6/18/13 6:33 PM arghlblargh! Page 1 of 21 http://julieyumi.tumblr.com/post/22267813238/second-aid-usmle-mnemonics — SECOND AID: USMLE MNEMONICS This is a list of medical mnemonics, side-notes, and generalizations I wrote down while going through my 2010 First Aid book while supplementing with 2012 Falcon, Kaplan, and a bit of Goljan. I stopped at around three-quarters of the text because I got tired and felt like not many people would be interested…(Update: sorry, but I’m too busy to go back and type the rest! ><). P.S. If you want to find a topic fast, I suggest Ctrl+F Behavioral Science: Statistical distribution: Positive skew = meAn>meDian>mOde Positive skew = alphabetical from greatest to least Reportable diseases: “It was reported that studly Mr. Shigella ate salmon, chicken, and liver”: “It was REPORTED that STuDly MMR SHIGELLA aTB Salmon, Chicken, and Liver” STDs: AIDs, Gonorrhea, Syphilis, Chlamydia (*NOT HIV!) MMR: Measles, Mumps, Rubella Shigella TB Salmonella Chicken Pox Hepatits A, B, C Health care payment: CARE for the Elderly, AID the destitute Medicare - elderly, Medicaid - low income people Early developmental milestones: # of blocks stacked = age in years * 3 2 word sentences at 2 “pee at three”; tricycle at three “four-square at four” = can hop at four drawings: 3yo = circle 4yo = + 5yo = square 6yo = triangle See reference: Biochemistry: Stop codons: UGA, UAA, UAG U Go Away, U Are Away, U Are Gone EXpress EXons, INtrons are IN the way Proto-oncogenes: Mike’s sis returned with her two new breasts she was able to grow because of herbs. “MYC’s SIS RETurned with HER2Neu breasts she RAS ABLe To-Grow BCl of hERBs.” Myc sis ret Her2/neu ras abl TGFalpha bcl2 ERB-B1, B2 Collagen: The higher the number, the smaller and softer it gets Type 1 - bone (skin) - Osteogenesis Imperfecta (failed glycosylation and formation of procollagen triple helix with ER) Type 2 - cartilage - death in utero Type 3 - blood vessels - Ehlers-Danlos (failure of cross-linking by lysyl oxidase to make collagen fibrils outside fibroblasts), berry aneurysms Type 4: basement membrane - Alport’s nephritis (+ deafness and vision problems; “can’t see, can’t pee, can’t hear”) Blotting procedures:
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Transcript
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—"SECOND"AID:"USMLE"MNEMONICSThis is a list of medical mnemonics, side-notes, and generalizations I wrote down while going through my 2010 First Aidbook while supplementing with 2012 Falcon, Kaplan, and a bit of Goljan. I stopped at around three-quarters of the textbecause I got tired and felt like not many people would be interested…(Update: sorry, but I’m too busy to go back and typethe rest! ><).
P.S. If you want to find a topic fast, I suggest Ctrl+F
Behavioral Science:
Statistical distribution:
Positive skew = meAn>meDian>mOdePositive skew = alphabetical from greatest to least
Reportable diseases:“It was reported that studly Mr. Shigella ate salmon, chicken, and liver”:“It was REPORTED that STuDly MMR SHIGELLA aTB Salmon, Chicken, and Liver”
STDs: AIDs, Gonorrhea, Syphilis, Chlamydia (*NOT HIV!)MMR: Measles, Mumps, RubellaShigellaTBSalmonellaChicken PoxHepatits A, B, C
Health care payment:
CARE for the Elderly, AID the destituteMedicare - elderly, Medicaid - low income people
Early developmental milestones:
# of blocks stacked = age in years * 32 word sentences at 2“pee at three”; tricycle at three“four-square at four” = can hop at fourdrawings:
Stop codons: UGA, UAA, UAGU Go Away, U Are Away, U Are Gone
EXpress EXons, INtrons are IN the way
Proto-oncogenes:Mike’s sis returned with her two new breasts she was able to grow because of herbs.“MYC’s SIS RETurned with HER2Neu breasts she RAS ABLe To-Grow BCl of hERBs.”
MycsisretHer2/neurasablTGFalphabcl2ERB-B1, B2
Collagen: The higher the number, the smaller and softer it gets
Type 1 - bone (skin) - Osteogenesis Imperfecta (failed glycosylation and formation of procollagen triple helix withER)Type 2 - cartilage - death in uteroType 3 - blood vessels - Ehlers-Danlos (failure of cross-linking by lysyl oxidase to make collagen fibrils outsidefibroblasts), berry aneurysmsType 4: basement membrane - Alport’s nephritis (+ deafness and vision problems; “can’t see, can’t pee, can’thear”)
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SNOWDROP
S/D: Southern blot = DNA sample identified with DNA probeN/R: Northern blot = RNA sample identified with DNA probeO/OW/P: Western blot = protein sample identified with antibody probe
Model systems:
Knock out = take a gene OUTKnock in = INsert a geneKnock down = knock down the expression of the gene via complementary mRNA antagonist
William’s syndrome: Will Farrell in Elf: elfin faces, mental retardation, well-developed verbal skills, extreme friendliness
DiGeorge syndrome: CATCH-22
Cleft palateAbnormal faciesThymic aplasia (T-cell deficiency)Cardiac defectsHypocalcemia (secondary to parathyroid aplasia; remember third pharyngeal pouch: inferior parathyroids aregrown with thymus and descend together)microdeletion at chromosome 22q11
Vitamin B1: ThiamineThiamine pyrophosphate (TPP) is needed for a number of enzymes, but is rarely required alone. Whenever you need B1,you usually need FAD (B2), NAD (B3), CoA (B5), and Lipoic Acid, so just group them together: B1,2,3,5+LA.Enzymes that use B1, 2, 3, 5 + LA:
Glycolysis/TCA: PDH (X = lactic acidosis; Tx: ketogenic Leucine, Lysine + high fat diet)TCA: alphaKGDHHMP: transketolasebranched chain AADH (X = Maple Syrup Urine Disease —> severe CNS defects, MR, and death)
Related problems:
Lipoic acid is antagonized by Arsenic, which causes rice water diarrhea and garlic breath.B1 deficiency in alcoholics —> Wernicke-Korsakoff, beriberiPDH deficiency/dysfunction —> inability to continue TCA —> diversion to lactic acidosis; brain starves for energy—> neurologic defects. To keep brain from starving, Tx with ketogenic amino acids LEUCINE and LYSINE andhigh fat diet (beta oxidation of fats will produce acetyl CoA —> TCA/ketogenesis).
Vitamin B6: PyridoxineMajor pathways that use B6:
1. Glycogenolysis RLS: Glycogen —> G1P via glycogen phosphorylase2. Heme synthesis RLS: Succinyl CoA (TCA) + Glycine —> delta aminolevulinic acid (ALA) via deltaaminolevulinic
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3. histidine to histamine4. glycine to porphyrin (in heme production; no B6 = hypochromic, microcytic anemia)5. glutamate to GABA (no B6 = loss of GABA = increased excitation —> convulsions/seizures)
Vitamin B12: CobalaminCofactor when you see “Meth” in product or substrate:
1. METHylmalonylCoA —> Succinyl CoA via methylmalonylCoA isomerase2. homocysteine + N-METHylTHF —> METHionine + THF via homocysteine methyltransferase
Absorbed in the ileum (Crohn’s, gastric bypass, sprue, Diphyllobothrium latum) with IF (pernicious anemia); use Schillingtest to determine if it’s intake/absorption or lack of IF problem. B12 stores last for YEARS. Deficiency causes an increase inmethylmalonic acid (peripheral neuropathy) and homocysteine (megaloblastic anemia).
Other causes of megaloblastic anemia = folate deficiency (incr. homocysteine but not methylmalonic acid, so noneuropathy) and chronic alcoholism.
Vitamin B7: BiotinWhile Vitamin B6 is needed for DEcarboxylation reactions (amino acid production), B7 is needed for CARBOXylationreactions:
1. PropionylCoA(oddchainFA/branchedchainAA metab)—>MethylmalonylCoA via proprionylCoA carboxylase (whichgoes on to form succinyl CoA of TCA with methylmalonylCoA isomerase and B12)
2. Pyruvate(glycolysis)—>OAA (TCA) via pyruvate carboxylase3. AcetylCoA(TCA)—>MalonylCoA(FA synthesis RLS)
Avidin in egg-whites Avidly binds B7.
Vitamin C: Ascorbic Acid
1. Iron absorption and Fe2+ state maintenance2. Collagen synthesis: hydroxylation of proline and lysine within fibroblast ER <—SCURVY3. dopamine —> NE via dopamine beta hydroxylase, blocked by Reserpine
Vitamin D: the longest name with a 1: (1,25-(OH)2D3) Calcitriol = active form (PTH stimulates conversion of liver’s25OHvitamin D to 1,25-(OH)2D3 in kidney by 1alpha hydroxylase)
Vitamin E: E is for Erythrocytes; it’s an antioxidant that prevents hemolytic anemia and neurodysfunction
Vitamin K: inject newborns with it to make sure they’re oK (prevent hemorrhage); deficiency = normal bleeding time, butincreased PT and aPTTNote:
“You always want to REDUCE your CHOLESTEROL”: HMGCoA reductase = RLS for cholesterol synthesisvs. HMGCoA synthase = ketogenesis (your brain wants to SYNTHESIZE KETONES when there’s no glucose)
Glycolytic enzyme deficiency: RBCs solely depend on glycolysis for energy so no Pyruvate Kinase/PhosphoglycerateKinase (ATP generating steps) = decreased ATP —> can’t maintain membrane gradient —> cell swells —> hemolyticanemia
G6PD deficiency = (x-r) —> no NADPH = no glutathione reductase = oxidative damage = hemolytic anemia (bite cells -RBCs partially eaten by macrophages (M0’s), Heinz bodies - oxidized Hb that precipitated in RBCs)Drugs that cause hemolytic anemia in G6PD deficiency:“Prima had to take Aspirin when she INHaled her I.B.Professor Dapsone’s Sulfurous Fava bean NitroFarts.”
CGD (chronic granulomatous disease, Dx: negative Nitroblue tetrazolium reduction) = NADPH oxidase deficiency —>susceptible to Catalase+ organisms:“The recoiling Red Asp wasn’t Sorry towards the moaning Cat because it had Noheart.”
Disorders of __ metabolism:”__-kinase” is the enzyme that immediately follows the breakdown of __:
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Glucose —> G6P via Gluco(Hexo)kinaseFructose —> F1P via FructokinaseGalactose —> Gal1P via Galactokinase
Deficiencies of Fructo and Galactokinases causes MILD symptoms (respective sugars are present in urine). The SEcondsteps cause SEvere symptoms (AldolaseB and Uridyl transferase, respectively).
Watch out when you see “ALDO-” because it means something bad is going to happen:
Glucose —> Sorbitol via Aldose Reductase + NADPH (CATARACTS)Note: Sorbitol —> Fructose via SorbitolDH Galactose —> Galactilol via Aldose Reductase + NADPH (CATARACTS)Fructose1P —> Glyceraldehide and DihydroxyacetoneP via Aldolase B (FRUCTOSE INTOLERANCE)
Negatively charged amino acids:Negative experience to be burned by Acid:Aspartic acid and glutamic acidNote: Aspartate and Glutamate (as N-acetyl glutamate) are involved in Urea cycle elimination of ammonia
Amino acids with three titratable H+:Ricky Can’t Hate EDRKY C H ED
Ectoderm:Surface: what you see (epidermis, hair, nails, teeth enamel, eye lens…) + anterior pituitary (Rathke’spouch)Neuro: everything connected to the CNS (brain, spinal cord, oligodendocytes, posterior pituitary, retina,pineal gland…) + pupillary muscles
Mesoderm:Neural crest: skull and PNS stuff (skull, head muscles, dentine, pia/arachnoid, Schwann cells, DRG,cranial nerves, celiac ganglion, parafollicular C cells of thyroid…) + adrenal medulla (chromaffin cells)+ melanocytes (last to migrate)Paraxial: axial stuff (axial skeleton, skeletal muscles, connective tissue and dermis…) + dura materIntermediate: urogenital ridge (kidneys and ureters, vas deferens, gonads, uterus and uterinetubules…)Lateral: non-skeletal muscle and blood-related organs (visceral muscle and connective tissue, blood,lymph, spleen, cardiovascular system…) + adrenal cortexNote: spleen = mesoderm, but supplied by celiac artery of the foregutMESODERMAL DEFECTS = “VACTERL”: Vertebral defects, Anal atresia, Cardiac defects,Tracheo-Esophageal fistulas, Renal defects, Limb defects
Endoderm: ear/mouth to anus hollow lining and organs + bladder and vaginatympanic cavity/auritory tube, tonsils, thymus, thyroid, parathyroidlarynx, trachea, bronchi, lungsGIT, liver, gallbladder, pancreasurinary bladder, urethra, lower 2/3 vagina (this explains how patients can still have a vagina even ifthe paramesonephric ducts fail to develop)
Notochord —> nucleus pulposus of intervertebral disk
Teratogens:
“Amina couldn’t hear because she was too absorbed in her reading.”Aminoglycosides prevent mRNA reading by interfering with 16S of 30S and cause CNVIII ototoxicity(Note: Congenital Syphilis also causes CNVIII ototoxicity + Saber shins + Saddle nose + Hutchinson’s teeth +Mulberry Molars + frontal bossing)Maternal Diabetes: hyperglycemia —> incr fetal insulin —> decr lung development = can’t breathe; “mermaidsalso can’t breathe air” —>maternal diabetes causes ARDs and sirenomelia/anal atresia (also, transposition of great vessels)
Umbilical cord:
Allantois: 2 arteries, 1 vein (“arteries” is 2x as long as “vein”) AllaNtois —(urachus)—> mediaN umbilical ligamentUmbiLical artery —> mediaL umbilical ligamentUmbilical vein - ligamentum teres hepatis
Allantois —> Urachus (wk3): urachus failure to obliterate = bladder to navel connection: umbilical urination or bladderoutpouching
Omphalomesenteric duct —> Vitelline duct (wk7): duct failure to obliterate = colon to navel connection: umbilical meconiumor Meckel’s diverticulum
Heart embryology:
Primitive __ —> trabeculated (rough) portion of __Smooth atrium = sinus venosusSmooth ventricle = bulbus cordisSVC = right common and anterior cardinal veinsAorta/Pulmonary artery = truncus arteriosus, separated by spiraling neural crest migration (X = Transposition ofGreat Vessels, Tetralogy of Fallot)
“PGA open”: PG keeps DA open (decr PG —> close DA with Indomethacin, NSAIDs)
Aortic arch derivatives: ”left side of body to right side, top to bottom”
I: maxillary artery (external carotid) - @ faceII: hyoid/stapedial artery - @ midline throatIII: common and internal carotid arteries - @ midline neckIV: right subclavian artery and aortic arch - @ right/middle chestVI: pulmonary artery (inc. ductus arteriosus connection to aorta) - @ right side of heart
Neural tube defects:The longer the name, the worse the symptoms:
Occulta: spinal canal opening but no herniation, tuft of hairMeningocele: herniation of meningesMeningomyelocele: herniation of spinal cord
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Branchial cleft cyst (lateral neck) vs Thyroglossal duct cyst (midline neck, moves with swallowing because “attached totongue”)
Branchial ARCH - mesoderm: ~musclesThe nerves that supply the branchial arches are all BOTH motor and sensory:“Some(I) Say(II) Marry(III) Money(IV) But(V) My(VI) Brother(VII) Says(VIII) Big(IX) Brains(X) Matter(XI) Most(XII)” (S =sensory, M = motor, B = both)**LOOK AT THE NERVES TO FIGURE OUT WHICH MUSCLES MAKE UP WHAT ARCH** or use the following mnemonic:“Chewing made me grimace so I swallowed, choked, then called for help.”
**MC site of obstruction = Ureteropelvic junction with kidney —> fetal hydronephrosis
Genital embryology:
Male = MesonephricPemale = Paramesonephric
“Men are Wolves” = “Wolffian ducts” —> ”SEVEN” in “SEVEN UP” (Seminal vesicles, Epididymis, Vas deferens,Ejaculatory duct, N = nothing) “Women Mull over past arguments” = “Mullerian ducts” —> fallopian tubes, uterus, and upper 1/3 of vagina (lower2/3 from urogenital sinus of endoderm)
Female = default genitals
Hormone overview:
Prolactin stimulates Dopamine inhibits ProlactinProlactin inhibits GnRHGnRH —> incr FSH, LHL in LH and Leydig: LH stimulates Leydig cells to produce testosterone —> develop Wolffian ductS in FSH, Sertoli, and Sperm: FSH stimulates Sertoli cells to produce Sperm, Inhibin, and Mullerian inhibitingfactor (MIF); MIF inhibits female paramesonephric duct development
Extrophy of bladder is associated with Epispadias (faulty positioning of genital tubercle)vs. Hypospadias = more common, failure of urethral fold closure, incr risk of UTI
Microbiology:
Encapsulated organisms: (+Quellung reaction: quell makes capsules swell)“Claustrophobic Pastor Salmon Echoed Back: Yersinful Crypt-dark Strip Clubs are Pseudo-Homes to Nice Men Francis andBruce.”
“Staff of grapes” = Staphylococcus is in clustersVS. Streptococcus = pairs/chains
Spirochetes: ”Spiraling Boris Lept then Tripped”
Spiraling = SpirochetesBoris = Borrelia (Giemsa stain = aniline dye; relapsing fever = result of antigenic variation)Lept = LeptospiraTripped = Treponema (Dark Field Microscopy, VDRL cardiolipin screening, FTA-ABS confirmation)
Mycoplasma vs Mycobacteria
Bacteria have cell walls (Mycobacteria have mycolic acid in their cell walls that stain acid-fast)Plasma membranes have sterols (Mycoplasma have sterols and no cell wall)
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PASs the sugar and whip cream (PAS stains glycogen and Dx Whipple’s disease)“Legions who Sustained injuries get Silver stars”: Legionella, grow with Cysteine, silver stain; water source
Special Culture:
“Nice Homes have chocolate”: Neisseria and Haemophilus grow on Chocolate agar +:Neisseria = Thayer Martin media: Vancomycin (vs G+), Polymyxin (vs g-), Nystatin (vs fungi)Haemophilus = V (NAD+) and X (hematin)
“If I Tell-U the Corny joke Right, you’ll Laugh”:TellURight = tellurite agarCorny = CorynebacteriumLaugh = Lofflers media
“TB and J”: M. tuberculosis on lowenstEIN-Jensen agar (takes 3-4 weeks to grow, but diagnostic)
Obligate aerobes:“If No AER, Anthrax and TB can’t survive!”
No = NOcardiaAer = pseudomonas AERuginosaAnthrax = B. anthracisTB = M. tuberculosis
Note: intracellular pathogens require cell-mediated immunity (CMI), so neonates are at risk (E.G., Listeria —> neonatalmeningitis: tumbles, has endotoxin, and a narrow zone of beta hemolysis)
Bacterial virulence factors:
protein A for staph. Aureus: binds Fc of Ig to prevent opsonization and phagocytosisM protein (prevents phagocytosis) —> strep. pyogene’s rheuMatic fever (Sx: subcutaneous plaques, polyarthritis,erythema marginatum, chorea, carditis)IgA protease (to colonize respiratory mucosa) + antiphagocytic capsule (infects ASPLENIC patients b/c decr M0and IgM/complement C3 activation (E.G., Sickle Cell autosplenectomy)) + causes meningitis = SHiNNote: can also undergo “transformation” (pick up DNA from environment)
Strep pneumoH. influenza type B (B polysaccharide)Neisseria meningitidis
Exotoxin vs Endotoxin:
EXotoxin = from EXogenous source (plasmid or bacteriophage) and EXcreted from bacteria, EXtremely toxic(even small dose), EXact effects (different toxins produce different symptoms); ~heat-labileENDOtoxin (Lipid A)- ENDOgenous (made from bacterial chromosome, ENtegral to outer membrane of most g-Neg bacteria (and Listeria(G+))); heat stable; causes gENeral fever, shock/sepsis via direct MACROPHAGEresponse (binds CD14-M0 marker) —> release TNF and IL-1 (no Th involvement)
Exotoxin subclass: SUPERANTIGENS: bind directly to MHCII and TH1(CD4) —> explosive release of IFNgamma and IL2(non-specific immune response):
S. aureus = TSST-1 —> Toxic Shock Syndrome (fever, rash, shock)S. pyogenes = Erythrogenic toxin —> Scarlet fever with Toxic-Shock-like symptomsNote: S. pyogenes also has Streptolysin O (lyses RBC); Dx: Rheumatic Fever with anti-Streptolysin-O antibody(ASOAb)
E. coli ADP ribosylating A-B toxin:“Labile like Air, Stable like Ground”:
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Novobiocin resistant)alpha hemolytic Strep: ”OVeRPasS”: Optochin Viridans Resistant, Pneumonia SensitiveNote: Strep pneumonia is bile soluble (= can’t be cultured in bile, unlike gamma hemolytic Strep) beta hemolytic Strep: ”BBBR”: Beta hemolytic, group B strep (Strep agalactiae), Bacitracin Resistant (VS. groupA strep (Strep. pyogenes) = bacitracin sensitive)OR“B-BRAS” - Bacitracin: group B = resistant, group A = sensitive gamma hemolytic Strep: grows in bile; ”stomach is used to salty foods” = Enterococci grows in 6.5%NaCl (VS. Strep. bovis —> does NOT grow in 6.5%NaCl)
Exposure/PRIMARY TB:
Ghon complex = Ghon focus of LOWER lobe + peri-hilar lymph nodesYou think they are “Ghon” but they’re just waiting to become secondary TB (fibrocaseous cavitary lesion ofUPPER lobe)
gram negative: acetone + saffranin = pink
N. Meningities ferMents Maltose, has a capsule, and vaccine (gonorrhea doesn’t; NOTE**: gonorrhea’s pilusprotein undergoes antigenic variation!!)Note:-N. meningitidis = respiratory/oral spread —> meningococcemia and Waterhouse-Friderichsen adrenalhemorrhage (hypotension and DIC)-N. gonorrhea = STD—> high fever, septic arthritis, neonatal conjunctivitis, PID, Fitz-Hugh-Curtis (cervicitis—>salpingitis—>liver capsule infection)Enterobacteriae: CAPSULE = VIRULENCE FACTOR, all ferment glucose
Lactose fermenters (pink on MacConkey, blue on Eosin-Methylene blue) = “SEEK”: Serratia,Enterobacter, E. coli (blue-black metallic sheen), KlebsiellaNon-lactose fermenters = “PSSY”: Proteus, Salmonella, Shigella, YersiniaH2S producing (black on Hektoen Agar) + motile (flagellar H antigen): Proteus (swarming, urease+,staghorn ammonium struvite stones), SalmonellaNote: Salmonella and Shigella both invade mucosa —> bloody diarrhea; Salmonella is motile (w/ 2flagellar antigen variants) and produces H2S, S. typhi of Typhoid fever causes abdominal rose spotsand can remain chronically in gallbladder; Shigella is more virulent, moves by actin polymerization and60S deactivating toxin induces HUS.
oxidase + organisms: ”when you go Camping at a quiet Pasture you’d Moan More with Nice Vibrators”
V = viruses: EBV, hepatitisD = drugsR = Rheumatic fever (Dx w/ S. pyogenes ASO titers)L = Lupus and Leprosy
Chlamydia: Dx via Giemsa stain (ChlamydiA, MalariA, BorreliA + TrypanosomA)
Elementary body is Enfectious and Enters cells via EndocytosisReticulate body Replicates in cell by fission“Tricky Dick”: TRIC = serotypes D—K:
—> MC PID, cervicitis, ectopic pregnancy—> Fitz-Hugh-Curtis liver capsule infection (from spread of PID) + “violin string” adhesions of parietalperitoneum to liver—> neonatal pneumonal/conjunctivitis—> REITER’S: ”Can’t see, can’t pee, can’t climb a tree” = conjunctivitis, urethritis, arthritis
VS. trAChoma = serotypes A-C —> blindnessVS. L1-L3 = Lymphogranuloma venerum: ulcers —> lymphadenopathy, rectal strictures mistaken for PIDTx: mothers and infants with Chlamydia with Erythromycin estolate, though there is a risk of maternal acutecholestatic hepatitis
My = Mycoplasma (IgM = cold agglutinins —> agglutinate or lyse RBCs; grown on Eaton’s agar; Tx: tetracyclineor macrolide)Clammy = Chlamydia (Tx: tetracycline or macrolide)Legion = Legionella (Tx: macrolide)
Fungi:
Dimorphic: ”cold = mold, heat = yea(s)t” + “Blast His Cock” = East Coast to West Coast (Tx: Ketoconazole)
Blast = Blastomycosis = east of Mississippi RiverHis = Histoplasmosis = Mississippi River and Ohio riverCock = Coccidiomycosis = Southwest US: CA, AZ
“His Woodpecker Blasted Wood into Dust”:
His Woodpecker = Histoplasmosis from bird/bat droppings = macrophage filled with round yeast; “Histo Hideswithin macrophages”Blasted Wood = Blastomycosis in wood = Broad-Based-Budding fungi; the handle of a baseball bat looks like it’sbudding off the shaft)Dust = Coccidiomycosis = large spherule filled with endospores; “barrel-shaped arthroconidia”; “Cock is filled withSperm, Coccidio is filled with Spores”
DNA viruses: ”HeHe PoPa ParAde”: first three = enveloped
He = HerpesHe = HepaDNA (HBV; carries special RT: DNAdDNAp)Po = Pox (smallpox, molluscum contagiosum; carries DNAdRNAp and replicates in cytoplasm)Pa = Papilloma (HPV: (6,11): condylomata acuminata/genital warts, koilocytes=squamous cell with perinuclearcytoplasmic halo; (16,18): CIN; anal squamous cell CA) + Polyoma (JC, PML demyelinating encephalopathy)Par = Parvo = B19/Erythema infectiosum (ssDNA)Ade = Adenovirus (swimming pool conjunctivitis, gastroenteritis)
Herpes: ”2 Simple Chickens Barred Sight from Rose Patches”
2 Simple = HSV1,2Chickens = HHV3: Chicken pox (truncal rash —> extremities; lesions of different age)/shinglesBarred = HHV4: EBV (mono, Burkitt’s, large cell non-Hodgkins @ Waldeyer’s ring, nasopharyngeal CA, hairyleukoplakia on lateral tongue; infects B cells via CD21-EBV receptor)Sight = HHV5: CMV (retinitis, negative mono-spot mono, TORCH; both intranuclear “owl-eye” and cytoplasmicinclusion bodies)Rose = HHV6: Roseola/Erythema subitum (high fever —> rash)Patches = HHV8: Kaposi-sarcoma
RNA viruses:
+RNA = “PiToFlaCoCa”: middle 3 = enveloped
Pi = PicoRNA = PECoRnA:P = Polio (both colonizes nasopharynx and causes meningitis like Hib —> myalgia and paralysis)E = Echovirus: swimming pool aseptic meningitis/myocarditisC = Coxsackie: aseptic meningitis/myocarditis, hand-foot-mouth (palm and sole vesicular rash alsoseen in secondary syphilis and Rickettsial Rocky Mountain Spotted Fever)Rn = RHINOvirus (stuffy NOSE from common cold)A = HAV
To = Toga“Togas Rubelled against Germany with TORCHs” = Togavirus, Rubella, German Measles (post-auricular occipital lymphadenopathy, fine truncal rash), TORCH infection (blueberry muffin rash,deaf, cataracts, PDA)VS. Rubeola: ”a PARA Ruby weasles caught SSPEcial measles” = Paramyxo, Rubeola, SSPEcomplication, MeaslesVS. Roseola: HHV6 (high fever/seizures —> truncal rash)
Fla = Flavi (HCV, yellow, dengue, St. Louis, West Nile)yellow fever causes yellowing skin (jaundice) and black vomit
Co = Corona (common cold, SARS)Ca = Calici = “Norwalk, CA Cruises” (gastroenteritis from cruises)
-RNA = all enveloped + RNAdRNApol
Reovirus = dsRNA, segmented: ROTAvirus = right out the anus (childhood winter gastroenteritis)HepEvirus = HEV (water epidemic, only dangerous if pregnant)Orthomyxo: O for octo = 8 segments —> reassortment = Influenza pandemic (Ag shift)Paramyxo = PaRaMyX2o:
P or PARA = Parainfluenza = croupR = RSV; Tx: Ribavirin (vs. IMPDH of purine synthesis; AE: hemolytic anemia, teratogen) or “RSVP Liz”where “P Liz” = Palivizumab which binds Paramyxo F protein, preventing respiratory epithelial syncytiaformationMx2 = Measles and Mumps:
(before surgery/dental), syphilis prophylaxis)3. ‘Nam = AztreoNAM (binds PBP3 for Pencillin-allergy pts; vs “SEEK Pseudomonas”- Serratia, E.coli,
Enterobacter, Klebsiella, Pseudomonas), MeropeNEM and ImipeNEM+Cilastatin (Merpenem/Imipenemvs. everything, esp. Enterobacter, but causes SEIZURES; Cilastatin inhibits renal dihydropeptidase I toinhibit renal tubule Imipinem inactivation)
2. blocks PG synthesis:1. Bacitracin (vs. S. pyogenes (GAS))2. Vancomycin (binds D-Ala-D-Ala and interferes with PG-elongating transglycosylase
1. vs. resistant G+ inc, MRSA and C.diff!!2. “TON of AE’s”: T = thrombophlebitis, O = ototoxic, N = nephrotoxic + Red Man (slow infusion
and pretreat with anti-histamine to prevent)) 3. vs. g- by disrupting cell membranes: Polymyxins (neosporin) - detergent vs cell membrane; AE: neurotoxicity,
acute renal tubular necrosis4. vs. G+/g- by blocking folate —> no nucleotide synthesis (megaloblastic anemia):
1. Sulfonamides (comp inhibit PABA for dihydropteroate synthetase —> no DHF synthesis; AE: infantkernicterus (avoid in pregnancy), SJ, nephrotox, G6PD hemolysis)
1. Sulfamethoxazole-Trimethoprim (TMP-SMX) vs UTI, P. jirovecii prophylaxis in AIDS2. Sulfadiazine+Pyrimethamine vs Toxoplasma3. Sulfadoxin+Pyrimethamine vs Malaria
2. Trimethoprim, Pyrimethamine (DHF—Xdihydrofolate reductase—>THF like Methotrexate)5. vs. URIs (S. pneumo), UTIs, GITIs, and Pseudomonas by blocking topoII (DNA gyrase) and IV: Fluoroquinolones
(AE: cartilage/tendon rupture, incr QT, G6PD hemolysis)6. vs. Mycobacterum, prophylaxis for Hib and N.men by blocking DNAdRNAp = no transcription: Rifampin7. Protein synthesis inhibitors: ”Quinn get in Line and take 50MC’s to 30ST”:
conformation for better Quin-binding2. Linezolid: binds 50S P-site and blocks 70S assembly
Tx: Quin-Dalfo and Linezolid is good for ALL RESISTANT BACTERIA: VRE, MRSA 3. MACrolidEs (“ACE”mycin = Azithro, Clarithro, Erythromycin): “MacroLIDEs prevent sLIDing of
mRNA” = inhibit translocation by binding to 23S of 50S1. Tx: “PUS” - atypical Pneumonia, URI’s, STDs2. AE: PROLONG QT, acute cholestatic hepatitis, incr serum concentration of
warfarin3. resistance via METHYLATION OF drug binding site on 50S rRNA
Note: Azithromycin = AIDS MAC prophylaxis4. Chloramphenicol: “ChLorAMPS Peptidyltransferase” - prevents peptide bond formation; Tx:
meningitis (H. flu, N. men, Strep. pneumo); AE: aplastic anemia and gray baby; resistance viaACETYLATION
5. Clindamycin: also blocks peptide bond formation at 50S; vs. ANAEROBES (B. fragilis, C.perfringens) like Metronidazole; AE: Pseudomembranous colitis like Ampicillin
2. 30ST = Streptomycin (aminoglycosides), Tetracycline block 30S1. “Amina didn’t hear the GNATS because she was busy reading”:
Aminoglycosides (GNATS = Genta, Neo, Amikacin, Tobra, and Stretomycins) causeototoxicity (and nephrotox) and act by binding to 16S and causing mRNA misreading; vs. g-rods; REQUIRES O2 UPTAKE so ineffective against anaerobes; resistance via modification of30S (acetylation, etc)
2. Tetracyclines block TRNA from binding A-site and discolors Teeth/bones1. caTion-chelator, do NOT take with antacids, milk, or iron-containing prep!2. AE: photosensitivity (“SAT for photo” - sulfonamides, amiodarone,
Amphotericin B:AmphoTEARicin TEARS holes in fungal membrane (binds ergosterol and forms pores)AmphoTERRible: AE: fever/chills, hypotension, nephrotox, arrhythmia, anemia, IV phlebitis
Antiviral:
“ARM2 cure A FLU” = Amantadine Rimantidine block M2 protein (viral uncoating) vs. Influenza A; AE: AtaxiAHerpes = “Cyclovir’s” (virally activated guanosine analogs) + Trifluridine (thymidine analog)CMV = “Cid’s Gang loved seeing Foamy Scarlet” = Cidofovir (Cytosine analog + Probenicid to prevent excretion),Ganciclovir (intraocular implant), Fomivirsen (intraocular injection, anti-sense RNA therapy), FOScarnet (unlikeganciclovir, doesn’t require thymidine kinase activation; pyroFOSphate analog that directly inhibits DNApol)
HIV therapy:
Protease inhibitors = “navir’s” (AE: GI intolerance, hyperglycemia, lipodystrophy, cyp450 inhibitor)NRTI’s: ”Abe Did Embark on a L-AZy Start”
NNRTI’s: ”Move to Delaware? Effin’ Never!”DelavirdineEfavirenzNevirapine
FUsion inhibitor = enFUvirtide (gp41 binder)
Interferons: activates NK cells; AE: Neutropenia
IFNalpha - “alpha B C” —> Tx: HBV, HCVIFNbeta - “PMS sounds like BMS” —> Tx: Multiple SclerosisNOTE**: alpha and beta IFNs decr viral replication and incr antiviral protein synthesis that impairs viral mRNAtranslationIFNgamma - “G in gamma is for cGd” —> Tx: Chronic Granulomatous Disease (NADPH oxidase deficiency)NOTE**: IFNgamma incr MHCI and II expression, activates M0 —> TNFalpha, IL1, IL6
Immunology:
B-cells are always found in (white) Follicles closer to the outside of the LN or spleenVS. T-cells are found in the deeper medulla(LN)/PALS(spleen)
Lymph drainage:
rectum above pectinate line = internal iliacumbilicus to legs (inc, superficial genitals and anal canal below pectinate line) = superficial inguinaltestes = para-aortic
MHC I and II: ”Rule of 8’s”
1*8 = MHCI x CD8 = 82*4 = MHCII x CD4 = 8
Natural Killer cells: detects MHCI
“Gotta KIL to survive” (KIR + KIL = survive)KIR only = release perforins and granzymes —> apoptosis
Antibody cleavage:
Papain cleaves Ab into 3 pieces: Pa Pa In (evenly splits into 3)Protease cleaves Ab into 2 pieces: Prot Ease (evenly splits into 2; complement can still bind hinge)
Cytokines: ”Hot T-Bone stEAk”
IL1 (and IL6): hot = fever; secreted by M0IL2: T = T-cell proliferation; secreted by Th1IL3: Bone = Bone marrow stimulation (acts like GM-CSF); secreted by T cellsIL4: E = IgE (and IgG) class switching; secreted by Th2IL5: A = IgA (and eosinophil) production; secreted by Th2
IL8: ”8” looks like multilobed nucleus of neutrophil = PMN chemotaxisLTB4’s “B” also looks like neutrophil multilobed nucleus
Immunosuppression Rx vs. IL2: ”(IL)2 Pro-Cyclists Secreted Tacks in Response to Serious/Sirius Dax”; prevent transplantrejection
vs. production: Cyclosporin (via inhibit calcineurin)vs. secretion: Tacrolimus (via binding FK-protein)vs. response to: Sirolimus (via MTOR)vs. receptor: Daclizumab
**NOTE: MCC SCID = defective IL2 receptor > ADA deficiency; decr T —> decr B activation: all types of recurrentinfections (viral/bacterial/fungal)
Rx vs TNF: Tx: Rheumatoid arthritis
vs. TNF: Infliximabvs. TNF receptor: Adalimumabfake TNF receptor: Etanercept
Complement:
C_a for anaphylaxis (histamine release —> edema —> hypotension, anaphylaxis)C_b for binding bacteria (opsonizes and forms pores)
“low 3 causes 3”: C3 deficiency causes HSRIII (immune complex deposit), seen especially in glomerulonephritis;susceptible to S. pneumo and Hib —> severe recurrent pyogenic sinus and respiratory tract infections**Remember “SHiN”: S(trep. pneumo) + Hi(b) = C3 deficiency; N(eisseria) = C5-C9/MAC deficiency
Passive immunity: ”To Be Healed Rapidly” - Tetanus Botulism HBV, Rabies/(RSV in premies every winter month)
Immune deficiencies:
Bruton’s agammaglobulinemia = (x-r) Boys with BTK (tyrosine kinase) defect —> Blocked B-cell differentiation:
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recurrent Bacterial infection after 6 months (when mom’s IgG disappears) b/c no Ig’sSelective Ig(A) deficiency: milk Allergies, blood product Anaphylaxis, giardiA infections; IgA is missing in mucusso recurrent sinus and lung infections**Note: IgA deficiency also seen in Ataxia-Telangiectasia:defective DNA repair enzymes, sensitive to ionizingradiation, cerebellar atrophy —> ataxia, spider angiomas (telangiectasias); assoc. w/ lymphomas and acuteleukemiasHyper-IgE/Job’s Syndrome: ”I’m Hyper Excited for my FATEd Job”
Chediak-Higashi (a-r): ”Grandpa Al couldn’t eat Eastern food with his fingers.”Grandpa = Gram positive cocci infections: Staph and StrepAl = partial albinismcouldn’t eat = defective microtubules = defective phagocytosis and lysosomal fusionEastern = Higashi (“higashi” means “East” in Japanese)with his fingers = peripheral neuropathy
Pathology:
Proto-oncogenes: tumor promoters; damage one allele —> gain of function (VS. tumor suppressors need to damage bothalleles to lose function)“Mike’s sis returned with her2new breasts that she was able to-grow-faster b/c of herbs.”
Mike = myc: C-myc - Burkitt’s, N-myc - adrenal Neuroblastoma, L-myc - small cell lung CAsis: astrocytoma, osteosarcomareturned = ret: MENIIher2new = Her2/neu: breast cancerwas = ras: colon, bladder, lung, pancreas, renal CAable = abl: CML, ALL (“ALL able CaMeLs are from Philadelphia t(9;22)”)to-grow-faster = TGF: astrocytoma, HCCb/c = bcl2: follicular lymphoma herbs = ERB-B1,2: ERB-B1 - lung squamous cell CA, ERB-B2 - breast, ovarian, gastric CA
Psammoma bodies: concentric Ca2+ spheres; looks like thumbprint; ”PSaMMoma”:
P = papillary thyroid tumorS = serous cystadenocarcinoma of ovaryM = mesotheliomaM = meningioma
ESR (marker of inflammation): inflammatory product fibrinogen coats RBC causing aggregation —> weight pulls RBC down= fall at faster rate in test tube
incr/faster ESR = inflammation: infection, cancer, pregnancy, SLE…decr/slower ESR = “de-prESsed Heart is Sick from Too Much Blood.”
Heart = CHFSick = Sickle CellToo Much Blood = Polycythemia
Pharmacology:
Kompetitive inhibitors incr Km, decrease affinity/potency (amount of drug needed for effect); sigmoid effect curve shifts right;Lineweaver-Burke lines cross at Y-axis(VS non-competitive inhibitors decr Vm, decrease efficacy (maximal effect of drug); sigmoid effect curve’s vertical maximumeffect is reduced; Lineweaver-Burke lines join at X-axis)
Zero-order elimination: constant amount of drug eliminated per unit time = “PEA” - Phenytoin, Ethanol, Aspirin
Urine pH and drug elimination: medicine gets trapped in opposite urine pH:
acid (phenobarb, MTX, TCA, aspirin) trapped in basic bicarbonate**Note: Acetazolamide alkalinizes urine by getting rid of bicarbonate; Tx: cysteine stones and altitude sickness(hyperventilation —> respiratory alkalosis)base (amphetamine) trapped in acidic ammonium chloride
Phase I vs Phase II metabolism: ”1 red ox went 2 conjugate polar bears.”
DiarrheaUrinationMiosisBradycardiaBronchospasmExcitation of skeletal muscle and CNSLacrimationSalivationSweating
Atropine poisoning: ”what would happen if you got lost in the desert: Hot, Dry, Red, Blind (cycloplegia), Mad (delirium),urinary retention(/constipation)”
Hexamethonium: ”Put a Hex on reFLEX bradycardia” - Hexamethonium prevents NE reflex bradycardia by blocking allNicotinic receptors (ganglion blocker inhibits Na/K ligand-gated channels)
DeFERoxamine Tx’s Fe (iron)“Children Suck on Lead pencils”: Succimer Tx’s Lead poisoning in children (Tx is CaEDTA in adults)DiMERcaprol Tx’s MERcury, arsenic, gold“Copper Penny”: Copper, arsenic, gold Tx w/ PENIcillamineNITRoprusside turns into Cyanide which is Tx’d w/ NITRite, hydroxocobalamin, and thiosulfateMETHylene blue and VitC Tx’s METHemoglobinETHANOL Tx’s mETHANOL poisoning“Heparin’s H looks like a Proton”: PROTamine Tx’s Heparin toxicity
Drug reactions:
TCA’s “3 C’s”: Cardiotoxicity, Convulsions, ComaCutaneous flushing: ”VANC” = Vancomycin, Adenosine, Niacin, Ca2+ channel blockersDilated cardiomyopathy = Doxorubicin and DaunorubicinTorsades de Pointes: ”The Method to get 31Awesome QT’s is to wear a Halo and Risper that you bought aMacro-PIe from Quinn.”
Method = Methadone31Awesome = Class III, Class Ia antiarrhythmicsHalo = haloperidolRisper = risperidoneMacro = macrolidePI = HIV protease inhibitorsQuinn = Chloroquine/Mefloquine
Aplastic anemia: ”Chlora SAID “Ptuey” to Meth”:Chlora = ChloramphenicalSAID = NSAIDPTUey = PTU (antithyroid)Meth = Methimazole (antithryoid)
Hemolysis in G6PD: ”Prima had to take Aspirin after INHaling her I.B.Professor Dapsone’s Sulfurous Fava BeanNitrofarts”
SLE-like syndrome: ”SHIPP”SulfonamidesHydralazine (“Hydra’s neck Loops (Lupus) around in circles”)INHPhenytoinProcainamide
Disulfiram-like reaction: ”Drunk Ceph said he was Pro-Car (okay to drive) at Night, but to avoid a Gruesomeaccident, Chlora made him Suffer the Metro.”
Ototoxicity/Nephrotoxicity: ”Mice use Platinum earring Loops to crawl into your Ear and make you deaf”Mice = -mycins = aminoglycosides and vancomycinPlatinum = CisplatinLoops = Loop diuretics
p450 interactions:p450 inducers: ”Queen Barb’s riFamily induced Saint John to eat a Pheny-looking Greasy Carb”
holosystolic = all regurg’s + VSDmurmurs that increase with breathing:
rIght murmurs increase with InspirationlEft murmurs increase with Expiration
“Wolf = Lone Canis” - Wolff-Parkinson-White is treated with amiodaRONE and ProCAINamide
AV blocks:“First, a girl stays out ‘til 12 even though her curfew is 10.”“Then, the teenager stays out later and later, ‘til her mom throws a fit.”“Afterwards, despite the teenager being good, the mom throws random fits probably because of menopause.”“Finally, the young woman is old enough to whatever she wants separately from her parents.”
1st degree: increased PR2nd degree:
Type 1 Wenckebach: incr PR until QRS dropType 2: random QRS drop
3rd degree: PR and QRS = independent rates; seen in Lyme disease
DiGeorge “Tet’s”: TETralogy of Fallow + TETany from hypocalcemia (lack of parathyroids) (also, truncus arteriosus)
“PGA open”: PGE kEEps PDA open (PGE1 analogs: Alprostadil, Misoprostol); close with Indomethacin
Evolution of MI: ”4 and death are both pronounced “shi” in Japanese”
Initially: nothing4 hours-4days later: PMN’s, coagulative necrosis, risk of arrhythmia (esp. V-fib)4-10 days later: M0’s thinned walls —> increased risk of rupture and tamponade>10 days: risk for ventricular aneurysm (bulging scar because fibrosis made it lose its ability to contract) <—ventricular remodeling can be prevented with ACE-I’s
Bacterial endocarditis: ”FROM JANE”:
FeverRoth spots: round retinal white spots surrounded by hemorrhageOsler’s nodes: tender raised red lesions on fingers and toe padsMurmur (new)Janeway lesions: non-tender small red lesions on palms and solesAnemiaNail-bed (splinter) hemorrhageEmboli
IVDA = right-sided bacterial endocarditis: ”don’t TRI drugs” (tricuspid valve)
SLE causes LSE (Libman Sacks endocarditis with warty sterile vegetations on both sides of valve, assoc. w/ mitral regurg)
Rheumatic heart disease of S. pyogenes (beta-hemolytic, bacitracin-sensitive Strep): ”AAAAAA”
group A Strepautoimmune (Ab to antiphagocytic M protein —> MVP —> Mitral Stenosis), feverAschoff bodies (granulomas with giant cells) = subcutaneous nodulesAnitschkow cells (activated histiocytes)elevated ASO titers and ESRmigratorypolyArthritis
Adrenal steroids: ”In an enzyme deficiency, if the first digit is a 1, then the patient will be hypertensive. If the second digit isa 1, then the patient will look male.”
see Homer-Wright pseudorosettes and incr HVA (Dopamine derivative) in urinescenario: ~2yo with retroperitoneal ab mass presents with HTN hypotonia, myoclonus, and non-rhythmicconjugate eye movements (opsoclonus-myoclonus)mass may invade into an intervertebral epidural space and look like a “dumbbell”
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Neoplasms (e.g., breast cancer = osteolytic)Zollinger-Ellison syndrome (pancreatic tumor —> incr gastrin; associated with MENI (parathyroid tumor)Excess vitamin DExcess vitamin A (incr bone resorption —> incr Ca2+)Sarcoidosis (or granulomatous disease)
Hyperparathyroidism:
Primary: Osteitis fibrosa cystica = “stones, bones, and groans” = kidney stones, brown bone tumors, weaknessand constipation; incr cAMP in urineVS Secondary: Renal osteodystrophy = renal disease —> decr Vit D —> decr Ca2+ —> incr PTH —> bonelesions
Hypocalcemia signs:
C = Chvostek sign = Cheek tapping —> facial muscle ContractionT = Trosseau’s sign = Tight BP cuff —> hand Tetany (spasm)
Dexamethasone vs Demeclocycline vs Desmopressin:
Dexamethasone = steroid to Dx ACTH disease/syndromeDemecloCYCLine = tetracycline ADH antagonist vs CYCLophosphamide-induced SIADH; Tx: SIADHDesmoPRESSIN = vasoPRESSIN (ADH) analog; Tx: central Diabetes insipidus(Note: nephrogenic DI is treated by hydrochlorothiazide (Ca2+ sparing diuretic), indomethacin (decr renal bloodflow), or amiloride (K+ sparing aldosterone receptor antagonist diuretic that closes Na+ channels that alsoreabsorbs Li to Tx Li-induced DI)
Brunner’s (submucosal, alkaline mucus secreting) glands = DuodenumIleum = Peyer’s Patches (M cells take up antigen; also location of IgA-secreting plasma cells)Note: Shigella is taken up by the M-cells of Peyer’s Patches; viruses like Adenovirus may invade Peyer’s Patchesand cause intussusception; Sabin (live Polio vaccine) increases IgA immunity
Enteric nerve plexuses: ”AUerbach is on the AUtside, MeiSSner’s is SSubmucosal”
Auerbach’s = Myenteric = coordinates Motility by being wedged between the inner/circular and outer/longitudinalmusclesMeissner’s = Submucosal = regulates Secretions, blood flow, and absorption between mucosa and inner/circularmuscles
Defect in Auerbach’s causes AchalasiaLack of both Auerbach and Meissner’s due to failure of neural crest cell migration causes Hirschsprung’s CongenitalMegacolon, assoc. with Down Syndrome (see failure to pass meconium, like in Cystic Fibrosis)
Portosystemic anastomoses:The mnemonic is from Systemic (IVC) to Portal (Celiac, SMV, IMV) veins:”MI Superior’s an Ass. He makes me feel Inferior about my Superficial appearance by poking near my Belly-button so IEat Less.”
Rectal anastomoses: (X=hemorrhoids)”MI Superior is an Ass”:Systemic: Middle and Inferior Rectal
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toPortal: Superior RectalUmbilical anastomoses: (X=caput medusae)”Inferior about my Superficial appearance by poking near my Belly-button”:Systemic: Inferior, Superficial EpigastrictoPortal: ParaumbilicalEsophageal anastomoses: (X=esophageal varices)”Eat Less”: (X = esophageal varices)Systemic: Esophageal (azygos)toPortal: Left Gastric
Liver anatomy: ”1ABC”
“1ABC”:Zone 1 = Apical surface of hepatocytes face Bile Canaliculi = periportal zoneAlso, when you think of “ABC”, you should think of Hepatitis A, B, C…Zone 1 = first affected by viral hepatitis because closest to hepatic artery (Remember: Portal triad = bileduct, hepatic artery, and portal vein)
“The 3rd letter in the alphabet = C”:Zone 3 = Centrilobular (periCentral vein) = where blood drains into the hepatic veinbecause it’s so far from the hepatic artery, it’s the first place to suffer from ischemiaalso, since blood pools in veins, you can think of drugs/poisons pooling there, too
Bottom line: Zone 1 = susceptible to viruses, Zone 3 = susceptible to drugs/ischemia
Femoral region: ”NAVEL with the Venous near the Penis”
Lateral to medial: Nerve, Artery, Vein, Empty space, (deep inguinal) Lymphatics/Lacunar ligamentNote: femoral sheath does not contain femoral nerve
Inguinal canal: ”INternal (deep) inguinal ring = INdirect hernia that may go INto the scrotum” = lateral to inferior epigastricvesselsVS. ”an alien Directly bursting from your stomach” = direct hernia = protrudes from abdominal wall medial to inferiorepigastric vessels:
or “MD’s don’t LIe”: Medial = Direct, Lateral = Indirect
“Fem-Fem”: femoral hernias occur more often in females (and is the leading cause of bowel incarceration)
GI secretory products:
“IF you PARTY too hard, you’ll vomit out a lot of GASTRIC ACID.”:Parietal cells secrete IF (intrinsic factor) and HCl (gastric acid)“Pep-pep to the Chief”:Chief cells make Pepsin
Vitamin/Mineral absorption:
Duodenum: ”FED” = Fe (iron) in DuodenumJejunum: ”The Jester is a Fat Fool” = Jejunum absorbs most Fats and FolateIleum: The ileum is the last part of the small intestine; it’s where you say “Bye Bye to the SI”: Byle acid, B12/IF isreabsorbed in the Ileum
Bilirubin:
Rules of thumb:The two-named diseases don’t go togetherThe one named diseases are milder
INdirect = UNconjugated = water INsoluble: Crigler-Najjar, Gilbert = “KING KONG” —> “CING CUNG” —> Criggler-Indirect/Unconjugated-Najjar-GilbertYou get Crigler-Najjar/Gilbert’s when you’re unable to conjugate bilirubin into a water-soluble/excretable form ~Glucuronyl transferase deficiency Direct = conjugated = Water soluble: Dubin-Johnson, Rotor’s = ”Dubin-Johnson called Rotor-rooter to fix his WaterPipes.”You get direct bilirubinemia when there’s a problem with bile Pipes/excretion (E.G., biliary tree obstruction)Note: Dubin-Johnson is “worse” than Rotor’s in that the liver is pigmented black
Achalasia: ”AABBCC”
Achalasialoss of Auerbach’s myenteric plexusBirds beak on Barium swallowassociated with Chaga’s and CREST
Boerhaave syndrome = “Been-Heaving”; transmural complication of Mallory-Weiss
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BARRett’s esophagus = Becomes Adenocarcinoma, Results from Reflux
Squamous cell = Spread out worldwide (most prevalent worldwide); upper 2/3s (where striated muscle can befound)Adenocarcinoma = most prevalent in America (lower 1/3, location of pure smooth muscle)
Gastritis:
Acute gastritis (erosive):“Burned by Curling iron”: Curling’s ulcer = stress ulcer from burns:decr plasma volume —> sloughing of gastric mucosa “Cushion the brain”: Cushing’s ulcer = stress ulcer from head injury:incr ICP —> incr vagal stimulation —> incr ACh —> incr H+)
Chronic gastritis (non-erosive): ”AB-pairing”Type A (fundus/Body) = Autoimmune/Anemia:AutoAb to parietal cells, pernicious anemia (Ab to IF), achlorhydriaType B (Antrum) = Bacterial:H.pylori infection (duodenal > stomach ulcer), increased risk of MALT lymphoma
Peptic ulcer disease:
Gastric ulcer pain = Greater with foodDuodenal ulcer pain = Decreases with food (will see hypertrophy of Brunner’s glands and clean “punched out”margins unlike carcinoma raised/irregular margins)
Inflammatory bowel disease (IBD): Crohn’s vs Ulcerative Colitis
Crohn’s: ”A Creepy Fat old Crone (Granny) went Skipping on Cobblestones while pumping her Arthritic Fist in theair.”
Creepy Fat = Creeping fatCrone = Crohn’s disease(Granny) non-caseating GranulomasSkipping = transmural Skip lesionsCobblestone = Cobblestone mucosaArthritic = Migratory polyarthritisFist = Fistulas“Gum to Bum” lesions and extraintestinal manifestations (systemic) like erythema nodosum (~shins),ankylosing spondylitis, and uveitisNote: this is disordered response to intestinal bacteria
Ulcerative colitis: ”If you have a Lead Pipe jammed up your Rectum, you’ll get Bloody Diarrhea.”Lead Pipe = loss of haustra leads to “lead pipe” appearance on imagingRectum = UC always involves the rectal mucosa/submucosa and procedes continuously up unlikeCrohn’s which tends to spare the rectumBloody diarrhea (another trait not shared with Crohn’s)Note: this is autoimmuneUC is also associated with friable pseudopolyps, pyoderma gangrenosum, and primary sclerosingcholangitis
Meckel’s diverticulum: ”Rule of 2’s”
2 inches long2 feet from ileocecal valve2% of population2yo (or younger)2 types of ectopic epithelia: gastric or pancreatic
Colonic polyps: ”VILLous = VILLainOUS” because villous polyps are more likely to be malignant (villous > tubulovillous >tubulous)
Colorectal cancer (CRC):
Familial adenomatous polyposis (FAP): ”polyposis” = thousands of polyps; FAPCancer involves APC gene;always involves rectumVS. HNPCC/Lynch which doesn’t have many polyps and involves the PROXIMAL colonGardner’s syndrome = “Gardeners Grow all kinds of things”: Gardner’s = FAP + osteomas + lipomas/soft tissuetumors + retinal hyperplasiaTurcot’s syndrome: ”TURcot = TURban”; FAP + malignant CNS tumor (medulloblastoma)
Presentation of CRC: Think of the colon as a funnel that shrinks towards the anus (and also that visceral nerves don’t haveas many localized pain receptors as the anus):
Al = AluMINIMUM amount of feces: constipationMg = Must Go to the bathroom: diarrhea
And this was where I stopped. If you have specific questions, feel free to ask me (but don’t forget to leave me a way tocontact you!).
I hope this list comes in handy for someone. Good luck with the exam!
Update (3/31/13): Unfortunately, I’m very busy with clerkships/shelves and studying for the Step2CK, so I won’t be able topost the rest of my mnemonics, but my Ask box is always open for advice! ^^ Thanks for understanding.