The document summarizes causes of meningitis by age group, key findings in Fragile X syndrome, provides a mnemonic and description for Ewing's tumor, lists drugs that cause gingival hyperplasia and hypothyroidism, and discusses hypertension treatment based on comorbid conditions. Newborns are most commonly affected by GBS, E.coli, and listeria. Children under 6 years old are most commonly affected by strep pneumoniae, Neisseria, and H. Influenzae. Adults 6-60 years old are most commonly affected by Neisseria Meningitidis, enteroviruses, and strep pneumoniae. Adults over 60 years old are most commonly

1. Causes of Meningitis with respect to Age:
Newborns:
1- GBS
2- E.coli
3- listeria
Children less than 6 years:
1- strep pneumoniae
2- Neisseria
3- H Influenzae
4- enteroviruses
6 years to 60 years:
1- Neisseria Meningitidis
2- enteroviruses
3- strep pneumoniae
4- HSV
Over 60 years:
1- strep pneumoniae
2- listeria
The story is different in HIV and immune-compromised patients where you have to think of
listeria, fungi, JC virus, and toxoplasmosis.
Important findings in Fragile X syndrome= "6M"
1) Mental Retardation
2) Mutation in FMR1 gene on X chromosome (X linked Dominant)
3) Macro jaw(large jaw)
4) Macro orchidism
5) Macrotia (large everted ears)
6) Mitral valve prolapse is associated with it.
(Other points to remember for Fragile X=1)CGG Trinucleotide repeats in non-coding region of
DNA 2)can cause Attention deficit disorder in females)

2. Ewings Tumor Picture Mnemonic!
The above picture gives mnemonic for Ewing's tumor. First let us analyse the picture. Note the
chick and swelling of Diaphysis of Tibia with the onion. Chick says VAC VACVAC VACA,
VAC VACVAC AV / CV. The chick has fat and hence PAS stain positive. Note the moon and
star at the top, Radio streaming music and chick fluttering it's wings up and down to the music as
represented by 2 arrow marks at the left side. See the melted snow below the bone and a blood
vessel from the side ( left corner )
Now, this is what the picture says: Ewings - the chick with wings; Arises from Diaphysis, most
common bone is Tibia. Seen in children as represented by the chick. Onion represents the onion
peel appearance in X-rays. The wings going up and down ( arrows ) represent that the size of
tumor increases and decreases ( H/O Exacerbations and remissions ). The moon & star represents
the clinical feature that pain is worse at night. Radio represents that the tumor is extremely
radiosensitive - therefore melts like snow. Spread is by blood vessels and lymphatics. And what
the chick says is the chemotherapy regimen - VAC ( Vincristine, Adriamycin,
Cyclophosphamide ), VACA ( VAC + Actinomycin ), AV alternating with CV.
Drugs causing Gingival Hyperplasia (Enlargement)
Calcium channel blockers; specifically Nifedipine and Verapamil
Anticonvulsants; sepcifically Phenytoin but also others
Cyclosporine

3. Drugs causing Hypothyroidism mnemonic
I SCALP......
Iodine overdose, Interferon, Imatinib
Sulfonamide
Carbamazepine
Amiodarone, Aspirin, Antidepressants
Lithium
Phenytoin, Phenylbutazone
Hypertension + Adrenal Mass
If you face a case where the patient is presented with elevated blood pressure and a mass in the
adrenal seen in CT scan or MRI then you have two options:
1. Pheochromocytoma
2. Primary hyperaldosteronism
The differentiation is relatively easy:
In Pheochromocytoma you have elevated catecholamines with its consequent increased urinary
VMA and cortisol and the crises of tachycardia, sweating, irritability ...etc
In Conn's syndrome you have the effects of high aldosterone such as hypokalemia and
alkalosis.
While surgical treatment is similar for both of them with resection of the tumor or
adrenalectomy, medical treatment is certainly different.
In pheo you give alpha and beta blockers while in conn you give aldosterone antagonists such as
sprinolactone or amiloride.
mnemonic 4 drugs causing flushing
Mnemonic is NIACiN:
Nitrates
Isoproterenol
Adenosine
Clomiphene
Calcium channel blockers
NserottoNin
Nitrates
as niacin is famous for its side effect flushing so we can remember all flushing causing drugs by
this.

4. Drugs Causing Acute Interstitial Nephritis
FEVER + RASH + JOINT PAIN = AIN
Drugs are SCARP
SCARP
S= SULFA DRUG
C= CEPHALOSPORIN
A= ALLOPURINOL , ASPIRIN ( NSAIDs )
R= RIFAMPIN
P= PENICILLIN , PPI
SLE DIAGNOSTIC CRITERIA
DOPAMINE RASH
Discoid rash
Oral ulcer
Photosensitivity
Arthiritis
Malar rash
Immunologic criterias
Neurological symptoms-(lupus ceribrites)
Elevated ESR
Renal disease
ANA+ve
Serosites
Heamatological abnormality
Hypertension Drug of Choice in various coexisting conditions
*Best initial therapy= Thiazide
*Excellent treatment of systolic HTN= CCB
*HTN + Recurrent stroke= ACEI, Thiazide
*HTN + Migraine = BB or CCB
*HTN + Raynaud's phenomena= CCB
*HTN + Essential tremor= BB
*HTN + Glaucoma= BB
*HTN + Hyperthyroidism= BB
*HTN + Depression= avoid BB
*HTN + Asthma= avoid BB
*HTN + CHF + AF from ischemia= BB
*HTN + LVH= BB, CCB
*HTN + CAD= BB, ACEI, ARB

5. *HTN + Heart failure= ACEI, ARB, BB, Spironolactone
*HTN + Osteoporosis= Thiazide
*HTN + ADPKD= ACEI
*HTN + Pregnancy= M.dopa , nifedipine
HTN + Multiple cardiovascular risk factors + Undergo non-cardiac surgery= BB
*HTN + BPH=ALPHA Blockers
*HTN + Bilateral renal artery stenosis= Avoid ACEI*HTN + MI + low EF<40 %= ACEI or ARBs
HTN secondary to Pheochromocytoma
Phentolamine or Phenoxybenzamine OR Labetalol/Carvelidol as they have BOTH beta and
alpha blocking activity
CML Mnemonic
Imp features of CML is an exam of UK ..PLAB
P = PHILADELPHIA CHROMOSOME
L = LEUKOCYTOSIS
A = ALKP low
B = Basophilia
IHD Patient discharge Mnemonic
Here's the mnemonic
ABCDE
Aspirin and Anti-Anginals
Beta blocker, Blood pressure control
Cholesterol lowering and stopping Cigarettes
Diet and Diabetes control
Education and Exercise
Hypokalemia Mnemonic
hypokalemia caused by 4 D:
1-diarrhea
2-diabetes mellitus ...( insulin therapy )
3-digitalis
4-diuretics

6. Types of Vaginal Discharges
Here is quick list of Vaginal Discharges and their common presentation with diagnosis White-curd like = Candida Albicans Vaginitis
Purulent = N.Gonorrhoeae&C.Trachomatis
Yellow-Green, foamy, foul smelling = Trichomonas
Gray, fishy odor = G.VaginalisVaginosis
Drug of choice for Tineacapitis is Oral Griseofulvin or itraconazole. According to
JM its Griseofulvin while according to Kaplan its itraconazole orally.
Drug of choice for alopecia Areata in children is topical steroids ( children below 2
years) while for elderly or grown up people its Intralesional steroids.
Difference between Histrionic and Borderline personalities.
Borderline personality------they have intense but shallow emotions;
-pros and cons view.
-multiple partners(promisquity)
-they have unclear self image
-impulsive,low frustration tolerance
-easily addicted to substance use and suicidal attempts.
-they feel sense of emptiness associated wit psychotic episodes
Histrionic---------they seek attention..wanted to be center of attraction
-they have superficial relationships, low tolerance to frustration( like borderline)
-seducing,egocentric,manipulative behavior
--extreme sensitive to criticism
-exhibitionism,dramatic,hurt others

7. Differentiating Alpha from Beta Thalassemias
BETA THALASSEMIA SYNDROMES:
"blacks, Greeks and Italians"
1.-Major beta thalassemia
- Skeletal changes : "chipmunk facies", delayed skeletal maturation and "hair-on-end"
radiographic appearance of the skull.
- Hepatomegaly is prominent early in the disease + massive splenomegaly
- Endocrine and metabolic abnormalities*(quite common) attributable, at least in part, to chronic
iron overload.
Hypogonadism 40 percent, Growth failure 33 percent, Diabetes 13 percent & Hypothyroidism 10
percent.
- Cardiac malfunction, including heart failure and fatal arrhythmias, are frequent causes of death,
and cardiac dilatation secondary to anemia is nearly universal.
basic lab: profound hypochromic, microcytic anemia (MCV < 65 fL) & target cell
2.- Beta thalassemia minor (or beta thalassemia trait / silent carrier of beta thalassemia =
heterozygotes who carry one normal beta globin allele and one beta globin thalassemic allele.)
The vast majority of these patients are entirely asymptomatic.
Typically, the blood count and peripheral blood film exhibit features similar to those seen in iron
deficiency anemia (eg, hypochromia and microcytosis), but this patients almost always have a
hematocrit >30 percent, and a mean corpuscular volume of the red cells (MCV) <75 fL. We also
can see target and tear drop shaped red cells.
ALPHA THALASSEMIA SYNDROMES:
"blacks and Southeast Asians"
1.-Alpha thalassemia-2 trait (aka alpha thalassemia minima aa/a-): Patients are
asymptomatic. The complete blood count, hemoglobin electrophoresis, and peripheral smear are
usually normal.
2.-Alpha thalassemia-1 trait (aka alpha thalassemia minor) resembles mild beta thalassemia
trait.
3.-Hemoglobin H disease: This patients suffer from hemolytic anemia throughout much of
gestation and are symptomatic at birth, often presenting with neonatal jaundice and anemia, and
occasionally with hydropsfetalis. This occurs because alpha globin synthesis is required in utero
for the production of the major hemoglobin found during late gestation: hemoglobin F
(alpha2/gamma2). Patients with beta thalassemia, on the other hand, do not have these
difficulties until a few months after birth, when hemoglobin F production decreases markedly
and there is a need for increased production of beta chains for hemoglobin A (alpha2/beta2).
4.-Hydropsfetalis and hemoglobin Barts is usually fatal in utero.

8. Borderline Personality Disorder Mnemonic
PRAISE:
Paranoid ideas
Relationship instability
Affective instability/ Abandonment fears/ Angry outbursts
Impulsiveness/ Identity disturbance
Suicidal behavior/ Self-harming behavior
Emptiness
Conduct Disorder Vz Antisocial Personality Disorder
Conduct Disorder is seen in Children
Antisocial Personality Disorder is seen in Adults
Rheumatic Fever Jone's Criteria Mnemonic
Jones 5 criteria: Rheumatic fever: SPACE
S: Subcutaneous nodules
P:Pancarditis
A: Arthritis
C: Chorea
E: Erythema Marginatum
Minor criteria
Fever
Arthralgia
Raised ESR or CRP
Leukocytosis
1st degree heart block
Previous episode of rheumatic fever or inactive heart disease
Sublimation - transfer of unacceptable impulse into acceptable 1 like one is
frustrated and he goes home and paints to take out the bad feeling. Negetive
emotions but positive outcome.
Displacement is like you angry on A and you take it out on B, just the target
changes but the primary emotion doesn't get altered. Out come Negative

9. Diagnostic algorithm for RA
Target population (who should be tested?): patients who
1) have at least one joint with definite clinical synovitis (swelling)*
2) with the synovitis not better explained by another disease†
Classification criteria for RA (score-based algorithm: add score of categories A–D
a score of ≥6/10 is needed for classification of a patient as having definite RA)
A. Joint involvement§
1 large joint 0
2−10 large joints 1
1−3 small joints (with or without involvement of large joints) 2
4−10 small joints (with or without involvement of large joints) 3
>10 joints (at least one small joint) 5
B. Serology (at least 1 test result is needed for classification)
Negative RF and negative ACPA 0
Low-positive RF or low-positive ACPA 2
High-positive RF or high-positive ACPA 3
C. Acute-phase reactants (at least one test result is needed for classification)
Normal CRP and normal ESR 0
Abnormal CRP or normal ESR 1
D. Duration of symptoms
<6 weeks 0
≥6 weeks 1
RF is type 2 hypersensitivity
RA is type 3 hypersensitivity
RF:commonly involves large joints,small joints involvement is uncommon,asymmetrical joints
involvement
RA:involve both large and small joints,symmetrical joint involvement
RF:acuteonset,lasts for shorter period
RA:insidiousonset,lasts longer than RF
RF:arthritis dramatically responds to aspirin
RA:arthritis mainly responds to DMARDs
RF:usually no deformity of joint occur
RA:high rate of deformity of joint
RF:H/o sore throat 2-4 weeks prior to onset of illness

10. RA:usually there is no h/o sore throat
RF:it involves heart(carditis/valvular lesion) and brain(chorea) other than joint
RA:uveitis,lymphadenopathy,hepatosplenomegaly occur other than arthritis
polymyositis and dermatomyositis are inflammatory myopathies often confused
with similar features here are some features
similar features------both cause proximal muscle weakness,elevatedcreatine kinase, anti Jo-1
antibody(60%)
here are some contrast features-----1) dermatomyositis------gottron'spapules,heliotrope rash, malar rash(like sle),antibody mediated
damage,perifascicular atrophy(perimysial inflammation-----as @beka-cts told remember it as
skin lie towards the surface)
2) polymyositis------no papules,no rash, T-cell mediated damage(CD8-MHC-1------>lymphocytic infiltrate),endomysial inflammation,@ with gastric carcinoma usually
Causes of deficiency (Pellagra):
Dietary deficiency mainly arise in geographic areas where consumption of corn is the
main source of staple rather than wheat. Niacin in corn in nonabsorbable. This is
specially seen in African countries.
Hartnup disease, because Tryptophan being a large neutral amino acid will be deficient
and thence Niacin will also be deficient.
Isoniazid treatment as it inhibits vitamin B6 needed for endogenous synthesis as
mentioned above.
Alcoholics as the over active dehydrogenases will consume all the NAD available.
HIV patients
Multiple Myeloma
Calcium elevation
Renal disease
Anemia
Bone/back pain.
Plasma cells and bence jones proteinuria.