PATHOLOGY

SL. No. CHAPTER

Sl. 1No. Cell Injury Section-1 : Hematology Page No.
21. Leukemia & Lymphoma
Inflammation 3
32. Repair
RBC &And Regeneration
Anemia 11
43. Bleeding & Coagulation
Hemodynamics And Bleeding 15
54. Blood Transfusion
Genetics 17
6 Immune System Section-2 : General Pathology
75. Cell Injury
Neoplasia 19
86. Inflammation
Acute Luekemia 22
97. Immune
Chronic System
Myeloproliferative Neoplasms 24
10 Lymphoma Section-3 : Systemic Pathology
8.
11 Respiratory
RBCS System
And Anemia 33
9.
12 Liver
Vessels 36
10.
13 Kidney
Heart 37
11.
14 Heart
Lungs 40
12.
15 Gastro intestinal system
GIT 43
13.
16 CNS Tumor
Liver 46
14. Endocrine 48
17 Renal System
18 CNS tumors
19 IBD
 Hematology

Section
Hematology
01

1. LEUKEMIA & LYMPHOMA

• CD

• Immature - CD 34

• HSC - CD 34, HLADR

• Lymphoblast- CD 34, TDT terminal deoxy transferases

• Mature WBS- CD 45

• Myeloid - MPO, CD 13, 33, 117

Lymphoid
• B - CD 19, 20, 21, 22, 23, 24, 10, 79, PAX 5

• T - CD 3, 1, 2, 3, 4, 5, 6, 7, 8

• NK- CD 16, 56, 94

• Mono - CD 14, 64

• RBC- Glycophorin

• plat - CD 41, 42, 61

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 Pink

A. Lymphocytes C
DR BH
MEDICAL COACH
PATHOLOGY B. Neutro
PAG
No.1 PG Medical Coachi

WHO 2022 AML C. Eosino

IA B IB
1. AML e defining genetic mutation:D. Baso
good prog Band
A RCB
• AML irrespective of Blast % E. Monocyte Peripheral Smear
D Pink
• t RUNX, RUNXTI (8,21) – M2 A. Lymphocytes C

B. Neutro
• t PML, RARA (15,17) – M3 Klima
C. Eosino E

PAGE NO 36
• t CBFB, MYH (16,16) OR Inv 16 – M4 B
D. Baso
(↑EOSINO)

IB
A
E. Monocyte SALAH
D

Band E

Peripheral Smear RCB

Pink

tes C
2. AML myelodysplasia related poor prog JAMSHEDI
Klima

3. AML therapy related

B poor ISLAM

4. AML e 2-myeloid neoplasm:

A
Poor
(>20%) D mc
SALAH
CML in Blast Crisis
2. AML myelodysplasia related
chr 5q del , 7q del
5.h/o ofAML
MDSe germ
+ Mutline mut good prog
Transient
3. AML therapy related
TriEchr 21 (down synd) Mono 5q, 7q
poor
IC
– M7
4. AML e 2 myeloid neoplasm:
6. Acute leukemia of ambiguous lineage
CML in Blast Crisis (>20%)
IC
5. AML e germ live mut
good prog
CD CD
Tri chr 21 (doon eynd) - Transient
M7

6. Acute leukemia of ambiguous lineage

Poor
(ALAL) ≥2 specific lineage markers
prog
Biphenotypic Mixed phenotypic
Same Blast
2 diff Blast population
Population
MPO 19
MPO

IC 34
19
34 & 34

CD

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 Hematology

7. AML defined by differentiation old (NOS)

Mo without deff Poor prog
M1 with diff/ without maturation
M2 maturation Best prog, chloroma
M3 Ac Promyelocytic
H5 Ac myelo mono [gum hyperplasia, gum invol]
M6 Ac monoblastic M5 > M4
M6 Ac. erythroblastic (Down synd)
M7 Ac. megakaryoblastic
M6/M7: BM fibrosis

APML Auer Rods Dic PT/ aptt

max d dimer
PS: & schistocytes

t [PML, RARA]

Re: ATRA, AsO3

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 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

ALL WHO 2022 PROGNOSIS

FAVORABLE UNFAV
Age 2-9Yr <1yr, >10yr
Gender F M
TLC <10,000 >2 Lakhs
FAB L1 L3
Variable
WHO t(12,21) t (5,14) ; (9,22); (v,11)
Hyperdiploidy, Trisomy Hypodiploidy
Response lo Rx <7d >28d

BM Blood Blood
Follicle (Node)
Hairy cell leukemia
HSC
TDT Memory
CD34 Naive Post G.C. B Cell
Mantle G.C
B-Blast CD19 B cells Marginal
20 5- 10- Plasma
5+ 5+ 10+ 23+ Cell
B. lymphocyte 38+
• Follicular 23-
19+,20+ MZL
• DLBCL
45+ C.L.L C.L.L
• Bulkitts M.Myeloma

CLL Smudge Cells

LM

Two follicles Roulenx

6 IHC:BCC2+
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 Hematology

Burkit Lymphoma
Tumor cells
EBV+ starry sky

Vacuoles

• Mandible Macro
• African

LM LM EM EM

Roulenx Mott Flame cell

Roulenx Mott Flame cell

hoff
hoff

Reed Sternberg
Hodgkins Lymphoma
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7
Hodgkins Lymphoma cell
 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

lymphoma Mut CD Morphology

[19,20,45+]

1.CLL/ Chr 13q 5+ PS: Convent girl app (Hallmark)

SLL del 23+ Smudge cell
L.N: pseudo follicular
architecture

2.Mantle (anti apop) Mantle zone

BLL-1+(11) 5+ Prolif
Cyclin D1
t(11,14)
SOX 11+ve
3.Follicular Bcl-2+(18) 10+ True Follicular
t(14,18) pattern

(mc:India)
4.DLBCL BCl6+ (3) Diffuse effacement of L.N by
10+
EBV+ t(3,14) med.large lymphocytes
HiV +/-

C-MYC (8) 10+

5.Burkitt BM
EBV++ t(8,14)(2,8) SIgX+
Hiv +/- (8,22 Tumor by
vacuoles
starry sky

6.Marginal BCL-10(1) _ Maltoma

lymphoma Chalmydia - ocular

(1,14)
H. pylori - gastric
Borrelia - skin
Sjogren's Lacrimal
Salivary
Hashimoto: thyroid

7. Hairy cell BRAF 11C,25,

leuk 103, FMC-7,
stain: TRAP,
annexin A1 BMAP / BX: fried egg
DBA44

8. Plasma Chr 13qdel 38+ Halo hoff

Cell 14qdel
11,14; 4,14 138+ flame cell
myeloma
14,16,14,20
Rx:
Bortezomib mott/ Inclusion
(Proteo some grape cyto
Inhibitors) Dutcher (Eosino Russel)

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 Hematology

Hodgkins Reed Sternburg

EBV+ Cells
B cell in
G.C

B– ,T–,NK–,
CD45–
CD15+,30+

Classical Non classical

+ CD15 –
+ 30 –
– 20 B +
+
LM EBV – EM
+/– BCL6 +/–
1. Nodular lympho
mc: India
1.Mixed Cellularity:mc: in Hiv Predominent H.L
• Rare
Mono nuclear popcorn • Best prog
2.Nodulal Sclerosis ) mc.world (L&H) • EBV –

Roulenx Mott Flame cell

Lacunar
3.Lympho rich
4.lympho depleted (Seen in Hiv hoff
Only)
Worst prog

Reed Sternberg
Hodgkins Lymphoma cell

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MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Lacunar cells NS

Popcorn Cells L&H:

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 Hematology

2. RBC & ANEMIA

Hereditary Spherocytosis

AD
mc max hemolysis
Mut: Ankyrin> Band -3> spectrin Hb
MCHC = ed
PCV
RBC memb dis integration mc def in HE:
s.area spectrin Normal RBC

non deformable
(dehydration)

EVH
Conf: OFT
. EMA : Eafin 5-mandellic acid Binds to Band-3
Reticulocyte
Reticulocyte
Rx:• folic acid
• BTX
B
Normal RBC Thalassemia
• Elective splenectomy Basophi
100%
N EVH
Micro Sphero
%lysis Right Gallstones
left

0.3 x
0.1% 0.5 0.9
%Nall

Reticulocyte Spherocyte
Spherocyte
Reticulocyte

Basophilic Stippling
Basophilic Stippling Howell Jolly Bodies
Howell Jolly Bodies

Spherocyte Bite Cells (Keratocytes) Heinz bodies. Severe

Sickle Cells Heinz bodies.
Bite Cells (Keratocytes) Sev
Spherocyte

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 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Bite Cells
Bite Cells (Keratocytes)
(Keratocytes) Heinzbodies.
Heinz bodies. Severe Hypochromia
Severe : Iron De
Hypochromia:

Iron Deficiency Anemia

Duodenum:
ferritin
Duo Cyto Breductase S.Iron,
Hephestin % Tr. Saturation
Transferrin
Fe3+ o Thalassemia E
Fe3+
Fe2+ BM
Macro ferritin
Ferroportin
E
DMT-1 –
+
Inflam HEPSIDIN
+
Ferritin

Ferritin Transferrin ( TIBC)

F α
TIBC

Basophilic Stippling Howell Jolly Bodies

Sickle Cells
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 Hematology

Sickle Cells
Sickle Cells

es. Severe Hypochromia : Iron Deficiency Anemia

es. Severe Hypochromia : Iron Deficiency Anemia

S-Iron Studies

Iron overload
Test IDA SA ACD

S.Iron

S Ferritin

%Tr.Sat

TIBC

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 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Megaloblastic Anemia

B12 def: Demyelination (SACD)

Neurological Deficits

Lab: ↑ M.M. CoA

↑ Homocysteine

Folic Def:

Lab : ↑ Homocysteine

Folic acid : alone

• Neurological deficits : worsen

• Anemia : Improve

Macrocytic
Macrocytic AnemiaAnemia

Teardrop cell

Macro-ovalocytes

Hypersegmented neutrophil
Teardrop cell

Macro-ovalocytes

Hypersegmented neutrophil

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 Hematology

3. BLEEDING & COAGULATION

BLEEDING & COAGULATION

vwf/fibrinogen I B
P II G
b. gp IIb/ IIIa Glanzman thrombesthenia
P gp Ib/IX Bernard Solier / Big plat
A.
vwf VWD
1 plug a. adhesion
b. Aggregation
Defect:
C.f : pehiche 1-3 mm
purpura 3-10 mm
Ecchymosis >1cm

2.plug: IPHMWK
EP
F XII XIIa
VII
lab: Kaolin Thromboplastin
lab : tissue factor
XI XIa (fIII)
VIIa
apTT
IX IXa
IP+CP
VIII (fIV : Ca)
PT
10 X Xa
5 Ca/PL EP+CP
Va Ca/PL
2
prothrombin II IIa Thrombin
1
fibrinogen I Ia fibrin
XIIIa
Stable Clot
FDP
dimer
CoagTest: plasmin

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 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Sample: Plat poor plasma

add
Kaolin + Ca/PL thromboplastin + Ca/PL
apTT PT

Case 1: PT FVII Def , vit k def→ 2,7,9,10

n aPTT Warfarin dose
Y carboxylation of
glutamic acid
warfarin ISI warfarin -
PT pt
PT - INR =
BT Connor F7: shortest E 1/2 4hr
80; Vit k dif (Warfarin: PTonly

Case2: apTT F XII, XI, IX, VIII Def

n PT VWD

VWF a adhesions>> agg

b Stabilizes F8 so, apTT only

Care 3: PT IP +EP def DIC
apTT CP def : F X, V, II, I Def

Def
Def: Muscle joint bleed
F 8 - Hemo A 11 - Heme C
XR AR
9 - Hemo B 5 - Parahemo

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 Hematology

4. BLOOD TRANSFUSION

BLOOD BANKING.

Storage
Q Components Use
Temp Time
1 PRBC Anemia 2-6oC 21/35/42 days

2 FFP Dic – 40oC 1 yr

Hemo A/B (– 20oC)
3 Cryoppt Hemo A
f 8/vwf+ VWD – 80oC 1 yr
fibrin Hypofibrin
4 Cryopoor – 80oC 1 yr
Hemo B
(Coag-f8/vwf)

5 plat Thrombocytopenia 22oC 5 day

6 Washed Allo
2o-6C 1 day
RBCs immunization

5 Massive BTα: equal blood volume of pt given

in 24h or
50% Blood vol 3hrs
Complication:
Hypothermia
Transfusion
HYPER K+
hypoca PRBC: FFP: CP=
Citrate toxicity 1 : 1: 1
hypo Mg
Met acidosis > Alkalosis
Dilutional coagulopathy
Shelf life
ACD 21d
CPDA 35d
CPDA+ 42d
SAGM
Universal Donor:
PRBC O >> O +ve
FFP AB >> AB +ve

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NOTES
 General pathology

Section
General Pathology
02
5. CELL INJURY

Reversible Cloudy swelling

Blebs
EM
loss of LM
MV fatty
change
Rev Na+ lactic organelle
N acid
pyknosis
ECF
TG
ATP
FFA Hydropic change

Irreversible Ca: Activates Lysosomal Enzymes

a Necrosis

{
EM (a) Na, Ca2+ LM
large flocculent amorphous
density
PAGE NO - 25 = = Myelin
figures
PM: damage
protein damage
=
=

(Irrev >> Rev) Karyolysis

Inflam +

PM

maintained mc Not maintained

Coagulative liquefactive

Barrett's ESO

goblet cells

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 Fibrinoid
Fibrinoid
necrosis
necrosis
in in
vessels
vessels
DR BH
PATHOLOGY Barretts Esophagus
MEDICAL COACH
Barrett No.1 PG Medical Coachi
Esophagus Fibrinoid necrosis in vessels
Coagulative
Liquifactive
Liquifactive
necrosis
necrosis Necrosis
in in
brain
brain Heart
Fatty Necrosis : Chalky
Coagulative Necrosis Heart white deposits
Fatty Necrosis : Chalky
Liquifactive necrosis in brain white deposits

Brain atrophy

Brain atrophy Fibrinoid

Apoptotic
Apoptotic necrosis in vessels
cell
cell
Gangrene
Gangrene Fibrinoid necrosis in vessels

Gangrene Apoptotic cell

Liquifactive necrosis
Liquifactive in brain
necrosis in brain

Hydropic change : light microscopy

Dry
DryGangrene
Gangrene Wet
WetGangrene
Gangrene
Central vein
Hydropic change : light microscopy
Normal hepatocytes AA
Dry Gangrene Wet Gangrene
Caseous
CaseousNecrosis
Necrosisin in
Lungs
Lungs
Gangrene Apoptotic cell
Apoptotic cell
Caseous Gangrene
Necrosis in Lungs

Portal tract
AA

DNA Electropheresis BB
Hepatocytes with A : NORMAL
hydropic change CC
B : APOPTOSIS
Dry Gangrene Wet Gangrene
C : NECROSIS
A
Dry Gangrene Wet Gangrene
Caseous Necrosis in Lungs
EM : Normal Cell & Reversible Injury
EM : Normal Cell & Reversible Injury
Caseous Necrosis in Lungs
L
2626 L MV A
MV NEET
NEETPGPG/ INI-CET
/ INI-CETWORKBOOK
WORKBOOKBYBYDR.
DR.PRAVEEN
PRAVEENKRKRGUPTA
GUPTA
B

DNA Electropheresis C
A : NORMAL
B : APOPTOSIS
C : NECROSIS

A B

20
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BY DR. PRAVEEN OneShot • Vol-1 • v3.0 • ©2025
KR GUPTA
26 NEET PG / INI-CET WORKBOOK BY DR. PRAVEEN KR GUPTA
 General pathology

b APOP: Mechanism:
I.P
cell
Injury + Apop sensors EP (Site: Thymus)
(Bim, Bid, Bad, Noxa, Puma) FAS-L [TNF]
+
FAS [TNFR/CD95]
proapop Anti apop +
BAK BCL, BCL-XL FADD
BAX MCL-1
(L:long life)
Extrinsic
{ Cyt - C
8
Eight

+ APAF+
Apoptosome
CAPSASE 3,6
[9 3,6]
3,6

protein break- Endonuclease

down achivation
(Cleave asparatic acid)
Engulfed by
Apop Body Macro
N N

efferocytosis

N Feature A
Size
damage outline Intact
Lysis Chromatin Condensation
+ Inflam –
Lysosomal Enz Caspase

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 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Inflamation 6. INFLAMMATION
cellular events:
Bombay group
LAD-2 (AR)

Sialyl lewis-x-gp Integrins β1 (AR)

Integrins
1 2 3 β2 LAD-1

PECAM-1
4 (CD31)
Selectins
1.Margination
2.Rolling ICAM 5 6
3.Adhesion VCAM
4.Transmigration / Diapedesis
5.Chemotaxis: C(5a, (ao)
LTB4 (Before) Phagosome
IL-8
Bacteria
6. Phagocytosis: Recognition , opsonization engulfment
obsonin: LYST gene
• C3b, C4b, C5b Chediak Higashi
• IgG, Synd.
• C RP
fibrinogen
7. Killing

7a. O2 independent: Lysosomal Enzymes

O2
7b. O2 dependent:
Phagocytic

NADPH / oxidase
PHOX gene O2 cyto
mut: ch. SOD
-No Mito Fentons
granulomatous ONOO H O Fe Fe3+ + OH.
2+

ds 2 2
Cell death
MPO halide Ferroptosis

OCL

OCI most efficient Bactericidal Ion

H2O2-MPO-halide: most efficient bactericidal System

Cytokin : Acute Inf: IL-1 , TNF- α
IL - 17, 22,23
Antinflam
Chronic in : IL-12 TGF - β +
Repair
IFN-γ

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 General pathology

Necrotic granuloma

Necrotic granuloma

on Non Necrotizing Granuloma

Necrotic granuloma
n Non Necrotizing Granuloma

Keloid & Hypertrophic scar

K H.S
Time >2 month <2 month
cation Non Necrotizing Granuloma
Collagen I > III III > I
Reuilrance ++ +
Regness not can
Site Sternum, Pinna, any where
Keloid & Hypertrophic scar
Shoulder
Colour Darker Same as
Shin
Rx: Thimciloneing Reasource
Amyloidosis : Apple Green birefrigence + Surgical

Keloid & Hypertrophic scar

Amyloidosis : Apple Green birefrigence

A Amyloidosis : Apple Green birefrigence

A
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 Cytokin : Acute Inf: IL-1 , TNF- α
IL - 17, 22,23
DR BH
PATHOLOGY Antinflam MEDICAL COACH
No.1 PG Medical Coachi

Chronic in : IL-12 TGF - β +

Repair
IFN-γ
7. IMMUNE SYSTEM

Homogenous Nucleolar Centromere Speckled

Dna SLE RNA Centromere Ab Smith Ab DNA

Histone Ab Polymerase Ab CREST SS-A(RO) SS
Drug Sue diffuse SSC SS-B (La) Diffuse

Scl-70 Ab SSC
(Topo)
U RNP Ab MCID

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 General pathology

Graft Rejection
Graft Rejection
Hyperacute Acute Chronic
Time min - hrs Day - wks >6m
Mech: preformed Post Tx Post Tx
Type2 Type4
antidonar HLA
Ab med T cell
Type2 Ab in receipient Type2
(Prior: Blood/ T cell med
organ Tx)

Ab : C4d dep Organ fibrosis

Biopsy : Dense Neutro ++
: Thrombotic occlusion Tcell: CD3+T +
: Fibrinoid Necrosis Cells Atrophy

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 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Amyloid: Amylose (Starch Like)

Abdominal fat
Bx:
Rectal Bx
localized Generalized
Calcification Non Necrotizing Granuloma
1. Alzheimer's –Aβ
1 2
2. Medullary Ca Thyroid: A cal AL: Myeloma
3. Insulinoma - AaPP Chronic inflam
4. Isolated Arial - A ANP Auto Immune
Malignancy
AA
mc: kidney
.NS
(mc: death) Familial Others
ome Heat Arythmia
Restrictive CM
cal Mediterranean Cardiac Senile dialysis
Spleen: Red: Lardaceous Fever amyloid asso
Keloid & Hypertrophic scarATTR
White: SAGO Serum polyneuropathy Aβ m
mut 2

A amyloid ATTR
unmut /wild

EM:unbranching fibrils, X-ray Crystallography: β pleated sheets

Specific stain: Congo Red – Apple green biref ningence

Amyloidosis : Apple Green birefrigence

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 General pathology

1o Immunodeficiency Diseases
HSC XR > AR
IL - Rmut > ADA def
Common Common Serene
no B/ T/ NK
myeloid lymphoid Combined
Cells
Immuno Def
Pro B Pro T ProNK SCID

Pre B BTK mut (XR)

Brutons-X- agammaglobulinemia
B- Blast
BAFFmut:
B-lymph ocyte Common Variable
Immune def

IgM PC Isotype/Class Switch

CD40 def
PC Hyper IgM Syndrome

IgG A D E

selective IgA def

JOBS: STAT 3 mut

F- Face: Coarse facial
A- Abscess: Cold abscess: Staph aureus
T- Teeth: Abn 1o Teeth
E- Eczema, IgE

Di George Synd: 3rd/4th ph. pouch

CATCH 22
microdel of Chr22q Velo Cardio facial defect :
C - Clefs palate
A - Anomalous face
T - Thymus hypoplasia: T Cells
C - Cardiac defects
H - Hypo Ca

BLS: Bare lymphocyte synd

Type I II mc
Defect: Absent MHCI MHC II

CD8T Cells CD4T

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 DR BH
MEDICAL COACH
PATHOLOGY GENETICS No.1 PG Medical Coachi

GENETICS
Punch Biopsy GENETICS Turners
Punch Biopsy
Punch Biopsy Turners
Turners
Punch Biopsy Turners
PATAU Syndrome

Skin Area to
Cleft lip/palate be removed
Skin Area to "CRAMP"
Renal abnormalities
Fat be removed
Lesion
cArdiac defects
Fat Shield shaped chest
Microcephaly Low posterior with widely spaced
Lesion
Mental retardation Webbed neck nipples
hairline Shield shaped chest
Skin sample
Polydactyly is removed Low posterior with widely spaced
Webbed neck hairline nipples
Skin sample
is removed

FNAC
13 letters = Trisomy 13
FNAC D E
FNAC PATAU Syndrome
FNAC Lymphedema of hands & feet
Microcephaly D E
Mental retardation
Lymphedema of hands
Edwards & feet
Syndrome
cleft lip / palate Edwards Syndrome
malformed ears Edwards
Edwards Syndrome
Syndrome
Cardiac defects

Renal problems Overlapping

polydactyly or Fingure
extra fingers
Undescended or
abnormal testes Rocker bottom foot

DOWNS Syndrome
DOWNS Syndrome
DOWNS Syndrome
CLINODACTYLY

DOWNS Syndrome
CLINODACTYLY

Rocker-
Bottom Foot
a

Mongoloid slant
Epicanthic folds
Depressed nasal bridge Sandle gap Simian crease

Downs
Mongoloid slant
Epicanthic folds
Downs
Downs 29
Depressed nasal bridge Sandle gap Simian crease

Downs

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 CLOWNS

General pathology

GENETICS
GENETICS
GENETICS
CLINODACTYLY CLOWNS
CLINODACTYLY

Mongoloid slant
Epicanthic folds
Depressed nasal bridge Sandle gap Simian crease

Trisomy 18 (Edwards syndrome)

Mongoloid slant
Mongoloid
Epicanthic folds slant
"ROCKY Mountain”
bridgefolds Sandle gap
Epicanthic
Depressed nasal Simian crease
Depressed nasal bridge Sandle gap Simian crease • R: Rocker bottom foot
• O: Overlapping fingers
Trisomy 18 (Edwards syndrome)
• C: Cardiac defects
Trisomy 18 (Edwards syndrome)
• K: Kidney malformations
"ROCKY Mountain”
"ROCKY Mountain”
• R: •Rocker
Y: MicrocephalY
bottom foot
• R: Rocker bottom foot
• O:•Overlapping
M: Mental fingers
retardation
• O: Overlapping fingers
• C: Cardiac defects
• C: Cardiac defects
• K: Kidney malformations
• K: Kidney malformations
• Y: MicrocephalY
• Y: MicrocephalY
• M: Mental retardation
• M: Mental retardation

1 2 3 4 5

1 2 3 4 5
61 72 8 3 9 10 4 11 5 12

6 7 8 9 10 11 12
Shield shaped chest 136 147 15
8 9 16 1117 12 18
10
Low posterior with widely spaced
hairline nipples
Shield shaped chest 13 19 1520
14 16 X Y 18 21 22
17
Webbed neck Shield
with widely shaped chest
spaced 13 14 15 16 17 18
Low posterior
Low posterior
hairline with widely spaced
nipples 19 20 X Y 21 22
Webbed neck nipples
Webbed neck hairline 19 20 X Y 21 22

D E
D E
D Lymphedema of handsE& feet
Lymphedema of hands & feet
Lymphedema of hands & feet

30 30 NEETNEET PG / INI-CET
PG / INI-CET WORKBOOK
WORKBOOK BY DR. PRAVEEN
BY DR. PRAVEEN KR GUPTA KR GUPTA
30 DBMCI OneShot • Vol-1 • v3.0NEET
• ©2025
PG / INI-CET WORKBOOK BY DR. PRAVEEN KR29GUPTA
 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

TUMOR MARKERS

Selected Tumor Markers

Tumor Markers Tumor Types
Hormones

Human chorionic gonadotropin Germ Cell Tumor-Ovary, Testis

Calcitonin MCT medullary Ca Thyroid

Catecholamine and metabolites Pheochromocytoma

Ectopic hormones Paraneoplastic Syndrome

Oncofetal Antigens

a-Fetoprotein (AFP) a-Fetoprotein sac tumor HCC

Carcinoembryonic antigen Ca Colon, lungs

Lineage- Specific Proteins

Immunoglobulins Multiple myeloma [G>A>M>D>E)

Prostate-specific antigen and Prostate Adeno Ca

prostate-specific membrane
antigen
Mucins and other Glycoproteins
CA-125 Ovarian (Epithelial Tumors)
CA-19-9 Pancreatic Ca

CA-15-3 Breast Ca

Cell-Free DNA Markers

EGFR mutants in serum
TP53, APC, RAS mutants in
stool and serum
30 DBMCI OneShot • Vol-1 • v3.0 • ©2025
TP53, RAS mutants in stool and
serum
NOTES
NOTES
 Systemic pathology

Section
Systemic Pathology
03
SYSTEMIC
SYSTEMIC PATHOLOGY 8. RESPIRATORY SYSTEM
PATHOLOGY
Ch.pul.ds:
FEV1FEV1
Ch.pul.ds: >70%>70%
(>0.7)(>0.7)
FVC FVC
Obstructive FEV1 ↓↓(<0.7)
Obstructive FEV1FVC↓↓(<0.7)
FVC

1 Emphysema 2 Athma 3 Ch-Bronchitis 4 Bronchiectasis

1 Emphysema 2 Athma 3 Ch-Bronchitis 4 Bronchiectasis
Irrev Reversible Irrev Irrev
Irrev Reversible Irrev Irrev
Acinus Bronchus Bronchus Bronchus
Acinus Bronchus Bronchus Bronchus
Centi mc Pan • 3C Sputum >3m of lower
Centi mc Pan prox + distal
• 3C Sputum >3mproductive
of lower
Lobe
prox acinus • Charcot leyden Lobe
prox acinus prox + distal • Charcot leyden productive
cough in last ↓
Crystals cough in last ↓ dilated/
Apex lung Base Crystals 2 consecutive years
Apex lung Base Q • Creola Body 2 consecutive years dilated/
destroyed
• Creola Body Resp cells
damaged Reid index destroyed
Bronchus
Smoking Ethiology Q
Emphysema
∝1 AT def damaged Resp cells Reid index
• Cushman >0.4 Bronchus
Smoking Ethiology ∝1 AT def >0.4 Ethiology:
• Cushman spiral • Squamous
spiralImpacted mucin • Squamous
metaplasia Ethiology:
• Foreign Body
Impacted metaplasia • Foreign Body
• Direct B/V/F/
Ethiology: Smoking ∝ AT def pugs mucin
pugs• Remod of Bronchus • Smoking • Direct B/V/F/
Aspergillus
Ethiology: Smoking ∝ AT def
Aspergillus
• Congenital
• Remod Typeof 1Bronchus
hsn • dust
• Smoking – Cystic fibrosis
• Congenital
Type 1 hsn • dust – Kartagener
– Cystic fibrosis synd
– KartagenerSynd
– Young synd
– Young Synd
Sputm findings in Bronchial Asthma

Charcot Leyden Creola bodies

crystals

Curschmann spirals

Emphysema

Sputm findings in Bronchial Asthma

DBMCI OneShot • Vol-1 • v3.0 • ©2025 33
 Schauman
Sarcoidosis
DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Asteroid
Pneumoconiosis : Injury α amount, duration, smoking
α 1
Size
Coal mc
Silicosis Asbestosis
(Anthracosis) Black

Dust Coal Crystalline Injury Amphibole

Crochidolite
Lung UL UL LL
CAPLAN (1st + seen) + +
(P + RA)
TB

Pleura +
lung ca
PMF ++ + +
Morpho: Black pig: B/L HILAR L.Node Pl Plaque/
Anthracotic Xray: Eggshell effusion
calif lung fibrosis
m/e: Coal deposit collagen nodules
Asbestos Body
Ferrugenous Body
Asbestos + Iron protein

Granuloma
non Casealing Lupus Pernio Cavitation
Schauman Well diff Sq. cell C
Sarcoidosis Sheek
Kebab app

Asteroid

Black

Well diff Adenocarcinoma

34 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Systemic pathology

Lung Ca: Smoking, Ni, Cr, cadmium, Radon

Non Small Cell Ca (NET)

Neuroendocrine tumor

Sq. cellca Adenoca

MC: Smokers Benign Malignant
me: Non-smokero
Carcinoid • Atypical carcinoid
Cf : 2C Hyperca India ,World
• SCC
Cavitation Me: Malig Gland+
m/e: Nests • LCC
M/e: Keratin pearl Mucin
IHC: CK Small Cell Ca : Max paraneoplastic
• p40/p63 (exc Hyperca)
1HC: CK m/e:
worst prog
NAPSIN 99% in smokers
TTF-1 • Spindle Azzopardi

IHC: S,C,NSE,56,INSM-1
Site: Bronchus

EM: Serotonin
Diarrhea + flushing + Cyanosis,
Carcinoid Synd
Cavitation
Well diff Sq. cell Ca

K.P

Well diff Adenocarcinoma

DBMCI OneShot • Vol-1 • v3.0 • ©2025 35

 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

9. LIVER
Hepatitis

Surface Ag HBSAg: s'gene

HBV: envelop Ag HbeAg : pre c'gene
Core Ag HBC Ag: c'gene

DNA
Acute HBV
Infection SAg + : Infected SAG - : Recovery
Ig MHBCAb IgGHBCAb
S Ag
HBe Ag HBeAb
e AG IgM
C Ab
HBS Ag
e Ab HBSAb

S Ab HBV
DNA: Earliest
SAg SAb+ marker
o

1 Acute hep B
Infection: HBS Ag (1st macher)
HBeAg: Infectivity (HBVDNA )
IgM HBC Ab

2 Recovery: HBSAg –

Recent: IgM HBC Ab HBC Ab +/–

Remote: IgG HBC Ab HBe Ab +/–
3 Core window: HBSAg –
HBSAb–
IgM HBCAb+

4 vaccination HBS Ab > l0milli IU/mL

5 Mut:
a surface mut: HBSAg +
HBSAb +
b Pretene mut : HBeAg –
HBV DNA
Chronic: HBSAg +>6m
HBeAg
IgGHBCAb

Carrier: HBSAg + (only)

No symptoms

36 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Systemic pathology

10. KIDNEY

Renal Cell Ca:

RCC:
Clear Ca Papillary Ca
Origin: PCT DCT , PCT
mut: VHC (3p) MET(7p):
Tri 7, 17, loss of YGN
IgA nephropathy / Mesangioproliferative

m/e: Chromophilic

Glycogen / lipid
A Other Orgin
B prog m/e
Plant cell
3. Chromophobic – CD good
app
4. Belini duet Ca – CD Poor

Hob Nail

Renal Cell Carcinoma

Clear
Vacuoles

Pathology - Nodular Pathology - Diffuse

DBMCI OneShot • Vol-1 • v3.0 • ©2025 37

 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Glomerulonephritis :

Nephritic
LM EM FM
1- PSGN Max Endo+ Starry sky
Exo Capillary
Sub ep. Humps
Prolif

2. IgA nephro Mesangio – Mesangial IgA>G,M +C3

proliferation – deposit in mesangium

3. MPGN Prolif of GBM I-Sub endothelial Granular

mesangium + Tram
C deposit
Capillary Track app
II -Intramemb
C
Dense deposit ds
4. RPGN Cresents Rupture of GBM I- linear
Gross: flea Bitten II- Granular
III- X
Nephrotic

1. Minimal
change ds
effacement of F.P
of podocyte
Diffuse
2. Membranous Granular
GBM
GN deposits
thickenning
Spike Dome
3. Focal Fibrosis
IgG/M+C3 in
Segmental <50%) of
Sclerosed
Glom- glomerle (f) Effacement part
Sclerosis involving
part(S)

38 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 P P

CL e
Systemic pathology
A
US
Humps
CL
Pathology - Nodular Pathology - Diffuse
C

Part MCD
<So% ← FSGS

1
2 3

IgA nephropathy / Mesangioproliferative GN

A B

RPGN

Flea bitten
kidney
Renal Cell Carcinoma

Clear
Vacuoles
Cresents

G.P.S
l
mla A B linear
qra

Pathology - Nodular Pathology - Diffuse

D E

DBMCI OneShot • Vol-1 • v3.0 • ©2025 39

No change EM N
 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

11. HEART
Morphological changes of MI

Time Gross LM EM

<30 min (Rev) — — • loss of M.V

• Blebs, organelle Swell

• Pyknosis; Relax of
myofibrils

30 min-4 hv (Irrev) — Waviness of myofibrils • large flocc density (Ca)

• Myelin figures (PL)

12hr 24hr Red • N

 ecrosis-Starts Neutro - —
appear

d1 - d3 Red • N
 ecrosis ++ —
Neutro ++/Brisk
yellow

d3 - d7 yellow • M
 acrophages appear —
(engulf debris)

d7 - d14 Red • G
 ranulation tissue —
(FB+ vessel)

>d14 Grey • Collagen appears —

TPTC test in MI
TPTC test in MI
IE
IE

A-72-58

A-72-58
Day 3 MI RHD
Day 3 MI RHD

Fish Mouth Appearance

Day 7 MI
Fish Mouth Appearance

Day 7 MI

40 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Systemic pathology

Rheumatic Heart Disease

Pancarditis
Peri-carditis Endo
Myo all 3 layer LA
M. Regurgitation
Aschoff Body Mitral
M
L. A Size
MC Callums patch
LV

Bread/Butter
Serofibrinous Anitschkow
Cell Chronic
Pericarditis Commissural
M. Stenosis fusion
Fish mouth

Fusion of cords

VASCULITIS :
Intlammation of vessels Small

Classitication:

Intlammation of vessels
Large Medium Small
Type 4 Immune complex (ANCA) Pauciimm

ClassiticG:
atiGiant
on: cell arteritis P: PAN-type 3 HSP Chrug straus
Type 3 Type 2&4
T: Takayasu arteritis K-Kawasakids - type 2 hSn SLE Wegener's
(anti endo Ab) granulomato
Large Medium Type 2
Type 4 Immune complex (ANCA) PauciimmuneMicroscopic

G: Giant cell arteritis P: PAN-type 3 HSP Chrug strauss

Type 3 Type 2&4
T: Takayasu arteritis K-Kawasakids - type 2 hSn SLE Wegener's
(anti endo Ab) granulomatosis
Type 2
Microscopic polyangitis

DBMCI OneShot • Vol-1 • v3.0 • ©2025 41

 C
IE
Vegetations
DR BH
PATHOLOGY IE MEDICAL COACH
Ashoff Body No.1 PG Medical Coachi

C
Vegetations

A-72-58

A-72-58
RHD
RHD- Rheumatic heart diseases IE- Infective endocarditis
RHD- Rheumatic heart diseases RHD
IE- Infective endocarditis

Anitschkow Cells
Anitschkow Cells

37 37

NBTE- Non bacterial

NBTE- Non bacterial LSE- Libman-Sacks endocarditis
thrombotic endocarditis LSE- Libman-Sacks endocarditis
thrombotic endocarditis

Fish Mouth Appearance

Fish Mouth Appearance

Ashoff Body

Ashoff Body

ocarditis

Anitschkow Cells

arditis
37

endocarditis Anitschkow Cells

docarditis
42 DBMCI OneShot • Vol-1 • v3.0 • ©2025
 Systemic pathology

12. GASTRO INTESTINAL SYSTEM

Colorectal polyps:

Sessile Pedunculated

Hyperplastic Malignant
Benign Inflammatory
Hamartomatous
Adenomatous
M/e: dysplasia

Juvenile Peutz-Jeghers
<5 yr age >5 yr

Rectum Site Jejunum

Tubular Villous T–V

SMAD-4 Mut STK-11/p53
(most invosive)
Rectal Bleed C.F Perioral hyperpig
Size ∝ Malig
AD Synd AD
(premalig) FAP:
mut: APC(5q); AD inh

number >100 →100% Risk of Adenoca

m/e:
Syndrome of FAP

Turcot
Gardner
(Turban)
Arborizing Pattern FAP
Brain tumor
Osteoma
MB/GBM
Odontoma ( Teeth)
Desmoid

Attenuated FAP: polyp ≈ 60

Mut: MYH
HNPCC/LYNCH Synd
Mut: MSH/MLH

DBMCI OneShot • Vol-1 • v3.0 • ©2025 43

 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

INTESTINAL MALABSORPTION SYNDROME:

1. Celiac disease :

• Hypersensitivity to Gluten

• HLA DQ-2/B-8

Pancreatic Enz
Duodenum

Villi

CD8t

Th
Deamidated gliadin

APC
HLA

IgA anti TTG Ab: most sensitive, cross reacts e skin Ag Dermatitis herpetiformis

IgA anti Gliadin Ab:

IgA anti Endomysial Ab: most sp

44 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Systemic pathology
Juvenile Polyps large gland
Juvenile Polyps mucin large gland
mucin

Peutz
Jegher's Peutz
Polyp Jegher's
Polyp

Arborizing Pattern
1 2 Arborizing Pattern
1 2

FAP

DBMCI OneShot • Vol-1 • v3.0 • ©2025 45

 Antoni B DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

Hypocell

13. CNS TUMOR

Benign Most Malig

CNS Tumors: WHO Grade I , II , III , IV

Meningioma Medulloblastoma
Glioma
Gr IV
Gr I/II/III
PNET, Cerebellum
NF-2
Astro Oligo- NF-2
Cellular
cytoma dendroglioma Ependymoma m/e:
(Gr II) (Gr II) Antoni A
Psammoma
Homer Wright
Medulloblastoma Homes coright Body
pseudorosette
Site: Frontal 4th Ventricle/
spinal canal
Calcif ++

m/e: Rosette

Dystrophic
Antoni B
Calcification
Fried egg Hypocell
True Pseudo

Dura Tail Sign Medulloblastoma

Astrocytoma Schwannoma
Gr I IV

Pilocytic Glioblastoma
Medulloblastoma Homes coright
Cerebrum

Site: Cerebellum
m/e: Rosenthal
fibres P
pa seu
lis do
ad Necrosis
in
g

Dura Tail Sign Medulloblastoma

46 DBMCI OneShot • Vol-1 • v3.0 • ©2025
a
Homer Wright
pseudorosette Systemic pathology

Astrocytoma Schwannoma
Gr I IV
hic Glioblastoma
Pilocytic
tion
Cerebrum

Site: Cerebellum
m/e: Rosenthal
fibres P
pa seu
lis do
ad Necrosis
in
g

Schwannoma

Cellular
m/e: Verocay

Antoni A

A
Antoni A

Antoni B
hypocellular : Antoni
Hypocell
B

Homes coright

DBMCI OneShot • Vol-1 • v3.0 • ©2025 47

 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

14. ENDOCRINE

• CAPSULE

Thyroid Ca: Risk: Radiation exp: PTC > FTC FC

Colloid
Multinodular Goiter : FTC > PTC ‘C’ cells

MC 2nd mc 5% Rare
Papillary Ca (PTC) Follicular Ca(FTC) Medullary Ca Anaplastic

Origin: Follicular Cell (FC) (FC) ‘C’ cells undiff

Mut: BRAF RAS, PI3K RET p53

(Men2A/B)

m/e: Amyloid
Papillary Cathyroid Anaplasia
ACal
(Calcitonin)
Pseudo Inclusion
Capsular
Orphan annie nuclei
grooves Invasion

Psammoma Body

Papillary Cathyroid A

B
Vessels
Papilla

B
48 DBMCI OneShot • Vol-1 • v3.0 • ©2025
Vessels
Papilla
 Capsular
invasion Systemic pathology
Follicular Ca Thyroid
Capsular
invasion
Follicular Ca Thyroid

CAPSULE

CAPSULE

Follicles

Follicles

Medullary Ca Thyroid

Medullary Ca Thyroid

A
A

A A
A

A
A
A
A

A
A

DBMCI OneShot • Vol-1 • v3.0 • ©2025 49

 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

IMAGE 1
IMAGE 1
Identify
Identify and mention and
uses? mention uses?

50 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Systemic pathology

IMAGE 2

CASE: “ ”

CASE: “ ”

DBMCI OneShot • Vol-1 • v3.0 • ©2025 51

 DR BH
MEDICAL COACH
PATHOLOGY No.1 PG Medical Coachi

IMAGE 3
A 55-year-old female patient having large adnexal mass and abdominal
discomfort. Ovary was removed, morphology of which has been shown
below. Identify the type of tumor?

CASE: “A” CASE: “B”

Granulosa all Tumor
Teratoma (Dermoid Cyst)
Call Exner Body

Hair

Rokitansky protuberance

CASE: “C” CASE: “D”

Reinke Crystalloids
Vesdo Hilus Cell Tumor/
Shillar Tumor Leydig cell tumor
Derval Body

52 DBMCI OneShot • Vol-1 • v3.0 • ©2025

NOTES
NOTES
PSYCHIATRY
Sl. No. CHAPTER Page No.
1. Delusional Disorders 59
2. Schizophrenia 61
3. Mood Disorders 65
4. Neurosis 69
5. Eat, Sleep, Sex, Personality Disorders 73
6. Substance Use 79
7. Psychopharmacology 83
8. Peadiatric 91
9. Psychology 95
10. Delirium and Dementia 99
11. Forensic and Community Psychiatry 103
12. Mental Status Examination 105
 PSYCHIATRY

Delusion Hallucination Illusion

False Perception without a stimulus Misinterpretation of stimulus

Fixed

Firm beleif

Subjective certainity

Outside ones socio cultural

background

Reference - People are plotting against me

Persecution - People are talking about me

Nihilsm - I dont exist, the whole world is going to die (INI-CET MAY 2023)

Grandiosity - I have extra ordinary powers

DBMCI OneShot • Vol-1 • v3.0 • ©2025 57

NOTES
 Delusional disorders

Chapter
Delusional Disorders
01

1. Othello Syndrome

• Substance--

2. Declerambault Syndrome

3. Cotard Syndrome

(INI-CET MAY 2023)

4. Ekboms Syndrome

5. Delusion of Doubles

◊ Capgras--

* Familiar Person Replaced by Non Familiar Person

◊ Fregoli

DBMCI OneShot • Vol-1 • v3.0 • ©2025 59

NOTES
 Schizophrenia

Chapter
Schizophrenia
02

Prognosis and Types

Treatment

Prognosis Type
Catatonia Best
Paranoid Better
Undifferentiated Good
Hebephrenic Bad

Disorganised
Simple Worst

Catatonia (INI-CET 2020)

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 DR BH
MEDICAL COACH
PSYCHIATRY No.1 PG Medical Coachi

(INI-CET 2020)

Factors Prognosis Factors Prognosis

Gender Duration of untreated
psychosis less
Age of onset Treatment compliance
Responds to treatment
Type of onset Developing country
With stressor Emotional support
With family history of psychosis
With family history of mood
disorder
Positive sx
Negative sx
Affective sx

62 DBMCI OneShot • Vol-1 • v3.0 • ©2025

NOTES
NOTES
 Mood disorders

Chapter
Mood Disorders
03

Duration Criteria

• Beck’s triad

• Melancholic depression

• Atypical depression

• Winter depression

• Mild depression==

• Severe depression with psychosis

• Severe depression with suicidal ideas

DBMCI OneShot • Vol-1 • v3.0 • ©2025 65

 DR BH
MEDICAL COACH
PSYCHIATRY No.1 PG Medical Coachi

Verguath Fold

Omega Sign

Coorugtor and Procerus

Triangular Palpebral Fold

• Melancholic Depression-- Intense Misery-- NEET 2019

Atypical Depression May AIIMS 2018

• Neuro Transmitters-- Serotonin and Nor Epinephrine

• Psychological Model--

66 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Mood disorders

• POST PARTUM BLUES

◊ 75%

◊ Irritability, Tearfulness, Worries

◊ No Treatment

◊ Emotional Support, Sleep Regualtion

• MANIA -- NEET 2021

◊ Increased Mood

◊ Over Familiarity

◊ Pressure of Speech

◊ Flight of Ideas

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 DR BH
MEDICAL COACH
PSYCHIATRY No.1 PG Medical Coachi

68 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Neurosis

Chapter
Neurosis
04

OCD

• Disorder of Thought --possession (INI-CET 2020)

• M.C Obsession-- contamination, pathological doubt (AIIMS 2018)

• M.C Compulsion--checking

• Neuro Anatomy--OFC, Cingulate, Caudate

• Comorbidity--depression (INI-CET 2021)

• Prevelance 2-3%- (INI-CET MAY 2022)

• Pharmacological --SSRI

• Non Pharmacological--ERPT - (INI-CET JUN 2021)

• OCRD- (INI-CET JUN 2021)

◊ OCD

◊ Hoarding-- Least Improvement with ERPT (NEET 2019)

◊ Trichitallomania-- Trichobezor

◊ Excoriation Disorder

◊ Body Dysmorphic Disorder (NEET 2024)

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 DR BH
MEDICAL COACH
PSYCHIATRY No.1 PG Medical Coachi

• Panic Attack-- (NEET 2018) (NEET 2020) (NEET 2023)

◊ Sx-- Palpitation, Breathlessness

◊ Substance Intoxication-- Cocaine

• Phobia

◊ Nyctaphobia- Darkness

◊ Systematic Desensitization- Joseph Wolpe

• GAD (INI-CET NOV 2022)

◊ Free Floating Anxiety

◊ Excessive Worries

• Conversion Disorder

◊ Psycolgical Pain to Neurological Sx

◊ Females

◊ Does Not Follow Neurology Anatomical Basis (INI-CET NOV 2022

◊ LA Belle Indifference--Apparent Inconcern (INI-CET MAY 2023)

◊ Hoovers Sign

(a)

Push down with

your right heel

No effect

(b)

"Lift your left leg

Right hip extends

◊ Astasia Abasia

70 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Neurosis

• Adjustment Disorder- (INI-CET NOV 2020)

(INI-CET NOV 2020)

• PTSD (INI-CET 2022)

◊ Flashbacks, Autonomic Arousal, Avoidance, Low Mood

◊ EMDR

Type Of Disorder Presenting Sx Ask For

Somatization Disorder Somatic Sx Treatment
Hypochondriasis Comes With Fear of Illness Investigation

Type Of Disorder Basic Underlying Need

Manchausens Sx Produce Sx Sick Role
Manchausen by Proxy Produce Sx on Loved Ones Sick Role
Malingering Produce Sx Money Benefits
Gansers Sx Produce Sx Exempted FRPM Court Duty

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 DR BH
MEDICAL COACH
PSYCHIATRY No.1 PG Medical Coachi

72 DBMCI OneShot • Vol-1 • v3.0 • ©2025

 Eat, sleep, sex, personality disorders

Chapter
Eat, Sleep, Sex, Personality Disorders
05
Eating Disorders
Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder
LEAN Binge+ Purging behavior EATING FAST

Body image disturbance (INI-CET NOV 2022) EATING MORE

BMI- LESS THAN 17.5 EATING FULL

AMNEORRHEA CRITERIA Electrolyte abnormalties

removed

Refeeding syndrome to be
avoided

Restrict wash room 2hrs after RUSSELS SIGN

meals (AIIMS 2019)

Increased

Cortisol CRH, ACTH

BUN

LFT

Russell's Sign

Parotits

Dental enamel erosion

SCOFF QUESTIONERRE

(INI-CET MAY 2023)

Post Partum Blues Post Partum Depression Post Partum Psychosis

(NEET 2022)
Tearfulness 14 days Psychotic sx

Mood swings Depression

Sleep decreased Suicidal ideas

Appetite decreased
Emotional support Brexenalone

Sleep regulation Zuranalone

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 DR BH
MEDICAL COACH
PSYCHIATRY No.1 PG Medical Coachi

Sexual Disorders
Desire Exitement Orgasm Resolution
HYPO ACTIVE SEXUAL ED PME shortest phase of POST COITAL
sexual response cycle DYSPHORIA
DESIRE DISORDER

Treatment

BUPROPION

• ED

◊ Phase of Sexual Cycle-- Arousal

◊ Pharmacological

◊ Psychological Treatment--Master and Johnson/ Dual Sex

• PME

◊ Phase OF Sexual Cycle-- Orgasm-- (NEET 2019)

◊ Pharmacological Treament

◊ Psychological Treatment-- Squeeze Technique (NEET 2023)

• Exhibitionism- (NEET 2021)

• Gender Dysphoria/ Gender Identity Disorder

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 Eat, sleep, sex, personality disorders

Eonism (NEET 2024)

Images (INI-CET MAY 2022)

Hypnogram
Awake
REM

1
Sleep
Stage 2

0 1 2 3 4 5 6
Hours In Bed

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 DR BH
MEDICAL COACH
PSYCHIATRY No.1 PG Medical Coachi

N REM REM
Muscle tone is present Absent

Initial part of the sleep Late part of sleep

Somnambulism (NEET 2019)

Night mare
Night terrors   

Narcolepsy

Cataplexy

Hypnogogic hallucinations

Sleep paralysis

Sleep attacks

Hypocretin and orexin

Modafinil and psychostimulants

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 Eat, sleep, sex, personality disorders

RLS Gabapentin

Rotigatone

Pramipexole

Ropiniole

Personality Disorders
Cluster A Cluster B Cluster C
PARANOID HISTIRIONIC ANXIOUS

  Seductive

   Centre of stage

SCHIZOID    Multiple superficial DEPENDENT

Relationships
(AIIMS 2018)  

– Born loners
NARCISSTIC ANAKASTIC
– Cold
ANTI SOCIAL __ (NEET 2024)
– Alone
No guilt

No shame
SCIZOTYPAL
Police cases

Criminal

Substance

BORDERLINE

Impulsive

SUICIDAL IDEAS

EUPD

SPLITTING

Black and white thinking

DBT

Marsha lienhan

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NOTES
 Substance use

Chapter
Substance Use
06

Alcohol

• 72 Hours--delirium tremenS (NEET 2018)

(NEET 2021)

• Infection Sudden Stopping (NEET 2019)

• Wernicke Encephalopathy-- Global Confusion, Ophthalmo Plegia and Ataxia

(NEET 2023)

• First treat with THIAMINE AND THEN GLUCOSE (NEET 2024, AIIMS 2020)

• Korsakoff Psychosis- Anterograde Amnesia+ Confabulation

(INI-CET NOV 2021)

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• Detoxification (INI-CET NOV 2022)

• Chlordiazepoxide- Normal LFT

• Lorazepam- Deranged LFT (AIIMS 2020)

• Deaddiction (INI-CET NOV 2022)

◊ Naltrexone, Acamprosate

◊ Disulfiram-

• 250 mg

• No antic craving property

• Blocks acetaldehyde dehydrogenase

• Causes allergic reaction (NEET 2024)

Nicotine

• NRT

◊ Gums- Avoid Taking Coffee

• Drugs

• Vareniciline- Alpha 4 Beta 2 Partal Agonist (NEET 2024)

◊ Drug Of Choice

◊ Bupropion- Both Antidepressant and Anti Craving

Opiods

• Heroin, Morphine

• Opiod Intoxication (INI-CET NOV 2024)

◊ Pin Point Pupil, Respiratory Depression

◊ Iv Naloxone

• Opiod Withdrawal

◊ All Orifices Bleed, Mydriasis

◊ Symptomatic

• Detoxification

◊ Buprenorphine (NEET 2024)

◊ Methadone

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 Substance use

• Deaddiction

◊ Naloxone

◊ Naltrexone

◊ Nalmefene

• Cocaine

◊ Snorting

◊ Panic Attack

◊ Tactile Hallucinations

• Hallicinogens

◊ Lsd- Yellow Sunshine

◊ Pcp-Angel Dust

◊ Ketamine-Anti Suicidal

◊ Synesthesia, Bad Trips, Flash Backs

• Inhalants

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NOTES
 Psychopharmacology

Chapter
Psychopharmacology
07

Anti psychotics

◊ Maximum Weight Gain

◊ Least Weight Gain

◊ Trs

Clozapine (NEET 2024)

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Risperidone (NEET 2018)

Type Presentation Treatment

Dystonia Im Promethazine

Torticollis Benztrophine

Prophylactic Thp (Tri

Hexyphenidyl)
Akathisa Restlessness Propanalol
EPS Parkins Sx Tri Hexy Phenidyl

(NEET 2020)
Tardive Dyskinesia Chorea Movements Tetra Benazine

Super Sensitivity Of Receptors Val Benazine

Neuroleptic Malignant Syndrome 106 F 1.

CPK Elevation 2.

Myoglobinuria 3. Dantrolene

Delirium 4. Levodopa, Bromocriptine

5. ECT

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 Psychopharmacology

Long Acting - Z Track (AIIMS 2019)

Class Names Side Effects

MAOI Phenelezine, Tranylcypromine Cheese Reaction     
TCA Amitriptilline Suicidal Thoughts

Imipramine (INI-CET 2020)

Clomipramine Hyperthermia

Arrythmia Sodium Bi
Carbonate

Manic Switch
SSRI Paroxetine Low Apgar Score Adhd

Dapoxetine Vivid Dreams Delayed Milestones

(AIIMS 2018) Low Apgar Sscore

           
         Persistent Pul Ht

(INI-CET NOV 2022)

          

Suicide Occur When

Patient Starts to
Recover

Serotonin Sx (NEET 2024)

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Class Names Side Effects

SNRI Venlafaxine Diastolic Hypertension     
Desvenlafaxine
Discontinuation Sx (AIIMS 2018)
Duloxetine
                 

NDRI Bupropion Seizures

Least Sexual Side Effects

Smoking Cessation     (NEET 2019)

                   
SARI Trazadone, Nefazadone Trazadone-Priapism (INI-CET MAY 2023)

SPARI Vilazadone   

• Patient on anti depressant had mania sx--- (NEET 2020)

• Depression patient with past history of mania--

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 Psychopharmacology

• MOOD STABILIZERS

• LITHIUM

◊ Friendly to

◊ Eliminated by

◊ Narrow theruputic index

◊ Tremors

◊ If patient comes with git sx , coarse tremors--- u will ask for--- (NEET 2020)

◊ Teratogenic potential (AIIMS 2018)

◊ Pre lithium workup

◊ Drug interactions

◊ Preganancy and lithium (INI-CET 2023)

• VALPROATE

• CARBAMEZEPINE

◊ IF LITHIUM AND VALPORATE IS GIVEN TOGETHER-- LIVER DAMAGE (AIIMS 2018)

   

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• OX CARBAMEZEPINE

• ECT---- modified ECT

◊ ----succinyl choline+ methexitol (AIIMS 2020)

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NOTES
 Peadiatric

Chapter
Peadiatric
08

MR------------ (NEET 2018)

• Intellectual Disability, Intellectual Developmental Disorder -

• Adaptive Skills Given More Importance

ADHD---Minimal Dysfunction Sx (NEET 2018)

• Inattention, Hyper Activity, Impulsivity

• Stimulants

◊ Methyl Phenidate, Dextro Amphetamine

• Non Stimulants

◊ Atomoxetine, Reboxetine, Clonidine (NEET 2024)

PDD

• Autism/ Autism Spectrum Disorder

• Verbal and non verbal communication, social interaction, RRBI

• RETTS-- Mecp2 GENE MUTATION

◊ FEMALES with head deceleration

◊ TRO FINE TIDE (INI-CET MAY 2023)

• KLEPTOMANIA

• PYROMANIA

• NYMPHOMANIA

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• DIPSOMANIA-- (INI-CET NOV 2022)

• ONIOMANIA

• TRICHITALLOMANIA

• Selective Mutism (INI-CET 2020)

Enuresis

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NOTES
NOTES
 Psychology

Chapter
Psychology
09

Sigmund Freud

• Psychoanalysis

• Psychosexual Stages of Development

• 5 Stages

• Free Assosiation, Couch Technique

• Abreaction-- Emotional Reliving of Repressed Emotions

• Topographic Theory Of Mind-- Pre, Un, Consious

• Structural Theory of Mind

• Abreaction (NEET 2018)

◊ Emotional Release By Reliving of Experience

• Interpretation of Dreams

◊ CONDENSATION (NEET 2018)

◊ SYMBOLIZATION

◊ DISPLACEMENT

• Transference

• Counter Transference - (NEET 2021)

STRESS

• Body’s Response to Anything that Requires Attention or Action that Requires Physical, Emotional Or
Psychological Strain (INI-CET NOV 2022)

SUICIDE--

• Womens physician, relationship problems, substance abuse

BURN OUT-- (INI-CET JULY 2021)

• Physical and emotional exhaustion

OVER WORKING--

• Feeling goes away once u finish ur shift

DEPRESSION--

• Difficult to diagnose-- physicians prode

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Psychotic Mature

Narcisstic
Denial Anticipation

Distortion Altruism

Projection Ascetism

Sublimiation

Suppression

Humor

Displacement

Reaction Formation

Rationalization

• Spikes Protocol-- Breaking Bad New-- (AIIMS 2018)

◊ Home,

◊ Education/ Employment,

◊ Activities,

◊ Drugs,

◊ Sex and relationships,

◊ Self harm and depression,

◊ Safety and abuse.

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 Psychology

Significance

• Projective Test

Thematic Apperception Test

Significance

• Dynamics of Patients Personality

• Apperception Test

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 Delirium and dementia

Chapter
Delirium and Dementia
10

Cortical Dementia Sub Cortical Demenντια

Amnesia Movement side effects

Apraxia Psychiatric disorder

Agnosia

Executive dysfunction
Alzeimers DLB (AIIMS 2019)

Fronto temporal dementia- PICKS DEMENTIA-

(INI-CET NOV 2020)

CJD

                

Huntingtons

Wilsons parkinsons

Reversible Vitamine B1, B12, Niacin

Normal Pressure Hydrocephalus

AIIMS 2019

Normal NPH

Hypo Thyroidism

                                     

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CAM Screening Components: (NEET 2019)

CAM screens for the presence of four clinical features of delirium (does not identify severity)

• Acute onset and Fluctuating Course (INI-CET 2020)

• Inattention

• Disorganized Thinking

• Altered Level of Consciousness (INI-CET 2020)

Mini-Mental State Examination (MMSE)

Patient's Name Date

Instructions: Ask the questions in the order listed.

Score one point for each correct response within each question or activity.

Maximum Patient's
Questions
Score Score
5 "What is the year? Season? Date? Day of the week? Month?"

5 "Where are we now: State? County? Town/city? Hospital? Floor?"

The examiner names three unrelated objects clearly and slowly, then asks
3 the patient to name all three of them. The patient's response is used for
scoring. The examiner repeats them until patient learns all of them,
if possible. Number of trials:,
"I would like you to count backward from 100 by sevens." (93, 86, 79,72, 65, ...) Stop
5
after five answers.Alternative:"Spell WORLD backwards." (D-L-R-O-W)

3 "Earlier I told you the names of three things. Can you tell me what those were?"

Show the patient two simple objects, such as a wristwatch and a pencil, and ask the
2
patient to name them.

1 "Repeat the phrase: "No Ifs, ands, or buts."

"Take the paper in your right hand, fold it in half, and put it on the floor."
3
(The examiner gives the patient a piece of blank paper.)
1 "Please read this and do what it says." (Written instruction is "Close your eyes.")

"Make up and write a sentence about anything." (This sentence must contain a noun
1
and a verb.)
"Please copy this picture." (The examiner gives the patient a blank piece of paper and
asks him/her to draw the symbol below. All 10 angles must be present and two must
intersect.)
1

30 TOTAL

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NOTES
 Forensic and community psychiatry

Chapter
Forensic and Community Psychiatry
11
• MHE

• Emergency Treatment

• Advanced Directive- (AIIMS 2018, AIIMS 2019)

• Nominated Representative

• Voultary Admission-- Maximum is 30 days

• Only Modified ECT

• Decrimalisation of Suicide

• 30 mg/dl-- Above This Drunkenness

• Posco-Aggravated Sexual Offence (AIIMS 2018)

• MHGAP (AIIMS 2018)

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NOTES
 Mental status examination

Chapter
Mental Status Examination
12

Thought

◊ Form (NEET 2021)

* D

* T

* LO

* N

Stream

• Flight of Ideas

◊ Jumps from one thought to another

◊ Goal not reached

• Circumstantiality

◊ Adds unwanted details before reaching goal

◊ Goal reached

• Persevertion

◊ Persistence beyound point of relavance

• Possession-- Obsession

• Content-- Delusion

• INSIGHT

• GRADE I- Denial of Illness (AIIMS 2019)

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MEDICAL COACH
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Emotions

• Labile affect-- rapid fluctuations in emotions

• Mania

• Twilight State-- Altered Sensorium (INI-CET JUL 2021)

• Oneroid State-- Dream Like State

• Oligophrenia---Subnormal Intelligence

WHEN YOU WANT SOMETHING,

ALL THE UNIVERSE CONSPIRES
IN HELPING YOU TO ACHIEVE IT.
“ PAULO COELHO ”

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NOTES
NOTES
 E

Sl. No. CHAPTER Page No.

1. Ear Anatomy 111
2. Labyrinth 115
3. Investigation of Ear Diseases 117
4. Infective Diseases of Ear 123
5. Non Infective Diseases of Ear 129
6. Throat Anatomy 135
7. Diseases of Throat 137
8. Diseases of Larynx 143
9. Carcinomas 147
10. Nose and Sinuses 151
11. Diseases of Nose and Sinuses 155
12. Questions 163
 Ear anatomy

Chapter
Ear Anatomy
01

Ear Anatomy

Arnolds nerve

Auriculotemporal nerve

Auricle/Sensory branch of facial nerve

Lesser occipital nerve

Greater auricular nerve

Middle Ear Anatomy with Facial Nerve

Eustachean Tube Stapedius Muscle

36 mm long Function: Dampens loud sound

Child- straighter Acoustic Reflex

Function- Balance pressure & Drainage Afferent Nerve-VIIIn

Inv: Tympanometry Efferent Nerve – VIIn

Absent reflex: Hyperacussis

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Prussack’s Space Facial Recess

Sup: Lateral Malleal fold Facial Nerve

Med: Neck of malleus Corda Tympani

Lat: Pars flaccida & Scutum Fossa Incudis

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NOTES
 Labyrinth

Chapter
Labyrinth
02

Labyrinth

Cochlea Vestibule Semi circular canals

Inner Hair cells Outer hair cells

X Produces OAE

X Easily damaged

Hearing test Vestibular function Test

Tuning Fork Test Caloric test

Audiometry Fistula test

Tympanometry HINT

BERA VEMP-Vestibular evoked myogenic potential

OAE

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NOTES
 Investigation of ear diseases

Chapter
Investigation of Ear Diseases
03

Tunning Fork Tests (512Hz)

1. Rinne test

2. Weber test

3. ABC test/Schwabach’s test

4. Bing test

5. Gelle test

256Hz 512Hz 1024Hz Hearing loss

-ve +ve +ve 15-30db
-ve -ve +ve 30-45dB
-ve -ve -ve 45-60dB

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Audiometry

Bilateral congenital hearing loss Carhart's notch in otosclerosis

10
0
Frequency in Hertz
10 125 250 500 1000 2000 4000 8000

20 0

Hearing loss in dB
30 10
40 20
50 30
60 X X X 40
X X X 50
70
80 60

90 70
80
100
90
110
120 100

125 250 500 1000 2000 4000 8000 110

Meniere's Disease in Left ear

125 250 500 1000 2000 4000 8000
-10 -10

0 0

10 10

20 20
30 30

40 40

50 50

60 60

70 70

80 80

90 90

100 100

110 110

120 120

130 130

B/L BC > AC, Webers to left side B/L AC > BC; Webers to Right side

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 Investigation of ear diseases

Tympanometry types:
A-------------

As------------

Ad------------

B/Flat--------

C/Negative-

BERA & OAE

Children:

Adult (If SNHL):

SNHL

Cochlear disease Retro cochlear disease

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Caloric Test

C O W S
Hypoactive labyrinth: Nystagmus will be on opposite side but Eyeball movement on same side

Hyperactive labyrinth: Nystagmus on same side but eye ball movement on opposite side

B
A

True + Fistula test False + FT ( Hennebert’s sign)

1. Labyrinthine fistula, or CSOM Meniere’s disease

2. Fenestration surgery or

Type V tympanoplasty

3. Post stapedectomy

4. Perilymph fistula

Siegle’s speculum

Head Impulse test

In vestibular neuronitis: On tilting the head on the side of the lesion, Saccadic movement will be seen on
the opposite side

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NOTES
 Infective diseases of ear

Chapter
Infective Diseases of Ear
04
Acute Infections

Malignant otitis externa ASOM Acute mastoiditis

Pseudomonas Strep pneumonae Strep pyogenes

Diabetic H. influenza

Nocturnal pain Moraxella Ironed out mastoid

Osteitis & facial palsy Pinna: antero-inferiorly

Red, bulging TM Light house sign

Cart wheel Reservoir sign

Fluid level

Light house sign Bezold’s abscess- SCM

Reservoir sign Citelli’s abscess- Digastric

Luc’s abscess- Sup canal wall

Nasal decongestants & AMB

Myringotomy

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Chronic Infections

SOM/Glue ear Safe CSOM Unsafe CSOM Tuberculosis

No Pathogen Pseudomonas Pseudomonas Painless

Child: Adenoid HT Scanty discharge Fouls smelling, scanty d/s Watery d/s

Adult: Nasopharyngoscopy Central perforation Multiple perf

M/C/C of HL in child Retraction pocket Pale granulations

Myringoplasty cholesteotoma

Retracted TM Marginal perf

Air bubbles Attic perf

Tympanogram: As type MRM

Myringotomy+ grommet+
Adenoidectomy

B B B BB

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 Infective diseases of ear

Complications

Cholesteotoma Gradenigo’s Labyrinthine Lat sinus Brain abscess

synd fistula thrombosis
Prusscak’s space 3 D’s Bulge of LSCC Picket fence fever Fever & headache

Keratin squa epith Discharge Vertigo Gresinger’s sign Aphasia

Diplopia Nystagmus Delta sign convulsions

Wittmack’s theory Deep pain Crow beck sign

MRM True +ve FT Tobey ayer sign

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Surgeries:

Myringotomy + Myringoplasty Tympanoplasty Mastoidectomy

Grommet
ASOM: post-infer Safe CSOM Types: Simple: Ac mastoiditis

Temporalis fascia I: malleus-Myringoplasty MRM: unsafe CSOM

has low BMR
Glue ear: antero-infe II: incus

III: stapes head- Columella Radical has 3 steps:

IV: round window & ET Exteriorization

V: fistula on LSCC- Fenestration Retain footplate

Block ET

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NOTES
 Non infective diseases of ear

Chapter
Non Infective Diseases of Ear
05

Non-Infective diseases

Otosclerosis Meniere’s disease BPPV Sup canal

dehiscent syd
Fissula ante fenestrum Endolymphatic hydrops Posterior SCC Minor’s synd

35 yrs pregnant lady, CHL Mutation: short arm ch 6 Positional vertigo < 20sec 3rd window effect

Schwartz sign Fluctuating SNHL, Tinnitus

Paracussis willisi Vertigo: 24 min-24 hrs Dix hallpike maneuver CHL & Autophony

Gelle’s test is -ve Electrocochleography Epley’s maneuver Conservative

Tympanometry: As

TOC:stapedotomy Beta histine

DOC: sod flouride

Meniett’s device

Intratympanic genta

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Epley's Maneuver

Dix hallpike maneuver

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 Non infective diseases of ear

Tumours:

Glomus tumour Acoustic Neuroma

Is a Paraganglioma Arises from Inferior vestibular nerve

Presentation: Site is C-P angle

Pulsatile tinnitus

Rising sun sign M/C manifestation: loss of corneal reflex

Brown’s sign Histelberger’s sign

Phelp’s sign

Aquino sign Gold std inv: Gadolinium MRI

Gamma knife stereotactic RT

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Assistive device for Hearing

Hearing aid Cochlear implant Brainstem implant

Is an amplifier Used in B/L severe HL due to Used in B/L severe HL due to retro-
cochlear disease cochlear diseases
Used in any type of hearing loss

Electrodes are implanted: Implanted into recess of IV ventricle

Through round window

Into scala tympani

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NOTES
NOTES
 Throat anatomy

Chapter
Throat Anatomy
06
Throat:

Arteries of Tonsil:
1. main: Tonsillar or of facial Art

2. Ascending Pharyngeal

3. Ascending Palatine

4. Descending palatine

5. Dorsal Lingual

Muscles of larynx & movement of vocal cord

Abduction Adduction Tension

Helps in Breathing Helps in Voice production Helps in High pitch voice
Post cricoarytenoid muscle Lat. cricoarytenoid muscle Cricothyrpoid muscle

Inter-arytenoid muscle Thyroarytenoid muscle

Thyroarytenoid muscle

Cricothyroid muscle
Supplied by recurrent laryngeal nerve External laryngeal nerve

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NOTES
 Diseases of throat

Chapter
Diseases of Throat
07
Nasopharyngeal image & diseases

Features of Adenoid facies

High arched palate

Crowded upper teeth

Collapsed ala

Hypoplastic maxilla

Dull expression

Choanal Atresia

Caused by Bucco-nasal membrane

mcGovern’s technique

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 Diseases of throat

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Tonsillectomy

Indications Contraindications
Recurrent tonsillitis Acute tonsillitis

Chronic tonsillitis Bleeding disorders

Quincy Cleft palate

Eagle’s disease

BOYLE DAVIS
MOUTH GAG

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 Diseases of throat

Complication of tonsillectomy
1. Bleeding

Primary bleeding Reactionary bleeding Secondary bleeding

Caused by veins Within 24 hrs after surgery 5-8 day

Caused by arteries Infection is cause

Immediate re-ligation in GA Antibiotic + re-ligation

Other complications
2. Grisel’s syndrome

3. Hyper-nasal voice/rhinolalia aperta

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NOTES
 Diseases of larynx

Chapter
Diseases of Larynx
08

Congenital Diseases of Larynx

Laryngomalacia: is the m/c congenital disease of larynx

Presents: a newborn with inspiratory stridor

Omega shaped epiglottis

Tubular
epiglottis

Redundant
supra-arytenoid
tissue

Treatment: Reassurance

Subglottic stenosis: May cause expiratory or Biphasic stridor

It is graded into 4 grades by ‘Myer & Cotton’

Topical Mitamycin-C may be beneficial

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Laryngitis:

Acute epiglottis CROUP Tuberculosis

Strep pyogenes Parainfluenza virus Site: Inter-arytenoid area

Child in Tripod position Child lying on mother’s lap

Fever, Dyspnea, Dysphagia Dyspnea, voice change Hoarseness & Pain

X-ray: Thumb sign X-Ray: Steeple sign Cobble stone appearance

DOC: Cephalosporin Treatment: Mouse nibbled appearance

Steroid Turban epiglottis

Nebulisation

Antibiotics

Non Neoplastic growth

VC Nodule VC Polyp Rienke’s edema Laryngocele Granuloma

Misuse of voice Misuse Hypothyroidism Dilation of Intubation
saccule in
Site: junction of 1/3 Site: same TOC: Conservati trumpet blower Post 1/3
& 2/3
TOC: MLS + PPI -Microflap tech -Conservative CO2 laser
TOC: Voice Rest
+ botox

+ mitamycin C

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 Diseases of larynx

Benign growths of throat

Juvenila nasopharyngeal Angiofibroma Laryngeal papilloma

Site: Sphenopalatine foramen Site: M/C Glottis

Presents: Juvenil male with Epistaxis Etiology: HPV 6 & HPV 11

Signs: Antral sign & frog face Presents: A child with hoarseness

IOC: CECT

Treatment: Embolization & Excision Microdebridement + intralesional cidofovir

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NOTES
 Carcinomas

Chapter
Carcinomas
09

Carcinomas

Nasopharyngeal carcinoma Laryngeal carcinoma

Site: Fossa of Rosenmuller Site: Glottis

Etiology: EBV & Nitrosamine Etiology: Smoking & Alcohol

M/C presents: Lymphadenopathy Presents: Hoarseness & Dyspnea

Trotter’s triad I/L: proliferative growth

Soft palate palsy Treatment:

Facial pain Stages I & II: transoral laser Microsurgery

Hearing loss Stage III & IV: concurrent Chemoradiation

Treatment: chemoradiation

Tracheostomy: M/C indication: laryngeal block due to laryngeal carcinoma

Site: Tracheal ring 2 & 3

High tracheostomy: done in ring 1

Mini-tracheostomy is also called ‘cricothyroidotomy’

M/C complication: Dislodgment of tube & Bleeding

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 SPEECH REHABILITATION
Carcinomas

Speech rehabilitation

Tracheostomy:

Fenestrated tube + Muir

passay valve

Laryngectomy:
C
Trachea-esophageal speech

Electrolarynx

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 Nose and sinuses

Chapter
Nose and Sinuses
10
Nose & Sinus
Anatomy

Nasal septal arteries Lateral wall

Sphenopalatine artery Spheno-ethmoidal recess: Sphenoid ostia

Greater palatine art Superior meatus: Posterior ethmoid ostia

Superior Labial art Middle meatus: Maxilla, Frontal & Ant ethmoid ostia

Anterior ethmoidal art Inferior meatus: Naso-lacrimal duct

Post ethmoidal art

Anterior
Ethmoidal
nerve block

Anterior Ethmoidal nerve block

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X-Ray of Sinuses

Water’s view Pierre’s view Caldwell’s view

M/C view done M/C view Done for Frontal sinus

Best view to see maxilla Best for Maxilla & Sphenoid

Sphenoid is NOT seen, at all

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NOTES
NOTES
 Diseases of nose and sinuses

Chapter
Diseases of Nose and Sinuses
11

Septal diseases
Epistaxis

M/C site: Little’s area/Kiesselbach’s plexus

Artery of epistaxis: Sphenopalatine artery

M/C cause: Nose picking & Idiopathic

Treatment: Nose picking, Cautery with silver nitrate, Nasal packing, Ligation of vessels

Ligation: TESPAL

Anterior Ethmoidal ligation

Deviated Nasal Septum (DNS)

M/C presents as:

1. Nasal Block- mainly on the same side

2. Sometimes, on opposite side: Compensatory HT of Inferior turbinate

Headache: called Sluder’s neuralgia/Anterior Ethmoidal syndrome

Boundaries of Nasal Valve

1. Anterior end of inferior turbinate

2. Lower end of upper lateral cartilage

3. septum

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Treatment:

Septoplasty Sub mucosal resectiom

Freer’s incision/ Hemitransfixation Killian’s incision

Preferred after 16-17 years Bleeding is the m/c complication

Dane after 16-17 years

Nasal polyps:
Features:

1. are pale in colour

2. have poor blood supply

3. have poor nerve supply

Cause: m/c/c is allergy

May be seen in syndromes, like

Samter’s Trias Kartegener’s syndrome Young’s syndrome

Polyps Polyps Polyps

Asthma Bronchiectasis Bronchiectasis

Aspirin sensitivity Situs inversus Azoospermia

Maxillary/Antro-choanal polyp Ethmoidal polyp

M/c in children M/C in adults

U/L & single B/L & Multiple: ‘Bunch of Grapes’

Not Recurrent Is recurrent

Rx: Antibiotic & FESS Rx: Steroid & Fess

If recurrence → Ethmoidectomy

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 Diseases of nose and sinuses

Rhinosinusitis
Non-Infective rhinosinusitis

Allergic rhinitis Vasomotor rhinitis Atrophic rhiitis

Allergic shiners Increased Parasymphathetic M/C/C decreased Estrogen

Allergic salute Rx: Vidian Neurectomy Features

Denis morgan lines Roomy cavity & Dry

Crust- ------------Causes Block

Foul smell

Merciful Anosmia

Anosmia

Alkaline nasal douche

1. Sodium bicarbonate

2. Sodium biborate

3. Sodium chloride

Sx: Young’s surgery

Lautenslager’s Sx

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Fungal rhinosinusitis

Aspergillosis Mucormycosis Allergic fungal sinusitis

Rhino-Orbito-Cerebral fungus
Is M/C type Is called ‘Black fungus’ Bent & Kuhn criteria

A fumigatus Seen in Diabetic

Major criteria Minor criteria
Aspergilloma Caused by Rhizopus 1. E
 vidence of type I 1. Asthma
IgE-mediated hypersensitivity
Is angio-invasive 2. Unilateral predominance 2. Nasal polyposis
3. Radiographic bone erosion 3. C
 haracteristic CT
Causes necrosis (black fungus) findings
DOC: lyposom amphotericin B 4. Fungal culture 4. Eosinophilic mucus
5. Charcot-Leyden crystals 5. Positive fungal smear
6. Serum eosinophilia

Black fungus

Double density scan

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 Diseases of nose and sinuses

Rhinophyma Rhinoscleroma Rhinosporidiosis

Is called ‘Potato Nose’ Is called ‘Woody nose’ Rhinosporidiun seeberi

Due to HT if sebaceous gland Kleb. Rhinoscleromatis

Also called Frisch bacilli Aquatic protozoa

‘Strawberry polyp’

HPE: Mikulicz cell & Russell body

DOC: Streptomycin HPE: sporangia with endospores

DOC: Dapsone

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Fractures of facial bones

M/C facial bone to fracture is facial bone

Septum fracture Maxilla/Le Fort fracture CSF Rhinorrhea

Vertical: Chevrellet fracture LF I: Horizontal fracture M/C/C: cribriform plate
fracture
Horizontal: Jarjavay fracture LF II: Pyramidal fracture
Features:
LF III: cranio-facial dysjunction
Halo sign/Target sign
Rx: Closed reduction
Glucose > 30gm

B2 transferrin

Rx: Conservative
A

Ash’s forcep

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 Diseases of nose and sinuses

Tumours of Nose & Sinuses

Inverted Papilloma/Ringertz tumour Sinonasal carcinoma

Is a benign tumour with malignant potential M/C site is Maxilla: has squamous cell CA

Rx: Excision & wide margin/ Medial maxillectomy 2nd: ethmoids; has adenocarcinoma

m/c in woodworkers

Ohngrens’s line helps know the prognosis of

maxillary carcinoma

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NOTES
 Questions

Chapter
Questions
12
1. A 8 years old child presented with hearing 3. A 35 years old lady presented with nasal
loss and the following surgery was done obstruction & anosmia for few weeks.
in this child. The CT Scan of PNS of this lady is shown.
Which of the following is NOT a major
criteria by ‘Bent & Kuhn’?

Which of the following could be true in

this child?

a. May have tonsillectomy along this this

b. If we culture the fluid of ear, it will be

sterile

c. This is done in the anteroinferior quadrant

a. The finding is described as’ double density
d. All are true scan’
2. This is the image of a teacher who b. Nasal poly is a common finding
presented with hoarseness of voice. c. Fungal culture will be positive for fungus
d. Nasal mucin will have eosinophilia

4. A 3 years old child had fever for 2-3

days. Today she has difficult in breathing
and looked cyanosed. X-ray was done is
shown below. True in this case is?

Pick the correct statement in this patient:

a. This condition is usually unilateral

b. It is due to fibrosis of the vocal cord

c. Voice rest with proton pump inhibitor is

the TOC

d. All are true

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a. This is a case CROUP 7. A patient presented with hearing loss

b. The X-ray is showing ‘steeple sign’ & otorrhea. He was operated for this
ailment. The image of the surgery is
c. Steroid with nebulization with adrenalin
could be beneficial shown

d. All are true

5. The X-ray of PNS shown below is done for

which sinus?

Which of the following is true in this

patient?

a. This is ‘Columella surgery’

b. Most likely diagnosis was serous otitis

RT
media

c. The prosthesis shown is ‘Total ossicular

a. Maxillary sinus replacement prosthesis’
b. Frontal sinus d. All are true
c. Ethmoidal sinus
8. A 13 years old school going male child has
d. Sphenoidal sinus sudden episode of epistaxis in school. He

6. A patient come to ENT OPD and was being was immediately brought to emergency.

examined for some ENT complaint. The His bleeding had stopped when he

following instrument was being used. reached the hospital. Nasal endoscopy
was done few days later and the image is
shown. Which of these is true?

Which of the could be the primary

complaint (most likely) of this patient?

a. Hoarseness of voice

b. Hearing loss

c. Nasal obstruction

d. Feeling of lump in throat

a. The contractile layers in the blood vessels
of this tumour are absent

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 Questions

b. May have antral sign 10. Looking at the image of the procedure
c. M/C site is ‘sphenopalatine foramen’ and pick the correct statement:

d. All are true

9. A driver presented with hearing loss. The

audiogram is shown.

FREQUENCY IN HERTZ (Hz)

125 250 500 1000 2000 4000 8000
HEARING LEVEL IN DECIBELS (dB) RE ANSI 1989

750 1500 3000 6000

-10
0
10
20
30
40
50
a. This is canalolith repositioning maneuver
60
70 b. It is done in a patient who has continuous
vertigo for few days
80
90 c. Labyrinthectomy is the alternate
treatment in this case
100
110 d. All are true
120

If tuning fork tests are done in this

patient, which of these could be the
finding?

a. B/L positive Rinne’s with Weber’s

lateralized to right side
b. B/L positive Rinne’s with Weber’s
lateralised to left side
c. B/L negative Rinne’s with Weber’s
lateralised to left side
d. Right side positive Rinne’s & left side
negative Rinne’s

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NOTES