Mnemonics for USMLE Step 1

8/9/2019 Mnemonics for USMLE Step 1

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● Behavioral science○ Case control (OR) is in past, cohort study is in future (relative risk); OR comes before RR alphabetically

○ Evaluation of diagnostic tests

■ SNOUT = S eNsitivity rules OUT ; SPIN = SP ecificty rules IN

■ If can create 2X2 disease/test table (FA 2011 P. 51; note that disease which comes first

alphabetically is on top), can use the following:● Vertical → Sensitivity/specificity formulas; vagina is VERTICAL slit; the vagina is

SENSITIVE

○ Positive and negative skew

■ M edian is always in the m iddle when mean, median and mode are ranked; mode is logically placed

(point at peak), median is middle, mean is on ot her end

○ Odds ratio vs. relative risk: create 2X2 table using the alphebetical order rule; D isease comes before R isk

factor; formulas are p retty logical

○ Bias

■ Pyg malion effect → Researcher’s belief in efficacy of Tx changes the outcome of the treatment

■ Haw thorne effect → Group changes its behavior owing to knowledge of being studied

■ Statistical hypotheses and error

■ Make a 2X2 table; again, use the ABC rule to place R eality on top and S tudy results on the side

■ Power is when the experimental hyp othesis is true and the study also shows that it is true

■ Alpha error (Type I) → false Positive error → The P in Positive has one ( I) vertical line, so

corresponds to type I

● Goes in false positive box in 2X2 table

■ Beta error (Type II) → false Negative error → The N in negative has two ( II) vertical lines, so

corresponds to type II

● Goes in false negative box in 2X2 table

○ t-test vs. ANOVA vs. chî 2

■ t-test checks difference between the means of 2 groups → Mr. T is mean

■ ANOVA checks difference between the means of 3 or more groups → ANOVA is ANalysis Of VAriance of 3 or more groups

■ Chî 2 symbol looks like a percentage sign (%); thus chi squared is used to compare

percentages/prop ortions

■○ Reportable diseases: Hep, Hep, Hep, Hooray, the SSSMMART Chick is Gon e. Hep A, B, C, H IV

S almonella, Shigella, Syphilis, Measles & Mumps, AIDS, R ubella, TB, C hickenpox Gonorrhea○ Malpractice → The four Ds for Doom (you are doomed if you get in trouble for malpractice) D → Duty

(phy sician had a duty to the patient) D → Dereliction (physician breached that duty) D → Damage (patient

suffers harm) D → D irect (t he breach of duty is what caused the harm)

○ Developmental Milestones

■ Blocks (age in years times 3): 1 year → 3 blocks, 2 years → 6 blocks, 3 years → 9 blocks

■ Language: 15 months → A few words , 200 words and 2 word sentences at age 2, 900 words and

complete sentences at 3 years


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■ Toilet training at 3 years → Pee at age 3 and Rides tri( 3)cycle at 3 years

■ Cooperative play at 4 y ears; pair of 2s, like two 2s are cooperating

■ Normal grief 2 months; patho after this Kubler-Ross grief stages

■ Denial, Anger, Bargaining, G rieving, Accept ance → Death Arrives Bringing Grave Adjustments

■ Sl eep stages

● At night, BATS D rink Blood

● Beta → Awake (eyes open)

● Alpha → Awake (eyes closed)

● Theta → Stage 1, light sleep

● S leep Spindles and K complexes → Stage 2, deeper

● Delta → Deepest non-REM sleep; delta waves have lowest frequency, highest amplitude

● Beta → During REM

■ REM: like sex: increase pulse, penis/clitoris get hard (tumescence), decreases w/ age

■ Narcolepsy. Hypna GO gic hallucatinations → While GO ing to bed. Hyp nopo M p ic → Just before

awakening in the M orning

● Biochemistry○ Chromatin structure: Hetero C hromatin = H ighly C ondensed

■ H1 is the linker region between histone octamer balls (beads on a st ring); the 1 is like the little piece

of string connecting them

○ Nucleot ides

● Pyrimidines only have one ring, as the other was “CUT” off

● THY mine has a me THY l

● Purine synthesis starts with sugar (Ribose-5P --> PRPP), and then this sugar is modified

to create the purine; pyrimidine starts with synthesis of the pyrimidine and then later a

sugar is added; If you are pure you are as sweet as sugar from the start

○ Methionine is encoded by only AUG, unlike the other AAs where you have redundancy in the code andmultiple codons coding for them --> “ Hey ( A) you ( U), G , I want to buy that meth from you because it is so

awesome/ unique !”

○ Stop Codons- UGA, UAA, UAG- U go away, U are away, U are gone

○ Stop the nonsense! --> Nonsense mutation introduced stop codon

○ Protein synthesis

■ Eukaryotes --> Even --> 40S + 60S = 80S (all differ by 20)

■ Pr O karyotes --> O dd --> 30S + 50S = 70S (smaller numbers because are smaller, always smaller by

10, all differ by 20)

○ AUG is mRNA start codon (rarely GUG) --> AUG inAUG urates p rotein sy nthesis

○ DNA rep licat ion

■ Prokary otes● DNA p ol I (one) --> One (me, number 1, looking out for number 1) --> “I always have to

do all of the bullshit, like fixing the bullshit mess of RNA created by primase”

■ Eukary otes

● DNA p olymerase gamma replicates mitochondrial DNA; beta and epsilon repair DNA

○ Gamma (grandma) might (mitochondria) beat-off ( beta) e lderly ( e psilon)

repair men ( repair )

○ RNA polymerases: Eukaryotes: RNA polymerase I (rRNA), II (mRNA), and III (tRNA) --> Numbered as


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their products are used in protein synthesis

○ Ty pes of RNA: rRNA is the most abundant typ e; m RNA is the longest type; tRNA is the smallest ty pe,

R ampant, M assive, T iny

○ Protein synthesis : ATP for tRNA Activation; GTP for tRNA G ripping and Going places (t ranslocation)

○ Cell cycle phases

■ G = Gap or G rowth (); S = S ynthesis (of DNA, as in replication)

○ Microtubule: Kin esin moves ant erograde to microtubule (same direction it is growing in, i.e. negative to

positive); your aunt is your kin

○ Freidreich ataxia --> Clumsiness (can remember this from “ataxia” --> Due to GAA repeat --> When they fall

they are like “ GAA aaaaaa”

○ Laboratory techniques

■ SN oW DR oP → S outhern blot analyzes D NA (DNA probe); Northern blot analyzes R NA (DNA

probe); Western blot analyzes Protein (using an antibody p robe, which is logical as DNA/RNA

cannot bind a protein)

○ Collagen: S trong S lippery Bloody BM

Strong (Bone, tendon, dentin), Slippery (Cartilage, nucleus pulposus )

● Type III collagen → Bloody ( granulation tissue, blood vessels, uterus, fetal tissue)

● Typ e IV collagen → Basement membrane ( BM ) (or basal lamina)○ Hetero PLASM y --> Presence of both normal and mutated mitochondrial DNA, resulting in variable

expression in mitochondrial inherited dz --> associate with mito-DNA because it is circular like a PLASM id

○ Imprint ing: Prader-Willi --> Del of normally active Paternal allele; maternal allele is methylated&nonfunct

○ Autosomal dominant diseases

■ Achondroplasia , ADPKD (mutated chromo 16), Fam ADenomatous polyposis (chromo 5), HD,

NF1 (17), NF 2 (22), vHL (3 words, chromo 3)

○ Autosomal recessive diseases --> SAT CPM GASH (I actually attended class and SAT in CPM for once,

and I ended up with a GASH in my head because I shot myself)

■ G lycogen storage diseases, Albinism, S ickle, Hemochromatosis, S phingolipidoses (except Fabry ’s),

ARPKD, Thalassemias, C F, PKU, Mucopolysaccharidoses (except Hunter’s)

○ X-linked diseases■ Be Wise, Fool’s Fragile GOLD H eeds Hope:

● Bruton’s agammaglobulinemia, Wiskott-Aldrich syndrome, Fabry’s disease, Fragile X,

G6PD deficiency, O cular albinism, Lesch-Nyan syndrome, Duchenne’s (and Becker’s)

muscular dystrophy, Hunter’s syndrome, Hemophilia A and B.

○ Trinucleotide repeat expansion diseases

■ Hunting ton’s disease, my otonic dystrophy, Fried reich’s ataxia, fragile X syndrome --> Try

(tri nucleotide) hunting for my fried eggs ( X)

● CT G --> Myo Tonic dystrophy

● CGG --> Fragile X syndrome

● GAA --> Friedreich’s ataxia --> Ataxia falling down --> Fall and yell “GAAaaaa”

○ 22q11 deletion syndromes --> CATCH 22 C --> C left palate A --> A bnormal facies T --> T hymus aplasia (T

cell deficiency) C --> C ardiac defects Hypocalcemia (secondary to parathyroid aplasia)

○ Co-factors for PDH, alpha-ketoglutarate, branched chain ketoacid dehydrogenase: → "Tender Loving care for

Noone"

■ TPP, Lipoic acid, Coenxyme A, FAD, NAD

■ Kwashiorkor: protein-def MEAL : M --> Malnutr, E --> Edema, A --> Anemia, L --> Liver (fatty)

■ M arasmus results in Muscle wasting

○ Cystinuria → Hereditary defect fo renal tubular amino acid transporter for the COLA amino acids →

Cysteine, Ornithine, Lysine, Arginine


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■ Hunter’s syndrome

● X marks the spot for treasure hunter; thus it is X linked

● Hunter’s = mild hurler’s + aggresive behavior; a hunter is very aggressive

● Hunters see clearly, no corneal clouding (unlike Hurlers, the similar but severe disease)

○ Dermatan sulfate & Heparan sulfate accumulate in both!!!

■ Hurler’s syndrome: I have an uncle Hurley; he is big and ugly like a gargoyle (gargoylism)

○ Fatty acid metabolism

■ SYtrate shuttle = SYnthesis of fatty acids

■ CAR nitine shuttle = CAR nage of fatty acids

■ FA degradation occurs where its p roducts will be consumed --> The mitochondria

○ Metabolism sitesle, G luconeogenesis --> HUG s take two

■ Pathways that occur in BOTH mitochondria and cytop lasm --> Heme synthesis, Urea cyc

○ ETC: Uncoupling agents → DNP → D -Not- Proton Channel

■ Four things directly inhibit electron transport → RAACC → → Retonone, antimycin A, CN, CO

→ When you see breasts (a rack), you may forget to do when you are supposed to do (make

electrons flow)

○ Gluconeogenesis

■ The key irreversible enzymes → PPFG → Pathway Produces Fresh G lucose → Pyruvatecarboxylase, PEP carboxykinase, Fructose-1,6,-bisphosphate, G lucose-6-phophatase

○ Amino Acids: Essential AAs → PVT TIM HALL

● P (Phenylalanine) V (Valine) T (Threonine) T (Trypt ophan) I (Isoleucine) M

(Methionine) H (Histidine) A (Arginine) L (Lysine) L (Leucine)

● Ket ogen AAs → Leu cine and Ly sine

■ Arg and His for growth → Guys (His) want to get big, they go “Arg” like primitive cavemen

○ Urea cy cle: O rdinarily C areless C rappers Are Also Frivolous A bout Urination → O rnithine, C arbamoyl

phosphate, C itrulline, Aspartate, Argininosuccinate, Fumarate, Arginine, Urea.My urea cycle (instead of the

lame one in First Aid) Coffee And Alcohol Form Aggregious Urine Overload

○ Cystinuria: Defect of renal tubular AA transporter for C ysteine, O rnithine, Lysine, and Arginine ( COLA ) →

Coca COLA is bad for you, so it causes cysts in your urine (Cystinuria)○ Lip id t ransport

■ A1 Activates LCAT, which catalyz es esterification of cholesterol --> Putt ing A1 steak sauce on a

CAT

■ B-100 Binds to LDL receptor, mediates VLDL secretion (from first aid, worst fucking mnemonic

ever lol); it is the only apolipoprotein left on LDL

● B-100 gets the bad LDL out of the blood and into liver; thus you have it because you

want to B-100 some day (i.e. liver to the age of 100), not die from atherosclerosis

■ C -II is a C ofactor for lipoprotein lipase (thus must be on chylomicron and VLDL)

■ E mediates Extra (remnant) uptake

■ B-for-eight ( B48 ) is only seen on chylomicron; chylomicron comes from dietry lipid, i.e. the stuff

that you ate (8) B-for (B4) all of the other lipid pathways st arted; logically, it mediates

chylomicron secretion

● Embryology○ Sonic Hedgehog Gene --> In the videogame, sonic could run forward and backward; anterior and post erior

○ Homeobox gene --> Involved in segmental organization of embryo in craniocaudal direction --> Homosexuals

(HOM EObox) put t heir heads (cranio) in the tails (caudal) of other men

○ Week 10 --> Genitals have male/female characteristics; 1 is like a penis, 0 is like a vagina


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○ Rules of early development

■ Rule of 2’s for the 2nd week: 2 germ layers (bilaminar disk): epiblast, hypoblast), 2 cavities:

amniotic cavity, yolk sac), 2 component to placenta: cytotrophoblast, syncytiotrophoblast

■ Rule of 3’s for the 3rd week: 3 germ layers (gastrula): Ectoderm, mesoderm, endoderm

■ Rule of 4’s for the 4th week: 4 heart chambers; 4 limb buds grow

○ Embryological derivatives

■ Neural crest (most important to know) --> Think PNS and non-neural structures nearby

● Odonto = teeth; think crest toothp aste; logical that bones of skull would be from same

thing as they are attached, and p ia/arachnoid too as t hey are closely associated with this

● Neural structures --> ANS, dorsal root ganglia, cranial nerves, celiac ganglion, chromaffin

cells of adrenal medulla, Schwann cells

● Non-neural structures --> Melanocyte, parafollicular (C) cells of thyroid,

aorticopulmonary septum

■ Neuroectoderm --> CNS stuff: Brain (neurohyp ophy sis, CNS neurons, oligodendrocyt es,

astrocytes, ep endymal cells, p ineal gland), retina, sp inal cord

■ Thyroid follicular cells --> Endoderm --> Thyroid descends from tongue, so logically relates to gut;

parathyroid as well, as so intimately associated with thy roid

○ Placental development: Cytotrop hoblast --> Makes cells for developing structure --> Cyto makes Cells○ Urachus --> Connects bladder to yolk sac --> Ur (urine) and achus (achu, sneeze, snot is like yolk)

○ Brachial arch derivatives

■ 1 --> MAX illary artery --> 1st arch is M AXimal (1st place is best place)

■ 2 --> Stapedial artery --> S econd = S tapedial

■ 3 --> common C arotid artery --> C is 3rd letter of alphabet

■ 4 --> On left, aortic arch; on right, p roximal part of right subclavian artery --> 4th arch (4 limbs) =

systemic

■ 5 --> Does nothing --> Five is not Alive

■ 6 --> Proximal part of p ulmonary arteries and (on left only) ductus arteriosus --> 6th arch (6 letters

in both “p atent” & “ductus”)

○ Branchial apparatus: CAP covers outside from inside○ Branchial arch derivatives

■ 1 --> Ms and Ts --> M s (M uscles of M astication ( Masseter, lateral and M edial pterygoids),

M ylohyoid, M axillary (V2) and Mandibular (V3) nerves; Meckel’s cartilage ( M andible, M alleus,

incus, spheno M andibular ligament)) and T s (Tensor ty mpani, Tensor veli palatini, anterior 2/3 of

Tongue)

■ 2 --> Ss ( S tapedius, S ty lohyoid, CN S even, S tapes, S ty lohyoid ligament)

■ 3 --> Pharyngeal stuff (Stylopharyngeus, which is innervated by glossopharyngeal nerve; CN IX

(stylopharyngeous))

■ Five does nothing; five is not alive

■ 4-6 --> Structures around neck/voice box

● Cartilages (thyroid, cricoid, arytenoids, corniculate, cuneiform)

● Cranial nerve X (4th arch (Superior laryngeal branch for swallowing); 6th arch (recurrent

laryngeal branch for speaking)

● Muscles (Pharyngeal constrictors, cricothyroid , levator veli palatini; 6th arch is all

intrinsic mm. of larynx EXCEPT CRICOTHYROID )

○ Branchial pouch derivatives

■ Aberrant development of 3rd and 4th pouches --> 22q11 deletion --> Catch 22 --> CATCH --> C

(C ardiac abnormality , esp ecially tetrology of Fallot; A bnormal facies; Thymic aplasia (thus T-cell

deficiency); C left p alate; Hypocalcmia (due to lack of parathyroid development))


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■ Omphalocele --> O is like a nice circular, central hole; thus this one is based on the persistence of

herniation of abdominal contents into umbilical cord

○ Formation of pancreas --> From dorsal and ventral buds; everyone loves getting head, both contribute to head

■ Ventral buds --> Portion of head; uncinate process

■ Dorsal buds --> Portion of head; tail (if we had a tail, it would be on our dorsal surface) and body

(tail attached to body, so we can associate them)

■○ Kidney embryology (DIT claims this is extremely low y ield)

■ Pronephros --> Degenerates at week 4; “pro” things tend to go away

■ Mesonephros --> Interim kidney for 1st tri; later contrib to male genital system (Wolffian duct)■ Metanephros --> Sounds like mesonephric, which we can easily associate with the genitals from

repro, but this is the permanent kidney

● Ureteric bud --> Ureter, pelvises, calyces, collecting ducts (BIG stuff; ureter = “your

eater” = my eater has to have a big app etite because my wiener is so big)

● Metanephric mesenchyme -->Glomerulus and renal tubules to distal convoluted tubule

(SMALL stuff; this is induced by ureteric bud; the big stuff bosses the small stuff

around)

○ Genital embryology

■ Mesonephric duct --> Associate with men because of lack of prefix; female stuff has prefix

(FE-male, WO-man, PARA-mesonephric); associate Wolffian with male. Leads to SEED structures

--> S eminal vesicles, E p ididymis, E jaculat duct, Ductus def ■ Paramesonephric duct --> Female due to prefix thing described above

■ Vestibular bulbs --> Internal part of the clitoris --> turned on, like light bulb

○ Congenital penile abnormalities

■ Hypospadia --> Urethral on underside of penis. Hypo is below

■ Ep isp adia: Exstrophy of bladder is assoc with E pisp adia . Wrong positioning of genital tubercle

○ Descent of testes and ovaries: Processus vaginalis becomes tunica vaginalis in men, obliterated in women

● Microbiology○ Bacteria

■ Bugs that do not gram stain well --> These R ascals M ay M icroscopically Lack C olor

● T reponema (too thin to be seen), R ickett sia (icparasite), Mycobacteria (high lipid contentcell wall requires acid fast stain) Mycoplasma (no cell wall), Legionella pneumop hila

(primarily ic), Chlamydia (intracellular parasite, lacks muramic acid in cell wall)

■ Use Loffler’s media for diptheriae!!

■ Which bugs need cysteine? The -ella's, or the girls. Francisella, Brucella, Pasteurella, Legionella

■ Bacteria that produce exotoxins that increase levels of cAMP

● C → C holera (Vibrio cholea)

● A → Antrhax (Bacillus anthracis)


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● M → M onteczuma’s revenge (popular name for enterotoxigenic E. coli)

● P → Pertussis (Bordetella pertussis)

■ Spirochete: Leptospira Interrogans (question mark). surfers and people in the tropics who get in

water with animal urine .

■ Obligate aerobes --> Nagging Pests Must Breathe --> Nocardia, Pseudomonas, M ycobacterium

tuberculosis, Bacillis (B. anthracis, B. cereus)

■ Pseudomonas AER uginosa is an AER obe

■ Anaerobes C an’t Breathe Air --> C lostridium, Bacteriodes, Actinomyces. Amin O2 glycosides are

ineffective against anaerobes because these antibiotics require O2 to enter the bacterial cell

■ Group B strep → Think B for Baby. Neonatal meningitis , pneumonia , sepsis

● Pneumococcus is for Parents. Meningitis , pneumonia , sepsis in adults

■ 3 MCC of otitis media → haem Influenzae, moraxella C atarrhalis, strep Pneumo → ICP , like the

Insane Clown Posse; their music sucks so much it really hurts the middle ear

■ Bacteria identification with antibiotics (novobiocin, optochin, bacitracin)

● When have it narrowed down to...

○ S taph → Novobiocin test → kills EPIDERMI dis

○ AL pha hemolyt ic → O pt ochin test → kills PNEUMO

○ Beta hemolytic → Bacitracin → Kills PYogenes■ Chlamydia types D-K cause STDs (and infant pneumonia, inclusion conjunctivitis in newborns),

whereas A, B and C are associated with trachomas (leading cause of blindness worldwide)

● D-K → D icK → STD

● L subtypes (L1, L2, L3) cause Lymphogranuloma venereum → Painless p apule (bump)

or ulceration of genitals; heals spontaneously; bacteria migrate to regional lymph nodes,

which enlarge; become tender and may break open/drain pus

● TRACH oma → can lead to blindness

■ HACEK bacteria → Slow growing bacteria, cause endocarditis (must let grow for like 2 weeks).

Haemophilus sp ecies, Actinobacillus species, C ardiobacterium sp , Eikenella sp, K ingella sp

■ N. M enin G itidis → Ferments M altose+ G lucose● In cont ras t to N. Gonorrhoeae, which only ferments G lucose (no M in name)

■ Some important details about PSEUDO monas → BE PSEUDO : BurnsE, Endocarditis ,

Pneumonia, S epsis, External malignant otitis media, UTI, D iabetic O steomyelitis

■ Encapsulated bacteria --> Positive quellung reaction, where capsule swells, S ome K illers Have N ice

S hiny Bodies --> S treptococcus pneumo, K lebsiella pneumo, H . influenzae type B, Neisseria

meningitidis, S almonella, group B strep

■ Urease positive bugs --> K lebsiella, Proteus, H . py lori, Ureaplasma

■ Anti-bacterial Antibiotics

● Bacteriostatic vs. bactericidal

○ Bacteriostatic → We’re ECST aT iC about bacteriorstat ics!” → Erythromycin,

C lindamycin, S ulfamethoxazole, T rimethoprim, Tetracycl, C hloramphenicol

○ Bactericidal → “ Very F inely Proficient At C ell M urder” → Vancomycin,

Fluoroquniolones, Penicillin, Aminoglycosides, C ephalosporins, M etro

● Protein synthesis inhibitors → “Buy AT 30 , CCELL (sell) at 50”

○ 30S inhibitors ( AT ) → Aminoglycosides (bactericid Al), tet racycline

(bacteriostatic)


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○ 50S inhibitors ( CCELL ) → C hloramphenicol, C lindamycin, Erythromycin,

Lincomycin, Linezolid

■ All bacteriostatic, except for Linezolid whcih is variable

● Penicillinase-res penicillins for S. aureus (not MRSA) → Use naf (nafcillin) for staph

● The anti-PA drugs

○ TCP → T icarcillin, C arbenicillin, P iperacillin → Takes C are of Pseudomonas

● Beta lactamase inhibitors → CAST → C lavulanic Acid, S ulbactam, Tazobactam!!!!

● Cephalosporins

○ 1st gen → PEcK organisms → Proteus mirabilis, E. coli, K lebsiella pneumo

○ 2nd gen → Treat the HEN PEcKS organisms → H . influenzae, Enterobacter,

Neisseria sp p., Proteus, E. coli, K lebsiella pneumo, S erratia marcescens

● Imipenem and meropenem

○ Give imipenem with cilostatin, inhib of renal dihydropeptidase I; decreases

inactiv of drug in renal tubules → kill is LASTIN’ with ci LASTATIN ”

○ Imipenem NW: GIT, rash, CNS toxicity . Meropenem is less harsh, no seizures

● Aminoglycosides → “ Mean ” GNATS canNOT kill anaerobes

○ Mean → Aminoglycosides○ Can´t kill anaerobes → O2 needed for aminoglycoside upt ake

○ GNATS → The different aminoglycosides → Gentamycin, Neomycin,

Amikacin, T obramycin, S treptomycin

○ NOT covers NW → Nephrotoxicity, O totoxicity, Teratogen!!!

● C lindamycin & M etro for anaerobes. C lindamycin A bove diapgragm, Metro Below

● Trimethoprim ( TMP ) → megalo anemia, leukop, granulocytop → T reats M arrow Poorly

● TB Drugs: When someone is infected with TB, they are RIPE

○ Iso niazid (INH): Injures Neurons and Hepatocytes

■ R ifampin: R ed, RNA (inhib DNA-dependent RNA polymerase of

TB), R evs up microsomal P-450), R apid resistance if used alone■ Pyr azinamide

■ Other drugs for TB not associated with liver damage:

● Ethambutol : ocular tox/neuropathy : red-green blind

● St rep tomy cin

● Fluoroquinolones: -floxacin ; Inhibits DNA gyrase. NW: GI irratabili ty, vomiting.

Fluoroquino LONES hurt att achments t o your BONES →

● Vancomy cin

○ NOT have many problems → Nephrotoxicity, O totoxicity, Thrombophlebitis

■ Mechanism --> Inhibits peptidoglycan p roduction; complexes with

D-alanine D-alanine to inhibits transp ept idation

■ NW --> Red man syndrome (release of histamine causes red rash of

the torso and itching skin)

● Metro nidazole (the metro bus ); used to treat some protozoa

○ “ GET GAP on the Metro !”G iardia, Entamoeba, T richomonas, Gardnerella

Anaerobes (bacteriodes, clostridium), H. Pylori

● Polymyxins → Polymyxin B, polymyxin E (colistimethate)

○ Mechanism → Bind to cell membranes of bacteria disrupt their osmotic

propert ies; basic proteins act like detergents → MYX ins MIX up membranes

■ Neurotoxicity is seen → They also scramble ( MIX up) the brain


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○ Fungi■ Fungi grow on Sab ouraud’s agar

■ Actinomyces and nocardia are the “fungi-like” bacteria; filamentous, beaded, branching g+

● Actin omyces --> Bacteria acting like fungi

○ Actinomyces Israelii ---> Yellow granules called sulfur granules

○ Nocardia --> Acid fast stain positive, like TB■ For the dimorphic fungi, cold = mold, heat = yeast

■ H isto H ides (within macrophages)

■ Blastomycosis → Broad Based Buds

■ Histo plasmosis → Histop lasmosis associated with bat dropp ings

■ Paracoccidio Parasails with the captain’s wheel all the way to Latin America → Paracoccidio has

budding yeast with captain’s wheel formation, seen in latin america

■ Wide vs. acute angle in fungi

● Asp ergillus → A → Acute angle. M ucor → Flip M to have a W → Wide angle

■ Antifungal antibiotics

● Amphotericin B is Amphoterrible, terrorizes ergosterol and the kidney

○ Ampho- tear -acin tears holes in the fungal membrane by forming pores

● Ny astatin → “ Nasty Nyastatin ”

○ Too strong to take IV (would be highly toxic); thus must use top ically/orally

○ Same mechanism as ampho

○ FlUcyst osine is an ant imetabolite like 5- FU

○ Similarly causes b one marrow depression , nausea/vomiting/diarrhea (→

damage rapidly dividing cells like bone marrow, GI)

● Azoles

○ Keto conazole (and all of the azoles) inhibits cytochrome P-450, which is

important in testosterone synthesis; this causes gynecomastia/impotence/etc.

● cASP ofungin → Used to treat invasive ASP ergillosis, inhibits synthesis of beta-glucan

Griseofulvin: Inhib fungal growth by disrupt ing sp indle formation, prevent mitosis● Terbinafine

○ Viruses■ Negative RNA is negative/shitty; must be transcribed into positive RNA in order for it to be useful

■ Negative DNA is negative/shitty and not actually read; it is pos DNA that is used to do something

■ DNA viruses → The HHAPPP y viruses Herpes Hepadna Adeno Papova Parvo Pox

Hepatitis

● H AV --> A for Asy mpt ( jaundice in some cases), Acute, Alone (no carriers)

● H BV --> B for Blood borne; the cousin of HCV, as both predispose to chronic active

hepatitis, cirrhosis, hepatocellular carcinoma

● H C V --> C for C hronic, C irrhosis, C arcinoma, C arriers● H DV --> D for Defective, Dependent on HBV

● H EV --> E for Enteric, Expectant mothers (normally mild like A, but mortality in SS)

■ Orthomyxo and paraorthomyxo

● OR thomyxo causes OR dinary flu; PARA ortho causes an influenza like illness in addition

to a PARA de of distinctly different diseases

■ Papovaviridae → PA -PO -VA -viridae


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● PA p illoma; human warts and cervical cancer

● PO lyomavirus; composed of human BK and JC virus

○ JC virus

■ JC Polyomavirus --> PML; memory loss, poor speech,

incoordination secondary to CNS white matter damage

■ Ebo la → Hemorhagic fever → Bleed from mucous membranes

■ Anti-viral medications● Foscarnet → DNA p olymerase inhibitor that binds the pyrophosphate-binding site of the

enzyme → FOS carnet = py ro FOS phate analog

● HIV drugs

○ Nucleoside/nucleotide/etc. Reverse transcriptase inhibitors (NRTIs)

■ Tenofovir --> Nucleo T ide analogue

■ Zidovudine (ZDV), Stavudine → “Have you dined (vudine ) with

my nuclear (nucleosides ) family?”

● Bot h are NRT Is

● Z DV p revent s familial transmission from mother to fetus

○ Efa viren z → Causes abnormal dreams that are often scary → Dreaming about

axe-wiel ding elves

■ Think of efavir ENZ as “ the Ns ” → NRTI cause Nausea & nightmare

○ Protease inhibitors: n avir ; associate this with n o vir us

■ Riton avir inhib P-450, “boost er” to make other antivirals last longer

○ Fusion inhibitors: en FUvirtide → FU for FUSE

● Influenza drugs

○ Amantadine

■ influenza A , NOTinfluenza B; that is what the “ A” in Amantadine

is for; in addition, the A is for problems with the cerebell A (ataxis,

dizizness, slurred speech)■ prevents viral genome uncoating in the host cell

■ Rim antidine is similar but with extra perks, does not require dose

adjustments in renal failure, less CNS side effects (anxiety/confusion)

○ Neuraminidase inhibitors → Oseltamivir, zanamavir

○ Helminths

■ Nematode routes of infection

● Ingest ed → Enterobius, Ascaris, T richinella → You’ll get sick if you EAT these

● Cut aneous → S trongyloides, Ancylostoma, Necator → Get into your feet from the

SAN d

■ Anti-Helminth antibiotics: Mebendazole.Inhibits the synthesis of microtubules (are BENDY)

● Immunology○ Anatomy/histology of immune system structures

■ T cells are in the “ P” areas; Paracortex in lymph node, Periart lymphat sheath (PALS) in spleen

■ Lymph node → CB PT M Mmmmm (CB is my old nick name, PT for patient, MM for

delicious...this mnemonic is awful but better t han nothing)

● C ortex → Follicles with B cells


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● Paracortex → T cells

● M edulla → M acrophages

■ M HC I and II

■ MHC is encoded by HLA genes

■ MHC I --> 1 is simple --> Thus matched with the simple letters: A, B, C --> MHC I is encoded by

HLA-A, HLA-B, HLA-C

■ MHC 2 --> HLA-DR, HLA DQ, HLA-DP --> The DR went to dairy queen ( DQ ) to get a doctor

pepp er ( DP )

○ Cytokines and their functions■ To remember IL-1 through IL-5, use Hot T -Bone st EA k

● IL-1 --> Causes fever ( hot ), IL-2 --> Stimulates T cells, IL-3 --> Stimulates BM

● IL-4 --> Stimulates Ig E production (that is, it st imulates class switching; thus bot h IgE

and IgG, as well as differentiation into Th2 cells, growth of B cells)

● IL-5 --> Stimulates Ig A p roduction (and thus class switching from IgM to IgA; also

promotes differentiation of B cells, stimulates growth/differentiation of eosinophils)

■ IL-6 is a py rogen; 6 is devil number (666), so can associate with heat/fire

■ “Clean up on aisle 8 ” --> Neutrophils are recruited by IL- 8 to clear infections IL-10 --> 10,

rhymes with men --> I don’t like men, so they inhibit me having a boner --> IL-10 inhibits T cells

and macrophages (most of the other ones we have to memorize are stimulatory)

● Thus logically secreted by regulatory T cells. BUT, it activates Th2

■ IL-11 → Makes megakaryocyte differentiate into platelets; picture the 1 and 1 of 11 as two little

platelet particles...look at that shit below, those p latelets look like 11.

■■ IL- 12 → Activates Th 1 cells → Activates 1 in order 2 take care of invaders

■ IL- 13 → Isoty pe switching to IgE; since this causes allergy/rash/etc., it is logical that it would be

this very unlucky number ( 13)

■ Isotype switching occurs due to IL- 4, IL- 5, and IL- 6; this results in the p roduction of IgA, IgE, and

IgG → Note that 4 is like an A, 6 is like a G ; just remember that 5 is also relevant and in the middle○ Immunoglobulin isotypes

■ When B lympho older can isotyp e switch; it can then secrete A, G and E; does this in its old AGE

■ In the classic pathway, Ig G and Ig M fix complement; General motors ( GM ) is a classic

■ IgM is a pentamer when in blood; note that the letter “ M ” has 5 points (5 = penta)

■ IgE activates Eosinophils to kill parasites

■ I want to B and MD → B cells have Ig M and Ig D on t heir surface acting as receptors

○ Cytotoxic T cells have Granzyme and Granulysin


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■ AB and function: The constant F c region: C onstant, C arboxy terminal, C omplement binding at

CH2, C arbohydrate side chains

○ Complement : C3 b → Opsonization; binds bacteria. C3 a , C5 a → Anaphalaxis

○ Cell surface proteins: CD 21 is the receptor for EBV!

○ Passive vs. active immunity

■ After exposure to T etanus t oxin, Botulinum toxin, HBV, or R abies virus, patients are given

preformed antibodies (passive) To Be Healed R apidly

○ Autoant ibodies

■ Anti C entromere → C REST scleroderma

■ Anti- Jo -1 → Poly MY ositis, dermato MY ositis → MY grandma’s name is JO anne

■ Diffuse SCL eroderma → anti- S CL -70 Abs

■ c-ANCA → Wegener’s granulomatosis → Like that old school tv channel the CW

○ Immune Deficiencies

■ Bruton’s agammaglobulinemia → Seen in Boys because it is X-linked

● Defect in BTK, a ty rosine kinase gene

● Blocks pro- B-cell from forming pre- B-cell → B cells are fucking up in Bruton’s

■ Hyper-Ig M → B cells cannot M ature → Thus B cells cannot class switch → Thus B cells can onlymake IgM (not A, G E seen in class switching)

■ Select ive I g deficiency → Ig A deficiency most common → the defect in isotype switching,

■ Hyper-IgE syndrome → Job’s syndrome

■ Wiskott- Aldrich ( WA ) syndrome I → Infections Thrombocytopenia E → Eczema

● There is also decreased IgM in this condition;

● Ataxia-telangiectasia → Ig A deficiency (this is one part of 3 in triad; the other 2 are

extremely obvious from the name of the condition (ataxia, telangiectasia))

■ Leukocyte Adhesion deficiency ( LAD ) → Small LAD ,delayed separation of the umbilicus

● Pathology○ Amy loidosis

■ Primary amyloidosis → Protein is AL, derived from Ig light chains (multiple myeloma) → A L =

Light chain

■ Secondary amyloidosis is based on the protein AA;

● This is derived from serum amyloid-associated (SAA) p rotein, which is seen in chronic

inflammatory disease → AA = Acute-phase reactant

■ Senile cardiac amyloidosis → The protein that accumulates is transthyretin, which is derived from

AF → A F = old Fogies

■ DM typ e 2 amyloidosis is based on amylin, which is derived from AE → A E = Endocrine

■ Medullary carcinoma of tthyroid → Protein is A- CAL , derived from CAL citonin; note also that

calcitonin is made in the C cells of the thyroid, so the calcitonin/thyroid connection is logical

● Pharmacology○ Enzyme Kinet ics

■ Competitive inhibitors cross each other competitively, while noncompetitive inhibitors do not


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■ To remember that Y-intercept is Vmax → “Youare still a Virgin? Hahaha, Y?”

● And the other one is X-intercept

○ Elimination of drugs

■ Drugs that display zero ( 0) order elimination (linear decrease in concentration with time) include

Phenytoin, Ethanol, Asp irin (at high or t oxic concentrations) → PEA is round like a 0

○ Therapeutic index can be remembered using the mnemonic TILE → Therapeutic Index = TI = LD50/ ED50

○ Ach recep tors : N icotinic Ach receptors are ligand-gated Na/K channels; N M found in M uscle; NN found in

autonomic ganglia (like N for Nerve)

○ G-protein-linked 2nd messengers

■ To remember the protein class of the various receptors: qiss (kiss) and qiq (kick) till you’re siq

(sick) of sqs (sex)

● Alpha1 → q

● Alpha2 → i

● Beta1 → s● Beta2 → s

● M1 → q

● M2 → i

● M3 → q

● D1 → s

● D2 → i

● H1 → q

● H2 → s

● V1 → q

● V2 → s

■ G q activates phospholipase C → Cutsie ( q-C )● Associated with H1, Alpha1, V1, M 1, M 3 → “C utseies HAV e 1 M&M ”

■ G i is linked to M2, Alpha2, D2 → The “ MAD 2s ”; they are pissy , so they inhibit everything

○ Cholinomimetic agents

■ Direct agonists → Directly bind cholinergic receptors

● Tend t o have “ -chol ” in the name; logical given that this is direct stimulation of

chol inergic receptors


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● Bethanechol activates Bowel and Bladder smooth muscle

● Carb achol is a carb on copy of acety l chol ine; used to treat glaucoma

● Pil ocarpine is a potent stimulator of sweat, tears, saliva → PIL e on the sweat and tears

● Methacholine → test for asthma; stim muscarininc receptors in airway

■ Indirect agonists → Does not directly bind receptor; rather, anticholinesterases,“-stigmine” in name

● Neo stigmine has no CNS penetration → NEO CNS = NO CNS

● Edro phon ium is used in the diagnosis of myasthenia gravis,

● Phys ostigmine treats glaucoma → PHYS is for EYES

● Treats atropine overdose → Physo Phix es atropine OD

○ Muscarinic antagonists

■ Benz tropine is used to treat Parkinson’s disease → PARK my BENZ

■ Ipra tropium is used to treat asthma, COPD → “ I pray I can breathe soon!”

■ Side effects of muscarinic blockade ( typ for atropine, which is an extremely common cause of

delerium in the elderly): Hot as a hare (increased body T bc less sweating), dry as a bone (less secret

in airway, GI, dry mouth), red as a beet (flushed), blind as a bat (far sighted, ciliary muscle can´t

contract&cause accomod), mad as a hatter (disorient), bloated as a toad (const ip)

■ Hexamethonium is a nicotinic agonist; thus it blocks all of the ganglia of the autonomic NS

(parasympathetic AND sympathetic) → Put a hex on smokers ( nicotine ) to make them quit○ Direct Sympathomimetics

■ Epinephine binds ALL adrenergic receptors, but selective for beta1 at low dosages → Blow

■ Iso proterenol binds beta1 and beta2 equally well → Iso lated to beta; iso implies same

■ Dopamine binds as follows: D1 = D2 > beta > alpha → It is obvious that they bind D best; then it

just goes down alphebetically

■ The selective beta2 drugs (beta2 > beta1) are the MAST drugs → M etaproterenol, Albuterol,

S almeterol, Terbutaline

■ riTO drine binds beta TO (beta2)

○ Alpha blockers

■ Pheochromocytoma should be surgically removed in conjunction with p henoxybenzamine and

phentolamine → Use Phe and Phe to treat a Pheo● Phenoxy BENZ amine is irrev → IF someone gave me a BENZ , would never get back

○ Beta blockers

■ Partial beta- Agonists → P indolol, Acebutolol

■ Nonselective antagonists (beta1 = beta2) all start with letters between N and Z (with the one

exception of labetolol) → Prop ranolol, t imolo, nadolol, pindolol

■ Beta1-selective antagonists all start with letters between A and M → Acebutolol, Betaxolol,

Esmolol, Atenolo, M etoprolol

● A BEAM of beta1 blockers

■ Almost all beta blockers end in -olol; the non-selective beta AND alpha antagonists have weird

name endings → labet alol , carved ilol

○ Drugs causing flushing → VANC → Vancomycin (red man), Adenosine, N iacin, C a2+ channel blockers

○ Drugs causing hemolysis in G6PD patients → Hemolysis IS PAIN

■ Isoniazid

■ S ulfonamides

■ Primqquine

■ Aspirin

■ I buprofen

■ N itrofurantoin

○ Drugs causing megalo blast anemia → Phenytoin, M TX, S ulfa drugs → Having a BLAS T with PMS


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○ Drugs causing pulmonary fibrosis: BLAB (it’s hard to blab when you have pulmonary fibrosis)

■ BLeomycin, Amiodarone, Busulfan

○ Drugs causing gynecomastia → S ome D rugs C reate Awesome K nocker s

■ S p iro, D igitalis, C imetidine, Alcohol, K etoconazole

○ Drugs causing photosensitivity: SAT for a photo: S ulfonamides, Amiodarone, Tetracycline

○ Drugs causing SJ syndrome (rash) → S eizure, C illins, S ulfas → Can’t get any SCS (sex) bc you have a rash

○ Drugs causing SLE-like syndrome: SHIPP : S ulfonamides, Hydralazine, I NH, Procainamide, Phenytoin

○ Drugs causing cinch onism (dizziness, h/a, vision changes, tinnitus) → Quin idine, quin ine

○ Drugs causing seizures: Bupropion, Imipenem, I NH

○ Drugs causing disulfiram-like reaction: Metro, S ulfonureas (1s t gen), C ephalos (cefemendole), Procarbazine

○ P450 inducers: BCG PQRS): Barbs, Carbama, Griseo Phenytoin, Quinidine, Rifampin (revs it up ), St

Johns

○ P450 inhibitors: PICK EGS : P rotease inh, INH, Cimetidine, Keto Erythro, Grapefruit, Sulfonamides

● Cardiovascular○ Heart sounds

■ S3 → increased filling pressures and more common in dilated ventricles. Early diastole, whereas S4

is late diastole; thus S3/S4 numbering is logical

■ S4 → stiff ventricle Four → Whore → Prost itutesmake me stiff;

■ JVP: a wave, c wave, x wave, v wave, y wave → At C arter’s crossing ( X) Vehicles Yield

○ Heart murmurs

■ MP - MSC

■ MS - OS → Microsoft ( MS ) makes an operating system ( OS )

■ AS has the ejection click ( EC )

○ Cardiac myocyte physiology

■ Phase 0: rapid upst roke, where potential gets really high → “You have to be a total ZERO to get

HIGH ”. Phase 2 is the plateau → Phase 2 is the pla-2

■ Tetralogy of fallot → PROVe

● P → Pulmonary stenosis

● R → R VH (logical given the pulmonary stenosis)

● O → O verriding aorta (overrides the VSD)

● V → VSD

■ Patent ductus arteriosus: ENDO methacine (indomethacin) END s patency; PG EE k EE ps it open

○ Cardiomyopathies

■ Dilated (congestive) cardiomyopathy

● ABCD

○ A → Alcohol abuse○ B → wet Beriberi

○ C → C oxsackie B virus myocarditis, chronic C ocaine use, C hagas’ disease

○ D → Doxorubicin toxicity

■

○ Also hemochromatosis, peripartum cardiomyopathy

■ Hyp ertrophic cardiomyopathy → A common cause of sudden death in young athletes

■ Treatment of acute heart falilure → LMNOP


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○ Adrenal s teroids

■ Congenital bilateral adrenal hyperp lasias → Can have deficiency in 17alpha-hydroxylase,

21-hydroxylase, or 11beta-hydroxylase

● All have 2 numbers in name, we will call them XY. In 17alpha-hydroxylase, X = 1, Y = 7

● If X is 1 → Hypertension is seen

● If Y is 1 → Masculinization is seen

● Thus, for example 11beta-hydroxylase has BOTH masculinization and hyp ertension

○ PTH → Increases Ca levels, decreases phosp hate levels → PTH stands for Phosphate T rashing Hormone

○ Calcitonin decreases Ca2+ levels → Calci TON in TON es down Ca2+ levels

○ Signaling pathways of endocrine hormones■ cAMP → FLAT CHAMP → (same FLAT as before, i.e. the anterior pituitary hormones FH, LH,

ACTH, TSH), C RH, h CG, ADH (V2 receptor), M SH, PTH

● Can make it FLAT CHAMP OF C omputer Graphics in Games to include C alcitonin,

GHRH, G lucagon

● Can remember V2 rather than V1 due to the fact that V1 is the vascular one, and it needs

to use IP3 to increase Ca2+

■ cGMP → THink vasodilators → ANP, NO (EDRF)

■ IP3 → GnRH, O xytocin, ADH (V1 receptor) , TRH → GOAT

● Note: oxyt ocin and ADH at V1 both logically need to increase Ca2+, which IP3 can do

■ The ONLY hormones binding nucl steroid receptors are T3/T4; others bind cytosolic steroid recept

■ Cytosolic steroid receptors → VET CAP → Vitamin D, Estrogen, Testosterone, C ortisol,

Aldosterone, Progesterone

■ Intrinsic tyrosine kinase (MAP kinase pathway) → Think growth factors → Insuklin, IGF-1

(produced by GH), FGF, PDGF

■ Receptor-associated tyrosine kinase (JAK/STAT pathway) → GH, p rolactin (the posterior

pituitary hormones), also cytokine IL-2

○ Addison’s disease shows Adrenal Atropy and A bsence of hormone production!

○ Pheochromocytoma: 10s → 10% all of these things: Malignant, bilateral, extra-adrenal, calcify, kids, familial■ Dopamine is metabolized to HVA → DHV

■ Nore pinephrine is metabolized to VMA

■ Epin ephrine converted to metan ephrine → Easy to remember

○ Hyperparathyroidism: A disease of stones (stones due to hypercalciuria), bones (cyst ic bone space filled

w/brown fibrous tissue), and groans (constip; gastric ulcers due to increased gastrin, due to increased Ca2+)

○ Hyp oparathyroidism: Due to hyp ocalcemia and resultant tetany, see → C hvostek’s sign, T rousseau’s sign

● C hvostek s ign → C heek → Tapping of facial n. causes contraction of facial mm.

● T rousseau’s s ign → C uff → Occlusion of brachial artery triggers carpal sp asm

○ Pituitary adenoma: Bro mocriptine or cab ergoline (dopamine agonists ) cause shrinkage of prolactinomas

○ Carcinoid syndrome → High levels of serotonin. Increases 5-HIAA in urine . Rule of 1/3s → ⅓ metastasize,

⅓ p resent with 2nd malignancy, ⅓ multiple○ Multiple endocrine neoplasia (MEN). Autosomal dominant , because MEN are dominant

■ MEN 1 → 3 Ps; MEN 1, so carry just 1 over (Parathyroid)

● Parathyroid tumors

● P ituitary tumors (prolactin or GH)

● Pancreatic endocrine tumors (ZES, insulinoma, VIPoma, rarely glucagonoma)

■ MEN 2A → 2 Ps; MEN 2, so carry 2 over (Pheo, Medullary)

● Parathyroid tumors


19/33

● Pheochromocytoma

● Medullary thyroid carcinoma

■ MEN 2B → 1 P

● Pheochromocytoma

● Medullary thyroid carcinoma

● Oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)

○ Diabetes d rugs

■ Pi oglitazone (also rosiglitazone) causes weight gain → Pig -glitazone

■ Fat, pig-like, rosy-faced golfer ( pioglitazone and rosiglitazine bind PPAR-gamma (par like golf)

○ Other endocrine drugs: Demeclocycline → ADH antagonist used in the treatment of SIADH!!!

● Gastrointestinal○ Retroperitoneal structures: Most of pancreas is retro, but not t ail → tail wagging can´t be constricted to retro!

○ Digestive tract anatomy

■ M uscularis externa → Includes Myenteric plexus ( Auer bach’s → Lift weights with Musc les for an

Auer ) → This muscle plexus handles motility, which is logical (muscle!); the other plexus

(submucosal, or M eissner’s) regulates secretions/blood flow/absorp tion

■ Relative peristalsis frequency works alphabetically → Duodenum ( f irst letter is f astest; 12

waves/min) > Ileum (8-9 waves/min) > S tomach (3 waves/min)

○ GI blood supply and innervation

■ Foregut and midgut are supp lied by vagus; hindgut (like butthole) supplied by pelvic n. (anal sex)

○ Portosystemic anastomoses

■ Portal HTN → Varices of gut , butt and caput

● Gut → Left gastric v. connects to esophageal v. → Esophageal varices (can rupt ure and

kill via massive hemorrhage)

● Butt → Superior rectal v. connects to middle/inferior rectal vv. → Internal hemorrhoids

● Caput → Paraumbilical v. connects to superficial and inferior epigastric vv. → Caput

medusae

○ Order of things in Femoral Triangle: NAVEL (lateral to medial) Nerve, Artery, Vein, Empty, Lymphatic

○ Hernias

■ IN direct hernia → Goes through the IN ternal (deep) inguinal ring and IN to the scrotum and occurs

in IN fants (due to failure of p rocessus vaginalis to close; can form hy drocele)

■ Direct hernia →

■ Location of hernias: Long Island MD (LIMD ) (or, alternatively, MD s don’t LI e)

● Lateral to inferior epigastric a. = Indirect hernia

● M edial to inferior epigastric a. = D irect hernia

■ FEM oral hernia → FEM inine → More common in women

Salivary secretion_ Parotids release most serous substance; sublingual release most mucinous substance →S erous on the S ides (parotids), M ucinous in the M iddle (sublingual);

Nutrient absorp tion: Fructose is taken up by Facilitated diffusion by GLUT-5 (unlike glucose and galactose, which undergo

cotransport with Na via the SGLT1)

○ Plummer-Vinson Syndrome: esophageal webs, Glossitis, Fe-deficient anemia

○ RFs for esophageal cancer (A-H)

■ Achalasia

■ Barrett’s


20/33

■ C igs

■ D iverticuli

■ Esophageal webs/ Esophagitis

■ Familial

■ GERD

■ Hot Dogs (nitrosamines)

○ Malabsorption syndromes → These Will C ause Devastating A bsorp tion Problems

■ T ropical sprue → Tails (follows) celiac sprue (similar to celiac sprue)

■ Whip ple’s disease → C ardiac problems, Arthralgias, Neurological problems

■ C eliac sp rue

■ D isaccharidase deficiency

■ A beta-lipoproteinemia → Decreased apoB

■ Pancreatic insufficiency

○ Gastritis

■ Acute gastrit is

● Curling ’s ulcer → Gastritis due to a burn; sloughing of gastric mucosa →

● Cush ing’s ulcer → Brain injury causes increased vagal stimulation, thus increased ACh,

thus increased H production, thus ulcer → Always CUSH ion the brain■ Chronic Gastrit is

● Type A ( fundus/body ) found above type B ( antrum ) b/c A comes before B

● Type A → Autoimmune, Auto.AB t o p arietal cells, pernicious Anemia, Achlorhydria

● Typ e B → Caused by H. py lori infection (most common)

● AB paring: Type A → Pernicious Anemia affects gastric Body

○ Type B → Bacterium affects Antrum

○ Men etrier’s Disease → Stomach rugae look like brain; due to the fact that t hey are sup er hyp ertrophied

○ Gastric Ulcer vs. Duodenal Ulcer

■ Gastric → Pain is G reater with meals (results in weight loss)

■ Duodenal → Pain is Decreased with meals (results in weight gain)

○ Inflammatory bowel disease■ Crohn’s , think of a fat gra nny and an old crone skipping down a cobblestone

■ Fat → Creeping fat Granny → Noncaseating gran uloma Skipping → Skip lesions Cobblestone

→ Cobblestone mucosa Away from wreck → Rec tal sparing

■ The other typ e of IBD is ulcerative colitis → Always with rectal involvement is implied by

“colitis”; starts with rectum and works its way up

○ Meckel’s diverticulum → The five 2’s

■ 2 inches long, 2 feet from ileocecal valve, 2% of pat, first 2y , 2 epithel (gastric/pancreatic)

○ Colorectal cancer

■ Gardner’s Syndrome: FAP + osseous/soft tissue masses, retinal hyperplasia

■ Turcot’s syndrome: FAP + malignant CNS tumor → TUR ban around the head

○ Carcinoid tumor

■ May have carcinoid syndrome (secondary to 5-HT p roduction from the neoplasm; ONLY seen if

has metastasized beyond GI, as 5-HT from GI will be removed by first pass effect)

Wilson’s disease The ABCDs of Wilson’s diseaseA → Asterixis B → Basal ganglia degeneration (PD Sx) C

→ C eruloplasmin decrease, C irrhosis, C orneal deposits (Kayser-Fleischer rings), C opp er accumulation,

C arcinoma (hepatocellular), C horeiform movements D → Dementia

○ Hemochromatosis: Hemochromatosis C an C ause Deposits → C irrhosis, C HF, D iabetes mellitus

○ Causes of acute pancreatitis → GET SMASHED

■ G → Gallstones


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■ E → Ethanol

■ T → T rauma

■ S → S teroids

■ M → M umps

■ A → Autoimmune diseases

■ S → S corion sting

■ H → Hypercalcemia/ Hyperlipidemia

■ E → ERCP

■ D → D rugs (e.g. sulfa drugs)

○ RFs for Gallstones Fat, Female, Forty, Fertile:

○ Porcelain Gall Bladder → GB w/ dystrophic calcification

○ H2 blockers

■ Take H2 blockers before you DINE → All end in -dine (cimeti DINE , raniti DINE , famoti DINE ,

nizati DINE ); remember the 2 in H 2 with “table for 2”

○ Trip le therapy : PPI, M etronidazole, Amoxicillin (or Tetracycline), Bismuth → P lease MA ke Tummy Better

○ Misoprostol → A PGE1 analog → Miso- PROS -tol, similar to a pros taglandin

○ Ant acids: Alu mininum hydroxide → Causes constipation, or a MINIMUM amt of feces

■ Mag nesium hydroxide → Causes diarrhea○ Ondansetron → A 5-HT3 antagonist, control vomiting post operatively and in chemo patients

xHematology and Oncology○ WBC differential from highest to lowest → Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils

→ N eutrophils Like M aking Everything Better

○ Eosinophilia ( DNAAACP ): D rugs Neoplasms Atopic disease (asthma, allergies) Addison’s Acute Interstitial

Nephrit is C ollagen Vascular Disease Parasites (invasive)

○ The intrinsic and extrinsic pathways meet at factor X and activate it → Like two teams racing for a treasure,X marks the sp ot

■ PT comes before PTT alphabetically; extrinsic comes before intrinsic alphabetically; thus PT goes

with extrinsic, PTT goes with intrinsic

○ Coagulation cascade components

■ Vitamin K is needed to synthesize 2, 7, 9, 10 AND protein C/S (two things)

■ Heparin activates antithrombin, which inactivates 2, 7, 9, 10 AND 11/12 (two things)

○ Basophilic stippling → Bas te the ox TAIL → Caused by Thalassemias, Anemia of chronic disease, Iron

deficiency, Lead poisoning

○ Pathologic RBC forms

■ Causes of target cells → HALT said the hunter to his target → H bC disease, Asplenia, Liver

disease, Thallasemia. Can also rearrange to THAL to better remember Thalassemia○ Hb Bart s → All gamma (gamma4), or all fetal → Like Bart Simpson, who is a child and for kids

○ Lead poisoning

■ LEAD → Lead lines on gingivae (Burton’s lines) and on ep iphy ses of long bones on x-ray;

Encephalopathy and Erythrocyte basophilic stippling; A bdominal colic and sideroblastic Anemia;

D rops (foot and wrist), D imercaprol and E DTA 1st line of treatment

● Suc cimer is first line of treatment for kids → It “ suc ks” to be a kid who eats lead

○ Autoimmune hemolyt anemia: Warm agglutinin is Ig G → Warm is GGG reat. Cold is IgM → Cold ice cream,


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MMM

○ Porp hy rias

■ Porphyria cutanea tarda → Caused by a defect in uropor phyrinogen dexarboxylase, get buildup of

uroporphyrin (causing tea colored urine)

■ Acute intermittent porp hyria → Defective enzyume is porp hobilinogen deamine, leading to buildup

of p orphobilinogen

● Por-phob -ilinogen → Poor FOB (like fresh off t he boat fob) → T hey are here acutely

and intermittently because they are deported

■ Disseminated Intravascular Coagulation (DIC)

● Caused by → S epsis (gram-negative), T rauma, O bstetric compli, acute Pancreatitis,

M alignancy, Nephrotic syndrome, T ransfusion → STOP M aking New Thrombi

○ Non-Hodgkins lymphoma subtypes

■ Mantle cell lymphoma → CD5+ → Men high 5 more commonly

■ Adult T cell lymphoma → Caused by H TLV-1, adult presents with cu Taneous lesions

■ Burkitt lymphoma: c-myc, "starry sky".t(8:14)

○ Mult iple myeloma CRAB: C → hyper C alcemia R → R enal insufficiency A → Anemia B → Bone lytic

lesions/ Back pain. (monocloncal plasms cells have f ried-egg appearence )

■ Lots of M s → M ultiple Myeloma: M onocloncal M protein spike that is Ig M

○ Chromosomal translocations

■ CML → t(9;22), the Philadelphia chromosome → Philadelphia C reaML cheese

■ Burkitt's: t(8;14) → Uppercase B looks like an 8

■ Mant ll e cell → t( 11 ;14) → ll implise 11 ; Increased cyclin-d 1 so crazy increase in cell cycle rate

■ Follicular → t(14;18) → Fourteen starts with F

■ Ewing’s sarcoma → t(11,22) → Patrick Ewing’s number was 33, which equals 11 + 22

○ CMP dz : My elofibrosis is fibrotic obliteration of the bone marrow; teardrop cells are seen

○ Heparin

■ For rapid reversal of heparin effects, us prot amine sulfate → A positively charged molecule that

binds the negatively charged heparin → Positively charged like a prot on■ Lepirudin and bivalirudin directly inhibit thrombin, and are used as a heparin alternative in patients

with heparin induced thrombocytopenia (HIT) → Lepi- rudin and bivalirudin are rude in that

they take heparins job and make it worthless

■ He PAR in → PAR tial thromboplastin time (PTT); warfarin is the other one (prothrombin time, PT)

○ Cancer drugs

■ dACT inomycin is used for childhood tumors, including Wilms’ tumor, Ewing’s sarcoma,

rhabdomyosarcoma → Children ACT out

■ 6-MP... picture an MP(military policeman or woman ) blowing kisses=XO (xanthine oxidase)■ 5-FU... Fotosensitive

■ Busulfan & Bleomycin... The 2 B's blow up your Bronchi

■ CY-clophosphamide... Hemmorhagic CY-stitis■ Nitrosoureas... most have "must" in their names... I picture them as alcoholics that are acting crazy

= Those Alky's MUST be Crazy = alky agents, CNS tox.

■ Cisplatin... "I heard platinum crosses the kidneys" = heard(oto-tox), crosses(X-linking), kidney(RF)

■ Carmustine = CAR-MUST-ine = "I drove a CAR (Mustang) across the BBB"

■ DoXorubicin is more toXic than Duanorubicin

■ eTOP oside → inhibits TOP oisomerase II, thus increasing DNA degradation

■ Vin cristine, vin blastine → Alkaloids that bind to tubulin in M-p hase and block polymerization of


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microtubules so that mitot ic spindle cannot form → Microtubules are the vines of your cells

■ Pacli TAX el and other TAX ols → Hyperstabalize polymerized microtubules in M-phase so that

mitotic spindle cnanot break down (anaphase cannot occur) → It is TAXi ng to stay polymerized,

but the TAX ols make it happ en; also, t hese drugs are used t o t reat ovarian and breast carcinoas → It

is TAX ing to be a female, having a period and such; also, females are very sensitive about

everythnig, so these drugs cause hyper sensitiv ity

■ CisPLATin, carbo PLAT in → Causes acoustic nerve damage → When you drop a PLAT e it makes a

loud horrific shattering sound, damaging your acoustic nerve

Bortezomib -Bart likes going to M ultiple M cdonalds ( M ultiple M yeloma).- treatment for refractory

Multiple myeloma.Toxicity-Going to M cdonalds t o often will Produces nausea, diarrhea, weakening of

muscles, bone marrow sup pression, peripheral neuropathy , fever, anorexia, anemia and const ipation.

Trastuzumab- cant trust a girl with big boobs so you have to block her with MAB(monclonalAB).

Toxic-she is also going to hurt your heart when combined with Adriamycin .

■

● Musculoskeletal and Connective Tissue

○ Epithelial cell junctions

■ Zona adherens has Actin attached to it; composed of cad herins ( C a2+ dependent ADhesion

molecules) which sound like adh erens; these cadherens connect to the actin

■ Macula adherens: K eratin (intermediate fillament) attached to desmopla K in

■ Desmosome vs hemidesmosome

● HEMI-desmosome has more letters; it thus corresponds to the disease with more letters

(bullous PEMPHIGOID (10 letters)); also, antibodies to the hemidesmosome are

BULLO w t he dermis

● Desmosome has fewer letters; it thus corresponds to the disease with fewer letters

(PEMPHIGUS (9 letters) vulgaris)

○ Unhappy triad (knee injury)

■ In the knee, you have menisci, collateral ligaments, and cruciate ligaments■ MAL → Like Prof. Mal, who was big like a football player (this is a common football injury when a

player is hit from the side)

○ M → M edial collateral ligament

○ A → Anterior cruciate ligament

○ L → Lateral meniscus

■ Positive anterior drawer indicates tearing of the ACL

○ Rotator cuff muscles: SItS → S upraspinatus, Infraspinatus, Teres minor (small t for minor), S ubscrapularis

○ Upper extremity innvervation

■ If you do a RAD jump on a skateboard, you may hurt y ourself and get crutches → Incorrect use of

crutch can cause RAD ial nerve compression

○ Brachial plexus■ Comp osed of R oots, T runks, D ivisions, C ords, Branches → R andy T ravis D rinks C old Beer

○ Carpal bones : S caphoid, Lunate, T riquetral, P isiform, T rapezium, T rapezoid, C apitate, Hamate → S ome

Lovers T ry Positions That They C an’t Handle

○ Upper extremity nerves

■ Being rad is the BES T → Radial nerve innervates the “BEST” extensors

● B → Brachioradialis

● E → Extensorts of wrist/fingers


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● S → S upinators

● T → T riceps

■ Erb- Duch enne palsy is waiter’s tip palsy → Waiter’s at restaurants tend to be douches

■ Klum pke’s palsy → claw hand

○ Hand muscles

■ Thenar & ulnar muscle groups have same functions: O pp ose, A bduct, and Flex, OAF

■ Dorsal interosseous muscle Abduct the fingers; Palmar interosseous muscle Adduct the fingers

● DAb with a PAd

■ Ulnar nerve supplies the wimpy stuff

● Tiny wimpy little pinky

● Tiny wimpy little interosseous muscles

○ Lower extremity nerves

■ PED → Peroneal Everts and Dorsiflexes; if injured, foot drop PED (dorsiflex = extend foot)

■ TIP → T ibial Inverts and P lantarflexes; if injured, can’t stand on TIP toes

○ Sarcomere: Z line → Z is at end of alphabet, Z line is at end of sarcomere. H → Thick letter, so only thick

filaments. I → Thin letter, so only thin filaments. A band is Always the same length; HIZ shrinkage

○ Muscle fibers: One slow red ox → Ty pe 1 fiber slow twitch; red mito+myoglobin; more ox idat metabol

○ Bone mineralization diseases■ Osteo POR osis → Decreased primarily trabecular (spongy) bone mass (i.e. the type with pores ;

also the decrease in bone mass is like creating pores )

■ Osteo PET rosis → Failure of bone breakdown

■ Osteomalacia → vitamin D deficiency; low Vit D, low blood Ca2+, low bone mineralization

■ Page t → Page is a girl’s name → Girls can never make up their minds; absorp tion & resorp tion

■ Ewing’s sarcoma: onion skin appearence → Ewings and onion rings t 11;22 translocation

○ Gout: Crystals are negatively birefringent; ye ll ow cryst als under para ll el light

○ Pseudogout: calcium Pyrophosphate crystals cause Pseudogout and t hey are Positively birefringent

○ Infectious arthritis: N. gonorrhoeae, STD → S ynovitis (knee), Tenosynovitis ( hand), Dermatitis (pustules)

○ Skin disorders: Macule is a small patch, Papule is a small plaque

■ Acanthosis nigricans is hyp erplasia of the stratum spinosum■ Staph scalded skin syndrome (SSSS) → Affects stratum granulosum

■ Lichen P lanus → Pruritic, Purple, Polygonal, Papules!

○ Arachidonic acid products

■ Lipoxygenase pathway yields Leukotrienes

■ LT B4 → Neutrop hil chemotactic agents; neutrop hils arrive B4 other cells

■ PGI 2 inhibits platelet aggregation → Platelet Gathering Inhibitor

○ Bisphosphonates: corrosive esophagitis and osteonecrosis of t he jaw

○ TNF-alpha inhibitors

■ Etanercept → Etaner CEPT is TNF decoy re CEPT or

■ InFLIX imab → Predisposes to infections, such as reactivation of TB

● Neurology○ CNS/PNS origins

■ from neuroectoderm, neural crest, and mesoderm; m icroglia, like m acrophages, from m esoderm

■ Neural crest → Schwann cells and P NS neurons; think of a family crest with a Pear and a swan

○ Sensory corpuscles

■ Pac inian corpuscle → Associate with tu PAC

● Sense → Vibration and pressure, like Tupac’s fly ass rap music with thumping bass


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■ Meiss ner’s corpuscles → Picture an old meiss erly gentleman

● Seen in glabrous (hairless) skin → Old men are bald, hairless

○ While Merkel’s adapts slowly, M eissner’s adapts quickly; thus while Merkel’s

handles st atic touch, Meissner’s handles dy namic touch

○ While Marker’s handles hair follicles, Meissner’s glaborous (hairless) skin

● Free nerve endings are made up of C and ADelta fibers → “You C an AD for free ”

○ Neurotransmitters: Nucleus ac CUM bens → Reward center, pleasure, addiction; like CUM ming

● Also makes GAB A, because GAB rielle Union makes you cum

○ Hypothalamus

■ wears TAN HATS: T hirst & water balance, Adenohyp ophy sis control, Neurohyp ophy sis releases

hormones from hypothal, Hunger, Autonomic regulation, T emperature regulation, S exual urges

■ lateral nucleus of the hypothalamus handles hunger → zap lateral nucleus, you shrink laterally

■ The ventromedial nucleus handles satiety → zap ventromedial nucl, grow ventrally and medially

○ Posterior pituiatary (neurohypophysis) Adenohypophysis → Anterior pituitary

○ Thalamus

■ VP M relays face sensation and taste; VPL relays

pain/temperature/pressure/touch/vibration/prop riocept ion for the body● M akeup goes on the face (VP M )

■ LGN → Relays vision information; M GN → Relays auditory information

● Lateral = Light; M edial = M usic

○ Limb ic system → The famous 5 Fs, one of which being fucking; you use your “ limbs ” to finger or fist

someone

■ Responsible for Feeding, F leeing, F ighting, Feeling, and Fucking

○ Cerebellum

■ Deep nuclei, from medial to latereal → Fastigial, G lobose, Emboliform, Dentate → Fat Gerbils

Exercise Daily (note useful association with movement)

○ Basal ganglia

■ D1 receptor is involved in the direct/excitatory p athway, whereas D2 recept or is involved in theindirect/inhibitory pathway

● D1-R is used in the D1R ect pathway

● Indirect pathway is Inhibitory

○ Cerebral cortex functions

■ Princip le motor area is anterior to principal sensory areas, just like motor is in the front of a car

○ Brain les ions

■ AMY gdala lesion (bilateral) → Kluver- Bucy syndrome (hyperorality, hypersexuality, disinhibited)

■ Cerebellum: Cerebellar hemispheres are laterally located and affect lateral limbs (intention t remor,

limb ataxia); vermis is centrally located and affects central body (truncal ataxia, dysarthria)

■ Contralateral hemi BALL ismus occurs due to lesion to SUB thalamic nucleus

■ Eye movement problems

● SUPERIOR colliculus lesion causes paralys is of UPWARD gaze

● Front al eye field lesion makes eyes look toward lesion → You look at something that is

right in front of you

● Par amedian pontine reticular formation (PPRF) lesion makes you look away from the

lesion → You look toward the par iphery

○ Aneury sms

■ Causes of berry aneurysm include Ehlers-danlos, M arfan’s, and Adult poly C ystic kidney disease

■ C harcot- Bouchard microaneurysms → chronic HTN; C hronic- BP p roblem microaneurysms


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○ Spinal nerves

■ 31 spinal nerves, just like there are 31 flavors at Baskin Robbins. 1 cocc ygeal nerve, 1 cock

○ Spinal cord, Lower extent

■ Lumbar puncture is usually p erformed in L3-L4 or L4-L5 interpsaces, at level of cauda equina →

To keep the sp inal cord alive, keep the spinal needle between L3 and L5

○ Spinal cord and associated tracts

■ Legs are Lateral in Lateral corticospinal (voluntary motor), sp inothalamic tracts (pain/temperature)

■ Dorsal collumn is organized as you are, with hands at sides; arms outside (the laterally placed

fasciculus cuneatus carries info from up per body , extremities), legs inside (the medially placed

fasciculus gracilis carries info from lower body, extremities)

■ Intermediate horn with sympathetic fibers is in thoracic spinal cord only → You should have

SYMP athy for THOR because he is forced to use hammer

○ Werdnig-Hoffman disease: AR, infantile spinal muscular atrophy . Floppy baby with tongue fasciculations;

median age of death is 7 months; degeneration of anterior horns (LM N)

○ Amyotrophic lateral sclerosis (AML, or Lou Gehrig’s disease)

■ Both UMN and LMN signs, but no sensory/cognitive/oculomotor deficits. Stephen Hawking smart

like a super human mutant , ALS can be caused by defect in super oxide dis mut ase 1 ( SOD1 )

○ Friedrich’s ataxia: AR trinucleotide repeat disorder (GAA) in gene that encodes frataxin○ Landmark dermatomes

■ C6 → Stick arm out like crucifixion stance. Curl your thumb and forefinger into an "OK"

symbol while keeping your other fingers s traight. Your hand should now look like a 6 shape. So C 6

dermatome is your thumb and top of arm (reason for crucifix stance).

■ C7 includes the middle finger → C7 give sthe middle finger to heaven

■ T4 is at the nipple → T4 is at the teat pore

■ T 7 is at the Xiphoid process → 7 has a line that is identical to p art of the X of Xiphoid process

■ T10 is at the umbilicus (important for early appendicitis pain referral) → T10 is at belly but TEN

■ L1 is at the Inguinal Ligament → L1 is IL

■ L4 includes the kneecaps → Down on L4s (all fours )

■ S2, S3, S4 are responsible for erection and sensation of penile and anal zones → “ S2, 3, 4 keep the penis off the floor”

○ Clinical reflexes. Reflexes count up in order, from the bottom to the top

● Achilles → S1, 2

● Patella → L3, 4

● Bicep s → C5, 6

○ Biceps before T riceps alphabetically

● Tricep s → C7, 8

○ Primitive reflexes

■ Rooting reflex → Movement of head toward one side if cheek or mouth is stroked (nipp le seeking)

■ Moro reflex → “Hang on for life” reflex; baby that is st artled will abduct/extend limbs,Brain stem

■ CNs that lie medially at the brain stem → 3, 6, 12 ; 3(X2) = 6(X2) = 12

● All motor → Motor = M edial

■ Superior colliculi are the conjugate vertical gaze center; inferior colliculi are for auditory info

● Your eyes are above your ears, and superior colliculus (visual) is above the inferior

colliculus (auditory)

■ Parinaud syndrome → Paralysis of conjugate vertical gaze due to lesion in superior colliculi; makes

you parinaud (paranoied) bc you don’t know what’s above you

Cranial nerves

■ To determine if the nerve is S ensory, M otor, or Both → S ome (1) S ay (2) M arry (3) Money (4)


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But (5) M y (6) Brother (7) S ays (8) Big (9) Boobs (10) M atter (11) M ost (12)

■ Salivation: Facial controls submandibular, sublingual; Glossopharyngeal ( 9) controls Parotid → Flip

the 9 over and have a P for Parotid

■ Cranial nerve nuclei: Medial nuclei are M otor

■ Vagal nuclei

● nucleus S olitarius → visceral S ensory information (e.g. taste, baroreceptors, gut

distension)

● nucleus a M biguus → M otor innervation of pharynx, larynx and upper esophagus (e.g.

swallowing, palate elevation)

○ Cranial nerve and vessel pathways

■ Cranial nerve V has V1, V2 and V3, which leave the skull at the S uperior orbital fissure, foramen

R otundum, and foramen O vale, respectively → CN V leaves because it is S tanding R oom O nly

○ Cranial nerve lesions: In a CNXII lesion, the tongue deviates towards the side of the lesion → You want to

lick your wounds

○ Facial nerve lesions: Bell’s palsy is a complication of AIDs, Ly me disease, Herpes, Sarcoidosis, Tumors,

Diabetes → ALexander gra Ham Bell with an STD

○ KLM sounds: Kuh-kuh-kuh tests palate elevation (CN X); La-la-la tests tongue (CN XII); mi-mi-mi tests lips

(CN VII) → It would be a KaLaMity to lose Cn X, XII nad VII○ Mastication muscles

■ 3 muscles close jaw: Masseter, te M poralis, M edial p terygoid; 1 muscle opens: Lateral pterygoid

● M ’s M unch

● Lateral Lowers (i.e. lowers the jaw down, as in op ening the mouth)

● “It takes more muscle to keep y our mouth shut”

○ Glaucoma: Op en/wide angle. Seen in African-Americans, old peop le most commonly → Black girls have wide

asses; old people get fat and have wide asses

○ Extraocular muscles and nerves

■ CN 6 supplies the Lateral R ectus; CN 4 supplies the S uperior O blique; CN 3 supplies the R est →

LR4SO4R3

■ The inferior oblique performs EX cyclotorsion, while the superior oblique performs IN cyclotorsion→ “My EX is INFERIOR to my current girl” and “the SUP is IN the kitchen”

■ CN III lesion → Eye looks down and out

● “I’m down and out because I’ve never had a three -some”

● 3 is half of 6 (devil’s number), so it makes you sad ( down and out )

■ Testing extraoccular muscles

● To test Inferior O blique, have patient look U p (also slightly nasal, as the oblique muscles

work for elevation/depression when the eye is adducted) → IOU

○ Superior oblique is down (and a bit nasal), or the opposite

■ Pupillary control

● Constriction (miosis; can remember that miosis is constriction because it is a tiny little

word relative to mydriasis, and thus can better “fit” into the small pupil)

○ Pupillary sphincter muscle via Parasympathetics

● D ilation (my D riasis) → Radial muscle

■ Cranial nerve 3 in cross section

● M iddle is Motor; Periphery is Parasympathetic

○ Visual field defects

■ Central scotoma is macular degeneration in retina, causes visual defect like a little ball where macula

is → central scrotom a filled with balls

■ Mey er’s loop is lateral and goes inferior to lingual gyrus → Mey lats are inferior to Arnold’s,


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but I make up for it by giving awesome oral sex ( lingual gyrus)

○ Internuclear ophthalmoplegia (MLF syndrome): M LF sy ndrome is seen in M S

○ Dementia: Alzheimer’s disease (Early onset form associated with the pres enilin-1 and pres enilin-2 genes)

■ Lewy body dementia → alpha- S YN uclein defect seen histologically → Lewd and SYN ful

○ MS: Charcot’s triad is SIN: S canning speech, Intention tremor, Incont, I NO (M LF), Nystagmus

■ Tub erous sclerosis → Think wild hot Tub party: People fuck in hot tubs, so associated with

SHAG reen patches. Someone is getting hammered, so this disease is based on hamar tomas. People

are smoking weed in the hot tub, so they have ash leaf spot s

○ Meningitis: fever, headache, nuchal rigidity , and Kernig’s sign: With p atient supine, Dr flexes pat hip but

cannot extend the knee without causing pain (stretches meninges, pain seen with meningeal irritation).

○ Opoid analgesics

■ M u receptors bind M orphine; Delta receptors bind EN kephalin; Kap pa receptors bind DYnorphin

(if you get “ cap ped” (slang for gett ing shot) you “ dy”)

○ Inhaled anesthetics

■ Halothane is Hepatotoxic

■ Enflurane is a p roconvulsant, or it has E p ilept ic sides

■ Meth oxyflurane is nephrotoxic → Meth is Neph

○ IV Anes thet ics■ Barbiturates, Benzodiazepines, K etamine, O p iates, Propofol → B . B. K ing on OPIATES

PROP oses FOOL ishly

■ Midazolam is most common drug used for endoscopy → Use Mid -Az -olam when you want to p ut

an endoscope in the Mid dle of someones Az (ass)

■ Propofol is associated with high triglycerides, milky blood, pancreatitis

■ Local Anesthetics: -caine ;

■ Either esters or am Ides; the am Ides have 2 Is → L Idoca Ine, mep Ivaca Ine, bup Ivaca Ine

○ Parkinson’s disease treatment

■ The drugs used to treat PD are the BALSAC drugs (which is logical, since it is fun to expose your

ballsac the park ) → Bromocriptine, Amantadine, L-dopa, S elegiline, Antimuscarinics, C arbadopa

■ Benz trop ine is an antimuscarinic improves tremor and rigidity but has little effect on bradykinesia■ enta CAPONE and tol CAPONE are COMT inhibitors that prevent L-dropa degradation

Sumatriptan → 5HT1B/1D agonist (5-HT being seritonin, hy droxy TRYP tamine), used t o t reat

headaches (cluster, migraine) → A SUM o wrestler TRYP s and falls on your head .

● Psychiatry○ Intelligence quotient: Stanford-Binet → Calculates IQ as (Mental age/Chronological age)*100

○ Freud’s structural theory of the mind

■ Unorganized part of p ersonality structure that contains the basic drives; food, sex, aggression →

The Id is all about t he Instincts

■ Super ego is all about being just SUPER moral

○ Ego defenses■ The mature ego defenses are S ublimation, Altruism, S upp ression, and Humor; commonly found in

emotionally mature adults ( in contrast, some of the others are immature or even pathological)

● Mature women wear a SASH

○ Infant deprivation effect: 4 Ws, deprived babies Wah, Wah, Wah, Wah → Weak (no muscle tone, weight loss,

phys ical illness), Wordless (poor language), Wanting (poor socialization skills), Wary (no trust)

○ Orientation: Order of loss → 1st time, then place, then person last

○ Delirium vs. Dementia → Deli RIUM has changes in senso RIUM (waxing/waning consciousness,


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hallucinations, disorganized thinking, illusions misperceptions) ; deMEM tia has MEM ory loss

■ del- EE -rium has an abnormal EE G, whereas dementia does not

○ Hallucination types. hypna GO gic hallucination → Occurs while GO ing to sleep. hypno POMP ic hallucation

■ AT ypical Depression is FAT ypical depression → hypersomnia (fat person is lazy and sleeps all

the t ime), overeating (fat), weight gain (fat), sensitivity to rejection (happens to fat p eople a lot)

○ Antipsychotics (neuroleptics)

■ These drugs are haloperidol and the -azines (ex. fluphenazine, thioridazine)

■ C hlorpromazine → C orneal deposits

■ Thiordazine → re T inal deposits

■ These drugs can cause neuroleptic malignant syndrome (NMS), which can have hyp erpyrexia

(fevers great than 106.7 degrees!!!) → T hus the menmonic for NM S is FEVER

● F → FeverE → EncephalopathyV → Vitals unstableE → Elevates enzymes (muscle

breakdown, myoglobinuria)R → R igidity of muscles

○ Atypical antipsychotics

■ Atypicals include ol anzapine, cloz apine, quet iapine, risper idone, a ripiprazole, z iprasidone → It’s

atypical for ol d clos ets to quiet ly risper from A to Z

■ Olanzapine and clozapine: weight gain, you can’t wear your OL d CLOZ (clothes) anymore■ Clozapine: agranulocytosis (requires weekly WBC monitoring) → Must watch cloz apine cloz ely

○ Tricyclic antidepressants: Side effects

● The TRI -C yclics cause the tri-C s → C onvulsions, C oma, C ardiotoxicity (arrhythmias)

● Old people can get confusion and hallucinations due to the anticholinergic side effect of

TCAs, so must give them no r trip tyline (this is a secondary TCA; they have fewer

anticholinergic effects) → To prevent the old p erson from have a bad trip , give them

NO -r-TRIP tyline

● Renal○ Acidosis/alkalosis

■ In metabolic acidosis, check the anion gap. Causes of increases anion gap → MUDPILES

(remember that when a pile builds up, something is increased)

● M → M ethanol (formic acid)

● U → Uremia

● D → D iabetic ketoacidosis

● P → Paraaldehyde/ Phenformin

● I → Iron tablets or I NH

● L → Lactic acidosis

● E → Ethylene glycol (oxalic acid)

● S → S alicylates/ S hock ■ Renal tubular acidosis

● Ty pe 1 → “Distal” renal tubular acidosis → Defect is at the level of the collecting duct; it

cannot excrete H+ → The number 1 is a big straight line similar to the way the collecting

duct is always drawn

● Ty pe 2 → “Proximal” renal tubular acidosis → Remember that p roximal comes right after

distal

○ Pro-two-type (like pro-to-type) → This word links “pro” and “to”


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● Ty pe 3 → Nothing; a lot of people link 3 or 333 and the devils number 666; thus do not

wanta 3. 666 is especially bad/scary if you are on ACID

● Type 4 → Hyperkalemic.

○ 60-40-20 rule: TBW is 60% of body weight; ICF is 40% of body weight; ECF is 20% of body weight

○ Measuring fluid compartment volumes

■ Mannitol measures ECF → Mann-E, like the name Manny

■ evans BLUE measures P lasma → BLUE-P er → Blooper

■ Radioiodinated serum albumin

○ NephrItic syndrome → Inflammatory process; vs. NephrOtic → massive prOtei nuria

■ Rapidly progressive (crescentic) glomerulonephritis (RPGN)

● RPG N → Like an RPG video game → These games are notorious for having good music

→ Caused by Goodpasture, Wegener’s, M icroscopic poly angiitis → Games With M usic

● Remember crescent MOON shape becuase of the classic RPG game Harvest MOON

■ Diffuse proliferative glomerulonephritis

● See “wire looping ” of capillaries on LM → This condition is caused by lupus →

Wire- lupus lesion

■ Berger’s disease → Think of as “ boogers ” disease● Increased synthesis of IgA → Boogers are in the nose; the nasal mucous membrane is

associated with IgA antibodies; boogers have lots of IgA in t hem

● Often presents/flares with a URI or acute gastroenteritis → Often have lots of

mucous/ boogers when you are sick

● LM and IF show ICs deposited in the mesangium → Picture boogers in the mesangium

● MC in children /young adults → Children commonly pick boogers out of their noses

■ Alport’s sy ndrome → Can’t see (ocular disorders), can’t pee (nephritic syndrome), can’t hear

(deafness). M utation in ty pe 4 collagen

○ Nephr Itic syndrome → Inflammatory process; vs. Nephr O tic → massive pr O teinuria

■ Minimal change → change is minimal , normal LM (but on EM can see foot process effacement)

● Minimal change disease is MC seen in minimal age people (children,


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○ Drugs that cause gynecomastria

■ S ome D rugs C reate Awesome K nockers → Spiro, Digitalis, Cimetidine, Alc, Ketoconazole

■ Also, PHEM (like PHEM inine) → Psychoactive drugs, Heroin, Estrogen, M arijuana

○ Pharmacology

■ Leuprolide → GnRH analog with agonist prop erties when used in pulsatile fashion; antagonist

properties when used in a continuous fashion → Leu prolide can be used in lieu of GnRH

■ Ritodrine → Beta2-agonist that relaxes the uterus → Ritodrine allows the fetus to “ re turn to

dream s” by preventing early delivery

● Terbutaline does the same thing

■ Tamsulosin (Flomax) is selective for alpha1 A,D receptors (found on prostate); does not bind

vascular alpha1 B receptors → The prostate one binds the Asshole, D ick receptor whereas the

vascular one binds the Blood rece0ptor as well

■ Sildenafil (Viagra), vardenafil → NW: Headache, Heartburn, Hyp otension. Imp aired blue/green

vision → Viagra is the “little blue pill”

● Respiratory○ Pneumocytes → Lecithin to sphingomyelin ratio can be used to assess maturity of fetal lungs; mature when

lecithin:sphingo is > 2; you pick your nose with your SPHINGER (sphingomyelin), which is immature; thus

want this to be low in ratio to indicate maturity

■ Typ e I cells are thin like “I”; type II are cuboidal

■ Typ e II cells are precursors to both type I/II cells, 2 as in your are given a 2nd chance

○ Bronchopulmonary segm

Documents

Mnemonics for USMLE Step 1