Some CPSP favourite points which you must go through before exam 👉 👉👉👉👉👉👉

👉👉👉👉👉👉 👉👉👉👉 👉

Vitamins green vegetables

Minerals (least) tubers +( highest soya beans)

Bronchopulmonary segment supplied by tertiary bronchus

Renal column / capsule interlobar Arteries

Glomeruli interlobular arteires

Most agreessive CA melanoma

Locally Malignant ameloblastoma

Median structurally largest lobe

Lateral anatomically largest lobe

Peripheral largest zone

CA prostate peripheral zone and Posterior lobe + Metastasize to Vertebraal column and

brain by Anterio Intervertebral venous plexous BPH median lobe and transitional zone

External laryngeal nerve thryoidectomy

Recurrent laryngeal nerve tracheotomy

Bronchoscopy first seen will be upper lobe of right lung

Aspiration most common Apical segment of right lower lobe

Supine position right lower lobe

Lying on right side right upper lobe

Lower airways T3_T4

PTH regulates Ca and vitamin D levels + Hypertrophy in CRF

Breast has 15-20 lacterous tubules + medial side (internal thoracic ) upper outer quadrant
(Anterior / pectoral )

Hemoorghagic Infarcts + red Infarcts

Testes + Intestine + lungs + liver

Ischemic Infarcts + pale Infarcts heart + spleen + kidneys

Becks Triad (Cardiac temponade) Muffled HS, Hypotension and Raised JVP

Rustling /Pericardial Rub Pericarditis

Normal individual 70kg (42 litres )

ICF 28 litre (2/3rd) ECF

14 litres (1/3rd )
ECF further has two parts :

Plasma 3.5 litres

Remaining is Interstitial fluid 10.5 litres

Max absoprtion of water and salts+ Aldosterone independent water absorption + passive sodium

absorption Jejunum

Aldosterone dependent water absoprtion + Active sodium absorption+ Max efficiency of water

absoprtion. colon.
Duodenum calcium + iron absorption in Fe+2 (ferrous form in heme )

Heme binds with hemopexin

Hemoglobin binds with Haptoglobin

Fat necrosis pancreas + breast (trauma) + omentum

Coagulative (cell outerline is preserved ) kidney + hearts + liver

Metastatic calcification lungs

Dystrophic necrotic tissues

Liquefactive brain

Amyloidosis (Congo red stain + rectal biopsy ) kidney affected

Pulmonary embolism clinically silent + S1Q3T3 + gallium scan

Fat embolism occur after 12 hours + long bones fracture

Amniotic fluid embolism pregnant lady in 3rd trimester

Asthma Decreased FEV1/ FVC ratio -- 0.75

Heparin Acts on activates Antithrombin 3

Heparin Blocks factor Xa and Thrombin

Sarcoidosis (ERYTHEMA NODOSUM ) microscopic (non- caseating granuloma ) histoology

(epithelioid cells + astroid bodies ) + LUNGS most common affected

TB ( delayed cell mediated type 4 Immunity ) microscopic ( caseating granuloma)

Histology ( epithelioid cells with granuloma ) + helper T cells in PPD test + initial for TB X- ray +
confirmation AFB by ZN staining + primary Tb (Gohn complex having granuloma with surrounding
Lymphatics )

Asbestosis lower lobe of Lungs + bronchogenic CA > mesothelioma (pleural plaques ) +

FERRUGINOUS BODIES + construction workers + plumbers

Silicosis upper lobe of right + EGG SHELL CALCIFICATION + sandblasting , foundaries and mines
+ Increasead risk of TB +

Berrylisosis textile industry (cotton )

Anthracosis black lung + due to inhaled carbon

Alveolar macrophages fighters in lungs

Most common cause of death in SLE Renal Failure

Most common cause of death in Multiple myeloma Renal failure>>Infection

Autoimmune disease effecting single organ Hashimotto

Hashimoto thyroiditis Type 4>>>Type 2

Diagnostic Test for Multiple myeloma Biopsy>>>Protein electrophoresis HLA B27

Aankylosing spondylitis (bamboo spine ) + Reiter Syndrome + IBD + psoriatic

HLA used for graft + graft rejection + identical twins have similar HLA

SLE sensitive is ANA + specific is anti Smith and anti ds DNA RA morning
Stiffness + HLA B4

Glomerulosa aldosterone
Fasciulata (under control of ACTH )
Cortisol ( cortisol regulates lymphocytes production turn over )

Reticularis androgens

Left Gastric vein Hematemesis in CLD ( terlipressin > octreotide )

Bronchial Artery hempotysis

Esophageal vein + paraumblical veins dilation in portal HTN

Superior rectal vein + left Gastric + paraumblical veins + esophageal veins part of portal system

Nerve / structure damaged during Appendectomy iliohypogastric nerve

Artery damaged during Appendectomy Deep Circumflex artery Appendicular artery

terminal branch of ileocecolic artery

Superficial inguinal ring externally oblique

Deep Inguinal ring transversalis fascia

Facial sheath formed by transversalis fascia + fascia iliaca

Conjoint tendon formed by aponeurosis of internal oblique and transversus abdominus

Prostate internal iliac

Cervix internal iliac + external iliac ( prefer internal iliac )

Most common source of emboli femoral vein Most

common site of DVT popliteal vein most common

cause immobilization
Early wound healing + granulation tissue Type 3 collagen

Late wound healing + wound strength

Type 1 collagen

Diet defficent in fruits and vegetables Decreased tensile strength

Diet having complete absence of fruits and vegetables Decreased collagen synthesis..

Vitamin C hydroxylation of glycine and proline residues

Maximum sensory cortex area Lips

Maximum motor coretx area dorsum of hand

The distance where two stimuli are perceived to be different is Maximum at back of scapula

Extreme flexion of neck ligament nuchae damaged Extreme extension

Anterio Longitude ligament vertebra held in place by ant and post

longitudinal ligament Vertebra attached to adjacet lamina Ligamentum

flavum

Regarding mengitis :

Neonate till 6 months Group B streptococci (S. Agalactiae )

6months till 2 years strep pneumoniae > H. Influenzae

6 years till 60 years N. meningitidis Above 60 +

alcoholics strep pneumoniae

immunocompromised (HIV) / Renal transplant cryptococcus

Renin secretion increased by sympathetic stimulation > Hyponatremia >

Hypokalemia

Aldosterone secretions increasead by Hyperkalemia

After radiotherapy skin lesions and fibrosis : acute

desquamtion

Chronic Endarteritis obliterans

Late lymphoproliferative disorders

Vessels of heart 2 coronary Arteries +1 Artrioventricular +1 Auricular+ 1 Septal

Fibroblast has abundant amorphous subatance

Fibrocartilage has abundant collagen

Pituitary tumor / optic chiasma Bitemporal hemianopia Optic tract

homonymous hemianopia

Cytoskelton ECM to ICM Intermediate Filament

Cytoskeleton To ECM integrins

ECM to ICM Integrins

Cells to Cells adhesion Cadhrins

Desmosomes Cytokeratin/Intermediate Filament

Transient adhesions Selectin>>>E-Cadhrins

Metastasis Loss of E-Cadhrin

Leukocyte adhesion LFA-1

WBC to endothelium ICAM

Most common premalignant lesion Leukoplakia Most lethal

premalignant lesion Erthroplakia most common

premalignant condition SMF

Most lethal premalignant condition lichen planus premalignant lesion

diagnostic pleomorphism premalignant condition diagnostic High

N/C ratio Malignancy Metastasis>> Invasion>> Pleomorphism>>

Premalignant conditions Lichen planus and Barret esophagus

Anterior duodenum perforation right paracolic gutter > Right iliac fossa > right post
subphrenic space

Posterior duodenal perforation lesser sac

SYNCHONDROSIS Primary cartilaginous joint +Hyaline cartilage

Eg ----> Epiphyseal plates of long bones

SYMPHYSIS Secondary cartilaginous joint +Fibrocartilage

Eg ---> Intervertebral discs + pubic Symphysis

Wrist condyloid joint

Knee + ankle + Elbow hinge joint

Hip + shoulder ball and socket

EBV Nasopharyngeal CA

Oropharyngeal HPV

Bronchogenic CA CMV / HPV

Primary ameonorrhea + webbed neck + short height In a female turner syndrome (45X0)
Absent uterus on scan + well developed breast and normal height Androgens insensitivity
syndrome
(46XY )

Ambigous genitalia + 46XX congenital adrenal Syndrome

Blind vagina + absent uterus testicular feminization /adrogenital syndrome Single Palmer

crease + mental retarded + low set ears + trisomy 21 down syndrome

Hysterectomy + tubal ligation ureter damage + uterine artery ligation

Oophorectomy (Ovarian fossa ) internal iliac vessels

Superficial perineal poch rupture of bulbar urethra

Deep perineal pouch rupture of memberanous urethra

PCT Maximum reabsorption (67%)

HCO3- PCT and CD

Maximum absorberd glucose

Drug actively secreted by renal tubules benzyl penicillin

Most Hypotonic urine DCT

Most Hypertonic CT

Thiziade diuretics Hypokalemia > Hyperglycemia > Hyperuricemia >

Hypercalcemia

Hematuria after sore throat post streptococcal glomerulonephritis

UTI + pyelonephritis E. Coli

Thrist stimulation angiotensin 2

Morphine Strong meu receptor agonist +
Increases bronchial tone +Antidote is naloxone +DOC in acute pancreatitis +
Causes bradypnea + miosis

Pethidine Causes fatal excitation when given with MAO Inhibitors

Toradol Weak meu agonist

Nitrates Weak anesthetic + strong analgesia + Decreased preload + given in MI for pain relief
High first pass effect ( Sub- lingual)

Highest pulse pressure Femoral artery> popliteal > Aorta

Highest MAP aorta

Highest systolic pressure Renal artery

Highest Oxygen tension pulmonary artery

Adult spinal cord lower border of L1 or upper border of L2

Neonates spinal cord upper border of L3

Tracheostomy in adults C2-C3 ( prefer C2) Tracheostomy in children

C3-C4 ( prefer C3)

Regarding Embryogy :

Remnant of gubernaculum scrotal ligament (male ) + Round ligament of uterus and ovarian
ligament (females )

Medial umbilical ligament umblical arteies

Median umbilical Ligament urachus

Patent Allantois forms urachul fistula

Remnant of paramesonephric ducts in males appendix testes

Limbs buds appear 4th week

Thymus develops from endoderm of 3rd brachial pouch

Formaen Caecum produces thryoid

Germ cells arise in yolk sac 3rd week from EPIBLAST / ECTODERM

Primitive streak (cranially ) forms ectopic anal opening

Urachus forms median umbilical Ligament

Maxillary artery derivative of first arch

Tunica vaginalis remnant of processus vaginalis

Ventral mesogstrium hepatoduodenal Ligament

Dorsal mesogstrium gastrocolic ligament

Exo-celomic cavity derived from hypoblast

Lacrimal glands developed from surface ECTODERM

Thioridazine Blocks Dopamine receptors.

Cervical Dysplasia caused by HPV > Multiparty

Partial resection of pancreas leads to loss of exocrine function, what finding will present Absent
trypsin in dudeneal fluid

Hemorrhage due to perforation of lesser curvature of stomach , artery involved Left gastric
artery
Pt has painless red purple lesion, oral thrush and diarrhea . what causes the red purple painless

skin lesion HHV-8

Main function of cerebellum Coordination of agonist and antagonist muscles Hepatic adenoma
OCPs + anablic steroids

Angiosarcoma arsenic + vinyl chloride

HCC aflatoxins
Liver malignancy secondary Metastasis is more common than primary CA

Strong antimicrobicidal effect OH > H2O2 > Superoxide

Renal buffer bicarbonate

Renal tubular buffer phosphate

Buffer only in kidney ammonia

Intracellular buffer protiens RBC buffer

Hemoglobin

Narrowest part of urethra External urethral meatus

Shortest and least dilatable memberanous urethra

Most dilatable Prostatic urethra

Female urethra is prone to infections due to short length

Landmark for dissection of neck + landmark for neck traingles Scalene anterior Landmarks for

neck muscle + landmark for examination of neck SCM

sudden painless vision loss + HTN CRAO

Diabetics CRVO

Loss of Accomodation in old age Stiffness of lens

Mysthenia gravis antibiodies against presynaptic volatge gated cannels

Diagnostic test ACH receptor antibodies

Most accurate/confirmatory/gold standard EMG

DOC initial is neostigmine while for maintained therapy is pyridostigmine Physostigmine
crosses BBB immediately and Increase Acetylcholine

Chancre (painless ) Syphilis

Chanchroid (painful ) Hemophilus Ducrecy

Vesicles HSV 2

Non ulcer lesions Gonorrhea

Warty Lesions of genitalia Chlamydia

Intraepithelial Lesions of genitalia Paget diasease of Vulva (pre-malignat)

Most aggressive CA Melanoma

Pre-malignant lesion on face which must be excised Actinic keratosis (caused by UV light )

Condition having Highest malignant potential Basal cell CA ( SCC in situ )

HCC HBV>>HCV

chronicity HCV>>HBV cirrhosis

Alcoholism>>HCV>>HBV Blood transfusion most

CMV >HCV>>HBV

Lethal transfusion reaction + after transplant CMV

Most common skin Ca is BCC

Most common site of BCC is upper lip

Most common after Basal is Squammous Most

common site of SCC is lower lip

Lateral Relations of vagina ( has abundant elastic tissue ) :

Lateral to upper part of vagina Ureter

Lateral to middle part of vagina Anterior fibers of Levator Ani

Lateral to lower part of vagina Urogenital Diaphragm

Immediate mediator of inflammation+ mediator causing vasoconstriction Histamine

Delayed mediator Leukotrines and PG + IL-12

Fever mediator IL-1 &TNF alpha

Pain mediator Bradykinin (potent ) and PG -E2

Potent chemotactic factor C5a >>LTB4

Important role of bradykinin increase vascular permeability

Chemotactic factor for neutrophils IL-8

Vimentin connective tissue Desmin

muscles

Cimetidine (H2 blockers ) cytochrome P-450 inhibitor and Increases effects of most of the drugs
and Decreasing their clearance from liver + Inhibits sucralfate getting absorbed

Side effects :

Protamine hypotension

IUCD bleeding + discharge

Penicilllin bronchospasm

Chlorpromazine dystonia

TCAs (analgesic effect in 7-10 days ) generalized tonic clonic seizures

Captopril fetal kidney damage in utero

Tetracycline teeth abnormality

Ethambutol Retrobulbar neuritis

Pyrazinamide Hyperuricemia

Streptomycin + gentamicin Nephrotoxicity (given with caution )

Cylophosphamide hemorrhagic cystitis

Optic neuritis B12

Peripheral neuritis + high output cardiac failure B1

Pellagra (3Ds ) Niacin B3

Cheilosis + angular stomatitis Riboflavin B2

Part of acetyl CO-A and synthathase B5

Transamination for liver B6

Carboxylation (addition of 1 carbon ) B7

Methylation + nuclei acid synthesis B9

Orofecal route Hep E > Hep A

Lethal Hepatitis Hep D

Pregnancy + fulminant hepatitis Hep E

For amoebic abscess serology

Pyogenic cyst CT scan

Hydatid cyst immunological test / immunoassay..

Ptosis +Mieosis Horner syndrome

Ptosis+Mydriasis CN 3

Ptsosis + normal pupil Myesthenia gravis

reticular fibers longitudinal appearance under light microscope Collagen fibers
lamellar appearance under light microscope

Forceful expiration internal intercostal + abdominal muscles (external oblique and rectus
abdominus )

Forceful inspiration external intercostal

Laboured breath during stab wound when abdomen is moving more External oblique

Hemodynamics :

Proliferation of blood stem cells --> Growth factor

Proliferation of RBCs ---> Erthyropoitein
Reticulocytes count tells --> bone marrow response to anemia
Coombs test ---> autoimmune hemolytic anemia
Bite cells and Heinz bodies + protection against malaria ---> G6pd defficency
(protection against malaria )
Failure to thrive + family Hx + target cells --> thalassemia most common
cause of thrombocytopenia -- ITP
Most common presentation of thrombocytopenia --- petechial hemorrhage and increased BT
Most common cause of increased BT -- Aspirin use
Platelets are produced by ---> megakaryocytes
Most serious transfusion reaction --> A donor blood given to O receipteint
Howel jowel bodies -- sickle cell anemia
Hemlet cells - DIC
Tear drop cells - myelofibrosis
Llarge size platelets + platelets adhesion defects + thrombocytopenia -- Bernard soullier Syndrome

Osteoporosis thin and wide trabeculae + long term use of steroid is the cause
Osteogenesis osteoclasts in howhship lacunae

REGARDING bone appositional growth

Osteoblast bone making cells + produce ALP

Osteoclast bone resorption

Blood supply of spinal cord Anterior + Posterior spinal arteires > VERTEBRAL
Artery

Characteristic sign of cerebellar lesion DYSDIADOCHOKINESIA characteristic sign of cerebellar

disease
NYSTAGMUS

MARFAN SYNDROME Talk + subluxation of lens + dissecting aortic aneurysm OSTEOGENESIS

IMPERFECTA Blue sclera + defective collagen synthesis + bone prone to fracture

Virus cause cancer because it has oncogenes

Virus cause cancer by alterations in Protein synthesis / alterations in protooncogene

Ionizing radiations cause injury free - radical formation

Conduction deafness defect of external or middle Ear + Weber lateralized to affected Ear +
negative Reine test

Sensorineural deafness defect of inner ear or processing centres /CN 8 +

Weber lateralized to normal ear + positive Reine test

Mixed deafness both combined + common in old age

Man is unable to hear in high frequency sounds Otosclerosis

Patient has cast applied now has Decreased muscle mass Disuse atrophy +
Decreased no of actin and myosin + Decreased work load

Micuturition controlled by Pons (stimulatory) + Midbrain (Inhibitory) + processing (cerebral

cortex)

Micuturition reflex sacral segments of spinal cord through pelvic splanchnic nerves S2_S4

Micuturition voluntarily controlled activating of pudendal nerve

Runner in marrrathon has excessive sweating Heat exhaustion due to

DEHYDRATION

If Runner in marrrathon has no sweating it can be heat stroke

Athletes at the end of marathon Increased glucagon and Decreased insulin

Athletes at rest more stroke volume and Bradycardia

Sitting to standing (by glutues maximus --inferior gluteal nerve) Decreased venous return +
increasead venous tone + increasead HR

Trendelenburg test if standing on right leg then it's right superior gluteal nerve (gluteus MEDIUS
)

Foot drop ( neck of fibula ) CPN (DORSIFLEXION + EVERSIONS IS MAIN ROLE )

Wrist drop radial nerve ( LOST SENSATIONS ON DORSUM OD HAND +

INABILITY TO OPEN HAND AFTER CLOSING )

Claw hand ulnar nerve (SUPPLIES MEDIAL 1 AND HALF FINGER and hypothenar Eminence )

Carpal tunnel Syndrome ( thenar atrophy ) median nerve (thenar Eminence + lateral 3 and half
fingers )

Upper limb clavicle (MIDDLE 2/3RD AND LATERAL THIRD )

Lower limb tibia ( AS ITS MOST SUPERFICIAL )

Overall clavicle most common injured

Strongest ligament ILIOFEMORAL LIGAMENT

HIP JOINT INFERIORLY OBTURATOR EXTERNUS

COMMON SITE OF FRACTURE OF RIB ANGLE OF RIB

FALSE RIBS 9th AND 10th

FLOATING RIBS 11th AND 12th

Vertebrae 33

Spinal nerves 31 pairs

Spinal cord is suspended in duramater by denticulate ligament

Pia matter continuewith sulci and fissures of brain

Cauda equina L1-L5 anteior + posterior spinal nerve roots

RETE EDGES VERRUCOUS CA

Dysplasia loss of polarity

Metaplasia change in one normal epithelium with another normal epithelium

Anteior to right kidney liver

Anteior to hilum of right kidney 2nd part of duodenum

Whenever there is Decreased po2 Hypoxic hypoxia .

Drug absorption depends on lipid solubility

Substances which can cross largely hydrophobic but solube in aqeous solution Highest Aqueous

diffusion digoxin ( it increases intracellular Ca ions )

cAMP TSH CGMP

ANP

Phospholipase G- protien coupled receptors IP3 and Increases Ca ions

Blood loss normocytic normochromic anemia

Blood loss and then GFR is Decreased due to Decreased atrial blood flow

Sertoli cells produce mullerian Inhibitory factor + cause of azoospermia

Leydig cells secrete testesterone (potent Protein synthesis )

Epidydmis Motility starts here

Shortest proerthrocytic phase P. Falciparum ( responsible for Cerebral malaria )

Longest proerthrocyic phase P. Malariae

Fever with chills prefer malaria always

CD15 and CD 30 cells Hodgkin lymphoma (nodular Sclerosis is most common + lymphocytic

predominant has better prognosis ) Young age + blast cells + immature lymphocytes ALL

Old age + mature lymphocytes CLL (Philadelphia Chromosome 9,22 )

EBV causes Burkett lymphoma c-Myc translocation 8,14 and oncogenesis by gene transcription
..!

Superficial Epigastric Artery femoral artery

Inferior Epigastric Artery external iliac artery

Structure passing above piriformis fossa superior gluteal artery

Gut loops in a child in X ray pleuro-peritoneal defect / incomplete pleuroperitoneal membrane

Tumor of head of pancreas compress CBD

Pain in calf relieved after walking popliy artery

Refered Pain of appendicitis umblicus

Referred Pain of diaphgram (primary Muscle of respiration ) neck and shoulder

Most medial structure in cubital fossa median nerve

Elipoloic appendages sigmoid colon

Abdominal angina superior messenteric artery (supplies till middle 3rd of transverse colon )

Suprarenal gland Greater splanchnic nerve

Filling and pain sensation in bladder sympathetic ( all others parasympathetic )

Right testicular vein IVC

Left testicular vein + left suprarenal vein left renal vein

Lumbar outflow is sympathetic ( during lumbar sympathetectomy L1 should be saved )

Pulsating abdominal mass L1-L3

Shoulder dislocation infeior axillary nerve + axillary vessels

Shoulder dislocation anterior (COMMONEST ) axilary nerve +Posterior Circumflex

artery pus in adductor canal compresses femoral vein

infectioous mononucleosis EBV (hetrop antibody Test / anti-sheep )

Alcoholic increasead AST /SGOT + On microscopy Mallory bodies > piecemeal necrosis ...!

Liver diasease ALT

Newborn having yellow diaper stained biliary atresia ( drooling of saliva ) Child having

more unconjugated Billirubin Gilbert ( liver can't process conjugation of Billirubin)

Child or adult having conjugated Billirubin

Dubin - Johnson Syndrome

After chemotherapy + stones in duct APOPTOSIS (activation of caspases )

Moderator band right Venticle

Pectinate muscle right atrium

LANDMARK DERMATOMES :

C2 posterior half of skull

C3-C5 phrenic nerve ( Main part by C4)

C6 thumbs

T4 Nipples

T7 xiphiod process

T8 IVC

T10 umbilicus

L1 Inguinal Ligament

L4 patella

T3-T4 lower airways

REFLEX :

Ankle reflex S1- S2 (main S1)

Knee jerk L2-L4 (L3)

Biceps reflex C5- C6 (C6)

Triceps reflex C6-C8

Cremasteric reflex L1-L2

Anal reflex S3-S4

COMMON STRUCTURES AT VERTEBRAL LEVELS :

Hyoid bone C3

Common carotid bifurcation C4

Trachea bifurcation T4-T5

Bronchial artery formation T5-T6

Xiphiod process T9

Abdominal aorta bifurcation L4

IVC L5-T8

Esophagus T10

Aortic hiatus T12

Progression to Symptomatic stage in HIV PCR

Follow up Cd4 count

Muscle arising from femur and stablizing Knee joint vastus lateralis Stablizing Patella vastus
medialis

Only DNA virus adenovirus

Thymic hypoplasia + absent germinal centres + all 3 infections bacterial , viral and fungal SCID (
cause is adenosine deaminase defficency )
Bruton A-gammaglobinema only igG defficency most common Chance of pyogenic (bacterial )
infection in this

Antibiodies produced by plasma cells

Type 1 collagen Fibrocartilage + bone + tendons + fascia

Type 2 elastic and Hyaline cartilage + viteous body

Type 3 blood vessels + uterus

Type 4 Basement membrane + lens

HLA B5 behcets diasease

Child died of anuerysm Kawasaki disease

PAN Hep B associated

Temporal Arteritis giant cells

Wegner granulomatois ANCa + glomerulonephritis + nasal pathology

Leprosy nasal bone deformation ( initially nasal scrapings are done ) Soldier returning from

hillly areas + cyanosis + vision disorder + chronic secondary polycythemia

Man at height felt dyspnea suddenly HAPE ( height associated Pulmonary edema )

Pregnancy phsyiological anemia due to dilution + Decreased TLC + increasead

RBC mass ( polycythemia ) + IDA is common + give Ca , Iron (800) and folate by vegetables (neural
tube defects ) + Premature rupture of memberanes causing chorioamnionitis by bacterial
vaginosis(IL-6 ) + dead fetus expulsion with vaginal discharge and abdominal pain ( toxoplasma
gondii )
Dysplasia HPV>IUCD

Metaplasia multiparity

Lung abscess + hospital acquired infection staph aureus

Jaw draining abscess Actinomyces israeili

Blood Hep C

Sexual contact Hep B

Pain in peptic ulcer + supra renal gland + peritoneal irritation (GIT till

dudenojejunal junction) greater splanchnic nerves From duodenum further

Lesser splanchnic nerves

Complication after lymphoma HIV

Complication after Sjogren syndrome lymphoma complication after CREST

pulmonary fibrosis

Raynaud's phenomenon cynosis if fingers in cold + associated with Scleroderma

Heat loss Depends upon Core body Temperature (if not present choose
Temperature of External environment )

Set point Increased than Hypothalamus shivering happens and sweating

Decreases (vice versa )

If a person is lying naked heat loss radiation and conduction

Marathon running and having excessive sweating Heat exhaustion > DEHYDRATION

If a person has no sweating and then collapsed heat stroke

Farmer In a sunny day collapsed Hyponatremia Due to excessive sweating

Dysnea on lying done retrosternal goiter

Alcohol detoxification Peroxisomes ( they have oxidases too )

Drugs detoxification SER

Superficial fascia loose areolar + adipose tissue

Above transverse Colon SMA ( abdominal angina + wet Gangrene )

From LATERAL transverse colon to rectum IMA

Arteries in rectum :

Superior rectal Artery branch of IMA

Middle rectal Artery ( stays in pelvis ) branch of internal iliac artery

Inferior rectal Artery branch of internal pudendal artery

Bicuspid aortic valve associated with coarctation of Aorta

Swelling Anterio to SCM compressing External jugular vein

Source of nitrogen in urea cycle aspartate and ammonia

Phenylketonuria Decreased conversion to tyrosine

In carcinoid Syndrome 5HIAA Raised (serotonin syndrome / starts from tryptophan)

Glans penis and corpora deep Inguinal lymph nodes ( if not present choose Superficial inguinal )

Heart works as a synctium gap junctions

SA node automacity + generates impulses at a faster rate + prominent pre- potentiall + slowest
potential + heart rate 40-72 + present at Crista terminalis
(upper part of sulcus terminalis )

Speed of conduction His-purkinje > Atria > Ventricles > AV nodes

( SLOWEST )

HEART RATE 40-60 CONDUCTION SYSTEM IN AV node

HEART RATE 15-40 CONDUCTION SYSTEM IN PURKINJE FIBERS (widest diameter that's why
fastest )

Epithelium of bladderr endoderm

Trigone mesoderm

Transitional epithelium of balldeer endoderm + mesoderm

Good pasture Syndrome hempotysis , hematuria and glomerulonephritis + liner deposits +

Type 2 hypersensitivity

Vitamin D resistant rickets Franconi Syndrome

Rickets (children) / osteomalacia (adults ) vitamin D defficency ( bowing of legs + frontal

bossing )

Incisive Foramen Nasopharyngeal nerve

Foramen Caecum nasal emissory veins

Foramen spinosum middle meningeal artery

Superior orbital fissure 3,4,6, opthalmic vein + V1

Foramen Rotundum maxillary nerve V2

Foramen Ovale Mandibular nerve V3

Foramen magnum spinal cord

Jugular Foramen 9, 10 and 11 nerves

Bare area of liver limited by Coronary ligament

Connects liver to anterior abdomial wall Falciform Ligament

Connects liver with first part of duodenum Hepatoduodenal Ligament ( is a portion of

lesser omentum contains PORTAL TRIAD ) Tail of pancreas lies in linorenal Ligament

Femoral artery pulsations mid-inguinal point

Radial artery pulsations between Brachioradialis and flexor carpi radilis Facial Artery
palpable at the anteroinferior angle of the masseter muscle against the bony surface of the
mandible

Axillary artery continuatin of subclavian atery

Axillary vein basilic vein + vena comitantes brachial veins ( parallel to brachial artery in arm )

Thoracic ducts drain at the union of left Subclavian and left internal jugular
BRACHIOCEPHALIC TRUNK

Source of emboli Femoral vein

Site of DVT popliteal vein

Most common cause immobilization

At standing minimum pressure superior sggital sinus

Superficial Epigastric Artery branch of femoral artery

Inferior Epigastric Artery branch of external iliac artery

Burns risk for DIC + Hyperkalemia > Hyponatremia + Decreased albumin causing edema +
contracture formation occurs

Worst prognostic for sepsis is DIC

Keloid occurs in black Africans

SEROSANGUINOUS FLUID FOREIGN BODY

LOCAL factor for delayed wound healing infection

SYSTEM factor for delayed wound healing anemia > malnutrition

Old age Decreased wound healing Hormonal and endocrinological changes Old man fell and

fractured his bone and delayed wound healing Decreased blood supply

Blood supply of head of femur childens (OBTURATOR artery ) + Adults

(Retinacular artery > Posterior Circumflex artery )

Fracture of femur in old age long term complication is avascular necrosis (watershed areas )

In old age high BP only 1 reading + sleep disturbance isolated Systolic HTN of old age ( due it
increased vascular Stiffness )

Newborn C- shaped Vertebral volume + circular abdominal cavity + liver has

5% of body weight ( largest organ ) + sample taken from DORSALIS pedis artery > posterior tibial
artery

Sample taken in shock Femoral artery

Sample taken for ABGs heparinized arterial sample

Edema + apathy + pigmentation kwashiorkor

Most common Secondary cause of HTN Renal artery stenosis ( atherosclerosis proximal to it )

ESRD increasead creatinine

Best measure of GFR inulin clearance

Estimation / clinical measurement creatinine clearance

Decision betwen dialysis and transplant creatinine clearance

Only intracranial branch of facial nerve nerve to stapedius

GVE smooth muscles and glands

SVA chorda tampani Anterio 2/3rd of tongue

Sympathetic Cholinergic only sweat glands

Neurotransmitter releasd at post-ganglionic endings acetylcholine

Submandibular + submental lymph nodes lower lip CA

Jugulo-digastric lymph nodes Palatine tonsils

Stratified cuboidal epithelium sweat glands

Vagina more elastic tissue

Cords of Brachial plexus :

Posterior cord radial + axillary nerve

Lateral cord musculocutaneous + median nerve

Medial cord ulnar + median nerve

Direct continuation supra-scapular nerve

Forceps delivery upper trunk of Brachial plexus

Shoulder delivery klumpke's paralysis

Erb's palsy a paralysis of the arm caused by injury to the upper group of the arm's main nerves,
specifically the severing of the upper trunk C5–C6 nerves.

Differentiating between meningitis :

1)Protien and glucose normal + increasead lymphocytes viral meningitis 2)Glucose Decreased

(>50)+ increasead lymphocytes + Proteins decreasead or maybe normal + clear /straw colored
TB meningitis
3)Glucose Decreased (>40)+ increasead Protein + increased Neutrophils

+Turbid CSF bacterial meningitis

Patent urachus urine comes out from umblicus

Patent Allantois urachul fistula

Patent vitelline duct fecal matter from umblicus

Clocal membrane caudly patent ectopic anal opening

Clocal membrane cranially patent extrophy bladder

Giant cell tumor (soap bubble appearance ) Epiphysis

Osteosarcoma (codman triangle sunburst appearance ) + osteochondroma (most common benign

) metaphysis

Ewing sarcoma (onion skin ) diaphysis

Osteoblastoma vertebrae

Osteioid osteoma cortex of long bones + has radiolucent osteiod core

D dimers sensitive for DVT

FDP specific for DVT

Acute endocarditis staph aureus

Sub-acute + dental proceduress strep viridians

Rheumatic heart disease pansystolic murmur (MS ) + given penicillin and gentamicin

Superior thryoid artery external carotid

Inferior thyroid thyrocervical trunk

Thick jelly mucoid sputum ( currant jelly sputum ) klebsiella

Thick jelly sputum after influenzae pneumonia staph aureus

Farmer lung diasease aspergillosis

Farmer feet cutaneous larva migrans

Histopalsmosis affects reticuloendothelial system

Blood - thymus barrer protects T- lymphocytes from autoimmune distruction

Pain unrelated to respiration myocarditis

Conduction system of heart sun-endocardium

Hyaline cartilage larynx + articular surfaces of Synovial joints

Elastic cartilage Ear pinna + nose

Antibiodies against presynaptic ca channels Lambert eaten Syndrome

Blue cell tumor in children + releasing catecholamines + gene Amplification

Neuroblastoma
Radiation induced Brain malignancy meningioma

Overall radiation induced CA leukemia

Absent seizures Ethusuxamide

Generalized tonic clonic valproi acid

Liver Decompensation oxazepam > lorazepam can be used Shortest acting

midazolam

Steroid given for maturation of fetal lungs betamethasone

Hyaline disease / disase of Prematurity Decreased type 2 pneumocytes ( Decreased

surfactant -- Decreased surface tension -- increasead tendency of lung to collapse )

Lung compliance provided by surfactant

First cry necessary for Pulmonary function

Commonest Congenital anomaly VSD

Common Cyanotic anomaly TOF

Common Cyanotic Anomaly at birth TGA

Congenital anomaly in Prematurity + mother living on hilly areas PDA

After 24 hours physiologial jaundice

Before 24 hours pathologial jaundice

Erethoblastos fetalis if mother is positive then chill there is no need to worry

BUT if mother is negative and father is homozygous positive then ALL CHILDREN WILL BE
POSITIVE
AUTOSOMAL DOMINANT 50% CHILDREN AFFECTED + ONLY ONE PARENT IS
AFFECTED + CO-DOMINANCE PATTERN OF INHERITABILITY + HETROZYGOUS
CAN CAUSE DIASEASE

Examples are retinoblastoma + HNPCC

X- linked recessive Duchene muscular dystrophy ( absent dystrophin gene + Positive Gower sign
) + familiar occurrence

Sickle cell anemia Hemolytic crisis

knee and hip flexor SARTORIUS

Knee flexor and hip extensor HAMSTRING MUSCLES ( major is semitendinosus

+ others are biceps femeoris and semimembranous )

Knee extensor and hip flexors QUADRICEPS MUSCLES (rectus femoris + vastus medialis + vastus
lateralis + vastus intermedius )

Athletes (tennis players ) having severe pain + echymosis / Swelling over ankle
PLANTARIS TENDON RUPTURE + PLANTARIS MUSCLE INVOLVEMENT

Lower limb sensation fasciculus gracilus

Upper limb sensation fasciculus cuneatus

Anterior cruciate ligament prevents backward dislocation of femur

Posterior cruciate ligament prevents forward dislocation of femur

Popliteus unlocking of knee + has intra-articular tendon

○Intragluteal injection nerve damage Superior gluteal nerve

CALCANEUM largest tarsal bone + most commonly fractured bone of foot + makes lateral
longitudinal arch

CALCANEONAVECULAR LIGAMENT provides support to MEDIAL

LONGITUDINAL ARCH (pillar is Talus bone Which has no muscle attachment) +
FLATFOOT (if damaged)

Largest sesamoid bone PATELLA

Ideal site of venous grafting saphenous vein Microbiology :

Torrential diarrhea and donut shaped crystals cryptosporidiosis

○Motile Pear shaped organism + green discharge trichomonas

○Motile Pear shaped organism + greyish discharge Giardiasis

○Death due to lethal diarhhea Vibrio cholera

Death due to food poisoning clostridium botulinum

○Dry heat oxidation

Moist heat coagulation

○Decreased vision + nodules under skin + lives near river oncochera

○Decreased vision + worms in eye + conjunctivitis Loa Loa

○Plague caused by yersinia pestis

Playgue transmitted by Rodent Flea

○Coagulase +ve Staph aureus Catalse +ve

streph epidermis

Alpha toxins + phospholipase C. Perfringes

Fruity smell pseudomonas

○Macrocytic anemia Diphylobatrum lathum (fish tapeworm )

90% of antrax infection leads to skin lesions

○NASOPHARYNGEAL SINUSITIS + greyish exudative membrane + enlarged lymph nodes
Corynebacterium

Pneumonia in HIV Strep pneumoniae

○Live vaccine MMR

○Toxoid vaccine diphteria + Tetanus clear

cytoplasm and HALO around it

CYPTOCOCUUS NEOFORMANS

○common cause of PID Chlamydia

○PID in case of IUCD Actinomyces

○Tubo-ovarian abscess Gonococcus

○multiple draining abscess + yellow sulphate granules Actinomycosis Israeli

○ pregnant female + foul smelling discharge + dead fetus delivery premature Treponema
pallidum

In OT frequency hand washing ( by chlorhexidine and alcohol )

Floor 1 % hypochromic

Instruments 2% gluteraldhyde

In influenzae vaccine is 60% preventive so choose it for primary prevention

Primary prevention before a disase ( vaccination or any other prevention ) Secondary

prevention after a disease vaccination

Specific protection against a specified diasease ( giving vit D to childens or giving folate to

mothers ) Cardiology :
Irregular R-R interval + irregularly irregular pulse atrial fibrillation

Saw tooth waves atrial flutter

Difference in BP in both arms + notching if ribs coarctation of Aorta ( postductal)

Wise pulse pressure difference + increasead EDV + Diastolic murmur Aortic Regurgitation

During extra systole Decreased pulse pressure due to Decreased stroke volume

After extra systole Increased pulse pressure due to increased contractility

Mobitz type 2 atrial rate greater than ventricular rate

Determinant of Preload EDV

Determinant of afteeload MAP

Determinant of TPR Diastolic BP

Atherosclerosis (fatty streak first prominent sign ) Diastolic HTN

First heart sound isovolumetric contraction ( closure of mitral and tricuspid valve ) + felt at
mitral area

Second heart rate isovolumetric relaxation ( closure of aortic and Pulmonary valve ) + felt at
left upper sternal border

Third heart sound rapid ventricular filling + best at apex + normal in childens, pregnancy and
athletes

Fourth heart sound Non- compliant left Venticle + best at apex + due to increasead atrial
pressure

Highest oxygen consumption isovolumetric contraction

Tall QRS complex LVH

A-wave of JVP coincides with PR interval +

absent in A.fibrillation
Anterior interventricular groove great cardiac vein + anterior interventricular artery ( LAD )

Posterior interventricular groove middle cardiac vein + posterior inventricular artery ( RCA)

RV most anterior part + Commonly Injured in trauma

Left atrium dilation compresses esophagu + RLN ( ortner syndrome)

Anterior border of heart right Ventricle

Diaphragmatic border left ventricle

Right border of heart right atrium

Right border on x ray Right atrium + SVC

Stab Injury at 5th-6th ICS Right atrium

Pericardium supplied mainly by pericardiophrenic arteries + phrenic nerve

Epicardium supplied by Coronary arteries

Apex LAD ( Anterior interventricular artery )

RBB LCA

inferior wall Mi RCA(RMA)

Anerior wall Mi LAD

Lateral wall MI LCX ( left atrium + left ventricle )

Right and left ventricles Posterior Descending artery SA node

RCA mainly

NEUROLOGY :
Covering of Peripheral Nerve :
Endoneurium --- individual nerve fiber perineurium ----
bundle of nerve fibers Epineurium --- entire Nerve
Nodes Ranvier contains Na+ channels

○marker of astrocytes GFAP

○Neural tube defects AFP raised + increase Acetylcholinesterases

(confirmatory )

○Arachnoid matter avascular space

○ Blood supply of scalp External carotid artery ( three branches Superficial temporal + Posterior
auricular + occipital )
---> blood supply is in dense connective tissue layer > loose alerolar layer

Loss of light relfex but intact accommodation reflex PRETECTAL NUCLEUS

(MIDBRAIN AT THE LEVEL OF SUPERIOR COLLICULUS )

○Loss of Accomodation reflex cerebral cortex

○Loss of Accomodation + 3rd CN involvment Midbrain ( due to edinger westphal nucleus )

○corneal reflex lost Pons

○Right side weakness + double vision on seeing left MIDBRAIN (involved in movement of eyes
+ auditory and visual processing )

Lower face weakness ( face deviation)+ contralateral spastic hemiplegia of both upper and lower

limb INTERNAL CAPSULE ( opposite side )

○Inhibition of feeding LATERAL HYPOTHALAMUS

○Inhibition of satiety centre VENTROMEDIAL HYPOTHALAMUS

○Sexual centre NUCLEUS ACUMBENS

○cooling + parasympathetic effect ANTERIOR HYPOTHALAMUS

○Heating + sympathetic effect POSTERIOR

HYPOTHALAMUS

○OVERALL TEMPERATURE CONTROL ANTERIOR HYPOTHALAMUS

○Astereognosis is inability to recognize objects while eyes closed associated with lesions of the
:
PARIETAL LOBE
DORSAL COLUMN
POSTERIOR CENTRAL GYRUS
PARIETO- TEMPORO-OCCIPITAL lobe (posterior association areas) of either the right or left
hemisphere of the cerebral cortex

○FOLIA CEREBELLUM FOLDS

○HYPERACUSIS Geniculate ganglion ( medial wall of middle Ear ) ○Brocoa aphasia

motor aphasia + Non-fluent + area 44 and 45 + inferior frontal gyrus

○Wernicke aphasia sensory aphasia + fluent + area 22+ superior temporal gyrus

○Global aphasia both Wernicke and brocoa aphasia + arcuate fasciculus ○Anomic aphasia
mild fluent aphasia + failure of word retrieveal + angular gyrus
○
lesion in DCML SENSORYY ATAXIA + ASTEROGNOSIA

Reduced motivation and depression FRONTAL LOBE

RESTING TREMORS SUBSTANTIA NIGRA

○INTENTIONAL TREMORS CEREBELLUM

○papez circuit in limbic system connects Fornix + Mammillary body +

Thalamus + Cingulate gyrus

Fastest fibers A alpha

Fast pain fibers A delta Slow pain

fibers C fibers preganglionic fibers

beta fibers postganglionic fibers C

fibers

○Type A pressure

Type B .Hypoxia

Type c .Anesthesia

Itching Slow C fibers

○Thrist zone area postrema and nucleus tractus solitarius

○ tractus solitarius 2nd order neurons and carry taste sensations

○Sleep centre preoptic nucleus

○Circadian rythum suprachiasmatic nucleus

○Chorea (jerky+ quick movements ) caudate nucleus (basal ganglia)

○Athetosis ( slow + writhing to) Globus pallidus or putamen ( basal ganglia)

○
○hemi-ballismus Sub-thalamic nuleus lesion

○fusiform gyrus (TEMPORAL LOBE ) FACIAL RECOGNITION (unable to recognize face called
propognosia )

cingulate gyrus (LIMBIC SYSTEM) EMOTIONS

○Hippocampus short term memory + recollection in long term memory ( long term memory
formed by new Protein synthesis )

○large receptive field PAIN and TEMPRATURE

○structure close to crus cerebri substantia nigra

○medial leminiscus formed by decussation of INTERNAL ARCUATE FIBERS

○In UMN lesion fibers decussate at the level of PYRAMID

○cerebellum connected to Midbrain by superior cerebellar peduncle

Sub-dural hematoma emissary veins (superior cerebral veins ) + common in

Alcoholics and shaken babies + crescent shaped

○ Epidural hemorghage middle meningela artey ( branch of maxillary artery ) +

LUCID INTERVAL (unconsciousness ) + bioconvex shaped

○Subarachnoid hemorrhage rupture of saccular aneurysm + worst headache of life + increase

risk for hydrocephalus

○spinal nerves mixed nerves ( both sensory and motor fibers ) + formed in intravertebral
Foramina + exit intervetebral Foramina

○ spinal ganglia has pseudounipolar neurons

○Dysphagia + Dysarthria + analgesia thermoanesthesia + ipsilateral hornor

Syndrome lesion of PICA

○
○Anterior spinothalamic tracts pressure and crude touch

○lateral spinothalamic tract pain and Temperature

○Dorsal column fine touch + pressure + vibrations + proprioception

○abundant at fingerpads Meissner corpuscles for ( LIGHT TOUCH )

○Paccinian corpuscle vibrations and pressure

rapidly adapting Pacinian > meissner

○Ruffini nerve endings sustained pressure ( SLOW ADAPTATION ) ○meckle nerve endings
position + deep touch + secrete serotonin

○fine movements of hand controlled by CEREBELLUM through Corticospinal tracts

○centre for direct autonomic reflexes Hypothalamus ( only OLFACTION does not relay here )

○ autoregulation of cerebral perfusion primarily by PCO2

MCA (upper limbs + aphsia ) INSULA AND OPERCULA

○ACA ( lower limbs + aphasia )

○TABES DORSALIS ATONIC BLADDER

○AICA (face +taste + salivation + lacrimation) branch of basilar artery

○PICA (hoarseness + gag reflex + dysphagia) vertebral artery

○1)proximal muscle flexion rubrospinal tracts

2)Proximal muscle extension vestibulospinal tracts

COMMUNITY MEDICINE :

T-test Done to compare 2 categories

ANOVA Done to compare 3 categories

○
Chi -square done to see if distribution of categorical variables differ from one another +
distribution of frequencies + includes 2*2. Tables

Specific excludes true negatives after positive screening

Sensitive includes all positives

Positive predictive value includes true positive after a positive screening test

negative predictive value includes persons who had negative screening test and are truly
negatives

Pie chart different percentages given ( famous example of CPSP that 20% postmenoupausal
females need HRT, 40% don't need HRT and 40% are absolutely normal )

Regression analysis estimating relationship of dependent variable with independent variable

[Famous example of CPSP student seeing changes in temperature changes in patients during
surgery over a specific time ]

Data are individual pieces of factual information recorded and used for the purpose of
analysis. It is the raw information from which statistics are created.

CASE CONTROL :

Effect to cause
E.g ==> Two groups having lung cancer
Then relating the lung cancer to its cause of risk factor such as smokers and non smokers
(retrospective study) ..!

CO-HORT STUDY :
cause to effect E.g ==>
two groups :
1---> CHD and associated risk factor
2---> CHD and no risk factor
E.g==> association of smoking with lung cancer

Randomized control trial random choosing of groups of individuals of a specific disease

Eg a Dr operated 20 patients surgically and choose 10 patients among them and seeing it's result
after 6 months this is an example of randomized control trial

Single blind Only Dr knows about the efficacy of drug

Double blind Both doctorr and Patient don't know about the efficacy of drug

Mean adding all no.s and dividing it by no of variables

Mode most repeated no in a calculation

Median making two halves and choosing the middle one

Standard deviation Mean and it's standing error on both sides of normal distribution curve

Incidence Newly diagnosed cases

Prevalence overall total cases

Some high yields *

Cloacal membrane cranially ectopic anal opening caudally

exostrophy of bladdey

Soyabeans unsaturated fatty acids Vegetable oil

saturated fatty acid

Structure damaged during delivery + major support of Pelvic viscera Levator

Ani (made by pubocoxygeous > puborectalis )

Cutting in mediolateral episiotomy bulbospongiosus

Main support of uterus transverse cervical ligament / cardinal ligament

Vitamin k after antiobiotics

Vitamin A increasead (hepatomegaly ) Decreased ( scally dermatitis + juandice )

Vitamin A DEFFICENT NIGHT BLINDNESS (SYMPTOM ) AND CONJUNCTIVAL

XEROSIS (SIGN )

VITAMIN E antioxidant + defficency causes muscular

dystrophy > Hemolytic anemia Glutathione strongest

antioxidant

Neutrophils related to bar body + oxidative burst related to antimicrobicidal

Killing + free radicals formation

Bar body 1 is normal in females + related to Turner syndome

Regarding Hb ===>

Hb formation starts in ---> pronormoblast / proerythroblast

Hb starts appearing at ----> intermediate normoblast stage

Hb maximum rate of synthesis --> intermediate and late normoblast

RBC nuclei disappears in ---> late normoblast (orthochromatic erthyroblast )

Hb becomes max in concentration ---> reticulocytes > late normoblast

Important for Edema

Causes of Edema and examples :

Increased hydrostatic pressure heart failure

Increased capillary permeability toxins + infections

Increased interstitial fluid colloid osmotic pressure lymphatic blockage

Decreased plasma proteins / Decreased plasma colloid osmotic pressure

Nephrotic syndrome + liver failure + protein malnutrition

Cause of Generalized Edema decreased albumin

Cause of edema In Ascites portal hypertension

Factor preventing edema arteriolar constriction

Burns Decreased albumin > increasead vascular permeability

Lymphatic flow Decreased in hemorrhage

In Diabetes common non-infectious Gangrene is DRY GANGRENE

But whenever it states diabetic Limb or Diabetic foot it's
WET GANGRENE

Lab findings in hematology :

1)aPTT raised only -- hemophilia
2)aPTT and BT raised -- vWBD
3)apTT and PT raised -- vit deficiency or liver disease (if doesn't improved by giving vit k)
4) if all 3 raised --- Think for DIC )