«Joel G Ray, MD MSc FRCPC Professor, Departments of Medicine, Health Policy Management and Evaluation, and Obstetrics and Gynecology, St. Michael’s ...»
A politically correct, non-inclusive approach
to remembering things you might
otherwise forget in med school
Joel G Ray, MD MSc FRCPC
Professor, Departments of Medicine, Health Policy Management and Evaluation, and
Obstetrics and Gynecology, St. Michael’s Hospital
Matthew L. Stein
PhD Candidate at the University of Waterloo, School of Public Health and Health Systems
MHSc, University of Ontario Institute of Technology
HBA, McMaster University Table of contents Section and title (click on section name to get there faster) Page number
1. ANATOMY 4-6
2. ANESTHESIA 7 8-13
4. COMMUNITY HEALTH AND OCCUPATIONAL MEDICINE 14
5. DERMATOLOGY 15
6. EMERGENCY MEDICINE/TRAUMA 16-17
7. ENDOCRINOLOGY 18-21
8. ETHICS 22
9. GASTROENTEROLOGY 23-26
10. GENERAL SURGERY 27
11. GYNECOLOGY 28-29
12. HEMEATOLOGY 30-31
13. INFECTIOUS DISEASE 32-33
14. METABOLIC DISEASES 34
15. NEPHROLOGY 35-36
16. NEUROLOGY 37-40
17. NEUROSURGERY 41 2
18. OBSTETRICS 42-44
19. ONCOLOGY 45
20. OPTHAMOLOGY 46
21. ORTHOPEDICS 47
22. OTOLARYNGOLOGY 48
23. PATIENT HISTORY AND EXAMINATIONS 49-50
24. PEDIATRICS AND NEONATOLOGY 51-54
25. PHARMACOLOGY 55
26. PLASTIC SURGERY 56
27. PSYCHIATRY 57-61
28. REHABILITTATION MEDICINE 62
29. RESPIROLOGY 63
30. RHEUMATOLOGY 64-66
31. UROLOGY 67-68 3
Carpal Bones of the Hand:
Simply Learn The Positions That The Carpals Have Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid, Capitate Hamate Carpal bones: trapezium vs. trapezoid location · Since there's two T's in carpal bone mnemonic sentences,
need to know which T is where:
TrapeziUM is by the thUMB, TrapeziOID is inSIDE.
---Tom Ball Median Nerve Supply to the Hand: LOAF Lumbricals of digits 1 and 2 Opponens Abductor pollicis brevis Flexor pollicis Rotator Cuff Tendons: SITS Suprapinatus Infraspinatus Teres minor Subscapularis
Zona Glomerulosa (produces mineralocorticoids) Zona Fasciculata (produces glucocorticoids) Zona Reticularis (produces androgens) Systems review: systems checklist: I PUNCH EAR Integumental Pulmonary Urogenital Nervous Cardiovascular Hematolymphoid Endocrine Alimentary Reproductive
--- Beth Ann Young and Robert O'Connor Femoral triangle: arrangement of contents: NAVEL
From lateral hip towards medial navel:
Nerve (directly behind sheath) Artery (within sheath) Vein (within sheath) Empty space (between vein and lymph) Lymphatics (with deep inguinal node) Nerve/Artery/Vein are all called Femoral.
--- Andrew J. Vasil Balance organs Utricle and Saccule keep US balanced.
People (or PPL, for short) have three tonsils:
Pharyngeal Palatine Lingual.
Airflow Passages: Mouthy People are Loud Talkers Mouth Pharynx Larynx Trachea Scalp nerve supply: GLASS Greater occipital/ Greater auricular Lesser occipital Auriculotemporal Supratrochlear Supraorbital
Six Questions to ask a conscious patient or his/her relative in a life-threatening emergency prior to taking him/her to the operating room: SAMPLE?
Allergies to medications or previous anesthetics?
Medications or alcohol use?
Past medical history?
Events leading up to present injury or collapse?
Maintenance Intravenous Fluids in the Adult or Child: 4, 2, 1 4 mL/kg/hr for the first 10 kg 2 mL/kg/hr for the next 10 kg 1 mL/kg/hr for each remaining kg Eg: A 37 kg adolescent requires (4x10) + (2x10) + (1x17) = 77 mL/hr IV fluid
Bradycardia, causes: STAGeRD J Sick sinus syndrome Thyroid (ie, hypothyroidism) Athletic heart Gastrointestinal mesenteric traction Rest/sleep Drugs (eg, beta-blockers, digitalis) Jaundice Cardiomyopathy, Classification: DR. HO Dilated Restrictive Hypertrophic Obliterative
Heart Sounds, Corresponding Order of Valve Closure:
“Many Things Are Possible” Mitral valve closure = 1st part of 1st heart sound = A1 Tricuspid valve closure = 2nd part of 1st heart sound = A2 Aortic valve closure = 1st part of 2nd heart sound = P2 Pulmonic valve closure = 2nd part of 2nd heart sound = P2 Chest Pain, Acute, Causes: CHEST MAPPPED Cardiac anoxia (ie, ischemia or infarction) Hematological (e.g., sickle cell chest crisis) Esophagus (ie, spasm, esophagitis, rupure) Spinal (ie, nerve root damage, spinal column disease) Trachea or bronchus Mediastinum: infection or mediastinal emphysema Aorta: Dissection or aneurysm Parietal surfaces (ie, pleural, pericardial, diaphragm) Pulmonary embolus Pneumonia Extra-thoracic organs (eg, stomach, gallbladder, liver, pancreas) Diseases of viral origin (eg, epidemic pleurodynia, herpes Zoster, costochondritis) 8 Endocarditis, Clinical Manifestations: LIME Local (ie, valvular vegetations and destruction) Immune complexes (ie, retinal Roth spots, renal lesions, Janeway lesions, Osler's nodes) Metastatic lesions (ie, bacterial "mycotic" aneurysms) Embolism (ie, splenic, cerebral, renal and adrenal infarcts) Hypertension, Effects on Organs: HIgHER PEa Heart (ie, left ventricular hypertrophy, angina, myocardial infarction) Infarction in brain g Hemorrhage in brain Encephalopathy Renal disease (eg, glomerulosclerosis) Peripheral vascular disease Eyes (ie, arteriolar narrowing, retinal hemorrhages and exudates, papilledema) a Hypertension, Secondary Causes: RENALS Renal (eg, glomerulonephritis, renal artery stenosis) Endocrine (eg, Cushing's disease, Conn's syndrome, pheochromocytoma, acromegaly, corticosteroids, oral contraceptive pill) Neurogenic (eg, raised intracranial pressure) Aortic coarctation Little people (ie, pregnancy-induced hypertension) Stress (eg, trauma, white coat hypertension) Digoxin, Drug Interactions: QuAcK Quinidine Amiodarone Kalcium-channel blockers (especially verapamil)
Metabolic (eg, thyrotoxicosis) Drugs (eg, sympathomimetics, anticholinergics) Pain Ischemia Sepsis Hypotension Hypoxia Hypercarbia Thrombolysis, Contraindications to Use of Streptokinase or TPA: S^5 Stroke within 3 months Stomach ulcer or other GI bleed Surgery within the past six weeks Severe hypertension Streptokinase received previously (then can give tPA) Chest X-ray: cavitating lesions differential: WEIRD HOLES Wegener's disease Embolic (pulmonary, septic) Infection (anaerobes, pneumocystis, TB) Rheumatoid (necrobiotic nodules) Developmental cysts (sequestration) Histiocytosis Oncological Lymphangioleiomyomatosis Environmental, occupational Sarcoid
---LW Mason Murmurs: systolic types: SAPS Systolic Aortic Pulmonic Stenosis Systolic murmurs include aortic and pulmonary stenosis.
Similarly, it's common sense that if it is aortic and pulmonary stenosis it could also be mitral and tricusp regurgitation].
---Sara Nemetz Congestive Heart Failure: causes of exacerbation FAILURE Forgot medication Arrhythmia/ Anaemia Ischemia/ Infarction/ Infection Lifestyle: taken too much salt Upregulation of CO: pregnancy, hyperthyroidism Renal failure Embolism: pulmonary
---Lau Yue Young Geoffrey Murmurs: systolic vs. diastolic PASS: Pulmonic & Aortic Stenosis=Systolic.
PAID: Pulmonic & Aortic Insufficiency=Diastolic.
---W. Ciulla Myocarcdial Infarction: therapeutic treatment O BATMAN!
Oxygen Beta blocker ASA Thrombolytics (eg heparin) Morphine Ace prn Nitroglycerin
Triple vessel disease
Exercise ECG testing contraindications:
RAMP Recent MI Aortic stenosis MI in the last 7 days Pulmonary hypertension
---Sushant Varma ECG T wave inversion causes: INVERT Ischemia Normality [esp. young, black] Ventricular hypertrophy Ectopic foci [eg calcified plaques] RBBB, LBBB Treatments [digoxin]
---Robert O'Connor Atrial fibrillation causes: PIRATES Pulmonary: PE, COPD Iatrogenic Rheumatic heart: mitral regurgitation Atherosclerotic: MI, CAD Thyroid: hyperthyroid Endocarditis Sick sinus syndrome Blue toe (microembolic toe) CAVEMAN Cholesterol embolizations Atrial fib with electricity or digitoxin Valvular problems Endocarditis Mural thrimbosis Aneurysm/ AV fistula Nothing
---Samuel Atom Baek-Kim
Hypertension, Treatment: ABCDE ACE inhibitors Beta-blockers Calcium-channel blockers Diuretics Exercise, weight loss, and dietary modifications (try first) Myocardial Infarction, Medical Management: ABCDE ASA Beta-blocker Cagulation (i.e., thrombolytic; add heparin for anterior MI) Dilator (i.e., ACE inhibitor) Elevated lipids (measure fasting lipids within 48 hours of admission, and start a statin agent if total cholesterol or LDL are elevated).
T-Wave Inversion on the ECG, Causes: BIND HEP Bundle-branch block Infarction Normal (in AVR and V1) Digoxin effect Hypertrophy of left ventricle with strain Embolus (ie, pulmonary embolism) Pericarditis Valve Disease, Causes: DIC Degenerative (most common in North America) Inflammatory (e.g., lupus, rheumatic fever) Congenital (e.g., bicuspid aortic valve, Marfan's syndrome)
Arsenic (causes skin cancer) Asbestos (causes mesothelioma, laryngeal cancer) Benzidine dye (causes bladder cancer) Beta-naphthylamine (causes bladder cancer) Chromium (causes nasal cancer) Chloride vinyl (causes liver angiosarcoma) Lead Poisoning, Clinical Manifestations: CRACK CNS (headache, memory loss, personality changes, encephalopathy) Reproductive (abortion, stillbirth) Anemia (microcytic) Colic ("lead colic" abdominal pain) Kidney (proximal tubular damage, interstitial fibrosis) Occupational Lung Disease, Classification: ASTHMA Asthma Silicosis Toxic gases Hypersensitivity pneumonitis (ie, extrinsic allergic alveolitis) Many others Asbestosis Erythema Nodosum, Causes: SITS Sarcoidosis Inflammatory bowel disease TB Streptococcal infection (post-infectious)
Toxic Epidermal Necrolysis characteristics :TEN Thickness Epidermal Necrosis Neurofibromatosis, Clinical Characteristics: CANAL Cafe-au-lait spots Autosomal dominant, gene 17 Neurofibromas of the skin Associated findings (eg, optic gliomas, Multiple Endocrine Neoplasia) Lisch nodules (hamartomas) of the iris, seen under slit lamp Malignant Melanoma, Diagnostic Characteristics: ABCD Asymmetry of lesion Border irregularity Colour variegation Diameter greater than 6 mm (Source: Friedman and Rigel 1985) Staphylococcal Scalded Skin Syndrome (SSSS) vs Toxic Epidermal Necrolysis (TEN): Pathological Difference SSSS is Superficial Subcorneal Skin Separation TEN is full-Thickness Epidermal Necrosis
Adrenalin 0.01 mg/kg IM or IV Noradrenalin, 8 mg in 500 mL 2/3 1/3, at 2 mL/min infusion for average adult Antihistamine (ie, diphenhydramine 1 mg/kg IM/IV over 3 min) Proximal placement of tourniquet to relative to antigen site (eg, bee sting), removed every 15 minutes H2 histamine blocker (ie, ranitidine 50 mg or cimetidine 300 mg IV) for refractory hypotension) -- unproven value Yell for help and oxygen, 100% by mask Lower extremity elevation, patient in recumbent position Aminophylline, 6 mg/kg IV over 20 minutes, to control bronchospasm Xtra (ie, extra) treatments for patients already on beta-blockers (ie, isoproterenol 2-20 micrograms/kg/min to achieve heart rate of 60/min; or atropine 0.5 mg IV q 5 min until heart rate above 60/min) Intubation Steroids (eg, hydrocortisone 100 mg IV push and then 100 mg in 500 mL 2/3 1/3 q 2-4 hours; or methylprednisone 1 mg/kg IV push, and then 1 mg/kg IV q 8 hours)
Trauma Patient, Initial Assessment and Management:
ABC^4 Airway Breathing Circulation Cervical spine injury Chest (tension pneumothorax, flail chest, pericardial tamponade) Consciousness (assess level according to the Glasgow Coma Scale) (Source: Budassi Sheehy 1984) Trauma Patient, Initial Assessment and Management: ABCDEF Airway/breathing (C-spine stabilization is actually first) Bleeding sites Central nervous system Digestive organs Excretory organs (ie, urine colour, quantity) Fractures
Alcohols (ethanol, methanol, ethylene glycol ASA Acetaminophen Anticonvulsants (phenytoin, phenobarbital) Antidepressants (tricyclics, lithium) Anxiolytics (benzodiazepines) Iron Overdose, Symptoms and Signs: HIS HeP Hemorrhagic gastroenteritis (30-60 minutes post-ingestion) Improvement (appears improved 2-12 hours post-ingestion) Shock (12-48 hours post-ingestion) Hepatic damage with possible hepatic failure (late) e Pyloric stenosis (residual complication) 17