MIST All in One 8th Edition Medical Textbook PDF

 Compiled and Edited by: TEAM MIST AITBS PUBLISHERS, INDIA MEDICAL PUBLISHERS J-5/6, Krishan Nagar, Delhi-110051 (INDIA) Phone: 011-49067602, 40167052; Fax: 011-22009074 E-mail: [email protected] & [email protected] © 2022 A...

 Compiled and Edited by: TEAM MIST AITBS PUBLISHERS, INDIA MEDICAL PUBLISHERS J-5/6, Krishan Nagar, Delhi-110051 (INDIA) Phone: 011-49067602, 40167052; Fax: 011-22009074 E-mail: [email protected] & [email protected] © 2022 AITBS Publishers, India all Rights Reserved. No part of this book may be reproduced or transmitted in any form or by any means of electronic or mechanical including photocopying, recording or any information stored in a retrieval system, without the prior written permission of the publisher. This book has been published in good faith that the materials provided by the editors are original and are responsible for the views expressed in this publication. Every effort has been made to avoid errors or omissions in this publication. In spite of this, some errors might have crept in. Any mistake, error or discrepancy noted may be brought to our notice which shall be taken care of in the next edition. It is notified that neither the publisher nor the editor or seller will be responsible for any damage or loss of action to any one, of any kind, in any manner, there from. In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. We have applied for copyright permission wherever possible. In some instances we have been unable to trace the owners of copyright material and we would appreciate any information that would enable us to do unintentional omissions. We would be pleased to insert the appropriate acknowledgement in any subsequent edition of this publication. For binding mistakes, misprints or for missing pages, etc., the publisher’s liability is limited to replacement within one month of purchase by similar edition. All expenses in this connection are to be borne by the purchaser. 1st Edition : 2013-14 2nd Edition : 2016 3rd Edition : 2017 4th Edition : 2018 5th Edition : 2019 6th Edition : 2019 7th Edition : 2020 8th Edition : 2022 ISBN: 978-93-7473-641-8 Published by: Virender Kumar Arya for AITBS Publishers, India Medical Publishers J-5/6, Krishan Nagar, Delhi-110051 (INDIA) Phone: 011-49067602, 40167052; Fax: 011-22009074 E-mail: [email protected] & [email protected] Printed by AITBS, Delhi Preface to the 8th Edition We at MIST are delighted to present the 8th Edition of MIST All in One for FMGE. Keeping in view of continuous suggestions and input provided by our FMGE students regarding the book, we are presenting this 8th edition, according to the current examination pattern. In this edition, Lot of Miscellaneous Points and Images have been added which are a must for FMG (Foreign Medical Graduate) before the exam. Every effort has been made to incorporate the most important and relevant points which are must to remember before the final frontier, still keeping it as short as possible. Students are advised to go through each and every chapter, recollect the concepts and remember each and every point. It has been proven that majority of Post Graduate Entrance Exams and especially the Foreign Medical Graduate Entrance Exam usually comprises of approximately half of the questions from the frequently asked topics which have been summarized here. MIST All in One for FMGE book has proved extremely beneficial in the final stages of preparation for the entrance exam specially the Foreign Medical Graduate Entrance Exam. We have tried to keep things as simple, short and comprehensible as possible for you. We are also thankful to Virender Kumar Arya and his team at AITBS Publishers India, for untiring efforts in direction of bringing out this book on time. —Team MIST Preface to the 1st Edition This book specially designed for comprises of quick revision for all the 19 subjects in a very short period of time. Every effort has been made to incorporate the most important relevant points which are must to remember before the final frontier, still keeping it as short as possible. Students are advised to go through each and every chapter, recollect the concepts and remember each and every point. It has been proven that majority of Post Graduate Entrance Exams and specially the Foreign Medical Graduate Entrance Exam usually comprises of approximately half of the questions from the frequently asked topics which have been summarized here. MIST All in One for MCI Screening Test Book is likely to prove extremely beneficial in the final stages of preparation for the entrance exam specially the Foreign Medical Graduate Entrance Exam. We have tried to keep things as simple, short and as sweet as possible for you. We are also thankful to Virender Kumar Arya and his team at AITBS Publishers India, for their meticulous efforts in the direction of bringing out this book on time. –Team MIST Acknowledgements Team MIST’s dedicated day and night efforts has produced this quick revision concise book in the utmost interest of students willing to clear the MCI Entrance Examination. We sincerely believe that revision is the most important and in this summarised story of all 19 subjects, a quick and smart revision in the last stages has proved beneficial time and again. Quality and not the quantity matters in this short book and we wish good future to all the students going through this book. The entire Team MIST is thankful to the invaluable contributions from the various renowned authors who have smartly brought the most important must read points at one place just before the exams. We are highly thankful to all the students preparing for foreign medical graduate exam for showing overwhelming response towards revision from this book. It is your continuous motivation that we have been inspired to always bring out the best in all our endeavours. –Team MIST Senior’s Advice Before Exams  Sleep on time and sleep nicely for five nights before the exams. Sleep schedule should be such that you have maximum awareness at the timing of examination. This should be practiced well before in advance to set the schedule.  Reading a few jokes just before sleep help in having a good sleep. Do not think about studies once you are in bed.  On the exam day, get ready on time, wear comfortable clothes and comfortable shoes, avoid reading, relax yourself and pray to the almighty to give you the strength and courage to be cool for the exam day.  Make sure to carry your photo identity card, admit card, stationary, wrist watch and any other important belonging with you.  At the centre, do not indulge yourself in group discussions, just have a positive energy, stay as calm as possible without creating any panic. This helps in solving even tough questions which you are unaware of.  Take your seat in the examination hall at the designated time so as to avoid any panic – Listen carefully to the invigilator instructions as they are very helpful at the last minute and do not involve in any conflict with the examiner.  Cheer yourself up and start cracking the questions.  If you get hard questions in the beginning, do not feel disgusted as the question paper is bound to have many questions of your liking... Wait for the loose ball to be hit... This should be your master stroke... Gain confidence.. And then again start solving.  In the middle of the exam if you feel the going gets tougher, wait for a while, take a short break of 2-3 minutes, drink some water and then refresh your mind and start solving the questions again.  Be careful in marking the answers in the right circles.  Do not be in a hurry to leave the examination hall. Wait, reconcile yourself and recheck the paper finally before handing it over to the invigilator.  God is great and he has done his best for your honesty... Thank him and loosen yourself.... MAY GOD BLESS YOU AND YOU ALL COME OUT WITH FLYING COLOURS BEST OF LUCK Truly yours Dr. Vineet Gupta Do and Dont’s for FMGE Students  Every single day is important. Do not waste time thinking exam is far.  Always have a time table/study plan in your mind.  Divide your study hours smartly. As the exam is Multiple Choice Question based so try to solve at least 40-50 MCQ’s everyday.  Do not directly try to solve questions from question bank. First study the notes, understand the topic and then solve the MCQ’s, it will allow you to assess your preparation level.  Try to comprihend the topic covered in the class on daily basis as there will be never a spare day.  It is always better to avoid consulting multiple books. Just stick to the notes provided supported by a good question bank.  Always attend all the tests conducted at the institute. This is the only way before exam where you can gauge your preparation.  Never get demoralized by seeing others. Believe in yourself. They have their way and you have your own.  Always remember — THOSE WHO BELIEVE, THEY CAN. WISH YOU ALL THE VERY BEST –Team MIST Why MIST is the Best for FMGE  We know the easy way out.  Only institute dedicated exclusively for Foreign Medical Graduates.  Best classroom teaching of average six to seven hours daily.  Best infrastructure and best study environment.  Highly reputed teachers with many years of MCI coaching experience.  Our faculties dedicated in extracting the examination pattern of every session and teaching accordingly.  MIST All in One Book covering most important details from which many questions are asked in MCI Exam.  Continuous student monitoring through dedicated CCTV’s.  MIST mobile application: “MIST-FMGE” – Available on Google Play Store.  Interactive Sessions and Interstate Academy Competition to encourage and motivate all...  Parental homely environment. MIST is the leader amongst coaching institutes for Foreign Medical Graduates in FMGE Exam since inception Current Examination Pattern FMGE LICENSING SCREENING EXAM:  This is a screening exam, for Foreign Medical Graduates which do not have any ranking system comprising of 300 questions and each question carry 1 mark. You are required to score 50% marks to pass this exam, i.e., 150 marks out of 300 is pass.  The question paper is in two parts: Paper I and II. Each paper comprises of 150 questions each which is an online computer based test. Questions shall be coming on the computer screen and you will have to select one correct answer for each question.  Each paper is of 150 minutes duration. It means you will be getting 1 minute to select the right answer for each question which is a fair enough time. There shall be a break of approximately two hours between the two papers where you can go out from the centre and have some snacks and rest.  The examination is conducted in June and December every year. BRIEF DESCRIPTION ABOUT THE QUESTIONS PATTERN:  Approximately 95% questions are text written questions and 5% are visual slide based questions.  Text written questions are from all 19 subjects while visual questions are mainly from Surgery/ Radiology & Obstetrics and Gynaecology. 2-3 visual questions may be asked from Pathology/ Microbiology/PSM/Ophthalmology/Orthopaedics/Dermatology and Medicine.  The blue print posted by the DNB at their website www.natboard.edu.in suggest the following descriptions of questions asked from different subjects. “However, more questions can be asked from one subject and less questions from another”  MIST ALL IN ONE FOR FMGE ANATOMY 17 PHYSIOLOGY 17 BIOCHEMISTRY 17 PATHOLOGY 13 MICROBIOLOGY 13 PHARMACOLOGY 13 FORENSIC MEDICINE 10 PSM 30 ENT 15 OPHTHALMOLOGY 15 MEDICINE 33 SURGERY 32 OBSTETRICS AND GYNAECOLOGY 30 PAEDIATRICS 15 ORTHOPAEDICS 5 SKIN 5 PSYCHIATRY 5 RADIOLOGY 10 ANAESTHESIA 5 xiv General Abbreviations ABC ____ Airway, breathing and circulation DPT ____ Diphtheria, Pertusis, Tetanus ABG ____ Arterial blood gas DUB ____ Dysfunctional uterine bleeding ACE ____ Angiotension converting enzymes DVT ____ Deep vein thrombosis ALT ____ Alanine aminotransferase ECG ____ Electrocardiogram ARDS ___ Acute respiratory distress syndrome EDTA ___ Ethylene diaminetetra acetic acid AST ____ Aspartate transaminase EEG ____ Electroencephalogram BCG ____ Bacille Calmette-Guerin ELISA ___ Enzyme linked immunosorbent assay BMI ____ Basal mass index EMG ___ Electromyogram BMR ___ Basal metabolic rate ESR ____ Erythrocyte sedimentation rate BMT ____ Bone marrow transplantation ESRD ___ End stage renal disease BPH ____ Benign prostate of hyperplasia FBS ____ Fasting blood sugar BUN ____ Blood urea nitrogen FNAB ___ Fine needle aspiration biopsy CABG ___ Coronary artery bypass graft FNAC ___ Fine needle aspiration cytology CAD ____ Coronary artery disease FRC ____ Functional residual capacity CBC ____ Complete blood count FSH ____ Follicle stimulating hormone CHF ____ Congestive heart failure GTT ____ Glucose tolerance test COPD ___ Chronic obstructive pulmonary disease HAV ____ Hepatitis A virus CPR ____ Cardio pulmonary resuscitation HBV ____ Hepatitis B virus CRF ____ Chronic renal failure HDL ____ High density lipoprotein CSF ____ Cerebro spinal fluid HTL ____ Helper T-cell CTL ____ Cytotoxic T-cell ICCU ___ Intensive coronary care unit CVA ____ Cerebro vascular accident ICP _____ Intra cranial pressure CVP ____ Central venous pressure ICS _____ Intercostal space DDT ____ Dichoro diphenyl trichloroethane ICU ____ Intensive care unit DOTS ___ Directly observed therapy short course INH ____ Isonicotinic acid hydrazide  MIST ALL IN ONE FOR FMGE IUCD ___ Intra uterine contraceptive device PUO ____ Pyrexia by unknown organism IUD ____ Intra uterine device RBC ____ Red blood cells IVP _____ Intra venous pressure ROM ___ Range of motion KUB ____ Kidney, ureter, bladder RS _____ Reed Sternburg LDH ____ Lactate dehydrogenase RVF ____ Right ventricular failure LDL ____ Low density lipoprotein SGOT ___ Serum glutamic oxaloacetic transaminase LFT _____ Liver function test SGPT ___ Serum glutamic pyruvic transaminase LH _____ Luteinizing hormone STD ____ Sexually transmitted disease LHRH ___ Luteinizing hormone THA ____ Total hip arthroplasty MCH ___ Mean corpuscular haemoglobin THR ____ Total hip replacement MCHC __ Mean corpuscular haemoglobin concentration TLR ____ Toll like receptor MCV ___ Mean corpuscular volume TPR ____ Temperature, pulse and respiration MI _____ Myocardial infarction TSH ____ Thyroid stimulating hormone TSS _____ Toxic shock syndrome MRI ____ Magnetic resonance imaging TURP ___ Transurethral resection of prostate MVR ___ Mitral valve replacement URI ____ Upper respiratory infection NSAID __ Non-steroid anti-inflammatory drug URT ____ Upper respiratory tract OPV ____ Oral polio vaccine VD _____ Venereal diseases ORS ____ Oral rehydration solution VDRL ___ Venereal Disease Research ORT ____ Oral rehydration therapy Laboratories OT _____ Operation theatre VLDL ___ Very low density lipoprotein PID _____ Pelvic inflammatory disease VSD ____ Ventricular septal defect PT _____ Prothrombin time VWF ____ Von willibrand factor PTCA ___ Percutaneous transluminal coronary WBC ___ White blood cells angiography xvi  MIST ALL IN ONE FOR FMGE (xvii) MIST CLASSROOMS IN INDIA MIST CLASSROOMS – OUT SIDE INDIA (xviii) MIST ALL IN ONE FOR FMGE MIST LIBRARY COMPUTER LAB Contents Preface to the 8th Edition (v) Preface to the 1st Edition (vi) Acknowledgements (vii) Senior’s Advice Before Exams (ix) Do and Dont’s for FMGE Students (xi) Why MIST is the Best for FMGE (xii) Current Examination Pattern (xiii) General Abbreviations (xv) MIST Classroom in India & Out Side India (xvii) MIST Library & Computer Lab (xviii) 1. Anatomy ________________________________________________________________ 1.1-1.15 2. Physiology _______________________________________________________________ 2.1-2.24 Visuals (Multi Colour) _____________________________________________________ 2.25-2.26 3. Biochemistry _____________________________________________________________ 3.1-3.13 4. Pathology ______________________________________________________________ 4.1-4.12A Visuals (Multi Colour) _____________________________________________________ 4.13-4.18 5. Microbiology _____________________________________________________________ 5.1-5.17 6. Pharmacology ____________________________________________________________ 6.1-6.17 7. Forensic Medicine __________________________________________________________ 7.1-7.9 8. Preventive and Social Medicine (PSM) ________________________________________ 8.1-8.28A Visuals (Multi Colour) _____________________________________________________ 8.29-8.32 9. ENT (Ear, Nose, Throat) ______________________________________________________ 9.1-9.9 10. Ophthalmology ________________________________________________________ 10.1-10.10A Visuals (Multi Colour) ___________________________________________________ 10.11-10.16  MIST ALL IN ONE FOR FMGE 11. Medicine _____________________________________________________________ 11.1-11.20A Visuals (Multi Colour) ___________________________________________________ 11.21-11.24 12. Surgery _______________________________________________________________ 12.1-12.18 Visuals (Multi Colour) ___________________________________________________ 12.19-12.30 13. Obstetrics and Gynaecology ______________________________________________ 13.1-13.14A Visuals (Multi Colour) ___________________________________________________ 13.15-13.18 14. Paediatrics _____________________________________________________________ 14.1-14.7 15. Orthopaedics ____________________________________________________________ 15.1-15.6 Visuals (Multi Colour) _____________________________________________________ 15.7-15.8 16. Dermatology ____________________________________________________________ 16.1-16.4 Visuals (Multi Colour) _____________________________________________________ 16.5-16.8 17. Psychiatry ______________________________________________________________ 17.1-17.9 18. Radiology ______________________________________________________________ 18.1-18.6 Visuals (Multi Colour) _____________________________________________________ 18.7-18.8 19. Anaesthesia ____________________________________________________________ 19.1-19.6 20. Important Points ________________________________________________________ 20.1-20.11 21. Common Drug Toxicities ___________________________________________________ 21.1-21.3 22. Syndromes ______________________________________________________________ 22.1-22.9 #MISTACHIEVER’S—DEC. 2020 #MISTACHIEVER’S—AUG. 2020 #MISTACHIEVER’S—2019 #MISTACHIEVER’S—2018 #PROUDMISTIAN’S SAYS—2020 #PROUDMISTIAN’S SAYS—2019 #PROUDMISTIAN’S SAYS—2018 xviii  1 Anatomy HEAD AND NECK Tongue  All muscles of the tongue are supplied by hypoglossal nerve except palatoglossus which is supplied by cranial part of accessory nerve via pharyngeal plexus.  Sensory nerve supply Part of Tongue General Sensation Taste Sensation Anterior 2/3rd Lingual nerve Chorda tympani Posterior 1/3rd Glossopharyngeal nerve Glossopharyngeal nerve Posterior most Internal laryngeal nerve Vagus nerve  Circumvallate papillae are supplied by glossopharyngeal nerve.  All muscles of mastication are supplied by mandibular nerve.  Depressor of the mandible is lateral pterygoid.  Extraocular muscles: Nerve supply SO4 LR6 O3. Pharynx and Larynx  All muscles of pharynx—cranial root of accessory nerve except stylopharyngeus—glossopharyngeous nerve.  All muscles of palate—cranial root of accessory nerve except tensor veli palatini—mandibular nerve.  Safety muscle of the larynx—posterior cricoarytenoid, it is the only abductor of the vocal cords.  All intrinsic muscles of the larynx—recurrent laryngeal nerve except cricothyroid—external laryngeal nerve. Branches of External Carotid Artery (8 Branches) 1. Ascending pharyngeal artery 2. Superior thyroid artery 3. Lingual artery 1.1  MIST ALL IN ONE FOR FMGE 4. Facial artery Anat 5. Occipital artery 6. Maxillary artery 7. Superficial temporal artery 8. Posterior auricular artery  Muscle which dilates palpebral apparatus is – levator palpebrae superioris.  Stapedius is supplied by – facial nerve.  Superficial cut in posterior triangle of neck – shrugging of shoulder.  Structure within parotid gland are: Facial nerve External carotid artery Retromandibular vein Except facial artery. THORAX Heart  SA node, AV node and AV bundle are supplied by right coronary artery.  Structures opening into right atrium Superior vena cava Inferior vena cava Coronary sinus  Right border of heart is formed by SIR – Superior vena cava, Inferior vena cava and Right atrium.  Right coronary dominance means origin of posterior interventricular artery from right coronary artery.  Lower border of lung: 6th rib—midclavicular line 8th rib—midaxillary line 10th rib—posteriorly Part of Heart Formed by Inferior surface Both ventricles Base Both atria Apex Left ventricle  In the adult heart, floor of fossa ovalis represents Septum primum.  Ligamentum arteriosum is derived from Ductus arteriosus.  Normal fluid level in the pericardial cavity 50 ml. 1.2  ANATOMY  Lower end of scapula correspond to T7. Anat  Esophagus lie in posterior mediastinum.  Bifurcation of trachea—T6 (T4–Cadeveric bifurcation).  Sternal angle—2nd rib.  Muscle used in quite breathing during inspiration is diaphragm. Peculiarities of Clavicle  Only long bone lying horizontally  No medullary cavity  Subcutaneous throughout  First to start ossification (5th week of IUL) and last to complete it (25 years)  Ossifies from two primary centres  Ossifies mostly in membrane  Pierced by cutaneous nerves. ABDOMEN  Transpyloric plane passes through the lower border of L1.  The superficial inguinal ring is a triangular opening in the external oblique aponeurosis.  Direct inguinal hernia passes through the Hesselbach’s triangle. Thoracoabdominal Diaphragm  Openings: T8 – Inferior vena cava T10 – Esophagus T12 – Aorta [Voice of America (VOA)]  Inferior vena cava extends from L5 to T8 Stomach bed:  Splenic flexure of colon  Left kidney  Left suprarenal gland  Splenic artery  Pancreas  Transverse mesocolon  Left dome of diaphragm. 1.3  MIST ALL IN ONE FOR FMGE Abdominal Aorta Anat Extends from T12 to L4  Ventral Branches: — Coeliac trunk-T12 – Supplies the Fore gut — Superior mesenteric artery-L1 – Supplies the Mid gut — Inferior mesenteric artery-L3 – Supplies the Hind gut — Not a ventral branch – Gonadal vessel.  Lateral Branches: — Inferior phrenic artery — Middle supra-renal artery — Renal artery-L2 — Gonadal artery (ovarian/testicular).  Posterior Branches: — Four pairs of lumbar arteries — One median sacral artery.  Terminal Branches: — Right and left common iliac arteries. Branches of Celiac Trunk  Left gastric artery.  Common hepatic artery [right gastric artery, gastroduodenal (right gastroepiploic and superior pancreaticoduodenal)].  Splenic artery (Pancreatic branches, Short gastric arteries and Left gastroepiploic artery). Internal Iliac Artery  Branches of the anterior division – superior vesical artery/inferior vesical artery. Inferior Vena Cava (L5 to T8)  Tributaries: Four pairs of lumbar veins Inferior phrenic veins Right gonadal vein Renal veins Right suprarenal vein Hepatic veins. *Left ovarian/testicular vein/left supra renal vein drains into left renal vein. 1.4  ANATOMY Supra-renal Gland Anat  Right Adrenal – Pyramidal shape.  Left Adrenal – Semilunar shape.  Arterial Supply: Superior supra-renal artery – branch of inferior phrenic artery. Middle supra-renal artery – branch of abdominal aorta. Inferior supra-renal artery – branch of renal artery.  Venous Drainage: Right supra-renal vein drains into the inferior vena cava. Left supra-renal vein drains into left renal vein.  Development: Cortex is mesodermal in origin. Medulla is neuroectodermal in origin (from neural crest cells). UPPER LIMB Nerves Related to the Humerus:  Axillary nerve: Posterior aspect of surgical neck.  Radial nerve: Radial groove/Spiral groove.  Ulnar nerve: Posterior aspect of medial epicondyle. Structures Lying in the Radial Groove: Radial nerve/Profunda brachii vessels.  Ape thumb: Median nerve.  Partial Claw hand: Ulnar nerve.  Wrist drop: Radial nerve.  Complete Claw Hand: Median and Ulnar Nerves.  Tennis elbow: Lateral epicondylitis.  Golfer’s elbow: Medial epicondylitis.  Musician nerve: Ulnar nerve.  Foot drop: Common peronial nerve.  Flame foot: Posterior tibial nerve.  Labourer’s nerve: Median nerve.  Housemaid's knee: Prepatellar bursitis. Hand  Most commonly fractured carpal bone – scaphoid (Boat shapted).  Carpal bone most prone to avascular necrosis following fracture – scaphoid.  Most commonly dislocated carpal – lunate (Half moon shaped). 1.5  MIST ALL IN ONE FOR FMGE Brachial Plexus Anat Formed by ventral primary rami of C5-8 and T1. Parts: Roots, Trunks, Divisions and Cords and Branches. Location:  Roots and trunks – neck.  Divisions – behind the clavicle.  Cords – axilla. Branches  From roots: (a) Dorsal scapular nerve; nerve to rhomboids (C5). (b) Long thoracic nerve; nerve to serratus anterior; nerve of Bell (C5,6,7).  From trunks (only upper trunk has branches): (a) Suprascapular nerve (C5,6). (b) Nerve to subclavius (C5,6) (branches from Erb’s point).  From cords: (a) Branches from lateral cords – (LML) Musculocutaneous nerve (C5,6,7) supplies brachialis, coracobrachialis and biceps brachialis except brachioradialis. Lateral pectoral nerve (C5,6,7) Lateral root of median nerve (C5,6,7) (b) Branches from medial cords – (M4U) Ulnar nerve (C7,8, T1) Medial cutaneous nerve of arm (C8,T1) Medial cutaneous nerve of forearm (C8,T1) Medial root of median nerve (C8,T1) Medial pectoral nerve (C8,T1) (c) Branches from posterior cords – (LUNAR) Radial nerve (C5,6,7,8,T1) Axillary nerve (C5,6) Upper subscapular nerve (C5,6) Lower subscapular nerve (C5,6) Thoracodorsal nerve/nerve to latissimus dorsi (C6,7,8)  Muscles supplied by lower subscapular nerve – Subscapularis/Teres major.  Muscles supplied by axillary nerve – Deltoid/Teres minor. 1.6  ANATOMY  Injury to Upper Trunk (ERB’s Point): Policeman’s Tip Hand/Porter’s Tip Hand Anat  Injury to Lower Trunk: Klumpke’s Paralysis (C8T1)  Injury to Long Thoracic Nerve: Winging of Scapula (serratus anterior). Axillary Artery Divided into three parts by the pectoralis minor muscle: Part No. of Branches Branches 1st 1 Superior thoracic artery. 2nd 2 Lateral thoracic Thoracoacromial arteries. 3rd 3 Subscapular Anterior circumflex humeral Posterior circumflex humeral arteries.  Structures Passing Superficial to Flexor Retinaculum of the Wrist: Ulnar nerve and vessels. Palmar cutaneous branch of ulnar nerve. Palmar cutaneous branch of median nerve. Tendon of Palmaris longus.  Structures passing through flexor retinaculum of wrist Flexor digitorum superficialis Flexor digitorum profundus Flexor pollicis longus  Structures passing through the Carpal Tunnel: Tendons of flexor digitorum superficialis. Tendons of flexor digitorum profundus. Tendons of flexor pollicis longus. Median nerve.  Compression of Median Nerve in the Carpal Tunnel leads to Carpal Tunnel Syndrome  Anatomical Snuff Box: Triangular deepening at scaphoid and trapezium.  Structure passing through anatomical snuff box—Radial artery. Cubital fossa Axillary fossa Medial boundary: Pronator teres Medial wall – Serratus anterior. Lateral boundary: Brachioradialis Posterior wall – Subscapularis, Teres major, Lattisimus dorsi. 1.7  MIST ALL IN ONE FOR FMGE Abduction of arm: Anat  0-15°: Supraspinatus  15-90°: Deltoid  Above 90° (overhead abduction): Trapezius and serratus anterior. LOWER LIMB  Muscles attached to Ischial tuberosity are: Semimembranosus Semitendinosus Long head of biceps femoris Ischial head of adductor magnus.  Ossification of lower end of femur – end of 9th month of intrauterine life (just before birth). Patella  Largest sesamoid bone.  Found in the tendon of quadriceps femoris. Fibula  Common peroneal nerve is at neck of fibula.  Talus bone articulates with Tibia, Calcaneum and Navicular not with Cuboid. Femoral Sheath Funnel shaped sleeve of deep fascia enclosing upper 3-4 cm of femoral vessels. Three compartments:  Lateral/arterial compartment containing femoral artery and femoral branch of genitofemoral nerve.  Intermediate/venous compartment containing femoral vein.  Medial/lymphatic compartment also known as femoral canal, contains lymph node of cloquet/ rosenmuller. BRAIN Cavity Name Brain Ventricles Cerebral hemisphere Lateral ventricle Diencephalon 3rd ventricle Hindbrain 4th ventricle 1.8  ANATOMY  Lesion in the internal capsule—hemiplegia on the opposite side of the body. Anat  Visual area/Brodman’s area: 17, 18, 19.  Speech area/Broca’s: 44, 45.  Wernicke’s area: 22, 39 and 40  Middle meningeal artery arise from Maxillary artery.  CSF obtained from the space between Arachnoid mater and Pia mater.  Spinal cord ends at lower end of L1.  Spinal cord ends in neonates at L3.  Nucleus Ambiguous is associate with 9,10,11 cranial nerve not with 12th. Corpus Callosum  Largest band of commissural fibres in the brain.  Parts: Rostrum, genu, trunk/body and splenium. Internal Capsule  Parts: Anterior limb, genu, posterior limb, retrolentiform part and sublentiform part.  Optic radiations pass through the retrolentiform part.  Auditory radiations pass through the sublentiform part.  Corticospinal fibres pass through the posterior limb.  Genu contains corticonuclear fibres. EMBRYOLOGY  Polar bodies are found in the process of oogenesis.  Spermatogenesis: (a) Development of spermatozoa from spermatogonia. (b) Duration – 72-74 days. (c) Site – Seminiferous tubules. (d) Temperature required is 2°C lower than the core body temperature. (e) Four stages: Primary spermatocyte Secondary spermatocyte Spermatids Spermatozoa. (f) Storage of spermatozoa—Epididymis. (g) Motility of sperm—Epididymis. 1.9  MIST ALL IN ONE FOR FMGE  Ducts of seminal vesicle and ductus deferens unite to form the ejaculatory duct which opens in the Anat prostatic urethra.  X chromosome—Large submetacentric  Y chromosome—Small Acrocentric.  Oogenesis: Event of Oogenesis Time Period Max. number of Germ cell (7 million) 5th month – prenatal All oogonia become atretic 7th month – prenatal Primary oocyte is surrounded by follicular cell called as Primordial follicle All primary oocyte have started prophase of Meiosis I, but instead of Near the time of birth proceeding into metaphase they enter into Diplotene stage Primary oocyte remains in the prophase of Meiosis I until Puberty Primordial follicle Primary follicle Secondary follicle or 36 hours before ovulation Graafian follicle. Secondary follicle enters preovulatory stage. This results in completion of Meiosis I and formation by Secondary oocyte and 1st Polar body. Secondary oocyte enters in Meiosis II but arrest in Metaphase 3 hours before ovulation Meiosis II is completed with formation of Ova and 2nd Polar body Fertilization occurs If fertilization does not occur then secondary oocyte degenerates within 24 hours after ovulation  Pharyngeal/Branchial Arches: (a) At first there are 6 arches, however 5th arch disappears. (b) Each arch has 4 Ectodermal Clefts, Mesodermal Arch and Endodermal pouch. Ectodermal Cleft: Cleft Fate 1st Ventral part is obliterated. Dorsal part forms the epithelium of External Auditory meatus/Ear Drum and Pinna 2nd and 3rd 2nd arch overgrows and covers 2nd, 3rd and 4th cleft to form cervical sinus, normally cervical sinus disappears but may persist as branchial cyst. Endodermal Pouch: Pouch Fate 1st Ventral – Tongue Dorsal – Tubotympanic recess 2nd Ventral – Tonsil Dorsal – Tubotympanic recess 3rd Thymus and Inferior Parathyroid Gland 4th Superior Parathyroid Gland 5th Ultimobranchial body (Para follicular C cells of thyroid) 1.10  ANATOMY  Derivatives of Neural Crest Cells Anat Mneumonic Pia Piamater, Arachnoid mater G Glial cells Please Parasympathetic ganglia of GIT Add Adrenal Medulla Odd Odontoblast, Dermis in face and neck New Neurons of Sensory ganglia of 5,7,8,9,10th cranial nerve, Sensory (Dorsal/Posterior) spinal root ganglia, Sympathetic chain ganglia Colour of Chromaffin tissue/C cells of Thyroid, conotruncal septum of heart Sense to Schwann cells Me Melanoblast, Mesenchyme of Dental Papilla  Development of Tongue: Anterior 2/3rd Posterior 1/3rd Posterior most part Derived from 1st pharyngeal Central part of pouch hypo- 4th arch branchial eminence (Copula), from 2nd, 3rd, and 4th part of 4th pharyngeal pouch Sensory supply Lingual branch of mandibular Glossopharyngeal nerve Vagus nerve nerve/Special sensation of taste by Chorda tympani branch of facial nerve Embryonal structure Fate in female Fate in male Genital ridge Ovary Testis Genital swelling Labia majora Scrotum Genital fold Labia minora Ventral aspects of penis and penile urethra Genital tubercle Clitoris Glans penis Sex cords Granulosa cells Sertoli cells 1.11  MIST ALL IN ONE FOR FMGE Anat Type of Epithelium Location Simple squamous epithelium Alveoli of lung Mesothelium, i.e., free serous surface of pleura, pericardium, peritoneum. Endocardium Endothelium (inner layer of blood vessels and lymphatics) Loop of henle. Keratinized stratified squamous epithelium Skin of whole body Duct of sebaceous gland Non keratinized stratified squamous epithelium Mouth, tongue, tonsil, pharynx, oesophagus Cornea Vagina Columnar epithelium with brush border Gall bladder Ciliated columnar epithelium Uterus and fallopian tube Efferent ductile of testis Central canal of spinal cord and ventricles of brain Cuboidal epithelium Duct of glands Eye Follicles of thyroid gland Germinal epithilium Transitional epithelium Renal pelvis, calyces, ureter. MISCELLANEOUS POINTS  Tail of Pancreas associated with Lienorenal ligament.  Vasa breviais related to short gastric arteries originating from the Splenic artery.  Wernickes’s area and Broca’s area are joined by Arcuate fasciculus.  Accessory muscle of mastication is Digastric.  Structure arching over the hilum of right Lung – Azygos vein.  Eversion of foot is caused by – Peroneus longus.  Parotid gland lymphatics drain into – Preauricular lymph node.  Lower lip supplied by branch of – Mandibular nerve.  Biceps brachii muscle inserted into – Radial tuberosity. 1.12  ANATOMY  Axis of Fetal midgut rotation is around – Superior mesenteric artery and is Anticlockwise 270 degree. Anat  Muscle supplied by both Sciatic and Obturator nerve is Adductor Magnus.  Blaschko’s lines – Lines of normal cell development in skin.  Protraction of scapula occurs at Scapulocostal joint.  Muscle affected in Trismus – Lateral Pterygoid.  Muscles originating from 1st pharyngeal arch include – Muscles of mastication.  Derivative of 2nd pharyngeal pouch is – Palatine tonsils.  All are seen in Horner’s syndrome except – Mydriasis.  Defect seen due to Failure of closure of cranial neuropore – Anencephaly.  Narrowest part of larynx in children – Subglottis.  Lateral cutaneous nerve of arm is a branch of – Musculocutaneous nerve.  Muscle tendon stretched in Prepatellar reflex – Quadriceps femoris.  Highest level of iliac crest correspond to – L4.  Partial loss of vision, hematoma of occipital lobe – artery involved-Posterior cerebral artery.  Trigone of urinary bladder originate from – Distal mesonephric duct.  Lacrimal gland is supplied through – Pterygo palatine ganglia.  Fenestrated capillaries are not found in Muscle.  Hassal’s corpuscles are seen in Thymus.  Tympanic membrane of the ear has origin from all three layers of germ layers.  Order of neurovascular bundle in the intercostals space—VAN.  Inhaled foreign body usually lodges in the lower lobe of right lung.  Umbilical cord contains 2 arteries and 1 vein.  Function of umbilical vein is to carry oxygenated blood towards the fetus.  Ligamentum teres is Remnant of left umbilical vein.  Gland of Brunner’s are found in Duodenum.  Peyer’s patches are present in Ileum.  Periarteriolar lymphoid sheaths are seen in Spleen.  Fate of notochord is Nucleus pulposus.  Trigone of urinary bladder develops from Mesoderm.  Blood testes barrier is formed by the Sertoli cells.  Appendix of the testis is a remnant of the paramesonephric duct.  Appendix of the epididymis is a remnant of cranial end of mesonephric duct.  Testis is supplied by: T10 segment of spinal cord (referred pain to umbilicus).  Lymphatics drain into pre and para-aortic group of lymph nodes.  Mucous membrane of vagina is lined by – Non-keratinized Stratified Squamous epithelium.  Gluteus maximus is supplied by inferior Gluteal nerve. 1.13  MIST ALL IN ONE FOR FMGE  Gluteus medius, gluteus minimus and tensor fascia lata are supplied by superior Gluteal nerve. Anat  Action of gluteus medius and minimus – abduction of hip joint.  Standing from sitting is via Gluteus maximus muscle.  Action of superior and inferior gemelli is lateral rotation.  Unlocking of the knee joint is done by popliteus.  Locking muscle of the knee – Quadriceps.  Pseudo locking of knee – Hamstring spasm.  Glands are absent in vagina.  Tendon is made of collagen fibre.  Ligament resisting hyperextension of hip – Ischiofemoral, Pubofemoral and iliofemoral NOT SACROILIAC.  Coccyx is made up of 4 vertebrae.  Pineal gland is derivative of diencephalon.  Ischial spine is at 1st coccyx level.  Placenta is formed at 4th month.  Lymphatic drainage of nipple and areola is to apical lymph nodes.  There are 11 pairs of external and internal intercostal muscles.  Cricoid cartilage is a derivative of 4th pharyngeal arch.  Vertebral level of posterior superior iliac spine is S2.  Iliotibial tract gives attachment to tensor fasciae latae.  Anterior pituitary is derived from Rathke’s pouch.  At adductor hiatus, femoral artery continue down as popliteal artery.  Platysma is derived from 2nd pharyngeal arch.  MC type of cartilage covering articular surfaces is hyaline.  Centre region of long bone is diaphysis.  Supination/pronation occur at radioulnar joint.  Corticospinal tract decussate at medulla oblongata.  Vidian nerve — deep petrosal + greater petrosal.  Angle between rectum and anal canal is 120°.  Area between I and II metatarsal is supplied by deep peroneal nerve.  Positive trendelenburg test indicates palsy of gluteus medius and minimus.  Deltoid ligament is related to ankle joint (Medial ligament of ankle).  Zygote enters the uterine cavity in 16 cell stage (Morula).  Right umblical vein is first to disappear amongst umbilical cord vessels.  Cystohepatic  of calot’s is formed by: — Cystic artery — Cystic duct — Right hepatic artery. 1.14  ANATOMY  Talus bone: Anat — No muscle attachment only ligament attachment.  Superior constrictors forms Passavant’s ridge.  Umblical cord: — Umblical artery: fetus to mother — Umblical vein: oxygenated blood to fetal heart.  Blood supply of ovary: Ovarian artery which is a branch of abdominal aorta. It is supplemented by some branches of uterine artery which is branch of internal illiac artery.  Swallowing in fetus starts by 12 weeks.  Femoral triangle Floor is made of: — Adductor longus — Iliacus — Pectineus and Psoas major  Cremasteric muscle of scrotum is supplied by Genital branch of genitofemoral nerve  Superior mediastinal organs: — Arch of aorta — Thymus — Thoracic duct.  Most common nerve injured in leg is sciatic nerve.  Abdominal part of esophagus is supplied by Left gastric artery  Mandibular Nerve passes through lateral wall of cavernous sinus  Parotid gland is supplied by Glossopharyngeal nerve  Structure passing through Guyon's canal are Ulnar nerve, Ulnar artery  Peripheral aneurysm seen in Popliteal artery  Blood supply of prostate is Ilioinguinal artery 1.15  1 2 Physiology CELL MEMBRANE  33% of the total body water – ECF.  1 osmole of NaCl – 58.5 gms of NaCl.  Ammonia transport in the kidney – Non-ionic diffusion.  Isoelectric potential is given by Nernst equation.  RMP of a neuron is approximately –70 mV  70 percentage of ECF sodium is exchangeable (100% K+ is exchangeable).  most abundant intracellular anion – Phosphate.  RMP is mostly due to K+ diffusion.  Iodide transport in the thyroid cell is an example of Secondary active transport.  Lead is a non-essential mineral.  Glucose transporter in myocyte is GLUT.  Pseudohyponatremia is seen in dyslipidemia.  First change seen with salicylate poisoning is Metabolic acidosis.  D2O is used in determination of Total body water.  Auto-regulation is NOT seen in Cutaneous circulation.  pH of extracellular fluid is 7.4.  Auto-regulation maintains the blood flow.  Maximum oxygen consumption seen in – Skeletal muscle > liver > brain.  Na+ symport transports glucose in GIT and PCT.  Basal metabolic rate is dependent on the amount of lean body mass.  Ketone bodies produced by Liver.  Plasma membrane is chiefly made up of Protein.  Maximum triglycerides are in Chylomicron.  Triple helix structure is seen in Collagen. 2.1  MIST ALL IN ONE FOR FMGE  EDRF simulates the action of nitric oxide.  Force generating protein – Dynein. Physio  Most abundant anion in blood plasma after chloride ions – Bicarbonates.  Nitric oxide is released from Endothelial cells.  The cell junctions allowing exchange of cytoplasmic molecules between the 2 cells are called as Gap junctions.  Second messenger mediates intracellular activities of enzymes and hormones.  Carrier proteins meditates the transport of chemicals across cell membrane against the gradient.  Sodium-potassium-ATPase helps in the maintenance of Cell surface charge, Cell volume and RMP.  Albumin acts as a co-transport for Fatty acids.  Barr body is found in the Interphase phase of the cell cycle.  Oral rehydration mixture contains glucose and sodium because both of them facilitate the transport of each other from the intestinal mucosa to blood.  The endothelial cells produce thrombomodulin, EXCEPT those found in Cerebral microcirculation.  Non-constitutive exocytosis is the example of “Regulated pathway”.  The poison cyanide inhibits the reaction between Cytochrome oxidase and molecular oxygen.  Cyclic AMP is intraneural secondary messenger.  Number of bonds broken in protein synthesis – Four.  Earliest definite sign of death – Absent brain stem reflexes.  7 cal of energy is yielded by 1 ml of alcohol (per gram) in the body.  Various cells respond differentially to a second messenger (such as increased cAMP) because they have different Enzymatic composition.  Adenylate cyclase is a membrane bound enzyme that catalyzes the formation of cyclic AMP from ATP.  Inositol triphosphate increases the release of Ca++ from endoplasmic reticulum.  The most abundant glycoprotein present in basement membrane is Laminin.  Sweating is mediated through Sympathetic Cholinergic.  In Brain ischemia the level of creatinine kinase 1 increases.  Acetyl choline is NOT therapeutic because as it is rapidly metabolized.  The first physiological used response to high environmental temperature is Vasodilatation.  Kidney has the most permeable capillaries: DUE TO FENESTRATION.  Muscle phosphorylase is activated by Calmodulin.  RBC rouleux formation is due to increased blood viscostiy and slow circulation.  Content of Na+ in ringer lactate is 130meq/L.  Androgen receptors are coded in Long arm of X chromosome.  Extra cellular fluid has the majority of body sodium.  Nissl’s substance is composed of rough endoplasmic reticulum. 2.2  PHYSIOLOGY  Most diffusible ion in excitable tissue – K+.  Fe++ is state of Iron responsible for O2 transport. Physio  Calcium ion binding protein – Troponin and Calmodulin.  Compound action potential is seen in Mixed nerve.  Chronaxie is minimum in Myelinated nerve.  Amplitude of action potential can be increased maximally by increased no. of open Na+ channel.  Increasing lipid solubility of the membrane increases particle diffusion across the cell membrane.  Thin filament are made up of Actin, Troponin and tropomyosin.  Relaxation protein is TROPOMYOSIN.  The term Milieu interior was coined by Claude Bernard (FATHER OF PHYSIOLOGY).  Isotonic contraction with shortening of muscle fibres seen in Preload.  Van’thoff gave the Osmotic principle.  ECF is measured by Inulin.  Evans blue dye is used to measure the Plasma volume.  Facilitated diffusion does NOT require energy. NERVE – MUSCLE PHYSIOLOGY Membrane Potentials  Presynaptic inhibition occurs due to hyperpolarisation of presynaptic membrane.  End plate potential follows Depolarisation law.  Continuous sub-threshold stimulus leading to sustained response and increase in threshold for action potential is known as Accommodation.  Rheobase is an indicator of Magnitude of current.  Antidromic conduction is seen in Axon reflex.  Synaptic conduction is mostly orthodromic because Chemical mediator is located only in the presynaptic terminal.  Action potential is produced because of Na+ influx.  The permeability of Na+ ions increases during depolarization of a nerve fiber.  Mg+ is NOT associated with nerve transmission.  Nerve impulse is initiated at axon hillock because it has lower threshold than the rest of axon.  In a motor nerve fiber, lower threshold potential is seen in Axon hillock.  Initiation of impulse starts in Axon hillock + initial segment.  EPSP is due to Na+ influx. 2.3  MIST ALL IN ONE FOR FMGE  Excitatory Postsynaptic Potentials (EPSP) are proportional to the amount of transmitter released by the presynaptic neuron. Physio  A traveling nerve impulse does not depolarize the area immediately behind it, because it is refractory.  Example of bio feedback inhibition – Renshaw cell inhibition.  Concentration of Potassium determines the Resting Membrane Potential (RMP) on nerve.  Nerve action potential conduction requires a threshold stimulus to be activated.  Synaptic potentials can be recorded by Microelectrode.  Neuronal degeneration is NOT seen in Neuropraxia.  Saltatory conduction in myelinated axons results from the fact that Voltage-gated sodium channels are concentrated at the nodes of Ranvier.  Tetanus toxin and botulinum toxin exert their effects by disrupting the function of SNARES, inhibiting the docking and binding of synaptic vesicles to the presynaptic membrane.  A high membrane resistance of the postsynaptic neuron would optimize the effectiveness of two closely spaced axodendritic synapses.  The action potential occurs due to sudden opening of Na+ channels.  An increase in the action potential frequency in a sensory nerve usually signifies increased intensity of the stimulus.  Sensory receptors that adapt rapidly are well suited to sensing the rate at which an extremity is being moved.  Adaptation in a sensory receptor is associated with decline in the amplitude of the generator potential. Muscle  Muscle’s blood supply increases during exercise due to Accumulation of active metabolites.  Ca2+ binding troponin C triggers muscle contraction.  The motor unit consists of motor nerve and muscle fibers that it supplies.  Intercalated disks are found in Cardiac muscles.  Myasthenia gravis is a disorder of Neuromuscular junction.  Contraction of covering binding sites on actin is prevented by Troponin.  Tropomyosin covers myosin and prevents attachments of actin and myosin.  Muscle contraction dependent on calcium.  Amongst the muscles, skeletal muscle is the most excitable tissue because there are two “T tubules per sarcomere and has well developed sarcoplasmic reticulum.  Duchenne Muscular dystrophy is a disease of Sarcolemmal proteins.  In severe exercise muscle spasm occurs due to Accumulation of K+.  Golgi tendon organ determines Muscle tension.  Many signaling pathways involve the generation of inositol trisphosphate (IP3) and diacylglycerol (DAG). These molecules are derived from PIP2. 2.4  PHYSIOLOGY KIDNEY Nephron, Blood Flow and Glomerular Filtration Physio  Juxtaglomerular apparatus is ABSENT in the medulla.  Glomerular filtration rate is best estimated by Inulin clearance.  Relaxation of mesangial cells of kidney is brought about by cAMP.  GFR increases if afferent arteriole dilates or Efferent arteriole constricts.  In renal disease albumin is first to appear in urine because it has molecular weight slightly greater than themolecules normally getting filtered.  Mesangium does not form filtration barrier in nephrons. Transport of Various Substance  The status of fluid in distal convoluted tubule is Always hypotonic.  Maximum absorption of HCO3 occurs is PCT.  Creatinine is least absorbed in tubules.  Even in the presence of vasopressin the greatest fraction (~70%) of filtrated water is re-absorbed in Proximal tubule.  Potassium is either reabsorbed or secreted in DCT.  Active potassium secretion occurs at Distal convoluted tubule.  Maximum reabsorption of Mg2+ occurs in PCT in thick ascending limb.  Na absorption is maximum at PCT.  In Proximal segment by active reabsorption of Na+, the major portion of glomerular filtrate is reabsorbed.  The urine/plasma ratio of sodium ion is 0.6.  The amount of protein normally excreted in urine per day is upto 150 mg.  TmG for glucose is 375 mg/min.  Transport maximum (Tm) means Maximum reabsorption and secretion.  60 to 70% of glomerular filterate is reabsorbed in proximal tubule.  Potassium is maximally absorbed in Proximal convulated tubules.  Over half of the Potassium that appears in the urine of a patient, who has ingested some potassium salts, is derived from Secretion by the distal tubule. Clearance  Clearance of a substance which is secreted is greater than GFR.  Renal plasma flow is best determined by PAH.  PAH (Para-Aminohippuric Acid) clearance is equal to Renal plasma flow. 2.5  MIST ALL IN ONE FOR FMGE  Inulin clearance is equal to 125 ml/min.  Free water clearance by the kidney is increased by Diabetes insipidus. Physio  Inulin clearance provides the most accurate measure of GFR.  PAH has the highest renal clearance. Counter Current Mechanism  Urinary concentrating ability of the kidney is increased by ECF volume contraction.  Renal medullar hyperosmolarity is due to increased interstitial Na, K and Urea.  In PCT 60-70% filtrates are reabsorbed. Acid-Base Balance  Anion gap is normal in RTA, GI bicarbonate loss like diarrhea.  The enzyme required for the generation of the ammonium ion in the kidney is Glutaminase.  The Henderson-Hasselbalch equation is used for measuring the acid base balance.  I cells are responsible for acid secretion in kidney. Endocrine Functions of Kidney & other Applied Aspects  Ureteric peristalsis is due to pace maker activity of the smooth muscle cells in the renal pelvis.  Sodium is excreted in urine in SIADH.  In Hypervolemia, renin secretion is inhibited.  Renin is released when there is low sodium.  Renovascular hypertension is the renin induced hypertension.  In micturition reflex, the first change to occur is relaxation of perineal muscle.  Vasopressin secretion is increased by decreased ECF volume and Carbamazepine.  ADH act at Collecting tubules.  Production of aldosterone is stimulated by Renin.  The part of Nephron most impermeable to water is Ascending Loop.  ANP acts at Collecting duct.  In collecting duct there is increased excretion of K+.  An athelete came to casualty with 4 days of passing red coloured urine, the cause of hematuria is hemoglobin.  Monitoring of serum cystatin levels for Renal functions.  Increased Efferent arteriolar resistance tends to increase peritubular capillary fluid reabsorption.  In a person with severe central diabetes insipidus (deficient production or release of AVP), urine osmolality and flow rate is typically about 50 mOsm/kg H2O, 18 L/day. 2.6  PHYSIOLOGY  The primary reason that the female phenotype develops in an XY male is the lack of testosterone action. Physio  Renin in synthesized by JG cells.  Arginine Vasopressin (AVP) is synthesized in the Anterior hypothalamus.  An increase in central blood volume leads to decreased Na+ reabsorption by the kidneys.  Intravenous infusion of isotonic saline causes decreased renin release by the kidneys.  Skeletal muscle injury cause hyperkalemia.  Aldosterone acts on cortical collecting ducts to increase K+ secretion.  In response to an increase in GFR, the proximal tubule and the loop of Henle demonstrate an increase in the rate of Na+ reabsorption. This phenomenon is called as Glomerulotubular balance.  Intravenous infusion of 2.0 L of isotonic saline (0.9% NaCl) results in increased plasma Atrial Natriuretic Peptide (ANP) concentration.  The main driving force for water reabsorption by the proximal tubule epithelium is ACTIVE reabsorption of Na+. CARDIOVASCULAR SYSTEM  HR increases with parasympathetic Denervation.  Vagal stimulation causes increase in R-R interval in EC.  The maximum conduction rate is at Purkinje fiber.  Conduction velocity is least at AV node.  SA node is the pacemaker of heart because it generates impulses at a faster rate.  The pacemaker potential is due to decrease in K+ permeability.  Calcium enters the cardiac cell during plateau phase of the action potential.  Endocardium, epicardium, upper most part of septum.is the correct order of activation after stimulation of Purkinje fibers.PR interval indicates AV node conduction time & Atrial depolarization.  QRS complex indicates Ventricular depolarization.  Osborne J wave is the ECG hallmark of hypothermia.  Voltage-gated Ca2+ channels is most responsible for phase 0 of a cardiac nodal cell.  Atrial repolarization normally occurs during the QRS complex.  The P wave is normally positive in lead I of the ECG because depolarization of the atria proceeds from right to left.  Excitation of the ventricles proceeds from the subendocardium to subepicardium.  AV nodal cells conduct impulses more slowly than either atrial or ventricular cells.  The R wave in lead I of the ECG reflects a net dipole associated with ventricular depolarization.  During the cardiac cycle, the aortic and mitral valves never open at the same time. 2.7  MIST ALL IN ONE FOR FMGE Cardiac Cycle & JVP Changes  ‘C’ wave in JVP is due to: Bulging of the tricuspid value into the right atrium. Physio  First heart sound occurs due to closure of AV valve.  Second heart sound occurs due to closure of aortic and pulmonary valve.  The iso-volumetric relaxation stops when Ventricular pressure falls below atrial pressure.  Opening of AV valve marks the end of isovolumetric relaxation.  During the cardiac cycle the opening of the aortic valve takes place at the end of isovolumeric contraction. Cardiac Output & Ventricular Functions  Myocardial O2 demand is directly proportional to duration of systole.  Ejection fraction increases with End Diastolic volume.  Standing to sitting change is immediate Increase in Venous Return.  When a person changes position from standing to lying down position, Venous return to heart rises immediately.  Cardiac output in liter per minute divided by heart rate gives Mean stroke volume.  The basal cardiac output in adults is 5.5 liter.  Fick’s principle is used for measuring Cardiac output.  Starling’s principle is: that within physiological limits, the force of contraction is proportional to initial length of cardiac muscle fiber.  Oxygen demand of heart increases proportionately with heart rate. Principles of Hemodynamics  Capillaries contain 5% blood.  Laminar flow is dependent on critical velocity.  Maximum peripheral resistance is at Arterioles.  Bernoulli’s principle states that Sum of kinetic energy of flow and pressure energy is constant.  Maximum CROSS SECTIONAL area is present in Capillaries.  Blood flow through a vessel varies directly with pressure of difference.  Cutaneous shunt vessels helps in thermoregulation. Blood Pressure  Mean circulatory pressure is Pressure at any point when the heart is stopped.  The blood pressure measured by Sphygmomanometer is Higher than the intraarterial pressure.  Pulmonary (CAPILLARY) wedge pressure corresponds to Left atrial pressure.  Mean arterial pressure is equal to Diastolic + 1/3rd Pulse pressure.  Occlusion of common carotid artery on both sides leads to increases in HR & BP.  Carotid sinus baroreceptor is most sensitive to Mean blood pressure. 2.8  PHYSIOLOGY  Diastolic Pr. In Aorta is maintained by Elastic recoil of aorta.  Blood pressure measured using a sphygmomanometer may be falsely high in obese patients (LQ). Physio Cardiovascular Regulatory Mechanisms  Vasomotor Centre (VMC) acts along with the Cardiovagal Centre (CVC) to maintain blood pressure.  Pressure on carotid sinus leads to reflex bradycardia. Special Circulation & Applied  CSF pressure is mainly regulated by rate of CSF absorption.  Maximum heart rate with exercise is 200/min.  Blood supply during exercise does not decrease in Coronary circulation.  Histamine give rise to Lewis Triple Response.  The regional arterial resistance of the mesentry and kidney vessels is reduced by Dopamine.  The pressure-volume curve is shifted to the left in Aortic stenosis.  Vagal stimulation causes increase in R-R interval in ECG.  In peripheral chemoreceptors, activation is important in the cardiovascular response to hemorrhagic hypotension.  Parasympathetic stimulation of the heart accompanied by a withdrawal of sympathetic tone to most of the blood vessels of the body is characteristic of: Vasovagal syncope.  A patient suffers a severe hemorrhage resulting in a lowered mean arterial pressure. Which of the following would be elevated above normal levels: Heart rate.  A person stands up. Compared with the recumbent position, 1 minute after standing, the: Volume of blood in leg veins increases.  A manual labourer moves in March from Kashmir to Delhi and becomes acclimatized by working outdoors for a month. Compared with his responses on the first few days in the Delhi, for the same activity level after acclimatization one would expect higher: Sweating rate.  In the presence of a drug that blocks all effects of norepinephrine and epinephrine on the heart, the autonomic nervous system can lower the heart rate below its intrinsic rate.  At a constant blood flow, an increase in the number of perfused capillaries improves the exchange between blood and tissue because of greater surface area for the diffusion of molecules. RESPIRATION Mechanics of Breathing  Specific compliance is NOT reduced in the Chronic bronchitis.  The intrapleural pressure is negative both during inspiration and expiration because: Thoracic cage and lung’s opposite recoil. 2.9  MIST ALL IN ONE FOR FMGE Surface Tension and Surfactant  Stability of alveoli maintain by surfactant. Physio  Surfactant is made up of mainly Phospholipids.  Type II pneumocytes secrete surfactant.  Surfactant is present in amniotic fluid at 28 weeks. Ventilation/Perfusion Pressure  In Apex of lung the ventilation perfusion ratio is maximum.  Total alveolar ventilation volume is 4.2 liter/mm.  Alveolar PaO2 is maximum at apex of lung.  Ventilation-perfusion ratio is maximum at apex of lung due to poor blood flow. Lung Volume and Capacities  During plethesmography, pressure in lungs increases and in the box decreases as patient expires with closed glottis.  Flow in small airways is laminar because the linear velocity of airflow in the small airways is extremely low.  Vital capacity is TV+IRV+ERV. (~4.5L).  Total lung capacity is 6 to 7 litres.  Anatomic dead space is 30% of tidal volume.  Volume of air present after normal expiration – FRC.  Normal functional residual capacity is 2.3L.  Lung diffusion capacity is measured with CO.  Total lung capacity depend on Lung compliance. Gas Exchange and Transport  Reason for fast CO2 diffusion in blood is the more soluble in plasma.  Cause of sigmoid shape of O2 curve is the binding of one O2 molecule increase the affinity of binding of other O2 molecules.  High affinity of HbF with O2 due to decrease binding with 2,3 DPG.  An increase in Oxygen affinity of hemoglobin will shift the O2 dissociation curve to the left.  2, 3 diphosphoglycerate alters affinity to hemoglobin.  Oxygen affinity decreases in hypoxia.  Decreased O2 affinity of Hb in blood with decreased pH: Bohr effect.  Dissolved oxygen is NOT dependent on Hb.  Carbon dioxide is transported in blood mainly as Bicarbonate.  The concentration of oxygen provided by mouth-to-mouth respiration is 16%. 2.10  PHYSIOLOGY Regulation of Respiration  Loading reflex to monitor tidal volume is the Thoracic muscle spindles. Physio  Pacemaker for the start of rhythmic respiration is Pre – botzinger complex.  Central chemoreceptors are most sensitive to Increase in CO2 Tension.  “Inflation of lungs induces further inflation” is explained by Heads paradoxical reflex.  The vasodilatation produced by carbon dioxide is maximum in Brain.  Peripheral chemoreceptors are stimulated maximally by Cyanide.  In Asthma there is increased FRC and Increased Residual Vol. Applied Respiratory Physiology  Nitrogen narcosis is caused due to Increased solubility of nitrogen in nerve cell membrane.  Due to High position of the larynx an infant can breathe while suckling breast milk.  Cyanosis doesn’t occur in Anemia because Certain min. amount of reduced Hb should be present.  At high altitude pulmonary edema is more likely to occur above height of 300m.  Earliest change in high altitude is Hyperventillation.  An untrained person going to higher altitude for training can have maximum anabolic effect by: Decrease in workload, increase in duration of exercise.  Cyanosis which is not corrected by 100% oxygen therapy is due to shunt.  In moderate exercise stimulation of respiration is due to Joint propioception receptor.  Best-known metabolic function of the lung – Conversion of angiotensin I to angiotensin II.  Hypoxia causes vasoconstriction in Lungs.  In Cyanide poisoning, there is tissue hypoxia without alteration of oxygen content of blood.  Death due to cyanide poisoning results from Histotoxic hypoxia.  100 feet deep under water, the pressure is 4 atm.  Partial pressure of oxygen in venous blood is 40 mm Hg.  Diaphragm is lowest in sitting posture.  Maximum increase in minute volume is seen in exercise.  In healthy individuals, the cause of an (A-a) O2 gradient is a bronchial circulation (physiological) shunt. CENTRAL NERVOUS SYSTEM General, Neurons, Neurotransmitters  Pain insensitive structure in brain is choroid plexus.  Memory cells escape apoptosis because of nerve growth factor.  Substance p is released in response to pain in periphery Nerve terminals. 2.11  MIST ALL IN ONE FOR FMGE  Inhibitory neurotransmitter of central nervous system is Gamma-aminobutyric acid.  Sine qua non for cerebral cortex are Pyramidal cells. Physio  Exposure to darkness leads to increased melatonin secretion. It is brought about by the increasing the serotonin N-acetyl transferase.  Melatonin is a serotonergic.  Acetylcholine is a preganglionic sympathetic neurotransmitter.  Glutamate is excitatory.  Gamma-amino-butyric acid and Glycine example of Inhibitatory transmitter.  Renshaw cell inhibition is a typical example of Recurrent inhibition.  In the postnatal period the greatest growth in the grey matter of the C.N.S. is of the Dendritic tree.  Phagocytosis in the CNS is done by Microglia.  The inhibition substance in spinal cord is Glycine.  The inhibitory neurotransmitter in central nervous system is Gamma-aminobutyric acid.  Gamma neurons innervate the Intrafusal muscle fibers.  The brain neurons may get irreversibly damaged if exposed to significant hypoxia for 8 minutes.  Peptide transmitters would be most affected by a toxin that disrupted microtubules within neurons.  Degeneration of corpus striatum cause chorea.  Umami taste is due to glutamate.  Otoaccoustic emissions are related to outer hair cells.  Nociceptin acts via Orphanin receptors.  Acetyl choline is secreted by which cells of retina amacrine cells.  Transducin protein is seen in vision.  Nerve fibres affected mainly by local anaesthetic B. Sensory System, Spinal Cord and Tracts  Due to a central cord lesion, dissociative sensory loss seen due to Decussating branches of lateral spinothalamic tract.  Function of spinocerebellar tract – Coordination & smoothing of movement.  In Brown-Sequard’s syndrome there is Ipsilateral loss of proprioception.  Conscious proprioception is carried by Dorsal column.  Fine touch is transmitted via the dorsal lemniscal system.  Stereoanesthesia is due to lesion of Nucleus cuneatus.  As per Weber Fechner law, sensation is proportional to Logarithm of stimulus strength.  Destruction of sensory area 1 of brain leads to loss of which sensations like Stereognosis & 2 point discrimination.  A person with intractable pain over the right leg is benefited by Left Spinothalamic tract cordectomy. 2.12  PHYSIOLOGY  Sensation transmitted by pacinian corpuscles is Vibration.  Pacinian corpuscles are rapidly adapting mechanoreceptors. Physio  Phantom limb phenomenon can be described by Law of projection.  The distance by which two touch stimuli must be separated to be perceived as two separate stimuli is greatest the back of scapula.  Massage and the application of ligaments to painful areas in the body relieves pain due to Inhibition by large myelinated afferent fibres.  If a single spinal nerve is cut, the area of tactile loss is always greater than the area of loss of painful sensations, because degree of overlap of fibres carrying tactile sensation is much less.  Hot water bag use in intestine colic works by inhibiting Adrenergic receptors. Motor System and Reflexes  Muscle spindle function is Length.  Golgi tendon organ determines Muscle tension.  Lower motor neuron is involved in amyotrophic lateral sclerosis.  Fasciculation is the twitch of a single motor unit.  Skilled voluntary movement is initiated at Cerebral Cortex (motor cortex).  Pyramidal fibers are Projection fibres.  Lesions of pyramidal tract do not present with Abnormal movements.  Lower motor neuron lesions are associated with Flaccid paralysis.  Crossed extensor reflex is a Withdrawal reflex. Basal Ganglia  Basal ganglion is related with Planning of voluntary movements.  In substantia nigra, the major neurotransmitter is Dopaminergic.  In subthalamic nuclei the major neurotransmitter is glutamate.  Functions of Basal ganglia include the skilled motor movements.  Huntington’s disease is due to the loss of Intrastriatal GABAergic neurons. Cerebellum  Spinocerebellar ataxia exclusively involve neurons.  Cerebellum in motor performance smoothens and coordinates ongoing movements.  Archicerebellum is Flocculus.  Mossy fibers which are cerebellar component that would be abnormal in a degenerative disease that affected spinal sensory neurons. 2.13  MIST ALL IN ONE FOR FMGE EEG and Sleep  In EEG, delta waves are seen in deep sleep. Physio  Sleep spindles and K complexes seen in NREM 2 stage.  A person with eyes closed and mind wandering will have the Alpha waves in EEG.  Waves seen in EEG at the Hippocampus Theta.  Nightmares are seen in REM sleep.  Dreams occurred in both NREM and REM sleep.  Primary visual cortex’s blood flow not increased in REM sleep, Hypothalamus  Shivering is NOT occurring in child exposed to cold climate; due to Brown fat.  Sleep is primarily regulated by Hypothalamus.  Satiety center is located in Ventromedial nucleus of hypothalamus; hunger center is located in lateral nucleus of hypothalamus.  Thermoregulatory center is located at Hypothalamus.  Primary motor area for shivering is Dorsomedial posterior hypothalamus.  Thirst is activated by Extracellular hyperosmolarity.  Circadian rhythm is controlled by Suprachiasmatic nucleus.  Drinking can be induced by Electrical stimulation of the preoptic nucleus.  Osmoreceptor is located at Anterior hypothalamus site.  Osmoreceptors are present in anterior hypothalamus.  True about non-shivering thermogenesis is that Fatty acids show uncoupled oxidative phosphorylation. Higher Functions  Remembering things a week old is remote memory.  Representation in Cerebral cortex is vertically.  Conversion of short-term - memory into long term memory occurs in Hippocampus.  Papez circuit in limbic system involves Anterior thalamic nuclei.  Prosopagnosia is Inability to recognize faces.  Lesion of which of the following structure leads to Kluver-Bucy syndrome Amygdala.  Emotional effect to a physical response is given by Hippocampus.  Arousal response in mediated by Reticulo activating system (LQ).  Prosapagnosia is Inability to recognise faces.  Part of brain most sensitive to hypoxia is Hippocampus. Speech and Aphasia  Broca’s area is involved in Word formation.  Broca’s area 44 of speech is located in Inferior border of frontal lobe.  Motor aphasia is Verbal expression. 2.14  PHYSIOLOGY Cerebro Spinal Fluid (CSF)  CSF pressure depends primarily upon Rate of absorption. Physio  CSF plasma glucose ratio is 0.64.  Normal pressure of CSF in adult is 6-l2 mmHg (50-l80 mm H2O).  CSF production per minute 0.30-0.35 ml/min.  Blood brain barrier is deficient at Area postrema. Autonomic Nervous System  Autonomic ganglion is mainly Cholinergic.  Parasympathetic stimulation will cause Pupillary constriction.  Sensory fiber with maximum conduction velocity Alpha fiber.  Sympathetic ganglia arises from Thoracolumbar. VISION AND HEARING Special Senses  Bitter taste is mediated by action of G protein.  Red Green spectrum of colour is highest visualized due to central cones.  The rod receptor potential differs from other sensory receptors in that it shows Hyperpolarization.  During the dark phase of visual cycle, the form of vitamin A combines with opsin to make Rhodopsin is 11-cis-Retinaldehyde.  The parvocellular pathway from lateral geniculate nucleus to visual cortex is most sensitive for the stimulus of colour contrast  Amacrine cells are seen in Retina.  Receptor which itself is a dendrite of a nerve is Olfactory.  In the inner ear, stereocilia are the mechanosensing organelles of hair cells, which respond to fluid motion. ENDOCRINOLOGY General and Mechanism of Hormones Action  Adrenaline, noradrenaline, dopamine, serotonin act through 7 pass receptor.  Prolactin, insulin & Growth hormone act by tyrosine kinase receptors PIG. Pituitary Gland: Growth Hormone and Prolactin  High prolactin is associated with Increase estradiol.  In obstructive azoospermia, FSH & LH Both normal.  The secretion of prolactin is controlled by: Dopamine.  LH surge is responsible for menopausal hot flashes.  The antidiuretic hormone is released by Posterior pituitary. 2.15  MIST ALL IN ONE FOR FMGE  Transection of pituitary stalk leads to the increase in prolactin.  Lactogenesis is caused by prolactin; ejection of milk by Oxytocin. Physio  Acromegaly occurs due to Acidophilic adenoma.  Pituicyte is located in Neurohypophysis.  Apart from TSH, TRH also stimulates the release of Prolactin.  Posterior pituitary stores and releases Oxytocin and vasopressin.  Follicle stimulating hormone is produced by Basophilic cells of pituitary.  In the neurohypophysis, secretory granules accumulate in nerve endings.  Insulin stress test assay estimates Growth hormone.  Growth Hormone causes hyperglycemia. Thyroid Gland  Thyroid act by nuclear receptors.  TSH level gives an indication of Thyroid state.  “C” cells are found in thyroid. Pancreas  Somatomedin mediates the deposition of chondroitin sulphate.  Epinephrine decreases insulin release.  Delta cells or ‘D’ cells of pancreas Secrete somatostatin.  Human insulin differ from beef insulin by 3 Amino acid.  Insulin does not cause Lipolysis.  Insulin does not cross placenta.  HbA1c level in blood explains the long term status of blood sugar. Adrenals  Vanillylmandelic acid is the principal metabolite in norepinephrine metabolism excreted in urine.  In the adrenal gland, androgens are produced by the cells in the Zona reticularis.  Zona glomerulosa secretes aldosterone.  Non-shivering thermogenesis in adults is due to Noradrenaline. Calcium and Potassium  Ionized calcium is the active form of calcium in the body.  The mechanism by which hyperventilation may cause muscle spasm is decreased calcium.  Osteoclast has specific receptor for Calcitonin.  Sudden decrease in serum calcium is associated with increased sensitivity of muscle and nerve.  Inositol triphosphate acts to increase the release of Ca2+ from endoplasmic reticulum. 2.16  PHYSIOLOGY  Parathyroid hormone is responsible for increased production of 1, 25 & dihydroxycholecalciferol in kidney.  Osteomalacia is associated with increase in osteoid maturation time. Physio  Main mineral salt of bone in Hydroxyapatite. Reproduction and Related Hormones  Capacitance of sperm takes place in Uterus.  Best indicator for ovarian reserve is FSH.  Estrogen action on carbohydrate metabolism shows Glycolysis increase.  Sertoli cells are associated with Spermiogenesis.  Leydig cells secrete testosterone.  Correct sequence of sperm movement is straight tubules – rete testis – efferent tubules.  Sertoli cells in the testis have receptors for FSH.  Sperms acquire motility in Epididymis.  Inhibin hormone is secreted by Sertoli cells.  Antibodies against sperms develop after vasectomy.  Progesterone causes increase in basal body temperature during ovulation.  In postmenopausal women, estrogen is metabolized mostly into Estrone.  Elasticity of cervical mucous is seen at time of Midcycle.  The correct position of OH groups in estradiol are C3 and Cl7.  Nucleus is the site of estrogen action.  Normal or elevated LH/FSH is seen during polycystic ovary disease.  Gene coding for androgen receptors is situated in Long arm of X chromosome.  FSH is inhibited by Inhibin.  After formation, the sperms are stored in Epididymis.  Meiosis occurs in human males in Seminiferous tabules.  Length of spermatozoa 50 micron.  Sertoli cells have receptors for: Follicle stimulating hormone.  The enzyme associated with the conversion of androgen to oestrogen in the growing ovarian follicle is Aromatase.  Androsterone is responsible for hirsuitism.  Blood testis barrier is formed by Sertoli cells.  Prostaglandins found in the seminal fluid are the secreting products of Seminal vesicle.  Hormone responsible for initiation of ovulation is LH.  Pancreatic  cell are freely permeable to glucose via B GLUT2.  Insulin stimulated glucose entry is seen in cardiac muscle.  Fructose is secreted by seminal vesicle.  Hormone acting on adjacent cells is called – Paracrine.  Premenopausal peripheral conversion of estrogen precursors in the obese patient results in the formation of Estrone. 2.17  MIST ALL IN ONE FOR FMGE  Insulin secretion is inhibited by Hypokalemia.  Epiphyseal closure is due to Androgen. Physio  GnRH acts via Phospholipase C.  Glucose mediated insulin release is mediated through ATP sensitive K+ channels. Thyroid Gland  Reabsorption Lacunae in thyroid are seen in Colloid, in active follicles.  Thyroglobulin synthesis does not take place in colloid.  The R.M.P of thyroid cell is approximately: –50mv  Iodide uptake into thyroid cell is an example of Secondary active transport.  The minimum amount in thyroid secretion is that of MIT.  Active form of thyroid hormone is T3.  An increase in both TSH as well as thyroid hormones can be encountered in T3, T4 resistance. Adrenal Glands  In the adrenal medulla: 90% of cells are of epinephrine secreting type.  Most of the total mass of adrenal gland is made up of Zona fasciculate.  Secretion of adrenal androgens is controlled mainly by ACTH.  Glucocorticoids act as anti-inflammatory/anti-allergic agents because they Prevent release of histamine/cytokines.  ACTH bursts are maximum Early morning.  The primary form of cortisol in the plasma is that which is: Bound to Corticosteroid-Binding Globulin (CBG).  The rate-limiting step in the synthesis of cortisol is catalyzed by Cholesterol side-chain cleavage enzyme. Pancreas  The enzyme that controls entry of glucose into circulation from liver is Glucose – 6 phosphatase. Parathyroid Glands  Main effect of VIT.D. (1,25 DHCC) is es intestinal absorption of Ca++.  The major site(s) for control of body’s phosphorous is Kidney.  The major storage form of vit. D is 25 OHCC.  Hyperparathyroidism responsible for osteoporosis. Reproduction and Related Hormones  Estriol production during pregnancy requires Androgens substrates from the fetus.  A major causal factor in some cases of hypogonadism is reduced secretion of Gonadotropin-Releasing Hormone (GnRH).  The major function of follistatin is to bind activin and thus decrease FSH secretion.  The production of mature spermatozoa from spermatogonia takes 70 days. 2.18  PHYSIOLOGY  Testosterone is converted to dihydrotestosterone in the prostate.  Sex Hormone-Binding Globulin (SHBG) binds testosterone with a higher affinity than estradiol.  The production of estradiol by the testes requires Leyd