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MCI propose Indian Medical Graduate exam from 2013

Written By Dr Medicos on Wednesday, 10 August 2011 | 15:43

15:43 | 21 comments


Written By Dr Medicos on Monday, 8 August 2011 | 23:44

The most trusted textbook in medicine — featuring the acclaimed Harrison’s DVD — updated with 57 additional chapters and exclusive video and tutorials Extensively revised and expanded by the world’s leading physicians, Harrison’s Principles of Internal Medicine, 18e continues to set the standard as the pinnacle of current medical knowledge and practice, offering the definitive review of disease mechanisms and management. CURRENT
All chapters have been completely up

Harrison's Principles of Internal Medicine: Volumes 1 and 2, 18th Edition
23:44 | 14 comments

Biochemistry Mnemonics

Essential Amino Acids
Phe, Val, Thr, Trp, Ile, Met, His, Arg, Leu, Lys

Urea Cycle
Ordinarily, Careless Crappers, Are Also Frivolous About Urination.
Ornithine, Carbamoyl, Citrulline, Arginosuccinate, Aspartate, Fumarate, Arginine, Urea.

Cell division
Prophase, metaphase, anaphase, telophase.
"People Meet And Talk."

In the PhastedState
Phosphorylate Phosphorylation cascade active when blood glucose low.
DNA expression into mature mRNA
Exons expressed, Introns in the trash.
Pyrimidines are CUT from purines.
Pyrimidines are Cytosine, Uracil, Thiamine and are one ring structures.
Purines are double ring structures.

Porphyrias: acute intermittent porphyria symptoms 5 P's:
Pain in abdomen
Psychologial abnormalities
Pink urine
Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)

BUN:creatinine elevation: causes ABCD:
Azotremia (pre-renal)
Bleeding (GI)
Catabolic status
Diet (high protein parenteral nutrition)

G6PD: oxidant drugs inducing hemolytic anemia AAA: Antibiotic (eg: sufamethoxazole)
Antimalarial (eg: primaquine)
Antipyretics (eg: acetanilid, but not aspirin or acetaminophen)

Vitamin B3 (niacin, nicotinic acid) deficiency: pellagra
The 3 D's of pellagra: Dermatitis Diarrhea Dementia
· Note vitamin B3 is the 3 D's.

Tangier's disease: hallmark
"Tangierene tonsils":
Hallmark is large orange tonsils.
· Important clinical note: there is no increased risk of atherosclerosis, just like eating tangerenes.

Na+/K+ pump: movement of ions and quantity
K+ and in each consist of 2 characters, so so 2 K+ are pumped in. Na+ and out each consist of 3 characters, so 3 Na+ are pumped out

Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect
Anderson's=Branching enzyme.
Cori's=Debranching enzyme.
· Otherwise, can't really distinguish clinically.

Nitric oxide: amino acid precursor
When the dentist works on your teeth, you say, "AAArg! (Arginine)" before he administers Nitric Oxide (NO) to take the pain away.
· Other players necessary for NO synthesis: NO synthase, Ca++, NADPH.

Pompe's disease: type "Police = Po + lys":
Pompe's disease is a lysosomal storage disease (alpha 1,4 glucosidase).

Metabolic acidosis (normal anion-gap): causes
· With hyperkalemia: RAISE K+:
RTA type 4
Aldosterone or mineralocorticord deficiency
Iatrogenic: NH4Cl, HCl
"Stenosis": obstructive uropathy
Early uremia
· With hypokalemia: ReDUCE K+:
Renal TA type 1 and 2
Urine diversion into gut
Carbonate anhydrase inhibitor

Galactosaemia: enzyme deficiency
GALIPUT: Galactose 1 Phosphate Uridyl Transferase.
· There is an assay called the Galiput test for this.

Citric acid cycle compounds
"Our City Is Kept Safe And Sound From Malice":
Oxaloacetate Citrate Isocitrate alpha-Ketoglutarate Succinyl-CoA Succinate Fumarate Malate

Folate deficiency: causes A FOLIC DROP:
Folic acid antagonists
Oral contraceptives
Low dietary intake
Infection with Giardia
Celiac sprue
Relative folate deficiency

Mitochondrial DNA (mt DNA) properties
"mt DNA".
mt stands for: Maternal Transfer Mutates Tremendously (high mutation rate)

Vitamins: which are fat soluble
"The FAT cat is in the ADEK (attic)":
Fat soluble vitamins are A,D,E,K.

Enzyme kinetics: competitive vs. non-competitive inhibition
With Kompetitive inhibition: Km increases; no change in Vmax. With Non-kompetitive inhibition: No change in Km; Vmax decreases.

Glycogen storage: names of types I through VI
"Viagra Pills Cause A Major Hardon":
Von Gierke's

Sickle cell disease pathophysiology
SICKle cell disease is due to a Substitution of the SICKsth amino acid of the B chain.

Glucagon function
"Mr. Gluca has Gone to the cAMP to bring out some Glucose":
· Glucagon elevates glucose by cAMP mechanism.

Van den Bergh reaction (Jaundice test)
"Indirect reacting bilirubin = Unconjugated bilirubin":
Both start with vowels, so they go together:
Indirect & Unconjugated.

Hemoglobin binding curve: causes of shift to right
"CADET, face right!":
2,3-DPG (aka 2,3 BPG)

G proteins for respective receptors
"QISS & QIQ" (Kiss and Kick):
· G-proteins and their respective receptors (alphabetical order):
Q: alpha 1 I: alpha 2 S: beta 1 S: beta 2 &
Q: M1 I: M2 Q: M3

Adrenaline mechanism
"ABC of Adrenaline":
Adrenaline--> activates
Beta receptors--> increases
Cyclic AMP

Citric acid cycle compounds
"Can I Keep Selling Sex For Money, Officer?":
Citrate Isocitrate alpha Ketogluterate Succinyl CoA Succinate Fumerate Malate Oxaloacetate

Carbon monoxide: electron transport chain target
"CO blocks CO":
Carbon monoxide (CO) blocks Cytochrome Oxidase (CO)

Metabolism sites
"Use both arms to HUG":
Heme synthesis Urea cycle Gluconeogenesis · These reactions occur in both cytoplasm and mitochondria.

Na/K pump: concentrations of Na vs. K on inside/outside of cell, pump action, number of molecules moved
HIKIN': There is a HIgh K concentration INside the cell. From this can deduce that the Na/K pump pumps K into cell and Na out of cell. Alternatively: When I was learning this pump (circa 1992), a band that was "in" was Kris Kross, and a band that was "out" was "Sha Na Na Na": So pump moves K K (2 K) in and Na Na Na (3 Na) out. · Sadly, as infectious as their debut album was, Kris Kross can really no longer be classed as "in".

DNA bond strength (nucleotides)
"Crazy Glue":
Strongest bonds are between Cytosine and Guanine, strong like Crazy Glue (3 H-bonds), whereas the A=T only have 2 H-bonds. · This is relevant to DNA replication, as the weaker A=T will be the site where RNA primer makes the initial break.

Dicarboxylic acids (alpha, omega) C2 through C10: common names
"Oh My, Such Good Apple Pie, Sweet As Sugar!":
Oxalic Malonic Succinic Glutaric Adipic Pimelic Suberic Azelaic Sebacic

Infantile Beriberi symptoms
Restlessness Sleeplessness Breathlessness Soundlessness (aphonia) Eatlessness (anorexia) Great heartedness (dilated heart)
· Alternatively: Get 5 of 'em with BERI: Breathless/ Big hearted, Eatless, Restless, Insomnia.

AcetylCoA and acetacetylCoA: amino acids forming them
"A Lighter Lease" (A LyTr LeIs):
A=AcetylCoA or Acetoacetyl CoA

Fasting state: branched-chain amino acids used by skeletal muscles
"Muscles LIVe fast":

Glycolysis steps
"Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies":
2-Phosphoglycerate (to)
Phosphoenolpyruvate [PEP] Pyruvate · 'Did', 'By' and 'Pies' tell you the first part of those three: di-, bi-, and py-.
· 'PrEPare' tells location of PEP in the process.

Fabry's disease
Foam cells found in glomeruli and tubules/ Febrile episodes
Alpha galactosidase A deficiency/ Angiokeratomas
Burning pain in extremities/ BUN increased in serum/ Boys
Renal failure
YX genotype (male, X linked recessive)

B vitamin names
"The Rhythm Nearly Proved Contagious":
· In increasing order: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pyridoxine (B6) Cobalamin (B12)

Electron transport chain: Rotenone's site of action
Rotenone is a site specific inhibitor of complex one.

Citric acid cycle compounds
"Oh! Can I Keep Some Succinate For Myself?":
Oxaloacetate Citrate Isocitrate Ketoglutarate Succinyl coA Succinate Fumarate Malate

Citric acid cycle compounds
"Oh Citric Acid Is Of (course) A SiLly STupid Funny Molecule":
Oxaloacetate Citrate Aconitate Isocitrate Oxalosuccinate Alpha-ketoglutarate SuccinyL-CoA SuccinaTe Fumarate Malate
· SilLy and sTupid used to differentiate succinyL and succinaTe

Type 1 glycogen storage disease
Type 1 = one (Von), ie Von Giereke's disease

Essential amino acids
PVT. TIM HALL: Phe Val Thr Trp Ile Met His Arg Leu Lys
· Pvt. is short for Private in the military.
· Arg and His are considered semiessential.
· Alternatively: "MATT VIL PHLy".

Citric acid cycle compounds
"Can I Ask Sharon Stone For My Orgasm?":
Citrate Isocitrate Alpha-Ketoglutarate Succinyl CoA Succinate Fumerate Maleate Oxaloacetate

Golgi complex: functions
"Golgi Distributes A SPAM":
Distributes proteins and lipids from ER
Add mannose onto specific lysosome proteins
Sulfation of sugars and slected tyrosine
Proteoglycan assembly
Add O-oligosugars to serine and threnonine
Modify N-ologosugars on asparagine

Pyruvate: products of complete oxidation
"4 Naked Fun 3 Coeds + 1 Guy":
· Complete oxidation of pyruvate yields:

Catabolism steps of branched chain amino acids
"Truck hit the Ox to Death":
Oxidative decarboxylation

Niacin deficiency: signs and symptoms
The famous 4 D's:
Diarrhoea Dermatitis Dementia Death (if untreated)

Creatine phosphate: amino acid precursors
"Nice GAMs!": Glycine Arginine Methionine
· Gam is slang for a person's leg, especiallay an attractive female's leg: "Nice gams = nice legs!"
· Creatine phosphate is a muscle energy store, and spontaneously converts to creatinine which is excreted in the urine in direct proportion to muscle mass: clinically useful, such as in MS Dx.

Enzymes: classification
"Over The HILL":
· Enzymes get reaction over the hill.

Insulin: function
INsulIN stimulates 2 things to go IN 2 cells: Potassium and Glucose.

Collagen concisely covered
C-terminal propeptide (procollagen)/ Covalent Cross links/ C vitamin/ Connective tissue/ Cartilage/ Chondroblasts/ Copper Cofactor (Covalent Cross linking)
Outside the cell is where collagen normally functions/ Osteoblasts/ Osteogenesis imperfecta
Lysyl hydroxylase/ Lysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last biosynthesis step)
Long triple helical fibers/ Ligaments
Alpha chains/ Attached by H bonds form triple helix/ Ascorbate for hydroxylation of lysyl and prolyl residues of pro-Alpha chains (postranslational modification)
Gly in every third position/ Glycosylation of hydroxyl group of hydroxylysine with Glucose and Galactose; GOlgi allows procollagen to GO outside of cell
Extracellular matrix/ Eye (cornea, sclera)/ Ehlers-Danlos Syndrome
N-terminal propeptide (procollagen)/ Nonhelical terminal extensions
· Note: Procollagen LEAVEs the cell to be cLEAVEd by procollagen peptidases

Essential amino acids
"PVT. TIM HALL always argues, never tires":
Phe Val Thr Trp Ile Met His Arg Lue Lys
· Always argues: the A is for Arg, not Asp.
· 'Never tires': T is not Tyr, but is both Thr and Trp.

Hypervitaminosis A: signs and symptoms
"Increased Vitamin A makes you HARD":
Headache/ Hepatomegaly
Anorexia/ Alopecia
Really painful bones
Dry skin/ Drowsiness

Heme synthesis: amino acid precursors to basic unit of porphyrins, heme (pyrrole ring)
"Dracula wants to Suck a Co-ed's blood [think heme] with his Glystening teeth!":
Succinyl CoA and Glycine are precursor amino acids to pyrrole rings, which is the basic unit of porphyrins and heme.

Enzymes: competitive inhibitors
"Competition is hard because we have to travel more kilometers (Km) with the same velocity":
With competitive inhibitors, velocity remains same but Km increases

Phosphorylation cascade: action during low glucose
"In the Phasted State, Phosphorylate":
The phosphorylation cascade becomes active when blood glucose is low.

Sickle cell anemia: mutation
"HbS isn't Very Good":
At Sixth position of HB beta chain, Valine is present instead of Glutamic acid.

tRNA: molecular shape
Fortunately, tRNA (Transfer RNA) is shaped like a capital T.
· See diagram.

Malate-aspartate shuttle
"MAD commute":
Malate in. Alpha-ketoglutarate and D (Aspartate) out.

Vitamins: which are fat soluble
KADE: Vitamin K Vitamin A Vitamin D Vitamin E

Phenylketonuria: which enzyme is deficient
PHenylketonuria is caused by a deficiency of: Phenylalanine Hydroxylase

In the Phasted State Phosphorylate
Phosphorylation cascade active when blood glucose low.

Exons expressed, Introns in the trash--DNA expression into mature mRNA

Pyrimidines are CUT from purines.
Pyrimidines are Cytosine, Uracil, Thiamine and are one ring structures.
Purines are double ring structures.

Amino Acids:The ten essential amino acids:
"These Ten Valuable Amino Acids Have Long Preserved Life In
(Threonine, Tryptophan, Valine, Arginine, Histidine, Lysine,
Phenylalanine, Leucine, Isoleucine, Methionine)

INsulin gets sugar INto cells- (Excess sugar is removed via urine.The Romans noticed bees attracted to the urine of diabetics and coined the term "diabetes" to describe the overflow of sugar.)

GOAT FLAP- Eight hormones: Growth hormone, Oxytocin, Adenocorticotropin, Thyroid stimulating hormone, Follicle stimulating hormone, Leutinizing hormone (interstitial cell stimulating hormone in males), Anti-diruetic(Vasopressin), and Prolactin
(shhhh.... also Melatonin!)
15:17 | 20 comments

Medicine Mnemonics

Systemic features of Marfan syndrome:
Mitral prolapse
Aortic dissection
Regurgitant aortic valve
Fingers long (arachnodactyly)
Arm span>height
Nasal voice (high arched palate)
Sternal excavation

· Multiple Endocrine Neoplasia: Each of the MENs is a disease of three or two letters plus a feature.
MEN I is a disease of 3 P's (pituitary, parathyroid, and pancreas) plus adrenal cortex
MEN II is a disease of 2 C's(carcinoma of thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIB(aka MEN III)

· Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate

· Acute pneumonia caused by Miscellaneous microbes--Mononuclear infiltrate

· The five W's--post-operative fever
Wind--pneumonia, atelectasis
Wound--wound infections
Water--urinary tract infection
Walking--walking can help reduce deep vein thromboses and pulmonary embolus
Wonderdrugs--especially anesthesia

· Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER
C--cardiac disease
R--rest (bed-bound)
E--estrogen, pregnancy, post-partum
P--past hx
R--road trip


· HYPERSENSITIVITY REACTIONS: "Anna Cycled Immediately Downhill--Gell & Goombs" or "ACID."
Type I Anaphylaxis
Type II Cytotoxic-mediated
Type III Immune-complex
Type IV Delayed hypersensitivity

· WBC Count: "Never Let Mom Eat Beans" and "60, 30, 6, 3, 1"
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1:

Abdominal swelling causes 5 F's:
Fat Feces Fluid Flatus Fetus Full-sized tumors

Patient examination organization SOAP:
Subjective: what the patient says.
Objective: what the examiner observes.
Assessment: what the examiner thinks is going on.
Plan: what they intend to do about it.

Vomiting: non-GIT differential ABCDEFGHI:
Acute renal failure Brain [increased ICP] Cardiac [inferior MI] DKA Ears [labyrinthitis] Foreign substances [Tylenol, theo, etc.] Glaucoma Hyperemesis gravidarum Infection [pyelonephritis, meningitis]

History: quick EMS medical history checklist SAMPLE:
Signs/ Symptoms Allergies Medications Pertinent history Last oral intake Events preceding this incident

Medical history: disease checklist MJ THREADS:
Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic fever/ Rheumatoid arthritis Epilepsy Asthma Diabetes Strokes

Heart valve auscultation sites "All Patients Take Meds":
· Reading from top left:
· See diagram.
· Alternatively: All Prostitutes Take Money.
· Alternatively: APe To Man.

Short statue causes RETARD HEIGHT:
Rickets Endocrine (cretinism, hypopituitarism, Cushing's) Turner syndrome Achondroplasia Respiratory (suppurative lung disease) Down syndrome Hereditary Environmental (postirradiation, postinfectious) IUGR GI (malabsorption) Heart (congenital heart disease) Tilted backbone (scoliosis)

Ascultation: crackles (rales )"PEBbles":
Pneumonia Edema of lung Bronchitis

Family history (FH)
Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart disease Alcoholism Stroke Mental health disorders (depression, etc.)

Blood clotting factors
"Foolish People Try Climbing Long Slopes After Christmas Some People Have Fallen"
Factor I = Fibrinogen
Factor II = Prothrombin
Factor III = Tissue factor
Factor IV = Calcium
Factor V = Labile factor
Factor VI - Does not exist as it was named initially but later on discovered not to play a part in blood coagulation.
Factor VII = Stable factor
Factor VIII = Antihemophilic factor A
Factor IX = Antihemophilic factor B or Christmas factor (named after the first patient in whom the factor deficiency was documented)
Factor X = Stuart Prower factor
Factor XI = Antihemophilic factor C
Factor XII = Hageman factor Factor
XIII = Fibrin stabilising factor

Branham sign: definition
BRAnham sign:
BRAdycardia after compression or excision of a large AV fistula.

Glasgow coma scale: components and numbers
· Scale types is 3 V's: Visual response Verbal response Vibratory (motor) response
· Scale scores are 4,5,6:
Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawl)

Meckel’s diverticulum- rule of 2’s
2 inches long,
2 feet from the ileocecal valve,
2% of the population
commonlly presents in the first 2 years of life
may contain 2 types of epithelial tissue

Pheochromocytoma-rule of 10s:
10% malignant
10% Bilateral
10% extraadrenal
10% calcified
10% children
10% familial
* discussed 10 times more often than actually seen

"BROKen aphasia" (Broca’s aphasia-broken speech)
"Wordys aphasia" (Wernicke’s aphasia- wordy, but making no sense)

GET SMASH'D--Causes of Acute pancreatitis
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics)

(Multiple endocrine neoplasia) Each of the MENs is a
disease of three or two letters plus a feature.
"MEN I" is a disease of the 3 Ps (pituitary, parathyroid and pancreas)
plus adrenal cortex.
"MEN II " is a disease of the two Cs (carcinoma of the thyroid and
catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or
mucocutaneous neuromas for MEN IIb (aka MEN III).

Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate
Acute pneumonia caused by Miscellaneous microbes --Mononuclear infiltrate

Takayasu's diz = pulseless diz, therefore when you have
Takayasu's, I can't Tak'a yu pulse.

Argyll-Robertson Pupil--syphilitic pupil (AKA "Prostitute's pupil" - Accommodates, but doesn't react )
Accommodation reflex present, Pupillary reflex absent

The five W's--post-operative fever
Wind--pneumonia, atelectasis
Water--urinary tract infection
Wound--wound infections
Wonderdrugs--especially anesthesia
Walking--walking can help reduce deep vein thromboses and pulmonary embolus

ACID or "Anna Cycled Immediately Downhill"
classification of hypersensitivity reactions
Type I - Anaphylaxis
Type II - Cytotoxic-mediated
Type III - Immune-complex
Type IV - Delayed hypersensitivity

WBC Count:
"Never Let Momma Eat Beans(60, 30, 6, 3, 1)
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1%

A - appearance (color)
P - pulse (heart rate)
G - grimmace (reflex, irritability)
A - activity (muscle tone)
R - respiratory effort

Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER
C--cardiac disease
R--rest (bed-bound)
E--estrogen, pregnancy, post-partum
P--past hx
R--road trip

The 4 P's of arterial Occlusion: pain pallor pulselessness paresthesias

The 4 T's of Anterior Mediastinal Mass:Thyroid tumor,Thymoma,Teratoma, Terrible Lymphoma

-causes of Hematuria
H-Hemorrhagic diseases
M-maignant hypertension
A-A.G.N-acute glomerulonephritis
T-TB kidney,tumor bladder
R-renal infarct
S-Stones in urinary tract,snake bite
15:16 | 16 comments

Psalm for the Day


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