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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 f elt like not many people would be interested(Update: sorry , but Im too busy to go
back and ty pe the rest! ><).
P.S. If y ou want to f ind a topic f ast, I suggest Ctrl+F
Behavioral Science:
Statistical distribution:
Positiv e skew = meAn>meDian>mOde
Positiv e skew = alphabetical f rom greatest to least
Reportable diseases:
"It was reported that studly Mr. Shigella ate salmon, chicken, and liv er":
"It was REPORTED that STuDly MMR SHIGELLA aTB Salmon, Chicken, and Liv er"
STDs: AIDs, Gonorrhea, Sy philis, Chlamy dia (*NOT HIV!)
MMR: Measles, Mumps, Rubella
Shigella
TB
Salmonella
Chicken Pox
Hepatits A, B, C
Health care pay ment:
CARE f or the Elderly , AID the destitute
Medicare - elderly , Medicaid - low income people
Early dev elopmental milestones:
# of blocks stacked = age in y ears * 3
2 word sentences at 2
"pee at three"; tricy cle at three
"f our-square at f our" = can hop at f our
drawings:
3y o = circle
4y o = +
5y o = square
6y o = triangle
See ref erence:

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.
"MY Cs SIS RETurned with HER2Neu breasts she RAS ABLe To-Grow BCl of hERBs."
My c
sis
ret
Her2/neu
ras
abl
TGFalpha
bcl2
ERB-B1, B2
Collagen: The higher the number, the smaller and sof ter it gets
Ty pe 1 - bone (skin) - Osteogenesis Imperf ecta (f ailed gly cosy lation and f ormation of procollagen triple
helix with ER)
Ty pe 2 - cartilage - death in utero
Ty pe 3 - blood vessels - Ehlers-Danlos (f ailure of cross-linking by ly sy l oxidase to make collagen f ibrils
outside f ibroblasts), berry aneury sms
Ty pe 4: basement membrane - Alports nephritis (+ deaf ness and v ision problems; cant see, cant pee,
cant hear)
Blotting procedures:

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SNOW
DROP
S/D: Southern blot = DNA sample identif ied with DNA probe
N/R: Northern blot = RNA sample identif ied with DNA probe
O/O
W/P: Western blot = protein sample identif ied with antibody probe
Model sy stems:
Knock out = take a gene OUT
Knock in = INsert a gene
Knock down = knock down the expression of the gene v ia complementary mRNA antagonist
Imprinting:
Prader-Willi = Paternal deletion
AngelMans = Maternal deletion
Genetics:
Autosomal Dominant: hav e f amilial or hereditary in name +
"A Brainy Dwarf named Marf an v on Hippel-Lindau hired MEN to Hunt f or Potatoes."
Brainy = Neurof ibromatosis1, 2
Dwarf = Achondroplasia
Marf an
v on Hippel-Lindau
MEN1, 2a, 2b
Huntingtons
Potato = Tuberous sclerosis
X-linked recessiv e:
"Duke Fabry s Brutal Gopher Hunter, Lesch, Was-Actually a Fragile Albino Hemophiliac."
Duke = Duchennes
Fabry
Brutal = Brutons
Gopher > G6Pher = G6PD def iciency
Hunter = Hunters
Lesch-Ny han
Was-Actually = Wiskott-Aldrich
Fragile X
ocular Albinism
Hemophilia A, B
Fragile X = Xtra large testes, jaws, ears
FraGile X = cGg trinucleotide repeat
my oTonic dy strophy = cTg trinucleotide repeat
Autosomal trisomies: Pat Ed Down = 13, 18, 21
Puberty at 13, Election at 18, Drinking at 21
Down sy ndrome is associated with ALL (and AML) and ALzheimers and decreased ALpha-f etoprotein > ALL f all
DOWN; also associated with:
Duodenal Atresia (f ailure to recanalize = blind duodenum > bilious v omiting with f irst f eed; double-bubble)
Celiac Disease (associated with dermatitis herpetif ormis)
Annular Pancreas
Hirschprung congenital megacolon (f ailure of neural crest cell migration: no Auerbach or Meissners plexus
> constipation/meconium ileus)
Edwards: watch 99 balloons
Pataus: rocker bottom Pedals/f eet, clef t lip/Palate, holoProsencephaly (sonic hedgehog def iciency ), Poly dacty ly
Williams sy ndrome: Will Farrell in Elf : elf in f aces, mental retardation, well-dev eloped v erbal skills, extreme
f riendliness
DiGeorge sy ndrome: CATCH-22
Clef t palate
Abnormal f acies
Thy mic aplasia (T-cell def iciency )
Cardiac def ects
Hy pocalcemia (secondary to parathy roid aplasia; remember third phary ngeal pouch: inf erior parathy roids
are grown with thy mus and descend together)
microdeletion at chromosome 22q11
Vitamin B1: Thiamine
Thiamine py rophosphate (TPP) is needed f or a number of enzy mes, but is rarely required alone. Whenev er y ou need
B1, y ou usually need FAD (B2), NAD (B3), CoA (B5), and Lipoic Acid, so just group them together: B1,2,3,5+LA.
Enzy mes that use B1, 2, 3, 5 + LA:
Gly coly sis/TCA: PDH (X = lactic acidosis; Tx: ketogenic Leucine, Ly sine + high f at diet)
TCA: alphaKGDH
HMP: transketolase
branched chain AADH (X = Maple Sy rup Urine Disease > sev ere CNS def ects, MR, and death)
Related problems:
Lipoic acid is antagonized by Arsenic, which causes rice water diarrhea and garlic breath.
B1 def iciency in alcoholics > Wernicke-Korsakof f , beriberi
PDH def iciency /dy sf unction > inability to continue TCA > div ersion to lactic acidosis; brain starv es f or
energy > neurologic def ects. To keep brain f rom starv ing, Tx with ketogenic amino acids LEUCINE and
LY SINE and high f at diet (beta oxidation of f ats will produce acety l CoA > TCA/ketogenesis).
Vitamin B6: Py ridoxine
Major pathway s that use B6:
1. Gly cogenoly sis RLS: Gly cogen > G1P v ia gly cogen phosphory lase
2. Heme sy nthesis RLS: Succiny l CoA (TCA) + Gly cine > delta aminolev ulinic acid (ALA) v ia
deltaaminolev ulinic acid sy nthase
3. Cy steine sy nthesis: Homocy steine + Serine > Cy stathione v ia Cy stathione sy nthase (X =
homocy steinuria: Marf anoid Sx+MR+atherosclerosis)
Note: Cy stinuria due to PCT reabsorption def ect > staghorn cy stine kidney stones; Tx: acetazolamide to
alkalinize urine

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4. ALT/AST transamination:
Alanine+alphaKG(TCA)<ALT>Py ruv ate(gly coly sis)+glutamate
Aspartate(Urea cy cle)+alphaKG(TCA)<AST>OAA(TCA)+glutamate
5. Amino acid production (hy droxy lation, decarboxy lation reactions):
1. ty rosine hy droxy lation> dopa decarboxy lation> dopamine
2. try ptophan to niacin/B3 (no B6 = no B3 = Pellagra)
3. histidine to histamine
4. gly cine to porphy rin (in heme production; no B6 = hy pochromic, microcy tic anemia)
5. glutamate to GABA (no B6 = loss of GABA = increased excitation > conv ulsions/seizures)
Vitamin B12: Cobalamin
Cof actor when y ou see Meth in product or substrate:
1. METHy lmalony lCoA > Succiny l CoA v ia methy lmalony lCoA isomerase
2. homocy steine + N-METHy lTHF > METHionine + THF v ia homocy steine methy ltransf erase
Absorbed in the ileum (Crohns, gastric by pass, sprue, Diphy llobothrium latum) with IF (pernicious anemia); use
Schilling test to determine if its intake/absorption or lack of IF problem. B12 stores last f or Y EARS. Def iciency
causes an increase in methy lmalonic acid (peripheral neuropathy ) and homocy steine (megaloblastic anemia).
Other causes of megaloblastic anemia = f olate def iciency (incr. homocy steine but not methy lmalonic acid, so no
neuropathy ) and chronic alcoholism.
Vitamin B7: Biotin
While Vitamin B6 is needed f or DEcarboxy lation reactions (amino acid production), B7 is needed f or CARBOXy lation
reactions:
1. Propiony lCoA(oddchainFA/branchedchainAA metab)>Methy lmalony lCoA v ia propriony lCoA carboxy lase
(which goes on to f orm succiny l CoA of TCA with methy lmalony lCoA isomerase and B12)
2. Py ruv ate(gly coly sis)>OAA (TCA) v ia py ruv ate carboxy lase
3. Acety lCoA(TCA)>Malony lCoA(FA sy nthesis RLS)
Av idin in egg-whites Av idly binds B7.
HELLO~ I'M A PEACEFUL MEDICAL RESIDENT WITH A DARK SENSE OF HUMOR ~ (
`)
Vitamin C: Ascorbic Acid
1. Iron absorption and Fe2+ state maintenance
2. Collagen sy nthesis: hy droxy lation of proline and ly sine within f ibroblast ER <SCURVY
3. dopamine > NE v ia dopamine beta hy droxy lase, blocked by Reserpine

HOME
ASK
CHIVE
A
S e f orm (PTH
TAstimulates
GS
HEME
Vitamin
D: the longest
name with a A
1:R
(1,25-(OH)2D3)
CalcitriolF
=Q
activ
convT
ersion
of liv ers
25OHv itamin D to 1,25-(OH)2D3 in kidney by 1alpha hydroxylase)

arghlblargh!

Vitamin E: E is f or Ery throcy tes; its an antioxidant that prev ents hemoly tic anemia and neurody sf unction
Vitamin K: inject newborns with it to make sure they re oK (prev ent hemorrhage); def iciency = normal bleeding time,
but increased PT and aPTT
Note:
platelet dy sf unction > BT
extrinsic (shorter) pathway > PT (shorter name); VII; monitor w/ Warf arin
intrinsic (longer) pathway > PTT (longer name); monitor w/ Heparin
Carbamoy l phosphate sy nthetase: UP 1, 2.
Urea cy cle RLS: CPS1
Py rimidine sy nthesis RLS: CPS2
HMGCoA ___:
"Y ou alway s want to REDUCE y our CHOLESTEROL": HMGCoA reductase = RLS f or cholesterol sy nthesis
v s. HMGCoA sy nthase = ketogenesis (y our brain wants to SY NTHESIZE KETONES when theres no
glucose)
Regulation by F2,6BP: 2 supports 1:
PFK2 supports PFK1 > gly coly sis
F26BP supports F16BP > gly coly sis
MOA: insulin > decreases cAMP > decreases PKA > dephosphory lated FBPase2 = PFK2 > F6P to F26BP >
stimulates PFK1 > incr F6P to F16BP (gly coly sis)
Note: glucose > decreases cAMP > decreases CAP-cAMP binding of lac operon = RNA poly merase cant bind to
promoter
Gly coly tic enzy me def iciency : RBCs solely depend on gly coly sis f or energy so no Py ruv ate
Kinase/Phosphogly cerate Kinase (ATP generating steps) = decreased ATP > cant maintain membrane gradient >
cell swells > hemoly tic anemia
HMP shunt/Pentose Phosphate Pathway :
G6P > Ribulose5P + 2NADPH v ia RLS G6PDH
Ribulose5P > Ribose5P > purine sy nthesis
NADPH:
1.
2.
3.
4.

f atty acid and steroid sy nthesis

oxidativ e burst (NADPH oxidase; X = Chronic Granulomatous Disease)
p450
glutathione reductase AKA RBC antioxidation

G6PD def iciency = (x-r) > no NADPH = no glutathione reductase = oxidativ e damage = hemoly tic anemia (bite cells
- RBCs partially eaten by macrophages (M0s), Heinz bodies - oxidized Hb that precipitated in RBCs)
Drugs that cause hemoly tic anemia in G6PD def iciency :
"Prima had to take Aspirin when she INHaled her I.B.Prof essor Dapsones Sulf urous Fav a bean NitroFarts."
Prima = Primaquine
Aspirin
INH (Isoniazid)
I.B.Prof essor = Ibuprof en
Dapsone
Sulf urous = Sulf onamides
Fav a bean
NitroFarts = Nitrof urantoin
CGD (chronic granulomatous disease, Dx: negativ e Nitroblue tetrazolium reduction) = NADPH oxidase def iciency >
susceptible to Catalase+ organisms:
"The recoiling Red Asp wasnt Sorry towards the moaning Cat because it had Noheart."

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recoiling = E.coli
red = Serratia
Asp = Aspergillus
Sorry = S. Aureus
moaning = Pseudomonas
Cat = Catalase + organism
NoHeart = Nocardia

Never miss a post!

julieyumi
arghlblargh!

Disorders of __ metabolism:
__-kinase is the enzy me that immediately f ollows the breakdown of __:

GlucoseFollow
> G6P v ia Gluco(Hexo)kinase
Fructose > F1P v ia Fructokinase
Galactose > Gal1P v ia Galactokinase
Def iciencies of Fructo and Galactokinases causes MILD sy mptoms (respectiv e sugars are present in urine). The
SEcond steps cause SEv ere sy mptoms (AldolaseB and Uridy l transf erase, respectiv ely ).
Watch out when y ou see ALDO- because it means something bad is going to happen:
Glucose > Sorbitol v ia Aldose Reductase + NADPH (CATARACTS)
Note: Sorbitol > Fructose v ia SorbitolDH
Galactose > Galactilol v ia Aldose Reductase + NADPH (CATARACTS)
Fructose1P > Gly ceraldehide and Dihy droxy acetoneP v ia Aldolase B (FRUCTOSE INTOLERANCE)
Essential amino acids:
TV FILM HWRK (Threonine(T), Valine(V), PHENY LALANINE(F), Isoleucine(I), Leucine(L), Methionine(M), Histidine(H),
TRY PTOPHAN(W), ARGININE(R), LY SINE(K))
Negativ ely charged amino acids:
Negativ e experience to be burned by Acid:
Aspartic acid and glutamic acid
Note: Aspartate and Glutamate (as N-acety l glutamate) are inv olv ed in Urea cy cle elimination of ammonia
Amino acids with three titratable H+:
Ricky Cant Hate ED
RKY C H ED
Arginine(R) - 12.5
Ly sine(K) - 10.5
Ty rosine(Y ) - 10.1
Cy steine(C) - 8.2
Histidine(H) - 6
Aspartic acid(E) - 4.3
Glutamic acid(D) - 3.7
The numbers arent important except f or Histidine. Just know the order and that it goes in descending pHs. FY I:
COO-=2, NH3+=9.5
KNOW: Ketogenic amino acids:
Leucine and Ly sine > USED TO TREAT PDH DEFICIENCY
Cy cles: Urea cy cle and TCA ov erlap:
OAA(TCA) + Glutamate <AST> Aspartate(Urea) + alphaKG(TCA)
Aspartate(Urea) + Citrulline(Urea) > Arginosuccinate(Urea) > Arginine(Urea) + Fumarate(TCA)
Urea cy cle enzy me def iciency > decreased TCA intermediates > TCA INHIBITION + HY PERAMMONEMIA (b/c
decreased NH4+ excretion).
Sx: asterixis, slurred speech, somnolence, blurry v ision, v omiting
Tx: less protein in diet + Benzoate/Pheny lbuty rate (bind a.a.>excrete)
OTC = major urea cy cle enzy me:
Ornithine + carbamoy l-phosphate > Citrulline v ia OTC
OTC def iciency (x-r) = shunting of carbamoy l phosphate f rom urea cy cle to py rimidine sy nthesis:
carbamoy l phosphate + aspartate > orotic acid
Orotic Aciduria > decreased BUN + hy perammonemia
Amino acid deriv ativ es:
Phenylalanine (Pheny lalanine hy droxy lase + THB + NADPH v ia Dihy dropterin reductase)> Tyrosine(X
= PKU (a-r): screened by Guthrie test 2-3 day s af ter birth; Tx: decr Phen, incr Ty r diet):
> Fumarate v ia Homogentinsic acid oxidase (X = Alkaptonuria)
> Thyroxine
(Ty rosine hy droxy lase/B6, blocked by Mety rosine)> Dopa:
> Melanin (X = Albinism: decreased pigment)
(Dopa decarboxy lase/B6, blocked by Carbidopa)> Dopamine (Dopamine
Hy droxy lase/VitC, blocked by Reserpine)> NE (PNMT/SAM)>Epinephrine
Tryptophan(X in Hartnups):
(B6)> Niacin=B3 > NAD+/NADP+ (X = Pellagra)
(BH4)> Serotonin > Melatonin (sleep)
Ly sosomal storage diseases:
Tay -SaX = HeXosaminidase A > incr GM2: no hepatosplen; cherry macula, onion skin ly sosomes
"Fab-Gal is into Ceramics"
Fabry s = alphaGALactosidase A > incr Ceramide trihexose: peripheral neuropathy , angiokeratoma,
CV/renal disease
"Gauched out my f emur when I was on a sugar high"
Gaucher, Femur Necrosis, Sugar High = GlucoCerebrosidase
Gauchers = betaGlucocerebrosidase > incr glucocerebroside: aseptic f emur necrosis,
hepatosplenomegaly , crumpled tissue paper cy toplasm
Blind Intelligent Intergalactic Crab
Intelligent Intergalactic = Galactocerebroside
Krabbes = Galactocerebrosidase > incr galactocerebroside: blindness, peripheral neuropathy ,
dev elopmental delay , globoid cells
Niemann Picks his nose with hisphinger
Niemann-Pick = Sphingomy elinase > incr Sphingomy elin: cherry macula with hepatosplenomegaly ,
neurodegeneration, f oam cells
"Sulf ur tides are multicolored"
Sulf ur tide = Sulf atide
Multicolored = Metachromic
Metachromic leukody strophy = Ary l sulf atase A > incr Sulf atides: central and peripheral demy elination
with ataxia, dementia
Mucopoly saccharidoses:

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HurLers = alpha-L-iduronidase > incr heparan sulf ate, dermatan sulf ate: corneal clouding, gargoy lism,
airway obstruction
Hunters = iduronate sulf atase > incr heparan sulf ate, dermatan sulf ate: NO CORNEAL CLOUDING
because Hunters need to see clearly
Major apolipoproteins:
"II:LL"
C-II = cof actor f or Lipoprotein Lipase
Treat abetalipoproteinemias (def icient apoB100, B48 > night blindness, acanthocy tes (spiky RBC), steatorrhea,
ataxia) with Vitamin E
Embryology:
Important Genes f or Embry ogenesis:
Sonic the Hedgehog f ights a One-Ey ed Monster:
Sonic Hedgehog mutation > Holoprosencephaly
FGF gene = Fibroblast Growth Factor: Growth Factor lengthens limbs
FGF mutation > Achondroplasia (A-D dwarf ism)
HOX (Homeobox) gene: Boxes help with organization
organizes/determines limb location (Vitamin A toxicity alters HOX expression > clef t palate, cardiac
abnormalities, spontaneous abortion)
Rules of Early Dev elopment:
Week 2: 2 germ lay ers (epiblast, hy poblast), 2 cav ities (amniotic, y olk sac), 2 placental components
(cy totrophoblast, sy ncy tiotrophoblast)
Week 3: 3 germ lay ers (ectoderm, mesoderm, endoderm)
Week 4: 4 heart chambers, 4 limb buds
Note: neural tube closes by week 4:
def . f olic acid> spina bif ida, etc.
neural tube def ect has incr alpha-f etoprotein+AChesterase
(**Gastroschisis and Omphalocele, pretty much ANY internal organ extrusion results in incr alphaf etoprotein)
"SAD DAVE":
SAD: Sensory = Alar Plate/Af f erent nerv es = Dorsal
DAVE: Dorsal=Af f erent, Ventral=Ef f erent
Embry ologic deriv ativ es:
Ectoderm:
Surf ace: what y ou see (epidermis, hair, nails, teeth enamel, ey e lens) + anterior pituitary
(Rathkes pouch)
Neuro: ev ery thing connected to the CNS (brain, spinal cord, oligodendocy tes, posterior pituitary ,
retina, pineal gland) + pupillary muscles
Mesoderm:
Neural crest: skull and PNS stuf f (skull, head muscles, dentine, pia/arachnoid, Schwann cells,
DRG, cranial nerv es, celiac ganglion, paraf ollicular C cells of thy roid) + adrenal
medulla (chromaf f in cells) + melanocy tes (last to migrate)
Paraxial: axial stuf f (axial skeleton, skeletal muscles, connectiv e tissue and dermis) + dura
mater
Intermediate: urogenital ridge (kidney s and ureters, v as def erens, gonads, uterus and uterine
tubules)
Lateral: non-skeletal muscle and blood-related organs (v isceral muscle and connectiv e tissue,
blood, ly mph, spleen, cardiov ascular sy stem) + adrenal cortex
Note: spleen = mesoderm, but supplied by celiac artery of the f oregut
MESODERMAL DEFECTS = VACTERL: Vertebral def ects, Anal atresia, Cardiac def ects,
Tracheo-Esophageal f istulas, Renal def ects, Limb def ects
Endoderm: ear/mouth to anus hollow lining and organs + bladder and v agina
ty mpanic cav ity /auritory tube, tonsils, thy mus, thy roid, parathy roid
lary nx, trachea, bronchi, lungs
GIT, liv er, gallbladder, pancreas
urinary bladder, urethra, lower 2/3 vagina (this explains how patients can still hav e a v agina
ev en if the paramesonephric ducts f ail to dev elop)
Notochord > nucleus pulposus of interv ertebral disk
Teratogens:
"Amina couldnt hear because she was too absorbed in her reading."
Aminogly cosides prev ent mRNA reading by interf ering with 16S of 30S and cause CNVIII ototoxicity
(Note: Congenital Sy philis also causes CNVIII ototoxicity + Saber shins + Saddle nose + Hutchinsons teeth
+ Mulberry Molars + f rontal bossing)
Maternal Diabetes: hy pergly cemia > incr f etal insulin > decr lung dev elopment = cant breathe;
mermaids also cant breathe air >
maternal diabetes causes ARDs and sirenomelia/anal atresia (also, transposition of great v essels)
Umbilical cord:
Allantois: 2 arteries, 1 v ein (arteries is 2x as long as v ein)
AllaNtois (urachus)> mediaN umbilical ligament
UmbiLical artery > mediaL umbilical ligament
Umbilical v ein - ligamentum teres hepatis
Allantois > Urachus (wk3): urachus f ailure to obliterate = bladder to nav el connection: umbilical urination or bladder
outpouching
Omphalomesenteric duct > Vitelline duct (wk7): duct f ailure to obliterate = colon to nav el connection: umbilical
meconium or Meckels div erticulum
Heart embry ology :
Primitiv e __ > trabeculated (rough) portion of __
Smooth atrium = sinus v enosus
Smooth v entricle = bulbus cordis
SVC = right common and anterior cardinal v eins
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 deriv ativ es: lef t side of body to right side, top to bottom
I: maxillary artery (external carotid) - @ f ace
II: hy oid/stapedial artery - @ midline throat

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III: common and internal carotid arteries - @ midline neck
IV: right subclav ian artery and aortic arch - @ right/middle chest
VI: pulmonary artery (inc. ductus arteriosus connection to aorta) - @ right side of heart
Neural tube def ects:
The longer the name, the worse the sy mptoms:
Occulta: spinal canal opening but no herniation, tuf t of hair
Meningocele: herniation of meninges
Meningomy elocele: herniation of spinal cord
Phary ngeal/Branchial CAP:
Clef t = ectoderm (~external hollow spaces)
Arches = mesoderm (~muscles)
Pouches = endoderm (~immune organs abov e the neck)
Branchial CLEFT - ectoderm: ~external hollow spaces
Clef t 1: external auditory meatus
Clef ts 2-4: temporary cerv ical sinus (f ail to obliterate = lateral neck branchial clef t cy st)
Branchial clef t cy st (lateral neck) v s Thy roglossal duct cy st (midline neck, mov es with swallowing because attached
to tongue)
Branchial ARCH - mesoderm: ~muscles
The nerv es 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) Say s(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 f ollowing
mnemonic:
"Chewing made me grimace so I swallowed, choked, then called f or help."
chewing = arch 1 (V2,3) = muscles of mastication, ant. 2/3 tongue + malleus/incus/tensor ty mpani
grimace = arch 2 (VII) = f acial expression + stapes/stapedius (def ect = Treacher Collins mandibular
hy poplasia and f acial abnormalities)
swallowed = arch 3 (IX)= sty lophary ngeus (def ect = f issure f rom neck to tonsils)
choked = arch 4 (X, sup lary ngeal)= phary ngeal constrictors and cricothy roid
called f or help = arch 6 (X, inf lary ngeal)= intrinsic lary nx muscles except cricothy roid
Note: Arch 4&6 make up post. 1/3 tongue
Branchial POUCH - endoderm: ~immune organs abov e the neck + middle ear
Pouch
Pouch
Pouch
Pouch

1
2
3
4

=
=
=
=

auditory tube, middle ear, mastoid air cells

tonsils and tonsillar sinus
inf erior parathy roid + thy mus (they descend together)
superior parathy roid + paraf ollicular C cells of thy roid

Failure of 3rd and 4th Pouch = DiGeorges: no thy mus (= T cell def iciency ), no parathy roids (= hy pocalcemia >
tetany )
"C3, 4, 5 keeps the diaphragm aliv e."
Kidney embry ology : main play er = Metanephros:
Ureteric Bud = ureter>pelv is>collecting ducts
JOINS
Metanephric Mesenchy me = glomerulus>DCT
Def ectiv e ureteric bud = renal agenesis; B/L renal agenesis > oligohy dramnios > Potters: pulmonary hy poplasia +
f ace/limb def ormities
**MC site of obstruction = Ureteropelv ic junction with kidney > f etal hy dronephrosis
Genital embry ology :
Male = Mesonephric
Pemale = Paramesonephric
"Men are Wolv es" = "Wolf f ian ducts" > "SEVEN" in "SEVEN UP" (Seminal v esicles, Epididy mis, Vas
def erens, Ejaculatory duct, N = nothing)
"Women Mull ov er past arguments" = "Mullerian ducts" > f allopian tubes, uterus, and upper 1/3 of v agina
(lower 2/3 f rom urogenital sinus of endoderm)
Female = def ault genitals
Hormone ov erv iew:
Prolactin stimulates Dopamine inhibits Prolactin
Prolactin inhibits GnRH
GnRH > incr FSH, LH
L in LH and Ley dig: LH stimulates Ley dig cells to produce testosterone > dev elop Wolf f ian duct
S in FSH, Sertoli, and Sperm: FSH stimulates Sertoli cells to produce Sperm, Inhibin, and Mullerian inhibiting
f actor (MIF); MIF inhibits f emale paramesonephric duct dev elopment
Genital homologues:
Urogenital sinus:
Bulbourethral glands = Bartholins greater v estibular glands
proState gland = Skene urethral and paraurethral glands
Extrophy of bladder is associated with Epispadias (f aulty positioning of genital tubercle)
v s. Hy pospadias = more common, f ailure of urethral f old closure, incr risk of UTI
Microbiology:
Encapsulated organisms: (+Quellung reaction: quell makes capsules swell)
"Claustrophobic Pastor Salmon Echoed Back: Y ersinf ul Cry pt-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)
Y ersinf ul = Y ersinia
Cry pt-dark = Cry ptococcus (India Ink, narrow-based budding in meningitis)
Strip = Streptococcus

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Clubs = Klebsiella
Pseudo = Pseudomonas
Homes = Haemophilus
Nice men = Neisseria meningitidis
Francis = Francisella
Bruce = Brucella
"BAD" - Bacillus Anthracis unique capsule contains D-glutamate
"Staf f of grapes" = Staphy lococcus is in clusters
VS. Streptococcus = pairs/chains
Spirochetes: Spiraling Boris Lept then Tripped
Spiraling = Spirochetes
Boris = Borrelia (Giemsa stain = aniline dy e; relapsing f ev er = result of antigenic v ariation)
Lept = Leptospira
Tripped = Treponema (Dark Field Microscopy , VDRL cardiolipin screening, FTA-ABS conf irmation)
My coplasma v s My cobacteria
Bacteria hav e cell walls (My cobacteria hav e my colic acid in their cell walls that stain acid-f ast)
Plasma membranes hav e sterols (My coplasma hav e sterols and no cell wall)
Stains:
GiemsA stains BorreliA, MalariA, Chlamy diA, Try panosomA
PASs the sugar and whip cream (PAS stains gly cogen and Dx Whipples disease)
"Legions who Sustained injuries get Silv er stars": Legionella, grow with Cy steine, silv er stain; water source
Special Culture:
"Nice Homes hav e chocolate": Neisseria and Haemophilus grow on Chocolate agar +:
Neisseria = Thay er Martin media: Vancomy cin (v s G+), Poly my xin (v s g-), Ny statin (v s f ungi)
Haemophilus = V (NAD+) and X (hematin)
"If I Tell-U the Corny joke Right, y oull Laugh":
TellURight = tellurite agar
Corny = Cory nebacterium
Laugh = Lof f lers 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 surv iv e!"
No = NOcardia
Aer = pseudomonas AERuginosa
Anthrax = B. anthracis
TB = M. tuberculosis
Microaerophils = bacters: Campy lobacter, Helicobacter
Obligate anaerobes: These BACTERia ACTIN CLOSTRophobic env iroments (non-healing ulcers):
BACTERia = Bacteroides (E.G., B. f ragilis)
ACTIN = Actinomy ces
CLOSTRophobic = CLOSTRidium
Obligate Intracellular: REACh f or My COX if y ou want me INSIDE y ou.
R = Rickettsia
E = Ehrlichia
A = Anaplasma
Ch = Chlamy dia
My = My coplasma
Cox = Coxiella
Inside = intracellular
Facultativ e intracellular: Legions of Salmon, Rabbits, N Cows Tumble IN My y ard.
Legions = Legionella
Salmon = Salmonella
Rabbits = Francisella
N = Neisseria
Cows = Brucella
Tumble = Listeria
In = intracellular
My = My cobacterium
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 hemoly sis)
Bacterial v irulence f actors:
protein A f or staph. Aureus: binds Fc of Ig to prev ent opsonization and phagocy tosis
M protein (prev ents phagocy tosis) > strep. py ogenes rheuMatic f ev er (Sx: subcutaneous plaques,
poly arthritis, ery thema marginatum, chorea, carditis)
IgA protease (to colonize respiratory mucosa) + antiphagocy tic capsule (inf ects ASPLENIC patients b/c decr
M0 and IgM/complement C3 activ ation (E.G., Sickle Cell autosplenectomy )) + causes meningitis = SHiN
Note: can also undergo transf ormation (pick up DNA f rom env ironment)
Strep pneumo
H. inf luenza ty pe B (B poly saccharide)
Neisseria meningitidis
Exotoxin v s Endotoxin:
EXotoxin = f rom EXogenous source (plasmid or bacteriophage) and EXcreted f rom bacteria, EXtremely toxic
(ev en small dose), EXact ef f ects (dif f erent toxins produce dif f erent sy mptoms); ~heat-labile
ENDOtoxin (Lipid A)- ENDOgenous (made f rom bacterial chromosome, ENtegral to outer membrane of most
g-Neg bacteria (and Listeria(G+))); heat stable; causes gENeral f ev er, shock/sepsis v ia direct
MACROPHAGE response (binds CD14-M0 marker) > release TNF and IL-1 (no Th inv olv ement)
M0 activ ation:
IL1 = Fev er
TNF alpha = f ev er, hemorrhagic tissue necrosis
Nitric oxide = hy potension/shock
alternate complement pathway :
C3a = Anaphy laxis (basophil and mast cell degranulation > hy potension, edema)
C5a = neutrophil chemotaxis

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Hageman f actor: coagulation cascade> DIC/microthrombi
Exotoxin subclass: SUPERANTIGENS: bind directly to MHCII and TH1(CD4) > explosiv e release of IFNgamma
and IL2 (non-specif ic immune response):
S. aureus = TSST-1 > Toxic Shock Sy ndrome (f ev er, rash, shock)
S. py ogenes = Ery throgenic toxin > Scarlet f ev er with Toxic-Shock-like sy mptoms
Note: S. py ogenes also has Streptoly sin O (ly ses RBC); Dx: Rheumatic Fev er with anti-Streptoly sin-O
antibody (ASOAb)
E. coli ADP ribosy lating A-B toxin:
"Labile like Air, Stable like Ground":
heat-Labile toxin stimulates Adeny late cy clase
heat-Stable toxin stimulates Guany late cy clase
Both cause watery diarrhea.
Bacterial Toxins Env oded in Ly sogenic Phage: ABCDE
ShigA-like toxin - EHEC 0157:H7 - cleav es host cell rRNA/inactiv ates 60S; also, incr cy tokines > HUS
Botulinum toxin - inhibits ACh v esicle release f rom presy naptic neuron > f laccid paraly sis
Cholera toxin - activ ates Gs > incr cAMP > incr Cl- secretion into gut = decr Na+ absorption > watery
diarrhea
Diptheria toxin - ADP-ribosy lating A-B toxin (like Pseudomonas exotoxin A) - B binds, A enters and
ribosy lates EF2 > no more protein sy nthesis > cell death; pseudomembrane f ormation
Ery throgenic (superantigen) toxin of Strep. py ogenes > Scarlet Fev er - activ ates both TH1(CD4) and
MHCII > incr INFgamma + IL2 > incr M0 and T-cell non-specif ic immune response > ~Toxic Shock
Gram Positiv es: cry stal v iolet + iodine = blue
Coag negativ e Staph: SENsitiv e: Staph. Epi = Nov obiocin SENSITIVE (VS. Staph. saprophy ticus =
Nov obiocin resistant)
alpha hemoly tic Strep: OVeRPasS: Optochin Viridans Resistant, Pneumonia Sensitiv e
Note: Strep pneumonia is bile soluble (= cant be cultured in bile, unlike gamma hemoly tic Strep)
beta hemoly tic Strep: BBBR: Beta hemoly tic, group B strep (Strep agalactiae), Bacitracin Resistant (VS.
group A strep (Strep. py ogenes) = bacitracin sensitiv e)
OR
"B-BRAS" - Bacitracin: group B = resistant, group A = sensitiv e
gamma hemoly tic Strep: grows in bile; stomach is used to salty f oods = Enterococci grows in 6.5%NaCl
(VS. Strep. bov is > does NOT grow in 6.5%NaCl)
Exposure/PRIMARY TB:
Ghon complex = Ghon f ocus of LOWER lobe + peri-hilar ly mph nodes
Y ou think they are Ghon but they re just waiting to become secondary TB (f ibrocaseous cav itary lesion of
UPPER lobe)
gram negativ e: acetone + saf f ranin = pink
N. Meningities f erMents Maltose, has a capsule, and v accine (gonorrhea doesnt; NOTE**: gonorrheas
pilus protein undergoes antigenic variation!!)
Note:
-N. meningitidis = respiratory /oral spread > meningococcemia and Waterhouse-Friderichsen adrenal
hemorrhage (hy potension and DIC)
-N. gonorrhea = STD> high f ev er, septic arthritis, neonatal conjunctiv itis, PID, Fitz-Hugh-Curtis (cerv icitis
>salpingitis>liv er capsule inf ection)
Enterobacteriae: CAPSULE = VIRULENCE FACTOR, all f erment glucose
Lactose f ermenters (pink on MacConkey , blue on Eosin-Methy lene blue) = SEEK: Serratia,
Enterobacter, E. coli (blue-black metallic sheen), Klebsiella
Non-lactose f ermenters = PSSY : Proteus, Salmonella, Shigella, Y ersinia
H2S producing (black on Hektoen Agar) + motile (f lagellar H antigen): Proteus (swarming, urease+,
staghorn ammonium struv ite stones), Salmonella
Note: Salmonella and Shigella both inv ade mucosa > bloody diarrhea; Salmonella is motile (w/ 2
flagellar antigen variants) and produces H2S, S. ty phi of Ty phoid f ev er causes abdominal rose
spots and can remain chronically in gallbladder; Shigella is more v irulent, mov es by actin
poly merization and 60S deactiv ating toxin induces HUS.
oxidase + organisms: when y ou go Camping at a quiet Pasture y oud Moan More with Nice Vibrators
Camping = Campy lobacter
Pasture = Pasturella
Moan = Pseudomonas
More = Moraxella
Nice = Neisseria
Vibrators = Vibrio
VDRL f alse positiv es: VDRL
V = v iruses: EBV, hepatitis
D = drugs
R = Rheumatic f ev er (Dx w/ S. py ogenes ASO titers)
L = Lupus and Leprosy
Chlamy dia: Dx v ia Giemsa stain (Chlamy diA, MalariA, BorreliA + Try panosomA)
Elementary body is Enf ectious and Enters cells v ia Endocy tosis
Reticulate body Replicates in cell by f ission
"Tricky Dick": TRIC = seroty pes DK:
> MC PID, cerv icitis, ectopic pregnancy
> Fitz-Hugh-Curtis liv er capsule inf ection (f rom spread of PID) + v iolin string adhesions of
parietal peritoneum to liv er
> neonatal pneumonal/conjunctiv itis
> REITERS: Cant see, cant pee, cant climb a tree = conjunctiv itis, urethritis, arthritis
VS. trAChoma = seroty pes A-C > blindness
VS. L1-L3 = Lymphogranuloma venerum: ulcers > ly mphadenopathy , rectal strictures mistaken f or
PID
Tx: mothers and inf ants with Chlamy dia with Ery thromy cin estolate, though there is a risk of maternal
acute cholestatic hepatitis
Aty pical (walking) pneumonias: My Clammy Legion walked; Tx: macrolides
My = My coplasma (IgM = cold agglutinins > agglutinate or ly se RBCs; grown on Eatons agar; Tx:
tetracy cline or macrolide)
Clammy = Chlamy dia (Tx: tetracy cline or macrolide)
Legion = Legionella (Tx: macrolide)

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Fungi:
Dimorphic: cold = mold, heat = y ea(s)t + Blast His Cock = East Coast to West Coast (Tx: Ketoconazole)
Blast = Blastomy cosis = east of Mississippi Riv er
His = Histoplasmosis = Mississippi Riv er and Ohio riv er
Cock = Coccidiomy cosis = Southwest US: CA, AZ
"His Woodpecker Blasted Wood into Dust":
His Woodpecker = Histoplasmosis f rom bird/bat droppings = macrophage f illed with round y east; Histo
Hides within macrophages
Blasted Wood = Blastomy cosis in wood = Broad-Based-Budding f ungi; the handle of a baseball bat looks
like its budding of f the shaf t)
Dust = Coccidiomy cosis = large spherule f illed with endospores; barrel-shaped arthroconidia; Cock is f illed
with Sperm, Coccidio is f illed with Spores
Actinomy ces = Acute Angles, Septate
(VS. Mucormy cosis/Rhizopus = Wide angles, non-septate; ~in Diabetics)
Helminth drugs:
Worms = Bendazole
Praziquantel = f oods: Pork, Fish, Crab, Snails
Pork = Taenia
Fish = Diphy llo, Clonorchis
Crab = Paragonimus
Snails = Schistosoma
Antigenic shif t v s. drif t: SPED
Shif t (reassortment v ia segmented v iruses) = Pandemic
Epidemic = Drif t (random mutations)
Vaccines:
Liv e: See MMR. Sabins small y ellow chickens liv e.
MMR = Measles, Mumps, Rubella
Sabin (Polio, oral)
small pox
y ellow f ev er
chicken pox/shingles
Killed: RIP Alway s
Rabies
Inf luenza
Polio (SalK = Killed, injected)
Adenov irus
Recombinant: H_V
Worms = Bendazole
Praziquantel = f oods: Pork, Fish, Crab, Snails
Viruses:
DNA v iruses: HeHe PoPa ParAde: f irst three = env eloped
He = Herpes
He = HepaDNA (HBV; carries special RT: DNAdDNAp)
Po = Pox (smallpox, molluscum contagiosum; carries DNAdRNAp and replicates in cy toplasm)
Pa = Papilloma (HPV: (6,11): condy lomata acuminata/genital warts, koilocy tes=squamous cell with
perinuclear cy toplasmic halo; (16,18): CIN; anal squamous cell CA) + Poly oma (JC, PML demy elinating
encephalopathy )
Par = Parv o = B19/Ery thema inf ectiosum (ssDNA)
Ade = Adenov irus (swimming pool conjunctiv itis, gastroenteritis)
Herpes: 2 Simple Chickens Barred Sight f rom Rose Patches
2 Simple = HSV1,2
Chickens = HHV3: Chicken pox (truncal rash > extremities; lesions of dif f erent age)/shingles
Barred = HHV4: EBV (mono, Burkitts, large cell non-Hodgkins @ Waldey ers ring, nasophary ngeal CA,
hairy leukoplakia on lateral tongue; inf ects B cells v ia CD21-EBV receptor)
Sight = HHV5: CMV (retinitis, negativ e mono-spot mono, TORCH; both intranuclear owl-ey e and
cy toplasmic inclusion bodies)
Rose = HHV6: Roseola/Ery thema subitum (high f ev er > rash)
Patches = HHV8: Kaposi-sarcoma
RNA v iruses:
+RNA = PiToFlaCoCa: middle 3 = env eloped
Pi = PicoRNA = PECoRnA:
P = Polio (both colonizes nasophary nx and causes meningitis like Hib > my algia and paraly sis)
E = Echov irus: swimming pool aseptic meningitis/my ocarditis
C = Coxsackie: aseptic meningitis/my ocarditis, hand-f oot-mouth (palm and sole v esicular rash
also seen in secondary sy philis and Rickettsial Rocky Mountain Spotted Fev er)
Rn = RHINOv irus (stuf f y NOSE f rom common cold)
A = HAV
To = Toga
"Togas Rubelled against Germany with TORCHs" = Togav irus, Rubella, German Measles (postauricular occipital lymphadenopathy, f ine truncal rash), TORCH inf ection (blueberry muf f in
rash, deaf , cataracts, PDA)
VS. Rubeola: a PARA Ruby weasles caught SSPEcial measles = Paramy xo, Rubeola, SSPE
complication, Measles
VS. Roseola: HHV6 (high f ev er/seizures > truncal rash)
Fla = Flav i (HCV, y ellow, dengue, St. Louis, West Nile)
y ellow f ev er causes y ellowing skin (jaundice) and black v omit
Co = Corona (common cold, SARS)
Ca = Calici = Norwalk, CA Cruises (gastroenteritis f rom cruises)
-RNA = all env eloped + RNAdRNApol
Reov irus = dsRNA, segmented: ROTAv irus = right out the anus (childhood winter gastroenteritis)
HepEv irus = HEV (water epidemic, only dangerous if pregnant)
Orthomy xo: O f or octo = 8 segments > reassortment = Inf luenza pandemic (Ag shif t)
Paramy xo = PaRaMy X2o:
P or PARA = Parainf luenza = croup
R = RSV; Tx: Ribav irin (v s. IMPDH of purine sy nthesis; AE: hemoly tic anemia, teratogen) or

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RSVP Liz where P Liz = Paliv izumab which binds Paramy xo F protein, prev enting respiratory
epithelial sy ncy tia f ormation
Mx2 = Measles and Mumps:
Measles: A PARA RUBY weasles caught SSPEcial Measles = paramy xo, rubeola,
SSPE complication, Measles 3 Cs = cough, cory za, conjunctiv itis + Koplik spots; rash
f rom head down like Rubella
Mumps: parotitis, orchitis, aseptic meningitis
Segmented v iruses: BOAR
B = Buny a (Hanta hemorrhagic f ev er)
O = Orthomy xo (Inf luenza)
A = Arena (mouse Lassa encephalitis)
R = Reov irus (right out the anus childhood diarrhea)
Hepatitis:
HAV = Picorna (+RNA); f ecal-oral (ice cubes, shellf ish)
HBV = HepaDNA (env , dsDNA); blood (renal dialy sis, needle stick), sex, mother; Dx: PCR
HCV = Flav i (env , +RNA); blood (IVDA, transf usion); Dx: RT-PCR
HDV = Delta (def ectiv e env , -RNA); inf ects with HBV
HEV = HepEv irus (+RNA); f ecal-oral (water epidemic)
ToRCHS: hepatosplenomegaly , jaundice, thrombocy topenia, growth retardation
T = Toxoplasma: ToxoTriad: intracranial calcif ications, chorioretinitis, hy drocephalus = SAME TRIAD AS
CMV!!; f rom cat f eces, ring-enhancing brain abscess); Tx: Sulf adiazine+Py rimethamine
R = Rubella (Togav irus, +RNA): PDA, cataracts, deaf , blueberry muf f in rash; maternal rash and arthritis
C = CMV: Toxoplasma triad (intracranial calcif ication, chorioretinitis, hy drocephalus) + UNILATERAL hearing
loss, seizures
H = HSV (+HIV): temporal lobe encephalitis, herpetic lesions (f ingers)
S = Sy philis: hy drops f etalis stillbirth > Hutchinson teeth, saddle nose, saber shins
Note: B19 also causes hy drops f etalis
Bactericidal drugs (all else = bacteriostatic): Sephiroth Met Vancouv er Penpal Amina in Florida, then KILLED HER D:
Seph(iroth) = Cephalosporin
Met = Metronidazole
Vancouv er = Vancomy cin
Penpal = Penicillin
Amina = Aminogly cosides
Florida = Fluoroquinolones
Antimicrobial drugs:
1. inhibits PG cross-linking > no cell wall: Ceph Chills-in Nam watching PG mov ies:
1. Ceph = Cephalosporin
2. Chills-in = cillins (binds PBP, block transpeptidase cross-linking; Penicillin = endocarditis
prophy laxis (bef ore surgery /dental), sy philis prophy laxis)
3. 'Nam = AztreoNAM (binds PBP3 f or Pencillin-allergy pts; v s SEEK Pseudomonas- Serratia, E.coli,
Enterobacter, Klebsiella, Pseudomonas), MeropeNEM and ImipeNEM+Cilastatin
(Merpenem/Imipenem v s. ev ery thing, esp. Enterobacter, but causes SEIZURES; Cilastatin inhibits
renal dihy dropeptidase I to inhibit renal tubule Imipinem inactiv ation)
2. blocks PG sy nthesis:
1. Bacitracin (v s. S. py ogenes (GAS))
2. Vancomy cin (binds D-Ala-D-Ala and interf eres with PG-elongating transgly cosy lase
1. v s. resistant G+ inc, MRSA and C.diff!!
2. "TON of AEs": T = thrombophlebitis, O = ototoxic, N = nephrotoxic + Red Man (slow
inf usion and pretreat with anti-histamine to prev ent))
3. v s. g- by disrupting cell membranes: Poly my xins (neosporin) - detergent v s cell membrane; AE:
neurotoxicity , acute renal tubular necrosis
4. v s. G+/g- by blocking f olate > no nucleotide sy nthesis (megaloblastic anemia):
1. Sulf onamides (comp inhibit PABA f or dihy dropteroate sy nthetase > no DHF sy nthesis; AE:
inf ant kernicterus (av oid in pregnancy ), SJ, nephrotox, G6PD hemoly sis)
1. Sulf amethoxazole-Trimethoprim (TMP-SMX) v s UTI, P. jirov ecii prophy laxis in AIDS
2. Sulf adiazine+Py rimethamine v s Toxoplasma
3. Sulf adoxin+Py rimethamine v s Malaria
2. Trimethoprim, Py rimethamine (DHFXdihy drof olate reductase>THF like Methotrexate)
5. v s. URIs (S. pneumo), UTIs, GITIs, and Pseudomonas by blocking topoII (DNA gy rase) and IV:
Fluoroquinolones (AE: cartilage/tendon rupture, incr QT, G6PD hemoly sis)
6. v s. My cobacterum, prophy laxis f or Hib and N.men by blocking DNAdRNAp = no transcription: Rif ampin
7. Protein sy nthesis inhibitors: Quinn get in Line and take 50MCs to 30ST:
1. Quinn, Line 50MCs = Quin-Dalf o, Linezolid, Macrolides, Chloramphenicol/Clindamy cin block 50S
1. Quin-Dalf o (streptogramins): Quinupristin prev ents elongation, Dalf opristin changes 50S
conf ormation f or better Quin-binding
2. Linezolid: binds 50S P-site and blocks 70S assembly
Tx: Quin-Dalf o and Linezolid is good f or ALL RESISTANT BACTERIA: VRE, MRSA
3. MACrolidEs (ACEmy cin = Azithro, Clarithro, Ery thromy cin): MacroLIDEs prev ent
sLIDing of mRNA = inhibit translocation by binding to 23S of 50S
1. Tx: PUS - aty pical Pneumonia, URIs, STDs
2. AE: PROLONG QT, acute cholestatic hepatitis, incr serum concentration of
warf arin
3. resistance v ia METHY LATION OF drug binding site on 50S rRNA
Note: Azithromy cin = AIDS MAC prophy laxis
4. Chloramphenicol: ChLorAMPS Peptidy ltransf erase - prev ents peptide bond f ormation;
Tx: meningitis (H. f lu, N. men, Strep. pneumo); AE: aplastic anemia and gray baby ;
resistance v ia ACETY LATION
5. Clindamy cin: also blocks peptide bond f ormation at 50S; v s. ANAEROBES (B. f ragilis,
C. perf ringens) like Metronidazole; AE: Pseudomembranous colitis like Ampicillin
2. 30ST = Streptomy cin (aminogly cosides), Tetracy cline block 30S
1. "Amina didnt hear the GNATS because she was busy reading":
Aminogly cosides (GNATS = Genta, Neo, Amikacin, Tobra, and Stretomy cins) cause
ototoxicity (and nephrotox) and act by binding to 16S and causing mRNA misreading; v s.
g- rods; REQUIRES O2 UPTAKE so inef f ectiv e against anaerobes; resistance v ia
modif ication of 30S (acety lation, etc)
2. Tetracy clines block TRNA f rom binding A-site and discolors Teeth/bones
1. caTion-chelator, do NOT take with antacids, milk, or iron-containing prep!
2. AE: photosensitiv ity (SAT f or photo - sulf onamides, amiodarone,
TETRACY CLINE)
3. v s. VACUUM TH BedRoom - Vibrio, acne, Chlamy dia, ureaplasma,
urealy ticum, My coplasma pneumonia, Tularemia, H. py lori, Borrelia, Rickettsia
4. resistance v ia decr uptake, incr export
NOTE: DEMECLOCY CLINE = DIURETIC = ADH ANTAGONIST (Tx: SIADH)

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Ampicillin and Amoxicillin are Anti-G+ Aminopenicillins that HELPS kill Pseudomonas with Sulbactam/Clav ulanic acid
(beta lactamase inhibitor):
H = Haemophilus
E = E. coli
L = Listeria
P = Proteus
S = Salmonella
Note: Ampicillin = intrapartum injection, GBS prophy laxis
"TCP Takes Care of Pseudomonas":
Ticarcillin
Carbenicillin
Piperacillin
Cephalosporins:
1st generation (cef a): G+ + PEcK: Proteus, E.coli, Klebsiella
2nd generation (f ur f ox f otetan): G+ + HEN-PEcKS: Haemophilus, Enterobacter, Neisseria, Proteus, E.
coli, Klebsiella, Serratia
"Fur cap" - Cef uroxime f or Community Acquired Pneumonia
"Linda Brought a Fragile Fox f oTito" - Clindamy cin, B. f ragilis, Cef uroxime, Cef otetan
3rd generation (trix tax taz): Meningitis, Gonorrhea, Ty phoid f ev er (Salmonella)
Cef triaxone = #1
Cef TAZidime is f or Pseudomonas like TAZobactam+Piperacillin (but causes neutropenia)
4th generation (Cef epime) = G+ + pseudomonas
Metronidazole: f orms toxic metabolite that damages DNA; Tx: GET GAP on the METRO
G = Giardia
E = Entamoeba histoly tica (liv er abscess)
T = Trichomonas
G = Gardnerella
A = Anaerobes (B. f ragilis, C. dif f icile)
P = H. Py lori (+ bismuth + amoxicillin/tetracy cline)
Anti-TB: INH-SPIRE: AE: hepatotoxic
INH = Isoniazid (inactiv ates my colic acid sy nthesis enzy mes enoy l-acy l carrier protein reductase (InhA
ov erexpression = resistance) and betaketoacy lACPsy nthase (KasA); KatG gene encodes catalase
peroxidase that activ ates INH); solo-TB prophy laxis; AE: hepatotoxicity , neurotoxicity (prev ented by B6),
drug-induced lupus (anti-histone Ab)
S = Streptomy cin (aminogly coside v s 30S mRNA reading)
P = Py razinamide - activ e in acidic pH, inhibits my cobacterial growth in M0; AE: hy peruricemia/gout
(I = INH)
R = Rif ampin - inhibits DNA-dRNAp = no transcription (rapid resistance) AND blocks packaging and
assembly of v iruses; induces cy p450; prophy laxis f or N. men and Hib; AE: red secretions, stop therapy
with purpura, bone marrow suppression
E = Ethambutol - AE: optic neuropathy (red green colorblindness)
Antif ungal:
Amphotericin B:
AmphoTEARicin TEARS holes in f ungal membrane (binds ergosterol and f orms pores)
AmphoTERRible: AE: f ev er/chills, hy potension, nephrotox, arrhy thmia, anemia, IV phlebitis
Antiv iral:
"ARM2 cure A FLU" = Amantadine Rimantidine block M2 protein (v iral uncoating) v s. Inf luenza A; AE: AtaxiA
Herpes = Cy clov irs (v irally activ ated guanosine analogs) + Trif luridine (thy midine analog)
CMV = Cids Gang lov ed seeing Foamy Scarlet = Cidof ov ir (Cy tosine analog + Probenicid to prev ent
excretion), Ganciclov ir (intraocular implant), Fomiv irsen (intraocular injection, anti-sense RNA therapy ),
FOScarnet (unlike ganciclov ir, doesnt require thy midine kinase activ ation; py roFOSphate analog that
directly inhibits DNApol)
HIV therapy :
Protease inhibitors = nav irs (AE: GI intolerance, hy pergly cemia, lipody strophy , cy p450 inhibitor)
NRTIs: Abe Did Embark on a L-AZy Start
Abacav ir
Didanosine
Emtriciabine
Lamiv udine
AZT (Zidov udine)
Stav udine
NNRTIs: Mov e to Delaware? Ef f in Nev er!
Delav irdine
Ef av irenz
Nev irapine
FUsion inhibitor = enFUv irtide (gp41 binder)
Interf erons: activ ates 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 v iral replication and incr antiv iral protein sy nthesis that impairs v iral
mRNA translation
IFNgamma - G in gamma is f or cGd > Tx: Chronic Granulomatous Disease (NADPH oxidase
def iciency )
NOTE**: IFNgamma incr MHCI and II expression, activ ates M0 > TNFalpha, IL1, IL6
Immunology:
B-cells are alway s f ound in (white) Follicles closer to the outside of the LN or spleen
VS. T-cells are f ound in the deeper medulla(LN)/PALS(spleen)
Ly mph drainage:
rectum abov e pectinate line = internal iliac
umbilicus to legs (inc, superf icial genitals and anal canal below pectinate line) = superf icial inguinal
testes = para-aortic
MHC I and II: Rule of 8s
1*8 = MHCI x CD8 = 8

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2*4 = MHCII x CD4 = 8
Natural Killer cells: detects MHCI
"Gotta KIL to surv iv e" (KIR + KIL = surv iv e)
KIR only = release perf orins and granzy mes > apoptosis
Antibody cleav age:
Papain cleav es Ab into 3 pieces: Pa Pa In (ev enly splits into 3)
Protease cleav es Ab into 2 pieces: Prot Ease (ev enly splits into 2; complement can still bind hinge)
Cy tokines: Hot T-Bone stEAk
IL1 (and IL6): hot = f ev er; secreted by M0
IL2: T = T-cell prolif eration; 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 v s. IL2: (IL)2 Pro-Cy clists Secreted Tacks in Response to Serious/Sirius Dax; prev ent
transplant rejection
v s.
v s.
v s.
v s.

production: Cy closporin (v ia inhibit calcineurin)

secretion: Tacrolimus (v ia binding FK-protein)
response to: Sirolimus (v ia MTOR)
receptor: Daclizumab

**NOTE: MCC SCID = def ectiv e IL2 receptor > ADA def iciency ; decr T > decr B activ ation: all ty pes of recurrent
inf ections (v iral/bacterial/f ungal)
Rx v s TNF: Tx: Rheumatoid arthritis
v s. TNF: Inf liximab
v s. TNF receptor: Adalimumab
f ake TNF receptor: Etanercept
Complement:
C_a f or anaphy laxis (histamine release > edema > hy potension, anaphy laxis)
C_b f or binding bacteria (opsonizes and f orms pores)
"low 3 causes 3": C3 def iciency causes HSRIII (immune complex deposit), seen especially in glomerulonephritis;
susceptible to S. pneumo and Hib > sev ere recurrent py ogenic sinus and respiratory tract inf ections
**Remember SHiN: S(trep. pneumo) + Hi(b) = C3 def iciency ; N(eisseria) = C5-C9/MAC def iciency
Passiv e immunity : To Be Healed Rapidly - Tetanus Botulism HBV, Rabies/(RSV in premies ev ery winter month)
Immune def iciencies:
Brutons agammaglobulinemia = (x-r) Boy s with BTK (ty rosine kinase) def ect > Blocked B-cell
dif f erentiation: recurrent Bacterial inf ection af ter 6 months (when moms IgG disappears) b/c no Igs
Selectiv e Ig(A) def iciency : milk Allergies, blood product Anaphy laxis, giardiA inf ections; IgA is missing in
mucus so recurrent sinus and lung inf ections
**Note: IgA def iciency also seen in Ataxia-Telangiectasia:def ectiv e DNA repair enzy mes, sensitiv e to
ionizing radiation, cerebellar atrophy > ataxia, spider angiomas (telangiectasias); assoc. w/ ly mphomas and
acute leukemias
Hy per-IgE/Jobs Sy ndrome: Im Hy per Excited f or my FATEd Job
Hy per Excited = Hy per IgE
F = coarse Facies
A = cold, noninf lamed Staph Abcesses
T = retained primary Teeth
E = Eczema
Job = Jobs
Chediak-Higashi (a-r): Grandpa Al couldnt eat Eastern f ood with his f ingers.
Grandpa = Gram positiv e cocci inf ections: Staph and Strep
Al = partial albinism
couldnt eat = def ectiv e microtubules = def ectiv e phagocy tosis and ly sosomal f usion
Eastern = Higashi (higashi means East in Japanese)
with his f ingers = peripheral neuropathy
Pathology:
Proto-oncogenes: tumor promoters; damage one allele > gain of f unction (VS. tumor suppressors need to damage
both alleles to lose f unction)
"Mikes sis returned with her2new breasts that she was able to-grow-f aster b/c of herbs."
Mike = my c: C-my c - Burkitts, N-my c - adrenal Neuroblastoma, L-my c - small cell lung CA
sis: astrocy toma, 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 f rom Philadelphia t(9;22))
to-grow-f aster = TGF: astrocy toma, HCC
b/c = bcl2: f ollicular ly mphoma
herbs = ERB-B1,2: ERB-B1 - lung squamous cell CA, ERB-B2 - breast, ov arian, gastric CA
Psammoma bodies: concentric Ca2+ spheres; looks like thumbprint; PSaMMoma:
P = papillary thy roid tumor
S = serous cy stadenocarcinoma of ov ary
M = mesothelioma
M = meningioma
ESR (marker of inf lammation): inf lammatory product f ibrinogen coats RBC causing aggregation > weight pulls RBC
down = f all at f aster rate in test tube
incr/f aster ESR = inf lammation: inf ection, cancer, pregnancy , SLE
decr/slower ESR = de-prESsed Heart is Sick f rom Too Much Blood.
Heart = CHF
Sick = Sickle Cell
Too Much Blood = Poly cy themia

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Pharmacology:
Kompetitiv e inhibitors incr Km, decrease af f inity /potency (amount of drug needed f or ef f ect); sigmoid ef f ect curv e
shif ts right; Lineweav er-Burke lines cross at Y -axis
(VS non-competitiv e inhibitors decr Vm, decrease ef f icacy (maximal ef f ect of drug); sigmoid ef f ect curv es v ertical
maximum ef f ect is reduced; Lineweav er-Burke lines join at X-axis)
Zero-order elimination: constant amount of drug eliminated per unit time = PEA - Pheny toin, 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: cy steine stones and altitude
sickness (hy perv entilation > respiratory alkalosis)
base (amphetamine) trapped in acidic ammonium chloride
Phase I v s Phase II metabolism: 1 red ox went 2 conjugate polar bears.
Phase 1: cy p450 red-ox (+ hy droly sis); geriatrics lose phase 1 f irst
Phase 2: conjugation (acety lation, glucuronidation, sulf ation) > y ields v ery polar renally excreted inactiv e
metabolites
Therapeutic index: TILED with TI= LD#/ED# and the #s adding up to 100; saf er drugs hav e higher TIs
G-protein-linked 2nd messenger:
Gs = adeny ly l cy clase > ATP-to-cAMP > PKA > cascade
Gi = inhibit adeny ly l cy clase > decr cAMP > decr PKA
Gq = phospholipase C > lipids-to-PIP2 > IP3 incr intracellular Ca2+, DAG stim PKC > cascade
"Kiss and Kick til y oure 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 lipoly sis
Gs = beta 2: decr Diastolic BP, v aso/bronchodilation, incr heart rate, contractility , incr lipoly sis, incr
insulin release (think Beta2 stimulates Beta islet cells of pancreas), decr uterine tone
Gq = M1: CNS, enteric nerv ous sy stem
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 v ascular SM contraction
Gs = V2: incr H2O reabsorption in kidney s CD (ADH action)
Signaling pathway s:
cAMP (Gs, Gi): FLAT CHAMP + calcitonin + glucagon
F = FSH
L = LH
A = ACTH
T = TSH
C = CRH
H = hCG
A = ADH (V2)
M = MSH
P = PTH
calcitonin
glucagon (incr cAMP > activ ates PKA > incr F16BPase > gluconeogenesis RLS)
IP3 (Gq): hIP3othalamic GGOAT
GHRH
GnRH
oxy tocin
ADH (V1)
TRH
cGMP: v asodilators
ANP
NO (NO v enodilates decreasing preload VS beta-blockers arteriodilate and reduce af terload)
ty rosine kinase: the Ty K Grows In Milk
GH
IGF-1
FGF
PDGF
Insulin
Prolactin
steroid receptor: cy toplasmic (except thy roid hormone = intranuclear)
(Adrenal cortex:) Aldosterone, Glucocorticoid, Testosterone, Estrogen
Progesterone
Vitamin D
T4/T3 (intranuclear receptor)
Glaucoma drugs: AABBCDF
AA = Alpha Agonist: v asoconstriction > decr aq humor sy nthesis (not f or closed angle glaucoma)
BB = Beta Blocker (Timolol): decr aq humor secretion
C = Cholinomimetic (Carbachol, Pilocarpine; Phy s is f or the Ey es Phy sostigmine, Echothiophate): incr
outf low (contract ciliary muscle and open trabecular meshwork into canal of Schlemm)
D = Diuretic: Acetazolamide (carbonic anhy drase inhibitor), Mannitol: decr aq humor secretion
F = PGF2alpha (Latanoprost): incr uv eoscleral outf low; AE: dy es irises brown
Cholinomimetics:
Bethanechol: Giv e Beth-ann-a-call if y ou want y our PNS stimulated: Tx: post-op neurogenic ileus and
urinary retention
Anticholinesterases = -stigmines + Edrophonium + Echothiophate
Organophosphate poisoning: DUMBBELSS: Tx: Atropine, Pralidoxime

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Diarrhea
Urination
Miosis
Brady cardia
Bronchospasm
Excitation of skeletal muscle and CNS
Lacrimation
Saliv ation
Sweating
Atropine poisoning: what would happen if y ou got lost in the desert: Hot, Dry , Red, Blind (cy cloplegia), Mad
(delirium), urinary retention(/constipation)
Hexamethonium: Put a Hex on reFLEX brady cardia - Hexamethonium prev ents NE ref lex brady cardia 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/Mecamy lamine blocks these)
Muscarinic = G-coupled receptors; M1,2,3=QIQ (Atropine blocks these)
Specif ic 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 Cy anide which is Txd w/ NITRite, hy droxocobalamin, and thiosulf ate
METHy lene 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 , Conv ulsions, Coma
Cutaneous f lushing: VANC = Vancomy cin, Adenosine, Niacin, Ca2+ channel blockers
Dilated cardiomy opathy = Doxorubicin and Daunorubicin
Torsades de Pointes: The Method to get 31Awesome QTs is to wear a Halo and Risper that y ou bought a
Macro-PIe f rom Quinn.
Method = Methadone
31Awesome = Class III, Class Ia antiarrhy thmics
Halo = haloperidol
Risper = risperidone
Macro = macrolide
PI = HIV protease inhibitors
Quinn = Chloroquine/Mef loquine
Aplastic anemia: Chlora SAID Ptuey to Meth:
Chlora = Chloramphenical
SAID = NSAID
PTUey = PTU (antithy roid)
Meth = Methimazole (antithry oid)
Hemoly sis in G6PD: Prima had to take Aspirin af ter INHaling her I.B.Prof essor Dapsones Sulf urous Fav a
Bean Nitrof arts
Primaquine
Aspirin
INH
Ibuprof en
Dapsone
Sulf onamides
Fav a bean
Nitrof urantoin
"Pseudomembranous colitis makes y ou want to ClAmp y our ass": CLindamy cin, AMPicillin
Photosensitiv ity : SAT f or a Photo:
S = Sulf onamides
A = Amiodarone
T = Tetracy clines
Stev ens-Johnson rash: Seizures, Sulf as, and Cillins + Allopurinol
Seizure drugs: ethosuximide, lamotrigine, carbamazepine, phenobarbital, pheny toin
Sulf a drugs
Penicillin
Allopurinol
SLE-like sy ndrome: SHIPP
Sulf onamides
Hy dralazine (Hy dras neck Loops (Lupus) around in circles)
INH
Pheny toin
Procainamide
Disulf iram-like reaction: Drunk Ceph said he was Pro-Car (okay to driv e) at Night, but to av oid a
Gruesome accident, Chlora made him Suf f er the Metro.
Ceph = Cephalosporin
Procar = Procarbazine
Night = Nitrof urantoin
Gruesome = Griseof ulv in
Chlora = Chloramphenicol
Suf f er = Sulf ony lureas
Metro = Metronidazole
Ototoxicity /Nephrotoxicity : Mice use Platinum earring Loops to crawl into y our Ear and make y ou deaf
Mice = -my cins = aminogly cosides and v ancomy cin
Platinum = Cisplatin
Loops = Loop diuretics
p450 interactions:
p450 inducers: Queen Barbs riFamily induced Saint John to eat a Pheny -looking Greasy Carb
Queen = Quinidine
Barbara = Barbiturate
riFamily = Rif ampin
induced
Saint John = Saint Johns Wort
Pheny -looking = Pheny toin (AE: gingiv al hy perplasia)
Greasy = Griseof ulv in
Carb = Carbamazepine
See ref erence:

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p450 inhibitors: Without a Key , Kim was inhibited f rom PIES and Juice
Key = Ketoconazole
Kim = Cimetidine
inhibited
PI = HIV Protease Inhibitors
E = Ery thromy cin
S = Sulf onamides
Juice = grapef ruit juice
See ref erence:

Toxicity bear: Cumulativ ely Toxic Drugs and their Rescues

Asparagine: neurotoxicity
Cisplatin: ototoxic/nephrotoxic; Tx: Amif ostine
Vincristine/Vinblastine: Christ my nerv es, Blast my bones - Vincristine = peripheral neuropathy ,
Vinblastine = my elosuppression
Bleomy cin: pulmonary f ibrosis
Doxorubicin: cardiotoxic; Tx; Dexrozoxane (f or cardiotoxicity ), Dimethy l-sulphoxide (f or ROS
ulcers)
Cyclophosphamide: Acrolein = nephro/bladder toxic (Tx: Mesna); also SIADH ef f ects (Tx:
Demeclocycline)
Methotrexate: nephrotoxic (Tx: Leucov orin), my elosuppression (Tx; Filgrastim)
See ref erence:

Cardiovascular:
Contractility decreases with: ABBCCC:
A = Acidosis
BB = Beta blocker
CCC = hy perCO2, CHF, non-DHP Ca2+ channel blockers
Heart murmurs:

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"MR. ASS and MS. ARD" =
MR = mitral regurg
AS = aortic stenosis
S = sy stolic murmurs
and
MS = mitral stenosis
AR = aortic regurg
D = diastolic murmurs
holosy stolic = all regurgs + VSD
murmurs that increase with breathing:
rIght murmurs increase with Inspiration
lEf t murmurs increase with Expiration
"Wolf = Lone Canis" - Wolf f -Parkinson-White is treated with amiodaRONE and ProCAINamide
AV blocks:
"First, a girl stay s out til 12 ev en though her curf ew is 10."
"Then, the teenager stay s out later and later, til her mom throws a f it."
"Af terwards, despite the teenager being good, the mom throws random f its probably because of menopause."
"Finally , the y oung woman is old enough to whatev er she wants separately f rom her parents."
1st degree: increased PR
2nd degree:
Ty pe 1 Wenckebach: incr PR until QRS drop
Ty pe 2: random QRS drop
3rd degree: PR and QRS = independent rates; seen in Ly me disease
DiGeorge Tets: TETralogy of Fallow + TETany f rom hy pocalcemia (lack of parathy roids) (also, truncus arteriosus)
"PGA open": PGE kEEps PDA open (PGE1 analogs: Alprostadil, Misoprostol); close with Indomethacin
Ev olution of MI: 4 and death are both pronounced shi in Japanese
Initially : nothing
4 hours-4day s later: PMNs, coagulativ e necrosis, risk of arrhy thmia (esp. V-f ib)
4-10 day s later: M0s thinned walls > increased risk of rupture and tamponade
>10 day s: risk f or v entricular aneury sm (bulging scar because f ibrosis made it lose its ability to contract) <
v entricular remodeling can be prev ented with ACE-Is
Bacterial endocarditis: FROM JANE:
Fev er
Roth spots: round retinal white spots surrounded by hemorrhage
Oslers nodes: tender raised red lesions on f ingers 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 v alv e)
SLE causes LSE (Libman Sacks endocarditis with warty sterile v egetations on both sides of v alv e, assoc. w/ mitral
regurg)
Rheumatic heart disease of S. py ogenes (beta-hemoly tic, bacitracin-sensitiv e Strep): AAAAAA
group A Strep
autoimmune (Ab to antiphagocy tic M protein > MVP > Mitral Stenosis), f ev er
Aschof f bodies (granulomas with giant cells) = subcutaneous nodules
Anitschkow cells (activ ated histiocy tes)
elev ated ASO titers and ESR
migratory poly Arthritis
+ Ery thema martginatum, Sy ndenhams/St. Vitus chorea (of f ace, tongue, and upper limb)
"ACE-inhibitors are ACEs at controlling HTN":
essential hy pertension
HTN+CHF (decreases both preload and af terload)
HTN+DM (protective against Diabetic nephropathy )
Antihy pertensiv e 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
Antiarrhy thmics: No Bad Boy Keeps Clean
Ty pe
Ty pe
Ty pe
Ty pe

I: Na+ blocker (incr QT)

II: Beta blocker (incr PR); Tx OD w/ Glucagon
III: K+ blocker (incr QT)
IV: Ca2+ blocker (incr PR); Tx coronary and cerebral v asospasms

Ty pe I antiarrhy thmics:
Ia: The Queen Werewolf Disappeared
Quinidine, Procainamide, Disopy ramide (incr AP)
Ib: To Funny Little Mexico
Tocainide, Pheny toin, Lidocaine, Mexiletine (decr AP)
Ic: Properly Fleeing Endangerment
Propaf enone, Flecainide, Encainide
Ty pe III: Amiodarone: check PFTs, LFTs, and TFTs
pulmonary f ibrosis
hepatotoxicity
hy po/hy perthy roidism (amiodarone = mostly iodine, resembles thy roid hormone)
+ photodermatitis (SAT f or a photo)
Endocrine:
Adrenal cortex: GFR: The deeper y ou go, the sweeter it gets.

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"salt": zona Glomerulosa: aldosterone
"sugar": zona Fasciculata: cortisol
"sex": zona Reticularis: androgens
Adenohy pophy sis = 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)
Neurohy pophy sis = Posterior pituitary (Neural tube of ectoderm): secretes hy pothalamic substances: A Pair of Ox
were Supra Dehy drated
Parav entricular nucleus - Oxy tocin
Supraoptic nucleus - Vasopressin (ADH)
Adrenal steroids: In an enzy me def iciency , if the f irst digit is a 1, then the patient will be hy pertensiv e. If the
second digit is a 1, then the patient will look male.
17alpha hy droxy lase def iciency : HTN, f eminine
21 hy droxy lase def iciency (MC): hy potension, masculine
11 beta hy droxy lase def iciency : HTN, masculine
PTH = phosphate trashing hormone (note: decreased f ree serum Mg2+, decreases PTH secretion; common causes of
decr Mg2+ = alcohol, aminogly cosides, diarrhea, diuretics)
Calcitonin = f rom paraf ollicular C cells of thy roid = neural Crest deriv ativ e, secreted in medullary thy roid Cancer
(MENII)
(Signaling pathway mnemonics were cov ered earlier)
Thy roid hormone f unctions: T3 = 5Bs
Brain (CNS) maturation (def ect = mental retardation seen in Cretinism)
Bone growth (sy nergism with GH; def ect = Cretinism)
Beta1 adrenergic ef f ects (Thy roid Storm: incr HR, contractility > arrhy thmia; Tx with propanolol or PTU
(OK in pregnant))
incr BMR
incr Blood sugar: gly cogenoly sis, gluconeogenesis, lipoly sis
Pheochromocy toma (PCC): Rule of 10s
10%
10%
10%
10%
10%
10%

malignant
bilateral
extra-adrenal
calcif y
kids
f amilial

Neuroblastoma (MCC adrenal medulla tumor in children) = N-my c oncogene, stain = Neurof ilaments, tumor marker
= Bombesin
see Homer-Wright pseudorosettes and incr HVA (Dopamine deriv ativ e) in urine
scenario: ~2y o with retroperitoneal ab mass presents with HTN hy potonia, my oclonus, and non-rhy thmic
conjugate ey e mov ements (opsoclonus-my oclonus)
mass may inv ade into an interv ertebral epidural space and look like a dumbbell
Hy pOthy roidism = cOld intolerance; Hy pErthy roidism = hEat intolerance
"CHIMPANZEES" cause Hy percalcemia:
Calcium ingestion (incr antacids > milk-alkali sy ndrome)
Hy perparathy roid/Hy perthy roid
Iatrogenic: Thiazides
Multiple my eloma
Pagets disease (when patients are immobilized, normally normocalcemic)
Addisons disease
Neoplasms (e.g., breast cancer = osteoly tic)
Zollinger-Ellison sy ndrome (pancreatic tumor > incr gastrin; associated with MENI (parathy roid tumor)
Excess v itamin D
Excess v itamin A (incr bone resorption > incr Ca2+)
Sarcoidosis (or granulomatous disease)
Hy perparathy roidism:
Primary : Osteitis f ibrosa cy stica = stones, bones, and groans = kidney stones, brown bone tumors,
weakness and constipation; incr cAMP in urine
VS Secondary : Renal osteody strophy = renal disease > decr Vit D > decr Ca2+ > incr PTH > bone
lesions
Hy pocalcemia signs:
C = Chv ostek sign = Cheek tapping > f acial muscle Contraction
T = Trosseaus sign = Tight BP cuf f > hand Tetany (spasm)
Dexamethasone v s Demeclocy cline v s Desmopressin:
Dexamethasone = steroid to Dx ACTH disease/sy ndrome
DemecloCY CLine = tetracy cline ADH antagonist v s CY CLophosphamide-induced SIADH; Tx: SIADH
DesmoPRESSIN = v asoPRESSIN (ADH) analog; Tx: central Diabetes insipidus
(Note: nephrogenic DI is treated by hy drochlorothiazide (Ca2+ sparing diuretic), indomethacin (decr renal
blood f low), or amiloride (K+ sparing aldosterone receptor antagonist diuretic that closes Na+ channels that
also reabsorbs Li to Tx Li-induced DI)
Multiple endocrine neoplasias (MEN): (A-D)
MENI (Wermers): 3Ps
pancreatic - ~Zollinger-Ellison gastrinoma - peptic ulcers
parathy roid - incr PTH - hy percalcemia
pituitary - ~prolactin or GH - amenorrhea, lactation
MENIIa (Sipples): 2Ps
parathy roid - incr PTH - hy percalcemia

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PCC - incr catecholamines (Epi/Nor), urine VMA and Metanephrine
medullary thy roid (paraf ollicular C) - poly gonal, incr calcitonin - hy pocalcemia
MENIIb: 1P
PCC - incr catecholamines, urine VMA/metanephrine
medullary thy roid (paraf ollicular C) - incr calcitonin - hy pocalcemia
Marf ans habitus + oral/intestinal mucosal neuromas
Note: MENIIs are associated with ret oncogene
Also, the II in MENII stands f or the 2Cs in PCC
Diabetic drugs:
"Metf ormin Glitters in Sunny Gliptin Tides"
Metformin = incr glucose uptake in muscle and f at v ia GLUT4 (aka incr insulin sensitivity in peripheral
tissue) and decr liv er glucose production v ia incr AMPK and decr PEPCK (OAAtoPEP) and decr G6Pase
(G6PtoGlucose) production
-Glitazones = incr insulin sensitivity v ia PPARgamma/adiponectin
Sulfonamides = incr pancreatic insulin production v ia blocking ATP-dep. K+ ef f lux
-Gliptins, -Tides = incr insulin, decr glucagon, decr gastric motility (incr satiety )
+ Acarbose/Miglitol = decr starch hy droly sis and glucose GI uptake
Diabetes drugs mechanisms of action:
"PPARazzi camera f lashes GLITA" - PPARgamma -Glitazones
"GULP TIDES" - GLP1 -Tides
"Dr.PPer and Lipton" - DPP4 inhibitor -Gliptins
Acarbose - Alpha glucosidase
Remember:
insulin > decreases cAMP > decreases PKA > dephosphory lated FBPase2 = PFK2 > F6P to F26BP
> F26BP stimulates PFK1 > incr F6P to F16BP (gly coly sis)
glucose > decreases cAMP > decreases CAP-cAMP binding of lac operon = RNA poly merase cant bind
to promoter
Gastrointestinal:
Retroperitoneal structures: I ASK DR. PC
Primary retroperitoneal (nev er pushed into sac):
IVC
Ab aorta
Suprarenal glands
Kidney s/Ureters
Secondary retroperitoneal (pushed into sac, but escaped):
Duodenum (2, 3, 4)
Rectum
Pancreas (head, body )
Colon (ascending, descending)
OR SAD PUCKER = suprarenal, abdominal aorta, duodenum, pancreas, ureter, colon, kidney , esophagus, rectum
Digestiv e tract histology : Brunch DIP:
Brunners (submucosal, alkaline mucus secreting) glands = Duodenum
Ileum = Pey ers Patches (M cells take up antigen; also location of IgA-secreting plasma cells)
Note: Shigella is taken up by the M-cells of Pey ers Patches; v iruses like Adenov irus may inv ade Pey ers
Patches and cause intussusception; Sabin (liv e Polio v accine) increases IgA immunity
Enteric nerv e plexuses: AUerbach is on the AUtside, MeiSSners is SSubmucosal
Auerbachs = My enteric = coordinates Motility by being wedged between the inner/circular and
outer/longitudinal muscles
Meissners = Submucosal = regulates Secretions, blood f low, and absorption between mucosa and
inner/circular muscles
Def ect in Auerbachs causes Achalasia
Lack of both Auerbach and Meissners due to f ailure of neural crest cell migration causes Hirschsprungs Congenital
Megacolon, assoc. with Down Sy ndrome (see f ailure to pass meconium, like in Cy stic Fibrosis)
Portosy stemic anastomoses:
The mnemonic is f rom Sy stemic (IVC) to Portal (Celiac, SMV, IMV) v eins:
MI Superior's an Ass. He makes me f eel Inferior about my Superficial appearance by poking near my Bellybutton so I Eat Less.
Rectal anastomoses: (X=hemorrhoids)
MI Superior is an Ass:
Sy stemic: Middle and Inf erior Rectal
to
Portal: Superior Rectal
Umbilical anastomoses: (X=caput medusae)
Inferior about my Superficial appearance by poking near my Belly-button:
Sy stemic: Inferior, Superficial Epigastric
to
Portal: Paraumbilical
Esophageal anastomoses: (X=esophageal v arices)
Eat Less: (X = esophageal v arices)
Sy stemic: Esophageal (azy gos)
to
Portal: Lef t Gastric
Liv er anatomy : 1ABC
"1ABC":
Zone 1 = Apical surf ace of hepatocy tes f ace Bile Canaliculi = periportal zone
Also, when y ou think of ABC, y ou should think of Hepatitis A, B, C
Zone 1 = f irst af f ected by v iral hepatitis because closest to hepatic artery (Remember: Portal triad
= bile duct, hepatic artery , and portal v ein)
"The 3rd letter in the alphabet = C":
Zone 3 = Centrilobular (periCentral v ein) = where blood drains into the hepatic v ein
because its so f ar f rom the hepatic artery , its the f irst place to suf f er f rom ischemia
also, since blood pools in v eins, y ou 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: Nerv e, Artery , Vein, Empty space, (deep inguinal) Ly mphatics/Lacunar ligament

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Note: f emoral sheath does not contain f emoral nerv e
Inguinal canal: INternal (deep) inguinal ring = INdirect hernia that may go INto the scrotum = lateral to inf erior
epigastric v essels
VS. an alien Directly bursting f rom y our stomach = direct hernia = protrudes f rom abdominal wall medial to
inf erior epigastric v essels:

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

"Fem-Fem": f emoral hernias occur more of ten in f emales (and is the leading cause of bowel incarceration)
GI secretory products:
"IF y ou PARTY too hard, y oull v omit out a lot of GASTRIC ACID.":
Parietal cells secrete IF (intrinsic f actor) 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 y ou say By e By e to the SI: By le acid,
B12/IF is reabsorbed in the Ileum
Bilirubin:
Rules of thumb:
The two-named diseases dont go together
The one named diseases are milder
INdirect = UNconjugated = water INsoluble: Crigler-Najjar, Gilbert =
"KING KONG" > "CING CUNG" > Criggler-Indirect/Unconjugated-Najjar-Gilbert
Y ou get Crigler-Najjar/Gilberts when y oure unable to conjugate bilirubin into a water-soluble/excretable f orm
~ Glucurony l transf erase def iciency
Direct = conjugated = Water soluble: Dubin-Johnson, Rotor's =
Dubin-Johnson called Rotor-rooter to f ix his WaterPipes.
Y ou 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 liv er is pigmented black
Achalasia: AABBCC
Achalasia
loss of Auerbach's my enteric plexus
Birds beak on Barium swallow
associated with Chagas and CREST
Boerhaave sy ndrome = Been-Heaving; transmural complication of Mallory -Weiss
BARRetts esophagus = Becomes Adenocarcinoma, Results f rom Ref lux
Esophageal cancer risk f actors: ABCDEFGH
Alcohol, Achalasia
Barretts esophagus
Cigarettes
Div erticuli (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 prev alent worldwide); upper 2/3s (where striated muscle can be
f ound)
Adenocarcinoma = most prev alent in America (lower 1/3, location of pure smooth muscle)
Gastritis:
Acute gastritis (erosiv e):
"Burned by Curling iron": Curlings ulcer = stress ulcer f rom burns:
decr plasma v olume > sloughing of gastric mucosa
"Cushion the brain": Cushings ulcer = stress ulcer f rom head injury :
incr ICP > incr v agal stimulation > incr ACh > incr H+)
Chronic gastritis (non-erosiv e): AB-pairing
Ty pe A (f undus/Body ) = Autoimmune/Anemia:
AutoAb to parietal cells, pernicious anemia (Ab to IF), achlorhy dria
Ty pe B (Antrum) = Bacterial:

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H.py lori inf ection (duodenal > stomach ulcer), increased risk of MALT ly mphoma
Peptic ulcer disease:
Gastric ulcer pain = Greater with f ood
Duodenal ulcer pain = Decreases with f ood (will see hy pertrophy of Brunners glands and clean punched
out margins unlike carcinoma raised/irregular margins)
Inf lammatory bowel disease (IBD): Crohns v s Ulcerativ e Colitis
Crohns: A Creepy Fat old Crone (Granny ) went Skipping on Cobblestones while pumping her Arthritic Fist
in the air.
Creepy Fat = Creeping f at
Crone = Crohns disease
(Granny ) non-caseating Granulomas
Skipping = transmural Skip lesions
Cobblestone = Cobblestone mucosa
Arthritic = Migratory poly arthritis
Fist = Fistulas
"Gum to Bum" lesions and extraintestinal manifestations (sy stemic) like ery thema nodosum
(~shins), anky losing spondy litis, and uv eitis
Note: this is disordered response to intestinal bacteria
Ulcerativ e colitis: If y ou hav e a Lead Pipe jammed up y our Rectum, y oull get Bloody Diarrhea.
Lead Pipe = loss of haustra leads to lead pipe appearance on imaging
Rectum = UC alway s inv olv es the rectal mucosa/submucosa and procedes continuously up unlike
Crohns which tends to spare the rectum
Bloody diarrhea (another trait not shared with Crohns)
Note: this is autoimmune
UC is also associated with f riable pseudopoly ps, py oderma gangrenosum, and primary sclerosing
cholangitis
Meckels div erticulum: Rule of 2s
2 inches long
2 f eet f rom ileocecal v alv e
2% of population
2y o (or y ounger)
2 ty pes of ectopic epithelia: gastric or pancreatic
Colonic poly ps: VILLous = VILLainOUS because v illous poly ps are more likely to be malignant (v illous >
tubulov illous > tubulous)
Colorectal cancer (CRC):
Familial adenomatous poly posis (FAP): poly posis = thousands of poly ps; FAPCancer inv olv es APC gene;
alway s inv olv es rectum
VS. HNPCC/Ly nch which doesnt hav e many poly ps and inv olv es the PROXIMAL colon
Gardners sy ndrome = Gardeners Grow all kinds of things: Gardners = FAP + osteomas + lipomas/sof t
tissue tumors + retinal hy perplasia
Turcots sy ndrome: TURcot = TURban; FAP + malignant CNS tumor (medulloblastoma)
Presentation of CRC: Think of the colon as a f unnel that shrinks towards the anus (and also that v isceral nerv es
dont hav e as many localized pain receptors as the anus):
distal colon (lef t side, near anus) = obstruction, sharp colicky pain, hematochezia
proximal colon (right side) = iron def iciency anemia, dull pain, f atigue
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 (hemoly tic)
Basal ganglia degeneration (Parkinsonism)
decr Ceruloplasmin, Cirrhosis, Corneal deposits, Cancer (HCC)
Dementia
Encephalopathy
Fanconis Sy ndrome: def ectiv e PCT reabsorption
Gallstones (cholelithiasis): Risk f actors = 4Fs:
Fat
Fertile
Female
Forty
Acute pancreatitis causes: GET SMASHED > DIC, ARDS
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune disease
Scorpion Sting
Hy percalcemia, Hy perlipidemia
ERCP
Drugs (E.G., Sulf a drugs)
Antacid adv erse ef f ects:
Al = AluMINIMUM amount of f eces: constipation
Mg = Must Go to the bathroom: diarrhea
And this was where I stopped. If y ou hav e specif ic questions, f eel f ree to ask me (but dont f orget to leav e me a
way to contact y ou!).
I hope this list comes in handy f or someone. Good luck with the exam!
Update (3/31/13): Unf ortunately , Im v ery busy with clerkships/shelv es and study ing f or the Step2CK, so I wont be
able to post the rest of my mnemonics, but my Ask box is alway s open f or adv ice! ^^ Thanks f or understanding.

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Posted 2 y ears ago 103 notes
#USMLE #anatomy #bacteriology #biochemistry #biostatistics #histology #immunology #microbiology #neurology
#neuroscience #parasitology #pathology #phy siology #psy chiatry #ross #v irology
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