First Aid Mneumonics Behavioral Science Mneumonic 1 Mr.

T is Mean 2 3 ANalysis Of VAriance PDR Association/Meaning and extra notes t-test checks for diff. between means of 2 groups ANOVA checks diff. between means of 3 or more groups To Prevent a Disease: 1-Prevent (vaccine) 2-Early Detection (Pap smear) 3-Reduce disability from disease (chemotherapy) Reportable Diseases: Hep A, B, C, HIV, Salmonella, Shigella, Syphilis, Measles, Mumps, AIDS, Rubella, TB, Chicken pox, Gonorrhea MedicarE A: Hospital bills for Elderly MedicarE B: Doctor bills for Elderly MedicAID: Aid for poor people (Destitute) 4 Ds for malpractice: 1-Duty to patient 2Breach of Duty 3-Damage to patient 4Damage to patient caused by Breach of Duty Appearance, Pulse, Grimace, Activity, Respiration 10 point scale measured at 1 and 5 mins after birth Stages of Grief: Denial, Anger, Bargaining, Grief (depression), Acceptance Doesnt have to be this particular order Effects of stress: increase FFA production, increase cholesterol, increase corticosteroids (immunosuppression) Ecg sleep waves B = Beta wave (inc. freq, low Amp). AWAKE A = Alpha wave. AWAKE with eyes closed T = Theta wave. Light sleep S = Sleep Spindles and K complexes. Deeper sleep, Bruxism D = Delta wave (low freq, high Amp slow wave). Deepest sleep. NON-REM sleep with sleep walking, night terrors, bed wetting. Delta sleep is decreased by benzos and Imipramine (used to Rx Enuresis) B = Beta wave. REM sleep. Dreaming, loss of motor tone, memory processing, erection, increased O2 use by brain. REM sleep decreased by NE and mediated by Ach.

5 6 7

Hep, Hep, Hep, Hooray, the SSSMMART Chick is Gone! MedicarE MedicAID Duty, Dereliction, Damage, Direct APGAR score

8 9 10

Death Arrives Bargaining Grave Adjustments STRESS makes you fat and sick @ night, BATS Drink Blood

Psychiatry

Mneumonic Standard Binet IQ test

2 3 4

Kids WISC cookie crumbs off the table Mature women wear a SASH Deprived babies say Wah, Wah, Wah, Wah

DeliRIUM

6 7 8 9

DeMEMentia Formication HypnaGOgic Hallucination HypnoPOMPic hallucination Maniacs DIG FAST

10

SIG E CAPS

11

SAD PERSONS

12

PANICS more like PPANIICCCCSSS

Association/Meaning and extra notes IQ = (mental age/Chronological age) X 100 Mean =100. STD =15. MR= IQ<70. Severe MR= IQ<40. Profound MR=IQ<20 Wechsler Intelligence Scale for Children (WISC) between age 6-16 Mature Ego defenses: Sublimation, Altruism, Suppression, Humor 4 Ws: Weak, Wordless, Wanting (socially), Wary. These are longterm Deprivation effects on infants. Deprivation over 6 months can lead to irreversible changes Changes in sensoRIUM. Waxing and waning consciousness, acute onset, reversible. Visual hallucinations. Check for drugs with anticholinergic effects MEMory loss, irreversible, no change in consciousness, gradual onset Sensation of ants crawling on ones skin. Seen in Alcohol withdrawal and Cocaine users Occurs while Going to sleep POMPous upon waking Can occur in narcolepsy Distractibility, Irresponsibility (no regard to consequence), Grandiosity, Flight of ideas, Activity (goal directed) increases/Agitation, Sleep decreases, Talkativeness Major Depressive episode (5 of 9 symptoms for 2 weeks) Sleep disturbance, Interest loss, Guilt/worthlessness feelings, Energy loss, Concentration loss, appetite/weight changes, Psychomotor retardation, Suicide ideations and Depressed mood Risk factors for Suicide completion: Sex (male), Age (teen, elderly), Depression, Previous attempt, Ethanol or drug use, loss of Rational thought, Sickness, Organized plan, No spouse, Social support lack. Women try more, Men succeed more Panic disorder symps: Palpitations, Parethesias, Abdominal distress, Nausea, Intense fear of dying, lIght

13

Cluster A personality disorders Weird (Accusatory, Aloof, Awkward) Genetic Association with Schizophrenia PSS Cluster B personality disorders Wild (Bad to the Bone) genetic association with mood disorders and substance abuse ABHN

14

15

Cluster C personality disorders Worried (Cowardly, Compulsive, Clingy) genetic association with anxiety disorder AOD CNS depressants CNS stimulants Hallucinogens Wernickes encephalopathy Korsakoffs psychosis Corneal deposits ReTinal deposits FEVER Its atypical for old closets to quietly risper from A to Z

16 17 18 19 20 21 22 23

Headedness, Chest pain, Chills, Choking, disConnectedness, Sweating, Shaking, Shortness of Breath 1. Paranoid: distrust, suspiciousness, Accusatory(Projection is major defense) 2. Schizoid: voluntary social withdrawal, social isolation, Aloof (SchizoiD=Distrust) 3. Schizotypal: odd beliefs, magical thinking, interpersonal Awkwardness (SchizoTypal = magical Thinking) 1. Antisocial: no regard for rights, criminality 2. Borderline: sense of emptiness, self mutilation, impulsiveness, unstable mood (splitting major defense mechanism) 3. Histrionic: excessive emotionality, excitability, attention seeking, sexually provocative. Overly Concerned with appearance. 4. Narcissistic: Grandiosity, lack of empathy, reacts to criticism with rage 1. Avoidant: hypersensitive to rejection. Feelings of inadequacy, desires relations with others. 2. Obsessive Compulsive: preoccupation with order, perfection. 3. Dependent: submissive and clinging. Excessive need to be taken care of, low self confidence Alcohol, Opioids(morphine, heroin, methadone), Barbituates, Benzos Amphetamines, Cocaine, Caffeine, Nicotine PCP Triad of: confusion, ophthalmoplegia, ataxia Memory loss, confabulation, personality change Chlorpromazine (low potency neuroleptic) Thioridazine (low potency neuroleptic) Neuroleptic Malignant syndrome Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigidity of muscles Atypical Antipsychotics: Olanzapine (SE: weight gain), clozapine (SE:agranulocytosis, seizures), quetiapine, risperidone, aripiprazole,

24

LMNOP

25 26

Tri-Cs: Convulsions, Coma, Cardiotoxicity (arrythmia) TrazoBONE (trazodone)

ziprasidone (SE: prolonged QT) Lithium side effects: Movement tremor, Nephrogenic Diabetes Insipidus, HypOthyroidism, Pregnancy problems (ebsteins anomaly: atrialized R. ventricle, downward displacement of tricuspid valve TCA toxicity Causes priapism

Neurology 1 2 Mesoderm GFAP Microglia (type of macrophage) Glial Fibrillary Acid marker = astrocyte marker. Function of astrocytes: K+ metabolism, maintain BBB, reactive gliosis in response to injury, removal of excess NT Changes in Disease Inc. in anxiety, dec. in depression Inc. in schizophrenia, dec. in parkinsons and depression Dec. in anxiety and depression Dec. in Alzheimers and Huntingtons. REM sleep Dec. in Anxiety, Huntingtons Hypothalums functions: Thirst and water balance, Adenohypophysis control, Neurohypophysis release of hormones from hypothalamus, Hunger, Autonomic regulation, Temperature regulation, Sexual urges. Feeding, Fleeing, Fighting, Feeling, and Fucking (LM) Dentate, Emboliform, Globose, Fastigal output to contralateral cortex via sup. peduncle Parkinsons Disease: Tremor, Rigidity, Akinesia, Postural instability Acute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness. Caused by very rapid correction of hyponatremia Normal pressure hydrocephalus-no incr. in subarachnoid space. Clinical triad of dementia (wacky), urinary incontinence(wet), ataxia (wobbly)

Neurotransmitter synthesis NE: Locus Ceruleus Dopamine: ventral tegmentum, SNc 5-HT: Raphe nucleus Ach: Basal nucleus of Meynert GABA: Nucleus Accumbens TAN HATS

5 6

Famous 5 Fs for the limbic system (cingulate, hippo, hypo, thalamus) Dont Eat Greasy Foods Deep nuclei of the cerebellum You are TRAPed in your body Central Pontine Myelinolysis Wet, wobbly, and wacky

7 8 9

10 11

Both UMN and LMN signs Floppy baby

12

FRAT boy is always Stumbling, staggering, falling

13 14

Standing Room Only Lick your wounds

15 16 17 18

Brushing teeth, shaving, eating, hot/cold temps stimulate what nerve? AL Has Bells STD Kuh, La, Mi Ms Munch Lateral Lowers All inervated by V3 Perilymph vs Endolymph

ALS- also known as Lou Gehrigs disease. Can be caused by defect in superoxide dismutase 1 or betel nut ingestion Werdnig-Hoffman disease AR, infantile spinal muscular atrophy, tongue fasiculations. Death at 7 months. Degeneration of anterior horns. Friedreichs ataxia: trinucleotide repeat (GAA, frataxin gene). Impairment in mitochondrial functioning. Staggering gate, frequent falling, dysarthria, pes cavus, hammer toes, hypertrophic cardiomyopathy. Kyphoscoliosis in childhood Exits of Trigeminal branches: V1=Superior Orbital fissure, V2= Rotundum foramen, V3=Ovale Foramen CN XII lesion- tongue deviates toward side of lesion, innervates contralateral hypoglossal muscle CN V-jaw deviates toward side of lesion, innervate lateral pterygoid muscle CN X lesion- uvula deviate AWAY from lesion CN V- trigeminal neuralgia, episodic shock or electrical like pain in the distribution of the trigeminal nerve Bells Palsy is a complication in AIDS, Lyme disease, Herpes zoster, Sarcoidosis, Tumors, Diabetes Kuh=CN X, palate deviation La=CN XII, tongue Mi=CN VII, lips Masseter, teMporalis, Medial pterygoid=close jaw Lateral Pterygoid opens Peri = outside cell, rich in Na+, similar to ECF Endo= inside cell, rich in K+, made by stria vascularis, similar to ICF Cold water: quick phase to Oppossite side, nystagmus same side. Warm water: quick phase to Same side, nystagmus to opposite side for multiple sclerosis Scanning speech, Intention tremor, Icontinence, Internuclear ophthalmoplegia (MLF syndrome), Nystagmus Treat: Interferon B or immunosuppression Fatigue after heat exposure b/c heat inc.

19

20

COWS Water irrigation and quick phase Charcots classic triad of MS SIN

21

neuronal fire (hot shower, exercise), Macrophages activated by Y-Interferron Biochemistry Mneumonic 1 HeteroChromatin 2 3 GAG Purine/pyrimidine synthesis Hes Got Purine Recovery Trouble X-linked DNA polymerases III DNA polymerase I 5 EURAKYOTES RNA polymerase I RNA polymerase II RNA polymerase III 6 7 8 9 10 Lupus SNoW DRoP Blotting procedures Hypophosphatemic Rickets Fragile X Trinucleotide repeat (CGG) Try hunting for my fried eggs (X) Trinucleotide repeat diseases Down syndrome Trisomy 21

Association/meaning and extra notes Highly Condensed = transcriptionally inactive Glycine, Aspartate, Glutamate needed for purine synthesis. Aspartate and Carbamoyl phosphate needed for Pyrimidine synthesis HGPRT deficiency in Lesch-Nyhan Syndrome Retardation, self mutilation, aggression, hyperuricemia, gout, choreoathetosis Prokaryote only. 53 synthesis, 35 proofread exonuclease Prokaryote only, Degrades RNA primer and fills gap with DNA 53 exonuclease Makes rRNA Makes mRNA, opens DNA at promoter site Inhibited by alpha-amanitin(cap mushrooms) Makes tRNA Patient with Lupus makes antibodies to spliceosomal snRNPs therefore cannot splice out introns Southern = DNA Northern = RNA Western = Protein Formerly known as vitamin D resistant rickets. Inherited (X-linked Dominant). Phosphate wasting at proximal tubule. Xtra large testes, jaw, and ears, FMR1 gene Mitral valve prolapse, mental retardation Huntingtons = CAG MyoTonic dystrophy = CTG FraGile X syndrome = CGG Friedreichs ataxia = GAA Associated with septum primum ASD, inc risk of ALL and Alzheimers. Due to meiotic nondisjunction, robertsonian translocation, or mosaicism. Dec. Alpha fetoprotein, dec estriol Inc. Beta hCG, inc. inhibin A. Nuchal translucency on ultrasound Nonreciprical chromosomal translocation

11

12

Robertsonian translocation

13

Williams syndrome William is 7 letters long

14

CATCH 22

15

TRN PPB

16

ADEK

17 18

Riboflavin Deficiency FAD, FMN Pellagra

19

B12 def

20 21

Folate def Avidin

usually involves 13, 14, 15, 21, 22 Microdeletion of long arm chrom. 7. Deleted region includes elastin gene. elfin facies, mental retardation, hypercalcemia (inc. sensitivity to vit D), well developed verbal skills, extreme friendliness with strangers, cardiovascular problems 22q11 deletion syndromes Cleft Palate, Abnormal facies, Thymic aplasia (t cell def), Cardiac defects, Hypocalcemia. DiGeorge=thymic, parathyroid, and cardiac defects (brachial pouch 3 and 4 defect) Velocardiofacial syndrome = palate, facial and cardiac defects Water soluble vitamins Thiamine (B1), Riboflavin (B2), Niacin (B3, derived from tryptophan, requires B6 for synthesis),Panthothenic acid (B5), Pyridoxine (B6), Biotin (B7), cobalamin(B12), C (ascorbic acid), Folate B12 and Folate stored in liver Fat soluble vitamins Vit A = vision, differentiation of epithelial cells into specialized tissue. Def-night blindness and dry skin. Tox-alopecia, teratogenic B2 deficiency: Cheilosis (inflammation of lips, scaling and fissures at corners of the mouth), Corneal vascularization 3 Ds. caused by vit B3 def or in Hartnup disease due to dec in Tryptophan absorption, malignant carcinoid syndrome b/c of inc tryptophan metabolism, and B6 def (INH, oral contraceptives) Macrocytic, megaloblastic anemia, hypersegmented PMNs, neurologic symptoms (posterior and lateral spinal column degeneration), axonal degeneration of peripheral nerves. Def caused by malabsorption, diphyllobothrium latum, lack of intrinsic factor (pernicious anemia, gastric bypass surgery) or absence of terminal ileum (chrons) Caused by drugs (phenytoin, sulfonamides, methotrexate) Found in egg whites (raw). Causes def of biotin (dermatitis, alopecia, enteritis). Def of biotin also caused by antibiotic use)

22

Vit C function

23

vit D def

24 25

Kwashorker results from protein deficient MEAL Mitochondria -----------------> Cytoplasm --------------------> Both -----------------------------> Arsenic

Antioxidant, keeps Fe in 2+ form for better absorption, hydroxylation reactions in collagen synthesis, dopamine hydroxylase (dopamineNE) (NEEpi need SAM) Excessive vit Coxalate crystals Rickets (kids), osteomalacia (adults), hypocalcemic tetany. Excess vit D: seen in sarcoidosis b/c of inc. activation of vit D by epithelioid macrophages Malnutrition, Edema, Anemia, Liver (fatty) B-oxidation, acetyl-CoA production, TCA cycle, oxidative phosphorylation Glycolysis, FA synthesis, HMP shunt, protein synthesis (RER), steroid synthesis (SER) Heme synthesis, Urea cycle, Gluconeogeneis HUGs take both Inhibits lipoic acid (therefore inhibits pyruvate dehydrogenase complex and alpha-ketoglutarate dehydrogenase). Vomiting, rice water stools, garlic breath Lactate producing in RBCs, leukocytes, kidney medulla, lens, testes, cornea Cori cycle-carries lactate to liver to convert to glucosenet loss of 4 ATP Uncouplers, dec. proton gradient, inc O2 consumption, no ATP production, ETC continues, HEAT produced These are oxidizing agents that can cause hemolytic anemia in patients deficient in G6PD: fava beans, sulfonamides, primaquine, anti-TB drugs. Patients with G6PD def have increased malarial resistance Galactokinase def. blood/urine with galactose, infantile cataracts. NO jaundice as opposed to classic galactosemia Lack sorbitol dehydrogenase (sorbitolfructose), are at inc. risk of sorbitol accumulation. Prolonged hyperglycemic states (diabetes) can lead to sorbitol accum.-->cataracts, retinopathy, peripheral neuropathy DopamineHVA NEVMA Epimetanephrine Due to def in Phenylalanine hydroxylase or def in THB (def in dihydropterin reductase).

26

27

Anaerobic glycolysis

28 29

2,4 Dinitrophenol, aspirin Drugs that can cause hemolytic anemia

30 31

Failure to track objects or develop a social smile in infants Schwann cells, lens, retina, and kidneys

32

Breakdown products of Catecholamines via MAO and COMT PKU

33

34 35

Ca2+/calmodulin in muscle Very Poor Carbohydrate Metabolism Glycogen storage diseases

36

1) angiokeratomas, peripheral neuropathy 2) macrophages that look like crumpled tissue paper 3) cherry red macula, foam cell 4) cherry red macula with lyosome with onion skin 5)peripheral neuropathy, optic atrophy, globoid cells 6)central/peripheral demyelination, ataxia, dementia 7)gargoylism, develp. Delay, corneal clouding 8)mild hurlers, aggressive behavior, no corneal clouding (see clearly)

Tyrosine essential. Mental and growth retardation, seizures, fair skin, eczema, musty body odor, pallor of basal ganglia Activates phosphorylase kinaseglycogenolysis is stimulated in coordination with muscle activity Von Gierkes (1): G6 phosphatase def Pompes (2): lysosomal alpha 1,4 glucosidase def (acid maltase), cardiomegaly Coris (3): debranching enzyme (alpha 1,6 glucosidase) def. McArdles (5): muscle glycogen phosphorylase def, myoglobinuria 1)Fabrys: XR, def. of -galactosidase A, ceramide accum. 2)Gauchers: AR, def. of glucocerebrosidase, glucocerebroside accum. Hep/spln megaly, necrosis of femur. 3)Niemann-pick: AR, def of sphingomyelinase, sphingomyelin accum. Neurodegen., hep/spln megaly. Inc incidence in Ashkenazi Jews 4)tay-sachs: AR, def. of hexoaminidase A, GM2 ganglioside accum, neurodegen, develop. Delay. Inc incidence in Ashkenazi Jews 5)Krabbes: AR, def of galactocerebrosidase, galactocerebroside accum. 6)Metachromatic leukodystrophy: AR def of Arylsulfatase A, cerebroside sulfate accum. 7)Hurlers: AR, def of -L-iduronidase, Heparan sulfate, dermatan sulfate accum. 8)Hunters: XR, def of Iduronate sulfatase, Heparan sulfate, dermatan sulfate accum. hunters see clearly no clouding Citrate shuttle used in synthesis (transports Acetyl-CaA) Carnitine shuttle is used in degradation (transports Acyl-CoA, by malonyl CoA) Carnitene def, dec ATP production b/c dec in oxidation of FFA, not enough ATP for glycogen breakdown

37

38

Shuttles in Fatty acid metabolism SYtrate=Synthesis=SYtop lasm CARnitine=CARnage of FAs Myoglobinemia, weakness after exercise, elevated muscle TAG, hypoketonemia

39 40

Phytanic acid accumulation Zellwegers

Refsums disease- def in -oxidation in peroxisome Impaired peroxisome function, accumulate very long chain fatty acid and branched fatty acids. Avoid foods with chlorophyl

Embryology (plz review page 120) Mneumonic/concept Association/Meaning and extra notes 1 Sonic Hedgehog gene Made at base of limbs-patterning along ----> ant/post axis Made at apical ectodermal ridge (distal part Wnt-7 gene of developing limb)-for proper organization -----------------> along dorsal-ventral axis Made at apical ectodermal ridge-mitosis of underlying mesoderm for lengthening of FGF gene limbs --------------------> Involved in segmental organization Homeobox gene -----------> VACTERL

Recurrent laryngeal nerve 6th arch derivatives speaking muscles of larynx Several Parts Builds Diaphragm CAP covers outside from insided Arch derivatives and nerve supply

Mesodermal defects= Vertebral defects, Anal atresia, Cardiac defects, TracheoEsophageal fistula, Renal defects, Limb defects (bone and muscle) Branch of vegas nerve, supplies all of intrinsic muscles of larynx EXCEPT cricothyroid (supplied by superior laryngeal branch of vegas, part of 4th arch) Septum transersumcentral tendon Pleuroperitoneal folds, Body wall, Dorsal mesentery of esophaguscrura Branchial apparatus C=clefts = ectoderm A=Arches =mesoderm P=Pouches =endoderm Arch1: mastication muscles, ant. Belly of digastric, ant. 2/3 of tongue N:V2, V3 Arch2: facial expression muscles, post. Belly of digastric, stapedius N: CN VII Arch3: stylopharyngeus N: CN IX (Congenital Pharyngo-cutaneous fistulapersistence of cleft and pouch, fistula between tonsillar area, cleft in lateral neck) Arch4: pharyngeal constrictors, cricothyroid N: CN X, sup. Laryngeal branch-swallowing Arch6: all intrinsic muscles of larynx except

10

cricothyroid N: CN X, recurrent laryngeal branch-speaking 7 Aortic arch derivatives 1st: Maxillary artery (from external carotid) 2nd: Stapedial artery and hyoid artery 3rd: common Carotid and prox. Internal carotid 4th: L. sideAortic arch. R. sideprox. Part of right subclavian artery 6th: prox. Part of pul arteries and ductus arteriosus (L. side only) Genital tubercleM: glans penis, corpus cavernosum and spontiosum F: Glans clitoris, vestibular bulbs Urogenital sinusM: Bulbourethral glands of cowper, prostate gland F: Greater vestibular glands of Bartholin, Urethral and paraurethral glands of skene Urogenital foldsM:ventral shaft of penis (penile urethra) F: Labia Minora Labioscrotal swellingM:Scrotum F: Labia Majora

Male/Female genital homologies Male organs due to DHT Femal organs due to estrogen

9 10 11 12 13 14 Renal 1 2 Mneumonic/concept Water under the bridge 60-40-20 rule (% of Body weight) 290 mOSM 3 Prostaglandins ( by NSAID) Angiotensin II ( by ACEi) Proximal tubule Association/meaning and extra notes Urters pass under ductus deferens (retroperitoneal) and under uterine artery 60% total body water (kg) 40% ICF 20% ECF plasma vol, interstitial vol plasma vol measured by radiolabeled albumin ECF measured by inulin Dilate afferent arteriole inc. GFR, inc RPF, FF same Constricts efferent dec. RPF, inc GFR, FF inc. Brush border. Reabsorbs all glucose &Amino acids. Most HCO3- reabsorbed, sodium, chloride and water. Isotonic reabsorption. Secretes ammonia to buffer H+ PTHNa/phosphate cotransportphosph. Excrete ATII Na/H exchangerinc Na and H2O

11

Thin descending loop ----- Thick ascending loop ------ Early distal convulated --- Collecting tubules ---------

Anion gap anion gap: MUDPILES N: 8-12 mEq/L

7 8

Metabolic alkalosis with compensation (hypoventilation) Renal Tubular Acidosis (RTA)

reabsorp-tion which permits contraction alkalosis Makes urine hypertonic, reabsorbs water, not Na Reabsorbs Na, K, Cl, actively, paracellular Mg, Ca reabsorption. Impermeable to H2O, makes urine less concentrated Actively reabsorbs Na, Cl. Diluting seg. Makes urine hypotonic. PTHinc. Ca/Na exchangeCa reabsorp. Reabsorbs Na in exchange for secreting K and H Aldosteroneinsertion of Na channel on luminal side ADHacts at V2 receptorsinsert aquaporin H2O channels on luminal side Na-(Cl+HCO3) increases in metabolic acidosis with compensation Methanol (formic acid), Uremia, Diabetic ketoacidosis, Paraldehyde or Phenformin, Iron tablets or INH, Lactic acidosis, Ethylene glycol (oxalic acid), Salicylates Diuretic use, vomiting, antacid use, hyperaldosteronism Type 1 (distal): CT cant excrete H+. Hypokalemia and risk of calcium containing kidney stones Type 2 (proximal): Prox tubule cant reabsorb HCO3. Hypokalemia and hypophasphatemic rickets Type 4 (hyperkalemic): hypoaldosteronism or lack of CT response to aldosteronehyperkalemiaof ammonia excretion in prox tubuledec urine PH Acute tubular necrosis Advanced renal disease/CRF Bladder cancer/kidney stonesRBCs, no casts Acute cystitisWBCs, no casts Minimal change, membranous glomerulonephritis, focal segmental glomerulosclerosis, Diabetic nephropathy, amyloidosis IgA nephropathy (Bergers), Poststreptococcal, TTP-HUS, Alports, Henoch-Schonlein purpora (also is immune complex RPGN) 1)Membranoproliferative glomerulonephritis: Type 1GBM splitting, tram track, HBV association Type 2dense deposits, C3 nephritic factoractivation of Alternate compliment

Granular (muddy brown) casts Waxy casts Presence of casts indicates renal origin Nephrotic Nephritic Both Nephrotic and Nephritic

10 11 12

12

13

Cryglobulinemia

14 15 16 17

Pauci immune Membranous glomerulonephritis Amyloidosis Diabetic glomerulonephropathy HIV patients Ammonium, magnesium, phosphate (struvite) stones Cystine stones WAGR complex

pathway, C3, C1 and C4 normal (also seen in poststreptococcal glomerulonephritis) 2)SLE (also is immune complex RPGN) Immune complex RPGN. Blood contains large amts of cryoglobulins (protein that becomes insoluable @reduced temperatures). Associated w/Multiple Myeloma and Hep C infection Wegeners, churg strauss, microscopic polyarteritis, PAN Caused by drugs, infections, SLE, solid tumors Associated with Multiple myeloma, chronic conditions, TB, rheumatoid arthritis Nonenzymatic glycosylation of GBM and efferent arteriolesinc permeability and GFR respectively. GBM thickening, mesangial expansion, nodular glomerulosclerosis (KM nodules) Focal segmental glomerulosclerosis is most common. Segmental sclerosis and hyalinosis Caused by infection of urease positive bugs. Staghorn calculi. Worsened by alkaluria Secondary to cystinuria. Hexagonal shape. Rx with alkalinization of urine Wilms tumor, Aniridia (no iris), Genitourinary malformation, Retardation (mental-motor) Wilms tumor associated with hemihypertrophy syndromes and has embryonic glomerular structures Transitional cell carcinoma painless hematuria=bladder Phenacetin, Smoking, Aniline dyes, Cyclophosphamide Cortex affected, WBC casts, CVA tenderness. Tubules can have eosinophilic casts (thyroidization of kidney) Rennin secreting, small, solitary, benign, hypertension Sloughing of renal papillaeproteinuria, hematuria Associated w/ DM, Acute peylonephritis, chronic phenacetin use, sickle cell anemia Pre-renal azotemia (acute renal failure) due to RBF Intrinsic renal failure due to tubular necrosis or ischemia proxima tubule transport of AA, glucose, phosphate, uric acid, protein, and electrolytes. Causes: 13ilsons, glycogen storage disease, drugs

18 19 20 21

22

Pee SAC

23 24 25

Pyelonephritis Juxtaglomerular cell tumor Renal Papillary necrosis

26 27 28

BUN/creatinine ratio >20 BUN/creatinine ration <15 Fanconis syndrome

13

29

Medullary cystic disease

30

K+ low K+ high Mg2+ high Renal dysplasia OH DANG

31 32

33

CAPTOPRIL

(cisplastin, expired tetracycline) HCO3 reabsorptionmet. Acidosis type 2 RTA phosphate reabsorptionrickets early Na reabsorption distal Na reabsorption hypokalemia Medullary sponge kidneymedullary cysts leads to fibrosis and renal failure w/ insufficient urinary concentration. Cysts of collecting ducts. Small kidney. Swiss cheese appearance. Risk of developing kidney stones U waves on ECG, flattened T waves, arrhythmias, paralysis Peaked T waves, wide QRS DTR (deep tendon reflexes) Most common renal cystic disease in kids. Cysts+cartilage SE of Furosemide (loop diuretics): Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis, Gout Bumetanide also loop diuretic used to Rx pul edema Ethacrynic acid: same action as furosemide, for people with sulfa allergy SE of ACE s: Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problem (fetal renal damage), Rash, Increased renin, Lower ATII. And Hyperkalemia. Significantly dec. GFR

Equations: Clearance of X = Cx=(Ux V)/Px (Ux=urine [X], Px= plasma [X], V=urine flow rate) mL/min GFR=Uinulin V/Pinulin = Cinulin =100 mL/min Creatinine clearance is also approximate measure of GFR, but creatinine is moderately secreted ERPF= UPAH V/PPAH = CPAH RBF=RPF/(1-Hct) FF=GFR/RPF = normal around 20% Filtered load = GFR x Px Excretion rate= V x Ux Reabsorption =filtered-excreted (GFRxP VxU) Secretion = excreted-filtered (VxU GFRxP) Metabolic Acidosis, Respiratory compensation in response measured by Winters formula: PCO2=1.5 (HCO3-) + 8 +/- 2

14

Reproductive Mneumonic/concept 1 Lymphatic drainage

Vessels in ligaments (female)

Point and Shoot

Sperm development 2N4N2NNN same for oogenesis with ovum as final product (haploid N) Testosterone DHT Estrogen Progesterone

6 7

Mittelschmerz Pregnancy

Klinefelters -----------------> Turners ------------------------>

Meaning/association and extra notes Ovary/testespara-aortic lymph nodes (retroperitoneal) Distal 1/3 of vaginal/vulva/scrotumsuperficial inguinal Prox 2/3 of vagina/uterusobturator, external iliac, and hypogastric Suspensory lig of ovaries (to lateral pelvic wall)ovarian vessels Cardinal lig (cervix to side wall of pelvis)uterine vessels Round lig of uterus (uterine fundus to labia majora)no vessels, travels through inguinal canal Broad lig (uterus, fallopian tubes, ovaries to pelvic side wall) no vessels, ovaries, fallopian tubes, and round lig ErectionParasympatheticPelvic nerve EmissionSympathetichypogastric nerve Ejaculationsomatic nervesPudendal nerve Spermatogonium: Diploid 2N Primary spermatocyte: Diploid 4N Secondary spermatocyte: Haploid 2N Spermatid: Haploid N Spermatozoan: Haploid N LDL, HDL, closing of epiphyseal plates, internal male organs external male genetalia, balding HDL, LDL, myocardial excitability myocardial excitability, maintain pregnancy, body temp Blood from ruptured follicle during ovulation causes peritoneal irritation that can mimic appendicitis (ectopic pregnancy can also mimic appendicitis) hCG in blood1 wk after conception (after implantation) hCG in urine2 wk after conception lactation after labor due to in maternal steroids HPL (human placental lactogen) increases throughout pregnancy fetal mass proportionate Dec. inhibin from sertoli cellsinc FSH, dec testosteroneinc LH, inc estrogen. Destruction and hyalinization of seminiferous tubules, barr body Dec estrogen leads to inc LH and FSH, streak ovary, bicuspid aortic valve, web neck, cystic

15

10

Inc. test, inc LH Inc test, dec LH Dec Test, inc LH Dec test, dec LH Cyclic bleeding, severe menstrual pain, chocolate cysts (blood filled) hCG, LDH Inc hCG, theca luten cysts, moles, large hyperchromatic syncytiotrophoblastic cells Inc AFP, sacrococcygeal area in young children, ovaries, testes, yellow mass, schiller duval bodies (resemble glomeruli) Teratoma (2-3 germ layers)

hygroma, coarctation of aorta, lymphedema Defective androgen receptor Testosterone secreting tumor, exogenous steroids Primary hypogonadism Hypogonadotropic hypogonadism Endometriosis, in ovary or peritoneum can be due to retrograde menstrual flow of ascending infection. Adenomyosis: endometrium within myometrium Dysgerminoma (F), equivalent to male seminoma. Sheets of uniform cells Choriocarcinoma (F)

11 12

13

Yolk sac tumor (endodermal sinus)

14

15 16

17 18

Ovarian fibroma, ascites, hydrothorax, pulling sensation in groin Inc. estrogen, endometrial hyperplasia, call-exner bodies (small follicles filled with eosinophilic secretions) Desmin positive, girls<4 yrs of age, spindle shaped tumor cells DES

Mature is benign in females, malignant in males Mature-dermoid cyst in ovary Immature-Malignant in femal, benign in male Struma ovarii-has functional thyroid tissuehyperthyroidism Meigs syndrome Granulosa cell tumor with abnormal uterine bleeding

Sarcoma botryoides (rhabdomyosarcoma variant) Increases risk of breask cancer and mortality due to breast cancer, if exposure is in utero2nd generation daughters can develop vaginal clear cell adenocarcinoma due to exposure Fibroadenoma, inc size and tenderness with inc estrogen (pregnancy, menstruation) age<25 Intraductal papilloma

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Small, mobile breast mass, estrogen sensitive Small tumor that grows in lactiferous ducts, beneath areola, serous or bloody nipple discharge Large bulky mass of CT and cysts, leaf like

Phyllodes tumor age in 6th decade

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projections Firm fibrous rock hard breast mass, small, glandular duct like cells Dermal lymphatic invasion, breast skin resembles orange peel Eczematous patches on nipple Large cells in epidermis with clear halo Fibrocystic disease-cystic form Sclerosing adenosis (fibrocystic disease) Some Drugs Create Awesome Knockers Inc free PSA Dec free PSA, inc total PSA, prostatic acid phosphatase Male testicular cancer with fried egg appearance Reinke crystals, androgen producing tumor Gray solitary, crusty plaque on shaft of penis or scrotum Red velvety plaques on glans penis Reddish brown papular lesions HPV associated cancer in men Abnormally bent penis Promote anabolism after burn injury

Invasive ductal carcinoma. Worst and most common Inflammatory breast cancer Pagets disease, suggest underlying carcinoma, also seen on vulva Fluid filled blue dome, ductal dilation Inc. acini, intralobular fibrosis, with calcifications Spironolactone, digitalis, cimetidine, alcohol, ketoconazole BPH..treat with 1-antagonists and finasteride Prostatic adenocarcinomahas osteoblastic metastasis to bone, inc in serum alkaline phosphatase Seminoma: inc LDH, inc hCG, large cells in lobules with watery cytoplasm. Leydig cell tumor- gynecomastia in men, precocious puberty, golden brown color Bowens disease-can progress to invasive SCC, 5th decade of life Erythroplasia of queyrat Bowenoid papulosis-younger age group, no invasiveness SCC of penis. Can also be due to lack of circumcision Peyronies diseasefibrous tissue formation Testosterone (methyltestosterone): also used for hypogonadism, and ER-positive Breast cancer

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