73. Drugs Aggravating Myasthenia

AminoglycosidesOther antimicrobials: macrolides, fluoroquinolones, quinine derivativesBeta BlockersMagnesiumBotulinum toxinLocal anestheticsNon depolarisng muscle relaxantsPenicillamine

72. Scleroderma Associated Syndromes

CREST SyndromeCalcinosis cutis Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly, and Telangiectasia  POEMS syndromePolyneuropathy Organomegaly (liver, spleen, lymph nodes), Endocrinopathy (gynecomastia, impotence, amenorrhea), Production of M protein, Skin changes (hyperpigmentation, sclerodermatous changes, hirsutism, hyperhidrosis, angiomas). 

71. EHS Classification Incisional Hernia

European Hernia Society Classification of Incisional Hernia

70. HIV Post Exposure Prophylaxis (PEP)

69. Abduction of Arm

Muscles involved in abduction of arm at shoulder joint are: 0–15 degrees: by supraspinatus15–90 degrees: by deltoidAbove 90 degrees: hyperabduction (overhead abduction) by trapezius and serratus anterior 

68. Vitamin B12 dependent enzymes

The two vitamin B12 (cobalamin) dependent enzymes are Methylmalonyl CoA mutase Methionine synthase (Homocsyteine methyltransferase)

Why Don't They Ever Understand !?

Why don't "THEY" ever understand ???? Many of you medicos would have come across this question in your mind at some point of time - either as a medical student or as an intern, PG aspirant/PG resident or ultimately as a practicing doctor. "THEY" could include All Non-Medicos - Parents, Siblings (brother/sisters), Relatives (uncles, aunts, grandparents, In-laws), Spouses (husband/wife), Friends, and of course ultimately Your Patients - Let me tell you - they are totally justified in NOT understanding. Why ??? A medical student spends almost 99% the time studying for 2 years after 10th standard - (11th,12th or PUC or Intermediate or whatever you call it) to crack the highly competitive MBBS entrance exam. "They" didn't do it. After getting into MBBS, the young medicos are totally overwhelmed by the sheer volume of information (Almost all books run into 1000s of pages) that  they have to study. "They" didn't face this. The medico spends more than a year sitting in a stinking dissection hall in front of dead bodies stored in formalin filled tanks and learns anatomy by dissecting these cadavers. They also carry bones in their college bags for learning anatomy. "They" didn't do it. Again the medicos view fresh dead bodies being cut open in the forensic medicine department as a part of the autopsy/post mortem. "They" didn't do it. Most medicos slowly lose touch with their hobbies, their sports, their school friends because they just don't have time for these, Studying takes up ALL of their time. "They" didn't go through this.While other students of the same age in other non-medical fields have time to party and enjoy, most medicos lose out on this - again - because they just don't have time for these, Studying takes up ALL of their time. "They" didn't go through this.Attending family functions becomes a thing of the past  - because the medicos just don't have time for these, Studying takes up ALL of their time. "They" didn't go through this.Once internship begins, life becomes even more hectic with many continuous 24-36 hours duties - spent all among sick people. "They" didn't go through this.While most other non - medical people get jobs and start earning - the interns get a meagre stipend in most cases which cannot be compared with their counterparts in other fields at all. "They" didn't go through this.To get into post graduation (PG), it  involves another 1-2 years of continuous full time study for the PG medical entrance exams. The non-medicos wonder what's wrong with you - even though you are a doctor, you are still studying !?? "They" didn't go through this.Once the medicos join PG - it is considered as being married to the course, married to the wards/OT/the department for the next 3 years. The most "draining time" of a medico's career. This is also the age during which most of your counterparts in other fields are probably getting married OR are already married and starting to have kids while most medicos will not be in that stage. "They" didn't go through this.The "compulsory rural service" either post MBBS or post-PG in many states is another trial by fire.....poor facilities in many of these areas depresses the young doctors. "They" didn't go through this.AND the constant threat of being beaten up by an angry patient/mob in spite of your best efforts to treat the patient is not any encouragement either !!! "They" don't go through this.Finally, by the age of around 29-30-31 the medico finishes his training and starts his career (sometimes later -32-33-34 in case of super specialists). The salaries/earnings are quite low to begin with and the next decade is spent in trying to establish the career/practice and earn a decent living. "They" didn't go through this.Effectively, the prime of youth of medicos is spent in getting ready to practice the profession of medicine for the rest of their lives that will benefit thousands of patients. "They" didn't go through this.Most medicos realize that there the profession is not "glamorous" as the general non-medico public assumes it to be - the majority of a doctors life is spent among sick people - nothing glamorous there !!! "They" don't know this.Many a lunch/dinner with wife, husband, children, father, mother, friends gets missed because of the 'emergency' patient who arrives just as you are ready to leave. "They" don't know this.Most medicos understand all the above mentioned points and never complain, NOR are they sad/sorry for having taken up this profession. They consider it as their destiny to be in a field where they end up helping fellow human beings in the closest possible way.  "They" don't know this. And I am sure you medicos can think of many more examples/situations that medicos face,  to add to the above list. When "THEY" - the non-medicos have not faced any of these issues - how can they EVER understand what goes into the making of a doctor. So STOP begging non-medicos to understand - they WILL NOT - they WILL NEVER - NOT in a zillion years. The sooner you make peace with this fact - the better you will be able to handle your professional future. All the Best Dr Ramgopal

Ophthalmology High Yield Images

Ophthalmology Images for PG Medical Entrance CRAO with Cherry Red Spot and pale retina CRVO - Retinal hemorrhages all over with blood and thunder appearance Central Serous Retinopathy - Blister of fluid at the macula - causes micropsia Macular hole, differentiated from CRAO by absence of retinal pallor. Add captionAdd captionAdd captionAdd captionAdd captionAdd captionAdd captionAdd caption Best's Disease: Egg Yolk like appearance at the macula Headlight in the fog appearance in Toxoplasmosis Snow banking/Snowbank exudates in Pars Planitis Fundus photographs of the patient before (A) and after (B) dark adaptation. The fundus appearance was characteristic of Oguchi disease with grayish-yellow discoloration that had normal appearance after 2–3 h of dark adaptation.- MIZUO phenomenon CMV Retinitis - Pizza Pie or Cottage Cheese and Tomato Ketchup retinopathy Corneal Endothelium seen by Specular Microscopy  Cobblestone papillae in Vernal Conjunctivitis (spring catarrh) Horner Trantas Spots in vernal conunctivitis (spring catarrh) Amsler grid for monitoring macular pathology (ARMD, drusen etc) Pterygium Cornea verticillata - Vortex keratopathy Band Keratopathy Bitot's spots Blepharitis Chalazion Hordeolum externum - stye - at base of hair follicle Incision and Curettage of a chalazion with chalazion clamp also seen Sebaceous gland carcinoma - maybe mistaken as recurrent chalazion Acute dacryocystitis - treat with antibiotics; definitive treatment is DCR once the infections settles down. Congenital dacryocystitis Bowman's lacrimal probe and Nettleship punctum dilator Dacryoadenitis - S shaped ptosis Right orbital floor fracture - Tear drop sign - orbital contents prolapsing into maxillary sinus   Signs of orbital blow out fracture Lagophthalmos of left eye with exposure keratopathy of left inferior cornea Corneal abrasion stained by fluorescein and viewed with cobalt blue light - epithelial defects stains underlying stroma with fluorescein Corneal dendritic ulcer - HSV keratitis 

67. Vericiguat

Vericiguat:  is a soluble guanylate cyclase (sGC) stimulator, indicated to reduce the risk of cardiovascular death and heart failure (HF) hospitalization following a hospitalization for heart failure or need for outpatient IV diuretics, in adults with symptomatic chronic HF and ejection fraction less than 45%.Dose: The recommended starting dose is 2.5 mg orally once daily with food. MOA: Vericiguat is a stimulator of soluble guanylate cyclase (sGC), an important enzyme in the nitric oxide (NO) signaling pathway. When NO binds to sGC, the enzyme catalyzes the synthesis of intracellular cyclic guanosine monophosphate (cGMP), a second messenger that plays a role in the regulation of vascular tone, cardiac contractility, and cardiac remodeling. Heart failure is associated with impaired synthesis of NO and decreased activity of sGC, which may contribute to myocardial and vascular dysfunction. By directly stimulating sGC, independently of and synergistically with NO, vericiguat augments levels of intracellular cGMP, leading to smooth muscle relaxation and vasodilation.

66. Apfel Score

The Apfel score can be used to predict patients with a high risk for perioperative nausea and vomiting (PONV). It includes four factors in the patients’ history: Female gender, Nonsmoker, Postoperative use of opioids, and Previous PONV or motion sickness. Each of these risk factors is supposed to elevate the PONV-incidence about 20%