Second Aid: USMLE mnemonics

This is a list of medical mnemonics, side-notes, and generalizations I wrote down while
going through my 2010 First Aid book while supplementing with 2012 Falcon, Kaplan,
and a bit of Goljan. I stopped at around three-quarters of the text because I got tired and
felt like not many people would be interested(Update: sorry, but Im too busy to go
back and type the rest! ><).
P.S. If you want to find a topic fast, I suggest Ctrl+F
Varicocele: clin +/- ache(pain) in testicle, feel of heaviness, visbile palpable enlargd
vein. PE bag wormsl Mass of enlarged vein that develops in spermatic cord. mcc
15-25; Left sided varicocele or bilatersl suspect renal vein thrombosis seen in reneal
cell carcinoma or neprotic syndrome
Trt ligate of affected spermatic vein. Transilluminate negative
hydrocele-fluid in tunica vaginalis or if congentinal it is incomplete obliteration
(fusion)?)of processus vaginaliszoez; painless enlarged scrotum. linked to indirect
inguinal hernia
Hypospidiasis-incomplete fusion of urethral folds
Behavioral Science:
Statistical distribution:

Positive skew = meAn>meDian>mOde

Positive skew = alphabetical from greatest to least

Reportable diseases:
"It was reported that studly Mr. Shigella ate salmon, chicken, and liver":
"It was REPORTED that STuDly MMR SHIGELLA aTB Salmon, Chicken, and Liver"

STDs: AIDs, Gonorrhea, Syphilis, Chlamydia (*NOT HIV!)

MMR: Measles, Mumps, Rubella

Shigella

TB

Salmonella

Chicken Pox

Hepatits A, B, C

Health care payment:

CARE for the Elderly, AID the destitute

Medicare - elderly, Medicaid - low income people

Early developmental milestones:

# of blocks stacked = age in years * 3

2 word sentences at 2

"pee at three"; tricycle at three

"four-square at four" = can hop at four

drawings:

3yo = circle

4yo = +

5yo = square

6yo = triangle

See reference

Biochemistry:
Stop codons: UGA, UAA, UAG
U Go Away, U Are Away, U Are Gone

EXpress EXons, INtrons are IN the way

Proto-oncogenes:
Mikes sis returned with her two new breasts she was able to grow because of herbs.
"MYCs SIS RETurned with HER2Neu breasts she RAS ABLe To-Grow BCl of hERBs."

Myc

sis

ret

Her2/neu

ras

abl

TGFalpha

bcl2

ERB-B1, B2

Collagen: The higher the number, the smaller and softer it gets

Type 1 - bone (skin) - Osteogenesis Imperfecta (failed glycosylation and

formation of procollagen triple helix with ER)

Type 2 - cartilage - death in utero

Type 3 - blood vessels - Ehlers-Danlos (failure of cross-linking by lysyl oxidase

to make collagen fibrils outside fibroblasts), berry aneurysms

Type 4: basement membrane - Alports nephritis (+ deafness and vision

problems; cant see, cant pee, cant hear)

Blotting procedures:
SNOW
DROP

S/D: Southern blot = DNA sample identified with DNA probe

N/R: Northern blot = RNA sample identified with DNA probe

O/O

W/P: Western blot = protein sample identified with antibody probe

Model systems:

Knock out = take a gene OUT

Knock in = INsert a gene

Knock down = knock down the expression of the gene via complementary mRNA
antagonist

Imprinting:

Prader-Willi = Paternal deletion

AngelMans = Maternal deletion

Genetics:
Autosomal Dominant: have familial or hereditary in name +
"A Brainy Dwarf named Marfan von Hippel-Lindau hired MEN to Hunt for Potatoes."

Brainy = Neurofibromatosis1, 2

Dwarf = Achondroplasia

Marfan

von Hippel-Lindau

MEN1, 2a, 2b

Huntingtons

Potato = Tuberous sclerosis

X-linked recessive:
"Duke Fabrys Brutal Gopher Hunter, Lesch, Was-Actually a Fragile Albino
Hemophiliac."

Duke = Duchennes

Fabry

Brutal = Brutons

Gopher > G6Pher = G6PD deficiency

Hunter = Hunters

Lesch-Nyhan

Was-Actually = Wiskott-Aldrich

Fragile X

ocular Albinism

Hemophilia A, B

Fragile X = Xtra large testes, jaws, ears

FraGile X = cGg trinucleotide repeat

myoTonic dystrophy = cTg trinucleotide repeat

Autosomal trisomies: Pat Ed Down = 13, 18, 21

Puberty at 13, Election at 18, Drinking at 21
Down syndrome is associated with ALL (and AML) and ALzheimers and decreased
ALpha-fetoprotein > ALL fall DOWN; also associated with:

Duodenal Atresia (failure to recanalize = blind duodenum > bilious vomiting

with first feed; double-bubble)

Celiac Disease (associated with dermatitis herpetiformis)

Annular Pancreas

Hirschprung congenital megacolon (failure of neural crest cell migration: no

Auerbach or Meissners plexus > constipation/meconium ileus)

Edwards: watch 99 balloons

Pataus: rocker bottom Pedals/feet, cleft lip/Palate, holoProsencephaly (sonic hedgehog
deficiency), Polydactyly
Williams syndrome: Will Farrell in Elf: elfin faces, mental retardation, well-developed
verbal skills, extreme friendliness
DiGeorge syndrome: CATCH-22

Cleft palate

Abnormal facies

Thymic aplasia (T-cell deficiency)

Cardiac defects

Hypocalcemia (secondary to parathyroid aplasia; remember third pharyngeal

pouch: inferior parathyroids are grown with thymus and descend together)

microdeletion at chromosome 22q11

Vitamin B1: Thiamine

Thiamine pyrophosphate (TPP) is needed for a number of enzymes, but is rarely required
alone. Whenever you need B1, you usually need FAD (B2), NAD (B3), CoA (B5), and
Lipoic Acid, so just group them together: B1,2,3,5+LA.
Enzymes that use B1, 2, 3, 5 + LA:

Glycolysis/TCA: PDH (X = lactic acidosis; Tx: ketogenic Leucine, Lysine + high

fat diet)

TCA: alphaKGDH

HMP: transketolase

branched chain AADH (X = Maple Syrup Urine Disease > severe CNS defects,
MR, and death)

Related problems:

Lipoic acid is antagonized by Arsenic, which causes rice water diarrhea and garlic
breath.

B1 deficiency in alcoholics > Wernicke-Korsakoff, beriberi

PDH deficiency/dysfunction > inability to continue TCA > diversion to lactic

acidosis; brain starves for energy > neurologic defects. To keep brain from
starving, Tx with ketogenic amino acids LEUCINE and LYSINE and high fat diet
(beta oxidation of fats will produce acetyl CoA > TCA/ketogenesis).

Vitamin B6: Pyridoxine

Major pathways that use B6:
Glycogenolysis RLS: Glycogen > G1P via glycogen phosphorylase
Heme synthesis RLS: Succinyl CoA (TCA) + Glycine > delta aminolevulinic acid
(ALA) via deltaaminolevulinic acid synthase
Cysteine synthesis: Homocysteine + Serine > Cystathione via Cystathione synthase
(X = homocysteinuria: Marfanoid Sx+MR+atherosclerosis)
Note: Cystinuria due to PCT reabsorption defect > staghorn cystine kidney
stones; Tx: acetazolamide to alkalinize urine
ALT/AST transamination:
Alanine+alphaKG(TCA)<ALT>Pyruvate(glycolysis)+glutamate
Aspartate(Urea cycle)+alphaKG(TCA)<AST>OAA(TCA)+glutamate
Amino acid production (hydroxylation, decarboxylation reactions):
tyrosine hydroxylation> dopa decarboxylation> dopamine
tryptophan to niacin/B3 (no B6 = no B3 = Pellagra)
histidine to histamine
glycine to porphyrin (in heme production; no B6 = hypochromic, microcytic
anemia)
glutamate to GABA (no B6 = loss of GABA = increased excitation >
convulsions/seizures)
Vitamin B12: Cobalamin
Cofactor when you see Meth in product or substrate:
METHylmalonylCoA > Succinyl CoA via methylmalonylCoA isomerase
homocysteine + N-METHylTHF > METHionine + THF via homocysteine
methyltransferase
Absorbed in the ileum (Crohns, gastric bypass, sprue, Diphyllobothrium latum) with IF
(pernicious anemia); use Schilling test to determine if its intake/absorption or lack of IF
problem. B12 stores last for YEARS. Deficiency causes an increase in methylmalonic
acid (peripheral neuropathy) and homocysteine (megaloblastic anemia).
Other causes of megaloblastic anemia = folate deficiency (incr. homocysteine but not
methylmalonic acid, so no neuropathy) and chronic alcoholism.
Vitamin B7: Biotin
While Vitamin B6 is needed for DEcarboxylation reactions (amino acid production), B7
is needed for CARBOXylation reactions:
PropionylCoA(oddchainFA/branchedchainAA metab)>MethylmalonylCoA via
proprionylCoA carboxylase (which goes on to form succinyl CoA of TCA with
methylmalonylCoA isomerase and B12)
Pyruvate(glycolysis)>OAA (TCA) via pyruvate carboxylase
AcetylCoA(TCA)>MalonylCoA(FA synthesis RLS)

Avidin in egg-whites Avidly binds B7.

Vitamin C: Ascorbic Acid
Iron absorption and Fe2+ state maintenance
Collagen synthesis: hydroxylation of proline and lysine within fibroblast ER <
SCURVY
dopamine > NE via dopamine beta hydroxylase, blocked by Reserpine
Vitamin D: the longest name with a 1: (1,25-(OH)2D3) Calcitriol = active form (PTH
stimulates conversion of livers 25OHvitamin D to 1,25-(OH)2D3 in kidney by 1alpha
hydroxylase)
Vitamin E: E is for Erythrocytes; its an antioxidant that prevents hemolytic anemia and
neurodysfunction
Vitamin K: inject newborns with it to make sure theyre oK (prevent hemorrhage);
deficiency = normal bleeding time, but increased PT and aPTT
Note:

platelet dysfunction > BT

extrinsic (shorter) pathway > PT (shorter name); VII; monitor w/ Warfarin

intrinsic (longer) pathway > PTT (longer name); monitor w/ Heparin

Carbamoyl phosphate synthetase: UP 1, 2.

Urea cycle RLS: CPS1

Pyrimidine synthesis RLS: CPS2

HMGCoA ___:

"You always want to REDUCE your CHOLESTEROL": HMGCoA reductase =

RLS for cholesterol synthesis

vs. HMGCoA synthase = ketogenesis (your brain wants to SYNTHESIZE

KETONES when theres no glucose)

Regulation by F2,6BP: 2 supports 1:

PFK2 supports PFK1 > glycolysis

F26BP supports F16BP > glycolysis

MOA: insulin > decreases cAMP > decreases PKA > dephosphorylated FBPase2
= PFK2 > F6P to F26BP > stimulates PFK1 > incr F6P to F16BP (glycolysis)
Note: glucose > decreases cAMP > decreases CAP-cAMP binding of lac operon =
RNA polymerase cant bind to promoter
Glycolytic enzyme deficiency: RBCs solely depend on glycolysis for energy so no
Pyruvate Kinase/Phosphoglycerate Kinase (ATP generating steps) = decreased ATP >
cant maintain membrane gradient > cell swells > hemolytic anemia
HMP shunt/Pentose Phosphate Pathway:

G6P > Ribulose5P + 2NADPH via RLS G6PDH

Ribulose5P > Ribose5P > purine synthesis

NADPH:
fatty acid and steroid synthesis
oxidative burst (NADPH oxidase; X = Chronic Granulomatous Disease)
p450
glutathione reductase AKA RBC antioxidation
G6PD deficiency = (x-r) > no NADPH = no glutathione reductase = oxidative damage
= hemolytic anemia (bite cells - RBCs partially eaten by macrophages (M0s), Heinz
bodies - oxidized Hb that precipitated in RBCs)
Drugs that cause hemolytic anemia in G6PD deficiency:
"Prima had to take Aspirin when she INHaled her I.B.Professor Dapsones Sulfurous
Fava bean NitroFarts."

Prima = Primaquine

Aspirin

INH (Isoniazid)

I.B.Professor = Ibuprofen

Dapsone

Sulfurous = Sulfonamides

Fava bean

NitroFarts = Nitrofurantoin

CGD (chronic granulomatous disease, Dx: negative Nitroblue tetrazolium reduction) =

NADPH oxidase deficiency > susceptible to Catalase+ organisms:
"The recoiling Red Asp wasnt Sorry towards the moaning Cat because it had Noheart."

recoiling = E.coli

red = Serratia

Asp = Aspergillus

Sorry = S. Aureus

moaning = Pseudomonas

Cat = Catalase + organism

NoHeart = Nocardia

Disorders of __ metabolism:
__-kinase is the enzyme that immediately follows the breakdown of __:

Glucose > G6P via Gluco(Hexo)kinase

Fructose > F1P via Fructokinase

Galactose > Gal1P via Galactokinase

Deficiencies of Fructo and Galactokinases causes MILD symptoms (respective sugars are
present in urine). The SEcond steps cause SEvere symptoms (AldolaseB and Uridyl
transferase, respectively).
Watch out when you see ALDO- because it means something bad is going to happen:

Glucose > Sorbitol via Aldose Reductase + NADPH (CATARACTS)

Note: Sorbitol > Fructose via SorbitolDH

Galactose > Galactilol via Aldose Reductase + NADPH (CATARACTS)

Fructose1P > Glyceraldehide and DihydroxyacetoneP via Aldolase B

(FRUCTOSE INTOLERANCE)

Essential amino acids:

TV FILM HWRK (Threonine(T), Valine(V), PHENYLALANINE(F), Isoleucine(I),
Leucine(L), Methionine(M), Histidine(H), TRYPTOPHAN(W), ARGININE(R),
LYSINE(K))
Negatively charged amino acids:
Negative experience to be burned by Acid:
Aspartic acid and glutamic acid
Note: Aspartate and Glutamate (as N-acetyl glutamate) are involved in Urea cycle
elimination of ammonia
Amino acids with three titratable H+:
Ricky Cant Hate ED
RKY C H ED

Arginine(R) - 12.5

Lysine(K) - 10.5

Tyrosine(Y) - 10.1

Cysteine(C) - 8.2

Histidine(H) - 6

Aspartic acid(E) - 4.3

Glutamic acid(D) - 3.7

The numbers arent important except for Histidine. Just know the order and that it goes in
descending pHs. FYI: COO-=2, NH3+=9.5
KNOW: Ketogenic amino acids:
Leucine and Lysine > USED TO TREAT PDH DEFICIENCY
Cycles: Urea cycle and TCA overlap:

OAA(TCA) + Glutamate <AST> Aspartate(Urea) + alphaKG(TCA)

Aspartate(Urea) + Citrulline(Urea) > Arginosuccinate(Urea) >

Arginine(Urea) + Fumarate(TCA)

Urea cycle enzyme deficiency > decreased TCA intermediates > TCA INHIBITION
+ HYPERAMMONEMIA (b/c decreased NH4+ excretion).
Sx: asterixis, slurred speech, somnolence, blurry vision, vomiting
Tx: less protein in diet + Benzoate/Phenylbutyrate (bind a.a.>excrete)
OTC = major urea cycle enzyme:
Ornithine + carbamoyl-phosphate > Citrulline via OTC
OTC deficiency (x-r) = shunting of carbamoyl phosphate from urea cycle to pyrimidine
synthesis:
carbamoyl phosphate + aspartate > orotic acid
Orotic Aciduria > decreased BUN + hyperammonemia
Amino acid derivatives:

Phenylalanine (Phenylalanine hydroxylase + THB + NADPH via

Dihydropterin reductase)> Tyrosine(X = PKU (a-r): screened by Guthrie test 23 days after birth; Tx: decr Phen, incr Tyr diet):

> Fumarate via Homogentinsic acid oxidase (X = Alkaptonuria)

> Thyroxine

(Tyrosine hydroxylase/B6, blocked by Metyrosine)> Dopa:

> Melanin (X = Albinism: decreased pigment)

(Dopa decarboxylase/B6, blocked by Carbidopa)> Dopamine

(Dopamine Hydroxylase/VitC, blocked by Reserpine)> NE
(PNMT/SAM)>Epinephrine

Tryptophan(X in Hartnups):

(B6)> Niacin=B3 > NAD+/NADP+ (X = Pellagra)

(BH4)> Serotonin > Melatonin (sleep)

Lysosomal storage diseases:

Tay-SaX = HeXosaminidase A > incr GM2: no hepatosplen; cherry macula,

onion skin lysosomes

"Fab-Gal is into Ceramics"

Fabrys = alphaGALactosidase A > incr Ceramide trihexose: peripheral
neuropathy, angiokeratoma, CV/renal disease

"Gauched out my femur when I was on a sugar high"

Gaucher, Femur Necrosis, Sugar High = GlucoCerebrosidase
Gauchers = betaGlucocerebrosidase > incr glucocerebroside: aseptic femur
necrosis, hepatosplenomegaly, crumpled tissue paper cytoplasm

Blind Intelligent Intergalactic Crab

Intelligent Intergalactic = Galactocerebroside
Krabbes = Galactocerebrosidase > incr galactocerebroside: blindness,
peripheral neuropathy, developmental delay, globoid cells

Niemann Picks his nose with hisphinger

Niemann-Pick = Sphingomyelinase > incr Sphingomyelin: cherry macula with
hepatosplenomegaly, neurodegeneration, foam cells

"Sulfur tides are multicolored"

Sulfur tide = Sulfatide
Multicolored = Metachromic
Metachromic leukodystrophy = Aryl sulfatase A > incr Sulfatides: central and
peripheral demyelination with ataxia, dementia

Mucopolysaccharidoses:

HurLers = alpha-L-iduronidase > incr heparan sulfate, dermatan sulfate:

corneal clouding, gargoylism, airway obstruction

Hunters = iduronate sulfatase > incr heparan sulfate, dermatan sulfate: NO

CORNEAL CLOUDING because Hunters need to see clearly

Major apolipoproteins:
"II:LL"
C-II = cofactor for Lipoprotein Lipase
Treat abetalipoproteinemias (deficient apoB100, B48 > night blindness, acanthocytes
(spiky RBC), steatorrhea, ataxia) with Vitamin E
Embryology:
Important Genes for Embryogenesis:

Sonic the Hedgehog fights a One-Eyed Monster:

Sonic Hedgehog mutation > Holoprosencephaly

FGF gene = Fibroblast Growth Factor: Growth Factor lengthens limbs

FGF mutation > Achondroplasia (A-D dwarfism)

HOX (Homeobox) gene: Boxes help with organization

organizes/determines limb location (Vitamin A toxicity alters HOX expression
> cleft palate, cardiac abnormalities, spontaneous abortion)

Rules of Early Development:

Week 2: 2 germ layers (epiblast, hypoblast), 2 cavities (amniotic, yolk sac), 2

placental components (cytotrophoblast, syncytiotrophoblast)

Week 3: 3 germ layers (ectoderm, mesoderm, endoderm)

Week 4: 4 heart chambers, 4 limb buds

Note: neural tube closes by week 4:
def. folic acid> spina bifida, etc.
neural tube defect has incr alpha-fetoprotein+AChesterase
(**Gastroschisis and Omphalocele, pretty much ANY internal organ extrusion
results in incr alpha-fetoprotein)

"SAD DAVE":

SAD: Sensory = Alar Plate/Afferent nerves = Dorsal

DAVE: Dorsal=Afferent, Ventral=Efferent

Embryologic derivatives:

Ectoderm:

Surface: what you see (epidermis, hair, nails, teeth enamel, eye lens) +
anterior pituitary (Rathkes pouch)

Neuro: everything connected to the CNS (brain, spinal cord,

oligodendocytes, posterior pituitary, retina, pineal gland) + pupillary
muscles

Mesoderm:

Neural crest: skull and PNS stuff (skull, head muscles, dentine,
pia/arachnoid, Schwann cells, DRG, cranial nerves, celiac ganglion,
parafollicular C cells of thyroid) + adrenal medulla (chromaffin cells)
+ melanocytes (last to migrate)

Paraxial: axial stuff (axial skeleton, skeletal muscles, connective tissue and
dermis) + dura mater

Intermediate: urogenital ridge (kidneys and ureters, vas deferens, gonads,

uterus and uterine tubules)

Lateral: non-skeletal muscle and blood-related organs (visceral muscle and

connective tissue, blood, lymph, spleen, cardiovascular system) +
adrenal cortex
Note: spleen = mesoderm, but supplied by celiac artery of the foregut

MESODERMAL DEFECTS = VACTERL: Vertebral defects, Anal

atresia, Cardiac defects, Tracheo-Esophageal fistulas, Renal defects,
Limb defects

Endoderm: ear/mouth to anus hollow lining and organs + bladder and vagina

tympanic cavity/auritory tube, tonsils, thymus, thyroid, parathyroid

larynx, trachea, bronchi, lungs

GIT, liver, gallbladder, pancreas

urinary bladder, urethra, lower 2/3 vagina (this explains how patients
can still have a vagina even if the paramesonephric ducts fail to develop)

Notochord > nucleus pulposus of intervertebral disk

Teratogens:

"Amina couldnt hear because she was too absorbed in her reading."
Aminoglycosides prevent mRNA reading by interfering with 16S of 30S and
cause CNVIII ototoxicity
(Note: Congenital Syphilis also causes CNVIII ototoxicity + Saber shins + Saddle
nose + Hutchinsons teeth + Mulberry Molars + frontal bossing)

Maternal Diabetes: hyperglycemia > incr fetal insulin > decr lung
development = cant breathe; mermaids also cant breathe air >
maternal diabetes causes ARDs and sirenomelia/anal atresia (also, transposition of
great vessels)

Umbilical cord:

Allantois: 2 arteries, 1 vein (arteries is 2x as long as vein)

AllaNtois (urachus)> mediaN umbilical ligament

UmbiLical artery > mediaL umbilical ligament

Umbilical vein - ligamentum teres hepatis

Allantois > Urachus (wk3): urachus failure to obliterate = bladder to navel connection:
umbilical urination or bladder outpouching
Omphalomesenteric duct > Vitelline duct (wk7): duct failure to obliterate = colon to
navel connection: umbilical meconium or Meckels diverticulum
Heart embryology:

Primitive __ > trabeculated (rough) portion of __

Smooth atrium = sinus venosus

Smooth ventricle = bulbus cordis

SVC = right common and anterior cardinal veins

Aorta/Pulmonary artery = truncus arteriosus, separated by spiraling neural crest

migration (X = Transposition of Great Vessels, Tetralogy of Fallot)

"PGA open": PG keeps DA open (decr PG > close DA with Indomethacin, NSAIDs)
Aortic arch derivatives: left side of body to right side, top to bottom

I: maxillary artery (external carotid) - @ face

II: hyoid/stapedial artery - @ midline throat

III: common and internal carotid arteries - @ midline neck

IV: right subclavian artery and aortic arch - @ right/middle chest

VI: pulmonary artery (inc. ductus arteriosus connection to aorta) - @ right side of
heart

Neural tube defects:

The longer the name, the worse the symptoms:

Occulta: spinal canal opening but no herniation, tuft of hair

Meningocele: herniation of meninges

Meningomyelocele: herniation of spinal cord

Pharyngeal/Branchial CAP:

Cleft = ectoderm (~external hollow spaces)

Arches = mesoderm (~muscles)

Pouches = endoderm (~immune organs above the neck)

Branchial CLEFT - ectoderm: ~external hollow spaces

Cleft 1: external auditory meatus

Clefts 2-4: temporary cervical sinus (fail to obliterate = lateral neck branchial cleft
cyst)

Branchial cleft cyst (lateral neck) vs Thyroglossal duct cyst (midline neck, moves with
swallowing because attached to tongue)
Branchial ARCH - mesoderm: ~muscles
The nerves that supply the branchial arches are all BOTH motor and sensory:
"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)
**LOOK AT THE NERVES TO FIGURE OUT WHICH MUSCLES MAKE UP WHAT
ARCH** or use the following mnemonic:
"Chewing made me grimace so I swallowed, choked, then called for help."

chewing = arch 1 (V2,3) = muscles of mastication, ant. 2/3 tongue +

malleus/incus/tensor tympani

grimace = arch 2 (VII) = facial expression + stapes/stapedius (defect = Treacher

Collins mandibular hypoplasia and facial abnormalities)

swallowed = arch 3 (IX)= stylopharyngeus (defect = fissure from neck to tonsils)

choked = arch 4 (X, sup laryngeal)= pharyngeal constrictors and cricothyroid

called for help = arch 6 (X, inf laryngeal)= intrinsic larynx muscles except
cricothyroid

Note: Arch 4&6 make up post. 1/3 tongue

Branchial POUCH - endoderm: ~immune organs above the neck + middle ear

Pouch 1 = auditory tube, middle ear, mastoid air cells

Pouch 2 = tonsils and tonsillar sinus

Pouch 3 = inferior parathyroid + thymus (they descend together)

Pouch 4 = superior parathyroid + parafollicular C cells of thyroid

Failure of 3rd and 4th Pouch = DiGeorges: no thymus (= T cell deficiency), no

parathyroids (= hypocalcemia > tetany)
"C3, 4, 5 keeps the diaphragm alive."
Kidney embryology: main player = Metanephros:

Ureteric Bud = ureter>pelvis>collecting ducts

JOINS

Metanephric Mesenchyme = glomerulus>DCT

Defective ureteric bud = renal agenesis; B/L renal agenesis > oligohydramnios >
Potters: pulmonary hypoplasia + face/limb deformities
**MC site of obstruction = Ureteropelvic junction with kidney > fetal hydronephrosis
Genital embryology:

Male = Mesonephric

Pemale = Paramesonephric

"Men are Wolves" = "Wolffian ducts" > "SEVEN" in "SEVEN UP" (Seminal
vesicles, Epididymis, Vas deferens, Ejaculatory duct, N = nothing)

"Women Mull over past arguments" = "Mullerian ducts" > fallopian tubes,
uterus, and upper 1/3 of vagina (lower 2/3 from urogenital sinus of endoderm)

Female = default genitals

Hormone overview:

Prolactin stimulates Dopamine inhibits Prolactin

Prolactin inhibits GnRH

GnRH > incr FSH, LH

L in LH and Leydig: LH stimulates Leydig cells to produce testosterone >

develop Wolffian duct

S in FSH, Sertoli, and Sperm: FSH stimulates Sertoli cells to produce Sperm,
Inhibin, and Mullerian inhibiting factor (MIF); MIF inhibits female
paramesonephric duct development

Genital homologues:

Urogenital sinus:

Bulbourethral glands = Bartholins greater vestibular glands

proState gland = Skene urethral and paraurethral glands

Extrophy of bladder is associated with Epispadias (faulty positioning of genital tubercle)

vs. Hypospadias = more common, failure of urethral fold closure, incr risk of UTI
Microbiology:
Encapsulated organisms: (+Quellung reaction: quell makes capsules swell)
"Claustrophobic Pastor Salmon Echoed Back: Yersinful Crypt-dark Strip Clubs are
Pseudo-Homes to Nice Men Francis and Bruce."

Claustrophobic = Clostridium

Pastor = Pasturella

Salmon = Salmonella

Echoed = E.coli

Back = Bacillus anthracis (D-glutamate)

Yersinful = Yersinia

Crypt-dark = Cryptococcus (India Ink, narrow-based budding in meningitis)

Strip = Streptococcus

Clubs = Klebsiella

Pseudo = Pseudomonas

Homes = Haemophilus

Nice men = Neisseria meningitidis

Francis = Francisella

Bruce = Brucella

"BAD" - Bacillus Anthracis unique capsule contains D-glutamate

"Staff of grapes" = Staphylococcus is in clusters
VS. Streptococcus = pairs/chains
Spirochetes: Spiraling Boris Lept then Tripped

Spiraling = Spirochetes

Boris = Borrelia (Giemsa stain = aniline dye; relapsing fever = result of antigenic
variation)

Lept = Leptospira

Tripped = Treponema (Dark Field Microscopy, VDRL cardiolipin screening,

FTA-ABS confirmation)

Mycoplasma vs Mycobacteria

Bacteria have cell walls (Mycobacteria have mycolic acid in their cell walls that
stain acid-fast)

Plasma membranes have sterols (Mycoplasma have sterols and no cell wall)

Stains:

GiemsA stains BorreliA, MalariA, ChlamydiA, TrypanosomA

PASs the sugar and whip cream (PAS stains glycogen and Dx Whipples disease)

"Legions who Sustained injuries get Silver stars": Legionella, grow with Cysteine,
silver stain; water source

Special Culture:

"Nice Homes have chocolate": Neisseria and Haemophilus grow on Chocolate

agar +:

Neisseria = Thayer Martin media: Vancomycin (vs G+), Polymyxin (vs

g-), Nystatin (vs fungi)

Haemophilus = V (NAD+) and X (hematin)

"If I Tell-U the Corny joke Right, youll Laugh":

TellURight = tellurite agar

Corny = Corynebacterium

Laugh = Lofflers media

"TB and J": M. tuberculosis on lowenstEIN-Jensen agar (takes 3-4 weeks to grow,
but diagnostic)

Obligate aerobes:
"If No AER, Anthrax and TB cant survive!"

No = NOcardia

Aer = pseudomonas AERuginosa

Anthrax = B. anthracis

TB = M. tuberculosis

Microaerophils = bacters: Campylobacter, Helicobacter

Obligate anaerobes: These BACTERia ACTIN CLOSTRophobic enviroments (nonhealing ulcers):

BACTERia = Bacteroides (E.G., B. fragilis)

ACTIN = Actinomyces

CLOSTRophobic = CLOSTRidium

Obligate Intracellular: REACh for My COX if you want me INSIDE you.

R = Rickettsia

E = Ehrlichia

A = Anaplasma

Ch = Chlamydia

My = Mycoplasma

Cox = Coxiella

Inside = intracellular

Facultative intracellular: Legions of Salmon, Rabbits, N Cows Tumble IN My yard.

Legions = Legionella

Salmon = Salmonella

Rabbits = Francisella

N = Neisseria

Cows = Brucella

Tumble = Listeria

In = intracellular

My = Mycobacterium

Note: intracellular pathogens require cell-mediated immunity (CMI), so neonates are at

risk (E.G., Listeria > neonatal meningitis: tumbles, has endotoxin, and a narrow zone
of beta hemolysis)
Bacterial virulence factors:

protein A for staph. Aureus: binds Fc of Ig to prevent opsonization and

phagocytosis

M protein (prevents phagocytosis) > strep. pyogenes rheuMatic fever (Sx:

subcutaneous plaques, polyarthritis, erythema marginatum, chorea, carditis)

IgA protease (to colonize respiratory mucosa) + antiphagocytic capsule (infects

ASPLENIC patients b/c decr M0 and IgM/complement C3 activation (E.G.,
Sickle Cell autosplenectomy)) + causes meningitis = SHiN
Note: can also undergo transformation (pick up DNA from environment)

Strep pneumo

H. influenza type B (B polysaccharide)

Neisseria meningitidis

Exotoxin vs Endotoxin:

EXotoxin = from EXogenous source (plasmid or bacteriophage) and EXcreted

from bacteria, EXtremely toxic (even small dose), EXact effects (different toxins
produce different symptoms); ~heat-labile

ENDOtoxin (Lipid A)- ENDOgenous (made from bacterial chromosome,

ENtegral to outer membrane of most g-Neg bacteria (and Listeria(G+))); heat
stable; causes gENeral fever, shock/sepsis via direct MACROPHAGE response
(binds CD14-M0 marker) > release TNF and IL-1 (no Th involvement)

M0 activation:

IL1 = Fever

TNF alpha = fever, hemorrhagic tissue necrosis

Nitric oxide = hypotension/shock

alternate complement pathway:

C3a = Anaphylaxis (basophil and mast cell degranulation >

hypotension, edema)

C5a = neutrophil chemotaxis

Hageman factor: coagulation cascade> DIC/microthrombi

Exotoxin subclass: SUPERANTIGENS: bind directly to MHCII and TH1(CD4) >

explosive release of IFNgamma and IL2 (non-specific immune response):

S. aureus = TSST-1 > Toxic Shock Syndrome (fever, rash, shock)

S. pyogenes = Erythrogenic toxin > Scarlet fever with Toxic-Shock-like

symptoms
Note: S. pyogenes also has Streptolysin O (lyses RBC); Dx: Rheumatic Fever
with anti-Streptolysin-O antibody (ASOAb)

E. coli ADP ribosylating A-B toxin:

"Labile like Air, Stable like Ground":

heat-Labile toxin stimulates Adenylate cyclase

heat-Stable toxin stimulates Guanylate cyclase

Both cause watery diarrhea.

Bacterial Toxins Envoded in Lysogenic Phage: ABCDE

ShigA-like toxin - EHEC 0157:H7 - cleaves host cell rRNA/inactivates 60S; also,
incr cytokines > HUS

Botulinum toxin - inhibits ACh vesicle release from presynaptic neuron >
flaccid paralysis

Cholera toxin - activates Gs > incr cAMP > incr Cl- secretion into gut = decr
Na+ absorption > watery diarrhea

Diptheria toxin - ADP-ribosylating A-B toxin (like Pseudomonas exotoxin A) - B

binds, A enters and ribosylates EF2 > no more protein synthesis > cell death;
pseudomembrane formation

Erythrogenic (superantigen) toxin of Strep. pyogenes > Scarlet Fever activates both TH1(CD4) and MHCII > incr INFgamma + IL2 > incr M0 and
T-cell non-specific immune response > ~Toxic Shock

Gram Positives: crystal violet + iodine = blue

Coag negative Staph: SENsitive: Staph. Epi = Novobiocin SENSITIVE (VS.

Staph. saprophyticus = Novobiocin resistant)

alpha hemolytic Strep: OVeRPasS: Optochin Viridans Resistant, Pneumonia

Sensitive
Note: Strep pneumonia is bile soluble (= cant be cultured in bile, unlike gamma
hemolytic Strep)

beta hemolytic Strep: BBBR: Beta hemolytic, group B strep (Strep agalactiae),
Bacitracin Resistant (VS. group A strep (Strep. pyogenes) = bacitracin sensitive)
OR
"B-BRAS" - Bacitracin: group B = resistant, group A = sensitive

gamma hemolytic Strep: grows in bile; stomach is used to salty foods =

Enterococci grows in 6.5%NaCl (VS. Strep. bovis > does NOT grow in
6.5%NaCl)

Exposure/PRIMARY TB:

Ghon complex = Ghon focus of LOWER lobe + peri-hilar lymph nodes

You think they are Ghon but theyre just waiting to become secondary TB
(fibrocaseous cavitary lesion of UPPER lobe)

gram negative: acetone + saffranin = pink

N. Meningities ferMents Maltose, has a capsule, and vaccine (gonorrhea doesnt;

NOTE**: gonorrheas pilus protein undergoes antigenic variation!!)
Note:
-N. meningitidis = respiratory/oral spread > meningococcemia and WaterhouseFriderichsen adrenal hemorrhage (hypotension and DIC)
-N. gonorrhea = STD> high fever, septic arthritis, neonatal conjunctivitis, PID,
Fitz-Hugh-Curtis (cervicitis>salpingitis>liver capsule infection)

Enterobacteriae: CAPSULE = VIRULENCE FACTOR, all ferment glucose

Lactose fermenters (pink on MacConkey, blue on Eosin-Methylene blue)

= SEEK: Serratia, Enterobacter, E. coli (blue-black metallic sheen),
Klebsiella

Non-lactose fermenters = PSSY: Proteus, Salmonella, Shigella, Yersinia

H2S producing (black on Hektoen Agar) + motile (flagellar H antigen):

Proteus (swarming, urease+, staghorn ammonium struvite stones),
Salmonella

Note: Salmonella and Shigella both invade mucosa > bloody diarrhea;
Salmonella is motile (w/ 2 flagellar antigen variants) and produces H2S,
S. typhi of Typhoid fever causes abdominal rose spots and can remain
chronically in gallbladder; Shigella is more virulent, moves by actin
polymerization and 60S deactivating toxin induces HUS.

oxidase + organisms: when you go Camping at a quiet Pasture youd Moan More with
Nice Vibrators

Camping = Campylobacter

Pasture = Pasturella

Moan = Pseudomonas

More = Moraxella

Nice = Neisseria

Vibrators = Vibrio

VDRL false positives: VDRL

V = viruses: EBV, hepatitis

D = drugs

R = Rheumatic fever (Dx w/ S. pyogenes ASO titers)

L = Lupus and Leprosy

Chlamydia: Dx via Giemsa stain (ChlamydiA, MalariA, BorreliA + TrypanosomA)

Elementary body is Enfectious and Enters cells via Endocytosis

Reticulate body Replicates in cell by fission

"Tricky Dick": TRIC = serotypes DK:

> MC PID, cervicitis, ectopic pregnancy

> Fitz-Hugh-Curtis liver capsule infection (from spread of PID) +

violin string adhesions of parietal peritoneum to liver

> neonatal pneumonal/conjunctivitis

> REITERS: Cant see, cant pee, cant climb a tree =

conjunctivitis, urethritis, arthritis

VS. trAChoma = serotypes A-C > blindness

VS. L1-L3 = Lymphogranuloma venerum: ulcers > lymphadenopathy, rectal
strictures mistaken for PID

Tx: mothers and infants with Chlamydia with Erythromycin estolate, though there
is a risk of maternal acute cholestatic hepatitis

Atypical (walking) pneumonias: My Clammy Legion walked; Tx: macrolides

My = Mycoplasma (IgM = cold agglutinins > agglutinate or lyse RBCs; grown

on Eatons agar; Tx: tetracycline or macrolide)

Clammy = Chlamydia (Tx: tetracycline or macrolide)

Legion = Legionella (Tx: macrolide)

Fungi:
Dimorphic: cold = mold, heat = yea(s)t + Blast His Cock = East Coast to West Coast
(Tx: Ketoconazole)

Blast = Blastomycosis = east of Mississippi River

His = Histoplasmosis = Mississippi River and Ohio river

Cock = Coccidiomycosis = Southwest US: CA, AZ

"His Woodpecker Blasted Wood into Dust":

His Woodpecker = Histoplasmosis from bird/bat droppings = macrophage filled

with round yeast; Histo Hides within macrophages

Blasted Wood = Blastomycosis in wood = Broad-Based-Budding fungi; the

handle of a baseball bat looks like its budding off the shaft)

Dust = Coccidiomycosis = large spherule filled with endospores; barrel-shaped

arthroconidia; Cock is filled with Sperm, Coccidio is filled with Spores

Actinomyces = Acute Angles, Septate

(VS. Mucormycosis/Rhizopus = Wide angles, non-septate; ~in Diabetics)

Helminth drugs:

Worms = Bendazole

Praziquantel = foods: Pork, Fish, Crab, Snails

Pork = Taenia

Fish = Diphyllo, Clonorchis

Crab = Paragonimus

Snails = Schistosoma

Antigenic shift vs. drift: SPED

Shift (reassortment via segmented viruses) = Pandemic

Epidemic = Drift (random mutations)

Vaccines:

Live: See MMR. Sabins small yellow chickens live.

MMR = Measles, Mumps, Rubella

Sabin (Polio, oral)

small pox

yellow fever

chicken pox/shingles

Killed: RIP Always

Rabies

Influenza

Polio (SalK = Killed, injected)

Adenovirus

Recombinant: H_V

Worms = Bendazole

Praziquantel = foods: Pork, Fish, Crab, Snails

Viruses:
DNA viruses: HeHe PoPa ParAde: first three = enveloped

He = Herpes

He = HepaDNA (HBV; carries special RT: DNAdDNAp)

Po = Pox (smallpox, molluscum contagiosum; carries DNAdRNAp and replicates

in cytoplasm)

Pa = Papilloma (HPV: (6,11): condylomata acuminata/genital warts,

koilocytes=squamous cell with perinuclear cytoplasmic halo; (16,18): CIN; anal
squamous cell CA) + Polyoma (JC, PML demyelinating encephalopathy)

Par = Parvo = B19/Erythema infectiosum (ssDNA)

Ade = Adenovirus (swimming pool conjunctivitis, gastroenteritis)

Herpes: 2 Simple Chickens Barred Sight from Rose Patches

2 Simple = HSV1,2

Chickens = HHV3: Chicken pox (truncal rash > extremities; lesions of different
age)/shingles

Barred = HHV4: EBV (mono, Burkitts, large cell non-Hodgkins @ Waldeyers

ring, nasopharyngeal CA, hairy leukoplakia on lateral tongue; infects B cells via
CD21-EBV receptor)

Sight = HHV5: CMV (retinitis, negative mono-spot mono, TORCH; both

intranuclear owl-eye and cytoplasmic inclusion bodies)

Rose = HHV6: Roseola/Erythema subitum (high fever > rash)

Patches = HHV8: Kaposi-sarcoma

RNA viruses:
+RNA = PiToFlaCoCa: middle 3 = enveloped

Pi = PicoRNA = PECoRnA:

P = Polio (both colonizes nasopharynx and causes meningitis like Hib >
myalgia and paralysis)

E = Echovirus: swimming pool aseptic meningitis/myocarditis

C = Coxsackie: aseptic meningitis/myocarditis, hand-foot-mouth (palm

and sole vesicular rash also seen in secondary syphilis and Rickettsial
Rocky Mountain Spotted Fever)

Rn = RHINOvirus (stuffy NOSE from common cold)

A = HAV

To = Toga

"Togas Rubelled against Germany with TORCHs" = Togavirus, Rubella,

German Measles (post-auricular occipital lymphadenopathy, fine
truncal rash), TORCH infection (blueberry muffin rash, deaf, cataracts,
PDA)

VS. Rubeola: a PARA Ruby weasles caught SSPEcial measles =

Paramyxo, Rubeola, SSPE complication, Measles

VS. Roseola: HHV6 (high fever/seizures > truncal rash)

Fla = Flavi (HCV, yellow, dengue, St. Louis, West Nile)

yellow fever causes yellowing skin (jaundice) and black vomit

Co = Corona (common cold, SARS)

Ca = Calici = Norwalk, CA Cruises (gastroenteritis from cruises)

-RNA = all enveloped + RNAdRNApol

Reovirus = dsRNA, segmented: ROTAvirus = right out the anus (childhood winter
gastroenteritis)

HepEvirus = HEV (water epidemic, only dangerous if pregnant)

Orthomyxo: O for octo = 8 segments > reassortment = Influenza pandemic (Ag

shift)

Paramyxo = PaRaMyX2o:

P or PARA = Parainfluenza = croup

R = RSV; Tx: Ribavirin (vs. IMPDH of purine synthesis; AE: hemolytic

anemia, teratogen) or RSVP Liz where P Liz = Palivizumab which
binds Paramyxo F protein, preventing respiratory epithelial syncytia
formation

Mx2 = Measles and Mumps:

Measles: A PARA RUBY weasles caught SSPEcial Measles =

paramyxo, rubeola, SSPE complication, Measles 3 Cs = cough,
coryza, conjunctivitis + Koplik spots; rash from head down like
Rubella

Mumps: parotitis, orchitis, aseptic meningitis

Segmented viruses: BOAR

B = Bunya (Hanta hemorrhagic fever)

O = Orthomyxo (Influenza)

A = Arena (mouse Lassa encephalitis)

R = Reovirus (rotavirus) (right out the anus childhood diarrhea)

Hepatitis:

HAV = Picorna (+RNA); fecal-oral (ice cubes, shellfish)

HBV = HepaDNA (env, dsDNA); blood (renal dialysis, needle stick), sex, mother;
Dx: PCR

HCV = Flavi (env, +RNA); blood (IVDA, transfusion); Dx: RT-PCR

HDV = Delta (defective env, -RNA); infects with HBV

HEV = HepEvirus (+RNA); fecal-oral (water epidemic)

ToRCHS: hepatosplenomegaly, jaundice, thrombocytopenia, growth retardation

T = Toxoplasma: ToxoTriad: intracranial calcifications, chorioretinitis,

hydrocephalus = SAME TRIAD AS CMV!!; from cat feces, ring-enhancing brain
abscess); Tx: Sulfadiazine+Pyrimethamine

R = Rubella (Togavirus, +RNA): PDA, cataracts, deaf, blueberry muffin rash;

maternal rash and arthritis

C = CMV: Toxoplasma triad (intracranial calcification, chorioretinitis,

hydrocephalus) + UNILATERAL hearing loss, seizures

H = HSV (+HIV): temporal lobe encephalitis, herpetic lesions (fingers)

S = Syphilis: hydrops fetalis stillbirth > Hutchinson teeth, saddle nose, saber shins

Note: B19 also causes hydrops fetalis

Bactericidal drugs (all else = bacteriostatic): Sephiroth Met Vancouver Penpal Amina in
Florida, then KILLED HER D:

Seph(iroth) = Cephalosporin

Met = Metronidazole

Vancouver = Vancomycin

Penpal = Penicillin

Amina = Aminoglycosides

Florida = Fluoroquinolones

Antimicrobial drugs:
inhibits PG cross-linking > no cell wall: Ceph Chills-in Nam watching PG
movies:
Ceph = Cephalosporin
Chills-in = cillins (binds PBP, block transpeptidase cross-linking; Penicillin =
endocarditis prophylaxis (before surgery/dental), syphilis prophylaxis)
'Nam = AztreoNAM (binds PBP3 for Pencillin-allergy pts; vs SEEK
Pseudomonas- Serratia, E.coli, Enterobacter, Klebsiella, Pseudomonas),
MeropeNEM and ImipeNEM+Cilastatin (Merpenem/Imipenem vs.
everything, esp. Enterobacter, but causes SEIZURES; Cilastatin inhibits
renal dihydropeptidase I to inhibit renal tubule Imipinem inactivation)
blocks PG synthesis:
Bacitracin (vs. S. pyogenes (GAS))
Vancomycin (binds D-Ala-D-Ala and interferes with PG-elongating
transglycosylase
vs. resistant G+ inc, MRSA and C.diff!!
"TON of AEs": T = thrombophlebitis, O = ototoxic, N = nephrotoxic
+ Red Man (slow infusion and pretreat with anti-histamine to
prevent))

vs. g- by disrupting cell membranes: Polymyxins (neosporin) - detergent vs cell

membrane; AE: neurotoxicity, acute renal tubular necrosis
vs. G+/g- by blocking folate > no nucleotide synthesis (megaloblastic anemia):
Sulfonamides (comp inhibit PABA for dihydropteroate synthetase > no
DHF synthesis; AE: infant kernicterus (avoid in pregnancy), SJ,
nephrotox, G6PD hemolysis)
Sulfamethoxazole-Trimethoprim (TMP-SMX) vs UTI, P. jirovecii
prophylaxis in AIDS
Sulfadiazine+Pyrimethamine vs Toxoplasma
Sulfadoxin+Pyrimethamine vs Malaria
Trimethoprim, Pyrimethamine (DHFXdihydrofolate reductase>THF like
Methotrexate)
vs. URIs (S. pneumo), UTIs, GITIs, and Pseudomonas by blocking topoII (DNA
gyrase) and IV: Fluoroquinolones (AE: cartilage/tendon rupture, incr QT, G6PD
hemolysis)
vs. Mycobacterum, prophylaxis for Hib and N.men by blocking DNAdRNAp = no
transcription: Rifampin
Protein synthesis inhibitors: Quinn get in Line and take 50MCs to 30ST:
Quinn, Line 50MCs = Quin-Dalfo, Linezolid, Macrolides,
Chloramphenicol/Clindamycin block 50S
Quin-Dalfo (streptogramins): Quinupristin prevents elongation,
Dalfopristin changes 50S conformation for better Quin-binding
Linezolid: binds 50S P-site and blocks 70S assembly
Tx: Quin-Dalfo and Linezolid is good for ALL RESISTANT
BACTERIA: VRE, MRSA
MACrolidEs (ACEmycin = Azithro, Clarithro, Erythromycin):
MacroLIDEs prevent sLIDing of mRNA = inhibit translocation
by binding to 23S of 50S
Tx: PUS - atypical Pneumonia, URIs, STDs
AE: PROLONG QT, acute cholestatic hepatitis, incr serum
concentration of warfarin
resistance via METHYLATION OF drug binding site on 50S
rRNA
Note: Azithromycin = AIDS MAC prophylaxis
Chloramphenicol: ChLorAMPS Peptidyltransferase - prevents
peptide bond formation; Tx: meningitis (H. flu, N. men, Strep.
pneumo); AE: aplastic anemia and gray baby; resistance via
ACETYLATION
Clindamycin: also blocks peptide bond formation at 50S; vs.
ANAEROBES (B. fragilis, C. perfringens) like Metronidazole;

AE: Pseudomembranous colitis like Ampicillin

30ST = Streptomycin (aminoglycosides), Tetracycline block 30S
"Amina didnt hear the GNATS because she was busy reading":
Aminoglycosides (GNATS = Genta, Neo, Amikacin, Tobra, and
Stretomycins) cause ototoxicity (and nephrotox) and act by binding
to 16S and causing mRNA misreading; vs. g- rods; REQUIRES O2
UPTAKE so ineffective against anaerobes; resistance via
modification of 30S (acetylation, etc)
Tetracyclines block TRNA from binding A-site and discolors
Teeth/bones
caTion-chelator, do NOT take with antacids, milk, or ironcontaining prep!
AE: photosensitivity (SAT for photo - sulfonamides,
amiodarone, TETRACYCLINE)
vs. VACUUM TH BedRoom - Vibrio, acne, Chlamydia,
ureaplasma, urealyticum, Mycoplasma pneumonia,
Tularemia, H. pylori, Borrelia, Rickettsia
resistance via decr uptake, incr export
NOTE: DEMECLOCYCLINE = DIURETIC = ADH
ANTAGONIST (Tx: SIADH)
Ampicillin and Amoxicillin are Anti-G+ Aminopenicillins that HELPS kill
Pseudomonas with Sulbactam/Clavulanic acid (beta lactamase inhibitor):

H = Haemophilus

E = E. coli

L = Listeria

P = Proteus

S = Salmonella

Note: Ampicillin = intrapartum injection, GBS prophylaxis

"TCP Takes Care of Pseudomonas":

Ticarcillin

Carbenicillin

Piperacillin

Cephalosporins:

1st generation (cefa): G+ + PEcK: Proteus, E.coli, Klebsiella

2nd generation (fur fox fotetan): G+ + HEN-PEcKS: Haemophilus,

Enterobacter, Neisseria, Proteus, E. coli, Klebsiella, Serratia

"Fur cap" - Cefuroxime for Community Acquired Pneumonia

"Linda Brought a Fragile Fox foTito" - Clindamycin, B. fragilis,

Cefuroxime, Cefotetan

3rd generation (trix tax taz): Meningitis, Gonorrhea, Typhoid fever

(Salmonella)

Ceftriaxone = #1

CefTAZidime is for Pseudomonas like TAZobactam+Piperacillin (but

causes neutropenia)

4th generation (Cefepime) = G+ + pseudomonas

Metronidazole: forms toxic metabolite that damages DNA; Tx: GET GAP on the
METRO

G = Giardia

E = Entamoeba histolytica (liver abscess)

T = Trichomonas

G = Gardnerella

A = Anaerobes (B. fragilis, C. difficile)

P = H. Pylori (+ bismuth + amoxicillin/tetracycline)

Anti-TB: INH-SPIRE: AE: hepatotoxic

INH = Isoniazid (inactivates mycolic acid synthesis enzymes enoyl-acyl carrier

protein reductase (InhA overexpression = resistance) and
betaketoacylACPsynthase (KasA); KatG gene encodes catalase peroxidase that
activates INH); solo-TB prophylaxis; AE: hepatotoxicity, neurotoxicity (prevented
by B6), drug-induced lupus (anti-histone Ab)

S = Streptomycin (aminoglycoside vs 30S mRNA reading)

P = Pyrazinamide - active in acidic pH, inhibits mycobacterial growth in M0; AE:

hyperuricemia/gout

(I = INH)

R = Rifampin - inhibits DNA-dRNAp = no transcription (rapid resistance) AND

blocks packaging and assembly of viruses; induces cyp450; prophylaxis for N.
men and Hib; AE: red secretions, stop therapy with purpura, bone marrow
suppression

E = Ethambutol - AE: optic neuropathy (red green colorblindness)

Antifungal:

Amphotericin B:

AmphoTEARicin TEARS holes in fungal membrane (binds ergosterol and

forms pores)

AmphoTERRible: AE: fever/chills, hypotension, nephrotox, arrhythmia,

anemia, IV phlebitis
Antiviral:

"ARM2 cure A FLU" = Amantadine Rimantidine block M2 protein (viral

uncoating) vs. Influenza A; AE: AtaxiA

Herpes = Cyclovirs (virally activated guanosine analogs) + Trifluridine

(thymidine analog)

CMV = Cids Gang loved seeing Foamy Scarlet = Cidofovir (Cytosine analog +
Probenicid to prevent excretion), Ganciclovir (intraocular implant), Fomivirsen
(intraocular injection, anti-sense RNA therapy), FOScarnet (unlike ganciclovir,
doesnt require thymidine kinase activation; pyroFOSphate analog that directly
inhibits DNApol)

HIV therapy:

Protease inhibitors = navirs (AE: GI intolerance, hyperglycemia,

lipodystrophy, cyp450 inhibitor)

NRTIs: Abe Did Embark on a L-AZy Start

Abacavir

Didanosine

Emtriciabine

Lamivudine

AZT (Zidovudine)

Stavudine

NNRTIs: Move to Delaware? Effin Never!

Delavirdine

Efavirenz

Nevirapine

FUsion inhibitor = enFUvirtide (gp41 binder)

Interferons: activates NK cells; AE: Neutropenia

IFNalpha - alpha B C > Tx: HBV, HCV

IFNbeta - PMS sounds like BMS > Tx: Multiple Sclerosis

NOTE**: alpha and beta IFNs decr viral replication and incr antiviral protein
synthesis that impairs viral mRNA translation

IFNgamma - G in gamma is for cGd > Tx: Chronic Granulomatous Disease

(NADPH oxidase deficiency)
NOTE**: IFNgamma incr MHCI and II expression, activates M0 > TNFalpha,
IL1, IL6

Immunology:

B-cells are always found in (white) Follicles closer to the outside of the LN or spleen
VS. T-cells are found in the deeper medulla(LN)/PALS(spleen)
Lymph drainage:

rectum above pectinate line = internal iliac

umbilicus to legs (inc, superficial genitals and anal canal below pectinate line) =
superficial inguinal

testes = para-aortic

MHC I and II: Rule of 8s

1*8 = MHCI x CD8 = 8

2*4 = MHCII x CD4 = 8

Natural Killer cells: detects MHCI

"Gotta KIL to survive" (KIR + KIL = survive)

KIR only = release perforins and granzymes > apoptosis

Antibody cleavage:

Papain cleaves Ab into 3 pieces: Pa Pa In (evenly splits into 3)

Protease cleaves Ab into 2 pieces: Prot Ease (evenly splits into 2; complement can
still bind hinge)

Cytokines: Hot T-Bone stEAk

IL1 (and IL6): hot = fever; secreted by M0

IL2: T = T-cell proliferation; secreted by Th1

IL3: Bone = Bone marrow stimulation (acts like GM-CSF); secreted by T cells

IL4: E = IgE (and IgG) class switching; secreted by Th2

IL5: A = IgA (and eosinophil) production; secreted by Th2

Neutrophil chemotaxis: CILK: C5a, IL8, LTB4, Kallikrein

IL8: 8 looks like multilobed nucleus of neutrophil = PMN chemotaxis

LTB4s B also looks like neutrophil multilobed nucleus

Immunosuppression Rx vs. IL2: (IL)2 Pro-Cyclists Secreted Tacks in Response to

Serious/Sirius Dax; prevent transplant rejection

vs. production: Cyclosporin (via inhibit calcineurin)

vs. secretion: Tacrolimus (via binding FK-protein)

vs. response to: Sirolimus (via MTOR)

vs. receptor: Daclizumab

**NOTE: MCC SCID = defective IL2 receptor > ADA deficiency; decr T > decr B
activation: all types of recurrent infections (viral/bacterial/fungal)

Rx vs TNF: Tx: Rheumatoid arthritis

vs. TNF: Infliximab

vs. TNF receptor: Adalimumab

fake TNF receptor: Etanercept

Complement:

C_a for anaphylaxis (histamine release > edema > hypotension, anaphylaxis)

C_b for binding bacteria (opsonizes and forms pores)

"low 3 causes 3": C3 deficiency causes HSRIII (immune complex deposit), seen
especially in glomerulonephritis; susceptible to S. pneumo and Hib > severe recurrent
pyogenic sinus and respiratory tract infections
**Remember SHiN: S(trep. pneumo) + Hi(b) = C3 deficiency; N(eisseria) = C5C9/MAC deficiency
Passive immunity: To Be Healed Rapidly - Tetanus Botulism HBV, Rabies/(RSV in
premies every winter month)
Immune deficiencies:

Brutons agammaglobulinemia = (x-r) Boys with BTK (tyrosine kinase) defect

> Blocked B-cell differentiation: recurrent Bacterial infection after 6 months
(when moms IgG disappears) b/c no Igs

Selective Ig(A) deficiency: milk Allergies, blood product Anaphylaxis, giardiA

infections; IgA is missing in mucus so recurrent sinus and lung infections
**Note: IgA deficiency also seen in Ataxia-Telangiectasia:defective DNA repair
enzymes, sensitive to ionizing radiation, cerebellar atrophy > ataxia, spider
angiomas (telangiectasias); assoc. w/ lymphomas and acute leukemias

Hyper-IgE/Jobs Syndrome: Im Hyper Excited for my FATEd Job

Hyper Excited = Hyper IgE

F = coarse Facies

A = cold, noninflamed Staph Abcesses

T = retained primary Teeth

E = Eczema

Job = Jobs

Chediak-Higashi (a-r): Grandpa Al couldnt eat Eastern food with his fingers.

Grandpa = Gram positive cocci infections: Staph and Strep

Al = partial albinism

couldnt eat = defective microtubules = defective phagocytosis and

lysosomal fusion

Eastern = Higashi (higashi means East in Japanese)

with his fingers = peripheral neuropathy

Pharmacology:
Kompetitive inhibitors incr Km, decrease affinity/potency (amount of drug needed for
effect); sigmoid effect curve shifts right; Lineweaver-Burke lines cross at Y-axis
(VS non-competitive inhibitors decr Vm, decrease efficacy (maximal effect of drug);
sigmoid effect curves vertical maximum effect is reduced; Lineweaver-Burke lines join
at X-axis)
Zero-order elimination: constant amount of drug eliminated per unit time = PEA Phenytoin, Ethanol, Aspirin
Urine pH and drug elimination: medicine gets trapped in opposite urine pH:

acid (phenobarb, MTX, TCA, aspirin) trapped in basic bicarbonate

**Note: Acetazolamide alkalinizes urine by getting rid of bicarbonate; Tx:
cysteine stones and altitude sickness (hyperventilation > respiratory alkalosis)

base (amphetamine) trapped in acidic ammonium chloride

Phase I vs Phase II metabolism: 1 red ox went 2 conjugate polar bears.

Phase 1: cyp450 red-ox (+ hydrolysis); geriatrics lose phase 1 first

Phase 2: conjugation (acetylation, glucuronidation, sulfation) > yields very

polar renally excreted inactive metabolites

Therapeutic index: TILED with TI= LD#/ED# and the #s adding up to 100; safer
drugs have higher TIs
G-protein-linked 2nd messenger:

Gs = adenylyl cyclase > ATP-to-cAMP > PKA > cascade

Gi = inhibit adenylyl cyclase > decr cAMP > decr PKA

Gq = phospholipase C > lipids-to-PIP2 > IP3 incr intracellular Ca2+, DAG

stim PKC > cascade

"Kiss and Kick til youre Sick of Sex"

"QISS QIQ SIQ SQS"

Gq = alpha 1: SM contraction, mydriasis; incr Systolic and Diastolic BP

Gi = alpha 2: decr SNS, decr insulin

Gs = beta 1: incr heart rate and contractility, incr renin, incr lipolysis

Gs = beta 2: decr Diastolic BP, vaso/bronchodilation, incr heart rate,

contractility, incr lipolysis, incr insulin release (think Beta2 stimulates Beta
islet cells of pancreas), decr uterine tone

Gq = M1: CNS, enteric nervous system

Gi = M2: decr HR, decr atrial contractility

Gq = M3: incr secretions, peristalsis, miosis, accommodation (ciliary muscle

contraction)

Gs = D1: renal perfusion (renal artery dilation)

Gi = D2: brain neurotransmitter

Gq = H1: pruritus/pain, incr nasal/bronchial mucus, contract bronchioles

Gs = H2: incr gastric acid secretion (inhibited by -idines)

Gq = V1: incr vascular SM contraction

Gs = V2: incr H2O reabsorption in kidneys CD (ADH action)

Signaling pathways:

cAMP (Gs, Gi): FLAT CHAMP + calcitonin + glucagon

F = FSH

L = LH

A = ACTH

T = TSH

C = CRH

H = hCG

A = ADH (V2)

M = MSH

P = PTH

calcitonin

glucagon (incr cAMP > activates PKA > incr F16BPase >
gluconeogenesis RLS)

IP3 (Gq): hIP3othalamic GGOAT

GHRH

GnRH

oxytocin

ADH (V1)

TRH

cGMP: vasodilators

ANP

NO (NO venodilates decreasing preload VS beta-blockers arteriodilate and reduce

afterload)

tyrosine kinase: the TyK Grows In Milk

GH

IGF-1

FGF

PDGF

Insulin

Prolactin

steroid receptor: cytoplasmic (except thyroid hormone = intranuclear)

(Adrenal cortex:) Aldosterone, Glucocorticoid, Testosterone, Estrogen

Progesterone

Vitamin D

T4/T3 (intranuclear receptor)

Glaucoma drugs: AABBCDF

AA = Alpha Agonist: vasoconstriction > decr aq humor synthesis (not for

closed angle glaucoma)

BB = Beta Blocker (Timolol): decr aq humor secretion

C = Cholinomimetic (Carbachol, Pilocarpine; Phys is for the Eyes

Physostigmine, Echothiophate): incr outflow (contract ciliary muscle and open
trabecular meshwork into canal of Schlemm)

D = Diuretic: Acetazolamide (carbonic anhydrase inhibitor), Mannitol: decr aq

humor secretion

F = PGF2alpha (Latanoprost): incr uveoscleral outflow; AE: dyes irises brown

Cholinomimetics:

Bethanechol: Give Beth-ann-a-call if you want your PNS stimulated: Tx: postop neurogenic ileus and urinary retention

Anticholinesterases = -stigmines + Edrophonium + Echothiophate

Organophosphate poisoning: DUMBBELSS: Tx: Atropine, Pralidoxime

Diarrhea

Urination

Miosis

Bradycardia

Bronchospasm

Excitation of skeletal muscle and CNS

Lacrimation

Salivation

Sweating

Atropine poisoning: what would happen if you got lost in the desert: Hot, Dry, Red,
Blind (cycloplegia), Mad (delirium), urinary retention(/constipation)
Hexamethonium: Put a Hex on reFLEX bradycardia - Hexamethonium prevents NE
reflex bradycardia by blocking all Nicotinic receptors (ganglion blocker inhibits Na/K
ligand-gated channels)
ACh receptors:

Nicotinic = Na/K ligand-gated channels (ANS and NMJ)

(Hexamethonium/Mecamylamine blocks these)

Muscarinic = G-coupled receptors; M1,2,3=QIQ (Atropine blocks these)

Specific antidontes:

DeFERoxamine Txs Fe (iron)

"Children Suck on Lead pencils": Succimer Txs Lead poisoning in children (Tx
is CaEDTA in adults)

DiMERcaprol Txs MERcury, arsenic, gold

"Copper Penny": Copper, arsenic, gold Tx w/ PENIcillamine

NITRoprusside turns into Cyanide which is Txd w/ NITRite, hydroxocobalamin,

and thiosulfate

METHylene blue and VitC Txs METHemoglobin

ETHANOL Txs mETHANOL poisoning

"Heparins H looks like a Proton": PROTamine Txs Heparin toxicity

Drug reactions:

TCAs 3 Cs: Cardiotoxicity, Convulsions, Coma

Cutaneous flushing: VANC = Vancomycin, Adenosine, Niacin, Ca2+ channel

blockers

Dilated cardiomyopathy = Doxorubicin and Daunorubicin

Torsades de Pointes: The Method to get 31Awesome QTs is to wear a Halo and
Risper that you bought a Macro-PIe from Quinn.

Method = Methadone

31Awesome = Class III, Class Ia antiarrhythmics

Halo = haloperidol

Risper = risperidone

Macro = macrolide

PI = HIV protease inhibitors

Quinn = Chloroquine/Mefloquine

Aplastic anemia: Chlora SAID Ptuey to Meth:

Chlora = Chloramphenical

SAID = NSAID

PTUey = PTU (antithyroid)

Meth = Methimazole (antithryoid)

Hemolysis in G6PD: Prima had to take Aspirin after INHaling her I.B.Professor
Dapsones Sulfurous Fava Bean Nitrofarts

Primaquine

Aspirin

INH

Ibuprofen

Dapsone

Sulfonamides

Fava bean

Nitrofurantoin

"Pseudomembranous colitis makes you want to ClAmp your ass": CLindamycin,

AMPicillin

Photosensitivity: SAT for a Photo:

S = Sulfonamides

A = Amiodarone

T = Tetracyclines

Stevens-Johnson rash: Seizures, Sulfas, and Cillins + Allopurinol

Seizure drugs: ethosuximide, lamotrigine, carbamazepine, phenobarbital,

phenytoin

Sulfa drugs

Penicillin

Allopurinol

SLE-like syndrome: SHIPP

Sulfonamides

Hydralazine (Hydras neck Loops (Lupus) around in circles)

INH

Phenytoin

Procainamide

Disulfiram-like reaction: Drunk Ceph said he was Pro-Car (okay to drive) at

Night, but to avoid a Gruesome accident, Chlora made him Suffer the Metro.

Ceph = Cephalosporin

Procar = Procarbazine

Night = Nitrofurantoin

Gruesome = Griseofulvin

Chlora = Chloramphenicol

Suffer = Sulfonylureas

Metro = Metronidazole

Ototoxicity/Nephrotoxicity: Mice use Platinum earring Loops to crawl into your

Ear and make you deaf

Mice = -mycins = aminoglycosides and vancomycin

Platinum = Cisplatin

Loops = Loop diuretics

p450 interactions:

p450 inducers: Queen Barbs riFamily induced Saint John to eat a Phenylooking Greasy Carb

Queen = Quinidine

Barbara = Barbiturate

riFamily = Rifampin

induced

Saint John = Saint Johns Wort

Pheny-looking = Phenytoin (AE: gingival hyperplasia)

Greasy = Griseofulvin

Carb = Carbamazepine
ima

See reference:

ge

p450 inhibitors: Without a Key, Kim was inhibited from PIES and Juice

Key = Ketoconazole

Kim = Cimetidine

inhibited

PI = HIV Protease Inhibitors

E = Erythromycin

S = Sulfonamides

Juice = grapefruit juice

ima

ge

See reference:

Toxicity bear: Cumulatively Toxic Drugs and their Rescues

Asparagine: neurotoxicity

Cisplatin: ototoxic/nephrotoxic; Tx: Amifostine

Vincristine/Vinblastine: Christ my nerves, Blast my bones - Vincristine

= peripheral neuropathy, Vinblastine = myelosuppression

Bleomycin: pulmonary fibrosis

Doxorubicin: cardiotoxic; Tx; Dexrozoxane (for cardiotoxicity),

Dimethyl-sulphoxide (for ROS ulcers)

Cyclophosphamide: Acrolein = nephro/bladder toxic (Tx: Mesna); also

SIADH effects (Tx: Demeclocycline)

Methotrexate: nephrotoxic (Tx: Leucovorin), myelosuppression (Tx;

Filgrastim)
ima

ge

See reference:

Cardiovascular:
Contractility decreases with: ABBCCC:

A = Acidosis

BB = Beta blocker

CCC = hyperCO2, CHF, non-DHP Ca2+ channel blockers

Heart murmurs:

"MR. ASS and MS. ARD" =

MR = mitral regurg

AS = aortic stenosis

S = systolic murmurs

and

MS = mitral stenosis

AR = aortic regurg

D = diastolic murmurs

holosystolic = all regurgs + VSD

murmurs that increase with breathing:

rIght murmurs increase with Inspiration

lEft murmurs increase with Expiration

"Wolf = Lone Canis" - Wolff-Parkinson-White is treated with amiodaRONE and

ProCAINamide
AV blocks:
"First, a girl stays out til 12 even though her curfew is 10."
"Then, the teenager stays out later and later, til her mom throws a fit."
"Afterwards, despite the teenager being good, the mom throws random fits probably
because of menopause."
"Finally, the young woman is old enough to whatever she wants separately from her
parents."

1st degree: increased PR

2nd degree:

Type 1 Wenckebach: incr PR until QRS drop

Type 2: random QRS drop

3rd degree: PR and QRS = independent rates; seen in Lyme disease

DiGeorge Tets: TETralogy of Fallow + TETany from hypocalcemia (lack of

parathyroids) (also, truncus arteriosus)
"PGA open": PGE kEEps PDA open (PGE1 analogs: Alprostadil, Misoprostol); close
with Indomethacin
Evolution of MI: 4 and death are both pronounced shi in Japanese

Initially: nothing

4 hours-4days later: PMNs, coagulative necrosis, risk of arrhythmia (esp. V-fib)

4-10 days later: M0s thinned walls > increased risk of rupture and tamponade

>10 days: risk for ventricular aneurysm (bulging scar because fibrosis made it
lose its ability to contract) <ventricular remodeling can be prevented with ACEIs

Bacterial endocarditis: FROM JANE:

Fever

Roth spots: round retinal white spots surrounded by hemorrhage

Oslers nodes: tender raised red lesions on fingers and toe pads

Murmur (new)

Janeway lesions: non-tender small red lesions on palms and soles

Anemia

Nail-bed (splinter) hemorrhage

Emboli

IVDA = right-sided bacterial endocarditis: dont TRI drugs (tricuspid valve)

SLE causes LSE (Libman Sacks endocarditis with warty sterile vegetations on both sides
of valve, assoc. w/ mitral regurg)
Rheumatic heart disease of S. pyogenes (beta-hemolytic, bacitracin-sensitive Strep):
AAAAAA

group A Strep

autoimmune (Ab to antiphagocytic M protein > MVP > Mitral Stenosis),

fever

Aschoff bodies (granulomas with giant cells) = subcutaneous nodules

Anitschkow cells (activated histiocytes)

elevated ASO titers and ESR

migratorypolyArthritis

+ Erythema martginatum, Syndenhams/St. Vitus chorea (of face, tongue, and upper
limb)
"ACE-inhibitors are ACEs at controlling HTN":

essential hypertension

HTN+CHF (decreases both preload and afterload)

HTN+DM (protective against Diabetic nephropathy)

Antihypertensive therapy: ABCD:

ACE-I/ARBs

Beta blockers

Calcium channel blockers

Diuretics (LOOps LOOse Calcium, Thiazides retain calcium)

"Aden Diaz is Mine OK?": Adenoxine, Diazoxide and Minoxidil Open K+ channels
Antiarrhythmics: No Bad Boy Keeps Clean

Type I: Na+ blocker (incr QT)

Type II: Beta blocker (incr PR); Tx OD w/ Glucagon

Type III: K+ blocker (incr QT)

Type IV: Ca2+ blocker (incr PR); Tx coronary and cerebral vasospasms

Type I antiarrhythmics:

Ia: The Queen Werewolf Disappeared

Quinidine, Procainamide, Disopyramide (incr AP)

Ib: To Funny Little Mexico

Tocainide, Phenytoin, Lidocaine, Mexiletine (decr AP)

Ic: Properly Fleeing Endangerment

Propafenone, Flecainide, Encainide

Type III: Amiodarone: check PFTs, LFTs, and TFTs

pulmonary fibrosis

hepatotoxicity

hypo/hyperthyroidism (amiodarone = mostly iodine, resembles thyroid hormone)

+ photodermatitis (SAT for a photo)

Endocrine:
Adrenal cortex: GFR: The deeper you go, the sweeter it gets.

"salt": zona Glomerulosa: aldosterone

"sugar": zona Fasciculata: cortisol

"sex": zona Reticularis: androgens

Adenohypophysis = Anterior pituitary (RAthkes pouch of ectoderm): FLAT PEG

FSH

LH

ACTH

TSH

Prolactin

endorphins (share POMC origin with ACTH and MSH)

GH

Basophilic = B-FLAT: Basophilic-FSH, LH, ACTH, TSH (VS Acidophils-Prolactin,

GH)
Neurohypophysis = Posterior pituitary (Neural tube of ectoderm): secretes hypothalamic
substances: A Pair of Ox were Supra Dehydrated

Paraventricular nucleus - Oxytocin

Supraoptic nucleus - Vasopressin (ADH)

Adrenal steroids: In an enzyme deficiency, if the first digit is a 1, then the patient will be
hypertensive. If the second digit is a 1, then the patient will look male.

17alpha hydroxylase deficiency: HTN, feminine

21 hydroxylase deficiency (MC): hypotension, masculine

11 beta hydroxylase deficiency: HTN, masculine

PTH = phosphate trashing hormone (note: decreased free serum Mg2+, decreases PTH
secretion; common causes of decr Mg2+ = alcohol, aminoglycosides, diarrhea, diuretics)
Calcitonin = from parafollicular C cells of thyroid = neural Crest derivative, secreted in
medullary thyroid Cancer (MENII)
(Signaling pathway mnemonics were covered earlier)
Thyroid hormone functions: T3 = 5Bs

Brain (CNS) maturation (defect = mental retardation seen in Cretinism)

Bone growth (synergism with GH; defect = Cretinism)

Beta1 adrenergic effects (Thyroid Storm: incr HR, contractility > arrhythmia;
Tx with propanolol or PTU (OK in pregnant))

incr BMR

incr Blood sugar: glycogenolysis, gluconeogenesis, lipolysis

Pheochromocytoma (PCC): Rule of 10s

10% malignant

10% bilateral

10% extra-adrenal

10% calcify

10% kids

10% familial

Neuroblastoma (MCC adrenal medulla tumor in children) = N-myc oncogene, stain =

Neurofilaments, tumor marker = Bombesin

see Homer-Wright pseudorosettes and incr HVA (Dopamine derivative) in urine

scenario: ~2yo with retroperitoneal ab mass presents with HTN hypotonia,

myoclonus, and non-rhythmic conjugate eye movements (opsoclonus-myoclonus)

mass may invade into an intervertebral epidural space and look like a dumbbell

HypOthyroidism = cOld intolerance; HypErthyroidism = hEat intolerance

"CHIMPANZEES" cause Hypercalcemia:

Calcium ingestion (incr antacids > milk-alkali syndrome)

Hyperparathyroid/Hyperthyroid

Iatrogenic: Thiazides

Multiple myeloma

Pagets disease (when patients are immobilized, normally normocalcemic)

Addisons disease

Neoplasms (e.g., breast cancer = osteolytic)

Zollinger-Ellison syndrome (pancreatic tumor > incr gastrin; associated with

MENI (parathyroid tumor)

Excess vitamin D

Excess vitamin A (incr bone resorption > incr Ca2+)

Sarcoidosis (or granulomatous disease)

Hyperparathyroidism:

Primary: Osteitis fibrosa cystica = stones, bones, and groans = kidney stones,
brown bone tumors, weakness and constipation; incr cAMP in urine

VS Secondary: Renal osteodystrophy = renal disease > decr Vit D > decr
Ca2+ > incr PTH > bone lesions

Hypocalcemia signs:

C = Chvostek sign = Cheek tapping > facial muscle Contraction

T = Trosseaus sign = Tight BP cuff > hand Tetany (spasm)

Dexamethasone vs Demeclocycline vs Desmopressin:

Dexamethasone = steroid to Dx ACTH disease/syndrome

DemecloCYCLine = tetracycline ADH antagonist vs CYCLophosphamideinduced SIADH; Tx: SIADH

DesmoPRESSIN = vasoPRESSIN (ADH) analog; Tx: central Diabetes insipidus

(Note: nephrogenic DI is treated by hydrochlorothiazide (Ca2+ sparing diuretic),
indomethacin (decr renal blood flow), or amiloride (K+ sparing aldosterone
receptor antagonist diuretic that closes Na+ channels that also reabsorbs Li to Tx
Li-induced DI)

Multiple endocrine neoplasias (MEN): (A-D)

MENI (Wermers): 3Ps

pancreatic - ~Zollinger-Ellison gastrinoma - peptic ulcers

parathyroid - incr PTH - hypercalcemia

pituitary - ~prolactin or GH - amenorrhea, lactation

MENIIa (Sipples): 2Ps

parathyroid - incr PTH - hypercalcemia

PCC - incr catecholamines (Epi/Nor), urine VMA and Metanephrine

medullary thyroid (parafollicular C) - polygonal, incr calcitonin hypocalcemia

MENIIb: 1P

PCC - incr catecholamines, urine VMA/metanephrine

medullary thyroid (parafollicular C) - incr calcitonin - hypocalcemia

Marfans habitus + oral/intestinal mucosal neuromas

Note: MENIIs are associated with ret oncogene

Also, the II in MENII stands for the 2Cs in PCC

Diabetic drugs:

"Metformin Glitters in Sunny Gliptin Tides"

Metformin = incr glucose uptake in muscle and fat via GLUT4 (aka incr
insulin sensitivity in peripheral tissue) and decr liver glucose production via incr
AMPK and decr PEPCK (OAAtoPEP) and decr G6Pase (G6PtoGlucose)
production

-Glitazones = incr insulin sensitivity via PPARgamma/adiponectin

Sulfonamides = incr pancreatic insulin production via blocking ATP-dep. K+

efflux

-Gliptins, -Tides = incr insulin, decr glucagon, decr gastric motility (incr
satiety)

+ Acarbose/Miglitol = decr starch hydrolysis and glucose GI uptake

Diabetes drugs mechanisms of action:

"PPARazzi camera flashes GLITA" - PPARgamma -Glitazones

"GULP TIDES" - GLP1 -Tides

"Dr.PPer and Lipton" - DPP4 inhibitor -Gliptins

Acarbose - Alpha glucosidase

Remember:

insulin > decreases cAMP > decreases PKA > dephosphorylated FBPase2
= PFK2 > F6P to F26BP > F26BP stimulates PFK1 > incr F6P to F16BP

(glycolysis)

glucose > decreases cAMP > decreases CAP-cAMP binding of lac operon =
RNA polymerase cant bind to promoter

Gastrointestinal:
Retroperitoneal structures: I ASK DR. PC

Primary retroperitoneal (never pushed into sac):

IVC

Ab aorta

Suprarenal glands

Kidneys/Ureters

Secondary retroperitoneal (pushed into sac, but escaped):

Duodenum (2, 3, 4)

Rectum

Pancreas (head, body)

Colon (ascending, descending)

OR SAD PUCKER = suprarenal, abdominal aorta, duodenum, pancreas, ureter, colon,

kidney, esophagus, rectum
Digestive tract histology: Brunch DIP:

Brunners (submucosal, alkaline mucus secreting) glands = Duodenum

Ileum = Peyers Patches (M cells take up antigen; also location of IgA-secreting

plasma cells)
Note: Shigella is taken up by the M-cells of Peyers Patches; viruses like
Adenovirus may invade Peyers Patches and cause intussusception; Sabin (live
Polio vaccine) increases IgA immunity

Enteric nerve plexuses: AUerbach is on the AUtside, MeiSSners is SSubmucosal

Auerbachs = Myenteric = coordinates Motility by being wedged between the

inner/circular and outer/longitudinal muscles

Meissners = Submucosal = regulates Secretions, blood flow, and absorption

between mucosa and inner/circular muscles

Defect in Auerbachs causes Achalasia

Lack of both Auerbach and Meissners due to failure of neural crest cell migration causes
Hirschsprungs Congenital Megacolon, assoc. with Down Syndrome (see failure to pass
meconium, like in Cystic Fibrosis)
Portosystemic anastomoses:
The mnemonic is from Systemic (IVC) to Portal (Celiac, SMV, IMV) veins:
MI Superior's an Ass. He makes me feel Inferior about my Superficial appearance by

poking near my Belly-button so I Eat Less.

Rectal anastomoses: (X=hemorrhoids)

MI Superior is an Ass:
Systemic: Middle and Inferior Rectal
to
Portal: Superior Rectal

Umbilical anastomoses: (X=caput medusae)

Inferior about my Superficial appearance by poking near my Belly-button:
Systemic: Inferior, Superficial Epigastric
to
Portal: Paraumbilical

Esophageal anastomoses: (X=esophageal varices)

Eat Less: (X = esophageal varices)
Systemic: Esophageal (azygos)
to
Portal: Left Gastric

Liver anatomy: 1ABC

"1ABC":

Zone 1 = Apical surface of hepatocytes face Bile Canaliculi = periportal

zone

Also, when you think of ABC, you should think of Hepatitis A, B, C

Zone 1 = first affected by viral hepatitis because closest to hepatic artery

(Remember: Portal triad = bile duct, hepatic artery, and portal vein)

"The 3rd letter in the alphabet = C":

Zone 3 = Centrilobular (periCentral vein) = where blood drains into the

hepatic vein

because its so far from the hepatic artery, its the first place to suffer from
ischemia

also, since blood pools in veins, you can think of drugs/poisons pooling
there, too

Bottom line: Zone 1 = susceptible to viruses, Zone 3 = susceptible to

drugs/ischemia

Femoral region: NAVEL with the Venous near the Penis

Lateral to medial: Nerve, Artery, Vein, Empty space, (deep inguinal)

Lymphatics/Lacunar ligament
Note: femoral sheath does not contain femoral nerve

Inguinal canal: INternal (deep) inguinal ring = INdirect hernia that may go INto the
scrotum = lateral to inferior epigastric vessels
VS. an alien Directly bursting from your stomach = direct hernia = protrudes from

abdominal wall medial to inferior epigastric vessels:

h
t

s
i

s w
i

s
r

e t
h

a h

n
r

a t
i
h

g h

or MDs dont LIe: Medial = Direct, Lateral = Indirect

"Fem-Fem": femoral hernias occur more often in females (and is the leading cause of
bowel incarceration)
GI secretory products:

"IF you PARTY too hard, youll vomit out a lot of GASTRIC ACID.":
Parietal cells secrete IF (intrinsic factor) and HCl (gastric acid)

"Pep-pep to the Chief":

Chief cells make Pepsin

Vitamin/Mineral absorption:

Duodenum: FED = Fe (iron) in Duodenum

Jejunum: The Jester is a Fat Fool = Jejunum absorbs most Fats and Folate

Ileum: The ileum is the last part of the small intestine; its where you say Bye
Bye to the SI: Byle acid, B12/IF is reabsorbed in the Ileum

Bilirubin:

Rules of thumb:

The two-named diseases dont go together

The one named diseases are milder

INdirect = UNconjugated = water INsoluble: Crigler-Najjar, Gilbert =

"KING KONG" > "CING CUNG" > Criggler-Indirect/Unconjugated-NajjarGilbert
You get Crigler-Najjar/Gilberts when youre unable to conjugate bilirubin into a

water-soluble/excretable form ~ Glucuronyl transferase deficiency

Direct = conjugated = Water soluble: Dubin-Johnson, Rotor's =

Dubin-Johnson called Rotor-rooter to fix his WaterPipes.
You get direct bilirubinemia when theres a problem with bile Pipes/excretion
(E.G., biliary tree obstruction)
Note: Dubin-Johnson is worse than Rotors in that the liver is pigmented black

Achalasia: AABBCC

Achalasia

loss of Auerbach's myenteric plexus

Birds beak on Barium swallow

associated with Chagas and CREST

Boerhaave syndrome = Been-Heaving; transmural complication of Mallory-Weiss

BARRetts esophagus = Becomes Adenocarcinoma, Results from Reflux
Esophageal cancer risk factors: ABCDEFGH

Alcohol, Achalasia

Barretts esophagus

Cigarettes

Diverticuli (e.g., Zenkers)

Esophageal web (e.g., Plummer-Vinson), Esophagitis

Familial

GERD

Hot dogs (nitrosamines)

Esophageal cancer epidemiology and locations:

Squamous cell = Spread out worldwide (most prevalent worldwide); upper 2/3s
(where striated muscle can be found)

Adenocarcinoma = most prevalent in America (lower 1/3, location of pure smooth

muscle)

Gastritis:

Acute gastritis (erosive):

"Burned by Curling iron": Curlings ulcer = stress ulcer from burns:

decr plasma volume > sloughing of gastric mucosa

"Cushion the brain": Cushings ulcer = stress ulcer from head injury:
incr ICP > incr vagal stimulation > incr ACh > incr H+)

Chronic gastritis (non-erosive): AB-pairing

Type A (fundus/Body) = Autoimmune/Anemia:

AutoAb to parietal cells, pernicious anemia (Ab to IF), achlorhydria

Type B (Antrum) = Bacterial:

H.pylori infection (duodenal > stomach ulcer), increased risk of MALT
lymphoma

Peptic ulcer disease:

Gastric ulcer pain = Greater with food

Duodenal ulcer pain = Decreases with food (will see hypertrophy of Brunners
glands and clean punched out margins unlike carcinoma raised/irregular
margins)

Inflammatory bowel disease (IBD): Crohns vs Ulcerative Colitis

Crohns: A Creepy Fat old Crone (Granny) went Skipping on Cobblestones

while pumping her Arthritic Fist in the air.

Creepy Fat = Creeping fat

Crone = Crohns disease

(Granny) non-caseating Granulomas

Skipping = transmural Skip lesions

Cobblestone = Cobblestone mucosa

Arthritic = Migratory polyarthritis

Fist = Fistulas

"Gum to Bum" lesions and extraintestinal manifestations (systemic) like

erythema nodosum (~shins), ankylosing spondylitis, and uveitis

Note: this is disordered response to intestinal bacteria

Ulcerative colitis: If you have a Lead Pipe jammed up your Rectum, youll get
Bloody Diarrhea.

Lead Pipe = loss of haustra leads to lead pipe appearance on imaging

Rectum = UC always involves the rectal mucosa/submucosa and procedes

continuously up unlike Crohns which tends to spare the rectum

Bloody diarrhea (another trait not shared with Crohns)

Note: this is autoimmune

UC is also associated with friable pseudopolyps, pyoderma gangrenosum,

and primary sclerosing cholangitis

Meckels diverticulum: Rule of 2s

2 inches long

2 feet from ileocecal valve

2% of population

2yo (or younger)

2 types of ectopic epithelia: gastric or pancreatic

Colonic polyps: VILLous = VILLainOUS because villous polyps are more likely to be
malignant (villous > tubulovillous > tubulous)
Colorectal cancer (CRC):

Familial adenomatous polyposis (FAP): polyposis = thousands of polyps;

FAPCancer involves APC gene; always involves rectum
VS. HNPCC/Lynch which doesnt have many polyps and involves the
PROXIMAL colon

Gardners syndrome = Gardeners Grow all kinds of things: Gardners = FAP +

osteomas + lipomas/soft tissue tumors + retinal hyperplasia

Turcots syndrome: TURcot = TURban; FAP + malignant CNS tumor

(medulloblastoma)

Presentation of CRC: Think of the colon as a funnel that shrinks towards the anus (and
also that visceral nerves dont have as many localized pain receptors as the anus):

distal colon (left side, near anus) = obstruction, sharp colicky pain, hematochezia

proximal colon (right side) = iron deficiency anemia, dull pain, fatigue

CRC: Apple core lesion on barium enema x-ray, CEA tumor marker
Molecular pathogenesis of CRC: alphabetical order
lose APC (decreased intercellular Adhesion) then mutate kRAS (unregulated signal
transduction MAPK) then lose p53 (no apoptosis)
Wilsons disease (hepatolenticular degeneration): a-r inadequate copper excretion, treated
with penicillamine (copper penny): ABCDEF

Asterixis, Ataxia, Anemia (hemolytic)

Basal ganglia degeneration (Parkinsonism)

decr Ceruloplasmin, Cirrhosis, Corneal deposits, Cancer (HCC)

Dementia

Encephalopathy

Fanconis Syndrome: defective PCT reabsorption

Gallstones (cholelithiasis): Risk factors = 4Fs:

Fat

Fertile

Female

Forty

Acute pancreatitis causes: GET SMASHED > DIC, ARDS

Gallstones

Ethanol

Trauma

Steroids

Mumps

Autoimmune disease

Scorpion Sting

Hypercalcemia, Hyperlipidemia

ERCP

Drugs (E.G., Sulfa drugs)

Antacid adverse effects:

Al = AluMINIMUM amount of feces: constipation

Mg = Must Go to the bathroom: diarrhea