Medical Mnemonics for Examinations

Dow Jones Industrial Average Closing Stock Report

From proximal to distal: Duodenum Jejunum Ileum Appendix Colon Sigmoid Rectum

Dow Jones Industrial Climbing Average Closing Stock Report

From proximal to distal: Duodenum Jejunum Ileum Cecum Appendix Colon Sigmoid Rectum

Causes of Acute Pancreatitis

"GET SMASHED" Gall stones Ethanol Trauma Steroids Mumps Autoimmune disease Scorpion venom Hyperlipidemia ERCP (dye) Drugs (Azathioprine, Asparginase, Mercaptopurines, Pentamidine)

Alcohol and Gallstones are most common causes.

A-P-G-A-R

Score 0-2 at 1 and 5 minutes in each of 5 categories: A - Appearance (Color: blue/pale, trunk pink, all pink) P - Pulse (Heart rate: 0, <100, 100+) G - Grimace (Reflex irritability: 0, grimace, grimace+cough) A - Activity (Muscle tone: limp, some, active) R - Respiration (Respiratory effort: 0, irregular, regular)

10 is perfect score

Multiple Endocrine Neoplasia (MEN)

Each of the MENs is a disease of three or two letters plus a feature, and all are Autosomal Dominant inheritance.

• MEN I is a disease of 3 P's (pituitary, parathyroid, and pancreas) plus adrenal cortex
• MEN II is a disease of 2 C's(carcinoma of thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIB (aka MEN III)
• Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate
• Acute pneumonia caused by Miscellaneous microbes--Mononuclear infiltrate
• Takayasu's disease = pulseless disease, therefore when you have Takayasu's, I can't Tak'a yu pulse.

CAGE - alcohol use screening

• Have you ever felt it necessary to CUT DOWN on your drinking?
• Have you ever been ANNOYED when people suggest you cut down on your drinking?
• Have you ever felt GUILTY about your drinking?
• Have you ever felt the need to have a drink in the morning for an EYE OPENER?

O-P-Q-R-S-T - eliciting and HPI and exploring symptoms

O - Onset of pain (what was the patient doing when the pain started?) P - Palliative or Provocative factors for the pain Q - Quality of pain (burning, stabbing, aching, etc.) R - Radiation (up to jaw, down left arm, etc.) S - Severity of pain (usually 1 - 10 scale) T - Timing of pain (eg: after meals, in the morning, how long it lasts, etc.)

S-O-C-R-A-T-E-S - exploring the presenting complaint==

S - Site of pain O - Onset of pain C - Character of pain (dull, sharp, aching, stabbing, tearing etc.) R - Radiation of pain (eg. central abdominal pain radiating to Right Iliac Fossa) A - Associated factors (eg. nausea/vomiting) T - Timing of pain/duration E - Exacerbating/alleviating factors S - Severity of pain (usually 1 - 10 scale)

A-S-C-L-A-S-T - eliciting and HPI and exploring symptoms==

A - Aggravatiing and Alleviating factors S - Severity C - Character, quality L - Location A - Associated symptoms S - Setting T - Timing

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

The five W's--post-operative fever

Wind - pneumonia, atelectasis Wound - wound infections Water - urinary tract infection Walking - walking can help reduce deep vein thromboses and pulmonary embolus Wonderdrugs - especially anesthesia

Predisposing Conditions for Pulmonary Embolism: TOM SCH PREFER

T - Trauma O - Obesity M - Malignancy S - Surgery C - Cardiac disease H - Hospitalization P - Past history R - Rest (bed-bound) E - Estrogen, pregnancy, post-partum F - Fracture E - Elderly R - Road trip

6 P 's

ARTERIAL OCCLUSION (Signs of Compartment Syndrome)

• Pain
• Paleness (Pallor)
• Perishing with Cold (Poikilothermia)
• Pulselessness
• Paresthesias
• Paralysis

DAVE WILMINGTON

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

• Diet
• Activity
• Vital signs (how often)
• Excrement (test urine / stool)
• Weight (how often to monitor)
• I / O (monitor input / output)
• Labs (what, how often)
• Meds (which, route, interval)
• I V fluids (what and at what rate)
• Nursing care (e.g. position, wound care, up in chair, ostomy care etc)
• General care (e.g. Physical Therapy, Respiratory Thearpy etc)
• Tests (X-ray, EKG, EEG etc)
• Observe for reaction, seizure, neuro exams
• Notify parameters (e.g. Temp > 100 / respiration changes)

More standard is ADC VAAN DIML (pronounced ADC van dim(e)l)

Admit (23 hours, full admit, service of attending,...) Diagnosis Condition ("Stable", "Guarded", etc.) Vitals (post-op, routine, q 1 hour, etc.) Allergies Activities (Strict bed rest, fall precautions, ad lib, bathroom privileges, etc.) Nursing (Strict I&O's, Daily weights, Call P.R.N. whatever, etc.) Diet (NPO, Regular, Clears - advance diet as tolerated, 2000 cal ADA, renal, etc.) IV fluids (D5 1/2 NS c 20 KCL at 110 ml/hr, LR @ 100 ml/hr, etc.) Meds (scheduled and PRN's) Labs and x-ray (CBC in AM, PCXR in PACU, etc.)

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

VITAMIN C

Causes of Diseases

• Vascular
• Infectious
• Trauma
• Auto-immune
• Metabolic
• Idiopathic/Iatrogenic
• Neoplastic
• Congenital

M U D P I L E S

Causes of Metabolic Acidosis

• Methanol poisoning
• Uremia
• Diabetic Keto-acidosis
• Para-aldehyde ingestion
• Ischemia
• Lactic Acidosis
• Ethanol poisoning
• Salicylate ingestion

Causes of HyperCalcemia

PAM SCHMIDT OR MISHAP Paget's Disease Malignancy Amyloid Intoxication (hypervitaminosis) Multiple Myeloma Sarcoidosis Sarcoid Hyperparathyroidism Cancer Alkalai ( Milk ) syndrome Hormomal (para-thyroid) Paget's Disease bone Milk-alkali Syndrome Immobilization D-vitamin overdose Thyrotoxicosis

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

5 SIGNS OF INFLAMMATION (as described by Celsus)=

• Redness/Erythema (Rubor)
• Raised temperature (Calor)
• Swelling (Tumor)
• Pain (Dolor)
• Loss of Function (Functio Laesa)

ACID

(Gell & Goombs" classification for HYPERSENSITIVITY REACTIONS): Anna Cycled Immediately Downhill Type I Anaphylaxis Type II Cytotoxic-mediated Type III Immune-complex Type IV Delayed hypersensitivity

Never Let Monkeys Eat Bananas

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

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

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

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

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

Sunday Hot Day, Better Give Iced Fluids Today!

Treatment of Malignant Hyperthermia S: Stop all triggering agents, give 100% O2 H: Hyperventillate D: Dantrolene 2.5 mg/kg B: Bicarbonate G: Glucose and Insulin I: IV Fluids, Cooling Blanket F: Fluid Output; Furosemide T: Tachycardia, be prepared to treat V Tach

DISK MASS

Reasons of Back Pain D == Degeneration: DJD, Osteoporosis, spondylosis I == Infection: UTI, PID, Potts, osteomyelitis, prostatitis, Injury/fracture, compression fracture. S == Spondylitis, ankylosing Spondyloarthropathies (rheumatoid arthritis, Reiters, SLE) K == Kidney stones/infarction/infection (pyelo/abscess)

M == Multiple myeloma, Metastasis from breast, prostate, lung, thyroid, kidney CA A == Aneurysm, Abdominal pain referred to the back (see acute abdominal pain) S == Slipped disk, Spondylolisthesis S == Strain, Scoliosis/lordosis, Skin: herpes zoster.

Regarding what to do in case of syncope

If the face is red, raise the head. If the face is pale, raise the tail!

BRACHIAL PLEXUS

Roots, Trunks, Divisions, Cords, Branches:

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

CRANIAL NERVES

I - olfactory II - optic III - oculomotor IV - trochlear V - trigeminal VI - abducens VII - facial VIII - acoustic (vestibulocochlear) IX - glossophrayngeal X - vagus XI - accessory XII - hypoglossal

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

LR6 SO4 3

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

BRANCHES OF FACIAL NERVE

Temporal, Zygomatic, Buccal, Mandibular, Cervical

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

INNERVATION OF PENIS

• Parasympathetic causes erection. Sympathetic causes ejaculation. "Point and Shoot."
• "S2, 3, 4 keep the penis off the floor"
• Innervation of the penis by branches of the pudendal nerve, derived from spinal cord levels S2-4

ABC'S

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

N(AVEL)

Order of things in the Femoral Triangle

• Nerve
• Artery
• Vein
• Empty space
• Lymphatics

NOTE: Parenthesis includes things contained in the femoral sheath.

Hurler syndrome features HURLER'S

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

CHILD HAS PROBLEM!

Down syndrome features

• Congenital heart disease/ Cataracts
• Hypotonia/ Hypothyroidism
• Incure 5th finger/ Increased gap between 1st and 2nd toe
• Leukemia risk x2/ Lung problem
• Duodenal atresia/ Delayed development

• Hirshsprung's disease/ Hearing loss
• Alzheimer's disease/ Alantoaxial instability
• Squint/ Short neck

• Protruding tongue/ Palm crease
• Round face/ Rolling eye (nystagmus)
• Occiput flat/ Oblique eye fissure
• Brushfield spot/ Brachycephaly
• Low nasal bridge/ Language problem
• Epicanthic fold/ Ear folded
• Mental retardation/ Myoclonus

Drink at 21

Down Syndrome - Chromosome 21

Puberty at 13

Patau's Syndrome - Chromosome 13

Election voter at 18

Edward's Syndrome - Chromosome 18

Down syndrome pathology DOWN

Decreased alpha-fetoprotein and unconjugated estriol (maternal) One extra chromosome twenty-one Women of advanced age Non-disjunction during maternal meiosis

CUT the PY (cut the pie)

Pyrimidines nucleotides

• Cytosine
• Uracil
• Thiamine the
• PYrimidines

CATCH 22

DiGeorge/ Velocardiofacial syndrome

• Cardiac abnormalities
• Abnormal facies
• Thymic aplasia
• Cleft palate
• Hypocalcemia
• 22q11 deletion

MARFAN

1. Mitral valve prolapse
2. Aortic Aneurysm
3. Retinal detachment
4. Fibrillin
5. Arachnodactyly
6. Negative Nitroprusside test (differentiates from homocystinuria)

Go Sally Go! Make Children!

Cell cycle stages

• G1 phase (Growth phase 1)
• S phase (DNA Synthesis)
• G2 phase (Growth phase 2)
• M phase (Mitosis)
• C phase (Cytokinesis)

APKD

ADult Polycystic Kidney Disease is Autosomal Dominant Also, "Polycystic kidney" has 16 letters and is due to a defect on chromosome 16.

Essential Amino Acids

PriVaTe TIM HALL

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

Urea Cycle

Ordinarily, Careless Crappers, Are Also Frivolous About Urination.

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

People Meet And Talk

Cell division

• Prophase
• Metaphase
• Anaphase
• Telophase

5P 's for acute intermittent porphyria

• Pain in abdomen
• Polyneuropathy
• Psychologial abnormalities
• Pink urine
• Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)

ABCD for BUN & creatinine elevation

• Azotremia (pre-renal)
• Bleeding (GI)
• Catabolic status
• Diet (high protein parenteral nutrition)

G6PD: oxidant drugs inducing hemolytic anemia AAA

Antibiotic (eg: sufamethoxazole) Antimalarial (eg: primaquine) Antipyretics (eg: acetanilid, but not aspirin or acetaminophen) Vitamin B3 (niacin, nicotinic acid) deficiency: pellagra

The 3D 's of pellagra

Pellegra: Vitamin B3 (niacin, nicotinic acid) deficiency

1. Dermatitis
2. Diarrhea
3. Dementia

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

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

Metabolic acidosis (normal anion-gap) causes

1. With hyperkalemia: RAISE K+:

RTA type 4 Aldosterone or mineralocorticord deficiency Iatrogenic: NH4Cl, HCl "Stenosis": obstructive uropathy Early uremia

1. With hypokalemia: ReDUCE K+:

Renal TA type 1 and 2

Diarrhoea

Urine diversion into gut

Carbonate anhydrase inhibitor

Ex-hyperventilation

Galactosaemia: enzyme deficiency

GALIPUT: Galactose 1 Phosphate Uridyl Transferase. • There is an assay called the Galiput test for this.

==Folate deficiency: causes A FOLIC DROP==* Alcoholism

• Folic acid antagonists
• Oral contraceptives
• Low dietary intake
• Infection with Giardia
• Celiac sprue
• Dilatin
• Relative folate deficiency
• Old
• Pregnant

The FAT cat is in the ADEK (attic)

Vitamins: which are fat soluble Fat soluble vitamins are A,D,E,K.

Hemoglobin binding curve: causes of shift to right

"CADET, face right!"

• C = Increase in carbon dioxide
• A = Acidosis (low ph)
• D = Increase in 2,3 DPG aka 2,3 BPG
• E = Exercise
• T = increase in temperature

G proteins for respective receptors

"QISS & QIQ" (Kiss and Kick):

G-proteins and their respective receptors (alphabetical order)

Q: alpha 1 I: alpha 2 S: beta 1 S: beta 2 & Q: M1 I: M2 Q: M3

Adrenaline mechanism

"ABC of Adrenaline":

• Adrenaline--> activates
• Beta receptors--> increases
• Cyclic AMP

Carbon monoxide: electron transport chain target

"CO blocks CO" Carbon monoxide (CO) blocks Cytochrome Oxidase (CO)

Metabolism sites

"Use both arms to HUG": Heme synthesis Urea cycle Gluconeogenesis • These reactions occur in both cytoplasm and mitochondria.

AcetylCoA and acetacetylCoA

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

• A=AcetylCoA or Acetoacetyl CoA
• Ly=Lysine
• Tr=Tryptophan
• Le=Leucine
• Is=Isoleucine

Fasting state: branched-chain amino acids used by skeletal muscles

"Muscles LIVe fast":

• Leucine
• Isoleucine
• Valine

Glycolysis steps

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

• Glucose
• Glucose-6-P
• Fructose-6-P
• Fructose-1,6-diP
• Dihydroxyacetone-P
• Glyceraldehyde-P
• 1,3-Biphosphoglycerate
• 3-Phosphoglycerate
• 2-Phosphoglycerate (to)
• Phosphoenolpyruvate [PEP] Pyruvate • 'Did', 'By' and 'Pies' tell you the first part of those three: di-, bi-, and py-.

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

Glycolysis Enzymes

“Hungry Peter Pan And The Growling Pink Panther Eat Pies” Hexokinase Phosphohexo isomerase Phosphofructokinase-1 (6-phosphofructo-1 kinase) Aldolase, Triose phosphate isomerase Glyceraldehyde 3-phosphate dehydrogenase Phosphoglycerate kinase Phosphoglycerate mutase Enolase Pyruvate kinase

Citric acid cycle compounds

"Our City Is Kept Safe And Sound From Malice": Oxaloacetate Citrate Isocitrate alpha-Ketoglutarate Succinyl-CoA Succinate Fumarate Malate

Citric acid cycle compounds

"Can I Keep Selling Sex For Money, Officer?":

• Citrate
• Isocitrate
• alpha-Ketogluterate
• Succinyl CoA
• Succinate
• Fumerate
• Malate
• Oxaloacetate

Citric acid cycle compounds

"Oh! Can I Keep Some Succinate For Myself?":

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

Citric acid cycle compounds

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

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

Citrate Cycle Enzymes

"Corrupt Anti Intelligence Agent Spoke Slander For Money."

• Citrate synthatase
• aconitase
• Isocitrate dehydrogenase
• Alpha ketogluturate dehydrogenase
• Succinyl CoA synthetase
• Succinate dehydrogenase
• Fumarase
• Malate Dehydrogenase

Fabry's disease: FABRY'S

• Foam cells found in glomeruli and tubules/ Febrile episodes
• Alpha galactosidase A deficiency/ Angiokeratomas
• Burning pain in extremities/ BUN increased in serum/ Boys
• Renal failure
• YX genotype (male, X linked recessive)
• Sphingolipidoses

B vitamin names

"The Rhythm Nearly Proved Contagious": In increasing order:

• Thiamine (B1)
• Riboflavin (B2)
• Niacin (B3)
• Pyridoxine (B6)
• Cobalamin (B12)

Essential amino acids

PVT. TIM HALL: Phe Val Thr Trp Ile Met His Arg Leu Lys Pvt. is short for Private in the military. Arg and His are considered semiessential. Alternatively: "MATT VIL PHLy".

Golgi complex: functions

"Golgi Distributes A SPAM": Distributes proteins and lipids from ER Add mannose onto specific lysosome proteins Sulfation of sugars and slected tyrosine Proteoglycan assembly Add O-oligosugars to serine and threnonine Modify N-ologosugars on asparagine

Catabolism steps of branched chain amino acids

"Truck hit the Ox to Death":

• Transamination
• Oxidative decarboxylation
• Dehydrogenation

Niacin deficiency

The famous 4 D's:

1. Diarrhea
2. Dermatitis
3. Dementia
4. Death (if untreated)

Creatine phosphate: amino acid precursors

"Nice GAMs!":

• Glycine
• Arginine
• Methionine

Enzymes: classification

"Over The HILL":

• Oxidoreductases
• Transferases
• Hydrolases
• Isomerases
• Ligases
• Lyases

COLLAGEN

• C-terminal propeptide (procollagen)/ Covalent Cross links/ C vitamin/ Connective tissue/ Cartilage/ Chondroblasts/ Copper Cofactor (Covalent Cross linking)
• Outside the cell is where collagen normally functions/ Osteoblasts/ Osteogenesis imperfecta
• Lysyl hydroxylase/ Lysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last
• biosynthesis step)
• Long triple helical fibers/ Ligaments
• Alpha chains/ Attached by H bonds form triple helix/ Ascorbate for hydroxylation of lysyl and prolyl residues of pro-Alpha chains
• (postranslational modification)
• Gly in every third position/ Glycosylation of hydroxyl group of hydroxylysine with Glucose and Galactose; GOlgi allows procollagen to GO outside of cell
• Extracellular matrix/ Eye (cornea, sclera)/ Ehlers-Danlos Syndrome
• N-terminal propeptide (procollagen)/ Nonhelical terminal extensions

Essential amino acids

"PVT. TIM HALL always argues, never tires":

• Phe
• Val
• Thr
• Trp
• Ile
• Met
• His
• Arg
• Lue
• Lys

Hypervitaminosis A

Increased Vitamin A makes you HARD

• Headache/ Hepatomegaly
• Anorexia/ Alopecia
• Really painful bones
• Dry skin/ Drowsiness