SECOND AID: USMLE MNEMONICS

This is a list of medical mnemonics, side-notes, and generalizations I wrote down while going through my 2010 First Aid book while supplementing with
2012 Falcon, Kaplan, and a bit of Goljan. I stopped at around three-quarters of the text because I got tired and felt like not many people would be
interested(Update: sorry, but Im too busy to go back and type the rest! ><).
P.S. If you want to find a topic fast, I suggest Ctrl+F
Behavioral Science:
Statistical distribution:
Positive skew = meAn>meDian>mOde
Positive skew = alphabetical from greatest to least
Reportable diseases:
It was reported that studly Mr. Shigella ate salmon, chicken, and liver:
It was REPORTED that STuDly MMR SHIGELLA aTB Salmon, Chicken, and Liver
STDs: AIDs, Gonorrhea, Syphilis, Chlamydia (*NOT HIV!)
MMR: Measles, Mumps, Rubella
Shigella
TB
Salmonella
Chicken Pox
Hepatits A, B, C
Health care payment:
CARE for the Elderly, AID the destitute
Medicare - elderly, Medicaid - low income people
Early developmental milestones:
# of blocks stacked = age in years * 3
2 word sentences at 2
pee at three; tricycle at three
four-square at four = can hop at four
drawings:
o 3yo = circle
o 4yo = +
o 5yo = square
o 6yo = triangle
o See reference:

Biochemistry:
Stop codons: UGA, UAA, UAG
U Go Away, U Are Away, U Are Gone
EXpress EXons, INtrons are IN the way
Proto-oncogenes:
Mikes sis returned with her two new breasts she was able to grow because of herbs.
MYCs SIS RETurned with HER2Neu breasts she RAS ABLe To-Grow BCl of hERBs.
Myc
sis
 ret
Her2/neu
ras
abl
TGFalpha
bcl2
ERB-B1, B2
Collagen: The higher the number, the smaller and softer it gets
Type 1 - bone (skin) - Osteogenesis Imperfecta (failed glycosylation and formation of procollagen triple helix with ER)
Type 2 - cartilage - death in utero
Type 3 - blood vessels - Ehlers-Danlos (failure of cross-linking by lysyl oxidase to make collagen fibrils outside fibroblasts), berry
aneurysms
Type 4: basement membrane - Alports nephritis (+ deafness and vision problems; cant see, cant pee, cant hear)
Blotting procedures:
SNOW
DROP
S/D: Southern blot = DNA sample identified with DNA probe
N/R: Northern blot = RNA sample identified with DNA probe
O/O
W/P: Western blot = protein sample identified with antibody probe
Model systems:
Knock out = take a gene OUT
Knock in = INsert a gene
Knock down = knock down the expression of the gene via complementary mRNA antagonist
Imprinting:
Prader-Willi = Paternal deletion
AngelMans = Maternal deletion
Genetics:
Autosomal Dominant: have familial or hereditary in name +
A Brainy Dwarf named Marfan von Hippel-Lindau hired MEN to Hunt for Potatoes.
Brainy = Neurofibromatosis1, 2
Dwarf = Achondroplasia
Marfan
von Hippel-Lindau
MEN1, 2a, 2b
Huntingtons
Potato = Tuberous sclerosis
X-linked recessive:
Duke Fabrys Brutal Gopher Hunter, Lesch, Was-Actually a Fragile Albino Hemophiliac.
Duke = Duchennes
Fabry
Brutal = Brutons
Gopher > G6Pher = G6PD deficiency
Hunter = Hunters
Lesch-Nyhan
Was-Actually = Wiskott-Aldrich
Fragile X
ocular Albinism
Hemophilia A, B
Fragile X = Xtra large testes, jaws, ears
FraGile X = cGg trinucleotide repeat
myoTonic dystrophy = cTg trinucleotide repeat
Autosomal trisomies: Pat Ed Down = 13, 18, 21
Puberty at 13, Election at 18, Drinking at 21
Down syndrome is associated with ALL (and AML) and ALzheimers and decreased ALpha-fetoprotein > ALL fall DOWN; also associated with:
Duodenal Atresia (failure to recanalize = blind duodenum > bilious vomiting with first feed; double-bubble)
Celiac Disease (associated with dermatitis herpetiformis)
Annular Pancreas
Hirschprung congenital megacolon (failure of neural crest cell migration: no Auerbach or Meissners plexus > constipation/meconium
ileus)
Edwards: watch 99 balloons
Pataus: rocker bottom Pedals/feet, cleft lip/Palate, holoProsencephaly (sonic hedgehog deficiency), Polydactyly
Williams syndrome: Will Farrell in Elf: elfin faces, mental retardation, well-developed verbal skills, extreme friendliness
DiGeorge syndrome: CATCH-22
Cleft palate
Abnormal facies
Thymic aplasia (T-cell deficiency)
Cardiac defects
Hypocalcemia (secondary to parathyroid aplasia; remember third pharyngeal pouch: inferior parathyroids are grown with thymus and
descend together)
microdeletion at chromosome 22q11
Vitamin B1: Thiamine
Thiamine pyrophosphate (TPP) is needed for a number of enzymes, but is rarely required alone. Whenever you need B1, you usually need FAD (B2),
NAD (B3), CoA (B5), and Lipoic Acid, so just group them together: B1,2,3,5+LA.
Enzymes that use B1, 2, 3, 5 + LA:
Glycolysis/TCA: PDH (X = lactic acidosis; Tx: ketogenic Leucine, Lysine + high fat diet)
TCA: alphaKGDH
HMP: transketolase
branched chain AADH (X = Maple Syrup Urine Disease > severe CNS defects, MR, and death)
Related problems:
Lipoic acid is antagonized by Arsenic, which causes rice water diarrhea and garlic breath.
B1 deficiency in alcoholics > Wernicke-Korsakoff, beriberi
PDH deficiency/dysfunction > inability to continue TCA > diversion to lactic acidosis; brain starves for energy > neurologic defects. To
keep brain from starving, Tx with ketogenic amino acids LEUCINE and LYSINE and high fat diet (beta oxidation of fats will produce acetyl
CoA > TCA/ketogenesis).
Vitamin B6: Pyridoxine
Major pathways that use B6:
1. Glycogenolysis RLS: Glycogen > G1P via glycogen phosphorylase
2. Heme synthesis RLS: Succinyl CoA (TCA) + Glycine > delta aminolevulinic acid (ALA) via deltaaminolevulinic acid synthase
3. Cysteine synthesis: Homocysteine + Serine > Cystathione via Cystathione synthase (X = homocysteinuria: Marfanoid
Sx+MR+atherosclerosis)
Note: Cystinuria due to PCT reabsorption defect > staghorn cystine kidney stones; Tx: acetazolamide to alkalinize urine
4. ALT/AST transamination:
Alanine+alphaKG(TCA)<ALT>Pyruvate(glycolysis)+glutamate
Aspartate(Urea cycle)+alphaKG(TCA)<AST>OAA(TCA)+glutamate
5. Amino acid production (hydroxylation, decarboxylation reactions):
1. tyrosine hydroxylation> dopa decarboxylation> dopamine
2. tryptophan to niacin/B3 (no B6 = no B3 = Pellagra)
3. histidine to histamine
4. glycine to porphyrin (in heme production; no B6 = hypochromic, microcytic anemia)
5. glutamate to GABA (no B6 = loss of GABA = increased excitation > convulsions/seizures)
Vitamin B12: Cobalamin
Cofactor when you see Meth in product or substrate:
1. METHylmalonylCoA > Succinyl CoA via methylmalonylCoA isomerase
2. homocysteine + N-METHylTHF > METHionine + THF via homocysteine methyltransferase
Absorbed in the ileum (Crohns, gastric bypass, sprue, Diphyllobothrium latum) with IF (pernicious anemia); use Schilling test to determine if its
intake/absorption or lack of IF problem. B12 stores last for YEARS. Deficiency causes an increase in methylmalonic acid (peripheral neuropathy) and
homocysteine (megaloblastic anemia).
Other causes of megaloblastic anemia = folate deficiency (incr. homocysteine but not methylmalonic acid, so no neuropathy) and chronic alcoholism.
Vitamin B7: Biotin
While Vitamin B6 is needed for DEcarboxylation reactions (amino acid production), B7 is needed for CARBOXylation reactions:
1. PropionylCoA(oddchainFA/branchedchainAA metab)>MethylmalonylCoA via proprionylCoA carboxylase (which goes on to form succinyl
CoA of TCA with methylmalonylCoA isomerase and B12)
2. Pyruvate(glycolysis)>OAA (TCA) via pyruvate carboxylase
3. AcetylCoA(TCA)>MalonylCoA(FA synthesis RLS)
Avidin in egg-whites Avidly binds B7.
Vitamin C: Ascorbic Acid
1. Iron absorption and Fe2+ state maintenance
2. Collagen synthesis: hydroxylation of proline and lysine within fibroblast ER <SCURVY
3. dopamine > NE via dopamine beta hydroxylase, blocked by Reserpine
Vitamin D: the longest name with a 1: (1,25-(OH)2D3) Calcitriol = active form (PTH stimulates conversion of livers 25OHvitamin D to 1,25-(OH)2D3
in kidney by 1alpha hydroxylase)
Vitamin E: E is for Erythrocytes; its an antioxidant that prevents hemolytic anemia and neurodysfunction
Vitamin K: inject newborns with it to make sure theyre oK (prevent hemorrhage); deficiency = normal bleeding time, but increased PT and aPTT
Note:
platelet dysfunction > BT
extrinsic (shorter) pathway > PT (shorter name); VII; monitor w/ Warfarin
intrinsic (longer) pathway > PTT (longer name); monitor w/ Heparin
Carbamoyl phosphate synthetase: "UP 1, 2.
Urea cycle RLS: CPS1
Pyrimidine synthesis RLS: CPS2
HMGCoA ___:
"You always want to REDUCE your CHOLESTEROL: HMGCoA reductase = RLS for cholesterol synthesis
 vs. HMGCoA synthase = ketogenesis (your brain wants to SYNTHESIZE KETONES when theres no glucose)
Regulation by F2,6BP: "2 supports 1:
PFK2 supports PFK1 > glycolysis
F26BP supports F16BP > glycolysis
MOA: insulin > decreases cAMP > decreases PKA > dephosphorylated FBPase2 = PFK2 > F6P to F26BP > stimulates PFK1 > incr F6P to
F16BP (glycolysis)
Note: glucose > decreases cAMP > decreases CAP-cAMP binding of lac operon = RNA polymerase cant bind to promoter
Glycolytic enzyme deficiency: RBCs solely depend on glycolysis for energy so no Pyruvate Kinase/Phosphoglycerate Kinase (ATP generating steps) =
decreased ATP > cant maintain membrane gradient > cell swells > hemolytic anemia
HMP shunt/Pentose Phosphate Pathway:
G6P > Ribulose5P + 2NADPH via RLS G6PDH
Ribulose5P > Ribose5P > purine synthesis
NADPH:
1. fatty acid and steroid synthesis
2. oxidative burst (NADPH oxidase; X = Chronic Granulomatous Disease)
3. p450
4. glutathione reductase AKA RBC antioxidation
G6PD deficiency = (x-r) > no NADPH = no glutathione reductase = oxidative damage = hemolytic anemia (bite cells - RBCs partially eaten by
macrophages (M0s), Heinz bodies - oxidized Hb that precipitated in RBCs)
Drugs that cause hemolytic anemia in G6PD deficiency:
"Prima had to take Aspirin when she INHaled her I.B.Professor Dapsones Sulfurous Fava bean NitroFarts.
Prima = Primaquine
Aspirin
INH (Isoniazid)
I.B.Professor = Ibuprofen
Dapsone
Sulfurous = Sulfonamides
Fava bean
NitroFarts = Nitrofurantoin
CGD (chronic granulomatous disease, Dx: negative Nitroblue tetrazolium reduction) = NADPH oxidase deficiency > susceptible to Catalase+
organisms:
The recoiling Red Asp wasnt Sorry towards the moaning Cat because it had Noheart.
recoiling = E.coli
red = Serratia
Asp = Aspergillus
Sorry = S. Aureus
moaning = Pseudomonas
Cat = Catalase + organism
NoHeart = Nocardia
Disorders of __ metabolism:
__-kinase is the enzyme that immediately follows the breakdown of __:
Glucose > G6P via Gluco(Hexo)kinase
Fructose > F1P via Fructokinase
Galactose > Gal1P via Galactokinase
Deficiencies of Fructo and Galactokinases causes MILD symptoms (respective sugars are present in urine). The SEcond steps cause SEvere
symptoms (AldolaseB and Uridyl transferase, respectively).
Watch out when you see ALDO- because it means something bad is going to happen:
Glucose > Sorbitol via Aldose Reductase + NADPH (CATARACTS)
Note: Sorbitol > Fructose via SorbitolDH
Galactose > Galactilol via Aldose Reductase + NADPH (CATARACTS)
Fructose1P > Glyceraldehide and DihydroxyacetoneP via Aldolase B (FRUCTOSE INTOLERANCE)
Essential amino acids:
TV FILM HWRK (Threonine(T), Valine(V), PHENYLALANINE(F), Isoleucine(I), Leucine(L), Methionine(M), Histidine(H), TRYPTOPHAN(W),
ARGININE, LYSINE(K))
Negatively charged amino acids:
Negative experience to be burned by Acid:
Aspartic acid and glutamic acid
Note: Aspartate and Glutamate (as N-acetyl glutamate) are involved in Urea cycle elimination of ammonia
Amino acids with three titratable H+:
Ricky Cant Hate ED
RKY C H ED
Arginine - 12.5
Lysine(K) - 10.5
Tyrosine(Y) - 10.1
Cysteine - 8.2
Histidine(H) - 6
 Aspartic acid(E) - 4.3
Glutamic acid(D) - 3.7
The numbers arent important except for Histidine. Just know the order and that it goes in descending pHs. FYI: COO-=2, NH3+=9.5
KNOW: Ketogenic amino acids:
Leucine and Lysine > USED TO TREAT PDH DEFICIENCY
Cycles: Urea cycle and TCA overlap:
OAA(TCA) + Glutamate <AST> Aspartate(Urea) + alphaKG(TCA)
Aspartate(Urea) + Citrulline(Urea) > Arginosuccinate(Urea) > Arginine(Urea) + Fumarate(TCA)
Urea cycle enzyme deficiency > decreased TCA intermediates > TCA INHIBITION + HYPERAMMONEMIA (b/c decreased NH4+ excretion).
Sx: asterixis, slurred speech, somnolence, blurry vision, vomiting
Tx: less protein in diet + Benzoate/Phenylbutyrate (bind a.a.>excrete)
OTC = major urea cycle enzyme:
Ornithine + carbamoyl-phosphate > Citrulline via OTC
OTC deficiency (x-r) = shunting of carbamoyl phosphate from urea cycle to pyrimidine synthesis:
carbamoyl phosphate + aspartate > orotic acid
Orotic Aciduria > decreased BUN + hyperammonemia
Amino acid derivatives:
Phenylalanine (Phenylalanine hydroxylase + THB + NADPH via Dihydropterin reductase)> Tyrosine(X = PKU (a-r): screened by
Guthrie test 2-3 days after birth; Tx: decr Phen, incr Tyr diet):
o > Fumarate via Homogentinsic acid oxidase (X = Alkaptonuria)
o > Thyroxine
o (Tyrosine hydroxylase/B6, blocked by Metyrosine)> Dopa:
> Melanin (X = Albinism: decreased pigment)
(Dopa decarboxylase/B6, blocked by Carbidopa)> Dopamine (Dopamine Hydroxylase/VitC, blocked by
Reserpine)> NE (PNMT/SAM)>Epinephrine
Tryptophan(X in Hartnups):
o (B6)> Niacin=B3 > NAD+/NADP+ (X = Pellagra)
o (BH4)> Serotonin > Melatonin (sleep)
Lysosomal storage diseases:
Tay-SaX = HeXosaminidase A > incr GM2: no hepatosplen; cherry macula, onion skin lysosomes
Fab-Gal is into Ceramics
Fabrys = alphaGALactosidase A > incr Ceramide trihexose: peripheral neuropathy, angiokeratoma, CV/renal disease
Gauched out my femur when I was on a sugar high
Gaucher, Femur Necrosis, Sugar High = GlucoCerebrosidase
Gauchers = betaGlucocerebrosidase > incr glucocerebroside: aseptic femur necrosis, hepatosplenomegaly, crumpled tissue paper
cytoplasm
Blind Intelligent Intergalactic Crab
Intelligent Intergalactic = Galactocerebroside
Krabbes = Galactocerebrosidase > incr galactocerebroside: blindness, peripheral neuropathy, developmental delay, globoid cells
Niemann Picks his nose with hisphinger
Niemann-Pick = Sphingomyelinase > incr Sphingomyelin: cherry macula with hepatosplenomegaly, neurodegeneration, foam cells
Sulfur tides are multicolored
Sulfur tide = Sulfatide
Multicolored = Metachromic
Metachromic leukodystrophy = Aryl sulfatase A > incr Sulfatides: central and peripheral demyelination with ataxia, dementia
Mucopolysaccharidoses:
HurLers = alpha-L-iduronidase > incr heparan sulfate, dermatan sulfate: corneal clouding, gargoylism, airway obstruction
Hunters = iduronate sulfatase > incr heparan sulfate, dermatan sulfate: NO CORNEAL CLOUDING because Hunters need to see clearly
Major apolipoproteins:
II:LL
C-II = cofactor for Lipoprotein Lipase
Treat abetalipoproteinemias (deficient apoB100, B48 > night blindness, acanthocytes (spiky RBC), steatorrhea, ataxia) with Vitamin E
Embryology:
Important Genes for Embryogenesis:
Sonic the Hedgehog fights a One-Eyed Monster:
Sonic Hedgehog mutation > Holoprosencephaly
FGF gene = Fibroblast Growth Factor: Growth Factor lengthens limbs
FGF mutation > Achondroplasia (A-D dwarfism)
HOX (Homeobox) gene: "Boxes help with organization"
organizes/determines limb location (Vitamin A toxicity alters HOX expression > cleft palate, cardiac abnormalities, spontaneous abortion)
Rules of Early Development:
Week 2: 2 germ layers (epiblast, hypoblast), 2 cavities (amniotic, yolk sac), 2 placental components (cytotrophoblast, syncytiotrophoblast)
Week 3: 3 germ layers (ectoderm, mesoderm, endoderm)
Week 4: 4 heart chambers, 4 limb buds
Note: neural tube closes by week 4:
def. folic acid> spina bifida, etc.
neural tube defect has incr alpha-fetoprotein+AChesterase
(**Gastroschisis and Omphalocele, pretty much ANY internal organ extrusion results in incr alpha-fetoprotein)
SAD DAVE:
 SAD: Sensory = Alar Plate/Afferent nerves = Dorsal
DAVE: Dorsal=Afferent, Ventral=Efferent
Embryologic derivatives:
Ectoderm:
o Surface: what you see (epidermis, hair, nails, teeth enamel, eye lens) + anterior pituitary (Rathkes pouch)
o Neuro: everything connected to the CNS (brain, spinal cord, oligodendocytes, posterior pituitary, retina, pineal gland)
+ pupillary muscles
Mesoderm:
o Neural crest: skull and PNS stuff (skull, head muscles, dentine, pia/arachnoid, Schwann cells, DRG, cranial nerves, celiac
ganglion, parafollicular C cells of thyroid) + adrenal medulla (chromaffin cells) + melanocytes (last to migrate)
o Paraxial: axial stuff (axial skeleton, skeletal muscles, connective tissue and dermis) + dura mater
o Intermediate: urogenital ridge (kidneys and ureters, vas deferens, gonads, uterus and uterine tubules)
o Lateral: non-skeletal muscle and blood-related organs (visceral muscle and connective tissue, blood, lymph, spleen,
cardiovascular system) + adrenal cortex
Note: spleen = mesoderm, but supplied by celiac artery of the foregut
o MESODERMAL DEFECTS = VACTERL: Vertebral defects, Anal atresia, Cardiac defects, Tracheo-Esophageal
fistulas, Renal defects, Limb defects
Endoderm: ear/mouth to anus hollow lining and organs + bladder and vagina
o tympanic cavity/auritory tube, tonsils, thymus, thyroid, parathyroid
o larynx, trachea, bronchi, lungs
o GIT, liver, gallbladder, pancreas
o urinary bladder, urethra, lower 2/3 vagina (this explains how patients can still have a vagina even if the paramesonephric
ducts fail to develop)
Notochord > nucleus pulposus of intervertebral disk
Teratogens:
Amina couldnt hear because she was too absorbed in her reading.
Aminoglycosides prevent mRNA reading by interfering with 16S of 30S and cause CNVIII ototoxicity
(Note: Congenital Syphilis also causes CNVIII ototoxicity + Saber shins + Saddle nose + Hutchinsons teeth + Mulberry Molars + frontal
bossing)
Maternal Diabetes: hyperglycemia > incr fetal insulin > decr lung development = cant breathe; mermaids also cant breathe air >
maternal diabetes causes ARDs and sirenomelia/anal atresia (also, transposition of great vessels)
Umbilical cord:
Allantois: 2 arteries, 1 vein (arteries is 2x as long as vein)
AllaNtois (urachus)> mediaN umbilical ligament
UmbiLical artery > mediaL umbilical ligament
Umbilical vein - ligamentum teres hepatis
Allantois > Urachus (wk3): urachus failure to obliterate = bladder to navel connection: umbilical urination or bladder outpouching
Omphalomesenteric duct > Vitelline duct (wk7): duct failure to obliterate = colon to navel connection: umbilical meconium or Meckels diverticulum
Heart embryology:
Primitive __ > trabeculated (rough) portion of __
Smooth atrium = sinus venosus
Smooth ventricle = bulbus cordis
SVC = right common and anterior cardinal veins
Aorta/Pulmonary artery = truncus arteriosus, separated by spiraling neural crest migration (X = Transposition of Great Vessels, Tetralogy of
Fallot)
PGA open: PG keeps DA open (decr PG > close DA with Indomethacin, NSAIDs)
Aortic arch derivatives: "left side of body to right side, top to bottom"
I: maxillary artery (external carotid) - @ face
II: hyoid/stapedial artery - @ midline throat
III: common and internal carotid arteries - @ midline neck
IV: right subclavian artery and aortic arch - @ right/middle chest
VI: pulmonary artery (inc. ductus arteriosus connection to aorta) - @ right side of heart
Neural tube defects:
The longer the name, the worse the symptoms:
Occulta: spinal canal opening but no herniation, tuft of hair
Meningocele: herniation of meninges
Meningomyelocele: herniation of spinal cord
Pharyngeal/Branchial CAP:
Cleft = ectoderm (~external hollow spaces)
Arches = mesoderm (~muscles)
Pouches = endoderm (~immune organs above the neck)
Branchial CLEFT - ectoderm: ~external hollow spaces
Cleft 1: external auditory meatus
Clefts 2-4: temporary cervical sinus (fail to obliterate = lateral neck branchial cleft cyst)
Branchial cleft cyst (lateral neck) vs Thyroglossal duct cyst (midline neck, moves with swallowing because attached to tongue)
Branchial ARCH - mesoderm: ~muscles
The nerves that supply the branchial arches are all BOTH motor and sensory:
Some(I) Say(II) Marry(III) Money(IV) But(V) My(VI) Brother(VII) Says(VIII) Big(IX) Brains(X) Matter(XI) Most(XII) (S = sensory, M = motor, B = both)
**LOOK AT THE NERVES TO FIGURE OUT WHICH MUSCLES MAKE UP WHAT ARCH** or use the following mnemonic:
Chewing made me grimace so I swallowed, choked, then called for help.
chewing = arch 1 (V2,3) = muscles of mastication, ant. 2/3 tongue + malleus/incus/tensor tympani
grimace = arch 2 (VII) = facial expression + stapes/stapedius (defect = Treacher Collins mandibular hypoplasia and facial abnormalities)
swallowed = arch 3 (IX)= stylopharyngeus (defect = fissure from neck to tonsils)
choked = arch 4 (X, sup laryngeal)= pharyngeal constrictors and cricothyroid
called for help = arch 6 (X, inf laryngeal)= intrinsic larynx muscles except cricothyroid
Note: Arch 4&6 make up post. 1/3 tongue
Branchial POUCH - endoderm: ~immune organs above the neck + middle ear
Pouch 1 = auditory tube, middle ear, mastoid air cells
Pouch 2 = tonsils and tonsillar sinus
Pouch 3 = inferior parathyroid + thymus (they descend together)
Pouch 4 = superior parathyroid + parafollicular C cells of thyroid
Failure of 3rd and 4th Pouch = DiGeorges: no thymus (= T cell deficiency), no parathyroids (= hypocalcemia > tetany)
C3, 4, 5 keeps the diaphragm alive.
Kidney embryology: main player = Metanephros:
Ureteric Bud = ureter>pelvis>collecting ducts
JOINS
Metanephric Mesenchyme = glomerulus>DCT
Defective ureteric bud = renal agenesis; B/L renal agenesis > oligohydramnios > Potters: pulmonary hypoplasia + face/limb deformities
**MC site of obstruction = Ureteropelvic junction with kidney > fetal hydronephrosis
Genital embryology:
Male = Mesonephric
Pemale = Paramesonephric
Men are Wolves = Wolffian ducts > "SEVEN" in SEVEN UP (Seminal vesicles, Epididymis, Vas deferens, Ejaculatory duct, N =
nothing)
Women Mull over past arguments = Mullerian ducts > fallopian tubes, uterus, and upper 1/3 of vagina (lower 2/3 from urogenital sinus
of endoderm)
Female = default genitals
Hormone overview:
Prolactin stimulates Dopamine inhibits Prolactin
Prolactin inhibits GnRH
GnRH > incr FSH, LH
L in LH and Leydig: LH stimulates Leydig cells to produce testosterone > develop Wolffian duct
S in FSH, Sertoli, and Sperm: FSH stimulates Sertoli cells to produce Sperm, Inhibin, and Mullerian inhibiting factor (MIF); MIF inhibits
female paramesonephric duct development
Genital homologues:
Urogenital sinus:
o Bulbourethral glands = Bartholins greater vestibular glands
o proState gland = Skene urethral and paraurethral glands
Extrophy of bladder is associated with Epispadias (faulty positioning of genital tubercle)
vs. Hypospadias = more common, failure of urethral fold closure, incr risk of UTI
Microbiology:
Encapsulated organisms: (+Quellung reaction: quell makes capsules swell)
Claustrophobic Pastor Salmon Echoed Back: Yersinful Crypt-dark Strip Clubs are Pseudo-Homes to Nice Men Francis and Bruce.
Claustrophobic = Clostridium
Pastor = Pasturella
Salmon = Salmonella
Echoed = E.coli
Back = Bacillus anthracis (D-glutamate)
Yersinful = Yersinia
Crypt-dark = Cryptococcus (India Ink, narrow-based budding in meningitis)
Strip = Streptococcus
Clubs = Klebsiella
Pseudo = Pseudomonas
Homes = Haemophilus
Nice men = Neisseria meningitidis
Francis = Francisella
Bruce = Brucella
BAD - Bacillus Anthracis unique capsule contains D-glutamate
Staff of grapes = Staphylococcus is in clusters
VS. Streptococcus = pairs/chains
Spirochetes: "Spiraling Boris Lept then Tripped"
Spiraling = Spirochetes
Boris = Borrelia (Giemsa stain = aniline dye; relapsing fever = result of antigenic variation)
Lept = Leptospira

Tripped = Treponema (Dark Field Microscopy, VDRL cardiolipin screening, FTA-ABS confirmation)
Mycoplasma vs Mycobacteria
Bacteria have cell walls (Mycobacteria have mycolic acid in their cell walls that stain acid-fast)
Plasma membranes have sterols (Mycoplasma have sterols and no cell wall)
Stains:
GiemsA stains BorreliA, MalariA, ChlamydiA, TrypanosomA
PASs the sugar and whip cream (PAS stains glycogen and Dx Whipples disease)
Legions who Sustained injuries get Silver stars: Legionella, grow with Cysteine, silver stain; water source
Special Culture:
Nice Homes have chocolate: Neisseria and Haemophilus grow on Chocolate agar +:
o Neisseria = Thayer Martin media: Vancomycin (vs G+), Polymyxin (vs g-), Nystatin (vs fungi)
o Haemophilus = V (NAD+) and X (hematin)
If I Tell-U the Corny joke Right, youll Laugh:
o TellURight = tellurite agar
o Corny = Corynebacterium
o Laugh = Lofflers media
TB and J: M. tuberculosis on lowenstEIN-Jensen agar (takes 3-4 weeks to grow, but diagnostic)
Obligate aerobes:
If No AER, Anthrax and TB cant survive!
No = NOcardia
Aer = pseudomonas AERuginosa
Anthrax = B. anthracis
TB = M. tuberculosis
Microaerophils = bacters: Campylobacter, Helicobacter
Obligate anaerobes: "These BACTERia ACTIN CLOSTRophobic enviroments (non-healing ulcers):
BACTERia = Bacteroides (E.G., B. fragilis)
ACTIN = Actinomyces
CLOSTRophobic = CLOSTRidium
Obligate Intracellular: "REACh for My COX if you want me INSIDE you.
R = Rickettsia
E = Ehrlichia
A = Anaplasma
Ch = Chlamydia
My = Mycoplasma
Cox = Coxiella
Inside = intracellular
Facultative intracellular: "Legions of Salmon, Rabbits, N Cows Tumble IN My yard.
Legions = Legionella
Salmon = Salmonella
Rabbits = Francisella
N = Neisseria
Cows = Brucella
Tumble = Listeria
In = intracellular
My = Mycobacterium
Note: intracellular pathogens require cell-mediated immunity (CMI), so neonates are at risk (E.G., Listeria > neonatal meningitis: tumbles, has
endotoxin, and a narrow zone of beta hemolysis)
Bacterial virulence factors:
protein A for staph. Aureus: binds Fc of Ig to prevent opsonization and phagocytosis
M protein (prevents phagocytosis) > strep. pyogenes rheuMatic fever (Sx: subcutaneous plaques, polyarthritis, erythema marginatum,
chorea, carditis)
IgA protease (to colonize respiratory mucosa) + antiphagocytic capsule (infects ASPLENIC patients b/c decr M0 and IgM/complement C3
activation (E.G., Sickle Cell autosplenectomy)) + causes meningitis = SHiN
Note: can also undergo transformation (pick up DNA from environment)
o Strep pneumo
o H. influenza type B (B polysaccharide)
 o Neisseria meningitidis
Exotoxin vs Endotoxin:
EXotoxin = from EXogenous source (plasmid or bacteriophage) and EXcreted from bacteria, EXtremely toxic (even small dose), EXact
effects (different toxins produce different symptoms); ~heat-labile
ENDOtoxin (Lipid A)- ENDOgenous (made from bacterial chromosome, ENtegral to outer membrane of most g-Neg bacteria (and
Listeria(G+))); heat stable; causes gENeral fever, shock/sepsis via direct MACROPHAGE response (binds CD14-M0 marker) > release
TNF and IL-1 (no Th involvement)
o M0 activation:
IL1 = Fever
TNF alpha = fever, hemorrhagic tissue necrosis
Nitric oxide = hypotension/shock
o alternate complement pathway:
C3a = Anaphylaxis (basophil and mast cell degranulation > hypotension, edema)

C5a = neutrophil chemotaxis
o Hageman factor: coagulation cascade> DIC/microthrombi
Exotoxin subclass: SUPERANTIGENS: bind directly to MHCII and TH1(CD4) > explosive release of IFNgamma and IL2 (non-specific immune
response):
S. aureus = TSST-1 > Toxic Shock Syndrome (fever, rash, shock)
S. pyogenes = Erythrogenic toxin > Scarlet fever with Toxic-Shock-like symptoms
Note: S. pyogenes also has Streptolysin O (lyses RBC); Dx: Rheumatic Fever with anti-Streptolysin-O antibody (ASOAb)
E. coli ADP ribosylating A-B toxin:
Labile like Air, Stable like Ground:
heat-Labile toxin stimulates Adenylate cyclase
heat-Stable toxin stimulates Guanylate cyclase
Both cause watery diarrhea.
Bacterial Toxins Envoded in Lysogenic Phage: "ABCDE"
ShigA-like toxin - EHEC 0157:H7 - cleaves host cell rRNA/inactivates 60S; also, incr cytokines > HUS
Botulinum toxin - inhibits ACh vesicle release from presynaptic neuron > flaccid paralysis
Cholera toxin - activates Gs > incr cAMP > incr Cl- secretion into gut = decr Na+ absorption > watery diarrhea
Diptheria toxin - ADP-ribosylating A-B toxin (like Pseudomonas exotoxin A) - B binds, A enters and ribosylates EF2 > no more protein
synthesis > cell death; pseudomembrane formation
Erythrogenic (superantigen) toxin of Strep. pyogenes > Scarlet Fever - activates both TH1(CD4) and MHCII > incr INFgamma + IL2 >
incr M0 and T-cell non-specific immune response > ~Toxic Shock
Gram Positives: crystal violet + iodine = blue
Coag negative Staph: "SENsitive": Staph. Epi = Novobiocin SENSITIVE" (VS. Staph. saprophyticus = Novobiocin resistant)
alpha hemolytic Strep: "OVeRPasS": Optochin Viridans Resistant, Pneumonia Sensitive
Note: Strep pneumonia is bile soluble (= cant be cultured in bile, unlike gamma hemolytic Strep)
beta hemolytic Strep: "BBBR": Beta hemolytic, group B strep (Strep agalactiae), Bacitracin Resistant (VS. group A strep (Strep.
pyogenes) = bacitracin sensitive)
OR
B-BRAS - Bacitracin: group B = resistant, group A = sensitive
gamma hemolytic Strep: grows in bile; "stomach is used to salty foods" = Enterococci grows in 6.5%NaCl (VS. Strep. bovis > does NOT
grow in 6.5%NaCl)
Exposure/PRIMARY TB:
Ghon complex = Ghon focus of LOWER lobe + peri-hilar lymph nodes
You think they are Ghon but theyre just waiting to become secondary TB (fibrocaseous cavitary lesion of UPPER lobe)
gram negative: acetone + saffranin = pink
N. Meningities ferMents Maltose, has a capsule, and vaccine (gonorrhea doesnt; NOTE**: gonorrheas pilus
protein undergoes antigenic variation!!)
Note:
-N. meningitidis = respiratory/oral spread > meningococcemia and Waterhouse-Friderichsen adrenal hemorrhage (hypotension and DIC)
-N. gonorrhea = STD> high fever, septic arthritis, neonatal conjunctivitis, PID, Fitz-Hugh-Curtis (cervicitis>salpingitis>liver capsule
infection)
Enterobacteriae: CAPSULE = VIRULENCE FACTOR, all ferment glucose
o Lactose fermenters (pink on MacConkey, blue on Eosin-Methylene blue) = SEEK: Serratia, Enterobacter, E. coli (blue-black
metallic sheen), Klebsiella
o Non-lactose fermenters = PSSY: Proteus, Salmonella, Shigella, Yersinia
o H2S producing (black on Hektoen Agar) + motile (flagellar H antigen): Proteus (swarming, urease+, staghorn ammonium
struvite stones), Salmonella
o Note: Salmonella and Shigella both invade mucosa > bloody diarrhea; Salmonella is motile (w/ 2 flagellar antigen variants)
and produces H2S, S. typhi of Typhoid fever causes abdominal rose spots and can remain chronically in gallbladder; Shigella
is more virulent, moves by actin polymerization and 60S deactivating toxin induces HUS.
oxidase + organisms: "when you go Camping at a quiet Pasture youd Moan More with Nice Vibrators"
Camping = Campylobacter
Pasture = Pasturella
Moan = Pseudomonas
More = Moraxella
 Nice = Neisseria
Vibrators = Vibrio
VDRL false positives: "VDRL"
V = viruses: EBV, hepatitis
D = drugs
R = Rheumatic fever (Dx w/ S. pyogenes ASO titers)
L = Lupus and Leprosy
Chlamydia: Dx via Giemsa stain (ChlamydiA, MalariA, BorreliA + TrypanosomA)
Elementary body is Enfectious and Enters cells via Endocytosis
Reticulate body Replicates in cell by fission
Tricky Dick: TRIC = serotypes DK:
o > MC PID, cervicitis, ectopic pregnancy
o > Fitz-Hugh-Curtis liver capsule infection (from spread of PID) + violin string adhesions of parietal peritoneum to liver
o > neonatal pneumonal/conjunctivitis
o > REITERS: "Cant see, cant pee, cant climb a tree" = conjunctivitis, urethritis, arthritis
VS. trAChoma = serotypes A-C > blindness
VS. L1-L3 = Lymphogranuloma venerum: ulcers > lymphadenopathy, rectal strictures mistaken for PID
Tx: mothers and infants with Chlamydia with Erythromycin estolate, though there is a risk of maternal acute cholestatic hepatitis
Atypical (walking) pneumonias: "My Clammy Legion walked"; Tx: macrolides
My = Mycoplasma (IgM = cold agglutinins > agglutinate or lyse RBCs; grown on Eatons agar; Tx: tetracycline or macrolide)
Clammy = Chlamydia (Tx: tetracycline or macrolide)
Legion = Legionella (Tx: macrolide)
Fungi:
Dimorphic: "cold = mold, heat = yea(s)t" + Blast His Cock = East Coast to West Coast (Tx: Ketoconazole)
Blast = Blastomycosis = east of Mississippi River
His = Histoplasmosis = Mississippi River and Ohio river
Cock = Coccidiomycosis = Southwest US: CA, AZ
His Woodpecker Blasted Wood into Dust:
His Woodpecker = Histoplasmosis from bird/bat droppings = macrophage filled with round yeast; Histo Hides within macrophages
Blasted Wood = Blastomycosis in wood = Broad-Based-Budding fungi; the handle of a baseball bat looks like its budding off the shaft)
Dust = Coccidiomycosis = large spherule filled with endospores; barrel-shaped arthroconidia; Cock is filled with Sperm, Coccidio is filled
with Spores
Actinomyces = Acute Angles, Septate
(VS. Mucormycosis/Rhizopus = Wide angles, non-septate; ~in Diabetics)
Helminth drugs:
Worms = Bendazole
Praziquantel = foods: Pork, Fish, Crab, Snails
o Pork = Taenia
o Fish = Diphyllo, Clonorchis
o Crab = Paragonimus
o Snails = Schistosoma
Antigenic shift vs. drift: "SPED"
Shift (reassortment via segmented viruses) = Pandemic
Epidemic = Drift (random mutations)
Vaccines:
Live: "See MMR. Sabins small yellow chickens live.
o MMR = Measles, Mumps, Rubella
o Sabin (Polio, oral)
o small pox
o yellow fever
o chicken pox/shingles
Killed: "RIP Always
o Rabies
o Influenza
o Polio (SalK = Killed, injected)
o Adenovirus
Recombinant: "H_V"
o Worms = Bendazole
o Praziquantel = foods: Pork, Fish, Crab, Snails
Viruses:
DNA viruses: "HeHe PoPa ParAde": first three = enveloped
He = Herpes
He = HepaDNA (HBV; carries special RT: DNAdDNAp)
 Po = Pox (smallpox, molluscum contagiosum; carries DNAdRNAp and replicates in cytoplasm)
Pa = Papilloma (HPV: (6,11): condylomata acuminata/genital warts, koilocytes=squamous cell with perinuclear cytoplasmic halo; (16,18):
CIN; anal squamous cell CA) + Polyoma (JC, PML demyelinating encephalopathy)
Par = Parvo = B19/Erythema infectiosum (ssDNA)
Ade = Adenovirus (swimming pool conjunctivitis, gastroenteritis)
Herpes: "2 Simple Chickens Barred Sight from Rose Patches"
2 Simple = HSV1,2
Chickens = HHV3: Chicken pox (truncal rash > extremities; lesions of different age)/shingles
Barred = HHV4: EBV (mono, Burkitts, large cell non-Hodgkins @ Waldeyers ring, nasopharyngeal CA, hairy leukoplakia on lateral
tongue; infects B cells via CD21-EBV receptor)
Sight = HHV5: CMV (retinitis, negative mono-spot mono, TORCH; both intranuclear owl-eye and cytoplasmic inclusion bodies)
Rose = HHV6: Roseola/Erythema subitum (high fever > rash)
Patches = HHV8: Kaposi-sarcoma
RNA viruses:
+RNA = PiToFlaCoCa: middle 3 = enveloped
Pi = PicoRNA = PECoRnA:
o P = Polio (both colonizes nasopharynx and causes meningitis like Hib > myalgia and paralysis)
o E = Echovirus: swimming pool aseptic meningitis/myocarditis
o C = Coxsackie: aseptic meningitis/myocarditis, hand-foot-mouth (palm and sole vesicular rash also seen in secondary syphilis
and Rickettsial Rocky Mountain Spotted Fever)
o Rn = RHINOvirus (stuffy NOSE from common cold)
o A = HAV
To = Toga
o Togas Rubelled against Germany with TORCHs = Togavirus, Rubella, German Measles (post-auricular occipital
lymphadenopathy, fine truncal rash), TORCH infection (blueberry muffin rash, deaf, cataracts, PDA)
o VS. Rubeola: "a PARA Ruby weasles caught SSPEcial measles" = Paramyxo, Rubeola, SSPE complication, Measles
o VS. Roseola: HHV6 (high fever/seizures > truncal rash)
Fla = Flavi (HCV, yellow, dengue, St. Louis, West Nile)
o yellow fever causes yellowing skin (jaundice) and black vomit
Co = Corona (common cold, SARS)
Ca = Calici = Norwalk, CA Cruises (gastroenteritis from cruises)
-RNA = all enveloped + RNAdRNApol
Reovirus = dsRNA, segmented: ROTAvirus = right out the anus (childhood winter gastroenteritis)
HepEvirus = HEV (water epidemic, only dangerous if pregnant)
Orthomyxo: O for octo = 8 segments > reassortment = Influenza pandemic (Ag shift)
Paramyxo = PaRaMyX2o:
o P or PARA = Parainfluenza = croup
o R = RSV; Tx: Ribavirin (vs. IMPDH of purine synthesis; AE: hemolytic anemia, teratogen) or RSVP Liz where P Liz =
Palivizumab which binds Paramyxo F protein, preventing respiratory epithelial syncytia formation
o Mx2 = Measles and Mumps:
Measles: "A PARA RUBY weasles caught SSPEcial Measles" = paramyxo, rubeola, SSPE complication, Measles 3
Cs = cough, coryza, conjunctivitis + Koplik spots; rash from head down like Rubella
Mumps: parotitis, orchitis, aseptic meningitis
Segmented viruses: "BOAR"
B = Bunya (Hanta hemorrhagic fever)
O = Orthomyxo (Influenza)
A = Arena (mouse Lassa encephalitis)
R = Reovirus (right out the anus childhood diarrhea)
Hepatitis:
HAV = Picorna (+RNA); fecal-oral (ice cubes, shellfish)
HBV = HepaDNA (env, dsDNA); blood (renal dialysis, needle stick), sex, mother; Dx: PCR
HCV = Flavi (env, +RNA); blood (IVDA, transfusion); Dx: RT-PCR
HDV = Delta (defective env, -RNA); infects with HBV
HEV = HepEvirus (+RNA); fecal-oral (water epidemic)
ToRCHS: hepatosplenomegaly, jaundice, thrombocytopenia, growth retardation
T = Toxoplasma: ToxoTriad: intracranial calcifications, chorioretinitis, hydrocephalus = SAME TRIAD AS CMV!!; from cat feces, ring-
enhancing brain abscess); Tx: Sulfadiazine+Pyrimethamine
R = Rubella (Togavirus, +RNA): PDA, cataracts, deaf, blueberry muffin rash; maternal rash and arthritis
C = CMV: Toxoplasma triad (intracranial calcification, chorioretinitis, hydrocephalus) + UNILATERAL hearing loss, seizures
H = HSV (+HIV): temporal lobe encephalitis, herpetic lesions (fingers)
S = Syphilis: hydrops fetalis stillbirth > Hutchinson teeth, saddle nose, saber shins
Note: B19 also causes hydrops fetalis
Bactericidal drugs (all else = bacteriostatic): "Sephiroth Met Vancouver Penpal Amina in Florida, then KILLED HER D:
Seph(iroth) = Cephalosporin
Met = Metronidazole
Vancouver = Vancomycin
Penpal = Penicillin
Amina = Aminoglycosides
Florida = Fluoroquinolones
Antimicrobial drugs:
1. inhibits PG cross-linking > no cell wall: "Ceph Chills-in Nam watching PG movies:
1. Ceph = Cephalosporin
2. Chills-in = 'cillins (binds PBP, block transpeptidase cross-linking; Penicillin = endocarditis prophylaxis (before surgery/dental),
syphilis prophylaxis)
3. 'Nam = AztreoNAM (binds PBP3 for Pencillin-allergy pts; vs SEEK Pseudomonas- Serratia, E.coli, Enterobacter, Klebsiella,
Pseudomonas), MeropeNEM and ImipeNEM+Cilastatin (Merpenem/Imipenem vs. everything, esp. Enterobacter, but causes
SEIZURES; Cilastatin inhibits renal dihydropeptidase I to inhibit renal tubule Imipinem inactivation)
2. blocks PG synthesis:
1. Bacitracin (vs. S. pyogenes (GAS))
2. Vancomycin (binds D-Ala-D-Ala and interferes with PG-elongating transglycosylase
1. vs. resistant G+ inc, MRSA and C.diff!!
2. TON of AEs: T = thrombophlebitis, O = ototoxic, N = nephrotoxic + Red Man (slow infusion and pretreat with anti-
histamine to prevent))
3. vs. g- by disrupting cell membranes: Polymyxins (neosporin) - detergent vs cell membrane; AE: neurotoxicity, acute renal tubular necrosis
4. vs. G+/g- by blocking folate > no nucleotide synthesis (megaloblastic anemia):
1. Sulfonamides (comp inhibit PABA for dihydropteroate synthetase > no DHF synthesis; AE: infant kernicterus (avoid in
pregnancy), SJ, nephrotox, G6PD hemolysis)
1. Sulfamethoxazole-Trimethoprim (TMP-SMX) vs UTI, P. jirovecii prophylaxis in AIDS
2. Sulfadiazine+Pyrimethamine vs Toxoplasma
3. Sulfadoxin+Pyrimethamine vs Malaria
2. Trimethoprim, Pyrimethamine (DHFXdihydrofolate reductase>THF like Methotrexate)
5. vs. URIs (S. pneumo), UTIs, GITIs, and Pseudomonas by blocking topoII (DNA gyrase) and IV: Fluoroquinolones (AE: cartilage/tendon
rupture, incr QT, G6PD hemolysis)
6. vs. Mycobacterum, prophylaxis for Hib and N.men by blocking DNAdRNAp = no transcription: Rifampin
7. Protein synthesis inhibitors: "Quinn get in Line and take 50MCs to 30ST":
1. Quinn, Line 50MCs = Quin-Dalfo, Linezolid, Macrolides, Chloramphenicol/Clindamycin block 50S
1. Quin-Dalfo (streptogramins): Quinupristin prevents elongation, Dalfopristin changes 50S conformation for better
Quin-binding
2. Linezolid: binds 50S P-site and blocks 70S assembly
Tx: Quin-Dalfo and Linezolid is good for ALL RESISTANT BACTERIA: VRE, MRSA
3. MACrolidEs (ACE"mycin = Azithro, Clarithro, Erythromycin): "MacroLIDEs prevent sLIDing of mRNA = inhibit
translocation by binding to 23S of 50S
1. Tx: PUS - atypical Pneumonia, URIs, STDs
2. AE: PROLONG QT, acute cholestatic hepatitis, incr serum concentration of warfarin
3. resistance via METHYLATION OF drug binding site on 50S rRNA
Note: Azithromycin = AIDS MAC prophylaxis
4. Chloramphenicol: ChLorAMPS Peptidyltransferase - prevents peptide bond formation; Tx: meningitis (H. flu, N.
men, Strep. pneumo); AE: aplastic anemia and gray baby; resistance via ACETYLATION
5. Clindamycin: also blocks peptide bond formation at 50S; vs. ANAEROBES (B. fragilis, C. perfringens) like
Metronidazole; AE: Pseudomembranous colitis like Ampicillin
2. 30ST = Streptomycin (aminoglycosides), Tetracycline block 30S
1. Amina didnt hear the GNATS because she was busy reading:
Aminoglycosides (GNATS = Genta, Neo, Amikacin, Tobra, and Stretomycins) cause ototoxicity (and nephrotox)
and act by binding to 16S and causing mRNA misreading; vs. g- rods; REQUIRES O2 UPTAKE so ineffective
against anaerobes; resistance via modification of 30S (acetylation, etc)
2. Tetracyclines block TRNA from binding A-site and discolors Teeth/bones
1. caTion-chelator, do NOT take with antacids, milk, or iron-containing prep!
2. AE: photosensitivity (SAT for photo - sulfonamides, amiodarone, TETRACYCLINE)
3. vs. "VACUUM TH BedRoom" - Vibrio, acne, Chlamydia, ureaplasma, urealyticum, Mycoplasma
pneumonia, Tularemia, H. pylori, Borrelia, Rickettsia
4. resistance via decr uptake, incr export
NOTE: DEMECLOCYCLINE = DIURETIC = ADH ANTAGONIST (Tx: SIADH)
Ampicillin and Amoxicillin are Anti-G+ Aminopenicillins that HELPS kill Pseudomonas with Sulbactam/Clavulanic acid (beta lactamase inhibitor):
H = Haemophilus
E = E. coli
L = Listeria
P = Proteus
S = Salmonella
Note: Ampicillin = intrapartum injection, GBS prophylaxis
TCP Takes Care of Pseudomonas:
Ticarcillin
Carbenicillin
Piperacillin
Cephalosporins:
1st generation (cefa): G+ + PEcK: Proteus, E.coli, Klebsiella
 2nd generation (fur fox fo'tetan): G+ + HEN-PEcKS: Haemophilus, Enterobacter, Neisseria, Proteus, E. coli, Klebsiella, Serratia
o Fur cap - Cefuroxime for Community Acquired Pneumonia
o Linda Brought a Fragile Fox fo'Tito - Clindamycin, B. fragilis, Cefuroxime, Cefotetan
3rd generation (trix tax taz): Meningitis, Gonorrhea, Typhoid fever (Salmonella)
o Ceftriaxone = #1
o CefTAZidime is for Pseudomonas like TAZobactam+Piperacillin (but causes neutropenia)
4th generation (Cefepime) = G+ + pseudomonas
Metronidazole: forms toxic metabolite that damages DNA; Tx: "GET GAP on the METRO"
G = Giardia
E = Entamoeba histolytica (liver abscess)
T = Trichomonas
G = Gardnerella
A = Anaerobes (B. fragilis, C. difficile)
P = H. Pylori (+ bismuth + amoxicillin/tetracycline)
Anti-TB: "INH-SPIRE": AE: hepatotoxic
INH = Isoniazid (inactivates mycolic acid synthesis enzymes enoyl-acyl carrier protein reductase (InhA overexpression = resistance) and
betaketoacylACPsynthase (KasA); KatG gene encodes catalase peroxidase that activates INH); solo-TB prophylaxis; AE: hepatotoxicity,
neurotoxicity (prevented by B6), drug-induced lupus (anti-histone Ab)
S = Streptomycin (aminoglycoside vs 30S mRNA reading)
P = Pyrazinamide - active in acidic pH, inhibits mycobacterial growth in M0; AE: hyperuricemia/gout
(I = INH)
R = Rifampin - inhibits DNA-dRNAp = no transcription (rapid resistance) AND blocks packaging and assembly of viruses; induces cyp450;
prophylaxis for N. men and Hib; AE: red secretions, stop therapy with purpura, bone marrow suppression
E = Ethambutol - AE: optic neuropathy (red green colorblindness)
Antifungal:
Amphotericin B:
o AmphoTEARicin TEARS holes in fungal membrane (binds ergosterol and forms pores)
o AmphoTERRible: AE: fever/chills, hypotension, nephrotox, arrhythmia, anemia, IV phlebitis
Antiviral:
ARM2 cure A FLU = Amantadine Rimantidine block M2 protein (viral uncoating) vs. Influenza A; AE: AtaxiA
Herpes = Cyclovirs (virally activated guanosine analogs) + Trifluridine (thymidine analog)
CMV = Cids Gang loved seeing Foamy Scarlet = Cidofovir (Cytosine analog + Probenicid to prevent excretion), Ganciclovir (intraocular
implant), Fomivirsen (intraocular injection, anti-sense RNA therapy), FOScarnet (unlike ganciclovir, doesnt require thymidine kinase
activation; pyroFOSphate analog that directly inhibits DNApol)
HIV therapy:
Protease inhibitors = navirs (AE: GI intolerance, hyperglycemia, lipodystrophy, cyp450 inhibitor)
NRTIs: "Abe Did Embark on a L-AZy Start"
o Abacavir
o Didanosine
o Emtriciabine
o Lamivudine
o AZT (Zidovudine)
o Stavudine
NNRTIs: "Move to Delaware? Effin Never!
o Delavirdine
o Efavirenz
o Nevirapine
FUsion inhibitor = enFUvirtide (gp41 binder)
Interferons: activates NK cells; AE: Neutropenia
IFNalpha - "alpha B C > Tx: HBV, HCV
IFNbeta - PMS sounds like BMS > Tx: Multiple Sclerosis
NOTE**: alpha and beta IFNs decr viral replication and incr antiviral protein synthesis that impairs viral mRNA translation
IFNgamma - G in gamma is for cGd > Tx: Chronic Granulomatous Disease (NADPH oxidase deficiency)
NOTE**: IFNgamma incr MHCI and II expression, activates M0 > TNFalpha, IL1, IL6
Immunology:
B-cells are always found in (white) Follicles closer to the outside of the LN or spleen
VS. T-cells are found in the deeper medulla(LN)/PALS(spleen)
Lymph drainage:
rectum above pectinate line = internal iliac
umbilicus to legs (inc, superficial genitals and anal canal below pectinate line) = superficial inguinal
testes = para-aortic
MHC I and II: "Rule of 8s"
1*8 = MHCI x CD8 = 8
 2*4 = MHCII x CD4 = 8
Natural Killer cells: detects MHCI
Gotta KIL to survive (KIR + KIL = survive)
KIR only = release perforins and granzymes > apoptosis
Antibody cleavage:
Papain cleaves Ab into 3 pieces: Pa Pa In (evenly splits into 3)
Protease cleaves Ab into 2 pieces: Prot Ease (evenly splits into 2; complement can still bind hinge)
Cytokines: "Hot T-Bone stEAk"
IL1 (and IL6): hot = fever; secreted by M0
IL2: T = T-cell proliferation; secreted by Th1
IL3: Bone = Bone marrow stimulation (acts like GM-CSF); secreted by T cells
IL4: E = IgE (and IgG) class switching; secreted by Th2
IL5: A = IgA (and eosinophil) production; secreted by Th2
Neutrophil chemotaxis: "CILK": C5a, IL8, LTB4, Kallikrein
IL8: "8" looks like multilobed nucleus of neutrophil = PMN chemotaxis
LTB4s B also looks like neutrophil multilobed nucleus
Immunosuppression Rx vs. IL2: "(IL)2 Pro-Cyclists Secreted Tacks in Response to Serious/Sirius Dax"; prevent transplant rejection
vs. production: Cyclosporin (via inhibit calcineurin)
vs. secretion: Tacrolimus (via binding FK-protein)
vs. response to: Sirolimus (via MTOR)
vs. receptor: Daclizumab
**NOTE: MCC SCID = defective IL2 receptor > ADA deficiency; decr T > decr B activation: all types of recurrent infections (viral/bacterial/fungal)
Rx vs TNF: Tx: Rheumatoid arthritis
vs. TNF: Infliximab
vs. TNF receptor: Adalimumab
fake TNF receptor: Etanercept
Complement:
C_a for anaphylaxis (histamine release > edema > hypotension, anaphylaxis)
C_b for binding bacteria (opsonizes and forms pores)
low 3 causes 3: C3 deficiency causes HSRIII (immune complex deposit), seen especially in glomerulonephritis; susceptible to S. pneumo and Hib >
severe recurrent pyogenic sinus and respiratory tract infections
**Remember SHiN: S(trep. pneumo) + Hi(b) = C3 deficiency; N(eisseria) = C5-C9/MAC deficiency
Passive immunity: "To Be Healed Rapidly" - Tetanus Botulism HBV, Rabies/(RSV in premies every winter month)
Immune deficiencies:
Brutons agammaglobulinemia = (x-r) Boys with BTK (tyrosine kinase) defect > Blocked B-cell differentiation: recurrent Bacterial infection
after 6 months (when moms IgG disappears) b/c no Igs
Selective Ig(A) deficiency: milk Allergies, blood product Anaphylaxis, giardiA infections; IgA is missing in mucus so recurrent sinus and
lung infections
**Note: IgA deficiency also seen in Ataxia-Telangiectasia:defective DNA repair enzymes, sensitive to ionizing radiation, cerebellar
atrophy > ataxia, spider angiomas (telangiectasias); assoc. w/ lymphomas and acute leukemias
Hyper-IgE/Jobs Syndrome: "Im Hyper Excited for my FATEd Job"
o Hyper Excited = Hyper IgE
o F = coarse Facies
o A = cold, noninflamed Staph Abcesses
o T = retained primary Teeth
o E = Eczema
o Job = Jobs
Chediak-Higashi (a-r): "Grandpa Al couldnt eat Eastern food with his fingers.
o Grandpa = Gram positive cocci infections: Staph and Strep
o Al = partial albinism
o couldnt eat = defective microtubules = defective phagocytosis and lysosomal fusion
o Eastern = Higashi ("higashi means East in Japanese)
o with his fingers = peripheral neuropathy
Pathology:
Proto-oncogenes: tumor promoters; damage one allele > gain of function (VS. tumor suppressors need to damage both alleles to lose function)
Mikes sis returned with her2new breasts that she was able to-grow-faster b/c of herbs.
Mike = myc: C-myc - Burkitts, N-myc - adrenal Neuroblastoma, L-myc - small cell lung CA
sis: astrocytoma, osteosarcoma
returned = ret: MENII
her2new = Her2/neu: breast cancer
was = ras: colon, bladder, lung, pancreas, renal CA
able = abl: CML, ALL (ALL able CaMeLs are from Philadelphia t(9;22))
to-grow-faster = TGF: astrocytoma, HCC
 b/c = bcl2: follicular lymphoma
herbs = ERB-B1,2: ERB-B1 - lung squamous cell CA, ERB-B2 - breast, ovarian, gastric CA
Psammoma bodies: concentric Ca2+ spheres; looks like thumbprint; "PSaMMoma":
P = papillary thyroid tumor
S = serous cystadenocarcinoma of ovary
M = mesothelioma
M = meningioma
ESR (marker of inflammation): inflammatory product fibrinogen coats RBC causing aggregation > weight pulls RBC down = fall at faster rate in test
tube
incr/faster ESR = inflammation: infection, cancer, pregnancy, SLE
decr/slower ESR = de-prESsed Heart is Sick from Too Much Blood.
o Heart = CHF
o Sick = Sickle Cell
o Too Much Blood = Polycythemia
Pharmacology:
Kompetitive inhibitors incr Km, decrease affinity/potency (amount of drug needed for effect); sigmoid effect curve shifts right; Lineweaver-Burke lines
cross at Y-axis
(VS non-competitive inhibitors decr Vm, decrease efficacy (maximal effect of drug); sigmoid effect curves vertical maximum effect is reduced;
Lineweaver-Burke lines join at X-axis)
Zero-order elimination: constant amount of drug eliminated per unit time = PEA - Phenytoin, Ethanol, Aspirin
Urine pH and drug elimination: medicine gets trapped in opposite urine pH:
acid (phenobarb, MTX, TCA, aspirin) trapped in basic bicarbonate
**Note: Acetazolamide alkalinizes urine by getting rid of bicarbonate; Tx: cysteine stones and altitude sickness (hyperventilation >
respiratory alkalosis)
base (amphetamine) trapped in acidic ammonium chloride
Phase I vs Phase II metabolism: "1 red ox went 2 conjugate polar bears.
Phase 1: cyp450 red-ox (+ hydrolysis); geriatrics lose phase 1 first
Phase 2: conjugation (acetylation, glucuronidation, sulfation) > yields very polar renally excreted inactive metabolites
Therapeutic index: "TILED with TI= LD#/ED# and the #s adding up to 100; safer drugs have higher TIs
G-protein-linked 2nd messenger:
Gs = adenylyl cyclase > ATP-to-cAMP > PKA > cascade
Gi = inhibit adenylyl cyclase > decr cAMP > decr PKA
Gq = phospholipase C > lipids-to-PIP2 > IP3 incr intracellular Ca2+, DAG stim PKC > cascade
Kiss and Kick 'til youre Sick of Sex
QISS QIQ SIQ SQS
Gq = alpha 1: SM contraction, mydriasis; incr Systolic and Diastolic BP
Gi = alpha 2: decr SNS, decr insulin
Gs = beta 1: incr heart rate and contractility, incr renin, incr lipolysis
Gs = beta 2: decr Diastolic BP, vaso/bronchodilation, incr heart rate, contractility, incr lipolysis, incr insulin release (think Beta2
stimulates Beta islet cells of pancreas), decr uterine tone
Gq = M1: CNS, enteric nervous system
Gi = M2: decr HR, decr atrial contractility
Gq = M3: incr secretions, peristalsis, miosis, accommodation (ciliary muscle contraction)
Gs = D1: renal perfusion (renal artery dilation)
Gi = D2: brain neurotransmitter
Gq = H1: pruritus/pain, incr nasal/bronchial mucus, contract bronchioles
Gs = H2: incr gastric acid secretion (inhibited by -idines)
Gq = V1: incr vascular SM contraction
Gs = V2: incr H2O reabsorption in kidneys CD (ADH action)
Signaling pathways:
cAMP (Gs, Gi): "FLAT CHAMP + calcitonin + glucagon"
o F = FSH
o L = LH
o A = ACTH
o T = TSH
o C = CRH
o H = hCG
o A = ADH (V2)
o M = MSH
o P = PTH
o calcitonin
o glucagon (incr cAMP > activates PKA > incr F16BPase > gluconeogenesis RLS)
IP3 (Gq): "hIP3othalamic GGOAT"
GHRH
 GnRH
oxytocin
ADH (V1)
TRH
cGMP: vasodilators
ANP
NO (NO venodilates decreasing preload VS beta-blockers arteriodilate and reduce afterload)
tyrosine kinase: "the TyK Grows In Milk"
GH
IGF-1
FGF
PDGF
Insulin
Prolactin
steroid receptor: cytoplasmic (except thyroid hormone = intranuclear)
(Adrenal cortex:) Aldosterone, Glucocorticoid, Testosterone, Estrogen
Progesterone
Vitamin D
T4/T3 (intranuclear receptor)
Glaucoma drugs: "AABBCDF"
AA = Alpha Agonist: vasoconstriction > decr aq humor synthesis (not for closed angle glaucoma)
BB = Beta Blocker (Timolol): decr aq humor secretion
C = Cholinomimetic (Carbachol, Pilocarpine; Phys is for the Eyes Physostigmine, Echothiophate): incr outflow (contract ciliary muscle and
open trabecular meshwork into canal of Schlemm)
D = Diuretic: Acetazolamide (carbonic anhydrase inhibitor), Mannitol: decr aq humor secretion
F = PGF2alpha (Latanoprost): incr uveoscleral outflow; AE: dyes irises brown
Cholinomimetics:
Bethanechol: "Give Beth-ann-a-call if you want your PNS stimulated": Tx: post-op neurogenic ileus and urinary retention
Anticholinesterases = -stigmines" + Edrophonium + Echothiophate
Organophosphate poisoning: "DUMBBELSS: Tx: Atropine, Pralidoxime
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation of skeletal muscle and CNS
Lacrimation
Salivation
Sweating
Atropine poisoning: "what would happen if you got lost in the desert: Hot, Dry, Red, Blind (cycloplegia), Mad (delirium), urinary
retention(/constipation)
Hexamethonium: "Put a Hex on reFLEX bradycardia - Hexamethonium prevents NE reflex bradycardia by blocking all Nicotinic receptors (ganglion
blocker inhibits Na/K ligand-gated channels)
ACh receptors:
Nicotinic = Na/K ligand-gated channels (ANS and NMJ) (Hexamethonium/Mecamylamine blocks these)
Muscarinic = G-coupled receptors; M1,2,3=QIQ (Atropine blocks these)
Specific antidontes:
DeFERoxamine Txs Fe (iron)
Children Suck on Lead pencils: Succimer Txs Lead poisoning in children (Tx is CaEDTA in adults)
DiMERcaprol Txs MERcury, arsenic, gold
Copper Penny: Copper, arsenic, gold Tx w/ PENIcillamine
NITRoprusside turns into Cyanide which is Txd w/ NITRite, hydroxocobalamin, and thiosulfate
METHylene blue and VitC Txs METHemoglobin
ETHANOL Txs mETHANOL poisoning
Heparins H looks like a Proton: PROTamine Txs Heparin toxicity
Drug reactions:
TCAs 3 Cs: Cardiotoxicity, Convulsions, Coma
Cutaneous flushing: "VANC" = Vancomycin, Adenosine, Niacin, Ca2+ channel blockers
Dilated cardiomyopathy = Doxorubicin and Daunorubicin
Torsades de Pointes: "The Method to get 31Awesome QTs is to wear a Halo and Risper that you bought a Macro-PIe from Quinn.
 o Method = Methadone
o 31Awesome = Class III, Class Ia antiarrhythmics
o Halo = haloperidol
o Risper = risperidone
o Macro = macrolide
o PI = HIV protease inhibitors
o Quinn = Chloroquine/Mefloquine
Aplastic anemia: "Chlora SAID "Ptuey to Meth":
o Chlora = Chloramphenical
o SAID = NSAID
o PTUey = PTU (antithyroid)
o Meth = Methimazole (antithryoid)
Hemolysis in G6PD: "Prima had to take Aspirin after INHaling her I.B.Professor Dapsones Sulfurous Fava Bean Nitrofarts"
o Primaquine
o Aspirin
o INH
o Ibuprofen
o Dapsone
o Sulfonamides
o Fava bean
o Nitrofurantoin
Pseudomembranous colitis makes you want to ClAmp your ass: CLindamycin, AMPicillin
Photosensitivity: "SAT for a Photo":
o S = Sulfonamides
o A = Amiodarone
o T = Tetracyclines
Stevens-Johnson rash: "'Seizures, Sulfas, and Cillins + Allopurinol"
o Seizure drugs: ethosuximide, lamotrigine, carbamazepine, phenobarbital, phenytoin
o Sulfa drugs
o Penicillin
o Allopurinol
SLE-like syndrome: "SHIPP"
o Sulfonamides
o Hydralazine (Hydras neck Loops (Lupus) around in circles)
o INH
o Phenytoin
o Procainamide
Disulfiram-like reaction: "Drunk Ceph said he was Pro-Car (okay to drive) at Night, but to avoid a Gruesome accident, Chlora made him
Suffer the Metro.
o Ceph = Cephalosporin
o Procar = Procarbazine
o Night = Nitrofurantoin
o Gruesome = Griseofulvin
o Chlora = Chloramphenicol
o Suffer = Sulfonylureas
o Metro = Metronidazole
Ototoxicity/Nephrotoxicity: "Mice use Platinum earring Loops to crawl into your Ear and make you deaf
o Mice = -mycins = aminoglycosides and vancomycin
o Platinum = Cisplatin
o Loops = Loop diuretics
p450 interactions:
o p450 inducers: "Queen Barbs riFamily induced Saint John to eat a Pheny-looking Greasy Carb"
Queen = Quinidine
Barbara = Barbiturate
riFamily = Rifampin
induced
Saint John = Saint Johns Wort
Pheny-looking = Phenytoin (AE: gingival hyperplasia)
Greasy = Griseofulvin
Carb = Carbamazepine
 See reference:

o p450 inhibitors: "Without a Key, Kim was inhibited from PIES and Juice"
Key = Ketoconazole
Kim = Cimetidine
inhibited
PI = HIV Protease Inhibitors
E = Erythromycin
S = Sulfonamides
Juice = grapefruit juice
See reference:

Toxicity bear: Cumulatively Toxic Drugs and their Rescues

o Asparagine: neurotoxicity
o Cisplatin: ototoxic/nephrotoxic; Tx: Amifostine
o Vincristine/Vinblastine: "Christ my nerves, Blast my bones" - Vincristine = peripheral neuropathy, Vinblastine =
myelosuppression
o Bleomycin: pulmonary fibrosis
o Doxorubicin: cardiotoxic; Tx; Dexrozoxane (for cardiotoxicity), Dimethyl-sulphoxide (for ROS ulcers)
o Cyclophosphamide: Acrolein = nephro/bladder toxic (Tx: Mesna); also SIADH effects (Tx: Demeclocycline)
o Methotrexate: nephrotoxic (Tx: Leucovorin), myelosuppression (Tx; Filgrastim)
 o See reference:

Cardiovascular:
Contractility decreases with: "ABBCCC":
A = Acidosis
BB = Beta blocker
CCC = hyperCO2, CHF, non-DHP Ca2+ channel blockers
Heart murmurs:
MR. ASS and MS. ARD =
o MR = mitral regurg
o AS = aortic stenosis
o S = systolic murmurs
o and
o MS = mitral stenosis
o AR = aortic regurg
o D = diastolic murmurs
holosystolic = all regurgs + VSD
murmurs that increase with breathing:
o rIght murmurs increase with Inspiration
o lEft murmurs increase with Expiration
Wolf = Lone Canis - Wolff-Parkinson-White is treated with amiodaRONE and ProCAINamide
AV blocks:
First, a girl stays out 'til 12 even though her curfew is 10.
Then, the teenager stays out later and later, 'til her mom throws a fit.
Afterwards, despite the teenager being good, the mom throws random fits probably because of menopause.
Finally, the young woman is old enough to whatever she wants separately from her parents."
1st degree: increased PR
2nd degree:
o Type 1 Wenckebach: incr PR until QRS drop
o Type 2: random QRS drop
3rd degree: PR and QRS = independent rates; seen in Lyme disease
DiGeorge "Tets: TETralogy of Fallow + TETany from hypocalcemia (lack of parathyroids) (also, truncus arteriosus)
PGA open: PGE kEEps PDA open (PGE1 analogs: Alprostadil, Misoprostol); close with Indomethacin
Evolution of MI: "4 and death are both pronounced shi in Japanese"
Initially: nothing
4 hours-4days later: PMNs, coagulative necrosis, risk of arrhythmia (esp. V-fib)
4-10 days later: M0s thinned walls > increased risk of rupture and tamponade
>10 days: risk for ventricular aneurysm (bulging scar because fibrosis made it lose its ability to contract) <ventricular remodeling can be
prevented with ACE-Is
Bacterial endocarditis: "FROM JANE":
Fever
Roth spots: round retinal white spots surrounded by hemorrhage
Oslers nodes: tender raised red lesions on fingers and toe pads
Murmur (new)
Janeway lesions: non-tender small red lesions on palms and soles
 Anemia
Nail-bed (splinter) hemorrhage
Emboli
IVDA = right-sided bacterial endocarditis: "dont TRI drugs" (tricuspid valve)
SLE causes LSE (Libman Sacks endocarditis with warty sterile vegetations on both sides of valve, assoc. w/ mitral regurg)
Rheumatic heart disease of S. pyogenes (beta-hemolytic, bacitracin-sensitive Strep): "AAAAAA"
group A Strep
autoimmune (Ab to antiphagocytic M protein > MVP > Mitral Stenosis), fever
Aschoff bodies (granulomas with giant cells) = subcutaneous nodules
Anitschkow cells (activated histiocytes)
elevated ASO titers and ESR
migratorypolyArthritis
+ Erythema martginatum, Syndenhams/St. Vitus chorea (of face, tongue, and upper limb)
ACE-inhibitors are ACEs at controlling HTN:
essential hypertension
HTN+CHF (decreases both preload and afterload)
HTN+DM (protective against Diabetic nephropathy)
Antihypertensive therapy: "ABCD":
ACE-I/ARBs
Beta blockers
Calcium channel blockers
Diuretics (LOOps LOOse Calcium, Thiazides retain calcium)
Aden Diaz is Mine OK?: Adenoxine, Diazoxide and Minoxidil Open K+ channels
Antiarrhythmics: "No Bad Boy Keeps Clean"
Type I: Na+ blocker (incr QT)
Type II: Beta blocker (incr PR); Tx OD w/ Glucagon
Type III: K+ blocker (incr QT)
Type IV: Ca2+ blocker (incr PR); Tx coronary and cerebral vasospasms
Type I antiarrhythmics:
Ia: "The Queen Werewolf Disappeared"
Quinidine, Procainamide, Disopyramide (incr AP)
Ib: "To Funny Little Mexico"
Tocainide, Phenytoin, Lidocaine, Mexiletine (decr AP)
Ic: "Properly Fleeing Endangerment"
Propafenone, Flecainide, Encainide
Type III: Amiodarone: "check PFTs, LFTs, and TFTs"
pulmonary fibrosis
hepatotoxicity
hypo/hyperthyroidism (amiodarone = mostly iodine, resembles thyroid hormone)
+ photodermatitis (SAT for a photo)
Endocrine:
Adrenal cortex: "GFR: The deeper you go, the sweeter it gets.
"salt: zona Glomerulosa: aldosterone
sugar: zona Fasciculata: cortisol
sex: zona Reticularis: androgens
Adenohypophysis = Anterior pituitary (RAthkes pouch of ectoderm): "FLAT PEG"
FSH
LH
ACTH
TSH
Prolactin
endorphins (share POMC origin with ACTH and MSH)
GH
Basophilic = B-FLAT: Basophilic-FSH, LH, ACTH, TSH (VS Acidophils-Prolactin, GH)
Neurohypophysis = Posterior pituitary (Neural tube of ectoderm): secretes hypothalamic substances: "A Pair of Ox were Supra Dehydrated"
Paraventricular nucleus - Oxytocin
Supraoptic nucleus - Vasopressin (ADH)
Adrenal steroids: "In an enzyme deficiency, if the first digit is a 1, then the patient will be hypertensive. If the second digit is a 1, then the patient will
look male.
17alpha hydroxylase deficiency: HTN, feminine
21 hydroxylase deficiency (MC): hypotension, masculine
11 beta hydroxylase deficiency: HTN, masculine
PTH = phosphate trashing hormone (note: decreased free serum Mg2+, decreases PTH secretion; common causes of decr Mg2+ = alcohol,
aminoglycosides, diarrhea, diuretics)
Calcitonin = from parafollicular C cells of thyroid = neural Crest derivative, secreted in medullary thyroid Cancer (MENII)
(Signaling pathway mnemonics were covered earlier)
Thyroid hormone functions: "T3 = 5Bs
Brain (CNS) maturation (defect = mental retardation seen in Cretinism)
Bone growth (synergism with GH; defect = Cretinism)
Beta1 adrenergic effects (Thyroid Storm: incr HR, contractility > arrhythmia; Tx with propanolol or PTU (OK in pregnant))
incr BMR
incr Blood sugar: glycogenolysis, gluconeogenesis, lipolysis
Pheochromocytoma (PCC): "Rule of 10s"
10% malignant
10% bilateral
10% extra-adrenal
10% calcify
10% kids
10% familial
Neuroblastoma (MCC adrenal medulla tumor in children) = N-myc oncogene, stain = Neurofilaments, tumor marker = Bombesin
see Homer-Wright pseudorosettes and incr HVA (Dopamine derivative) in urine
scenario: ~2yo with retroperitoneal ab mass presents with HTN hypotonia, myoclonus, and non-rhythmic conjugate eye movements
(opsoclonus-myoclonus)
mass may invade into an intervertebral epidural space and look like a dumbbell
HypOthyroidism = cOld intolerance; HypErthyroidism = hEat intolerance
CHIMPANZEES cause Hypercalcemia:
Calcium ingestion (incr antacids > milk-alkali syndrome)
Hyperparathyroid/Hyperthyroid
Iatrogenic: Thiazides
Multiple myeloma
Pagets disease (when patients are immobilized, normally normocalcemic)
Addisons disease
Neoplasms (e.g., breast cancer = osteolytic)
Zollinger-Ellison syndrome (pancreatic tumor > incr gastrin; associated with MENI (parathyroid tumor)
Excess vitamin D
Excess vitamin A (incr bone resorption > incr Ca2+)
Sarcoidosis (or granulomatous disease)
Hyperparathyroidism:
Primary: Osteitis fibrosa cystica = stones, bones, and groans = kidney stones, brown bone tumors, weakness and constipation; incr
cAMP in urine
VS Secondary: Renal osteodystrophy = renal disease > decr Vit D > decr Ca2+ > incr PTH > bone lesions
Hypocalcemia signs:
C = Chvostek sign = Cheek tapping > facial muscle Contraction
T = Trosseaus sign = Tight BP cuff > hand Tetany (spasm)
Dexamethasone vs Demeclocycline vs Desmopressin:
Dexamethasone = steroid to Dx ACTH disease/syndrome
DemecloCYCLine = tetracycline ADH antagonist vs CYCLophosphamide-induced SIADH; Tx: SIADH
DesmoPRESSIN = vasoPRESSIN (ADH) analog; Tx: central Diabetes insipidus
(Note: nephrogenic DI is treated by hydrochlorothiazide (Ca2+ sparing diuretic), indomethacin (decr renal blood flow), or amiloride (K+
sparing aldosterone receptor antagonist diuretic that closes Na+ channels that also reabsorbs Li to Tx Li-induced DI)
Multiple endocrine neoplasias (MEN): (A-D)
MENI (Wermers): "3Ps"
o pancreatic - ~Zollinger-Ellison gastrinoma - peptic ulcers
o parathyroid - incr PTH - hypercalcemia
o pituitary - ~prolactin or GH - amenorrhea, lactation
MENIIa (Sipples): "2Ps"
o parathyroid - incr PTH - hypercalcemia
o PCC - incr catecholamines (Epi/Nor), urine VMA and Metanephrine
o medullary thyroid (parafollicular C) - polygonal, incr calcitonin - hypocalcemia
MENIIb: "1P"
o PCC - incr catecholamines, urine VMA/metanephrine
o medullary thyroid (parafollicular C) - incr calcitonin - hypocalcemia
o Marfans habitus + oral/intestinal mucosal neuromas
Note: MENIIs are associated with ret oncogene
 Also, the II in MENII stands for the 2Cs in PCC
Diabetic drugs:
Metformin Glitters in Sunny Gliptin Tides
Metformin = incr glucose uptake in muscle and fat via GLUT4 (aka incr insulin sensitivity in peripheral tissue) and decr liver glucose
production via incr AMPK and decr PEPCK (OAAtoPEP) and decr G6Pase (G6PtoGlucose) production
-Glitazones = incr insulin sensitivity via PPARgamma/adiponectin
Sulfonamides = incr pancreatic insulin production via blocking ATP-dep. K+ efflux
-Gliptins, -Tides = incr insulin, decr glucagon, decr gastric motility (incr satiety)
+ Acarbose/Miglitol = decr starch hydrolysis and glucose GI uptake
Diabetes drugs mechanisms of action:
PPARazzi camera flashes GLITA - PPARgamma -'Glitazones
GULP TIDES - GLP1 -'Tides
Dr.PPer and Lipton - DPP4 inhibitor -'Gliptins
Acarbose - Alpha glucosidase
Remember:
insulin > decreases cAMP > decreases PKA > dephosphorylated FBPase2 = PFK2 > F6P to F26BP > F26BP stimulates PFK1 >
incr F6P to F16BP (glycolysis)
glucose > decreases cAMP > decreases CAP-cAMP binding of lac operon = RNA polymerase cant bind to promoter
Gastrointestinal:
Retroperitoneal structures: "I ASK DR. PC"
Primary retroperitoneal (never pushed into sac):
o IVC
o Ab aorta
o Suprarenal glands
o Kidneys/Ureters
Secondary retroperitoneal (pushed into sac, but escaped):
o Duodenum (2, 3, 4)
o Rectum
o Pancreas (head, body)
o Colon (ascending, descending)
OR "SAD PUCKER" = suprarenal, abdominal aorta, duodenum, pancreas, ureter, colon, kidney, esophagus, rectum
Digestive tract histology: "Brunch DIP":
Brunners (submucosal, alkaline mucus secreting) glands = Duodenum
Ileum = Peyers Patches (M cells take up antigen; also location of IgA-secreting plasma cells)
Note: Shigella is taken up by the M-cells of Peyers Patches; viruses like Adenovirus may invade Peyers Patches and cause
intussusception; Sabin (live Polio vaccine) increases IgA immunity
Enteric nerve plexuses: "AUerbach is on the AUtside, MeiSSners is SSubmucosal"
Auerbachs = Myenteric = coordinates Motility by being wedged between the inner/circular and outer/longitudinal muscles
Meissners = Submucosal = regulates Secretions, blood flow, and absorption between mucosa and inner/circular muscles
Defect in Auerbachs causes Achalasia
Lack of both Auerbach and Meissners due to failure of neural crest cell migration causes Hirschsprungs Congenital Megacolon, assoc. with Down
Syndrome (see failure to pass meconium, like in Cystic Fibrosis)
Portosystemic anastomoses:
The mnemonic is from Systemic (IVC) to Portal (Celiac, SMV, IMV) veins:
MI Superiors an Ass. He makes me feel Inferior about my Superficial appearance by poking near my Belly-button so I Eat Less.
Rectal anastomoses: (X=hemorrhoids)
MI Superior is an Ass:
Systemic: Middle and Inferior Rectal
to
Portal: Superior Rectal
Umbilical anastomoses: (X=caput medusae)
Inferior about my Superficial appearance by poking near my Belly-button:
Systemic: Inferior, Superficial Epigastric
to
Portal: Paraumbilical
Esophageal anastomoses: (X=esophageal varices)
Eat Less: (X = esophageal varices)
Systemic: Esophageal (azygos)
to
Portal: Left Gastric
Liver anatomy: "1ABC"
1ABC:
o Zone 1 = Apical surface of hepatocytes face Bile Canaliculi = periportal zone
o Also, when you think of ABC, you should think of Hepatitis A, B, C
o Zone 1 = first affected by viral hepatitis because closest to hepatic artery (Remember: Portal triad = bile duct, hepatic artery,
and portal vein)
The 3rd letter in the alphabet = C:
 o Zone 3 = Centrilobular (periCentral vein) = where blood drains into the hepatic vein
o because its so far from the hepatic artery, its the first place to suffer from ischemia
o also, since blood pools in veins, you can think of drugs/poisons pooling there, too
Bottom line: Zone 1 = susceptible to viruses, Zone 3 = susceptible to drugs/ischemia
Femoral region: "NAVEL with the Venous near the Penis"
Lateral to medial: Nerve, Artery, Vein, Empty space, (deep inguinal) Lymphatics/Lacunar ligament
Note: femoral sheath does not contain femoral nerve
Inguinal canal: "INternal (deep) inguinal ring = INdirect hernia that may go INto the scrotum" = lateral to inferior epigastric vessels
VS. "an alien Directly bursting from your stomach" = direct hernia = protrudes from abdominal wall medial to inferior epigastric vessels:

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

Fem-Fem: femoral hernias occur more often in females (and is the leading cause of bowel incarceration)
GI secretory products:
IF you PARTY too hard, youll vomit out a lot of GASTRIC ACID.:
Parietal cells secrete IF (intrinsic factor) and HCl (gastric acid)
Pep-pep to the Chief:
Chief cells make Pepsin
Vitamin/Mineral absorption:
Duodenum: "FED" = Fe (iron) in Duodenum
Jejunum: "The Jester is a Fat Fool" = Jejunum absorbs most Fats and Folate
Ileum: The ileum is the last part of the small intestine; its where you say Bye Bye to the SI: Byle acid, B12/IF is reabsorbed in the Ileum
Bilirubin:
Rules of thumb:
o The two-named diseases dont go together
o The one named diseases are milder
INdirect = UNconjugated = water INsoluble: Crigler-Najjar, Gilbert =
KING KONG > CING CUNG > Criggler-Indirect/Unconjugated-Najjar-Gilbert
You get Crigler-Najjar/Gilberts when youre unable to conjugate bilirubin into a water-soluble/excretable form ~ Glucuronyl transferase
deficiency
Direct = conjugated = Water soluble: Dubin-Johnson, Rotors =
Dubin-Johnson called Rotor-rooter to fix his WaterPipes.
You get direct bilirubinemia when theres a problem with bile Pipes/excretion (E.G., biliary tree obstruction)
Note: Dubin-Johnson is worse than Rotors in that the liver is pigmented black
Achalasia: "AABBCC"
Achalasia
loss of Auerbachs myenteric plexus
Birds beak on Barium swallow
associated with Chagas and CREST
Boerhaave syndrome = Been-Heaving; transmural complication of Mallory-Weiss
BARRetts esophagus = Becomes Adenocarcinoma, Results from Reflux
Esophageal cancer risk factors: "ABCDEFGH"
Alcohol, Achalasia
 Barretts esophagus
Cigarettes
Diverticuli (e.g., Zenkers)
Esophageal web (e.g., Plummer-Vinson), Esophagitis
Familial
GERD
Hot dogs (nitrosamines)
Esophageal cancer epidemiology and locations:
Squamous cell = Spread out worldwide (most prevalent worldwide); upper 2/3s (where striated muscle can be found)
Adenocarcinoma = most prevalent in America (lower 1/3, location of pure smooth muscle)
Gastritis:
Acute gastritis (erosive):
o Burned by Curling iron: Curlings ulcer = stress ulcer from burns:
decr plasma volume > sloughing of gastric mucosa
o Cushion the brain: Cushings ulcer = stress ulcer from head injury:
incr ICP > incr vagal stimulation > incr ACh > incr H+)
Chronic gastritis (non-erosive): "AB-pairing"
o Type A (fundus/Body) = Autoimmune/Anemia:
AutoAb to parietal cells, pernicious anemia (Ab to IF), achlorhydria
o Type B (Antrum) = Bacterial:
H.pylori infection (duodenal > stomach ulcer), increased risk of MALT lymphoma
Peptic ulcer disease:
Gastric ulcer pain = Greater with food
Duodenal ulcer pain = Decreases with food (will see hypertrophy of Brunners glands and clean punched out margins unlike carcinoma
raised/irregular margins)
Inflammatory bowel disease (IBD): Crohns vs Ulcerative Colitis
Crohns: "A Creepy Fat old Crone (Granny) went Skipping on Cobblestones while pumping her Arthritic Fist in the air.
o Creepy Fat = Creeping fat
o Crone = Crohns disease
o (Granny) non-caseating Granulomas
o Skipping = transmural Skip lesions
o Cobblestone = Cobblestone mucosa
o Arthritic = Migratory polyarthritis
o Fist = Fistulas
o "Gum to Bum lesions and extraintestinal manifestations (systemic) like erythema nodosum (~shins), ankylosing spondylitis,
and uveitis
o Note: this is disordered response to intestinal bacteria
Ulcerative colitis: "If you have a Lead Pipe jammed up your Rectum, youll get Bloody Diarrhea.
o Lead Pipe = loss of haustra leads to "lead pipe appearance on imaging
o Rectum = UC always involves the rectal mucosa/submucosa and procedes continuously up unlike Crohns which tends to spare
the rectum
o Bloody diarrhea (another trait not shared with Crohns)
o Note: this is autoimmune
o UC is also associated with friable pseudopolyps, pyoderma gangrenosum, and primary sclerosing cholangitis
Meckels diverticulum: "Rule of 2s"
2 inches long
2 feet from ileocecal valve
2% of population
2yo (or younger)
2 types of ectopic epithelia: gastric or pancreatic
Colonic polyps: "VILLous = VILLainOUS" because villous polyps are more likely to be malignant (villous > tubulovillous > tubulous)
Colorectal cancer (CRC):
Familial adenomatous polyposis (FAP): "polyposis" = thousands of polyps; FAPCancer involves APC gene; always involves rectum
VS. HNPCC/Lynch which doesnt have many polyps and involves the PROXIMAL colon
Gardners syndrome = Gardeners Grow all kinds of things: Gardners = FAP + osteomas + lipomas/soft tissue tumors + retinal
hyperplasia
Turcots syndrome: "TURcot = TURban"; FAP + malignant CNS tumor (medulloblastoma)
Presentation of CRC: Think of the colon as a funnel that shrinks towards the anus (and also that visceral nerves dont have as many localized pain
receptors as the anus):
distal colon (left side, near anus) = obstruction, sharp colicky pain, hematochezia
proximal colon (right side) = iron deficiency anemia, dull pain, fatigue
CRC: "Apple core" lesion on barium enema x-ray, CEA tumor marker
Molecular pathogenesis of CRC: alphabetical order
lose APC (decreased intercellular Adhesion) then mutate kRAS (unregulated signal transduction MAPK) then lose p53 (no apoptosis)
Wilsons disease (hepatolenticular degeneration): a-r inadequate copper excretion, treated with penicillamine (copper penny): "ABCDEF"
 Asterixis, Ataxia, Anemia (hemolytic)
Basal ganglia degeneration (Parkinsonism)
decr Ceruloplasmin, Cirrhosis, Corneal deposits, Cancer (HCC)
Dementia
Encephalopathy
Fanconis Syndrome: defective PCT reabsorption
Gallstones (cholelithiasis): Risk factors = 4Fs:
Fat
Fertile
Female
Forty
Acute pancreatitis causes: "GET SMASHED" > DIC, ARDS
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune disease
Scorpion Sting
Hypercalcemia, Hyperlipidemia
ERCP
Drugs (E.G., Sulfa drugs)
Antacid adverse effects:
Al = AluMINIMUM amount of feces: constipation
Mg = Must Go to the bathroom: diarrhea