Mnemonics and triads and buzz words from USMLE
Signs of a MCA stroke: Mnemonic: MCA stroke can cause CHANGes
C-contralateral paresis and sensory loss in face and arm H- homonymous hemianopia A- aphasia (dominant) N- neglect (nondominant) G-gaze preference toward side of lesion
What cranial nerve sign is associated with berry aneurysms?
CN III with pupillary involvement
What does CREST syndrome consist of?
Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
What condition is the BRC-ABL translocation due to t(9,22) of the Philadelphia chromosome associated with?
Chronic Myelogenous Leukaemia
what are smudge cells associated with?
Chronic lymphocytic leukaemia (CLL) due to fragile leukaemia cells being crushed by coverslip
What is charcot's triad?
Classic triad of MS: scanning speech, intranuclear ophthalmoplegia, and nystagmus
What are the classic radiographic findings in Osteosarcoma?
Codman's triangle: periosteal new-bone formation at the diaphyseal end of the bone lesion Sunburst pattern of osteosarcoma
Causes of pericarditis Mnemonic CARDIAC RIND
Collagen vascular disease Aortic dissection Radiation Drugs Infections Acute renal failure Cardiac (MI) Rheumatic fever Injury Neoplasms Dressler's syndrome
What does B12 deficiency lead to?
Combined systems disease. Subacute degeneration of the posterior and lateral columns of the spinal cord and peripheral neuropathy.
TCAs toxicity: Tri-Cs
Convulsions Coma Cardiac arrhythmias
Bleeding episodes in Mild haemophilia and vonWillebrand's disease can be treated with what agent?
Desmopressin, helps the body to release extra factor VIII
4 deadly Ds of posterior circulation stroke:
Diplopia Dizziness Dysphagia Dysarthria
Symptoms of mania DIG FAST
Distractibility Insomnia (decreased need for sleep) Grandiosity Flight of ideas Agitation (psychomotor) Sexual indiscretions Talkativeness (pressured speech)
What is the classic triad of symptoms in Wernicke's encephalopathy?
Encephalopathy: disorientation, inattentiveness, confusion, coma Ophthalmoplegia: nystagmus, lateral rectus palsy, conjugate gaze palsy, vertical gaze palsy Ataxia: polyneuropathy, cerebellar and vestibular dysfunction leading to problems standing or walking.
Characteristics of a personality disorder: MEDIC
Maladaptive Enduring Deviate from cultural norms Inflexible Cause impairments in social or occupational functioning
What is the first and second most common primary tumours of bone?
Most common is multiple myeloma, Osteosarcoma is second most common primary.
What is Medullary thyroid carcinoma associated with?
Multiple Endocrine Neoplasia (MEN) type 2 and postive family history
What ages of presentation and chromosomes are associated with neurofibromatosis type 1 and 2?
NF1: 15 years and CS 17 NF2: 20 years and CS 22
What is Libman-Sack's endocarditis?
NONinfectious vegetations often seen on the MITRAL valve in association with SLE and antiphospholipid syndrome.
What are the causes of secondary eosinophilia? NAACP
Neoplasm Allergies Asthma Collagen vascular disease Parasites
What is the most common haematopoietic neoplasm?
Non-Hodgkins lymphoma
Type of fibres carried in the cranial nerves Mnemonic: some say marry money but my brother says big brains matter most.
Olfactory: sensory Ophthalmic: sensory Oculomotor: motor Troclear: motor Trigeminal: both Abducens: motor Facial: both Vestibulocochlear: sensory Glossopharyngeal: both Vagus: both Accessory: motor Hypoglossal: motor
What is the most common benign bone tumour?
Osteochondroma
What are Dutcher bodies and what condition are they associated with?
PAS +ive IgM deposits around nucleus of plasma cells in Waldenstrom's Macroglobulinemia
What organs does Multiple Endocrine Neoplasias 1 (MEN1) affect? P organs
Pancreas Parathyroid glands Pituitary
Thyroid Neoplasms (4 types)
Papillary (most common and best prognosis) Follicular Medullary Anaplastic (most rare and worse prognosis)
There are 4 PaRTS to Parkinson's: what are they?
Postural instability, Rigidity (cogwheeling), Tremor (pill-rolling), Slowed movements (bradykinesia)
the 5 Ps of Pheochromocytoma presentation:
Pressure (BP) Pain (headache) Perspiration Palpitations Pallor
What conditions are spherocytes seen in?
RBCs which lack aread of central pallor Seen in autoimmune haemolysis and in hereditary spherocytosis
Symptoms of a depressive episode SIG E CAPS
Sleep (hypersomnia or insomnia) Interest (anhedonia) Guilt (feelings of worthlessness or inappropriate guilt) Energy decreased Concentration decreased Appetite up or down (weight up or down) Psychomotor agitation or retardation Suicidal ideation
What is Lhermitte's sign?
Vibratory/ electrical sensations traveling up or down the neck and back with flexion, generally suggesting the presence of cervical myelitis
Classic triad in Normal Pressure Hydrocephalus?
Wet (urinary incontinence), Wobbly (gait apraxia) and Wacky (dementia)
After ABCs, what is the treatment indicated for someone in a coma? Mnemonic DONT
administer: D-dextrose, O- oxygen, N-naloxone, T-thiamine
What are the differentials for dementia? Mnemonic: DEMENTIAS
neuroDegenerative diseases Endocrine Metabolic Exogenous Neoplasm Trauma Infection Affective disorders Stoke/Structural
Damage to which area of the brain causes Broca's aphasia?
posterior inferior frontal gyrus
What are the 4 aspects of capacity for decision making?
1. Ability to understand the information given to them and the nature of the decision 2. Are able to make choices 3. Can reason through the consequences of their choices 4. Can communicate their choice.
Triad in Still's disease:
1. Arthritis 2. Daily high spiking fevers 3. maculopapular, evanescent salmon rash
What are the three skin lesions seen in Tuberous Sclerosis?
1. Ash leaf hypopigmented lesion 2. Sebaceous adenomas (small red nodules in shape of butterfly on cheeks and nose) 3. Shagreen patch (rough papule in lumbosacral region)
What is the triad suggesting multiple myeloma?
1. Bone pain 2. Anaemia 3. Renal failure
What are the features of serotonin syndrome? (4)
1. Fever 2. Myoclonus 3. Mental state changes 4. Cardiovascular collapse Can occur if SSRIs are used with MAOIs
What are the three causes of microangiopathic haemolytic anaemia?
1. Haemolytic-uremic syndrome (HUS) 2. Thrombotic Thrombocytopenic purpura (TTP) 3. DIC
What are the questions in the CAGE questionairre for alcoholism screening?
1. Have you ever felt the need to Cut down on your drinking? 2. Have you ever felt Annoyed by criticism about your drinking? 3. Have you ever felt Guilty about your drinking? 4. Have you ever had to have a morning Eye opener drink? 1 or more positive answers means that alcoholism is likely
Conn's syndrome triad (Conn's = excess aldosterone)
1. Hypertension 2. Unexplained hypokalemia 3. Metabolic alkalosis
What features are seen in haemolytic anaemia?
1. Jaundice 2. Haemoglobinuria 3. Elevated reticulocyte count
What is the triad of signs in ECG in cardiac tamponade?
1. Low voltage 2. Tachycardia 3. Electrical alternans
The 6 Ps of Acute ischemia:
1. Pain 2. Pallor 3. Paralysis 4. Pulse deficit 5. Paraesthesia 6. Poikilothermia
What is the triad in Horner's syndrome?
1. Ptosis 2. Miosis 3. Anhidrosis (dryer due to reduced sweating)
What is the triad seen in Felty's syndrome?
1. RA 2. splenomegaly 3. neutropenia
Pheochromocytoma rule of 10s (there are 5)
10% are extra-adrenal 10% bilateral 10% malignant 10% occur in children 10% familial
Under microscopy, what are Auer's rods associated with?
Acute myelogenous leukaemia (AML) especially acute promyelocytic leukaemia (APL)
What are the 4 As of Dementia (the progression of cognitive impairment follows this order)
Amnesia: partial or total memory loss Aphasia: language impairment Apraxia: inability to perform motor activities Agnosia: inability to recognize previously known objects/places/people
What result on tissue biopsy confirms diagnosis of amyloidosis?
Apple-green birefringence under polarized light on Congo red staining.
What additional symptoms occur in Korsakoff's dementia to Wernicke's encephalopathy?
As well as encephalopaty, ophthalmoplegia and ataxia, get horizontal nystagmus, confabulations, anterograde and retrograde amnesia.
What is MEN type 2B associated with? (4)
-Medullary carcinoma of the thyroid -Pheochromocytoma -Oral and Intestinal ganglioneuromatosis -Marfanoid habitus
What are the 5 As of Guillain-Barre syndrome?
Acute inflammatory demyelinating polyradiculopathy Ascending paralysis Autonomic neuropathy Arrythmias Albuminocytologic dissociation
What is the classic diagnostic criteria for multiple myeloma?
1. >10% plasma cells in bone marrow 2. M protein in plasma or urine 3. Lytic bone lesions
What are the features of Extrapyramidal Side effects? Think 4 and A (and one T)
4 hours: Acute dystonia (sustained muscle contractions frequently causing neck torticollis) 4 days: Akinesia (loss of voluntary motor control) 4 weeks: Akathisia (feeling of inner restlessness and need to be in constant motion) 4 months: Tardive dyskinesia (involuntary movements of the tongue, lips, face, trunk and extremities)
Criteria for SLE: DOPAMINE RASH
4+ make SLE likely Discoid rash Oral ulcers Photosensitivity Athritis Malar rash Immunologic criteria Neurological symptoms (lupus cerebritis and seizures) Elevated ESR Renal disease ANA + Serositis (pleural or pericardial effusion) Haematologic abnormalities
Bell's palsy can be idiopathic or a complication in which conditions? Mnemonic: ALexander Bell with STD
AIDS, Lyme, sarcoidosis, tumors,diabetes
What is the age of presentation typically for ALL, AML, CML and CLL?
ALL: <13 years but can occur in any age AML: 13-40 years but can occur at any age CML: 40-60 years CLL: >60 years
What should you consider if ALP and GGT are elevated?
A biliary disorder
Acute cardiac tamponade presents with what triad if signs?
Beck's triad 1. JVD 2. Hypotension 3. Distant heart sounds
What needs to be talked about when obtaining Informed Consent? BRAIN
Benefits Risks Alternatives Indications Nothing (what would happen if no intervention occurred)
A child 10-20 years of age with a multilayered "onion-skinning" finding on Xray in the diaphyseal regions of the femur.
Ewing's sarcoma
What are the VitK dependent coagulation factors, inhibited by Warfarin? 1972
Factors, II, VII, IX and X
What is the most common cause of mild elevation of liver transmaminases?
Fatty liver/ hepatic steatosis
What is Lennox-Gastaut syndrome
Form of childhood onset seizures, appearing between 2-6years with multiple daily seizures and nocturnal clinic seizures. Refractory to treatment.
What is West syndrome?
Form of generalized epilepsy presenting within 6 months of births. Affects males more than females and has a positive family history.
What conditions are Schistocytes associated with?
Fragmented RBCs seen in microangiopathic haemolytic anaemia and mechanical haemolysis
A femal 20-40 years with knee pain and a mass, along with "soap bubble" appearance on xray in the metaphyseal/epiphyseal region of long bones.
Giant cell tumour of bone
What condition does MALT gastric lymphoma (a NHL) have a strong association with?
H. Pylori infection.
What are the differential diagnosis of thrombocytopenia? HIT SHOC
HIT SHOC HIT or HUS ITP TTP or Treatment (meds) Splenomegaly Hereditary (Wiskott-Aldrich syndrome) Oncological e.g. malignancy Chemotherapy
What deficiency is seen in Haemophilia B and Haemophilia A? Clue: Haemophilia is not BENIGN and is not caused by what they ATE
Haemophilia B- factor IX deficiency Haemophilia A- factor VIII deficiency
What condition are hairy cells, with Tartrate-resistant acid phosphatase (TRAP) staining associated with?
Hairy cell Leukaemia
What condition are Reed-Sternberg cells associated with?
Hodgkins lymphoma
What is the most common immunologic disorder in women of childbearing age?
Idiopathic Thrombocytopenic Purpura (IgG formed against patient's own platelets)
What is the treatment of CML in the chronic phase? (has to do with BRA-ABL)
Imatinib, which is a selective inhibitor of the BCR-ABL tyrosine kinase
Major causes of delerium: I WATCH DEATH
Infection Withdrawal Acute metabolic/substance Abuse Trauma CNS pathology Hypoxia Deficiencies Endocrine Acute vascular/MI Toxins/Drugs Heavy metals
What is Sipple's syndrome?
MEN type 2A - Medullary carcinoma of the thyroid -pheochromocytoma or adrenal hyperplasia -Parathyroid gland hyperplasia
What condition are doughnut cells associated with?
Iron defiency anaemia (enlarged area of central pallor)
What should you consider in a child with Gout and unexplained injuries?
Lesh-Nyhan syndrome
What cancers typically metastasise to the brain?
Lung and Skin Go to the BRain: Lung, Skin, GI, Breast, Renal
Conditions associated with berry aneurysm which can MAKE an SAH more likely:
M- marfan's syndrome A- aortic coarctation K- kidney disease (AD, polycystic) E- ehlers-danlos syndrome S- sickle cell anaemia A- atherosclerosis H- history (family)
What is Wermer's syndrome?
MEN type 1 -Pancreatic islet cell tumours -Parathyroid hyperplasia -Pituitary adenomas
What condition is Hypersegmentation of neutrophils associated with?
Megaloblastic anaemia
What is an Austin Flint murmur?
Mid diastolic rumble heard in aortic regurgitation
Contraindications to tPA therapy in Acute stroke Mnemonic: sample stages
S- stroke or head trauma within the last 3 months A- anticoagulation with INR >1.7 or prolonged PTT M-MI recently P- prior intracranial haemorrhage L- low platelet count <100,000 S- surgery in the past 14 days T-TIA A- age <18 G- GI or urinary bleeding E- elevated or decreased blood glucose S- seizures present at onset of stroke
Mnemonic for differentials of paediatric limp: STARTSS HOTT
S: septic joint T: tumour A: AVN (perthes) R: Rheumatoid arthritis/ JIA T: Tuberculosis S: sickle cell disease S: SUFE H: Henloch-schoenlein purpura O: Osteomyelitis T: Trauma T: Transient synovitis (irritable hip)
Mnemonic for types of fracture in Salter Harris classification of paediatric fractures: SMACK!
S: slipped (type 1) M: metaphyseal (type 2) A: Articular and epiphyseal (type 3) C: Complete- epiphyseal and metaphyseal, and physeal (type 4) K: Krushed! type 5
What are the 4 S's of adrenal crisis management?
Salt (0.9% saline) Steroids: IV hydrocortisone 100mg q8h Support Search for the underlying illness
Haematuria plus eosinophila makes you consider?
Schistosomiasis -parasitic infection with trematodes aka snail fever
What condition are target cells associated with?
Sickle cell anaemia
What T score for bone mass density represents Osteoporosis?
T = <-2.5
What are the common causes of microcytic anaemia? TICS
Thalassemia Iron deficiency Chronic disease Sideroblastic anaemia
What vitamin deficiency leads to Wernicke's encephalopathy and Korsakoff's dementia?
Thiamine/B1
What are the features of substance dependance? WITHDraw IT
Three or more of 7 within a 12 month period: Withdrawal Interest or Important activities given up or reduced Tolerance Harm (physical and psycosocial) with continued use Desire to cut down/control Intended time/amount exceeded Time spent using/obtaining substance is increased.
What is Virchow's triad?
Triad of risk factors for thrombus formation: 1. Haemostasis 2. Endothelial damage 3. Hypercoagulability
What condition is an "ash leaf" hypopigmented lesion seen in?
Tuberous Sclerosis
What do infantile spasms in the setting of a hypopigmented lesion on the child's trunk make you think of?
Tuberous sclerosis
Damage to which area of the brain causes Wernicke's aphasia?
left posterior superior temporal gyrus