MEGA NEET BTR-2025
INTEGRATED SYSTEMS, PEDS,
MICRO
INTEGRATED SYSTEMS
MEDICINE
Antiarrhythmic drugs DYSLIPIDEMIC DRUGS:
IA: K-: Quinidine, Procainamine, Disopyramide Statins-HMG coA reductase inhibitor
IB: K +: Lignocaine, Phenytoin Ezitimibe-Absorption –
IC: K no: Fleicanide, Propafenone Fibrates-PPAR alpha + Baroreceptor:
II Niacin-HSL –
III-Amiodarone, Ibulitide Dofetilide, Sotalol Alirocumab, Evolocumab-PCSK9-
IV Evinacumab: ANGPTL3 inhibitor
Adenosine: Max dose PCSK9 synthesis inhibitor: Inclisiran
Dose with theophylline / caffeine: MTTP-: Lomitapide
Bempedoic acid: ATP citrate lyase-
Bile acid binding salts-
Cholestryamine, Colestipol
Rx HMOD:
ACE PDA
Pulmonary edema
Hypertension with:
DM / CKD/ Scleroderma-
Resistant hypertension/Conn/ Cirrhosis-
Osteoporosis/ Renal stones-
Raynaud/ Cyclosporine induced-
BPH-
Migraine/ Thyrotoxicosis/ Angina/ Tremor-
Cheese reaction-
Pheochromocytoma-
CHA2DS2-VASc Score
C Congestive Heart Failure 1 point
H Hypertension 1 point
A2 Age >75 y 2 points
D Diabetes 1 point
S2 Stroke 2 points
V Vascular disease 1 point
A Age>65 y 1 point
Sc Sex category, female 1 point
ESC 2010 Anticoagulation Recommendations:
Score=1 Aspirin
Score> 2 oral anticoagulation.
Rheumatic Fever (RF) Prophylaxis – Duration for Secondary Prevention
RF without carditis: 5 years or until 21 years old (whichever is longer)
RF with carditis but no residual heart disease: 10 years or until 21 years old (whichever is longer)
RF with carditis & residual heart disease: 10 years or until 40 years old (whichever is longer)
Metabolic syndrome: NCEP-ATP III CURB-65 Scoring OP:0
1. Central obesity: IP: 1-2
Symptom Points
>102 cm (India-90cm) in men ICU: 3-4
Confusion 1
>88 cm (India-80cm) in women
Urea: BUN>19 mg/dL (>7 1
2. Elevated triglycerides: >150 mg/dL
3. HDL mmol/L)
< 40 mg/dL in men Respiratory rate>30 breaths /min 1
< 50 mg/dL in women. Systolic BP <90 mm Hg or 1
4. Blood pressure: >130/85 mm Hg diastolic BP <60 mm Hg
5. Fasting glucose: >100 mg/dL Age> 65 years 1
Loud S1: MS, Reduced PR (WPW-
Child), Hyperdynamic circulation
Soft S1: MR/TR, CHF, Calcified valves,
Prolonged PR (1st degree heart block)
Bainbridge reflex
Bezold-Jarisch reflex
J reflex
Hering-Breur reflex
Weber-Fechner law
Large v wave
Prominent x and y descent
Blunted y descent
Pre renal Acute Tubular necrosis
Fractional
excretion of Na
Urine Na
Urine
Osmolality
BUN/Creatinine
During contraction: Urine casts
Prominent-
Disappear-
Shorten-
Constant-
Serum osmolarity: 2(Na) + glucose/18 + BUN/2.8 K Ca Urinary Nephrolithiasis
pH
Anion gap
Winter’s formula
Sodium deficit
Tdt
CD13,33,
117 CD14, 64
CD16, 56, 94
CD71 CD41,42,
61
CD38,138
Pancytopenia with HSM –
Pancytopenia with HSM +
CYCLIN D1+ / SOX 11+
Idarucizumab: Andexanet alfa: Ciraparantag:
Massive BT:
Refeeding syndrome:
Polyuric phase of AKI :
Tumor lysis:
Cryo-poor plasma
Ristocetin aggregation test abN
Dimorphic RBCs
Direct Coombs test
Indirect Coombs test
Pap smear-95% ethanol
Glu -> Valine: <1yr, >10yr Pre B cell
Glu -> Lysine T cell –Acid phosphatase + PAX5, RUNX1,E2A
Chr 16 deletion: Mediastinum, Brain, L1
Chr 11 Splicing mutation NS1-5 G-> Testes Hyperdiploidy
C: L2 t 12;21
NOTCH-T ALL TRISOMY 4,7,10
Hypodiploidy Females
t (9;22)
Agonist: BETHANECHOL t (4;11)
Antagonist: Solifenacin, Oxybutynin,
Flavoxate, Tolterodine, Darfenacine
CD20 + CD 15 +
CD45+ CD30 + most sensitive
EMA + PAX5 most specific
BCL-6 + EBV LMP +
EBV LMP -
MIRABEGRON
Cyclophosphamide
TAMSULOSIN
Busulfan
Bleomycin
Vincristine Carmustine
Bleomycin Methotrexate
L-aspararginase Amiodarone
Anti-enolase: • Local anaesthetic: Ag and Ad>> Aα and
Anti-endothelial cell Aβ >> B >>C
MODY3:
• Pressure:
Anti-GM1
Anti-GQ1b • Hypoxia:
Anti-Aqp4
Euvolemic hypoNa
CA 15-3, CA 27-9
CA-19-9
CA 72-4
NMP22
Dose Action Use MIGRAINE
40-80 mg/day Antiplatelet Myocardial Infarction, First line: DOC: 5HT1B/1D+ :
Stroke
Prophylaxis:
325–650 mg per dose Antipyretic, Analgesic Fever, pain 5HT1F + : LASMIDITAN
3-5g/day in divided dose Antinflammatory Rheumatoid Arthritis CGRP-: RimeGIPANT
ERENUMAB, GALANEZUMAB
CLUSTER HEADACHE
DOC:
Prophylaxis:
TENSION HEADACHE
DOC:
Prophylaxis:
1L-2, IL-12, INF-G: Locations of synthesis
IL-4, IL-5, IL-13: Acetylcholine Basal nucleus of Meynert
IL-1, IL-6, TNF-A: Dopamine Ventral tegmentum, SNc
1L-10, TGF-B, Lipoxin: GABA Nucleus accumbens
IL-8, C5a, LTB4, 5HETE, Kallikrein: Norepinephrine Locus ceruleus
C3b, IgG: Serotonin Raphe nuclei (medulla, pons)
Gamma-delta T cell receptor:
MHC-I: Alzheimer’s
MHC-II: Mild: Donepezil
Affinity maturation-Somatic hypermutation Severe: Memantine
Isotype switching-Alternate RNA splicing Lecanemab, Aducanumab
Hyper IgM disease Transdermal patch:
Positive selection: 4A test: Alertness
Negative selection-AIRE: Abbreviated mental test
Stain MI- Acute change
Leukocyte common Ag: Attention
Terminal comp /MAC def:
IDH wild:
IDH mutant:
TTR mutant
D2 blockers:
Metoclopramide:
Domperidone:
MALARIA:
D2 agonist-Cabergoline/ Bromocriptine
[Link] –Artesunate + SP + PQ
[Link]-CQ + PQ
Complicated
BUY AT 30 SELCC AT 50
PaO2 normal
during day
RV:
Body plethysmography
Helium dilution
N2 washout method
Obesity +
Hypoventilation
PaCo2 high during
day and night
CYP2C19: Enzyme inducers Enzyme inhibitors
CLOPIDOGREL -> active
Griseofulvin Valproate
CYP2C9: both zero order Phenobarbitone Ketoconazole
WARFARIN Phenytoin Cimetidine
PHENYTOIN Rifampicin Omeprazole
Carbamazepine Ciprofloxacin
CYP 3A4 Smoking, Ethanol Erythro/clarithromycin
CAT Clarithromycin
Cisapride
INH
Astemizole
Terfenadine Verapamil
OCP(ESTROGEN) Amiodarone
Cyclosporine/ Tacrolimus
Statins / AMiodarone gp120-
Fostemsavir
CYP2D6 (oral)
TAMOXIFEN -> active gp41-
Bblocker Enfuviritide
CD4:
SSRI Ibalizumab
CCR5:
Maraviroc (oral)
Agent Mechanism of action Side effects
Sulfonylureas Increases insulin secretion by inhibiting B- Hypoglycemia , Weight gain
Chlorpropamide cell K+ ATP channels Chlorpropamide:
Glipizide, Glyburide
Meglitinides
Repaglinide, Nateglinide
Biguanides Stimulates AMP kinase, decreasing insulin Lactic acidosis, Weight loss, Vit B12 deficiency
Metformin resistance Max reduction in HbA1c
Useful in CV risk mortality
Thiazolidinediones Activates transcription regulator PPAR-g, Weight gain, Heart failure, Hepatotoxic, Fractures
Pioglitazone decreasing insulin resistance Risk of bladder cancer -
Rosiglitazone MI-
GLP-1 agonists Increases glucose- dependent insulin Increase satiety, Weight loss
Exenatide, Liraglutide-SC secretion, decreases glucagon secretion, Pancreatitis –
Semaglutide-Oral delays gastric emptying MTC
Tirazepatide: + GIP analogue Useful in CV risk mortality Nasopharyngitis-
DPP4 inhibitors : ORAL GLP-2 agonist: DPP4 - : CI in renal failure except:
Sitagliptin, Saxagliptin, Linagliptin
Amylin Analogue Decreases glucagon secretion, delays Increase satiety
Pramlintide gastric emptying
α-glucoside inhibitors Reduces intestinal disaccharide absorption Diarrhea, Flatulence
Acarbose , Miglitol CI in IBD
SGLT2 Inhibitors Increases renal glucose excretion Urinary tract infections , Polyuria (osmotic diuresis)
Canagliflozin, Dapagliflozin Useful in CV risk mortality Weight loss
Step1,2: Symptoms <5d/week:
LD-ICS-Formoterol as needed
Step 3: Most days/ >1/week
nighttime:
LD-ICS-Formoterol
Step 4: Low lung function:
MD-ICS-Formoterol
Step 5: Add LAMA + HD-ICS +
Anti-IgE/IL5
IL-4 inhibitor:
Dupilumab
IL-13 inhibitor:
Tralokinumab
Lebrikizumab
Tesamorelin
Mecasermin
TNF-apha inhibitors:Adalimumab /Certolizumab /Etanercept/ Infliximab/Golimumab
IL-1R Antagonist:
JAK inhibitors: Tofacitinib, Baricitinib, Upadacitinib
ATT drug causing psychosis:
ATT drug causing Hypothyroidism:
ART causing intracranial bleed:
Teplizumab:
Omavexolone:
Ravulizumab, Rozanolixizumab, ZILUCOPLAN, EFGARTIGIMOD
Daprodustat:
Vanoprazan:
Palbociclib : Cyclin- dependent kinase 4/6 -Breast cancer
Olaparib : Poly(ADP-ribose) polymerase (↓ DNA repair) : Breast, ovarian, pancreatic and prostate
cancers (BRCA +)
Cetuximab, Panitumumab
Emicizumab, Fitusiran, Concizumab, MARSTACIMAB
LANDIOLOL
Fomivirsen
Mipomersen
Eteplirsen
Casimersen
Riluzole
Edavarone
Sodium phenylbutyrate-Turursodiol
Tofersen
SOD1
Bunina bodies
FEEDBACK: Singer-Nicholson:
Baroreceptor reflex: Protein > Lipid > Carbs
Parturition-Ferguson reflex / Milk let down- Except-inner mitochondrial membrane
ejection
Clotting
CICR
LH surge
Head’s paradoxical reflex-Inflation of alveoli
Hodgkin cycle-Na opening
Salivation on thinking about food:
Exercise
Core body Temperature
RyR-MH
Na: +60 mV
Ca: +100 mV
Cl: -70mV
K: -90V
PEDIATRICS
• PLAN B Neonatal fluid requirement:
<1500g: 80ml/kg
• PLAN C >1500g: 60ml/kg
• Fluid of choice >1week: 150ml /kg
• CRASH and burn Fluid for maintenance:
• Cyanotic Congenital heart disease -> Oligemia NS (or N/2) + 5% dextrose
1st 10kg: 100ml/kg
-> Plethora Next 10 kg: 50ml/kg
• Term infant-Parasagittal injury: >20kg: 20ml/kg
Screening: Denver
• Preterm infant-Periventricular leukomalacia Goodenough-Harris
• Status marmoratus: Trivandrum development
Phatak Baroda
• Preterm IVH IOC: Definitive: Bayley
Stanford Binet
• SLC39A4 Welscher Intelligence
Vineland adaptive
MCC Of mortality:
Neonate – Prematurity > Asphyxia > Sepsis > Congenital CF: Chromosome:
anomalies -MC mutation:
-MC class of mutation:
U5- Prematurity > Neonatal infection> Asphyxia > -Trikafta: Elexacaftor + Tezacaftor + Ivacaftor
Pneumonia > Diarrhea
(Ref: O.P Ghai)
Primary failure: Lecithin: Sphingomyelin ratio
• Failure to regain appetite by day 4 Nile blue sulfatase test
• Failure to lose edema by day 4 Synthesis begins-
• Presence of edema on day 10 Amniotic fluid-
• Failure to gain at least 5mg/kg/day Mature lungs-
by day 10 INSURE:
Composition ReSoMal Reduced
(mmol/L) osmolarity ORS
Glucose 125 75
Sodium 45 75
Potassium 40 20
Chloride 70 65
Citrate 7 10
Magnesium 3 ---
Zinc 0.3 ---
Copper 0.045 ---
Osmolarity 300 245
(mOsm/L)
Score 0 1 2
Respirate <60 60-80 >80
Rate
Cyanosis None No cyanosis Cyanosis with
with oxygen oxygen
Retractions None Mild Moderate to
severe
Grunting None Audible with Audible without
stethoscope stethoscope
Air Entry Good Decreased Barely Audible
Weight with age: Height with age: US:LS : Surrogate marker of height:
Birth
Birth Birth Mid-parental height:
20-40g/day * 3months 3mon 3yr
400g/month till 1 year 1yr 7yr
Adults: 0.9 Proportionate short stature:
5mon 2yr
Dispoportionate short stature-
1yr 4yr
2yr 6cm / yr till 12yrs
HC Short trunk
Birth-32-35cm SED, MPS, Pott spine, Alagille Sx
3yr
1st 3month: Dispoportionate short stature-
5yr
Next 3month:
7yr Short limb
Next 6month:
10yr
Next 2 yrs:
Rickets, Achondroplasia, OI,
>2cm/month always abN Congenital hypothyroidism
Bone Age ˂ Chronological Age
Bone = Chronological Age
MICROBIOLOGY
• ICAM-1: ACE2: Nicotinic
AchR:
• CD21: Integrin:
• Breteau index: Cheopsis index:
Chandler index:
• Galactomannan:
• B-glucan:
• SDA: cycloheximide + gentamicin + pH 5.6
• White Piedra: Trichosporon bigelii
• Black: Piedra hortae
• NEHA SUIT CHEST
• Auramine-Rhodamine:
• Acridine orange:
• Calcofluor white:
• FITC:
• Casoni / Arc5 electrophoresis-
• Montenegro-
• Bachmann
• Fairly
• Frenkel
• Mazzotti-
• Fullborne-
Complement fixation:
Wassermann, TPI
Sabin Feldman
Bartonella bacilliformis henselae quintana
DH:
IH First:
IH Second:
Paragonimus -
Opisthorchis/ Clonorchis-
Fasciola-
Sterilization
HOT AIR OVEN AUTOCLAVE RADIATION: Aldehydes: H2O2= ETO
160 X 2HR 121 x 15min x 15psi Gamma rays Glutaraldehyde 2% Plasma
Hypochlorite 5%
CONTROL: MILK PASTEURISATION:
[Link]: 63 X 30min
[Link]: 72 X 15s
[Link]:
125 X 3s
[Link]:
Coliform, standard plate, phosphatase test
