●
Behavi Be havioral oral science ○
Case Case contro controll (OR) (OR) is in in past, cohort cohort study is in future future (re (rela lative tive risk); risk); OR comes comes before RR alphabetically
○
Evalu valuati ation on of of dia diagnosti nosticc tests tests ■
ecificty rules IN SNOUT = S eNsitivity rules OUT; SPIN = S Pecificty
■
If can can create create 2X2 disea disease/ se/test test table (FA 2011 P. 51; note that disea disease se which which come comess first alphabetically alphabetically is on t op ), can use the fo llowing: llowing: ●
Vertica Verticall → Sensitiv Sensitivity/sp ity/sp ecifi ecifici city ty formula formulas; s; vagina vagina is is VERTICAL VERTICAL slit; the vag vagina is is SENSITIVE
○
Positi Positive ve and neg negative tive skew skew ■
edian is always in the middle when mean, median and mode are ranked; mode is logically placed Median (point (p oint at peak), median median is middle, mean mean is on ot her end
○
Odds ratio vs. rela relative tive risk: risk: crea create te 2X2 table using the alphebetic alphebetical al order order rule; rule; Disease comes before R isk isk factor; formulas formulas are p retty logica logicall
○
Bias ■
Pygmalion effect → Researcher’s belief in efficacy of Tx changes the outcome of the treatment
■
changes its behavior behavior ow ing to knowledge of being studied Hawthorne effect → Group changes
■
S tatistical hypotheses hypotheses and error error
■
Make a 2X2 2X2 tabl table; e; agai again, n, use use the ABC rule rule to place place R eality eality on top and S tudy results results on the side
■
Power Power is when when the ex experime perimental ntal hyp othesis othesis is is true and and the study study also also shows that that it is true
■
A lp lp ha ha error (T (T y pe pe I) → false Positive error → The P in Positive has one ( I) vertical line, so corresponds to type I ●
■
Goes Goes in fal false se positi positive ve box box in 2X2 2X2 tabl tablee
Bet a error (T y pe pe II) → false Negative error → The N in negative has two ( II) vertical lines, so corresponds to type II ●
○
Goes Goes in false false neg negative ative box in 2X2 tabl tablee
t-te t-test st vs. vs. ANOV ANOVA A vs. vs. chi^2 hi^2 ■
t-test checks checks diffe differenc rencee betwee between n the means means of of 2 groups groups → Mr. T is mea mean n
■
ANOVA chec checks ks differe difference nce between between the mea means ns of 3 or more groups → ANOVA is ANalysis ANalysis Of VAriance of 3 or more groups
■
Chi^2 Chi^2 sy mbol looks looks like like a percentag percentagee sig sign (%); thus chi square squared d is used used to compare compare p ercentage ercentages/prop s/prop ortions
■ ○
Repor Reporta tabl blee dise diseaases: ses: Hep, Hep, Hep, Hooray, ooray, the SSSMMART Chick is Gone. Hep A, B, C, HIV
almonella, Shigella, Shigella, Syp Sy p hilis, Measles & Mumps, AIDS, R ubella, ubella, TB, ChickenpoxGonorrhea S almonella, ○
Mal Malprac practic tice → The The fou fourr Ds for Doom (you are doomed if you get get in trouble for malpractice) D → Duty (phy sicia sician n had a duty to t he patient) patient) D → Dereliction (physician breached that duty) D → Damage (patient suffers harm) D → Direct irect (t he breach breach of dut y is what caused the harm)
○
Developmental Developmental Mile stones
■
Blocks Blocks (ag (age in in years times times 3): 1 year → 3 blocks, blocks, 2 years → 6 blocks, blocks, 3 years → 9 blocks blocks
■
Lang Langua uag ge: 15 15 mon months ths → A few few wor words ds, 200 words and 2 word sentences at age 2, 900 words and complete sentences sentences at 3 y ears
■
Toi Toilet tra training ning at 3 years → Pee at age 3 and Rides tri(3)cycle at 3 years
■
Coopera Cooperativ tivee play play at 4 y ears; ears; pair pair of of 2s, lik likee two 2s are are cooper cooperati ating ng
■
Normal Normal grief rief 2 months; months; patho after after this Kuble Kubler-Ross r-Ross grief rief stages stages
■
ccept ance → Death Arrives Bringing Grave Adjustments Denial, Anger, Bargaining, Grieving, Accept
■
Sl eep stages stages
●
A t night , BATS Drink Blood
●
Beta → Awake (eyes open)
●
Alpha → Awake (eyes closed)
●
Theta → Stage 1, light sleep
●
S leep Spindles and K complexes → Stage 2, deeper
●
leep ; delta delta waves have lowest frequency, highest highest amplitude Delta → Deepest non -REM s leep
●
Beta → During REM
■
REM: like like sex: sex: increase increase pulse, p enis/clitoris enis/clitoris get get hard (tumescence), (tumescence), decrea decreases ses w/ age age
■
N ar arcolep sy sy . Hy p na naGOgic gic hallucatinations → While GOing to bed. Hyp nopoM p ic → Just before awakening in the Morning
●
Biochemistry ○
Chrom hromaatin tin struc structu ture re:: HeteroChromatin = Highly Condensed ■
H1 is the linker linker reg region between between histone histone octamer octamer ball ballss (beads (beads on a st ring); ring); the 1 is like like the little little piece piece of string connecting them
○
Nucleot id ides ●
Pyrimid Pyrimidin ines es only only have have one one rin ring g, as the other other was “CUT” off
●
THYmine has a me THYl
●
Purine sy nthesis nthesis starts with sugar sugar (Ribose (Ribose-5P -5P --> PRPP), and then this sugar sugar is is modifie modified d to create the purine; pyrimidine starts with synthesis of the pyrimidine and then later a sugar sugar is added; added; If y ou are pure you are as sweet as sugar sugar from the start
○
Methionine Methionine is is encoded encoded by only AUG, unlike unlike the other AAs where where you have have redun redundanc dancy y in the code code and multiple codons coding for them --> “ Hey (A) you (U), G, I want to buy t hat meth from you because it is so awesome/unique !”
○
Stop CodonsCodons- UGA, UAA, UAG- U go go away, away, U are are away, away, U are are gone gone
○
Stop the nonsense! --> Nonsense mutation introduced stop codon
○
Prot Proteein synth syntheesis sis ■
ukaryot es --> Even --> 40S + 60S = 80S (all differ differ by 20) Eukaryot
■
Pr O karyotes --> O dd --> 30S + 50S = 70S (smaller numbers because are smaller, always smaller by 10, all differ differ by 20)
○
AUG is is mRNA mRNA start start cod codon on (rare (rarely ly GUG) GUG) --> --> AUG inAUG urates p rotein rotein sy nthesis nthesis AUGurates
○
DN A re rep li licat io ion ■
P rokary ot ot es ●
DNA p ol I (one) (one) --> One (me, (me, number number 1, looki looking ng out for number number 1) --> “I alwa always ys have to do all of the bullshit, like fixing fixing the bullshit bullshit mess of RNA created created by p rimase” rimase”
■
Eukary ot ot es ●
DNA p olymerase olymerase gamma amma replica replicates tes mitochondr mitochondria iall DNA; beta beta and and epsilon epsilon repair repair DNA ○
Gamma Gamma (g (grandm randma) a) mig might ht (mitoch (mitochond ondri ria) a) beat-off (beta) e lderly (e p silon) repairmen (repair)
○
RNA polymerases: polymerases: Eukaryotes: Eukaryotes: RNA polymerase polymerase I (rRNA), (rRNA), II (mRNA), and III (tRNA) --> Numbere Numbered d as as
■
Toi Toilet tra training ning at 3 years → Pee at age 3 and Rides tri(3)cycle at 3 years
■
Coopera Cooperativ tivee play play at 4 y ears; ears; pair pair of of 2s, lik likee two 2s are are cooper cooperati ating ng
■
Normal Normal grief rief 2 months; months; patho after after this Kuble Kubler-Ross r-Ross grief rief stages stages
■
ccept ance → Death Arrives Bringing Grave Adjustments Denial, Anger, Bargaining, Grieving, Accept
■
Sl eep stages stages
●
A t night , BATS Drink Blood
●
Beta → Awake (eyes open)
●
Alpha → Awake (eyes closed)
●
Theta → Stage 1, light sleep
●
S leep Spindles and K complexes → Stage 2, deeper
●
leep ; delta delta waves have lowest frequency, highest highest amplitude Delta → Deepest non -REM s leep
●
Beta → During REM
■
REM: like like sex: sex: increase increase pulse, p enis/clitoris enis/clitoris get get hard (tumescence), (tumescence), decrea decreases ses w/ age age
■
N ar arcolep sy sy . Hy p na naGOgic gic hallucatinations → While GOing to bed. Hyp nopoM p ic → Just before awakening in the Morning
●
Biochemistry ○
Chrom hromaatin tin struc structu ture re:: HeteroChromatin = Highly Condensed ■
H1 is the linker linker reg region between between histone histone octamer octamer ball ballss (beads (beads on a st ring); ring); the 1 is like like the little little piece piece of string connecting them
○
Nucleot id ides ●
Pyrimid Pyrimidin ines es only only have have one one rin ring g, as the other other was “CUT” off
●
THYmine has a me THYl
●
Purine sy nthesis nthesis starts with sugar sugar (Ribose (Ribose-5P -5P --> PRPP), and then this sugar sugar is is modifie modified d to create the purine; pyrimidine starts with synthesis of the pyrimidine and then later a sugar sugar is added; added; If y ou are pure you are as sweet as sugar sugar from the start
○
Methionine Methionine is is encoded encoded by only AUG, unlike unlike the other AAs where where you have have redun redundanc dancy y in the code code and multiple codons coding for them --> “ Hey (A) you (U), G, I want to buy t hat meth from you because it is so awesome/unique !”
○
Stop CodonsCodons- UGA, UAA, UAG- U go go away, away, U are are away, away, U are are gone gone
○
Stop the nonsense! --> Nonsense mutation introduced stop codon
○
Prot Proteein synth syntheesis sis ■
ukaryot es --> Even --> 40S + 60S = 80S (all differ differ by 20) Eukaryot
■
Pr O karyotes --> O dd --> 30S + 50S = 70S (smaller numbers because are smaller, always smaller by 10, all differ differ by 20)
○
AUG is is mRNA mRNA start start cod codon on (rare (rarely ly GUG) GUG) --> --> AUG inAUG urates p rotein rotein sy nthesis nthesis AUGurates
○
DN A re rep li licat io ion ■
P rokary ot ot es ●
DNA p ol I (one) (one) --> One (me, (me, number number 1, looki looking ng out for number number 1) --> “I alwa always ys have to do all of the bullshit, like fixing fixing the bullshit bullshit mess of RNA created created by p rimase” rimase”
■
Eukary ot ot es ●
DNA p olymerase olymerase gamma amma replica replicates tes mitochondr mitochondria iall DNA; beta beta and and epsilon epsilon repair repair DNA ○
Gamma Gamma (g (grandm randma) a) mig might ht (mitoch (mitochond ondri ria) a) beat-off (beta) e lderly (e p silon) repairmen (repair)
○
RNA polymerases: polymerases: Eukaryotes: Eukaryotes: RNA polymerase polymerase I (rRNA), (rRNA), II (mRNA), and III (tRNA) --> Numbere Numbered d as as
their products are used in protein synthesis ○
T y pe p es of RN A : rRNA is the most abundant abundant t yp e; mRNA is the longest type; tRNA is the smalle smallest st ty pe, ampant, Massive, Tiny R ampant,
○
Prot Proteein synth syntheesis: sis: ATP for tRNA Activation; GTP for tRNA Gripping and Going places (t ranslocation) ranslocation)
○
Cell cyc cyclle pha phases ses ■
○
G = Gap or Growth (); S = S ynthesis (of DNA, as in replication)
M ic icrot ub ubule: Kin esin moves anterograde to microtubule (same direction it is growing in, i.e. negative to po sitive); y our aunt is your kin
○
Freidrei Freidreich ch atax ataxia --> --> Clumsine Clumsiness ss (can reme remembe mberr this from “ataxia “ataxia”” --> Due to GAA repeat --> When they fall they are like “ GAA GAAaaaaaa”
○
Labora borator tory y tec techni hnique ques ■
NA (DN A S NoW DR oP → S outhern blot analyzes D NA (DN A p robe); Northern blot analyzes R p robe); Western blot analyzes Protein (using an antibody p robe, which is logica logicall as DN A/RNA cannot bind a protein)
○
Collagen: S trong S lippery Bloody BM (Cartilage, nucleus nucleus p ulposus ) Strong (Bone, tendon, dentin), Slippery (Cartilag
○
●
Type III III col colllagen → Bloody ( granulation granulation tissue, blood vessels, uterus, fet al tissue)
●
Typ e IV IV coll collag agen en → Base Baseme ment nt memb membra rane ne (BM) (or basal lamina)
Het eroPLAS mitochondrial DNA, resulting in in variable variable PLASM My --> Presence of bot h normal and mutated mitochondrial expression in mitochondrial inherited dz --> associate with mito-DNA because it is circular like a PLAS PLASM Mid
○
Imp ri rint in ing: Prader-Willi --> Del of normally active Paternal allele; maternal allele is methylated&nonfunct
○
Autosomal dominant diseases
■
Achond Achondropla roplasia sia , ADPKD (mutate (mutated d chrom chromo o 16), Fam ADenomatous polyposis (chromo 5), HD, NF1 (17), NF 2 (22), vHL (3 words, chromo 3)
○
Autosomal Autosomal recessive diseases --> SAT CPM GASH (I actually attended class and SAT in CPM for once,
and I ended up with a GASH in my head because I shot myself) ■
hingolipidoses (except (except Fabry ’s), Glycogen storage diseases, Albinism, S ickle, Hemochromatosis, S p hingolipidoses ARPKD, Thalassemias, CF, PKU, Mucopolysaccharidoses (except Hunter’s)
○
X-link X-link ed disease disease s
■
Be Wise, Fool’s Fragile GOLD Heeds Hope:
●
agammaglobulinemia, lobulinemia, Wiskott-Aldrich syndrome, Fabry’s disease, disease, Fragile X, Brut on’s agammag deficiency y , O cular albinism, Lesch-Nyan syndrome, Duchenne’s (and Becker’s) G6PD deficienc muscula muscularr dy strop hy, Hunter’s syndrome, Hemophilia A and B.
○
Trinucleotide Trinucleotide rep repeat eat e xpansion xpansion disease s
■
disease, myotonic dystrophy, Friedreich’s ataxia, fragile X syndrome --> Try Huntington’s disease, (trinucleotide) hunting for my fried eggs (X)
○
●
CTG --> MyoTonic dystrophy
●
CGG CGG --> --> Fra Fragile X syndr syndrom omee
●
GAA --> Friedreich’s ataxia --> Ataxia falling down --> Fall and yell “GAAaaaa”
facies T --> Thymus aplasia (T 22q11 deletion syndromes --> CATCH 22 C --> Cleft palate A --> A bnormal facies cell deficiency) C --> Cardiac defects Hypocalcemia (secondary to parathyroid aplasia)
○
Co-factors for PDH, alpha-ketoglutarate, alpha-ketoglutarate, branched branched chain chain ketoacid ketoacid dehyd dehyd rogenase: rogenase: → "Tender Loving care for Noone"
○
■
TPP, Lipoi Lipoicc aci acid, d, Coe Coenx nxyme yme A, FAD, FAD, NAD
■
Kwash Kwashiiorko orkor: r: prote proteiin-de n-deff MEAL: M --> Malnutr, E --> Edema, A --> Anemia, L --> Liver (fatty)
■
Marasmus results in Muscle wasting
Cystinuria → Hereditar Hereditary y defect defect fo renal renal tubular tubular amino amino aci acid d transporter for the COLA ami amino no acids acids → Cys teine, Ornithine, Lys ine, Arginine Arginine
○
Maple Syrup Urine Disease → Blocked degradation of BRANCHED amino acids (Ile, Leu, Val) → I Love Vermont maple syrup from maple trees (that have BRANCHES )
○
ABC Enzymes: Py ruvate carboxylase, Acety l CoA Carbox, Propionyl-CoA Carbox ■
○
5 required co-enzymes for alpha-ketoglut DH, Pyruvate DH, alpha-ketoacid DH ■
○
ATP, Biotin, CO2
Tender Love And Care For Noone --> Thiamine, Lipoic Acid, CoA, FAD, NAD
Glycogen synthesis ■
1,4 bonds are straight; four = whore = girl = straight; 1,6 NOT straight (branched), 6 --> 666 --> satan/devil, homosexuality
○
ABC carboxylases --> Require ATP, biotin, CO2; 3 of them are relevant to step 1 ■
Pyruvate carboxylase (used in gluconeogenesis)
■
Acetyl CoA carboxylase (used in FA synthesis)
■
Propionyl-CoA Carboxylase (used in beta oxidation of odd chain FAs)
○
Two essent ial FAs: Linolenic acid & Linoleic acid --> Lino-LAY-ic acid --> Gett ing laid is essential
○
Lipoprotein metabolism ■
apoC-II activates LPL, leading to t he cleavage of FAs and accumulation of FAs in adipose tissue --> “You are so fucking fat it is like I can see two (C-II) of you”
■
apoB-100; this is the only apolipop rotein on the LDL particle, and it is referred to as the “LDL receptor” --> “ If y ou are going to B 100 y ears old, you are going to have fucked up cholesterol levels (LDL)”
■
A1 steak sauce is fucking delicious; HDL uses apoA-1 for cholesterol recovery from fatty st reaks in the blood vessels; this is a good (fucking delicious) thing
○
Lysosomal storage diseases ■
■
Fabry disease --> Think of a totally fabulous gay MAN ●
XR, Small, raised reddish-purp le blemishes on t he skin (angiokeratomas) --> Like STD
●
Ceramide trihexosidase accumulates, as gay men enjoy making things with ceramics
●
Eye manifestations, especially cloudiness of the cornea;
●
“ look mom - it s a GAy guy” = a-Galactosidase A
Niemann-Pick disease ●
No man picks (Niemann-Pick ) his nose with his sphinger (sphingomyelinase is t he deficient enzyme, leading to accumulation of sphingomyelin)
●
Foam cells --> Like foamy booger from nose picking
●
Cherry red spot on macula --> From picking it
●
hepatospleenomegaly - if you look at the body the Liver looks like a finger try ing to pick at the spleen which looks like a booger
■
Tay-Sachs disease ●
Lysosomes with onion skin --> Onion skin dress is so hot this season; so is cherry red spot on macula to match red jewel necklace
● ■
■
Tay-SaX lacks heXosaminidase A; leads to accumulation of GM2 ganglioside
Krabbe’s disease ●
Galacto-cerebrosidase deficiency and has accumulation of galactocerebroside
●
Dumb people get crabs - the STD - Dumb correlates with neurologic problems
●
Crabs have Globoid eyes (globoid cells) but can't see very well ( optic atrophy)
Metachromatic leukodystrophy ●
M etachrom --> Color; sulfur has a yellow color; thus deficient enzyme is arylsulfatase A and cerebroside sulfate accum ( be careful bc sulfate also shows up in Hurler/Hunter’s)
●
Metachromatic = A YeLlow color like sulfur (Ar yl sulfatase)
●
Cerebroside sulfate accumulates, also see demyelination & ataxia ( cerebellum problem)
■
H unt er’s s y ndrome ●
X marks the spot for treasure hunter; thus it is X linked
●
Hunter’s = mild hurler’s + aggresive behavior; a hunter is very aggressive
●
Hunters see clearly, no corneal clouding (unlike Hurlers, the similar but severe disease) ○
■ ○
○
Hurler’s syndro me: I have an uncle Hurley; he is big and ugly like a gargoyle (gargoylism)
Fatty acid metabolism ■
S Ytrate shuttle = S Ynthesis of fatty acids
■
CAR nitine shuttle = CAR nage of fatt y acids
■
FA degradation occurs where its p roducts will be consumed --> The mitochondria
Metabolism sitesle, Gluconeogenesis --> HUGs take two ■
○
Dermatan sulfate & Heparan sulfate accumulate in both!!!
Pathways that occur in BOTH mitochondria and cytop lasm --> Heme synthesis, Urea cyc
ETC: Uncoupling agents → DNP → D-Not- Proton Channel ■
Four things directly inhibit electron transport → RAACC → → Retonone, antimycin A, CN, CO → When you see breasts (a rack), you may forget to do when you are supposed to do (make electrons flow)
○
Gluconeogenesis
■
The key irreversible enzymes → PPFG → Pathway Produces Fresh Glucose → Pyruvate carboxylase, PEP carboxykinase, Fructose-1,6,-bisphosphate, Glucose-6-phophatase
○
Amino Acids: Essential AAs → PVT TIM HALL ●
P (Phenylalanine) V (Valine) T (Threonine) T (Try pt ophan) I (Isoleucine) M (M ethionine) H (Histidine) A (Arginine) L (Lys ine) L (Leucine)
● ■ ○
Ket ogen AAs → Leu cine and Lysine
Arg and His for growth → Guys (His) want to get big, they go “Arg” like primitive cavemen
Urea cy cle: O rdinarily Careless Crappers Are Also Frivolous A bout Urination → O rnithine, Carbamoyl phosp hate, Citrulline, Aspartate, Argininosuccinate, Fumarate, Arginine, Urea.My urea cycle (instead of the lame one in First Aid) Coffee And Alcohol Form Aggregious Urine Overload
○
Cystinuria: Defect of renal tubular AA transporter for Cysteine, O rnithine, Lysine, and Arginine (COLA) → Coca COLA is bad for you, so it causes cysts in your urine (Cystinuria)
○
Lip id t rans port ■
A1 Activates LCAT, w hich catalyz es esterification of cholesterol --> P utting A1 steak sauce on a CAT
■
B-100 Binds t o LDL recept or, mediates VLDL secretion (from first aid, worst fucking mnemonic
ever lol); it is the only apolipoprotein left on LDL ●
B-100 gets the bad LDL out of the blood and into liver; thus y ou have it because you want to B-100 some day (i.e. liver to t he age of 100), not die from atherosclerosis
■
C-II is a Cofactor for lipoprotein lipase (thus must be on chylomicron and VLDL)
■
E mediates Extra (remnant) uptake
■
B-for-eight (B48) is only seen on chylomicron; chylomicron comes from dietry lipid, i.e. the stuff that you ate (8) B-for (B4) all of th e other lipid p athway s st arted; logically, it mediates chylomicron secretion
●
Embryology ○
Sonic Hedgehog Gene --> In the videogame, sonic could run forward and backward; anterior and post erior
○
Homeobox gene --> Involved in segmental organization of embryo in craniocaudal direction --> Homosexuals (HOM EObox) p ut t heir heads (cranio) in the tails (caudal) of other men
○
Week 10 --> Genitals have male/female characteristics; 1 is like a penis, 0 is like a vagina
○
Rules of early development ■
Rule of 2’s for the 2nd week: 2 germ layers (bilaminar disk): epiblast, hy poblast), 2 cavities: amniotic cavity, yolk sac), 2 component to placenta: cytotrophoblast, syncytiotrophoblast
○
■
Rule of 3’s for the 3rd week: 3 germ layers (gastrula): Ectoderm, mesoderm, endoderm
■
Rule of 4’s for the 4th week: 4 heart chambers; 4 limb buds grow
Embryological derivatives ■
Neural crest (most important to know) --> Think PNS and non-neural structures nearby ●
Odonto = teeth; think crest toothp aste; logical that bones of skull would be from same thing as they are attached, and p ia/arachnoid too as t hey are closely associated with this
●
Neural structu res --> ANS, dorsal root ganglia, cranial nerves, celiac ganglion, chromaffin cells of adrenal medulla, Schwann cells
●
Non-neural structures --> Melanocyte, parafollicular (C) cells of thyroid, aorticopulmonary septum
■
Neuroectoderm --> CNS stuff: Brain (neurohyp ophy sis, CNS neurons, oligodendrocyt es, astrocy tes, ep endymal cells, p ineal gland), retina, sp inal cord
■
Thy roid follicular cells --> Endoderm --> Thyroid descends from tongue, so logically relates to gut; parathyroid as well, as so intimately associated with thy roid
○
Placental development: Cytotrop hoblast --> Makes cells for developing structure --> Cyto makes Cells
○
Urachus --> Connects bladder to y olk sac --> Ur (urine) and achus (achu, sneeze, snot is like yolk)
○
Brachial arch derivatives ■
1 --> MAXillary artery --> 1st arch is M AXimal (1st place is best place)
■
2 --> Stapedial artery --> S econd = S tapedial
■
3 --> common Carotid artery --> C is 3rd letter of alphabet
■
4 --> On left, aortic arch; on right, p roximal part of right subclavian artery --> 4th arch (4 limbs) = systemic
■
5 --> Does nothing --> Five is not Alive
■
6 --> Proximal part of p ulmonary arteries and (on left only) ductus arteriosus --> 6th arch (6 letters in both “p atent” & “ductus”)
○
Branchial apparatus: CAP covers outside from inside
○
Branchial arch derivatives ■
1 --> M s and T s --> Ms (Muscles of Mastication ( Masseter, lateral and Medial pterygoids), Mylohyoid, Maxillary (V2) and Mandibular (V3) nerves; Meckel’s cartilage ( Mandible, Malleus,
incus, sphenoMandibular ligament)) and Ts (Tensor ty mpani, Tensor veli palatini, anterior 2/3 of Tongue)
■
2 --> Ss (S tapedius, S ty lohyoid, CN S even, S tapes, S ty lohyoid ligament)
■
3 --> Pharyngeal stuff (Stylopharyngeus, which is innervated by glossopharyngeal nerve; CN IX (stylopharyngeous))
■
Five does nothing; five is not alive
■
4-6 --> Structures around neck/voice box ●
Cartilages (thyroid, cricoid, arytenoids, corniculate, cuneiform)
●
Cranial nerve X (4th arch (Superior laryngeal branch for swallowing); 6th arch (recurrent laryngeal branch for speaking)
●
Muscles (Pharyngeal constrictors, cricothyroid, levator veli palatini; 6th arch is all intrinsic mm. of larynx EXCEPT CRICOTHYROID)
○
Branchial pouch derivatives ■
Aberrant development of 3rd and 4th pouches --> 22q11 deletion --> Catch 22 --> CATCH --> C (Cardiac abnormality , esp ecially tetrology of Fallot; A bnormal facies; Thymic aplasia (thus T-cell deficiency); Cleft p alate; Hypocalcmia (due to lack of p arathyroid development))
■
Omphalocele --> O is like a nice circular, central hole; thus this one is based on the persistence of herniation of abdominal contents into umbilical cord
○
Formation of pancreas --> From dorsal and ventral buds; everyone loves getting head, both contribute to head ■
Ventral buds --> Portion of head; uncinate process
■
Dorsal buds --> Portion of head; tail (if we had a tail, it would be on our dorsal surface) and body (tail attached to body , so w e can associate them)
■ ○
Kidney embryology (DIT claims this is extremely low y ield) ■
Pronephros --> Degenerates at week 4; “pro” things tend to go away
■
Mesonephros --> Interim kidney for 1st tri; later contrib to male genital system (Wolffian duct)
■
Metanephros --> Sounds like mesonephric, which we can easily associate with the genitals from repro, but this is the permanent kidney ●
Ureteric bud --> Ureter, pelvises, calyces, collecting ducts (BIG stuff; ureter = “your eater” = my eater has to have a big app etite because my wiener is s o big)
●
M etanephric mesenchyme -->Glomerulus and renal tubules to distal convoluted tubule (SMALL stuff; this is induced by ureteric bud; the big stuff bosses the small stuff around)
○
Genital embryology ■
Mesonephric duct --> Associate with men because of lack of prefix; female stuff has prefix (FE-male, WO-man, PARA-mesonephric); associate Wolffian with male. Leads to S EED structures --> S eminal vesicles, E pididymis, E jaculat duct, Ductus def
○
○ ●
■
Paramesonephric duct --> Female due to prefix thing described above
■
Vestibular bulbs --> Internal part of the clitoris --> turned on, like light bulb
Congenital penile abnormalities ■
Hypospadia --> Urethral on underside of penis. Hypo is below
■
Ep isp adia: Exstrophy of bladder is assoc with E pisp adia. Wrong positioning of genital tubercle
Descent of testes and ovaries: Processus vaginalis becomes tunica vaginalis in men, obliterated in women
Microbiology ○
Bacteria
■
Bugs that do not gram stain well --> These R ascals May Microscopically Lack Color ●
Treponema (too thin to be seen), R ickett sia (icparasite), Mycobacteria (high lipid content
cell wall requires acid fast stain) Mycoplasma (no cell wall), Legionella pneumop hila (primarily ic), Chlamydia (intracellular parasite, lacks muramic acid in cell wall) ■
Use Loffler’s media for diptheriae!!
■
Which bugs need cysteine? The -ella's, or the girls. Francisella, Brucella, Pasteurella, Legionella
■
Bacteria that produce exotoxins that increase levels of cAMP
●
C → Cholera (Vibrio cholea)
●
A → Antrhax (Bacillus anthracis)
■
●
M → Monteczuma’s revenge (popular name for enterotoxigenic E. coli)
●
P → Pertussis (Bordetella pertussis)
Spirochete: Leptospira Interrogans (question mark). surfers and people in the tropics who get in water with animal urine .
■
Obligate aerobes --> Nagging Pests Must Breathe --> Nocardia, Pseudomonas, Mycobacterium tuberculosis, Bacillis (B. anthracis, B. cereus)
■
Pseudomonas AER uginosa is an AER obe
■
Anaerobes Can’t Breathe Air --> Clostridium, Bacteriodes, Actinomyces. AminO2 glycosides are ineffective against anaerobes because these antibiotics require O2 to enter the bacterial cell
■
Group B strep → Think B for Baby. N eonatal meningitis, pneumonia, sepsis ●
■
Pneumococcus is for Parents. Meningitis , pneumonia, sepsis in adults
3 MCC of otitis media → haem Influenzae, moraxella Catarrhalis, strep Pneumo → ICP, like the Insane Clown Poss e; their music sucks so much it really hurts the middle ear
■
Bacteria identification with antibiotics (novobiocin, optochin, bacitracin) ●
■
When have it narrowed down to... ○
S taph → Novobiocin test → kills EPIDERMIdis
○
AL pha hemolyt ic → O pt ochin test → kills PNEUMO
○
Beta hemolytic → Bacitracin → Kills PYogenes
Chlamy dia ty p es D-K cause STDs (and infant p neumonia, inclusion conjunctivitis in newborns), whereas A, B and C are associated with trachomas (leading cause of blindness worldwide) ●
D-K → DicK → S TD
●
L subtypes (L1, L2, L3) cause Lymphogranuloma venereum → Painless p apule (bump)
or ulceration of genitals; heals sp ontaneously; bacteria migrate t o regional lymph nodes, which enlarge; become tender and may break open/drain pus ● ■
TRACHoma → can lead to blindness
HACEK bacteria → Slow growing bacteria, cause endocarditis (must let grow for like 2 weeks). Haemophilus sp ecies, Actinobacillus species, Cardiobacterium sp , Eikenella sp, K ingella sp
■
N. MeninGitidis → Ferments Maltose+Glucose ●
■
In cont ras t t o N . Gonorrhoeae, which only ferments Glucose (no M in name)
Some important details about PSEUDO monas → BE PSEUDO : BurnsE, Endocarditis , Pneumonia, S epsis, External malignant otitis media, UTI, Diabetic O steomyelitis
■
Encapsulated bacteria --> Positive quellung reaction, where capsule swells,S ome K illers Have Nice S hiny Bodies --> S treptococcus pneumo, K lebsiella pneumo, H. influenzae type B, Neisseria
meningitidis, S almonella, group B strep ■
Urease positive bugs --> K lebsiella, Proteus, H. py lori, Ureaplasma
■
Anti-bacterial Antibiotics ●
Bacteriostatic vs. bactericidal ○
Bacteriostatic → We’re ECSTaTiC about bacteriorstat ics!” → Erythromycin, Clindamycin, S ulfamethoxazole, Trimethoprim, Tetracycl, Chloramphenicol
○
Bactericidal → “ Very Finely Proficient At Cell Murder” → Vancomycin, Fluoroquniolones, Penicillin, Aminoglycosides, Cephalosporins, Metro
●
Protein synthesis inhibitors → “Buy AT 30, CCELL (sell) at 50” ○
30S inhibitors (AT) → Aminoglycosides (bactericidAl), tet racycline (bacteriostatic)
○
50S inhibitors (CCELL) → Chloramphenicol, Clindamycin, Erythromycin, Lincomycin, Linezolid
■
All bacteriostatic, except for Linezolid whcih is variable
●
Penicillinase-res penicillins for S. aureus (not MRSA) → Use naf (nafcillin) for staph
●
The anti-PA drugs ○
TCP → Ticarcillin, Carbenicillin, Piperacillin → Takes Care of Pseudomonas
●
Beta lactamase inhibitors → CAST → Clavulanic Acid, S ulbactam, Tazobactam!!!!
●
Cep halos porins ○
1st gen → PEcK organisms → Proteus mirabilis, E. coli, K lebsiella pneumo
○
2nd gen → Treat the HEN PEcKS organisms → H. influenzae, Enterobacter, Neisseria sp p., Proteus, E. coli, K lebsiella pneumo, S erratia marcescens
●
Imipenem and meropenem ○
Give imipenem with cilostatin, inhib of renal dihydropeptidase I; decreases inactiv of drug in renal tubules → kill is LASTIN’ with ciLAS TATIN”
○ ●
Imipenem NW: GIT, rash, CNS toxicity . Meropenem is less harsh, no seizures
Aminoglycosides → “ Mean” GNATS canNOT kill anaerobes ○
Mean → Aminoglycosides
○
Can´t kill anaerobes → O2 needed for aminoglycoside upt ake
○
GNATS → The different aminoglycosides → Gentamycin, Neomycin, Amikacin, Tobramycin, S treptomycin
○
NOT covers NW → Nephrotoxicity, O totoxicity, Teratogen!!!
●
Clindamycin &Metro for anaerobes. Clindamycin A bove diapgragm, Metro Below
●
T rimet hop rim (TMP) → megalo anemia, leukop, granulocytop → Treats Marrow Poorly
●
TB Drugs: When someone is infected with TB, they are RIPE ○
Isoniazid (INH): Injures Neurons and Hepatocytes
■
R ifampin: R ed, RNA (inhib DNA-dependent RNA polymerase of
TB), R evs up microsomal P-450), R apid resist ance if us ed alone
●
■
Pyrazinamide
■
Other drugs for TB not associated with liver damage: ●
Ethambutol : ocular tox/neuropathy : red-green blind
●
St rep tomy cin
Fluoroquinolones: -floxacin ; Inhibits DNA gyrase. NW: GI irratability, vomiting. FluoroquinoLONES hurt att achments t o y our BONES →
●
Vancomy cin ○
NOT have many problems → Nephrotoxicity, O totoxicity, Thrombophlebitis
■
Mechanism --> Inhibits peptidoglycan p roduction; complexes with D-alanine D-alanine to inhibits transp ept idation
■
NW --> Red man syndrome (release of histamine causes red rash of the to rso and itching skin)
●
Metronidazole (the metro bus ); used to treat some protozoa
○
“ GET GAP on the Metro!”Giardia, Entamoeba, Trichomonas, Gardnerella Anaerobes (bacteriodes, clostridium), H. Pylori
●
Polymyxins → Polymyxin B, polymyxin E (colistimethate) ○
Mechanism → Bind to cell membranes of bacteria disrupt their osmotic pro pert ies; basic proteins act like detergents → MYXins MIX up membranes ■
Neurotoxicity is seen → They also scramble (MIX up) the brain
○
Fungi ■
Fungi grow on S abouraud’s agar
■
Actinomyces and nocardia are the “fungi-like” bacteria; filamentous, beaded, branching g+ ●
Actin omyces --> Bacteria acting like fungi
○
Actinomyces Israelii ---> Yellow granules called sulfur granules
○
Nocardia --> Acid fast stain positive, like TB
■
For the dimorphic fungi, cold = mold, heat = yeast
■
Histo Hides (wit hin macrophages)
■
Blastomycosis → Broad Based Buds
■
Histo plasmosis → Histop lasmosis associated with bat dropp ings
■
Paracoccidio Parasails with the captain’s wheel all the way to Latin America → Paracoccidio has
budding yeast w ith captain’s wheel formation, seen in latin america ■
Wide vs. acute angle in fungi ●
■
Asp ergillus → A → Acute angle. Mucor → Flip M to have a W → Wide angle
Antifungal antibiotics ●
Amphotericin B is Amphot errible, terrorizes ergosterol and the kidney
○ ●
Ampho-tear-acin tears holes in the fungal membrane by forming pores
Ny astatin → “ Nasty Nyastatin ” ○
Too strong to take IV (would be highly toxic); thus must use top ically/orally
○
Same mechanism as ampho
○
FlUcyst osine is an ant imetabolite like 5-FU
○
Similarly causes bone marrow depressi on , nausea/vomiting/diarrhea (→ damage rapidly dividing cells like bone marrow, GI)
●
Azoles
○
Ketoconazole (and all of the az oles) inhibits cytochrome P-450, which is
important in testosterone synthesis; this causes gynecomastia/impotence/etc. ●
cASPofungin → U sed to treat invasive ASPergillosis, inhibits synthesis of beta-glucan Griseofulvin: Inhib fungal growth by disrupt ing sp indle formation, p revent mitosis
● ○
T erbinafine
Viruses ■
Negative RNA is negative/shitty; must be transcribed into positive RNA in order for it to be useful
■
Negative DNA is negative/shitty and not actually read; it is pos DNA that is used to do something
■
D NA viruses → T he HHAPPPy viruses Herpes Hepadna Adeno Papova Parvo Pox
Hepatitis ●
HAV --> A for Asy mpt ( jaundice in some cases), Acute, Alone (no carriers)
●
HBV --> B for Blood borne; the cousin of HCV, as both predispose to chronic active hepatitis, cirrhosis, hep atocellular carcinoma
■
●
HCV --> C for Chronic, Cirrhosis, Carcinoma, Carriers
●
HDV --> D for Defective, Dependent on HBV
●
HEV --> E for Enteric, Expectant mothers (n ormally mild like A, but mortality in SS)
Orthomyxo and paraorthomyxo ●
OR thomy xo causes OR dinary flu; PARAortho causes an influenza like illness in addition
to a PARAde of distinctly different diseases ■
Papovaviridae → PA-PO-VA-viridae
●
PA pilloma; human warts and cervical cancer
●
POlyomavirus; composed of human BK and JC virus
○
JC virus
■
JC Polyomavirus --> PML; memory loss, poor speech, incoordination secondary to CNS white matt er damage
■
Ebola → Hemorhagic fever → Bleed from mucous membranes
■
Anti-viral medications ●
Foscarnet → DNA p olymerase inhibitor that binds the pyrophosphate-binding site of the enzyme → FOS carnet = py roFOS phate analog
●
HIV drugs ○
Nucleoside/nucleotide/etc. Reverse transcriptase inhibitors (NRTIs) ■
Tenofovir --> NucleoTide analogue
■
Zidovudine (ZDV), Stavudine → “Have you dined (vudine ) with my nuclear (nucleosides ) family?”
○
●
Bot h are NRT Is
●
Z DV p revent s familial transmission from mother to fetus
Efavirenz → Causes abnormal dreams that are often scary → Dreaming about axe-wiel ding el ves
■ ○
Protease inhibitors: navir ; associate th is with no virus ■
○ ●
T hink of efavirENZ as “ the Ns” → NRTI cause Nausea & nightmare Ritonavir inhib P-450, “boost er” to make other antivirals last longer
Fusion inhibitors: enFUvirtide → FU for FUSE
Influenza drugs ○
Amantadine ■
influenza A, NOTinfluenza B; that is what the “ A” in Amantadine
is for; in addition, the A is for problems wit h the cerebellA (ataxis, dizizness, slurred speech) ■
prevents viral genome uncoating in the host cell
■
Rimantidine is similar but with extra perks, does not require dose
adjustments in renal failure, less CNS side effects (anxiety/confusion) ○ ○
Neuraminidase inhibitors → Oseltamivir, zanamavir
Helminths
■
Nematode routes of infection ●
Ingest ed → Enterobius, Ascaris, Trichinella → You’ll get sick if you EAT these
●
Cut aneous → S trongyloides, Ancylostoma, Necator → Get into your feet from the S ANd
■
●
Anti-Helminth antibiotics: M ebendazole.Inhibits the synthesis of microtubules (are BENDY)
Immunology ○
Anatomy/histology of immune system structures ■
T cells are in the “ P” areas; Paracortex in lymp h node, Periart lymphat sheath (PALS) in spleen
■
Lymph node → CB PT M Mmmmm (CB is my old nick name, PT for patient, MM for delicious...this mnemonic is awful but better t han noth ing) ●
Cortex → Follicles with B cells
●
Paracortex → T cells
●
Medulla → Macrophages
■
M HC I and II
■
MHC is encoded by HLA genes
■
MH C I --> 1 is simple --> Thus matched with the simple letters: A, B, C --> MH C I is encoded by HLA-A, HLA-B, HLA-C
■
MHC 2 --> HLA-DR, HLA DQ, HLA-DP --> The DR went to dairy queen (DQ ) to get a doctor pepp er (DP)
○
Cytokines and their functions ■
To remember IL-1 through IL-5, use Hot T-Bone st EAk ●
IL-1 --> Causes fever (hot), IL-2 --> Stimulates T cells, IL-3 --> Stimulates BM
●
IL-4 --> Stimulates IgE production (that is, it st imulates class switching; thus bot h IgE and IgG, as well as differentiation into Th2 cells, growth of B cells)
●
IL-5 --> Stimulates IgA p roduction (and thus class s witching from IgM t o IgA; also promotes differentiation of B cells, stimulates growt h/differentiation of eosinop hils)
■
IL-6 is a py rogen; 6 is devil number (666), so can associate with heat/fire
■
“Clean up on aisle 8 ” --> Neutrophils are recruited by IL-8 to clear infections IL-10 --> 10,
rhymes with men --> I don’t like men, so they inhibit me having a boner --> IL-10 inhibits T cells and macroph ages (most of the ot her ones we have to memorize are stimulatory) ● ■
Thus logically secreted by regulatory T cells. BUT, it activates Th2
IL-11 → Makes megakaryocyt e differentiate into platelets; picture the 1 and 1 of 11 as two little platelet p articles...look at that shit below, those p latelets look like 11.
■ ■
IL-12 → Activates Th 1 cells → Activates 1 in order 2 take care of invaders
■
IL-13 → Is oty pe switching to IgE; since this causes allergy/rash/etc., it is logical that it would be this very unlucky number (13)
■
Isotype switching occurs due to IL-4, IL-5, and IL-6; this results in the p roduction of IgA, IgE, and IgG → Note that 4 is like an A, 6 is like a G; just remember that 5 is also relevant and in the middle
○
○
Immunoglobulin isotypes
■
When B lympho older can isotyp e switch; it can then secrete A, G and E; does this in its old AGE
■
In the classic pat hway, IgG and IgM fix complement; General motors (GM) is a classic
■
IgM is a pentamer when in blood; note that the letter “ M” has 5 p oints (5 = penta)
■
IgE activates Eosinophils to kill parasites
■
I want to B and MD → B cells have IgM and IgD on t heir surface acting as recept ors
Cytotoxic T cells have Granzyme and Granulysin
■
AB and function: The constant Fc region: Constant, Carboxy terminal, Complement binding at CH2, Carbohydrate side chains
○
Comp lement : C3b → Opsonization; binds bacteria. C3 a, C5a → Anaphalaxis
○
Cell surface proteins: CD 21 is t he receptor for EBV!
○
Passive vs. active immunity ■
After exposure to Tetanus t oxin, Botulinum toxin, HBV, or R abies virus, patients are given preformed antibodies (p assive) To Be Healed R apidly
○
○
Aut oant ibodies ■
AntiCentromere → CREST scleroderma
■
Anti-Jo-1 → Poly MYositis, dermatoMYositis → MY grandma’s name is JO anne
■
Diffuse S CLeroderma → anti-S CL-70 Abs
■
c-ANCA → Wegener’s granulomatosis → Like that old school tv channel the CW
Immune Deficiencies
■
■
Bruton’s agammaglobulinemia → Seen in Boys because it is X-linked
●
Defect in BTK, a ty rosine kinase gene
●
Blocks pro-B-cell from forming pre-B-cell → B cells are fucking up in Bruton’s
Hyper-IgM → B cells cannot Mature → Thus B cells cannot class s witch → T hus B cells can only make IgM (not A, G E seen in class switching)
■
Select ive Ig deficiency → IgA deficiency most common → the defect in isoty pe sw itching,
■
Hyper-IgE syndrome → Job’s sy ndrome
■
Wiskott-Aldrich (WA) syndrome I → Infections Thrombocytopenia E → Eczema
●
There is also decreased IgM in this condition;
●
Ataxia-telangiectasia → IgA deficiency (this is one part of 3 in triad; the other 2 are
extremely obvious from the name of the condition (ataxia, telangiectasia)) ■ ●
Leukocyte Adhesion deficiency ( LAD) → Small LAD,delayed separation of the umbilicus
Pathology ○
Amy loidosis ■
Primary amyloidosis → Protein is AL, derived from Ig light chains (multiple myeloma) → AL = Light chain
■
Secondary amyloidosis is based on the protein AA;
●
This is derived from serum amyloid-associated (SAA) p rotein, which is seen in chronic inflammatory disease → AA = Acute-phase reactant
■
Senile cardiac amyloidosis → The protein that accumulates is transthyretin, which is derived from AF → AF = old Fogies
■
DM typ e 2 amyloidosis is based on amylin, which is derived from AE → AE = Endocrine
■
Medullary carcinoma of tthyroid → Protein is A-CAL, derived from CALcitonin; note also that calcitonin is made in the C cells of the thyroid, so the calcitonin/thyroid connection is logical
●
Pharmacology ○
Enz yme Kinet ics ■
Competitive inhibitors cross each other competitively, while noncompetitive inhibitors do not
■
To remember that Y-intercept is Vmax → “You are still a Virgin? H ahaha, Y?” ●
○
And the other one is X-intercept
Elimination of drugs ■
Drugs that display zero (0) order elimination (linear decrease in concentration with time) include Phenytoin, Ethanol, Asp irin (at high or t oxic concentrations) → PEAis round like a 0
○
Therapeutic index can be remembered using the mnemonic TILE → Therapeutic Index = TI = LD50/ED50
○
Ach recep t ors : Nicotinic Ach receptors are ligand-gated Na/K channels; N M found in Muscle; NN found in autonomic ganglia (like N for Nerve)
○
G-protein-linked 2nd messengers ■
To remember the protein class of the various receptors: qiss (kiss) and qiq (kick) till you’re siq (sick) of sqs (sex)
■
●
Alpha1 → q
●
Alpha2 → i
●
Beta1 → s
●
Beta2 →s
●
M1 → q
●
M2 → i
●
M3 → q
●
D1 → s
●
D2 → i
●
H1 → q
●
H2 → s
●
V1 → q
●
V2 → s
Gq activates phospholipase C → Cutsie ( q-C) ●
■ ○
Associated with H1, Alpha1, V1, M1, M3 → “Cutseies HAVe 1 M&M”
Gi is linked to M2, Alpha2, D2 → The “ MAD 2s”; they are pissy , so they inhibit everything
Cholinomimetic agents
■
Direct agonists → Directly bind cholinergic receptors ●
T end t o have “ -chol ” in the name; logical given that this is direct stimulation of chol inergic receptors
■
○
●
Bethanechol activates Bowel and Bladder smooth muscle
●
Carbachol is a carbon copy of acety lchol ine; used to treat glaucoma
●
Pil ocarpine is a potent stimulator of sweat, tears, saliva → PILe on the sweat and tears
●
M ethacholine → test for asthma; stim muscarininc receptors in airway
Indirect agonists → Does not directly bind receptor; rather, anticholinesterases,“-stigmine” in name ●
Neo stigmine has no CN S penetration → NEO CNS = NO CNS
●
Edrophonium is used in the diagnosis of myasthenia gravis,
●
Physostigmine treats glaucoma → PHYS is for EYES
●
Treats atropine overdose → Physo Phixes atropine OD
Muscarinic antagonists
■
Benz tropine is used to treat Parkinson’s disease → PARK my BENZ
■
Ipratropium is used to treat asthma, COPD → “ I pray I can breathe soon!”
■
Side effects of muscarinic blockade ( typ for atropine, which is an extremely common cause of delerium in the elderly): Hot as a hare (increased body T bc less sweating), dry as a bone (less s ecret in airway, GI, dry mouth), red as a beet (flushed), blind as a bat (far sighted, ciliary muscle can´t contract&cause accomod), mad as a hatter ( disorient), bloated as a toad (const ip)
■
Hexamethonium is a nicotinic agonist; thus it blocks all of the ganglia of the autonomic NS (parasympathetic AND sympathetic) → Put a hex on smokers ( nicotine ) to make them quit
○
Direct Sympathomimetics
■
Epinephine binds ALL adrenergic receptors, but selective for beta1 at low dosages → Blow
■
Iso proterenol binds beta1 and beta2 equally w ell → Isolated to bet a; iso implies same
■
Dopamine binds as follows: D1 = D2 > beta > alpha → It is obvious that they bind D best; then it just goes down alphebetically
■
The selective beta2 drugs (beta2 > beta1) are the MAST drugs → Metaproterenol, Albuterol, S almeterol, Terbutaline
■ ○
riTO drine binds betaTO (beta2)
Alpha blockers
■
Pheochromocytoma should be surgically removed in conjunction with p henoxybenzamine and phentolamine → Use Phe and Phe to treat a Pheo ●
○
Phenoxy BENZamine is irrev → IF someone gave me a BENZ, would never get back
Beta blockers
■
Partial beta- Agonists → Pindolol, Acebutolol
■
Nonselective antagonists (beta1 = beta2) all start w ith letters betw een N and Z (with the one
exception of labetolol) → Prop ranolol, timolo, nadolol, p indolol ■
Beta1-selective antagonists all start with letters between A and M → Acebutolol, Betaxolol, Esmolol, Atenolo, Metoprolol
● ■
A BEAM of beta1 blockers
Almost all beta blockers end in -olol; the non-selective beta AND alpha antagonists have weird name endings → labetalol , carvedilol
○
Drugs causing flushing → VANC → Vancomycin (red man), Adenosine, Niacin, Ca2+ channel blockers
○
Drugs causing hemolysis in G6PD patients → Hemolysis IS PAIN
○
■
Isoniazid
■
S ulfonamides
■
Primqquine
■
Aspirin
■
I bup rofen
■
Nitrofurantoin
Drugs causing megaloblast anemia → Phenytoin, MTX, S ulfa drugs → Having a BLAS T with PMS
○
Drugs causing pulmonary fibrosis: BLAB (it’s hard to blab when you have pulmonary fibrosis) ■
○
BLeomycin, Amiodarone, Busulfan
Drugs causing gynecomastia → S ome Drugs Create Awesome K nocker s
■
S piro, Digitalis, Cimetidine, Alcohol, K etoconazole
○
Drugs causing photosensitivity: S AT for a photo: S ulfonamides, Amiodarone, Tetracycline
○
Drugs causing SJ syndrome (rash) → S eizure, Cillins, S ulfas → Can’t get any SCS (sex) bc you have a rash
○
Drugs causing SLE-like syndrome: SHIPP: S ulfonamides, Hydralazine, I NH, Procainamide, Phenytoin
○
Drugs causing cinchonism (dizziness, h/a, vision changes, tinnitus) → Quinidine, quin ine
○
Drugs causing seizures: Bupropion, Imipenem, I NH
○
Drugs causing disulfiram-like reaction: Metro, S ulfonureas (1s t gen), Cephalos (cefemendole), Procarbazine
○
P450 inducers: BCG PQ RS): Barbs, Carbama, Griseo Pheny toin, Quinidine, Rifampin (revs it up ), St
Johns ○
●
P450 inhibitors: PICK EGS : Protease inh, INH, Cimetidine, Keto Eryt hro, Grapefruit, Sulfonamides
Cardiovascular ○
Heart sounds ■
S3 → increased filling pressures and more common in dilated ventricles. Early diastole, whereas S4 is late diastole; thus S3/S4 numbering is logical
○
○
■
S4 → stiff ventricle Four → Whore → Prost itutesmake me stiff;
■
JVP: a wave, c wave, x wave, v wave, y wave → At Carter’s crossing (X) Vehicles Yield
Heart murmurs ■
MP - MSC
■
MS - OS → M icrosoft ( MS ) makes an operating system (OS )
■
AS has the ejection click ( EC)
Cardiac myocyte physiology ■
Phase 0: rapid upst roke, where pot ential gets really high → “You have to be a total ZERO to get HIGH”. Phase 2 is the plateau → Phase 2 is the pla-2
■
■ ○
Tetralogy of fallot → PROVe ●
P → Pulmonary stenosis
●
R → R VH (logical given the pulmonary stenosis)
●
O → O verriding aorta (overrides the VSD)
●
V → VSD
Patent ductus arteriosus: ENDO methacine (indomethacin) END s p atency; PG EE k EE ps it op en
Cardiomyopathies ■
Dilated (congestive) cardiomyopathy ●
ABCD
○
A → Alcohol abuse
○
B → wet Beriberi
○
C → Coxsackie B virus myocarditis, chronic Cocaine use, Chagas’ disease
○
D → Doxorubicin toxicity
○
Also hemochromatosis, peripartum cardiomyopathy
■ ■
Hyp ertrophic cardiomyopathy → A common cause of sudden death in young athlete s
■
Treatment of acute heart falilure → LMNOP
●
L → Lasix
●
M → Morphione (patient chills out, decrease sympathetic activity)
●
N → Nitrates (decrease pulmonary congestion)
●
O → O xygen
●
P → Positioning (sit on edge of bed, pool blood in legs rather than pulmonary vasculature, improves breathing), Pressors (ex. d obutamine)
○
Bacterial endocarditis
■
Tricuspid valve endocarditis is associated with IV drug abuse → Don’t Tri drugs
●
Most common bacteria here are Pseudomonas, staph Aureus, Candida → PAC, like tup ac, who got high on drugs all the time
■
HACEK organisms cause culture-negative endocarditis → Haemophilus, Actinobacillus, Cardiobacterium, Eichenella, K ingella
■
Signs/Sx of bacterial endocarditis → “ I got bacterial endocarditis FROM JANE!”: Fever, R other’s spot s (round white spot s on the R etina surrounded by hemorrhage), O sler’s nodes (t ender raised lesions on finger or toe p ads) Murmur, Janeway lesions (small eryt hematous lesions on p alm or sole), Anemia, Nail-bed hemorr/splinter hemorr), Emboli
○
Calcium channel blockers
●
Verapamil works at the heart more than any other, Verapamil = Ventricle
●
Nifedipine works at vasculature : Ni fedipine is a dihydrop eridine whereas vereapamil and diltiazem are nondihydrop eridines → T he Ni- is the Di-
○
○
Malignant hyp ertension treatment ■
NITroprusside, Fenoldopam, Di azoxide
■
fenolDOPam → DOP amine D1 receptor agonist; relaxes renal vascular SM
Antianginal therapy : Nifedepine is similar to Nitrates in effect (logical, since both w ork on vasculature rather than heart); verapamil is similar to beta-blockers
○
Antiarrhythmics ■
“ No (class 1) Bad Boy (class 2) K eeps (class 3) Clean (class 4)”
■
Class 1 → Na Channel Blockers ●
Three classes (IA, IB, IC), each containing three drugs ○
Class IA: Procainamide, Disopyramide, Q uinidine (Double Quarter Pounder) ■
IB: Tocainide, Lidocaine, Mexiletine (Tomato, Lettuce, Mayo)
■
IC: Flecainide, Propafenone, Encainide (Extra Fries Please)
■
Class 2 → Beta blockers
■
Class 3 → K+ channel blockers ●
Class 3 works at p hase 3!!!
●
amIODarone contains IODine → messes with thy roid: hyp o- or hy perthy roidism!! Also causes pulmonary fibrosis, hepatotoxicity → check PFTs, LFTs, and TFTs
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Endocrine Endocrine p ancreas cell typ es ■
INS ulin (beta cells) INS ide the islet (alpha cells for glucagon are on the p eriphery of the islet, delta cells for somatostatin at the junction between the two)
○
Insulin: Don’t need insulin for glucose upt ake: Brain, RBC, Intestine, Cornea, Kidney, Liver ■
GLUT-2 is BI( 2)-directional (and thus not used by tissues that REALLY need gluc) → Beta islet cells, liver, kidney, small intestine;GLUT-1 in tissues that do REALLY need glucose: RBCs brain
○
Adrenal steroids ■
Congenital bilateral adrenal hyperp lasias → Can have deficiency in 17alpha-hydroxylase, 21-hydroxylase, or 11beta-hydroxylase ●
All have 2 numbers in name, we will call them XY. In 17alpha-hydroxylase, X = 1, Y = 7
●
If X is 1 → Hypertension is seen
●
If Y is 1 → Masculinization is seen
●
Thus, for example 11beta-hydroxylase has BOTH masculinization and hyp ertension
○
PTH → Increases Ca levels, decreases phosp hate levels → PTH stands for Phosphate Trashing Hormone
○
Calcitonin decreases Ca2+ levels → Calci TON in TON es down Ca2+ levels
○
Signaling pathways of endocrine hormones ■
cAM P → FLAT C HAMP → (same FLAT as before, i.e. the anterior pituitary hormones FH, LH, ACTH, TSH), CRH, hCG, ADH (V2 receptor), MSH, PTH
●
Can make it FLAT CHAMP OF Computer Graphics in Games to include Calcitonin, GHRH, Glucagon
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Can remember V2 rather than V1 due to the fact t hat V1 is the vascular one, and it needs to us e IP3 t o increase Ca2+
■
cGMP → THink vasodilators → ANP, NO (EDRF)
■
IP3 → GnRH, O xytocin, ADH (V1 receptor) , TRH → GOAT ●
Note: oxyt ocin and ADH at V1 both logically need to increase Ca2+, which IP3 can do
■
The ONLY hormones binding nucl steroid receptors are T3/T4; others bind cytosolic steroid recept
■
Cytosolic steroid receptors → VET CAP → Vitamin D, Estrogen, Testosterone, Cortisol, Aldosterone, Progesterone
■
Intrinsic tyrosine kinase (MA P kinase pathway) → Think growth factors → Insuklin, IGF-1 (produced by GH), FGF , PDGF
■
Receptor-associated tyrosine kinase (JAK/STAT pathway) → GH, p rolactin (the posterior pituitary hormones), also cytokine IL-2
○
Addison’s disease shows Adrenal Atropy and A bsence of hormone production!
○
Pheochromocytoma:10s → 10% all of these things: Malignant, bilateral, extra-adrenal, calcify, kids, familial
○
■
Dopamine is metabolized to HVA → DHV
■
Nore pinep hrine is metabolized to VMA
■
Epinephrine converted to metanephrine → Easy to remember
Hyperparathyroidism: A disease of stones (stones due to hypercalciuria), bones (cyst ic bone sp ace filled w/brown fibrous tissue), and groans (constip; gastric ulcers due to increased gastrin, due to increased Ca2+)
○
Hyp oparathyroidism: Due to hyp ocalcemia and resultant tetany, see → Chvost ek’s sign, Trousseau’s sign ●
Chvostek s ign → Cheek → Tapping of facial n. causes contraction of facial mm.
●
Trousseau’s s ign → Cuff → O cclusion of brachial artery triggers carpal sp asm
○
Pituitary adenoma: Bromocriptine or cabergoline (dopamine agonists) cause shrinkage of prolactinomas
○
Carcinoid syndrome → High levels of serotonin. Increases 5-HIAA in urine . Rule of 1/3s → ⅓ metastasize, ⅓ p resent with 2nd malignancy, ⅓ multiple
○
Multiple endocrine neoplasia (MEN). Autosomal dominant, because MEN are dominant ■
■
MEN 1 → 3 Ps; MEN 1, so carry just 1 over (Parathyroid) ●
Parathyroid tumors
●
Pituitary tumors (prolactin or GH)
●
Pancreatic endocrine tumors (ZES, insulinoma, VIPoma, rarely glucagonoma)
MEN 2A → 2 Ps; MEN 2, so carry 2 over (Pheo, Medullary) ●
Parathyroid tumors
■
○
○ ●
●
Pheochromocytoma
●
Medullary thyroid carcinoma
MEN 2B → 1 P ●
Pheochromocytoma
●
Medullary thyroid carcinoma
●
Oral/intestinal ganglioneuromatosis (associated with marfanoid habitus)
Diabet es d rugs ■
Pioglitazone (also rosiglitazone) causes weight gain → Pig-glitazone
■
Fat, pig-like, rosy-faced golfer (pioglitazone and rosiglitazine bind PPAR-gamma (par like golf)
Other endocrine drugs: Demeclocycline → ADH antagonist used in the treatment of SIADH!!!
Gastrointestinal ○
Retroperitoneal structures: Most of pancreas is retro, but not t ail → tail wagging can´t be constricted to retro!
○
Digestive tract anatomy ■
Muscularis externa → Includes Myenteric plexus ( Auer bach’s → Lift weights w ith Muscles for an Auer) → This muscle plexus handles motility, which is logical (muscle!); the other plexus
(submucosal, or M eissner’s) regulates secretions/blood flow/absorp tion ■
Relative peristalsis frequency works alphabetically → Duodenum (f irst letter is f astest; 12 waves/min) > Ileum (8-9 waves/min) > S tomach (3 waves/min)
○
GI blood supply and innervation ■
○
Foregut and midgut are supp lied by vagus; hindgut (like butthole) sup plied by pelvic n. (anal sex)
Portosystemic anastomoses ■
Portal HTN → Varices of gut, butt and caput ●
Gut → Left gastric v. connects to esophageal v. → Esop hageal varices ( can rupt ure and
kill via massive hemorrhage) ●
Butt → Superior rectal v. connects to middle/inferior rectal vv. → Internal hemorrhoids
●
Caput → Paraumbilical v. connects to superficial and inferior epigastric vv. → Caput
medusae ○
Order of things in Femoral Triangle: NAVEL (lateral to medial) Nerve, Artery, Vein, Empt y, Lymphatic
○
Hernias ■
INdirect hernia → Goes through th e INternal (deep) inguinal ring and INto the scrotum and occurs
in INfants (d ue to failure of p rocessus vaginalis t o close; can form hy drocele) ■
D irect hernia →
■
Location of hernias: Long Island MD (LIMD) (or, alternatively, MDs don’t LIe)
■
●
Lateral to inferior epigastric a. = Indirect hernia
●
Medial to inferior epigastric a. = Direct hernia
FEMoral hernia → FEMinine → More common in women
Salivary secretion_ Parotids release most serous s ubstance; sublingual release most mucinous subst ance → S erous on the S ides (parotids), Mucinous in the Middle (sublingual);
Nutrient absorp tion: Fructose is taken up by Facilitated diffusion by GLUT-5 (unlike glucose and galactose, which undergo cotransport with Na via the SGLT1) ○
Plummer-Vinson Syndrome: esophageal webs, Glossitis, Fe-deficient anemia
○
RFs for esophageal cancer (A-H) ■
Achalasia
■
Barrett’s
○
○
■
Cigs
■
Diverticuli
■
Esophageal webs/Esophagitis
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Familial
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GERD
■
Hot D ogs (nitrosamines)
Malabsorption syndromes → These Will Cause Devastating A bsorp tion Problems ■
Tropical sprue → Tails (follows) celiac sprue (similar to celiac sprue)
■
Whip ple’s disease → Cardiac problems, Arthralgias, Neurological p roblems
■
Celiac sp rue
■
Disaccharidase deficiency
■
A beta-lipoproteinemia → Decreased apoB
■
Pancreatic insufficiency
Gastritis ■
Acute gastritis ●
Curling’s ulcer → Gastritis due to a burn; sloughing of gastric mucosa →
●
Cushing’s ulcer → Brain injury causes increased vagal stimulation, thus increased ACh,
thus increased H production, thus ulcer → Always CUSHion the brain ■
Chronic Gastritis ●
Type A (fundus/body) found above type B (antrum) b/c A comes before B
●
Type A → Autoimmune, Auto.AB t o p arietal cells, p ernicious Anemia, Achlorhydria
●
Typ e B → Caused by H. py lori infection (most common)
●
AB paring: Ty pe A → Pernicious Anemia affects gastric Body
○
Type B → Bacterium affects Antrum
○
Menetrier’s Disease → Stomach rugae look like brain; due to t he fact that t hey are sup er hyp ertrop hied
○
Gastric Ulcer vs. Duodenal Ulcer
○
■
Gastric → Pain is Greater with meals (results in weight loss)
■
Duodenal → Pain is Decreased with meals (results in weight gain)
Inflammatory bowel disease ■
Crohn’s , think of a fat granny and an old crone skipping down a cobblestone
■
Fat → Creeping fat Granny → Noncaseating gran uloma Skipping → Skip lesions Cobblestone
→ Cobblestone mucosa Away from wreck → Rectal sparing ■
The other typ e of IBD is ulcerative colitis → Always with rectal involvement is implied by “colitis”; starts with rectum and works its way up
○
Meckel’s diverticulum → The five 2’s ■
○
○
2 inches long, 2 feet from ileocecal valve, 2% of pat, first 2y , 2 epithel (gastric/pancreatic)
Colorectal cancer ■
Gardner’s Syndrome: FAP + osseous/soft tissue masses, retinal hyperplasia
■
Turcot’s syndrome: FAP + malignant CNS tumor → TUR ban around the head
Carcinoid tumor ■
May have carcinoid syndrome (secondary to 5-HT p roduction from the neoplasm; ONLY seen if has metastasized beyond GI, as 5-HT from GI will be removed by first pass effect)
Wilson’s disease The ABCDs of Wilson’s diseaseA → Asterixis B → Basal ganglia degeneration (PD Sx) C → Ceruloplasmin decrease, Cirrhosis, Corneal deposits (Kay ser-Fleischer rings), Copp er accumulation, Carcinoma (hepatocellular), Choreiform movements D → Dementia
○
Hemochromatosis: Hemochromatosis Can Cause Deposits → Cirrhosis, CHF, Diabetes mellitus
○
Causes of acute pancreatitis → GET ■
G → Gallstones
SMASHED
■
E → Ethanol
■
T → Trauma
■
S → S teroids
■
M → Mumps
■
A → Autoimmune diseases
■
S → S corion sting
■
H → Hypercalcemia/ Hyperlipidemia
■
E → ERCP
■
D → Drugs (e.g. sulfa drugs)
○
RFs for Gallstones Fat, Female, Forty, Fertile:
○
Porcelain Gall Bladder → GB w/ dystrop hic calcification
○
H2 blockers ■
Take H2 blockers before you DINE → All end in -dine (cimetiDINE, ranitiDINE, famotiDINE, nizatiDINE); remember the 2 in H 2 with “table for 2”
○
T rip le t herap y : PPI, Metronidazole, Amoxicillin (or Tetracycline), Bismuth → Please MAke Tummy Better
○
Misoprostol → A PGE1 analog → Miso-PROS -tol, similar to a prostaglandin
○
Ant acids: Alumininum hy droxide → Causes constip ation, or a MINIMUM amt of feces ■
○
Magnesium hydroxide → Causes diarrhea
Ondansetron → A 5-HT3 antagonist, control vomiting post operatively and in chemo patients
xHematology and Oncology ○
WBC differential from highest to lowest → Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils → Neutrophils Like Making Everything Better
○
Eosinop hilia (DNAAACP): Drugs Neoplasms Atopic disease (asthma, allergies) Addison’s Acute Interstitial Nephrit is Collagen Vascular D isease Parasites (invasive)
○
The intrinsic and extrinsic pathways meet at factor X and activate it → Like two teams racing for a treasure, X marks the sp ot ■
PT comes before PTT alphabetically; extrinsic comes before intrinsic alphabetically; thus PT goes with extrinsic, PT T goes with int rinsic
○
○
Coagulation cascade components ■
Vitamin K is needed to synthesize 2, 7, 9, 10 AND protein C/S (two things)
■
Heparin activates antithrombin, which inactivates 2, 7, 9, 10 AND 11/12 (two things)
Basophilic stippling → Baste the ox TAIL → Caused by Thalassemias, Anemia of chronic disease, Iron deficiency, Lead poisoning
○
Pathologic RBC forms ■
Causes of target cells → HALT said the hunter to his target → H bC disease, Asplenia, Liver disease, Thallasemia. Can also rearrange to THAL to better remember Thalassemia
○
Hb Barts → A ll gamma (gamma4), or all fetal → Like Bart Simpson , who is a child and for kids
○
Lead p oisoning ■
LEAD → Lead lines on gingivae (Burton’s lines) and on ep iphy ses of long bones on x-ray; Encephalopathy and Erythrocyte basophilic stippling; A bdominal colic and sideroblastic Anemia; Drops (foot and wrist), Dimercaprol and EDTA 1st line of treatment
● ○
S uccimer is first line of treatment for kids → It “ sucks” to be a kid who eats lead
Autoimmune hemolyt anemia: Warm agglutinin is IgG → Warm is GGGreat. Cold is IgM → Cold ice cream,
MMM
○
Porp hy rias ■
Porphyria cutanea tarda → Caused by a defect in uropor phyr inogen dexarboxylase, get buildup of urop orphyrin (causing tea colored urine)
■
Acute intermittent porp hyria → Defective enzy ume is porp hobilinogen deamine, leading to buildup of p orph obilinogen ●
Por-phob-ilinogen → Poor FOB (like fresh off t he boat fob) → T hey are here acutely
and intermittently because they are deport ed ■
Disseminated Intravascular Coagulation (DIC) ●
Caused by → S epsis (gram-negative), Trauma, O bstetric compli, acute Pancreatitis, Malignancy, Nephrotic syndrome, Transfusion → STOP Making New Thrombi
○
○
Non-Hodgkins lymphoma subtypes ■
Mantle cell lymphoma → CD5+ → Men high 5 more commonly
■
Adult T cell lymp homa → Caused by H TLV-1, adult presents with cu Taneous lesions
■
Burkitt lymphoma: c-myc, "starry sky".t(8:14)
Multiple myeloma CRAB: C → hyper Calcemia R → R enal insufficiency A → Anemia B → Bone lytic lesions/Back pain. (monocloncal plasms cells have f ried-egg appearence ) ■
○
Lots of Ms → Multiple Myeloma: Monocloncal M protein spike that is IgM
Chromosomal translocations ■
CML → t(9;22), the Philadelphia chromosome → Philadelphia C reaML cheese
■
Burkitt's: t(8;14) → Uppercase B looks like an 8
■
Mant ll e cell → t( 11;14) → ll implise 11; Increased cyclin-d1 so crazy increase in cell cycle rate
■
Follicular → t(14;18) → Fourteen st arts with F
■
Ewing’s sarcoma → t(11,22) → P atrick Ewing’s number was 33, which equals 11 + 22
○
CMP dz : My elofibrosis is fibrotic obliteration of the bone marrow; teardrop cells are seen
○
Heparin ■
For rapid reversal of heparin effects, us protamine sulfate → A positively charged molecule that binds the negatively charged heparin → Positively charged like a proton
■
Lepirudin and bivalirudin directly inhibit thrombin, and are used as a heparin alternative in patients with heparin induced thrombocytopenia (HIT) → Lepi-rudin and bivali-rudin are rude in that they take heparins job and make it worthless
■ ○
HePAR in → PAR tial thromboplastin time (PTT); warfarin is the other one (prothrombin time, PT)
Cancer drugs ■
dACTinomycin is used for childhood tumors, including Wilms’ tumor, Ewing’s sarcoma, rhabdomyosarcoma → Children ACT out
■
6-MP... picture an M P(military policeman or woman
) blowing kisses=XO (xanthine oxidase)
■
5-FU... Fotosensitive
■
Busulfan & Bleomycin... The 2 B's blow up your Bronchi
■
CY-clophosphamide... Hemmorhagic CY-stitis
■
Nitrosoureas... most have "must" in their names... I picture them as alcoholics that are acting crazy = Those Alky's MUST be Crazy = alky agents, CNS tox.
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Cisplatin... "I heard platinum crosses the kidneys" = heard(oto-tox), crosses(X-linking), kidney(RF)
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Carmustine = CAR-MUST-ine = "I drove a CAR (Mustang) across the BBB"
■
DoXorubicin is more toXic than Duanorubicin
■
eTOPoside → inhibits TOPoisomerase II, thus increasing DNA degradation
■
Vincristine, vin blastine → Alkaloids that b ind to tubulin in M-p hase and block polymerization of
microtubules so that mitot ic spindle cannot for m → M icrotubules are the vines of y our cells ■
PacliTAXel and other TAXols → Hyperstabalize polymerized microtubules in M-phase so that mitotic sp indle cnanot break down (anaphase cannot occur) → It is TAXi ng to stay polymerized, but t he TAXols make it happ en; also, t hese drugs are used t o treat ovarian and breast carcinoas → It is TAXing to be a female, having a period and such; also, females are very sensitive about everythnig, so these drugs cause hyper s ensitivity
■
CisPLATin, carboPLATin → Causes acoustic nerve damage → When you drop a PLATe it makes a loud horrific shattering sound, damaging your acoustic nerve
Bortezomib -Bart likes going to M ultiple M cdonalds (M ultiple M yeloma).- treatment for r efractory
Multiple my eloma.Toxicity-G oing to M cdonalds t o oft en will Produces nausea, diarrhea, weakening of muscles, bone marrow sup pression, p eripheral neurop athy , fever, anorexia, anemia and const ipation. Trastuzumab- cant trust a girl with big boobs so you have to block her with MAB(monclonalAB). Toxic-she is also going to hurt your heart when combined with Adriamycin .
■ ●
Musculoskeletal and Connective Tissue ○
Epithelial cell junctions ■
Zona adherens has Actin attached to it; composed of cadherins (Ca2+ dependent ADhesion molecules) which sound like adherens; these cadherens connect to the actin
■
Macula adherens: K eratin (intermediate fillament) attached t o desmopla K in
■
Desmosome vs hemidesmosome ●
HEMI-desmosome has more letters; it thus corresponds to the disease with more letters (bullous PEMP HIGOID (10 letters)); also, antibodies to the hemidesmosome are BULLO w t he dermis
●
Desmosome has fewer letters; it thus corresp onds to the disease with fewer letters (PEMPHIGUS (9 letters) vulgaris)
○
Unhappy triad (knee injury) ■
In the knee, you have menisci, collateral ligaments, and cruciate ligaments
■
MAL → Like Prof. Mal, who w as big like a football play er (this is a common football injury when a
player is hit from the side)
■
○
M → Medial collateral ligament
○
A → Anterior cruciate ligament
○
L → Lateral meniscus
Positive anterior drawer indicates tearing of the ACL
○
Rotator cuff muscles: SItS → S upraspinatus, Infraspinatus, Teres minor (small t for minor), S ubscrapularis
○
Upper extremity innvervation ■
If you do a RAD jump on a skateboard, you may hurt y ourself and get crutches → Incorrect use of crutch can cause RADial nerve compression
○
Brachial plexus ■
○
Comp osed of R oots, Trunks, Divisions, Cords, Branches → R andy Travis Drinks Cold Beer
Carp al bones : S caphoid, Lunate, Triquetral, Pisiform, Trapezium, Trapezoid, Capitate, Hamate → S ome Lovers Try Positions That They Can’t Handle
○
Upper extremity nerves ■
Being rad is the BES T → Radial nerve innervates the “BEST” extensors ●
B → Brachioradialis
●
E → Extensorts of wrist/fingers
○
●
S → S upinators
●
T → Triceps
■
Erb-Duch enne palsy is waiter’s tip palsy → Waiter’s at restaurants tend to be douches
■
Klum pke’s palsy → claw hand
Hand muscles ■
Thenar & ulnar muscle groups have same functions: O pp ose, A bduct, and Flex, OAF
■
Dorsal interosseous muscle Abduct the fingers; Palmar interosseous muscle Adduct the fingers
● ■
○
○
DAb with a PAd
Ulnar nerve supplies the wimpy stuff ●
Tiny wimpy little pinky
●
Tiny wimpy little interosseous muscles
Lower extremity nerves ■
PED → Peroneal Everts and Dorsiflexes; if injured, foot drop PED (dorsiflex = extend foot)
■
TIP → Tibial Inverts and Plantarflexes; if injured, can’t stand on TIPtoes
Sarcomere: Z line → Z is at end of alphabet, Z line is at end of sarcomere. H → Thick letter, so only thick filaments. I → T hin letter, so only thin filaments. A band is Always the same length; HIZ shrinkage
○
Muscle fibers: One slow red ox → Ty pe 1 fiber slow twitch; red mito+myoglobin; more oxidat metabol
○
Bone mineralization diseases ■
OsteoPOR osis → Decreased primarily trabecular (spongy) bone mass (i.e. the type with pores ; also the decrease in bone mass is like creating pores ) OsteoPETrosis → F ailure of bone breakdown
■
Osteomalacia → vitamin D deficiency; low Vit D, low blood Ca2+, low bone mineralization
■
Page t → Page is a girl’s name → Girls can never make up t heir minds; absorp tion & resorp tion
■
Ewing’s sarcoma: onion skin appearence → Ewings and onion rings t 11;22 translocation
○
Gout: Crystals are negatively birefringent; yell ow cryst als under p arall el light
○
Pseudogout: calcium Pyrophosphate crystals cause Pseudogout and t hey are Positively birefringent
○
Infectious arthritis: N. gonorrhoeae, STD → S ynovitis (knee), Tenosynovitis ( hand), Dermatitis (pustules)
○
Skin disorders: Macule is a small patch, Papule is a small plaque
○
●
■
■
Acanthosis nigricans is hyp erplasia of the stratum spinosum
■
Staph scalded skin sy ndrome (SSSS) → Affects stratum granulosum
■
Lichen Planus → Pruritic, Purple, Polygonal, Papules!
Arachidonic acid products ■
Lipoxygenase pathway yields Leukotrienes
■
LTB4 → Neutrop hil chemotactic agents; neutrop hils arrive B4 other cells
■
PGI2 inhibits platelet aggregation → Platelet Gathering Inhibitor
○
Bisphosphonates: corrosive esophagitis and osteonecrosis of t he jaw
○
TNF-alpha inhibitors ■
Etanercept → Etaner CEPT is TNF decoy reCEPTor
■
InFLIXimab → Predisp oses t o infections, such as reactivation of T B
Neurology ○
○
CNS/PNS origins ■
from neuroectoderm, neural crest, and mesoderm; microglia, like macrophages, from mesoderm
■
N eural crest → Schwann cells and P NS neurons; think of a family crest with a Pear and a swan
Sensory corpuscles ■
Pacinian corp uscle → Associate with tu PAC
●
Sense → Vibration and pressure, like Tupac’s fly ass rap music with thumping bass
■
Meissner’s corpus cles → P icture an old meisserly gentleman
●
Seen in glabrous (hairless) skin → Old men are bald, hairless ○
While Merkel’s adapts slowly, M eissner’s adapts quickly; thus while Merkel’s handles st atic touch, M eissner’s handles dy namic touch
○ ● ○
Free nerve endings are made up of C and ADelta fibers → “You C an AD for free ”
Neurotransmitters: Nucleus acCUM bens → Reward center, pleasure, addiction; like CUMming ●
○
While Marker’s handles hair follicles, M eissner’s glaborous (hairless) skin
Also makes GABA, because GABrielle Union makes you cum
Hypothalamus
■
wears TAN HATS : Thirst & water balance, Adenohyp ophy sis control, Neurohyp ophy sis releases hormones from hypothal, Hunger, Autonomic regulation, Temperature regulation, S exual urges
■
lateral nucleus of the hypothalamus handles hunger → zap lateral nucleus, you shrink laterally
■
The ventromedial nucleus handles satiety → zap ventromedial nucl, grow ventrally and medially
○
Posterior pituiatary (neurohypophysis) Adenohypophysis → Anterior pituitary
○
Thalamus ■
VPM relays face sensation and t aste; VPL relays pain/temperature/pressure/touch/vibration/prop riocept ion for the body ●
■
LGN → Relays vision information; MGN → Relays auditory information
● ○
Makeup goes on the face (VP M) Lateral = Light; Medial = Music
Limbic sys tem → The famous 5 F s, one of w hich being fucking; you use y our “ limbs ” to finger or fist
someone ■ ○
Responsible for Feeding, Fleeing, Fighting, Feeling, and Fucking
Cerebellum ■
Deep nuclei, from medial to latereal → Fastigial, Globose, Emboliform, Dentate → Fat Gerbils Exercise Daily (note useful association with movement)
○
Basal ganglia ■
D1 receptor is involved in the direct/excitatory p athway, whereas D2 recept or is involved in the indirect/inhibitory pathway
○
D1-R is used in the D1R ect pathway
●
Indirect pathway is Inhibitory
Cerebral cortex functions ■
○
●
Princip le motor area is anterior to principal sensory areas, just like motor is in the front of a car
Brain les ions ■
AMYgdala lesion (bilateral) → Kluver- Bucy syndrome (hyperorality, hypersexuality, disinhibited)
■
Cerebellum: Cerebellar hemispheres are laterally located and affect lateral limbs (int ention t remor, limb ataxia); vermis is centrally located and affects central body (truncal ataxia, dysarthria)
■
Contralateral hemiBALLismus occurs due to lesion to S UBthalamic nucleus
■
Eye movement problems ●
S UPERIOR colliculus lesion causes paralys is of UPWARD gaze
●
Frontal eye field lesion makes eyes look toward lesion → You look at something that is
right in front of you ●
Paramedian pont ine reticular formation (PP RF) lesion makes y ou look away from the
lesion → You look tow ard the pariphery ○
Aneury sms ■
Causes of berry aneurysm include Ehlers-danlos, Marfan’s, and Adult poly Cystic kidney disease
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Charcot-Bouchard microaneurysms → chronic HTN ; Chronic-BP p roblem microaneurys ms
○
Sp inal nerves ■
○
31 spinal nerves, just like there are 31 flavors at Baskin Robbins. 1 coccygeal nerve, 1cock
Spinal cord, Lower extent ■
Lumbar puncture is usually p erformed in L3-L4 or L4-L5 interpsaces, at level of cauda equina → To keep the sp inal cord alive, keep the s pinal needle between L3 and L5
○
Spinal cord and associated tracts ■
Legs are Lateral in Lateral corticosp inal (voluntary motor), sp inothalamic tracts (pain/temperature)
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Dorsal collumn is organized as you are, with hands at sides; arms outside (the laterally placed fasciculus cuneatus carries info from up per body , extremities), legs inside (the medially placed fasciculus gracilis carries info from lower body, extremities)
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Intermediate horn with sympathetic fibers is in thoracic spinal cord only → You should have SYMPathy for THOR because he is forced to use hammer
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Werdnig-Hoffman disease: AR, infantile spinal muscular atrophy . Flopp y baby with tongue fasciculations; median age of death is 7 months; degeneration of anterior horns (LM N)
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Amyotrophic lateral sclerosis (AML, or Lou Gehrig’s disease) ■
Both UMN and LMN signs, but no sensory/cognitive/oculomotor deficits. Stephen Hawking smart like a superhuman mutant, ALS can be caused by defect in superoxide dismutase 1 (SOD1)
○
Friedrich’s ataxia: AR trinucleotide repeat disorder (GAA) in gene that encodes frataxin
○
Landmark dermatomes ■
C6 → Stick arm out like crucifixion stance. Curl your thumb and forefinger into an "O K" sy mbol while keeping your other fingers straight. Your hand should now look like a 6 shape. So C6 dermatome is y our thumb and top of arm (reason for crucifix stance).
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C7 includes the middle finger → C7 give sthe middle finger to heaven
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T4 is at the nipple → T4 is at the teat pore
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T 7 is at the Xiphoid process → 7 has a line that is identical to p art of t he X of Xiphoid process
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T10 is at the umbilicus (important for early appendicitis pain referral) → T10 is at belly but TEN
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L1 is at the Inguinal Ligament → L1 is IL
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L4 includes the kneecaps → D own on L4s (all fours )
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S2, S3, S4 are respons ible for erection and sensation of p enile and anal zones → “ S2, 3, 4 keep t he
penis off the floor” ○
Clinical reflexes. Reflexes count up in order, from the bottom to the top ●
Achilles → S1, 2
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P at ella → L3, 4
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Bicep s → C5, 6 ○
● ○
Biceps before Triceps alphabetically
T ricep s → C7, 8
Primitive reflexes ■
Rooting reflex → Movement of head toward one side if cheek or mouth is stroked (nipp le seeking)
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Moro reflex → “Hang on for life” reflex; baby that is st artled will abduct/extend limbs,Brain stem
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CNs that lie medially at the brain stem → 3, 6, 12; 3(X2) = 6(X2) = 12 ●
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All motor → Motor = Medial
Superior colliculi are the conjugate vertical gaze center; inferior colliculi are for auditory info ●
Your eyes are above your ears, and superior colliculus (visual) is above the inferior colliculus (auditory)
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Parinaud sy ndrome → Paralysis of conjugate vertical gaze due to lesion in superior colliculi; makes you parinaud (paranoied) bc you don’t know what’s above you
Cranial nerves ■
To determine if the nerve is S ensory, Motor, or Both → S ome (1) S ay (2) Marry (3) Money (4)
But (5) My (6) Brother (7) S ays (8) Big (9) Boobs (10) Matter (11) Most (12)
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Salivation: Facial controls s ubmandibular, sublingual; Glossopharyngeal (9) controls Parotid → Flip the 9 over and have a P for Parotid
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Cranial nerve nuclei: Medial nuclei are Motor
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Vagal nuclei ●
nucleus S olitarius → visceral S ensory information (e.g. taste, baroreceptors, gut distension)
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nucleus aM biguus → Motor innervation of pharynx, larynx and upper esophagus (e.g. swallowing, palate elevation)
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Cranial nerve and vessel pathways ■
Cranial nerve V has V1, V2 and V3, which leave the skull at the S uperior orbital fissure, foramen R otundum, and foramen O vale, respectively → CN V leaves because it is S tanding R oom O nly
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Cranial nerve lesions: In a CNXII lesion, the tongue deviates towards the side of the lesion → You want to lick your wounds
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Facial nerve lesions: Bell’s palsy is a complication of AIDs, Ly me disease, Herpes, Sarcoidosis, T umors, Diabetes → ALexander graHam Bell with an S TD
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KLM sounds: Kuh-kuh-kuh tests palate elevation (CN X); La-la-la tests tongue (CN XII); mi-mi-mi tests lips (CN VII) → It would be a KaLaMity to lose Cn X, XII nad VII
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Mastication muscles ■
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3 muscles close jaw: Masseter, teM por alis, Medial p terygoid; 1 muscle op ens: Lateral ptery goid ●
M’s Munch
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Lateral Lowers (i.e. lowers the jaw down, as in op ening the mouth)
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“It takes more muscle to keep y our mouth shut”
Glaucoma: Op en/wide angle. Seen in African-Americans, old peop le most commonly → Black girls have wide asses; old p eople get fat and have wide asses
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Extraocular muscles and nerves ■
CN 6 sup plies the Lateral R ectus; CN 4 sup plies the S uperior O blique; CN 3 sup plies the R est → LR4SO4R3
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The inferior oblique performs EXcyclotorsion, while the superior oblique performs INcyclotorsion → “My EX is INFERIOR to my current girl” and “the SUP is IN the kitchen”
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CN III lesion → Eye looks down and out ●
“I’m down and out because I’ve never had a three-some”
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3 is half of 6 (devil’s number), so it makes you sad (down and out)
Testing extraoccular muscles ●
To test Inferior O blique, have patient look U p (also slightly nasal, as the oblique muscles work for elevation/depression when the ey e is adducted) → IOU ○
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Superior oblique is down (and a bit nasal), or the opposite
Pupillary control ●
Constriction (miosis; can remember that miosis is constriction because it is a tiny little word relative to mydriasis, and thus can better “fit” into the small pupil) ○
● ■
Dilation (my Driasis) → Radial muscle
Cranial nerve 3 in cross section ●
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Pupillary sp hincter muscle via Parasympathetics
Middle is Motor; Periphery is Parasympathetic
Visual field defects ■
Central scotoma is macular degeneration in retina, causes visual defect like a little ball where macula is → central scrotom a filled with balls
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Meyer’s loop is lateral and goes inferior to lingual gyrus → Mey lats are inferior to Arnold’s,
but I make up for it by giving awesome oral sex (lingual gyrus) ○
Internuclear ophthalmoplegia (MLF syndrome): MLF sy ndrome is seen in MS
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Dementia: Alzheimer’s disease (Early onset form associated with the presenilin-1 and pres enilin-2 genes) ■
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Lewy body dementia → alpha-S YNuclein defect seen histologically → Lewd and S YNful
MS: Charcot’s triad is SIN: S canning speech, Intention tremor, Incont, I NO (M LF), Nystagmus ■
Tuberous sclerosis → Think wild hot Tub part y: People fuck in hot t ubs, so associated with SHAGreen patches. Someone is getting hammered, so this disease is based on hamartomas. People
are smoking weed in the hot tub, s o they have ash leaf spot s ○
Meningitis: fever, headache, nuchal rigidity , and Kernig’s sign: With p atient s upine, Dr flexes p at hip but cannot extend the knee without causing pain (stretches meninges, pain seen with meningeal irritation).
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Opoid analgesics ■
Mu receptors bind Morphine; Delta receptors bind ENkephalin; Kap pa receptors bind DYnorphin
(if you get “ cap ped” (slang for gett ing shot ) you “ dy”) ○
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Inhaled anesthetics ■
Halothane is Hepatotoxic
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Enflurane is a p roconvulsant, or it has E pilept ic sides
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Meth oxyflurane is nephrot oxic → Meth is Neph
IV Anes thet ics ■
Barbiturates, Benzodiazepines, K etamine, O piates, Propofol → B. B. K ing on OPIATES PROPoses FOOLishly
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Midazolam is most common drug used for endoscopy → Use Mid-Az-olam when you want t o p ut an endoscope in the Middle of someones Az (ass)
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Propofol is associated with high triglycerides, milky blood, pancreatitis
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Local Anesthetics: -caine ;
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Either esters or amIdes; the amIdes have 2 Is → LIdocaIne, mep IvacaIne, bup IvacaIne
Parkinson’s disease treatment ■
The drugs used to treat PD are the BALS AC drugs (which is logical, since it is fun to expose your ballsac the park ) → Bromocriptine, Amantadine, L-dopa, S elegiline, Antimuscarinics, Carbadopa
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Benz trop ine is an antimuscarinic improves tremor and rigidity but has little effect on brady kinesia
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entaCAPONE and tolCAPONE are COMT inhibitors that prevent L-dropa degradation Sumatript an → 5HT 1B/1D agonist (5-H T being seritonin, hy droxyTRYPtamine), used t o treat headaches (cluster, migraine) → A S UMo wrestler TRYPs and falls on your head.
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Psychiatry ○
Intelligence quotient: Stanford-Binet → Calculates IQ as (Mental age/Chronological age)*100
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Freud’s structural theory of the mind ■
Unorganized part of p ersonality structure that contains the basic drives; food, sex, aggression → The Id is all about t he Instincts
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Superego is all about being just S UPER moral
Ego defens es ■
The mature ego defenses are S ublimation, Altruism, S upp ression, and Humor; commonly found in emotionally mature adults ( in contrast, some of the others are immature or even pathological) ●
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Mature women wear a SASH
Infant deprivation effect: 4 Ws, dep rived babies Wah, Wah, Wah, Wah → Weak (no muscle tone, weight loss, phys ical illness), Wordless (poor language), Wanting (poor socialization s kills), Wary (no trust)
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Orientation: Order of loss → 1st time, then place, then person last
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Delirium vs. Dementia → DeliRIUM has changes in senso RIUM (waxing/waning consciousness,
hallucinations, disorganized thinking, illusions misperceptions) ; deMEMtia has MEMory loss ■ ○
del-EE-rium has an abnormal EEG, whereas dementia does not
Hallucination types. hypnaGOgic hallucination → Occurs while GOing to sleep. hypnoPOMPic hallucation ■
ATypical Depression is FATypical depression → hypersomnia (fat person is lazy and sleeps all
the t ime), overeating (fat), weight gain (fat), s ensitivity to rejection (happ ens to fat p eople a lot) ○
Antipsychotics (neuroleptics)
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These drugs are haloperidol and the -azines (ex. fluphenazine, thioridazine)
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Chlorpromazine → Corneal deposits
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Thiordazine → reTinal deposits
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These drugs can cause neuroleptic malignant syndrome (NMS), which can have hyp erpyrexia (fevers great t han 106.7 degrees!!!) → T hus t he menmonic for NM S is FEVER ●
F → FeverE → EncephalopathyV → Vitals unstableE → Elevates enz ymes (muscle breakdown, myoglobinuria)R → R igidity of muscles
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Atypical antipsychotics ■
Atypicals include ol anzapine, cloz apine, quetiapine, risperidone, aripiprazole, z iprasidone → It’s atypical for ol d clos ets to quietly risper from A to Z
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Olanzapine and clozapine: weight gain, you can’t wear your OLd CLOZ (clothes) anymore
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Clozapine: agranulocyt osis (requires weekly WBC monitoring) → Must watch cloz apine cloz ely
Tricyclic antidepressants: Side effects ●
The TRI-Cyclics cause the tri-C s → Convulsions, Coma, Cardiotoxicity (arrhyt hmias)
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Old people can get confusion and hallucinations due to the anticholinergic side effect of TCAs, so must give them nor triptyline (this is a secondary TCA; they have fewer anticholinergic effects) → To prevent the old p erson from have a bad trip, give them NO -r-TRIPtyline
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Renal ○
Acidosis/alkalosis ■
In metabolic acidosis, check the anion gap. Causes of increases anion gap → MUDPILES (remember that when a pile builds up, something is increased)
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M → Methanol (formic acid)
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U → Uremia
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D → Diabetic ketoacidosis
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P → Paraaldehyde/Phenformin
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I → Iron tablets or I NH
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L → Lactic acidosis
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E → Ethylene glycol (oxalic acid)
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S → S alicylates/ S hock
Renal tubular acidosis ●
Ty pe 1 → “ Distal” renal tubular acidosis → Defect is at the level of the collecting duct; it cannot excrete H+ → The number 1 is a big straight line similar to the way the collecting duct is always drawn
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Ty pe 2 → “Proximal” renal tubular acidosis → Remember that p roximal comes right after distal ○
Pro-two-type (like pro-to-type) → This word links “pro” and “to”
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Ty pe 3 → Nothing; a lot of people link 3 or 333 and the devils number 666; thus do not wanta 3. 666 is especially bad/scary if you are on ACID
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Type 4 → Hyperkalemic.
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60-40-20 rule: TBW is 60% of body weight; ICF is 40% of body weight; ECF is 20% of body weight
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Measuring fluid compartment volumes
○
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Mannitol measures ECF → Mann-E, like the name Manny
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evans BLUE measures Plasma → BLUE-Per → Blooper
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Radioiodinated serum albumin
NephrItic syndrome → Infl ammatory process; vs. Ne phrOtic → massi ve prOtei nuria
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Rapidly progressive (crescentic) glomerulonephritis (RPGN) ●
RPG N → Like an RPG video game → These games are notorious for having good music
→ Caused by Goodpasture, Wegener’s, Microscopic poly angiitis → Games With Music ● ■
Remember crescent MOON shape becuase of the classic RPG game Harvest MOON
Diffuse proliferative glomerulonephritis ●
See “wire looping ” of capillaries on LM → This condition is caused by lupus → Wire-lupus lesion
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Berger’s disease → Think of as “ boogers ” disease
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Increased synthesis of IgA → Boogers are in the nose; the nasal mucous membrane is associated wit h IgA antibodies; boogers have lots of IgA in t hem
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Often presents/flares with a URI or acute gastroenteritis → Often have lots of mucous/boogers when you are sick
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LM and IF show ICs deposited in the mesangium → Picture boogers in the mesangium
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M C in children /young adults → Children commonly pick boogers out of their noses
Alport’s sy ndrome → Can’t see (ocular disorders), can’t pee (nephritic sy ndrome), can’t hear (deafness). M utation in ty pe 4 collagen
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NephrI tic syndrome → Inflammatory process; vs. Nephr O tic → massive pr O teinuria ■
Minimal change → change is minimal , normal LM (but on EM can see foot process effacement) ●
■ ○
Minimal change disease is MC seen in minimal age people (children, <10 yo)
Focal segmental glomerulosclerosis → M C glomerular disease in HIV patients ( Fags)
Kidney st ones: Of all kidney stone typ es (Ca, ammonium Mg phosp hate, uric acid, cys tine), only Uric acid is radiolUcent → All others are radiopaque
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Kidney cancers ■
Renal cell carcinoma → Mos t generic, basic name imaginable → Mos t common renal malignancy
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Wilm’s tumor → part of WAGR complex → Wilms tumor, Aniridia, Genitourinary malformation,
and mental-motor R etardation ■
Transitional cell ca: issue in Pee SAC → Phenacetin, S moking, Aniline dy esk Cyclophophamide
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Diuretics
Pharmacology ●
Acetazolamide → ACIDazolamide causes ACIDosis!!!
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Loop diuretics (furosemide, bumetanide, torsemide, ethacrynic acid) → Loops Loose Ca2+, thiazides don’t ○
“ OH DANG, that bitch is FURious (F URosemide)!” → Sides of loop diuretics → O totoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis (interstitial), Gout
○
Ethacrynic acid → Phenoxyacetic acid derivative, NOT a sulfonamide; essentially the same action as furosemide → If someone is being a little bitch and CRYN about sulfonamide drug, give them etha CRYNic acid; can also use in case of gout, wheras furosemide causes gout
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Thiazide diuretics (hydrochlorothiazide ○
Toxicity → HyperGLUC → hyper Glycemia, hyper Lipidemia, hyper Uricemia, hyper Calcemia
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K sparing diuretics → The K S TAys → S pironolactone, Triamaterene, Amiloride (also E plerenone, perhaps remember as STAEs although this is kind of stupid)
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ACE inhibitors → Captopril, enalapril, lisinopril ●
Sides → CAPTOPRIL. Cough, Angioedema, Taste changes, hy p O tension, Pregnancy problems, R ash, Increased renin, Lower angiotensin II
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Reproductive ○
Round ligament of the uterus does not contain any structures → A zero is round; it contains zero structures; travels through the round inguinal canal
○
Pathway of sperm during ejaculation → SEVEN UP → S eminiferous tubules, E pidy dimus, Vas deferens, E jaculatory duct, Nothing, Urethra, Penis
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Mesonephric ducts → Male, Paramesonephric ducts → Female; the female one has the added prefix of “para-”, just like FEmale and WOman
○
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Autonomic innervation of the male sexual response ■
Erect ion is Parasymp athetic, ejaculation is S ymp athetic → Point and S hoot
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Erection, Emission, Ejaculation → Pelvic n., hypoGastric n., Pudendal n. → Penis Goes in Pussy
Sperm parts: Middle piece (neck) has mitochondria, feeds on Fructose. Acrosome derived from Golgi!!! Regulation of spermatogenesis
○
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FS H → S ertoli cell → Sp erm product ion
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LDH → Leydig cell → Testos terone
Oogenesis ■
Meiosis I is arrested in pr O phase for y ears until O vulation (stuck as primary oocytes)
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Meiosis II is arrested in METaphase unt il fertilization (stuck as a s econdary oocyt e) → An egg MET a sperm
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Preeclampasia: Associated with HELLP syndrome → Hemolysis, Elevated LFTs, Low Platelets
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Pregnancy complications ■
Abruptio placentae → Premature detachment of placenta from implantation site
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In p lacent a accreta, you exccreta a shitload of blood bc the p lacenta is attached to t he myometrium
○
RF for endometrial carcinoma → HONDA → Hyperplasia, O besity , Nuliparity, Diabetes, Anovulatory
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Ovarian germ cell tumors ■
Dysgerminoma → Elavated LDH, hCG → There are a lot of germs on a Large Cock
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Choriocarcinoma has elevated h CG only
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Yolk sac tumor → AFP tu marker → FAP is internet s lang for masturbate
○
Ovarian non-germ cell tumors: Brenner tumor → Benign and looks like Bladder
○
Benign breast tumors ■
Phyllodes Tumor → Present later in life (6th decade), large/immobile
Malignant breast tumors ■
Comedocarcinoma → breast cancer with causeous necrosis
■
Inflamm breast cancer → Has peau d’orange
○
○
Drugs that cause gynecomastria ■
S ome Drugs Create Awesome K nockers → Spiro, Digitalis, Cimetidine, Alc, Ketoconazole
■
Also, PHEM (like PHEMinine) → Psy choactive drugs, Heroin, Estrogen, Marijuana
Pharmacology
■
Leuprolide → GnRH analog with agonist prop erties when used in pulsatile fashion; antagonist properties when used in a continuous fashion → Leu prolide can be used in lieu of GnRH
■
Ritodrine → Beta2-agonist t hat relaxes the ut erus → Ritodrine allows t he fetus t o “ return to dreams” by preventing early delivery
● ■
Terbutaline does the same thing
Tamsulosin (Flomax) is selective for alpha1A,D receptors (found on prostate); does not bind vascular alpha1B receptors → The prostate one binds the Asshole, Dick receptor whereas the vascular one binds t he Blood rece0ptor as well
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Sildenafil (Viagra), vardenafil → NW: Headache, Heartburn, Hyp otension. Imp aired blue/green vision → Viagra is the “little blue pill”
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Respiratory ○
Pneumocytes → Lecithin to sphingomyelin ratio can be used to assess maturity of fetal lungs; mature when lecithin:sphingo is > 2; you pick your nose with your SPHINGER (sphingomyelin), which is immature; thus want this to be low in ratio to indicate maturity
○
○
■
Typ e I cells are thin like “I”; type II are cuboidal
■
Typ e II cells are precursors to both type I/II cells, 2 as in your are given a 2nd chance
Bronchopulmonary segments ■
Lung Relations:Left lung 2 lobes (heart “ replaces” one)+Lingula(homologous to right middle lobe)
■
RALS describes relation of p ulm artery t o bronchus at each lung hilus → R ight Ant, Left S uperior
Diaphragm structures ■
C3,4,5 keep the diaphragm alive
■
Number of letters = T level where structure perforates diaphragm:
■
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T 8: Vena Cava
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T10: (o)esophagus
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T12: Aortic hiatus
Another T level mnemonic: “I (IVC) ate (8) ten (10) eggs (esophagus) at (aorta) twelve (12)” ●
M odified version to include more: I (IVA) ate (8) ten (10) vagina (vagus) eggs (esophagus) at (aorta) twelve (12). Ass-y (Azygous vein) Taste (thoracic duct) (ass-like taste because of vagina thing of course, the ass is like RIGHT there)
○
○
8 → IVC
○
10 → Vagus n., esophagus
○
12 → Aorta, azygous vein, thoracic duct
Lung volumes ■
Remember that capacities are combinations of volumes; only 4 basic volumes exist → Tidal volume, inspiratory reserve volume, expiratory reserve volume, and residual volume; everything else combines t hese, so start with these as an easy-t o-remember logical framework ●
Total lung capacity is obvious (all volumes combined); vital capacity is easy to remember because of the FVC measurement, where someone breathes in and then breathes out maximally (thus it is everything but residual volume)
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The two remaining volumes are just combibnations of the top two volumes (TV + IRV, or inspirat cap acity ) and bott om two volumes (ERV + RV, or functional residual capacity)
