Forensic Medicine Mnemonics
Dr K Chaudhry

FIRST Author of Jaypee Brothers

 

 

My teacher’s Family History :-

Dr SH Rizwi was Lecturer & HOD Forensic Medicine.

His younger brother Abdul Hamid Rizwi was my senior.

AH Rizwi appeared in I professional Examination, passed Anatomy and failed in Physiology.

He appeared in Supplementary examination and failed again in Physiology.

As per rules, he had to appear in both the subjects again next year.

Next year, he passed Physiology and failed in Anatomy.

He appeared in Supplementary examination and failed again in Anatomy.

As per rules, he was not allowed any further attempts and was expelled from the college.

Perhaps a year spent in Courts.

The Court eventally upheld AH Rizwi as having passed both Anatomy and Physiology, and set aside expulsion from JN Medical College. He was promoted in accordance with the period elapsed. That way my senior AH Rizwi became my batchmate and VERY close friend.


 

Forensic Medicine

Abortifacients

 

 

Drugs

 

 

Mifepristone

 

 

Misoprostol

 

 

Oxytocin

 

 

Oleanders

 

 

Aconite

 

Herbal

 

 

Pill aloes et myrrh – A WONDER substitute for Methergin

 

 

Calotropes

 

 

..

.

 


 

Medicine


 Chapter 01 : Haemopoietic System


Anaemia - Causes

Boring

A. Blood loss (Haemorrhagic anaemia)

 

Prick

1. Postoperative

 

And

2. Accidents

 

Pain

3. Peptic ulcer

 

Have

4. Haemorrhoids

 

Made

5. Menstruation

 

History

6. Hookworm infestation

Dames

B. Deficiency of haemopoietic factors (Dyspoietic anaemia)

 

1. Iron deficiency anaemia

 

2. Pernicious anaemia

Don’t

C. Destruction of erythrocytes (Haemolytic anaemia)

 

Some

1. Spherocytosis

 

Secret

2. Sickle-cell anaemia

 

Enemy

3. Erythroblastosis foetalis

Love

D. Lowered activity of haemopoietic tissue (Aplastic anaemia)

 

Tapeworm

1. Toxic anaemia 

 

Bachelor

a. Benzene derivatives

 

Computer

b. Chloramphenicol

 

Applications

c. Arsenic

 

In

2. Irradiation anaemia

 

- X-rays

 

Infected

3. Infections

 

a. Typhoid

 

b. Diphtheria

 

Men

4. Marrow replacement

 

Love

a. Leukaemias

 

My

b. Multiple myeloma

 

Husband

c. Hodgkin's disease

 

Investigation of a Case of Anaemia 

 

 

A. History

 

 

 

(a) Age and sex

 

 

 

 

1.  Infants. Prematurity

 

 

 

 

2. School children. Worm infestation

 

 

 

 

3. Young ladies. Menstrual disorders

 

 

 

 

4. Old age. Malignancies

 

 

 

(b) Onset acute in :-

 

 

 

 

1.  Haemarrhage

 

 

 

 

2.  Acute leukamia

 

 

 

 

3. Haemolysis

 

 

 

(c) Occupation

 

 

 

 

1.  Agriculture. Hookworm

 

 

 

 

2. Industry. Toxic chemicals

 

 

 

(d) latrogenic

 

 

 

 

1.  Salicylates

 

 

 

 

2.  Radiotherapy

 

 

 

(e) Diet

 

 

 

 

(f) Family history

 

 

 

 

1.  Congenital haemolytic anaemias

 

 

 

 

2.  Pernicious anaemia

 

 

 

(g) Haemorrhage

 

 

 

 

1.  Haematemesis

 

 

 

 

2.  Melaena

 

 

 

 

3.  Haemorrhoids

 

 

 

 

4.  Menorrhagia and metrorrhagia

 

 

 

 

5.  Haematuria. 

 

 

 

 

6.  Haemoptysis

 

 

 

(h) Gastrointestinal Symptoms

 

 

 

 

1 . Peptic ulcer

 

 

 

 

2.  Liver cirrhosis

 

 

 

 

3.  Malignancies

 

 

 

 

4.  Hiatus hernia

 

 

 

 

5. Diarrhoea and vomiting (chronic)

 

 

 

 

6.  Glossitis

 

 

 

(i) Bleeding tendency

 

 

 

 

1.  Bruises

 

 

 

 

2.  Petechiae

 

 

 

 

3. Prolonged bleeding at multiple sites

 

 

B. Physical examination

 

 

 

(a) Skin

 

 

 

 

1. Lemon yellow tint. Pernicious anaemia

 

 

 

2.  Ashen tint. Acute leukaemia

 

 

 

3.  Coarse and dry. Myxoedema

 

 

 

4.  Petechiae

 

 

 

 

(i) Aplastic anaemia

 

 

 

 

(ii) Leukaemia

 

 

(b) Nails

 

 

 

 

1. Brittleness

 

 

 

 

2. Ridging

 

 

 

 

3. Koilonychia

 

 

(c) Conjunctivae

 

 

 

 

1.  Pallor

 

 

 

 

2. Icterus suggests haemolytic anaemia or hepatic disease ; mild icterus may suggest pernicious anaemia. 

 

 

(d) Mouth

 

 

 

 

1. Gums. Hypertrophy in leukaemia (monocytic)

 

 

 

 

2. Tongue. Smooth tongue in megaloblastic or occasionally iron­deficiency anaemia

 

 

 

 

3. Mucous membrane. Petechiae in aplastic anaemia and leukaemia

 

 

 

 

4. Pharynx. Ulceration in acute aplastic anaemia and leukaemia

 

 

 

 

5. Angular stomatitis. Iron dcficiency anaemia

 

 

(e) Cardiovascular system

 

 

 

 

1 . Hypertension. Renal disease

 

 

 

 

2. Cardiac murmur. Subacute bacterial enclocarditis, rheumatic fever, congenital heart disease

 

 

 

 

3. Haemic murmur. Nonspecific anaemia

 

 

(f) Abdomen

 

 

 

1.  Splenomegaly

 

 

 

 

(i) Leukaemia

 

 

 

 

(ii) Haemolytic anaemias

 

 

 

 

(iii) Megaloblastic anaemias

 

 

 

 

(iv) Multiple myeloma

 

 

 

 

(v) Myelosclerosis

 

 

 

 

(vi)  Severe iron deficiency anaemia

 

 

 

Abdominal mass

 

 

 

 

(i)  Gastric carcinoma

 

 

 

 

(ii) Retro-peritoneal malignant lymph nodes

 

 

 

 

(iii) Malignant lymphoma

 

 

 

 

(iv) Chronic lymphatic leukaemia

 

 

 

3. Localised tenderness

 

 

 

 

- Peptic ulcer

 

 

(g) Lymph nodes enlarged in :-

 

 

 

 

1. Leukaemia

 

 

 

 

2. Malignant lymphoma

 

 

 

 

3. Secondary carcinoma

 

 

(h)  Bones - Tenderness, particularly sternal, in :-

 

 

 

 

1. Leukaemia

 

 

 

 

2. Malignant lymphomas

 

 

 

 

3. Metastatic bone carcinoma

 

 

 

 

4. Multiple myeloma

 

 

 

 

5. Myelosclerosis

 

 

(i)  Breast  - Evidence of breast carcinoma

 

 

(j) Rectal examination

 

 

 

 

1. Haemarrhoids and fissure

 

 

 

 

2. Prostatic carcinoma

 

 

(k)  Pelvic examination - Female genital disorders

 

 

(1) Fonclus examination

 

 

 

 

1. Infiltration. Leukaemia

 

 

 

 

2. Retinitis. Chronic renal failure

 

Iron Deficiency Anaemia - Causes

A. Deficient intake

B. Improper utilisation

C. Excessive demand

1. Children 6 months - 2 years

2. Adolescents

3. Menstruation

4. Pregnancy and lactation

D. Blood loss

1. External haemorrhage

2. Menorrhagia

3. Gastrointestinal bleeding

i. Peptic ulcer

ii. Portal hypertension

iii. Oesophageal varices

iv. Ulcerative colitis

v. Amoebic dysentery

vi. Carcinoma of stomach, rectum

4. Urinary track bleeding

i. Haematuria

ii. Haemoglobinuria

5. Other bleeding

i. Epistaxis

ii. Haemoptysis

6. Parasitic infestations

- Ankylostomiasis

E. Iron loss without bleeding

- Exfoliative dermatitis

Iron Deficiency Anaemia - Symptoms

1. Weakness and lassitude

2. Dyspnoea on exertion

3. Palpitation

4. Headache, bodyache

5. Pallor

6. Precordial pain

7. Oedema of ankles

8. Gastrointestinal symptoms

i. Abdominal pain

ii. Anorexia and pica

 

Iron Deficiency Anaemia - Diagnosis

 

1. Blood picture

 

 

(i) Erythrocyte count low

 

 

(ii) Colour index low

 

 

(iii) Mean corpuscular diameter smaller

 

 

(iv)  No evidence of haemolysis

 

 

(v) Leucopenia with relative lymphocytosis

 

 

(vi)  Thrombocytopenia

 

2. Serum iron depressed ; total iron binding capacity elevated

 

3. Serum ferritin concentration depressed

 

4. Erythrocyte protoporphyrin elevated

 

5. Bone-marrow 

 

 

(i) Normoblastic hyperplasia with normoblasts of varying maturity comprising majority of total nucleated cell count

 

 

(ii)  Frequent malformed cells

 

 

(iii)  Haemoglobinization deficient in proportion to nuclear maturity

 

 

(iv)  Micronormoblasts numerous, in severe cases

 

6. Stool examination 

 

 

(i)  Ova of ankylostoma and amoebic cysts

 

 

(ii)  Voluminous fatty stools in malabsorption

 

 

(iii)  Occult blood

 

7. Barium meal X-ray, may show gastrointestinal bleeding disorder

 

8. Endoscopy. Proctoscopy, sigmoidoscopy

 

9. Urine examination and I.V.P. , if haematuria

 

Megaloblastic Anaemia

Conditions associated

I

1. Intrinsic factor deficiency

i. Pernicious anaemia

ii. Postgastrectomy syndrome

D

2. Diet deficiency

B

3. Blind or stagnant loop

I [IDBI]

4. Infancy and pregnancy

Pernicious Anaemia - Symptoms

1. Onset insidious with progressive weekness

2. Pallor

3. Dyspnoea on exertion

4. Palpitation

5. Anginal pains (occasionally)

6. Tongue sore

7. Numbness and tingling

8. Vomiting and diarrhoea

9. Vision diminished

10. Weight loss

Signs

1. Tongue smooth and atrophic

2. Curtaneous pigmentation with leucoderma and petechiae

3. Spleen palpable

4. Patchy anaesthesia of leg

5. Muscle weakness and extensor plantar response

6. Depressed tendon reflexes

7. Oedema of ankles

8. Cardiomegaly

9. Optic atrophy

Aplastic Anaemia

Causes

A. Chemical agents

1. Benzene derivatives

2. Chloramphenicol

3. Arsenic and heavy metals

4. Sulphonamides

5. Chlorpropamide

B. Physical agents

X-ray and radium

C. Infections

1. Typhoid

2. Diphtheria

3. Miliary tuberculosis

4. Malignant endocarditis

D. Replacement causes

1. Leukaemias

2. Multiple myeloma

3. Hodgkin's disease

4. Ewing's disease

5. Osteosclerosis

6. Multiple secondary carcinomatous deposit

Haemolytic Anaemia

Etiology

A. Intrinsic defects in red cells

a. Inherited

1. Familial acholuric jaundice (Spherocytosis

2. Non-spherocytic haemolytic anaemia

3. Hereditary elliptocytosis

4. Haemoglobinopathies

i. Sickle cell anaemia

ii. Thalassaemia

b. Acquired

1. Paroxysmal nocturnal haemoglobinuria

2. Dyspoietic anaemia

B. Pathological haemolytic mechanisms

a. Obscure antibodies

1. Idiopathic acquired haemolytic anaemia

2. Secondary haemolytic anaemia

i. Carcinomatosis

ii. Reticulosis

b. Isoglutinins and lysins

1. Rh incompatibility

2. Transfusion reaction

3. Cold haemoglobinuria

c. Parasitic disease

Malaria

d. Haemolytic poisons

1. Bacterial

i. Clostridium welchii

ii. Streptococcus pyogenes

2. Chemical

i. Phenylhydrazine

ii. Potassium chlorate

iii. Lead

3. Vegetable

Saponin

Clinical picture

1. Anaemia

2. Fever

3. Jaundice

4. Spleen enlarged and tender

Polycythaemia

Etiology

A. Relative polycythaemia (dehydration)

1. Vomiting

2. Diarrhoea

3. Traumatic shock

4. Excessive burns

B. True polycythaemia (polycythaemia rubra)

a. Primary or idiopathic (polycythaemia vera)

b. Compensatory polycythaemia

1. High altitudes

2. Chronic pulmonary disease

i. Emphysema

ii. Chronic pulmonary fibrosis

iii. Chronic pulmonary congestion

3. Increased erythropoietin production

i. Renal lesions

Tumours

Cysts

Hydronephrosis

ii. Carcinoma of liver

iii. Cerebellar haemangioblastoma

iv. Uterine myomata

Symptoms

1. Headache and vertigo

2. Weakness and lassitude

3. Dyspnoea with haemoptysis

4. Diplopia

5. Left upper abdominal pain

6. Bone pains

7. Dyspepsia and neuralgia

8. Neurological symptoms

i. Hemiplegia

ii. Transitory unconsciousness

iii. Epileptiform fits

iv. Paraesthesia

v. Insomnia

vi. Tingling of extremities

vii. Psychic disturbances

9. Intolerance to cold and heat

10. Haemorrhages

11. Pruritus

Signs

1. Face congested with prominent malar bones

2. Ecchymoses, purpura and haemorrhages

3. Eyes blood shot, retinal vessels tortuous, papilloedema

4. Complexion dusky

5. Cyanosis

6. Signs of thrombosis at any site

7. Hypertension

8. Spleen enlarged

Transfusion Reactions

1. Febrile reactions

2. Allergic reactions

3. Circulatory reactions

4. Haemolytic reactions

5. Reactions due to infected blood

6. Thrombophlebitis

7. Air embolism

8. Transmission of disease

9. Transfusion haemosiderosis

10. Immunological sensitization

Leucocytosis

Causes

A. Physiological

1. After meals

2. Exercise

3. Emotional stimuli

4. Pregnancy

B. Pathological

1. Infection

2. Haemorrhage

3. Malignancies

4. Trauma

i. Surgical operations

ii. Crush injuries

iii. Burns

5. Myocardial infarction

6. Drugs

i. Phenacetin

ii. Digitalis

iii. Quinine

iv. Adrenalin

v. Organic arsenicals

vi. Metals, eg mercury, lead

vii. Carbon monoxide

7. Metabolic disorders

i. Renal failure

ii. Diabetic coma

iii. Acute gout

iv. Eclampsia

8. Collagen disease

i. Polyarteritis nodosa

ii. Rheumatoid arthritis

iii. Disseminated lupus erythematosus

iv. Dermatomyositis

9. Miscellaneous

i. Acute intravascular haemoptysis

ii. Serum sickness

iii. Acute anoxia

iv. Spider venom poisoning

Polymorphonuclear Leucocytosis

Causes

1. Pneumococcal pneumonia

2. Empyemia

3. Furunculosis

4. Perinephric abscess

5. Osteomyelitis

6. Appendicular abcess

7. Septicaemia

8. Bacterial endocarditis

Lymphocytosis

Causes

I. Absolute lymphocytosis

A. Chronic infections

1. Tuberculosis

2. Syphilis

3. Undulant fever

4. Malaria

B. Acute infections

1. Infectious mononucleosis

2. Pertussis

C. Lymphosarcoma

D. Thyrotoxicosis

E. Obesity

F. Diabetes mellitus

II. Relative lymphocytosis

1. Viral infections

a. Influenza

b. Measles

2. Typhoid

3. Neutrophilic leucopenia

4. High altitudes

Eosinophilia

Causes

1. Parasitic infestations

i. Ascariasis

ii. Ankylostomiasis

iii. Hydatid cysts

iv. Filariasis

2. Allergic conditions

i. Bronchial asthma

ii. Hay fever

iii. Drug allergy

iv. Serum sickness

v. Angioneurotic oedema

vi. Milk allergy (in infants)

3. Skin disease

i. Urticaria

ii. Eczema

iii. Pemphigus

iv. Exfoliative dermatitis

v. Psoriasis

vi. Dermatitis multiformis

vii. Scabes

4. Drugs

i. Liver extract

ii. Penicillin

iii. Chlorpromazine

iv. Pilocarpine

5. Acute infections

i. Scarlet fever

ii. Chorea

6. Blood dyscrasias and malignant lymphomas

i. Chronic myeloid leukaemia

ii. Polycythaemia

iii. Hodgkin's disease

iv. Multiple myeloma

7. Idiopathic familial eosinophilia

8. Eosinophilic granulomatosis

9. Post-splenectomy

Eosinopenia

Causes

1. Drugs

i. Corticosteroids

ii. Adrenaline

iii. Ephedrine

iv. Insulin

2. Stress

i. Acute infections

ii. Traumatic shock

iii. Surgical operations

iv. Burns

3. Endocrine disorders

i. Cushing's disease

ii. Acromegaly

4. Aplastic anaemia

5. Disseminated lupus erythematosis

Monocytosis

Causes

1. Bacterial infections

i. Tuberculosis

ii. Subacute bacterial endocarditis

iii. Typhoid

2. Protozoal infection

i. Malaria

ii. Kala azar

iii. Trypanosomiasis

iv. Rocky-mountain spotted fever

v. Infectious mononucleosis

vi. Hodgkin's disease

Basophilia

Causes

1. Chronic myeloid leukaemia

2. Myelosclerosis

3. Polycythaemia vera

4. Irradiation

Agranulocytosis

Etiology

1. Acute lymphatic leukaemia

2. Drugs

i. Amidopyrine

ii. Neomercazole

iii. Antihistaminics

a. Pyribenzamine

b. Promethazine

c. Chlorpheniramine

iv. Tranquilizers

a. Chlorpromazine

b. Meprobamate

c. Trifluopromazine

d. Thiethylperazine

v. Antibiotics

a. Chloramphenicol

b. Tetracycline

c. Streptomycin

d. Methicillin

vi. Anticoagulants

a. Phenindione

b. Dicoumarole

vii. Antitubercular drugs

a. Isoniazid

b. Thiacetazone

c. Paraaminosalicylic acid

viii. Miscellaneous

a. Phenytoin sodium

b. Amodiaquin

c. Dinitrophenol

d. Procainamide

e. Mercurial diuretics

d. Carbutamide

3. Bacterial infections

i. Pneumonia

ii. Osteomyelitis

4. Aplastic anaemia 

5. Hypersplenism

6. Idiopathic

Clinical picture

A. Constitutional symptoms

1. Onset sudden

2. Fever with chills

3. Sweating

4. Headache

5. Muscle pains

6. prostration

7. Nausea and vomiting

8. Jaundice

9. Delirium

B. Infective lesions

1. Sore throat

2. Stomatitis

3. Dysphagia

4. Haematemesis and malaena

5. Tongue dry and furred

6. Recurrent infection at site

Leucopenia

Causes

1. Infection

a. Bacterial

1. Typhoid

2. Paratyphoid

3. Brucellosis

4. Fulminant tuberculosis

b. Viral

1. Influenza

2. Measles

3. Infective hepatitis

4. Atypical viral pneumonia

c. Rickettsial typhus

d. Protozoal

1. Malaria

2. Kala-azar

2. Subleukaemic leukaemia

3. Drugs

1. Chloramphenicol

2. Amidopyrine

3. Arsenicals

4. Barbiturates

4. Aplastic anaemia

5. Hypersplenism

6. Bone marrow affections

1. Secondary carcinomas

2. Malignant lymphomas

3. Myelosclerosis

7. Megaloblastic anaemias

8. Disseminated lupus erythematosus

9. Miscellaneous

i. Anaphylactoid shock

ii. Myxoedema

iii. Thyrotoxicosis

iv. Hypopituitarism

v. Liver cirrhosis

vi. Paroxysmal nocturnal haemoglobinuria

Leukaemia

Types

A. Acute leukaemia

1. Lymphoblastic leukaemia

2. Myeloblastic leukaemia

3. Monoblastic leukaemia

4. Stem cell leukaemia

B. Chronic leukaemia

1. Lymphatic leukaemia

2. Myeloid leukaemia

3. Monocytic leukaemia

C. Miscellaneous (rare acute and chronic leukaemia

1. Erythroleukaemia (Di Guglielmo's disease)

2. Eosinophilic leukaemia

3. Megakaryocytic leukaemia

4. Plasma cell leukaemia

5. Chloroma

Acute leukaemia

Clinical picture

1. Sudden onset

2. Anaemia

3. Haemorrhage

4. Upper respiratory infections

5. Other infections

i. Cellulitis

ii. Paronychia

iii. Bacteraemia

iv. Pyaemia

v. Otitis media

6. Constitutional symptoms

i. Fever

ii. Malaise

iii. Prostration

iv. Generalized pains

7. Lymph nodes enlarged

8. Liver and spleen enlarged

9. Bone and joint pains

10. Tachycardia, arrhythmia, signs of pericarditis

11. Signs of intracerebral haemorrhage and meningeal irritation

Chronic myeloid leukaemia

Symptoms

1. Onset insidious

2. Weakness - pallor, dyspnoea

3. Malaise, weight loss, night sweating

4. Left hypochondrial pain

5. Gastrointestinal symptoms

i. Dyspepsia

ii. Flatulence

iii. Fullness after eating

iv. Swealling of abdomen

v. Diarrhoea or constipation

vi. Vomiting and nausea

6. Haemorrhages

7. Bone and joint pains

8. Amenorrhoea

9. Priapism

10. Symptoms of cerebral haemorrage

11. Skin lesions and pruritus

12. Fever (late)

Signs

1. Anaemia

2. Spleen highly enlarged

3. Liver enlarged, with smooth surface

4. Lymph nodes enlarged

5. Muscle wasting

6. Ascites

7. Buising of skin

8. Bone tenderness

Bleeding Disorders

A. Due to defects in intrinsic clotting mechanism

1. Haemophilia

2, Christmas disease

3. Hypothrombinaemia

4. Fibrinogenopenia (congenital and acquired)

B. Due to deficiency of platelets

1. Idiopathic thrombocytopenic purpura

2. Secondary thrombocytopenic purpura

C. Due to defects in capillary endothelium

1. Anaphylactoid purpura (Henoch-Schoenlein purpura)

2. Drug purpura

i. Iodides

ii. Belladonna alkaloids

iii.Cinchona alkaloids

iv. Ergot

v. Salicylates

vi. Snake venom

3. Infections

i. Meningococcal meningitis

ii. Bacterial endocarditis

iii. Rheumatic fever

iv. Septicaemia

v. Measles

4. Ascorbic acid deficiency

5. Senile purpura

6. Metabolic purpura

i. Uraemia

ii. Cholaemia

7. Hereditary

i. Von Willebrand disease

ii. Hereditary haemorrhagic telangectasia

 


 

Chapter 02 : Endocrine disorders


Causes of Thyroid Enlargement

A. Toxic goitres

1. Primary

2. Secondary to nodular goitre

B. Toxic

1. Physiological hyperplasia

i. Puberty

ii. Pregnancy

iii. Menopause

2. Colloid goitre

i. Multiple

a. Endemic

b. Sporadic

ii. Solitary

C. Neoplasms

1. Carcinoma

2. Reticulosarcoma

3. Secondary tumour

D. Thyroiditis

1. Hashimoto's disease

2. Riedel's thyroiditis

3. de Quervain thyroiditis

4. Acute thyroiditis

D/D Dwarfism

1. Pituitary dwarfism

2. Cretinism

3. Turner's syndrome

4. Sexual precocity

5. Achondroplastic dwarfism

6. Primordial dwarfism

Complications of Diabetes Mellitus

1. Generalised arteriosclerosis involving particularly

i. Coronary arteries

ii. Cerebral arteries

iii. Arteries of the extremeties

2. Diabetic nephropathy

i. Intercapillary glomerulosclerosis

ii. Acute or chronic pylonephritis

iii. Papillitis necroticans

iv. Renal arteriosclerosis

3. Diabetic retinopathy

i. Punctate haemorrhages and exudates

ii. Venous distension and tortuosity

iii. Arteriosclerotic changes when associated with hypertension

iv. Retinitis proliferans

v. Capillary microaneurysms

4. Diabetic neuropathy

a. Peripheral neuritis

b. Autonomic visceral neuropathies

i. Nocturnal diarrhoea

ii. Constipation

iii. Urinary incontinence

iv. Atonic bladder

v. Myotic sluggish pupils

vi. Peripheral oedema

vii. Impotence

viii. Charcot's degenerative joint disease

5. Pregnancy complications

1. Dystocia

2. Repeated abortions

3. Stillbirths

4. Deformed baby

5. Eclampsia

Causes of Tetany

1. Parathyroid deficiency

i. Damage during thyroidectomy

ii. After parathyroidectomy

iii. Congenital

2. Deficient calcium absortion

i. Rickets

ii. Coeliac disease

iii. Sprue

iv. Cholera

v. Megacolon

3. Alkalosis

i. Pyloric stenosis

ii. Overuse of antacids

iii. Persistent vomiting

iv. Intestinal obstruction

v. Nephritis

4. Hyperpnoea

i. Hysterical

ii. Voluntary

iii. Excessive exercise

5. Poisons

i. Chloroform

ii. Lead

iii. Morphine

iv. Arsenic

6. Nervous

i. Syringomyelia

ii. Cerebral tumours

7. Pregnancy and lactation

8. Idiopathic

03 Alimentary System


Tongue

 

Senior

A. Size

 

Students

B. Shape

 

Come

C. Colour changes

 

Along

D. Altered hydration

 

Andhra

E. Abnormal furring

 

Pradesh

F. Papillae

 

Union

G. Ulcers

 

To

H. Taste sensation

 

Continue

I. Consistence

 

Movement

J. Movements and articulation 

Tongue - Size

a. Large tongue

(i) Uniform

Please

1. Primary amyloidosis

Give

2. Glycogen storage diseases

My

3. Mucopolysaccharoidosis

Compli-

4. Congenital heart disease

Ments

5. Mongolism

And

6. Angioneurotic oedema

Congrats

7. Cretinism and Myxoedema

And

8. Acromegaly

Thanks

9. Tumours of muscle tissue

And

10. Anaemia

Love

11. Ludwig's angina

(ii) Localised

Central

1. Congenital hemiatrophy of face

Pay

2. Plexiform neurofibroma of the trigeminal nerve

Office

3. Oedema due to

Tumbler

i. Trauma

Is

ii. Infections

A

iii. Allergy

Little

iv. Lymphatic Obstruction

Vessel

v. Venous Obstruction

Means

4. Median rhomboid glossitis

Central

5. Congenital cysts

Service

6. Suprahyoid cysts

Relating

7. Ranula

To

8. Tuberculous infiltration

Give

9. Gumma

And

10. Actinomycosis

Take

11. Tumours of nerves and vessels

b. Small tongue

(i) Symmetrical

Patient

1. Pseudobulbar palsy

People

2. Progressive bulbar palsy

Drive

3. Dehydration

Slowly;

4. Starvation or malnutrition

Hence

5. Haemorrhage

Are

6. Atrophic glossitis

Truly

7. Typhus

Safe

8. Simmond's disease

(ii) Asymmetrical

Copper

1.Congenital hemiatrophy of face

Heavy

2. Hypoglossal palsy

Metal

3. Myasthenia gravis

Tongue - Shape

Some

1. Sickle-Shaped 

- Ipsilatral lower motor neurone lesion

Salary

2. Small-pointed 

- Pseudobulbal palsy

Plus

3. Plication

- Melkersson's syndrome

Allowances

4. Alligator

- Diabetes mellitus

Tongue - Colour

Generally

1. Greyish

- Normal

Common

2. Chalky white

- Ankylostomiasis

People

3. Pale

- Iron deficiency anaemia

Rely

4. Red or magenta

Some

a. Sprue

Teachers

b. Tropical macrocytic anaemia

Love

c. Liver cirrhosis

Poetry

d. Pernicious anaemia

Upon

5. Uniform blue

- Central cyanosis e.g., Fallot's tetrology

Purity

6. Patchy blue (in apicomarginal zone)

- Prolonged bismuth therapy

Yet

7. Yellow

- Jaundice

Bombayites

8. Black

Call

a. Congenital melanoglossia

An

b. Addison's disease

Able

c. Ankylostomiasis

Physician

d. Pernicious anaemia

Drink

9. Dirty-brown

Can

a. Chronic uraemia

Eat

b. Excessive smoking

Mango

c. Mouth breathing

Diet

d. Dehydration

Far

10. Fiery red

- Nicotinamide deficiency

Poor

11. Purple

- Polycythaemia

Standard

12. Strawberry

- Scarlet fever

Wines

13. White

To

a. Thrush

See

b. Syphilis (Secondary stage)

Look

c. Leukaemia

Carefully

d. Carcinoma

Tongue - Hydration

(i) Excessive moisture

1. Irritative lesions

Local

Sharp

a. Stomatis

Edge

b. Epithelioma of tongue

Cutter

c. Carious teeth

Nervous

a. Trigeminal neuralgia

b. Herpes zozter of trigeminal nerve

2. Increased salivary production

- Hyperacidity

3. Defective swallowing

a. Parkinsonism

b. Hydrophobia

(ii) Excessive dryness

D (3Ds)

1. Diminished salivary secretion

Some

a. Sarcoidosis

Silly

b. Sjogren's syndrome

Men

c. Mikulicz's syndrome

Live

d. Lymphatic leukaemia

Like

e. Lymphosarcoma

Bandits

f. Belladonna preparations

D

2. Depletion of body fluids

Physiological

Dance

a. Diminished intake

Every

b. Excessive output

Moment

c. Mouth breathing

Pathological

Can

a. Cholera

Pay

b. Polyuria

Daily

c. Diarrhoea

Visits

d. Vomiting

D

3. Defective development

- Endocrinal dysplasia

 Tongue - Furring

Bombay

(i) Bilateral accessive furring

1. Local infections

State

a. Stomatitis

Trading

b. Tonsillitis

Corpn

c. Colds

Sale

d. Sinusitis

Purchase

e. Pneumonia

Branch

f. Bronchitis

2. Dehydration of mouth

Good

a. General dehydration

People

b. Pyrexia

May

c. Mouth breathing

Stay

d. Smoking

United

e. Uraemia

University

(ii) Unilateral furring

Heavy

1. Hypoglossal furring

Traffic

2. Trigeminal neuralgia

Hazards

3. Herpes zoster of trigeminal nerve (mandibular branch)

Closed

(iii) Centripetal furring

- Typhoid fever

Again

(iv) Absence of fur

Visit

1. Vitamin B deficiency

Any

2. Anaemia

Small

3. Subacute combined degeneration of cord

Station

4. Sprue

 Tongue - Papillae

1. Smooth tongue

- Riboflavin deficiency

2. Smooth red raw tongue

Soft

a. Steatorrhoea

Spoken

b. Sprue

Chartered

c. Chronic dysentery

Accountant

d. After gastroenterostomy

 Tongue - Ulcers

 

All

1. Aphthous ulcers

 

Service

2. Syphilitic ulcers

 

Doctors

3. Dental ulcers

 

To

4. Tuberculous ulcers

Come

5. Chronic nonspecific ulcers

Closer

6. Carcinomatous ulcer

 Tongue - Taste sensation

Long

A. Loss of taste sensation (ageusia)

A

1. Anterior 2/3 (Lesions of...)

Central

a. Chorda tympani

Govt

b. Geniculate ganglion

Men

c. Mandibular branch of trigeminal nerve

Pigeon

2. Posterior 1/3 

- Lesions of Glossopharyngeal nerve

Under

3. Unilateral

- Lesions of Tractus

Bucket

4. Bilateral

- Lesions of Middle of Pons

Travel

B. Taste hallucinations and parageusia

- Irritative lesion in neighbourhood of uncus

Makes

C. Metallic taste

1. Arsenic and Bismuth therapy

2. Prolonged antibiotic therapy

Giddy

D. Garlic taste

- Phosphorus poisoning

 Tongue - Consistence

Seen

1. Soft - Normal

From

2. Flabby - Lower motor neurone paralysis

Front

3. Firm - Upper motor neurone paralysis

Window

4. Woody - Lipoid proteinosis

 Tongue - Movement and articulation

Pretty

A. Protrusion delayed

My

1. Mentally retarded patients

Lovely

2. Lowered conscious state

Party

3. Parkinson's disease 

Trick

4. Thick tongue

Dancer

2. Deviation of tongue

1. Apparent deviation

i. Facial palsy

ii. Trigeminal palsy

2. True deviation (in relation to central incisors

- Hypoglossal palsy

Doing

3. Diminished or absent normal movements

1. Without motor disorders

i. Malignant infiltration

ii. Apraxia

iii. Myasthenia gravis

2. With motor disorders

a. Nuclear or infranuclear lesions

(i). Progressive bulbar palsy

(ii). Syringobulbia

(iii). Infiltration of hypoglossal nerve by a tumour

b. Supranuclear lesion

- Pseudobulbar palsy

A

4. Abnormal movements

1. Extraneurological

A

i. Anxiety and fever

Happy

ii. Habit spasm

Scene

iii. Senility

At

iv. Alcoholism

Theatre

v. Thyrotoxicosis

2. Neurological

i. Chorea (bizarre movements)

ii. Parkinsonism (tremor)

iii. GPI (trombone movements

iv. Degerative lesions of lower motor neurone (fibrillation)

Dance

5. Difficulty in articulation - big, thick, dry tongue

 Symptoms of Big Tongue

The

1. Thick speech

First

2. Frequent tongue biting

Day

3. Dysphagia

Play

4. Protrusion out of the mouth

Ends

5. Excessive salivation

Stomatitis
Types

Same

1. Simple catarrhal stomatitis

Day

2. Deficiency stomatitis

Same

3. Stomatitis in blood dyscrasias

Bankers

4. Bacterial stomatitis

Found

5. Fungal stomatitis (thrush)

Them

6. Viral stomatitis

Attacking

7. Allergic stomatitis

Them

8. Toxic stomatitis

Inside

9. Idiopathic stomatitis (aphthous stomatitis)

Anorexia
Causes

Guys

A. Gastrointestinal

Can

1. Carcinoma of stomach

Count

2. Chronic gastritis

People

3. Pernicious anaemia

In

B. Infections

Pakistan

1. Pulmonary tuberculosis

International

2. Infective hepatitis

Airlines

3. Acute febrile illness

Emergency

C. Endocrine disorders

A

1. Addison's disease

Second

2. Simmond's disease

Hand

3. Hyperparathyroidism

Machine

4. Myxoedema

Never

D. Nervous

1. Anorexia nervosa

2. Anxiety and depression

Pay

E. Physiological

Zebra

1. Zinc deficiency

And

2. Avitaminosis

Horse

3. High carbohydrate diet

Inside

4. Irregular meals

More

F. Miscellaneous

1. Uraemia

2. Digitalis toxicity

Nausea & Vomiting
Causes

Rita

A. Reflex causes

a. Abdominal

Generally

1. Gastric ulcer

Good

2. Gastritis

People

3. Pylorospasm or stenosis

Feel

4. Food poisoning

It

5. Intestinal obstruction

A

6. Acute appendicitis

Privilege

7. Acure peritonitis

Caring

8. Acute cholecystitis

People

9. Acute pancreatitis

Rain Hit

10. Renal and biliary colics

11. Helminths

b. Extra-abdominal

Indian

1. Irritation of pharynx and fauces

Standard

2. Shock

Time

3. Travel sickness

Can

B. Central causes

Heavily 

1. Hydrocephalus

Bred

2. Brain tumour or abscess

Mosquitoes

3. Meningitis

Can

4. Concussion

Cause

5. Cerebral haemorrhage

Malaria

6. Migraine

To

7. Tabes dorsalis

Often

8. Offensive taste

Make

C. Metabolic

His

1. Hepatic disorders

Doctor

2. Diabetic acidosis

Understands

3. Uraemia

Aikment

4. Alkalosis

And

5. Adrenal crisis

Treats

6. Toxaemia of pregnancy

Meticulously

7. Morning sickness in pregnancy

Pudding

D. Psychogenic or hysterical

Weight Loss
Causes

A. With diminished appetite

Pay

a. Psychogenic

Aone

1. Anorexia nervosa

Article

2. Anxiety and depression

Genuine

b. Gastrointestinal

Call

1. Chronic diarrhoea

Every

2. Enzyme deficiencies

Armed

3. Achlorhydria

Man

4. Malabsorption syndrome

In

5. Intestinal parasites

Dues

c. Debilitating states

Two

1. Tuberculosis

Make

2. Malignancy

Company

3. Cardio-vascular disease

My

d. Metabolic

Unions

1. Uraemia

Are

2. Addison's disease

High

3. Hypercalcaemia

Headed

4. Hypokalaemia

Boy

e. Blood disorders

Look

1. Leukaemia

Here

2. Hodgkin's disease

Mister

3. Mylofibrosis

Keep

f. Kidney diseases

1. Chronic glomerulonephritis

2. Pyelonephritis

Lowering

g. Liver disorders

Long

1. Liver cirrhosis

Life

2. Liver abscess

Dues

h. Diarrhoea and vomiting

B. With increased appetite

a. Diminished absorption

Don't

1. Diarrhoea and vomiting

Invite

2. Intestinal fistulae

Him

3. Hypermotility carcinoid

b. Increased utilization

1. Thyrotoxicosis

2. Diabetes mellitus

Dysphagia
Causes

Police

A. Painful diseases of mouth and pharynx

Some

1. Stomatitis

Thing

2. Tonsillitis

Queen

3. Quinsy

Tring

4. Tuberculous laryngitis

To

5. Tumours

Probe

6. Pharyngo-oesophageal pouch

Never

B. Nervous disturbances

Don't

(i) Diphtheritic neuritis

Mind!

(ii) Myasthenia gravis

Bulky

(iii) Bulbar paralysis

Girls

(iv) Globus hystericus

Are

(v) Achalasia cardia

Obstinate

(vi) Oesophageal spasm

Enter

C. Extrinsic oesophageal compression

Tom

(i) Thyroid enlargement

Makes

(ii) Mediastinal adenitis

A

(iii) Aneurysm of aorta

Paper

(iv) Peticardial effusion

Boat

(v) Bronchial neoplasms

Inside

D.  Intrinsic oesophageal lesions

(i) Congenital short oesophagus

(ii) Inflammatory and degenerative process

Police

a. Peptic oesophagitis

Carry

b. Corrosive oesophagitis and stenosis

The

c.  Traction diverticulum

Sticks

d. Sideropenic dysphagia (Plummer-Vinson Syndrome)

(iii) Neoplasms

Cigarette

a.  Carcinoma of Oesophagus

Case

b.  Carcinoma of stomach

Stolen

c.  Sarcoma and benign tumours of the oesophagus

Dyspepsia
Causes

Our

A. Organic disease

One

1. Oesophageal tumour

Can

2. Cardiospasm

Date

3. Diaphragmatic hernia

A

4. Achlorhydria

Good

5. Gastritis

Pretty

6. Peptic ulcer

Chap

7. Carcinoma stomach

Radio

B. Reflex dyspepsia

A

1. Appendicitis

Cunning

2. Cholecystitis

Pet

3. Pancreatitis

Ate

4. Amoeblasis

Some

5. Steatorrhoea

Sweet

6. Spastic colon

Apple

7. Helminthiasis

Seldom

C.  Systemic disease

Can

1. Cardiac failure

Papa

2. Pulmonary tuberculosis

And

3. Anaemia

An

4. Addison's disease

Uncle

5. Uraemia

Hide?

6. Hyperparathyroidism

Fails

D.  Functional

Friends

1. Faulty eating habits

Never

2. Nervous exhaustion

Attack

3. Anxiety and depression

History

One

1. Onset

Day

2. Duration of symptoms

The

3. Type of pain

Aged

4. Anorexia

Nurse

5. Nausea and vomiting

Had

6. Haematemesis

Bruised

7. Bowel action

Her

8. Heartburn

Forearm

9. Flatulence

On

10.Occupation

Front

11. Family history

Physical examination

Get

1. General appearance

Out

2. Oral cavity

And

3. Abdomen

Direct

i. Distention

People

ii. Peristalsis

To

iii. Tenderness

Leave

iv. Lump

Houses

v. Hepatomegaly

Cry

4. Chest

Lab investigations

Great

1. Gastric analysis

Soldiers

2. Stool examination

Under

3. Urine examination

His

4. Haemogram

Able

5. Absorption studies

Leadership

6. Liver function tests

Kept

7. Kidney function tests

People

8. Pancreatic function tests

Live

9. Liver biopsy

Visual tests

Every

1. Endoscopy

Lady

2. Laparoscopy

Pretty

3. Proctoscopy

Oesophageal Spasm
Types

Pack

1. Primary

Red

2. Reflux

Piece

3. Plummer-Vinson syndrome

Clinical picture

A

1. Age - Middle aged woman or old man

Doctor

2. Dysphagia

Received

3. Retrosternal pain

The

4. Tongue smooth or sore

Patient

5.Phyarynx pale and dry

So

6. Skin pale

Kindly

7. Koilonychia

My

8. Mouth angles cracked

Heavens

9. Hepatosplenomegaly

Achalasia Cardia
Treatment

Be

1. Bland semisolid diet

Sensible

2. Sedative

And

3. Anticholinergic

Deliver

4. Dilatation

Some

i. Stark's dilator

Never

ii. Negar's bag

Marry

iii. Mercury bougies

Chairty

5. Cardiomyotomy or Hellor's operation

Goods

6. Gastrostomy

Hiatus Hernia
Types

Central

1. Congenital short oesophagus

Post

2. Para-oesophago-gastric hernia

Office

3. Oesophago-gastric hernia

Differential diagnosis

Can

1. Coronary insufficiency

Become

2. Biliary colic

Public Property

3. Pancreatitis

4. Peptic ulcer

Indications of surgery

I

1. Intermittent obstruction

Can

2. Cardiorespiratory symptoms

Play

3. Perforation

Some

4. Strangulation

Humour

5. Haemorrhage

Haematemesis
Causes

People

A. Peptic ulcer

1. Duodenal ulcer

2. Gastric ulcer

And

B. Acute gastric erosions

Indians

1. Idiopathic

Are

2. Aspirin and phenylbutazone

Admired

3. Alcohol

Frequently

4. Food allergy

People

C. Postoperative

1. Gastroenterostomy

2. Gastrectomy

Enter

D. Erosions and ulcers associated with hiatus hernia

Open

E.  Oesophageal varices 

Race

F. Rare causes

Indian

(i) Ingested epistaxis

Civil

(ii) Carcinoma of stomach

Service

(iii) Sarcoma of stomach

Owns

(iv) other gastric tumours

Benign

(v) Blood disorders

Honest

(vi) Hereditory telangiectasia

Polite

(vii) Pseudoxanthona elasticum

Men

(vii) Mallory-Weiss syndrome.

Lower Gastrointestinal Bleeding

 Causes

A. Anal lesions

1. Haemorrhoids

2. Anal fissures

B. Diseases of large bowel

Upon

1. Ulcerative colitis

A

2. Amoebi and bacillary dysentery

Rat

3. Rectal polyp

Cat

4. Carcinoma of rectum and colon

Nips

5. Nonspecific colitis

Chronic Diarrhoea
Causes

Good

A. Gastric

Her

1. Hypersecretion of gastric juice

Cousin

2. Chronic gastritis

Can

3. Carcinoma of stomach

Pay

4. Pyloric obstruction 

Premium

5. Pernicious anaemia

Speeches

B. Small intestinal 

In

1. Intolerance to lactose or sucrose

Comparison

2. Coeliac disease

To

3. Tropical sprue

Well

4. Whipple's disease

Attired

5. Amyloidosis

Ladies

6. Lymphoma

Terribly

7. Tuberculosis

Clad

8. Crohn's disease

Hubbies

9. Hypogammaglobinaemia

Can

10. Carcinoid.syndrome

Cause

11. Carcinoma

Many

12. Mesenteric vascular disease

Serious

13. Systemic lupus erythematosus

Problems

14. Polyarteritis

Some

15. Scleroderma 

Really

16. Radiation enteritis

Generate

17. Giardiasis

Funny

18. Food allergy

Scenes

19. Severe protein malnutrition

Can

C. Colonic

Indian

1. Irritable bowel syndrome (spastic colon) 

Universities

2. Ulcerative colitis

Can

3. Carcinoma of colon

Manage

4. Multiple polyposis

CAT

5. Chronic bacillary infection

And

6. Amoebic colitis

Allied

7. Actinomycosis

Examinations

8. Endomettiosis

Developed

9. Diverticulitis 

Indigenously

10. ischaemic colitis

Render

D. Rectal

Case

1. Carcinoma of rectum

Under

2. Ulcerative proctitis 

Very

3. Villous adenoma

Aged

4. Antibiotic proctitis 

Lady

5. Lymphogranuloma venereum

His

E. Hepato-biliary

1. Biliary obstruction

2. Portal hypertension

Party

F. Pancreatic

Can

1. Chronic pancreatitis

Control

2. Carcinoma of pancreas

Central

3. Cystic fibrosis 

Zone

4. Zollinger-Ellison syndrome

Men

G. Metabolic

His

1. Hyperthyroidism

Details

2. Diabetes mellitus

Are

3. Addison's disease

Hidden

4. Hypoparathyroidism

Under 

5. Uraemia

Some

6. Severe malnutrition

Protection

7. Pellagra 

Doubly

H. Drug induced

Central

1. Cathartics

Armed

2. Antacids

Police

3. Parasympathomimetics

Gave

4. Ganglion blocing agents

An

5. Antibiotics

Attack

6. Alcohol

To

7. Thyroid

Delhi

8. Digitalis

Cricket

9. Contraceptives - Oral

Club

10. Colchicine

Polite

I. Postoperative

Very

1. Vagotomy

Dull

2. Dumping syndrome

And

3. Afferent loop syndrome

Boring

4. Blind loop syndrome

Ground

5. Gastroileostomy

Fielding

6. Fistulae

In

7. Ileal resection - Subacute

India

8. Intestinal obstruction

Hepatomegaly
Causes

I

A. Infectious

Very

a. Viral 

I

1. Infective hepatitis

Saw

2. Serum hepatitis

Yellow

3. Yellow fever

Inkpot

4. Infectious mononucleosis

Big

b. Bacterial