Medical Mnemonics for Examinations: Difference between revisions

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=='''D'''ow '''J'''ones '''I'''ndustrial '''A'''verage '''C'''losing '''S'''tock '''R'''eport==
''From proximal to distal:''
# '''D'''uodenum
# '''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==
<font color="Navy">'''1. ANATOMY'''</font>
==GI Anatomy==
<font color="red">{{cquote|'''D'''ow '''J'''ones '''I'''ndustrial '''A'''verage '''C'''losing '''S'''tock '''R'''eport}}</font>
''From proximal to distal:''
''From proximal to distal:''
# '''D'''uodenum
# '''D'''uodenum
# '''J'''ejunum
# '''J'''ejunum
# '''I'''leum
# '''I'''leum
# '''C'''ecum
# '''A'''ppendix
# '''A'''ppendix
# '''C'''olon
# '''C'''olon
Line 21: Line 13:
# '''R'''ectum
# '''R'''ectum


==Causes of Acute Pancreatitis==
==Brachial Plexus Organization==
"'''GET SMASHED'''"
<font color="red">{{cquote|'''Radical Teachers Drink Cold Beers'''}}</font>
# '''G'''all stones
<font color="red">{{cquote|'''Randy Travis Drinks Cold Beers'''}}</font>
# '''E'''thanol
<font color="red">{{cquote|'''Robert Taylor Drinks Cold Beer'''}}</font>
# '''T'''rauma
<font color="red">{{cquote|'''Red Trucks Drive Cats Nuts'''}}</font>
# '''S'''teroids
# Roots
# '''M'''umps
# Trunks
# '''A'''utoimmune disease
# Divisions
# '''S'''corpion venom
# Cords
# '''H'''yperlipidemia
# Branches
# '''E'''RCP (dye)
# '''D'''rugs (Azathioprine, Asparginase, Mercaptopurines, Pentamidine)
 
Alcohol and Gallstones are the most common causes.
 
==A-P-G-A-R==
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
 
==Multiple Endocrine Neoplasia (MEN)==
Each of the MENs is a disease of three or two letters plus a feature, and all are Autosomal Dominant inheritance.
* 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==
* 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==
* '''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.)
 
==S-O-C-R-A-T-E-S - exploring the presenting complaint====
* '''S''' - '''S'''ite of pain
* '''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====
* '''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.
 
==The five '''W''''s--post-operative fever==
* '''W'''ind - pneumonia, atelectasis
* '''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'''==
* '''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==
ARTERIAL OCCLUSION (Signs of Compartment Syndrome)
#* Pain
#* Paleness (Pallor)
#* Perishing with Cold (Poikilothermia)
#* Pulselessness
#* Paresthesias
#* Paralysis
 
==DAVE WILMINGTON==
To write Admission Orders to Hospital
(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)
* '''D'''iet
* '''A'''ctivity
* '''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)==
'''A'''dmit (23 hours, full admit, service of attending,...)
'''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).
 
==VITAMIN C==
'''Causes of Diseases'''
*Vascular
*Infectious
*Trauma
*Auto-immune
*Metabolic
*Idiopathic/Iatrogenic
*Neoplastic
*Congenital
 
==Metabolic Acidosis Causes==
MUDPILES
* '''M'''ethanol poisoning
* '''U'''remia
* '''D'''iabetic Keto-acidosis
* '''P'''ara-aldehyde ingestion
* '''I'''schemia
* '''L'''actic Acidosis
* '''E'''thanol poisoning
* '''S'''alicylate ingestion
 
==Hypercalcemia Causes==
'''PAM SCHMIDT'''                       
* '''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
* '''MISHAP'''
* Malignancy
* Intoxication (hypervitaminosis)
* Sarcoidosis
* Hyperparathyroidism
* Alkali (Milk) syndrome
* Paget's Disease (bone)
* <font color="#000000"></font>
also consider Addison's Disease, thiazide diuretics and simple lab error
 
==5 SIGNS OF INFLAMMATION (as described by Celsus)==
# Redness/Erythema (Rubor)
# Raised temperature (Calor)
# Swelling (Tumor)
# Pain (Dolor)
# Loss of Function (Functio Laesa)
 
==Hypersentivity Reactions (Gell & Goombs Classification)==
ACID  OR'''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==
* '''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'''==
* '''N'''eutrophils '''60'''%
* '''L'''ymphocytes '''30'''%
* '''M'''onocytes '''6'''%
* '''E'''osinophils '''3'''%
* '''B'''asophils '''1'''%
 
=='''N'''ice '''L'''adies '''M'''ake '''E'''aster '''B'''read" and "'''60''', '''30''', '''6''', '''3''', '''1'''==
* '''N'''eutrophils '''60'''%
* '''L'''ymphocytes '''30'''%
* '''M'''onocytes '''6'''%
* '''E'''osinophils '''3'''%
* '''B'''asophils '''1'''%
 
==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
 
==Back Pain Causes==
'''DISK MASS'''
* '''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
 
==Syncope Management==
* If the face is red, raise the head!
* If the face is pale, raise the tail!
 
==BRACHIAL PLEXUS==
Roots, Trunks, Divisions, Cords, Branches:
* Radical Teachers Drink Cold Beers
* Randy Travis Drinks Cold Beers
* Robert Taylor Drinks Cold Beer
* Red Trucks Drive Cats Nuts
 
==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


==Cranial Nerves==
<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
# I - olfactory
# II - optic
# II - optic
Line 283: Line 40:
# XII - hypoglossal
# XII - hypoglossal


==LR6 SO4 3==
==Extraocular Muscles Innervation==
* LR6 - Lateral Rectus --> CN VI Abducens
<font color="red">{{cquote|'''LR6 SO4 3'''}}</font>
* SO4 - Superior Oblique --> CN IV Trochlear
* '''LR 6''' - '''L'''ateral '''R'''ectus by the '''VI'''  cranial nerve (Abducens)
* 3 - The remaining 4 eyeball movers --> CN III Occulomotor
* '''SO 4''' - '''S'''uperior '''O'''blique by the '''IV''' cranial nerve (Trochlear)
* or '''LAST''': LA = '''L'''ateral Rectus - '''A'''bducens Nerve, ST = '''S'''uperior Oblique - '''T'''rochlear Nerve
* '''3''' - The remaining by the '''III''' cranial nerve (Occulomotor)


==BRANCHES OF FACIAL NERVE==
<font color="red">{{cquote|'''LAST'''}}</font>
Temporal, Zygomatic, Buccal, Mandibular, Cervical
* '''L''' - '''L'''ateral Rectus
* Two Zebras Bought My Car
* '''A''' - '''A'''bducens Nerve
* Two Zebras Bit My Cookie
* '''S''' - '''S'''uperior Oblique
* To Zanzibar By Motor Car
* '''T''' - '''T'''rochlear Nerve
* Ten Zulus Buggered My Cat


==PENIS INNERVATION==
==Facial Nerve Branches==
"'''P'''oint and '''S'''hoot"
<font color="red">{{cquote|'''Two Zebras Bought My Car'''}}</font>
<font color="red">{{cquote|'''Two Zebras Bit My Cookie'''}}</font>
<font color="red">{{cquote|'''To Zanzibar By Motor Car'''}}</font>
<font color="red">{{cquote|'''Ten Zulus Buggered My Cat'''}}</font>
# Temporal
# Zygomatic
# Buccal
# Mandibular
# Cervical
 
==Penis Innervation==
<font color="red">{{cquote|'''P'''oint and '''S'''hoot}}</font>
* '''P'''arasympathetic causes erection
* '''P'''arasympathetic causes erection
* '''S'''ympathetic causes ejaculation
* '''S'''ympathetic causes ejaculation


"S2, 3, 4 keep the penis off the floor"
<font color="red">{{cquote|'''S2, 3, 4 keep the penis off the floor'''}}</font>
* Innervation of the penis by branches of the pudendal nerve, derived from spinal cord levels S2-4
* Innervation of the penis by branches of the pudendal nerve, derived from spinal cord levels '''S 2-4'''


==Aorta Branches==
==Aorta Branches==
'''ABC'S'''
<font color="red">{{cquote|'''ABC'S'''}}</font>
* '''A'''ortic arch gives off the
* '''A'''ortic arch gives off the:
* '''B'''racheiocephalic trunk
# '''B''' - '''B'''racheiocephalic trunk
* the left '''C'''ommon Carotid, and the left Subclavian artery
# '''C''' - Left '''C'''ommon '''C'''arotid
# '''S''' - Left '''S'''ubclavian artery


==Femoral Triangle Structures in Order==
==Femoral Triangle Structures in Order==
'''N(AVEL)''
<font color="red">{{cquote|'''N (AVEL)'''}}</font>
* Nerve
* '''N'''erve
* Artery
* '''A'''rtery
* Vein
* '''V'''ein
* Empty space
* '''E'''mpty space
* Lymphatics
* '''L'''ymphatics
- Parenthesis includes things contained in the femoral sheath.
<br><br>
<font color="navy">'''2. CELL BIOLOGY'''</font>
==Cell Division Phases==
<font color="red">{{cquote|'''People Meet And Talk'''}}</font>
* '''P''' - '''P'''rophase
* '''M''' - '''M'''etaphase
* '''A''' - '''A'''naphase
* '''T''' - '''T'''elophase


NOTE: Parenthesis includes things contained in the femoral sheath.
==Cell Cycle Stages==
<font color="red">{{cquote|'''Go Sally Go! Make Children!'''}}</font>
* '''G1''' phase - Growth phase 1
* '''S''' phase - DNA synthesis
* '''G2''' phase - Growth phase 2
* '''M''' phase - Mitosis
* '''C''' phase - Cytokinesis


==Hurler Syndrome Features==  
==Golgi Complex Functions==
'''HURLER'S'''
<font color="red">{{cquote|'''Golgi Distributes A SPAM'''}}</font>
*Heptosplenomegaly
* '''Distributes''' proteins and lipids from ER
*Ugly facies
* '''A'''dd mannose onto specific lysosome proteins
*Recessive (AR inheritance)
* '''S'''ulfation of sugars and slected tyrosine
*L-iduronidase deficiency (alpha)
* '''P'''roteoglycan assembly
*Eyes clouded
* '''A'''dd O-oligosugars to serine and threnonine
*Retarded Short/
* '''M'''odify N-ologosugars on asparagine
*Stubby fingers


=='''CHILD HAS PROBLEM!'''==
==Collagen==
''Down syndrome features''
<font color="red">{{cquote|'''COLLAGEN'''}}</font>
* '''C'''ongenital heart disease/ '''C'''ataracts
* '''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)
* '''H'''ypotonia/ Hypothyroidism
* '''O''' - '''O'''utside the cell is where collagen normally functions/ '''O'''steoblasts/ '''O'''steogenesis imperfecta
* '''I'''ncure 5th finger/ '''I'''ncreased gap between 1st and 2nd toe
* '''L''' - '''L'''ysyl hydroxylase / '''L'''ysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last biosynthesis step)
* '''L'''eukemia risk x2/ '''L'''ung problem
* '''L''' - '''L'''ong triple helical fibers / '''L'''igaments
* '''D'''uodenal atresia/ '''D'''elayed development
* '''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


* '''H'''irshsprung's disease/ '''H'''earing loss
==Carbon Monoxide: Electron Transport Chain Target==
* '''A'''lzheimer's disease/ Alantoaxial instability
<font color="red">{{cquote|'''CO blocks CO'''}}</font>
* Squint/ Short neck
Carbon monoxide '''(CO)''' blocks Cytochrome Oxidase '''(CO)'''  


* Protruding tongue/ Palm crease
==Hemoglobin Binding Curve: Right Shift Causes==
* Round face/ Rolling eye (nystagmus)
<font color="red">{{cquote|'''CADET, face right!'''}}</font>
* Occiput flat/ Oblique eye fissure
* Brushfield spot/ Brachycephaly
* Low nasal bridge/ Language problem
* Epicanthic fold/ Ear folded
* Mental retardation/ Myoclonus
 
=='''D'''rink at 21==
Down Syndrome - Chromosome 21
 
=='''P'''uberty at 13==
Patau's Syndrome - Chromosome 13
 
==Election voter at 18==
Edward's Syndrome - Chromosome 18
 
==Down syndrome pathology DOWN==
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)==
''Pyrimidines nucleotides''
* Cytosine
* Uracil
* Thiamine the
* PYrimidines
 
==CATCH 22==
''DiGeorge/ Velocardiofacial syndrome''
* Cardiac abnormalities
* Abnormal facies
* Thymic aplasia
* Cleft palate
* Hypocalcemia
* 22q11 deletion
 
==MARFAN==
# Mitral valve prolapse
# Aortic Aneurysm
# Retinal detachment
# Fibrillin
# Arachnodactyly
# Negative Nitroprusside test (differentiates from homocystinuria)
 
==Go Sally Go! Make Children!==
''Cell cycle stages''
* G1 phase (Growth phase 1)
* S phase (DNA Synthesis)
* G2 phase (Growth phase 2)
* M phase (Mitosis)
* C phase (Cytokinesis)
 
==APKD==
ADult Polycystic Kidney Disease is  Autosomal Dominant
Also, "Polycystic kidney" has 16 letters and is due to a defect on chromosome 16.
 
==Essential Amino Acids==
'''PriVaTe TIM HALL'''
* Phe, Val, Thr, Trp, Ile, Met, His, Arg, Leu, Lys
 
==Urea Cycle==
'''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==
''Cell division''
* Prophase
* Metaphase
* Anaphase
* Telophase
 
==5'''P''' 's for acute intermittent porphyria==
* Pain in abdomen
* Polyneuropathy
* Psychologial abnormalities
* Pink urine
* Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)
 
==ABCD for BUN & creatinine elevation==
* Azotremia (pre-renal)
* Bleeding (GI)
* Catabolic status
* Diet (high protein parenteral nutrition)
 
==G6PD: oxidant drugs inducing hemolytic anemia AAA==
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==
Pellegra: Vitamin B3 (niacin, nicotinic acid) deficiency
# Dermatitis
# Diarrhea
# Dementia
 
==Pompe's disease: type "Police = Po + lys"==
Pompe's disease is a lysosomal storage disease (alpha 1,4 glucosidase).
 
==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
 
==Galactosaemia: enzyme deficiency==
GALIPUT: Galactose 1 Phosphate Uridyl Transferase.
• There is an assay called the Galiput test for this.
 
==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
 
==The FAT cat is in the ADEK (attic)==
''Vitamins: which are fat soluble''
Fat soluble vitamins are A,D,E,K.
 
==Hemoglobin binding curve: causes of shift to right==
"CADET, face right!"
* C = Increase in carbon dioxide
* C = Increase in carbon dioxide
* A = Acidosis (low ph)
* A = Acidosis (low ph)
Line 499: Line 135:
* E = Exercise
* E = Exercise
* T = increase in temperature
* T = increase in temperature
<br><br>
<font color="Navy">'''3. RECEPTORS'''</font>
==G-proteins Receptors==
<font color="red">{{cquote|'''QISS & QIQ" (Kiss and Kick)'''}}</font>
In alphabetical order
* Q: alpha 1
* I: alpha 2
* S: beta 1
* S: beta 2
* &
* Q: M1
* I: M2
* Q: M3


==G proteins for respective receptors==
==Adrenaline Mechanism==
"QISS & QIQ" (Kiss and Kick):
<font color="red">{{cquote|'''ABC of Adrenaline'''}}</font>
 
==G-proteins and their respective receptors (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
* Adrenaline--> activates
* Beta receptors--> increases
* Beta receptors--> increases
* Cyclic AMP  
* Cyclic AMP
<br><br>
<font color="Navy">'''4. BIOCHEMISTRY'''</font>
==Enzymes Classification==
<font color="red">{{cquote|'''Over The HILL'''}}</font>
* '''O''' - '''O'''xidoreductases
* '''T''' - '''T'''ransferases
* '''H''' - '''H'''ydrolases
* '''I''' - '''I'''somerases
* '''L''' - '''L'''igases
* '''L''' - '''L'''yases


==Carbon monoxide: electron transport chain target==
==Glycolysis Enzymes==
"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
==Metabolism sites==
* Phosphofructokinase-1 (6-phosphofructo-1 kinase)
"Use both arms to HUG":
* Aldolase, Triose phosphate isomerase
Heme synthesis Urea cycle Gluconeogenesis • These reactions occur in both cytoplasm and mitochondria.
* Glyceraldehyde 3-phosphate dehydrogenase
* Phosphoglycerate kinase
* Phosphoglycerate mutase
* Enolase
* Pyruvate kinase


==AcetylCoA and acetacetylCoA==
==Glycolysis Steps==
"A Lighter Lease" (A LyTr LeIs): amino acids forming them
<font color="red">{{cquote|'''Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies'''}}</font>
* A=AcetylCoA or Acetoacetyl CoA
* Ly=Lysine
* Tr=Tryptophan
* Le=Leucine
* Is=Isoleucine
 
==Fasting state: branched-chain amino acids used by skeletal muscles==
"Muscles LIVe fast":
* 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 548: Line 190:
* 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.  
<br><br>
<font color="Navy">'''5. METABOLISM'''</font>
==Metabolism Sites==
<font color="red">{{cquote|'''Use both arms to HUG'''}}</font>
# Heme synthesis
# Urea cycle
# Gluconeogenesis
These reactions occur in both cytoplasm and mitochondria


==Glycolysis Enzymes==
==AcetylCoA and AcetacetylCoA==
“Hungry Peter Pan And The Growling Pink Panther Eat Pies”
<font color="red">{{cquote|'''A Lighter Lease (A LyTr LeIs)'''}}</font>
Hexokinase
Amino acids forming them:
Phosphohexo isomerase
* A=AcetylCoA or Acetoacetyl CoA
Phosphofructokinase-1 (6-phosphofructo-1 kinase)
* Ly=Lysine
Aldolase, Triose phosphate isomerase
* Tr=Tryptophan
Glyceraldehyde 3-phosphate dehydrogenase
* Le=Leucine
Phosphoglycerate kinase
* Is=Isoleucine
Phosphoglycerate mutase
Enolase
Pyruvate kinase


==Citric acid cycle compounds==
==Citric Acid Cycle Compounds==
"Our City Is Kept Safe And Sound From Malice":
<font color="red">{{cquote|'''Our City Is Kept Safe And Sound From Malice'''}}</font>
Oxaloacetate
* Oxaloacetate
Citrate
* Citrate
Isocitrate  
* Isocitrate
alpha-Ketoglutarate  
* alpha-Ketoglutarate
Succinyl-CoA
* Succinyl-CoA
Succinate  
* Succinate
Fumarate
* Fumarate
Malate
* Malate


==Citric acid cycle compounds==
<font color="red">{{cquote|'''Can I Keep Selling Sex For Money, Officer?'''}}</font>
"Can I Keep Selling Sex For Money, Officer?":
* Citrate
* Citrate
* Isocitrate
* Isocitrate
Line 583: Line 229:
* 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 593: Line 239:
* Malate  
* Malate  


==Citric acid cycle compounds==
==Citric Acid Cycle Enzymes==
"Oh Citric Acid Is Of (course) A SiLly STupid Funny Molecule":
<font color="red">{{cquote|'''Corrupt Anti Intelligence Agent Spoke Slander For Money'''}}</font>
* Oxaloacetate
* Citrate
* Isocitrate, alpha-Ketoglutarate
* Succinyl CoA
* Succinate
* Fumarate
* Malate
 
==Citrate Cycle Enzymes==  
"Corrupt Anti Intelligence Agent Spoke Slander For Money."
* Citrate synthatase
* Citrate synthatase
* aconitase
* Aconitase
* Isocitrate dehydrogenase
* Isocitrate dehydrogenase
* Alpha ketogluturate dehydrogenase
* Alpha ketogluturate dehydrogenase
Line 614: Line 250:
* Malate Dehydrogenase
* Malate Dehydrogenase


==Fabry's disease: FABRY'S==
==Essential Amino Acids==
* Foam cells found in glomeruli and tubules/ Febrile episodes
<font color="red">{{cquote|'''P''' ri '''V''' a '''T''' e  '''TIM  HALL'''}}</font>
* Alpha galactosidase A deficiency/ Angiokeratomas
<font color="red">{{cquote|'''PVT. TIM HALL'''}}</font>
* Burning pain in extremities/ BUN increased in serum/ Boys
<font color="red">{{cquote|'''"PVT. TIM HALL always argues, never tires"'''}}</font>
* Renal failure
* '''P''' - '''P'''he
* YX genotype (male, X linked recessive)
* '''V''' - '''V'''al
* Sphingolipidoses
* '''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'''
 
==Creatine Phosphate: Amino Acid Precursors==
<font color="red">{{cquote|'''Nice GAMs!'''}}</font>
* '''G''' - '''G'''lycine
* '''A''' - '''A'''rginine
* '''M''' - '''M'''ethionine
 
==Branched Chain Amino Acids Catabolism Steps==
<font color="red">{{cquote|'''Truck hit the Ox to Death'''}}</font>
* '''T''' - '''T'''ransamination
* '''O''' - '''O'''xidative decarboxylation
* '''D''' - '''D'''ehydrogenation
 
==Branched-chain Amino Acids Used by Skeletal Muscle (Fasting State)==
<font color="red">{{cquote|'''Muscles LIVe fast'''}}</font>
* Leucine
* Isoleucine
* Valine


==B vitamin names==
==Urea Cycle==
"The Rhythm Nearly Proved Contagious":
<font color="red">{{cquote|'''O'''rdinarily '''C'''areless '''C'''rappers '''A'''re '''A'''lso '''F'''rivolous '''A'''bout '''U'''rination!}}</font>
In increasing order:
* '''O''' - '''O'''rnithine
* Thiamine (B1)
* '''C''' - '''C'''arbamoyl
* Riboflavin (B2)
* '''C''' - '''C'''itrulline
* Niacin (B3)
* '''A''' - '''A'''spartate
* Pyridoxine (B6)
* '''A''' - '''A'''rginosuccinate
* Cobalamin (B12)  
* '''F''' - '''F'''umarate
* '''A''' - '''A'''rginine
* '''U''' - '''U'''rea
 
==Pyrimidines Nucleotides==
<font color="red">{{cquote|'''CUT the PY (pie)'''}}</font>
* '''C'''ytosine
* '''U'''racil
* '''T'''hiamine
* '''T'''he
* '''PY'''rimidines
<br><br>
<font color="Navy">'''6. ENZYME DEFICIENCIES'''</font>
==G6PD: Oxidant Drugs Inducing Hemolytic Anemia ==
<font color="red">{{cquote|'''AAA'''}}</font>
* Antibiotic (eg: sufamethoxazole)
* Antimalarial (eg: primaquine)
* Antipyretics (eg: acetanilid, but not aspirin or acetaminophen)
 
==Pompe's Disease==
<font color="red">{{cquote|'''Type "Police: Po + lys"'''}}</font>
* '''PO'''mpe's disease is a '''LYS'''osomal storage disease (alpha 1,4 glucosidase)
 
==Galactosemia==
<font color="red">{{cquote|'''GALIPUT'''}}</font>
* Galactose 1 Phosphate Uridyl Transferase
* There is an assay called the Galiput test for this


==Essential amino acids==
==Fabry's Disease==
PVT. TIM HALL: Phe Val Thr Trp Ile Met His Arg Leu Lys
<font color="red">{{cquote|'''FABRY ' S'''}}</font>
Pvt. is short for Private in the military.
* '''F''' - '''F'''oam cells found in glomeruli and tubules / '''F'''ebrile episodes
Arg and His are considered semiessential.
* '''A''' - '''A'''lpha galactosidase '''A''' deficiency / '''A'''ngiokeratomas
Alternatively: "MATT VIL PHLy".
* '''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


==Golgi complex: functions==
==Hurler Syndrome Features==  
"Golgi Distributes A SPAM": Distributes proteins and lipids from ER
<font color="red">{{cquote|'''HURLER'S'''}}</font>
Add mannose onto specific lysosome proteins
*'''H'''eptosplenomegaly
Sulfation of sugars and slected tyrosine
*'''U'''gly facies
Proteoglycan assembly
*'''R'''ecessive (AR inheritance)
Add O-oligosugars to serine and threnonine
*'''L'''-iduronidase deficiency (alpha)
Modify N-ologosugars on asparagine
*'''E'''yes clouded
*'''R'''etarded
*'''S'''tubby fingers/'''S'''hort


==Catabolism steps of branched chain amino acids==
==Acute Intermittent Porphyria==  
"Truck hit the Ox to Death":  
<font color="red">{{cquote|'''5  P's '''}}</font>
* Transamination
* '''P'''ain in abdomen
* Oxidative decarboxylation
* '''P'''olyneuropathy
* Dehydrogenation
* '''P'''sychologial abnormalities
* '''P'''ink urine
* '''P'''recipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)
<br><br>
<font color="Navy">'''7. VITAMINS'''</font>
==B Vitamins==
<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)


==Niacin deficiency==
==Niacin Deficiency==
The famous 4 D's:
<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
==Folate Deficiency Causes==
<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
==Fat Soluble Vitamins==
<font color="red">{{cquote|'''The FAT cat is in the ADEK (attic)'''}}</font>
Fat soluble vitamins are ''A,D,E,K.'''
==Hypervitaminosis A==
<font color="red">{{cquote|Increased Vitamin A makes you '''HARD'''}}</font>
* '''H''' - '''H'''eadache / '''H'''epatomegaly
* '''A''' - '''A'''norexia / '''A'''lopecia
* '''R''' - '''R'''eally painful bones
* '''D''' - '''D'''ry skin / '''D'''rowsiness
<br><br>
<font color="Navy">'''8. HISTORY TAKING'''</font>
==Alcoholism Screening==
<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?
==Chief Complaint==
<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.
==Hospital Admission Orders==
<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).
==Post-Op Fever Causes==
<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
==Predisposing Conditions for Pulmonary Embolism==
<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


==Creatine phosphate: amino acid precursors==
==Compartment Syndrome Signs (Arterial Occlusion)==
"Nice GAMs!":
<font color="red">{{cquote|'''6 P's'''}}</font>
* Glycine
# Pain
* Arginine
# Pale (Pallor)
* Methionine
# Perishing with Cold (Poikilothermia)
# Pulseless
# Paresthesias
# Paralysis
<br><br>
<font color="Navy">'''9. PATHOLOGY'''</font>
==Causes of Diseases==
<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


==Enzymes: classification==
==5 Signs of Inflammation==
"Over The HILL":  
# '''Rubor''': redness/erythema
* Oxidoreductases
# '''Calor''': raised temperature
* Transferases
# '''Tumor''': swelling
* Hydrolases
# '''Dolor''': pain
* Isomerases
# '''Functio Laesa''': loss of function
* Ligases
- Described by Celsus
* Lyases


==COLLAGEN==
==Hypersentivity Reactions (Gell & Goombs Classification)==
* C-terminal propeptide (procollagen)/ Covalent Cross links/ C vitamin/ Connective tissue/ Cartilage/ Chondroblasts/ Copper Cofactor (Covalent Cross linking)
<font color="red">{{cquote|'''ACID'''}}</font> <font color="red">{{cquote|'''A'''nna '''C'''ycled '''I'''mmediately '''D'''ownhill}}</font>
* Outside the cell is where collagen normally functions/ Osteoblasts/ Osteogenesis imperfecta
# Type I  '''A'''naphylaxis
* Lysyl hydroxylase/ Lysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last
# Type II  '''C'''ytotoxic-mediated
* biosynthesis step)
# Type III '''I'''mmune-complex
* Long triple helical fibers/ Ligaments
# Type IV  '''D'''elayed hypersensitivity
* 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==
==Multiple Endocrine Neoplasia (MEN)==
"PVT. TIM HALL always argues, never tires":  
Each of the MENs is a disease of '''three or two letters plus a feature'''; all are autosomal dominant.
* Phe
<font color="red">{{cquote|'''MEN I: 3 P's'''}}</font>
* Val
# '''P'''ituitary
* Thr
# '''P'''arathyroid
* Trp
# '''P'''ancreas
* Ile
# Plus Adrenal cortex
* Met
* His
* Arg
* Lue
* Lys


==Hypervitaminosis A==
<font color="red">{{cquote|'''MEN II:  2 C's'''}}</font>
''Increased Vitamin A makes you '''HARD'''''
# '''C'''arcinoma of thyroid
* Headache/ Hepatomegaly
# '''C'''atacholamines (pheochromocytoma)
* Anorexia/ Alopecia
- MEN IIA: parathyroid
* Really painful bones
- MEN IIB (MEN III): mucocutaneous neuromas for
* Dry skin/ Drowsiness
 
==Acute Pneumonia Infiltrates==
* '''P'''yogenic bacteria: '''P'''MN infiltrate
* '''M'''iscellaneous microbes: '''M'''ononuclear infiltrate
 
==Takayasu's Disease/Pulseless Disease==
<font color="red">{{cquote|'''When you have Takayasu's, I can't Tak'a yu pulse'''}}</font>
 
==CBC Normal Differential==
<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'''%
<br><br>
<font color="Navy">'''10. CAUSES'''</font>
==Metabolic Acidosis Causes==
<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
 
==Metabolic Acidosis (Normal Anion-Gap) Causes==
===With Hyperkalemia===
<font color="red">{{cquote|'''RAISE K+'''}}</font>
* RTA type 4
* Aldosterone or mineralocorticord deficiency
* Iatrogenic: NH4Cl, HCl
* "Stenosis": obstructive uropathy
* Early uremia
===With hypokalemia===
<font color="red">{{cquote|'''ReDUCE K+'''}}</font>
* Renal TA type 1 and 2
* Diarrhoea
* Urine diversion into gut
* Carbonate anhydrase inhibitor
* Ex-hyperventilation
 
==BUN & Creatinine Elevation Causes==
<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)
 
==Hypercalcemia Causes==
<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
 
==Acute Pancreatitis Causes==
<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.
 
==Back Pain Causes==
<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
<br><br>
<font color="Navy">'''11. TREATMENT'''</font>
==Syncope Management==
<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>
 
==Malignant Hyperthermia Treatment==
<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
<br><br>
<font color="Navy">'''12. GENETICS'''</font>
==Down Syndrome Features==
<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
 
==Patau's Syndrome - Chromosome 13==
<font color="red">{{cquote|'''P'''uberty at 13}}</font>


==Edward's Syndrome - Chromosome 18==
<font color="red">{{cquote|Election voter at 18}}</font>


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==DiGeorge (Velocardiofacial) Syndrome==
{{WikiDoc Sources}}
<font color="red">{{cquote|'''CATCH 22'''}}</font>
* '''C'''ardiac abnormalities
* '''A'''bnormal facies
* '''T'''hymic aplasia
* '''C'''left palate
* '''H'''ypocalcemia
* '''22'''q11 deletion


==Marfan Syndrome Features==
# '''M'''itral valve prolapse - MVP
# '''A'''ortic Aneurysm
# '''R'''etinal detachment
# '''F'''ibrillin
# '''A'''rachnodactyly
# '''N'''egative '''N'''itroprusside test (differentiates from homocystinuria)


[[Category:Medical Mnemonics for Examinations|Medical Mnemonics]]
==Adult Polycystic Kidney Disease==
<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
<br><br>
<font color="Navy">'''13. PEDIATRICS'''</font>
==APGAR Score==
<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.

Latest revision as of 00:18, 1 February 2014


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

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



3. RECEPTORS

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

5 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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