Indian Medical PG Entrance exam preparation Tips
Following article is copied from AIPPG
There are no shortcuts. Competition is quite fierce these days and a casual approach to exam is not going to help. But if u plan properly and keep your cool during exam, there is no reason that you cant make it. I will try to give some tips. I hope some of you can benefit from it. All the views expressed here are my own and true and helpful to the best of my knowledge!!
- All India Pevious years' solved papers by Mudit Khanna
- AIIMS solved papers by Amit and Ashish
- Tehalaka by Dr. Rajesh Prasad (it contains solved mcqs of anatomy, physiology, biochemistry and forensic medicine)...Must read book according to me
- Sure Success By Ramgopal
- Chauthary For PGI (not that useful for all india)
These are the basic mcq books that should be done thoroughly. If u done with them, than you can do salgunan. In my opinion, this book is not necessary for all india. atleast i didnt read it
Regardless of what i write here, you must follow your own plan according to your strengths and weaknesses. Spend more time on the subjects in which you are weak. This is the kkey to success. You have to identify which subjects made you suffer during your profs or during your previous attempt(s). Its always a good idea to finish them first. You can follow any order in doing subjects as u like. Try to finish all subjects atleast2-3 months beforte the main exam so that you can have adequate time to give the revisions.
For each subject, you have to do the previous years' questions(AIIMS and All India), corresponding theory book and Ramgopal sure success. I also would recommend to keep Harrison alongside as a referance while doing any subject. It will always come handy.
I also recommend you to take a small notebook and start taking notes of difficult to remember points, some important flow charts and tables. These come really handy for last day revision before the exam. You have to make sure that you don get too carried away with writing more and more as it will just waste your time and you may not be able to revise the whole things in one day before the exam. You ma do it subjectwise (if u have the patience)...or you can just write the points randomly (just like me).
This is the subject i never did all through my preparation! Indeed it seems too much for an effort to read through all volumes of chaurasiya and still not able to solve the mcqs.
Recommended Books: Chaurasiya (all 3 volumes), Sure success by Ramgopal(big book), Tehalaka by Dr. Rajesh Prasad(for mcqs)
if u ae short on time, i would suggest to read the anatomy pages from ramgopal's book and do mcqs from tehalaka...this way you should be able to answer more than half the questions from anatomy, which according to my opinion is quite good. you should concentrate on nerve injuries, nerve entrapment syndromes, muscles nerve supply and actions(especially upper limb), various type of joints(asked many times!), various fossa and there contents and cranial nerves. anyway one should not be spending too much of time on anatomy as itsa low yielding subject.
Recommended books: Ganong (very good book), Guyton (only for referance), Tehalaka.
Here tehalaka comes in very handy. if you read all the mcqs with explaination from this, you would be able to solve majority of the common questions from physiology. supplement it with ganong with selected reading with special emphasis on general physiology topics
Recommonded books: Harper, Tehalaka, lippincott (as an alternative)
lot of people will say that lippincott is very good, but i never found it that good. I would recommend reading Harper. The newer editions of Harper have been progressively trimmed, so it should not take more that 10 days to read on the first go. Topics that should be stressed are genetics(obviously!), chapters at the beginning(like enzymes, amino acids and some general chapters), regarding metabolism, it would certainly help, if you take notes of some important points on a note book for quick revision before exam. It will certainly help.. Tehalaka is nice for revising the facts quickly
Recommended books: Pareikh, Tehalaka, forensic SARP
Here again Tehalaka comes in very handy. you can solve most of the mcqs from this book. Also forensic SARP is not bad at all for poisonings (especially do lead, mercuary, arsenic and others commonly asked). I would suggest you to make small notes of important features of common poisonings for quick revision later on. From Pareikh, do only selected reading. Always spend some time on ballistics...they need to be understood properly to solve the related mcqs.
Recommended books: Robbins(big)
This is the only book thats needed...and of course, i am not including harrison, because i persume that you keep it alongside for referance while doning any subject. This in my opinion is the most important subject(even more than medicine, surgery). If u have good grasp of pathology, it would certainly go a long way to improve your chances in PG exams. I recommend you to read this book thoroughly with more emphasis on blood, GIT, kidney and general pathology...things that you can probably skip or do selectively are: CNS, Musculoskeletal system and other chapters towards the end of the book. I you have read this book during your prof, it would certainly help.
Recommended books: Tripathi, Katzung (Referance), Goodman & Gilman (only for referance, not at all essential!), Tumors SARP
Agian this is a very important and productive subject. In tripathi, more stress should be on ANS and CVS. Tumors SARP is also quite good...just to be read selectively
Recommended books: Ananthnarayan(very good book), jawetz(review), chatterjee(parsitology), SARP microbiology
Jawetz (review, not the text book) i recommend for reading the immunology part. it will help you understand the basics of immunology in a very easy manner. For rest, Ananthnarayan is good enough...special emphasis should be on general microbiology. Virology can be done selectively like doing common ones like hepatitis, rabies, AIDS, rota virus, polio and from parts you see the questions...never forget to do general virology. Bacteriology has be done thoroughly in my view. For mycology, ananthnarayan is good. you may also look at SARP for mycology. For parasitology, although chatterjee is the recommended book but it consumes much of time..i would suggest just reading it from jawetz and doing mcqs. that should be enough for only 1-2 quesions are asked from parasitology.
Recommended books: Park (what else!), High yield biostats by tyagi or Mahajan
SPM is the subject thats often said to decide matters. If prepared properly, it can be quite scoring subject as well ...as hardly anything is asked outside Park. Important topics are first 116 (or something like that) pages. I mean up to the chapter about screening. Learn all the concepts properly. this will help you solve more than half the mcqs of SPM. Diseases should be done selectively. Do the more important diseases like tuberculosis, polio, leprosy, rabies, AIDS, syphilis, respiratory infections, rickettsial diseases, dengue, yellow fever(who cares it doesn’t occur in India!), diptheria and as you see the questions. From the remaining chapters, you should do environment and health chapter, contraceptives, health and nutrition and disease control programmes, health goals and about the health workers and their population allocations....rest can be done selectively.
Biostats you can do from high yield biostats. Its quite good. and you can do it in just one day. Nowadays some questions may even be out of that book. Ypu can also do Mahajan for biostats. Its better but consumes more time
Recommended books: Khurana, kaski (referance), parson(referance)
Khurana will do for most of the questions. for some really hard questions, kanski comes in handy . important topics are... Cataracts, ocular injuries, uveitis, corneal ulcer, refractive errors, tumors(retinoblastoma, melanoma), retinitis pigmentosa, optic atrophy, papiloedema, chalazion.
Recommended books: Dhingra
Nothing much to say. Dhingra will do for most of the questions. read selectively. more impotant topics acoustic neuroma, facial nerve course and palsy, otosclerosis, CSOM and its complications, layrngeal polps, nodules and cancer, DNS, sinusitis, epistaxis, abscess in reation to pharynx, tonsils.
Recommended books: Ghai, Nelson(referance)
Sometimes questions seem to be set from nelson and ghai seems to be insufficient. while thats true, but thats not a reason to read nelson. you cant gain much by reading nelson(its too huge a book). rather reading some selected topics may be useful. In Ghai, more stress should be on nenatology part, also CVS in quite good. also dont forget metabolic diseases and genetic diseases. Use nelson for refreance purpose as and when required. If u can spare some time, try to read the kidney part..that is cysts, dysplasias and vesicoureteric reflux.
Gynae and Obs:
Recommended books: Shaw(Gynae) and Dutta(Obs.)
Both very good books. in gynae, more stress should be on oncology, endometriosis, menstural disorders, infertility, fibroids. In Obs., do all the tables and flow charts. that makes it very easy to understand and most of the questions can be solved quite easily. And dont forget chapter of population dynamics and birth control.
Recommended books: Bailey & Love, Sabiston pretest, Schwartz (reference)
Bailey has to be done selectively according to the topics from which mcqs appear. More stress should be on GIT and genitourinary system. Schwartz can be useful for referance especially in GIT
Recommended books: HARRISON or CMDT(depending upon what u have already read), Harrison pretest, Medicine self assessment guide by Amit Ashish
Both books are good. Do the one that you have read during your profs. If u read Davidson during profs, i would suggest to do important topics from CMDT and less important topics from Davidson. As for Harrison, if u have read during your profs, it would certainly give you an edge. Some high yielding topics in Harrison are: CVS, Kidney(especially glomerulonephritis, renal failure), acid base imbalance, Hematology, Genetics, Viral Hepatitis. Important thing is not to get lost in reading medicine alone. Its huge subject and will never finish. So do selectively. Keep more stress on previous years' papers and the topics asked there. Medicine self assessment guide by Amit Ashish come handy for reading selectively from Harrison in retrograde manner
Skin: Harrison, Sure Success Ramgopal, Roxberg (referance)
Harisson and previous years, mcqs will do for most of the questions. Do it from sure success(ramgopal) also. Roxberg has to be used for referance as and when needed.
Anaesthesia: Sure Success Ramgopal, Lee(referance), Yadav
Nothing much to say. Mainly concentrate on previous years, questions. Yadav is said to be very good. But personally I never read it.
This is the only book you should do. even though these days some questions are asked which have referances from PG level books. You are not expected to answer that. Remember you don’t need to score 100%. A score of around 65% actually will give you a very good rank
Psychiatry: Sure Success Ramgopal, Ahuja, High yield psychiatry.
Concentrate on schezophrenia, mood disorders, substance abuse, sleep cycle and disorders, autistc disorder
Radiology : No books needed here in my opinion. Just do previous years, mcqs and also do from Sure Success Ramgopal.
Time to spend on each subject: It depends upon how strong(or weak) you are in a particular subject. also you have to spend less time on subjects from which less questions area asked. anyway, i will try to give a rough idea...
Anatomy-3days(will mainly do questions from Tehalka)
Physio- 5 days
Gynae & Obs.- 20days
Paeds- 7 days
SARP- 5 days
This roughly comes out to be a little more than 6months. You may take some more or some less time depending upon your level of preparation. Its very important not to get stuck at one subject for too long.
1) Should i join a coaching class?
It depends upon yourself. If u can sit and study urself., there is no reason to join any coaching classes. all what coaching classes do, is they help you to get oriented towards your study. It has some advantages but it has some disadvantages too....like tests they take are oten out of reality, course management is usually a mess and you have to follow there programme ion your study. So think and decide!
2) Where should i study?
Wherever you can concentrate without undue interferance. For me, at home.
3) How many hours should i study?
12hrs a day should be the goal. make sure dont let any day go by without studying atleast an hour. Most imporant is to keep maintaining the continuity
4) Should I study alone or in a group?
Its always said to be good to do group study. But it depends upon your nature. I have always studied alone. If u are studying alone, make sure that you keep track of aippg.com forums. it can also serve as an effective group and help you to get the focus right in difficult times.
Best of luck
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TIPS TO BE REMEMBERED WHILE PREPARING FOR PRE PG EXAM
The typical presentation of a thrombosed external hemorrhoid is an acute onset of very severe perianal pain, particularly when walking and sitting.
2. You know that external hemorrhoid is below the dentate line. internal hemorrhoids arise above the dentate line.
3. thrombosed external hemorrhoid requires immediate incision and evacuation of the clot to provide symptomatic relief. Pressure by compression is usually all that is needed to control the bleeding.
4..Sitz baths, applying a topical steroid cream, and increasing fiber intake are the usual treatment for symptomatic external hemorrhoids that are not thrombosed.
5..as a rule alwayes remember that external hemorrhoid s hurts but donot bleeding(opossit internal hemorrhoids)
6.typical picture of pyloric stenosis.,Projectile non-bilious vomiting is seen in virtually all patients. Patients also often develop a hypokalemic, hypochloremic metabolic alkalosis from the persistent vomiting. remeber if they give a child with intermittent spitting up think about pyloric stenosis.
7.abrupt onset of colicky abdominal pain in childeren <2 years ,think about intussusception! what's the etiology? The exact cause is unknown. However, it is associated with Meckel's diverticulum, cystic fibrosis, polyps, and Henoch-Schonlein purpura.
remeber A barium enema or air enema is both diagnostic and therapeutic.
8.Remember In any patient with dysphagia that is progressive for only solids, it suggests a growing and obstructive lesion. The history of tobacco and alcohol use, puts person at a much higher risk of carcinoma. The two ways to diagnose this are a barium swallow study, which will show the mucosal mass, or an upper endoscopy study to directly visualize and biopsy the lesion.
9.Remember Esophageal manometry is used to evaluate dysphagia caused by motility disorders. These typically present with dysphagia for solids and liquids and may or may not be progressive.
10.Incarcerated or strangulated hernias in an elderly patient can cause acute abdomen, dehydration, and altered mental status.
11.. Frequent, greasy, malodorous stools are a result of steatorrhea from chronic pancreatitis. This happens from the lack of pancreatic enzymes. Non-enteric coated pancreatic enzyme supplements with concurrent H2 blockers will deliver active enzymes to the proximal small bowel and help reduce malabsorption and steatorrhea.
12.. Acute acalculous cholecystitis is characterized by fever, nausea and vomiting, right upper quadrant abdominal pain, and inspiratory arrest on palpation of the right upper quadrant (Murphy's sign). An elevated leukocyte count is usually present. Gallstones are not present and it is usually associated with trauma, burn, surgery, diabetes mellitus, and bacterial infections of the gallbladder. BUT
biliary colic, which is characterized by crampy, right upper quadrant abdominal pain that may radiate to the back and often follows a meal. Nausea and vomiting may be present. Fever, chills, and leukocytosis are notably absent. Gallstones are present on an ultrasound.
13.Acute cholangitis is characterized by fever, right upper quadrant pain, and jaundice (Charcot's triad).
14.The hallmark of mesenteric ischemia is pain out of proportion to physical exam findings. Mesenteric ischemia is especially likely in a patient with known vascular disease and a history of cigarette smoking. The next diagnostic step is a mesenteric angiogram. The superior mesenteric artery is the most often compromised vessel.
15. Patients with ulcerative colitis are at high risk for toxic megacolon, which is also associated with Clostridium difficile colitis
16.. Toxic megacolon presents clinically as abdominal distension and bowel motility disturbances. The next step in evaluation is an abdominal radiograph which will demonstrate a distended large bowel.
17.spontaneous bacterial peritonitis. This diagnosis should be first on your list in any patient with ascites who presents with fevers, abdominal pain, change in mental status, or with other non-specific complaints. These patients need to have a paracentesis. This fluid is then sent to the lab for a cell count, culture, and Gram stain. The diagnosis of SBP can be made by seeing bacteria on a Gram stain, having more than 500 WBC or 250 PMNs in the cell count, or a positive peritoneal fluid culture. Patients with SBP need to be started on a third-generation cephalosporin
18.. Lead levels over 10 mg/dL are considered abnormal.
19.Remeber Fluoxetine is a serotonin reuptake inhibitor that requires 5 weeks to reach a steady state in the body and takes approximately 6-8 weeks to show an adequate response. This should be explained to patients before and during treatment to help them understand the importance of staying on the medication even though they do not feel any effects.
20.congenital diaphragmatic hernia, which is when the abdominal contents herniate into the left hemithorax through a congenital defect in the left hemidiaphragm. This causes displacement of the heart into the right hemithorax and pulmonary hypoplasia.
21 key finding for Esophageal atresia with distal tracheoesophageal fistula usually presents with a history of polyhydramnios, cyanosis with feeding, and increased oropharyngeal secretions.
22.Remember in a traumatic lumbar puncture even though the CSF is initially red, the supernatant of the centrifuged cerebrospinal fluid is clear. This means that the red blood cells have not yet had a chance to lyse and release their intracellular contents into the cerebrospinal fluid.
BUT in subarachnoid hemorrhage there would be blood in the CSF, the supernatant of the centrifuged fluid would be xanthochromatic (yellow) due to the lysis of red blood cells and the release of their intracellular contents into the cerebrospinal fluid.
23.The symptoms of crampy abdominal pain and watery, explosive, secretory diarrhea are consistent with enterotoxic E. coli. the cause of traveler's diarrhea ,treatment ciprofloxacin if symptoms persistent.
24.The symptoms of Giardiasis, which usually occur about a week after exposure, include flatus, loose stools, diarrhea, abdominal pain, bloating, and vomiting. The usual scenario for a healthy person that develops this infection is the onset of these symptoms after a camping trip. tx:metronidazole
25.infectious mononucleosis typically presents with a few-week history of fatigue, malaise, and a sore throat. Examination often shows pharyngeal edema, erythema, and palatal petechiae, lymphadenopathy, and splenomegaly. Hepatomegaly may also occur.
26.Hyperthyroidism during pregnancy is treated with propylthiouracil, which crosses the placenta less than other medicines such as methimazole. It should be given in the lowest effective dose and tapered as the patient becomes euthyroid. Untreated severe hyperthyroidism during pregnancy has been associated with spontaneous abortion and premature labor.
27.Remember sudden onset of right upper quadrant pain associated with nausea and vomiting and history right upper quadrant and epigastric pain before, associated with food intake. These symptoms are classical for a perforated peptic ulcer. In a perforated peptic ulcer, a patient can still have right upper quadrant localized tenderness, a thickened gallbladder wall, and pericholecystic fluid from the perforated ulcer. Hence, with any abdominal pain associated with signs, abdominal x-rays both erect and supine are very essential in the initial evaluation to rule out any free air.
28.The first line in treatment of panic disorder is selective serotonin reuptake inhibitors (SSRIs), a group of medications including sertraline, paroxetine, fluoxetine, and citalopram. .
29.Remember Surveillance colonoscopies are generally recommended every 6 months for 2 years beginning after 8 to 10 years duration of ulcerative colitis.
30.The presence of endocervical cells on a Pap test is regarded as evidence of adequate sampling of the transformation zone during cytologic screening of the cervix. When these cells are absent, it indicates that this area may not have been sampled. This is considered a satisfactory, but limited smear. In patients with no known risk factors (i.e., prior abnormal Pap test, multiple sexual partners, smoking) the American College of Obstetricians and Gynecologists recommends that the physician may defer to repeating the Pap test in 12 months even if the sample is not adequ
31.in superior vena cava syndrome (SVCS), which is due to obstruction of the superior vena cava. The vast majority of cases of SVCS are caused by malignancies, with lung cancer being the most common. The most feared complication of SVCS is upper airway obstruction. Radiation therapy is the treatment of choice for most patients with SVCS.
32.Remember in patients with known lung cancer, a biopsy of the mass causing the SVCS is usually not necessary and treatment can commence once the clinical diagnosis is made. In patients without a history of cancer, every effort should be made to obtain a diagnosis before starting treatment, as there are benign causes of SVCS (e.g., thyroid enlargement, thrombosis).
33.Pregnancy is characterized by increased alkaline phosphatase being secreted from the placenta. Alkaline phosphatase is usually secreted by biliary canalicular cells, placenta, bone, and intestinal mucosal cells. Hence, raised alkaline phosphatase is a normal value in growing children and pregnant women.
34.Acneiform eruptions is characterized by papules and pustules resembling acne lesions. The eruptions are distinguished by their sudden onset.
Oral medications such as iodides, bromides, testosterone, cyclosporine, antiepileptic medications, lithium, and systemic corticosteroids are common agents that can lead to acneiform eruption. When medium or high doses of corticosteroids are taken for as short a time as 3-5 days, a distinctive eruption may occur, known as steroid acne. It is a sudden out-cropping of inflamed papules, most numerous on the upper trunk and arms, but also seen on the face. The lesions typically present as papules rather than comedones. Tretinoin cream applied once or twice daily may clear the lesions within 1-3 months, despite the continuation of high doses of corticosteroid.
35.The management of hematuria associated with trauma differs in adults and children. In the adult population, imaging is performed only in those patients with gross hematuria or microscopic hematuria plus hypotension. This differs from the pediatric patient. In children, any degree of hematuria (gross or microscopic) should be investigated with imaging studies. One reason for this discrepancy is that large amounts of catecholamines released in injured children may sustain blood pressure in the face of hypovolemia. A CT scan is the most useful imaging modality in this setting. A CT is noninvasive, accurate and fast, and it can help in assessing the size and extent of retroperitoneal hematomas and renal parenchymal trauma.
36. Remeber anterior uveitis is associated with sarcoidosis. Anterior uveitis is usually marked by the abrupt onset of pain and photophobia. Specifically anterior uveitis causes iritis and iridocyclitis. Constriction of the pupil causes increased pain. Slit-lamp examination is diagnostic, showing inflammatory cells in the aqueous humor or deposited along the corneal endothelium.
37.Many diseases are associated with anterior uveitis, including sarcoidosis and the seronegative spondyloarthropathies, including ankylosing spondylitis, psoriasis, inflammatory bowel disease, and Behçet's disease. Infectious disease may also cause uveitis. Some of the associated infections include herpesviruses, tuberculosis, onchocerciasis, and leprosy. In the majority of cases, uveitis is idiopathic. Treatment should include topical corticosteroids to decrease inflammation and mydriatics because dilation of the pupil decreases pain and the formation of synechiae.
38. hyperventilation causes a mild respiratory alkalosis and is experienced as acral and periorbital dysesthesias.(tingling sensation in the fingertips.)
39.Remember treatment of CMV retinitis in HIV if Gancyvlovier dosen't work is FOSCARNET(can cuase renal toxicity).
it's characterized by defecits in interpersonal development,restricted patterns of interest&behaivior,and normal cognitive and speech development.
41.Spondylolysis is a defect seen in the pars interarticularis portion of the lamina.Spondylolysis is believed to be caused by repeated microtrauma, resulting in stress fracture of the pars interarticularis. Heredity also is believed to be a factor. Patients with spina bifida occulta have an increased risk for spondylolysis. Approximately 95% of cases of spondylolysis occur at the L5 level.Athletes who participate in sports, such as soccer, baseball, football, wrestling, gymnastics, and tennis, are more likely to have symptomatic spondylolysis at some point(with hyperextension maneuvers)
42.Patients with suspected spondylolysis should be evaluated initially with plain radiography, consisting of anteroposterior, lateral, and oblique views of the lumbar spine. The lateral views are most sensitive for detection of pars fractures, and the oblique views are most specific.
43..Remember The sudden onset of tachycardia and hypotension in a patient who is being mechanically ventilated with positive pressure, is at increased risk of a bullous rupture from barotrauma, leading to a pneumothorax,
44.young age, occurrence of pain at night, negativity of rheumatoid factor, and especially, bilateral involvement of sacroiliac joints are consistent with ankylosing spondylitis.
45.Ankylosing spondylitis should be suspected in any young person complaining of chronic lower back pain and confirmed by radiographs or CT scans of sacroiliac joints. The disease usually progresses to involve the whole vertebral column, producing ankylosis and respiratory failure secondary to restrictive lung disease. Uveitis and aortic insufficiency are additional manifestations.
46.Still disease is a rare systemic form of arthritis with onset before age 17. It manifests with spiking fever and systemic symptoms that usually antedate arthritis. Associated manifestations include a morbilliform rash, hepatosplenomegaly, serositis, anemia, and leukocytosis.
47.whenever the terms "coin-shaped" or "discoid" are used to describe a patient's skin lesions in a question you should think about nummular dermatitis.
48.Remeber symptoms of congestive heart failure and possible atrial fibrillation, as demonstrated by irregularly irregular heartbeat in question(they never mention stright forward A.F). In addition, are at high risk for the development of an embolic occlusion of the superior mesenteric artery. These patients will present with severe pain out of proportion to their objective physical findings. The diagnosis should be suspected clinically, and immediate superior mesenteric arteriogram should be performed. If evidence of ischemia is confirmed, the patient should proceed to exploratory laparotomy to evaluate for intestinal ischemia and possible gangrenous bowel.
49.BUT Ischemic colitis will usually present as diarrhea, often bloody, in elderly patients with known atherosclerotic heart disease.
50.malignant external otitis, This form is specifically caused by Pseudomonas aeruginosa, and tends to affect elderly diabetics and AIDS patients, causing the findings in the severe and persistent earache. Otoscopic examination demonstrates foul-smelling purulent otorrhea and a red mass lesion of the external ear canal. Biopsy of the mass demonstrates granulation tissue rather than tumor.
51.Headache of sudden onset ("thunderclap" headache), rapid deterioration of mental status and blood in the CSF are virtually diagnostic of ruptured berry aneurysms. Note the characteristic hyperdensity on CT of the suprasellar cistern, indicating blood in the subarachnoid space. Rupture of a berry aneurysm is the most common cause of subarachnoid bleeding.
52.PBC is due to an autoimmune destruction of intrahepatic bile ductules, and the diagnosis is made by liver biopsy. The serology that should be checked is the antimitochondrial antibody. Primary biliary cirrhosis is often seen in individuals with other autoimmune diseases, such as Sjögren syndrome, pernicious anemia, and Hashimoto thyroiditis.
53.Myasthenia gravis is an autoimmune disease in which antibodies directed against the acetylcholine receptor of the muscle side of the neuromuscular junction block the ability of the receptor to bind to acetylcholine. Remember insulin resistance is also produced by a similar mechanism, i.e. antibodies to insulin receptors block the receptors' ability to bind to insulin
54.The first step in the approach to a patient with a community-acquired pneumonia is to categorize condition according to the American Thoracic Society guidelines (1993), which are based on severity of illness, age, comorbidities, and the need for hospitalization. the criteria for hospitalization (one of the following is needed: respiratory rate > 30 breaths/min, room air PaO2< 60 mm Hg, O2 saturation less than 90% on room air, or bilateral or multiple lobes involved), and older than 60 years.
55.normal value for the anion gap is 12 ± 4 mEq/L. Causes of increased anion gap include conditions that produce ketoacidosis (diabetes mellitus, alcoholism, starvation), renal failure with retained sulfate and phosphate, drugs or metabolites (salicylate or ethylene glycol poisoning), alkalosis with increased negative charge of protein anions, and dehydration (hemoconcentration).
56.Remember Subcutaneous unfractionated heparin is used for prevention of DVT in immobile patients or in hospitalized patients unable to ambulate. However, after orthopedic surgery, especially after joint procedures, its efficacy is very poor, given the increased venous stasis ,you should use warfarin.
57.Remember Both chronic laxative use and chronic diuretic use can produce hypokalemia. Severe hypokalemia, with plasma potassium <3 mEq/L, can markedly affect skeletal, smooth, and cardiac muscles. Skeletal muscle effects can include weakness, cramping, fasciculations, paralysis (with risk of respiratory failure), tetany, and rhabdomyolysis. Smooth muscle effects include hypotension and paralytic ileus. Cardiac muscle effects include premature ventricular and atrial contractions, tachyarrhythmias, and AV block. Additional ECG changes can include ST segment depression, increased U wave amplitude, and T wave amplitude less than U wave.
58.Basal cell carcinoma affects sun-exposed areas, particularly the mid and upper face, in patients lacking protective pigmentation. One of its morphologic forms is that of a raised, waxy, pale lesion that grows very slowly and doesn't metastasize to lymph nodes.
59.Key for Keratoacanthoma : grows very rapidly in a matter of weeks and has a scaly, rough appearance, with a core of keratin. If untreated, it eventually sloughs off.
60.Squamous cell carcinoma is usually an ulcer, rather than a nodule. In the face, it favors the lower lip. If present for several years, lymph node metastasis can sometimes occur.
61.euthyroid sick syndrome, which occurs in many seriously ill patients who do not have clinical hypothyroidism. especially in ICU
61. The TSH level is usually most helpful in distinguishing euthyroid sick syndrome from true hypothyroidism, as it often above 30 mU/mL in true hypothyroidism and may be below normal, normal, or minimally elevated in euthyroid sick syndrome. Disproportionately decreased T3 is also typical of euthyroid sick syndrome, and T4 may be normal or decreased.
62.Remember hepatorenal syndrome occurs during the end stages of cirrhosis and is characterized by diminished urine output and low urinary sodium. In the setting of end-stage liver disease, renal vasoconstriction occurs, and the distal convoluted tubule responds by conserving sodium. Unless the renal function is allowed to deteriorate further, liver transplantation will reverse this vasoconstriction and kidney function will return to normal.
then when ever you have cirrhosis with reanal faiuler the most appropriate treatment is LIVER TRANSPALNTION!
63.In beta thalassemia, a reduced production of beta chains occurs with normal amounts of alpha production
64.A shock-like pain upon percussion on the volar aspect of the wrist (Tinel sign) is a characteristic sign of Carpal tunnel syndrome ,,is most often idiopathic, but may represent a manifestation of underlying disorders such as rheumatoid arthritis, sarcoidosis, amyloidosis, acromegaly, and leukemia.
65.Fibrositis , also known as fibromyalgia, refers to a poorly understood syndrome of widespread musculoskeletal pain associated with tenderness in multiple trigger points. Fatigue, headache, and numbness are also common. Women between 20 and 50 years of age are most commonly affected. Neck, shoulders, low back and hips are usually involved.
66.Reflex sympathetic dystrophy describes a syndrome of pain and swelling of one extremity (most commonly a hand), associated with skin atrophy. It is thought to be secondary to vasomotor instability. Sometimes, it follows injuries to the shoulder (shoulder-hand variant).
67.Femoral pseudoaneurysms represent an important vascular complication of cardiac catheterization. The combination of a pulsatile mass, femoral bruit, and compromised distal pulses make this diagnosis likely. The diagnosis can be confirmed by ultrasound of the groin.(it was exam question of one of my friend).
68.Cholesterol emboli syndrome is also an important complication to recognize in the post-catheterization patient. It usually presents, however, with skin findings in the distal extremities of livedo reticularis, ischemic ulcerations, cyanosis, gangrene, or subcutaneous nodules.
69.Remember Another important complication of cardiac catheterization via the femoral artery is a retroperitoneal bleed . This complication presents, however, as either new back pain, an unexplained drop in the hematocrit, or purpura over the flanks.
70.what is piriformis syndrome??
As you may recall from your anatomy, the piriformis is the small muscle that crosses the greater sciatic foramen, cutting it into two spaces as the muscle passes from the edge of the sacrum to the greater trochanter. The sciatic nerve comes out of the greater sciatic foramen below the piriformis, and is liable to compression by the muscle. Symptoms are as described above; bicycle riding and running may also set off the symptoms, which may take the form of chronic nagging ache, pain, tingling, or numbness. Treatment is usually to teach the patient to avoid maneuvers that set off the symptoms. Some patients have been helped by corticosteroid injection near the site where the piriformis muscle crosses the sciatic nerve; this therapy is thought to work by reducing the fat around the muscle and thereby increasing the available space in the area.
71.in Adison disease Laboratory findings include hyponatremia (due to aldosterone deficiency), hyperkalemia, and normocytic anemia with eosinophilia and lymphocytosis. The diagnosis is made with the ACTH stimulation test. Cortisol and aldosterone levels do not increase when the ACTH is given. The treatment is glucocorticoid and mineralocorticoid replacement.
72.HIV encephalitis, clinically known as AIDS dementia complex, . The pathologic substrate is a subacute inflammatory infiltration of the brain caused by direct spread of HIV to the CNS.
73. The diagnosis of HIV encephalitis (or AIDS dementia complex) must be reached by exclusion of other infective and neoplastic conditions associated with AIDS. AIDS dementia complex is characterized by cognitive impairment, incontinence, impairment of motor skills, and confusion. MRI studies and CSF analysis are useful in excluding other CNS diseases .
74.HIV myelopathy manifests mainly with spastic paraparesis. It is a complication similar in pathologic substrate to vitamin B12 deficiency, i.e., vacuolar degeneration of the posterior and lateral columns of the spinal cord.
75.Progressive multifocal leukoencephalopathy consists of multifocal areas of myelin destruction. These changes would be visible on MRI. This complication is due to JC virus, a papovavirus that causes asymptomatic infections in immunocompetent individuals.
76.Patients with longstanding extensive ulcerative colitis for at least 10 years' duration are at increased colon cancer risk. Appropriate surveillance involves annual or biannual colonoscopy with multiple biopsies at regular intervals, even of normal appearing mucosa, to check for dysplasia
77.Individuals with herpes zoster are contagious and can spread the VZV virus.
78.Decreased esophageal peristalsis and decreased LES pressure :SCLERODERMA , These patients are therefore at risk for severe GERD and subsequent complications of peptic stricture and Barrett's esophagus.
79.Patients with this erythema infectiosum (Fifth disease) are only infectious before the onset of the rash, during the period with the nonspecific febrile illness. The virus typically only causes a significant, severe illness in individuals with sickle cell disease and other hemoglobinopathies. In rare cases, parvovirus contracted during pregnancy has been associated with fetal hydrops and death.
80.If a pergnant woman was in contact with a patient with fifth disease during the phase of the illness before the onset of the rash, she should have serologic testing and a fetal ultrasound to evaluate the health of her and the baby. It should be mentioned that the complications of parvovirus in pregnant women typically occur during the first half of pregnancy.
81.Most authorities think that it is appropriate to initiate a progestin-only method of contraception immediately postpartum. It has no impact on lactation or the quality of breast milk.
82.The triad of miosis, respiratory depression, and coma is suggestive of opioid intoxication
83.Phenelzine is an antidepressant monoamine oxidase inhibitor (MAOI) that causes hypertensive crises and the serotonin syndrome (hypertension, tachycardia, fever, coma, and possibly death) when combined with tyramine-containing food (cheese) and serotonin-altering drugs.Pseudoephedrine and other nasal decongestants, bronchodilators, amphetamines can cause severe hypertension when monoamine oxidase is inhibited and should be avoid.
84.the classic signs of chronic plaque psoriasis are silvery or pink well-defined plaques, which can span the whole body from the scalp to the feet. The most classically involved areas include the scalp, ears, elbows, knees, sacrum and ankles.
85.Fiberoptic bronchoscopy is part of the evaluation of a patient with hemoptysis, but it is typically performed after a chest x-ray. It is the next step if a chest x-ray shows a mass, if the chest x-ray is normal and there are major risk factors for cancer, or if the chest x-ray is normal and there are no risk factors for cancer, but there is a recurrence of hemoptysis after weeks to months of observation.
then remeber if you have a patient with hemoptysis with past history of smoking ,your first step is CXR even if he/she is normal right now!but!!!!!!!Keep in mind that a chest x-ray is not part of a routine physical examination of an asymptomatic smoker.
86.Complications of ovarian torsion include infection, peritonitis, sepsis, adhesions, chronic pelvic pain, and infertility due to the loss of the viability of the torsed ovary.
87.Remember One of the most important considerations in evaluating patients with conjunctivitis is to rule out any vision-threatening conditions such as iritis, keratitis, glaucoma, or a corneal ulceration. Symptoms such as marked photophobia, decreased visual acuity, or globe pain suggest that ocular structures other than the conjunctiva are involved and should trigger immediate ophthalmologic evaluation.
88.The pathophysiology of ITP:
involves antibody (IgG or IgM) binding to platelets. These antibody- coated platelets are subsequently destroyed in the spleen.
89.Remember an extremely important aspect of management of the asplenic patient includes permanent penicillin prophylaxis in addition to pneumococcal and Haemophilus influenza vaccines. These measures decrease the risk of morbidity and mortality associated with overwhelming sepsis by encapsulated organisms in asplenic patients.
90.Multifocal glioblastoma multiforme (GBM) , the most frequent malignant primary brain neoplasm, manifests as an ill-defined mass in the white matter.
91.Wernicke encephalopathy is characterized by nystagmus progressing to ophthalmoplegia, truncal ataxia and confusion.
92.Korsakoff syndrome refers to alcohol-related amnesia and confabulation. Wernicke-Korsakoff syndrome is due to vitamin B1 deficiency, which is often seen in chronic alcoholics. This deficiency results in degeneration of periaqueductal gray matter.
93.Remember Huntington disease autosomal dominant condition is caused by an unstable expansion of a CAG trinucleotide repeat and MRI examination of the brain reveals hyperintensity in the region of the caudate on T2-weighted images.
94.The pathologic substrate of this condition(Huntington disease ) is degeneration of the striatal neurons, especially those in the caudate nucleus.
95.the pathogenesis of stress-induced gastritisdiffuse gastric mucosal vasoconstriction
96.Right-sided endocardial fibrosis, with pulmonary stenosis and tricuspid regurgitation, is common in carcinoid patients and is the result of toxic damage to the heart
97.Ondansetron, a 5-hydroxytryptamine3 antagonist, is the most potent antiemetic available for chemotherapy-induced vomiting.It has side effects only infrequently, the most common being constipation.
98.Copper deficiency can present with anemia and neutropenia, Zinc deficeincy will present with alopecia, impaired wound healing , dermaititis, selenium def will present with dilated cardiomyopathy
99.Bernard-Soulier syndrome is an autosomal recessive disease of platelet adhesion which causes prolonged bleeding times in the presence of normal platelet counts. These patients' platelets cannot bind to subendothelial collagen properly because of a deficiency or dysfunction of the glycoprotein Ib-IX complex. Clinically the patients have impaired hemostasis and recurrent severe mucosal hemorrhage. The only treatment for an acute episode is a transfusion of normal platelets. This patient has a slightly decreased hemoglobin due to blood loss.
100.Von Willebrand's disease causes increased bleeding times with normal platelet counts. It is the most common inherited bleeding disorder, caused by a defect in von Willebrand factor, which aids the binding of platelets to collagen. Even though the platelets themselves are normal, binding is impaired, thus a platelet transfusion would not correct the problem. Cryoprecipitate, a plasma fraction rich in von Willebrand factor, would help in the case of von Willebrand's disease, but would not help with Bernard-Soulier syndrome.
Coarctations account for approximately 7% of congenital cardiac abnormalities, occur more frequently (2x) in men than in women, and are associated with gonadal dysgenesis and bicuspid aortic valves. Adults will present with hypertension, manifestations of hypertension in the upper body (headache, epistaxis), or leg claudication. Physical examination reveals diminished and/or delayed lower extremity pulses, enlarged collateral vessels in the upper body, or reduced development of the lower extremities.
most repeated entrance topics
1) Viral Hepatitis –Repeated 20 times
Refer 16th edition Harrison Vol 2 page no 1845-1851
2) Acid base balance – Repeated 15 times
Refer 16th edition Harrison Vol 1 page no 263-270
3) CA lung – Repeated 14 times
(Ref: 16th edition Harrison vol 1 page no 506-514)
4) Migraine/Temp Arteritis/Cluster Head Ache – Repeated 14 times
(Ref: 16th edition Harrison vol 1 page no 87-93)
5) Intracranial Haemorrhage – Repeated 13 times
(Ref: 16th edition Harrison vol 2 page no 2387)
6) Hyperparathyroidism – Repeated 11 times
(Ref: 16th edition Harrison vol 2 page no 2252)
7) Cardiac Tamponade -Repeated 11 times
(Ref: 16th edition Harrison vol 2 page no 1415)
8) CSF in meningitis –Repeated 10 times
(Ref: 16th edition Harrison vol 2 page no 2476-Table 360-1)
9) HOCM – Repeated 10 times
(Ref: 16th edition Harrison vol 2 page no 1410)
10) Antiphosholipid antibody syndrome – Repeated 10 times
(Ref: 16th edition Harrison vol 2 page no 1681-1682)
11) Multiple myeloma- Repeated 10 times
(Ref: 16th edition Harrison vol 1 page no 656)
12) Coarctation of aorta – Repeated 9 times
(Ref: 16th edition Harrison vol 2 page no 1387)
13) HSP – Repeated 9 times
(Ref: 16th edition Harrison vol 2 page no 2010)
14) Psoriatic/Osteo/Rheumatoid Arthritis – Repeated 9 times
(Ref: 16th edition Harrison vol 2 page no 1998/2036/1968)
15) Thymoma leads to Hypogammaglobulinaemia – repeated 8 times
(Ref: 16th edition Harrison vol 2 page no 1946)
16) MEN – Repeated 8 times
(Ref: 16th edition Harrison vol 2 page no 2231)
17) Phaeochromocytoma – Repeated 8 times
(Ref: 16th edition Harrison vol 2 page no 2148)
18) No infective endocarditis in ASD- Repeated 8 times
(Ref: 16th edition Harrison vol 2 page no 1385)
19) Polycythaemia – Repeated 7 times
(Ref: 16th edition Harrison vol 1 page no 335)
20) Vit B12 deficiency – Repeated 7 times
(Ref: 16th edition Harrison vol 2 page no 2404)
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oho!! but it would be really nice of u ppl, if u could post some useful ones for us too...
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