Anatomy, Biochemistry Mnemonics


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Concised approach to long term memory of location and names of anatomical structures...biochemical enzymes....................

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Anatomy, Biochemistry Mnemonics

  1. 1. Anatomy Mnemonics BY ORIBADAN LANGOYA, MBchB,MAKchsBones of the WristSome Lovers Try Positions That They Cannot HandleSlowly Lower Tillys Pants To The Curly HairsScaphoid, Lunate, Triquetrum, Pisiform, Trapezium,Trapezoid, Capitate, HamateBrachial PlexusRandy Travis Drinks Cold Beers Robert Taylor DrinksCold BeerRoots, Trunks, Divisions, Cords, BranchesBranches of the Brachial Plexus (In order from mostlateral to most medial)My Aunt Raped My UncleMusculocutaneous, Axillary, Radial, Median, UlnarExtraocularmotor musclesLR6 (SO4) LR6: Lateral rectus --> VI abductensSO4: Superior Oblique --> IV TrochlearAll other extraocularmotor muscles are CN IIIBranches of the Facial NerveTen Zebras Bought My CarTen Zebras Bit My CockTwo Zulus Buggered My CatTo Zanzibar By Motor CarTemporal, Zygomatic, Buccal, Masseteric, CervicalInnervation of phrenic nervec345 keeps the phrenic alivec345 keep the diaphragm aliveLong thoracic nerve innervates serratus anteriorc5-6-7 raise your arms to heavenRelationship of Thorasic duct to Esophagous andAzygousThe duck is between two = thoracic duct 2 gooses = azyGOUS andesophaGOUSAttachments of Pectoralis Major, Teres Major andLatissimus DrosiA 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 bicipitalgroove. The "lati" is between two "majors."Innervation of the PenisParasympathetic puts it up; sympathetic spurts it out.Point Shoot ScoreParasympathetic, sympathetic, somatomotorLateral and Medial Pectoral NerveLateral is less, medial is more.Lateral pectoral nerves goes through pectoralis majorwhile medial pn goes though both pectoral major andminor.Layers of the epidermisGranpa Shagging Grandmas Love Child.Brent Spiner Gained Lieutenant CommanderGerminativum or Basale, Spinosum, Granulosum,Lucidum, CorneumTarsal bones"Tall Californian Navy Medcial Interns Lay Cuties":
  2. 2. · In order (right foot, superior to inferior, medial tolateral): Talus Calcanous Navicular Medial cuneiformIntermediate cuneiform Lateral cuneifrom CuboidBronchopulmonary segments of right lung"A PALM Seed Makes Another Little Palm":· In order from superior to inferior: Apical PosteriorAnterior Lateral Medial Superior Medial basal Anteriorbasal Lateral basal Posterior basalHead & NeckCRANIAL 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-HypoglossalOn Old Olympus Towering Tops, A Finn And GermanViewed Some Hops (older and cleaner)Oh Oh Oh To Touch And Feel A Girls Vagina AndHymen (newer and, well ...)Which cranial nerve is Sensory, Motor, or Both- SomeSay Marry Money, But My Brother Says Big BreastsMatter MoreBRANCHES OF FACIAL NERVE: Temporal,Zygomatic, Buccal, Mandibular, CervicalTen Zebras Beat My CockTwo Zulus buggered my cat –(for the sicker, amongstyou!)You have I nose. You have II eyes. (I - Olfactory; II --Optic)Standing Room Only -Exit of branches of trigeminalnerve from the skull SV1 -Superior orbital fissure, V2 -foramen Rotundum,V3 -foramen OvaleFor the order of nerves that pass through the superiororbital fissure:"Lazy French Tarts Lie Naked inAnticipation."(Lacrimal, Frontal, Trochlear, Lateral,Nosociliary, Internal,Abducens)2 Muscle of mastication- Lateral Lowers- lateralpterygoid is the one that opens the jaw4 Muscles of Mastication MTPP( which could be readas "Empty Peepee") -masseter, temporal, lateral andmedial pterygoids --Arteries as they come off the external carotid:Superior thyroid, Ascending pharyngeal, Lingual,Facial, Occipital, Post Auricular, Superficial temporal,MaxillarySome Anatomists Like making babiesing, OthersPrefer S & MSome Angry Lady Figured out PMSInnervation of Extraocular motor Muscles: LR6 SO4 3LR6--Lateral rectus--> VI abductensSO4--Superior Oblique--> IV Trochlear3--The remaining 4 eyeball movers = III OculomotorABCS of the aortic arch!Aortic arch gives off the Bracheiocephalic trunk,the left Common Carotid, and the left
  3. 3. Subclavian arteryBRACHIAL PLEXUS: Roots, Trunks, Divisions,Cords, BranchesRobert Taylor Drinks Cold Beer.CERVICAL SPINAL NERVES:c345 keeps the phrenic alive (innervation of phrenicnerve) c345 keep the diaphragm alive (innervation ofdiaphragm)c5-6-7 raise your arms to heaven (nerve roots of longthoracic nerve innervate serratus anterior)Cranial BonesAnnoying, arent 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 isbetween two gooses (duck = thoracic duct) 2 gooses =azyGOUS and esophaGOUSCartilages of the Larynx - There are 4 cartilages in thelarynx whose initial letters are TEAC (also thebrandname of a home stereo).Thyroid, Epiglottis, Arytenoid, CricoidAbdomen-PelvisINNERVATION OF PENIS:Parasympathetic puts it up; sympathetic spurts it outPoint , Shoot, Score! (erection, emmision ,ejaculation)Parasympathetic, Sympathetic , Somatomotor"S2, 3, 4 keep the penis off the floor" Innervation of thepenis by branches of the pudental nerve, derived fromspinal cord levels S2-4Structures perforating the esophagus"At T8 you see, perforates the IVC" (inferior VenaCava)the "EsoVagus" pierce T10 (esophagus, vagus nerve)T12 - red, white and blue (aorta,thoracic duct,azygousvein)Femoral Sheath (lateral to medial) order of things inthigh -NAVELNerve, Artery, Vein, Empty, Space, LymphaticsRadial n. innervates the BEST!!!!BrachioradialisExtensorsSupinatorTricepsCourse of UretersWater runs under the bridge (uterine a. and ductusdeferens)Carotid Sheath-- VANInternal Jugular VeinCommon carotid ArteryVagus NerveDermatomesC3 is a high turtleneck shirt
  4. 4. T4 is at the nippleL1 is at the inguinal ligament (or L1 is IL -Inguinalligament)Randy Travis Drinks Cold Beer--Brachial plexusRobert Taylor Drinks Cold BeerRoots, Trunks, Divisions, Cords, BranchesBones of the wrist -Scaphoid, Lunate, Triquetrum,Pisiform, Trapezium,Trapezoid, Capitate, Hamate1. Slowly Lower Tillys Pants To The Curly Hairs2. Swifty Lower Tillys Pants to try coitus here. (therisque version)3.Scared Lovers Try Positions That They CantHandle. (Classic version)Pelvic DiaphragmPICOLO(A) -Posterior to anteriorPIriformisCOccygeusLevator AniPelvic Splanchic-ParasympatheticSacral Splanchic-SympatheticArmies travel over bridges, the Navy travels under.(Bridge is the ligament...reference to suprascapularartery and nerve.)Pad, dab. Dorsal ABduct...PalmarADduct...interosseous muscles of hand/foot.Layers of the epidermis-Germinativum or Basale,Spinosum, Granulosum, Lucidum, CorneumGrandpa Shagging Grandmas Love Child.Limbic System- the 5 F’s- Feeding, Fighting, Feeling,Flight and making babiesingThe 5 sphincters found in the Alimentary Canal areAPE OIL:Anal, Pyloric, Lower Esophogeal, Oddi, and Ileocecum.Sally Thompson Loves Sex And Pot pie. The branchesof the Axillary Artery are: Superior Thoracic,Thoracoacromial, Lateral Thoracic, Subscapular,Anterior Circumflex Humeral, Posterior CircumflexHumeral, and Profunda Brachii.TIRE- four abdominal muscles -- transversus, internaloblique, rectus abdominus, and external obliqueAnesthesia MnemonicsSpinal anesthesia agents"Little Boys Prefer Toys":
  5. 5. LidocaineBupivicaineProcaineTetracaineXylocaine: where not to use with epinephrine"Nose, Hose, Fingers and Toes"· Vasoconstrictive effects of xylocaine withepinephrine are helpful in providing hemostasiswhile suturing. However, may cause local ischemicnecrosis in distal structures such as the digits, tip ofnose, penis, ears.General anaesthesia: equipment check prior toinducingMALES:MasksAirwaysLaryngoscopesEndotracheal tubesSuction/ Stylette, bougieEndotracheal intubation: diagnosis of poorbilateral breath sounds after intubationDOPE:Displaced (usually right mainstem, pyreform fossa,etc.)Obstruction (kinked or bitten tube, mucuous plug,etc.)Pneumothorax (collapsed lung)EsophagusAnesthesia machine/room checkMS MAID:Monitors (EKG, SpO2, EtCO2, etc)SuctionMachine check (according to ASA guidelines)Airway equipment (ETT, laryngoscope, oral/nasalairway)IV equipmentDrugs (emergency, inductions, NMBs, etc)Anesthesia: quick checkSOAP:SuctionOxygenAirwayPharmacologyAnesthetics equipment checkMISMADE:Machine checkIV suppliesSuctionMonitorsAirwaysDrugsEquipmentFailed intubation: causesINTUBATION:Infections of larynxNeck mobility abnormalitiesTeeth abnormalites (eg poor dentifom, loose andprotuberant teeth)Upper airway abnormalities, strictures, or swellingsBullsneck deformitiesAnkylosing spondylitisTrauma/ TumourInexperienceOedema of upperairwayNarrowing of lower airwayRespiratory complications of anaesthesia:patients at riskCOUPLES:COPDObeseUpper abdominal surgeryProlonged bed restLong surgeryElderlySmokersBiochemistry MnemonicsEssential Amino Acids PriVaTe TIM HALL Phe, Val, Thr, Trp, Ile, Met, His, Arg, Leu, LysUrea Cycle Ordinarily, Careless Crappers, Are Also FrivolousAbout Urination. Ornithine, Carbamoyl, Citrulline,Arginosuccinate, Aspartate, Fumarate, Arginine,Urea.
  6. 6. Cell division Prophase, metaphase, anaphase, telophase. "People Meet And Talk."In the Phasted State Phosphorylate Phosphorylation cascade activewhen blood glucose low. DNA expression into mature mRNA Exons expressed, Introns in the trash. Pyrimidines are CUT from purines. Pyrimidines are Cytosine, Uracil, Thiamine andare one ring structures. Purines are double ring structures.Amino Acids:The ten essential amino acids:"These Ten Valuable Amino Acids HaveLong Preserved Life InMan."(Threonine, Tryptophan, Valine, Arginine,Histidine, Lysine,Phenylalanine, Leucine, Isoleucine,Methionine)GOAT FLAP- Eight hormones: Growth hormone,Oxytocin, Adenocorticotropin, Thyroid stimulatinghormone, Follicle stimulating hormone, Leutinizinghormone (interstitial cell stimulating hormone inmales), Anti-diruetic(Vasopressin), and Prolactin(shhhh.... also Melatonin!)Hypervitaminosis A: signs and symptoms"Increased Vitamin A makes you HARD":Headache/ HepatomegalyAnorexia/ AlopeciaReally painful bonesDry skin/ DrowsinessEnzymes: classification"Over The HILL":OxidoreductasesTransferasesHydrolasesIsomerasesLigasesLyases· 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 PickingPumpkins (to) Prepare Pies":GlucoseGlucose-6-PFructose-6-PFructose-1,6-diPDihydroxyacetone-PGlyceraldehyde-P1,3-Biphosphoglycerate3-Phosphoglycerate
  7. 7. 2-Phosphoglycerate (to)Phosphoenolpyruvate [PEP] Pyruvate · Did, By andPies 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 byskeletal muscles"Muscles LIVe fast":LeucineIsoleucineValineInfantile Beriberi symptomsRestlessness Sleeplessness Breathlessness Soundlessness(aphonia) Eatlessness (anorexia) Great heartedness (dilatedheart)· Alternatively: Get 5 of em with BERI: Breathless/ Bighearted, Eatless, Restless, Insomnia.Folate deficiency: causes A FOLIC DROP:AlcoholismFolic acid antagonistsOral contraceptivesLow dietary intakeInfection with GiardiaCeliac sprueDilatinRelative folate deficiencyOldPregnantVitamin B3 (niacin, nicotinic acid) deficiency: pellagraThe 3 Ds of pellagra: Dermatitis Diarrhea Dementia· Note vitamin B3 is the 3 Ds.Porphyrias: acute intermittent porphyria symptoms 5Ps:Pain in abdomenPolyneuropathyPsychologial abnormalitiesPink urinePrecipitated by drugs (eg barbiturates, oral contraceptives,sulpha drugs)Cardiology MnemonicsAortic stenosis characteristics SAD:SyncopeAnginaDyspnoeaMI: basic management BOOMAR:Bed restOxygenOpiateMonitorAnticoagulateReduce clot sizeECG: left vs. right bundle block "WiLLiaMMaRRoW":W pattern in V1-V2 and M pattern in V3-V6 isLeft bundle block.M pattern in V1-V2 and W in V3-V6 is Rightbundle block.· Note: consider bundle branch blocks when QRS
  8. 8. complex is wide.Pericarditis: causes CARDIAC RIND:Collagen vascular diseaseAortic aneurysmRadiationDrugs (such as hydralazine)InfectionsAcute renal failureCardiac infarctionRheumatic feverInjuryNeoplasmsDresslers syndromeMurmurs: systolic types SAPS:SystolicAorticPulmonicStenosis· Systolic murmurs include aortic and pulmonarystenosis.· Similarly, its common sense that if it is aorticand pulmonary stenosis it could also be mitral andtricusp regurgitation].MI: signs and symptoms PULSE:Persistent chest painsUpset stomachLightheadednessShortness of breathExcessive sweatingHeart compensatory mechanisms that saveorgan blood flow during shock "HeartSAVER":Symphatoadrenal systemAtrial natriuretic factorVasopressinEndogenous digitalis-like factorRenin-angiotensin-aldosterone system· In all 5, system is activated/factor is releasedMurmurs: right vs. left loudness "RILE":Right sided heart murmurs are louder onInspiration.Left sided heart murmurs are loudest onExpiration.· If get confused about which is which, rememberLIRE=liar which will be inherently false.ST elevation causes in ECG, ELEVATION:ElectrolytesLBBBEarly repolarizationVentricular hypertrophyAneurysmTreatment (eg pericardiocentesis)Injury (AMI, contusion)Osborne waves (hypothermia)Non-occlusive vasospasmBecks triad (cardiac tamponade) 3 Ds:Distant heart soundsDistended jugular veinsDecreased arterial pressureMI: therapeutic treatment ROAMBAL:ReassureOxygenAspirinMorphine (diamorphine)Beta blockerArthroplastyLignocaineCHF: causes of exacerbation FAILURE:Forgot medicationArrhythmia/ AnaemiaIschemia/ Infarction/ InfectionLifestyle: taken too much saltUpregulation of CO: pregnancy, hyperthyroidismRenal failureEmbolism: pulmonary
  9. 9. Murmurs: systolic vs. diastolic PASS:Pulmonic & Aortic Stenosis=Systolic.PAID: Pulmonic & AorticInsufficiency=Diastolic.Murmurs: systolic vs. diastolic Systolicmurmurs: 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 isfemale predominant.MR is a male title (Mr.) and it is malepredominant.Pericarditis: EKG "PericarditiS":PR depression in precordial leads.ST elevation.Jugular venous pressure (JVP) elevation:causes HOLT: Grab Harold Holt around the neckand throw him in the ocean:Heart failureObstruction of venea cavaLymphatic enlargement - supraclavicularIntra-Thoracic pressure increaseDepressed ST-segment: causes DEPRESSEDST:Drooping valve (MVP)Enlargement of LV with strainPotassium loss (hypokalemia)Reciprocal ST- depression (in I/W AMI)Embolism in lungs (pulmonary embolism)Subendocardial ischemiaSubendocardial infarctEncephalon haemorrhage (intracranialhaemorrhage)Dilated cardiomyopathyShockToxicity of digitalis, quinidineMurmurs: innocent murmur features 8 Ss:SoftSystolicShortSounds (S1 & S2) normalSymptomlessSpecial tests normal (X-ray, EKG)Standing/ Sitting (vary with position)Sternal depressionMurmur attributes "IL PQRST" (person has illPQRST heart waves):IntensityLocationPitchQualityRadiationShapeTimingMurmurs: locations and descriptions "MRSbutt":MRS: Mitral Regurgitation--Systolicbutt: Aortic Stenosis--Systolic· The other two murmurs, Mitral stenosis andAortic regurgitation, are obviously diastolic.Betablockers: cardioselective betablockers"Betablockers Acting Exclusively AtMyocardium"· Cardioselective betablockers are:BetaxololAcebutelolEsmololAtenololMetoprololApex beat: abnormalities found on palpation,causes of impalpable HILT:HeavingImpalpableLaterally displacedThrusting/ Tapping· If it is impalpable, causes are COPD:COPD
  10. 10. ObesityPleural, Pericardial effusionDextrocardiaMI: treatment of acute MI COAG:CyclomorphOxygenAspirinGlycerol trinitrateCoronary artery bypass graft: indicationsDUST:Depressed ventricular functionUnstable anginaStenosis of the left main stemTriple vessel diseasePeripheral vascular insufficiency: inspectioncriteria SICVD:Symmetry of leg musculatureIntegrity of skinColor of toenailsVaricose veinsDistribution of hairHeart murmurs "hARD ASS MRS. MSD":hARD: Aortic Regurg = DiastolicASS: Aortic Stenosis = SystolicMRS: Mitral Regurg = SystolicMSD: Mitral Stenosis = DiastolicMitral regurgitation When you hear holosystolicmurmurs, think "MR-THEM ARE holosystolicmurmurs".Sino-atrial node: innervation Sympathetic actson Sodium channels (SS).Parasympathetic acts on Potassium channels(PS).Supraventricular tachycardia: treatmentABCDE:AdenosineBeta-blockerCalcium channel antagonistDigoxinExcitation (vagal stimulation)Ventricular tachycardia: treatment LAMB:LidocaineAmiodaroneMexiltene/ MagnesiumBeta-blockerPulseless electrical activity: causes PATCHMED:Pulmonary embolusAcidosisTension pneumothoraxCardiac tamponadeHypokalemia/ Hyperkalemia/ Hypoxia/Hypothermia/ HypovolemiaMyocardial infarctionElectrolyte derangementsDrugsSinus bradycardia: aetiology "SINUSBRADICARDIA" (sinus bradycardia):SleepInfections (myocarditis)Neap thyroid (hypothyroid)Unconsciousness (vasovagal syncope)Subnormal temperatures (hypothermia)Biliary obstructionRaised CO2 (hypercapnia)AcidosisDeficient blood sugar (hypoglycemia)Imbalance of electrolytesCushings reflex (raised ICP)AgingRx (drugs, such as high-dose atropine)Deep anaesthesiaIschemic heart diseaseAthletesRheumatic fever: Jones criteria · Major criteria:CANCER:CarditisArthritis
  11. 11. NodulesChoreaErythemaRheumatic anamnesis· Minor criteria: CAFE PAL:CRP increasedArthralgiaFeverElevated ESRProlonged PR intervalAnamnesis of rheumatismLeucocytosisJVP: wave form ASK ME:Atrial contractionSystole (ventricular contraction)Klosure (closure) of tricusps, so atrial fillingMaximal atrial fillingEmptying of atrium· See diagram.Coronary artery bypass graft: indicationsDUST:Depressed ventricular functionUnstable anginaStenosis of the left main stemTriple vessel diseaseExercise ramp ECG: contraindicationsRAMP:Recent MIAortic stenosisMI in the last 7 daysPulmonary hypertensionECG: T wave inversion causes INVERT:IschemiaNormality [esp. young, black]Ventricular hypertrophyEctopic foci [eg calcified plaques]RBBB, LBBBTreatments [digoxin]Rheumatic fever: Jones major criteria JONES:Joints (migrating polyarthritis)Obvious, the heart (carditis, pancarditis,pericarditis, endocarditis or valvulits)Nodes (subcutaneous nodules)Erythema marginatumSydenhams choreaMyocardial infarctions: treatmentINFARCTIONS:IV accessNarcotic analgesics (eg morphine, pethidine)Facilities for defibrillation (DF)Aspirin/ Anticoagulant (heparin)RestConverting enzyme inhibitorThrombolysisIV beta blockerOxygen 60%NitratesStool SoftenersAtrial fibrillation: causes PIRATES:Pulmonary: PE, COPDIatrogenicRheumatic heart: mirtral regurgitationAtherosclerotic: MI, CADThyroid: hyperthyroidEndocarditisSick sinus syndromeAtrial fibrillation: management ABCD:Anti-coagulateBeta-block to control rateCardiovertDigoxinAnti-arrythmics: for AV nodes "Do Block AV":DigoxinB-blockersAdenosineVerapamil
  12. 12. Murmurs: systolic MR PV TRAPS:MitralRegurgitation andProlaspeVSDTricupsidRegurgitationAortic andPulmonaryStenosisApex beat: differential for impalpable apexbeat DOPES:DextrocardiaObesityPericarditis or pericardial tamponadeEmphysemaSinus inversus/ Student incompetenceClinical Mnemonics CAUSES OF ACUTE PANCREATITIS: "GET SMASHD"o Gallstones, Ethanol, Trauma, Steroids,Mumps, Autoimmune(PAN), Scorpionbites, 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 adisease of three or two letters plus a feature. MEN I is a disease of 3 Ps (pituitary, parathyroid,and pancreas) plus adrenal cortex MEN II is a disease of 2 Cs(carcinoma of thyroidand catacholamines [pheochromocytoma]) plusparathyroid for MEN IIa or mucocutaneousneuromas for MEN IIB(aka MEN III) P-Q-R-S-T--eliciting and HPI and exploringsymptoms 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 exploringsymptoms 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 dueto damage at pretectal area. Also called the "prostitutespupil" (accommodates but does not react). The five Ws--post-operative fever Wind--pneumonia, atelectasis Wound--wound infections Water--urinary tract infection Walking--walking can help reduce deep veinthromboses and pulmonary embolus Wonderdrugs--especially anesthesia Predisposing Conditions for Pulmonary Embolism:TOM SCHREPFER T--trauma O--obesity M--malignancy S--surgery C--cardiac disease
  13. 13.  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 CycledImmediately 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 Fs:Fat Feces Fluid Flatus Fetus Full-sized tumorsPatient 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 [inferiorMI] 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 painQuality of pain (throbbing, stabbing, dull, etc.) Region ofbody affected Severity of pain (usually scale of 1-10)Timing of pain (after exercise, in evening, etc.) U: Howdoes it affect U in your daily life?· May wish to expand to OPPQRRSTTUVW, with theextra 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:VascularInflammatory (Infectious and non-Infectious)Trauma/ ToxinsAutoimmuneMetabolicIdiopathicNeoplastic
  14. 14. · Example usage: List causes of decreased vision: Centralretinal artery occlusion, Retinitis pigmentosa, Perforationto gobe, Chronic Gentamycin use, Ruematoid arthritis,Diabetes, Idiopathic, Any eye tumor, Myopia.Sign vs. symptomsIgn: something I can detect even if patient is unconscious.sYMptom is something only hYM knows about.Eyes: abbreviations for the eyesYou look OUt with Both eyes. Take the Right dose so youwont 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 TuberculosisHypertension Rheumatic fever/ Rheumatoid arthritisEpilepsy Asthma Diabetes StrokesPain history checklist "On Days Feeling Low Character,Run A Seven Pace Race":OnsetDurationFrequencyLocationCharacterRadiationSeverityPrecipitating factorsRelieving factorsPain history checklist ASK LAST:Aggravating/ AlleviatingSeverityKaracterLocationAssociated symptomsSettingTimingPain history checklist SOCRATES:SiteOnsetCharacterRadiationAlleviating factors/ Associated symptomsTiming (duration, frequency)Exacerbating factorsSeverity· Alternatively, Signs and Symptoms with the S.Symptom attributes "FAST LQQS":Factors that make it better/worseAssociated manifestationsSettingTimingLocationQualityQuantitySeverityHeart valve auscultation sites "All Patients Take Meds":· Reading from top left:AorticPulmonaryTricuspidMitral· See diagram.· Alternatively: All Prostitutes Take Money.· Alternatively: APe To Man.Four point physical assessment of a disease"Im A People Person":InspectionAuscultationPercussionPalpationPhysical exam for lumps and bumps
  15. 15. "6 Students and 3 Teachers go for CAMPFIRE":Site, Size, Shape, Surface, Skin, ScarTenderness, Temperature, TransilluminationConsistencyAttachmentMobilityPulsationFluctuationIrreducibilityRegional lymph nodesEdgeSurgical sieve VANISHED:VascularAccident & traumaNeoplasticInflammatorySepticHaematologic/ HereditaryEndocrinologicalDegenerativeDifferential diagnosis checklist "I VINDICATE":IatrogenicVascularInfectiousNeoplasticDegenerative/ DrugsInflammatory/ IdiopathicCongenitalAllergic/ AutoimmuneTraumaticEndocrinal & metabolicSymptom sieve "TIN CAN BED DIP POG":TraumaInfectionNeoplasmCardiacAutoimmuneNeurologicalBlood/ BoneEndocrineDisintegration/ DegenerationDrugsIatrogenic/ IdiopathicPsychologicalPaediatricObstetricGynaecologicalSurgical sieve for diagnostic categoriesINVESTIGATIONS:Iatrogenic Neoplastic Vascular Endocrine Structural/Mechanical Traumatic Inflammatory Genetic/ CongenitalAutoimmune Toxic Infective Old age/ DegenerativeNutritional Spontaneous/ IdiopathicMental state examination: stages in order"Assessed Mental State To Be Positively ClinicallyUnremarkable":Appearance and behaviour [observe state, clothing...]Mood [recent spirit]Speech [rate, form, content]Thinking [thoughts, perceptions]Behavioural abnormalitiesPerception abnormalitiesCognition [time, place, age...]Understanding of condition [ideas, expectations, concerns]Branham sign: definitionBRAnham sign:BRAdycardia after compression or excision of a large AVfistula.
  16. 16. Glasgow coma scale: components and numbers· Scale types is 3 Vs: Visual response Verbal responseVibratory (motor) response· Scale scores are 4,5,6:Scale of 4: see so much more Scale of 5: talking jive Scaleof 6: feels the pricks (if testing motor by pain withdrawl)Meckel’s diverticulum- rule of 2’s2 inches long,2 feet from the ileocecal valve,2% of the populationcommonlly presents in the first 2 years of lifemay contain 2 types of epithelial tissuePheochromocytoma-rule of 10s:10% malignant10% Bilateral10% extraadrenal10% calcified10% children10% familial* discussed 10 times more often than actually seenAphasia"BROKen aphasia" (Broca’s aphasia-broken speech)"Wordys aphasia" (Wernicke’s aphasia- wordy, butmaking no sense)GET SMASHD--Causes of Acute pancreatitisGallstones, Ethanol, Trauma, Steroids, Mumps,Autoimmune(PAN), Scorpion bites, Hyperlipidemia,Drugs(azathioprine, diuretics)(Multiple endocrine neoplasia) Each of the MENs is adisease of three or two letters plus a feature."MEN I" is a disease of the 3 Ps (pituitary, parathyroidand pancreas)plus adrenal cortex."MEN II " is a disease of the two Cs (carcinoma of thethyroid andcatacholamines [pheochromocytoma]) plus parathyroidfor MEN IIa ormucocutaneous neuromas for MEN IIb (aka MEN III).Acute pneumonia caused by Pyogenic bacteria--PMNinfiltrateAcute pneumonia caused by Miscellaneous microbes --Mononuclear infiltrateArgyll-Robertson Pupil--syphilitic pupil (AKA"Prostitutes pupil" - Accommodates, but doesnt react)Accommodation reflex present, Pupillary reflex absentCAGE--alcohol use screening1. Have you ever felt it necessary to CUT DOWN onyour drinking?2. Has anyone ever told you they were ANNOYED byyour drinking?
  17. 17. 3. Have you ever felt GUILTY about your drinking?4. Have you ever felt the need to have a drink in themorning for an EYE OPENER?P-Q-R-S-T--eliciting and HPI and exploring symptomsP--palliative or provocative factors for the painQ--quality of pain(burning, stabbing, aching, etc.)R--region of body affectedS--severity of pain(usually 1-10 scale)T--timing of pain(eg.-after meals, in the morning, etc.)The five Ws--post-operative feverWind--pneumonia, atelectasisWater--urinary tract infectionWound--wound infectionsWonderdrugs--especially anesthesiaWalking--walking can help reduce deep veinthromboses and pulmonary embolusACID or "Anna Cycled Immediately Downhill"classification of hypersensitivity reactionsType I - AnaphylaxisType II - Cytotoxic-mediatedType III - Immune-complexType IV - Delayed hypersensitivityWBC 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 effortPredisposing Conditions for Pulmonary Embolism:TOM SCHREPFERT--traumaO--obesityM--malignancyS--surgeryC--cardiac diseaseH--hospitalizationR--rest (bed-bound)E--estrogen, pregnancy, post-partumP--past hx
  18. 18. F--fractureE--elderlyR--road tripThe 4 Ps of arterial Occlusion: pain pallorpulselessness paresthesiasThe 4 Ts of Anterior Mediastinal Mass:Thyroidtumor,Thymoma,Teratoma, Terrible LymphomaDermatology MnemonicsMalignant melanoma: 3 sites with poorprognosisBANS:Back of ArmNeckScalpAlbinism: type I vs. II classification"One has None. Two Accumulates":Type I: have no pigment.Type II: No pigment at birth, but accumulates asperson ages.Generalized skin hyperpigmentation: causes"With generalized, none of skin is SPARED":SunlightPregnancyAddisons diseaseRenal failureExcess iron (haemochromatosis)Drugs (eg busulphan)Clubbing: causesCLUBBING:Cyanotic heart diseaseLung disease (hypoxia, lung cancer,bronchiectasis, cystic fibrosis)UC/Crohns diseaseBiliary cirrhosisBirth defect (harmless)Infective endocarditisNeoplasm (esp. Hodgkins)GI malabsorptionCutaneous inflammation patterns"Pus of Pig Valve"· Remove the vowels: PSFPGVLV:PsoriaformSpongiotic (eczematous)FolliculitisPanniculitisGranulomatousVasculopathicLichenoidVessiculobullousNodules: painful cutaneous nodules causesBENGAL CO.:Blue rubber bleb nevusEccrine spiradenomaNeurilemmoma/ NeuromaGlomus tumorAngiolipoma/ Angioleiomyoma/ AngiosarcomaLeiomyomaCutaneous endometriosis/ Calcinosis cutisOsteoma cutisWound healing: factors delaying
  19. 19. DID NOT HEAL:DrugsInfection/ Icterus/ IschemiaDiabetesNutritionOxygen (hypoxia)ToxinsHypothermia/ HyperthermiaEtOHAcidosisLocal anestheticsWhite patch of skin: differential"Vitiligo PATCH":VitiligoPityriasis alba/ Post-inflammatory hypopigmentationAge related hypopigmentationTinea versicolor/ Tuberous sclerosis (ashleaf macule)Congenital birthmarkHansens (leprosy)Psoriasis: pathophysiologyPSORIASIS:Pink Papules/ Plaques/ Pinpoint bleeding (Auspitz sign)/Physical injury (Koebner phenomenon)/ PainSilver Scale/ Sharp marginsOnycholysis/ Oil spotsRete Ridges with Regular elongationItchingArthritis/ Abscess (Munro)Stratum corneum with nuclei, neutrophilsImmunologicStratum granulosum absent/ Stratum Spinosum thickeningRaynauds phenomenon: causesCOLD HAND:Cryoglobulins/ CryofibrinogensObstruction/ OccupationalLupus erythematosus, other connective tissue diseaseDiabetes mellitus/ DrugsHematologic problems (polycythemia, leukemia, etc)Arterial problems (atherosclerosis)Neurologic problems (vascular tone)Disease of unknown origin (idiopathic)Embryology MnemonicsVitelline duct: closure timeVItelline duct normally closes around week VI ofintrauterine life.Potter syndrome: features POTTER:Pulmonary hypoplasiaOligohydrominiosTwisted skin (wrinkly skin)Twisted face (Potter facies)Extremities defectsRenal agenesis (bilateral)Placenta-crossing substances "WANT My Hot Dog":WastesAntibodiesNutrientsTeratogensMicroorganismsHormones/ HIVDrugsCranial and spinal neural crest: major derivativesGAMES:Glial cells (of peripheral ganglia)Arachnoid (and pia)
  20. 20. MelanocytesEnteric gangliaSchwann cellsMesoderm components MESODERM:Mesothelium (peritoneal, pleural, pericardial)/ Muscle(striated, smooth, cardiac)Embryologic Spleen/ Soft tissue/ Serous linings/ Sarcoma/SomiteOsseous tissue/ Outer layer of suprarenal gland (cortex)/OvariesDura/ Ducts of genitaliaEndotheliumRenal MicrogliaMesenchyme/ Male gonadVasculogenesis vs. angiogenesis"Vascu is new. Angi is pre": Vasculogenesis is newvessels 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 eachWeek Two: Bilaminar germ disc.Week Three: Trilaminar germ disc.Week Four: Four limbs appear.Teratogenesis: when it occursTEratogenesis is most likely during organogenesis--between the: Third and Eighth weeks of gestation.Tetrology of Fallot "Dont DROP the baby":Defect (VSD)Right ventricular hypertrophyOverriding aortaPulmonary stenosisLung development phases "Every Premature ChildTakes Air":Embryonic periodPseudoglandular periodCanalicular peroidTerminal sac periodAlveolar periodBranchial arch giving rise to aorta"Aor- from Four": Aorta is from fourth arch.Neuroectoderm derivativesNeuroectoderm gives rise to:
  21. 21. NeuronsNeurogliaNeurohypophysispiNeurol (pineal) glandTetrology of Fallot"IHOP-International House of Pancakes":Interventricular septal defectHypotrophy of right ventricleOverriding aortaPulmonary stenosisWoffian duct (mesonephric duct) derivatives.Gardeners SEED:· Female: Gartners duct, cyst· Male:Seminal vesiclesEpididymisEjaculatory ductDuctus deferensForegut derivatives"Little Embryo People Do Like Swallowing, ProducingGas": Lungs Esophagus Pancreas Duodenum (proximal)Liver Stomach Pancreas Gall bladderEmergency MnemonicsComa: conditions to exclude as cause MIDAS:MeningitisIntoxicationDiabetesAir (respiratory failure)Subdural/ Subarachnoid hemorrhageResuscitation: basic steps ABCDE:AirwayBreathingCirculationDrugsEnvironmentMalignant hyperthermia treatment"Some Hot Dude Better Give Iced Fluids Fast!"(Hot dude = hypothermia):Stop triggering agentsHyperventilate/ Hundred percent oxygenDantrolene (2.5mg/kg)BicarbonateGlucose and insulinIV Fluids and cooling blanketFluid output monitoring/ Furosemide/ Fast heart[tachycardia]Vfib/Vtach drugs used according to ACLS "EveryLittle Boy Must Pray":EpinephrineLidocaineBretyliumMagsulfateProcainamideComa causes checklist AEIOU TIPS:Acidosis/ AlcoholEpilepsyInfectionOverdosed
  22. 22. UremiaTrauma to headInsulin: too little or or too muchPyschosis episodeStroke occurredShock: types RN CHAMPS:RespiratoryNeurogenicCardiogenicHemorrhagicAnaphylacticMetabolicPsychogenicSeptic· Alternatively: "MR. C.H. SNAP", or "NH CRAMPS".Shock: signs and symptoms TV SPARC CUBE:ThirstVomitingSweatingPulse weakAnxiousRespirations shallow/rapidCoolCyanoticUnconsciousBP lowEyes blankFall: potential causes CLADE SPADE:Cardiovascular/ CerebrovascularLocomotor (skeletal, muscular, neurological)Ageing (increased body sway, decreased reaction time)Drugs (esp. antihypertensives, antipsychotics)EnvironmentalSensory deficits (eg. visual problems)Psychological/ Psychiatric (depression)Acute illnessDementiaEpilepsyDiabetic ketoacidosis management F*¢KING:Fluids (crytalloids)Urea (check it)Creatinine (check it)/ CatheterizeK+ (potassium)Insulin (5u/hour. Note: sliding scale no longerrecommended 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 lifethreatening)V-fib/pulseless v-tach (new ACLS as of 2001)"EVAL My Pumper":Epinephrine Vasopressin Amiodarone (class IIb--better forheart failure) Lidocaine (indeterminate - better for young,healthy or persistent) MgSO4 (IIb for hypomagnesemicstate or torsades) Procainamide (IIb forintermittent/recurrent VF/VT)Trauma: motor vehicle accident considerationsI 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?) Compartmentintrusion (>12 inches?) Age (<5 or >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
  23. 23. Boyles law: volume of gas is inversely proportionate to itspressure. · Therefore, BOYLE:Breathe (as you ascend) Or Your Lung Explodes · Breatheas you ascend after scuba diving, since the pressuredecreases on surfacing, so the gas volume in lungsincreases.Pain history checklistOLDER SAAB:Onset Location Description (what does it feel like)Exacerbating factors Radiation Severity Associatedsymptoms Alleviating factors Before (ever experience thisbefore)Asystole: treatment"Have some asystole "TEA":Transcutaneous pacing Epi AtropineEndotrachial tube deliverable drugsO NAVEL:Oxygen Naloxone Atropine Ventolin (albuterol)Epinephrine Lidocaine · If you cant get IV accessestablished, and have necessity to administer resuscitativemeds, remember you have the airway and can give theabove drugs. · Drug delivery is enhanced if diluted with10cc NS and rapid introduced for aeresolization. ·Alternatively, bare bone version is ALE, as above.RLQ pain: differentialAPPENDICITIS:Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/Endometriosis Neoplasia Diverticulitis IntussusceptionCrohns Disease/ Cyst (ovarian) IBD Torsion (ovary)Irritable Bowel Syndrome StonesSubarachnoid hemorrhage (SAH) causesBATS:Berry aneurysm Arteriovenous malformation/ Adultpolycystic kidney disease Trauma (eg being struck withbaseball bat) StrokeSyncope causes, by systemHEAD HEART VESSELS:· CNS causes include HEAD:Hypoxia/ Hypoglycemia Epilepsy Anxiety Dysfunctionalbrain stem (basivertebral TIA)· Cardiac causes are HEART: Heart attack Embolism (PE)Aortic obstruction (IHSS, AS or myxoma) Rhythmdisturbance, ventricular Tachycardia· Vascular causes are VESSELS: Vasovagal Ectopic(reminds one of hypovolemia) Situational Subclavian stealENT (glossopharyngeal neuralgia) Low systemic vascularresistance (Addisons, diabetic vascular neuropathy)Sensitive carotid sinusComa 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, cerebralabscess, etc.ENT Mnemonics
  24. 24. Oralpharangeal cancers: aetiology6 Ss:SmokingSpicy foodSyphilisSpirits [booze]Sore toothSepsis· Also bezel nuts.Ear drops: direction to pull ear when instillingFor an grown UP it is UP.For a chilD it is Down.Nasopharyngeal carcinoma: classic symptomsNOSE:Neck massObstructed nasal passageSerous otitis media externaEpistaxis or dischargeGastroenterology MnemonicsUlcerative colitis: definition of a severe attackA STATE:Anemia less than 10g/dlStool frequency greater than 6 stools/day with bloodTemperature greater than 37.5Albumin less than 30g/LTachycardia greater than 90bpmESR greater than 30mm/hrVomiting: extra GI differentialVOMITING:Vestibular disturbance/ Vagal (reflex pain)OpiatesMigrane/ Metabolic (DKA, gastroparesis,hypercalcemia)InfectionsToxicity (cytotoxic, digitalis toxicity)Increased ICP, Ingested alcoholNeurogenic, psychogenicGestationPancreatitis (acute): causesI GET SMASHED:IdiopathiticGallstonesEthanolTraumaSteroidsMumpsAutoimmune (PAN)Scorpion stingsHyperlipidemia/ HypercalcemiaERCPDrugs (including azathioprine and diuretics)· Note: Get Smashed is slang in some countries fordrinking, and ethanol is an important pancreatitiscause.· Note: Shortest answer is gallstones for women, andethanol for men. And scorpian stings for people fromTrinidad.IBD: surgery indications"I CHOP":InfectionCarcinomaHaemorrhageObstructionPerforation· "Chop" convenient since surgery chops them open.Hereditary Nonpolyposis Colorectal Cancer(HNPCC) cause is DNA mismatch repairDNA mismatch causes a bubble in the strand wherethe two nucleotides dont match.This looks like the ensuing polyps that arise in thecolon.· See diagram.IBD: extraintestinal manifestationsA PIE SAC:Aphthous ulcersPyoderma gangrenosumIritisErythema nodosumSclerosing cholangitisArthritisClubbing of fingertips
  25. 25. Digestive disorders: pH levelWith 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 inhibitorMetronidazoleTetracyclineBismuth· Alternatively: TOMB:TetracyclineOmeprazoleMetronidazoleBismuthBilirubin: common causes for increased levels"HOT Liver":HemolysisObstructionTumorLiver diseaseUlcerative colitis: complications"PAST Colitis":Pyoderma gangrenosumAnkylosing spondylitisSclerosing pericholangitisToxic megacolonColon carcinomaImmunology MnemonicsHypersensitivity reactions: Gell and GoombsnomenclatureACID· From I to IV:Anaphylactic type: type ICytotoxic type: type IIImmune complex disease: type IIIDelayed hypersensitivity (cell mediated): type IVMHC I vs. II: T cell interactionThe "=8" equation:2x4=8, and 1x8=8.MHC II goes with CD4.MHC I goes with CD8.Immunoglobulin (Ig) types: the important onesworth remembering, in order of appearanceMAGDElaine (a girls name):IgMIgAIgGIgDIgE· Magdelaine tells you the order they usually appear:M first, then A or G.· Alternatively: IgM is IMmediate.Acute inflammation featuresSLIPR:SwellingLoss of functionIncreased heatPainRedness· "What a cute pair of slippers" can be used to tieacute inflammation to SLIPR.Lupus signs and symptomsSOAP BRAIN:Serositis [pleuritis, pericarditis]Oral ulcersArthritisPhotosensitivityBlood [all are low - anemia, leukopenia,thrombocytopenia]Renal [protein]ANAImmunologic [DS DNA, etc.]Neurologic [psych, seizures]Goodpastures Syndrome componentsGoodPasture is Glomerulonephritis andPnuemonitits.· From autoantibodies attacking Glomerular andPulmonary basement membranes.Complement: function of C3a versus C3bC3a: Activates Acute [inflammation].C3b: Bonds Bacteria [to macrophages--easierdigestion].· If wish to know more than just C3:C3a, C4a, C5a activate acute.
  26. 26. 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 diseaseexamplesHLA-DR:Hashimotos diseaseLeukemia/ LupusAutoimmune adrenalitis/ Anemia (pernicious)Diabetes insipidousRheumatoid arthritisComplement cascade initiating items: alternativevs. classicClassic: Combined Complexes.Alternative: Activators Alone, or IgA.· Complexes are made of Ab and Ag combinedtogether.· Examples of activators: endotoxin, microbialsurface.Internal Medicine MnemonicsPancytopaenia differential"All Of My Blood Has Taken Some Poison":Aplastic anaemiasOverwhelming sepsisMegaloblastic anaemiasBone marrow infiltrationHypersplenismTBSLEParoxysmal nocturnal haemoglobinuriaHaematology: key numbers3 and 4 are key in in haematology:1.34 cm3 of oxygen is carried by a gram ofhemoglobin.Theres 3.4mg of iron in each gram of hemoglobin.Theres an average of 3.4 lobes per neutrophil.Theres 34mg bilirubin from each gram ofhemoglobin.Back trouble causesO, VERSALIUS (Versalius was the name of afamous physician):OsteomyelitisVertebral fractureExtraspinal tumourSpondylolisthesisAnkylosing spondylitisLumbar disk increaseIntraspinal tumorUnhappinessStressSports injuries: course of actionRICE:RestIceCompressionElevation· RICE especially for fractures, sprains, musclestrains, contusions· Alternatively: I=Immobilization, C=Coldcompresses.Back pain causesDISK MASS (since near vertebral disc):Degeneration (DJD, osteoporosis, spondylosis)Infection (UTI, PID, Potts disease, osteomyelitis,prostatitis)/ Injury, fracture or compression fractureSpondylitis (ankylosing spondyloarthropathies suchas rheumatoid arthritis, Reiters, SLE)Kidney (stones, infarction, infection)Multiple myeloma/ Metastasis (from cancers ofbreast, kidney, lung, prostate, thyroid)Abdominal pain (referred to the back)/ AneurysmSkin (herpes zoster)/ Strain/ Scoliosis and lordosisSlipped disk/ SpondylolisthesisBronchiectasis: differentialBRONCHIECTASIS:Bronchial cystRepeated gastric acid aspirationOr due to foreign bodiesNecrotizing pneumoniaChemical corrosive substancesHypogammaglobulinemiaImmotile cilia syndromeEosinophilia (pulmonary)Cystic fibrosisTuberculosis (primary)Atopic bronchial asthmaStreptococcal pneumoniaIn Youngs syndromeStaphylococcal pneumoniaSickle cell disease complicationsSICKLE:
  27. 27. Strokes/ Swelling of hands and feet/ SpleenproblemsInfections/ InfarctionsCrises (painful, sequestration, aplastic)/Cholelithiasis/ Chest syndrome/ Chronic hemolysis/Cardiac problemsKidney diseaseLiver disease/ Lung problemsErection (priapism)/ Eye problems (retinopathy)ADP: role in platelet aggregationADP = Aggregation from the Dense bodies ofPlatelets.Gynecomastia: common causesGYNECOMASTIA:Genetic Gender disorder (Klinefelter)Young boy (pubertal)*Neonate*EstrogenCirrhosis/ Cimetidine/ Ca Channel blockersOld age*MarijuanaAlcoholismSpironolactoneTumors (Testicular & adrenal)Isoniazid/ Inhibition of testosteroneAntineoplastics (Alkylating Agents)/Antifungal(ketoconazole)· * Asterisk indicates physiologic cause.Lethargy, malaise causesFATIGUED:Fat/ Food (poor diet)AnemiaTumorInfection (HIV, endocarditis)General joint or liver diseaseUremiaEndocrine (Addisons, myxedema)Diabetes/ Depression/ DrugsMicrobiology MnemonicsHepatitis: transmission routes"Vowels are bowels":Hepatitis A and E transmitted by fecal-oral route.RNA viruses: negative stranded"Always Bring Polymerase Or Fail Replication":ArenaBunyaParamyxoOrthomyxoFiloRhabdo· Note: Negative RNA viruses need there ownpolymerase.RNA viruses: negative stranded"Orthodox Rhabbis Party Around Fine Bunnies":OrthomyxoRhabdoParamyxoArenaFiloBunyaEndocarditis: indications for surgeryPUS RIVER:Prosthetic valve endocarditis (most cases)Uncontrolled infectionSupporative local complications with conductionabnormalitiesResection of mycotic aneurysmIneffective antimicrobial therapy (eg Vs fungi)Valvular damage (significant)Embolization (repeated systemic)Refractory congestive heart failureTeratogens: placenta-crossing organismsToRCHeS:ToxoplasmaRubellaCMVHerpes simplex, Herpes zoster (varicella), HepatitisB,C,ESyphilis· Alternatively: TORCHES: with Others (parvo,listeria), add HIV to Hs, Enteroviruses.Streptococcus pyogenes: diseases causedNIPPLES:Necrotising fasciitis and myositisImpetigoPharyngitisPneumoniaLymphangitisErysipelas and cellulitis
  28. 28. Scarlet fever/ Streptococcal TSSEndotoxin featuresENDOTOXIN:Endothelial cells/ EdemaNegative (gram- bacteria)DIC/ DeathOuter membraneTNFO-antigenX-tremely heat stableIL-1Nitric oxide/ Neutrophil chemotaxisAcute post-streptococcal glomerulonephritis:classic presentation"Sore throat, Face bloat, Pi$$ coke":Sore throat: 1 week agoFace bloat: facial edemaPi$$ coke: coke-coloured urine· Alternatively, short version: "Throat, bloat andcoke".Staphylococcus aureus: diseases causedSOFT PAINS:Skin infectionsOsteomyelitisFood poisoningToxic shock syndromePneumoniaAcute endocarditisInfective arthritisNecrotizing fasciitisSepsisPicornavirus: featuresPICORNAvirus:Positive senseICOsahedralRNA virusAIDS pathogens (T-cell suppression) worthknowing"The Major Pathogens Concerning Complete T-CellCollapse":Toxoplasma gondiiM. avium intracellularePneumocystis cariniiCandida albicansCryptococcus neoformansTuberculosisCMVCryptosporidium parvumGram+: bacterial cell wall· Gram+ has:+hick pepidoglycan layer.+eichoic acid in wall.Streptococci: classification by hemolytic abilityGamma: Garbage (no hemolytic activity).Alpha: Almost (almost lyse, but incomplete).Beta: Best (complete lysis).Syphilis vs. H. ducreyi (chancroid): which ulcer ispainful"In du-crey-i, you do cry (because it is painful)":In H. ducreyi, the ulcer is painful, in syphilis theulcer is painless.Influenza infection: clinical manifestations"Having Flu Symptoms Can Make MoaningChildren A Nightmare":HeadacheFeverSore throatChillsMyalgiasMalaiseCoughAnorexiaNasal congestionIgA protease-producing bacteria"Nice Strip of Ham":NeisseriaStreptococcus pneumoniaHaemophilus influenzaCatalase positive organimsSPACE:Staphylococcus aureusPseudomonasAspergillusCandidaEnterobacter
  29. 29. Neisseria: fermentation of N. gonorrhoeae vs. N.meningitidisGonorrhoeae: Glucose fermenter only.MeninGitidis: Maltose and Glucose fermenter.· Maltose fermentation is a useful property to know,since its the classic test to distinguish the Neisseriatypes.UTI-causing microorganismsKEEPS:KlebsiellaEnterococcus faecalis/ Enterobacter cloacaeE. coliPseudomonas aeroginosa/ Proteus mirabilisStaphylococcus saprophyticcus/ Serratia marcescensE. coli: diseases caused in presence of virulencefactorsDUNG:DiarrheaUTINeonatal meningitisGram 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 HamburgersEnteroInvasive:· Immune-mediated InflammationEnteroToxigenic:· Travellers diarrheaMeningitis: risk factors"Can Induce Severe Attacks Of Head PAINS":CancerImmunocompromised stateSinusitisAge extremesOtitisHead traumaParameningeal infectionAlcoholismInfections (systemic, esp. respiratory)Neurosurgical proceduresSplenectomyStreptococcus pyogenes: virulence factorsSMASHED:StreptolysinsM proteinAnti-C5a peptidaseStreptokinaseHyaluronidaseExotoxinDNAsesCapsulated bacteria"Some Bacteria Have An Effective PasteSurrounding Membrane Yielding Pseudo Fort,Bypassing Killing":Strep pneumoniaBacteroidesH. influenzaAnthrax (B. anthracis)E. coliPasteurellaSalmonellaMenigitidis (N. Menigitidis)Yersinia pestisPseudomonasFrancisellaBrucellaKlebsiellaDNA viruses: morphology rule of thumbDNA:Double-strandedNuclear replicationAnhedral symmetry· Rule breakers: pox (cytoplasmic), parvo (single-stranded).Obligate anaerobes: members worth knowingABC:ActinomycesBacteroidesClostridium
  30. 30. Urease positive organismsPUNCH:Proteus (leads to alkaline urine)Ureaplasma (renal calculi)NocardiaCryptoccocus (the fungus)Helicobacter pyloriFood poisoning: bugs inducing"Eating Contaminated Stuff Causes Very BigSmelly 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: motilityIstanbul sounds like Listambul = list + tumble.Listeria has tumbling motility.RNA enveloped virusesFORT ABC, Puerto Rico:Flavivirus/ FiloOrthomyxoRetroTogaArenaBunyaCoronaParamyxoRhabdoTetanus: treatment for infectionSAD RAT:SedationAntitoxinDebridementRelaxantAntibioticTracheostomyTrichomaniasis: features· 5 Fs:FlagellaFrothy dischargeFishy odor (sometimes)Fornication (STD)Flagyl (metronidazole) RxEndocarditis: causes of culture negativeendocarditis"With Negative Tests, Investigators Should FocusAttention Somewhere Meaningful":Wrong diagnosisNoninfectious endocarditisTiming (cultures drawn at end of chronic course)obligate Intracellular organismsSlow growing fastidious organismsFungal infectionAntibiotic used previouslySubacute right-sided endocarditisMural endocarditisStreptococcus pneumoniae: diseases causedCOMPS:ConjunctivitisOtitis mediaMeningitisPneumoniaSinusitisNeurology MnemonicsNeurofibromatosis: diagnositic criteria (type-1)CAFE SPOT:Cafe-au-lait spotsAxillary, inguinal frecklingFibromaEye: lisch nodulesSkeletal (bowing leg, etc)Pedigree/ Positive family historyOptic Tumor (glioma)Ramsay-Hunt syndrome: cause and commonfeature"Ramsay Hunt":· Etiology:ReactivatedHerpes zoster· Complication:ReducedHearingNeurofibromatosis: diagnostic criteriaROLANDO:Relative (1st degree)Osseous fibromasLisch nodules in eyes
  31. 31. Axillary frecklingNeurofibromasDime size cafe au lait spotsOptic gliomasPeripheral nervous examination"Tall People Run-over Small Children":TonePowerReflexesSensationCo-ordination/ ClonusPeripheral neuropathy: differentialSTAGLAND:SarcoidThyroidAmyloidGuillian-BarreLeadAlcoholNutritionalDrugs/ DiabetesHead trauma: rapid neuro exam· 12 Ps:Psychological (mental) statusPupils: size, symmetry, reactionPaired ocular movememtsPapilloedemaPressure (BP, increased ICP)Pulse and rateParalysis, ParesisPyramidal signsPin prick sensory responsePee (incontinent)Patellar relex (and others)Ptosis· Reevaluate patient every 8 hrs.Perinauds syndrome: clinical featuresPERINAUDS:Pseudo 6th nerve palsy/ Penial regionEyelid RetractionInternuclear ophthalmoplegiaNystagmusAccomodation reflex presentUpward gaze palsyDefective convergence/ Decerebrate rigiditySkew deviationAlzheimers disease: progressive phasesABCD:Amnesic phase (forgetting keys, leaving cooker on)Behavioural problems (antisocial, wandering)Cortical phase (incontinence, falls)Decerebrate phase (return of primitive reflexes)Vertigo: differentialVOMITS:VestibulitisOtotoxic drugsMenieres diseaseInjuryTumorSpin (benign positional vertigo)Huntingtons: chromosome, involvementHUNT 4 DATE:HUNTingtons on chromosome 4, with cauDATEnucleus involvement.Peripheral neuropathies: differentialDANG THERAPIST:DiabetesAmyloidNutritional (eg B12 deficiency)Guillain-BarreToxic (eg amiodarone)HeriditaryEndocrineRecurring (10% of G-B) AlcoholPb (lead)IdiopathicSarcoidThyroidProximal myopathy: differentialPEACH PODS:PolymyositisEndocrine: hyper, hypothyroidism, Cushingssyndrome, acromegalyAlcoholCarcinomaHIV infectionPeriodic hypokalemic paralysisOsteomalaciaDrugs: steroids, statinsSarcoidosisPupillary dilatation (persistent): causes3AM:3rd nerve palsyAnti-muscarinic eye drops (eg to facilitate
  32. 32. fundoscopy)Myotonic pupil (Holmes Adie pupil): mostcommonly in young women, with absent/delayedreaction to light and convergence, and of nopathological significanceDementia: treatable causesDEMENTIA:Drug toxicityEmotional (depression, anxiety, OCD, etc.)Metabolic (electrolytes, liver dz, kidney dz, COPD)Eyes/ Ears (peripheral sensory restrictions)Nutrition (vitamin, iron deficiencies/ NPH [NormalPressure Hydrocephalus]Tumors/ Trauma (including chronic subduralhematoma)Infection (meningitis, encephalitis, pneumonia,syphilis)Arteriosclerosis and other vascular diseaseCerebellar signsPINARDS:Past pointingIntention tremorNystagmusAtaxiaReboundDysdiadokinesiaSlurred speech[Note: If you havent done Obs yet, a Pinards is forlistening to a babys heart on mothers abdomen]Status epilepticus: treatment"Thank Goodness All Cerebral Bursts Dissipate":ThiamineGlucoseAtivanCerebyxBarbiturateDiprivanBalints syndromeSOOT:SimultagnosiaOptic ataxiaOcular apraxiaTunnel visionChorea: common causesSt. VITUSS DANCE:SydenhamsVascularIncreased RBCs (polycythemia)Toxins: CO, Mg, HgUremiaSLESenile choreaDrugsAPLA syndromeNeurodegenerative conditions: HD,neuroacanthocytosis, DRPLAConception related: pregnancy, OCPsEndocrine: hyperthyroidism, hypo-, hyperglycemiaMultiple sclerosis: signs and symptomsINSULAR:Intention tremorNystagmusSlurred speechUthoffs phenomenonLhermittes signAtaxiaReboundDementia: some common causesDEMENTIA:DiabetesEthanolMedicationEnvironmental (eg CO poisoning)NutritionalTraumaInfectionAlzheimersConscious change: causesAEIOU TIPS:AlcoholEncephalopathyInfectionOpioidUremiaTraumaInsulinPsychosisSyncopePin-point pupil causesPin-Point Pupils are due to oPioids and PontinePathologyWhipples disease: features [for neurologists]A WHIPPLES DOOM:Arthralgias
  33. 33. Whipplei (organism)Hypothalamic involvementIntestinal involvement/ Intestinal biopsy requiredPAS positive macrophagesPCR positivityLymphadenopathyExtrapyramidal involvementSeptran treat withDementiaOcular abnormalities (vertical gaze palsy)Oculomasticatory myorhythmiaMyoclonusStroke risk factorsHEADS:Hypertension/ HyperlipidemiaElderlyAtrial fibDiabetes mellitus/ Drugs (cocaine)Smoking/ Sex (male)Babinski and LMN signs: conditions exhibitingthem"D MASTS":DiabetesMotor neuron diseaseAtaxia (friedrichs)Subacute combined degeneration of cordTabo paresisSyringobulbiaVisual loss: persistent bilateral sudden onsetvisual loss differentialFLOP:FunctionalLebers hereditary neuropathyOccipital infarctionsPituitary apoplexyBattle signBattlE:Behind EarNeuropathy: diagnosis confirmationNEuropathy:Nerve conduction velocityElectromyographyOcular 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 causesDEMENTIA:Drugs/ DepressionElderlyMulti-infarct/ MedicationEnvironmentalNutritionalToxinsIschemiaAlcoholHydrocephalus: Normal pressure hydrocephalusDDx3 Ws:Wet: urinary incontinenceWobbly: gait abnormalityWacky: dementia, memory problemsStroke: basic work upThe 3 Ps:PumpPipesPlasmaMultiple sclerosis (MS): epidemiologyMS is a feminine title (Ms.) and is femalepredominant.Encephalitis: differentialHES LATIN AMERICAN:HerpesviridaeEnteroviridae (esp. Polio)Slow viruses (esp. JC, prions)SyphilisLegionella/ Lyme disease/ LymphocyticmeningoencephalitisAspergillusToxoplasmosisIntracranial pressureNeisseria meningitidisArboviridaeMeasles/ Mumps/ Mycobacterium tuberculosis/MucorE. coliRabies/ RubellaIdiopathicCryptococcus/ CandidaAbscessNeoplasm/ Neurocysticercosis
  34. 34. · Neurocysticercosis should be assumed with recentLatin American immigrant patient unless provenotherwise.Stroke: young patients likely causes7 Cs:CocaineConsanguinity [familial such as neurofibromatosisand von Hippel-Lindau]CancerCardiogenic embolhyperCoagulationCNS infection [eg: HIV conditions]Congenital arterial lesionBenidicts syndrome: site affectedBenidicts test for sugar gives red precipitate.Similarly, Benidicts syndrome affects red nucleus.Decreased level of consciousness: metaboliccausesMETABOLIC:Major end organs (liver, kidney)Endocrine/ ElectrolytesToxinsAcidBase disordersOxygenationLung (PE, pneumonia)Infection/ Inflammatory/ IatrogenicCalciumCongenital myopathy: featuresDREAMS:Dominantly inherited, mostlyReflexes decreasedEnzymes normalApathetic floppy babyMilestones delayedSkeletal abnormalitiesObstetrics and Gynecology - MnemonicsFemale pelvis: shapesGAP:· In order from most to least common:GynecoidAndroid /AnthropoidPlatypelloidOral contraceptives: side effectsCONTRACEPTIVES:Cholestatic jaundiceOedema (corneal)Nasal congestionThyroid dysfunctionRaised BPAcne/ Alopecia/ AnaemiaCerebrovascular diseaseElevated blood sugarPorphyria/ Pigmentation/ PancreatitisThromboembolismIntracranial hypertensionVomiting (progesterone only)Erythema nodosum/ Extrapyramidal effectsSensitivity to lightPost-partum haemorrhage (PPH): causes4 Ts:Tissue (retained placenta)Tone (uterine atony)Trauma (traumatic delivery, episiotomy)Thrombin (coagulation disorders, DIC)Forceps: indications for useFORCEPS:Fully dilated cervix0 ["Zero"] CPDRuptured membranesCephalic or at least deliverable presentation/Contracting uterusEpisiotomy done/ Epidural doneP!ss and S#!t (bladder and bowel empty)Post-partum examination simplified checklistBUBBLES:BreastUterusBowelBladderLochiaEpisotomySurgical site (for Cesarean section)Miscarriage: recurrent miscarriage causesRIBCAGE:RadiationImmune reactionBugs (infection)Cervical incompetenceAnatomical anomaly (uterine septum etc.)Genetic (aneuploidy, balanced translocation etc.)Endocrine
  35. 35. Alpha-fetoprotein: causes for increased maternalserum AFP during pregnancy"Increased Maternal Serum Alpha Feto Protein":Intestinal obstructionMultiple gestation/ Miscalculation of gestationalage/ MyeloschisisSpina bifida cysticaAnencephaly/ Abdominal wall defectFetal deathPlacental abruptionGestation period, oocytes, vaginal pH, menstrualcycle: normal numbers4 is the normal pH of the vagina.40 weeks is the normal gestation period.400 oocytes released between menarche andmenopause.400,000 oocytes present at puberty.28 days in a normal menstrual cycle.280 days (from last normal menstrual period) in anormal gestation period.Oral contraceptive complications: warning signsACHES:Abdominal painChest painHeadache (severe)Eye (blurred vision)Sharp leg painCVS and amniocentesis: when performed"Chorionic" has 9 letters and Chorionic villussampling performed at 9 weeks gestation."AlphaFetoProtein" has 16 letters and its measuredat 16 weeks gestation.Prenatal care questionsABCDE:Amniotic fluid leakage?Bleeding vaginally?Contractions?Dysuria?Edema?Fetal movement?Asherman syndrome featuresASHERMAN:Acquired AnomalySecondary to SurgeryHysterosalpingography confirms diagnosisEndometrial damage/ EugonadotropicRepeated uterine traumaMissed MensesAdhesionsNormal estrogen and progesteroneAbdominal pain: causes during pregnancyLARA CROFT:LabourAbruption of placentaRupture (eg. ectopic/ uterus)AbortionCholestasisRectus sheath haematomaOvarian tumourFibroidsTorsion of uterusPreeclampsia: classic triadPREeclampsia:ProteinuriaRising blood pressureEdemaParity abbreviations (ie: G 3, P 2012)"To Peace And Love":T: of Term pregnanciesP: of Premature birthsA: of Abortions (spontaneous or elective)L: of Live births· Describes the outcomes of the total number ofpregnancies (Gravida).Forceps: indications for deliveryFORCEPS:Foetus aliveOs dilatedRuptured membraneCervix taken upEngagement of headPresentation suitableSagittal suture in AP diameter of inletFetus: cardinal movements of fetus"Dont Forget I Enjoy Really ExpensiveEquipment":DescentFlexionInteral rotationExtensionRestitutionExternal rotationExpulsion
  36. 36. Pelvic Inflammatory Disease (PID): complicationsI FACE PID:InfertilityFitz-Hugh-Curitis syndromeAbscessesChronic pelvic painEctopic pregnancyPeritonitisIntestinal obstructionDisseminated: sepsis, endocarditis, arthritis,meninigitisAPGAR score componentsSHIRT:Skin color: blue or pinkHeart rate: below 100 or over 100Irritability (response to stimulation): none, grimaceor cryRespirations: irregular or goodTone (muscle): some flexion or activeVaginal pHVagina has 4 labia and normal pH of vagina is about4.Early cord clamping: indicationsRAPID CS:Rh incompatibilityAsphyxiaPremature deliveryInfectionsDiabetic motherCS (caesarian section) previously, so the funda isRAPID CSIUGR: causesIUGR:Inherited: chromosomal and genetic disordersUterus: placental insufficencyGeneral: maternal malnutrition, smokingRubella and other congenital infectonPostpartum collapse: causesHEPARINS:HemorrhageEclampsiaPulmonary embolismAmniotic fluid embolismRegional anaethetic complicationsInfarction (MI)Neurogenic shockSeptic shockDelivery: instrumental delivery prerequisitesAABBCCDDEE:AnalgesiaAntisepsisBowel emptyBladder emptyCephalic presentationConsentDilated cervixDisproportion (no CPD)EngagedEpisiotomyPelvic Inflammatory Disease (PID): causes,effects"PID CAN be EPIC":· Causes:Chlamydia trachomatisActinomycetesNeisseria gonorrhoeae· Effects:EctopicPregnancyInfertilityChronic painShoulder dystocia: managementHELPER:Call for HelpEpisiotomyLegs up [McRoberts position]Pressure subrapubically [not on fundus]Enter vagina for shoulder rotationReach for posterior shoulder and deliver posteriorshoulder/ Return head into vagina [Zavanellimaneuver] for C-section/ Rupture clavicle or pubicsymphisisSecondary amenorrhea: causesSOAP:StressOCPAnorexiaPregnancyRLQ pain: brief female differentialAEIOU:Appendicitis/ Abscess
  37. 37. Ectopic pregnancy/ EndometriosisInflammatory disease (pelvic)/ IBDOvarian cyst (rupture, torsion)Uteric colic/ Urinary stonesMultiple pregnancy complicationsHI, PAPA:Hydramnios (Poly)IUGRPreterm labourAntepartum haemorrhagePre-eclampsiaAbortionOvarian cancer: risk factors"Blue FILM":Breast cancerFamily historyInfertilityLow parityMumpsOmental caking: likeliest causeOmental CAking = Ovarian CA· "Omental caking" is term for ascities, plus a fixedupper abdominal and pelvic mass. Almost alwayssignifies ovarian cancer.Spontaneous abortion: definition"Spontaneous abortion" has less than 20 letters [itsexactly 19 letters].Spontaneous abortion is defined as delivery or lossof products of conception at less than 20 weeksgestation.Dysfunctional uterine bleeding (DUB): 3 majorcausesDUB:Dont ovulate (anovulation: 90% of cases)Unusual corpus leuteum activity (prolonged orinsufficient)Birth control pills (since increases progesterone-estrogen ratio)Post-partum haemmorrage (PPH): risk factorsPARTUM:Polyhydroamnios/ Prolonged labour/ PreviouscesarianAPH/ ANTHRecent bleeding historyTwinsUterine fibroidsMultiparityLabour: preterm labor causesDISEASE:DehydrationInfectionSexExercise (strenuous)ActivitiesStressEnvironmental factor (job, etc)Alpha-fetoprotein: some major causes forincreased maternal serum AFP during pregnancyTOLD:Testicular tumoursObituary (fetal death)Liver: hepatomasDefects (neural tube defects)IUD: side effectsPAINS:Period that is lateAbdominal crampsIncrease in body temperatureNoticeable vaginal dischargeSpottingPolycystic Ovarian Syndrome (PCOS): first linetreatmentTreat PCOS with OCPs (oral contraceptive pills).Sexual response cycleEXPLORE:EXcitementPLateauOrgasmicREsolutionB-agonist tocolytic (C/I or warning)ABCDE:Angina (Heart disease)BP highChorioamnionitisDiabetesExcessive bleedingOphthalmology Mnemonics
  38. 38. Corneal stromal dystrophies"Marilyn Monroe Gets High in LA":Macular: MucopolysaccharideGranular: HyalineLattice: AmyloidOptic atrophy causesICING:IschaemiaCompressed nerveIntracranial pressure [raised]Neuritis historyGlaucomaChoroidal neovascular membraneHAMMAR:HistoplasmosisARMDMultifocal ChoroiditisMyopiaAngiodRupture of the choroidNasopharyngeal cancer: classic symptomsNOSE:Neck massObstructed nasal passageSerous otitis media externaEpistaxis and dischargeDiplopia (uniocular): causesABCD:AstigmatismBehavioral: psychogenicCataractDislocated lensAnopsia: quarantic anopsia: location of lesionUpper: Top: Temporal lesions.Lower: Pits: Parietal lesions.Cataracts: causesCATARAct:CongenitalAgingToxicity (steroids, etc)AccidentsRadiationAbnormal metabolism (diabetes mellitus, Wilsons)Red eye causesGO SUCK:GlaucomaOrbital diseaseScleritisUveitisConjunctivitisKeratitisCataracts: causesABCDE:AgingBang: trauma, other injuries (eg infrared)CongenitalDiabetes and other metabolic disturbances (egsteroids)Eye diseases: glaucoma, uveitisCataracts: differentialCATARAct:CongenitalAgingToxicity (steroids, etc)AccidentsRadiationAbnormal metabolism (DM, Wilsons, etc)Orthopedics MnemonicsCarpal (Wrist) Bones"Scared Lovers Try Positions That They CantHandle." Starting from the thumb, the eightcarpal bones are Scaphoid, Lunate, Triquetrum,Pisiform, Trapezium, Trapezoid, Capitate, andHamate. To tell the three Ts apart... triquetrumhas "tri/try" in it, and trapezium and trapezoid arein alphabetical order.CARPenters use their hands. The CARPALbones are of the hand, and not the foot.Cranial BonesAnnoying, arent they? The cranial bones are thePEST OF 6...PESTOF
  39. 39. ParietalEthmoidSphenoidTemporalOccipitalFrontalthe six? the number of bones!Try this one as well: Old People From TexasEat Spiders.Cranial SuturesSutures have CLASS...CLASSCoronalLambdoidandSquamousSagittalFacial Bones"Con Man Max and Pal Ziggy Lack NastyVoices". Not the most intuitive acrostic in theworld, but it works...ConManMaxPalZiggyLackNastyVoicesConchaeMandibleMaxillaPalatineZygomaticLacrimalNasalVomerFontanels (Infant Skull)A babys first words might be "PAPA!"...PAPAPosteriorAnteriorPosterio-LateralAnterio-LateralFracturesStar Wars fans (hi, Inderpal!) use "Go C3PO" torecall the seven types of bone fractures...GOCCCPOGreenstickOpenCompleteClosedComminutedPartialOtherLower Leg BonesCant tell your tib from your fib? The TIBia is theThick, Inner Bone. The FibuLa is Finer, Fluted,and Lateral.Orbital BonesThis ones a bit silly. It relies on the belief that aspecies called the FLEZMS are in ORBITaroundthe earth.FLEZMSFrontalLacrimalEthmoidZygomaticMaxillaSphenoidBranches of the facial nerveTwo Zulus Bruised My Cervix
  40. 40. This one is used to remember the branches of thefacial nerve...a (Sent to me by emporal nerveZ ygomatic nerveB uccal nerveM arginal mandibular nerveC ervical nerveTo Zanzibar By MotorcarFracture: how to describePLASTER OF PARIS:PlaneLocationArticular cartilage involvementSimple or comminutedType (eg Colles)ExtentReasonOpen or closedForeign bodiesdisPlacementAngulationRotationImpactionShorteningSalter Harris fracture classificationSalter Harris, modified to SALTR:type 1: Slipped epiphysistype 2: Above the eiphyseal platetype 3: Lower than the eiphyseal platetype 4: Through both above and below eiphysealplatetype 5: Raised epiphysis, as in a compression injury· Salter Harris classification utilises visualising longbone distal portion with diaphysis superiorly placedand epiphysis inferiorly placed.Pagets disease of bone: signs and symptomsPANICS:PainArthralgiaNerve compression / Neural deafnessIncreased bone densityCardiac failureSkull / Sclerotic vertebraeOsteosarcoma: risk factorsPRIMARY:PagetsRadiationInfaction of boneMaleAlcohol, poor diet, sedentary lifestyle [adults only]Retinoblastoma, Li-Fraumeni syndromeYoung [10-20 yrs]· Osteosarcoma is the most common primarymalignant tumor of bone.Fractures: principles of managementFRIAR:First aidReductionImmobilisationActive RehabilitationBryants traction: positionBrYants traction:Bent Y.· Patients body is the stem of the Y laying on thebed, and legs are the ends of the Y up in the air.Monoarthritis differentialGHOST:GoutHaemarthrosisOsteoarthritisSepsisTraumaSacroiliitis: causesPUB CAR:PsoriasisUlcerative colitisBehcets diseaseCrohns diseaseAnkylosing spondylitisReiters diseaseCarpal tunnel syndrome: treatmentWRIST:Wear splints at nightRestInject steroidSurgical decompression
  41. 41. Take diureticsForearm fractures: bone in Monteggia vs.GaleazziMonteggia is fracture of ulna.Therefore, Galeazzi is fracture of radius.Bone fracture types [for Star Wars fans]GO C3PO:GreenstickOpenComplete/ Closed/ ComminutedPartialOthers· Note: C3P0 is droid in the Star-Wars movies.Fracture: describing (short version)DOCTOR:Displaced vs. non-displacedOpen vs. closedComplete vs. incompleteTransverse fracture vs. linear fractureOpen Reduction vs. closed reductionCongenital talipes equinovarus (CTEV, clubfoot):major physical findingsCAVE:CavusAdductionVarusEquinusFracture: descriptionBLT LARD:BoneLocation on boneType of fractureLengtheningAngulationRotationDisplacementNonunion of bones: differentialYou need a SPLINT:Soft tissue interpositionPosition of reduction (too much traction,immobilization, or movement)Location (eg. lower third of tibia slow to heal)InfectionNutritional (damaged vessels or diseased bone)Tumor (pathological fracture)Joints classification, by amount of allowedmovement at jointSAD:SynarthrosesAmphiarthrosesDiarthrosesForearm: fractures"Break the forearm of the MUGR (mugger)":Monteggia=UlnaGaleazzi=RadiusPathology MnemonicsOral cancer risksPATH LAB:Plummer-vinson syndromeAlcoholTobaccoHuman papilloma virusLeukoplakiaAsbestosBad oral hygieneWernickes encephalopathy: componentsWACO:· Wernickes is:AtaxiaConfusion (or clouded consciousness)Ocular problems· Note: Waco is the town in Texas, USA madefamous for a standoff with a David Koresh and theBranch Davidians.TTP: clinical featuresThrombosis and thrombocytopenia PARTNERtogether:Platelet count lowAnemia (microangiopathic hemolytic)Renal failureTemperature riseNeurological deficitsER admission (as it is an emergency)
  42. 42. Edwards syndrome: characteristicsEDWARDS:Eighteen (trisomy)Digit overlapping flexionWide headAbsent intellect (mentally retarded)Rocker-bottom feetDiseased heartSmall lower jawAchalasia: 1 possible cause, 1 treatmentaCHAlasia:1 possible cause: CHAgas disease1 treatment: Ca++ CHAnnel blockersCOPD: blue bloater vs. pink puffer diseasesemPhysema has letter P (and not B) so Pink Puffer.chronic Bronchitis has letter B (and not P) so BlueBloater.Duchenne vs. Becker Muscular DystrophyDuchenne Muscular Dystrophy (DMD) : DoesntMake Dystrophin.Becker Muscular Dystrophy (BMD): Badly MadeDystrophin (a truncated protein).Ovarian cancers: important types, by WHOclassification· Surface:"My Sister Began Experiencing Cancer":MucinousSerousBrennerEndometrioidClear· Germ cell:"Doctor Examined The Ovaries":DysgerminomaEndometrial sinusTeratomaOvarian choriocarcinoma· Sex cord:"She Felt Grim":Sertoli-LeydigFibromaGranulosa-theca· Metastatic"Killed":KrukenbergAlzheimers disease: featuresRONALD (Ronald Reagan, a famous victim):Reduction of AchOld ageNeurofibrillary tanglesAtrophy of cerebral cortex (diffuse)Language impairmentDementia (MC in elderly)/ Downs syndromeDandy-Walker syndrome: components"Dandy Walker Syndrome":Dilated 4th ventricleWater on the brainSmall vermisPericarditis: findingsPERICarditis:Pulsus paradoxusECG changesRubIncreased JVPChest pain [worse on inspiration, better when leanforward]Histiocytosis X: hallmark finding"Birbecks rackets is X":Tennis rackets under electron microscope isHistiocystosis X.Consider 2 tennis rackets in an X formation.MI: post-MI complicationsACT RAPID:Arrhythmias (SVT, VT, VF)Congestive cardiac failureTamponade/ Thromboembolic disordersRupture (ventricle, septum, papillary muscle)Aneurysm (ventricle)PericarditisInfaction (a second one)Death/ Dresslers syndromeHemolytic anemia typesSHEEP T!T:Sickle cellHeriditary splenocytosisEnzyme deficiencies: [G6P, pyruvate kinase]Erythroblastosis fetalis
  43. 43. Paroxysmal nocturnal hemoglobinuriaTrauma to RBCsImmunohemolytics: [warm Ab, cold Ag]Thalassemias: [alpha, beta]Thrombotic thrombocytopenic purpura: signsFAT RN:FeverAnemiaThrombocytopeniaRenal problemsNeurologic dysfunctionPancreatitis: causesBAD S#!T:Biliary: gallstones, 1% of ERCP patientsAlcoholism/ AzotemiaDrugsScorpion bite/ Sea anenome/ SLEHyperlipidemia/ HypercalcemiaIdiopathic/ Infectious (mumps, coxsackie,salmonella, ascariasis)Tumor/ Trauma· The drugs are: penacillamine, furosemide,thiazides, ethacrynic acid, steroids, sulfas, aceinhibitors, N-SAIDs, erythromycin, estrogen.Portal hypertension: featuresABCDE:AscitesBleeding (haematemesis, piles)Caput medusaeDiminished liverEnlarged spleenGout: major featuresGOUT:Great toeOne joint (75% monoarticular)Uric acid increased (hence urolithiasis)TophiAPKD: signs, complications, accelerators11 Bs:· Signs:Bloody urineBilateral pain [vs. stones, which are usuallyunilateral pain]Blood pressure upBigger kidneysBumps palpable· Complications:Berry aneurysmBiliary cystsBicuspid valve [prolapse and other problems]· Accelerators:BoysBlacksBlood pressure highCardiovascular risk factorsFLASH BODIES:Family historyLipidsAgeSexHomocystinaemiaBlood pressureObesityDiabetes mellitusInflammation (raised CRP)/ Increased thrombosisExerciseSmokingPyrogenic 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: componentsMEN III is a disease of 3 Ms:Medullary thyroid carcinomaMedulla of adrenal (pheochromocytoma)Mucosal neuromaMI: sequence of elevated enzymes after MI"Time to CALL 911":· From first to appear to last:TroponinCK-MBASTLDH1MEN I (Multiple Endocrine Neoplasia)syndrome: components"Please Please Pay Attention To peptic ulceration,you worms":· Adenomas of:Pituatary
  44. 44. Pancreatic isletsParathyroidAdrenal cortexThyroid, associated with peptic ulceration· Syndrome is called "Wermers syndrome".Parkinsons disease: symptomsPQRST:Paucity of expressionparQinsonRigidity (cogwheel)Stooped postureTremor at rest· If cant remember that Parkinsons tremor is the onethat is "resting tremor", look at the last 3 letters:RST.Gout: factors that can precipitate an attack ofacute gouty arthritisDARK:DiureticsAlcoholRenal diseaseKicked (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 inorder from least aggressive to most aggressive:Papillary carcinomaFollicular carcinomaMedullary thyroid carcinomaAnaplastic carcinomaBronchial obstruction: consequencesAPPLE BABE:AtelectasisPleural adhesionsPleuritisLipid pneumoniaEffusion->organisation->fibrosisBronchiectasisAbscessBroncho and lobar pneumoniaEmphysemaPicks disease: location, action, epidemiology· See figure.Pick axes are Picking away at the old womanscerebral cortex, causing cortical atrophy.2 pick axes on her brain: frontal lobe and anterior 1/3of temporal.An old woman, since epidemiology is elderly &more common in women.Wernicke-Korsakoffs psychosis: findingsCOAT RACK:· Wernickes encephalopathy (acute phase):ConfusionOphthalmoplegiaAtaxiaThiamine tx.· Korsakoffs psychosis (chronic phase):Retrograde amnesiaAnterograde amnesiaConfabulationKorsakoffs psychosisEndometrial carcinoma: risk factorsENDOMET:ElderlyNulliparityDiabetesObesityMenstrual irregularityEstrogen therapyhyperTensionRespiratory distress syndrome in infants: majorrisk factorsPCD (Primary Ciliary Dyskinesia, a cause ofRespiratory distress syndrome):PrematurityCesarean sectionDiabetic motherBlood disorders: commoner sexHE (male) gets:HEmophilia (X-linked)HEinz bodies (G6PD deficiency, causing HEmolyticanemia: X-linked)HEmochromatosis (male predominance)HEart attacks (male predominance)HEnoch-Schonlein purpura (male predominance)SHE (female) gets:SHEehans syndromeTakayasus disease is Pulseless disease"Cant Taka ya pulse" (Cant take your pulse):Takayasus disease known as Pulseless disease, sincepulse is weakened in the upper extremities.
  45. 45. Osteomyelitis: complicationsFIBRES:FracturesIntraosseous (broidie) abscessesBacteremi/ Brodie abscessReactive amyloidosisEndocarditisSinus tracts/ Squamous cell CANasopharyngeal malignant cancersNASOPharyngeal:NasophayngealAdenocarcinomaSquamous cell carcinomaOlfactory neuroblastomaPlasmacytomaEmphysema: types, most important feature ofeach"Cigarettes Is Primary Problem":· Types:CentrilobularIrregularPancinarParaseptal· Most important feature for each type (in order asabove):CigarrettesInflammation healed to scarProtease inhibitor deficiency (a1-antitrypsin)Pneumothorax· "Cigarettes is primary problem" used sincecigarettes is most common cause of emphysema.· Keeping Ps straight: Pan is antitrypsin.Baldness risk factors"Daddy Doesnt Deny Getting Hair Implants":DietDiseaseDrugsGenesHormonesInjury to the scalpThrombus: possible fatesDOPE:DissolutionOrganization & repairPropagationEmbolizationBuergers disease features"burger SCRAPS":Segmenting thrombosing vasculitisClaudication (intermittent)Raynauds phenomenonAssociated with smokingPain, even at restSuperficial nodular phlebitis· Alternatively, if hungry for more detail [sic],"CRISP PIG burgers":Chronic ulcerationRaynauds phenomenonIntermittent claudicationSegmenting, thrombosing vasculitisPain, even at restPhlebitis (superficial nodular)IdiopathicGangreneTB: featuresTB is characterised by 4 Cs:CaseationCalcificationCavitationCicatrizationKawasaki 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 orcrusting)To have Kawasaki disease you must have fever forgreater than 5 days plus 4 of the above.Ulcerative colitis: featuresULCERATIONS:UlcersLarge intestineCarcinoma [risk]Extraintestinal manifestationsRemnants of old ulcers [pseudopolyps]Abscesses in cryptsToxic megacolon [risk]Inflamed, red, granular mucosaOriginates at rectumNeutrophil invasionStools bloodyThyroid storm characteristics"Storm HITS girls cAMP":
  46. 46. Thyroid storm due to:HyperthyroidismInfection or Illness at childbirthTraumaSurgery· 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 ThatHyperthyroidism Will Make Grossly Evident":AnxietyPalpitations/ Pulse rapidFatigabilityEmotional labilitySweatingTremorHeat intoleranceWeight loss with good appetiteMuscular weakness/ Menstrual changesGoitreEye changesEndometrial carcinoma: risk factorsHONDA:HypertensionObesityNulliparityDiabetesAge (increased)Tabes Dorsalis morphologyDORSALIS:Dorsal column degenerationOrthopedic pain (Charcot joints)Reflexes decreased (deep tendon)Shooting painArgyll-Robertson pupilsLocomotor ataxiaImpaired proprioceptionSyphilisPneumothorax: presentationP-THORAX:Pleuretic painTrachea deviationHyperresonanceOnset suddenReduced breath sounds (& dypsnea)Absent fremitusX-ray shows collapseRenal failure (chronic): consequencesABCDEFG:Anemia-due to less EPOBone alterations-osteomalacia-osteoporosis-von RecklinghausenCardiopulmonary-atherosclerosis-CHF-hypertension-pericarditisD vitamin lossElectrolyte imbalance-sodium loss/gain-metabolic acidosis-hyperkalemiaFeverous infections-due to leukocyte abnormalities and dialysis hazardsGI disturbances-haemorrhagic gastritis-peptic ulcer disease-intractable hiccupsCarcinomas having tendency to metastasize tobone"Kinds Of Tumors Leaping Primarily To Bone":KidneysOvariesTestesLungsProstateThyroidBreasts· 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 pigmentationBiking: Bronze diabetesMarathon: Micronodular pigment cirrhosisWiskott-Aldrich syndrome: symptom triad"PET WASP":Pyrogenic infectionsEczemaThrombocytopenia· WASP is the name of the causitive agent: Wiskott-
  47. 47. Aldrich Syndrome Protein.· Alternatively: Wiskott=Hot, Aldrich=Itch,Syndrom=Throm.Pancoast tumor: relationship with Hornerssyndrome"Horner has a MAP of the Coast":A panCoast tumor is a cancer of the lung apex thatcompresses the cervical sympathetic plexus, causingHorners syndrome, which is MAP:MiosisAnhidrosisPtosisGallstones/cholecystitis: risk factors5 Fs:FatFemaleFamily historyFertileFortyLou Gehrigs is both upper and lower motorneuron signsLoU = Lower & Upper.Nephrotic syndrome: hallmark findings"Protein LEAC":ProteinuriaLipid upEdemaAlbumin downCholesterol up· In nephrotic, the proteins leak out.Virchows triad (venous thrombosis)"VIRchow":Vascular traumaIncreased coagulabilityReduced blood flow (stasis)PKU findingsPKU:Pale hair, skinKrazy (neurological abnormalities)Unpleasant smellOsteosarcoma: featuresPEARL HARBOR:Pagets disease (10-20%)*Early age (10-20 yrs)Around kneeRaised periosteum by expanding tumor: "sunburstpattern"Lace-like architectureHyaline arteoriosclerosisAlkaline phosphatase increasedRetinoblastoma*Boys, predominantlyOsteomyelitis DDxRadiation*· Sunburst pattern was Japanese Navy emblemduring WWII.*: Predisposing factors.Sarcoidosis summarizedSARCOIDOISIS:Schaumann calcificationsAsteroid bodies/ [ACE] increase/ AnergyRespiratory complications/ Renal calculi/ Restrictivelung disease/ Restrictive cardiomyopathyCalcium increase in serum and urine/ CD4 helpercellsOcular lesionsImmune mediated noncaseating granulomas/ [Ig]increaseDiabetes insipidus/ [D vit.] increase/ DyspneaOsteopathySkin (Subcutaneous nodules, erythema nodosum)Interstitial lung fibrosis/ IL-1Seventh CN palsyPediatrics MnemonicsWilliams syndrome: featuresWILLIAMS:Weight (low at birth, slow to gain)Iris (stellate iris)Long philtrumLarge mouthIncreased Ca++Aortic stenosis (and other stenoses)Mental retardationSwelling around eyes (periorbital puffiness)Sturge-Weber syndrome: hallmark featuresSturge-Weber:1. Seizures
  48. 48. 2. PortWine stainCroup: symptoms3 Ss:StridorSubglottic swellingSeal-bark coughNeonatal resuscitation: successive steps"Do What Pediatricians Say To, Or Be InvitingCostly Malpractice":DryingWarmingPositioningSuctioningTactile stimulationOxygenBaggingIntubate endotracheallyChest compressionsMedicationsMeasles: complications"MEASLES COMP" (complications):MyocarditisEncephalitisAppendicitisSubacute sclerosing panencephalitisLaryngitisEarly deathSh!ts (diarrhoea)Corneal ulcerOtis mediaMesenteric lymphadenitisPneumonia and related (bronchiolitis-bronchitis-croup)Short stature: differentialABCDEFG:Alone (neglected infant)Bone dysplasias (rickets, scoliosis,mucopolysaccharidoses)Chromosomal (Turners, Downs)Delayed growthEndocrine (low growth hormone, Cushings,hypothyroid)FamilialGI malabsorption (celiac, Crohns)Cystic fibrosis: presenting signsCF PANCREAS:Chronic cough and wheezingFailure to thrivePancreatic insufficiency (symptoms ofmalabsorption like steatorrhea)Alkalosis and hypotonic dehydrationNeonatal intestinal obstruction (meconium ileus)/Nasal polypsClubbing of fingers/ Chest radiograph withcharacteristic changesRectal prolapseElectrolyte elevation in sweat, salty skinAbsence or congenital atresia of vas deferensSputum with Staph or Pseudomonas (mucoid)Pyloric stenosis (congential): presentationPyloric stenosis is 3 Ps:Palpable massParistalsis visibleProjectile vomiting (2-4 weeks after birth)Dentition: eruption times of permanent dentition"Mama Is In Pain, Papa Can Make Medicine":1st Molar: 6 years1st Incisor: 7 years2nd Incisor: 8 years1st Premolar: 9 years2nd Premolar: 10 yearsCanine: 11 years2nd Molar: 12 years3rd Molar: 18-25 yearsCyanotic heart diseases: 5 types· Use your five fingers:1 finger up: Truncus Arteriosus (1 vessel)2 fingers up: Dextroposition of the Great Arteries (2vessels transposed)3 fingers up: Tricuspid Atresia (3=Tri)4 fingers up: Tetralogy of Fallot (4=Tetra)5 fingers up: Total Anomalous Pulmonary VenousReturn (5=5 words)Haematuria: differential in childrenABCDEFGHIJK:Anatomy (cysts, etc)Bladder (cystitis)Cancer (Wilms tumour)Drug related (cyclophosphamide)Exercise inducedFactitious (Munchausen by proxy)GlomerulonephritisHaematology (bleeding disorder, sickle cell)Infection (UTI)In Jury (trauma)Kidney stones (hypercalciuria)
  49. 49. Septic Arthritis: most common causeStaphylococcus Aureus is the most common cause ofSeptic Arthritis in the pediatric population.Cough (chronic): differentialWhen cough in nursery, rock the "CRADLE":Cystic fibrosisRings, slings, and airway things (tracheal rings)/Respiratory infectionsAspiration (swallowing dysfunction, TE fistula,gastroesphageal reflux)Dyskinetic ciliaLung, airway, and vascular malformations(tracheomalacia, vocal cord dysfunction)Edema (heart failure)Breast feeding: contraindicated drugsBREAST:Bromocriptine/ BenzodiazepinesRadioactive isotopes/ RizatriptanErgotamine/ EthosuximideAmiodarone/ AmphetaminesStimulant laxatives/ Sex hormonesTetracycline/ TretinoinBeckwith-Widemann syndrome: featuresHOMO:HypoglycemiaOmphalocelMacroglossia/ MacrosomiaOrganomegalyAPGAR score componentsAPGAR:Appearance: cyanosis--peripheral, central, nonePulse: pulse rateGrimace: response to stimulationActivity: movement of the baby (muscle tone)Respiration: respiratory rateGuthrie card: diseases identified with it"Guthrie Cards Can Help Predict Bad Metabolism":GalactosaemiaCystic fibrosisCongenital adrenal hyperplasiaHypothyroidismPhenylketonuriaBiotidinase deficiencyMaple syrup urine diseasePediatric milestones in development1 year:-single words2 years:-2 word sentences-understands 2 step commands3 years:-3 word combos-repeats 3 digits-rides tricycle4 years:-draws square-counts 4 objectsHead circumference with age· Remember 3, 9, and multiples of 5:Newborn 35 cm3 mos 40 cm9 mos 45 cm3 yrs 50 cm9 yrs 55 cmWeights of children with ageNewborn 3 kg6 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 kg7 yrs 25 kg9 yrs 30 kg11 yrs 35 kg (add 10 kg thereafter)13 yrs 45 kg15 yrs 55 kg17 yrs 65 kgCystic fibrosis: exacerbation of pulmonaryinfectionCF PANCREAS:Cough (increase in intensity and frequent spells)Fever (usually low grade, unless severebronchopneumonia is present)Pulmonary function deteriorationAppetite decreaseNutrition, weight lossCBC (leukocytosis with left shift)Radiograph (increase overaeration, peribronchialthickening, 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
  50. 50. abundant, forming plugs)Cyanotic heart diseases: 5 types· 5 Ts:Tetralogy of FallotTransposition of the great arteriesTruncus arteriosusTricuspid atresia, pulmonary aTresiaTotal anomalous pulmonary venous drainageHemolytic-Uremic Syndrome (HUS): components"Remember to decrease the RATE of IV fluids inthese patients":Renal failureAnemia (microangiopathic, hemolytic)ThrombocytopeniaEncephalopathy (TTP)Rubella: congenital signs"Rubber Ducky, Im so blue!" (like the "RubberDucky" song):Rubber: RubellaDucky: Patent Ductus Arteriosus, VSD andpulmonary artery stenosis.Im: Eyes (cataracts, retinopathy, micropthalmia,glaucoma).Blue: "Blueberry Muffin" rash (extramedullaryhematopoesis in skin +purpura)· Also, deafness, growth retardation, and some more.Cerebral palsy (CP): most likely causeCP: Cerebral PalsyChild Premature· The premature brain is more prone to all thepossible insults.Guthrie card: diseases identified with itGUTHRIE:GalactosaemiaUrine [maple syrup urine disease]THyRoid [hypothyroidism]Inborn Errors of metabolism [eg: PKU]Vacterl syndrome: componentsVACTERL:Vertebral anomaliesAnorectal malformationCardiac anomalyTracheo-esophageal fistulaExomphalos (aka omphalocele)Renal anomaliesLimb anomaliesPerez reflexEliciting the PErEz reflex will make the baby PEE.Duodenal atresia vs. Pyloric stenosis: site ofobstructionDuodenal Atresia: Distal to Ampulla of vater.Pyloric stenosis: Proximal to it.Cyanotic congenital heart diseases5 Ts:Truncus arteriosusTransposition of the great arteriesTricuspid atresiaTetrology of FallotTotal anomalous pulmonary venous returnPaediatric history taking· Begin with standard things: patient name,presenting complaint, history of presentingcomplaint and past medical history.· Then ask BIFIDA:Birth details and problemsImmunisationsFeedingInfection, exposure toDevelopment, normality ofAllergies· End by customary review of the rest of the standardthings: medications, family history and socialhistory.Gastroschisis: usual locationGasTRoscHIsis usually occurs on theRIGHT side of the umbilicus.(Unscramble the letters).Bilirubin: phototherapyBiLirUbin absorbs light maximally in theBLUe range.Russell Silver syndrome: featuresABCDEF:Asymmetric limb (hemihypertrophy)Bossing (frontal)Clinodactyly/ Cafe au lait spotsDwarf (short stature)