Can be best if you review this site to summarize course before MBBS prof , usmle , Plab, AMC. All pages are linked with additional information on forum sabirkhan.dailyforum.net where you can also add commit and suggestions.

History Taking

HPI (history of present illness)
Ask for: LIQOR AAA
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L Location of the symptom (forehead, wrist...)
I Intensity of the symptom (scale 1-10, 6/10)
Q Quality of the symptom (burning, pulsating pain...)
O Onset of the symptom + precipitating factors
R Radiation of the symptom ( to left shoulder and arm)
A Associated symptoms ( palpitations, shortness of breath)
A Alleviating factors (sitting with my chest on my knees)
A Aggravating factors (effort, smoking, large meals)

PMH (past medical history)
Search for: PAM HUGS FOSS

P Previous presence of the symptom (same chief complaint)
A Allergies (drugs, foods, chemicals, dust ...)
M Medicines (any drugs the patient used)

H Hospitalization for any illness in the past
U Urinary changes ( esp if diabetic, elderly...)
G Gastrointestinal complains (diet changes, bowel movements...)
S Sleep pattern (waking up/going to sleep...)

F Family history (similar chief complaints/serious illness)
O OB/GYN history (LMP, abortions, para...)
S Sexual habits (active/preferences/STD...)
S Social life (job/house/smoking/alcohol.....) *SODA* Smoking<Occupation>Drugs<Alcohol>

Peads History

BINDER - birth history, immunization history, nutrition, development, Eating, Rash... also it's good to ask where the child is during the day - (i.e. day care, school, grandmother's house, etc...)

For all Discharges.... including Diarrhea, Cough ...............ACCOD
A-amount ,C -consistency ,C- color ,O- odor ,D- duration

Pain history checklist OPQRSTU:
Onset of pain (time, duration)
Palliative factors for pain
Quality of pain (throbbing, stabbing, dull, etc.)
Region of body affected
Severity of pain (usually scale of 1-10)
Timing of pain (after exercise, in evening, etc.)
U: How does it affect 'U' in your daily life?
· May wish to expand to OPPQRRSTTUVW, with the extra letters representing:
Provocative factors
Radiation (how does pain spread)
Treatments tried
Deja Vu: Has this happened before?
Worry: What do you think or fear that it is?

Fracture: how to describe PLASTER OF PARIS:
Plane, Location, Articular cartilage involvement, Simple or comminuted, Type (eg Colles'),
Extent, Reason ,Open or closed, Foreign bodies, displacement ,Angulation ,Rotation ,Impaction, Shortening

Differential diagnosis checklist "I VINDICATE":
Iatrogenic ,Vascular ,Infectious ,Neoplastic ,Degenerative/ Drugs ,Inflammatory/ Idiopathic
,Congenital ,Allergic/ Autoimmune ,Traumatic ,Endocrinal & metabolic

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Asthma

Triad              Cough---SOB---Wheezing

Management is ASTHMA

Albuterol (4 short term rescue) ,Steroid   (inhaled or systemic),Theophylline ( narrow therapeutic window),Humified oxygen (in acute exacerbation),Mast cell stabilizer (cromolyn,Na & nedocromil),Antileukotrienes (zileuton,montelukast & zafirlukast)

Pneumothorax: presentation
P-THORAX:
Pleuretic pain ,

Trachea deviation ,

Hyperresonance ,

Onset sudden ,

Reduced breath sounds (& dypsnea) ,

Absent fremitus ,X-ray shows collapse

EmPhysema has letter P (and not B) so Pink Puffer.
chronic Bronchitis has letter B (and not P) so Blue Bloater.

Cushing syndrome
CUSHING:
Central obesity/ Cervical fat pads/ Collagen fiber weakness/ Comedones (acne)
Urinary free corisol and glucose increase
Striae/ Suppressed immunity
Hypercortisolism/ Hypertension/ Hyperglycemia/ Hirsutism
Iatrogenic (Increased administration of corticosteroids)
Noniatrogenic (Neoplasms)
Glucose intolerance/ Growth retardation

Disseminated intravascular coagulation ( DIC )

D-I-S-S-E-M-I-N-A-T-E-D

D-Dx: D dimer ,

I-Immune complexes ,

S-Snakebite, shock, heatstroke,

S-SLE

E-Eclampsia, HELLP syndrome,

M-Massive tissue damage ,

I-Infections: viral and bacterial ,

N-Neoplasms ,

A-Acute promyelocytic leukemia ,

T-Tumor factors

E-Endotoxins (bacterial),

D-Dead fetus (retained)

TTP: clinical features
Thrombosis and thrombocytopenia PARTNER together:
Platelet count low
Anemia (microangiopathic hemolytic)
Renal failure
Temperature rise
Neurological deficits
ER admission (as it is an emergency)

SARCOIDOSIS

S----Schaumann calcification

A---Asteroid bodies / ACE increase /Anergy skin

R---Respiratory complication / Restrictive lung disease/Renal calculi

C---Ca increase in serum & urine /CD4 helper cells

O---Ocular lesion

I----Immune mediated NON-CASEATING granuloma/Ig increase

D---Diabetes inspidus/ D vitamin increase/ Dysponea

O---Osteopathy

S---Skin (Subcut nodule,Erythema nodosum)

I---Interstitial lung fibrosis/IL—1

S—Seventh cranial nerve palsy

NEPHROTIC SYNDROME (NS) is characterized by the follow

N = Na + water retention
This occurs due to several factors, including compensatory secretion of aldosterone in response to hypovolemia-mediated release of ADH.
E = Edema
Due to hypoproteinemia + Na, water retention. Edema is soft, pitting and starts in the periorbital region .

P = Proteinuria >3.5gm/1.74sq. ml/24hrs
H = Hypertension + hyperlipidemia (due to increased lipoprotein synthesis in liver, abnormal transport of circulating lipoproteins, decreased catabolism.)
R = Renal vein thrombosis
O = "Oval fat bodies" in the urine. Lipiduria follows hyperlipidemia. Albumin as well as lipoproteins are lost. Lipoproteins are reabsorbed by tubular epithelial cells and they shed along with degenerated cells- this appears as "oval fat bodies" in urine.
T = Thrombotic + thromboembolic complications owing to loss of anticoagulant factors (eg. anti-thrombin III )
I = Infection. These patients are prone to infection, especially with staphylococci and pneumococci. Vulnerability is due to loss of immunoglobulins.
C = hyperCoagulable state

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CELIAC disease

CELIAC:                                                         www.sabirkhan.com
Cell-mediated autoimmune disease
European descent
Lymphocytes in Lamina propria/ Lymphoma risk
Intolerance of gluten (wheat)
Atrophy of villi in small intestine/ Abnormal D-xylose test
Childhood presentation
· Atrophied villi cause less absorption, so diarrhea, weight loss, less energy.

----------------------------------------------------------------------------------

Chest pain D/D

C—Costo-chondritis/Cocaine abuse

H—Herpes zoster/Hyperventilation

E---Esophagitis

S—Stenosis (arotic stenosis)

T---Trauma

P---Pul edema/Pneumonia/Pericarditis/Pancreatitis

A—Angina/Arotic Aneurysm/Aortic dissection

I----Infarction

N—Neuropsychiatric disorder e.g depression

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DeMENtia ----------------------MEMory impairment

Delirium    ---------------------Change in sensoRIUM

DEMENTIA

D--------Degenerative disease (Parkinson , Huntington Disease)

E--------Endocrine  (Thyroid,parathyroid,Adrenal)

M-------Metabolic (Alcohol,Electrolyte,Hypoglycemia,B12 deficinecy)

E-------Exogenous (Heacy metals,CO,drugs)

N------Neoplasm

T-----Trauma

I------Infection (meningitis,Encephalitis,Syphilis,HIV,Prion)

A-----Affective disorder (pseudodementia)

S-----Shock/Structure vascular dementia,hypoxia

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D-----Disease of mouth, tonsil/diffuse esophageal spasm/DM

I------Intrinsic lesion

S------Scleroderma

P------Pharyngeal disorders /Palsy bulbar----MND

H----Heart (Left atrial enlargement)

A----Achalsia

G----Goiter/Myasthenia Gravis/Mediastinal Gland infection

I-----Infection

A---American trypanosomes (Chagas disease)

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CHOLANGITIS

Charcot triad (fever, epigastric & RUQ pain, emesis & nausea),

Hepatic Abscesses /HLA DR4,

Obstruction,

Leukocytosis,

Alkaline PO4 Increase,

Neoplasm,

Gallstone,

IBD,

Transaminase increase (ALT,AST),

Infection,

Sclerosing cholangitis

VAGINAL BLEEDS
V - Vaginal injuries
A - Adenomyosis + Abortion
G - Genital cancer
I - Infections: PID
N - Neoplasms [Maligant(endometrial CA) + benign ( fibromas)
A - Abruptio placentae
B - Beeding disorders
L - Leiomyomas
E - Ectopic pregnancy
E - Endocrinopathies, Endometriosis
D - DUB
S - Sores, Condylomas ( after trauma)

Hepatic Necrosis: drugs causing focal to massive necrosis "Very Angry Hepatocytes", Valproic acid, Acetaminophen, Halothane, Amiodarone

Portal Hypertension   ABCDE:
Ascites , Bleeding (haematemesis, piles) , caput medusae , Diminished liver ,
Enlarged spleen

Complication of Cirrhosis  ,CRAVE

Carcinoma , Renal failure , Ascites , Variceal ,Encephalopathy

VARICOSE vein    (All vowels)

Aching, Eczema , Itching, Oedema ,Ulceration (hemosiderin deposition varicosities)

RLQ Pain Differentials “APPENDICITIS”

Appendicitis/ Abscess ,
PID/ Period
Pancreatitis
Ectopic/ Endometriosis
Neoplasia
Diverticulitis
Intussusception
Crohns Disease/ Cyst (ovarian)
IBD
Torsion (ovary)
Irritable Bowel Syndrome
Stones

ICU Management    (A-Z)

Airway, Blood pressure, Circulation, Drains, Ecg, Fluid status, GI loss, Head positioning, Insensible loss, Jvp, Kidness, Limb care/label, Mouth care, Nutrition, Oxygenation, Pulse oxymetry/peristalsis, Quiet surrounding, Stress ulcers, Temp, Urinary output, Ventilator, Wound, Xerosis prevention, Y(whY)before doin any procedure, Zestful care of pt

6 W of Postop Fever

Water, wind, walk, wound ,weird drugs ,wonder where(deep abscess)

Cardiovascular risk factors
FLASH BODIES:
Family history ,Lipids ,Age ,Sex ,Homocystinaemia ,Blood pressure ,Obesity ,Diabetes mellitus ,Inflammation (raised CRP)/ Increased thrombosis, Exercise ,Smoking

MI: post-MI complications
ACT RAPID:
Arrhythmias (SVT, VT, VF) ,Congestive cardiac failure ,Tamponade/ Thromboembolic disorders ,Rupture (ventricle, septum, papillary muscle),Aneurysm (ventricle), Pericarditis ,Infaction (a second one) ,Death/ Dressler's syndrome
No Apex beat         “DOPES “

 Dextrocardia, Obesity, Pleural/Pericardial effusion, Emphysema, Shock

Mitral Stenosis complications PASTRI

Pulmonary increase BP, Atrial fib, Systemic Embolism, Tricuspid regurg, Rg heart failure, Infective Endocarditis

Causes of ST Elevation

"ELEVATION"

Electrolytes,  LBBB , Early Repolarization , Ventricular hypertrophy, Aneurysm, Treatment – Pericardiocentesis, Injury (AMI, contusion),  Osborne waves (hypothermia), Non-occlusive vasospasm

Hyperkalamia causes large T waves on the ECG, Hypokalaemia causes small ones - ie. large pot - lots of tea, small pot - no tea.

If QRS complex is wide, consider bundle branch block. LBBB causes a "W" pattern in V1-2 and a "M" pattern in V5-6. RBBB is the other way round. Remember as WiLLiaM MaRRoW.

Sequence of elevated enzymes after MI
"Time to CALL 911"
· From first to appear to last:
Troponin  ,CK-MB, AST ,LDH1

Murmurs: systolic vs. diastolic

 PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.

Symptoms of aortic stenos is are SAD - Syncope, Angina, Dyspnea

Alkalosis vs. Acidosis

Directions of PH and HCO3 ROME: Respiratory= Opposite:

 pH is high, PCO2 is down (Alkalosis). · pH is low, PCO2 is up (Acidosis).

Metabolic= Equal: · pH is high, HCO3 is high (Alkalosis). · pH is low, HCO3 is low (Acidosis)

 Alkalosis: metabolic changes in alkalosis

"Al-K-loss, Al-Ca-loss": There is loss of K+ (hypokalemia) and Ca++ (hypocalcaemia) in state of alkalosis

BUN:Creatinine elevation:         “ABCD”

Azotremia (pre-renal),Bleeding (GI),Catabolic status,

Diet (high protein parenteral nutrition)

Non-gap acidosis: causes HARD UP
Hyperalimentation
Acetazolamide (carbonic anhydrase inhibitors)
RTA
Diarrhea
Ureterosigmoidostomy
Pancreatic fistula

Metabolic acidosis (normal anion-gap):

 With hyperkalemia: RAISE K+:

RTA type 4

Aldosterone or mineralocorticord deficiency

Iatrogenic: NH4Cl, HCl

"Stenosis": obstructive uropathy

Early uremia

· With hypokalemia: ReDUCE K+:

Renal TA type 1 and 2

Diarrhoea

Urine diversion into gut

Carbonate anhydrase inhibitor

Ex-hyperventilation

Respiratory Alkalosis

Asthmatic Sally poisoned POPE's HEN

Asthma , Salicylate poisoning , Pulmonary Oedema , Pulmonary Embolism, Hepatic Encephalopathy

Most common symptoms of PHEochromocytoma begin with the first 3 letters - Palpitations, Headache, Episodic diaphoresis (sweating)

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WBC Count

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

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

Root values of reflexes are 1,2,3,4,5,6,7,8 - S1-2 ankle, L3-4 knee, C5-6 biceps/supinator, C7-8 triceps.

Stroke RISK Factors  “HEADS”

Hypertension/ Hyperlipidemia
Elderly
Atrial fib
Diabetes mellitus/ Drugs (cocaine)
Smoking/ Sex (male)

Anterior cerebral artery (A*C*A) occlusion:

*C*-Contralateral Crural (leg) monoplegia

*C*-Crest of Cerebral hemispheres and medial hemispheric walls represent the leg area of the motor strip

Middle cerebral artery (MCA) occlusion:

"Difficulty with A-B-Cs in M-C-A"

A-Apraxia

B-Blindness in corresponding half of the visual field (contralateral homonymous hemianopsia)

C-Contralateral Clumsiness of arm, face. -- Leg is somewhat spared

M-Memorization difficulties

C-Calculation difficulties

A-Aphasia with language-dominant hemispheral involvement

Posterior cerebral artery (PCA) occlusion: P-O-S-T

P-Proximal fling movements

O-Occipital lobe infarction results in contralateral homonymous hemianopsia which may be complete

S-Speech and Spelling maintained, but unable to read fluently

T-Thalamic syndrome

________________________________________

A well-known mnemonic regarding occlusion of the vertebral-basilar circulation: 4D                  Dizziness ,Diplopia , Dysarthria , Dysphagia

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Drugs that can go into an ET tube “LANE”

Lidocaine ,Atropine ,Naloxone, EPi

Some like NAVEL, which includes Valium. Others have commented that valium should not go in an ET tube.

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ANTIDOTES

Beta blockers--------------------Glucagon

Fe-----------------------------------Deferoxamine

Lead-------------------------------EDTA

CO----------------------------------100% oxygen, hyperbaric oxygen

Opoids---------------------------Naloxone/naltrexone

Heparin----------------------------Protamine

Warfarin---------------------------Vit K

Streptokinase-------------------Aminocaproic acid

Paracetamol--------------------Acetylcysteine

Methanol----------------------ethanol

Digoxin-----------------------normalize potassium,digoxin antibodies

Benzodiazepines---------------Flumazenil

Tricyclic antidepressant-------NAHCO3 (cardio protective)

Word association helpful in mcq`s

Friction rub---------------------pericariditis

Kussmaul breathing ----------diabetic,ketoacidosis

Bronz skin plus diabetes--------Hemochromatosis

Malar Rash----------------------SLE

Heliotrope rash ----------------Dermatomyositis

Rectal prolapse --------------Cystic fibrosis

Amaurosis fugax------------Ophthalmic artery

Café-au-lait spot with normal IQ-----Neurofibromatosis

Worse headache of pt life-----------subarachnoid hemorrhage

Abdominal striae--------------------cushing syndrome or preg

Left lower tenderness or rebound------diverticulitis

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Cat like cry in an infant---------------cri-du—chat syndrome

Low grade fever after first 24 hour of surgery------atelactasis

Bilateral hilar adenopathy----------sarcoidosis

Absent breath sounds in trauma pt ---------------pneumothorax

Intermittent bursts of swearing ----------------tourette syndrome

Daytime sleepiness & occasional falling down--------narcolepsy

Beck’s triad-------------JVP,muffled heart sounds, hypotension

Kehr`s sign---------pain in left shoulder (ruptured spleen)

Tinel sign-----------tapping on surface of wrist elicit paresthesias (carpel tunnel)

Ortolani`s sign--------abducting infants`s flexed hips causes a palpable/audible click(congenital hip dysplasia)

Prehn sign--------elevation of painful testicle relieve pain ( epididymitis vs testicular torsion)

Anemia: TIBC finding to differentiate iron deficiency vs. chronic disease
TIBC levels at the: Top=Iron deficiency, Bottom=Chronic disease.

Hematology : key numbers

3 and 4 are key in in haematology:

1.34 cm3 of oxygen is carried by a gram of hemoglobin.

There's 3.4mg of iron in each gram of hemoglobin.

There's an average of 3.4 lobes per neutrophil.

There's 34mg bilirubin from each gram of hemoglobin.

Blood disorders: commoner sex
HE (male) gets:
HEmophilia (X-linked)
HEinz bodies (G6PD deficiency, causing HEmolytic anemia: X-linked)
HEmochromatosis (male predominance)
HEart attacks (male predominance)
HEnoch-Schonlein purpura (male predominance)
SHE (female) gets:
SHEehan's syndrome

Hematuria: urethral causes NUTS:
Neoplasm ,Urethritis ,Tumour ,Stone

Oral cancer risks
PATH LAB:
Plummer-vinson syndrome ,Alcohol ,Tobacco ,Human papilloma virus ,Leukoplakia
Asbestos ,Bad oral hygiene

Parkinson's symptoms     RATS
Rigitidy (cogwheel)  ,Akinesia ,Tremor (resting),Shuffling gate

Achalasia: 1 possible cause, 1 treatment
aCHAlasia:
1 possible cause: CHAgas' disease
1 treatment: Ca++ CHAnnel blockers

Screening in type 2 diabetes;   “HELP”

Diabetic Complication “KNIVES” 

Kidney, Neuropathy, Infections, Vascular, Eye, Skin manifestation

Ketoacidosis  “SAD”       Starvation, Alcohol, DM

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

INsulin gets sugar INto cells- (Excess sugar is removed via urine. The Romans noticed bees attracted to the urine of diabetics and coined the term "diabetes" to describe the overflow of sugar.) Medical students need to distinguish between the two types of diabetes: mellitus and insipidus. Both cause increased urine flow, but for different reasons altogether. D. mellitus is characterized by excessive sugar present in the urine due to lack of insulin. D. insipidus is recognized by high volumes of watery urine due to lack of anti-diuretic hormone (ADH), usually caused by a damaged hypothalamus gland. In the old days, a physician would taste the urine to determine which form of diabetes his patient had.

Chronic Vs Acute kidney failure,        “BANS”

Bone disease, Anemia, Neuropathy (perip) , Small kidney

Chronic Kidney failure   GLAD SHOP

Glomerulonephritis , Lupus, Analgesia, DM, Systemic Vascular Disease, HTN, Obstruction, Polycystic Kidney disease

Renal failure (chronic): consequences ,ABCDEFG:
Anemia
-due to less EPO
Bone alterations
-osteomalacia
-osteoporosis
-von Recklinghausen
Cardiopulmonary
-atherosclerosis
-CHF
-hypertension
-pericarditis
D vitamin loss
Electrolyte imbalance
-sodium loss/gain
-metabolic acidosis
-hyperkalemia
Feverous infections
-due to leukocyte abnormalities and dialysis hazards
GI disturbances
Haemorrhagic gastritis
-peptic ulcer disease
-intractable hiccups

Tuberculosis: features
TB is characterised by 4 C's:
Caseation ,Calcification ,Cavitation ,Cicatrization

. Osteoporosis Risk Factors   “ACCESS”
Alcohol ,Corticosteroid, Calcium low ,Estrogen low ,Smoking
Sedentary lifestyle
Ankylosing Spondylitis extra-articular manifestations   “6 A's”
Atlanto-axial subluxation
Anterior uveitis
Apical lung fibrosis
Aortic incompetence
Amyloidosis (kidneys)
Autoimmune bowel disease (UC)
Hypercalcemia  “MISHAP”

Non-essential Amino Acids mnemonics Caaats gggP . Cysteine, alanine, aspartate, asparagine, tyrosine, serine glycine, glutamate, glutamine, proline   Essential amino acids mnemonics PVT TIM HALL Phenylalanine Valine Threonine Tryptophan Isoleucine Methionine Histidine Arginine Lysine “All amino acids that start with T are ketogenic and glucogenic threonine tyrosine tryptophan”

Urea Cycle

Ordinarily, Careless Crappers, Are Also Furious About Urination.

Ornithine, Carbamoyl, Citrulline, Arginosuccinate, Aspartate, Fumarate, Arginine, Urea

Citric acid cycle compounds

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

Oxaloacetate Citrate Isocitrate alpha-Ketoglutarate Succinyl-CoA Succinate Fumarate Malate

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.

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

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

 Na/K pump: concentrations of Na vs. K on inside/outside of cell, pump action, number of molecules moved HIKIN':
There is a HIgh K concentration INside the cell.
From this can deduce that the Na/K pump pumps K into cell and Na out of cell.
Alternatively: When I was learning this pump (circa 1992), a band that was "in" was Kris Kross, and a band that was "out" was "Sha Na Na Na":
So pump moves K K (2 K) in and Na Na Na (3 Na) out.
· Sadly, as infectious as their debut album was, Kris Kross can really no longer be classed as "in"

Nitric oxide: amino acid precursor

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

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

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

Anderson's=Branching enzyme

Cori's=Debranching enzyme.

Otherwise, can't really distinguish clinically

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

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

. Galactosaemia: enzyme deficiency

GALIPUT: Galactose 1 Phosphate Uridyl Transferase.

· There is an assay called the Galiput test for this

Glycogen storage: Names of types I through VI

"Viagra Pills Cause A Major Hardon"

Von Gierke's ,Pompe's ,Cori's ,Anderson's ,McArdle's

Enzyme kinetics: competitive vs. non-competitive inhibition

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

Sickle cell disease pathophysiology

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

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Glucagon function

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

Glucagon elevates glucose by cAMP mechanism.  

Van den Bergh reaction (Jaundice test)

"Indirect reacting bilirubin = Unconjugated bilirubin":

Both start with vowels, so they go together:

Indirect & Unconjugated 

Hemoglobin binding curve: causes of shift to right

"CADET, face right!"

 CO2 ,Acid ,2,3-DPG (aka 2,3 BPG) ,Exercise ,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

"ABC of Adrenaline":

Adrenaline--> activates

Beta receptors--> increases

Cyclic AMP

Embryology:

 Weeks 2, 3, 4 of development: an event for each
Week Two: Bilaminar germ disc.
Week Three: Trilaminar germ disc.
Week Four: Four limbs appear.

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

Carcinomas having tendency to metastasize to bone
"Particular Tumours Love Killing Bone":
Prostate ,Thyroid ,Lung ,Kidney ,Breast

Pancytopenia: causes
"All my blood has taken some poison"
Aplastic anemias ,Megaloblastic anemias, Bone marrow infiltration, Hypersplenism, TB, SLE, Paroxysmal nocturnal hemoglobinuria

 Epidermis layers (Histology)

"Come, Let's Get Sun Burned":

· From superficial to deep: Corneum Lucidum Granulosum Spinosum

· Acidophilic: GPA: Growth hormone Prolactin Acidophilic

· Basophilic: B-FLAT Basophilic FSH LH ACTH TSH

Rashes: time of appearance after fever onset

"Really Sick Children Must Take No Exercise":
· Number of days after fever onset that a rash will appear:
1 Day: Rubella
2 Days: Scarlet fever/ Smallpox
3 Days: Chickenpox
4 Days: Measles (and see the Koplik spots one day prior to rash)
5 Days: Typhus & rickettsia (this is variable)
6 Days: Nothing
7 Days: Enteric fever (salmonella)

Pruritus without rash: DDx ITCHING DX:
Infections (scabies, toxocariasis, etc)
Thyroidal and other endocrinopathies (eg diabetes mellitus)
Cancer
Hematologic diseases (eg iron deficiency)/ Hepatopathies/ HIV
Idiopathic
Neurotic
Gravid (pruritus of pregancy)
Drugs
eXcretory dysfunctions (eg uremia)

Adrenal gland: functions ACTH:
Adrenergic functions
Catabolism of proteins/ Carbohydrate metabolism
T cell immunomodulation
Hyper/ Hypotension (blood pressure control)
Antibiotics contraindicated during pregnancy MCAT:
Metronidazole
Chloramphenicol
Aminoglycoside
Tetracycline

 Oral contraceptive complications: warning signs ACHES:
Abdominal pain
Chest pain
Headache (severe)
Eye (blurred vision)
Sharp leg pain

Beta-blockers: nonselective beta-blockers "Tim Pinches His Nasal Problem" (because he has a runny nose...):
Timolol
Pindolol
Hismolol
Naldolol
Propranolol

Placenta-crossing substances "WANT My Hot Dog":
Wastes
Antibodies
Nutrients
Teratogens
Microorganisms
Hormones/ HIV
Drugs

Head circumference with age · Remember 3, 9, and multiples of 5:
Newborn 35 cm
3 mos 40 cm
9 mos 45 cm
3 yrs 50 cm
9 yrs 55 cm

Weights of children with age Newborn 3 kg
6 mos 6 kg (2x birth wt at 6 mos)
1 yr 10 kg (3x birth wt at 1 yr)
3 yrs 15 kg (odd yrs, add 5 kg until 11 yrs)
5 yrs 20 kg
7 yrs 25 kg
9 yrs 30 kg
11 yrs 35 kg (add 10 kg thereafter)
13 yrs 45 kg
15 yrs 55 kg
17 yrs 65 kg

Bowel components "Dow Jones Industrial Average Closing Stock Report": From proximal to distal: Duodenum Jejunum Ileum Appendix Colon Sigmoid Rectum

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

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SYNDROMES
• BROWN-SEQUARD SYNDROME: Damage
(injury) to half of spinal cord ------> symptoms:
o Loss of pain and temperature sensation on
contra lateral side of body.
o Loss of proprioception and discriminatory
touch on ipsilateral side of body.

CARDIO Syndrome`s
• FLOPPY-VALVE SYNDROME: Mitral
Incompetence due to myxomatous degeneration of the
leaflets.
• LERICHE'S SYNDROME: Occlusion of distal
aorta ------>
o Hip, thigh, and calf fatigue.
o Impotence
• BEHCET'S SYNDROME: Vasculitis ------>
secondary symptoms:
o Oral and genital ulcers
o Uveitis
o Optic atrophy
• SHOULDER-HAND SYNDROME: Pain in
shoulder and swelling in hand, sometimes occurring
after Myocardial Infarction.
• SICK SINUS SYNDROME: Chaotic atrial activity;
continual changes in P-Waves. Bradycardia,
alternating with recurrent ectopic beats and runs of
tachycardia.
• SUPERIOR VENA CAVA SYNDROME: Caused
by a tumor. Obstruction of SVC ------>
o Edema
o Engorgement of the vessels of face,
neck, and arms.
o Nonproductive cough
o Dyspnea
• TAKAYASU'S SYNDROME: Arteritis of the
Aortic Arch, resulting in no pulse. Seen in young
women.
• WOLF-PARKINSON WHITE SYNDROME:                                                
ECG pattern of Paroxysmal Tachycardia.
o Short PR interval
o Delta wave = early QRS complex.
IATROGENIC (or Secondary to Medical Treatment)
• ASHERMAN'S SYNDROME: Adhesions
within the endometrial cavity, causing
amenorrhea and infertility.
o Adhesions probably were caused by
surgery.
NEOPLASTIC (Malignant or Benign) Syndrome
• CARCINOID SYNDROME: Carcinoid tumor
producing Bradykinin + Serotonin ------>
secondary symptoms:
o Cyanotic flushing
o Diarrhea
o Bronchial spasm
o Edema, ascites.   
• GARDNER'S SYNDROME: Multiple
inherited tumors, hereditary dominant trait.
o Skull osteomas, Fibromas, Epidermoid
cysts
o Colonic polyposis (APC gene) ------>
predisposition to colonic
adenocarcinoma.
• LAMBERT-EATON SYNDROME:
Progressive proximal muscle weakness
secondary to a carcinoma.
• MEIGS' SYNDROME: Fibroma of ovary with
ascites and hydrothorax
• PANCOAST SYNDROME: Tumor near
pulmonary apex ------>
o Neuritic pain of chest and arm
o Muscle atrophy of the arm                                                                          
o Horner's Syndrome (impaired cervical
• PEUTZ-JEGHERS SYNDROME: Polyposis
(hamartomas) of small intestine
o Also see melanin pigmentation of buccal
mucosa and skin around mouth and lips
CONGENITAL Syndrome
• CERVICAL SYNDROME: Supernumerary C7 rib -
-----> Pressure on brachial plexus ------> pain
radiating over shoulder, arm, and forearm over C7
distribution.
• DIGEORGE SYNDROME: Congenital absence of
3rd and 4th Branchial Arches (Thymus and Parathyroid
Glands) ------> secondary symptoms:
o No cell-mediated immunity ------> Frequent
viral and fungal infections
o Characteristic facial deformities
• DOWN SYNDROME: Trisomy 21. Mental
retardation, characteristic facial features, Simeon
crease in hand.
• FANCONI'S SYNDROME Type I: Bone-marrow
hypoplasia ------> refractory anemia, pancytopenia.
• FETAL ALCOHOL SYNDROME: Fetal
malformations, growth deficiencies, craniofacial
anomalies, limb defects.
• GOODPASTURE'S SYNDROME: Autoantibodies
against basement membranes ------>
Glomerulonephritis (kidney) and hemoptysis (lungs).
o Often, death by renal failure
• KLINEFELTER'S SYNDROME: Trisomy XXY ---
---> testicular atrophy, increase in gonadotropins in
urine.
• LESCH-NYHAN SYNDROME: Deficiency of
HGPRT (Hypoxanthine-Guanine Phosphoribosyltransferase
------>
o Hyperuricemia, uric acid kidney stones
o Choreoathetosis
o Mental retardation, autism, spastic
cerebral palsy
o X-Linked recessive
• MARFAN SYNDROME: Connective Tissue
disorder ------>
o Arachnodactyly: Abnormally long
digits and extremities
o Subluxation of lens
o Dissecting aortic aneurism
• TURNER'S SYNDROME: XO monosomy.
o Dwarfism
o Webbed neck
o Valgus of elbow.
o Amenorrhea
• WILSON SYNDROME: Congenital defect in
Ceruloplasmin, leading to buildup of copper -----
-> mental retardation, cirrhosis, hepatolenticular
degeneration.
ENDOCRINE, REPRODUCTIVE Syndrome
• CONN'S SYNDROME: Primary
Hyperaldosteronism ------> muscular weakness,
hypertension, hypokalemia, alkalosis.
• CUSHING'S SYNDROME: Hypersecretion of
cortisol ------> secondary symptoms and
characteristics:
o Fatness of face and trunk with wasting
of extremities
o Buffalo hump
o Bone decalacification
o Corticoid diabetes
o Hypertension
• PREMENSTRUAL SYNDROME: Abnormal
sensation in breasts, abdominal pain, thirst,
headache, pelvic congestion, nervous irritability.
o Ocassionally nausea and vomiting.
• SHEEHAN'S SYNDROME: Post-partum pituitary
necrosis ------> hypopituitarism.
PULMONARY Syndrome
• KARTAGENER'S SYNDROME: Situs Inversus
(lateral transposition of lungs) resulting from chronic
sinusitis and bronchiectasis.
• CHURG-STRAUSS SYNDROME: Allergic
Granulomatous Angiitis: Asthma, fever, eosinophilia.
INFECTIOUS Syndrome
• FITZ-HUGH-CURTIS SYNDROME: Gonococcal
Periphepatitis in woman, as a complication of
Gonorrhea.
• GUILLAN-BARRE SYNDROME: Infectious
Polyneuritis of unknown cause.
• REYE'S SYNDROME: Loss of consciousness and
seizures in kids, after a viral infection treated by
aspirin.
• REITER'S SYNDROME: Symptom cluster.
Etiology is thought to be Chlamydial or postchlamydial.
o Urethritis
o Iridocyclitis (Conjunctivitis)
o Arthritis
o Skin lesions like karatoderma
blenorrhagicum
o Also can see fatty liver or liver necrosis.
• TOXIC SHOCK SYNDROME: Caused by
superabsorbent tampons. Infection with Staph
Aureus and subsequent toxicity of exotoxin
TSST ------> systemic anaphylaxis.
o Fever, vomiting, diarrhea
o Red rash followed by desquamation
• WATERHOUSE-FRIEDRICHSON
SYNDROME: Meningeococcal Meningitis ------
> DIC, hemorrhagic infarct of adrenal glands ----
--> fulminant adrenal failure.
o Vomiting, diarrhea.
o Shock
o Extensive purpura, cyanosis, circulatory
collapse.
RENAL Syndrome
• KEMMELSTIEL-WILSON SYNDROME:
Diabetic Glomerulosclerosis.
• BARTTER'S SYNDROME: Juxtaglomerular
Cell Hyperplasia ------> secondary symptoms:
o Hyperaldosteronism, Hypokalemic
Alkalosis, elevated renin and
angiotensin
o No hypertension.
o Compare to Conn's Syndrome
• FANCONI'S SYNDROME Type II: Renal
aminoaciduria, glycosuria, hypophosphaturia,
cysteine deposition, rickets.
NEUROLOGICAL Syndrome
• CARPAL-TUNNEL SYNDROME:
Compression of Median Nerve through the
Carpal Tunnel ------> pain and parasthesia over
distribution of Median N.
• KORSAKOFF SYNDROME: Loss of short-term
memory in chronic alcoholism, caused by
degeneration of mamillary bodies.
• MALLORY-WEISS SYNDROME: Laceration of
lower end of esophagus from vomiting ------>
hematemesis. Often seen in alcoholics.
• BARRET SYNDROME: Chronic peptic ulcer of the
lower esophagus, resulting in metaplasia of
esophageal columnar epithelium ------> squamous
epithelium.
• ZOLLINGER-ELLISOHN SYNDROME: Gastrinsecreting
tumor in pancreas ------> Severe peptic
ulcers, gastric hyperacidity.
• PLUMMER-VINSON SYNDROME: Esophageal
Webs, leading to dysphagis and atrophy of papillae of
tongue.
o  hypochromic anemia,
splenomegaly.
• BUD-CHIARI SYNDROME:
o ACUTE: Hepatic Vein Thrombosis ------>
Massive ascites and dramatic death.
o CHRONIC: Gradual hepatomegaly, portal
hypertension, nausea, vomiting, edema,
ulimately death.
• FELTY'S SYNDROME: Rheumatoid Arthritis with
splenomegaly, leukopenia, anemia, and
thrombocytopenia.
• LOFFLER'S SYNDROME: Eosinophilia with
transient infiltrates in lungs.
UNCATEGORIZED
• YELLOW-NAIL SYNDROME: Stop growth
of nails ------> increased convexity, thickening,
and yellowing of nails.
o Found in Lymphedema, bronchitis,
chronic bronchiectasis.
• COSTOCHONDRAL SYNDROME: Pain in
chest with tenderness over one or more
costochondral junctions.
o Similar to Tietze's Syndrome but no
specific inflammation.
• TIETZE'S SYNDROME: Costochondritis.
Swelling and tenderness of the costal cartilege.
• MIKULICZ'S SYNDROME: Salivary and
lacrimal enlargement as seen in several diseases:
o Sarcoidosis
o Tuberculosis
o Leukemia
• PICKWICKIAN SYNDROME: Symptom
cluster
o Obesity
o Hypoventilation
o Somnolence
o Erythrocytosis 
• STRAIGHT BACK SYNDROME: Loss of
normal kyphosis of thoracic spine ------>
o Straight spine
o Ejection murmur
o Widened cardiac silouhette on x-ray
• SJÖGREN'S SYNDROME: Autoimmune
complex
o Keratoconjuctivitis Sicca (dry eyes and
mouth)
o Dryness of Mucous membranes
o Telangiectasias in face
o Parotid enlargement