Surgery Facts from Previous Papers

·         CXR finding of thoracic aortic injury – Widening of mediastinum >8 cm (due to presence of mediastinal hematoma)

·         Eponymous Signs in Splenic rupture:

1.       Ballance's  sign - Ballance's sign is dullness to percussion in the left flank LUQ and shifting dullness to percussion in the right flank seen with splenic rupture/hematoma. The dullness in the left flank is due to coagulated blood, the shifting dullness on the right due to fluid blood.

2.       Kehr's  sign - Kehr's sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Kehr's sign in the left shoulder is considered a classical symptom of a ruptured spleen. Kehr's sign is a classical example of referred pain: irritation of the diaphragm is signalled by the phrenic nerve as pain in the area above the collarbone.

3.       Saegasser's  sign  - Palpation of  left upper quadrant  inferior to ribs  elicits neck pain in the  patient.

·         Different Eponymous types of Herniasurgery pearls

Amyand's hernia :The term Amyand’s hernia refers to the presence of the appendix within the hernial sac, and has been variously defined as the occurrence of either an inflammed or perforated appendix within an inguinal hernia, or simply, the presence of a non-inflammed appendix within an irreducible inguinal hernia.

Barth's hernia :Hernia of the loops of intestine between the serosa of the abdominal wall and that of a persistent vitelline duct.

Beclard's hernia - femoral hernia through saphenous opening

Berger's hernia - hernia in Pouch of Douglas

Bochdalek hernia :(congenital posterolateral hernia of the diaphragm)A Bochdalek Hernia is one of two forms of a congenital diaphragmatic hernia, the other form being Morgagni's hernia.

Radiology Facts from Previous Papers

·         Honeycomb appearance of the lung on chest X-ray :
Mnemonic : CD(bbcmn) SPLINTER

1. Cystic fibrosis

2. Cystic bronchiectasis

3. Collagen disorders : Rheumatoid arthritis and Scleroderma

4. Drugs : Busulphan, Bleomycin, Cyclophosphamide, Melphalan and Nitrofurantoin

5. Pneumoconioses

6. Langerhan cell histiocytosis

7. Interstitial lung diseases

8. Idiopathic interstitial fibrosis ( Fibrosing necrotizing alveolitis )

9. Neurofibromatosis

10. Tuberous sclerosis

11. Extrinsic allergic alveolitis

Psychiatry Facts from Previous Papers

·         Anxiety––↑i NE, ↓d GABA, ↓d serotonin (5-HT).

·         Depression––↓d NE and ↓d serotonin (5-HT).

·         Alzheimer’s dementia––↓d ACh.

·         Huntington’s disease––↓d GABA, ↓d  ACh.

·         Schizophrenia––↑i dopamine.

·         Parkinson’s disease––↓d dopamine.

·         Hallucinations are perceptions in the absence of external stimuli.

·         Illusions are misinterpretations of actual external stimuli.

·         Delusions are false beliefs not shared with other members of culture/subculture that are firmly maintained in spite of obvious proof to the contrary.

·         Loose associations are disorders in the form of thought (the way ideas are tied together).

·         1° gain––what the symptom does for the patient’s internal psychic economy.

·         2° gain––what the symptom gets the patient (sympathy, attention).

·         3° gain––what the caretaker gets (like an MD on an interesting case).

·         Selected Important Court Cases

ii.       Karen Ann Quinlan: Substituted Judgment Standard

iii.      Brother Fox(Eichner vs Dillon):Best Interest Standard

iv.     Infant Doe: Foregoing Lifesaving Surgery, Parents Withholding Treatment

v.       Roe vs Wade(1973):The Patient Decides

vi.     Tarasoff Decision: Duty to Warn and Duty to Protect

·         Autoscopic psychosis – Visual hallucination of a transparent phantom of one’s own body

Lycanthopy – Delusion that the person is a werewolf/other animal

·         Many antidepressants including SSRIs, TCAs & MAOIs suppress REM sleep & can be useful in Tt of cataplexy.

·         In amphetamine abuse these two do not occur together

- Formication (tactile hallucination) is seen in ®  Chronic abuse.

- Paranoid ideation (delusion of persecution) occurs in ®  Acute intoxication.

 On the other hand both delusion of persecution and formication are seen together in chronic cocaine abuse.

·         Dd

·          

1)      "AKATHISIA---restlessness/irresitible urge to move about & increased motor activity,Rx-amantadine,benzhexol,propranolol,"----------((2))

2) "ALZHEMER'S DISORDER---Ach.-biochemical cause ,predisposing factors--down's synd.,head trauma,low edu.group,"---------((2))

3) "ANTIPSYCHOTICS---longacting -Fluphenazin,"----------((2))

4) "BEHAVIOUR---TYPE A---time urgency ,impatiency,hard driving ,career orientation,ambitiousness, COINED BY friedman & rosenman ,"---------((2))

5) "BEHAVIOR THERAPY---indicated for Phobia,cardinal elements--Systemic desensitization & Flooding,"----------((2))

6) "BUSPIRONE---anti-anxiolytic,newer NONSEDATIVE ,non hypnotic axiolytic,"---------(2)

7) "CLOZAPINE---assosiated with agranulocytosis , causes sialorrhyroea,"-----------(( 2))

8) "EEG---alpha waves--> awake & eyes closed ( stage I sleep) ( ATKD'S-MNEMONIC-B,,,,A1,T1K2,D34(NREM),,,B-REMS)"-----------((2))

9) "FEAR---due to abnormal experiences of childhood , over consciousness & excess perception of danger , least common in depressive psychosis ,"-----------((2))

10) "FLUOXETINE---mech. of action--inhibition of serotonin uptake , side-effect--Anxiety,loose stools,Nause is troublesome"-----------((2))

11) "GPI(GENERAL PARESIS OF INSANE) ---fes. Confabulation, Grandiose, Delusions, Mental deterioration, "-----------((2))

12) "HALLUCINOGENS---Cocaine, Mescaline, LSD, Phencyclidine, "----------((2))

13) "HALOPERIDOL----acute drug dystonia after> 1day, causes Akathesia , used in BALLISMUS aswell,"---------((2))

14) "HYPOCHONDRIASIS---Preoccupation with body diseases, Over conscious about some illness, "----------((2))

15) "IMPOTENCE---it is also seen in D.M., diff. Between psy.Impotence & Organic I.--is diagnosed by monitoring of Penile TUMESCENCE during sleep ,"-----------((2))

16) "INTELLIGENCE QUOTIENT---I.Q.= (mental age X 100)/ chronological age (%), I.Q. Test = Binet Stanfort Test"------------((2))

17) "NEUROLEPTICS---blood levels checked for toxicity , commonest side-effect--Sedation , "---------((2))

18) "OEDIPUS COMPLEX---coined by sigmund Freud, seen in boys 3-5yrs of age,"------------((2))

19) "PHENOTHIAZINEs---involuntary perioral movement , used in Rx of depression , tardive dyskinesia is the side-effect,"------------((2))

20) POST-TRAUMATIC STRESS DISORDER---most common after major life threatening event/ e.g. any CAR accident,rape,earthquake,.. etc.-----------((2))

21) "PREMATURE EJACULATION --- Rx-SQUEEZE Technique, "------------((2))

22) "PSYCHONEUROSIS---diagnosis by VERBAL ACCOUNTS.,"------------((2))

23) "PSYCHOSOMATIC DISORDERS---e.g.--HTN,Peptic Ulcer disease, Bronchial Asthama, Hyperventilation"------------((2))

24) "THOUGHT---DISORDERS--loosening of Association, THOUGHT INSERTION---this is SCHEIDNER'S FIRST RANK SYMP."--------------((2))

25) "WITHDRAWAL SYMP.---PHYSICAL--absent-in Cannabis, Present in Pethidine,Opium,Haloperidol,Alcohol, Rx required in for withdrawal symp.--Cannabis, Cocaine,Alcohol,"------------((2))

1) ABREACTION---used in Rx of phobia,-----------((1))

2) "AFFECT---disorders of affect , disturbances of affect--panic , apathy , phobia,"---------((1))

3) "AFFECTIVE DISORDERS---depression ,reaction form'n ,adjustment reaction ,"-------((1))

4) "AGGRESSION ---PASSIVE AGG.--spills half,"-------((1))

5) "AGORAPHOBIA---fear of open spaces , DOC.--alprazolam,"-------((1))

6) "ALEXITHYMIA---inability to recognize & describe feelings,"--------((1))

7) "AMBIVALENCE---coined by EUGEN BLEULER,"---------(1))

8) "AMNESIA---anterograde amnesia--caused by giving ECT.,good prognostic indicator of head injury.,"---------((1))

9) "AMOTIVATIONAL SYNDROME---seen in cannabis,"------((1))

10) "AMOXAPINE---antidepressant with side effects like -tardive dyskinesia & neuroleptic malignant synd.,"-------((1))

11) AMPHETAMINES--- ,-----((1))

12) "ATTENTION DEFICIT DISORDER---seen with phenobarbitone ,"--------((1))

13) "AUTISTIC DISORDER---lesion is in Temporal lobe ,"-------((1))

14) "BALLISMUS---Rx haloperidol ,"-------((1))

15) "CHLORPROMAZINE---?rigidity,mask like face,tremors,(uses/side effects),"------(1))

16) "CLAUSTROPHBIA---fear of CLOSED spaces ,"-------((1))

17) "COGNITVE BEHAVIORAL THERAPY---is the Rx for Depression ,"-------((1))

18) "COPROLALIA---seen in TOURETTE'S SYND.,"-------((1))

19) CYCLOSERINE---anti -TB.-shows NeuroPsychiatric manifestation,--------((1))

20) "DÉJÀ VU---seen in normal persion ,temporal lobe epilepsy,psychosis,"--------((1))

21) DISORIENTATION---seen in Organic brain synd.,------------((1))

22) Diethyl Propion---1st. Choice in wt. reduction prog.,---------((1))

23) "DRUG DEPENDENCE---is due to withdrawal symptoms ,"---------((1))

24) "EXHIBITIONISM---shameless exposure of genitals ,"-------((1))

25) "FETISHISM---obtaining Sexual excitement with inanimate objects , "--------((1))

26) FREE ASSOCIATION---coined by FREUD.,------((1))

27) "GANSER'S SYND.---inappropriate answer...... , "--------------((1))

28) HASHISH---active substance—TetraHydroCannabinol,----------((1))

29) "HEROIN---withdrawal fes.--Yawing, muscle cramps, Hypersomnia, HTN.,"---------((1))

30) "HICCOUGH---Intractable--DOC-chlorpromazine/Largactil , "--------((1))

31) ILLUSIONS---,------((1))

32) "IMIPRAMINE---antidepressant ,DOC--in nocturnal enuresis , "--------((1))

33) INSOMNIA---Familial Fatal Insomnia--seen in PRION disease,-------((1))

34) KLEPTOMANIA---Irresistible ure to STEAL things of LITTLE value,---------((1))

35) "La Belle Indifference---seen in Dissociative disorders ,"--------((1))

36) LUCID INTERVAL---seen in INSANITY,------------((1))

37) least addictive---DihyroxyPropoxyphene,-----------((1))

38) MAOIS---induced hypertensive crisis-Rx-->reversed with Phentolamine,----------((1))

39) "MANDRAX---is combination of HYPNOTIC + ANTI-HISTAMINE,"----------((1))

40) "MASOCHISM---sexual partner are aroused & gratified by whipping ,"------------((1))

41) "MEMORY---RECENT--CENTRE--HIPPOCAMPUS ,"-------------((1))

42) "METHADONE---used in maintainance of Rx of opium dependence/ ?Withdrawal ,"-------------((1))

43) "MORPHINE---addiction , Withdrawal is done with Clonidine ,"---------------((1))

44) MYXEDEMA---ass. with depression ,-----------((1))

45) "MUNCHAUSEN SYND.---factitious disorder ,"---------((1))

46) "NARCOLEPSY---symp.--Cataplexy , Sleep acttacks, Sleep paralysis, "-----------((1))

47) "NIGHT TERRORS-seen in NREM sleep--TOC.-clonazepam,"-------------((1))

48) "NYMPHOMANIA---not a compulsive & habit forming disorder , "---------((1))

49) ORGANIC AMNESTIC SYND.---most common cause—Concussion,----------((1))

50) OTHELLO SYND.---Delusion of Infidelity on part of Sexual partner,-----------((1))

51) PARANOID DISORDER---Pseudocommunity,---------((1))

52) PERSONALITY DISORDERS---BORDERLINE-sucidal tendencies,--------((1))

53) PHENCYCLIDINE---ass. With DEPERSONALISATION,-----------((1))

54) "PICASSO SYND.---painter obsession developed into artistic painting, "--------((1))

55) PROJECTION---mature defense mech.,------------((1))

56) "PSYCHIATRIC MANIFESTATION---seen in Hypothyroidism, Hyperthyroidism, Acute Intermittent Porphyria, Inability for Erection, Inability to take deep breath , Pain,"--------((1))

57) "PSYCHOTHERAPY---PSYCHOANALYTICAL---Insight therapy, Behavioral therapy & SUPPORTIVE therapy, "--------------((1))

58) PUNISHMENT---inflicting pain to get rid of a bad habit ,--------------((1))

59) "PUNCH DRUNKENNESS ---is ass. With BOXING.,"--------------((1))

60) BRIEF REACTIVE PSYCHOSIS---after loss of loved-one's,--------------((1))

61) REINFORCEMENT---+ve R.-? Conditioned learning,----------------((1))

62) "SLEEP DEPRIVATION---leads to decreased mental altertness,"----------((1))

63) SLEEP-WALKING-somnabulism--seen in NREM STAGE 3/4 Sleep,-------(1))

64) "STUPOR---DEPRESSIVE--loss of power in all 4 limbs, Waxy Flexibility of muscle tone in limbs,"-------------((1))

65) "SUPERSTITION---a False belief unexplained by reality ( Shared by a number of persons/people ) ,"---------((1))

66) SUPER-EGO---coined by Sigmund Freund,--------((1))

67) "TARDIVE DYSKINESIA---due to Reserpine,HALOPERIDOL,"--------((1))

68) "THINKING---ABSTRACT--similarity between chair & table->both has 4 legs,"-------((1))

69) "THIORIDAZINE---side-effect--Pigmentary Retinopathy,"--------((1))

70) "THERMATIC PERCEPTION TEST---by Wechslers , "---------((1))

71) WERNICKE'S ENCEPHALOPATHY----Rx-Thiamine supplement,---------((1))

72) EIGHT STAGE CLASSIFICATION OF HUMAN LIFE---BY ERIKSON ,-----------((1))

PSM Facts from Previous Papers

·         Indian Red Cross Act - 1920.

·         Indian Factory Act- 1941 ( F=First=41)

·         ESIS- 1948 (E=Eight=8)

·         SIDA - Swedish International Development Agency - RNTCP (T.B).

·         DANIDA - NBCP. ( BLIND ~)

·         AIIMS- New Zealand ( MEMO: AIIMS always does the NEW)

·         COLOMBO Plan: Canada supplying COBALT THERAPY UNITS to Medical institutions in india.

·          

·         For disinfection of large water bodies - Method of choice of chlorination is CHLORINE GAS. 

·         Chlorine gas is produced by PATERSON's CHLORONOME.

·         Greatest drawback of Chloramine is - SLOW ONSET of action.   

·         Perchloron / HTH has 60-70%  'Available Chlorine'. Whereas Commercial Bleaching Powder has only 33% Available Chlorine.

·         Biological Transmission of Diseases 3 Types 

1. Propagative : Only multiplication of organisms, no change in form inside the vectors 

                                         Eg:- Plague bacilli in Rat fleas.

2. Cyclopropagative : Both multiplication in number and change in form.

                                Eg:- Malarial parasites in female anopheles mosquiotes.

3. Cyclodevelopmental : Only change in form, but no multiplication in numbers.

                                  Eg:- Filarial parasite in Culex mosquito**, Guinea Worm in Cyclops.

·         Live Attenuated Vaccines

1. MMR

2. BCG

3. Polio

4. Epidemic Typhus

5. Chicken Pox -----------> You can Remember the last 6 as PEt-CITY.

6. Influenza

7. Typhoral

8. Yellow fever Vaccine

·         Categorization of wastes

category 1 : Human anatomical wastes

category 2 : Animal wastes

category 3 : Microbiology and Biotechnology wastes

category 4 : Waste sharps

category 5 : Discarded medicines and Cytotoxic drugs

category 6 & 7 : Solid wastes

category 8 : Liquid wastes

category 9 : Incineration ash

category 10 : chemicals used in the production of biologicals

·         Strains used for production of Vaccine:

Measles - Edmonston Zogreb Strain

Typh-Oral - Ty21a Strain

Chicken Pox - OKA Strain

Rabies - Pitts Moore Strain

BCG - Danish 1331

Polio - Lancing, Leon, Brunhilde Strain

Mumps- Jeryll Lynn Strain

Yellow Fever- 17 D vaccine Strain

Hep A - HM175/GBM strain

Rubella- RA 27/3 Strain

Diphtheria- Park Williams 8 Strain

·         DOTS Plus:

IP: KP CEO E

CP: CEO E

·         Secondary attack rare in Chicken Pox & Measles, while common in Typhoid & Pertusis.

·         No carrier /subclinical cases in Measle & Pertusis, while carriers are more imp in M.meningitis & Diphtheria.

·         Salmonella typhi,paratyphi A & C are not Zoonosis while paratyphi B is Zoonosis.

·         CEREALS are deficient in LYSINE and PULSES are deficient in METHIONINE.

·         Influenza more common in WINTER in world, but in india it is more common in SUMMER.

·         HIV sex distribution in world- M:F = 1:7-10

But in india, M:F = 3:2 (as Females are not diagnosed due to TEST STIGMA)

·         POLIO, NNT have time distribution: July to Sep

·         Remember, RUBELLA is not a SEX DISTRIBUTION of Dz.

·         GOITER was PLACE Distribution in india, now it is not an example of place distribution because now we derive our IODINE from SALT and not from SOIL.

·         In the calculation of Years of Potential Life Lost (YPLL), denominator is – Popn under 65 yrs

·         Budgeting process that utilizes the scarce financial resources optimally, identifies waste expenditure & helps in rational decision making – Zero base budgeting

·         Insecticidal method of choice for controlling mosquitoes & sandflies during disaster situation –Indoor Residual spraying

·         A large no. of middle aged men with risk factors for IHD join a health insurance plan as compared to young persons with low risk factors. This is termed as – Adverse selection

·         For food-borne pathogens, danger zone of temperature is – 5-60°C

·          

·         HIV is more common in: <15, 15-29, 30-44, >45

·         Ca CERVIX is not an example of SEX DISTRIBUTION of Dz as it is SEX RESTRICTED Dz.

·         JE cases MC in GORAKHPUR. 90-95%

·         SR>1000 – Kerala (1058) & PUNDUCHERI (1001)

·         Lowest SR india: Daman & Div

States: Harayana, Punjab, Delhi

·          

·         Montreal Protocol – Production & consumption of ozone depleting compounds in stratosphere are to be phased out

It is believed that if the international agreement is adhered to, the ozone layer is expected to recover by 2050.

·          

The National Institute of Virology, Pune is India's Premier Virology Research institute, part of Indian Council of Medical Research (ICMR). It was previously known as 'Virus Research Center' and was founded in collaboration with the Rockefeller Foundation.

The National Institute of Communicable Diseases (NICD) is situated in New Delhi.

The National Dairy Research Institute or the NDRI Karnal

India's National Centre for Radio Astrophysics (NCRA), located on the Pune University Campus, is part of the Tata Institute

of Fundamental Research. At Khodad, 80 km from Pune, NCRA has set up the Giant Metrewave Radio Telescope (GMRT), the world's largest telescope operating at meter wavelengths.

National Brain Research Centre is a major neuroscience research group, situated in Manesar township of Haryana, India. It is an Autonomous Government Institute accredited with a deemed university status and is a nodal center under Department of Biotechnology of the Ministry of Science and Technology, Government of India

Physiology Facts from Previous Papers

         Two types of NO synthase (NOS) have been identified: constitutive Ca2+- calmodulin dependent enzyme, and inducible Ca2+ - independent enzyme. Both enzymes are flavoproteins containing bound flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD).

·         Cells of JEJUNUM resemble that of PCT of Kidney.

Pharmacology Facts from Previous Papers

·         Amantadine's mechanism of action involves inhibition of uncoating of the influenza A viral DNA. The primary target is the membrane M2 protein. The drug does not affect penetration and DNA-dependent RNA polymerase activity.

·         Cloramphenicol: Nitrobenzene group

·         8-aminoquinoline derivatives: Primaquine

·         4-quinoline derivatives: Chloro, Meflo, AmodiaQUINE

·         salicylamide derivative: Niclosamide

·         derivative of adamantine: Rimantadine

·         derivative of pyrophosphate: Foscarnet

·         derivative of chloroethylamine: Cyclophosphamide

·         derivative of ethylenimine: Thiotepa

·         derivative of alkylsulfonate: Busulfan

·         anticancer drug of plant origin: Vincristine

·          

·         Acyclovir not effective against CMV.

·         Antimicrobial drug causing myopathy – Daptomycin

·          

·         Drugs that cause osteoporosis are : ( GHALACTose)

1. glucocorticoids, GnRH antagonists

2. heparin

3. anticonvulsants, aluminium,

4. lithium

5. alcohol excess intake

6. cyclosporine, cytotoxic drugs

7. thyroxine excess

·         drugs causing gingival hyperplasia:

•phenytoin(dilantin)-antiepileptic

•cyclosporine-immunosuppresant

•calcium channel blockers especially nifedipine

·         drugs causing pseudotumor cerebri:

•tetracyclines,naldixic acid,nitrofurantoin

•indomethacin-NSAID

•oral contraceptive pills

•vitamin A

•isotretinon-retinoic acid derivative used for acne

•lithium-used in bipolar disorder

•danazol-antigonadotropic drug

·         drugs causing photosensitivity:

•tetracycline,fluroquinolones-antibiotics

•NSAIDs

•ACE(angiotensin converting enzyme)inhibitors-antihypertensives

•tricyclic antidepressants

•phenothiazines

•oral contraceptives.

·         Drugs that may produce disulfiramlike reactions with ethanol include the following:

•Mushrooms (eg, Coprinus atramentarius [inky cap], Clitocybe claviceps)

•Antibiotics

1.metronidazole,Tinidazole is chemically similar to metronidazole and so may cause the same reaction

2.sulfonamides(trimethoprim-sulfamethoxazole)

3.some cephalosporins( eg: cephamandole, cefoperazone, cefmenoxime, cefotetan, Moxalactam)- due to METHYLTETRAZOLETHIOL side chain.

4.nitrofurantoin,

5.chloramphenicol

6.furazolidine

7.Antimalarial Quinacrine

•Oral hypoglycemics (eg: chlorpropamide, tolbutamide)- these sulphonylureas compete with acetaldehyde for binding sites on ALDH.

•Pesticides (eg: carbamates, monosulfiram [Tetmosol])

•Chloral hydrate

•Antifungals (griseofulvin)

·         plants from which commonly used drugs are derived.

Claviceps purpurea                 Ergotamine
Erythroxylon coca                   Cocaine
Papavertum somniferum          Morphine, codeine, thebaine, papaverine etc.
Digitalis purpurea                    Lantana digoxin
Rauwolfia serpentina               Reserpine
Atropa belladonna                   Atropine
Hyocyamus niger                    Hyoscine

Pediatric Facts from Previous Papers

·         IMP DZ WITH HYPERTONIA:

Edward’s, 21q-, Krabbe’s, Kernicterus(Acute), Menke Kinky Hair Syndrome, SSPE,

·         Clinical pointers towards specific IEM’s

·         Coarse facies: Lysosomal disorders

·         Cataract: Galactosemia, Zellweger syndrome

·         Retinitis pigmentosa: Mitochondrial disorders

·         Cherry red spot: Lipidosis

·         Hepatomegaly: Storage disorders, urea cycle defects

·         Renal enlargement: Zellweger syndrome

·         Eczema/alopecia: Biotinidase deficiency

·         Abnormal kinky hair: Menke disease

·         Decreased pigmentation: Phenylketonuria

·         Hiccups: Nonketotic hyperglycinemia

·         Ophthalmoplegias: MSUD, Nonketotic hyperglycinemia

·         Apnea monitors based on chest wall movement are likely to miss obstructive apnea. Monitors with facilities for measuring heart rate and oxygen saturation would be more useful in the monitoring of significant apnea in preterm infants.

·         Methylxanthines have been the mainstay of pharmacologic treatment of AOP. The loading dose of intravenous aminophylline is 5 to 6 mg/kg, followed by 1.5 to 3 mg/kg every 8 to 12 hours. Caffeine available for both oral and intravenous use has some advantages over theophylline. Because it has a higher therapeutic index, toxicity is less of a concern. Also, once-daily dosing is possible due to its longer halflife. A typical loading dose of 20 mg/kg caffeine citrate is followed in 24 hours by 5 to 8 mg/kg per dose, administered once every 24 hours. Recommended therapeutic levels are 5 to 10 μg/ml for  minophylline and 8 to 20 μg/ml for caffeine.

Caffeine: The drug is not available in India at present.

The drug of choice would be caffeine, which is not available in India. Hence we prefer to use aminophylline as the drug of choice in the management of AOP.

·         Injection doxapram has 0.9% benzyl alcohol as a preservative. The recommended dose of 2-2.5 mg/kg/hr would deliver 21.6-32.4 mg/kg/day of benzyl alcohol. Although this dose is below the toxic dose of alcohol (45 mg/kg/day), there have been case reports of “gasping syndrome” with this lower dose in literature.

·         Similarly, extubation to CPAP following early surfactant administration (‘INtubateSURfactantExtubate’ = INSURE Approach) has been shown to reduce the need for mechanical ventilation but it is still uncertain if BPD is reduced by this approach.

·         Preterm infants are susceptible to oxidant injury because they are deficient in antioxidant enzymes. Hence, antioxidants such as superoxide dismuatase (SOD) promise to be an exciting strategy for prevention of BPD. A randomized trial that enrolled around 300 infants proved the safe nature of the drug CuZnSOD, but did not find any difference in the primary outcome of BPD at 36 weeks PMA. Interestingly, SOD treated infants had fewer episodes of respiratory illness at I year of age suggesting that the drug could prevent long-term lung injury caused by reactive oxygen species.43 Further studies are needed to define its exact role in the management of BPD. Other antioxidants/free radical scavengers like vitamins C and E, allopurinol, N-acetyl-Cysteine have not been proved to be useful till now.

·          

·         Spitzer's laws of neonatology

1.       The more stable a baby appears to be, the more likely he will "crump" that day.

2.       The nicer the parents, the sicker the baby.

3.       The likelihood of bronchopulmonary dysplasia (BPD) is directly proportional to the number of physicians involved in the care of that baby.

4.       The longer a patient is discussed during rounds, the more certain it is that no one has the faintest idea of what is going on or what to do.

5.       The sickest infant in the nursery can always be discerned by the fact that he or she is being cared for by the newest, most inexperienced nursing orienteer.

6.       The surest way to have an infant linger interminably is to inform the parents that death is imminent.

7.       The more miraculous the "save," the more likely that you will be sued for something totally inconsequential.

8.       If they are not breathin', they may be seizin'.

9.       Antibiotics should always be continued for ____ days. (Fill in the blank with any number 1-21.)

10.   If you cannot figure out what is going on with a baby, call the surgeons. They won't figure it out either, but they will sure as hell do something about it.

·         Yale Observation Scales

This set of six items of observation and physical signs was designed at Yale to assist in detecting serious illness in febrile children who were <24 months old. Normal (1 point), moderate impairment (3 points), and severe impairment (5 points) scores are given for quality of cry, reaction to parental stimulation, state of alertness, color, hydration, and response to social overtures. Scores of =10 correlate with a low likelihood of serious illness, primarily in infants >2 months old