S.P.M.

1.Hep A - Faeco-oral route

2.Hep B - Sexual, Perinatal, percutaneous
3.Hep C - Percutaneous
4.Hep D - Sexual, Perinatal, percutaneous
5.Hep E - Faeco-oral route..
In India, for diabetes:
Screening test of choice- Fasting blood sugar
Diagnostic test of choice- GTT (glucose tolerance test)..
Lymphogranuloma Venerum is caused by Chlamydia trachomatis. Infections caused by
chlamydia trachomatis is:
1.Trachoma- Strains A, B, Ba, C
2.Adult Inclusion conjunctivitis- Strains D to K
3. Lymphogranuloma venerum- Strains L1, L2, L3
In general Chlamydial infections are treated with tetracylcines. But-
1.Drug of Choice for Trachoma is: Azithromycin
2.Drug of Choice for Lymphogranoloma venerum is: Doxycycline.
Type IV hypersensitivity is also known as cell mediated or delayed type hypersen
sitivity..
In India, for TB:
Screening test of choice- Sputum smear examination
Diagnostic test of choice - Sputum smear examination.
In case of Ionizing radiation, increase in temperature is negligible and hence i
s also given the name: Cold sterilization
WHO criteria for obesity, based on BMI:
1.Underweight- <18.5
2.Normal BMI- 18.5 to 25
3.Pre-obesity- 25 to 30
4.Obesity I degree- 30 to 35
5.Obesity II degree- 35 to 40
5. Obesity III degree- >40
Drug of choice for any Benign Malaria is: Chloroquine Drug of choice for any Com
plicated Malaria is: Artesunate Drug of choice for chloroquine resistant malaria
: Quinine Drug of choice for Malaria in pregnancy: Quinine..
JONES CRITERIA:-
Major criteria:
1. Migratory polyarthritis: a temporary migrating inflammation of the large join
ts, usually starting in the legs and migrating upwards.
2.Carditis: inflammation of the heart muscle which can manifest as congestive he
art failure with shortness of breath, pericarditis with a rub, or a new heart mu
rmur.
3.Subcutaneous nodules: painless, firm collections of collagen fibers over bones
or tendons. They commonly appear on the back of the wrist, the outside elbow, a
nd the front of the knees.
4.Erythema marginatum: a long lasting rash that begins on the trunk or arms as m
acules and spreads outward to form a snake like ring while clearing in the middl
e. This rash never starts on the face and it is made worse with heat.
5.Sydenham's chorea (St. Vitus' dance): a characteristic series of rapid movemen
ts without purpose of the face and arms. This can occur very late in the disease
.
Minor criteria:
1.Fever
2.Arthralgia: Joint pain without swelling (Cannot be included if polyarthritis i
s present as a major symptom)
3.Raised erythrocyte sedimentation rate or C reactive protein
4.Leukocytosis
5. ECG showing features of heart block, such as a prolonged PR interval (Cannot
be included if carditis is present as a major symptom)
Supporting evidence of streptococcal infection: elevated or rising antistreptoly
sin O titre or DNAase.
Previous episode of rheumatic fever or inactive heart disease
MOTHER TO CHILD INFECTIONS PREVENTION:-
Prevention of these infections:
1.Toxoplasmosis MTCT prevention- Spiramycin
2.HIV MTCT prevention- A single dose Nevirapine to mother and single dose to bab
y.
(Nevirapine decreases MTCT from 30% to 15%. In United states, the guidelines for
MTCT prevention of HIV states administration of Zidovudine to mother from 2nd t
rimester and Nevirapine single dose at birth to both mother and baby, this combi
ned effect alongwith C-section delivery decreases MTCT from 30% to 2%. But due t
o financial problems, Indian guidelines does not include Zidovudine administrati
on)
3. Hep B MTCT prevention- Hep B immunoglobulin to baby within 72 hrs after birth
and then Hep B vaccine for active immunity on 0,6,10,14th week after birth.
(This reduces MTCT from 90% to 0%, the most effective MTCT prevention method so
far)
4.Herpes MTCT prevention- Acyclovir course to mother
5.CMV MTCT prevention- Ganciclovir course to mother..
Materials sterilized by hot air: Forceps, glassware, scalpels, scissors, glass-s
yringes, swabs, liquid paraffin, fats, grease
Doses of immunoglobulins used:
1.Hep B - 0.05 ml/kg body weight
2.Rubella - 20ml
3.Varicella zoster- 15-25 units/kg body weight
4.Rabies- 20 IU/kg body weight
5.Measels- 0.25ml/kg body weight
6.Tetanus - 250 units for prophylaxis
3000-6000 units for treatment
Endemic Typhus:
-Causative agent: Rickettsia typhi (not Rickettsia prowazeki, it causes Epidemic
typhus)
-Vector: Rat flea
-Reservoir: Rodents (Not humans)
-Weil felix reaction (with OX-19 and OX-2) is +ve in 2nd week.
-Drug of choice: Tetracycline
Few important microscopic features of diseases:
1.Negri Body - Rabies
2.Warthin finkeldy cells - Measels
3.Halbester Prowazek bodies - Trachoma
4.Cowdry A bodies - Hanta virus, yellow fever virus
5.Cowdry B bodies- Adenovirus, Polio virus
Mnemonic- To remember Cowdry bodies: "Cowdry BAP HAY" BAP - Cowdry B in A and P
HAY- Cowdry A in H and Y.
1.Mantoux test for TB - PPD antigen
2.Lepromin test - Dhamendra antigen
3.Shick toxin test- Shick toxin
4.Dipstick test for Kala azar- rk 39 antigen
5.Dipstick test for malaria- HRP II antigen (Histidine rich protein II).
As neonatal tetanus (aka Tetanus neonatorum) is called as "8th day disease" and
occurs on 8th day after birth and not on the 1st day..
Important rickettsial agents and their vectors:


Disease
Vector
1.
R.prowazekii
Epidemic typhus
Louse
2.
R. Typhi
Endemic typhus
Flea
3.
R. tsutsugamushi Scrub typhus
Mite
4.
R.akari
Rickettsial pox

Mite
5.
R.conori
Indian tick typhus
Tick
6.
R. rickettsii
Rocky mountain
Tick


spotted fever


WHO has recommended SAFE strategy for global elimination of blinding due to Trac
homa. The strategy includes:
S- SURGERY
A- ANTIBIOTIC USE
F- FACIAL CLEANLINESS
E- ENVIRONMENTAL CLEANLINESS..
Formulation of new ORS is:
Composition in grams:
Sodium chloride- 2.6g
Potassium chloride- 1.5g
Sodium citrate- 2.9g
Glucose- 13.5g.
Drug of choice for any Benign Malaria is: Chloroquine Drug of choice for any Com
plicated Malaria is: Artesunate Drug of choice for chloroquine resistant malaria
: Quinine Drug of choice for Malaria in pregnancy: Quinine.
Important periods of communicability you need to know:
1.Chicken pox- 1 day prior to appearance of rash and 4 days afterwards.
2.Measels- 4 days before rash to 5 days later
3.Rubella and polio- 1 week before and 1 week after onset of symptoms
4. Influenza- 1 day before and 1 day after onset of symptoms.
Doses of immunoglobulins used:
1.Hep B - 0.05 ml/kg body weight
2.Rubella - 20ml
3.Varicella zoster- 15-25 units/kg body weight
4.Rabies- 20 IU/kg body weight
5.Measels- 0.25ml/kg body weight
6.Tetanus - 250 units for prophylaxis
3000-6000 units for treatment.
Y. pseudotuberculosis infections can mimic appendicitis, especially in children
and younger adults.
Different diseases with their period when maximum chances of peri-natal transmis
sion is seen:
1.Rubella - I trimester
2.Varicella - I trimester
3.Syphilis - III trimester
4.Toxoplasmosis- III trimester
5.Heptatitis B- III trimester
6.HIV - During delivery
7.Herpes- During delivery..
est specimen for diagnosis of a few important diseases:
1.Rabies (Living person) - Biopsy of skin follicle on nape of neck
2.Rabies (dead person) - Brain biopsy
3.Diphtheria - Nasal swabs
4.Influenza - Nasopharyngeal secretions
5.TB - Sputum
6.Malaria- Blood
7.HIV - Blood
A few most common complications of certain diseases:
1.Measels - Otitis media
2.Mumps - Aseptic meningitis
3.Mumps (adolescents) - Orchitis (oophoritis in female)
4.Chicken pox Pneumonia
In India, for diabetes:
Screening test of choice- Fasting blood sugar
Diagnostic test of choice- GTT (glucose tolerance test)..
WHO defines blindness as "visual acuity< 3/60 in the better eye with best possib
le correction", which means cannot count fingers at 3 metres distance..
Major side effect of any Aminoglycoside is Oto-toxicity.
Red-green color blindness (optic neuritis) is a s/e of: Ethambutol
1.the CD4 cell count falls below 500 cells/mm. These include pneumoccocal and oth
er pneumonia, pulmonary tuberculosis, Herpes Zoster, candidisis, Kaposi's sarcom
a, cryptosporidiosis, Oral hairy leukoplakia.
2.Levels lower than 200 cells/mm are associated with P.Jirovekii pneumonia, Toxop
lasmosis, miliary and extra pulmonary tuberculosis.
3.Levels lower than 50 cells/mm is associated with disseminated CMV (CMV retiniti
s) and Mycobacterium avium complex infections.
Hepatitis B markers:
1.HBsAg (Austrailia antigen)- Epidemiological marker for Hep B infection
2.HBcAg- No significance clinically
3.HBeAg- Indicates viral replication & is a marker of infectivity
4. Anti-HBcAg- First antibody to appear & is a marker of 'Acute hepatitis B'..
Disease
Incubation period
1.
Cholera
1-2 days
2. Kala Azar
1-4 months
3.
Filariasis
8-16 months
4. Measels
10-14 days.
Routes of HIV transmission:
Frequnecy of transmission Efficiency
1. Sexual -
85%
0.01-1%
2. Blood transfusion-
2%
>90%
3. Sharing needles-
2%
3%
4. MTCT-
4%
30%.............
Most common cancer worldwide: Lung Cancer
Most common cancer in India: Oro-Pharyngeal Cancer
Most common cancer causing death, both India and worldwide: Lung cancer
Males:
Most common cancer in males worldwide: Lung Cancer
Most common cancer in males in India: Oro-Pharyngeal cancer
Most common cancer causing death in males, both India and Worldwide: Lung Cancer
Females:
Most common cancer in females worldwide: Breast Cancer
Most common cancer in females in India: Cervical Cancer
Most common cancer causing death in females worldwide and in India: Breast Cance
r.
1. Mycoplasma Hominis- May be a normal microflora in vagina but can cause Pelvic
Inflammatory disease (PID)
2.Coxiella Burnetti- Causes Q-fever
3.Hemophillus ducryi- causes Soft Chancre (Chancroid)
4.Bartonella Quintana- causes Trench fever
There are 4 screening tests for breast cancer in India:
1.Mammography
2.Thermography
3.Breast self examination
4.Palpation by physician
But, FNAC is not a method of screening. It is used as diagnostic or confirmatory
test in India
Silent epidemic of this century is: Alzheimer's disease
Modern epidemic of this century is: Coronary heart disease
Dengue haemorrhagic fever (DHF): Severe form of Dengue fever, caused by infectio
n with more than one dengue virus type:
-Incubation period: 4-6 days
-Clinical features:
1.Rash less common
2.Rising haematocrit value (>20% of baseline)
3.Moderate to severe thrombocytopenia (<1 lac/cumm)
4.Hepatomegaly
5.Positive tourniquet test >20 petechiae per sq.inch
- Diagnosis of DHF: Fever + Hemorrhagic manifestations + Thrombocytopenia + Hemo
concentration or rising hematocrit.
But, narrowing of pulse pressure is a symptom seen in Dengue shock syndrome and
not Dengue hemorrhagic fever
A single dose Nevirapine is used in India to reduce MTCT (Mother to child transm
ission) of HIV from 30% to 15%. It is required to be given within 72 hrs of deli
very..
Contraceptions-
12-18yrs OCP
18-35yrs-OCP
>35- Diaphragm..
According to RCH programme, contraceptives supplied free of cost by Indian gover
nment are:
1.Male Condoms
2.OCPs
3.Vasectomy
4.Tubectomy
5.IUDs.
Condoms are preferred is because of reduced side effects & due to preventive rol
e in STI/HIV transmission.
Nutritional supplementation given daily according to various schemes:
1.ICDS scheme (Anganwadi) - 1/3 calories, 1/2 proteins
2.Mid-day meal programme- 1/3 calories, 1/2 proteins..
) Pauci-bacillary(PB) leprosy : 1-5 skin lesions Regimen of two drugs Rifampicin
and Dapsone for 6 months;
b) Multi-bacillary(MB) leprosy : >5 skin lesions Regimen of three drugs Rifampic
in, Clofazimine and Dapsone for 12 months..
This answer is correct according to Census 2011. The growth rate of India declin
ed from 1.93% in 2001 to 1.41% in 2011
Till 20 weeks of pregnancy abortion can be done..
Total Carbohydrate provided in MID DAY MEAL SCHEME IS 100mg
The patients suffering from TB are categorized into 3 different categories:
2HRZES + 1HRZE + 5HRE2HRZ + 4HR2HRZE + 4HR
Category
Type of Patients
Treatment
I Smear positive new cases Seriously ill extra- pulmonary
II Relapsers & Defaulters
III Non-seriously ill extrapulmonary
This treatment regimen is called DOTS regime for TB treatment.
But, recently there have emerged many cases with MDR-TB, i.e Multi-drug resistan
t TB, such cases are treated with DOTS-PLUS regime.
MDR-TB means TB resistant to all drugs of DOTS regime. Hence we use drugs from m
any different groups to treat such a TB:
DOTS-PLUS:
Category IV - 4 (KOCZEEt) + 12-18 (OCEEt)
(Note- The numbers in treatment regime indicate no. of months that treatment sho
uld be taken.
R- Rifampicin
E- Ethambutol
H- Isoniazid
S- Streptomycin
Z- Pyrazinamide
K- Kanamycin
O- Ofloxacin
C- Cycloserine
Et- Ethionamide
m/c side effect of IUCDs - Bleeding
m/c side effect leading to removal of IUCDs Pain
VISION 2020 is the global initiative for the elimination of avoidable blindness
(preventable and curable)
DOC for trachoma in India is: Azithromycin
Drugs where macrolides are used as DOC:
Mnemonic: CLAWD
Chancroid, campylobacter
Legionella
Atypical pneumonia
Whooping cough
Diphtheria.
Progestasert is a 3rd generation IUD. It was 'the first hormonal uterine device'
developed in 1976.
Shelf life- 1 to 1 and 1/2 years
(Hence cannot be used for more than 18 months) Mechanism of action: 1. direct lo
cal effect on uterine lining
2.Effect on cervical mucus
3.Efffect on sperms
Failure rate: 2% per year
Shelf lives of various IUDs: (approved usage period)
1.
Copper IUDs
-
3 to 5 yrs
2.
Progestasert
-
1 year
3.
CuT 200
-
4 yrs
4. NOVA T
-
5 yrs
5. LNG IUD
-
7 to 10 yrs
6. CuT 380A
-
10 yrs..
Child Woman ratio: It is the number of 0-4yrs aged children expressed per 1000 w
omen in reproductive age group (i.e 15- 49 yrs).
New NIS scheme:
Vit A is given at: 9 months after birth- 1 lac IU
18 months after birth- 2 lac IU
thereafter every 6 months till age of 5 yrs- 2 lac IU
each
Total- 17 lac IU
Diagnosis of Poliomyelitis in India now is done by Isolation of Virus in culture
with help of stool samples collected from cases. These stool samples are transp
orted in a cold environment i.e +2 to +8 C & is termed as Reverse Cold chain..
Senile: A person in old age i.e >60-65 years old
Pre-senile: A period prior to usual onset of senility. Hence this period preceed
s the age of 60-65 years. So person having a disease in this age group will be h
aving a pre-senile disease.
Define age groups in public health:
1.Ovum- 0 to 2 weeks
2.Embryo- 2 to 9 weeks
3.Fetus- 9 weeks to delivery
4.Neonate- 0 to 28 days after birth
5.Infant- 1st year of life (0 to 365 days after birth)
6.Toddler- 1 to 3 years
7.Preschool child: 3 to 6 years
8.Adolescent- 10 to 19 years
9.Youth- 15 to 24 years
10.Reproductive age group- 15 to 45 years
11.Geriatric age- >60 years.
GLUCOSE TOLERANCE TEST-a standard dose of 75g glucose is ingested by mouth and b
lood levels are checked two hours later.
Results of GTT and their interpretation:
1.<120 mg/dl - Normal
2.120-180 mg/dl - Impaired glucose tolerance
3.>180 mg/dl - Diagnostic of Diabetes mellitus..
So Natural Family Planning includes:
1.Basal Body temperature
2.Cervical Mucus method
3.Sympto-thermic method.
Pearl's Index: It is one of the most commonly used method for measuring the fail
ure rate of a birth control method.
Formula: PI = Total accidental pregnancies / Total months of exposure to a parti
cular contraceptive X 1200.
Reverse Cold Chain Reactions are used to transport Polio Stool Samples +2 TO +8
degrees..
Imp points about Anti-retro viral treatment:
-Zidovudine was the 'first approved agent for treatment of HIV'
-Zidovudine and Stavudine are antagonistic in action, so must never be given tog
ether.
-Protease inhibitors should never be used alone.
Crude death rate: Annual number of deaths per 1000 mid-year population
Crude death rate of India: 8.0 per 1000 population (according to census 2001)
6.4 per 1000 population (according to
census 2011)..
Population of India in different age groups:

Age group
% population
1.
0-4 years
10%
2.
5-14 years
23%
3.
15-49 years
53%
4.
50-59 years
7%
5.
>60 years
7%..........
Sex ratio of INDIA is 940.
Follow ups for DOTS therapy-
Category 1 - 2, 4, 6 months
Category 2 - 3, 5, 8 months
Category 3- 2, 6 months (as they are not seriously ill cases and hence only 2 fo
llow-ups are enough)..
Total fertility rate of India (Census 2011) - 2.72%..........
Eligible couple: A currently married couple with wife in the reproductive age gr
oup (15-45 yrs)
Eligible couples in India: 150-180 per 1000 population.
DOC for both Type 1 and Type 2 Lepra reactions is: Prednisolone. Thalidomide is
not used because it causes Teratogenic effects
Various Side effects of OCPs:
1.Increases thromboembolism
2.Carcinogenesis - Cervical & Breast Cancer
3.Causes Dyslipidemis
4.Causes Hyperglycemia
5.Causes Liver & Gall bladder disease
6.Decreases milk volume during lactation
7.Can cause Depression
Beneficial effects of OCPs: (It prevents:)
1.Benign breast diseases (fibroadenoma, fibrocystic disease)
2.Benign ovarian diseases & ovarian cancer
3.PID (pelvic inflammatory disease)
4.Ectopic pregnancy
5.Endometrial cancer
6.Iron deficiency anemia..
Subacute combined degeneration of spinal cord, also known as Lichtheim's disease
, refers to degeneration of the posterior and lateral columns of the spinal cord
as a result of vitamin B12 deficiency (most common cause), vitamin E deficiency
or Friedrich's ataxia. It is usually associated with pernicious anemia..
Folic Acid Tablets are given to the pregnant women in her first trimester at a d
osage of 400mcgs.
Breast milk is generally deficient in: Vit C
Vit D
Vit K
Iron
but, Breast milk is most deficient in: Vit D..
Various terms to know:
1.Ovum - 0 to 2 weeks
2.Embryo - 2 to 9 weeks
3.Fetus - 9 weeks to delivery
4.Neonate - delivery to 1 month
5.Infant - delivery to 1 year
6.Toddler - 1 to 3 years
7.Preschool child - 3 to 6 years
8.Adolescent - 10 to 19 years
9.Reproductive age - 15 to 45 years
10.Geriatric age > 60 years.
Nutritive values of breast milk: (Per 100 g)
1.Lactose: 7.4 g
2.Proteins: 1.1 g
3.Fat: 3.4 g
4.Calcium: 28 mcg
5.Iron: 1 mg
6.Water: 88 g
7.Energy: 65 Kcal..
Daily total requirement of Iodine by an adult person: 150 mcg Lifetime requireme
nt of Iodine: 5 grams (appx 1 teaspoon)..
(Milk contains calcium and hence should never be given with Iron, or else it wil
l decrease Iron absorption)
Animal fat (animal liver, liver oil) is used to make tablets of Cod liver oil, w
hich is used mainly in treatment of Vit A & D deficiencies. It is rich in fat so
luble vitamins like:
Vit A &
Vit D.
Most common cause of maternal mortality rate: Haemorrhage (Post partum Haemorrha
ge)
Post partum bleeding can be prevented by administering Methergin I.V during labo
r
Some important terms related to pregnancy:
1.Pre-term: Deliveries occuring before the end of 37 weeks of gestation
2.Term babies: Deliveries occuring between 37 weeks to less than 42 weeks of ges
tation (Normal)
3.Post-term: Deliveries occuring after 42 weeks of gestation
Most sensitive tool for evaluation of iron status (Investigation of choice): Ser
um ferritin
Most practical indirect tool for evaluation of iron status: Serum Haemoglobin
Screening test of choice for IDA: RDW (Red cell distribution width)
Daily Iron requirement:
1. Adult Male
-
28 mg
2. Adult Female during menstruation -
30 mg
3.
Pregnancy first half
-
38 mg
4.
Pregnancy second half/lactation -
30 mg..
Content of IFA tabs:
Adult tablet of IFA contains: Iron 100 mg, Folic acid 500 mcg (given for minimum
100 days in pregnancy)
Pediatric tablet of IFA contains: Iron 20 mg, Folic acid 100 mcg (given for 100
days minimum every year till age of 5 years.).
Mid-arm circumference: Used for assessment of nutritional status in children
Weight for age: Used for assessment of malnutrition in children
Body Mass Index (BMI): Used for assessment of nutritional status in adults..
Levels of Intelligence based on IQ levels:
1.
Idiot
-
0 to 24
2.
Imbecile
-
25 to 49
3. Moron
-
50 to 69
4.
Borderline
-
70 to 79
5. Low Normal
-
80 to 89
--------------------------------------------
6. Normal - 90 to 110
7.
Superior
-
110 to 119
8.
Very superior
-
120 to 139
9. Near genius
-
> 140..
Pellagra is a deficiency of Vitamin B3 (Niacin). It is a life- threatening condi
tion characterized by 4 Ds in its clinics:
1.Diarrhea
2.Dementia
3.Dermatitis
& if not treated- 4. Death..
Vitamin deficiencies causing anemia:
1.Vitamin A
2.Vitamin B2
3.Vitamin B6 (microcytic hypochromic anemia)
4.Vitamin B12 (megaloblastic anemia)
5.Vitamin B9 (megaloblastic anemia)
6.Vitamin C
7.Vitamin E (Hemolytic anemia)
Vitamin B3 (niacin) deficiency causes Pellagra (Characterized by Dementia, Diarr
hea, Dermatitis).
Tests to check efficiency of pasteurization milk:
1.Phosphatase test (very commonly used)
2.Standard plate count
3.Coliform count
Methylene blue reduction test: Used to test contamination of milk
Orthotoulidine test: Used to test
1.level of free chlorine &
2.Level of total chlorine (free+combined)
Orthotoulidine arsenite test: Used to test
1.Level of free chlorine
2.Level of Combined chlorine
Vitamin A deficiency aka "Xerophthalmia" is characterized by many ocular symptom
s.
It is important to know a few points related to MCQs which are frequently asked
based on Vitamin A and its deficiency:
1.Earliest manifestation of Vit A Deficiency: Night blindness
2.Earliest sign: Conjunctival xerosis
3.Earliest symptom: Night blindness
4.Severest form of Vit A Def: Keratomalacia
Fatty Acid found in breast milk is Docosa hexanoic acid
PUFA content of different oils:
1.Safflower oil - 75%
2.Sunflower seed oil- 65%
3.Soya bean oil- 62%
4.Margarine- 50%
5.Groundnut oil- 31%
6.Palm oil- 10%
7.Butter- 3%..........
Maternal Mortality Rate is calculated till 42days aftr termination of pregnancy..
Average weight at birth- 2.8 Kg
It doubles at: 5 months
triples at: 1 year quadruples at: 2 years
Neonatal age: First 28 days of life (1 month) Early neonate: First week of life
(0-7 days) Late neonate: 8-28 days of age Post-neonate: 28 days to 1 year of age..
Indicator of Acute malnutrition: Weight for age/weight for height
Indicator of chronic malnutrition: Height for age
Some points to remember:
1.Single best parameter for assessment of physical growth: Weight
2.Single most sensitive measure of growth: Weight
3.Single most reliable criterion of assessment of health & nutritional status: W
eight
4.Age independent parameters for growth assessment:
-weight for height
-Mid arm circumference
-Thickness of subcutaneous fat
-Body ratios like Weight:height or
Mid arm circumference: Head circumference..
Tetanus prevention in pregnancy:
In a previously vaccinated woman: 2 doses of Tetanus toxoid (TT1 & TT2) are give
n one month apart, preferably on 4th and 5th month of pregnancy.
In previously unvaccinated/uncertain woman: 2 doses of Tetanus toxoid are given
one month apart, and then 3rd injection after 6 months of 2nd. Then 2 booster do
ses after 1 year each.
Low birth weight criteria for India: <2.5 kg
Prevalence of LBW in India - 26%
LBW is counted regardless of gestational age (so even if the baby is premature,
still its called LBW if its <2.5 Kg)
Goal in National health policy: Reduce LBW to <10% by 2000
Other parameters:
Very low birth weight: <1.5kg
Extremely low birth weight: <1.0kg..
Low birth weight criteria for India: <2.5 kg
Prevalence of LBW in India - 26%
LBW is counted regardless of gestational age (so even if the baby is premature,
still its called LBW if its <2.5 Kg)
Goal in National health policy: Reduce LBW to <10% by 2000
Other parameters:
Very low birth weight: <1.5kg
Extremely low birth weight: <1.0kg
0.5 to 1 mg Vitamin K is administered to all newborns shortly after birth
Bleaching powder required for disinfection of 1000 liters of water: 2.5 g..
Best chemical indicator for air pollution is Sulphur Di Oxide and best biologica
l indicator for air pollution is Lichens.
1. Yellow bag:
- Contains: Human anatomical waste, animal waste, microbiological waste.
- Treatment: Incineration/deep burial
2. Red bag:
- Contains: Blood and products contaminated with blood (Rem: Red for blood)
- Treatment: Autoclave/chemical treatment/Microwave
3. Blue/white bag:
- Contains: All sharps
- Treatment: Shredding/destruction or Autoclave/chemical treatment/Microwave
4. Black bag:
-Contains: Discarded medicines, Incineration ash, Powdery chemical waste (Rem: A
ny powdery waste is to be grounded & as it is to be grounded it is put in black
bag)
-Treatment: Secured landfill.
Recommended optimum level of fluorine intake: 0.5-0.8 ppm Dental fluorosis occur
s at level of fluorine intake: >1.5 ppm Skeletal fluorosis occurs at level of fl
uorine intake: >3 to 6 ppm
Crippling chronic fluorosis occurs at level of fluorine intake: >10 ppm.
Chlorine content in bleaching powder: 33%........
Various industries and the occupational diseases they usually cause:
1.Textile industry - Byssinosis
2.Asbestos industry - Asbestosis
3.
Glass industry
- Silicosis
4.
Cement industry
- Silicosis
5.
Sugar industry
- Bagassosis.
During chlorination of water, it is important to keep note on FRC values recomme
nded. FRC (Free residual chlorine) calues recommended are:
1. Drinking water
- >0.5 ppm*
2. Swimming pool sanitation
- >1.0 ppm
3. Drinking water to kill cyclops - >2.0 ppm
[*1 ppm= 1 mg per liter]..
BACTERIOLOGICAL INDICATORS OF WATER QUALITY:
1. Coliform organisms:
- Primary & most reliable bacterial indicator for water quality is: E.coli
2. Fecal streptococci:
- Indicate 'Recent contamination of water'
3. Clostridium perfringens:
- Indicate 'Remote contamination of water'.
1.
Sugarcane dust causes: Bagassosis
2.
Coal dust causes
: Anthracosis
3.
Cotton dust causes
: Byssinosis
4.
Silica dust causes
: Silicosis
"Potable water"- defined as Zero coliforms in any amount of drinking water..
Group discussion: It is an aggregation of people interacting in a face-to-face s
ituation
Panel Discussion: features of a panel discussion are:
1. 4 to 8 persons who are qualified to talk about the topic sit & discuss a give
n problem/topic in front of a target group or audience.
2.Panel comprises of a chairman or moderator, and 4 to 8 speakers
3.There is 'no specific agenda, no order of speaking and no set speeches'
Symposium: A series of speeches on a selected subject where each person or exper
t presents an aspect briefly. There is no discussion amongst symposium members.
Air cooling power
- Kata thermometer
Air pressure
- Barometer
Air humidity
- Hygrometer, sling psychrometer,
Assman pscyhrometer

Degree of hotness in air Thermometers.
Maximum dose of radiation exposure for a person per year is 5rad..
Kuppuswami classification is based on 3 parameters:
a. Education status of head of family
b.Occupation of head of family
c.Income of family per month.
Vector of Loa loa: Deerfly, Horsefly, Mangofly.
Clinical picture of lead poisoning:
1. Non-CNS effects:
-Facial pallor (Earliest and most common)
-Anemia: Microcytic hypochromic
-Punctate basophilia or stippling of RBCs
-Burtonian line: Lead sulphide on upper gums
-Lead colic: constipation (or diarrhea)
-Lead palsy: Wrist/foot drop
-Lead encephalopathy
2. CNS effects:
- Insomnia
-Mental confusion
-Headache
-Delirium.
Occupational exposures and cancers:
1. Asbestos
- Mesothelioma
2.
Arsenic
- Skin, lung, liver cancer
3.
Aniline dye
- Bladder cancer
4. Benzene
- Leukemia
5.
Ethylene oxide
- Leukemia
6.
Vinyl chloride
- Liver cancer.
Target for daily use of water in rural areas in India: 40 liters per capita
Target for daily use of water in urban areas in India: 160 liters per capita
Daily requirement of Drinking water: 2 liters per capita
Sickness absenteeism is a 'useful index in industry to asses the state of health
workers' & their physical, mental & social well- being.
Burtonian's line is characteristic of: Lead poisoning
Mee's line is seen in: Arsenic poisoning.
Ades Mosquito is known as Tiger mosquito..
Most Common Occupational cancer in India is Skin Cancer
Biological transmission of arthropod-borne diseases:
There are 3 different types of transmission of arthropod-borne diseases:
1. Propagative transmission: Here the agent being transmitted only multiplies in
the vector (arthropod) carrying it.
eg. Yersenis pestis (Plague bacillus) in Rat fleas
Yellow fever virus in Aedes mosquitoes
2. Cyclo-propagative: Here the agent being transmitted multiplies as well as dev
elops (grows) in the vector (arthropod) carrying it.
eg: Malarial parasite in Anopheles mosquito
3. Cyclo-developmental: Here the agent being transmitted only develops (grows) i
n the vector (arthropod) carrying it.
eg: Filarial parasite in culex mosquitoes
Guineaworm embryo in Cyclops.
Nitrates in drinking water indicates: Remote pollution
Nitrites in drinking water indicates: Recent pollution..
Primary health care system:
Within Population Norm
(at plains/non-tribal areas)
1. Sub-centre level
- 5000
2.
Primary health Centre
-
30,000
3.
Secondary health care
-
1,20,000.
List of Quarantinable Diseases:
1.Diphtheria
2.Plague
3.Yellow fever
4.Infectious TB
5.Viral Haemorrhagic fevers
6.Small pox
7.SARS
[Mnemonic: DPYIHSS- Deepika Padukone Ya Imran Hashmi Sex Scandal should be Quara
ntined]
According to Alma-Ata declaration, there are 8 essential elements of Primary Hea
lth Centre-
E - Education concerning health problems and their control L - Locally endemic d
iseases prevention & control
E - Essential drugs
M - Maternal & child health care including family planning E - EPI (Immunization
) against Vaccine Preventable Diseases N - Nutrition and promoting proper food s
upply
T - Treatment of common diseases and injuries S - Safe water supply and sanitati
on
[Mnemonic: ELEMENTS]
Diseases under International Health Regulations (IHR):
1.Cholera
2.Plague
3.Yellow fever
4.Wild poiiomyelitis
5.Human influenza
6.SARS
7. Small pox
But, not HIV..
Under the IHR (1969), only Cholera, Plague, Yellow fever remain Notifiable.
Notifiable diseases means that states are required to notify WHO if and when the
se diseases occur in their territory
Provision of beds at:
1.Sub-centre: None
2.Primary health centre (PHC): 4-6
3.Community health centre (CHC): 30.
Specific side-effects of vaccines:
-Guillian barre syndrome: Killed influenza vaccine
-Vaccine associated paralysis: OPV
-Toxic shock syndrome: Measels, MMR
-Shock: DPT, Pertussis
-Allergy (Hypersensitivity): Hep B, Meningococcal vaccine, DPT
The allergy to DPT is due to its thiomersal component which is added as a preser
vative.
Influenza gets its cyclical trends due to Antigenic variations in Influenza-
eg: Type A causes epidemics every 2-3 yrs Type B causes epidemics every 4-7 yrs
Type C causes pandemics every 10-15 yrs.

Vaccine
Diluent for reconstituition
1.
BCG vaccine
-
Normal saline
2.
Yellow fever Vaccine
-
Normal saline
3.
H.influenza (HiB)
-
Normal saline/DPT vaccine
4.
Measels vaccine
-
Distilled water
5. MMR
-
Distilled water..
The vaccines that give herd immunity are:
1.Diphtheria & Pertussis (DP)
2.MMR
3.OPV
4.Small pox
Rabies Vaccine does not provide herd immunity, or else nobody
would fear dog bites anymore would they?......
The diseases who do not show carrier state are:
1.Rabies
2.Tetanus
3.Measels
4.Rubella.
Simultaneous administration of Measels vaccine & Measels Immunoglobulin decrease
s efficacy of Measels Vaccine & hence are never given together.
Measels vaccine- provides active immunity
Measels immunoglobulin- provides passive immunity.
Phase I- performed on healthy volunteers- to check for side effects
terminally ill cancer patients
those with lack of treatment options
Phase II- performed on small no. of patients- to check for effectiveness
Phase III- performed on around 2000 patients- to check for rare side effects and
effectiveness
Phase IV- performed after drug approval- to check for very rare side effects..
Quarantine period of yellow fever=IP of yellow fever=6 days.
Cold chain temperatures of vaccines available in India:
1. OPV & yellow fever: -20 C to -40 C (Hence they require freezing during transp
ort)
2.All other vaccines: +2 to +8 C (this temperature is also known as 'Cold chain
temperature of vaccines in India)
3.Vit A: It is stored outside cold chain (i.e at room temperature)
Human Development Index comprises of 3 indicators:
1.Longevity- Life expectancy at birth
2.Income- Real GDP per capita in PPP US $
3.Knowledge- Mean years of schooling
2. All Live vaccines as a rule require only a single dose to acheive immunity (e
xcept OPV).
Prophylaxis in Rabies:
Type
Schedule of vaccination
Post-exposure
-
Day 0,3,7,14,28,90
Pre-exposure Post-exposure in previously Vaccinated people
-Day 0,7,28
-Day 0,3,7..
Parenteral cholera vaccine is effective for: 3-6 months Oral Cholera vaccine is
effective for: 3 years
1.
Cohort study
-
Incidence, Relative risk
2.
Case control study
-
Odds ratio
3.
Cross sectional study
-
Prevalence
4.
Ecological study
-
Group characteristics.
Vaccines contraindicated in HIV:
1.Asymptomatic- None
2.Symptomatic- All live Vaccines except BCG and MMR vaccines.
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Measels vaccine is effective after 3 days of administration..
Following are a few important strains of vaccines you need to know for FMGE:
1.Danish 1331- BCG vaccine
2.Edmonston-Zagreb- Measels
3.Park William 8- Diphtheria
4.Jeryl lynn- Mumps
New NIS scheme:
Vit A is given at: 9 months after birth- 1 lac IU 18 months after birth- 2 lac I
U
thereafter every 6 months till age of 5 yrs- 2 lac IU
each
Total- 17 lac IU.
Hep B vaccination schedule for Children according to NIS- 6,10,14 weeks
Hep B vaccination schedule for Adults- 0,1,6 months..
Physical Quality of Life Index (PQLI) comprises of 3 parameters:
1.Life expectancy at 1 year age
2.Infant mortality rate
3.Literacy rate.
All Millennium Development Goals are to be achieved by 2015, out of these 8 goal
s, 3 are directly related to health:
Goal 4- Reduce child mortality rate by 2/3rd Goal 5- Reduce maternal mortality r
ate by 3/4th Goal 6- Combat HIV, Malaria and others
Vaccines contraindicated in pregnancy are: All Live Vaccines except OPV and Yell
ow fever..
Rabies Street virus is the one that causes Rabies and is pathogenic one. But Rab
ies fixed virus is the one which is used to form Vaccine and is rarely pathogeni
c..
Paediatrics.
The asymmetrical tonic neck reflex (ATNR) is a primitive reflex found in newborn
humans, but normally vanishes around six months of age.
The STNR emerges between 6 and 9 months of life, and should be integrated by 9 t
o 12 months of life.
The two earliest tests that were introduced in the 1970's to assess fetal lung m
aturity were:
i.The Lecithin:sphingomyelinn ratio
ii.Detection of Phosphatidylyglycerol
iii.Another test actually measures he functional capacity of the surfaces that a
re present in the amniotic fluid. This test is called foam acidity index. .
Causes for hyperbilirubinemia appearing within 24 hours of age:
i. Hemolytic disease of newborn: Rh, ABO and minor group incompatibility. (Most
common cause)
ii.Infections: intrauterine viral, bacterial; malaria
iii.G-6PD deficiency
iv.Pyruvate kinase deficiency
APGAR score is screening tool to determine whether a newborn needs medical atten
tion to stabilize heart or breathing function.
The parameters examined in a Newborn are:
i.Breathing effort
ii.Heart rate
iii.Muscle tone
iv.Reflexes
v.Skin color..
Characteristics of physiological jaundice:
i.First appears between 24-27 hours of age
ii.Maximum intensity seen on 4-5th day in term and 7th day in preterm neonates
iii.Clinically undecteble after 14 days (But if it prolongs, it may indicate a p
athology)
iv.No treatment is required but baby should be observed closely for signs of wor
sening jaundice.
Posterior and lateral fontanelles are obliterated by about six months after birt
h, the anterior is not completely closed until about middle of the second year.
(i.e 18months)
- Height at 4 yr is about double birth length
Terminology for low birth weight:
Low birthweight (LBW) - Birthweight < 2.5 kg
Very low birthweight (VLBW) - Birthweight between 1 kg and 1.5 kg
Extremely Low birthweight (ELBW) - Birthweight < 1 kg
Triple marker test for Down Syndrome:-
1)Beta hcg INCREASE
2)AFP DECREASE
3)Estriol DECREASE.
Antibodies to streptolysin O are produced in approximately 75- 80% of Group A st
reptococcus infections (Raised ASO titres), but are usually not seen in skin inf
ections caused by this organism. The antibodies are usually detected within one
to two weeks following acute pharyngitis.
8 month old baby sits without support i.e. sable sitting..
Normal increase in weight:
1.weight doubles by 6 months of age
2.weight triples by 1 year of age
3.Weight quadruples by 2 years of age
4.Annual increase from 2-9years: 2kg/year..
Left to right shunts doesn't present with cyanosis, though they are prone for fr
equent chest infections. The three main L-R shunts are:
i. ASD
ii.VSD
iii.PDA
The right to left shunts present with cyanosis at birth. These are:
1.Tetralogy of fallot
2.Transposition of great vessels
3.Tricuspid atresia
4.Total anomalous pulmonary venous drainage
5.Truncus arteriosus communis
(Mnemonic: The 5 Ts of cyanosis)
Eisenmenger complex also causes cyanosis, which is a result of conversion of Lef
t-to-right shunt to form a Right-to-left shunt, primarily due to Pulmonary hyper
tension
When a child is born, he is approximately 50cm in height. The height doubles at
4 yrs of age (i.e becomes 100cm).
Most common cause of Neonatal mortality in India: Prematurity
Most common cause of Infantile mortality in India: Prematurity
Most common cause of under 5 mortality in India: Gastro- enteritis.
Aortic stenosis can be a serious and potentially life threatening condition. Som
e of the possible complications include:
i.Pulmonary edema
ii.Cardiomagely
iii.Congestive heart failure
iv.Heart arrythmia
Some arrythmias in the ventricles may be associated with cardiac death, such as
`Ventricular fibrillation' (especially due to IHD).
Jaundice appearing after 72 hrs:
i.Sepsis neonatorum
ii.Neonatal hepatitis
iii.Extra hepatic biliary artesia
iv.Brest milk jaundice
v.Metabolic disorders
Whereas, Rh Incompatiblity causes jaundice in first 24 hrs after birth.
Most common cause of portal hypertension in children - EHPVO
Most common cause of portal hypertension in adults - Non- cirrhotic portal fibro
sis..
Indicators used to assess malnourishment:
Mid-arm circumference: Used for assessment of nutritional status in children
Weight for age: Used for assessment of malnutrition in children
Body Mass Index (BMI): Used for assessment of nutritional status in adults
Weight for height: To assess acute Malnutrition
Height for age: To assess chronic Malnutrition.
The most common childhood malignancies are acute lymphoblastic leukemia (ALL), c
entral nervous system (CNS) tumors and lymphomas. Together, these cancers accoun
t for 63% of cases.
Single most common malignancy in childhood ALL..
Most common cause of Diarrhea worldwide: Rotavirus
Most common cause of Diarrhea in India: Amoebic Dysentery
Most common viral cause of diarrhea worldwide and in India: Rotavirus
Leukocyte alkaline phosphatase is a test to check how much alkaline phosphatase
(ALP) is inside white blood cells.
A. Higher than normal results may be due to:
i.Leukemoid (leukemia-like) reaction
ii.Myelofibrosis
iii. Polycythemia vera
B. Lower-than-normal results may be due to:
i.Aplastic anemia
ii.Chronic granulocytic leukemia
iii.Pernicious anemia
Moro reflex is normally present in all infants/newborns and disappears by 3-6 Mo
nths.
Congenital heart defects are classified into two broad categories:
1. Acyanotic: The most common acyanotic lesions are ventricular septal defect, a
rtrial Septal Defect, atrioventricular canal, pulmonary stenosis, petent ductus
arteriosus, aortic stenosis and coarctation of the aorta.
Congestive heart failure is the primary concern in infants with acyanotic lesion
s.
2. Cyanotic: The most common cyanotic lesions are tetralogy of Fallot and transp
osition of great arteries. In infants with cyanotic lesions, hypoxia is more of
a problem than congestive heart failure.
Suspision of a congenital heart defect should be raised by the presence of feedi
ng difficulties in association with tachypnea, sweating and subcostal recession,
or several growth impairment.
As TOF is a cyanotic heart disease, it does not lead to congestive heart failure
1)Copying a circle: 3 years
2)Rides tricycle: 3 years
3)Copies Cross: 4 years
4)Copying triangle: 5 years..
Scurvy is a disease caused by deficiency of Vitamin C (Ascorbic acid)
One of the first signs of scurvy is the development of perifollicular hyperkerat
otic papules, often on the Shins. These appear as reddish/bluish bruise-like spo
ts surrounding hair follicules. The central hairs are twisted like corkscrews th
at may break easily. The papules may join together to form large areas of palpab
le purpura or ecchymoses (bruises).
Gums may swell and become red, soft and spongy. Any slight friction may cause th
e gums to bleed. Bleeding in the joints causes extreme discomfort and pain.
Patients may complain of dryness, irritation, light intolerence, transient visua
l blurring and stickiness.
Frankel's line is dense zone of provisional calcification at edge of metaphysis,
just beneath epiphysis seen in scurvy.
Corticosteroid can lower the risk of:
i.Respiratory Distress Syndrome after birth
ii.Bleeding within the brain called Intraventricular Hemorrhage.
iii. Other problems that may cause harm to babies that are born too soon such as
intestinal infections called Necrotizing Enterocolitis.
They are indicated in all women with preterm labor between 24 and 34 weeks of ge
station.
They should be avoided in clinical chorio-amnionitis and eclampsia.
One should avoid multiple courses of antenatal steroids, if the woman remains un
delivered after the first course
Zinc deficiency causes Acrodermatitis enteropathica.
It also causes Growth failure, anemia, leuconychia.
Treatment of TOF:
- Palliative treatment consists of anastomosis of a systemic artery with pulmona
ry artery so as to increase the pulmonary blood flow and thus increase the amoun
t of oxygenated blood reaching systemic circulation.
-Definitive treatment consists of Modifies Blolock-Taussig shunt, which consists
of subclavian artery to pulmonary artery anastomosis using a Gorotex graft.
-Humidified oxygen is used only in anoxic spells.
Children with hypothyroidism may have delaying in loosing their baby teeth
Neonatal sepsis was one of the common causes of neonatal mortality contributing
to 23% of all neonatal deaths. Klebsiella pneumoniae was the most frequently iso
lated pathogen (31.2%), followed by Staphylococcus aureus (17.5%)
MICROBIOLOGY
Erythroblastosis Foeatalis is type 2 hypersensitivity..
Eg. of Type II hypersensitivity:
1.Hyperacute graft rejection of an organ transplant
2.Coomb's positive hemolytic anemias
3.Hashimoto's disease
4.Goodpasteur's syndrome.
1. Pyogenic infections:
-Sore throat (most common bacterial cause of tonsillitis and pharyngitis)
-Skin infections like erysipelas & impetigo
-Scarlet fever (Rash+pharyngitis)
2. Non-pyogenic infections:
- Acute rheumatic fever (Due to antigen mimicry)
- Acute glomerulonephritis (Type III hypersensitivity)
For HIV ELISA is best screening test. Western Blotting Technique is best diagnost
ic test
Type 3 hypersensitivity eg:- Localized- Arthus reaction Generalized- 1. Serum si
ckness
2.Acute glomerulonephritis
3.All autoimmune diseases (like SLE)..
Procedure of fumigation of operation theatre:
1.Seal the room with adhesive tapes round the edges of doors, windows, ventilato
rs and apertures.
2.For each 1000 cu. ft of space, place 500 ml formaldehyde (40% solution) and 10
0 ml of water in an electric boiler. Switch on the boiler, leave the room and se
al the door.
3.Seal the room for 24 hours.
4. Then open the door & neutralize any residual formaldehyde
Di-George syndrome is a syndrome caused by the deletion of a small piece of chro
mosome 22. The deletion occurs near the middle of the chromosome at a location d
esignated q11.2 i.e., on the long arm of one of the pair of chromosomes 22. This
leads to Thymic Hypoplasia.
Thymus is an organ where secondary maturation of T- lymphocytes occurs after the
ir primary formation in Bone Marrow. Hence, in this disorder, due to thymic hypo
plasia, T- cell function (Cell mediated immunity) is significantly effected.
Tests to determine pasteurization of Milk:
1. Phosphatase test: very widely used test. Alkaline phosphatase is an enzyme no
rmally found in raw milk. But effective pasteurization inactivates the enzyme an
d is not detected anymore. The heat stability of this enzyme is greater
than that of bacteriae present in the milk and hence serves as an indicator for
effective pasteurization.
2.Standard plate count
3.Coilform count
Test for contamination (to determine viable bacteria count) of milk:
1.Methylene blue reduction test
2.Resazurin test
Test for determining sterilization of milk: Turbidity test.
IgM: It is the heaviest antibody & is also known as "Millenium molecule".
-It is also called the oldest antibody as it is the first antibody produced by f
etus at an age of 20 weeks of intrauterine life.
-It occurs in pentameric form. Hence 5 four-peptide subunits present
NK (Natural killer) cells: aka "Large granular lymphocytes" or "Lymphocyte activ
ation cell" are a type of cytotoxic T- lymphocyte that constitute a major compon
ent of immune system. Unlike T and B cells, NK cells do not require receptors fo
r their activation. They are specifically active against:
1.Tumor cells/ Cancer cells
2.Viruses
3.Graft rejection
4.Type II hypersensitivity..
Borellia recurrentis:
-Disease Caused: Relapsing fever
-Vector: Louse
-Route of entry: via mucus membrane
* Relapse in relapsing fever occurs due to antigenic variability. Bacteria keeps
on changing its antigens in body & patient has relapses till the antibodies are
formed against all the antigens.
There are 2 types of immunity working against a foreign antigen:
1.B-cell mediated: aka Humoral immunity - It includes the conversion of B-cell t
o plasma cell and then form Antibodies to work against the antigen.
2.T-cell mediated: aka Cell-mediated immunity - It includes the action of T-help
er(CD4) and T-killer (CD8) cells in order to destroy the antigen..
Enriched media: These are basically simple media enriched by addition of egg, bl
ood or serum.
Eg. 1. Blood agar
2.Chocolate agar
3.Loeffler's serum slope (for C.Diptheriae)
4.Lowenstein Jensen medium (for M.tuberculosis)
5.Dorset egg medium (for M.tuberculosis)..
Enrichment medium: It is a liuid selective medium in which few chemicals are add
ed to suppress the growth of unwanted bacteria and enhance the growth of wanted
bacteris.
Eg: 1. Selinite F Broth
2. Tetrathionate broth
These both media are used for growth of Salmonella & shigella
-Alkaline peptone water: Transport medium for V.Cholera
-Dorset egg medium: Enriched medium for growth of M.Tuberculosis
(Note the difference between Enriched & Enrichment media, Enriched media are sim
ple media enriched by addition of egg, blood or serum.
Dark ground microscopy:
- The principle of dark ground microscopy is that we cut short undeviated light
and only deviated (reflected) light is captured.
-This microscopy is used for: Spirochaetes like borellia, leptospira & treponema
.
-It is used to see the motility of the bacteria
-It is also helpful to see very thin bacteria like spirochaetes
Transport media for various organisms:
1.Vibrio cholerae - Venkatraman ramkrishnan medium
-Cary Blair medium
-Alkaline peptone water
2.Streptococcus - Pikes medium
3. Gonococcus - Stuart and Aemies medium.
Intravascular Hemolysis is mediated by IgG.
Cold Sterilization is done by Ionization radiations..
Hot-air oven: It is an electrical instrument which is specifically used for ster
ilization of a few selective articles like:
1. All-glass materials
2.cotton swabs
3.Antibiotic powder
4.Sharp instruments
5.Any medium containing oil or paraffin
Temperature: 160 C
Time: 60 min.
Organisms showing positive Urease test:
1.Proteus
2.Klebsiella
Urea Breath test is done for H.pylori in which the subect drinks a urea containi
ng solution labelled with carbom, which can be detected in the breath.
IgG: It is the most abundant antibody. It has a longest half-life of 23 days.
-Its levels are increased in chronic infection
-It is the only antibody which crosses placenta
-It has been classified into 4 subtypes: IgG (1-4)..
Steam under pressure: (Autoclave) It is the Best method of sterilization unless
contraindicated (eg: sharp instruments blunt up when sterilized by this method a
nd hence autoclave is contraindicated for sharps).
Temperature: 121 C
Time: 15 min
Pressure: 15 pounds pressure
Uses: Autoclave is commonly used for sterilization of hospital gowns, dressing m
aterial, culture media & non-sharp surgical instruments.
To check the efficacy of sterilization we use Indicators: eg. Bacillus stearothe
rmophillus is a biological indicator used to check Autoclave
Important culture media you need to know in Microbiology:
1.Levinthal & Mannitol salt agar: Staphylococcus Aureus
2.Crystal Violet blood agar: Streptococcus pyogenes
3.Loeffler's serum slope & Potassium tellurite blood agar: Corynebacterium dipht
heriae
4.Saboraud's dextrose agar: Nocardia
5.Robertson cooked meat medium: All Anaerobic bacteria
6.PLET medium: Bacillus Anthracis
7.Thayer martin or New york city medium: Gonococcus & Meningococcus
8.MacConkey's agar: All Enterobactericeae
9.Selenite F Broth & Tetrathionate broth: Salmonella and shigella.
Moist heat includes the following methods of disinfection:
1. Waterbath - 56 C for 30 min
2. Pasteurization - It is used for sterilization of Milk and milk products. 3 me
thods of pasteurization exists:
a.Holder's method: 63 C for 30 min
b.Flash method: 72 C for 15 secs
c.UST method (Ultra heat short time)
Most of the methods in Moist heat cannot kill Coxiella burnetti (an organism of
Rickettsia group), except the Flash method of sterilization..
Otomycosis is a fungal infection of the external ear. It is very common disease
and is usually caused by species of aspergilli (A. niger or A. fumigatus) and pe
nicllia.
The symptoms are Itching, pain and deafness. Secondary bacterial infection, comm
only due to Pseudomonas and proteus, causes suppuration.
Diagnosis can be made by demonstration of fungi in scrapings and by culture
Staph aureus is a normal inhabitant of Nasal passages.
Staph epidermidis is an inhabitant of skin.
Toxic shock syndrome is caused by reaction of human immune system to these bacte
rial superantigens. Organisms producing superantigens:
1.Staph aureus
2.Strep mitis & suis
3.Strep agalactiae
4.Strep pyogenes
IgM anti bodies are always present in Secondary reactions.
Diseases caused by E.Coli:
EPEC - Infantile diarrhea
EHEC - most serious type of diarrhea (Haemorrhagic colitis & Hemolytic uremic sy
ndrome)
ETEC - Traveller's diarrhea
EIEC - Invasive diarrhea.
Cidex solution is a solution of 2.4% Glutaraldehyde. Glutaraldehyde is the only
Chemical sterilizer. (Others are disinfectants)
Glutaraldehyde is used to sterilize:
1.All scopes like endoscopes, cystoscope, etc
2.Rubber tubes
3.face masks
4.Endotracheal tubes.
Strongyloides stercoralis is the most common parasitic infection in A.I.D.S.
Paragonimus westrmani is also called as Lung Fluke.
Most common cause of Acute bacterial endocarditis: Staphylococcus aureus
Most common cause of Subacute bacterial endocarditis: Streptococcus viridans
Most common cause of prosthetic valve endocarditis: Staphylococcus epidermidis
Most common cause of endocarditis in drug addicts: Staphylococcus epidermidis.
Organisms showing swarming growth on blood agar:
1.Proteus
2.Vibrio Alginolyticus
3.Clostridium tetani
(Rem Mnemonic: PVC shows swarming growth)
But out of the options provided, C.tetani is the only gram positive bacillus, he
nce the answer is C.tetani..
Lab diagnosis of Leishmania:
1. Direct examination:
- Bone marrow biopsy
-Lymph node biopsy
-Spleen puncture
(These specimen are checked under microscope on giemsa staining.
2. Serology:
-Non specific - Aldehyde test, Antimony test, WKK test
-Specific - ELISA & DAT(direct agglutination test)
Amongst the serological test, most sensitive and most specific test is Immunoflu
orescence antibody test.
3. Culture: It is done in NNN (Novy-McNeal-Nicolle) medium. On culture we see th
e promastigote form of Leishmania as outside body it is always in promastigote f
orm.
Most common cause of UTI: E.coli
Most common cause of Catheter induced UTI: E.Coli
There are many organisms that can cause Catheter induced UTI:
1.E.Coli
2.Proteus
3.Klebsiella
4.Pseudomonas
5.Some fungi like candida..
Babesiosis is a malaria-like parasitic disease caused by infection with Babesia,
a genus of protozoal piroplasms. After trypanosomes, Babesia are thought to be
the second most common blood parasites of mammals and they can have a major impa
ct on health of domestic animals in areas without severe winters
Babesiosis is a vector-borne illness usually transmitted by Ixodes ticks. Babesi
a microti uses the same tick vector, as Lyme disease and ehrlichiosis, i.e Ixode
s scapularis, and may occur in conjunction with these other diseases. In endemic
areas, the organism can also be transmitted by blood transfusion.
Miscellaneous important points on Parasitology:
1. Eggs which are non-bile stained: (You need to know this because most of the e
ggs become yellow when stained with bile)
a.Necator Americanus
b.Enterobius vermicularis
c.Hemanolepis Nana
d.Ancyclostoma duodenale
(Mnemonic: NEHA's eggs are non-bile stained)
2. Eggs which do not float in saturated salt solution: (Normally, we take stool
sample and suspend it in hypertonic saline & as eggs are light they come up in 2
hours. Thats how they are collected)
a.Unfertilized eggs of Ascaris Lumbricoides
b.Taenia solium
c.Taenia saginata
d.Strongyloides stercoralis
(Mnemonic: Eggs that do not float in salt solution cannot be removed STAT)
3. Man is an intermediate host in: (In all other parasites, man is a definitive
host)
a.Toxoplasma gondii - Here cat is the definite host
b.Echinococcus granulosus - Here dog is the definite host
c.Taenia solium - Here pig is the definite host
d.Plasmodium - Here mosquito is the definitive host.
The WarthinStarry stain (WS) is a silver nitrate-based staining method (a silver
stain) used in histology. It has been considered the best stain for detection of
spirochetes, and is also used to stain Helicobacter pylori, Lawsonia intracellu
laris, Microsporidia, and particulates
Cancers associated with organisms:
1.Gastric carcinoma - H. Pylori
2.hepatocellular carcinoma - Hepatitis B and C viruses
3.Nasopharyngeal caricnoma - Ebstein barr virus
4.Bladder carcinoma - Schistosoma Haematobium
5.Cholangiocarcinoma - Chlonorchis sinensis..
Brugia Malayi microfilariae resemble W.Bancrofti & loa loa microfilariae with mi
nor differences that can aid in lab diagnosis.
B.Malayi microfilariae can be distinguished by the non- continuous row of nuclei
found in the tip of the tail. There are two terminal nuclei that are distinctly
seperated from the other nuclei in the tail, whereas the tail of W.Bancrofti, O
.Volvulus & Mansonella ozzardi contains no nuclei & loa loa microfilariae nuclei
form a continuous row in tail.
Anaemias caused due to parasites-:
Megaloblastic anaemia-Diphyllobothrium latum
Iron def anaemia- Ancyclostoma duodenale and Necator americanus.
Swimming pool granuloma results when water containing an mycobacterium marinum,
enters a break in a skin. It takes 3 weeks for granuloma to form in the infected
area.
The lesion appears as reddish papules which slowly grows into purplish nodules.
Common sites: elbow, fingers, back of hand, and knees are the most common sites
affected. The nodules may break down and leave an open sore, or spread up on the
limb.
Diagnosis: Usually by a skin biopsy and culture. PPD skin test will usually be p
ositive.
Cryptococcus neoformans is the most common cause for chronic meningitis.
The EpsteinBarr virus (EBV), also called human herpesvirus 4 (HHV-4), is a virus
of the herpes family, which includes herpes
simplex virus 1 and 2, and is one of the most common viruses in humans.
It is best known as the cause of infectious mononucleosis. It is also associated
with particular forms of cancer, particularly Hodgkin's lymphoma, Burkitt's lym
phoma, nasopharyngeal carcinoma, and central nervous system lymphomas associated
with HIV.
Finally, there is evidence that infection with the virus is associated with a hi
gher risk of certain autoimmune diseases, especially dermatomyositis, systemic l
upus erythematosus, rheumatoid arthritis, Sjgren's syndrome, and multiple scleros
is..
Dimorphic fungi are fungi which can exist as mold/hyphal/filamentous form or as
yeast.
Following species of fungi are dimorphic:
1.Coccidioides immitis,
2.Penicillium marneffei
3.Paracoccidioides brasiliensis,
4.Candida albicans,
5.Ustilago maydis,
6.Blastomyces dermatitidis,
7.Histoplasma capsulatum, and
8.Sporothrix schenckii.
Cryptococcus neoformans is a yeast/unicellular fungi. It exists only in yeast fo
rm. But all dimorphic fungi exist in 2 forms:
At room temperature, they grow as a mold.
At body temperature, they grow as a yeast..
For Cryptosporodium the definitive test for diagnosis is Immunoflourescence..
Types of fungal infection:
1. Superficial:
a. Taenia versicolor
b. Dermatophytes (like Epidermophyton, Microsporum, Trichophyton)
2.Subcutaneous: a. Maduramycosis b. Sporotrichosis c. Rhinosporidiosis
d. Chromoblastomycosis
3.Systemic:
a.Histoplasmosis
b.Blastomycosis
c.Coccidiomycosis
d.Paracoccidiomycosis
e.Phaeohypomycosis
4. Oppurtunistic:
a.Candida
b.Cryptococcus
c.Aspergillus
d.Zygomycosis
e.Penicillium Marnefii..
Cromoblastomyosis can be diagnosed by the presence of sclerotic bodies and prese
nce of Muriform cells.
The incubation period of staphylococcal food poisoning is short i.e around 2-6 h
ours (Other types of food poisonings have a longer incubation period of 18-24 hr
s)
Only 2 food poisonings have shorter incubation period:
1.Staph aureus
2.Bacillus cereus (only emetic type, because diarrheal type of bacillus cereus h
as IP of 18-24 hours)
Symptoms: Explosive vomiting and nausea, and sometimes diarrhea and severe abdom
inal pain, starting within 30 minutes to 8 hours of eating the contaminated food
and lasting about 1 day.
Management: Immediately start antibiotic treatment. Also hydration is the mainst
ay as is for any other diarrhea.
1.M.Leprae: It is hence grown in Footpad of Mice or Armedillo
2.Treponema pallidum: It is grown in Rabbit testes.
Pulmonary pneumatoceles are thin-walled, air-filled cysts that develop within th
e lung parenchyma. They can be single emphysematous lesions but are more often m
ultiple, thin- walled, air-filled, cystlike cavities. Most often, they occur as
a sequela to acute pneumonia, commonly caused by Staphylococcus aureus. However,
pneumatocele formation also occurs with other agents, including Streptococcus p
neumoniae, Haemophilus influenzae, Escherichia coli, group A streptococci, Serra
tia marcescens, Klebsiella pneumoniae, adenovirus, and tuberculosis. Pneumatocel
es are generally observed soon after the development of pneumonia but can be obs
erved on the initial chest radiograph.
Noninfectious etiologies include hydrocarbon ingestion, trauma, and positive pre
ssure ventilation.
In most circumstances, pneumatoceles are asymptomatic and do not require surgica
l intervention.
Treatment of the underlying pneumonia with antibiotics is the first-line therapy
. Close observation in the early stages of the infection and periodic follow-up
care until resolution of the pneumatocele is usually adequate treatment. The nat
ural course of a pneumatocele is slow resolution with no further clinical sequel
ae. Invasive approaches should only be reserved for patients who develop complic
ations..
LD Bodies are associated with Kala Azar..
Cresentric Macrogametocyte is seen in plasmodium falciparum
The commonly encountered fungal infections in HIV-positive patients are Candidos
is, cryptococcosis, & histoplasmosis.
But infections like Aspergillosis are rare in HIV patients
Gonococcus has an ability to penetrate intact cornea. Hence, a mother with Gonor
rhea can transfer it to the child's eye during delivery..
The most common method of lab diagnosis of toxoplasma gondii is by serology like
Sabin-Feldman dye test.
Other methods of lab diagnosis are: Immunofluorenscence, indirect haemagglutinat
ion, complement fixation & ELISA.
The sabin feldman dye test is based on the presence of certain antibodies that p
revent methylene blue dye from entering the cytoplasm of Toxoplasma organisms..
1.Photochromogens: Pigmentation only after exposure to light eg: Mycobacterium K
ansasii
Mycobacterium marinum
2.Scotochromogens: Pigmentation in the dark (and light both) eg: Mycobacterium s
crofulaceium
Mycobacterium gordonae
3.Non-Photochromogens: No pigmentation at all eg: Mycobacterium avium intracellu
lare
4.Rapid growers:
eg: Mycobacterium fortuitum Mycobacterium chelonei
Fungi are of 3 types morphologically:
1.Yeast (they have a bud on a round body, no hyphae seen)
-eg: Cryptococcus, Sacchromyces
2.Yeast-like (they have pseudohyphae but with a round body)
-eg: Candida
3. Filamentous (they have hyphae with septae and buds on them)
- eg: Dermatophytes, Penicillium..
Diphtheria toxin acts inhibits elongation factor eEF-2 required for translation
process to occur. The process of translation forms proteins and occurs in follow
ing 3 steps:
1.Initiation
2.Elongation
3.Termination
The 2nd step in eukaryotes requires an elongation factor eEF-2, which is inhibit
ed by Diphtheria toxin.
Similar mechanism of action is shown by:
1.Pseudomonas toxin
2.Shigella toxin
3.Diphtheria toxin
(Mnemonic: PSD - are Protein Synthesis Decrea.
Black Malarial Pigment is due to Plasmodium falciform..
Carriers for H.S.V. are humans.
For Leishmaniasis-:
2. Serology:
-Non specific - Aldehyde test, Antimony test, WKK test
-Specific - ELISA & DAT(direct agglutination test)
Amongst the serological test, most sensitive and most specific test is Immunoflu
orescence antibody test.
3. Culture: It is done in NNN (Novy-McNeal-Nicolle) medium. On culture we see th
e promastigote form of Leishmania as outside body it is always in promastigote f
orm
Follow-up is an essential part of treatment of Tuberculosis. Follow-up timings o
f different categories of TB:
1.Category I - 2, 4, 6 months of treatment
2.Category II - 3, 5, 8 months of treatment
3.Category III - 2, 6 months of treatment
4.Category IV - every 2 months of treatment
BIOCHEMISTRY
. Phenylalanine is a precursor for tyrosine, the monoamine signaling molecules d
opamine, norepinephrine (noradrenaline), and epinephrine (adrenaline), and the s
kin pigment melanin..
Tryptophan synthesizes Serotonin, melatonin, Niacin, Auxin..
Glucose 6 phosphatase is an enzyme used in Gluconeogenesis to reverse one of the
3 major irreversible steps of Glycolysis, so that we can form glucose in a reve
rse manner of glycolysis:
1.Pyruvate to PEP- Reversed by Pyruvate carboxylase and PEPCK (Phosphoenol pyruv
ate carboxykinase)
2.Fructose 1,6 Bisphosphate to Fructose 6 phosphate- Reversed by Fructose 1,6 Bi
sphosphatase
3.Glucose 6 phosphate to Glucose- Reversed by Glucose 6 phosphatase
Rest 3 are steps in glycolysis.
Carbamoyl Phosphate Synthetase I is a ligase enzyme located in the mitochondria,
involved in the production of urea. Carbamoyl Phosphate Synthetase I (CPS-I) tr
ansfers an ammonia from
glutamine to a molecule of bicarbonate that has been phosphorylated by a molecul
e of ATP. The resulting carbamate is then phosphorylated with another molecule A
TP. Thus forming Carbamoyl Phosphate.
C-peptide is formed when Pro-insulin is cleaved to form Insulin. Hence it is a p
art of proinsulin..
Substrate-level phosphorylation is a type of chemical reaction that results in t
he formation and creation of adenosine triphosphate (ATP) or guanosine triphosph
ate (GTP) by the direct transfer and donation of a phosphoryl (PO3) group to ade
nosine diphosphate (ADP) or guanosine diphosphate (GDP) from a phosphorylated re
active intermediate. By convention, however, the phosphoryl group that is transf
erred is referred to as a phosphate group.
An alternative way to create ATP is through oxidative phosphorylation, which tak
es place during the process of cellular respiration, in addition to the substrat
e-level phosphorylation that occurs during glycolysis and the Krebs cycle. Durin
g oxidative phosphorylation, NADH is oxidized to NAD+, yielding 2.5 ATPs, and FA
DH2 yields 1.5 ATPs when it is oxidized. Oxidative phosphorylation uses electroc
hemical or chemiosmotic gradient of protons (H+) across the inner mitochondrial
membrane to generate ATP from ADP, which is a key difference from substrate-leve
l phosphorylation.
In Kreb's cycle:
GTP is formed directly in the following step:
- Guanosine triphosphate (GTP) is created from GDP by transfer of a phosphate gr
oup during the conversion of Succinyl CoA to Succinate. This phosphate is transf
erred to ADP in another substrate-level phosphorylation event. The reaction is c
atalyzed by the enzyme Succinyl-CoA synthetase. (aka Succinate Thiokinase)
The major substrate for fatty acid biosynthesis is Acetyl CoA. Formation of fatt
y acid also requires a potent reducer NADPH, which can be obtained from one of t
he 2 places in the body:
1.HMP shunt
2.MAlic enzyme in fatty acid biosynthesis.
Following are essential fatty acids:
1.Linoleic acid - The most imp essential fatty acid
2.Linolenic acid
3.Arachidonic acid
4. Eicosapentanoic acid
Phospho triose Isomerase is an enzyme that catalyzes the reversible interconvers
ion of the triose phosphate isomers Dihydroxyacetone phosphate(DHAP- Ketose suga
r) and D- glyceraldehyde 3-phosphate.(Aldose sugar)
Anaerobic glycolysis is the transformation of glucose to pyruvate when limited a
mounts of oxygen (O2) are available. Anaerobic glycolysis is only an effective m
eans of energy production during short, intense exercise, providing energy for a
period ranging from 10 seconds to 2 minutes. The anaerobic glycolysis (lactic a
cid) system is dominant from about 1030 seconds during a maximal effort. It reple
nishes very quickly over this period and produces 2 ATP molecules per glucose mo
lecule, and a byproduct Lactate
Familial hypercholesterolemia is a genetic disorder caused by a defect on chromo
some 19.
The defect makes the body unable to remove low density lipoprotein (LDL, or "bad
") cholesterol from the blood, because of defective LDL receptors and hence decr
eased uptake of LDL
from blood. This results in high levels of LDL in the blood. High levels of LDL
cholesterol make you more likely to have narrowing of the arteries from atherosc
lerosis at an early age. Those with familial hypercholesterolemia are more likel
y to have a family history of high cholesterol and heart disease at a younger ag
e than normal.
The condition is typically passed down through families in an autosomal dominant
manner. That means you only need to get the abnormal gene from one parent in or
der to inherit the disease.
In rare cases, a child may inherit the gene from both parents.When this occurs,
the increase in cholesterol levels is much more severe, greatly increasing the r
isk for heart attacks and heart disease.
This is because Fructose 1,6-bisphosphate splits to form DHAP & Glyceraldehyde 3
-P, later DHAP converts to form 2 molecules of Glyceraldehyde 3-P in presence of
Isomerase. Hence further all products formed are 2 in number, including pyruvat
e.
LDL is a carrier for cholesterol
LDH, CPK-MB and Troponins along with Myoglobin are important markers of Myocardi
al infarction.
1. Functional lactate dehydrogenase are homo or hetero tetramers composed of M a
nd H protein subunits encoded by the LDHA and LDHB genes respectively:
LDH-1 (4H) - in the heart and RBCs
LDH-2 (3H1M) - in the reticuloendothelial system
LDH-3 (2H2M) - in the lungs
LDH-4 (1H3M) - in the kidneys, placenta and pancreas
LDH-5 (4M) - in the liver and striated muscle
Usually LDH-2 is the predominant form in the serum. A LDH-1 level higher than th
e LDH-2 level (a "flipped pattern"), suggests myocardial infarction (damage to h
eart tissues releases heart LDH, which is rich in LDH-1, into the bloodstream).
But still LDH detection is not the best method to diagnose MI.
2.CPK-MB resides in the cytosol and facilitates high energy phosphates into and
out of mitochondria. It is distributed in a large number of tissues even in the
skeletal muscle. Since it has a short duration, it cannot be used for late diagn
osis of acute MI but can be used to suggest infarct extension if levels rise aga
in. This is usually back to normal within 23 days.
3.Troponin is released during MI from the cytosolic pool of the myocytes. Its su
bsequent release is prolonged with degradation of actin and myosin filaments. Di
fferential diagnosis of troponin elevation includes acute infarction, severe pul
monary embolism causing acute right heart overload, heart failure, myocarditis.
Troponins can also calculate infarct size but the peak must be measured in the 3
rd day. released in 24 hours and persists for up to 7 days.
It is the most sensitive and specific test for myocardial damage. Because it has
increased specificity compared with CK-MB, troponin is a superior marker for my
ocardial injury.
Time which cardiac markers take to peak in blood:
1. Troponin: 1-2days
2.CPK-MB: 10-24hrs
3.LDH: 72 hrs
4.Myoglobin: 2 hrs
Myoglobin is the earliest Cardiac marker to be detected in serum..
List of essential amino acids:
Phenylalanine
Valine
Threonine
Histidine
Isoleucine
Tryptophan
Methionine
Alanine
Leucine
Lysine
Mnemonic to remember this: PVT HIT MALL.
Glutamine is a non-essential amino acid which can cross Blood- Brain barrier. It
is found circulating in blood as well as stored in Muscles. It can become condi
tionally essential in case of Illness and Injury.
Glutamine enhances brain function by helping the formation of 2 meurotransmitter
s:
1.Glutamate
2.GABA
One main function of Glutamine is sequestration of ammonia in a non-toxic form
A musty odour in urine may be caused by liver failure or a rare metabolic disord
er such as phenylketonuria..
Lecithin-cholesterol acyltransferase (LCAT, also called phosphatidylcholine-ster
ol O-acyltransferase) is an enzyme that converts free cholesterol into cholester
yl ester (a more
hydrophobic form of cholesterol), which is then sequestered into the core of a l
ipoprotein particle, eventually making the newly synthesized HDL spherical and f
orcing the reaction to become unidirectional since the particles are removed fro
m the surface.
LCAT is mainly present on HDL, where in presence of ApoA1, it activates to form
cholesterol esters.
Insulin mediates glucose uptake through GLUT-4 transporters in tissues like Adip
ose tissue and skeletal muscles. In RBCs and other tissues, instead of GLUT-4 up
take via Insulin, there is GLUT-1 transporter. GLUT-2 is present in liver and pa
ncreas.
GLUT(glucose transporters) types and location:
1. GLUT-1 - Is widely distributed in fetal tissues. In the adult, it is expresse
d at highest levels in erythrocytes and also in the endothelial cells of barrier
tissues such as the blood-brain barrier. However, it is responsible for the low
-level of basal glucose uptake required to sustain respiration in all cells.
2.GLUT-2 - Is expressed by renal tubular cells and small intestinal epithelial c
ells that transport glucose, liver cells and pancreatic bcells.Allthreemonosacchar
idesaretransported from the intestinal mucosal cell into the portal circulation
by GLUT2
3.GLUT-3 - Expressed mostly in neurons (where it is believed to be the main gluc
ose transporter isoform), and in the placenta.
4.GLUT-4 - It is the one whose exocytosis to cell membrane is governed by Insuli
n. Found in adipose tissues and striated muscle (skeletal muscle and cardiac mus
cle)
MC type of porphyria is Porphyria Cutanea Tarda.
Acute intermittent porphyria is due to deficiency of enzyme porphobilinigen.
Amino acids most deficient in proteins of food items are called 'Limiting amino
acids'
Food Item

Limiting amino acid
1.cereals
-
Threonine and lysine
2. Pulses
-
Methionine and cysteine
3. Maize
-
Tryptophan and lysine
..
LCAT is am activator of Apo A1..
Pentose Phosphate Pathway or Hexose Monophosphate shunt (HMP-shunt) is a pathway
governed by a rate limiting enzyme Glucose 6- phosphate dehydrogenase (G6PD). T
his pathway produces a 2 molecules of NADPH, a potent reducing agent.
2 sources of NADPH in the body:
1.HMP Shunt
2.Fatty acid synthesis (via Malic enzyme)
Now this NADPH is used in Fatty acid synthesis in the step catalyzed by an enzym
e "Fatty acid synthase".
Uses of NADPH:
1.Fatty acid synthesis
2.Glutathione reduction during neutralization of Free oxygen radicals
Chitin is a polymer of N-acetyl glucosamine, which is one of the main components
of Cell wall in many living organisms (including bacteria and fungi). By nature
it is a structural polysaccharide..
All 3 metabolisms, i.e Carbohydrate, protein & fat metabolisms form Acetyl-CoA w
hich is compound used in TCA cycle at its beginning. Thus all these metabolisms
do pass through Kreb's cycle via Acetyl-CoA synthesis.
Prostaglandins and Thromboxane A2 are synthesized in Arachidonic acid pathway, w
hereas corticosteroids inhibit Phospholipase A2, inturn inhibiting formation of
Arachidonic acid from Membrane Phospholipids.
Coconut oil has 92.1% of Saturated fatty acids, 6.2% monounsaturated and 1.6% po
lyunsaturated fatty acids..
Phenylketonuria is a disease due to deficiency of enzyme Phenylalanine hydroxyla
se, which converts Phenlyalanine to
Tyrosine. Thus in phenyl ketonuria, tyrosine becomes deficient..
Free fatty acids are transported in blood by Albumin (a protein formed in liver)
but most other lipids are transported in blood by Lipoproteins (eg: LDL, VLDL,
HDL, Chylomicrons, etc).