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New FIGO 2010 Staging for Carcinoma

By Pratyush kumar

Carcinoma of the Vulva

IA         Tumor confined to the vulva or perineum, ≤ 2cm in size with stromal invasion ≤ 1mm, negative nodes
IB         Tumor confined to the vulva or perineum, > 2cm in size or with stromal invasion > 1mm, negative nodes
II          Tumor of any size with adjacent spread (1/3 lower urethra, 1/3 lower vagina, anus), negative nodes
IIIA      Tumor of any size with positive inguino-femoral lymph nodes
            (i) 1 lymph node metastasis greater than or equal to 5 mm
            (ii) 1-2 lymph node metastasis(es) of less than 5 mm
IIIB      (i) 2 or more lymph nodes metastases greater than or equal to 5 mm
          (ii) 3 or more lymph nodes metastases less than 5 mm
IIIC      Positive node(s) with extracapsular spread
IVA       (i) Tumor invades other regional structures (2/3 upper urethra, 2/3 upper vagina), bladder mucosa, rectal mucosa, or fixed to pelvic bone
            (ii) Fixed or ulcerated inguino-femoral lymph nodes
IVB       Any distant metastasis including pelvic lymph nodes

Carcinoma of the Cervix

IA1       Confined to the cervix, diagnosed only by microscopy with invasion of < 3 mm in depth and lateral spread < 7 mm
IA2       Confined to the cervix, diagnosed with microscopy with invasion of > 3 mm and < 5 mm with lateral spread < 7mm
IB1       Clinically visible lesion or greater than A2, < 4 cm in greatest dimension
IB2       Clinically visible lesion, > 4 cm in greatest dimension
IIA1      Involvement of the upper two-thirds of the vagina, without parametrial invasion, < 4 cm in greatest dimension
IIA2      > 4 cm in greatest dimension
IIB        With parametrial involvement
IIIA/B   Unchanged
IVA/B    Unchanged

Carcinoma of the Endometrium

IA         Tumor confined to the uterus, no or < ½ myometrial invasion
IB         Tumor confined to the uterus, > ½ myometrial invasion
II          Cervical stromal invasion, but not beyond uterus
IIIA      Tumor invades serosa or adnexa
IIIB      Vaginal and/or parametrial involvement
IIIC1    Pelvic node involvement
IIIC2    Para-aortic involvement
IVA       Tumor invasion bladder and/or bowel mucosa
IVB       Distant metastases including abdominal metastases and/or inguinal lymph nodes
Uterine sarcomas were staged previously as endometrial cancers, which did not reflect clinical behavior. Therefore, a new corpus sarcoma staging system was developed based on the criteria used in other soft tissue sarcomas.[2] This is described as a best guess staging system, so data will need to be collected and evaluated for further revision.

Uterine Sarcomas (Leiomyosarcoma, Endometrial Stromal Sarcoma, and Adenosarcoma)

IA         Tumor limited to uterus < 5 cm
IB         Tumor limited to uterus > 5 cm
IIA        Tumor extends to the pelvis, adnexal involvement
IIB        Tumor extends to extra-uterine pelvic tissue
IIIA      Tumor invades abdominal tissues, one site
IIIB      More than one site
IIIC      Metastasis to pelvic and/or para-aortic lymph nodes
IVA       Tumor invades bladder and/or rectum
IVB       Distant metastasis

Adenosarcoma Stage I Differs from Other Uterine Sarcomas

IA         Tumor limited to endometrium/endocervix
IB         Invasion to < ½ myometrium
IB         Invasion to > ½ myometrium

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Deadliest disease in the world

By Pratyush kumar

The following are the leading causes of death:
PUBLISHED in who website


No.CauseEstimated number of deaths (in millions)Percent of all deaths
1Ischaemic heart disease7.212.2
2Cerebrovascular disease5.79.7
3Lower respiratory infections4.27.1
4Chronic obstructive pulmonary disease3.05.1
5Diarrhoeal diseases2.23.7
6HIV/AIDS2.03.5
7Tuberculosis1.52.5
8Trachea, bronchus, lung cancers1.32.3
9Road traffic accidents1.32.2
10Prematurity and low birth weight1.22.0
11Neonatal infectionsa1.11.9
12Diabetes mellitus1.11.9
Source: Global Burden of Disease: 2004 update

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common adverse effects of anti tubercular drugs and management

By Pratyush kumar

as given in DOTS_Plus_Guidelines_Jan2010.pdf 
AMINOGLYOCIDES :- KANAMYCIN
-ototoxicity
-nephrotoxicity
-vertigo
-electrolyte imbalance


QUINOLONES:- OFLOXACIN
-photosensitivity
-tendinopathies
-skin rash
-arthalgia
-cardiotoxicity
-diarrhoea


ETHAMBUTOL
-optic neuritis
leads to visual disturbances, colour blindness


PYRAZINAMIDE
-Arthralgia
• Hyperuricaemia
• Hepatitis
• Pruritis with or without rash


ETHIONAMIDE

-Psychiatric: hallucination and depression
• Hepatitis
• Hypothyroidism and goitre with prolonged administration
• Gynaecomastia,menstrual disturbances, impotence, acne, headache, and peripheral neuropathy


CYCLOSERINE

-CNS: dizziness, slurred speech, convulsions, headache, tremor, and insomnia
• Psychiatric: confusion, depression, altered behaviour, and suicidal tendency
• Hypersensitivity reaction


PAS
-Gastro-intestinal: anorexia, nausea, vomiting, and abdominal discomfort
• Skin rash
• Hepatic dysfunction
• Hypokalemia
• Hypothyroidism and goitre with prolonged administration

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chronic liver disease

By Pratyush kumar

uploading my pedatric seminar topic on chronic liver disease (pathogenesis and complications).


Chronic liver failure

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question and answer

By Pratyush kumar

THESE ARE THE QUESTIONS ASKED IN OUR 1ST MEDICINE INTERNAL TEST.
Q.1 - Classify aneamia. megaloblastic anemia. {long question}
Q.2 - Metabolic syndrome
Q.3-  Type 1 diabestese mellitus.
answer:-
1) def:- aneamia is defined as decrease in oxygen carrying capacity of blood , decrease number of red cell ,which varies according to age sex and altitude.
classification:-
 aneamia is classified on the basis of reticulocyte index
1> reticulocyte index <2.5 {hypo proliferative aneamia}
                      a> normocytic
                           iron deficiency aneamia
                           marrow supression
                           aplastic aneamia
                     b> microcytic
                          iron deficiency aneamia
                          thallasemia
                          sideroblastic aneamia
2> reticulocyte index >2.5 {hyperproliferative aneamia}
                         macrocytic:-
                          megaloblastic aneamia
                          blood loss
                           
MEGALOBLASTIC ANEAMIA
 aetiology:-

              cobalamin deficiency:-
                vegans
                intrinsic factor deficiency
                post gastrectomy
                decrease intake
                increased demand :- pregnancy, growth spurt
                worm infestation :-diphylobrothum latum
              folate deficiency:-
               anti folate drugs:- methotrexate
              increased demand 
              decrease absorption:- crohn disease, gluten sensitive enteropathy
               increased metabiolism
pathogenesis:-
             necessary for the synthesis of dna
             disparity in the synthesis of nucleotides
             helps in conversion of udp-->tdp
clinical features:-
             symptoms:
              anorexia
               malaise
               constipation
               fever
               weakness
               decrease exercise tolerance
              jaundice
neurological manifestation:-
            demyelination of posterior cord pyramidal tract
            bilateral neuropathy
            muscle weakness
            visual defect
             sluggish reflex
investigation:-
          blood picture:-
          hypersegmented neutrophils
          oval macrocytes
          fragmented rbc
          leukopenia
other test
         schilling test
         methyl malionic aciduria
         serum cobalamin
         serum folate
treatment
        cobalamin -1000mcg for 7 days
        folic acid - 5-15 mg for 7 days
 before giving folic acid therapy cobalamin deficiency must be ruled out..otherwise it may cause cobalamin neuropathy

2) Metabolic syndrome:-
    other names:-insulin resistance syndrme , syndrome X 
  defn:- seen as triad of hypertension, dyslipidemia, and hyperglyceamia
 seen i type 2 diabetese mellitus
  
there are two of insulin resistance 
TYPE A:- Seen in younger people
TYPE B:- Seen in older people.
investigation :-
bmi - >30
blood pressur ->140/90
cholestrol- elevated
hdl- decreased
ldl- elevated
treatment
ace inhibitors and thiazide diuretics are given
3) type 1 diabetese mellitus..
  defn:- it is a group of metabolic disorder sharing the phenotype of hyperglyceamia due to partial or complete
lack of insulin.{earlier it was called insulin dependant diabetese mellitus IDDM }
Aetiology:- autoimmune
                  genetic:- mody 1 ,2,3.4.5
                  endocrinopathies:- acromegaly, cushing syndrome ,
                  infection:- congenital rubella syndrome
                  tumour:- gulacagonoma ,
                  *autoantibody to glyceamic acid decarboxylase (gad) is found
pathogenesis:-
                autoimmune mediated beta cell destruction
                insulinitis:-  t cell  mediated destruction
                                  infiltration of lymphocyte
                                  fibrous change
               genetic:- involvement of HLA-DR6 , CTLA - 4, on chromosome 6
                honeymoon phase:- this is the phase gyceamic control is attained with little or no insulin.
                                               symptom less period..due to compensation by remaining beta cell
               impaired glucose tolerance is seen
investigation:-
              fpg->126 mg/dl
             pp> 200 mg/dl
             presence of c peptide
              glucose tolerance test
              glycosylated hb:- helpful in prognosis of diabetese mellitus 
treatment:-
             insulin infusion
             0.5-1 U/Kg.......50% must be given as basal dose
             various regimes are there:-
             continuous subcutaneous insulin infusion
             types :-
               regular , lispro, aspart
complication:-
              diabetic ketoacidosis:- due to lack of insulin
                      

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orthopaedics viva

By Pratyush kumar

 I am going to write about my ortho viva..it was very interesting one..
so questions were ranging from peripheral nerve injury to fracture dislocation and pathology of bone and joints.
WHILE answering any question REGARDING MANAGEMENT one should be very particular in mentioning 
INVESTIGATIONS first and then TREATMENT..{examiners look for it}

my first question was on radial nerve injury , its course ..
injury at the origin of radial nerve will paralyse all the muscles
injury at the level of radial groove{Saturday night palsy} ,triceps muscle escapes..
radial nerve causes extension so injury to it causes wrist drop{ unable to extend at the level of wrist}
interossei are also supplied by ulnar nerve so it escapes..
brachioradialis is supplied by the nerve before it divides into superficial and deep branches so testing the muscle will tell the level of injury..
injury to posterior interosseous branch cause wrist drop.. but extensor carpi radialis longus may escape  
then the next question was on ANGULAR DEFORMITY at the knee joint.
genu-knee , coxa -hip , cubitus -elbow
so genu valgum and genu varum are the angular deformity..to know the severity we can measure inter malleolar and inter condylar distance. Q angle is also diagnostic.

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gold medal for microbiology

By Pratyush kumar

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