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60 Cards in this Set
- Front
- Back
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Retroperitoneal structures
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SAD PUCKER
Suprarenal (adrenal) Aorta and IVC Duodenum (2nd-4th) Pancreas (except tail) Ureters Colon (ascending and descending) Kidneys Esophagus (thoracic portion) Rectum (partially) |
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Femoral region organization lateral to medial |
NAVaL femoral Nerve femoral Artery femoral Vein A gap (Canal) Lymphatics Artery vein and lymphatics are within the femoral sheath surface marking for femoral artery: midinguinal point |
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Spermatic cord layers |
ICE tie Internal spermatic fascia = transversalis fascia Cremasteric muscle and fascia = internal oblique External spermatic fascia = external oblique through deep inguinal ring to superficial ring deep inguinal surface marking = midpoint of the inguinal ligament |
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Location of hernias |
MD's dont LIe Medial to inferior epigastric vessels = direct Lateral to inferior epigastric vessels = indirect Direct = hesselbach(inguinal) triangle inferior epigastric laterally inguinal ligament inferiorly rectus abdominus medially floor = transversalis fascia |
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Plummer Vinson |
Plumbers DIE of scc dysphagia iron deficiency anaemia esophageal webs increased risk of SCC |
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Whipple's disease |
Foamy Whipped Cream in a CAN Foam cells (macrophages in intestinal lamina propria and mesenteric nodes) Cardiac symptoms Arthralgias Neurological symptoms (incl psychiatric) gram+ve actinomycesPAS+ve diastase resistant granules -most often in older men |
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Ulcerative Colitis
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ULCCCERS Ulcers Large intestine Continuous Colorectal Carcinoma Crypt abscesses Extends proximally Red diarrhea Sclerosing cholangitis |
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Zenker Diverticulum (false diverticulum) |
Elder MIKE has bad breath Elderly Males Inferior pharyngeal constrictor (between cricopharyngeal and thyropharyngeal parts) Killian triangle Esophageal dysmotility Halitosis px: dysphagia, obstruction, gurgling, bad breath, aspiration, neck mass (lateral) |
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Meckel's diverticulum (true diverticulum) |
the six 2's: 2% population 2* more common in males 2 inches long 2 feet from ileocecal valve 2 types of ectopic tissue (gastric, pancreatic) commonly presents by age 2 |
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Molecular Pathogenesis of colon cancer Chromosomal instability pathway |
Firing order: AK53
APC loss (decreased inter-cellular adhesion, increased proliferation) KRAS mutation (uncontrolled intracellular signalling) p53 loss +DCC loss (tumirogenesis - loss of cell cycle control) |
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H2 blockers |
-dines = "H2 blockers before you dine. table for 2" acid suppression therapy |
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Cortisol effects |
BIG FIB Blood pressure (^) Insulin resistance Gluconeogenesis, lipolysis, proteolysis Fibroblast inhibition (connective tissue effects) Immune changes (many*) Bone formation inhibition (decreased osteoblast activity) |
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Basophilic cells of Anterior Pituitary |
those that produce: B-FLAT = FSH = LH = ACTH = TSH acidophilic = GH and PRL |
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tissues with insulin-independent glucose transporters
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BRICK-L Brain RBCs Intestines Cornea Kidney Liver |
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Thyroid hormone functions (esp T3) |
4'Bs: Bone growth Brain maturation B1 upregulation Basal metabolic rate increase |
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Hormones signalling through cAMP |
G-FLAT ChAMP GHRH glucagon FSH LH ACTH TSH CRH & calcitonin hCG ADH (v2 receptors) MSH PTH |
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Hormones signalling through cGMP |
BAD GraMPa (think vasodilators) BNP ANP EDRF (ex. NO... = endothelium derived relaxing factor) |
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Hormones signalling through IP3 (often Gq) |
GOAT HAG GnRH Oxytocin ADH (v1 receptor) TRH Histamine (H1 receptor) Angiotensin II Gastrin |
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Intracellular receptors |
PET CAT on TV **think steroids and fat-solubles Progesterone Estrogen Testosterone Cortisol Aldosterone T3/T4 Vit D |
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Receptor tyrosine kinase |
MAP kinase pathway * think growth factors Insulin IGF-1 FGF PDGF EGF |
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Non-receptor tyrosine kinase |
PIGGLET JAK-STAT pathway **think acidophils and cytokines Prolactin Immunomodulators (cytokines IL2, IL6, IFN) GH G-CSF EPO Thrombopoeitin |
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Phaechromocytomas |
Rule of 10's 10% malignant 10% bilateral 10% in kids 10% extra-adrenal 10% calcify up to 25% associated with familial syndromes (VHL, RET (MEN2A,B) NF1) |
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Episodic adrenergic symptoms of phaechromo |
5P's Pressure (BP up) Palpitations (tachy) Pain (headache) Perspiration Pallor |
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Congenital Hypothyroidism findings in the child |
6P's Pot-bellied Pale Puffy-faced Protruding umbilicus Protruberant tongue Poor brain development |
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IgG4 related systemic disease |
"AARR" Aortitis (noninfectious) Autoimmune pancreatitis Riedel's fibrosing thyroiditis (1/3 hypothyroid) Retroperitoneal fibrosis |
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Treatment of Thyroid Storm |
4Ps: Propylthiouracil Propanolol (non-selective b-blockers) Prednisolone (corticosteroids) Potassium Iodide (Lugol's iodide) NB: lugol's iodide prevents iodine uptake - can be used in the prevention of radioactive iodine uptake following radioactive exposure |
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Glucagonoma |
5Ds: Dermatitis (necrolytic migratory erythema) Diabetes (increased blood sugar) DVT Declining weight Depression |
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Insulinoma |
Whipple's triad: low serum glucose symptoms of hypoglycemia resolution of symptoms with glucose normalization *increased C-peptide |
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Ascending cholangitis |
Charcot triad: fever RUQ pain jaundice Raynaud pentad: +hypotension and confusion |
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Pancreatic adenoCa (ductal) |
Courviosier's law: painless, palpable jaundice unlikely to be cholelithiasis |
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MEN1 (menin, chr11) |
3 P's pituitary tumours (PRL or GH) pancreatic tumours (Zollinger Ellison, insulinoma, VIPoma, glucagonoma (rare)) parathyroid adenomas |
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Carcinoid syndrome |
Rule of 1/3s: 1/3 metastasize 1/3 present with 2nd malignancy 1/3 are multiple |
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Manic episode |
at least 3 for at least 1 week requires hospitalization DIG FAST distractibility irresponsibility (hedonism) grandiosity flight of ideas activity (goal-directed) increase, psychomotor agitation sleeping needs decreased talkativeness (pressured speech) |
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Major Depressive Disorder |
Depressed mood + 4 more of the following: SIG E CAPS sleep disturbance interest loss (anhedonia) guilt or worthlessness energy loss/fatigue concentration difficulty appetite changes psychomotor agitation/retardation suicidal ideations |
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Risk factors for suicide completion |
SAD PERSONS Sex (male) Age (young adult or elderly) Depression Previous attempt Ethanol/drug use Rational thinking loss (psychosis) Sickness (chronic medical illness) Organized plan No spouse/social support Stated intent *access to firearms increases the risk of completion** |
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Panic Disorder |
PANICS Palpitations, paraesthesias, dePersonalization/derealization Abdominal pain Intense fear of dying/losing control/going crazy, lightheadedness, Chest pain, chills, choking Sweating, shaking, shortness of breath *strong genetic component S |
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Onset of EPS (most commonly high potency antipsychotics) |
ADAPT Acute dystonia (hours to days) Akathisia Parkinsonism (days to months) Tardive dyskinesia (months to years) |
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NMS |
FEVER Fever Encephalopathy Vitals unstable (autonomic instability) Enzymes elevated (myoglobinuria) Rigidity of muscles Tx: dantrole (ryanodine antag.) and D2 agonists |
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Serotonin syndrome |
3 A's neuromuscular Activity (clonus, hyperreflexia, hypertonia, tremor, seizure) Autonomic stimulation (hyperthermia, diaphoresis, diarrhea) Agitation Tx: cyproheptadine |
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MAOIs |
MAO Takes Pride In Shanghai Tranylcypromine Phenelzine Isocarboxazid Selegiline **risk hypertensive crisis C/I with SSRIs, TCAs, St John's Wort, Meperidine, Dextromethorphan wait 2 weeks to stop dietary restrictions |
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Causes of ARDS |
SPARTAS sepsis pancreatitis pneumonia amniotic fluid embolism uRaemia Trauma aspiration shock |
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Side effects of Oxygen therapy in prematurity |
RIB
intraventricular haemorrhage bronchopulmonary dysplasia |
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Factors increasing oxygen dissociation (shift right) |
ACE BAT acid (H+) CO2 Exercise Bpg (2,3) Altitude Temperature |
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Types of emboli |
FAT BAT Fat Amniotic fluid Thrombus Bacteria (septic) Air Tumour |
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Calculation of physiological dead space |
= Taco Paco PEco Paco |
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HIKIN
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Hi K+ Intracellularly |
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Patient with hyperkalemia? (Extracellular shift) |
DO LABS Digoxin hyperOsmolarity Lysis of cells Acidosis B-blockers (decreased Na/K ATPasE) Sugar increase (decreased insulin) |
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Increased anion gap metabolic acidosis |
MUDPILES methanol (formic acid) uraemia diabetic ketoacidosis propylene glycol iron tablets or INH lactic acidosis ethylene glycol (+oxalic acid stones) salicylates (late) |
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normal anion gap acidosis |
HARDASS hyperalimentation (IV nutrition) Addison's (aldosterone deficiency) Renal tubular acidosis Diarrhea Acetazolamide Spirinolactone Saline infusion |
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Chronic Renal Failure consequences |
MAD HUNGER Metabolic acidosis Dyslipidaemia (triglycerides up esp) Hyperkalemia Uraemia (platelet dysfunction, encephalopathy, asterixis, nausea vomiting anorexia, pericarditis, risk of ARDS) Na/h20 retention Growth retardation/developmental delay EPO deficiency Renal osteodystrophy (osteitis fibrossa cystica and adynamic bone disease) |
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Renal papillary necrosis causes |
SAAD Papa
Sickle cell disease or trait Acute pyelonephritis Analgesics (NSAIDs) Diabetes mellitus |
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Side effects Loop diuretics
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OH DANG ototoxicity hypokalemia dehydration alkalosis nephritis (interstitial) gout (hyperuricaemia) + sulfa allergy |
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Side effects Thiazides |
hyperGLUC hyperglycaemia hyperlipidaemia hyperuricaemia hypercalcaemia + sulfa allergy |
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ACEi Side effects
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CATCHH cough (increased bradykinin - c/i C1 esterase inhibitor deficiency) angioedema teratogen (Fetal renal malformations) creatinine increased (decreased GFR) * careful in bilateral renal artery stenosis hyperkalemia hypotension |
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bones of hand
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So long to pinky here comes the thumb Scaphoid lunate Triquetrium Pisiform Hamate Capitate Trapezoid Trapezium |
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Interossei |
DAB PAD Dorsals abduct Palmars adduct all supplied by ulnar |
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Causes of avascular necrosis of the femur |
CAST Bent LeGS Corticosteroids Alcohol Sickle cell Trauma Bends (caisson's) Leggs calve perthes Gauchers disease Slipped capital femoral epiphyses |
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Causes of interstitial nephritis |
P's Pain free (NSAIDs) Penicillins and cephalosporins and sulfonamides rifamPin Pee (Diuretics) PPIs **characteristic eosinophilic infiltrate |
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Seronegative arthritis |
PAIR psoriatic ankylosing spondyloarthropaty IBD associated Reactive (Can't see cant pee cant bend a knee - conjunctivits, urethritis, arthritis) |
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SLE |
RASH OR PAIN Rash (malar or discoid) arthritis (nonerosive) Serositis (cardiac, pleural etc) Haematological - cytopenias Oral/nasopharyngeal ulcers Renal disease Photosensitivity ANA Immunological - antiphospholipids, anti-dsDNA, anti-sm Neurological disorders (psychosis, seizures) |
