WBR mnemonics: Difference between revisions
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* Lys | * Lys | ||
==Golgi | ==Golgi Complex Functions== | ||
<font color="red">{{cquote|'''Golgi Distributes A SPAM'''}}</font> | <font color="red">{{cquote|'''Golgi Distributes A SPAM'''}}</font> | ||
Distributes proteins and lipids from ER | * '''Distributes''' proteins and lipids from ER | ||
* '''A'''dd mannose onto specific lysosome proteins | |||
* '''S'''ulfation of sugars and slected tyrosine | |||
* '''P'''roteoglycan assembly | |||
* '''A'''dd O-oligosugars to serine and threnonine | |||
* '''M'''odify N-ologosugars on asparagine | |||
==Catabolism Steps of Branched Chain Amino Acids== | ==Catabolism Steps of Branched Chain Amino Acids== |
Revision as of 20:02, 31 January 2014
WikiDoc Board Review |
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The Project |
The Team |
Guidelines |
Question List |
Quality Checklist |
Medical Illustrations |
Question Template |
High Yield! |
Normal Labs |
Mnemonics |
Test Taking Tips |
Resources |
Editors-In-Chief: William J. Gibson, B.S.[1]; Gonzalo A. Romero, M.D.[2]
GI Anatomy
“ | Dow Jones Industrial Average Closing Stock Report | ” |
From proximal to distal:
- Duodenum
- Jejunum
- Ileum
- Appendix
- Colon
- Sigmoid
- Rectum
Acute Pancreatitis Causes
“ | GET SMASHED | ” |
"GET SMASHED"
- Gall stones
- Ethanol
- Trauma
- Steroids
- Mumps
- Autoimmune disease
- Scorpion venom
- Hyperlipidemia
- ERCP (dye)
- Drugs (Azathioprine, Asparginase, Mercaptopurines, Pentamidine)
Alcohol and Gallstones are the most common causes.
APGAR Score
“ | APGAR | ” |
- Appearance (color): blue/pale, trunk pink, all pink
- Pulse (heart rate): 0, <100, 100+
- Grimace (reflex irritability): 0, grimace, grimace+cough
- Activity (muscle tone): limp, some, active
- Respiration (respiratory effort): 0, irregular, regular
- Score 0-2 at 1 and 5 minutes in each of 5 categories, being 10 the perfect score.
Multiple Endocrine Neoplasia (MEN)
Each of the MENs is a disease of three or two letters plus a feature; all are autosomal dominant.
“ | MEN I: 3 P's | ” |
- Pituitary
- Parathyroid
- Pancreas
- Plus Adrenal cortex
“ | MEN II: 2 C's | ” |
- Carcinoma of thyroid
- Catacholamines (pheochromocytoma)
- MEN IIA: parathyroid - MEN IIB (MEN III): mucocutaneous neuromas for
Acute Pneumonia Infiltrates
- Pyogenic bacteria: PMN infiltrate
- Miscellaneous microbes: Mononuclear infiltrate
Takayasu's Disease/Pulseless Disease
“ | When you have Takayasu's, I can't Tak'a yu pulse | ” |
Alcoholism Screening
“ | CAGE | ” |
- Have you ever felt it necessary to CUT DOWN on your drinking?
- Have you ever been ANNOYED when people suggest you cut down on your drinking?
- Have you ever felt GUILTY about your drinking?
- Have you ever felt the need to have a drink in the morning for an EYE OPENER?
Chief Complaint
“ | OPQRST | ” |
- O - Onset of pain: what was the patient doing when the pain started?
- P - Palliative or Provocative factors for the pain
- Q - Quality of pain (burning, stabbing, aching, etc.)
- R - Radiation (up to jaw, down left arm, etc.)
- S - Severity of pain (usually 1 - 10 scale)
- T - Timing of pain (eg: after meals, in the morning, how long it lasts, etc.)
“ | SOCRATES | ” |
- S - Site of pain
- O - Onset of pain
- C - Character of pain: dull, sharp, aching, stabbing, tearing
- R - Radiation of pain: central abdominal pain radiating to Right Iliac Fossa
- A - Associated factors: eg. nausea/vomiting
- T - Timing of pain/duration
- E - Exacerbating/alleviating factors
- S - Severity of pain (1 - 10 scale)
“ | ASCLAST | ” |
- A - Aggravatiing and Alleviating factors
- S - Severity
- C - Character, quality
- L - Location
- A - Associated symptoms
- S - Setting
- T - Timing
NOTE: ASCLAST means let the patient talk first, then ask him/her specific questions.
Post-Op Fever Causes
“ | Five W's | ” |
- Wind: pneumonia, atelectasis
- Wound: wound infections
- Water: urinary tract infection
- Walking: DVT/PE (walking can help reduce DVT/PE)
- Wonderdrugs: especially anesthesia
Predisposing Conditions for Pulmonary Embolism
“ | TOM SCH PREFER | ” |
- T - Trauma
- O - Obesity
- M - Malignancy
- S - Surgery
- C - Cardiac disease
- H - Hospitalization
- P - Past history
- R - Rest (bed-bound)
- E - Estrogen, pregnancy, post-partum
- F - Fracture
- E - Elderly
- R - Road trip
Compartment Syndrome Signs (Arterial Occlusion)
“ | 6 P's | ” |
- Pain
- Pale (Pallor)
- Perishing with Cold (Poikilothermia)
- Pulseless
- Paresthesias
- Paralysis
Hospital Admission Orders
“ | DAVE WILMINGTON | ” |
- Diet
- Activity
- Vital signs: how often to monitor
- Excrement: test urine/stool
- Weight: how often to monitor
- I / O: monitor input/output
- Labs: which/how often
- Meds: which/route/interval
- I V fluids: what/at what rate
- Nursing care: e.g. position, wound care, up in chair, ostomy care
- General care: e.g. physical/respiratory therapy
- Tests: e.g. X-ray/EKG/EEG
- Observe for: reaction/seizure/neuro exams
- Notify parameters: e.g. Temperature > 100 F / respiration changes
After noting date and time of admission as well as diagnosis and condition (ADC), use the mnemonic to ensure all areas are addressed, but not all apply to every patient.
“ | ADC VAAN DIML, pronounced ADC van dim(e)L | ” |
- Admit: 23 hours, full admit, service of attending
- Diagnosis
- Condition: "Stable"/"Guarded"
- Vitals: post-op, routine, q 1 hour
- Allergies
- Activities: strict bed rest/fall precautions/ad lib/bathroom privileges
- Nursing: strict I&O's/daily weights/call P.R.N.
- Diet: NPO/regular/clears/advance diet as tolerated/2000 cal ADA/renal
- IV fluids: D5, 1/2 NS, 20 KCL at 110 ml/hr, LR @ 100 ml/hr
- Meds: scheduled and PRN's
- Labs and X-ray: CBC in AM, PCXR in PACU
Note that IV fluids follows Diet. If one writes NPO, then all such patients get maintenance fluids (use the 4-2-1 rule).
Causes of Diseases
“ | VITAMIN C | ” |
- Vascular
- Infectious
- Trauma
- Auto-immune
- Metabolic
- Idiopathic/Iatrogenic
- Neoplastic
- Congenital
Metabolic Acidosis Causes
“ | MUDPILES | ” |
- Methanol poisoning
- Uremia
- Diabetic Keto-acidosis
- Para-aldehyde ingestion
- Ischemia
- Lactic Acidosis
- Ethanol poisoning
- Salicylate ingestion
Hypercalcemia Causes
“ | PAM SCHMIDT | ” |
- Paget's Disease
- Amyloid
- Multiple Myeloma
- Sarcoid
- Cancer
- Hormomal (para-thyroid)
- Milk-alkali Syndrome
- Immobilization
- D-vitamin overdose
- Thyrotoxicosis
OR
“ | MISHAP | ” |
- Malignancy
- Intoxication (hypervitaminosis)
- Sarcoidosis
- Hyperparathyroidism
- Alkali (Milk) syndrome
- Paget's Disease (bone)
Also consider Addison's disease, thiazide diuretics and simple lab error
5 SIGNS OF INFLAMMATION (as described by Celsus)
- Rubor: redness/erythema
- Calor: raised temperature
- Tumor: swelling
- Dolor: pain
- Functio Laesa: loss of function
Hypersentivity Reactions (Gell & Goombs Classification)
“ | ACID | ” |
“ | Anna Cycled Immediately Downhill | ” |
- Type I Anaphylaxis
- Type II Cytotoxic-mediated
- Type III Immune-complex
- Type IV Delayed hypersensitivity
CBC Normal Differential
“ | Never Let Monkeys Eat Bananas | ” |
“ | Nice Ladies Make Easter Bread" | ” |
“ | 60, 30, 6, 3, 1 | ” |
- Neutrophils: 60%
- Lymphocytes: 30%
- Monocytes: 6%
- Eosinophils: 3%
- Basophils: 1%
Malignant Hyperthermia Treatment
“ | Sunday Hot Day, Better Give Iced Fluids Today! | ” |
- S- Stop all triggering agents, give 100% O2
- H- Hyperventillate
- D- Dantrolene 2.5 mg/kg
- B- Bicarbonate
- G- Glucose and Insulin
- I- IV Fluids, Cooling Blanket
- F- Fluid Output; Furosemide
- T- Tachycardia, be prepared to treat V Tach
Back Pain Causes
“ | DISK MASS | ” |
- D-Degeneration: DJD, Osteoporosis, spondylosis
- I-Infection: UTI, PID, Potts, osteomyelitis, prostatitis, Injury/fracture, compression fracture
- S-Spondylitis, ankylosing Spondyloarthropathies (rheumatoid arthritis, Reiters, SLE)
- K-Kidney stones/infarction/infection (pyelo/abscess)
- M-Multiple myeloma, Metastasis from breast, prostate, lung, thyroid, kidney CA
- A-Aneurysm, Abdominal pain referred to the back (see acute abdominal pain)
- S-Slipped disk, Spondylolisthesis
- S-Strain, Scoliosis/lordosis, Skin: herpes zoster
Syncope Management
“ | If the face is red, raise the head! | ” |
“ | If the face is pale, raise the tail! | ” |
Brachial Plexus Organization
“ | Radical Teachers Drink Cold Beers | ” |
“ | Randy Travis Drinks Cold Beers | ” |
“ | Robert Taylor Drinks Cold Beer | ” |
“ | Red Trucks Drive Cats Nuts | ” |
- Roots
- Trunks
- Divisions
- Cords
- Branches
Cranial Nerves
“ | On Old Olympus Towering Tops, A Finn And German Viewed Some Hops | ” |
“ | Our Only Object To Touch And Feel Virgin Girls Vagina And Hymen | ” |
- I - olfactory
- II - optic
- III - oculomotor
- IV - trochlear
- V - trigeminal
- VI - abducens
- VII - facial
- VIII - acoustic (vestibulocochlear)
- IX - glossophrayngeal
- X - vagus
- XI - accessory
- XII - hypoglossal
Extraocular Muscles Innervation
“ | LR6 SO4 3 | ” |
- LR6 - Lateral Rectus --> CN VI Abducens
- SO4 - Superior Oblique --> CN IV Trochlear
- 3 - The remaining 4 eyeball movers --> CN III Occulomotor
“ | LAST | ” |
- L-Lateral Rectus
- A-Abducens Nerve
- S-Superior Oblique
- T-Trochlear Nerve
Facial Nerve Branches
“ | Two Zebras Bought My Car | ” |
“ | Two Zebras Bit My Cookie | ” |
“ | To Zanzibar By Motor Car | ” |
“ | Ten Zulus Buggered My Cat | ” |
- Temporal
- Zygomatic
- Buccal
- Mandibular
- Cervical
Penis Innervation
“ | Point and Shoot | ” |
- Parasympathetic causes erection
- Sympathetic causes ejaculation
“ | S2, 3, 4 keep the penis off the floor | ” |
- Innervation of the penis by branches of the pudendal nerve, derived from spinal cord levels S2-4
Aorta Branches
“ | ABC'S | ” |
- Aortic arch gives off the
- Bracheiocephalic trunk
- Left Common Carotid
- And left Subclavian artery
Femoral Triangle Structures in Order
“ | N (AVEL) | ” |
- Nerve
- Artery
- Vein
- Empty space
- Lymphatics
- Parenthesis includes things contained in the femoral sheath.
Hurler Syndrome Features
“ | HURLER'S | ” |
- Heptosplenomegaly
- Ugly facies
- Recessive (AR inheritance)
- L-iduronidase deficiency (alpha)
- Eyes clouded
- Retarded
- Stubby fingers/Short
Down Syndrome Features
“ | CHILD HAS PROBLEM! | ” |
- Congenital heart disease/ Cataracts
- Hypotonia/ Hypothyroidism
- Incure 5th finger/ Increased gap between 1st and 2nd toe
- Leukemia risk x2/ Lung problem
- Duodenal atresia/ Delayed development
- Hirshsprung's disease/ Hearing loss
- Alzheimer's disease/ Alantoaxial instability
- Squint/ Short neck
- Protruding tongue/ Palm crease
- Round face/ Rolling eye (nystagmus)
- Occiput flat/ Oblique eye fissure
- Brushfield spot/ Brachycephaly
- Low nasal bridge/ Language problem
- Epicanthic fold/ Ear folded
- Mental retardation/ Myoclonus
“ | DOWN | ” |
- Decreased alpha-fetoprotein and unconjugated estriol (maternal)
- One extra chromosome twenty-one
- Women of advanced age
- Non-disjunction during maternal meiosis
“ | Drink at 21 | ” |
Chromosome 21
Patau's Syndrome - Chromosome 13
“ | Puberty at 13 | ” |
Edward's Syndrome - Chromosome 18
“ | Election voter at 18 | ” |
Pyrimidines Nucleotides
“ | CUT the PY (pie) | ” |
- Cytosine
- Uracil
- Thiamine
- The
- PYrimidines
DiGeorge (Velocardiofacial) Syndrome
“ | CATCH 22 | ” |
- Cardiac abnormalities
- Abnormal facies
- Thymic aplasia
- Cleft palate
- Hypocalcemia
- 22q11 deletion
MARFAN Syndrome Features
- Mitral valve prolapse - MVP
- Aortic Aneurysm
- Retinal detachment
- Fibrillin
- Arachnodactyly
- Negative Nitroprusside test (differentiates from homocystinuria)
Cell Cycle Stages
“ | Go Sally Go! Make Children! | ” |
- G1 phase - Growth phase 1
- S phase - DNA synthesis
- G2 phase - Growth phase 2
- M phase - Mitosis
- C phase - Cytokinesis
APKD
“ | ” |
ADult Polycystic Kidney Disease is Autosomal Dominant Also, "Polycystic kidney" has 16 letters and is due to a defect on chromosome 16.
Essential Amino Acids
“ | P ri V a T e TIM HALL | ” |
- P - Phe
- V - Val
- T - Thr
- T - Trp
- I - Ile
- M - Met
- H - His
- A - Arg
- L - Leu
- L - Lys
Urea Cycle
“ | Ordinarily Careless Crappers Are Also Frivolous About Urination! | ” |
- O - Ornithine
- C - Carbamoyl
- C - Citrulline
- A - Aspartate
- A - Arginosuccinate
- F - Fumarate
- A - Arginine
- U - Urea
Cell Division Phases
“ | People Meet And Talk | ” |
- P - Prophase
- M - Metaphase
- A - Anaphase
- T - Telophase
Acute Intermittent Porphyria
“ | 5 P's | ” |
- Pain in abdomen
- Polyneuropathy
- Psychologial abnormalities
- Pink urine
- Precipitated by drugs (eg barbiturates, oral contraceptives, sulpha drugs)
BUN & Creatinine Elevation
“ | ABCD | ” |
- A - Azotremia (pre-renal)
- B - Bleeding (GI)
- C - Catabolic status
- D - Diet (high protein parenteral nutrition)
G6PD: oxidant drugs inducing hemolytic anemia AAA
“ | ” |
Antibiotic (eg: sufamethoxazole) Antimalarial (eg: primaquine) Antipyretics (eg: acetanilid, but not aspirin or acetaminophen) Vitamin B3 (niacin, nicotinic acid) deficiency: pellagra
The 3D 's of pellagra
“ | ” |
Pellegra: Vitamin B3 (niacin, nicotinic acid) deficiency
- Dermatitis
- Diarrhea
- Dementia
Pompe's disease: type "Police = Po + lys"
“ | ” |
Pompe's disease is a lysosomal storage disease (alpha 1,4 glucosidase).
Metabolic acidosis (normal anion-gap) causes
“ | ” |
- With hyperkalemia: RAISE K+:
RTA type 4 Aldosterone or mineralocorticord deficiency Iatrogenic: NH4Cl, HCl "Stenosis": obstructive uropathy Early uremia
- With hypokalemia: ReDUCE K+:
Renal TA type 1 and 2
Diarrhoea
Urine diversion into gut
Carbonate anhydrase inhibitor
Ex-hyperventilation
Galactosaemia: enzyme deficiency
“ | ” |
GALIPUT: Galactose 1 Phosphate Uridyl Transferase. • There is an assay called the Galiput test for this.
==Folate deficiency: causes A FOLIC DROP==* Alcoholism
“ | ” |
- Folic acid antagonists
- Oral contraceptives
- Low dietary intake
- Infection with Giardia
- Celiac sprue
- Dilatin
- Relative folate deficiency
- Old
- Pregnant
The FAT cat is in the ADEK (attic)
“ | ” |
Vitamins: which are fat soluble Fat soluble vitamins are A,D,E,K.
Hemoglobin binding curve: causes of shift to right
“ | ” |
"CADET, face right!"
- C = Increase in carbon dioxide
- A = Acidosis (low ph)
- D = Increase in 2,3 DPG aka 2,3 BPG
- E = Exercise
- T = increase in temperature
G proteins for respective receptors
“ | ” |
"QISS & QIQ" (Kiss and Kick):
G-proteins and their respective receptors (alphabetical order)
“ | ” |
Q: alpha 1 I: alpha 2 S: beta 1 S: beta 2 & Q: M1 I: M2 Q: M3
Adrenaline mechanism
“ | ” |
"ABC of Adrenaline":
- Adrenaline--> activates
- Beta receptors--> increases
- Cyclic AMP
Carbon monoxide: electron transport chain target
“ | ” |
"CO blocks CO" Carbon monoxide (CO) blocks Cytochrome Oxidase (CO)
Metabolism sites
“ | ” |
"Use both arms to HUG": Heme synthesis Urea cycle Gluconeogenesis • These reactions occur in both cytoplasm and mitochondria.
AcetylCoA and acetacetylCoA
“ | ” |
"A Lighter Lease" (A LyTr LeIs): amino acids forming them
- A=AcetylCoA or Acetoacetyl CoA
- Ly=Lysine
- Tr=Tryptophan
- Le=Leucine
- Is=Isoleucine
Fasting state: branched-chain amino acids used by skeletal muscles
“ | ” |
"Muscles LIVe fast":
- Leucine
- Isoleucine
- Valine
Glycolysis steps
“ | ” |
"Goodness Gracious, Father Franklin Did Go By Picking Pumpkins (to) Prepare Pies":
- Glucose
- Glucose-6-P
- Fructose-6-P
- Fructose-1,6-diP
- Dihydroxyacetone-P
- Glyceraldehyde-P
- 1,3-Biphosphoglycerate
- 3-Phosphoglycerate
- 2-Phosphoglycerate (to)
- Phosphoenolpyruvate [PEP] Pyruvate • 'Did', 'By' and 'Pies' tell you the first part of those three: di-, bi-, and py-.
• 'PrEPare' tells location of PEP in the process.
Glycolysis Enzymes
“ | ” |
“Hungry Peter Pan And The Growling Pink Panther Eat Pies” Hexokinase Phosphohexo isomerase Phosphofructokinase-1 (6-phosphofructo-1 kinase) Aldolase, Triose phosphate isomerase Glyceraldehyde 3-phosphate dehydrogenase Phosphoglycerate kinase Phosphoglycerate mutase Enolase Pyruvate kinase
Citric acid cycle compounds
“ | ” |
"Our City Is Kept Safe And Sound From Malice": Oxaloacetate Citrate Isocitrate alpha-Ketoglutarate Succinyl-CoA Succinate Fumarate Malate
Citric acid cycle compounds
“ | ” |
"Can I Keep Selling Sex For Money, Officer?":
- Citrate
- Isocitrate
- alpha-Ketogluterate
- Succinyl CoA
- Succinate
- Fumerate
- Malate
- Oxaloacetate
Citric acid cycle compounds
“ | ” |
"Oh! Can I Keep Some Succinate For Myself?":
- Oxaloacetate
- Citrate
- Isocitrate, alpha-Ketoglutarate
- Succinyl CoA
- Succinate
- Fumarate
- Malate
Citric acid cycle compounds
“ | ” |
"Oh Citric Acid Is Of (course) A SiLly STupid Funny Molecule":
- Oxaloacetate
- Citrate
- Isocitrate, alpha-Ketoglutarate
- Succinyl CoA
- Succinate
- Fumarate
- Malate
Citrate Cycle Enzymes
“ | ” |
"Corrupt Anti Intelligence Agent Spoke Slander For Money."
- Citrate synthatase
- aconitase
- Isocitrate dehydrogenase
- Alpha ketogluturate dehydrogenase
- Succinyl CoA synthetase
- Succinate dehydrogenase
- Fumarase
- Malate Dehydrogenase
Fabry's disease: FABRY'S
“ | ” |
- Foam cells found in glomeruli and tubules/ Febrile episodes
- Alpha galactosidase A deficiency/ Angiokeratomas
- Burning pain in extremities/ BUN increased in serum/ Boys
- Renal failure
- YX genotype (male, X linked recessive)
- Sphingolipidoses
B Vitamins
“ | The Rhythm Nearly Proved Contagious | ” |
In increasing order:
- Thiamine (B1)
- Riboflavin (B2)
- Niacin (B3)
- Pyridoxine (B6)
- Cobalamin (B12)
Essential Amino Acids
“ | PVT. TIM HALL | ” |
Phe Val Thr Trp Ile Met His Arg Leu Lys Pvt. is short for Private in the military. Arg and His are considered semiessential. Alternatively: "MATT VIL PHLy".
“ | "PVT. TIM HALL always argues, never tires" | ” |
- Phe
- Val
- Thr
- Trp
- Ile
- Met
- His
- Arg
- Lue
- Lys
Golgi Complex Functions
“ | Golgi Distributes A SPAM | ” |
- Distributes proteins and lipids from ER
- Add mannose onto specific lysosome proteins
- Sulfation of sugars and slected tyrosine
- Proteoglycan assembly
- Add O-oligosugars to serine and threnonine
- Modify N-ologosugars on asparagine
Catabolism Steps of Branched Chain Amino Acids
“ | Truck hit the Ox to Death | ” |
- T - Transamination
- O - Oxidative decarboxylation
- D - Dehydrogenation
Niacin Deficiency
“ | The famous 4 D's | ” |
- Diarrhea
- Dermatitis
- Dementia
- Death (if untreated)
Creatine Phosphate: Amino Acid Precursors
“ | Nice GAMs! | ” |
- G - Glycine
- A - Arginine
- M - Methionine
Enzymes Classification
“ | Over The HILL | ” |
- O - Oxidoreductases
- T - Transferases
- H - Hydrolases
- I - Isomerases
- L - Ligases
- L - Lyases
Collagen
“ | COLLAGEN | ” |
- C - C-terminal propeptide (procollagen) / Covalent Cross links/ C vitamin/ Connective tissue/ Cartilage/ Chondroblasts/ Copper Cofactor (Covalent Cross linking)
- O - Outside the cell is where collagen normally functions/ Osteoblasts/ Osteogenesis imperfecta
- L - Lysyl hydroxylase / Lysyl oxidase (oxidatively deaminates lysyl and hydroxylysyl residues to form collagen cross links, last biosynthesis step)
- L - Long triple helical fibers / Ligaments
- A - Alpha chains / Attached by H bonds form triple helix / Ascorbate for hydroxylation of lysyl and prolyl residues of pro-Alpha chains
(postranslational modification)
- G - Gly in every third position / Glycosylation of hydroxyl group of hydroxylysine with Glucose and Galactose; GOlgi allows procollagen to GO outside of cell
- E - Extracellular matrix / Eye (cornea, sclera) / Ehlers-Danlos Syndrome
- N - N-terminal propeptide (procollagen) / Nonhelical terminal extensions
Essential Amino Acids
Hypervitaminosis A
“ | Increased Vitamin A makes you HARD | ” |
- H - Headache / Hepatomegaly
- A - Anorexia / Alopecia
- R - Really painful bones
- D - Dry skin / Drowsiness