Mnemonics -Easy way to remember difficult things

Hai guys
here i am giving you some Mnemonics they are sub wise use them they really help
if you find them useful let me know pls


Anatomy Mnemonics
Bones of the Wrist
Some Lovers Try Positions That They Cannot Handle
Slowly Lower Tilly's Pants To The Curly Hairs

Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate

Brachial Plexus
Randy Travis Drinks Cold Beers Robert Taylor Drinks Cold Beer

Roots, Trunks, Divisions, Cords, Branches

Branches of the Brachial Plexus (In order from most lateral to most medial)
My Aunt Raped My Uncle

Musculocutaneous, Axillary, Radial, Median, Ulnar

Extraocularmotor muscles
LR6 (SO4) LR6: Lateral rectus --> VI abductens
SO4: Superior Oblique --> IV Trochlear
All other extraocularmotor muscles are CN III

Branches of the Facial Nerve
Ten Zebras Bought My Car
Ten Zebras Bit My Cock
Two Zulus Buggered My Cat
To Zanzibar By Motor Car

Temporal, Zygomatic, Buccal, Masseteric, Cervical

Innervation of phrenic nerve
c345 keeps the phrenic alive
c345 keep the diaphragm alive


Long thoracic nerve innervates serratus anterior
c5-6-7 raise your arms to heaven


Relationship of Thorasic duct to Esophagous and Azygous
The duck is between two gooses.
duck = thoracic duct 2 gooses = azyGOUS and esophaGOUS


Attachments of Pectoralis Major, Teres Major and Latissimus Drosi
A lady between tow majors.
Pectoralis major attaches to lateral lip of bicipital groove, the teres major attaches to medial lip of bicipital groove, and the latissimus dorsi attaches to the floor of bicipital groove. The "lati" is between two "majors."


Innervation of the Penis
Parasympathetic puts it up; sympathetic spurts it out.
Point Shoot Score
Parasympathetic, sympathetic, somatomotor


Lateral and Medial Pectoral Nerve
Lateral is less, medial is more.
Lateral pectoral nerves goes through pectoralis major while medial pn goes though both pectoral major and minor.


Layers of the epidermis
Granpa Shagging Grandma's Love Child.
Brent Spiner Gained Lieutenant Commander
Germinativum or Basale, Spinosum, Granulosum, Lucidum, Corneum



Tarsal bones
"Tall Californian Navy Medcial Interns Lay Cuties":
· In order (right foot, superior to inferior, medial to lateral): Talus Calcanous Navicular Medial cuneiform Intermediate cuneiform Lateral cuneifrom Cuboid

Bronchopulmonary segments of right lung
"A PALM Seed Makes Another Little Palm":
· In order from superior to inferior: Apical Posterior Anterior Lateral Medial Superior Medial basal Anterior basal Lateral basal Posterior basal

Head & Neck
CRANIAL NERVES: I-Optic, II-Olfactory, III-Oculomotor, IV-Trochlear, V-Trigeminal, VI-Abducens, VII-Facial, VIII-Acoustic (Vestibulocochlear), IX-Glossophrayngeal, X-Vagus, XI-Spinal Accessory, XII-Hypoglossal
On Old Olympus Towering Tops, A Finn And German Viewed Some Hops (older and cleaner)
Oh Oh Oh To Touch And Feel A Girls Vagina And Hymen (newer and, well ...)

Which cranial nerve is Sensory, Motor, or Both- Some Say Marry Money, But My Brother Says Big Breasts Matter More

BRANCHES OF FACIAL NERVE: Temporal, Zygomatic, Buccal, Mandibular, Cervical
Ten Zebras Beat My Cock
Two Zulus buggered my cat –(for the sicker, amongst you!)

You have I nose. You have II eyes. (I - Olfactory; II -- Optic)

Standing Room Only -Exit of branches of trigeminal nerve from the skull S
V1 -Superior orbital fissure, V2 -foramen Rotundum, V3 -foramen Ovale



For the order of nerves that pass through the superior orbital fissure:
"Lazy French Tarts Lie Naked in Anticipation."
(Lacrimal, Frontal, Trochlear, Lateral, Nosociliary, Internal,
Abducens)

2 Muscle of mastication- Lateral Lowers- lateral pterygoid is the one that opens the jaw
4 Muscles of Mastication MTPP( which could be read as "Empty Peepee") -masseter, temporal, lateral and medial pterygoids --


Arteries as they come off the external carotid:
Superior thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Post Auricular, Superficial temporal, Maxillary
Some Anatomists Like making babiesing, Others Prefer S & M
Some Angry Lady Figured out PMS


Innervation of Extraocular motor Muscles: LR6 SO4 3
LR6--Lateral rectus--> VI abductens
SO4--Superior Oblique--> IV Trochlear
3--The remaining 4 eyeball movers = III Oculomotor

ABC'S of the aortic arch!
Aortic arch gives off the Bracheiocephalic trunk,
the left Common Carotid, and the left
Subclavian artery

BRACHIAL PLEXUS: Roots, Trunks, Divisions, Cords, Branches
Robert Taylor Drinks Cold Beer.

CERVICAL SPINAL NERVES:
c345 keeps the phrenic alive (innervation of phrenic nerve) c345 keep the diaphragm alive (innervation of diaphragm)
c5-6-7 raise your arms to heaven (nerve roots of long thoracic nerve innervate serratus anterior)


Cranial Bones
Annoying, aren't they?
The cranial bones are the PEST OF 6...

Parietal, Ethmoid,Sphenoid,Temporal,Occipital,Frontal- 6 ? (6-the number of bones!)
( another one) Old People From Texas Eat Spiders.


LOCATION OF THORACIC DUCT: The duck is between two gooses (duck = thoracic duct) 2 gooses = azyGOUS and esophaGOUS


Cartilages of the Larynx - There are 4 cartilages in the larynx whose initial letters are TEAC (also the brandname of a home stereo).
Thyroid, Epiglottis, Arytenoid, Cricoid


Abdomen-Pelvis

INNERVATION OF PENIS:
Parasympathetic puts it up; sympathetic spurts it out
Point , Shoot, Score! (erection, emmision ,ejaculation) Parasympathetic, Sympathetic , Somatomotor
"S2, 3, 4 keep the penis off the floor" Innervation of the penis by branches of the pudental nerve, derived from spinal cord levels S2-4

Structures perforating the esophagus
"At T8 you see, perforates the IVC" (inferior Vena Cava)
the "EsoVagus" pierce T10 (esophagus, vagus nerve)
T12 - red, white and blue (aorta,thoracic duct,azygous vein)

Femoral Sheath (lateral to medial) order of things in thigh -NAVEL
Nerve, Artery, Vein, Empty, Space, Lymphatics

Radial n. innervates the BEST!!!!
Brachioradialis
Extensors
Supinator
Triceps

Course of Ureters
Water runs under the bridge (uterine a. and ductus deferens)

Carotid Sheath-- VAN
Internal Jugular Vein
Common carotid Artery
Vagus Nerve

Dermatomes
C3 is a high turtleneck shirt
T4 is at the nipple
L1 is at the inguinal ligament (or L1 is IL -Inguinal ligament)
Randy Travis Drinks Cold Beer--Brachial plexus
Robert Taylor Drinks Cold Beer
Roots, Trunks, Divisions, Cords, Branches

Bones of the wrist -Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium,
Trapezoid, Capitate, Hamate

1. Slowly Lower Tilly's Pants To The Curly Hairs
2. Swifty Lower Tilly's Pants to try coitus here. (the risque version)
3.Scared Lovers Try Positions That They Can't Handle. (Classic version)


Pelvic Diaphragm
PICOLO(A) -Posterior to anterior
PIriformis
COccygeus
Levator Ani


Pelvic Splanchic-Parasympathetic
Sacral Splanchic-Sympathetic


Armies travel over bridges, the Navy travels under.
(Bridge is the ligament...reference to suprascapular artery and nerve.)


Pad, dab. Dorsal ABduct...Palmar ADduct...interosseous muscles of hand/foot.


Layers of the epidermis-Germinativum or Basale, Spinosum, Granulosum, Lucidum, Corneum

Grandpa Shagging Grandma's Love Child.

Limbic System- the 5 F’s- Feeding, Fighting, Feeling, Flight and making babiesing



The 5 sphincters found in the Alimentary Canal are APE OIL:
Anal, Pyloric, Lower Esophogeal, Oddi, and Ileocecum.


Sally Thompson Loves Sex And Pot pie. The branches of the Axillary Artery are: Superior Thoracic, Thoracoacromial, Lateral Thoracic, Subscapular, Anterior Circumflex Humeral, Posterior Circumflex Humeral, and Profunda Brachii.



TIRE- four abdominal muscles -- transversus, internal oblique, rectus abdominus, and external oblique

Anesthesia Mnemonics



Spinal anesthesia agents
"Little Boys Prefer Toys":
Lidocaine
Bupivicaine
Procaine
Tetracaine



Xylocaine: where not to use with epinephrine
"Nose, Hose, Fingers and Toes"
· Vasoconstrictive effects of xylocaine with epinephrine are helpful in providing hemostasis while suturing. However, may cause local ischemic necrosis in distal structures such as the digits, tip of nose, penis, ears.



General anaesthesia: equipment check prior to inducing
MALES:
Masks
Airways
Laryngoscopes
Endotracheal tubes
Suction/ Stylette, bougie



Endotracheal intubation: diagnosis of poor bilateral breath sounds after intubation
DOPE:
Displaced (usually right mainstem, pyreform fossa, etc.)
Obstruction (kinked or bitten tube, mucuous plug, etc.)
Pneumothorax (collapsed lung)
Esophagus



Anesthesia machine/room check
MS MAID:
Monitors (EKG, SpO2, EtCO2, etc)
Suction
Machine check (according to ASA guidelines)
Airway equipment (ETT, laryngoscope, oral/nasal airway)
IV equipment
Drugs (emergency, inductions, NMBs, etc)



Anesthesia: quick check
SOAP:
Suction
Oxygen
Airway
Pharmacology


Anesthetics equipment check
MISMADE:
Machine check
IV supplies
Suction
Monitors
Airways
Drugs
Equipment



Failed intubation: causes
INTUBATION:
Infections of larynx
Neck mobility abnormalities
Teeth abnormalites (eg poor dentifom, loose and protuberant teeth)
Upper airway abnormalities, strictures, or swellings
Bullsneck deformities
Ankylosing spondylitis
Trauma/ TumourInexperienceOedema of upper airwayNarrowing of lower airway



Respiratory complications of anaesthesia: patients at risk
COUPLES:
COPD
Obese
Upper abdominal surgery
Prolonged bed rest
Long surgery
Elderly
Smokers
Biochemistry Mnemonics
Essential Amino Acids
PriVaTe TIM HALL
Phe, Val, Thr, Trp, Ile, Met, His, Arg, Leu, Lys


Urea Cycle
Ordinarily, Careless Crappers, Are Also Frivolous About Urination.
Ornithine, Carbamoyl, Citrulline, Arginosuccinate, Aspartate, Fumarate, Arginine, Urea.


Cell division
Prophase, metaphase, anaphase, telophase.
"People Meet And Talk."


In the Phasted State
Phosphorylate Phosphorylation cascade active when blood glucose low.
DNA expression into mature mRNA
Exons expressed, Introns in the trash.
Pyrimidines are CUT from purines.
Pyrimidines are Cytosine, Uracil, Thiamine and are one ring structures.
Purines are double ring structures.

Amino Acids:The ten essential amino acids:
"These Ten Valuable Amino Acids Have Long Preserved Life In
Man."
(Threonine, Tryptophan, Valine, Arginine, Histidine, Lysine,
Phenylalanine, Leucine, Isoleucine, Methionine)



GOAT FLAP- Eight hormones: Growth hormone, Oxytocin, Adenocorticotropin, Thyroid stimulating hormone, Follicle stimulating hormone, Leutinizing hormone (interstitial cell stimulating hormone in males), Anti-diruetic(Vasopressin), and Prolactin
(shhhh.... also Melatonin!)

Hypervitaminosis A: signs and symptoms
"Increased Vitamin A makes you HARD":
Headache/ Hepatomegaly
Anorexia/ Alopecia
Really painful bones
Dry skin/ Drowsiness
Enzymes: classification

"Over The HILL":
Oxidoreductases
Transferases
Hydrolases
Isomerases
Ligases
Lyases
· Enzymes get reaction over the hill.

B vitamin names
"The Rhythm Nearly Proved Contagious":
· In increasing order: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pyridoxine (B6) Cobalamin (B12)

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.

Fasting state: branched-chain amino acids used by skeletal muscles
"Muscles LIVe fast":
Leucine
Isoleucine
Valine

Infantile Beriberi symptoms
Restlessness Sleeplessness Breathlessness Soundlessness (aphonia) Eatlessness (anorexia) Great heartedness (dilated heart)
· Alternatively: Get 5 of 'em with BERI: Breathless/ Big hearted, Eatless, Restless, Insomnia.

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

Vitamin B3 (niacin, nicotinic acid) deficiency: pellagra
The 3 D's of pellagra: Dermatitis Diarrhea Dementia
· Note vitamin B3 is the 3 D's.

Porphyrias: acute intermittent porphyria symptoms 5 P's:
Pain in abdomen
Polyneuropathy
Psychologial abnormalities
Pink urine
Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)
Cardiology Mnemonics

Aortic stenosis characteristics SAD:
Syncope
Angina
Dyspnoea



MI: basic management BOOMAR:
Bed rest
Oxygen
Opiate
Monitor
Anticoagulate
Reduce clot size


ECG: left vs. right bundle block "WiLLiaM MaRRoW":
W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.
M pattern in V1-V2 and W in V3-V6 is Right bundle block.
· Note: consider bundle branch blocks when QRS complex is wide.


Pericarditis: causes CARDIAC RIND:
Collagen vascular disease
Aortic aneurysm
Radiation
Drugs (such as hydralazine)
Infections
Acute renal failure
Cardiac infarction
Rheumatic fever
Injury
Neoplasms
Dressler's syndrome


Murmurs: systolic types SAPS:
Systolic
Aortic
Pulmonic
Stenosis
· Systolic murmurs include aortic and pulmonary stenosis.
· Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation].


MI: signs and symptoms PULSE:
Persistent chest pains
Upset stomach
Lightheadedness
Shortness of breath
Excessive sweating


Heart compensatory mechanisms that 'save' organ blood flow during shock "Heart SAVER":
Symphatoadrenal system
Atrial natriuretic factor
Vasopressin
Endogenous digitalis-like factor
Renin-angiotensin-aldosterone system
· In all 5, system is activated/factor is released


Murmurs: right vs. left loudness "RILE":
Right sided heart murmurs are louder on Inspiration.
Left sided heart murmurs are loudest on Expiration.
· If get confused about which is which, remember LIRE=liar which will be inherently false.


ST elevation causes in ECG, ELEVATION:
Electrolytes
LBBB
Early repolarization
Ventricular hypertrophy
Aneurysm
Treatment (eg pericardiocentesis)
Injury (AMI, contusion)
Osborne waves (hypothermia)
Non-occlusive vasospasm


Beck's triad (cardiac tamponade) 3 D's:
Distant heart sounds
Distended jugular veins
Decreased arterial pressure

MI: therapeutic treatment ROAMBAL:
Reassure
Oxygen
Aspirin
Morphine (diamorphine)
Beta blocker
Arthroplasty
Lignocaine


CHF: causes of exacerbation FAILURE:
Forgot medication
Arrhythmia/ Anaemia
Ischemia/ Infarction/ Infection
Lifestyle: taken too much salt
Upregulation of CO: pregnancy, hyperthyroidism
Renal failure
Embolism: pulmonary


Murmurs: systolic vs. diastolic PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.

Murmurs: systolic vs. diastolic Systolic murmurs: MR AS: "MR. ASner".
Diastolic murmurs: MS AR: "MS. ARden".
· The famous people with those surnames are Mr. Ed Asner and Ms. Jane Arden.

Mitral stenosis (MS) vs. regurgitation (MR): epidemiology MS is a female title (Ms.) and it is female predominant.
MR is a male title (Mr.) and it is male predominant.

Pericarditis: EKG "PericarditiS":
PR depression in precordial leads.
ST elevation.

Jugular venous pressure (JVP) elevation: causes HOLT: Grab Harold Holt around the neck and throw him in the ocean:
Heart failure
Obstruction of venea cava
Lymphatic enlargement - supraclavicular
Intra-Thoracic pressure increase


Depressed ST-segment: causes DEPRESSED ST:
Drooping valve (MVP)
Enlargement of LV with strain
Potassium loss (hypokalemia)
Reciprocal ST- depression (in I/W AMI)
Embolism in lungs (pulmonary embolism)
Subendocardial ischemia
Subendocardial infarct
Encephalon haemorrhage (intracranial haemorrhage)
Dilated cardiomyopathy
Shock
Toxicity of digitalis, quinidine


Murmurs: innocent murmur features 8 S's:
Soft
Systolic
Short
Sounds (S1 & S2) normal
Symptomless
Special tests normal (X-ray, EKG)
Standing/ Sitting (vary with position)
Sternal depression



Murmur attributes "IL PQRST" (person has ill PQRST heart waves):
Intensity
Location
Pitch
Quality
Radiation
Shape
Timing


Murmurs: locations and descriptions "MRS butt":
MRS: Mitral Regurgitation--Systolic
butt: Aortic Stenosis--Systolic
· The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic.


Betablockers: cardioselective betablockers "Betablockers Acting Exclusively At Myocardium"
· Cardioselective betablockers are:
Betaxolol
Acebutelol
Esmolol
Atenolol
Metoprolol


Apex beat: abnormalities found on palpation, causes of impalpable HILT:
Heaving
Impalpable
Laterally displaced
Thrusting/ Tapping
· If it is impalpable, causes are COPD:
COPD
Obesity
Pleural, Pericardial effusion
Dextrocardia


MI: treatment of acute MI COAG:
Cyclomorph
Oxygen
Aspirin
Glycerol trinitrate

Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease

Peripheral vascular insufficiency: inspection criteria SICVD:
Symmetry of leg musculature
Integrity of skin
Color of toenails
Varicose veins
Distribution of hair

Heart murmurs "hARD ASS MRS. MSD":
hARD: Aortic Regurg = Diastolic
ASS: Aortic Stenosis = Systolic
MRS: Mitral Regurg = Systolic
MSD: Mitral Stenosis = Diastolic


Mitral regurgitation When you hear holosystolic murmurs, think "MR-THEM ARE holosystolic murmurs".


Sino-atrial node: innervation Sympathetic acts on Sodium channels (SS).
Parasympathetic acts on Potassium channels (PS).

Supraventricular tachycardia: treatment ABCDE:
Adenosine
Beta-blocker
Calcium channel antagonist
Digoxin
Excitation (vagal stimulation)

Ventricular tachycardia: treatment LAMB:
Lidocaine
Amiodarone
Mexiltene/ Magnesium
Beta-blocker

Pulseless electrical activity: causes PATCH MED:
Pulmonary embolus
Acidosis
Tension pneumothorax
Cardiac tamponade
Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia
Myocardial infarction
Electrolyte derangements
Drugs


Sinus bradycardia: aetiology "SINUS BRADICARDIA" (sinus bradycardia):
Sleep
Infections (myocarditis)
Neap thyroid (hypothyroid)
Unconsciousness (vasovagal syncope)
Subnormal temperatures (hypothermia)
Biliary obstruction
Raised CO2 (hypercapnia)
Acidosis
Deficient blood sugar (hypoglycemia)
Imbalance of electrolytes
Cushing's reflex (raised ICP)
Aging
Rx (drugs, such as high-dose atropine)
Deep anaesthesia
Ischemic heart disease
Athletes

Rheumatic fever: Jones criteria · Major criteria: CANCER:
Carditis
Arthritis
Nodules
Chorea
Erythema
Rheumatic anamnesis
· Minor criteria: CAFE PAL:
CRP increased
Arthralgia
Fever
Elevated ESR
Prolonged PR interval
Anamnesis of rheumatism
Leucocytosis


JVP: wave form ASK ME:
Atrial contraction
Systole (ventricular contraction)
Klosure (closure) of tricusps, so atrial filling
Maximal atrial filling
Emptying of atrium
· See diagram.


Coronary artery bypass graft: indications DUST:
Depressed ventricular function
Unstable angina
Stenosis of the left main stem
Triple vessel disease

Exercise ramp ECG: contraindications RAMP:
Recent MI
Aortic stenosis
MI in the last 7 days
Pulmonary hypertension


ECG: T wave inversion causes INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]

Rheumatic fever: Jones major criteria JONES:
Joints (migrating polyarthritis)
Obvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits)
Nodes (subcutaneous nodules)
Erythema marginatum
Sydenham's chorea


Myocardial infarctions: treatment INFARCTIONS:
IV access
Narcotic analgesics (eg morphine, pethidine)
Facilities for defibrillation (DF)
Aspirin/ Anticoagulant (heparin)
Rest
Converting enzyme inhibitor
Thrombolysis
IV beta blocker
Oxygen 60%
Nitrates
Stool Softeners


Atrial fibrillation: causes PIRATES:
Pulmonary: PE, COPD
Iatrogenic
Rheumatic heart: mirtral regurgitation
Atherosclerotic: MI, CAD
Thyroid: hyperthyroid
Endocarditis
Sick sinus syndrome


Atrial fibrillation: management ABCD:
Anti-coagulate
Beta-block to control rate
Cardiovert
Digoxin


Anti-arrythmics: for AV nodes "Do Block AV":
Digoxin
B-blockers
Adenosine
Verapamil


Murmurs: systolic MR PV TRAPS:
Mitral
Regurgitation and
Prolaspe
VSD
Tricupsid
Regurgitation
Aortic and
Pulmonary
Stenosis


Apex beat: differential for impalpable apex beat DOPES:
Dextrocardia
Obesity
Pericarditis or pericardial tamponade
Emphysema
Sinus inversus/ Student incompetence
Clinical Mnemonics

? CAUSES OF ACUTE PANCREATITIS:
"GET SMASH'D"
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics)

? A-P-G-A-R:
A - appearance (color)
P - pulse (heart rate)
G - grimmace (reflex, irritability)
A - activity (muscle tone)
R - respiratory effort

? Multiple Endocrine Neoplasia: Each of the MENs is a disease of three or two letters plus a feature.
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)

? P-Q-R-S-T--eliciting and HPI and exploring symptoms
P--palliative or provocative factors for the pain
Q--quality of pain(burning, stabbing, aching, etc.)
R--region of body affected
S--severity of pain(usually 1-10 scale)
T--timing of pain(eg.-after meals, in the morning, etc.)

? A-S-C-L-A-S-T--eliciting and HPI and exploring symptoms
A--aggravatiing and alleviating factors
S--severity
C--character, quality
L--location
A--associated sx
S--setting
T--timing
note: ASCLAST means let the patient talk first, then ask him/her specific questions

? Argyll-Robertson Pupil--syphilitic pupil: Accommodation reflex present, Pupillary reflex absent due to damage at pretectal area. Also called the "prostitute's pupil" (accommodates but does not react).

? The five W's--post-operative fever
Wind--pneumonia, atelectasis
Wound--wound infections
Water--urinary tract infection
Walking--walking can help reduce deep vein thromboses and pulmonary embolus
Wonderdrugs--especially anesthesia

? Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER
T--trauma
O--obesity
M--malignancy
S--surgery
C--cardiac disease
H--hospitalization
R--rest (bed-bound)
E--estrogen, pregnancy, post-partum
P--past hx
F--fracture
E--elderly
R--road trip

? ARTERIAL OCCLUSION:
pain
pallor
pulselessness
paresthesias

? HYPERSENSITIVITY REACTIONS: "Anna Cycled Immediately Downhill--Gell & Goombs" or "ACID."
Type I Anaphylaxis
Type II Cytotoxic-mediated
Type III Immune-complex
Type IV Delayed hypersensitivity

? WBC Count: "Never Let Mom Eat Beans" and "60, 30, 6, 3, 1"
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1:

Abdominal swelling causes 5 F's:
Fat Feces Fluid Flatus Fetus Full-sized tumors

Patient examination organization SOAP:
Subjective: what the patient says.
Objective: what the examiner observes.
Assessment: what the examiner thinks is going on.
Plan: what they intend to do about it.


Vomiting: non-GIT differential ABCDEFGHI:
Acute renal failure Brain [increased ICP] Cardiac [inferior MI] DKA Ears [labyrinthitis] Foreign substances [Tylenol, theo, etc.] Glaucoma Hyperemesis gravidarum Infection [pyelonephritis, meningitis]

Pain history checklist OPQRSTU:
Onset of pain (time, duration) Palliative factors for pain Quality of pain (throbbing, stabbing, dull, etc.) Region of body affected Severity of pain (usually scale of 1-10) Timing of pain (after exercise, in evening, etc.) U: How does it affect 'U' in your daily life?
· May wish to expand to OPPQRRSTTUVW, with the extra letters representing:
Provocative factors Radiation (how does pain spread) Treatments tried Deja Vu: Has this happened before? Worry: What do you think or fear that it is?


Differential diagnosis checklist "A VITAMIN C"
A and C stand for Acquired and Congenital
· VITAMIN stands for:
Vascular
Inflammatory (Infectious and non-Infectious)
Trauma/ Toxins
Autoimmune
Metabolic
Idiopathic
Neoplastic
· Example usage: List causes of decreased vision: Central retinal artery occlusion, Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia.

Sign vs. symptoms
Ign: something I can detect even if patient is unconscious.
sYMptom is something only hYM knows about.


Eyes: abbreviations for the eyes
You look OUt with Both eyes. Take the Right dose so you won't OD [overdose]. The only one that is Left is OS.
· Both eyes=OU, Right eye=OD, Left eye=OS.


Medical history: disease checklist MJ THREADS:
Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic fever/ Rheumatoid arthritis Epilepsy Asthma Diabetes Strokes
Pain history checklist "On Days Feeling Low Character, Run A Seven Pace Race":
Onset
Duration
Frequency
Location
Character
Radiation
Severity
Precipitating factors
Relieving factors


Pain history checklist ASK LAST:
Aggravating/ Alleviating
Severity
Karacter
Location
Associated symptoms
Setting
Timing


Pain history checklist SOCRATES:
Site
Onset
Character
Radiation
Alleviating factors/ Associated symptoms
Timing (duration, frequency)
Exacerbating factors
Severity
· Alternatively, Signs and Symptoms with the 'S'.


Symptom attributes "FAST LQQ'S":
Factors that make it better/worse
Associated manifestations
Setting
Timing
Location
Quality
Quantity
Severity


Heart valve auscultation sites "All Patients Take Meds":
· Reading from top left:
Aortic
Pulmonary
Tricuspid
Mitral
· See diagram.
· Alternatively: All Prostitutes Take Money.
· Alternatively: APe To Man.


Four point physical assessment of a disease
"I'm A People Person":
Inspection
Auscultation
Percussion
Palpation

Physical exam for 'lumps and bumps'
"6 Students and 3 Teachers go for CAMPFIRE":
Site, Size, Shape, Surface, Skin, Scar
Tenderness, Temperature, Transillumination
Consistency
Attachment
Mobility
Pulsation
Fluctuation
Irreducibility
Regional lymph nodes
Edge


Surgical sieve VANISHED:
Vascular
Accident & trauma
Neoplastic
Inflammatory
Septic
Haematologic/ Hereditary
Endocrinological
Degenerative



Differential diagnosis checklist "I VINDICATE":
Iatrogenic
Vascular
Infectious
Neoplastic
Degenerative/ Drugs
Inflammatory/ Idiopathic
Congenital
Allergic/ Autoimmune
Traumatic
Endocrinal & metabolic



Symptom sieve "TIN CAN BED DIP POG":
Trauma
Infection
Neoplasm
Cardiac
Autoimmune
Neurological
Blood/ Bone
Endocrine
Disintegration/ Degeneration
Drugs
Iatrogenic/ Idiopathic
Psychological
Paediatric
Obstetric
Gynaecological


Surgical sieve for diagnostic categories
INVESTIGATIONS:
Iatrogenic Neoplastic Vascular Endocrine Structural/ Mechanical Traumatic Inflammatory Genetic/ Congenital Autoimmune Toxic Infective Old age/ Degenerative Nutritional Spontaneous/ Idiopathic


Mental state examination: stages in order
"Assessed Mental State To Be Positively Clinically Unremarkable":
Appearance and behaviour [observe state, clothing...]
Mood [recent spirit]
Speech [rate, form, content]
Thinking [thoughts, perceptions]
Behavioural abnormalities
Perception abnormalities
Cognition [time, place, age...]
Understanding of condition [ideas, expectations, concerns]


Branham sign: definition
BRAnham sign:
BRAdycardia after compression or excision of a large AV fistula.


Glasgow coma scale: components and numbers
· Scale types is 3 V's: Visual response Verbal response Vibratory (motor) response
· Scale scores are 4,5,6:
Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawl)

Meckel’s diverticulum- rule of 2’s
2 inches long,
2 feet from the ileocecal valve,
2% of the population
commonlly presents in the first 2 years of life
may contain 2 types of epithelial tissue

Pheochromocytoma-rule of 10s:
10% malignant
10% Bilateral
10% extraadrenal
10% calcified
10% children
10% familial
* discussed 10 times more often than actually seen

Aphasia
"BROKen aphasia" (Broca’s aphasia-broken speech)
"Wordys aphasia" (Wernicke’s aphasia- wordy, but making no sense)

GET SMASH'D--Causes of Acute pancreatitis
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics)


(Multiple endocrine neoplasia) Each of the MENs is a
disease of three or two letters plus a feature.
"MEN I" is a disease of the 3 Ps (pituitary, parathyroid and pancreas)
plus adrenal cortex.
"MEN II " is a disease of the two Cs (carcinoma of the 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

Argyll-Robertson Pupil--syphilitic pupil (AKA "Prostitute's pupil" - Accommodates, but doesn't react )
Accommodation reflex present, Pupillary reflex absent


CAGE--alcohol use screening
1. Have you ever felt it necessary to CUT DOWN on your drinking?
2. Has anyone ever told you they were ANNOYED by your drinking?
3. Have you ever felt GUILTY about your drinking?
4. Have you ever felt the need to have a drink in the morning for an EYE OPENER?


P-Q-R-S-T--eliciting and HPI and exploring symptoms
P--palliative or provocative factors for the pain
Q--quality of pain(burning, stabbing, aching, etc.)
R--region of body affected
S--severity of pain(usually 1-10 scale)
T--timing of pain(eg.-after meals, in the morning, etc.)


The five W's--post-operative fever
Wind--pneumonia, atelectasis
Water--urinary tract infection
Wound--wound infections
Wonderdrugs--especially anesthesia
Walking--walking can help reduce deep vein thromboses and pulmonary embolus


ACID or "Anna Cycled Immediately Downhill"
classification of hypersensitivity reactions
Type I - Anaphylaxis
Type II - Cytotoxic-mediated
Type III - Immune-complex
Type IV - Delayed hypersensitivity


WBC Count:
"Never Let Momma Eat Beans(60, 30, 6, 3, 1)
Neutrophils 60%
Lymphocytes 30%
Monocytes 6%
Eosinophils 3%
Basophils 1%


A-P-G-A-R:
A - appearance (color)
P - pulse (heart rate)
G - grimmace (reflex, irritability)
A - activity (muscle tone)

R - respiratory effort

Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER
T--trauma
O--obesity
M--malignancy
S--surgery
C--cardiac disease
H--hospitalization
R--rest (bed-bound)
E--estrogen, pregnancy, post-partum
P--past hx
F--fracture
E--elderly
R--road trip

The 4 P's of arterial Occlusion: pain pallor pulselessness paresthesias


The 4 T's of Anterior Mediastinal Mass:Thyroid tumor,Thymoma,Teratoma, Terrible Lymphoma
Dermatology Mnemonics


Malignant melanoma: 3 sites with poor prognosis
BANS:
Back of Arm
Neck
Scalp



Albinism: type I vs. II classification
"One has None. Two Accumulates":
Type I: have no pigment.
Type II: No pigment at birth, but accumulates as person ages.



Generalized skin hyperpigmentation: causes
"With generalized, none of skin is SPARED":
Sunlight
Pregnancy
Addison's disease
Renal failure
Excess iron (haemochromatosis)
Drugs (eg busulphan)



Clubbing: causes
CLUBBING:
Cyanotic heart disease
Lung disease (hypoxia, lung cancer, bronchiectasis, cystic fibrosis)
UC/Crohn's disease
Biliary cirrhosis
Birth defect (harmless)
Infective endocarditis
Neoplasm (esp. Hodgkins)
GI malabsorption



Cutaneous inflammation patterns
"Pus of Pig Valve"
· Remove the vowels: PSFPGVLV:
Psoriaform
Spongiotic (eczematous)
Folliculitis
Panniculitis
Granulomatous
Vasculopathic
Lichenoid
Vessiculobullous



Nodules: painful cutaneous nodules causes
BENGAL CO.:
Blue rubber bleb nevus
Eccrine spiradenoma
Neurilemmoma/ Neuroma
Glomus tumor
Angiolipoma/ Angioleiomyoma/ Angiosarcoma
Leiomyoma
Cutaneous endometriosis/ Calcinosis cutis
Osteoma cutis



Wound healing: factors delaying
DID NOT HEAL:
Drugs
Infection/ Icterus/ Ischemia
Diabetes
Nutrition
Oxygen (hypoxia)
Toxins
Hypothermia/ Hyperthermia
EtOH
Acidosis
Local anesthetics


White patch of skin: differential
"Vitiligo PATCH":
Vitiligo
Pityriasis alba/ Post-inflammatory hypopigmentation
Age related hypopigmentation
Tinea versicolor/ Tuberous sclerosis (ashleaf macule)
Congenital birthmark
Hansen's (leprosy)



Psoriasis: pathophysiology
PSORIASIS:
Pink Papules/ Plaques/ Pinpoint bleeding (Auspitz sign)/ Physical injury (Koebner phenomenon)/ Pain
Silver Scale/ Sharp margins
Onycholysis/ Oil spots
Rete Ridges with Regular elongation
Itching
Arthritis/ Abscess (Munro)
Stratum corneum with nuclei, neutrophils
Immunologic
Stratum granulosum absent/ Stratum Spinosum thickening



Raynaud's phenomenon: causes
COLD HAND:
Cryoglobulins/ Cryofibrinogens
Obstruction/ Occupational
Lupus erythematosus, other connective tissue disease
Diabetes mellitus/ Drugs
Hematologic problems (polycythemia, leukemia, etc)
Arterial problems (atherosclerosis)
Neurologic problems (vascular tone)
Disease of unknown origin (idiopathic)
Embryology Mnemonics
Vitelline duct: closure time
VItelline duct normally closes around week VI of intrauterine life.


Potter syndrome: features POTTER:
Pulmonary hypoplasia
Oligohydrominios
Twisted skin (wrinkly skin)
Twisted face (Potter facies)
Extremities defects
Renal agenesis (bilateral)


Placenta-crossing substances "WANT My Hot Dog": Wastes
Antibodies
Nutrients
Teratogens
Microorganisms
Hormones/ HIV
Drugs


Cranial and spinal neural crest: major derivatives GAMES:
Glial cells (of peripheral ganglia)
Arachnoid (and pia)
Melanocytes
Enteric ganglia
Schwann cells


Mesoderm components MESODERM:
Mesothelium (peritoneal, pleural, pericardial)/ Muscle (striated, smooth, cardiac)
Embryologic Spleen/ Soft tissue/ Serous linings/ Sarcoma/ Somite
Osseous tissue/ Outer layer of suprarenal gland (cortex)/ Ovaries
Dura/ Ducts of genitalia
Endothelium
Renal Microglia
Mesenchyme/ Male gonad


Vasculogenesis vs. angiogenesis
"Vascu is new. Angi is pre": Vasculogenesis is new vessels developing in situ from existing mesenchyme. Angiogenesis is vessels develop from sprouting off pre-existing arteries.


Weeks 2, 3, 4 of development: an event for each
Week Two: Bilaminar germ disc.
Week Three: Trilaminar germ disc.
Week Four: Four limbs appear.


Teratogenesis: when it occurs
TEratogenesis is most likely during organogenesis--between the: Third and Eighth weeks of gestation.


Tetrology of Fallot "Don't DROP the baby":
Defect (VSD)
Right ventricular hypertrophy
Overriding aorta
Pulmonary stenosis


Lung development phases "Every Premature Child Takes Air":
Embryonic period
Pseudoglandular period
Canalicular peroid
Terminal sac period
Alveolar period


Branchial arch giving rise to aorta
"Aor- from Four": Aorta is from fourth arch.


Neuroectoderm derivatives
Neuroectoderm gives rise to:
Neurons
Neuroglia
Neurohypophysis
piNeurol (pineal) gland


Tetrology of Fallot
"IHOP-International House of Pancakes":
Interventricular septal defect
Hypotrophy of right ventricle
Overriding aorta
Pulmonary stenosis


Woffian duct (mesonephric duct) derivatives.
Gardener's SEED:
· Female: Gartner's duct, cyst
· Male:
Seminal vesicles
Epididymis
Ejaculatory duct
Ductus deferens


Foregut derivatives
"Little Embryo People Do Like Swallowing, Producing Gas": Lungs Esophagus Pancreas Duodenum (proximal) Liver Stomach Pancreas Gall bladder
Emergency Mnemonics
Coma: conditions to exclude as cause MIDAS:
Meningitis
Intoxication
Diabetes
Air (respiratory failure)
Subdural/ Subarachnoid hemorrhage


Resuscitation: basic steps ABCDE:
Airway
Breathing
Circulation
Drugs
Environment


Malignant hyperthermia treatment
"Some Hot Dude Better Give Iced Fluids Fast!"
(Hot dude = hypothermia):
Stop triggering agents
Hyperventilate/ Hundred percent oxygen
Dantrolene (2.5mg/kg)
Bicarbonate
Glucose and insulin
IV Fluids and cooling blanket
Fluid output monitoring/ Furosemide/ Fast heart [tachycardia]


Vfib/Vtach drugs used according to ACLS "Every Little Boy Must Pray":
Epinephrine
Lidocaine
Bretylium
Magsulfate
Procainamide


Coma causes checklist AEIOU TIPS:
Acidosis/ Alcohol
Epilepsy
Infection
Overdosed
Uremia
Trauma to head
Insulin: too little or or too much
Pyschosis episode
Stroke occurred


Shock: types RN CHAMPS:
Respiratory
Neurogenic
Cardiogenic
Hemorrhagic
Anaphylactic
Metabolic
Psychogenic
Septic
· Alternatively: "MR. C.H. SNAP", or "NH CRAMPS".



Shock: signs and symptoms TV SPARC CUBE:
Thirst
Vomiting
Sweating
Pulse weak
Anxious
Respirations shallow/rapid
Cool
Cyanotic
Unconscious
BP low
Eyes blank


Fall: potential causes CLADE SPADE:
Cardiovascular/ Cerebrovascular
Locomotor (skeletal, muscular, neurological)
Ageing (increased body sway, decreased reaction time)
Drugs (esp. antihypertensives, antipsychotics)
Environmental
Sensory deficits (eg. visual problems)
Psychological/ Psychiatric (depression)
Acute illness
Dementia
Epilepsy


Diabetic ketoacidosis management F*¢KING:
Fluids (crytalloids)
Urea (check it)
Creatinine (check it)/ Catheterize
K+ (potassium)
Insulin (5u/hour. Note: sliding scale no longer recommended in the UK)
Nasogastic tube (if patient comatose)
Glucose (once serum levels drop to 12)


Asthma: management of acute severe "O S#!T":
Oxygen (high dose: >60%)
Salbutamol (5mg via oxygen-driven nebuliser)
Hydrocortisone (or prednisolone)
Ipratropium bromide (if life threatening)
Theophylline (or preferably aminophylline-if life threatening)

V-fib/pulseless v-tach (new ACLS as of 2001)
"EVAL My Pumper":
Epinephrine Vasopressin Amiodarone (class IIb--better for heart failure) Lidocaine (indeterminate - better for young, healthy or persistent) MgSO4 (IIb for hypomagnesemic state or torsades) Procainamide (IIb for intermittent/recurrent VF/VT)

Trauma: motor vehicle accident considerations
I AM SCARED:
Impact (head-on, rear-end, t-bone, rollover, rotational etc.) Auto vs. pedestrian, bike, motorcycle (start @ speed >10mph) Medical history (cardiac, coagulolation, liver, immuno, obese, prego) Speed (>50 mph?) Compartment intrusion (>12 inches?) Age (<5>55 y.o.?) Restraints (lap & shoulder, either, airbag, infant or child seat?) Ejection/ Extrication (eject=25x greater death, extr>20min) Death (at scene, same vehicle, other)


Decompression sickness
Boyle's law: volume of gas is inversely proportionate to its pressure. · Therefore, BOYLE:
Breathe (as you ascend) Or Your Lung Explodes · Breathe as you ascend after scuba diving, since the pressure decreases on surfacing, so the gas volume in lungs increases.


Pain history checklist
OLDER SAAB:
Onset Location Description (what does it feel like) Exacerbating factors Radiation Severity Associated symptoms Alleviating factors Before (ever experience this before)


Asystole: treatment
"Have some asystole "TEA":
Transcutaneous pacing Epi Atropine


Endotrachial tube deliverable drugs
O NAVEL:
Oxygen Naloxone Atropine Ventolin (albuterol) Epinephrine Lidocaine · If you can't get IV access established, and have necessity to administer resuscitative meds, remember you have the airway and can give the above drugs. · Drug delivery is enhanced if diluted with 10cc NS and rapid introduced for aeresolization. · Alternatively, bare bone version is ALE, as above.


RLQ pain: differential
APPENDICITIS:
Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/ Endometriosis Neoplasia Diverticulitis Intussusception Crohns Disease/ Cyst (ovarian) IBD Torsion (ovary) Irritable Bowel Syndrome Stones


Subarachnoid hemorrhage (SAH) causes
BATS:
Berry aneurysm Arteriovenous malformation/ Adult polycystic kidney disease Trauma (eg being struck with baseball bat) Stroke


Syncope causes, by system
HEAD HEART VESSELS:
· CNS causes include HEAD:
Hypoxia/ Hypoglycemia Epilepsy Anxiety Dysfunctional brain stem (basivertebral TIA)
· Cardiac causes are HEART: Heart attack Embolism (PE) Aortic obstruction (IHSS, AS or myxoma) Rhythm disturbance, ventricular Tachycardia
· Vascular causes are VESSELS: Vasovagal Ectopic (reminds one of hypovolemia) Situational Subclavian steal ENT (glossopharyngeal neuralgia) Low systemic vascular resistance (Addison's, diabetic vascular neuropathy) Sensitive carotid sinus


Coma and signicantly reduced conscious state causes:
Causes COMA:
CO2 and CO excess Overdose: TCAs, Benzos, EtOH, insulin, paracetamol, etc. Metabolic: BSL, Na+, K+, Mg2+, urea, ammonia, etc. Apoplexy: stroke, SAH, extradural, subdural, Ca, meningitis, encephalitis, cerebral abscess, etc.
ENT Mnemonics



Oralpharangeal cancers: aetiology
6 S's:
Smoking
Spicy food
Syphilis
Spirits [booze]
Sore tooth
Sepsis
· Also bezel nuts.

Ear drops: direction to pull ear when instilling
For an grown UP it is UP.
For a chilD it is Down.



Nasopharyngeal carcinoma: classic symptoms
NOSE:
Neck mass
Obstructed nasal passage
Serous otitis media externa
Epistaxis or discharge
Gastroenterology Mnemonics



Ulcerative colitis: definition of a severe attack
A STATE:
Anemia less than 10g/dl
Stool frequency greater than 6 stools/day with blood
Temperature greater than 37.5
Albumin less than 30g/L
Tachycardia greater than 90bpm
ESR greater than 30mm/hr



Vomiting: extra GI differential
VOMITING:
Vestibular disturbance/ Vagal (reflex pain)
Opiates
Migrane/ Metabolic (DKA, gastroparesis, hypercalcemia)
Infections
Toxicity (cytotoxic, digitalis toxicity)
Increased ICP, Ingested alcohol
Neurogenic, psychogenic
Gestation



Pancreatitis (acute): causes
I GET SMASHED:
Idiopathitic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune (PAN)
Scorpion stings
Hyperlipidemia/ Hypercalcemia
ERCP
Drugs (including azathioprine and diuretics)
· Note: 'Get Smashed' is slang in some countries for drinking, and ethanol is an important pancreatitis cause.
· Note: Shortest answer is gallstones for women, and ethanol for men. And scorpian stings for people from Trinidad.



IBD: surgery indications
"I CHOP":
Infection
Carcinoma
Haemorrhage
Obstruction
Perforation
· "Chop" convenient since surgery chops them open.


Hereditary Nonpolyposis Colorectal Cancer (HNPCC) cause is DNA mismatch repair
DNA mismatch causes a bubble in the strand where the two nucleotides don't match.
This looks like the ensuing polyps that arise in the colon.
· See diagram.



IBD: extraintestinal manifestations
A PIE SAC:
Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
Clubbing of fingertips



Digestive disorders: pH level
With vomiting both the pH and food come up.
With diarrhea both the pH and food go down.



H. Pylori treatment regimen (rough guidelines)
"Please Make Tummy Better":
Proton pump inhibitor
Metronidazole
Tetracycline
Bismuth
· Alternatively: TOMB:
Tetracycline
Omeprazole
Metronidazole
Bismuth



Bilirubin: common causes for increased levels
"HOT Liver":
Hemolysis
Obstruction
Tumor
Liver disease



Ulcerative colitis: complications
"PAST Colitis":
Pyoderma gangrenosum
Ankylosing spondylitis
Sclerosing pericholangitis
Toxic megacolon
Colon carcinoma
Immunology Mnemonics



Hypersensitivity reactions: Gell and Goombs nomenclature
ACID
· From I to IV:
Anaphylactic type: type I
Cytotoxic type: type II
Immune complex disease: type III
Delayed hypersensitivity (cell mediated): type IV

MHC I vs. II: T cell interaction
The "=8" equation:
2x4=8, and 1x8=8.
MHC II goes with CD4.
MHC I goes with CD8.


Immunoglobulin (Ig) types: the important ones worth remembering, in order of appearance
MAGDElaine (a girl's name):
IgM
IgA
IgG
IgD
IgE
· Magdelaine tells you the order they usually appear: M first, then A or G.
· Alternatively: IgM is IMmediate.


Acute inflammation features
SLIPR:
Swelling
Loss of function
Increased heat
Pain
Redness
· "What a cute pair of slippers" can be used to tie acute inflammation to SLIPR.


Lupus signs and symptoms
SOAP BRAIN:
Serositis [pleuritis, pericarditis]
Oral ulcers
Arthritis
Photosensitivity
Blood [all are low - anemia, leukopenia, thrombocytopenia]
Renal [protein]
ANA
Immunologic [DS DNA, etc.]
Neurologic [psych, seizures]


Goodpasture's Syndrome components
GoodPasture is Glomerulonephritis and Pnuemonitits.
· From autoantibodies attacking Glomerular and Pulmonary basement membranes.


Complement: function of C3a versus C3b
C3a: Activates Acute [inflammation].
C3b: Bonds Bacteria [to macrophages--easier digestion].
· If wish to know more than just C3:
C3a, C4a, C5a activate acute.
C3b, C4b bind bacteria.


MHC I vs. MHC II properties
"Immunity helps to exterminate fun for bacteria"
· See attached chart.


HLA-DR genetic predisposition immune disease examples
HLA-DR:
Hashimoto's disease
Leukemia/ Lupus
Autoimmune adrenalitis/ Anemia (pernicious)
Diabetes insipidous
Rheumatoid arthritis


Complement cascade initiating items: alternative vs. classic
Classic: Combined Complexes.
Alternative: Activators Alone, or IgA.
· Complexes are made of Ab and Ag combined together.
· Examples of activators: endotoxin, microbial surface.
Internal Medicine Mnemonics

Pancytopaenia differential
"All Of My Blood Has Taken Some Poison":
Aplastic anaemias
Overwhelming sepsis
Megaloblastic anaemias
Bone marrow infiltration
Hypersplenism
TB
SLE
Paroxysmal nocturnal haemoglobinuria


Haematology: key numbers
3 and 4 are key in in haematology:
1.34 cm3 of oxygen is carried by a gram of hemoglobin.
There's 3.4mg of iron in each gram of hemoglobin.
There's an average of 3.4 lobes per neutrophil.
There's 34mg bilirubin from each gram of hemoglobin.


Back trouble causes
O, VERSALIUS (Versalius was the name of a famous physician):
Osteomyelitis
Vertebral fracture
Extraspinal tumour
Spondylolisthesis
Ankylosing spondylitis
Lumbar disk increase
Intraspinal tumor
Unhappiness
Stress


Sports injuries: course of action
RICE:
Rest
Ice
Compression
Elevation
· RICE especially for fractures, sprains, muscle strains, contusions
· Alternatively: I=Immobilization, C=Cold compresses.


Back pain causes
DISK MASS (since near vertebral disc):
Degeneration (DJD, osteoporosis, spondylosis)
Infection (UTI, PID, Pott's disease, osteomyelitis, prostatitis)/ Injury, fracture or compression fracture
Spondylitis (ankylosing spondyloarthropathies such as rheumatoid arthritis, Reiters, SLE)
Kidney (stones, infarction, infection)
Multiple myeloma/ Metastasis (from cancers of breast, kidney, lung, prostate, thyroid)
Abdominal pain (referred to the back)/ Aneurysm
Skin (herpes zoster)/ Strain/ Scoliosis and lordosis
Slipped disk/ Spondylolisthesis


Bronchiectasis: differential
BRONCHIECTASIS:
Bronchial cyst
Repeated gastric acid aspiration
Or due to foreign bodies
Necrotizing pneumonia
Chemical corrosive substances
Hypogammaglobulinemia
Immotile cilia syndrome
Eosinophilia (pulmonary)
Cystic fibrosis
Tuberculosis (primary)
Atopic bronchial asthma
Streptococcal pneumonia
In Young's syndrome
Staphylococcal pneumonia


Sickle cell disease complications
SICKLE:
Strokes/ Swelling of hands and feet/ Spleen problems
Infections/ Infarctions
Crises (painful, sequestration, aplastic)/ Cholelithiasis/ Chest syndrome/ Chronic hemolysis/ Cardiac problems
Kidney disease
Liver disease/ Lung problems
Erection (priapism)/ Eye problems (retinopathy)


ADP: role in platelet aggregation
ADP = Aggregation from the Dense bodies of Platelets.


Gynecomastia: common causes
GYNECOMASTIA:
Genetic Gender disorder (Klinefelter)
Young boy (pubertal)*
Neonate*
Estrogen
Cirrhosis/ Cimetidine/ Ca Channel blockers
Old age*
Marijuana
Alcoholism
Spironolactone
Tumors (Testicular & adrenal)
Isoniazid/ Inhibition of testosterone
Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)
· * Asterisk indicates physiologic cause.



Lethargy, malaise causes
FATIGUED:
Fat/ Food (poor diet)
Anemia
Tumor
Infection (HIV, endocarditis)
General joint or liver disease
Uremia
Endocrine (Addison's, myxedema)
Diabetes/ Depression/ Drugs
Microbiology Mnemonics



Hepatitis: transmission routes
"Vowels are bowels":
Hepatitis A and E transmitted by fecal-oral route.



RNA viruses: negative stranded
"Always Bring Polymerase Or Fail Replication":
Arena
Bunya
Paramyxo
Orthomyxo
Filo
Rhabdo
· Note: Negative RNA viruses need there own polymerase.



RNA viruses: negative stranded
"Orthodox Rhabbi's Party Around Fine Bunnies":
Orthomyxo
Rhabdo
Paramyxo
Arena
Filo
Bunya


Endocarditis: indications for surgery
PUS RIVER:
Prosthetic valve endocarditis (most cases)
Uncontrolled infection
Supporative local complications with conduction abnormalities
Resection of mycotic aneurysm
Ineffective antimicrobial therapy (eg Vs fungi)
Valvular damage (significant)
Embolization (repeated systemic)
Refractory congestive heart failure



Teratogens: placenta-crossing organisms
ToRCHeS:
Toxoplasma
Rubella
CMV
Herpes simplex, Herpes zoster (varicella), Hepatitis B,C,E
Syphilis
· Alternatively: TORCHES: with Others (parvo, listeria), add HIV to H's, Enteroviruses.


Streptococcus pyogenes: diseases caused
NIPPLES:
Necrotising fasciitis and myositis
Impetigo
Pharyngitis
Pneumonia
Lymphangitis
Erysipelas and cellulitis
Scarlet fever/ Streptococcal TSS



Endotoxin features
ENDOTOXIN:
Endothelial cells/ Edema
Negative (gram- bacteria)
DIC/ Death
Outer membrane
TNF
O-antigen
X-tremely heat stable
IL-1
Nitric oxide/ Neutrophil chemotaxis



Acute post-streptococcal glomerulonephritis: classic presentation
"Sore throat, Face bloat, Pi$$ coke":
Sore throat: 1 week ago
Face bloat: facial edema
Pi$$ coke: coke-coloured urine
· Alternatively, short version: "Throat, bloat and coke".


Staphylococcus aureus: diseases caused
SOFT PAINS:
Skin infections
Osteomyelitis
Food poisoning
Toxic shock syndrome
Pneumonia
Acute endocarditis
Infective arthritis
Necrotizing fasciitis
Sepsis



Picornavirus: features
PICORNAvirus:
Positive sense
ICOsahedral
RNA virus


AIDS pathogens (T-cell suppression) worth knowing
"The Major Pathogens Concerning Complete T-Cell Collapse":
Toxoplasma gondii
M. avium intracellulare
Pneumocystis carinii
Candida albicans
Cryptococcus neoformans
Tuberculosis
CMV
Cryptosporidium parvum


Gram+: bacterial cell wall
· Gram+ has:
+hick pepidoglycan layer.
+eichoic acid in wall.



Streptococci: classification by hemolytic ability
Gamma: Garbage (no hemolytic activity).
Alpha: Almost (almost lyse, but incomplete).
Beta: Best (complete lysis).



Syphilis vs. H. ducreyi (chancroid): which ulcer is painful
"In du-crey-i, you do cry (because it is painful)":
In H. ducreyi, the ulcer is painful, in syphilis the ulcer is painless.



Influenza infection: clinical manifestations
"Having Flu Symptoms Can Make Moaning Children A Nightmare":
Headache
Fever
Sore throat
Chills
Myalgias
Malaise
Cough
Anorexia
Nasal congestion


IgA protease-producing bacteria
"Nice Strip of Ham":
Neisseria
Streptococcus pneumonia
Haemophilus influenza


Catalase positive organims
SPACE:
Staphylococcus aureus
Pseudomonas
Aspergillus
Candida
Enterobacter



Neisseria: fermentation of N. gonorrhoeae vs. N. meningitidis
Gonorrhoeae: Glucose fermenter only.
MeninGitidis: Maltose and Glucose fermenter.
· Maltose fermentation is a useful property to know, since it's the classic test to distinguish the Neisseria types.



UTI-causing microorganisms
KEEPS:
Klebsiella
Enterococcus faecalis/ Enterobacter cloacae
E. coli
Pseudomonas aeroginosa/ Proteus mirabilis
Staphylococcus saprophyticcus/ Serratia marcescens



E. coli: diseases caused in presence of virulence factors
DUNG:
Diarrhea
UTI
Neonatal meningitis
Gram negative sepsis
· Dung, since contract E. coli from dung-contaminated water.

Hepatitis: oral-fecal transmitted types
"A$$ Eaters":
· Types A and E by oral-fecal route.



E. coli: major subtypes, key point of each
"HIT by E. coli outbreak":
EnteroHemorrhagic:
· HUS from Hamburgers
EnteroInvasive:
· Immune-mediated Inflammation
EnteroToxigenic:
· Traveller's diarrhea




Meningitis: risk factors
"Can Induce Severe Attacks Of Head PAINS":
Cancer
Immunocompromised state
Sinusitis
Age extremes
Otitis
Head trauma
Parameningeal infection
Alcoholism
Infections (systemic, esp. respiratory)
Neurosurgical procedures
Splenectomy



Streptococcus pyogenes: virulence factors
SMASHED:
Streptolysins
M protein
Anti-C5a peptidase
Streptokinase
Hyaluronidase
Exotoxin
DNAses


Capsulated bacteria
"Some Bacteria Have An Effective Paste Surrounding Membrane Yielding Pseudo Fort, Bypassing Killing":
Strep pneumonia
Bacteroides
H. influenza
Anthrax (B. anthracis)
E. coli
Pasteurella
Salmonella
Menigitidis (N. Menigitidis)
Yersinia pestis
Pseudomonas
Francisella
Brucella
Klebsiella



DNA viruses: morphology rule of thumb
DNA:
Double-stranded
Nuclear replication
'Anhedral symmetry
· Rule breakers: pox (cytoplasmic), parvo (single-stranded).



Obligate anaerobes: members worth knowing
ABC:
Actinomyces
Bacteroides
Clostridium


Urease positive organisms
PUNCH:
Proteus (leads to alkaline urine)
Ureaplasma (renal calculi)
Nocardia
Cryptoccocus (the fungus)
Helicobacter pylori


Food poisoning: bugs inducing
"Eating Contaminated Stuff Causes Very Big Smelly Vomit":
E. coli O157-H7 [undercooked meat, esp. hamburgers]
Clostridium botulinum [canned foods]
Salmonella [poultry, meat, eggs]
Vibrio parahaemolyticus [seafood]
Bacillus cereus [reheated rice]
Staphylococcus aureus [meats, mayo, custard]
Clostridium perfringens [reheated meat]
Vibrio vulnificus [seafood]


Listeria: motility
Istanbul sounds like Listambul = list + tumble.
Listeria has tumbling motility.



RNA enveloped viruses
FORT ABC, Puerto Rico:
Flavivirus/ Filo
Orthomyxo
Retro
Toga
Arena
Bunya
Corona
Paramyxo
Rhabdo



Tetanus: treatment for infection
SAD RAT:
Sedation
Antitoxin
Debridement
Relaxant
Antibiotic
Tracheostomy



Trichomaniasis: features
· 5 F's:
Flagella
Frothy discharge
Fishy odor (sometimes)
Fornication (STD)
Flagyl (metronidazole) Rx



Endocarditis: causes of culture negative endocarditis
"With Negative Tests, Investigators Should Focus Attention Somewhere Meaningful":
Wrong diagnosis
Noninfectious endocarditis
Timing (cultures drawn at end of chronic course)
obligate Intracellular organisms
Slow growing fastidious organisms
Fungal infection
Antibiotic used previously
Subacute right-sided endocarditis
Mural endocarditis



Streptococcus pneumoniae: diseases caused
COMPS:
Conjunctivitis
Otitis media
Meningitis
Pneumonia
Sinusitis
Neurology Mnemonics


Neurofibromatosis: diagnositic criteria (type-1)
CAFE SPOT:
Cafe-au-lait spots
Axillary, inguinal freckling
Fibroma
Eye: lisch nodules
Skeletal (bowing leg, etc)
Pedigree/ Positive family history
Optic Tumor (glioma)


Ramsay-Hunt syndrome: cause and common feature
"Ramsay Hunt":
· Etiology:
Reactivated
Herpes zoster
· Complication:
Reduced
Hearing


Neurofibromatosis: diagnostic criteria
ROLANDO:
Relative (1st degree)
Osseous fibromas
Lisch nodules in eyes
Axillary freckling
Neurofibromas
Dime size cafe au lait spots
Optic gliomas


Peripheral nervous examination
"Tall People Run-over Small Children":
Tone
Power
Reflexes
Sensation
Co-ordination/ Clonus


Peripheral neuropathy: differential
STAGLAND:
Sarcoid
Thyroid
Amyloid
Guillian-Barre
Lead
Alcohol
Nutritional
Drugs/ Diabetes


Head trauma: rapid neuro exam
· 12 P's:
Psychological (mental) status
Pupils: size, symmetry, reaction
Paired ocular movememts
Papilloedema
Pressure (BP, increased ICP)
Pulse and rate
Paralysis, Paresis
Pyramidal signs
Pin prick sensory response
Pee (incontinent)
Patellar relex (and others)
Ptosis
· Reevaluate patient every 8 hrs.


Perinaud's syndrome: clinical features
PERINAUD'S:
Pseudo 6th nerve palsy/ Penial region
Eyelid Retraction
Internuclear ophthalmoplegia
Nystagmus
Accomodation reflex present
Upward gaze palsy
Defective convergence/ Decerebrate rigidity
Skew deviation


Alzheimer's disease: progressive phases
ABCD:
Amnesic phase (forgetting keys, leaving cooker on)
Behavioural problems (antisocial, wandering)
Cortical phase (incontinence, falls)
Decerebrate phase (return of primitive reflexes)


Vertigo: differential
VOMITS:
Vestibulitis
Ototoxic drugs
Meniere's disease
Injury
Tumor
Spin (benign positional vertigo)


Huntington's: chromosome, involvement
HUNT 4 DATE:
HUNTington's on chromosome 4, with cauDATE nucleus involvement.



Peripheral neuropathies: differential
DANG THERAPIST:
Diabetes
Amyloid
Nutritional (eg B12 deficiency)
Guillain-Barre
Toxic (eg amiodarone)
Heriditary
Endocrine
Recurring (10% of G-B) Alcohol
Pb (lead)
Idiopathic
Sarcoid
Thyroid


Proximal myopathy: differential
PEACH PODS:
Polymyositis
Endocrine: hyper, hypothyroidism, Cushing's syndrome, acromegaly
Alcohol
Carcinoma
HIV infection
Periodic hypokalemic paralysis
Osteomalacia
Drugs: steroids, statins
Sarcoidosis


Pupillary dilatation (persistent): causes
3AM:
3rd nerve palsy
Anti-muscarinic eye drops (eg to facilitate fundoscopy)
Myotonic pupil (Holmes Adie pupil): most commonly in young women, with absent/delayed reaction to light and convergence, and of no pathological significance


Dementia: treatable causes
DEMENTIA:
Drug toxicity
Emotional (depression, anxiety, OCD, etc.)
Metabolic (electrolytes, liver dz, kidney dz, COPD)
Eyes/ Ears (peripheral sensory restrictions)
Nutrition (vitamin, iron deficiencies/ NPH [Normal Pressure Hydrocephalus]
Tumors/ Trauma (including chronic subdural hematoma)
Infection (meningitis, encephalitis, pneumonia, syphilis)
Arteriosclerosis and other vascular disease


Cerebellar signs
PINARD'S:
Past pointing
Intention tremor
Nystagmus
Ataxia
Rebound
Dysdiadokinesia
Slurred speech
[Note: If you haven't done Obs yet, a Pinard's is for listening to a baby's heart on mother's abdomen]


Status epilepticus: treatment
"Thank Goodness All Cerebral Bursts Dissipate":
Thiamine
Glucose
Ativan
Cerebyx
Barbiturate
Diprivan


Balint's syndrome
SOOT:
Simultagnosia
Optic ataxia
Ocular apraxia
Tunnel vision


Chorea: common causes
St. VITUS'S DANCE:
Sydenhams
Vascular
Increased RBC's (polycythemia)
Toxins: CO, Mg, Hg
Uremia
SLE
Senile chorea
Drugs
APLA syndrome
Neurodegenerative conditions: HD, neuroacanthocytosis, DRPLA
Conception related: pregnancy, OCP's
Endocrine: hyperthyroidism, hypo-, hyperglycemia


Multiple sclerosis: signs and symptoms
INSULAR:
Intention tremor
Nystagmus
Slurred speech
Uthoff's phenomenon
Lhermitte's sign
Ataxia
Rebound


Dementia: some common causes
DEMENTIA:
Diabetes
Ethanol
Medication
Environmental (eg CO poisoning)
Nutritional
Trauma
Infection
Alzheimer's



Conscious change: causes
AEIOU TIPS:
Alcohol
Encephalopathy
Infection
Opioid
Uremia
Trauma
Insulin
Psychosis
Syncope


Pin-point pupil causes
Pin-Point Pupils are due to oPioids and Pontine Pathology


Whipple's disease: features [for neurologists]
A WHIPPLES DOOM:
Arthralgias
Whipplei (organism)
Hypothalamic involvement
Intestinal involvement/ Intestinal biopsy required
PAS positive macrophages
PCR positivity
Lymphadenopathy
Extrapyramidal involvement
Septran treat with
Dementia
Ocular abnormalities (vertical gaze palsy)
Oculomasticatory myorhythmia
Myoclonus


Stroke risk factors
HEADS:
Hypertension/ Hyperlipidemia
Elderly
Atrial fib
Diabetes mellitus/ Drugs (cocaine)
Smoking/ Sex (male)


Babinski and LMN signs: conditions exhibiting them
"D MASTS":
Diabetes
Motor neuron disease
Ataxia (friedrichs)
Subacute combined degeneration of cord
Tabo paresis
Syringobulbia

Visual loss: persistent bilateral sudden onset visual loss differential
FLOP:
Functional
Leber's hereditary neuropathy
Occipital infarctions
Pituitary apoplexy


Battle sign
BattlE:
Behind Ear


Neuropathy: diagnosis confirmation
NEuropathy:
Nerve conduction velocity
Electromyography


Ocular bobbing vs. dipping
"Breakfast is fast, Dinner is slow, both go down":
Bobbing is fast.
Dipping is slow.
In both, the initial movement is down.


Dementia: reversible dementia causes
DEMENTIA:
Drugs/ Depression
Elderly
Multi-infarct/ Medication
Environmental
Nutritional
Toxins
Ischemia
Alcohol



Hydrocephalus: Normal pressure hydrocephalus DDx
3 W's:
Wet: urinary incontinence
Wobbly: gait abnormality
Wacky: dementia, memory problems


Stroke: basic work up
The 3 P's:
Pump
Pipes
Plasma


Multiple sclerosis (MS): epidemiology
MS is a feminine title (Ms.) and is female predominant.


Encephalitis: differential
HE'S LATIN AMERICAN:
Herpesviridae
Enteroviridae (esp. Polio)
Slow viruses (esp. JC, prions)
Syphilis
Legionella/ Lyme disease/ Lymphocytic meningoencephalitis
Aspergillus
Toxoplasmosis
Intracranial pressure
Neisseria meningitidis
Arboviridae
Measles/ Mumps/ Mycobacterium tuberculosis/ Mucor
E. coli
Rabies/ Rubella
Idiopathic
Cryptococcus/ Candida
Abscess
Neoplasm/ Neurocysticercosis
· Neurocysticercosis should be assumed with recent Latin American immigrant patient unless proven otherwise.


Stroke: young patient's likely causes
7 C's:
Cocaine
Consanguinity [familial such as neurofibromatosis and von Hippel-Lindau]
Cancer
Cardiogenic embol
hyperCoagulation
CNS infection [eg: HIV conditions]
Congenital arterial lesion


Benidict's syndrome: site affected
Benidict's test for sugar gives red precipitate.
Similarly, Benidict's syndrome affects red nucleus.


Decreased level of consciousness: metabolic causes
METABOLIC:
Major end organs (liver, kidney)
Endocrine/ Electrolytes
Toxins
Acid
Base disorders
Oxygenation
Lung (PE, pneumonia)
Infection/ Inflammatory/ Iatrogenic
Calcium


Congenital myopathy: features
DREAMS:
Dominantly inherited, mostly
Reflexes decreased
Enzymes normal
Apathetic floppy baby
Milestones delayed
Skeletal abnormalities
Obstetrics and Gynecology - Mnemonics

Female pelvis: shapes
GAP:
· In order from most to least common:
Gynecoid
Android /Anthropoid
Platypelloid


Oral contraceptives: side effects
CONTRACEPTIVES:
Cholestatic jaundice
Oedema (corneal)
Nasal congestion
Thyroid dysfunction
Raised BP
Acne/ Alopecia/ Anaemia
Cerebrovascular disease
Elevated blood sugar
Porphyria/ Pigmentation/ Pancreatitis
Thromboembolism
Intracranial hypertension
Vomiting (progesterone only)
Erythema nodosum/ Extrapyramidal effects
Sensitivity to light


Post-partum haemorrhage (PPH): causes
4 'T's:
Tissue (retained placenta)
Tone (uterine atony)
Trauma (traumatic delivery, episiotomy)
Thrombin (coagulation disorders, DIC)


Forceps: indications for use
FORCEPS:
Fully dilated cervix
0 ["Zero"] CPD
Ruptured membranes
Cephalic or at least deliverable presentation/ Contracting uterus
Episiotomy done/ Epidural done
P!ss and S#!t (bladder and bowel empty)


Post-partum examination simplified checklist
BUBBLES:
Breast
Uterus
Bowel
Bladder
Lochia
Episotomy
Surgical site (for Cesarean section)


Miscarriage: recurrent miscarriage causes
RIBCAGE:
Radiation
Immune reaction
Bugs (infection)
Cervical incompetence
Anatomical anomaly (uterine septum etc.)
Genetic (aneuploidy, balanced translocation etc.)
Endocrine


Alpha-fetoprotein: causes for increased maternal serum AFP during pregnancy
"Increased Maternal Serum Alpha Feto Protein":
Intestinal obstruction
Multiple gestation/ Miscalculation of gestational age/ Myeloschisis
Spina bifida cystica
Anencephaly/ Abdominal wall defect
Fetal death
Placental abruption


Gestation period, oocytes, vaginal pH, menstrual cycle: normal numbers
4 is the normal pH of the vagina.
40 weeks is the normal gestation period.
400 oocytes released between menarche and menopause.
400,000 oocytes present at puberty.
28 days in a normal menstrual cycle.
280 days (from last normal menstrual period) in a normal gestation period.

Oral contraceptive complications: warning signs
ACHES:
Abdominal pain
Chest pain
Headache (severe)
Eye (blurred vision)
Sharp leg pain


CVS and amniocentesis: when performed
"Chorionic" has 9 letters and Chorionic villus sampling performed at 9 weeks gestation.
"AlphaFetoProtein" has 16 letters and it's measured at 16 weeks gestation.



Prenatal care questions
ABCDE:
Amniotic fluid leakage?
Bleeding vaginally?
Contractions?
Dysuria?
Edema?
Fetal movement?


Asherman syndrome features
ASHERMAN:
Acquired Anomaly
Secondary to Surgery
Hysterosalpingography confirms diagnosis
Endometrial damage/ Eugonadotropic
Repeated uterine trauma
Missed Menses
Adhesions
Normal estrogen and progesterone


Abdominal pain: causes during pregnancy
LARA CROFT:
Labour
Abruption of placenta
Rupture (eg. ectopic/ uterus)
Abortion
Cholestasis
Rectus sheath haematoma
Ovarian tumour
Fibroids
Torsion of uterus


Preeclampsia: classic triad
PREeclampsia:
Proteinuria
Rising blood pressure
Edema

Parity abbreviations (ie: G 3, P 2012)
"To Peace And Love":
T: of Term pregnancies
P: of Premature births
A: of Abortions (spontaneous or elective)
L: of Live births
· Describes the outcomes of the total number of pregnancies (Gravida).


Forceps: indications for delivery
FORCEPS:
Foetus alive
Os dilated
Ruptured membrane
Cervix taken up
Engagement of head
Presentation suitable
Sagittal suture in AP diameter of inlet


Fetus: cardinal movements of fetus
"Don't Forget I Enjoy Really Expensive Equipment":
Descent
Flexion
Interal rotation
Extension
Restitution
External rotation
Expulsion


Pelvic Inflammatory Disease (PID): complications
I FACE PID:
Infertility
Fitz-Hugh-Curitis syndrome
Abscesses
Chronic pelvic pain
Ectopic pregnancy
Peritonitis
Intestinal obstruction
Disseminated: sepsis, endocarditis, arthritis, meninigitis


APGAR score components
SHIRT:
Skin color: blue or pink
Heart rate: below 100 or over 100
Irritability (response to stimulation): none, grimace or cry
Respirations: irregular or good
Tone (muscle): some flexion or active


Vaginal pH
Vagina has 4 labia and normal pH of vagina is about 4.



Early cord clamping: indications
RAPID CS:
Rh incompatibility
Asphyxia
Premature delivery
Infections
Diabetic mother
CS (caesarian section) previously, so the funda is RAPID CS


IUGR: causes
IUGR:
Inherited: chromosomal and genetic disorders
Uterus: placental insufficency
General: maternal malnutrition, smoking
Rubella and other congenital infecton


Postpartum collapse: causes
HEPARINS:
Hemorrhage
Eclampsia
Pulmonary embolism
Amniotic fluid embolism
Regional anaethetic complications
Infarction (MI)
Neurogenic shock
Septic shock


Delivery: instrumental delivery prerequisites
AABBCCDDEE:
Analgesia
Antisepsis
Bowel empty
Bladder empty
Cephalic presentation
Consent
Dilated cervix
Disproportion (no CPD)
Engaged
Episiotomy


Pelvic Inflammatory Disease (PID): causes, effects
"PID CAN be EPIC":
· Causes:
Chlamydia trachomatis
Actinomycetes
Neisseria gonorrhoeae
· Effects:
Ectopic
Pregnancy
Infertility
Chronic pain


Shoulder dystocia: management
HELPER:
Call for Help
Episiotomy
Legs up [McRoberts position]
Pressure subrapubically [not on fundus]
Enter vagina for shoulder rotation
Reach for posterior shoulder and deliver posterior shoulder/ Return head into vagina [Zavanelli maneuver] for C-section/ Rupture clavicle or pubic symphisis


Secondary amenorrhea: causes
SOAP:
Stress
OCP
Anorexia
Pregnancy


RLQ pain: brief female differential
AEIOU:
Appendicitis/ Abscess
Ectopic pregnancy/ Endometriosis
Inflammatory disease (pelvic)/ IBD
Ovarian cyst (rupture, torsion)
Uteric colic/ Urinary stones


Multiple pregnancy complications
HI, PAPA:
Hydramnios (Poly)
IUGR
Preterm labour
Antepartum haemorrhage
Pre-eclampsia
Abortion


Ovarian cancer: risk factors
"Blue FILM":
Breast cancer
Family history
Infertility
Low parity
Mumps



Omental caking: likeliest cause
Omental CAking = Ovarian CA
· "Omental caking" is term for ascities, plus a fixed upper abdominal and pelvic mass. Almost always signifies ovarian cancer.


Spontaneous abortion: definition
"Spontaneous abortion" has less than 20 letters [it's exactly 19 letters].
Spontaneous abortion is defined as delivery or loss of products of conception at less than 20 weeks gestation.


Dysfunctional uterine bleeding (DUB): 3 major causes
DUB:
Don't ovulate (anovulation: 90% of cases)
Unusual corpus leuteum activity (prolonged or insufficient)
Birth control pills (since increases progesterone-estrogen ratio)


Post-partum haemmorrage (PPH): risk factors
PARTUM:
Polyhydroamnios/ Prolonged labour/ Previous cesarian
APH/ ANTH
Recent bleeding history
Twins
Uterine fibroids
Multiparity



Labour: preterm labor causes
DISEASE:
Dehydration
Infection
Sex
Exercise (strenuous)
Activities
Stress
Environmental factor (job, etc)

Alpha-fetoprotein: some major causes for increased maternal serum AFP during pregnancy
TOLD:
Testicular tumours
Obituary (fetal death)
Liver: hepatomas
Defects (neural tube defects)


IUD: side effects
PAINS:
Period that is late
Abdominal cramps
Increase in body temperature
Noticeable vaginal discharge
Spotting


Polycystic Ovarian Syndrome (PCOS): first line treatment
Treat PCOS with OCP's (oral contraceptive pills).


Sexual response cycle
EXPLORE:
EXcitement
PLateau
Orgasmic
REsolution


B-agonist tocolytic (C/I or warning)
ABCDE:
Angina (Heart disease)
BP high
Chorioamnionitis
Diabetes
Excessive bleeding
Ophthalmology Mnemonics

Corneal stromal dystrophies
"Marilyn Monroe Gets High in LA":
Macular: Mucopolysaccharide
Granular: Hyaline
Lattice: Amyloid


Optic atrophy causes
ICING:
Ischaemia
Compressed nerve
Intracranial pressure [raised]
Neuritis history
Glaucoma


Choroidal neovascular membrane
HAMMAR:
Histoplasmosis
ARMD
Multifocal Choroiditis
Myopia
Angiod
Rupture of the choroid

Nasopharyngeal cancer: classic symptoms
NOSE:
Neck mass
Obstructed nasal passage
Serous otitis media externa
Epistaxis and discharge


Diplopia (uniocular): causes
ABCD:
Astigmatism
Behavioral: psychogenic
Cataract
Dislocated lens


Anopsia: quarantic anopsia: location of lesion
Upper: Top: Temporal lesions.
Lower: Pits: Parietal lesions.


Cataracts: causes
CATARAct:
Congenital
Aging
Toxicity (steroids, etc)
Accidents
Radiation
Abnormal metabolism (diabetes mellitus, Wilson's)


Red eye causes
GO SUCK:
Glaucoma
Orbital disease
Scleritis
Uveitis
Conjunctivitis
Keratitis


Cataracts: causes
ABCDE:
Aging
Bang: trauma, other injuries (eg infrared)
Congenital
Diabetes and other metabolic disturbances (eg steroids)
Eye diseases: glaucoma, uveitis


Cataracts: differential
CATARAct:
Congenital
Aging
Toxicity (steroids, etc)
Accidents
Radiation
Abnormal metabolism (DM, Wilsons, etc)
Orthopedics Mnemonics

Carpal (Wrist) Bones
"Scared Lovers Try Positions That They Can't Handle." Starting from the thumb, the eight carpal bones are Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, and Hamate. To tell the three T's apart... triquetrum has "tri/try" in it, and trapezium and trapezoid are in alphabetical order.
CARPenters use their hands. The CARPAL bones are of the hand, and not the foot.

Cranial Bones
Annoying, aren't they? The cranial bones are the PEST OF 6...
P
E
S
T
O
F


Parietal
Ethmoid
Sphenoid
Temporal
Occipital
Frontal
the six? the number of bones!


Try this one as well: Old People From Texas Eat Spiders.


Cranial Sutures
Sutures have CLASS...
C
L
A
S
S
Coronal
Lambdoid
and
Squamous
Sagittal


Facial Bones
"Con Man Max and Pal Ziggy Lack Nasty Voices". Not the most intuitive acrostic in the world, but it works...
Con
Man
Max
Pal
Ziggy
Lack
Nasty
Voices
Conchae
Mandible
Maxilla
Palatine
Zygomatic
Lacrimal
Nasal
Vomer


Fontanels (Infant Skull)
A baby's first words might be "PAPA!"...
P
A
P
A
Posterior
Anterior
Posterio-Lateral
Anterio-Lateral

Fractures
Star Wars fans (hi, Inderpal!) use "Go C3PO" to recall the seven types of bone fractures...
G
O
C
C
C
P
O
Greenstick
Open
Complete
Closed
Comminuted
Partial
Other


Lower Leg Bones
Can't tell your tib from your fib? The TIBia is the Thick, Inner Bone. The FibuLa is Finer, Fluted, and Lateral.

Orbital Bones
This one's a bit silly. It relies on the belief that a species called the FLEZMS are in ORBITaround the earth.
F
L
E
Z
M
S
Frontal
Lacrimal
Ethmoid
Zygomatic
Maxilla
Sphenoid

Branches of the facial nerve
Two Zulu's Bruised My Cervix
This one is used to remember the branches of the facial nerve...a (Sent to me by axe@iinet.net.au)

T emporal nerve
Z ygomatic nerve
B uccal nerve
M arginal mandibular nerve
C ervical nerve

To Zanzibar By Motorcar

Fracture: how to describe
PLASTER OF PARIS:
Plane
Location
Articular cartilage involvement
Simple or comminuted
Type (eg Colles')
Extent
Reason
Open or closed
Foreign bodies
disPlacement
Angulation
Rotation
Impaction
Shortening


Salter Harris fracture classification
Salter Harris, modified to SALTR:
type 1: Slipped epiphysis
type 2: Above the eiphyseal plate
type 3: Lower than the eiphyseal plate
type 4: Through both above and below eiphyseal plate
type 5: Raised epiphysis, as in a compression injury
· Salter Harris classification utilises visualising long bone distal portion with diaphysis superiorly placed and epiphysis inferiorly placed.



Pagets disease of bone: signs and symptoms
PANICS:
Pain
Arthralgia
Nerve compression / Neural deafness
Increased bone density
Cardiac failure
Skull / Sclerotic vertebrae



Osteosarcoma: risk factors
PRIMARY:
Paget's
Radiation
Infaction of bone
Male
Alcohol, poor diet, sedentary lifestyle [adults only]
Retinoblastoma, Li-Fraumeni syndrome
Young [10-20 yrs]
· Osteosarcoma is the most common primary malignant tumor of bone.



Fractures: principles of management
FRIAR:
First aid
Reduction
Immobilisation
Active Rehabilitation



Bryant's traction: position
BrYant's traction:
Bent Y.
· Patient's body is the stem of the Y laying on the bed, and legs are the ends of the Y up in the air.



Monoarthritis differential
GHOST:
Gout
Haemarthrosis
Osteoarthritis
Sepsis
Trauma



Sacroiliitis: causes
PUB CAR:
Psoriasis
Ulcerative colitis
Behcet's disease
Crohn's disease
Ankylosing spondylitis
Reiter's disease



Carpal tunnel syndrome: treatment
WRIST:
Wear splints at night
Rest
Inject steroid
Surgical decompression
Take diuretics



Forearm fractures: bone in Monteggia vs. Galeazzi
Monteggia is fracture of ulna.
Therefore, Galeazzi is fracture of radius.



Bone fracture types [for Star Wars fans]
GO C3PO:
Greenstick
Open
Complete/ Closed/ Comminuted
Partial
Others
· Note: C3P0 is droid in the Star-Wars movies.



Fracture: describing (short version)
DOCTOR:
Displaced vs. non-displaced
Open vs. closed
Complete vs. incomplete
Transverse fracture vs. linear fracture
Open Reduction vs. closed reduction



Congenital talipes equinovarus (CTEV, clubfoot): major physical findings
CAVE:
Cavus
Adduction
Varus
Equinus


Fracture: description
BLT LARD:
Bone
Location on bone
Type of fracture
Lengthening
Angulation
Rotation
Displacement



Nonunion of bones: differential
You need a SPLINT:
Soft tissue interposition
Position of reduction (too much traction, immobilization, or movement)
Location (eg. lower third of tibia slow to heal)
Infection
Nutritional (damaged vessels or diseased bone)
Tumor (pathological fracture)



Joints classification, by amount of allowed movement at joint
SAD:
Synarthroses
Amphiarthroses
Diarthroses



Forearm: fractures
"Break the forearm of the MUGR (mugger)":
Monteggia=Ulna
Galeazzi=Radius
Pathology Mnemonics

Oral cancer risks
PATH LAB:
Plummer-vinson syndrome
Alcohol
Tobacco
Human papilloma virus
Leukoplakia
Asbestos
Bad oral hygiene


Wernickes encephalopathy: components
WACO:
· Wernickes is:
Ataxia
Confusion (or clouded consciousness)
Ocular problems
· Note: Waco is the town in Texas, USA made famous for a standoff with a David Koresh and the Branch Davidians.


TTP: clinical features
Thrombosis and thrombocytopenia PARTNER together:
Platelet count low
Anemia (microangiopathic hemolytic)
Renal failure
Temperature rise
Neurological deficits
ER admission (as it is an emergency)



Edwards' syndrome: characteristics
EDWARDS:
Eighteen (trisomy)
Digit overlapping flexion
Wide head
Absent intellect (mentally retarded)
Rocker-bottom feet
Diseased heart
Small lower jaw


Achalasia: 1 possible cause, 1 treatment
aCHAlasia:
1 possible cause: CHAgas' disease
1 treatment: Ca++ CHAnnel blockers


COPD: blue bloater vs. pink puffer diseases
emPhysema has letter P (and not B) so Pink Puffer.
chronic Bronchitis has letter B (and not P) so Blue Bloater.



Duchenne vs. Becker Muscular Dystrophy
Duchenne Muscular Dystrophy (DMD) : Doesn't Make Dystrophin.
Becker Muscular Dystrophy (BMD): Badly Made Dystrophin (a truncated protein).


Ovarian cancers: important types, by WHO classification
· Surface:
"My Sister Began Experiencing Cancer":
Mucinous
Serous
Brenner
Endometrioid
Clear
· Germ cell:
"Doctor Examined The Ovaries":
Dysgerminoma
Endometrial sinus
Teratoma
Ovarian choriocarcinoma
· Sex cord:
"She Felt Grim":
Sertoli-Leydig
Fibroma
Granulosa-theca
· Metastatic
"Killed":
Krukenberg


Alzheimer's disease: features
RONALD (Ronald Reagan, a famous victim):
Reduction of Ach
Old age
Neurofibrillary tangles
Atrophy of cerebral cortex (diffuse)
Language impairment
Dementia (MC in elderly)/ Down's syndrome



Dandy-Walker syndrome: components
"Dandy Walker Syndrome":
Dilated 4th ventricle
Water on the brain
Small vermis



Pericarditis: findings
PERICarditis:
Pulsus paradoxus
ECG changes
Rub
Increased JVP
Chest pain [worse on inspiration, better when lean forward]


Histiocytosis X: hallmark finding
"Birbeck's rackets is X":
Tennis rackets under electron microscope is Histiocystosis X.
Consider 2 tennis rackets in an X formation.


MI: post-MI complications
ACT RAPID:
Arrhythmias (SVT, VT, VF)
Congestive cardiac failure
Tamponade/ Thromboembolic disorders
Rupture (ventricle, septum, papillary muscle)
Aneurysm (ventricle)
Pericarditis
Infaction (a second one)
Death/ Dressler's syndrome



Hemolytic anemia types
SHEEP T!T:
Sickle cell
Heriditary splenocytosis
Enzyme deficiencies: [G6P, pyruvate kinase]
Erythroblastosis fetalis
Paroxysmal nocturnal hemoglobinuria
Trauma to RBCs
Immunohemolytics: [warm Ab, cold Ag]
Thalassemias: [alpha, beta]


Thrombotic thrombocytopenic purpura: signs
FAT RN:
Fever
Anemia
Thrombocytopenia
Renal problems
Neurologic dysfunction


Pancreatitis: causes
BAD S#!T:
Biliary: gallstones, 1% of ERCP patients
Alcoholism/ Azotemia
Drugs
Scorpion bite/ Sea anenome/ SLE
Hyperlipidemia/ Hypercalcemia
Idiopathic/ Infectious (mumps, coxsackie, salmonella, ascariasis)
Tumor/ Trauma
· The drugs are: penacillamine, furosemide, thiazides, ethacrynic acid, steroids, sulfas, ace inhibitors, N-SAIDs, erythromycin, estrogen.



Portal hypertension: features
ABCDE:
Ascites
Bleeding (haematemesis, piles)
Caput medusae
Diminished liver
Enlarged spleen



Gout: major features
GOUT:
Great toe
One joint (75% monoarticular)
Uric acid increased (hence urolithiasis)
Tophi


APKD: signs, complications, accelerators
11 B's:
· Signs:
Bloody urine
Bilateral pain [vs. stones, which are usually unilateral pain]
Blood pressure up
Bigger kidneys
Bumps palpable
· Complications:
Berry aneurysm
Biliary cysts
Bicuspid valve [prolapse and other problems]
· Accelerators:
Boys
Blacks
Blood pressure high


Cardiovascular risk factors
FLASH BODIES:
Family history
Lipids
Age
Sex
Homocystinaemia
Blood pressure
Obesity
Diabetes mellitus
Inflammation (raised CRP)/ Increased thrombosis
Exercise
Smoking



Pyrogenic meningitis: likeliest bug in age group
"Explaining Hot Neck Stiffness":
· In order from birth to death:
E. coli [infants]
Haemophilus influenzae [older infants, kids]
Neisseria meningitis [young adults]
Streptococcus pneumoniae [old folks]


Multiple endocrine neoplasia III: components
MEN III is a disease of 3 M's:
Medullary thyroid carcinoma
Medulla of adrenal (pheochromocytoma)
Mucosal neuroma


MI: sequence of elevated enzymes after MI
"Time to CALL 911":
· From first to appear to last:
Troponin
CK-MB
AST
LDH1


MEN I (Multiple Endocrine Neoplasia) syndrome: components
"Please Please Pay Attention To peptic ulceration, you worms":
· Adenomas of:
Pituatary
Pancreatic islets
Parathyroid
Adrenal cortex
Thyroid, associated with peptic ulceration
· Syndrome is called "Wermer's syndrome".


Parkinson's disease: symptoms
PQRST:
Paucity of expression
parQinson
Rigidity (cogwheel)
Stooped posture
Tremor at rest
· If can't remember that Parkinson's tremor is the one that is "resting tremor", look at the last 3 letters: RST.


Gout: factors that can precipitate an attack of acute gouty arthritis
DARK:
Diuretics
Alcohol
Renal disease
Kicked (trauma)
· And, the attack occurs most often at night [thus "dark"].


Thyroid carcinoma: frequency
"Please Feel My A$$":
In order of most frequent to least frequent, and in order from least aggressive to most aggressive:
Papillary carcinoma
Follicular carcinoma
Medullary thyroid carcinoma
Anaplastic carcinoma


Bronchial obstruction: consequences
APPLE BABE:
Atelectasis
Pleural adhesions
Pleuritis
Lipid pneumonia
Effusion->organisation->fibrosis
Bronchiectasis
Abscess
Broncho and lobar pneumonia
Emphysema


Pick's disease: location, action, epidemiology
· See figure.
Pick axes are Picking away at the old woman's cerebral cortex, causing cortical atrophy.
2 pick axes on her brain: frontal lobe and anterior 1/3 of temporal.
An old woman, since epidemiology is elderly & more common in women.


Wernicke-Korsakoff's psychosis: findings
COAT RACK:
· Wernicke's encephalopathy (acute phase):
Confusion
Ophthalmoplegia
Ataxia
Thiamine tx.
· Korsakoff's psychosis (chronic phase):
Retrograde amnesia
Anterograde amnesia
Confabulation
Korsakoff's psychosis



Endometrial carcinoma: risk factors
ENDOMET:
Elderly
Nulliparity
Diabetes
Obesity
Menstrual irregularity
Estrogen therapy
hyperTension


Respiratory distress syndrome in infants: major risk factors
PCD (Primary Ciliary Dyskinesia, a cause of Respiratory distress syndrome):
Prematurity
Cesarean section
Diabetic mother


Blood disorders: commoner sex
HE (male) gets:
HEmophilia (X-linked)
HEinz bodies (G6PD deficiency, causing HEmolytic anemia: X-linked)
HEmochromatosis (male predominance)
HEart attacks (male predominance)
HEnoch-Schonlein purpura (male predominance)
SHE (female) gets:
SHEehan's syndrome

Takayasu's disease is Pulseless disease
"Can't Tak'a ya pulse" (Can't take your pulse):
Takayasu's disease known as Pulseless disease, since pulse is weakened in the upper extremities.


Osteomyelitis: complications
FIBRES:
Fractures
Intraosseous (broidie) abscesses
Bacteremi/ Brodie abscess
Reactive amyloidosis
Endocarditis
Sinus tracts/ Squamous cell CA


Nasopharyngeal malignant cancers
NASOPharyngeal:
Nasophayngeal
Adenocarcinoma
Squamous cell carcinoma
Olfactory neuroblastoma
Plasmacytoma


Emphysema: types, most important feature of each
"Cigarettes Is Primary Problem":
· Types:
Centrilobular
Irregular
Pancinar
Paraseptal
· Most important feature for each type (in order as above):
Cigarrettes
Inflammation healed to scar
Protease inhibitor deficiency (a1-antitrypsin)
Pneumothorax
· "Cigarettes is primary problem" used since cigarettes is most common cause of emphysema.
· Keeping P's straight: Pan is antitrypsin.


Baldness risk factors
"Daddy Doesn't Deny Getting Hair Implants":
Diet
Disease
Drugs
Genes
Hormones
Injury to the scalp


Thrombus: possible fates
DOPE:
Dissolution
Organization & repair
Propagation
Embolization


Buerger's disease features
"burger SCRAPS":
Segmenting thrombosing vasculitis
Claudication (intermittent)
Raynaud's phenomenon
Associated with smoking
Pain, even at rest
Superficial nodular phlebitis
· Alternatively, if hungry for more detail [sic], "CRISP PIG burgers":
Chronic ulceration
Raynaud's phenomenon
Intermittent claudication
Segmenting, thrombosing vasculitis
Pain, even at rest
Phlebitis (superficial nodular)
Idiopathic
Gangrene



TB: features
TB is characterised by 4 C's:
Caseation
Calcification
Cavitation
Cicatrization


Kawasaki Disease Criteria
"Be careful when riding a Kawasaki motorcycle, you might get CREAMed.
Conjunctivitis (non-exudative)
Rash (polymorphous non-vesicular)
Edema (or erythema of hands or feet)
Adenopathy (cervical, often unilateral)
Mucosal involvement (erythema or fissures or crusting)
To have Kawasaki disease you must have fever for greater than 5 days plus 4 of the above.


Ulcerative colitis: features
ULCERATIONS:
Ulcers
Large intestine
Carcinoma [risk]
Extraintestinal manifestations
Remnants of old ulcers [pseudopolyps]
Abscesses in crypts
Toxic megacolon [risk]
Inflamed, red, granular mucosa
Originates at rectum
Neutrophil invasion
Stools bloody


Thyroid storm characteristics
"Storm HITS girls cAMP":
Thyroid storm due to:
Hyperthyroidism
Infection or Illness at childbirth
Trauma
Surgery
· girls: Thyroid storm more common in females.
· cAMP: Tx involves high dose of beta blockers (beta receptors work via cAMP)
· Alternatively: "S#IT storm": Surgery, Hyperthyroidism, Infection/ Illness, Trauma.

Thyrotoxicosis syndrome: signs and symptoms
"A Penny For Every Symptom That Hyperthyroidism Will Make Grossly Evident":
Anxiety
Palpitations/ Pulse rapid
Fatigability
Emotional lability
Sweating
Tremor
Heat intolerance
Weight loss with good appetite
Muscular weakness/ Menstrual changes
Goitre
Eye changes


Endometrial carcinoma: risk factors
HONDA:
Hypertension
Obesity
Nulliparity
Diabetes
Age (increased)


Tabes Dorsalis morphology
DORSALIS:
Dorsal column degeneration
Orthopedic pain (Charcot joints)
Reflexes decreased (deep tendon)
Shooting pain
Argyll-Robertson pupils
Locomotor ataxia
Impaired proprioception
Syphilis


Pneumothorax: presentation
P-THORAX:
Pleuretic pain
Trachea deviation
Hyperresonance
Onset sudden
Reduced breath sounds (& dypsnea)
Absent fremitus
X-ray shows collapse


Renal failure (chronic): consequences
ABCDEFG:
Anemia
-due to less EPO
Bone alterations
-osteomalacia
-osteoporosis
-von Recklinghausen
Cardiopulmonary
-atherosclerosis
-CHF
-hypertension
-pericarditis
D vitamin loss
Electrolyte imbalance
-sodium loss/gain
-metabolic acidosis
-hyperkalemia
Feverous infections
-due to leukocyte abnormalities and dialysis hazards
GI disturbances
-haemorrhagic gastritis
-peptic ulcer disease
-intractable hiccups


Carcinomas having tendency to metastasize to bone
"Kinds Of Tumors Leaping Primarily To Bone":
Kidneys
Ovaries
Testes
Lungs
Prostate
Thyroid
Breasts
· Alternatively: "Promptly" instead of "Primarily".
· Alternatively: "BLT2 with a Kosher Pickle".



Haemochromatosis definition, classic triad
"Iron man triathalon":
Iron man: deposition of iron in many body tissues.
· Triathalon has 3 components, which match triad:
Swimming: Skin pigmentation
Biking: Bronze diabetes
Marathon: Micronodular pigment cirrhosis


Wiskott-Aldrich syndrome: symptom triad
"PET WASP":
Pyrogenic infections
Eczema
Thrombocytopenia
· WASP is the name of the causitive agent: Wiskott-Aldrich Syndrome Protein.
· Alternatively: Wiskott=Hot, Aldrich=Itch, Syndrom=Throm.


Pancoast tumor: relationship with Horner's syndrome
"Horner has a MAP of the Coast":
A panCoast tumor is a cancer of the lung apex that compresses the cervical sympathetic plexus, causing Horner's syndrome, which is MAP:
Miosis
Anhidrosis
Ptosis


Gallstones/cholecystitis: risk factors
5 F's:
Fat
Female
Family history
Fertile
Forty



Lou Gehrig's is both upper and lower motor neuron signs
LoU = Lower & Upper.



Nephrotic syndrome: hallmark findings
"Protein LEAC":
Proteinuria
Lipid up
Edema
Albumin down
Cholesterol up
· In nephrotic, the proteins leak out.


Virchow's triad (venous thrombosis)
"VIRchow":
Vascular trauma
Increased coagulability
Reduced blood flow (stasis)


PKU findings
PKU:
Pale hair, skin
Krazy (neurological abnormalities)
Unpleasant smell



Osteosarcoma: features
PEARL HARBOR:
Paget's disease (10-20%)*
Early age (10-20 yrs)
Around knee
Raised periosteum by expanding tumor: "sunburst pattern"
Lace-like architecture
Hyaline arteoriosclerosis
Alkaline phosphatase increased
Retinoblastoma*
Boys, predominantly
Osteomyelitis DDx
Radiation*
· Sunburst pattern was Japanese Navy emblem during WWII.
*: Predisposing factors.



Sarcoidosis summarized
SARCOIDOISIS:
Schaumann calcifications
Asteroid bodies/ [ACE] increase/ Anergy
Respiratory complications/ Renal calculi/ Restrictive lung disease/ Restrictive cardiomyopathy
Calcium increase in serum and urine/ CD4 helper cells
Ocular lesions
Immune mediated noncaseating granulomas/ [Ig] increase
Diabetes insipidus/ [D vit.] increase/ Dyspnea
Osteopathy
Skin (Subcutaneous nodules, erythema nodosum)
Interstitial lung fibrosis/ IL-1
Seventh CN palsy

Pediatrics Mnemonics

Williams syndrome: features
WILLIAMS:
Weight (low at birth, slow to gain)
Iris (stellate iris)
Long philtrum
Large mouth
Increased Ca++
Aortic stenosis (and other stenoses)
Mental retardation
Swelling around eyes (periorbital puffiness)


Sturge-Weber syndrome: hallmark features
Sturge-Weber:
1. Seizures
2. PortWine stain


Croup: symptoms
3 S's:
Stridor
Subglottic swelling
Seal-bark cough


Neonatal resuscitation: successive steps
"Do What Pediatricians Say To, Or Be Inviting Costly Malpractice":
Drying
Warming
Positioning
Suctioning
Tactile stimulation
Oxygen
Bagging
Intubate endotracheally
Chest compressions
Medications


Measles: complications
"MEASLES COMP" (complications):
Myocarditis
Encephalitis
Appendicitis
Subacute sclerosing panencephalitis
Laryngitis
Early death
Sh!ts (diarrhoea)
Corneal ulcer
Otis media
Mesenteric lymphadenitis
Pneumonia and related (bronchiolitis-bronchitis-croup)


Short stature: differential
ABCDEFG:
Alone (neglected infant)
Bone dysplasias (rickets, scoliosis, mucopolysaccharidoses)
Chromosomal (Turner's, Down's)
Delayed growth
Endocrine (low growth hormone, Cushing's, hypothyroid)
Familial
GI malabsorption (celiac, Crohn's)


Cystic fibrosis: presenting signs
CF PANCREAS:
Chronic cough and wheezing
Failure to thrive
Pancreatic insufficiency (symptoms of malabsorption like steatorrhea)
Alkalosis and hypotonic dehydration
Neonatal intestinal obstruction (meconium ileus)/ Nasal polyps
Clubbing of fingers/ Chest radiograph with characteristic changes
Rectal prolapse
Electrolyte elevation in sweat, salty skin
Absence or congenital atresia of vas deferens
Sputum with Staph or Pseudomonas (mucoid)


Pyloric stenosis (congential): presentation
Pyloric stenosis is 3 P's:
Palpable mass
Paristalsis visible
Projectile vomiting (2-4 weeks after birth)


Dentition: eruption times of permanent dentition
"Mama Is In Pain, Papa Can Make Medicine":
1st Molar: 6 years
1st Incisor: 7 years
2nd Incisor: 8 years
1st Premolar: 9 years
2nd Premolar: 10 years
Canine: 11 years
2nd Molar: 12 years
3rd Molar: 18-25 years


Cyanotic heart diseases: 5 types
· Use your five fingers:
1 finger up: Truncus Arteriosus (1 vessel)
2 fingers up: Dextroposition of the Great Arteries (2 vessels transposed)
3 fingers up: Tricuspid Atresia (3=Tri)
4 fingers up: Tetralogy of Fallot (4=Tetra)
5 fingers up: Total Anomalous Pulmonary Venous Return (5=5 words)



Haematuria: differential in children
ABCDEFGHIJK:
Anatomy (cysts, etc)
Bladder (cystitis)
Cancer (Wilm's tumour)
Drug related (cyclophosphamide)
Exercise induced
Factitious (Munchausen by proxy)
Glomerulonephritis
Haematology (bleeding disorder, sickle cell)
Infection (UTI)
In Jury (trauma)
Kidney stones (hypercalciuria)


Septic Arthritis: most common cause
Staphylococcus Aureus is the most common cause of
Septic Arthritis in the pediatric population.


Cough (chronic): differential
When cough in nursery, rock the "CRADLE":
Cystic fibrosis
Rings, slings, and airway things (tracheal rings)/ Respiratory infections
Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux)
Dyskinetic cilia
Lung, airway, and vascular malformations (tracheomalacia, vocal cord dysfunction)
Edema (heart failure)


Breast feeding: contraindicated drugs
BREAST:
Bromocriptine/ Benzodiazepines
Radioactive isotopes/ Rizatriptan
Ergotamine/ Ethosuximide
Amiodarone/ Amphetamines
Stimulant laxatives/ Sex hormones
Tetracycline/ Tretinoin


Beckwith-Widemann syndrome: features
HOMO:
Hypoglycemia
Omphalocel
Macroglossia/ Macrosomia
Organomegaly


APGAR score components
APGAR:
Appearance: cyanosis--peripheral, central, none
Pulse: pulse rate
Grimace: response to stimulation
Activity: movement of the baby (muscle tone)
Respiration: respiratory rate


Guthrie card: diseases identified with it
"Guthrie Cards Can Help Predict Bad Metabolism":
Galactosaemia
Cystic fibrosis
Congenital adrenal hyperplasia
Hypothyroidism
Phenylketonuria
Biotidinase deficiency
Maple syrup urine disease


Pediatric milestones in development
1 year:
-single words
2 years:
-2 word sentences
-understands 2 step commands
3 years:
-3 word combos
-repeats 3 digits
-rides tricycle
4 years:
-draws square
-counts 4 objects


Head circumference with age
· Remember 3, 9, and multiples of 5:
Newborn 35 cm
3 mos 40 cm
9 mos 45 cm
3 yrs 50 cm
9 yrs 55 cm


Weights of children with age
Newborn 3 kg
6 mos 6 kg (2x birth wt at 6 mos)
1 yr 10 kg (3x birth wt at 1 yr)
3 yrs 15 kg (odd yrs, add 5 kg until 11 yrs)
5 yrs 20 kg
7 yrs 25 kg
9 yrs 30 kg
11 yrs 35 kg (add 10 kg thereafter)
13 yrs 45 kg
15 yrs 55 kg
17 yrs 65 kg



Cystic fibrosis: exacerbation of pulmonary infection
CF PANCREAS:
Cough (increase in intensity and frequent spells)
Fever (usually low grade, unless severe bronchopneumonia is present)
Pulmonary function deterioration
Appetite decrease
Nutrition, weight loss
CBC (leukocytosis with left shift)
Radiograph (increase overaeration, peribronchial thickening, mucus plugging)
Exam (rales or wheezing in previously clear areas, tachypnea, retractions)
Activity (decreased, impaired exercise intolerance, increased absenteeism)
Sputum (becomes darker, thicker, and more abundant, forming plugs)


Cyanotic heart diseases: 5 types
· 5 T's:
Tetralogy of Fallot
Transposition of the great arteries
Truncus arteriosus
Tricuspid atresia, pulmonary aTresia
Total anomalous pulmonary venous drainage


Hemolytic-Uremic Syndrome (HUS): components
"Remember to decrease the RATE of IV fluids in these patients":
Renal failure
Anemia (microangiopathic, hemolytic)
Thrombocytopenia
Encephalopathy (TTP)


Rubella: congenital signs
"Rubber Ducky, I'm so blue!" (like the "Rubber Ducky" song):
Rubber: Rubella
Ducky: Patent Ductus Arteriosus, VSD and pulmonary artery stenosis.
I'm: Eyes (cataracts, retinopathy, micropthalmia, glaucoma).
Blue: "Blueberry Muffin" rash (extramedullary hematopoesis in skin +purpura)
· Also, deafness, growth retardation, and some more.


Cerebral palsy (CP): most likely cause
CP: Cerebral Palsy
Child Premature
· The premature brain is more prone to all the possible insults.


Guthrie card: diseases identified with it
GUTHRIE:
Galactosaemia
Urine [maple syrup urine disease]
THyRoid [hypothyroidism]
Inborn Errors of metabolism [eg: PKU]


Vacterl syndrome: components
VACTERL:
Vertebral anomalies
Anorectal malformation
Cardiac anomaly
Tracheo-esophageal fistula
Exomphalos (aka omphalocele)
Renal anomalies
Limb anomalies


Perez reflex
Eliciting the PErEz reflex will make the baby PEE.


Duodenal atresia vs. Pyloric stenosis: site of obstruction
Duodenal Atresia: Distal to Ampulla of vater.
Pyloric stenosis: Proximal to it.


Cyanotic congenital heart diseases
5 T's:
Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetrology of Fallot
Total anomalous pulmonary venous return



Paediatric history taking
· Begin with standard things: patient name, presenting complaint, history of presenting complaint and past medical history.
· Then ask BIFIDA:
Birth details and problems
Immunisations
Feeding
Infection, exposure to
Development, normality of
Allergies
· End by customary review of the rest of the standard things: medications, family history and social history.


Gastroschisis: usual location
GasTRoscHIsis usually occurs on the
RIGHT side of the umbilicus.
(Unscramble the letters).


Bilirubin: phototherapy
BiLirUbin absorbs light maximally in the
BLUe range.


Russell Silver syndrome: features
ABCDEF:
Asymmetric limb (hemihypertrophy)
Bossing (frontal)
Clinodactyly/ Cafe au lait spots
Dwarf (short stature)
Excretion (GU malformation)
Face (triangular face, micrognathia)


WAGR syndrome: components
WAGR:
Wilm's tumor
Aniridia
Gential abnormalities
Mental retardation


Ataxia-Telangiectasia (AT): common sign
AT:
Absent
Thymus


APGAR score components
· Five B's:
Breathing (respiratory effort)
Beating (heart rate)
Buff (tone)
Bothered (response to stimulation)
Blue (cyanosis)


Vitamin toxicities: neonatal
Excess vitamin A: Anomalies (teratogenic)
Excess vitamin E: Enterocolitis (necrotizing enterocolitis)
Excess vitamin K: Kernicterus (hemolysis)


Breast feeding: benefits
ABCDEFGH:
· Infant:
Allergic condition reduced
Best food for infant
Close relationship with mother
Development of IQ, jaws, mouth
· Mother:
Econmical
Fitness: quick return to pre-pregnancy body shape
Guards against cancer: breast, ovary, uterus
Hemorrhage (postpartum) reduced


Milk protein: women vs. cows
Woman: Whey (mostly)
Cow: Casein (mostly)


Pharmacology Mnemonics
Emergency Mnemonics

Teratogenic drugs: major non-antibiotics TAP CAP:
Thalidomide Androgens Progestins Corticosteroids Aspirin & indomethacin Phenytoin

Steroid side effects CUSHINGOID:
Cataracts
Ulcers
Skin: striae, thinning, bruising
Hypertension/ Hirsutism/ Hyperglycemia
Infections
Necrosis, avascular necrosis of the femoral head
Glycosuria
Osteoporosis, obesity
Immunosuppression
Diabetes

Muscarinic effects SLUG BAM:
Salivation/ Secretions/ Sweating
Lacrimation
Urination
Gastrointestinal upset
Bradycardia/ Bronchoconstriction/ Bowel movement
Abdominal cramps/ Anorexia
Miosis


Sulfonamide: major side effects
· Sulfonamide side effects:
Steven-Johnson syndrome
Skin rash
Solubility low (causes crystalluria)
Serum albumin displaced (causes newborn kernicterus and potentiation of other serum albumin-binders like warfarin)


Epilepsy types, drugs of choice:
"Military General Attacked Weary Fighters Pronouncing 'Veni Vedi Veci' After Crushing Enemies":
· Epilepsy types: Myoclonic Grand mal Atonic West syndrome Focal Petit mal (absence)
· Respective drugs: Valproate Valproate Valproate ACTH Carbamazepine Ethosuximide


Narcotics: side effects "SCRAM if you see a drug dealer": Synergistic CNS depression with other drugs
Constipation
Respiratory depression
Addiction
Miosis
Sex hormone drugs: male "Feminine Males Need Testosterone":
Fluoxymesterone
Methyltestosterone
Nandrolone
Testosterone


Ca++ channel blockers: uses CA++ MASH:
Cerebral vasospasm/ CHF
Angina
Migranes
Atrial flutter, fibrillation
Supraventricular tachycardia
Hypertension
· Alternatively: "CHASM":
Cererbral vasospasm / CHF
Hypertension
Angina
Suprventricular tachyarrhythmia
Migranes


Disulfiram-like reaction inducing drugs "PM PMT" as in Pre Medical Test in the PM:
Procarbazine
Metronidazole
Cefo (Perazone, Mandole, Tetan).


Delerium-causing drugs ACUTE CHANGE IN MS:
Antibiotics (biaxin, penicillin, ciprofloxacin)
Cardiac drugs (digoxin, lidocaine)
Urinary incontinence drugs (anticholinergics)
Theophylline
Ethanol
Corticosteroids
H2 blockers
Antiparkinsonian drugs
Narcotics (esp. mepridine)
Geriatric psychiatric drugs
ENT drugs
Insomnia drugs
NSAIDs (eg indomethacin, naproxin)
Muscle relaxants
Seizure medicines


Morphine: side-effects MORPHINE:
Myosis
Out of it (sedation)
Respiratory depression
Pneumonia (aspiration)
Hypotension
Infrequency (constipation, urinary retention)
Nausea
Emesis


Therapeutic dosage: toxicity values for most commonly monitored medications
"The magic 2s":
Digitalis (.5-1.5) Toxicity = 2.
Lithium (.6-1.2) Toxicity = 2.
Theophylline (10-20) Toxicity = 20.
Dilantin (10-20) Toxicity = 20.
APAP (1-30) Toxicity = 200.


Diuretics:
thiazides: indications "CHIC to use thiazides":
CHF
Hypertension
Insipidous
Calcium calculi


Migraine: prophylaxis drugs
"Very Volatile Pharmacotherapeutic Agents For Migraine Prophylaxis":
Verpamil
Valproic acid
Pizotifen
Amitriptyline
Flunarizine
Methysergide
Propranolol


Adrenoceptors: vasomotor function of alpha vs. beta
ABCD:
Alpha = Constrict.
Beta = Dilate.


Antiarrhythmics: classification
I to IV MBA College
· In order of class I to IV:
Membrane stabilizers (class I)
Beta blockers
Action potential widening agents
Calcium channel blockers


Opiods: mu receptor effects "MD CARES":
Miosis
Dependency
Constipation
Analgesics
Respiratory depression
Euphoria
Sedation


Cancer drugs: time of action between DNA->mRNA ABCDEF: Alkylating agents
Bleomycin
Cisplastin
Dactinomycin/ Doxorubicin
Etoposide
Flutamide and other steroids or their antagonists (eg tamoxifen, leuprolide)


Tetracycline: teratogenicity
TEtracycline is a TEratogen that causes staining of TEeth in the newborn.


Patent ductus arteriosus: treatment
"Come In and Close the door": INdomethacin is used to Close PDA.

Antirheumatic agents (disease modifying): members
CHAMP:
Cyclophosphamide
Hydroxycloroquine and choloroquinine
Auranofin and other gold compounds
Methotrexate
Penicillamine

Antiarrhythmics: class III members BIAS:
Bretylium
Ibutilide
Amiodarone
Sotalol


MAOIs: indications MAOI'S:
Melancholic [classic name for atypical depression]
Anxiety
Obesity disorders [anorexia, bulemia]
Imagined illnesses [hypochondria]
Social phobias
· Listed in decreasing order of importance.
· Note MAOI is inside MelAnchOlIc.


SIADH-inducing drugs ABCD:
Analgesics: opioids, NSAIDs
Barbiturates
Cyclophosphamide/ Chlorpromazine/ Carbamazepine
Diuretic (thiazide)


K+ increasing agents K-BANK:
K-sparing diuretic
Beta blocker
ACEI
NSAID
K supplement

Beta-blockers: side effects "BBC Loses Viewers In Rochedale": Bradycardia
Bronchoconstriction
Claudication
Lipids
Vivid dreams & nightmares
-ve Inotropic action
Reduced sensitivity to hypoglycaemia

Vir-named drugs: use"-vir at start, middle or end means for virus": · Drugs:
Abacavir,
Acyclovir,
Amprenavir,
Cidofovir,
Denavir,
Efavirenz,
Indavir,
Invirase,
Famvir,
Ganciclovir,
Norvir,
Oseltamivir,
Penciclovir,
Ritonavir,
Saquinavir,
Valacyclovir,
Viracept,
Viramune,
Zanamivir,
Zovirax.


Opioids: effects BAD AMERICANS:
Bradycardia & hypotension
Anorexia
Diminished pupilary size
Analgesics
Miosis
Euphoria
Respiratory depression
Increased smooth muscle activity (biliary tract constriction) Constipation
Ameliorate cough reflex
Nausea and vomiting
Sedation


TB: antibiotics used
STRIPE:
STreptomycin Rifampicin Isoniazid Pyrizinamide Ethambutol


Phenytoin: adverse effects PHENYTOIN:
P-450 interactions
Hirsutism
Enlarged gums
Nystagmus
Yellow-browning of skin
Teratogenicity
Osteomalacia
Interference with B12 metabolism (hence anemia)
Neuropathies: vertigo, ataxia, and headache


Thrombolytic agents USA:
Urokinase Streptokinase Alteplase (tPA)


Routes of entry: most rapid ways meds/toxins enter body
"Stick it, Sniff it, Suck it, Soak it":
Stick = Injection
Sniff = inhalation
Suck = ingestion
Soak = absorption


Asthma drugs: leukotriene inhibitor action
zAfirlukast: Antagonist of lipoxygenase
zIlueton: Inhibitor of LT receptor


Direct sympathomimetic catecholamines DINED:
Dopamine
Isoproterenol
Norepinephrine
Epinephrine
Dobutamine


Anticholinergic side effects
"Know the ABCD'S of anticholinergic side effects":
Anorexia
Blurry vision
Constipation/ Confusion
Dry Mouth
Sedation/ Stasis of urine


Aspirin: side effects ASPIRIN:
Asthma
Salicyalism
Peptic ulcer disease/ Phosphorylation-oxidation uncoupling/ PPH/ Platelet disaggregation/ Premature closure of PDA
Intestinal blood loss
Reye's syndrome
Idiosyncracy
Noise (tinnitus)


Lupus: drugs inducing it HIP:
Hydralazine
INH
Procanimide


Morphine: effects at mu receptor PEAR:
Physical dependence
Euphoria
Analgesia
Respiratory depression


Depression: 5 drugs causing it PROMS:
Propranolol
Reserpine
Oral contraceptives
Methyldopa
Steroids


Lead poisoning: presentation ABCDEFG:
Anemia
Basophilic stripping
Colicky pain
Diarrhea
Encephalopathy
Foot drop
Gum (lead line)


Morphine: effects MORPHINES:
Miosis
Orthostatic hypotension
Respiratory depression
Pain supression
Histamine release/ Hormonal alterations
Increased ICT
Nausea
Euphoria
Sedation


Inhalation anesthetics SHINE:
Sevoflurane
Halothane
Isoflurane
Nitrous oxide
Enflurane
· If want the defunct Methoxyflurane too, make it MoonSHINE.


Cholinergics (eg organophosphates): effects
If you know these, you will be "LESS DUMB":
Lacrimation
Excitation of nicotinic synapses
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction


Teratogenic drugs "W/ TERATOgenic":
Warfarin
Thalidomide
Epileptic drugs: phenytoin, valproate, carbamazepine
Retinoid
ACE inhibitor
Third element: lithium
OCP and other hormones (eg danazol)


Gynaecomastia-causing drugs DISCOS:
Digoxin
Isoniazid
Spironolactone
Cimetidine
Oestrogens
Stilboestrol


Anesthesia: 4 stages "Anesthesiologists Enjoy S & M":
Analgesia
Excitement
Surgical anesthesia
Medullary paralysis


Osmotic diuretics: members GUM:
Glycerol
Urea
Mannitol


Sodium valproate: side effects VALPROATE:
Vomiting
Alopecia
Liver toxicity
Pancreatitis/ Pancytopenia
Retention of fats (weight gain)
Oedema (peripheral oedema)
Appetite increase
Tremor
Enzyme inducer (liver)


Nitrofurantoin: major side effects NitroFurAntoin:
Neuropathy (peripheral neuropathy)
Fibrosis (pulmonary fibrosis)
Anemia (hemolytic anemia)

Zero order kinetics drugs (most common ones) "PEAZ (sounds like pees) out a constant amount":
Phenytoin
Ethanol
Aspirin
Zero order
· Someone that pees out a constant amount describes zero order kinetics (always the same amount out)


Hepatic necrosis: drugs causing focal to massive necrosis
"Very Angry Hepatocytes":
Valproic acid
Acetaminophen
Halothane


Steroids: side effects BECLOMETHASONE:
Buffalo hump
Easy bruising
Cataracts
Larger appetite
Obesity
Moonface
Euphoria
Thin arms & legs
Hypertension/ Hyperglycaemia
Avascular necrosis of femoral head
Skin thinning
Osteoporosis
Negative nitrogen balance
Emotional liability


Amiodarone: action, side effects 6 P's:
Prolongs action potential duration
Photosensitivity
Pigmentation of skin
Peripheral neuropathy
Pulmonary alveolitis and fibrosis
Peripheral conversion of T4 to T3 is inhibited -> hypothyroidism

Monoamine oxidase inhibitors:
Members "PIT of despair":
Phenelzine
Isocarboxazid
Tranylcypromine ·
A pit of despair, since MAOs treat depression


Warfarin: metabolism SLOW:
· Has a slow onset of action.
· A quicK Vitamin K antagonist, though.
Small lipid-soluble molecule
Liver: site of action
Oral route of administration.
Warfarin


Propythiouracil (PTU):
Mechanism It inhibits PTU:
Peroxidase/ Peripheral deiodination
Tyrosine iodination Union (coupling)


Antibiotics contraindicated during pregnancy MCAT:
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline


Beta-blockers:
nonselective beta-blockers"Tim Pinches His Nasal Problem"
(because he has a runny nose...):
Timolol
Pindolol
Hismolol
Naldolol
Propranolol


Methyldopa:
side effects METHYLDOPA:
Mental retardation
Electrolyte imbalance
Tolerance
Headache/ Hepatotoxicity psYcological upset
Lactation in female
Dry mouth
Oedema
Parkinsonism
Anaemia (haemolytic)


Lithium: side effects LITH:
Leukocytosis
Insipidus [diabetes insipidus, tied to polyuria]
Tremor/ Teratogenesis
Hypothyroidism


Respiratory depression inducing drugs "STOP breathing":
Sedatives and hypnotics
Trimethoprim
Opiates
Polymyxins
Physiology Mnemonics

Einthoven's Triangle: organization
Corners are at RA (right arm), LA (left arm), LL (left leg).
Number of L's at a corner tell how many + signs are at that corner [eg LL is ++].
Sum of number of L's of any 2 corners tells the name of the lead [eg LL-LA is lead III].
For reference axes, the negative angle hemisphere is on the half of the triangle drawing that has all the negative signs; positive angle hemisphere contains only positive signs.
· See diagram.


Adrenal cortex layers and products
"Get My Freakin' Gun Right Away":
Glomerulosa: Mineralcorticoid (aldosterone)
Fasiculata: Glucocorticoid (cortisol)
Reticularis: Androgens

Alkalosis vs. acidosis: directions of pH and HCO3
ROME:
Respiratory= Opposite:
· pH is high, PCO2 is down (Alkalosis).
· pH is low, PCO2 is up (Acidosis).
Metabolic= Equal:
· pH is high, HCO3 is high (Alkalosis).
· pH is low, HCO3 is low (Acidosis).


Prolactin and oxytocin: functions
PROlactin stimulates the mammary glands to PROduce milk.
Oxytocin stimulates the mammary glands to Ooze (release) milk.


Adrenal gland: functions
ACTH:
Adrenergic functions
Catabolism of proteins/ Carbohydrate metabolism
T cell immunomodulation
Hyper/ Hypotension (blood pressure control)


Adrenal cortex layers and products
"Go Find Rex, Make Good Sex":
· Layers:
Glomerulosa
Fasiculata
Reticulata
· Respective products:
Mineralcorticoids
Glucocorticoids
Sex hormones
· Alternatively for layers: GFR (Glomerular Filtration Rate, convenient since adrenal glands are atop kidney).


Diabetes Insipidous: diagnosing subtypes
After a desmopression injection:
Concentrated urine = Cranial.
No effect = Nephrogenic.


Rods vs. cone function
RoD: Dim light.
Cones: Color.


Oxytocin-producing nucleus of hypothalamus
Paraventricular nucleus--> Parturition (childbirth is oxytocin's most important role).


Hyperthyroidism: signs and symptoms
THYROIDISM:
Tremor
Heart rate up
Yawning [fatigability]
Restlessness
Oligomenorrhea & amenorrhea
Intolerance to heat
Diarrhea
Irritability
Sweating
Musle wasting & weight loss



MAO isoenzyme form locations
· MAO-A in:
Adrenergic peripheral structures
Alimentary mucosa [intestine]
· MAO-B in:
Brain
Blood platelets


Hemoglobin and myoglobin: binding strengths, sites
"ABC" of glycosylated Hb (Hb1c):
· Glucose binds to Amino terminal of Beta Chain.
"HbF binds Forcefully":
· HbF binds oxygen more forcefully than HbA, so Oxy-Hb dissociation curve shifts to left.
Stored blood is SOS:
· Stored blood Hb binds to Oxygen Strongly because of decrease in 2,3 BPG.
2,3 BPG binding site is BBC:
· BPG binds to Beta Chain of Hb.
Myoglobin binding strength is MOM:
· Myoglobin binds Oxygen More strongly than Hb.


PGI2 vs. TxA2 coagulation function
TxA2 Aggregates platelets.
PGI2 Inhibits aggregation.
· Note: full name of PGI2 is prostaglandin I2 or prostacyclin, full name of TxA2 is thromboxane A2.


VO2 normal value is 250 mL/min
"V02" is the numbers, just need to rearrange the order.
V is roman numeral for 5, so rearrange to 2V0, or 250 mL/min.


Heart valves: closure sequence
"Many Things Are Possible":
Mitral, Tricuspid, Aortic, Pulmonic


Heart electrical conduction pathway
"If patient's family are all having Heart attacks, you must SAVe HIS KIN!"
SA node --->
AV node --->
His (bundle of) -->
PurKINje fibers


Temperature control: cerebral regions
"High Power Air Conditioner":
Heating = Posterior hipothalamo [hypothalamus].
Anterior hipothalamo [hypothalamus] = Cooling.


Heart valves: sequence of flow
TRIPS BIAS:
TRIcuspid
Pulmonary
Semilunar
BIcuspid
Aortic
Semilunar
Alternatively: "TRIPS, MI ASs!" (uses MItral instead of BIcuspid)


Adrenal cortex layers and products
"Great Attire And Fast Cars Are Really Sexy Attributes":
Granulosa secretes Aldosterone in response to Angiotensin II.
Fasiculata secretes Cortisol in response to ACTH.
Reticularis secretes Sex steroids in response to ACTH.


LH vs FSH: function in male
LH: Leydig cells stimulated to produce testosterone.
FSH: Spermatogenesis stimulated.



Urination: autonomic control
"When you pee, it's PISs":
Parasympathetic Inhibits Sympathetic.


Heart: -tropic definitions
Lusitropic: loose is relaxed. Definition: relax heart.
Inotropic: when heart wall contracts, moves inward. Definition: contract heart.
Chronotropic: 'chrono-' means 'time'. Defintion: heart rate (of SA node impulses).
Dromotropic: only one left, it must be conduction speed by default.


Pituitary: anterior hypophysis hormones
FLATPiG:
FSH
LH
ACTH
TSH
Prolactin
ignore GH


Adrenal cortex layers and products
"Get your Facts Right, Men are Glued to their Gonads":
Glomerulosa
Fasciculata
Reticularis
Mineralocorticoids
Glucocorticoids
Gonadocorticoids [androgens]


Hb-oxygen dissociation curve shifts: effect, location
Left shift: causes Loading of O2 in Lungs.
Right shift: causes Release of O2 from Hb.


Nervous stimulus: the 4 ways to classify
"A MILD stimulus":
Modality
Intensity
Location
Duration


Intrinsic vs. extrinsic pathway tests
"PeT PiTTbull":
PeT: PT is for extrinsic pathway.
PiTTbull: PTT is for intrinsic pathway.


Pituitary hormones
FLAGTOP:
Follicle stimulating hormone
Lutinizing hormone
Adrenocorticotropin hormone
Growth hormone
Thyroid stimulating hormone
Oxytocin
Prolactin
Alternatively: GOAT FLAP with the second 'A' for Anti-diruetic homone/vasopressin
· Note: there is also melanocyte secreting homone and Lipotropin, but they are not well understood.

Aldosterone: regulation of secretion from adrenal cortex
RNAs
Renin-angiotensin m echanism
Na concentraton in blood
ANP (atrial natriuretic peptide)
Stress


Osteoblast vs. osteoclast
OsteoBlast Builds bone.
OsteoClast Consumes bone.



Compliance of lungs factors
COMPLIANCE:
Collagen deposition (fibrosis)
Ossification of costal cartilages
Major obesity
Pulmonary venous congestion
Lung size
Increased expanding pressure
Age
No surfactant
Chest wall scarring
Emphysema
· All but L/A/E decrease compliance.


Progesterone: actions
PROGESTE:
Produce cervical mucous
Relax uterine smooth muscle
Oxycotin sensitivity down
Gonadotropin [FSH, LH] secretions down
Endometrial spiral arteries and secretions up
Sustain pregnancy
Temperature up / Tit development
Excitability of myometrium down


Carotid sinus vs. carotid body function
carotid SinuS: measures preSSure.
carotid bO2dy measures O2.


V/Q gradient in lung
Infinity, a lung and a zero stack nicely.
V/Q is lowest at bottom, highest at top.
· See diagram.


Heart valves: placement of valves on standard heart anterior view
"Try before you Buy": When read across the page, the tricuspid valve comes before the bicuspid valve.
Also, the lunar valves are near the top (in the sky), like the moon.


Mechanoreceptor types
"Frustated Muscular Mechanics Rub Her P*ssy":
Free nerve endings
Meisner's
Merkel's disc
Ruffini's
Hair end organ
Pacinian corpuscle


Balance organs
Utricle and Saccule keep US balanced.


Gut intrinsic innervation: myenteric plexus vs. submucosal plexus function
Myenteric: Motility.
Submucosal: Secretion and blood flow.


Fluid compartments: volumes
12345:
12 liters of interstitial fluid
3 liters plasma volume and 30 liters inside cells
45 liters total body water


Pepsin-producing cells
"Chief of Pepsi-Cola":
· Chief cells of stomach produce Pepsin.



Adrenal cortex layers and products
"Get All Fat Chicks Right Away":
· Layers:
Glomerulosa
Fasciculata
Reticularis
· Products:
Aldosterone
Cortisol
Androgens


Oestrogen: functions
OESTROGEN SUX:
Organ development (sex organs)
Endocrine: FSH and LH regulation
Secondary sex characteristics development
Tropic for pregnancy
Receptor synthesis (of progesterone, oestrogen, LH)
Osteoporosis decrease (inhibits bone reabsorption)
Granulosa cell development
Endocrine: increases prolactin secretion, but then blocks its effect
Nipple development
Sex drive increase
Uterine contractility increase
oXytocin sensitivity increase


Skin vasoconstriction and temperature
When the skin needs to CONServe heat, the
blood vessels of the skin CONStrict.
When the skin is COld, the blood
vessels of the skin COnstrict.

Vitamin D: site of conversion
Vitamin D is made in the Dermis


Muscle spindle: origin of primary vs. secondary endings
"1 from 1, 2 from 2":
Primary ending is from Group Ia.
Secondary ending from Group II.
· See diagram.


Prostaglandins: dilatation abilities
Prospectors keep mineshafts open:
Mineshaft 1: Patent ductus ateriosus.
Mineshaft 2: renal afferent arteriole dilatation.


Cochlea: inner vs. outer hair cell function
"Outer cells are Out of the brain. Inner cells are Into the brain":
Outer hair cells are motor efferents to amplify signal.
Inner hair cells are sensory afferents that actually pick up the sound.


Electrical conductivity of tissues
"Be Careful To Shock My Best Nerve":
In order of least conductive to most conductive:
Bones
Cartilage
Tendon
Skin
Muscle
Blood
Nerve


Potassium: causes of potassium leaving cells
A$$E$
Acidosis: H+ ions move in.
Starvation: catabolism of cells.
Stress: catabolism of cells (postoperative).
Exercise: catabolism of cells.
Sodium chloride lost: K+ replaces it and is then excreted.

Surgery Mnemonics

Disease description: organization of answer
"In A Surgeon's Gown, Physicians May Make Some Clinical Progress":
Incidence
Age
Sex
Geography
Predisposing factors
Macroscopic appearance
Microscopic appearance
Spread
Clinical features
Prognosis


Swollen leg: unilateral swelling causes
TV BAIL:
Trauma
Venous (varicose veins, DVT, venous insufficiency)
Baker's cyst
Allergy
Inflammation (cellulitis)
Lymphoedema


Varicose veins: symptoms
AEIOU:
Aching
Eczema
Itching
Oedema
Ulceration/ Ugly (LDS, haemosiderin, varicosities)


GI bleeding: causes
ABCDEFGHI:
Angiodysplasia
Bowel cancer
Colitis
Diverticulitis/ Duodenal ulcer
Epitaxis/ Esophageal (cancer, esophagitis, varices)
Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
Hemorrhoids
Infectious diarrhoea/ IBD/ Ischemic bowel


Post-operative complications (immediate)
"Post-op PROBS":
Pain
Primary haemorrhage
Reactionary haemorrhage
Oliguria
Basal atelectasis
Shock/ Sepsis


Child-Pugh classification
"Pour Another Beer At Eleven":
PT
Albumin
Bilirubin
Ascites
Encephalopathy
·Scoring (each is either 1, 2 or 3 points):
PT (greater than 12 sec.): 1-3 or 4-6 or >6.
Albumin: >3.5 or 2.8-3.5 or less than 2.8
Bilirubin: less than 2 or 2-3 or >3.
Ascities: none or slight or moderate
Encephalopathy: none or 1-2 (subjective) or 3-4 (subjective)
· Interpretation:
Class A: 5-6 points (candidate for surgical liver resection).
Class B: 7-9 points (consider chemoembolization or RFA).
Class C: 10-15 points (consider options in B or no therapy).


Hernias of Abdominal Wall
Think of the abdomen as a bucket, or PAIL that contains the viscera. These are the four groups of hernias:
Pelvic hernias: obturator, perineal, sciatic
Anterior hernias: epigastric, incisional, Spigelian, supravesical, umbilical
Inguinal hernias: indirect, direct, femoral
Lumbar hernias: inferior lumbar triangle (Petit), superior lumbar triangle (Grynfelt)


Melanoma sites
"Mel SEA" (Pronounced "Mel C" from the Spice Girls)
· Melanoma sites, in order of frequency:
Skin
Eyes
Anus


Oesophageal cancer risk factors
PC BASTARDS:
Plummer-Vinson syndrome
Coeliac disease
Barrett's
Alcohol
Smoking
Tylosis
Achalasia
Russia (geographical distribution)
Diet
Stricture


Fistulas: conditions preventing closure
FRIEND:
Foreign body
Radiation
Infection/ Inflammation (Crohn)
Epithelialization
Neoplasia
Distal obstruction



Appendicectomy: complications
WRAP IF HOT:
Wound infection
Respiratory (atelectasis, pneumonia)
Abscess (pelvic)
Portal pyemia
Ileus (paralytic)
Fecal fistula
Hernia (r. inguinal)
Obstruction (intestinal due to adhesions)
Thrombus (DVT)


TPN indications
"MISIPPI Burning":
Major visceral injury
IBD
Sepsis
Ileus
Post-op
Paralysis
Intestinal fistula
Burns


Scrotum: scrotum swelling differential
THE THEATRES:
Torsion
Hernia
Epididymytis, orchitis
Trauma
Hydrocoele, varicocele, hematoma
Edema
Appendix testes (torsion, hemorrhage)
Tumour
Recurrent leukemia
Epididymal cyst
Syphilis, TB


Post-operative fever causes
Six W's:
Wind: pulmonary system is primary source of fever first 48 hours, may have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due to pelvic pooling or restricted mobility related to pain and fatigue
Whiz: urinary tract infection if urinary catheterization
Wonder drugs: drug-induced fever


Appendicitis: Alvarado's scoring system for diagnosis
MANTRELS:
Migratory pain (1)
Anorexia (1)
Nausea (1)
Tenderness (2)
Rebound tenderness (1)
Elevated temperature (1)
Leucocytosis (2)
Shift to left (1)
· Score 3-4 = no appendicitis. Score 5-6 = doubtful. Score 7 or more = appendicitis is confirmed.


Abdominal aortic aneurysm: genetic component
AAA (3 A's) is sometimes due to a defect in the gene encoding for type III procollagen.


Post operative order list check-up
FLAVOR:
Fluids
Laboratories
Activity
Vital signs
Oral allowances
Rx [medications]


Fistulas: conditions preventing closure
FETID:
Foreign body
Epithelialization
Tumor
Infection
Distal obstruction


Inguinal mass: differential
"Hernias Very Much Like To Swell":
Hernias (inguinal, femoral)
Vascular (femoral aneurysm, sapheno varyx)
Muscle (psoas abscess)
Lymph nodes
Testicle (ectopic, undescended)
Spermatic cord (lipoma, hydrocoele)


Abdomen: inspection
5 S's:
Size
Shape
Scars
Skin lesions
Stoma



Hernias: abdominal wall: pelvic
The end products of metabolism that are released through the pelvis, are "Pee Or Stool":
Perineal hernia
Obturator hernia
Sciatic hernia


Compartment syndrome: signs and symptoms
· 5 P's:
Pain
Palor
P ulseless
Paresethesia
Pressure (increased)


Ulcers: edge types
F PURE:
Flat (eg venous)
Punched-out (eg trophic, arterial)
Undetermined (eg pressure, TB)
Rolled (eg BCC)
Everted (eg SCC)


Pancreatitis: treatment
MACHINES:
Monitor vital signs
Analgesia/ Antibiotics
Calcium gluconate (if deemed necessary)
H2 receptor antagonist
IV access/ IV fluids
Nil by mouth
Empty gastric contents
Surgery if required/ Senior review


Oedema causes: localised
ALIVE:
Allergic (angio-oedema)
Lymphatic (elephantiasis)
Inflammatory (infection, injury)
VEnous (DVT, chronic venous insufficiency)


Oedema causes: generalised
"HILARI IS SAVE" (Hilary):
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH increased
Renal cause
Inadequate protein in blood (hypoalbuminaemia)
· Causes for the inadequate protein in blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased (pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's disease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)


Surgical discharge checklist
FLAG COUP:
Lucid
Ambulatory
GP letter sent
CVS checked (BP, pulse
Operation site OK
Urinating OK
Prescription


Hernias: abdominal wall: lumbar triangles (with eponyms)
PIGS:
Petit aka Inferior lumbar triangle
Grynfelt aka Superior lumbar triangle


Haematocele: etiology
3T's and 2 H's:
Tumor
Torsion
Trauma
Hydrocele as a complication
Haemophilia (blood diseases)

Urology/Nephrology Mnemonics

Hematuria: differential
HEMATURIA:
Hereditary (PCK and OWR) / Henoch Schonlein purpura
Embolism (infective endocarditis)
Malignant HTN
Acute and chronic glomerulonephritis / IgA nephropathy
Tumors / Trauma / Toxic drugs
Urolithiasis
Renal papillary necrosis
Infection (pyelonephritis, cystitis, urethritis)
Anti-coagulants


Prostatism: initial symptoms
"Prostatism is initially FUN":
Frequency
Urgency
Nocturia


Nephrotic syndrome: causes for secondary nephrotic syndrome
DAVID:
Diabetes mellitus
Amyloidosis
Vasculitis
Infections
Drugs


Dialysis: indications
AEIOU:
Acid-base problems (severe acidosis or alkalosis)
Electrolyte problems (hyperkalemia)
Intoxications
Overload, fluid
Uremic symptoms


Nephrectomy: indications
4 T's:
Trauma
Tumor
TB
Transplantation


Epididmyitis: bacterial causes
CENT:
Chlamydia trachomatis
E. coli
Nisseria gonorrhoeae
Tuberculos bacteria


Renal failure: symptoms/signs
"My Big Nob Vibrates Gently In Her Purulent Pelvis":
Malaise
Breathlessness
Nausea
Vomiting
GI motility
Headache
Pruritis
Pigmentation


Enlarged kidneys: causes
SHAPE:
Sclerderma
HIV nephropathy
Amyloidosis
Polycystic kidney disease
Endocrinophathy (diabetes)


Urinary incontinence: causes of acute and reversible
DRIP:
Delirium
Restricted mobility/ Retention
Inflammation / Infection/ Impaction [fecal]
Pharmaceuticals / Polyuria
· "Drip" is convenient since it is urinary incontinence, so urine only drips out.


Renal Cell Cancer (RCC): genetic marker
"RCC" equals three. Or, "C" is the third letter of the alphabet.
· RCC is associated with genetic abberations on the third chromosome (VHL gene)



Glomerular disease with a reduced complement level
PELICAN:
Post-streptococcal glomerulonephritis
Endocarditis (sub-acute)
Lupus erythematosus
Idiopatic membranoproliferative glomerulonephritis
Cryoglobulinemia
Abscess (visceral)
Nephritis


Hematuria: differential
"S#!T":
Stones/ Systemic disease (SLE)/ Structural lesions (UPJ obstruction)
Hematologic disease (sickle cell, coagulopathy)/ Hypercalciuria/ Hereditary (Alport nephritis)/ HSP/ HUS
Infectious and Immunologic (PSGN)/ IgA nephropathy (Berger nephritis)/ Interstitial disease (interstitial nephritis)/ Idiopathic conditions (thin glomerular basement membrane disease or benign familial hematuria)
Trauma/ Tumor/ TB/ Toxins


Pyelonephritis (acute): predisposing factors
SCARRIN' UP:
Sex (females <40,>40)
Catheterization
Age (infant, elderly)
Renal lesions
Reflux (vesciouteral)
Immunodeficienct
NIDDM, IDDM
Urinary obstuction
Pregnant
· Acute pyelonephritis heals by scarrin' up the area (pyelonephritic scar).

Hydronephrosis: differential
· Unilateral is PACT:
Pelvic-uteric obstruction (congenital or acquired)
Aberrant renal vessels
Calculi
Tumours of renal pelvis
· Bilateral is SUPER:
Stenosis of the urethra
Urethral valve
Prostatic enlargement
Extensive bladder tumour
Retro-peritoneal fibrosis


Testicular atrophy: differential
TESTES SHRINK:
Trauma
Exhaustional atrophy
Sequelae
Too little food
Elderly
Semen obstruction
Sex hormone therapy
Hypopituitarism
Radiation
Inflammatory orchitis
Not descended
Kleinfelter's


Metabolic waste products retention: clinical features
ABCDEFGHI:
Apathy/ Anorexia/ Anemia
Bleeding
Confusion/ Coma
Dizziness
Emesis/ Edema of the lung
Fits
Gastrointestinal bleeding
Hiccups
Infection


Urinary incontinence: differential
DIAPERS:
Delirium
Infection
Atrophic urethritis and vaginitis
Pharmaceuticals/ Psychologic
Excessive urine output
Restricted mobility
Stool impaction


Renal tubular acidosis: type with common nephrocalcinosis
The stONE (nephrocalcinosis) is common in type ONE.



Polycystic kidney: genetic marker
"P" is the 16th letter of the alphabet.
· Autosomal dominant Polycystic kidney disease is associated with abberation on the 16th chromosome.