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60 Cards in this Set

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Retroperitoneal structures
SAD PUCKER

Suprarenal (adrenal)
Aorta and IVC
Duodenum (2nd-4th)
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus (thoracic portion)
Rectum (partially)

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

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

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

Plummer Vinson

Plumbers DIE of scc




dysphagia


iron deficiency anaemia


esophageal webs




increased risk of SCC

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

Ulcerative Colitis

ULCCCERS




Ulcers


Large intestine


Continuous


Colorectal Carcinoma


Crypt abscesses


Extends proximally


Red diarrhea


Sclerosing cholangitis

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)

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

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)


H2 blockers

-dines


= "H2 blockers before you dine. table for 2"


acid suppression therapy

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)

Basophilic cells of Anterior Pituitary

those that produce:


B-FLAT


= FSH


= LH


= ACTH


= TSH




acidophilic = GH and PRL

tissues with insulin-independent glucose transporters

BRICK-L




Brain


RBCs


Intestines


Cornea


Kidney


Liver

Thyroid hormone functions (esp T3)

4'Bs:




Bone growth


Brain maturation


B1 upregulation


Basal metabolic rate increase

Hormones signalling through cAMP

G-FLAT ChAMP




GHRH


glucagon


FSH


LH


ACTH


TSH


CRH & calcitonin


hCG


ADH (v2 receptors)


MSH


PTH

Hormones signalling through cGMP

BAD GraMPa (think vasodilators)




BNP


ANP


EDRF (ex. NO... = endothelium derived relaxing factor)



Hormones signalling through IP3


(often Gq)

GOAT HAG




GnRH


Oxytocin


ADH (v1 receptor)


TRH


Histamine (H1 receptor)


Angiotensin II


Gastrin

Intracellular receptors

PET CAT on TV


**think steroids and fat-solubles




Progesterone


Estrogen


Testosterone


Cortisol


Aldosterone


T3/T4


Vit D

Receptor tyrosine kinase

MAP kinase pathway


* think growth factors




Insulin


IGF-1


FGF


PDGF


EGF

Non-receptor tyrosine kinase

PIGGLET


JAK-STAT pathway


**think acidophils and cytokines




Prolactin


Immunomodulators (cytokines IL2, IL6, IFN)


GH


G-CSF


EPO


Thrombopoeitin



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)

Episodic adrenergic symptoms of phaechromo

5P's




Pressure (BP up)


Palpitations (tachy)


Pain (headache)


Perspiration


Pallor

Congenital Hypothyroidism


findings in the child

6P's




Pot-bellied


Pale


Puffy-faced


Protruding umbilicus


Protruberant tongue


Poor brain development



IgG4 related systemic disease

"AARR"




Aortitis (noninfectious)


Autoimmune pancreatitis


Riedel's fibrosing thyroiditis (1/3 hypothyroid)


Retroperitoneal fibrosis

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

Glucagonoma

5Ds:




Dermatitis (necrolytic migratory erythema)


Diabetes (increased blood sugar)


DVT


Declining weight


Depression

Insulinoma

Whipple's triad:




low serum glucose


symptoms of hypoglycemia


resolution of symptoms with glucose normalization




*increased C-peptide

Ascending cholangitis

Charcot triad:




fever


RUQ pain


jaundice




Raynaud pentad: +hypotension and confusion

Pancreatic adenoCa (ductal)

Courviosier's law:




painless, palpable jaundice unlikely to be cholelithiasis

MEN1 (menin, chr11)

3 P's




pituitary tumours (PRL or GH)


pancreatic tumours (Zollinger Ellison, insulinoma, VIPoma, glucagonoma (rare))


parathyroid adenomas

Carcinoid syndrome

Rule of 1/3s:




1/3 metastasize


1/3 present with 2nd malignancy


1/3 are multiple

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)

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





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**

Panic Disorder

PANICS




Palpitations, paraesthesias, dePersonalization/derealization


Abdominal pain
Nausea


Intense fear of dying/losing control/going crazy, lightheadedness,


Chest pain, chills, choking


Sweating, shaking, shortness of breath




*strong genetic component


S

Onset of EPS (most commonly high potency antipsychotics)

ADAPT




Acute dystonia (hours to days)


Akathisia


Parkinsonism (days to months)


Tardive dyskinesia (months to years)



NMS

FEVER




Fever


Encephalopathy


Vitals unstable (autonomic instability)


Enzymes elevated (myoglobinuria)


Rigidity of muscles




Tx: dantrole (ryanodine antag.) and D2 agonists

Serotonin syndrome

3 A's




neuromuscular Activity (clonus, hyperreflexia, hypertonia, tremor, seizure)


Autonomic stimulation (hyperthermia, diaphoresis, diarrhea)


Agitation




Tx: cyproheptadine

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



Causes of ARDS

SPARTAS




sepsis


pancreatitis


pneumonia


amniotic fluid embolism


uRaemia


Trauma


aspiration


shock

Side effects of Oxygen therapy in prematurity

RIB



retinopathy of prematurity


intraventricular haemorrhage


bronchopulmonary dysplasia

Factors increasing oxygen dissociation (shift right)

ACE BAT




acid (H+)


CO2


Exercise


Bpg (2,3)


Altitude


Temperature

Types of emboli

FAT BAT




Fat


Amniotic fluid


Thrombus


Bacteria (septic)


Air


Tumour

Calculation of physiological dead space

= Taco Paco PEco Paco

HIKIN

Hi K+ Intracellularly

Patient with hyperkalemia? (Extracellular shift)

DO LABS




Digoxin


hyperOsmolarity


Lysis of cells


Acidosis


B-blockers (decreased Na/K ATPasE)


Sugar increase (decreased insulin)



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)

normal anion gap acidosis

HARDASS




hyperalimentation (IV nutrition)


Addison's (aldosterone deficiency)


Renal tubular acidosis


Diarrhea


Acetazolamide


Spirinolactone


Saline infusion

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)

Renal papillary necrosis causes

SAAD Papa

Sickle cell disease or trait
Acute pyelonephritis
Analgesics (NSAIDs)
Diabetes mellitus

Side effects Loop diuretics

OH DANG


ototoxicity


hypokalemia


dehydration


alkalosis


nephritis (interstitial)


gout (hyperuricaemia)


+


sulfa allergy

Side effects Thiazides

hyperGLUC




hyperglycaemia


hyperlipidaemia


hyperuricaemia


hypercalcaemia


+


sulfa allergy

ACEi Side effects

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

bones of hand

So long to pinky here comes the thumb




Scaphoid


lunate


Triquetrium


Pisiform


Hamate


Capitate


Trapezoid


Trapezium

Interossei

DAB PAD


Dorsals abduct


Palmars adduct




all supplied by ulnar

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

Causes of interstitial nephritis

P's




Pain free (NSAIDs)


Penicillins and cephalosporins and sulfonamides


rifamPin


Pee (Diuretics)


PPIs




**characteristic eosinophilic infiltrate

Seronegative arthritis

PAIR




psoriatic


ankylosing spondyloarthropaty


IBD associated


Reactive (Can't see cant pee cant bend a knee - conjunctivits, urethritis, arthritis)

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)