WBR mnemonics: Difference between revisions
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<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''CO blocks CO'''}}</font> | <font color="red">{{cquote|'''CO blocks CO'''}}</font> | ||
Carbon monoxide '''(CO)''' blocks Cytochrome Oxidase '''(CO)''' | Carbon monoxide '''(CO)''' blocks Cytochrome Oxidase '''(CO)''' | ||
</div></div> | </div></div> | ||
| Line 233: | Line 233: | ||
<div class="mw-collapsible mw-collapsed"> | <div class="mw-collapsible mw-collapsed"> | ||
==G-proteins Receptors== | ==G-proteins Receptors== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
| Line 246: | Line 246: | ||
* Q: M1 | * Q: M1 | ||
* I: M2 | * I: M2 | ||
* Q: M3 | * Q: M3 | ||
</div></div> | </div></div> | ||
| Line 263: | Line 263: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
<font color="Navy">'''4. BIOCHEMISTRY'''</font> | <font color="Navy">'''4. BIOCHEMISTRY'''</font> | ||
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<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Enzymes Classification== | ==Enzymes Classification== | ||
| Line 285: | Line 285: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Glycolysis Enzymes== | ==Glycolysis Enzymes== | ||
| Line 302: | Line 302: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Glycolysis Steps== | ==Glycolysis Steps== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies'''}}</font> | <font color="red">{{cquote|'''Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies'''}}</font> | ||
* Glucose | * Glucose | ||
* Glucose-6-P | * Glucose-6-P | ||
| Line 317: | 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> | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
<font color="Navy">'''5. METABOLISM'''</font> | <font color="Navy">'''5. METABOLISM'''</font> | ||
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<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
| Line 343: | Line 343: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==AcetylCoA and AcetacetylCoA== | ==AcetylCoA and AcetacetylCoA== | ||
| Line 354: | Line 354: | ||
* Tr=Tryptophan | * Tr=Tryptophan | ||
* Le=Leucine | * Le=Leucine | ||
* Is=Isoleucine | * Is=Isoleucine | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Citric Acid Cycle Compounds== | ==Citric Acid Cycle Compounds== | ||
| Line 390: | Line 390: | ||
* Succinate | * Succinate | ||
* Fumarate | * Fumarate | ||
* Malate | * Malate | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Citric Acid Cycle Enzymes== | ==Citric Acid Cycle Enzymes== | ||
| Line 409: | Line 409: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Essential Amino Acids== | ==Essential Amino Acids== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Creatine Phosphate: Amino Acid Precursors== | ==Creatine Phosphate: Amino Acid Precursors== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Branched Chain Amino Acids Catabolism Steps== | ==Branched Chain Amino Acids Catabolism Steps== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Branched-chain Amino Acids Used by Skeletal Muscle (Fasting State)== | ==Branched-chain Amino Acids Used by Skeletal Muscle (Fasting State)== | ||
| Line 465: | Line 465: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Urea Cycle== | ==Urea Cycle== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Pyrimidines Nucleotides== | ==Pyrimidines Nucleotides== | ||
| Line 489: | Line 489: | ||
* '''C'''ytosine | * '''C'''ytosine | ||
* '''U'''racil | * '''U'''racil | ||
* '''T'''hiamine | * '''T'''hiamine | ||
* '''T'''he | * '''T'''he | ||
* '''PY'''rimidines | * '''PY'''rimidines | ||
</div></div> | </div></div> | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
<font color="Navy">'''6. ENZYME DEFICIENCIES'''</font> | <font color="Navy">'''6. ENZYME DEFICIENCIES'''</font> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==G6PD: Oxidant Drugs Inducing Hemolytic Anemia== | ==G6PD: Oxidant Drugs Inducing Hemolytic Anemia== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''AAA'''}}</font> | <font color="red">{{cquote|'''AAA'''}}</font> | ||
* Antibiotic (eg: sufamethoxazole) | * Antibiotic (eg: sufamethoxazole) | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Pompe's Disease== | ==Pompe's Disease== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Galactosemia== | ==Galactosemia== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Fabry's Disease== | ==Fabry's Disease== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Hurler Syndrome Features== | ==Hurler Syndrome Features== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''HURLER'S'''}}</font> | <font color="red">{{cquote|'''HURLER'S'''}}</font> | ||
*'''H'''eptosplenomegaly | *'''H'''eptosplenomegaly | ||
*'''U'''gly facies | *'''U'''gly facies | ||
*'''R'''ecessive (AR inheritance) | *'''R'''ecessive (AR inheritance) | ||
*'''L'''-iduronidase deficiency (alpha) | *'''L'''-iduronidase deficiency (alpha) | ||
*'''E'''yes clouded | *'''E'''yes clouded | ||
*'''R'''etarded | *'''R'''etarded | ||
*'''S'''tubby fingers/'''S'''hort | *'''S'''tubby fingers/'''S'''hort | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Acute Intermittent Porphyria== | ==Acute Intermittent Porphyria== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
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<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
<font color="Navy">'''7. VITAMINS'''</font> | <font color="Navy">'''7. VITAMINS'''</font> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==B Vitamins== | ==B Vitamins== | ||
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<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''The Rhythm Nearly Proved Contagious'''}}</font> | <font color="red">{{cquote|'''The Rhythm Nearly Proved Contagious'''}}</font> | ||
In increasing order: | In increasing order: | ||
* '''T''' - '''T'''hiamine (B1) | * '''T''' - '''T'''hiamine (B1) | ||
* '''R''' - '''R'''iboflavin (B2) | * '''R''' - '''R'''iboflavin (B2) | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Niacin Deficiency== | ==Niacin Deficiency== | ||
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# Dermatitis | # Dermatitis | ||
# Dementia | # Dementia | ||
# Death (if untreated) | # Death (if untreated) | ||
<font color="red">{{cquote|'''The 3D's of pellagra'''}}</font> | <font color="red">{{cquote|'''The 3D's of pellagra'''}}</font> | ||
Vitamin B3 (niacin, nicotinic acid) deficiency | Vitamin B3 (niacin, nicotinic acid) deficiency | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Folate Deficiency Causes== | ==Folate Deficiency Causes== | ||
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* Relative folate deficiency | * Relative folate deficiency | ||
* Old | * Old | ||
* Pregnant | * Pregnant | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Fat Soluble Vitamins== | ==Fat Soluble Vitamins== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Hypervitaminosis A== | ==Hypervitaminosis A== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
<font color="Navy">'''8. HISTORY TAKING'''</font> | <font color="Navy">'''8. HISTORY TAKING'''</font> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Alcoholism Screening== | ==Alcoholism Screening== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Chief Complaint== | ==Chief Complaint== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Hospital Admission Orders== | ==Hospital Admission Orders== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Post-Op Fever Causes== | ==Post-Op Fever Causes== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Predisposing Conditions for Pulmonary Embolism== | ==Predisposing Conditions for Pulmonary Embolism== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Compartment Syndrome Signs (Arterial Occlusion)== | ==Compartment Syndrome Signs (Arterial Occlusion)== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Causes of Diseases== | ==Causes of Diseases== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==5 Signs of Inflammation== | ==5 Signs of Inflammation== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Hypersentivity Reactions (Gell & Goombs Classification)== | ==Hypersentivity Reactions (Gell & Goombs Classification)== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''ACID'''}}</font> <font color="red">{{cquote|'''A'''nna '''C'''ycled '''I'''mmediately '''D'''ownhill}}</font> | <font color="red">{{cquote|'''ACID'''}}</font> <font color="red">{{cquote|'''A'''nna '''C'''ycled '''I'''mmediately '''D'''ownhill}}</font> | ||
# Type I '''A'''naphylaxis | # Type I '''A'''naphylaxis | ||
# Type II '''C'''ytotoxic-mediated | # Type II '''C'''ytotoxic-mediated | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Multiple Endocrine Neoplasia (MEN)== | ==Multiple Endocrine Neoplasia (MEN)== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Acute Pneumonia Infiltrates== | ==Acute Pneumonia Infiltrates== | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Takayasu's Disease/Pulseless Disease== | ==Takayasu's Disease/Pulseless Disease== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==CBC Normal Differential== | ==CBC Normal Differential== | ||
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<div class="mw-collapsible-content"> | <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'''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|'''N'''ice '''L'''adies '''M'''ake '''E'''aster '''B'''read"}}</font> | ||
<font color="red">{{cquote|'''60''', '''30''', '''6''', '''3''', '''1'''}}</font> | <font color="red">{{cquote|'''60''', '''30''', '''6''', '''3''', '''1'''}}</font> | ||
# '''N'''eutrophils: '''60'''% | # '''N'''eutrophils: '''60'''% | ||
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</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
<font color="Navy">'''10. CAUSES'''</font> | <font color="Navy">'''10. CAUSES'''</font> | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Metabolic Acidosis Causes== | ==Metabolic Acidosis Causes== | ||
| Line 910: | Line 910: | ||
==Metabolic Acidosis (Normal Anion-Gap) Causes== | ==Metabolic Acidosis (Normal Anion-Gap) Causes== | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
===With Hyperkalemia=== | ===With Hyperkalemia=== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''RAISE K+'''}}</font> | <font color="red">{{cquote|'''RAISE K+'''}}</font> | ||
* RTA type 4 | * RTA type 4 | ||
* Aldosterone or mineralocorticord deficiency | * Aldosterone or mineralocorticord deficiency | ||
* Iatrogenic: NH4Cl, HCl | * Iatrogenic: NH4Cl, HCl | ||
* "Stenosis": obstructive uropathy | * "Stenosis": obstructive uropathy | ||
* Early uremia | * Early uremia | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
===With hypokalemia=== | ===With hypokalemia=== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''ReDUCE K+'''}}</font> | <font color="red">{{cquote|'''ReDUCE K+'''}}</font> | ||
* Renal TA type 1 and 2 | * Renal TA type 1 and 2 | ||
* Diarrhoea | * Diarrhoea | ||
| Line 936: | Line 936: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==BUN & Creatinine Elevation Causes== | ==BUN & Creatinine Elevation Causes== | ||
| Line 948: | Line 948: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Hypercalcemia Causes== | ==Hypercalcemia Causes== | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<font color="red">{{cquote|'''PAM SCHMIDT'''}}</font> | <font color="red">{{cquote|'''PAM SCHMIDT'''}}</font> | ||
* '''P'''aget's Disease | * '''P'''aget's Disease | ||
* '''A'''myloid | * '''A'''myloid | ||
| Line 966: | Line 966: | ||
'''OR''' | '''OR''' | ||
<font color="red">{{cquote|'''MISHAP'''}}</font> | <font color="red">{{cquote|'''MISHAP'''}}</font> | ||
* '''M'''alignancy | * '''M'''alignancy | ||
* '''I'''ntoxication (hypervitaminosis) | * '''I'''ntoxication (hypervitaminosis) | ||
| Line 976: | Line 976: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Acute Pancreatitis Causes== | ==Acute Pancreatitis Causes== | ||
| Line 995: | Line 995: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Back Pain Causes== | ==Back Pain Causes== | ||
| Line 1,013: | Line 1,013: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
| Line 1,020: | Line 1,020: | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Syncope Management== | ==Syncope Management== | ||
| Line 1,029: | Line 1,029: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Malignant Hyperthermia Treatment== | ==Malignant Hyperthermia Treatment== | ||
| Line 1,048: | Line 1,048: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
<font color="Navy">'''12. GENETICS'''</font> | <font color="Navy">'''12. GENETICS'''</font> | ||
| Line 1,054: | Line 1,054: | ||
<div class="mw-collapsible-content"> | <div class="mw-collapsible-content"> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Down Syndrome Features== | ==Down Syndrome Features== | ||
| Line 1,065: | Line 1,065: | ||
* '''I'''ncure 5th finger/ '''I'''ncreased gap between 1st and 2nd toe | * '''I'''ncure 5th finger/ '''I'''ncreased gap between 1st and 2nd toe | ||
* '''L'''eukemia risk x2/ '''L'''ung problem | * '''L'''eukemia risk x2/ '''L'''ung problem | ||
* '''D'''uodenal atresia/ '''D'''elayed development | * '''D'''uodenal atresia/ '''D'''elayed development | ||
* '''H'''irshsprung's disease/ '''H'''earing loss | * '''H'''irshsprung's disease/ '''H'''earing loss | ||
* '''A'''lzheimer's disease/ Alantoaxial instability | * '''A'''lzheimer's disease/ Alantoaxial instability | ||
* '''S'''quint/ Short neck | * '''S'''quint/ Short neck | ||
* '''P'''rotruding tongue/ '''P'''alm crease | * '''P'''rotruding tongue/ '''P'''alm crease | ||
* '''R'''ound face/ '''R'''olling eye (nystagmus) | * '''R'''ound face/ '''R'''olling eye (nystagmus) | ||
| Line 1,075: | Line 1,075: | ||
* '''L'''ow nasal bridge/ '''L'''anguage problem | * '''L'''ow nasal bridge/ '''L'''anguage problem | ||
* '''E'''picanthic fold/ '''E'''ar folded | * '''E'''picanthic fold/ '''E'''ar folded | ||
* '''M'''ental retardation/ '''M'''yoclonus | * '''M'''ental retardation/ '''M'''yoclonus | ||
<font color="red">{{cquote|'''DOWN'''}}</font> | <font color="red">{{cquote|'''DOWN'''}}</font> | ||
| Line 1,081: | Line 1,081: | ||
* '''O'''ne extra chromosome twenty-one | * '''O'''ne extra chromosome twenty-one | ||
* '''W'''omen of advanced age | * '''W'''omen of advanced age | ||
* '''N'''on-disjunction during maternal meiosis | * '''N'''on-disjunction during maternal meiosis | ||
<font color="red">{{cquote|'''Drink at 21'''}}</font> | <font color="red">{{cquote|'''Drink at 21'''}}</font> | ||
| Line 1,087: | Line 1,087: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Patau's Syndrome - Chromosome 13== | ==Patau's Syndrome - Chromosome 13== | ||
| Line 1,095: | Line 1,095: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==Edward's Syndrome - Chromosome 18== | ==Edward's Syndrome - Chromosome 18== | ||
| Line 1,103: | Line 1,103: | ||
</div></div> | </div></div> | ||
<div class="mw-collapsible mw-collapsed | <div class="mw-collapsible mw-collapsed"> | ||
==DiGeorge (Velocardiofacial) Syndrome== | ==DiGeorge (Velocardiofacial) Syndrome== | ||
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* '''C'''left palate | * '''C'''left palate | ||
* '''H'''ypocalcemia | * '''H'''ypocalcemia | ||
* '''22'''q11 deletion | * '''22'''q11 deletion | ||
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==Marfan Syndrome Features== | ==Marfan Syndrome Features== | ||
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# '''F'''ibrillin | # '''F'''ibrillin | ||
# '''A'''rachnodactyly | # '''A'''rachnodactyly | ||
# '''N'''egative '''N'''itroprusside test (differentiates from homocystinuria) | # '''N'''egative '''N'''itroprusside test (differentiates from homocystinuria) | ||
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==APGAR Score== | ==APGAR Score== | ||
Revision as of 22:35, 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:
- Duodenum
- Jejunum
- Ileum
- Appendix
- Colon
- Sigmoid
- Rectum
Brachial Plexus Organization
| “ | Radical Teachers Drink Cold Beers | ” |
| “ | Randy Travis Drinks Cold Beers | ” |
| “ | Robert Taylor Drinks Cold Beer | ” |
| “ | Red Trucks Drive Cats Nuts | ” |
- Roots
- Trunks
- Divisions
- Cords
- 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 | ” |
- 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
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 | ” |
- Temporal
- Zygomatic
- Buccal
- Mandibular
- 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:
- B - Bracheiocephalic trunk
- C - Left Common Carotid
- 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 | ” |
- Heme synthesis
- Urea cycle
- 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 | ” |
- Diarrhea
- Dermatitis
- Dementia
- Death (if untreated)
| “ | The 3D's of pellagra | ” |
Vitamin B3 (niacin, nicotinic acid) deficiency
- Dermatitis
- Diarrhea
- 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 | ” |
- Pain
- Pale (Pallor)
- Perishing with Cold (Poikilothermia)
- Pulseless
- Paresthesias
- Paralysis
9. PATHOLOGY
Causes of Diseases
| “ | VITAMIN C | ” |
- Vascular
- Infectious
- Trauma
- Auto-immune
- Metabolic
- Idiopathic/Iatrogenic
- Neoplastic
- Congenital
5 Signs of Inflammation
- Rubor: redness/erythema
- Calor: raised temperature
- Tumor: swelling
- Dolor: pain
- Functio Laesa: loss of function
- Described by Celsus
Hypersentivity Reactions (Gell & Goombs Classification)
| “ | ACID | ” |
| “ | Anna Cycled Immediately Downhill | ” |
- Type I Anaphylaxis
- Type II Cytotoxic-mediated
- Type III Immune-complex
- 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 | ” |
- Pituitary
- Parathyroid
- Pancreas
- Plus Adrenal cortex
| “ | MEN II: 2 C's | ” |
- Carcinoma of thyroid
- 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 | ” |
- Neutrophils: 60%
- Lymphocytes: 30%
- Monocytes: 6%
- Eosinophils: 3%
- 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 | ” |
- Gall stones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune disease
- Scorpion venom
- Hyperlipidemia
- ERCP (dye)
- 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
- Mitral valve prolapse - MVP
- Aortic Aneurysm
- Retinal detachment
- Fibrillin
- Arachnodactyly
- 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.