Medical Mnemonics for Examinations

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From proximal to distal:

Duodenum

Jejunum

Ileum

Appendix

Colon

Sigmoid

Rectum

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From proximal to distal:

Duodenum

Jejunum

Ileum

Cecum

Appendix

Colon

Sigmoid

Rectum

Causes of Acute Pancreatitis
"GET SMASHED"

Gall stones Ethanol

Trauma

Steroids

Mumps

Autoimmune disease

Scorpion venom

Hyperlipidemia

ERCP (dye)

Drugs (Azathioprine, Asparginase, Mercaptopurines, Pentamidine)

Alcohol and Gallstones are most common causes.

A-P-G-A-R
Score 0-2 at 1 and 5 minutes in each of 5 categories:

A - Appearance (Color: blue/pale, trunk pink, all pink)

P - Pulse (Heart rate: 0, <100, 100+)

G - Grimace (Reflex irritability: 0, grimace, grimace+cough)

A - Activity (Muscle tone: limp, some, active)

R - Respiration (Respiratory effort: 0, irregular, regular)

10 is perfect score

Multiple Endocrine Neoplasia (MEN)
Each of the MENs is a disease of three or two letters plus a feature, and all are Autosomal Dominant inheritance.


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


 * MEN II is a disease of 2 C's(carcinoma of thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIB (aka MEN III)


 * Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate


 * Acute pneumonia caused by Miscellaneous microbes--Mononuclear infiltrate


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

CAGE - alcohol use screening

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


 * Have you ever been ANNOYED when people suggest you cut down on your drinking?


 * Have you ever felt GUILTY about your drinking?


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

O-P-Q-R-S-T - eliciting and HPI and exploring symptoms
O - Onset of pain (what was the patient doing when the pain started?)

P - Palliative or Provocative factors for the pain

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

R - Radiation (up to jaw, down left arm, etc.)

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

T - Timing of pain (eg: after meals, in the morning, how long it lasts, etc.)

S-O-C-R-A-T-E-S - exploring the presenting complaint
S - Site of pain

O - Onset of pain

C - Character of pain (dull, sharp, aching, stabbing, tearing etc.)

R - Radiation of pain (eg. central abdominal pain radiating to Right Iliac Fossa)

A - Associated factors (eg. nausea/vomiting)

T - Timing of pain/duration

E - Exacerbating/alleviating factors

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

A-S-C-L-A-S-T - eliciting and HPI and exploring symptoms
A - Aggravatiing and Alleviating factors

S - Severity

C - Character, quality

L - Location

A - Associated symptoms

S - Setting

T - Timing

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

The five W's--post-operative fever
Wind - pneumonia, atelectasis

Wound - wound infections

Water - urinary tract infection

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

Wonderdrugs - especially anesthesia

Predisposing Conditions for Pulmonary Embolism: TOM SCH PREFER
T - Trauma

O - Obesity

M - Malignancy

S - Surgery

C - Cardiac disease

H - Hospitalization

P - Past history

R - Rest (bed-bound)

E - Estrogen, pregnancy, post-partum

F - Fracture

E - Elderly

R - Road trip

6 P 's
ARTERIAL OCCLUSION (Signs of Compartment Syndrome)

Pain

Paleness (Pallor)

Perishing with Cold (Poikilothermia)

Pulselessness

Paresthesias

Paralysis

DAVE WILMINGTON
To write Admission Orders to Hospital

(After noting date and time of Admission as well as Diagnosis and Condition (ADC), use the mnemonic to ensure all areas are addressed, but not all apply to every patient)

Diet

Activity

Vital signs (how often)

Excrement (test urine / stool)

Weight (how often to monitor)

I / O (monitor input / output)

Labs (what, how often)

Meds (which, route, interval)

I V fluids (what and at what rate)

Nursing care (e.g. position, wound care, up in chair, ostomy care etc)

General care (e.g. Physical Therapy, Respiratory Thearpy etc)

Tests (X-ray, EKG, EEG etc)

Observe for reaction, seizure, neuro exams

Notify parameters (e.g. Temp > 100 / respiration changes)

More standard is ADC VAAN DIML (pronounced ADC van dim(e)l)
Admit (23 hours, full admit, service of attending,...)

Diagnosis

Condition ("Stable", "Guarded", etc.)

Vitals (post-op, routine, q 1 hour, etc.)

Allergies

Activities (Strict bed rest, fall precautions, ad lib, bathroom privileges, etc.)

Nursing (Strict I&O's, Daily weights, Call P.R.N. whatever, etc.)

Diet (NPO, Regular, Clears - advance diet as tolerated, 2000 cal ADA, renal, etc.)

IV fluids (D5 1/2 NS c 20 KCL at 110 ml/hr, LR @ 100 ml/hr, etc.)

Meds (scheduled and PRN's)

Labs and x-ray (CBC in AM, PCXR in PACU, etc.)

Note that IV fluids follows Diet. If one writes NPO, then all such patients get maintenance fluids (use the 4-2-1 rule).

VITAMIN C
Causes of Diseases


 * Vascular,


 * Infectious,


 * Traumatic,


 * Auto-immune,


 * Metabolic,


 * Idiopathic/Iatrogenic,


 * Neoplastic,


 * Congenital)

M U D  P I L E S
Causes of Metabolic Acidosis

Methanol poisoning

Uremia

Diabetic Keto-acidosis

Para-aldehyde ingestion

Ischemia

Lactic Acidosis

Ethanol poisoning

Salicylate ingestion

Causes of HyperCalcemia
PAM SCHMIDT          OR              MISHAP

Paget's Disease                       Malignancy

Amyloid                               Intoxication (hypervitaminosis)

Multiple Myeloma                      Sarcoidosis

Sarcoid                               Hyperparathyroidism

Cancer                                Alkalai ( Milk ) syndrome

Hormomal (para-thyroid)               Paget's Disease bone

Milk-alkali Syndrome

Immobilization

D-vitamin overdose

Thyrotoxicosis

also consider Addison's Disease, thiazide diuretics and simple lab error

5 SIGNS OF INFLAMMATION (as described by Celsus)

 * Redness/Erythema Italic text(Rubor)


 * Raised temperature Italic text(Calor)


 * Swelling Italic text(Tumor)


 * Pain Italic text(Dolor)


 * Loss of Function Italic text(Functio Laesa)

ACID
(Gell & Goombs" classification for HYPERSENSITIVITY REACTIONS):

Anna Cycled Immediately Downhill

Type I  Anaphylaxis

Type II Cytotoxic-mediated

Type III Immune-complex

Type IV Delayed hypersensitivity

Never Let Monkeys Eat Bananas

 * Neutrophils 60%
 * Lymphocytes 30%
 * Monocytes 6%
 * Eosinophils 3%
 * Basophils 1%

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

 * Neutrophils 60%
 * Lymphocytes 30%
 * Monocytes 6%
 * Eosinophils 3%
 * Basophils 1%

Nice Ladies Make Easter Bread" and "60, 30, 6, 3, 1

 * Neutrophils 60%
 * Lymphocytes 30%
 * Monocytes 6%
 * Eosinophils 3%
 * Basophils 1%

Sunday Hot Day, Better Give Iced Fluids Today!
Treatment of Malignant Hyperthermia

S: Stop all triggering agents, give 100% O2

H: Hyperventillate

D: Dantrolene 2.5 mg/kg

B: Bicarbonate

G: Glucose and Insulin

I: IV Fluids, Cooling Blanket

F: Fluid Output; Furosemide

T: Tachycardia, be prepared to treat V Tach

DISK MASS
Reasons of Back Pain

D ==   Degeneration: DJD, Osteoporosis, spondylosis

I  ==   Infection: UTI, PID, Potts, osteomyelitis, prostatitis, Injury/fracture, compression fracture.

S ==   Spondylitis, ankylosing Spondyloarthropathies (rheumatoid arthritis, Reiters,  SLE)

K ==   Kidney stones/infarction/infection (pyelo/abscess)

M ==  Multiple myeloma, Metastasis from breast, prostate, lung, thyroid, kidney CA

A ==   Aneurysm, Abdominal pain referred to the back (see acute abdominal pain)

S ==   Slipped disk, Spondylolisthesis

S ==   Strain, Scoliosis/lordosis, Skin: herpes zoster.

Regarding what to do in case of syncope
If the face is red, raise the head.

If the face is pale, raise the tail!

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


 * Radical Teachers Drink Cold Beers
 * Randy Travis Drinks Cold Beers.
 * Robert Taylor Drinks Cold Beer.
 * Red Trucks Drive Cats Nuts.

CRANIAL NERVES
I - olfactory,

II - optic,

III - oculomotor,

IV - trochlear,

V - trigeminal,

VI - abducens,

VII - facial,

VIII - acoustic (vestibulocochlear),

IX - glossophrayngeal,

X - vagus,

XI - accessory,

XII - hypoglossal


 * On Old Olympus Towering Tops, A Finn And German Viewed Some Hops
 * Our Only Object To Touch And Feel Virgin Girls Vagina And Hymen

LR6 SO4 3

 * LR6 - Lateral Rectus --> CN VI Abducens
 * SO4 - Superior Oblique --> CN IV Trochlear
 * 3 - The remaining 4 eyeball movers --> CN III Occulomotor
 * or LAST: LA = Lateral Rectus - Abducens Nerve, ST = Superior Oblique - Trochlear Nerve

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


 * Two Zebras Bought My Car
 * Two Zebras Bit My Cookie
 * To Zanzibar By Motor Car
 * Ten Zulus Buggered My Cat

INNERVATION OF PENIS

 * Parasympathetic causes erection. Sympathetic causes ejaculation. "Point and Shoot."


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

ABC'S

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

N(AVEL)
Order of things in the Femoral Triangle

Nerve,

Artery,

Vein,

Empty space,

Lymphatics

NOTE: Parenthesis includes things contained in the femoral sheath.

Hurler syndrome features HURLER'S

 * Heptosplenomegaly
 * Ugly facies
 * Recessive (AR inheritance)
 * L-iduronidase deficiency (alpha)
 * Eyes clouded
 * Retarded Short/
 * Stubby fingers

CHILD HAS PROBLEM!
Down syndrome features Congenital heart disease/ Cataracts

Hypotonia/ Hypothyroidism

Incure 5th finger/ Increased gap between 1st and 2nd toe

Leukemia risk x2/ Lung problem

Duodenal atresia/ Delayed development

Hirshsprung's disease/ Hearing loss

Alzheimer's disease/ Alantoaxial instability

Squint/ Short neck

Protruding tongue/ Palm crease

Round face/ Rolling eye (nystagmus)

Occiput flat/ Oblique eye fissure

Brushfield spot/ Brachycephaly

Low nasal bridge/ Language problem

Epicanthic fold/ Ear folded

Mental retardation/ Myoclonus

Drink at 21
Down Syndrome - Chromosome 21

Puberty at 13
Patau's Syndrome - Chromosome 13

Election voter at 18
Edward's Syndrome - Chromosome 18

Down syndrome pathology DOWN
Decreased alpha-fetoprotein and unconjugated estriol (maternal)

One extra chromosome twenty-one

Women of advanced age

Non-disjunction during maternal meiosis

CUT the PY (cut the pie)
Pyrimidines nucleotides Cytosine

Uracil

Thiamine are

the

PYrimidines

CATCH 22
DiGeorge/ Velocardiofacial syndrome

Cardiac abnormalities

Abnormal facies

Thymic aplasia

Cleft palate

Hypocalcemia

22q11 deletion

MARFAN
Mitral valve prolapse

Aortic Aneurysm

Retinal detachment

Fibrillin

Arachnodactyly

Negative Nitroprusside test (differentiates from homocystinuria)

Go Sally Go! Make Children!
Cell cycle stages

G1 phase (Growth phase 1)

S phase (DNA Synthesis)

G2 phase (Growth phase 2)

M phase (Mitosis)

C phase (Cytokinesis)

APKD
ADult Polycystic Kidney Disease is Autosomal Dominant

Also, "Polycystic kidney" has 16 letters and is due to a defect on chromosome 16.

Essential Amino Acids
PriVaTe TIM HALL


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

Urea Cycle
Ordinarily, Careless Crappers, Are Also Frivolous About Urination.

Ornithine,

Carbamoyl,

Citrulline,

Aspartate,

Arginosuccinate,

Fumarate,

Arginine,

Urea.

People Meet And Talk
Cell division

Prophase,

Metaphase,

Anaphase,

Telophase.

5P 's for acute intermittent porphyria
Pain in abdomen

Polyneuropathy

Psychologial abnormalities

Pink urine

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

ABCD for BUN & creatinine elevation
Azotremia (pre-renal)

Bleeding (GI)

Catabolic status

Diet (high protein parenteral nutrition)

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

Antimalarial (eg: primaquine)

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

Vitamin B3 (niacin, nicotinic acid) deficiency: pellagra

The 3D 's of pellagra
Pellegra: Vitamin B3 (niacin, nicotinic acid) deficiency

Dermatitis

Diarrhea

Dementia

Pompe's disease: type "Police = Po + lys"
Pompe's disease is a lysosomal storage disease (alpha 1,4 glucosidase).

Metabolic acidosis (normal anion-gap) causes

 * 1) With hyperkalemia: RAISE K+:

RTA type 4

Aldosterone or mineralocorticord deficiency

Iatrogenic: NH4Cl, HCl

"Stenosis": obstructive uropathy

Early uremia


 * 1) With hypokalemia: ReDUCE K+:

Renal TA type 1 and 2

Diarrhoea

Urine diversion into gut

Carbonate anhydrase inhibitor

Ex-hyperventilation

Galactosaemia: enzyme deficiency
GALIPUT: Galactose 1 Phosphate Uridyl Transferase.

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

Folate deficiency: causes A FOLIC DROP
Alcoholism

Folic acid antagonists

Oral contraceptives

Low dietary intake

Infection with Giardia

Celiac sprue

Dilatin

Relative folate deficiency

Old

Pregnant

The FAT cat is in the ADEK (attic)
Vitamins: which are fat soluble

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

Hemoglobin binding curve: causes of shift to right
"CADET, face right!"

C = Increase in carbon dioxide,

A = Acidosis (low ph),

D = Increase in 2,3 DPG aka 2,3 BPG,

E = Exercise,

T = increase in temperature

G proteins for respective receptors
"QISS & QIQ" (Kiss and Kick):

G-proteins and their respective receptors (alphabetical order)
Q: alpha 1 I: alpha 2 S: beta 1 S: beta 2 &

Q: M1 I: M2 Q: M3

Adrenaline mechanism
"ABC of Adrenaline":

Adrenaline--> activates

Beta receptors--> increases

Cyclic AMP

Carbon monoxide: electron transport chain target
"CO blocks CO"

Carbon monoxide (CO) blocks Cytochrome Oxidase (CO)

Metabolism sites
"Use both arms to HUG":

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

AcetylCoA and acetacetylCoA
"A Lighter Lease" (A LyTr LeIs): amino acids forming them

A=AcetylCoA or Acetoacetyl CoA

Ly=Lysine

Tr=Tryptophan

Le=Leucine

Is=Isoleucine

Fasting state: branched-chain amino acids used by skeletal muscles
"Muscles LIVe fast":

Leucine

Isoleucine

Valine

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

Glucose

Glucose-6-P

Fructose-6-P

Fructose-1,6-diP

Dihydroxyacetone-P

Glyceraldehyde-P

1,3-Biphosphoglycerate

3-Phosphoglycerate

2-Phosphoglycerate (to)

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

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

Glycolysis Enzymes
“Hungry Peter Pan And The Growling Pink Panther Eat Pies”

Hexokinase,

Phosphohexo isomerase,

Phosphofructokinase-1 (6-phosphofructo-1 kinase),

Aldolase, Triose phosphate isomerase,

Glyceraldehyde 3-phosphate dehydrogenase,

Phosphoglycerate kinase,

Phosphoglycerate mutase,

Enolase,

Pyruvate kinase

Citric acid cycle compounds
"Our City Is Kept Safe And Sound From Malice":

Oxaloacetate,

Citrate,

Isocitrate,

alpha-Ketoglutarate,

Succinyl-CoA,

Succinate,

Fumarate,

Malate

Citric acid cycle compounds
"Can I Keep Selling Sex For Money, Officer?":

Citrate,

Isocitrate,

alpha-Ketogluterate,

Succinyl CoA,

Succinate,

Fumerate,

Malate,

Oxaloacetate

Citric acid cycle compounds
"Oh! Can I Keep Some Succinate For Myself?":

Oxaloacetate,

Citrate,

Isocitrate, alpha-Ketoglutarate,

Succinyl CoA,

Succinate,

Fumarate,

Malate

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

Oxaloacetate,

Citrate,

Isocitrate, alpha-Ketoglutarate,

Succinyl CoA,

Succinate,

Fumarate,

Malate

Citrate Cycle Enzymes
"Corrupt Anti Intelligence Agent Spoke Slander For Money."

Citrate synthatase,

aconitase,

Isocitrate dehydrogenase,

Alpha ketogluturate dehydrogenase,

Succinyl CoA synthetase,

Succinate dehydrogenase,

Fumarase,

Malate Dehydrogenase

Fabry's disease: FABRY'S
Foam cells found in glomeruli and tubules/ Febrile episodes

Alpha galactosidase A deficiency/ Angiokeratomas

Burning pain in extremities/ BUN increased in serum/ Boys

Renal failure

YX genotype (male, X linked recessive)

Sphingolipidoses

B vitamin names
"The Rhythm Nearly Proved Contagious":

In increasing order:

Thiamine (B1)

Riboflavin (B2)

Niacin (B3)

Pyridoxine (B6)

Cobalamin (B12)

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

• Pvt. is short for Private in the military.

• Arg and His are considered semiessential.

• Alternatively: "MATT VIL PHLy".

Golgi complex: functions
"Golgi Distributes A SPAM": Distributes proteins and lipids from ER

Add mannose onto specific lysosome proteins

Sulfation of sugars and slected tyrosine

Proteoglycan assembly

Add O-oligosugars to serine and threnonine

Modify N-ologosugars on asparagine

Catabolism steps of branched chain amino acids
"Truck hit the Ox to Death": Transamination Oxidative decarboxylation Dehydrogenation

Niacin deficiency
The famous 4 D's:

Diarrhoea

Dermatitis

Dementia

Death (if untreated)

Creatine phosphate: amino acid precursors
"Nice GAMs!":

Glycine

Arginine

Methionine

Enzymes: classification
"Over The HILL":

Oxidoreductases

Transferases

Hydrolases

Isomerases

Ligases

Lyases

COLLAGEN
C-terminal propeptide (procollagen)/ Covalent Cross links/ C vitamin/ Connective tissue/ Cartilage/ Chondroblasts/ Copper Cofactor (Covalent Cross linking)

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

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

Long triple helical fibers/ Ligaments

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

Gly in every third position/ Glycosylation of hydroxyl group of hydroxylysine with Glucose and Galactose; GOlgi allows procollagen to GO outside of cell

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

N-terminal propeptide (procollagen)/ Nonhelical terminal extensions

Essential amino acids
"PVT. TIM HALL always argues, never tires":

Phe

Val

Thr

Trp

Ile

Met

His

Arg

Lue

Lys

Hypervitaminosis A
Increased Vitamin A makes you HARD

Headache/ Hepatomegaly

Anorexia/ Alopecia

Really painful bones

Dry skin/ Drowsiness