Confusion to Clarity

CA19-9 is a marker for... 1.cholangioca.,
2.ca pancreas,
3.GB ca.,
4.HCC
..more is more
malignant>100 (cut off)

Trypsinogen is a marker for
Primary sclerosing cholangitis

CEA is marker for
Ca.pancreas

Thesis/ scientific research paper selection and study design

For Acute Appendicitis a recent urinary biomarker developed is LA2Gp.
leucinerich alpha 2 glycoprotein.

HIV is Plural ...with decreasing CD 4 count so many other infections creep in.
So If one infection is seen we can understand the CD4 count to be in that range.Beware of malware in tests.but not in Human immunity...

Gastrointestinal Stromal Tumor...GIST....

Referred Otalgia
In Head and Neck Malignancies.
Example:
Oro-pharyngeal
Salivary gland tumors.

1. Aaron’s sign · Appendicitis → Epigastric distress
2. Alder’s sign · Appendicitis in pregnancy → Shifting tenderness
3. Cullen’s sign · Ectopic pregnancy → Ecchymosis of umbilicus
· Hemorrhagic Pancreatitis (haemoperitoneum)

4. Carnett’s sign · Plane of Abdominal Swelling
5. Chilaiditi’s sign · Interposition of colon between liver and diaphragm
6. Cope’s sign (Psoas sign) · Acute appendicitis
7. Cope’s psoas test · Acute appendicitis
8. Courvoisier’s sign · Obstructive jaundice → If gall bladder is palpable it is not due to gall stones (Curvoisier’s law)
9. Crowe’s sign · Neurofibromatosis Axillary feckling
10. DaRLymple sign · Grave’s ophthalmopathy → Retraction of upper eyeLid
11. Dance sign · Intussusception Emptiness in right iliac fossa
12. Echo sign · Heard over hydatid cyst → Percussion sound resembling an echo
13. Ewart’s sign · Pericardial effusion → Dull on percussion at lower angle of left scapula
14. Fox sign · Hemorrhagic Pancreatitis → Discoloration near in­guinal ligament
15. Flush tank sign · Hydronephrosis
16. Grey Turner sign · Hemorhagicparicreatitis → Bruising in left flank (flanks TURn Grey)
17. Griffith sign · Grave’s ophthalmopatly → Lower lid lag on upward gaze
18. Guyon’s sign · Ballottement → Floating kidney
19. Homan’s sign · Deep vein thrombosis of calf veins → Pain on sudden dorsiflexion of foot
20. Hamilton Bailey sign · Intussusception → Sausage shaped mass
21. Hitzelberger’s sign · Acoustic neuroma → An­esthesia of external auditory canal due to compression of facial nerve
22. Joffroy’s sign · Grave’s → Absence of wrinkling on forehead
23. Kanavel’s sign · Ulnar bursitis → Site of maximum tenderness
24. Kehr sign · Splenic rupture → Pain elicited in left shoulder

25. Lesar Trelat sign · Internal malignancy of GIT → Sudden appearance & rapid increase in size & number of “seborrhoeic keratosis”
26. Mc. Burney’s sign · Appendicitis → Tenderness over Mc.Bumey point
27. Murphy’s sign · Cholecystitis
28. Moebius sign · Grave’s → Inability to keep eye balls converged
29. Mose’s sign · Deep vein thrombosis → Squeezing relaxed calf causes pain
30. Prehn’s sign · Epididymo-orchitis → El­evation & support of sc***um relieves pain(not in torsion)
31. Puddle sign · Ascites → Small amount (150-500 ml)
32. Pemberton’s sign · Retrosternal thyroid
33. Pointing sign · Appendicitis → Site of maximum pain
34. Panda sign (Raccoon sign) · Trauma/fracture of floor of anterior fossa of skull (black eye)
35. Argyll Robertson pupil sign · Neurosyphilis → Light reflex lost accommodation reflex retained
36. Banana sign · Arnold-Chiari deformity (Hydrocepalus)
37. Bird’s sign · Hydatid disease of lung → Definite zone of dullness
38. Boston’s sign · [Von Graefis sign] → Thyrotoxicosis → Lid lag
39. Bent inner tube sign · Sigmoid volvulus
40. Bird of Prey sign · Barium e***a → Sigmoid volvulus
41. Carman’s sign · [Meniscus sign] → Gastric ulcer
42. Chilaiditis sign · Interposition of colon between liver and diaphragm
43. Coiled spring sign · Barium e***a → Intussusception
44. Colon cut off sign · Appendicular perforation
· Acute pancreatitis

45. Cupola sign · Pneumoperitoneum → Gas under diaphragm
46. Crow foot sign · Mercedes Benz sign, Seagull’s sign → Gall stones
47. Claw sign · Ileo-colic intuscesception
48. Coffee bean sign · Volvulus of sigmoid colon
49. Double bubble sign · Duodenal obstruction (atresia)
50. Tinel’s sign · Prognostic indicator of nerve recovery
51. Echo sign · Percussion sound heard over hydatid cyst
52. ‘E’ sign (Reverse 3 sign) · Coarctation of aorta (barium swallow)
53. Figure of 3 Sign · Coarctation of aorta (chest x-ray)
54. Frostberg’s sign · Barium study → CA of head of pancreas involving duodenum
55. Kanavey’s sign · Acute pancreatitis (kanavel sign = Tenosynovitis)

56. Hamman’s sign · Pneumo mediastinitis with esophageal rupture → Precordial crunching
57. Kernig’s sign · Meningitis
58. String sign of Kantor · Barium e***a → Crohn’s disease
59. Lemon sign · Arnold Chiari deformity → Scalloping of frontal bones
60. Oliver’s sign · Tracheal tug → Aneurysm of aorta
61. Omega sign · Sigmoid volulus
62. Panda sign · Raccoon sign (Black eye) Trauma, fracture of floor of the anterior fossa of skull
63. Rat tail sign · Esophageal carcinoma
64. Trail’s sign · Sternal head of sternomastoid muscle will become prominent on the side to which trachea is deviated
65. Trousseau’s sign · Hypocalcemia → Carpo pedal spasm
· CA pancreas → Migrat­ing superficial thrombophle­bills

66. Water lily sign · Hydatid cyst of the lung
67. Rovsing sign · Acute appendicitis → When left iliac fossa is pressed, pain is felt in right iliac fossa
68. Stellwag’s sign · Grave’s → Staring look
69. Slip sign · Lipoma
70. Suzmann’s sign · Coarctation of aorta
71. Von Graefe’s sign · Grave’s → Lagging of upper lid
72. Tea pot sign · CSF rhinorrhea
73. Jackson sign · Pooling of saliva in pyriform fossa in pyriform cancer fossa
ORTHOPEDICS
74. Sagging rope sign · Perthe’s disease
75. Finger in Ballon sign · Aneurysmal bone cyst
76. Brim sign · Page’s disease involving pelvis
77. Tripod sign · None paralytic polio
78. Sectoral · AVN of femoral head
79. Phalen Dickson sign · Spondylolisthesis
80. Ludloff sign · Lesser trochanter avulsion
81. Kanavel sign · Infection of ulnar bursa
82. Martorell sign · Gout
83. Aneurysmal sign · TB spine
84. Sulcus sign · Inferior disclocation of shoulder
85. Wilson sign · Osteo chondritis sign
86. Payrs sign · Meniscal sign
87. Galleazi/Alli sign · CDH
88. Trethovan sign · Slipped capital femoral epiphysis
· Steels metaphyseal blanch sign

89. Vascular sign of Narath · Posterior dislocation of hip
90. Catterall sign · Leg calve perthe disease
91. Hot cross bun sign · Rickets
ENT SIGNS
92. Congenital syphilis · Hennebert sign
93. Furuncle of ear · Tragal sign
94. Hematoma of pinna · Cauliflower ear, wrestler’s ear
95. Diffuse otitis externa · Swimmer’s ear, tropical ear, Singapore ear
96. ASOM · Cartwheel appearance, light house sign
97. Lateral sinus thrombo­phlebitis · Hectic type picket fence fever, Delta sign in CT contrast
· Griesenger sign – obstruction of mastoid emissiary veins, Crowbeck sign

98. Acute mastioditis · Reservoir sign
99. Meniere’s disease · Diplacusis, Tullio phenom­enon,
· Metz recruitment phenom­enon,

· Tumarken crisis (macula destruction-linear balance is lost)

100. Otosclerosis · Schwartz sign (flamingo pink TM) Carhart notch
101. Glomus tumor · Brown sign, rising sun appear­ance, Phleps sign on CECT
102. Acoustic neuroma · Hitselberger sign
103. Exostosis · Surfer’s ear
104. Chronic hypertrophic rhinitis · Mulberry turbinate
105. Rhinosporidiosis · Mulberry mucosa
106. Rhinophyma · Potato nose
107. Rhinoscleroma · Hard woody nose
· Russel bodies, Mikulicz cells

108. Antrochoanal polyp · Crescent sign/ Dot sign
109. Frontal mucocele · Egg shell crackling
110. Osteomyelitis of frontal sinus · Potts puffy tumor
111. Blow out # of orbit · Tear drop appearance
112. Nasal # · Pignose deformity
113. CSF rhinorrhea · Halo sign, target sign,reservoir sign, double ring sign
114. Adenoid cystic carcinoma · Swiss cheese pattern
115. Inverted papilloma of Nose · Schnederian papilloma/ Ringert’s tumor
116. Nasopharyngeal
Angiofibroma

· Holman Miller sign/ Antral sign on CT frog like facies
117. Nasopharyngeal
Carcinoma

· Lhermitte’s sign
118. Quinsy · Hot potato voice
119. Ludwig angina · Woody feel
120. Kawasaki disease · Strawberry tongue
121. Wegener’s Gra nulomatosis · Strawberry gingiva
122. Zenker’s diverticulum · Boyce sign
123. Laryngomalacia · Curled up, omega shaped
· Epiglottis

· Prominent arytenoids

· Floppy aryepiglottic fold

124. Acute epiglottitis · Thumb sign on X-ray, rising sun appearance
125. Phonesthesia · Key hole appearance (both transverse and interarytenoid)
126. TB larynx · Pseudoedema of vocal cords
· Mamillated arytenoids (swol­len)

· Turban epiglottis

· Mouse nibbled ulcers

OBSTETRICS
127. Chadwick’s sign/ · Bluish hue to the vestibule and
128. Jacquemier’s sign · anterior vaginal wall (Jack bluein titanic!)
129. Osiander’s sign · Pulsations in the lateral fornix (0 = P)
130. Palmer’s sign · Regular rhythmic contractions in uterus → 6 8 weeks
131. Piskacek’s sign · Asymmetric growth occurs to the uterus in initial stages of pregnancy due to thelateral implantation of the blastocyst
132. Goodell sign · Marked softening of the cervix (good and soft)
133. Von F’ernwald’s sign · Irregular softening and enlarge­ment of the uterine F’undus Five (5-8 weeks)
134. Hegar sign · An indication of pregnancy. Softening of the lower parts of the uterus enables approxima­tion of vaginal and abdominal fingers in bimanual pelvic examination.
135. Ladin’s sign · Softening in the mid line of the sterus anteriorly at the junc­tion of the uterus andcervix (6 weeks gestation)
136. McDonald sign · Flexible uterus =8 weeks (McDonalds = flexible price)
137. Banana sign /Lemon sign · Ultrasound sign in open spina bifida. Shows abnormal ante­rior curvature of cerebellum due to the associated Arnold­Chiari malformation.
138. Blob sign · Mass is separate from the o***y
139. Bagel sign (Tubal ring sign) · Ectopic pregnancy → Gestational sac in the adnexa with hyperechoic ring. (also remember salpingitis isthmica nodosa)
140. Bishop’s sign · Abdominal ectopic pregnancy
141. Interstitial line sign · Interstitial ectopic pregnancy
142. Danforth sign · Shoulder pain in ruptured ec­topic
143. Bathroom sign · Blood in pouch of Douglas → in ruptured ectopic
144. Cullen sign · Bluish discoloration of skin around umbilicus. Seen in ruptured ectopic pregnancy
145. Stallworthy’s sign · Posterior placenta praevia→ Slowing of fetal heart rate on pressing the head down into the pelvis and prompt. Recovery on release of pressure.
146. Kustner’s sign · Sign of placental separation. On pushing the uterus upwards does not move the cord with it (due to the separation)
147. Schroder’s sign · Placental separation. Uterus rises up when the separated placenta ispassed downwards
148. Robert’s sign · Earliest sign of intrauterine fetal death. X-ray shows presence of gas in the fetal great vessels
149. Spalding sign · Sign of intrauterine fetal death. Overlapping of skull bones after fetal death(USG)
150. Ball sign · Sign of intrauterine fetal death. X-ray shows crumpled up spine of the fetus
151. Double decidual sac sign · USG appearance of intrauterine gestational sac
152. T’ sign · USG sign seen in monochromic twins
153. USG sign seen in monochromic twins · USG sign seen in dichorionic pregnancies. Due to the cho­rionic tissue in between the two layers of the membrane between the twins
154. Stuck twin sign · Seen in twin to twin transfusion syndrome. Due to the severe oligohydramnios smaller twin is held in a fixed position along the uterine wall. This is called stuck twin sign.
DERMATOLOGY
155. Hunterian chancre · primary syphilis
156. Ollendorf sign · secondary syphilis
157. Moth eaten alopecia · secondary syphilis
158. Kassowitz law, Pseudoparalysis of parrot, Moons molars, Cluttons joints, sabre tibia · Congenital syphilis
159. Esthiomene, Groove sign · LGV
160. Onycholysis, oil drop sign, sub unga I hvperkeratosis, Pencil in cup deformity, Munroe microabscesses, Candle grease sign, Grattage test, Ingram regimen

· Psoriasis
161. Wickhams striae, Civatte bodies, Koebners phenomenon, Band infiltrate, Pterygium · Lichen Planus
162. Christmas fir tree appearance, Herald pattern, Cigarette paper like scales, Collarette of scales · Pityriasis rosea
163. Dennie Morgan fold,Head light sign · Atopic dermatitis
164. Cradle crap · Infantile seborrheic dermatitis
165. Nikolsky sign, Asboe Hansen sign, Row of tombstones, Chicken wire appearance, Fish net appearance · Pemphigus Vulgaris
166. Dermatitis Herpetiforrnis · Duhrings disease
167. Orentriech sign (Tonsure alopecia) · Trichotillomania
168. Plucked chicken skin appearance, Angioid streaks · Psudox­anthoma elasticurn
169. Casals necklace, Cravat · Pellagra
170. Lesar Trelat sign · Seborrhoeic keratosis
171. Nevus of O’ta · O’cular
172. Nevus of I’to · I’ntercostal
173. Stroke bite, Angels kiss · Salmon patch
174. Pautriers micro abscesses, Epidermotropism · Mycosis fun­goides
175. Crowd sign, Patrick Yesudian sign · Neurofibromatosis
176. Shagreen patches, Angiomyolipoma, Periungal fibroma (Koenen tumors), Ash leaf macules · Tuberous sclerosis

Face reconstruction

Histiogenesis of Salivary gland Neoplasms.

Salivary gland Tumors embryology in a nut shell.

Why Preoperative preparation is necessary for Thyrotoxicosis patient?
1. To avoid thyroid storm
2. To ensure total thyroidectomy
PropylThyoUracil ---PTU
Is nowadays not being favoured because "it is associated with Liver failure to the level of Transplantation."
(From Sabistons Text book of Surgery)

Hypospadias
Urethral opening is on ventral side of the p***s in a male child.
Implications:
1. Stream is nearer to body
2. Distal are easier to repair and with good results than ventral and scrotal or perenial varieties.
3. Repair should be taken up before child goes to school.
4. A dedicated surgical team necessary to plan the staging and reconstruction.

When FRIEND becomes Enemy 😀!?

Factors responsible for Entero Cutaneous Fistula.
F foreign body
R radiotherapy
I inflammatory bowel disease(crohn's and Ulcerative colitis)
Infection or sepsis as Peritoneal abscess,interloop collection
E epithelisation of tract
N neoplasia
D distal obstruction.

LV Dysfunction....
Surgeons and Physicians need to know about this .
In a 2D echo
1.Left Atrial volume is the best measure of chronic LV Dysfunction
2. Mitral inflow velocity Pattern is the fresh or ongoing changes in filling pressures.
👍👍

IHC.
immunohistochemistry of necknodes:
1.Cytokeratin
(to distinguish between sq.cell.ca.
& Adeno ca.)H/o smoking >10 pack years.
2.P16- for

NBI
Narrow Band imaging
------------------------------------
For mucosal lesions of

Metastasis of Unknown Origin...MUO
Neck nodes if Bilateral
Think of
Tongue...Base
Palate.. and palatine tonsil
Nasopharynx
Laryngopharynx
For N. pharynx...radiation to ear (apart from Nasal obstruction)
For Oro pharynx...tobacco abuse or risk behaviour (for HPV)
For Laryngo ph.dys/odynophagia and hoarseness of voice.

BIRADS ...breast imaging and Database system...a non-invasive method to evaluate
>35 yrs age for baseline screening,
first degree relatives of Breast cancer patients,Mastalgia unreleived by medication, Impalpable Lumps in Breast.

The risk factors for Rheumatoid Arthritis are
1. To***co use
2.Vit.D.Deficiency
3.Excessive coffee consumption
4.High Salt intake.
Decreased risk is associated with
1.Statin use.
2.Omega3 fatty acids
Etiology:
1.HLADR 4 clusters-50% of population affected with RA
2.Female...

How to identify in MRI
The perineural spread into Facial Nerve in case of a Parotid Malignancy?
Clues......
1.Widening of Stylomastoid Foramen
2. Diameter of Facial Nerve is wider compared to opposite side nerve.
3.Obliteration of Perineural Fat plane.

Peri Neural
Spread....along nerve metastasis from malignant tumors spread.
Neurotrophic tumors- examples.
1.a.Adenocystic carcinoma of Parotid
b. High grade Mucoepidermoid carcinomas of Parotid
2. Oral cavity Squamous cell carcinoma.
3. MELANOMAS
4.Poorly differentiated Basalcell carcinomas.

The five F s of Parotid Surgery...
1. Fluid collection
2.Flap necrosis
3.Frey's syndrome
4.Fascial Nerve injury
5.Fistula...gland/ duct.

Indications for MRI in Carcinoma Breast:
1.Young,BRCA mutation +ve
2.Dense parenchyma.
3.Prior Surgery/Implants.
(4.As part of trials )

3.pr

For Paget's disease MRI is the gold standard test.
(Ref.: Text book of Schwartz)

heat Map
Represents molecular subtypes of a cancer to understand the chemo/radio sensitivity.

What is oncotype DX assay?
A 21 gene paraffin embedded RECURRENCE SCORE ASSAY.
Useful In Carcinoma Breast.