mnemonics

ANATOMY

Bones of the Wrist

Some Lovers Try Positions That They Cannot Handle

Slowly Lower Tilly's Pants To The Curly Hairs

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

Brachial Plexus

Randy Travis Drinks Cold Beers Robert Taylor Drinks Cold Beer

Roots, Trunks, Divisions, Cords, Branches

Branches of the Brachial Plexus (In order from most lateral to most medial)

My Aunt Raped My Uncle

Musculocutaneous, Axillary, Radial, Median, Ulnar

Cranial Nerves

Oh Oh Oh To Touch And Feel Virgin Girls Vaginas And Hymens

You have 1 nose. You have 2 eyes. (The first "O" is Olfactory, second "O" is Optic)

To remember what cranial nerve is Motor, Sensory, or Both use this ( In order from CN I to CN XII):

Some Say Marry Money, But My Brother Says Big Bras Matter Most

Extraocularmotor muscles

LR6 (SO4) LR6: Lateral rectus --> VI abductens

SO4: Superior Oblique --> IV Trochlear

All other extraocularmotor muscles are CN III

Branches of the Facial Nerve

Ten Zebras Bought My Car

Ten Zebras Bit My Cock

Two Zulus Buggered My Cat

To Zanzibar By Motor Car

Temporal, Zygomatic, Buccal, Masseteric, Cervical

Miscelaneous Anatomy Mnemonics

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

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

Relationship of Thorasic duct to Esophagous and Azygous

ANATOMY

The duck is between two gooses.

duck = thoracic duct 2 gooses = azyGOUS and esophaGOUS

Attachments of Pectoralis Major, Teres Major and Latissimus Drosi

A lady between tow majors.

Pectoralis major attaches to lateral lip of bicipital groove, the teres major attaches to medial lip of bicipital groove, and the latissimus dorsi attaches to the floor of bicipital groove. The "lati" is between two "majors."

Innervation of the Penis

Parasympathetic puts it up; sympathetic spurts it out.

Point Shoot Score

Parasympathetic, sympathetic, somatomotor

Lateral and Medial Pectoral Nerve

Lateral is less, medial is more.

Lateral pectoral nerves goes through pectoralis major while medial pn goes though both pectoral major and minor.

Layers of the epidermis

Granpa Shagging Grandma's Love Child.

Brent Spiner Gained Lieutenant Commander

Germinativum or Basale, Spinosum, Granulosum, Lucidum, Corneum

Things going through Orbital Fissure

Seven French Tarts Sit Naked In Anticipation

Brachial plexus subunits"Randy Travis Drinks Cold Beer": Roots Trunks Divisions Cords

Branches · Alternatively: "Real Texans Drink Coors Beer".

Tarsal bones

"Tall Californian Navy Medcial Interns Lay Cuties":

· In order (right foot, superior to inferior, medial to lateral): Talus Calcanous Navicular

Medial cuneiform Intermediate cuneiform Lateral cuneifrom Cuboid

Atrioventricular valves"LAB RAT": Left Atrium: Bicuspid Right Atrium: Tricuspid

Tarsal tunnel: contents

"Tiny Dogs Are Not Hunters":

· From superior to inferior:

T: Tibialis posterior F: flexor Digitorum longus A: posterior tibial Artery N: tibial Nerve

H: flexor Hallucis longus

ANATOMY

Vagal nerve: path into thoraxVagus nerve, unlike phrenic, continues through diaphragm with esophagus--it is "Not Left Behind": · The left vagus is anterior, right is posterior

[behind].

Inguinal canal: walls"MALT: 2M, 2A, 2L, 2T":

· Starting from superior, moving around in order to posterior: Superior wall (roof): 2

Muscles: · internal oblique Muscle · transverse abdominus Muscle Anterior wall: 2

Aponeuroses: · Aponeurosis of external oblique · Aponeurosis of internal oblique Lower wall (floor): 2 Ligaments: · inguinal Ligament · lacunar Ligament Posterior wall: 2Ts: ·

Transversalis fascia · conjoint Tendon

Bronchopulmonary segments of right lung

"A PALM Seed Makes Another Little Palm":

· In order from superior to inferior: Apical Posterior Anterior Lateral Medial Superior

Medial basal Anterior basal Lateral basal Posterior basal

Tarsal bones

"Traverse City (is) Noted (for) MIchigan's Lovely Cherries": Talus Calcaneus (new row)

Navicular (new row) Medial Intermediate cuneiforms Lateral cuneiform Cuboid

Aorta vs. vena cava: right vs. leftAorta and right each have 5 letters, so aorta is on the right. Vena and cava and left each have 4 letters, so vena cava is on the left.

Hip: lateral rotators"Play Golf Or Go On Quaaludes": · From top to bottom: Piriformis

Gemellus superior Obturator internus Gemellus inferior Obturator externus Quadratus femoris · Alternatively: "P-GO-GO-Q".

Facial bones"Virgil Can Not Make My Pet Zebra Laugh!": Vomer Conchae Nasal Maxilla

Mandible Palatine Zygomatic Lacrimal

Scalp layers

SCALP: · From superficial to deep: Skin Connective tissue Aponeurosis Loose areolar tissue Pericranium

Thoracoacromial artery branches"CAlifornia Police Department": Clavicular Acromial

Pectoral Deltoid

Ankle: anterior compartment of leg contents

"The Hamptons Are Never Dull Parties": · From medial malleolus: Tibialis anterior tendon (Extensor) Hallacus longus Artery (anterior tibial) Nerve (deep peroneal)

(Extensor) Digitorum Peroneus tertius

Erector spinae muscles

"I Love Sex":

· From lateral to medial: Iliocostalis Longissimus Spinalis

· Alternatively:

ANATOMY

"I Long for Spinach"

· "Sex" helps you think of "Erector", but "Long" and "Spinach" help you remember the muscles' names.

Leg: anterior muscles of leg"The Hospitals Are Not Dirty Places": T: Tibialis anterior H: extensor Hallucis longus A: anterior tibial Artery N: deep fibular Nerve D: extensor

Digitorum longus P: Peronius tertius [aka fibularis tertius]

Nasal cavity components

"Never Call Me Needle Nose!":

Nares [external] Conchae Meatuses Nares [internal] Nasopharynx · Note mnemonic sentence is nasally-related.

Rotator cuff muscles"The SITS muscles":

· Clockwise from top: Supraspinatus Infraspinatus Teres minor Subscapularis · A pro baseball pitcher has injured his rotator cuff muscles. As a result, he SITS out for the rest of the game, and then gets sent to the minor leagues.

Radial nerve: muscles innervated

"Try A Big Chocolate Chip Sundae, Double Dip Cherries And Peanuts Preferably

Included":

· In order of their innervation, proximal to distal:

Triceps Anconeus Brachioradialis ext. Carpi radialis longus ext. Carpi radialis brevis

Supinator ext. Digitorum ext.Digiti minimi ext. Carpi ulnaris Abductor poll. longus ext.

Poll. brevis ext. P poll. longus ext. Indicis · For the neighboring words that start with the same letter (eg: chocolate and chip), notice that the longer word in the mnemonic, corresponds to the longer of the two muscle names (ex: ext. carpi radialis longus and ext. carpi radialis brevis)

Deep tendon reflexes: root supply

· God designed body reflexes according to a nursery rhyme: One, two-- buckle my shoe.

Three, four-- kick the door. Five, six-- pick up sticks. Seven, eight-- shut the gate. S1,2 = ankle jerk L3,4 = knee jerk C5,6 = biceps and brachioradialis C7,8 = triceps

Penis autonomic innervation actions

"Parasympathetic Puts it up. Sympathetic Spurts it out". Alternatively: "Point and Shoot":

Parasympathetic Points it, Sympathetic Shoots out the semen.

· Erection and Ejaculation (Emission).

Internal iliac artery: anterior branchesWhat Bill admitted to Hilary: "I Milked Our

Insatiable Intern's Udders Under the Desk": Inferior gluteal Middle rectal Obturator

Inferior vesical artery Internal pudendal artery Umbilical U/D=Uterine artery (female)/

Deferential artery (male)

ANATOMY

Muscles: potentially absent ones · Muscles which may be absent but may be important: 5

P's: Palmaris longus [upper limb] Plantaris [lower limb] Peroneus tertius [lower limb]

Pyramidalis [anterior abdominal wall] Psoas minor [posterior abdominal wall]

Carpal bones"Stop Letting Those People Touch The Cadaver's Hand": · Proximal row, lateral-to-medial: Scaphoid Lunate Triquetrum Pisiform · Distal row, lateral-to-medial:

Trapezium Trapezoid Capitate Hamate

Carpal bones"She Looks Too Pretty; Try To Catch Her": · Proximal row then distal row, both lateral-to-medial: Scaphoid Lunate Triquetrium Pisiform Trapezium Trapezoid

Capate Hamate · Alternatively: "She Likes To Play; Try To Catch Her".

Flexor digitorum muscles: how they insert onto fingers · A little rhyme: Superficialis

Splits in two, To Permit Profundus Passing through.

Scrotum layers

"Some Damn Englishman Called It The Testis":

· From superficial to deep: Skin Dartos External spermatic fascia Cremaster Internal spermatic fascia Tunica vaginalis Testis

Femoral triangle: contents NAVY:

· In order from lateral to medial: Nerve Artery Vein Y of the groin · Alternatively: Y = Yfronts [male underwear].

Vagus nerve: path into thorax"I Left my Aunt in Vegas": Left Vagus nerve goes Anterior descending into the thorax.

Supine vs. prone body position Know SUPination is your hand while carrying a bowl of

SOUP. Your face follows where your palm is facing [i.e. up]. Put a handpuppet on your hand while hand is in supination and the puppet will be the supine position. · See diagram.

Axillary artery branches

"Suzy Thompkins Loves Sex, Alcohol, and Pot": · From proximal to distal: Superior thoracic Thoracacromial Lateral thoracic Subscapular Anterior circumflex humeral

Posterior circumflex humeral

Horner's syndrome componentsSPAM: Sunken eyeballs/ Symphathetic plexus (cervical) affected Ptosis Anhydrosis Miosis

Voicebox: names of parts in sagittal cross-section

"There's 3 V's in your Voicebox": Vestibular fold Ventricle Vocal fold · Note: Vestibular and Vocal cord also known as false and true cords respectively.

Serratus anterior: innervation SALT: Serratus Anterior = Long Thoracic.

Hip: lateral rotators "Piece Goods Often Go On Quilts": Piriformis Gemellus superior

Obturator internus Gemellus inferior Obturator externus Quadratus femoris

ANATOMY

Thigh: innervation by compartment" MAP OF Sciatic":

Medial compartment: Obturator Anterior compartment: Femoral Posterior compartment:

Sciatic

· So all the thigh muscles in that compartment get innervated by that nerve.

Internal jugular vein: tributaries"Medical Schools Let Confident People In": · From inferior to superior: Middle thyroid Superior thyroid Lingual Common facial Pharyngeal

Inferior petrosal sinus

Genu valgum vs. genu vargum Genu valGUM (knock-knee): knees are GUMmed together.

· Varum (bowleg) is the other by default, or Far rhymes with Var, so knees are far apart.

Erector spinae muscles"I Like Standing":

· From lateral to medial Illiocostalis Longissimus Spinalis

Cubital fossa contents "N-MAN":

· From lateral to medial: Nerve Muscle Artery Nerve · Specifics are radial Nerve, biceps

Muscle tendon, brachial Artery, median Nerve.

External carotid artery branches"Suzy Always Lays Flat On Pillows Making Sex

Terrific": Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superificial Temporal

Median nerve: recognizing it in an opened axillaThe Median nerve is the Middle of a giant capital "M" formed by the musculocutaneous and ulnar nerves.

Trigeminal nerve: where branches exit skull"Standing Room Only": Superior orbital fissure is V1 foramen Rotundum is V2 foramen Ovale is V3

Dermatome C7 locationC7 gives the finger to heaven (as in middle finger).

External carotid artery branches"Some Angry Lady Figured Out PMS": Superior thyroid

Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superificial temporal

Brachioradialis: function, innervation, one relation, one attachment BrachioRadialis:

Function: Its the Beer Raising muscle, flexes elbow, strongest when wrist is oriented like holding a beer. Innervation: Breaks Rule: it’s a flexor muscle, But Radial. (Radial nerve usually is for extensors: Recall BEST rule: B was for brachioradialis). Important relation:

Behind it is the Radial nerve in the cubital fossa. Attachment: Attaches to Bottom of

Radius.

Pleura surface markings"All the even ribs, in order: 2,4,6,8,10,12 show its route": Rib2: sharp angle inferiorly Rib4: the left pleura does a lateral shift to accommodate heart Rib6: both diverge laterally Rib8: midclavicular line Rib10: midaxillary line Rib12: the back ·

See diagram.

Aortic arch: major branch order "Know your ABC'S":

ANATOMY

Aortic arch gives rise to: Brachiocephalic trunk left Common Carotid left Subclavian ·

Beware though trick question of 'What is first branch of aorta?' Technically, it's the coronary arteries.

V3 innervated muscles (branchial arch 1 derivatives)

"M.D. My TV": Mastication [masseter, temporalis, pterygoids] Digastric [anterior belly]

Mylohyoid tensor Tympani tensor Veli palatini

Foramen ovale contents

MALE: Mandibular nerve Accessory meningeal artery Lesser petrosal nerve Emissary veins

Head & Neck

CRANIAL NERVES: I-Optic, II-Olfactory, III-Oculomotor, IV-Trochlear, V-Trigeminal,

VI-Abducens, VII-Facial, VIII-Acoustic (Vestibulocochlear), IX-Glossophrayngeal, X-

Vagus, XI-Spinal Accessory, XII-Hypoglossal

On Old Olympus Towering Tops, A Finn And German Viewed Some Hops (older and cleaner)

Oh Oh Oh To Touch And Feel A Girls Vagina And Hymen (newer and, well ...)

Which cranial nerve is Sensory, Motor, or Both- Some Say Marry Money, But My

Brother Says Big Breasts Matter More

BRANCHES OF FACIAL NERVE: Temporal, Zygomatic, Buccal, Mandibular, Cervical

Ten Zebras Beat My Cock

Two Zulus buggered my cat –(for the sicker, amongst you!)

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

Standing Room Only -Exit of branches of trigeminal nerve from the skull S

V1 -Superior orbital fissure, V2 -foramen Rotundum, V3 -foramen Ovale

For the order of nerves that pass through the superior orbital fissure:

"Lazy French Tarts Lie Naked in Anticipation."

(Lacrimal, Frontal, Trochlear, Lateral, Nosociliary, Internal,

Abducens)

2 Muscle of mastication- Lateral Lowers- lateral pterygoid is the one that opens the jaw

4 Muscles of Mastication MTPP( which could be read as "Empty Peepee") -masseter, temporal, lateral and medial pterygoids --

Arteries as they come off the external carotid:

Superior thyroid, Ascending pharyngeal, Lingual, Facial, Occipital, Post Auricular,

Superficial temporal, Maxillary

Some Anatomists Like makin loveg, Others Prefer S & M

ANATOMY

Some Angry Lady Figured out PMS

Innervation of Extraocularmotor Muscles: LR6 SO4 3

LR6--Lateral rectus--> VI abductens

SO4--Superior Oblique--> IV Trochlear

3--The remaining 4 eyeball movers = III Oculomotor

ABC'S of the aortic arch!

Aortic arch gives off the Bracheiocephalic trunk, the left Common Carotid, and the left

Subclavian artery

BRACHIAL PLEXUS: Roots, Trunks, Divisions, Cords, Branches

Robert Taylor Drinks Cold Beer.

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

Cranial Bones

Annoying, aren't they?

The cranial bones are the PEST OF 6...

Parietal, Ethmoid,Sphenoid,Temporal,Occipital,Frontal- 6 ? (6-the number of bones!)

( another one) Old People From Texas Eat Spiders.

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

Cartilages of the Larynx - There are 4 cartilages in the larynx whose initial letters are

TEAC (also the brandname of a home stereo).

Thyroid, Epiglottis, Arytenoid, Cricoid

Abdomen-Pelvis

INNERVATION OF PENIS:

Parasympathetic puts it up; sympathetic spurts it out

Point , Shoot, Score! (erection, emmision ,ejaculation) Parasympathetic, Sympathetic ,

Somatomotor

"S2, 3, 4 keep the penis off the floor" Innervation of the penis by branches of the pudental nerve, derived from spinal cord levels S2-4

Structures perforating the esophagus

ANATOMY

"At T8 you see, perforates the IVC" (inferior Vena Cava) the "EsoVagus" pierce T10 (esophagus, vagus nerve)

T12 - red, white and blue (aorta,thoracic duct,azygous vein)

Femoral Sheath (lateral to medial) order of things in thigh -NAVEL

Nerve, Artery, Vein, Empty, Space, Lymphatics

Radial n. innervates the BEST!!!!

Brachioradialis

Extensors

Supinator

Triceps

Course of Ureters

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

Carotid Sheath-- VAN

Internal Jugular Vein

Common carotid Artery

Vagus Nerve

Dermatomes

C3 is a high turtleneck shirt

T4 is at the nipple

L1 is at the inguinal ligament (or L1 is IL -Inguinal ligament)

Randy Travis Drinks Cold Beer--Brachial plexus

Robert Taylor Drinks Cold Beer

Roots, Trunks, Divisions, Cords, Branches

Bones of the wrist -Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium,

Trapezoid, Capitate, Hamate

1. Slowly Lower Tilly's Pants To The Curly Hairs

2. Swifty Lower Tilly's Pants to try coitus here. (the risque version)

3. Scared Lovers Try Positions That They Can't Handle. (Classic version)

Pelvic Diaphragm

PICOLO(A) -Posterior to anterior

PIriformis

COccygeus

ANATOMY

Levator Ani

Pelvic Splanchic-Parasympathetic

Sacral Splanchic-Sympathetic

Armies travel over bridges, the Navy travels under.

(Bridge is the ligament...reference to suprascapular artery and nerve.)

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

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

Corneum

Grandpa Shagging Grandma's Love Child.

Limbic System- the 5 F’s- Feeding, Fighting, Feeling, Flight and makin loveg

The 5 sphincters found in the Alimentary Canal are APE OIL:

Anal, Pyloric, Lower Esophogeal, Oddi, and Ileocecum.

Sally Thompson Loves Sex And Pot pie. The branches of the Axillary Artery are:

Superior Thoracic, Thoracoacromial, Lateral Thoracic, Subscapular, Anterior Circumflex

Humeral, Posterior Circumflex Humeral, and Profunda Brachii.

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

GFR -Layers of the adrenal:-- Glomerular, Fascicular, Reticular

• BRACHIAL PLEXUS: Roots, Trunks, Divisions, Cords, Branches

•

•

Randy Travis Drinks Cold Beers.

Robert Taylor Drinks Cold Beer.

• CRANIAL NERVES: I-optic, II-olfactory, III-oculomotor, IVtrochlear, V-trigeminal, VI-abducens, VII-facial, VIII-acoustic

(vestibulocochlear), IX-glossophrayngeal, X-vagus, XI-spinal accessory, XII-hypoglossal

•

•

On Old Olympus Towering Tops, A Finn And German

Viewed Some Hops

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

Optic)

• Innervation of Extraocularmotor Muscles:

• LR6 (SO4) 3

•

•

•

LR6--Lateral rectus--> VI abductens

SO4--Superior Oblique--> IV Trochlear

3--The remaining 4 eyeball movers = III

ANATOMY

• Some Say Marry Money, But My Brother Says Big Bras Matter

More (what cranial nerve is Motor, Sensory, or Both)

• BRANCHES OF FACIAL NERVE: Temporal, Zygomatic, Buccal,

Masseteric, Cervical

• Ten Zebras Bought My Car

• To Zanzibar By Motor Car

• CERVICAL SPINAL NERVES:

•

•

•

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

• LOCATION OF THORACIC DUCT:

• The duck is between two gooses (duck = thoracic duct)

• 2 gooses = azyGOUS and esophaGOUS

• ATTACHMENTS OF CHEST MUSCLES:

A lady between two majors.

•

•

Pectoralis major attaches to lateral lip of bicipital groove.

Teres major attaches to medial lip of bicipital groove.

• Latissimus dorsi attaches to the floor of bicipital groove.

• The "lati" is between two "majors."

• INNERVATION OF PENIS:

•

•

Parasympathetic puts it up; sympathetic spurts it out

"S2, 3, 4 keep the penis off the floor"

• Innervation of the penis by branches of the pudental nerve, derived from spinal cord levels S2-4

• "Lateral is less, medial is more."

• Lateral pectoral nerves goes through pectoralis major while medial p.n. goes though both pec major and minor

• AORTIC BRANCHES:

• ABC'S

ANATOMY

• Aortic arch gives off the Bracheiocephalic trunk, the left Common Carotid, and the left Subclavian artery

• ORDER OF THINGS IN THIGH:

•

•

"NAVEL" nerve, artery, vein, empty space, lymphatics

Pterygoid muscles: function of lateral vs. medial

"Look at how your jaw ends up when saying first syllable of 'Lateral' or 'Medial' ":

"La": your jaw is now open, so Lateral opens mouth.

"Me": your jaw is still closed, so medial closes the mandible.

Supine vs. prone body position"Supine is on your spine.

Therefore, prone's the "other" one. · Also, prone to suffocate in prone position.

Meckel's diverticulum details

2 inches long. 2 feet from end of ileum. 2 times more common in men. 2% occurrence in population. 2 types of tissues may be present. · Note: "di-" means "two", so diverticulum is the thing with all the twos.

Perineal vs. peroneal

Perineal is in between the legs. Peroneal is on the leg.

Anterior forearm muscles: superficial groupThere are five, like five digits of your hand.

Place your thumb into your palm, then lay that hand palm down on your other arm, as shown in diagram. Your 4 fingers now show distribution: spells PFPF [pass/fail, pass/ fail]: Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Your thumb below your 4 fingers shows the muscle which is deep to the other four: Flexor digitorum superficialis.

Carpal tunnel syndrome causesMEDIAN TRAP: Myxoedema Edema premenstrually

Diabetes Idiopathic Agromegaly Neoplasm Trauma Rheumatoid arthritis Amyloidosis

Pregnancy · Mnemonic fits nicely since median nerve is trapped.

Lumbar plexus "I, I Get Laid On Fridays":

Iliohypogastric [L1]

Ilioinguinal [L1]

Genitofemoral [L1, L2]

Lateral femoral cutaneous [L2, L3]

Obtruator [L2, L3, L4]

Femoral [L2, L3, L4]

ANATOMY

· Alternatively: "I twice Get Laid On Fridays". · Alternatively: "Interested In Getting Laid

On Fridays?"

Elbow: muscles that flex itThree B's Bend the elBow: Brachialis Biceps Brachioradialis

Cavernous sinus contents O TOM CAT:

O TOM are lateral wall components, in order from superior to inferior. CA are the components within the sinus, from medial to lateral. CA ends at the level of T from O

TOM. · See diagram. Occulomotor nerve (III) Trochlear nerve (IV) Ophthalmic nerve

(V1) Maxillary nerve (V2) Carotid artery Abducent nerve (VI) T: When written, connects to the T of OTOM.

Bronchi: which one is more vertical"Inhale a bite, goes down the right": Inhaled objects more likely to lodge in right bronchus, since it is the one that is more vertical

61

Carotid sheath contents "I See 10 CC's in the IV":

I See (I.C.) = Internal Carotid artery

10 = CN 10 (Vagus nerve)

CC = Common Carotid artery

IV = Internal Jugular Vein

V3 innervated muscles "My A$$ Meets The Toilet":

Mylohyoid

Anterior digastric

Muscles of Mastication

Tensor veli palatini

Tensor tympani

Inferior vena cava tributaries "I Like To Rise So High":

Illiacs

Lumbar

Testicular

Renal

Suprarenal

Hepatic vein.

· Think of the IVC wanting to rise high up to the heart.

Spleen: dimensions, weight, surface anatomy "1,3,5,7,9,11":

ANATOMY

Spleen dimensions are 1 inch x 3 inches x 5 inches.

Weight is 7 ounces.

It underlies ribs 9 through 11.

Heart valve sequence "Try Pulling My Aorta":

Tricuspid

Pulmonary

Mitral

Aorta

Liver: side with ligamentum venosum/ caudate lobe vs. side with quadrate lobe/ ligamentum teres "VC goes with VC":

The Venosum and Caudate is on same side as Vena Cava [posterior]. Therefore, quadrate and teres must be on anterior by default.

· See inferior-view diagram.

Cranial bones "PEST OF 6":

Parietal

Ethmoid

Sphenoid

Temporal

Occipital

Frontal

· The 6 just reminds that there's 6 of them to remember.

Thyroid: isthmus location "Rings 2,3,4 make the isthmus floor":

Isthmus overlies tracheal rings 2,3,4

Cervical plexus: arrangement of the important nerves "GLAST":

· 4 compass points: clockwise from north on the right side of neck:

Great auricular

Lesser occipital

Accessory nerve pops out between L and S

Supraclavicular

Transverse cervical

· See diagram.

ANATOMY

Lumbar plexus roots "2 from 1, 2 from 2, 2 from 3":

2 nerves from 1 root: Ilioinguinal (L1), Iliohypogastric (L1).

2 nerves from 2 roots: Genitofemoral (L1,L2), Lateral Femoral (L2,L3).

2 nerves from 3 roots: Obturator (L2,L3,L4), Femoral (L2,L3,L4).

71

Joints in the midline "SC":

In medial line, below Second Cervical, joints are Secondary Cartilaginous and usually have a diSC.

· Notes: secondary cartilaginous is also known as symphysis. The one that doesn't have a disc is xiphi-sternal.

Anterior forearm muscles: superficial group "Pimps F*ck Prostitutes For Fun":

Pronator teres

Flexor carpi radialis

Palmaris longous

Flexor carpi ulnaris

Flexor digitorum superficialis

External carotid artery branches "Some Aggressive Lovers Find Odd Positions More

Stimulating":

Superior thyroid

Ascending pharyngeal

Lingual

Facial

Occiptal

Posterior auricular

Maxillary

Superficial temporal

Axillary artery branches "Screw The Lawyer Save A Patient":

Superior thoracic

Thoracoacromiol

Lateral thoracic

Subscapular

Anterior circumflex humeral

ANATOMY


Descending abdominal aorta branches from diaphragm to iliacs "Prostitutes Cause

Sagging Swollen Red Testicles [in men] Living In Sin":

Phrenic [inferior]

Celiac

Superior mesenteric

Suprarenal [middle]

Renal

Testicular ["in men" only]

Lumbars

Inferior mesenteric

Sacral

Inversion vs. eversion muscles in leg

Second letter rule for inversion/eversion:

· Eversion muscles: pErineus longus pErineus brevis pErineus terius

· Inversion muscles: tIbialis anterior tIbialis posterior

External carotid artery branches "Sister Lucy's Powdered Face Often Attracts Silly

Medicos":

· Before entering the parotid gland:

Superior thyroid

Lingual

Posterior auricular

Facial

Occipital


· Ends as:

Superficial temporal and

Maxillary bifurcating in the in the parotid gland

ANATOMY

Spermatic cord contents "3 arteries, 3 nerves, 3 other things":

3 arteries: testicular, ductus deferens, cremasteric.

3 nerves: genital branch of the genitofemoral, cremasteric, autonomics.

3 other things: ductus deferens, pampiniform plexus, lymphatics.

· Note some argument about this: Moore doesn't put in cremasteric nerve, Lumley puts in inguinal...

Fibula vs. tibia: which is the bigger one People talk of telling just a "little white lie", or a

"little fib":

Therefore, the fibula is smaller.

· Alternatively: TIBia is the Thicker Inner Bone.

· Alternatively: "Little lat FIB, big fat TIB".

Interossei muscles: actions of dorsal vs. palmar in hand "PAd and DAb":

The Palmar Adduct and the Dorsal Abduct.

· Use your hand to dab with a pad.

Thoracic duct: relation to azygous vein and esophagus "The duck between 2 gooses":

Thoracic duct (duck) is between 2 gooses, azygous and esophagus.

Lumbricals action Lumbrical action is to hold a pea, that is to flex the metacarpophalangeal joint and extend the interphalangeal joints. When look at hand in this position, can see this makes an "L" shape, since L is for Lumbrical.

Pectoral nerves: path of lateral vs. medial "Lateral Less, Medial More":

Lateral pectoral nerve only goes through Pectoralis major, but

Medial pectoral nerve goes though both Pectoralis major and minor.

Intrinsic muscles of hand (palmar surface) "A OF A OF A":

· Thenar, lateral to medial:

ANATOMY

Abductor pollicis longus

Opponens pollicis

Flexor pollicis brevis

Adductor pollicis.

· Hypothenar, lateral to medial:

Opponens digiti minimi

Flexor digiti minimi

Abductor digiti minimi

Diaphragm innervation "3, 4, 5 keeps the diaphragm alive":

Diaphragm innervation is cervical roots 3, 4, and 5.

Femoral triangle: arrangement of contents NAVEL:

· From lateral hip towards medial navel:

Nerve (directly behind sheath)

Artery (within sheath)

Vein (within sheath)

Empty space (between vein and lymph)

Lymphatics (with deep inguinal node)

· Nerve/Artery/Vein are all called Femoral.

Lingual nerve course

The Lingual nerve

Took a curve

Around the Hyoglossus.

"Well I'll be f*#ked!"

Said Wharton's Duct,

"The bastard's gone and crossed us!"

External carotid artery branches

"Some Anatomists Like F*#king, Others Prefer S & M":

Superior thyroid


ANATOMY

Lingual

Facial

Occipital

Posterior auricular


Maxillary

· Alternatively: As She Lay Flat, Oscar's Passion Slowly Mounted".

Abdominal muscles

"Spare TIRE around their abdomen":

Transversus abdominis

Internal abdominal oblique

Rectus abdominis

External abdominal oblique

Bicipital groove: attachments of muscles near it

"The lady between two majors":

Teres major attaches to medial lip of groove.

Pectoralis major to lateral lip of groove.

Latissimus (Lady) is on floor of groove, between the 2 majors.

Carpal bones

"Some Lovers Try Positions That They Can't Handle":

· Proximal row then distal row, both lateral-to-medial:

Scaphoid

Lunate

Triquetrium

Pisiform

Trapezium

Trapezoid

Capate

Hamate

· Alternatively: "Scared Lovers..."

· Alternatively: "Senior Lecturers...".

ANATOMY

Bronchi: which is more vertical "Right on Red":

Many places allow making a right hand turn at a red light, if you first come to a complete stop.

A child swallowing a red penny is more likely to get it stopped down the right bronchus, since it is more vertical.

L4 landmark: 2 items "B4U" [before you]:

Bifurcation of aorta

L4

Umbilicus

Retroperitoneal structures list

SAD PUCKER:

Suprarenal glands

Aorta & IVC

Duodenum (half)

Pancreas

Ureters

Colon (ascending & descending)

Kidneys

Esophagus (anterior & left covered)

Rectum

External carotid artery branches "Some Aberdeen Ladies F#ck, Others Prefer Manual

Stimulation":

· From inferior to superior:

Superior thyroid


Lingual

Facial

Occipital

Posterior auricular

Maxillary


ANATOMY

Superior mediastinum: contents

PVT Left BATTLE:

Phrenic nerve

Vagus nerve

Thoracic duct

Left recurrent laryngeal nerve (not the right)

Brachiocephalic veins

Aortic arch (and its 3 branches)

Thymus

Trachea

Lymph nodes

Esophagus

Retroperitoneal organs (major)

"AC/DC Rocker Kids Party Down":

Ascending Colon

Descending Colon

Rectum

Kidneys

Pancreas

Duodenum

Bell's palsy: symptoms

BELL'S Palsy:

Blink reflex abnormal

Earache

Lacrimation [deficient, excess]

Loss of taste

Sudden onset

Palsy of VII nerve muscles

· All symptoms are unilateral.

ANATOMY

Liver inferior markings showing right/left lobe vs. vascular divisions There's a Hepatic

"H" on inferior of liver. One vertical stick of the H is the dividing line for anatomical right/left lobe and the other vertical stick is the divider for vascular halves. Stick that divides the liver into vascular halves is the one with vena cava impression (since vena cava carries blood, it's fortunate that it's the divider for blood halves).

Extraocular muscles cranial nerve innervation "LR6SO4 rest 3":

Lateral Rectus is 6th

Superior Oblique is 4th rest are all 3rd cranial nerve

Femoral hernia: epidemiology

FEMoral hernias are more common in FEMales.

Obturator canal: relations of structures "Who's flying in the top of Obturator canal?

Obviously Not A Vein!":

Obturator

Nerve

Artery

Vein

Thoracoacromial artery branches ABCD:

Acromial

Breast (pectoral)

Clavicular

Deltoid

Diaphram aperatures: spinal levels "Come Enter the Abdomen:

Vena Cava [8]

Esophagus [10]

Aorta [12]

ANATOMY

Cubital fossa contents

"My Bottoms Turned Red":

· From medial to lateral:

Median nerve

Brachial artery

Tendon of biceps

Radial nerve

Thyroids: relative sizes

Thyroid looks like a bra (see picture).

Breasts are bigger in women, so thyroid bigger in women.

Pregnant women have biggest breasts of all, so they have the biggest thyroids.

Navicular contacts 3 of 5 cuneiform bones

"Navicular is like the Navigator logo":

There are 3 things coming off each.

· See diagram.

Therefore, cuboid has to contact 2 of the 5.

Kidney hilums at transpyloric plane [L1] L-1 goes through hilum of only 1 kidney, and it’s the Left one.

Radial nerve: muscles supplied (simplified) "BEST muscles":

Brachioradialis

Extensors

Supinator

Triceps

Superior orbital fissure: structures passing through "Lazy French Tarts Lie Naked In

Anticipation Of Sex":

Lacrimal nerve

Frontal nerve

ANATOMY

Trochlear nerve

Lateral nerve

Nasociliary nerve

Internal nerve

Abducens nerve

Ophthalmic veins

Sympathetic nerves

Cranial bones"Fraternity Parties Occasionally Teach Spam Etiquette": · The first two letters of each bone: Frontal Parietal Occipital Temporal Sphenoid Ethmoid

Internal iliac artery: posterior branchPILS: Posterior branch Iliolumbar Lateral sacral

Superior gluteal

Foramen ovale contentsOVALE: Otic ganglion (just inferior) V3 cranial nerve Accessory meningeal artery Lesser petrosal nerve Emisary veins

Anatomical planes: coronal, horizontal, sagittal

Coronal: A classic painting/stained glass window of a saint/angel has a corona radiating around the person's head. The plane of the glass/page is cutting their head in the coronal plane. Horizontal: Someone coming over the horizon has their abdomen cut in the horizontal plane. Sagittal: the remaining one by default.

Brachial plexus branches"My Aunt Raped My Uncle": · From lateral to medial:

Musculocutaneous Axillary Radial Median Ulnar

Tibia vs. fibula: which is lateralThe FibuLA is LAteral.

Superior orbital fissure: structures passing through"Lonely Fat Teenage Virgins Rarely

Like Swallowing And Never Ingest": Lacrimal nerve Frontal nerve Trochlear nerve Vein: ophthalmic Ring: tendinous · From the ring, arises: Lateral rectus Superior division III

Abducent nerve Nasociliary nerve Inferior divison III

Brachial plexus: branches of posterior cordSTAR: Subscapular [upper and lower]

Thoracodorsal Axillary Radial

Dermatome C6 location

Stick arm out like crucifixion stance. Curl your thumb and forefinger into an "OK" symbol while keeping your other fingers straight. Your hand should now look like a 6 shape. So C6 dermatome is your thumb and top of arm (reason for crucifix stance). · See diagram.

Heart valves

"Toilet Paper My A$$": · From right to left: Tricuspid Pulmonic Mitral Aortic

121

ANATOMY

Median nerve: hand muscles innervated "The LOAF muscles":

Lumbricals 1 and 2

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

· Alternatively: LLOAF, with 2 L's, to recall there's 2 lumbricals.

· To remember that these are the Median nerve muscles, think "Meat LOAF".

Interossei muscles: number of palmars vs. dorsals "3 on the P, 4 on the Dor":

There are 3 Palmar, and 4 Dorsal interossei.

Carpal bones: trapezium vs. trapezoid location · Since there's two T's in carpal bone mnemonic sentences, need to know which T is where:

TrapeziUM is by the thUMB, TrapeziOID is inSIDE.

· Alternatively, TrapeziUM is by the thUMB, TrapezOID is by its SIDE.

Sperm pathway through male reproductive tract SEVEN UP:

Seminiferous tubules

Epididymis

Vas deferens

Ejaculatory duct

Nothing

Urethra

Penis

Ureter to ovarian/testicular artery relation "Water under the bridge":

The ureters (which carry water), are posterior to the ovarian/testicular artery.

· Clinically important, since a common surgical error is to cut ureter instead of ovarian artery when removing uterus.

Soleus vs. gastrocnemius muscle function "Stand on your Soles. Explosive gas":

ANATOMY

You stand on soles of your shoes, so Soleus is for posture.

Gasoline is explosive, so Gastrocnemius is for explosive movement.

Serratus anterior: innervation and action "C5-6-7 raise your arms up to heaven":

Long thoracic nerve roots (567) innervate Serratus anterior.

· Test C567 roots clinically by ability to raise arm past 90 degrees.

Wrist: radial side vs. ulnar side Make a fist with your thumb up in the air and say "Rad!".

Your thumb is now pointing to your Radius.

· Note: 'Rad!' was a late 80's catchphrase, short for 'Radical'. Things that were good were called 'Rad'.

Medial malleolus: order of tendons, artery, nerve behind it "Tom, Dick, And Nervous Harry":

· From anterior to posterior:

Tibialis

Digitorum

Artery

Nerve

Hallicus

· Full names for these are: Tibialis Posterior, Flexor Digitorum Longus, Posterior Tibial

Artery, Posterior Tibial Nerve, Flexor Hallicus Longus.

· Alternatively: "Tom, Dick ANd Harry".

· Alternatively: "Tom, Dick And Not Harry".

Hip posterior dislocation: most likely arrangement for one "Hitting the brake pedal before the accident":

You are sitting, so hip is flexed, and adducted and medially rotated so can move your foot away from the gas pedal over to the brake pedal.

· Note: car accidents are

131

Diaphragm apertures "3 holes, each with 3 things going through it":

Aortic hiatus: aorta, thoracic duct, azygous vein.

Esophageal hiatus: esophagus, vagal trunks, left gastric vessels.

Caval foramen: inferior vena cava, right phrenic nerve, lymph nodes.

ANATOMY

Buttock quadrant safest for needle insertion "Shut up and butt out":

The Upper Outer quadrant of the Buttock safely avoids hitting sciatic nerve.

Superior thyroid artery branches "May I Softly Squeeze Charlie's Girl?":

Muscular

Infrahyoid

Superior laryngeal

Sternomastoid

Cricothyroid

Glandular

Deep tendon reflexes: root supply "1,2,3,4,5,6,7,8":

S1-2: ankle

L3-4: knee

C5-6: biceps, supinator

C7-8: triceps

Vertebrae: recognizing a thoracic from lumbar Examine vertebral body shape:

Thoracic is heart-shaped body since your heart is in your thorax.

Lumbar is kidney-bean shaped since kidneys are in lumbar area.

· See diagram.

Cubital fossa contents MBBR:


Median nerve

Brachial artery

Biceps tendon

Radial nerve

Ear: bones of inner ear Take a Hammer: Malleus

ANATOMY

Hit an Indian Elephant: Incus

It puts its foot in a stirrup: Stapes

· Describes the shape, and relative position (from out to in) of the inner ear bones.

· Alternatively: "Mailing Includes Stamps".

Popliteal fossa: muscles arrangement The two Semi's go together, Semimembranosus and

Semitendonosus.

The Membranosus is Medial and since the two semis go together, Semitendonosus is also medial.

Therefore, Biceps Femoris has to be lateral.

Of the semi's, to remember which one is superficial: the Tendonosus is on Top.

CN VII innervated muscles (branchial arch 2 derivatives)

"Imagine someone making the facial expression to say 'PSS...' ":

Facial expression muscles

Posterior belly of digastric

Stapedius

Stylohyoid

Carpal bones

"Scottish Lads Take Prostitutes To The Caledonian Hotel":

· Proximal row, then distal row:

Scaphoid

Lunate

Triquetrium

Pisiform

Trapezium

Trapezoid

Capate

Hamate

· Alternatively: "Students Like Taking Prostitutes To The Carelton Hotel".

Bronchopulmonary segments of the left lung "Astute Anatomists Share Inside Secrets

About Lungs":

Apicoposterior (S1+2)

Anterior (S3)

Superior (S4)

Inferior (S5)

ANATOMY

Superior (S6)

Anteromedial basal (S7+8)

Lateral basal (S9)

Biceps brachii muscle: origins

"You walk shorter to a street corner. You ride longer on a superhighway.":

· Short head originates from coracoid process.

· Long head originates from the supraglenoid cavity.

Extrinsic muscles of tongue [for pro soccer fans] "Paris St. Germain's Hour":

Palatoglossus

Styloglossus

Genioglossus

Hyoglossus

· PSG is a French soccer team (foreign), hence extrinsic comes to mind.

Anteflexed vs. anteverted: what bodypart each describes "Anteflexed and Anteverted both bend toward Anterior".

· The "V" words go together: Verted is for the cerVix (therefore flexed must be uterus).

Lung lobe numbers: right vs. left Tricuspid heart valve and tri-lobed lung both on the right side.

Bicuspid and bi-lobed lung both on the left side.

Axillary artery branches "Send The Lord to Say A Prayer":

· From proximal to distal:

Superior thoracic

Thoracacromial

Lateral thoracic

Subscapular

Anterior circumflex humeral


Foramen spinosum: location on base of skull Foramen spinosum is adjacent to the spine of sphenoid.

ANATOMY

Tonsils: The three types "PPL (people) have tonsils":

Pharyngeal

Palatine

Lingual

Palmaris longus: location, relative to wrist nerves "The Palmaris between two Palmars":

Palmaris longus is between the Palmar cutaneous branch of Ulnar nerve and Palmar cutaneous branch of Median nerve.

Hyoid bone: muscle attachments "Christ, He Didn't Screw Girls Much. That's Obvious,

Stupid":

· The first sentence is for 6 muscles attaching superiorly, the second sentence is for 3 muscles attaching inferiorly.

· Both sentences are in order from lateral to medial:

Constricter (middle)

Hyoglossus

Digastric

Stylohyoid

Geniohyoid

Myloyoid

Thyrohyoid

Omohyoid

Sternohyoid

151

Lung lobes: segments of right middle lobe "ML=ML":

Segments of Middle Lobe are Medial & Lateral.

Female pelvic organs' blood supply "3 organs, each get 2 blood supplies":

Uterus: uterine, vaginal.

Rectum: middle rectal, inferior rectal [inferior rectal is the end of pudendal].

Bladder: superior vesical, inferior vesical.

ANATOMY

Face muscles: large muscle groups' cranial innervation Mandibular nerve: Mastication.

Facial nerve: Facial expression.

Femoral triangle: arrangement of nerve, artery, vein VAN:


Vein

Artery

Nerve

· Nerve/Artery/Vein are all called Femoral.

Cranial bones "Old Pygmies From Thailand Eat Skulls":

Occipital

Parietal

Frontal

Temporal

Ethmoid

Sphenoid

· Note: 'skull-eating pygmies' helps remind that mnemonic is for the skull.

· Alternatively: "Old People From Texas Eat Spiders".

· Alternatively: "Prostitutes Offer Free Sex To Everyone".

Psoas major: innervation If you hit L2, 3, 4

Psoas gets sore!

Ansa cervicalis nerves "GHost THought SOmeone STupid SHot Irene":

Geniohyoid

Thyrohyoid

Superior Omohyoid

Sternothyroid

Sternohyoid

Inferior omohyoid

ANATOMY

Leg: anterior muscles of leg "Tom's Hairy ANd Dirty Penis":

T: Tibialis anterior

H: extensor Hollicis longus

AN: anterior tibial Artery & deep fibular Nerve

D: extensor Digitorum longus

P: Peronius tertius [aka fibularis tertius]

Eye rotation by oblique muscles "I Love S&M":

Inferior oblique: Lateral eye rotation.

Superior oblique: Medial eye rotation.

Inversion vs. eversion direction in the foot Little INtroVERted boys roll their feet in when talking to girls.

Also, can just watch which way the sole of the foot goes: does it face in or out?

· See diagram.

Bowel components

"Dow Jones Industrial Average Closing Stock Report": · From proximal to distal:

Duodenum Jejunum Ileum Appendix Colon Sigmoid Rectum · Alternatively: to include the cecum, "Dow Jones Industrial Climbing Average Closing Stock Report".

Ulnar nerve to ulnar artery and radial nerve to radial artery relationsThink "peripheral nerves": The ulnar nerve is "ulnar" to the ulnar artery. Radial nerve is "radial" to the radial artery.

Carpal bones

"Her C#nt's Too Tight So Lubricate The Penis": · Anticlockwise: Hamate Capate

Trapezoid Trapezium Scaphoid Lunate Triquetral Pisiform

Oblique muscles: direction of externals vs. internals

"Hands in your pockets": When put hands in your pockets, fingers now lie on top of external obliques and fingers point their direction of fibers: down and towards midline. ·

Note: "oblique" tells that must be going at an angle. · Internal obliques are at right angles to external.

ANATOMY

Murphy's point organ [for Irish]"Murphy was an Irishman (and Murphy is a classic Irish surname), and Ireland=green": Green organ in body is gallbladder, so Murphy's point is the gall bladder.

Duodenum: lengths of parts"Counting 1 to 4 but staggered": 1st part: 2 inches 2nd part: 3 inches 3rd part: 4 inches 4th part: 1 inch

Elbow: which side has common flexor originFM (as in FM Radio): Flexor Medial, so

Common Flexor Origin is on the medial side.

Carpal bones

"She Licks Toms Prick; Her Cu*t's Too Tight": Scaphoid Lunate Triquetrum Pisiform

Hamate Capitate Trapezoid Trapezium

Supination vs. pronation: which is more powerfulScrews were designed to be tightened well by majority of people. "Righty tighty": to tighten screws you turn to the right.

Majority of people are right-handed. Turning right-hand to the right is supination.

Median and ulnar nerves: common featuresEach supply 1/2 of flexor digitorum profundus. Each supplies 2 lumbricals. Each has a palmar cutaneous nerve that pops off prematurely. Each supplies an eminence group of muscles [ulnar: hypothenar. median: thenar]. Each enters forearm through two heads [ulnar: heads of flexor carpi ulnaris. median: heads of pronator teres]. Each has no branches in upper arm. Each makes two fingers claw when cut at wrist. Each supplies a palmaris [median: palmaris longus. ulnar: palmaris brevis].

171

Bowel components "Dublin Sisters Ceramic Red Colored Jewelry Apparently Illegal":

· 2-4 letters of each component:

Duodenum

Sigmoid

Cecum

Rectum

Colon

Jejunum

Appendix

Ileum

Thoracic duct: which half of upper body does it drain Know drains all of lower body, but was it the right or the left part of the upper body?

Answer: its Lymph from the Left of the upper body.

Mediastinums: posterior mediastinum structures

There are 4 birds:

The esophaGOOSE (esophagus)

The vaGOOSE nerve

ANATOMY

The azyGOOSE vein

The thoracic DUCK (duct)

Maxillary artery branches

"DAM I AM Piss Drunk But Stupid Drunk I Prefer, Must Phone Alcoholics Anonymous":

Deep auricular

Anterior tympanic

Middle meningeal

Inferior alveolar

Accessory meningeal

Masseteric

Pterygoid

Deep temporal

Buccal

Sphenopalatine

Descending palatine

Infraorbital

Posterior superior alveolar

Middle superior alveolar

Pharyngeal

Anterior superior alveolar

Artery of the pterygoid canal

Ulna bone: quick recognition in oral exam The Ulnar bone has a "U" at the end where it goes over the trochlea.

Vetebrae subtypes "Certain Doctors Luv Saddling Coeds":


Cervical

Dorsal

Lumbar

Sacrum

Coccyx

External carotid artery branches StApLE OPIS:

Superior thyroid


Lingual

External maxillary (facial)

Occipital

ANATOMY

Posterior auricular

Internal maxillary


Carpal bones "The boat sailed to the moon with 3 pEas in a rOw, at the wheel was

Captain Hook":

· Carpal bones in order of occurrence:

Boat is scaphoid. Moon is lunate. 3 is triquetrum. Peas is pisiform (stressing the E sound for trapezium). Row is trapezoid (stressing the O for trapezOid). Captain is capitate.

Hook is hamate (hamate has the hook).

Coelic trunk: branches Left Hand Side (LHS):

Left gastric artery

Hepatic artery

Splenic artery

Penis: spinal level innervation "S2, 3, 4 keep the penis off the floor":

· Alternatively: "S2, 3, 4 make a mess on the floor".

Penis innervated by pudendal nerve branches, derived from spinal cord levels S2-4.

181

Thoracic cage: relations to the important venous structures Behind the sternoclavicular joints: the brachiocephalic veins begin.

Behind the 1st costal cartilage on the right the superior vena cava begins.

Behind the 2nd costal cartilage on the right the azygos vein ends.

Behind the 3rd costal cartilage on the right the superior vena cava ends.

Lacrimal nerve course "Lacrimal's story of 8 L's":

Lacrimal nerve runs on Lateral wall of orbit above Lateral rectus, then Lets communicating branch join in, then supplies Lacrimal gland, then Leaves it and supplies

Lateral upper eye Lid!

ANATOMY

Saphenous veins: path of great vs. small at malleolus "MAGdelaine has varicose veins" [The saphenous veins are important for varicose veins]:

Medial maleolus, Anterior to maleolus, and Great saphenous go together.

Then the opposites of these go together: Small saphenous is posterior to the lateral maleolus.

Leino- definition "Leino" rhymes with "spleen-o":

Therefore leino- means something to do with the spleen.

Spermatic cord contents "Piles Don't Contribute To A Good Sex Life":

Pampiniform plexus

Ductus deferens

Cremasteric artery

Testicular artery

Artery of the ductus deferens

Genital branch of the genitofemoral nerve

Sympathetic nerve fibers

Lymphatic vessels

Brachial plexus organization "The Castrated Dog Turns Rabid":

· From lateral to medial:

Terminal branches

Cords

Divisions

Trunks

Roots

Lordosis vs. kyphosis Lordosis: Lumbar.

KYphosis is HY up on the spine.

Carpal bones "Happy Cat Tom Took Pie To Little Sister":

Hamate

ANATOMY

Capitate

Trapezoid

Trapezium

Pisiform

Triquital

Lunate

Scaphoid

Plantarflexion vs. dorsiflexion Plantar flexion occurs when you squish a Plant with your foot.

Autonomics to the gut "The PARAsympathetics follow a rule of TWO" [pair = two]:

· The vagus does the top, the sacral splanchnics the outflow tract.

"The sympathetics follow a rule of threes":

· Greater, lesser, least splanchnic nerves go to the celiac,superior and inferior mesenteric ganglion.

191

Adductor magnus innervation "AM SO!":

Adductor Magnus innervated by Sciatic and Obturator.

Carpal tunnel syndrome: causes TRAMP:

Trauma (occupational)

Rheumatiod arthritis

Acromegaly

Myxoedema

Pregnancy

· Alternatively: ARMPIT to include Idiopathic.

Musculocutaneous nerve: muscles innervated BBC (British Broadcasting Corporation):

Biceps brachii

Brachioradialis

Coracobrachialis

Descending abdominal aorta: seven divisions "Sometimes Intestines Get Really Stretched

Causing Leakage":

ANATOMY

Suprarenals [paired]

Inferior mesenteric

Gonadal [paired]

Renals [paired]

Superior mesenteric

Celiac

Lumbar [paired]

Menisci attachments in knee "Each meniscus has something attached to it":

The medial meniscus has the medial collateral ligament.

The lateral meniscus is attached to the popliteal muscle.

Carpel bones "So Long To Pinky, Here Comes The Thumb":

· Proximal row, lateral-to-medial, then distal row, medial-to-medial:

Scaphoid

Lunate

Triquetrium

Pisiform

Hamate

Capate

Trapezoid

Trapezium

Cruciate ligaments: insertions PAMS APPLES:

Posterior [passes] Anterior [inserts] Medially.

Anterior [passes] Posteriorly [inserts] Laterally.

Sperm: path through male reproductive system "My boyfriend's name is STEVE":

Seminiferous Tubules

Epididymis

Vas deferens

Ejaculatory duct

Femoral artery deep branches "Put My Leg Down Please":

Profundus femoris (deep femoral artery)

Medial circumflex femoral artery

Lateral circumflex femoral artery

Descending genicular arteries

Perforating arteries

ANATOMY

Lower limb peripheral nerve injurys "Drop into a DEeP PIT and shuffle your way out":

Foot Drop results from Dorsiflexors and Evertors paralysis, due to common Peroneal nerve lesion.

Plantarflexion and Inversion impairment due to Tibial nerve lesion, results in a shuffling gait.

Supination vs. pronation "SOUPination": Supination is to turn your arm palm up, as if you are holding a bowl of soup.

"POUR-nation": Pronation is to turn your arm with the palm down, as if you are pouring out whatever is your bowl.

· Alternatively, Pronation donation: Pronation is palm facing downward, as if making a donation.

Subclavian artery branches "Very Tired Individuals Sip Strong Coffee Served Daily":

Vertebral artery

Thyrocervical trunk

---Inferior thyroid

---Superficial cervical

---Suprascapular

Costocervical

---Superior intercostal

---Deep cervical

Scalp: nerve supply GLASS:

Greater occipital/ Greater auricular

Lesser occipital

Auriculotemporal

Supratrochlear

Supraorbital

Tibia: muscles of pes anserinus (the muscles attached to tibia's medial side) "A Girl between Two Sargeants":

ANATOMY

Gracilus is between

Sartorius and

Semitendonosus

Rib costal groove: order of intercostal blood vessels and nerve VAN:


Vein

Artery

Nerve

Internal pudendal branches "I Pee Pee But Don't Dump!":

Inferior rectal

Posterior scrotal (or labial)

Perineal

Bulb

Deep artery

Dorsal artery

Spinal cord: length in vertebral column SCULL:

Spinal Cord Until L2 (LL).

Erector spinae muscles: order Spinalis is on the spine (most medial).

Iliocostalis is on the ribs (most lateral).

And it's a Long (Longissimus) way between the spine and the ribs!

Portal-systemic anastomoses: main 2 places that retroperitoneals connect into systemic

RetroPeritoneals hook up with Renal and Paravertebral veins.

Carpum and tarsum "SCIT":

(Artum) Superior Carpum

(Artum) Inferior Tarsum

211

ANATOMY

Brachial artery: recurrent and collateral branches "I Am Pretty Sexy"

Inferior ulnar collateral artery goes with Anterior ulnar recurrent artery.

Posterior ulnar recurrent artery goes with Superior ulnar collateral artery.

· Alternatively: "I Am Pretty Smart".

Orbit: bones of medial wall "My Little Eye Sits in the orbit":

Maxilla (frontal process)

Lacrimal

Ethmoid

Sphenoid (body)

Facial nerve branches "Two Zombies Buggered My Cat":


Temporal branch

Zygomatic branch

Buccal branch

Mandibular branch

Cervical branch

· Alternatively: "Two Zulus Bit My Cat".

· Alternatively: "Two Zebras Bit My Coccyx".

· Alternatively: "To Zanzibar By Motor Car".

· Alternatively: "Tall Zulus Bear Many Children".

Cartilage derivatives of 1st pharyngeal arch (mandibular) "I'M A Super Sexy Guy" (or

Girl):

Incus

Malleus

Anterior ligament of malleus

Spine of sphenoid

Sphenomandibular ligament

Genial tubercle of mandible

Facial nerve: branches after Stylomastoid foramen "Ten Zulus Buggered My Cat

(Painfully)":


Temporal branch

ANATOMY

Zygomatic branch

Buccal branch

Mandibular branch

Cervical branch

(Posterior auricular nerve)

· Alternatively: "PAssing Through Zanzibar By Motor Car" (PA for Posterior Auricular).

Sperm pathway through male reproductive tract "STaRT DEEP--VD!":

· Sperm duct system progression, from smallest to largest:

ST: Seminiferous Tubules

RT: Rete Testes

DE: Ductus Efferentes

EP: Epididymis

VD: Vas Deferens

Superior orbital fissure: structures passing through "Live Free To See Absolutely No

Insult":

Lacrimal nerve

Frontal nerve

Trochlear nerve

Superior branch of oculomotor nerve

Abducent nerve

Nasociliary nerve

Inferior branch of oculomotor nerve

Vertebrae: number of facets a typical thoracic has Typical Thoracic has Ten facets.

External carotid artery branches "So Long For Acting Old Parenting Means Stability":

Superior thyroid

Lingual

Facial


Occiptal

Posterior auricular

Maxillary


Horner's syndrome components "HORNy PAM"

ANATOMY

· Horner's is:

Ptosis

Anhidrosis

Miosis

221

Superior mediastinum contents "BATS & TENT":

Brachiocephalic veins

Arch of aorta

Thymus

Superior vena cava

Trachea

Esophagus

Nerves (vagus & phrenic)

Thoracic duct

Scrotum layers "Some Days Eddie Can Irritate People Very Thourougly":

Skin

Dartos layer

External spermatic fascia

Cremaster muscle

Internal spermatic fascia

Parietal tunica vaginalis

Visceral tunica vaginalis

Tunica albuginea

External carotid artery branches "Sally Ate Lots Of Fresh Produce March Through

September":

Superior thyroid

Ascending laryngeal

Lingual

Occipital (O before F is an extremely common variation)

Facial

Posterior auricular

Maxillary

Transverse facial


ANATOMY

Cubital fossa contents "Really Need Booze To Be At My Nicest":

· From lateral to medial:

Radial Nerve

Biceps Tendon

Brachial Artery

Median Nerve

Cricoarytenoids: abductor vs. adductor When aliens abduct you, they Probe you.

Posterior cricoarytenoids abduct. Lateral therefore is adduct by default.

Extensor expansion location in the hand The eXtensor eXpansion is on the proXimal phalynX.

Carpal bone having the hook The Hamate has the Hook.

External carotid artery branches "She Lay Flaccid As Olaf's Penis Slipped In":

· From caudal to cephalad:

Superior thyroid

Lingual

Facial


Occipital

Posterior auricular


(Internal) maxillary

Brachial artery is medial to biceps tendon "BAMBI":

Brachial Artery is Medial to Biceps In elbow.

Ossification ages "Every Potential Anatomist Should Know When"

· When they ossify, in order of increasing year:

Elbow: 16 years

Pelvis, Ankle: 17 years

Shoulder, Knee: 18 years

Wrist: 19 years

ANATOMY

231

Carpal bones (multangular names) "Never Lower Tillie's Pants. Mother May Come

Home.":

Navicular

Lunate

Triquetrium

Pisiform greater Multangular (trapezium) lesser Multangular (trapezoid)

Capitate

Hamate

V3: sensory branches "Buccaneers Are Inferior Linguists":

Buccal

Auriculotemporal

Inferior alveolar

Lingual

BEHAVIORAL

MNEMONICS

Premature ejaculation: treatment 2 S's:

SSRIs [eg: fluoxitime]

Squeezing technique [glans pressure before climax]

· More detail with 2 more S's:

Sensate-focus excercises [relieves anxiety]

Stop and start method [5-6 rehearsals of stopping stimulation before climax]

Keober-Ross dying process: stages

"Death Always Brings Great Acceptance":

Denial Anger Bargaining Grieving Acceptance

ANATOMY

Male erectile dysfunction (MED): biological causes MED: Medicines(propranalol, methyldopa, SSRI, etc.)

Ethanol

Diabetes mellitus

Male Erectile Dysfunction (MED): drugs causing it

"STOP erection":

SSRI (fluoxtine)

Thioridazone methyldOpa

Propranalol

Gain: primary vs. secondary vs. tertiary

Primary: Patient's Psyche improved.

Secondary: Symptom Sympathy for patient.

Tertiary: Therapist's gain.

Depression: major episode characteristics

SPACE DIGS:

Sleep disruption

Psychomotor retardation

Appetite change

Concentration loss

Energy loss

Depressed mood

Interest wanes

Guilt

Suicidal tendencies

Depression: symptoms

BAD CRISES:

Behavioural change (slowing down or agitation)

ANATOMY

Appetite change (weight loss or weight gain in the young)

Depressed look (looking down)

Concentration decrease (does not do serial 7s well)

Ruminations (constant negative thoughts, hopelessness good indicator of suicidality)

Interest (reduced interest in what is normally pleasurable)

Sleep change (insomnia or hypersomnia, sleeping early, waking up at night, waking up feeling tired)

Energy change (fatigue)

Suicide

Autistic disorder: features

AUTISTICS:

Again and again (repetitive behavior)

Unusual Abilities

Talking (language) delay

IQ subnormal

Social development poor

Three years onset

Inherited component [35% concordance]

Cognitive impairment

Self injury

Sleep stages: features

DElta waves during DEepest sleep (stages 3 & 4, slow-wave). dREaM during REM sleep.

Narcolepsy: symptoms, epidemiology

CHAP: Cataplexy Hallucinations Attacks of sleep Paralysis on waking

· Usual presentation is a young male, hence "chap".

Cluster personality disorders

Cluster A Disorder = Atypical. Unusual and eccentric.

Cluster B Disorder = Beast. Uncontrolled wildness.

ANATOMY

Cluster C Disorder = Coward [avoidant type], Compulsive [obsessive-compulsive type], or Clingy [dependent type].

Reinforcement schedules: variable ratio

SLOT machines show SLOwesT extinction.

AIDS Dementia Complex (ADC): features

AIDS:

Atrophy of cortex

Infection/ Inflammation

Demyelination

Six months death

HM: this classic patient's lesion

HM had Hippocampus Missing.

Middle adolescence (14-17 years): characteristics

HERO:

Heterosexual crushes/ Homosexual Experience

Education regarding short term benefits

Risk taking

Omnipotence

· And there is interest in being a Hero (popular).

Impotence causes

PLANE:

Psychogenic: performance anxiety

Libido: decreased with androgen deficiency, drugs

Autonomic neuropathy: impede blood flow redirection

Nitric oxide deficiency: impaired synthesis, decreased blood pressure

Erectile reserve: can't maintain an erection

ANATOMY

REM: features

REM:

Rapid pulse/ Respiratory rate

Erection

Mental activity increase/ Muscle paralysis

BIOCHEMISTRY

MNEMONICS

Essential Amino Acids

• PriVaTe TIM HALL

• Phe, Val, Thr, Trp, Ile, Met, His, Arg, Leu, Lys

Urea Cycle

• Ordinarily, Careless Crappers, Are Also Frivolous About Urination.

• Ornithine, Carbamoyl, Citrulline, Arginosuccinate, Aspartate,

Fumarate, Arginine, Urea.

Cell division

• Prophase, metaphase, anaphase, telophase.

• "People Meet And Talk."

In the Phasted State

• Phosphorylate Phosphorylation cascade active when blood glucose low.

• DNA expression into mature mRNA

• Exons expressed, Introns in the trash.

• Pyrimidines are CUT from purines.

• Pyrimidines are Cytosine, Uracil, Thiamine and are one ring structures.

• Purines are double ring structures.

Porphyrias: acute intermittent porphyria symptoms 5 P's:

Pain in abdomen

Polyneuropathy

ANATOMY

Psychologial abnormalities

Pink urine

Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)

BUN:creatinine elevation: causes ABCD:

Azotremia (pre-renal)

Bleeding (GI)

Catabolic status

Diet (high protein parenteral nutrition)

G6PD: oxidant drugs inducing hemolytic anemia AAA: Antibiotic (eg: sufamethoxazole)

Antimalarial (eg: primaquine)

Antipyretics (eg: acetanilid, but not aspirin or acetaminophen)

Vitamin B3 (niacin, nicotinic acid) deficiency: pellagra

The 3 D's of pellagra: Dermatitis Diarrhea Dementia

· Note vitamin B3 is the 3 D's.

Tangier's disease: hallmark

"Tangierene tonsils":

Hallmark is large orange tonsils.

· Important clinical note: there is no increased risk of atherosclerosis, just like eating tangerenes.

Na+/K+ pump: movement of ions and quantity

K+ and in each consist of 2 characters, so so 2 K+ are pumped in. Na+ and out each consist of 3 characters, so 3 Na+ are pumped out

Glycogen storage: Anderson's (IV) vs. Cori's (III) enzyme defect

ABCD:

Anderson's=Branching enzyme.

Cori's=Debranching enzyme.

· Otherwise, can't really distinguish clinically.

Nitric oxide: amino acid precursor

When the dentist works on your teeth, you say, "AAArg! (Arginine)" before he administers Nitric Oxide (NO) to take the pain away.

· Other players necessary for NO synthesis: NO synthase, Ca++, NADPH.

Pompe's disease: type "Police = Po + lys":

ANATOMY

Pompe's disease is a lysosomal storage disease (alpha 1,4 glucosidase).

Metabolic acidosis (normal anion-gap): causes

· With hyperkalemia: RAISE K+:

RTA type 4

Aldosterone or mineralocorticord deficiency

Iatrogenic: NH4Cl, HCl

"Stenosis": obstructive uropathy

Early uremia

· With hypokalemia: ReDUCE K+:

Renal TA type 1 and 2

Diarrhoea

Urine diversion into gut

Carbonate anhydrase inhibitor

Ex-hyperventilation

Galactosaemia: enzyme deficiency

GALIPUT: Galactose 1 Phosphate Uridyl Transferase.

· There is an assay called the Galiput test for this.

Citric acid cycle compounds

"Our City Is Kept Safe And Sound From Malice":

Oxaloacetate Citrate Isocitrate alpha-Ketoglutarate Succinyl-CoA Succinate Fumarate

Malate

Folate deficiency: causes A FOLIC DROP:

Alcoholism

Folic acid antagonists

Oral contraceptives

Low dietary intake

Infection with Giardia

Celiac sprue

Dilatin

Relative folate deficiency

Old

Pregnant

ANATOMY

Mitochondrial DNA (mt DNA) properties

"mt DNA". mt stands for: Maternal Transfer Mutates Tremendously (high mutation rate)

Vitamins: which are fat soluble

"The FAT cat is in the ADEK (attic)":

Fat soluble vitamins are A,D,E,K.

Enzyme kinetics: competitive vs. non-competitive inhibition

With Kompetitive inhibition: Km increases; no change in Vmax. With Non-kompetitive inhibition: No change in Km; Vmax decreases.

Glycogen storage: names of types I through VI

"Viagra Pills Cause A Major Hardon":

Von Gierke's

Pompe's

Cori's

Anderson's

McArdle's

Her's

Sickle cell disease pathophysiology

SICKle cell disease is due to a Substitution of the SICKsth amino acid of the B chain.

Glucagon function

"Mr. Gluca has Gone to the cAMP to bring out some Glucose":

· Glucagon elevates glucose by cAMP mechanism.

Van den Bergh reaction (Jaundice test)

"Indirect reacting bilirubin = Unconjugated bilirubin":

Both start with vowels, so they go together:

Indirect & Unconjugated.

Hemoglobin binding curve: causes of shift to right

"CADET, face right!":

CO2

Acid

2,3-DPG (aka 2,3 BPG)

Exercise

ANATOMY

Temperature

G proteins for respective receptors

"QISS & QIQ" (Kiss and Kick):

· G-proteins and their respective receptors (alphabetical order):

Q: alpha 1 I: alpha 2 S: beta 1 S: beta 2 &

Q: M1 I: M2 Q: M3

Adrenaline mechanism

"ABC of Adrenaline":

Adrenaline--> activates

Beta receptors--> increases

Cyclic AMP


"Can I Keep Selling Sex For Money, Officer?":

Citrate Isocitrate alpha Ketogluterate Succinyl CoA Succinate Fumerate Malate

Oxaloacetate

Carbon monoxide: electron transport chain target

"CO blocks CO":

Carbon monoxide (CO) blocks Cytochrome Oxidase (CO)

Metabolism sites

"Use both arms to HUG":

Heme synthesis Urea cycle Gluconeogenesis · These reactions occur in both cytoplasm and mitochondria.

Na/K pump: concentrations of Na vs. K on inside/outside of cell, pump action, number of molecules moved

HIKIN': There is a HIgh K concentration INside the cell. From this can deduce that the

Na/K pump pumps K into cell and Na out of cell. Alternatively: When I was learning this pump (circa 1992), a band that was "in" was Kris Kross, and a band that was "out" was

"Sha Na Na Na": So pump moves K K (2 K) in and Na Na Na (3 Na) out. · Sadly, as infectious as their debut album was, Kris Kross can really no longer be classed as "in".

DNA bond strength (nucleotides)

"Crazy Glue":

Strongest bonds are between Cytosine and Guanine, strong like Crazy Glue (3 H-bonds), whereas the A=T only have 2 H-bonds. · This is relevant to DNA replication, as the weaker A=T will be the site where RNA primer makes the initial break.

ANATOMY

Dicarboxylic acids (alpha, omega) C2 through C10: common names

"Oh My, Such Good Apple Pie, Sweet As Sugar!":

Oxalic Malonic Succinic Glutaric Adipic Pimelic Suberic Azelaic Sebacic

Infantile Beriberi symptoms

Restlessness Sleeplessness Breathlessness Soundlessness (aphonia) Eatlessness

(anorexia) Great heartedness (dilated heart)

· Alternatively: Get 5 of 'em with BERI: Breathless/ Big hearted, Eatless, Restless,

Insomnia.

AcetylCoA and acetacetylCoA: amino acids forming them

"A Lighter Lease" (A LyTr LeIs):

A=AcetylCoA or Acetoacetyl CoA

Ly=Lysine

Tr=Tryptophan

Le=Leucine

Is=Isoleucine

Fasting state: branched-chain amino acids used by skeletal muscles

"Muscles LIVe fast":

Leucine

Isoleucine

Valine

Glycolysis steps

"Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies":

Glucose

Glucose-6-P

Fructose-6-P

Fructose-1,6-diP

Dihydroxyacetone-P

Glyceraldehyde-P

1,3-Biphosphoglycerate

3-Phosphoglycerate

2-Phosphoglycerate (to)

Phosphoenolpyruvate [PEP] Pyruvate · 'Did', 'By' and 'Pies' tell you the first part of those three: di-, bi-, and py-.

ANATOMY

· 'PrEPare' tells location of PEP in the process.

Fabry's disease

FABRY'S:

Foam cells found in glomeruli and tubules/ Febrile episodes

Alpha galactosidase A deficiency/ Angiokeratomas

Burning pain in extremities/ BUN increased in serum/ Boys

Renal failure

YX genotype (male, X linked recessive)

Sphingolipidoses

B vitamin names

"The Rhythm Nearly Proved Contagious":

· In increasing order: Thiamine (B1) Riboflavin (B2) Niacin (B3) Pyridoxine (B6)

Cobalamin (B12)

Electron transport chain: Rotenone's site of action

Rotenone is a site specific inhibitor of complex one.


"Oh! Can I Keep Some Succinate For Myself?":

Oxaloacetate Citrate Isocitrate Ketoglutarate Succinyl coA Succinate Fumarate Malate


"Oh Citric Acid Is Of (course) A SiLly STupid Funny Molecule":

Oxaloacetate Citrate Aconitate Isocitrate Oxalosuccinate Alpha-ketoglutarate SuccinyL-

CoA SuccinaTe Fumarate Malate

· SilLy and sTupid used to differentiate succinyL and succinaTe

Type 1 glycogen storage disease

Type 1 = one (Von), ie Von Giereke's disease

Essential amino acids

PVT. TIM HALL: Phe Val Thr Trp Ile Met His Arg Leu Lys

· Pvt. is short for Private in the military.

· Arg and His are considered semiessential.

· Alternatively: "MATT VIL PHLy".


"Can I Ask Sharon Stone For My Orgasm?":

ANATOMY

Citrate Isocitrate Alpha-Ketoglutarate Succinyl CoA Succinate Fumerate Maleate

Oxaloacetate

Golgi complex: functions

"Golgi Distributes A SPAM":

Distributes proteins and lipids from ER

Add mannose onto specific lysosome proteins

Sulfation of sugars and slected tyrosine

Proteoglycan assembly

Add O-oligosugars to serine and threnonine

Modify N-ologosugars on asparagine

Pyruvate: products of complete oxidation

"4 Naked Fun 3 Coeds + 1 Guy":

· Complete oxidation of pyruvate yields:

4 NADH FADH2 3 CO2 1 GTP

Catabolism steps of branched chain amino acids

"Truck hit the Ox to Death":

Transamination

Oxidative decarboxylation

Dehydrogenation

Niacin deficiency: signs and symptoms

The famous 4 D's:

Diarrhoea Dermatitis Dementia Death (if untreated)

Creatine phosphate: amino acid precursors

"Nice GAMs!": Glycine Arginine Methionine

· Gam is slang for a person's leg, especiallay an attractive female's leg: "Nice gams = nice legs!"

· Creatine phosphate is a muscle energy store, and spontaneously converts to creatinine which is excreted in the urine in direct proportion to muscle mass: clinically useful, such as in MS Dx.

Enzymes: classification

"Over The HILL":

Oxidoreductases

Transferases

ANATOMY

Hydrolases

Isomerases

Ligases

Lyases

· Enzymes get reaction over the hill.

Insulin: function

INsulIN stimulates 2 things to go IN 2 cells: Potassium and Glucose.

Collagen concisely covered

COLLAGEN:

C-terminal propeptide (procollagen)/ Covalent Cross links/ C vitamin/ Connective tissue/

Cartilage/ Chondroblasts/ Copper Cofactor (Covalent Cross linking)

Outside the cell is where collagen normally functions/ Osteoblasts/ Osteogenesis imperfecta

Lysyl hydroxylase/ Lysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last biosynthesis step)

Long triple helical fibers/ Ligaments

Alpha chains/ Attached by H bonds form triple helix/ Ascorbate for hydroxylation of lysyl and prolyl residues of pro-Alpha chains (postranslational modification)

Gly in every third position/ Glycosylation of hydroxyl group of hydroxylysine with

Glucose and Galactose; GOlgi allows procollagen to GO outside of cell

Extracellular matrix/ Eye (cornea, sclera)/ Ehlers-Danlos Syndrome

N-terminal propeptide (procollagen)/ Nonhelical terminal extensions

· Note: Procollagen LEAVEs the cell to be cLEAVEd by procollagen peptidases

Essential amino acids

"PVT. TIM HALL always argues, never tires":

Phe Val Thr Trp Ile Met His Arg Lue Lys

· Always argues: the A is for Arg, not Asp.

· 'Never tires': T is not Tyr, but is both Thr and Trp.

Hypervitaminosis A: signs and symptoms

"Increased Vitamin A makes you HARD":

Headache/ Hepatomegaly

Anorexia/ Alopecia

Really painful bones

ANATOMY

Dry skin/ Drowsiness

Heme synthesis: amino acid precursors to basic unit of porphyrins, heme (pyrrole ring)

"Dracula wants to Suck a Co-ed's blood [think heme] with his Glystening teeth!":

Succinyl CoA and Glycine are precursor amino acids to pyrrole rings, which is the basic unit of porphyrins and heme.

Enzymes: competitive inhibitors

"Competition is hard because we have to travel more kilometers (Km) with the same velocity":

With competitive inhibitors, velocity remains same but Km increases

Phosphorylation cascade: action during low glucose

"In the Phasted State, Phosphorylate":

The phosphorylation cascade becomes active when blood glucose is low.

Sickle cell anemia: mutation

"HbS isn't Very Good":

At Sixth position of HB beta chain, Valine is present instead of Glutamic acid. tRNA: molecular shape

Fortunately, tRNA (Transfer RNA) is shaped like a capital T.

· See diagram.

Malate-aspartate shuttle

"MAD commute":

Malate in. Alpha-ketoglutarate and D (Aspartate) out.

Vitamins: which are fat soluble

KADE: Vitamin K Vitamin A Vitamin D Vitamin E

Phenylketonuria: which enzyme is deficient

PHenylketonuria is caused by a deficiency of: Phenylalanine Hydroxylase

In the Phasted State Phosphorylate

Phosphorylation cascade active when blood glucose low.

Exons expressed, Introns in the trash--DNA expression into mature mRNA

Pyrimidines are CUT from purines.

Pyrimidines are Cytosine, Uracil, Thiamine and are one ring structures.

Purines are double ring structures.

Amino Acids:The ten essential amino acids:

ANATOMY

"These Ten Valuable Amino Acids Have Long Preserved Life In

Man."

(Threonine, Tryptophan, Valine, Arginine, Histidine, Lysine,

Phenylalanine, Leucine, Isoleucine, Methionine)

INsulin gets sugar INto cells- (Excess sugar is removed via urine.The Romans noticed bees attracted to the urine of diabetics and coined the term "diabetes" to describe the overflow of sugar.)

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

BONES

Back Trouble?

This uses the name of a famous Flemish physician to list off the different factors causing back troubles. It's pretty old, though, as knife and bullet wounds aren't mentioned. :^)

I

L

S

A

O

V

E

U

S

Osteomyelitis

Vertebral Fracture

Extraspinal Tumour

Spondylolisthesis

Ankylosing Spondylitis

Lumbar Disk Increase

Intraspinal Tumour

Unhappiness

Stress

Carpal (Wrist) Bones

"Scared Lovers Try Positions That They Can't Handle."

Starting from the thumb, the eight carpal bones are Scaphoid,

Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, and Hamate. To tell the three T's apart... triquetrum has "tri/

ANATOMY

T

O

F

P

E

S try" in it, and trapezium and trapezoid are in alphabetical order.

CARPenters use their hands. The CARPAL bones are of the hand, and not the foot.

Cranial Bones

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

Parietal

Ethmoid

Sphenoid

Temporal

Occipital

Frontal the six? the number of bones!

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

Cranial Sutures

Sutures have CLASS...

C

L

A

S

S

Coronal

Lambdoid and

Squamous

Sagittal

Facial Bones

ANATOMY

"Con Man Max and Pal Ziggy Lack Nasty Voices". Not the most intuitive acrostic in the world, but it works...

Con

Man

Max

Pal

Ziggy

Lack

Nasty

Voices

Conchae

Mandible

Maxilla

Palatine

Zygomatic

Lacrimal

Nasal

Vomer

Fontanels (Infant Skull)

A baby's first words might be "PAPA!"...

C

P

C

C

G

O

P

A

P

A

Posterior

Anterior

Posterio-Lateral

Anterio-Lateral

Fractures

Star Wars fans (hi, Inderpal!) use "Go C3PO" to recall the seven types of bone fractures...

ANATOMY

O

Greenstick

Open

Complete

Closed

Comminuted

Partial

Other

Lower Leg Bones

Can't tell your tib from your fib? The TIBia is the Thick, Inner

Bone. The FibuLa is Finer, Fluted, and Lateral.

Orbital Bones

This one's a bit silly. It relies on the belief that a species called the FLEZMS are in ORBITaround the earth.

F

L

E

Z

M

S

Frontal

Lacrimal

Ethmoid

Zygomatic

Maxilla

Sphenoid

Two Zulu's Bruised My Cervix

This one is used to remember the branches of the facial nerve...a (Sent to me by axe@iinet.net.au)

T emporal nerve

Z ygomatic nerve

B uccal nerve

M arginal mandibular nerve

C ervical nerve

To Zanzibar By Motorcar

ANATOMY

Cardiology

Aortic stenosis characteristics SAD:

Syncope

Angina

Dyspnoea

MI: basic management BOOMAR:

Bed rest

Oxygen

Opiate

Monitor

Anticoagulate

Reduce clot size

Some Lovers Try Positions That

They Can't Handle

For the order of the bones in the wrist : Scaphoid, Lunate,

Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate.

Some Say Marry Money But My Brother Says Big Breasts

Matter Most

For the Cranial Nerves 1 through 12, in determining whether they are Sensory, Motor, or Both (starting with Cranial Nerve

1)

CARDIOLOGY

MNEMONICS

ECG: left vs. right bundle block "WiLLiaM MaRRoW":

W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.

M pattern in V1-V2 and W in V3-V6 is Right bundle block.

· Note: consider bundle branch blocks when QRS complex is wide.

Pericarditis: causes CARDIAC RIND:

Collagen vascular disease

Aortic aneurysm

Radiation

Drugs (such as hydralazine)

Infections

ANATOMY

Acute renal failure

Cardiac infarction

Rheumatic fever

Injury

Neoplasms

Dressler's syndrome

Murmurs: systolic types SAPS:

Systolic

Aortic

Pulmonic

Stenosis

· Systolic murmurs include aortic and pulmonary stenosis.

· Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation].

MI: signs and symptoms PULSE:

Persistent chest pains

Upset stomach

Lightheadedness

Shortness of breath

Excessive sweating

Heart compensatory mechanisms that 'save' organ blood flow during shock "Heart

SAVER":

Symphatoadrenal system

Atrial natriuretic factor

Vasopressin

Endogenous digitalis-like factor

Renin-angiotensin-aldosterone system

· In all 5, system is activated/factor is released

Murmurs: right vs. left loudness "RILE":

Right sided heart murmurs are louder on Inspiration.

ANATOMY

Left sided heart murmurs are loudest on Expiration.

· If get confused about which is which, remember LIRE=liar which will be inherently false.

ST elevation causes in ECG, ELEVATION:

Electrolytes

LBBB

Early repolarization

Ventricular hypertrophy

Aneurysm

Treatment (eg pericardiocentesis)

Injury (AMI, contusion)

Osborne waves (hypothermia)

Non-occlusive vasospasm

Beck's triad (cardiac tamponade) 3 D's:

Distant heart sounds

Distended jugular veins

Decreased arterial pressure

11

MI: therapeutic treatment ROAMBAL:

Reassure

Oxygen

Aspirin

Morphine (diamorphine)

Beta blocker

Arthroplasty

Lignocaine

CHF: causes of exacerbation FAILURE:

Forgot medication

Arrhythmia/ Anaemia

Ischemia/ Infarction/ Infection

ANATOMY

Lifestyle: taken too much salt

Upregulation of CO: pregnancy, hyperthyroidism

Renal failure

Embolism: pulmonary

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

PAID: Pulmonic & Aortic Insufficiency=Diastolic.

Murmurs: systolic vs. diastolic Systolic murmurs: MR AS: "MR. ASner".

Diastolic murmurs: MS AR: "MS. ARden".

· The famous people with those surnames are Mr. Ed Asner and Ms. Jane Arden.

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

MR is a male title (Mr.) and it is male predominant.

Pericarditis: EKG "PericarditiS":

PR depression in precordial leads.

ST elevation.

Jugular venous pressure (JVP) elevation: causes HOLT: Grab Harold Holt around the neck and throw him in the ocean:

Heart failure

Obstruction of venea cava

Lymphatic enlargement - supraclavicular

Intra-Thoracic pressure increase

Depressed ST-segment: causes DEPRESSED ST:

Drooping valve (MVP)

Enlargement of LV with strain

Potassium loss (hypokalemia)

ANATOMY

Reciprocal ST- depression (in I/W AMI)

Embolism in lungs (pulmonary embolism)

Subendocardial ischemia

Subendocardial infarct

Encephalon haemorrhage (intracranial haemorrhage)

Dilated cardiomyopathy

Shock

Toxicity of digitalis, quinidine

22

Murmurs: innocent murmur features 8 S's:

Soft

Systolic

Short

Sounds (S1 & S2) normal

Symptomless

Special tests normal (X-ray, EKG)

Standing/ Sitting (vary with position)

Sternal depression

Murmur attributes "IL PQRST" (person has ill PQRST heart waves):

Intensity

Location

Pitch

Quality

Radiation

Shape

Timing

Murmurs: locations and descriptions "MRS butt":

MRS: Mitral Regurgitation--Systolic butt: Aortic Stenosis--Systolic

· The other two murmurs, Mitral stenosis and Aortic regurgitation, are obviously diastolic.

ANATOMY

Betablockers: cardioselective betablockers "Betablockers Acting Exclusively At

Myocardium"

· Cardioselective betablockers are:

Betaxolol

Acebutelol

Esmolol

Atenolol

Metoprolol

Apex beat: abnormalities found on palpation, causes of impalpable HILT:

Heaving

Impalpable

Laterally displaced

Thrusting/ Tapping

· If it is impalpable, causes are COPD:

COPD

Obesity

Pleural, Pericardial effusion

Dextrocardia

MI: treatment of acute MI COAG:

Cyclomorph

Oxygen

Aspirin

Glycerol trinitrate

Coronary artery bypass graft: indications DUST:

Depressed ventricular function

Unstable angina

Stenosis of the left main stem

Triple vessel disease

ANATOMY

Peripheral vascular insufficiency: inspection criteria SICVD:

Symmetry of leg musculature

Integrity of skin

Color of toenails

Varicose veins

Distribution of hair

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

ASS: Aortic Stenosis = Systolic

MRS: Mitral Regurg = Systolic

MSD: Mitral Stenosis = Diastolic

33

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

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

Parasympathetic acts on Potassium channels (PS).

Supraventricular tachycardia: treatment ABCDE:

Adenosine

Beta-blocker

Calcium channel antagonist

Digoxin

Excitation (vagal stimulation)

ANATOMY

Ventricular tachycardia: treatment LAMB:

Lidocaine

Amiodarone

Mexiltene/ Magnesium

Beta-blocker

Pulseless electrical activity: causes PATCH MED:

Pulmonary embolus

Acidosis

Tension pneumothorax

Cardiac tamponade

Hypokalemia/ Hyperkalemia/ Hypoxia/ Hypothermia/ Hypovolemia

Myocardial infarction

Electrolyte derangements

Drugs

Sinus bradycardia: aetiology "SINUS BRADICARDIA" (sinus bradycardia):

Sleep

Infections (myocarditis)

Neap thyroid (hypothyroid)

Unconsciousness (vasovagal syncope)

Subnormal temperatures (hypothermia)

Biliary obstruction

Raised CO2 (hypercapnia)

Acidosis

Deficient blood sugar (hypoglycemia)

Imbalance of electrolytes

Cushing's reflex (raised ICP)

Aging

Rx (drugs, such as high-dose atropine)

Deep anaesthesia

Ischemic heart disease

Athletes

Rheumatic fever: Jones criteria · Major criteria: CANCER:

ANATOMY

Carditis

Arthritis

Nodules

Chorea

Erythema

Rheumatic anamnesis

· Minor criteria: CAFE PAL:

CRP increased

Arthralgia

Fever

Elevated ESR

Prolonged PR interval

Anamnesis of rheumatism

Leucocytosis

JVP: wave form ASK ME:

Atrial contraction

Systole (ventricular contraction)

Klosure (closure) of tricusps, so atrial filling

Maximal atrial filling

Emptying of atrium

· See diagram.

Coronary artery bypass graft: indications DUST:

Depressed ventricular function

Unstable angina

Stenosis of the left main stem

Triple vessel disease

41

Exercise ramp ECG: contraindications RAMP:

Recent MI

Aortic stenosis

MI in the last 7 days

Pulmonary hypertension

ECG: T wave inversion causes INVERT:

ANATOMY

Ischemia

Normality [esp. young, black]

Ventricular hypertrophy

Ectopic foci [eg calcified plaques]

RBBB, LBBB

Treatments [digoxin]

Rheumatic fever: Jones major criteria JONES:

Joints (migrating polyarthritis)

Obvious, the heart (carditis, pancarditis, pericarditis, endocarditis or valvulits)

Nodes (subcutaneous nodules)

Erythema marginatum

Sydenham's chorea

Myocardial infarctions: treatment INFARCTIONS:

IV access

Narcotic analgesics (eg morphine, pethidine)

Facilities for defibrillation (DF)

Aspirin/ Anticoagulant (heparin)

Rest

Converting enzyme inhibitor

Thrombolysis

IV beta blocker

Oxygen 60%

Nitrates

Stool Softeners

Atrial fibrillation: causes PIRATES:

Pulmonary: PE, COPD

Iatrogenic

Rheumatic heart: mirtral regurgitation

Atherosclerotic: MI, CAD

Thyroid: hyperthyroid

Endocarditis

Sick sinus syndrome

ANATOMY

Atrial fibrillation: management ABCD:

Anti-coagulate

Beta-block to control rate

Cardiovert

Digoxin

Anti-arrythmics: for AV nodes "Do Block AV":

Digoxin

B-blockers

Adenosine

Verapamil

Murmurs: systolic MR PV TRAPS:

Mitral

Regurgitation and

Prolaspe

VSD

Tricupsid

Regurgitation

Aortic and

Pulmonary

Stenosis

Apex beat: differential for impalpable apex beat DOPES:

Dextrocardia

Obesity

Pericarditis or pericardial tamponade

Emphysema

Sinus inversus/ Student incompetence

CLINICAL MNEMONICS

ANATOMY

!

CAUSES OF ACUTE PANCREATITIS:

• "GET SMASH'D"

• Gallstones, Ethanol, Trauma, Steroids, Mumps,

Autoimmune(PAN), Scorpion bites, Hyperlipidemia,

Drugs(azathioprine, diuretics)

!

A-P-G-A-R:

• A - appearance (color)

• P - pulse (heart rate)

• G - grimmace (reflex, irritability)

• A - activity (muscle tone)

• R - respiratory effort

!

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

• MEN I is a disease of 3 P's (pituitary, parathyroid, and pancreas) plus adrenal cortex

• MEN II is a disease of 2 C's(carcinoma of thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN

IIa or mucocutaneous neuromas for MEN IIB(aka MEN III)

!

Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate

!

Acute pneumonia caused by Miscellaneous microbes--Mononuclear infiltrate

!

Takayasu's diz = pulseless diz, therefore when you have Takayasu's, I can't Tak'a yu pulse.

!

CAGE--alcohol use screening

• Have you ever felt it necessary to CUT DOWN on your drinking?

• Has anyone ever told you they were ANNOYED by your drinking?

• Have you ever felt GUILTY about your drinking?

• Have you ever felt the need to have a drink in the morning for an

EYE OPENER?

!

P-Q-R-S-T--eliciting and HPI and exploring symptoms

• P--palliative or provocative factors for the pain

• Q--quality of pain(burning, stabbing, aching, etc.)

• R--region of body affected

ANATOMY

• S--severity of pain(usually 1-10 scale)

• T--timing of pain(eg.-after meals, in the morning, etc.)

!

A-S-C-L-A-S-T--eliciting and HPI and exploring symptoms

• A--aggravatiing and alleviating factors

• S--severity

• C--character, quality

• L--location

• A--associated sx

• S--setting

• T--timing

• note: ASCLAST means let the patient talk first, then ask him/her specific questions

!

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

!

The five W's--post-operative fever

• Wind--pneumonia, atelectasis

• Wound--wound infections

• Water--urinary tract infection

• Walking--walking can help reduce deep vein thromboses and pulmonary embolus

• Wonderdrugs--especially anesthesia

!

Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER

• T--trauma

• O--obesity

• M--malignancy

• S--surgery

• C--cardiac disease

• H--hospitalization

• R--rest (bed-bound)

• E--estrogen, pregnancy, post-partum

• P--past hx

ANATOMY

• F--fracture

• E--elderly

• R--road trip

!

ARTERIAL OCCLUSION:

• pain

• pallor

• pulselessness

• paresthesias

!

HYPERSENSITIVITY REACTIONS: "Anna Cycled Immediately Downhill--Gell &

Goombs" or "ACID."

• Type I Anaphylaxis

• Type II Cytotoxic-mediated

• Type III Immune-complex

• Type IV Delayed hypersensitivity

!

WBC Count: "Never Let Mom Eat Beans" and "60, 30, 6, 3, 1"

• Neutrophils 60%

• Lymphocytes 30%

• Monocytes 6%

• Eosinophils 3%

• Basophils 1:

Clinical - Free Association

Proud Dead Guys and Other Diseases

Addison’s Disease • primary adrenocortical deficiency Addisonian Anemia • pernicious anemia (antibodies to intrinsic factor or parietal cells → ↓ IF → ↓ Vit B12 → megaloblastic anemia) Albright’s Syndrome • polyostotic fibrous dysplasia, precocious puberty, café au lait spots, short stature, young girls Alport’s Syndrome • hereditary nephritis with nerve deafness, Type 4 collagen defect (basement membranes) Alzheimer’s

• progressive dementia; tau proteins, neurofibrillary tangles, apolipoprotein E4 allele, narrow gyri and wide sulci (atrophy), occipital sparing, hydrocephalus ex vacuo, plaques in hippocampus and cortex, ↓ Acetylcholine, Hiramo bodies (inrtacellular inclusion bodies in hippocampal cells) Argyll-Robertson Pupil • loss of light reflex constriction

(contralateral or bilateral) • “Prostitute’s Eye” - accommodates but does not react •

Pathognomonic for 3°Syphilis Arnold-Chiari Malformation • cerebellar tonsil herniation

Barrett’s • columnar metaplasia of lower esophagus (* risk of adenocarcinoma)

ANATOMY

Bartter’s Syndrome • hyperreninemia Becker’s Muscular Dystrophy • similar to

Duchenne, but less severe (deficiency in dystrophin protein) Bell’s Palsy • CNVII palsy

(entire face; recall that UMN lesion only affects lower face) Berger’s Disease • IgA nephropathy Bernard-Soulier Disease • defect in platelet adhesion (abnormally large platelets & lack of platelet-surface glycoprotein) Berry Aneurysm • circle of Willis

(subarachnoid bleed) • often associated with ADPKD Bowen’s Disease • carcinoma in situ on shaft of penis (* risk of visceral ca)

Briquet’s Syndrome • somatization disorder • psychological: multiple physical complaints without physical pathology Broca’s Aphasia • Motor Aphasia intact comprehension

Bronchiolitis RSV Brown-Sequard • hemisection of cord (contralateral loss of pain & temp / ipsilateral loss of fine touch, UMN) Bruton’s Disease • X-linked agammaglobinemia Budd-Chiari • post-hepatic venous thrombosis Buerger’s Disease • acute inflammation of small, medium arteries * painful ischemia * gangrene

Burkitt’s Lymphoma • small noncleaved cell lymphoma EBV • 8:14 translocation

Caisson Disease • gas emboli Carpal Tunnel Syndrome Median nerve entrapment

Chagas’ Disease • Trypansoma infection sleeping disease, cardiomegaly with apical atrophy, achlasia Chediak-Higashi Disease • Phagocyte Deficiency: neutropenia, albinism, cranial & peripheral neuropathy • repeated infections Congenital adrenal hyperplasia 21-hydroxylase deficiency: virilism, no cortisol, salt loss, hypotension 11hydroxylase deficiency: virilism, no cortisol, salt retention, hypertension Conn’s

Syndrome • primary aldosteronism Cori’s Disease • glycogen storage disease

(debranching enzyme deficiency) Creutzfeldt-Jakob • prion infection * cerebellar & cerebral degeneration

Crigler-Najjar Syndrome • congenital hyperbilirubinemia (unconjugated) • glucuronyl transferase deficiency Crohn’s • IBD; ileocecum, transmural, skip lesions, lymphocytic infiltrate, granulomas (contrast to UC: limited to colon, mucosa & submucosa, crypt abscesses, pseudopolyps, * colon cancer risk)

Croup Parainfluenza Curling’s Ulcer • acute gastric ulcer associated with severe burns

Cushing’s • Disease: hypercorticism 2* to * ACTH from pituitary (basophilic adenoma) •

Syndrome: hypercorticism of all other causes (1* adrenal or ectopic)

Cushing’s Ulcer • acute gastric ulcer associated with CNS trauma de Quervain’s

Thyroiditis • self-limiting focal destruction (subacute thyroiditis) DiGeorge’s Syndrome • thymic hypoplasia * T-cell deficiency • hypoparathyroidism Down’s Syndrome • trisomy

21 or translocation Dressler’s Syndrome • Post-MI Fibrinous Pericarditis autoimmune

Dubin-Johnson Syndrome • congenital hyperbilirubinemia (conjugated) • striking brownto-black discoloration of the liver Duchenne Muscular Dystrophy • deficiency of dystrophin protein * MD X-linked recessive

Edwards’ Syndrome • trisomy 18 • rocker-bottom feet, low ears, heart disease Ehler’s-

Danlos • defective collagen Eisenmenger’s Complex • late cyanotic shunt (R → L) pulmonary HTN & RVH 2° to long-standing VSD, ASD, or PDA Erb-Duchenne Palsy • trauma to superior trunk of brachial plexus Waiter’s Tip Ewing Sarcoma •

ANATOMY undifferentiated round cell tumor of bone Eyrthroplasia of Queyrat • carcinoma in situ on glans penis Fanconi’s Syndrome • impaired proximal tubular reabsorption 2* to lead poisoning or Tetracycline (glycosuria, hyperphosphaturia, aminoaciduria, systemic acidosis) Felty’s Syndrome • rheumatoid arthritis, neutropenia, splenomegaly Gardner’s

Syndrome • adenomatous polyps of colon plus osteomas & soft tissue tumors Gaucher’s

Disease • Lysosomal Storage Disease glucocerebrosidase deficiency • hepatosplenomegaly, femoral head & long bone erosion, anemia Crinkled tissue paper cells in marrow Gilbert’s Syndrome • benign congenital hyperbilirubinemia

(unconjugated) GIST Tumor arising in cells of Cajal (pacemakers of gut) Glanzmann's

Thrombasthenia • defective glycoproteins on platelets Goodpasture’s • autoimmune: ab’s to glomerular & alveolar basement membranes; linear immunofluorescence Grave’s

Disease • autoimmune hyperthyroidism (TSI) Guillain-Barre • idiopathic polyneuritis

(ascending muscle weakness & paralysis; usually self-limiting) Hamman-Rich Syndrome

• idiopathic pulmonary fibrosis Hand-Schuller-Christian • chronic progressive histiocytosis Hashimoto’s Thyroiditis • autoimmune hypothyroidism (antimicrosomal or antithyroglobulin); Hurthle cells, thyroid germinal centers, Hapooh poohoxicosis • initial hyperthyroidism in Hashimoto’s Thyroiditis that precedes hypothyroidism Henoch-

Schonlein purpura • hypersensivity vasculitis • hemmorhagic urticaria (with fever, arthralgias, GI & renal involvement) • associated with upper respiratory infections

Hereditary Spherocytosis RBC cytoskeletin defect, most commonly spectrin

Hirschprung’s Disease • aganglionic megacolon Horner’s Syndrome • ptosis, miosis, anhidrosis (lesion of cervical sympathetic nerves often 2* to a Pancoast tumor)

Huntington’s • progressive degeneration of caudate nucleus, putamen & frontal cortex;

AD Hunter’s Decreased iduronosulfate sulfatase Hurler’s Decreased alpha-L-iduronidase

Jacksonian Seizures • epileptic events originating in the primary motor cortex (area 4)

Job’s Syndrome • immune deficiency: neutrophils fail to respond to chemotactic stimuli

Kaposi Sarcoma • malignant vascular tumor (HHV8 in homosexual men) Kartagener’s

Syndrome • immotile cilia 2° to defective dynein arms infection, situs inversus, sterility

Kawasaki Disease • mucocutaneous lymph node syndrome (lips, oral mucosa)

Keratoconjunctivitis adenovirus Klinefelter’s Syndrome • 47, XXY Kluver-Bucy • bilateral lesions of amygdala (hypersexuality; oral behavior) Krabbe Disease Betagalactosidase deficiency Krukenberg Tumor • adenocarcinoma with signet-ring cells

(typically originating from the stomach) metastases to the ovaries Laennec’s Cirrhosis • alcoholic cirrhosis Lesch-Nyhan • HGPRT deficiency • gout, retardation, self-mutilation

Letterer-Siwe • acute disseminated Langerhans’ cell histiocytosis Libman-Sacks • endocarditis with small vegetations on valve leaflets • associated with SLE Lou Gehrig’s

• Amyotrophic Lateral Sclerosis degeneration of upper & lower motor neurons Mallory-

Weis Syndrome • bleeding from esophagogastric lacerations 2* to wretching (alcoholics)

Marfan’s • elastin defect, floppy mitral valve, arachnodactyly, cystic medial necrosis, subluxed lens McArdle’s Disease • glycogen storage disease (muscle phosphorylase deficiency) Meckel’s Diverticulum • rule of 2’s: 2 inches long, 2 feet from the ileocecum, in 2% of the population • embryonic duct origin; may contain ectopic tissue (gastric,

ANATOMY pancreatic, etc.) Meig’s Syndrome • Triad: ovarian fibroma, ascites, hydrothorax

Menetrier’s Disease • giant hypertrophic gastritis (enlarged rugae; plasma protein loss)

Monckeberg’s Arteriosclerosis • calcification of the media (usually radial & ulnar aa.), pipestem arteries Munchausen Syndrome • factitious disorder (consciously creates symptoms, but doesn’t know why) Meningioma Arachnoid cap cells, whorls of cells

Mesothelioma Asbestos exposure Nelson’s Syndrome • 1* Adrenal Cushings * surgical removal of adrenals * loss of negative feedback to pituitary * Pituitary Adenoma

Niemann-Pick • Lysosomal Storage Disease sphingomyelinase deficiency • “foamy histiocytes” Osler-Weber-Rendu Syndrome • Hereditary Hemorrhagic Telangiectasia

Osteogenesis imperfecta Type I collagen defect Paget’s Disease • abnormal bone architecture (thickened, numerous fractures * pain) , woven and lamellar bone mosaic

Pancoast Tumor • bronchogenic tumor with superior sulcus involvement * Horner’s

Syndrome

Parkinson’s • dopamine depletion in nigrostriatal tracts; Cogwheel rigidity Peutz-Jegher’s

Syndrome • melanin pigmentation of lips, mouth, hand, genitalia plus hamartomatous polyps of small intestine Peyronie’s Disease • subcutaneous fibrosis of dorsum of penis

Pick’s Disease • progressive dementia similar to Alzheimer’s, knife-edged gyri

Plummer’s Syndrome • hyperthyroidism, nodular goiter, absence of eye signs (Plummer’s

= Grave’s - eye signs) Plummer-Vinson • esophageal webs & iron-deficiency anemia, ↑

SCCA of esophagus Pompe’s Disease • glycogen storage disease (acid maltase deficiency) * cardiomegaly

Pott’s Disease • tuberculous osteomyelitis of the vertebrae Potter’s Complex • renal agenesis * oligohydramnios * hypoplastic lungs, defects in extremities

Raynaud’s • Disease: recurrent vasospasm in extremities • Phenomenon: 2* to underlying disease (SLE or scleroderma)

Reiter’s Syndrome • "Can't see, can't pee, can't climb a tree" • urethritis, conjunctivitis, arthritis non-infectious (but often follows infections), HLA-B27, polyarticular Reye’s

Syndrome • microvesicular fatty liver change & encephalopathy • 2* to aspirin ingestion in children following viral illness

Riedel’s Thyroiditis • idiopathic fibrous replacement of thyroid Rotor Syndrome • congenital hyperbilirubinemia (conjugated) • similar to Dubin-Johnson, but no discoloration of the liver Sezary Syndrome • leukemic form of cutaneous T-cell lymphoma (mycosis fungoides) Shaver’s Disease • aluminum inhalation → lung fibrosis

Sheehan’s Syndrome • postpartum pituitary necrosis Shy-Drager • parkinsonism with autonomic dysfunction & orthostatic hypotension Simmond’s Disease • pituitary cachexia

Sipple’s Syndrome • MEN type IIa (pheochromocytoma, thyroid medulla, parathyroid)

Sjogren’s Syndrome • triad: dry eyes, dry mouth, arthritis ↑ risk of B-cell lymphoma

Spitz Nevus • juvenile melanoma (always benign) Stein-Leventhal • polycystic ovary

Stevens-Johnson Syndrome • erythema multiforme, fever, malaise, mucosal ulceration

(often 2° to infection or sulfa drugs) Struma Ovarii Thyroid teratoma of ovary Still’s

ANATOMY

Disease • juvenile rheumatoid arthritis (absence of rheumatoid factor) Takayasu’s arteritis

• aortic arch syndrome • loss of carotid, radial or ulnar pulses Tay-Sachs • gangliosidosis

(hexosaminidase A deficiency * GM2 ganglioside)

Tetralogy of Fallot • ÊVSD, Ëoverriding aorta, Ìpulmonary artery stenosis, Íright ventricular hypertrophy

Tourette’s Syndrome • involuntary actions, both motor and vocal Turcot’s Syndrome • adenomatous polyps of colon plus CNS tumors Turner’s Syndrome • 45, XO Typhoid

Fever Bradycardia and in white people rose spots on abdomen Vincent’s Infection •

“trench mouth” - acute necrotizing ulcerative gingivitis von Gierke’s Disease • glycogen storage disease (G6Pase deficiency) von Hippel-Lindau • hemangioma (or hemangioblastoma) • adenomas of the viscera, especially renal cell carcinoma defect in

VHL tumor suppressor von Recklinghausen’s • neurofibromatosis & café au lait spots &

Lisch nodule (iris hamartomas) von Recklinghausen’s Disease of Bone • osteitis fibrosa cystica (“brown tumor”) 2* to hyperparathyroidism von Willebrand’s Disease • defect in platelet adhesion 2* to deficiency in vWF; increased bleeding time and PTT

Waldenstrom’s macroglobinemia • proliferation of IgM-producing lymphoid cells

Wallenberg’s Syndrome • Posterior Inferior Cerebellar Artery (PICA) thrombosis

“Medullary Syndrome” • Ipsilateral: ataxia, facial pain & temp; Contralateral: body pain

& temp Waterhouse-Friderichsen • catastrophic adrenal insufficiency 2* to hemorrhagic necrosis (eg, DIC) • often 2* to meningiococcemia

Weber’s Syndrome • Paramedian Infarct of Midbrain • Ipsilateral: mydriasis;

Contralateral: UMN paralysis (lower face & body) Wegener’s Granulomatosis • necrotizing granulomatous vasculitis of paranasal sinuses, lungs, kidneys, etc. Weil’s

Disease • leptospirosis Wermer’s Syndrome • MEN type I (thyroid, parathyroid, adrenal cortex, pancreatic islets, pituitary) Wernicke’s Aphasia • Sensory Aphasia impaired comprehension Wernicke-Korsakoff Syndrome • thiamine deficiency in alcoholics; bilateral mamillary bodies (confusion, ataxia, ophthalmoplegia) Whipple’s Disease • malabsorption syndrome (with bacteria-laden macrophages) & polyarthritis Wilson’s

Disease • hepatolenticular degeneration (copper accumulation & decrease in ceruloplasmin) Wiskott-Aldrich Syndrome • immunodeficiency: combined B- &T-cell deficiency (thrombocytopenia & eczema) Wolff-Chaikoff Effect • high iodine level (*)’s thyroid hormone synthesis

Zenker’s Diverticulum • esophageal; cricopharyngeal muscles above UES Zollinger-

Ellison • gastrin-secreting tumor of pancreas (or intestine) * * acid * intractable ulcers

Hallmark Findings (and a few odd items mixed in) Adhesive arachnoiditis Caused by bacterial meningitis, leads to obstructive hydrocephalus Albumino-Cytologic

Dissociation • Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count) AFP increase Neural tube defects, hepatocellular carcinoma, yolk

ANATOMY sac and embryonal carcinoma AFP decrease Down’s Amnion nodosum Renal agenesis

Amyloid in thyroid Thyroid medullary carcinoma (calcitonin) Analgesic abuse Papillary necrosis, esp. in diabetics Anasarca Minimal change disease Aneurysmal nodules

Polyarteritis nodosa Angiomyolipoma Tuberous sclerosis Anosmia Kallman’s syndrome

Anterior vermian atrophy alcoholism Anti-centromere antibody Limited scleroderma

(CREST) Anti-DNA topoisomerase antibody Diffuse scleroderma Anti-endomysial antibody Celiac sprue Anti-jo antibody polymositis Anti-mitochondrial antibody Primary biliary cirrhosis Antiplatelet Antibodies • idiopathic thrombocytopenic purpura Antisacharommyces cervisiae antibody Crohn’s Anti-Smith antibodies Specific for SLE, antiribonulceoprotein Anti-smooth muscle antibody Autoimmune hepatitis type I

Arachnodactyly • Marfan’s Aschoff Bodies • rheumatic fever Ashleaf spots (skin)

Tuberous sclerosis Atypical lymphocytes EBV Auer Rods • acute promyelocytic leukemia (AML type M3) Autosplenectomy • sickle cell anemia Babinski • UMN lesion

Bacterial conjuntivitis S. aureus, strep. pneumo, Hemophilus aegyptius Basophilic

Stippling of RBCs • lead poisoning Bence Jones Protein • multiple myeloma free light chains (either kappa or lambda) • Waldenstrom’s macroglobinemia Bilateral breast cancer

Lobular carcinoma Bilateral renal cell carcinoma Von Hippel-Lindau Birbeck Granules • histiocytosis X (eosinophilic granuloma) Bladder trabeculation BPH Bloody nipple discharge Intraductal papilloma Blueberry muffin baby Rubella Blue Bloater • Chronic

Bronchitis Blue Sclera Osteogenesis imperfecta Boot-Shaped Heart • Tetralogy of Fallot

Bouchard’s Nodes • osteoarthritis (PIP) Boutonniere’s Deformity • rheumatoid arthritis

Bronze Diabetes Hemochromatosis Brown Tumor • hyperparathyroidism Brudzinski sign meningitis Brushfield Spots • Down’s, on iris Call-Exner Bodies • granulosa cell tumor

Carbon monoxide poisoning Hyperemia, edema and necrosis of globus Cardiomegaly with Apical Atrophy • Chagas’ Disease Central Nuclei in Muscle Muscular dystrophies

Chancre • 1* Syphilis, painless firm ulcers

Chancroid • Haemophilus ducreyi, painful soft ulcers Charcot Triad • multiple sclerosis

(nystagmus, intention tremor, scanning speech) Charcot-Leyden Crystals • bronchial asthma Cherry-red spot on macula Tay-Sachs, 50% of Niemann-Pick Cheyne-Stokes

Breathing • cerebral lesion Chocolate Cysts • endometriosis Cholesterol clefts atherosclerosis Chordae tendinae short and fused Rheumatic heart disease Chronic staph infections Chronic granulomatous disease, a deficiency of NADPH oxidase, can’t kill catalase positive bugs Chvostek’s Sign • Hypocalcemia facial spasm in tetany Clear nuclei Thyroid papillary carcinoma (Orphan Annie’s eyes) Clue Cells • Gardnerella vaginitis Codman’s Triangle • osteosarcoma Coin Lesions in Lung Pulmonary

Hamartoma Cold Agglutinins • Mycoplasma pneumoniae • infectious mononucleosis

Cold thyroid nodules Colloid cyst or thyroid adenoma Concentric laminar intimal fibrosis of small arteries of lung Primary pulmonary hypertension Condyloma Lata • 2* Syphilis • new coffee flavor at Bagel & Bagel Congenital Hepatic Fibrosis Polycystic Kidney

Disease, juvenile autosomal recessive form Contraction Band Necrosis MI Cotton Wool

Spots • HTN Councilman Bodies • dying hepatocytes Crescents In Bowman’s Capsule • rapidly progressive (crescentic glomerulonephritis) Crushed ping pong balls

ANATOMY

Pneumocystis carinii Crypt abscesses Ulcerative colitis Currant-Jelly Sputum • Klebsiella

Curschmann’s Spirals • bronchial asthma Cystathioine synthase deficieny homocystinuria

D-dimers DIC Depigmentation Of Substantia Nigra • Parkinson’s Dew drop on rose petal

Chicken pox Diaphragmatic pleural plaques Asbestosis Donovan Bodies • granuloma inguinale (STD) Double bubble sign on ultrasound Down’s syndorme – duodenal atresia

Duret Hemorrhages Uncal herniation Eburnation • osteoarthritis (polished, ivory-like appearance of bone) Eccentric intimal fibrosis with medial hypertrophy Chronic transplant rejection Ectopia Lentis • Marfan’s Embolizing endocarditis Infectious, marantic (fibrin deposits in hypercoagulable states) Erythema Chronicum Migrans •

Lyme Disease Excavation of Optic Cup Glaucoma Exopthalmos hyperthyroid FAT RN

TTP (fever, anemia, thrombocytopenia, renal failure, neuro problems) Fatty Liver •

Alcoholism Fecalith Acute appendicitis False positive VDRL SLE, Treponema pertenue

(non-STD tropical infection) Ferruginous Bodies • asbestosis Fish-mouthed mitral valve

Rheumatic heart disease Flea-bitten Kidney Malignant Hypertension Frontal bossing

Sickle cell anemia Fungus ball in lung Apergillus galactosemia Galactose-1-phosphate uridyl transferase deficiency or galactokinase deficiency Garlic odor on breath Arsenic

(or lasagna) Ghon Complex • Tuberculosis, primary Gold Pneumonia Lipid pneumonia, exogenous (aspiration) or endogenous (obstruction Gower’s Maneuver • Duchenne’s MD use of arms to stand Gray discoloration of skin Argyria (silver poisoning) Hat size increase Paget’s disease of bone Heart Failure Cells CHF; hemosiderin-laden macrophages in lungs Heberden’s Nodes • Osteoarthritis (DIP) Heinz Bodies • G6PDH

Deficiency Hemarthrosis Coagulation factor deficiency Hemorrhagic Temporal Lobe

Lesion HSV Hemorrhagic Urticaria • Henoch-Schonlein Heterophil Antibodies • infectious mononucleosis (EBV) Hirano Bodies • Alzheimer’s HLA B27 Ankylosing spondylitis ochronosis (dark pigment of fibrous tissue) Alkaptonuria –homogentisic acid oxidase deficiency Honeycomb lung Pulmonary fibrosis Howell Jolley Bodies

Splenectomy, remnant of nuclear DNA H shaped vertebrae Sickle cell anemia Human placental lactogen increase Placental site trophoblastic tumor Hyaline thrombi TTP

Hydrosalpinx Chronic pelvic inflammatory disease Hypersegmented PMNs •

Megaloblastic anemia Hypochromic Microcytic RBCs • iron-deficiency anemia IgM against IgG Rheumatoid arthritis (rheumatoid factor) ↓ Immunoglobulins X-linked

Brutons agammaglobulinemia, and common variable immunodeficiency Index finger overlapping 3rd and 4th Edward’s (Trisomy 18) Jarisch-Herxheimer Reaction • Syphilis over-aggressive treatment of an asymptomatic pt. that causes symptoms 2° to rapid lysis

Joint Mice • osteoarthritis (fractured osteophytes) Kaussmaul Breathing • acidosis

Keratin Pearls • SCCA Kernig’s sign meningitis Keyser-Fleischer Ring • Wilson’s

Kimmelstiel-Wilson Nodules • diabetic nephropathy Koilocytes • HPV Koplik Spots • measles Lacunar cells Variant of Reed-Sternberg cell seen in nodular sclerosing

Hodgkin’s Disease Lacunar infarct Chronic hypertension Lamellar bodies Contain surfactant in Type II pneumocytes Langhans giant cells Tuberculosis, other including coccidioides Lemon yellow skin color Pernicious anemia Lemon sign Ultrasonographic finding in Neural Tube Defects Leukocoria Retinoblastoma Lewy Bodies • Parkinson’s

(eosinophilic inclusions in damaged substantia nigra cells) Leukocyte alk. Phos. Positive

ANATOMY

Leukemoid rxn. Lines of Zahn • arterial thrombus Lisch Nodules • neurofibromatosis

(von Recklinhausen’s disease) Loss of grey-white junction Tuberous sclerosis Low set ears Downs, DiGeorge, Trisomy 18 (Edwards) Lumpy-Bumpy IF Glomeruli • poststreptococcal glomerulonephritis Machine-like murmur Patent ductus arteriosus

Macronodular cirrhosis Wilson’s, viral hepatitis, alpha-1-antitrypsin Malignant pustule

Anthrax (black skin lesion) Mallory Bodies Alcoholic liver disease: intermediate filaments of hepatocyte cytoskeleton Maple syrup/burnt sugar urine Alpha-ketoacid dehydrogenase deficiency; valine, leucine and isoleucine build up (branched)

McBurney’s Sign • appendicitis (McBurney’s Point is 2/3 of the way from the umbilicus to anterior superior iliac spine) Meconium ileus Cystic Fibrosis Mees lines Arsenic

(parallel lines on fingernails) Melanosis coli Laxative abuse Mental probs. with heart defect Mitral prolapse Michealis-Gutmann Bodies • Malakoplakia, an abnormal tissue response to kidney infection Microglial nodules HIV Micrognathia DiGeorge

Micronodular cirrhosis Wilsons, alcoholic, hemochromatosis, primary biliary cirrhosis

Microsatellite instability HNPCC (right-sided colon cancer), but also possible in other cancers Mid-systolic click Mitral prolapse Monoclonal Antibody Spike • multiple myeloma this is called the M protein (usually IgG or IgA) • MGUS Mousy / musty odor

PKU Mucosal bleeding Platelet problem (qualitative or quantitative) Myxedema • hypothyroidism Necrolytic migratory erythema dermatitis α -cell islet tumor Negri Bodies and hydrophobia • rabies Neuritic Plaques • Alzheimer’s Neurofibrillary Tangles •

Alzheimer’s Night pain relieved by aspirin Osteoid osteoma Non-embolizing endocarditis Rheumatic, Libman-Sacks (with SLE) Non-pitting Edema • Myxedema •

Anthrax Toxin Notching of Ribs • Coarctation of Aorta Nutmeg Liver • CHF, right heart

Onion skin kidney arterioles Malignant nephrosclerosis (malignant hypertension)

Oligoclonal band Multiple sclerosis Osteoid production osteosarcoma Painless Jaundice • pancreatic CA (head) Palatal Petechaie Strep pharyngitis Palpable purpura

Hypersensitivity vasculitis (Henoch-Schonlein, serum sickness) Pancarditis Rheumatic fever Pannus • rheumatoid arthritis PAS positive macrophages Whipple’s disease Patent ductus arteriosus Maternal rubella and prematurity Pautrier’s Microabscesses • mycosis fungoides (cutaneous T-cell lymphoma) Periductal edema Gynecomastia Periventricular

Calcifications Congenital CMV (brain ventricles, that is) Phenylalanine hydroxylase deficiency PKU Philadelphia Chromosome • CML Pick Bodies • Pick’s Disease

Piecemeal Necrosis Chronic active hepatitis (periportal hepatocytes) Plexiform lesions

Pulmonary HTN (aneurysmal expansion of vessel wall) Pink, foamy lung exudate

Pneumocystis carinii pneumonia Pink Puffer • Emphysema Centroacinar – smoking

Panacinar - α 1-antitrypsin deficiency Podagra • gout (MP joint of hallux) Porcelain gallbladder Chronic cholecystitis (scarring) Porcelain gallstones Associated with gallbladder adenocarcinoma Port-Wine Stain • Hemangioma Posterior Anterior Drawer

Sign • tearing of the ACL Proliferating bile ducts Obstructive jaundice Psammoma

Bodies • Papillary adenocarcinoma of the thyroid • Serous papillary cystadenocarcinoma of the ovary • Meningioma • Mesothelioma Pseudohypertrophy • Duchenne muscular dystrophy Pseudopoyps Ulcerative colitis Pulmonary atherosclerosis Cor pulmonale

Punched-Out Bone Lesions • multiple myeloma Punched-out esophageal lesions herpes

ANATOMY

Rash on Palms & Soles • 2° Syphilis • RMSF RBC poikilocytosis Beta-thalassemia

Rectangular RBC’s Hemoglobin SC Red hyalin globules Alpha-1-antitrypsin deficiency

(in liver) Red Morning Urine • paroxysmal nocturnal hemoglobinuria Reed-Sternberg

Cells • Hodgkin’s Disease Reid Index Increased • chronic bronchitis Reinke Crystals •

Leydig cell tumor Rhomboid crystals Pseudogout Rim pattern SLE, staining pattern with anti-double stranded DNA antibodies Rockerbottom feet Patau (Trisomy 13), Edward’s

(Trisomy 18) Rose thorns Sporotrichosis Rouleaux Formation • multiple myeloma RBC’s stacked as poker chips Rugae loss Pernicious anemia (atrophic gastritis) S3 Heart Sound •

L → R Shunt (VSD, PDA) • Mitral Regurg • LV Failure S4 Heart Sound • Pulmonary

Stenosis • Pulmonary HTN Scalloped colloid Grave’s disease Schwartzman Reaction •

Neisseria meningitidis impressive rash with bugs Shagreen patches Tuberous sclerosis

Simian Crease • Down’s Smith Antigen • SLE (also anti-dsDNA) Smudge cells CLL

(delicate cells easily destroyed on peripheral smear) Soap Bubble on X-Ray • giant cell tumor of bone Soldiers plaque Clinically insignificant remnant of healed pericarditis

Spider telangiectasia Hyperestrinism: liver faillure, pregnancy Spike & Dome Glomeruli

• membranous glomerulonephritis Splinter hemorrhages Infective endocarditis

Strawberry tongue Scarlet fever, Kawasaki’s Strawberry cervix Trichomonas vaginalis

Strawberry gallbladder cholesterolosis String Sign on X-ray • Crohn’s bowel wall thickening Sugar icing on spleen Portal hypertension Sulfer granules Collection of actinomyces or nocardia organisms in chronic abscessing bronchopneumonia Swiss cheese brain Clostridia (gas forming) Syncitia RSV, measles Tamm-Horsfall protein

Hyaline casts (non-specific) Target Cells • Thalassemia Teardrop RBCs Myelofibrosis

Temporal lobe encephalitis Herpes Tendinous Xanthomas • Familial

Hypercholesterolemia Tethered cord Arnold-Chiari malformation (tonsilar herniation)

Tetrahydrobiopterin cofactor def. PKU Thymidine dimers Xeroderma pigmentosum

Thymus, parathyroid agenesis Digeorge (3rd and 4th pharyngeal pouch) Thyroidization of Kidney • chronic pyelonephritis TIBC increase Anemia of chronic disease Tingible

Bodies Macrophage in lymph node germinal centers Tophi • gout Tram-Track Glomeruli

• membranoproliferative glomerulonephritis Tree bark aorta Syphilis Trousseau’s Sign • visceral ca, classically pancreatic (migratory thrombophlebitis) • hypocalcemia (carpal spasm) These are two entirely different disease processes and different signs, but they unfortunately have the same name. TSI > TGI Grave’s TGI > TSI Hashimoto’s

Tyrosinase deficiency Albinism Virchow’s Node • supraclavicular node enlargement by metastatic carcinoma of the stomach VMA and metenephrins in urine

Pheochromocytoma Warthin-Finkeldey Giant Cells • Measles Waterhammer pulse Aortic regurgitation WBC Casts • pyelonephritis White matter petechaie Fat emboli Winged scapula Long thoracic nerve (C5,6,7) damage, common with radical mastectomy Wire

Loop Glomeruli • lupus nephropathy, type IV Wrinkled glomerular basement membrane ischemia ↑ AFP in amniotic fluid or mother’s serum • Spina Bifida • Anencephaly ↑ Uric

Acid • Gout • Lesch Nyhan • Myeloproliferative Disorders • Diuretics (Loop &

Thiazides) ↓ FEV1/FVC • COPD ↓ glucose, ↑ protein in CSF Bacterial meningitis ↑ dopamine receptors Schizophrenia ↓ dopamine receptors Parkinson’s

ANATOMY

Most Common… 1° Tumor arising from bone in adults • Multiple Myeloma Adrenal

Medullary Tumor – Adults • Pheochromocytoma Adrenal Medullary Tumor – Children •

Neuroblastoma Arteries of stroke Lateral striate Bacterial Meningitis – adults • Neisseria meningitidis Bacterial Meningitis – elderly • Strep pneumoniae Bacterial Meningitis – newborns • E. coli Bacterial Meningitis – toddlers • Hib B cell defect (genetic) Isolated

IgA deficiency Bone Tumors • Metasteses from Breast & Prostate Brain Tumor – Child •

Medulloblastoma (cerebellum) Brain Tumor –Adult • Astrocytoma (including

Glioblastoma Multiforme) then: mets, meningioma, Schwannoma Breast Carcinoma •

Invasive Duct Carcinoma Breast Mass • Fibrocystic Change (Carcinoma is the most common is post-menopausal women) Bug in Acute Endocarditis • Staph aureus Bug in debilitated, hospitalized pneumonia pt • Klebsiella Bug in Epiglottitis • Hib Bug in GI

Tract • Bacteroides (2nd – E. coli) Bug in IV drug user bacteremia / pneumonia • Staph aureus Bug in PID • N. Gonnorrhoeae Bug in Subacute Endocarditis • Strep Viridans

Cardiac 1° Tumor – Adults • Myxoma “Ball Valve” Cardiac 1° Tumor – Child •

Rhabdomyoma Cardiac Tumor – Adults • Metasteses Cardiomyopathy • Dilated

(Congestive) Cardiomyopathy Carpal bone fractured scaphoid Cause of 2° HTN • Renal

Disease Cause of Addison’s • Autoimmune (2nd – infection) Cause of Congenital

Adrenal Hyperplasia • 21-Hydroxylase Deficiency (then, 11-) Cause of Cushings •

Exogenous Steroid Therapy (then, 1° ↑ ACTH, Adrenal Adenoma, Ectopic ACTH) Cause of death in Alzheimer pts • Pneumonia Cause of death in amyloidosis Chronic renal failure Cause of death in Diabetics • MI Cause of Death in SLE pts. • Lupus Nephropathy

Type IV (Diffuse Proliferative) Cause of Dementia • Alzheimer’s Cause of Dementia

(2nd most common) • Multi-Infarct Dementia Cause of food poisoning • Staph aureus

Cause of mental retardation • Down’s Cause of mental retardation (2nd most common) •

Fragile X Cause of preventable blindness • Chlamydia Cause of Pulmonary HTN • COPD

Cause of SIADH • Small Cell Carcinoma of the Lung Chromosomal disorder • Down’s

Congenital cardiac anomaly • VSD (membranous > muscular) Congenital early cyanosis

• Tetralogy of Fallot Coronary Artery thrombosis • LAD Demyelinating Disease •

Multiple Sclerosis Dietary Deficiency • Iron Disseminated opportunistic infection in

AIDS • CMV (Pneumocystis carinii is most common overall) Esophageal cancer • SCCA

Fatal genetic defect in Caucasians • Cystic Fibrosis Female Tumor • Leimyoma Form of

Amyloidosis • Immunologic (Bence Jones protein in multiple myeloma is also called the

Amyloid Light Chain) Form of Tularemia • Ulceroglandular Gynecologic malignancy •

Endometrial Carcinoma Heart Murmur • Mitral Valve Prolapse Heart problem in AIDS

Pericarditis Heart tumor in adults myxoma Heart tumor in kids rhabdomyoma Heart

Valve in bacterial endocarditis • Mitral Heart Valve in bacterial endocarditis in IV drug users • Tricuspid Heart Valve involved in Rheumatic Fever • Mitral then Aortic

Hereditary Bleeding Disorder • Von Willebrand’s Disease Liver 1° Tumor • Hepatoma, seen in women on oral contraceptives Liver Disease • Alcoholic Liver Disease Location of Adult brain tumors • Above Tentorium Location of Childhood brain tumors • Below

Tentorium Location of GI tuberculosis Ileocecal Lysosomal Storage Disease • Gaucher’s

Motor Neuron Disease • ALS Myocarditis cause Coxsackie B Neoplasm – Child •

Leukemia Neoplasm – Child (2nd most common) • Medulloblastoma of brain

ANATOMY

(cerebellum) Nephrotic Syndrome • Membranous Glomerulonephritis Opportunistic infection in AIDS • PCP Osteomyelitis in IV drug user Pseudomonas Osteomyelitis in sickle cell Salmonella Ovarian Malignancy • Serous Cystadenoma Ovarian Tumor •

Hamartoma Pancreatic Tumor • Adeno (usually in the head) Patient with ALL / CLL /

AML / CML • ALL - Child / CLL - Adult over 60 / AML - Adult over 60 / CML - Adult

35-50 Patient with Goodpasture’s • Young male Patient with Reiter’s • Male Pituitary

Tumor • Prolactinoma (2nd – Somatotropic “Acidophilic” Adenoma) Primary

Hyperparathyroidism • Adenomas (followed by: hyperplasia, then carcinoma) Pt. With

Hodgkin’s • Young Male (except Nodular Sclerosis type – Female) Pt. With Minimal

Change Disease • Young Child Secondary Hyperparathyroidism • Hypocalcemia of

Chronic Renal Failure Sexually transmitted disease • Chlamydia Site of Diverticula •

Sigmoid Colon Site of metastasis • Regional Lymph Nodes Site of metastasis (2nd most common) • Liver Sites of atherosclerosis • Abdominal aorta > coronary > popliteal > carotid Skin Cancer • Basal Cell Carcinoma Stomach cancer • Adeno Testicular Tumor •

Seminoma Thyroid Cancer • Papillary Carcinoma Tracheoesophageal Fistula • Lower esophagus joins trachea / upper esophagus – blind pouch Tumor of Infancy •

Hemangioma Type of Hodkin’s • Mixed Cellularity (versus: lymphocytic predominance, lymphocytic depletion, nodular sclerosis) Type of Non-Hodgkin’s • Follicular, small cleaved Vasculitis (of medium & small arteries) • Temporal Arteritis Viral Encephalitis •

HSV Worm infection in US • Pinworm (2nd – Ascaris)

Signature Drug Toxicities Agranulocytosis • Clozapine Aplastic Anemia •

Chloramphenicol • NSAIDs • Benzene Arrhythmia Tricyclic antidepressant (wide QRS)

Cardiac glycosides, especially with hypokalemia Atropine-like Side Effects • Tricyclics

Blindness Methanol (Formic Acid) Cardiotoxicity • Doxorubicin • Daunorubicin

Cartilage Damage in children • Fluoroquinolones (Ciprofloxacin & Norfloxacin)

Cinchonism • Quinidine Cough • ACE Inhibitors Diabetes Insipidus • Lithium

Disulfiram-like effect • Metronidazole • Sulfonylureas (1st generation) Extrapyramidal

Side Effects • Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine) Fanconi’s

Syndrome • Tetracycline Fatal Hepatotoxicity (necrosis) • Valproic Acid • Halothane •

Acetaminophen Gingical Hyperplasia • Phenytoin Gray Baby Syndrome •

Chloramphenicol Gynecomastia • Cimetidine • Azoles • Spironolactone • Digitalis

Hemolytic Anemia in G6PD-deficiency • Sulfonamides • Isoniazid • Aspirin • Ibuprofen •

Primaquine Hepatitis • Isoniazid Hepatocellular carcinoma Polyvinyl chloride, anaphylatoxins Hot Flashes, Flushing • Niacin • Tamoxifen • Ca++ Channel Blockers

Induce CP450 • Barbiturates • Phenytoin • Carbamazepine • Rifampin Inhibit CP450 •

Cimetidine • Ketoconazole Interstitial Nephritis • Methicillin • NSAIDs (except Aspirin)

• Furosemide • Sulfonamides Lupus like Procainamide, hydralazine Malignant hyperthermia Succinyl choline, halothane Monday Disease • Nitroglycerin Industrial exposure → tolerance during week → loss of tolerance during weekend → headache, tach, dizziness upon re-exposure Neuroleptic malignant syndrome Haloperidol Orange

Body Fluids • Rifampin Osteoporosis • Heparin • Corticosteroids Positive Coombs’ Test •

ANATOMY

Methyldopa Pulmonary Fibrosis • Bleomycin • Amiodarone Red Man Syndrome •

Vancomycin Severe HTN with Tyramine • MAOIs

SLE-like Syndrome • Procainamide • Hydralazine Tardive Dyskinesia • Antipsychotics

(Thioridazine, Haloperidol, Chlorpromazine) Tinnitus • Aspirin • Quinidine Torsade de pointes Quinidine Vaginal Adenosis and Clear Cell Carcinoma DES

Miscellaneous • Fastest growing tumor – Burkitt’s • PE’s are found in half of all autopsies • Courvoisier’s Law: tumors that obstruct the common bile duct cause enlarged gallbladders, but obstructing gallstones do not (too much scarring). • Only DNA virus to replicate in cytoplasm: Pox • Only RNA virus to replicate in nucleus: Influenza • Bacillus anthracis has the only protein capsule • Bordetella pertussis (Whooping Cough) elicits lymphocytosis rather than granulocytosis • Bronchioalveolar carcinomas grow without destroying the normal architecture of the lung • Cryptococcus neoformans often lacks a capsule and, when stained with GMS, looks just like Pneumycistis carinii, except that

Cryptococcus lacks the prominent nucleoli.

Alcohol abuse screening questions CAGE:

1. Ever felt it necessary to Cut down on drinking?

2. Has anyone ever said they felt Annoyed by your drinking?

3. Ever felt Guilty about drinking?

4 Ever felt a need to have a morning drink as an Eye opener?

Abdominal swelling causes 5 F's:

Fat Feces Fluid Flatus Fetus Full-sized tumors

Patient examination organization SOAP:

Subjective: what the patient says.

Objective: what the examiner observes.

Assessment: what the examiner thinks is going on.

Plan: what they intend to do about it.

Vomiting: non-GIT differential ABCDEFGHI:

Acute renal failure Brain [increased ICP] Cardiac [inferior MI] DKA Ears [labyrinthitis]

Foreign substances [Tylenol, theo, etc.] Glaucoma Hyperemesis gravidarum Infection

[pyelonephritis, meningitis]

History: quick EMS medical history checklist SAMPLE:

Signs/ Symptoms Allergies Medications Pertinent history Last oral intake Events preceding this incident

Pain history checklist OPQRSTU:

Onset of pain (time, duration) Palliative factors for pain Quality of pain (throbbing, stabbing, dull, etc.) Region of body affected Severity of pain (usually scale of 1-10)

ANATOMY

Timing of pain (after exercise, in evening, etc.) U: How does it affect 'U' in your daily life?

· May wish to expand to OPPQRRSTTUVW, with the extra letters representing:

Provocative factors Radiation (how does pain spread) Treatments tried Deja Vu: Has this happened before? Worry: What do you think or fear that it is?

Differential diagnosis checklist "A VITAMIN C"

A and C stand for Acquired and Congenital

· VITAMIN stands for:

Vascular

Inflammatory (Infectious and non-Infectious)

Trauma/ Toxins

Autoimmune

Metabolic

Idiopathic

Neoplastic

· Example usage: List causes of decreased vision: Central retinal artery occlusion,

Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid arthritis,

Diabetes, Idiopathic, Any eye tumor, Myopia.

Sign vs. symptoms

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

Eyes: abbreviations for the eyes

You look OUt with Both eyes. Take the Right dose so you won't OD [overdose]. The only one that is Left is OS.

· Both eyes=OU, Right eye=OD, Left eye=OS.

Medical history: disease checklist MJ THREADS:

Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic fever/ Rheumatoid arthritis Epilepsy Asthma Diabetes Strokes

Pain history checklist "On Days Feeling Low Character, Run A Seven Pace Race":

Onset

Duration

Frequency

Location

Character

Radiation

Severity

Precipitating factors

Relieving factors

ANATOMY

Pain history checklist ASK LAST:

Aggravating/ Alleviating

Severity

Karacter

Location

Associated symptoms

Setting

Timing

Pain history checklist SOCRATES:

Site

Onset

Character

Radiation

Alleviating factors/ Associated symptoms

Timing (duration, frequency)

Exacerbating factors

Severity

· Alternatively, Signs and Symptoms with the 'S'.

Symptom attributes "FAST LQQ'S":

Factors that make it better/worse

Associated manifestations

Setting

Timing

Location

Quality

Quantity

Severity

Heart valve auscultation sites "All Patients Take Meds":

· Reading from top left:

Aortic

Pulmonary

Tricuspid

Mitral

· See diagram.

· Alternatively: All Prostitutes Take Money.

· Alternatively: APe To Man.

Four point physical assessment of a disease

"I'm A People Person":

Inspection

ANATOMY

Auscultation

Percussion

Palpation

Physical exam for 'lumps and bumps'

"6 Students and 3 Teachers go for CAMPFIRE":

Site, Size, Shape, Surface, Skin, Scar

Tenderness, Temperature, Transillumination

Consistency

Attachment

Mobility

Pulsation

Fluctuation

Irreducibility

Regional lymph nodes

Edge

Surgical sieve VANISHED:

Vascular

Accident & trauma

Neoplastic

Inflammatory

Septic

Haematologic/ Hereditary

Endocrinological

Degenerative

Differential diagnosis checklist "I VINDICATE":

Iatrogenic

Vascular

Infectious

Neoplastic

Degenerative/ Drugs

Inflammatory/ Idiopathic

Congenital

Allergic/ Autoimmune

Traumatic

Endocrinal & metabolic

Symptom sieve "TIN CAN BED DIP POG":

Trauma

ANATOMY

Infection

Neoplasm

Cardiac

Autoimmune

Neurological

Blood/ Bone

Endocrine

Disintegration/ Degeneration

Drugs

Iatrogenic/ Idiopathic

Psychological

Paediatric

Obstetric

Gynaecological

Pain history checklist LOST WAR:

Location Onset Severity Time Worsening factors Alleviating factors Radiation

Short statue causes RETARD HEIGHT:

Rickets Endocrine (cretinism, hypopituitarism, Cushing's) Turner syndrome

Achondroplasia Respiratory (suppurative lung disease) Down syndrome Hereditary

Environmental (postirradiation, postinfectious) IUGR GI (malabsorption) Heart

(congenital heart disease) Tilted backbone (scoliosis)

Ascultation: crackles (rales )"PEBbles":

Pneumonia Edema of lung Bronchitis

Pain history checklist CHLORIDE:

Character (stabbing, throbbing, etc.) Location Onset Radiation Intensity Duration Events

(associated with, or palliative and provocative factors)

Differential diagnosis CIMETIDINE:

Congenital Infection/ Inflammatory Metabolic Endocrine Trauma Iatrogenic

Degenerative Idiopathic Neoplastic Everything else

Sign vs. symptom Remember Ace of Base's song that goes like this: "I Saw the Sign, and it opened up my eyes".

The physician sees the signs.

Systems review: systems checklist I PUNCH EAR:

Integumental Pulmonary Urogenital Nervous Cardiovascular Hematolymphoid Endocrine

Alimentary Reproductive

ANATOMY

Pain history checklist MR. C T FARADS:

Main site Radiation Character Timing Frequency Associated factors Relieving factors

Aggravating factors Duration Severity

Abdomen assessment To assess abdomen, palpate all 4 quadrants for DR. GERM:

Distension: liver problems, bowel obstruction Rigidity (board like): bleeding Guarding: muscular tension when touched Eviseration/ Ecchymosis Rebound tenderness: infection

Masses

Pain history checklist CLITORIS:

Character Location Intensity Timing Onset Radiating Irritating and relieving factors

Symptoms associated

Past medical history (PMH)

VAMP THIS:

Vices (tobacco, alcohol, other drugs, sexual risks) Allergies Medications Preexisting medical conditions Trauma Hospitalizations Immunizations Surgeries

Patient profile (PP)

LADDERS:

Living situation/ Lifestyle Anxiety Depression Daily activities (describe a typical day)

Environmental risks/ Exposure Relationships Support system/ Stress

Family history (FH)

BALD CHASM:

Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart disease Alcoholism

Stroke Mental health disorders (depression, etc.)

Differential diagnosis checklist

DIRECTION:

Drugs Infection Rheumatologic Endocrine Cardiovascular Trauma Inflammatory Other

Neoplasm

Pathologic classification

NIT DIT FIT:

Neoplastic Infectious Traumatic Degenerative/ Drugs Immune Toxic Vascular

Inflammatory Totally obscure

Pyrexia of Unknown Origin: history taking

SIT ON FRAD:

Sexual history Immunisation status Travel history Occupational history Nutrition

(consumption of dairy products, etc.) Family history Recreational habits Animal contacts

(including ticks and other vectors) Drug history

ANATOMY

Health related behavior (HRB) topics: history taking

"Healthy SEEDS":

Substances (alcohol, tobacco, IV drugs?) Environment (hazards at home or work? feel safe?) Exercise (what do you do? how often do you do it?) Diet (any special diet?) Sex

(active with m/f/both? >1 partner? safe sex? STD history? difficulty with arousal or orgasm? history of abuse?)

· I find this order works well: patients most expect to be asked about alcohol and they least want to talk about their STD history, but taking a solid HRB history first reassures them that it's all part of good medical care.

Breast history checklist

LMNOP:

Lump Mammary changes Nipple changes Other symptoms Patient risk factors

Pain history checklist

COLDER BARS:

Character Onset Location Duration Exacerbating factors Radiation Before (ever happened before) Associated symptoms Relieving factors Severity


SO CRAP:

Site Onset Character Radiates to Associated symptoms/ Alleviating and exacerbating factors Periodicity

History, HCFA components for E+M coding

Q LSD MCAT:

Quality Location Severity Duration Modifying factors Context Associated signs and symptoms Timing

Surgical sieve for diagnostic categories

INVESTIGATIONS:

Iatrogenic Neoplastic Vascular Endocrine Structural/ Mechanical Traumatic

Inflammatory Genetic/ Congenital Autoimmune Toxic Infective Old age/ Degenerative

Nutritional Spontaneous/ Idiopathic

Mental state examination: stages in order

"Assessed Mental State To Be Positively Clinically Unremarkable":

Appearance and behaviour [observe state, clothing...]

Mood [recent spirit]

Speech [rate, form, content]

Thinking [thoughts, perceptions]

Behavioural abnormalities

ANATOMY

Perception abnormalities

Cognition [time, place, age...]

Understanding of condition [ideas, expectations, concerns]

Branham sign: definition

BRAnham sign:

BRAdycardia after compression or excision of a large AV fistula.

Glasgow coma scale: components and numbers

· Scale types is 3 V's: Visual response Verbal response Vibratory (motor) response

· Scale scores are 4,5,6:

Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawl)

Meckel’s diverticulum- rule of 2’s

2 inches long,

2 feet from the ileocecal valve,

2% of the population commonlly presents in the first 2 years of life may contain 2 types of epithelial tissue

Pheochromocytoma-rule of 10s:

10% malignant

10% Bilateral

10% extraadrenal

10% calcified

10% children

10% familial

* discussed 10 times more often than actually seen

Aphasia

"BROKen aphasia" (Broca’s aphasia-broken speech)

"Wordys aphasia" (Wernicke’s aphasia- wordy, but making no sense)

GET SMASH'D--Causes of Acute pancreatitis

Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites,

Hyperlipidemia, Drugs(azathioprine, diuretics)

(Multiple endocrine neoplasia) Each of the MENs is a disease of three or two letters plus a feature.

ANATOMY

"MEN I" is a disease of the 3 Ps (pituitary, parathyroid and pancreas) plus adrenal cortex.

"MEN II " is a disease of the two Cs (carcinoma of the thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIb (aka MEN III).

Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate

Acute pneumonia caused by Miscellaneous microbes --Mononuclear infiltrate

Takayasu's diz = pulseless diz, therefore when you have

Takayasu's, I can't Tak'a yu pulse.

Argyll-Robertson Pupil--syphilitic pupil (AKA "Prostitute's pupil" - Accommodates, but doesn't react )

Accommodation reflex present, Pupillary reflex absent

CAGE--alcohol use screening

1. Have you ever felt it necessary to CUT DOWN on your drinking?

2. Has anyone ever told you they were ANNOYED by your drinking?

3. Have you ever felt GUILTY about your drinking?

4. Have you ever felt the need to have a drink in the morning for an EYE OPENER?

P-Q-R-S-T--eliciting and HPI and exploring symptoms

P--palliative or provocative factors for the pain

Q--quality of pain(burning, stabbing, aching, etc.)

R--region of body affected

S--severity of pain(usually 1-10 scale)

T--timing of pain(eg.-after meals, in the morning, etc.)

The five W's--post-operative fever

Wind--pneumonia, atelectasis

Water--urinary tract infection

Wound--wound infections

Wonderdrugs--especially anesthesia

Walking--walking can help reduce deep vein thromboses and pulmonary embolus

ACID or "Anna Cycled Immediately Downhill" classification of hypersensitivity reactions

Type I - Anaphylaxis

ANATOMY

Type II - Cytotoxic-mediated

Type III - Immune-complex

Type IV - Delayed hypersensitivity

WBC Count:

"Never Let Momma Eat Beans(60, 30, 6, 3, 1)

Neutrophils 60%

Lymphocytes 30%

Monocytes 6%

Eosinophils 3%

Basophils 1%

A-P-G-A-R:

A - appearance (color)

P - pulse (heart rate)

G - grimmace (reflex, irritability)

A - activity (muscle tone)

R - respiratory effort

Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER

T--trauma

O--obesity

M--malignancy

S--surgery

C--cardiac disease

H--hospitalization

R--rest (bed-bound)

E--estrogen, pregnancy, post-partum

P--past hx

F--fracture

E--elderly

R--road trip

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

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

Lymphoma

ANATOMY

EMBRYOLOGY

MNEMONICS

Vitelline duct: closure time

VItelline duct normally closes around week VI of intrauterine life.

Potter syndrome: features POTTER:

Pulmonary hypoplasia

Oligohydrominios

Twisted skin (wrinkly skin)

Twisted face (Potter facies)

Extremities defects

Renal agenesis (bilateral)

Placenta-crossing substances "WANT My Hot Dog": Wastes

Antibodies

Nutrients

Teratogens

Microorganisms

Hormones/ HIV

Drugs

Cranial and spinal neural crest: major derivatives GAMES:

Glial cells (of peripheral ganglia)

Arachnoid (and pia)

Melanocytes

Enteric ganglia

Schwann cells

Mesoderm components MESODERM:

Mesothelium (peritoneal, pleural, pericardial)/ Muscle (striated, smooth, cardiac)

Embryologic Spleen/ Soft tissue/ Serous linings/ Sarcoma/ Somite

Osseous tissue/ Outer layer of suprarenal gland (cortex)/ Ovaries

ANATOMY

Dura/ Ducts of genitalia

Endothelium

Renal Microglia

Mesenchyme/ Male gonad

Vasculogenesis vs. angiogenesis

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

Weeks 2, 3, 4 of development: an event for each

Week Two: Bilaminar germ disc.

Week Three: Trilaminar germ disc.

Week Four: Four limbs appear.

Teratogenesis: when it occurs

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

Tetrology of Fallot "Don't DROP the baby":

Defect (VSD)

Right ventricular hypertrophy

Overriding aorta

Pulmonary stenosis

Lung development phases "Every Premature Child Takes Air":

Embryonic period

Pseudoglandular period

Canalicular peroid

Terminal sac period

Alveolar period

Branchial arch giving rise to aorta

ANATOMY

"Aor- from Four": Aorta is from fourth arch.

Neuroectoderm derivatives

Neuroectoderm gives rise to:

Neurons

Neuroglia

Neurohypophysis piNeurol (pineal) gland

Tetrology of Fallot

"IHOP-International House of Pancakes":

Interventricular septal defect

Hypotrophy of right ventricle

Overriding aorta

Pulmonary stenosis

Woffian duct (mesonephric duct) derivatives.

Gardener's SEED:

· Female: Gartner's duct, cyst

· Male:

Seminal vesicles

Epididymis

Ejaculatory duct

Ductus deferens

Foregut derivatives

"Little Embryo People Do Like Swallowing, Producing Gas": Lungs Esophagus Pancreas

Duodenum (proximal) Liver Stomach Pancreas Gall bladder

EMERGENCY

MEDICINE

MNEMONICS

Emergency Medicine

ANATOMY

Coma: conditions to exclude as cause MIDAS:

Meningitis

Intoxication

Diabetes

Air (respiratory failure)

Subdural/ Subarachnoid hemorrhage

Resuscitation: basic steps ABCDE:

Airway

Breathing

Circulation

Drugs

Environment

Malignant hyperthermia treatment

"Some Hot Dude Better Give Iced Fluids Fast!"

(Hot dude = hypothermia):

Stop triggering agents

Hyperventilate/ Hundred percent oxygen

Dantrolene (2.5mg/kg)

Bicarbonate

Glucose and insulin

IV Fluids and cooling blanket

Fluid output monitoring/ Furosemide/ Fast heart [tachycardia]

Vfib/Vtach drugs used according to ACLS "Every Little Boy Must Pray":

Epinephrine

Lidocaine

Bretylium

Magsulfate

Procainamide

Coma causes checklist AEIOU TIPS:

Acidosis/ Alcohol

Epilepsy

Infection

Overdosed

Uremia

Trauma to head

Insulin: too little or or too much

ANATOMY

Pyschosis episode

Stroke occurred

Shock: types RN CHAMPS:

Respiratory

Neurogenic

Cardiogenic

Hemorrhagic

Anaphylactic

Metabolic

Psychogenic

Septic

· Alternatively: "MR. C.H. SNAP", or "NH CRAMPS".

Shock: signs and symptoms TV SPARC CUBE:

Thirst

Vomiting

Sweating

Pulse weak

Anxious

Respirations shallow/rapid

Cool

Cyanotic

Unconscious

BP low

Eyes blank

Fall: potential causes CLADE SPADE:

Cardiovascular/ Cerebrovascular

Locomotor (skeletal, muscular, neurological)

Ageing (increased body sway, decreased reaction time)

Drugs (esp. antihypertensives, antipsychotics)

Environmental

Sensory deficits (eg. visual problems)

Psychological/ Psychiatric (depression)

Acute illness

Dementia

Epilepsy

ANATOMY

Diabetic ketoacidosis management F*¢KING:

Fluids (crytalloids)

Urea (check it)

Creatinine (check it)/ Catheterize

K+ (potassium)

Insulin (5u/hour. Note: sliding scale no longer recommended in the UK)

Nasogastic tube (if patient comatose)

Glucose (once serum levels drop to 12)

Asthma: management of acute severe "O S#!T":

Oxygen (high dose: >60%)

Salbutamol (5mg via oxygen-driven nebuliser)

Hydrocortisone (or prednisolone)

Ipratropium bromide (if life threatening)

Theophylline (or preferably aminophylline-if life threatening)

V-fib/pulseless v-tach (new ACLS as of 2001)

"EVAL My Pumper":

Epinephrine Vasopressin Amiodarone (class IIb--better for heart failure) Lidocaine

(indeterminate - better for young, healthy or persistent) MgSO4 (IIb for hypomagnesemic state or torsades) Procainamide (IIb for intermittent/recurrent VF/VT)

Trauma: motor vehicle accident considerations

I AM SCARED:

Impact (head-on, rear-end, t-bone, rollover, rotational etc.) Auto vs. pedestrian, bike, motorcycle (start @ speed >10mph) Medical history (cardiac, coagulolation, liver, immuno, obese, prego) Speed (>50 mph?) Compartment intrusion (>12 inches?) Age (<5 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

Boyle's law: volume of gas is inversely proportionate to its pressure. · Therefore,

BOYLE:

Breathe (as you ascend) Or Your Lung Explodes · Breathe as you ascend after scuba diving, since the pressure decreases on surfacing, so the gas volume in lungs increases.


OLDER SAAB:

ANATOMY

Onset Location Description (what does it feel like) Exacerbating factors Radiation

Severity Associated symptoms Alleviating factors Before (ever experience this before)

Asystole: treatment

"Have some asystole "TEA":

Transcutaneous pacing Epi Atropine

Endotrachial tube deliverable drugs

O NAVEL:

Oxygen Naloxone Atropine Ventolin (albuterol) Epinephrine Lidocaine · If you can't get

IV access established, and have necessity to administer resuscitative meds, remember you have the airway and can give the above drugs. · Drug delivery is enhanced if diluted with

10cc NS and rapid introduced for aeresolization. · Alternatively, bare bone version is

ALE, as above.

RLQ pain: differential

APPENDICITIS:

Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/ Endometriosis Neoplasia

Diverticulitis Intussusception Crohns Disease/ Cyst (ovarian) IBD Torsion (ovary)

Irritable Bowel Syndrome Stones

Subarachnoid hemorrhage (SAH) causes

BATS:

Berry aneurysm Arteriovenous malformation/ Adult polycystic kidney disease Trauma

(eg being struck with baseball bat) Stroke

Syncope causes, by system

HEAD HEART VESSELS:

· CNS causes include HEAD:

Hypoxia/ Hypoglycemia Epilepsy Anxiety Dysfunctional brain stem (basivertebral TIA)

· Cardiac causes are HEART: Heart attack Embolism (PE) Aortic obstruction (IHSS, AS or myxoma) Rhythm disturbance, ventricular Tachycardia

· Vascular causes are VESSELS: Vasovagal Ectopic (reminds one of hypovolemia)

Situational Subclavian steal ENT (glossopharyngeal neuralgia) Low systemic vascular resistance (Addison's, diabetic vascular neuropathy) Sensitive carotid sinus

ANATOMY

Coma and signicantly reduced conscious state causes:

Causes COMA:

CO2 and CO excess Overdose: TCAs, Benzos, EtOH, insulin, paracetamol, etc.

Metabolic: BSL, Na+, K+, Mg2+, urea, ammonia, etc. Apoplexy: stroke, SAH, extradural, subdural, Ca, meningitis, encephalitis, cerebral abscess, etc.

GASTROINTESTINAL

MNEMONICS

Bowel Segments

"Dow Jones Industrial Averages Closing Stock Report" is a good one, even though it misses the Cecum...

Dow

Jones

Industrial

Averages

Closing

Stock

Report

Duodenum

Jejunum

Ileum

Appendix

Colon

Sigmoid

Rectum

Liver Lobes

The four lobes of the liver: caudate, quadrate, left and right, bring to mind the newspaper headline of the wheelchair bound fellow who left a party right after his ugly girlfriend departed:

"QUAD LEFT RIGHT after COW-DATE"

Pertoneum Facts

The idea is to relate key letters of related parts...

stOMach and OMentum (which lays over the stomach)

The bacterium e. coLI is found in the Large Intestine

The OMentum covers the stOMach

The Lesser OMentum holds the Liver and stOMach

The Mesentery holds the sMall intestine

The mesoCOLON attaches the large intestine (COLON) to the posterior abdominal wall.

The periTONEa, which prevents the intestines from kinking,

TONES the GI tract.

Sphincters of the Ailmentary Canal

APE OIL initials the five of them...

ANATOMY

I

O

L

A

P

E

Anal

Pyloric

(Lower) Esophageal

Oddi

Ileocecum iLeocecum

Stomach Parts

"The CAR is FUN 'til the BODY PILES" relates the four parts of the stomach: Cardiac, Fundus, Body, Pylorus. The pylorus is where the food piles waiting for the sphincter to open.

Ulcerative colitis: definition of a severe attack A STATE:

Anemia less than 10g/dl

Stool frequency greater than 6 stools/day with blood

Temperature greater than 37.5

Albumin less than 30g/L

Tachycardia greater than 90bpm

ESR greater than 30mm/hr

Vomiting: extra GI differential VOMITING:

Vestibular disturbance/ Vagal (reflex pain)

Opiates

Migrane/ Metabolic (DKA, gastroparesis, hypercalcemia)

Infections

Toxicity (cytotoxic, digitalis toxicity)

Increased ICP, Ingested alcohol

Neurogenic, psychogenic

Gestation

Pancreatitis (acute): causes GET SMASHED:

Gallstones

Ethanol

Trauma

Steroids

Mumps

Autoimmune (PAN)

Scorpion stings

Hyperlipidemia/ Hypercalcemia

ERCP

Drugs (including azathioprine and diuretics)

· Note: 'Get Smashed' is slang in some countries for drinking, and ethanol is an important pancreatitis cause.

ANATOMY

IBD: surgery indications "I CHOP":

Infection

Carcinoma

Haemorrhage

Obstruction

Perforation

· "Chop" convenient since surgery chops them open.

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) cause is DNA mismatch repair

DNA mismatch causes a bubble in the strand where the two nucleotides don't match.

This looks like the ensuing polyps that arise in the colon.

IBD: extraintestinal manifestations A PIE SAC:

Aphthous ulcers

Pyoderma gangrenosum

Iritis

Erythema nodosum

Sclerosing cholangitis

Arthritis

Clubbing of fingertips

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

With diarrhea both the pH and food go down.

H. Pylori treatment regimen (rough guidelines) "Please Make Tummy Better":

Proton pump inhibitor

Metronidazole

Tetracycline

Bismuth

· Alternatively: TOMB:

Tetracycline

Omeprazole

Metronidazole

Bismuth

Bilirubin: common causes for increased levels "HOT Liver":

Hemolysis

Obstruction

Tumor

Liver disease

Ulcerative colitis: complications "PAST Colitis":

ANATOMY

Pyoderma gangrenosum

Ankylosing spondylitis

Sclerosing pericholangitis

Toxic megacolon

Colon carcinoma

Cholangitis features CHOLANGITITS:

Charcot's triad/ Conjugated bilirubin increase

Hepatic abscesses/ Hepatic (intra/extra) bile ducts/ HLA B8, DR3

Obstruction

Leukocytosis

Alkaline phosphatase increase

Neoplasms

Gallstones

Inflammatory bowel disease (ulcerative colitis)

Transaminase increase

Infection

Sclerosing

Charcot's triad (gallstones) "Charge a FEE":

Charcot's triad is:

Fever

Epigastric & RUQ pain

Emesis & nausea

Haemachromatosis complications "HaemoChromatosis Can Cause Deposits Anywhere":

Hypogonadism

Cancer (hepatocellular)

Cirrhosis

Cardiomyopathy

Diabetes mellitus

Arthropathy

Pancreatitis: criteria PANCREAS:

PaO2 below 8

Age >55

Neutrophils: WCC >15

Calcium below 2

Renal: Urea >16

Enzymes: LDH >600; AST >200

Albumin below 32

Sugar: Glucose >10 (unless diabetic patient)

ANATOMY

Pancreatitis: Ranson criteria for pancreatitis: at admission "GA LAW" (GA is abbreviation for the U.S. state of Georgia):

Glucose >200

AST >250

LDH >350

Age >55 y.o.

WBC >16000

Pancreatitis: Ranson criteria for pancreatitis: initial 48 hours "C & HOBBS" (Calvin and

Hobbes):

Calcium < 8

Hct drop > 10%

Oxygen < 60 mm

BUN > 5

Base deficit > 4

Sequestration of fluid > 6L

Pancreatitis: Ranson criteria for pancreatitis at admission LEGAL:

Leukocytes > 16.000

Enzyme AST > 250

Glucose > 200

Age > 55

LDH > 350

GIT symptoms BAD ANAL S#!T:

Bleeding

Abdominal pain

Dysphagia

Abdominal bloating

Nausea & vomiting

Anorexia/ Appetite changes

Lethargy

S#!ts (diarrhea)

Heartburn

Increased bilirubin (jaundice)

Temperature (fever)

Crohn's disease: morphology, symptoms CHRISTMAS:

Cobblestones

High temperature

Reduced lumen

Intestinal fistulae

ANATOMY

Skip lesions

Transmural (all layers, may ulcerate)

Malabsorption

Abdominal pain

Submucosal fibrosis

Dysphagia: differential DISPHAGIA:

Disease of mouth and tonsils/ Diffuse oesophageal spasm/ Diabetes mellitus

Intrinsic lesion

Scleroderma

Pharyngeal disorders/ Palsy-bulbar-MND

Achalasia

Heart: eft atrium enlargement

Goitre/ myesthenia Gravis/ mediastinal Glands

Infections

American trypanosomiasis (chagas disease)

21

Dry mouth: differential "DRI":

· 2 of each:

Drugs/ Dehydration

Renal failure/ Radiotherapy

Immunological (Sjogren's)/ Intense emotions

Liver failure: decompensating chronic liver failure differential HEPATICUS:

Haemorrhage

Electrolyte disturbance

Protein load/ Paracetamol

Alcohol binge

Trauma

Infection

Constipation

Uraemia

Sedatives/ Shunt/ Surgery

Cirrhosis: causes of hepatic cirrhosis HEPATIC:

Hemochromatosis (primary)

Enzyme deficiency (alpha-1-anti-trypsin)

Post hepatic (infection + drug induced)

Alcoholic

Tyrosinosis

Indian childhood (galactosemia)

Cardiac/ Cholestatic (biliary)/ Cancer/ Copper (Wilson's)

ANATOMY

Hepatic encephalopathy: precipitating factors HEPATICS:

Hemorrhage in GIT/ Hyperkalemia

Excess protein in diet

Paracentesis

Acidosis/ Anemia

Trauma

Infection

Colon surgery

Sedatives

Diabetic ketoacidosis: precipitating factors · 5 I's:

Infection

Ischaemia (cardiac, mesenteric)

Infarction

Ignorance (poor control)

Intoxication (alcohol)

Whipple's disease: clinical manifestations SHELDA:

Serositis

Hyperpigmentation of skin

Eating less (weight loss)

Lymphadenopathy

Diarrhea

Arthritis

Celiac sprue gluten sensitive enteropathy: gluten-containing grains BROW:

Barley

Rye

Oats

Wheat

· Flattened intestinal villi of celiac sprue are smooth, like an eyebrow.

Liver failure (chronic): signs found on the arms CLAPS:

Clubbing

Leukonychia

Asterixis

Palmar erythema

Scratch marks

Splenomegaly: causes CHIMP:

Cysts

Haematological ( eg CML, myelofibrosis)

Infective (eg viral (IM), bacterial)

ANATOMY

Metabolic/ Misc (eg amyloid, Gauchers)

Portal hypertension

GENETICS

MNEMONICS

DNA: Z vs. B form: which is inactive

ZZZZ is sleeping (inactive). B form is therefore active DNA.

Nucleotides: purines vs. pyrimidines

Guardian Angels are Pure, with two Wings: G and A are Purines, with two Rings.

Nucleotides: purines

AGUA PURa: Adenine and GUAnine are PURines.

· Agua pura is spanish for pure water.

Hurler Syndrome features HURLER'S:

Hepatospenomegaly

Ugly facies

Recessive (AR inheritance)

L-iduronidase deficiency (alpha)

Eyes clouded

Retarded Short/

Stubby fingers

Nucleotides: which are purines

Pure Silver:

· Chemical formula of Pure silver is Ag. Therefore, Purines are Adenine and Guanine.

Down syndrome features: complete

My CHILD HAS PROBLEM!:

Congenital heart disease/ Cataracts

Hypotonia / Hypothyroidism

Incure 5th finger/ Increased gap between 1st and 2nd toe

Leukemia risk x2/ Lung problem

Duodenal atresia / Delayed development

Hirshsprung's disease / Hearing loss

Alzheimer's disease / Alantoaxial instability

Squint/ Short neck

Protruding tongue/ Palm crease

ANATOMY

Round face/ Rolling eye (nystagmus)

Occiput flat/ Oblique eye fissure

Brushfield spot/ Brachycephaly

Low nasal bridge/ Language problem

Epicanthic fold/ Ear folded

Mental retardation/ Myoclonus

Blots: function of Southern vs. Northern vs. Western

SN0W DR0P:

· Match up the 1st word letter with 2nd word letter:

Southern=DNA

Northern=RNA

Western=Protein

· The 0's in snow drop are zeros, since there is no Eastern blot.

Down syndrome pathology DOWN:

Decreased alpha-fetoprotein and unconjugated estriol (maternal)

One extra chromosome twenty-one

Women of advanced age

Nondisjunction during maternal meiosis

Pyrimidines nucleotides

CUT the PY (cut the pie):

Cytosine Uracil Thiamine are the PYrimidines

DiGeorge/ Velocardiofacial syndrome: features CATCH 22: Cardiac abnormalities

Abnormal facies

Thymic aplasia

Cleft palate

Hypocalcemia

22q11 deletion

Marfan syndrome features MARFAN:

Mitral valve prolapse

Aortic Aneurysm

Retinal detachment

Fibrillin

Arachnodactyly

Negative Nitroprusside test (differentiates from homocystinuria)

Cell cycle stages

ANATOMY

Go Sally Go! Make Children!:

G1 phase (Growth phase 1)

S phase (DNA Synthesis)

G2 phase (Growth phase 2)

M phase (Mitosis)

C phase (Cytokinesis)

Cri-du-chat syndrome: chromosomal deletion causing it is 5p(-)

What's another name for a cat that's five letters long and starts with a P? (Answer: kitty).

Why is the cat crying? Missing its P.

APKD: genetics

ADult Polycystic Kidney Disease is Autosomal Dominant

· Also, Polycystic kidney has 16 letters and is due to a defect on chromosome 16.

Hardy-Weinberg equilibrium: causes for deviations from it

Maggie May Does Not Smoke:

Mutations Migration Drift Non-random mating Selection

Achrondroplasia dwarfism: inheritance pattern

Achondroplasia Dwarfism is Autosomal Dominant.

Exon vs. intron function

Exons Expressed. InTrons In Trash.

Nucleotides: class having the single ring ·

Pyrimadines are CUT from purines

· Pyrimidines are: Cytosine Uracil Thiamine They are cut from purines so the pyrimadines must be smaller (one ring).

Codons: nonsense mutation

Stop talking nonsense!:

Nonsense mutation causes premature stop.

Tumor suppressor vs. proto-onogene mutations: recessive vs. dominant

Recess Suppress:

Tumor suppressor mutations are recessive. Proto-oncogenes are opposite (dominant).

ANATOMY

Pedigree symbols: gender and affected

Gender: The cIRcle is a gIRl [so boys are squares].

Affected: Black plague was a disease, so black-filled symbol means an affected/diseased person [so non-filled-in is unaffected].

Tay Sach's features SACHS:

Spot in macula

Ashkenazic Jews

CNS degeneration

Hex A deficiency

Storage disease

· Extra details with TAY:

Testing recommended

Autosomal recessive/ Amaurosis

Young death (<4 yrs)

Chromosome 15 diseases

Chromosome 15 has its own MAP:

Marfan syndrome

Angelman syndrome

Prader-Willi syndrome

Bartter syndrome: inheritance

BARtter syndrome is autosomal recessive (AR).

Nucleotides: double vs. triple bonded basepairs

TU bonds (two bonds):

T-A and U-A have Two bonds. G-C therefore has the three bonds.

Imprinting diseases: Prader-Willi and Angelman

Pray to an Angel:

Prader-Willi and Angelman are the 2 classic imprinting diseases. · Which disease results, depends on whether 15q deletion is maternal or paternal. Keep them straight by: Paternal is Prader-Willi.

NEUROLOGY

MNEMONICS

Dementia: some common causes

DEMENTIA:

ANATOMY

Diabetes Ethanol Medication Environmental (eg CO poisoning) Nutritional Trauma

Infection Alzheimer's

Whipple's disease: features [for neurologists]

A WHIPPLES DOOM

Arthralgias Whipplei (organism) Hypothalamic involvement Intestinal involvement/

Intestinal biopsy required PAS positive macrophages PCR positivity Lymphadenopathy

Extrapyramidal involvement Septran treat with Dementia Ocular abnormalities (vertical gaze palsy) Oculomasticatory myorhythmia Myoclonus

Neurofibromatosis: diagnostic criteria

ROLANDO:

Relative (1st degree) Osseous fibromas Lisch nodules in eyes Axillary freckling

Neurofibromas Dime size cafe au lait spots Optic gliomas

Visual loss: persistent bilateral sudden onset visual loss differential

FLOP:

Functional Leber's hereditary neuropathy Occipital infarctions Pituitary apoplexy

Neurofibromatosis: diagnositic criteria (type-1)

CAFE SPOT:

Cafe-au-lait spots Axillary, inguinal freckling Fibroma Eye: lisch nodules Skeletal

(bowing leg, etc) Pedigree/ Positive family history Optic Tumor (glioma)

Babinski and LMN signs: conditions exhibiting them

"D MASTS":

Diabetes Motor neuron disease Ataxia (friedrichs) Subacute combined degeneration of cord Tabo paresis Syringobulbia

Ramsay-Hunt syndrome: cause and common feature

"Ramsay Hunt":

· Etiology: Reactivated Herpes zoster

· Complication: Reduced Hearing

Stroke risk factors

HEADS: Hypertension/ Hyperlipidemia Elderly Atrial fib Diabetes mellitus/ Drugs

(cocaine) Smoking/ Sex (male)

Vertigo: differential

VOMITS:

Vestibulitis Ototoxic drugs Meniere's disease Injury Tumor Spin (benign positional vertigo)

ANATOMY

Encephalitis: differential

HE'S LATIN AMERICAN:

Herpesviridae

Enteroviridae (esp. Polio)

Slow viruses (esp. JC, prions) Syphilis

Legionella/ Lyme disease/ Lymphocytic meningoencephalitis

Aspergillus

Toxoplasmosis

Intracranial pressure

Neisseria meningitidis

Arboviridae

Measles/ Mumps/ Mycobacterium tuberculosis/ Mucor

E. coli

Rabies/ Rubella

Idiopathic

Cryptococcus/ Candida

Abscess

Neoplasm/ Neurocysticercosis · Neurocysticercosis should be assumed with recent Latin

American immigrant patient unless proven otherwise.

PEDIATRICS

MNEMONICS

Measles: complications "MEASLES COMP" (complications):

Myocarditis

Encephalitis

Appendicitis

Subacute sclerosing panencephalitis

Laryngitis

Early death

Sh!ts (diarrhoea)

Corneal ulcer

Otis media

Mesenteric lymphadenitis

Pneumonia and related (bronchiolitis-bronchitis-croup)

Sturge-Weber syndrome: hallmark features Sturge-Weber:

1. Seizures

2. PortWine stain

Guthrie card: diseases identified with it "Guthrie Cards Can Help Predict Bad

Metabolism":

Galactosaemia

ANATOMY

Cystic fibrosis

Congenital adrenal hyperplasia

Hypothyroidism

Phenylketonuria

Biotidinase deficiency

Maple syrup urine disease

Croup: symptoms 3 S's:

Stridor

Subglottic swelling

Seal-bark cough

Ataxia-Telangiectasia (AT): common sign AT:

Absent

Thymus

Cerebral palsy (CP): most likely cause CP: Cerebral Palsy

Child Premature

· The premature brain is more prone to all the possible insults.

Vacterl syndrome: components VACTERL:

Vertebral anomalies

Anorectal malformation

Cardiac anomaly

Tracheo-esophageal fistula

Exomphalos (aka omphalocele)

Renal anomalies

Limb anomalies

Guthrie card: diseases identified with it GUTHRIE:

Galactosaemia

Urine [maple syrup urine disease]

THyRoid [hypothyroidism]

Inborn Errors of metabolism [eg: PKU]

Duodenal atresia vs. Pyloric stenosis: site of obstruction Duodenal Atresia: Distal to

Ampulla of vater.

Pyloric stenosis: Proximal to it.

Bilirubin: phototherapy BiLirUbin absorbs light maximally in the

BLUe range.

11

ANATOMY

Williams syndrome: features WILLIAMS:

Weight (low at birth, slow to gain)

Iris (stellate iris)

Long philtrum

Large mouth

Increased Ca++

Aortic stenosis (and other stenoses)

Mental retardation

Swelling around eyes (periorbital puffiness)

Russell Silver syndrome: features ABCDEF:

Asymmetric limb (hemihypertrophy)

Bossing (frontal)

Clinodactyly/ Cafe au lait spots

Dwarf (short stature)

Excretion (GU malformation)

Face (triangular face, micrognathia)

Dentition: eruption times of permanent dentition "Mama Is In Pain, Papa Can Make

Medicine":

1st Molar: 6 years

1st Incisor: 7 years

2nd Incisor: 8 years

1st Premolar: 9 years

2nd Premolar: 10 years

Canine: 11 years

2nd Molar: 12 years

3rd Molar: 18-25 years

Cyanotic heart diseases: 5 types · Use your five fingers:

1 finger up: Truncus Arteriosus (1 vessel)

2 fingers up: Dextroposition of the Great Arteries (2 vessels transposed)

3 fingers up: Tricuspid Atresia (3=Tri)

4 fingers up: Tetralogy of Fallot (4=Tetra)

5 fingers up: Total Anomalous Pulmonary Venous Return (5=5 words)

Cyanotic congenital heart diseases 5 T's:

Truncus arteriosus

Transposition of the great arteries

Tricuspid atresia

Tetrology of Fallot

Total anomalous pulmonary venous return

ANATOMY

Head circumference with age · Remember 3, 9, and multiples of 5:

Newborn 35 cm

3 mos 40 cm

9 mos 45 cm

3 yrs 50 cm

9 yrs 55 cm

Weights of children with age Newborn 3 kg

6 mos 6 kg (2x birth wt at 6 mos)

1 yr 10 kg (3x birth wt at 1 yr)

3 yrs 15 kg (odd yrs, add 5 kg until 11 yrs)

5 yrs 20 kg

7 yrs 25 kg

9 yrs 30 kg

11 yrs 35 kg (add 10 kg thereafter)

13 yrs 45 kg

15 yrs 55 kg

17 yrs 65 kg

Hemolytic-Uremic Syndrome (HUS): components

"Remember to decrease the RATE of IV fluids in these patients":

Renal failure

Anemia (microangiopathic, hemolytic)

Thrombocytopenia

Encephalopathy (TTP)

Cough (chronic): differential When cough in nursery, rock the "CRADLE":

Cystic fibrosis

Rings, slings, and airway things (tracheal rings)/ Respiratory infections

Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux)

Dyskinetic cilia

Lung, airway, and vascular malformations (tracheomalacia, vocal cord dysfunction)

Edema (heart failure)

Cystic fibrosis: presenting signs CF PANCREAS:

Chronic cough and wheezing

Failure to thrive

Pancreatic insufficiency (symptoms of malabsorption like steatorrhea)

Alkalosis and hypotonic dehydration

Neonatal intestinal obstruction (meconium ileus)/ Nasal polyps

Clubbing of fingers/ Chest radiograph with characteristic changes

Rectal prolapse

Electrolyte elevation in sweat, salty skin

ANATOMY

Absence or congenital atresia of vas deferens

Sputum with Staph or Pseudomonas (mucoid)

21

Cystic fibrosis: exacerbation of pulmonary infection CF PANCREAS:

Cough (increase in intensity and frequent spells)

Fever (usually low grade, unless severe bronchopneumonia is present)

Pulmonary function deterioration

Appetite decrease

Nutrition, weight loss

CBC (leukocytosis with left shift)

Radiograph (increase overaeration, peribronchial thickening, mucus plugging)

Exam (rales or wheezing in previously clear areas, tachypnea, retractions)

Activity (decreased, impaired exercise intolerance, increased absenteeism)

Sputum (becomes darker, thicker, and more abundant, forming plugs)

Pyloric stenosis (congential): presentation Pyloric stenosis is 3 P's:

Palpable mass

Paristalsis visible

Projectile vomiting (2-4 weeks after birth)

Cyanotic heart diseases: 5 types · 5 T's:

Tetralogy of Fallot

Transposition of the great arteries

Truncus arteriosus

Tricuspid atresia, pulmonary aTresia

Total anomalous pulmonary venous drainage

Breast feeding: benefits ABCDEFGH:

· Infant:

Allergic condition reduced

Best food for infant

Close relationship with mother

Development of IQ, jaws, mouth

· Mother:

Econmical

Fitness: quick return to pre-pregnancy body shape

Guards against cancer: breast, ovary, uterus

Hemorrhage (postpartum) reduced

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

WAGR syndrome: components WAGR:

ANATOMY

Wilm's tumor

Aniridia

Gential abnormalities

Mental retardation

Haematuria: differential in children ABCDEFGHIJK:

Anatomy (cysts, etc)

Bladder (cystitis)

Cancer (Wilm's tumour)

Drug related (cyclophosphamide)

Exercise induced

Factitious (Munchausen by proxy)

Glomerulonephritis

Haematology (bleeding disorder, sickle cell)

Infection (UTI)

In Jury (trauma)

Kidney stones (hypercalciuria)

Vitamin toxicities: neonatal Excess vitamin A: Anomalies (teratogenic)

Excess vitamin E: Enterocolitis (necrotizing enterocolitis)

Excess vitamin K: Kernicterus (hemolysis)

Rubella: congenital signs "Rubber Ducky, I'm so blue!" (like the "Rubber Ducky" song):

Rubber: Rubella

Ducky: Patent Ductus Arteriosus, VSD and pulmonary artery stenosis.

I'm: Eyes (cataracts, retinopathy, micropthalmia, glaucoma).

Blue: "Blueberry Muffin" rash (extramedullary hematopoesis in skin +purpura)

· Also, deafness, growth retardation, and some more.

Pediatric milestones in development 1 year:

-single words

2 years:

-2 word sentences

-understands 2 step commands

3 years:

-3 word combos

-repeats 3 digits

-rides tricycle

4 years:

-draws square

-counts 4 objects

31

ANATOMY

Gastroschisis: usual location GasTRoscHIsis usually occurs on the

RIGHT side of the umbilicus.

(Unscramble the letters).

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

Cow: Casein (mostly)

Short stature: differential ABCDEFG:

Alone (neglected infant)

Bone dysplasias (rickets, scoliosis, mucopolysaccharidoses)

Chromosomal (Turner's, Down's)

Delayed growth

Endocrine (low growth hormone, Cushing's, hypothyroid)

Familial

GI malabsorption (celiac, Crohn's)

PHYSIOLOGY

MNEMONICS

ANATOMY

Organs

Better than Murder …

While working to uncover a hidden acrostic in the list of bodily organ systems, I strung out the first letters of the 10 and immediately picked out MURDER, but had the letters

N, I, C, I left over and did not want to suggest MURDER NICI because NICKI is also the name of my favorite ex-girlfriend. Then, I wrote out the first three letter of each and managed to create two phrases which are easy to recall and make remembering the ten systems a cinch! Ergo:

Sir: I'm nervous about reproducing with the rest. Uri must dig into the end.

The organ system names buried within the phrases are (in order): circulatory, immune, nervous, reproduction, respiratory, urinary, muscle, digestive, integumentary, and endocrine. Easy now?

Taxonomy

Carolus Linnaeus (1707-1778) named and classified the various forms of life as a way of seeking order in diversity. He created taxonomy to do this, thus giving headaches to many generations of students. His system of kingdom (plant or animal), phylum

(backbone?), class (mammal?), order (carnivore?), family (cat, dog, ape), genus

(orangutan or human), species and variety is still used today, only slightly modified from the original. One easy sentence used is King Philip Conquers Our Fifty Grateful

States. Two others: King Phillip's Class Of Family Geniuses Specializes in Variety and

Kind Phillip's Class Orders Family-sized Gino's Special.

Finally, Z.L. offers this hockey mnemonic: Kings Play Calgary On Friday. Gretzky

Scores! Take your pick.

The 5 kingdoms (used to be only 2 or 3) are protoctista, plantae, fungi, monera, animalia. I embedded them into neurons by: Protecting Plants is Fun, Mon Ami, which sounds like a slogan for a French environmental activist group.

Kingdom, phylum

Keep Perverts Cleverly Occupied, For Gosh Sake!!

(Hallie Ray, Science Department, Rappahannock Community College Warsaw, VA)

Alimentary and Digestion

Ape Oil

The 5 sphincters found in the Alimentary Canal spell APE OIL: Anal, Pyloric, Lower

Esophageal, Oddi, and Ileocecum. Also, try An Odd Pile Lowers the Ileocecum.

Cars, Piles, and the Bay of Fundy

"The CAR is FUN `til the BODY PILES " I remember the 5 layers of the GI stomach:

Cardiac, Fundus, Body, and Pylorus. The fundus looks like the Bay of Fundy (to me, anyway), and the pylorus is where the food piles waiting for the sphincter to open.

Some are Ugly

The 4 lobes of the liver -- quadrate, left & right, caudate -- bring to mind the newspaper headline of the wheelchair-bound fellow who left a party right after his ugly girlfriend departed: QUAD LEFT RIGHT after Cow Date .

Dow Jones and the Cannibal

We are supposed to remember the lengths of the first 3 parts of the digestive system after the stomach, so I came up with the story of a cannibal who consumes a dozen people, including an ailing stock market analyst. It goes: One Ate 12, including an Ill

Dow Jones referring of course to 1, 8, 12-feet lengths for the Ileum, Duodenum,

Jejunum.

A really good device for recalling the bowels is to remember the market news: Dow

Jones Industrial Averages Closing Stock Report whose initial letters also identify the

Duodenum, Jejunum, Ileum, Appendix, Colon, Sigmoid, and Rectum. It misses the cecum but is otherwise unforgettable.

Quick Peritoneum Facts

The idea is to relate key letters of related parts. E.g., stomach and omentum (which lays over the stomach) share the letters OM.

• The bacterium E. coli is found in Everybody's Colon

•

•

The Omentum covers the stomach

The Lesser Omentum holds the Liver and stomach

•

•

•

The Mesentery holds the small intestine

The mesoCOLON attaches the large intestine (colon) to the posterior abdominal wall

The PERITONEUM , holds PERson's Intestines To Nearest wall.

Oh! Curling turns my Stomach Inside Out

This is what a housewife might say in reaction to her husband's sports selection, but it is a student's way of knowing the 3 layers of muscle around the stomach. The layers are: Oblique , Circular , Longitudinal from inside to outside.

PPL's Tonsils

People (PPL for short) have 3 tonsils: Pharyngeal, Palatine, and Lingual .

Digestive Juices

ANATOMY

RESPIRATORY

MNEMONICS

Airflow Passages

Airflows are prominent in Mouthy People who are Loud

Talkers.

Mouthy

People

Loud

Talkers

Mouth

Pharynx

Larynx

Trachea

Cartilages of the Larynx

There are 4 cartilages in the larynx whose initial letters are

TEAC (also the brandname of a home stereo). Associate the

TEAC sound and the vocal cords, and you get the connection.

T

E

A

C

Thyroid

Epiglottis

Arytenoid

Cricoid

The snake in Garden of Eden spoke with a lisp, saying

"Adam, thry thith apple." This refers to the fact that the

THYRoid cartilage is also called the Adam's Apple.

Lung Lobes

The segments of the (right) Middle Lobe of the lung are

Medial and Lateral [ML=ML]

Nasal Cavity

Never Call Me Needle Nose helps remember the parts of the nasal cavity: Nares (external), Conchae, Meatuses, Nares

(internal), Nasopharynx.

Respiratory Tract

It's a bit of an extended version of the Airflow Passage mnemonic above. Movie Personality Lana Turner's Pretty

Sexy Thighs Turn Retinas All Around helps you recall the order of the respiratory tract segments...

ANATOMY

Movie

Personality

Lana

Turner's

Pretty

Sexy

Thighs

Turn

Retinas

All

Around

Mouth

Pharynx

Larynx

Trachea

Primary Bronchus

Secondary Bronchus

Teritary Bronchus

Terminal Bronchiole

Respiratory Bronchiole

Alveolar Duct

Alveolar Sac

Three Tonsils

People (or PPL, for short) have three tonsils: Pharyngeal,

Palatine, and Lingual.

SURGERY

MNEMONICS

Surgery Mnemonics

The 5 W’s For Remembering Common Causes of Fever Post-Operation:

WATER, WIND, WALK, WOUND, & WEIRD DRUGS

• WATER = urinary tract infections

• WIND = atelectasis or pneumonia

• WALK = deep vein thrombosis

• WOUND = surgucal wound infection

• WEIRD DRUGS = drug induced fever

F = Foreign bodies

E = Epithelization

T = Tumors

I = infection

I = Irradiated tissue

I = IBD

D = Distal obstruction

CT scan indications in trauma setting:

Uncle Nelson ARgues ABout Kids

• Unconcious pt after head trauma

• Neck injury; to confirm vertebral fracture when Xray is equivocal

ANATOMY

• Aortic Rupture (after Xray, Before Aortogram)

• Abdominal penetrating wound; when gloved finger in ER cant say for sure if theres penetration

• Kidney injury leading to blood in urine; blunt abdominal trauma

Topic

Anatomy

Neurology

Cardiology

Fact Mnemonic

Branches of the External

Carotid Artery in order starting with the first branch

(superior thyroid artery).

See plate 29 in Netter's Atlas of

Human Anatomy.

Sally Superior Thyroid

Ann Ascending Pharyngeal

Likes Lingual

Flirting Facial

Contributed by Calvin Lee,

Surgical Resident, Case Western

Philidelphia's Posterior auricular

Reserve on 7/22/98. This is a

On Occipital

Main Maxillary good "pimp" question/fact when

Street Superficial temporal you are in the OR assisting on a thyroid or a carotid case. Know this one!

How to remember the basic framework of the Glasgow coma scale?

Eye opening: 4 eyes (glasses)

Motor: 6 cylinder engine

Verbal: Jackson 5

Gives you a total of 15. (A brick has a GCS of 3)

For Causes of A-Fib/Flutter:

Mnemonic by Chris

"Get it? ... A-fib.. occurs in the

HEART ?? Ok.. well I'm postcall..."

H= cHf, other cardiomyopathies

E= Enlargement of the atria

A= Alcohol binge drinking

R= Rheumatic heart disease

T= hyperThyroid

ANATOMY

Mnemonic for remembering antiarrhythmics

Cardiology

Class Drug Mnemonic

Class IA Procainamide

Quinidine

Professor

Quackers

Class IB Lidocaine

Phenytoin penny

Lydia's

Mexiletine Mexican

Class IC

Class II

Flecainide

Propranolol feeling proper

Class III Amiodarone amiable

Bretylium British

Class IV Verapamil virtually

Read as:

* Note: "Dissed" is used here as the slang term "dis" - from dismiss. I.e.,

ANATOMY

Cardiology

Proven MI.. should be met by

M.O.N.A.

M = morphine

O = oxygen

N = nitrates

A = aspirin

Pathology submitted by Chris

Classification of hypersensitivity reactions submitted by Jed.

Caveat: is suspected right ventricular MI suspected .. hold the Nitrates.

_________________

ACLS (1997).

"ACID"

Type I A naphylaxis

Type II C ytotoxic - mediated

Type III I mmune - complex

Type IV D elayed hypersensitivity

Remember the following mnemonic when determining the possible cause(s) of fever in a patient who has recently undergone a surgical procedure: the 5 W's (or 6 W's)

Surgery

Causes of post op fever

Submitted by Jed

Wind: the pulmonary system is the primary source of fever in the first 48 hours.

Wound: there might be an infection at the surgical site.

Water: check intravenous access site for signs of phlebitis.

Walk: deep venous thrombosis can develop due to pelvic pooling or restricted mobility related to pain and fatigue.

Whiz: a urinary tract infection is possible if urinary catheterization was required.

Also Wonder drugs - drug fevers.

(added by Calvin Lee)

ANATOMY

As Easy as 'LMNOP'

Remember the mnemonic LMNOP when treating a patient with acute pulmonary edema:

Lasix® (furosemide) intravenous (IV), one to two times the patient's usual dose, or 40 mg if the patient does not usually take the drug.

Pulmonary

Treatment of acute pulmonary edema

Submitted by Jed

Morphine sulfate. Initial dose, 4 to 8 mg

IV (subcutaneous administration is effective in milder cases); may repeat in 2 to 4 hours. Avoid respiratory depression.

Morphine increases venous capacity, lowering left atrial pressure, and relieves anxiety, which reduces the efficiency of ventilation.

Urology

Nitroglycerin IV, 5 to 10 ug/min. Increase by 5 ug/min q 3 to 5 minutes. Reduces left ventricular preload. Caution: may cause hypotension.

Oxygen, 100% given to obtain an arterial

PO2>60 mm Hg.

Causes of acute and reversible forms of urinary incontinence

Submitted by Jed

Position patient sitting up with legs dangling over the side of the bed. This facilitates respiration and reduces venous return.

The following mnemonic aids in remembering the causes of acute and reversible forms of urinary incontinence -

DRIP:

D: Delirium

R: Restricted mobility, retention

I: Infection, inflammation, impaction

(fecal)

P: Polyuria, pharmaceuticals

ANATOMY

Use the mnemonic SITTT as an aid in evaluating the cause of hematuria:

S: Stone

I: Infection

Urology

Causes of hematuria

Submitted by Jed

T: Trauma

T: Tumor

T: Tuberculosis

Remember the following mnemonic when evaluating patients for hyperthyroidism:

S: Sweating

Endocrine

Symptoms of hyperthyroidism

Submitted by Jed

T: Tremor or Tachycardia

I: Intolerance to heat, Irregular menstruation, and Irritability

N: Nervousness

Cardiology

5 T's of early cyanosis:

Sumbitted by Ben Humphreys

G: Goiter and Gastrointestinal (loose stools/diarrhea).

Tetralogy, Transposition, Truncus, Total anomalous, Tricuspid atresia

HEMATOLOGY

DATs Right! - the oxygen dissociation curve shifts RIGHT whenever there is an

INCREASE in any of the following: DPG, Acidity, Temperature (DAT)

NEUROANATOMY

For the function of the temporal lobes, think of a helmet which covers the side of the head:

HELM:

ANATOMY

H : hearing

E : emotion

L : learning

M : memory

PSYCHIATRY

Here's one from one of the psychiatrists on how to remember the symptoms of depression. He said it was like writing a prescription for Energy Capsules.

SIG:ECAPS

S - Sleep

I - Interest

G - Guilt

: - (Colon can refer to bowel complaints as this is a common presentation of depression, but not official)

E - Energy (decreased)

C - Concentration (difficult, decreased)

A - Appetite (decreased)

S - Suicidal ideation

RENAL

1. HUS/TTP

HUS/TTP is a CRAFTY syndrome:

C : CNS symptoms

R : Renal failure

A : Anemia (microangiopathic hemolytic anemia, "MAHA")

F : Fever

T : Thrombocytopenia

Y : no one knows "Y" it occurs

2. Normal anion gap acidosis

There's the older mnemonic USED CAR:

U : uterosigmoidostomy

S : saline administration (in the face of renal dysfunction)

E : endocrine (Addisons, spironolactone, triamterene, amiloride, primary hyperparathyroidism)

ANATOMY

MISCELLANEOUS

Clubbing (by Doog)

D : diarrhea

C : carbonic anhydrase inhibitors

A : ammonium chloride

R : renal tubular acidosis and a newer mnemonic RAGE:

R : renal tubular acidosis, respiratory acidosis

A : acetazolamide, ammonium chloride

G : GI (diarrhea, enteroenteric fistula, ureterosigmoidostomy)

E : endocrine (same as above endocrine list)

3. Increased anion gap acidosis

The older mnemonic is MUDPIES:

M : methanol

U : uremia

D : diabetes

P : paraldehyde

I : idiopathic (lactic acidosis)

E : ethylene glycol

S : salicylates and a newer one called DULSI:

D : diabetic ketoacidosis

U : uremia

L : lactic acidosis

S : salicylate poisoning

I : intoxicants (methanol, ethanol, ethylene glycol)

C : cardiac (R -> L shunt)

L : lung (tumor, fibrosis)

U : ulcerative colitis (also Crohn's disease less commonly)

B : bronchiectasis

B : benign mesothelioma

I : inherited; idiopathic; IBD

ANATOMY

N : neurogenic tumors

G : GI (cirrhosis, crohn's, UC) also, Hyperplastic Pulmonary Osteoarthropathy, which didn't fit in the mnemonic!

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