa ka Des Superficial fibromatosis Palmar fibromatoses (Dupuytren’s contracture) Plantar fibromatoses Penile fibromatoses (Peyronie’s disease) • Prader-Willi syndrome: Clinical features Mental retardation Diminished fetal activity Hypotonia Obesity Short stature Hypogonadotrophic hypogonadism Mnemonic: Pradip MDHOSH • Angelman–Willi syndrome Seizures Hypotonia Inappropriate laughter (Happy puppets) Mental retardation Ataxia Mnemonic: Happy puppet SHIMA • Multiple myeloma Dutcher bodies—nuclear Mnemonic: Multiple nuclear Dutch Russell bodies: Cytoplasmic (Mnemonic: Russell Crowe) • Mooser’s bodies: Endemic typhus Mnemonic: Moosa is endemic Miyagawa bodies: Chlamydia trachomatis Mnemonic: Miya Kalam Lafora bodies: Familial myoclonic epilepsy Mnemonic: Lofar in Family
Pathology 85 • Pancytopenia with cellular bone marrow Myelodysplastic syndrome Myelofibrosis Myelophthisis Bone marrow lymphoma Aleukemic leukemia Hairy cell leukemia Mnemonic: Cellular bone marrow M3 ka BAP hai • Cold antibody hemolytic anaemia—usually IgM Mnemonic: CM – Class Mate • Proteins defective in hereditary spherocytosis Ankyrin > protein 3 (anion transport channel) > α-spectrin > protein 4.2 (palladin) Mnemonic: AP3 ααααα S P4.2 First memorize APSP Then AP3SP Then AP3 α SP Then AP3 α SP4.2 • Prader-Willi syndrome: (Chromosome 15) Paternal deletion Maternal imprinting Maternal disomy AngeIman syndrome: Maternal deletion (Chromosome 15) Paternal imprinting Paternal disomy • Mechanism of apoptosis Caspase 9 (Nine): Intrinsic pathway Mnemonic: In for In Caspase 8 (Eight): Extrinsic pathway Mnemonic: E for E • Histochemical staining of amyloid with Congo red observed under ordinary light—pink red colour. Observed under polarized light: Green birefringence Mnemonic: PG • Genes regulating apoptosis Anti-apoptotic Pro-apoptotic
Mnemonics86 bcl-2 bax bcl-XL bad bak bim bcl-xs Mnemonic: L and LXL are anti-apoptotic • Chronic manifestations of splenectomy Anisocytosis Basophilic stippling Howell-Jolly bodies (nuclear remnants) Heinz bodies (denatured Hb) Nucleated erythrocytes in peripheral blood, occasionally Poikilocytosis • Howell-Jolly bodies occur most frequently after Splenectomy Megaloblastic anaemia Severe hemolytic anaemia Mnemonic: Jolly SMS • Inactivation of free radical reactions Enzymes: Glutathione peroxidase Catalase Superoxide dismutase Mnemonic: GCS Non-enzymatic system: Endogenous/exogenous anti-oxidants a. Vitamin E, vitamin C b. Sulfhydryl containing compounds: glutathione, cysteine c. Serum protein: Albumin Ceruloplasmin Transferrin Mnemonic: EC GC ACT • Renal lesions in SLE (WHO classifications) Class I: Normal by light, electron and immunofluorescent microscopy Class II: Mesangial lupus GN (Mildest clinical variant proteinuria, microscopic hematuria rare)
Pathology 87 Class III: Focal proliferative GN (Moderate, presents with proteinuria and hematuria) Class IV: Diffuse proliferative GN (Haematuria, nephrotic range proteinuria, mild to severe renal failures) Class V: Membranous GN (Massive proteinuria and nephrotic syndrome) Class VI: End stage of proliferative lupus nephritis Mnemonic: No Money FD ME Note: GN—glomerulonephritis • Location of epitheloid—Testis Ovary (tunica) Pancreas (Islet) Mnemonic: TOP Pathologically found in granuloma. • Antigen presenting cells (APC) Professional (MHC II, GVHD)—Dendritic cells Langerhans’ cells Follicular dendritic cells. Mnemonic: DLF is Very professional Non-professional (MHC I, graft rejection)—Macrophages B-lymphocytes Glial cells Endothelial cells Thymic epithelial cells. • Autosomal dominant (AD) H—Hypercholesterolemia (familial) Hereditary spherocytosis Huntington’s chorea E—Ehlers-Danlos syndrome A—Achondroplasia V—von Willebrand’s disease (type I and II) Y—Pseudohypoparathyroidism D—Dystrophica myotonica
Mnemonics88 O—Osteogenesis imperfect M—Marfan’s syndrome I—Intermittent porphyria N—Noonan’s syndrome A—AD PKD N—NF I and NF II T—Tuberous sclerosis • Marfan’s syndrome M—Mitral valve prolapse A—Arachnodactyly (long fingers) R—Retinal detachment F—Fibrillin I deficiency Family history A—Ascending aorta aneurysm N—Negative nitroprusside test S—Superotemporal subluxation of lens • Neurofibromatosis I (17q) N—Neurofibroma O—Optic nerve glioma S—Sphenoid dysplasia (most common skeletal deformity) P—Plexiform NF Positive family history A—Axillary freckling C—Café-au-lait spots E—Eye (Lisch nodules on iris) • Neurofibromatosis II (22q) M—Multiple I—Inherited S—Schwannoma M—Meningioma E—Ependymoma • Autosomal recessive A— Alkaptonuria Albinism B—Beta thalassemia, sickle cell anemia C—Cystic fibrosis
Pathology 89 D—Deafness (sensorineural) E—Emphysema (Panacinar-α1 antitrypsin deficiency) F—Friedrick’s ataxia G—Gaucher’s disease H—Hurler’s disease Hemochromatosis I—Inborn errors of metabolism Others—Niemann-Pick’s disease Tay-Sachs disease Wilson’s disease • X linked recessive Less—Lesch-Nyhan syndrome Chronic—Chronic granulomatous disease Hunter—Hunter’s disease Hemophilic—Haemophila A and B Girls—G6PD deficiency Don’t—Duchenne muscular dystrophy Dent’s disease Color—Color blindness Fragile—Fragile X syndrome Fab—Fabry’s disease Brutun—Brutun’s X linked agammaglobulinemia Wisely—Wiskott-Aldrich syndrome • X linked dominant Rat me—Rett syndrome (only seen in females) Char—Charcoat Mari tooth disease Pig—Incontinenta pigmenti (only seen in females) Airport pe—Alport syndrome Phosphate kha raha tha—X linked hypophosphatemic rickets • Mitochondrial inheritance K—Kearns Sayre syndrome L—Leber’s hereditary optic neuropathy M—MERRF (myoclonic epilepsy with ragged red fibres) MELAS (mitochondrial encephalopathy with lactic acidosis with stroke like syndrome) N—NARP (neurologic ataxia with retinitis pigmentosa)
Mnemonics90 O—Ophthalmoplegia (chronic external ophthalmoplegia) P—Pearson syndrome • Multiple myeloma Symptoms C—Hypercalcemia R—Renal failure A—Anemia B—Bone lytic lesion (on X-ray or bone scan) • ALL Testicular infiltration Mediastinal lymph node involvement CNS infiltration Mnemonic: TMC • Supravital stains—Brilliant cresyl blue New methylene blue Crystal violet Mnemonic: BNC • Stain Acidic Basic Cytoplasm DNA • Warm antibody—IgG Cold antibody—IgM Mnemonic: Classmate Exception—PCH (Donath Landsteiner antibody)-IgG • Differential diagnosis of microcytic hypochromic anemia Sideroblastic anemia Iron deficiency anemia Thalassemia Anemia of chronic disease Mnemonic: SITA • Migratory thrombophlebitis (Trousseau syndrome) S—Stomach L—Lung
Pathology 91 A—Adenocarcinoma P—Pancreas • Mutation of p53 Li-Fraumeni syndrome. It is the most common gene mutation causing human cancer. S—Stomach cancer B—Breast cancer B—Brain cancer A—Adrenal cancer L—Lung cancer (squamous cell carcinoma) Mnemonic: SBBAL • Flea bitten kidney found in We—Wegener’s granulomatosis Hate—HSP P—Polyngitis S—Subacute endocarditis M—Malignant hypertension • Posterior fossa anomalies Dandy-Walker syndrome—Dilatation of 4th ventricle because of midline arachnoid cyst. Posterior fossa volume is increased. Mnemonic: D for D. D is 4th letter Arnold-Chiari malformation—cerebellar herniation. • Myelin formation CNS—Oligodendrocytes PNS—Schwann’s cells. Mnemonic: COPS • Serology in hepatitis B— s—HbsAg e—HbeAg c—anti HBc ab e—anti HBe ab s—anti HBs ab Note: c antigen lacks soluble surface receptor. So, do not appear in serum.
Mnemonics92 • Hepatitis D virus Delta virus Defective virus (HDV RNA) Dependent (on HBV) • Causes of Mallory-Denk body— Indian childhood cirrhosis Wilson’s disease Hepatocellular carcinoma Alcoholism α1 anti-trypsin (AT) deficiency Primary biliary cirrhosis Mnemonic: Indian child wil have alcohol AT primary bill • Focal nodular hyperplasia Females more commonly affected (ten times) OCP use is associated Asymptomatic Single Mnemonic: FOCAl
• Mechanism of Injury caused by lightening flash as described by Cooper and Andrews (1995) Direct strike Side flash Step voltage Sledge hammer effect (blunt trauma) Surface arc discharges and touch voltage Mnemonic: 5S Also remember: Four factors of Spencer Burning by superheated air Sledge hammer and blow death by compress pushed before the current Direct effect of high voltage current Effect of expanded and repelled air Mnemonic: BCDE • Drug used for narcoanalysis (truth serum drugs) Scopolamine Sodium pentathal Sodium amytal Sodium seconal Mnemonic: PAS Sodium and Scopolamine • Exception to general rule of professional secrecy C Crime I Infectious disease V Venereal disease I Interest (Self) C Courts of Law S Servants and employees 93 Forensic Medicine and Toxicology (FMT) 7
Mnemonics94 I Interest (Patient’s) N Negligence suits notifiable disease. CIVIC SIN InP.S . Interest: Patient’s and self • Anti-cholinergic (atropine dhatura) poisoning Dry as a bone (dryness of mouth and skin) Red as a beet (flushed face) Blind as a bat (dilated pupil) Hot as a hare (hyperpyrexia) Mad as a wet hen (delirium) Or Dryness of mouth and anus (i.e. constipation) Dysphagia Dilated pupils Dry hot skin Drunken gait Delirium Drowsiness Death due to respiratory failure • Seminial stain is identified by UV light (physical methods) Mnemonic: SUV • Constituents of a typical embalming solution Formalin Glycerin Mnemonic: EFG • Methods of torture suspension by the wrist: La bandera (Mnemonic: Wrist band) Beating with the palm on both ears simultaneously— telephone Mnemonic: We pickup telephone to ear • Hanging versus strangulation Hanging features: Stretched neck Saliva (often runs out of mouth) Seminal fluid at glands Carotid artery damage may be seen
Forensic Medicine and Toxicology (FMT) 95 Oblique ligature mark Mnemonic: Hang SSS and CO • Fatty liver is found in Phosphorus > arsenic > mercury poisoning Mnemonic: Fatty PAM • Mercury poisoning: Diphtheritic colitis Mnemonic: Mercury Dips in Cold • Clinical feature of chronic lead poisoning—acute mani- festations Anemia (with punctate basophilia) Burtonian line Colic and constipation: First symptom to arouse suspicion of lead poisoning Drop of wrist and foot Encephalopathy in children Facial pallor: Earliest symptom Genitourinary system: Menstrual disorders, abortions still- births, degenerate off-springs and sterility. • Forensic tests to detect seminal stain Acid phosphatase test Barberio test Creatine phosphatase test ELISA test Fluorescence test Mnemonic: ABCEF • Fingerprint patterns Loops 67% Whorls 25% Arches 6–7% Composite 1–2% Mnemonic: LWAC • Cephalic index 70–74.9 Pure aryans (Dolichocephalic) Aborigins
Mnemonics96 Negroes Indians Mnemonic: PANI in Doli 75–79.9 Europeans (Mesaticephalic) Chinese Mnemonic: European in Chinese mess 80–84.9 Mongols (Brachicephalic) Oriental Asians Native Americans Mnemonic: MONA Dolichocephalic Rectangular Mesaticephalic Triangular Brachicephalic Rounded Mnemonic: DMB in increasing order • Screening tests for blood stains Benzidine Orthotoluidine Leucomalachite green Phenolphthalein Note: All these works on the principle of Hb as peroxidase, which in presence H2O2 turns odourless bases into coloured salts. • Blood /urine alcohol levels Alcohol dehydrogenase method (ADH method) Breath analysis Cavett method/Kozelka and Hinc method Gas chromatography—most desirable for medicolegal purpose Mnemonic: ABC-GK • Snake venoms Vasculotoxic Vipers (V for V) Neurotoxic Cobra (Convulsion) (C for C) Krait (paralysis) Coral Mnemonic: CKC Myotoxic: Sea snake
Forensic Medicine and Toxicology (FMT) 97 • Gustafson method of age determination by inspection of individual teeth: Root transparency: Precise measurement Root resorption Attrition Paradentosis Secondary dentin formation Cementum opposition Mnemonic: TRAP SC • Harrison and Gilroy test: Antimony, barium, lead Mnemonic: Anbale Atomic absorption spectroscopy (AAS): Antimony, Copper, barium Mnemonic: Ancoba Neutron activation analysis: Antimony, copper • Getters test is done for drowning. It estimates chloride content of blood from both sides of the heart. A difference of 25% in chloride content is considered. Significant features seen Fresh water drowning: Hemodilution Lysis of RBC with liberation of potas- sium Chloride content of left side of heart decreased Salt water drowning : Hemoconcentration RBCs are crenated Chloride content of left side of heart increased • Sign of death from typical drowning Persistent profuse fine froth from the mouth and nose Materials (that could be obtained from water only) grasped in the hand Fine typical froth from the air passage Increased volume and edematous condition of the lungs. Finding of diatoms in the tissues, especially brain and bone marrow.
Mnemonics98 • Permanent teeth Eruption time First molar 6–7 years Central incisor (6–8 years) 7–8 years Lateral incisor 8–9 years First premolar 9–11 years Second premolar 10–12 years Canines (11–12 years) 11–13 years Second molars 12–14 years Third molars 17– 25 years • Magnan’s symptoms: Feeling as if grains of sago are lying under skin Feeling as if small insects (cocaine bugs) are creeping on the skin. It is seen in chronic cocaine poisoning. Macewan sign: An indication of hydrocephalus in which percussion of the skull generates a cracked pot sound. • Putrefaction is delayed after death due to poisoning by Carbolic acid Arsenic Antimony Nux Vomica (strychnine) Zinc chloride Mnemonic: CARAN Vomit Zinc to delay putrefaction • Dactylography (Galton system)—Study of finger prints. Mnemonic: DaGa Poroscopy (Locard’s system)—Study of number, sizes and distribution of pores of sweat glands on ridges (used only when a part of finger print is available). Mnemonic: PoLo Podogram—Study of foot print. Cheiloscopy (queiloscopy)—Study of lip prints. Rugoscopy (palatoprints)—Study of anterior part of palate. Mnemonic: RuPa • White vitriol—Zinc sulphate Blue vitriol—Copper sulphate.
• World health report 2008 Primary health care: now more than ever—the report proposes four sets of reforms Public policy reforms Leadership reforms Universal coverage reforms Service delivery reforms Mnemonic: PLUS • Eight essential components of primary health care (Alma-Ata declaration) Education concerning prevailing health problems and methods of preventing and controlling them. Prevention and control of locally endemic diseases Immunization against major infection diseases Maternal and child health care including family planning Essential drugs provisions Promotion of food supply and proper nutrition Treatment of common diseases and injuries Adequate supply of safe water and sanitation. Mnemonic: ELIMENTS • Ratio: Prevalence Standardised mortality ratio Case fatality ratio Mnemonic: PSC (Public Service Commission) • National health policy 2002 2005—Polio, leprosy and yaws Mnemonic: POLY 2015 (fifteen) – filaria. Mnemonic: f for f 99 Preventive and Social Medicine (PSM) 8
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  • 2. Presents 600 high quality mnemonics Enhances quick recall and recollection of high value facts Provides “cutting-edge” technique in remembering “long-winding” statements/particulars/facts Packs mnemonics that count
  • 3. Arun Kumar MBBS DNB(s) CBS Publishers & Distributors Pvt Ltd New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Mumbai Hyderabad • Nagpur • Patna • Pune • Vijayawada MNEMONICS for Sure Success in PG Medical Entrance Examinations Second Edition
  • 4. ISBN: 978-93-85915-33-8 Copyright © Author and Publisher First Edition: 2015 Second Edition: 2016 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the author and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt Ltd 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi 110 002, India. Ph: 23289259, 23266861, 23266867 Website: www.cbspd.com Fax: 011-23243014 e-mail: delhi@cbspd.com; cbspubs@airtelmail.in. Corporate Office: 204 FIE, Industrial Area, Patparganj, Delhi 110 092 Ph: 4934 4934 Fax: 4934 4935 e-mail: publishing@cbspd.com; publicity@cbspd.com Branches • Bengaluru: Seema House 2975, 17th Cross, K.R. Road, Banasankari 2nd Stage, Bengaluru 560 070, Karnataka Ph: +91-80-26771678/79 Fax: +91-80-26771680 e-mail: bangalore@cbspd.com • Chennai: 7, Subbaraya Street, Shenoy Nagar, Chennai 600 030, Tamil Nadu Ph: +91-44-26680620, 26681266 Fax: +91-44-42032115 e-mail: chennai@cbspd.com • Kochi: Ashana House, No. 39/1904, AM Thomas Road, Valanjambalam, Ernakulam 682 018, Kochi, Kerala Ph: +91-484-4059061-65 Fax: +91-484-4059065 e-mail: kochi@cbspd.com • Kolkata: 6/B, Ground Floor, Rameswar Shaw Road, Kolkata-700 014, West Bengal Ph: +91-33-22891126, 22891127, 22891128 e-mail: kolkata@cbspd.com • Mumbai: 83-C, Dr E Moses Road, Worli, Mumbai-400018, Maharashtra Ph: +91-22-24902340/41 Fax: +91-22-24902342 e-mail: mumbai@cbspd.com Representatives • Hyderabad 0-9885175004 • Nagpur 0-9021734563 • Patna 0-9334159340 • Pune 0-9623451994 • Vijayawada 0-9000660880 Printed at Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The author has tried his best in giving information available to him while preparing the material for this book. Although, all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible that some errors might have been left. The publisher, the printer and the author will not be held responsible for any inadvertent errors or inaccuracies. MNEMONICS for Sure Success in PG Medical Entrance Examinations
  • 5. To my elder brother Ajay Kumar Ajit who shaped my career and life
  • 6. ??? Preface to the Second Edition
  • 7. This book on mnemonics has been writen in view of problems faced by PG aspirants and MBBS students. All the hard work comes to naught if a student confuses while giving examination. Mnemonics has been prepared to eliminate the confusion one encounters during memorizing the points in a topic. This book is sure to improve your rank in any PG entrance examination especially the one based on factual questions like DNB and state PG entrance examinations. Only 600 mnemonics has been included in this edition to enable students to complete and revise the book in a short time. Students are also encouraged to point out the mistakes in this book for which they will be given the incentive of ` 50/- recharge done in their mobile number provided they are the first to point out the mistake and give reference for the same. One lucky student will also get to avail free discussion and explanation with the author every week. For this they need to provide their name, college name, batch of MBBS admission to author’s contact number. Readers are also advised to give their valuable opinions and suggestions which will be appreciated and acknowledged. Arun Kumar Contact: 9718161947 Email.id: drarunkumarjamui@yahoo.co.in Preface to the First Edition
  • 8. First I want to thank all my teachers in both school and college who have encouraged and inspired me for hard work. I also want to thank Dr Nitish, Dr Aporva, Dr Rajdeep and Dr Puneet who have been very supportive of me to write this book. I took the inspiration to write the book from my teacher ‘Dr Arup Kumar Kundu’ who has been a leading writer in medical field. My heartfelt thanks to my fiancée who contributed significantly in writing this book. I also like to take this opportunity to thanks my parents, sisters, my brothers, brothers-in-law and all family members who have always had faith in my abilities. I would also like to thank CBS Publishers & Distributors, Mr YN Arjuna (Senior Vice President—Publishing, Editorial and Publicity), Mrs Ritu Chawla (Assistant General Manager—Production) and Mr Vikrant Sharma (DTP Operator) to help me realize my dream of writing the book and publishing the book so beautifully. I would also like to thank my friend Pawan, Bipulji and Dr Pradeep for their valuable support. I would also like to thank my teachers Dr MP Sharma for his guidance. Finally with all my humbleness and sincerity, I thank one and all who have helped me directly and indirectly in completing this book. Arun Kumar Acknowledgements
  • 9. Preface to the Second Edition vii Preface to the First Edition ix 1. Anatomy 1 2. Biochemistry 17 3. Physiology 26 4. Pharmacology 35 5. Microbiology 72 6. Pathology 81 7. Forensic Medicine and Toxicology (FMT) 93 8. Preventive and Social Medicine (PSM) 99 9. Eye 111 10. Ear, Nose and Throat (ENT) 117 11. Medicine 122 12. Surgery 152 13. Gynecology and Obstetrics (G and O) 162 14. Pediatrics 170 15. Skin 177 16. Anesthesia 180 17. Radiology 184 18. Psychiatry 186 19. Orthopedics 189 Contents
  • 10. • Floor of third ventricle (formed primarily by hypothalamic structures) Optic chiasma Infundibular recess (which extends into pituitary stalk) Tuber cinereum Mammillary bodies Posterior perforated substance Tegmentum of the midbrain Mnemonic: Opin Tuma Posteg • Muscles of gluteal region Gamellus superior—Nerve to obturator internus (L5, S 1, S2) Mnemonic: GSOI 512 Gamellus inferior—Nerve to quadratus femoris (L4, L5, SI) Mnemonic: IQ 451 • Foramen magnum—Structures passing through its anterior part Apical ligament of Dens Vertical band of cruciate ligament Membrane tectoria Mnemonic: AVM • Foramen ovale Mandibular nerve Accessory meningeal artery (A for Artery) Lesser petrosal nerve Emissary vein (cavernous sinus to pterygoid plexus) Mnemonic: MALE 1 Anatomy 1
  • 11. Mnemonics2 • Foramen spinosum Middle meningeal artery and vein (posterior trunk) Emissary vein Nervus spinosus (meningeal branch of mandibular nerve) Mnemonic: MENS • Foramen rotundum—Maxillary nerve Mnemonic: Maxm round Maxillary nerve passes through fossa, fissure and foramen Foramen Foramen rotundum Fissure inferior orbital fissure Fossa pterygopalatine fossa Mnemonic: RIP • Internal acoustic meatus Facial N (VIIIth/7th) Vestibulocochlear N (VIIIth/8th) Nervus intermedius or pars intermedia of Wrisburg Labyrinthine vessels Mnemonic: 78 Intermediate Lab • Foramen lacerum Meningeal branch of ascending pharyngeal artery Emissary vein Mnemonic: MAPEL • Jugular foramen Anterior part Middle part Posterior part Inferior petrosal 9th cranial nerve Internal jugular vein sinus 10th cranial nerve Sigmoid sinus junction 11th cranial nerve Emissary vein (sigmoid Meningeal branch sinus to occipital veins) of ascending Occipital artery pharyngeal (meningeal branch) artery Mnemonic: IPS IS evaluating Our 9, 10, 11 MAP
  • 12. 3Anatomy • Anatomical snuff box—when thumb is fully extended, depression seen on lateral aspect of wrist, immediately distal to radial styloid process Content—Cephelic vein Superficial radial nerve Radial artery Mnemonic: CSR Floor—Base of first metacarpal Radial styloid Scaphoid Trapezium Mnemonic: BRST Note: Proximal to distal order is RSTB. Boundaries: Lateral wall (anterior wall): Abductor pollicis longus Extensor pollicis brevis Medial wall (Posterior wall): Extensor pollicis longus Mnemonic: EPL is MP • Secretomotor pathway for parotid gland Pons Inferior Salivatory nucleus Glossopharyngeal nerve Tympanic branch and plexus Lesser petrosal nerve Otic ganglion Auriculo temporal nerve Parotid gland Mnemonic: PINS GLOTY LEPO ATP • Structure passing through superior orbital fissure Lateral to annulus of Zinn: Lacrimal nerve Frontal nerve Trochlear nerve Superior ophthalmic vein
  • 13. Mnemonics4 Meningeal branch of lacrimal artery Mnemonic: LFT Through annulus of Zinn: Nasociliary nerve Oculomotor nerve (superior and inferior division) (3rd CN) Abducens nerve (6th CN) Mnemonic: NOA 36 Inferomedial to annulus—inferior ophthalmic vein • Anterior and Middle superior alveolar nerves are branches of Infraorbital (terminal branch of maxillary nerve) Posterior superior alveolar nerve is direct branch of maxillary nerve Mnemonic: IAM Appendices epiploicae are small sacs of peritoneum filled with fat (adipose projections) over the whole colon except caecum appendix (vermiform) rectum Mnemonic: CAR Note: Taenia coli are absent in distal sigmoid colon and rectum. • Femoral triangle content Lateral to medial Femoral nerve Femoral artery Femoral vein Lymphatic vessels and deep inguinal lymph node of Cloquet Mnemonic: NAVEL Boundaries Laterally—medial border of sartorius Medially—medial border of adductor longus Superiorly—inguinal ligament Mnemonic: SAIL Branches of third part of maxillary artery Infraorbital A
  • 14. 5Anatomy Posterior superior alveolar A Pharyngeal A Artery of pterygoid canal A Greater palatine A Sphenopalatine A Mnemonic: Inferoposterior pharyngeal artery of greater sphenoid • Bipolar neurons are located in the retina, olfactory epithe- lium, cochlear and vestibular ganglia (all three are sensory pathway for vision, smell and hearing) • Triangle of auscultation Scapula Latissimus dorsi Trapezius Mnemonic: Scalattra • Alar plate derivatives become sensory nuclei while basal plate derivatives become motor nuclei Mnemonic: Sailor/Ala senses • Branch of first part of subclavian artery Vertebral artery Internal thoracic artery Thyrocervical trunk Mnemonic: VIT • Branch of thyrocervical trunk Suprascapular A Inferior thyroid A Transverse cervical A Mnemonic: SIT • Axillary artery First part—Superior thoracic artery Second part—Acromiothoracic artery Lateral thoracic artery Mnemonic: SALT
  • 15. Mnemonics6 • Adductor magnus is a composite muscle and is doubly innervated by the obturator nerve and tibial nerve Mnemonic: MagOT • Biceps femoris: Long head—Tibial nerve Short head—common peroneal nerve Mnemonic: Long tibial • Bronchial artery Left—two bronchial arteries arising directly from descending thoracic aorta Mnemonic: Directly descending Right—One bronchial artery arises indirectly from descending thoracic aorta either from i. Third posterior intercostal artery ii. Upper left bronchial artery • Branches of anterior division of internal iliac artery Superior vesical artery Obturator artery Middle rectal artery Uterine artery (only in females) Inferior vesical artery (replaced by vaginal in females) Inferior gluteal artery Internal pudendal artery Mnemonic: SOMU and 3IV • Nasal septum—osseous part Vomer Sphenoid Nasal bone Frontal bone Ethmoid Palatine Maxillary Mnemonic: Very special news for Ethiopian PM • Large opening of diaphragm T8—Venacaval opening T10—Oesophageal opening
  • 16. 7Anatomy T12—Aortic opening Mnemonic: Voice of America Aortic opening Aorta Thoracic duct Azygos vein Mnemonic: ATA Vena caval opening—Right phrenic nerve Inferior vena cava Mnemonic: RP in Cave Oesophageal opening—Left vagus Right vagus Oesophagus Oesophageal branch of left gastric artery Mnemonic: Vagus, phagus, gas • Supports of uterus Muscular supports/active supports Perineal body Urogenital diaphragm Levator ani (pelvic diaphragm) Mnemonic: PULP Mechanical supports Transverse cervical ligament (Mackenrodt’s ligament) Uterosacral ligament (most strong) Round ligament of uterus Uterine axis Pubocervical ligament Mnemonic: TURUP (T and P are cervical) • Branches of cerebral part of internal carotid artery Anterior cerebral artery Middle cerebral artery Ophthalmic artery Anterior choroidal artery Posterior communicating artery Mnemonic: AM OCP
  • 17. Mnemonics8 • Branches of cavernous part of internal carotid artery Meningeal branches Cavernous branches Hypophyseal branches Mnemonic: MCH • Secondary curves: Adult curvatures of spinal cord Anteriorly Mn Cervical spine Convex X Lordosis Thoracic spine Concave Cave Kyphosis Lumbar spine Convex X Lordosis Pelvic curve Concave Cave Kyphosis (sacrococcygeal) Lumbar: Lordosis (L for L) Convex anteriorly: Lordosis Mnemonic: XL • Shoulder abduction 0–15° Supraspinatus (suprascapular nerve) 15°–90° Deltoid (axillary nerve) 90°–120° Deltoid (+ short external rotators) (axillary nerve) 120°–180° Serratus anterior (nerve to serratus anterior) Trapezius (spinal accessory nerve) • Subclavian triangle Nerve contents Three trunks of brachial plexus Nerve to serratus anterior Nerve to subclavius Suprascapular nerve Mnemonic: 3S in subclavian Triangle • Maxillary A (branch of external carotid artery) Branches of first part Middle meningeal artery Accessory meningeal artery Inferior alveolar artery Deep auricular artery
  • 18. 9Anatomy Anterior tympanic artery Mnemonic: MAIDA Branches of second part Deep temporal Pterygoid Masseteric Buccal Mnemonic: All muscular branches • Prostate Median lobe—benign Posterior lobe—Malignant/carcinomatous transformation Mnemonic: PMC (Patna Medical College) • Least dilatable and narrowest part of male urethra = Membranous (except external urethral orifice) Mnemonic: LMN • Branches of external carotid artery Anterior: Superior thyroid artery Facial artery Lingual artery Posterior: Occipital artery Posterior auricular artery Medial: Ascending pharyngeal artery Terminal: Maxillary artery Superficial temporal artery Mnemonic: SFL (Safal) OP Ascends Max STep • Primary cartilaginous joint/hyaline cartilaginous joint/ synchondrosis Joint between epiphysis and diaphysis of long bone Spheno-occipital joint First chondrosternal joint Costochondral joint Mnemonic: PHC • Secondary cartilaginous joint/fibrocartilaginous joint/ symphysis – Symphysis pubis – Symphysis menti
  • 19. Mnemonics10 – Intervertebral joint between vertebral bodies (sacro- coccygeal joint) – Manubriosternal Joint – Xiphisternal Joint Mnemonic: 2SIMa–X Fibrous joints Sutures: Skull Gomphosis: Tooth in its sockets Syndesmosis: Inferior tibiofibular joint, middle radioulnar joint, tympanostapedial joint Mnemonic: Iti Mira Tysta • Synovial joint Plane synovial joint: Joint between articular process of vertebra Intercarpal and intertarsal Mnemonic: Art of car and tar are plane Hinge joint Interphalangeal Elbow Ankle Mnemonic: HIPEA Pivot (trochoid) Median atlanto-axial joint Inferior and superior radioulnar joint Mnemonic: MAA and ISRU Ellipsoid: Metacarpophalangeal joint Atlanto-occipital joint Wrist joint Mnemonic: MCP AO, wrist Condylar (bicondylar): Knee joint Right and left jaw joint Mnemonic: J and K are bicondylar Saddle (sellar): Sternoclavicular joint 1st carpometacarpal joint Calcaneocuboid joint Mnemonic: Stern 1st CM of Calca is sad Ball and socket: Shoulder joint
  • 20. 11Anatomy Hip joint Talocalcaneonavicular joint • Epiphysis Pressure epiphysis: Head of femur Condyles of tibia Lower end of radius Mnemonic: Press HCL Traction epiphysis: Tubercles of humerus—Mastoid process Trochanters of femur Mnemonic: TMT Atavistic epiphysis: Coracoid process of scapula Osmium trigonum Aberrant epiphysis: Head of first metacarpal Base of other metacarpals • Veins of heart Contents of coronary sulcus: Great cardiac vein Coronary sinus Small cardiac vein Mnemonic: GCS Anterior cardiac vein drains directly into right atrium Mnemonic: ADDRA Smallest cardiac vein/Thesbian veins/venae cordis minimi drains directly into the cavity in all four chambers. Rest drains into coronary sinus, i.e, great cardiac vein (Anterior Interventricular septum) Middle cardiac vein (Posterior interventricular septum) Mnemonic: Middle Post Small cardiac vein Posterior vein of LV Oblique vein of LA Right marginal vein • Muscles of mastication Pterygoid—lateral and medial Masseter Temporalis Mnemonic: PMT
  • 21. Mnemonics12 • Structures derived from the neural crest C-cells of thyroid Conotruncal septum (Chromaffin tissue) (adrenal medulla) Neurons: The neurons of Spinal dorsal root ganglia Sensory ganglia of 5th, 7th, 8th, 9th and 10th cranial nerves Sympathetic ganglia Pia-arachnoid mater Schwann cells Melanoblasts (mesenchyme of dental papilla and pharyngeal arches) Mnemonic: 3C 3S PSM • Yellow elastic cartilage forms: External ear External auditory canal Eustachian tube Epiglottis Tip of arytenoids Tip of nose Corniculate cartilage Cuneiform cartilage Mnemonic: E4T2C2 • Hyaline cartilage forms: (Type 2 collagen) Costal Nasal Some laryngeal Tracheobronchial All temporary and most articular cartilages Mnemonic: ATMA • Femoral artery: Superficial branches Superficial external pudendal Superficial epigastric Superficial circumflex iliac Deep branches Profunda femoris
  • 22. 13Anatomy Deep external pudendal Muscular branches Mnemonic: PDM External iliac artery:Branches Inferior epigastric artery Deep circumflex iliac artery Note: 1. Inferior epigastric artery anastomoses with superior epigastric artery (a branch of internal thoracic artery). 2. Profunda femoris is the largest branch of femoral artery. It is the chief artery to supply all 3 compartments of thigh. lts branches 1. Medial circumflex femoral artery 2. Lateral circumflex femoral artery 3. Four perforating arteries • Sites of narrowing of normal ureter Ureteric orifice Ureterovesical junction Juxtaposition of the vas deferens or broad ligament Crossing of the iliac artery Ureteropelvic junction Mnemonic: Ureteric orifice is VVIP • Anterior belly of digastric is supplied by mandibular nerve Postserior belly of digastric is supplied by facial nerve Mnemonic: ADM and PDF • Mandibular nerve (lst arch): Mylohyoid Muscles of mastication Anterior belly of digastric Tensor tympani Tensor veli palati Mnemonic: My Mast Ant digest Tension • Facial Nerve (2nd arch): Stapedius Stylohyoid Posterior belly of digastric Muscles of facial expression Mnemonic: Stupid style Dip muscles of facial expression
  • 23. Mnemonics14 • Glossopharyngeal nerve (3rd arch): Stylopharyngeus Mnemonic: Gloss style-pharyngeal common) • Superior laryngeal nerve (4th arch) Muscles of pharynx (except stylopharyngeus) Muscles of palate (except tensor veli palati) • Recurrent laryngeal nerve (6th arch): Muscles of larynx (except cricothyroid) Note: Cricothyroid muscle is supplied by external branch of superior laryngeal nerve. Mnemonic: Ex Cricketer • Stapes—Smallest Mnemonic: S for S Malleus: Largest • Direction of nasolacrimal duct: Downward, backward and laterally. Mnemonic: DBL, i.e. double • Inferior meatus: Nasolacrimal duct Mnemonic: INLD Middle meatus: 4 openings: Middle ethmoidal air cells Maxillary sinus Anterior ethmoidal air cells Frontal sinus Superior meatus: Posterior ethmoidal sinus. Mnemonic: SuPES Sphenoethmoidal recess—Sphenoid air cells. Mnemonic: SERS • Coronal suture—between 2 ears (Can in hindi) Mnemonic: C for C Sagittal suture—between 2 parietal bones. Asterion—parietomastoid occipital (PMO).
  • 24. 15Anatomy Bregma—Anterior fontanelle Mnemonic: AB Lambda—Posterior fontanelle • Routine opening of mouth: Lateral pterygoid. Forceful opening of mouth: Digastric Geniohyoid Myelohyoid Mnemonic: DGM • Infrahyoid muscles—also known as strap muscles: Sternohyoid Omohyoid Sternothyroid Thyrohyoid • Ansa cervicalis is nerve supply of: Omohyoid Sternothyroid Sternohyoid Mnemonic: OH Anshu SiT on Shoe • C1 is the nerve supply of: Thyrohyoid Geniohyoid Mnemonic: C1 is The GHar • Male internal genitalia S: Seminal vesicles E: Epididymis E: Ejaculatory duct D: Ductus deferens (Vas deferens) Mnemonic: SEED • Paranasal sinuses Maxillary sinus—develops at birth Ethmoidal sinus—develops at birth Frontal sinus—develops at 2 years Sphenoid sinus—develops at 3–5 years. Mnemonic: MEFS • The inferior turbinate is a separate bone, while rest of the turbinates are a part of ethmoidal bone. Mnemonic: Inferior—Independent
  • 25. Mnemonics16 • Cerebellum Cerebellar cortex—five cells: Granule cells Golgi cells Purkinje cells Stellate cells Basket cells Mnemonic: Garm gol puri in steel basket Deep cerebellar nuclei: Dentate Emboliform Fastigial Globose Mnemonic: DEFG Note: The axons of Purkinje cells are the only output from the cerebellar cortex, generally pass to the deep nuclei. • Appendix of testis—Paramesonephric duct Mnemonic: ATP Appendix of epididymis—Mesonephric duct Mnemonic: MEA
  • 26. • Inhibitors of TCA cycle Fluoroacetate inhibits aconitase (non-competitive > competitive) Arsenite inhibits α-Ketoglutarate dehydrogenase (non- competitive) Malonate inhibits succinate dehydrogenase (competitive) Mnemonic: FAM inhibits AKS • Transamination reaction Aspartate + α-ketoglutarate → oxaloacetate + glutamate Mnemonic: ASO Alanine + α-ketoglutarate → pyruvate + glutamate Mnemonic: PyAl G for G—Glutamate–ketoglutarate • Sphingolipidosis: X-linked recessive → Fabry’s disease Mnemonic: Fab X • Biochemical tests • Sugars (reducing sugars) Fehling’s test Benedict’s test Mnemonic: FBS (or fasting blood sugar) • Bile pigments Gmelin test Fouchet test Rosenbach’s test Mnemonic: Pig GFR 17 Biochemistry 2
  • 27. Mnemonics18 Also remember Ketone bodies Rothera test (Nitroprusside test)—Roth Nite Gerhardt test (Ferric chloride test) Mnemonic: GF • SGPT – ALT – Cytosolic Mnemonic: CLP Also remember: SGOT (AST)—80% mitochondrial and 20% cytosolic • Water soluble vitamins: Vitamins B and C Mnemonic: WBC Vit. B complex energy releasing Thiamine (B1) Riboflavin (B2) Niacin (B3) Mnemonic: 123-TRN (Tarun in Hindi) Biotin Pantothenic acid Pyridoxine B6 Mnemonic: six pyre • Blot transfer techniques Southern blot DNA Northern blot RNA Western blot Protein Mnemonic: South – Dakshin – DNA Western – Paschim – Protein • Respiratory chain inhibitors Complex IV inhibitors: Cyanide (CN) Carbon monoxide (CO) Hydrogen sulphide (H2S) Sodium azide Mnemonic: ides are complex IV inhibitors • Location of major glycosaminoglycans Hyaluronic acid: Synovial fluid Loose connective tissue
  • 28. 19Biochemistry Vitreous humor Cartilage Mnemonic: Hy SyL Vi in Car Chondroitin sulphate: Cartilage Bone Cornea Mnemonic: CBC Karatan sulphate: Cornea (KS I) Loose connective tissue (KS II) Heparin: Mast cells Heparan sulphate: Aortic wall Skin fibroblasts Dermatan sulphate: Wide distribution • Catabolism of carbon skeletons of amino acids Oxaloacetate forming amino acid—Asparagine (aspartate) Mnemonic: Ox in spa Fumarate forming amino acids—Phenylalanine, tyrosine Mnemonic: PheTyr fumes Succinyl CoA: Threonine, valine, isoleucine, methionine Mnemonic: Three successful VIM • Ketoglutarate: Proline, histidine, arginine, glutamine Mnemonic: ααααα PHAG Pyruvate: Cystine, threonine, glycine, alanine, serine Mnemonic: CT GAS in Peru Acetyl CoA/Acetoacetyl CoA forming amino acids: Leucine, isoleucine, lysine, tryptophan, phenylalanine, tyrosine Mnemonic: Lily Try Phe Tyr in AC • Transport of ammonia to liver Muscle—uses alanine Mnemonic: Amma ki Mala Other tissues use glutamine • Metabolic role of vitamin B12 Methylation of homocysteine to methionine Isomerization of methyl malonyl CoA to succinyl CoA Methylation of pyrimidine ring to form thymine
  • 29. Mnemonics20 Interconversion of glutamate and β-methyl aspartate in bacteria Conversion of ribonucleotides to deoxyribonucleotides in DNA synthesis Metabolism of diols Mnemonic: HMP and GRD in B12 • HGPRTase deficiency Partial def: Kelly Siegmiller’s syndrome No CNS involvement Complete def: Lesch-Nyhan syndrome Mnemonic: Kelly is Partial • Classification of amino acids Amino acids with aliphatic side chain Glycine Alanine Valine Leucine Isoleucine Mnemonic: GAVLI With side chain containing OH (hydroxyl) group Tyrosine Threonine Serine Mnemonic: oh tie three Sari With side chain containing sulphur atoms Methionine Cysteine Mnemonic: MSC Containing aromatic rings Histidine Tryptophan Phenylalanine Tyrosine Mnemonic: Histry Phe Tyr
  • 30. 21Biochemistry • RNA polymerase transcribes Type 1—rRNA Types 2—mRNA Type 3—tRNA Mnemonic: RMT = Remote • Homozygous substitution with other amino acids in place of Valine at position 67 of β-chain Glutamate—Hb milwaukee Mnemonic: Gala Milo Aspartic acid—Hb bristol Mnemonic: Brass Alanine—Hb sydney Mnemonic: Alan border of sydney • CPK-1-CPK BB—brain (Mnemonic: BB no. 1) CPK-2-CPK MB—myocardium Mnemonic: MB Heart attack CPK-3-CPK MM—skeletal muscle CPK-MB 1—extra cardiac form CPK-MB 2—cardiac form Mnemonic: Heart attack especially in 2nd MB • Fructose 2, 6-bisphosphate + ve on PFK 1 – ve on PFK 2 – ve on fructose 1, 6-bisphosphatase Note: PFK 2 is bifunctional (2 is bi.) • Ehrlich’s aldehyde reagent test Chloroform layer turns pink—Urobilinogen (Mnemonic: CPU) Aqueous layer turns pink—porphobilinogen • Mg2+ (Magnesium) is required in covalent modification of enzymes by phosphorylation, dephosphorylation of seryl residues. It is required in: Ribonuclease
  • 31. Mnemonics22 Kinase Transketolase Peptidases Ca carboxylase Adenyl cyclase Phosphatase Mnemonic: RiKi Trap Car, add phos • Tryptophan → Serotonin → Melatonin Niacin (nicotinic acid/nicotinamide) Tryptophan contains indole functional group. • Tyrosine is formed from phenylalanine (Enz-phenylalanine hydroxylase) Tyrosine is also precursor for Dopa Dopamine Epinephrine Norepinephrine Thyroxine Triiodothyronine Melamine Note: Codon for tyrosine are UAC and UAU. In Papaver somniferum, the opium poppy, tyrosine is used to produce the alkaloid morphine. • Substrate level phosphorylation 1, 3-bisphosphoglycerate to 3-phosphoglycerate (phospho- glycerate kinase), glycolysis Phosphoenol pyruvate to pyruvate (pyruvate kinase)- glycolysis Succinyl CoA to succinate (succinyl CoA synthetase or succinate thiokinase), Kreb’s cycle • Basic amino acid Pka of ‘R’ Histidine 6 Lysine 10.8 Arginine 12.5
  • 32. 23Biochemistry Higher the Pka, more basic will be amino acid. Mnemonic: Increasing order HLA • Guanine to cytosine G ≡ C (3 hydrogen bonds) adenosine to thymidine A = T (2 hydrogen bonds) Mnemonic: 3G • Named mutations Nonsense mutation: Sense codon to change into nonsense stop codon, causing premature termination of translation. Missense mutation: Change of one sense codon into another sense codon, for different amino acids Mnemonic: Different Miss Silent mutation: Change of one sense codon into another sense codon for same amino acids (Mnemonic: S for S) Null mutation: Leads to no functional gene product (complete loss of function) Loss of function mutation: Results of gene product having less or no function. Gain of function mutation: Change the gene product such that it gains a new and abnormal function. Neutral mutation: Different but chemically similar amino acid. • Insulin receptor: Two subunits • α subunit: It is extracellular and its function is to bind insulin. • β subunit: It is a transmembrane protein and its function is signal transduction. Note: The cytoplasmic portion of subunit has tyrosine kinase activity (enzymatic receptor). • Three steps in glycolysis that are physiologically irreversible. These reactions are catalyzed by – Hexokinase–glucokinase (glucose to glucose 6-phosphate) – Phosphofructokinase (fructose 6 phosphate to fructose 1, 6-bisphosphate) – Pyruvate kinase (phosphoenol pyruvate to pyruvic acid) To remember: All three are kinases. One involves glucose, another fructose and third one pyruvate.
  • 33. Mnemonics24 • Metabolic fuels Organ Fed Fasting Starvation Mnemonics Brain Glucose Glucose Ketone bodies Gul Gul Ke Heart Fatty acid Fatty acid Ketone bodies FFK (Fafakna in Hindi) Liver Glucose Fatty acid Amino acid GFA (Girl Friend Ayi rahne) Muscles Glucose Fatty acid Fatty acid GFF (is muscil in Hindi) RBC Glucose Glucose Glucose Only glucose • DNA Purines—Adenine, guanine Pyrimidines—Cytosine, thymine Mnemonic: Y for Y • Amino acids Ketogenic— Leucine Lysine Mnemonic: KiLL Both glucogenic and ketogenic—Isoluecine Tryptophan Phenylalanine Tyrosine Mnemonic: GK Is trying phenyl on tyre • Protein degeneration in eukaryotes 1. Protein degeneration in lysosomes—involves lysosomal proteins. This process does not involve ATP. 2. Protein degradation in proteosomes—involves ubiquitin- proteosome pathway. This process requires ATP, i.e. ATP dependent. Mnemonic: UPA • Trypsin—a proteolytic enzyme (proteinase) It acts in an alkaline medium.
  • 34. 25Biochemistry Activators: Enterokinase Calcium Trypsin itself Mnemonic: ECT Inhibitors: Human and bovine colostrums Egg white (contains water soluble mucoprotein) Raw soyabean Alpha antiproteinase/α-1 antitrypsin Diisopropyl flurophosphate (DFP) Mnemonic: HERALD • Helicase—Unwinds dsDNA to provide ssDNA Mnemonic: HU Topoisomerase—Relieves torsional strain that results from helicase induced unwinding. Mnemonic: T for T
  • 35. • Papez circuit Cingulate gyrus Anterior thalamic (limbic system) nucleus (thalamus) ↓ ↑ Hippocampus Mammillary body (limbic system) (hypothalamus) Mnemonic: HiMaAnCi • Limbic system Cingulate gyrus (rim of cortical tissue around hilum of cerebral hemisphere) Amygdala Septal nuclei Hippocampus formation Mnemonic: CASH • Precursors of Clotting factors Carboxylase Mature clotting II, VII, IX and X factors II, VII, IX, X (inactive- Vitamin K (active γ-carboxy- glutamyl glutamyl) Gla residues) (Hydroxyquinone) residues This reaction requires CO2 and hydroxyquinone form of vit. K Mnemonic: CHK • Phase of minimum cardiac motion At low/intermediate heart rates—Mid-diastole Mnemonic: Mid day minimum At high heart rates: Late systole 26 → ← → Physiology 3
  • 36. 27Physiology • Nitric oxide synthase NOS 1 (Endothelial NOS): Constitutive/Calcium dependent NOS 2 (Inducible NOS): Inducible/Calcium Independent NOS 3 (Neuronal NOS): Constitutive/Calcium dependent Mnemonic: EIN—Alphabetically and In for In • Intestinal hormone stimulating insulin secretion Gastrin Gastric inhibitory peptide (GIP) Glucagon Glucagon like peptide (GLP) Cholecystokinin (CCK) Secretin Mnemonic: 4GCS • Features of cerebellar function/lesion Past pointing Hypotonia Cerebellar nystagmus Dysmetria Dysarthria Dysdiadochokinesia Intention tremor Ataxia Mnemonic: PHC D3 I2 A1 • Pain insensitive structure Parenchyma of brain Plexus (choroid) Ependymoma Pia-arachnoid Dura over convexity of skull Mnemonic: PCS is insensitive Also remember: Vasomotor center (VMC) Excitatory: Cortex Pain pathway Carotid and aortic chemoreceptors Direct stimulators: CO2 Hypoxia
  • 37. Mnemonics28 • Cells within gastric glands Chief Zudge fund of pepsi—chief cells/zymogenic cells— fundus of stomach—pepsin Ox and Pari are intrinsic to HCL—oxyntic cells or parietal cells—secrete HCL. • Abnormal Hb with decreased solubility HbS (β6-GLU-VAL) HbC (β6-GLU-LYS) HbD (β6-GLU-GLM) Mnemonic: Supreme Court Decision-Very Long Gap • Parasympathetic fibres carrying cranial nerves—3, 7, 9, 10 Pure motor—3, 4, 6, 11, 12 Pure sensory—1, 2, 8 • The Dorsal spinocerebellar tract enters the cerebellum through inferior cerebellar peduncle. The ventral tract enters into the cerebellum through superior cerebellar peduncle. Mnemonic: DIN • Medullary respiratory centres: Dorsal respiratory group (DRG), located in the dorsal portion of the medulla, which mainly causes inspiration Mnemonic: Din Ventral respiratory group (VRG) located in the ventrolateral part of the medulla, which mainly causes expiration. • Hormones with second messenger cGMP Atrial natriuretic factor Nitric oxide Mnemonic: NAG Hormones with second messenger Creatine Kinase Growth hormone Erythropoietin Prolactin Insulin Insulin like growth factors I and II Chorionic somatomammotropin Mnemonic: Growing EPICK
  • 38. 29Physiology Hormones with second messenger cAMP α2 adrenergic catecholamines β adrenergic catecholamines Adrenocorticotropic hormone (ACTH)—pituitary Antidiuretic hormone (V2)—2 ampoule Calcitonin—parafollicular ‘C’ cell of thyroid Chorionic gonadotropin, human Corticotropin release hormone Dopamine Glucagon—pancreas FSH—pituitary LH—pituitary MSH PTH—parathyroid Somatostatin TSH—pituitary (FLAT) Mnemonic: ACD GF LM PST Second messenger is Ca2+ /PIP Oxytocin ADH (V1A and V1B) TRH Gonadotropin releasing hormone Gastrin Cholecystokinin Acetylcholine α1-adrenergic catecholamine • Intrinsic muscle control Golgi tendon organ—detects muscle tension—inverse stretch reflex—lengthening reaction Mnemonic: T for T Muscle spindle—detects muscle length—stretch reflex Mnemonic: S for S • Vestibular cerebellum—equilibrium spinocerebellum—Smoothens and coordinates Mnemonic: S for S Neocerebellum—planning and programming
  • 39. Mnemonics30 • Trichromatic theory Red—protanomaly Green—deuteranomaly Blue—tritanomaly Mnemonic: Red-Green-Blue (Ragbi) • General somatic efferents: Motor functions of skeletal muscles derived from somites: Cranial nerves III (Oculomotor nucleus) IV (Trochlear nucleus) VI (Abducens nucleus): Supplies extraocular muscles XII (Hypoglossal nucleus): Supplies tongue muscles Mnemonic: Tongue muscles and Extraocular muscles • General visceral efferents: Motor function of smooth muscles and glands of head and viscera that receive parasympathetic supply Cranial nerves Superior salivatory nucleus (VII) Superior Seven Inferior salivatory nucleus (IX) Inferior Nine Dorsal motor nucleus (X) Dorsal ~ Das (Hindi) Edinger-Westphal nucleus (III) Mnemonic: SIDE • Bronchial efferents/special visceral efferents Ambiguous nucleus (IX, X, XI) Masticatory nucleus (V) Spinal accessory nucleus (XI) Facial nucleus (VII) Mnemonic: Ambi Ka Mast Special accessory face • Axon reflex contributes only to the Flare component of triple response. Mnemonic: Flaxon • Sarcolemmal proteins localized to the cytoplasmic side of sarcolemma Dysferlin Dystrophin Calpain Mnemonic: Fer pin Pain
  • 40. 31Physiology Also remember: Transmembrane sarcolemmal proteins Dystroglycans, integrins, sarcoglycans and caveolin Mnemonic: DISC • The dorsal column ascends such that it remains ipsilateral along the entire length of spinal cord (its branch cross over in medulla) Mnemonic: DCM-Dorsal column cross over in medulla Sensations transmitted by spinothalamic tract Anterior spinothalamic tract Mnemonic: Crude ATP-Crude touch and pressure in anterior Spinothalamic tract Lateral spinothalamic tract Pain (pin prick) Temperature Mnemonic: PLT Note: The spinothalamic tract crosses more or less at point of entry itself such that it remains contralateral along the whole length of spinal cord. • When compared to plasma Serum has no fibrinogen, clotting factors II, V and VIII but has higher serotonin content because of platelet breakdown in serum Mnemonic: S for S • Frequency of sleep waves Gamma oscillations 30–80 Hz Great Beta waves 18–30 Hz B Alpha waves 8–12 Hz A Theta waves 4–7 Hz T Delta waves < 4 Hz Dance Awake person Eyes opened Beta waves Mnemonic: Opening batsman Eyes closed Alpha waves
  • 41. Mnemonics32 • Oxygen toxicity Acute—Bert effect—CNS effects are predominant (muscle twitching, convulsions, coma) (Mnemonic: ABC) Chronic—Smith effect—pulmonary effects (pulmonary edema, lung atelectasis) • Hormones produced in kidney Renin Erythropoietin 1, 25-Dihydroxycholecalciferol—vit. D Mnemonic: RED • Testis Interstitial cells of Leydig—secrete testosterone Mnemonic: Lete Most other functions—Sertoli cells Y-Chromosome—small acrocentric Mnemonic: Yac • Naturally occurring estrogens Estrone: Major estrogen in postmenopausal women Mnemonic: NM Estradiol: Major and most potent estrogen in women Estriol: Major estrogen in pregnancy, marker for fetoplacental unit. Mnemonic: PT • Clasp knife spasticity: Upper motor neuron lesion (corticospinal pyramidal system involved) Mnemonic: Up in Spa Lead pipe and cogwheel rigidity occurs in extrapyramidal syndrome, e.g. Parkinsonism. Mnemonic: Extra rigid in Parkinsonism Paratonia/gegenhalten—bilateral frontal lobe damage Mnemonic: FG Cerebrovascular disease. • Sympathetic outflow: Thoracolumbar outflow Mnemonic: SLT Parasympathetic outflow: Craniosacral outflow Mnemonic: PCS
  • 42. 33Physiology • LH surge: Ovulation—hormone picture High estrogen Low progesterone Mnemonic: HELP • IRV + TV = Inspiratory capacity (Mn: ITI) ERV + RV = Functional residual capacity (Mnemonic: FER) IRV + TV + ERV = Vital capacity IRV + TV + ERV + RV = Total lung capacity VC + RV = TLC (Mnemonic: VRT) • Positive feedback mechanisms Parturition Action potential initiation Blood clotting/clot formation LH surge Ca2+ mediated contraction Shock Mnemonic: PABLCS • Sympathetic cholinergic system serves two important functions: a. Sweat gland—secretion of sweat. b. Vasodilatation in skeletal muscles—a part of the neurons to blood vessels in skeletal muscles is anatomically sympathetic but secrete acetylcholine. Stimulation of this system of neurons produces vasodilatation in skeletal muscles. • Stimulus for CCK-PZ secretion: a. Presence of peptides and amino acids in contact with mucosa of small intestine. b. Presence in the duodenum of fatty acids having more than 10 carbon atoms. Stimulus for secretin secretion: a. Acidity of chyme b. Products of protein digestion • Stage IV: NREM sleep disorders: Sleep walking (somnambulism)
  • 43. Mnemonics34 Sleep terorr or night terror (pavor nocturnus) Sleep related enuresis (bed wetting) Bruxism (tooth grinding) Sleep talking (somniloquy) • REM sleep disorders: RBD-REM sleep behaviour disorder Nightmares Narcolepsy (hallmark—decreased sleep latency) Note: Penile tumescence is seen in REM sleep. Mnemonic: RML Pens REM • Difference between T3 and T4 T3 is more potent. T3 has faster onset of action. T3 binds more avidly to nuclear receptors. T4 is more secreted by thyroid. T4 is major circulating hormone. T4 binds more avidly to plasma proteins (15 times). T4 has more plasma t½ To remember: T4 = Pharmacokinetics T3 = Pharmacodynamics Note: About 1/3 of T4 is converted to T3 in peripheral tissues. • Ions predominant in ICF: Potassium Phosphate (organic) Protein Magnesium Mnemonic: 3PM Ions predominant in ECF—Na+ /Cl– /HCO3 – /Ca2+
  • 44. • Therapeutic Index = D50 D50 L E or LD50/ED50 Mnemonic: TILE • Selective phosphodiesterase 4 (PDE4) inhibitors Roflumilast Cilomilast Tofimilast Mnemonic: RCT-Milast • Small molecule tyrosine kinase inhibitors HER1 (EGFR) Erb B1: Erlotinib (reversible) Canertinib (Irreversible) Gefitinib Mnemonic: I Can do ECG • VGFR TK inhibitors—Sorafenib—Renal cell cancer Sunitinib—Renal cell cancer Mnemonic: VRS • Drugs used for acute gout NSAIDS Colchicine Corticosteroids Mnemonic: NCC • Relative potency of same steroid at equivalent concentrations in different formulation Ointment > Emollient > Gel > Cream > Lotion Mnemonic: OEGCL 35 Pharmacology 4
  • 45. Mnemonics36 • Anticancer cells: Cell cycle specific G2 phase specific: Daunorubicin Etoposide Bleomycin Topotecan and Irinotecan Mnemonic: DEBT S-phase specific agent: Antimetabolites Mtx 6MP 6TG 5-FU Cytarabine Hydroxyurea M-phase specific: Vinca alkaloids Paclitaxel and Docetaxel G1 phase: Vinblastine • Drugs causing hyperuricemia L-Dopa Ethambutol Aspirin Diuretic Cyclosporine Alcohol Nicotinic acid Pyrazinamide Mnemonic: LEAD CAN poison • Anti-TNF-α drugs Etanercept Adalimumab Infliximab Mnemonic: Etalion adalat Ka Insaf • Clomiphene citrate Enclomiphene—trans-antagonist Zuclomiphene—cis-weak agonist Mnemonic: N for N • Anti-anxiety Benzodiazepines Diazepam Chlordiazepoxide
  • 46. Pharmacology 37 Oxazepam Lorazepam Alprazolam Mnemonic: Dia Ka CHOLA • Anti-pseudomonal penicillins Azlocillin Mezlocillin Carbenicillin Piperacillin Ticarcillin Mnemonic: (Az) (Mez) pe Car Ka Pipe Tica • Penicillinase susceptible penicillins Penicillin G: Acid labile Penicillin V: Acid stable Mnemonic: Galib • Penicillinase resistant Nafcillin Methicillin Flucloxacillin Oxacillin Cloxacillin Dicloxacillin Mnemonic: Name Flu of OCD (last four are—oxa) • Intramuscular penicillins Benzathine penicillin G Procaine penicillin G Mnemonic: BP (measured on muscle) Intravenous intramuscular Penicillin G Crystalline penicillin G or sodium penicillin G • Anti-fungal drugs Systemic azoles Itraconazole Voriconazole Fluconazole Mnemonic: IVF
  • 47. Mnemonics38 Note: Ketoconazole is both topical and systemic. • Side effects: Tacrolimus versus cyclosporine Tacrolimus causes more Neurotoxicity Nephrotoxicity Diabetes mellitus Diarrhoea Mnemonic: N2D2: ND Tiwari Cyclosporine causes more Hirsutism Hyperplasia of gums Hypertension Hepatotoxicity (4H: First two are absent in tacrolimus) • Management of PSVT Adenosine > beta (β) blocker > calcium channel blocker (verapamil) > digoxin Mnemonic: ABCD • Beta agonists—side effects Tolerance Tachycardia Tremor Mnemonic: 3T • Effects mediated through β2 receptor agonists Relaxation of smooth muscles Airway (bronchial muscles) Bronchodilatation (relaxation) Blood vessels Vasodilatation (relaxation) (Arterioles and Veins) Ciliary muscles in eye Relaxation Detrusor muscles in bladder Relaxation Gall bladder and duct Relaxation Gastrointestinal tract Relaxation Uterus Relaxation Splenic capsule Relaxation Mnemonic: ABCD G2US (i.e. ABCD GO TO US)
  • 48. Pharmacology 39 • Oral drug therapy for treatment of erectile dysfunction P Pentoxyfylline O Opoid antagonist (naltrexone) D Dopamine agonist (bomocriptine, apomorphine) A Alpha blockers (yohimbine, idaxozan) Mnemonic: PODA • Prostaglandin E1 (PGE1) analogues Riopristil Alprostadil Misoprostol Mnemonic: RAM Prostaglandin F2α (PGF2α) analogues Dinoprost Carboprost Latanoprost Mnemonic: Prost • Hormones acting through cell membrane receptors G protein coupled receptors Enzymatic receptors • G protein coupled receptors act either Through alteration in CAMP concentration, or Through IP3/DAG generation CAMP altering hormones are (another Mnemonic: ABCD GF LMPST) Pancreas: Glucagon, somatostatin (delta cells) Pituitary: FSH, LH, ACTH, TSH (Mnemonic: FLAT—CAMP) Parathyroid: PTH Parafollicullar C cells of thyroid: Calcitonin Posterior pituitary: Vasopressin (V2) Plus hypothalamic releasing hormones (CRH, dopamine) Placenta: hCG Peptide of intermediate pituitary: MSH Through IP3/DAG: Oxytocin TRH gastrin Acetylcholine Vasopressin Gn RH Angiotensin II (V1)
  • 49. Mnemonics40 Through cGMP—NO ANF Mnemonic: NAG (NO, ANF through cGMP) • Rapid acting human insulin analogues Insulin aspart Insulin lispro Insulin glulisine Mnemonic: Asli Glu Also Remember: Long acting human insulin analogues Insulin glargine Insulin detemir • Mechanism of action of antiepileptic agents Facilitation of GABA mediated chloride channel opening Barbiturates Benzodiazepines Gabapentin Tiagabine Topiramate Vigabatrin Valproate Mnemonic: BaBe Girl Tia Top in Viva of GABA class • Inhibition of T type Ca2+ current Valproate Trimethadione Ethosuximide Mnemonic: Vallore try ethical current • Prolongation of Na+ channel inactivation Valproate Lamotrigine Zonisamide Phenytoin Carbamazepine Topiramate Mnemonic: Very long zone of Na+ in PCT
  • 50. Pharmacology 41 • Gp II b/III a antagonist Eptifibatide Tirofiban Abciximab Mnemonic: EpTiAb • All Navirs are protease inhibitors • NNRTI: Efavirenz Etravirine Nevirapine Delaviridine Mnemonic: 2END • Didanosine Stavudine Zalcitabine (20%) (71%) (15%) Similar toxic profiles Peripheral neuropathy (% in bracket) Lactic acidosis Pancreatitis Liver: Hepatomegaly with steatosis Mnemonic: PLPL • Anti-metabolite acting by hypomethylation (inhibit DNA methyl transferase) Azacitidine Decitabine Mnemonic: Hypo Aza D • Thymine less death (inhibit DNA synthesis by blocking synthesis of thymidylate) causing anti-metabolites 5-Fluorouracil (5-Fu) Capecitabine (5-Fu analogues) • Anti-metabolite acting by inhibition of DNA elongation (DNA intercalating agent) Cytarabine or cytosine arabinoside (pyrimidine-cytidine analogue) Gemcitabine (Pyrimidine-cytidine analogue) Mnemonic: Arab Gem inhibit elongation
  • 51. Mnemonics42 • Filgrastim is recombinant GCSF (glycoprotein) produced in E. coli Mnemonic: EFG • High dose methotrexate is used for osteosarcoma, brain tumors and hematological malignancies. Mnemonic: Bone, Brain, Blood • Filgrastim: GCSF/(Gra for granulocyte) Sargramostim GM-CSF (Gramo for granulocyte monocyte) • Drugs associated with SIADH Vasopressin or desmopressin Chlorpropamide Oxytocin, high dose Vincristine Carbamazepine Nicotine Phenothiazines Cyclophosphamide TCA MAO inhibitors SSRI Mnemonic: VCO VCN PC, TMS • Drugs causing constipation Aluminium hydroxide Barium sulphate Calcium carbonate Ferrous sulphate Ganglionic blockers Ion exchange resins Opiates Phenothiazines Tricyclic antidepressants Verapamil (calcium channel blockers) Mnemonic: ABC, FGI, OP, TV) Note: Mg2+ is laxative.
  • 52. Pharmacology 43 • Benzodiazepines that do not produce active metabolites Oxazepam Midazolam Lorazepam Tamazepam Triazolam Mnemonic: OMLTT (Omlette) • Drugs acting on GABA A (intrinsic ion channel receptors) Agonist: Muscimol Antagonist: Bicuculline Agonist: Baclofen (B for B) Antagonist: Saclofen Drugs acting on GABA B (G protein coupled receptors) (Mn: GB) Mnemonic: MBBS (Muscimol, Bicuculline, Baclofen, Saclofen) • Absence seizure: Drug of choice < 3 yrs of age: Ethosuximide > 3 yrs of age: Valproic acid • Interactions of valproate May precipitate phenobarbitone toxicity by inhibiting metabolism May precipitate phenytoin toxicity by displacing it from protein binding sites and inhibiting metabolism. May precipitate absence status when used with clonazepam. • Immunosuppression with triple therapy: Nice guidelines Cyclosporine (calcineurin inhibitor) Azathioprine (anti-proliferative agent) Prednisolone (corticosteroid) Mnemonic: CAP Note: Azathioprine may be replaced by mycofenolate mofetil. • Adverse effects of amiodarone (iodine containing long acting anti-arrhythmic belong to class III) Thyroid—hypothyroidism and hyperthyroidism
  • 53. Mnemonics44 Peripheral neuropathy Myocardial depression Pulmonary alveolitis and fibrosis (lung)—dry cough Corneal microdeposits Liver toxicity Photosensitization Mnemonic: The Periphery of My lung cornea live with photosensitivity • Fluoroquinolones excreted primarily by non-renal mechanism Pefloxacin Trovafloxacin Grepofloxacin Nalidixic acid Mnemonic: Petro Grenal Note: Sparfloxacin has 50% renal and 50% fecal route of excretion. • Anti-pseudomonal cephalosporins Ceftazidime Cefoperazone Cefepime Cefotaxine • Second line anti-tubercular drugs Old drugs PAS Ethionamide Cycloserine Thioacetazone Mnemonic: PECT Amikacin Kanamycin Capreomycin Mnemonic: Ami KC New drugs Ciprofloxacin Ofloxacin
  • 54. Pharmacology 45 Clarithromycin Azithromycin Rifabutin Mnemonic: COCA-Rafa • Chelating agents in heavy metal poisoning Dimercaprol (BAL): Bismuth Antimony Lead Mercury Arsenic Copper Nickel Gold Mnemonic: BALMA CNG • Calcium disodium edetate (CaNa2EDTA) Lead poisoning Mnemonic: Ledta Zn, Cd, Mn, Cu, Fe poisoning • Penicillamine Copper Mercury Lead Mnemonic: CML Note: BAL: Not in iron and cadmium poisoning Mnemonic: BANIC EDTA: Not in mercury poison Mnemonic: ENM Penicillamine: Not in iron poisoning Mnemonic: PNI • Phenytoin—side effects Hyperplasia of gums Hyperglycemia Hirsutism Hypersensitivity reaction Hydantoin syndrome: Teratogenicity
  • 55. Mnemonics46 Lymphadenopathy Megaloblastic anaemia Neurological symptoms Osteomalacia Mnemonic: 5H + LMNOP • Valproate—side effects Anorexia, vomiting Alopecia (transient) Ataxia, sedation Ammonemia (hyper) Thrombocytopenia Tremor Hepatotoxicity Neural tube defect Weight gain Mnemonic: VAT + HNW • Antidote of warfarin (oral anticoagulants): Vitamin K1 (phytonadione) Antidote of heparin—protamine sulphate • Drugs acting on cell membrane and promoting leakage from membranes Polyenes: Amphotericin B Hamycin Nystatin Polypeptides: Polymyxin Colistin Mnemonic: AB HaNy and PoCo leak membrane • Mechanism of action of anti-microbial agents Inhibition of DNA gyrase: Fluoroquinolones Mnemonic: FG Misreading of mRNA code: Aminoglycoside (Mn:Amina misread code) Inhibition of protein synthesis Chloramphenicol 50S Erythromycin 50S
  • 56. Pharmacology 47 Clindamycin 50S Mnemonic: CEC 50 Tetracycline 30S Aminoglycoside 30S • Beta adrenergic agonists, nitrates, digitalis and diuretics are best avoided during treatment of HOCM. Mnemonic: BeNi DiDi avoid HOCM • Contraceptive failure may occur if any of the following drugs is used concurrently: Enzyme inducers: Phenytoin, phenobarbitone primidone, carbamazepine, rifampicin, griseofulvin. Suppression of intestinal microflora tetracycline, ampicillin • Drugs following zero order kinetics Warfarin Ethyl alcohol Theophylline Tolbutamide Phenytoin Aspirin (salicylate) Propranolol Mnemonic: Zero WATT PAP • Adrenaline: α1 + α2 + β1 + β2 Noradrenaline: α1 + α2 + β1 (no β2 action) Dopamine: D1 + D2 + α1 + α2 + β1 (no β2) Isoprenaline: β1 + β2 (no α action) Dobutamine relatively β1 selective (no dopamine receptor action) Mnemonic: DONO has no B2 action • Adrenaline: Systolic BP increased Diastolic BP decreased Heart rate increased Noradrenaline: Systolic BP increased Diastolic BP increased Heart rate decreased
  • 57. Mnemonics48 Isoprenaline: Systolic BP normal/decreased Diastolic BP decreased Heart rate increased • Dopamine: D1 receptors in renal and mesenteric blood vessels are very sensitive IV infusion of low doses of DA dilates mesenteric vessels and improves renal perfusion. Dobutamine: Inotropic action • Selective MAO-A inhibitor: Clorgiline Maclobemide Selective MAO-B inhibitor: Selegiline Non-selective MAO inhibitor Isocarboxazid Tranylcypromine Phenelzine Mnemonic: ITP • Hemodialysis is not used in Benzodiazepines (BZD) Digitalis Organophosphates Copper sulphate Kerosene Mnemonic: BZD DOCK • Diagnostic test for myasthenia gravis a. Ameliorative test: Edrophonium (anti-cholinesterase) b. Provocative test—d-tubocurarine • Pheochromocytoma α-blockage is the basis of management in preoperative period. Phenoxybenzamine is the agent of choice. β-blockers should not be employed prior to establishing effective α-receptor blockage, since unopposed β receptor blockage could theoretically cause blood pressure elevation from increased vasoconstriction. Atenolol however is a selective β1 agonist, and acts on the heart and not on peripheral blood vessels.
  • 58. Pharmacology 49 • Diuretics, which do not promote bicarbonate excretion Thiazide like diuretics, e.g. metazoline, indapamide, chlorthalidone, Ethacrynic acid (unlike other loop diuretics) Mnemonic: MICE Most marked kaliuresis: Acetazolamide Mnemonic: AK Most marked natriuresis: Furosemide Mnemonic: FuNa • Pharmacokinetics ADME Absorption Distribution Metabolism Excretion • Plasma protein binding is associated with— Duration Distribution Disease (hypoalbuminemia) Displacement Dialysis • Area outside blood–brain barrier (circumventricular organs) Subfornical organ OVLT (organum vasculosum of lamina terminalis) Area postrema Posterior pituitary Mnemonic: SOAP Note: CTZ (Chemoreceptor trigger zone) is also outside blood–brain barrier and responsible for vomiting. • Enzyme inducers— G—Griseofulvin P—Phenytoin, Primidone R—Rifampicin S—Smoking (PAH—polycyclic aromatic hydrocarbons) Car—Carbamazepine Phone—phenobarbitone
  • 59. Mnemonics50 • Enzyme inhibitors— Valla’s—Valproate Kit—Ketoconazole Can—Cimetidine Cause—Ciprofloxacin Enzyme—Erythromycin Inhibition—INH (Isoniazid) • Order of kinetics First order— CHF constant Clearance Half life Fraction excreted Zero order—RA constant Rate of elimination Amount eliminated • Nuclear hormones— S—Sex hormones (Estrogen, Progesterone and Testosterone) A—Vitamin A T—Thyroid hormones Mnemonic: SATurday Night Cytoplasmic receptor hormones—Corticosteroids Vitamin D Mnemonic: CCD • Drugs metabolized by acetylation— S—Sulfonamide including dapsone H—Hydralazine I—INH (Isoniazid) P—Procainamide (antiarrhythmic drug) Note: They can cause SLE. • Parasympathetic fibres are long in preganglionic. Mnemonic: Para-Pre—long • Preganglionic fibres release acetylcholine in both sympathetic and parasympathetic systems.
  • 60. Pharmacology 51 • Sympathetic system— Postganglionic fibres release noradrenaline Exceptions— Sympathetic nerve fibres going to kidney secrete dopamine. Sympathetic nerve fibres going to sweat glands release acetylcholine (sympathetic cholinergic) Mnemonic: Kid is sympathetic to dopa • Heart rate—Chronotropic Mnemonic: HR Conduction—Dromotropic Mnemonic: D for D Contractility—Ionotropic • Hemicholinium—inhibits uptake of choline. Vesamichol—inhibits entry of acetylcholine in the vesicle Botulinum toxin—inhibits release of acetylcholine. • M1—Stomach (increases acid secretion) M2—Heart (Bradycardia) M3—Rest organs like eye, GIT, urinary bladder, bronchus, glands M4—CNS M5—CNS Mnemonic: Ma says—First eat, Second heart and rest work later on • Drugs directly acting on parasympathetic system Pilocarpine acts on Pupil (M3)—miosis in glaucoma. Mnemonic: P for P Bethanichol acts on Bladder (M3)—contracts urinary bladder in urinary retention. Mnemonic: B for B Methacholine acts on Myocardium (M2)—used in tachyarrhy- thmia. Carbachol action—Common action—acts both on nicotinic and muscarinic receptors. Mnemonic: C for C
  • 61. Mnemonics52 • Oximes (enzyme reactivators) are acetylcholinesterase reactivators. Oximes are used only for organophosphorous poisoning. Mnemonic: OOO For example, Pralidoxime (PAM)—acts only in periphery. Mnemonic: P for P Diacetyl monoxime (DAM)—acts on both sites. • Anticholinergic drugs act as cycloplegic. Ciliary muscle contracts to cause accommodation. Its nerve supply is short ciliary nerve—branch of oculomotor nerve (3rd cranial nerve). So, it is a part of parasympathetic system. That is why anticholinergic drugs cause cycloplegia by blocking ciliary muscle contraction and causing loss of accommodation. Anticholinergic drugs are— Atropine—strongest cycloplegic drug. Very long acting. Used for refraction testing in children. Homatropine Cyclopentolate Tropicamide (Shortest acting. Preferred in adults.) Mnemonic: D for adult • Anticholinergic drugs acting on urinary bladder (M3)— block—less contraction. Cause urinary retention (side effect) Used in overactive bladder/incontinence/detrusser instability. Drugs used are— S—Solifenacin O—Oxybutynin F—Flavoxate T—Tolterodine, Trospium bladder—Darifenacin Mnemonic: SOFT bladder
  • 62. Pharmacology 53 • Belladonna poisoning = Atropine poisoning = Dhatura poisoning. Mnemonic: BAD • β1: Heart Mnemonic: Heart is 1 in number β2: Lungs Mnemonic: Lungs are 2 in number • α1: Vasoconstriction α2: Vasodilatation Mnemonic: A 1–C B 2–D • M3: Circular muscles—Constrictor pupillae—supplied by short ciliary nerve—active miosis—parasympathomimetic. Mnemonic: MCC MAO α1: Radial muscles—dilator pupillae—supplied by long ciliary nerve—active mydriasis—sympathomimetics. • Dopamine acts on: μg/kg/min D1: Low dose < 2 β1 + D1: Intermediate dose 2–10 α1 + β1 + D1: High dose > 10 Mnemonic: DBA • Dopa in name stimulates D1 For example, Dopamine Fenoldopam Note: Dobutamine mainly acts on β1. • Adrenaline acts on all 4 receptors (α1, α2, β1 and β2) Noradrenaline—not all (α1, α2, β1) Isoprenaline—only β—β1and β2 • β2 agonists Salbutamol Terbutaline
  • 63. Mnemonics54 Salmetrol Formetrol Mnemonic: Metro is long acting. Salmetrol is slow onset (S for S) Formetrol is fast onset (F for F) Side effects—Tremor Tachycardia Tolerance Mnemonic: 3T • Selective α1 blocker—Zosine • α1A—Prostate α1B—Blood vessels Mnemonic: B for blood vessels Note: Selective α1A blocker—Tamsulosin, Silodosin. • β1 blockers/cardioselective/2nd generation New—Nebivolol Beta—Betaxolol Blockers—Bisoprolol Act—Acebutolol Exclusively—Esmolol At—Atenolol Myo—Metoprolol Cardium—Celiprolol • β blockers with intrinsic sympathomimetic activity (partial agonist) Contain—Celiprolol Partial—Pindolol Agonistic—Alprenolol Activity—Acebutolol Mnemonic: All pind sell ace intrinsically • β blockers with membrane stabilizing property Possess—Propranolol Membrane stabilizing or—Metoprolol
  • 64. Pharmacology 55 Local—Labetalol Anesthetic—Acebutolol Property—Pindolol • Water soluble β blockers—contraindicated in renal failure: A—Atenolol N—Nadolol S—Sotalol Mnemonic: SoNaAta • Nadolol is the longest acting β blocker Esmolol is the shortest acting β blocker. • 3rd generation β blockers: β blockers with any additional cardiovascular advantage (vasodilatation) a. α + β blockade—Labetalol, Carvedilol b. NO release—Nebivolol. Mnemonic: N for N c. Ca2+ channel blocker—Carvedilol Mnemonic: C for C d. K+ channel blocker—Tilisilol e. β2 agonist—Celiprolol • Carvedilol—α blocker Ca2+ channel blocker Antioxidant • Celiprolol— β2 agonist Cardioselective Intrinsic sympathomimetic activity. • Loop and thiazide diuretics Na+ , K+ , Mg2+ , H+ —decrease Sugar, lipid, uric acid—increase Mnemonic: Loop looses calcium. It causes hypocalcemia. But thiazides cause hypercalcemia • Digoxin—contraindicated in renal failure. Digitoxin—contraindicated in hepatic failure. Mnemonic: Toxin is metabolized in liver
  • 65. Mnemonics56 • Drugs causing gynaecomastia— Di—Digitalis S—Spironolactone C—Cimetidine O—Oestrogen • Drug interactions of digitalis— Quinidine Verapamil Amiodarone Thiazides Mnemonic: Queen’s VAT digitally • Vasodilators Mainly vein—Nitrates Mainly artery—Hydralazine Mnemonic: Hydra is artist Both— α blockers ACE inhibitors AT receptor blockers Sodium nitroprusside • Drugs causing hirsutism— Cyclosporine Phenytoin Minoxidil Mnemonic: CPM ka Hero • Diazoxide—decrease Insulin • Ca2+ channel— L type—in CVS T type—in Thalamus (brain) Mnemonic: T for T • Renin inhibitor Approved for the treatment of hypertension Can be given orally Aliskiren
  • 66. Pharmacology 57 Remikiren Enalkiren Mnemonic: Inhibitor of Renin • Prils are ACE inhibitors. Depines are calcium channel blockers. Mnemonic: CD • ACE inhibitors A—Active C—Captopril L—Lisinopril • ACE inhibitors—Captopril C—Cough A—Angioedema P—Prodrug (except Captopril and Lisinopril) T—Taste alteration (dysguesia) O—Orthostatic hypotension/Postural hypotension P—Pregnancy is absolute contraindication R—Renal artery stenosis (bilateral) is absolute contraindication I—Increase in K+ —hyperkalemia is contraindication L—Lowers the risk of diabetic complications Note: Angiotensin receptor blockers also follow these except first 3 (CAP). • Sartans are angiotensin receptor blockers (block AT1 only). Sartans are selective AT1 receptor antagonist. • Drugs safe in pregnancy Better—Beta blockers Mother—Methyldopa Care—Clonidine During—Dihydroperidine Hypertensive—Hydralazine Pregnancy—Prazosin Note: Antihypertensive drugs contraindicated in pregnancy are ACE inhibitors and ARB.
  • 67. Mnemonics58 • Nitrate with minimum first pass metabolism—IMN Mnemonic: Iska Metabolism Nahi hota Longest acting nitrate—PETN Mnemonic: Longest name Shortest acting nitrate—AN Mnemonic: Shortest name • Coronary steal phenomenon can be caused by— Hydralazine Dipyridamol Isoflurane Mnemonic: HDI steal from Heart • Ivabradine I—IF blocker (funny current, which opens in hyperpolarisation instead of depolarization) Va—Visual field defect Bradi—cause bradycardia Ne—Na+ channel blocker • Rho kinase inhibitor—Fasudil Mnemonic: Dil me fas—ro mat • Myocardial infarction Non-ST elevation MI— M—Morphine O—Oxygen N—Nitrates A—Aspirin ST elevation MI— S—Streptokinase O—Oxygen N—Nitrate A—Aspirin M—Morphine • Antiarrhythmic drugs—Vaughan William classification: I—Sodium channel blockers II—Beta blockers
  • 68. Pharmacology 59 III—Potassium channel blockers IV—Calcium channel blockers V—Others Mnemonic: SBP • Class III antiarrhythmic drugs B—Bretylium I—Ibutilide D—Dofetilide A—Amioderone S—Sotalol Note: They can cause Torased des pointes. • Benzodiazepines GABA facilitatory Increases frequency of chloride channel opening DRC flat Specific antidote—Flumazenil Mnemonic: 4F • Short acting benzodiazepines T—Triazolam, Temazepam O—Oxazepam L—Lorazepam E—Estazolam Note: Short acting BZD are—safe in elderly, liver disease, no hangover and no active metabolite. • Vigabatrin Vi—Visual field defect Gaba—GABA Tr—Transaminase In—inhibitor. ‘In’ also stands for infantile spasm Note: Vigabatrin is the drug of choice for infantile spasm with tuberous sclerosis. ACTH is drug of choice for infantile spasm.
  • 69. Mnemonics60 • Tiagabine Mnemonic: Transport inhibitor of GABA It is GABA reuptake inhibitor by inhibiting GAT1 • Drug decreasing alcohol craving— N—Naltrexone A—Acamprosate T—Topiramate O—Ondansetron • Atypical antipsychotics—5HT2A/2C blockers, e.g. pine, done and aripiprazole. • Uses of topiramate—all seizures except absence. Migraine prophylaxis Obesity Smoking Alcohol addiction Mnemonic: MOSA • Uses of antipsychotic drugs— Anti—Antiemetic property Psy—psychosis Cho—chorea (Huntington’s chorea) Tic—Tic disorder like Gille de La Tourette syndrome • Agonist (κ)—antagonist (μ) P—Pentazocine N—Nelbuphine D—Dezocine • Partial agonist—Buprenorphine, Butorphenol. Mnemonic: 2B • Drugs inhibiting cell wall Firmly—Fosfomycin Bind to—Bacitracin Bacterial—β lactum Cell—Cycloserine Wall—Vancomycin
  • 70. Pharmacology 61 Note: β lactum antibiotics—Penicillins Cephalosporins Carbapenems Monobactum • Penicillinase inhibitor or β lactumase inhibitor C—Clavulanic acid—with amoxicillin S—Sulbactum—with ampicillin T—Tazobactum—with piperacillin • Uses of penicillin G L—Listeria A—Actinomyces S—Syphilis T—Tetanus M—Meningococcus An—Anthrax Go—Gonococcus (drug of choice is ceftriaxone) Mnemonic: A men act on the list of gone sipohi • No β lactum is effective against MRSA except 5th generation cephalosporin. • 1st generation cephalosporin Cefazolin Cefalexin Cefadroxil Cefalothin Cefaloridine Mnemonic: Cefa Exception: Cefaclor is 2nd generation. • 4th generation cephalosporin Cefepime Cefpirome • 5th generation cephalosporin Ceftaroline Ceftibiprole Mnemonic: rol
  • 71. Mnemonics62 • Cephalosporins secreted by bile Ceftriaxone Cefoperazone Mnemonic: Bile per try • Cephalosporins effective against pseudomonas— Cefepime Cefepirome Cefoperazone Ceftazidime Mnemonic: 3P and ziddi • Cefoperazone— Secreted by bile Effective against pseudomonas Disulfiram like reaction hypoprothrombinemia • Mechanism of action of tetracycline—prevents tRNA to bind to A site. Mnemonic: T for T • Antimicrobial drug preventing translocation— M—Macrolides C—Clindamycin Q—Quinapristin • Buy AT 30S SELL @ 50S AT— Aminoglycoside Tetracycline SELL— Streptogramin (Quinapristine) Erythromycin (Macrolides) Linezolid Lincosamide • Uses of tetracycline S—SIADH R—Rickettsial infection
  • 72. Pharmacology 63 I—Inguinale granuloma L—Lymphogranuloma venerum A—Atypical N—pNeumonia C—Cholera A—Amoebiasis • Tetracyclines—contraindications and adverse effects— K—contraindicated in Kidney failure A—Antianabolic action P—Phototoxicity I—Insipidus—DI L—Liver failure is C/I D—Dental—affects growing bone and teeth. C/I in pregnancy and child < 8 years. E—Expiry date—causes Fanconi syndrome after expiry date V—Vestibular dysfunction • Macrolides is the drug of choice for— C—Chancroid L—Legionella A—Atypical pneumonia P—Pertussis Can also be used for— C—Corynebacterium diphtheria H—Haemophilus influenzae A—Atypical mycobacteria T—Toxoplasmosis Side effects of macrolides— M—Motilin receptor stimulation A—Allergy C—Cholestatic jaundice R—Reversible O—Ototoxicity Note: Vancomycin and aminoglycosides cause irreversible ototoxicity.
  • 73. Mnemonics64 • Aminoglycoside Neomycin— Most nephrotoxic Most neuromuscular blockade Used only topically After neomycin, Gentamycin is most nephrotoxic Mnemonic: G affects GFR Streptomycin affects neuromuscular blockade Mnemonic: S affects Skeletal muscle Note: Maximum hearing loss—Amikacin Mnemonic: A affects auditory Maximum vestibular damage—Streptomycin • Side effects of Sulfonamide— A—Aplastic anemia B—Bilirubiun displacement—Kernicterus C—Crystalluria R—Rash A—Acetylation S—SLE H—Hemolysis in G6PD deficiency • Pyrimethamine—Antiparasite Mnemonic: P for P Methotrexate—Anticancer Mnemonic: M for M Trimethoprim—Antibacterial • Fluoroquinolones are contraindicated in renal failure except— P—Pefloxacin M—Moxifloxacin T—Trovafloxacin • Respiratory flouroquinolones—can kill any bacteria causing respiratory tract infection O—Ofloxacin and levofloxacin M—Moxifloxacin G—Gemifloxacin
  • 74. Pharmacology 65 • Gatifloxacin—Glucose—withdrawn because it causes hypoglycemia and hyperglycemia. Mnemonic: G for G • Multibacillary leprosy—treatment OCD—Once daily Clofazimine (50 mg) and Dapsone (100 mg) RCM—Rifampicin (600 mg) and Clofazimine (300 mg) Note: Monthly dose are supervised. Paucibacillary leprosy—Treatment -???? • Bactericidal drugs— β lactum Aminoglycoside Flouroquinolones Vancomycin • Fast acting antimalarial drugs— M—Mefloquine A—Atovaquine C—Chloroquine H—Halofantrine, lumefantrine A—Artemisin group R—Res Q (Quinine) Slow acting Proguanil Pyrimethamine Sulphadoxine Tetracycline • Fluconazole—DOC for Candida, Cryptococcus Mnemonic: Flue can treat cry Note: Fluconazole is also the DOC for prophylaxis of febrile neutropenia in immunosuppressants. • Terbinafine—DOC for dermatophytosis. • Posaconazole—DOC for mucormycosis • Voriconazole—DOC for invasive aspergillosis, treatment of febrile neutropenia. • Itraconazole—DOC for all non-serious fungal infection except Candida and Cryptococcus.
  • 75. Mnemonics66 • Hepatitis B—DOC—Entecavir Alternate drugs— oral— Lamivudine Emtricitabine Tenofovir Injectable— Interferon α • NRTI used in hepatitis B— L—Lamivudine E—Emtricitabine T—Tenofovir • Hepatitis C—DOC—Interferon and ribavarin • NNRTI—1st generation E—Efavirenz N—Nevirapine D—Delaviridine 2nd generation Etravirine Rilpivirine • Metronidazole is DOC for G—Giardiasis U—Ulcer—peptic ulcer P—Pseudomembranous colitis T—Trichomoniasis A—Anaerobic bacterial infection G—Gardenella vaginalis (bacterial vaginosis) • Antihelminthic drugs Platyhelminths—Flukes and tapeworm—DOC—Praziquentel. Mnemonic: P for P Nemathelminthes—DOC—Albendazole Exceptions to platyhelminthes— Liver fluke (Fasciola hepatica) Dog tapeworm (Echinococcus)
  • 76. Pharmacology 67 Exceptions to Nemathelminthes— Filaria—DOC—DEC Strongyloides—DOC—Ivermectin Onchocerca (river blindness)—DOC—Ivermectin Mnemonic: iver for river • Pulsatile GnRH is indicated in— C—Cryptoorchidism H—Hypogonadotrophic hypogonadism A—Anovulatory infertility N—uNdescended testis D—Delayed puberty Note: Continuous GnRH is indicated in Precocious puberty Cancer like breast carcinoma, prostate carcinoma Endometriosis Fibroid liomyoma (symptomatically) • GnRH agonist Leuprolide—First drug Gonadorelin Nafarelin—Nasally Mnemonic: N for N Gosarelin Busurelin Histarelin • GnRH antagonist—relix Cetrorelix Ganirelix Abarelix Degarelix Mnemonic: X means cross means antagonist • Thyroid inhibitors Peripheral conversion inhibitors— 5’ deiodinase inhibitors— Propylthiouracil
  • 77. Mnemonics68 Propranolol Prednisolone Mnemonic: 3P • Metformin—used for Obese patient Sulfonylurea—used for Thin patient Mnemonic: MOST • PTH causes partiality— Increases serum Ca2+ Decreases serum phosphate Note: Vitamin D decreases both while calcitonin increases both. • Tamoxifen is a SERM and has beneficial action on Bone—increases formation Blood—decreases LDL, increases HDL Breast—decreases risk of carcinoma Note: Doloxifen and Toremifen has similar action. Raloxifen—only unfavorable action is thromboembolism. • Thromboxane A2—aggregate platelets Mnemonic: A for A Prostaglandin I2—Inhibits aggregation of platelets Mnemonic: I for I • Uses of colchicine— G—Gout C—Cirrhosis M—Acute Mediterranean fever S—Sarcoidosis • Acute gout— N—NSAIDS C—Colchicine C—Corticosteroids
  • 78. Pharmacology 69 • Indications of chloroquine— R—RA E—Extraintestinal amoebiasis D—DLE L—Lepra reaction I—Infectious mononucleosis P—Photogenic reactions Mala—Malaria G—Giardiasis • Anakinra—IL 1 receptor antagonist. Mnemonic: A1 • Oprelvekin is IL 11 used in anticancer drug induced thrombo- cytopenia. Mnemonic: Eleven kin • Ticlopedine causes thrombocytopenia Mnemonic: T for T • Side effects of heparin— A—Alopecia B—Bleeding H—Hyperkalemia O—Osteoporosis T—Thrombocytopenia • Mast cell stabilizers K—Ketotifen N—Nedocromil S—Sodium cromoglycate • Busulfan—side effects— S—Skin pigmentation U—Uric acid increased LF—Lung fibrosis A—Adrenal insufficiency
  • 79. Mnemonics70 • TOC for Hodgkin’s lymphoma— Earlier: M—Mechlorethamine O—Oncovin (Vincristine) P—Prednisolone P—Procarbazine Now preferred: A—Adriamycin/Doxorubicin B—Bleomycin V—Vinblastin D—Dacarbazine • TOC for NHL— C—Cyclophosphamide H—Hydroxydaunorubicin/Doxorubicin O—Oncovin/Vincristine P—Prednisolone +/– R—Rituximab • TOC for colorectal carcinoma— FOLFOX or FOLFIRI FOL—Folinic acid F—5FU OX—Oxaliplatin or IRI—Irinotecan • Uses of methotrexate— C—Choriocarcinoma A—Abortion N—NHL C—Crohn’s disease E—Ectopic pregnancy R—RA • Etoposide is used in— T—Testicular carcinoma O—Oat cell carcinoma P—Prostate carcinoma
  • 80. Pharmacology 71 • Side effects of cytotoxic drugs— B—Bone marrow suppression A—Alopecia D—Diarrhea H—Hyperuricemia • Hypolipidemic drugs—bile acid binding agent Cholestyramine Cholestipol Cholesevalam Mnemonic: Chole • Ketamine K—Kids. Induction agent of choice in children. E—Emergency reaction T—Thalamocortical junction is site of action causing dissociative anesthesia A—Analgesia (profound) M—Meals—can be given after meals I—Increase all pressures (BP, IOP, ICP) N—NMDA receptor blocker of glutamate E—Excellent bronchodilator—preferred in asthamatics.
  • 81. • Class I MHC molecules: CD8 T cells 1 × 8 = 8 Class II MHC molecules: CD4 T cells 2 × 4 = 8 Peptide binding site on Class IMHC molecules is located in a groove between distal domains of α subunits (between α1 and α2 domains) Mnemonic: 1dααααα • Mechanism of resistance Production of βββββ-lactamase: Both gram +ve and gram –ve Alteration in PBP: Gram-positive Impaired permeability: Gram-negative Mnemonic: Beta both PBP: Positive (2P is positive) • Hepatitis virus Hep A Hep B Hep C Hep D Hep E Hep G Picorna Hepa DNA Flavivirus Incomplete Calcivirus Calcivirus Mnemonic: PH FICC (Pic of Hema Fall In Class) • Dengue hemorrhagic fever Serotype 1 followed by serotype 2 is more dangerous than Serotype 4 followed by: Serotype 2 Mnemonic: 12 >42 Also remember: Serotype 2 is more dangerous than other serotypes. • Lysogenic conversion Salmonella typhi 72 Microbiology 5
  • 82. Microbiology 73 Clostridium botulinum Corynebacterium diphtheriae Mnemonic: Salmon bottles corn for lysogeny • Nuclear inclusion bodies Cowdry type A: Herpesvirus Yellow fever virus Mnemonic: HAY Cowdry type B: Adenovirus Poliovirus Mnemonic: BAP • Methods for sterilization of endoscopes Rigid endoscope Autoclave Mnemonic: RiA Flexible endoscope Glutaraldehyde peracetic acid (20% cidex) Mnemonic: EFG • Dimorphic fungi Penicillium marneffei Blastomyces Histoplasma capsulatum Paracoccidiomyces Candida albicans (not other Candida) Sporothrix Mnemonic: Dimorphic Penicillin Blast his Para’s albi spores • Culture media for isolation of Leptospira Korthof medium EMJH medium Fletcher medium Stuart medium Mnemonic: KEFS • Man is the definitive host in most of the parasitic infections except the following parasites where it is an intermediate host Hydatid worm (Echinococcus granulosus) Malaria (Plasmodium)
  • 83. Mnemonics74 Taenia solium (both definitive and intermediate host) Toxoplasma gondii Sarcocystis lindemanii Mnemonic: HMT goli • Parasites malabsorption Common to adults and children: Entamoeba histolytica Giardia lamblial Hymenolepis nana Mnemonic: EGH Only adults Strongyloides Cyclospora Mnemonic: Strong Cycle of adults Only Children: Ancylostoma duodenale Isospora belli Cryptosporidium Mnemonic: An Iso Cry of Children • Antigen–antibody reaction Ascending part: Prozone or zone of antibody excess Peak—zone of equivalence Descending part—post zone or zone of antigen excess Mnemonic: A Probe • Oocyst size of acid fast parasites causing malabsorption Cryptosporidium—5 μm Cyclospora—10 μm Isospora—25 μm (Alphabetically arranged, size increases) • Parasite causing autoinfection Mnemonic: Strong Heman cryptically enters Philippines for Taenia solium auto infection. Strongyloides stercoralis Hymenolepis nana Cryptosporidium parvum Enterobius vermicularis
  • 84. Microbiology 75 Capillaria Philippinensis Taenia solium • Worms that do not multiply in host. Ancylostoma duodenale Enterobius vermicularis Wuchereria bancrofti Mnemonic: Duodenum bans entry and multiplication Also remember Worms that crawl out Enterobius vermicularis T. saginata Mnemonic: Crawling entry of saginata • Microaerophilic bacteria Helicobacter pylori Borrelia burgdorferi Campylobacter Mnemonic: Hell Boy in Micro Camp • Viruses associated with blood transfusion Parvovirus B-19 Hepatitis B Hepatitis C Hepatitis G HIV type 1 HTLV type 1 Cytomegalovirus Mnemonic: 19 BCG transfuses type 1 of Cytomegalovirus • Transport media for Vibrio cholerae Venkatraman Ramkrishnan (VR) media Alkaline peptone water Monsur’s taurocholate tellurite peptone water Mnemonic: Venkat transport Alkaline water to Maissur • Obligate intracellular parasite Virus Chlamydia Rickettsiae
  • 85. Mnemonics76 Legionella Mnemonic: VCRL (Viru Chalne ke liye Rickshaw lega) • Selective media in which substances that inhibit or poison all but a few microorganisms are added to a solid media (S for S). Enrichment media are produced by adding selective substances to liquid media. Enriched media are basal media enriched with blood, serum or egg. • Classification of streptococci: Hemolytic (P) streptococci are classified by Lancefield classification—based on nature of a carbohydrate ‘C’ antigen (Group A to K without I and J) Griffith typing—‘M’ Protein Mnemonic: GMP • 01 Vibrio cholerae Classical: Polymixin, Phage 4 Mnemonic: Polyphagic class Eltor: Eltor, chick embryo • Mycobacterium tuberculosis complex No environmental source M. tuberculosis M. bovis M. africanum M. microti • Non-tuberculous mycobacteria (Atypical mycobacteria) Environmental source is postulated M. avium intracellulare complex M. kansasii Mnemonic: Kans ka avium in atypical environment • Enteropathogenic E.coli or Enteroadhesive E. coli—attaches intimately to enterocyte membrane, Infants and Children, Epidemic Mnemonic: Infant attaches ad for epidemic in Patho. Enterotoxigenic E.coli: Traveller’s diarrhea Mnemonic: T for T—Produces enterotoxin (Labile/Stable)
  • 86. Microbiology 77 Enteroaggregated E.coli: Persistent diarrhea—heat stable enterotoxin EAST I Mnemonic: Aggregate persists Enteroinvasive resembles shigellosis Detected by Sereny tests, penetration of the Hela and Hep2 cells. Mnemonic: H2 S2 invades • Leptospira: Three Rs Rat, Rice, Rainfield. • Treponema palladium, Syphilis endemicum: Bejel Mnemonic: Bend Pertunae: Yaws (Mnemonic: Ytune) Caratium: Pinta (Mnemonic: Pintu ki Car) • Chlamydia trachomatis Serotype A, B, Ba, C: Endemic blinding trachoma Serotype D–K: Inclusion conjunctivitis, genital chlamydiasis, Infant pneumonia Mnemonic: IGI Serotype L1, L2, L3: Lymphogranuloma venereum Mnemonic: L for L • Immunoglobulin IgG IgA IgM IgD IgE Percentage of 75–85% 7–15 5–10 0.3 0.019 total serum Ig Serum half-life days 23 6 5 3 2.5 Mnemonic: In decreasing order GAMDE Classical complement activation: IgM and IgG (Mnemonic: Mahatma Gandhi Classical) Alternate complement activation: IgA Mnemonic: A for A Ig present in milk: IgA and IgG (Mnemonic: AG in milk) • Epitope: Antigen Paratope: Antibody • Toxin acting by inhibiting protein synthesis Shiga toxin
  • 87. Mnemonics78 Pseudomonas toxin Diphtheria toxin Mnemonic: Antiprotein ships dip p-pilli are pyelonephritis associated pilli that are found on uropathic strains of E. coli. Mnemonic: P for P • Gram-positive coccobacilli: Listeria • Gram-negative coccobacilli: Bordetella Brucella Campylobacter Chlamydia Helicobacter Haemophilus Rickettsia Mnemonic: BCHR • Bacteria acquiring characteristics Transformation (free DNA soluble DNA): Pneumococcus Bacillus Haemophilus Mnemonic: BPH/PnBaha Transduction (bacteriophage): Method of genetic engineering T/t of inborn errors of metabolism Mnemonic: DIG Conjugation (actual physical contact): Episomes and plasmids for resistance. Lysogenic conversion (phage DNA itself is new genetic element) Corynebacterium diphtheriae Salmonella typhi Clostridium botulinum • Thymus dependent tissues (collection of T-lymphocytes) Spleen: Malpighian corpuscle in white pulp (periarterial) Lymph node: Paracortical area between follicles in cortex and medullary cords in medulla Mnemonic: Para Mal dependent Bursa dependent (collection of B-lymphocytes)
  • 88. Microbiology 79 (Thymus independent) Spleen: Germinal centre Mantle layer Perifollicular region Mnemonic: German Man around follicle are independent Lymph nodes: Medullary cords Cortical follicles Germinal centres Mnemonic: Medulla and cortex in Germany are also independent • Property S. aureus S. epidermidis Coagulase Positive Negative Mannitol Ferments Non-fermenting Pathogenicity Pathogenic Non-pathogenic • Susceptibility tests Shick test: Diphtheria Dick test: Scarlet fever Mnemonic: S for D and D for S (opposite) • Spirochete: Borrelia Leptospira Treponema Mnemonic: BLT (Balti in Hindi) • Combined immunodeficiency SCID (severe combined immunodeficiency)—def. of ADA Wiskott-Aldrich syndrome Ataxia-telangiectasia Nezelof syndrome Mnemonic: SWAN Defective Phagocytosis Chronic granulomatous disease (def. of NADPH oxidase) Chediak-Higashi syndrome Myeloperoxidase def. Job’s syndrome • Two pigments produced by Pseudomonas aeruginosa Pyocyanine: Bluish green pigment Mnemonic: BC Pyoverdin (fluorescein): Greenish yellow pigment
  • 89. Mnemonics80 • Visceral larva migrains—Toxocara canis Cutaneous larva migrains— A—Ancylostoma duodenale N—Necator americanus S—Strongyloides stercoralis • Human is the dead end host for L—Leptospirosis T—Tetanus T—Taenia solinum E—Endemic typhus Japan—Japanese encephalitis L—Legionella E—Echinococcus, trichinella H—Human rabies
  • 90. • Characteristic features of Staphylococcus pneumoniae Pneumatocele (thin walled cystic spaces that may contain air fluid levels) Pleural effusion Pyopneumothorax (bronchopleural fistula) Abscess formation Cavitation (single or multiple thick-walled cavities) (may be bilateral) Empyema Mnemonic: 3P and ACE • Actin: AD FSGS CD2AP: Adult proteinuria Steroid sensitive: NPHS I-Nephrin-19q. Finish congenital nephrotic syndrome Steroid resistant: NPHS 2-Podocin-lq: AR acquired FSGS Mnemonic: 2R-lq-AP • Type III (pauci immune) RPGN ANCA small vessel vasculitis Wegener’s granulomatosis Microscopic polyangiitis Churg-Strauss syndrome Mnemonic: WMC • Cox 1 Constitutive Cox 2 Inducible • Large vessel vasculitis Giant cell arteritis (temporal arteritis) Takayasu arteritis 81 Pathology 6
  • 91. Mnemonics82 Cogan syndrome Mnemonic: Large giant taka of cogan • Medium vessel vasculitis PAN Kawasaki disease Buerger’s disease Mnemonic: Pan per kabab aur burger) • DNA repair defects HNPCC (mismatch repair): Colon ca. Bloom syndrome: Developmental defects Fanconi anaemia: Bone marrow aplasia Ataxia-telangiectasia: Neural symptoms Xeroderma pigmentosa (nucleotide excision repair)—skin ca. Mnemonic: HB FAX • Bcl-1: Mantle cell lymphoma Bcl-2: Follicular lymphoma Bcl-6: Burkitt lymphoma Mnemonic: My favourite Band is Bcl-126 Diffuse large B cell lymphoma—Bcl-2 and Bcl-6 Mnemonic: D-26 • HLA B27 is associated with Juvenile rheumatoid arthritis Psoriatic spondylitis Ankylosing spondylitis Inflammatory bowel disease Reactive arthritis/Reiter’s syndrome Mnemonic: Juvenile PAIR at 27 yrs of age • Risk factors for atherosclesosis in decreasing order Total cholesterol: HDLC Apoprotein B 100: HDLC LDL cholesterol: HDLC Mnemonic: TBL ratio H • Classification of hyperlipoproteinemias Lipoproteins elevated
  • 92. Pathology 83 I: chylomicrons IV: VLDL V: (1+ 4 = 5)—chylomicron and VLDL III: (4 – 1 = 3)—chylomicron and VLDL remnant II: LDL (lla—LDL, IIb—LDL and VLDL) • Radical scavenging enzymes – Glutathion peroxidase – Catalase – Superoxide dismutase Mnemonic: GCS Note: Superoxide dismutase also generates free radicals (H2O2). • Amyloid proteins and their clinical settings Transthyretin (ATTR) Familial amyloidotic neuropathy Mnemonic: FAT Systemic senile amyloidosis Mnemonic: SST β2 microglobulin (Aβ2m): Hemodialysis associated amyloidosis Mnemonic: Dial M for amyloid β2: amyloid protein (Aβ): Alzheimer’s disease Senile cerebral disease Mnemonic: Sc and Ad • Flexner-Wintersteiner rosettes are characteristic of retinoblastoma May also be seen in Medulloblastoma and pineoblastoma Mnemonic: Flexible RMP (All are blast) • Glomerulonephritis without proliferative changes Minimal change disease Amyloidosis Membranous glomerulonephritis Diabetic nephropathy ± FSGS Mnemonic: Minimum Amul for membranous Dia
  • 93. Mnemonics84 • Fibromatosis represent a group of fibrous benign or tumour- like conditions Deep fibromatosis: Desmoid tumors Mnemonic: Deepa ka Des Superficial fibromatosis Palmar fibromatoses (Dupuytren’s contracture) Plantar fibromatoses Penile fibromatoses (Peyronie’s disease) • Prader-Willi syndrome: Clinical features Mental retardation Diminished fetal activity Hypotonia Obesity Short stature Hypogonadotrophic hypogonadism Mnemonic: Pradip MDHOSH • Angelman–Willi syndrome Seizures Hypotonia Inappropriate laughter (Happy puppets) Mental retardation Ataxia Mnemonic: Happy puppet SHIMA • Multiple myeloma Dutcher bodies—nuclear Mnemonic: Multiple nuclear Dutch Russell bodies: Cytoplasmic (Mnemonic: Russell Crowe) • Mooser’s bodies: Endemic typhus Mnemonic: Moosa is endemic Miyagawa bodies: Chlamydia trachomatis Mnemonic: Miya Kalam Lafora bodies: Familial myoclonic epilepsy Mnemonic: Lofar in Family
  • 94. Pathology 85 • Pancytopenia with cellular bone marrow Myelodysplastic syndrome Myelofibrosis Myelophthisis Bone marrow lymphoma Aleukemic leukemia Hairy cell leukemia Mnemonic: Cellular bone marrow M3 ka BAP hai • Cold antibody hemolytic anaemia—usually IgM Mnemonic: CM – Class Mate • Proteins defective in hereditary spherocytosis Ankyrin > protein 3 (anion transport channel) > α-spectrin > protein 4.2 (palladin) Mnemonic: AP3 ααααα S P4.2 First memorize APSP Then AP3SP Then AP3 α SP Then AP3 α SP4.2 • Prader-Willi syndrome: (Chromosome 15) Paternal deletion Maternal imprinting Maternal disomy AngeIman syndrome: Maternal deletion (Chromosome 15) Paternal imprinting Paternal disomy • Mechanism of apoptosis Caspase 9 (Nine): Intrinsic pathway Mnemonic: In for In Caspase 8 (Eight): Extrinsic pathway Mnemonic: E for E • Histochemical staining of amyloid with Congo red observed under ordinary light—pink red colour. Observed under polarized light: Green birefringence Mnemonic: PG • Genes regulating apoptosis Anti-apoptotic Pro-apoptotic
  • 95. Mnemonics86 bcl-2 bax bcl-XL bad bak bim bcl-xs Mnemonic: L and LXL are anti-apoptotic • Chronic manifestations of splenectomy Anisocytosis Basophilic stippling Howell-Jolly bodies (nuclear remnants) Heinz bodies (denatured Hb) Nucleated erythrocytes in peripheral blood, occasionally Poikilocytosis • Howell-Jolly bodies occur most frequently after Splenectomy Megaloblastic anaemia Severe hemolytic anaemia Mnemonic: Jolly SMS • Inactivation of free radical reactions Enzymes: Glutathione peroxidase Catalase Superoxide dismutase Mnemonic: GCS Non-enzymatic system: Endogenous/exogenous anti-oxidants a. Vitamin E, vitamin C b. Sulfhydryl containing compounds: glutathione, cysteine c. Serum protein: Albumin Ceruloplasmin Transferrin Mnemonic: EC GC ACT • Renal lesions in SLE (WHO classifications) Class I: Normal by light, electron and immunofluorescent microscopy Class II: Mesangial lupus GN (Mildest clinical variant proteinuria, microscopic hematuria rare)
  • 96. Pathology 87 Class III: Focal proliferative GN (Moderate, presents with proteinuria and hematuria) Class IV: Diffuse proliferative GN (Haematuria, nephrotic range proteinuria, mild to severe renal failures) Class V: Membranous GN (Massive proteinuria and nephrotic syndrome) Class VI: End stage of proliferative lupus nephritis Mnemonic: No Money FD ME Note: GN—glomerulonephritis • Location of epitheloid—Testis Ovary (tunica) Pancreas (Islet) Mnemonic: TOP Pathologically found in granuloma. • Antigen presenting cells (APC) Professional (MHC II, GVHD)—Dendritic cells Langerhans’ cells Follicular dendritic cells. Mnemonic: DLF is Very professional Non-professional (MHC I, graft rejection)—Macrophages B-lymphocytes Glial cells Endothelial cells Thymic epithelial cells. • Autosomal dominant (AD) H—Hypercholesterolemia (familial) Hereditary spherocytosis Huntington’s chorea E—Ehlers-Danlos syndrome A—Achondroplasia V—von Willebrand’s disease (type I and II) Y—Pseudohypoparathyroidism D—Dystrophica myotonica
  • 97. Mnemonics88 O—Osteogenesis imperfect M—Marfan’s syndrome I—Intermittent porphyria N—Noonan’s syndrome A—AD PKD N—NF I and NF II T—Tuberous sclerosis • Marfan’s syndrome M—Mitral valve prolapse A—Arachnodactyly (long fingers) R—Retinal detachment F—Fibrillin I deficiency Family history A—Ascending aorta aneurysm N—Negative nitroprusside test S—Superotemporal subluxation of lens • Neurofibromatosis I (17q) N—Neurofibroma O—Optic nerve glioma S—Sphenoid dysplasia (most common skeletal deformity) P—Plexiform NF Positive family history A—Axillary freckling C—Café-au-lait spots E—Eye (Lisch nodules on iris) • Neurofibromatosis II (22q) M—Multiple I—Inherited S—Schwannoma M—Meningioma E—Ependymoma • Autosomal recessive A— Alkaptonuria Albinism B—Beta thalassemia, sickle cell anemia C—Cystic fibrosis
  • 98. Pathology 89 D—Deafness (sensorineural) E—Emphysema (Panacinar-α1 antitrypsin deficiency) F—Friedrick’s ataxia G—Gaucher’s disease H—Hurler’s disease Hemochromatosis I—Inborn errors of metabolism Others—Niemann-Pick’s disease Tay-Sachs disease Wilson’s disease • X linked recessive Less—Lesch-Nyhan syndrome Chronic—Chronic granulomatous disease Hunter—Hunter’s disease Hemophilic—Haemophila A and B Girls—G6PD deficiency Don’t—Duchenne muscular dystrophy Dent’s disease Color—Color blindness Fragile—Fragile X syndrome Fab—Fabry’s disease Brutun—Brutun’s X linked agammaglobulinemia Wisely—Wiskott-Aldrich syndrome • X linked dominant Rat me—Rett syndrome (only seen in females) Char—Charcoat Mari tooth disease Pig—Incontinenta pigmenti (only seen in females) Airport pe—Alport syndrome Phosphate kha raha tha—X linked hypophosphatemic rickets • Mitochondrial inheritance K—Kearns Sayre syndrome L—Leber’s hereditary optic neuropathy M—MERRF (myoclonic epilepsy with ragged red fibres) MELAS (mitochondrial encephalopathy with lactic acidosis with stroke like syndrome) N—NARP (neurologic ataxia with retinitis pigmentosa)
  • 99. Mnemonics90 O—Ophthalmoplegia (chronic external ophthalmoplegia) P—Pearson syndrome • Multiple myeloma Symptoms C—Hypercalcemia R—Renal failure A—Anemia B—Bone lytic lesion (on X-ray or bone scan) • ALL Testicular infiltration Mediastinal lymph node involvement CNS infiltration Mnemonic: TMC • Supravital stains—Brilliant cresyl blue New methylene blue Crystal violet Mnemonic: BNC • Stain Acidic Basic Cytoplasm DNA • Warm antibody—IgG Cold antibody—IgM Mnemonic: Classmate Exception—PCH (Donath Landsteiner antibody)-IgG • Differential diagnosis of microcytic hypochromic anemia Sideroblastic anemia Iron deficiency anemia Thalassemia Anemia of chronic disease Mnemonic: SITA • Migratory thrombophlebitis (Trousseau syndrome) S—Stomach L—Lung
  • 100. Pathology 91 A—Adenocarcinoma P—Pancreas • Mutation of p53 Li-Fraumeni syndrome. It is the most common gene mutation causing human cancer. S—Stomach cancer B—Breast cancer B—Brain cancer A—Adrenal cancer L—Lung cancer (squamous cell carcinoma) Mnemonic: SBBAL • Flea bitten kidney found in We—Wegener’s granulomatosis Hate—HSP P—Polyngitis S—Subacute endocarditis M—Malignant hypertension • Posterior fossa anomalies Dandy-Walker syndrome—Dilatation of 4th ventricle because of midline arachnoid cyst. Posterior fossa volume is increased. Mnemonic: D for D. D is 4th letter Arnold-Chiari malformation—cerebellar herniation. • Myelin formation CNS—Oligodendrocytes PNS—Schwann’s cells. Mnemonic: COPS • Serology in hepatitis B— s—HbsAg e—HbeAg c—anti HBc ab e—anti HBe ab s—anti HBs ab Note: c antigen lacks soluble surface receptor. So, do not appear in serum.
  • 101. Mnemonics92 • Hepatitis D virus Delta virus Defective virus (HDV RNA) Dependent (on HBV) • Causes of Mallory-Denk body— Indian childhood cirrhosis Wilson’s disease Hepatocellular carcinoma Alcoholism α1 anti-trypsin (AT) deficiency Primary biliary cirrhosis Mnemonic: Indian child wil have alcohol AT primary bill • Focal nodular hyperplasia Females more commonly affected (ten times) OCP use is associated Asymptomatic Single Mnemonic: FOCAl
  • 102. • Mechanism of Injury caused by lightening flash as described by Cooper and Andrews (1995) Direct strike Side flash Step voltage Sledge hammer effect (blunt trauma) Surface arc discharges and touch voltage Mnemonic: 5S Also remember: Four factors of Spencer Burning by superheated air Sledge hammer and blow death by compress pushed before the current Direct effect of high voltage current Effect of expanded and repelled air Mnemonic: BCDE • Drug used for narcoanalysis (truth serum drugs) Scopolamine Sodium pentathal Sodium amytal Sodium seconal Mnemonic: PAS Sodium and Scopolamine • Exception to general rule of professional secrecy C Crime I Infectious disease V Venereal disease I Interest (Self) C Courts of Law S Servants and employees 93 Forensic Medicine and Toxicology (FMT) 7
  • 103. Mnemonics94 I Interest (Patient’s) N Negligence suits notifiable disease. CIVIC SIN InP.S . Interest: Patient’s and self • Anti-cholinergic (atropine dhatura) poisoning Dry as a bone (dryness of mouth and skin) Red as a beet (flushed face) Blind as a bat (dilated pupil) Hot as a hare (hyperpyrexia) Mad as a wet hen (delirium) Or Dryness of mouth and anus (i.e. constipation) Dysphagia Dilated pupils Dry hot skin Drunken gait Delirium Drowsiness Death due to respiratory failure • Seminial stain is identified by UV light (physical methods) Mnemonic: SUV • Constituents of a typical embalming solution Formalin Glycerin Mnemonic: EFG • Methods of torture suspension by the wrist: La bandera (Mnemonic: Wrist band) Beating with the palm on both ears simultaneously— telephone Mnemonic: We pickup telephone to ear • Hanging versus strangulation Hanging features: Stretched neck Saliva (often runs out of mouth) Seminal fluid at glands Carotid artery damage may be seen
  • 104. Forensic Medicine and Toxicology (FMT) 95 Oblique ligature mark Mnemonic: Hang SSS and CO • Fatty liver is found in Phosphorus > arsenic > mercury poisoning Mnemonic: Fatty PAM • Mercury poisoning: Diphtheritic colitis Mnemonic: Mercury Dips in Cold • Clinical feature of chronic lead poisoning—acute mani- festations Anemia (with punctate basophilia) Burtonian line Colic and constipation: First symptom to arouse suspicion of lead poisoning Drop of wrist and foot Encephalopathy in children Facial pallor: Earliest symptom Genitourinary system: Menstrual disorders, abortions still- births, degenerate off-springs and sterility. • Forensic tests to detect seminal stain Acid phosphatase test Barberio test Creatine phosphatase test ELISA test Fluorescence test Mnemonic: ABCEF • Fingerprint patterns Loops 67% Whorls 25% Arches 6–7% Composite 1–2% Mnemonic: LWAC • Cephalic index 70–74.9 Pure aryans (Dolichocephalic) Aborigins
  • 105. Mnemonics96 Negroes Indians Mnemonic: PANI in Doli 75–79.9 Europeans (Mesaticephalic) Chinese Mnemonic: European in Chinese mess 80–84.9 Mongols (Brachicephalic) Oriental Asians Native Americans Mnemonic: MONA Dolichocephalic Rectangular Mesaticephalic Triangular Brachicephalic Rounded Mnemonic: DMB in increasing order • Screening tests for blood stains Benzidine Orthotoluidine Leucomalachite green Phenolphthalein Note: All these works on the principle of Hb as peroxidase, which in presence H2O2 turns odourless bases into coloured salts. • Blood /urine alcohol levels Alcohol dehydrogenase method (ADH method) Breath analysis Cavett method/Kozelka and Hinc method Gas chromatography—most desirable for medicolegal purpose Mnemonic: ABC-GK • Snake venoms Vasculotoxic Vipers (V for V) Neurotoxic Cobra (Convulsion) (C for C) Krait (paralysis) Coral Mnemonic: CKC Myotoxic: Sea snake
  • 106. Forensic Medicine and Toxicology (FMT) 97 • Gustafson method of age determination by inspection of individual teeth: Root transparency: Precise measurement Root resorption Attrition Paradentosis Secondary dentin formation Cementum opposition Mnemonic: TRAP SC • Harrison and Gilroy test: Antimony, barium, lead Mnemonic: Anbale Atomic absorption spectroscopy (AAS): Antimony, Copper, barium Mnemonic: Ancoba Neutron activation analysis: Antimony, copper • Getters test is done for drowning. It estimates chloride content of blood from both sides of the heart. A difference of 25% in chloride content is considered. Significant features seen Fresh water drowning: Hemodilution Lysis of RBC with liberation of potas- sium Chloride content of left side of heart decreased Salt water drowning : Hemoconcentration RBCs are crenated Chloride content of left side of heart increased • Sign of death from typical drowning Persistent profuse fine froth from the mouth and nose Materials (that could be obtained from water only) grasped in the hand Fine typical froth from the air passage Increased volume and edematous condition of the lungs. Finding of diatoms in the tissues, especially brain and bone marrow.
  • 107. Mnemonics98 • Permanent teeth Eruption time First molar 6–7 years Central incisor (6–8 years) 7–8 years Lateral incisor 8–9 years First premolar 9–11 years Second premolar 10–12 years Canines (11–12 years) 11–13 years Second molars 12–14 years Third molars 17– 25 years • Magnan’s symptoms: Feeling as if grains of sago are lying under skin Feeling as if small insects (cocaine bugs) are creeping on the skin. It is seen in chronic cocaine poisoning. Macewan sign: An indication of hydrocephalus in which percussion of the skull generates a cracked pot sound. • Putrefaction is delayed after death due to poisoning by Carbolic acid Arsenic Antimony Nux Vomica (strychnine) Zinc chloride Mnemonic: CARAN Vomit Zinc to delay putrefaction • Dactylography (Galton system)—Study of finger prints. Mnemonic: DaGa Poroscopy (Locard’s system)—Study of number, sizes and distribution of pores of sweat glands on ridges (used only when a part of finger print is available). Mnemonic: PoLo Podogram—Study of foot print. Cheiloscopy (queiloscopy)—Study of lip prints. Rugoscopy (palatoprints)—Study of anterior part of palate. Mnemonic: RuPa • White vitriol—Zinc sulphate Blue vitriol—Copper sulphate.
  • 108. • World health report 2008 Primary health care: now more than ever—the report proposes four sets of reforms Public policy reforms Leadership reforms Universal coverage reforms Service delivery reforms Mnemonic: PLUS • Eight essential components of primary health care (Alma-Ata declaration) Education concerning prevailing health problems and methods of preventing and controlling them. Prevention and control of locally endemic diseases Immunization against major infection diseases Maternal and child health care including family planning Essential drugs provisions Promotion of food supply and proper nutrition Treatment of common diseases and injuries Adequate supply of safe water and sanitation. Mnemonic: ELIMENTS • Ratio: Prevalence Standardised mortality ratio Case fatality ratio Mnemonic: PSC (Public Service Commission) • National health policy 2002 2005—Polio, leprosy and yaws Mnemonic: POLY 2015 (fifteen) – filaria. Mnemonic: f for f 99 Preventive and Social Medicine (PSM) 8