#mikmonics

[usmle1mikmonics]

Dose Dependent effects of Dopamine mnemonic

Simplified version of Dopamine's dose-dependent MAJOR effects:

low doses - activates D1 receptors (Gs) - vasodilates renal blood vessels*

med.doses - activates B1 receptors (Gs) - increases heart rate/contractility etc..

high doses - activates A1 (Gq) - vasoconstricts,

*increased renal perfusion, GFR, also vasodilates mesenteric and coronary vessels 

source: http://reference.medscape.com/drug/intropin-dopamine-342435

[usmle1mikmonics]

Neuromuscular Blocking Drugs

Lots of great stuff at sketchymedicine.com including this breakdown of the train-of-four responses and what not of neuromuscular blocking drugs http://sketchymedicine.com/2013/11/1216/ 

Depolarizing: Succinylcholine

Nondepolarizing: -curarine, -curium, -curonium

Here's a super simplified mnemonic for which does what in case of a brain freeze

[usmle1mikmonics]

Rule of 4 of the Brainstem

Ugh got destroyed by another brainstem lesion question on Qbank- went searching for some help and was THRILLED to find Robert Gate's Rule of 4 of the Brainstem and this diagram to go with it: 

Below the summarized Rules of 4 and a link for the full-size diagram and a link to an online powerpoint that summarizes it all and walks you through practice questions. I recommend printing out the diagram and writing your notes over it because its a bit hard to read- then go through the powerpoint with it. 

I realize its an oversimplification but its crunch time now and I'm all for simplifying the brainstem!

Cheers! 

link to diagram: http://lifeinthefastlane.com/the-rule-of-4-of-the-brainstem/

link to powerpoint: http://www.slideshare.net/guest2f088d1/brainstem-lesions

In the rule of 4 there are 4 rules

There are 4 structures in the ‘midline‘ beginning with M

There are 4 structures to the ‘side‘ (lateral) beginning with S

There are 4 cranial nerves in the medulla, 4 in the pons and 4 above the pons (2 in the midbrain)

The 4 motor nuclei that are in the midline are those that divide equally into 12 except for 1 and 2, that is 3, 4, 6 and 12

(5, 7, 9 and 11 are in the lateral brainstem)

 The 4 Medial structures and the associated deficits are:

1)Motor pathway (or corticospinal tract): CL weakness of the arm and leg

2)Medial Lemniscus: CL loss of vibration and proprioception in the arm and leg

3)MLF: IPSI inter-nuclear ophthalmoplegia (failure of adduction of the IPSI eye +nystagmus in the opposite eye as it looks laterally)

4)Motor nucleus and nerve: IPSI loss of the cranial nerve that is affected (3, 4, 6 or 12)

The 4 ’Side’ (lateral) structures and the associated deficits are:

1) Spinocerebellar pathway: IPSI ataxia of the arm and leg

2) Spinothalamic pathway: CL alteration of pain and temperature affecting the arm, leg and rarely the trunk

3) Sensory nucleus of the 5th cranial nerve: IPSI alteration of pain and temperature on the face in the distribution

4) Sympathetic pathway: IPSI Homer’s syndrome, that is partial ptosis and a small pupil (miosis)

The 4 cranial nerves in the medulla are CN9-12:

1) Glossopharyngeal (CN9): IPSI loss of pharyngeal sensation

2) Vagus (CN10): IPSI palatal weakness

3) Spinal accessory (CN11): IPSI weakness of the trapezius and stemocleidomastoid muscles

4) Hypoglossal (CN12): IPSI weakness of the

The 4 cranial nerves in the pons are CN5-8:

1) Trigeminal (CN5):IPSI alteration of pain, temperature and light touch on the face back as far as the anterior two-thirds of the scalp and sparing the angle of the jaw.

2) Abducent (CN6): IPSI weakness of abduction (lateral movement) of the eye (lateral rectus).

3) Facial (CN7): IPSI facial weakness.

4) Auditory (CN8): IPSI deafness. The 6th cranial nerve is the motor nerve in the medial pons.

The 7th is a motor nerve but it also carries pathways of taste, and using the rule of 4 it does not divide equally in to 12 and thus it is not a motor nerve that is in the midline.

The vestibular portion of the 8th nerve is not included in order to keep the concept simple and to avoid confusion. Nausea and vomiting and vertigo are often more common with involvement of the vestibular connections in the lateral medulla. 

The 4 cranial nerves above the pons are CN1-4: Olfactory and Optic not in midbrain

1) Oculomotor (CN3): impaired adduction, supradduction and infradduction of the IPSI eye with or without a dilated pupil. The eye is turned out and slightly down.

2) Trochlear (CN4): eye unable to look down when the eye is looking in towards the nose (superior oblique). The 3rd and 4th cranial nerves are the motor nerves in the midbrain.

Thus a medial brainstem syndrome will consist of the 4 M’s and the relevant motor cranial nerves, and a lateral brainstem syndrome will consist of the 4 S’s and either

the 9-11th cranial nerve if the lesion is in the medulla, or the 5th, 7th and 8th cranial nerve if the lesion is in the pons.

Handy tip: If there are signs of both a lateral and a medial (paramedian) brainstem syndrome, then one needs to consider a basilar artery problem, possibly an occlusion.

[usmle1mikmonics]

Disulfiram-like reaction mnemonic

No FO’TE’s for A-MAN OPERAting a METRO or PROCAR or he’ll SULF-er a GRISzly TOLL   

Cephalosprorins: ceFOTEtan, cefAMANdole, cefOPERAzone

METROnidazole

PROCARbazine

1st gen SULFonylureas: TOLbutamide, chlorpropramide

GRISeofulvin

way more depressing version (but reminds you this mnemonic is for disulfiram-like reactions) 

Want to Die-sulfering-like? or get a grizzly toll? Give fo’te’s to an alcoholic man operating a metro or procar

These medications cause a disulfiram-like reaction to alcohol and should be avoided in alcoholics. Disulfiram inhibits acetaldehyde dehydrogenase in alcohol metabolism causing an accumulation of acetaldehyde if alcohol is ingested- producing an immediate and severe negative reaction to alcohol intake - like a severe hangover.

[usmle1mikmonics]

CD what?? Cluster of Designation/Differentiation mnemonics

I had a UWorld question today asking me which surface marker is most specific for the large cells with abundant pale cytoplasm surrounding caseous necrosis (macrophages) - I had no idea (it's CD14) so I hunted down some mnemonics. Here's mine: 

and here's some I found (and edited) followed by some tables with way more than you'd ever want to know: 

Tiny CDs - T-cells:  1 - 8 

(also CD28,  CD1a Tiniest-  Tennis racket - Langerhans) 

Bigger CDs- B-cells:  19 - 24 (also CD10 - CALLA, ALL) 

Middle CDs - MyeloMonocytic (granulocytes and monocytes): 11-18  

- http://hematologyoutlines.com/index.php?SCREEN=glossary_fetch&study_set=CD%20markers

http://www.mediconotebook.com/2012/10/cd-markers.html

http://www.pathologystudent.com/?p=7963

[usmle1mikmonics]

Atherosclerosis location mnemonic

Atherosclerosis- Crappy Plaque In Circles 

according to Uworld: most commonly involved vessels in decreasing order is

Abdominal Aorta (esp around ostia- openings of major branches) 

Coronary Artery

Popliteal Artery

Internal Carotid (esp. at carotid sinus) 

Circle of Willis 

* In can remind you its the intima involved 

* Crappy could be replaced by Cholesterol to remind you of cholesterol crystals

*Circles could be replaced by Circular vessels if you want it to make more sense 

[usmle1mikmonics]

Sulfa drugs mnemonic

FirstAids mnemonic is:  "Popular FACTSSS" but I have a hard time remembering drugs from just the first letters so here is an alternative: 

Probe your patients Fur Thier Celect Sulfa Allergies (and you'll be an ACE) 

Probenecid (gout drug) Furosemide (and other loop diuretics other than  Ethracrynic acid) Thiazides (diuretics) Celecoxib (selective COX2 inhibitor) Sulfonamide/Sulfasalazine/Sulfonylureas, Acetazolamide (CA inhibitor)  which you can remember with just the first letter because its another diuretic or you can add on "and you'll be an Ace" if you dont want to rely on the first letter.

[usmle1mikmonics]

Hypothalamic nuclei mnemonics

Lateral area: Stim the lat, get fat": Stimulating lateral increases hunger, inhibited by leptin

Ventromedial "Stim the ven, get thin with leptin: Stimulating ventromedial increases satiety, stim by leptin.

Anterior nucleus: A/C - Anterior Cooling pArasympathetic

PoSterior n - Shivering, Sympathetic (watch yo back - fight or flight) 

supraoptic stim? SIADH (releases ADH) 

Suprachiasmatic - circadian rhythm - you need sleep to be charismatic 

DorsoMedial - stim → Damn Mean/Meaty (savage+ fat)

Paraventricular - Para Partuition + Parents - Oxytocin

Melatonin - MELlows your PINing for sex  :( from PINeal gland, inhibits ant pit release of LH/FSH so suppresses libido in winter  

PRE-optic - seeing someone PREtty gets your gonads going → reg release gonadotropic hormones (LH, FSH)

http://baronerocks.com/mnemonics/mnemonics-anatomy/223-barone-mnemonic-neuroanatomy