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Anatomy

45. Spaces of the hand

Space of Parona: A space between the pronator quadratus deep and the overlying flexor tendons of the forearm that is continuous through the carpal tunnel with the medial central palmar space. Bunnell’s No man’s land: A fanciful term for the fibrous sheath of the flexor tendons of the hand, specifically in the zone from the distal palmar crease to the proximal interphalangeal joint–corresponds to zone II of hand. Thenar space: closely related to radial bursa. Midpalmar space: closely related to ulnar bursa. Pulp space: abscess in the pulp space is called whitlow or felon. 

Radiodiagnosis

44. TLD Badge

All occupational radiation workers need to be monitored to safe guard them from the deleterious somatic and genetic effects of ionizing radiations. This radiation monitoring is done with TLD Badges.TLD discs are made of a thermoluminescent material, commonly calcium sulphate doped with dysprosium  or lithium fluoride.

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OBG

43. Hydatifdiform Mole

Feature Complete mole Partial mole Karyotype 46 XX Triploid, 69, XXY Villous edema All villi Some villi Trophoblast proliferation Diffuse, circumferential Focal, slight Atypia Often present Absent Serum hCG Elevated Less elevated hCG in tissue ++++ + Behavior 2% choriocarcinoma Rare choriocarcinoma Fetal parts Rarely seen More common 

ENT

42. Sinus associated Cells

Agger nasi cells: Most anterior of Anterior ethmoidal cells and lie close to frontal recess; can obstruct frontal sinus drainage. HAller cell: Anterior Ethmoidal cell in roof of maxillary sinus/floor of orbit. Haller cells overlooked during surgery can be a source of persistent mucopurulent secretion. Onodi cell:POsterior ethmoidal cell related to optic nerve; identify these cells during FESS to avoid optic N injury 

Medicine

41. CURB-65

The CURB-65 Severity Score estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment. Confusion BUN > 19 mg/dL (7 mmol/L) / Respiratory Rate ≥ 30 / Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg / Age ≥ 65 Interpretation of CURB-65 score: 0-1: Probably suitable for home treatment; low risk of death2: Consider hospital supervised treatment3-5: Manage in hospital as severe pneumonia; high risk of death

Microbiology

39. Atypical pneumonia

Common pathogens that cause atypical pneumonia are:  Mycoplasma pneumoniae Legionella pneumophila Chlamydophila pneumoniae Chlamydophila psitacci Coxiella Burnetti 

Medicine

38. Tremors

Resting (static) tremor: In Parkinson’s disease (pill rolling tremor) Intentional tremor: In cerebellar lesion Postural tremor: In thyrotoxicosis, essential familial tremor Flapping tremor/asterixis: In hepatic encephalopathy, renal failure, resp. failure, metabolic encephalopathy Perioral tremor: General paresis of insane Holmes tremor: Midbrain or rubral tremor; caused by lesion close to red nucleus. 

ENT

37. Basal Skull Fracture

Most basilar/basal skull fractures are caused by high-velocity blunt trauma such as motor vehicle collisions, motorcycle crashes, and pedestrian injuries.  Structures involved: petrous temporaL bone (MC), the external auditory canal, and tympanic membrane. Signs of basal skull fracture Hemotympanum (blood pooling behind tympanic membrane making it appear purple - earliest finding)Cerebrospinal fluid (CSF) otorrhea or rhinorrhea (“Halo” sign is the double ring pattern described when bloody fluid from the ear or nose containing CSF is dripped onto paper or linen)Battle sign (retroauricular or mastoid ecchymosisRaccoon/Panda eyes (periorbital ecchymosis).