AMAZING SPLEEN !

1. Most Common location of Accessory Spleen(Splenenculi) - Splenic Hilum


2. Most Common Primary benign lesion of spleen - Cavernous Hemangioma.


3. Most Common primary malignant lesion of spleen is - Lymphoma


4. Most Commonly ruptured intra-abdominal organ in the setting of trauma - Spleen
     (Why? Ans: due to its complex ligamentous attachments and spongy parenchymal consistency)


5.Most common infection involving Spleen in Immunocompromised - Candidiasis.


6. Most Common organ involved in Sickle Cell Disease - Spleen


7. Most Common cause of Splenic Vein Thrombosis - Secondary to Pancreatitis.




DV-

Parkinson’s disease - Genetic Mutations

The cause of sporadic Parkinson’s disease is still unclear. Major risk factors include age, not smoking, and living in rural areas. Familial forms of PD are rare accounting for less than 5% of all cases of PD. However, elucidation of several genes over the last decade has shed considerable light on the pathogenesis of typical sporadic PD (Table 2).

Locus	Inheritance	Gene	Function	Pathogenesis
PARK1/4	AD	α-synuclein	Unknown	Protein aggregation
PARK2	AR	parkin	Ub E3 ligase	UPS dysfunction
PARK3	AD	Unknown	-	-
PARK5	AD	UCHL1	Ub hydrolase	UPS dysfunction
PARK6	AR	PINK1	Kinase	Mitochondrial dysfunction
PARK7	AR	DJ-1	Binds RNA?	Oxidative stress
PARK8	AD	LRRK2	Kinase	Multiple pathways?
PARK9	AR	ATP13A2	P-type ATPase	Lysosomal dysfunction
PARK10	Susceptibility locus	-	-	-
PARK11	AD	GIGYF2	Unknown	-

Screening for Lp(a)

Patients at high to moderate risk of cardiovascular disease should be screened for elevated levels of lipoprotein(a) (Lp[a]) and take niacin to bring their Lp(a) level under 50 mg/dL, according to a consensus statement from the European Atherosclerosis Society.

Lp(a) is a plasma lipoprotein consisting of a cholesterol-rich LDL particle with one molecule of apolipoprotein B-100 and a molecule of apolipoprotein A. About 20% of people are thought to have plasma Lp(a) levels over 50 mg/dL; there are no gender differences in Lp(a) concentrations, but racial differences have been observed, with whites and Asians having lower levels while black and Hispanics generally have somewhat higher levels.
Since lifestyle appears to have little impact on an individual's Lp(a) level, the EAS consensus panel recommends that 1 to 3 g of niacin (nicotinic acid) daily is the best treatment for lowering Lp(a) levels. However, the group acknowledges that there have not been randomized, controlled trials selectively targeting plasma levels of Lp(a) and calls for further studies in both primary- and secondary-prevention settings to better define which patients should be targeted for treatment and what the target level of Lp(a) should be.

High Anion Gap Acidosis

High Anion Gap Acidosis

Mnemonic is MUD-PILES:

 

M : methanol

U : uremia (renal failure)

D : diabetic ketoacidosis

P : paraldehyde

I  : Iron, Isoniazid

L : Lactic Acidosis.

E : ethylene glycol, ethanol.

S : salicylates

Normal anion gap acidosis : Mnemonic

Normal anion gap acidosis

 

Mnemonic USED CAR:

 

U : uterosigmoidostomy

S : saline administration (in the face of renal dysfunction)

E : endocrine (Addisons, spironolactone, triamterene, amiloride,

primary hyperparathyroidism)

D : diarrhea

 

C : carbonic anhydrase inhibitors

A : ammonium chloride

R : renal tubular acidosis

 

    OR

RAGE:

 

R : renal tubular acidosis, respiratory acidosis

A : acetazolamide, ammonium chloride

G : GI (diarrhea, enteroenteric fistula, ureterosigmoidostomy)

E : endocrine (same as above endocrine list)

 

CAUSES OF HYPERCALCEMIA

CAUSES OF HYPERCALCEMIA
Harrison 17th, AIIMS Nov 2007 Q

Excessive PTH production

Primary hyperparathyroidism (adenoma, hyperplasia, rarely carcinoma)

Tertiary hyperparathyroidism (long-term stimulation of PTH secretion in renal insufficiency)

Ectopic PTH secretion (very rare)

Inactivating mutations in the CaSR (FHH)

Alterations in CaSR function (lithium therapy)

Hypercalcemia of malignancy

Overproduction of PTHrP (many solid tumors)

Lytic skeletal metastases (breast, myeloma)

Excessive 1,25(OH)2D production

Granulomatous diseases (sarcoidosis, tuberculosis, silicosis)

Lymphomas

Vitamin D intoxication

Primary increase in bone resorption

Hyperthyroidism

Immobilization

Excessive calcium intake

Milk-alkali syndrome

Total parenteral nutrition

Other causes

Endocrine disorders (adrenal insufficiency, pheochromocytoma, VIPoma)

Medications (thiazides, vitamin A, antiestrogens)

Note: CaSR, calcium sensor receptor; FHH, familial hypocalciuric hypercalcemia; PTH, parathyroid hormone; PTHrP, PTH-related peptide.

Additions:-

**William's Syndrome causes hypercalcemia d/t increased sensitivity to Vitamin D, it is also called as Idiopathic Hypercalcemia of Infancy.

**Increased Bone turnover has also been mentioned for Vitamin A Intoxication and for Thiazides.

pgmeenotesby dv.

Differential Diagnosis of PANCYTOPENIA

Differential Diagnosis of PANCYTOPENIA
AIIMS November 2007, Medicine

Pancytopenia with Hypocellular Bone Marrow 

Acquired aplastic anemia

Constitutional aplastic anemia (Fanconi's anemia, dyskeratosis congenita)

Some myelodysplasia

Rare aleukemic leukemia (AML)

Some acute lymphoid leukemia

Some lymphomas of bone marrow

Pancytopenia with Cellular Bone Marrow 

Primary bone marrow diseases

  Myelodysplasia

  Paroxysmal nocturnal hemoglobinuria

  Myelofibrosis

  Some aleukemic leukemia

  Myelophthisis

  Bone marrow lymphoma

  Hairy cell leukemia

Secondary to systemic diseases

  Systemic lupus erythematosus

  Hypersplenism

  B₁₂, folate deficiency

  Overwhelming infection

  Alcohol

  Brucellosis

  Sarcoidosis

  Tuberculosis

  Leishmaniasis

Hypocellular Bone Marrow ± Cytopenia 

Q fever

Legionnaires' disease

Anorexia nervosa, starvation

Mycobacteria

pgmee notes by dv.

Most Commons Medicine

Most common finding in histopathological examination of kidney in Denys-Drash Syndrome - Diffuse Mesangial Sclerosis

MC ECG manifestation of PTE / Pulm.ThromboEmbolism : Sinus Tachcardia >> Irregular ST-T changes

MCC for Drug induced SLE : Procainamide > Hydrallazine

Intracranial Neuropathies of Aneurysmal Etiology

1. Anterior Cerebral Artery Aneurysm / Supraclinoid Carotid artery aneurysm ---> Optic Nerve Compression ----> Visual Field defects.

2. Middle Cerebral Artery expanding aneurysm - Pain in eye / behind eye / in temple region.

3. Posterior Cerebral Artery (P.C.A) Aneurysm - Occulomotor Nerve.

4. AICA / PICA aneurysm - occipital or posterior cervical pain.

5. Ophthalmic Artery Aneurysm - Optic Nerve Compression --> Visual Loss.

pgmeenotes by dv........

Most Commons : Renal lesion in HIV infection

** The most common renal lesion in HIV infected individuals is  : 

                              OR 

** The most common HIV Associated Nephropathy is                :

ANSWER : FSGS- Collapsing Variant.

Reference : Robbins 7/e, p.n. 984 : pgmeenotes by dv.

Classic TRIAD of REITER's Disease

Described by Hans Reiter.

1. Urethritis - Non-gonococcal.

2. Arthritis.

3. Conjunctivitis.

This classic triad is seen only in 33% or 1/3rd of the patients with Reiter's Disease / ReA.

The Most Common cause of ReA is Chlamydia Trachomatis.

Other organisms include Shigella, Salmonella, Campylobacter, Yersinia.

pgmeenotes by dv

Most Commons : PUO (Medicine)

********MC - Most Common ::: MCC- Most Common Cause ::: MCS - Most Common Site***********


PUO - Pyrexia of Unknown Origin MC

MCC of PUO - Extrapulmonary Tuberculosis

MCC of PUO in Elderly - Giant Cell Arteritis

MC Infectious cause responsible for PUO in elderly : Tuberculosis

MC fungus to cause PUO - Histoplasmosis

(These 4 are from Harrison 17th, the next one is from a guide)

MC Cancer to present as PUO - Leukemia & Lymphoma.

Whipple's triad : Insulinoma

 
Whipple's triad : Insulinoma of the pancreas

Diagnostic features

1. Symptoms and signs of hypoglycaemia: confusion, personality changes, tachycardia, seizure, stupor, coma, focal neurologic findings.

2. Blood sugar levels below 40 mg/dL. 

3. Immediate recovery from attack following the administration of glucose.

HUTCHINSON"S TRIAD

Hutchinson's Triad is seen in Congenital Syphilis with

1. Hutchinson's teeth (Peg shaped Incisors)

2. Interstiatial Keratitis

3. Nerve Deafness.

(Picture of Hutchinson's teeth)

6 Numbered Diseases : Childhood Viral Exanthems

FIRST DISEASE : ---> Measles.

SECOND DISEASE : ---> Scarlet Fever.

THIRD DISEASE :---> Rubella or German Measles.

FOURTH DISEASE :---> Duke's Disease 

FIFTH DISEASE :---> Erythema Infectiosum caused by Parvovirus B19

SIXTH DISEASE :---> Exanthem Subitum / Roseola Infantum (HHV-6)(HHV-7 also mentioned)

Please Note : The terms "fourth disease" and "Dukes' disease" are rarely used today.

More on Duke's Disease 

1. http://en.wikipedia.org/wiki/Duke's_disease

2. http://aje.oxfordjournals.org/cgi/content/abstract/134/6/628

The TRIAD of Hemolytic Uremic Syndrome

The TRIAD of HUS consists of

A -- Anemia ---> Micro Angiopathic Hemolytic Anemia

R -- Renal Failure ---> or UREMIA

T -- Thrombocytopenia

MOST COMMONS

The Most Common cause of Drug Induced SLE is

 ::---> PROCAINAMIDE >> Hydrallazine.

Most Commons :: Medicine Contd.

MC acute complication of hemodialysis : Hypotension (Impaired Autonomic Respone)

Tests for Detection of H. pylori

Tests for Detection of H. pylori

Test	Sensitivity/Specificity, %
Invasive (Endoscopy/Biopsy Required)
Rapid urease	80–95/95–100	Simple, false negative with recent use of PPIs, antibiotics, or bismuth compounds
Histology	80–90/>95	Requires pathology processing and staining; provides histologic information
Culture	—/—	Time-consuming, expensive, dependent on experience; allows determination of antibiotic susceptibility
Non-invasive
Serology	>80/>90	Inexpensive, convenient; not useful for early follow-up
Urea breath test	>90/>90	Simple, rapid; useful for early follow-up; false negatives with recent therapy (see rapid urease test); exposure to low-dose radiation with 14C test
Stool antigen	>90/>90	Inexpensive, convenient; not established for eradication but promising

Recommendations for Treatment of NSAID-Related Mucosal Injury

Recommendations for Treatment of NSAID-Related Mucosal Injury

Clinical Setting Recommendation Active ulcer NSAID discontinued H2 receptor antagonist or PPI NSAID continued PPI Prophylactic therapy Misoprostol PPI Selective COX-2 inhibitor H. pylori infection Eradication if active ulcer present or there is a past history of peptic ulcer disease