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SECONDAID:USMLEMNEMONICS
Thisisalistofmedicalmnemonics,sidenotes,andgeneralizationsIwrotedownwhilegoingthroughmy2010FirstAid
bookwhilesupplementingwith2012Falcon,Kaplan,andabitofGoljan.Istoppedataroundthreequartersofthetext
becauseIgottiredandfeltlikenotmanypeoplewouldbeinterested(Update:sorry,butImtoobusytogobackand
typetherest!><).
P.S.Ifyouwanttofindatopicfast,IsuggestCtrl+F
BehavioralScience:
Statisticaldistribution:
Positiveskew=meAn>meDian>mOde
Positiveskew=alphabeticalfromgreatesttoleast
Reportablediseases:
ItwasreportedthatstudlyMr.Shigellaatesalmon,chicken,andliver:
ItwasREPORTEDthatSTuDlyMMRSHIGELLAaTBSalmon,Chicken,andLiver
STDs:AIDs,Gonorrhea,Syphilis,Chlamydia(*NOTHIV!)
MMR:Measles,Mumps,Rubella
Shigella
TB
Salmonella
ChickenPox
HepatitsA,B,C
Healthcarepayment:
CAREfortheElderly,AIDthedestitute
Medicareelderly,Medicaidlowincomepeople
Earlydevelopmentalmilestones:
#ofblocksstacked=ageinyears*3
2wordsentencesat2
peeatthreetricycleatthree
foursquareatfour=canhopatfour
drawings:
3yo=circle
4yo=+
5yo=square
6yo=triangle
Seereference:

Biochemistry:
Stopcodons:UGA,UAA,UAG
UGoAway,UAreAway,UAreGone
EXpressEXons,INtronsareINtheway
Protooncogenes:
Mikessisreturnedwithhertwonewbreastsshewasabletogrowbecauseofherbs.
MYCsSISRETurnedwithHER2NeubreastssheRASABLeToGrowBClofhERBs.
Myc
sis
ret
Her2/neu
ras
abl
TGFalpha
bcl2
ERBB1,B2
Collagen:Thehigherthenumber,thesmallerandsofteritgets
Type1bone(skin)OsteogenesisImperfecta(failedglycosylationandformationofprocollagentriplehelix
withER)
Type2cartilagedeathinutero
Type3bloodvesselsEhlersDanlos(failureofcrosslinkingbylysyloxidasetomakecollagenfibrils
outsidefibroblasts),berryaneurysms
Type4:basementmembraneAlportsnephritis(+deafnessandvisionproblemscantsee,cantpee,
canthear)
Blottingprocedures:
SNOW
DROP
S/D:Southernblot=DNAsampleidentifiedwithDNAprobe
N/R:Northernblot=RNAsampleidentifiedwithDNAprobe
O/O
W/P:Westernblot=proteinsampleidentifiedwithantibodyprobe
Modelsystems:
Knockout=takeageneOUT
Knockin=INsertagene

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Knockdown=knockdowntheexpressionofthegeneviacomplementarymRNAantagonist
Imprinting:
PraderWilli=Paternaldeletion
AngelMans=Maternaldeletion
Genetics:
AutosomalDominant:havefamilialorhereditaryinname+
ABrainyDwarfnamedMarfanvonHippelLindauhiredMENtoHuntforPotatoes.
Brainy=Neurofibromatosis1,2
Dwarf=Achondroplasia
Marfan
vonHippelLindau
MEN1,2a,2b
Huntingtons
Potato=Tuberoussclerosis
Xlinkedrecessive:
DukeFabrysBrutalGopherHunter,Lesch,WasActuallyaFragileAlbinoHemophiliac.
Duke=Duchennes
Fabry
Brutal=Brutons
Gopher>G6Pher=G6PDdeficiency
Hunter=Hunters
LeschNyhan
WasActually=WiskottAldrich
FragileX
ocularAlbinism
HemophiliaA,B
FragileX=Xtralargetestes,jaws,ears
FraGileX=cGgtrinucleotiderepeat
myoTonicdystrophy=cTgtrinucleotiderepeat
Autosomaltrisomies:PatEdDown=13,18,21
Pubertyat13,Electionat18,Drinkingat21
DownsyndromeisassociatedwithALL(andAML)andALzheimersanddecreasedALphafetoprotein>ALLfall
DOWNalsoassociatedwith:
DuodenalAtresia(failuretorecanalize=blindduodenum>biliousvomitingwithfirstfeeddoublebubble)
CeliacDisease(associatedwithdermatitisherpetiformis)
AnnularPancreas
Hirschprungcongenitalmegacolon(failureofneuralcrestcellmigration:noAuerbachorMeissnersplexus>
constipation/meconiumileus)
Edwards:watch99balloons
Pataus:rockerbottomPedals/feet,cleftlip/Palate,holoProsencephaly(sonichedgehogdeficiency),Polydactyly
Williamssyndrome:WillFarrellinElf:elfinfaces,mentalretardation,welldevelopedverbalskills,extremefriendliness
DiGeorgesyndrome:CATCH22
Cleftpalate
Abnormalfacies
Thymicaplasia(Tcelldeficiency)
Cardiacdefects
Hypocalcemia(secondarytoparathyroidaplasiarememberthirdpharyngealpouch:inferiorparathyroidsare
grownwiththymusanddescendtogether)
microdeletionatchromosome22q11
VitaminB1:Thiamine
Thiaminepyrophosphate(TPP)isneededforanumberofenzymes,butisrarelyrequiredalone.Wheneveryouneed
B1,youusuallyneedFAD(B2),NAD(B3),CoA(B5),andLipoicAcid,sojustgroupthemtogether:B1,2,3,5+LA.
EnzymesthatuseB1,2,3,5+LA:
Glycolysis/TCA:PDH(X=lacticacidosisTx:ketogenicLeucine,Lysine+highfatdiet)
TCA:alphaKGDH
HMP:transketolase
branchedchainAADH(X=MapleSyrupUrineDisease>severeCNSdefects,MR,anddeath)
Relatedproblems:
LipoicacidisantagonizedbyArsenic,whichcausesricewaterdiarrheaandgarlicbreath.
B1deficiencyinalcoholics>WernickeKorsakoff,beriberi
PDHdeficiency/dysfunction>inabilitytocontinueTCA>diversiontolacticacidosisbrainstarvesfor
energy>neurologicdefects.Tokeepbrainfromstarving,TxwithketogenicaminoacidsLEUCINEand
LYSINEandhighfatdiet(betaoxidationoffatswillproduceacetylCoA>TCA/ketogenesis).
VitaminB6:Pyridoxine
MajorpathwaysthatuseB6:
1.GlycogenolysisRLS:Glycogen>G1Pviaglycogenphosphorylase
2.HemesynthesisRLS:SuccinylCoA(TCA)+Glycine>deltaaminolevulinicacid(ALA)viadeltaaminolevulinic
acidsynthase
3.Cysteinesynthesis:Homocysteine+Serine>CystathioneviaCystathionesynthase(X=homocysteinuria:
MarfanoidSx+MR+atherosclerosis)
Note:CystinuriaduetoPCTreabsorptiondefect>staghorncystinekidneystonesTx:acetazolamideto
alkalinizeurine
4.ALT/ASTtransamination:
Alanine+alphaKG(TCA)<ALT>Pyruvate(glycolysis)+glutamate
Aspartate(Ureacycle)+alphaKG(TCA)<AST>OAA(TCA)+glutamate
5.Aminoacidproduction(hydroxylation,decarboxylationreactions):
1.tyrosinehydroxylation>dopadecarboxylation>dopamine
2.tryptophantoniacin/B3(noB6=noB3=Pellagra)
3.histidinetohistamine
4.glycinetoporphyrin(inhemeproductionnoB6=hypochromic,microcyticanemia)
5.glutamatetoGABA(noB6=lossofGABA=increasedexcitation>convulsions/seizures)
VitaminB12:Cobalamin
CofactorwhenyouseeMethinproductorsubstrate:
1.METHylmalonylCoA>SuccinylCoAviamethylmalonylCoAisomerase
2.homocysteine+NMETHylTHF>METHionine+THFviahomocysteinemethyltransferase
Absorbedintheileum(Crohns,gastricbypass,sprue,Diphyllobothriumlatum)withIF(perniciousanemia)useSchilling
testtodetermineifitsintake/absorptionorlackofIFproblem.B12storeslastforYEARS.Deficiencycausesan
increaseinmethylmalonicacid(peripheralneuropathy)andhomocysteine(megaloblasticanemia).
Othercausesofmegaloblasticanemia=folatedeficiency(incr.homocysteinebutnotmethylmalonicacid,sono
neuropathy)andchronicalcoholism.
VitaminB7:Biotin
WhileVitaminB6isneededforDEcarboxylationreactions(aminoacidproduction),B7isneededforCARBOXylation
reactions:
1.PropionylCoA(oddchainFA/branchedchainAAmetab)>MethylmalonylCoAviaproprionylCoAcarboxylase(which
goesontoformsuccinylCoAofTCAwithmethylmalonylCoAisomeraseandB12)
2.Pyruvate(glycolysis)>OAA(TCA)viapyruvatecarboxylase

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3.AcetylCoA(TCA)>MalonylCoA(FAsynthesisRLS)
AvidinineggwhitesAvidlybindsB7.
VitaminC:AscorbicAcid
1.IronabsorptionandFe2+statemaintenance
2.Collagensynthesis:hydroxylationofprolineandlysinewithinfibroblastER<SCURVY
3.dopamine>NEviadopaminebetahydroxylase,blockedbyReserpine
VitaminD:thelongestnamewitha1:(1,25(OH)2D3)Calcitriol=activeform(PTHstimulatesconversionoflivers
25OHvitaminDto1,25(OH)2D3inkidneyby1alphahydroxylase)
VitaminE:EisforErythrocytesitsanantioxidantthatpreventshemolyticanemiaandneurodysfunction
VitaminK:injectnewbornswithittomakesuretheyreoK(preventhemorrhage)deficiency=normalbleedingtime,but
increasedPTandaPTT
Note:
plateletdysfunction>BT
extrinsic(shorter)pathway>PT(shortername)VIImonitorw/Warfarin
intrinsic(longer)pathway>PTT(longername)monitorw/Heparin
Carbamoylphosphatesynthetase:"UP1,2.
UreacycleRLS:CPS1
PyrimidinesynthesisRLS:CPS2
HMGCoA___:
"YoualwayswanttoREDUCEyourCHOLESTEROL:HMGCoAreductase=RLSforcholesterolsynthesis
vs.HMGCoAsynthase=ketogenesis(yourbrainwantstoSYNTHESIZEKETONESwhentheresnoglucose)
RegulationbyF2,6BP:"2supports1:
PFK2supportsPFK1>glycolysis
F26BPsupportsF16BP>glycolysis
MOA:insulin>decreasescAMP>decreasesPKA>dephosphorylatedFBPase2=PFK2>F6PtoF26BP>
stimulatesPFK1>incrF6PtoF16BP(glycolysis)
Note:glucose>decreasescAMP>decreasesCAPcAMPbindingoflacoperon=RNApolymerasecantbindto
promoter
Glycolyticenzymedeficiency:RBCssolelydependonglycolysisforenergysonoPyruvateKinase/Phosphoglycerate
Kinase(ATPgeneratingsteps)=decreasedATP>cantmaintainmembranegradient>cellswells>hemolytic
anemia
HMPshunt/PentosePhosphatePathway:
G6P>Ribulose5P+2NADPHviaRLSG6PDH
Ribulose5P>Ribose5P>purinesynthesis
NADPH:
1.fattyacidandsteroidsynthesis
2.oxidativeburst(NADPHoxidaseX=ChronicGranulomatousDisease)
3.p450
4.glutathionereductaseAKARBCantioxidation
G6PDdeficiency=(xr)>noNADPH=noglutathionereductase=oxidativedamage=hemolyticanemia(bitecells
RBCspartiallyeatenbymacrophages(M0s),HeinzbodiesoxidizedHbthatprecipitatedinRBCs)
DrugsthatcausehemolyticanemiainG6PDdeficiency:
"PrimahadtotakeAspirinwhensheINHaledherI.B.ProfessorDapsonesSulfurousFavabeanNitroFarts.
Prima=Primaquine
Aspirin
INH(Isoniazid)
I.B.Professor=Ibuprofen
Dapsone
Sulfurous=Sulfonamides
Favabean
NitroFarts=Nitrofurantoin
CGD(chronicgranulomatousdisease,Dx:negativeNitrobluetetrazoliumreduction)=NADPHoxidasedeficiency>
susceptibletoCatalase+organisms:
TherecoilingRedAspwasntSorrytowardsthemoaningCatbecauseithadNoheart.
recoiling=E.coli
red=Serratia
Asp=Aspergillus
Sorry=S.Aureus
moaning=Pseudomonas
Cat=Catalase+organism
NoHeart=Nocardia
Disordersof__metabolism:
__kinaseistheenzymethatimmediatelyfollowsthebreakdownof__:
Glucose>G6PviaGluco(Hexo)kinase
Fructose>F1PviaFructokinase
Galactose>Gal1PviaGalactokinase
DeficienciesofFructoandGalactokinasescausesMILDsymptoms(respectivesugarsarepresentinurine).The
SEcondstepscauseSEveresymptoms(AldolaseBandUridyltransferase,respectively).
WatchoutwhenyouseeALDObecauseitmeanssomethingbadisgoingtohappen:
Glucose>SorbitolviaAldoseReductase+NADPH(CATARACTS)
Note:Sorbitol>FructoseviaSorbitolDH
Galactose>GalactilolviaAldoseReductase+NADPH(CATARACTS)
Fructose1P>GlyceraldehideandDihydroxyacetonePviaAldolaseB(FRUCTOSEINTOLERANCE)
Essentialaminoacids:
TVFILMHWRK(Threonine(T),Valine(V),PHENYLALANINE(F),Isoleucine(I),Leucine(L),Methionine(M),Histidine(H),
TRYPTOPHAN(W),ARGININE,LYSINE(K))
Negativelychargedaminoacids:
NegativeexperiencetobeburnedbyAcid:
Asparticacidandglutamicacid
Note:AspartateandGlutamate(asNacetylglutamate)areinvolvedinUreacycleeliminationofammonia
AminoacidswiththreetitratableH+:
RickyCantHateED
RKYCHED
Arginine12.5
Lysine(K)10.5
Tyrosine(Y)10.1
Cysteine8.2
Histidine(H)6
Asparticacid(E)4.3
Glutamicacid(D)3.7
ThenumbersarentimportantexceptforHistidine.JustknowtheorderandthatitgoesindescendingpHs.FYI:
COO=2,NH3+=9.5

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KNOW:Ketogenicaminoacids:
LeucineandLysine>USEDTOTREATPDHDEFICIENCY
Cycles:UreacycleandTCAoverlap:
OAA(TCA)+Glutamate<AST>Aspartate(Urea)+alphaKG(TCA)
Aspartate(Urea)+Citrulline(Urea)>Arginosuccinate(Urea)>Arginine(Urea)+Fumarate(TCA)
Ureacycleenzymedeficiency>decreasedTCAintermediates>TCAINHIBITION+HYPERAMMONEMIA(b/c
decreasedNH4+excretion).
Sx:asterixis,slurredspeech,somnolence,blurryvision,vomiting
Tx:lessproteinindiet+Benzoate/Phenylbutyrate(binda.a.>excrete)
OTC=majorureacycleenzyme:
Ornithine+carbamoylphosphate>CitrullineviaOTC
OTCdeficiency(xr)=shuntingofcarbamoylphosphatefromureacycletopyrimidinesynthesis:
carbamoylphosphate+aspartate>oroticacid
OroticAciduria>decreasedBUN+hyperammonemia
Aminoacidderivatives:
Phenylalanine(Phenylalaninehydroxylase+THB+NADPHviaDihydropterinreductase)>Tyrosine(X=
PKU(ar):screenedbyGuthrietest23daysafterbirthTx:decrPhen,incrTyrdiet):
>FumarateviaHomogentinsicacidoxidase(X=Alkaptonuria)
>Thyroxine
(Tyrosinehydroxylase/B6,blockedbyMetyrosine)>Dopa:
>Melanin(X=Albinism:decreasedpigment)
(Dopadecarboxylase/B6,blockedbyCarbidopa)>Dopamine(Dopamine
Hydroxylase/VitC,blockedbyReserpine)>NE(PNMT/SAM)>Epinephrine
Tryptophan(XinHartnups):
(B6)>Niacin=B3>NAD+/NADP+(X=Pellagra)
(BH4)>Serotonin>Melatonin(sleep)
Lysosomalstoragediseases:
TaySaX=HeXosaminidaseA>incrGM2:nohepatosplencherrymacula,onionskinlysosomes
FabGalisintoCeramics
Fabrys=alphaGALactosidaseA>incrCeramidetrihexose:peripheralneuropathy,angiokeratoma,CV/renal
disease
GauchedoutmyfemurwhenIwasonasugarhigh
Gaucher,FemurNecrosis,SugarHigh=GlucoCerebrosidase
Gauchers=betaGlucocerebrosidase>incrglucocerebroside:asepticfemurnecrosis,hepatosplenomegaly,
crumpledtissuepapercytoplasm
BlindIntelligentIntergalacticCrab
IntelligentIntergalactic=Galactocerebroside
Krabbes=Galactocerebrosidase>incrgalactocerebroside:blindness,peripheralneuropathy,developmental
delay,globoidcells
NiemannPickshisnosewithhisphinger
NiemannPick=Sphingomyelinase>incrSphingomyelin:cherrymaculawithhepatosplenomegaly,
neurodegeneration,foamcells
Sulfurtidesaremulticolored
Sulfurtide=Sulfatide
Multicolored=Metachromic
Metachromicleukodystrophy=ArylsulfataseA>incrSulfatides:centralandperipheraldemyelinationwith
ataxia,dementia
Mucopolysaccharidoses:
HurLers=alphaLiduronidase>incrheparansulfate,dermatansulfate:cornealclouding,gargoylism,
airwayobstruction
Hunters=iduronatesulfatase>incrheparansulfate,dermatansulfate:NOCORNEALCLOUDINGbecause
Huntersneedtoseeclearly
Majorapolipoproteins:
II:LL
CII=cofactorforLipoproteinLipase
Treatabetalipoproteinemias(deficientapoB100,B48>nightblindness,acanthocytes(spikyRBC),steatorrhea,ataxia)
withVitaminE
Embryology:
ImportantGenesforEmbryogenesis:
SonictheHedgehogfightsaOneEyedMonster:
SonicHedgehogmutation>Holoprosencephaly
FGFgene=FibroblastGrowthFactor:GrowthFactorlengthenslimbs
FGFmutation>Achondroplasia(ADdwarfism)
HOX(Homeobox)gene:"Boxeshelpwithorganization"
organizes/determineslimblocation(VitaminAtoxicityaltersHOXexpression>cleftpalate,cardiac
abnormalities,spontaneousabortion)
RulesofEarlyDevelopment:
Week2:2germlayers(epiblast,hypoblast),2cavities(amniotic,yolksac),2placentalcomponents
(cytotrophoblast,syncytiotrophoblast)
Week3:3germlayers(ectoderm,mesoderm,endoderm)
Week4:4heartchambers,4limbbuds
Note:neuraltubeclosesbyweek4:
def.folicacid>spinabifida,etc.
neuraltubedefecthasincralphafetoprotein+AChesterase
(**GastroschisisandOmphalocele,prettymuchANYinternalorganextrusionresultsinincralphafetoprotein)
SADDAVE:
SAD:Sensory=AlarPlate/Afferentnerves=Dorsal
DAVE:Dorsal=Afferent,Ventral=Efferent
Embryologicderivatives:
Ectoderm:
Surface:whatyousee(epidermis,hair,nails,teethenamel,eyelens)+anteriorpituitary
(Rathkespouch)
Neuro:everythingconnectedtotheCNS(brain,spinalcord,oligodendocytes,posteriorpituitary,
retina,pinealgland)+pupillarymuscles
Mesoderm:
Neuralcrest:skullandPNSstuff(skull,headmuscles,dentine,pia/arachnoid,Schwanncells,
DRG,cranialnerves,celiacganglion,parafollicularCcellsofthyroid)+adrenal
medulla(chromaffincells)+melanocytes(lasttomigrate)
Paraxial:axialstuff(axialskeleton,skeletalmuscles,connectivetissueanddermis)+dura
mater
Intermediate:urogenitalridge(kidneysandureters,vasdeferens,gonads,uterusanduterine
tubules)
Lateral:nonskeletalmuscleandbloodrelatedorgans(visceralmuscleandconnectivetissue,
blood,lymph,spleen,cardiovascularsystem)+adrenalcortex
Note:spleen=mesoderm,butsuppliedbyceliacarteryoftheforegut
MESODERMALDEFECTS=VACTERL:Vertebraldefects,Analatresia,Cardiacdefects,Tracheo
Esophagealfistulas,Renaldefects,Limbdefects
Endoderm:ear/mouthtoanushollowliningandorgans+bladderandvagina
tympaniccavity/auritorytube,tonsils,thymus,thyroid,parathyroid
larynx,trachea,bronchi,lungs
GIT,liver,gallbladder,pancreas

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urinarybladder,urethra,lower2/3vagina(thisexplainshowpatientscanstillhaveavaginaeven
iftheparamesonephricductsfailtodevelop)
Notochord>nucleuspulposusofintervertebraldisk
Teratogens:
Aminacouldnthearbecauseshewastooabsorbedinherreading.
AminoglycosidespreventmRNAreadingbyinterferingwith16Sof30SandcauseCNVIIIototoxicity
(Note:CongenitalSyphilisalsocausesCNVIIIototoxicity+Sabershins+Saddlenose+Hutchinsonsteeth
+MulberryMolars+frontalbossing)
MaternalDiabetes:hyperglycemia>incrfetalinsulin>decrlungdevelopment=cantbreathemermaids
alsocantbreatheair>
maternaldiabetescausesARDsandsirenomelia/analatresia(also,transpositionofgreatvessels)
Umbilicalcord:
Allantois:2arteries,1vein(arteriesis2xaslongasvein)
AllaNtois(urachus)>mediaNumbilicalligament
UmbiLicalartery>mediaLumbilicalligament
Umbilicalveinligamentumtereshepatis
Allantois>Urachus(wk3):urachusfailuretoobliterate=bladdertonavelconnection:umbilicalurinationorbladder
outpouching
Omphalomesentericduct>Vitellineduct(wk7):ductfailuretoobliterate=colontonavelconnection:umbilical
meconiumorMeckelsdiverticulum
Heartembryology:
Primitive__>trabeculated(rough)portionof__
Smoothatrium=sinusvenosus
Smoothventricle=bulbuscordis
SVC=rightcommonandanteriorcardinalveins
Aorta/Pulmonaryartery=truncusarteriosus,separatedbyspiralingneuralcrestmigration(X=Transposition
ofGreatVessels,TetralogyofFallot)
PGAopen:PGkeepsDAopen(decrPG>closeDAwithIndomethacin,NSAIDs)
Aorticarchderivatives:"leftsideofbodytorightside,toptobottom"
I:maxillaryartery(externalcarotid)@face
II:hyoid/stapedialartery@midlinethroat
III:commonandinternalcarotidarteries@midlineneck
IV:rightsubclavianarteryandaorticarch@right/middlechest
VI:pulmonaryartery(inc.ductusarteriosusconnectiontoaorta)@rightsideofheart
Neuraltubedefects:
Thelongerthename,theworsethesymptoms:
Occulta:spinalcanalopeningbutnoherniation,tuftofhair
Meningocele:herniationofmeninges
Meningomyelocele:herniationofspinalcord
Pharyngeal/BranchialCAP:
Cleft=ectoderm(~externalhollowspaces)
Arches=mesoderm(~muscles)
Pouches=endoderm(~immuneorgansabovetheneck)
BranchialCLEFTectoderm:~externalhollowspaces
Cleft1:externalauditorymeatus
Clefts24:temporarycervicalsinus(failtoobliterate=lateralneckbranchialcleftcyst)
Branchialcleftcyst(lateralneck)vsThyroglossalductcyst(midlineneck,moveswithswallowingbecauseattachedto
tongue)
BranchialARCHmesoderm:~muscles
ThenervesthatsupplythebranchialarchesareallBOTHmotorandsensory:
Some(I)Say(II)Marry(III)Money(IV)But(V)My(VI)Brother(VII)Says(VIII)Big(IX)Brains(X)Matter(XI)Most(XII)(S=
sensory,M=motor,B=both)
**LOOKATTHENERVESTOFIGUREOUTWHICHMUSCLESMAKEUPWHATARCH**orusethefollowingmnemonic:
ChewingmademegrimacesoIswallowed,choked,thencalledforhelp.
chewing=arch1(V2,3)=musclesofmastication,ant.2/3tongue+malleus/incus/tensortympani
grimace=arch2(VII)=facialexpression+stapes/stapedius(defect=TreacherCollinsmandibular
hypoplasiaandfacialabnormalities)
swallowed=arch3(IX)=stylopharyngeus(defect=fissurefromnecktotonsils)
choked=arch4(X,suplaryngeal)=pharyngealconstrictorsandcricothyroid
calledforhelp=arch6(X,inflaryngeal)=intrinsiclarynxmusclesexceptcricothyroid
Note:Arch4&6makeuppost.1/3tongue
BranchialPOUCHendoderm:~immuneorgansabovetheneck+middleear
Pouch1=auditorytube,middleear,mastoidaircells
Pouch2=tonsilsandtonsillarsinus
Pouch3=inferiorparathyroid+thymus(theydescendtogether)
Pouch4=superiorparathyroid+parafollicularCcellsofthyroid
Failureof3rdand4thPouch=DiGeorges:nothymus(=Tcelldeficiency),noparathyroids(=hypocalcemia>tetany)
C3,4,5keepsthediaphragmalive.
Kidneyembryology:mainplayer=Metanephros:
UretericBud=ureter>pelvis>collectingducts
JOINS
MetanephricMesenchyme=glomerulus>DCT
Defectiveuretericbud=renalagenesisB/Lrenalagenesis>oligohydramnios>Potters:pulmonaryhypoplasia+
face/limbdeformities
**MCsiteofobstruction=Ureteropelvicjunctionwithkidney>fetalhydronephrosis
Genitalembryology:
Male=Mesonephric
Pemale=Paramesonephric
MenareWolves=Wolffianducts>"SEVEN"inSEVENUP(Seminalvesicles,Epididymis,Vasdeferens,
Ejaculatoryduct,N=nothing)
WomenMulloverpastarguments=Mullerianducts>fallopiantubes,uterus,andupper1/3ofvagina
(lower2/3fromurogenitalsinusofendoderm)
Female=defaultgenitals
Hormoneoverview:
ProlactinstimulatesDopamineinhibitsProlactin
ProlactininhibitsGnRH
GnRH>incrFSH,LH
LinLHandLeydig:LHstimulatesLeydigcellstoproducetestosterone>developWolffianduct
SinFSH,Sertoli,andSperm:FSHstimulatesSertolicellstoproduceSperm,Inhibin,andMullerianinhibiting
factor(MIF)MIFinhibitsfemaleparamesonephricductdevelopment

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arghlblargh!
Genitalhomologues:
Urogenitalsinus:
Bulbourethralglands=Bartholinsgreatervestibularglands
proStategland=Skeneurethralandparaurethralglands
ExtrophyofbladderisassociatedwithEpispadias(faultypositioningofgenitaltubercle)
vs.Hypospadias=morecommon,failureofurethralfoldclosure,incrriskofUTI
Microbiology:
Encapsulatedorganisms:(+Quellungreaction:quellmakescapsulesswell)
ClaustrophobicPastorSalmonEchoedBack:YersinfulCryptdarkStripClubsarePseudoHomestoNiceMenFrancis
andBruce.
Claustrophobic=Clostridium
Pastor=Pasturella
Salmon=Salmonella
Echoed=E.coli
Back=Bacillusanthracis(Dglutamate)
Yersinful=Yersinia
Cryptdark=Cryptococcus(IndiaInk,narrowbasedbuddinginmeningitis)
Strip=Streptococcus
Clubs=Klebsiella
Pseudo=Pseudomonas
Homes=Haemophilus
Nicemen=Neisseriameningitidis
Francis=Francisella
Bruce=Brucella
BADBacillusAnthracisuniquecapsulecontainsDglutamate
Staffofgrapes=Staphylococcusisinclusters
VS.Streptococcus=pairs/chains
Spirochetes:"SpiralingBorisLeptthenTripped"
Spiraling=Spirochetes
Boris=Borrelia(Giemsastain=anilinedyerelapsingfever=resultofantigenicvariation)
Lept=Leptospira
Tripped=Treponema(DarkFieldMicroscopy,VDRLcardiolipinscreening,FTAABSconfirmation)
MycoplasmavsMycobacteria
Bacteriahavecellwalls(Mycobacteriahavemycolicacidintheircellwallsthatstainacidfast)
Plasmamembraneshavesterols(Mycoplasmahavesterolsandnocellwall)
Stains:
GiemsAstainsBorreliA,MalariA,ChlamydiA,TrypanosomA
PASsthesugarandwhipcream(PASstainsglycogenandDxWhipplesdisease)
LegionswhoSustainedinjuriesgetSilverstars:Legionella,growwithCysteine,silverstainwatersource
SpecialCulture:
NiceHomeshavechocolate:NeisseriaandHaemophilusgrowonChocolateagar+:
Neisseria=ThayerMartinmedia:Vancomycin(vsG+),Polymyxin(vsg),Nystatin(vsfungi)
Haemophilus=V(NAD+)andX(hematin)
IfITellUtheCornyjokeRight,youllLaugh:
TellURight=telluriteagar
Corny=Corynebacterium
Laugh=Lofflersmedia
TBandJ:M.tuberculosisonlowenstEINJensenagar(takes34weekstogrow,butdiagnostic)
Obligateaerobes:
IfNoAER,AnthraxandTBcantsurvive!
No=NOcardia
Aer=pseudomonasAERuginosa
Anthrax=B.anthracis
TB=M.tuberculosis
Microaerophils=bacters:Campylobacter,Helicobacter
Obligateanaerobes:"TheseBACTERiaACTINCLOSTRophobicenviroments(nonhealingulcers):
BACTERia=Bacteroides(E.G.,B.fragilis)
ACTIN=Actinomyces
CLOSTRophobic=CLOSTRidium
ObligateIntracellular:"REAChforMyCOXifyouwantmeINSIDEyou.
R=Rickettsia
E=Ehrlichia
A=Anaplasma
Ch=Chlamydia
My=Mycoplasma
Cox=Coxiella
Inside=intracellular
Facultativeintracellular:"LegionsofSalmon,Rabbits,NCowsTumbleINMyyard.
Legions=Legionella
Salmon=Salmonella
Rabbits=Francisella
N=Neisseria
Cows=Brucella
Tumble=Listeria
In=intracellular
My=Mycobacterium
Note:intracellularpathogensrequirecellmediatedimmunity(CMI),soneonatesareatrisk(E.G.,Listeria>neonatal
meningitis:tumbles,hasendotoxin,andanarrowzoneofbetahemolysis)
Bacterialvirulencefactors:
proteinAforstaph.Aureus:bindsFcofIgtopreventopsonizationandphagocytosis
Mprotein(preventsphagocytosis)>strep.pyogenesrheuMaticfever(Sx:subcutaneousplaques,
polyarthritis,erythemamarginatum,chorea,carditis)
IgAprotease(tocolonizerespiratorymucosa)+antiphagocyticcapsule(infectsASPLENICpatientsb/cdecr
M0andIgM/complementC3activation(E.G.,SickleCellautosplenectomy))+causesmeningitis=SHiN
Note:canalsoundergotransformation(pickupDNAfromenvironment)
Streppneumo
H.influenzatypeB(Bpolysaccharide)
Neisseriameningitidis
ExotoxinvsEndotoxin:
EXotoxin=fromEXogenoussource(plasmidorbacteriophage)andEXcretedfrombacteria,EXtremelytoxic
(evensmalldose),EXacteffects(differenttoxinsproducedifferentsymptoms)~heatlabile
ENDOtoxin(LipidA)ENDOgenous(madefrombacterialchromosome,ENtegraltooutermembraneofmostg
Negbacteria(andListeria(G+)))heatstablecausesgENeralfever,shock/sepsisviadirectMACROPHAGE
response(bindsCD14M0marker)>releaseTNFandIL1(noThinvolvement)
M0activation:

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IL1=Fever
TNFalpha=fever,hemorrhagictissuenecrosis
Nitricoxide=hypotension/shock
alternatecomplementpathway:
C3a=Anaphylaxis(basophilandmastcelldegranulation>hypotension,edema)
C5a=neutrophilchemotaxis
Hagemanfactor:coagulationcascade>DIC/microthrombi
Exotoxinsubclass:SUPERANTIGENS:binddirectlytoMHCIIandTH1(CD4)>explosivereleaseofIFNgammaandIL2
(nonspecificimmuneresponse):
S.aureus=TSST1>ToxicShockSyndrome(fever,rash,shock)
S.pyogenes=Erythrogenictoxin>ScarletfeverwithToxicShocklikesymptoms
Note:S.pyogenesalsohasStreptolysinO(lysesRBC)Dx:RheumaticFeverwithantiStreptolysinO
antibody(ASOAb)
E.coliADPribosylatingABtoxin:
LabilelikeAir,StablelikeGround:
heatLabiletoxinstimulatesAdenylatecyclase
heatStabletoxinstimulatesGuanylatecyclase
Bothcausewaterydiarrhea.
BacterialToxinsEnvodedinLysogenicPhage:"ABCDE"
ShigAliketoxinEHEC0157:H7cleaveshostcellrRNA/inactivates60Salso,incrcytokines>HUS
BotulinumtoxininhibitsAChvesiclereleasefrompresynapticneuron>flaccidparalysis
CholeratoxinactivatesGs>incrcAMP>incrClsecretionintogut=decrNa+absorption>watery
diarrhea
DiptheriatoxinADPribosylatingABtoxin(likePseudomonasexotoxinA)Bbinds,Aentersandribosylates
EF2>nomoreproteinsynthesis>celldeathpseudomembraneformation
Erythrogenic(superantigen)toxinofStrep.pyogenes>ScarletFeveractivatesbothTH1(CD4)andMHCII
>incrINFgamma+IL2>incrM0andTcellnonspecificimmuneresponse>~ToxicShock
GramPositives:crystalviolet+iodine=blue
CoagnegativeStaph:"SENsitive":Staph.Epi=NovobiocinSENSITIVE"(VS.Staph.saprophyticus=
Novobiocinresistant)
alphahemolyticStrep:"OVeRPasS":OptochinViridansResistant,PneumoniaSensitive
Note:Streppneumoniaisbilesoluble(=cantbeculturedinbile,unlikegammahemolyticStrep)
betahemolyticStrep:"BBBR":Betahemolytic,groupBstrep(Strepagalactiae),BacitracinResistant(VS.
groupAstrep(Strep.pyogenes)=bacitracinsensitive)
OR
BBRASBacitracin:groupB=resistant,groupA=sensitive
gammahemolyticStrep:growsinbile"stomachisusedtosaltyfoods"=Enterococcigrowsin6.5%NaCl
(VS.Strep.bovis>doesNOTgrowin6.5%NaCl)
Exposure/PRIMARYTB:
Ghoncomplex=GhonfocusofLOWERlobe+perihilarlymphnodes
YouthinktheyareGhonbuttheyrejustwaitingtobecomesecondaryTB(fibrocaseouscavitarylesionof
UPPERlobe)
gramnegative:acetone+saffranin=pink
N.MeningitiesferMentsMaltose,hasacapsule,andvaccine(gonorrheadoesntNOTE**:gonorrheaspilus
proteinundergoesantigenicvariation!!)
Note:
N.meningitidis=respiratory/oralspread>meningococcemiaandWaterhouseFriderichsenadrenal
hemorrhage(hypotensionandDIC)
N.gonorrhea=STD>highfever,septicarthritis,neonatalconjunctivitis,PID,FitzHughCurtis(cervicitis
>salpingitis>livercapsuleinfection)
Enterobacteriae:CAPSULE=VIRULENCEFACTOR,allfermentglucose
Lactosefermenters(pinkonMacConkey,blueonEosinMethyleneblue)=SEEK:Serratia,
Enterobacter,E.coli(blueblackmetallicsheen),Klebsiella
Nonlactosefermenters=PSSY:Proteus,Salmonella,Shigella,Yersinia
H2Sproducing(blackonHektoenAgar)+motile(flagellarHantigen):Proteus(swarming,urease+,
staghornammoniumstruvitestones),Salmonella
Note:SalmonellaandShigellabothinvademucosa>bloodydiarrheaSalmonellaismotile(w/2
flagellarantigenvariants)andproducesH2S,S.typhiofTyphoidfevercausesabdominalrose
spotsandcanremainchronicallyingallbladderShigellaismorevirulent,movesbyactin
polymerizationand60SdeactivatingtoxininducesHUS.
oxidase+organisms:"whenyougoCampingataquietPastureyoudMoanMorewithNiceVibrators"
Camping=Campylobacter
Pasture=Pasturella
Moan=Pseudomonas
More=Moraxella
Nice=Neisseria
Vibrators=Vibrio
VDRLfalsepositives:"VDRL"
V=viruses:EBV,hepatitis
D=drugs
R=Rheumaticfever(Dxw/S.pyogenesASOtiters)
L=LupusandLeprosy
Chlamydia:DxviaGiemsastain(ChlamydiA,MalariA,BorreliA+TrypanosomA)
ElementarybodyisEnfectiousandEnterscellsviaEndocytosis
ReticulatebodyReplicatesincellbyfission
TrickyDick:TRIC=serotypesDK:
>MCPID,cervicitis,ectopicpregnancy
>FitzHughCurtislivercapsuleinfection(fromspreadofPID)+violinstringadhesionsofparietal
peritoneumtoliver
>neonatalpneumonal/conjunctivitis
>REITERS:"Cantsee,cantpee,cantclimbatree"=conjunctivitis,urethritis,arthritis
VS.trAChoma=serotypesAC>blindness
VS.L1L3=Lymphogranulomavenerum:ulcers>lymphadenopathy,rectalstricturesmistakenforPID
Tx:mothersandinfantswithChlamydiawithErythromycinestolate,thoughthereisariskofmaternalacute
cholestatichepatitis
Atypical(walking)pneumonias:"MyClammyLegionwalked"Tx:macrolides
My=Mycoplasma(IgM=coldagglutinins>agglutinateorlyseRBCsgrownonEatonsagarTx:
tetracyclineormacrolide)
Clammy=Chlamydia(Tx:tetracyclineormacrolide)
Legion=Legionella(Tx:macrolide)
Fungi:
Dimorphic:"cold=mold,heat=yea(s)t"+BlastHisCock=EastCoasttoWestCoast(Tx:Ketoconazole)
Blast=Blastomycosis=eastofMississippiRiver
His=Histoplasmosis=MississippiRiverandOhioriver
Cock=Coccidiomycosis=SouthwestUS:CA,AZ
HisWoodpeckerBlastedWoodintoDust:
HisWoodpecker=Histoplasmosisfrombird/batdroppings=macrophagefilledwithroundyeastHistoHides
withinmacrophages

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BlastedWood=Blastomycosisinwood=BroadBasedBuddingfungithehandleofabaseballbatlookslike
itsbuddingofftheshaft)
Dust=Coccidiomycosis=largespherulefilledwithendosporesbarrelshapedarthroconidiaCockisfilled
withSperm,CoccidioisfilledwithSpores
Actinomyces=AcuteAngles,Septate
(VS.Mucormycosis/Rhizopus=Wideangles,nonseptate~inDiabetics)
Helminthdrugs:
Worms=Bendazole
Praziquantel=foods:Pork,Fish,Crab,Snails
Pork=Taenia
Fish=Diphyllo,Clonorchis
Crab=Paragonimus
Snails=Schistosoma
Antigenicshiftvs.drift:"SPED"
Shift(reassortmentviasegmentedviruses)=Pandemic
Epidemic=Drift(randommutations)
Vaccines:
Live:"SeeMMR.Sabinssmallyellowchickenslive.
MMR=Measles,Mumps,Rubella
Sabin(Polio,oral)
smallpox
yellowfever
chickenpox/shingles
Killed:"RIPAlways
Rabies
Influenza
Polio(SalK=Killed,injected)
Adenovirus
Recombinant:"H_V"
Worms=Bendazole
Praziquantel=foods:Pork,Fish,Crab,Snails
Viruses:
DNAviruses:"HeHePoPaParAde":firstthree=enveloped
He=Herpes
He=HepaDNA(HBVcarriesspecialRT:DNAdDNAp)
Po=Pox(smallpox,molluscumcontagiosumcarriesDNAdRNApandreplicatesincytoplasm)
Pa=Papilloma(HPV:(6,11):condylomataacuminata/genitalwarts,koilocytes=squamouscellwithperinuclear
cytoplasmichalo(16,18):CINanalsquamouscellCA)+Polyoma(JC,PMLdemyelinatingencephalopathy)
Par=Parvo=B19/Erythemainfectiosum(ssDNA)
Ade=Adenovirus(swimmingpoolconjunctivitis,gastroenteritis)
Herpes:"2SimpleChickensBarredSightfromRosePatches"
2Simple=HSV1,2
Chickens=HHV3:Chickenpox(truncalrash>extremitieslesionsofdifferentage)/shingles
Barred=HHV4:EBV(mono,Burkitts,largecellnonHodgkins@Waldeyersring,nasopharyngealCA,hairy
leukoplakiaonlateraltongueinfectsBcellsviaCD21EBVreceptor)
Sight=HHV5:CMV(retinitis,negativemonospotmono,TORCHbothintranuclearowleyeandcytoplasmic
inclusionbodies)
Rose=HHV6:Roseola/Erythemasubitum(highfever>rash)
Patches=HHV8:Kaposisarcoma
RNAviruses:
+RNA=PiToFlaCoCa:middle3=enveloped
Pi=PicoRNA=PECoRnA:
P=Polio(bothcolonizesnasopharynxandcausesmeningitislikeHib>myalgiaandparalysis)
E=Echovirus:swimmingpoolasepticmeningitis/myocarditis
C=Coxsackie:asepticmeningitis/myocarditis,handfootmouth(palmandsolevesicularrashalso
seeninsecondarysyphilisandRickettsialRockyMountainSpottedFever)
Rn=RHINOvirus(stuffyNOSEfromcommoncold)
A=HAV
To=Toga
TogasRubelledagainstGermanywithTORCHs=Togavirus,Rubella,GermanMeasles(post
auricularoccipitallymphadenopathy,finetruncalrash),TORCHinfection(blueberrymuffinrash,
deaf,cataracts,PDA)
VS.Rubeola:"aPARARubyweaslescaughtSSPEcialmeasles"=Paramyxo,Rubeola,SSPE
complication,Measles
VS.Roseola:HHV6(highfever/seizures>truncalrash)
Fla=Flavi(HCV,yellow,dengue,St.Louis,WestNile)
yellowfevercausesyellowingskin(jaundice)andblackvomit
Co=Corona(commoncold,SARS)
Ca=Calici=Norwalk,CACruises(gastroenteritisfromcruises)
RNA=allenveloped+RNAdRNApol
Reovirus=dsRNA,segmented:ROTAvirus=rightouttheanus(childhoodwintergastroenteritis)
HepEvirus=HEV(waterepidemic,onlydangerousifpregnant)
Orthomyxo:Oforocto=8segments>reassortment=Influenzapandemic(Agshift)
Paramyxo=PaRaMyX2o:
PorPARA=Parainfluenza=croup
R=RSVTx:Ribavirin(vs.IMPDHofpurinesynthesisAE:hemolyticanemia,teratogen)orRSVP
LizwherePLiz=PalivizumabwhichbindsParamyxoFprotein,preventingrespiratoryepithelial
syncytiaformation
Mx2=MeaslesandMumps:
Measles:"APARARUBYweaslescaughtSSPEcialMeasles"=paramyxo,rubeola,SSPE
complication,Measles3Cs=cough,coryza,conjunctivitis+Koplikspotsrashfrom
headdownlikeRubella
Mumps:parotitis,orchitis,asepticmeningitis
Segmentedviruses:"BOAR"
B=Bunya(Hantahemorrhagicfever)
O=Orthomyxo(Influenza)
A=Arena(mouseLassaencephalitis)
R=Reovirus(rightouttheanuschildhooddiarrhea)
Hepatitis:
HAV=Picorna(+RNA)fecaloral(icecubes,shellfish)
HBV=HepaDNA(env,dsDNA)blood(renaldialysis,needlestick),sex,motherDx:PCR
HCV=Flavi(env,+RNA)blood(IVDA,transfusion)Dx:RTPCR
HDV=Delta(defectiveenv,RNA)infectswithHBV
HEV=HepEvirus(+RNA)fecaloral(waterepidemic)
ToRCHS:hepatosplenomegaly,jaundice,thrombocytopenia,growthretardation
T=Toxoplasma:ToxoTriad:intracranialcalcifications,chorioretinitis,hydrocephalus=SAMETRIADASCMV!!
fromcatfeces,ringenhancingbrainabscess)Tx:Sulfadiazine+Pyrimethamine
R=Rubella(Togavirus,+RNA):PDA,cataracts,deaf,blueberrymuffinrashmaternalrashandarthritis
C=CMV:Toxoplasmatriad(intracranialcalcification,chorioretinitis,hydrocephalus)+UNILATERALhearing
loss,seizures
H=HSV(+HIV):temporallobeencephalitis,herpeticlesions(fingers)

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S=Syphilis:hydropsfetalisstillbirth>Hutchinsonteeth,saddlenose,sabershins
Note:B19alsocauseshydropsfetalis
Bactericidaldrugs(allelse=bacteriostatic):"SephirothMetVancouverPenpalAminainFlorida,thenKILLEDHERD:
Seph(iroth)=Cephalosporin
Met=Metronidazole
Vancouver=Vancomycin
Penpal=Penicillin
Amina=Aminoglycosides
Florida=Fluoroquinolones
Antimicrobialdrugs:
1.inhibitsPGcrosslinking>nocellwall:"CephChillsinNamwatchingPGmovies:
1.Ceph=Cephalosporin
2.Chillsin='cillins(bindsPBP,blocktranspeptidasecrosslinkingPenicillin=endocarditis
prophylaxis(beforesurgery/dental),syphilisprophylaxis)
3.'Nam=AztreoNAM(bindsPBP3forPencillinallergyptsvsSEEKPseudomonasSerratia,E.coli,
Enterobacter,Klebsiella,Pseudomonas),MeropeNEMandImipeNEM+Cilastatin(Merpenem/Imipenem
vs.everything,esp.Enterobacter,butcausesSEIZURESCilastatininhibitsrenaldihydropeptidase
ItoinhibitrenaltubuleImipineminactivation)
2.blocksPGsynthesis:
1.Bacitracin(vs.S.pyogenes(GAS))
2.Vancomycin(bindsDAlaDAlaandinterfereswithPGelongatingtransglycosylase
1.vs.resistantG+inc,MRSAandC.diff!!
2.TONofAEs:T=thrombophlebitis,O=ototoxic,N=nephrotoxic+RedMan(slow
infusionandpretreatwithantihistaminetoprevent))
3.vs.gbydisruptingcellmembranes:Polymyxins(neosporin)detergentvscellmembraneAE:neurotoxicity,
acuterenaltubularnecrosis
4.vs.G+/gbyblockingfolate>nonucleotidesynthesis(megaloblasticanemia):
1.Sulfonamides(compinhibitPABAfordihydropteroatesynthetase>noDHFsynthesisAE:infant
kernicterus(avoidinpregnancy),SJ,nephrotox,G6PDhemolysis)
1.SulfamethoxazoleTrimethoprim(TMPSMX)vsUTI,P.jiroveciiprophylaxisinAIDS
2.Sulfadiazine+PyrimethaminevsToxoplasma
3.Sulfadoxin+PyrimethaminevsMalaria
2.Trimethoprim,Pyrimethamine(DHFXdihydrofolatereductase>THFlikeMethotrexate)
5.vs.URIs(S.pneumo),UTIs,GITIs,andPseudomonasbyblockingtopoII(DNAgyrase)andIV:
Fluoroquinolones(AE:cartilage/tendonrupture,incrQT,G6PDhemolysis)
6.vs.Mycobacterum,prophylaxisforHibandN.menbyblockingDNAdRNAp=notranscription:Rifampin
7.Proteinsynthesisinhibitors:"QuinngetinLineandtake50MCsto30ST":
1.Quinn,Line50MCs=QuinDalfo,Linezolid,Macrolides,Chloramphenicol/Clindamycinblock50S
1.QuinDalfo(streptogramins):Quinupristinpreventselongation,Dalfopristinchanges50S
conformationforbetterQuinbinding
2.Linezolid:binds50SPsiteandblocks70Sassembly
Tx:QuinDalfoandLinezolidisgoodforALLRESISTANTBACTERIA:VRE,MRSA
3.MACrolidEs(ACE"mycin=Azithro,Clarithro,Erythromycin):"MacroLIDEspreventsLIDing
ofmRNA=inhibittranslocationbybindingto23Sof50S
1.Tx:PUSatypicalPneumonia,URIs,STDs
2.AE:PROLONGQT,acutecholestatichepatitis,incrserumconcentrationof
warfarin
3.resistanceviaMETHYLATIONOFdrugbindingsiteon50SrRNA
Note:Azithromycin=AIDSMACprophylaxis
4.Chloramphenicol:ChLorAMPSPeptidyltransferasepreventspeptidebondformationTx:
meningitis(H.flu,N.men,Strep.pneumo)AE:aplasticanemiaandgraybabyresistance
viaACETYLATION
5.Clindamycin:alsoblockspeptidebondformationat50Svs.ANAEROBES(B.fragilis,C.
perfringens)likeMetronidazoleAE:PseudomembranouscolitislikeAmpicillin
2.30ST=Streptomycin(aminoglycosides),Tetracyclineblock30S
1.AminadidntheartheGNATSbecauseshewasbusyreading:
Aminoglycosides(GNATS=Genta,Neo,Amikacin,Tobra,andStretomycins)cause
ototoxicity(andnephrotox)andactbybindingto16SandcausingmRNAmisreadingvs.
grodsREQUIRESO2UPTAKEsoineffectiveagainstanaerobesresistancevia
modificationof30S(acetylation,etc)
2.TetracyclinesblockTRNAfrombindingAsiteanddiscolorsTeeth/bones
1.caTionchelator,doNOTtakewithantacids,milk,orironcontainingprep!
2.AE:photosensitivity(SATforphotosulfonamides,amiodarone,
TETRACYCLINE)
3.vs."VACUUMTHBedRoom"Vibrio,acne,Chlamydia,ureaplasma,urealyticum,
Mycoplasmapneumonia,Tularemia,H.pylori,Borrelia,Rickettsia
4.resistanceviadecruptake,increxport
NOTE:DEMECLOCYCLINE=DIURETIC=ADHANTAGONIST(Tx:SIADH)
AmpicillinandAmoxicillinareAntiG+AminopenicillinsthatHELPSkillPseudomonaswithSulbactam/Clavulanicacid
(betalactamaseinhibitor):
H=Haemophilus
E=E.coli
L=Listeria
P=Proteus
S=Salmonella
Note:Ampicillin=intrapartuminjection,GBSprophylaxis
TCPTakesCareofPseudomonas:
Ticarcillin
Carbenicillin
Piperacillin
Cephalosporins:
1stgeneration(cefa):G++PEcK:Proteus,E.coli,Klebsiella
2ndgeneration(furfoxfo'tetan):G++HENPEcKS:Haemophilus,Enterobacter,Neisseria,Proteus,E.
coli,Klebsiella,Serratia
FurcapCefuroximeforCommunityAcquiredPneumonia
LindaBroughtaFragileFoxfo'TitoClindamycin,B.fragilis,Cefuroxime,Cefotetan
3rdgeneration(trixtaxtaz):Meningitis,Gonorrhea,Typhoidfever(Salmonella)
Ceftriaxone=#1
CefTAZidimeisforPseudomonaslikeTAZobactam+Piperacillin(butcausesneutropenia)
4thgeneration(Cefepime)=G++pseudomonas
Metronidazole:formstoxicmetabolitethatdamagesDNATx:"GETGAPontheMETRO"
G=Giardia
E=Entamoebahistolytica(liverabscess)
T=Trichomonas
G=Gardnerella
A=Anaerobes(B.fragilis,C.difficile)
P=H.Pylori(+bismuth+amoxicillin/tetracycline)
AntiTB:"INHSPIRE":AE:hepatotoxic
INH=Isoniazid(inactivatesmycolicacidsynthesisenzymesenoylacylcarrierproteinreductase(InhA
overexpression=resistance)andbetaketoacylACPsynthase(KasA)KatGgeneencodescatalaseperoxidase
thatactivatesINH)soloTBprophylaxisAE:hepatotoxicity,neurotoxicity(preventedbyB6),druginduced
lupus(antihistoneAb)
S=Streptomycin(aminoglycosidevs30SmRNAreading)
P=PyrazinamideactiveinacidicpH,inhibitsmycobacterialgrowthinM0AE:hyperuricemia/gout
(I=INH)
R=RifampininhibitsDNAdRNAp=notranscription(rapidresistance)ANDblockspackagingandassembly
ofvirusesinducescyp450prophylaxisforN.menandHibAE:redsecretions,stoptherapywithpurpura,

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bonemarrowsuppression
E=EthambutolAE:opticneuropathy(redgreencolorblindness)
Antifungal:
AmphotericinB:
AmphoTEARicinTEARSholesinfungalmembrane(bindsergosterolandformspores)
AmphoTERRible:AE:fever/chills,hypotension,nephrotox,arrhythmia,anemia,IVphlebitis
Antiviral:
ARM2cureAFLU=AmantadineRimantidineblockM2protein(viraluncoating)vs.InfluenzaAAE:AtaxiA
Herpes=Cyclovirs(virallyactivatedguanosineanalogs)+Trifluridine(thymidineanalog)
CMV=CidsGanglovedseeingFoamyScarlet=Cidofovir(Cytosineanalog+Probenicidtoprevent
excretion),Ganciclovir(intraocularimplant),Fomivirsen(intraocularinjection,antisenseRNAtherapy),
FOScarnet(unlikeganciclovir,doesntrequirethymidinekinaseactivationpyroFOSphateanalogthatdirectly
(`)
inhibitsDNApol)
HIVtherapy:

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Emtriciabine
Lamivudine
AZT(Zidovudine)
Followjulieyumi
Stavudine
NNRTIs:"MovetoDelaware?EffinNever!
Delavirdine
Efavirenz
Nevirapine
FUsioninhibitor=enFUvirtide(gp41binder)

arghlblargh!

Interferons:activatesNKcellsAE:Neutropenia
IFNalpha"alphaBC>Tx:HBV,HCV
IFNbetaPMSsoundslikeBMS>Tx:MultipleSclerosis
NOTE**:alphaandbetaIFNsdecrviralreplicationandincrantiviralproteinsynthesisthatimpairsviralmRNA
translation
IFNgammaGingammaisforcGd>Tx:ChronicGranulomatousDisease(NADPHoxidasedeficiency)
NOTE**:IFNgammaincrMHCIandIIexpression,activatesM0>TNFalpha,IL1,IL6
Immunology:
Bcellsarealwaysfoundin(white)FolliclesclosertotheoutsideoftheLNorspleen
VS.Tcellsarefoundinthedeepermedulla(LN)/PALS(spleen)
Lymphdrainage:
rectumabovepectinateline=internaliliac
umbilicustolegs(inc,superficialgenitalsandanalcanalbelowpectinateline)=superficialinguinal
testes=paraaortic
MHCIandII:"Ruleof8s"
1*8=MHCIxCD8=8
2*4=MHCIIxCD4=8
NaturalKillercells:detectsMHCI
GottaKILtosurvive(KIR+KIL=survive)
KIRonly=releaseperforinsandgranzymes>apoptosis
Antibodycleavage:
PapaincleavesAbinto3pieces:PaPaIn(evenlysplitsinto3)
ProteasecleavesAbinto2pieces:ProtEase(evenlysplitsinto2complementcanstillbindhinge)
Cytokines:"HotTBonestEAk"
IL1(andIL6):hot=feversecretedbyM0
IL2:T=TcellproliferationsecretedbyTh1
IL3:Bone=Bonemarrowstimulation(actslikeGMCSF)secretedbyTcells
IL4:E=IgE(andIgG)classswitchingsecretedbyTh2
IL5:A=IgA(andeosinophil)productionsecretedbyTh2
Neutrophilchemotaxis:"CILK":C5a,IL8,LTB4,Kallikrein
IL8:"8"lookslikemultilobednucleusofneutrophil=PMNchemotaxis
LTB4sBalsolookslikeneutrophilmultilobednucleus
ImmunosuppressionRxvs.IL2:"(IL)2ProCyclistsSecretedTacksinResponsetoSerious/SiriusDax"prevent
transplantrejection
vs.production:Cyclosporin(viainhibitcalcineurin)
vs.secretion:Tacrolimus(viabindingFKprotein)
vs.responseto:Sirolimus(viaMTOR)
vs.receptor:Daclizumab
**NOTE:MCCSCID=defectiveIL2receptor>ADAdeficiencydecrT>decrBactivation:alltypesofrecurrent
infections(viral/bacterial/fungal)
RxvsTNF:Tx:Rheumatoidarthritis
vs.TNF:Infliximab
vs.TNFreceptor:Adalimumab
fakeTNFreceptor:Etanercept
Complement:
C_aforanaphylaxis(histaminerelease>edema>hypotension,anaphylaxis)
C_bforbindingbacteria(opsonizesandformspores)
low3causes3:C3deficiencycausesHSRIII(immunecomplexdeposit),seenespeciallyinglomerulonephritis
susceptibletoS.pneumoandHib>severerecurrentpyogenicsinusandrespiratorytractinfections
**RememberSHiN:S(trep.pneumo)+Hi(b)=C3deficiencyN(eisseria)=C5C9/MACdeficiency
Passiveimmunity:"ToBeHealedRapidly"TetanusBotulismHBV,Rabies/(RSVinpremieseverywintermonth)
Immunedeficiencies:
Brutonsagammaglobulinemia=(xr)BoyswithBTK(tyrosinekinase)defect>BlockedBcelldifferentiation:
recurrentBacterialinfectionafter6months(whenmomsIgGdisappears)b/cnoIgs
SelectiveIg(A)deficiency:milkAllergies,bloodproductAnaphylaxis,giardiAinfectionsIgAismissingin
mucussorecurrentsinusandlunginfections
**Note:IgAdeficiencyalsoseeninAtaxiaTelangiectasia:defectiveDNArepairenzymes,sensitiveto
ionizingradiation,cerebellaratrophy>ataxia,spiderangiomas(telangiectasias)assoc.w/lymphomasand
acuteleukemias
HyperIgE/JobsSyndrome:"ImHyperExcitedformyFATEdJob"
HyperExcited=HyperIgE
F=coarseFacies
A=cold,noninflamedStaphAbcesses
T=retainedprimaryTeeth
E=Eczema

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Job=Jobs
ChediakHigashi(ar):"GrandpaAlcouldnteatEasternfoodwithhisfingers.
Grandpa=Grampositivecocciinfections:StaphandStrep
Al=partialalbinism
couldnteat=defectivemicrotubules=defectivephagocytosisandlysosomalfusion
Eastern=Higashi("higashimeansEastinJapanese)
withhisfingers=peripheralneuropathy
Pathology:
Protooncogenes:tumorpromotersdamageoneallele>gainoffunction(VS.tumorsuppressorsneedtodamage
bothallelestolosefunction)
Mikessisreturnedwithher2newbreaststhatshewasabletogrowfasterb/cofherbs.
Mike=myc:CmycBurkitts,NmycadrenalNeuroblastoma,LmycsmallcelllungCA
sis:astrocytoma,osteosarcoma
(`)
returned=ret:MENII
her2new=Her2/neu:breastcancer
was=ras:colon,bladder,lung,pancreas,renalCA
able=abl:CML,ALL(ALLableCaMeLsarefromPhiladelphiat(922))
julieyumi
togrowfaster=TGF:astrocytoma,HCC
b/c=bcl2:follicularlymphoma
arghlblargh!
herbs=ERBB1,2:ERBB1lungsquamouscellCA,ERBB2breast,ovarian,gastricCA

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Psammomabodies:concentricCa2+sphereslookslikethumbprint"PSaMMoma":

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THEME

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P=papillarythyroidtumor
S=serouscystadenocarcinomaofovary
M=mesothelioma
M=meningioma

ESR(markerofinflammation):inflammatoryproductfibrinogencoatsRBCcausingaggregation>weightpullsRBC
down=fallatfasterrateintesttube
incr/fasterESR=inflammation:infection,cancer,pregnancy,SLE
decr/slowerESR=deprESsedHeartisSickfromTooMuchBlood.
Heart=CHF
Sick=SickleCell
TooMuchBlood=Polycythemia
Pharmacology:
KompetitiveinhibitorsincrKm,decreaseaffinity/potency(amountofdrugneededforeffect)sigmoideffectcurveshifts
rightLineweaverBurkelinescrossatYaxis
(VSnoncompetitiveinhibitorsdecrVm,decreaseefficacy(maximaleffectofdrug)sigmoideffectcurvesvertical
maximumeffectisreducedLineweaverBurkelinesjoinatXaxis)
Zeroorderelimination:constantamountofdrugeliminatedperunittime=PEAPhenytoin,Ethanol,Aspirin
UrinepHanddrugelimination:medicinegetstrappedinoppositeurinepH:
acid(phenobarb,MTX,TCA,aspirin)trappedinbasicbicarbonate
**Note:AcetazolamidealkalinizesurinebygettingridofbicarbonateTx:cysteinestonesandaltitude
sickness(hyperventilation>respiratoryalkalosis)
base(amphetamine)trappedinacidicammoniumchloride
PhaseIvsPhaseIImetabolism:"1redoxwent2conjugatepolarbears.
Phase1:cyp450redox(+hydrolysis)geriatricslosephase1first
Phase2:conjugation(acetylation,glucuronidation,sulfation)>yieldsverypolarrenallyexcretedinactive
metabolites
Therapeuticindex:"TILEDwithTI=LD#/ED#andthe#saddingupto100saferdrugshavehigherTIs
Gproteinlinked2ndmessenger:
Gs=adenylylcyclase>ATPtocAMP>PKA>cascade
Gi=inhibitadenylylcyclase>decrcAMP>decrPKA
Gq=phospholipaseC>lipidstoPIP2>IP3incrintracellularCa2+,DAGstimPKC>cascade
KissandKick'tilyoureSickofSex
QISSQIQSIQSQS
Gq=alpha1:SMcontraction,mydriasisincrSystolicandDiastolicBP
Gi=alpha2:decrSNS,decrinsulin
Gs=beta1:incrheartrateandcontractility,incrrenin,incrlipolysis
Gs=beta2:decrDiastolicBP,vaso/bronchodilation,incrheartrate,contractility,incrlipolysis,incr
insulinrelease(thinkBeta2stimulatesBetaisletcellsofpancreas),decruterinetone
Gq=M1:CNS,entericnervoussystem
Gi=M2:decrHR,decratrialcontractility
Gq=M3:incrsecretions,peristalsis,miosis,accommodation(ciliarymusclecontraction)
Gs=D1:renalperfusion(renalarterydilation)
Gi=D2:brainneurotransmitter
Gq=H1:pruritus/pain,incrnasal/bronchialmucus,contractbronchioles
Gs=H2:incrgastricacidsecretion(inhibitedbyidines)
Gq=V1:incrvascularSMcontraction
Gs=V2:incrH2OreabsorptioninkidneysCD(ADHaction)
Signalingpathways:
cAMP(Gs,Gi):"FLATCHAMP+calcitonin+glucagon"
F=FSH
L=LH
A=ACTH
T=TSH
C=CRH
H=hCG
A=ADH(V2)
M=MSH
P=PTH
calcitonin
glucagon(incrcAMP>activatesPKA>incrF16BPase>gluconeogenesisRLS)
IP3(Gq):"hIP3othalamicGGOAT"
GHRH
GnRH
oxytocin
ADH(V1)
TRH
cGMP:vasodilators
ANP
NO(NOvenodilatesdecreasingpreloadVSbetablockersarteriodilateandreduceafterload)
tyrosinekinase:"theTyKGrowsInMilk"
GH
IGF1
FGF
PDGF
Insulin
Prolactin
steroidreceptor:cytoplasmic(exceptthyroidhormone=intranuclear)

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(Adrenalcortex:)Aldosterone,Glucocorticoid,Testosterone,Estrogen
Progesterone
VitaminD
T4/T3(intranuclearreceptor)
Glaucomadrugs:"AABBCDF"
AA=AlphaAgonist:vasoconstriction>decraqhumorsynthesis(notforclosedangleglaucoma)
BB=BetaBlocker(Timolol):decraqhumorsecretion
C=Cholinomimetic(Carbachol,PilocarpinePhysisfortheEyesPhysostigmine,Echothiophate):incr
outflow(contractciliarymuscleandopentrabecularmeshworkintocanalofSchlemm)
D=Diuretic:Acetazolamide(carbonicanhydraseinhibitor),Mannitol:decraqhumorsecretion
F=PGF2alpha(Latanoprost):incruveoscleraloutflowAE:dyesirisesbrown
Cholinomimetics:
(`)
Bethanechol:"GiveBethannacallifyouwantyourPNSstimulated":Tx:postopneurogenicileusand
urinaryretention
Anticholinesterases=stigmines"+Edrophonium+Echothiophate

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julieyumi
Organophosphatepoisoning:"DUMBBELSS:Tx:Atropine,Pralidoxime
HOME

Diarrhea
Urination ASK
ARCHIVE
Miosis
Bradycardia
Bronchospasm
ExcitationofskeletalmuscleandCNS
Lacrimation
Salivation
Sweating

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Atropinepoisoning:"whatwouldhappenifyougotlostinthedesert:Hot,Dry,Red,Blind(cycloplegia),Mad(delirium),
urinaryretention(/constipation)
Hexamethonium:"PutaHexonreFLEXbradycardiaHexamethoniumpreventsNEreflexbradycardiabyblockingall
Nicotinicreceptors(ganglionblockerinhibitsNa/Kligandgatedchannels)
AChreceptors:
Nicotinic=Na/Kligandgatedchannels(ANSandNMJ)(Hexamethonium/Mecamylamineblocksthese)
Muscarinic=GcoupledreceptorsM1,2,3=QIQ(Atropineblocksthese)
Specificantidontes:
DeFERoxamineTxsFe(iron)
ChildrenSuckonLeadpencils:SuccimerTxsLeadpoisoninginchildren(TxisCaEDTAinadults)
DiMERcaprolTxsMERcury,arsenic,gold
CopperPenny:Copper,arsenic,goldTxw/PENIcillamine
NITRoprussideturnsintoCyanidewhichisTxdw/NITRite,hydroxocobalamin,andthiosulfate
METHyleneblueandVitCTxsMETHemoglobin
ETHANOLTxsmETHANOLpoisoning
HeparinsHlookslikeaProton:PROTamineTxsHeparintoxicity
Drugreactions:
TCAs3Cs:Cardiotoxicity,Convulsions,Coma
Cutaneousflushing:"VANC"=Vancomycin,Adenosine,Niacin,Ca2+channelblockers
Dilatedcardiomyopathy=DoxorubicinandDaunorubicin
TorsadesdePointes:"TheMethodtoget31AwesomeQTsistowearaHaloandRisperthatyouboughta
MacroPIefromQuinn.
Method=Methadone
31Awesome=ClassIII,ClassIaantiarrhythmics
Halo=haloperidol
Risper=risperidone
Macro=macrolide
PI=HIVproteaseinhibitors
Quinn=Chloroquine/Mefloquine
Aplasticanemia:"ChloraSAID"PtueytoMeth":
Chlora=Chloramphenical
SAID=NSAID
PTUey=PTU(antithyroid)
Meth=Methimazole(antithryoid)
HemolysisinG6PD:"PrimahadtotakeAspirinafterINHalingherI.B.ProfessorDapsonesSulfurousFava
BeanNitrofarts"
Primaquine
Aspirin
INH
Ibuprofen
Dapsone
Sulfonamides
Favabean
Nitrofurantoin
PseudomembranouscolitismakesyouwanttoClAmpyourass:CLindamycin,AMPicillin
Photosensitivity:"SATforaPhoto":
S=Sulfonamides
A=Amiodarone
T=Tetracyclines
StevensJohnsonrash:"'Seizures,Sulfas,andCillins+Allopurinol"
Seizuredrugs:ethosuximide,lamotrigine,carbamazepine,phenobarbital,phenytoin
Sulfadrugs
Penicillin
Allopurinol
SLElikesyndrome:"SHIPP"
Sulfonamides
Hydralazine(HydrasneckLoops(Lupus)aroundincircles)
INH
Phenytoin
Procainamide
Disulfiramlikereaction:"DrunkCephsaidhewasProCar(okaytodrive)atNight,buttoavoidaGruesome
accident,ChloramadehimSuffertheMetro.
Ceph=Cephalosporin
Procar=Procarbazine
Night=Nitrofurantoin
Gruesome=Griseofulvin
Chlora=Chloramphenicol
Suffer=Sulfonylureas
Metro=Metronidazole
Ototoxicity/Nephrotoxicity:"MiceusePlatinumearringLoopstocrawlintoyourEarandmakeyoudeaf
Mice=mycins=aminoglycosidesandvancomycin
Platinum=Cisplatin
Loops=Loopdiuretics
p450interactions:
p450inducers:"QueenBarbsriFamilyinducedSaintJohntoeataPhenylookingGreasyCarb"
Queen=Quinidine
Barbara=Barbiturate
riFamily=Rifampin
induced
SaintJohn=SaintJohnsWort
Phenylooking=Phenytoin(AE:gingivalhyperplasia)
Greasy=Griseofulvin
Carb=Carbamazepine

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Seereference:

(`)

julieyumi
arghlblargh!
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p450inhibitors:"WithoutaKey,KimwasinhibitedfromPIESandJuice"
Key=Ketoconazole
Kim=Cimetidine
inhibited
PI=HIVProteaseInhibitors
E=Erythromycin
S=Sulfonamides
Juice=grapefruitjuice
Seereference:

Toxicitybear:CumulativelyToxicDrugsandtheirRescues
Asparagine:neurotoxicity
Cisplatin:ototoxic/nephrotoxicTx:Amifostine
Vincristine/Vinblastine:"Christmynerves,Blastmybones"Vincristine=peripheralneuropathy,
Vinblastine=myelosuppression
Bleomycin:pulmonaryfibrosis
Doxorubicin:cardiotoxicTxDexrozoxane(forcardiotoxicity),Dimethylsulphoxide(forROSulcers)
Cyclophosphamide:Acrolein=nephro/bladdertoxic(Tx:Mesna)alsoSIADHeffects(Tx:
Demeclocycline)
Methotrexate:nephrotoxic(Tx:Leucovorin),myelosuppression(TxFilgrastim)
Seereference:

Cardiovascular:
Contractilitydecreaseswith:"ABBCCC":
A=Acidosis
BB=Betablocker
CCC=hyperCO2,CHF,nonDHPCa2+channelblockers
Heartmurmurs:
MR.ASSandMS.ARD=
MR=mitralregurg
AS=aorticstenosis
S=systolicmurmurs
and

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MS=mitralstenosis
AR=aorticregurg
D=diastolicmurmurs
holosystolic=allregurgs+VSD
murmursthatincreasewithbreathing:
rIghtmurmursincreasewithInspiration
lEftmurmursincreasewithExpiration
Wolf=LoneCanisWolffParkinsonWhiteistreatedwithamiodaRONEandProCAINamide
AVblocks:
First,agirlstaysout'til12eventhoughhercurfewis10.
Then,theteenagerstaysoutlaterandlater,'tilhermomthrowsafit.
Afterwards,despitetheteenagerbeinggood,themomthrowsrandomfitsprobablybecauseofmenopause.
Finally,theyoungwomanisoldenoughtowhatevershewantsseparatelyfromherparents."
(`)
1stdegree:increasedPR
2nddegree:
Type1Wenckebach:incrPRuntilQRSdrop
Type2:randomQRSdrop
julieyumi
3rddegree:PRandQRS=independentratesseeninLymedisease
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DiGeorge"Tets:TETralogyofFallow+TETanyfromhypocalcemia(lackofparathyroids)(also,truncusarteriosus)

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PGAopen:PGEkEEpsPDAopen(PGE1analogs:Alprostadil,Misoprostol)closewithIndomethacin

a r g h l b l a r g h ! Followjulieyumi

EvolutionofMI:"4anddeatharebothpronouncedshiinJapanese"

Initially:nothing
4hours4dayslater:PMNs,coagulativenecrosis,riskofarrhythmia(esp.Vfib)
410dayslater:M0sthinnedwalls>increasedriskofruptureandtamponade
>10days:riskforventricularaneurysm(bulgingscarbecausefibrosismadeitloseitsabilitytocontract)<
ventricularremodelingcanbepreventedwithACEIs
Bacterialendocarditis:"FROMJANE":
Fever
Rothspots:roundretinalwhitespotssurroundedbyhemorrhage
Oslersnodes:tenderraisedredlesionsonfingersandtoepads
Murmur(new)
Janewaylesions:nontendersmallredlesionsonpalmsandsoles
Anemia
Nailbed(splinter)hemorrhage
Emboli
IVDA=rightsidedbacterialendocarditis:"dontTRIdrugs"(tricuspidvalve)
SLEcausesLSE(LibmanSacksendocarditiswithwartysterilevegetationsonbothsidesofvalve,assoc.w/mitral
regurg)
RheumaticheartdiseaseofS.pyogenes(betahemolytic,bacitracinsensitiveStrep):"AAAAAA"
groupAStrep
autoimmune(AbtoantiphagocyticMprotein>MVP>MitralStenosis),fever
Aschoffbodies(granulomaswithgiantcells)=subcutaneousnodules
Anitschkowcells(activatedhistiocytes)
elevatedASOtitersandESR
migratorypolyArthritis
+Erythemamartginatum,Syndenhams/St.Vituschorea(offace,tongue,andupperlimb)
ACEinhibitorsareACEsatcontrollingHTN:
essentialhypertension
HTN+CHF(decreasesbothpreloadandafterload)
HTN+DM(protectiveagainstDiabeticnephropathy)
Antihypertensivetherapy:"ABCD":
ACEI/ARBs
Betablockers
Calciumchannelblockers
Diuretics(LOOpsLOOseCalcium,Thiazidesretaincalcium)
AdenDiazisMineOK?:Adenoxine,DiazoxideandMinoxidilOpenK+channels
Antiarrhythmics:"NoBadBoyKeepsClean"
TypeI:Na+blocker(incrQT)
TypeII:Betablocker(incrPR)TxODw/Glucagon
TypeIII:K+blocker(incrQT)
TypeIV:Ca2+blocker(incrPR)Txcoronaryandcerebralvasospasms
TypeIantiarrhythmics:
Ia:"TheQueenWerewolfDisappeared"
Quinidine,Procainamide,Disopyramide(incrAP)
Ib:"ToFunnyLittleMexico"
Tocainide,Phenytoin,Lidocaine,Mexiletine(decrAP)
Ic:"ProperlyFleeingEndangerment"
Propafenone,Flecainide,Encainide
TypeIII:Amiodarone:"checkPFTs,LFTs,andTFTs"
pulmonaryfibrosis
hepatotoxicity
hypo/hyperthyroidism(amiodarone=mostlyiodine,resemblesthyroidhormone)
+photodermatitis(SATforaphoto)
Endocrine:
Adrenalcortex:"GFR:Thedeeperyougo,thesweeteritgets.
"salt:zonaGlomerulosa:aldosterone
sugar:zonaFasciculata:cortisol
sex:zonaReticularis:androgens
Adenohypophysis=Anteriorpituitary(RAthkespouchofectoderm):"FLATPEG"
FSH
LH
ACTH
TSH
Prolactin
endorphins(sharePOMCoriginwithACTHandMSH)
GH
Basophilic=BFLAT:BasophilicFSH,LH,ACTH,TSH(VSAcidophilsProlactin,GH)
Neurohypophysis=Posteriorpituitary(Neuraltubeofectoderm):secreteshypothalamicsubstances:"APairofOx
wereSupraDehydrated"
ParaventricularnucleusOxytocin
SupraopticnucleusVasopressin(ADH)

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Adrenalsteroids:"Inanenzymedeficiency,ifthefirstdigitisa1,thenthepatientwillbehypertensive.Ifthesecond
digitisa1,thenthepatientwilllookmale.
17alphahydroxylasedeficiency:HTN,feminine
21hydroxylasedeficiency(MC):hypotension,masculine
11betahydroxylasedeficiency:HTN,masculine
PTH=phosphatetrashinghormone(note:decreasedfreeserumMg2+,decreasesPTHsecretioncommoncausesof
decrMg2+=alcohol,aminoglycosides,diarrhea,diuretics)
Calcitonin=fromparafollicularCcellsofthyroid=neuralCrestderivative,secretedinmedullarythyroidCancer(MENII)
(Signalingpathwaymnemonicswerecoveredearlier)
Thyroidhormonefunctions:"T3=5Bs

(`)
Brain(CNS)maturation(defect=mentalretardationseeninCretinism)
Bonegrowth(synergismwithGHdefect=Cretinism)
Beta1adrenergiceffects(ThyroidStorm:incrHR,contractility>arrhythmiaTxwithpropanololorPTU(OKin
pregnant))
julieyumi
incrBMR
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incrBloodsugar:glycogenolysis,gluconeogenesis,lipolysis

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Pheochromocytoma(PCC):"Ruleof10s"
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10%malignant
10%bilateral
10%extraadrenal
10%calcify
10%kids
10%familial

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Neuroblastoma(MCCadrenalmedullatumorinchildren)=Nmyconcogene,stain=Neurofilaments,tumormarker
=Bombesin
seeHomerWrightpseudorosettesandincrHVA(Dopaminederivative)inurine
scenario:~2yowithretroperitonealabmasspresentswithHTNhypotonia,myoclonus,andnonrhythmic
conjugateeyemovements(opsoclonusmyoclonus)
massmayinvadeintoanintervertebralepiduralspaceandlooklikeadumbbell
HypOthyroidism=cOldintoleranceHypErthyroidism=hEatintolerance
CHIMPANZEEScauseHypercalcemia:
Calciumingestion(incrantacids>milkalkalisyndrome)
Hyperparathyroid/Hyperthyroid
Iatrogenic:Thiazides
Multiplemyeloma
Pagetsdisease(whenpatientsareimmobilized,normallynormocalcemic)
Addisonsdisease
Neoplasms(e.g.,breastcancer=osteolytic)
ZollingerEllisonsyndrome(pancreatictumor>incrgastrinassociatedwithMENI(parathyroidtumor)
ExcessvitaminD
ExcessvitaminA(incrboneresorption>incrCa2+)
Sarcoidosis(orgranulomatousdisease)
Hyperparathyroidism:
Primary:Osteitisfibrosacystica=stones,bones,andgroans=kidneystones,brownbonetumors,
weaknessandconstipationincrcAMPinurine
VSSecondary:Renalosteodystrophy=renaldisease>decrVitD>decrCa2+>incrPTH>bone
lesions
Hypocalcemiasigns:
C=Chvosteksign=Cheektapping>facialmuscleContraction
T=Trosseaussign=TightBPcuff>handTetany(spasm)
DexamethasonevsDemeclocyclinevsDesmopressin:
Dexamethasone=steroidtoDxACTHdisease/syndrome
DemecloCYCLine=tetracyclineADHantagonistvsCYCLophosphamideinducedSIADHTx:SIADH
DesmoPRESSIN=vasoPRESSIN(ADH)analogTx:centralDiabetesinsipidus
(Note:nephrogenicDIistreatedbyhydrochlorothiazide(Ca2+sparingdiuretic),indomethacin(decrrenal
bloodflow),oramiloride(K+sparingaldosteronereceptorantagonistdiureticthatclosesNa+channelsthat
alsoreabsorbsLitoTxLiinducedDI)
Multipleendocrineneoplasias(MEN):(AD)
MENI(Wermers):"3Ps"
pancreatic~ZollingerEllisongastrinomapepticulcers
parathyroidincrPTHhypercalcemia
pituitary~prolactinorGHamenorrhea,lactation
MENIIa(Sipples):"2Ps"
parathyroidincrPTHhypercalcemia
PCCincrcatecholamines(Epi/Nor),urineVMAandMetanephrine
medullarythyroid(parafollicularC)polygonal,incrcalcitoninhypocalcemia
MENIIb:"1P"
PCCincrcatecholamines,urineVMA/metanephrine
medullarythyroid(parafollicularC)incrcalcitoninhypocalcemia
Marfanshabitus+oral/intestinalmucosalneuromas
Note:MENIIsareassociatedwithretoncogene
Also,theIIinMENIIstandsforthe2CsinPCC
Diabeticdrugs:
MetforminGlittersinSunnyGliptinTides
Metformin=incrglucoseuptakeinmuscleandfatviaGLUT4(akaincrinsulinsensitivityinperipheral
tissue)anddecrliverglucoseproductionviaincrAMPKanddecrPEPCK(OAAtoPEP)anddecrG6Pase
(G6PtoGlucose)production
Glitazones=incrinsulinsensitivityviaPPARgamma/adiponectin
Sulfonamides=incrpancreaticinsulinproductionviablockingATPdep.K+efflux
Gliptins,Tides=incrinsulin,decrglucagon,decrgastricmotility(incrsatiety)
+Acarbose/Miglitol=decrstarchhydrolysisandglucoseGIuptake
Diabetesdrugsmechanismsofaction:
PPARazzicameraflashesGLITAPPARgamma'Glitazones
GULPTIDESGLP1'Tides
Dr.PPerandLiptonDPP4inhibitor'Gliptins
AcarboseAlphaglucosidase
Remember:
insulin>decreasescAMP>decreasesPKA>dephosphorylatedFBPase2=PFK2>F6PtoF26BP>
F26BPstimulatesPFK1>incrF6PtoF16BP(glycolysis)
glucose>decreasescAMP>decreasesCAPcAMPbindingoflacoperon=RNApolymerasecantbindto
promoter
Gastrointestinal:
Retroperitonealstructures:"IASKDR.PC"
Primaryretroperitoneal(neverpushedintosac):

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IVC
Abaorta
Suprarenalglands
Kidneys/Ureters
Secondaryretroperitoneal(pushedintosac,butescaped):
Duodenum(2,3,4)
Rectum
Pancreas(head,body)
Colon(ascending,descending)
OR"SADPUCKER"=suprarenal,abdominalaorta,duodenum,pancreas,ureter,colon,kidney,esophagus,rectum
Digestivetracthistology:"BrunchDIP":
Brunners(submucosal,alkalinemucussecreting)glands=Duodenum
Ileum=PeyersPatches(McellstakeupantigenalsolocationofIgAsecretingplasmacells)
(`)
Note:ShigellaistakenupbytheMcellsofPeyersPatchesviruseslikeAdenovirusmayinvadePeyers
PatchesandcauseintussusceptionSabin(livePoliovaccine)increasesIgAimmunity

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Entericnerveplexuses:"AUerbachisontheAUtside,MeiSSnersisSSubmucosal"

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Auerbachs=Myenteric=coordinatesMotilitybybeingwedgedbetweentheinner/circularand
arghlblargh!
outer/longitudinalmuscles
Meissners=Submucosal=regulatesSecretions,bloodflow,andabsorptionbetweenmucosaand
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inner/circularmuscles

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DefectinAuerbachscausesAchalasia
Followjulieyumi
LackofbothAuerbachandMeissnersduetofailureofneuralcrestcellmigrationcausesHirschsprungsCongenital
Megacolon,assoc.withDownSyndrome(seefailuretopassmeconium,likeinCysticFibrosis)
Portosystemicanastomoses:
ThemnemonicisfromSystemic(IVC)toPortal(Celiac,SMV,IMV)veins:
MISuperiorsanAss.HemakesmefeelInferioraboutmySuperficialappearancebypokingnearmyBellybutton
soIEatLess.
Rectalanastomoses:(X=hemorrhoids)
MISuperiorisanAss:
Systemic:MiddleandInferiorRectal
to
Portal:SuperiorRectal
Umbilicalanastomoses:(X=caputmedusae)
InferioraboutmySuperficialappearancebypokingnearmyBellybutton:
Systemic:Inferior,SuperficialEpigastric
to
Portal:Paraumbilical
Esophagealanastomoses:(X=esophagealvarices)
EatLess:(X=esophagealvarices)
Systemic:Esophageal(azygos)
to
Portal:LeftGastric
Liveranatomy:"1ABC"
1ABC:

Zone1=ApicalsurfaceofhepatocytesfaceBileCanaliculi=periportalzone
Also,whenyouthinkofABC,youshouldthinkofHepatitisA,B,C
Zone1=firstaffectedbyviralhepatitisbecauseclosesttohepaticartery(Remember:Portaltriad=
bileduct,hepaticartery,andportalvein)
The3rdletterinthealphabet=C:
Zone3=Centrilobular(periCentralvein)=whereblooddrainsintothehepaticvein
becauseitssofarfromthehepaticartery,itsthefirstplacetosufferfromischemia
also,sincebloodpoolsinveins,youcanthinkofdrugs/poisonspoolingthere,too
Bottomline:Zone1=susceptibletoviruses,Zone3=susceptibletodrugs/ischemia
Femoralregion:"NAVELwiththeVenousnearthePenis"
Lateraltomedial:Nerve,Artery,Vein,Emptyspace,(deepinguinal)Lymphatics/Lacunarligament
Note:femoralsheathdoesnotcontainfemoralnerve
Inguinalcanal:"INternal(deep)inguinalring=INdirectherniathatmaygoINtothescrotum"=lateraltoinferior
epigastricvessels
VS."analienDirectlyburstingfromyourstomach"=directhernia=protrudesfromabdominalwallmedialtoinferior
epigastricvessels:

orMDsdontLIe:Medial=Direct,Lateral=Indirect
FemFem:femoralherniasoccurmoreofteninfemales(andistheleadingcauseofbowelincarceration)
GIsecretoryproducts:
IFyouPARTYtoohard,youllvomitoutalotofGASTRICACID.:
ParietalcellssecreteIF(intrinsicfactor)andHCl(gastricacid)
PeppeptotheChief:
ChiefcellsmakePepsin
Vitamin/Mineralabsorption:
Duodenum:"FED"=Fe(iron)inDuodenum
Jejunum:"TheJesterisaFatFool"=JejunumabsorbsmostFatsandFolate

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Ileum:TheileumisthelastpartofthesmallintestineitswhereyousayByeByetotheSI:Byleacid,
B12/IFisreabsorbedintheIleum
Bilirubin:
Rulesofthumb:
Thetwonameddiseasesdontgotogether
Theonenameddiseasesaremilder
INdirect=UNconjugated=waterINsoluble:CriglerNajjar,Gilbert=
KINGKONG>CINGCUNG>CrigglerIndirect/UnconjugatedNajjarGilbert
YougetCriglerNajjar/Gilbertswhenyoureunabletoconjugatebilirubinintoawatersoluble/excretableform~
Glucuronyltransferasedeficiency
Direct=conjugated=Watersoluble:DubinJohnson,Rotors=
DubinJohnsoncalledRotorrootertofixhisWaterPipes.
YougetdirectbilirubinemiawhentheresaproblemwithbilePipes/excretion(E.G.,biliarytreeobstruction)
Note:DubinJohnsonisworsethanRotorsinthattheliverispigmentedblack
(`)

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Achalasia
lossofAuerbachsmyentericplexus
BirdsbeakonBariumswallow
associatedwithChagasandCREST

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Achalasia:"AABBCC"

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Boerhaavesyndrome=BeenHeavingtransmuralcomplicationofMalloryWeiss

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BARRettsesophagus=BecomesAdenocarcinoma,ResultsfromReflux
Esophagealcancerriskfactors:"ABCDEFGH"
Alcohol,Achalasia
Barrettsesophagus
Cigarettes
Diverticuli(e.g.,Zenkers)
Esophagealweb(e.g.,PlummerVinson),Esophagitis
Familial
GERD
Hotdogs(nitrosamines)
Esophagealcancerepidemiologyandlocations:

Squamouscell=Spreadoutworldwide(mostprevalentworldwide)upper2/3s(wherestriatedmusclecanbe
found)
Adenocarcinoma=mostprevalentinAmerica(lower1/3,locationofpuresmoothmuscle)
Gastritis:
Acutegastritis(erosive):
BurnedbyCurlingiron:Curlingsulcer=stressulcerfromburns:
decrplasmavolume>sloughingofgastricmucosa
Cushionthebrain:Cushingsulcer=stressulcerfromheadinjury:
incrICP>incrvagalstimulation>incrACh>incrH+)
Chronicgastritis(nonerosive):"ABpairing"
TypeA(fundus/Body)=Autoimmune/Anemia:
AutoAbtoparietalcells,perniciousanemia(AbtoIF),achlorhydria
TypeB(Antrum)=Bacterial:
H.pyloriinfection(duodenal>stomachulcer),increasedriskofMALTlymphoma
Pepticulcerdisease:
Gastriculcerpain=Greaterwithfood
Duodenalulcerpain=Decreaseswithfood(willseehypertrophyofBrunnersglandsandcleanpunchedout
marginsunlikecarcinomaraised/irregularmargins)
Inflammatoryboweldisease(IBD):CrohnsvsUlcerativeColitis
Crohns:"ACreepyFatoldCrone(Granny)wentSkippingonCobblestoneswhilepumpingherArthriticFistin
theair.
CreepyFat=Creepingfat
Crone=Crohnsdisease
(Granny)noncaseatingGranulomas
Skipping=transmuralSkiplesions
Cobblestone=Cobblestonemucosa
Arthritic=Migratorypolyarthritis
Fist=Fistulas
"GumtoBumlesionsandextraintestinalmanifestations(systemic)likeerythemanodosum
(~shins),ankylosingspondylitis,anduveitis
Note:thisisdisorderedresponsetointestinalbacteria
Ulcerativecolitis:"IfyouhaveaLeadPipejammedupyourRectum,youllgetBloodyDiarrhea.
LeadPipe=lossofhaustraleadsto"leadpipeappearanceonimaging
Rectum=UCalwaysinvolvestherectalmucosa/submucosaandprocedescontinuouslyupunlike
Crohnswhichtendstosparetherectum
Bloodydiarrhea(anothertraitnotsharedwithCrohns)
Note:thisisautoimmune
UCisalsoassociatedwithfriablepseudopolyps,pyodermagangrenosum,andprimarysclerosing
cholangitis
Meckelsdiverticulum:"Ruleof2s"
2incheslong
2feetfromileocecalvalve
2%ofpopulation
2yo(oryounger)
2typesofectopicepithelia:gastricorpancreatic
Colonicpolyps:"VILLous=VILLainOUS"becausevillouspolypsaremorelikelytobemalignant(villous>tubulovillous
>tubulous)
Colorectalcancer(CRC):
Familialadenomatouspolyposis(FAP):"polyposis"=thousandsofpolypsFAPCancerinvolvesAPCgene
alwaysinvolvesrectum
VS.HNPCC/LynchwhichdoesnthavemanypolypsandinvolvesthePROXIMALcolon
Gardnerssyndrome=GardenersGrowallkindsofthings:Gardners=FAP+osteomas+lipomas/soft
tissuetumors+retinalhyperplasia
Turcotssyndrome:"TURcot=TURban"FAP+malignantCNStumor(medulloblastoma)
PresentationofCRC:Thinkofthecolonasafunnelthatshrinkstowardstheanus(andalsothatvisceralnervesdont
haveasmanylocalizedpainreceptorsastheanus):
distalcolon(leftside,nearanus)=obstruction,sharpcolickypain,hematochezia
proximalcolon(rightside)=irondeficiencyanemia,dullpain,fatigue
CRC:"Applecore"lesiononbariumenemaxray,CEAtumormarker
MolecularpathogenesisofCRC:alphabeticalorder
loseAPC(decreasedintercellularAdhesion)thenmutatekRAS(unregulatedsignaltransductionMAPK)thenlosep53
(noapoptosis)
Wilsonsdisease(hepatolenticulardegeneration):arinadequatecopperexcretion,treatedwithpenicillamine(copper
penny):"ABCDEF"
Asterixis,Ataxia,Anemia(hemolytic)
Basalgangliadegeneration(Parkinsonism)

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decrCeruloplasmin,Cirrhosis,Cornealdeposits,Cancer(HCC)
Dementia
Encephalopathy
FanconisSyndrome:defectivePCTreabsorption
Gallstones(cholelithiasis):Riskfactors=4Fs:
Fat
Fertile
Female
Forty
Acutepancreatitiscauses:"GETSMASHED">DIC,ARDS

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Gallstones
Ethanol
(`)
Trauma
Steroids
Mumps
Autoimmunedisease
ScorpionSting
Hypercalcemia,Hyperlipidemia
ERCP
Drugs(E.G.,Sulfadrugs)
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Antacidadverseeffects:

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Al=AluMINIMUMamountoffeces:constipation
Mg=MustGotothebathroom:diarrhea

AndthiswaswhereIstopped.Ifyouhavespecificquestions,feelfreetoaskme(butdontforgettoleavemeaway
tocontactyou!).
Ihopethislistcomesinhandyforsomeone.Goodluckwiththeexam!
Update(3/31/13):Unfortunately,Imverybusywithclerkships/shelvesandstudyingfortheStep2CK,soIwontbe
abletoposttherestofmymnemonics,butmyAskboxisalwaysopenforadvice!^^Thanksforunderstanding.
Posted4yearsago267notes
#USMLE#anatomy#bacteriology#biochemistry#biostatistics#histology#immunology#microbiology#neurology
#neuroscience#parasitology#pathology#physiology#psychiatry#ross#virology
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