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1DERMATOLOGY

Gattrons papule, civatte bodies - Dermatomyositis

Helmet cell - Anaemia of hemolytic uremic syndrome(HUS)

Lisch Nodule - Neurofibromatosis

Row of tumbstone - Pemphigus

Vitiligo patch does not have melanocytes

Honey coloured patch in impetigo.

Nail involved in psoriaris, lichen planus, dermatomyositis.

Oil drop nail - psOriasis

Rain drop nail - aRsenic

Beaus line - transverse line in nail occurs few weeks after acute illness.

Paronychia- inflammed and swollen nail fold.

Commonest metal to cause skin hypersensitivity is nickel.

Vitamin A deficiency - Phrynoderma.

Herpes zoster affects most commonly thoracic region. In pregnancy it ismost common in peri-umbilical region.

Cradle cap - Pityriasis capitis.

Genital wart treament - Podophylium


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Quinkes disease - Angioneurotic oedema

Gonorhhoea does not affect testes and vaginal wall.

Commonest nerve to be involved in leprosy is ulnar nerve.Tinea unguim affects nail plate.

Reiters syndrome - conjunctivitis+urethritis+arthritis

Acrodermatitis enteropathica - zinc deficiency

Rhinophyma - Potato nose - hypertrophied sebaceous gland.

Pyoderma gangreonosum - ulcerative colitis

Plantar wart - Myrmecia wart

Dapsone - adverse reaction - hemolytic anaemia, porphyria, dermatitis,

psychosis.

Type 2 lepra reaction - immune complex mediated vasculitis.

Type 1 lepra reaction - due to cellular hypersensitivity.

Iris pearl - leprosy

Burrow is scabies occurs in stratum corneum.

Scabies in children is different from adult by it also affects face.

Most severe form or scabies - Norwegian scabies.

Atopic dermatitis diagnosed by clinical examination.

Molluscum contagiosum - umbilcated pearly white asymptomatic skin


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lesion.

Most potent topical steroid - Clobetasol propionate (0.05%)

Exclamation mark of hair - Alopecia areata.

Alopecia totalis- complete loss of scalp hair.

Alopecia universalis - complete loss of body hair.

Genital elephantiasis - Lymphogranuloma venerum (LGV)

Auspitz sign - Psoriasis- Distal inter-phalangeal joints arthritis, HLA-

B27, treatment are coal tar, dithranol, calcipotriol, topical corticosteroid,ultraviolet radiation. Systemic treatment- phototherapy with PUVA,

retionoids, methotrexate, cyclosporins.

Lichen plannus- itchy flat topped pink purplish papule in volar (flexor)

surface with Wickhams striae, and Kobners phenomenon.

Pityriasis rosea- herald patch, Christmas- tree distribution, delicate

peripheral ( Collarette) scale.

Pemphigus vulgaris- intra epidermal flaccid bullae in trunk, flexures and

scalp involving oral mucosa in middle age person with poor health. IgG

to epidermal intracellular substances.

Pemphigoid- subepidermal tensed blood filled bullae in flexures and rare

involvement of oral mucosa in an old person with good health. IgG

against basement membrane.

Dermatitis herpetiformis - Subepidermal, itchy bullae in elbows, knees,

upper back and buttock of an adult, with rare involvement of oral

mucosa, I gG against endomysium of muscles.

Vitiligo associated with auto immune diseases such as diabetes, thyroid,

adrenal disorders, and pernicious anaemia.


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Basal cell carcinoma- most common skin cancer, most commom site eye

lid, face, Rodent ulcer( nodulo- ulcerative) with Rolled margin.

Squamous cell carcinoma- most common in lip, keratotic nodule, keartin

pearls, predisposed by xeroderma pigmentosa, human papillomavirus,leukoplakia. Raised everted edge, indurated base,

Melanoma malignancy featured by Asymmetry, Boarder irregular,

Colour irregular, Diameter more than 0.5 cm, Elevation irregular,

metastasize to placenta as well.( ABCDE).

Neurofibromatosis- Lisch nodule( pigmented hamartomas of iris),

cafeau lait spot, axillary freckling in early childhood. Autosomaldominant.

Erythyema nodosum- due to vasculitits in deep dermis and

subcutaneous fat. Caused by bacteria( streptococcus, tuberculosis, and

brucellosis), viruses, mycoplasma, chlamydia and fungi,

drugs( sulfonamides, OCPs).

Erythema multiforme - Target lesion( Bulls Lesion).

Generalized pruritus - Liver disease, chronic renal failure, iron

deficiency, polycythemia, hypo/hyper thyroid state, Hodgkins disease

and other lymphomas.

Tinea pedis - Athletes foot is the most common type of fungal

infection- caused by Trichophyton rubrum, T. mentagrophites .

Trichophyton - Skin, hair, nail infection.Epidermopyton- Skin and nail infection.

Microsporum- Skin and hair infection.

Tinea capitis- Scalp

Tinea unguium- Nail


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Tinea cruris- groin

Tinea corporis- Body/ trunk.

Tinea manuum- Hand.

Colour of scrapping in Pityriasis versicolar- (?) yellow

OPHTHALMOLOGY

Congenital toxoplasmosis- Chorioretinitis.

Lens -Developed from ectoderm, oldest part at the centre.

Lens dislocation occurs in Marfans syndrome, homocystinuria, trauma.

Broad day light - decreased vision in central cataract.

Snowflake cataract- Diabetes mellitus.

Sunflower cataract- Chalcosis

Zonular cataract- Riders cataract.

Trauma- Rosette cataract, lens dislocation, Berlins oedema.

Follicles seen in trachoma( sago grain follicles), spring catarrh(Horner

Trantas spots), adenovirus conjunctivitis (acute hemorrhegic

conjunctivitis)

Spring catarrh- white ropy discharge, lacrymation, itchy eye,photophobia, burning sensation, Horner Trantas spots. Treatment with

steroid, acetyl cystine, sodium cromoglycate.Cobble stone appearance of

conjuntiva.

Normal eye IOP- 15 to 22 mm Hg.

Eye ball size 23 by 24 mm square.


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Average volume of eye ball 30 cc.

Anterior chamber depth 2 to 3 mm

Visible spectrum 400 to 700 nm

Eye power 58 D.

Credes method Silver nitrate 1%.(AgNO3).

Papilloedema- Blurred disc margin, elevated disc, cotton wool spot, but

normal vision. Caused by raised ICT.

New born eye hypermetropic, tears formed at the age of 3 weeks

Myopia-Near sightedness, large eye ball, image from distance fallsbefore the retina, correction by concave lens, retinal detachment occurs

as complication in high myopia.

Hypermetropia- Far sightedness, small eye ball, image from near object

form beyond the retina so treated by convex lens.

Astigmatism- Curvature ametropia, treatment by cylindrical lens.

Steroids contraindicated in chronic simple glaucoma, herpetic corneal

ulcer.

Tylosis- hypertrophy and drooping of eye lid.

Fungal keratits- cotton cheese hypopyon, and satellite lesions.

Optic foramen present in lesser wing and body of sphenoid.

Ethambutol- Toxic amblyopia, optic neuritis.

Chloroquine- Bulls eye maculopathy.

Ulcus serpens - Corneal ulcer caused by pneumococci.

Foster Kennedy syndrome- Papilloedema in one side and optic atrophy

in other eye.


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Indirect ophthalmopathy- Image is inverted, real and magnified.

Keratometry- measures the diameter of cornea.

Keratoconus best treated by contact lens.

Lacrymal duct opens in inferior meatus.

IOP increased by ketamine and succinylcholine.

Iris Bombe- Ring synechia

Dalen Fuchs nodule in sympathetic ophthalmitis is proliferation in

pigment iris and ciliary body.

Sympathetic ophthalmitis- bilaterlal granulomatous pan-uveitis.

Aqueous humor formed by ciliary body and capillaries by secretion and

ultra- filtration.

Aqueous circulation-posterior chamber to pupil to anterior chamber to

drainage at angle to episcleral veins. Second exit is uveo-scleral outflow.

Contraindication to intra-ocular lens - young diabetics, one eyed person,overt corneal dystrophy.

Yoke muscle- Synergistic muscle- e.g. right superior rectus- left inferior

rectus.

Paralytic squint- head position is adjusted.

Diabetic retinopathy- earliest change is micro aneurysm.

Vortex vein drains- Uveal tract.

Commonest carcinoma in lid is basal cell carcinoma.

Metabolically active layer of cornea is endothelium.

Central retinal vein occlusion( CRVO) -painless loss of vision.

Cherry red spot- Central retinal artery occlusion(CRAO), Tay Sachs


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disease, Niemann Pick disease..

Zies gland- Sebaceous gland.

Molls gland- sweat gland.

Eales disease- young adult vitreous hemorrhage.

Finchams test- to differentiate the acute congestive glaucoma and

cataract.

Thyrotoxicosis- most commonly involved extra -ocular muscle is inferior

rectus.

Angle closure glaucoma treatment is pilocarpine and laser iridotomy.

Protanopia- red cones are absent.

Deuteranopia- green cones are absent.

Tritanopia- blue cones are absent.

Weakest wall of the human orbit- Medial.

ENT

CSOM- commonest complication is conductive deafness.

Ototoxic drugs- Streptomycin, kanamycin,gentamycin( vestibulotoxic),

Diuretics, Salicylates( tinnitus+ sesorineural deafness bilaterally).

Quinine- tinnitus and sensorineural deafness due to vaso-constriction.

Myringitis bullosa- virus, or mycoplasma.

Myringotomy- incision in tympanic membrane. Postero-inferior

incision for acute suppurative otitis media. Postero- inferior or anterio-

inferior incision in serous otitis media/ glue ear.

Myringoplasty- plastic repair of tympanic membrane perforation. Graft

material is used most commonly from temporalis fascia, perichondrium


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of tragus can be used, and also vein.

Tympanoplasty- eradicate middle ear disease and re-construct hearing

mechanism.

Ossiculoplasty- Repair of ossicular chain.

Middle ear cleft- Eustachian tube, aditus, antrum and mastoid air cell.

Middle ear roof- Tegmen tympani

Middle ear floor- thin plate of bone to separate the jugular bulb.

Middle ear anterior wall- thin plate of bone to separate the internal

carotid artery.

Middle ear posterior wall- mastoid air cell.

Medial wall - bony labyrinth.Lateral wall-tympanic membrane.

Tympanic membrane-> malleus-> incus-> stapes-> oval window.

Round window - covered by secondary tympanic membrane.

External auditory meatus - 32 mm length, outer cartilaginous part-8mm, upward backward and medial direction( CUB). Bony part 24 mm,

downward forward and medial direction.

Eustachian tube- 36 mm, lateral 1/3 is 12 mm and bony part, medial

fibro-cartilaginous part is 24 mm and these two parts meet at isthmus

making an angle of 100 degree, tube opens at pharynx making an

elevation called torus tubaris.

Tympanic membrane develops from all three layers, size 9-10 mm tall,8mm wide, 0.1 mm thick,pearly white color, two parts are pars tensa

which make most part of it and forms annulus tympanicus which is a

fibro-cartilaginous ring at periphery, central part tented inwards called

umbo, and pars flaccida which is situated above the lateral process of

malleus.


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Otosclerosis - treatment is stepedectomy

Cholesteatomy - treatment is radical mastiodectomy.

At birth frontal sinus is not present.

Maggots in nose - Chloroform drops.

Tonsil blood supply -tonsillar branch of facial artery is the main artery,

ascending pharyngeal artery from external carotid artery. Ascending

palatine branch of facial artery, dorsal lingual branch of lingual artery,

descending palatine branch of maxillary artery.

Menieres disease -Vertigo, sensorineural deafness, tinnitus.

Reverse of Menieres disease is Lermoyez syndrome.

Peritonsillar abscess- Quinsy, tosillectomy after 6 weeks.

Otomycosis- Aspergillosus niger, A. fumigatus, Candida albicans.

Hematoma of auricle- Cauliflower ear.

Furuncle - acute otitis externa.

Malignant otitis externa- Pseudomonas infection in diabetics.

Herpes zoster oticus - Ramsay Hunt Syndrome- Facial paralysis with

vesciles inexternal auditory canal and pinna, hearing impairment due to

8th cranial nerve and anaesthesia of due to trigeminal nerve involvement.

Littles area- Kiesselbachs plexus- 1. Anterior ethmoidal artery

2. Septal branch of superficiallabial artery

3. Greater palatine artery.

4. Sphenopalatine artery.

Littles area commonest site of bleeding area.

Retro columellar vein -site of venoous bleeding in young adults.


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Nasal septum- tuberculosis affects the anterior part and causes

perforation in the cartilaginous part,syphilis affects bony part.

Septoplasty for symptomatic DNS and septorhinoplasty for cosmetic

purposes.

SMRfor symptomatic DNS, recurrent epistaxis due to spur, as apreliminary step of hypophysectomy and vidian neurectomy.

Achalasia cardia- difficulty in swallowing liquid, but not solid.

Dysphagia lusoria- dysphagia due to aberrant great vessels.

Antrochonal polyp- Children and adolescent, allergic aetiology,

originates in maxillary sinus, mostly unilateral, single, no recurrence

after radical operation.Ethmoidal polyp- Middle age, allergic or infective aetiology, arises from

ethmoidal sinus, bilateral and multiple polyps, recurrence.

Rhinosporodiosis- Rhiosporidium seeberi. Treatment is excision and

dapsone.

Rhinoscleroma- Gram negative bacteria called Klebsiella

rhinoscleromatis orFRISCHbacillus, has Mikulicz cells and Russels

bodies( resembles plasma cell), treatment is strerptomycin 1gm / day for4-6 weeks.

Rhinophymoma- Potato nose is hypertrophied sebaceous gland at the

tip of nose.

Laryngeal stridor - Laryngomalacia, treatment is reassurance to parents.

Vocal cord abductor- posterior crico-arytenoid.

Vocal cord tensor- Cricothyroid/ vocalis

Vocal cord adductor- Lateral crico-arytenoid

Frontal sinusitis- Office headache

Mastoidectomy- commonest complication is facial palsy.

Tonsillectomy - commonest complication is hemorrhage.

Middle meatus- Frontal sinus, Ethmoidal sinus( anterior) and Maxillary


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sinus open( FEM).

Alports syndrome- Sensorineural deafness with glomerulonephritis

Pendreds syndrome- Sensorineural deafness with thyroid swelling.

Recurrent laryngeal nerve related to inferior thyroid artery.

Skin at the angle of the jaw supplied by greater auricular nerve.

Caloric test- at 30 and 44 degree Celsius. Eyes movements as cold

opposite and warm same side( COWS).or remember ACTH= Away from

cold, towards hot.

Rinne test- Positive is normal i.e. air conduction is better than bonecnduction, also positive in sensorineural deafness. Rinne negative is

abnormal i.e bone conduction is better than air conduction, occurs in

external ear obstruction. Vibrating tunning fork placed on mastoid bone

then next to the external meatus when hearing stops on mastoid.

Webers test - vibrating tunning fork placed on the vortex( forehead).

Normal- sound heard equally on both side. Sound lateralized in

conductive deafness towards the worse ear, and better ear insensorineural deafness.

Absolute bone conduction test is for the measurement of cochlear

function, patients bone conduction is compares with that of examiner

with meatus occluded.

Schwabachs test- Patients bone conduction is compared to that of

examiner with meatus not occluded.

Pulsatile tinnitus- Glommus jugulare.

Pulsatile otorrhoea- ASOM

In migraine headache is due to dilatation of cranial vessels, so the

treatment is ergometrine.


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Hypernasality- due to cleft palate, bifid uvula, submucous cleft.

Bezolds abscess- Abscess in sternocleidomastoid.

Citellis abscess- pus from inner table of mastoid tip to posterior belly ofdigastric muscles and swelling seen in digastric triangle.

Lucs abscess- pus through bony antrum and swelling is in deep part of

bony meatus.

CSF rhinorrhoea- Cribiform plate fracture.

CSF otorrhoea- Petrous temporal bone fracture.

Crooked nose- DNS+ deviated tip of nose.

Freys syndrome- Gustatory sweating+ flushing

Youngs operation for Atrophic rhinitis. Atrophic rhinitis- also called

Ozaena caused by Klebsiella ozaenae (Perez bacilli), merciful anosmia

with severe crusting.

Nasal irrigation with solution made from Sodium bicarbonate 1 part,

sodium biborate 1 part, sodium chloride 2 parts in 280ml water. Localantibiotic, oestradiol spray, placental extract, KI, Youngs operation.

Tympanic membrane- nerve supply by auriculotemporal nerve.

Cohort notch- 2000Hz.

Acute tonsillitis- Jugulodigastric lymph node enlargement.

Pyriform fossa drained by upper deep cervical lymph node.

Larynx - Ciliated columnar epithelium except the vocal cord and upperpart of vestibule which are lined by stratified squamous epithelium.

Schwartzs operation= simple mastoidectomy= cortical mastoidectomy.

Vidian nerve in pterygoid canal. Vidian neuronectomy in vasomotor

rhinitis.


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Mc Ewans triangle/ Suprameatal triangle- landmark of mastoid antrum.

15 mm deep in the suprameatal triangle.

Otosclerosis- affects the round window.

Stapes rests over the oval window.Cottles test for patency of nares in DNS.

Laryngeal papilloma- recurrent, multiple and associated with HPV.

Lateral sinus thrombosis- Toby Ayers test, papilloedema, Crowe Becks

test, Griesingers sign- swelling over posterior part of mastoid.

Gradinegos syndrome- CSOM, lateral rectus palsy( 6th

nerve palsy) deepseated orbital or retro orbital pain.Occurs in petrositis.

Presbycusis- Sensorineural deafness associated with physiological aging

process.

Wallenbergs syndrome- Posterior inferior celebellar artery thrombosis-

vertigo, diplopia, dysphagia, hoarseness, Horners syndrome, ipsilateral

sensory loss in face with contralateral body and ataxia. Rotatorynystagmus.

CSOM - tubotympanic is safe variety, perforation in centre, odorless

discharge, no cholesteatoma; attico antral is unsafe variety, marginal

perforation, fowl discharge, cholesteatoma formation.

Otosclerosis- painless bilateral condutive deafness, paracusis willisii

(better hearing in noisy environment). Treatment is stapedectomy.

Branches of facial nerve-1) Greater superficial petrosal nerve-secretomotor fibres to lacrymal

gland and glands of nasal mucosa.

2) Nerve to stapedius

3) Nerve to chorda tympani.


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4) Communicating branch.

5) Posterior auricular nerve

6)Muscular branch to stylohoid and posterior belly of digastric.

7) Peripheral branches/ pes anserinus- temporal, zygomatic, buccal,

mandibular, and cervial.

Neuropraxia-conduction block.

Axonotemesis- injury to axon

Neurotemesis- injury to nerve

Schrimers test for comparing the lacrimation of two sides.

Complication of facial palsy- exposure keratitis, incomplete recovery,synkinesis, tics and spasm, crocodile tears, Freys syndrome,

psychological syndrome.

Jacobson nerve- tympanic branch of 9th Cranial nerve.

Acoustic neuroma- 8th Cranial nerve. Also involve 5th , 9th , 10th and 12th

Cranial nerve.

Inferior meatus - Nasolacrymal duct

Middle meatus- frontal sinus, ethmoidal sinus(middle), maxillary sinus,bulla ethmoidalis, hiatus semilunaris,

Superior meatus - posterior ethmoidal sinus and sphenoidal sinus.

Rhinitis medicamentosa- due to topical decongestant, rebound

phenomenon.

Maxilla fractures- Le Fort 1-transverse, Le Fort 2- pyramidal always

accompanied by orbital floor- blow out fracture, and Le Fort 3-craniofacial.

Mandible - condylar fracture is the most common, then common sites are

angle, body and symphsis in decreasing order.

Ethmoidal sinusitis common in childhood.

Ludwigs angina- infection of submandibular space-staph, streptococci,


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bacteroides, E.coli, pseudomonas

Acute oral thrush- pseudomembranous erythematous mucosa.

Chronic candidiasis - cannot be wiped off.

Bachets syndrome- oral ulcer, genital ulcer, and uveitis.

Carcinoma of lip most commonly Squamous cell carcinoma.

Most common site for carcinoma of tongue is lateral aspect of anterior

2/3 of ventral surface.

Most common benign tumor of salivary gland- Pleomorphic adenoma,treatment superficial parotidectomy.

Warthins tumor- adenolymphoma, treatment is superficial partidectomy.

Killians dehiscence- gateway of tears.

Waldeyers ring -nasopharyngeal tonsil or adenoids, palatine tonsil or

tonsils,lingual tonsil, tubal tonsil, lateral pharyneal band, and nodules.

Adenoid facies - elongated face, open mouth, prominent and crowdedteeth, hitched up upper lip, high arched hard palate, are due to chronic

nasal obstruction and mouth breathing. Pulmonary hypertension

develops.

Nasopharyngeal fibroma( Juvenile nasopharyngeal angiofibroma)-

adolescent male,second decade of life so ? Testosterone dependent,

recurrent profuse bleeding, nasal obstruction, conductive deafness, and

serous otitis media, CT and angiogram, but no biopsy.

Bed of tonsil- superior constrictor and styloglossus muscle. Lymph node

drainage is upper deep cervical lymph nodes.

Larynx - three unpaired cartilages are-Epiglottis, thyroid and cricoid

( ETC) , and three paired cartilages are -Arytenoid, corniculate and

cuneiform( ACC).


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Larynx Nerve supply -Motor- All muscles are supplied by recurrent

laryngeal nerve except cricothyroid supplied by external laryngeal nerve.

Sensory- Above vocal cord is by internal laryngeal nerve, below vocal

cord by recurrent laryngeal nerve.

Internal and external laryngeal nerve are the branches of superiorlaryngeal nerve.

Position of vocal cord-

Intermediate/cadaveric- paralysis of both superior and recurrent

laryngeal nerve.

Median- midline, RLN paralysis.

Paramedian- strong whisper, RLN paralysis.

Acute epiglottitis- Hemophilus influenzae B

Acute laryngo- tracheo- bronchitis- viral infection.

Tuberculosis of larynx- hyperemia of vocal cord, mamillated appearance,

mouse nibbled appearance, turban epiglottitis, pale surrounding

mucosa.

Singers nodule formed at the junction of anterior1/3 and posterior 2/3,hoarseness, vocal fatigue, treat conservatively and later surgery for large

nodule.

Rinkes oedema- oedema in subepithelial space of Rinke.

Carcinoma larynx- Supraglottic- hoarseness is late feature.

Glottic- Hoarseness is early feature.

Subglottic- Stridor is the early feature.

Hyponasality-Rhinolalia clausa- blockage of nose and nasopharynxHypernasality- Rhinolalia aperta- cleft palate, paralysis of soft palate,

lagre nasopharynx, submucous palate, oronasal fistula.

Plummer Vinson ( Patterson Brown- Kelly) syndrome- dysphagia, iron

deficiency anaemia, glossitis, angular stoamtitis, achlorhydria. 10%

develops post cricoid carcinoma.


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Globus hystericus- functional disorder where patient complains lump in

throat, and feeling of lump mared in between the meals. Treatment is

reassurance.

Diffuse oesophageal spasm- dysphygia and odynophagia, cork- screwappearance in barium swallow.

Achalasia- dysphigia to liquid is more than to solid. Barium swallow

shows Rat tailed appearance. Manometric studies shows low pressure

in body of oesophagus and very high pressure in lower oesophagus.

Treatment is modified Hellers operation.

Oesophageal carcinoma most common is squamous cell carcinoma inmiddle 1/3. Adenocarcinoma in lower 1/3. Bariun swallow shows

irregular lumen and proximal dilatation. Surgery is the treatment of

choice for carcinoma in lower 1/3 and radiotherapy for carcinoma in

upper 2/3.

Roses position for tonsillectomy. Secondary hemorrhage in 5 th to 10th

day due to infection.


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