Answer to Quiz - 1

Itai-itai disease

This disease occurs due to cadmium poisoning.

-One of the main effects of this painful cadmium poisoning are very weak and brittle bones.

-Other complications include coughing, anemia, and kidney failure, leading to death.

-Renal Failure resembles Fanconi's Syndrome.

Quiz - 1

This disease in Japanese literally means "Ouch-ouch" . The patients have pathological fractures and their bone may show mixed pattern of osteomalacia and osteoporosis. They have renal failure and it resembles Fanconi's Syndrome. It occurs due to a heavy metal poisoning. What is the disease am i talking about??

Answer will be posted two days later......

Arteries

Arteries

Aorta

- Asending aorta branches

n Right coronary artery

n Left coronary artery

- Arch of aorta:

n Brachiocephalic

--- Right subclavian

--- Right common carotid artery

n Left subclavian artery

n Left common carotid artery

- Descending aorta branches (at chest):

n Lower 9 posterior intercostals (3-11) arteries

n subcostal artery

n Bronchial arteries (right + left)

n Esophageal artery

n Pericardial artery

- Descending aorta branches (at abdomen + pelvis):

n 3 anterior visceral (single)

--- Ciliac artery

--- Superior mesenteric artery

--- Inferior mesenteric artery

n 3 lateral visceral (paired)

--- Renal artery

---- Suprarenal branch

---- Anterior branch (apical, upper, middle, lower branches)

---- Posterior branch

---- Ureteric branches

--- Suprarenal artery

--- Gonadal artery

n 5 lateral abdominal wall (paired)

--- Inferior phrenic artery

---- Phrenic branch

---- Suprarenal branch

--- 4 lumbar arteries

n 3 terminal branches

--- Right common iliac

--- Left common iliac

--- Median sacral artery

Coronary arteries:

- Right Coronary arteries

n Right marginal

--- Sinuatrial nodal branch

--- Right atrial

--- Right clonus branch

--- left atrial

n Posterior interventricular artery

--- Atrioventricular nodal branch

--- Septal branches

- Left coronary arteries

n Circumflex branches

--- left marginal

n Anterior interventricular artery

--- Left conus branch

--- Septal branches

--- Diagonal branch

Subclavian artery branches: (in left, direct from aorta. In right, from brachiocephalic artery)

- First part:

1- Internal thoracic artery

--- (1-6) anterior intercostals arteries

--- pericardiophrenic artery

--- Superior epigastric artery

--- musculophrenic

---- (7-9) anterior intercostals arteries

---- Phrenic branch

2- Vertebral artery

--- Meningeal arteries

--- Anterior + posterior spinal arteries

--- postroinferior cerebellar artery

--- medullary arteries

- Second part

1- Costocervical trunk

--- Intercostals artery

--- Deep cervical artery

2- Superior intercostals artery

--- Posterior intercostals artery of 1^st + 2^nd IC spaces

3- Deep cervical artery

- Third part

1- Superficial cervical artery

2- Suprasccapular artery

Axillary artery branches: (continuation of subclavian artery, ends as brachial artery)

- First part

1- Highest thoracic artery (superior)

- Second part

1- Thoracoacromial trunk

2- Lateral thoracic artery

- Third part

1- Subscapular artery

2- Anterior circumflex humeral artery

3- Posterior circumflex humeral artery

Brachial artery branches: (continuation of Axillary artery, ends as radial + ulnar arteries)

1- Muscular branches (front of arm)

2- Nutrient artery to humerus

3- Profunda brachii artery

4- Superior ulnar collateral artery

5- Inferior ulnar collateral artery

Radial artery branches: (continuation of brachial ends as deep palmar arch)

1- Muscular branches (front of forearm)

2- Recurrent branch (anastomosis around elbow joint)

3- Superficial palmar branch (to join superficial palmar arch)

4- Dorsal digital arteries

n Arteria radialis indicis (to index)

n Arteria princeps pollicis (to thumb)

5- Deep palmar arch

n Branches to wrist joint

n Branches tp join the digital branches of thr r superficial palmar arch

Ulnar artery branches: (branch of brachial artery, ends as superficial palmar arch)

1- Muscular branches (front of forearm)

2- Anterior ulnar recurrent artery

3- Posterior ulnar recurrent artery

4- Common interosseous

n Anterior interosseous

--- perforating branch

n Posterior interosseous

5- Deep branch (to join deep palmar arch)

6- Superficial palmar arch

n 4 digital arteries

Celiac trunk (arise from aorta at T12)

1- Left gastric artery:

--- Gives few esphogeal branches

2- Splenic artery:

--- Pancreatic branches

--- Left gastroepiploic artery

--- Short gastric arteries

--- Splenic branches

3- Common Hepatic artery:

--- Right gastric artery

--- Gastroduodenal artery:

---- Right gastroepiploic

---- Superior pancreaticoduodenal artery:

---- Posterior branch

---- Anterior branch

--- Left hepatic artery

--- Right hepatic artery:

---- Cystic artery

Superior mesenteric artery branches: (arise from aorta just below celiac artery)

1- Inferior pancreaticoduodenal artery

2- Middle colic artery (gives right + left branches)

3- Right colic artery (gives ascending + descending branches)

4- Ileocolic artery:

n Superior branch

n Inferior branch:

--- Anterior cecal arteries

--- Posterior cecal arteries:

---- appendicular artery

5- Jejuna branches (arcades)

6- Ileal branches (arcades)

Inferior mesenteric artery branches: (arise from aorta before its bifurcation by 3.8 cm)

1- Left colic artery (gives ascending + descending branches)

2- Sigmoid arteries

3- Superior rectal artery

External iliac artery: (branch of common iliac artery)

- deep circumflex iliac artery

- inferior epigastric artery

--- Pubic branch

--- cremastric artery

Internal iliac artery: (branch of common iliac artery)

- Anterior division branches

n Umbilical artery

--- Superior vesical artery

n Obturator artery

n Inferior vesicle artery

--- Artery to vas deference

n Middle rectal artery

n Internal pudendal artery

--- Inferior rectal artery

--- Deep artery of penis

--- Dorsal artery of penis

--- Urethral

--- Perineal

--- Artery to bulb

n Inferior gluteal artery

n Uterine artery

n Vaginal artery

- Posterior division branches:

n Iliolumbar artery (lumbar + iliac branches)

n Lateral sacral arteries

n Superior gluteal artery (superficial + deep branches)

Femoral artery: (continuation of external iliac artery)

- Superficial branches

1- Superficial circumflex iliac artery

2- Superficial epigastric artery

3- Superficial external pudendal artery

- Deep branches

1- Profunda femoris artery

--- Medial femoral circumflex

--- Lateral femoral circumflex

--- The perforating arteries

--- ends as 4^th perforating artery

2- Descending genicular artery

Popliteal artery (continuation of femoral artery)

- Muscular branches

- Articular branches

n Superior medial genicular artery

n Superior lateral genicular artery

n Inferior medial genicular artery

n Inferior lateral genicular artery

n Middle genicular artery

- Terminal

n Anterior tibial artery

n Posterior tibial artery

- Sural artery

Anterior tibial artery (anterior compartment of the leg)

- Muscular branches

- Anastomotic branches (around knee, ankle, joints)

- Ends as dorsalis pedis artery:

--- Lateral tarsal artery

--- arcuate artery

--- First dorsal metatarsal artery

Posterior tibial artery (posterior compartment of leg)

1- Peroneal artery

n Muscular branches (to lateral compartment)

n Nutrient arteries to fibula

n Perforating branches

2- Muscular branches (to posterior compartment)

3- Nutrient arteries to tibia

4- Anastomotic branches

5- Medial + lateral planter arteries

Spinal Cord

Definition:
Elongated and cylindrical part of the central nervous system which is contained in the upper two-third of the vertebral canal.

Function:
Integration and association of sensory modalities.


Extent :
Begin as continuation of the medulla oblongata at the level of the upper border of posterior arch of Atlas above (rostral) to first pair of cervical nerve , cuts middle of dens Axis vertebrae and end as a pointed end -conus medularis at the level of L1.


Dimension :
Length - 45cm in male and 42 cm in female
Weight- 30 gm

Enlargements :
Cervical C4-T2
Lumbosacral L1-S3

SEGMENT
Part of the spinal cord where a pair of spinal nerves is attached.

Coverings:
Duramater (endosteal + meningeal)
Acachnoid mater
Piamater

Contents of epidural space
fat
connective tissue
internal vertebral venous plexus


Filum terminale:
Continuation of piamater .
starts from the lower end of spinal cord at level of L1.
Has 2 parts : Filum terminale internum-15cm and filum terminale externum-5cm

Best site for lumbar puncture :
Adult : between L3-L4
Infant: between L4-L5

Protection of spinal cord
Vertebral canal
Meninges
Hydrostatic pressure of CSF
Filum terminale
Ligamentum denticulatum


Arterial supply of spinal cord.
2 sources
1. Longitudinally oriented vessels
anterior spinal artery
posterior spinal artery

2. segmental spinal arteries derived from:
verterbral artery
deep cervical arteries
posterior intercostal arteries
lumbar arteries


Structure of spinal cord :
Inner core of the Grey matter and outer white matter


Nerve cell groups in :
Anterior grey column
alpha efferent
and
gamma efferent

Posterior grey column
substantia Gelatinosa
Nucleus proprius
Nucleus dorsalis
Visceral affarent nucleus

Nuclei of Cerebellum

Freaky Guys End-up Dead

F - Fastigius
G- Globose
E- Emboliformis
D-Dentate

Clavipectoral Fascia

Structures piercing the Clavipectoral Fascia are

C - Cephalic Vein
A - Acromiothoracic artery (Thorocoacromian)
L - Lateral Pectoral N.
L - Lymphatics

Structures under Flexor Retinaculum

Tina Deserves A Nice Husband
From Medial to lateral side:

T- Tibialis posterior
D- Flexor Digitorum Longus
A- post. tibial artery
N- tibial nerve
H- flexor hallucis longus

Salivary Ducts

Submandibular duct - Wharton's duct

Parotid Gland - Stenson's duct

Sublingual Gland - Rivini's Duct

McQ 6-10

6) Pautries micro abscesses are seen in
a. Mycosis fungoides b. Squamous cell carcinoma
c. Basal cell carcinoma d. Malignany Melanoma

7) Which of the following is not a myelo proliferative disorder
a. Hairy cell leukemia b. Polycythemia Vera
c. Essential Thrombocytosis d. Chronic Myeloid Leukemia

8) Carcinoid Tumour secretes elevated levels of
a. Serotonin b. Histamine
c. Bradykinin d. All of the above

9) Primary amyloidosis is least common in
a. GIT b. Heart
c. Liver d. Peripheral nerve

10) Which of the following Not a feature of McCune Albright syndrome
a. Precocious puberty b. Pigmentation
c. Osteogenesis imperfecta d. Polyostotic fibrous dysplasis


Answers
6. Mycosis fungoides
7. Hairy cell leukemia
8. All of the above
9. Liver
10. Osteogenesis imperfecta

McQs 1-5

1. Which one of the listed substances has the following characteristic serum changes following a myocardial infarction: levels begin to increase 4 to 6 h after the onset of chest pain, reach maximal serum concentration in about 12 to 24 h, and remain elevated for about 7 to 10 days?
a. AST (SGOT)
b. CPK-MB
c. LDH (with isotype LDH1 greater than LDH2)
d. Troponin I

2. Which of the following scan will selectively label the infracted area if the patient has MI?
a. Thallium-201
b. Xenon-131
c. Technetium-99 PYP
d. MUGA scan

3. The presence of lipoprotein(a) elevated is also seen. The possible reason for Lp (a) being a risk factor is related to the fact that lipoprotein(a) has kringle regions, which are regions that have structural homology with
a. Cardiolipin, and this homology increases the formation of clots on cardiac valves
b. Plasminogen, and this homology decreases the ability to clear thrombi
c. Lipoprotein lipase, and this homology decreases the ability to metabolize chylomicrons
d. Fibrinogen, and this homology increases the formation of fibrin thrombi

4. A 36 year old male develops high fever with chill and rigor. On examination he was found to have well defined erythematous rashes. Blood and CSF culture were done. CSF was sterile. However it was considered to be a bad prognosis. Three days later he developed shock and died. Autopsy revealed hemorrhagic adrenals. What would the blood culture show?
a. Neisseria meningitidis
b. Vibrio vulnificus
c. Streptococcus viridians
d. Haemophilus influenzae

5. A obese female 47 yrs of age had a H/o calf pain for he past 2 wks. Suddenly she developed excrutiating chest pain. She was admitted and treated for it. She was sent home with some medications. Five days later she noticed darkening of both her breasts. Which drug could have caused this?
a. Streptokinase
b. Aspirin
c. Epsilon amino Caproic Acid
d. Warfarin






Answers:
1. Troponin I
2. Technetium-99 PYP
3. Fibrinogen, and this homology increases the formation of fibrin thrombi
4. Neisseria meningitidis
5. Warfarin

List of Pathological Bodies

The following is a list of pathological bodies that are quite often asked in various PG Examinations...

1. Aschoff Bodies - rheumatic fever
2. Asteroid body – sporotrichosis
3. BABES - ERNST Bodies - metachromatic granules
4. BALBIANI'S Bodies – yolk nucleus
5. Bamboo bodies – asbestosis
6. Bodies OF ARANTIUS - aortic valve nodules
7. BODY OF HIGHMORE - mediastinum testis
8. Bollinger bodies - fowlpox
9. Brassy body – dark shrunken blood corpuscle found in malaria
10. Call exners bodies – granulosa theca cell tumour
11. Chromatid bodies - entamoeba histolytica precyst
12. Citron bodies - cl. Septicum
13. Civatte bodies – lichen planus
14. Councilman bodies – hepatitis B
15. Coccoid X bodies – psittacosis
16. Creola bodies - asthma
17. Cystoid bodies – in degenerated retinal nerve fibers ( seen in Cotton wool spots)
18. Donnes bodies – colostrums corpuscles
19. Donovan bodies – granulose inguinale (LGV)
20. Ferruginous bodies – asbestosis
21. Gamma gandy bodies – congestive splenomegaly
22. Guarnieri bodies - inclusion bodies of vaccinia
23. Henderson Peterson bodies - molluscum contagiosum
24. Harting bodies – calcospheritis in the cerebral capillaries
25. Heinz bodies – G 6 PD deficiency
26. Herring bodies – neurohypophysis
27. Heterophil antibodies – infectious mononucleosis
28. Hirano bodies – alzheimer’s disease
29. Lewy bodies – parkinsonism
30. Levinthal coles lille bodies - psittacosis
31. Mallory bodies – alcoholic hepatitis
32. Masson bodies – rheumatic pneumonia
33. Michelis guttman bodies – malakoplakia
34. Mooser bodies – endemic typhus
35. Moot bodies – multiple myeloma
36. Negri bodies – rabies
37. Odland body – keratinosome
38. Oken’s body - mesonephros
39. Paschen bodies – vaccinia / variola
40. Pick bodies – picks disease
41. Psamomma bodies –
a.papillary carcinoma of thyroid
b.serous papillary carcinoma of ovary
c.meningiomad.mesothelioma
42. Reilly bodies – hurler’s syndrome
43. Rokitansky bodies - teratoma
44. Ross’s bodies – syphilis
45. Rushton bodies – odontogenic cyst
46. Sclerotic bodies - chromoblastomycosis
47. Sandstorm bodies – parathyroid glands
48. Schillar dual bodies - yolk sac tumour
49. Schaumann bodies - sarcoidosis
50. Verocay bodies – schwanoma
51. Winkler bodies – syphilis
52. Zebra bodies – metachromatic leukodystrophy

If you have more you can add them to the comments...

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