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=='''D'''ow '''J'''ones '''I'''ndustrial '''A'''verage '''C'''losing '''S'''tock '''R'''eport==
__NOTOC__
''From proximal to distal:''
{{Board review project}}
'''D'''uodenum
[[Image:Main_help_page_small.PNG|100px|link=Help]][[Image:Projects.PNG|100px|link=Projects]][[Image:Editor's_Tools.PNG|100px|link=Help Menu]]
'''J'''ejunum
'''I'''leum
'''A'''ppendix
'''C'''olon
'''S'''igmoid
'''R'''ectum


=='''D'''ow '''J'''ones '''I'''ndustrial '''C'''limbing '''A'''verage '''C'''losing '''S'''tock '''R'''eport==
<div class="mw-collapsible mw-collapsed">
''From proximal to distal:''
'''D'''uodenum
'''J'''ejunum
'''I'''leum
'''C'''ecum
'''A'''ppendix
'''C'''olon
'''S'''igmoid
'''R'''ectum


==Causes of Acute Pancreatitis==
<font color="Navy">'''1. Anatomy'''</font>


"'''GET SMASHED'''"
<div class="mw-collapsible-content">
'''G'''all stones
'''E'''thanol
'''T'''rauma
'''S'''teroids
'''M'''umps
'''A'''utoimmune disease
'''S'''corpion venom
'''H'''yperlipidemia
'''E'''RCP (dye)
'''D'''rugs (Azathioprine, Asparginase, Mercaptopurines, Pentamidine)


Alcohol and Gallstones are most common causes.
<div class="mw-collapsible mw-collapsed">


==A-P-G-A-R==
==GI Anatomy==
Score 0-2 at 1 and 5 minutes in each of 5 categories:
A - Appearance (Color: blue/pale, trunk pink, all pink)
P - Pulse (Heart rate: 0, <100, 100+)
G - Grimace (Reflex irritability: 0, grimace, grimace+cough)
A - Activity (Muscle tone: limp, some, active)
R - Respiration (Respiratory effort: 0, irregular, regular)


10 is perfect score
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''D'''ow '''J'''ones '''I'''ndustrial '''A'''verage '''C'''losing '''S'''tock '''R'''eport}}</font>
''From proximal to distal:''
# '''D'''uodenum
# '''J'''ejunum
# '''I'''leum
# '''A'''ppendix
# '''C'''olon
# '''S'''igmoid
# '''R'''ectum


==Multiple Endocrine Neoplasia (MEN)==
</div></div>
Each of the MENs is a disease of three or two letters plus a feature, and all are Autosomal Dominant inheritance.
<div class="mw-collapsible mw-collapsed">
* MEN I is a disease of 3 P's (pituitary, parathyroid, and pancreas) plus adrenal cortex
* MEN II is a disease of 2 C's(carcinoma of thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIB (aka MEN III)
* Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate
* Acute pneumonia caused by Miscellaneous microbes--Mononuclear infiltrate
* Takayasu's disease = pulseless disease, therefore when you have Takayasu's, I can't Tak'a yu pulse.


=='''CAGE''' - alcohol use screening==
==Brachial Plexus Organization==
* Have you ever felt it necessary to '''C'''UT DOWN on your drinking?
* Have you ever been '''A'''NNOYED when people suggest you cut down on your drinking?
* Have you ever felt '''G'''UILTY about your drinking?
* Have you ever felt the need to have a drink in the morning for an '''E'''YE OPENER?


==O-P-Q-R-S-T - eliciting and HPI and exploring symptoms==
<div class="mw-collapsible-content">
'''O''' - '''O'''nset of pain (what was the patient doing when the pain started?)
<font color="red">{{cquote|'''Radical Teachers Drink Cold Beers'''}}</font>
'''P''' - '''P'''alliative or '''P'''rovocative factors for the pain
<font color="red">{{cquote|'''Randy Travis Drinks Cold Beers'''}}</font>
'''Q''' - '''Q'''uality of pain (burning, stabbing, aching, etc.)
<font color="red">{{cquote|'''Robert Taylor Drinks Cold Beer'''}}</font>
'''R''' - '''R'''adiation (up to jaw, down left arm, etc.)
<font color="red">{{cquote|'''Red Trucks Drive Cats Nuts'''}}</font>
'''S''' - '''S'''everity of pain (usually 1 - 10 scale)
# Roots
'''T''' - '''T'''iming of pain (eg: after meals, in the morning, how long it lasts, etc.)
# Trunks
# Divisions
# Cords
# Branches


==S-O-C-R-A-T-E-S - exploring the presenting complaint====
</div></div>
'''S''' - '''S'''ite of pain
<div class="mw-collapsible mw-collapsed">
'''O''' - '''O'''nset of pain
'''C''' - '''C'''haracter of pain (dull, sharp, aching, stabbing, tearing etc.)
'''R''' - '''R'''adiation of pain (eg. central abdominal pain radiating to Right Iliac Fossa)
'''A''' - '''A'''ssociated factors (eg. nausea/vomiting)
'''T''' - '''T'''iming of pain/duration
'''E''' - '''E'''xacerbating/alleviating factors
'''S''' - '''S'''everity of pain (usually 1 - 10 scale)


==A-S-C-L-A-S-T - eliciting and HPI and exploring symptoms====
==Cranial Nerves==
'''A''' - '''A'''ggravatiing and '''A'''lleviating factors
'''S''' - '''S'''everity
'''C''' - '''C'''haracter, quality
'''L''' - '''L'''ocation
'''A''' - '''A'''ssociated symptoms
'''S''' - '''S'''etting
'''T''' - '''T'''iming


NOTE: ASCLAST means let the patient talk first, then ask him/her specific questions.
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''On Old Olympus Towering Tops, A Finn And German Viewed Some Hops'''}}</font>
<font color="red">{{cquote|'''Our Only Object To Touch And Feel Virgin Girls Vagina And Hymen'''}}</font>
# I - olfactory
# II - optic
# III - oculomotor
# IV - trochlear
# V - trigeminal
# VI - abducens
# VII - facial
# VIII - acoustic (vestibulocochlear)
# IX - glossophrayngeal
# X - vagus
# XI - accessory
# XII - hypoglossal


==The five '''W''''s--post-operative fever==
</div></div>
'''W'''ind - pneumonia, atelectasis
<div class="mw-collapsible mw-collapsed">
'''W'''ound - wound infections
'''W'''ater - urinary tract infection
'''W'''alking - walking can help reduce deep vein thromboses and pulmonary embolus
'''W'''onderdrugs - especially anesthesia


==Predisposing Conditions for Pulmonary Embolism: '''TOM SCH PREFER'''==
==Extraocular Muscles Innervation==
'''T''' - '''T'''rauma
'''O''' - '''O'''besity
'''M''' - '''M'''alignancy
'''S''' - '''S'''urgery
'''C''' - '''C'''ardiac disease
'''H''' - '''H'''ospitalization
'''P''' - '''P'''ast history
'''R''' - '''R'''est (bed-bound)
'''E''' - '''E'''strogen, pregnancy, post-partum
'''F''' - '''F'''racture
'''E''' - '''E'''lderly
'''R''' - '''R'''oad trip


==6 '''P''' 's==
<div class="mw-collapsible-content">
ARTERIAL OCCLUSION (Signs of Compartment Syndrome)
<font color="red">{{cquote|'''LR6 SO4 3'''}}</font>
* Pain
* '''LR 6''' - '''L'''ateral '''R'''ectus by the '''VI'''  cranial nerve (Abducens)
* Paleness (Pallor)
* '''SO 4''' - '''S'''uperior '''O'''blique by the '''IV''' cranial nerve (Trochlear)
* Perishing with Cold (Poikilothermia)
* '''3''' - The remaining by the '''III''' cranial nerve (Occulomotor)
* Pulselessness
* Paresthesias
* Paralysis


==DAVE WILMINGTON==
<font color="red">{{cquote|'''LAST'''}}</font>
To write Admission Orders to Hospital
* '''L''' - '''L'''ateral Rectus
(After noting date and time of Admission as well as Diagnosis and Condition (ADC), use the mnemonic to ensure all areas are addressed, but not all apply to every patient)
* '''A''' - '''A'''bducens Nerve
* '''D'''iet
* '''S''' - '''S'''uperior Oblique
* '''A'''ctivity
* '''T''' - '''T'''rochlear Nerve
* '''V'''ital signs (how often)
* '''E'''xcrement (test urine / stool)
* '''W'''eight (how often to monitor)
* '''I''' / O (monitor input / output)
* '''L'''abs (what, how often)
* '''M'''eds (which, route, interval)
* '''I''' V fluids (what and at what rate)
* '''N'''ursing care (e.g. position, wound care, up in chair, ostomy care etc)
* '''G'''eneral care (e.g. Physical Therapy, Respiratory Thearpy etc)
* '''T'''ests (X-ray, EKG, EEG etc)
* '''O'''bserve for reaction, seizure, neuro exams
* '''N'''otify parameters (e.g. Temp > 100 / respiration changes)


==More standard is ADC VAAN DIML (pronounced ADC van dim(e)l)==
</div></div>
'''A'''dmit (23 hours, full admit, service of attending,...)
<div class="mw-collapsible mw-collapsed">
'''D'''iagnosis
'''C'''ondition ("Stable", "Guarded", etc.)
'''V'''itals (post-op, routine, q 1 hour, etc.)
'''A'''llergies
'''A'''ctivities (Strict bed rest, fall precautions, ad lib, bathroom privileges, etc.)
'''N'''ursing (Strict I&O's, Daily weights, Call P.R.N. whatever, etc.)
'''D'''iet (NPO, Regular, Clears - advance diet as tolerated, 2000 cal ADA, renal, etc.)
'''I'''V fluids (D5 1/2 NS c 20 KCL at 110 ml/hr, LR @ 100 ml/hr, etc.)
'''M'''eds (scheduled and PRN's)
'''L'''abs and x-ray (CBC in AM, PCXR in PACU, etc.)


Note that IV fluids follows Diet. If one writes NPO, then '''all''' such patients get maintenance fluids (use the 4-2-1 rule).
==Facial Nerve Branches==


==VITAMIN C==  
<div class="mw-collapsible-content">
'''Causes of Diseases'''
<font color="red">{{cquote|'''Two Zebras Bought My Car'''}}</font>
*Vascular
<font color="red">{{cquote|'''Two Zebras Bit My Cookie'''}}</font>
*Infectious
<font color="red">{{cquote|'''To Zanzibar By Motor Car'''}}</font>
*Trauma
<font color="red">{{cquote|'''Ten Zulus Buggered My Cat'''}}</font>
*Auto-immune
# Temporal
*Metabolic
# Zygomatic
*Idiopathic/Iatrogenic
# Buccal
*Neoplastic
# Mandibular
*Congenital
# Cervical


==M U D    P I L E S==
</div></div>
Causes of Metabolic Acidosis
<div class="mw-collapsible mw-collapsed">
* '''M'''ethanol poisoning
* '''U'''remia
* '''D'''iabetic Keto-acidosis
* '''P'''ara-aldehyde ingestion
* '''I'''schemia
* '''L'''actic Acidosis
* '''E'''thanol poisoning
* '''S'''alicylate ingestion


== Causes of HyperCalcemia==
==Penis Innervation==
'''PAM SCHMIDT'''          OR              '''MISHAP'''
'''P'''aget's Disease                        Malignancy
'''A'''myloid                                Intoxication (hypervitaminosis)
'''M'''ultiple Myeloma                      Sarcoidosis
'''S'''arcoid                                Hyperparathyroidism   
'''C'''ancer                                Alkalai ( Milk ) syndrome
'''H'''ormomal (para-thyroid)                Paget's Disease bone
'''M'''ilk-alkali Syndrome
'''I'''mmobilization
'''D'''-vitamin overdose
'''T'''hyrotoxicosis


also consider Addison's Disease, thiazide diuretics and simple lab error
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''P'''oint and '''S'''hoot}}</font>
* '''P'''arasympathetic causes erection
* '''S'''ympathetic causes ejaculation


==5 SIGNS OF INFLAMMATION (as described by Celsus)===
<font color="red">{{cquote|'''S2, 3, 4 keep the penis off the floor'''}}</font>
*Redness/Erythema (Rubor)
* Innervation of the penis by branches of the pudendal nerve, derived from spinal cord levels '''S 2-4'''
*Raised temperature (Calor)
*Swelling (Tumor)
*Pain (Dolor)
*Loss of Function (Functio Laesa)


==ACID==
</div></div>
(Gell & Goombs" classification for HYPERSENSITIVITY REACTIONS):
<div class="mw-collapsible mw-collapsed">
'''A'''nna '''C'''ycled '''I'''mmediately '''D'''ownhill
Type I  '''A'''naphylaxis
Type II  '''C'''ytotoxic-mediated
Type III '''I'''mmune-complex
Type IV  '''D'''elayed hypersensitivity


=='''N'''ever '''L'''et '''M'''onkeys '''E'''at '''B'''ananas==
==Aorta Branches==
* '''N'''eutrophils '''60'''%
* '''L'''ymphocytes '''30'''%
* '''M'''onocytes '''6'''%
* '''E'''osinophils '''3'''%
* '''B'''asophils '''1'''%


=='''N'''ever '''L'''et '''M'''om '''E'''at '''B'''eans" and "'''60''', '''30''', '''6''', '''3''', '''1'''==
<div class="mw-collapsible-content">
* '''N'''eutrophils '''60'''%
<font color="red">{{cquote|'''ABC'S'''}}</font>
* '''L'''ymphocytes '''30'''%
* '''A'''ortic arch gives off the:
* '''M'''onocytes '''6'''%
# '''B''' - '''B'''racheiocephalic trunk
* '''E'''osinophils '''3'''%
# '''C''' - Left '''C'''ommon '''C'''arotid
* '''B'''asophils '''1'''%
# '''S''' - Left '''S'''ubclavian artery


=='''N'''ice '''L'''adies '''M'''ake '''E'''aster '''B'''read" and "'''60''', '''30''', '''6''', '''3''', '''1'''==
</div></div>
* '''N'''eutrophils '''60'''%
<div class="mw-collapsible mw-collapsed">
* '''L'''ymphocytes '''30'''%
* '''M'''onocytes '''6'''%
* '''E'''osinophils '''3'''%
* '''B'''asophils '''1'''%


=='''Sunday Hot Day, Better Give Iced Fluids Today!'''==
==Femoral Triangle Structures in Order==
Treatment of Malignant Hyperthermia
S: Stop all triggering agents, give 100% O2
H: Hyperventillate
D: Dantrolene 2.5 mg/kg
B: Bicarbonate
G: Glucose and Insulin
I: IV Fluids, Cooling Blanket
F: Fluid Output; Furosemide
T: Tachycardia, be prepared to treat V Tach


=='''DISK MASS'''==
<div class="mw-collapsible-content">
Reasons of Back Pain
<font color="red">{{cquote|'''N (AVEL)'''}}</font>
'''D''' ==  '''D'''egeneration: DJD, Osteoporosis, spondylosis
* '''N'''erve
'''I'''   ==  '''I'''nfection: UTI, PID, Potts, osteomyelitis, prostatitis, Injury/fracture, compression fracture.
* '''A'''rtery
'''S''' ==  '''S'''pondylitis, ankylosing Spondyloarthropathies (rheumatoid arthritis, Reiters,  SLE)
* '''V'''ein
'''K'''  ==  '''K'''idney stones/infarction/infection (pyelo/abscess)
* '''E'''mpty space
* '''L'''ymphatics
- Parenthesis includes things contained in the femoral sheath.


'''M'''  ==  '''M'''ultiple myeloma, '''M'''etastasis from breast, prostate, lung, thyroid, kidney CA
</div></div>
'''A'''  ==  '''A'''neurysm, '''A'''bdominal pain referred to the back (see acute abdominal pain)
'''S'''  ==  '''S'''lipped disk, '''S'''pondylolisthesis
'''S'''  ==  '''S'''train, '''S'''coliosis/lordosis, '''S'''kin: herpes zoster. 


==Regarding what to do in case of syncope==
</div></div>
If the face is red, raise the head.
If the face is pale, raise the tail!


==BRACHIAL PLEXUS==
<div class="mw-collapsible mw-collapsed">
Roots, Trunks, Divisions, Cords, Branches:


* Radical Teachers Drink Cold Beers
<font color="Navy">'''2. Cell Biology'''</font>
* Randy Travis Drinks Cold Beers
* Robert Taylor Drinks Cold Beer
* Red Trucks Drive Cats Nuts


==CRANIAL NERVES==
<div class="mw-collapsible-content">
I - olfactory
II - optic
III - oculomotor
IV - trochlear
V - trigeminal
VI - abducens
VII - facial
VIII - acoustic (vestibulocochlear)
IX - glossophrayngeal
X - vagus
XI - accessory
XII - hypoglossal


* On Old Olympus Towering Tops, A Finn And German Viewed Some Hops
<div class="mw-collapsible mw-collapsed">
* Our Only Object To Touch And Feel Virgin Girls Vagina And Hymen


==LR6 SO4 3==
==Cell Division Phases==
* LR6 - Lateral Rectus --> CN VI Abducens
* SO4 - Superior Oblique --> CN IV Trochlear
* 3 - The remaining 4 eyeball movers --> CN III Occulomotor
* or '''LAST''': LA = '''L'''ateral Rectus - '''A'''bducens Nerve, ST = '''S'''uperior Oblique - '''T'''rochlear Nerve


==BRANCHES OF FACIAL NERVE==
<div class="mw-collapsible-content">
Temporal, Zygomatic, Buccal, Mandibular, Cervical
<font color="red">{{cquote|'''People Meet And Talk'''}}</font>
* Two Zebras Bought My Car
* '''P''' - '''P'''rophase
* Two Zebras Bit My Cookie
* '''M''' - '''M'''etaphase
* To Zanzibar By Motor Car
* '''A''' - '''A'''naphase
* Ten Zulus Buggered My Cat
* '''T''' - '''T'''elophase


==INNERVATION OF PENIS==
</div></div>
* '''P'''arasympathetic causes erection. '''S'''ympathetic causes ejaculation. "'''P'''oint and '''S'''hoot."
<div class="mw-collapsible mw-collapsed">
* "S2, 3, 4 keep the penis off the floor"
* Innervation of the penis by branches of the pudendal nerve, derived from spinal cord levels S2-4


==ABC'S==
==Cell Cycle Stages==
* Aortic arch gives off the Bracheiocephalic trunk, the left Common Carotid, and the left Subclavian artery


=='''N(AVEL)'''==
<div class="mw-collapsible-content">
''Order of things in the Femoral Triangle''
<font color="red">{{cquote|'''Go Sally Go! Make Children!'''}}</font>
* Nerve
* '''G1''' phase - Growth phase 1
* Artery
* '''S''' phase - DNA synthesis
* Vein
* '''G2''' phase - Growth phase 2
* Empty space
* '''M''' phase - Mitosis
* Lymphatics
* '''C''' phase - Cytokinesis


NOTE: Parenthesis includes things contained in the femoral sheath.
</div></div>
<div class="mw-collapsible mw-collapsed">


==Hurler syndrome features HURLER'S==  
==Golgi Complex Functions==
*Heptosplenomegaly
*Ugly facies
*Recessive (AR inheritance)
*L-iduronidase deficiency (alpha)
*Eyes clouded
*Retarded Short/
*Stubby fingers


=='''CHILD HAS PROBLEM!'''==
<div class="mw-collapsible-content">
''Down syndrome features''
<font color="red">{{cquote|'''Golgi Distributes A SPAM'''}}</font>
* Congenital heart disease/ Cataracts
* '''Distributes''' proteins and lipids from ER
* Hypotonia/ Hypothyroidism
* '''A'''dd mannose onto specific lysosome proteins
* Incure 5th finger/ Increased gap between 1st and 2nd toe
* '''S'''ulfation of sugars and slected tyrosine
* Leukemia risk x2/ Lung problem
* '''P'''roteoglycan assembly
* Duodenal atresia/ Delayed development
* '''A'''dd O-oligosugars to serine and threnonine
* '''M'''odify N-ologosugars on asparagine


* Hirshsprung's disease/ Hearing loss
</div></div>
* Alzheimer's disease/ Alantoaxial instability
<div class="mw-collapsible mw-collapsed">
* Squint/ Short neck


* Protruding tongue/ Palm crease
==Collagen==
* Round face/ Rolling eye (nystagmus)
* Occiput flat/ Oblique eye fissure
* Brushfield spot/ Brachycephaly
* Low nasal bridge/ Language problem
* Epicanthic fold/ Ear folded
* Mental retardation/ Myoclonus


=='''D'''rink at 21==
<div class="mw-collapsible-content">
Down Syndrome - Chromosome 21
<font color="red">{{cquote|'''COLLAGEN'''}}</font>
* '''C''' - '''C'''-terminal propeptide (procollagen) / '''C'''ovalent '''C'''ross links/ '''C''' vitamin/ '''C'''onnective tissue/ '''C'''artilage/'''C'''hondroblasts/'''C'''opper Cofactor (Covalent Cross linking)
* '''O''' - '''O'''utside the cell is where collagen normally functions/ '''O'''steoblasts/ '''O'''steogenesis imperfecta
* '''L''' - '''L'''ysyl hydroxylase / '''L'''ysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last biosynthesis step)
* '''L''' - '''L'''ong triple helical fibers / '''L'''igaments
* '''A''' - '''A'''lpha chains / '''A'''ttached by H bonds form triple helix / '''A'''scorbate for hydroxylation of lysyl and prolyl residues of pro-Alpha chains
(postranslational modification)
* '''G''' - '''G'''ly in every third position / '''G'''lycosylation of hydroxyl group of hydroxylysine with '''G'''lucose and '''G'''alactose;'''GO'''lgi allows procollagen to '''GO''' outside of cell
* '''E''' - '''E'''xtracellular matrix / '''E'''ye (cornea, sclera) / '''E'''hlers-Danlos Syndrome
* '''N''' - '''N'''-terminal propeptide (procollagen) / '''N'''onhelical terminal extensions


=='''P'''uberty at 13==
</div></div>
Patau's Syndrome - Chromosome 13


==Election voter at 18==
</div></div>
Edward's Syndrome - Chromosome 18


==Down syndrome pathology DOWN==
<div class="mw-collapsible mw-collapsed">
Decreased alpha-fetoprotein and unconjugated estriol (maternal)
One extra chromosome twenty-one
Women of advanced age
Non-disjunction during maternal meiosis


==CUT the PY (cut the pie)==
<font color="Navy">'''3. Molecular Biology'''</font>
''Pyrimidines nucleotides''
* Cytosine
* Uracil
* Thiamine the
* PYrimidines


==CATCH 22==
<div class="mw-collapsible-content">
''DiGeorge/ Velocardiofacial syndrome''
* Cardiac abnormalities
* Abnormal facies
* Thymic aplasia
* Cleft palate
* Hypocalcemia
* 22q11 deletion


==MARFAN==
<div class="mw-collapsible mw-collapsed">
# Mitral valve prolapse
# Aortic Aneurysm
# Retinal detachment
# Fibrillin
# Arachnodactyly
# Negative Nitroprusside test (differentiates from homocystinuria)


==Go Sally Go! Make Children!==  
==Carbon Monoxide: Electron Transport Chain Target==
''Cell cycle stages''
* G1 phase (Growth phase 1)
* S phase (DNA Synthesis)
* G2 phase (Growth phase 2)
* M phase (Mitosis)
* C phase (Cytokinesis)


==APKD==
<div class="mw-collapsible-content">
ADult Polycystic Kidney Disease is  Autosomal Dominant
<font color="red">{{cquote|'''CO blocks CO'''}}</font>
Also, "Polycystic kidney" has 16 letters and is due to a defect on chromosome 16.
Carbon monoxide '''(CO)''' blocks Cytochrome Oxidase '''(CO)'''


==Essential Amino Acids==
</div></div>
'''PriVaTe TIM HALL'''
<div class="mw-collapsible mw-collapsed">
* Phe, Val, Thr, Trp, Ile, Met, His, Arg, Leu, Lys


==Urea Cycle==
==Hemoglobin Binding Curve: Right Shift Causes==
'''O'''rdinarily, '''C'''areless '''C'''rappers, '''A'''re '''A'''lso '''F'''rivolous '''A'''bout '''U'''rination.
* Ornithine
* Carbamoyl
* Citrulline
* Aspartate
* Arginosuccinate
* Fumarate
* Arginine
* Urea


==People Meet And Talk==
<div class="mw-collapsible-content">
''Cell division''
* Prophase
* Metaphase
* Anaphase
* Telophase


==5'''P''' 's for acute intermittent porphyria==
<font color="red">{{cquote|'''CADET, face right!'''}}</font>
* Pain in abdomen
* C = Increase in carbon dioxide
* Polyneuropathy
* A = Acidosis (low ph)
* Psychologial abnormalities
* D = Increase in 2,3 DPG aka 2,3 BPG
* Pink urine
* E = Exercise
* Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)
* T = increase in temperature


==ABCD for BUN & creatinine elevation==
</div></div>
* Azotremia (pre-renal)
<div class="mw-collapsible mw-collapsed">
* Bleeding (GI)
* Catabolic status
* Diet (high protein parenteral nutrition)


==G6PD: oxidant drugs inducing hemolytic anemia AAA==  
==G-proteins Receptors==
Antibiotic (eg: sufamethoxazole)
Antimalarial (eg: primaquine)
Antipyretics (eg: acetanilid, but not aspirin or acetaminophen)
Vitamin B3 (niacin, nicotinic acid) deficiency: pellagra


==The 3'''D''' 's of pellagra==
<div class="mw-collapsible-content">
Pellegra: Vitamin B3 (niacin, nicotinic acid) deficiency
# Dermatitis
# Diarrhea
# Dementia


==Pompe's disease: type "Police = Po + lys"==
<font color="red">{{cquote|'''QISS & QIQ" (Kiss and Kick)'''}}</font>
Pompe's disease is a lysosomal storage disease (alpha 1,4 glucosidase).
In alphabetical order
* Q: alpha 1
* I: alpha 2
* S: beta 1
* S: beta 2
* &
* Q: M1
* I: M2
* Q: M3


==Metabolic acidosis (normal anion-gap) causes==
</div></div>
#With hyperkalemia: RAISE K+:
<div class="mw-collapsible mw-collapsed">


RTA type 4
==Adrenaline Mechanism==
Aldosterone or mineralocorticord deficiency
Iatrogenic: NH4Cl, HCl
"Stenosis": obstructive uropathy
Early uremia


#With hypokalemia: ReDUCE K+:
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''ABC of Adrenaline'''}}</font>
* Adrenaline--> activates
* Beta receptors--> increases
* Cyclic AMP


Renal TA type 1 and 2
</div></div>


Diarrhoea
</div></div>


Urine diversion into gut
<div class="mw-collapsible mw-collapsed">


Carbonate anhydrase inhibitor
<font color="Navy">'''4. Biochemistry'''</font>


Ex-hyperventilation
<div class="mw-collapsible-content">


==Galactosaemia: enzyme deficiency==
<div class="mw-collapsible mw-collapsed">
GALIPUT: Galactose 1 Phosphate Uridyl Transferase.
• There is an assay called the Galiput test for this.


==Folate deficiency: causes A FOLIC DROP==* Alcoholism
==Enzymes Classification==
* Folic acid antagonists
* Oral contraceptives
* Low dietary intake
* Infection with Giardia
* Celiac sprue
* Dilatin
* Relative folate deficiency
* Old
* Pregnant


==The FAT cat is in the ADEK (attic)==
<div class="mw-collapsible-content">
''Vitamins: which are fat soluble''
Fat soluble vitamins are A,D,E,K.


==Hemoglobin binding curve: causes of shift to right==
<font color="red">{{cquote|'''Over The HILL'''}}</font>
"CADET, face right!"
* '''O''' - '''O'''xidoreductases
* C = Increase in carbon dioxide
* '''T''' - '''T'''ransferases
* A = Acidosis (low ph)
* '''H''' - '''H'''ydrolases
* D = Increase in 2,3 DPG aka 2,3 BPG
* '''I''' - '''I'''somerases
* E = Exercise
* '''L''' - '''L'''igases
* T = increase in temperature
* '''L''' - '''L'''yases


==G proteins for respective receptors==
</div></div>
"QISS & QIQ" (Kiss and Kick):


==G-proteins and their respective receptors (alphabetical order)==
<div class="mw-collapsible mw-collapsed">
Q: alpha 1 I: alpha 2 S: beta 1 S: beta 2 &
Q: M1 I: M2 Q: M3


==Adrenaline mechanism==
==Glycolysis Enzymes==
"ABC of Adrenaline":
* Adrenaline--> activates
* Beta receptors--> increases
* Cyclic AMP


==Carbon monoxide: electron transport chain target==
<div class="mw-collapsible-content">
"CO blocks CO"
<font color="red">{{cquote|'''Hungry Peter Pan And The Growling Pink Panther Eat Pies'''}}</font>
Carbon monoxide (CO) blocks Cytochrome Oxidase (CO)  
* Hexokinase
* Phosphohexo isomerase
* Phosphofructokinase-1 (6-phosphofructo-1 kinase)
* Aldolase, Triose phosphate isomerase
* Glyceraldehyde 3-phosphate dehydrogenase
* Phosphoglycerate kinase
* Phosphoglycerate mutase
* Enolase
* Pyruvate kinase


==Metabolism sites==
</div></div>
"Use both arms to HUG":
<div class="mw-collapsible mw-collapsed">
Heme synthesis Urea cycle Gluconeogenesis • These reactions occur in both cytoplasm and mitochondria.


==AcetylCoA and acetacetylCoA==
==Glycolysis Steps==
"A Lighter Lease" (A LyTr LeIs): amino acids forming them
* A=AcetylCoA or Acetoacetyl CoA
* Ly=Lysine
* Tr=Tryptophan
* Le=Leucine
* Is=Isoleucine


==Fasting state: branched-chain amino acids used by skeletal muscles==
<div class="mw-collapsible-content">
"Muscles LIVe fast":
<font color="red">{{cquote|'''Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies'''}}</font>
* Leucine
* Isoleucine
* Valine
 
==Glycolysis steps==
"Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies":
* Glucose
* Glucose
* Glucose-6-P
* Glucose-6-P
Line 532: Line 317:
* 3-Phosphoglycerate
* 3-Phosphoglycerate
* 2-Phosphoglycerate (to)
* 2-Phosphoglycerate (to)
* Phosphoenolpyruvate [PEP] Pyruvate • 'Did', 'By' and 'Pies' tell you the first part of those three: di-, bi-, and py-.  
* Phosphoenolpyruvate [PEP] Pyruvate • 'Did', 'By' and 'Pies' tell you the first part of those three: di-, bi-, and py-.
• 'PrEPare' tells location of PEP in the process.  
• 'PrEPare' tells location of PEP in the process.
 
</div></div>
 
</div></div>


==Glycolysis Enzymes==
<div class="mw-collapsible mw-collapsed">
“Hungry Peter Pan And The Growling Pink Panther Eat Pies”
 
Hexokinase
<font color="Navy">'''5. Metabolism'''</font>
Phosphohexo isomerase
 
Phosphofructokinase-1 (6-phosphofructo-1 kinase)
<div class="mw-collapsible-content">
Aldolase, Triose phosphate isomerase
 
Glyceraldehyde 3-phosphate dehydrogenase
<div class="mw-collapsible mw-collapsed">
Phosphoglycerate kinase
 
Phosphoglycerate mutase
 
Enolase
==Metabolism Sites==
Pyruvate kinase
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''Use both arms to HUG'''}}</font>
# Heme synthesis
# Urea cycle
# Gluconeogenesis
These reactions occur in both cytoplasm and mitochondria
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==AcetylCoA and AcetacetylCoA==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''A Lighter Lease (A LyTr LeIs)'''}}</font>
Amino acids forming them:
* A=AcetylCoA or Acetoacetyl CoA
* Ly=Lysine
* Tr=Tryptophan
* Le=Leucine
* Is=Isoleucine
 
</div></div>
<div class="mw-collapsible mw-collapsed">


==Citric acid cycle compounds==
==Citric Acid Cycle Compounds==
"Our City Is Kept Safe And Sound From Malice":
Oxaloacetate
Citrate
Isocitrate
alpha-Ketoglutarate
Succinyl-CoA
Succinate
Fumarate
Malate


==Citric acid cycle compounds==
<div class="mw-collapsible-content">
"Can I Keep Selling Sex For Money, Officer?":
<font color="red">{{cquote|'''Our City Is Kept Safe And Sound From Malice'''}}</font>
* Oxaloacetate
* Citrate
* Isocitrate
* alpha-Ketoglutarate
* Succinyl-CoA
* Succinate
* Fumarate
* Malate
 
<font color="red">{{cquote|'''Can I Keep Selling Sex For Money, Officer?'''}}</font>
* Citrate
* Citrate
* Isocitrate
* Isocitrate
Line 569: Line 382:
* Oxaloacetate
* Oxaloacetate


==Citric acid cycle compounds==
<font color="red">{{cquote|'''Oh! Can I Keep Some Succinate For Myself?'''}}</font>
"Oh! Can I Keep Some Succinate For Myself?":
<font color="red">{{cquote|'''Oh Citric Acid Is Of (course) A SiLly STupid Funny Molecule'''}}</font>
* Oxaloacetate
* Oxaloacetate
* Citrate
* Citrate
Line 577: Line 390:
* Succinate
* Succinate
* Fumarate
* Fumarate
* Malate  
* Malate
 
</div></div>
<div class="mw-collapsible mw-collapsed">


==Citric acid cycle compounds==
==Citric Acid Cycle Enzymes==
"Oh Citric Acid Is Of (course) A SiLly STupid Funny Molecule":
* Oxaloacetate
* Citrate
* Isocitrate, alpha-Ketoglutarate
* Succinyl CoA
* Succinate
* Fumarate
* Malate


==Citrate Cycle Enzymes==
<div class="mw-collapsible-content">
"Corrupt Anti Intelligence Agent Spoke Slander For Money."
<font color="red">{{cquote|'''Corrupt Anti Intelligence Agent Spoke Slander For Money'''}}</font>
* Citrate synthatase
* Citrate synthatase
* aconitase
* Aconitase
* Isocitrate dehydrogenase
* Isocitrate dehydrogenase
* Alpha ketogluturate dehydrogenase
* Alpha ketogluturate dehydrogenase
Line 600: Line 408:
* Malate Dehydrogenase
* Malate Dehydrogenase


==Fabry's disease: FABRY'S==
</div></div>
* Foam cells found in glomeruli and tubules/ Febrile episodes
<div class="mw-collapsible mw-collapsed">
* Alpha galactosidase A deficiency/ Angiokeratomas
 
* Burning pain in extremities/ BUN increased in serum/ Boys
==Essential Amino Acids==
* Renal failure
 
* YX genotype (male, X linked recessive)
<div class="mw-collapsible-content">
* Sphingolipidoses
<font color="red">{{cquote|'''P''' ri '''V''' a '''T''' e  '''TIM  HALL'''}}</font>
<font color="red">{{cquote|'''PVT. TIM HALL'''}}</font>
<font color="red">{{cquote|'''"PVT. TIM HALL always argues, never tires"'''}}</font>
* '''P''' - '''P'''he
* '''V''' - '''V'''al
* '''T''' - '''T'''hr
* '''T''' - '''T'''rp
* '''I''' - '''I'''le
* '''M''' - '''M'''et
* '''H''' - '''H'''is
* '''A''' - '''A'''rg
* '''L''' - '''L'''eu
* '''L''' - '''L'''ys
* Pvt. is short for Private in the military
* Arg and His are considered semi-essential
* Alternatively: '''MATT VIL PHLy'''
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Creatine Phosphate: Amino Acid Precursors==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''Nice GAMs!'''}}</font>
* '''G''' - '''G'''lycine
* '''A''' - '''A'''rginine
* '''M''' - '''M'''ethionine
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Branched Chain Amino Acids Catabolism Steps==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''Truck hit the Ox to Death'''}}</font>
* '''T''' - '''T'''ransamination
* '''O''' - '''O'''xidative decarboxylation
* '''D''' - '''D'''ehydrogenation
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Branched-chain Amino Acids Used by Skeletal Muscle (Fasting State)==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''Muscles LIVe fast'''}}</font>
* Leucine
* Isoleucine
* Valine
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Urea Cycle==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''O'''rdinarily '''C'''areless '''C'''rappers '''A'''re '''A'''lso '''F'''rivolous '''A'''bout '''U'''rination!}}</font>
* '''O''' - '''O'''rnithine
* '''C''' - '''C'''arbamoyl
* '''C''' - '''C'''itrulline
* '''A''' - '''A'''spartate
* '''A''' - '''A'''rginosuccinate
* '''F''' - '''F'''umarate
* '''A''' - '''A'''rginine
* '''U''' - '''U'''rea
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Pyrimidines Nucleotides==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''CUT the PY (pie)'''}}</font>
* '''C'''ytosine
* '''U'''racil
* '''T'''hiamine
* '''T'''he
* '''PY'''rimidines
 
</div></div>
 
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
<font color="Navy">'''6. Enzyme Deficiencies'''</font>
 
<div class="mw-collapsible-content">
 
<div class="mw-collapsible mw-collapsed">
 
==G6PD: Oxidant Drugs Inducing Hemolytic Anemia==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''AAA'''}}</font>
* Antibiotic (eg: sufamethoxazole)
* Antimalarial (eg: primaquine)
* Antipyretics (eg: acetanilid, but not aspirin or acetaminophen)
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Pompe's Disease==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''Type "Police: Po + lys"'''}}</font>
* '''PO'''mpe's disease is a '''LYS'''osomal storage disease (alpha 1,4 glucosidase)


==B vitamin names==
</div></div>
"The Rhythm Nearly Proved Contagious":
<div class="mw-collapsible mw-collapsed">
In increasing order:
* Thiamine (B1)
* Riboflavin (B2)
* Niacin (B3)
* Pyridoxine (B6)
* Cobalamin (B12)


==Essential amino acids==
==Galactosemia==
PVT. TIM HALL: Phe Val Thr Trp Ile Met His Arg Leu Lys
Pvt. is short for Private in the military.
Arg and His are considered semiessential.
Alternatively: "MATT VIL PHLy".


==Golgi complex: functions==
<div class="mw-collapsible-content">
"Golgi Distributes A SPAM": Distributes proteins and lipids from ER
<font color="red">{{cquote|'''GALIPUT'''}}</font>
Add mannose onto specific lysosome proteins
* Galactose 1 Phosphate Uridyl Transferase
Sulfation of sugars and slected tyrosine
* There is an assay called the Galiput test for this
Proteoglycan assembly
Add O-oligosugars to serine and threnonine
Modify N-ologosugars on asparagine


==Catabolism steps of branched chain amino acids==
</div></div>
"Truck hit the Ox to Death":
<div class="mw-collapsible mw-collapsed">
* Transamination
* Oxidative decarboxylation
* Dehydrogenation


==Niacin deficiency==
==Fabry's Disease==
The famous 4 D's:
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''FABRY ' S'''}}</font>
* '''F''' - '''F'''oam cells found in glomeruli and tubules / '''F'''ebrile episodes
* '''A''' - '''A'''lpha galactosidase '''A''' deficiency / '''A'''ngiokeratomas
* '''B''' - '''B'''urning pain in extremities / '''B'''UN increased in serum / '''B'''oys
* '''R''' - '''R'''enal failure
* '''Y''' - '''Y'''X genotype (male, X linked recessive)
* '''S''' - '''S'''phingolipidoses
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Hurler Syndrome Features==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''HURLER'S'''}}</font>
*'''H'''eptosplenomegaly
*'''U'''gly facies
*'''R'''ecessive (AR inheritance)
*'''L'''-iduronidase deficiency (alpha)
*'''E'''yes clouded
*'''R'''etarded
*'''S'''tubby fingers/'''S'''hort
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Acute Intermittent Porphyria==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''5  P's '''}}</font>
* '''P'''ain in abdomen
* '''P'''olyneuropathy
* '''P'''sychologial abnormalities
* '''P'''ink urine
* '''P'''recipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)
 
</div></div>
 
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
<font color="Navy">'''7. Vitamins'''</font>
 
<div class="mw-collapsible-content">
 
<div class="mw-collapsible mw-collapsed">
 
==B Vitamins==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''The Rhythm Nearly Proved Contagious'''}}</font>
In increasing order:
* '''T''' - '''T'''hiamine (B1)
* '''R''' - '''R'''iboflavin (B2)
* '''N''' - '''N'''iacin (B3)
* '''P''' - '''P'''yridoxine (B6)
* '''C''' - '''C'''obalamin (B12)
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Niacin Deficiency==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''The famous 4 D's'''}}</font>
# Diarrhea
# Diarrhea
# Dermatitis
# Dermatitis
# Dementia
# Dementia
# Death (if untreated)  
# Death (if untreated)
<font color="red">{{cquote|'''The 3D's of pellagra'''}}</font>
Vitamin B3 (niacin, nicotinic acid) deficiency
# Dermatitis
# Diarrhea
# Dementia
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Folate Deficiency Causes==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''A FOLIC DROP'''}}</font>
* Alcoholism
* Folic acid antagonists
* Oral contraceptives
* Low dietary intake
* Infection with Giardia
* Celiac sprue
* Dilatin
* Relative folate deficiency
* Old
* Pregnant


==Creatine phosphate: amino acid precursors==
</div></div>
"Nice GAMs!":
<div class="mw-collapsible mw-collapsed">
* Glycine
* Arginine
* Methionine


==Enzymes: classification==
==Fat Soluble Vitamins==
"Over The HILL":
* Oxidoreductases
* Transferases
* Hydrolases
* Isomerases
* Ligases
* Lyases


==COLLAGEN==
<div class="mw-collapsible-content">
* C-terminal propeptide (procollagen)/ Covalent Cross links/ C vitamin/ Connective tissue/ Cartilage/ Chondroblasts/ Copper Cofactor (Covalent Cross linking)
<font color="red">{{cquote|'''The FAT cat is in the ADEK (attic)'''}}</font>
* Outside the cell is where collagen normally functions/ Osteoblasts/ Osteogenesis imperfecta
Fat soluble vitamins are ''A,D,E,K.'''
* Lysyl hydroxylase/ Lysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last
* biosynthesis step)
* Long triple helical fibers/ Ligaments
* Alpha chains/ Attached by H bonds form triple helix/ Ascorbate for hydroxylation of lysyl and prolyl residues of pro-Alpha chains
* (postranslational modification)
* Gly in every third position/ Glycosylation of hydroxyl group of hydroxylysine with Glucose and Galactose; GOlgi allows procollagen to GO outside of cell
* Extracellular matrix/ Eye (cornea, sclera)/ Ehlers-Danlos Syndrome
* N-terminal propeptide (procollagen)/ Nonhelical terminal extensions


==Essential amino acids==
</div></div>
"PVT. TIM HALL always argues, never tires":
<div class="mw-collapsible mw-collapsed">
* Phe
* Val
* Thr
* Trp
* Ile
* Met
* His
* Arg
* Lue
* Lys


==Hypervitaminosis A==
==Hypervitaminosis A==
''Increased Vitamin A makes you '''HARD'''''
 
* Headache/ Hepatomegaly
<div class="mw-collapsible-content">
* Anorexia/ Alopecia
<font color="red">{{cquote|Increased Vitamin A makes you '''HARD'''}}</font>
* Really painful bones
* '''H''' - '''H'''eadache / '''H'''epatomegaly
* Dry skin/ Drowsiness
* '''A''' - '''A'''norexia / '''A'''lopecia
* '''R''' - '''R'''eally painful bones
* '''D''' - '''D'''ry skin / '''D'''rowsiness
 
</div></div>
 
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
<font color="Navy">'''8. History Taking'''</font>
 
<div class="mw-collapsible-content">
 
<div class="mw-collapsible mw-collapsed">
 
==Alcoholism Screening==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''CAGE'''}}</font>
* Have you ever felt it necessary to '''C'''UT DOWN on your drinking?
* Have you ever been '''A'''NNOYED when people suggest you cut down on your drinking?
* Have you ever felt '''G'''UILTY about your drinking?
* Have you ever felt the need to have a drink in the morning for an '''E'''YE OPENER?
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Chief Complaint==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''OPQRST'''}}</font>
* '''O''' - '''O'''nset of pain:  what was the patient doing when the pain started?
* '''P''' - '''P'''alliative or '''P'''rovocative factors for the pain
* '''Q''' - '''Q'''uality of pain (burning, stabbing, aching, etc.)
* '''R''' - '''R'''adiation (up to jaw, down left arm, etc.)
* '''S''' - '''S'''everity of pain (usually 1 - 10 scale)
* '''T''' - '''T'''iming of pain (eg: after meals, in the morning, how long it lasts, etc.)
 
<font color="red">{{cquote|'''SOCRATES'''}}</font>
* '''S''' - '''S'''ite of pain
* '''O''' - '''O'''nset of pain
* '''C''' - '''C'''haracter of pain: dull, sharp, aching, stabbing, tearing
* '''R''' - '''R'''adiation of pain: central abdominal pain radiating to Right Iliac Fossa
* '''A''' - '''A'''ssociated factors: eg. nausea/vomiting
* '''T''' - '''T'''iming of pain/duration
* '''E''' - '''E'''xacerbating/alleviating factors
* '''S''' - '''S'''everity of pain (1 - 10 scale)
 
<font color="red">{{cquote|'''ASCLAST'''}}</font>
* '''A''' - '''A'''ggravatiing and '''A'''lleviating factors
* '''S''' - '''S'''everity
* '''C''' - '''C'''haracter, quality
* '''L''' - '''L'''ocation
* '''A''' - '''A'''ssociated symptoms
* '''S''' - '''S'''etting
* '''T''' - '''T'''iming
 
NOTE: ASCLAST means let the patient talk first, then ask him/her specific questions.
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Hospital Admission Orders==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''DAVE WILMINGTON'''}}</font>
* '''D'''iet
* '''A'''ctivity
* '''V'''ital signs: how often to monitor
* '''E'''xcrement: test urine/stool
* '''W'''eight: how often to monitor
* '''I''' / O: monitor input/output
* '''L'''abs: which/how often
* '''M'''eds: which/route/interval
* '''I''' V fluids: what/at what rate
* '''N'''ursing care: e.g. position, wound care, up in chair, ostomy care
* '''G'''eneral care: e.g. physical/respiratory therapy
* '''T'''ests: e.g. X-ray/EKG/EEG
* '''O'''bserve for: reaction/seizure/neuro exams
* '''N'''otify parameters: e.g. Temperature > 100 F / respiration changes
 
After noting date and time of admission as well as diagnosis and condition (ADC), use the mnemonic to ensure all areas are addressed, but not all apply to every patient.
<font color="red">{{cquote|'''ADC VAAN DIML''', pronounced ADC van dim(e)L}}</font>
* '''A'''dmit: 23 hours, full admit, service of attending
* '''D'''iagnosis
* '''C'''ondition: "Stable"/"Guarded"
* '''V'''itals: post-op, routine, q 1 hour
* '''A'''llergies
* '''A'''ctivities: strict bed rest/fall precautions/ad lib/bathroom privileges
* '''N'''ursing: strict I&O's/daily weights/call P.R.N.
* '''D'''iet: NPO/regular/clears/advance diet as tolerated/2000 cal ADA/renal
* '''I'''V fluids: D5, 1/2 NS, 20 KCL at 110 ml/hr, LR @ 100 ml/hr
* '''M'''eds: scheduled and PRN's
* '''L'''abs and X-ray: CBC in AM, PCXR in PACU
 
Note that IV fluids follows Diet. If one writes NPO, then '''all''' such patients get maintenance fluids (use the 4-2-1 rule).
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Post-Op Fever Causes==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''Five W's'''}}</font>
* '''W'''ind: pneumonia, atelectasis
* '''W'''ound: wound infections
* '''W'''ater: urinary tract infection
* '''W'''alking: DVT/PE (walking can help reduce DVT/PE)
* '''W'''onderdrugs: especially anesthesia
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Predisposing Conditions for Pulmonary Embolism==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''TOM SCH PREFER'''}}</font>
* '''T''' - '''T'''rauma
* '''O''' - '''O'''besity
* '''M''' - '''M'''alignancy
* '''S''' - '''S'''urgery
* '''C''' - '''C'''ardiac disease
* '''H''' - '''H'''ospitalization
* '''P''' - '''P'''ast history
* '''R''' - '''R'''est (bed-bound)
* '''E''' - '''E'''strogen, pregnancy, post-partum
* '''F''' - '''F'''racture
* '''E''' - '''E'''lderly
* '''R''' - '''R'''oad trip
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Compartment Syndrome Signs (Arterial Occlusion)==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''6 P's'''}}</font>
# Pain
# Pale (Pallor)
# Perishing with Cold (Poikilothermia)
# Pulseless
# Paresthesias
# Paralysis
 
</div></div>
 
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
<font color="Navy">'''9. Pathology'''</font>
 
<div class="mw-collapsible-content">
 
<div class="mw-collapsible mw-collapsed">
 
==Causes of Diseases==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''VITAMIN C'''}}</font>
*'''V'''ascular
*'''I'''nfectious
*'''T'''rauma
*'''A'''uto-immune
*'''M'''etabolic
*'''I'''diopathic/Iatrogenic
*'''N'''eoplastic
*'''C'''ongenital
 
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
==Signs of Inflammation==
 
<div class="mw-collapsible-content">
 
# '''Rubor''': redness/erythema
# '''Calor''': raised temperature
# '''Tumor''': swelling
# '''Dolor''': pain
# '''Functio Laesa''': loss of function
- Described by Celsus
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Hypersentivity Reactions (Gell & Goombs Classification)==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''ACID'''}}</font> <font color="red">{{cquote|'''A'''nna '''C'''ycled '''I'''mmediately '''D'''ownhill}}</font>
# Type I  '''A'''naphylaxis
# Type II  '''C'''ytotoxic-mediated
# Type III '''I'''mmune-complex
# Type IV  '''D'''elayed hypersensitivity
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Multiple Endocrine Neoplasia (MEN)==
 
<div class="mw-collapsible-content">
Each of the MENs is a disease of '''three or two letters plus a feature'''; all are autosomal dominant.
<font color="red">{{cquote|'''MEN I:  3 P's'''}}</font>
# '''P'''ituitary
# '''P'''arathyroid
# '''P'''ancreas
# Plus Adrenal cortex
 
<font color="red">{{cquote|'''MEN II:  2 C's'''}}</font>
# '''C'''arcinoma of thyroid
# '''C'''atacholamines (pheochromocytoma)
- MEN IIA: parathyroid
- MEN IIB (MEN III): mucocutaneous neuromas for
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Acute Pneumonia Infiltrates==
 
<div class="mw-collapsible-content">
* '''P'''yogenic bacteria: '''P'''MN infiltrate
* '''M'''iscellaneous microbes: '''M'''ononuclear infiltrate
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Takayasu's Disease/Pulseless Disease==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''When you have Takayasu's, I can't Tak'a yu pulse'''}}</font>
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==CBC Normal Differential==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''N'''ever '''L'''et '''M'''onkeys '''E'''at '''B'''ananas}}</font>
<font color="red">{{cquote|'''N'''ice '''L'''adies '''M'''ake '''E'''aster '''B'''read"}}</font>
<font color="red">{{cquote|'''60''', '''30''', '''6''', '''3''', '''1'''}}</font>
# '''N'''eutrophils: '''60'''%
# '''L'''ymphocytes: '''30'''%
# '''M'''onocytes: '''6'''%
# '''E'''osinophils: '''3'''%
# '''B'''asophils: '''1'''%
 
</div></div>
 
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
<font color="Navy">'''10. Causes'''</font>
 
<div class="mw-collapsible-content">
 
<div class="mw-collapsible mw-collapsed">
 
==Metabolic Acidosis Causes==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''MUDPILES'''}}</font>
* '''M'''ethanol poisoning
* '''U'''remia
* '''D'''iabetic Keto-acidosis
* '''P'''ara-aldehyde ingestion
* '''I'''schemia
* '''L'''actic Acidosis
* '''E'''thanol poisoning
* '''S'''alicylate ingestion
 
</div></div>
 
==Metabolic Acidosis (Normal Anion-Gap) Causes==
<div class="mw-collapsible mw-collapsed">
 
===With Hyperkalemia===
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''RAISE K+'''}}</font>
* RTA type 4
* Aldosterone or mineralocorticord deficiency
* Iatrogenic: NH4Cl, HCl
* "Stenosis": obstructive uropathy
* Early uremia
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
===With hypokalemia===
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''ReDUCE K+'''}}</font>
* Renal TA type 1 and 2
* Diarrhoea
* Urine diversion into gut
* Carbonate anhydrase inhibitor
* Ex-hyperventilation
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==BUN & Creatinine Elevation Causes==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''ABCD'''}}</font>
* '''A''' - '''A'''zotremia (pre-renal)
* '''B''' - '''B'''leeding (GI)
* '''C''' - '''C'''atabolic status
* '''D''' - '''D'''iet (high protein parenteral nutrition)
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Hypercalcemia Causes==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''PAM SCHMIDT'''}}</font>
* '''P'''aget's Disease
* '''A'''myloid
* '''M'''ultiple Myeloma
* '''S'''arcoid
* '''C'''ancer
* '''H'''ormomal (para-thyroid)
* '''M'''ilk-alkali Syndrome
* '''I'''mmobilization
* '''D'''-vitamin overdose
* '''T'''hyrotoxicosis
 
'''OR'''
<font color="red">{{cquote|'''MISHAP'''}}</font>
* '''M'''alignancy
* '''I'''ntoxication (hypervitaminosis)
* '''S'''arcoidosis
* '''H'''yperparathyroidism
* '''A'''lkali (Milk) syndrome
* '''P'''aget's Disease (bone)
Also consider Addison's disease, thiazide diuretics and simple lab error
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Acute Pancreatitis Causes==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''GET SMASHED'''}}</font>
# '''G'''all stones
# '''E'''thanol
# '''T'''rauma
# '''S'''teroids
# '''M'''umps
# '''A'''utoimmune disease
# '''S'''corpion venom
# '''H'''yperlipidemia
# '''E'''RCP (dye)
# '''D'''rugs (Azathioprine, Asparginase, Mercaptopurines, Pentamidine)
Alcohol and Gallstones are the most common causes.
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Back Pain Causes==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''DISK MASS'''}}</font>
* '''D'''-'''D'''egeneration: DJD, Osteoporosis, spondylosis
* '''I'''-'''I'''nfection: UTI, PID, Potts, osteomyelitis, prostatitis, Injury/fracture, compression fracture
* '''S'''-'''S'''pondylitis, ankylosing Spondyloarthropathies (rheumatoid arthritis, Reiters,  SLE)
* '''K'''-'''K'''idney stones/infarction/infection (pyelo/abscess)
* '''M'''-'''M'''ultiple myeloma, '''M'''etastasis from breast, prostate, lung, thyroid, kidney CA
* '''A'''-'''A'''neurysm, '''A'''bdominal pain referred to the back (see acute abdominal pain)
* '''S'''-'''S'''lipped disk, '''S'''pondylolisthesis
* '''S'''-'''S'''train, '''S'''coliosis/lordosis, '''S'''kin: herpes zoster
 
</div></div>
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
<font color="Navy">'''11. Treatment'''</font>
 
<div class="mw-collapsible-content">
 
<div class="mw-collapsible mw-collapsed">
 
==Syncope Management==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''If the face is red, raise the head!'''}}</font>
<font color="red">{{cquote|'''If the face is pale, raise the tail!'''}}</font>
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Malignant Hyperthermia Treatment==
 
<div class="mw-collapsible-content">
 
<font color="red">{{cquote|'''Sunday Hot Day, Better Give Iced Fluids Today!'''}}</font>
* '''S'''- Stop all triggering agents, give 100% O2
* '''H'''- Hyperventillate
* '''D'''- Dantrolene 2.5 mg/kg
* '''B'''- Bicarbonate
* '''G'''- Glucose and Insulin
* '''I'''- IV Fluids, Cooling Blanket
* '''F'''- Fluid Output; Furosemide
* '''T'''- Tachycardia, be prepared to treat V Tach
 
</div></div>
 
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
<font color="Navy">'''12. Genetics'''</font>
 
<div class="mw-collapsible-content">
 
<div class="mw-collapsible mw-collapsed">
 
==Down Syndrome Features==
 
<div class="mw-collapsible-content">
 
<font color="red">{{cquote|'''CHILD HAS PROBLEM!'''}}</font>
* '''C'''ongenital heart disease/ '''C'''ataracts
* '''H'''ypotonia/ Hypothyroidism
* '''I'''ncure 5th finger/ '''I'''ncreased gap between 1st and 2nd toe
* '''L'''eukemia risk x2/ '''L'''ung problem
* '''D'''uodenal atresia/ '''D'''elayed development
* '''H'''irshsprung's disease/ '''H'''earing loss
* '''A'''lzheimer's disease/ Alantoaxial instability
* '''S'''quint/ Short neck
* '''P'''rotruding tongue/ '''P'''alm crease
* '''R'''ound face/ '''R'''olling eye (nystagmus)
* '''O'''cciput flat/ '''O'''blique eye fissure
* '''B'''rushfield spot/ '''B'''rachycephaly
* '''L'''ow nasal bridge/ '''L'''anguage problem
* '''E'''picanthic fold/ '''E'''ar folded
* '''M'''ental retardation/ '''M'''yoclonus
 
<font color="red">{{cquote|'''DOWN'''}}</font>
* '''D'''ecreased alpha-fetoprotein and unconjugated estriol (maternal)
* '''O'''ne extra chromosome twenty-one
* '''W'''omen of advanced age
* '''N'''on-disjunction during maternal meiosis
 
<font color="red">{{cquote|'''Drink at 21'''}}</font>
Chromosome 21
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Patau's Syndrome - Chromosome 13==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''P'''uberty at 13}}</font>
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Edward's Syndrome - Chromosome 18==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|Election voter at 18}}</font>
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==DiGeorge (Velocardiofacial) Syndrome==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''CATCH 22'''}}</font>
* '''C'''ardiac abnormalities
* '''A'''bnormal facies
* '''T'''hymic aplasia
* '''C'''left palate
* '''H'''ypocalcemia
* '''22'''q11 deletion
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Marfan Syndrome Features==
 
<div class="mw-collapsible-content">
# '''M'''itral valve prolapse - MVP
# '''A'''ortic Aneurysm
# '''R'''etinal detachment
# '''F'''ibrillin
# '''A'''rachnodactyly
# '''N'''egative '''N'''itroprusside test (differentiates from homocystinuria)
 
</div></div>
<div class="mw-collapsible mw-collapsed">
 
==Adult Polycystic Kidney Disease==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'"Polycystic kidney"' has '''16 letters'''}}</font>
Also,  and is due to a defect on chromosome 16.
<font color="red">{{cquote|'''APKD'''}}</font>
ADult Polycystic Kidney Disease is  Autosomal Dominant
 
</div></div>
 
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
<font color="Navy">'''13. Pediatrics'''</font>
 
<div class="mw-collapsible-content">
 
<div class="mw-collapsible mw-collapsed">
 
==APGAR Score==
 
<div class="mw-collapsible-content">
<font color="red">{{cquote|'''APGAR'''}}</font>
* '''A'''ppearance (color): blue/pale, trunk pink, all pink
* '''P'''ulse (heart rate): 0, <100, 100+
* '''G'''rimace (reflex irritability): 0, grimace, grimace+cough
* '''A'''ctivity (muscle tone): limp, some, active
* '''R'''espiration (respiratory effort): 0, irregular, regular
- Score 0-2 at 1 and 5 minutes in each of 5 categories, being 10 the perfect score.
 
</div></div>

Latest revision as of 23:03, 3 February 2014

WikiDoc Board Review
The Project
The Team
Guidelines
Question List
Quality Checklist
Medical Illustrations
Question Template
High Yield!
Normal Labs
Mnemonics
Test Taking Tips
Resources

1. Anatomy

GI Anatomy

“ Dow Jones Industrial Average Closing Stock Report ”

From proximal to distal:

  1. Duodenum
  2. Jejunum
  3. Ileum
  4. Appendix
  5. Colon
  6. Sigmoid
  7. Rectum

Brachial Plexus Organization

“ Radical Teachers Drink Cold Beers ”

“ Randy Travis Drinks Cold Beers ”

“ Robert Taylor Drinks Cold Beer ”

“ Red Trucks Drive Cats Nuts ”
  1. Roots
  2. Trunks
  3. Divisions
  4. Cords
  5. Branches

Cranial Nerves

“ On Old Olympus Towering Tops, A Finn And German Viewed Some Hops ”

“ Our Only Object To Touch And Feel Virgin Girls Vagina And Hymen ”
  1. I - olfactory
  2. II - optic
  3. III - oculomotor
  4. IV - trochlear
  5. V - trigeminal
  6. VI - abducens
  7. VII - facial
  8. VIII - acoustic (vestibulocochlear)
  9. IX - glossophrayngeal
  10. X - vagus
  11. XI - accessory
  12. XII - hypoglossal

Extraocular Muscles Innervation

“ LR6 SO4 3 ”
  • LR 6 - Lateral Rectus by the VI cranial nerve (Abducens)
  • SO 4 - Superior Oblique by the IV cranial nerve (Trochlear)
  • 3 - The remaining by the III cranial nerve (Occulomotor)

“ LAST ”
  • L - Lateral Rectus
  • A - Abducens Nerve
  • S - Superior Oblique
  • T - Trochlear Nerve

Facial Nerve Branches

“ Two Zebras Bought My Car ”

“ Two Zebras Bit My Cookie ”

“ To Zanzibar By Motor Car ”

“ Ten Zulus Buggered My Cat ”
  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Mandibular
  5. Cervical

Penis Innervation

“ Point and Shoot ”
  • Parasympathetic causes erection
  • Sympathetic causes ejaculation

“ S2, 3, 4 keep the penis off the floor ”
  • Innervation of the penis by branches of the pudendal nerve, derived from spinal cord levels S 2-4

Aorta Branches

“ ABC'S ”
  • Aortic arch gives off the:
  1. B - Bracheiocephalic trunk
  2. C - Left Common Carotid
  3. S - Left Subclavian artery

Femoral Triangle Structures in Order

“ N (AVEL) ”
  • Nerve
  • Artery
  • Vein
  • Empty space
  • Lymphatics

- Parenthesis includes things contained in the femoral sheath.

2. Cell Biology

Cell Division Phases

“ People Meet And Talk ”
  • P - Prophase
  • M - Metaphase
  • A - Anaphase
  • T - Telophase

Cell Cycle Stages

“ Go Sally Go! Make Children! ”
  • G1 phase - Growth phase 1
  • S phase - DNA synthesis
  • G2 phase - Growth phase 2
  • M phase - Mitosis
  • C phase - Cytokinesis

Golgi Complex Functions

“ Golgi Distributes A SPAM ”
  • Distributes proteins and lipids from ER
  • Add mannose onto specific lysosome proteins
  • Sulfation of sugars and slected tyrosine
  • Proteoglycan assembly
  • Add O-oligosugars to serine and threnonine
  • Modify N-ologosugars on asparagine

Collagen

“ COLLAGEN ”
  • C - C-terminal propeptide (procollagen) / Covalent Cross links/ C vitamin/ Connective tissue/ Cartilage/Chondroblasts/Copper Cofactor (Covalent Cross linking)
  • O - Outside the cell is where collagen normally functions/ Osteoblasts/ Osteogenesis imperfecta
  • L - Lysyl hydroxylase / Lysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last biosynthesis step)
  • L - Long triple helical fibers / Ligaments
  • A - Alpha chains / Attached by H bonds form triple helix / Ascorbate for hydroxylation of lysyl and prolyl residues of pro-Alpha chains

(postranslational modification)

  • G - Gly in every third position / Glycosylation of hydroxyl group of hydroxylysine with Glucose and Galactose;GOlgi allows procollagen to GO outside of cell
  • E - Extracellular matrix / Eye (cornea, sclera) / Ehlers-Danlos Syndrome
  • N - N-terminal propeptide (procollagen) / Nonhelical terminal extensions

3. Molecular Biology

Carbon Monoxide: Electron Transport Chain Target

“ CO blocks CO ”

Carbon monoxide (CO) blocks Cytochrome Oxidase (CO)

Hemoglobin Binding Curve: Right Shift Causes

“ CADET, face right! ”
  • C = Increase in carbon dioxide
  • A = Acidosis (low ph)
  • D = Increase in 2,3 DPG aka 2,3 BPG
  • E = Exercise
  • T = increase in temperature

G-proteins Receptors

“ QISS & QIQ" (Kiss and Kick) ”

In alphabetical order

  • Q: alpha 1
  • I: alpha 2
  • S: beta 1
  • S: beta 2
  • &
  • Q: M1
  • I: M2
  • Q: M3

Adrenaline Mechanism

“ ABC of Adrenaline ”
  • Adrenaline--> activates
  • Beta receptors--> increases
  • Cyclic AMP

4. Biochemistry

Enzymes Classification

“ Over The HILL ”
  • O - Oxidoreductases
  • T - Transferases
  • H - Hydrolases
  • I - Isomerases
  • L - Ligases
  • L - Lyases

Glycolysis Enzymes

“ Hungry Peter Pan And The Growling Pink Panther Eat Pies ”
  • Hexokinase
  • Phosphohexo isomerase
  • Phosphofructokinase-1 (6-phosphofructo-1 kinase)
  • Aldolase, Triose phosphate isomerase
  • Glyceraldehyde 3-phosphate dehydrogenase
  • Phosphoglycerate kinase
  • Phosphoglycerate mutase
  • Enolase
  • Pyruvate kinase

Glycolysis Steps

“ Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies ”
  • Glucose
  • Glucose-6-P
  • Fructose-6-P
  • Fructose-1,6-diP
  • Dihydroxyacetone-P
  • Glyceraldehyde-P
  • 1,3-Biphosphoglycerate
  • 3-Phosphoglycerate
  • 2-Phosphoglycerate (to)
  • Phosphoenolpyruvate [PEP] Pyruvate • 'Did', 'By' and 'Pies' tell you the first part of those three: di-, bi-, and py-.

• 'PrEPare' tells location of PEP in the process.

5. Metabolism


Metabolism Sites

“ Use both arms to HUG ”
  1. Heme synthesis
  2. Urea cycle
  3. Gluconeogenesis

These reactions occur in both cytoplasm and mitochondria

AcetylCoA and AcetacetylCoA

“ A Lighter Lease (A LyTr LeIs) ”

Amino acids forming them:

  • A=AcetylCoA or Acetoacetyl CoA
  • Ly=Lysine
  • Tr=Tryptophan
  • Le=Leucine
  • Is=Isoleucine

Citric Acid Cycle Compounds

“ Our City Is Kept Safe And Sound From Malice ”
  • Oxaloacetate
  • Citrate
  • Isocitrate
  • alpha-Ketoglutarate
  • Succinyl-CoA
  • Succinate
  • Fumarate
  • Malate

“ Can I Keep Selling Sex For Money, Officer? ”
  • Citrate
  • Isocitrate
  • alpha-Ketogluterate
  • Succinyl CoA
  • Succinate
  • Fumerate
  • Malate
  • Oxaloacetate

“ Oh! Can I Keep Some Succinate For Myself? ”

“ Oh Citric Acid Is Of (course) A SiLly STupid Funny Molecule ”
  • Oxaloacetate
  • Citrate
  • Isocitrate, alpha-Ketoglutarate
  • Succinyl CoA
  • Succinate
  • Fumarate
  • Malate

Citric Acid Cycle Enzymes

“ Corrupt Anti Intelligence Agent Spoke Slander For Money ”
  • Citrate synthatase
  • Aconitase
  • Isocitrate dehydrogenase
  • Alpha ketogluturate dehydrogenase
  • Succinyl CoA synthetase
  • Succinate dehydrogenase
  • Fumarase
  • Malate Dehydrogenase

Essential Amino Acids

“ P ri V a T e TIM HALL ”

“ PVT. TIM HALL ”

“ "PVT. TIM HALL always argues, never tires" ”
  • P - Phe
  • V - Val
  • T - Thr
  • T - Trp
  • I - Ile
  • M - Met
  • H - His
  • A - Arg
  • L - Leu
  • L - Lys
  • Pvt. is short for Private in the military
  • Arg and His are considered semi-essential
  • Alternatively: MATT VIL PHLy

Creatine Phosphate: Amino Acid Precursors

“ Nice GAMs! ”
  • G - Glycine
  • A - Arginine
  • M - Methionine

Branched Chain Amino Acids Catabolism Steps

“ Truck hit the Ox to Death ”
  • T - Transamination
  • O - Oxidative decarboxylation
  • D - Dehydrogenation

Branched-chain Amino Acids Used by Skeletal Muscle (Fasting State)

“ Muscles LIVe fast ”
  • Leucine
  • Isoleucine
  • Valine

Urea Cycle

“ Ordinarily Careless Crappers Are Also Frivolous About Urination! ”
  • O - Ornithine
  • C - Carbamoyl
  • C - Citrulline
  • A - Aspartate
  • A - Arginosuccinate
  • F - Fumarate
  • A - Arginine
  • U - Urea

Pyrimidines Nucleotides

“ CUT the PY (pie) ”
  • Cytosine
  • Uracil
  • Thiamine
  • The
  • PYrimidines

6. Enzyme Deficiencies

G6PD: Oxidant Drugs Inducing Hemolytic Anemia

“ AAA ”
  • Antibiotic (eg: sufamethoxazole)
  • Antimalarial (eg: primaquine)
  • Antipyretics (eg: acetanilid, but not aspirin or acetaminophen)

Pompe's Disease

“ Type "Police: Po + lys" ”
  • POmpe's disease is a LYSosomal storage disease (alpha 1,4 glucosidase)

Galactosemia

“ GALIPUT ”
  • Galactose 1 Phosphate Uridyl Transferase
  • There is an assay called the Galiput test for this

Fabry's Disease

“ FABRY ' S ”
  • F - Foam cells found in glomeruli and tubules / Febrile episodes
  • A - Alpha galactosidase A deficiency / Angiokeratomas
  • B - Burning pain in extremities / BUN increased in serum / Boys
  • R - Renal failure
  • Y - YX genotype (male, X linked recessive)
  • S - Sphingolipidoses

Hurler Syndrome Features

“ HURLER'S ”
  • Heptosplenomegaly
  • Ugly facies
  • Recessive (AR inheritance)
  • L-iduronidase deficiency (alpha)
  • Eyes clouded
  • Retarded
  • Stubby fingers/Short

Acute Intermittent Porphyria

“ 5 P's ”
  • Pain in abdomen
  • Polyneuropathy
  • Psychologial abnormalities
  • Pink urine
  • Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)

7. Vitamins

B Vitamins

“ The Rhythm Nearly Proved Contagious ”

In increasing order:

  • T - Thiamine (B1)
  • R - Riboflavin (B2)
  • N - Niacin (B3)
  • P - Pyridoxine (B6)
  • C - Cobalamin (B12)

Niacin Deficiency

“ The famous 4 D's ”
  1. Diarrhea
  2. Dermatitis
  3. Dementia
  4. Death (if untreated)

“ The 3D's of pellagra ”

Vitamin B3 (niacin, nicotinic acid) deficiency

  1. Dermatitis
  2. Diarrhea
  3. Dementia

Folate Deficiency Causes

“ A FOLIC DROP ”
  • Alcoholism
  • Folic acid antagonists
  • Oral contraceptives
  • Low dietary intake
  • Infection with Giardia
  • Celiac sprue
  • Dilatin
  • Relative folate deficiency
  • Old
  • Pregnant

Fat Soluble Vitamins

“ The FAT cat is in the ADEK (attic) ”

Fat soluble vitamins are A,D,E,K.'

Hypervitaminosis A

“ Increased Vitamin A makes you HARD ”
  • H - Headache / Hepatomegaly
  • A - Anorexia / Alopecia
  • R - Really painful bones
  • D - Dry skin / Drowsiness

8. History Taking

Alcoholism Screening

“ CAGE ”
  • Have you ever felt it necessary to CUT DOWN on your drinking?
  • Have you ever been ANNOYED when people suggest you cut down on your drinking?
  • Have you ever felt GUILTY about your drinking?
  • Have you ever felt the need to have a drink in the morning for an EYE OPENER?

Chief Complaint

“ OPQRST ”
  • O - Onset of pain: what was the patient doing when the pain started?
  • P - Palliative or Provocative factors for the pain
  • Q - Quality of pain (burning, stabbing, aching, etc.)
  • R - Radiation (up to jaw, down left arm, etc.)
  • S - Severity of pain (usually 1 - 10 scale)
  • T - Timing of pain (eg: after meals, in the morning, how long it lasts, etc.)

“ SOCRATES ”
  • S - Site of pain
  • O - Onset of pain
  • C - Character of pain: dull, sharp, aching, stabbing, tearing
  • R - Radiation of pain: central abdominal pain radiating to Right Iliac Fossa
  • A - Associated factors: eg. nausea/vomiting
  • T - Timing of pain/duration
  • E - Exacerbating/alleviating factors
  • S - Severity of pain (1 - 10 scale)

“ ASCLAST ”
  • A - Aggravatiing and Alleviating factors
  • S - Severity
  • C - Character, quality
  • L - Location
  • A - Associated symptoms
  • S - Setting
  • T - Timing

NOTE: ASCLAST means let the patient talk first, then ask him/her specific questions.

Hospital Admission Orders

“ DAVE WILMINGTON ”
  • Diet
  • Activity
  • Vital signs: how often to monitor
  • Excrement: test urine/stool
  • Weight: how often to monitor
  • I / O: monitor input/output
  • Labs: which/how often
  • Meds: which/route/interval
  • I V fluids: what/at what rate
  • Nursing care: e.g. position, wound care, up in chair, ostomy care
  • General care: e.g. physical/respiratory therapy
  • Tests: e.g. X-ray/EKG/EEG
  • Observe for: reaction/seizure/neuro exams
  • Notify parameters: e.g. Temperature > 100 F / respiration changes

After noting date and time of admission as well as diagnosis and condition (ADC), use the mnemonic to ensure all areas are addressed, but not all apply to every patient.

“ ADC VAAN DIML, pronounced ADC van dim(e)L ”
  • Admit: 23 hours, full admit, service of attending
  • Diagnosis
  • Condition: "Stable"/"Guarded"
  • Vitals: post-op, routine, q 1 hour
  • Allergies
  • Activities: strict bed rest/fall precautions/ad lib/bathroom privileges
  • Nursing: strict I&O's/daily weights/call P.R.N.
  • Diet: NPO/regular/clears/advance diet as tolerated/2000 cal ADA/renal
  • IV fluids: D5, 1/2 NS, 20 KCL at 110 ml/hr, LR @ 100 ml/hr
  • Meds: scheduled and PRN's
  • Labs and X-ray: CBC in AM, PCXR in PACU

Note that IV fluids follows Diet. If one writes NPO, then all such patients get maintenance fluids (use the 4-2-1 rule).

Post-Op Fever Causes

“ Five W's ”
  • Wind: pneumonia, atelectasis
  • Wound: wound infections
  • Water: urinary tract infection
  • Walking: DVT/PE (walking can help reduce DVT/PE)
  • Wonderdrugs: especially anesthesia

Predisposing Conditions for Pulmonary Embolism

“ TOM SCH PREFER ”
  • T - Trauma
  • O - Obesity
  • M - Malignancy
  • S - Surgery
  • C - Cardiac disease
  • H - Hospitalization
  • P - Past history
  • R - Rest (bed-bound)
  • E - Estrogen, pregnancy, post-partum
  • F - Fracture
  • E - Elderly
  • R - Road trip

Compartment Syndrome Signs (Arterial Occlusion)

“ 6 P's ”
  1. Pain
  2. Pale (Pallor)
  3. Perishing with Cold (Poikilothermia)
  4. Pulseless
  5. Paresthesias
  6. Paralysis

9. Pathology

Causes of Diseases

“ VITAMIN C ”
  • Vascular
  • Infectious
  • Trauma
  • Auto-immune
  • Metabolic
  • Idiopathic/Iatrogenic
  • Neoplastic
  • Congenital

Signs of Inflammation

  1. Rubor: redness/erythema
  2. Calor: raised temperature
  3. Tumor: swelling
  4. Dolor: pain
  5. Functio Laesa: loss of function

- Described by Celsus

Hypersentivity Reactions (Gell & Goombs Classification)

“ ACID ”
“ Anna Cycled Immediately Downhill ”
  1. Type I Anaphylaxis
  2. Type II Cytotoxic-mediated
  3. Type III Immune-complex
  4. Type IV Delayed hypersensitivity

Multiple Endocrine Neoplasia (MEN)

Each of the MENs is a disease of three or two letters plus a feature; all are autosomal dominant.

“ MEN I: 3 P's ”
  1. Pituitary
  2. Parathyroid
  3. Pancreas
  4. Plus Adrenal cortex

“ MEN II: 2 C's ”
  1. Carcinoma of thyroid
  2. Catacholamines (pheochromocytoma)

- MEN IIA: parathyroid - MEN IIB (MEN III): mucocutaneous neuromas for

Acute Pneumonia Infiltrates

  • Pyogenic bacteria: PMN infiltrate
  • Miscellaneous microbes: Mononuclear infiltrate

Takayasu's Disease/Pulseless Disease

“ When you have Takayasu's, I can't Tak'a yu pulse ”

CBC Normal Differential

“ Never Let Monkeys Eat Bananas ”

“ Nice Ladies Make Easter Bread" ”

“ 60, 30, 6, 3, 1 ”
  1. Neutrophils: 60%
  2. Lymphocytes: 30%
  3. Monocytes: 6%
  4. Eosinophils: 3%
  5. Basophils: 1%

10. Causes

Metabolic Acidosis Causes

“ MUDPILES ”
  • Methanol poisoning
  • Uremia
  • Diabetic Keto-acidosis
  • Para-aldehyde ingestion
  • Ischemia
  • Lactic Acidosis
  • Ethanol poisoning
  • Salicylate ingestion

Metabolic Acidosis (Normal Anion-Gap) Causes

With Hyperkalemia

“ RAISE K+ ”
  • RTA type 4
  • Aldosterone or mineralocorticord deficiency
  • Iatrogenic: NH4Cl, HCl
  • "Stenosis": obstructive uropathy
  • Early uremia

With hypokalemia

“ ReDUCE K+ ”
  • Renal TA type 1 and 2
  • Diarrhoea
  • Urine diversion into gut
  • Carbonate anhydrase inhibitor
  • Ex-hyperventilation

BUN & Creatinine Elevation Causes

“ ABCD ”
  • A - Azotremia (pre-renal)
  • B - Bleeding (GI)
  • C - Catabolic status
  • D - Diet (high protein parenteral nutrition)

Hypercalcemia Causes

“ PAM SCHMIDT ”
  • Paget's Disease
  • Amyloid
  • Multiple Myeloma
  • Sarcoid
  • Cancer
  • Hormomal (para-thyroid)
  • Milk-alkali Syndrome
  • Immobilization
  • D-vitamin overdose
  • Thyrotoxicosis

OR

“ MISHAP ”
  • Malignancy
  • Intoxication (hypervitaminosis)
  • Sarcoidosis
  • Hyperparathyroidism
  • Alkali (Milk) syndrome
  • Paget's Disease (bone)

Also consider Addison's disease, thiazide diuretics and simple lab error

Acute Pancreatitis Causes

“ GET SMASHED ”
  1. Gall stones
  2. Ethanol
  3. Trauma
  4. Steroids
  5. Mumps
  6. Autoimmune disease
  7. Scorpion venom
  8. Hyperlipidemia
  9. ERCP (dye)
  10. Drugs (Azathioprine, Asparginase, Mercaptopurines, Pentamidine)

Alcohol and Gallstones are the most common causes.

Back Pain Causes

“ DISK MASS ”
  • D-Degeneration: DJD, Osteoporosis, spondylosis
  • I-Infection: UTI, PID, Potts, osteomyelitis, prostatitis, Injury/fracture, compression fracture
  • S-Spondylitis, ankylosing Spondyloarthropathies (rheumatoid arthritis, Reiters, SLE)
  • K-Kidney stones/infarction/infection (pyelo/abscess)
  • M-Multiple myeloma, Metastasis from breast, prostate, lung, thyroid, kidney CA
  • A-Aneurysm, Abdominal pain referred to the back (see acute abdominal pain)
  • S-Slipped disk, Spondylolisthesis
  • S-Strain, Scoliosis/lordosis, Skin: herpes zoster

11. Treatment

Syncope Management

“ If the face is red, raise the head! ”

“ If the face is pale, raise the tail! ”

Malignant Hyperthermia Treatment

“ Sunday Hot Day, Better Give Iced Fluids Today! ”
  • S- Stop all triggering agents, give 100% O2
  • H- Hyperventillate
  • D- Dantrolene 2.5 mg/kg
  • B- Bicarbonate
  • G- Glucose and Insulin
  • I- IV Fluids, Cooling Blanket
  • F- Fluid Output; Furosemide
  • T- Tachycardia, be prepared to treat V Tach

12. Genetics

Down Syndrome Features

“ CHILD HAS PROBLEM! ”
  • Congenital heart disease/ Cataracts
  • Hypotonia/ Hypothyroidism
  • Incure 5th finger/ Increased gap between 1st and 2nd toe
  • Leukemia risk x2/ Lung problem
  • Duodenal atresia/ Delayed development
  • Hirshsprung's disease/ Hearing loss
  • Alzheimer's disease/ Alantoaxial instability
  • Squint/ Short neck
  • Protruding tongue/ Palm crease
  • Round face/ Rolling eye (nystagmus)
  • Occiput flat/ Oblique eye fissure
  • Brushfield spot/ Brachycephaly
  • Low nasal bridge/ Language problem
  • Epicanthic fold/ Ear folded
  • Mental retardation/ Myoclonus

“ DOWN ”
  • Decreased alpha-fetoprotein and unconjugated estriol (maternal)
  • One extra chromosome twenty-one
  • Women of advanced age
  • Non-disjunction during maternal meiosis

“ Drink at 21 ”

Chromosome 21

Patau's Syndrome - Chromosome 13

“ Puberty at 13 ”

Edward's Syndrome - Chromosome 18

“ Election voter at 18 ”

DiGeorge (Velocardiofacial) Syndrome

“ CATCH 22 ”
  • Cardiac abnormalities
  • Abnormal facies
  • Thymic aplasia
  • Cleft palate
  • Hypocalcemia
  • 22q11 deletion

Marfan Syndrome Features

  1. Mitral valve prolapse - MVP
  2. Aortic Aneurysm
  3. Retinal detachment
  4. Fibrillin
  5. Arachnodactyly
  6. Negative Nitroprusside test (differentiates from homocystinuria)

Adult Polycystic Kidney Disease

“ '"Polycystic kidney"' has 16 letters ”

Also, and is due to a defect on chromosome 16.

“ APKD ”

ADult Polycystic Kidney Disease is Autosomal Dominant

13. Pediatrics

APGAR Score

“ APGAR ”
  • Appearance (color): blue/pale, trunk pink, all pink
  • Pulse (heart rate): 0, <100, 100+
  • Grimace (reflex irritability): 0, grimace, grimace+cough
  • Activity (muscle tone): limp, some, active
  • Respiration (respiratory effort): 0, irregular, regular

- Score 0-2 at 1 and 5 minutes in each of 5 categories, being 10 the perfect score.

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